2013-11-13T10:40:59-07:00 2012-12-31 990 2012-01-01 160743905 ARNOT OGDEN MEDICAL CENTER ARNO 6077374235 600 ROE AVENUE ELMIRA NY 14905 Ronald Kintz 6077374235 2013-11-13 2012 2016-02-25 16:41:14Z RONALD J KINTZ SENIOR VP CFO 600 ROE AVENUE ELMIRA NY 14905 273257127 0 X www.aomc.org X 1889 NY Arnot Ogden Medical Center is a community based hospital with an open emergency room and selected highly specialized services that are part of a high quality health care delivery system that serves Chemung County, NY and the Twin Tier Regions of New York and Pennslyvania. 21 19 2656 580 -192962 -130433 2953037 3498007 257725224 256345564 415497 3041400 6597412 4828667 267691170 267713638 0 0 0 0 167747671 171187900 0 0 0 90037042 91369565 257784713 262557465 9906457 5156173 245234878 261001988 97381862 115377683 147853016 145624305 Arnot Ogden Medical Center is an independent, not-for-profit, 256-bed tertiary medical facility with more than 300 physicians from over 50 specialties. Arnot Ogden Medical Center offers specialty services at the Falck Cancer Center, Heart and Vascular Institute, Stroke Care, Maternity, Surgery. 0 0 209966372 0 261777710 The Arnot Ogden Medical Center continues to provide of health care related services since it opened in 1889, serving Chemung County and the Twin Tier Regions of New York and Pennsylvania. The Medical Center specialzied in the fields of Cardiology, Oncology, Renal, Neonatology, Bariatrics and Emergency Care. Other sub specialized services include but are not limited to Anesthesiology, Surgery, Laboratory, Imaging, Physical Therapy, Obstetrics, and Gynecology. In 2012 the Medical Center's 2,079 Full-time Equivalent of employees cared for 12,582 inpatient admissions in its 254 staffed beds. The Medical Center provided Outpatient Services to approximately 370,847 Outpatient Visits in its subspecialty services. The approximately xxx physicans provided for 150,752 office visits in the areas of primary care and specialty services. 744642 0 329863 The Arnot Ogden Medical Center School of Nursing began in 1889 and continues to offer a three year diploma program accredited by the National League for Nursing with approximately xx students enrolled. The Arnot Ogden School of Radiologic Sciences began in 1953 continues to offer a two year certificate program which is accredited by the Joint Review Commission on Education in Radiologic Technology with approximatedly xx students enrolled. Upon completion of their program of study, students are eligible to take the NYS licensing examinations for Registered Nurse or Radiologic Technologist. 0 0 0 210711014 1 1 1 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 0 0 0 0 0 0 1 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 383 0 1 2656 1 1 1 0 0 0 0 0 X 21 19 1 0 0 0 0 0 0 1 1 0 1 1 1 1 1 1 1 1 1 1 0 NY X X RONALD J KINTZ 6077374235 ACCOUNTING DEPARTMENT 600 ROE AVENUE ELMIRA NY 14905 S Jan Eberhard 10 0 X 0 0 0 Joseph P Manning 2 0 X 0 0 0 John R Alexander 1 0 X 0 0 0 Daniel J Burke 2 0 X 0 0 0 Francisco Corbalan 1 0 X X 0 257140 3520 David Dalrymple 1 0 X 0 0 0 Christine M Deschamps 2 0 X 0 0 0 John T Gough 1 0 X 0 0 0 Mark J Hagan 2 0 X 0 0 0 Michael Hosey 1 0 X 0 0 0 Roy A Kyles 1 0 X 0 0 0 Randy S Lehman 1 0 X 0 0 0 Ben E Lynch 7 0 X 0 0 0 Robert McNamara 1 0 X 0 0 0 Mary Louise Mitchell 4 0 X 0 0 0 John F O'Mara 1 0 X 0 0 0 Donald Quick 2 0 X 0 0 0 Patrick J Rogers 1 0 X 0 0 0 Melinda Sartori 1 0 X 0 0 0 Roger Schenone 1 40.00 X 172823 142215 12261 Gregory Schultz 1 0 X 185269 0 39972 Margaret B Streeter 1 0 X 0 0 0 Ronald J Kintz 40 14 X 360608 0 47593 Anthony Cooper 48 7 X 667160 0 48893 H Fred Farley 50 5 X 390276 0 48893 Wesley Blauvelt 43 5 X 221752 0 42858 James Watson 40 1 X 219720 0 10367 William Huffner 48 5 X 348104 0 30455 Robert Lambert 45 5 X 467257 0 41593 Debra Martin 50 5 X 158053 0 24140 Gregg Martin 40 5 X 162110 0 37637 Richard Hoffman 45 5 X 162412 0 36713 Marc Rustici 50 5 X 160304 0 35940 Joseph Braunschiedel 40 5 X 165142 0 28800 Mary Vosburgh 55 5 X 159006 0 26426 Kimberly Panosian 45 5 X 198195 0 26559 Vidyasagar Mokureddy 40 1 X 1143010 0 12138 William DeLuccia 40 1 X 745326 0 31900 Paul Hicks 40 1 X 747430 0 24512 Nishith Amin 40 1 X 744135 0 30887 Ravi Akula 40 1 X 685680 0 30887 8263772 399355 672944 163 1 1 0 Associated Anesthesiologists of the Finger Lakes PO Box 1253 Elmira NY 14902 Anesthesiology Services 2340267 HHA Services Inc PO Box 935695 Atlanta GA 31193 Management Services 1035790 Unified Trust Company 2353 Alexandria Drive Suite 100 Lexington KY 40504 Pension Services 855133 Delphi Hospitalist Services 1880 East Ridge Road Suite 6 Upper Level Rochester NY 14622 Emergency Physicians 687989 Alliance Healthcare Services PO Box 96485 Chaicago IL 60693 Medical Services 685050 35 0 0 0 429658 3068349 0 0 3498007 Net Patient Service Revenue Hospital 900099 208068142 208068142 0 0 Net Patient Service Revenue Physician 621110 47808272 47808272 0 0 School of Nursing 611600 387169 387169 0 0 School of Radiologic Technology 611600 81981 81981 0 0 0 0 0 0 256345564 1550525 0 0 1550525 0 0 0 0 0 0 0 0 386183 0 643647 0 -257464 0 -257464 0 -257464 0 4913409 0 3383993 38541 1529416 -38541 1490875 0 0 1490875 119908 0 45219 74689 0 74689 0 0 0 0 0 0 568827 1432089 -863262 0 0 -863262 Housekeeping & Medical Waste Removal 561720 43503 0 43503 0 Maintenance Services 561790 17066 0 17066 0 Education/Seminars/Workshops 611699 48193 0 0 48193 5765942 5762009 3933 0 5874704 267713638 262107573 -192962 2301020 0 0 0 0 0 0 0 0 2455158 0 2455158 0 0 0 0 0 126930212 110462802 16467410 0 