2013-11-12T14:52:14-07:00 2012-12-31 990 2012-01-01 160743024 FREDERICK FERRIS THOMPSON HOSPITAL FRED 5853966124 350 Parrish Street Canandaigua NY 14424 Mark Prunoske 5853966490 2013-11-12 2012 2016-02-24 21:20:13Z Michael Stapleton Frederick Ferris Thompson Hospital 350 Parrish Street Canandaigua NY 14424 95753550 0 X www.thompsonhealth.org X 1904 NY FF Thompson Hospital Inc. is a community hospital which exists to serve the health care needs of the people in partnership with regional health care providers. FF Thompson Hospital serves as the center of a health care network to provide a full range of health care services and to improve community health. 25 22 1638 222 356037 -95046 8689165 2096585 91020033 91501000 401087 126216 1143873 1273332 101254158 94997133 0 0 0 0 49761743 52947205 0 0 210000 39464646 43172066 89226389 96119271 12027769 -1122138 96052782 100901418 62399983 69169974 33652799 31731444 FF Thompson Hospital Inc. is a community hospital which exists to serve the health care needs of the people in partnership with regional health care providers. FF Thompson Hospital serves as the center of a health care network to provide a full range of health care services and to improve community health. 0 0 78522661 0 88127390 Inpatient care: 4,854 Inpatient discharges, 19,191 Inpatient Days. Outpatient: 994,835 Lab visits/tests, 25,965 ED visits, 65,829 Diagnostic Imaging, 17,035 Urgent Care, 26,964 Rehabilitation Services, and 5,391 Surgical Services. Charity Care was provided in the amount of $1,276,957 (at cost). Community Benefit was $1,951,578. Uncompensated Care was $3,369,803 (at cost). 0 0 0 78522661 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 0 0 0 0 0 0 0 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 1 203 0 1 1638 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 25 22 0 0 1 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X FF Thompson Hospital 5853966124 350 Parrish Street Canandaigua NY 14424 Ellie Fralick 0.5 0.5 X 0 0 0 Richard Cutri 0.5 0.5 X 0 0 0 William R Kenyon 0.5 0.5 X X 0 0 0 George W Hamlin IV 0.5 0.5 X X 0 0 0 David Baum MD 42 0.5 X X 320566 0 77329 Robert Sands 0.5 0.5 X X 0 0 0 Ronald Knight 0.5 0.5 X X 0 0 0 Reverend Thomas Mull 0.5 0.5 X 0 0 0 James H Barr CPA 0.5 0.5 X 0 0 0 Paul Hudson 0.5 0.5 X 0 0 0 Randall Farnsworth 0.5 0.5 X 0 0 0 Brian Meath 0.5 0.5 X X 0 0 0 Richard H Hawks Jr 0.5 0.5 X 0 0 0 Thomas Kubiak 0.5 0.5 X 0 0 0 Dr Carl Sahler MD 0.5 0.5 X 0 0 0 Deborah Price 0.5 0.5 X 0 0 0 Dianne Cooney Miner PhD 0.5 0.5 X 0 0 0 Michael Stapleton RN 33 7 X X 0 301766 77352 Bradford Berk MD 0.5 0.5 X 0 0 0 Roger Friedlander 0.5 0.5 X 0 0 0 Daniel Fuller 0.5 0.5 X 0 0 0 Steven Goldstein 0.5 0.5 X 0 0 0 Frank Hamlin 0.5 0.5 X 0 0 0 Robert N Latella Esq 0.5 0.5 X 0 0 0 Raymond Mayewski MD 0.5 0.5 X 0 0 0 Linda M Farchione 33 7 X X 0 480527 215504 Carlos Ortiz MD 35 5 X 0 292669 72172 Christopher B Mahan 20 20 X 67599 125540 62772 Jennifer DeVault 40 0 X 120567 0 43040 Mark Prunoske 27 13 X 0 205782 69235 Hazel Robertshaw 40 0 X 112096 0 16292 Dr Anthony Geraci MD 40 0 X X 72678 0 28107 Dr John McGuire MD 40 0 X 167514 0 47160 Kurt Koczent 33 7 X 42876 10719 5607 Dr Vijay Bansal MD 47 0 X 350730 0 33968 Dr Timothy Pitler MD 44 0 X 333044 0 104019 Dr Matthew Osborne MD 42 0 X 304639 0 44176 Dr William Livingston MD 41 0 X 286571 0 41661 Dr John Sullivan MD 40 0 X 281318 0 41966 2460198 1417003 980360 36 1 1 0 LeChase Construction Services LLC 300 Trolley Blvd Rochester NY 14606 Construction 11440631 Bond Schoeneck & King PLLC Attorney 350 Linden Oaks Suite 310 Rochester NY 14625 Legal Services 262620 Canandaigua Medical Group 335 Parrish Street Canandaigua NY 14424 On Call Services 443741 Canandaigua Orthopaedic Association 229 Parrish Street Canandaigua NY 14424 On Call Services 313773 HMP of Ontario County PLLC PO Box 645037 Cincinnati OH 452645037 Hospitalist Medical Services 1042417 10 0 0 0 2043405 53180 0 0 2096585 Community Health Service 622000 82350900 81994863 356037 0 Medicare/Medicaid Payments 622000 9150100 9150100 0 0 0 0 0 0 91501000 110990 110990 0 0 45726 725917 9999 746418 35727 -20501 15226 0 0 15226 0 Associate/Patient Support 622000 1273332 0 0 1273332 0 0 0 0 