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        <BookValueAmt>20423505</BookValueAmt>
      </OtherLandBuildingsGrp>
      <TotalBookValueLandBuildingsAmt>111331517</TotalBookValueLandBuildingsAmt>
      <OtherAssetsOrgGrp>
        <Desc>DUE FROM FOUNDATION</Desc>
        <BookValueAmt>5580115</BookValueAmt>
      </OtherAssetsOrgGrp>
      <OtherAssetsOrgGrp>
        <Desc>EQUITY IN RELATED PARTIES</Desc>
        <BookValueAmt>4529261</BookValueAmt>
      </OtherAssetsOrgGrp>
      <OtherAssetsOrgGrp>
        <Desc>INSURANCE RECEIVABLE</Desc>
        <BookValueAmt>4831855</BookValueAmt>
      </OtherAssetsOrgGrp>
      <OtherAssetsOrgGrp>
        <Desc>UNAMORTIZED BOND COSTS</Desc>
        <BookValueAmt>1059329</BookValueAmt>
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      <TotalBookValueOtherAssetsAmt>16000560</TotalBookValueOtherAssetsAmt>
      <OtherLiabilitiesOrgGrp>
        <Desc>DUE TO THIRD PARTY PAYERS</Desc>
        <Amt>8026198</Amt>
      </OtherLiabilitiesOrgGrp>
      <OtherLiabilitiesOrgGrp>
        <Desc>FAIR VALUE OF INTEREST RATE SWAP</Desc>
        <Amt>697346</Amt>
      </OtherLiabilitiesOrgGrp>
      <OtherLiabilitiesOrgGrp>
        <Desc>ACCRUED INSURANCE CLAIMS</Desc>
        <Amt>3244076</Amt>
      </OtherLiabilitiesOrgGrp>
      <TotalLiabilityAmt>11967620</TotalLiabilityAmt>
      <FootnoteTextInd>X</FootnoteTextInd>
      <TotalRevEtcAuditedFinclStmtAmt>195020509</TotalRevEtcAuditedFinclStmtAmt>
      <NetUnrealizedGainsInvstAmt>8471048</NetUnrealizedGainsInvstAmt>
      <OtherRevenueAmt>4499100</OtherRevenueAmt>
      <RevenueNotReportedAmt>12970148</RevenueNotReportedAmt>
      <RevenueSubtotalAmt>182050361</RevenueSubtotalAmt>
      <RevenueNotReportedFinclStmtAmt>0</RevenueNotReportedFinclStmtAmt>
      <TotalRevenuePerForm990Amt>182050361</TotalRevenuePerForm990Amt>
      <TotExpnsEtcAuditedFinclStmtAmt>170505560</TotExpnsEtcAuditedFinclStmtAmt>
      <OtherExpensesIncludedAmt>77255</OtherExpensesIncludedAmt>
      <ExpensesNotReportedAmt>77255</ExpensesNotReportedAmt>
      <ExpensesSubtotalAmt>170428305</ExpensesSubtotalAmt>
      <ExpensesNotRptFinclStmtAmt>0</ExpensesNotRptFinclStmtAmt>
      <TotalExpensesPerForm990Amt>170428305</TotalExpensesPerForm990Amt>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART V, LINE 4:</FormAndLineReferenceDesc>
        <ExplanationTxt>THE INTENDED USE FOR THE ENDOWMENT FUND OF THE CAYUGA MEDICAL CENTER AT ITHACA IS TO SUPPORT THE HOSPITAL'S ONGOING MISSION TO DELIVER THE HIGHEST QUALITY HEALTHCARE IN PARTNERSHIP WITH OUR COMMUNITY, ONE PERSON AT A TIME.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART X, LINE 2:</FormAndLineReferenceDesc>
        <ExplanationTxt>THE MEDICAL CENTER IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE, AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE INTERNAL REVENUE CODE. THE MEDICAL CENTER HAS ALSO BEEN CLASSIFIED BY THE INTERNAL REVENUE SERVICE (IRS) AS AN ENTITY THAT IS NOT A PRIVATE FOUNDATION. AS OF DECEMBER 31, 2013 AND 2012, THE MEDICAL CENTER DID NOT HAVE A LIABILITY FOR UNRECOGNIZED TAX BENEFITS. THE MEDICAL CENTER FILES INCOME TAX RETURNS IN THE U.S. FEDERAL JURISDICTION AND NEW YORK STATE. THE MEDICAL CENTER IS NO LONGER SUBJECT TO U.S. FEDERAL AND STATE INCOME TAX EXAMINATIONS BY TAX AUTHORITIES FOR YEARS BEFORE 2010.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART XI, LINE 2D - OTHER ADJUSTMENTS:</FormAndLineReferenceDesc>
        <ExplanationTxt>UNREALIZED LOSS ON INTEREST RATE SWAP 594,354. PENSION AND POST RETIREMENT RELATED CHANGES 11,921,977. RENTAL EXPENSES 77,255. EQUITY IN OTHER CORPORATIONS -8,094,486.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART XII, LINE 2D - OTHER ADJUSTMENTS:</FormAndLineReferenceDesc>
        <ExplanationTxt>RENTAL EXPENSES 77,255.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleD>
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      <ReportPublicallyAvailableInd>1</ReportPublicallyAvailableInd>
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      <TotalOtherBenefitsGrp>
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      <TotalCommunityBenefitsGrp>
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        <TotalExpensePct>0.16810</TotalExpensePct>
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      <BadDebtExpenseReportedInd>1</BadDebtExpenseReportedInd>
      <BadDebtExpenseAmt>6778247</BadDebtExpenseAmt>
      <BadDebtExpenseAttributableAmt>2930914</BadDebtExpenseAttributableAmt>
      <ReimbursedByMedicareAmt>9809773</ReimbursedByMedicareAmt>
      <CostOfCareReimbursedByMedcrAmt>16989786</CostOfCareReimbursedByMedcrAmt>
      <MedicareSurplusOrShortfallAmt>-7180013</MedicareSurplusOrShortfallAmt>
      <CostingMethodologyUsedGrp>
        <CostToChargeRatioInd>X</CostToChargeRatioInd>
      </CostingMethodologyUsedGrp>
      <WrittenDebtCollectionPolicyInd>1</WrittenDebtCollectionPolicyInd>
      <FinancialAssistancePrvsnInd>0</FinancialAssistancePrvsnInd>
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      <HospitalFacilitiesGrp>
