2019-10-28T08:34:32-05:00 2018-12-31 160765486 LUMSDEN & MCCORMICK LLP 369 FRANKLIN STREET BUFFALO NY 14202 990 2018-01-01 160755799 ORLEANS COMMUNITY HEALTH ORLE 5857988102 200 OHIO STREET MEDINA NY 14103 MARK CYE CEO 5857988102 2019-10-07 1 JILL M JOHNSON CPA P01701478 7168563300 2019-10-07 38.122.36.250 2019-10-07 16:30:23 ED P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 178EDCBBEFC1CD3328C1DD6E94D390C4A7F3C5E4 2018 2020-03-31 21:24:44Z MARK CYE 200 OHIO STREET MEDINA NY 14103 27399792 0 X WWW.ORLEANSCOMMUNITYHEALTH.ORG X 1908 NY SEE SCHEDULE O.ORLEANS COMMUNITY HEALTH EXISTS TO IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE BY PROVIDING EQUAL ACCESS TO QUALITY HEALTH CARE SERVICES PROVIDED AT THE RIGHT TIME, IN THE RIGHT PLACE, WITH THE MOST EFFICIENT USE OF RESOURCES. THIS WILL BE ACCOMPLISHED THROUGH A COLLABORATIVE EFFORT WITH PHYSICIAN PARTNERS, HOSPITAL ASSOCIATES, VOLUNTEERS AND THE TWIG ASSOCIATION, USING A PHILOSOPHY OF CONTINUOUS QUALITY IMPROVEMENT. 13 13 384 40 0 0 3450723 1341629 19281085 19857455 1700 853 4090753 6199855 26824261 27399792 0 0 0 0 16199499 15017786 0 0 0 10039405 10419358 26238904 25437144 585357 1962648 11007377 11280051 9666555 8197146 1340822 3082905 X SEE SCHEDULE O.ORLEANS COMMUNITY HEALTH EXISTS TO IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE BY PROVIDING EQUAL ACCESS TO QUALITY HEALTH CARE SERVICES PROVIDED AT THE RIGHT TIME, IN THE RIGHT PLACE, WITH THE MOST EFFICIENT USE OF RESOURCES. THIS WILL BE ACCOMPLISHED THROUGH A COLLABORATIVE EFFORT WITH PHYSICIAN PARTNERS, HOSPITAL ASSOCIATES, VOLUNTEERS AND THE TWIG ASSOCIATION, USING A PHILOSOPHY OF CONTINUOUS QUALITY IMPROVEMENT. 0 0 18951021 26045789 PATIENT SERVICES - THE HOSPITAL PROVIDES ACUTE INPATIENT, LONG-TERM SKILLED NURSING FACILITY AND OUTPATIENT CARE TO PATIENTS WHO RESIDE PRIMARILY IN THE LOCAL GEOGRAPHIC REGION. THE HOSPITAL ACCEPTS ALL PATIENTS, REGARDLESS OF ABILITY TO PAY. THE POLICY ESTABLISHED BY THE HOSPITAL DEFINES CHARITY SERVICES AS THOSE SERVICES FOR WHICH NO PAYMENT IS ANTICIPATED. 18951021 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 0 1 0 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 0 0 0 1 52 0 1 384 1 0 0 0 0 0 0 0 0 0 0 X 13 13 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X X MARK CYE 5857988423 200 OHIO STREET MEDINA NY 14103 DAWN MELAND CHAIRMAN 2.00 X X 0 0 0 SHANNON BLOUT VICE CHAIRMAN 2.00 X X 0 0 0 CINDY HEWITT SECRETARY 2.00 X X 0 0 0 DAVID G MONTI DVM TREASURER 2.00 X X 0 0 0 KEVIN FOLEY DIRECTOR 2.00 X 0 0 0 LYNNE JOHNSON DIRECTOR 2.00 X 0 0 0 JEFF KLOTZBACH DIRECTOR 2.00 X 0 0 0 W BRUCE KRENNING DIRECTOR 2.00 X 0 0 0 APRIL MCGAFFICK DIRECTOR 2.00 X 0 0 0 JOSEPH MISITI MD DIRECTOR 2.00 X 0 0 0 AARON SLACK DIRECTOR 2.00 X 0 0 0 DALE SPONAUGLE MD DIRECTOR 2.00 X 0 0 0 REV DR WILLIAM H WILKINSON DIRECTOR 2.00 X 0 0 0 MARK CYE CHIEF EXECUTIVE OFFICER 40.00 1.00 X 231416 0 7336 LEE VINCENT PHYSICIAN 40.00 X 240273 0 7241 MARY RYKERT-WOLF PHYSICIAN 40.00 X 199162 0 6159 ANSHU BAIS PHYSICIAN 40.00 X 178220 0 5367 PAULA DRESSER DIRECTOR OF SURGICAL SERVICES 40.00 X 127312 0 4093 KATHLEEN BRAUEN DIRECTOR OF PHARMACY 