2015-11-10T15:47:12-07:00 2014-12-31 990 2014-01-01 160743163 ST JOSEPHS HOSPITAL STJO 6077336541 555 ST JOSEPHS BLVD ELMIRA NY 14901 Lambert Robert President & CEO 6077374100 2015-11-10 2014 2016-03-07 17:11:31Z RONALD J KINTZ SENIOR VP CFO 600 ROE AVENUE ELMIRA NY 14905 44880470 0 X www.stjosephs.org X 1908 NY MINISTERS TO INPATIENTS AND OUTPATIENTS, SERVING AS A PRIMARY CARE AND SPECIALTY REFERRAL CENTER 21 18 697 100 -293 -293 2624208 1727591 52554056 41775654 69514 -68419 803446 888487 56051224 44323313 0 0 0 0 34133217 23612200 0 0 0 22122620 21900784 56255837 45512984 -204613 -1189671 42240832 37061239 31922086 33078494 10318746 3982745 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 33624101 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 33624101 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 1 0 0 0 1 0 0 1 697 1 1 1 0 0 0 0 0 X 21 18 1 1 0 0 0 0 0 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 NY X RONALD KINTZ 6077374100 555 ST JOSEPHS BLVD ELMIRA NY 14901 Michael Hosey Chairman of the Board 1 3 X 0 0 0 Joseph P Manning Vice Chairman 0.3 0.9 X 0 0 0 Daniel J Burke Board Member 0.3 0.9 X 0 0 0 Kenneth Herzl Betz Board Member 0.3 0.9 X 0 0 0 David Dalrymple Board Member 0.3 0.9 X 0 0 0 Christine M Deschamps Board Member 0.2 0.7 X 0 0 0 S Jan Eberhard Board Member 0.7 2.2 X 0 0 0 John T Gough Board Member 0.1 0.4 X 0 0 0 Mark J Hagan Board Member 0.7 2 X 0 0 0 Roy A Kyles Board Member 0.1 0.4 X 0 0 0 Ben E Lynch Board Member 0.7 2.2 X 0 0 0 Robert McNamara Board Member 0.1 0.4 X 0 0 0 Mary Louise Mitchell Board Member 0.2 0.7 X 0 0 0 John F OMara Board Member 0.3 0.9 X 0 0 0 Donald Quick Board Member 0.5 1.4 X 0 0 0 Patrick J Rogers Board Member 0.1 0.4 X 0 0 0 Melinda Sartori Board Member 0.2 0.7 X 0 0 0 Roger Schenone Board Member 0.5 1.4 X 0 0 0 Kevin OConnor Board Member 0.1 0.4 X 0 0 0 Margaret Streeter Board Member 0.1 0.4 X 0 0 0 Robert Lambert President Arnot Health 7 40 X X 0 586846 36639 John R Alexander Secretary 0.1 0.4 X 0 0 0 Ronald J Kintz Senior VP/CFO 7 46 X 0 361864 36639 H Fred Farley Hospital President COO 6.00 45.00 X 0 374508 36639 Kevin Deluca VP Medical Affairs 3 20 X X 0 173650 20669 Wes Blauvelt VP Planning 4 32 X X 0 194566 9414 Mary Ann Mahajan Pharmacist 40 0 X 137000 0 14634 Roberta Conz RN 46 0 X 102230 0 7572 Ann Jacobs RN 46 0 X 104377 0 2880 343607 1691434 165086 3 1 1 0 Streeter Associates PO Box 118 Elmira NY 14902 Construction Services 915046 Otis Elevator Company 2 Townline Circle Rochester NY 14623 Equipment Installation & Service 895104 Delphi Healthcare PLLC 1880 East Ridge Road Suite 6 Upper Level Rochester NY 14622 Emergency Room Physicians 766998 Quadramed Box 347188 Pittsburgh PA 15251 Equipment Installation & Service 607423 ABM Healthcare Support Services PO Box 935695 Atlanta GA 31193 Consulting Services 292485 14 1727591 1727591 Net Patient Service Hospital Revenue 900099 41775654 41775654 0 0 0 0 0 0 41775654 79117 0 0 79117 0 0 0 0 0 0 0 0 2100 0 2393 0 -293 0 -293 0 -293 0 0 286749 0 434285 0 -147536 -147536 0 0 -147536 0 0 0 0 0 0 0 0 0 0 0 0 216325 120479 95846 0 0 95846 792934 0 0 792934 792934 44323313 41775654 -293 820361 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 17602425 14583859 3018566 0 1239461 0 1239461 0 3467259 4127 3463132 0 1303055 1046882 256173 0 382677 123906 258771 0 47749 13 47736 0 7695 0 7695 0 12631 0 12631 0 0 0 463 0 463 0 883243 752375 130868 0 39 0 39 0 1565501 1041850 523651 0 216135 33531 182604 0 0 0 0 0 1154174 29939 1124235 0 4355 4131 224 0 0 0 0 0 8981 8063 918 0 47319 0 47319 0 0 0 0 0 3054357 1578405 1475952 0 205631 0 205631 0 Medical/Surgical/Pharmaceutical Supplies 12140595 9003377 3137218 0 Maintenance Contracts/Purchased Services 2132703 1518234 614469 0 Leases 36536 10415 26121 0 Benefit Allocation 0 3884994 -3884994 0 0 45512984 33624101 11888883 0 28414 22874 3166196 1946945 1068429 831612 7320613 7255979 92738 113042 587101 580861 193215 149896 103302679 81659399 24088487 21643280 394784 394784 1400000 5300855 2721966 42240832 37061239 4449779 2875412 0 0 0 0 0 0 0 0 0 0 2161171 1612507 0 0 25311136 28590575 31922086 33078494 X 8807654 3804767 1345307 145078 165785 32900 10318746 3982745 42240832 37061239 X -1189671 0 0 0 0 -5146330 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 12631 12631 0 Schedule C, Part II-B, Line 1 ST JOSEPH'S PAYS ANNUAL DUES TO THE HEALTH ASSOCIATION OF NEW YORK. PART OF THE DUES ARE USED FOR LOBBYING EXPENSES. 