2014-11-17T09:37:36-06:00 2013-12-31 264298079 EFP ROTENBERG LLP 280 KENNETH DRIVE ROCHESTER NY 14623 990 2013-01-01 160743979 NICHOLAS H NOYES MEMORIAL HOSPITAL NICH 5853356001 111 CLARA BARTON STREET DANSVILLE NY 14437 AMY POLLARD PRESIDENT/CEO 5853356001 2014-11-13 1 WILLIAM MCDONALD P01600766 5854278900 2014-11-13 2013 2015-11-30 17:44:51Z AMY POLLARD 111 CLARA BARTON STREET DANSVILLE NY 14437 47330307 0 X WWW.NOYES-HEALTH.ORG X 1927 NY NICHOLAS H. NOYES MEMORIAL HOSPITAL IS A 72 BED HOSPITAL WHICH PROVIDES ACUTE, SUB-ACUTE, EMERGENCY AND OTHER OUTPATIENT CARE AND WHOSE MISSION IS TO SUPPORT AND PROMOTE THE HEALTH OF OUR COMMUNITIES THROUGH COMPASSIONATE QUALITY CARE. 16 9 579 92 878931 -470269 535141 374206 44963366 44674685 65961 68268 1465350 1866387 47029818 46983546 0 0 0 0 25484324 24354966 0 0 51384 23209089 24043917 48693413 48398883 -1663595 -1415337 38233892 44386301 19788711 22710156 18445181 21676145 NICHOLAS H. NOYES MEMORIAL HOSPITAL SUPPORTS AND PROMOTES THE HEALTH OF OUR COMMUNITIES THROUGH COMPASSIONATE QUALITY CARE. 0 0 37103928 44674685 NICHOLAS H. NOYES MEMORIAL HOSPITAL IS A 72 BED HOSPITAL WHICH PROVIDES ACUTE, SUB-ACUTE, AND OUTPATIENT CARE. 37103928 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 1 1 0 0 1 1 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 1 0 0 0 1 79 0 1 579 1 1 1 0 0 0 0 1 1 0 0 0 0 0 0 0 X 16 9 0 0 0 0 0 0 0 1 1 1 0 1 1 1 1 1 1 1 0 0 NY X X JAY MASLYN 5853354306 111 CLARA BARTON STREET DANSVILLE NY 14437 GRAHAM FRAZER SECOND VICE CHAIRPERSON 2.00 X 0 0 0 JOHN LOCKHART DIRECTOR 2.00 X 0 0 0 MICHAEL JOHNSEN CHAIRPERSON 10.00 X 0 0 0 LESLIE COLE JR FIRST VICE CHAIRPERSON 2.00 X 0 0 0 JOE BUCCI JR DIRECTOR 1.00 X 0 0 0 AMY POLLARD PRESIDENT/CEO 40.00 X X 177591 0 19647 JOAN FLENDER MD DIRECTOR 1.00 X 0 0 0 GEOFFREY WITTIG MD PRESIDENT ELECT, MEDICAL STAFF 1.00 X 0 0 0 MARK LYONS DIRECTOR 1.00 X 0 0 0 DOMENICK MARTELLO DIRECTOR 1.00 X 0 0 0 DOUGLAS MAYHLE MD MEDICAL DIRECTOR 40.00 X 366243 0 14434 LINDSAY QUINTILONE DIRECTOR 1.00 X 0 0 0 ARIF QURESHI MD PRESIDENT, MEDICAL STAFF 2.00 X 0 0 0 BERNARD SWEENEY MD DIRECTOR 1.00 X 0 0 0 MARILYN MOORE PAST CHAIRPERSON/SECRETARY 5.00 X 0 0 0 JAMES CULBERTSON TREASURER 1.00 X 0 0 0 JAY MASLYN CFO 40.00 X 136540 0 3289 ROBERT CAPECCI MD PHYSICIAN-ORTHOPEDIST 40.00 X 630949 0 17282 KEVIN WENTWORTH PHYSICIANS ASSISTANT 40.00 X 182270 0 16486 JACOB TALLMAN FAMILY PRACTITIONER 40.00 X 217606 0 17258 BRIAN FORESMAN GENERAL SURGEON 40.00 X 452739 0 17038 MICHAEL PARKOT PHYSICIANS ASSISTANT 40.00 X 179045 0 16828 2342983 0 122262 8 0 1 0 DANSVILLE ANESTHESIA & PAIN MGMT PO BOX 33058 PALM BEACH GARDENS FL 33420 ANESTHESIOLOGIST 2162922 ARUP LABORATORIES 500 CHIPETA WAY SALT LAKE CITY UT 841081221 LAB TESTING SERVICES 783254 GARDNER PLUS ARCHITECTS PLCC 40 WILDBRIAR RD ROCHESTER NY 14623 ARCHITECTS 418642 SLEEP INSIGHTS MANAGEMENT