2012-11-12T11:48:47-06:00 2011-12-31 990 2011-01-01 160743192 Soldiers and Sailors Memorial Hospital of Yates County SOLD 3157874085 418 North Main Street Penn Yan NY 14527 PATRICIA P THOMPSON 3157874031 2012-11-12 2011 2016-02-24 21:20:13Z Patricia P Thompson 196 North Street Geneva NY 14456 34187275 0 X www.flhealth.org X 1924 NY Provider of Healthcare Services. 18 15 546 44 0 0 6040103 328055 29140134 28132801 525072 692631 1023975 1099758 36729284 30253245 0 0 0 0 19902189 19818760 0 0 0 11296657 11225034 31198846 31043794 5530438 -790549 45826852 43447790 25506129 26333221 20320723 17114569 Soldiers & Sailors Memorial Hospital of Yates County is a community owned, not-for-profit hospital dedicated to maintaining and improving the health of all people in the Central Finger Lakes Region. 0 0 27598205 29232559 Patient Service Program - inpatient and outpatient general hospital care. In 2011, Soldiers & Sailors Memorial Hospital of Yates County had 55,941 patient days, 7,666 emergency room visits, 155,146 outpatient procedures and 12,020 outpatient clinic visits. In 2011 Soldiers & Sailors Memorial Hospital of Yates County had Charity Care totaling $88,487 with a Community Benefit valued at $903,969. 27598205 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 1 2 0 1 546 1 0 0 0 0 0 0 0 0 X 18 15 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X Patricia Thompson 3157874031 196 North Street Geneva NY 14456 Donald Wertman 1.00 X X 0 0 0 Dominic Fonte 1.00 X X 0 0 0 Phil Beckley 1.00 X X 0 0 0 Rev James Adams 1.00 X 0 0 0 David Bunnell 1.00 X 0 0 0 Menzo Case 1.00 X 0 0 0 Richard Catanise 1.00 X 0 0 0 Stephen DeRaddo 1.00 X 0 0 0 Donald Gentilcore Jr 1.00 X 0 0 0 John Hicks 1.00 X 0 0 0 Steven Lasser MD 1.00 X 0 0 0 Charles Lilly MD 1.00 X 279681 0 2299 James Long 1.00 X 0 0 0 Carolanne Marquis 1.00 X 0 0 0 Ann McMullen 1.00 X 0 0 0 Kelly Mittiga 1.00 X 0 0 0 Paul Bleakley MD 1.00 X 0 0 0 Jason Feinberg MD 1.00 X 0 316209 19034 Suzanne Sinclair 1.00 X X 0 46423 1991 Jose Acevedo MD MBA 40.00 X 0 476146 23507 Patricia Thompson 40.00 X 0 181284 22107 Lawrence J Farnand 40.00 X 0 262414 11960 Taryn Draxler MD 40.00 X 181529 0 29554 Nancy-Jo Rembaum 40.00 X 140733 0 9823 Richard Norris 40.00 X 118498 0 2957 Reginald Ewing MD 40.00 X 249535 0 0 Magda Daoud MD 40.00 X 201149 0 12098 James Dooley 40.00 X 0 361441 16480 1171125 1643917 151810 6 1 1 0 0 8263 319792 328055 Net Patient Revenue 621990 28132801 28132801 28132801 284687 284687 4303906 38068 3934030 369876 38068 407944 407944 Other Revenue 900099 1099758 1099758 1099758 30253245 29232559 0 692631 15567523 13839664 1727859 245236 218017 27219 3034481 2697680 336801 971520 863690 107830 261459 232439 29020 110111 97890 12221 34470 30644 3826 18107 16097 2010 34787 30926 3861 176583 156984 19599 509497 452947 56550 4185 3721 464 39249 34893 4356 604736 537616 67120 2163430 1923308 240122 381167 338861 42306 Purchased Services & Le 2513433 2234464 278969 Supplies 2059919 1831286 228633 Bad Debts 1512360 1344501 167859 NYS Receipts Tax 711900 632885 79015 89641 79692 9949 31043794 27598205 3445589 0 25403 26020 1572750 870238 3009346 3311628 375714 219174 168651 134779 268050 302296 57217496 37233376 21278509 19984120 19128429 18599535 45826852 43447790 3222679 3016336 9847788 9687943 9717124 9001652 2718538 4627290 25506129 26333221 X 20320723 17114569 20320723 17114569 45826852 43447790 X -790549 -2415605 X X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 399264 399264 27527930 12645794 14882136 1906031 1374329 531702 27384271 23213253 4171018 19984120 Mortgage Sinking Funds 2492345 Plant Replacement Investment 11489326 Reserve for Replacement LTC 1408257 Escrow Reserve LTC 80392 Capital Lease 19906 Construction In Progress 76644 SSMH Plant Operating Fund 2151010 5 Star Money Market 275279 SSMH Ventures 328572 Due From Affiliates 277804 18599535 Additional Pension Liability 4255800 BCR Advance 371490 4627290 