2018-11-13T09:08:26-07:00 2017-12-31 990 2017-01-01 150533564 SCHUYLER HOSPITAL INC SCHU 6075357121 220 Steuben Street Montour Falls NY 14865 Rebecca Gould CFO / Director of Finance 6075358639 2018-11-13 64.196.182.162 2017 2019-02-21 02:37:17Z James Watson President 220 Stueben Street Montour Falls NY 14865 35024599 0 X http://www.schuylerhospital.org X 1929 NY Schuyler Hospital is a 25 bed acute care facility with critical access hospital status and 24 hour emergency services. It provides a full complement of healthcare services to the public in support of the community need for healthcare close to home, which includes the residents of Schuyler County and its surrounding communities. Medical services in 2017 included 3,318 inpatient days, 38,903 Long Term Care days, 177,440 outpatient procedures and 25,835 physician visits. In 2017 Schuyler Hospital provided over $68k in free and reduced cost care through its charity care policy and incurred over $682 thousand in bad debt due to the remaining uninsured and increasing under-insured population in the community. 21 18 489 234 0 0 1389202 471117 32802220 33478167 67055 87440 904522 987875 35162999 35024599 0 0 0 0 22783662 22089227 0 0 120325 10598939 10934986 33382601 33024213 1780398 2000386 28604005 29161949 13243249 11674906 15360756 17487043 Schuyler Hospital is a network of providers, programs and services that meets the healthcare needs of a population of over 32,000 residents, through a wide range of medical services, highly skilled medical staff, and our devotion to customer service. Our Mission: To optimize the health and healing experience of all people we service in a safe, compassionate, and respectful environment. Our Vision: As a community led organization, we will be the healthcare provider of choice, delivering excellent, innovative services to meet the needs of the communities we serve. Our Values Include: Integrity and Honesty - We keep our word and treat everyone with mutual trust; Quality and Accountability - We accept responsibility for the trust placed in us; Dignity and Respect - We treat everyone with honor and compassion; Teamwork - We align our energies and enhance patient/resident care by working together; and Continuous Learning - We encourage and foster individual growth and learning. 0 0 28099275 35024599 Schuyler Hospital is a 25 bed acute care facility with critical access hospital status and 24 hour emergency services. It provides a full complement of healthcare services to the public in support of the community need for healthcare close to home, which includes the residents of Schuyler County and its surrounding communities. Medical services in 2017 included 3,318 inpatient days, 38,903 Long Term Care days, 177,440 outpatient procedures and 25,835 physician visits. In 2017 Schuyler Hospital provided over $111k in free and reduced cost care through its charity care policy and incurred over $682 thousand in bad debt due to the remaining uninsured and increasing under-insured population in the community. 0 0 0 28099275 1 0 0 1 0 0 0 0 1 1 1 0 0 1 0 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 0 0 0 1 144 0 489 1 0 0 0 0 0 0 X 21 18 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X Rebecca Gould CFO 6075353801 220 Steuben Street Montour Falls NY 14865 Larry Baum Board Chair 1 0 X X 0 0 0 Kyle Tuttle Vice-Chair 2 0 X X 0 0 0 Greg Hartz Treasurer 2 1 X X 0 0 0 Thomas LiVigne Secretary 1 0 X X 0 0 0 Richard Weakland Board Member 1 0 X 0 0 0 Benjamin Saks Board Member and Physician 40 X 278504 0 51946 Fred Wickham Board Member 1 0 X 0 0 0 Ashraf Sabahat President Med Staff Ex-Officio 40 0 X 392002 0 54437 Eunice Nayo Board Member and Physician 40 0 X 18000 0 0 Peter Bardaglio Board Member 1 0 X 0 0 0 Rev Dr Kenneth Clarke Board Member 1 0 X 0 0 0 Noel Desch Board Member 1 0 X 0 0 0 Gary Ferguson Board Member 1 0 X 0 0 0 Paula Younger Board Member 1 0 X 0 0 0 Carl Sgrecci Board Member 1.00 X 0 0 0 James Brown Board Member 1 0 X 0 0 0 Jerry Mickelson Board Member 1 0 X 0 0 0 Dr John Lambert Board Member 1 0 X 0 0 0 Suzanne Blowers Board Member 1 0 X 0 0 0 Joel Malina Board Member 1 0 X 0 0 0 Kitty Shallenberger Auxiliary President and Ex-Officio Board Member 2 0 X 0 0 0 James Watson President 40 2 X 296553 0 25488 Amy Castle through 08-09-17 CFO/VP of Finance 40 2 X 140345 0 17266 John Collett CFO 2 0 X 0 0 0 Jagmahan Singh Physician 40 0 X 300091 0 51839 Stephen Spaulding Family Medicine Physician 36 0 X 184129 0 51839 Kristina Cummings Physician 40 0 X 170847 0 44227 Amanda Kinsman Nurse Practitioner 40 0 X 130153 0 19734 Mary Ann Mahajan