2012-11-14T16:09:33-06:00 2011-12-31 454051133 FREED MAXICK CPAS PC 800 LIBERTY BLDG 420 MAIN ST BUFFALO NY 142023508 990 2011-01-01 150532245 ST ELIZABETH MEDICAL CENTER STEL 3157988151 2209 GENESEE STREET UTICA NY 135015999 LOUIS AIELLO 3157988151 2012-11-13 1 MARY MADONIA P00405803 7168472651 2011 2016-02-24 21:20:13Z RICHARD KETCHAM 2209 GENESEE STREET UTICA NY 135015999 211842631 0 X WWW.STEMC.ORG X 1861 NY ST. ELIZABETH MEDICAL CENTER COMMUNITY, INSPIRED BY ST. FRANCIS OF ASSISI AND FAITHFUL TO THE TEACHINGS OF THE ROMAN CATHOLIC CHURCH, IS COMMITTED TO EXCELLENCE IN HEALTHCARE AND EDUCATION. 11 8 2279 178 376854 -77195 2609558 1455110 197921236 199858890 961227 1270313 5017543 5234727 206509564 207819040 0 0 0 0 116961087 116656665 0 0 0 88530469 88012854 205491556 204669519 1018008 3149521 133682865 136782075 112978659 131891120 20704206 4890955 X ST. ELIZABETH MEDICAL CENTER COMMUNITY, INSPIRED BY ST. FRANCIS OF ASSISI AND FAITHFUL TO THE TEACHINGS OF THE ROMAN CATHOLIC CHURCH, IS COMMITTED TO EXCELLENCE IN HEALTHCARE AND EDUCATION. 0 0 108329517 110871670 INPATIENT SERVICES- ST ELIZABETH MEDICAL CENTER IS A FULL SERVICE GENERAL HOSPITAL WITH 201 LICENSED BEDS. THE HOSPITAL PROVIDES A FULL RANGE OF ROUTINE AND ANCILLARY SERVICES, INCLUDING CARDIAC SURGERY AND ANGIOPLASTY. DISBURSEMENTS MADE BY THE HOSPITAL ARE EXCLUSIVELY FOR SERVICES AND MATERIALS USED IN PERFORMING THE HOSPITAL'S EXEMPT FUNCTIONS. ST. ELIZABETH MEDICAL CENTER PROVIDES CARE TO EVERYONE REGARDLESS OF RACE, RELIGION OR ABILITY TO PAY. 24675670 25086598 AMBULATORY SURGERY- ST. ELIZABETH MEDICAL CENTER HAS A FULL RANGE OF AMBULATORY SURGERY SERVICES ON ITS CAMPUS FOR PATIENTS THAT DO NOT REQUIRE OVERNIGHT OR LONG INPATIENT STAYS. ST. ELIZABETH MEDICAL CENTER PROVIDES SERVICES TO EVERYONE REGARDLESS OF RACE, RELIGION, OR ABILITY TO PAY. 13181133 16394996 OUR EMERGENCY DEPARTMENT CONSISTS OF 33 PRIVATE ROOMS. AS A LEVEL II TRAUMA CENTER, OUR EMERGENCY DEPARTMENT OFFERS 24 HOUR SERVICE FOR EMERGENCY EVALUATION OF PATIENTS. THE EMERGENCY DEPARTMENT SERVES OVER 41,000 PATIENTS EACH YEAR WITH A VARIETY OF ILLNESSES RANGING FROM MINOR ILLNESS TO MAJOR TRAUMAS AND HEART ATTACKS. THE STAFF IS COMPRISED OF BOARD CERTIFIED PHYSICIANS, PHYSICIAN ASSISTANTS, NURSE PRACTITIONERS, REGISTERED NURSES, LICENSED PRACTICAL NURSES AND EMERGENCY DEPARTMENT ASSISTANTS. 37417906 51797199 OTHER PROGRAM SERVICES INCLUDE COMMUNITY MEDICINE, REFERRED AMBULATORY, CLINICS, FAMILY PRACTICE, SPORTS MEDICINE CENTER, COLLEGE OF NURSING, INTERNS AND RESIDENTS, AND HOME HEALTH AGENCY. 37417906 51797199 183604226 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 0 0 1 144 0 2279 1 1 1 0 0 0 0 0 0 0 0 0 X 11 8 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 0 1 0 NY X X ST ELIZABETH MEDICAL CENTER 3157988151 2209 GENESEE STREET UTICA NY 13501 SR DONNA MCGARTLAND 1.00 X X 0 0 0 CATHERINE COMINSKY 1.00 X X 0 0 0 GREGORY P EVANS 2.00 X 0 0 0 HARRISON J HUMMEL III 1.00 X 0 0 0 TIMOTHY PAGE MD 1.00 X 55025 0 0 RAYMOND MEIER 1.00 X 0 0 0 HON NORMAN I SIEGEL 2.00 X X 0 0 0 STEVEN WILLIAMS MD 1.00 X 0 0 0 ERIC YOSS MD 1.00 X 26125 0 0 RICHARD F ZWEIFEL 1.00 X X 0 0 0 ANDREW S KOWALCZYK III 1.00 X 0 0 0 ROBERT SCHOLEFIELD 40.00 X 220014 0 23751 RICHARD KETCHAM 40.00 X 341443 0 12935 LOU AIELLO 40.00 X 269866 0 22924 ALBERT D'ACCURZIO MD 40.00 X 280461 0 25374 VARINYA SHEPPARD 40.00 X 159140 0 13060 OLEG DULKEN MD 40.00 X 296252 0 21974 ERIC FREIBERGER MD 40.00 X 315565 0 23359 SUNDAY ASAJU MD 40.00 X 346217 0 24459 FRANCIS CONSTANTINE MD 40.00 X 288396 0 23983 CLIFFORD SOULTS MD 40.00 X 318559 0 6670 2917063 0 198489 73 0 1 0 UPTOWN ANESTHESIA ASSOC 2405 GENESEE STREET UTICA NY 13501 ANESTHESIA SERVICES 1439710 ACUSIS PO BOX 951107 CLEVELAND OH 44193 TRANSCRIPTION SERVICES 1083252 MAYO COLLABORATIVE SERVICES PO BOX 