2014-11-12T08:42:14-06:00 2013-12-31 161226221 FUST CHARLES CHAMBERS LLP 5784 WIDEWATERS PARKWAY SYRACUSE NY 13214 990 2013-01-01 150532079 CORTLAND REGIONAL MEDICAL CENTER INC CORT 6077563501 134 HOMER AVENUE CORTLAND NY 13045 DENISE WRINN VP OF FINANCE/CFO 6077563501 2014-11-03 1 JOSEPH J SCHLEGEL P00301329 3154463600 2013 2015-11-30 17:44:51Z DENISE WRINN 134 HOMER AVENUE CORTLAND NY 13045 97852158 0 X WWW.CORTLANDREGIONAL.ORG X 1892 NY CORTLAND REGIONAL MEDICAL CENTER,INC., LOCATED IN CORTLAND, NY, IS A NOT-FOR-PROFIT ACUTE CARE HOSPITAL. THE HOSPITAL PROVIDES GENERAL INPATIENT, INPATIENT PSYCHIATRIC, OUTPATIENT, EMERGENCY, LONG-TERM HOME HEALTH CARE AND SKILLED NURSING SERVICES FOR RESIDENTS IN THE GREATER CORTLAND COUNTY AREA. ADMITTING PHYSICIANS ARE PRIMARILY PRACTITIONERS IN THE LOCAL AREA. 15 14 1141 316 -7396794 -125968 11964754 9617428 84005531 78019082 404419 1053733 4096133 -6968855 100470837 81721388 0 0 0 0 53606737 52660746 0 0 155494 37214685 39377829 90821422 92038575 9649415 -10317187 122400145 123229396 55351431 51933413 67048714 71295983 X CORTLAND REGIONAL MEDICAL CENTER PROVIDES QUALITY HEALTH CARE WITH SKILL AND COMPASSION, MEETING THE LIFE LONG HEALTH CARE NEEDS OF ALL CITIZENS OF CORTLAND AND THE SURROUNDING COMMUNITIES. 0 0 73045958 78019082 CORTLAND REGIONAL MEDICAL CENTER IS DEDICATED TO SERVING THE LIFELONG HEALTH CARE NEEDS OF CORTLAND AND THE SURROUNDING AREA. AS A TEAM-ORIENTED COMMUNITY HEALTH AND MEDICAL ORGANIZATION, CORTLAND REGIONAL MEDICAL CENTER PROVIDES QUALITY CARE, SKILL AND COMPASSION TO ALL PEOPLE REGARDLESS OF THEIR ABILITY TO PAY. OUR HOSPITAL IS COMMITTED TO: *IMPROVING THE WELLNESS OF THE COMMUNITY THROUGH LEADERSHIP IN HEALTH-RELATED ACTIVITIES AND EDUCATION. *SUPPORTING AND PRESERVING THE PERSONAL AND PROFESSIONAL GROWTH OF OUR QUALITY HEALTH-CARE TEAM, THEREBY PROVIDING STIMULATING ENVIRONMENT FOR ALL EMPLOYEES. *RECRUITING AND RETAINING QUALITY HEALTH-CARE PROFESSIONALS. *COOPERATING WITH OTHER HEALTH-CARE PROVIDERS,REGULATORY AGENCIES, AND INSURANCE COMPANIES TO ADVANCE OUR SERVICE TO EVERY MEMBER OF THE COMMUNITY. *MAINTAINING THE HOSPITALS FINANCIAL VIABILITY FOR THE WELL-BEING OF THE COMMUNITY. *ACQUIRING AND MAINTAINING EQUIPMENT REQUIRED TO PROVIDE QUALITY CARE. *ENCOURAGING THE ACTIVE PARTICIPATION OF COMMUNITY MEMBERS IN A VOLUNTEER CAPACITY IN ORDER TO AUGMENT OUR SERVICES. CORTLAND REGIONAL MEDICAL CENTER IS A VOLUNTARY, NOT-FOR-PROFIT CORPORATION. THE MEDICAL CENTER PROVIDES HEALTH CARE SERVICES OF PREVENTIVE, CURATIVE AND EDUCATIONAL NATURE. THE PRIMARY SERVICES PROVIDED ARE: ACUTE MEDICAL INPATIENT CARE (INCLUDING PEDS AND MATERNITY), PSYCHIATRIC INPATIENT CARE, RESIDENTIAL CARE (SKILLED NURSING FACILITY), EMERGENCY ROOM, AMBULATORY SURGERY, OUTPATIENT DIAGNOSTIC SERVICES, LONG TERM HOME HEALTH CARE PROGRAM, COMMUNITY HEALTH WELLNESS SCREENING, ADULT DAY CARE AND CLINIC. INPATIENT PATIENT DAYS WERE 53,725 AND OUTPATIENT SERVICE (ER, CLINIC, AMB SURG, REF AMB & LTHHC) VISITS WERE 114,327. THE HOSPITAL PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY WITHOUT CHARGE. THE CHARGES FOREGONE UNDER THIS POLICY AMOUNTED TO APPROXIMATELY $700,000 IN 2013. 73045958 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 1 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 1 1 1 0 0 1 98 0 1 1141 1 1 1 0 0 0 0 0 0 0 0 0 X 15 14 1 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X DENISE WRINN - CORTLAND REGIONAL MED 6077563501 134 HOMER AVENUE CORTLAND NY 13045 STEVEN CINQUANTI BOARD MEMBER 1.00 X X 0 0 0 NANCY RONGO BOARD MEMBER - CHAIRPERSON 1.00 X X 0 0 0 WILLIAM POMEROY BOARD MEMBER - VICE CHAIRP 1.00 X X 0 0 0 JOHANNA AMES BOARD MEMBER - TREASURER 1.00 X X 0 0 0 DOUGLAS RAHNER MD BOARD MEMBER 1.00 X 0 0 0 ANTHONY BONARTI BOARD MEMBER 1.00 X 0 0 0 CHARLOTTE HAWKINS MD BOARD MEMBER 1.00 X 0 0 0 GARRY VANGORDER BOARD MEMBER 1.00 X 0 0 0 ROSEMARIE HURLEY MD BOARD MEMBER 1.00 X 0 0 0 MARK RAYMOND BOARD MEMBER 1.00 X 0 0 0 LEO MCGRATTAN BOARD MEMBER 1.00 X 0 0 0 MARK PRUS BOARD MEMBER 1.00 X 0 0 0 LEE SHURTLEFF BOARD MEMBER 1.00 X 0 0 0 JEFFREY SEIBERT BOARD MEMBER - SECRETARY 1.00 X 0 0 0 R MICHAEL SHAFER BOARD MEMBER 1.00 X 0 0 0 DAVID WIRTZ MD BD MBER EX OFFICIO TRUSTEE 1.00 X 30000 0 0 BRIAN MITTEER PRESIDENT/CEO 37.50 X 192746 0 25095 JEFFREY EARLE SENIOR VICE PRESIDENT 37.50 X 85142 0 7511 DENISE MIRONTI SENIOR VICE PRESIDENT 37.50 X 169574 0 36960 DENISE WRINN VICE PRESIDENT 37.50 X 214974 0 44661 THOMAS HALLISEY VICE PRESIDENT 37.50 X 161814 0 35737 JUSSI MAIJALA VICE PRESIDENT 37.50 X 159533 0 33274 ROBERT KARPMAN VICE PRESIDENT MEDICAL AFF 37.50 X 313484 0 35241 JANICE JAMES PRESIDENT/CEO 37.50 X 414000 0 0 MARY WRIGHT ADMIN DIR OF LTC - NURSING 37.50 X 137503 0 34473 ARTHUR DUNN COO 37.50 X 232673 0 0 DAVID KAMINSKY PHARMACIST 37.50 X 115839 0 7955 THOMAS ROBERTS PHARMACIST 37.50 X 114549 0 25851 CHRISTINA DENNISTON DIRECTOR - PHARMACY 37.50 X 130342 0 33504 MATTHEW DENNISTON PHARMACIST 37.50 X 110081 0 16139 MICHELLE TUCKER PHARMACIST 37.50 X 116127 0 33045 2698381 0 369446 17 0 1 0 HAYNER HOYT CORPORATION 625 ERIE BLVD WEST SYRACUSE NY 13204 CONSTRUCTION SERVICES 10224163 PRISM HEALTHCARE PARTNERS LTD 190 S LASALLE ST SUITE 2900 CHICAGO IL 60603 CONSULTING SERVICES 2807892 NY ACUTE CARE SPECIALIST PC PO BOX 634850 CINCINNATI OH 45263 PHYSICIAN SERVICES 1419058 EMERGENCY MEDICINE PHYSICIANS 4535 DRESSLER ROAD NW CANTON OH 44718 PHYSICIAN SERVICES 769927 AMES LINEN SERVICE 67 HUNTINGTON STREET CORTLAND NY 13045 LINEN SERVICE 714215 26 110082 1153137 8354209 9617428 PROGRAM SERVICE REVENUE 621990 78019082 78019082 78019082 412227 412227 16772276 16130770 641506 641506 641506 CHILD DAYCARE REVENUE 900099 376700 103917 272783 CAFETERIA REVENUE 900099 241118 241118 REBATES 900099 82904 82904 -7669577 -7669577 -6968855 81721388 78447021 -7396794 1053733 2364395 30000 2334395 36294926 30677972 5505291 111663 3788866 3151561 625052 12253 7620670 6452042 1145255 23373 2591889 2194272 389552 8065 108957 108957 110208 110208 90894 90894 8488832 3972444 4516388 191205 191205 788446 287107 501339 1310377 786226 524151 2214564 1657175 557389 562504 372456 190048 44644 30354 14290 5206181 4387595 818586 761705 674397 87308 SUPPLIES 9693474 9411862 281612 PURCHASED SERVICES 4359134 3777371 581623 140 BAD DEBT EXPENSE 3147604 3147604 EQUIPMENT RENTAL & MAIN 1299442 1210270 89172 999658 825250 174408 92038575 73045958 18837123 155494 14009 14459 8830613 6803635 12130142 6896490 15481390 11879563 14066389 17600056 580321 501010 932664 721766 132062809 89257187 37251647 42805622 17865461 19186763 15247509 16820032 122400145 123229396 9916695 15484032 16320210 21300000 1291901 1100216 27822625 14049165 55351431 51933413 X 52860566 63737702 10414003 3568982 3774145 3989299 67048714 71295983 122400145 123229396 X -10317187 358260 14206198 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 90894 0 0 90894 0 PART II-B, LINE 1: CORTLAND REGIONAL MEDICAL CENTERS LOBBYING ACTIVITY CONSISTED OF: COUNSEL, ADVOCACY AND REPRESENTATION OF CORTLAND REGIONAL MEDICAL CENTER WITH THE GOVERNORS OFFICE, THE LEGISLATURE AND STATE AGENCIES IN REGARD TO BUDGET OR REGULATORY ISSUES. PART OF WHAT WE PAY LAW OFFICES OF WILSON, ELSER, MOSKOWITZ, EDELMAN & DICKER LLP AND A PORTION OF THE DUES PAID TO HEALTHCARE ASSOCIATION OF NEW YORK STATE (HANYS), IROQUOIS HEALTHCARE ASSOCIATION, HOME CARE ASSOCIATION OF NEW YORK (HCA), AMERICAN HOSPITAL ASSOCIATION (AHA) AND NEW YORK ASSOCIATION OF HOME AND SERVICES FOR THE AGING (NYAHSA) IS DESIGNATED TO LOBBYING ACTIVITIES. 14188155 1273892 188855 8092623 7558281 4676900 9189148 91654 -230453 14188155 4761500 169260 -28062 225798 4676900 4512049 252043 105167 107759 4761500 3801098 284226 134885 -291840 4512049 0.52800 0.47200 0 1 1 2961688 2961688 66106086 41044287 25061799 55383330 45761417 9621913 7611705 2451483 5160222 42805622 BENEFICIAL INTEREST IN NET ASSETS OF CORTLAND MEMORIAL FOUNDATION 4690019 UNAMORTIZED DEBT ISSUANCE COST 677853 OTHER RECEIVABLES 11452160 16820032 DUE TO THIRD PARTY PAYORS 2825814 ADDITIONAL MINIMUM PENSION LIABILITY 7931723 ADVANCES FROM THIRD PARTY PAYORS 752238 LONG TERM INSURANCE LIABILITY 2539390 14049165 X PART V, LINE 4: THE HOSPITAL'S ENDOWMENT CONSISTS OF FUNDS ESTABLISHED TO PURCHASE MEDICAL EQUIPMENT WHICH SUPPORTS VARIOUS DEPARTMENTS OF THE HOSPITAL. PART X, LINE 2: INCOME TAXES: THE HOSPITAL QUALIFIES AS A TAX-EXEMPT, NOT-FOR-PROFIT ORGANIZATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. AS OF DECEMBER 31, 2013 AND 2012, THE HOSPITAL DID NOT HAVE ANY UNRECOGNIZED TAX BENEFITS OR ANY RELATED ACCRUED INTEREST OR PENALTIES. THE TAX YEARS OPEN TO EXAMINATION BY FEDERAL AND NEW YORK STATE TAXING AUTHORITIES ARE 2010 THROUGH 2013. THE HOSPITAL DOES NOT ANTICIPATE THAT THE TOTAL UNRECOGNIZED TAX BENEFITS WILL CHANGE IN THE NEXT TWELVE MONTHS. 