Director of Pharmacy 40 0 X 128650 0 36005 2039274 0 352781 19 0 1 0 Medical Solutions LLC 1010 N 102 2nd St Suite 300 Omaha NE 68114 Contract Registered Nurses 385299 Supplemental Health Care PO Box 677896 Dallas TX 752677896 Contract Registered Nurses 347399 Hale Contracting 2054 Grand Central Ave Horseheads NY 14845 Renovation Services 300509 Kings Medical Company 1920 Georgetown Rd Hudson OH 44236 MRI Services (Equipment and Tech) 260000 Sunbelt Staffing Dept Ch 14430 Palatine IL 600554430 Contract Registered Nurses 223365 10 0 0 0 93616 374697 2804 0 471117 Net Patient Service Revenues 622000 32054305 32054305 0 0 1423862 1423862 0 0 33478167 63604 0 0 63604 0 0 0 0 0 0 0 0 0 0 0 23836 0 0 0 23836 23836 0 0 23836 0 Cafe sales, Vending, Rebates and Other Misc Revs 622000 987875 859919 0 127956 0 0 0 0 987875 35024599 34338086 0 215396 X 1274541 794889 479652 16105937 14331328 1747960 26649 312186 273418 38335 433 3175804 2717477 454045 4282 1220759 1069162 149904 1693 89654 1083 88571 81131 10948 63536 6647 23494 23494 259528 3775 224786 30967 2523397 2320253 176125 27019 562490 417406 142601 2483 8497 8126 362 9 87623 55479 31477 667 101901 101901 1376296 1120850 255446 184751 49006 135744 1 Purchased Services 4068701 3759756 301007 7938 Provision for Bad Debt 682683 682683 0 0 884840 483636 389667 11537 33024213 28099275 4804613 120325 776267 556103 5450623 6854556 1314914 862828 3090863 3996940 0 0 0 618381 612307 155692 253497 30289003 18475217 12245301 11813786 331754 258031 4620210 3953901 28604005 29161949 9415337 9833272 0 0 294893 258031 0 0 53135 46986 0 0 1986667 1536617 0 0 1493217 0 13243249 11674906 X 10200354 13579247 4068194 2717337 1092208 1190459 15360756 17487043 28604005 29161949 X 2000386 0 0 0 0 125901 X 0 1 X 1 0 X 0 35580 35580 0 35580 7116 1779 0 28464 1 0 0 4497 7116 11613 17420 0 0 22487 35580 58067 0 0 1124 1779 2903 4355 0 0 0 0 0 0 1 X 1060895 0 65919 0 1126814 0 0 1037986 0 22909 0 0 0 1060895 1072207 0 -34221 0 0 0 1037986 1065773 0 6434 0 0 0 1072207 969176 0 96597 0 0 0 1065773 0 0 1 0 1 1 131599 0 131599 19486636 0 10401528 9085108 20143 0 20143 0 10650625 0 8053546 2597079 0 0 0 0 11813786 Beneficial Interest in Schuyler Health Foundation 2339704 Due From Affiliate 16349 Assets whose use is limited - Trust 1190459 Other Assets 194150 Pension - Pre-Funded Status 213239 3953901 Schedule D, Part IV, Line 2b Schuyler Hospital services as custodian for residents in our in our Skilled Nursing Facility. Residents have access to their funds 24 hours a day, 7 days a week. Schedule D, Part V, Line 4 Sched D - Part V - Line 4 - Schuyler Health Foundation, a subsidiary of Schuyler Hospital, has been named a beneficiary of 50% of a Term Endowment. This event occurred during 2017 and this asset was transferred to the Schuyler Health Foundation at that time. In July 2017, the Trust money was received and in August the board voted to fund Schuyler Hospital's frozen Defined Benefit Pension Plan for $1,126,814. 1 1 1 X 1 X 1000 1 1 0 1 1 683835 57174 626661 0.0194 11209528 6944475 4265053 0.1319 0 0 0 0 0 0 11893363 7001649 4891714 0.1513 21742 1188 20554 0.0006 199243 0 199243 0.0062 4688046 3604948 1083097 0.0335 0 0 0 0 35225 0 35225 0.0011 0 0 4944256 3606136 1338119 0.0414 0 0 16837619 10607785 6229833 0.1927 0 0 0 0 0 0 0 0 1168 1168 0 0.0 0 0 0 0 0 0 0 0 6175 0 6175 0.00019 15449 1890 13559 0.00042 3000 0 3000 0.00009 0 0 0 0 0 0 25792 3058 22734 0.00070 1 682683 204805 10854883 11341979 -487096 X 1 0 1 1 Schuyler Hospital 220 Steuben Street Montour Falls NY 14865 http://www.schuylerhospital.org X X X X Surgical Services,Lab,Imaging,Respiratory,Rehab,Skilled Nursing Facility,Employed Physicians Schuyler Hospital 1 0 0 1 X X X X X X X X X 16 1 0 1 1 X www.schuylerhospital.org X X 1 16 1 https://schuylerhospital.org/about-us/annual-community-report/ 0 0 1 X 100 1000 X X X X X 1 1 X X X X 1 X https://schuylerhospital.org/visiting-us/paying-for-your-care/ X https://schuylerhospital.org/visiting-us/paying-for-your-care/ X https://schuylerhospital.org/visiting-us/paying-for-your-care/ X X X X X 1 X 0 X X X 1 X 0 0 Schedule H, Part V, Section B, Line 5-Schuyler Hospital Schuyler County Public Health Department participated in the development of the 2016-2018 Community Health Assessment. Schedule H, Part V, Section B, Line 6b-Schuyler Hospital The hospital facility took into account input from persons who represent the community. The primary partners in the assessment process include Schuyler County Public Health, Schuyler Hospital, S2AY and the FLHSA, however, there are a wide variety of other community