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        <BusinessName>
          <BusinessNameLine1>CAYUGA MEDICAL CENTER AT ITHACA</BusinessNameLine1>
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          <AddressLine1>101 DATES DRIVE</AddressLine1>
          <City>ITHACA</City>
          <State>NY</State>
          <ZIPCode>14850</ZIPCode>
        </USAddress>
        <WebsiteAddressTxt>WWW.CAYUGAMED.ORG</WebsiteAddressTxt>
        <LicensedHospitalInd>X</LicensedHospitalInd>
        <GeneralMedicalAndSurgicalInd>X</GeneralMedicalAndSurgicalInd>
        <EmergencyRoom24HrsInd>X</EmergencyRoom24HrsInd>
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      <HospitalFcltyPoliciesPrctcGrp>
        <HospitalFacilityName>
          <BusinessNameLine1>CAYUGA MEDICAL CENTER AT ITHACA</BusinessNameLine1>
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        <FacilityNum>1</FacilityNum>
        <CHNAConductedInd>1</CHNAConductedInd>
        <CommunityDefinitionInd>X</CommunityDefinitionInd>
        <CommunityDemographicsInd>X</CommunityDemographicsInd>
        <ExistingResourcesInd>X</ExistingResourcesInd>
        <HowDataObtainedInd>X</HowDataObtainedInd>
        <CommunityHealthNeedsInd>X</CommunityHealthNeedsInd>
        <CommunityHlthNeedsIdProcessInd>X</CommunityHlthNeedsIdProcessInd>
        <ConsultingProcessInd>X</ConsultingProcessInd>
        <InformationGapsInd>X</InformationGapsInd>
        <CHNAConductedYr>13</CHNAConductedYr>
        <TakeIntoAccountOthersInputInd>1</TakeIntoAccountOthersInputInd>
        <CHNAConductedWithOtherFcltsInd>0</CHNAConductedWithOtherFcltsInd>
        <CHNAReportWidelyAvailableInd>1</CHNAReportWidelyAvailableInd>
        <RptAvailableOnOwnWebsiteInd>X</RptAvailableOnOwnWebsiteInd>
        <OwnWebsiteURLTxt>WWW.CAYUGAMED.ORG/DOCS/CHNA13.PDF</OwnWebsiteURLTxt>
        <RptAvailableUponRequestInd>X</RptAvailableUponRequestInd>
        <AdoptImplementationStrategyInd>X</AdoptImplementationStrategyInd>
        <DevelopCommunityWidePlanInd>X</DevelopCommunityWidePlanInd>
        <PrioritizeHealthNeedsInd>X</PrioritizeHealthNeedsInd>
        <PrioritizeServicesInd>X</PrioritizeServicesInd>
        <AllNeedsAddressedInd>0</AllNeedsAddressedInd>
        <OrganizationIncurExciseTaxInd>0</OrganizationIncurExciseTaxInd>
        <EligCriteriaExplainedInd>1</EligCriteriaExplainedInd>
        <FPGUsedDeterEligFreeCareInd>1</FPGUsedDeterEligFreeCareInd>
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        <FPGUsedDetermEligDscntCareInd>1</FPGUsedDetermEligDscntCareInd>
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        <IncomeLevelInd>X</IncomeLevelInd>
        <AssetLevelInd>X</AssetLevelInd>
        <InsuranceStatusInd>X</InsuranceStatusInd>
        <MedicaidMedicareInd>X</MedicaidMedicareInd>
        <ResidencyInd>X</ResidencyInd>
        <AppFinancialAsstExplnInd>1</AppFinancialAsstExplnInd>
        <IncludesPublicityMeasuresInd>1</IncludesPublicityMeasuresInd>
        <PostedOnWebsiteInd>X</PostedOnWebsiteInd>
        <AttachedToInvoiceInd>X</AttachedToInvoiceInd>
        <PostedInEmergencyRoomInd>X</PostedInEmergencyRoomInd>
        <PostedInAdmissionOfficeInd>X</PostedInAdmissionOfficeInd>
        <ProvidedOnAdmissionInd>X</ProvidedOnAdmissionInd>
        <AvailableOnRequestInd>X</AvailableOnRequestInd>
        <FAPActionsOnNonpaymentInd>1</FAPActionsOnNonpaymentInd>
        <PermitReportToCreditAgencyInd>X</PermitReportToCreditAgencyInd>
        <PermitLawsuitInd>X</PermitLawsuitInd>
        <PermitLienOnResidenceInd>X</PermitLienOnResidenceInd>
        <CollectionActivitiesInd>1</CollectionActivitiesInd>
        <ReportingToCreditAgencyInd>X</ReportingToCreditAgencyInd>
        <LawsuitInd>X</LawsuitInd>
        <LiensOnResidencesInd>X</LiensOnResidencesInd>
        <DocumentedEligDeterminationInd>X</DocumentedEligDeterminationInd>
        <NondisEmergencyCarePolicyInd>1</NondisEmergencyCarePolicyInd>
        <OtherMethodUsedInd>X</OtherMethodUsedInd>
        <AmountsGenerallyBilledInd>0</AmountsGenerallyBilledInd>
        <GrossChargesInd>0</GrossChargesInd>
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      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>CAYUGA MEDICAL CENTER AT ITHACA</FormAndLineReferenceDesc>
        <ExplanationTxt>PART V, SECTION B, LINE 3: INFORMATION FOR THE CHNA WAS GATHERED IN FOUR WAYS: A META-ANALYSIS OF HEALTH ASSESSMENTS FOR CAYUGA, CORTLAND, SCHUYLER, SENECA, TIOGA, AND TOMPKINS COUNTIES; PARTICIPATION AND USE OF TOMPKINS COUNTY HEALTH PLANNING COUNCIL'S COMMUNITY SURVEY; CONDUCTED FOCUS GROUPS WITHIN THE ITHACA COMMUNITY; AND FEEDBACK GATHERED THROUGH PARTICIPATION ON OVER 15 COMMUNITY BOARDS. TARGET REQUESTS FOR PARTICIPATION ON THE ONLINE SURVEY WERE MADE TO COUNTY DEPARTMENTS, COMMUNITY ORGANIZATIONS, HEALTH COUNCIL BOARD EDUCATORS, HEALTH CARE PROFESSIONALS, LOCAL LEGISLATORS, AND THE BOARD OF HEALTH. THE TWO FOCUS GROUPS WERE CONDUCTED WITHIN THE DOWNTOWN ITHACA, NY AREA. THIS AREA HAS SOME OF THE HIGHEST CONCENTRATION OF SOME OF THE MOST DISPARATE GROUPS WITHIN CAYUGA MEDICAL CENTERS PRIMARY SERVICE AREA. THE FIRST FOCUS GROUP WAS COMPRISED OF BUSINESS OWNERS AND OPERATORS TO ADDRESS THE HEALTH NEEDS OF THE INDIVIDUALS WHO COMMUTE INTO ITHACA FOR WORK. THE SECOND FOCUS GROUP ADDRESSED THE CONCERNS OF THE DOWNTOWN ITHACA AREA, WITH A STRONG SEGMENT OF THE GROUP MADE UP OF INDIVIDUALS IN LOW-INCOME SITUATIONS.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>CAYUGA MEDICAL CENTER AT ITHACA</FormAndLineReferenceDesc>