7240630 0 7240630 0 26375775 7171 26368604 0 8186125 6687755 1498370 0 3623549 1100162 2523387 0 1087379 138234 949145 0 132958 3595 129363 0 0 0 0 0 0 0 365123 637 364486 0 5204471 4399632 804839 0 939754 91144 848610 0 46331221 45423575 907646 0 3980273 3253392 726881 0 0 0 0 0 2861940 527178 2334762 0 373527 295335 78192 0 0 0 0 0 203736 146762 56974 0 1672184 0 1672184 0 0 0 0 0 11340839 25000 11315839 0 2519983 1797198 722785 0 Maintenance Contracts 3014970 2367248 647722 0 Medical Payments to Outside Contractors 2655085 2655085 0 0 Contracted Labor 261743 261743 0 0 All other expenses 4800830 2374520 2426310 0 0 28692846 -28692846 0 262557465 210711014 51846451 0 7742 8742 8466886 14515647 489994 107936 37269051 34228063 0 0 0 0 7745562 14941225 1655177 1150273 2095679 2047415 232508898 145106858 89104033 87402040 48466708 53345353 0 0 0 0 851045 807361 49083001 52447933 245234878 261001988 21352761 22569992 0 0 14280 127509 28890794 27646178 0 0 0 0 5070608 7745933 9611992 7905047 32441427 49383024 97381862 115377683 X 140838664 136458200 4187148 6227351 2827204 2938754 147853016 145624305 245234878 261001988 X 5156173 6592814 0 0 0 -13977698 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 32274 32274 0 SchC_P1A_S00_L01 Schedule C, Part I-A, Line 1 Arnot Ogden Medical Center pays annual dues to the American Hospital Association, AHA and the Hospital Association of New York State, HANYS, of which a percentage is for lobbying fees. The total lobbying fees paid to both in 2012 was $32,274. SchC_P2B_S00_L01 Schedule C, Part II-B, Line 1 Arnot Ogden Medical Center pays annual dues to the American Hospital Association, AHA and the Hospital Association of New York State, HANYS of which a percentage is for lobbying fees. The total lobbying fees paid to both in 2012 is $32,274. 2827204 0 0 0 0 0 2827204 2431346 0 395858 0 0 0 2827204 2430246 1100 0 0 0 0 2431346 2429726 520 0 0 0 0 2430246 2429026 700 0 0 0 0 2429726 0 1 0 0 1 1 4415546 0 4415546 124966929 0 65824073 59142856 1339948 0 926128 413820 99110684 0 76676264 22434420 2675791 0 1680393 995398 87402040 Investment & Advances in Subsidiaries 4217874 AWUL - Malpractice & Depreciation Invest 31420264 Tax Exempt Bond Payment Fund 3497693 AWUL - 457 Investment 2852117 Interest in Net Assets of Foundation 10459985 52447933 0 Third Party Reserve & Pools Payable 4663374 Self Insurance Malpractice\Workers Comp\Health 11720247 Minimum Pension Liability 22678535 Subsidiary Investment Funds Payable 7408381 457 Investment Funds Liability 2852107 Miscellaneous 60380 49383024 X 269010451 0 0 0 0 0 269010451 274576 -1571389 -1296813 267713638 264358625 0 0 0 2075736 2075736 262282889 274576 0 274576 262557465 SchD_P05_S00_L04 Schedule D, Part V, Line 4 Schedule D, Part V, Line 4 - The Organization has interpreted the New York State Prudent Management of Instituional Funds Act Law, NYPMIFA, as requiring the preservation of the historical dollar value of the corpus of the permanent restricted endowment funds absent of donor stipulations to the contrary. The net appreciation of the permanently restricted net assets is considered temporarily restricted net assets until those amounts are appropriated for expenditure by the Ogranization in a manner consistent with the standard of prudence prescribed by NYPMIFA. If the fair value of the investments assets falls below the level of the donor, NYPMIFA requires the Center to retain the fund in perpetual duration. There were no such deficiences as of December 31, 2012. To ensure the preservation of the corpus of the permanently restricted endowent funds, the total fair value of all commingled investment assets are classified first to the level of the permanently restricted endowment funds corpus, an endowment fund deficiency receivable from the unrestricted net assets would be recognized until the deficiency is recovered. SchD_P10_S00_L02 Schedule D, Part X, Line 2 Arnot Ogden Medical Center, AOMC Foundation, AOMC Auxiliary, Ira Davenport Memorial Hospital, Keuka Foundation, St. Joseph's Hospital, St. Joseph's Foundation and St. Joseph's Health System are organized as not-for profit corporations as described in Section 501(c)(3) of the Internal Revenue Code (the Code) and accordingly, are exempt from Federal income taxes on related income pursuant to Section 501(c)(3) fo the Cod SchD_P11_S00_L04b Schedule D, Part XI, Line 4b Schedule D, Part XII, Line 4b - Donations for Capital Funding, $429,658, Fundraising Income from Restricted Fund Balance, $74,689, Rental Expense to Offset Rental Income, $(643,647), Nutritional Services Expenses to offset Cost of Goods Sold, $(1,432,089). SchD_P12_S00_L02d Schedule D, Part XII, Line 2d Schedule D, Part XIII, Line 2d - Cost of Goods Sold to offset Nutritional Services Revenue, $(1,432,089), Rental Expenses to offset Rental Income, $(643,647) GOLF TOURNAMENT 41354 0 41354 1784 0 9290 6040 0 6603 MOONLIGHT & MIRACLES 47962 0 47962 0 0 0 9464 4400 2695 1 30592 0 30592 0 0 0 0 0 4943 119908 0 119908 1784 0 9290 15504 4400 14241 45219 74689 1 1 1 X 1 X 1 1 0 1 1 0 923 3537207 41739 3495468 0.0133 0 37586 21755042 -541915 22296957 0.0849 0 21617 0 0 0 0 0 60126 25292249 -500176 25792425 0.0982 32 6712 705922 0 705922 0.0027 76 290 1518636 557436 961200 0.0037 6 11633 12357782 12678392 -320610 0.0012 0 0 0 0 0 0 0 0 109207 0 109207 0.0004 114 18635 14691547 13235828 1455719 0.0080 114 78761 39983796 12735652 27248144 0.1062 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 137200 0 137200 0.0005 0 0 0 0 0 0 10 0 0 0 0 0 5 0 249489 0 249489 0.001 0 0 187500 0 187500 0.0007 3 0 0 0 0 0 18 0 574189 0 574189 0.0022 0 17289735 0 63498426 80567945 -17069519 X 1 1 Ivy Street Development Corp Collection of Services & Rentals 1 0 0 1 1 Arnot Ogden Medical Center