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 43141 6000 0 0 1000 0 48141 0.82 0.18 0 0 0 0 1197617 1197617 0 29661384 18210457 11450927 0 0 0 0 0 72443678 63448942 8994736 0 0 0 0 21643280 Accounts Receivable Workers Compensation Insurance 838874 Self Insurance Reserve 1798255 Swartwood Prize Fund 33143 Other Assets 51694 2721966 0 DUE TO RELATED ORGANIZATIONS 12173029 MINIMUM PENSION LIABILITY 9611404 WORKERS COMPENSATION RESERVE 4639090 THIRD PARTY REIMBURSEMENT PAYABLES 2167052 28590575 X 44446185 0 0 0 122872 122872 44323313 0 0 0 44323313 45635856 0 0 0 122872 122872 45512984 0 0 0 45512984 Schedule D, Part V, Line 4 PERMANENTLY RESTRICTED ENDOWMENT FUND 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 cosnoldiated financial statements. Schedule D, Part XI, Line 2d COST OF GOODS SOLD NUTRITIONAL SERVICES 120,479 AND RENTAL EXPENSES 2,393 OFFSET VS. REVENUES ON FORM 990, INCLUDED WITH EXPENSES ON AUDITED FINANCIAL STATEMENTS Schedule D, Part XII, Line 2d COST OF GOODS SOLD NUTRITIONAL SERVICES 120,479 AND RENTAL EXPENSES 2,393 OFFSET VS. REVENUES ON FORM 990, INCLUDED WITH EXPENSES ON AUDITED FINANCIAL STATEMENTS 1 1 X 1 X 1 X 1 1 1 0 1 1 167 103917 7963 95954 0.0021 0 0 0 0 0 0 5463091 4026536 1436555 0.0316 0 167 5567008 4034499 1532509 0.0337 1104 98349 0 98349 0.0022 1 2 0 0 0 0.00 0 0 0 0 0 0.00 0 0 0 0 0 0.00 1 0 179 0 179 0 2 1106 98528 0 98528 0.0022 2 1273 5665536 4034499 1631037 0.0359 0 0 0 0 0 0.00 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 2 730 0 730 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 730 0 730 0.00 0 3593292 0 12340705 13634699 -1293994 X 1 1 ARNOT OGDEN MEDICAL CENTER ADMINISTRATION & CONSULTING 0 0 0 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 13 1 1 0 1 X www.arnothealth.org/community-leadership X X 1 13 1 www.arnothealth.org/aboutus 0 0 1 X 150 400 X X X 1 1 X X X 1 X X X X X X X 1 X 0 X X X X X 1 X 0 1 Schedule H, Part V, Section B, Line 5-ST JOSEPHS HOSPITAL Arnot Health participated in a comprehensive year-long process to assess community needs across county lines with partners such as: The Chemung County Health Department; Steuben County Public Health; other hospitals and healthcare agencies in Chemung, Steuben, and Schuyler Counties; a diverse collaborative of community partners and community residents. The year-long process of Assessing Community Health Needs was facilitated by a consultant contracted by Chemung County Health Department and technical assistance from the S2AY Rural Health Network in Steuben County. Arnot Health, in partnership with the dual-county collaborative network, used the MAPP process (Mobilizing for Action through Planning and Partnership), to collect and analyze data from a variety of sources. Valuable input was gained from surveying Chemung and Steuben County residents about their current health, and opinions on County wide health challenges. Areas of disparity were also assessed within each county. Schedule H, Part V, Section B, Line 6a-ST JOSEPHS HOSPITAL Arnot Health is a regional healthcare system that serves five counties within the Southern Tier Region of New York State and the Northern Tier of Pennsylvania. Arnot Health's three hospitals are located in two counties: Arnot Ogden Medical Center and St. Joseph's Hospitals are located in Chemung County, and Ira Davenport Memorial Hospital is situated in Steuben County. With hospital facilities in two counties, Arnot Health followed guidance from the New York State Department of Health (NYSDOH) and the 2013-2017 Prevention Agenda to answer the question of health priorities impacting the wellness of our communities. 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: Web site Documents will be posted on the healthcare system's Web site at the following URL: http://www.arnothealth.org/aboutus. Arnot Health's CSP and CHIP can also be found by entering the words "Community Service Plan" in the general search tool on the system's Web site, and typing "Arnot Health "Community Service Plan" in Google's Search Engine. Arnot Health plans to develop a section of the system's Web site dedicated to community outreach in 2014, budget permitting, to bring community service work to a more prominent place within the site. Partner Web sites Chemung and Steuben Counties will post links to their CHA and CHIP on their Web sites. HP2 and SHPT partners have also agreed to investigate the possibility of