2014-08-01T11:26:34-07:00 2013-12-31 990 2013-01-01 222807681 MEMORIAL HOSPITAL OF WILLIAM F AND GERTRUDE F JONES INC MEMO 5855931100 191 N Main Street Wellsville NY 14895 Tracy Gates CFO 5855964002 2014-07-31 2013 2015-11-30 17:44:51Z X Rich Shear 191 N Main Street Wellsville NY 14895 34961830 0 X www.jmhny.org X 1921 NY JONES MEMORIAL HOSPITAL IS COMMITTED TO ENSURING ACCESS TO THE HIGHEST QUALITY HEALTHCARE FOR OUR COMMUNITY IN A CARING MANNER. 12 11 434 60 0 0 2804442 2002211 31310728 30958432 344442 380337 2081040 1614251 36540652 34955231 0 0 0 0 20633841 21013281 0 0 0 13939210 14070783 34573051 35084064 1967601 -128833 29677209 31235553 24532390 20310446 5144819 10925107 Provision of healthcare services 0 0 28218069 0 0 QUALITY OF HEALTH CARE: THE MEMORIAL HOSPITAL OF WILLIAM F. & GERTRUDE F. JONES, INC. A/K/A JONES MEMORIAL HOSPITAL IS A SOLE COMMUNITY PROVIDER WITH 70 ACUTE CARE BEDS, NOT FOR PROFIT, LOCATED IN RURAL WELLSVILLE NY IN A PROFESSIONALLY UNDERSERVED AREA. WE PROVIDE PRIMARY CARE, AMBULATORY CARE, EMERGENCY CARE AND ACUTE (MEDICAL, SURGICAL, PEDIATRIC, OB AND GYN) AND INTENSIVE CARE PLUS COMMUNITY OUTREACH PROGRAMS. WE ADMITTED 1553 PATIENTS PLUS 268 BIRTHS AND HAD 87450 PATIENT ENCOUNTERS ON AN OUTPATIENT BASIS. THE HOSPITAL HAS PROVIDED CHARITY CARE TO INDIGENT PATIENTS TOTALING $1,256,065. 0 0 0 28218069 1 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 1 0 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 0 0 0 0 1 46 0 1 434 1 0 0 0 0 0 0 X 12 11 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X TRACY GATES CFO 5855964002 191 N Main Street Wellsville NY 14895 ROBERT GILFERT BOARD MEMBER 2 0 X 0 0 0 MICHAEL BERARDI BOARD MEMBER 2 0 X 0 0 0 KIMBERLY TOOT BOARD MEMBER 2 0 X 0 0 0 WILLIAM COCH BOARD MEMBER 2 0 X 0 0 0 GARY BALCOM BOARD MEMBER 2 0 X 0 0 0 KATHY WOUGHTER BOARD MEMBER 2 0 X 0 0 0 MARY KATE COLE BOARD MEMBER 2 0 X 0 0 0 RICHARD SHEAR CHAIRMAN 2 0 X 0 0 0 SAMANTHA GILKEY VICE CHAIRPERSON 2 0 X 0 0 0 BARRY KULP SECRETARY 2 0 X 0 0 0 DANIEL GUINEY TREASURER 2 0 X 0 0 0 EVA BENEDICT Exec Director/CEO 40 0 X 215730 0 7614 TRACY GATES CFO 40 0 X 153014 0 18637 HEATHER LANPHERE OB/GYN 40 0 X 300000 0 43762 F CLIFTON MILLER OB/GYN 40 0 X 292000 0 43401 LU-ANNE KAYE MD 40 0 X 185000 0 34457 MARK ELLIOTT CRNA 40 0 X 196335 0 19369 BILLY CARSTENS D.O. 40 0 X 180000 0 37009 1522079 0 204249 17 0 1 0 DELPHI HOSPITALIST SERVICE 2701 CULVER ROAD ROCHESTER NY 14622 STAFFING 562245 DELPHI HEALTHCARE LLC 2701 CULVER ROAD ROCHESTER NY 14622 Staffing 377748 DR STEVEN COLLINS 6801 GLEASON HILL ROAD BELFAST NY 14711 MEDICAL PHYSICIAN 223200 CHARLES COLE MEMORIAL HOSPITAL 1001 E SECOND STREET COUDERSPORT PA 16915 STAFFING 190988 PICCO PULMONARY & INTERNAL MEDICINE 11 MAIN STREET HORNELL NY 14843 STAFFING 149167 6 0 0 0 0 1727864 274347 0 2002211 PATIENT SERVICES 622000 30958432 30958432 0 0 0 0 0 0 30958432 386066 