1 1 1 X 300.000000000000 1 X 1 1 0 1 1 788 275904 275904 0.00310 27325 23353020 17549765 5803255 0.06520 28113 23628924 17549765 6079159 0.06830 9668270 5478438 4189832 0.04710 9668270 5478438 4189832 0.04710 28113 33297194 23028203 10268991 0.11540 1 3147604 311613 22263429 35924750 -13661321 X 1 1 1 1 CORTLAND REGIONAL MEDICAL CENTER INC 134 HOMER AVENUE CORTLAND NY 13045 WWW.CORTLANDREGIONAL.ORG 1101000H X X X CORTLAND REGIONALMEDICAL CENTER INC 1 1 X X X X X X X X 13 1 0 1 X WWW.CORTLANDREGIONAL.ORG/ABOUT-CRMC/COMMU X CCHD.CORTLAND-CO.ORG/INDEX.PHP/DATA-AND-REPORT X X X X X X X 1 0 1 1 300.000000000000 1 300.000000000000 1 X 1 1 X X X X X X 1 0 X X X 1 X 0 0 CORTLAND REGIONAL.MEDICAL CENTER, INC. PART V, SECTION B, LINE 3: DATA GATHERED WITH CORTLAND COUNTY HEALTH DEPARTMENT, SUNY CORTLAND, UNITED WAY FOR CORTLAND COUNTY, SEVEN VALLEYS HEALTH COALITION, CORTLAND COUNTY BUSINESS DEVELOPMENT CORPORATION, CORTLAND AREA COMMUNITIES THAT CARE COALITION AND FAMILY HEALTH NETWORK. PARTICIPATING FOCUS GROUPS WERE: 4-H TEEN COUNCIL MEMBERS, ACCESS TO INDEPENDENCE STAFF, CORTLAND COUNTY YOUTH BUREAU STUDENTS, LOAVES AND FISHES CLIENTS, WISHING WELLNESS CENTER CLIENTS, LEADERS OF HEALTH AND HUMAN SERVICE AGENCIES, SUNY CORTLAND STUDENTS, CHARLES STREET AND LAWRENCE HOUSE RESIDENTS, CORTLAND COUNTY HEALTH DEPARTMENT STAFF, CORTLAND REGIONAL MEDICAL CENTER STAFF, MEALS ON WHEELS RECIPIENTS, LGBT COMMUNITY MEMBERS, YWCA MODEL MOMS PARTICIPANTS, HOMER AND WILLET SENIOR CENTER PARTICIPANTS AND CORTLAND CAREER WORKS PARTICPANTS. CORTLAND REGIONAL.MEDICAL CENTER, INC. PART V, SECTION B, LINE 5D: CORTLAND REGIONAL MEDICAL CENTER'S COMMUNITY SERVICE PLAN IS PLACED IN THE COUNTY'S PUBLIC LIBRARIES, INCLUDING CINCINNATUS, CORTLAND, HOMER, MARATHON AND MCGRAW. THE COMMUNITY SERVICE PLAN IS ALSO AVAILABLE ON THE MEDICAL CENTER'S WEBSITE AT WWW.CORTLANDREGIONAL.ORG AND ON THE SEVEN VALLEYS HEALTH COALITION WEBSITE AT WWW.SEVENVALLEYSHEALTH.ORG. CORTLAND REGIONAL.MEDICAL CENTER, INC. PART V, SECTION B, LINE 20D: USED HIGHEST VOLUME THIRD PARTY PAYER RATE. 5 CRNURSING & REHABILITATION FACILITY 134 HOMER AVENUE CORTLAND NY 13045 SKILLED NURSING FACILITY CRMC OUTPATIENT SERVICE CENTER 4005 WEST ROAD - ROUTE 281 CORTLAND NY 13045 PHYSICAL THERAPY AND IMAGING SERVICE CRMC LONG TERM HOME HEALTH CARE 134 HOMER AVENUE CORTLAND NY 13045 LONG TERM HOME HEALTH CARE CRMC LABORATORY SERVICE CENTER 4077 WEST ROAD - ROUTE 281 CORTLAND NY 13045 LABORATORY SERVICES CRMC LABORATORY SERVICE CENTER 6 EUCLID AVENUE CORTLAND NY 13045 LABORATORY SERVICES PART I, LINE 7: THE COST WAS CALCULATED USING WORKSHEET 2 RATIO OF PATIENT CARE COST TO CHARGES FROM SCHEDULE H INSTRUCTIONS. PART I, LINE 7G: MANY PHYSICIANS NO LONGER WANT TO BE IN PRIVATE PRACTICE, BUT SEEK EMPLOYMENT ARRANGEMENTS WITH HOSPITALS OR HOSPITAL-AFFILIATED PHYSICIAN GROUPS. REGIONAL MEDICAL PRACTICE (RMP), A PHYSICIAN GROUP CONTROLLED AND SUPPORTED BY THE HOSPITAL, WAS FORMED TO FURTHER THE MEDICAL CENTER'S CHARITABLE PURPOSES TO HELP RECRUIT SPECIALTY PHYSICIANS INTO THE RURAL CORTLAND AREA. THROUGH RMP, WE HAVE BEEN ABLE TO RECRUIT TWO CARDIOLOGISTS AND TWO CARDIAC NURSE PRACTITIONER, AND SEVERAL ORTHOPEDIC SURGEONS. AN OBSTETRICIAN WAS RECRUITED THROUGH RMP AND HAS BECOME AN INDEPENDENT PHYSICIAN IN THE COMMUNITY. PRIOR TO RMP, THERE WERE NO CARDIOLOGISTS AT ALL IN CORTLAND AND NO ORTHOPEDIC SURGEONS PERFORMING SURGERY IN CORTLAND, SO PATIENTS HAD TO TRAVEL OVER 30 MILES FOR THESE SERVICES. THE HOSPITAL IS CLASSIFIED AS A SOLE COMMUNITY PROVIDER BY MEDICARE BECAUSE OF THE DISTANCE FROM OTHER HOSPITALS, SO IT IS VERY IMPORTANT TO HAVE THESE PHYSICIAN SERVICES IN CORTLAND AND NOT OVER 30 MILES AWAY. THE AMOUNTS SHOWN ON PART I, LINE 7G REPRESENT REVENUES, EXPENSES, AND THE RESULTING LOSSES FOR RMP CARDIOLOGY AND ORTHOPEDICS. THESE LOSSES ARE CONSIDERED SUBSIDIZED HEALTH SERVICES FOR 990 REPORTING PURPOSES BECAUSE IF THE HOSPITAL DID NOT SUPPORT THESE RMP PHYSICIAN SPECIALTIES, THESE VITAL SERVICES WOULD NOT BE AVAILABLE IN THE CORTLAND COMMUNITY. RMP HAS FILED FORM 1023 "APPLICATION FOR RECOGNITION OF EXEMPTION UNDER SECTION 503(C)(3) OF THE INTERNAL REVENUE CODE". THIS APPLICATION HAS BEEN APPROVED. PART I, LN 7 COL(F): BAD DEBT EXPENSE IS FROM THE INCOME STATEMENT.CREDIT AND COLLECTION POLICY: CORTLAND REGIONAL MEDICAL CENTER WILL PRACTICE COLLECTION PROCEDURES IN A UNIFORM MANNER TO ENSURE THAT ALL PATIENTS/DEBTORS ARE TREATED FAIRLY WHEN DEALING WITH AMOUNTS OWED TO THE HOSPITAL. THE TRANSFER OF SELF PAY ACCOUNT BALANCES TO BAD DEBT AND AN OUTSIDE COLLECTION AGENCY WILL OCCUR FOLLOWING SPECIFIC STANDARDS AND GUIDELINES. 1. SELF PAY (SP) ACCOUNTS ARE DEFINED AS ACCOUNTS FOR WHICH THE BALANCE DUE IS OWED BY THE PATIENT/GUARANTOR, RATHER THAN A THIRD PARTY RESOURCE.2. ALL BUSINESS OFFICE STAFF WILL GUIDE PATIENTS IN NEED OF ASSISTANCE PAYING ACCOUNT BALANCE(S). SPECIFICALLY, THE PATIENT ADVOCATE AND FINANCIAL COUNSELORS GENERATE REPORTS DAILY FOR THE PREVIOUS DAYS SP REGISTRATIONS. THE STAFF THEN UTILIZES VARIOUS WEB SITES TO CHECK FOR POSSIBLE THIRD PARTY PAYER COVERAGE. IF NO COVERAGE IS FOUND, OTHER METHODS ARE USED. THESE METHODS INCLUDE PHONE CALLS TO PHYSICIAN OFFICES AND PATIENTS AS WELL AS RECENT HISTORY IN MEDITECH.3. THE PATIENT ADVOCATE IS A FACILITATED ENROLLER AND WILL OFFER ASSISTANCE IN APPLYING FOR GOVERNMENT INSURANCE PROGRAMS. THE FINANCIAL COUNSELORS WILL OFFER GUIDANCE IN APPLYING FOR FINANCIAL ASSISTANCE AND SETTING UP MONTHLY CONTRACT PAYMENT ARRANGEMENTS.4. THE FINANCIAL COUNSELORS WILL REVIEW ALL ACCOUNTS WITH SP BALANCES PRIOR TO TRANSFERRING UNPAID ACCOUNTS TO COLLECTION. THE FINANCIAL COUNSELORS WILL ATTEMPT TO VERIFY THAT BALANCES SHOULD BE IN SP STATUS, AND THEN USE DISCRETION IN SETTING UP PAYMENT ARRANGEMENTS, ARRANGING FINANCIAL ASSISTANCE OR TRANSFERRING THE ACCOUNT(S) TO BAD DEBT WITH AN OUTSIDE COLLECTION AGENCY.5. PATIENTS/GUARANTORS WILL RECEIVE 4 STATEMENTS AND A 10-DAY LETTER PRIOR TO TRANSFERRING THE ACCOUNT TO BAD DEBT AND COLLECTION. EXCEPTIONS: A) SMALL BALANCE ACCOUNTS UNDER $50.00 MAY RECEIVE ONLY ONE STATEMENT, THEN A 10-DAY LETTER. B) IF AT ANY TIME DURING THE SEQUENCE OF STATEMENTS A PATIENT/GUARANTOR ABSOLUTLEY REFUSES TO MAKE PAYMENT ARRANGEMENTS TO CRMC, THE 4 STATEMENT SEQUENCE MAY BE BYPASSED AT ANY POINT AND THE 10-DAY LETTER MAY BE SENT. SHOULD THIS SITUATION OCCUR, THE ACCOUNT(S) WILL BE DOCUMENTED ACCORDINGLY. C) IF WE REPEATEDLY RECEIVE RETURN MAIL WITH NO FORWARDING ADDRESS AND ARE UNABLE TO OBTAIN THE CURRENT VALID ADDRESS, THE ACCOUNT(S) WILL BE TRANSFERRED TO BAD DEBT WITH AN OUTSIDE COLLECTION AGENCY. SHOULD THIS SITUATION OCCUR, THE ACCOUNT(S) WILL BE DOCUMENTED ACCORDINGLY. REPEATEDLY IS CONSIDERED TO BE 2 CONSECUTIVE STATEMENTS OR ANY OTHER CORRESPONDENCE SENT BY CRMC.PROCEDURE:1. OUTPATIENT ACCOUNTS REGISTERED AS SP ONLY, WILL HOLD THE FOLLOWING SEQUENCE PROVIDED NO OTHER EVENTS OCCUR TO CAUSE A DELAY IN THE PROCESS: A) A FINAL BILL WILL DROP 5 DAYS AFTER DISCHARGE IF CODING OF ACCOUNT IS COMPLETE. OTHERWISE, A FINAL BILL WILL DROP UPON COMPLETION OF CODING. B) IF FULL PAYMENT IS NOT RECEIVED, STATEMENT 1 WILL DROP 20 DAYS AFTER THE FINAL BILL IS POSTED. C) IF BALANCE REMAINS, STATEMENT 2 WILL DROP 23 DAYS AFTER STATEMENT 1. D) IF BALANCE REMAINS, STATEMENT 3 WILL DROP 23 DAYS AFTER STATEMENT 2. E) IF BALANCE REMAINS, STATEMENT 4 WILL DROP 23 DAYS AFTER STATEMENT 3. EVENTS THAT OCCUR WHICH WILL CAUSE A DELAY ARE DEFINED AS BILL REVERSAL, INSURANCE BALANCE EDIT, BAD DEBT TRANSFER, RECEIPT, ADJUSTMENT, AND REFUND. THESE EVENTS ARE ALL SET TO WAIT 1 DAY AFTER THE EVENT TAKES PLACE. WHEN ONE OF THESE EVENTS OCCUR, THE ACCOUNTS NEXT STATEMENT DATE IS THEN SET TO THE EVENTS TRANSACTION DATE PLUS 1 DAY FOR THE EVENT. IT IS IMPORTANT TO NOTE THAT THE STATEMENT FILE IS COMPILED TWICE A WEEK ON TUESDAYS AND THURSDAYS. THEREFORE IF THE NEXT STATEMENT DATE HAPPENS TO BE ON A MONDAY, THE STATEMENT WONT BE COMPILED UNTIL THE NEXT DAY. 2. ALL ACCOUNTS FOLLOW THE SAME SEQUENCE AND HAVE THE SAME DELAY EVENTS AS THE OUTPATIENT ACCOUNTS REGISTERED AS SP ONLY LISTED ABOVE. HOWEVER DIFFERENCES OCCUR IN THE SPECIFIC ACCOUNT TYPE AND INSURANCE COMBINATIONS DEFINED IN MEDITECH. THESE DIFFERENCES ARE NOTED IN THE NUMBER OF DAYS TO WAIT AFTER DISCHARGE, THE NUMBER OF DAYS TO WAIT AFTER THE BILL IS POSTED, THE MINIMUM NUMBER OF DAYS BETWEEN STATEMENTS AND THE NUMBER OF DAYS TO WAIT AFTER THE DELAY EVENTS. TWO EXAMPLES OF THIS ARE LISTED BELOW. 