2016-10-07T09:44:49-07:00 2015-12-31 990 2015-01-01 160743163 ST JOSEPHS HOSPITAL STJO 6077336541 555 ST JOSEPHS BLVD ELMIRA NY 14901 Lambert Robert President & CEO 6077374100 2016-08-31 2015 2017-02-10 21:41:12Z RONALD J KINTZ SENIOR VP CFO 600 ROE AVENUE ELMIRA NY 14905 47150730 0 X www.stjosephs.org X 1908 NY MINISTERS TO INPATIENTS AND OUTPATIENTS, SERVING AS A PRIMARY CARE AND SPECIALTY REFERRAL CENTER 19 15 692 150 -250 -250 1727591 0 41775654 43846284 -68419 95184 888487 3079201 44323313 47020669 0 0 0 0 23612200 22587094 0 0 0 21900784 22262641 45512984 44849735 -1189671 2170934 37061239 30317747 33078494 23401574 3982745 6916173 MINISTERS TO INPATIENTS AND OUTPATIENTS, SERVING A PRIMARY CARE AND SPECIALTY REFERRAL CENTER FOR PEOPLE FROM ALL FAITHS LIVING IN CHEMUNG COUNTY AND THE SURROUNDING COUNTIES OF NEW YORK AND PENNSYLVANIA 0 0 33180528 0 45356375 ST JOSEPHS ACUTE CARE UNITS COMBINE ADVANCED TECHNOLOGY WITH HIGHLY TRAINED STAFF TO MEET THE MEDICAL AND SURGICAL NEEDS OF OUR INPATIENTS. OUR STAFF IS DEDICATED TO PROVIDING PHYSICAL, EMOTIONAL AND SPIRITUAL CARE TO ALL PATIENTS BOTH DURING AND AFTER THEIR HOSPITAL STAY. OUR SKILLED NURSING FACILITY IS RESPONSIBLE FOR DELIVERING NURSING CARE TO SHORT TERM PATIENTS AND LONG TERM RESIDENTS BY PROVIDING PREVENTATIVE, THERAPEUTIC, AND REHABILITATION SERVICES. OUR NURSING STAFF ASSISTS RESIDENTS IN MAINTAINING AND/OR REGAINING THE HIGHEST POSSIBLE LEVEL OF WELLNESS. REHABILITATION IS THE FIRST STEP TOWARDS RECOVERY FOR ST JOSEPH'S INPATIENTS. OUR REHABILITATION TEAM OF MEDICAL PROFESSIONALS, SERVING A 7 COUNTY AREA, IS DEDICATED TO RESTORING THE INDEPENDENCE OF EACH PATIENT, THROUGH RETRAINING PROGRAMS AND ACTIVE PARTICIPATION. MISCELLANEOUS OTHER PROGRAM SERVICES INCLUDE, BUT ARE NOT LIMITED TO, EMERGENCY SERVICES, INTENSIVE CARE UNIT, SURGICAL SERVICES, MEDICAL IMAGING AND RADIOLOGY, ADDICTION REHABILITATION UNIT, LABORATORY SERVICES, ENDOSCOPY, PRIMARY CARE OFFICES, BEHAVIORAL SCIENCE UNIT, PHARMACY, RESPIRATORY THERAPY. 0 0 0 33180528 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 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 1 0 0 1 692 1 1 1 0 0 0 0 0 X 19 15 0 1 0 0 0 0 0 1 1 0 1 1 1 1 1 1 1 1 1 1 0 NY X RONALD KINTZ 6077374100 555 ST JOSEPHS BLVD ELMIRA NY 14901 Michael Hosey Chairman of the Board 1 1 X 0 0 0 Mark J Hagan Vice Chairman 1 2 X 0 0 0 Daniel J Burke Board Member 1 1 X 0 0 0 Kathleen Lucke Board Member 1 1 X 0 0 0 David Dalrymple Board Member 1 1 X 0 0 0 Richard Simons Board Member 1 1 X 0 0 0 S Jan Eberhard Board Member 1 3 X 0 0 0 Scott Sprague Board Member 1 1 X 0 0 0 Jan van den Blink Board Member 1 1 X 0 0 0 Roy A Kyles Board Member 1 1 X 0 0 0 Robert McNamara Board Member 1 1 X 0 0 0 Mary Louise Mitchell Board Member 1 1 X 0 0 0 Donald Quick Board Member 1 1 X 0 0 0 Pat J Rodgers Board Member 1 1 X 0 0 0 Melinda Sartori Board Member 1 1 X 0 0 0 Alan Angell Board Member 1.00 40.00 X 0 500243 30433 Roger Schenone Board Member 1.00 40.00 X 0 355697 11456 Kevin OConnor Board Member 40.00 1 X 0 420574 36826 Robert Lambert President Arnot Health 4.00 46.0 X X 0 630621 36827 John R Alexander Secretary 1 1 X 0 0 0 Ronald J Kintz Senior VP/CFO 4.00 46.00 X 0 392468 36827 Kenneth Herzl-Betz Senior VP/Medical Affairs 1.00 40.00 X 0 306741 26744 Nancy ODacre VP Strategic Planning 10.00 40.00 X 0 63346 7907 H Fred Farley Hospital President COO 4.00 46.00 X X 0 394339 36827 Nancy O'Dacre VP Strategic Planning 5 45 X 0 63346 7907 Clara Tryon Nursing Home Adminstrator 40 0 X 129587 0 3114 Kim Davenport System Director, Behavioral Health 40 0 X 118005 0 3114 Roberta Conz RN 46 0 X 105311 0 3065 Mary Ann Mahajan Pharmacist 40 0 X 102042 0 0 454945 3127375 241047 6 1 1 0 Edger