600 Roe Avenue Elmira NY 14905

X X X 2 Arnot Ogden Medical Center Health Center for Women

600 Fitch Street Elmira NY 14905

www.aomc.org X Hospital Extension Clinic - Diagnostic Radiology 3 Arnot Ogden Medical Center Horseheads Campus

100 John Rommelt Drive Horseheads NY 14845

X Clinical Laboratory Service & Radiology Diagnostic Outpatient. 4 Arnot Ogden Medical Center Dialysis Center

8 West Pultney Street Corning NY 14830

X Hospital Extension Clinic providing Outpatient Hemodialysis services Arnot Ogden Medical Center 1 1 X X X X X X X X X X 12 1 0 1 X X X X X X X X X X 1 0 1 1 100 1 400 1 X X X 1 1 X X X 1 X X X 1 X X X X X X 1 X 0 1 Arnot Ogden Medical Center Health Center for Women 2 0 1 1 400 1 1 X X X 1 1 X X X X X 1 X X X 1 X X X X X X 1 X 0 1 Arnot Ogden Medical Center Horseheads Campus 3 0 1 1 1 400 1 X X X 1 1 X X X X X 1 X X X 1 X X X X X X 1 X 0 1 Arnot Ogden Medical Center Dialysis Center 4 1 X X X X X X X 09 1 1 1 X X X X X X X X X X X X 1 0 1 0 1 400 1 X X X 1 1 X X X X X 1 X X X 1 X X X X X X 1 X 0 1 SchH_P01_S00_L06a Schedule H, Part I, Line 6a Part VI - Line 6 - Arnot Ogden Medical Center prepares an annual Community Service Plan Report to the community that is available on our website, www.aomc.org. SchH_P01_S00_L07 Schedule H, Part I, Line 7 Arnot Ogden Medical Center uses a Cost to Charges ratio to calculate the Financial Assistance and Community Benefit Section. The Medical Center offers a variety of services to the community it serves as part of an integrated delivery system. It is necessary to financially subsidize some of these services as the revenue generated does not cover the cost of providing the services. SchH_P02_S00_L00 Schedule H, Part II Example #1: Arnot Health works collaboratively with the Chemung County Health Department, Chemung Valley Rural Health Network, Cornell Cooperative Extension, other area hospitals, faith based organizations, and community partners to assess public health needs within the community. Programs to prevent obesity and diabetes, such as a free 6-week community walking program called "Step It Up", are planned, implemented and evaluated in partnership. Pre and post program health screening data is shared between agencies, and outreach efforts are coordinated to maximize reach and community health impact. Example #2: Arnot Health has a leadership role in the NYSDOH grant-funded Creating Healthy Places to Live, Work and Play partnership. This diverse collaborative of over 30 community partners across public, private and non-profit sectors is working together to plan, implement and evaluate environmental, policy and systems changes to promote physical activity and nutrition. The Creating Healthy Places partnership's goal is to prevent obesity and diabetes through rehabilitating Elmira parks and playgrounds, increasing safe access to open public places for physical activity, building community gardens to increase access to fresh fruits and vegetables and working with local restaurants to offer healthier options on their menus. Example 3: Public Health Priorities: Arnot Health's Public Health Priorities remain unchanged from the development of the 2009 three-year Prevention Agenda strategic plan. Physical activity and nutrition as it relates to disease prevention, Tobacco use as it relates to chronic disease, access to quality healthcare. Raise awareness of the importance of physical activity and nutrition in regard to disease prevention. * Increase awareness of opportunities for physical activity. * Promote healthy food choices. * Facilitate weight loss. * Reduce incidence of chronic disease. * Reduce the risk of complications from preexisting health conditions. Goals: * By the year 2013, reduce the percentage of overweight and obese adults over age 18 to no more than 15% (Healthy People 2010 Goal). * Increase the number of Chemung County residents who are physically active by offering interactive programs and educational events that focus on disease prevention through exercise and healthy food choices. * Continue to collaborate with Chemung County Health Department, hospitals, other healthcare agencies and community partners to create environmental, policy and systems changes to promote physical activity and the consumption of fresh fruits and vegetables. 2. Priority: Tobacco Cessation as it relates to chronic disease Objectives: * Discourage tobacco use. * Raise awareness of tobacco cessation resources. * Promote understanding of how tobacco relates to chronic disease. Goals: * Maintain collaborations with Arnot Ogden Medical Center Tobacco Cessation Center and Southern Tier Tobacco Awareness Community Partnership to promote healthy behaviors and discourage tobacco use. * By the year 2013, reduce the prevalence of smoking in adults to no more than 12% (Healthy People 2010 Goal). 