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      <PreparerPersonNm>JILL M JOHNSON CPA</PreparerPersonNm>
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      <ActivityOrMissionDesc>THE MISSION OF OLEAN GENERAL HOSPITAL TO PROVIDE EXCELLENT CARE IN RESPONSE TO THE HEALTH CARE NEEDS OF THE OLEAN, NY AND BRADFORD, PA COMMUNITIES. IN SUPPORT OF THIS MISSION, OLEAN GENERAL HOSPITAL IS COMMITTED TO THE FOLLOWING:- COMPASSION: OUR SYMPATHETIC AWARENESS OF EACH PERSON'S NEEDS- INTEGRITY: OUR DEDICATION TO HONESTY- INNOVATION: OUR PURSUIT OF CREATIVITY- RESPECT: OUR COMMITMENT TO TREAT EVERYONE WITH DIGNITY- COMMUNITY: OUR UNDERSTANDING THAT WE EXIST TO SERVE THOSE AMONG US- EDUCATION: OUR BELIEF THAT KNOWLEDGE FOSTERS EXCELLENCE</ActivityOrMissionDesc>
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      <MissionDesc>THE MISSION OF OLEAN GENERAL HOSPITAL IS TO PROVIDE EXCELLENT CARE IN RESPONSE TO THE HEALTH CARE NEEDS OF THE OLEAN, NY AND BRADFORD, PA COMMUNITIES. IN SUPPORT OF THIS MISSION, OLEAN GENERAL HOSPITAL IS COMMITTED TO THE FOLLOWING:- COMPASSION: OUR SYMPATHETIC AWARENESS OF EACH PERSON'S NEEDS- INTEGRITY: OUR DEDICATION TO HONESTY- INNOVATION: OUR PURSUIT OF CREATIVITY- RESPECT: OUR COMMITMENT TO TREAT EVERYONE WITH DIGNITY- COMMUNITY: OUR UNDERSTANDING THAT WE EXIST TO SERVE THOSE AMONG US- EDUCATION: OUR BELIEF THAT KNOWLEDGE FOSTERS EXCELLENCE</MissionDesc>
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      <Desc>IN 2020, OLEAN GENERAL HOSPITAL (OGH) DISCHARGED APPROXIMATELY 9,000 PATIENTS AND PROVIDED SERVICES TO APPROXIMATELY 184,000 OUTPATIENT VISITORS.THE OGH CAMPUS IN OLEAN, NY INCLUDES 186 PATIENT ROOMS, TOGETHER WITH COMPREHENSIVE PATIENT, ADMINISTRATIVE AND PHYSICIAN SERVICES AND ACCOMMODATIONS TO MEET THE DIAGNOSTIC, TREATMENT, ADMINISTRATIVE AND EDUCATIONAL NEEDS OF ITS PATIENTS AND MEDICAL STAFF. THE BRMC CAMPUS INCLUDES 89 PATIENT ROOMS AND 95 SKILLED NURSING BEDS. OGH OFFERS PATIENTS AND THEIR FAMILIES A FULL RANGE OF DIAGNOSTIC AND MEDICAL SERVICES, AS WELL AS MANY SPECIALTY SERVICES. A WIDE ARRAY OF MULTI-SPECIALTY PHYSICIANS AND CLINICIANS OFFER SERVICES RANGING FROM CANCER, CARDIAC AND VASCULAR CARE, OB/GYN, GENERAL SURGERY, UROLOGY, WOMEN'S HEALTH, INTERNAL MEDICINE, PEDIATRICS, SLEEP MEDICINE, AND PSYCHIATRIC CARE.2020 WAS A DIFFICULT YEAR TO ACCOMPLISH "NORMAL" IMPROVEMENTS AND PROGRAM ACCOMPLISHMENTS AS A RESULT OF THE COVID 19 PANDEMIC. THERE ARE COUNTLESS STORIES OF HEROIC DEEDS BY MANY OF OUR HEALTHCARE WORKERS WHICH MADE A DIFFERENCE IN OUR PATIENTS' LIVES AS WELL AS SIMPLY SAVED LIVES. OUR GREATEST ACCOMPLISHMENT IN 2020 WAS MOBILIZING TO REACT TO THE PANDEMIC. BELOW WE ALSO HIGHLIGHT A FEW TRADITIONAL AREAS OF FOCUS AT OGH RELATIVE TO ACCOMPLISHMENTS IN 2020.HIGHLIGHTED BELOW ARE SOME OF THE INITIATIVES THAT WERE REALIZED IN 2020 AT OGH:- PROVIDER RECRUITMENT IS CRITICAL TO OFFER EXISTING AND EXPANDED SERVICES AT A HEALTH SYSTEM. DURING 2020, OGH WAS SUCCESSFUL IN RECRUITING AND PROGRAM DEVELOPMENT IN THE FOLLOWING AREAS:PRIMARY CARE- HIRED 1 PHYSICIAN AND 3 MID-LEVELS;SURGERY- HIRED A COLORECTAL/GENERAL SURGEON;ORTHOPEDICS- HIRED 1 ORTHOPEDIC SURGEON AND 2 MID-LEVELS;HOSPITALISTS- HIRED 3 HOSPITALISTS TO SOLIDIFY THE SERVICE;OTHER- HIRED A GASTROENTEROLOGY MID-LEVEL AND A UROLOGY MID-LEVEL2020 FINANCIAL PERFORMANCE- OLEAN GENERAL HOSPITAL (OGH) REPORTED A NET LOSS OF ($5,442,000) FOR 2020 WHICH RESULTS WERE VERY NEGATIVELY IMPACTED BY THE COVID 19 PANDEMIC. REVENUE WAS UNDER BUDGET ($33,882,000) AND EXPENSES WERE UNDER BUDGET BY $11,284,000. STIMULUS FUNDING OF APPROXIMATELY $11,000,000 WAS RECEIVED AGAINST THE 2020 COVID 19 LOSS. DURING 2020 THE OGH BOARD, IN CONNECTION WITH ITS PARENT CORPORATION- UPPER ALLEGHENY HEALTH SYSTEM (UAHS)- VOTED TO IMPLEMENT A FINANCIAL IMPROVEMENT PLAN THAT WOULD HELP MANAGE THESE LARGE LOSSES INTO THE FUTURE. THE PLAN INCLUDED 17 IMPROVEMENT PROJECTS AND HAS A POTENTIAL IMPROVEMENT VALUE OF OVER $11,000,000 ANNUALLY AFTER FULL IMPLEMENTATION IN 2023.2020 QUALITY MATTERS - OLEAN GENERAL HOSPITAL (OGH) DEVELOPS A QUALITY IMPROVEMENT PLAN ANNUALLY. WHILE 2020 WAS NO DIFFERENT THAN ANY OTHER PLANNING YEAR, THE COVID 19 PANDEMIC FORCED OGH TO FOCUS INTERNALLY ON PLANNING FOR POTENTIAL DISASTERS AND ULTIMATELY TAKING CARE OF LARGE NUMBERS OF COVID 19 INFECTED PATIENTS. THIS PUT A DAMPER ON A NUMBER OF QUALITY IMPROVEMENT INITIATIVES. DESPITE THAT IMPACT, SEVERAL PROJECTS WERE PURSUED DURING 2020 INCLUDING:DEVELOPED PLANS TO IMPROVE HCAHPS SCORES THROUGH: ORGANIZING THE PATIENT EXPERIENCE COMMITTEE; LEADERSHIP ROUNDING ON FLOORS; INCREASED AWARENESS OF ALL LEVELS OF STAFF ON IMPORTANCE OF CUSTOMER SATISFACTION; FOCUS ON "COMMIT TO SIT" PROGRAM AS WELL AS ANSWERING PATIENT CALL BELLS ON A MORE TIMELY BASIS; IMPROVE DISCHARGE INSTRUCTIONS AND PATIENT UNDERSTANDING; IMPROVE BAR CODE MEDICATION SCANNING; IMPROVE PATIENT MED RECONCILIATIONS TO 95% OF ALL PATIENTS; REDUCE OR EVEN ELIMINATE STAGE I, II AND III PRESSURE ULCERS; DEVELOPED A NURSE RECRUITMENT AND RETENTION COMMITTEE TO ASSIST IN DEVELOPING AND KEEPING AN ADEQUATE SUPPLY OF NURSES AT OGH.2020 INFORMATION TECHNOLOGY MATTERS -- BRMC AND OGH IMPLEMENTED THE SERVICENOW PLATFORM TO IMPROVE THE EFFICIENCY OF THE IT HELPDESK.- BRMC AND OGH REPLACED ITS AGING CORE NETWORK SWITCHES AND ROUTERS WITH NEW CISCO HARDWARE. THIS IMPROVED HOSPITAL NETWORK PERFORMANCE AND RESILIENCY.- BRMC AND OGH IMPLEMENTED A NEW TELEHEALTH PLATFORM TO ALLOW VIRTUAL EMERGENCY DEPARTMENT VISITS.- OGH COMPLETED THE INSTALLATION OF A NEW NURSE CALL SYSTEM ON TWO NURSING UNITS.- OGH AND BRMC UPGRADED ITS ECLINICALWORKS EMR SOFTWARE TO THE LATEST VERSION AND MIGRATED THE SERVICE TO CLOUD HOSTING. THE IMPLEMENTATION OF TELEHEALTH VISITS WAS INCLUDED IN THIS PROJECT. - THE HEALTH SYSTEM IMPLEMENTED THE WEBEX VIRTUAL MEETING PLATFORM TO ALLOW FOR BETTER COLLABORATION AND TO SUPPORT WORK FROM HOME EMPLOYEES.- OGH AND BRMC IMPLEMENTED THE JAMF MOBILE DEVICE MANAGEMENT SYSTEM TO IMPROVE THE SECURITY OF OUR MOBILE DEVICES AND TO ALLOW FOR THE VIRTUAL PATIENT VISITS NECESSITATED BY COVID-19 RESTRICTIONS ON PATIENT VISITATION.</Desc>
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      <Form990PartVIISectionAGrp>
        <PersonNm>SHABIR BHAYANI MD</PersonNm>
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      <Form990PartVIISectionAGrp>
        <PersonNm>THOMAS BUFFAMANTE</PersonNm>