3. ACCOUNTS REGISTERED WITH INSURANCE(S), OTHER THAN MEDICARE PRIMARY, THAT HAVE SP BALANCES DUE WILL BE MAILED STATEMENT 1 THREE DAYS AFTER THE FINAL INSURANCE PAYMENT HAS BEEN POSTED. STATEMENTS 2, 3, AND 4 WILL FOLLOW THE SAME 23 DAY SEQUENCE AS NOTED ABOVE. THE ACTUAL DELAY EVENTS THEMSELVES ARE THE SAME AS NOTED ABOVE, HOWEVER THE NUMBER OF DAYS SET TO WAIT AFTER THE EVENT TAKES PLACE ARE NOT. 4. ACCOUNTS REGISTERED WITH MEDICARE AS THE PRIMARY INSURANCE THAT HAVE SP BALANCES DUE WILL BE MAILED STATEMENT 1 THREE DAYS AFTER THE FINAL INSURANCE PAYMENT HAS BEEN POSTED. STATEMENTS 2, 3, 4, AND 5 WILL DROP AT 40 DAY INTERVALS. NOTE: IF THE ACCOUNT HAS A BALANCE AFTER MEDICARE, THE ACCOUNT WILL NOT BE REFERRED TO BAD DEBT AND COLLECTION FOR AT LEAST 120 DAYS AFTER THE INITIAL SP STATEMENT HAS BEEN SENT TO THE PATIENT/GUARANTOR. 5. NO LONGER THAN 30 DAYS AFTER THE 4TH STATEMENT GOES OUT TO THE PATIENT/GUARANTOR, A 10-DAY LETTER IS ISSUED. THE 10-DAY LETTER SERVES AS A NOTICE OF INTENT TO SEND THE ACCOUNT(S) TO BAD DEBT AND COLLECTION. 6. IF THERE IS NO PAYMENT OR RESPONSE FROM THE PATIENT/GUARANTOR WITHIN 14 DAYS OF SENDING THE 10-DAY LETTER, THE ACCOUNT WILL BE OFFICALLY TRANSFERRED TO BAD DEBT AND AN OUTSIDE COLLECTION AGENCY. 7. CONTRACT PAYMENT ARRANGEMENTS: IF AT ANY TIME IN THE ABOVE NOTED SEQUENCE OF STATEMENTS, THE PATIENT/GUARANTOR CONTACTS CRMC, BUT CANNOT MAKE PAYMENT IN FULL, CONTRACT PAYMENT ARRANGEMENTS WILL BE OFFERED. THE FOLLOWING SHOULD BE USED AS A GUIDELINE ONLY. (NEVER REFUSE A PAYMENT OFFER, REGARDLESS OF THE AMOUNT. ACCOUNT BALANCE CONTRACT PAYMENT ARRANGEMENTS PERIOD 3.00 - 500.00 BALANCE IN FULL EXTEND UP TO 6 MONTHS 1 - 6 MONTHS 501.00 - 1000.00 MIMIMUM OF 75.00/MONTH 7 - 13 MONTHS 1001.00 - 1500.00 MINIMUM OF 100.00/MONTH 10 - 15 MONTHS 1501.00 - 2000.00 MINIMUM OF 125.00/MONTH 12 - 16 MONTHS 2001.00 - 3000.00 MINIMUM OF 150.00/MONTH 13 - 20 MONTHS 3001.00 - OVER BALANCE IF FULL EXTEND UP TO 24 MONTHS MAX - 24 MONTHS ONCE CONTRACT PAYMENT ARRANGEMENTS ARE FINALIZED, THE CONTRACT CONFIRMATION LETTER IS MAILED TO THE PATIENT/GUARANTOR. ALL TERMS ARE EXPLAINED TO AND AGREED UPON BY THE PATIENT/GUARANTOR. THE LETTER SERVES AS AN AGREEMENT BETWEEN CRMC AND THE DEBTOR. IF THE DEBTOR DEFAULTS, THE CONTRACT CONFIRMATION LETTER MAY BE USED AGAINST HIM/HER IF THE ACCOUNT IS REFERRED TO COLLECTION. 8. FINANCIAL ASSISTANCE APPLICATION: IF AT ANY TIME IN THE ABOVE NOTED SEQUENCE OF STATEMENTS THE PATIENT/GUARANTOR CONTACTS CRMC, BUT CANNOT MAKE EVEN A PARTIAL PAYMENT, A FINANCIAL ASSISTANCE APPLICATION WILL BE OFFERED. - REFER TO POLICY 13-7000-3, FINANCIAL ASSISTANCE. 9. COLLECTION ACCOUNTS: ONCE AN ACCOUNT IS TRANSFERRED TO AN OUTSIDE COLLECTION AGENCY, IT IS PREFERRED THAT THE AGENCY HANDLE ALL DIRECT PATIENT/GUARANTOR COMMUNICATION. ALL CALLS REGARDING BAD DEBT ACCOUNTS SHOULD BE REFERRED TO THE AGENCY. HOWEVER, IF THE PATIENT/GUARANTOR INSISTS ON DEALING ONLY WITH CRMC, BUSINESS OFFICE STAFF WILL ACCEPT PAYMENT OR PAYMENT TERMS. ALL PAYMENTS AND ARRANGEMENTS WILL BE COMMUNICATED TO THE COLLECTION AGENCY. 10. ACCOUNT COMMENTS: ALL COMMUNICATION, AS WELL AS COMMUNICATION ATTEMPTS, WILL BE DOCUMENTED BY THE BUSINESS OFFICE STAFF IN THE PATIENT ACCOUNT COMMENTS. PART III, LINE 4: AUDITED FINANCIAL STATEMENT FOOTNOTE (PAGE 12) PATIENT ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTIBILITY OF PATIENT ACCOUNTS RECEIVABLE, THE HOSPITAL AND PRACTICE ANALYZE PAST PAYMENT HISTORY AND IDENTIFY TRENDS FOR EACH MAJOR PAYOR SOURCE OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. FOR RECEIVABLES ASSOCIATED WITH PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL AND PRACTICE ANALYZE CONTRACTUALLY DUE AMOUNTS AND PROVIDE AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS AND FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS, THE HOSPITAL AND PRACTICE ALSO ANALYZE AMOUNTS DUE AND PROVIDE AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE BASED ON PAST EXPERIENCE, INCLUDING CONSIDERATION OF CURRENT BUSINESS AND ECONOMIC CONDITIONS. WHEN THE HOSPITAL AND PRACTICE ESTABLISH THE ALLOWANCE FOR DOUBTFUL ACCOUNTS BOTH TAKE INTO CONSIDERATION THE FACT THAT MANY SELF-PAY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. THE HOSPITAL'S AND PRACTICE'S ALLOWANCE FOR DOUBTFUL ACCOUNTS WAS 27.9% AND 27.5% OF THE RELATED PATIENT ACCOUNTS RECEIVABLE, NET OF CONTRACTUAL ALLOWANCES AT DECEMBER 31, 2013 AND 2012, RESPECTIVELY. THE SLIGHT INCREASE RELATES TO NEGATIVE TRENDS EXPERIENCED IN THE COLLECTION OF AMOUNTS FROM SELF-PAY PATIENTS IN RECENT YEARS AS A RESULT OF CONTINUING HIGH LEVELS OF UNEMPLOYED AND UNINSURED PATIENTS IN THE REGION. PART III, LINE 8: THE MEDICARE COST WAS CALCULATED USING THE WORKSHEET IN THE SCHEDULE H INSTRUCTIONS.FINANCIAL ASSISTANCE POLICY:CORTLAND REGIONAL MEDICAL CENTER ATTEMPTS TO GIVE BACK TO THE COMMUNITY A REASONABLE AMOUNT OF ITS SERVICES WITHOUT CHARGE OR AT REDUCED CHARGES TO ELIGIBLE PERSONS WHO CANNOT AFFORD TO PAY. THIS POLICY ENSURES THAT CORTLAND REGIONAL MEDICAL CENTER IS IN COMPLIANCE WITH ALL APPLICABLE GUIDELINES AND THAT ALL APPLICATIONS FOR ASSISTANCE ARE PROCESSED ACCURATELY AND IN A TIMELY MANNER. PROCEDURE: I. INCOME GUIDELINES1. THE FEDERAL POVERTY LEVELS ARE THE GUIDELINES USED TO DETERMINE ELIGIBILITY. FINANCIAL ASSISTANCE BEGINS WITH THOSE UNINSURED PATIENTS WITH INCOMES BELOW AT LEAST THREE HUNDRED PERCENT OF THE FEDERAL POVERTY LEVEL. THESE GUIDELINES ARE UPDATED ANNUALLY. 2. THE DECISION TO PROVIDE SERVICES FREE OF CHARGE OR AT REDUCED LEVELS CAN BE CHANGED WITHIN THE CONFINES OF THE LAW BY MANAGEMENT. 3. THE AMOUNT OF THE FINANCIAL ASSISTANCE IS DETERMINED BY THE AMOUNT THAT WOULD HAVE BEEN PAID FOR THE SAME SERVICES BY THE HIGHEST VOLUME PAYOR OF CRMC. II. NOTICE TO THE PUBLIC1. NOTICES CONCERNING FINANCIAL ASSISTANCE FOR MEDICAL EXPENSES INCURRED AT CRMC ARE VISIBLY POSTED IN ALL REGISTRATION AREAS OF THE MEDICAL CENTER. 2. WHEN A PATIENT/GUARANTOR CALLS WITH PAYMENT CONCERNS, THEY ARE INFORMED OF THE FINANCIAL ASSISTANCE PROGRAM AND SENT AN APPLICATION. 3. NOTICE OF THE FINANCIAL ASSISTANCE PROGRAM IS POSTED ON THE MEDICAL CENTER'S WEBSITE. 4. NOTICE OF THE FINANCIAL ASSISTANCE PROGRAM IS INDICATED ON THE PATIENTS' BILLS. III. TERMS FOR FINANCIAL ASSISTANCE 1. PATIENTS HAVE 90 DAYS TO APPLY FOR ASSISTANCE. 2. THE COMPLETED APPLICATION ACCOMPANIED WITH THE REQUIRED SUPPORTING DOCUMENTATION MUST BE RETURNED TO CRMC FOR PROCESSING WITHIN 20 DAYS OF RECEIPT OF THE APPLICATION. 3. ONCE THE COMPLETED APPLICATION AND REQUIRED DOCUMENTATION HAS BEEN RECEIVED, CRMC HAS 30 DAYS TO PROCESS A WRITTEN APPROVAL OR WRITTEN DENIAL.4. PATIENTS HAVE 20 DAYS FROM THE DATE OF THE APPROVAL OR DENIAL TO APPEAL THE DETERMINATION.5. INCOMPLETE APPLICATIONS AND/OR MISSING DOCUMENTATION CAN RESULT IN A DENIAL. CRMC WILL ATTEMPT TO GET THE MISSING INFORMATION AFTER THE REVIEW OF THE ORIGINAL APPLICATION. 6. ANY OUTSTANDING ACCOUNTS WITHIN 2 YEARS OF THE DATE OF THE APPLICATION ARE ELIGIBLE, UNLESS THEY ARE IN THE PROCESS, OR HAVE BEEN PROCESSED,FOR A JUDGMENT. 7. CRMC WILL HOLD THE BILLING FOR ANY ACCOUNTS THAT ARE BEING CONSIDERED FOR FINANCIAL AID. CRMC WILL INFORM THE PATIENT OF SUCH. IV. PAYMENT PLAN1. FOR PATIENTS WITH INCOMES AT OR BELOW ONE HUNDRED PERCENT OF THE FEDERAL POVERTY LEVEL, CRMC WILL NOT REQUIRE ANY PAYMENT (NOMINAL AMOUNT) FOR THE PATIENT. 