Enterprises 330 E 14TH Street Elmira Heights NY 14903 Construction Services 263531 Angelica Textile Services 1105 Lokewood Pkwy Suite 120 Alpharetta GA 30009 Linen Services 156621 Delphi Healthcare PLLC 1880 East Ridge Road Suite 6 Upper Level Rochester NY 14622 Emergency Room Physicians 759284 Trane 1150 University Ave Rochester NY 14607 Equipment Installation & Service 148489 ABM Healthcare Support Services PO Box 935695 Atlanta GA 31193 Consulting Services 197525 5 0 0 0 0 0 0 0 0 Net Patient Service Hospital Revenue 622110 43846284 43846284 0 0 0 0 0 0 43846284 98680 0 0 98680 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3496 0 -3496 -3496 0 0 -3496 0 0 0 0 0 0 0 0 0 0 0 0 232450 126565 105885 0 0 105885 NYS Vital Access Provider Funds 622210 1656732 1656732 0 0 1316584 0 -250 1316834 2973316 47020669 45503016 -250 1517903 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 17804151 14653484 3150667 0 1562113 0 1562113 0 1902329 30024 1872305 0 1318501 1077621 240880 0 311004 138509 172495 0 82458 6300 76158 0 7695 0 7695 0 7088 0 7088 0 0 0 427 0 427 0 818862 684467 134395 0 0 0 0 0 1488778 1110628 378150 0 289227 35081 254146 0 0 0 0 0 964046 22207 941839 0 15805 15805 0 0 0 0 0 0 15170 15170 0 0 34175 0 34175 0 0 0 0 0 2869014 1393569 1475445 0 372367 2444 369923 0 Medical/Surgical/Pharmaceutical Supplies 4866235 4804449 61786 0 Maintenance Contracts/Purchased Services 9560945 5913123 3647822 0 Leases 108807 37955 70852 0 Benefit Allocation 0 2813880 -2813880 0 450538 425812 24726 0 44849735 33180528 11669207 0 22874 33760 1946945 829815 831612 906463 7255979 4232007 0 0 0 0 113042 202805 580861 330540 149896 143832 96856368 77713687 21643280 19142681 394784 373878 1400000 1400000 0 0 0 0 2721966 2721966 37061239 30317747 2875412 3034665 0 0 0 0 0 0 0 0 0 0 1612507 1039154 0 0 28590575 19327755 33078494 23401574 X 3804767 6660096 145078 223177 32900 32900 3982745 6916173 37061239 30317747 X 2170934 0 0 0 0 762494 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 7088 7088 0 Schedule C, Part II-B, Line 1 ST JOSEPH'S PAYS ANNUAL DUES TO THE HEALTH ASSOCIATION OF NEW YORK AND ROCHESTER REGIONAL. PART OF THE DUES ARE USED FOR LOBBYING EXPENSES. 177977 49368 28731 0 0 0 256076 177977 0 0 0 0 0 177977 46842 0 131135 0 0 0 177977 48141 0 0 0 1299 0 46842 48141 0 0 0 0 0 48141 0 0.13 0.87 0 0 0 1197617 1197617 0 28789984 18863815 9926169 0 0 0 0 0 66868767 58849872 8018895 0 0 0 0 19142681 Accounts Receivable Workers Compensation Insurance 838874 Self Insurance Reserve 1798255 Swartwood Prize Fund 33143 Other Assets 51694 2721966 0 DUE TO RELATED ORGANIZATIONS 3886369 MINIMUM PENSION LIABILITY 8958558 WORKERS COMPENSATION RESERVE 3688086 THIRD PARTY REIMBURSEMENT PAYABLES 2794742 19327755 X 47098116 0 0 0 77447 77447 47020669 0 0 0 47020669 44976300 0 0 0 126565 126565 44849735 0 0 0 44849735 Schedule D, Part V, Line 4 PERMANENTLY RESTRICTED ENDOWMENT FUNDS Schedule D, Part X, Line 2 THE ORGANIZATION ACCOUNTS FOR UNCERTAIN TAX POSITIONS IN ACCORDANCE WITH US GAAP, WHICH REQUIRES THE RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS THAT THE ORGANIZATION HAS TAKEN OR EXPECTS TO TAKE IN THE ORGANIZATION'S TAX RETURNS. MANAGEMENT BELIEVES THERE ARE NO SIGNIFICANT UNCERTAIN TAX POSITIONS NOT REFLECTED IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. Schedule D, Part XI, Line 2d COST OF GOODS SOLD NUTRITIONAL SERVICES 126,565, TAX AND LICENSES EXPENSES 250 OFFSET VS. REVENUES ON FORM 990, INCLUDED WITH EXPENSES ON AUDITED FINANCIAL STATEMENTS. NET ASSETS RELEASED FROM RESTRICTIONS (49,368) INCLUDED WITH REVENUE ON AUDITED FINANCIAL STATEMENTS Schedule D, Part XII, Line 2d COSTS OF GOODS SOLD NUTRITIONAL SERVICES 126,565 OFFSET VS. REVENUES