9146 MINNEAPOLIS MN 55480 LABORATORY TESTING 843538 SODEXO OPERATIONS LLC PO BOX 81049 WOBURN MA 018131049 CAFETERIA AND FOOD 816665 ATLAS HEALTH CARE LINEN 414 WEST TAYLOR STREET SYRACUSE NY 13202 LAUNDERING SERVICES 776341 40 784895 465533 204682 1455110 MEDICARE/MEDICAID PAYM 900099 110635186 110635186 PATIENT SERVICE REVENU 900099 88893198 88893198 NURSING HOME LAB TESTI 621500 224928 224928 CYTOLOGY LAB TESTING 621500 105578 105578 199858890 311060 311060 612648 0 612648 612648 46348 566300 3264879 1717965 3053071 970520 211808 747445 959253 959253 TUTION: NURSING & X-RA 900099 1682132 1682132 EMPLOYEE & VISITOR MEA 900099 1087104 1087104 FAMILY PRACTICE SERVIC 900099 288378 288378 1564465 1564465 4622079 207819040 204150463 376854 1836613 1352074 1211052 141022 90591601 81277636 9313965 4475834 4009005 466829 13770793 12351140 1419653 6466363 5802148 664215 14998961 13438424 1560537 33988 30443 3545 155800 145014 10786 33244 29777 3467 304874 304874 42152070 37724920 4427150 558652 500385 58267 57596 51589 6007 183871 164693 19178 2038145 1825566 212579 8973793 8038294 935499 1901209 1702913 198296 BAD DEBT 8496829 7614897 881932 EQUIPMENT RENTAL AND MA 4911624 4399803 511821 UTILITIES 2297643 2057999 239644 DEBT ASSESSMENT 603131 540225 62906 311424 383429 -72005 204669519 183604226 21065293 0 6221349 4396864 22615059 25265618 5811795 5806080 523888 500747 178466868 100875675 74898945 77591193 16917068 14070433 6694761 9151140 133682865 136782075 22709215 23117362 35327411 32932544 6916413 8753914 1830163 1568712 46195457 65518588 112978659 131891120 X 19793513 3783143 533779 504322 376914 603490 20704206 4890955 133682865 136782075 X 3149521 -18962772 X X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 0 0 1 33244 33244 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: ACTIVITIES INCLUDE THE PORTION OF DUES PAID TO THE HEALTH CARE ASSOCIATION OF NEW YORK STATE. 910691 1288402 16768 16380 1091669 1107812 1264143 2090040 16876 32345 2428023 910691 1650930 976103 17145 18750 1361285 1264143 2723095 689098 20384 17850 1763797 1650930 0.20380 0.34100 0.45520 0 1 1 6781653 6781653 82662347 41469322 41193025 89022868 59406353 29616515 77591193 UNAMORTITZED DEBT FINANCING 1019346 OTHER RECEIVABLES 1927746 ASSETS WHOSE USE IS LIMITED- BOND FUNDS 3227678 INTEREST IN NET ASSETS OF SEMC FOUNDATION 1849215 OTHER ASSETS RESTRICTED BY DONORS 1127155 9151140 ACCRUED PENSION LIABILITY 56379388 LIABILITY TO THIRD PARTY PAYORS 9039200 PROFESSIONAL LIABILITY DEDUCTIBLE 100000 65518588 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: ENDOWMENT FUNDS - PART V THE INTENDED PURPOSE OF THE MEDICAL CENTER'S ENDOWMENT FUNDS ARE TO PROVIDE FUTURE SCHOLARSHIP AWARDS FOR STUDENTS IN THE COLLEGE OF NURSING PROGRAMS. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE MEDICAL CENTER IS A NOT-FOR-PROFIT ORGANIZATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS GENERALLY EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE MEDICAL CENTER FILES ITS RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX IN THE U.S. FEDERAL JURISDICTION. THE TAX YEARS 2008-2011 GENERALLY REMAIN OPEN TO EXAMINATION IN TAXING JURISDICTIONS IN WHICH THE MEDICAL CENTER IS SUBJECT TO THE FILING REQUIREMENTS OF THOSE JURISDICTIONS. 1 1 1 X 160.000000000000 1 X 230.000000000000 1 1 1 0 1 1 2526235 879813 1646422 0.00800 31386428 27662173 3724255 0.01820 3802320 2439191 1363129 0.00670 37714983 30981177 6733806 0.03290 193723 187217 6506 0.00000 7470474 4175305 3295169 0.01610 2664787 2277775 387012 0.00190 81642 67308 14334 0.00010 10410626 6707605 3703021 0.01810 48125609 37688782 10436827 0.05100 1 3698992 839000 41288489 44194115 -2905626 X 1 1 1 MVHI CARDIAC SERVICES 0.70000 0.00000 0.00000 2 MVEC GASTROENTEROLOGY SRVCS 0.20000 0.00000 0.00000 1 1 ST ELIZABETH MEDICAL CENTER