        <TitleTxt>DIRECTOR</TitleTxt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>DANIEL DEROSE</PersonNm>
        <TitleTxt>DIRECTOR</TitleTxt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>DAVID FERGUSON</PersonNm>
        <TitleTxt>DIRECTOR</TitleTxt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>LISA FIORENTINO PHD RN</PersonNm>
        <TitleTxt>DIRECTOR</TitleTxt>
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        <AverageHoursPerWeekRltdOrgRt>1.00</AverageHoursPerWeekRltdOrgRt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>JULIE MARASCO</PersonNm>
        <TitleTxt>DIRECTOR</TitleTxt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>DOUGLAS PISANO</PersonNm>
        <TitleTxt>DIRECTOR</TitleTxt>
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        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>ANIL PRADHAN MD</PersonNm>
        <TitleTxt>DIRECTOR</TitleTxt>
        <AverageHoursPerWeekRt>5.50</AverageHoursPerWeekRt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>DAVID PRINCE</PersonNm>
        <TitleTxt>DIRECTOR</TitleTxt>
        <AverageHoursPerWeekRt>5.50</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>1.00</AverageHoursPerWeekRltdOrgRt>
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        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>MELISSA SCHOLL OSF</PersonNm>
        <TitleTxt>DIRECTOR</TitleTxt>
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        <AverageHoursPerWeekRltdOrgRt>1.00</AverageHoursPerWeekRltdOrgRt>
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        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>GILBERT WITTE MD</PersonNm>
        <TitleTxt>DIRECTOR</TitleTxt>
        <AverageHoursPerWeekRt>5.50</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>1.00</AverageHoursPerWeekRltdOrgRt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>GAIL A BAGAZZOLI</PersonNm>
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      <Form990PartVIISectionAGrp>
        <PersonNm>RICHARD G BRAUN JR</PersonNm>
        <TitleTxt>COO</TitleTxt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>WILLIAM F MILLS</PersonNm>
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      <Form990PartVIISectionAGrp>
        <PersonNm>MELISSA SULLIVAN</PersonNm>
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      <Form990PartVIISectionAGrp>
        <PersonNm>MOHANED A AL-HUMADI</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>ASIM M MAKHDOM</PersonNm>
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      <Form990PartVIISectionAGrp>
        <PersonNm>JAVAID A MALIK</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>GARY CARL</PersonNm>
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      <Form990PartVIISectionAGrp>
        <PersonNm>DAVID GODFREY</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
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      <ContractorCompensationGrp>
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          <BusinessName>
            <BusinessNameLine1Txt>MCKESSON DRUG COMPANY</BusinessNameLine1Txt>
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        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>PO BOX 409521</AddressLine1Txt>
            <CityNm>ATLANTA</CityNm>
            <StateAbbreviationCd>GA</StateAbbreviationCd>
            <ZIPCd>30384</ZIPCd>
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        </ContractorAddress>
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      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>PA MOUNTAIN HEALTHCARE</BusinessNameLine1Txt>
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        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>150 MCCRACKEN RUN ROAD</AddressLine1Txt>
            <CityNm>DUBOIS</CityNm>
            <StateAbbreviationCd>PA</StateAbbreviationCd>
            <ZIPCd>15081</ZIPCd>
          </USAddress>
        </ContractorAddress>
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      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>QUEST DIAGNOSTIC INC</BusinessNameLine1Txt>
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        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>500 PLAZA DRIVE</AddressLine1Txt>
            <CityNm>SECAUCUS</CityNm>
            <StateAbbreviationCd>NJ</StateAbbreviationCd>
            <ZIPCd>07094</ZIPCd>
          </USAddress>
        </ContractorAddress>
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      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>APOGEE PHYSICIANS</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>15059 N SCOTTSDALE ROAD SUITE 600</AddressLine1Txt>
            <CityNm>SCOTTSDALE</CityNm>
            <StateAbbreviationCd>AZ</StateAbbreviationCd>
            <ZIPCd>85254</ZIPCd>
          </USAddress>
        </ContractorAddress>
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      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>COMPLETERX LTD</BusinessNameLine1Txt>
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        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>3100 S GESSNER SUITE 640</AddressLine1Txt>
            <CityNm>HOUSTON</CityNm>
            <StateAbbreviationCd>TX</StateAbbreviationCd>
            <ZIPCd>77063</ZIPCd>
          </USAddress>
        </ContractorAddress>
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      <RelatedOrganizationsAmt>1070895</RelatedOrganizationsAmt>
      <GovernmentGrantsAmt>12746727</GovernmentGrantsAmt>
      <AllOtherContributionsAmt>457380</AllOtherContributionsAmt>
      <TotalContributionsAmt>14275002</TotalContributionsAmt>
      <ProgramServiceRevenueGrp>
        <Desc>PATIENT SERVICE REVENUE</Desc>
        <BusinessCd>621990</BusinessCd>
        <TotalRevenueColumnAmt>154969842</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>154969842</RelatedOrExemptFuncIncomeAmt>
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      <TotalProgramServiceRevenueAmt>154969842</TotalProgramServiceRevenueAmt>
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        <TotalRevenueColumnAmt>100303</TotalRevenueColumnAmt>
        <ExclusionAmt>100303</ExclusionAmt>
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      <GrossRentsGrp>
        <RealAmt>568052</RealAmt>
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      <LessRentalExpensesGrp>