SVC 10 HAGEN DR SUITE 200 ROCHESTER NY 14625 POLYSOMNOGRAPHY SVC 292182 RONDON RAFAEL MD 84 ASHLAND AVENUE BUFFALO NY 14222 EMERGENCY PHYSICIAN 251320 5 275568 98638 374206 PATIENT SERVICE REVENUE 621990 44674685 44674685 44674685 51916 51916 280594 264242 16352 16352 16352 24051 9901 14150 14150 191421 72618 118803 118803 OTHER REVENUE 541380 1602783 748280 854503 SEAGATE ALLIANCE, LLC 900000 130651 130651 1733434 46983546 44793488 878931 936921 717744 262832 454912 19242387 14980769 4233325 28293 256259 199467 54088 2704 2761126 2175027 582786 3313 1377450 1030923 344363 2164 14938 13850 1088 85265 85265 61900 61900 61603 61603 66147 66147 4007584 3232034 775550 126321 39072 86356 893 8713237 8012407 686813 14017 984339 738254 246085 1489641 366515 1123126 13191 8871 4320 73215 57711 15504 65355 48932 16423 2277551 1267848 1009703 510309 401723 108586 BAD DEBT 2001783 2001783 OTHER PURCHASED SERVICE 1465352 973914 491438 EQUIPMENT RENTAL 942269 548852 393417 REPAIRS & MAINTENANCE 762584 497877 264707 321333 245267 76066 48398883 37103928 11243571 51384 5716 5399 1593512 977243 5099254 6492042 833562 892523 653881 816599 53894293 34358713 15876135 19535580 1464688 1582668 12707144 14084247 38233892 44386301 4988225 6599184 936052 4471895 8502949 7839581 5361485 3799496 19788711 22710156 X 17660248 20552522 41227 379917 743706 743706 18445181 21676145 38233892 44386301 X -1415337 78306 4567995 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 50000 0 1 11603 61603 0 PART II-B, LINE 1: AS MEMBERS OF 3 ASSOCIATIONS (AHA - AMERICAN HOSPITAL ASSOCIATION, HANYS-THE HEALTHCARE ASSOCIATION OF NEW YORK STATE & RRHA/SEAGATE ALLIANCE) A PORTION OF THE DUES (TOTAL REFLECTED ABOVE) ARE PAID AS PART OF MEMBERSHIP AND REPRESENT AMOUNTS DESIGNATED FOR LOBBYING ACTIVITIES. THESE ASSOCIATE ORGANIZATIONS OF WHICH WE ARE MEMBERS HANDLE THE DIRECT LOBBYING/ADVOCACY ACTIVITIES ON BEHALF OF THEIR MEMBERS. 1561127 138137 10726 1688538 1449363 121879 10115 1561127 1434453 24558 9648 1449363 1335945 107551 9043 1434453 1155614 188466 8135 1335945 0.61880 0.38120 0 0 372690 372690 22458238 13480440 8977798 24383902 20878273 3505629 6679463 6679463 19535580 BENEFICIAL INTEREST IN NET ASSETS OF FOUNDATION 12392365 DEBT ORIGINATION COSTS - NET 432400 MORTGAGE REPAYMENT ESCROW FUNDS 805638 OTHER 453844 14084247 DUE TO RELATED ENTITY 8288 DUE TO THIRD PARTY PAYORS- LONG TERM 1103190 DUE TO THIRD PARTY PAYORS- SHORT TERM 629959 LINE OF CREDIT 685000 PENSION LIABILITY 1225379 WORKERS COMPENSATION 147680 3799496 X 45142588 78306 78306 45064282 1919264 1919264 46983546 46479619 82519 82519 46397100 2001783 2001783 48398883 PART V, LINE 4: EMPLOYEE EDUCATION. PART X, LINE 2: IN ACCORDANCE WITH ASC 740-10-50, ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES, THE SYSTEM RECOGNIZES THE TAX BENEFITS FROM UNCERTAIN TAX POSITIONS ONLY IF IT IS MORE