2209 GENESEE STREET UTICA NY 13501

X ST ELIZABETH MEDICAL CENTER 1 1 1 160.000000000000 1 230.000000000000 1 X 1 1 X X X X X X 1 X X X 1 X X X X X X X X 1 X 0 0 16 SEMC AT FAMILY PRACTICE CENTER

120 HOBART STREET UTICA NY 13501

OUTPATIENT PHYSICIAN CLINIC WOMEN & CHILDREN'S FAMILY HEALTH CENTER

2212 GENESEE STREET UTICA NY 13502

OUTPATIENT PHYSICIAN CLINIC MARIAN MEDICAL IMAGING

2211 GENESEE STREET UTICA NY 13501

OUTPATIENT LAB/ XRAY CLINIC LITTLE FALLS FAMILY PRACTICE

500 MAIN STREET LITTLE FALLS NY 13365

OUTPATIENT PHYSICIAN CLINIC COMMUNITY MEDICINE-EAST UTICA

1256 CULVER AVE UTICA NY 13501

OUTPATIENT PHYSICIAN CLINIC WOUND CARE SERVICES

4401 MIDDLE SETTLEMENT ROAD NEW HARTFORD NY 13413

OUTPATIENT PHYSICIAN CLINIC ST ELIZABETH MEDICAL GROUP- NEW HARTFORD

86 GENESEE STREET NEW HARTFORD NY 13413

OUTPATIENT PHYSICIAN CLINIC NORTH UTICA COMMUNITY HEALTH CENTER

417 TRENTON ROAD UTICA NY 13502

OUTPATIENT PHYSICIAN CLINIC SAUQUOIT COMMUNITY MEDICINE

2888 ONEIDA STREET SAUQUOIT NY 13456

OUTPATIENT PHYSICIAN CLINIC CLINTON FAMILY HEALTH CENTER

101 COLLEGE STREET CLINTON NY 13323

OUTPATIENT PHYSICIAN CLINIC WATERVILLE FAMILY HEALTH CENTER

117 WEST MAIN STREET WATERVILLE NY 13480

OUTPATIENT PHYSICIAN CLINIC COMMUNITY MEDICAL SERVICES-MOHAWK

5 ANN STREET MOHAWK NY 13407

OUTPATIENT PHYSICIAN CLINIC COMMUNITY MEDICAL SERVICES- S UTICA

6 HAMPDEN PLACE UTICA NY 13501

OUTPATIENT PHYSICIAN CLINIC ADIRONDACK SPORTS MEDICINE

4401 MIDDLE SETTLEMENT ROAD NEW HARTFORD NY 13413

OUTPATIENT REHAB SERVICES KERNAN ELEMENTARY SCHOOL

926 YORK STREET UTICA NY 13502

SCHOOL BASED HEALTH CENTER MEDICAL ARTS

4401 MIDDLE SETTLEMENT ROAD NEW HARTFORD NY 13413

OUTPATIENT LAB/ XRAY CLINIC PART I, LINE 7: COSTING METHODOLOGY-CHARITY CARETHE COST TO CHARGE RATIO THAT WAS USED TO COMPLETE THE CHART FOR LINE 7 WAS DERIVED FROM THE WORKSKEET 2 CALCULATION. PART I, L7 COL(F): BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25BAD DEBT EXPENSE OF $8,501,615 IS INCLUDED ON FORM 990, PARK IX,LINE 25 AND HAS BEEN REMOVED FOR CALCULATING THE PERCENTAGES IN COLUMN 7(F). PART III, LINE 4: COSTING METHODOLOGY-BAD DEBT EXPENSEPART III, LINE 2 & 3: THE MEDICAL CENTER PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. THE CENTER'S POLICY IS NOT TO PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE. THE ESTIMATED COST OF PROVIDING UNCOMPENSATED CARE TO PATIENTS WAS APPROXIMATELY $1,949,000 OF CHARGES AND $839,000 OF COST FOR THE YEAR ENDED DECEMBER 31, 2011.THE MEDICAL CENTER GRANTS CREDIT WITHOUT COLLATERAL TO PATIENTS, MOST OF WHOM ARE LOCAL RESIDENTS AND ARE INSURED UNDER THIRD-PARTY AGREEMENTS. ADDITIONS TO THE ALLOWANCE FOR DOUBTFUL ACCOUNTS ARE MADE BY MEANS OF THE PROVISION FOR DOUBTFUL ACCOUNTS. ACCOUNTS WRITTEN OFF AS UNCOLLECTIBLE ARE DEDUCTED FROM THE ALLOWANCE AND SUBSEQUENT RECOVERIES ARE ADDED. THE AMOUNT OF THE PROVISION FOR DOUBTFUL ACCOUNTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL EXPECTED NET COLLECTIONS, BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN FEDERAL AND STATE GOVERNMENTAL HEALTH CARE COVERAGE AND OTHER COLLECTION INDICATORS. SERVICES RENDERED TO INDIVIDUALS WHEN PAYMENT IS EXPECTED AND ULTIMATELY NOT RECEIVED ARE WRITTEN OFF TO THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. PART III, LINE 8: COSTING