        <ExplanationTxt>PART V, SECTION B, LINE 7: CAYUGA MEDICAL CENTER DID NOT DEVELOP A PLAN TO ADDRESS THE ISSUES OF 1) % OF UNINSURED CHILDREN EXCEEDS STATE AVERAGE IN FIVE OUT OF SIX COUNTIES; OR 2) PHYSICIAN AVAILABILITY FOR MEDICAID PERSONS. BOTH OF THESE ISSUES REQUIRE SUBSTANTIAL COLLABORATION ACROSS CARE DELIVERY SYSTEMS AND ARE NOT SOMETHING THAT CAYUGA MEDICAL CENTER IS POISED TO ADDRESS INDPENDENTLY AT THIS TIME.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>CAYUGA MEDICAL CENTER AT ITHACA</FormAndLineReferenceDesc>
        <ExplanationTxt>PART V, SECTION B, LINE 20D: THE HOSPITAL FACILITY USED THE RATES NEGOTIATED OF THE LARGEST COMMERCIAL PAYERS IN THE MARKET.</ExplanationTxt>
      </SupplementalInformationGrp>
      <FacilityNum>6</FacilityNum>
      <OthHlthCareFcltsNotHospitalGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1>CAYUGA MEDICAL CENTER</BusinessNameLine1>
          </BusinessName>
          <USAddress>
            <AddressLine1>10 ARROWWOOD DRIVE</AddressLine1>
            <City>ITHACA</City>
            <State>NY</State>
            <ZIPCode>14850</ZIPCode>
          </USAddress>
          <FacilityTxt>URGENT CARE CLINIC &amp; DIAGNOSTIC IMAGING, HEMATOLOGY/ONCOLOGY SERVICE, LAB SV</FacilityTxt>
        </OthHlthCareFcltsGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1>CAYUGA MEDICAL CENTER</BusinessNameLine1>
          </BusinessName>
          <USAddress>
            <AddressLine1>1129 COMMON AVE</AddressLine1>
            <City>CORTLAND</City>
            <State>NY</State>
            <ZIPCode>13045</ZIPCode>
          </USAddress>
          <FacilityTxt>URGENT CARE CLINIC &amp; DIAGNOSTIC IMAGING,LAB SERVICES</FacilityTxt>
        </OthHlthCareFcltsGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1>CAYUGA MEDICAL CENTER</BusinessNameLine1>
          </BusinessName>
          <USAddress>
            <AddressLine1>310 TAUGHANOCK BLVD</AddressLine1>
            <City>ITHACA</City>
            <State>NY</State>
            <ZIPCode>14850</ZIPCode>
          </USAddress>
          <FacilityTxt>CARDIO, REHAB, SPORTS MEDICINE, OUTPATIENT REHAB,DIAGNOSTIC, NUTRITIONAL COU</FacilityTxt>
        </OthHlthCareFcltsGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1>CAYUGA MEDICAL CENTER</BusinessNameLine1>
          </BusinessName>
          <USAddress>
            <AddressLine1>201 DATES DRIVE</AddressLine1>
            <City>ITHACA</City>
            <State>NY</State>
            <ZIPCode>14850</ZIPCode>
          </USAddress>
          <FacilityTxt>HEMATOLOGY &amp; ONCOLOGY SERVICES</FacilityTxt>
        </OthHlthCareFcltsGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1>CAYUGA MEDICAL CENTER</BusinessNameLine1>
          </BusinessName>
          <USAddress>
            <AddressLine1>10 ARROWWOOD DRIVE</AddressLine1>
            <City>ITHACA</City>
            <State>NY</State>
            <ZIPCode>14850</ZIPCode>
          </USAddress>
          <FacilityTxt>OUTPATIENT SURGICAL SERVICES</FacilityTxt>
        </OthHlthCareFcltsGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1>CAYUGA MEDICAL CENTER</BusinessNameLine1>
          </BusinessName>
          <USAddress>
            <AddressLine1>10 BRENTWOOD DRIVE</AddressLine1>
            <City>ITHACA</City>
            <State>NY</State>
            <ZIPCode>14850</ZIPCode>
          </USAddress>
          <FacilityTxt>OUTPATIENT REHAB</FacilityTxt>
        </OthHlthCareFcltsGrp>
      </OthHlthCareFcltsNotHospitalGrp>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART I, LN 7 COL(F):</FormAndLineReferenceDesc>
        <ExplanationTxt>PART III, LINE 6: THE COST TO CHARGE RATIO CALCULATED ON SUPPLEMENTAL WORKSHEET 6 FROM PART 1 LINE 7 OF 57.09% WAS APPLIED TO THE MEDICARE GROSS PATIENT REVENUE OF $82,759,185 FOR THE FY 2012.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART III, LINE 2:</FormAndLineReferenceDesc>
        <ExplanationTxt>THE MEDICAL CENTER PROVIDES SERVICES THAT ARE PAID FOR BY THIRD-PARTY PAYERS AND INDIVIDUALS. THE MEDICAL CENTER DOES NOT ACCRUE INTEREST ON THESE RECEIVABLES. THE MEDICAL CENTER ESTIMATES THE AMOUNT TO BE RECOGNIZED IN THE FINANCIAL STATEMENTS FOR DOUBTFUL ACCOUNTS BY ANALYZING PATIENT ACCOUNTS FOR COLLECTIBILITY AND APPLYING HISTORICALLY ESTABLISHED PERCENTAGES FOR SELF-PAY AND VARIOUS THIRD-PARTY PAYERS TO THE AGING CATEGORIES IN THE ACCOUNTS RECEIVABLE AGING. ACCOUNTS FOR WHICH NO PAYMENTS HAVE BEEN RECEIVED FOR A SIGNIFICANT AMOUNT OF TIME ARE CONSIDERED DELINQUENT AND THE ACCOUNT IS WRITTEN-OFF WHEN CUSTOMARY COLLECTION EFFORTS ARE EXHAUSTED.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART III, LINE 3:</FormAndLineReferenceDesc>