0 0 386066 0 0 0 0 0 0 0 0 41910 0 0 0 41910 0 41910 0 0 41910 0 870 0 6599 0 -5729 -5729 0 0 -5729 0 PT & OT CONSULTING INCOME 900099 411958 0 0 411958 BAD DEBT CHARITY CARE POOL 900099 1256065 0 0 1256065 CAFETERIA 900099 249678 0 0 249678 -345360 0 0 -345360 1572341 34955231 30958432 0 1994588 0 0 0 0 0 0 0 0 368744 0 368744 0 0 0 0 0 15953977 12685656 3268321 0 742658 577177 165481 0 2803998 2803998 0 0 1143904 889017 254887 0 0 0 0 0 0 0 0 78473 0 78473 0 0 0 0 0 0 0 0 0 0 0 61940 61940 0 25625 0 25625 0 5405050 5001137 403913 0 0 0 0 0 0 0 0 0 0 0 0 0 38327 25258 13069 0 0 0 0 0 39124 1846 37278 0 321950 0 321950 0 0 0 0 0 1558838 1247070 311768 0 358767 0 358767 0 PURCHASED SERVICES 4411682 3967493 444189 0 LICENSES AND TAXES 243197 53902 189295 0 LEASES 585684 543757 41927 0 RECRUITMENT 124851 0 124851 0 817275 421758 395517 0 35084064 28218069 6865995 0 2507055 2371798 0 0 0 0 6948617 7078866 0 0 0 0 0 0 786993 796301 368891 290771 28247174 19350677 7734690 8896497 0 0 11330963 11801320 0 0 0 0 0 0 29677209 31235553 17114675 13950957 0 0 0 0 7417715 6359489 0 0 0 0 0 0 0 0 24532390 20310446 X 3295106 9060656 0 0 1849713 1864451 5144819 10925107 29677209 31235553 X -128833 0 0 0 0 5909121 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 145541 0 145541 12612802 0 9477378 3135424 767872 0 600881 166991 13794254 0 9272418 4521836 926705 0 0 926705 8896497 MORTGAGE RESERVE FUND 2397608 F CAPITAL IMPROVEMENTS 7318822 F TEMP RESTRICTED/STEUBEN TRUST 220439 F HELD IN TRUST/KEY BANK 1864451 F 11801320 34955231 0 0 0 0 0 34955231 0 0 0 34955231 35084064 0 0 0 0 0 35084064 0 0 0 35084064 1 1 X 1 X 1 X 1 1 1 0 1 1 0 0 759203 0 759203 0.0221 0 0 6676870 5908143 768727 0.0223 0 0 1130229 0 1130229 0.0329 0 0 8566302 5908143 2658159 0.0773 22 2415 196172 0 196172 0.0057 4 396 116195 0 116195 0.0034 0 0 9770 4778 4982 0.0001 0 0 0 0 0 18 0 10841 0 10841 0.0003 44 2811 332978 4778 328190 0.0095 44 2811 8899280 5912921 2986349 0.0868 0 0 0 0 0 0 0 0 0 0 0 0 7 16525 4750 0 4750 0.0001 0 0 0 0 0 0 1 12 340 0 340 0 0 0 0 0 0 0 0 0 0 0 0 0 2 75 2515 0 2515 0 0 0 0 0 0 0 10 16612 7605 0 7605 0.0001 1 758435 758435 4783311 7010524 -2227213 X 1 1 7 1 JONES MEMORIAL HOSPITAL 191 NORTH MAIN STREET WELLSVILLE NY 14895 X X A 2 JONES MEMORIAL HEALTH CARE CLINIC 127 NORTH MAIN STREET WELLSVILLE NY 14895 EXTENSION CLINIC A 3 JONES MEMORIAL HEALTH CARE CLINIC 15 LODER STREET WELLSVILLE NY 14895 EXTENSION CLINIC A 4 JONES MEMORIAL HEALTH CARE CLINIC 13 LODER STREET WELLSVILLE NY 14895 EXTENSION CLINIC A 6 JONES MEMORIAL HEALTH CARE CLINIC 5877 OLD STATE ROUTE 19 BELMONT NY 14813 EXTENSION CLINIC A 7 JONES MEMORIAL HEALTH CARE CLINIC 120 FIRST STREET BOLIVAR NY 14715 EXTENSION CLINIC A A 1 X X X X X X X 13 1 1 1 X X X X X X X X X 1 0 1 0 1 300 1 X 1 1 X X 1 X X 1 X X X X X X X 1 X 0 0 Schedule H, Part V, Section B, Line 3-Group A PLEASE SEE SCHEDULE H, PART VI, LINE 