2017-10-26T13:44:06-07:00 2016-12-31 990 2016-01-01 222807681 MEMORIAL HOSPITAL OF WILLIAM F AND GERTRUDE F JONES INC MEMO 5855931100 191 N Main Street Wellsville NY 14895 James Helms VP of Finance 5855964002 2017-10-26 2016 2022-09-23 18:48:47Z Mary Kate Cole 191 N Main Street Wellsville NY 14895 37578519 0 X www.jmhny.org X 1921 NY JONES MEMORIAL HOSPITAL IS COMMITTED TO ENSURING ACCESS TO THE HIGHEST QUALITY HEALTHCARE FOR OUR COMMUNITY IN A CARING MANNER. 15 15 472 60 0 0 1151666 1007619 33361598 34975703 234599 585650 2903443 1009547 37651306 37578519 0 0 0 0 22490218 23845349 0 0 0 16123810 15259434 38614028 39104783 -962722 -1526264 29029036 24520297 24792629 20370050 4236407 4150247 Provision of healthcare services 0 0 31744661 0 0 QUALITY OF HEALTH CARE: THE MEMORIAL HOSPITAL OF WILLIAM F. & GERTRUDE F. JONES, INC. A/K/A JONES MEMORIAL HOSPITAL IS A SOLE COMMUNITY PROVIDER WITH 70 ACUTE CARE BEDS, NOT FOR PROFIT, LOCATED IN RURAL WELLSVILLE NY IN A PROFESSIONALLY UNDERSERVED AREA. WE PROVIDE PRIMARY CARE, AMBULATORY CARE, EMERGENCY CARE AND ACUTE (MEDICAL, SURGICAL, PEDIATRIC, OB AND GYN) AND INTENSIVE CARE PLUS COMMUNITY OUTREACH PROGRAMS. WE ADMITTED 1607 PATIENTS PLUS 424 BIRTHS AND HAD 79045 PATIENT ENCOUNTERS ON AN OUTPATIENT BASIS. THE HOSPITAL HAS PROVIDED CHARITY CARE TO INDIGENT PATIENTS TOTALING $1,333,478. 0 0 0 31744661 1 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 1 0 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 44 0 1 472 1 0 0 0 0 0 0 X 15 15 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 NY X JAMES HELMS VP OF FINANCE 5855964002 191 N Main Street Wellsville NY 14895 ROBERT GILFERT BOARD MEMBER 2 0 X 0 0 0 WILLIAM COCH BOARD MEMBER 2 0 X 0 0 0 KATHY WOUGHTER BOARD MEMBER 2 0 X 0 0 0 RICHARD SHEAR BOARD MEMBER 2 0 X 0 0 0 DANIEL GUINEY BOARD MEMBER 2 0 X 0 0 0 RICHARD EWELL BOARD MEMBER 2 0 X 0 0 0 J EDMONSTON DO BOARD MEMBER 2 0 X 0 0 0 KAROL MARCIANO BOARD MEMBER 2 0 X 0 0 0 STEVEN GOLDSTEIN BOARD MEMBER 2 0 X 0 0 0 MARK TAUBMAN BOARD MEMBER 2 0 X 0 0 0 MICHAEL ROTONDO BOARD MEMBER 2 0 X 0 0 0 MARY KATE COLE CHAIRPERSON 2 0 X 0 0 0 BARRY KULP VICE CHAIRPERSON 2 0 X 0 0 0 KIMBERLY TOOT SECRETARY 2 0 X 0 0 0 GARY BALCOM TREASURER 2 0 X 0 0 0 EVA BENEDICT Exec Director/CEO 40 0 X 237480 0 8384 JAMES HELMS VP OF FINANCE 40 0 X 119570 0 12218 PAUL AXTELL MD 40 0 X 889842 0 66146 HEATHER LANPHERE OB/GYN 40 0 X 405329 0 45362 ANDRES RUBERT OB GYN 40 0 X 343284 0 9084 ELIZABETH OSBORN MD 40 0 X 231461 0 35381 MARK ELLIOTT CRNA 40 0 X 201694 0 21096 2428660 0 197671 20 0 1 0 DELPHI HOSPITALIST SERVICE 2701 CULVER ROAD ROCHESTER NY 14622 STAFFING 1164325 PICCO PULMONARY & INTERNAL MEDICINE 11 MAIN STREET HORNELL NY 14843 MEDICAL PHYSICIAN 681858 DELPHI HEALTHCARE LLC 2701 CULVER ROAD ROCHESTER NY 14622 Staffing 569475 DR STEVEN COLLINS 6801 GLEASON HILL ROAD BELFAST NY 14711 MEDICAL PHYSICIAN 216300 CARDINAL HEALTH PHARMACY REMOTE ORDER ENTRY 21377 NETWORK PLACE CHICAGO IL 60673 PHARMACY ORDER SERVICES 107020 6 0 0 0 0 845690 161929 0 1007619 PATIENT SERVICES 622000 34975703 34975703 0 0 0 0 0 0 34975703 585345 0 0 