2018-05-11T09:00:17-05:00 2017-06-30 990 2016-07-01 150532221 Our Lady of Lourdes Memorial Hospital Inc OURL 3147338000 169 Riverside Drive Binghamton NY 13905 Tonya Mershon Tax Officer 2017-11-13 2016 2022-09-23 18:48:47Z Sean Mills 169 Riverside Drive Binghamton NY 13905 348612857 false 0928 X www.lourdes.com X 1936 NY To improve the health and well-being of all people in the communities we serve. 13 11 2678 352 250467 -44864 2356588 4617605 292416171 318768665 1430560 8994965 14520865 6475349 310724184 338856584 0 60772 0 159852232 165163906 0 0 0 147648865 163052397 307501097 328277075 3223087 10579509 367488518 406205422 119678401 146765224 247810117 259440198 Our Mission as part of a Catholic health care system is to further the healing ministry of Jesus by continually improving the health and well-being of all people, especially the poor, in the communities we serve. false false 223065318 60772 318768665 OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC. (LOURDES) PROVIDES THE FOLLOWING INPATIENT AND OUTPATIENT MEDICAL SERVICES TO THE COMMUNITY: AMBULATORY INFUSION CENTER, CARDIAC SERVICES, REGIONAL CANCER CENTER, EMERGENCY CARE SERVICES, LABORATORY SERVICES, ORTHOPEDIC SERVICES, PRIMARY CARE PHYSICIANS, RADIOLOGY SERVICES, REHABILITATION SERVICES, SLEEP LAB, STROKE CENTER, WOMEN'S & CHILDREN'S SERVICES, PHYSICAL THERAPY, OCCUPATIONAL THERAPY, SPEECH THERAPY, WOUND CARE PROGRAM, SURGERY, LASER CARE, DIABETES CENTER, CENTER FOR ORAL HEALTH, HYPERBARIC OXYGEN THERAPY, PEDIATRICS, IMAGING SERVICES, HOME HEALTH PROGRAM, HOSPICE CARE, PALLIATIVE CARE AND NUTRITION SERVICES. DURING FY 2017, LOURDES TREATED 10,108 INPATIENT ADULTS AND CHILDREN IN THE COMMUNITY FOR A TOTAL OF 39,427 PATIENT DAYS OF SERVICE. LOURDES ALSO PROVIDED SERVICES TO 1,471,519 OUTPATIENTS INCLUDING: 16,694 OUTPATIENT SURGERIES, 45,661 EMERGENCY ROOM VISITS AND 9,859 CLINIC VISITS. LOURDES PROVIDES A SUBSTANTIAL PORTION OF ITS SERVICES TO THE ELDERLY AND POOR. DURING THE YEAR ENDED 6/30/2017, APPROXIMATELY 57.11% OF THE VALUE OF SERVICES RENDERED WERE TO ELDERLY PATIENTS UNDER THE MEDICARE PROGRAM. IN THE SPIRIT OF PRINCIPLES ADOPTED BY ASCENSION HEALTH, LOURDES HAS TAKEN PROACTIVE STEPS TO ADDRESS THOSE ISSUES THAT WILL AFFECT ACCESSIBILITY, FINANCING, AND DELIVERY OF HEALTHCARE TO ALL PERSONS, ESPECIALLY THE UNINSURED, UNDERINSURED AND THE UNDERSERVED. DURING THE YEAR ENDED 6/30/2017, THE ESTIMATED UNREIMBURSED COST OF SERVICES PROVIDED TO THE ELDERLY, UNINSURED AND UNDERINSURED TOTALED $35.377 MILLION. COMMUNITY BENEFITS ARE PROGRAMS OR ACTIVITIES THAT PROVIDE TREATMENT AND/OR PROMOTE HEALTH AND HEALING AS A RESPONSE TO IDENTIFIED COMMUNITY NEEDS. IN EFFORTS TO PROVIDE HEALTHY LIVING, LOURDES HAS MADE AVAILABLE THE FOLLOWING PROGRAMS TO THE COMMUNITY: COMMUNITY HEALTH PROGRAMS, MEDICAL EDUCATION, CANCER SCREENING PROGRAMS, FLU SHOT CLINIC, NUTRITION AND WEIGHT LOSS MANAGEMENT AND SMOKING CESSATION. 223065318 true true false true false false false false false false true false false true true true false true false false false false false false false false true true true false true false false false false false false false true false false false false false true true true true false true 202 0 true 2678 true true true false false false false false false false false false X 13 11 false false false false true true true true true false false false true true true true true false true true false NY X Dave Clements 6077985095 169 Riverside Drive Binghamton NY 13905 KATHRYN CONNERTON PRESIDENT/CEO 50.0 2.0 X X 651466 0 26014 MARK TINKLEPAUGH MD BOARD CHAIR 1.0 1.0 X X 0 0 0 DAVID CAHILL VICE CHAIR 1.0 1.0 X X 0 0 0 STEPHEN VANNOSTRAND SECRETARY 1.0 1.0 X X 0 0 0 FRANK GRECO JR TREASURER 1.0 1.0 X X 0 0 0 KEVIN DRUMM PHD BOARD MEMBER 1.0 1.0 X 0 0 0 MICHAEL FARRELL MD BOARD MEMBER 1.0 1.0 X 0 0 0 ROBERT FISHER BOARD MEMBER 1.0 1.0 X 0 0 0 CATHERINE MALIWACKI BOARD MEMBER 1.0 1.0 X 0 0 0 KIM MYERS BOARD MEMBER 1.0 1.0 X 0 0 0 JAMES ORBAND BOARD MEMBER 1.0 1.0 X 0 0 0 BRIAN ROSE BOARD MEMBER 1.0 2.0 X 0 0 0 JAMES STEINMETZ MD BOARD MEMBER 50.0 1.0 X 491833 0 41043 DAVID F CLEMENTS VICE PRESIDENT-FINANCE/CFO (END 8/2016) 50.0 2.0 X 212616 0 14569 SEAN MILLS VICE PRESIDENT-FINANCE/CFO (START 8/2016) 50.0 2.0 X 108755 0 13028 LISA HARRIS MD SR VP MEDICAL AFFAIRS/CMO 50.0 0 X 341175 0 38128 LINDA MILLER SR VP OPERATIONS/CNO (END 11/2016) 50.0 0 X 289532 0 25441 SISTER ELLEN REILLY CHIEF MISSION OFFICER (END 6/2017) 50.0 0 X 0 0 0 RICHARD BLANSKY MD PRESIDENT M/S 50.0 0 X 427558 0 20104 MARY HUGHS CHRO 50.0 0 X 163613 0 26926 DEB MICAN VP NURSING 50.0 0 X 194955 0 31407 CHAD PATTON VP, PROVIDER NETWORK 50.0 0 X 188050 0 35563 ANNE WOLANSKI VP QUALITY SVS & RISK/CRO (END 12/2016) 50.0 0 X 186596 0 29357 MICHAEL BARRETT MD PHYSICIAN 50.0 0 X 745821 0 43346 STEPHEN R LAUTERBACH MD PHYSICIAN 50.0 0 X 562470 0 33317 JOHN W MILLER MD PHYSICIAN 50.0 0 X 528585 0 28954 RATNAKISHORE PALLAPOTHU MD PHYSICIAN 50.0 0 X 666749 0 45318 TODD V PRIER MD PHYSICIAN 50.0 0 X 477908 0 41697 6237682 0 494212 188 false true false RIVERSIDE ASSOCIATES IN ANESTHESIA PC 40 FRONT STREET BINGHAMTON NY 13905 PHYSICIAN SERVICES 2648691 ARUP LABORATORIES PO BOX 27964 SALT LAKE CITY UT 84127 LABORATORY SERVICES 1009268 HOSP MEDICINE PHYSICIANS OF TEXAS PLLC 1498 PACIFIC AVE SUITE 400 TACOMA WA 984024208 PHYSICIAN SERVICES 931437 HMP OF BROOME COUNTY PLLC PO BOX 645037 CINCINNATI OH 45264 PHYSICIAN SERVICES 840728 CARDIOLOGY ASSOCIATES 30 HARRISON STREET SUITE 250 JOHNSON CITY NY 13790 PHYSICIAN SERVICES 686746 28 X 2313783 2254250 49572 4617605 NET PATIENT SERVICE REVENUE 621990 304500837 304500837 Pharmacy Revenue 446110 8118810 8118810 DSRIP & CARE COMPASS 621990 2969652 2969652 Government Incentives 900099 1616520 1616520 Rent from Affiliates 531120 680145 680145 882701 865952 16749 0 318768665 9321288 9321288 400567 400567 0 400567 400567 5000 331323 0 -326323 -326323 -326323 13967653 9424950 4542703 4542703 Child Care SErvices 624410 694775 224273 470502 Fitness Center 713940 49244 49244 Medical Staff Dues 900099 45450 45450 742610 0 9445 733165 1532079 338856584 318751916 250467 15236596 60772 60772 3557729 3557729 130822865 112519943 18302922 1917911 1609523 308388 19909126 16707862 3201264 8956275 7516162 1440113 267824 234515 33309 45833 45833 57688 7843 49845 3886 3886 15060467 11324292 3736175 0 318878 7773 311105 1590070 715556 874514 651164 282249 368915 8282823 5597333 2685490 919394 735440 183954 448840 244585 204255 1362850 1362850 11404633 4401855 7002778 2607442 -25833 2633275 MEDICAL SUPPLIES 45534694 45534694 PURCHASED SERVICES 51850552 4870366 46980186 CORPORATE