3. Priority: Access to Quality Healthcare Objectives: * Increase access to care for medically underserved populations. * Improve continuity of care across the care continuum. Goals: * Increase access to preventative health programs to decrease incidence of chronic disease. * Provide disease management tools to promote management of chronic disease and reduce risk of complications from chronic disease. Raise awareness of the importance of physical activity and nutrition in regard to disease prevention. * Increase awareness of opportunities for physical activity. * Promote healthy food choices. * Facilitate weight loss. * Reduce incidence of chronic disease. * Reduce the risk of complications from preexisting health conditions. Goals: * By the year 2013, reduce the percentage of overweight and obese adults over age 18 to no more than 15% (Healthy People 2010 Goal). * Increase the number of Chemung County residents who are physically active by offering interactive programs and educational events that focus on disease prevention through exercise and healthy food choices. * Continue to collaborate with Chemung County Health Department, hospitals, other healthcare agencies and community partners to create environmental, policy and systems changes to promote physical activity and the consumption of fresh fruits and vegetables. 2. Priority: Tobacco Cessation as it relates to chronic disease Objectives: * Discourage tobacco use. * Raise awareness of tobacco cessation resources. * Promote understanding of how tobacco relates to chronic disease. Goals: * Maintain collaborations with Arnot Ogden Medical Center Tobacco Cessation Center and Southern Tier Tobacco Awareness Community Partnership to promote healthy behaviors and discourage tobacco use. * By the year 2013, reduce the prevalence of smoking in adults to no more than 12% (Healthy People 2010 Goal). * 3. Priority: Access to Quality Healthcare Objectives: * Increase access to care for medically underserved populations. * Improve continuity of care across the care continuum. Goals: * Increase access to preventative health programs to decrease incidence of chronic disease. * Provide disease management tools to promote management of chronic disease and reduce risk of complications from chronic disease. SchH_P03_S0A_L04 Schedule H, Part III, Section A, Line 4 The Organization carriesits patient and resident accounts receivable at anticipated amounts due from privatepay patients and third party payors. Accounts receivable are reduced by an allowance for doubtful accounts. In evaluationg the collectability of accounts receivable, the Organization analyzes their past history and identifies trends for each of its major payor sources of revenue to estimate the appropriate allowance for doubtful accounts and provision for bad debts. Management regularly review data about these major payor sources of revenue in evaluating the sufficiency of the allowance for doubtful accounts. For receivables associated with services provided to patients who have gthird party coverage, the Organization analyzes congtractually due amounts and provides an allowance for doubtful accounts, if necessary, for receivables associated with self pay patients which includes both patients without insurance and patients with deductible and copayment balances due for which third-party coverage exists for part of the bill. The Organization records a provision for bad debts in the period of service on the basis of its past experience, which indicates that many patients are unable or unwilling to pay the portion of their bill for which they are financially responsible. The difference between the standard rates, or discounted rates if negotiated, and amounts actually collected after all reasonable collection efforts have been exhausted is charged off against the allowance for doubtful accounts. The Organization's allowance for doubtful accounts increased from 9.4% of gross accounts receivable at 12/31/11 to 11.1% of gross accounts receivable at 12/31/12. In addition, the Organization's bad debt write-offs increased approximately $2,600,000 from approximately $24,800,000 for fiscal year ended 2011 to approximately $27,400,000 for fiscal year end 2012. The increase in write-offs was to account for negative trends experienced in the collection of amounts from self pay patients in fiscal year 2012. The Organization has not changed its charity care or uninsured discount policies during fiscal year 2012. The Organization does not maintain a material allowance for doubtful accounts from third party payors, nor did it have significant write offs from third party payors. SchH_P03_S0B_L08 Schedule H, Part III, Section B, Line 8 The Medical Center provides Emergency, Stroke, Cardiac, Dialysis, Wound Care, Hyperbaric and other services that help prevent loss of life and extensive severity due to prompt treatment which benefits the community. SchH_P03_S0C_L09b Schedule H, Part III, Section C, Line 9b Self pay collection staff review any prior accounts to check for commercial insurance or Medicaid that may need to be applied to current self pay account. These accounts are reviewed using the self pay worklists. If insurance is located, self pay collector must verify eligibility for the date of service. The Self pay staff will change the health plan to the correct one for all covered dates of service and ARNOT Billing will submit claim(s). If no insurance is located, confirm if a patient may have qualified for Medicaid. If Medicaid coverage is approved self pay staff will change the health plan to Medicaid for all covered dates of service and follow correct billing process. Self Pay Collections Staff attempts to collect full balance due by check or credit card. If they are unable to make the full payment, self pay staff will attempt to make payment arrangements and to notify patient about the Arnot Ogden Medical Center Community Care Program. If the patient wants to apply for the community care program, the patient will be sent an application for the community care program and will be informed of documentation they will need to submit with the