585345 0 0 0 0 0 0 0 0 94873 0 0 0 94873 0 94873 0 0 94873 0 305 0 0 0 305 305 0 0 305 0 PT & OT CONSULTING INCOME 900099 33840 0 0 33840 CAFETERIA 900099 254845 0 0 254845 625989 0 0 625989 914674 37578519 34975703 0 1595197 0 0 0 0 0 0 0 0 359452 0 359452 0 0 0 0 0 18053433 14376946 3676487 0 1115327 870857 244470 0 3058057 3058057 0 0 1259080 983101 275979 0 0 0 0 0 13580 0 13580 0 78548 0 78548 0 0 0 0 0 0 0 0 0 0 0 136400 0 136400 0 58618 1463 57155 0 6208223 5805452 402771 0 0 0 0 0 0 0 0 0 0 0 0 0 23304 15741 7563 0 0 0 0 0 17844 9051 8793 0 157170 0 157170 0 0 0 0 0 1764424 1411539 352885 0 756276 0 756276 0 PURCHASED SERVICES 5544498 5123449 421049 0 LICENSES AND TAXES 177666 50445 127221 0 RECRUITMENT 35399 0 35399 0 287484 38560 248924 0 39104783 31744661 7360122 0 694767 612002 0 462580 0 0 9349942 7597596 0 0 0 0 0 0 930397 893542 320257 270744 30712373 24826948 6650997 5885425 0 11082676 8798408 0 0 0 0 0 0 29029036 24520297 20910808 17616418 0 0 0 0 3881821 2753632 0 0 0 0 0 0 0 0 24792629 20370050 X 2582172 2463750 0 0 1654235 1686497 4236407 4150247 29029036 24520297 X -1526264 0 0 0 0 1440104 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 145541 0 145541 794884 0 698222 96662 12915273 0 10627413 2287860 16405498 0 13501313 2904185 451177 0 0 451177 5885425 0 0 MORTGAGE RESERVE FUND 1496046 F MORGAN STANLEY BOARD FUNDS 4989042 F TEMP RESTRICTED STEUBEN TRUST 626823 F HELD IN TRUST KEY BANK 1686497 F 8798408 37578519 0 0 0 0 0 37578519 0 0 0 37578519 39104783 0 0 0 0 0 39104783 0 0 0 39104783 1 1 X 1 X 1 X 1 1 1 0 1 1 0 0 603585 0 603585 0.0154 0 0 8034629 5982355 2052274 0.0525 0 0 1383927 0 1383927 0.0354 0 0 10022141 5982355 4039786 0.1033 11 1054 53986 0 53986 2 181 32449 0 32449 0 0 0 0 0 0 0 0 0 0 7 40 2265 0 2265 20 1275 88700 0 88700 0.0000 20 1275 10110841 5982355 4128486 0.1033 0 0 0 0 0 0 0 0 0 0 0 0 3 2379 6507 0 6507 0 0 0 0 0 0 0 0 0 0 0 0 3 65 1168 0 1168 3 0 328 0 328 0 0 0 0 0 0 0 0 0 0 0 9 2444 8003 0 8003 0 1 861324 861324 4237321 6677659 -2440338 X 1 1 7 1 JONES MEMORIAL HOSPITAL 191 NORTH MAIN STREET WELLSVILLE NY 14895 www.jmhny.org X X A 2 JONES MEMORIAL HEALTH CARE CLINIC 127 NORTH MAIN STREET WELLSVILLE NY 14895 EXTENSION CLINIC A 3 JONES MEMORIAL HEALTH CARE CLINIC 15 LODER STREET WELLSVILLE NY 14895 EXTENSION CLINIC A 4 JONES MEMORIAL HEALTH CARE CLINIC 13 LODER STREET WELLSVILLE NY 14895 EXTENSION CLINIC A 6 JONES MEMORIAL HEALTH CARE CLINIC 5877 OLD STATE ROUTE 19 BELMONT NY 14813 EXTENSION CLINIC A 7 JONES MEMORIAL HEALTH CARE CLINIC 120 FIRST STREET BOLIVAR NY 14715 EXTENSION CLINIC A 8 JONES MEMORIAL HEALTH CARE CLINIC 430 CANISTEO STREET HORNELL NY 14843 EXTENSION CLINIC A A 0 0 1 X X X X X X X 13 1 1 1 1 X 1 16 1 WWW.JMHNY.ORG 0 0 1 X 50 300 1 1 X X X 1 X www.jmhny.org X www.jmhny.org X www.jmhny.org X X X X X X 1 0 1 0 0 Schedule H, Part V, Section B, Line 3-Group A PLEASE SEE SCHEDULE H, PART VI, LINE 2 SUPPLEMENTAL INFORMATION. Schedule H, Part V, Section B, Line 4-Group A PLEASE SEE SCHEDULE H, PARTVI, LINE 2 SUPPLEMENTAL INFORMATION. Schedule H, Part V, Section B, Line 5-Group A PLEASE SEE SCHEDULE