posting links to the plans on their Web sites and in their agencies' publications. Presentations Arnot Health's Community Health Department provides education about the healthcare systems' CSP and community outreach strategies to address public health priorities through presentations at community events, regional and state conferences, to Arnot Health's department managers and the healthcare system's Board of Directors. Local Media Outlets Arnot Health works with a variety of local media outlets to disseminate information about the Community Service Plan and community outreach programs and services. The health system continually assesses the effectiveness of each of those outlets. Historically, regional newspapers have proven an effective way to provide timely information to the public, based on consumer feedback at programs and events. Other methods include website, social media, television, radio, phone banking, direct mail, and other community publications. Health on Demand Call Center The public may call the healthcare system's Health on Demand Regional Medical Call Center at 607.737.4499 to receive a copy of the Community Service Plan and plan of action for improving the health of the community. Insight Newsletter Information about accessing Arnot Health's Community Service Plan and request for community input will be published annually in Insight, a monthly publication for employees, retirees and volunteers of the Arnot Health System. Former Insight Newsletters featured articles that illustrate the healthcare system's mission to provide quality preventative healthcare through community outreach and ongoing assessment of public health needs. Provider Offices The CSP will also be found in Arnot Health's providers' offices for the public to access during visits. Moving forward, Arnot Health will continue to identify ways to effectively communicate with residents in the service area to solicit input and provide an update to the plan of action. Schedule H, Part V, Section B, Line 11-ST JOSEPHS HOSPITAL Steuben County New York State Prevention Agenda 2013 to 2017 Public Health Priorities Prevent Chronic Disease. 1, Reduce obesity in children and adults. 2, Reduce illness, disability and death related to heart disease and hypertension. 3, Promote tobacco cessation, especially among low socioeconomic populations and those with mental health illness. Schedule H, Part V, Section B, Line 16a-ST JOSEPHS HOSPITAL www.arnothealth.org Schedule H, Part V, Section B, Line 16b-ST JOSEPHS HOSPITAL www.arnothealth.org Schedule H, Part V, Section B, Line 16c-ST JOSEPHS HOSPITAL www.arnothealth.org 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 worklist. If insurance is located, self pay collector must verify eligibility for the date of service. The self pay staff will change the health plan to the correct one for all covered dates of service and billing will submit 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 process. Self Pay Collections Staff attempts to collect full balance due by check or credit card. If they are unable to make the full payment, Self pay will attempt to make payment arrangements and to notify patient about the Community Care Program. If the patient wants to apply for the community care program, the patient will be sent an application for the program and will be informed of the documentation they 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 collectors staff enters the payment plan and document comments in Soarian. Payment plan statement is demanded and sent to the patient. If patient does not enter into a payment plan agreement, or fails to pay as agreed. account will go through the standard dunning and collection agency activity. See Guarantor Billing and Collections. 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 7 The hospital provides care to patients who meet certain criteria under its financial assistance policy without charge or at amounts less than established rates. Because the hospital does not pursue collection of amounts determined to qualify as charity care, they are not shown as revenue. The hospital maintains records to identify and monitor the level of chairty care it provides. These records include the amount of charges foregone for services furnished under its financial assistance program. Schedule H, Part II Dr. Lambert and Rosemary Anthony are both on the Chemung County Board of Health, Dr. Fred Farley is on