2023-04-05T08:15:06-05:00 2022-06-30 161131146 BONADIO & CO LLP 171 SULLYS TRAIL PITTSFORD NY 14534 990 2021-07-01 160743310 ST JAMES HOSPITAL STJA 6073248110 7329 SENECA ROAD NORTH HORNELL NY 14843 WENDY DISBROW INTERIM CFO 6073248110 2023-04-04 1 WENDY DISBROW 999009999 AIMEE JOZIC P01329472 5853811000 2023-04-04 0 AAL1 IAL1 2021 2023-04-26 12:10:37Z WENDY DISBROW 7329 SENECA ROAD NORTH HORNELL NY 14843 56209865 0 X HTTPS://WWW.URMC.ROCHESTER.EDU/ST-JAMES X 1921 NY ST. JAMES HOSPITAL IS COMMITTED TO THE HEALTH AND WELLNESS OF THE COMMUNITIES WE SERVE BY PROVIDING THE HIGHEST QUALITY OF CARE IN A COMPASSIONATE AND TRUSTED ENVIRONMENT. 11 8 476 8 0 0 12952596 11046943 38612959 44063382 190799 94300 1189607 1005240 52945961 56209865 0 0 0 0 19334124 22358595 0 0 0 26011147 32719247 45345271 55077842 7600690 1132023 102328620 100049317 34064785 31861907 68263835 68187410 ST. JAMES HOSPITAL IS COMMITTED TO THE HEALTH AND WELLNESS OF THE COMMUNITIES WE SERVE BY PROVIDING THE HIGHEST QUALITY OF CARE IN A COMPASSIONATE AND TRUSTED ENVIRONMENT. 0 0 42634607 45068622 ST. JAMES HOSPITAL IS AN ACUTE HEALTHCARE FACILITY PROVIDING ROUTINE, AMBULATORY AND ANCILLARY SERVICES. MAJOR SERVICES INCLUDE MEDICAL, SURGICAL, RADIOLOGY, AND LABORATORY. TOTAL ACUTE DISCHARGES FOR THE HOSPITAL WERE 952. OUTPATIENT REGISTRATIONS FOR THE HOSPITAL WERE 291,779. ST. JAMES HOSPITAL OPERATES SEVERAL PHYSICIAN PRACTICES. TOTAL OFFICE VISITS WERE 58,070, INCLUDING URGENT CARE. 42634607 1 1 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 36 0 1 476 1 0 0 0 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 1 0 NY X DEBRA MICHALEK 6072472200 7329 SENECA ROAD NORTH HORNELL NY 14843 STEVE GOLDSTEIN BOARD MEMBER 1.00 71.00 X 0 3165449 215223 MICHAEL KAMALI MD BOARD MEMBER 1.00 55.00 X 0 651541 76782 AILEEN SHINAMAN BOARD MEMBER 1.00 55.00 X 0 441052 109062 SHAWN HOGAN CHAIR 1.00 X X 0 0 0 PETE WALL VICE CHAIR 1.00 X 0 0 0 GREG SAMMONS SECRETARY 1.00 X X 0 0 0 JOHN WEYAND TREASURER 1.00 X X 0 0 0 ISMAIL MEHR MD BOARD MEMBER 1.00 X 0 0 0 SPENCER ANNABEL MD BOARD MEMBER 1.00 X 0 0 0 NICK KELLEY BOARD MEMBER 1.00 X 0 0 0 BRIAN SCHU BOARD MEMBER 1.00 X 0 0 0 SUSAN GRAY BOARD MEMBER 1.00 X 0 0 0 SKIP SULLIVAN BOARD MEMBER 1.00 X 0 0 0 WENDY DISBROW INTERIM CHIEF EXECUTIVE OFFICER 1.00 X X 23251 0 0 BRYAN O'DONOVAN CEO UNTIL 3/11/2022 40.00 X 228945 0 10840 JAMES WRIGHT INTERIM CFO EFFECTIVE 4/17/2022 20.00 20.00 X 0 210668 40158 JAMES HELMS CFO UNTIL 8/21/2021 20.00 20.00 X 0 200558 22086 JODI HOWE CFO UNTIL 4/16/2022 20.00 20.00 X 129685 0 24888 JOHN ROBSHAW PHYSICIAN 40.00 X 437576 0 31601 SHANE VARGHESE PHYSICIAN 40.00 X 272959 0 9435 SACHIN MANTHURUTHIL PHYSICIAN ASST 40.00 X 274449 0 9435 CURTIS WININGER PHYSICIAN ASST 40.00 X 217856 0 17959 GIACOMO FLORIO ADVANCED PRACTICE PROVIDER 40.00 X 220697 0 28168 1805418 4669268 595637 22 0 1 0 UNIVERSITY OF ROCHESTER MEDICAL FACULTY 135 CORPORATE WOODS 350 ROCHESTER NY 14623 PHYSICIAN SERVICES 6573914 MEDICAL SOLUTIONS LLC PO BOX 310737 DES MOINES IA 50331 NURSE STAFFING 3215379 UNIVERSITY OF ROCHESTER MEDICAL CENTER 601 ELMWOOD AVENUE ROCHESTER TX 14642 MANAGEMENT & ADMINISTRATIVE SERVICES 2166021 STRONG MEMORIAL HOSPITAL 601 ELMWOOD AVENUE ROCHESTER NY 14642 LABORATORY SERVICES 1201275 FSI ACOUSTICAL SYSTEMS INC 2213 BRIGHTON HENRIETTA TOWNLINE RO ROCHESTER NY 14623 CONSTRUCTION CONTRACTING 942617 5 3023148 7487260 536535 11046943 NET PATIENT REVENUE 621990 44063382 44063382 44063382 94300 94300 OTHER REVENUE 900099 1005240 1005240 1005240 56209865 45068622 0 94300 358630 358630 17957350 13663471 4293879 321207 239616 81591 