2017-11-09T10:41:25-06:00 2016-12-31 160765486 LUMSDEN & MCCORMICK LLP 369 FRANKLIN STREET BUFFALO NY 14202 990 2016-01-01 160743310 ST JAMES MERCY HOSPITAL STJA 6073248110 411 CANISTEO STREET HORNELL NY 148432104 STANLEY D KONOPKO CFO 6073248110 2017-11-06 1 MICHAEL J GRIMALDI P01295846 7168563300 38.122.36.250 2017-11-06 11:39:03 ES P 87273CE15A7E4D536C246F8BF2CA388F6BFCF293 ECFD8073557412C3490EDC284AF2457AA53A359D 2016 2021-01-29 14:40:06Z JENNIFER L SULLIVAN 411 CANISTEO STREET HORNELL NY 148432104 33324821 0 X WWW.STJAMESMERCY.ORG X 1992 NY SEE SCHEDULE O.ST. JAMES MERCY HOSPITAL, GOVERNED BY A SELF-PERPETUATING COMMUNITY BASED BOARD, IS A COMMUNITY OF PERSONS COMMITTED TO BEING A TRANSFORMING, HEALING PRESENCE WITHIN THE RURAL COMMUNITIES WE SERVE, PARTICULARLY ADDRESSING THE NEEDS OF THE POOR, UNDERSERVED AND DISADVANTAGED. 7 5 373 38 0 0 478689 712289 35822731 28097586 -128162 2766 10056987 4512180 46230245 33324821 0 0 0 0 24738233 14718785 0 0 0 24286419 18611648 49024652 33330433 -2794407 -5612 13999388 15218065 10758517 11954936 3240871 3263129 X SEE SCHEDULE O.ST. JAMES MERCY HOSPITAL, GOVERNED BY A SELF-PERPETUATING COMMUNITY BASED BOARD, IS A COMMUNITY OF PERSONS COMMITTED TO BEING A TRANSFORMING, HEALING PRESENCE WITHIN THE RURAL COMMUNITIES WE SERVE, PARTICULARLY ADDRESSING THE NEEDS OF THE POOR, UNDERSERVED AND DISADVANTAGED. 0 0 20831482 28371881 ST. JAMES MERCY HOSPITAL IS AN ACUTE HEALTHCARE FACILITY PROVIDING ROUTINE, AMBULATORY AND ANCILLARY SERVICES. MAJOR SERVICES INCLUDE MEDICAL, SURGICAL, RADIOLOGY, AND LABORATORY. TOTAL ACUTE DISCHARGES FOR THE HOSPITAL WERE 833. OUTPATIENT REGISTRATIONS FOR THE HOSPITAL WERE 85,892. ST. JAMES MERCY HOSPITAL OPERATES SEVERAL PHYSICIAN PRACTICES. TOTAL OFFICE VISITS WERE 10,024, INCLUDING EXPRESS CARE. 20831482 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 1 81 0 1 373 1 0 0 0 0 0 0 0 0 0 0 X 7 5 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X STANLEY D KONOPKO 6073248110 411 CANISTEO STREET HORNELL NY 14843 JOHN WEYAND DC CHAIR 1.00 X X 0 0 0 SUSAN GRAY PHD VICE CHAIR 1.00 X X 0 0 0 SHAWN HOGAN SECRETARY 1.00 X X 0 0 0 PETER D WALL TREASURER 1.00 X X 0 0 0 SPENCER ANNABEL MD BOARD MEMBER 36.00 X 126500 0 0 ISMAIL MEHR MD BOARD MEMBER 1.00 X 0 0 0 BRIAN SCHU BOARD MEMBER 1.00 X 0 0 0 JENNIFER L SULLIVAN PRESIDENT/CEO 39.00 1.00 X 243319 0 13079 STANLEY D KONOPKO CFO 39.70 0.30 X 0 0 0 NEVA BOSSARD CHIEF NURSING OFFICER 40.00 X 89650 0 14598 CHARLES M EDGECOMB PHARMACY MANAGER 40.00 X 130657 0 16670 JOHN ROBSHAW PHYSICIAN 40.00 X 108178 0 680 698304 0 45027 4 0 1 0 EXIGENCE PO BOX 643850 CINCINNATI OH 45263 ER PHYSICIANS 1206910 EXIGENCE HOSPITAL MEDICINE PO BOX 643850 CINCINNATI OH 45263 HOSPITALISTS 869195 ROCHESTER GENERAL HOSPITAL 1425 PORTLAND