2. FOR PATIENTS WITH INCOMES BETWEEN AT LEAST ONE HUNDRED ONE PERCENT(101) AND ONE HUNDRED FIFTY PERCENT (150) OF THE FEDERAL LEVEL, CRMC SHALL COLLECT NO MORE THAN THE AMOUNT IDENTIFIED AFTER APPLICATION OF A PROPORTIONAL SLIDING FEE SCHEDULE UNDER WHICH PATIENTS WITH LOWER INCOMES SHALL PAY THE LOWEST AMOUNT. SUCH SCHEDULE SHALL PROVIDE THE AMOUNT THAT CRMC MAY COLLECT FOR SUCH PATIENT'S INCREASES FROM THE NOMINAL AMOUNT DESCRIBED IN IV. 1 IN EQUAL INCREMENTS AS THE INCOME OF THE PATIENT INCREASES, UP TO A MAXIMUM OF TWENTY PERCENT OF THE GREATER OF THE AMOUNT THAT WOULD HAVE BEEN PAID FOR THE SAME SERVICES BY THE HIGHEST VOLUME PAYOR FOR CRMC OR FOR SERVICES PROVIDED PURSUANT TO MEDICARE OR MEDICAID. 3. FOR PATIENTS WITH INCOMES BETWEEN AT LEAST ONE HUNDRED FIFTY-ONE PERCENT AND TWO HUNDRED FIFTY PERCENT OF THE FEDERAL POVERTY LEVEL, CRMC SHALL COLLECT NO MORE THAN THE AMOUNT IDENTIFIED AFTER APPLICATION OF A PROPORTIONAL SLIDING FEE SCHEDULE UNDER WHICH PATIENTS WITH LOWER INCOME WILL PAY THE LOWEST AMOUNTS. SUCH SCHEDULE SHALL PROVIDE THAT THE AMOUNT CRMC MAY COLLECT FOR SUCH PATIENTS INCREASES FROM THE TWENTY PERCENT FIGURE DESCRIBED IN IV. 2 IN EQUAL INCREMENTS AS THE INCOME OF THE PATIENT INCREASES, UP TO A MAXIMUM OF THE GREATER OF THE AMOUNT THAT WOULD HAVE BEEN PAID FOR THE SAME SERVICES BY THE HIGHEST VOLUME PAYOR FOR CRMC OR FOR SERVICES PROVIDED MEDICARE OR MEDICAID.4. FOR PATIENTS WITH INCOMES BETWEEN AT LEAST TWO HUNDRED FIFTY-ONE PERCENT AND THREE HUNDRED PERCENT OF THE FEDERAL POVERTY LEVEL, CRMC SHALL COLLECT NO MORE THAN THE GREATER OF THE AMOUNT THAT WOULD HAVE BEEN PAID FOR THE SERVICES BY THE HIGHEST VOLUME PAYOR FOR CRMC OR FOR SERVICES PROVIDED MEDICARE OR MEDICAID. 5. FOR THE PURPOSES OF THIS POLICY, HIGHEST VOLUME PAYOR WILL MEAN THE INSURER, CORPORATION OR ORGANIZATION LICENSED, ORGANIZED OR CERTIFIED PURSUANT TO ARTICLE THIRTY-TWO, FORTY-TWO, OR FORTY-THREE OF THE INSURANCE LAW OR ARTICLE FORTY-FOUR OF THE PUBLIC HEALTH LAW, OTHER THIRD PARTY PAYOR WHICH HAS A CONTRACT OR AGREEMENT TO PAY CLAIMS FOR SERVICES PROVIDED BY CRMC AND INCURRED THE HIGHEST VOLUME OF CLAIMS IN THE PREVIOUS CALENDAR YEAR. 6. CRMC WILL NOT TAKE INTO CONSIDERATION ASSETS OWNED BY A PATIENT, WHO IS A NEW YORK STATE RESIDENT, AND/OR OTHER LEGALLY RESPONSIBLE INDIVIDUAL, WHO HAVE ANNUAL INCOME AT OR BELOW 150% OF THE FEDERAL POVERTY LEVEL IN DETERMINING THE PATIENT'S POTENTIAL ELIGIBILITY FOR FINANCIAL ASSISTANCE AS SPECIFIED IN THIS POLICY. 7. CRMC PROVIDES THE USE OF PAYMENT BY INSTALLMENT PLANS. FOR THOSE PATIENTS THAT RECEIVE FINANCIAL ASSISTANCE THE MONTHLY PAYMENT CANNOT BE MORE THAN 10% OF THE PATIENT MONTHLY GROSS INCOME. 8. IF CRMC EVER CHARGES INTEREST ON THE UNPAID BALANCES FOR THOSE ACCOUNTS UNDER FINANCIAL ASSISTANCE PROGRAM THE RATE OF INTEREST CAN NOT EXCEED THE RATE OF A NINETY-DAY SECURITY ISSUED BY THE UNITED STATES DEPARTMENT OF TREASURY PLUS .5 PER CENT AND A MISSED PAYMENT WILL NEVER TRIGGER A HIGHER RATE OF INTEREST. 9. IF THERE IS A DEPOSIT ON A NON-EMERGENT, MEDICALLY-NECESSARY CARE ACCOUNT IT WILL BE INCLUDED AS PART OF THE FINANCIAL AID CONSIDERATION. 10. SEE CHART FOR APPLICATION OF THIS SECTION. 11. FOR PATIENTS DETERMINED TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE, THERE WILL BE NO LIMITATIONS ON FINANCIAL AID FOR SERVICES BASED ON THE MEDICAL CONDITION OF THE APPLICANT, OTHER THAN TYPICAL LIMITATIONS OR EXCLUSIONS BASED ON MEDICAL NECESSITY OR THE CLINICAL OR THERAPEUTIC BENEFIT OF A PROCEDURE OR TREATMENT. V. REQUIRED DOCUMENTATION1. A COPY OF THE FEDERAL 1040 INCOME TAX RETURN AS VERIFICATION OF DEPENDANT STATUS FOR ALL HOUSEHOLD MEMBERS APPLYING FOR FINANCIAL ASSISTANCE. 2. A COPY OF THE W-2(S). 3. COPIES OF THE LAST FOUR PAY STUBS FOR ALL WORKING MEMBERS OF THE HOUSEHOLD. 4. COPIES OF THE MOST RECENT BANK STATEMENTS. 5. PROOF OF RESIDENCY. ACCEPTABLE DOCUMENTATION INCLUDES, BUT IS NOT LIMITED TO, A POSTMARKED ENVELOPE SHOWING CURRENT ADDRESS, A UTILITY BILL (GAS, ELECTRIC, CABLE), RENT RECEIPT, ETC. VI. REQUIRED COVERED SERVICES 1. EMERGENCY SERVICES, INCLUDING EMERGENCY TRANSFERS. 2. MEDICALLY NECESSARY ACUTE CARE SERVICES.VIII. NON-COVERED SERVICES 1. MEDICARE COINSURANCE AND DEDUCTIBLE AMOUNTS 2. ELECTIVE SURGERY (UNLESS MEDICALLY NECESSARY) 3. MEDICAID SPEND DOWNS AND NAMI AMOUNTS IX. GENERAL INFORMATION1. THIS POLICY APPLIES ONLY TO NEW YORK STATE RESIDENTS. HOWEVER NON-RESIDENTS WILL BE ENCOURAGED TO APPLY FOR FINANCIAL AID AND EACH APPLICATION WILL BE HANDLED ON A CASE-BY-CASE BASIS. 2. IF THE APPLICANT IS UNABLE TO APPLY IN PERSON, ONE OF THE FOLLOWING PROCEDURES IS ALLOWED: A) AN APPLICATION IS MAILED TO THE PATIENT, COMPLETED BY HIM AND RETURNED TO THE FINANCIAL COUNSELOR WITH APPROPRIATE SUPPORTING DOCUMENTS AS DISCUSSED ABOVE. B) A THIRD PARTY (SUCH AS SPOUSE, PARENT, DAUGHTER/SON, POWER OF ATTORNEY, SOCIAL SERVICES) COMPLETES AND SIGNS THE APPLICATION ON THE PATIENT'S BEHALF. THIS IS USUALLY DONE WHEN THE PATIENT IS A MINOR OR AND ELDERLY PERSON WHO IS NO LONGER CAPABLE OF HANDLING THEIR OWN AFFAIRS. C) THE INFORMATION IS OBTAINED OVER THE PHONE AND THE FINANCIAL COUNSELOR SIGNS THE PATIENT'S NAME AND NOTES THAT THEY SIGNED FOR HIM. THIS OPTION SHOULD BE USED AS A LAST RESORT AND ONLY AFTER OBTAINING THE BUSINESS OFFICE MANAGER'S APPROVAL. 3. APPLICATIONS FOR DECEASED PATIENTS CAN BE PROCESSED USING THE FOLLOWING INFORMATION: A) ELIGIBILITY IS BASED ON THE DECEDENT'S INCOME FOR THE 3 TO 12 MONTHS PRIOR PRECEDING DEATH. B) IF THE DECEDENT WAS PART OF A FAMILY HOUSEHOLD, THE FAMILY INCOME FOR THE 3 TO 12 MONTHS PRECEDING THE REQUEST IS UTILIZED. ELIGIBILITY IS DETERMINED USING THE CURRENT HOUSEHOLD INCOME, REGARDLESS OF WHEN THE PATIENT RECEIVED SERVICES OR WHEN THEY EXPIRED. 4. AN ORIGINAL COMPLETED APPLICATION AND REQUIRED SUPPORTING DOCUMENTATION CAN BE UTILIZED FOR A PERIOD OF SIX MONTHS. SEE SCHEDULE O FOR CONTINUATION PART III, LINE 9B: SEE FINANCIAL ASSISTANCE POLICY FROM PART III, LINE 8. PART VI, LINE 2: NEEDS ASSESSMENT: CRMC WORKS COLLABORATIVELY WITH THE CORTLAND COUNTY HEALTH DEPARTMENT, SUNY CORTLAND, UNITED WAY FOR CORTLAND COUNTY, FAMILY HEALTH NETWORK, AND SEVEN VALLEYS HEALTH COALITION ON AN ANNUAL BASIS TO DO A COUNTY WIDE INTEGRATED ASSESSMENT. THIS ASSESSMENT LOOKS AT 1) HEALTH & WELLNESS; 2) SOCIAL COHESION, CULTURE & RECREATION; 3) EMPLOYMENT, ECONOMY, & WELFARE; 4) HOUSING & ENVIRONMENT; 5) POSITIVE DEVELOPMENT THROUGH THE LIFE STAGES & HOW THEY ALL INTERSECT WITH EACH OTHER TO EFFECT A COMMUNITIES WELL-BEING. IT IS THRU THESE ASSESSMENTS, IN CONJUCTION WITH RESOURCE AVAILABILITY THAT PUBLIC HEALTH PRIORITIES ARE ESTABLISHED.ASSESSMENT OF PUBLIC HEALTH PRIORITIES: CRITERIA OF PUBLIC HEALTH PRIORITIES-CRITERIA:FOCUS GROUPS & GROUP SURVEYING HELP IDENTIFY THE TOP HEALTH ISSUES FROM THE COMMUNITIES PERSPECTIVE.COUNTY HEALTH DEPARTMENT MEASURES RELATED TO HEALTH PRIORITIES SUPPORT THE PUBLIC'S SUBJECTIVE OPINION. THAT IS, THE PRIORITY-SPECIFIC COUNTY MEASURES PUBLISHED IN CORTLAND COUNTS DEVIATE FROM STATE AND NATIONAL BENCHMARKS AND HEALTHY PEOPLE 2020 GOALS.MEDICAL CENTER INTERNAL DATA SUPPORTS ISSUES AS PRIORITIES BASED ON PATIENT VOLUME AND UTILIZATION OF SERVICES ASSOCIATED WITH THEM. MEDICAL CENTER AND COUNTY HEALTH DEPARTMENT CURRENTLY HAVE RESOURCES REQUIRED TO SIGNIFICANTLY IMPACT THE ISSUES AND MEASURE OUTCOMES.USE OF DATA: PRIMARY SOURCES AND UTILIZATION OF DATA TO TARGET A POPULATION ARE AS FOLLOWS:COMMUNITY FORUM HEALTH TRACK, FOCUS GROUPS, AND COMMUNITY SURVEY RESULTS: DESCRIBED PREVIOUSLY, THESE PROVIDED SUBJECTIVE DATA REGARDING HEALTH PRIORITIES. ISSUES CONSISTENTLY CONSIDERED AS "TOP HEALTH PRIORITIES" INCLUDED ACCESS TO QUALITY HEALTHCARE, HEALTHY MOTHERS/HEALTHY BABIES, CHRONIC DISEASE, HEALTHY ENVIRONMENT, AND MENTAL HEALTH.CORTLAND COUNTS COMMUNITY REPORT CARD: COUNTY STATISTICS (SEE FOLLOWING TABLE) THAT MOST SIGNIFICANTLY DEVIATED FROM STATE, REGIONAL, NATIONAL, AND HEALTHY PEOPLE 2020 GOALS ASSISTED IN DEFINING THE COUNTY PUBLIC HEALTH PRIORITIES.INDICATOR - CORTLAND COUNTY; UPSTATE NY; NYS; NATIONAL; HEALTHY PEOPLE 2020 GOALCIGARETTE USE IN WOMEN DURING PREGNANCY- 27.8%; 14.3%; 8.4%; 16.0%; 1.4%*COLORECTAL CANCER INCIDENCE WOMEN -46.0; 39.9; 39.8; 38.2; N/A*LUNG/BRONCHUS CANCERMEN - 104.5; 81.1; 75.5; 72.7; N/A WOMEN- 70.7; 63.9; 55.7; 51.1; N/A*CEREBROVASCULAR DISEASE MORTALITY RATE - 39.3; 29.6; 25.6; 39.1; 33.8*CLRD OR COPDMORTALITY RATE - 60.2; 36.8; 30.2; 42.2; 98.5 *RATE PER 100,000NEW YORK STATES PREVENTION QUALITY INDICATORS (PQI): REVIEW OF HOSPITALIZATION RATES BY ZIP CODE FOR CONDITIONS GENERALLY CONSIDERED PREVENTABLE WHEN GOOD PRIMARY CARE IS ACCESSIBLE (PQI) AIDED IN DETERMINING HEALTH PRIORITIES. BECAUSE CORTLAND COUNTY IS A HPSA FOR PRIMARY MEDICAL CARE (LOW-INCOME POPULATION), THE AREAS PQIS ARE EXPECTED TO BE HIGH. PQIS WERE DETERMINED USING THE FOLLOWING PARAMETERS:THE TWELVE CONDITIONS IN THE AREAS OF CIRCULATORY, DIABETES-RELATED, RESPIRATORY, AND ACUTE ILLNESSES. CORTLAND COUNTY ZIP CODES INDIVIDUALLY AND IN SUM.CORTLAND REGIONAL MEDICAL CENTER'S SERVICE AREA ZIP CODES INDIVIDUALLY AND IN SUM.RESULTS:CONDITIONS ASSOCIATED WITH HIGHEST PQI SCORES IN THE CORTLAND AREA ARE PNEUMONIA, COPD, AND CHF (ADMISSIONS AS PERCENT EXPECTED: 207%, 139%, AND 80%, RESPECTIVELY).FURTHER ASSESSMENT INDICATES THAT CORTLAND ZIP CODE 13045 IS ASSOCIATED WITH HIGHEST PNEUMONIA & COPD PQI'S (ADMISSION AS PERCENT EXPECTED: 249% & 168%, RESPECTIVELY). RACIAL/ETHNIC DISPARITIES ARE NOT INDICATED FOR ANY CONDITION PER PQI TOOL. ADMISSIONS AS PERCENT EXPECTED BY RACE/ETHNICITY FOR HISPANIC, AFRICAN, ASIAN, AND OTHER GROUPS WERE BELOW POPULATION THRESHOLD.CORTLAND REGIONAL MEDICAL CENTER DATA - INPATIENT CASE VOLUMES BY SERVICE LINE (MEASURED AS DISCHARGES) WERE CONSIDERED IN IDENTIFICATION OF HEALTH PRIORITIES. HIGHEST VOLUMES OF INPATIENT DISCHARGES HAVE CONSISTENTLY INCLUDED THE FOLLOWING: 2010; 2011; 2012; 2013(9 MOS.)PULMONARY/MEDICAL - 791; 816; 785; 696CARDIOVASCULAR DISEASES- 484; 618; 547; 395OBSTETRICS/DELIVERY - 465; 497; 585; 427NEW BORN - 472; 507; 485; 436TREO SERVICES 2014MEASUREMENTS OF THE MEDICAL CENTER'S AMBULATORY CARE SENSITIVE CONDITIONS (ACSC), THOSE ADMISSIONS THAT COULD HAVE BEEN TREATED AS OUTPATIENTS, WERE ALSO CONSIDERED IN DETERMINING HEALTH PRIORITIES. ACCESSIBILITY OF PRIMARY CARE IS A COMMON REASON FOR ASCS ADMISSIONS, AND AS PREVIOUSLY STATED, CORTLAND COUNTY IS A HPSA FOR PRIMARY MEDICAL CARE (LOW-INCOME). DATA ANALYSIS INDICATES THE FOLLOWING TRENDS TOWARD IMPROVEMENT IN CRMC'S TOP ACSC SEVERITY 1 CASES.* TREO SERVICESACSC SEVERITY 1 & 2: CASES PER MEDICAL 1000* 2010; 2011; 2012; 2013 (9 MOS.) CRMC; NYS; CRMC; NYS; CRMC; NYS; CRMC; NYSPNEUMONIA - 61.68; 21.85; 36.27; 17.82; 41.26; 16.33; 43.06; 15.37COPD - 55.74; 21.19; 39.58; 16.47; 48.48; 15.46; 34.91; 14.45CHF - 30.34; 21.88; 20.12; 15.87; 20.28; 15.15; 24.44; 15.14AMBULATORY PROMPT CARE IS CORTLAND REGIONAL MEDICAL CENTER'S PRIMARY CARE PROGRAM FOR NON-EMERGENCY CONDITIONS. EXTENDED HOURS OF SERVICE (7A-11P, 7DAYS/WK) ARE AVAILABLE TO SUPPLEMENT CARE PROVIDED AT PHYSICIANS' OFFICES DURING REGULAR BUSINESS HOURS. MEMBERS OF THE COMMUNITY WHO DO NOT HAVE ACCESS TO A MEDICAL HOME OFTEN SEEK TREATMENT THROUGH THIS SERVICE. PROMPT CARE'S PATIENT ENCOUNTER STATISTICS WERE ASSESSED IN CONSIDERATION OF PREVENTION PRIORITIES AND DEMONSTRATE CORTLAND'S STEADILY INCREASING UTILIZATION OF THE PROGRAM. THIS IS DESCRIBED AS FOLLOWS AND BASED ON INTERNAL STATISTICS:PROMPT CARE PATIENT ENCOUNTERS 2010; 2011; 2012; 2013 12996; 12570; 11967; 11540CURRENTLY, 7% OF PATIENTS SEEN IN CORTLAND REGIONAL MEDICAL CENTER'S EMERGENCY DEPARTMENT/PROMPT CARE PROGRAM LACK HEALTH INSURANCE. THIS COMPARES TO THE MOST RECENT NATIONAL AVERAGE OF 9% FOR EMERGENCY DEPARTMENTS (AGENCY FOR HEALTHCARE RESEARCH AND QUALIY) A COMPARISON OF NATIONAL, STATE, COUNTY AND CRMC HEALTH INSURANCE COVERAGE STATISTICS APPEARS IN THE FOLLOWING TABLE:UNINSURED INDIVIDUALS (18-64YRS) (4)2012U.S. 19.7%NYS 14.2%CORTLAND COUNTY 12.3%UNINSURED ENCOUNTERS AT CORTLAND REGIONAL MEDICAL CENTER(2)2008; 2012TOTAL ENCOUNTERS 157,309; 144,421NUMBER OF UNINSURED ENCOUNTERS 11,199; 5818% UNINSURED ENCOUNTERS 7.1%; 4.1%(2)CORTLAND REGIONAL MEDICAL CENTER; (4) WWW.CDC.GOV/BRFSS SELECTED PREVENTION AGENDA PRIORITIESBASED ON DATA ANALYSIS, THE CORTLAND COUNTY HEALTH DEPARTMENT AND CORTLAND REGIONAL MEDICAL CENTER WILL COLLABORATE ON THE FOLLOWING PUBLIC HEALTH PRIORITIES:CHRONIC DISEASE: DIABETES, DISEASES OF THE LUNG, ESPECIALLY RELATED TO HIGH RATES OF SMOKING FOR ALL SECTORS, INCLUDING PREGNANT WOMEN.HEALTHY MOTHERS/HEALTHY BABIES/HEALTHY CHILDREN: PROVISION OF QUALITY CARE, EDUCATION, AND SUFFICIENCY OF PROVIDERS AND PROVIDER SITES WILL BE ADDRESSED. A PRIMANRY FOCUS WILL BE TO INCLUDE EXCLUSIVE BREASTFEEDING DURING HOSPITALIZATION. THIS WILL ASSIST IN IMPROVING THE HEALTH OUTCOMES OF THE MOTHER'S.STATUS OF PRIORITIESALL PRIORITIES REPRESENT EXISTING PROGRAMS THAT WILL BE SUPPLEMENTED BY INPUT AND SUPPORT FROM COMMUNITY PARTNERS.THREE-YEAR PLAN OF ACTIONSTRATEGIES FOR SELECTED PRIORITIESTHE PRIORITIES SELECTED THROUGH THE COLLABORATIVE ASSESSMENT PROCESS DESCRIBED IN THE PREVIOUS SECTION ARE ALL PUBLIC HEALTH ISSUES THAT HAVE BEEN RECOGNIZED IN THE PAST AS PRIORITIES FOR THE GREATER CORTLAND COMMUNITY AND TO WHICH CRMC AND ITS COMMUNITY PARTNERS HAVE DEDICATED RESOURCES.CHRONIC DISEASECORTLAND REGIONAL MEDICAL CENTER AND ITS COMMUNITY PARTNERS ARE FOCUSING ON DIABETES AND DISEASES OF THE LUNG. CRMC HAS A PROGRAM TARGETED TO REDUCE READMISSION OF PATIENTS FOR CHRONIC CONDITIONS. GENERAL APPROACHES TO IMPROVE CHRONIC DISEASE MANAGEMENT: TRANSITION COACH PROGRAM - CRMC HAS A PROGRAM TO ASSIST PATIENTS SUFFERING FROM CHRONIC DISEASES, SUCH AS CONGESTIVE HEART FAILURE & PULMONARY LUNG DISEASE IN MAKING THE TRANSITION FROM INSTITUTIONAL CARE TO INFORMAL CARE WITHIN THE HOME. LONG TERM HOME HEALTH CARE PROGRAM (LTHHCP) - CORTLAND REGIONAL MEDICAL CENTER'S LONG TERM HOME HEALTH CARE PROGRAM IS DESIGNED TO ALLOW NURSING HOME ELIGIBLE INDIVIDUALS WITH CHRONIC CONDITIONS TO REMAIN AT HOME BY PROVIDING NURSING CARE, ASSISTANCE OF HOME HEALTH AIDES, PHYSICAL THERAPY, AND A VARIETY OF OTHER SERVICES. MONITORING PATIENTS REMOTELY VIA TELEMEDICINE HAS NOT YET BEEN IMPLEMENTED, BUT IS STILL BEING CONSIDERED TO IMPROVE CARE PROVIDED TO LTHHCP PARTICIPANTS. GOAL: DECREASE READMISSION TO THE HOSPITAL AT 30 DAYS. MEASUREMENT: NUMVER OF READMISSIONS AT 30 DAYS.(CONTINUED IN SCHEDULE O) PART VI, LINE 3: FINANCIAL AID PROGRAMSUCCESSES AND CHALLENGESPROCESS IMPROVEMENTS AND GENERAL ACCOMPLISHMENTS:A PAMPHLET HIGHLIGHTING CRMC'S FINANCIAL AID PROGRAM AND HOW TO APPLY IS AVAILABLE AT ALL REGISTRATION LOCATIONS, ON AND OFFSITE.POLICY IS TO PROVIDE FINANCIAL AID TO INCOME LEVELS UP TO 300% OF THE FEDERAL POVERTY LEVEL.SIGNAGE ABOUT CRMC'S FINANCIAL AID PROGRAM IS IN ALL REGISTRATION AREAS, BOTH ON AND OFFSITE, AS WELL IN THE BUSINESS OFFICE AND MAIN LOBBY.DISTRIBUTED CRMC FINANCIAL AID PAMPHLETS AND APPLICATIONS AT FAMILY HEALTH NETWORK CLINIC SITES.FACILITATED ENROLLER FOR TOTAL CARE IS ONSITE TO ASSIST PATIENTS TWO DAYS EACH MONTH.BEST PRACTICES:PROVIDE A FULL-TIME, ONSITE FACILITATED ENROLLER FOR FAMILY HEALTH PLUS, CHILD HEALTH PLUS, AND MEDICAID.CONTRACT WITH AN OUTSIDE AGENCY, AHC, TO ASSIST ELIGIBLE INPATIENT SELF-PAY POPULATION TO OBTAIN MEDICAID.SCREEN SELF-PAY REGISTRATIONS FOR BLUE CROSS, MEDICAID, AND/OR FIDELIS COVERAGE. PATIENTS WITHOUT COVERAGE ARE CALLED FOR CURRENT INSURANCE INFORMATION, AND IF THEY HAVE NONE, THEY ARE OFFERED FINANCIAL ASSISTANCE AND/OR MONTHLY PAYMENT OPTIONS.PARTICIPATE IN ANNUAL HEALTH INSURANCE FAIR TO HELP RAISE AWARENESS OF THE OPTIONS AVAILABLE TO INDIVIDUALS WHO HAVE NO INSURANCE OR ARE UNDER INSURED.CHALLENGES:DIFFICULTY GAINING PATIENT COOPERATION WITH THE APPLICATION PROCESS AND PATIENTS' NON-COMPLIANCE WITH POLICY.LACK OF VALID PATIENT DEMOGRAPHIC INFORMATION, INCLUDING TELEPHONE NUMBERS.APPLICANTS DISHONESTY.ALSO, SEE WRITE UP FOR PART III, LINE 9 PART VI, LINE 4: HOSPITAL SERVICE AREACORTLAND REGIONAL MEDICAL CENTER IS LOCATED IN THE CITY OF CORTLAND, COUNTY OF CORTLAND, IN THE CENTRAL REGION OF NEW YORK STATE. THE MEDICAL CENTER IS APPROXIMATELY 35 MILES SOUTH OF SYRACUSE, NEW YORK; 40 MILES NORTH OF BINGHAMTON, NEW YORK; AND 24 MILES NORTHEAST OF ITHACA, NEW YORK. AS THE ONLY HOSPITAL IN CORTLAND COUNTY, CRMC IS FEDERALLY DESIGNATED A SOLE COMMUNITY HOSPITAL. THE MEDICAL CENTER SERVES ALL OF CORTLAND COUNTY AND NEIGHBORING PARTS OF SEVEN CONTIGUOUS COUNTIES, INCLUDING ONONDAGA, MADISON, CHENANGO, BROOME, TIOGA, TOMPKINS, AND CAYUGA.DESCRIPTION OF SERVICE AREACORTLAND REGIONAL MEDICAL CENTER DEFINES ITS PRIMARY SERVICE AREA AS AN 18-ZIP-CODE AREA IN AND AROUND CORTLAND PROPER. IT ACCOUNTS FOR APPROXIMATELY 92.8% OF CORTLAND REGIONAL MEDICAL CENTER'S TOTAL INPATIENT ADMISSIONS; THIS REPRESENTS APPROXIMATELY 52% MARKET SHARE. CORTLAND REGIONAL MEDICAL CENTER IS COMMITTED TO PROVIDING QUALITY