2280053 1700356 579697 1441355 1075231 366124 42532 14727 27805 138495 138495 170381 170381 282224 49614 232610 692180 256814 435366 42188 8458 33730 11434 11401 33 296660 146289 150371 4753920 2344257 2409663 450516 222159 228357 PHYSICIAN FEES 8256701 8256701 MEDICAL SUPPLIES AND DR 5311442 5357969 -46527 TEMPORARY STAFFING 4903301 4420574 482727 PURCHASED SERVICES 4021157 2939405 1081752 3346116 1927565 1418551 55077842 42634607 12443235 0 11404429 7682696 17292 17318 1002304 44000 5095005 7693361 5441600 5441600 1224712 916455 400271 390919 73326805 11570211 61865295 61756594 15877712 16106374 102328620 100049317 8779355 9848728 9617273 8776836 15668157 13236343 34064785 31861907 X 66588340 67376192 1675495 811218 68263835 68187410 102328620 100049317 X 1132023 -1208448 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 26366 26366 26366 26366 26366 26366 26366 26366 27732 -1366 26366 1.00000 0 1 1 935597 935597 54172573 5272335 48900238 136058 136058 0 17782645 6139708 11642937 299932 22110 277822 61756594 OTHER RECEIVABLES - CURRENT 2588289 OTHER RECEIVABLES - NONCURRENT 3130090 RIGHT TO USE ASSET 9881934 OTHER INVESTMENTS 710077 ASSETS LIMITED AS TO USE - CURRENT -204016 16106374 OTHER LIABILITIES - CURRENT 322417 OTHER LIABILITIES - NONCURRENT 123213 DUE TO THIRD PARTIES 437000 RIGHT TO USE LIABILITY 10974660 DUE TO AFFILIATES 1379053 13236343 PART V, LINE 4: WITH THE HELP OF 350 COMMUNITY MEMBERS, BUSINESS PARTNERS, EMPLOYEES, PROVIDERS, FRIENDS, AND DONORS, ST. JAMES FOUNDATION RAISES CHARITABLE GIFTS TO MAKE POSSIBLE A RANGE OF FACILITIES IMPROVEMENTS, CAPITAL EQUIPMENT AND PROGRAM INITIATIVES. 1 1 1 X 1 X 1 1 0 0 704436 728098 0 0.00000 11828044 8145018 3683026 0.06690 12532480 8873116 3683026 0.06690 33415 33415 0.00060 41385 41385 0.00080 10801 10801 0.00020 85601 85601 0.00160 12618081 8873116 3768627 0.06850 1812057 5570 7246735 9927838 -2681103 X 1 1 1 1 ST JAMES HOSPITAL 411 CANISTEO STREET HORNELL NY 14843 WWW.URMC.ROCHESTER.EDU/ST-JAMES 5002001H X X X ST JAMES HOSPITAL 1 0 0 1 X X X X X X X X X 22 1 1 1 1 X SEE SUPPLEMENTAL INFORMATION 1 22 1 SEE SUPPLEMENTAL INFORMATION 0 1 X 200.000000000000 400.000000000000 X X X X X 1 1 X X X X 1 X SEE SUPPLEMENTAL INFORMATION X SEE SUPPLEMENTAL INFORMATION X SEE SUPPLEMENTAL INFORMATION X X X X X X 1 X 0 X X X 1 0 0 ST. JAMES HOSPITAL PART V, SECTION B, LINE 5: THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) WAS CONDUCTED IN 2022 IN COLLABORATION WITH STEUBEN COUNTY PUBLIC HEALTH. THIS INCLUDED THE THREE HOSPITALS LOCATED WITHIN THE COUNTY. A VARIETY OF PARTNERS WERE ENGAGED THROUGHOUT THE PROCESS INCLUDING REPRESENTATIVES FROM ACADEMIA, NOT-FOR-PROFIT ORGANIZATIONS, BUSINESSES, THE GENERAL PUBLIC AND LOCAL GOVERNMENT. THE PARTNERS WERE ENGAGED THROUGHOUT THE ASSESSMENT PERIOD VIA AN ONLINE SURVEY AND FOCUS GROUPS. A FULL LIST OF PARTICIPANTS CAN BE FOUND IN THE STEUBEN COUNTY CHNA LOCATED ON THE ST. JAMES HOSPITAL (SJH) WEBSITE. ST. JAMES HOSPITAL PART V, SECTION B, LINE 6A: ARNOT HEALTH - IRA DAVENPORT MEMORIAL HOSPITAL, GUTHRIE CORNING HOSPITAL, ST. JAMES HOSPITAL ST. JAMES HOSPITAL PART V, SECTION B, LINE 6B: STEUBEN COUNTY PUBLIC HEALTH, COMMUNITY HEALTH, OAK ORCHARD HEALTH, PIVITAL PUBLIC HEALTH PARTNERSHIP, PREGNANCY RESOURCE CENTER OF THE VALLEYS, GUTHRIE CLINIC, STEUBEN PREVENTION COALITION, COMMON GROUND HEALTH, VA MEDICAL CENTER, SOUTHERN TIER LIBRARY SYSTEM, PROACTION, FINGER LAKES COMMUNITY HEALTH, HORNELL YMCA, STEUBEN RURAL HEALTH NETWORK AT THE INSTITUTE FOR HUMAN SERVICES INC, SOUTHERN TIER TOBACCO AWARENESS COALITION, WEGMANS, COUNTY LEGISLATURE, CATHOLIC