AVENUE ROCHESTER NY 14621 ORTHOPEDIC PHYSICIAN SERVICES, BUSINESS 735107 RAZAK ASSOCIATES ARCHITECTURE 2060 FAIRPORT NINE MILE ROAD SUITE PENFIELD NY 14526 ARCHITECTURE SERVICES 544440 ABADAN MEDICAL PLLC 325 CLEVELAND AVENUE HORNELL NY 14843 ANESTHESIOLOGY SERVICES 384775 15 569436 142853 712289 PATIENT SERVICE REVENUE 621990 28097586 28097586 28097586 2766 2766 175542 0 175542 175542 175542 NYS FUNDING 900099 3409823 3409823 TRINITY REVENUE 900099 809905 274295 535610 116910 116910 4336638 33324821 28371881 0 4240651 360646 258207 102439 11067095 6609365 4457730 168033 100913 67120 2271025 1358920 912105 851986 511968 340018 86764 45817 40947 65386 34528 30858 935164 493831 441333 1257341 505286 752055 25708 13576 12132 69826 28061 41765 548550 220445 328105 PURCHASED SERVICES 4367143 2306146 2060997 PHYSICIAN FEES 3982109 3982109 SUPPLIES 3897317 2058047 1839270 BAD DEBT EXPENSE 1716338 1427669 288669 1660002 876594 783408 33330433 20831482 12498951 0 1700934 5610284 17000 6468357 4120667 555132 582843 212893 178581 2146297 74742 292679 2071555 4769393 2637135 13999388 15218065 6513345 7312382 2768922 2068455 1000000 1476250 1574099 10758517 11954936 X 2700146 2694534 270451 298321 270274 270274 3240871 3263129 13999388 15218065 X -5612 27870 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 500000 500000 771866 74742 697124 874431 874431 2071555 ESTIMATED THIRD PARTY PAYOR SETTLEMENTS 6575 ASSETS WHOSE USE IS LIMITED 2630560 2637135 ESTIMATED THIRD PARTY PAYOR SETTLEMENTS 1311052 OTHER CURRENT LIABILITIES 263047 1574099 1 1 1 X 1 X 1 1 0 1 1 1584369 987526 596843 0.01870 8709993 6546991 2163002 0.06780 10294362 7534517 2759845 0.08650 47484 47484 0.00150 69548 13195 56353 0.00180 43295 43295 0.00140 160327 13195 147132 0.00470 10454689 7547712 2906977 0.09120 353 353 0.00000 353 353 0.00000 0 682354 8045 7627276 8618106 -990830 X 1 1 1 1 ST JAMES MERCY HOSPITAL 411 CANISTEO STREET HORNELL NY 14843 WWW.STJAMESMERCY.ORG 5002001H X X X ST JAMES MERCY HOSPITAL 0 0 1 X X X X X X X X X 16 1 1 1 1 X WWW.STJAMESMERCY.ORG X HTTPS://STEUBENCONY.ORG/FILES/DOCUMENTS/PUBLICHEALTH/STEUBEN_COUNTY_CHA-CSP 1 16 1 WWW.STJAMESMERCY.ORG 0 1 X 200.000000000000 300.000000000000 X X X X X 1 1 X X X X 1 X WWW.STJAMESMERCY.ORG/FINANCIAL.SHTML X X X X X 1 X 0 1 0 0 ST. JAMES MERCY HOSPITAL PART V, SECTION B, LINE 5: THE COMMUNITY NEEDS ASSESSMENT (CHNA) WAS CONDUCTED IN COLLABORATION WITH STEUBEN COUNTY PUBLIC HEALTH. THIS INCLUDED THE THREE HOSPITALS LOCATED WITHIN THE COUNTY. IN ADDITION, THERE WERE SEVERAL OTHER PARTNERS INCLUDING REPRESENTATION FROM FEDERALLY QUALIFIED HEALTH CENTERS (FQHC), COMMUNITY BASED ORGANIZATIONS (CBO), THE LEGISLATURE, COMMUNITY ACTION ORGANIZATIONS AND REPRESENTATIVES FROM LOCAL SCHOOLS. CHNA INCLUDED REVIEW AND