HEALTHCARE SERVICES BY USING AVAILABLE RESOURCES TO MEET THE NEEDS OF THE PEOPLE WHO LIVE OR WORK IN ITS SERVICE AREA. PART VI, LINE 5: ACCESS TO QUALITY HEALTH CARETHE MEDICAL CENTER PARTNERS WITH COMMUNITY ORGANIZATIONS TO INCREASE MEDICAID ENROLLMENT, EXPAND ACCESS TO PROVIDERS, AND RECRUIT NEW PROVIDERS TO ENSURE A SUFFICIENT NUMBER OF PRIMARY CARE AND SPECIALTY PHYSICIANS TO MEET THE COMMUNITY'S NEEDS.MEDICAID ENROLLMENT:EMPLOY A FULL-TIME FACILITATED ENROLLER TO ASSIST INDIVIDUALS WITH THE MEDICAID ENROLLMENT PROCESS. THE CORTLAND COUNTY DEPARTMENT OF HEALTH ADMINISTERS THE GRANT THAT PROVIDES PARTIAL FUNDING FOR THIS POSITION. -OFFER ONSITE CONSULTATIONS WITH FACILITATED ENROLLER FOR TOTAL CARE. INITIATED DISCUSSIONS WITH FIDELIS TO OFFER SIMILAR SERVICE FOR ITS MANAGED CARE FOR MEDICAID PROGRAM; HOWEVER, FIDELIS DECLINED THE OPPORTUNITY. -CONTRACT WITH AHC TO ASSIST INPATIENTS WHO ARE MEDICAID ELIGIBLE TO OBTAIN COVERAGE. -PARTICIPATE IN ANNUAL HEALTH INSURANCE FAIR TO RAISE AWARENESS OF AVAILABLE COVERAGE. GOAL: REDUCE THE NUMBER OF UNINSURED INDIVIDUALS IN CORTLAND COUNTY. MEASUREMENT: NUMBER OF UNINSURED COUNTY RESIDENTS. THE GOAL OF REDUCING THE NUMBER OF UNINSURED INDIVIDUALS IN CORTLAND COUNTY IS BEING MET. THE NUMBER OF UNINSURED ENCOUNTERS AT CORTLAND REGIONAL MEDICAL CENTER HAS DECLINED FROM 7.1% IN 2008 TO 4.1% IN 2012.EXPAND ACCESS TO PROVIDERS:PROVIDE INCREASED ACCESS FOR MEDICAID RECIPIENTS BY HAVING PHYSICIANS EMPLOYED BY REGIONAL MEDICAL PRACTICE, P.C. ACCEPT MEDICAID AND OTHER INSURANCES THAT MANY PHYSICIAN PRACTICES DO NOT ACCEPT. GOAL: PROVIDE MEDICAID RECIPIENTS GREATER ACCESS TO OFFICE-BASED MEDICAL CARE. MEASUREMENT: NUMBER OF MEDICAID RECIPIENTS IN RMP PHYSICIAN PRACTICES.APPROXIMATELY 9% OF CORTLAND COUNTY RESIDENTS ARE MEDICAID RECIPIENTS WHILE NEARLY 20% OF THE PATIENTS SEEN BY RMP PHYSICIANS ARE INSURED BY MEDICAID. THESE STATISTICS SUGGEST THAT CRMC'S EFFORTS TO IMPROVE MEDICAID RECIPIENTS' ACCESS TO MEDICAL CARE HAVE BEEN SUCCESSFUL. PROVIDE SUFFICIENT NUMBERS OF PROVIDERS:PHYSICIAN RECRUITMENT AND RETENTION PLAN - CORTLAND REGIONAL MEDICAL CENTER ADOPTED A COMPREHENSIVE PHYSICIAN RECRUITMENT AND RETENTION PLAN THAT ESTABLISHES RECRUITMENT PRIORITIES OVER THE NEXT FIVE YEARS BASED ON A SURVEY OF COMMUNITY PHYSICIANS, INTERNAL DATA INCLUDING MEDICAL STAFF AGES AND ANTICIPATED RETIREMENTS, AND EXTERNAL DATA ON THE SUPPLY AND DISTRIBUTION OF PHYSICIANS. -PRIORITY SPECIALTY RECRUITMENT YEARS 1-3 -PRIMARY CARE: FAMILY PRACTICE, INTERNAL MEDICINE, ORTHOPEDICS, OB/GYN, GENERAL SURGERY, CARDIOLOGY, UROLOGY, PSYCHIATRY, ONCOLOGY AND PULMONOLOGIST. RECRUITMENT EFFORTS HAVE BEEN SUCCESSFUL IN THE AREAS OF ORTHOPEDICS, OBSTETRICS/ GYNECOLOGY, ONCOLOGY, INTERNAL MEDICINE AND CARDIOLOGY. -PRIORITY SPECIALTY RECRUITMENT YEARS 3-5 - NEUROLOGY, GASTROENTEROLOGY, PRIMARY CARE: FAMILY PRACTICE, AND INTERNAL MEDICINE. GOAL: SUCCESSFUL RECRUITMENT OF ADDITIONAL PHYSICIANS. MEASUREMENT: NUMBER OF NEW PHYSICIANS OPENING OR JOINING EXISTING PRACTICES. HEALTHY MOTHERS/HEALTHY BABIES/HEALTHY CHILDRENCORTLAND REGIONAL MEDICAL CENTER, TOGETHER WITH COMMUNITY PARTNERS, IS FOCUSING ON IMPROVING THE QUALITY OF OBSTETRICAL AND PEDIATRIC CARE, PROVIDING EDUCATION TO PREGNANT WOMEN AND NEW MOTHERS, AND ENSURING THERE ARE SUFFICIENT NUMBERS OF PHYSICIANS IN THE COMMUNITY TO PROVIDE IMPROVED ACCESS TO OBSTETRICAL AND PEDIATRIC CARE. EDUCATION:-CHILD BIRTH CLASSES -EVERY OTHER MONTH, CRMC OFFERS A FULL TWO-DAY, WEEKEND CHILD BIRTH CLASS FOR EXPECTANT PARENTS THAT COVERS A VARIETY OF TOPICS, INCLUDING: NUTRITION; THE ROLE OF THE COACH; BREATHING AND RELAXATION TECHNIQUES FOR LABOR; CARE AND CHARACTERISTICS OF THE NEWBORN; BREASTFEEDING; PARENTING SKILLS; POST PARTUM ISSUES; AND INFANT SAFETY. CRMC ALSO PROVIDES SPACE FOR ITS COMMUNITY PARTNER, FAMILY HEALTH NETWORK, TO HOLD CHILD BIRTH CLASSES.-POSTPARTUM AND NEWBORN CARE EDUCATION - MATERNITY STAFF PROVIDE EDUCATION TO NEW MOTHERS ABOUT HOW TO CARE FOR THEMSELVES AND THEIR NEWBORNS.-POST DISCHARGE BREASTFEEDING SUPPORT - A FOLLOW UP SERVICE PROVIDED AFTER MOTHER AND BABY HAVE GONE HOME TO IMPROVE BREASTFEEDING SUCCESS AND ENCOURAGE THAT IT CONTINUES TO PROVIDE THE NEW INFANT A HEALTHY START.-HEALTHY BEGINNINGS PROGRAM - IN COLLABORATION WITH THE CORTLAND COUNTY HEALTH DEPARTMENT, CRMC DISTRIBUTES PACKETS THAT EMPHASIZE THE IMPORTANCE OF IMMUNIZATIONS AND ALSO PROVIDES INFORMATION ON LEAD POISONING PREVENTION; INFANT/CHILD SAFETY; NUTRITION; AND HEALTH AND DENTAL CARE. CRMC REGISTERS MOTHERS FOR HEALTHY BEGINNINGS NEWSLETTERS, WHICH THE HEALTH DEPARTMENT SENDS TO PARENTS AT OR AROUND THE TIME THEIR CHILD IS DUE FOR A WELL-CHILD VISIT DURING THE FIRST TWO YEARS OF LIFE.(CONTINUED IN SCHEDULE O) PART VI, LINE 6: PARTICIPANTSCORTLAND REGIONAL MEDICAL CENTER COLLABORATES WITH THE CORTLAND COUNTY HEALTH DEPARTMENT, SUNY CORTLAND, AND THE UNITED WAY FOR CORTLND COUNTY TO MAINTAIN AN ONGOING COMMUNITY NEEDS ASSESSMENT UNDER THE AUSPICES OF THE SEVEN VALLEYS HEALTH COALITION. A COMMUNITY ASSESSMENT TEAM (CAT) COMPRISED OF THE MEDICAL CENTER'S CEO AND THE CORTLAND COUNTY PUBLIC HEALTH DIRECTOR, AS WELL AS REPRESENTATIVES FROM EACH OF THE OTHER INVOLVED ORGANIZATIONS, OVERSEES THE ANNUAL UPDATING OF THE ASSESSMENT. AT A MINIMUM, THE CAT MEETS BIANNUALLY AND MORE FREQUENTLY IF NEEDED. CORTLAND COUNTS: AN ASSESSMENT OF HEALTH AND WELL BEING IN CORTLAND COUNTY IS A COMPREHENSIVE COMMUNITY NEEDS ASSESSMENT THAT IS UPDATED EVERY FOUR YEARS. IN THE YEARS BETWEEN FULL ASSESSMENTS, AN ABBREVIATED VERSION, THE COMMUNITY REPORT CARD, IS PUBLISHED TO PROVIDE UPDATED HIGHLIGHTS OF THE COMPREHENSIVE ASSESSMENT IN AN "AT-A-GLANCE" FORMAT. THE MOST RECENT EDITION OF CORTLAND COUNTS COMPREHENSIVE REPORT WAS RELEASED IN OCTOBER 2013.OUTCOMESA BLUE RIBBON COMMITTEE (BRC) THAT INCLUDES BROAD COMMUNITY REPRESENTATION WAS ESTABLISHED IN 2002 TO REVIEW THE CORTLAND COUNTS ASSESSMENT IN LIGHT OF DATA PROVIDED BY FOCUS GROUPS AND CITIZEN SURVEYS CONDUCTED BY THE COMMUNITY ASSESSMENT TEAM, AS WELL AS OTHER COMMUNITY RESEARCH AND FEEDBACK. USING BOTH SUBJECTIVE AND OBJECTIVE DATA, THE BRC SET PRIORITIES AND DEVELOPED A STRATEGIC PLAN THAT CURRENTLY INCLUDES FIVE BROAD TRACKS: ECONOMIC DEVELOPMENT, YOUTH, HOUSING, HEALTH AND SUSTAINABILITY. A COMMUNITY ORGANIZATION, OR COALITION OF ORGANIZATIONS, IS TAKING THE LEAD TO ADDRESS EACH BROAD TRACK:THE CORTLAND COUNTY BUSINESS DEVELOPMENT CORPORATION IS SPEARHEADING ECONOMIC DEVELOPMENT INITIATIVES.THE CORTLAND AREA COMMUNITIES THAT CARE COALITION (CACTC) IS COORDINATING EFFORTS TO IMPROVE SERVICES AND EXPAND OPPORTUNITIES FOR THE YOUTH IN THE GREATER CORTLAND COMMUNITY.SEVERAL AGENCIES ARE INVOLVED IN ADDRESSING THE NEED FOR BETTER QUALITY, AFFORDABLE HOUSING.THE SEVEN VALLEYS HEALTH COALITION, IN COLLABORATION WITH CORTLAND REGIONAL MEDICAL CENTER, THE CORTLAND COUNTY HEALTH DEPARTMENT, FAMILY HEALTH NETWORK, AND OTHER COMMUNITY-BASED AGENCIES, IS DIRECTING THE FOCUS ON COMMUNITY HEALTH.THE BLUE RIBBON COMMITTEE MEETS ANNUALLY AND INVITES THE ENTIRE COMMUNITY TO PARTICIPATE IN REDEFINING PRIORITIES AND UPDATING THE STRATEGIC PLAN. CORTLAND COUNTS IS A KEY DOCUMENT THAT THE MEDICAL CENTER AND MANY COMMUNITY AGENCIES UTILIZE IN SETTING PRIORITIES FOR THE CONTINUATION OF EXISTING SERVICES AND THE DEVELOPMENT OF NEW/ENHANCED PROGRAMS AND SERVICES.PUBLIC INPUT IN THE ASSESSMENT PROCESSTHE 2013 CORTLAND COUNTS COMMUNITY FORUM, SPONSORED BY THE BLUE RIBBON COMMITTEE, WAS HELD JANUARY 11, 2013. MEMBERS OF THE COMMUNITY AT LARGE AND STAKEHOLDERS REPRESENTING EACH OF THE STRATEGIC PLAN TRACKS WERE IN ATTENDANCE. THE FINDINGS PUBLISHED IN THE LATEST EDITION OF CORTLAND COUNTS WERE REVIEWED AT THIS MEETING AND ATTENDEES WERE GIVEN THE OPPORTUNITY TO PROVIDE FEEDBACK AND INPUT ON 2013 PRIORITIES FOR EACH TRACK. CORTLAND COUNTS IS A KEY DOCUMENT THAT THE MEDICAL CENTER AND MANY COMMUNITY AGENCIES UTILIZE IN SETTING PRIORITIES FOR THE CONTINUATION OF EXISTING SERVICES AND THE DEVELOPMENT OF NEW/ENHANCED PROGRAMS AND SERVICES.BARRIERS TO CARE/GAPS IN SERVICETRANSPORTATION:LACK OF TRANSPORTATION CONTINUES TO BE A BARRIER TO ACCESSING SERVICES FOR MANY INDIVIDUALS IN THE GREATER CORTLAND COMMUNITY. DETERMINING HOW MANY RESIDENTS ARE UNABLE TO OBTAIN HEALTHCARE BECAUSE OF TRANSPORTATION ISSUES IS AN ONGOING CHALLENGE. THIS