2016-10-06T08:16:57-07:00 2015-12-31 990 2015-01-01 160835446 IRA DAVENPORT MEMORIAL HOSPITAL INC IRAD 6077768500 7571 State Route 54 Bath NY 14810 Ronald Kintz CFO 6077374325 2016-09-01 2015 2017-02-10 21:41:12Z Ronald J Kintz 600 Roe Ave Elmira NY 14905 22835005 0 X www.arnothealth.org X 1910 NY IRA DAVENPORT MEMORIAL HOSPITAL IS DEDICATED TO ENHANCING THE QUALITY OF LIFE WITHIN THEIR RURAL COMMUNITY. 11 9 361 28 0 0 269522 299583 21983133 21924572 266655 35149 611554 554581 23130864 22813885 0 0 0 0 12395998 12175241 0 0 0 10762627 11860327 23158625 24035568 -27761 -1221683 22253572 18825598 8023382 5706252 14230190 13119346 IRA DAVENPORT MEMORIAL HOSPITAL IS DEDICATED TO ENHANCING THE QUALITY OF LIFE WITHIN THEIR RURAL COMMUNITY BY PROVIDING LOCAL HIGH QUALITY PRIMARY, ACUTE, RESTORATIVE AND RESIDENTIAL HEALTH SERVICES. 0 0 18076946 299583 22813888 IRA DAVENPORT PROVIDED BOTH ACUTE CARE AND LONG-TERM CARE SERVICES TO PATIENTS DURING 2015. LONG-TERM CARE DAYS WERE 40,172 AND THE HOSPITAL HAD 604 DISCHARGES. THE FRED AND HARRIETT TAYLOR HEALTH CARE CENTER IS A 120 BED LONG-TERM CARE/SKILLED NURSING FACILITY. THE HEALTH CENTER PROVIDES A COMMUNITY FOR PEOPLE WHO REQUIRE ASSISTANCE WITH DAILY LIVING OR AROUND-THE-CLOCK NURSING SERVICES. THE HEALTH CARE CENTER ALSO PROVIDES DAY CARE SERVICES AND REHABILITATION SERVICES. 0 0 0 18076946 1 1 0 1 0 0 0 0 0 1 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 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 361 1 0 0 0 0 0 0 X 11 9 1 1 0 0 0 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X X RONALD KINTZ 6077374325 600 Roe Ave Elmira NY 14905 Patrick J Rogers Chairman of the Board 2 1.0 X 0 0 0 Scott Sprague Vice Chairman 1 0 X 0 0 0 Bernard Burns Secretary 1 0 X 0 0 0 Joseph F Meade Treasurer 1 0 X 0 0 0 Jeffrey Albright Board Member 1 0 X 0 0 0 Patricia Baroody Board Member 1 0 X 0 0 0 Mary Hope Benedict Board Member 1 0 X 0 0 0 Werner Brammer MD Board Member 1 0 X 0 0 0 Mark Hagan Board Member 1 0 X 0 0 0 Bridgette Lanphere Board Member 1 0 X 0 0 0 David Nesbitt Board Member 1 0 X 0 0 0 Dennis O' Connor MD Medical Director 1 0 X X 58889 0 1757 Ronald J Kintz Senior VP/CFO 1.00 49.00 X 0 392468 36827 Robert Lambert President Arnot Health 1.00 49.00 X 0 630621 36827 H Fred Farley Hospital President COO 1.00 44.00 X 0 394339 36827 James Watson President IDMH 40.00 0.00 X X 0 227391 9740 Kevin Murray Director of Pharmacy 40 0 X 149642 0 12252 Vandelinder AmyBeth DIR LABORATORY SVS 40 0 X 100168 0 3101 308699 1644819 137331 6 0 1 1 Delphi Healthcare PLLC 1880 East Ride Road Suite 6 Upper Level Rochester NY 14622 ER Doctor coverage 745595 Delphi Hospitalist Services 1880 East Ridge Road Suite 6 Upper Level Rochester NY 14622 Emergency Physicians 478553 Kings Medical Group 1920 A Georgetown Road Hudson OH 44236 Medical Services 219820 Medical Solutions 1010 N 102nd Street Suite 300 Omaha NE 68114 Contracted RN service 216362 Focusone Solutions LLC 13609 California St Omaha NE 68154 Contracted Employee 152454 8 0 0 0 0 200871 98712 0 299583 Net Patient Service Revenue 622110 23722072 23722072 0 0 Bad Debt 622110 -1797500 -1797500 0 0 0 0 0 0 21924572 35149 35149 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 102668 21120 81548 81548 0 0 Managements Infromatins Services 900099 244286 244286 0 0 Contracted Therapy 900099 12518 12518 0 0 Miscellaneous 900099 216229 216229 0 0 0 0 0 0 473033 22813885 22514302 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 9916344 8441286 1475058 0 186308 0 186308 0 1339993 0 1339993 0 732596 612783 119813 0 413385 263788 149597 0 27575 0 27575 0 5375 0 5375 0 4069 0 4069 0 0 0 2858 30 2828 0 1810077 1684048 126029 0 13548 12 13536 0 719038 506268 212770 0 179999 12764 167235 0 0 0 0 0 384633 15235 369398 0 14723 2138 12585 0 0 0 0 0 3538 2107 1431 0 27136 0 27136 0 0 0 0 0 1341080 743651 597429 0 199980 0 199980 0 Medical/Surgical/Pharmaceutical Supplies 1914217 1899253 14964 0 Maintenance Contracts/Purshased Services 4039565 1991843 2047722 0 Leases 89404 58106 31298 0 Benefits Allocations 0 1299530 -1299530 0 670127 544104 126023 0 24035568 18076946 5958622 0 53234 43485 534382 459463 200000 36276 4642449 3036129 0 0 0 0 601796 20472 376092 384205 110200 88871 33109940 21679419 12304080 11430521 3431339 3326176 22253572 18825598 1508751 1355880 0 0 0 0 0 601148 468250 0 5913483 3882122 8023382 5706252 X 11377456 10219268 2827122 2874467 25612 25611 14230190 13119346 22253572 18825598 X -1221683 0 0 0 0 110839 X 1 X 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 4069 4069 0 Schedule C, Part II-B, Line 1 IDMH pays annual dues to American Hospital Associations, AHA and Healthcare Association of New York State, HANYS of which a percentage is for lobbying fees. The total fees paid to all in 2015 is $4,069 194062 133021 0 0 85676 0 241407 407988 134415 0 0 348341 0 194062 536754 118059 0 0 246825 0 407988 335165 499265 2324 0 300000 0 536754 25612 309553 0 0 0 0 335165 0 0.11 0.89 0 1 1 52925 0 52925 16717636 0 7902519 8815117 0 0 0 0 16339379 0 13776900 2562479 0 0 0 0 11430521 IDMH Children's Department Fund (children Trust Fund) 2120340 Deprecation Funds 850000 Interest in Net Assets of foundation 355836 3326176 0 Self Insurnace Reserve 1413281 Accrued