ANALYSIS OF CURRENT AND LOCAL DATA, NEEDS ASSESMENT INFORMATION FROM THE DELIVERY SYSTEM REFORM INCENTIVE PAYMENT (DSRIP) PROGRAM AND FROM 12 COMMUNITY FOCUS GROUPS. THE INPUT WAS USED TO INDENTIFY HEALTH FACTORS AND DISPARITIES. A FULL LIST OF PARTICIPANTS CAN BE FOUND IN THE COMMUNITY SERVICE PLAN LOCATED ON THE ST. JAMES MERCY HOSPITAL WEBSITE. ST. JAMES MERCY HOSPITAL PART V, SECTION B, LINE 6A: IRA DAVENPORT MEMORIAL HOSPITAL (ARNOT HEALTH), CORNING HOSPITAL (GUTHRIE HEALTH SYSTEM). ST. JAMES MERCY HOSPITAL PART V, SECTION B, LINE 6B: STEUBEN COUNTY PUBLIC HEALTH DEPARTMENT, IRA DAVENPORT MEMORIAL HOSPITAL (ARNOT HEALTH), CORNING HOSPITAL (GUTHRIE HEALTH SYSTEM), ST. JAMES MERCY HOSPITAL, S2AY RURAL HEALTH NETWORK, GENESEE VALLEY BOCES, COMMON GROUND HEALTH (FORMERLY KNOWN AS FINGER LAKES HEALTH SYSTEM AGENCY), FINGER LAKES COMMUNITY HEALTH, STEUBEN COUNTY LEGISLATURE, STEUBEN RURAL HEALTH NETWORK, CORNELL COOPERATIVE EXTENSION, PRO ACTION OF STEUBEN AND YATES, SOUTHERN TIER TOBACCO AWARENESS COALTION, CENTER FOR TOBACCO FREE FINGER LAKES AND CANCER SERVICES PROGRAM OF STEUBEN COUNTY. ST. JAMES MERCY HOSPITAL PART V, SECTION B, LINE 11: NEEDS IDENTIFIED VIA THE CHNA ARE BEING ADDRESSED THROUGH THE STEUBEN COUNTY COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP). THIS PLAN CAN BE REVIEWED WITHIN THE COMMUNITY SERVICE PLAN. THE PLAN OUTLINES PRIORITY AND FOCUS AREAS AS A RESULT OF THE CHNA. THESE FOCUS AREAS ARE FURTHER DEVELOPED INTO GOALS, OBJECTIVES, INTERVENTIONS/STRATEGIES/ACTIVITIES AND PROCESS MEASURES. PARTNER ROLES AND RESOURCES ARE ALSO DOCUMENTED IN THE CHIP. PART I, LINE 7: THE COST-TO-CHARGE RATIO IS USED FOR LINES 7A AND 7B, COMPUTED BY TAKING TOTAL EXPENSES LESS BAD DEBT DIVIDED BY TOTAL GROSS PATIENT REVENUE. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 1,427,669. PART II, COMMUNITY BUILDING ACTIVITIES: ST. JAMES MERCY HOSPITAL ACTIVELY RECRUITS PHYSICIANS AND OTHER HEALTH PROFESSIONALS TO PROVIDE SERVICES IN AREAS WITH A MEDICAL SHORTAGE OR ARE UNDERSERVED. PART III, LINE 2: THE HOSPITAL PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLES FOR ESTIMATED LOSSES RESULTING FROM THE INABILITY/UNWILLINGNESS OF PATIENTS TO MAKE PAYMENTS FOR SERVICES. THE ALLOWANCE IS DETERMINED BY ANALYZING HISTORICAL DATA AND TRENDS. ACCOUNTS RECEIVABLE ARE CHARGED OFF AGAINST THE ALLOWANCE FOR UNCOLLECTIBLES WHEN MANAGEMENT DETERMINES THAT RECOVERY IS UNLIKELY AND THE HOSPITAL CEASES COLLECTION EFFORTS. PART III, LINE 3: THE AMOUNT REPORTED IN PART III, SECTION A, LINE 3 IS DETERMINED BY ESTIMATING THE AMOUNT OF BAD DEBT EXPENSE THAT WOULD BE ATTRIBUTED TO PATIENTS WHO WOULD LIKELY QUALIFY FOR FINANCIAL ASSISTANCE BUT FOR WHOM SUFFICIENT INFORMATION WAS NOT OBTAINED TO MAKE THAT DETERMINATION. PART III, LINE 