LIKELY THAN NOT THAT THE TAX POSITION WILL BE SUSTAINED ON EXAMINATION BY THE TAXING AUTHORITIES. MANAGEMENT BELIEVES THAT THE SYSTEM IS CURRENTLY OPERATING IN COMPLIANCE WITH THE APPLICABLE REQUIREMENTS OF THE INTERNAL REVENUE CODE. THEREFORE, NO LIABILITY FOR UNRECOGNIZED TAX BENEFITS HAS BEEN INCLUDED ON THE SYSTEMS FINANCIAL STATEMENTS. THE EXEMPT SYSTEMS INFORMATIONAL RETURNS ARE SUBJECT TO AUDIT BY VARIOUS TAXING AUTHORITIES AND ITS OPEN AUDIT PERIODS ARE 2010 THROUGH 2012. PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 2,001,783. FUNDRAISING EXPENSES -9,901. COST OF GOODS SOLD -72,618. PART XII, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES 9,901. COST OF GOODS SOLD 72,618. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 2,001,783. GOLF TOURNAMENT 17729 17729 120 1815 3526 889 FLOWER SALE 6322 6322 3551 24051 24051 120 1815 3526 4440 9901 14150 1 1 0 1 X 1 1 1 0 1 1 643075 0 643075 0.01330 7608444 7176022 432422 0.00890 380 278631 229429 49202 0.00100 380 8530150 7405451 1124699 0.02320 17 17654 116105 9290 106815 0.00220 3 209 176738 7000 169738 0.00350 4087312 3385562 701750 0.01450 0 0 4 2029 33645 6986 26659 0.00060 24 19892 4413800 3408838 1004962 0.02080 24 20272 12943950 10814289 2129661 0.04400 1 111 14116 14116 0.00030 1 111 14116 14116 0.00030 1 2001783 838949 8299955 7419232 880723 X 1 1 1 1 NICHOLAS H NOYES MEMORIAL HOSPITAL 111 CLARA BARTON STREET DANSVILLE NY 14437 X X X NICHOLAS H NOYES MEMORIAL HOSPITAL 1 1 X X X X X X X X X 13 1 0 1 X WWW.NOYES-HEALTH.ORG/COMMUNITY-SERVICES X X X X X X X X X X 1 0 1 0 1 300.000000000000 1 X X X 1 1 X X X X X 1 0 X X X 1 0 0 NICHOLAS H NOYES MEMORIAL HOSPITAL PART V, SECTION B, LINE 5D: CHNA UPDATES PROVIDED IN 2014 FOR NOYES EXECUTIVE BOARD, LIVINGSTON COUNTY BOARD OF SUPERVISORS, LIVINGSTON COUNTY BOARD OF HEALTH, CHNA LEADERSHIP AND GENERAL PUBLIC. NICHOLAS H NOYES MEMORIAL HOSPITAL PART V, SECTION B, LINE 10: THE HOSPITAL DOES NOT GIVE FREE CARE TO ANY PATIENTS. 6 AFTER HOURS CARE CENTER 4440 LAKEVILLE ROAD GENESEO NY 14454 URGENT CARE CENTER LIVINGSTON HEALTH SERVICES 50 EAST SOUTH STREET GENESEO NY 14454 OUTPATIENT SURGERY AND DIAGNOSTIC MENTAL HEALTH CLINIC 1 MAIN STREET DANSVILLE NY 14437 MENTAL HEALTH CLINIC NOYES CTR FOR KIDNEY DISEASE & DIALYSIS 4616 MELLENIUM DRIVE GENESEO NY 14454 CHRONIC DIALYSIS CENTER AND NEPHROLOGIST OB-GYN ASSOC OF THE FINGER LAKES 253 MAIN STREET DANSVILLE NY 14437 OUTPATIENT PHYSICIAN CLINIC CREEKSIDE FAMILY MEDICINE 12 NORTH CHURCH ST CANASERAGA NY 14822 PRIMARY CARE PHYSICIAN OFFICE PART II, COMMUNITY BUILDING ACTIVITIES: NOYES HOSPITAL STAFF ACTIVELY PARTICIPATES IN MULTIPLE COMMUNITY COALITIONS AND PARTNERSHIPS TO COLLABORATIVELY ADDRESS THE HEALTH CARE NEEDS OF OUR COMMUNITY. THE FOLLOWING IS A LIST OF AGENCY AND ORGANIZATIONAL COMMITTEES/TEAMS THAT NOYES PARTICIPATES ON TO IMPROVE THE HEALTH OF