        <RealAmt>0</RealAmt>
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      <RentalIncomeOrLossGrp>
        <RealAmt>568052</RealAmt>
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      <NetRentalIncomeOrLossGrp>
        <TotalRevenueColumnAmt>568052</TotalRevenueColumnAmt>
        <ExclusionAmt>568052</ExclusionAmt>
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        <Desc>PHARMACY 340B</Desc>
        <BusinessCd>900099</BusinessCd>
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      <OtherRevenueMiscGrp>
        <Desc>OTHER</Desc>
        <BusinessCd>900099</BusinessCd>
        <TotalRevenueColumnAmt>2542864</TotalRevenueColumnAmt>
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      <OtherRevenueMiscGrp>
        <Desc>CAFETERIA/VENDING</Desc>
        <BusinessCd>722210</BusinessCd>
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        <ProgramServicesAmt>5853569</ProgramServicesAmt>
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        <ManagementAndGeneralAmt>268465</ManagementAndGeneralAmt>
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        <ManagementAndGeneralAmt>84984</ManagementAndGeneralAmt>
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        <ManagementAndGeneralAmt>291594</ManagementAndGeneralAmt>
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        <ManagementAndGeneralAmt>215702</ManagementAndGeneralAmt>
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        <ManagementAndGeneralAmt>906396</ManagementAndGeneralAmt>
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        <ProgramServicesAmt>4879937</ProgramServicesAmt>
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        <ProgramServicesAmt>3675688</ProgramServicesAmt>
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        <ProgramServicesAmt>27810727</ProgramServicesAmt>
        <ManagementAndGeneralAmt>3141533</ManagementAndGeneralAmt>
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      <OtherExpensesGrp>
        <Desc>MEDICAL EQUIPMENT RENTA</Desc>
        <TotalAmt>2227969</TotalAmt>
        <ProgramServicesAmt>2227969</ProgramServicesAmt>
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      <OtherExpensesGrp>
        <Desc>PROPERTY TAXES</Desc>
        <TotalAmt>72540</TotalAmt>
        <ProgramServicesAmt>72540</ProgramServicesAmt>
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      <OtherExpensesGrp>
        <Desc>PATIENT/RESIDENT ACTIVI</Desc>
        <TotalAmt>4025</TotalAmt>
        <ProgramServicesAmt>4025</ProgramServicesAmt>
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        <ProgramServicesAmt>121822171</ProgramServicesAmt>
        <ManagementAndGeneralAmt>60024965</ManagementAndGeneralAmt>
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        <EOYAmt>28147188</EOYAmt>
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        <EOYAmt>23309865</EOYAmt>
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      <InventoriesForSaleOrUseGrp>
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        <EOYAmt>5413240</EOYAmt>
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        <EOYAmt>2284418</EOYAmt>
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        <BOYAmt>61578477</BOYAmt>
        <EOYAmt>58125548</EOYAmt>
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      <InvestmentsPubTradedSecGrp>
        <BOYAmt>19725866</BOYAmt>
        <EOYAmt>21698382</EOYAmt>
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        <EOYAmt>3799750</EOYAmt>
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        <BOYAmt>49109435</BOYAmt>
        <EOYAmt>65738135</EOYAmt>
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        <ExplanationTxt>PART V, SECTION B, LINE 5: OLEAN GENERAL HOSPITAL AND BRADFORD REGIONAL MEDICAL CENTER ARE NOW A MERGED ORGANIZATION. HOWEVER, THE TWO CAMPUSES HAVE BEEN CONDUCTING INDEPENDENT COMMUNITY HEALTH NEEDS ASSESSMENTS AND COMMUNITY HEALTH IMPROVEMENT PLANS OVER THEIR HISTORIES. BECAUSE THE TWO CAMPUSES ARE IN SEPARATE STATES AND THE SERVICE NEEDS BETWEEN THE TWO SERVICE AREAS ARE DIFFERENT, A DECISION WAS MADE TO CONTINUE TO CONDUCT SEPARATE CHNAS FOR THE TWO CAMPUSES. STARTING IN 2021 CHNAS WILL BE A SINGLE DOCUMENT REPRESENTING BOTH FACILITIES.IN ADDITION, THE THREE-YEAR CYCLES OF THE TWO HOSPITAL ARE DIFFERENT. OLEAN GENERAL HOSPITAL APPROVED ITS MOST RECENT CHNA IN AUGUST 2019. THE LATEST CHNA FOR THE BRADFORD REGIONAL MEDICAL CENTER CAMPUS WAS COMPLETED IN DECEMBER 2018. CHNAS FOR BOTH HOSPITALS APPEAR ON THE WEBISTE FOR OLEAN GENERAL HOSPITAL AND BRADFORD REGIONAL MEDICAL CENTER (WWW.BRMC-OGH.ORG).OLEAN GENERAL HOSPITAL - THE 2019-2021 CATTARAUGUS COUNTY COMMUNITY SERVICE PLAN (CSP) AND COMMUNITY HEALTH ASSESSMENT AND COMMUNITY HEALTH IMPROVEMENT PLAN (CHA-CHIP) WERE DEVELOPED IN PARTNERSHIP BETWEEN OLEAN GENERAL HOSPITAL (OGH), WHICH IS PART OF UPPER ALLEGHENY HEALTH SYSTEM (UAHS) AND THE CATTARAUGUS COUNTY HEALTH DEPARTMENT (CCHD). STRATEGY SOLUTIONS, INC. (SSI) WAS ENGAGED BY CCHD AND OGH TO ASSIST WITH THE ASSESSMENT. REPRESENTATIVES FROM OGH AND CCHD WORKED COLLABORATIVELY TO GUIDE AND CONDUCT THE ASSESSMENT. A STEERING COMMITTEE MADE UP OF SENIOR LEADERS OF UAHS, OGH, CCHD, AND REPRESENTATIVES FROM THE CATTARAUGUS COUNTY HEALTHY LIVABLE COMMUNITIES CONSORTIUM, WHICH INCLUDES LEADING HEALTH AND SOCIAL SERVICE ORGANIZATIONS AND MUNICIPALITIES, PROVIDED ADDITIONAL INPUT. THE COMBINED EXPERTISE, INPUT AND KNOWLEDGE OF THE MEMBERS OF THE STEERING COMMITTEE WAS VITAL TO THE PROJECT. THIS GROUP DESERVES SPECIAL RECOGNITION FOR THEIR TIRELESS OVERSIGHT AND SUPPORT OF THE CSP/CHA-CHIP PROCESS. DURING THE CSP/CHA-CHIP PROJECT, TEN (10) STAKEHOLDERS WERE INTERVIEWED BY STRATEGY SOLUTIONS, INC. (SSI). SSI CONDUCTED A COMMUNITY HEALTH SURVEY WITH 669 SURVEYS COMPLETED, AND CCHD CONDUCTED A COMMUNITY HEALTH SURVEY WITH 227 SURVEYS COMPLETED. FINALLY, INFORMATION WAS GATHERED BY THE PROJECT TEAM THROUGH A SERIES OF TEN (10) FOCUS GROUPS WITH A TOTAL OF 56 PARTICIPANTS, INCLUDING A CROSS SECTOR OF COMMUNITY GROUPS. INFORMATION-GATHERING EFFORTS ALLOWED THE PROJECT TEAM AND STEERING COMMITTEE TO GAIN A BETTER UNDERSTANDING OF THE HEALTH STATUS, HEALTH CARE NEEDS, SERVICE GAPS, AND BARRIERS TO CARE FOR THOSE LIVING IN CATTARAUGUS COUNTY. FOLLOWING THE CONSOLIDATION OF DATA FOR THE COMMUNITY HEALTH ASSESSMENT (CHA), A PLANNING