30253245 31043794 -790549 -506853 -1908752 -2415605 -3206154 Description of Uncertain Tax Positions Under FIN 48: Part X: Soldiers & Sailors Memorial Hospital implemented FIN48 in 2008 and our current accounting policy for evaluating uncertain tax positions is in accordance with generally accepted accounting principles. SSMH has not recognized any benefits from uncertain tax postiions in 2011 and we believe that we have no uncertain tax positions for which it is reasonably possible that the total amounts of unrecognized tax benefits will significantly increase or decrease within 12 months of the balance sheet date. Part XI, Line 8 - Other Adjustments: Additional Pension Liability under FASB 158 -1,908,752. Schedule D, Pg 4, Part XI, Ln 8. Additional Pension Liability 1 1 1 X 1 X 1 1 0 1 1 225077 136590 88487 0.00300 10635748 10507010 128738 0.00440 10860825 10643600 217225 0.00740 227921 227921 0.00770 3636817 3089507 547310 0.01850 3864738 3089507 775231 0.02620 14725563 13733107 992456 0.03360 465 465 0.00000 150309 150309 0.00510 23 23 0.00000 35580 35580 0.00120 83854 83854 0.00280 40733 40733 0.00140 310964 310964 0.01050 1 1512360 383079 4447225 4679741 -232516 X 1 1 1 1 Soldiers & Sailors Memorial Hospital

418 North Main Street Penn Yan NY 14527

X X X X Soldiers and Sailors Memorial Hospital 1 1 1 100.000000000000 1 300.000000000000 1 X X X X X X X 1 1 X X X X X X 1 0 1 X 1 0 Part I, Line 7: Part I, 7, bMedicaid net community benefit expenseDirect offsetting revenues (net patient service revenue) includes a prior year settlement of $226,446 in revenue. This amount is not matched with current year expenses and therefore understates community benefit expense for 2011 by .77%.P Part I, Line 7, Column (f): The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 1512360. Part II: Part II Community Building Activities:Soldiers & Sailors Memorial Hospital's Community Building activities promote the health of the communities it serves through1. Economic Development: Soldiers & Sailors Memorial Hospital (SSMH) supports economic development in the community, via its membership in the Chamber of Commerce.2. Community Support:a. To be equipped for disaster situations, SSMH participates in emergency preparedness/disaster readiness activities, including disaster drills; stockpiling essential supplies for use during a disaster; training staff for disasters; and conducting POD events as training in the event of a disaster requiring mass immunizations. b. SSMH provides free meeting space and in some instances, facilitation, for various community organizations, such as TOPS, Community Blood Drives, Cancer Support Group, TB and Health Association, as well as providing free space for a Community Fitness Center.3. Environmental Improvements: SSMH accepts sharps from community households and provides proper disposal of same at no cost to the households. 4. Coalition Building:a. Finger Lakes Health, which includes SSMH, Administrative Team members participate in multiple community organizations/partnerships for the betterment of the communities it serves, including the United Way, Red Cross, Visiting Nurse Service, ARC, and Boys & Girls Club, among others.b. Likewise, employees of the organization participate in many community organizations on behalf of SSMH that benefit the health of the community, including the United Way, Regional EMS Councils, Poison Control Council, County Health Planning Council, Cancer Services Partnership, Obesity Task Force, among others. c. SSMH sponsors community non-for-profit activities for organizations such as, but not limited to, the Community Service Day, the Alzheimer's Association, and others.5. Workforce Development:a. Physician Recruitment - expenses associated with efforts to recruit physicians to meet an unmet community need in an underserved population include primary care physicians and specialists such as Psychiatry and Orthopedics.b. Health Careers