2018-08-29T12:24:54-07:00 2017-12-31 990 2017-01-01 160835446 IRA DAVENPORT MEMORIAL HOSPITAL INC IRAD 6077768500 7571 State Route 54 Bath NY 14810 Ronald Kintz CFO 6077374325 2018-08-29 2017 2022-09-23 18:48:47Z RONALD J KINTZ 600 ROW AVE ELMIRA NY 14905 24109471 0 X www.arnothealth.org X 1910 NY IRA DAVENPORT MEMORIAL HOSPITAL IS DEDICATED TO ENHANCING THE QUALITY OF LIFE WITHIN THEIR RURAL COMMUNITY. 14 13 393 28 0 0 504435 221529 20355127 23607292 3021 2604 895974 255754 21758557 24087179 0 0 0 0 12426686 13206499 0 0 0 12381031 11795627 24807717 25002126 -3049160 -914947 17197804 18069597 6970016 8241762 10227788 9827835 IRA DAVENPORT MEMORIAL HOSPITAL IS DEDICATED TO ENHANCING THE QUALITY OF LIFE WITHIN THEIR RURAL COMMUNITY BY PROVIDING LOCAL HIGH QUALITY PRIMARY, ACUTE, RESTORATIVE AND RESIDENTIAL HEALTH SERVICES. 0 0 19450978 0 23607292 IRA DAVENPORT PROVIDED BOTH ACUTE CARE AND LONG-TERM CARE SERVICES TO PATIENTS DURING 2017. LONG-TERM CARE DAYS WERE 40,784 AND THE HOSPITAL HAD 358 DISCHARGES. THE FRED AND HARRIETT TAYLOR HEALTH CARE CENTER IS A 120 BED LONG-TERM CARE/SKILLED NURSING FACILITY. THE HEALTH CENTER PROVIDES A COMMUNITY FOR PEOPLE WHO REQUIRE ASSISTANCE WITH DAILY LIVING OR AROUND-THE-CLOCK NURSING SERVICES. THE HEALTH CARE CENTER ALSO PROVIDES DAY CARE SERVICES AND REHABILITATION SERVICES. 0 0 0 19450978 1 1 0 1 0 0 0 0 0 1 1 0 0 1 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 0 0 1 393 1 0 0 0 0 0 0 X 14 13 1 1 0 0 0 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X X RONALD KINTZ 6077374325 600 Roe Ave Elmira NY 14905 Scott Sprague Chair 1 0 X 0 0 0 Patricia Baroody Vice-Chair 1 0 X 0 0 0 Bernard Burns Secretary 1 0 X 0 0 0 Joseph F Meade Treasurer 2 0 X 0 0 0 Jeffrey Albright Board Member 1 0 X 0 0 0 Patrick J Rogers Board Member 1 0 X 0 0 0 Laura Opelt Board Member 1 0 X 0 0 0 Werner Brammer MD Board Member 1 0 X 0 0 0 Mark Hagan Board Member 1 0 X 0 0 0 David Nesbitt Board Member 1 0 X 0 0 0 Kathryn Muller Board Member 1 0 X 0 0 0 Jaclyn Woollett Board Member 1 0 X 0 0 0 Jack Wheeler Board Member 1 0 X 0 0 0 Robert Lambert MD President Arnot Health 1 52 X X 0 537129 39639 Ronald J Kintz DHA Senior VP/CFO 2 52 X 0 336405 39638 Richard Cleland Site Adm Acute & Skilled Nursing Services 30 10 X 0 245016 8404 Dennis O' Connor MD Medical Director 20 0 X 61336 0 1830 Kevin Murray Director of Pharmacy 40 0 X 152741 0 12455 214077 1118550 101966 1 0 1 0 Delphi Healthcare PLLC 1160 Chili Ave Rochester NY 14624 ER Doctor coverage 718945 Delphi Hospitalist Services 1160 Chili Ave Rochester NY 14624 Hospital Physicians 593809 NES Medical Services of NY PC PO BOX 936451 ATLANTA GA 311936451 DOCTOR 385658 COMPHEALTH 6640 S MILLROCK DR SALT LAKE CITY UT 84121 CONTRACT RN 271167 Focusone Solutions LLC 13609 California St Omaha NE 68154 Contracted Employee RN 126096 5 0 0 0 0 133896 87633 0 221529 Net Patient Service Revene 622110 24948110 24948110 0 0 Bad Debt 622110 -1340818 -1340818 0 0 0 0 0 0 23607292 2604 2604 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 102985 22292 80693 80693 0 0 Contracted Therapy 900099 14297 14297 0 0 Miscellaneous 900099 160764 160764 0 0 0 0 0 0 175061 24087179 23865650 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10227616 8875549 1352067 0 95623 0 95623 0 2126502 28846 2097656 0 756758 647361 109397 0 218013 79062 138951 0 24061 0 24061 0 5000 0 5000 0 1285 0 1285 0 0 0 1590 0 1590 0 2404120 2326062 78058 0 25071 9 25062 0 829519 677265 152254 0 427629 282065 145564 0 0 0 0 0 361697 12435 349262 0 6886 4735 2151 0 0 0 0 0 1694 1086 608 0 0 0 0 0 0 0 0 0 1219306 720310 498996 0 174313 0 174313 0 Medical/Surgical/PHarmaceutical Supplies 1609254 1601946 7308 0 Maintenance Contracts/Purchased Services 3642545 1596508 2046037 0 Lease 62019 14811 47208 0 Benefits Allocations 0 1899858 -1899858 0 781625 683070 98555 0 25002126 19450978 5551148 0 38118 33468 560158 607710 0 0 1829951 2710280 0 0 0 0 48558 50680 269926 131800 138240 285348 34108159 23075616 10923543 11032543 850000 