2 SUPPLEMENTAL INFORMATION. Schedule H, Part V, Section B, Line 4-Group A PLEASE SEE SCHEDULE H, PART VI, LINE 2 SUPPLEMENTAL INFORMATION. Schedule H, Part V, Section B, Line 5-Group A PLEASE SEE SCHEDULE H, PART VI, LINE 2 SUPPLEMENTAL INFORMATION. Schedule H, Part V, Section B, Line 10-Group A THE HOSPITAL PROVIDES DISCOUNTED CARE NOT FREE CARE. Schedule H, Part I, Line 7 WORKSHEET 2 RATIO OF PATIENT CARE COST TO CHARGES CALCULATION WAS USED. Schedule H, Part I, Line 7g JONES MEMORIAL HOSPITAL OPERATES A DIABETIC CLINIC AS A SERVICE TO THE PUBLIC DUE TO THE HIGH NEED FOR IT IN ALLEGANY COUNTY. Schedule H, Part II AS A COMMUNITY HOSPITAL, JONES MEMORIAL TAKES AN ACTIVE PART IN PROMOTING THE HEALTH OF THOSE WE SERVE THROUGH A WIDE VARIETY OF ACTIVITIES. IN ADDITION TO COMMUNITY HEALTH FAIRS AND SCREENINGS, JMH IS COMMITTED TO MEETING THE NEEDS OF THIS COMMUNITY FOR GENERATIONS TO COME. WE PROVIDE HANDS ON EXPERIENCE FOR FUTURE HEALTHCARE PROVIDERS AND SHADOWING EXPERIENCES FOR STUDENTS EXPLORING THEIR CAREER OPTIONS. BY WORKING WITH ORGANIZATIONS LIKE THE WELLSVILLE AREA CHAMBER OF COMMERCE, THE ALLEGANY WESTERN STEUBEN RURAL HEALTH NETWORK AND SEVERAL ALLEGANY COUNTY DEPARTMENTS, WE ARE PARTNERS HELPING THIS COMMUNITY GROW TOWARDS A HEALTHY FUTURE. Schedule H, Part III, Section A, Line 4 PATIENT ACCOUNTS RECEIVABLE ARE DUE 30 DAYS AFTER THE DATE OF DISCHARGE. RECEIVABLES PAST DUE MORE THAN 120 DAYS ARE CONSIDERED DELINQUENT. DELINQUENT RECEIVABLES ARE GENERALLY WRITTEN OFF BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE PATIENT AND OTHER THIRD PARTY PAYORS. Schedule H, Part III, Section B, Line 8 THE AMOUNT ON LINE 6 IS CALCULATED FROM WORKSHEET E PARTS A AND B ON THE COST REPORT. THE FULL LOSS SHOULD BE CONSIDERED A COMMUNITY BENEFIT. Schedule H, Part III, Section C, Line 9b PATIENTS WHO QUALIFY TO FINANCIAL ASSISTANCE RECEIVE A DISCOUNT FROM A SLIDING FEE SCHEDULE BASED ON THE FEDERAL POVERTY GUIDELINES. FLEXIBLE PAYMENT PLANS ARE INCORPORATED AS APPROPRIATE. Schedule H, Part VI, Line 2 THE HOSPITAL USES SEVERAL METHODS TO ASESS THE HEALTHCARE NEEDS OF THOSE IN THE SERVICE AREA. PUBLIC SURVEY INCLUDES SOME DEMOGRAPHIC INFORMATION AND A RATINGS SYSTEM FOR 48 ITEMS IDENTIFIED AS HEALTH NEEDS. THE PUBLIC WAS NOTIFIED OF THE SURVEY PROCESS AND ENCOURAGED TO PARTICIPATE THROUGH PAID ADVERTISING IN THE WELLSVILLE DAILY REPORTER AND HORNELL EVENING TRIBUNE, PRESS RELEASES TO LOCAL NEWS AGENCIES, INVITATIONS ON THE HOSPITAL WEBSITE HOME PAGE, DISTRIBUTION OF PAPER SURVEYS THROUGH THE JMH MEDICAL PRACTICE SITES (FIVE IN TOTAL THROUGHOUT ALLEGANY COUNTY) AND THROUGH EMAIL DISTRIBUTION OF THE SURVEY TO AGENCY LIST SERVES IN THE REGION. THE SURVEY WAS ALSO DISTRIBUTED VIA SURVEY MONKEY, AN ONLINE SURVEY SERVICE TO ALLOW RECIPIENTS TO RECEIVE AND RESPOND VIA EMAIL. Schedule H, Part VI, Line 3 OUR PATIENT STATEMENTS PROVIDE A NOTICE INFORMING