ON FORM 990, INCLUDED WITH EXPENSES ON AUDITED FINANCIAL STATEMENTS 1 1 X 1 X 1 X 1 1 0 1 1 69 51011 2662 48349 0.0011 0 0 0 0 0 0 5753187 4560876 1192311 0.0266 0 69 5804198 4563538 1240660 0.0277 12 402 57752 0 57752 0.0013 1 2 5151 0 5151 0.0001 4 54123 12293609 7774092 4519517 0.1008 0 0 0 0 0 0 2 0 14600 0 14600 0.0003 19 54527 12371112 7774092 4597020 0.1025 19 54596 18175310 12337630 5837680 0.1302 0 0 0 0 0 0 0 2884620 0 11827826 10666294 1161532 X 1 1 1 1 ST JOSEPHS HOSPITAL 555 ST JOSEPHS BOULEVARD ELMIRA NY 14901 X X X SKILLED NURSING FACILITY ST JOSEPHS HOSPITAL 1 0 0 1 X X X X X X X X 15 1 1 1 1 X www.arnothealth.org/community-leadership X X 1 15 1 www.arnothealth.org/aboutus 0 0 1 X 150 400 X X X 1 1 X X X 1 X www.arnothealth.org X www.arnothealth.org X www.arnothealth.org X X X X X 1 X 0 X X X X 1 X 0 1 Schedule H, Part V, Section B, Line 5-ST JOSEPHS 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-ST JOSEPHS HOSPITAL Arnot Health is comprised of three hospitals: Arnot Ogden Medical Center and St. Joseph's Hospital in Elmira; and Ira Davenport Memorial Hospital in Bath, New York. Arnot Health provides diagnostic, ambulatory, secondary and tertiary acute care, as well as substance abuse, psychiatric, rehabilitative, and wellness services to meet the needs of residents in Chemung, Steuben, and Schuyler Counties in the Southern Tier of New York, and Bradford and Tioga Counties in the Northern Tier of Pennsylvania. Arnot 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-ST JOSEPHS 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 areas of public health concerns in Chemung and Steuben Counties. Schedule H, Part V, Section B, Line 7d-ST JOSEPHS HOSPITAL Arnot Health 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 Hospitals, and the CHIPS for Chemung and Steuben Counties: Website Documents will be posted on the healthcare system's website at the following URL: http://www.arnothealth.org/aboutus. Arnot Health plans to develop a section of the system's website dedicated to community outreach in 2016, budget permitting, to bring community service work to a more prominent place within the website. Partner websites Chemung and Steuben Counties will post links to their CHA and CHIP on their websites. Presenting Arnot Health's Community Health Department provides education about the healthcare systems' CSP and community outreach strategies. Schedule H, Part V, Section B, Line 11-ST JOSEPHS 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-ST JOSEPHS HOSPITAL Self pay collection staff reviews any prior accounts to check for commercial insurance or Medicaid that may need to be applied to current self pay accounts. These accounts are reviewed using the self pay work list. If insurance is located, the self pay collector must verify eligibility for the dates of service. The self pay staff will change the health plan to the correct plan for all covered dates of service and Arnot billing will submit the claim or claims. If no insurance is located, confirm if a patient may have qualified for Medicaid. If Medicaid coverage is approved self pay staff will change the health plan to Medicaid for all covered dates of service and follow correct billing processes. Self Pay Collection Staff attempts to collect the full balance due by check or credit card. If they are unable to make the full payment, the self pay staff will attempt to make payment arrangements and to notify the patient about the Arnot Ogden Medical Center Community Care Program. If the patient wants to apply for the community care program, the patients will be sent an application for the community care program and will be informed of documentation they will need to submit