2018-09-07T15:28:56-07:00 2017-12-31 990 2017-01-01 160743163 ST JOSEPHS HOSPITAL STJO 6077336541 555 ST JOSEPHS BLVD ELMIRA NY 14901 RONALD KINTZ VP/CHIEF FINANCIAL OFFICER 6077374100 2018-09-07 162.223.206.130 2017 2018-06-14 16:35:46Z RONALD J KINTZ SENIOR VP CFO 600 ROE AVENUE ELMIRA NY 14905 48952854 0 X WWW.ARNOTHEALTH.ORG X 1908 NY MINISTERS TO INPATIENTS AND OUTPATIENTS, SERVING AS A PRIMARY CARE AND SPECIALTY REFERRAL CENTER 14 14 643 100 81580 0 0 146430 48426243 47103612 324385 52469 3620336 1497931 52370964 48800442 0 0 0 0 22494750 20950250 0 0 0 24272420 31783262 46767170 52733512 5603794 -3933070 31791547 27913870 18787341 17576435 13004206 10337435 MINISTERS TO INPATIENTS AND OUTPATIENTS, SERVING A PRIMARY CARE AND SPECIALTY REFERRAL CENTER FOR PEOPLE FROM ALL FAITHS LIVING IN CHEMUNG COUNTY AND THE SURROUNDING COUNTIES OF NEW YORK AND PENNSYLVANIA 0 0 39220484 0 47103612 ST JOSEPHS ACUTE CARE UNITS COMBINE ADVANCED TECHNOLOGY WITH HIGHLY TRAINED STAFF TO MEET THE MEDICAL AND SURGICAL NEEDS OF OUR INPATIENTS. OUR STAFF IS DEDICATED TO PROVIDING PHYSICAL, EMOTIONAL AND SPIRITUAL CARE TO ALL PATIENTS BOTH DURING AND AFTER THEIR HOSPITAL STAY. OUR SKILLED NURSING FACILITY IS RESPONSIBLE FOR DELIVERING NURSING CARE TO SHORT TERM PATIENTS AND LONG TERM RESIDENTS BY PROVIDING PREVENTATIVE, THERAPEUTIC, AND REHABILITATION SERVICES. OUR NURSING STAFF ASSISTS RESIDENTS IN MAINTAINING AND/OR REGAINING THE HIGHEST POSSIBLE LEVEL OF WELLNESS. REHABILITATION IS THE FIRST STEP TOWARDS RECOVERY FOR ST JOSEPH'S INPATIENTS. OUR REHABILITATION TEAM OF MEDICAL PROFESSIONALS, SERVING A 7 COUNTY AREA, IS DEDICATED TO RESTORING THE INDEPENDENCE OF EACH PATIENT, THROUGH RETRAINING PROGRAMS AND ACTIVE PARTICIPATION. MISCELLANEOUS OTHER PROGRAM SERVICES INCLUDE, BUT ARE NOT LIMITED TO, EMERGENCY SERVICES, INTENSIVE CARE UNIT, SURGICAL SERVICES, MEDICAL IMAGING AND RADIOLOGY, ADDICTION REHABILITATION UNIT, LABORATORY SERVICES, ENDOSCOPY, PRIMARY CARE OFFICES, BEHAVIORAL SCIENCE UNIT, PHARMACY, RESPIRATORY THERAPY. 0 0 0 39220484 1 1 0 1 0 0 0 0 0 1 1 1 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 1 0 1 0 0 0 0 0 1 0 0 0 1 0 0 1 643 1 1 1 0 0 0 0 0 X 14 14 0 1 0 0 0 0 0 1 1 0 1 1 1 1 1 1 1 1 1 1 0 NY X RONALD KINTZ 6077374100 555 ST JOSEPHS BLVD ELMIRA NY 14901 Donald Quick CPA Chairman of the Board 2 0 X 0 0 0 Mark J Hagan Vice Chairman 2 0 X 0 0 0 Anders Tomson Board Member 1 0 X 0 0 0 David Dalrymple Board Member 1 0 X X 0 0 0 Jan van den Blink Board Member 1 0 X 0 0 0 Jeffrey Streeter Board Member 1 0 X 0 0 0 Kevin Corliss Board Member 1 0 X 0 0 0 Louis DiFabio Board Member 1 0 X 0 0 0 Mary Louise Mitchell Board Member 1 0 X X 0 0 0 Michael Hosey Board Member 1 0 X 0 0 0 Richard Simons Board Member 1 0 X 0 0 0 Robert McNamara Board Member 2 0 X 0 0 0 Roy A Kyles Board Member 1 0 X X 0 0 0 Scott Sprague Board Member 1 0 X 0 0 0 Robert Lambert MD Board Member/CEO 59 3 X X 0 537129 39636 Kathleen Lucke PhD Board Member/Education Director 1 50 X 0 