2016-11-07T15:19:58-06:00 2015-12-31 161226221 FUST CHARLES CHAMBERS LLP 5784 WIDEWATERS PARKWAY SYRACUSE NY 13214 990 2015-01-01 150532079 CORTLAND REGIONAL MEDICAL CENTER INC CORT 6077563501 134 HOMER AVENUE CORTLAND NY 13045 DENISE WRINN VP OF FINANCE/CFO 6077563501 2016-11-03 1 JOSEPH J SCHLEGEL P00301329 3154463600 2015 2017-02-10 21:41:12Z DENISE WRINN 134 HOMER AVENUE CORTLAND NY 13045 116575678 0 X WWW.CORTLANDREGIONAL.ORG X 1892 NY CORTLAND REGIONAL MEDICAL CENTER,INC., LOCATED IN CORTLAND, NY, IS A NOT-FOR-PROFIT ACUTE CARE HOSPITAL. THE HOSPITAL PROVIDES GENERAL INPATIENT, INPATIENT PSYCHIATRIC, OUTPATIENT, EMERGENCY, LONG-TERM HOME HEALTH CARE AND SKILLED NURSING SERVICES FOR RESIDENTS IN THE GREATER CORTLAND COUNTY AREA. 17 16 1139 298 304577 -142028 2100533 1441212 80728937 80207019 909862 1804718 3108262 5630307 86847594 89083256 0 0 0 0 46510897 48901318 0 0 0 38439398 38819282 84950295 87720600 1897299 1362656 115952391 112423568 54028595 49156386 61923796 63267182 X CORTLAND REGIONAL MEDICAL CENTER PROVIDES QUALITY HEALTH CARE WITH SKILL AND COMPASSION, MEETING THE LIFE LONG HEALTH CARE NEEDS OF ALL CITIZENS OF CORTLAND AND THE SURROUNDING COMMUNITIES. 0 0 71629644 85532749 CORTLAND REGIONAL MEDICAL CENTER IS DEDICATED TO SERVING THE LIFELONG HEALTH CARE NEEDS OF CORTLAND AND THE SURROUNDING AREA. AS A TEAM-ORIENTED COMMUNITY HEALTH AND MEDICAL ORGANIZATION, CORTLAND REGIONAL MEDICAL CENTER PROVIDES QUALITY CARE, SKILL AND COMPASSION TO ALL PEOPLE REGARDLESS OF THEIR ABILITY TO PAY. OUR HOSPITAL IS COMMITTED TO: *IMPROVING THE WELLNESS OF THE COMMUNITY THROUGH LEADERSHIP IN HEALTH-RELATED ACTIVITIES AND EDUCATION. *SUPPORTING AND PRESERVING THE PERSONAL AND PROFESSIONAL GROWTH OF OUR QUALITY HEALTH-CARE TEAM, THEREBY PROVIDING STIMULATING ENVIRONMENT FOR ALL EMPLOYEES. *RECRUITING AND RETAINING QUALITY HEALTH-CARE PROFESSIONALS. *COOPERATING WITH OTHER HEALTH-CARE PROVIDERS,REGULATORY AGENCIES, AND INSURANCE COMPANIES TO ADVANCE OUR SERVICE TO EVERY MEMBER OF THE COMMUNITY. *MAINTAINING THE HOSPITALS FINANCIAL VIABILITY FOR THE WELL-BEING OF THE COMMUNITY. *ACQUIRING AND MAINTAINING EQUIPMENT REQUIRED TO PROVIDE QUALITY CARE. *ENCOURAGING THE ACTIVE PARTICIPATION OF COMMUNITY MEMBERS IN A VOLUNTEER CAPACITY IN ORDER TO AUGMENT OUR SERVICES. CORTLAND REGIONAL MEDICAL CENTER IS A VOLUNTARY, NOT-FOR-PROFIT CORPORATION. THE MEDICAL CENTER PROVIDES HEALTH CARE SERVICES OF PREVENTIVE, CURATIVE AND EDUCATIONAL NATURE. THE PRIMARY SERVICES PROVIDED ARE: ACUTE MEDICAL INPATIENT CARE (INCLUDING PEDS AND MATERNITY), PSYCHIATRIC INPATIENT CARE, RESIDENTIAL CARE (SKILLED NURSING FACILITY), EMERGENCY ROOM, AMBULATORY SURGERY, OUTPATIENT DIAGNOSTIC SERVICES, LONG TERM HOME HEALTH CARE PROGRAM, COMMUNITY HEALTH WELLNESS SCREENING, ADULT DAY CARE AND CLINIC. INPATIENT PATIENT DAYS WERE 45,460 AND OUTPATIENT SERVICE (ER, CLINIC, AMB SURG, REF AMB & LTHHC) VISITS WERE 115,804. THE HOSPITAL PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY WITHOUT CHARGE. THE CHARGES FOREGONE UNDER THIS POLICY AMOUNTED TO $479,900 IN 2015. 71629644 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 1 1 0 0 0 1 110 0 1 1139 1 1 1 0 0 0 0 0 0 0 0 0 X 17 16 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X DENISE WRINN - CORTLAND REGIONAL MED 6077563501 134 HOMER AVENUE CORTLAND NY 13045 MARK RAYMOND BOARD MEMBER - SECRETARY 1.00 X X 0 0 0 STEVEN CINQUANTI BOARD MEMBER 1.00 X 0 0 0 WILLIAM POMEROY BOARD MEMBER - CHAIRPERSON 1.00 X X 0 0 0 JOHANNA AMES BOARD MEMBER - VICE CHAIRP 1.00 X X 0 0 0 JEFFREY SEIBERT BOARD MEMBER - TREASURER 1.00 X X 0 0 0 NANCY RONGO BOARD MEMBER 1.00 X 0 0 0 PATRICK HAYES MD BOARD MEMBER 1.00 X 0 0 0 CATHERINE BERTINI BOARD MEMBER 1.00 X 0 0 0 GARRY VANGORDER BOARD MEMBER 1.00 X 0 0 0 REV DAVID JOHNSON BOARD MEMBER 1.00 X 0 0 0 ANNA MARIE GARCIA MD BOARD MEMBER 1.00 X 0 0 0 LEO MCGRATTAN BOARD MEMBER 1.00 X 0 0 0 MARK PRUS BOARD MEMBER 1.00 X 0 0 0 LEE SHURTLEFF BOARD MEMBER 1.00 X 0 0 0 DAVID MAYO BOARD MEMBER 1.00 X 0 0 0 MARGARET PERI BOARD MEMBER 1.00 X 0 0 0 MANOJ KUMAR MD BOARD MEMBER 1.00 X 0 0 0 MARK WEBSTER PRESIDENT/CEO 37.50 X 537837 0 65187 DAVID KOBIS COO 37.50 X 183681 0 21128 MARY WRIGHT VICE PRESIDENT-NURSING SER 37.50 X 202479 0 28061 DENISE WRINN VICE PRESIDENT 37.50 X 263490 0 30801 ROGER SCOTT MD VICE PRESIDENT MEDICAL AFF 37.50 X 350249 0 27280 DENNIS TREPANIER COO 37.50 X 30000 0 185 DAVID KAMINSKY PHARMACIST 37.50 X 127532 0 4986 JOE DALLAIRD DIRECTOR - REVENUE CYCLE 37.50 X 161951 0 18404 CHRISTINA DENNISTON DIRECTOR - PHARMACY 37.50 X 133676 0 18578 ROBERT DUTHE DIRECTOR - IT 37.50 X 106443 0 7936 MICHELLE TUCKER PHARMACIST 37.50 X 119127 0 28802 2216465 0 251348 25 0 1 0 REGIONAL MEDICAL PRACTICE PC 134 HOMER AVENUE CORTLAND NY 13045 PHYSICIAN SERVICES 2883363 HAYNER HOYT CORPORATION 625 ERIE BLVD WEST SYRACUSE NY 13204 CONSTRUCTION SERVICES 2016009 EMERGENCY MEDICINE PHYSICIANS 4535 DRESSLER ROAD NW CANTON OH 44718 PHYSICIAN SERVICES 1128400 LECHASE CONSTRUCTION 205 INDIGO CREEK DR ROCHESTER NY 14626 CONSTRUCTION SERVICES 682139 LABORATORY CORP OF AMERICA PO BOX 12140 BURLINGTON NC 27216 LABORATORY SERVICES 569708 22 572174 809403 59635 1441212 PROGRAM SERVICE REVENUE 621990 80207019 80207019 80207019 451784 451784 28845356 27492422 1352934 1352934 1352934 RELATED COMPANY REIMBURSEMENT 900099 2122692 2122692 CHILD DAYCARE REVENUE 900099 375861 71284 304577 CAFETERIA REVENUE 900099 270495 270495 2861259 2861259 5630307 89083256 85532749 304577 1804718 1740378 932696 807682 36288068 30531614 5756454 1849855 1492053 357802 6342352 5086188 1256164 2680665 2155232 525433 142477 142477 110208 110208 94466 94466 6321992 4067103 2254889 253055 189335 63720 648691 249411 399280 1693634 1016180 677454 1983871 1489362 494509 334017 258635 75382 106147 55771 50376 5361898 4528147 833751 414462 322227 92235 SUPPLIES 10876821 10484603 392218 PURCHASED SERVICES 5590915 4617634 973281 BAD DEBT EXPENSE 2371287 2371287 EQUIPMENT RENTAL & MAIN 1114949 1021758 93191 1400392 760408 639984 87720600 71629644 16090956 0 13900 18114 7197692 9290175 1384464 182108 10363023 10916682 19021722 22905722 574874 673727 787684 990031 139298185 98365086 41588793 40933099 19856315 8699247 15163924 17814663 115952391 112423568 8558185 8631389 20400000 19470000 1109895 849830 23960515 20205167 54028595 49156386 X 55087467 58181422 2766445 1077265 4069884 4008495 61923796 63267182 115952391 112423568 X 1362656 -2463526 2444256 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 94466 0 0 94466 0 PART II-B, LINE 1: CORTLAND REGIONAL MEDICAL CENTERS LOBBYING ACTIVITY CONSISTED OF: COUNSEL, ADVOCACY AND REPRESENTATION OF CORTLAND REGIONAL MEDICAL CENTER WITH THE GOVERNORS OFFICE, THE LEGISLATURE AND STATE AGENCIES IN REGARD TO BUDGET OR REGULATORY ISSUES. PART OF WHAT WE PAY LAW OFFICES OF WILSON, ELSER, MOSKOWITZ, EDELMAN & DICKER LLP AND A PORTION OF THE DUES PAID TO HEALTHCARE ASSOCIATION OF NEW YORK STATE (HANYS), IROQUOIS HEALTHCARE ASSOCIATION, HOME CARE ASSOCIATION OF NEW YORK (HCA), AMERICAN HOSPITAL ASSOCIATION (AHA) AND LEADING AGE IS DESIGNATED TO LOBBYING ACTIVITIES. 6836329 -68552 1682017 5085760 7558281 73819 795766 6836329 14188155 1273892 188855 8092623 7558281 4676900 9189148 91654 -230453 14188155 4761500 169260 -28062 225798 4676900 0.78800 0.21200 0 1 1 2926033 2926033 72857890 44785549 28072341 59475495 50800649 8674846 4038767 2778888 1259879 40933099 BENEFICIAL INTEREST IN NET ASSETS OF CORTLAND MEMORIAL FOUNDATION 4536165 UNAMORTIZED DEBT ISSUANCE COST 605891 OTHER RECEIVABLES 12672607 17814663 DUE TO THIRD PARTY PAYORS 2543032 ADDITIONAL MINIMUM PENSION LIABILITY 14791700 ADVANCES FROM THIRD PARTY PAYORS 920238 LONG TERM INSURANCE LIABILITY 1691925 LONG TERM INTEREST RATE SWAP LIABILITY 258272 20205167 X PART V, LINE 4: THE HOSPITAL'S ENDOWMENT CONSISTS OF FUNDS ESTABLISHED TO PURCHASE MEDICAL EQUIPMENT WHICH SUPPORTS VARIOUS DEPARTMENTS OF THE HOSPITAL. PART X, LINE 2: INCOME TAXES: THE HOSPITAL QUALIFIES AS A TAX-EXEMPT, NOT-FOR-PROFIT ORGANIZATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. AS OF DECEMBER 31, 2015 AND 2014, THE HOSPITAL DID NOT HAVE ANY UNRECOGNIZED TAX BENEFITS OR ANY RELATED ACCRUED INTEREST OR PENALTIES. THE TAX YEARS OPEN TO EXAMINATION BY FEDERAL AND NEW YORK STATE TAXING AUTHORITIES ARE 2012 THROUGH 2015. THE HOSPITAL DOES NOT ANTICIPATE THAT THE TOTAL UNRECOGNIZED TAX BENEFITS WILL CHANGE IN THE NEXT TWELVE MONTHS. 