Pension Cost 65429 Accrued Reimbursement Pay Net 1172085 Due to Arnot Health 1231327 3882122 22835005 0 0 0 21120 21120 22813885 0 0 0 22813885 24056688 0 0 0 21120 21120 24035568 0 0 0 24035568 Schedule D, Part V, Line 4 The Intended uses for the endowment funds are based upon the designation from the organization documents which include staff educations, community education, and charity care. The board endowment fund is a board designed or use in the highest area of need Schedule D, Part XI, Line 2d Nutritional Service Expense of 21,120 reclass to reduce Revenue on Cost of Goods Sold Schedule D, Part XII, Line 2d Nutritional services expense of 21,120 offset to nutritional service income 1 1 X 1 X 1 X 1 1 0 1 1 0 134 70172 2995 67177 0.0028 0 0 0 0 0 0 0 9054 3176294 1649849 1526445 0.0635 0 9188 3246466 1652844 1593622 0.0663 23 2209 10567 0 10567 0.0004 2 59 206 0 206 0 9 87626 10190696 8730956 1459740 0.0607 0 0 0 0 0 0 5 1720 265 119 146 0 39 91614 10201734 8731075 1470659 0.0611 39 100802 13448200 10383919 3064281 0.1274 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 151371 151371 0 0 0 0 0 0 0 0 0 0 151371 151371 0 0 0 1797500 0 1836163 1975420 -139257 X 1 1 ARNOT OGDEN MEDICAL CENTER ADMINISTRATION & CONSULTING 0 0 0 1 1 IRA DAVENPORT MEMORIAL HOSPITAL 7571 ROUTE 54 BATH NY 14810 www.arnothealth.org X X IRA DAVENPORT MEMORIAL HOSPITAL 1 0 0 1 X X X X X X X X 15 1 1 1 1 X www.arnothealth.org X X 1 15 1 www.arnothealth.org 0 0 1 X 150 400 X X X 1 1 X X X 1 X www.arnothealth.org X www.arnothealth.org X www.arnothealth.org X X X X X 1 X 0 X X X X 1 X 0 1 Schedule H, Part V, Section B, Line 5-IRA DAVENPORT MEMORIAL HOSPITAL Arnot Health remains committed to preventing chronic disease in the community through free preventative health screenings, health promotion programs and wellness education. In 2015 Arnot Health participated in over 100 community events and served over 2,500 individuals in Chemung, Steuben and Schuyler Counties. Free health screenings included: blood pressure, blood glucose, diabetes risk assessment, stroke assessments, body fat analysis, body mass index, tobacco use screening, carboxyhemoglobin, and lung age. In addition to community outreach events Arnot Health serves populations at risk for developing chronic disease by offering free monthly health screenings in medically underserved locations such as soup kitchens and senior centers within a medically underserved area. Arnot Health Heart Vascular Institute also offers free weekly blood pressure screenings for the community. Community Health and outreach also includes working with local schools and summer programs to offer highly interactive educational programs on topics such as nutrition, sun safety, physical activity, injury prevention and tobacco use prevention. Arnot Health continues to serve on the Elmira City School District Wellness Committee and collaborated with the school district to develop new wellness policies that included healthier options in vending machines and increased physical activity during class time. Arnot Health continued to inform school officials on important health issues impacting the community and contributed topics for discussion at student forums and interactive community activities. Arnot Health collaborated with health and human service agencies to provide the Graduate Medical Education Residents with community rotations such as Arnot Health HIV Primary Care and Disease Management, Economic Opportunity Program Inc, Head Start Program, Comprehensive Interdisciplinary Developmental Services Inc, Chemung County Home Health Agency and Community Immunization Clinics. Arnot Health's Health Center for Women and the Falck Cancer Center includes working collaboratively with the New York State Cancer Services Program to provide free breast, cervical and colorectal screenings for the un/underinsured. Other cancer prevention strategies include annual skin cancer screenings and a lung cancer screening program for community members with a history of long term tobacco use. Falck Cancer Center offers a wide range of free monthly support groups for cancer survivors in the community. Arnot Health Diabetes Center provides diabetes education, support and management, and served over 350 community members in 2015. Other services provided by the Diabetes Center include insulin pump instruction and nutritional counseling. All diabetes education offered by Arnot Health is provided by Certified Diabetes Educators and is in accordance with the American Diabetes Association Standards of Care. Arnot Health has a leadership role in the multicounty Southern Tier Diabetes Coalition and in the planning and implementation of an annual Diabetes Fair in the fall of each year. In 2015 over 300 community members received diabetes prevention and management education and preventative health screenings. Education and screening opportunities included blood pressure, body fat and blood glucose screenings; foot care education; diabetes risk assessments; nutrition education meal planning and information on diabetes medications and equipment; and information about support groups and chronic disease self management classes. pneumovax and influenza vaccines were also provided. Arnot Health