CHARITIES/STEUBEN COUNCIL ON ADDICTIONS, COMMUNITY SERVICES/SUICIDE PREVENTION, CORNING COMMUNITY COLLEGE, UR PRIMARY CARE. ST. JAMES HOSPITAL PART V, SECTION B, LINE 11: PREVENT CHRONIC DISEASE/INCREASE SKILLS AND KNOWLEDGE TO SUPPORT HEALTH FOOD AND BEVERAGE CHOICES: SJH WILL WORK WITH HORNELL SCHOOL DISTRICT, HORNELL AREA YMCA AND CONCERN FOR YOUTH TO IDENTIFY WAYS TO DECREASE COSTS FOR ACTIVITIES AND INCREASE EDUCATION ABOUT HEALTHY FOOD CHOICES FOR KIDS. SJH WILL DISCUSS WITH HORNELL SCHOOL DISTRICT THE ITEMS OFFERED IN VENDING MACHINES AND AT MEAL TIMES. SJH WILL WORK WITH THOSE PARTNERS TO IDENTIFY CURRICULUMS TO USE IN SCHOOL DISTRICTS TO EDUCATE STUDENTS ON HEALTHY EATING. THE PARTNERS WILL WORK TO INCREASE THE NUMBER OF FREE OR LOW/COST SPORT/ACTIVITY PROGRAMS FOR CHILDREN IN THE HORNELL AREA.PROMOTE WELL-BEING AND PREVENT MENTAL AND SUBSTANCE USE DISORDERS/SUBSTANCE ABUSE DISORDERS SJH WILL REGISTER AS A NYS OPIOID OVERDOSE PREVENTION PROGRAM TO DISTRIBUTE NALOXONE FROM THE EMERGENCY DEPARTMENT TO PATIENTS AT RISK OF OVERDOSE. SJH WILL INCREASE THE NUMBER OF HOSPITAL STAFF TRAINED TO PROVIDE NARCAN TO MEMBERS OF THE COMMUNITY AND INCREASE THE NUMBER OF PROVERS WITH X-WAIVERS. SCHEDULE H, PART V, SECTION B, LINE 7A HTTPS://WWW.URMC.ROCHESTER.EDU/ST-JAMES/PATIENTS-VISITORS.ASPX SCHEDULE H, PART V, SECTION B, LINE 7B HTTPS://WWW.STEUBENCOUNTY.GOV/FILES/DOCUMENTS/PUBLICHEALTH/STEUBEN%20COUNTY%20CHIP%20CHART%20-%20120319.PDF SCHEDULE H, PART V, SECTION B, LINE 10A HTTPS://WWW.URMC.ROCHESTER.EDU/ST-JAMES/PATIENTS-VISITORS.ASPX SCHEDULE H, PART V, SECTION B, LINE 16A HTTPS://WWW.URMC.ROCHESTER.EDU/PAY-BILL/FINANCIAL-ASSISTANCE/ST-JAMES-HOSPITAL-FINANCIAL-ASSISTANCE.ASPX SCHEDULE H, PART V, SECTION B, LINE 16B HTTPS://WWW.URMC.ROCHESTER.EDU/PAY-BILL/FINANCIAL-ASSISTANCE/ST-JAMES-HOSPITAL-FINANCIAL-ASSISTANCE.ASPX SCHEDULE H, PART V, SECTION B, LINE 16C HTTPS://WWW.URMC.ROCHESTER.EDU/PAY-BILL/FINANCIAL-ASSISTANCE/ST-JAMES-HOSPITAL-FINANCIAL-ASSISTANCE.ASPX PART III, LINE 4: IMPLICIT PRICE CONCESSIONS FURTHER REDUCE CUSTOMER ACCOUNTS TO THEIR NET REALIZABLE VALUE AT THE TIME THEY ARE RECORDED AND REPRESENT ESTIMATED UNCOLLECTIBLE BALANCES OF SELF-PAY, DEDUCTIBLES AND CO-PAYMENTS EXTENDED PRIMARILY TO UNINSURED OR UNDER-INSURED CUSTOMERS. ESTIMATES OF IMPLICIT PRICE CONCESSIONS ARE DETERMINED BASED ON HISTORICAL COLLECTION EXPERIENCE WITH THESE CLASSES OF CUSTOMERS USING A PORTFOLIO APPROACH AS A PRACTICAL EXPEDIENT TO ACCOUNT FOR CUSTOMER CONTRACTS AS COLLECTIVE GROUPS RATHER THAN AS INDIVIDUAL CONTRACTS. THE FINANCIAL STATEMENT EFFECTS OF USING THIS PRACTICAL EXPEDIENT ARE NOT MATERIALLY DIFFERENT FROM AN INDIVIDUAL CONTRACT APPROACH. SCHEDULE H, PART I, LINE 7 THE COST-TO-CHARGE RATIO IS USED TO FIND 7A AND 7B, COMPUTED BY TAKING TOTAL EXPENSES DIVIDED BY TOTAL GROSS PATIENT REVENUE. SCHEDULE H, PART III, SECTION A, LINE 2 THE COSTING METHODOLOGY USED IN DETERMINING THE AMOUNTS REPORTED ON LINES 2 AND 3 ARE BASED ON ACTUAL CHARGES WRITTEN OFF (AMOUNTS THAT ARE DEEMED TO BE UNCOLLECTIBLE AND RECORDED AS IMPLICIT PRICE CONCESSIONS UNDER NEW ACCOUNTING PRONOUNCEMENT ASC606). THE TEST OF THE IMPLICIT PRICE CONCESSIONS (BAD DEBT EXPENSE) FOOTNOTE CAN BE FOUND ON THE ATTACHED AUDITED FINANCIAL STATEMENTS. SCHEDULE H, PART III, SECTION B, LINE 8 TO DETERMINE MEDICARE ALLOWABLE COSTS REPORTABLE IN THE MEDICARE COST REPORT, THE COST-TO-CHARGE RATIO IS APPLIED TO GROSS PATIENT REVENUE ASSOCIATED WITH SERVICES PERFORMED FOR PATIENTS WHO ARE ELIGIBLE FOR MEDICARE. CONSISTENT WITH THE CHARITABLE HEALTHCARE MISSION OF THE HOSPITAL AND THE COMMUNITY