37235 0 Alan Angell MD Board Member/Physician 1 61 X 0 402772 51303 Jonathon Lawrence Chief Operating Officer 16 37 X 0 253302 9942 John R Alexander Secretary 1 0 X 0 0 0 Ronald J Kintz DHA Senior VP/CFO 6 46 X 0 336405 39638 Sandra McCarthy RN Chief Nursing Officer 8 32 X 0 257115 30612 Robert de Bara MD President AMS 0 40 X X 0 420850 30724 Kenneth Herzl-Betz MD Senior VP/Medical Affairs 3 48 X 0 297488 30896 Richard Cleland Site Administrator IDMH 0 40 X 0 245016 8404 Nancy O'Dacre VP Planning 0 40 X X 0 43526 4924 Thomas Doak Pharmacy Technician 40 0 X 132675 0 0 Ilan Hadar Emergency Dept Director 40 0 X 133856 0 0 Kim Davenport BSU Director 40 0 X 130638 0 0 Roberta Conz Registered Nurse 40 0 X 107250 0 0 Ann Jacobs Registered Nurse 40 0 X 103007 0 0 607426 2830838 246079 13 1 1 0 Delphi Healthcare PLLC 1880 East Ridge Road Suite 6 Upper Level Rochester NY 14622 Emergency Room Physicians 736115 Angelica Textile Services 1105 Lokewood Pkwy Suite 120 Alpharetta GA 30009 Linen Services 216617 Mayo Medical Laboratories PO Box 4100 Business Office Rochester MN 55903 Patient Medical Lab Testing 173929 FocusOne Solutions PO Box 3037 Omaha NE 681030037 Nurse Staffing 148873 ABM Healthcare Support Services PO Box 935695 Atlanta GA 31193 Consulting Services 107366 5 0 0 0 0 37000 109430 0 146430 Net Patient Service Hospital Revenue 622110 46564922 46564922 0 0 Physical/Occupational Therapy Services 624110 538690 538690 0 0 0 0 0 0 47103612 52469 0 0 52469 0 0 0 0 0 0 0 0 81580 0 0 0 81580 0 81580 0 81580 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 284391 152412 131979 0 0 131979 NYS Vital Access Provider Funds 622210 855142 855142 0 0 Rebates/Discounts 900099 13801 13801 0 0 K-1 Tax Exempt Interest Income 523999 3771 3771 0 0 411658 411658 0 0 1284372 48800442 48387984 81580 184448 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 17090486 14446423 2644063 0 595966 0 595966 0 1998128 11181 1986947 0 1265670 1057341 208329 0 391370 234473 156897 0 16341 11237 5104 0 5000 0 5000 0 2354 0 2354 0 0 0 0 0 0 0 1296452 1182829 113623 0 0 0 0 0 1324686 1061899 262787 0 634547 437671 196876 0 0 0 0 0 884763 28803 855960 0 19538 17915 1623 0 0 0 0 0 3979 3479 500 0 7997 0 7997 0 0 0 0 0 2586301 1288502 1297799 0 316211 0 316211 0 Medical/Surgical/Pharmaceutical Supplies 5534100 5446024 88076 0 Maintenance Contracts/Purchased Services 18008659 11192770 6815889 0 Leases 234354 140313 94041 0 Benefit Allocation 0 2173544 -2173544 0 516610 486080 30530 0 52733512 39220484 13513028 0 23502 20910 1143398 1023244 54823 54823 5234041 5849944 0 0 0 0 156594 73585 340043 344092 101205 71682 97873657 81878296 17178041 15995361 394789 483937 1400000 1400000 0 0 0 0 5765111 2596292 31791547 27913870 3895114 3787532 0 0 0 0 0 0 0 0 0 0 440070 23047 0 0 14452157 13765856 18787341 17576435 X 12756609 10024271 214697 280264 32900 32900 13004206 10337435 31791547 27913870 X -3933070 66992 0 -3441 0 1202748 X 0 1 X 1 1 1 X 0 0 0 0 0 0 0 0 1 2354 2354 0 Schedule C, Part II-B, Line 1 ST JOSEPH'S PAYS ANNUAL DUES TO THE HEALTH ASSOCIATION OF NEW YORK AND ROCHESTER REGIONAL. PART OF THE DUES ARE USED FOR LOBBYING EXPENSES. 