3389310 2367768 17197804 18069597 1680002 1935552 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5290014 6306210 6970016 8241762 X 7070544 6608514 3131632 3193709 25612 25612 10227788 9827835 17197804 18069597 X -914947 0 0 0 0 514994 X 1 X 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 1285 1285 0 Schedule C, Part II-B, Line 1 IDMH pays annual dues to American Hospital Associations, AHA and Healthcare Association of New York State, HANYS of which a percentage is for Lobbying fees. Total Fes paid in all on 2017 $1,285 25612 0 0 0 0 0 25612 241407 0 0 0 215795 0 25612 194062 133021 0 0 85676 0 241407 407988 134415 0 0 348341 0 194062 536754 118059 0 0 246825 0 407988 0 1 0 0 1 1 52925 0 52925 17439394 0 9117908 8321486 0 0 0 0 16615840 0 13957708 2658132 0 0 0 0 11032543 IDMH Children's Department Fund (Children Trust Fund) 2026019 Interest in Net Assets of Foundation 341749 2367768 0 Self Insurance Reserve 859350 Accrued Reimbursement Pay Net 613297 Due to Arnot Health 4833563 6306210 24109471 0 0 0 22292 22292 24087179 0 0 0 24087179 25024418 0 0 0 22292 22292 25002126 0 0 0 25002126 Schedule D, Part V, Line 4 The Intended uses of the endowment funds are based upon the designations from the organizations documents which includes staff educations, community education, and charity care. the board endowment's funds is a board designed or use in the highest area of need. Schedule D, Part XI, Line 2d Nutritional services expense of 22,292 offset to Nutritional Service Income Schedule D, Part XII, Line 2d Nutritional Service Expense of 22,292 re-class to reduce revenue on the cost of goods sold 1 1 X 1 X 1 X 1 1 0 1 1 0 105 43323 -2607 45930 0.0024 0 1152 4314390 3855029 459361 0.0236 0 9692 5458567 3889726 1568840 0.0807 0 10949 9816280 7742148 2074131 0.1067 7 122 1769 0 1769 0.0001 0 0 0 0 0 0 2 43102 3233153 2496937 736216 0.0378 0 0 0 0 0 0 0 0 0 0 0 0 9 43224 3234922 2496937 737985 0.0379 9 54173 13051202 10239085 2812116 0.1446 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1074 0 1074 0.0001 0 0 0 0 0 0 0 0 0 0 0 0 1 0 2190 0 2190 0.0001 2 0 3264 0 3264 0.0002 0 1340818 0 3496972 3663306 -166334 X 1 1 ARNOT OGDEN MEDICAL CENTER ADMINISTRATION & CONSULTING 0 0 0 1 1 IRA DAVENPORT MEMORIAL HOSPITAL 7571 ROUTE 54 BATH NY 14810 www.arnothealth.org X X IRA DAVENPORT MEMORIAL HOSPITAL 1 0 0 1 X X X X X X X X 16 1 1 1 1 X www.arnothealth.org X 1 15 1 www.arnothealth.org 0 0 1 X 150 400 X X X 1 1 X X X 1 X www.arnothealth.org X www.arnothealth.org X www.arnothealth.org X X X X X 1 0 X X X 1 0 1 Schedule H, Part V, Section B, Line 5-IRA DAVENPORT MEMORIAL HOSPITAL In the Fall of 2015, Arnot Health participated in a comprehensive assessment of community needs across county lines with partners such as the Chemung County Health Department, Steuben County Public Health, other hospitals and healthcare agencies in Chemung, Steuben and Schuyler Counties, along with a diverse, collaborative community of partners and residents. The year-long process of assessing community health needs was facilitated by consultants contracted by the Chemung County Health Department from the S2AY Rural Health Network. Arnot Health, in partnership with this dual-county collaborative network, used the MAPP process (Mobilizing for Action through Planning and Partnership) to collect and analyze data from a variety of sources. Valuable input was gained from data retrieved and analyzed by the Finger Lakes Health System Agency from the New York State Prevention Agenda Dashboard, multi-payer claims data, EBRFSS, SPARCS and additional sources. Also, input was gained from diverse community focus groups made of both Chemung and Steuben County residents. The focus group meetings were facilitated by S2AY, Chemung and Steuben County Health Departments, Arnot Health and other partnership members. The residents were engaged in discussions concerning their current health status and opinions on specific county-wide health challenges. Areas of disparity were assessed within