1273332 94997133 91144963 356037 1399548 831218 488080 343138 0 41002887 35412903 5589984 0 2333751 2007026 326725 0 5445419 4683060 762359 3333930 2867180 466750 0 1635097 1175234 459863 0 82260 0 82260 0 92275 0 92275 0 0 0 0 0 0 0 0 0 0 0 5782956 4172722 1610234 0 28825 0 28825 0 13607673 13377559 230114 0 3561260 1483633 2077627 0 0 0 0 0 2004978 1830254 174724 0 191806 47655 144151 0 0 0 0 0 124632 112077 12555 0 960867 0 960867 0 210000 0 0 210000 6184098 5318324 865774 0 822551 58544 764007 0 Health System Member Assessment 3681440 1767091 1914349 Provision for Uncollectable Accounts 3373610 3373610 0 0 New York State Cash Assessment 354095 0 354095 0 Equipment & Maintenance 280610 265737 14873 0 193033 81972 111061 0 96119271 78522661 17386610 210000 3035 3308 17192913 9107193 6530760 7272795 1461006 1421573 1565291 1489919 135063956 64408494 58140097 70655462 707662 797879 10452018 10153289 96052782 100901418 14969807 13918568 11130000 23725911 10459184 14257203 25840992 17268292 62399983 69169974 X 29808998 28276790 3843801 3454654 0 0 33652799 31731444 96052782 100901418 X -1122138 0 0 0 0 -799217 X 0 1 X 1 0 X 6934130 167545 769935 0 300207 0 7571403 6239690 863280 44331 0 213171 0 6934130 5619137 72378 814801 0 266626 0 6239690 4831696 57312 976186 0 246057 0 5619137 7159761 267354 -2251021 0 344398 0 4831696 0.93 0.07 0 0 0 0 58217 58217 0 75276478 27578666 47697812 0 387316 213304 174012 0 54763612 35119243 19644369 0 4578333 1497281 3081052 70655462 Other Assets 552633 Due from Affiliates 1671411 Assets Limited as to Use 2696823 Beneficial interest in Charitable Remainder Trust 359046 Deferred Financing Costs, net 1777768 Beneficial Interest in net assets of FFTH Foundation 3095608 10153289 0 Accrued Pension Liability 14027466 Charitable Gift Annuity Payment Liability 156581 Interest Rate Swap Liability 910055 Third Party Payor Accrual 1306472 Other Non-Current Liabilities Acc Ins reserve 867718 17268292 X 93007453 0 0 0 179941 179941 92827512 0 2169621 2169621 94997133 92535661 0 0 0 0 0 92535661 0 3583610 3583610 96119271 SchD_P05_S00_L04 Schedule D, Part V, Line 4 The funds are for the benefit of FF Thompson Health System, Hospital, Senior Communities, and Continuing Care Center. The Foundation continuously evaluates the needs of these organizations and attempts to meet those needs. SchD_P10_S00_L02 Schedule D, Part X, Line 2 The Hospital adopted the provisions of ASC Section 740 on January 1, 2009, and there was no impact on the Hospital's financial statements. As of December 31, 2012 the Hospital does not have a liability for unrecognized tax benefits. SchD_P11_S00_L02d Schedule D, Part XI, Line 2d Net Assets released from restrictions used for operations SchD_P11_S00_L04b Schedule D, Part XI, Line 4b Investment Income $146,717, Loss on disposal of equipment -$20,501, Contributions from the FF Thompson Foundation Inc $103,124, Contributions from the FF Thompson Foundation Inc $1,940,281. SchD_P12_S00_L04b Schedule D, Part XII, Line 4b Contributions to the FF Thompson Foundation Inc $210,000. Provision for bad debts $3,373,610. 1 1 1 X 0 1 1 1 0 1 1 1547908 270951 1276957 0.0138 9316060 6645234 2670826 0.0289 0 0 10863968 6916185 3947783 0.0427 558783 53388 505395 0.0055 4106202 3771490 334712 0.0036 23276 0 23276 0.0003 0 0 4688261 3824878 863383 0.0094 0 0 15552229 10741063 4811166 0.0521 160630 0 160630 0.0017 45823 0 45823 0.0005 60998 0 60998 0.0007 820743 0 820743 0.0089 0 0 1088194 0 1088194 0.0118 1 3369803 46453 11940964 15250855 -3309891 X 1 1 1 1 The Fredrick Ferris Thompson Hospital

350 Parrish Street Canandaigua NY 14424