the CNY Health Health Careers Board, Adult Immunization Coalition (AIC), Chemung, Steuben and Schuyler County Health Departments, Cancer Services Chemung & Schuyler Counties, Chemung County Health Priorities Partnership, Housing Coalition - Catholic Charities, Hunger Coalition, and Poverty Coalition. Schedule H, Part III, Section A, Line 4 Basesd upon the historical experience, a significant portion of the organization's uninsured patients will be unable or unwilling to pay for the services provided. Thus, the organization records a significant provision for bad debts related to uninsured patients in the period the services are provided. The bad debt expense is recorded at a cost to charge ratio. Schedule H, Part III, Section B, Line 8 Basesd upon the historical experience, a significant portion of the organization's uninsured patients will be unable or unwilling to pay for the services provided. Thus, the organization records a significant provision for bad debts related to uninsured patients in the period the services are provided. The bad debt expense is recorded at a cost to charge ratio. 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 worklist. If insurance is located, self pay collector must verify eligibility for the date of service. The self pay staff will change the health plan to the correct one for all covered dates of service and billing will submit 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 process. Self Pay Collections Staff attempts to collect full balance due by check or credit card. If they are unable to make the full payment, Self pay will attempt to make payment arrangements and to notify patient about the Community Care Program. If the patient wants to apply for the community care program, the patient will be sent an application for the program and will be informed of the documentation they 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 collectors staff enters the payment plan and document comments in Soarian. Payment plan statement is demanded and sent to the patient. If patient does not enter into a payment plan agreement, or fails to pay as agreed. account will go through the standard dunning and collection agency activity. See Guarantor Billing and Collections. Schedule H, Part VI, Line 2 Arnot Health participated in a comprehensive year-long process to assess community needs across county lines with partners such as: The Chemung County Health Department; Steuben County Public Health; other hospitals and healthcare agencies in Chemung, Steuben, and Schuyler Counties; a diverse collaborative of community partners and community residents. The year-long process of Assessing Community Health Needs was facilitated by a consultant contracted by Chemung County Health Department and technical assistance from the S2AY Rural Health Network in Steuben County. Arnot Health, in partnership with the dual-county collaborative network, used the MAPP process (Mobilizing for Action through Planning and Partnership), to collect and analyze data from a variety of sources. Valuable input was gained from surveying Chemung and Steuben County residents about their current health, and opinions on County wide health challenges. Areas of disparity were also assessed within each county. Schedule H, Part VI, Line 3 In addition to website, the healthcare system uses a variety of methods to disseminate the community service plan, information about community health programs and the availability of financial assistance to the public. Some of these methods include presentations by the community health department to provide education about the healthcare system's community service plan, and community outreach strategies to address public health priorities through presentations at community events, regional and state conferences, by department managers and the healthcare system's joint board of directors. Work is done with a variety of local media outlets to disseminate information about community outreach programs and services, and continually assess the effectiveness of each of those outlets. Historically, regional newspapers have proven an effective way to provide timely information to the public, based on consumer feedback at programs and events. Other methods include television, radio, phone banking, direct mail and other community publications. St. Joseph's Hospital also communicates its community care program in the following ways - signage in