continues to collaborate with preventative health partners in Chemung and Steuben Counties and participates in the promotion and facilitation of evidence based programs such as the Chronic Disease Self Management Program, the Diabetes Self Management Program, and the National Diabetes Prevention Program, and Living Healthy workshops. Lower socioeconomic status is associated with an increased risk of smoking initiation and progression to regular smoking, and a decreased likelihood of successful smoking cessation. Arnot Health is working with local health departments and diverse multicounty partnerships to update the 2013 Community Health Needs Assessment, and engage community members in identifying public health priorities and unmet needs in the community. The process will be completed and an updated Community Health Improvement Plan will be available to the community in December 2016. The following are the obesity prevention strategies implemented and the accomplishments of the CHP partnership over the last five years. Arnot Health and the CHP partnership rehabilitated, maintained and promoted parks and recreation facilities in underserved residential areas to offer safe and accessible opportunities for physical activity for persons of all ages and abilities. CHP partners and the City of Elmira enhanced parks and playgrounds for children to make them safe and accessible in the following locations: McKinnon Park, Grove Park, Millers Pond Park, Eldridge Park, McCanns Park, Blandford Park, Pulaski Park, Quatrano Park, Frank Rhode Park, Woodlawn Playground, and Mark Twain Riverfront Park. CHP partnership worked to improve a seven mile stretch of the Lackawanna Rail Trail by installing a fitness station, solar lights and a informational kiosk with Get Active Elmira maps that were created by the partnership to highlight the 23 parks and playgrounds. Safety assessments of parks and playgrounds were conducted by organizations serving the developmentally disabled populations, seniors and the visually impaired. Other strategies implemented to promote safe access to open spaces for physical activity include installation of visual impact signage at parks, playgrounds, trails and street crossings, installation of video cameras, improved street lighting, installation of cross walks and ADA compliant curb cut outs and tactile ramps and speed reduction with playground warning signs for traffic. To increase access to fresh fruit and vegetables, the CHP partnership created community gardens and enhanced existing vegetable gardens by working with community planning boards, neighborhood associations, schools, persons with disabilities, and senior and low income housing developments. Provided schools and youth community centers with community gardens, installed a tool shed and provided gardening supplies to establish and maintain community gardens in underserved areas, supported the development of a community garden for persons with developmental disabilities and supported the Food Bank of the Southern Tier with fresh fruits and vegetables grown in the community gardens. Community Gardens were established or enhanced in the following locations: Near Westside Victorian Garden, Katy Leary Park, Quatrano Park, and Economic Opportunity Program at Ernie Davis Community Center, Woodlawn Community Garden and the Elmira City School District. Strategies implemented by restaurants and the CHP partnership to prevent obesity and educate the community about healthier eating choices include developing 3 different long running TV ads promoting healthy eating at restaurants, table top displays of eating out health tips for each partnering restaurant and distributed educational materials on healthy food options at community outreach events. Worked with hospital system to adopt Healthy Meeting policy and offer daily Well Being meals in the hospitals cafeterias for employees and the public. Examples of programs offered in 2015 include Community Walking Program, Fit Families of the Southern Tier, Strong Kids Safe Kids, Girls on the Run of the Southern Tier and the Wineglass Marathon. Participants in the free six week Step it Up Community Walking Program receive pre and post program health screenings and over the last five years have had consistent outcomes averaging: 65% reduction in blood pressure, 41% reduction in blood glucose, 69% reduction in weight, 71% reduction in body fat or BMI, 55% reported making healthier food choices as a result of the program. Arnot Health offers the FFIST Program for obese children and their families to teach children how to make healthier food choices, and increase their physical activity through fun activities such as games and active play. Children in the eight week FFIST program also receive pre and post program weight, BMI and strength and endurance fitness testing. As a result of the program, children have shown gains in strength and endurance, and report making healthier food choices. Arnot Health serves on the Chemung County Board of Health, the Community Services Board, the Healthcare Association of New York State Community Health Taskforce and the New York State Department of Health Community Health Needs Assessment Ad Hoc Group. Schedule H, Part V, Section