partners that serve on the Schuyler County Public Health Professional Advisory Committee (PAC) and other community based organization non for profits that participated at some point along this process and priority setting meetings. Schedule H, Part V, Section B, Line 7d-Schuyler Hospital Schuyler also filed Community Health Needs Assessment with NYS DOH, as the Annual Required Community Service Plan. Schedule H, Part V, Section B, Line 11-Schuyler Hospital Schuyler Hospital is working with Public Health and other County agencies to improve overall community Health. The CHNA is divided into three goals. Goal 1 Prevent Chronic Diseases; Goal 2 Promote Healthy Women, Infants and Children; Goal 3 Promote Mental Health and Prevent Substance Abuse Priority Area 1 Prevent Chronic Diseases (Reduce Obesity in Children and Adults & Increase Access to High Quality Chronic Disease Preventive Care and Management in Both Clinical and Community Settings. The first Schuyler County priority has not changed (Prevent Chronic Diseases - focusing on obesity and hypertension) from the 2013 Community Health Assessment (CHA) and Community Health Improvement Plan (CHIP), although the strategies to be used to address these priorities have evolved as seen in the attached CHIP. Obesity: 61.1% of adults in Schuyler County are classified as either overweight or obese on an age adjusted rate. Proportionally 35.7% of Schuyler County children are considered overweight or obese (85th percentile or higher (2012-2014) DOH health ranking data), this puts Schuyler County children in the 2nd quartile for county ranking when compared to the State average. 5.4% of adults have a diagnosis of pre-diabetes, 8% diabetes and 27.6% hypertension. Obesity is important due to the many related health conditions linked to obesity, including heart disease, hypertension, diabetes, lower back pain, arthritis, high cholesterol and several types of cancer. Therefore by addressing obesity, several other health-related problems may be prevented. Obesity related data and other statistics cited below can be reviewed in the Schuyler County EBFRSS at: https://www.health.ny.gov/statistics/brfss/expanded/2013/county/docs/schuyler.pdf Hypertension: According to the CDC, approximately 30% of adults are diagnosed with hypertension in the United States. Schuyler County is in line with those numbers with approximately 27.6% of the adult population residing in the county having been diagnosed with hypertension by a physician. Schuyler County has an above average control rate in the region for hypertension with approximately 72% of the population registering as in-control. (FLHSA/RBA High Blood Pressure Registry, June 2015). Priority Area 2 Child Health Dental health Unfortunately the most up to date Schuyler County dental health data is from 2011 and indicates that there are 14.3% of 3rd grade children having untreated dental caries placing it in the 1st quartile in NY State. While these percentages indicate child dental health is not a significant issue in Schuyler County, Public Health, and Schuyler Hospital in partnership with local physicians and dentists are continually monitoring dental health data and working to address issues. It remains a community priority due to the lack of dental services willing to accept Medicaid patients. Presently, no dentist within the county accepts Medicaid patients, requiring people to travel out of county for their dental care. Only 62.4% of adults have visited a dentist within the past year. Good oral health is essential to the general health of the community. Tooth decay is preventable, but continues to affect all ages. It is a greater problem for those who have limited access to prevention and treatment services. According to the NYSDOH untreated decay among children has been associated with difficulty in eating, sleeping, learning, and proper nutrition. An estimated 51 million school hours are lost due to cavities. Almost one fifth of all health care expenditures in children are related to dental care. Early Childhood: The health and well-being of families is fundamental to overall population health. The priority of the Schuyler County Community is to provide support to all families and nurture their abilities to develop their children's physical, cognitive and social emotional health. The averages of 40 % of our children entering Kindergarten (School Kindergarten Screenings for years 2014 and 2015) have some kind of a delay in a developmental domain. 23.9% of Schuyler County children living in poverty and 26.6 % of our children live in single parent households. 