BENEFIT STANDARDSET FORTH IN IRS REVENUE RULING 69545, THE HOSPITAL PROVIDES CARE FOR ALL PATIENTS COVERED BY MEDICARESEEKING MEDICAL CARE. SUCH CARE IS PROVIDED REGARDLESS OF WHETHER THE REIMBURSEMENT PROVIDED FORSUCH SERVICES MEETS OR EXCEEDS THE COSTS INCURRED BY THE HOSPITAL TO PROVIDE SUCH SERVICES. SCHEDULE H, PART III, SECTION C, LINE 9B A BAD DEBT RESULTS FROM A PATIENT ACCOUNT BALANCE FROM WHICH PAYMENT WAS ANTICIPATED FROM THE PATIENT, CREDIT EXTENDED AND THEN ACCOUNT LATER DEEMED TO BE UNCOLLECTIBLE. A BAD DEBT DOES NOT MEET THE CRITERIA FOR CHARITY CARE, THAT IS, BAD DEBT PATIENTS ARE CONSIDERED TO HAVE THE FINANCIAL CAPABILITY AND ABILITY TO PAY BUT ARE UNWILLING TO PAY. COLLECTION ACTIVITIES ARE ONLY PURSUED WITH RESPECT TO AMOUNTS THAT PATIENTS ARE ABLE TO PAY AS DETERMINED BY THE HOSPITAL'S CHARITY CARE POLICY. NO COLLECTION ACTIVITIES TAKE PLACE WITH RESPECT TO AMOUNTS THAT PATIENTS ARE NOT EXPECTED TO PAY UNDER THIS POLICY. THE CHARITY CARE POLICY IN PLACE WOULD BE EXHAUSTED BEFORE A PATIENT BALANCE WOULD BE DEEMED SELF-PAY. UNDER THE CHARITY CARE POLICY, CHARITY CARE/FINANCIAL ASSISTANCE IS PROVIDED TO A PATIENT WITH DEMONSTRATED INABILITY TO PAY. A PATIENT IS ELIGIBLE FOR CHARITY CARE/FINANCIAL ASSISTANCE CONSIDERATION BASED UPON MEETING CERTAIN INCOME ELIGIBILITY CRITERIA AS ESTABLISHED BY THE FEDERAL POVERTY GUIDELINE SLIDING SCALE. PER NYS PUBLIC HEALTH LAW 2807-K, THIS CONSIDERS PATIENTS WHOSE HOUSEHOLD INCOME IS UP TO 300% OF THE MOST RECENT FEDERAL POVERTY GUIDELINES. ALL UNINSURED, LOW-INCOME PATIENTS WHO CAN DEMONSTRATE AN INABILITY TO PAY MAY APPLY FOR CHARITY CARE/FINANCIAL ASSISTANCE FOR ADJUSTMENT TO THEIR BALANCES FOR ALL MEDICALLY NECESSARY HEALTHCARE SERVICES PROVIDED THAT A MEMBER IN GOOD STANDING OF THE SJH MEDICAL STAFF DETERMINES THE NEED FOR SUCH MEDICAL CARE. SCHEDULE H, PART VI, LINE 2 ST. JAMES HOSPITAL (SJH) CONDUCTS A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) EVERY THREE YEARS IN CONJUNCTION WITH STEUBEN COUNTY PUBLIC HEALTH. IN ADDITION TO THAT, SJH USES THE FOLLOWING TO DETERMINE THE HEALTH NEEDS OF THE COMMUNITY: SURVEYING PARTICIPANTS AT PUBLIC HEALTH EDUCATION PROGRAMS, LOCAL CASE MANAGEMENT MEETINGS, AND INFORMATION SHARED AT PHYSICIAN OFFICES. BASED ON THE CHNA AND OTHER INFORMATION GATHERED, THE COUNTY'S HEALTHCARE PRIORITIES, STRATEGIES AND PROGRAMS ARE DETERMINED. SJH CREATES AN ACTION PLAN BASED ON THE CHNA. THE PROGRESS OF THESE INITIATIVES ARE REPORTED ANNUALLY TO THE NYS DEPARTMENT OF HEALTH. SCHEDULE H, PART VI, LINE 3 FINANCIAL COUNSELING STARTS AT THE POINT OF REGISTRATION. REGISTRARS WILL ASK ALL UNINSURED PATIENTS IF THEY WOULD LIKE TO SPEAK WITH A FINANCIAL COUNSELOR. IF REQUESTED, THE COUNSELOR WILL THEN CONTACT THE PATIENT WITHIN 24 HOURS. THEY ARE ALSO AVAILABLE FOR PATIENTS TO COME ONSITE TO REVIEW THEIR DOCUMENTS AND FINANCIAL SITUATION. FINANCIAL COUNSELING SERVICES INCLUDE: ASSISTANCE WITH NAVIGATION OF NYS OF HEALTH ENROLLERS FOR MEDICAID APPLICATIONS, ASSISTANCE WITH CHARITY CARE APPLICATIONS, ASSISTANCE WITH OTHER DISCOUNT POLICIES FOR INPATIENTS AND HIGH COST SERVICES, FLEXIBLE PAYMENT ARRANGEMENTS AND ANSWERING QUESTIONS REGARDING PATIENT STATEMENTS. SCHEDULE H, PART VI, LINE 4 THE PRIMARY SERVICE AREA FOR SJH IS THE 15-MILE RADIUS EXTENDING FROM HORNELL, NY IN STEUBEN COUNTY. THE SECONDARY SERVICE AREA IS THE 30-MILE RADIUS EXTENDING FROM HORNELL. PER CENSUS DATA, THE POPULATION IN THE AREA HAS NOT CHANGED SIGNIFICANTLY OVER THE PAST SEVERAL YEARS. THROUGH 2040, THE POPULATION OF STEUBEN COUNTY IS PROJECTED TO DECREASE BETWEEN 6-7%. THE POPULATION