B, Line 6a-IRA DAVENPORT MEMORIAL HOSPITAL Arnot Health is comprised of three hospitals: Arnot Ogden Medical Center and St. Joseph's Hospital in Elmira; and Ira Davenport Memorial Hospital in Bath, New York. Arnot Health provides diagnostic, ambulatory, secondary and tertiary acute care, as well as substance abuse, psychiatric, rehabilitative, and wellness services to meet the needs of residents in Chemung, Steuben, and Schuyler Counties in the Southern Tier of New York, and Bradford and Tioga Counties in the Northern Tier of Pennsylvania. Arnot Ogden Medical Center, located in Elmira, NY and founded in 1888, is a not-for-profit, 256-bed tertiary medical facility offering specialty services including, cardiovascular care, cancer care, women's health services, emergency medicine and surgical services. Ira Davenport Memorial Hospital, located in Bath, NY and founded in 1910, is a not-for profit 38-bed acute care hospital offer ancillary services and emergency medicine. The campus also hosts a 120-bed skilled nursing facility, Taylor Health Center. St. Joseph's Hospital, located in Elmira, NY and founded in 1908 by the Sisters of St. Joseph of Rochester, New York, is a not-for-profit Catholic 79 acute care hospital specializing in orthopedic care, physical rehabilitation, geriatric medicine, behavioral science and alcohol rehabilitation. The campus also hosts a 111 bed skilled nursing facility. Arnot Medical Services is a multispecialty physician group associated with Arnot Health offering care throughout the Southern Tier of New York and Northern Tier of Pennsylvania in the areas of Cardiology, Cardiovascular Surgery, Endocrinology, ENT, Family Practice, Gastroenterology, Infectious Diseases, Internal Medicine, Nephrology, Neurology, Orthopedics, Pain Management, Rheumatology, Women's Health and Wound Care. Schedule H, Part V, Section B, Line 6b-IRA DAVENPORT MEMORIAL HOSPITAL In 2013 Arnot Health in collaboration with the Chemung county health department, Steuben County Public Health and a diverse community partnership conducted a comprehensive Community Health Needs Assessment (CHNA) to identify public health priorities in Chemung and Steuben Counties. The CHNA identified some overlapping area of public health concerns in Chemung and Steuben Counties. Schedule H, Part V, Section B, Line 7d-IRA DAVENPORT MEMORIAL HOSPITAL Arnot Ogden Medical Center will use a variety of methods to disseminate the community Service Plan for Arnot Ogden Medical Center, St. Joseph's Hospital and Ira Davenport Memorial Hospital, and the CHIPs for Chemung and Steuben Counties: Web site documents will be posted on the healthcares system web site at the following URL: http://www.arnothealth.org/about us. Arnot Health developed a section of the system's web site dedicated to community outreach in 2016, budget permitting to bring community service work to a more prominent place within the website. This can be accessed at: https://www.arnothealth.org/community-service-plans. Partner web sites Chemung and Steuben counties will post links to their CHA and CHIP on their web sites. Presentations at Arnot Health's Community Health Department provide education about the healthcare system and community outreach strategies. Schedule H, Part V, Section B, Line 11-IRA DAVENPORT MEMORIAL HOSPITAL Arnot Health promotes and supports the health in the community in many ways. The system hosts a variety of programs and activities in their facilities to meet specific needs within the community, and donates meeting space for activities such as: Blood Drives, Cancer survivor support groups, Community lectures, health screenings and workshops, Melanoma Monday Skin Cancer Screenings, Maternal, Child Health Education and Breastfeeding Classes, Community lactation rooms , CPR classes, Alcoholics Anonymous meetings, Women's Narcotics Anonymous, Narcotics Anonymous, Community Interfaith Chaplaincy training programs, Suicide prevention trainings, Celiac Disease Support Group, Widow Support Group, Child Life Grief Support Program, Focus groups to gain insight on community needs, Annual MASH Camp for students interested in health professions, Osteopathic Medicine Manipulation Clinics, Healthy Kitchens Program, Amputee Support Group, Hip and Knee Seminars, Functional Assessment Workshops. In addition, Arnot Health aims to improve the health of the community through active participation and leadership in local, regional and state level preventative health coalitions and taskforces. Arnot Health serves on the Chemung County Board of Health, the Community Services Board, the Economic Opportunity Program Board, the Healthcare Association of New York State's (HANYS) Community Health Taskforce and the New York State Department of Health's (NYSDOH) Community Health Needs Assessment Ad Hoc Group. Arnot Health has a leadership role in the Southeastern region of the Finger Lakes Performing Provider System (FLPPS) and the planning and implementation of eleven DSRIP projects designed to meet the complex and challenging medical and social needs of the Medicaid population. Arnot Health's leadership in regional and state initiatives informs key stakeholders of the needs in our community and leverages a broad set of resources