        <ExplanationTxt>FOR CALCULATING THE BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE FINANCIAL ASSISTANCE POLICY OF THE MEDICAL CENTER, THE DENIAL RATE WAS APPLIED TO THE REPORTED BAD DEBT EXPENSE. THIS ALLOWS THE MEDICAL CENTER TO BE CONSERVATIVE IN THE ESTIMATE OF WHAT AMOUNT THE ORGANIZATIONS BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE IS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART III, LINE 4:</FormAndLineReferenceDesc>
        <ExplanationTxt>THE PAGE NUMBER IN THE ATTACHED FINANCIAL STATEMENTS ON WHICH THE FOOTNOTE IS CONTAINED THAT DESCRIBES BAD DEBT IS PAGE 5, FOOTNOTE # 2 - SUMMARY SIGNIFICANT ACCOUNTING POLICIES - NET PATIENT SERVICE REVENUE AND PATIENT ACCOUNTS RECEIVABLE.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART VI, LINE 2:</FormAndLineReferenceDesc>
        <ExplanationTxt>THE CAYUGA MEDICAL CENTER AT ITHACA WORKS DIRECTLY WITH THE HEALTH PLANNING COUNCIL OF TOMPKINS COUNTY, BOTH ARE MEMBERS OF THE ADVISORY BOARD OF TOMPKINS COUNTY AND SURROUNDING AREAS AND SOLICIT VARIOUS FEEDBACK ON SERVICE GROWTH. AFTER CONDUCTING THE COMMUNITY HEALTH NEEDS ASSESSMENT IN 2013, CMC'S COMMUNITY HEALTH COUNCIL IDENTIFIED THE FOLLOWING COMMUNITY HEALTH NEEDS FOR CMC TO IMPACT: 1. CHILD OBESITY2. ADULT OBESITY3. IMPROVING BREAST CANCER SCREENING4. IMPACTING CHRONIC LOWER RESPIRATORY DISEASE THROUGH ASTHMA TREATMENT AND PREVENTION5. ASSIST IN IMPROVING MENTAL HEALTH RESOURCE COORDINATION6. IMPACTING THE SUICIDE RATE</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART VI, LINE 3:</FormAndLineReferenceDesc>
        <ExplanationTxt>CAYUGA MEDICAL CENTER AT ITHACA'S (CMC) BAD DEBT COLLECTION POLICY DOES NOT MAKE ANY SPECIFIC PROVISION FOR COLLECTION PRACTICES TO BE FOLLOWED FOR PATIENTS WHO ARE KNOWN TO QUALIFY FOR CHARITY CARE OR FINANCIAL ASSISTANCE. HOWEVER CMC'S STANDARD OPERATING PRACTICE IS TO STOP ALL COLLECTION EFFORTS AND HOLD ACCOUNTS BACK FROM BAD DEBT UNTIL THE PATIENT IS GIVEN SUFFICIENT TIME TO COMPLETE A FINANCIAL ASSISTANCE APPLICATION. REVIEW OF THE APPLICATION WILL BE MADE BY THE HOSPITAL AND PATIENTS ARE NOTIFIED OF DETERMINATION WITHIN 30 DAYS OF RECEIPT OF A COMPLETED APPLICATION. IF PATIENT DOES NOT QUALIFY FOR EITHER PARTIAL OR FULL ASSISTANCE, THEN A MONTHLY PAYMENT PLAN IS OFFERED TO THE PATIENT FOR ANY REMAINING BALANCES DUE. IF THE PATIENT QUALIFIES FOR ANY FINANCIAL ASSISTANCE, AN ADJUSTMENT IS IMMEDIATELY POSTED TO THE PATIENTS ACCOUNT UPON DETERMINATION OF QUALIFICATION.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART VI, LINE 4:</FormAndLineReferenceDesc>
        <ExplanationTxt>EACH YEAR MORE THAN 155,000 PATIENTS FROM THE GREATER CENTRAL NEW YORK REGION, INCLUDING, BUT NOT LIMITED TO TOMPKINS COUNTY AND PORTIONS OF CAYUGA, CHEMUNG, CORTLAND, SCHUYLER, SENECA AND TIOGA COUNTIES USE THE MEDICAL CENTER'S COMPREHENSIVE ACUTE CARE, URGENT CARE CENTERS, AND OUTPATIENT SERVICES.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART VI, LINE 7, REPORTS FILED WITH STATES</FormAndLineReferenceDesc>
        <ExplanationTxt>NY</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleH>
    <IRS990ScheduleI documentId="RetDoc1041900001">
      <GrantRecordsMaintainedInd>1</GrantRecordsMaintainedInd>
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        <GrantTypeTxt>EMPLOYEE DISASTER FUND</GrantTypeTxt>
        <RecipientCnt>15</RecipientCnt>
        <CashGrantAmt>7650</CashGrantAmt>
        <NonCashAssistanceAmt>0</NonCashAssistanceAmt>
        <ValuationMethodUsedDesc>BOOK</ValuationMethodUsedDesc>
      </GrantsOtherAsstToIndivInUSGrp>
      <GrantsOtherAsstToIndivInUSGrp>
        <GrantTypeTxt>KOMARMI SCHOLARSHIP</GrantTypeTxt>
        <RecipientCnt>2</RecipientCnt>
        <CashGrantAmt>1000</CashGrantAmt>
        <NonCashAssistanceAmt>0</NonCashAssistanceAmt>
        <ValuationMethodUsedDesc>BOOK</ValuationMethodUsedDesc>
      </GrantsOtherAsstToIndivInUSGrp>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART I, LINE 2:</FormAndLineReferenceDesc>
        <ExplanationTxt>THE EMPLOYEE DISASTER FUND (EDF) IS TO PROVIDE TEMPORARY AID TO EMPLOYEES WITH A DISASTER OR OTHER EMERGENCY HARDSHIP SITUATION. THE EDF COMMITTEE IS COMPRISED OF HOSPITAL EMPLOYEES, WITH A MAJORITY OF THE MEMBERS BEING IN A NON-MANAGEMENT POSITION. TO BE ELIGIBLE FOR ASSISTANCE, APPLICANTS MUST MEET CERTAIN CRITERIA AS SPECIFIED IN THE EDF POLICY. THE EDF COMMITTEE MAKES AWARDS BASED ON THE MERITS OF EACH CASE IN ACCORDANCE WITH THE POLICY. THE EDF COMMITTEE MAINTAINS COMPLETE AND ACCURATE MINUTES OF ITS PROCEEDINGS. THE KOMARMI SCHOLARSHIP IS A HEALTH CAREER SCHOLARSHIP THAT IS ADMINISTERED BY A COMMITTEE MADE UP OF TWO VOLUNTEER COMMUNITY MEMBERS, A REPRESENTATIVE FROM THE BOARD OF DIRECTORS AND A MEMBER OF THE ADMINISTRATIVE TEAM. THE COMMITTEE IDENTIFIES SPECIFIC AREAS EACH YEAR IN THE HOSPITAL WHICH ARE EXPERIENCING OR ANTICIPATING RECRUITMENT DIFFICULTIES RELATED TO THE SHORTAGE OF QUALIFIED CANDIDATES. THE COMMITTEE WORKS WITH THE ITHACA HIGH SCHOOL ADMINISTRATION TO IDENTIFY A GRADUATING SENIOR WHO IS PLANNING ON PURSUING A CAREER IN THE SELECTED HEALTH PROFESSION. THE AMOUNT OF THE SCHOLARSHIP CAN BE UP TO $1,000, TO BE AWARDED AT GRADUATION.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleI>