THE COMMUNITY WE SERVE: GENESEE VALLEY HEALTH PARTNERSHIP (GVHP): EXECUTIVE BOARD AND GENERAL MEMBERSHIP GVHP LIVINGSTON COUNTY COMMUNITY HEALTH IMPROVEMENT (CHIP) WORK GROUPS: PREVENTION AND MANAGEMENT OF CHRONIC DISEASE (NOYES MEMBER) IMPROVE ACCESS TO HEALTH CARE STRENGTHEN SOCIAL AND EMOTIONAL HEALTH (NOYES MEMBER) PROMOTE SAFE COMMUNITIES (NOYES MEMBER) LIVINGSTON WELLNESS PARTNERSHIP LIVINGSTON COUNTY LONG TERM CARE COUNCIL LIVINGSTON COUNTY ACHIEVE (ACTION COMMUNITIES FOR HEALTH, INNOVATIONS AND ENVIRONMENTAL CHANGE) GRANT COMMITTEE LIVINGSTON COUNTY MATERNAL CHILD HEALTH COALITION (NOYES LEAD) LIVINGSTON COUNTY DIABETES COALITION (NOYES LEAD) LIVINGSTON COUNTY SEXUAL RESPONSIBILITY COALITION LIVINGSTON COUNTY TOBACCO ACTION COALITION LIVINGSTON COUNTY TRAFFIC SAFETY COALITION LIVINGSTON COUNTY OFFICE FOR AGING ADVISORY BOARD FAITH IN ACTION ADVISORY BOARD PART III, LINE 4: COSTING METHOD FOR BAD DEBT EXPENSE AT COST IS RATIO OF PATIENT CARE COST TO CHARGES FROM WORKSHEET 2 MULTIPLIED BY THE DEMOGRAPHICS OF PRIMARY SERVICE AREA FOR THOSE WHO WOULD RECEIVE CHARITY CARE IF GIVEN ENOUGH INFORMATION. PART III, LINE 8: THE SOURCE OF THE MEDICARE ALLOWABLE COSTS IS THE 2013 CMS 2552 WORKSHEET I-4. PART VI, LINE 2: PUBLIC PARTICIPATION: COMMUNITY HEALTH ASSESSMENTA. IN MARCH 2013, THE LIVINGSTON COUNTY DEPARTMENT OF HEALTH STARTED WORKING WITH NOYES HEALTH TO COMPLETE THE LIVINGSTON COUNTY COMMUNITY HEALTH ASSESSMENT (CHA). A CHA LEADERSHIP TEAM WAS CREATED UNDER THE DIRECTION OF CO-COORDINATORS FROM THE LIVINGSTON COUNTY DEPARTMENT OF HEALTH AND NOYESHEALTH. THE CO-COORDINATORS MET FREQUENTLY BETWEEN LEADERSHIP MEETINGS TO IMPLEMENT THE CHA PROCESS.INVITATIONS TO JOIN THE TEAM WERE EXTENDED TO ALL MEMBERS OF THE GENESEE VALLEY HEALTH PARTNERSHIP (GVHP), A NON-PROFIT, RURAL HEALTH NETWORK OF MORE THAN 40 DIFFERENT ORGANIZATIONS THAT ARE EITHER BASED IN LIVINGSTON COUNTY OR PROVIDE SERVICES TO LIVINGSTON COUNTY RESIDENTS. GVHP IS A 501(C)3 ORGANIZATION WHOSE MISSION IS TO IMPROVE THE HEALTH AND WELL-BEING OF THE LIVINGSTON COUNTY COMMUNITY THROUGH COLLABORATION, EDUCATION AND PREVENTION. THEIR TAGLINE IS "CREATING A HEALTHY FUTURE NOW".THE CHA LEADERSHIP TEAM CONSISTS OF 22 MEMBERS FROM THE FOLLOWING 19 COMMUNITY HEALTH CARE ORGANIZATIONS, COUNTY AND GOVERNMENT AGENCIES, FAITH BASED ORGANIZATIONS, LOCAL SCHOOLS AND ACADEMIA, AND HUMAN SERVICE ORGANIZATIONS THAT PARTICIPATED IN THE CHA PROCESS THROUGHOUT THE FIVE MONTH PERIOD:- THE ARC OF LIVINGSTON-WYOMING COUNTY/KIDSTART- CATHOLIC CHARITIES OF LIVINGSTON COUNTY- CORNELL COOPERATIVE EXTENSION OF LIVINGSTON COUNTY- HEALTH AND WELLNESS- LITERACY VOLUNTEERS LIVINGSTON COUNTY OFFICE FOR AGING- LIVINGSTON COUNTY CENTER FOR NURSING AND REHAB- LIVINGSTON COUNTY EMS- LIVINGSTON COUNTY PLANNING DEPARTMENT- LIVINGSTON COUNTY DEPARTMENT OF SOCIAL SERVICES- LIVINGSTON COUNTY