to meet those needs. Schedule H, Part V, Section B, Line 20e-IRA DAVENPORT MEMORIAL HOSPITAL Self pay collection staff reviews any prior accounts to check for commercial insurance or Medicaid that may need to be applied to current self pay accounts. These accounts are reviewed using the self pay work list. If insurance is located, the self pay collector must verify eligibility for the dates of service. The self pay staff will change the health plan to the correct plan for all covered dates of service and Arnot billing will submit the claim or claims. If no insurance is located, confirm if a patient may have qualified for Medicaid. If Medicaid coverage is approved self pay staff will change the health plan to Medicaid for all covered dates of service and follow correct billing processes. Self Pay Collection Staff attempts to collect the full balance due by check or credit card. If they are unable to make the full payment, the self pay staff will attempt to make payment arrangements and to notify the patient about the Arnot Ogden Medical Center Community Care Program. If the patient wants to apply for the community care program, the patients will be sent an application for the community care program and will be informed of documentation they will need to submit with the application. The self pay collectors document all activity in Soarian, and enter any necessary hold to support resolution. Self pay collections staff enters the payment plan and document comments in Soarian. Payment plan statements are demanded and sent to the patient. If the patient does not enter into a payment plan agreement, or fails to pay as agreed, the account will go through the standard dunning and collection agency activity. See Guarantor Billing and Collections. Schedule H, Part V, Section B, Line 22d-IRA DAVENPORT MEMORIAL HOSPITAL FAP eligible patients receive a percentage discount either charges for the uninsured or patient responsibility for the insured Schedule H, Part V, Section B, Line 24-IRA DAVENPORT MEMORIAL HOSPITAL Participants in the Medicare System are required to charge all patients the same amount regardless of insurance per the Medicare Participant Guidelines. Schedule H, Part I, Line 6a Arnot Ogden Medical Center prepares the Community Benefit Report for three Hospitals, Arnot Ogden Medical Center, St Joseph's Hospital, Both in Elmira NY and Also for Ira Davenport Memorial Hospital in Bath NY Schedule H, Part I, Line 7 Arnot Ogden Medical Center uses a cost to charges Ratio to calculate he financial Assistance and Community Benefit Section. The Medical Center Offers A Variety of services to the community it servers as part of an integrated delivery system. It is Necessary to Financially Subsidized some of these services as the revenue generates does not cover the cost of providing the services. Schedule H, Part II In 2010, Arnot Health was awarded a five-year Creating Healthy Places to Live, Work and Play (CHP) grant from the New York State Department of Health to promote healthy lifestyles and prevent obesity and type 2 diabetes through environmental, policy, and system changes. The CHP grant was lead by Arnot Health and a partnership of 30 community-based agencies and organizations, and engagement from community members. Over the past five-years, the CHP partnership had four areas of focus: To increase physical activity, Improve safety and access to open spaces for physical activity, Increase access to and consumption of fresh fruits and vegetables, and to work with local restaurants to make eating out healthier. Funding for the CHP grant ended on September 30, 2015. However, the CHP partnership remains committed and engaged in sustaining the work of CHP through Arnot Health's subcontract with Genesee Valley Educational Partnership to implement the community's portion of the "Creating Healthy Schools and Communities" grant. Creating Healthy Places to Live, Work, and Play has made progress over the last five years in establishing an environment where it is easier for the community to be physically active and make healthier food choices. The following are the obesity prevention strategies implemented and the accomplishments of the CHP partnership over the last five years: A. Increase Physical Activity, Arnot Health and the CHP partnership created, rehabilitated, maintained and promoted parks and recreation facilities in underserved residential areas to offer safe, accessible and attractive opportunities for physical activity for persons of all ages and abilities. CHP partners and the City of Elmira developed and/or enhanced parks and playgrounds for children to make them safe, attractive and accessible in the following locations: McKinnon Park, Grove Park, Miller's Pond Park, Eldridge Park, McCann's Memorial Park, Blandford Park, Pulaski Park and Quatrano Park. In addition to replacing unsafe equipment and enhancing parks and playgrounds, CHP partnership worked to improve a seven-mile stretch of the Lackawanna Rail Trail by installing a fitness station, solar lights for safe passage on the trail, and an informational kiosk with "Get Active Elmira" maps that were created by the partnership to highlight the city's 23 parks and playgrounds. Other enhancements to