OVERHEAD 6304346 6304346 CONTRACT LABOR 5066128 4971814 94314 11274885 5748574 5526311 0 328277075 223065318 105211757 0 5089631 8205345 634 197287125 671227 516023 32441938 34519076 0 0 0 41250 0 4477739 4892242 1702010 1822514 211581037 105937240 97538289 105643797 0 0 605733 4721936 3362509 220803864 49351058 367488518 406205422 18764570 23975176 0 100913831 122790048 119678401 146765224 X 225528935 234670308 9666317 12155025 12614865 12614865 247810117 259440198 367488518 406205422 X 10579509 5113254 -4062682 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false true 3886 3886 false Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY Lobbying expenses represent the portion of dues paid to national and state hospital associations that is specifically allocable to lobbying. OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC. does not participate in or intervene in (including the publishing or distributing of statements) any political campaign on behalf of (or in opposition to) any candidate for public office. Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY Lobbying expenses represent the portion of dues paid to national and state hospital associations that is specifically allocable to lobbying. OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC. does not participate in or intervene in (including the publishing or distributing of statements) any political campaign on behalf of (or in opposition to) any candidate for public office. 544659 544659 138236322 67356511 70879811 2312356 1712355 600001 52528906 34150541 18378365 17958794 2717833 15240961 105643797 Interest in Investments Held by Ascension Health Alliance BENEFICIAL INTEREST IN Lourdes Hospital Foundation 23329942 Deferred Compensation 13810853 Due From Affiliates 6207767 Board Designated & Restricted Cash/Receivables Insurance Receivable Physician Guarantee 512040 Other Receivables 3329239 Investments in Unconsolidated Entities Estimated Third Party Payer Settlements 1868191 Cash Surrender Value of Life Insurance 132962 Other Assets 160064 49351058 Intercompany Debt with Ascension Health Alliance 41073708 Estimated 3rd Party Payor Settlement 4901966 Pension Liability 20480090 Deferred Compensation 13810853 Self Insurance IBNR 1929518 Due to Affiliates 34163746 Other Liabilities 3973301 Self Insurance Liability Savings Plan Liability 1847605 Asset Retirement Obligation 516449 Physician Guarantee 92812 122790048 X Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote THE SYSTEM ACCOUNTS FOR UNCERTAINTY IN INCOME TAX POSITIONS BY APPLYING A RECOGNITION THRESHOLD AND MEASUREMENT ATTRIBUTE FOR FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT OF A TAX POSITION TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN. THE SYSTEM HAS DETERMINED THAT NO MATERIAL UNRECOGNIZED TAX BENEFITS OR LIABILITIES EXIST AS OF JUNE 30, 2017. true true X true X 250 true X true true true false true true 4447554 4447554 0.0135 52585970 39441577 13144393 0.0400 0 0.0 0 0 57033524 39441577 17591947 0.0536 3677966 3677966 0.0112 2649279 2649279 0.0081 51095142 29346245 21748897 0.0663 0 0.0 3225 3225 0.0000 0 0 57425612 29346245 28079367 0.0855 0 0 114459136 68787822 45671314 0.1391 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 10977 10977 0.0000 0 0.0 0 0.0 0 0.0 0 0 10977 0 10977 0.0000 false 4504505 955735 55224717 58924168 -3699451 X true true 1 1 Our Lady of Lourdes Memorial Hospital Inc 169 Riverside Drive Binghamton NY 13905 www.lourdes.com 03011001H X X X X Our Lady of Lourdes Memorial Hospital Inc 1 false false true X X X X X X X X X 15 true true true true X https://www.lourdes.com/about-us/community-service-plan/ X true 15 true https://www.lourdes.com/about-us/community-service-plan/ false true X 250.0 400.0 X X X X true true X X X true X https://www.lourdes.com/patient-guide/billing/financial-assistance/pfap/ X https://www.lourdes.com/patient-guide/billing/financial-assistance/pfap/ X https://www.lourdes.com/patient-guide/billing/financial-assistance/pfap/ X X X X X true X false X X X X true X false false Schedule H, Part V, Section B, Line 5 Facility , 1 Facility , 1 - OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC.. LOURDES ELICITED INPUT OF REPRESENTATIVES WITH SPECIAL KNOWLEDGE OF PUBLIC HEALTH BY ENGAGING PERSONS WHO REPRESENT THE COMMUNITY SERVED BY LOURDES AND THOSE WITH SPECIAL KNOWLEDGE OF OR EXPERTISE IN PUBLIC HEALTH WERE INCLUDED IN THE EVALUATION OF COMMUNITY HEALTH NEEDS, IDENTIFICATION OF HEALTH PRIORITIES AND GOALS AND OBJECTIVES OF THE IMPLEMENTATION STRATEGY. THE PUBLIC PARTICIPATED IN THE DEVELOPMENT OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AND COMMUNITY HEALTH IMPROVEMENT PLAN/IMPLEMENTATION STRATEGY THROUGH INTERVIEWS, SURVEYS, INTERACTIVE PRESENTATIONS AND COMMUNITY MEETINGS. Schedule H, Part V, Section B, Line 6a Facility , 1 Facility , 1 - OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC.. UHS HOSPITAL Schedule H, Part V, Section B, Line 6b Facility , 1 Facility , 1 - OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC.. RMS HEALTHCARE Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - Our Lady of Lourdes Memorial Hospital, INc.. Our Lady of Lourdes Memorial Hospital, Inc. (Lourdes) identified several needs needs during the Community Health Needs Assessment for the 2016-2018 period. The following is a listing of the needs that Lourdes is addressing and how they are being addressed. Behavioral Health (Mental Health & Substance Abuse): Goal: lower barriers to mental health and substance use services Ways Addressed in FY 2017: - Lourdes Youth Services provided services to at-risk adolescents through two programs. The Lourdes Mental Health Juvenile Justice Project worked successfully to keep 100% of the youth served out of detention and out of home placement. The Detention Alternative After School Program kept 94.5% of the youth served out of placement. - Lourdes continued to offer suicide intervention training programs; lead a Lourdes specific Substance Abuse and Mental Health Task Force; administered suicide prevention screening; provided inpatient and emergency department screening for alcohol and substance abuse Obesity Prevention, Wellness & Chronic Disease Goal: lower barriers to healthy life style choices Ways Addressed in FY 2017: - diabetes education: providers participated in a professional teaching day and received advanced nursing accreditation - fit and fun meals were provided at the Lourdes' All spice cafe - supporting a healthy start for newborns, patients are encouraged to breast feed Socioeconomic Poor & Vulnerable Goal: Focus on the poor and vulnerable with special