X X X The Fredrick Ferris Thompson Hospital 1 1 1 100 1 300 1 X X X X X X 1 1 X X X X X 1 0 X X X X 1 X 0 0 SchH_P01_S00_L03c Schedule H, Part I, Line 3c All patients with no insurance receive a discount. Inpatient discount is applied to charges to bring to the Medicare Inpatient DRG reimbursement. A 50% discount to charges is applied for all Outpatient services. SchH_P01_S00_L07 Schedule H, Part I, Line 7 Patient Cost to Charge system from the worksheets. SchH_P01_S00_L072f Schedule H, Part I, Line 7, Column f Bad debt expense is removed for the purposes of calculating the percentage on Schedule H, Part I, Line 7, column A. SchH_P01_S00_L07g Schedule H, Part I, Line 7g There are no physician clinic costs included in these services. SchH_P02_S00_L00 Schedule H, Part II Thompson Health maintains many links and affiliations with community and health organizations to enhance its ability to develop and deliver community programs. Through these partnerships Thompson Health has established a diverse array of community health programs to meet the communities' specific needs. Some of our partnerships include work with the county, school districts, colleges, and industry as well as other non-profit community organizations. SchH_P03_S0A_L04 Schedule H, Part III, Section A, Line 4 As stated in the footnotes to Financial Statements, "An allowance for doubtful accounts receivable is estimated by management based on periodic reviews of collectability of accounts receivable considering historical experience and prevailing economic conditions." Bad Debt expense is not included in the community benefit number or treated as community benefit. Bad debt expenses are calculated by converting the net expense per the audited financials back to gross charges. Gross charges are then reduced to cost using the cost to charge ratio calculated on Worksheet A of the 2012 990 form. SchH_P03_S0B_L08 Schedule H, Part III, Section B, Line 8 Medicare payments are converted to Medicare gross charges. The cost to charge ratio computed on Worksheet 2, line 11 is then applied. Medicare shortfalls are not included in or considered community benefit. SchH_P03_S0C_L09b Schedule H, Part III, Section C, Line 9b Patient balance-due accounts that are not Medicare primary, which include patients that qualify for charity care or financial assistance that are not paid in full or are not subject of an agreed-upon payment arrangement or in the process of review for financial aid or pending Medicaid are eligible to be referred to a collection agency when they reach a delinquency status of 90 days old from date of first self-pay bill. Self-pay bills which are a result of Medicare coinsurance and/or deductible are eligible to be referred to a collection agency when they reach a delinquency status of 120 days old from date of first self-pay bill. SchH_P06_S00_L02 Schedule H, Part VI, Line 2 Based on its commitment to the community, FF Thompson hospital completed a community health assessment to better understand the needs of the community members. The following identifies the participants in the process of conducting the community health assessments. Participants: The hospital worked with a broad-base of area community agencies known as "The Ontario County Partners for Community Solutions" to continue actions and implement the community health assessment. The participants in this committee included FF Thompson health, the Ontario County Department of Public Health, the Ontario County Office of Aging, the Ontario County Youth Bureau, the United Way, and the Canandaigua Churches in Action (a local church consortium.) Together this group developed and implemented a community health assessment to determine the ongoing needs of the county and to continue laying the groundwork for a county plan to address these needs. SchH_P06_S00_L03 Schedule H, Part VI, Line 3 The Thompson Health Community Care Program is communicated in appropriate detail in several mediums. All efforts to provide information at a variety of locations using a variety of media and techniques are attempted. Thompson Health makes its best effort to make the program information available to patients prior to them receiving services, however; it is recognized that in many cases patients will investigate the Financial Aid/Community Care program after services are rendered. Thompson Health makes its best efforts to verbally communicate the program through its associates recognizing that there are levels of associate involvement. Patient registration staffs verbally inform all self-pay patients of this available benefit. There are pamphlets and informational sheets available for all patients in the registration area. Thompson Health associates are given information sheets to assist them with the ability to communicate this program