85.3% of our children aged 3-6 years on government sponsored insurance have received the recommended number of well child visits. Children need a healthy start in life and the opportunity for optimal growth and development throughout their lifespan. By approaching health as a continuum consideration is given the impact of social, economic, environmental, biological, behavioral and psychological factors on individuals and families throughout their lives. Supporting young families has proven to strengthen families with young children directly providing or connecting them with health, psychological, parenting and other services, depending on each family's unique needs. Priority Area 3: Prevent Substance Abuse and Other Mental Emotional Behavioral Disorders. Substance Abuse: (mental health and substance abuse) with data showing sharp increases in ED visits for substance abuse, heroin overdose, and mental health diagnoses, as well as admissions for heroin overdose. (as shown in the attached Power point presentations. Discussions of the analysis related to the opioid epidemic included mortality rates, premature loss of life, criminal behaviors related to substance abuse and the fact that substance use disorders affect entire families, often including the children of the person with the disorder. The opioid epidemic sweeping across the Nation is a significant health improvement priority and was analyzed at the national, state and local levels during the assessment. Schedule H, Part V, Section B, Line 16j-Schuyler Hospital Schuyler Hospital includes on every patient statement reference to the Financial Assistance Policy as well as the hospital's internet address where the policy can be found. 1 Seneca View Long Term Skilled Nursing Facility 220 Steuben Street Montour Falls NY 14865 120 Bed Skilled Nursing Facility, attached to and operated under Schuyler Hospital (provider based). Schedule H, Part I, Line 3c The organization uses a sliding fee scale for persons over 100% of the poverty guideline. There is no family income limit (though had to put a % in box on line 3 of 1000%) sliding fee scale is based on number of persons in household, % above FPG and then % off gross charges is determined by % over FPG as follows: 90% off 101-125% FPG, 80% off 126-150% FPG, 70% off 151-175% FPG, 60% off 176-200% FPG, 50% off 201-250% and 40% off 251 -300% above FPG. Schedule H, Part I, Line 6a Cayuga Health System Schedule H, Part I, Line 7 Used ratio of cost to charge calculation for lines 7a, 7b and 7g and used actual costs on lines 7e, 7f and 7i. Schedule H, Part I, Line 7, Column f $ 682,683 is the amount of bad debt expense that was included in Form 990, Part IX, line 25, Column (A), but removed for this figure for purposes of calculating the percentage in Schedule H, Part I, Line 7, column (f). Schedule H, Part I, Line 7g No physician amounts were included. Schedule H, Part II Schuyler Hospital, the county's largest employer of over 400 people, supports and promotes the community it operates in. The Hospital extends use of its facilities for health care related meetings of any type, along with other community meets and events. It hosts blood draws each year, provides a local credit union with space within the facility for minimal rent to provide its employees easier access to banking due to its rural location, and is a disaster preparedness hub for the county. Its employees volunteered over 1,350 hours to support community events this year. Schuyler actively works with the County Depart of Health and the Schuyler Health foundation to enrich the healthcare of the population it serves. Schedule H, Part III, Section A, Line 4 The hospital estimates the amount to be recognized in the consolidated financial statements for doubtful accounts by analyzing patient and resident accounts for collectability, considering prevailing economic conditions, and applying historically established percentages for self-pay and various third-party payors to the aging categories in the accounts receivable aging and reviewing specific outstanding balances. Accounts for which no payments have been received for significant amount of time are considered delinquent and the accounts are written-off when customary collection efforts are exhausted. The Hospital's accounting policy with respect to the consolidated financial statements is to report the consolidated bad debt expenses as a deduction from patient revenue. See page 8 of the AFS. Schedule H, Part III, Section B, Line 8 There was a shortfall in 2017. Costing methodology used in determining the "cost" of bad debt