PROCESS WAS INITIATED TO CREATE A 2019-2021 COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP). A TOTAL OF 28 PARTICIPANTS DESIGNATED AS THE CHIP PARTNERSHIP COMMITTEE FOCUSED ON THE TWO HEALTH PRIORITIES, WHICH WERE IDENTIFIED THROUGH A RIGOROUS COMMUNITY DATA ASSESSMENT STUDY AND DEVELOPED A GUIDE FOR IMPLEMENTING AN ACTION PLAN. A DISCUSSION OF EVIDENCED-BASED HEALTH RELATED PROGRAMS AND INITIATIVES THAT ARE CURRENTLY OFFERED OR ARE PLANNED FOR THE FUTURE WAS FACILITATED BY STRATEGY SOLUTIONS. BASED ON THIS DISCUSSION, A PLAN TO MEET THE COMMUNITY HEALTH NEEDS WAS DEVELOPED.THE 2019-2021 OLEAN GENERAL HOSPITAL COMMUNITY SERVICE PLAN (CSP) AND THE CATTARAUGUS COUNTY HEALTH DEPARTMENT'S COMMUNITY HEALTH ASSESSMENT AND COMMUNITY HEALTH IMPROVEMENT PLAN (CHA-CHIP) WERE CONDUCTED TO IDENTIFY SIGNIFICANT HEALTH NEEDS AS OUTLINED BY NEW YORK STATE DEPARTMENT OF HEALTH'S 2019-2024 PREVENTION AGENDA. IT ALSO PROVIDES CRITICAL INFORMATION TO OLEAN GENERAL HOSPITAL (OGH), CATTARAUGUS COUNTY HEALTH DEPARTMENT (CCHD), AND OTHERS IN A POSITION TO MAKE A POSITIVE IMPACT ON THE HEALTH OF THE REGION'S RESIDENTS. OGH, WHICH NOW INCLUDES BRADFORD REGIONAL MEDICAL CENTER IN BRADFORD, PA, IS A MEMBER HOSPITAL OF UPPER ALLEGHENY HEALTH SYSTEM AND AN AFFILIATE OF KALEIDA HEALTH, BUFFALO, NY. THE RESULTS ENABLE THE HEALTH DEPARTMENT, HOSPITAL AND OTHER COMMUNITY PARTNERS TO STRATEGICALLY ESTABLISH PRIORITIES, DEVELOP INTERVENTIONS AND DIRECT RESOURCES TO IMPROVE THE HEALTH OF RESIDENTS LIVING IN THE SERVICE AREA. TO CONDUCT THE COLLABORATIVE STUDY, OGH AND CCHD RETAINED STRATEGY SOLUTIONS, INC. (SSI), AN ERIE, PA PLANNING AND RESEARCH FIRM WHOSE MISSION IS TO CREATE HEALTHY COMMUNITIES. THE ASSESSMENT FOLLOWED BEST PRACTICES AS OUTLINED BY THE ASSOCIATION OF COMMUNITY HEALTH IMPROVEMENT (ACHI). THE ASSESSMENT WAS ALSO DESIGNED TO ENSURE OGH COMPLIANCE WITH CURRENT INTERNAL REVENUE SERVICE (IRS) GUIDELINES FOR CHARITABLE 501(C)(3) TAX-EXEMPT HOSPITALS THAT WAS PUBLISHED IN DECEMBER 2014. THE PREVENTION AGENDA IS A SIX-YEAR EFFORT TO MAKE NEW YORK THE HEALTHIEST STATE. DEVELOPED IN COLLABORATION WITH 140 ORGANIZATIONS, THE PLAN IDENTIFIES NEW YORK'S MOST URGENT HEALTH CONCERNS, AND SUGGESTS WAYS LOCAL HEALTH DEPARTMENTS, HOSPITALS, AND PARTNERS FROM HEALTH, BUSINESS, EDUCATION, AND COMMUNITY ORGANIZATIONS CAN WORK TOGETHER TO SOLVE THEM. THE CSP/CHA-CHIP INCLUDES A DETAILED EXAMINATION OF PRIORITY AREAS IDENTIFIED IN THE NYS PREVENTION AGENDA: (1) PREVENT CHRONIC DISEASES; (2) PROMOTE A HEALTHY AND SAFE ENVIRONMENT; (3) PROMOTE HEALTHY WOMEN, INFANTS AND CHILDREN; (4) PROMOTE WELL-BEING AND PREVENT MENTAL HEALTH AND SUBSTANCE USE DISORDERS; AND (5) PREVENT COMMUNICABLE DISEASES. OTHER AREAS INCLUDED IN THIS CSP/CHA-CHIP THAT MEET THE DECEMBER 2014 IRS REQUIREMENTS INCLUDE: EVALUATION OF THE 2016-2018(9) CSP/CHA-CHIP, DEMOGRAPHICS AND SOCIO-ECONOMIC INDICATORS, PRIORITIZATION OF NEEDS, AND CHIP/IMPLEMENTATION STRATEGY FOR NEXT THREE YEARS.A DETAILED PLAN OF IMPLEMENTATION IS DESCRIBED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT AND COMMUNITY HEALTH IMPLEMENTATION PLAN ON PAGES 149-171.BRADFORD REGIONAL MEDICAL CENTER - THIS REPORT SUMMARIZES A COMPREHENSIVE REVIEW AND ANALYSIS OF HEALTH STATUS INDICATORS, PUBLIC HEALTH, SOCIOECONOMIC, DEMOGRAPHIC AND OTHER QUALITATIVE AND QUANTITATIVE DATA FROM THE PRIMARY SERVICE AREA OF BRMC. THIS REPORT ALSO INCLUDES SECONDARY/ DISEASE INCIDENCE AND PREVALENCE DATA FROM MCKEAN COUNTY, THE PRIMARY SERVICE AREA OF THE HOSPITAL. THE DATA WAS REVIEWED AND ANALYZED TO DETERMINE THE TOP PRIORITY NEEDS AND ISSUES FACING THE REGION OVERALL.THE PRIMARY PURPOSE OF THIS ASSESSMENT WAS TO IDENTIFY THE HEALTH NEEDS AND ISSUES OF THE MCKEAN COUNTY COMMUNITY DEFINED AS THE PRIMARY SERVICE AREA OF BRMC. IN ADDITION, THE CHNA PROVIDES USEFUL INFORMATION FOR PUBLIC HEALTH AND HEALTH CARE PROVIDERS, POLICY MAKERS, SOCIAL SERVICE AGENCIES, COMMUNITY GROUPS AND ORGANIZATIONS, RELIGIOUS INSTITUTIONS, BUSINESSES, AND CONSUMERS WHO ARE INTERESTED IN IMPROVING THE HEALTH STATUS OF THE COMMUNITY AND REGION. THE RESULTS ENABLE THE HOSPITAL, AS WELL AS OTHER COMMUNITY PROVIDERS, TO MORE STRATEGICALLY IDENTIFY COMMUNITY HEALTH PRIORITIES, DEVELOP INTERVENTIONS, AND COMMIT RESOURCES TO IMPROVE THE HEALTH STATUS OF THE REGION.IMPROVING THE HEALTH OF THE COMMUNITY IS THE FOUNDATION OF THE MISSION OF BRMC, AND AN IMPORTANT FOCUS FOR EVERYONE IN THE SERVICE REGION, INDIVIDUALLY AND COLLECTIVELY. IN ADDITION TO THE EDUCATION, PATIENT CARE, AND PROGRAM INTERVENTIONS PROVIDED THROUGH THE HOSPITAL, WE HOPE THAT THE INFORMATION IN THIS CHNA WILL ENCOURAGE ADDITIONAL ACTIVITIES AND COLLABORATIVE EFFORTS TO IMPROVE THE HEALTH STATUS OF THE COMMUNITY THAT BRMC SERVES.FACILITATED BY STRATEGY SOLUTIONS, INC., A PLANNING AND RESEARCH FIRM WITH ITS MISSION TO CREATE HEALTHY COMMUNITIES, THIS CHNA FOLLOWS BEST PRACTICES AS OUTLINED BY THE ASSOCIATION FOR COMMUNITY HEALTH IMPROVEMENT, A DIVISION OF THE AMERICAN HOSPITAL ASSOCIATION, AND ENSURES COMPLIANCE WITH INTERNAL REVENUE SERVICE (IRS) GUIDELINES (IRS NOTICE 2011-52) THE PROCESS HAS TAKEN INTO ACCOUNT INPUT FROM THOSE WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITIES SERVED BY BRADFORD REGIONAL MEDICAL CENTER (BRMC), INCLUDING THOSE WITH KNOWLEDGE OF PUBLIC HEALTH, THE MEDICALLY UNDERSERVED, AND POPULATIONS WITH CHRONIC DISEASE.THE 2018 BRMC CHNA WAS CONDUCTED TO IDENTIFY PRIMARY HEALTH ISSUES, CURRENT HEALTH STATUS, AND HEALTH NEEDS TO PROVIDE CRITICAL INFORMATION TO THOSE IN A POSITION TO MAKE A POSITIVE IMPACT ON THE HEALTH OF THE REGION'S RESIDENTS. THE RESULTS ENABLE COMMUNITY MEMBERS TO MORE STRATEGICALLY ESTABLISH PRIORITIES, DEVELOP INTERVENTIONS, AND DIRECT RESOURCES TO IMPROVE THE HEALTH OF PEOPLE LIVING IN THE COMMUNITY.TWENTY STEERING COMMITTEE MEMBERS FROM A ACROSS THE COMMUNITY PARTICIPATED IN THE PRIORITIZATION EXERCISE. AFTER PRIORITIZATION AND DISCUSSION THE BRMC STEERING COMMITTEE IDENTIFIED FOUR NEEDS AS PRIORITIES FOR INTERVENTION AND ACTION PLANNING: CHRONIC DISEASE, ACCESS TO HEALTHCARE, MENTAL HEALTH AND SUBSTANCE ABUSE DISORDERS. CONTINUED IN PART VI.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>OLEAN GENERAL HOSPITAL</FormAndLineReferenceDesc>