OF 65+ RESIDENTS IN THE REGION IS PROJECTED TO GROW BY 11% OVER THE NEXT FIVE YEARS. THE POPULATION IN STEUBEN COUNTY IS ETHNICALLY HOMOGENOUS WITH 94% RESIDENTS BEING WHITE. AN ESTIMATED 14% OF STEUBEN COUNTY RESIDENTS ARE LIVING BELOW THE POVERTY LEVEL. EDUCATIONAL ATTAINMENT OF POST-HIGH SCHOOL EDUCATION HAS INCREASED SLIGHTLY IN RECENT YEARS. SCHEDULE H, PART VI, LINE 5 SJH IS THE LEAD AGENCY FOR THE CANCER SERVICES PROGRAM (CSP) OF STEUBEN COUNTY. A COMMUNITY-BASED, GRANT-FUNDED PROGRAM OF NEW YORK STATE DEPARTMENT OF HEALTH (NYSDOH), THE CSP SERVES AGE ELIGIBLE, UNINSURED MEN AND WOMEN WITH NO-COST SCREENINGS FOR BREAST, CERVICAL, AND COLORECTAL CANCER. THE ORGANIZATION PARTICIPATES IN LOCAL HEALTH FAIRS AND WORKS WITH LOCAL BUSINESSES TO PROMOTE WORKPLACE WELLNESS. IN ADDITION, SJH OPERATES A CARDIAC REHAB PROGRAM AND COUMADIN CLINIC THAT PROVIDE OUTPATIENT BASED SERVICES TO THE COMMUNITY. SJH STAFF MEMBERS THROUGHOUT THE ORGANIZATION PARTICIPATE IN COMMUNITY INITIATIVES AND HOLD SEATS ON VARIOUS BOARDS OF NON-PROFIT ORGANIZATIONS WHOSE PRIMARY MISSION IS TO ASSESS AND ADDRESS COMMUNITY NEEDS. SCHEDULE H, PART VI, LINE 6 THE UNIVERSITY OF ROCHESTER MEDICAL CENTER (URMC) IS ONE OF THE NATION'S LEADING ACADEMIC MEDICAL CENTERS. IT FORMS THE CENTERPIECE OF THE UNIVERSITY OF ROCHESTER'S HEALTH RESEARCH, TEACHING AND PATIENT CARE MISSIONS. URMC IS A PRIVATE, COEDUCATIONAL, NONSECTARIAN, AND NONPROFIT UNIVERSITY. URMC CONSISTS OF SIX HOSPITALS LOCATED THROUGHOUT THE FINGER LAKES AND SOUTHERN TIER REGIONS STRONG MEMORIAL, HIGHLAND, FF THOMPSON, NOYES MEMORIAL, JONES MEMORIAL AND ST. JAMES HOSPITALS AS WELL AS GOLISANO CHILDREN'S HOSPITAL, JAMES P WILMOT CANCER CENTER, EASTMAN INSTITUTE FOR ORAL HEALTH, UR MEDICINE HOME CARE, THE HIGHLANDS AT PITTSFORD AND HIGHLANDS AT BRIGHTON, NINE URGENT CARE CENTERS AND AN EXTENSIVE PRIMARY CARE NETWORK. SCHEDULE H, PART VI, LINE 7 NEW YORK STATE X X X X 0 1 0 0 0 0 0 0 0 STEVE GOLDSTEIN BOARD MEMBER 0 1326628 0 0 0 1838821 0 193001 0 22222 0 3380672 0 889000 MICHAEL KAMALI MD BOARD MEMBER 0 630325 0 18271 0 2945 0 46501 0 30281 0 728323 0 0 AILEEN SHINAMAN BOARD MEMBER 0 421302 0 0 0 19750 0 27248 0 81814 0 550114 0 0 JOHN ROBSHAW PHYSICIAN 388428 0 0 0 49148 0 0 0 31601 0 469177 0 0 0 SACHIN MANTHURUTHIL PHYSICIAN ASST 272049 0 0 0 2400 0 0 0 9435 0 283884 0 0 0 SHANE VARGHESE PHYSICIAN 272159 0 0 0 800 0 0 0 9435 0 282394 0 0 0 JAMES WRIGHT INTERIM CFO EFFECTIVE 4/17/2022 0 210418 0 0 0 250 0 14951 0 25207 0 250826 0 0 GIACOMO FLORIO ADVANCED PRACTICE PROVIDER 192492 0 0 0 28205 0 0 0 28168 0 248865 0 0 0 BRYAN O'DONOVAN CEO UNTIL 3/11/2022 228945 0 0 0 0 0 0 0 10840 0 239785 0 0 0 CURTIS WININGER PHYSICIAN ASST 212756 0 0 0 5100 0 0 0 17959 0 235815 0 0 0 JAMES HELMS CFO UNTIL 8/21/2021 0 200558 0 0 0 0 0 0 0 22086 0 222644 0 0 JODI HOWE CFO UNTIL 4/16/2022 129685 0 0 0 0 0 0 0 24888 0 154573 0 0 0 SCHEDULE J, PART I, LINE 4 THE FOLLOWING INDIVIDUAL PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN AND RECEIVED EMPLOYER PAID AMOUNTS THAT ARE INCLUDED IN DEFERRED COMPENSATION: STEVEN GOLDSTEIN - SERP PLAN - $159,400 MICHAEL KAMALI, MD - SERP PLAN - $12,900 THE FOLLOWING INDIVIDUAL PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN AND RECEIVED EMPLOYER PAID AMOUNTS THAT ARE INCLUDED IN OTHER REPORTABLE COMPENSATION: STEVEN GOLDSTEIN - 457(F) - $1,749,057 THESE AMOUNTS REPRESENT EMPLOYEE DEFFERALS OF COMPENSATION, PLUS INVESTMENT EARNINGS, OVER SEVERAL YEARS THAT VESTED AND WERE PAID PURSUANT TO THE REQUIREMENTS OF THE PLAN. THE EMPLOYEE DEFERRALS WERE REPORTED AS DEFERRED COMPENSATION IN