247597 0 65567 0 0 0 313164 256076 0 -8479 0 0 0 247597 177977 49368 28731 0 0 0 256076 177977 0 0 0 0 0 177977 46842 0 131135 0 0 0 177977 0 0.11 0.89 0 0 0 1197617 1197617 0 29201779 20220813 8980966 0 0 0 0 0 67474261 61657483 5816778 0 0 0 0 15995361 1400000 C 0 1400000 ACCOUNTS RECEIVABLE WORKERS COMPENSATION 713200 SELF INSURANCE RESERVE 1798255 SWARTWOOD PRIZE FUND 33143 OTHER ASSETS 51694 2596292 0 MINIMUM PENSION LIABILITY 6897216 WORKERS COMPENSATION RESERVE 3247909 MALPRACTICE LIABILITY 1533709 THIRD PARTY REIMBURSEMENT PAYABLES 1852784 OTHER LONG TERM LIABILITIES 103868 DUE TO RELATED ORGANIZATIONS 130370 13765856 X 48945641 0 0 0 148641 148641 48797000 3442 0 3442 48800442 52885924 0 0 0 152412 152412 52733512 0 0 0 52733512 Schedule D, Part V, Line 4 PERMANENTLY RESTRICTED ENDOWMENT FUNDS Schedule D, Part X, Line 2 THE ORGANIZATION ACCOUNTS FOR UNCERTIAN TAX POSITIONS IN ACCORDANCE WITH THE U.S. GAAP, WHICH REQUIRES THE RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS THAT THE ORGANIZATION HAS TAKEN OR EXPECTS TO TAKE IN THE ORGANIZATION'S TAX RETURNS. MANAGEMENT BELIEVES THERE ARE NO SIGNIFICANT UNCERTAIN TAX POSITIONS NOT REFLECTED IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. Schedule D, Part XI, Line 2d COSTS OF GOODS SOLD NUTRITIONAL SERVICES $152,412 OFFSET VS. REVENUES ON FORM 990, INCLUDED IN EXPENSES ON AUDITED FINANCIAL STATEMENTS; K-1 TAX EXEMPT INCOME NOT INCLUDED IN OTHER REVENUE $3,771 Schedule D, Part XII, Line 2d COSTS OF GOODS SOLD NUTRITIONAL SERVICES $152,412 OFFSET VS. REVENUES ON FORM 990, INCLUDED IN EXPENSES ON AUDITED FINANCIAL STATEMENTS 1 1 X 1 X 1 X 1 1 0 1 1 0 39 55575 5634 49941 0.0009 0 0 4567000 6083230 -1516230 0 0 0 9842442 6228564 3613878 0.0685 0 39 14465017 12317428 2147589 0.0694 8 48 4144 0 4144 0.0001 0 0 0 0 0 0 4 51249 14514326 10317458 4196868 0.0796 0 0 0 0 0 0 0 0 0 0 0 0 12 51297 14518470 10317458 4201012 0.0797 12 51336 28983487 22634886 6348601 0.1491 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 14139 0 14139 0.0003 0 0 14139 0 14139 0.0003 0 3200825 1273288 10837417 11471574 -634157 X 1 1 1 1 ST JOSEPHS HOSPITAL 555 ST JOSEPHS BOULEVARD ELMIRA NY 14901 X X X SKILLED NURSING FACILITY ST JOSEPHS HOSPITAL 1 0 0 1 X X X X X X X X 16 1 1 1 1 X www.arnothealth.org/community-leadership 1 16 1 www.arnothealth.org/aboutus 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 X 0 X X X 1 0 1 Schedule H, Part V, Section B, Line 5-ST JOSEPHS 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-ST JOSEPHS 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-ST JOSEPHS 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 11-ST JOSEPHS HOSPITAL Arnot Health works diligently to partner with the organizations throughout the service area in an effort to enhance healthcare services for the most vulnerable residents. Due to the