attention to those enrolled in the Medicaid program. Ways Addressed in FY 2017: - Lourdes was approved to participate in a federal drug discount program called 340B which helps hospitals to serve rural communities; under the program hospitals receive pharmaceuticals at discounted prices from drug companies - The Mission in Motion mobile mammography van provides no charge screening to those in need Lourdes recognizes that no one organization can address the entire health care needs of the community. Lourdes is conscious of its stewardship of resources to best meet the needs of our community. As such, Lourdes will focus resources in those areas in which Lourdes can impact community health most. Lourdes' practice is to maximize resources with existing programs, new services planned, to avoid duplication of services, and to establish metrics and tools which foster continuous improvement. For those reasons, the needs identified that will not be addressed are: - Improve Health Status and Health Disparities - Promote a Health and Safe Environment - Preventing Chronic Disease - Promoting Healthy Women, Infants, and Children Schedule H, Part V, Section B, Line 13 Facility , 1 Facility , 1 - OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC.. OUR LADY OF LOURDES MEMORIAL HOSPITAL USED THE FOLLOWING ADDITIONAL CRITERIA TO DETERMINE ELIGIBILITY FOR FREE DISCOUNTED CARE: - MEDICAID/MEDICARE - STATE REGULATIONS 14 Center for Family Health 303 Main Street Binghamton NY 13905 Primary Care Office Lourdes Pediatrics 161 Riverside Drive Suite 206 Binghamton NY 13905 Primary Care Office Lourdes at Home 4102 Old Vestal Road Vestal NY 13850 Home Care Internal Medicine 3101 Shippers Road Suite 202 Vestal NY 13850 Primary Care Office Primary Care Associates 276-280 Robinson Street Binghamton NY 13904 Primary Care Office Primary Care Associates 415 East Main Street Endicott NY 13760 Primary Care Office Riverside Surgical 169 Riverside Drive Binghamton NY 13905 Primary Care Office Hospice at Lourdes 4102 Old Vestal Road Vestal NY 13850 End of Life Care Family Medicine 3101 Shippers Road Suite 203 Vestal NY 13850 Primary Care Office Riverside Medical 161 Riverside Drive Suite 306 Binghamton NY 13905 Primary Care Office Lourdes Family Practice 500 5th Avenue Owego NY 13827 Primary Care Office Lourdes Gastroenterology 161 Riverside Drive Suite 210 Binghamton NY 13905 Primary Care Office Lourdes Family Practice 1130 Upper Front Street Binghamton NY 13901 Primary Care Office Lourdes Vascular Surgery 161 Riverside Drive Suite 105 Binghamton NY 13905 Primary Care Office Lourdes Dermatology 3101 Shippers Road Suite 102 Binghamton NY 13850 Primary Care Office Lourdes Family Practice 2660 Main Street Whitney Point NY 13862 Primary Care Office Lourdes Family Practice 39 East Main Street Hancock NY 13783 Primary Care Office North Tioga Center for Family Health 13293 Route 38 Richford NY 13835 Primary Care Office Schedule H, Part V, Section B, Line 17 Billing and Collection Policy During tax year 2017, the organization learned via verbal comments of IRS agents at public events that the IRS intends that the "readily obtainable" standard in the 501(r) regulations for the AGB calculation and billing and collection policy is only met if those items are posted to the organization's web site. The organization had interpreted that web posting standard to be a safe harbor after consulting with external counsel and tax advisors, and timely took other steps to make the information readily obtainable. Consequently, the organization does not believe its decision to not post these documents to its web site rises to the level of a failure, nor does it believe the circumstances were either willful or egregious, having otherwise timely taken the steps necessary to attain and continue to maintain compliance with the other requirements related to the billing and collection policy and the AGB, as part of its policies and procedures for ensuring compliance with all aspects of 501(r). However, the organization is making this voluntary disclosure in order to communicate to the IRS the changes it is undertaking in response to the recent IRS informal guidance on this specific point concerning the "readily obtainable" standard, and the fact that the organization has started the work necessary to post its AGB information and billing and collection policy to its web site and will complete those additional postings as soon as reasonably possible. The other web postings required under 501(r) (i.e., those related to the community health needs assessment and the financial assistance policy) were timely completed and continue to remain in place as required. The organization believes its safeguards worked as intended in this case (i.e., the organization has regular communications with a number of external law firms and tax consultants and the timely attention to the recent guidance was supported by the framework of regular access to subject matter experts). These changes are in the process of being incorporated into corporate policies and procedures that apply to the organization. Schedule H, Part I, Line 7g Subsidized Health Services OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC. INCLUDED AS SUBSIDIZED HEALTH SERVICES $20,052,056 OF COSTS ATTRIBUTABLE TO PHYSICIAN CLINICS. Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance The cost of providing charity care, means-tested government programs, and other community benefit programs is estimated using internal cost data, and is calculated in compliance with Catholic Health Association ("CHA") guidelines. The organization uses a cost accounting system that addresses all patient segments (for example, inpatient, outpatient, emergency room, private insurance, Medicaid, Medicare, uninsured, or self pay). The best available data was used to calculate the amounts reported in the table. For the information in the table, a cost-to-charge ratio was calculated and applied. Schedule H, Part II Community Building Activities RESEARCH SHOWS THAT SOCIAL DETERMINANTS AND QUALITY OF LIFE PLAY A MAJOR ROLE IN THE HEALTH STATUS OF INDIVIDUALS AND COMMUNITIES. COMMUNITY BUILDING ACTIVITIES, WHICH FOCUS ON IMPROVING THE QUALITY OF LIFE WITHIN A COMMUNITY, ULTIMATELY INFLUENCE AND IMPROVE HEALTH STATUS. Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount After satisfaction of amounts due from insurance and reasonable efforts to collect from the patient have been exhausted, the Corporation follows established guidelines for placing certain past-due patient balances within collection agencies, subject to the terms of certain restrictions on collection efforts as determined by Ascension Health. Accounts receivable are written off after collection efforts have been followed in accordance with the Corporation's policies. After applying the cost-to-charge ratio, the share of the bad debt expense in fiscal year 2017 was $13,484,057 at charges, ($4,504,505 at cost). Schedule H, Part III, Line 3 Bad Debt Expense Methodology The provision for doubtful accounts is based upon management's assessment of expected net collections considering historical experience, economic conditions, trends in healthcare coverage, and other collection indicators. Periodically throughout the year, management assesses the adequacy of the allowance for doubtful accounts based upon historical write-off experience by payor category, including those amounts not covered by insurance. The results of this review are then used to make any modifications to the provision for doubtful accounts to establish an appropriate allowance for doubtful accounts. Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote The organization is part of the Ascension Health Alliance's consolidated audit in which the footnote that discusses the bad debt expense is located on page 19. Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs A cost to charge ratio is applied to the organization's Medicare Expense to determine the Medicare allowable costs reported in the organization's Medicare Cost Report. Ascension Health and its related health ministries follow the Catholic Health Association (CHA) guidelines for determining community benefit. CHA community benefit reporting guidelines suggest that Medicare shortfall is not treated as community benefit. Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC. FOLLOWS THE ASCENSION GUIDELINES FOR COLLECTION PRACTICES RELATED TO PATIENTS QUALIFYING FOR CHARITY OR FINANCIAL ASSISTANCE. A PATIENT CAN APPLY FOR CHARITY OR FINANCIAL ASSISTANCE AT ANY TIME DURING THE COLLECTION CYCLE. ONCE QUALIFYING DOCUMENTATION IS RECEIVED THE PATIENT'S ACCOUNT IS ADJUSTED. PATIENT ACCOUNTS FOR THE QUALIFYING PATIENT IN THE PREVIOUS SIX MONTHS MAY ALSO BE CONSIDERED FOR CHARITY OR FINANCIAL ASSISTANCE. ONCE A PATIENT QUALIFIES FOR CHARITY OR FINANCIAL ASSISTANCE, ALL COLLECTION ACTIVITY IS SUSPENDED. Schedule H, Part V, Section B, Line 16a FAP website - Our Lady of Lourdes Memorial Hospital, Inc.: Line 16a URL: https://www.lourdes.com/patient-guide/billing/financial-assistance/pfap/; Schedule H, Part V, Section B, Line 16b FAP Application website - Our Lady of Lourdes Memorial Hospital, Inc.: Line 16b URL: https://www.lourdes.com/patient-guide/billing/financial-assistance/pfap/; Schedule H, Part V, Section B, Line 16c FAP plain language summary website - Our Lady of Lourdes Memorial Hospital, Inc.: Line 16c URL: https://www.lourdes.com/patient-guide/billing/financial-assistance/pfap/; Schedule H, Part VI, Line 2 Needs assessment Lourdes recognizes that Public Participation is an important aspect of the Community Health Needs Assessment, The Broome County Community Health Needs Assessment is the result of collaboration and the basis for the Public Health Priorities framing Lourdes' CHNA. Lourdes provides an update to the community on the implementation strategies in the CHNA annually in the Community Service Plan (CSP). This comprehensive plan reflects extensive communication and interaction with stakeholders from many sectors, to identify and prioritize unmet community needs and strategies for addressing them. As recommended by the New York State Department of Health, Lourdes was involved in the Community Health Needs Assessment and planning process of the local health department (Broome County), Outreach to health and human service organizations, consumers, community groups and facility advisory boards were accomplished in collaboration with the Broome County Health Department Community Health Assessment Steering Committee. This collective collaboration enabled the community to have more public participation in identifying community need than could have been accomplished independently by Lourdes. Additionally, Lourdes provided input to the Tioga County Health Department's Community Health Assessment through active participation on the Tioga County Community Health Needs Assessment Steering Committee. During 2014, Lourdes participated in the development of a comprehensive Community Health Needs Assessment as part of the NYS Delivery System Redesign Incentive Payment Program (DSRIP) planning grant. This extensive CHNA was for a ten county Southern Tier Rural Integrated Performing Provider System (STRIPPS) region, which included Lourdes Primary Service Area of Broome County, The CHNA focused on the health issues of Medicaid Beneficiaries, the uninsured (low and non-utilizers). 2,011 persons participated in this CHNA, representing providers, beneficiaries, community based organizations, and the community at large. Ninety in depth interviews were conducted and 15 focus groups with 127 Medicaid beneficiaries were held. Participants self-identified to participate in an on-going Panel which will continue to inform STRIPPS in the design of interventions (projects) to address Community Health status, This CHNA validated key health issues for the Medicaid and Uninsured population to be obesity prevention & associated cardiovascular chronic disease and mental health/substance abuse. To ensure that the CHNA is effective, Lourdes assesses the community's health care needs annually through several venues: - Broome County Community Health Assessment Steering Committee: Lourdes participates as a member of a multi-agency collaborative Community Health Assessment Steering Committee". This over-sight committee meets or communicates monthly to assess community health status/needs and identify and monitor interventions. The Steering Committee, under the guidance of the local Health Department and the New York State Health Department, addresses public health issues and underlying causes contributing factors to health status and chronic disease, and reviews current interventions and outcomes. Efforts to coordinate interventions and share best practices occur through these interactive meeting. Oversight and monitoring during 2014 also occurred through the design and development of the aforementioned DSRIP work: - Active participation on community committees, boards and coalitions: Key partners that Lourdes works with to achieve the Community Public Health Priorities include but are not limited to the American Cancer Association, American Diabetes Association, American Heart Association, Broome County Health