each county. Findings from the Community Health Assessment (CHA) data and community focus groups identified some overlapping areas of public health concerns and disparities in Chemung and Steuben Counties. Schedule H, Part V, Section B, Line 6a-IRA DAVENPORT MEMORIAL HOSPITAL Arnot Health is comprised of three hospitals: Arnot Ogden Medical Center and St. Joseph's Hospital in Elmira; and Ira Davenport Memorial Hospital in Bath, New York. Arnot Health provides diagnostic, ambulatory, secondary and tertiary acute care, as well as substance abuse, psychiatric, rehabilitative, and wellness services to meet the needs of residents in Chemung, Steuben, and Schuyler Counties in the Southern Tier of New York, and Bradford and Tioga Counties in the Northern Tier of Pennsylvania. Arnot Health System has more than 300 physicians from over 50 specialties. The independent, not-for-profit regional healthcare system currently has a total of 709 beds; 478 acute care beds and 231 skilled nursing/long-term beds. Schedule H, Part V, Section B, Line 6b-IRA DAVENPORT MEMORIAL HOSPITAL In 2015, Arnot Health participated in a comprehensive assessment of community needs across county lines with partners such as the Chemung County Health Department, Steuben County Public Health, other hospitals and healthcare agencies in Chemung, Steuben and Schuyler Counties, along with a diverse, collaborative community of partners and residents. Schedule H, Part V, Section B, Line 7d-IRA DAVENPORT MEMORIAL HOSPITAL Arnot Odgen Medical Center will use a variety of methods to disseminate the community service plan for Arnot Odgen Medical Center, St. Joseph's Hospital and Ira Davenport Memorial Hospital and the CHIPs of Chemung and Steuben Counties: Web site documents will be posted on the healthcare's system web site at the following url: http:/arnothealth.org/about us. Arnot Health developed a section of the system's web site dedicated to community outreach in 2016, budget permitting to bring community service work to a more prominent place within the websites. This can be accessed at: https://www.arnothealth.org/community-servcie-plans. Partner web sites Chemung and Steuben Counties will post links to their CHA and CHIP on their web sites. Presentations at Arnot Health's Community Health Department provide educations about the healthcare system and Community outreach strategies. Schedule H, Part V, Section B, Line 11-IRA DAVENPORT MEMORIAL HOSPITAL Beyond involvement in the aforementioned health collaboratives, Arnot Health participates in a number of community efforts aimed at improving health across the continuum. Arnot Health is committed to outreach in underserved populations and preventing chronic disease in the community through free community lectures, preventive health screenings, health promotion presentations , and provision of wellness education. In 2016, Arnot Health provided health promotion programs and screenings for children, adolescents, adults, and seniors. Screenings included blood pressure , blood glucose, body fat analysis, body mass index, diabetes risk assessments, COPD (Lung Age), Carboxyhemoglobin , vascular and skin screenings. Arnot Health participated in community forums and focus groups to assist in the development of strategic plans to increase economic development in the Finger Lakes and Southern Tier regions , reduce poverty in Elmira, and revitalize Elmira Downtown. Arnot Health continues to promote and support breastfeeding as a strategy to reduce obesity in children and mothers by serving on community coalitions, networks and partnerships in Chemung and Steuben Counties. Arnot Health has a leadership role in the Twin Tiers Breastfeeding Network (TTBN) in Chemung County. The TTBN is a collaborative effort to increase the rate of initiation and duration of breastfeeding among women in the Twin Tiers through support, education and referrals. The TTBN worked with the Chemung Library System to offer breastfeeding support free to the community. The Baby