1 1 1 X 1 X 1 1 0 1 1 1023 257982 257982 0.00300 31541 23724261 18050440 5673821 0.06650 32564 23982243 18050440 5931803 0.06950 16152637 10286919 5865718 0.06870 16152637 10286919 5865718 0.06870 32564 40134880 28337359 11797521 0.13820 1 2371287 242546 26881984 33429126 -6547142 X 1 1 1 1 CORTLAND REGIONAL MEDICAL CENTER INC 134 HOMER AVENUE CORTLAND NY 13045 WWW.CORTLANDREGIONAL.ORG 1101000H X X X CORTLAND REGIONALMEDICAL CENTER INC 1 0 0 1 X X X X X X X X 13 1 0 0 1 X WWW.CORTLANDREGIONAL.ORG/ABOUT-CRMC/COMMUNITY-SERVICE-P X CCHD.CORTLAND-CO.ORG/INDEX.PHP/DATA-AND-REPORTS X X 1 14 1 WWW.CORTLANDREGIONAL.ORG 0 0 1 X 200.000000000000 300.000000000000 X X X 1 1 X X X X 1 X WWW.CORTLANDREGIONAL.ORG X WWW.CORTLANDREGIONAL.ORG X WWW.CORTLANDREGIONAL.ORG X X X X 1 X 0 X X X X 1 X 0 0 CORTLAND REGIONAL.MEDICAL CENTER, INC. PART V, SECTION B, LINE 5: DATA GATHERED WITH CORTLAND COUNTY HEALTH DEPARTMENT, SUNY CORTLAND, UNITED WAY FOR CORTLAND COUNTY, SEVEN VALLEYS HEALTH COALITION, CORTLAND COUNTY BUSINESS DEVELOPMENT CORPORATION, CORTLAND AREA COMMUNITIES THAT CARE COALITION AND FAMILY HEALTH NETWORK. PARTICIPATING FOCUS GROUPS WERE: 4-H TEEN COUNCIL MEMBERS, ACCESS TO INDEPENDENCE STAFF, CORTLAND COUNTY YOUTH BUREAU STUDENTS, LOAVES AND FISHES CLIENTS, WISHING WELLNESS CENTER CLIENTS, LEADERS OF HEALTH AND HUMAN SERVICE AGENCIES, SUNY CORTLAND STUDENTS, CHARLES STREET AND LAWRENCE HOUSE RESIDENTS, CORTLAND COUNTY HEALTH DEPARTMENT STAFF, CORTLAND REGIONAL MEDICAL CENTER STAFF, MEALS ON WHEELS RECIPIENTS, LGBT COMMUNITY MEMBERS, YWCA MODEL MOMS PARTICIPANTS, HOMER AND WILLET SENIOR CENTER PARTICIPANTS AND CORTLAND CAREER WORKS PARTICPANTS. CORTLAND REGIONAL.MEDICAL CENTER, INC. PART V, SECTION B, LINE 7D: CORTLAND REGIONAL MEDICAL CENTER'S COMMUNITY HEALTH NEEDS ASSESSMENT IS PLACED IN THE COUNTY'S PUBLIC LIBRARIES, INCLUDING CINCINNATUS, CORTLAND, HOMER, MARATHON AND MCGRAW. THE COMMUNITY HEALTH NEEDS ASSESSMENT IS ALSO AVAILABLE ON THE MEDICAL CENTER'S WEBSITE AT WWW.CORTLANDREGIONAL.ORG AND ON THE SEVEN VALLEYS HEALTH COALITION WEBSITE AT WWW.SEVENVALLEYSHEALTH.ORG. CORTLAND REGIONAL.MEDICAL CENTER, INC. PART V, SECTION B, LINE 11: ACCESS TO PRIMARY CARE PHYSICIANS, AS WELL AS, SPECIALTY PHYSICIANS IS A CURRENT NEED IN CORTLAND COUNTY. CORTLAND REGIONAL MEDICAL CENTER IS ACTIVELY RECRUITING FOR GENERAL SURGEON, HEMATOLOGY/ONCOLOGY AND UROLOGY. CRMC HAS BEEN SUCCESSFUL RECRUITING OF INTERNAL MEDICINE, PSYCHIATRIST, PULMONOLOGIST, OPHTHALMOLOGIST, ENDOCRINOLOGIST, MIDWIVES AND GASTROENTEROLOGIST. IT IS IMPORTANT TO HAVE THESE PHYSICIAN SERVICES IN CORTLAND, CLOSE TO HOME FOR THE RESIDENTS OF CORTLAND COUNTY. THESE NEW SERVICES WILL GREATLY BENEFIT THE COMMUNITY HEALTH NEEDS FOR THE SURROUNDING CORTLAND AREA. 6 1 - CRNURSING & REHABILITATION FACILITY 134 HOMER AVENUE CORTLAND NY 13045 SKILLED NURSING FACILITY 2 - CRMC OUTPATIENT SERVICE CENTER 4005 WEST ROAD - ROUTE 281 CORTLAND NY 13045 WOUND CARE AND IMAGING SERVICE 3 - CRMC LONG TERM HOME HEALTH CARE 134 HOMER AVENUE CORTLAND NY 13045 LONG TERM HOME HEALTH CARE 4 - CRMC OUTPATIENT REHAB SERVICES 1259 FISHER AVENUE CORTLAND NY 13045 PHYSICAL & OCCUPATIONAL THERAPY 5 - CRMC LABORATORY SERVICE CENTER 4077 WEST ROAD - ROUTE 281 CORTLAND NY 13045 LABORATORY SERVICES 6 - CRMC LABORATORY SERVICE CENTER 6 EUCLID AVENUE CORTLAND NY 13045 LABORATORY SERVICES PART I, LINE 7: THE COST WAS CALCULATED USING WORKSHEET 2 RATIO OF PATIENT CARE COST TO CHARGES FROM SCHEDULE H INSTRUCTIONS. PART I, LINE 7G: MANY PHYSICIANS NO LONGER WANT TO BE IN PRIVATE PRACTICE, BUT SEEK EMPLOYMENT ARRANGEMENTS WITH HOSPITALS OR HOSPITAL-AFFILIATED PHYSICIAN GROUPS. REGIONAL MEDICAL PRACTICE (RMP), A MULTI-SPECIALTY PHYSICIAN GROUP CONTROLLED AND SUPPORTED BY THE HOSPITAL, WAS FORMED TO FURTHER THE MEDICAL CENTER'S CHARITABLE PURPOSES TO HELP RECRUIT SPECIALTY PHYSICIANS INTO THE RURAL CORTLAND AREA. THROUGH RMP, WE HAVE BEEN ABLE TO RECRUIT SPECIALTY PHYSICIANS FOR CARDIOLOGY, INTERNAL MEDICINE/INFECTOUS DISEASE HOSPITALIST, HEMATOLOGY/ONCOLOGY, ORTHOPEDICS, MIDWIVES, OPHTHALMOLOGY, PULMONOLOGIST, GASTROENTEROLOGIST, ENDOCRINOLOGIST AND PSYCHIATRIST. PRIOR TO RMP, THERE WERE NO CARDIOLOGISTS OR ENDOCRINOLOGIST AT ALL IN CORTLAND, NO ORTHOPEDIC SURGEONS PERFORMING SURGERY IN CORTLAND, SO PATIENTS HAD TO TRAVEL OVER 30 MILES FOR THESE SERVICES. THE HOSPITAL IS ACTIVELY RECRUITING FOR GENERAL SURGEON, HEMATOLOGY/ONCOLOGY AND OBSTETRICS/GYNECOLOGY PHYSICIANS. THE HOSPITAL IS CLASSIFIED AS A SOLE COMMUNITY PROVIDER BY MEDICARE BECAUSE OF THE DISTANCE FROM OTHER HOSPITALS, SO IT IS VERY IMPORTANT TO HAVE THESE PHYSICIAN SERVICES IN CORTLAND AND NOT OVER 30 MILES AWAY. THE AMOUNTS SHOWN ON PART I, LINE 7G REPRESENT REVENUES, EXPENSES, AND THE RESULTING LOSS FOR THE YEAR. THESE LOSSES ARE CONSIDERED SUBSIDIZED HEALTH SERVICES FOR 990 REPORTING PURPOSES BECAUSE IF THE HOSPITAL DID NOT SUPPORT THESE RMP PHYSICIAN SPECIALTIES, THESE VITAL SERVICES WOULD NOT BE AVAILABLE IN THE CORTLAND COMMUNITY. RMP HAS OBTAINED ITS EXEMPTION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE". PART I, LN 7 COL(F): BAD DEBT EXPENSE FROM THE INCOME STATEMENT IS SUBTRACTED OUT.GUIDELINES FOR CREDIT AND COLLECTIONSPOLICY:THE HOSPITAL WILL FOLLOW BILLING AND DEBT COLLECTION PRACTICES THAT:(I)COMPLY WITH ALL REQUIREMENTS OF FEDERAL AND STATE LAW, INCLUDING THE FAIR DEBT COLLECTION PRACTICE ACTS AND IRS 501R STANDARDS FOR TAX-EXEMPT HOSPITALS; (II)BALANCE THE NEED TO DILIGENTLY PURSUE FUNDS OWED TO THE ORGANIZATION WITH THE NEED TO PROVIDE FINANCIAL ASSISTANCE TO ELIGIBLE PATIENTS AND TO TREAT ALL PATIENTS WITH RESPECT AND COMPASSION; AND (III) REFLECT THE MISSION AND VALUES OF THIS ORGANIZATION.PROCEDUREI.BILLINGA.INSURED PATIENTS (E.G., MEDICARE, MEDICAID OR COMMERCIAL PAYOR)1.WHERE THE PATIENT IS INSURED (AND HAS ASSIGNED TO THE HOSPITAL HIS OR HER RIGHT TO PAYMENT), THE HOSPITAL WILL SUBMIT ITS CLAIM FOR PAYMENT TO THE INSURER AND NOT BILL THE PATIENT DIRECTLY, EXCEPT AS SET FORTH IN PARAGRAPH 2.THE HOSPITAL MAY STILL BILL AN INSURED PATIENT WHO HAS ASSIGNED CLAIMS:(A)FOR PATIENT COST-SHARING AMOUNTS (E.G., CO-PAYS, COINSURANCE OR DEDUCTIBLES); AND(B)FOR SERVICES NOT COVERED BY THE PATIENT'S HEALTH PLAN, OR SERVICES COVERED BY THE PLAN BUT FOR WHICH PAYMENT IS DENIED IN WHOLE OR PART BY THE PLAN, OR BALANCES DUE AFTER INSURANCE PAYMENT, TO THE EXTENT BILLING FOR SUCH AMOUNTS ARE PERMITTED BY LAW AND BY THE HOSPITAL'S CONTRACT WITH THE INSURER.WHEN BILLING FOR SUCH AMOUNTS, THE HOSPITAL WILL FOLLOW THE PRACTICES SET FORTH IN SECTION I.B BELOW, TO THE EXTENT SUCH PRACTICES ARE PERMITTED BY LAW AND BY THE HOSPITAL'S CONTRACT WITH THE INSURER. B.UNINSURED PATIENTS (I.E., SELF-PAY PATIENTS). 1.BILLING AMOUNT. WHERE THE PATIENT IS UNINSURED (OR HAS NOT ASSIGNED TO THE HOSPITAL HIS OR HER RIGHT TO PAYMENT), THE HOSPITAL WILL DETERMINE THE BILLING AMOUNT AS FOLLOWS: (A)THE HOSPITAL WILL INFORM THE PATIENT OF ITS FINANCIAL ASSISTANCE POLICY IN ACCORDANCE WITH POLICY #13-7000-03. IF THE PATIENT APPLIES FOR AND IS ELIGIBLE FOR FINANCIAL ASSISTANCE, THE BILL WILL BE DISCOUNTED IN ACCORDANCE WITH SUCH POLICY. (B)PATIENTS WHO DO NOT QUALIFY FOR FINANCIAL ASSISTANCE WILL BE OFFERED A 30% PROMPT PAYMENT DISCOUNT OFF GROSS CHARGES IF THE FULL BALANCE MINUS DISCOUNT IS RECEIVED WITHIN 45 DAYS OF THE DATE APPEARING ON THEIR FIRST STATEMENT. (THIS DISCOUNT IS NOT AVAILABLE FOR ANY PATIENT COST-SHARING BALANCE DUE BY AN INSURED PATIENT).(C)PATIENTS WHO DO NOT QUALIFY FOR FINANCIAL ASSISTANCE, AND WHO DO NOT PAY WITHIN 45 DAYS OF THE DATE APPEARING ON THEIR FIRST STATEMENT, WILL THEREAFTER BE BILLED GROSS CHARGES.2. BILLING PROCEDURE. (A)THE HOSPITAL WILL SEND SUCH PATIENT A MINIMUM OF THREE STATEMENTS OVER A 120 DAY PERIOD. EACH SUCH STATEMENT WILL PROVIDE INFORMATION ABOUT THE FINANCIAL ASSISTANCE POLICY (OR A REFERENCE TO SUCH A WEB ADDRESS WITH SUCH INFORMATION). DURING SUCH PERIOD, THE HOSPITAL SHALL NOT ENGAGE IN ANY EXTRAORDINARY COLLECTION ACTIONS. (B)AT 120 DAYS AFTER THE INITIAL STATEMENT, IF FULL PAYMENT HAS NOT BEEN RECEIVED OR OTHER PAYMENT ARRANGEMENTS NEGOTIATED, THE ACCOUNT MAY BE REFERRED TO THE HOSPITAL'S COLLECTION AGENCY, WHICH MAY COMMENCE EXTRAORDINARY COLLECTION ACTIONS.II.EXTRAORDINARY COLLECTION ACTIONS.A.BASIC LIMITATION ON EXTRAORDINARY COLLECTION ACTIONS. 1.THE HOSPITAL SHALL NOT ENGAGE IN EXTRAORDINARY COLLECTION ACTIONS AS DEFINED IN PARAGRAPH B BELOW, AGAINST AN INDIVIDUAL UNTIL THE HOSPITAL HAS MADE REASONABLE EFFORTS, AS DESCRIBED IN PARAGRAPH C BELOW, TO DETERMINE WHETHER THE INDIVIDUAL IS ELIGIBLE FOR ASSISTANCE UNDER THE HOSPITAL FINANCIAL ASSISTANCE POLICY (FAP).B.EXTRAORDINARY COLLECTION ACTIONS DEFINED 1.EXTRAORDINARY COLLECTION ACTIONS ARE ACTIONS TAKEN RELATED TO OBTAINING PAYMENT OF A BILL FOR HOSPITAL SERVICES THAT EITHER:(A)REQUIRE A LEGAL OR JUDICIAL PROCESS, (B)INVOLVE SELLING AN INDIVIDUALS' DEBT TO ANOTHER PARTY, OR (C)INVOLVE REPORTING ADVERSE INFORMATION ABOUT THE INDIVIDUAL TO CONSUMER CREDIT REPORTING AGENCIES OR CREDIT BUREAUS. 2.ACTIONS THAT REQUIRE LEGAL OR JUDICIAL PROCESS INCLUDE, BUT ARE NOT LIMITED TO, ACTIONS TO-(A) PLACE A LIEN ON AN INDIVIDUAL'S PROPERTY;(B) FORECLOSE ON AN INDIVIDUAL'S REAL PROPERTY;(C) ATTACH OR SEIZE AN INDIVIDUAL'S BANK ACCOUNT OR ANY OTHER PERSONAL PROPERTY;(D) COMMENCE A CIVIL ACTION AGAINST AN INDIVIDUAL;(E) CAUSE AN INDIVIDUAL'S ARREST;(F) CAUSE AN INDIVIDUAL TO BE SUBJECT TO A WRIT OF BODY ATTACHMENT; AND(G) GARNISH AN INDIVIDUAL'S WAGES.C.REASONABLE EFFORTS. 1.REASONABLE EFFORTS MEANS THAT THE HOSPITAL: (A)GAVE A PLAIN LANGUAGE SUMMARY OF ITS FINANCIAL ASSISTANCE PLAN (FAP) AND OFFER AN APPLICATION FORM, TO THE PATIENT BEFORE DISCHARGE FROM THE HOSPITAL;(B)INCLUDED INFORMATION ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE AND ABOUT HOW TO ACCESS THE FAP SUMMARY WITH ALL (AND AT LEAST THREE) BILLING STATEMENTS FOR THE CARE AND ALL OTHER WRITTEN COMMUNICATIONS REGARDING THE BILL PROVIDED TO THE INDIVIDUAL DURING THE PERIOD OF DATE OF HOSPITALIZATION UNTIL 120 DAYS AFTER THE FIRST BILLINGS STATEMENT (THE NOTIFICATION PERIOD.")(C)INFORMS THE INDIVIDUAL ABOUT THE FAP IN ALL ORAL COMMUNICATIONS WITH THE INDIVIDUAL REGARDING THE AMOUNT DUE FOR THE CARE THAT OCCUR DURING THE NOTIFICATION PERIOD; AND (D)PROVIDES THE INDIVIDUAL WITH AT LEAST ONE WRITTEN NOTICE THAT (I) INFORMS THE INDIVIDUAL ABOUT THE EXTRAORDINARY COLLECTION EFFORTS THE HOSPITAL OR OTHER AUTHORIZED PARTY MAY TAKE IF THE INDIVIDUAL DOES NOT SUBMIT A FAP APPLICATION OR PAY THE AMOUNT DUE BY A DEADLINE (SPECIFIED IN THE NOTICE) THAT IS NO EARLIER THAN THE LAST DAY OF THE NOTIFICATION PERIOD; AND (II) IS PROVIDED TO THE INDIVIDUAL AT LEAST 30 DAYS BEFORE THE DEADLINE SPECIFIED IN THE WRITTEN NOTICE.2.WITH RESPECT TO A PATIENT WHO SUBMITTED AN INCOMPLETE FAP APPLICATION, REASONABLE EFFORTS MEANS THAT THE HOSPITAL:(A)SUSPENDS EXTRAORDINARY COLLECTION EFFORTS AGAINST THE PATIENT;(B)PROVIDES THE PATIENT WITH A WRITTEN NOTICE THAT DESCRIBES THE ADDITIONAL INFORMATION AND/OR DOCUMENTATION REQUIRED, AND INCLUDES A COPY OF THE FAP; (C)COMPLIES WITH C.1.(D) ABOVE. 