SCHEDULE J, PART II, COLUMN C IN PRIOR YEARS AND ARE ALSO REFLECTED IN SCHEDULE J, PART II, COLUMN F. FORM 990, PART VI, SECTION A, LINE 2 GIVEN THAT MANY OF OUR BOARD MEMBERS INCLUDE PROFESSIONALS IN INDUSTRIES SUCH AS BANKING, LAW, AND FINANCIAL ADVISEMENT, IT IS OUR UNDERSTANDING THAT SOME BOARD MEMBERS ENGAGE WITH EACH OTHER IN PROFESSIONAL BUSINESS ACTIVITIES. GIVEN THE COMPREHENSIVE CONFLICT OF INTEREST FORMS THE BOARD MEMBERS COMPLETE, WE DO NOT BELIEVE ANY SUCH RELATIONSHIP IMPACTS THEIR DECISION MAKING AS TO ST. JAMES ACTIVITIES AND TO THE EXTENT THERE IS A POTENTIAL CONFLICT OF INTEREST IS DISCLOSED BY A BOARD MEMBER, THE BOARD MEMBER IS INSTRUCTED TO FOLLOW OUR CONFLICT OF INTEREST POLICY. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF ST. JAMES HOSPITAL IS THE UNIVERSITY OF ROCHESTER (UR). AS SUCH, UR HAS THE AUTHORITY TO ELECT THE GOVERNING BODY OF ST. JAMES HOSPITAL AND CERTAIN DECISIONS OF ST. JAMES HOSPITAL ARE SUBJECT TO THE APPROVAL OF UR. SUCH DECISIONS INCLUDE AMENDMENT OF THE CERTIFICATE OF INCORPORATION AND BYLAWS AND APPROVAL OF EXTRAORDINARY CORPORATE ACTIONS SUCH AS MERGER OR DISSOLUTION. FORM 990, PART VI, SECTION A, LINE 7A REFER TO SCHEDULE O, MEMBERSHIP INFORMATION FORM 990 PART VI, SECTION A, LINE 6 FORM 990, PART VI, SECTION A, LINE 7B REFER TO SCHEDULE O, MEMBERSHIP INFORMATION FORM 990 PART VI, SECTION A, LINE 6 FORM 990, PART VI, SECTION B, LINE 11B A COPY OF THE FORM 990 WAS MADE AVAILABLE TO EACH BOARD MEMBER BEFORE IT WAS FILED. ST. JAMES HOSPITAL HAS DESIGNATED THE AUDIT AND COMPLIANCE COMMITTEE AS THE GROUP TO BE EDUCATED AND TO REVIEW THE RETURN. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS, OFFICERS, AND KEY EMPLOYEES (DETERMINED BY THE PRESIDENT & CEO) COMPLETE CONFLICT OF INTEREST FORMS ANNUALLY TO IDENTIFY ACTUAL AND POTENTIAL CONFLICTS OF INTEREST THAT MAY EXIST RELATIVE TO THEIR DUTIES WITH THE ORGANIZATION AND THE ORGANIZATION'S COI POLICY. THE CEO SHALL DISCLOSE TO THE BOARD OR APPROPRIATE COMMITTEE THEREOF ANY EMPLOYEE DISCLOSURE MADE RELEVANT TO THE MATTER AND THE EVALUATION THEREOF. COPIES ARE PROVIDED TO THE CORPORATE COMPLIANCE OFFICER AND MAINTAINED BY THE EXECUTIVE ASSISTANT TO THE BOARD OF DIRECTORS AND THE CEO. IF A CONFLICT IS DISCLOSED, THAT PERSON SHALL LEAVE THE BOARD OR COMMITTEE MEETING WHILE THE DETERMINATION OF A CONFLICT OF INTEREST IS DISCUSSED AND VOTED UPON. THE CHAIRPERSON OF THE BOARD OR COMMITTEE WILL DETERMINE IF A CONFLICT OF INTEREST EXISTS. TO HELP ENSURE COMPLIANCE WITH THE COI POLICY, AMONG THE PROVISIONS THE PERSON WITH AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST WILL NOT BE ALLOWED TO PARTICIPATE IN ANY DISCUSSION OR DECISION ON ANY AREA OF THE CONFLICT IDENTIFIED AND LEAVE THE ROOM DURING DICUSSION AND VOTE. THE CORPORATE RESPONSIBILITY AND COMPLIANCE COMMITTEE REVIEWS THESE PROCEDURES EVERY TWO YEARS TO ASSESS THEIR EFFECTIVENESS AND RECOMMEND (OR MAKE) APPROPRIATE CHANGES AS NEEDED TO ENSURE THE CONFLICT OF INTEREST POLICY IS CONSISTENTLY AND EFFECTIVELY ENFORCED. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD HAS AN INDEPENDENT COMMITTEE REVIEW AND APPROVE ALL ELEMENTS OF REMUNERATION FOR KEY MANAGEMENT. THE BOARD/COMMITTEE HAS AN ESTABLISHED COMPENSATION PHILOSOPHY WHICH DETAILS THE OBJECTIVES OF MARKET POSITIONING AND PAY ELEMENTS. THE COMMITTEE REVIEWS MARKET DATA, COMPARATIVE MARKET COMPENSATION DATA, APPROVES ANY SALARY ADJUSTMENTS FOR THE EXECUTIVE POPULATION, CONSIDERS BOTH REASONABLENESS AND EFFECTIVENESS OF ALL REMUNERATIVE PROGRAMS AND ESTABLISHES THE DETAILED PERFORMANCE EXPECTATIONS. ALL OF THESE DISCUSSIONS