H, PART VI, LINE 2 SUPPLEMENTAL INFORMATION. Schedule H, Part V, Section B, Line 6a-Group A CUBA MEMORIAL HOSPITAL Schedule H, Part V, Section B, Line 6b-Group A ALLEGANY COUNTY DEPARTMENT OF HEALTH, ARDENT SOLUTIONS INC AND ALLEGANY COUNTY COMMUNITY WELLNESS COMMITTEE. Schedule H, Part V, Section B, Line 7d-Group A PLEASE SEE SCHEDULE H, PARTVI, LINE 2 SUPPLEMENTAL INFORMATION. Schedule H, Part V, Section B, Line 10-Group A THE HOSPITAL PROVIDES DISCOUNTED CARE NOT FREE CARE. Schedule H, Part V, Section B, Line 11-Group A FOR PRIORITY AREA#1: MENTAL HEALTH AND PREVENT SUBSTANCE ABUSE Focus Area 1: Promote Mental, Emotional and Behavioral Well-being: support of the Allegany County Suicide Prevention Coalition; an awareness and acceptance multipronged anti-stigma campaign; promotion of World Suicide Prevention Day Awareness Walk; support of suicide survivors through distribution of postvention resource packets and through promotion of the suicide survivor's support group and International Survivors of Suicide Loss Day; distribution of SafeTALK training; Mental Health First Aid training; ASIST training; and support of the Allegany County ARA, JMH and local DSRIP (FLPPS) efforts to co-locate . FOR PRIORITY AREA: PREVENT CHRONIC DISEASE Focus Area 3: Increase Access to High Quality Chronic Disease Preventive Care and Management in Both Clinical and Community Settings are: to implement a Million Heart Initiative collaborative which will include Healthy Heart workshops; media campaign on tobacco risks; Tobacco Cessation; promote physical activity opportunities in the community; encourage municipalities with adopted Complete Streets policies to create walkable/bikable communities; promote a low trans-fat and sodium diet by increasing restaurants who offer and display low trans-fat and low sodium options on menus; public awareness campaign to improve early detection, effective treatment and management of risk factors for heart disease and stroke; community health screening fairs with free blood pressure and cholesterol screenings; promotion of JMH Stroke Designation Center; Stanford University Chronic Disease Self-Management Workshops; awareness to increase usage of the JMH Cardiac Rehabilitation services; increase awareness of locations in communities for blood pressure screening; home-based blood pressure monitor loaner program; American Safety and Health Institute CPR/AED/1st Aid trainings; public education campaign on bystander liability; and encourage worksites to adopt formal protocol for responding to a heart attack or stroke including a response team trained in CPR and AED as a bridge to emergency medical services (EMS) assistance. FOR THE DISPARITY - SOCIO-ECONOMIC/INCOME: Evidence-based interventions, strategies, and activities for Priorities 1 and 2 will be offered at low cost or no cost to the residents of Allegany County. Offering the evidence-based interventions/strategies/activities locally reduce the financial burden to the residents of Allegany County by reducing the travel and time expense to county residents. Schedule H, Part V, Section B, Line 