40.00 X 126182 0 16572 1102565 0 46768 10 0 1 0 MEDICAL SOLUTIONS LLC PO BOX 310737 DES MOINES IA 50331 NURSING SERVICES 199519 SHARED IMAGING LLC LOCK BOX 88544 MILWAUKEE WI 53288 MRI SERVICES 125385 EASTOWN PLAZA ASSOCIATES LP 4221 TRANSIT ROAD WILLIAMSVILLE NY 14221 RENT 114877 3 130385 1168658 42586 1341629 PATIENT SERVICE REVENUE 621990 19857455 19857455 19857455 853 853 11521 0 11521 11521 11521 NEW YORK STATE DOH OPERATING ASSI 900099 4246014 4246014 MLMIC SETTLEMENT 900099 1243014 1243014 MEANINGFUL USE FUNDS 900099 223327 223327 475979 475979 6188334 27399792 26045789 0 12374 X 238752 238752 12074188 8714379 3359809 231557 178875 52682 1577242 1183227 394015 896047 672035 224012 94930 94930 3220480 2607196 613284 550770 374524 176246 494103 350813 143290 52187 7785 44402 53273 53273 1003772 712678 291094 288191 200945 87246 MEDICAL SUPPLIES 2023914 2023914 PROVISION FOR BAD DEBTS 841516 841516 REPAIRS AND MAINTENANCE 807677 601693 205984 NONMEDICAL SUPPLIES 378053 378053 610492 481441 129051 25437144 18951021 6486123 0 53430 678535 585153 386579 2331457 2531029 511718 480143 243069 194900 37681503 32102347 5603192 5579156 1679358 1429709 11007377 11280051 6939513 5839826 2121793 1662396 605249 694924 9666555 8197146 X -42336 1920312 1383158 1162593 1340822 3082905 11007377 11280051 X 1962648 -220565 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 120909 120909 14670134 9994645 4675489 124324 79747 44577 22316509 22027955 288554 449627 449627 5579156 NET ASSETS OF THE FOUNDATION 1162593 OTHER ASSETS 267116 1429709 OTHER LIABILITIES 28274 LOAN PAYABLE TO ORLEANS COMMUNITY HEALTH FOUNDATION, INC. 666650 694924 26558276 -841516 -841516 27399792 0 27399792 24595628 0 24595628 841516 841516 25437144 PART XI, LINE 2D - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS -841,516. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS 841,516. 1 1 1 X 1 X 1 0 0 678256 291677 386579 0.01570 3510540 2519735 990805 0.04030 4188796 2811412 1377384 0.05600 4188796 2811412 1377384 0.05600 0 841516 4787235 8362514 -3575279 X 1 0 1 1 ORLEANS COMMUNITY HEALTH 200 OHIO STREET MEDINA NY 14103 X X X X ORLEANS COMMUNITY HEALTH 1 0 0 1 X X X X X X X X 16 1 1 0 1 X ORLEANSCOMMUNITYHEALTH.ORG X X 1 16 1 HTTP://ORLEANSCOMMUNITYHEALTH.ORG/COMMUNITY-HEALTH-IMPROVEMENT-PLAN/ 0 1 X 100.000000000000 300.000000000000 1 1 X X 1 X HTTP://ORLEANSCOMMUNITYHEALTH.ORG/FINANCIAL-ASSISTANCE-CHARITY-CARE X HTTP://ORLEANSCOMMUNITYHEALTH.ORG/WP-CONTENT/UPLOADS/2016/08/FINANCIAL-ASSI X X X 1 X 0 1 0 0 ORLEANS COMMUNITY HEALTH PART V, SECTION B, LINE 5: COMMUNITY INPUT WAS OBTAINED THROUGH COMMUNITY HEALTH ASSESSMENT SURVEYS. THESE SURVEYS WERE USED TO HELP ASSESS THE COMMUNITY'S PERCEPTION OF HEALTH NEEDS. A SURVEY INSTRUMENT FOR USE IN ORLEANS, GENESEE AND WYOMING COUNTIES WAS DEVELOPED COLLABORATIVELY BY A GROUP OF LOCAL AGENCIES THAT INCLUDED THREE COUNTY HEALTH DEPARTMENTS (ORLEANS, GENESEE, WYOMING), ORLEANS COMMUNITY HEALTH, THE HEALTHY ORLEANS NETWORK (ORLEANS COMMUNITY HEALTH - CHIEF EXECUTIVE OFFICER, DIRECTOR OF RESOURCE DEVELOPMENT, DIRECTOR OF HEALTH EDUCATION, WELLNESS AND OUTREACH, ORLEANS COUNTY PUBLIC