Cafe model was adapted to fit the needs and resources of Chemung County and has been named the Baby Bistro. The Baby Bistro is staffed by the network's Peer Lactation Consultants , Certified Lactation Consultants, and the International Board Certified Lactation Consultant (IBCLC) members on a rotating basis at two of the libraries in Elmira. TTBN also received a small grant from the New York Statewide Breastfeeding Coalition to assist with breastfeeding promotion. The funds were used to recognize 31 businesses and organizations for creating and maintaining a breastfeeding friendly environment during World Breastfeeding Week in August. The recognition ceremony was held in Wisner Park at downtown Elmira's weekly farmer's market. Steuben County, the Public Health Department chairs the Steuben Breastfeeding Coalition and offers a Baby Cafe, which is a free community breastfeeding support group located at the collaboration with community partners, Arnot Health continued to plan and offer programs to promote physical activity and healthy choices in the community. Arnot Health participated in the following events during 2016: Step it Up Community Walking Program, Hunt for Gold Shoes, Fit Families of the Southern Tier, Strong Kids Safe Kids (Chemung, Steuben, and Schuyler Counties), Chemung County Summer Cohesion Travel Program, Girls on the Run of the Southern Tier, Davenport and Taylor Run, Wineglass Marathon Arnot Health, in collaboration with Southern Tier Pediatrics, also offers Fit Families in the Southern Tier (FFIST). This eight-week program is designed to teach obese children and their families healthy nutrition habits and physical activity. Each child must have a family member participate with them. To measure progress, staff assess pre- and post-program weight and BMI, and conduct strength and fitness testing. On average, participants experience 70 percent improvement in at least one area measured. Schedule H, Part V, Section B, Line 20e-IRA DAVENPORT MEMORIAL HOSPITAL Self pay collection staff reviews any prior accounts to check for commercial insurance or Medicaid that may need to be applied to current self pay accounts. These accounts are reviewed using the self pay worklist. If insurance is located, self pay collector must verify eligibility for the date of service. The Self pay staff will change the health plan to the correct one for all covered dates of service and ARNOT Billing will submit claim or claims. If no insurance is located, confirm if a patient may have qualified for Medicaid. If Medicaid coverage is approved self pay staff will change the health plan to Medicaid for all covered dates of service and follow correct billing process. Self Pay Collections Staff attempts to collect full balance due by check or credit card. If they are unable to make the full payment, Self pay staff will attempt to make payment arrangements and to notify patient about the Arnot Ogden Medical Center Community Care Program. If the patient wants to apply for the community care program, the patient will be sent an application for the community care program and will be informed of documentation they will need to submit with the application. The Self Pay Collectors documents all activity in Soarian, and enters any necessary hold to support resolution. Self pay collections staff enters the payment plan and documents comments in Soarian. Payment plan statement is demanded and sent to the patient. If patient does not enter into a payment plan agreement, or fails to pay as agreed, account will go through the standard dunning and collection agency activity. See Guarantor Billing and Collections. Schedule H, Part V, Section B, Line 24-IRA DAVENPORT MEMORIAL HOSPITAL Participants in the Medicare System are required to charge all patients the same amount of service regardless of insurance per the Medicare participation guide lines. Schedule H, Part I, Line 6a Arnot Ogden Medical Center prepares the Community Benefit Report for three hospitals- Arnot Ogden Medical