METHODOLOGY- MEDICARETHE COSTING METHODOLOGY USED TO DETERMINE THE AMOUNT REPORTED ON LINE 6 IS COST TO CHARGE RATIO. PART III, LINE 9B: DEBT COLLECTION POLICYCOLLECTION POLICY PROVISIONSPATIENTS THAT QUALIFY FOR THE MEDICAL CENTER'S CHARITY CARE PROGRAM HAVE THE CHARGES ON THEIR ACCOUNTS FORGIVEN AS THEY ARE PLACED IN CHARITY CARE AND THE BALANCES ARE WRITTEN OFF. THE MEDICAL CENTER'S CHARITY CARE PROGRAM USED THE FEDERAL POVERTY GUIDELINES (FPG) AS A GUIDE WITH HIGH-END LIMITS AT 160% OF THE FPG. IN THOSE SITUATIONS WHERE THE PATIENT'S INCOME IS BETWEEN 160%- 230% OF THE FPG, A SMALL COST SHARE WOULD BE THE ONLY AMOUNT NOT INCLUDED IN CHARITY CARE. ADDITIONALLY, THIS SMALL COST SHARE WOULD BE THE ONLY AMOUNT TURNED OVER TO COLLECTION WITH THE OPPORTUNITY OF EVENTUALLY BEING WRITTEN OFF TO BAD DEBT IF NOT PAID. FORM 990, SCHEDULE H, PART III, LINE C, 9B PATIENTS THAT QUALIFY FOR THE MEDICAL CENTER'S CHARITY CARE PROGRAM HAVE THE CHARGES ON THEIR ACCOUNTS FORGIVEN AS THEY ARE PLACED IN CHARITY CARE AND THE BALANCES ARE WRITTEN OFF. THE MEDICAL CENTER'S CHARITY CARE PROGRAM USED THE FEDERAL POVERTY GUIDELINES (FPG) AS A GUIDE WITH HIGH-END LIMITS AT 160% OF THE FPG. IN THOSE SITUATIONS WHERE THE PATIENT;S INCOME IS BETWEEN 160%-230% OF THE FPG, A SMALL COST SHARE WOULD BE THE ONLY AMOUNT NOT INCLUDED IN CHARITY CARE. ADDITIONALLY, THIS SMALL COST SHARE WOULD BE THE ONLY AMOUNT TURNED OVER TO COLLECTION WITH THE OPPORTUNITY OF EVENTUALLY BEING WRITTEN OFF TO BAD DEBT IF NOT PAID. ST ELIZABETH MEDICAL CENTER PART V, SECTION B, LINE 16E: REPORTING TO CREDIT AGENCY, LAWSUITS, LEINS AND ACCEPTED DISCOUNTED SETTLEMENTS. ST ELIZABETH MEDICAL CENTER PART V, SECTION B, LINE 19D: DURING THE YEAR OUR FACILITY DETERMINED THE MAXIMUM AMOUNTS THAT CAN BE CHARGED TO FAP ELIGIBLE INDIVIDUALS FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE BY ANNUALLY COMPARING THE TOP 10 PAYER RATES AND TAKING OUT THE HIGHEST AND LOWEST, THEN AVERAGING THE REST. PART VI, LINE 2: HEALTHCARE NEEDS OF THE COMMUNITYTHE MEDICAL CENTER ASSESSES HEALTHCARE NEEDS OF THE COMMUNITIES IT SERVES BY COLLABORATING WITH ONEIDA AND HERKIMER COUNTIES' DEPARTMENTS OF HEALTH ON COMMUNITY HEALTH ASSESSMENTS. DATA WAS COLLECTED IN 2009 THROUGH A MAPP PROCESS, AROUND THE NYS PREVENTION AGENDA ISSUES. FIVE RESULTING PRIORITY WORK GROUPS THAT CONTAIN MEDICAL CENTER EMPLOYEES CONTINUE TO ASSESS CHANGES AND ADDRESS PRIORITY AREAS. THESE WORK GROUPS ALSO REPORT TO THE SEMC COMMUNITY DESIGN TEAM, WHICH REGULARLY HEARS ABOUT HEALTHCARE NEEDS THROUGH THOSE IN AREA COMMUNITIES. PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCETHIS IS COMMUNICATED THROUGH SEMC'S FACILITATED ENROLLMENT PROGRAM AND THE MOTHER BERNARDINA CHARITY CARE PROGRAM. INFORMATION IS INCLUDED IN THE PATIENT INFORMATION GUIDES PRESENTED TO INPATIENTS AND OUTPATIENTS, AND IS AVAILABLE ON THE SEMC'S WEBSITE.ST. ELIZABETH MEDICAL CENTER RECOGNIZES THAT PROVIDING EXCEPTIONAL HEALTHCARE SERVICE TO THE COMMUNITY IS A VITAL COMMUNITY RESOURCE. OUR ACHIEVEMENTS ARE NOT OURS ALONE, BUT ARE OBTAINED BY COLLABORATIVE EFFORTS WITH OUR COMMUNITY AND GOVERNMENT LEADERS WORKING TOGETHER TO IMPROVE THE "HEALTH" OF THE COMMUNITY.SEMC'S FACILITATED ENROLLMENT PROGRAMIN 2000, ST. ELIZABETH MEDICAL CENTER DEVELOPED AND IMPLEMENTED THE FACILITATED