Department Community Health Needs Assessment (CHNA), Steering Committee, Broome County Health Department, local health departments in whose county Lourdes provides services, Action for Older Persons, Binghamton VA Outpatient Clinic, the Dr, Garrabed A, Fattal Community Free Clinic (Broome County based), Community Alternative Systems Agency (CASA), Communities Joined in Action, Department of Social Services, Mothers & Babies Perinatal Network of SCNY, Office of Mental Health, Rural Health Network of South Central New York, United Way, Binghamton University School of Nursing, and the Southern Tier Health Link: - Patient and provider satisfaction surveys/feedback - Lourdes Hospitals Patient and Family Advisory Council Community Focus Groups - New York State SPARCS data - New York State registries which provide prevalence and incidence rates of disease. Schedule H, Part VI, Line 3 Patient education of eligibility for assistance During registration insurance coverage for each patient is verified, If the patient is registered as self-pay (uninsured) the Lourdes Financial Counseling program is designed to assess each patient's eligibility for a NY healthcare program (Child Health Plus, NY Medicaid or a Qualified Health Plan through NY state) and the Lourdes Patient Financial Assistance Program. The process varies based on patient type and location of service, an overview of the existing process is summarized as follows: Lourdes Emergency Room: Lourdes Financial Counselors are on-site within the ER, they meet with each ER patient after treatment and prior to discharge. The Financial Counselor reviews insurance coverage with each patient. For each uninsured patient we attempt to conduct a face to face eligibility interview. The eligibility interview takes 5 minutes to determine if the patient is eligible for a NY State healthcare program and/or Lourdes' Patient Financial Assistance Program. We also help patients complete applications for Lourdes Patient Financial Assistance Program and assist in enrolling into Medicaid or during open enrollment, a Qualified Health Plan. Lourdes Primary Care Network: Uninsured patients are called by the Financial Counselors and interviewed for eligibility. Based on results we provide assistance for NY program or Lourdes Patient Financial Assistance Program enrollment. All Other Patient Types: The Business Office runs a monthly extract to identify account balances due from self-pay patients that are over 30 days old which indicates possible financial hardship, The Business Office Financial Counselors attempt to contact these patients by phone to determine if financial assistance is needed. Where ever possible we conduct eligibility interview over the phone. Based on results we provide assistance for NY program or Lourdes Patient Financial Assistance Program enrollment. Appointments are made as needed for facilitated enrollment into Affordable Care Act Medicaid programs or Qualified Health Plans. Patient Education: Brochures on the Lourdes Patient Financial Assistance Program are available at all Lourdes patient care sites and on the Lourdes internet web site. Schedule H, Part VI, Line 4 Community information Lourdes Hospital is based in Binghamton, New York. For community and local health planning purposes, Lourdes Community Health Needs Assessment (CHNA) addresses the needs of the residents of Broome County, as over 80% of those served by Lourdes reside in Broome County. This primary service area definition is consistent with physician needs assessment methodologies based on qualitative standards established by the Internal Revenue Service (IRS Final Revenue Ruling on Physician Recruitment: Revenue Rule 97-21, Source: Fall 2014 AmeriMed Consulting Medical Staff Development Plan for Our Lady of Lourdes Memorial Hospital, Executive Summary, page 1). A status report to the community is provided annually through Lourdes Community Service Plan (CSP). While Lourdes' CHNA and CSP address residents in Broome County, Lourdes extends its services and sphere of influence to the residents of Tioga, Delaware, and Chenango, New York, and to the residents of Susquehanna, Pennsylvania. Persons are served through Lourdes' comprehensive range of primary care (available in 10 locations within three counties), five walk-in clinics, Endocrinology & Diabetes Centers of Excellence, outpatient diagnostic services, outpatient physical therapy (4 locations), mobile van services (mammography & dental care}, regional cancer center services, specialty care, acute care, home health care, durable medical equipment company, hospice care, youth behavioral health and development, oral health, occupational health services and worker's compensation preferred provider organization programs, as well as health education and outreach programs. Schedule H, Part VI, Line 5 Promotion of community health (1) Lourdes evaluates existing infrastructure and location of services to ensure the community health needs are met. Results of these evaluations have resulted in the following: - Bone density testing and podiatry services were expanded to the rural community of Hancock - Lourdes Vestal: a project begun in 2012 was designed to bring many existing services together in one physical location, with the addition of some new services, the project was completed in calendar year 2014. The building and services were designed with the current and future health care needs of our patients and the community in mind, for persons of all ages, Our goal has always been to be true to our mission to create a positive patient and family experience, in a healing environment. The Lourdes Vestal services are convenient and accessible, are on bus routes; and will continue to provide safe, high quality care, Primary Care is provided by internal medicine and family practice providers from 4 existing Lourdes primary care practices. Not all of our existing sites have the same ancillary services, such as lab, x-ray, mammography, or physical therapy; hence location of these services will improve access for patients, Women's health services include screening and diagnostic mammography. Breast ultrasound and access to a Breast Surgeon on site was a new service begun in 2014. Occupational Health services was relocated from the hospital to Vestal to increase community access: - Other new services located at Lourdes vestal were also, based on community need and include, (a) bone densitometry for the evaluation of fracture risk and osteoporosis for women and men, This service is also available at the hospital, (b) Community Room- which will offer education supportive of