with the application. The self pay collectors document all activity in Soarian, and enter any necessary hold to support resolution. Self pay collections staff enters the payment plan and document comments in Soarian. Payment plan statements are demanded and sent to the patient. If the patient does not enter into a payment plan agreement, or fails to pay as agreed, the account will go through the standard dunning and collection agency activity. Schedule H, Part V, Section B, Line 22d-ST JOSEPHS HOSPITAL FAP eligible patients receive a percentage discount of either charges for the uninsured or patient responsibility for the insured patient. Schedule H, Part V, Section B, Line 24-ST JOSEPHS HOSPITAL Participants in the Medicare System are required to charge all patients the same amount for services regardless of insurance per the Medicare participation guidelines. Schedule H, Part I, Line 6a Arnot Ogden Medical Center prepares the Community Benefit Report for three hospitals- Arnot Ogden Medical Center, St. Joseph's Hospital, both in Elmira, NY and also for Ira Davenport Memorial Hospital in Bath, NY. Schedule H, Part I, Line 7 Arnot Health uses a Cost to Charges ratio to calculate the Financial Assistance and Community Benefit Section. The organization offers a variety of services to the community it serves as part of an integrated delivery system. It is necessary to financially subsidize some of these services as the revenue generated does not cover the cost of providing the services. Schedule H, Part I, Line 7, Column f St. Josephs Hospital excluded $2,884,620 in bad debt expense form the calculation. Schedule H, Part III, Section A, Line 4 The Organization's allowance for doubtful accounts increased from 14% of gross accounts receivable at December 31, 2014 to 19.98% of gross accounts receivable at December 31, 2015. In addition, the Organization's bad debt write-offs decreased from $3,580,722 for fiscal year 2014 to $2,884,620 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, nor did it have significant write-offs from third party payors. Schedule H, Part III, Section B, Line 8 Arnot Health uses a Cost to Charges ratio to calculate the Financial Assistance and Community Benefit Section. The organization offers a variety of services to the community it serves as part of an integrated delivery system. It is necessary to financially subsidize some of these services as the revenue generated does not cover the cost of providing the services. Schedule H, Part III, Section C, Line 9b Self pay collection staff reviews any prior accounts to check for commercial insurance or Medicaid that may need to be applied to current self pay accounts. These accounts are reviewed using the self pay work list. If insurance is located, the self pay collector must verify eligibility for the dates of service. The self pay staff will change the health plan to the correct plan for all covered dates of service and Arnot billing will submit the claim or claims. If no insurance is located, confirm if a patient may have qualified for Medicaid. If Medicaid coverage is approved self pay staff will change the health plan to Medicaid for all covered dates of service and follow correct billing processes. Self Pay Collection Staff attempts to collect the full balance due by check or credit card. If they are unable to make the full payment, the self pay staff will attempt to make payment arrangements and to notify the patient about the Arnot Ogden Medical Center Community Care Program. If the patient wants to apply for the community care program, the patients will be sent an application for the community care program and will be informed of documentation they will need to submit with the