3.HOSPITAL WILL NOT PERMIT A THIRD PARTY COLLECTION AGENT TO COMMENCE AN EXTRAORDINARY COLLECTION EFFORT AGAINST A PERSON FOR AN UNPAID HOSPITAL SERVICES BILL UNLESS AND UNTIL A HOSPITAL OFFICIAL HAS AUTHORIZED THE SPECIFIC ACTION(S) AGAINST THE SPECIFIC PERSON. III.FAIR DEBT COLLECTION PRACTICES. A.HOSPITAL SHALL, DIRECTLY OR THROUGH COLLECTION AGENTS, COMPLY WITH THE REQUIREMENTS OF THE FEDERAL FAIR DEBT COLLECTION PRACTICES ACT. SPECIFICALLY, THE HOSPITAL SHALL NOT ENGAGE IN ANY OF THE FOLLOWING ABUSIVE AND DECEPTIVE PRACTICES WHEN ATTEMPTING TO COLLECT DEBTS: 1.HOURS FOR PHONE CONTACT: CONTACTING CONSUMERS BY TELEPHONE OUTSIDE OF THE HOURS OF 8:00 A.M. TO 9:00 P.M. LOCAL TIME;2.FAILURE TO CEASE COMMUNICATION UPON REQUEST: COMMUNICATING WITH CONSUMERS IN ANY WAY (OTHER THAN LITIGATION) AFTER RECEIVING WRITTEN NOTICE THAT SAID CONSUMER WISHES NO FURTHER COMMUNICATION OR REFUSES TO PAY THE ALLEGED DEBT, WITH CERTAIN EXCEPTIONS, INCLUDING ADVISING THAT COLLECTION EFFORTS ARE BEING TERMINATED OR THAT THE COLLECTOR INTENDS TO FILE A LAWSUIT OR PURSUE OTHER REMEDIES WHERE PERMITTED;3.CAUSING A TELEPHONE TO RING OR ENGAGING ANY PERSON IN TELEPHONE CONVERSATION REPEATEDLY OR CONTINUOUSLY: WITH INTENT TO ANNOY, ABUSE, OR HARASS ANY PERSON AT THE CALLED NUMBER; 4.COMMUNICATING WITH CONSUMERS AT THEIR PLACE OF EMPLOYMENT AFTER HAVING BEEN ADVISED THAT THIS IS UNACCEPTABLE OR PROHIBITED BY THE EMPLOYER;5.CONTACTING CONSUMER KNOWN TO BE REPRESENTED BY AN ATTORNEY;6.COMMUNICATING WITH CONSUMER AFTER REQUEST FOR VALIDATION HAS BEEN MADE: COMMUNICATING WITH THE CONSUMER OR THE PURSUING COLLECTION EFFORTS BY THE DEBT COLLECTOR AFTER RECEIPT OF A CONSUMER'S WRITTEN REQUEST FOR VERIFICATION OF A DEBT MADE WITHIN THE 30 DAY VALIDATION PERIOD (OR FOR THE NAME AND ADDRESS OF THE ORIGINAL CREDITOR ON A DEBT) AND BEFORE THE DEBT COLLECTOR MAILS THE CONSUMER THE REQUESTED VERIFICATION OR ORIGINAL CREDITOR'S NAME AND ADDRESS7.MISREPRESENTATION OR DECEIT: MISREPRESENTING THE DEBT OR USING DECEPTION TO COLLECT THE DEBT, INCLUDING A DEBT COLLECTOR'S MISREPRESENTATION THAT HE OR SHE IS AN ATTORNEY OR LAW ENFORCEMENT OFFICER;8.PUBLISHING THE CONSUMER'S NAME OR ADDRESS ON A "BAD DEBT" LIST;9.SEEKING UNJUSTIFIED AMOUNTS, WHICH WOULD INCLUDE DEMANDING ANY AMOUNTS NOT PERMITTED UNDER AN APPLICABLE CONTRACT OR AS PROVIDED UNDER APPLICABLE LAW;10.THREATENING ARREST OR LEGAL ACTION THAT IS EITHER NOT PERMITTED OR NOT ACTUALLY CONTEMPLATED;11.ABUSIVE OR PROFANE LANGUAGE USED IN THE COURSE OF COMMUNICATION RELATED TO THE DEBT;12.COMMUNICATION WITH THIRD PARTIES: REVEALING OR DISCUSSING THE NATURE OF DEBTS WITH THIRD PARTIES (OTHER THAN THE CONSUMER'S SPOUSE OR ATTORNEY, OR OTHERS TO THE ETXENT PERMITTED BY THE FDPA. PART III, LINE 4: AUDITED FINANCIAL STATEMENT FOOTNOTE (PAGE 12) PATIENT ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTIBILITY OF PATIENT ACCOUNTS RECEIVABLE, THE HOSPITAL AND PRACTICE ANALYZE PAST PAYMENT HISTORY AND IDENTIFY TRENDS FOR EACH MAJOR PAYOR SOURCE OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. FOR RECEIVABLES ASSOCIATED WITH PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL AND PRACTICE ANALYZE CONTRACTUALLY DUE AMOUNTS AND PROVIDE AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS AND FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS, THE HOSPITAL AND PRACTICE ALSO ANALYZE AMOUNTS DUE AND PROVIDE AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE BASED ON PAST EXPERIENCE, INCLUDING CONSIDERATION OF CURRENT BUSINESS AND ECONOMIC CONDITIONS. WHEN THE HOSPITAL AND PRACTICE ESTABLISH THE ALLOWANCE FOR DOUBTFUL ACCOUNTS BOTH TAKE INTO CONSIDERATION THE FACT THAT MANY SELF-PAY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. THE HOSPITAL'S AND PRACTICE'S ALLOWANCE FOR DOUBTFUL ACCOUNTS WAS 23.2% AND 27.7% OF THE RELATED PATIENT ACCOUNTS RECEIVABLE, NET OF CONTRACTUAL ALLOWANCES AT DECEMBER 31, 2015 AND 2014. RESPECTIVELY. THE DECLINE RELATES TO A LOWER CONCENTRATION OF PRIVATE PAYOR RECEIVABLE AT DECEMBER 31, 2015. PART III, LINE 8: THE MEDICARE COST WAS CALCULATED USING THE WORKSHEET IN THE SCHEDULE H INSTRUCTIONS.FINANCIAL ASSISTANCE POLICY:PURPOSE: ALIGNED WITH OUR VALUES, WE PROVIDE CARE FOR PERSONS WHO ARE IN NEED AND GIVE SPECIAL CONSIDERATION TO THOSE WHO ARE MOST VULNERABLE, INCLUDING THOSE WHO ARE UNABLE TO PAY AND THOSE WHOSE LIMITED MEANS MAKE IT EXTREMELY DIFFICULT TO MEET THE HEALTH CARE EXPENSES INCURRED. CORTLAND REGIONAL MEDICAL CENTER IS COMMITTED TO:"PROVIDING ACCESS TO QUALITY HEALTH CARE SERVICES WITH COMPASSION, DIGNITY AND RESPECT FOR THOSE WE SERVE. "CARING FOR ALL PERSONS, REGARDLESS OF THEIR ABILITY TO PAY FOR SERVICES; AND"ASSISTING PATIENTS WHO CANNOT PAY FOR PART OR ALL OF THE CARE THAT THEY RECEIVE.DEFINITIONS: EMERGENT (SERVICE LEVEL) - MEDICAL SERVICES NEEDED FOR A CONDITION THAT MAY BE LIFE THREATENING OR THE RESULT OF A SERIOUS INJURY AND REQUIRING IMMEDIATE MEDICAL ATTENTION. THIS MEDICAL CONDITION IS GENERALLY GOVERNED BY EMERGENCY MEDICAL TREATMENT AND ACTIVE LABOR ACT (EMTALA).EXTRAORDINARY COLLECTION ACTIONS (ECA) - EXTRAORDINARY COLLECTIONS INCLUDE BUT ARE NOT LIMITED TO LAWSUITS, WAGE GARNISHMENTS OR OTHER SIMILAR COLLECTIONS PROCESSES.FAMILY -AS DEFINED BY THE U.S. CENSUS BUREAU, A GROUP OF TWO OR MORE PEOPLE WHO RESIDE TOGETHER AND WHO ARE RELATED BY BIRTH,MARRIAGE,OR ADOPTION. IF A PATIENT CLAIMS SOMEONE AS A DEPENDENT ON THEIR INCOME TAX RETURN, ACCORDING TO THE INTERNAL REVENUE SERVICE RULES, THEY MAY BE CONSIDERED A DEPENDENT FOR THE PURPOSE OF DETERMINING ELIGIBILITY UNDER THE CRMC FINANCIAL ASSISTANCE POLICY.INCOME -INCOME INCLUDES WAGES, SALARIES, SALARY AND SELF-EMPLOYMENT INCOME, UNEMPLOYMENT COMPENSATION, WORKER'S COMPENSATION,PAYMENTS FROM SOCIAL SECURITY,VETERAN'S BENEFITS, ALIMONY, SURVIVOR'S BENEFITS,PENSIONS,RETIREMENT INCOME AND ANNUITY PAYMENTS,INCOME FROM ESTATES AND TRUSTS,RENTS RECEIVED,INTEREST/DIVIDENDS, AND INCOME FROM OTHER MISCELLANEOUS SOURCES.FAMILY INCOME - A PERSON'S FAMILY INCOME INCLUDES THE INCOME OF ALL FAMILY MEMBERS IN THE HOUSEHOLD WHO CAN BE CLAIMED UPON THE TAX RETURN FILED BY THE APPLICANT. FOR PATIENTS UNDER 18 YEARS OF AGE, FAMILY INCOME INCLUDES THAT OF THE PARENTS AND/OR STEP-PARENTS, OR CARETAKER RELATIVES. TOTAL HOUSEHOLD INCOME IS INCOME FROM ALL MEMBERS OF A HOUSEHOLD FROM THE FOLLOWING SOURCES: WAGES, UNEMPLOYMENT INCOME, WORKERS COMPENSATION, VETERANS BENEFITS, SOCIAL SECURITY INCOME, DISABILITY INCOME, ALIMONY, AND OTHER CASH INCOME INCLUDING PENSION/RETIREMENT.PROOF OF EARNINGS MAY BE DETERMINED BY ANNUALIZING THE YEAR-TO-DATE FAMILY INCOME, TAKING INTO CONSIDERATION THE CURRENT EARNINGS RATE. FINANCIAL SUPPORT - SUPPORT (FINANCIAL AID, DISCOUNTS, ETC.) PROVIDED TO PATIENTS FOR WHOM IT WOULD BE A HARDSHIP TO PAY FOR THE FULL COST OF MEDICALLY NECESSARY SERVICES PROVIDED BY CRMC WHO MEET THE ELIGIBILITY CRITERIA FOR SUCH ASSISTANCE. OUR FINANCIAL AID PROGRAM IS IN THE FORM OF A DISCOUNT OFF OF CRMC'S AVG. CONTRACTUAL ADJUSTMENT AMOUNT FOR MEDICARE FOR THE SERVICES PROVIDED. THE AVERAGE ADJUSTMENT AMOUNT IS CALUCULATED ON AN ANNUAL BASIS USING MEDICARE PAYMENT DATA FOR THE PREVIOUS 12 MONTH PERIOD. FOR OUR UNINSURED PATIENTS OUR FINANCIAL AID PROGRAM IS IN THE FORM OF A DISCOUNT OFF OF CRMC'S AVG. CONTRACTUAL ADJUSTMENT AMOUNT FOR MEDICARE FOR THE SERVICES PROVIDED. THE DISCOUNT IS A SLIDING SCALE, DEPENDING ON YOUR INCOME. FOR OUR INSURED PATIENTS: ANY OPEN BALANCE INCLUDING CO-PAY AND DEDUCTIBLE ARE ELIGIBLE TO BE CONSIDERED FOR A FINANCIAL ASSISTANCE DISCOUNT WHICH WOULD BE APPLIED TO THE BALANCE THE PATIENT/GUARANTOR IS RESPONSIBLE TO PAY. THE DISCOUNT IS A SLIDING SCALE DEPENDING ON YOUR INCOME.UNINSURED PATIENT -AN INDIVIDUAL WHO IS UNINSURED, HAVING NO THIRD-PARTY COVERAGE BY A COMMERCIAL THIRD-PARTY INSURER, AN ERISA PLAN, A FEDERAL HEALTH CARE PROGRAM (INCLUDING WITHOUT LIMITATION MEDICARE, MEDICAID, SCHIP, AND CHAMPUS), WORKER'S COMPENSATION, OR OTHER THIRD PARTY ASSISTANCE TO COVER ALL OR PART OF THE COST OF CARE, INCLUDING CLAIMS AGAINST THIRD PARTIES COVERED BY INSURANCE TO WHICH CRMC IS SUBROGATED, BUT ONLY IF PAYMENT IS ACTUALLY MADE BY SUCH INSURANCE COMPANY. URGENT (SERVICE LEVEL) - MEDICAL SERVICES FOR A CONDITION NOT LIFE THREATENING, BUT REQUIRING TIMELY MEDICAL SERVICES.SERVICE AREA - A SERVICE AREA IS THE LIST OF ZIP CODES COMPRISING CRMC'S SERVICE MARKET AREA FOR PRIMARY HEALTH CARE SERVICES. PROCEDURE:I.QUALIFYING CRITERIA FOR FINANCIAL ASSISTANCE CRMC WILL ESTABLISH AND MAINTAIN A FINANCIAL ASSISTANCE POLICY (FAP) DESIGNED TO ADDRESS THE NEED FOR FINANCIAL ASSISTANCE AND SUPPORT TO PATIENTS FOR ALL ELIGIBLE SERVICES REGARDLESS OF RACE, CREED, SEX, OR AGE. ELIGIBILITY FOR FINANCIAL ASSISTANCE AND SUPPORT FROM CRMC WILL BE DETERMINED ON AN INDIVIDUAL BASIS USING SPECIFIC CRITERIA AND EVALUATED ON AN ASSESSMENT OF THE PATIENT'S AND/OR FAMILY'S HEALTH CARE NEEDS, FINANCIAL RESOURCES AND OBLIGATIONS. A.SERVICES ELIGIBLE FOR FINANCIAL SUPPORT:I.ALL MEDICALLY NECESSARY SERVICES, INCLUDING MEDICAL AND SUPPORT SERVICES PROVIDED BY CRMC WILL BE ELIGIBLE FOR FINANCIAL SUPPORT. II.EMERGENCY MEDICAL CARE SERVICES WILL BE PROVIDED TO ALL PATIENTS WHO PRESENT TO THE CRMC EMERGENCY DEPARTMENT, REGARDLESS OF THE PATIENT'S ABILITY TO PAY. SUCH MEDICAL CARE WILL CONTINUE UNTIL THE PATIENT'S CONDITION HAS BEEN STABILIZED PRIOR TO ANY DETERMINATION OF PAYMENT ARRANGEMENTS.B.SERVICES NOT ELIGIBLE FOR FINANCIAL SUPPORT: I.COSMETIC SERVICES, OTHER ELECTIVE PROCEDURES AND SERVICES THAT ARE NOT MEDICALLY NECESSARY. II.SERVICES PROVIDED IN CRMC'S SKILLED NURSING FACILITY AND SWING BED SERVICES.III.THIS POLICY ONLY COVERS SERVICES PROVIDED BY THE HOSPITAL. THIS POLICY DOES NOT APPLY TO OTHER BILLS YOU MAY RECEIVE FROM PRIVATE PHYSICIANS WHO MAY BE INVOLVED IN YOUR CARE INCLUDING BUT NOT LIMITED TO: RADIOLOGY, PATHOLOGITS, ANESTHESIOLOGISTS OR EMERGENCY ROOM PHYSICIANS.IV.AS PROVIDED IN SECTION II. CRMC WILL MAKE AFFIRMATIVE EFFORTS TO HELP PATIENTS APPLY FOR PUBLIC AND PRIVATE PROGRAMS. CRMC MAY DENY FINANCIAL SUPPORT TO THOSE INDIVIDUALS WHO DO NOT COOPERATE IN APPLYING