to patients. Translation services are available as needed for any population that reaches 5% of total population visits per year. A variety of written communications are also used such as: Information sheets - located in the same areas as the signs will be information sheets regarding the availability of a financial aid/community care program identifying key contacts for further information. Application and directions - these documents provide the patient with the program application and directions as to how to complete the application and the additional information required for a complete application. These applications are handed out in the Emergency Department to self-pay patients. Patient Bills and Collection Correspondence - patient billing statements include a statement regarding the existence of the program and who to contact. Similar information is included in the "collection" letters. Electronic Media: Intranet - Thompson Health's intranet includes this policy and directions in the Policy & Procedure Manual on the intranet making the policy and program available to all associates. Internet Web Site - Thompson Health incorporates general information about the policy, sliding fee application and directions on its web site. Non-Patient Communication - Financial counselors communicate the program with community health & human service agencies and social service organizations and agencies. (I.e. Office of the Aging, etc.) as well as companies it utilizes in its collection efforts (i.e. collection agencies.) SchH_P06_S00_L04 Schedule H, Part VI, Line 4 The method by which FF Thompson hospital defines its service area includes an analysis of its primary and secondary service area as well as the area demographics. The following defines the service areas and provides a demographic summary of the region. Definition of primary and secondary service areas: Thompson health provides services to persons in Ontario County and parts of Wayne, Monroe, Livingston, Yates, and Seneca counties. Thompson health defines its primary service area as including those zip codes that cumulatively add up to 70% of its inpatient admissions and where we receive greater than 50% of the market share. At the 70th percentile the remaining zip codes (up to the 90th percentile) comprise the secondary service area. Distribution by age group for the community is as follows: 29% 35 - 54, 18% 0 - 14, 13% 55 - 64, 12% 25 - 34, 10% 18 - 24, 8% 15 - 17. The current household incomes fall into the following groups: 27% $25-50k, 22% $50k - 75k, 19% Over $100k, 14% Schedule H, Part VI, Line 7 - New York X 1 1 X X X X 0 1 0 0 0 1 1 0 0 Linda M Farchione 0 271317 0 142186 0 67025 0 206467 0 9037 0 696032 0 0 Michael Stapleton RN 0 260863 0 34988 0 5916 0 55655 0 21697 0 379119 0 0 Carlos Ortiz MD 0 237302 0 22425 0 32941 0 53541 0 18632 0 364841 0 0 Mark Prunoske 0 179777 0 22040 0 3965 0 50425 0 18809 0 275016 0 0 Jennifer DeVault 110837 0 8962 0 768 0 21046 0 21994 0 163607 0 0 0 Dr Anthony Geraci MD 72577 0 0 0 100 0 22735 0 5372 0 100784 0 0 0 Hazel Robertshaw 107037 0 4678 0 381 0 14595 0 1698 0 128389 0 0 0 David Baum MD 320139 0 0 0 427 0 56532 0 20797 0 397895 0 0 0 Dr John McGuire MD 166621 0 700 0 193 0 28938 0 18222 0 214674 0 0 0 Dr Vijay Bansal MD 332875 0 12391 0 5463 0 26111 0 7858 0 384698 0 0 0 Dr Timothy Pitler MD 314023 0 5325 0 13696 0 86238 0 17781 0 437063 0 0 0 Dr Matthew Osborne MD 294113 0 0 0 10526 0 24575 0 19601 0 348815 0 0 0 Dr William Livingston MD 286378 0 0 0 193 0 23620 0 18041 0 328232 0 0 0 Dr John Sullivan MD 279855 0 0 0 1462 0 24785 0 17181 0 323283 0 0 0 SchJ_P01_S00_L01a Schedule J, Part I, Line 1a Club dues of $923 were paid for the President/CEO SchJ_P01_S00_L04 Schedule J, Part I, Line 4 The President/CEO and SR VP's participate in a 457 (f) plan. Contributions to the plan for 2012 were $87,700 (Michael Stapleton - $33,750, Carlos Ortiz - $23,833, Mark Prunoske - $18,368, and Chris Mahan - $11,749) SchJ_P01_S00_L06 Schedule J, Part I, Line 6 The President/CEO and SR executives are eligible for a variable % YE incentive based on predetermined goals. The goals are operational, financial, and managerial in nature. The financial goal is tied in