application. The self pay collectors document all activity in Soarian, and enter any necessary hold to support resolution. Self pay collections staff enters the payment plan and document comments in Soarian. Payment plan statements are demanded and sent to the patient. If the patient does not enter into a payment plan agreement, or fails to pay as agreed, the account will go through the standard dunning and collection agency activity. Schedule H, Part VI, Line 2 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 X 0 0 0 0 0 0 0 0 0 Michael Hosey Chairman of the Board 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Mark J Hagan Vice Chairman 0 0 0 0 0 0 0 0 0 0 0 0 0 0 John R Alexander Secretary 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Daniel J Burke Board Member 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Kathleen Lucke Board Member 0 0 0 0 0 0 0 0 0 0 0 0 0 0 David Dalrymple Board Member 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Richard Simons Board Member 0 0 0 0 0 0 0 0 0 0 0 0 0 0 S Jan Eberhard Board Member 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Scott Sprague Board Member 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Jan van den Blink Board Member 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Roy A Kyles Board Member 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Robert McNamara Board Member 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Mary Louise Mitchell Board Member 0 0 0 0 0 0 0 0 0 0 0 0 0 Donald Quick Board Member 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Pat J Rodgers Board Member 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Melinda Sartori Board Member 0 0 0 0 0 0 0 0 0 0 0 0 0 Alan Angell Board Member 0 437674 0 62569 0 0 0 9090 0 21344 0 530677 0 0 Roger Schenone Board Member 0 355697 0 0 0 0 0 9089 0 2367 0 367153 0 0 Kevin OConnor Board Member 0 317649 0 102925 0 0 0 13250 0 23577 0 457401 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 Kenneth Herzl-Betz Senior VP/Medical Affairs 0 303141 0 3600 0 0 0 5401 0 21344 0 333486 0 0 Nancy ODacre VP Strategic Planning 0 63346 0 0 0 0 0 0 0 7907 0 71253 0 0 Kim Davenport System Director, Behavioral Health 118005 0 0 0 0 0 0 0 3114 0 121119 0 0 0 Clara Tryon Nursing Home Adminstrator 129587 0 0 0 0 0 0 0 3114 0 132701 0 0 0 Roberta Conz RN 105311 0 0 0 0 0 0 0 3065 0 108376 0 0 0 Mary Ann Mahajan Pharmacist 98927 0 0 0 0 0 0 0 3114 0 102041 0 0 0 Schedule J, Part I, Line 3 Compensation for the President and Vice Presidents, although paid by related organizations, are set pursuant to a policy and compensation philosophy adopted by the Board of Directors. The Board has a Compensation Committee consisting of outside directors. The Compensation Committee uses a consultant to advise it on compensation for the officers. The consultant collects and reports compensation on similar positions in similar non-profit hospitals from upstate New York and Western Pennsylvania. The Compensation Committee recommends adjustments to the Executive Committee of the Board which reviews the recommendations and approves or disapproves without employees in the room. This action then is reviewed with the entire Board also in executive session. David Dalrymple Chairman of Board Chemung Canal Trust Co 1039154 Competitively Bids Loans 0 Form 990, Part VI, Section A, Line 2 David Dalrymple, Chairman of the Board of Chemung Canal Trust Company, Competitively Bids Loans 1,039,154 Form 990, Part VI, Section A, Line 3 ABM HEALTHCARE SUPPORT SERVICES, INC. PROVIDES MANAGEMENT SERVICES FOR NUTRITIONAL SERVICES, PLANT OPERATIONS SERVICES, AND HOUSEKEEPING SERVICES. Form 990, Part VI, Section B, Line 11b THE FORM 990 WAS REVIEWED