4: ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. TO EVALUATE THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS HISTORICAL DATA AND TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE TO EVALUATE THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS, THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF HISTORICAL DATA, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. PART III, LINE 8: TO DETERMINE MEDICARE ALLOWABLE COSTS REPORTABLE IN THE MEDICARE COST REPORT, THE COST-TO-CHARGE RATIO IS APPLIED TO GROSS PATIENT REVENUE ASSOCIATED WITH SERVICES PERFORMED FOR PATIENTS WHO ARE ELIGIBLE FOR MEDICARE. PART III, LINE 9B: A BAD DEBT RESULTS FROM A PATIENT ACCOUNT BALANCE FROM WHICH PAYMENT WAS ANTICIPATED FROM THE PATIENT, CREDIT EXTENDED AND THE ACCOUNT LATER DEEMED TO BE UNCOLLECTIBLE. A BAD DEBT DOES NOT MEET THE CRITERIA FOR CHARITY CARE, THAT IS, BAD DEBT PATIENTS ARE CONSIDERED TO HAVE THE FINANCIAL CAPABILITY AND ABILITY TO PAY, BUT ARE UNWILLING TO PAY. COLLECTION ACTIVITIES ARE ONLY PURSUED WITH RESPECT TO AMOUNTS THAT PATIENTS ARE ABLE TO PAY AS DETERMINED BY THE HOSPITAL'S CHARITY CARE POLICY. NO COLLECTION ACTIVITIES TAKE PLACE WITH RESPECT TO AMOUNTS THAT PATIENTS ARE NOT EXPECTED TO PAY UNDER THIS POLICY.A SEPARATE CHARITY CARE POLICY IS IN PLACE AND WOULD BE EXHAUSTED BEFORE A PATIENT BALANCE WOULD BE DEEMED SELF-PAY. UNDER THE CHARITY CARE POLICY, CHARITY CARE/FINANCIAL ASSISTANCE IS PROVIDED TO A PATIENT WITH A DEMONSTRATED INABILITY TO PAY. A PATIENT IS ELIBIBLE FOR CHARITY CARE/FINANCIAL ASSISTANCE CONSIDERATION BASED UPON MEETING CERTAIN INCOME ELIGIBILITY CRITERIA AS ESTABLISHED BY THE FEDERAL POVERTY INCOME GUIDELINE SLIDING SCALE. PER NYS PHL 2807K, THIS CONSIDERS PATIENTS WHOSE HOUSEHOLD INCOME IS UP TO 300% OF THE MOST RECENT FEDERAL POVERTY GUIDELINES.ALL UNINSURED, LOW-INCOME PATIENTS WITHIN ST. JAMES MERCY HOSPITAL'S PRIMARY SERVICE AREA WHO CAN DEMONSTRATE AN INABILITY TO PAY CHARGES MAY APPLY FOR CHARITY CARE/FINANCIAL ASSISTANCE FOR ADJUSTMENTS TO THEIR BALANCES FOR ALL MEDICALLY NECESSARY HEALTHCARE SERVICES, PROVIDED THAT A MEMBER, IN GOOD STANDING, OF ST. JAMES MERCY HOSPITAL'S MEDICAL STAFF DETERMINES THE NEED FOR SUCH MEDICAL CARE TREATMENT. PART VI, LINE 2: ST. JAMES MERCY HOSPITAL CONDUCTS A COMMUNITY NEEDS ASSESSMENT EVERY THREE YEARS IN CONJUNCTION WITH STEUBEN COUNTY PUBLIC HEALTH. BASED ON RESIDENTS' FEEDBACK, THE COUNTY'S HEALTH CARE PRIORITIES, STRATEGIES, AND PROGRAMS ARE DETERMINED. ST. JAMES MERCY HOSPTIAL CREATES AN ANNUAL PLAN BASED ON THIS ASSESSMENT, AND THE PROGRESS OF THESE INITIATIVES IS REPORTED ANNUALLY TO THE NYS DEPARTMENT OF HEALTH. LOCAL HEALTH CARE PRIORITIES ARE ALSO IDENTIFIED THROUGH SURVEYING PARTICIPANTS AT PUBLIC HEALTH EDUCATION