was the actual bad debt expense times the Ratio of Cost to Charge from the 2017 Medicare cost Report. Schedule H, Part III, Section C, Line 9b The policy does not specifically contain a provision on the collection practices to be followed for patients who are known to qualify for charity care of financial assistance, however the hospital's financial counselors do not send an account to collection if they are aware that the patient qualifies for charity care or financial assistance, as they are also the persons responsible for the charity care or financial assistance processes. Schedule H, Part VI, Line 2 In all S2AY Network Counties, the process began with a data update for the eight county region conducted by the Finger Lakes Health Systems Agency (FLHSA) at the request of S2AY. This data collection and analysis effort focused on data related to the main priorities in the 2013 CHA for the region as well as some emerging issues that the hospitals and Public Health agreed should be analyzed based both on their knowledge of what they were seeing in their communities and what was revealed in the for Delivery System Reform Incentive Payment Program (DSRIP) needs assessment, which was also completed by the FLHSA. 2013 Regional Priority Areas included: Obesity, Hypertension, Diabetes, Heart Disease, Tobacco Use, falls, slips and trips in the 65& population. Emerging issues included: Behavioral Health and Low back pain. The collaborative Mobilizing for Action Planning and Partnership (MAPP) was again used for this assessment. The data was presented to the Public Health Directors and the hospital representatives in a region meeting held on March 4, 2016. The data collected and analyzed came from the following sources: Expanded Behavioral Risk Factor Surveillance Survey (EBRFSS), Census Bureau, Statewide Planning and Research Cooperative System (SPARCS) data, NY State Prevention Agenda data set, Aggregated Claims Data, NY State Vital Statistics, and the Regional High Blood Pressure Registry, as can be seen in the attached copy of the presentation. Once this data had been reviewed, the S2AY reviewed other data to develop a summary Power Point presentation of the highest need areas for each county. This additional review of data included, among other things: County Prevention Agenda Dashboard, EBRFSS; Community Health Indicator Reports, Sub-County Data Reports, Leading Causes of Death Indicators and County Health Rankings. The primary data reviewed originated from the Regional Hypertension Registry, the 2013 and 2015 "Communities That Care" Grades 7-12 Student Survey results, as well as the five community focus groups input. Schedule H, Part VI, Line 3 Schuyler Hospital recognizes the needs in our community to provide financial counseling and assistance to those patients with limited income, no insurance, or high deductible insurance plans, who find it difficult to meet the expenses incurred in receiving health care services. The hospital has successfully been administering its financial aid policies and procedures for reducing charges otherwise applicable to low-income individuals without health insurance, or who have exhausted their health insurance benefits, and who can demonstrate an inability to pay full charges. Our Financial Assistance and Charity Program Policy defines the Financial Assistance Program and establishes the necessary criteria, guidelines and approval process for the provision of financial assistance and Sliding Fee Scale to eligible individuals to help ease the burden of the costs of health care services provided. Therefore, Schuyler Hospital updated its financial assistance program in 2007, 2010, 2014 and then again in 2016. In 2010 we established a self-pay task force to review our policies and follow up on any issues that arose from such financial aid policies and procedures. Currently, the monthly Revenue Cycle meetings handle any issues that may arise. We have a prompt pay discount for any payments from an individual, which is good for all balances except co-pays. Also, Schuyler Hospital has been able to discount co-pays and deductible payments from those individuals who can demonstrate an inability to pay such amounts. All patients who are self-pay or have large self-pay balances are proactively given Information regarding our charity care program and our sliding scale program, which is administered using the federal poverty guidelines. The hospital employs two full time financial counselors, who are located by the Admissions Department in the Emergency Room of the Hospital from 7:30am to 4:30pm Monday through