ENROLLMENT PROGRAM AS A RESULT OF THE UNIQUE COLLABORATION THAT WAS FORGED BETWEEN ST. ELIZABETH MEDICAL CENTER AND ONEIDA COUNTY SOCIAL SERVICE DEPARTMENT. THIS PROGRAM ALLOWS SEMC STAFF, PATIENT ACCOUNT REPRESENTATIVES, TO ACT AS AN AUTHORIZED REPRESENTATIVE OF THE PATIENT AT THE ONEIDA COUNTY DEPARTMENT OF SOCIAL SERVICES AND SUBMIT THE APPLICATION FOR BENEFITS. THIS SUCCESSFUL PROGRAM HAS EXPANDED THROUGHOUT THE PAST TWELVE YEARS TO INCLUDE OUTPATIENTS AND EMERGENCY DEPARTMENT PATIENTS.SEMC'S MOTHER BERNARDINA CHARITY CARE PROGRAMTO SUPPORT OUR MISSION, THE ST. ELIZABETH MEDICAL CENTER HAS DEVELOPED THE MOTHER BERNARDINA CHARITY CARE PROGRAM. THE MEDICAL CENTER WILL MAKE AVAILABLE A REASONABLE AMOUNT OF UNCOMPENSATED SERVICES TO ELIGIBLE PERSONS. PART VI, LINE 4: COMMUNITYST. ELIZABETH MEDICAL CENTER'S PRIMARY SERVICE AREA (PSA) CONSISTS OF THE ZIP CODES IN WHICH 80% OF ITS PATIENTS LIVE. ITS SECONDARY SERVICE AREA (SSA) CONSISTS OF ZIP CODES IN WHICH THE REMAINING 10+% OF ITS PATIENTS LIVE. METHODS USED TO DETERMINE THE SERVICE AREA ARE ANALYSIS OF PATIENT ORIGIN, BASED ON HOME ZIP CODE. IT IS AN ETHNICALLY AND ECONOMICALLY DIVERSE REGION, WITH MANY IMMIGRANTS AND AN OLDER POPULATION THAN THE NATIONAL AVERAGE. PART VI, LINE 5: PROMOTION OF COMMUNITY HEALTHTHESE ACTIONS REPRESENT THE MEDICAL CENTER'S EMPLOYEE OUTREACH BEYOND THE HOSPITAL AND MEDICAL GROUP OFFICES INTO AREA COMMUNITIES, AND THEY SPAN A WIDE REACH OF EVENTS AND SITES. ALONG WITH HOSPITALS ACROSS THE STATE AND NATION, ST. ELIZABETH NOW MONITORS HOW OUR FAITHFULNESS TO THE REGIONAL POPULATION MEETS OUR LOCAL COMMUNITIES' UNIQUE HEALTH NEEDS. THEREFORE, COMMUNITY BENEFITS ARE PROGRAMS OR ACTIVITIES THAT PROVIDE TREATMENT AND/OR PROMOTE HEALTH AND HEALING AS A RESPONSE TO IDENTIFIED COMMUNITY NEEDS. OUR CATHOLIC TRADITION AND MEDICAL CENTER MISSION TEACH US TO PUT THE NEEDS OF THE POOR AND VULNERABLE FIRST.AMONG OUR COMMUNITY BENEFIT ACTIVITIES ARE:-CHARITY CARE FOR PEOPLE UNABLE TO AFFORD SERVICE-HEALTH EDUCATION AND ILLNESS PREVENTION-HEALTHCARE INITIATIVES FOR AT-RISK YOUTHS-FREE OR LOW-COST CLINICS AND-INITIATIVES TO RAISE AWARENESS AND RECEIVE PUBLIC INPUTMANY OF THESE ACTIVITIES ARE ADVANCED IN COLLABORATION WITH COMMUNITY MEMBERS AND OTHER ORGANIZATIONS TO IMPROVE HEALTH AND QUALITY OF LIFE. THE MEDICAL CENTER FURTHERS ITS EXEMPT PURPOSE BY PROMOTING THE HEALTH OF THE COMMUNITY THROUGH AN OPEN MEDICAL STAFF AND A COMMUNITY BOARD. SEMC FURTHER PROMOTES THE HEALTH OF THE COMMUNITY BY USING ITS SURPLUS FOR TRAINING AND EDUCATION OF ITS EMPLOYEES AND BY INVESTING IN HEALTHCARE TECHNOLOGY.STATE FILING OF COMMUNITY BENEFIT REPORTNY X X X X X X 0 0 0 0 0 0 0 0 0 ROBERT SCHOLEFIELD 220014 0 0 0 0 0 15527 0 8224 0 243765 0 0 0 RICHARD KETCHAM 341443 0 0 0 0 0 4711 0 8224 0 354378 0 0 0 LOU AIELLO 269866 0 0 0 0 0 14700 0 8224 0 292790 0 0 0 ALBERT D'ACCURZIO MD 280461 0 0 0 0 0 17150 0 8224 0 305835 0 0 0 VARINYA SHEPPARD 159140 0 0 0 0 0 10815 0 2245 0 172200 0 0 0 OLEG DULKEN MD 270898 0 25354 0 0 0 12110 0 9864 0 318226 0 0 0 ERIC FREIBERGER MD 297673 0 17892 0 0 0 12118 0 11241 0 338924 0 0 0 SUNDAY ASAJU MD 304517 0 41700 0 0 0 14595 0 9864 0 370676 0 0 0 FRANCIS CONSTANTINE MD 218233 0 70163 0 0 0 13619 0 10364 0 312379 0 0 0 CLIFFORD SOULTS MD 318559 0 0 0 0 0 0 0 6670 0 325229 0 0 