rural nature of Chemung and Steuben Counties, the high percentage of low-income residents and the limited resources available in the community, Arnot Health understands the need to create meaningful partnerships to best serve the community at large. Arnot Health has formed collaborative relationships with organizations throughout Chemung and Steuben Counties to address health concerns across the continuum. Chemung and Steuben Counties maintain coalitions to collaboratively meet the healthcare needs of the community. The Chemung County Health Priority Partnership (HP2) has expanded to include insurance navigators. The Steuben County Health Priority Team (SHPT) worked to brand their coalition and has the new name, Smart Steuben. Both coalitions include organizations that are committed to improving the health of Chemung and Steuben County residents. The groups have met on a bi-monthly basis in Chemung County and monthly basis in Steuben County since Fall of 2015 to conduct a Community Health Needs Assessment (CHNA) and develop a Community Health Improvement Plan (CHIP)/Community Service Plan (CSP). The members of HP2 and Smart Steuben have agreed to continue expanding their partnerships, and meet on a regular basis to ensure that the initiatives outlined in the Community Health Improvement and Community Service Plans are implemented, monitored, and evaluated. Schedule H, Part V, Section B, Line 20e-ST JOSEPHS 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 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 V, Section B, Line 24-ST JOSEPHS HOSPITAL Participants in the Medicare System are required to charge all patients the same amount for services regardless of insurance per the Medicare participation guidelines. 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 In 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 several events during 2016 including Strong Kids Safe Kids. Strong Kids Safe Kids (SKSK) is a life-enriching community composed of volunteers, community agencies & businesses who come together to help develop strong, safe and healthy families. The Annual SKSK Festival of Chemung County focuses on giving families information about community services and safety issues while engaging children in fun activities where they can learn and their parents can learn with them. Today the SKSK committee is the Task Force and is committed to hosting the annual SKSK festival and other Community Support Projects to educate and strengthen Chemung and Steuben County Families. Arnot Health is committed to preventing chronic disease in the community through free health screenings, wellness presentations, and participation in coalitions, committees and taskforces. In 2016, Arnot Health participated in 90 events and programs between Chemung, Steuben and Schuyler Counties including Blood Glucose screenings. Schedule H, Part III, Section A, Line 4 The Organization's allowance for doubtful accounts increased from 15.17% of gross accounts receivable at December 31, 2016 to 16.04% of gross accounts receivable at December 31, 2017. In addition, the Organization's bad debt write-offs increased from $2,480,827 for fiscal year 2016 to $3,200,825 in fiscal year 2017. 