Center, St. Joseph's Hospital, both in Elmira, NY and also for Ira Davenport Memorial Hospital in Bath, NY. Schedule H, Part I, Line 7 Arnot Health uses a Cost to Charges ratio to calculate the Financial Assistance and Community Benefit Section. The organization offers a variety of services to the community it serves as part of an integrated delivery system. It is necessary to financially subsidize some of these services as the revenue generated does not cover the cost of providing the services Schedule H, Part II Beyond involvement in the aforementioned health collaboratives, Arnot Health participates in a number of community efforts aimed at improving health across the continuum. Arnot Health is committed to outreach in underserved populations and preventing chronic disease in the community through free community lectures, preventive health screenings, health promotion presentations , and provision of wellness education. In 2016, Arnot Health provided health promotion programs and screenings for children, adolescents, adults, and seniors. Screenings included blood pressure , blood glucose, body fat analysis, body mass index, diabetes risk assessments, COPD (Lung Age), Carboxyhemoglobin , vascular and skin screenings. Arnot Health participated in community forums and focus groups to assist in the development of strategic plans to increase economic development in the Finger Lakes and Southern Tier regions, reduce poverty in Elmira, and revitalize Elmira Downtown. Arnot Health continues to promote and support breastfeeding as a strategy to reduce obesity in children and mothers by serving on community coalitions, networks and partnerships in Chemung and Steuben Counties. Arnot Health has a leadership role in the Twin Tiers Breastfeeding Network (TTBN) in Chemung County. The TTBN is a collaborative effort to increase the rate of initiation and duration of breastfeeding among women in the Twin Tiers through support, education and referrals. The TTBN worked with the Chemung Library System to offer breastfeeding support free to the community. The Baby Cafe model was adapted to fit the needs and resources of Chemung County and has been named the Baby Bistro. The Baby Bistro is staffed by the network's Peer Lactation Consultants, Certified Lactation Consultants, and the International Board Certified Lactation Consultant (IBCLC) members on a rotating basis at two of the libraries in Elmira. TTBN also received a small grant from the New York Statewide Breastfeeding Coalition to assist with breastfeeding promotion. The funds were used to recognize 31 businesses and organizations for creating and maintaining a breastfeeding friendly environment during World Breastfeeding Week in August. The recognition ceremony was held in Wisner Park at downtown Elmira's weekly farmer's market. Steuben County, the Public Health Department chairs the Steuben Breastfeeding Coalition and offers a Baby Cafe, which is a free community breastfeeding support group located at the collaboration with community partners, Arnot Health continued to plan and offer programs to promote physical activity and healthy choices in the community. Arnot Health participated in the following events during 2016: Step it Up Community Walking Program, Hunt for Gold Shoes, Fit Families of the Suthern Tier, Strong Kids Safe Kids (Chemung, Steuben, and Schuyler Counties), Chemung County Summer Cohesion Travel Program, Girls on the Run of the Southern Tier, Davenport and Taylor Run, Wineglass Marathon Arnot Health, in collaboration with Southern Tier Pediatrics, also offers Fit Families in the Southern Tier (FFIST). This eight-week program is designed to teach obese children and their families healthy nutrition habits and physical activity. Each child must have a family member participate with them. To measure progress, staff assess pre- and post-program weight and BMI, and conduct strength and fitness testing. On average, participants experience 70 percent improvement in at least one area measured. Schedule