waiting rooms, brochures in waiting rooms and admission packages, notations on billing packages, staff education so they can share the availability of the program and contact information with patients, communication to and education of shared county department of social services staff so they are informed of the progam details and contact information, communication of program with collection agencies and collection attorneys so they can share the availability of the program and contact information with prospective enrollees, and informtion on the healthcare system's website. Schedule H, Part VI, Line 4 Arnot Health is comprised of three hospitals, Arnot Ogden Medical Center and St. Joseph's Hospitals 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. The distribution of patients from this service area, as measured by total discharges from system's hospitals, is as follows: Chemung (60.3%), Steuben (17.2%), Schuyler (8.3%), Bradford, PA (3.1%), Tioga, PA (3.1%) and all other (8%). Zip Codes within closest proximity to Arnot Health's hospital facilities include: Chemung County Steuben County Schuyler County 14814 Big Flats 14801 Addison 14805 Alpine 14816 Breesport 14809 Avoca 14812 Beaver Dams 14825 Chemung 14810 Bath 14815 Bradford 14901 Elmira (MUA) 14819 Cameron 14818 Burdett 14902 Elmira 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 Joseph P Manning 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 Kenneth Herzl Betz 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 Christine M Deschamps 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 John T Gough Board Member 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Mark J Hagan 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 Ben E Lynch 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 0 John F OMara Board Member 0 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 Patrick J Rogers 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 0 Roger Schenone Board Member 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Kevin OConnor Board Member 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Margaret Streeter Board Member 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Ronald J Kintz Senior VP/CFO 0 323362 0 38502 0 0 0 13000 0 23639 0 398503 0 0 Robert Lambert President Arnot Health 0 524738 0 62108 0 0 0 13000 0 23639 0 623485 0 0 H Fred Farley Hospital President COO 0 344660 0 29848 0 0 0 13000 0 23639 0 411147 0 0 Kevin Deluca VP Medical Affairs 0 173650 0 0 0 0 0 3925 0 16744 0 194319 0 0 Wes Blauvelt VP Planning 0 167826 0 26740 0 0 0 8142 0 1272 0 203980 0 0 Mary Ann Mahajan Physician 137000 0 0 0 0 0 3114 0 11520 0 151634 0 Roberta Conz RN 102230 0 0 0 0 0 2678 0 7572 0 112480 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 nonprofit 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 Company 1612506 Competetively bid loans 0 Form 990, Part VI, Section A, Line 2 David Dalrymple Chairman of Board Chemung Canal Trust Company Competetively Bid Loans 1,612,506 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 CONFILICT 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. THIS PROCESS WAS LAST UNDERTAKEN IN 2014. 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 Net Assets released from restrictions by Arnot Ogden Medical Center Foundation 14,113, Transfer of Net Assets to Arnot Ogden Medical Center Foundation (2,578,888), Pension amount charged to Equity (2,581,555) 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 St Josephs Hospital Foundation Accounting Dept 571 St Josephs Blvd Elmira NY 14901 161265182 Affiliate NY 501 (c) 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 0 0 0 0 0 0 0 0 1 1 1 0 1 0 1 0 0 Arnot Ogden Medical Center o -7616062 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 98356 ST. JOSEPH'S HOSPITAL PROVIDED EMPLOYEES TO ARNOT OGDEN MEDICAL CENTER FOR ENVIRONMENTAL AND PASTORAL SERVICES. THE METHOD OF DETERMINING THE AMOUNT WAS COST. St Josephs Hospital Foundation k -8373 ST. JOSEPH'S HOSPITAL RENTED SPACE IN A BUILDING OWNED BY ST. JOSEPH'S HOSPITAL FOUNDATION. THE METHOD OF DETERMINING THE AMOUNT WAS THE FAIR MARKET VALUE OF THE SQUARE FEET. St Josephs Hospital Foundation q 57364 ST. JOSEPH'S HOSPITAL CHARGED ST. JOSEPH'S HOSPITAL FOUNDATION FOR UTILITIES, AND MAINTENANCE AND ENVIRONMENTAL SERVICES. THE METHOD OF DETERMINING THE AMOUNT WAS COST. St. Joseph's Hospital Filed an Extension Request, which was granted.