community health priorities identified in the CHNA; (c) A dermatology practice; (d) Walk-in services and (e) Retail Pharmacy, - Lourdes Pediatric Walk-in services were added in 2014 to increase appropriate access for pediatric patients needing evening appointments, (2) Lourdes is considered a disproportionate share hospital for Medicaid purposes, Unique financial assistance programs that Lourdes offers or participates in include: Lourdes Patient Financial Assistance Program (PFAP), prompt pay program, Medicaid, Hope Dispensary, Lourdes Care Plus, Prenatal care Assistance Program, Child Health Plus, Medicaid and Medicaid Managed Care. Lourdes increased the employment of financial counselors from 8 to 11 to assist uninsured persons in determining eligibility for health care coverage and have implemented an "out bound call" program. All financial counselors became Certified Applications Counselors. (3) Lourdes participates in Health Prevention Initiatives through Breast, Cervical and Colorectal Cancer screening. Lourdes administers over $2.1 million annually in grant programs for at risk children and youth. Also active in promoting the health and well-being of the community are nearly 500 voluntary members of the medical staff and 15 volunteer community board members (which excludes senior leadership). Lourdes is active in medical staff development recruitment and succession planning. This year access to primary and specialty care was expanded through the hiring of seventeen providers. Throughout the year we continued to press forward to address access needs for children's oral health, pharmaceuticals, and behavioral health services for youth, Lourdes Center for Mental Health (LCMH) served 850 clients in 2014. The Lourdes Student Assistance Program and Alcohol and Drug Education Prevention Team provided alcohol and drug abuse prevention services to 9,043 students and parents through a variety of evidenced based programs. SBIRT training (Screening, Brief Intervention and Referral to Treatment) was provided to Lourdes associates in the ED as part of our commitment to the treatment of substance abuse. (4) Volunteering - As a Lourdes Volunteer, you become an integral part of the hospital team. Volunteers' efforts benefit the hospital in continuing its commitment to excellence while providing them with the personal satisfaction of contributing to the welfare of those in need. Each year, hundreds of volunteers find fulfillment, practical work experience and companionship within Lourdes. There are volunteer opportunities for Adults and Juniors. Volunteers provide many of the services that improve the quality of patient stays and support medical and administrative staff at Lourdes. The following are some, but not all of the opportunities volunteers can take part in: Lourdes Auxiliary Gift Shop & Cafe DePaul: Two to four hour assignments in the Gift Shop (gift suggestions/register) and Cafe DePaul (food preparation/serving). All proceeds from the Gift Shop & Cafe DePaul benefit Lourdes patients. Patient Care: Areas where volunteers provide hospitality and conversation while assisting the staff with general tasks - Emergency Room - Physical Therapy - Occupational Therapy - Speech Therapy - Ambulatory Surgery - Breast Care Center - Spiritual Care (Eucharistic Minister) - Patient Floors - Primary Care Facilities - Laser/Eye Center or Holding Area - Patient Reading Program - Diagnostic Imaging - Diabetic Education Clerical Areas: Volunteers assist the staff with clerical duties which may include photocopying, filing, faxing, telephones, collating, data entry and typing in the following departments: - Administration - Business Office - Pharmacy - Medical Staff Office - Nursing Education - Facilities Management - Public Relations - Human Resources - Purchasing Department - Volunteer Services - Physician Offices - Pre-Admission Testing - Patient Floor Clerical - Library - Diabetes Education - Information Systems - Laser/Eye Unit Lourdes Physician Practices: A wide variety of volunteer opportunities are available in many different departments throughout the hospital and at the Primary Care sites: - Blood Pressure Screening - Pharmacy Deliveries - Admit/Registration Escorting - Sterile Processing Department - Laboratory - Food & Nutrition (Dietary) - Information Desk - Flower Room - Laundry Services - Information Systems Schedule H, Part VI, Line 6 Affiliated health care system OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC, AND AFFILIATES (THE HOSPITAL) IS A MEMBER OF ASCENSION HEALTH. ASCENSION HEALTH ALLIANCE, DOING BUSINESS AS ASCENSION, IS THE SOLE CORPORATE MEMBER AND PARENT ORGANIZATION OF ASCENSION HEALTH, A CATHOLIC, NATIONAL HEALTH SYSTEM CONSISTING PRIMARILY OF NONPROFIT CORPORATIONS THAT OWN AND OPERATE MORE THAN 1,900 LOCAL HEALTH CARE FACILITIES, OR HEALTH MINISTRIES, LOCATED IN 24 OF THE UNITED STATES AND THE DISTRICT OF COLUMBIA. IN ADDITION TO SERVING AS THE SOLE CORPORATE MEMBER OF ASCENSION HEALTH. ASCENSION SERVES AS THE MEMBER OR SHAREHOLDER OF VARIOUS OTHER SUBSIDIARIES, ASCENSION, ITS SUBSIDIARIES, AND HEALTH MINISTRIES ARE REFERRED COLLECTIVELY FROM TIME TO TIME HEREAFTER AS THE SYSTEM. ASCENSION IS SPONSORED BY ASCENSION SPONSOR, A PUBLIC JURIDIC PERSON. THE PARTICIPATING ENTITIES OF ASCENSION SPONSOR ARE THE DAUGHTERS OF CHARITY OF ST. VINCENT DE PAUL IN THE UNITED STATES, ST. LOUISE PROVINCE, THE CONGREGATION OF ST. JOSEPH, THE CONGREGATION OF THE SISTERS OF ST. JOSEPH OF CARONDELET, THE CONGREGATION OF ALEXIAN BROTHERS OF THE IMMACULATE CONCEPTION PROVINCE-AMERICAN PROVINCE, AND THE SISTERS OF THE SORROWFUL MOTHER OF THE THIRD ORDER OF ST. FRANCIS OF ASSISI-US/CARIBBEAN PROVINCE. THE HOSPITAL, LOCATED IN BINGHAMTON, NEW YORK, IS A NONPROFIT ACUTE CARE HOSPITAL. THE HOSPITAL PROVIDES INPATIENT, OUTPATIENT AND EMERGENCY CARE SERVICES FOR THE RESIDENTS OF BROOME COUNTY AND THE SURROUNDING COMMUNITIES. ADMITTING PHYSICIANS ARE PRIMARILY PRACTITIONERS IN THE LOCAL AREA. ALSO INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS ARE CORBETT CORPORATION (CORBETT) , A FOR PROFIT, WHOLLY OWNED SUBSIDIARY OF THE HOSPITAL FORMED TO CONSTRUCT AND RENOVATE BUILDINGS IN THE HOSPITAL' S PROXIMITY, AND LOURDES REALTY, INC. (REALTY), A NONPROFIT REAL ESTATE COMPANY FORMED TO ACQUIRE AND RENOVATE OFFICE SPACE IN THE HOSPITAL' S PROXIMITY. THE HOSPITAL IS THE SOLE CORPORATE MEMBER OF REALTY. THE HOSPITAL IS RELATED TO ASCENSION HEALTH'S OTHER SPONSORED ORGANIZATIONS THROUGH COMMON CONTROL. SUBSTANTIALLY ALL EXPENSES OF ASCENSION HEALTH AND ITS SPONSORED ORGANIZATIONS ARE RELATED TO PROVIDING HEALTH CARE SERVICES. MISSION