0 ONEIDA COUNTRY IDA 166158201 682465AA7 2006-06-22 14000000 EMERGENCY ROOM & CAFETERIA PROJECT 0 0 0 14000000 280000 70817 13649183 2007 0 0 1 1 0 0 0 1 1 0.00000 0.00000 0.00000 1 0 1 0 0 0 0 PULMONARY CRITICAL CARE ASSOCIATES ERIC YOSS MD- TRUSTEE 281625 PULMONARY CARE- MEDICAL SERVICES 0 HUMMEL'S OFFICE PLUS HARRISON J. HUMMEL, III - TRUSTEE 174908 OFFICE SUPPLIES PURCHASES 0 FORM 990, PART VI, SECTION A, LINE 2 THE MEDICAL CENTER FOUNDATION BOARD MEMBER MARLENE ANDERSON IS THE SISTER OF THE MEDICAL CENTER KEY EMPLOYEE DR. D'ACCURZIO. FORM 990, PART VI, SECTION A, LINE 6 RESERVED POWERS TO THE GENERAL MINISTER AND COUNCILORS OF THE SISTERS OF ST. FRANCIS OF THE NEUMANN COMMUNITIES. THE FOLLOWING POWERS SHALL BE RESERVED TO THE CORPORATE MEMBER TO EXERCISE AND SHALL BE REFERRED TO AS RESERVED POWERS: A. TO CHANGE THE PHILOSOPHY, MISSION, AND PURPOSE OF THE CORPORATION. B. TO ADOPT AND/OR AMEND THE CERTIFICATE OF INCORPORATION. C. TO ADOPT AND/OR AMEND THE BYLAWS. D. TO APPOINT THE BOARD OF TRUSTEES AND TO REMOVE BOARD MEMBERS WITH OR WITHOUT CAUSE. E. TO CONFIRM THE APPOINTMENT OF THE PRESIDENT OF THE CORPORATION. F. TO APPOINT THE CHAIR OF THE BOARD OF TRUSTEES. G. TO APPROVE THE PURCHASE, SALE, LEASE, MORTGAGE OF REAL PROPERTY; TO APPROVE THE PURCHASE, SALE OR GIFT OF CAPITAL ASSETS. H. TO APPROVE THE MERGER, CONSOLIDATION, OR AFFILIATION OF THE CORPORATION WITH ANOTHER CORPORATION, ORGANIZATION, OR PROGRAM. I. TO APPROVE THE DISSOLUTION OF THE CORPORATION AND DISPOSITION OF ASSETS. FORM 990, PART VI, SECTION A, LINE 7A RESERVED POWERS TO THE GENERAL MINISTER AND COUNCILORS OF THE SISTERS OF ST. FRANCIS OF THE NEUMANN COMMUNITIES. THE FOLLOWING POWERS SHALL BE RESERVED TO THE CORPORATE MEMBER TO EXERCISE AND SHALL BE REFERRED TO AS RESERVED POWERS: A. TO CHANGE THE PHILOSOPHY, MISSION, AND PURPOSE OF THE CORPORATION. B. TO ADOPT AND/OR AMEND THE CERTIFICATE OF INCORPORATION. C. TO ADOPT AND/OR AMEND THE BYLAWS. D. TO APPOINT THE BOARD OF TRUSTEES AND TO REMOVE BOARD MEMBERS WITH OR WITHOUT CAUSE. E. TO CONFIRM THE APPOINTMENT OF THE PRESIDENT OF THE CORPORATION. F. TO APPOINT THE CHAIR OF THE BOARD OF TRUSTEES. G. TO APPROVE THE PURCHASE, SALE, LEASE, MORTGAGE OF REAL PROPERTY; TO APPROVE THE PURCHASE, SALE OR GIFT OF CAPITAL ASSETS. H. TO APPROVE THE MERGER, CONSOLIDATION, OR AFFILIATION OF THE CORPORATION WITH ANOTHER CORPORATION, ORGANIZATION, OR PROGRAM. I. TO APPROVE THE DISSOLUTION OF THE CORPORATION AND DISPOSITION OF ASSETS. FORM 990, PART VI, SECTION A, LINE 7B RESERVED POWERS TO THE GENERAL MINISTER AND COUNCILORS OF THE SISTERS OF ST. FRANCIS OF THE NEUMANN COMMUNITIES. THE FOLLOWING POWERS SHALL BE RESERVED TO THE CORPORATE MEMBER TO EXERCISE AND SHALL BE REFERRED TO AS RESERVED POWERS: A. TO CHANGE THE PHILOSOPHY, MISSION, AND PURPOSE OF THE CORPORATION. B. TO ADOPT AND/OR AMEND THE CERTIFICATE OF INCORPORATION. C. TO ADOPT AND/OR AMEND THE BYLAWS. D. TO APPOINT THE BOARD OF TRUSTEES AND TO REMOVE BOARD MEMBERS WITH OR WITHOUT CAUSE. E. TO CONFIRM THE APPOINTMENT OF THE PRESIDENT OF THE CORPORATION. F. TO APPOINT THE CHAIR OF THE BOARD OF TRUSTEES. G. TO APPROVE THE PURCHASE, SALE, LEASE, MORTGAGE OF REAL PROPERTY; TO APPROVE THE PURCHASE, SALE OR GIFT OF CAPITAL ASSETS. H. TO APPROVE THE MERGER, CONSOLIDATION, OR AFFILIATION OF THE