16a-Group A WWW.JMHNY.ORG Schedule H, Part V, Section B, Line 16b-Group A WWW.JMHNY.ORG Schedule H, Part V, Section B, Line 16c-Group A WWW.JMHNY.ORG Schedule H, Part I, Line 7 WORKSHEET 2 RATIO OF PATIENT CARE COST TO CHARGES CALCULATION WAS USED. Schedule H, Part I, Line 7g JONES MEMORIAL HOSPITAL OPERATES A DIABETIC CLINIC AS A SERVICE TO THE PUBLIC DUE TO THE HIGH NEED FOR IT IN ALLEGANY COUNTY. Schedule H, Part II AS A COMMUNITY HOSPITAL, JONES MEMORIAL HOSPITAL TAKES AN ACTIVE PART IN PROMOTING THE HEALTH OF THOSE WE SERVE THROUGH A WIDE VARIETY OF ACTIVITIES. IN ADDITION TO COMMUNITY HEALTH FAIRS AND SCREENINGS, JMH IS COMMITTED TO MEETING THE NEEDS OF THIS COMMUNITY FOR GENERATIONS TO COME. WE PROVIDE HANDS ON EXPERIENCE FOR FUTURE HEALTHCARE PROVIDERS AND SHADOWING EXPERIENCES FOR STUDENTS EXPLORING THEIR CAREER OPTIONS. BY WORKING WITH ORGANIZATIONS LIKE THE WELLSVILLE AREA CHAMBER OF COMMERCE, THE ALLEGANY WESTERN STEUBEN RURAL HEALTH NETWORK AND SEVERAL ALLEGANY COUNTY DEPARTMENTS, WE ARE PARTNERS HELPING THIS COMMUNITY GROW TOWARDS A HEALTHY FUTURE. Schedule H, Part III, Section A, Line 4 PATIENT ACCOUNTS RECEIVABLE ARE DUE 30 DAYS AFTER THE DATE OF DISCHARGE. RECEIVABLES PAST DUE MORE THAN 120 DAYS ARE CONSIDERED DELINQUENT. DELINQUENT RECEIVABLES ARE GENERALLY WRITTEN OFF BASED ON INVIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE PATIENT AND OTHER THIRD PARTY PAYORS. Schedule H, Part III, Section B, Line 8 THE AMOUNT ON LINE 6 IS CALCULATED FROM WORKSHEET E PARTS A AND B ON THE COST REPORT. THE FULL LOSS SHOULD BE CONSIDERED A COMMUNITY BENEFIT. Schedule H, Part III, Section C, Line 9b PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE RECEIVE A DISCOUNT FROM A SLIDING FEE SCHEDULE BASED ON THE FEDERAL POVERTY GUIDELINES. FLEXIBLE PAYMENT PLANS ARE INCORPORATED AS APPROPRIATE. Schedule H, Part VI, Line 2 THE HOSPITAL USES SEVERAL METHODS TO ASSESS THE HEALTHCARE NEEDS OF THOSE IN THE SERVICE AREA. PUBLIC SURVEY INCLUDES SOME DEMOGRAPHIC INFORMATION AND A RATINGS SYSTEM FOR 48 ITEMS IDENTIFIED AS HEALTH NEEDS. THE PUBLIC WAS NOTIFIED OF THE SURVEY PROCESS AND ENCOURAGED TO PARTICIPATE THROUGH PAID ADVERTISING IN THE WELLSVILLE DAILY REPORTER AND HORNELL EVENING TRIBUNE, PRESS RELEASES TO LOCAL NEWS AGENCIES, INVITATIONS ON THE HOSPITAL WEBSITE HOME PAGE, DISTRIBUTION OF PAPER SURVEYS THROUGH THE JMH MEDICAL PRACTICE SITES (SIX IN TOTAL THROUGHOUT ALLEGANY COUNTY) AND THROUGH EMAIL DISTRIBUTION OF THE SURVEY TO AGENCY LIST SERVES IN THE REGION. THE SURVEY WAS ALSO DISTRIBUTED VIA SURVEY MONKEY, AN ONLINE SURVEY SERVICE TO ALLOW RECIPIENTS TO RECEIVE AND RESPOND VIA EMAIL. Schedule H, Part VI, Line 3 OUR PATIENT STATEMENTS PROVIDE A NOTICE INFORMING PATIENTS ABOUT OUR FINANCIAL ASSISTANCE PROGRAM. WE HAVE FINANCIAL COUNSELORS THAT CONTACT OUR SELF PAY POPULATION AND INFORM THEM OF OUR PROGRAM. THEY SEND LETTERS FOR THOSE THEY ARE UNABLE TO REACH BY TELEPHONE. WE HAVE SIGNAGE THROUGHOUT OUR CAMPUS INDICATING WE HAVE A FINANCIAL ASSISTANCE PROGRAM WITH THE CONTACT INFORMATION. EACH SELF PAY INPATIENT IS SEEN AND EDUCATED ABOUT OUR