application. The Self Pay Collectors documents all activity in Soarian, and enters any necessary holds to support resolution. Self pay collections staff enters the payment plan and documents comments in Soarian. Payment plan statement is demanded and sent to the patient. NOTE: If patient does not enter into a payment plan agreement, or fails to pay as agreed, account will go through the standard dunning and collection agency activity. See Guarantor Billing and Collections. SchH_P05_S0B_L01 Schedule H, Part V, Section B, Line 1 Arnot Health is working with Steuben County's S2AY Rural Health Network and the Steuben County Public Health Priority Team to survey the community through a Community Health Needs Assessment, in order to identify Steuben County public health 26 needs and gaps in services. Data analysis from Community Health Needs Assessment is expected to be completed by October 2012. Arnot Health is currently conducting a Comprehensive Community Health Needs Assessment in Chemung County to identify minority health disparities and reassess public health priorities. The Compressive Community Health Needs Assessment is a collaborative effort among the local health department, the Chemung and Steuben County Rural Health Networks, other hospitals and healthcare agencies, the YWCA, the Economic Opportunity Program and the NAACP. The survey can be found at the following link: https://www.surveymonkey.com/s/chemungcha2012 Nurse Survey Arnot Health's Education Department surveyed hospital nurses to assess their ability to identify patients at risk for suicide, and determine their knowledge of suicide prevention techniques. The surveys indicated that hospital nurses could benefit from suicide prevention education and trainings. Plans are under development to offer SafeTalk trainings for Arnot Health's nursing staff. Currently, Arnot Health is in the process of conducting a Comprehensive Community Health Needs Assessment survey to identify minority health disparities and reassess public health priorities. The Compressive Community Health Needs Assessment is a collaborative effort among the local health department, the Chemung and Steuben County Rural Health Networks, other hospitals and healthcare agencies, Economic Opportunity Program, YWCA, faith based organizations and the NAACP. SchH_P05_S0B_L04 Schedule H, Part V, Section B, Line 4 The Community Service Plan explains in detail the involvement of members of the community in determining & identifying community needs. St. Joseph's Hospital in Elmira, NY and Ira Davenport Memorial Hospital in Bath, NY were included in the Community Service Plan. The Community Service Plan is available on our website, www.aomc.org. SchH_P05_S0B_L05 Schedule H, Part V, Section B, Line 5 In addition to Arnot Health's website, the healthcare system uses a variety of methods to disseminate the Community Service Plan, information about community health programs and the availability of financial assistance to the public. Some of these methods include: Presentations: Arnot Health's Community Health Department provides education about the healthcare systems' Community Service Plan and community outreach strategies to address public health priorities through presentations at community events, regional and state conferences, to Arnot Health's department managers and the healthcare system's joint Board of Directors. Local Media Outlets: Arnot Health works with a variety of local media outlets to disseminate information about community outreach programs and services, and disseminate information about community outreach programs and services, and continually assess the effectiveness of each of those outlets. Historically, regional newspapers have proven an effective way to provide timely information to the public, based on consumer feedback at programs and events. Other methods include television, radio, phone banking, direct mail and other community publications. Health on Demand Call Center: The public may call the Health on Demand Call Center to receive a copy of the Community Service Reports and all updates Insight Newsletter: Information about accessing Arnot Health's Community Service Plan and request for community input will be published annually in Insight, a monthly publication for employees, retirees and volunteers of the Arnot Health System. Recent Insight Newsletters featured articles that illustrate the healthcare system's mission to provide quality preventative healthcare through community outreach and ongoing assessment of public health needs (Figure 5 and Figure 6). Targeted Mailings: Arnot Ogden Medical Center used targeted mailings to disseminate the Community Service Plan in past years. Moving forward, Arnot Health will identify ways to effectively communicate with residents in the service area to solicit input and provide an update to the plan of action. SchH_P05_S0B_L06 Schedule H, Part V, Section B, Line 6 8. Public Health Priorities: Which did you choose? Arnot Health's Public Health Priorities remain unchanged from the development of the 2009 three-year Prevention Agenda strategic plan. Arnot Ogden Medical Center * Physical activity and nutrition as it relates to disease prevention * Tobacco use as it relates to chronic disease * Access to quality healthcare * Chronic disease * Tobacco use 9. Goals and Measures: Arnot Ogden Medical Center (Adapted from Arnot Ogden Medical Center's 2009-2011 Community Service Plans) 1. Priority: Physical Activity and Nutrition as it relates to disease prevention Objectives: * Raise awareness of the importance of