CORPORATION WITH ANOTHER CORPORATION, ORGANIZATION, OR PROGRAM. I. TO APPROVE THE DISSOLUTION OF THE CORPORATION AND DISPOSITION OF ASSETS. . FORM 990, PART VI, SECTION B, LINE 11 INFORMATION IS GATHERED FROM THE ACCOUNTING AND PAYROLL DEPARTMENTS, WHICH IS USED BY THE STAFF ACCOUNTANT TO PREPARE WORKSHEETS USED TO POPULATE THE FORM 990. MEMBERS OF AN EXTERNAL AUDIT AND TAX FIRM (CURRENTLY FREED MAXICK, CPAS, PC) INITIALLY DISCUSS, PREPARE AND REVIEW THE RETURN WITH THE STAFF ACCOUNTANT. THE SEMC MANAGEMENT TEAM REVIEWS THE DRAFT AND HAS THE OPPORTUNITY TO ASK QUESTIONS AND DISCUSS THE RETURN WITH FREED MAXICK CPAS, PC TAX STAFF. AFTER THE MANAGEMENT TEAM'S APPROVAL, THE FORM IS DISTRIBUTED TO THE GOVERNING BODY FOR THEIR REVIEW AND COMMENT PRIOR TO THE FILING OF THE FORM. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST POLICY PART VI, SECTION B, LINE 12C FIRST, EACH BOARD OF TRUSTEE MEMBER, THE PRESIDENT/CEO, CHIEF OPERATING OFFICER, AND EACH VICE PRESIDENT COMPLETE AN ANNUAL CONFLICT OF INTEREST QUESTIONNAIRE. THE RESULTS OF THE QUESTIONNAIRE ARE REVIEWED BY THE AUDIT COMMITTEE OF THE BOARD OF TRUSTEES WHICH IDENTITFIES ANY POTENTIAL CONFLICTS. AS PART OF THE POLICY, BOARD MEMBERS THAT HAVE A CONFLICT ARE UNABLE TO VOTE WHEN A SUBJECT THAT THEY HAVE A CONFLICT OF INTEREST IN COMES UP FOR A VOTE AT A BOARD MEETING. BOARD MEMBERS ARE NOT ALLOWED TO BE INVOLVED IN THE DISCUSSIONS RELATED TO THE ISSUE OTHER THAN TO MAKE A BRIEF COMMENT. STARTING IN SEPTEMBER OF 2010, THE MEDICAL CENTER BEGAN TO REQUIRE ALL DEPARTMENT MANAGERS TO COMPLETE A CONFLICT OF INTEREST QUESTIONNAIRE ON AN ANNUAL BASIS. STARTING IN SEPTEMBER OF 2010, ALL MEMBERS OF THE MEDICAL STAFF ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST QUESTIONNAIRE ONCE EVERY TWO YEARS, AS PART OF THE CREDENTIALING PROCESS. FOR ALL OTHER EMPLOYEES, A POLICY IS IN PLACE AS PART OF THE COMPLIANCE PLAN THAT REQUIRES EMPLOYEES TO DISCLOSE ANY CONFLICT OF INTEREST TO THEIR SUPERVISOR. THE SUPERVISOR IS THEN REQUIRED TO DISCLOSE THE INFORMATION TO THE COMPLIANCE OFFICER. BOARD MEMBERS OF SUBSIDIARIES ARE ALSO REQUIRED TO COMPLETE CONFLICT OF INTEREST QUESTIONNAIRES. FORM 990, PART VI, SECTION B, LINE 15A COMPENSATION POLICY PART VI, SECTION B, LINE 15 ST. ELIZABETH MEDICAL CENTER (SEMC) RECOGNIZES THAT STRONG AND EFFECTIVE EXECUTIVE LEADERSHIP IS NEEDED TO ACHIEVE ITS MISSION AND TO SERVE ITS COMMUNITY EFFECTIVELY. 1. THE CHAIRMAN OF THE BOARD OF TRUSTEES WILL APPOINT AN EXECUTIVE COMPENSATION COMMITTEE WHICH IS RESPONSIBLE FOR THE REVIEW AND APPROVAL OF ALL FORMS OF COMPENSATION BENEFITS PROVIDED TO THE PRESIDENT AND CEO OF THE MEDICAL CENTER. 2. IN ORDER TO RECRUIT AND RETAIN THE QUALITY OF LEADERSHIP NECESSARY IN A PRESIDENT AND CEO, SEMC WILL TARGET ITS TOTAL COMPENSATION PROGRAM FOR THE PRESIDENT AND CEO BY COMPARING SAME WITH SIMILARILY SIZED COMMUNITY HOSPITALS IN THE NORTHEASTERN UNITED STATES. 3. THE CEO SALARY RANGE WILL BE SET WITHIN THE RANGE FROM THOSE COMPARABLES. THE RANGE WILL BE REVIEWED PERIODICALLY AND ADJUSTMENTS WILL BE MADE WHEN MARKET CONDITIONS WARRANT AND WHEN FINANICAL PERFORMANCE OF THE MEDICAL CENTER ALLOWS. ANY ADJUSTMENT IN CEO SALARY WILL BE BASED ON THE PARTICULAR EXECUTIVE'S EXPERIENCE, PERFORMANCE, AND CONTRIBUTION TO SEMC, AS WELL AS ON THE COMPETITIVENESS OF THE EXECUTIVE'S SALARY WITHIN THE PEER GROUP. 