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. 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 Board Member/CEO 0 537129 0 0 0 0 0 13500 0 26138 0 576767 0 0 Alan Angell MD Board Member/Physician 0 402772 0 18449 0 0 0 9261 0 23593 0 454075 0 0 Jonathon Lawrence Chief Operating Officer 0 253302 0 0 0 0 0 3232 0 6710 0 263244 0 0 Ronald J Kintz DHA Senior VP/CFO 0 336405 0 0 0 0 0 13500 0 26138 0 376043 0 0 Sandra McCarthy RN Chief Nursing Officer 0 257115 0 0 0 0 0 8977 0 21635 0 287727 0 0 Robert de Bara MD President AMS 0 420850 0 0 0 0 0 9089 0 21635 0 451574 0 0 Kenneth Herzl-Betz MD Senior VP/Medical Affairs 0 297488 0 0 0 0 0 9261 0 21635 0 328384 0 0 Richard Cleland Site Administrator IDMH 0 245016 0 0 0 0 0 8404 0 0 0 253420 0 0 Nancy O'Dacre VP Planning 0 43526 0 0 0 0 0 1069 0 3855 0 48450 0 0 Thomas Doak Pharmacy Technician 132675 0 0 0 0 0 4679 0 0 0 137354 0 0 0 Ilan Hadar Emergency Dept Director 133856 0 0 0 0 0 4672 0 0 0 138528 0 0 0 Kim Davenport BSU Director 130638 0 0 0 0 0 3391 0 0 0 134029 0 0 0 Roberta Conz Registered Nurse 107250 0 0 0 0 0 3742 0 210 0 111202 0 0 0 Ann Jacobs Registered Nurse 103007 0 0 0 0 0 3537 0 212 0 106756 0 0 0 Schedule J, Part I, Line 3 Compensation for the President and Vice Presidents, although paid by related organizations, are set pursuant to a policy and compensation philosophy adopted by the Board of Directors. The Board has a Compensation Committee consisting of outside directors. The Compensation Committee uses a consultant to advise it on compensation for the officers. The consultant collects and reports compensation on similar positions in similar non-profit hospitals from upstate New York and Western Pennsylvania. The Compensation Committee recommends adjustments to the Executive Committee of the Board, which reviews the recommendations and approves or disapproves without the employees in the room. This action is then reviewed with the entire Board also in executive session. Louis DeFabio Executive Officer of Chemung Canal Trust Company 23047 Competitively Bids Loans 0 Form 990, Part VI, Section A, Line 3 ABM HEALTHCARE SUPPORT SERVICES, INC. PROVIDES MANAGEMENT SERVICES FOR NUTRITIONAL SERVICES, PLANT OPERATION SERVICES, AND HOUSEKEEPING SERVICES. Form 990, Part VI, Section B, Line 11b THE FORM 990 WAS REVIEWED BY MANAGEMENT. Form 990, Part VI, Section B, Line 12c EACH MEMBER OF THE BOARD OF DIRECTORS AND OTHER HOSPITAL INSIDERS MUST COMPLETE A CONFLICT OF INTEREST STATEMENT ANNUALLY. IN ADDITION, SITUATIONS WHICH CONSTITUTE, COULD CONSTITUTE, OR COULD BE PERCEIVED AS CONSTITUTING A CONFLICT OF INTEREST MUST BE REPORTED IMMEDIATELY TO THE HOSPITAL PRESIDENT. THE HOSPITAL PRESIDENT WILL THEN RELAY THE INFORMATION TO THE BOARD OF DIRECTORS. IF THE BOARD MEMBER OR INSIDER