physical activity and nutrition in regard to disease prevention. * Increase awareness of opportunities for physical activity. * Promote healthy food choices. * Facilitate weight loss. * Reduce incidence of chronic disease. * Reduce the risk of complications from preexisting health conditions. Goals: * By the year 2013, reduce the percentage of overweight and obese adults over age 18 to no more than 15% (Healthy People 2010 Goal). * Increase the number of Chemung County residents who are physically active by offering interactive programs and educational events that focus on disease prevention through exercise and healthy food choices. * Continue to collaborate with Chemung County Health Department, hospitals, other healthcare agencies and community partners to create environmental, policy and systems changes to promote physical activity and the consumption of fresh fruits and vegetables. 2. Priority: Tobacco Cessation as it relates to chronic disease Objectives: * Discourage tobacco use. * Raise awareness of tobacco cessation resources. * Promote understanding of how tobacco relates to chronic disease. Goals: * Maintain collaborations with Arnot Ogden Medical Center Tobacco Cessation Center and Southern Tier Tobacco Awareness Community Partnership to promote healthy behaviors and discourage tobacco use. * By the year 2013, reduce the prevalence of smoking in adults to no more than 12% (Healthy People 2010 Goal). * 3. Priority: Access to Quality Healthcare Objectives: * Increase access to care for medically underserved populations. * Improve continuity of care across the care continuum. Goals: * Increase access to preventative health programs to decrease incidence of chronic disease. * Provide disease management tools to promote management of chronic disease and reduce risk of complications from chronic disease. 6 * Reduce emergency room utilization through intensive case management based on the Medical Home Model to increase services, reduce cost and make connections to other community services based on individual need. ____________________________________ Arnot Ogden Medical Center, St. Joseph's Hospital and Ira Davenport Memorial Hospital uses several strategies to track and measure progress in Arnot Health's selected priority areas. Measures of effectiveness include: * State and County Indicators for Tracking Public Health Priority Areas * New York State Prevention Quality Indicators (PQI) * New York State Department of Health's Prevention Agenda for Healthiest Sate * Healthy People 2020 * Chemung, Steuben and Schuyler County Health Assessments * Chemung County Community Health Assessment Report Card 2010 - 2013 8 * BRFSS * EBRFSS * Data from Health on Demand Regional Call Center * Number of community outreach events and preventative health screenings (graphs of results emailed separately as Appendix A and Appendix B) * Number of participants in programs that promote physical activity and nutrition * Number of participants with improved health outcomes such as blood glucose, blood pressure, BMI, body fat and diabetes risk indicators as a result of programs that promote physical activity and nutrition * Program analysis and evaluation * Participant surveys * Number of Individuals who have received tobacco cessation, disease prevention and management educational materials * Chemung County's Suicide Mortality Rate * Chemung County Crisis Service Hotline Telephone Calls * Number of Individuals who have received Suicide Prevention Training Programs SchH_P05_S0B_L20 Schedule H, Part V, Section B, Line 20 Participants in the Medicare System are required to charge all patients the same amount for services regardless of insurance per the Medicare Participation Guidelines. SchH_P05_S0B_L22 Schedule H, Part V, Section B, Line 22 Part V, Section B, Line 21 - Participants in the Medicare System are required to charge all patients the same amount for services regardless of insurance per the Medicare Participation Guidelines. SchH_P06_S00_L02 Schedule H, Part VI, Line 2 Currently, Arnot Health is in the process of conducting a Comprehensive Community Health Needs Assessment survey to identify minority health disparities and reassess public health priorities. The Compressive Community Health Needs Assessment is a collaborative effort among the local health department, the Chemung and Steuben County Rural Health Networks, other hospitals and healthcare agencies, Economic Opportunity Program, YWCA, faith based organizations and the NAACP. SchH_P06_S00_L03 Schedule H, Part VI, Line 3 The Arnot Ogden Medical Center communicates our Community Care Program in the following ways: Signage in waiting rooms, Brochures in waiting rooms and Admission Packages, Notations on billing notices, Staff education so they can share availability of program and contact information with patients. Communication and education of shared County Dept of Social Services staff so they are informed of the program details and contact information. Communication of programs with Collection Agencies and collection attorneys so they can share the availability of the program and contact information with prospective enrollees. The information is also posted on our website, www.aomc.org. SchH_P06_S00_L04 Schedule H, Part VI, Line 4 The Medical Center serves residents of Chemung, Steuben, and Schuyler counties in NY and Bradford and Tioga counties in PA. The counties are classified as urban and rural. The Medical Center is located in Chemung County NY which has a population of approximately 88,000, with 50.3% female and 49.7 male. The