FOR PROGRAMS THAT MAY PAY FOR THEIR HEALTH CARE SERVICES, BUT SHALL NOT ENGAGE IN EXTRAORDINARY COLLECTION EFFORTS THAT COULD JEOPARDIZE CRMC'S TAX EXEMPT STATUS.C. RESIDENCY REQUIREMENTSI. CRMC WILL PROVIDE FINANCIAL SUPPORT TO PATIENTS WHO RESIDE WITHIN ITS SERVICE AREA AND QUALIFY UNDER CRMC'S FAP. II.SERVICE AREA ZIP CODES: 13045, 13077, 13073, 13118, 13068, 13053, 13159, 13803, 13040, 13092, 13101, 13052, 13158, 13141, 13136III.CRMC WILL PROVIDE FINANCIAL SUPPORT TO PATIENTS FROM OUTSIDE ITS SERVICE AREA WHO QUALIFY UNDER CRMC FAP AND WHO PRESENT WITH AN URGENT, EMERGENT OR LIFE-THREATENING CONDITION.IV.CRMC WILL PROVIDE FINANCIAL SUPPORT TO PATIENTS IDENTIFIED AS NEEDING SERVICE BY PHYSICIAN FOREIGN MISSION PROGRAMS CONDUCTED BY ACTIVE MEDICAL STAFF FOR WHICH PRIOR APPROVAL HAS BEEN OBTAINED FROM CRMCS PRESIDENT OR DESIGNEE.D.DOCUMENTATION FOR ESTABLISHING INCOMEI.INFORMATION PROVIDED TO CRMC BY THE PATIENT AND/OR FAMILY SHOULD INCLUDE EARNED INCOME, INCLUDING MONTHLY GROSS WAGES, SALARY AND SELF-EMPLOYMENT INCOME; BANK STATEMENTS UNEARNED INCOME INCLUDING ALIMONY, RETIREMENT BENEFITS, DIVIDENDS, INTEREST AND INCOME FROM ANY OTHER SOURCE; NUMBER OF DEPENDENTS IN HOUSEHOLD; AND OTHER INFORMATION TO DETERMINE THE PATIENT'S FINANCIAL RESOURCES. II.SUPPORTING DOCUMENTS SUCH AS PAYROLL STUBS, MAY BE REQUESTED TO SUPPORT INFORMATION REPORTED AND SHALL BE MAINTAINED WITH THE COMPLETED APPLICATION AND ASSESSMENT.HOW TO APPLY: APPLICATIONS AND/OR CONFIDENTIAL ASSISTANCE WITH COMPLETION OF THE APPLICATIN IS AVAILABLE FROM ANY REGISTRAR OF FROM OUR PATIENT ACCOUNTING OFFICE BY CALLING 607-756-3838.E.PRESUMPTIVE SUPPORT - UNINSURED PATIENTS ONLYI.CRMC RECOGNIZES THAT NOT ALL PATIENTS ARE ABLE TO PROVIDE COMPLETE FINANCIAL INFORMATION. THEREFORE, APPROVAL FOR FINANCIAL SUPPORT MAY BE DETERMINED BASED ON LIMITED AVAILABLE INFORMATION. WHEN SUCH APPROVAL IS GRANTED IT IS CLASSIFIED AS "PRESUMPTIVE SUPPORT". CRMC MAY UTILIZE CERTAIN TOOLS USING DEMOGRAPHIC INFORMATION COMMONLY AVAILABLE IN CONJUNCTION WITH A "FAST TRAK" FINANCIAL ASSISTANCE APPLICATION. APPROVAL IS FOR 6 MONTHS FROM THE DATE OF APPLICATION, SERVICE DATES PRIOR TO APPLICATION DATE ARE NOT ELIGIBLE FOR PRESUMPTIVE FINANCIAL ASSISTANCE.II. ANY TOOL USED AS PART OF THE PRESUMPTIVE ELIGIBILITY APPLICATION PROCESS CANNOT BE USED AS THE SOLE BASIS TO DENY A FINANCIAL AID APPLICATION.III.EXAMPLES OF PRESUMPTIVE CASES INCLUDE:"DECEASED PATIENTS WITH NO KNOWN ESTATE "HOMELESS "UNEMPLOYED PATIENTS "NON-COVERED MEDICALLY NECESSARY SERVICES PROVIDED TO PATIENTS QUALIFYING FOR PUBLIC ASSISTANCE PROGRAMS "PATIENT BANKRUPTCIES(CHAPTER 7), AND "MEMBERS OF RELIGIOUS ORGANIZATIONS WHO HAVE TAKEN A VOW OF POVERTY AND HAVE NO RESOURCES INDIVIDUALLY OR THROUGH THE RELIGIOUS ORDER.SEE SCHEDULE O FOR CONTINUATION PART III, LINE 9B: SEE FINANCIAL ASSISTANCE POLICY FROM PART III, LINE 8. PART VI, LINE 2: NEEDS ASSESSMENT: CRMC WORKS COLLABORATIVELY WITH THE CORTLAND COUNTY HEALTH DEPARTMENT, SUNY CORTLAND, UNITED WAY FOR CORTLAND COUNTY, FAMILY HEALTH NETWORK, AND SEVEN VALLEYS HEALTH COALITION ON AN ANNUAL BASIS TO DO A COUNTY WIDE INTEGRATED ASSESSMENT. THIS ASSESSMENT LOOKS AT 1) HEALTH & WELLNESS; 2) SOCIAL COHESION, CULTURE & RECREATION; 3) EMPLOYMENT, ECONOMY, & WELFARE; 4) HOUSING & ENVIRONMENT; 5) POSITIVE DEVELOPMENT THROUGH THE LIFE STAGES & HOW THEY ALL INTERSECT WITH EACH OTHER TO EFFECT A COMMUNITIES WELL-BEING. IT IS THRU THESE ASSESSMENTS, IN CONJUCTION WITH RESOURCE AVAILABILITY THAT PUBLIC HEALTH PRIORITIES ARE ESTABLISHED.ASSESSMENT OF PUBLIC HEALTH PRIORITIES: CRITERIA OF PUBLIC HEALTH PRIORITIES-CRITERIA:FOCUS GROUPS IDENTIFIED THE PRIORITY AS ONE OF THE COUNTY'S MOST SIGNIFICANT HEALTH ISSUES.COUNTY HEALTH DEPARTMENT MEASURES RELATED TO HEALTH PRIORITIES SUPPORT THE PUBLIC'S SUBJECTIVE OPINION, I.E. THE PRIORITY-SPECIFIC COUNTY MEASURES PUBLISHED IN CORTLAND COUNTS DEVIATE FROM STATE AND NATIONAL BENCHMARKS AND HEALTHY PEOPLE 2020 GOALS.MEDICAL CENTER INTERNAL DATA SUPPORTS ISSUES AS PRIORITIES BASED ON PATIENT VOLUME AND UTILIZATION OF SERVICES ASSOCIATED WITH THEM. USE OF DATA: THE FOLLOWING WERE THE PRIMARY SOURCES OF DATA USED TO TARGET A POPULATION:COMMUNITY FORUM HEALTH TRACK, FOCUS GROUPS, AND COMMUNITY SURVEY RESULTS-AS DESCRIBED ABOVE, THESE ACTIVITIES ELICITED SUBJECTIVE DATA REGARDING HEALTH PRIORITIES. ISSUES CONSISTENTLY NAMED "TOP HEALTH PRIORITIES" INCLUDE ACCESS TO QUALITY HEALTHCARE, HEALTHY MOTHERS/HEALTHY BABIES, CHRONIC DISEASE, HEALTHY ENVIRONMENT, AND MENTAL HEALTH AND SUBSTANCE ABUSE.CORTLAND COUNTS 2013: COUNTY STATISTICS (SEE FOLLOWING TABLE) THAT DEVIATED MOST SIGNIFICANTLY FROM STATE, REGIONAL, NATIONAL, AND HEALTHY PEOPLE 2020 GOALS WERE CONSIDERED IN DEFINING COUNTY PUBLIC HEALTH PRIORITIES.INDICATOR - CORTLAND COUNTY; UPSTATE NY; NYS; NATIONAL; HEALTHY PEOPLE 2020 GOALCIGARETTE USE IN WOMEN DURING PREGNANCY- 32.8%; 25.5%; N/A; 16.2%; 1.4%*COLORECTAL CANCER INCIDENCE WOMEN- 52.9; 40.8; 40.0; 39.3; N/A MEN-50.1; 52.1; 53.3, 52.2; N/A*LUNG/BRONCHUS CANCERMEN - 108.5; 82.1; 76.3; 74.3; N/A WOMEN- 70.5; 64.4; 56.0; 51.9; N/A*CEREBROVASCULAR DISEASE MORTALITY RATE - 44.9; 30.0; 26.6; 39.1; 33.8*CLRD OR COPD MORTALITY RATE - 72.3; 36.2; 30.5; 42.2; 98.5*RATE PER 100,000NEW YORK STATES PREVENTION QUALITY INDICATORS (PQI): REVIEW OF HOSPITALIZATION RATES BY ZIP CODE FOR CONDITIONS GENERALLY CONSIDERED PREVENTABLE WHEN GOOD PRIMARY CARE IS ACCESSIBLE (PQI) AIDED IN DETERMINING HEALTH PRIORITIES. BECAUSE CORTLAND COUNTY IS A HPSA FOR PRIMARY MEDICAL CARE (LOW-INCOME POPULATION), THE AREAS PQIS ARE EXPECTED TO BE HIGH. PQIS WERE DETERMINED USING THE FOLLOWING PARAMETERS:THE TWELVE CONDITIONS IN THE AREAS OF CIRCULATORY, DIABETES-RELATED, RESPIRATORY, AND ACUTE ILLNESSES. CORTLAND COUNTY ZIP CODES INDIVIDUALLY AND IN SUM.CORTLAND REGIONAL MEDICAL CENTER'S SERVICE AREA ZIP CODES INDIVIDUALLY AND IN SUM.RESULTS:CONDITIONS ASSOCIATED WITH HIGHEST PQI SCORES IN THE CORTLAND AREA ARE PNEUMONIA, COPD, AND CHF (ADMISSIONS AS PERCENT EXPECTED: 207%, 139%, AND 80%, RESPECTIVELY).FURTHER ASSESSMENT INDICATES THAT CORTLAND ZIP CODE 13045 IS ASSOCIATED WITH HIGHEST PNEUMONIA & COPD PQI'S (ADMISSION AS PERCENT EXPECTED: 249% & 168%, RESPECTIVELY). RACIAL/ETHNIC DISPARITIES ARE NOT INDICATED FOR ANY CONDITION PER PQI TOOL. ADMISSIONS AS PERCENT EXPECTED BY RACE/ETHNICITY FOR HISPANIC, AFRICAN, ASIAN, AND OTHER GROUPS WERE BELOW POPULATION THRESHOLD.CORTLAND REGIONAL MEDICAL CENTER DATA - INPATIENT CASE VOLUMES BY SERVICE LINE (MEASURED AS DISCHARGES) WERE CONSIDERED IN IDENTIFICATION OF HEALTH PRIORITIES. HIGHEST VOLUMES OF INPATIENT DISCHARGES HAVE CONSISTENTLY INCLUDED THE FOLLOWING: 2011; 2012; 2013; 2014; 2015PULMONARY/MEDICAL - 816; 785; 696; 594; 553CARDIOVASCULAR DISEASES- 618; 547; 395; 355; 290OBSTETRICS/DELIVERY - 497; 585; 427; 411; 431NEW BORN - 507; 485; 436; 431; 428MARKET EXPERT 2015MEASUREMENTS OF THE MEDICAL CENTER'S AMBULATORY CARE SENSITIVE CONDITIONS (ACSC), THOSE ADMISSIONS THAT COULD HAVE BEEN TREATED AS OUTPATIENTS, WERE ALSO CONSIDERED IN DETERMINING HEALTH PRIORITIES. ACCESSIBILITY OF PRIMARY CARE IS A COMMON REASON FOR ASCS ADMISSIONS, AND AS PREVIOUSLY STATED, CORTLAND COUNTY IS A HPSA FOR PRIMARY MEDICAL CARE (LOW-INCOME). DATA ANALYSIS INDICATES THE FOLLOWING TRENDS TOWARD IMPROVEMENT IN CRMC'S TOP ACSC SEVERITY 1 CASES.AMBULATORY PROMPT CARE IS CORTLAND REGIONAL MEDICAL CENTER'S PRIMARY CARE PROGRAM FOR NON-EMERGENCY CONDITIONS. EXTENDED HOURS OF SERVICE (7A-11P, 7DAYS/WK) ARE AVAILABLE TO SUPPLEMENT CARE PROVIDED AT PHYSICIANS' OFFICES DURING REGULAR BUSINESS HOURS. MEMBERS OF THE COMMUNITY WHO DO NOT HAVE ACCESS TO A MEDICAL HOME OFTEN SEEK TREATMENT THROUGH THIS SERVICE. PROMPT CARE'S PATIENT ENCOUNTER STATISTICS WERE ASSESSED IN CONSIDERATION OF PREVENTION PRIORITIES AND DEMONSTRATE CORTLAND'S STEADILY INCREASING UTILIZATION OF THE PROGRAM. THIS IS DESCRIBED AS FOLLOWS AND BASED ON INTERNAL STATISTICS:PROMPT CARE PATIENT ENCOUNTERS 2011; 2012; 2013; 2014; XXX-XX-XXXX; 11967; 11540; 13804; 13126UNINSURED ENCOUNTERS AT CORTLAND REGIONAL MEDICAL CENTER(2)2008; 2012; 2014; 2015TOTAL ENCOUNTERS 157,309; 144,421; 146,905; 144002NUMBER OF UNINSURED ENCOUNTERS 11,199; 5818; 4716; 6449% UNINSURED ENCOUNTERS 7.1%; 4.1%; 3.2%; 4.5%(2)CORTLAND REGIONAL MEDICAL CENTER SELECTED PREVENTION AGENDA PRIORITIESBASED ON DATA ANALYSIS, THE CORTLAND COUNTY HEALTH DEPARTMENT AND CORTLAND REGIONAL MEDICAL CENTER WILL COLLABORATE ON THE FOLLOWING PUBLIC HEALTH PRIORITIES:CHRONIC DISEASE: FOCUS WILL BE ON SMOKING CESSATION, WITH SPECIAL FOCUS ON PREGNANTWOMEN AND DECREASING DISABILITY RELATED TO SMOKING. ADDITIONAL FOCI INCLUDE OBESITY ANDEFFORTS TO INCREASE SCREENINGS FOR CARDIOVASCULAR DISEASE, DIABETES, AND BREAST, CERVICAL AND COLORECTAL CANCER.HEALTHY MOTHERS/HEALTHY BABIES/HEALTHY CHILDREN:THE PRIMARY FOCUS WILL BE ONINCREASING THE NUMBER OF BABIES EXCLUSIVELY BREASTFEED WHILE IN THE HOSPITAL, WHILESECONDARILY ADDRESSING THE DISPARITY BETWEEN MEDICAID AND NON-MEDICAID MOTHERS' DECISIONTO BREASTFEED. DECREASING THE SMOKING RATE AMONG PREGNANT WOMEN WILL ALSO BE ADDRESSED.STATUS OF PRIORITIESALL PRIORITIES REPRESENT EXISTING PROGRAMS EITHER AT CORTLAND REGIONAL MEDICAL CENTER OR THE CORTLAND COUNTY HEALTH DEPARTMENT; HOWEVER, A GOAL OF THIS PROJECT IS TO INCREASE COMMUNITY AWARENESS OF EXISTING PROGRAMS BY INVOLVING MORE COMMUNITY MEMBERS IN THE IMPLEMENTATION OF NEW INITIATIVES RELATED TO IDENTIFIED PRIORITIES.THREE-YEAR PLAN OF ACTIONSTRATEGIES FOR SELECTED PRIORITIESTHE PRIORITIES SELECTED THROUGH THE COLLABORATIVE ASSESSMENT PROCESS DESCRIBED IN THE PREVIOUS SECTION ARE ALL PUBLIC HEALTH ISSUES THAT HAVE BEEN RECOGNIZED IN THE PAST AS PRIORITIES FOR THE GREATER CORTLAND COMMUNITY AND TO WHICH CRMC AND ITS COMMUNITY PARTNERS HAVE DEDICATED RESOURCES.CHRONIC DISEASECORTLAND REGIONAL MEDICAL CENTER AND ITS COMMUNITY