4. SEMC'S CEO TOTAL COMPENSATION PROGRAM ALSO EMPHASIZES AND REWARDS OUTSTANDING PERFORMANCE THROUGH INCENTIVE AWARD OPPORTUNITIES. 5. THE EXECUTIVE COMPENSATION COMMITTEE WILL ANNUALLY REVIEW THE PRESIDENT AND CEO'S PERFORMANCE BASED UPON OBJECTIVE CRITERIA AND SUBJECTIVE CRITERIA IN AWARDING ANY ANNUAL INCENTIVE. THE COMMITTEE WILL CONSIDER VARIOUS FACTORS INCLUDING, BUT NOT LIMITED TO MEETING PREVIOUSLY APPROVED ANNUAL GOALS, THE OVERALL FINANCIAL PERFORMANCE OF THE MEDICAL CENTER, PATIENT SATISFACTION, QUALITY CARE INDICATORS, BOTH PUBLISHED AND NON-PUBLISHED, AND RESPONSE TO ANY OTHER UNUSUAL OR EXTRAORDINARY CIRCUMSTANCES OCCURRING DURING THE YEAR. THE PAYMENT OF THE INCENTIVE AWARD TO THE EXECUTIVE IS COMPLETELY CONTINGENT ON THE JUDGEMENT OF THE COMPENSATION COMMITTEE AS TO THE EXECUTIVE ACHIEVING PRE-ESTABLISHED GOALS AND TARGETS. IN ADDITION, THE POOL OF MONEY AVAILABLE FOR THE INCENTIVE IS ALSO CONTINGENT AND CONDITIONAL ON THE FINANCIAL PERFORMANCE OF THE MEDICAL CENTER. 6. THE EXECUTIVE COMPENSATION COMMITTEE MAY ALSO ESTABLISH AN ANNUAL INCENTIVE COMPENSATION POOL FOR THE VICE PRESIDENTS. WHEN THIS OCCURS, IT IS EXPECTED THAT THE CEO WILL INCLUDE A TEAM COMPONENT, AS WELL AS AN INDIVIDUAL COMPONENT, TO BE CONSIDERED WHEN DISTRIBUTING THIS POOL TO THE SENIOR LEADERSHIP TEAM. 7. THE COMPENSATION COMMITTEE SHALL ALSO REVIEW THE CEO'S PARTICIPATION AND LEADERSHIP IN COMMUNITY AND PROFESSIONAL ORGANIZATIONS ON WHICH THE EXECUTIVE SERVES. SEMC VALUES THE EXECUTIVE'S PARTICIPATING IN COMMUNITY AND PROFESSIONAL ORGANIZATIONS BUT ALSO RECOGNIZES THAT THE RESPONSIBILITIES TO SEMC MUST BE HIS/HER FIRST PRIORITY. 8. SEMC RECOGNIZES ITS RESPONSIBILITY TO ENSURE THAT ITS EXECUTIVE COMPENSATION PROGRAM IS APPROPRIATE IN VIEW OF ITS STATUS AS A NON-FOR-PROFIT COMMUNITY HOSPITAL AND IN ACCORDANCE WITH ITS TAX-EXEMPT STATUS, AND THAT ITS COMPENSATION AND BENEFITS ARE REASONABLE AND NOT EXCESSIVE. TO THAT END, SEMC AND THE COMMITTEE WILL REVIEW AND APPROVE ALL FORMS OF EXECUTIVE COMPENSATION AND BENEFITS IN A MANNER NECESSARY TO QUALIFY FOR THE "REBUTTABLE PRESUMPTION OF REASONABLENESS" UNDER THE INTERMEDIATE SANCTION RULES OF SECTION 4958 OF THE INTERNAL REVENUE CODE. 9. THE COMPENSATION COMMITTEE SHALL ENSURE THAT ALL ELEMENTS OF COMPENSATION AND BENEFITS PROVIDED TO EXECUTIVES OF SEMC ARE DISCLOSED A) TO THE FULL BOARD ON A REGULAR BASIS, AND B) ON IRS FROM 990 TO THE EXTENT REQUIRED BY LAW. FORM 990, PART VI, SECTION C, LINE 19 PUBLIC DISCLOSURE PART VI, SECION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. THE ORGANIZATION'S FORM 990 IS POSTED ON WWW.GUIDESTAR.ORG. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -379,472. PENSION RELATED CHANGES -18,716,883. NET CHANGE IN FOUNDATION NET ASSETS 133,583. TOTAL TO FORM 990, PART XI, LINE 5: -18,962,772. FORM 990, PART XII, LINE 2C THERE HAS BEEN NO CHANGE IN THE PROCESS BY WHICH THE ORGANIZATION SELECTS ITS INDEPENDENT ACCOUNTANT OR THE PROCESS BY WHICH IT OVERSEES THE AUDIT PROCESS. FORM 990, PART VII, SECTION A, LINE 1A SEMC DOES NOT COMPENSATE THE BOARD OF TRUSTEES FOR THEIR SERVICES AS BOARD MEMBERS. THE COMPENSATION PAID TO TIMOTHY PAGE AND ERIC YOSS WAS FOR PHYSICIAN SERVICES RENDERED. 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