        <ExplanationTxt>PART V, SECTION B, LINE 6B: IN DEVELOPING THE COMMUNITY HEALTH NEEDS ASSESSMENT FOR CATTARAUGUS COUNTY, OTHER MEMBERS CONSULTED INCLUDED ALLEGANY/W. STEUBEN RURAL HEALTH NETWORK, AMERICAN RED CROSS, CANCER SERVICES PROGRAM (ALLEGANY CO.), CATTARAUGUS COUNTY DEPARTMENT OF THE AGING, CATTARAUGUS COUNTY HEALTH DEPARTMENT, CATTARAUGUS COUNTY YOUTH BUREAU, CITY OF OLEAN YOUTH BUREAU, CORNELL COOPERATIVE EXTENSION, DIRECTIONS IN INDEPENDENT LIVING, EVERYWOMAN OPPORTUNITY CENTER, HEALTH CARE ACCESS COALITION, HEALTHY COMMUNITY ALLIANCE, HEALTHY SCHOOLS NY, P2 COLLABORATIVE OF WNY, SALAMANCA YOUTH BUREAU, SOUTHERN TIER HEALTHCARE SYSTEMS, SOUTHERN TIER WEST, STRAWW, TOBACCO-REALITY CHECK, TOTAL SENIOR CARE, TRICOUNTY TOBACCO COALITION, AND UNIVERA COMMUNITY HEALTH.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>OLEAN GENERAL HOSPITAL</FormAndLineReferenceDesc>
        <ExplanationTxt>PART V, SECTION B, LINE 11: DBA BRADFORD REGIONAL MEDICAL CENTER: THE HOSPITAL'S EFFORTS IN ADDRESSING SIGNIFICANT NEEDS ARE DESCRIBED IN ITS 2016-2018 COMMUNITY HEALTH NEEDS EXECUTIVE SUMMARY, PAGE 5.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>FORM 990, SCHEDEUL H, PART V, SECTION 5, LINE 5 CONTINUED</FormAndLineReferenceDesc>
        <ExplanationTxt>SECONDARY DATA ON DISEASE INCIDENCE AND MORTALITY, AS WELL AS BEHAVIORAL RISK FACTORS WERE GATHERED FROM THE PENNSYLVANIA DEPARTMENT OF HEALTH AND THE CENTERS FOR DISEASE CONTROL, AS WELL AS HEALTHY PEOPLE 2020, COUNTY HEALTH RANKINGS, US CENSUS, AMERICAN COMMUNITY SURVEY, AND THE 2017 PA YOUTH SURVEY.AGGREGATE UTILIZATION DATA WAS INCLUDED FROM BRMC PATIENT RECORDS (NO PRIVATE PATIENT INFORMATION WAS EVER TRANSMITTED TO STRATEGY SOLUTIONS, INC.). DEMOGRAPHIC DATA WAS COLLECTED FROM CLARITAS-POP-FACTS PREMIER, 2018, ENVIRONICS ANALYTICS. PRIMARY DATA COLLECTED SPECIFICALLY FOR THIS STUDY WERE BASED ON THE PRIMARY SERVICE AREA OF MCKEAN COUNTY. BRMC COLLECTED A TOTAL OF 304 COMMUNITY SURVEYS AND 25 INTERCEPT SURVEYS, AND CONDUCTED FOUR (4) FOCUS GROUPS WITH 90 PARTICIPANTS AS WELL AS 12 STAKEHOLDER INTERVIEWS. IT SHOULD BE NOTED THAT AN ADDITIONAL FOCUS GROUP WAS CONDUCTED BY A THIRD PARTY MCKEAN COUNTY COLLABORATIVE BOARD AND THE RESULTS SHARED WITH BRMC FOR THIS REPORT. THIS FOCUS GROUP HAD 38 PARTICIPANTS.A FULL ACCOUNTING OF INPUT FROM COMMUNITY GROUPS, IDENTIFIED COMMUNITY HEALTH ISSUES AS TOP PRIORITIES TO BE UNDERTAKEN BY THE HOSPITAL APPEAR IN THE FULL CHNA.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART I, LINE 7G:</FormAndLineReferenceDesc>
        <ExplanationTxt>SUBSIDIZED PROGRAMS ARE NOT RECORDED AT THIS LEVEL OF DETAIL. ALL COSTS ASSOCIATED WITH THESE PROGRAMS, INCLUDING IP PSYCHIATRIC DEPARTMENT, EMERGENCY DEPARTMENT AND SALAMANCA CLINIC ARE INCLUDED IN THE AMOUNTS PROVIDED.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART II, COMMUNITY BUILDING ACTIVITIES:</FormAndLineReferenceDesc>
        <ExplanationTxt>OVER THE LAST 10 YEARS, THE OLEAN AND BRADFORD AREAS HAD SIGNIFICANT PRIMARY CARE AND SPECIALIST CARE SHORTFALLS. AFTER A FEW YEARS OF SUCCESSFUL RECRUITING, NUMEROUS MID-LEVEL PRIMARY CARE PROVIDERS HAVE BEEN RECRUITED, HOWEVER THERE ARE STILL PHYSICIAN SHORTAGES IN THE PRIMARY CARE SPACE. SPECIALIST PHYSICIANS ARE STILL IN GREAT DEMAND IN THE AREA. THE MOST PRESSING NEEDS CURRENTLY ARE IN: CARDIOLOGY, UROLOGY, DERMATOLOGY, OBSTETRICS, PSYCHIATRY AND GASTROENTEROLOGY.THE HOSPITAL ALSO PROVIDES CLINICAL ROTATIONS FOR MEDICAL STUDENTS IN INTERNAL AND EMERGENCY MEDICINE THROUGH AN AFFILIATION AGREEMENT WITH LAKE ERIE COLLEGE OF OSTEOPATHIC MEDICINE. IN ADDITION, ST BONAVENTURE UNIVERSITY PRE-MEDICAL STUDENTS PARTICIPATE IN A 14 WEEK ROTATION PROVIDING EXPOSURE TO VARIOUS CLINICAL SPECIALTIES AND DIAGNOSTIC MODALITIES, FOR AN IN-DEPTH EXPOSURE TO THE REALITIES OF A CAREER IN MEDICINE. THE UNIVERSITY OF PITTSBURGH AT BRADFORD NURSING STUDENTS PARTICIPATE IN CLINICAL ROTATIONS THROUGH THE BRADFORD CAMPUS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART III, LINE 3:</FormAndLineReferenceDesc>
        <ExplanationTxt>THE RATIONALE USED TO ESTIMATE THE AMOUNT OF THE ORGANIZATION'S BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE PLAN WAS DETERMINED BY USING THE PERCENTAGE OF INCOMPLETE FINANCIAL ASSISTANCE APPLICATIONS TO TOTAL FINANCIAL ASSISTANCE APPLICATIONS (4%).</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART III, LINE 4:</FormAndLineReferenceDesc>
        <ExplanationTxt>PATIENT ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTIBILITY OF PATIENT ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS WHO ARE KNOWN TO HAVE FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. THE HOSPITAL'S 2019 RCC WAS APPLIED TO THE TOTAL BAD DEBT EXPENSE TO DETERMINE BAD DEBT EXPENSE AT COST. THE BAD DEBT AMOUNTS ABSORBED BY THE HOSPITAL ARE PART OF ITS COMMUNITY BENEFIT DUE TO ITS POLICY TO PROVIDE MEDICAL SERVICE TO THE COMMUNITY REGARDLESS OF THE PATIENT'S ABILITY TO PAY.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART III, LINE 8:</FormAndLineReferenceDesc>
        <ExplanationTxt>THE ALLOWABLE COSTS REPORTED ON LINE 6 ARE DIRECTLY FROM THE HOSPITAL'S 2020 MEDICARE COST REPORT, WHICH IS PREPARED USING A RATIO OF COST TO CHARGES BASIS (RCC) AS REQUIRED BY MEDICARE.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART III, LINE 9B:</FormAndLineReferenceDesc>
        <ExplanationTxt>COLLECTION PRACTICES:I) OGH WILL NOT CAUSE THE FORCED SALE OR FORECLOSURE ON A PATIENT'S PRIMARY RESIDENCE.II) OGH WILL NOT SEND ACCOUNT TO COLLECTION IF THE PATIENT HAS SUBMITTED A COMPLETED APPLICATION FOR FINANCIAL ASSISTANCE, INCLUDING THE REQUIRED DOCUMENTATION, WHILE AN APPLICATION IS PENDING.III) OGH WILL PROVIDE WRITTEN NOTIFICATION TO A PATIENT AT LEAST 30-DAYS BEFORE AN ACCOUNT IS SENT TO COLLECTION. THIS WRITTEN NOTICE MAY BE INCLUDED ON A BILL. IV) OGH REQUIRES THAT A COLLECTION AGENCY HAVE ITS WRITTEN CONSENT PRIOR TO STARTING LEGAL ACTION FOR COLLECTION.V) OGH WILL TRAIN ALL GENERAL HOSPITAL STAFF WHO INTERACT WITH PATIENTS OR HAVE RESPONSIBILITY FOR BILLING AND COLLECTION.VI) OGH WILL MEASURE OUR COMPLIANCE WITH THESE POLICES.VII) OGH REQUIRES ANY COLLECTION AGENCY UNDER CONTRACT TO FOLLOW OUR FINANCIAL ASSISTANCE POLICY AND PROVIDES INFORMATION TO PATIENT'S ON HOW TO APPLY, WHERE APPROPRIATE.VIII) OGH DOES NOT ALLOW COLLECTION ACTIVITY IF THE PATIENT IS DETERMINED ELIGIBLE FOR MEDICAID FOR THE SERVICES THAT WERE RENDERED AND OGH IS ABLE TO COLLECT MEDICAID PAYMENT.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART VI, LINE 2:</FormAndLineReferenceDesc>