PARTNERS WILL FOCUS ON DISEASES OF THE LUNG RELATED SPECIFICALLY TO SMOKING, OBESITY AND SCREENING FOR DIABETES, AND BREAST, CERVICAL AND COLORECTAL CANCER. THESE WILL ALL BE IMPLEMENTED USING THE MOST CURRENT EVIDENCE-BASED RECOMMENDATIONS. LUNG DISEASES: PULMONARY REHABILITATION PROGRAM V PULMONARY REHABILITATION IS AN EXERCISE PROGRAMDESIGNED FOR PATIENTS WITH CHRONIC PULMONARY OBSTRUCTIVE DISEASE (COPD) TO INCREASEEXERCISE TOLERANCE AND INDEPENDENCE IN ACTIVITIES OF DAILY LIVING AND TO DECREASESYMPTOMS AND UTILIZATION OF MEDICAL RESOURCES. PULMONARY REHABILITATION IS THE ONEINTERVENTION THAT STUDIES HAVE FOUND DECREASES HOSPITALIZATIONS, READMISSIONS, ANDINCREASES QUALITY OF LIFE FOR COPD PATIENTS. X GOAL: 25% INCREASE IN PATIENTS REFERRED TO PULMONARY REHABILITATION PROGRAM. X MEASUREMENT: NUMBER OF PATIENTS REFERRED TO PULMONARY REHABILITATION PROGRAM. (CONTINUED IN SCHEDULE O) PART VI, LINE 3: FINANCIAL AID PROGRAMSUCCESSES AND CHALLENGESPROCESS IMPROVEMENTS AND GENERAL ACCOMPLISHMENTS:A PAMPHLET HIGHLIGHTING CRMC'S FINANCIAL AID PROGRAM AND HOW TO APPLY IS AVAILABLE AT ALL REGISTRATION LOCATIONS, ON AND OFFSITE.POLICY IS TO PROVIDE FINANCIAL AID TO INCOME LEVELS UP TO 300% OF THE FEDERAL POVERTY LEVEL.SIGNAGE ABOUT CRMC'S FINANCIAL AID PROGRAM IS IN ALL REGISTRATION AREAS, BOTH ON AND OFFSITE, AS WELL IN THE BUSINESS OFFICE AND MAIN LOBBY.DISTRIBUTED CRMC FINANCIAL AID PAMPHLETS AND APPLICATIONS AT FAMILY HEALTH NETWORK CLINIC SITESBEST PRACTICES:PROVIDE A FULL-TIME, ONSITE PATIENT FINANCIAL NAVIGATOR (CERTIFIED APPLICATION COUNSELOR THROUGH NYS) TO ASSIST IN ENROLLING THOSE INDIVIDUALS WHO ARE UNINSURED OR UNDERINSURED IN THE NYS MARKETPLACECONTRACT WITH AN OUTSIDE AGENCY, CARDON, TO ASSIST ELIGIBLE INPATIENT SELF-PAY POPULATION TO OBTAIN MEDICAID.SCREEN SELF-PAY REGISTRATIONS FOR BLUE CROSS, MEDICAID, AND/OR FIDELIS COVERAGE. PATIENTS WITHOUT COVERAGE ARE CALLED FOR CURRENT INSURANCE INFORMATION, AND IF THEY HAVE NONE, THEY ARE OFFERED FINANCIAL ASSISTANCE AND/OR MONTHLY PAYMENT OPTIONS.PARTICIPATE IN ANNUAL HEALTH INSURANCE FAIR TO HELP RAISE AWARENESS OF THE OPTIONS AVAILABLE TO INDIVIDUALS WHO HAVE NO INSURANCE OR ARE UNDER INSURED.CHALLENGES:DIFFICULTY GAINING PATIENT COOPERATION WITH THE APPLICATION PROCESS AND PATIENTS' NON-COMPLIANCE WITH POLICY.LACK OF VALID PATIENT DEMOGRAPHIC INFORMATION, INCLUDING TELEPHONE NUMBERS.APPLICANTS DISHONESTY.ALSO, SEE WRITE UP FOR PART III, LINE 9 PART VI, LINE 4: HOSPITAL SERVICE AREACORTLAND REGIONAL MEDICAL CENTER IS LOCATED IN THE CITY OF CORTLAND, COUNTY OF CORTLAND, IN THE CENTRAL REGION OF NEW YORK STATE. THE MEDICAL CENTER IS APPROXIMATELY 35 MILES SOUTH OF SYRACUSE, NEW YORK; 40 MILES NORTH OF BINGHAMTON, NEW YORK; AND 24 MILES NORTHEAST OF ITHACA, NEW YORK. AS THE ONLY HOSPITAL IN CORTLAND COUNTY, CRMC IS FEDERALLY DESIGNATED A SOLE COMMUNITY HOSPITAL. THE MEDICAL CENTER SERVES ALL OF CORTLAND COUNTY AND NEIGHBORING PARTS OF SEVEN CONTIGUOUS COUNTIES, INCLUDING ONONDAGA, MADISON, CHENANGO, BROOME, TIOGA, TOMPKINS, AND CAYUGA.DESCRIPTION OF SERVICE AREACORTLAND REGIONAL MEDICAL CENTER DEFINES ITS PRIMARY SERVICE AREA AS AN 18-ZIP-CODE AREA IN AND AROUND CORTLAND PROPER. IT ACCOUNTS FOR APPROXIMATELY 92% OF CORTLAND REGIONAL MEDICAL CENTER'S TOTAL INPATIENT ADMISSIONS; THIS REPRESENTS APPROXIMATELY 52% MARKET SHARE. CORTLAND REGIONAL MEDICAL CENTER IS COMMITTED TO PROVIDING QUALITY HEALTHCARE SERVICES BY USING AVAILABLE RESOURCES TO MEET THE NEEDS OF THE PEOPLE WHO LIVE OR WORK IN ITS SERVICE AREA. PART VI, LINE 5: ACCESS TO QUALITY HEALTH CARETHE MEDICAL CENTER PARTNERS WITH COMMUNITY ORGANIZATIONS TO INCREASE MEDICAID ENROLLMENT, EXPAND ACCESS TO PROVIDERS, AND RECRUIT NEW PROVIDERS TO ENSURE A SUFFICIENT NUMBER OF PRIMARY CARE AND SPECIALTY PHYSICIANS TO MEET THE COMMUNITY'S NEEDS.MEDICAID ENROLLMENT:EMPLOY A FULL-TIME PATIENT FINANCIAL NAVIGATOR THROUGH CRMC. THIS STAFF MEMBER IS A CAC (CERTIFIED APPLICATION COUNSELOR) THROUGH NYS. ASSISTING IN ENROLLING THOSE INDIVIDUALS WHO ARE UNINSURED OR UNDERINSURED IN THE NYS MARKETPLACE. THIS STAFF IS ALSO ABLE TO ASSIST IN ENROLLING PATIENTS INTO MEDICAID AND MEDICAID MANAGED CARE PRODUCTS. THEY ARE ALSO IN CHARGE OF THE HOSPITALS FINANCIAL ASSISTANCE PROGRAM AND WORK WITH PATIENTS TO APPLY FOR FINANCIAL AID IN ORDER TO REDUCE HOSPITAL BILLS IN ACCORDANCE TO FPL REGULATIONS. THE GOAL IS TO REDUCE THE NUMBER OF UNINSURED PEOPLE IN CORTLAND COUNTY AND THE NUMBER OF PEOPLE THAT ARE SENT TO COLLECTION DUE TO HIGH COST MEDICAL BILLS. CRMC ALSO CONTRACTS WITH CARDON GROUP TO ASSIST INPATIENTS WHO ARE MEDICAID ELIGIBLE TO OBTAIN COVERAGE. -PARTICIPATE IN ANNUAL HEALTH INSURANCE FAIR TO RAISE AWARENESS OF AVAILABLE COVERAGE. GOAL: REDUCE THE NUMBER OF UNINSURED INDIVIDUALS IN CORTLAND COUNTY. EXPAND ACCESS TO PROVIDERS:PROVIDE INCREASED ACCESS FOR MEDICAID RECIPIENTS BY HAVING PHYSICIANS EMPLOYED BY REGIONAL MEDICAL PRACTICE, P.C. ACCEPT MEDICAID AND OTHER INSURANCES THAT MANY PHYSICIAN PRACTICES DO NOT ACCEPT. GOAL: PROVIDE MEDICAID RECIPIENTS GREATER ACCESS TO OFFICE-BASED MEDICAL CARE. MEASUREMENT: NUMBER OF MEDICAID RECIPIENTS IN RMP PHYSICIAN PRACTICES.APPROXIMATELY 22.3% OF CORTLAND COUNTY RESIDENTS ARE MEDICAID RECIPIENTS WHILE NEARLY 24.2% OF THE PATIENTS SEEN BY RMP PHYSICIANS ARE INSURED BY MEDICAID. THESE STATISTICS SUGGEST THAT CRMC'S EFFORTS TO IMPROVE MEDICAID RECIPIENTS' ACCESS TO MEDICAL CARE HAVE BEEN SUCCESSFUL. PROVIDE SUFFICIENT NUMBERS OF PROVIDERS:PHYSICIAN RECRUITMENT AND RETENTION PLAN - CORTLAND REGIONAL MEDICAL CENTER ADOPTED A COMPREHENSIVE PHYSICIAN RECRUITMENT AND RETENTION PLAN THAT ESTABLISHES RECRUITMENT PRIORITIES OVER THE NEXT FIVE YEARS BASED ON A SURVEY OF COMMUNITY PHYSICIANS, INTERNAL DATA INCLUDING MEDICAL STAFF AGES AND ANTICIPATED RETIREMENTS, AND EXTERNAL DATA ON THE SUPPLY AND DISTRIBUTION OF PHYSICIANS. -PRIORITY SPECIALTY RECRUITMENT YEARS 1-3 -PRIMARY CARE: FAMILY PRACTICE, INTERNAL MEDICINE, ORTHOPEDICS, OB/GYN, GENERAL SURGERY, CARDIOLOGY, UROLOGY, PSYCHIATRY, ONCOLOGY AND PULMONOLOGIST. RECRUITMENT EFFORTS HAVE BEEN SUCCESSFUL IN THE AREAS OF ORTHOPEDICS, OBSTETRICS/ GYNECOLOGY, ONCOLOGY, INTERNAL MEDICINE AND CARDIOLOGY. -PRIORITY SPECIALTY RECRUITMENT YEARS 3-5 - NEUROLOGY, GASTROENTEROLOGY, PRIMARY CARE: FAMILY PRACTICE, AND INTERNAL MEDICINE. GOAL: SUCCESSFUL RECRUITMENT OF ADDITIONAL PHYSICIANS. MEASUREMENT: NUMBER OF NEW PHYSICIANS OPENING OR JOINING EXISTING PRACTICES. HEALTHY MOTHERS/HEALTHY BABIES/HEALTHY CHILDRENCORTLAND REGIONAL MEDICAL CENTER, TOGETHER WITH COMMUNITY PARTNERS, IS FOCUSING ON IMPROVING THE QUALITY OF OBSTETRICAL AND PEDIATRIC CARE, PROVIDING EDUCATION TO PREGNANT WOMEN AND NEW MOTHERS, AND ENSURING THERE ARE SUFFICIENT NUMBERS OF PHYSICIANS IN THE COMMUNITY TO PROVIDE IMPROVED ACCESS TO OBSTETRICAL AND PEDIATRIC CARE. EDUCATION:-CHILD BIRTH CLASSES -EVERY OTHER MONTH, CRMC OFFERS A FULL TWO-DAY, WEEKEND CHILD BIRTH CLASS FOR EXPECTANT PARENTS THAT COVERS A VARIETY OF TOPICS, INCLUDING: NUTRITION; THE ROLE OF THE COACH; BREATHING AND RELAXATION TECHNIQUES FOR LABOR; CARE AND CHARACTERISTICS OF THE NEWBORN; BREASTFEEDING; PARENTING SKILLS; POST PARTUM ISSUES; AND INFANT SAFETY. CRMC ALSO PROVIDES SPACE FOR ITS COMMUNITY PARTNER, FAMILY HEALTH NETWORK, TO HOLD CHILD BIRTH CLASSES.-POSTPARTUM AND NEWBORN CARE EDUCATION - MATERNITY STAFF PROVIDE EDUCATION TO NEW MOTHERS ABOUT HOW TO CARE FOR THEMSELVES AND THEIR NEWBORNS.-POST DISCHARGE BREASTFEEDING SUPPORT - A FOLLOW UP SERVICE PROVIDED AFTER MOTHER AND BABY HAVE GONE HOME TO IMPROVE BREASTFEEDING SUCCESS AND ENCOURAGE THAT IT CONTINUES TO PROVIDE THE NEW INFANT A HEALTHY START.-HEALTHY BEGINNINGS PROGRAM - IN COLLABORATION WITH THE CORTLAND COUNTY HEALTH DEPARTMENT, CRMC DISTRIBUTES PACKETS THAT EMPHASIZE THE IMPORTANCE OF IMMUNIZATIONS AND ALSO PROVIDES INFORMATION ON LEAD POISONING PREVENTION; INFANT/CHILD SAFETY; NUTRITION; AND HEALTH AND DENTAL CARE. CRMC REGISTERS MOTHERS FOR HEALTHY BEGINNINGS NEWSLETTERS, WHICH THE HEALTH DEPARTMENT SENDS TO PARENTS AT OR AROUND THE TIME THEIR CHILD IS DUE FOR A WELL-CHILD VISIT DURING THE FIRST TWO YEARS OF LIFE.(CONTINUED IN SCHEDULE O) PART VI, LINE 6: PARTICIPANTSCORTLAND REGIONAL MEDICAL CENTER COLLABORATES WITH THE CORTLAND COUNTY HEALTH DEPARTMENT, SUNY CORTLAND, AND THE UNITED WAY FOR CORTLAND COUNTY TO MAINTAIN AN ONGOING COMMUNITY NEEDS ASSESSMENT UNDER THE AUSPICES OF THE SEVEN VALLEYS HEALTH COALITION. A COMMUNITY ASSESSMENT TEAM (CAT) COMPRISED OF THE MEDICAL CENTER'S CEO'S DESIGNEE AND THE CORTLAND COUNTY PUBLIC HEALTH DIRECTOR, AS WELL AS REPRESENTATIVES FROM EACH OF THE OTHER INVOLVED ORGANIZATIONS, OVERSEES THE ANNUAL UPDATING OF THE ASSESSMENT. THE FIRST EDITION OF CORTLAND COUNTS: AN ASSESSMENT OF HEALTH AND WELL BEING IN CORTLAND COUNTY WAS RELEASED IN 2001, AND COMPREHENSIVE ASSESSMENTS HAVE THEREAFTER BEEN CONDUCTED EVERY FIVE YEARS. IN THE YEARS BETWEEN FULL ASSESSMENTS, AN ABBREVIATED VERSION, THE COMMUNITY REPORT CARD, IS PUBLISHED TO PROVIDE UPDATED HIGHLIGHTS OF THE COMPREHENSIVE ASSESSMENT IN AN "AT-A-GLANCE" FORMAT. THE FOURTH EDITION OF THE COMPREHENSIVE REPORT WAS RELEASED IN SEPTEMBER 2013.OUTCOMESA BLUE RIBBON COMMITTEE (BRC) THAT INCLUDES BROAD COMMUNITY REPRESENTATION WAS ESTABLISHED IN 2002 TO REVIEW THE CORTLAND COUNTS ASSESSMENT IN LIGHT OF DATA PROVIDED BY FOCUS GROUPS AND CITIZEN SURVEYS CONDUCTED BY THE COMMUNITY ASSESSMENT TEAM, AS WELL AS OTHER COMMUNITY RESEARCH AND FEEDBACK. USING BOTH SUBJECTIVE AND OBJECTIVE DATA, THE BRC SET PRIORITIES AND DEVELOPED A STRATEGIC PLAN THAT CURRENTLY INCLUDES FOUR BROAD TRACKS: ECONOMIC DEVELOPMENT, YOUTH, HOUSING, AND HEALTH. A COMMUNITY ORGANIZATION, OR COALITION OF ORGANIZATIONS, IS TAKING THE LEAD TO ADDRESS EACH BROAD TRACK:THE CORTLAND COUNTY BUSINESS DEVELOPMENT CORPORATION IS SPEARHEADING ECONOMIC DEVELOPMENT INITIATIVES.THE CORTLAND