Program/Workforce Investment - expenses associated with programs, including summer camps and school-to-work experiences for the exploration of health careers by high school students; mentoring of high school and college-age students to provide training in various professions in our facilities; and partnerships with area colleges to provide education/mentoring for students in various health-related careers. Part III, Line 4: Part III, Section A, 4 Provision for Doubtful Accounts Footnote:The Hospitals, Living Centers and the Homestead estimate the amount to be recognized in the combined financial statements for doubtful accounts by analyzing specific patient and resident accounts for collectability and also by applying historically established percentages for self-pay and various third-party payers to the aging categories in the accounts receivable aging for each facility. Costing Methodology:HFMA P&P Board Statement 15, IX. Valuation and Disclosure of Bad Debts, 9.1 has been applied to the amount reported on line 2. The bad debt amount is recorded at the amount that the payer is expected to pay. The amount reported on line 3 is valued at patient care cost, i. e. the expected payment amount included in line 2 has been multiplied by the ratio of patient care cost to charges (57%). Based upon an analysis of income levels for accounts included in bad debts we estimated that 44% were eligible under the financial assistance program. Rationale for including a portion of bad debt amount as community benefit:It is not always possible to obtain sufficient information to make a determination of eligibility for financial assistance or reclassify bad debts as charity care. When income levels are learned we identify individuals unable to pay for services. Having provided services to those individuals we believe represents a community benefit. Part III, Line 8: Part III, Section B, 8Rationale for including shortfall as community benefit:Medicare payment rates reflect constraints on federal government expenditures. In spite of the significant losses caused by these low rates we provide access to health services for a large segment of our community. We believe this enhancement of population health represents a community benefit.Source of Medicare allowable costs:Cost information is taken from the Medicare cost report. Part III, Line 9b: Part III, Section C, 9b Collection practices for patients who are known to qualify for financial assistance:After the Customer Service Representative's initial determination or the determination rendered after an appeal review, the patient's hospital account is adjusted to reflect the amount of any financial assistance deduction to be applied to it. The patient is billed for any remaining amount due, and is offered the telephone number of an individual within Patient Accounts who is available to assist the person in creating a self-payment plan that outlines patient re-payment steps over a specified period of time should the patient require such assistance. Individuals with valid requests for financial assistance are exempt from referrals to a collection agency. Soldiers and Sailors Memorial Hospital Part V, Section B, Line 19d: Part V, 19 dMaximum amount charged FAP-eligible individuals:Presently we apply a percentage discount to published charges for patients eligible for assistance under our financial assistance policy. Part V, 20Amounts billed greater than insurance coverage:Because we apply a percentage discount to published charges any individual patient's discounted amount may or may not be more than the amounts generally billed to individuals who had insurance covering such care. Part VI, Line 2: Part VI, 2 Needs assessment:SSMH uses health indicators and utilization data to determine healthcare programs and services to meet the needs of our population. Specific indicators include the New York State Community Health data set on disease incidence