PROGRAMS. PART VI, LINE 3: AT THE TIME OF REGISTRATION, ALL SELF-PAY INDIVIDUALS RECEIVE AN INFORMATION SHEET DESCRIBING THE TYPES OF FEDERAL, STATE AND LOCAL GOVERNMENT PROGRAMS AVAILABLE, INCLUDING ST. JAMES MERCY HOSPITAL'S CHARITY CARE POLICY. THE ELIGIBILITY PROCESS IS COORDINATED BY A FINANCIAL COUNSELOR, WHO CONTACTS THE PATIENT OR PATIENT FAMILY MEMBER BY PHONE AND/OR LETTER. PATIENTS WHO QUALIFY FOR MEDICAID ARE ALSO DIRECTED TO AN IN-HOUSE FACILITATED ENROLLER, WHO COORDINATES THE MEDICAID APPLICATION PROCESS ON BEHALF OF THE PATIENT. PART VI, LINE 4: THE PRIMARY SERVICE AREA FOR ST. JAMES MERCY HOSPITAL IS THE 15-MILE RADIUS EXTENDING FROM HORNELL (STEUBEN COUNTY), NEW YORK, AND INCLUDES THE TOWNS OF WAYLAND TO THE NORTHEAST AND TROUPSBURG TO THE SOUTHEAST (JUST OUTSIDE OF THE 15-MILE RADIUS). THE SECONDARY SERVICE AREA IS THE 30-MILE RADIUS EXTENDING FROM HORNELL. PER THE 2010 CENSUS, THE POPULATION FOR THE PRIMARY SERVICE AREA (STEUBEN COUNTY) REMAINED RELATIVELY FLAT, INCREASING 0.3% FROM 2000 TO 2010 TO 98,990 AND IS PROJECTED TO REMAIN FLAT THROUGHOUT 2014. THE POPULATION AGED 65 AND OVER COMPRISES 16% OF THE PRIMARY SERVICE AREA COMPARED TO 13% FOR NEW YORK STATE. THE POPULATION IS RACIALLY AND ETHNICALLY HOMOGENOUS WITH 95.3% WHITE, 1.6% BLACK, 1.4% HISPANIC/LATINO, AND 1.2% ASIAN. PERSONS OVER THE AGE OF 65 REPRESENT 15.6% OF THE COUNTY, 2 PERCENTAGE POINTS HIGHER THAN THE STATE. MEDIAN HOUSEHOLD INCOME IS $42,764 COMPARED TO $54,554 FOR THE STATE. APPROXIMATELY 20% OF THE COUNTY POPULATION HAVE A BACHELOR'S DEGREE OR HIGHER COMPARED TO 32% OF STATE RESIDENTS. PART VI, LINE 5: ST. JAMES MERCY HOSPITAL IS THE LEAD AGENCY FOR THE CANCER SERVICES PROGRAM (CSP) OF STEUBEN COUNTY. A COMMUNITY-BASED, GRANT-FUNDED PROGRAM OF NEW YORK STATE DEPARTMENT OF HEALTH (NYSDOH), THE CSP SERVES UNINSURED MEN AND WOMEN WITH COMPREHENSIVE, AGE-APPROPRIATE, NO-COST SCREENINGS FOR BREAST, CERVICAL AND COLORECTAL CANCER. IN ADDITION, ST. JAMES MERCY HOSPITAL RECEIVED THE NYSDOH BREAST AND PROSTATE PEER EDUCATION PROGRAM IN 2016 AND BEGAN IMPLEMENTATION OF A COMMUNITY EDUCATION BASED PROGRAM. ST. JAMES MERCY HOSPITAL PARTICIPATES IN COORDINATING THE ANNUAL HEALTHY KIDS DAY AT THE MAPLE CITY KIDS QUARTER MILER. THIS EVENT IS DIRECTED TO PARENTS AND COMMUNITY YOUTH AND INCLUDES A PEDIATRIC HEALTH FAIR AND A LOGSTANDING COMMUNITY KIDS "FUN RUN" TO PROMOTE EXERCISE AND HEALTHY LIFESTYLES. ST. JAMES MERCY HOSPITAL STAFF MEMBERS THROUGHOUT THE ORGANIZATION PARTICIPATE IN COMMUNITY INITIATIVES AND HOLD SEATS ON BOARDS, INCLUDING THE STUEBEN RURAL HEALTH NETWORK, CATHOLIC CHARITIES, YMCA, UNITED WAY OF THE SOUTHERN TIER, SMART STEUBEN, STEUBEN PREVENTION COALITION AND OTHER NON-PROFIT ORGANIZATIONS WHOSE PRIMARY MISSION IS TO ASSESS AND