AND DECISIONS ARE DOCUMENTED THROUGH THE PROVISION OF MEETING MINUTES. FORM 990, PART VI, SECTION C, LINE 19 ST. JAMES HOSPITAL'S FORM 1023 AND FORM 990 ARE AVAILABLE UPON REQUEST. ST. JAMES HOSPITAL'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND AUDITED FINANCIAL STATEMENTS ARE NOT ROUTINELY MADE AVAILABLE TO THE PUBLIC. FORM 990, PART XI, LINE 9: CHANGE IN BENEFICIAL INTEREST IN NET ASSETS OF THE SJH FOUNDATION -1,165,799. TRANSFERS TO UNIVERSITY OF ROCHESTER MEDICAL CENTER -42,649. FFT SENIOR COMMUNITIES INC 1 FERRIS HILLS CANANDAIGUA NY 14424 161557494 ELDER CARE NY 501(C)(3) LINE 10 FF THOMPSON HEALTH SYSTEM INC 0 HIGHLAND COMMUNITY DEVELOPMENT CORP - 100 HAHNEMANN TRAIL PITTSFORD NY 14534 223154715 ELDER CARE NY 501(C)(3) LINE 10 STRONG PARTNERS HEALTH SYSTEM INC 0 HIGHLAND HOSPITAL OF ROCHESTER 1000 SOUTH AVENUE ROCHESTER NY 14620 160743037 HOSPITAL NY 501(C)(3) LINE 3 STRONG PARTNERS HEALTH SYSTEM INC 0 THE HIGHLAND FOUNDATION INC 1000 SOUTH AVENUE ROCHESTER NY 14620 237310662 FUNDRAISING NY 501(C)(3) LINE 12A, I HIGHLAND HOSPITAL OF ROCHESTER 0 HIGHLAND FACILITIES DEVELOPMENT CORPORATION 1000 SOUTH AVENUE ROCHESTER NY 14620 223039077 MEDICAL BLDG NY 501(C)(3) LINE 10 HIGHLAND HOSPITAL OF ROCHESTER 0 LIVINGSTON HEALTH CARE SYSTEM INC 111 CLARA BARTON STREET DANSVILLE NY 14427 161455240 SUPPORT ORG NY 501(C)(3) LINE 12A, I UNIVERSITY OF ROCHESTER 0 RED JACKET CENTER INC 111 CLARA BARTON STREET DANSVILLE NY 14427 161037658 MEDICAL BLDG NY 501(C)(3) LINE 12A, I LIVINGSTON HEALTH CARE SYSTEM INC 0 THE FOUNDATION FOR NOYES MEMORIAL HEALTH SYSTEM INC 111 CLARA BARTON STREET DANSVILLE NY 14427 161584778 FUNDRAISING NY 501(C)(3) LINE 7 LIVINGSTON HEALTH CARE SYSTEM INC 0 JONES MEDICAL SERVICES PC 191 NORTH MAIN STREET WELLSVILLE NY 14895 465210222 MEDICAL CLINIC NY 501(C)(3) LINE 3 THE MEMORIAL HOSPITAL OF WILLIAM F AND GERTRUDE F JONES INC 0 JONES MEMORIAL HOSPITAL FOUNDATION 191 NORTH MAIN STREET WELLSVILLE NY 14895 473763374 SUPPORT ORG NY 501(C)(3) LINE 7 THE MEMORIAL HOSPITAL OF WILLIAM F AND GERTRUDE F JONES INC 0 THE MEMORIAL HOSPITAL OF WILLIAM F AND GERTRUDE F JONES INC 191 NORTHMAIN STREET WELLSVILLE NY 14895 222807681 HOSPITAL NY 501(C)(3) LINE 3 UNIVERSITY OF ROCHESTER 0 UNIVERSITY OF ROCHESTER BROADCASTING CORPORATION 201 WILSON COMMONS ROCHESTER NY 14627 160743209 BROADCAST LIC NY 501(C)(4) UNIVERSITY OF ROCHESTER 0 UR MEDICINE HOME CARE COMMUNITY SERVICES INC 2180 EMPIRE BOULEVARD WEBSTER NY 14580 825091873 HEALTHCARE NY 501(C)(3) LINE 10 UR MEDICINE HOME CARE INC 0 UR MEDICINE HOME CARE LICENSED SERVICES INC 2180 EMPIRE BOULEVARD WEBSTER NY 14580 161561691 HEALTHCARE NY 501(C)(3) LINE 10 UR MEDICINE HOME CARE INC 0 UR MEDICINE HOME CARE CERTIFIED SERVICES INC 2180 EMPIRE BOULEVARD WEBSTER NY 14580 160743215 HEALTHCARE NY 501(C)(3) LINE 10 UR MEDICINE HOME CARE INC 0 UR MEDICINE HOME CARE INC 2180 EMPIRE BOULEVARD WEBSTER NY 14580 222577664 FUNDRAISING NY 501(C)(3) LINE 7 UNIVERSITY OF ROCHESTER 0 UR MEDICINE HOME CARE FOUNDATION INC 2180 EMPIRE BOULEVARD WEBSTER NY 14580 831912967 SUPPORT ORG NY 501(C)(3) LINE 12A, I UR MEDICINE HOME CARE INC 0 NEXTCORPS INC 260 EAST MAIN STREET SUITE 6000 ROCHESTER NY 14604 161195028 BUSINESS INCUB NY 501(C)(3) LINE 7 UNIVERSITY OF ROCHESTER 0 UR REAL ESTATE CORPORATION 263 WALLIS HALL ROCHESTER NY 14627 271140014 SUPPORT ORG NY 501(C)(3) LINE 12A, I UNIVERSITY OF ROCHESTER 0 MELIORA REAL ESTATE CORPORATION 263 WALLIS HALL ROCHESTER NY 14627 452464788 SUPPORT ORG NY 501(C)(3) LINE 12A, I UNIVERSITY OF ROCHESTER 0 EXCELL PARTNERS INC 343 STATE STREET KODAK TOWER 2ND FL ROCHESTER NY 