H, Part III, Section A, Line 4 The Organization's allowance for doubtful accounts deceased from 19.0% of gross accounts receivable at December 31, 2016 to 14.1% of gross accounts receivable at December 31, 2017. In addition, the Organization's bad debt write-offs decreased from $1,999,427 for fiscal year 2016 to $1,340,818 in fiscal year 2017. The decrease in bad debt write-offs is a result of the Organization assisting self-pay patients to obtain medical insurance through marketplace enrollment. The Organization has not changed its charity care or uninsured discount policies during the fiscal year 2016 or 2017. The Organization does not maintain a material allowance for doubtful accounts from third party payors, nor did it have significant write-offs from third party payors. Schedule H, Part III, Section B, Line 8 Arnot Health uses a Cost to Charges ratio to calculate the Financial Assistance and Community Benefit Section. The organization offers a variety of services to the community it serves as part of an integrated delivery system. It is necessary to financially subsidize some of these services as the revenue generated does not cover the cost of providing the services Schedule H, Part III, Section C, Line 9b Self-pay collection staff reviews any prior accounts to check for commercial insurance or Medicaid that may need to be applied to current self-pay accounts. These accounts are reviewed using the self-pay work list. If insurance is located, the self-pay collector must verify eligibility for the dates of service. The self-pay staff will change the health plan to the correct plan for all covered dates of service and Arnot billing will submit the claim or claims. If no insurance is located, confirm if a patient may have qualified for Medicaid. If Medicaid coverage is approved self-pay staff will change the health plan to Medicaid for all covered dates of service and follow correct billing processes. Self-Pay Collection Staff attempts to collect the full balance due by check or credit card. If they are unable to make the full payment, the self-pay staff will attempt to make payment arrangements and to notify the patient about the Arnot Ogden Medical Center Community Care Program. If the patient wants to apply for the community care program, the patients will be sent an application for the community care program and will be informed of documentation they will need to submit with the application. The self-pay collectors document all activity in Soarian, and enter any necessary hold to support resolution. Self-pay collections staff enters the payment plan and document comments in Soarian. Payment plan statements are demanded and sent to the patient. If the patient does not enter into a payment plan agreement, or fails to pay as agreed, the account will go through the standard dunning and collection agency activity. Schedule H, Part VI, Line 2 Findings from the Community Health Assessment (CHA) data and community focus groups identified some overlapping areas of public health concerns and disparities in Chemung and Steuben Counties. The top priority for both Chemung and Steuben Counties: To Prevent Chronic Disease. With the focus areas including: 1. Reduce obesity in children and adults; 2. Reduce Illness, Disability and Death Related to Tobacco Use and Secondhand Smoke Exposure; 3. Increase Access to High Quality Chronic Disease Preventative Care in Both Clinical and Community Settings. Two major contributors to the incidence of chronic disease in Chemung and Steuben Counties are obesity and tobacco use. Over the next two years, Arnot Health and cross-county collaborative partnerships will begin implementing the CHIP and monitoring the effectiveness in Chemung and Steuben Counties. Arnot Health's Annual Community Service Plan will report progress made towards the goals and impact on the community's health. The 2016-2018 Chemung and Steuben CHNAs and CHIPS are available on the Arnot Health website Community Service Plans Page at