the Lackawanna Rail Trail included benches, bike racks and mile markers. To increase access to fresh fruit and vegetables, the CHP partnership created community gardens and enhanced existing vegetable gardens by working with community planning boards, neighborhood associations, schools, persons with disabilities, and senior and low-income housing developments. Examples of strategies implemented to promote access to and consumption of fresh fruits and vegetables include: Provided Mobile Edible Wall Units (portable community gardens) for schools and youth community centers. Installed a tool shed and provided gardening supplies to establish and maintain community gardens in underserved areas. Supported the development of a community garden for persons with developmental disabilities. Supported the Food Bank of the Southern Tier with fresh fruits and vegetables grown in the community gardens. Community Gardens were established or enhanced in the following locations: Near Westside Victorian Garden, Katy Leary Park, Quatrano Park, Economic Opportunity Program at Ernie Davis Community Center, Woodlawn Community Garden, and the Elmira City School District. To make eating out in restaurants healthier, CHP partners worked with local restaurants to add healthier menu items including healthier "side" items provided with a meal; modify existing menu items and offer affordable and appropriately sized portions; make healthier items standard for children's meals; and publicize the calorie, fat and sodium content of menu items. Developed and distributed educational materials on healthy food options at community outreach events. Worked with hospital system to adopt Healthy Meeting policy and offer daily "Well Being" meals in the hospitals' cafeterias for employees and the public. Healthier menu options were adopted at the following restaurants: Hill Top Inn, Starlite Room, Classic Café, Charlie's Café, and Turtle Leaf Cafe. Developed three different long-running TV ads promoting healthy eating at restaurants and featured three of the restaurant partners. Created table top displays of "Eating out Healthier" tips for each partnering restaurant. Arnot Health and CHP partners worked collaboratively to improve street-scale urban design for safer and easier access to parks, playgrounds and trails. Safety assessments of parks and playgrounds were conducted by organizations serving the developmentally disabled populations, seniors and the visually impaired. The Elmira Traffic Board conducted a speed study near one of the most highly utilized parks in an underserved area to determine if speed reduction signs were necessary for traffic calming and safer access. Other strategies implemented to promote safe access to open spaces for physical activity include: Installation of "high visual impact" signage at parks, playgrounds, trails and street crossings, Installation of video cameras in select parks, Improved street lighting, Installation of cross walks and ADA compliant curb cut outs and tactile ramps, and utilized speed reduction and playground warning signs for traffic calming. Schedule H, Part III, Section A, Line 4 The Organization's allowance for doubtful accounts decreased from 11.1% of gross accounts receivable at December 31, 2014 to 10.5% of gross accounts receivable at December 31, 2015. In addition, the Organization's bad debt write-offs decreased from $22,828,514 for fiscal year 2014 to $14,550,590 in fiscal year 2015. The decrease in bad debt write-offs is to account for trends experienced in the collection of amounts from self-pay patients in fiscal year 2015. The Organization has not changed its charity care or uninsured discount policies during the fiscal year 2014 or 2015. The Organization does not maintain a material allowance for doubtful accounts from third party payors, not did it have significant write-offs from third party payors. Schedule H, Part III, Section B, Line 8 Arnot Ogden Medical Center uses a Cost to Charges ratio to calculate the Financial Assistance and Community Benefit Section. The medical Center offers a variety of services to the community it serves as part of an integrated delivery system. It is necessary to financially subsidize some of these services as the revenue generated does not cover the cost of providing the services. Schedule H, Part III, Section C, Line 9b Self pay collection staff reviews any prior accounts to check for commercial insurance or Medicaid that may need to applied to current self pay accounts. These accounts are reviewed using the self pay worklist. If insurance is located, the self pay collector must verify eligibility for the dates of service. The self pay staff will change the health plan to the correct plan for all covered dates of service and Arnot billing will submit the claim or claims. If no insurance is located, confirm if a patient may have qualified for Medicaid. If Medicaid coverage is approved self pay staff will change the health plan to Medicaid for all covered dates of service and follow correct billing processes. Self Pay Collection Staff attempts to collect the full balance due by check or credit card. If they are unable to make the full payment, the self pay staff will attempt to make payment arrangements