Friday, who make it their mission to reach out to those in need and help find a way to fund their health service's needs. Schuyler Hospital has also worked to provide monthly on-site facilitated enrollment for Medicaid and Child Health Plus and Family Health Plus programs. A large challenge Schuyler Hospital faces is actually getting people to apply for the program. It is a challenge to get the paperwork filled out and have patients who may be eligible under our financial aid policies and procedures to complete the application requirements and necessary documentation. The application process has been simplified in an attempt to make it easier for those in need to get the assistance they so desperately need. However, it continues to be a barrier to the success of the program. Also, it has been challenging ensuring that we have disseminated the information about the many policies we have that can be taken advantage of by patients. But the largest challenge has been the financial burden of such programs; reduced reimbursement for quality services provided additional overhead costs and additional time/resources. Schuyler Hospital provides emergency care and medically necessary Essential Health Services without regard to a patient's source of payment. In 2014, we created conspicuous signs that reside near every registration area indicating our FAP, and where it can be found. We also added the application to the Schuyler Hospital website for easy reference. Schedule H, Part VI, Line 4 Schuyler Hospital, Inc, located in Montour Falls, Schuyler County, is situated in rural upstate New York in the heart of the Finger Lakes, and is the only hospital in Schuyler County, a Federally Designated Medically Underserved Population and a Health Professional Shortage Area. Schuyler Hospital, established in 1920, is a 25-bed Critical Access Hospital that provides acute, ambulatory and long-term care services in Primary and Secondary Service areas with a population of 32,000. This rural population includes Schuyler County residents and the rural residents of adjoining Chemung, Steuben, Tompkins, Seneca and Yates counties. Additionally, Schuyler Hospital is the resource for medical services to over 2 million tourists who visit Schuyler County and the surrounding area each year. Schuyler County itself is the second smallest county in NYS and a rural county with a declining population. The 2017 census revealed a population with a minimal decline of more than 1% (-1.9%), to a total of 18,000 residents. Schuyler County is largely a "bedroom" community, with residents traveling a mean average of 25.6 minutes to/from their workplace. With that said, due to the county's rural nature, transportation to and from remote areas of the county is a challenge. In 2010, the county began operating its first public transit system, which reaches into the more populated villages of the county. Our service area also encompasses a large Amish and Mennonite population. Median household income is $47,680 (under the NYS median income of $59,268) and 12.5% of the county's population lives below the poverty level. The county's current rate of unemployment as of June 2017 is 4.4%. 34% of Schuyler Hospital patients are on Medicaid and another 18% are under insured. While Schuyler Hospital's main campus is located in Montour Falls, Schuyler has evolved over the years into a network of providers, programs, and services that reaches throughout Schuyler County and into southern Yates and Seneca Counties. For the purpose of the Community Service Plan, Schuyler Hospital and Schuyler County Public Health consider Schuyler County to be the Primary Service Area - encompassing the towns of Montour, Reading, Dix, Orange, Hector, Cayuta, Catherine and Tyrone; as well as the villages of Montour Falls, Burdett, Odessa and Watkins Glen. Schuyler County has a population of 18,000 within 328 square miles. This underserved rural population experiences significant social, economic and health issues. For nearly 100 years, Schuyler Hospital has provided basic and emergency care to the people of this community. As the county's largest employer, it is a large economic generator - over $56 million last year - due to jobs, purchasing, and taxes. Schuyler Hospital is accredited by The Joint Commission (formerly JCAHO). The medical staff includes physicians, specializing in internal medicine, family practice, surgery, orthopedics and sports medicine, pathology, critical care, pain management, sleep disorders, colon-rectal and anesthesiology. The hospital offers a wide array of services - including 24 hour