PROBLEM HAS BEEN COMPOUNDED IN THE PAST 12-18 MONTHS, BECAUSE OF THE STATE REDESIGN OF THE MEDICAID TRANSPORTATION PROGRAM.MENTAL HEALTH SERVICES:THE INADEQUACY OF MENTAL HEALTH SERVICES IN THE CORTLAND COMMUNITY, PARTICULARLY FOR CHILDREN, WAS THE PRIMARY TOPIC OF DISCUSSION REGARDING GAPS IN SERVICE. EXPANSION OF EXISTING CLINICS AND EXPLORATION OF PARTNERING WITH LARGER MEDICAL FACILITIES THROUGH TELEMEDICINE GRANT OPPORTUNITIES WERE DISCUSSED AS POSSIBLE SOLUTIONS. CORTLAND REGIONAL MEDICAL CENTER IS IN THE PROCESS OF RECRUITING A PSYCHIATRIST TO JOIN THE MEDICAL STAFF AND A REGIONAL PSYCHIATRY PRACTICE.PUBLIC NOTIFICATION OF OPPORTUNITIES TO PROVIDE INPUTADVERTISEMENTS WERE PLACED IN THE LOCAL NEWSPAPER AND ANNOUNCEMENTS WERE DISTRIBUTED VIA E-MAIL AND LISTSERVS. PUBLIC ASSISTANCE PROGRAMS WERE ALSO ENCOURAGED TO POST THE NOTIFICATIONS AND TO ADVISE CLIENTS OF OPPORTUNITIES TO PARTICIPATE. UPON EVALUATION, THE PROCESS OF NOTIFYING THE PUBLIC COULD BE IMPROVED BY PLACING NOTICES WHERE THOSE RESIDENTS WHOSE ACCESS TO HEALTHCARE IS LIMITED WOULD BE MORE LIKELY TO SEE THEM. SUGGESTED LOCATIONS INCLUDE THE COUNTYS SENIOR CENTERS, LOCAL FOOD PANTRIES, CORTLAND-CHENANGO RURAL SERVICES, AND THROUGH CONTACT WITH THE FAITH COMMUNITY. PART VI, LINE 7, REPORTS FILED WITH STATES NY X 1 1 X X X X X 1 0 0 0 0 0 0 0 0 BRIAN MITTEER PRESIDENT/CEO 188936 0 0 0 3810 0 14296 0 10799 0 217841 0 0 0 DENISE MIRONTI SENIOR VICE PRESIDENT 169298 0 0 0 276 0 10762 0 26198 0 206534 0 0 0 DENISE WRINN VICE PRESIDENT 214458 0 0 0 516 0 16890 0 27771 0 259635 0 0 0 THOMAS HALLISEY VICE PRESIDENT 161709 0 0 0 105 0 10386 0 25351 0 197551 0 0 0 JUSSI MAIJALA VICE PRESIDENT 159353 0 0 0 180 0 8782 0 24492 0 192807 0 0 0 ROBERT KARPMAN VICE PRESIDENT MEDICAL AFF 313484 0 0 0 0 0 15342 0 19899 0 348725 0 0 0 JANICE JAMES PRESIDENT/CEO 344997 0 0 0 69003 0 0 0 0 0 414000 0 0 0 MARY WRIGHT ADMIN DIR OF LTC - NURSING 137503 0 0 0 0 0 9113 0 25360 0 171976 0 0 0 ARTHUR DUNN COO 183500 0 0 0 49173 0 0 0 0 0 232673 0 0 0 CHRISTINA DENNISTON DIRECTOR - PHARMACY 130342 0 0 0 0 0 8457 0 25047 0 163846 0 0 0 PART I, LINE 1A THE HOSPITAL PROVIDED HOUSING FOR CONTRACTED CEO AND COO. PART I, LINE 4A THOMAS HALLISEY RECEIVED SEVERANCE PAYMENTS OF $60,314. A CORTLAND COUNTY DEVELOPMENT CORPORATION 455122714 2013-02-23 21300000 SEE PART VI 0 0 0 A 21300000 637047 2661982 14695622 3305349 2014 1 0 1 1 A 0 0 0 1 1 1 FIRST NIAGARA BANK 10.000000000000 0 0 0 0 0 A 0 SCHEDULE K, PARTS I-V PART I, LINE A, COLUMNG (F) - BONDS WERE USED FOR THE PURPOSE OF ASSISTING IN FINANCING AND/OR REFINANCING ALL OR A PORTION OF THE COSTS OF A CERTAIN PROJECT, WHICH DID NOT INVOLVE ANY EXTERIAL CONSTRUCTION AND/OR EXPANSION OF THE EXTERIOR OF THE FACILITY CONSISTING OF: A) ACQUISITION AND INSTALLATION OF IMAGING EQUIPMENT, CARDIAC MONITORS, WIRELESS UPGRADES FOR IV PUMPS, BOILERS, AND RELATED HOSPITAL EQUIPMENT FOR USE AT THE FACILITY. B) THE REFUNDING OF ALL OR A PORTION OF THE OUTSTANDING PRINCIPAL AMOUNT OF THE CORTLAND COUNTY INDUSTRIAL DEVELOPMENT AGENCY CIVIC FACILITY RESERVE BONDS, SERIES 2002, ISSUED JUNE 20, 2002. PART II, LINE 11 - OTHER SPENT PROCEEDS OF $14,695,622 WERE USED TO REFUND A PORTION OF THE SERIES 2002 BONDS DESCRIBED IN PART I, LINE A, COLUMN (F). PART IV, LINE 2C - NO REBATE DUE BECAUSE THERE WAS ZERO INVESTMENT PROCEEDS. PART IV, LINE 7 - THERE ARE NO WRITTEN PROCEDURES, BUT THE CFO AND CONTROLLER REVIEW ON AN ANNUAL BASIS TO MONITOR THE REQUIREMENTS. PART V - THERE WAS A TAX COMPLIANCE AGREEMENT COMPLETED AT THE TIME OF ISSUANCE. THE VP FINANCE/CFO IS RESPONSIBLE FOR MONITORING COMPLIANCE AND CONSULTS WITH OUR BOND ATTORNEY AS NEEDED. JOHANNA AMES TRUSTEE 714215 OFFICER OF AMES LINEN SERVICES 0 R MICHAEL SHAFER TRUSTEE 4294 PARTNER OF RIEHLMAN, SHAFER & SHAFER 0 DAVID MAYO MD TRUSTEE IN 2014 0 RENTS A BUILDING FROM REGIONAL MEDICAL PRACTICE. REGIONAL MEDICAL PRACTICE IS CONTROLLED BY THE HOSPITAL. 0 FORM 990, PART VI, SECTION A, LINE 2 CORTLAND REGIONAL MEDICAL CENTER CONDUCTS BUSINESS WITH AMES LINEN, WHOSE OFFICER, JOHANNA AMES IS A TRUSTEE ON THE CORLAND REGIONAL MEDICAL CENTER BOARD. LEE SHURTLEFF IS THE PRESIDENT OF THE BOARD OF TRUSTEES FOR GROTON NURSING FACILITY AND IS A TRUSTEE FOR CORTLAND REGIONAL MEDICAL CENTER. GROTON NURSING FACILITY USES AMES LINEN SERVICE, WHOSE OFFICER JOHANNA AMES IS A TRUSTEE FOR CORTLAND REGIONAL MEDICAL CENTER. CORTLAND REGIONAL MEDICAL CENTER CONDUCTS BUSINESS WITH RIEHLMAN, SHAFER & SHAFER, WHOSE PARTNER, R. MICHAEL SHAFER IS A TRUSTEE ON THE CORTLAND REGIONAL MEDICAL CENTER BOARD. THE BUSINESS BETWEEN CORTLAND REGIONAL MEDICAL CENTER AND RIEHLMAN, SHAFER & SHAFER ARE PRIMARILY FOR REAL ESTATE TRANSACTIONS. FORM 990, PART VI, SECTION A, LINE 3 THE CEO POSITION WAS TEMPORARILY CONTRACTED TO JANICE JAMES FROM APRIL 2013 TO JANUARY 2014. IN JANUARY 2014, MARK WEBSTER WAS HIRED AS THE CEO. THE COO POSITION WAS TEMPORARILY CONTRACTED TO ARTHUR DUNN FROM JUNE 2013 TO FEBRUARY 2014. CRMC IS CURRENTLY RECRUITING FOR A COO POSITION. FORM 990, PART VI, SECTION A, LINE 6 THE PARENT, CMH GROUP, INC, IS THE SOLE MEMBER. CMH GROUP, INC. APPOINTS THE HOSPITAL BOARD MEMBERS. FORM 990, PART VI, SECTION A, LINE 7A NO SINGLE PERSON, ONLY THE ORGANIZATION CMH GROUP, MAY ELECT OR APPOINT ONE OR MORE MEMBERS. FORM 990, PART VI, SECTION A, LINE 7B THE SOLE MEMBER OF THE CORPORATION (THE C.M.H. GROUP) SHALL APPOINT ANNUALLY INDIVIDUALS TO FILL THE THEN-EXISTING VACANCIES ON THE BOARD (OF TRUSTEES) SO LONG AS THE BOARD HAS PROPOSED THAT THE VACANCY BE FILLED. FORM 990, PART VI, SECTION B, LINE 11 BEFORE THE 990 IS SUBMITTED, IT IS MADE AVAILABLE TO THE BOARD OF TRUSTEES FINANCE COMMITTEE FOR THEIR REVIEW. QUESTIONS ARE THEN DIRECTED TO THE CFO/CONTROLLER. THE 990 IS THEN MADE AVAILABLE TO THE FULL BOARD PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C CORTLAND REGIONAL MEDICAL CENTER ENFORCES ITS CONFLICT OF INTEREST POLICY REQUIRING OFFICERS, DIRECTORS, TRUSTEES AND KEY EMPLOYEES TO SUBMIT ANNUAL CONFLICT OF INTEREST STATEMENTS. FORM 990, PART VI, SECTION B, LINE 15 CORTLAND REGIONAL MEDICAL CENTER EXECUTIVE COMMITTEE COMPENSATION PHILOSOPHY AND RESPONSIBILITY PURPOSE: AS DELEGATED REPRESENTATIVES OF THE BOARD OF TRUSTEES, THE EXECUTIVE COMMITTEE HAS THE POWER, DUTY AND RESPONSIBILITY TO DETERMINE THE ORGANIZATION'S OVERALL COMPENSATION PHILOSOPHY AND TO ESTABLISH THE GUIDELINES, RULES AND PROCEDURES NECESSARY FOR THE PROPER AND EFFICIENT ADMINISTRATION OF THE EXECUTIVE COMPENSATION PROGRAM. FURTHER, THE COMMITTEE ACKNOWLEDGES ITS RESPONSIBILITY TO ENSURE THAT THE EXECUTIVE COMPENSATION PROGRAM IS APPROPRIATE IN VIEW OF ITS MISSION, TAX-EXEMPT STATUS, CHARITABLE PURPOSE, AND THAT ITS COMPENSATION AND BENEFITS ARE REASONABLE AND NOT EXCESSIVE. TO THAT END, THE EXECUTIVE COMMITTEE WILL REVIEW AND APPROVE ALL FORMS OF EXECUTIVE COMPENSATION AND BENEFITS IN A MANNER NECESSARY TO QUALIFY FOR THE "REBUTTABLE PRESUMPTION OF REASONABLENESS" UNDER THE INTERMEDIATE SANCTIONS RULES OF SECTION 4958 OF THE IRC. MEMBERSHIP: THE COMMITTEE WILL CONSIST OF THE BOARD OF TRUSTEES EXECUTIVE COMMITTEE. COMPENSATION PHILOSOPHY: THE EXECUTIVE COMPENSATION PROGRAM IS DESIGNED TO ESTABLISH AND MAINTAIN A COMPENSATION PACKAGE WHICH WILL ENABLE THE ORGANIZATION TO ATTRACT, RETAIN, MOTIVATE AND REWARD THE MANAGEMENT TEAM LEADERSHIP NEEDED TO SUCCESSFULLY ACCOMPLISH THE ORGANIZATION'S STRATEGIC AND OPERATIONAL GOALS. THE FOLLOWING GUIDELINES WILL BE USED: A TOTAL COMPENSATION CONCEPT WILL BE USED EMPLOYING A COMBINATION OF BASE SALARY, INCENTIVE OPPORTUNITY, FLEXIBLE BENEFITS, DEFERRED COMPENSATION AND OTHER PERQUISITES AS MAY BE NEEDED FROM TIME TO TIME TO MAINTAIN A COMPETITIVE POSITION WITH PEER INSTITUTIONS IN THE REGION. BASE SALARY WILL BE TARGETED AT APPROXIMATELY THE 60TH PERCENTILE OF SIMILAR POSITIONS IN PEER INSTITUTIONS FOR EXPERIENCED PROFESSIONALS. PAY LEVELS FOR INDIVIDUALS WILL DEPEND UPON EXPERIENCE, OVERALL PERFORMANCE, AND CONTRIBUTION TO THE SUCCESS OF THE ORGANIZATION. ANNUAL REVIEWS WILL TAKE PLACE AS OF JANUARY 1 EACH YEAR. INCREASING EMPHASIS WILL BE PLACED ON INCENTIVE COMPENSATION TO THE EXTENT CONSISTENT WITH THE OBJECTIVE TO MAINTAIN THE TAX EXEMPT STATUS OF THE VARIOUS CORPORATE ENTITIES. THE MANAGEMENT TEAM WILL HAVE THE OPPORTUNITY TO REACH THE MAXIMUM PERCENTAGE OF TOTAL