OUR PATIENTS ABOUT OUR FINANCIAL ASSISTANCE PROGRAM. WE HAVE FINANCIAL COUNSELORS THAT CONTACT OUR SELF PAY POPULATION AND INFORM THEM OF OUR PROGRAM. THEY SEND LETTERS FOR THOSE THEY ARE UNABLE TO REACH BY TELEPHONE. WE HAVE SIGNAGE THROUGHOUT OUR CAMPUS INDICATING WE HAVE A FINANCIAL ASSISTANCE PROGRAM WITH THE CONTACT INFORMATION. EACH SELF PAY INPATIENT IS SEEN AND EDUCATED ABOUT OUR PROCESS FOR APPLYING FOR FINANCIAL ASSISTANCE. Schedule H, Part VI, Line 4 THE HOSPITAL SERVICE AREA IS PRIMARILY ALLEGANY COUNTY. WHILE 80 PERCENT OF THE INPATIENT AND OUTPATIENT VISITS ORIGINATE FROM WELLSVILLE, BOLIVAR, ANDOVER, BELMONT, SCIO, FRIENDSHIP, BELFAST, ANGELICA AND WHITESVILLE, FOR THE PURPOSES OF COMMUNITY HEALTH NEED AND COLLABORATIVE EFFORTS, JONES MEMORIAL HOSPITAL VIEWS THE GREATER ALLEGANY COUNTY REGION AS THE SERVICE AREA. JONES MEMORIAL HOSPITAL IS THE ONLY ACUTE CARE HOSPITAL IN ALLEGANY COUNTY HPSA DESIGNATION. X X X 0 0 0 0 0 0 0 0 0 EVA BENEDICT Exec Director/CEO 215730 0 0 0 0 0 0 0 7614 0 223344 0 0 0 TRACY GATES CFO 153014 0 0 0 0 0 0 0 18637 0 171651 0 0 0 F CLIFTON MILLER OB/GYN 292000 0 0 0 0 0 0 0 43401 0 335401 0 0 0 BILLY CARSTENS D.O. 180000 0 0 0 0 0 0 0 37009 0 217009 0 0 0 LU-ANNE KAYE MD 185000 0 0 0 0 0 0 0 34457 0 219457 0 0 0 MARK ELLIOTT CRNA 196335 0 0 0 0 0 0 0 18780 0 215115 0 0 0 HEATHER LANPHERE OB/GYN 300000 0 0 0 0 0 0 0 43762 0 343762 0 0 0 Form 990, Part VI, Section B, Line 11b THE 990 WAS PRESENTED TO THE BOARD OF DIRECTORS PRIOR TO FILING. THE 990 IS PREPARED BY THE ACCOUNTING DEPARTMENT AND REVIEWED BY THE CHIEF FINANCIAL OFFICER. Form 990, Part VI, Section B, Line 12c ANNUALLY, THE HOSPITAL REQUIRES ALL BOARD MEMBERS, SENIOR MANAGERS AND DEPARTMENT MANAGERS TO COMPLETE THE CONFLICT OF INTEREST STATEMENT. THE STATEMENTS ARE REVIEWED BY THE HOSPITAL'S COMPLIANCE OFFICER FOR ANY POTENTIAL CONFLICTS. Form 990, Part VI, Section B, Line 15 THE CEO'S SALARY IS SET FOR A SPECIFIC CONTRACT PERIOD BY THE BOARD OF DIRECTORS AND INCLUDES AN ESCALATION CLAUSE FOR INCREASES DURING THE CONTRACT PERIOD. THE PROCESS INCLUDES A REVIEW OF COMPARABLE DATA FOR THE MARKET AREA AND THE COMPLETE CONTRACT IS APPROVED BY THE BOARD OF DIRECTORS. Form 990, Part VI, Section C, Line 19 THE ORGANIZATION DOES MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. THE HOSPITAL PUBLISHES AN ANNUAL FINANCIAL AND STATISTICAL REPORT IN THE LOCAL NEWSPAPER EACH SPRING. IT ALSO HAS THESE DOCUMENTS AVAILABLE FOR IN PERSON REVIEW OR WITHIN 30 DAYS OF A WRITTEN REQUEST FROM THE GENERAL PUBLIC. COPIES OF THESE DOCUMENTS ARE STORED IN THE ADMINISTRATIVE OFFICE OF THE HOSPITAL FOR THIS PURPOSE. Form 990, Part XI, Line 9 CHANGE IN UNREALIZED GAIN/LOSSES ON INEVESTMENTS = 430,010, PENSION LIABILITY ADJUSTMENT = 4,903,743, TEMP RESTRICTED CONTRIBUTIONS = 560,632 AND CHANGE IN VALUE OF PERPETUAL TRUST = 14,736. TOTAL = 5,909,121. SUBMITTED FORM 8868