ER, ICU, and Imaging department (MRI, CT, Ultrasound, X-ray, Mammo, bone density testing). Extensive physical, occupational, respiratory and speech therapy programs, as well as pulmonary testing are offered. The primary care and family health centers in Montour Falls, Dundee, and Ovid provide pediatric, adolescent, and adult health and wellness care. Seneca View, our 120 bed skilled nursing facility, located in the hospital offering inpatient services that include physical, speech and occupational rehabilitation. Schedule H, Part VI, Line 5 Schuyler Hospital, Inc. is proud to provide care to our community. Our doors are open 24 hours a day, seven days a week, 365 days a year. Every year, we serve thousands of individuals and keep our community healthy, strong, and vibrant. This record of service is, and always will be, our most valuable contribution to the community. Additionally, Schuyler Hospital, being the largest employer in the county, is seeking to have a positive impact in the region, promote area development and hopefully also advance economic development, for which there is a documented need. The people of Appalachia must have adequate healthcare to promote socially and economically competitive communities, and Schuyler Hospital helps fulfill this need. It has been especially difficult to deliver services to remote rural regions due to the closing of independent community hospitals and/or some of the services they provide. Schuyler Hospital does not plan on being one of them and has continued to morph its vision and strategic plan to survive and continue to move forward, especially during difficult financial and economic times, to remain a pillar of strength in the community. In general, health-care and the delivery of medical services to patients, as well as the underlying operations to support patient services, have become increasingly dependent upon technology - especially communications and information technology. Schedule H, Part VI, Line 6 On September 29, 2014 Schuyler Hospital became a part of the Cayuga Health System. The mission of Cayuga Health System is to further the ability of its member healthcare organizations to honor their community based missions of providing the highest quality, patient centered care in a safe, compassionate and sustainable manner. The Vision of CHS is to "Further the ability for both organizations to meet their missions and realize their visions to improve the overall health care of our communities and generating loyalty and pride in the health care of our communities." Cayuga Health System will be recognized as an innovative, integrated regional health care leader committed to the health of our communities through the collaborative efforts of all members characterized by: * An ever improving quality of care provided within a culture of safety across the entire health system. * An unwavering focus on the health of the population served in our communities while empowering members of our communities to make healthy choices. * A steadfast drive to exceed the expectations of those we serve. * A sustainable business model with rigorous attention on achieving system efficiencies, regional growth, and sharing of expertise within an ever changing healthcare environment. * Local access to appropriate community based healthcare services enhanced by collaborations with regionally and nationally recognized healthcare resources. * An inclusive system that generates loyalty and pride from all of the communities we serve. Schedule H, Part VI, Line 7 New York X X X 0 0 0 0 0 0 0 0 0 Jagmahan Singh Physician 277841 0 22250 0 0 0 0 0 51839 0 351930 0 0 0 Stephen Spaulding Family Medicine Physician 184129 0 0 0 0 0 0 0 51839 0 235968 0 0 0 Kristina Cummings Physician 158847 0 12000 0 0 0 0 0 44227 0 215074 0 0 0 Mary Ann Mahajan Director of Pharmacy 128650 0 0 0 0 0 0 0 36005 0 164655 0 0 0 James Watson President 277803 0 18750 0 0 0 0 0 25488 0 322041 0 0 0 Amy Castle through 08-09-17 CFO/VP of Finance 114886 0 0 0 25459 0 0 0 17266 0 157611 0 0 0 Ashraf Sabahat President Med Staff Ex-Officio 392002 0 0 0 0 0 0 0 54437 0 446439 0 0 0 Benjamin Saks Board Member and Physician 234004 0 22250 0 0 0 0 0 51946 0 308200 0 0 0 Schedule J, Part I, Line 3 The executive compensation policy involves an annual survey of wages for the CEO, Former CFO, and CNO/COO, compared to the market using the regional and national Healthcare Wage Surveys. Due to constraints of the economy, these positions' compensation may not be adjusted annually. Any changes in CEO compensation is approved by the Executive Committee. Form 