and to notify the patient about the Arnot Ogden Medical Center Community Care Program. If the patient wants to apply for the community care program, the patients will be sent an application for the community care program and will be informed of documentation they will need to submit with the application. The self pay collectors document all activity in Sorian, and enter any necessary hold to support resolution. Self pay collections staff enters the payment plan and document comments in Sorian. Payment plan statements are demanded and sent to the patient. If the patient does not enter into a payment plan agreement, or fails to pay as agreed, the account will go through the standard dunning and collection agency activity. Schedule H, Part VI, Line 2 2015 Update to the Community Health Improvement Plan In 2013, Arnot Health in collaboration with the Chemung County Health Department, Steuben County Public Health and a diverse community partnership conducted a comprehensive Community Health Needs Assessment (CHNA) to identify public health priorities in Chemung and Steuben Counties. The CHNA identified some overlapping areas of public health concerns in Chemung and Steuben Counties. Chemung County Priority: Prevent Chronic Disease 1. Focus area: Reduce obesity in children and adults; and 2. Focus area: Reduce illness, disability, and death related to tobacco use and secondhand smoke exposure. Disparity: Reduce percentage of lower income individuals who smoke, including those with mental health and substance abuse issues. Steuben County Priority: Prevent Chronic Disease 1. Focus area: Reduce obesity in children and adults; and 2. Focus area: Reduce illness, disability and death related to heart disease and hypertension. Disparity: Promote tobacco cessation, especially among low socioeconomic populations and those with mental health illness. Over the last two years, Arnot Health and partners have been implementing and monitoring the effectiveness of the CHIP in Chemung and Steuben Counties. Since implementation of the 2013 CHIP, progress has been made in preventing chronic disease through strategies aimed at reducing obesity in children and adults, and reducing tobacco use. CHIP strategies to prevent chronic disease continued to focus on three key areas: 1) Health promotion activities to encourage healthy living and limit the onset of chronic diseases; 2) Early detection opportunities that include screening populations at risk; 3) Successful management strategies for existing diseases and related complications. Action plan strategies such as increasing physical activity, improving nutrition, and decreasing tobacco use from the core of the Preventing Chronic Diseases Action Plan for the New York State Prevention Agenda have been implemented (http://www.health.ny.gov/prevention/prevention_agenda/2013-2017/docs/prevent_chronic_diseases.pdf). Schedule H, Part VI, Line 3 The Arnot Ogden Medical Center communicates our Community Care Program in the following ways: Signage in waiting rooms, brochures in waiting rooms and Admission Packets, notations on billing notices, staff education so they can share availability of program and contact information with patients. Communication and education of our Certified Application Counselor for patient insurance enrollment are done so they are informed of the program details and contact information. Communication is also done with collection agencies and collection attorneys so they can also share the availability of the program and contact information with prospective enrollees. The information is also posted on our website at: www.arnothealth.org. Schedule H, Part VI, Line 4 Arnot Health is comprised of three hospitals, Arnot Ogden Medical Center, St. Joseph's Hospital in Elmira, NY, and Ira Davenport Memorial Hospital in Bath, NY. Arnot Health provides diagnostic, ambulatory, secondary and tertiary acute care, as well as substance abuse, psychiatric, rehabilitative and wellness services to meet the needs of residents in Chemung, Steuben and Schuyler Counties in the Southern Tier of New York and Bradford and Tioga Counties in the Northern Tier of Pennsylvania. The distribution of patients from this service area, as measured by total patient encounters from system's hospitals is as follows: Chemung 65.0 percent, Steuben 21.0 percent, Schuyler 4.6 percent, Tioga 3.4, Bradford 2.9 percent and all other 3.0 percent. X X 0 0 0 0 0 0 0 0 0 Robert Lambert President Arnot Health 0 527380 0 103241 0 0 0 13250 0 23577 0 667448 0 0 Ronald J Kintz Senior VP/CFO 0 331952 0 60516 0 0 0 13250 0 23577 0 429295 0 0 H Fred Farley Hospital President COO 0 353789 0 40550 0 0 0 13250 0 23577 0 431166 0 0 James Watson President IDMH 0 227391 0 0 0 0 0 7799 0 1941 0 237131 0 0 Kevin Murray Director of Pharmacy 149642 0 0 0 0 0 0 0 12252 0 161894 0 0 0 Vandelinder AmyBeth DIR LABORATORY SVS 75768 0 24400 0 0 0 3101 0 0 0 103269 0 0 0 Dennis O' Connor MD Medical Director 58889 0 0 0 0 0 1757 0 0 0 60646 0 0 0 Schedule J, Part I, Line 3 Compensation for the president and vice president is set pursuant to a policy and compensation philosophy adopted by the boards. The AOMC Board has a compensation committee consisting of outside directors (AOMC board