HEALTH FOR ORLEANS AND GENESEE, DIRECTOR OF COMMUNITY ACTION OF ORLEANS AND GENESEE, DIRECTOR OF OFFICE FOR THE AGING, DIRECTOR OF ORLEANS COUNTY MENTAL HEALTH, LOCAL SCHOOL REPRESENTATION, ORLEANS COUNTY LEGISLATURE, DIRECTOR OF LOCAL LIBRARY, YMCA FITNESS COORDINATOR, CHIEF EXECUTIVE OFFICER OF OAK ORCHARD COMMUNITY HEALTH, DIRECTOR OF INDEPENDENT LIVING OF ORLEANS AND GENESEE, DIRECTOR OF UNITED WAY, DIRECTOR OF ARC, AND THE DIRECTOR OF GCASA), UNITED MEMORIAL MEDICAL CENTER AND WYOMING COUNTY HOSPITAL. THE GOAL WAS TO DEVELOP ONE INSTRUMENT THAT WOULD BE USED FOR ALL THREE COUNTIES. ORLEANS COMMUNITY HEALTH PART V, SECTION B, LINE 6A: UNITED MEMORIAL MEDICAL CENTER AND WYOMING COUNTY HOSPITAL ORLEANS COMMUNITY HEALTH PART V, SECTION B, LINE 7D: THE SURVEY WAS DISTRIBUTED TO THE COMMUNITY BY INTERNET VIA SURVEY MONKEY TO HUMAN SERVICE ORGANIZATIONS, FAITH BASED ORGANIZATIONS, LIBRARIES, AND WORKSITES, WHO IN TURN DISTRIBUTED TO THEIR LIST SERVES, AND THROUGH PRINTED SURVEYS AT OUTREACH EVENTS (E.G. ROTARY DINNER, HAIR DRESSERS, FARMER'S MARKETS, MEDINA MEMORIAL HOSPITAL, HEALTH FAIRS). ORLEANS COMMUNITY HEALTH PART V, SECTION B, LINE 11: THE COMMUNITY HEALTH NEEDS ASSESSMENT IDENTIFIED TWO PRIORITY AREAS. THE FIRST PRIORITY OF PREVENTING CHRONIC DISEASE WILL BE ADDRESSED BY INCREASING SCREENING RATES FOR CARDIOVASCULAR DISEASE, DIABETES AND CERTAIN CANCERS, ESPECIALLY AMONG DISPARATE POPULATIONS. ALL CANCER SERVICES CLIENTS WILL BE EVALUATED FOR APPROPRIATE SCREENINGS. GRANT OPPORTUNITIES WILL BE RESEARCHED. AS FUNDING ALLOWS, THE DIABETES PREVENTION PROGRAM, THE CHRONIC DISEASE SELF-MANAGEMENT PROGRAM AND THE GET FIT PROGRAM WILL BE IMPLEMENTED. PROMOTING MENTAL HEALTH AND PREVENTING SUBSTANCE ABUSE WAS THE SECOND PRIORITY IDENTIFIED. THE HOSPITAL WILL INCREASE PUBLIC AWARENESS OF THE MENTAL HEALTH SERVICES AVAILABLE IN THE TRI-COUNTY AREA. 1 1 - ORLEANS COMMUNITY HEALTH OF ALBION 14789 ROUTE 31 ALBION NY 14411 FAMILY CLINIC PART I, LINE 7: THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS CONTAINED IN THE TABLE OF PART I, LINE 7, OF SCHEDULE H, IS A COST TO CHARGE RATIO CALCULATION IN WORKSHEET 2. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 841,516. PART II, COMMUNITY BUILDING ACTIVITIES: N/A PART III, LINE 2: BAD DEBT EXPENSE IS AN ACCUMULATION OF 3% OF GROSS CHARGES ESTIMATED AS BAD DEBT, ACTUAL AMOUNTS WRITTEN OFF AS BAD DEBT, BAD DEBT RECOVERY AND AN ADJUSTMENT TO THE BAD DEBT RESERVES ACCOUNT. PART III, LINE 4: PATIENT ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTIBILITY OF PATIENT ACCOUNTS RECEIVABLE, THE SYSTEM 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 SYSTEM 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 BE HAVING 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 SYSTEM 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. PART III, LINE 8: THE COSTING METHODOLOGY USED TO DETERMINE THE MEDICARE ALLOWABLE COSTS REPORTED IN THE HOSPITAL'S MEDICARE COST REPORT IS THE COST TO CHARGE RATIO. THE SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT. PART VI, LINE 2: THE HOSPITAL ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITY THROUGH PATIENT SATISFACTION SURVEYS; FOCUS GROUPS OF COMMUNITY MEMBERS, BOARD OF DIRECTORS, AND EMPLOYEES; AND SPECIFIC HEALTH-RELATED PRIORITIES AS THEY ARISE. PART VI, LINE 3: PATIENTS ARE INFORMED OF THE HOSPITAL'S CHARITY CARE POLICY AND GIVEN THE OPPORTUNITY TO APPLY. ELIGIBILITY REQUIREMENTS FOR MEDICAID AND RELATED GOVERNMENT ASSISTANCE PROGRAMS ARE ALSO SHARED WITH PATIENTS. PART VI, LINE 4: THE HOSPITAL IS THE ONLY HOSPITAL IN ORLEANS COUNTY AND PROVIDES SERVICES TO THE RURAL COMMUNITIES OF ORLEANS, EASTERN NIAGARA, AND NORTHERN GENESEE COUNTIES. PART VI, LINE 5: N/A PART VI, LINE 6: N/A PART VI, LINE 7, REPORTS FILED WITH STATES NY X X X 0 0 0 0 0 0 0 0 0 MARK CYE CHIEF EXECUTIVE OFFICER 231416 0 0 0 0 0 6942 0 394 0 238752 0 0 0 LEE VINCENT PHYSICIAN 240273 0 0 0 0 0 7208 0 33 0 247514 0 0 0 MARY RYKERT-WOLF PHYSICIAN 199162 0 0 0 0 0 5975 0 184 0 205321 0 0 0 ANSHU BAIS PHYSICIAN 178220 0 0 0 0 0 5347 0 20 0 183587 0 0 0 FORM 990, PART VI, SECTION B, LINE 11B THE 990 IS PREPARED AND REVIEWED BY VARIOUS INDIVIDUALS WITHIN MANAGEMENT AND PROVIDED TO THE GOVERNING BODY PRIOR TO ITS FILING AS TIME ALLOWS OR AT ITS NEXT MEETING WHEN TIME DOES NOT PERMIT REVIEW PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD OF DIRECTORS, OFFICERS, AND COMMITTEE MEMBERS ANNUALLY REVIEW AND SIGN THE HOSPITAL'S CONFLICT OF INTEREST POLICY. ACTUAL OR POTENTIAL CONFLICTS OF INTEREST MUST BE DISCLOSED TO THE BOARD. AFTER DISCLOSURE AND DISCUSSION OF THE CONFLICT, THE INTEREST PERSON MUST LEAVE THE MEETING WHILE THE REMAINING BOARD MEMBERS DISCUSS AND VOTE ON WHETHER A CONFLICT EXISTS. IF A CONFLICT DOES NOT EXIST, THE BOARD WILL DETERMINE WHETHER THEY CAN OBTAIN A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT FROM A PERSON OR ENTITY THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST. IF THAT IS NOT REASONABLY POSSIBLE, THE DISINTERESTED MEMBERS WILL VOTE TO DETERMINE WHETHER THE TRANSACTION OR ARRANGEMENT IS FAIR AND REASONABLE, IN THE HOSPITAL'S BEST INTEREST, AND TO THE HOSPITAL'S BENEFIT. FORM 990, PART VI, SECTION B, LINE 15 THE HUMAN RESOURCES DEPARTMENT PROVIDES DATA FOR OFFICERS AND KEY EMPLOYEES FROM THE WESTERN NEW YORK WAGE SURVEY TO DETERMINE COMPENSATION LEVELS WHICH ARE REVIEWED AND DETERMINED AT THE BOARD LEVEL. MINUTES ARE TAKEN FOR THESE MEETINGS. FORM 990, PART VI, SECTION C, LINE 19 THESE DOCUMENTS ARE AVAILABLE UPON REQUEST FROM THE CHIEF EXECUTIVE OFFICER. FORM 990, PART IX, LINE 11G OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 1,453,349. MANAGEMENT AND GENERAL EXPENSES 613,284. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,066,633. PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 1,153,847. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,153,847. FORM 990, PART XI, LINE 9: CHANGE IN NET ASSETS HELD BY FOUNDATION -90,180. NET ASSETS RELEASED FROM RESTRICTIONS -130,385. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. ORLEANS COMMUNITY HEALTH FOUNDATION INC 100 OHIO STREET MEDINA NY 14103 161155081 TO RAISE AND ORGANIZE FUNDS IN SUPPORT OF ORLEANS COMMUNITY HEALTH NY 501(C)(3) 11B N/A 0 0 0 1 0 1 0 0 0 0 0 0 1 1 0 0 0 1 0 0