    <IRS990ScheduleJ documentId="RetDoc1042400001">
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      <WrittenPolicyRefTAndEExpnssInd>1</WrittenPolicyRefTAndEExpnssInd>
      <SubstantiationRequiredInd>1</SubstantiationRequiredInd>
      <IndependentConsultantInd>X</IndependentConsultantInd>
      <WrittenEmploymentContractInd>X</WrittenEmploymentContractInd>
      <BoardOrCommitteeApprovalInd>X</BoardOrCommitteeApprovalInd>
      <SeverancePaymentInd>1</SeverancePaymentInd>
      <SupplementalNonqualRtrPlanInd>0</SupplementalNonqualRtrPlanInd>
      <EquityBasedCompArrngmInd>0</EquityBasedCompArrngmInd>
      <CompBasedOnRevenueOfFlngOrgInd>0</CompBasedOnRevenueOfFlngOrgInd>
      <CompBsdOnRevRelatedOrgsInd>0</CompBsdOnRevRelatedOrgsInd>
      <CompBsdNetEarnsFlngOrgInd>1</CompBsdNetEarnsFlngOrgInd>
      <CompBsdNetEarnsRltdOrgsInd>0</CompBsdNetEarnsRltdOrgsInd>
      <AnyNonFixedPaymentsInd>0</AnyNonFixedPaymentsInd>
      <InitialContractExceptionInd>0</InitialContractExceptionInd>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>JOHN B RUDD</PersonNm>
        <TitleTxt>PRESIDENT/CEO</TitleTxt>
        <BaseCompensationFilingOrgAmt>385000</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>22500</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>0</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>5100</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>23000</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>435600</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>JOHN COLLETT</PersonNm>
        <TitleTxt>VP/CFO</TitleTxt>
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        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
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        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>0</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
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        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>23000</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>232490</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
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      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>TIMOTHY BAEL MD</PersonNm>
        <TitleTxt>DIRECTOR/ONCOLOGIST</TitleTxt>
        <BaseCompensationFilingOrgAmt>512123</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>50655</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>0</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>5100</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>5758</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>573636</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>CHARLES GARBO MD</PersonNm>
        <TitleTxt>ONCOLOGIST</TitleTxt>
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        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>73363</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>0</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>5100</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>4458</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>587811</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>JULIE CAMPBELL MD</PersonNm>
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        <OtherCompensationFilingOrgAmt>0</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
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        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>456540</TotalCompensationFilingOrgAmt>
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        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
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      <RltdOrgOfficerTrstKeyEmplGrp>
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        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
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        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>327698</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>AUGUSTE DUPLAN MD</PersonNm>
        <TitleTxt>ADOL. PSYCHIATRIST</TitleTxt>
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        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
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        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>0</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>5100</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>4458</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>302877</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>D ROBERT MACKENZIE MD</PersonNm>
        <TitleTxt>FORMER CEO</TitleTxt>
        <BaseCompensationFilingOrgAmt>200000</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>50000</BonusFilingOrganizationAmount>