and mortality, the Behavior Risk Factor Surveillance System (BRFSS) data set from New York State Department of Health, and Statewide Planning and Research Cooperative System (SPARCS) database for data reported by NYS hospitals. This external data is supplemented by real-time information about our own current service area needs and utilization rates. Finger Lakes Health (FLH) mailed a survey to every household in our service area in the health systems biannual news magazine Family Focus. The Community Advisory Committee addressed many community needs, including access to care, transportation, diabetes, nutrition, childhood obesity, mental health services, cardiovascular risk, and lack of awareness regarding service availability. All the needs identified are addressed in the organization's strategic business plan, as well as our Community Service Plan. We engage an outside firm to conduct patient and resident satisfaction surveys for our inpatient and emergency services. We also conduct an annual Employee Opinion Survey. As the largest employer in our region, our employees are representative of our community at large and are in a unique position to help us identify needs and solutions. We participate in the needs assessment process conducted by multiple area health departments who participated in a wider rural health network to compare data between counties and develop common objectives using MAPP (Mobilizing for Action through Community Planning and Partnership) process to conduct a six county wide needs assessment. Finally, to know the needs of our community, our leadership team is actively engaged in the community through board participation on local and state-wide related organizations which regularly assess needs. Our strategic plan informs our priorities and guides us towards achieving our vision, and is informed by the needs of various stakeholders. This input is incorporated into departmental operations and multi-year plans and ultimately informs our Strategic Business Plan. Through this broad-based input, our health system has been able to evolve and grow to meet the changing needs of our community. Part VI, Line 3: Part VI, 3 Patient education of eligibility for assistance:Financial assistance under the organization's policy is available to assist uninsured or underinsured members of our community who are willing but unable to pay in full for their care. The program allows a person to receive medically necessary and emergency services at no charge or reduced charges when they meet certain eligibility requirements. Information about the services is available through signage and applications placed in the emergency department, registration areas, and the patient accounts office. We have also published this information in direct mail sent to area homes and also promoted the program on our local radio show. The hospital's website contains information on financial assistance. Part VI, Line 4: Part VI, 4 Community information:Soldiers & Sailors Memorial Hospital provides a full range of acute care services to residents of the Finger Lakes region in Upstate New York. The hospital reviews demographic data from sources such as the US Census to identify trends. The hospital uses health indicators and utilization data from numerous sources and receives community input from public surveys. We participate in a Needs Assessment Process and participate as an active member of the community through board participation on numerous local and state-wide health related organizations. Part VI, Line 5: Part VI, Line 6: Part VI, 6 Affiliated health system: Services are provided on three campuses located in Geneva, NY (Ontario County), Waterloo, NY (Seneca County) and Penn Yan, NY (Yates County). The health system offers a broad range of primary, specialty and sub-specialty services to residents of Finger Lakes. X X X X 0 0 0 0 0 0 0 0 0 Charles Lilly MD 253181 0 10000 0 16500 0 0 0 2299 0 