PROCESS FOR APPLYING FOR FINANCIAL ASSISTANCE. Schedule H, Part VI, Line 4 THE HOSPITAL SERVICE AREA IS PRIMARILY ALLEGANY COUNTY, WHILE 80 PERCENT OF THE INPATIENT AND OUTPATIENT VISITS ORIGINATE FROM WELLSVILLE, BOLIVAR, ANDOVER, BELMONT, SCIO, FRIENDSHIP, BELFAST, ANGELICA AND WHITESVILLE. FOR THE PURPOSES OF COMMUNITY HEALTH NEED AND COLLABORATION EFFORTS, JONES MEMORIAL HOSPITAL VIEWS THE GREATER ALLEGANY COUNTY REGION AS THE SERVICE AREA. JONES MEMORIAL HOSPITAL IS THE ONLY ACUTE CARE HOSPITAL IN ALLEGANY COUNTY WITH HPSA DESIGNATION. X X X 0 0 0 0 0 0 0 0 0 PAUL AXTELL MD 889842 0 0 0 0 0 0 0 66146 0 955988 0 0 HEATHER LANPHERE OB/GYN 405329 0 0 0 0 0 0 0 45362 0 450691 0 0 ANDRES RUBERT OB GYN 343284 0 0 0 0 0 0 0 9084 0 352368 0 0 ELIZABETH OSBORN MD 231481 0 0 0 0 0 0 0 35381 0 266862 0 0 0 EVA BENEDICT Exec Director/CEO 237480 0 0 0 0 0 0 0 8384 0 245864 0 0 MARK ELLIOTT CRNA 201694 0 0 0 0 0 0 0 21096 0 222790 0 0 JAMES HELMS VP OF FINANCE 119570 0 0 0 0 0 0 0 12218 0 131788 0 0 Form 990, Part VI, Section B, Line 11b THE 990 WAS PRESENTED TO THE BOARD OF DIRECTORS PRIOR TO FILING. THE 990 IS PREPARED BY THE ACCOUNTING DEPARTMENT AND REVIEWED BY THE VP OF FINANCE. Form 990, Part VI, Section B, Line 12c ANNUALLY, THE HOSPITAL REQUIRES ALL BOARD MEMBERS, SENIOR MANAGERS AND DEPARTMENT MANAGERS TO COMPLETE THE CONFLICT OF INTEREST STATEMENT. THE STATEMENTS ARE REVIEWED BY THE HOSPITAL'S COMPLIANCE OFFICER FOR ANY POTENTIAL CONFLICTS. Form 990, Part VI, Section B, Line 15 THE CEO'S SALARY IS SET FOR A SPECIFIC CONTRACT PERIOD BY THE BOARD OF DIRECTORS AND INCLUDES AN ESCALATION CLAUSE FOR INCREASES DURING THE CONTRACT PERIOD. THE PROCESS INCLUDES A REVIEW OF COMPARABLE DATA FOR THE MARKET AREA AND THE COMPLETE CONTRACT IS APPROVED BY THE BOARD OF DIRECTORS. Form 990, Part VI, Section C, Line 19 THE ORGANIZATION DOES MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. THE HOSPITAL PUBLISHES AN ANNUAL FINANCIAL AND STATISTICAL REPORT IN THE LOCAL NEWSPAPER EACH SPRING. IT ALSO HAS THESE DOCUMENTS AVAILABLE FOR IN PERSON REVIEW OR WITHIN 30 DAYS OF A WRITTEN REQUEST FROM THE GENERAL PUBLIC. COPIES OF THESE DOCUMENTS ARE STORED IN THE ADMINISTRATIVE OFFICE OF THE HOSPITAL FOR THIS PURPOSE. Form 990, Part XI, Line 9 PROVISION FOR BAD DEBTS = -861,324, CHANGE IN UNREALIZED GAIN/LOSSES ON INVESTMENTS = 60,330, PENSION LIABILITY ADJUSTMENT = 1,095,935, CHANGE IN EQUITY INVESTMENT = 705,804, TEMP RESTRICTED CONTRIBUTIONS = 407,072 AND CHANGE IN VALUE OF PERPETUAL TRUST = 32,287. TOTAL = 1,440,104. JONES MEDICAL SERVICES PC 191 N MAIN STREET WELLSVILLE NY 14895 465210222 MEDICAL CLINIC NY 3 501 C 3 N/A 0 JONES MEMORIAL HOSPITAL FOUNDATION 191 N MAIN ST WELLSVILLE NY 14895 473763374 FOUNDATION NY 3 501 C 3 N/A 0 UNIVERSITY OF ROCHESTER 601 ELMWOOD AVENUE ROCHESTER NY 14642 160743209 HEALTHCARE NY 3 501 C 3 N/A 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 JONES MEDICAL SERVICES PC l 680511 EXPENSES ARE ACTUAL INVOICES RECEIVED AND WAGES PAID FOR SERVICES. JONES MEDICAL SERVICES PC q 539000 AS CASH BECAME AVAILABLE PAYMENTS WOULD BE MADE. FILED FORM 8868