BY MANAGEMENT. Form 990, Part VI, Section B, Line 12c EACH MEMBER OF THE BOARD OF DIRECTORS AND OTHER HOSPITAL INSIDERS MUST COMPLETE A CONFLICT OF INTEREST STATEMENT ANNUALLY. IN ADDITION, SITUATIONS WHICH CONSTITUTE, COULD CONSTITUTE, OR COULD BE PERCEIVED AS CONSTITUTING A CONFLICT OF INTEREST MUST BE REPORTED IMMEDIATELY TO THE HOSPITAL PRESIDENT. THE HOSPITAL PRESIDENT WILL THEN RELAY THE INFORMATION TO THE BOARD OF DIRECTORS. IF THE BOARD MEMBER OR INSIDER FAILS TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT, THE BOARD OF DIRECTORS MUST INVESTIGATE THE MATTER FULLY AND IF THE BOARD DETERMINES THAT A VIOLATION HAS OCCURRED, THE BOARD IS RESPONSIBLE FOR TAKING APPROPRIATE DISCIPLINARY AND/OR CORRECTIVE ACTION. Form 990, Part VI, Section B, Line 15 THE EXECUTIVE AND FINANCE COMMITTEES OF THE BOARD WILL ESTABLISH THE COMPENSATION FOR THE CHIEF EXECUTIVE OFFICER. REPRESENTATIVES OF THESE COMMITTEES MAY CONSULT WITH THE DIRECTOR OF HUMAN RESOURCES REGARDING BENCHMARK SURVEY COMPENSATION DATA IN SETTING COMPENSATION FOR THE CHIEF EXECUTIVE OFFICER. THE COMPENSATION FOR THE CEO IS APPROVED BY THE ENTIRE BOARD OF DIRECTORS. Form 990, Part VI, Section C, Line 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON WRITTEN REQUEST. Form 990, Part XI, Line 9 PENSION AMOUNT CHARGED TO EQUITY 762,494 Arnot Ogden Medical Center Foundation Accounting Dept 600 Roe Avenue Elmira NY 14905 161109472 Affiliate NY 501(c)(3) 11B N/A 0 Arnot Ogden Medical Center Auxiliary 600 Roe Avenue Elmira NY 14905 510192902 Affiliate NY 501(c)(3) 11B N/A 0 Ira Davenport Memorial Hospital Inc Accounting Dept 7571 State Route 54 Bath NY 14810 160835446 Affiliate NY 501(c)(3) 3 N/A 0 Keuka Health Care Foundation Accounting Dept 7571 State Route 54 Bath NY 14810 161461215 Affiliate NY 501(c)(3) 11B N/A 0 Arnot Ogden Medical Center Accounting Dept 600 Roe Avenue Elmira NY 14905 160743905 Affiliate NY 501(c)(3) 3 N/A 0 Arnot Health 600 Roe Avenue Elmira NY 14905 453049405 Parent Organization NY 501(c)(3) 11B Arnot Ogden Medical Center 0 ST JOSEPHS HOUSING DEVELOPMENT FUND 555 ST JOSEPHS BLVD ELMIRA NY 14901 203240197 APARTMENTS NY ST JOSEPHS HEALTH SYSTEM C IVY STREET DEVELOPMENT CORPORATION ACCOUNTING DEPARTMENT 600 IVY STREET ELMIRA NY 14905 161009245 REAL ESTATE NY C 0 1 0 1 0 0 0 0 0 0 0 1 1 1 0 1 1 1 0 0 Arnot Ogden Medical Center o -7930329 ARNOT OGDEN MEDICAL CENTER PROVIDED EMPLOYEES TO ST. JOSEPH'S HOSPITAL FOR ADMINISTRATIVE, MEDICAL, MANAGEMENT INFORMATION, ACCOUNTING AND VARIOUS OTHER SERVICES. THE METHOD OF DETERMINING THE AMOUNT WAS COST. Arnot Ogden Medical Center o 93407 ST. JOSEPH'S HOSPITAL PROVIDED EMPLOYEES TO ARNOT OGDEN MEDICAL CENTER FOR ENVIRONMENTAL AND PASTORAL SERVICES. THE METHOD OF DETERMINING THE AMOUNT WAS COST. Arnot Ogden Medical Center Foundation q 61275 ST. JOSEPH'S HOSPITAL CHARGED ARNOT OGDEN MEDICAL CENTER FOUNDATION FOR UTILITIES, AND MAINTENANCE AND ENVIRONMENTAL SERVICES. THE METHOD OF DETERMINING THE AMOUNT WAS COST. Our recent request for a second extension for the 2015 St. Joseph's Hospital's (EIN: 16-0743163) Form 990 was denied due to Field 7 stating the reason for the need of the extension being inadvertently incomplete. Our parent organization is comprised of three hospitals. The accumulation of community outreach information required for Schedule H and the associated report on the community included in Schedule H is extensive, especially when including all three entities. Due to limited human resources and the extensive data accumulation required for the Schedule H's, additional time is required to accurately complete the 990. Please note that requests for second extensions for the other two hospitals were submitted and approved.