THE SYSTEM DIRECTS ITS GOVERNANCE AND MANAGEMENT ACTIVITIES TOWARD STRONG, VIBRANT, CATHOLIC HEALTH MINISTRIES UNITED IN SERVICE AND HEALING AND DEDICATES ITS RESOURCES TO SPIRITUALLY CENTERED CARE WHICH SUSTAINS AND IMPROVES THE HEALTH OF THE INDIVIDUALS AND COMMUNITIES IT SERVES. IN ACCORDANCE WITH THE SYSTEM'S MISSION OF SERVICE TO THOSE PERSONS LIVING IN POVERTY AND VULNERABLE PERSONS, EACH HEALTH MINISTRY ACCEPTS PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. THE SYSTEM USES FOUR CATEGORIES TO IDENTIFY THE RESOURCES USED FOR THE CARE OF PERSONS LIVING IN POVERTY AND COMMUNITY BENEFIT PROGRAMS: - TRADITIONAL CHARITY CARE INCLUDES THE COST OF SERVICES PROVIDED TO PERSONS WHO CANNOT AFFORD HEALTH CARE BECAUSE OF INADEQUATE RESOURCES AND/OR WHO ARE UNINSURED OR UNDERINSURED - UNPAID COST OF PUBLIC PROGRAMS, EXCLUDING MEDICARE REPRESENTS THE UNPAID COST OF SERVICES PROVIDED TO PERSONS COVERED BY PUBLIC PROGRAMS FOR PERSONS LIVING IN POVERTY AND OTHER VULNERABLE PERSONS - COST OF OTHER PROGRAMS FOR PERSONS LIVING IN POVERTY AND OTHER VULNERABLE PERSONS INCLUDES UNREIMBURSED COSTS OF PROGRAMS INTENTIONALLY DESIGNED TO SERVE PERSONS LIVING IN POVERTY AND OTHER VULNERABLE PERSONS OF THE ACOMMUNITY, INCLUDING SUBSTANCE ABUSERS, THE HOMELESS, VICTIMS OF CHILD ABUSE, AND PERSONS WITH ACQUIRED IMMUNE DEFICIENCY SYNDROME - COMMUNITY BENEFIT CONSISTS OF THE UNREIMBURSED COSTS OF COMMUNITY BENEFIT PROGRAMS AND SERVICES FOR THE GENERAL COMMUNITY, NOT SOLELY FOR PERSONS LIVING IN POVERTY, INCLUDING HEALTH PROMOTION AND EDUCATION, HEALTH CLINICS AND SCREENINGS. DISCOUNTS ARE PROVIDED TO ALL UNINSURED PATIENTS, INCLUDING THOSE WITH THE MEANS TO PAY. " DISCOUNTS PROVIDED TO THOSE PATIENTS WHO DID NOT QUALIFY FOR ASSISTANCE UNDER CHARITY CARE GUIDELINES ARE NOT INCLUDED IN THE COST OF PROVIDING CARE TO PERSONS LIVING IN POVERTY AND OTHER COMMUNITY BENEFIT PROGRAMS. THE COST OF PROVIDING CARE OF PERSONS LIVING IN POVERTY AND OTHER COMMUNITY BENEFIT PROGRAMS IS ESTIMATED BY REDUCING CHARGES FORGONE BY A FACTOR DERIVED FROM THE RATIO OF TOTAL OPERATING EXPENSES TO BILLED CHARGES FOR PATIENT CARE. Schedule H, Part VI, Line 7 State filing of community benefit report NY true AMERICAN HEART ASSOCIATION PO BOX 50075 PRESCOTT AZ 86304 135613797 501(C)(3) 5000 OPERATING SUPPORT EVANS STREET BASEBALL PO BOX 598 BINGHAMTON NY 13902 462306815 15200 OPERATING SUPPORT GREATER BINGHAMTON CHAMBER OF COMMERCE PO BOX 995 BINGHAMTON NY 13902 150245930 Gov't 5350 OPERATING SUPPORT MERCY HOUSE OF THE SOUTHERN TIER 212 N MCKINLEY AVENUE ENDICOTT NY 13760 465411006 501(C)(3) 7517 OPERATING SUPPORT RESCUE MISSION 155 GIFFORD STREET SYRACUSE NY 13202 150532146 501(C)(3) 5000 OPERATING SUPPORT THE MADRIGAL CHOIR OF BINGHAMTON 28 LATHROP AVENUE BINGHAMTON NY 13905 161264533 501(C)(3) 5000 OPERATING SUPPORT 5 1 Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds. DOCUMENTATION IS SUBMITTED BY THE REQUESTING ORGANIZATION BEFORE FUNDS ARE ISSUED. true true false false false false false false false KATHRYN CONNERTON PRESIDENT/CEO 357149 0 225547 0 68770 0 12740 0 13274 0 677480 0 0 0 JAMES STEINMETZ MD BOARD MEMBER 401506 0 85441 0 4886 0 13250 0 27793 0 532876 0 0 0 DAVID F CLEMENTS VICE PRESIDENT-FINANCE/CFO (END 8/2016) 188419 0 12562 0 11635 0 10936 0 3633 0 227185 0 0 0 LISA HARRIS MD SR VP MEDICAL AFFAIRS/CMO 288838 0 19501 0 32836 0 13250 0 24878 0 379303 0 0 0 LINDA MILLER SR VP OPERATIONS/CNO (END 11/2016) 219543 0 16821 0 53168 0 14487 0 10954 0 314973 0 0 0 RICHARD BLANSKY MD PRESIDENT M/S 425000 0 0 0 2558 0 13250 0 6854 0 447662 0 0 0 MARY HUGHS CHRO 151279 0 8083 0 4251 0 8397 0 18529 0 190539 0 0 0 DEB MICAN VP NURSING 172796 0 11531 0 10628 0 11299 0 20108 0 226362 0 0 0 CHAD PATTON VP, PROVIDER NETWORK 168834 0 11531 0 7685 0 12413 0 23150 0 223613 0 0 0 ANNE WOLANSKI VP QUALITY SVS & RISK/CRO (END 12/2016) 163455 0 11114 0 12027 0 11571 0 17786 0 215953 0 0 0 MICHAEL BARRETT MD PHYSICIAN 443787 0 299085 0 2949 0 14575 0 28771 0 789167 0 0 0 STEPHEN R LAUTERBACH MD PHYSICIAN 542830 0 17000 0 2640 0 12070 0 21247 0 595787 0 0 0 JOHN W MILLER MD PHYSICIAN 446458 0 73924 0 8203 0 13250 0 15704 0 557539 0 0 0 RATNAKISHORE PALLAPOTHU MD PHYSICIAN 329603 0 335442 0 1704 0 14017 0 31301 0 712067 0 0 0 TODD V PRIER MD PHYSICIAN 351435 0 122814 0 3659 0 14575 0 27122 0 519605 0 0 0 Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation ASCENSION HEALTH, A RELATED ORGANIZATION OF OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC., USES THE FOLLOWING TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S CEO/EXECUTIVE DIRECTOR: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - COMPENSATION SURVEY OR STUDY - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE Schedule J, Part I, Line 4a Severance or change-of-control payment THE FOLLOWING INDIVIDUAL(S) RECEIVED SEVERANCE PAYMENTS FROM THE ORGANIZATION OR A RELATED ORGANIZATION: LINDA MILLER - $29,356 Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan Eligible executives participate in a program that provides for supplemental retirement benefits. The payment of benefits under the program, if any, is entirely dependent upon the facts and circumstances under which the executive terminates employment with the organization. Benefits under the program are unfunded and non-vested. Due to the substantial risk of forfeiture provision, there is no guarantee that these executives will ever receive any benefit under the program. Any amount ultimately paid under the program to the executive is reported as compensation on Form 990, Schedule J, Part II, Column F in the year paid. NO PAYMENTS WERE MADE TO LISTED PERSONS IN PART VII UNDER THE VARIOUS NON-QUALIFIED DEFERRED COMPENSATION PLANS DURING THE YEAR. Riverside Associates in Anesthesia ENTITY OWNED BY DR. MARK TINKLEPAUGH, BOARD CHAIR 3357934 Services false Schedule L, Part IV All transactions reported on Part IV are reported as arms-length for fair market value. Form 990, Part VI, Line 15a PROCESS TO ESTABLISH COMPENSATION OF TOP MANAGEMENT OFFICIAL IN DETERMINING THE COMPENSATION OF THE ORGANIZATION'S PRESIDENT & CEO, THE PROCESS PERFORMED BY ASCENSION HEALTH, A RELATED ORGANIZATION OF OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC. INCLUDED A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. THE COMPENSATION COMMITTEE REVIEWED AND APPROVED THE COMPENSATION. IN THE REVIEW OF THE COMPENSATION, THE PRESIDENT & CEO WAS COMPARED TO INDIVIDUALS AT OTHER ORGANIZATIONS IN THE AREA WHO HOLD THE SAME TITLE. DURING THE REVIEW AND APPROVAL OF THE COMPENSATION, DOCUMENTATION OF THE DECISION WAS RECORDED IN THE COMMITTEE MINUTES. THE INDIVIDUAL WAS NOT PRESENT WHEN HIS COMPENSATION WAS DECIDED. Form 990, Part VI, Line 6 Classes of members or stockholders Our Lady of Lourdes Hospital, Inc. has a single corporate member, Ascension Health. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body Our Lady of Lourdes Memorial Hospital, Inc. has a single corporate member, Ascension Health, who has the ability to elect members to the governing body of Our Lady of Lourdes Memorial Hospital, Inc. Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders All decisions that have a material impact to Our Lady of Lourdes Memorial Hospital, Inc.'s. financial information or corporation as a whole are subject to approval by its sole corporate member, Ascension Health. Form 990, Part VI, Line 11b Review of form 990 by governing body DURING THE RETURN PREPARATION PROCESS, THE TAX DEPARTMENT WORKS WITH OTHER FUNCTIONAL AREAS INCLUDING FINANCE, ACCOUNTING, TREASURY, LEGAL, HUMAN RESOURCES, AND CORPORATE COMPLIANCE FOR ADVICE, INFORMATION AND ASSISTANCE IN ORDER TO PREPARE A COMPLETE AND ACCURATE RETURN. UPON COMPLETION, THE FORM 990 IS REVIEWED BY THE ORGANIZATION'S INTERNAL TAX DEPARTMENT WHICH CONSISTS OF ATTORNEYS AND CPAS. A COMPLETE FINAL COPY OF THE RETURN IS PROVIDED TO THE ORGANIZATION'S PRESIDENT, FINANCIAL OFFICER, AND/OR OTHER KEY OFFICERS IN LIEU OF THE FULL BOARD. Form 990, Part VI, Line 12c Conflict of interest policy The organization regularly and consistently monitors and enforces compliance with the conflict of interest policy in that any director, principal officer, or member of a committee with governing board delegated powers, who has a direct or indirect financial interest, must disclose the existence of the financial interest and be given the opportunity to disclose all material facts to the directors and members of the committees with governing board delegated powers considering the proposed transaction or arrangement. The remaining individuals on the governing board or committee will decide if conflicts of interest exist. Each director, principal officer and member of a committee with governing board delegated powers annually signs a statement which affirms such person has received a copy of the conflicts of interest policy, has read and understands the policy, has agreed to comply with the policy, and understands that the organization is charitable and in order to maintain its federal tax exemption it must engage primarily in activities which accomplish its tax-exempt purpose. Form 990, Part VI, Line 15b Process to establish compensation of other employees IN DETERMINING COMPENSATION OF THE ORGANIZATION'S OFFICERS AND KEY EMPLOYEES, THE PROCESS PERFORMED INCLUDED A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. THE EXECUTIVE COMPENSATION COMMITTEE REVIEWED AND APPROVED THE COMPENSATION. IN THE REVIEW OF THE COMPENSATION, THE OFFICERS' SALARIES WERE COMPARED TO INDIVIDUALS AT OTHER ORGANIZATIONS IN THE AREA WHO HOLD THE SAME TITLE. DURING THE REVIEW AND APPROVAL OF THE COMPENSATION, DOCUMENTATION OF THE DECISION WAS RECORDED IN THE MINUTES. INDIVIDUALS WERE NOT PRESENT WHEN THEIR COMPENSATION WAS DECIDED. Form 990, Part VI, Line 19 Required documents available to the public The Organization will provide any documents open to public inspection upon request. Form 990, Part VIII, Line 2f Other Program Service Revenue Income from Joint Ventures - Total Revenue: 57479, Related or Exempt Function Revenue: 40730, Unrelated Business Revenue: 16749, Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Fees from Affiliates - Total Revenue: 175613, Related or Exempt Function Revenue: 175613, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Management Services - Total Revenue: 410499, Related or Exempt Function Revenue: 410499, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Occupational Health - Total Revenue: 239110, Related or Exempt Function Revenue: 239110, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Form 990, Part VIII, Line 11d Other Miscellaneous Revenue Other MIscellaneous INcome - Total Revenue: 707071, Related or Exempt Function Revenue: , Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 707071; Medical Records - Total Revenue: 26094, Related or Exempt Function Revenue: , Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 26094; Housekeeping - Total Revenue: 9445, Related or Exempt Function Revenue: , Unrelated Business Revenue: 9445, Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Form 990, Part XI, Line 9 Other changes in net assets or fund balances FAS 158 Pension Adjustment - -5430245; Change in Interest of Foundation - 1367563; Form 990, Part XII, Line 2b AUDITED FINANCIAL STATEMENTS The activity of OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC. is reported in the consolidated financial statements of Ascension Health Alliance. No individual audit of OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC. is completed. Therefore, the attached audited financial statements are of Ascension Health Alliance and Affiliates, which include the activity of OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC.. Form 990, Part XII, Line 2c AUDIT COMMITTEE OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC. is included in the consolidated financial statements of Ascension Health Alliance. The Finance and Audit committee of Ascension Health Alliance's Board assumes responsibility for the consolidated organization as a whole. Ascension Health Alliance PO Box 45998 St Louis MO 631455998 453358926 National Health System MO 501(c)(3) Type I NA false Ascension Health PO Box 45998 St Louis MO 63145 311662309 National Health System MO 501(c)(3) Type I Ascension Health Alliance false Lourdes Realty Corporation Inc 169 Riverside Drive Binghamton NY 13905 222873637 Rental of Health Care Facilities NY 501(c)(2) Our Lady of Lourdes Memorial Hospital Inc true Lourdes Health Support LLC 333 Butternut Drive Suite 100 Dewitt NY 13214 161611707 Medical Equipment Provider NY Our Lady of Lourdes Memorial Hospital Inc Excluded -2119 753713 false -636 false 0.6 Corbet Corporation 169 Riverside Drive Binghamton NY 13905 161268267 Property Management NY Our Lady of Lourdes Memorial Hospital Inc C Corporation 128980 2070079 1 true false false false false false false false false false true true true true false true true false false false CORBETT CORPORATION L 3162611 FAIR MARKET VALUE CORBETT CORPORATION O 96353 FAIR MARKET VALUE LOURDES REALTY COMPANY K 466202 FAIR MARKET VALUE LOURDES REALTY COMPANY J 680145 FAIR MARKET VALUE LOURDES REALTY COMPANY L 3180454 FAIR MARKET VALUE LOURDES REALTY COMPANY O 120177 FAIR MARKET VALUE