DEPARTMENT OF HEALTH- LIVINGSTON COUNTY BOARD OF HEALTH- LIVINGSTON COUNTY PROBATION- LIVINGSTON COUNTY WORKFORCE DEVELOPMENT AND YOUTH BUREAU- LIVINGSTON COUNTY CHAMBER OF COMMERCE- LIVINGSTON COUNTY MENTAL HEALTH- NOYES HEALTH/COMMUNITY OUTREACH SERVICES- NOYES MENTAL HEALTH- STUDENT SUPPORT SERVICES CENTER GENESEE VALLEY EDUCATION PARTNERSHIPB. PUBLIC INPUT OUTCOMESMAY 2013: THE FIRST ORGANIZATIONAL MEETING OF THE CHA LEADERSHIP TEAM WAS HELD TO ESTABLISH THE CHA ASSESSMENT PROCESS TO IDENTIFY HEALTH CARE PRIORITIES. THE FIRST ACTION ITEM WAS TO COMPLETE THE COMMUNITY HEALTH SURVEY.JUNE 2013: THE LEADERSHIP TEAM THEN REVIEWED THE SURVEY RESULTS: 427 SURVEYS WERE COMPLETED USING BOTH SURVEY MONKEY AND PAPER SURVEYS AT MANY AGENCY LOCATIONS THROUGHOUT COUNTY. SURVEY RESULTS DEMONSTRATED GOOD ZIP CODE REPRESENTATION AND CROSS SECTIONAL DATA, INCLUDING: ANNUAL HOUSEHOLDINCOME, EMPLOYMENT, EDUCATION, AND RACE/ETHNICITY DISTRIBUTION. THE TEAM THEN PLANNED FOR TWO COMMUNITY FORUMS IN JULY.JULY 2013: THE COMMUNITY HEALTH STATUS DATA/REPORT CARD WAS PRESENTED WITH EXTENSIVE DISCUSSION FOCUSED ON CURRENT COUNTY-WIDE POSITIVE HEALTH OUTCOMES, ALONG WITH NEW OPPORTUNITIES FOR HEALTH IMPROVEMENT.JULY 2013: ATTENDEES REVIEWED COMMUNITY FORUM RESULTS AND COMPARED THEM TO THE COMMUNITY HEALTH STATUS DATA. THE ATTENDANCE WAS LOW AT THE FORUMS (APPROXIMATELY 15), BUT THE MEETINGS WERE PRODUCTIVE AND FEEDBACK WAS GOOD. IT WAS NOTED FOR FUTURE CHA PROCESSES, THAT IN ORDER TO INCREASE COMMUNITY PARTICIPATION AT FORUMS, WE NEED TO CONSIDER TAKING THE FORUMS TO THE COMMUNITY MEETINGS AND GROUPS, RATHER THAN EXPECT THE COMMUNITY TO COME TO US.AUGUST 2013: THE TEAM REVIEWED DATA FROM TWO AUGUST FOCUS GROUPS: A SENIOR NUTRITION SITE AND THE ARC OF LIVINGSTON-WYOMING COUNTY. (ADDITIONAL NOTE: ATTEMPT TO HOLD FOCUS GROUP WITH LIVINGSTON MENTAL HEALTH WAS UNSUCCESSFUL DUE TO INABILITY TO GET PARTICIPATE COMMITMENT). A DATA MATRIX WAS PRESENTED TO THE LEADERSHIP TEAM THAT INCLUDED ALL ASSESSMENT AND DATA ANALYSIS OUTCOMES (SEE #4 BELOW). EACH MEMBER OF THE LEADERSHIP TEAM THEN VOTED FOR THEIR TOP TWO PRIORITIES FROM THE TWELVE PRIORITIES IDENTIFIED THROUGHOUT THE CHA PROCESS.C. PUBLIC NOTIFICATION: LOCAL PENNYSAVER ADS AND GVHP MEMBERSHIP OUTREACH VIA STAFF AND INTERNET (WEBSITES/E-BLASTS/SURVEY MONKEY) WERE USED TO PROMOTE AND COMPLETE ALL CHA INITIATIVES.ASSESSMENT AND SELECTION OF PUBLIC HEALTH PRIORITIESTHE LEADERSHIP TEAM COMPILED ALL ASSESSMENT RESULTS AND REVIEWED ALL COUNTY-WIDE HEALTH CARE DATA. SUMMARY OF ALL ASSESSMENT RESULTS IS DOCUMENTED IN TABLE BELOW:ALL CHA HEALTH PRIORITIES IDENTIFIED:COMMUNITY SURVEY (427) COMMUNITY FORUMS(2) FOCUS GROUPS (2) LIV CO HEALTH DATA/REPORT CARDCHA LEADERSHIP VOTING - PRIORITIES (CONSENSOGRAM):MENTAL HEALTH 12CHRONIC DISEASE 10ALCOHOL/SUBSTANCE ABUSE 9AGING 1TOBACCO USECHILD ABUSE/NEGLECTACCESS TO HEALTH