281980 0 0 0 Jason Feinberg MD 0 273131 0 25978 0 17100 0 0 0 19034 0 335243 0 0 Jose Acevedo MD MBA 0 379154 0 79322 0 17670 0 0 0 23507 0 499653 0 0 Patricia Thompson 0 171687 0 7933 0 1664 0 0 0 22107 0 203391 0 0 Lawrence J Farnand 0 183106 0 62808 0 16500 0 0 0 11960 0 274374 0 0 Taryn Draxler MD 181446 0 0 0 83 0 0 0 29554 0 211083 0 0 0 Nancy-Jo Rembaum 139545 0 1188 0 0 0 0 0 9823 0 150556 0 0 0 Reginald Ewing MD 233035 0 0 0 16500 0 0 0 0 0 249535 0 0 0 Magda Daoud MD 175510 0 25500 0 139 0 0 0 12098 0 213247 0 0 0 James Dooley 0 361441 0 0 0 0 0 0 0 16480 0 377921 0 0 Supplemental Information Part III James J. Dooley, Former President & CEO Geneva General Hospital: Average Hours per week: 23.31; Base Compensation:$210,664;Benefits: $9,606 James J. Dooley, Former President & CEO Living Center at Geneva South Inc: Average Hours per week: 2.72; Base Compensation: $24,570; Benefits $1,120 James J. Dooley, Former President & CEO Living Center at Geneva North Inc: Average Hours per week: 1.60; Base Compensation: $14,415; Benefits: $657 James J. Dooley, Former President & CEO Huntington Living Center Inc: Average Hours per week: 3.20; Base Compensation: $28,919; Benefits: $1,319 James J. Dooley, Former Assistant Secretary Finger Lakes Health Foundation Inc: Average Hours per week: .23; Base Compensation: $2,105; Benefits: $96 James J. Dooley, Former President & CEO Soldiers & Sailors Memorial Hospital: Average Hours per week: 8.94; Base Compensation: $80,767; Benefits: $3,683 James J. Dooley, Former President & CEO Finger Lakes Health: Total Average Hours per week: 40; Total Base Compensation: $361,441; Total Benefits: $16,480 Lawrence J. Farnand, Treasurer & CFO Geneva General Hospital: Average Hours per week: 23.31; Base Compensation: $152,946; Benefits: $6,970 Lawrence J. Farnand, Treasurer & CFO Living Center at Geneva South Inc: Average Hours per week: 2.72; Base Compensation: $17,839; Benefits: $813 Lawrence J. Farnand, Treasurer & CFO Living Center at Geneva North Inc: Average Hours per week: 1.60; Base Compensation: $10,466; Benefits: $477 Lawrence J. Farnand, Treasurer & CFO Huntington Living Center Inc: Average Hours per week: 3.20; Base Compensation: $20,996; Benefits: $957 Lawrence J. Farnand, Treasurer Finger Lakes Health Foundation: Average Hours per week: .23; Base Compensation: $1,528; Benefits: $70 Lawrence J. Farnand, Treasurer & CFO Soldiers & Sailors Memorial Hospital: Average Hours per week: 8.94; Base Compensation: $58,639; Benefits: $2,673 Lawrence J. Farnand, Treasurer & CFO Finger Lakes Health: Total Average Hours per week: 40; Total Base Compensation: $262,414; Total Benefits: $11,960 Jose Acevedo MD MBA, President & CEO Geneva General Hospital: Average Hours per week: 23.31; Base Compensation: $277,518; Benefits: $13,700 Jose Acevedo MD MBA, President & CEO Living Center at Geneva South Inc: Average Hours per week: 2.72; Base Compensation: $32,368; Benefits: $1,598 Jose Acevedo MD MBA, President & CEO Living Center at Geneva North Inc: Average Hours per week: 1.60; Base Compensation: $18,990; Benefits: $938 Jose Acevedo MD MBA, President & CEO Huntington Living Center Inc: Average Hours per week: 3.20; Base Compensation: $38,097; Benefits: $1,881 Jose Acevedo MD MBA, Assistant Secretary Finger Lakes Health Foundation: Average Hours per week: .23; Base Compensation: $2,773; Benefits: $137 Jose Acevedo MD MBA, President & CEO Soldiers & Sailors Memorial Hospital: Average Hours per week: 8.94; Base Compensation: $106,399; Benefits: $5,253 Jose Acevedo MD MBA, President & CEO Finger Lakes Health: Total Average Hours per week: 40; Total Base Compensation: $476,146; Total Benefits: $23,507 Patricia Thompson, Treasurer & CFO Geneva General Hospital: Average Hours per week: 23.31; Base Compensation: $105,659; Benefits: $12,884 Patricia Thompson, Treasurer & CFO Living Center at Geneva South Inc: Average Hours per week: 2.72; Base Compensation: $12,324; Benefits: $1,503 Patricia Thompson, Treasurer & CFO Living Center at Geneva North Inc: Average Hours per week: 1.60; Base Compensation: $7,230; Benefits: $882 Patricia Thompson, Treasurer & CFO Huntington Living Center Inc: Average Hours per week: 3.20; Base Compensation: $14,505; Benefits: $1,769 Patricia Thompson, Treasurer Finger Lakes Health Foundation: Average Hours per week: .23; Base Compensation: $1,056; Benefits: $129 Patricia Thompson, Treasurer & CFO Soldiers & Sailors Memorial Hospital: Average Hours per week: 8.94; Base Compensation: $40,509; Benefits: $4,940 Patricia Thompson, Treasurer & CFO Finger Lakes Health: Total Average Hours per week: 40; Total Base Compensation: $181,284; Total Benefits: $22,107 FL Visiting Nurse Service CFO serves on Board of Directors 0 Form 990, Part VI, Section B, line 11 The Form 990 is reviewed by the Administrative Committee prior to being filed to ensure compliance with 990 Internal Revenue Service Review Requirements. Form 990, Part VI, Section B, line 12c Soldiers & Sailors Memorial Hospital of Yates County maintains a conflict of interest policy which board members are required to sign prior to taking office. Statements are updated annually and reviewed by an Administrative Committee. The process for handling any conflicts of interest which may arise are detailed in the corporate by-laws. Form 990, Part VI, Section B, line 15 Compensation of officers or key employees includes a review as well as comparability data as part of the decision. Form 990, Part VI, Section C, line 19 Soldiers & Sailors Memorial Hospital of Yates County makes its governing documents, conflict of interest policy, and financial statements available to the public where required by law and upon request. The organization's Form 990 is provided to any individual who provides a request in person or who submits a written request. There is no charge other than a reasonable fee for copying and postage. Copies are available at the hospital Finance Office or at www.guidestar.org Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized losses on investments: -506,853. Additional Pension Liability under FASB 158 -1,908,752. Total to Form 990, Part XI, Line 5: -2,415,605. Process is unchanged from prior year. Geneva General Hospital 196 North Street Geneva NY 14456 160743032 Provider of Healthcare Services NY 501 (C) (3) 3 Finger Lakes Health 22-3193606 0 Finger Lakes Health Foundation 196 North Street Geneva NY 14456 150549310 Coordinator of Fundraising Activities NY 501 (C) (3) 11c Finger Lakes Health 22-3193606 0 Living Center at Geneva South 196 North Street Geneva NY 14456 160957268 Skilled Nursing Facility NY 501 (C) (3) 3 Finger Lakes Health 22-3193606 0 Huntington Living Center 369 E Main Street Waterloo NY 13165 510169552 Skilled Nursing Facility NY 501 (C) (3) 3 Finger Lakes Health 22-3193606 0 Geneva General Hospital Housing Development Co 196 North Street Geneva NY 14456 222816883 Operate Low Income Housing for elderly & handicapped NY 501 (C) (3) 9 Finger Lakes Health 22-3193606 0 Taylor Brown Memorial Housing Development Co 371 East Main Street Waterloo NY 13165 222807734 Operate Low Income Housing for elderly & handicapped NY 501 (C) (3) 9 Finger Lakes Health 22-3193606 0 Living Center at Geneva North Inc 196 North Street Geneva NY 14456 161449543 Skilled Nursing Facility NY 501 (C) (3) 3 Finger Lakes Health 22-3193606 0 FLH Senior Communities Inc 196 North Street Geneva NY 14456 205604917 Develop and Operate Senior Citizen Housing Complex NY 501 (C) (3) 9 Finger Lakes Health 22-3193606 0 Soldiers Ventures Inc 196 North Street Geneva NY 14456 161556419 Holding, Investing NY C 1.00000 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 Finger Lakes Health Foundation C 8263 Finger Lakes Health Foundation R 690115 Geneva General Hospital Q 686301 Huntington Living Center R 44236 Living Center at Geneva South R 44058 Living Center at Geneva North R 6623