http://www.arnothealth.org/community-service-plans. This report and survey will be redone in 2018, Arnot Health has entered into an agreement with S2AY Rural Health Network to conduct the Community Health Assessment and Community Service Plan for 2019 through 2021 for Arnot Ogden Medical Center and St. Joseph's Hospital covering Chemung County, and Ira Davenport in Steuben County Schedule H, Part VI, Line 3 The Arnot Health communicates our Community Care Program in the following ways: Signage in waiting rooms, brochures in waiting rooms and Admission Packets, notations on billing notices, staff education so they can share availability of program and contact information with patients. Communication and education of our Certified Application Counselor for patient insurance enrollment are done so they are informed of the program details and contact information. Communication is also done with collection agencies and collection attorneys so they can also share the availability of the program and contact information with prospective enrollees. The information is also posted on our website at: www.arnothealth.org. Schedule H, Part VI, Line 4 Arnot Health's three hospitals are located in two counties. Arnot Ogden Medical Center and St. Joseph's Hospitals are located in Chemung County; Ira Davenport Memorial Hospital is situated in Steuben County. Together, Chemung and Steuben Counties make up approximately 1,801 square miles of geographical area in the Southern Tier of New York. The City of Elmira serves as Chemung County's seat and the primary metropolitan area. The county is characterized as 76 percent urban and 24 percent rural. Steuben County is a rural county, and with a land area of 1,393 miles, it is the seventh largest county in NYS. (http://www.city-data.com/county/Chemung _County-NY.html) X X X X X 0 0 0 0 0 0 0 0 0 Robert Lambert MD President Arnot Health 0 537129 0 0 0 0 0 13500 0 26139 0 576768 0 0 Ronald J Kintz DHA Senior VP/CFO 0 336405 0 0 0 0 0 13500 0 26138 0 376043 0 0 Richard Cleland Site Adm Acute & Skilled Nursing Services 0 245016 0 0 0 0 0 8404 0 0 0 253420 0 0 Dennis O' Connor MD Medical Director 61336 0 0 0 0 0 1830 0 0 0 63166 0 0 0 Kevin Murray Director of Pharmacy 152741 0 0 0 0 0 0 0 12455 0 165196 0 0 0 Schedule J, Part I, Line 3 Compensation for the president and vice president is set pursuant to a policy and compensation philosophy adopted by the boards. The AOMC Board has a compensation committee consisting of outside directors (AOMC board members are referred to as managers). The Compensation committee uses a consultant to advise it on compensation for the officers. The consultant collects and reports data on compensations for similar positions in similar nonprofit hospitals from upstate New York and western Pennsylvania. The compensation committee recommends any adjustments to the executive committee of the board which reviews the recommendations and approves them without employees in the room. This action is then reviewed with the entire board also in executive session. Form 990, Part VI, Section A, Line 2 Bernard Burns board Secretary is Executive Director of Arc of Steuben, Taylor SNF and Adult Day Care Contracts with Arc for transportation. Scott Sprague's wife is a director of Keuka Health care foundation, Joseph F Meade is the president of Keuka health care foundation and Mercury Aircraft Foundation Gifts to hospital. Kathryn Muller holds a contract with Arnot health/IRA Davenport hospital for Social Welfare Examine service to process Medical Applications. Robert Lambert MD is Elmira Saving Bank Director Arnot has loan with bank. Form 990, Part VI, Section A, Line 3 as a result of Arnot Ogden Medical Center becoming the "active parent" of Ira Davenport Memorial Hospital the management of several departments were consolidated under a single manager Form 990, Part VI, Section A, Line 7a Ira Davenport Hospital Board of Directors can only elect the president and hire medical directors and board members at that