CARE 9DOMESTIC (FAMILY) VIOLENCEINJURY PREVENTION/SAFETY 2ORAL HEALTHIMMUNIZATIONS/INFECTIOUS DISEASEMATERNAL/CHILD HEALTH 1AN OUTSIDE CONTRACTOR FACILITATED THE DISCUSSION WITH THE LEADERSHIP TEAM ON ALL ASSESSMENT OUTCOMES TO HELP EACH MEMBER IDENTIFY THEIR TOP TWO HEALTH PRIORITIES (RESULTS IN TABLE ABOVE). ONCE TOP TWO PRIORITIES WERE IDENTIFIED, THE FOLLOWING OUTCOME OBJECTIVES WERE DEFINED:TOP 2 HEALTH CARE PRIORITIES 2013 LIVINGSTON COUNTY1. PREVENT CHRONIC DISEASE: OBESITY AND DIABETES2. PROMOTE MENTAL HEALTH AND PREVENT SUBSTANCE ABUSENOTED: FEEDBACK FROM MENTAL HEALTH SERVICE PROVIDERS - LIVINGSTON COUNTY COUNCILFOR SUBSTANCE ABUSE IS UNDER-UTILIZED AND LOCAL COUNTY MENTAL HEALTH SERVICES NEED TO INCREASE CAPACITY TO MEET NEED.STAFF FROM THE LIVINGSTON COUNTY HEALTH DEPARTMENT AND NOYES HEALTH THEN LED SEPARATE WORK SESSIONS UTILIZING COMMUNITY PARTNERS TO IDENTIFY THE STRATEGIES, OBJECTIVES, ACTIVITIES, PARTNERS, TIMEFRAMES AND OUTCOME MEASUREMENTS FOR THREE YEAR PLAN OF ACTION OF TOP TWO PRIORITIES IDENTIFIED. PART VI, LINE 3: FOR 2013, WE CONTINUED OUR EFFORTS TO COMMUNICATE OUR FINANCIAL AID POLICY. EVERY UNINSURED AND UNDERINSURED PATIENT RECEIVED A FINANCIAL AID PACKET THAT CONSISTED OF THE FINANCIAL AID PROGRAM SUMMARY AND BROCHURE, A FINANCIAL AID (FA) APPLICATION AND INSTRUCTIONS ON HOW TO APPLY, AS WELL AS HOW TO RECEIVE ASSISTANCE IN APPLYING. WE HAVE A SOCIAL WORKER AND A DEDICATED FA BILLING REPRESENTATIVE WHO WORK SPECIFICALLY WITH ALL UNINSURED PATIENTS UPON ADMISSION. ONGOING CHALLENGE IS GETTING PATIENTS TO PARTICIPATE IN THE FINANCIAL ASSISTANCE PROCESS. WE GIVE MANY CHARITY CARE APPLICATIONS AND BROCHURES OUT AT THE TIME OF SERVICE AND THEN AGAIN WHEN BILLING STATEMENTS GO OUT TO PATIENTS. WE, LIKE MANY HOSPITALS, TRY TO EDUCATE PATIENTS ON FINANCIAL ASSISTANCE AVAILABLE VIA A VARIETY OF AVENUES, BUT STRUGGLE WITH THE CHALLENGE OF GETTING PATIENTS TO TAKE ADVANTAGE OF THE AVAILABLE ASSISTANCE. PART VI, LINE 4: NOYES MEMORIAL HOSPITAL SERVES A RURAL COMMUNITY IN THE NEW YORK FINGER LAKES AREA. OUR PRIMARY MARKET SHARE ZIP CODE REPORT DEMONSTRATES THAT LIVINGSTON COUNTY IS OUR HEALTH CARE SYSTEMS PRIMARY SERVICE AREA AND WE ALSO SERVE RESIDENTS IN THE SURROUNDING COUNTIES INCLUDING STEUBEN, ALLEGANY, WYOMING AND ONTARIO RESPECTIVELY. LIVINGSTON COUNTY WAS RANKED #5 IN 2012 AND #1 IN 2013 FOR HEALTH RANKINGS ACCORDING TO COUNTY HEALTH RANKINGS AND ROADMAPS REPORT.DEMOGRAPHIC DATA AS FOLLOWS:LIVINGSTON COUNTY IS A RURAL COUNTY (55%) IN WESTERN NEW YORK COVERING 640 SQUARE MILES WITH POPULATION OF 65,393.14% OF POPULATION OF 65+, 20% BELOW 18 YEARS OF AGE, 92% NON-HISPANIC WHITE, AND ONLY 1% NOT PROFICIENT IN ENGLISH. MEDIAN HOUSEHOLD INCOME IS $50,186 AND 22% CHILDREN ELIGIBLE FOR FREE LUNCH. HEALTH CARE SERVICES ARE PROVIDED AT THE FOLLOWING LOCATIONS THROUGHOUT LIVINGSTON COUNTY: NICHOLAS