median age is 40.9 years of age with 25% age 19 and under, 50% age 20 to 64, and 18% over the age of 64. The average houshold income is $44,502 with 15.2% living at the poverty level. The race breakdown is 87% caucasian, 6.2 african-american, 2.5% hispanic and all other 4.3% for all other. SchH_P06_S00_L05 Schedule H, Part VI, Line 5 Arnot Health works collaboratively with the Chemung County Health Department, Chemung Valley Rural Health Network, Cornell Cooperative Extension, other area hospitals, faith based organizations, and community partners to assess public health needs within the community. Programs to prevent obesity and diabetes, such as a free 6-week community walking program called "Step It Up", are planned, implemented and evaluated in partnership. Pre and post program health screening data is shared between agencies, and outreach efforts are coordinated to maximize reach and community health impact. Arnot Health has a leadership role in the NYSDOH grant-funded Creating Healthy Places to Live, Work and Play partnership. This diverse collaborative of over 30 community partners across public, private and non-profit sectors is working together to plan, implement and evaluate environmental, policy and systems changes to promote physical activity and nutrition. The Creating Healthy Places partnership's goal is to prevent obesity and diabetes through rehabilitating Elmira parks and playgrounds, increasing safe access to open public places for physical activity, building community gardens to increase access to fresh fruits and vegetables and working with local restaurants to offer healthier options on their menus. SchH_P06_S00_L06 Schedule H, Part VI, Line 6 Since 2009, Arnot Ogden Medical Center, St. Joseph's Hospital and Ira Davenport Memorial Hospital have merged to form a new healthcare system known as Arnot Health. Arnot Health's three hospitals work collaboratively and regionally across county lines to implement and evaluate their 2009 three-year strategic plans to address public health priorities. Collaborations with the Chemung, Steuben and Schuyler County Health Departments, Chemung and Steuben Rural Health Networks, regional hospitals, community organizations and local school districts have been maintained and expanded to continually assess community needs, and plan evidence-based strategies that prevent or reduce the incidence of chronic disease. Success: The merging of Arnot Ogden Medical Center, St. Joseph's Hospital and Ira Davenport Memorial Hospital is enhancing the healthcare system's Plan of through the coordination of community health services and preventative health outreach activities. Arnot Health's system approach to implementing primary, secondary and tertiary prevention strategies to address public health priorities will maximize reach and impact on the health of the community. SchH_P06_S00_L07 Schedule H, Part VI, Line 7 The Medical Center files the Community Report in NYS only. The Community Service Plan is also available on our website: www.aomc.org. X X 1 1 X X X X 0 0 0 0 0 1 1 0 0 Ronald J Kintz 299353 0 61255 0 0 0 24000 0 23593 0 408201 0 0 0 Anthony Cooper 503377 0 163783 0 0 0 25300 0 23593 0 716053 0 0 0 Roger Schenone 244053 34615 70984 0 0 0 5669 1315 4192 1085 324898 37015 0 0 Gregory Schultz 167433 0 17836 0 0 0 17393 0 22579 0 225241 0 0 0 Robert Lambert 377250 0 90007 0 0 0 18000 0 23593 0 508850 0 0 0 Wesley Blauvelt 205722 0 16030 0 0 0 19907 0 22951 0 264610 0 0 0 H Fred Farley 324630 0 65646 0 0 0 25300 0 23593 0 439169 0 0 0 William Huffner 311092 0 37012 0 0 0 9500 0 20955 0 378559 0 0 0 Debra Martin 145000 0 13053 0 0 0 14859 0 9280 0 182192 0 0 0 Gregg Martin 145400 0 16710 0 0 0 15272 0 22365 0 199747 0 0 0 Richard Hoffman 154440 0 7972 0 0 0 14260 0 22453 0 199125 0 0 0 Marc Rustici 143320 0 16984 0 0 0 13595 0 22345 0 196244 0 0 0 Joseph Braunschiedel 157498 0 7644 0 0 0 6317 0 22483 0 193942 0 0 0 Mary Vosburgh 154772 0 4234 0 0 0 6176 0 20250 0 185432 0 0 0 James Watson 200925 0 18795 0 0 0 8418 0 1949 0 230087 0 0 0 Kimberly Panosian 198195 0 0 0 0 0 7660 0 18899 0 224754 0 0 0 Vidyasagar Mokureddy 676125 0 466885 0 0 0 9500 0 2639 0 1155149 0 0 0 William DeLuccia 737334 0 7992 0 0 0 9500 0 22490 0 777316 0 0 0 Paul Hicks 737334 0 10096 0 0 0 14000 0 10512 0 771942 0 758344 0 Nishith Amin 737334 0 6801 0 0 0 9500 0 21388 0 775023 0 0 0 Ravi Akula 569200 0 116480 0 0 0 9500 0 21388 0 716568 0 0 0 Francisco Corbalan 0 218140 0 39000 0 3520 0 0 0 0 0 260660 0 0 SchJ_P01_S00_L01a Schedule J, Part I, Line 1a Part I, Line 1a - Dr. Huffner is allowed to travel first class to accomodate his disability under reasonable accomodations. The CEO and COO have their dues paid at the Elmira Country Club. The personal use portion is reported under taxable income. SchJ_P01_S00_L06 Schedule J, Part I, Line 6 The Medical Center has an Incentive Compensation Program for meeting the Organization's Board assigned goals. Part of the measure for financial viability is avoiding deficits and are measured by margins. A small part of compensation is based upon avoiding operating losses and financial viability and not the size or magnitude of any net earnings. A Chemung County Industrial Developmental Agency 166209017 000164019 2004-03-10 19912903 Series A Construction Bond 0 0 0 B Chemung County Industrial Developmental Agency 166209017 000164019 2004-03-10 16959701 Series B Facility Renovation 0 0 0 A 0 0 19912203 1317663 0 0 419500 0 1802477 16377225 0 0 2006 0 0 1 1 B 0 0 16959701 1042483 4561742 0 328213 0 0 10287552 0 0 2005 0 1 1 1 A 0 0 0 0 0 1 