members are referred to as managers). The Compensation committee uses a consultant to advise it on compensation for the officers. The consultant collects and reports data on compensations for similar positions in similar nonprofit hospitals from upstate New York and western Pennsylvania. The compensation committee recommends any adjustments to the executive committee of the board which reviews the recommendations and approves them without employees in the room. This action is then reviewed with the entire board also in executive session Form 990, Part VI, Section A, Line 2 For Bernard Burns Board Secretary He is Executive Director of Arc of Steuben, Taylor SNF and Adult Day Care contracts with Arc for Transportation. Scott Sprague wife is Director of Keuka Health Care Foundation. Joseph F Meade is the president of Keuka Health Care Foundation Form 990, Part VI, Section A, Line 3 as a result of Arnot Ogden Medical Center becoming the "active parent" of Ira Davenport Memorial Hospital the management of several departments were consolidated under a single manager Form 990, Part VI, Section A, Line 7a Ira Davenport Hospital Board of Directors can only elect the president and hire medical directors and board members at that facility. Affiliated Board of Directors of Arnot Health are responsible for operations of Ira Davenport Memorial Hospital. Form 990, Part VI, Section A, Line 7b Ira Davenport Hospital Board of Directors can only elect the president and hire medical directors and board members at that facility. Affiliated Board of Directors of Arnot Health are responsible for operations of Ira Davenport Memorial Hospital. Form 990, Part VI, Section B, Line 11b Once the 990 is in final form it is presented to the board committee and a copy is made available to all board members for review and questions. Form 990, Part VI, Section B, Line 12c All members of the Board of Managers, officers, and management employees shall be required annually to file a disclosure statement setting forth any respect in which such person, or any person associated with such person, has or may have any interest in any transaction in which there may be, or appear to be, a conflict between the interest of such person and the Arnot Ogden Medical Center, an associated included (1) Spouse, a descendant or an ancestor, of a spouse of a descendant of ancestor; (2) an organization in which the person of an associated is a partner of employee, or such person is an associated owns a more then 10% beneficial interest; (3) a trust in which such person is a trustee, or such person or an associate holds more than 10% beneficial interest and (4) a corporations in which such person or an associate is an officer or a director or employee, or such person or an associate is an owner of more than 10% of any class of securities Form 990, Part VI, Section B, Line 15 Compensation for the president and vice president is set pursuant to a policy and compensation philosophy adopted by the boards. The AOMC Board has a compensation committee consisting of outside directors (AOMC board members are referred to as managers). The Compensation committee uses a consultant to advise it on compensation for the officers. The consultant collects and reports data on compensations for similar positions in similar nonprofit hospitals from upstate New York and western Pennsylvania. The compensation committee recommends any adjustments to the executive committee of the board which reviews the recommendations and approves them without employees in the room. This action is then reviewed with the entire board also in executive session Form 990, Part VI, Section C, Line 19 Items required for public disclosure are made available for those who request the information and shared with guidestar.org and EMMA web site Form 990, Part XI, Line 9 Keuka Foundation Net loss (3,811), Donations from Capital Funding 63,295, Net assets released from restrictions (85,676), Pension charge to equity 186,839, Donations 133,022, Change in Charitable Trust (182,819), Cost of Inventory Adj (11) KEUKA HEALTH CARE FOUNDATION 7571 STATE ROUTE 54 BATH NY 14810 161461215 PROVIDE FINANCIAL NY 501(C)(3) 11 N/A 0 ARNOT OGDEN MEDICAL CENTER 600 ROE AVENUE ELMIRA NY 14905 160743905 AFFILIATE NY 501 (C)(3) 11 N/A 0 ARNOT OGDEN MEDICAL CENTER FOUNDATION 600 ROE AVENUE ELMIRA NY 14905 161109472 CONTRIBUTION MGT NY 501(C)(3) 11E N/A 0 ARNOT HEALTH INC 600 ROE AVENUE ELMIRA NY 14905 453049405 MANAGEMENT NY 501 (A)(3) N/A ARNOT HEALTH INC 0 ST JOSEPHS HOSPITAL 555 ST JOSEPHS BLVD ELMIRA NY 14901 160743163 AFFILIATE NY 501(C)(3) 11 N/A 0 IVY STREET DEVELOPMENT CORP 600 IVY STREET ELMIRA NY 14905 161009245 REAL ESTATE RENTAL NY N/A C 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0 ARNOT OGDEN MEDICAL CENTER o 3250977 Arnot Ogden Medical Center provided employees who provide medical, management information system, and various administrative services to Ira Davenport Memorial Hospital. The method of determining the amount was cost. KEUKA HEALTH CARE FOUNDATION c 63295 A gift from Keuka Health Care Foundation to Ira Davenport Memorial Hospital for contribution to the Taylor SNF and remodel of Emergency room entrance We have the form 8868 extension to November 15,2016