H. NOYES MEMORIAL HOSPITAL: A 72-BED ACUTE CARE HOSPITAL LOCATED IN DANSVILLE PROVIDING MEDICAL, SURGICAL, AND EMERGENCY INPATIENT/OUTPATIENT SERVICES THAT ALSO INCLUDE COMMUNITY OUTREACH WELLNESS, EDUCATION AND PREVENTION PROGRAMS. NOYES HEALTH SERVICES: AN AMBULATORY CARE FACILITY IN GENESEO THAT PROVIDES OUTPATIENT SURGICAL, RADIOLOGY, LABORATORY, PHYSICAL THERAPY, PAIN MANAGEMENT, AND PHYSICIAN SERVICES. NOYES AFTER HOUR CLINIC: WALK-IN URGENT CARE CLINIC HAS BEEN IN GENESEO (MID-COUNTY LOCATION) SINCE 2003 AND A NEW CLINIC WAS OPENED EARLY 2013 FOR DANSVILLE COMMUNITY (SOUTHERN COUNTY LOCATION). BOTH LOCATIONS SERVE PATIENTS EVENINGS AND WEEKENDS WHEN PHYCIAN OFFICES ARE CLOSED. NOYES MENTAL HEALTH: AN OUT-PATIENT CLINIC PROVIDING INDIVIDUAL, GROUP AND FAMILY COUNSELING SERVICES. NOYES PHYSICIAN SERVICE OFFICES: GENESEE REGIONAL ORTHOPEDICS: DANSVILLE CREEKSIDE FAMILY PRACTICE: CANASERAGA NOYES SURGICAL SERVICS NOYES CENTER FOR KIDNEY DISEASE AND DIALYSIS: A 16 STATION OUTPATIENT DIALYSIS AND RENAL DISEASE MANAGEMENT CENTER IN GENESEO. PART VI, LINE 5: THE NOYES BOARD OF DIRECTORS HAS 13 ACTIVE COMMUNITY REPRESENTATIVES ON THEIR 20 MEMBER BOARD. NOYES HAS AN OPEN MEDICAL STAFF PROVIDING A VARIETY OF MEDICAL SERVICES INCLUDING: CARDIOLOGY, EARS/NOSE/THROAT, FAMILY MEDICINE, GASTROENTEROLOGY, ORTHOPEDICS, GENERAL AND VASCULAR SURGERY, INTERNAL MEDICINE, OB/GYN, NEPHROLOGY, OPHTHALMOLOGY, PEDIATRICS, PAIN MANAGEMENT, AND UROLOGY. PART VI, LINE 7, REPORTS FILED WITH STATES NY X X X 0 0 0 1 0 0 0 0 0 AMY POLLARD PRESIDENT/CEO 176522 0 0 0 1069 0 0 0 19647 0 197238 0 0 0 DOUGLAS MAYHLE MD MEDICAL DIRECTOR 359481 0 0 0 6762 0 0 0 14434 0 380677 0 0 0 ROBERT CAPECCI MD PHYSICIAN-ORTHOPEDIST 629365 0 0 0 1584 0 0 0 17282 0 648231 0 0 0 KEVIN WENTWORTH PHYSICIANS ASSISTANT 171969 0 10000 0 301 0 0 0 16486 0 198756 0 0 0 JACOB TALLMAN FAMILY PRACTITIONER 169163 0 23580 0 24863 0 0 0 17258 0 234864 0 0 0 BRIAN FORESMAN GENERAL SURGEON 427384 0 25000 0 355 0 0 0 17038 0 469777 0 0 0 MICHAEL PARKOT PHYSICIANS ASSISTANT 178938 0 0 0 107 0 0 0 16828 0 195873 0 0 0 PART I, LINE 5 PHYSICIAN ENTITLED TO INCENTIVE COMPENSATION FROM POSITIVE PRACTICE NET INCOME ASSOCIATED WITH WORKED RVU'S AT A RATE OF 70% OF EACH ADDITIONAL WORKED RVU TIMES THE CURRENT MGMA CONVERSION FACTOR FOR FAMILY PRACTICE WITHOUT OBSTETRICS UP TO A MAXIMUM AMOUNT OF 50% OF THE PHYSICIAN'S BASE SALARY. A LIVINGSTON COUNTY INDUSTRIAL DEVELOPMENT AGENCY 161136853 538655AD3 2005-06-29 9471914 SEE PART VI 0 0 0 B LIVINGSTON COUNTY INDUSTRIAL DEVELOPMENT AGENCY 161136853 538655AE1 2007-12-20 615060 REFUND OF PRIOR BONDS (06/30/99) 0 0 1 A 2480000 9763548 805638 625676 189438 6449941 1692856 2006 1 0 1 1 B 267444 615060 12301 3084 10309 589366 2003 1 0 1 1 A 0 0 1 1 0 0.02400 0.02400 0 0 0 B 0 0 0 0 0 0 0 A 0 0 1 0 0 0 0 0 1 B 0 0 1 0 1 0 0 0 1 A 0 B 0 PART I, LINE