        <ExplanationTxt>THE STRATEGIC PLANNING COMMITTEE OF OLEAN GENERAL HOSPITAL IS CHARGED WITH DEVELOPING A STRATEGIC DIRECTION FOR THE HOSPITAL. OVER THE LAST FEW YEARS THAT COMMITTEE ASSISTED IN THE DEVELOPMENT OF SUSTAINABILITY STRATEGIES FOR THE HOSPITAL INCLUDING THE AFFILIATION WITH A TERTIARY CARE PROVIDER IN 2017 AND THE MERGER OF THE TWO PREVIOUS HOSPITALS (OLEAN GENERAL HOSPITAL AND BRADFORD REGIONAL MEDICAL CENTER INTO THE ONE SURVIVING HOSPITAL- OLEAN GENERAL HOSPITAL) IN 2018. IN 2019 THE COMMITTEE BEGAN DEVELOPING ADDITIONAL SUSTAINABILITY STRATEGIES FOR THE SYSTEM INCLUDING LOOKING AT TAKING ADVANTAGE OF THE HOSPITALS VARIOUS STRENGTHS IN DIFFERENT GEOGRAPHIC AREAS. THESE DELIBERATIONS WERE CONCLUDED IN 2020 AND A 17 POINT TRANSFORMATION PLAN WAS IMPLEMENTED INCLUDING CONSOLIDATION OF SURGERY AND HIGHER-END INPATIENT SERVICES TO THE OLEAN CAMPUS. THE PLAN SHOULD HAVE IN EXCESS OF A $10,000,000 IMPACT ON OGH'S FINANCIAL RESULTS ANNUALLY, AFTER 2023.ESSENTIAL TO THE SUCCESS OF ANY STRATEGIC PLAN IS THE HOSPITAL'S ABILITY TO BOTH IMPLEMENT RECOMMENDATIONS MADE WITHIN THE PLAN AND TO RECOGNIZE THE DOCUMENT AS A DYNAMIC AND FLEXIBLE TOOL TO BE USED AS A GUIDE FOR THE FUTURE. SPECIFIC GOALS AND STRATEGIES MAY OR MAY NOT BE OBTAINED AND, UPON EVALUATION AND THE AVAILABILITY OF NEW INFORMATION AND DEVELOPMENTS, MAY NEED TO BE MODIFIED. A SUCCESSFUL STRATEGIC PLAN RECOGNIZES THIS POTENTIAL FOR CHANGE AND IS FLEXIBLE ENOUGH TO ACCOMMODATE NEW OR DIFFERENT OPPORTUNITIES AND CHALLENGES.CRITICAL HEALTH CARE ISSUESTHE HEALTH CARE INDUSTRY IS UNDER CONSTANT SCRUTINY TO PROVIDE AFFORDABLE HEALTH CARE SERVICES THAT ARE ALSO OF THE HIGHEST QUALITY. A HOSPITAL'S ABILITY TO ACCOMPLISH THIS GOAL IS INFLUENCED BY SEVERAL FACTORS. FOLLOWING IS A LISTING OF CRITICAL ISSUES THAT WILL CONTINUE TO AFFECT HOSPITALS' ABILITY TO PERFORM.1. IMPACT OF COVID 19: THE SINGLE LARGEST EXTERNAL FACTOR AFFECTING HEALTHCARE TODAY IS THE IMPACT OF THE COVID 19 PANDEMIC ON HOSPITALS. ALTHOUGH THE PANDEMIC HIT US HOSPITALS IN EARLY 2020, THE LONG LASTING EFFECTS WILL BE FELT FOR YEARS TO COME. SEVERAL PHENOMENON CAUSED BY THE PANDEMIC INCLUDE:- LARGE FINANCIAL LOSSES, DESPITE FEDERAL STIMULUS FUNDING. OGH LOST ($9,000,000) FROM THE PANDEMIC AFTER CONSIDERATION OF $11,000,000 OF STIMULUS FUNDING. PATIENT VOLUMES CONTINUE TO BE DEPRESSED AS A RESULT OF RESOURCE CONSTRAINTS AS WELL AS PATIENT FEARS OVER CONTRACTING COVID.-STAFFING HAS BEEN IMPACTED GREATLY BY THE PANDEMIC. HIGH ACUITY PATIENTS AND WAVES OF THEM IN A SHORT PERIOD OF TIME COUPLED WITH THE STRESSES OF TAKING CARE OF HIGHLY INFECTIOUS PATIENTS HAS LED TO SIGNIFICANT PROVIDER BURN-OUT. IN FACT A NATIONAL MOVEMENT OF NURSES LEAVING THEIR POSITIONS AND TAKING "TRAVELER" ASSIGNMENTS HAS PUT A HUGE HOLE IN THE STAFFING AT HOSPITALS. REPLACEMENT STAFF, IF AVAILABLE, ARE AT A 300 TO 400 PERCENT INCREASE OVER FORMER COSTS.- EMERGENCY ROOM WAIT TIMES HAVE SOARED AS A RESULT OF THE PANDEMIC. THIS ALSO IMPACTS PATIENT SATISFACTION NEGATIVELY.2. QUALITY: HEALTH CARE QUALITY AND SAFETY HAVE BEEN STRATEGICALLY IMPORTANT FOR SEVERAL YEARS. WIDESPREAD PUBLIC REPORTING OF HOSPITAL QUALITY RESULTS AND VALUE BASED PAYMENT MODELS HAVE POSITIONED QUALITY AT THE FOREFRONT OF HEALTHCARE DELIVERY. RECRUITMENT AND RETENTION OF HIGHLY SKILLED DOCTORS AND NURSES, COMBINED WITH CAPABLE INFORMATION SYSTEMS ARE CRITICAL TO MEET THE HIGH STANDARDS SET TODAY IN HEALTHCARE. CONCEPTS SUCH AS: "RE-ADMISSIONS", HOSPITAL ACQUIRED INFECTIONS, FALL FREQUENCY AND PREVENTABLE MEDICATION ERRORS ARE HOUSEHOLD WORDS WHEN IT COMES TO EVALUATING A HOSPITAL'S QUALITY TODAY. HOSPITALS MUST MARSHAL THE NOTED RESOURCES AND PROVIDE HIGH-END CARE AS COMPARED TO OTHERS. THE VALUE BASED PAYMENT METHODOLOGIES ALSO HAVE SIGNIFICANT FINANCIAL IMPLICATIONS FOR HOSPITALS TODAY. CONSUMERS WILL CONTINUE TO SEEK OUT MORE AND MORE QUALITY DATA UPON WHICH TO BASE CARE DECISIONS ON.3. INFORMATION TECHNOLOGY: HEALTH INFORMATION TECHNOLOGY INCLUDES COMPUTER BASED TOOLS DEVELOPED SPECIFICALLY FOR HEALTH CARE DELIVERY. THESE TOOLS CAN PROVIDE CLINICIANS UP-TO-DATE INFORMATION ON THEIR PATIENTS, ACCESS TO THE LATEST MEDICAL KNOWLEDGE AND BEST PRACTICES THROUGH DECISION SUPPORT SYSTEMS. IT IS UNDERSTOOD THAT INVESTMENTS IN NEW CLINICAL AND INFORMATION TECHNOLOGY CAN SIGNIFICANTLY ENHANCE PATIENT SAFETY AND CLINICAL OUTCOMES. COMPUTERIZED PHYSICIAN ORDER ENTRY (CPOE), BAR CODING AND ITS POTENTIAL TO REDUCE MEDICATION ERRORS, AND ELECTRONIC MEDICAL RECORDS (EMRS) AND THEIR POSITIVE IMPACT ON MEDICAL ERRORS ARE ALL EXAMPLES OF HEALTH CARE'S USE OF IT SOLUTIONS TO IMPROVE QUALITY. THE FEDERAL GOVERNMENT HAS HIGHLIGHTED THE ROLE OF HEALTH INFORMATION TECHNOLOGY AS A MEANS TO IMPROVE HEALTH CARE QUALITY, SAFETY PROVIDED STIMULUS AND INCENTIVE PAYMENTS TO PROVIDERS TO FACILITATE AND HASTEN THEIR ADOPTION INTO THE CARE DELIVERY PROCESS. EMR'S HAVE BECOME A PREREQUISITE OF ANY DELIVERY SYSTEM THAT INTENDS TO PROVIDE COORDINATED COST EFFECTIVE CARE.4. PHYSICIANS: PHYSICIANS HAVE EMERGED AS CRITICAL OPERATIONAL AND STRATEGIC PARTNERS TO HOSPITALS. THOSE THAT ARE SUCCESSFUL IN ENGAGING AND COLLABORATING WITH THEIR MEDICAL STAFF WILL BE BEST ABLE TO DEMONSTRATE HIGH QUALITY CARE AND COMPLIANCE WITH HEALTH REFORM'S VALUE BASED PURCHASING AND OTHER QUALITY MANDATES. THE ABILITY TO SUCCESSFULLY RECRUIT PHYSICIANS WILL BE CRITICAL. AT A TIME WHEN HEALTHCARE EMPHASIZES THE ROLE OF PRIMARY CARE, THERE IS A SPECIAL NEED TO INTENSIFY EFFORTS TO RECRUIT, RETAIN AND AGGREGATE PRIMARY CARE PROVIDERS. BECAUSE THE VAST MAJORITY OF NEW PHYSICIANS PREFER EMPLOYMENT AS THEIR PRACTICE PREFERENCE, THE ABILITY OF HOSPITALS TO BE ABLE TO OFFER PHYSICIANS A CONTEMPORARY AND COMPETITIVE "EMPLOYMENT PLATFORM" IS ESSENTIAL.SEE CONTINUATION AT THE END OF PART VI.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART VI, LINE 3:</FormAndLineReferenceDesc>