FAILS TO DISCLOSE ANY ACTUAL OR POSSIBLE CONFLICT, THE BOARD OF DIRECTORS MUST INVESTIGATE THE MATTER FULLY AND IF THE BOARD DETERMINES THAT A VIOLATION HAS OCCURRED, THE BOARD IS RESPONSIBLE FOR TAKING APPROPRIATE DISCIPLINARY AND/OR CORRECTIVE ACTION. Form 990, Part VI, Section B, Line 15 COMPENSATION FOR THE PRESIDENT AND VICE PRESIDENT ARE SET PURSUANT TO A POLICY AND PHILOSOPHY ADOPTED BY THE BOARD OF MANAGERS. THE BOARD HAS A COMPENSATION COMMITTEE CONSISTING OF OUTSIDE DIRECTORS. THE COMPENSATION COMMITTEE USES A CONSULTANT, YAFFEE CONSULTING, TO ADVISE ON COMPENSATION FOR THE OFFICERS. THE CONSULTANT COLLECTS BENCHMARKS AND SURVEY DATA AND REPORTS COMPENSATION ON SIMILAR POSITIONS IN SIMILAR NONPROFIT HOSPITALS FROM UPSTATE NEW YORK AND WESTERN PENNSYLVANIA. THE COMPENSATION COMMITTEE RECOMMENDS ADJUSTMENTS TO THE EXECUTIVE COMMITTEE OF THE BOARD WHICH VIEWS THE RECOMMENDATIONS AND APPROVES OR DISAPPROVES 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 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON WRITTEN REQUEST. Form 990, Part XI, Line 2 COSTS OF GOOD SOLD NUTRITIONAL SERVICES $152,412 OFFSET VS. REVENUES ON FORM 990, INCLUDED IN EXPENSES ON AUDITED FINANCIAL STATEMENTS. Form 990, Part XI, Line 9 PENSION AMOUNT CHARGED TO EQUITY $943,238; DONATIONS TO CAPITAL FUNDING $259,510 Arnot Ogden Medical Center Foundation Accounting Dept 600 Roe Avenue Elmira NY 14905 161109472 Affiliate NY 501(c)(3) 11B N/A 0 Arnot Ogden Medical Center Auxiliary 600 Roe Avenue Elmira NY 14905 510192902 Affiliate NY 501(c)(3) 11B N/A 0 Ira Davenport Memorial Hospital Inc Accounting Dept 7571 State Route 54 Bath NY 14810 160835446 Affiliate NY 501(c)(3) 3 N/A 0 Keuka Health Care Foundation Accounting Dept 7571 State Route 54 Bath NY 14810 161461215 Affiliate NY 501(c)(3) 11B N/A 0 Arnot Ogden Medical Center Accounting Dept 600 Roe Avenue Elmira NY 14905 160743905 Affiliate NY 501(c)(3) 3 N/A 0 Arnot Health 600 Roe Avenue Elmira NY 14905 453049405 Parent Organization NY 501(c)(3) 11B Arnot Ogden Medical Center 0 ST JOSEPHS HOUSING DEVELOPMENT FUND 555 ST JOSEPHS BLVD ELMIRA NY 14901 203240197 APARTMENTS NY ST JOSEPHS HEALTH SYSTEM C IVY STREET DEVELOPMENT CORPORATION ACCOUNTING DEPARTMENT 600 IVY STREET ELMIRA NY 14905 161009245 REAL ESTATE NY ARNOT HEALTH C 0 1 0 1 0 0 0 0 0 0 0 1 1 1 0 1 1 1 0 0 Arnot Ogden Medical Center o -16820293 ARNOT OGDEN MEDICAL CENTER PROVIDED EMPLOYEES TO ST. JOSEPH'S HOSPITAL FOR ADMINISTRATIVE, MEDICAL, MANAGEMENT INFORMATION, ACCOUNTING AND VARIOUS OTHER SERVICES. THE METHOD OF DETERMINING THE AMOUNT WAS COST. Arnot Ogden Medical Center Foundation q 62820 ST. JOSEPH'S HOSPITAL CHARGED ARNOT OGDEN FOUNDATION FOR UTILITIES, MAINTENANCE AND ENVIRONMENTAL SERVICES. THE METHOD OF DETERMINING THE AMOUNT WAS COST. ST. JOSEPH'S HOSPITAL FILED FORM 8868-APPLICATION FOR EXTENSION OF TIME TO FILE AN EXEMPT ORGANIZATION RETURN AND RECEIVED OUR APPROVAL LETTER DATED 4/9/2018 GRANTING OUR EXTENSION TIME TO FILE TO NOVEMBER 15, 2018.