A, COLUMN (F): ACQUISITION, RENOVATION, CONSTRUCTION AND EQUIPPING OF IMPROVEMENTS TO A HOSPITAL FACILITY; REFUNDING OF PRIOR BONDS (9/17/1998) PART I, LINE B, COLUMN (E) AND PART II, LINES 1 - 12, COLUMN B REPRESENTS AM ALLOCATION OF 12.24% OF THIS BOND ISSUE; THE REMAINING 87.76% IS ALLOCATED TO RED JACKET CENTER, INC., A RELATED ORGANIZATION. PART II, LINE 3, COLUMN A THE TOTAL PROCEEDS DO NOT AGREE WITH THE ISSUE PRICE IN PART I, COLUMN (E) DUE TO INVESTMENTS EARNINGS. ROBERT BONVINO FORMER EMPLOYEE START-UP X 173535 163527 0 1 1 163527 NANCY JOHNSEN WIFE OF BOARD MEMBER 58013 COMPENSATION 0 FORM 990, PART VI, SECTION B, LINE 11 FORM 990 IS REVIEWED BEFORE IT IS FILED. FORM 990, PART VI, SECTION B, LINE 12C BOARD OF DIRECTORS REGULARLY REVIEWS THE CONFLICT OF INTEREST POLICY AND ASSURES ITS COMPLIANCE. FORM 990, PART VI, SECTION B, LINE 15A THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS REVIEWS THE GOALS AND OBJECTIVES OF THE CEO ALONG WITH COMPARABILITY DATA TO DETERMINE HER/HIS COMPENSATION. THE DELIBERATION AND DECISION IS RECORDED IN THE MINUTES OF THE EXECUTIVE COMMITTEE MEETING. FORM 990, PART VI, SECTION C, LINE 18 BY REQUEST TO THE CEO, CFO OR ADMINISTRATIVE ASSISTANT. ALSO AVAILABLE ON GUIDESTAR WEBSITE. FORM 990, PART VI, SECTION C, LINE 19 BY REQUEST TO THE CEO, CFO OR ADMINISTRATIVE ASSISTANT. FORM 990, PART VII GRAHAM FRAZER - 8889 REEDS CORNERS ROAD, DANSVILLE, NY 14437. JOHN LOCKHART - 32 MAIN STREET, GENESEO, NY 14454. MICHAEL JOHNSEN - 3927 COLTON HILL ROAD, DALTON, NY 14836. LESLIE COLE, JR. - 3186 BRONSON HILL ROAD, LIVONIA, NY 14487. JOE BUCCI, JR. - 35 CAVALRY ROAD, GENESEO, NY 14454. JOAN FLENDER, MD - P.O. BOX 499, DANSVILLE, NY 14437. GEOFFREY WITTIG, M.D. - 10055 MCNINCH RD, DANSVILLE, NY 14437. MARK LYONS - 3822 CENTER STREET, LIVONIA, NY 14487. DOMENICK MARTELLO - 4939 BLANK HILL ROAD, DANSVILLE, NY 14437. LINDSAY QUINTILONE - 2 COURT STREET, GENESEO, NY 14454. BERNARD SWEENEY, M.D. - 4380 RESERVOIR RD, GENESEO, NY 14454. MARILYN MOORE - 1856 DUNKLEY RD, LEICESTER, NY 14481. JAMES CULBERTSON - 5879 DIETER ROAD, DANSVILLE, NY 14437. FORM 990, PART XI, LINE 9: CHANGE IN INTEREST IN FOUNDATION 2,131,477. PENSION RELATED CHANGES OTHER THAN NET PERIODIC PENSION COSTS 2,436,518. FORM 990, PART XII, LINE 2(C): THE HOSPITAL DID NOT CHANGE THE OVERSIGHT PROCESS IN THE CURRENT YEAR. THE FOUNDATION FOR NOYES MEMORIAL HEALTH SYSTEM INC 111 CLARA BARTON ST DANSVILLE NY 14437 161584778 TO PROVIDE FUNDS FOR BENEFIT OF THE HOSPITAL NY 501(C)(3) 170(B)(1)(A) (VI) 0 RED JACKET CENTER INC 111 CLARA BARTON ST DANSVILLE NY 14437 161037658 TO MAINTAIN A BUILDING AND LEASE SPACE TO THE HOSPITAL NY 501(C)(3) SECTION 509 (A)(3) 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 RED JACKET CENTER INC Q 1849230 FOUNDATION FOR NOYES MEMORIAL HEALTH SYSTEM INC P 1849230 RED JACKET CENTER INC K 502278