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        <OtherCompensationFilingOrgAmt>1860554</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>4000</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>0</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>2114554</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART I, LINE 1A</FormAndLineReferenceDesc>
        <ExplanationTxt>PART I, LINE 1A: ALL EMPLOYEES ARE ELIGIBLE FOR A HEALTH CLUB MEMBERSHIP SUBSIDY, CAYUGA MEDICAL CENTER WILL REIMBURSE EMPLOYEES 50% OF THE SINGLE MONTHLY MEMBERSHIP FEE WHEN THEY ATTEND THE HEALTH CLUB AT LEAST 24 TIMES A QUARTER. IF AN INDIVIDUAL DOES NOT MEET THE CRITERIA, THEY WILL NOT RECEIVE THE SUBSIDY.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART I, LINE 4A</FormAndLineReferenceDesc>
        <ExplanationTxt>D ROB MACKENZIE RECEIVED A SERP LUMP SUM PAYMENT DURING 2013</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART I, LINE 6</FormAndLineReferenceDesc>
        <ExplanationTxt>YEAR END BONUS PROGRAM FOR ALL EMPLOYEES WAS BASED ON THE OPERATING MARGIN, PARTICIPATION IN THE ANNUAL SAFETY TRAINING AND REACHING PREDETERMINED CUSTOMER SATISFACTION SCORES.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleJ>
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        </IssuerName>
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        <PoolFinancingInd>0</PoolFinancingInd>
      </TaxExemptBondsIssuesGrp>
      <TaxExemptBondsIssuesGrp>
        <BondReferenceCd>B</BondReferenceCd>
        <IssuerName>
          <BusinessNameLine1>TOMPKINS COUNTY DEVELOPMENT CORP</BusinessNameLine1>
        </IssuerName>
        <BondIssuerEIN>272290745</BondIssuerEIN>
        <CUSIPNum>890096AA8</CUSIPNum>
        <BondIssuedDt>2010-08-31</BondIssuedDt>
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      </TaxExemptBondsIssuesGrp>
      <TaxExemptBondsIssuesGrp>
        <BondReferenceCd>C</BondReferenceCd>
        <IssuerName>
          <BusinessNameLine1>TOMPKINS COUNTY DEVELOPMENT CORP</BusinessNameLine1>
        </IssuerName>
        <BondIssuerEIN>272290745</BondIssuerEIN>
        <BondIssuedDt>2013-04-09</BondIssuedDt>
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        <PoolFinancingInd>0</PoolFinancingInd>
      </TaxExemptBondsIssuesGrp>
      <TaxExemptBondsProceedsGrp>
        <BondReferenceCd>A</BondReferenceCd>
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        <CapitalExpendituresAmt>14525625</CapitalExpendituresAmt>
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      <TaxExemptBondsProceedsGrp>
        <BondReferenceCd>B</BondReferenceCd>
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        <IssuanceCostsFromProceedsAmt>285500</IssuanceCostsFromProceedsAmt>
        <WorkingCapitalExpendituresAmt>142750</WorkingCapitalExpendituresAmt>
        <CapitalExpendituresAmt>13846750</CapitalExpendituresAmt>
        <SubstantialCompletionYr>2010</SubstantialCompletionYr>
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      <TaxExemptBondsProceedsGrp>
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        <CapitalExpendituresAmt>24386762</CapitalExpendituresAmt>
        <CurrentRefundingInd>0</CurrentRefundingInd>
        <AdvanceRefundingInd>0</AdvanceRefundingInd>
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      <TaxExemptBondsPrivateBusUseGrp>
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        <AnyResearchAgreementsInd>0</AnyResearchAgreementsInd>
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        <VariableRateIssueInd>1</VariableRateIssueInd>
        <HedgeIdentifiedInBksAndRecInd>1</HedgeIdentifiedInBksAndRecInd>
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        <HedgeTerminatedInd>0</HedgeTerminatedInd>
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        <GrossProceedsInvestedInd>0</GrossProceedsInvestedInd>
        <WrittenProcToMonitorReqsInd>0</WrittenProcToMonitorReqsInd>
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      <TaxExemptBondsArbitrageGrp>
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        <Form8038TFiledInd>1</Form8038TFiledInd>
        <VariableRateIssueInd>1</VariableRateIssueInd>
        <HedgeIdentifiedInBksAndRecInd>1</HedgeIdentifiedInBksAndRecInd>
        <HedgeProviderName>
          <BusinessNameLine1>DEUTSCHE BANK</BusinessNameLine1>
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        <TermOfHedgePct>12.000000000000</TermOfHedgePct>
        <SuperintegratedHedgeInd>0</SuperintegratedHedgeInd>
        <HedgeTerminatedInd>0</HedgeTerminatedInd>
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        <GrossProceedsInvestedInd>0</GrossProceedsInvestedInd>
        <WrittenProcToMonitorReqsInd>0</WrittenProcToMonitorReqsInd>
      </TaxExemptBondsArbitrageGrp>
      <TaxExemptBondsArbitrageGrp>
        <BondReferenceCd>C</BondReferenceCd>
        <Form8038TFiledInd>1</Form8038TFiledInd>
        <VariableRateIssueInd>0</VariableRateIssueInd>