AREA COMMUNITIES THAT CARE COALITION (CACTC) IS COORDINATING EFFORTS TO IMPROVE SERVICES AND EXPAND OPPORTUNITIES FOR THE YOUTH IN THE GREATER CORTLAND COMMUNITY.SEVERAL AGENCIES ARE INVOLVED IN ADDRESSING THE NEED FOR BETTER QUALITY, AFFORDABLE HOUSING.THE SEVEN VALLEYS HEALTH COALITION, IN COLLABORATION WITH CORTLAND REGIONAL MEDICAL CENTER, THE CORTLAND COUNTY HEALTH DEPARTMENT, FAMILY HEALTH NETWORK, AND OTHER COMMUNITY-BASED AGENCIES, IS DIRECTING THE FOCUS ON COMMUNITY HEALTH.THE BLUE RIBBON COMMITTEE MEETS ANNUALLY AND INVITES THE ENTIRE COMMUNITY TO PARTICIPATE IN REDEFINING PRIORITIES AND UPDATING THE STRATEGIC PLAN. CORTLAND COUNTS IS A KEY DOCUMENT THAT THE MEDICAL CENTER AND MANY COMMUNITY AGENCIES UTILIZE IN SETTING PRIORITIES FOR THE CONTINUATION OF EXISTING SERVICES AND THE DEVELOPMENT OF NEW/ENHANCED PROGRAMS AND SERVICES.PUBLIC INPUTA COMMUNITY FORUM WAS HELD IN JANUARY 2013 THAT INCLUDED STATEHOLDERS REPRESENTING EACH OF THE FOUR STRATEGIC PLAN TRACKS. TWO ADDITIONAL MEETINGS CONCERNING THE HEALTH TRACK WERE HELD IN FEBRUARY AND MAY TO ENSURE THAT THE HEALTH GOALS HAD BEEN CLEARLY IDENTIFIED AND WERE BEING ADDRESSED. CORTLAND COUNTS IS A KEY DOCUMENT THAT THE MEDICAL CENTER AND MANY COMMUNITY AGENCIES UTILIZE IN SETTING PRIORITIES FOR THE CONTINUATION OF EXISTING SERVICES AND THE DEVELOPMENT OF NEW/ENHANCED PROGRAMS AND SERVICES.BARRIERS TO CARE/GAPS IN SERVICEACCESS TO QUALITY HEALTH CARE:THE SURVEYS REVEALED RESIDENTS OF CORTLAND COUNTY WERE CONCERNED ABOUT THEIR ABILITY TO ACCESS HIGH QUALITY SPECIALTY AND PRIMARY CARE. A SHORTAGE OF PRIMARY CARE PROVIDERS AND SPECIALISTS IS FORCING RESIDENTS TO TRAVEL TO SYRACUSE, BINGHAMTON, ITHACA, OR FURTHER TO RECEIVE THE CARE THEY NEED.MENTAL HEALTH SERVICES:THE INADEQUACY OF MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES IN CORTLAND WAS IDENTIFIED AS A PRIMARY GAP IN SERVICE. EXPANSION OF EXISTING CLINICS AND EXPLORATION OF PARTNERING WITH LARGER MEDICAL FACILITIES THROUGH TELEMEDICINE GRANT OPPORTUNITIES WERE PROPOSED AS POSSIBLE SOLUTIONS.PUBLIC NOTIFICATION OF OPPORTUNITIES TO PROVIDE INPUTADVERTISEMENTS WERE PLACED IN THE LOCAL NEWSPAPER AND ANNOUNCEMENTS WERE DISTRIBUTED VIA E-MAIL AND LISTSERVS. PUBLIC ASSISTANCE PROGRAMS WERE ALSO ENCOURAGED TO POST THE NOTIFICATIONS AND TO ADVISE CLIENTS OF OPPORTUNITIES TO PARTICIPATE. UPON EVALUATION, THE PROCESS OF NOTIFYING THE PUBLIC COULD BE IMPROVED BY PLACING NOTICES WHERE THOSE RESIDENTS WHOSE ACCESS TO HEALTHCARE IS LIMITED WOULD BE MORE LIKELY TO SEE THEM. SUGGESTED LOCATIONS INCLUDE THE COUNTYS SENIOR CENTERS, LOCAL FOOD PANTRIES, CORTLAND-CHENANGO RURAL SERVICES, AND THROUGH CONTACT WITH THE FAITH COMMUNITY. PART VI, LINE 7, REPORTS FILED WITH STATES NY 1 X X X X X 0 0 0 0 0 0 0 0 0 MARK WEBSTER PRESIDENT/CEO 439441 0 96900 0 1496 0 41397 0 23790 0 603024 0 0 0 DAVID KOBIS COO 183299 0 0 0 382 0 999 0 20129 0 204809 0 0 0 MARY WRIGHT VICE PRESIDENT-NURSING SER 181500 0 20800 0 179 0 6981 0 21080 0 230540 0 0 0 DENISE WRINN VICE PRESIDENT 229222 0 33920 0 348 0 12515 0 18286 0 294291 0 0 0 ROGER SCOTT MD VICE PRESIDENT MEDICAL AFF 327201 0 22875 0 173 0 13100 0 14180 0 377529 0 0 0 JOE DALLAIRD DIRECTOR - REVENUE CYCLE 161951 0 0 0 0 0 2520 0 15884 0 180355 0 0 0 CHRISTINA DENNISTON DIRECTOR - PHARMACY 133676 0 0 0 0 0 5367 0 13211 0 152254 0 0 0 A CORTLAND COUNTY DEVELOPMENT CORPORATION 455122714 2013-02-26 21300000 SEE PART VI 0 0 0 A 21300000 637047 5967331 14695622 2014 1 0 1 1 A 0 0 0 0 0 0 0 A 0 0 0 1 1 1 FIRST NIAGARA BANK 10.000000000000 0 0 0 0 0 A 0 PART I, LINE A, COLUMN (F) BONDS WERE USED FOR THE PURPOSE OF ASSISTING IN FINANCING AND/OR REFINANCING ALL OR A PORTION OF THE COSTS OF A CERTAIN PROJECT, WHICH DID NOT INVOLVE ANY EXTERIOR CONSTRUCTION AND/OR EXPANSION OF THE EXTERIOR OF THE FACILITY CONSISTING OF: A) ACQUISITION AND INSTALLATION OF IMAGING EQUIPMENT, CARDIAC MONITORS, WIRELESS UPGRADES FOR IV PUMPS, BOILERS, AND RELATED HOSPITAL EQUIPMENT FOR USE AT THE FACILITY. B) THE REFUNDING OF ALL OR A PORTION OF THE OUTSTANDING PRINCIPAL AMOUNT OF THE CORTLAND COUNTY INDUSTRIAL DEVELOPMENT AGENCY CIVIC FACILITY RESERVE BONDS, SERIES 2002, ISSUED JUNE 20, 2002. PART II, LINE 11 - OTHER SPENT PROCEEDS OF $14,695,622 WERE USED TO REFUND A PORTION OF THE SERIES 2002 BONDS DESCRIBED IN PART I, LINE A, COLUMN (F). PART IV, LINE 2C - NO REBATE DUE BECAUSE THERE WAS ZERO INVESTMENT PROCEEDS. PART IV, LINE 7 - NO WRITTEN PROCEDURES SINCE NO ARBITRAGE WAS INVOLVED. PART V - THERE WAS A TAX COMPLIANCE AGREEMENT COMPLETED AT THE TIME OF ISSUANCE. THE VP FINANCE/CFO IS RESPONSIBLE FOR MONITORING COMPLIANCE AND CONSULTS WITH OUR BOND ATTORNEY AS NEEDED. JOHANNA AMES TRUSTEE 537143 OFFICER OF AMES LINEN SERVICES 0 DAVID MAYO MD TRUSTEE 54761 RENTS A BUILDING FROM REGIONAL MEDICAL PRACTICE. REGIONAL MEDICAL PRACTICE IS CONTROLLED BY THE HOSPITAL. 0 FORM 990, PART VI, SECTION A, LINE 2 CORTLAND REGIONAL MEDICAL CENTER CONDUCTS BUSINESS WITH AMES LINEN, WHOSE OFFICER, JOHANNA AMES IS A TRUSTEE ON THE CORTLAND REGIONAL MEDICAL CENTER BOARD. LEE SHURTLEFF IS THE PRESIDENT OF THE BOARD OF TRUSTEES FOR GROTON NURSING FACILITY AND IS A TRUSTEE FOR CORTLAND REGIONAL MEDICAL CENTER. CORTLAND REGIONAL MEDICAL CENTER HAS A MANAGEMENT AGREEMENT WITH GROTON NURSING FACILITY. THE CURRENT ADMINISTRATOR OF GROTON NURSING FACILITY IS CONTRACTED PER THIS AGREEMENT. FORM 990, PART VI, SECTION A, LINE 6 THE PARENT, CMH GROUP, INC, IS THE SOLE MEMBER. CMH GROUP, INC. APPOINTS THE HOSPITAL BOARD MEMBERS. FORM 990, PART VI, SECTION A, LINE 7A NO SINGLE PERSON, ONLY THE ORGANIZATION CMH GROUP, MAY ELECT OR APPOINT ONE OR MORE MEMBERS. FORM 990, PART VI, SECTION A, LINE 7B THE SOLE MEMBER OF THE CORPORATION (THE C.M.H. GROUP) SHALL APPOINT ANNUALLY INDIVIDUALS TO FILL THE THEN-EXISTING VACANCIES ON THE BOARD (OF TRUSTEES) SO LONG AS THE BOARD HAS PROPOSED THAT THE VACANCY BE FILLED. FORM 990, PART VI, SECTION B, LINE 11 BEFORE THE 990 IS SUBMITTED, IT IS MADE AVAILABLE TO THE BOARD OF TRUSTEES FINANCE COMMITTEE FOR THEIR REVIEW. QUESTIONS ARE THEN DIRECTED TO THE CFO/CONTROLLER. THE 990 IS THEN MADE AVAILABLE TO THE FULL BOARD PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C CORTLAND REGIONAL MEDICAL CENTER ENFORCES ITS CONFLICT OF INTEREST POLICY REQUIRING OFFICERS, DIRECTORS, TRUSTEES AND KEY EMPLOYEES TO SUBMIT ANNUAL CONFLICT OF INTEREST STATEMENTS. FORM 990, PART VI, SECTION B, LINE 15 CORTLAND REGIONAL MEDICAL CENTER EXECUTIVE COMMITTEE COMPENSATION PHILOSOPHY AND RESPONSIBILITY PURPOSE: AS DELEGATED REPRESENTATIVES OF THE BOARD OF TRUSTEES, THE EXECUTIVE COMMITTEE HAS THE POWER, DUTY AND RESPONSIBILITY TO DETERMINE THE ORGANIZATION'S OVERALL COMPENSATION PHILOSOPHY AND TO ESTABLISH THE GUIDELINES, RULES AND PROCEDURES NECESSARY FOR THE PROPER AND EFFICIENT ADMINISTRATION OF THE EXECUTIVE COMPENSATION PROGRAM. FURTHER, THE COMMITTEE ACKNOWLEDGES ITS RESPONSIBILITY TO ENSURE THAT THE EXECUTIVE COMPENSATION PROGRAM IS APPROPRIATE IN VIEW OF ITS MISSION, TAX-EXEMPT STATUS, CHARITABLE PURPOSE, AND THAT ITS COMPENSATION AND BENEFITS ARE REASONABLE AND NOT EXCESSIVE. TO THAT END, THE EXECUTIVE COMMITTEE WILL REVIEW AND APPROVE ALL FORMS OF EXECUTIVE COMPENSATION AND BENEFITS IN A MANNER NECESSARY TO QUALIFY FOR THE "REBUTTABLE PRESUMPTION OF REASONABLENESS" UNDER THE INTERMEDIATE SANCTIONS RULES OF SECTION 4958 OF THE IRC. MEMBERSHIP: THE COMMITTEE WILL CONSIST OF THE BOARD OF TRUSTEES EXECUTIVE COMMITTEE. COMPENSATION PHILOSOPHY: THE EXECUTIVE COMPENSATION PROGRAM IS DESIGNED TO ESTABLISH AND MAINTAIN A COMPENSATION PACKAGE WHICH WILL ENABLE THE ORGANIZATION TO ATTRACT, RETAIN, MOTIVATE AND REWARD THE MANAGEMENT TEAM LEADERSHIP NEEDED TO SUCCESSFULLY ACCOMPLISH THE ORGANIZATION'S STRATEGIC AND OPERATIONAL GOALS. THE FOLLOWING GUIDELINES WILL BE USED: A TOTAL COMPENSATION CONCEPT WILL BE USED EMPLOYING A COMBINATION OF BASE SALARY, INCENTIVE OPPORTUNITY, FLEXIBLE BENEFITS, DEFERRED COMPENSATION AND OTHER PERQUISITES AS MAY BE NEEDED FROM TIME TO TIME TO MAINTAIN A COMPETITIVE POSITION WITH PEER INSTITUTIONS IN THE REGION. BASE SALARY WILL BE TARGETED AT APPROXIMATELY THE 60TH PERCENTILE OF SIMILAR POSITIONS IN PEER INSTITUTIONS FOR EXPERIENCED PROFESSIONALS. PAY LEVELS FOR INDIVIDUALS WILL DEPEND UPON EXPERIENCE, OVERALL PERFORMANCE, AND CONTRIBUTION TO THE SUCCESS OF THE ORGANIZATION. ANNUAL REVIEWS WILL TAKE PLACE AS OF JANUARY 1 EACH YEAR. INCREASING EMPHASIS WILL BE PLACED ON INCENTIVE COMPENSATION TO THE EXTENT CONSISTENT WITH THE OBJECTIVE TO MAINTAIN THE TAX EXEMPT STATUS OF THE VARIOUS CORPORATE ENTITIES. THE MANAGEMENT TEAM WILL HAVE THE OPPORTUNITY TO REACH THE MAXIMUM PERCENTAGE OF TOTAL COMPENSATION AVAILABLE AT THE TOP OF THE RANGE PAID AMONG PEER INSTITUTIONS BASED ON ACHIEVING OUTSTANDING PERFORMANCE WITH STRATEGIC GOALS IN THE INCENTIVE PLAN. TARGET OPPORTUNITIES WILL BE GEARED TO THE 75TH PERCENTILE OF TOTAL COMPENSATION. DEFERRED COMPENSATION AND PREQUISITE OPPORTUNITIES WILL BE DEVELOPED TO OPTIMIZE WHATEVER TAX DEFERRAL OPPORTUNITIES EXIST WITHIN THE TAX CODE AND TO BE COMPETITIVE WITH PEER INSTITUTIONS. THIS PHILOSOPHY SHALL BE APPLIED EXCEPT AS REQUIRED TO RECRUIT HIGHLY MARKET SENSITIVE POSITIONS. THE EXECUTIVE COMPENSATION PROGRAM SHALL OPERATE AND BE CONSISTENT WITH ALL FEDERAL AND STATE LAWS, CODES, AND PROCEDURES SO LEGISLATED. COMMITTEE RESPONSIBILITIES: THE EXECUTIVE COMMITTEE HAS THE RESPONSIBILITY TO: -SET THE OVERALL COMPENSATION PHILOSOPHY -SET, MONITOR AND REVIEW THE BASE SALARY OF THE CEO AND OTHER MEMBERS OF THE EXECUTIVE MANAGEMENT TEAM AS SET FORTH IN APPLICABLE LEGISLATION -ESTABLISH, MONITOR AND DETERMINE ACCOMPLISHMENT OF INCENTIVE AWARD GOALS FOR THE CEO AND OTHER APPLICABLE EXECUTIVES -OVERSEE THE CLEAR AND ACCURATE DISCLOSURE OF THE TOTAL VALUE OF COMPENSATION PAID TO EXECUTIVES AND OTHER KEY INDIVIDUALS ON THE HOSPITAL'S FORM 990 -RESOLVE AND DETERMINE ALL DISPUTES OR QUESTIONS ARISING UNDER THE PROGRAM, INCLUDING THE POWER TO DETERMINE THE RIGHTS OF EMPLOYEES AND TO REMEDY ANY AMBIGUITIES, INCONSISTENCIES OR OMISSIONS -AMEND OR RESTRUCTURE THE PROGRAM AT ANY TIME AND FOR ANY REASON ANNUAL PROCESS: BEGINNING OF CYCLE ACTIVITIES: -MEET WITH THE CEO TO IDENTIFY APPROPRIATE GOALS AND SUPPORTING OBJECTIVES TO BE INCLUDED IN THE INCENTIVE AWARD PROGRAM -PRIORITIZE OBJECTIVES, ESTABLISH/REVIEW STANDARDS OF PERFORMANCE AND AWARD LEVELS FOR THE CEO AND OTHER APPROPRIATE PARTIES -DETERMINE THE FUNDING MECHANISM FOR THE INCENTIVE AWARD -SECURE MARKET INFORMATION WITH REGARD TO THE POSITIONING OF THE CHIEF EXECUTIVE OFFICER AND OTHER APPROPRIATE EXECUTIVES AND SET BASE SALARY FOR THE PERIOD INTERIM ACTIVITY: CONDUCT PROGRESS REVIEW OF CEO'S STATED OBJECTIVES AND STANDARDS OF PERFORMANCE, AS NECESSARY END OF CYCLE ACTIVITY: -REVIEW THE STANDARDS OF PERFORMANCE FOR THE KEY OBJECTIVES AND MEASURE RESULTS -CONSIDER FACTORS INVOLVED IN MANAGERIAL EFFECTIVENESS -CONSIDER ANY UNANTICIPATED RESPONSIBILITIES OR SPECIAL ACCOMPLISHMENTS -SOLICIT PERFORMANCE EVALUATION FROM ALL BOARD MEMBERS -CONDUCT A PERFORMANCE REVIEW OF THE CEO -DETERMINE THE OVERALL EVALUATION AND AWARD LEVEL -RECEIVE A PERFORMANCE REVIEW FROM THE CEO FOR ALL OTHER MEMBERS OF THE EXECUTIVE MANAGEMENT TEAM AND A SUMMARY OF PROPOSED SALARY AND INCENTIVE AWARDS FORM 990, PART VI, SECTION C, LINE 18 CORTLAND REGIONAL MEDICAL CENTER'S 990 IS AVAILABLE UPON WRITTEN REQUEST. FORM 990, PART VI, SECTION C, LINE 19 CORTLAND REGIONAL MEDICAL CENTER'S GOVERNING DOCUMENTS, FINANCIAL STATEMENT AND CONFLICT OF INTEREST POLICY ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: CHANGE IN FOUNDATION -612,800. PENSION AND POST RETIREMENT 3,180,843. CHANGE IN FAIR VALUE OF INTEREST RATE SWAP -123,787. PART XII LINE 2C THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. FORM 990, SCHEDULE H, PART III, LINE 8 CONTINUATION: FINANCIAL ASSISTANCE POLICY "PATIENTS WHO ARE NON-RESIDENTS OF NYS WHO HAVE BEEN APPROVED FOR MEDICAID BY THEIR STATE OF RESIDENCE. III. FOR PATIENTS WHO ARE NON-RESPONSIVE TO THE APPLICATION PROCESS, OTHER SOURCES OF INFORMATION, IF AVAILABLE, MAY BE USED TO MAKE AN INDIVIDUAL ASSESSMENT OF FINANCIAL NEED. THIS INFORMATION WILL ENABLE CRMC TO MAKE AN INFORMED DECISION ON THE FINANCIAL NEED OF NON-RESPONSIVE PATIENTS. IV.FOR THE PURPOSE OF HELPING FINANCIALLY NEEDY PATIENTS, A THIRD-PARTY MAY BE UTILIZED TO CONDUCT A REVIEW OF PATIENT INFORMATION TO ASSESS FINANCIAL NEED. CRMC DOES NOT UTILIZE A CREDIT SCORING TOOL AS PART OF THIS PROCESS. F.TIMELINE FOR ESTABLISHING FINANCIAL ELIGIBILITY I.EVERY EFFORT SHOULD BE MADE TO DETERMINE A PATIENT'S ELIGIBILITY FOR FINANCIAL SUPPORT PRIOR TO OR AT THE TIME OF ADMISSION OR SERVICE. FINANCIAL ASSISTANCE APPLICATIONS WILL BE ACCEPTED UP TO 240 DAYS AFTER THE FIRST BILLING STATEMENT TO THE PATIENT. II.DETERMINATION FOR FINANCIAL SUPPORT MAY BE MADE PRESUMPTIVELY, HOWEVER PATIENT IS ENCOURAGED TO CONTINUE ALL EFFORTS TO QUALIFY FOR GOVERNMENTAL FINANCIAL ASSISTANCE OR OTHER PROGRAMS. III.CRMC WILL MAKE EVERY EFFORT TO MAKE A FINANCIAL SUPPORT DETERMINATION WITHIN 20 DAYS OF RECEIPT OF COMPLETED APPLICATION. IF OTHER AVENUES OF FINANCIAL SUPPORT ARE BEING PURSUED, CRMC WILL COMMUNICATE WITH THE PATIENT REGARDING THE PROCESS AND EXPECTED TIMELINE FOR DETERMINATION AND SHALL NOT ATTEMPT COLLECTION EFFORTS WHILE SUCH DETERMINATION IS BEING MADE. IV.A PATIENT MAY SUBMIT A FINANCIAL ASSISTANCE APPLICATION AT ANY TIME WITHIN 240 DAYS AFTER THE FIRST BILLING STATEMENT. HOWEVER, EXTRAORDINARY COLLECTION EFFORTS MAY BE COMMENCED AFTER 120 DAYS FROM THE FIRST BILLING STATEMENT, IF NO APPLICATION HAS BEEN SUBMITTED. V.APPROVALS FOR FINANCIAL SUPPORT WILL BE FOR A PERIOD OF 6 MONTHS. ANY SERVICES PROVIDED BEYOND THE FAP APPROVAL PERIOD WILL REQUIRE A NEW APPLICATION. G.TERMS FOR FINANCIAL ASSISTANCE - FULL APPLICATION ONLY I.THE COMPLETED FULL APPLICATION MUST BE ACCOMPANIED WITH THE REQUIRED SUPPORTING DOCUMENTATION AND RETURNED TO CRMC FOR PROCESSING WITHIN 30 DAYS OF RECEIPT OF THE APPLICATION. ONCE THE COMPLETED APPLICATION AND REQUIRED DOCUMENTATION HAS BEEN RECEIVED, CRMC HAS 20DAYS TO PROCESS A WRITTEN APPROVAL OR WRITTEN DENIAL. DETERMINATION OF NEED FOR FINANCIAL ASSISTANCE WILL BE MADE BASED UPON THE INFORMATION PROVIDED ON THE FINANCIAL ASSISTANCE APPLICATION ALONG WITH DATA OBTAINED BY CRMC OR SUCH OTHER FIRM RETAINED TO ASSIST THE HOSPITAL IN PROCESSING SUCH APPLICATIONS. APPROVALS FOR FINANCIAL SUPPORT WILL BE FOR A PERIOD OF 6 MONTHS, IN ADDITION FOR APPROVED FULL APPLICATIONS ANY OPEN BALANCES (NOT IN BAD DEBT / COLLECTION) WITHIN 2 YEARS OF APPROVAL DATE ARE ALSO ELIGIBLE FOR THE FAP AWARD. II.PATIENTS HAVE 20 DAYS FROM THE DATE OF THE APPROVAL OR DENIAL TO APPEAL THE DETERMINATION. APPEALS MUST BE SUBMITTED IN WRITING TO: CORTLAND REGIONAL MEDICAL CENTER, 134 HOMER AVENUE, CORTLAND, NY 13045 ATTN: PATIENT FINANCIAL NAVIGATOR. III.INCOMPLETE APPLICATIONS AND/OR MISSING DOCUMENTATION CAN RESULT IN A DENIAL. CRMC WILL ATTEMPT TO GET THE MISSING INFORMATION AFTER THE REVIEW OF THE ORIGINAL APPLICATION. APPLICATIONS DEEMED TO BE INCOMPLETE WILL BE RETURNED TO THE APPLICANT WITH NOTIFICATION THAT FAILURE TO PROVIDE ALL REQUIRED DATA WITHIN 20 DAYS OF RECEIPT OF THE RETURNED APPLICATION WILL RESULT IN A DENIAL FOR FINANCIAL AID. IV.CRMC WILL HOLD THE BILLING FOR ANY ACCOUNTS THAT ARE BEING CONSIDERED FOR FINANCIAL AID. CRMC WILL INFORM THE PATIENT OF SUCH. V.A SEPARATE POLICY, CRMC POLICY # OP-020-23 - BILLING AND COLLECTIONS, ADDRESSES THE ACTIONS THAT THE HOSPITAL MAY TAKE IN THE EVENT OF NONPAYMENT. THOSE ACTIONS SPECIFY 1.OUR CONTRACTED COLLECTION AGENCIES COMPLY WITH CRMC'S FINANCIAL ASSISTANCE POLICY AND WILL PROVIDE APPLICATION INFORMATION TO INDIVIDUALS 2. PROHIBITS THE FORCED SALE OF FORECLOSURE OF AN INDIVIDUAL'S PRIMARY RESIDENCE 3. REQUIRES THE COLLECTION AGENCY TO OBTAIN CRMC'S APPROVAL BEFORE COMMENCING LEGAL ACTION 4. PAYMENT PLANS MONTHLY INSTALLMENTS CANNOT EXCEED 10% OF THE INDIVIDUAL'S MONTHLY GROSS INCOME. A FREE COPY OF CRMC'S BILLING AND COLLECTION POLICY IS AVAILABLE UPON REQUEST BY CALLING 607-756-3838 OR BY WRITTEN REQUEST MAILED TO: CORTLAND REGIONAL MEDICAL CENTER, 134 HOMER AVENUE, CORTLAND, NY 13045 ATTN: PATIENT FINANCIAL NAVIGATOR. H.LEVEL OF FINANCIAL SUPPORT I.CRMC WILL FOLLOW THE INCOME GUIDELINES ESTABLISHED BELOW IN EVALUATING A PATIENT'S ELIGIBILITY FOR FINANCIAL SUPPORT. A PERCENTAGE OF THE FEDERAL POVERTY GUIDELINES (FAP), WHICH IS UPDATED ON AN ANNUAL BASIS, IS USED FOR DETERMINING A PATIENT'S ELIGIBILITY FOR FINANCIAL SUPPORT. HOWEVER, OTHER FACTORS, AS IDENTIFIED ABOVE, ALSO SHOULD BE CONSIDERED SUCH AS THE PATIENT'S FINANCIAL STATUS AND/OR ABILITY TO PAY AS DETERMINED THROUGH THE ASSESSMENT PROCESS. II.FAMILY INCOME AT OR BELOW 200% OF FEDERAL POVERTY INCOME GUIDELINES: III.A FULL 100% DISCOUNT OFF ALL UNINSURED PATIENT BALANCES AND/OR INSURED PATIENT RESPONSIBLE BALANCES SPECIFIED BY THEIR INSURANCE CARRIER WILL BE PROVIDED FOR PATIENTS WHOSE FAMILY'S INCOME IS AT OR BELOW 200% OF THE MOST RECENT FEDERAL POVERTY INCOME GUIDELINES. PATIENTS WITH FAMILY INCOME UP TO AND INCLUDING 200% OF THE FEDERAL POVERTY INCOME GUIDELINES WILL BE ELIGIBLE FOR FINANCIAL SUPPORT FOR CO-PAY AND DEDUCTIBLE AMOUNTS PROVIDED THAT THERE IS NO CONFLICT WITH CONTRACTUAL ARRANGEMENTS WITH THE PATIENT'S INSURER AND THAT THEY APPLY FOR FINANCIAL ASSISTANCE. IV.FAMILY INCOME BETWEEN 201% AND 300% OF FEDERAL POVERTY INCOME GUIDELINES: A DISCOUNT OFF ALL UNINSURED PATIENT BALANCES AND/OR PATIENT RESPONSIBLE BALANCES SPECIFIED BY THEIR INSURANCE CARRIER WILL BE PROVIDED FOR PATIENTS WHOSE FAMILY'S INCOME FALLS WITHIN 201% TO 300 %OF FPL. DISCOUNT WILL BE BASED UPON FAMILY SIZE AND INCOME, SEE ATTACHMENT A FOR INCOME AND DISCOUNT GUIDELINES. V.MEDICALLY INDIGENT SUPPORT / CATASTROPHIC: FINANCIAL SUPPORT IS ALSO PROVIDED FOR MEDICALLY INDIGENT PATIENTS. MEDICAL INDIGENCE OCCURS WHEN A PERSON IS UNABLE TO PAY SOME OR ALL OF THEIR MEDICAL BILLS BECAUSE THEIR MEDICAL EXPENSES EXCEED A CERTAIN PERCENTAGE OF THEIR FAMILY OR HOUSEHOLD INCOME (FOR EXAMPLE, DUE TO CATASTROPHIC COSTS OR CONDITIONS), REGARDLESS OF WHETHER THEY HAVE INCOME OR ASSETS THAT OTHERWISE EXCEED THE FINANCIAL ELIGIBILITY REQUIREMENTS FOR FREE OR DISCOUNTED CARE UNDER CRMC'S FAP. CATASTROPHIC COSTS OR CONDITIONS OCCUR WHEN THERE IS A LOSS OF EMPLOYMENT, DEATH OF PRIMARY WAGE EARNER, EXCESSIVE MEDICAL EXPENSES OR OTHER UNFORTUNATE EVENTS. MEDICAL INDIGENCE / CATASTROPHIC CIRCUMSTANCES WILL BE EVALUATED ON A CASE-BY-CASE BASIS THAT INCLUDES A REVIEW OF THE PATIENT'S INCOME, EXPENSES AND ASSETS. IF AN INSURED PATIENT CLAIMS CATASTROPHIC CIRCUMSTANCES AND APPLIES FOR FINANCIAL ASSISTANCE, MEDICAL EXPENSES FOR AN EPISODE OF CARE THAT EXCEED 20% OF INCOME WILL PERMIT CO-PAYS AND DEDUCTIBLES TO QUALIFY AS CATASTROPHIC FINANCIAL ASSISTANCE DISCOUNTS FOR MEDICALLY INDIGENT CARE FOR THE UNINSURED WILL NOT BE LESS THAN CRMC'S AVERAGE CONTRACTUAL ADJUSTMENT AMOUNT FOR MEDICARE FOR THE SERVICES PROVIDED OR AN AMOUNT TO BRING THE PATIENTS CATASTROPHIC MEDICAL EXPENSE TO INCOME RATIO BACK TO 20%. MEDICAL INDIGENT AND CATASTROPHIC FINANCIAL ASSISTANCE WILL BE APPROVED BY CRMC DIRECTOR OF REVENUE CYCLE AND/OR MANAGER OF PATIENT FINANCIAL SERVICES VI.WHILE FINANCIAL SUPPORT SHOULD BE MADE IN ACCORDANCE WITH CRMC'S ESTABLISHED WRITTEN CRITERIA, IT IS RECOGNIZED THAT OCCASIONALLY THERE WILL BE A NEED FOR GRANTING ADDITIONAL FINANCIAL SUPPORT TO PATIENTS BASED UPON INDIVIDUAL CONSIDERATIONS. SUCH INDIVIDUAL CONSIDERATIONS WILL BE APPROVED BY CRMC CFO. FORM 990, SCHEDULE H, PART III, LINE 8 CONTINUATION: FINANCIAL ASSISTANCE POLICY G.ACCOUNTING AND REPORTING FOR FINANCIAL SUPPORT I.IN ACCORDANCE WITH THE GENERALLY ACCEPTED ACCOUNTING PRINCIPLES, FINANCIAL SUPPORT