        <ExplanationTxt>INSURANCE INFORMATION IS GATHERED DURING THE SCHEDULING AND/OR REGISTRATION PROCESS. IF THE PATIENT INDICATES THAT THEY HAVE NO INSURANCE, REGISTRATION STAFF WILL ASK THE PATIENT FOR PERMISSION TO TRANSFER THEM TO SOUTHERN TIER HEALTHCARE SYSTEMS FOR ASSISTANCE WITH SCREENING FOR ELIGIBILITY FOR GOVERNMENT PROGRAMS (I.E. MEDICAID, CHILD HEALTH PLUS, FAMILY HEALTH PLUS). SOUTHERN TIER HEALTHCARE SYSTEMS' PERSONNEL WILL CONTACT THE PATIENT AND DISCUSS OPTIONS, INCLUDING THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM. ALL REGISTRATION, CARE MANAGEMENT AND BILLING PERSONNEL ARE EDUCATED ABOUT THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM AND CAN DISCUSS AND SHARE INFORMATION WITH PATIENTS AT ANY TIME BEFORE, DURING OR AFTER THE EPISODE OF CARE. BILLING STATEMENTS CONTAIN THE FOLLOWING MESSAGE: IF YOU HAVE ANY QUESTIONS OR WOULD LIKE TO APPLY FOR OUR FINANCIAL ASSISTANCE PROGRAM, PLEASE CALL OUR OFFICE AT ...". THE FINANCIAL ASSISTANCE POLICY IS POSTED ON THE HOSPITAL WEBSITE TO HELP EDUCATE THE PUBLIC.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART VI, LINE 4:</FormAndLineReferenceDesc>
        <ExplanationTxt>OLEAN GENERAL HOSPITAL IS LOCATED IN OLEAN, NEW YORK, THE LARGEST CITY IN CATTARAUGUS COUNTY. THE HOSPITAL SERVES APPROXIMATELY 88,000 RESIDENTS OF CATTARAUGUS COUNTY AND THE SURROUNDING AREA. THE POPULATION OF THE AREA IS DISTRIBUTED AS FOLLOWS: 22% UNDER THE AGE OF 18, 60% AGE 18 TO 64 AND 18% 65 AND OLDER. THE ANNUAL HOUSEHOLD INCOME WAS DISTRIBUTED AS FOLLOWS: 27% EARNING LESS THAN $25K; 29% EARNING BETWEEN $25-$50K; AND 44% EARNING $50K OR HIGHER.THE BRADFORD CAMPUS IS LOCATED IN BRADFORD, PA. THE HOSPITAL SERVES APPROXIMATELY 55,000 RESIDENTS OF MCKEAN COUNTY AND THE SURROUNDING AREA. THE POPULATION OF THE AREA IS DISTRIBUTED AS FOLLOWS: 20% UNDER THE AGE OF 18, 60% AGE 18 TO 64 AND 20% 65 AND OLDER. THE ANNUAL HOUSEHOLD INCOME WAS DISTRIBUTED AS FOLLOWS: 28% EARNING LESS THAN $25,000; 30% EARNING BETWEEN $25-$50K; AND 42% EARNING $50K OR HIGHER.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART VI, LINE 6:</FormAndLineReferenceDesc>
        <ExplanationTxt>OLEAN GENERAL HOSPITAL IS PART OF THE UPPER ALLEGHENY HEALTH SYSTEM (UAHS), ORIGINALLY AN INTEGRATION OF TWO REGIONAL HOSPITALS UNDER A COMMON PARENT ORGANIZATION. UAHS HAS A MISSION OF COLLABORATIVE HEALTH CARE IN THE TWO COMMUNITIES SERVED BY THE INTEGRATED HOSPITALS TO MEET THE HEALTH CARE NEEDS OF THE RESIDENTS AND SURROUNDING AREAS. TO FURTHER THIS INTEGRATION, BRMC WAS MERGED INTO OGH ON JANUARY 12, 2018 AND IS NOW PART OF A 2 CAMPUS HOSPITAL.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART VI, LINE 7, REPORTS FILED WITH STATES</FormAndLineReferenceDesc>
        <ExplanationTxt>NY</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART VI, LINE 2</FormAndLineReferenceDesc>
        <ExplanationTxt>5. FINANCE AND CAPITAL: FINANCIAL PERFORMANCE AND ACCESS TO CAPITAL WILL CONTINUE TO BE AMONG THE MOST CRITICAL ISSUES CONFRONTING HOSPITALS. EVEN WITH HEALTHCARE REFORM EFFORTS, HEALTHCARE COSTS WILL CONTINUE TO OUTPACE INFLATION. INCREASING WAGE AND SALARY COSTS, AND RISING HEALTH CARE COSTS IN GENERAL WILL CONTINUE TO IMPACT OPERATING PERFORMANCE AND PRESS HOSPITALS TO CONTINUE A RELENTLESS FOCUS ON COST MANAGEMENT. ADDITIONALLY, REVENUE STRATEGIES WILL NEED TO BE DEVELOPED TO GENERATE PROFITABLE GROWTH IN PATIENT VOLUME, AS WILL THE NEED TO ENSURE OPTIMAL MANAGEMENT OF ALL REVENUE CYCLE ACTIVITIES. HOSPITALS ARE FACING SIGNIFICANT ANNUAL PAYMENT REDUCTIONS IN TERMS OF DECREASES IN MEDICARE UPDATES, DISPROPORTIONATE SHARE, SNF AND HOMECARE PAYMENTS, AND MEDICAID PAYMENT LEVELS. AS HOSPITALS CONTINUE TO POST LOW OR NO PROFIT MARGINS, INVESTMENT INCOME WILL BE MORE IMPORTANT THAN EVER. HOWEVER, GIVEN THE FACT THAT INVESTMENT INCOME IS A HIGHLY UNCERTAIN COMPONENT OF A HOSPITAL'S OVERALL FINANCIAL HEALTH, HOSPITALS WILL BE DRIVEN TO PURSUE MORE PHILANTHROPY. HOSPITAL CAPITAL SPENDING WILL BE DRIVEN BY GROWING DEMANDS FOR ADVANCED TECHNOLOGY NEEDED TO ENSURE PATIENT QUALITY AND SAFETY, THE NEED TO REPLACE AND UPDATE AGING FACILITIES, AND THE DESIRE AND NEED TO IMPROVE TECHNOLOGY BASED SERVICES.6. RISK MANAGEMENT AND COMPLIANCE: HEALTHCARE'S TECHNOLOGY HAS NEVER BEEN MORE COMPLICATED, PATIENTS' DEMANDS HIGHER, AND THE BUSINESS CHALLENGES GREATER. ACCORDINGLY, COMPREHENSIVE RISK MANAGEMENT PROGRAM ARE ESSENTIAL IN ASSURING CARE DELIVERY SYSTEMS THAT ARE HIGHLY EFFECTIVE IN TERMS OF ASSURING APPROPRIATE LEVELS OF PATIENT SAFETY AND QUALITY. THE DEPARTMENT OF JUSTICE ESTIMATES THAT THE FEDERAL GOVERNMENT LOSES BILLIONS OF DOLLARS ANNUALLY IN HEALTH CARE FRAUD. CONSEQUENTLY, THE GOVERNMENT'S HEALTHCARE FRAUD ENFORCEMENT ACTIVITIES WITH RESPECT TO ALL HEALTHCARE PROVIDERS CONTINUE TO GROW AND EXPAND. WELL ESTABLISHED CORPORATE COMPLIANCE PROGRAMS ARE ESSENTIAL IN TERMS OF ALLOWING HOSPITALS TO IDENTIFY POTENTIAL AREAS OF LIABILITY AND TO CORRECT PROBLEMS.6.NURSING: NURSES AND NURSING CARE ARE CENTRAL TO THE DELIVERY OF SAFE AND EFFECTIVE PATIENT CARE. ACCORDINGLY, ENSURING AN ADEQUATE NURSING WORKFORCE AND CREATING A WORK ENVIRONMENT THAT SUPPORTS NURSING PRACTICE AND INTERDISCIPLINARY COLLABORATION ARE IMPORTANT PRIORITIES FOR HOSPITALS TODAY.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART III, LINE 1, DESCRIPTION OF ORGANIZATION MISSION:(CONTINUED)</FormAndLineReferenceDesc>
        <ExplanationTxt>THE HOSPITAL IS GOVERNED BY A 17 MEMBER BOARD OF DIRECTORS COMPRISED OF 16 VOLUNTARY INDIVIDUALS WHO RESIDE THROUGHOUT THE OLEAN GENERAL HOSPITAL AND BRADFORD REGIONAL MEDICAL CENTER SERVICE AREAS AND THE CEO OF UPPER ALLEGHENY HEALTH SYSTEM. WITH A LICENSED CAPACITY OF 186 BEDS ON THE OLEAN CAMPUS AND 89 BEDS AT THE BRADFORD CAMPUS, THE HOSPITAL PROVIDES THE COMMUNITY WITH VITAL HEALTH CARE SERVICES INCLUDING MEDICAL/SURGICAL, PEDIATRIC AND OBSTETRICAL CARE. THE HOSPITAL ALSO PROVIDES INTENSIVE AND CORONARY CARE, BEHAVIORAL HEALTH, CHRONIC DIALYSIS, AND 24 HOUR EMERGENCY SERVICES WITH ACCESS TO HELICOPTERS FOR EMERGENCY TRANSFER OF PATIENTS REQUIRING TERTIARY CARE. ADDITIONAL SERVICES INCLUDE DIAGNOSTIC IMAGING, LABORATORY, CARDIOPULMONARY, OCCUPATIONAL WELLNESS, DIABETES TEACHING, PATIENT EDUCATION, RADIATION ONCOLOGY SPECIFICALLY ON THE OGH CAMPUS, A SLEEP DISORDERS CENTER, OUTPATIENT PRIMARY CARE, AND A DENTAL CENTER. OLEAN GENERAL HOSPITAL, IN CONJUNCTION WITH THE STATE UNIVERSITY OF NEW YORK AT BUFFALO, SPONSORS NEW YORK STATE'S ONLY RURAL TRACK POST GRADUATE MEDICAL EDUCATION/RESIDENCY TRAINING PROGRAM.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION A, LINE 6</FormAndLineReferenceDesc>
        <ExplanationTxt>UPPER ALLEGHENY HEALTH SYSTEM, INC. IS THE SOLE CORPORATE MEMBER OF THE HOSPITAL.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION A, LINE 7B</FormAndLineReferenceDesc>