0 1 B 0 0 0 0 0 1 0 1 A 1 0 0 0 0 1 B 0 0 0 0 0 0 0 0 1 A 1 B 1 F990_P06_S0A_L02 Form 990, Part VI, Section A, Line 2 Key employees Deborah Martin and Gregg Martin and brother and sister. F990_P06_S0B_L11b Form 990, Part VI, Section B, Line 11b Part VI, Section B, Line 11b - Upon completion of the Form 990 it is reviewed by our Audit Firm, Freed Maxick and then is presented by the Medical Center's Senior Vice President of Finance to the Audit and Finance committees of the board of Managers. The return is made available to all Board Members for review and questions. F990_P06_S0B_L12c Form 990, Part VI, Section B, Line 12c Part VI, Section B, Line 12c - All members of the Board of Managers, Officers and Management employees are required annually to file a Disclosure Statement setting forth any respect in which such a person, or any person associated with such person, has or may have any interest in a transaction in which there may be, or appear to be, a conflict between the interests of such person and the Arnot Ogden Medical Center. An Associate included (1) a spouse, a descendant or an ancestor, or a spouse of a descendant or ancestor; (2) an organization in which the person or an associate is a partner or employee, or such person or an associate owns a more than 10% beneficial interest; (3) a trust in which such a person is a trustee, or such person or an associate holds a more than 10% beneficial interest; and (4) a corporation in which such person or an associate is an officer or director or employee, or such person or an associate is an owner of more that 10% of any class of securities. F990_P06_S0B_L15 Form 990, Part VI, Section B, Line 15 Part VI, Section B, Line 15 - Compensation for the President and Vice Presidents are set pursuant to a policy and compensation philosophy adopted by the Board. The Board has a Compensation Committee consisting of outside directors. The Compensation Committee uses a comsultant to advise it on compensation for the officers. The consultant collects and reports compensation on similiar positions in similar nonprofit hospitals from upstate New York and Western Pennsylvania. The Compensation Committee recommends adjustments to the Executive Committee of the Board which reviews the recommendations and approves or disapproves without employees in the room. This action then is reviewed with the entire Board also in executive session. F990_P06_S0C_L19 Form 990, Part VI, Section C, Line 19 Upon request the 990 Form is made available to the public and also via www.guidestar.com. F990_P11_S00_L09 Form 990, Part XI, Line 9 Pension Charge to Equity - $(4,155,447), Donations - $368,942, Transfer of Net Assets from closed related parties, $(11,152,178), Net Loss on Restricted Investments - $(227,185), Change in Net Assets of Foundation - $1,168,170 Arnot Ogden Medical Center Foundation Accounting Dept 600 Roe Avenue Elmira NY 14905 161109472 Contribution Management NY 501(c)(3) 11E N/A 0 Arnot Ogden Medical Center Auxiliary 600 Roe Avenue Elmira NY 14905 510192902 Fund Raising NY 501(c)(3) 11 N/A 0 The Falck Foundation Accounting Dept 600 Roe Avenue Elmira NY 14905 223055110 Investments NY 501(c)(3) 11E N/A 0 Ira Davenport Memorial Hospital Inc Accounting Dept 7571 State Route 54 Bath NY 14810 160835446 Affiliate NY 501(c)(3) 11 N/A 0 Keuka Health Care Foundation Accounting Dept 7571 State Route 54 Bath NY 14810 161461215 Affiliate NY 501(c)(3) 11 N/A 0 St Josephs Hospital Accounting Dept 555 St Josephs Blvd Elmira NY 14901 160743163 Affiliate NY 501(c)(3) 11 N/A 0 St Josephs Hospital Foundation Accounting Dept 571 St Josephs Blvd Elmira NY 14901 161265182 Affiliate NY 501 (c) 7 N/A 0 St Josephs Health Systems Inc Accounting Dept 555 St Josephs Blvd Elmira NY 14901 223243418 Affiliate NY 501 (c) 11B N/A 0 Arnot Health 600 Roe Avenue Elmira NY 14845 453049405 Guide & Manage Arnot Ogden Medical Center, Ira Davenport Memorial Hospital and St. Joseph's Hosptial NY 501(c)(3) N/A 0 Fitch Street Associaties 600 Ivy Street Elmira NY 14905 161397356 Real Estate Rental NY Ivy Street Development Corporation Related 0 0 Ivy Street Development Corporation Accounting Department 600 Ivy Street Elmira NY 14905 161009245 Real Estate NY N/A C 1 Advantage Health Medical Service PC 517 St Josephs Blvd Elmira NY 14901 161455621 Physician Practice NY St Josephs Health System C 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 Ivy Street Development Corporation Accounting Department k 679396 Lease of Building per Agreement Ira Davenport Memorial Hospital Inc l 1289057 Provide Laboratory, Cardiac Lab, Sleep Lab, Rehabilitative, Marketing, Management Information, Laundry, Clinical Engineering, Respiratory, and Administrative Services per Contract Agreement St Josephs Hospital l 6245132 Provided Administrative, Endoscopy, Anesthesia Support, Laboratory, Materials Management, Dialysis, Laundry, Respiratory, Diagnostic, Skilled Nursing Facility, Rehabilitative, Pathology, Behavioral Science, Physician, Security, Management Information, Operating Room, and Blood Services per Contract Agreement St Josephs Hospital m 131187 Provided Pastoral Care, Radiology, Rehabilitative, and Educational Services per Contract Agreement Advantage Health Medical Service PC l 178063 Performed Administrative and Physicain Services per Contract Agreement Advantage Health Medical Service PC m 721041 Performed Physician Services per Contract Agreement Arnot Ogden Medical Center Foundation c 429658 Capital Contribution from AOMC Foundation to Arnot Ogden Medical Center for the purchase of capital equipment.