PROVIDED BY CRMC IS RECORDED SYSTEMATICALLY AND ACCURATELY IN THE FINANCIAL STATEMENTS AS A DEDUCTION FROM REVENUE IN THE CATEGORY FINANCIAL ASSISTANCE. FOR THE PURPOSES OF COMMUNITY BENEFIT REPORTING, FINANCIAL ASSISTANCE IS REPORTED AT ESTIMATED COST. II.THE FOLLOWING GUIDELINES ARE PROVIDED FOR THE FINANCIAL STATEMENT RECORDING OF FINANCIAL SUPPORT: "FINANCIAL SUPPORT PROVIDED TO PATIENTS UNDER THE PROVISIONS OF "FINANCIAL ASSISTANCE PROGRAM", INCLUDING THE ADJUSTMENT FOR AMOUNTS GENERALLY ACCEPTED AS PAYMENT FOR PATIENTS WITH INSURANCE, WILL BE RECORDED UNDER "FINANCIAL ASSISTANCE ALLOWANCE." "WRITE-OFF OF CHARGES FOR PATIENTS WHO HAVE NOT QUALIFIED FOR FINANCIAL SUPPORT UNDER THIS PROCEDURE AND WHO DO NOT PAY WILL BE RECORDED AS "BAD DEBT." "PROMPT PAY DISCOUNTS WILL BE RECORDED UNDER "OPERATIONAL ADJUSTMENTS- ADMINISTRATIVE OR "CONTRACTUAL ALLOWANCE." "ACCOUNTS INITIALLY WRITTEN-OFF TO BAD DEBT AND SUBSEQUENTLY RETURNED FROM COLLECTION AGENCIES WHERE THE PATIENT WAS DETERMINED TO HAVE MET THE FINANCIAL SUPPORT CRITERIA BASED ON INFORMATION OBTAINED BY THE COLLECTION AGENCY WILL BE RECLASSIFIED FROM "BAD DEBT" TO FINANCIAL ASSISTANCE ALLOWANCE". II.ASSISTING PATIENTS WHO MAY QUALIFY FOR COVERAGE A.CRMC WILL MAKE AFFIRMATIVE EFFORTS TO HELP PATIENTS APPLY FOR PUBLIC AND PRIVATE PROGRAMS FOR WHICH THEY MAY QUALIFY AND THAT MAY ASSIST THEM IN OBTAINING AND PAYING FOR HEALTH CARE SERVICES. B.CRMC WILL HAVE UNDERSTANDABLE, WRITTEN PROCEDURES TO HELP PATIENTS DETERMINE IF THEY QUALIFY FOR PUBLIC ASSISTANCE PROGRAMS OR CRMC'S FINANCIAL ASSISTANCE POLICY. III.EFFECTIVE COMMUNICATIONS A.CRMC WILL PROVIDE FINANCIAL COUNSELING TO PATIENTS ABOUT THEIR HEALTH CARE BILLS RELATED TO THE SERVICES THEY RECEIVED AT CRMC AND WILL MAKE THE AVAILABILITY OF SUCH COUNSELING. COUNSELING IS AVAILABLE AT TIME OF ADMISSION, DISCHARGE OR AT ANY TIME THE PATIENT CHOOSES TO REQUEST ASSISTANCE. CRMC'S PATIENT FINANCIAL NAVIGATOR IS AVAILABLE BETWEEN THE HOURS OF 8:00 AM AND 4:00 PM MONDAY THROUGH FRIDAY. THE NAVIGATORS OFFICE IS LOCATED ON THE HOSPITALS FIRST FLOOR NEXT TO THE CASHIERS OFFICE. IN ADDITION THE NAVIGATOR WILL ROUTINELY CALL OR WHERE ABLE, VISIT ALL PATIENTS ADMITTED WITH NO INSURANCE. THIS POLICY ONLY COVERS SERVICES PROVIDED BY THE HOSPITAL. THIS POLICY DOES NOT APPLY TO OTHER BILLS YOU MAY RECEIVE FROM PRIVATE PHYSICIANS WHO MAY BE INVOLVED IN YOUR CARE INCLUDING BUT NOT LIMITED TO: RADIOLOGISTS, PATHOLOGISTS, ANESTHESIOLOGISTS OR EMERGENCY ROOM PHYSICIANS. B.RMC WILL RESPOND PROMPTLY AND COURTEOUSLY TO PATIENTS' QUESTIONS ABOUT THEIR BILLS AND REQUESTS FOR FINANCIAL ASSISTANCE. C.CRMC WILL UTILIZE A BILLING PROCESS THAT IS CLEAR, CONCISE, CORRECT AND PATIENT FRIENDLY. PATIENT STATEMENTS WILL INCLUDE INFORMATION ON THE AVAILABILITY OF OUR FINANCIAL AID POLICY AND HOW TO CONTACT CRMC FOR MORE INFORMATION. D.CRMC WILL MAKE AVAILABLE FOR REVIEW BY THE PUBLIC SPECIFIC INFORMATION IN AN UNDERSTANDABLE FORMAT ABOUT WHAT THEY CHARGE FOR SERVICES. E.CRMC WILL POST SIGNS AND DISPLAY BROCHURES THAT PROVIDE BASIC INFORMATION ABOUT THEIR FINANCIAL ASSISTANCE POLICY (FAP) IN PUBLIC LOCATIONS: INCLUDING ALL OUTPATIENT REGISTRATION SITES, ER AND PROMPT CARE. IN ADDITION COPIES OF CRMC'S PLAIN LANGUAGE SUMMARY WILL BE PROVIDED TO ALL INPATIENT AND OBSERVATION PATIENTS AT TIME OF ADMISSION AND OFFERED TO ALL OUTPATIENTS AT INTAKE. F.CRMC WILL MAKE THE FINANCIAL ASSISTANCE POLICY (FAP), A PLAIN LANGUAGE SUMMARY OF THE FAP AND THE FAP APPLICATION FORM AVAILABLE TO PATIENTS UPON REQUEST, IN PUBLIC PLACES IN CRMC - INCLUDING ALL OUTPATIENT REGISTRATION SITES, ER AND PROMPT CARE, VIA MAIL AND ON THE CRMC WEBSITE. CRMC OFFERS ACCESS TO THE INTERNET FOR PATIENTS TO BE ABLE TO VIEW, DOWNLOAD AND PRINT A HARD COPY OF THESE DOCUMENTS. CRMC WILL PROVIDE ANY INDIVIDUAL WHO ASKS INFORMATION ON HOW TO ACCESS A COPY OF THE FAP, FAP APPLICATION FORM, OR PLAIN LANGUAGE SUMMARY OF THE FAP ONLINE WITH THE DIRECT WEBSITE ADDRESS, OR URL, WHERE THESE DOCUMENTS ARE POSTED. G.THESE DOCUMENTS WILL BE MADE AVAILABLE IN ENGLISH AND IN THE PRIMARY LANGUAGE OF ANY POPULATION WITH LIMITED PROFICIENCY IN ENGLISH THAT CONSTITUTES MORE THAN 100 PEOPLE OR 5 PERCENT OF THE RESIDENTS OF THE COMMUNITY SERVED BY CRMC. CRMC WILL LIST ITS FINANCIAL ASSISTANCE POLICY AND SUPPORTING DOCUMENTS ON THEIR WEBSITE. H.CRMC WILL PROVIDE A DESCRIPTION IN THE FAP OF THE MEASURES TAKEN TO NOTIFY MEMBERS OF THE COMMUNITY SERVED BY CRMC ABOUT THE FAP. SUCH MEASURES MAY INCLUDE, FOR EXAMPLE, THE DISTRIBUTION OF INFORMATION SHEETS SUMMARIZING THE FAP TO LOCAL PUBLIC AGENCIES AND NONPROFIT ORGANIZATIONS THAT ADDRESS THE HEALTH NEEDS OF THE COMMUNITY'S LOW INCOME POPULATIONS. IV.IMPLEMENTATION OF ACCURATE AND CONSISTENT POLICIES A.PATIENT FINANCIAL SERVICES AND PATIENT ACCESS WILL EDUCATE STAFF MEMBERS WHO WORK CLOSELY WITH PATIENTS (INCLUDING THOSE WORKING IN PATIENT REGISTRATION AND ADMITTING, FINANCIAL ASSISTANCE, CUSTOMER SERVICE, BILLING AND COLLECTIONS, PHYSICIAN OFFICES) ABOUT BILLING, FINANCIAL ASSISTANCE, COLLECTION POLICIES AND PRACTICES, AND TREATMENT OF ALL PATIENTS WITH DIGNITY AND RESPECT REGARDLESS OF THEIR INSURANCE STATUS OR THEIR ABILITY TO PAY FOR SERVICES. B.CRMC WILL HONOR FINANCIAL SUPPORT COMMITMENTS THAT WERE APPROVED UNDER PREVIOUS FINANCIAL ASSISTANCE GUIDELINES. AT THE END OF THAT ELIGIBILITY PERIOD THE PATIENT MAY BE RE-EVALUATED FOR FINANCIAL SUPPORT USING THE GUIDELINES ESTABLISHED IN THIS PROCEDURE. REFERENCES: "PATIENT PROTECTION AND AFFORDABLE CARE ACT STATUTORY SECTION 501(R) "INTERNAL REVENUE SERVICE SCHEDULE H (FORM 990) DEPARTMENT OF TREASURY, INTERNAL REVENUE SERVICE, ADDITIONAL REQUIREMENTS FOR CHARITABLE HOSPITALS; PROPOSED RULE: VOLUME 77, NO. 123, PART II, 26 CFR, SCHEDULE H, PARTI, LN 7 COL (F): CONTINUATION COLLECTION POLICY: 13.CONTACT BY EMBARRASSING MEDIA, SUCH AS COMMUNICATING WITH A CONSUMER REGARDING A DEBT BY POST CARD, OR USING ANY LANGUAGE OR SYMBOL, OTHER THAN THE DEBT COLLECTOR'S ADDRESS, ON ANY ENVELOPE WHEN COMMUNICATING WITH A CONSUMER BY USE OF THE MAILS OR BY TELEGRAM, EXCEPT THAT A DEBT COLLECTOR MAY USE HIS BUSINESS NAME IF SUCH NAME DOES NOT INDICATE THAT HE IS IN THE DEBT COLLECTION BUSINESS; 14.REPORTING FALSE INFORMATION ON A CONSUMER'S CREDIT REPORT OR THREATENING TO DO SO IN THE PROCESS OF COLLECTION. PAYMENT PLAN POLICY: PURPOSE TO ESTABLISH GUIDELINES BY WHICH CORTLAND REGIONAL MEDICAL CENTER WILL OFFER PATIENTS EXTENDED TIME PERIODS TO MAKE PAYMENT IN FULL ON OUTSTANDING SELF PAY BALANCES. DEFINITIONS "PAYMENT PLANS" ARE DEFINED AS INSTALLMENT ARRANGEMENTS FOR PATIENTS WHO ARE NOT ABLE TO PAY ACCOUNT BALANCES IN FULL AT THE TIME OF RECEIPT OF BILL. POLICY: TO PROVIDE PATIENTS OPTIONS ON PAYING OFF DEBT OWED TO CRMC FOR BILLS INCURRED FOR SERVICES PROVIDED BY THE MEDICAL CENTER. PROCEDURE 1)PATIENTS WILL RECEIVE BILLS ON TYPICAL BILLING CYCLE IN WHICH A DEBT IS OWED. 2)PATIENTS WILL BE CONTACTED THROUGH OUTSOURCED BUSINESS OFFICE FOR FOLLOW-UP AND SET UP OF PAYMENT PLAN. IF PATIENT REQUESTS FINANCIAL ASSISTANCE AND APPLICATION WILL BE SENT TO THE PATIENT. THE FOLLOWING CRITERIA WILL BE USED TO DETERMINE THE ALLOWABLE INSTALLMENT TERMS BY WHICH MONTHLY PAYMENTS WILL BE MADE INTERNALLY TO CRMC. PATIENT BALANCE CONTRACT PAYMENT AMOUNT MAXIMUM TERM BELOW $200.00 EXPECTED PAYMENT IN FULL - MINIMUM PAYMENT OF $50.00 $200.00 - $500.00 MINIMUM OF $50.00/MONTH 4-6 MONTHS $501.00 - $1000.00 MINIMUM OF 75.00/MONTH 7-13 MONTHS $1001.00 - $1500.00 MINIMUM OF 100.00/MONTH 10-15 MONTHS $1501.00 - $2000.00 MINIMUM OF 125.00/MONTH 12-16 MONTHS $2001.00 - $3000.00 MINUMUM OF 150.00/MONTH 13-20 MONTHS $3001.00 - OVER BALANCE IN FULL EXTEND UP TO 24 MONTHS MAX - 24 MONTHS 3)EXTENDED PAYMENT PLANS THROUGH HEALTH FIRST UP TO 24 MONTHS WILL BE AT 0% INTEREST. PAYMENT PLANS FROM 25 TO 60 MONTHS WILL BE AT 4% INTEREST. 4)BUSINESS OFFICE WILL PROVIDE THE PATIENT WITH THE PHONE NUMBER AND WILL CONTINUE TO SEND REGULAR BILLING STATEMENTS UNTIL APPROVAL IS COMPLETE. 5)IF PATIENT FAILS TO SIGN UP FOR EXTENDED LOAN CRMC WILL CONTINUE SELF-PAY COLLECTION CYCLE UNTIL SUCH TIME PATIENT WOULD QUALIFY FOR BAD DEBT. 6)LOANS THROUGH HEALTHFIRST ARE SET UP PER AGENCY DISCRETION AND MINIMUM PAYMENT STANDARDS. 7)IF LOAN DEFAULTS THROUGH HEALTHFIRST, ACCOUNT WILL RETURN TO CRMC FOR DEBT COLLECTION PROCESS AND FUNDED LOAN REMAINING BALANCE WILL BE RECOURSE BACK TO HEALTHFIRST. 8)PAYMENT PLAN REQUESTS FROM PATIENTS AND/OR GUARANTORS CAN BE EVALUATED, APPROVED, AND SET UP BY ALL BUSINESS OFFICE EMPLOYEES AS LONG AS THEY ARE IN COMPLIANCE WITH POLICY GUIDELINES, BUT SHOULD GO THROUGH PATIENT FINANCIAL NAVIGATOR UNLESS UNAVAILABLE. ANY EXCEPTIONS MUST BE REVIEWED AND APPROVED BY THE RELEVANT MANAGEMENT STAFF IN THE ABOVE LISTED AREAS. 9)EXISTING PAYMENT PLAN TERMS MAY BE ALTERED OR EXTENDED ON A TEMPORARY OR PERMANENT BASIS AS LONG AS THEY ARE IN COMPLIANCE WITH POLICY GUIDELINES. ANY EXCEPTIONS MUST BE REVIEWED AND APPROVED BY THE REVENUE CYCLE SUPERVISOR. 10)PATIENTS ON ESTABLISHED PAYMENT PLANS WHO DEFAULT IN THEIR MONTHLY PAYMENTS FOR TWO CONSECUTIVE MONTHS MAY BE REFERRED TO A COLLECTION AGENCY. 11)IF ANY NEW BALANCES ARE TRANSFERRED TO SELF-PAY RESPONSIBILITY AFTER A PAYMENT PLAN HAS ALREADY BEEN IMPLEMENTED, THEY ARE ELIGIBLE TO BE ROLLED INTO THE EXISTING PAYMENT PLAN AND WILL BE ADJUSTED IN ORDER TO COMPLY WITH THE ABOVE CRITERIA. CMH GROUP 134 HOMER AVENUE CORTLAND NY 13045 222933722 PARENT CORPORATION NY 501(C)(3) 11D N/A 0 CMH FOUNDATION 134 HOMER AVENUE CORTLAND NY 13045 222230692 RAISE FUNDS ONLY FOR THE HOSPITAL NY 501(C)(3) 7 CMH GROUP 0 REGIONAL MEDICAL PRACTICE 134 HOMER AVENUE CORTLAND NY 13045 204848729 PHYSICIAN GROUP NY 501(C)(3) 3 CORTLAND REGIONAL MEDICAL CENTER 0 CMH SERVICES 134 HOMER AVENUE CORTLAND NY 13045 161370440 DURABLE MEDICAL EQUIPMENT NY CM GROUP C 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0