        <HedgeIdentifiedInBksAndRecInd>0</HedgeIdentifiedInBksAndRecInd>
        <GrossProceedsInvestedInGICInd>0</GrossProceedsInvestedInGICInd>
        <GrossProceedsInvestedInd>0</GrossProceedsInvestedInd>
        <WrittenProcToMonitorReqsInd>0</WrittenProcToMonitorReqsInd>
      </TaxExemptBondsArbitrageGrp>
      <ProceduresCorrectiveActionGrp>
        <BondReferenceCd>A</BondReferenceCd>
        <ProceduresCorrectiveActionInd>0</ProceduresCorrectiveActionInd>
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      <ProceduresCorrectiveActionGrp>
        <BondReferenceCd>B</BondReferenceCd>
        <ProceduresCorrectiveActionInd>0</ProceduresCorrectiveActionInd>
      </ProceduresCorrectiveActionGrp>
    </IRS990ScheduleK>
    <IRS990ScheduleL documentId="RetDoc1042800001">
      <BusTrInvolveInterestedPrsnGrp>
        <NameOfInterested>
          <PersonNm>LARRY BAUM</PersonNm>
        </NameOfInterested>
        <RelationshipDescriptionTxt>BOARD CHAIR &amp; CEO OF COMPUTING CENTER</RelationshipDescriptionTxt>
        <TransactionAmt>513045</TransactionAmt>
        <TransactionDesc>PAYMENTS TO COMPUTING CENTER FOR SERVICES RENDERED</TransactionDesc>
        <SharingOfRevenuesInd>0</SharingOfRevenuesInd>
      </BusTrInvolveInterestedPrsnGrp>
      <BusTrInvolveInterestedPrsnGrp>
        <NameOfInterested>
          <PersonNm>GREGORY HARTZ</PersonNm>
        </NameOfInterested>
        <RelationshipDescriptionTxt>BOARD DIRECTOR &amp; PRESIDENT/CEO OF TOMPKINS TRUST COMPANY (TTC)</RelationshipDescriptionTxt>
        <TransactionAmt>182427</TransactionAmt>
        <TransactionDesc>PAYMENTS TO TTC FOR BANK FEES</TransactionDesc>
        <SharingOfRevenuesInd>0</SharingOfRevenuesInd>
      </BusTrInvolveInterestedPrsnGrp>
    </IRS990ScheduleL>
    <IRS990ScheduleO documentId="RetDoc1044400001">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 11</FormAndLineReferenceDesc>
        <ExplanationTxt>THE FORM IS REVIEWED WITH THE FINANCE, AUDIT AND PERSONNEL COMMITTEE AND IS MADE AVAILABLE TO THE ENTIRE BOARD OF DIRECTORS PRIOR TO FILING.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 12C</FormAndLineReferenceDesc>
        <ExplanationTxt>CAYUGA MEDICAL CENTER AT ITHACA MAINTAINS A CONFLICT OF INTEREST POLICY WHICH BOARD MEMBERS ARE REQUIRED TO SIGN ANNUALLY. THE HOSPITAL REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THE POLICY BY REVIEWING STATEMENTS ANNUALLY FOR CONFLICTS, IDENTIFYING DISQUALIFIED PERSONS, AND RECORDING ALL PROCEEDING RELATED TO A CONFLICT OF INTEREST TRANSACTION.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 15</FormAndLineReferenceDesc>
        <ExplanationTxt>CAYUGA MEDICAL CENTER AT ITHACA DETERMINES COMPENSATION OF THE CEO AND OTHER OFFICERS BY UTILIZING INDEPENDENT COMPENSATION CONSULTANT AND/OR COMPENSATION SURVEYS. FORMAL WRITTEN CONTRACT FOR CEO IS REVIEWED AND APPROVED BY THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION C, LINE 19</FormAndLineReferenceDesc>
        <ExplanationTxt>CAYUGA MEDICAL CENTER AT ITHACA FOLLOWS THE IRS DISCLOSURE REQUIREMENTS AND ALL REQUIRED DOCUMENTS ARE AVAILABLE UPON REQUEST.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART XI, LINE 9:</FormAndLineReferenceDesc>
        <ExplanationTxt>PENSION AND POST RETIREMENT RELATED CHANGES 11,921,977. UNREALIZED GAIN ON INTEREST RATE SWAP 594,354. RESERVE FOR CMA LOAN -8,094,486.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
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        </DisregardedEntityName>
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          <AddressLine1>101 DATES DRIVE</AddressLine1>
          <City>ITHACA</City>
          <State>NY</State>
          <ZIPCode>14850</ZIPCode>
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        <PublicCharityStatusTxt>11</PublicCharityStatusTxt>
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          <BusinessNameLine1>CAYUGA MEDICAL CENTER AT ITHACA</BusinessNameLine1>
        </DirectControllingEntityName>
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      <IdRelatedTaxExemptOrgGrp>
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          <BusinessNameLine1>CAYUGA MEDICAL ASSOCIATES</BusinessNameLine1>
        </DisregardedEntityName>
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          <AddressLine1>101 DATES DRIVE</AddressLine1>
          <City>ITHACA</City>
          <State>NY</State>
          <ZIPCode>14850</ZIPCode>
        </USAddress>
        <EIN>204356115</EIN>
        <PrimaryActivitiesTxt>ESTABLISH MEDICAL PRACTICES FOR LOCAL ACCESSIBILITY</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>NY</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(C)(3)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>9</PublicCharityStatusTxt>
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        </RelatedOrganizationName>
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          <AddressLine1>101 DATES DRIVE</AddressLine1>
          <City>ITHACA</City>
          <State>NY</State>
          <ZIPCode>14850</ZIPCode>
        </USAddress>