facility. Affiliated Board of Directors of Arnot Health are responsible for operations of Ira Davenport Memorial Hospital Form 990, Part VI, Section A, Line 7b Ira Davenport Hospital Board of Directors can only elect the president and hire medical directors and board members at that facility. Affiliated Board of Directors of Arnot Health are responsible for operations of Ira Davenport Memorial Hospital Form 990, Part VI, Section B, Line 11b Once the 990 is in final form it is presented to the board committee and a copy is made available to all board members for review and questions. Form 990, Part VI, Section B, Line 12c All members of the Board of Managers, officers, and management employees shall be required annually to file a disclosure statement setting forth any respect in which such person, or any person associated with such person, has or may have any interest in any transaction in which there may be, or appear to be, a conflict between the interest of such person and the Arnot Ogden Medical Center, an associated included (1) Spouse, a descendant or an ancestor, of a spouse of a descendant of ancestor; (2) an organization in which the person of an associated is a partner of employee, or such person is an associated owns a more then 10% beneficial interest; (3) a trust in which such person is a trustee, or such person or an associate holds more than 10% beneficial interest and (4) a corporation in which such person or an associate is an officer or a director or employee, or such person or an associate is an owner of more than 10% of any class of securities. Form 990, Part VI, Section B, Line 15 Compensation for the president and vice president is set pursuant to a policy and compensation philosophy adopted by the boards. The AOMC Board has a compensation committee consisting of outside directors (AOMC board members are referred to as managers). The Compensation committee uses a consultant to advise it on compensation for the officers. The consultant collects and reports data on compensations for similar positions in similar nonprofit hospitals from upstate New York and western Pennsylvania. The compensation committee recommends any adjustments to the executive committee of the board which reviews the recommendations and approves them without employees in the room. This action is then reviewed with the entire board also in executive session Form 990, Part VI, Section C, Line 19 Items required for public disclosure are made available for those who request the information and shared with guidestar.org and EMMA web site Form 990, Part XI, Line 9 IDMH Pension Charged to Equity 42,802, IDMH Donation from capital funding 432,712, IDMH change in Charitable Trust (130,612), IDMH Net Assets Released from restriction 414,500, IDMH Current year temp released (203,475), Keuka Foundation Net Loss (22,593), Keuka Donation 218,571, Keuka Net Assets Release from restrictions (236,907), Inventory Adj (4) KEUKA HEALTH CARE FOUNDATION 7571 STATE ROUTE 54 BATH NY 14810 161461215 PROVIDE FINANCIAL NY 501(C)(3) 11 N/A 0 ARNOT OGDEN MEDICAL CENTER 600 ROE AVENUE ELMIRA NY 14905 160743905 AFFILIATE NY 501 (C)(3) 11 N/A 0 ARNOT OGDEN MEDICAL CENTER FOUNDATION 600 ROE AVENUE ELMIRA NY 14905 161109472 CONTRIBUTION MGT NY 501(C)(3) 11E N/A 0 ARNOT HEALTH INC 600 ROE AVENUE ELMIRA NY 14905 453049405 MANAGEMENT NY 501 (C)(3) N/A ARNOT HEALTH INC 0 ST JOSEPHS HOSPITAL 555 ST JOSEPHS BLVD ELMIRA NY 14901 160743163 AFFILIATE NY 501(C)(3) 11 N/A 0 IVY STREET DEVELOPMENT CORP 600 IVY STREET ELMIRA NY 14905 161009245 REAL ESTATE RENTAL NY N/A C 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 0 ARNOT HEALTH INC o 3009790 Arnot Health Inc. provided employees who provide medical, management information's systems, and various administrative services to Ira Davenport Memorial Hospital, The method is determining the amount was cost. KEUKA HEALTH CARE FOUNDATION c 432712 A gift from Keuka Health care foundation to Ira Davenport Memorial Hospital fro contributions to the Taylor SNF.