part to the net earnings of the organization and its affiliates. A Ontario County Industrial Development Agency 521326077 683058AA9 2003-07-01 2000000 Retire outstanding debt of the hospital 0 0 0 B Ontario County Industrial Development Agency 521326077 683058AB7 2003-07-01 12800000 To construct an addition to and renovate portions of the hospital 0 0 0 C Ontario County Local Development Corporation 272435489 2010-08-10 29700000 To construct an addition to and renovate portions of the hospital 0 0 0 A 0 0 2000000 0 0 0 0 0 0 0 0 0 2004 1 0 1 1 B 0 0 12800000 0 0 0 0 0 0 0 0 0 2004 0 0 1 1 C 0 0 23725911 0 633000 0 952000 0 0 22140911 0 0 2012 0 0 0 1 A 0 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 0 C 0 0 0 0 0 0 0 0 A 0 0 0 0 1 1 Keybank 10 0 0 0 0 0 B 0 0 0 0 1 1 Keybank 10.00 0 0 0 0 0 C 0 0 0 0 0 0 0 0 0 A 0 B 0 C 0 F990_P06_S0A_L04 Form 990, Part VI, Section A, Line 4 Effective August 31, 2012, the Health System, the University of Rochester Medical Center (URMC), and the University of Rochester (UR) entered into an affiliation agreement, which resulted in the UR becoming the sole corporate member of the Health System. F990_P06_S0B_L11b Form 990, Part VI, Section B, Line 11b The Director of Finance reviewed the return and consulted with the independent auditors on any areas of question. The return was presented at a Board meeting prior to filing, with an overview of the changes from the prior year. The return was made available to the Board members via a shared intranet web-site. Questions were entertained by management prior to filing. F990_P06_S0B_L12c Form 990, Part VI, Section B, Line 12c The conflict of interest disclosure statements for the Board members are submitted annually to the Chair of the nominating committee and they are responsible for monitoring compliance and follow-up with any potential conflicts. For the Officers the statements are submitted annually to the CEO who is responsible for monitoring compliance and follow-up with any potential conflicts. F990_P06_S0B_L15 Form 990, Part VI, Section B, Line 15 Executive compensation at Thompson is established by the compensation committee of the Board of Directors. The committee uses an independent company to gather comparable data in determining compensation levels for the President/CEO and Senior level executives. The full Board of Directors is surveyed by the compensation committee on executive performance; this is considered in determining compensation levels. The compensation committee is also involved in goal setting for the executive team, which ties back to their performance reviews and compensation rates. F990_P06_S0C_L19 Form 990, Part VI, Section C, Line 19 These documents are available upon request by contacting the Administrative Office. F990_P11_S00_L09 Form 990, Part XI, Line 9 Change in net unrealized gains and losses on investments $178,042, Change in value of interest rate swap $3,968, Change in value of charitable gift annuities -$22,623, Change in funded status of pension plan -$569,457, Change in beneficial interest in charitable remainder trust $39,890, Change in beneficial interest in the net assets of the FF Thompson Foundation -$429,037. FF Thompson Foundation Inc 350 Parrish Street Canandaigua NY 14424 222959984 Philanthropic support for the services and priority needs of the system NY 501(c)(3) 7 N/A FF Thompson Health System Inc 350 Parrish Street Canandaigua NY 14424 222959987 Parent to 6 separate organizations to support the health and well being of the community NY 501(c)(3) 11a N/A M M Ewing Continuing Care Center 350 Parrish Street Canandaigua NY 14424 237046583 Long-term, rehabilitative and related services to the community NY 501(c)(3) 3 N/A FF Thompson Senior Communities Inc One Ferris Hills Canandaigua NY 14424 161557494 Senior living environment providing independent and enriched apts and services NY 501(c)(3) 9 N/A Finger Lakes Community Care Network 350 Parrish Street Canandaigua NY 14424 161423442 Currently inactive NY N/A C FF Thompson Properties and Services Inc 350 Parrish Street Canandaigua NY 14424 161286518 Plans, develops, implements, owns and manages health related ventures NY N/A C 1 0 1 0 1 0 0 0 0 1 1 0 1 0 1 0 1 0 0