COMPENSATION AVAILABLE AT THE TOP OF THE RANGE PAID AMONG PEER INSTITUTIONS BASED ON ACHIEVING OUTSTANDING PERFORMANCE WITH STRATEGIC GOALS IN THE INCENTIVE PLAN. TARGET OPPORTUNITIES WILL BE GEARED TO THE 75TH PERCENTILE OF TOTAL COMPENSATION. DEFERRED COMPENSATION AND PREQUISITE OPPORTUNITIES WILL BE DEVELOPED TO OPTIMIZE WHATEVER TAX DEFERRAL OPPORTUNITIES EXIST WITHIN THE TAX CODE AND TO BE COMPETITIVE WITH PEER INSTITUTIONS. THIS PHILOSOPHY SHALL BE APPLIED EXCEPT AS REQUIRED TO RECRUIT HIGHLY MARKET SENSITIVE POSITIONS. THE EXECUTIVE COMPENSATION PROGRAM SHALL OPERATE AND BE CONSISTENT WITH ALL FEDERAL AND STATE LAWS, CODES, AND PROCEDURES SO LEGISLATED. COMMITTEE RESPONSIBILITIES: THE EXECUTIVE COMMITTEE HAS THE RESPONSIBILITY TO: -SET THE OVERALL COMPENSATION PHILOSOPHY -SET, MONITOR AND REVIEW THE BASE SALARY OF THE CEO AND OTHER MEMBERS OF THE EXECUTIVE MANAGEMENT TEAM AS SET FORTH IN APPLICABLE LEGISLATION -ESTABLISH, MONITOR AND DETERMINE ACCOMPLISHMENT OF INCENTIVE AWARD GOALS FOR THE CEO AND OTHER APPLICABLE EXECUTIVES -OVERSEE THE CLEAR AND ACCURATE DISCLOSURE OF THE TOTAL VALUE OF COMPENSATION PAID TO EXECUTIVES AND OTHER KEY INDIVIDUALS ON THE HOSPITAL'S FORM 990 -RESOLVE AND DETERMINE ALL DISPUTES OR QUESTIONS ARISING UNDER THE PROGRAM, INCLUDING THE POWER TO DETERMINE THE RIGHTS OF EMPLOYEES AND TO REMEDY ANY AMBIGUITIES, INCONSISTENCIES OR OMISSIONS -AMEND OR RESTRUCTURE THE PROGRAM AT ANY TIME AND FOR ANY REASON ANNUAL PROCESS: BEGINNING OF CYCLE ACTIVITIES: -MEET WITH THE CEO TO IDENTIFY APPROPRIATE GOALS AND SUPPORTING OBJECTIVES TO BE INCLUDED IN THE INCENTIVE AWARD PROGRAM -PRIORITIZE OBJECTIVES, ESTABLISH/REVIEW STANDARDS OF PERFORMANCE AND AWARD LEVELS FOR THE CEO AND OTHER APPROPRIATE PARTIES -DETERMINE THE FUNDING MECHANISM FOR THE INCENTIVE AWARD -SECURE MARKET INFORMATION WITH REGARD TO THE POSITIONING OF THE CHIEF EXECUTIVE OFFICER AND OTHER APPROPRIATE EXECUTIVES AND SET BASE SALARY FOR THE PERIOD INTERIM ACTIVITY: CONDUCT PROGRESS REVIEW OF CEO'S STATED OBJECTIVES AND STANDARDS OF PERFORMANCE, AS NECESSARY END OF CYCLE ACTIVITY: -REVIEW THE STANDARDS OF PERFORMANCE FOR THE KEY OBJECTIVES AND MEASURE RESULTS -CONSIDER FACTORS INVOLVED IN MANAGERIAL EFFECTIVENESS -CONSIDER ANY UNANTICIPATED RESPONSIBILITIES OR SPECIAL ACCOMPLISHMENTS -SOLICIT PERFORMANCE EVALUATION FROM ALL BOARD MEMBERS -CONDUCT A PERFORMANCE REVIEW OF THE CEO -DETERMINE THE OVERALL EVALUATION AND AWARD LEVEL -RECEIVE A PERFORMANCE REVIEW FROM THE CEO FOR ALL OTHER MEMBERS OF THE EXECUTIVE MANAGEMENT TEAM AND A SUMMARY OF PROPOSED SALARY AND INCENTIVE AWARDS FORM 990, PART VI, SECTION C, LINE 18 CORTLAND REGIONAL MEDICAL CENTER'S 990 IS AVAILABLE UPON WRITTEN REQUEST. FORM 990, PART VI, SECTION C, LINE 19 CORTLAND REGIONAL MEDICAL CENTER'S GOVERNING DOCUMENTS, FINANCIAL STATEMENT AND CONFLICT OF INTEREST POLICY ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: CHANGE IN FOUNDATION -618,629. PENSION AND POST RETIREMENT 14,824,827. FORM 990, PART XII, LINE 2C. CORTLAND REGIONAL MEDICAL CENTER'S FINANCIAL STATMENTS ARE AUDITED BY AN INDEPENDENT ACCOUNTANT. THE INDEPENDENT ACCOUNTANT PRESENTS THE AUDIT TO THE FINANCE COMMITTEE AND THE FULL BOARD OF TRUSTEES ANNAUALLY. THIS PROCESS HAS NOT CHANGED FROM PRIOR YEARS. FORM 990, SCHEDULE H, PART III, LINE 8 CONTINUATION FROM FORM 990, SCHEDULE H, PART III, LINE 8: 5. ANY PAYMENTS MADE DURING THE APPLICATION PROCESS REMAIN THE PROPERTY OF CORTLAND REGIONAL MEDICAL CENTER. 6. PAYMENTS RECEIVED FROM THIRD PARTY PAYERS (IE: MEDICARE, MEDICAID, COMMERCIAL INSURANCE, ETC.) AFTER FINANCIAL ASSISTANCE HAS BEEN GRANTED, REMAIN THE PROPERTY OF CORTLAND REGIONAL MEDICAL CENTER. 7. CRMC WILL NOT FORCE A SALE OR FORECLOSURE ON A PATIENT'S PRIMARY RESIDENCE IN ORDER TO COLLECT AN OUTSTANDING MEDICAL BILL. 8. CRMC WILL NOT FORWARD AN ACCOUNT TO COLLECTION WHILE IT IS DETERMINING THE PATIENT'S ELIGIBILITY UNDER THE FINANCIAL ASSISTANCE POLICY. 9. CRMC WILL NOTIFY ITS PATIENTS AT LEAST 30 DAYS PRIOR TO SENDING AN ACCOUNT TO COLLECTION. 10. CRMC WILL REQUIRE ITS COLLECTION AGENCY TO OBTAIN WRITTEN PERMISSION ON ACCOUNTS BEFORE COMMENCING LEGAL ACTION. 11. CRMC WILL EDUCATION AND TRAIN ALL APPROPRIATE STAFF AND ITS COLLECTION AGENCY ON ITS FINANCIAL AID POLICY. 12. CRMC WILL NOT PURSUE COLLECTIONS FROM PATIENTS WHO WERE ELIGIBLE FOR MEDICAL ASSISTANCE UNDER THE MEDICAID PROGRAM AT THE TIME OF SERVICE. 13. CRMC WILL SUBMIT A REPORT CERTIFIED BY ONE OF ITS SENIOR OFFICIALS AND IT WILL INCLUDE: A) HOSPITAL COSTS INCURRED AND UNCOLLECTED AMOUNTS IN PROVIDING SERVICES TO ELIGIBLE PATIENTS WITHOUT INSURANCE, INCLUDING THE AMOUNT OF CARE PROVIDED FOR A NOMINAL AMOUNT. B) HOSPITAL COSTS INCURRED AND UNCOLLECTED AMOUNTS FOR DEDUCTIBLES AND COINSURANCE FOR ELIGIBLE PATIENTS WITH INSURANCE OR OTHER THIRD-PARTY PAYOR COVERAGE. C) THE NUMBER OF PATIENTS WHO APPLIED FOR FINANCIAL ASSISTANCE BROKEN DOWN BY THOSE THAT WERE APPROVED AND THOSE THAT WERE DENIED AND BY ZIP CODES. D) REIMBURSEMENT RECEIVED FOR INDIGENT CARE FOR THE POOL ESTABLISHED BY DEPARTMENT OF HEALTH. E) THE AMOUNT OF FUNDS THAT HAVE BEEN EXPENDED ON CHARITY CARE FROM CHARITABLE BEQUESTS MADE OR TRUSTS ESTABLISHED FOR THE PURPOSE OF PROVIDING FINANCIAL ASSISTANCE TO PATIENTS WHO ARE ELIGIBLE IN ACCORDANCE WITH THE TERMS OR SUCH BEQUEST OR TRUSTS. F) THE NUMBER OF MEDICAID APPLICATIONS THE HOSPITAL AND/OR ITS AGENT ASSISTED WITH AND THE NUMBER OF APPROVAL AND DENIALS. G) CRMC'S FINANCIAL LOSSES RESULTING FROM SERVICES PROVIDED UNDER MEDICAID. H) THE NUMBER OF LIENS PLACED ON PRIMARY RESIDENCES OF PATIENTS THROUGH THE COLLECTION PROCESS USED BY CRMC. X. APPEALS PROCESS 1. ALL APPLICANTS HAVE A RIGHT TO APPEAL THE DECISION MADE BY CRMC. 2. APPEALS MUST BE MADE IN WRITING WITHIN 20 DAYS FROM THE DATE OF APPROVAL OR DENIAL. 3. A FINAL DETERMINATION WILL BE MADE WITHIN 20 DAYS OF THE DATE OF THE APPEAL. FORWARD APPEALS TO: CORTLAND REGIONAL MEDICAL CENTER, SENIOR VICE PRESIDENT OPERATIONS/CFO, 134 HOMER AVE., CORTLAND, NEW YORK 13045 FINANCIAL AID PROGRAM SUCCESSES AND CHALLENGES ACCOMPLISHMENTS: -DISTRIBUTE PAMPHLETS HIGHLIGHTING CRMC'S FINANCIAL AID PROGRAM AND HOW TO APPLY; PAMPHLET IS AVAILABLE AT ALL REGISTRATION LOCATIONS, ON AND OFFSITE -PROVIDE FINANCIAL AID TO INCOME LEVELS UP TO 300% OF THE FEDERAL POVERTY LEVEL IN ACCORDANCE THE CRMC'S FINANCIAL ASSISTANCE POLICY -PROMINENTLY DISPLAY SIGNAGE ABOUT CRMC'S FINANCIAL AID PROGRAM IN ALL REGISTRATION AREAS, BOTH ON AND OFFSITE, AS WELL IN THE BUSINESS OFFICE AND MAIN LOBBY -DISSEMINATE CRMC FINANCIAL AID PAMPHLETS AND APPLICATIONS AT FAMILY HEALTH NETWORK CLINIC SITES -OFFER CONVENIENT ACCESS TO THE FACILITATED ENROLLER FOR TOTAL CARE WHO IS ONSITE TO ASSIST PATIENTS TWO DAYS EACH MONTH BEST PRACTICES: -PROVIDE A FULL-TIME, ONSITE FACILITATED ENROLLER FOR FAMILY HEALTH PLUS, CHILD HEALTH PLUS, AND MEDICAID -CONTRACT WITH AN OUTSIDE AGENCY, AHC, TO ASSIST ELIGIBLE INPATIENT SELF-PAY POPULATION TO OBTAIN MEDICAID -SCREEN SELF-PAY REGISTRATIONS FOR BLUE CROSS, MEDICAID, AND/OR FIDELIS COVERAGE AND CALL PATIENTS WITHOUT COVERAGE FOR CURRENT INSURANCE INFORMATION; IF THEY HAVE NONE, PATIENTS ARE OFFERED FINANCIAL ASSISTANCE AND/OR MONTHLY PAYMENT OPTIONS -PARTICIPATE IN ANNUAL HEALTH INSURANCE FAIR TO HELP RAISE AWARENESS OF THE OPTIONS AVAILABLE TO INDIVIDUALS WHO HAVE NO INSURANCE OR ARE UNDER INSURED CHALLENGES: -DIFFICULTY GAINING PATIENT COOPERATION WITH THE APPLICATION PROCESS AND PATIENTS' NON-COMPLIANCE WITH POLICY -LACK OF VALID PATIENT DEMOGRAPHIC INFORMATION, INCLUDING TELEPHONE NUMBERS -APPLICANTS' DISHONESTY THE FINANCIAL AID PROGRAM AS STRUCTURED APPEARS TO BE WORKING WELL TO MEET CRMC'S PATIENTS' NEEDS FOR FINANCIAL ASSISTANCE. NO CHANGES ARE ANTICIPATED IN THE COMING YEAR. CMH GROUP 134 HOMER AVENUE CORTLAND NY 13045 222933722 PARENT CORPORATION NY 501(C)(3) 11D N/A 0 CMH FOUNDATION 134 HOMER AVENUE CORTLAND NY 13045 222230692 RAISE FUNDS ONLY FOR THE HOSPITAL NY 501(C)(3) 7 CMH GROUP 0 REGIONAL MEDICAL PRACTICE 134 HOMER AVENUE CORTLAND NY 13045 204848729 PHYSICIAN GROUP NY 501(C)(3) 3 CMH GROUP 0 CMH SERVICES 134 HOMER AVENUE CORTLAND NY 13045 161370440 DURABLE MEDICAL EQUIPMENT NY CM GROUP C 1038548 784222 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 CMH SERVICES Q 804605 GL ACCOUNT CMH SERVICES J 52329 GL ACCOUNT