        <ExplanationTxt>GOVERNANCE DECISIONS ARE SUBMIT TO APPROVAL BY KALEIDA HEALTH.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 11B</FormAndLineReferenceDesc>
        <ExplanationTxt>A DRAFT COPY OF THE FORM 990 IS REVIEWED FOR ACCURACY AND COMPLETENESS BY THE HOSPITAL'S CHIEF FINANCIAL OFFICER AND SENIOR MANAGEMENT OF UPPER ALLEGHENY HEALTH SYSTEM. IN ADDITION, A FINAL DRAFT COPY OF THE FORM 990 IS PROVIDED TO MEMBERS OF THE BOARD OF DIRECTORS TO REVIEW AND COMMENT PRIOR TO FILING WITH THE IRS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 12C</FormAndLineReferenceDesc>
        <ExplanationTxt>THE HOSPITAL'S CONFLICT OF INTEREST POLICY IS PRESENTED AND REVIEWED ANNUALLY. EACH MEMBER OF THE BOARD COMPLETES A DISCLOSURE FORM. SEE THE FORMAL POLICY, AS OUTLINED IN THE ORGANIZATION'S BYLAWS, BELOW. CONFLICTS OF INTEREST: EACH DIRECTOR, PRIOR TO TAKING HIS POSITION ON THE BOARD, AND ALL PRESENT DIRECTORS AS SOON AS PRACTICABLE AFTER THE ADOPTION OF THESE BYLAWS, SHALL SUBMIT IN WRITING TO THE CHAIRMAN OF THE BOARD AND THE CHIEF EXECUTIVE OFFICER A LIST OF ALL BUSINESS OR OTHER ORGANIZATIONS OF WHICH HE IS AN OFFICER, DIRECTOR, TRUSTEE, MEMBER, OWNER (EITHER AS SOLE PROPRIETOR OR PARTNER), SHAREHOLDER WITH 5% OR GREATER INTEREST IN ALL OUTSTANDING VOTING SHARE, EMPLOYEE OR AGENT, WIHT WHICH THE CORPORATE HAS, OR MIGHT BE REASONABLY IN THE FUTURE ENTER INTO, A RELATIONSHIP OR A TRANSACTION IN WHICH THE DIRECTOR WOULD HAVE CONFLICTING INTERESTS. EACH WRITTEN STATEMENT WILL BE RESUBMITTED WITH ANY NECESSARY CHANGES EACH YEAR. THE CHAIRMAN OF THE BOARD SHALL BECOME FAMILIAR WITH THE STATEMENTS OF ALL DIRECTORS IN ORDER TO GUIDE HIS CONDUCT SHALL A CONFLICT ARISE. THE CHAIRMAN-ELECT OF THE BOARD SHALL BE FAMILIAR WITH THE STATEMENT FILED BY THE CHAIRMAN. SHOULD THE CHAIRMAN-ELECT POSITION BE VACANT, THE MOST SENIOR MEMBER OF THE EXECUTIVE COMMITTEE WILL ASSUME THIS RESPONSIBILITY. AT SUCH TIME AS ANY MATTER COMES BEFORE THE BOARD IN SUCH A WAY AS TO GIVE RISE TO A CONFLICT OF INTEREST, THE AFFECTED DIRECTOR SHALL MAKE KNOWN THE POTENTIAL CONFLICT WHETHER DISCLOSED BY HIS WRITTEN STATEMENT OR NOT, AND AFTER ANSWERING ANY QUESTIONS THAT MIGHT BE ASKED OF HIM, SHALL WITHDRAW FROM THE MEETING FOR SO LONG AS THE MATTER SHALL CONTINUE UNDER DISCUSSION. SHOULD THE MATTER BE BROUGHT TO A VOTE, THE AFFECTED DIRECTOR SHALL NOT VOTE ON IT. IN THE EVENT THE CONFLICT OF INTEREST AFFECTS THE CHAIRMAN, THE CHAIRMAN-ELECT IN EMPOWERED AND SHALL REQUIRE THAT THE CHAIRMAN REMOVE HIMSELF IN THE SAME MANNER, AND FOR THE DURATION OF DISCUSSION AND ACTION ON THE MATTER THE CHAIRMAN-ELECT SHALL PRESIDE. SHOULD THE CHAIRMAN-ELECT POSITION BE VACANT, THE MOST SENIOR MEMBER OF THE EXECUTIVE COMMITTEE WILL ASSUME THIS RESPONSIBILITY. IF THE MATTER IS THE ITEM OF BUSINESS FOR WHICH A SPECIAL MEETING OF THE BOARD WAS CALLED, THE AFFECTED DIRECTOR SHALL NOT BE COUNTED TO ESTABLISH A QUORUM, NOR SHALL HE PARTICIPATE IN THE DELIBERATIONS OR VOTE ON IT.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 15</FormAndLineReferenceDesc>
        <ExplanationTxt>THE EXECUTIVE COMMITTEE OF THE HOSPITAL D/B/A THE EXECUTIVE COMPENSATION COMMITTEE (THE COMMITTEE) IS APPOINTED BY THE BOARD OF DIRECTORS TO ASSIST THE BOARD IN ESTABLISHING AND OVERSEEING THE EXECUTIVE COMPENSATION PROGRAM OF THE HOSPITAL. THE COMMITTEE IS RESPONSIBLE FOR ADHERING TO THE OVERALL COMPENSATION PHILOSOPHY OF THE HOSPITAL. THE COMPENSATION PHILOSOPHY IS A TOTAL COMPENSATION CONCEPT THAT WILL EMPLOY A COMBINATION OF BASE SALARY, VARIABLE OPPORTUNITY, FLEXIBLE BENEFITS, DEFERRED COMPENSATION AND OTHER PERQUISITES AS MAY BE NEEDED FROM TIME TO TIME TO MAINTAIN A COMPETITIVE POSITION WITH PEER INSTITUTIONS IN THE REGION.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION C, LINE 19</FormAndLineReferenceDesc>
        <ExplanationTxt>THE HOSPITAL HAS AVAILABLE, UPON REQUEST TO ADMINISTRATION, ITS MOST RECENTLY FILED FORM 990, GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS. THE HOSPITAL ALSO REPORTS ANNUALLY ITS COMMUNITY BENEFIT EFFORTS AND ISSUES ANNUAL REPORT THAT INCLUDES FINANCIAL AND OTHER INFORMATION OF INTEREST TO THE PUBLIC.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART IX, LINE 11G</FormAndLineReferenceDesc>
        <ExplanationTxt>PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 12,628,896. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 12,628,896. CONSULTING: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 908,616. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 908,616. MAINTENANCE CONTRACTS: PROGRAM SERVICE EXPENSES 75,448. MANAGEMENT AND GENERAL EXPENSES 3,804,897. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,880,345. BUILDING AND EQUIPMENT MAINTENANCE AND REPAIRS: PROGRAM SERVICE EXPENSES 717,605. MANAGEMENT AND GENERAL EXPENSES 114,740. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 832,345. OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 18,384,800. MANAGEMENT AND GENERAL EXPENSES 105,377. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 18,490,177. COLLECTION FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 564,100. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 564,100. NON-HEALTHCARE PROVIDER FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 6,981,193. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,981,193.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART XI, LINE 9:</FormAndLineReferenceDesc>
        <ExplanationTxt>PENSION LIABILITY ADJUSTMENT -6,320,729. NET ASSETS CONTRIBUTIONS -72,764. NET ASSETS RELEASED FROM RESTRICTIONS 14,003,330.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART XII, LINE 2C</FormAndLineReferenceDesc>
        <ExplanationTxt>THE AUDIT AND COMPLIANCE COMMITTEE ASSUMES RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT, AS WELL AS THE CHOICE OF AN INDEPENDENT ACCOUNTANT. THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. AS PART OF KALEIDA HEALTH, THE FINANCIAL STATEMENTS OF OLEAN GENERAL HOSPITAL ARE PART OF THE CONSOLIDATED STATEMENTS ISSUED BY KALEIDA HEALTH. ADDITIONAL INFORMATION IS CONTAINED WITHIN THE KALEIDA HEALTH LONG-FORM REPORT. ANY AUDIT ISSUES RAISED BY THE KALEIDA HEALTH AUDITORS ARE REVIEWED BY THE OGH AUDIT AND COMPLIANCE COMMITTEE. KALEIDA HEALTH HAS AN AUDIT AND COMPLIANCE COMMITTEE THAT OVERSEES THE PROCESS AND SELECTED THE INDEPENDENT ACCOUNTANT.</ExplanationTxt>
      </SupplementalInformationDetail>
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