        <EIN>161261492</EIN>
        <PrimaryActivitiesTxt>BUILDING MANAGEMENT</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>NY</LegalDomicileStateCd>
        <DirectControllingNACd>N/A</DirectControllingNACd>
        <PredominantIncomeTypeTxt>RELATED</PredominantIncomeTypeTxt>
        <ShareOfTotalIncomeAmt>242811</ShareOfTotalIncomeAmt>
        <ShareOfEOYAssetsAmt>995969</ShareOfEOYAssetsAmt>
        <DisproportionateAllocationsInd>0</DisproportionateAllocationsInd>
        <UBICodeVAmt>918</UBICodeVAmt>
        <GeneralOrManagingPartnerInd>1</GeneralOrManagingPartnerInd>
        <OwnershipPct>0.58000</OwnershipPct>
      </IdRelatedOrgTxblPartnershipGrp>
      <IdRelatedOrgTxblCorpTrGrp>
        <RelatedOrganizationName>
          <BusinessNameLine1>TOMPKINS OFFICE MANAGEMENT SYSTEM</BusinessNameLine1>
        </RelatedOrganizationName>
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        <ShareOfEOYAssetsAmt>703743</ShareOfEOYAssetsAmt>
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        <ControlledOrganizationInd>1</ControlledOrganizationInd>
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      <IdRelatedOrgTxblCorpTrGrp>
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        <LegalDomicileStateCd>NY</LegalDomicileStateCd>
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      </IdRelatedOrgTxblCorpTrGrp>
      <IdRelatedOrgTxblCorpTrGrp>
        <RelatedOrganizationName>
          <BusinessNameLine1>CAP CONNECTLLC</BusinessNameLine1>
        </RelatedOrganizationName>
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          <City>ITHACA</City>
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          <BusinessNameLine1>CAYUGA MEDICAL CENTER AT ITHACA</BusinessNameLine1>
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        <EntityTypeTxt>C</EntityTypeTxt>
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      </IdRelatedOrgTxblCorpTrGrp>
      <ReceiptOfIntAnntsRntsRyltsInd>1</ReceiptOfIntAnntsRntsRyltsInd>
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      <GiftGrntCapContriFromOthOrgInd>0</GiftGrntCapContriFromOthOrgInd>
      <LoansOrGuaranteesToOtherOrgInd>0</LoansOrGuaranteesToOtherOrgInd>
      <LoansOrGuaranteesFromOthOrgInd>0</LoansOrGuaranteesFromOthOrgInd>
      <DivRelatedOrganizationInd>0</DivRelatedOrganizationInd>
      <AssetSaleToOtherOrgInd>0</AssetSaleToOtherOrgInd>
      <AssetPurchaseFromOtherOrgInd>0</AssetPurchaseFromOtherOrgInd>
      <AssetExchangeInd>0</AssetExchangeInd>
      <RentalOfFacilitiesToOthOrgInd>1</RentalOfFacilitiesToOthOrgInd>
      <RentalOfFcltsFromOthOrgInd>1</RentalOfFcltsFromOthOrgInd>
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      <SharingOfFacilitiesInd>0</SharingOfFacilitiesInd>
      <PaidEmployeesSharingInd>0</PaidEmployeesSharingInd>
      <ReimbursementPaidToOtherOrgInd>0</ReimbursementPaidToOtherOrgInd>
      <ReimbursementPaidByOtherOrgInd>0</ReimbursementPaidByOtherOrgInd>
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        </OtherOrganizationName>
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        <MethodOfAmountDeterminationTxt>CONTRACT</MethodOfAmountDeterminationTxt>
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      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1>CAYUGA MEDICAL OFFICE BUILDING ASSOCIATES</BusinessNameLine1>
        </OtherOrganizationName>
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        <MethodOfAmountDeterminationTxt>CONTRACT</MethodOfAmountDeterminationTxt>
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      <TransactionsRelatedOrgGrp>
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          <BusinessNameLine1>TOMPKINS OFFICE MANAGEMENT SYSTEMS INC</BusinessNameLine1>
        </OtherOrganizationName>
        <TransactionTypeTxt>L</TransactionTypeTxt>
        <InvolvedAmt>50655</InvolvedAmt>
        <MethodOfAmountDeterminationTxt>CONTRACT</MethodOfAmountDeterminationTxt>
      </TransactionsRelatedOrgGrp>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1>CAP CONNECT LLC</BusinessNameLine1>
        </OtherOrganizationName>
        <TransactionTypeTxt>L</TransactionTypeTxt>
        <InvolvedAmt>248911</InvolvedAmt>
        <MethodOfAmountDeterminationTxt>CONTRACT</MethodOfAmountDeterminationTxt>
      </TransactionsRelatedOrgGrp>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1>CAP CONNECT LLC</BusinessNameLine1>
        </OtherOrganizationName>
        <TransactionTypeTxt>J</TransactionTypeTxt>
        <InvolvedAmt>18672</InvolvedAmt>
        <MethodOfAmountDeterminationTxt>CONTRACT</MethodOfAmountDeterminationTxt>
      </TransactionsRelatedOrgGrp>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1>TOMPKINS OFFICE MANAGEMENT SYSTEMS INC</BusinessNameLine1>
        </OtherOrganizationName>
        <TransactionTypeTxt>J</TransactionTypeTxt>
        <InvolvedAmt>6366</InvolvedAmt>
        <MethodOfAmountDeterminationTxt>CONTRACT</MethodOfAmountDeterminationTxt>
      </TransactionsRelatedOrgGrp>
    </IRS990ScheduleR>
  </ReturnData>
</Return>