14650 201862628 ECONOMIC DEV NY 501(C)(4) UNIVERSITY OF ROCHESTER 0 FF THOMPSON HEALTH SYSTEM INC 350 PARRISH STREET CANANDAIGUA NY 14424 222959987 SUPPORT ORG NY 501(C)(3) LINE 12A, I UNIVERSITY OF ROCHESTER 0 MM EWING CONTINUING CARE CENTER 350 PARRISH STREET CANANDAIGUA NY 14424 237046583 HEALTHCARE NY 501(C)(3) LINE 3 FF THOMPSON HEALTH SYSTEM INC 0 THE FREDERICK FERRIS THOMPSON HOSPITAL 350 PARRISH STREET CANANDAIGUA NY 14424 160743024 HOSPITAL NY 501(C)(3) LINE 3 FF THOMPSON HEALTH SYSTEM INC 0 THE FF THOMPSON FOUNDATION INC 350 PARRISH STREET CANANDAIGUA NY 14424 222959984 FUNDRAISING NY 501(C)(3) LINE 7 FF THOMPSON HEALTH SYSTEM INC 0 NICHOLAS H NOYES MEMORIAL HOSPITAL INC 111 CLARA BARTON STREET DANSVILLE NY 14427 160743979 HOSPITAL NY 501(C)(3) LINE 3 LIVINGSTON HEALTH CARE SYSTEM INC 0 ST JAMES HOSPITAL FOUNDATION INC 7329 SENECA ROAD NORTH HORNELL NY 14843 161486437 FUNDRAISING NY 501(C)(3) LINE 7 ST JAMES HOSPITAL 1 THE HIGHLANDS LIVING CENTER INC 500 HAHNEMANN TRAIL PITTSFORD NY 14534 223240227 HEALTHCARE NY 501(C)(3) LINE 10 STRONG PARTNERS HEALTH SYSTEM INC 0 THE MEADOWS AT WESTFALL INC 5901 LAC DE VILLE BLVD ROCHESTER NY 14618 161502303 HEALTHCARE NY 501(C)(3) LINE 10 STRONG PARTNERS HEALTH SYSTEM INC 0 ROCHESTER BIOVENTURE CENTER INC 601 ELMWOOD AVENUE BOX 706 ROCHESTER NY 14642 202485999 BIOTECH INCUB NY 501(C)(3) LINE 12A, I UNIVERSITY OF ROCHESTER 0 STRONG PARTNERS HEALTH SYSTEM INC 601 ELMWOOD AVENUE BOX 706 ROCHESTER NY 14642 161499099 SUPPORT ORG NY 501(C)(3) LINE 12A, I UNIVERSITY OF ROCHESTER 0 FINGER LAKES HOME CARE INC 756 PRE-EMPTION ROAD GENEVA NY 14456 161489133 HEALTHCARE NY 501(C)(3) LINE 10 UR MEDICINE HOME CARE CERTIFIED SERVICES INC 0 UNIVERSITY OF ROCHESTER 910 GENESEE STREET STE 200 ROCHESTER NY 14611 160743209 SCHOOL NY 501(C)(3) LINE 2 N/A 0 EXCELL INNOVATIVE NY FUND LP 343 STATE STREET KODAK TOWER 2ND FL ROCHESTER NY 14650 462405519 INVESTMENT FUND NY ETV INC 0 0 EXCELL MINORITY AND WOMEN OWNED BUSINESS INVESTMENT FUND LP 343 STATE STREET KODAK TOWER 2ND FL ROCHESTER NY 14650 810723223 INVESTMENT FUND NY ETV INC 0 0 EXCELL PARTNERS INNOVATE TC FUND LP 343 STATE STREET KODAK TOWER 2ND FL ROCHESTER NY 14650 810711015 INVESTMENT FUND NY ETV INC 0 0 FINGER LAKES VENTURE FUND LP 343 STATE STREET KODAK TOWER 2ND FL ROCHESTER NY 14650 833941257 INVESTMENT FUND NY ETV INC 0 0 MEDICAL ADMINISTRATIVE ASSOCIATES INC 777 SOUTH CLINTON AVENUE ROCHESTER NY 14620 161354319 RETAIL PHARMACY NY HIGHLD HOSP C 0 UR EQUITY HOLDINGS INC 110 OFFICE PARK WAY PITTSFORD NY 14534 273040889 HOLDING CO DE UNIV OF ROCH C 0 FFTH PROPERTIES AND SERVICES INC 350 PARRISH STREET CANANDAIGUA NY 14424 161286518 HOLDING CO NY THS C 0 EXCELL TECHNOLOGY VENTURES INC 343 STATE STREET KODAK TOWER 2ND FL ROCHESTER NY 14650 800909149 BIOTECH INCUBATOR NY ROCH BIOVENTURE C 0 ACCOUNTABLE HEALTH PARTNERS LLC 135 CORPORATE WOODS STE 320 ROCHESTER NY 14623 300787967 ACCT CARE NETWORK NY UNIV OF ROCH C 0 LUMINATE VENTURE CHALLENGE CORP 260 EAST MAIN STREET SUITE 6000 ROCHESTER NY 14604 823954131 BUSINESS INCUB NY NEXTCORPS INC C 0 ACCOUNTABLE HEALTH PARTNERS IPA LLC 135 CORPORATE WOODS STE 320 ROCHESTER NY 14623 371746016 INDEP PRACTICE ASSOC NY AHP LLC C 0 AHP INSURANCE COMPANY 76 ST PAUL STREET SUITE 500 BURLINGTON VT 05401 814644839 CAPTIVE INSURANCE CO VT AHP LLC C 0 HORNELL MEDICAL VILLAGE LLC 7100 ROUTE 70A HORNELL NY 14843 611886763 HOLD REAL ESTATE NY ST JAMES HOSPITAL C 1 0 0 1 0 0 0 0 0 0 0 1 0 1 1 1 0 0 1 0 HORNELL MEDICAL VILLAGE LLC K 845520 RENTAL OF BUILDING AND EQUIPMENT ST JAMES HOSPITAL FOUNDATION C 881218 FAIR VALUE OF FUNDS GIVEN