ADDRESS COMMUNITY NEEDS. ST. JAMES MERY HOSPITAL WELCOMES COMMUNITY ORGANIZATIONS TO UTILIZE SPACE FOR MEETINGS, PROGRAMS AND ACTIVITIES THAT ARE DEEMED SUPPORTIVE TO THE HEALTH OF THE COMMUNITY. THIS INCLUDES SUPPORT GROUPS, DRIVER SAFETY PROGRAMS, BLOOD DRIVES, ETC. PART VI, LINE 7, REPORTS FILED WITH STATES NY X X X X 0 0 0 0 0 0 0 0 0 JENNIFER L SULLIVAN PRESIDENT/CEO 243319 0 0 0 0 0 2596 0 10483 0 256398 0 0 0 STANLEY D KONOPKO CFO STANLEY D. KONOPKO, CFO, IS A PARTNER AT BONADIO & CO., LLP 334894 BONADIO & CO. LLP IS PAID SERVICES PERFORMED BY MR. KONOPKO. 0 ISMAIL MEHR MD DR. MEHR IS A BOARD MEMBER OF THE HOSPITAL 384775 DR. MEHR PROVIDES ANESTHESIOLOGY SERVICES TO THE HOSPITAL THROUGH HIS COMPANY ABADAN MEDICAL, PLLC. 0 FORM 990, PART VI, SECTION A, LINE 3 STANLEY D. KONOPKO HAS SERVED AS THE ORGANIZATION'S CFO SINCE AUGUST 2013. MR. KONOPKO IS A PARTNER OF BONADIO & CO., LLP, AN ACCOUNTING FIRM, WHICH WAS PAID $334,894 FOR MR. KONOPKO'S SERVICES IN 2016. FORM 990, PART VI, SECTION B, LINE 11B A COPY OF THE FORM 990 WAS MADE AVAILABLE TO EACH BOARD MEMBER BEFORE IT WAS FILED. ST. JAMES MERCY HOSPITAL HAS DESIGNED THE AUDIT AND COMPLIANCE COMMITTEE AS THE GROUP TO BE EDUCATED AND TO REVIEW THE RETURN. FORM 990, PART VI, SECTION B, LINE 12C A CALL FOR CONFLICTS IS PART OF EVERY BOARD MEETING. THE ANNUAL BOARD OF DIRECTORS EDUCATION SESSION WAS COMPLETED IN DECEMBER 2016. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD HAS AN INDEPENDENT COMMITTEE REVIEW AND APPROVE ALL ELEMENTS OF REMUNERATION FOR ALL DISQUALIFIED PARTIES, AS WELL AS OTHER KEY MANAGEMENT. THE BOARD/COMMITTEE HAS AN ESTABLISHED COMPENSATION PHILOSOPHY WHICH DETAILS THE OBJECTIVES OF MARKET POSITIONING AND PAY ELEMENTS. THE COMMITTEE REVIEWS MARKET DATA, APPROVES ANY SALARY ADJUSTMENTS FOR THE EXECUTIVE POPULATION, CONSIDERS BOTH REASONABLENESS AND EFFECTIVENESS OF ALL REMUNERATIVE PROGRAMS AND ESTABLISHES THE DETAILED PERFORMANCE EXPECTATIONS. ALL OF THESE DISCUSSIONS AND DECISIONS ARE DOCUMENTED THROUGH THE PROVISION OF MEETING MINUTES. FORM 990, PART VI, SECTION C, LINE 19 ORGANIZATIONAL DOCUMENTS, SUCH AS THE ARTICLES OF INCORPORATION, CORPORATE BYALWS, GOVERNANCE POLICIES BELIEVED TO BE OF INTEREST TO THE PUBLIC, CONFLICT OF INTEREST POLICIES AND THE IRS FORM 990, ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: OTHER CHANGES IN NET ASSETS 27,870. FORM 990, PART XII, LINE 2C: THE AUDIT AND COMPLIANCE COMMITTEE IS RESPONSIBLE FOR THE SELECTION OF THE INDEPENDENT AUDITOR AND OVERSIGHT OF THE AUDIT. THERE HAS NOT BEEN A CHANGE FROM THE PRIOR YEAR. ST JAMES MERCY FOUNDATION INC 411 CANISTEO STREET HORNELL NY 14843 161486437 FOUNDATION NY 501(C)(3) LINE 7 ST JAMES MERCY HOSPITAL 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 0 1 0 0