990, Part VI, Section B, Line 11b The hospital Cost Accountant and Financial Analyst prepare the annual form 990 (with oversight from CFO) and CFO distributes to the Board of Directors and members of the Hospital Executive Team for review, comment, and questions prior to filing with IRS. Form 990, Part VI, Section B, Line 12c The hospital has a written conflict of interest policy. Each board member reviews annually and signs the corresponding conflict of interest statement. In addition, as new members are inducted, they read the policy and sign the conflict of interest statement. Form 990, Part VI, Section B, Line 15 The executive compensation policy involves an annual survey of wages for the CEO and Former CFO, compared to the market using the regional and national Healthcare Wage Surveys. Due to constraints of the economy, these positions' compensation may not be adjusted annually. In addition, the Medical Director's salary is compared to the MGMA data at the contract renewal rate. Any changes in CEO compensation is approved by the Executive Committee. Form 990, Part VI, Section C, Line 19 Upon request, appropriate schedules of the annual financial statements, IRS Form 990 and conflict of interest forms can be released to the public. The forms are housed in the executive office of the CEO and are available at a minimum copying fee. Form 990, Part IX, Line 24e Total Other expenses are comprised of: Late Fees ($1,433), Repairs and Maintenance ($169,071), Collection Services ($134,084), Contracted Services ($363,746), Recruitment Expense ($33,418), Service recovery expense ($979), Dues and Subscriptions ($76,967), Other direct expense ($81,136), and Advocacy expenses ($24,006) Form 990, Part XI, Line 9 Part XI - Line 9 - $125,901 consists of the following: $76,299 Change in Pension Obligation; $1,302,207 in Net Assets released from restriction and used for the purchase of property and equipment; ($744,393) change in beneficial interest in Schuyler Health Foundation; $1,119,746 Contributions and Grants Net; ($1,726,209) in Other Net Assets released from restriction; $98,252 change in permanently restricted Net Assets due to the market. Less 1 for rounding. (See page 27 of Audited Financial Statements). Schuyler Health Foundation 220 Steuben Street Montour Falls NY 14965 222890619 To raise funds to support the mission of Schuyler Hospital and healthcare in Schuyler County. NY 501(c)(3) 7 N/A 0 Cayuga Medical Center 101 Dates Drive Ithaca NY 14850 222325405 Hospital NY 501(c)(3) 3-Hospital N/A 0 Cayuga Health System 101 Dates Drive Ithaca NY 14850 471899601 To bring together organizations to serve community healthcare needs. NY 501(c)3 12 N/A 0 0 1 0 1 0 0 0 0 0 0 0 1 1 1 1 1 0 1 Schuyler Health Foundation c 30747 Schuyler Health Foundation holds an annual capital fund raising campaign to benefit Schuyler Hospital. Each year those funds are released to Schuyler Hospital as the purpose of the funds is met. In 2017 Schuyler Health Foundation transferred $30,747 for purchase of equipment, Shower Renovations, Lobby Upgrade, and ENT Start-up costs. Schuyler Health Foundation e 1000000 Schuyler Hospital has a line of credit with Chemung Canal Trust Company which is secured by investments owned by Schuyler Health Foundation. Schuyler Health Foundation q 87870 Schuyler Health Foundation reimburses Schuyler Hospital for expenses paid on their behalf. These expenses include the associated costs of office space and a copier/scanner/fax. Expenses are reconciled and reimbursed on a monthly basis. For 2017 total reimbursements to Schuyler Hospital amounted to $87,870 Schuyler Health Foundation o 39853 Schuyler Hospital reports wages and remits taxes for the four employees who carry out the Foundation responsibilities. Total 2017 wages for the Schuyler Health Foundation Executive Director and for the Foundation Assistants Totaled $39,853 Cayuga Medical Center p 663908 Schuyler Hospital reimburses Cayuga Medical Center for the following services: Anesthesia, Lab testing, Insights, KRONOS and Relay Health Software costs, AP mailings, Ortho Clinic time, Split Advertising, supplies as well as shared insurance and legal fees. Cayuga Medical Center m 357308 Schuyler Hospital utilizes Cayuga Medical Center to perform the following services: Sleep, EKG Staff, Payroll, AP, Wound Clinic Staff, Remote Pharmacy, Radiology Techs, Case Management, Bio-Engineering, and Athletic Trainer and Speech Therapist Coverage. Cayuga Medical Center l 81989 Schuyler Hospital provides staffing for nursing, pharmacy, lab, and nurse aid training positions as needed to CMC. In 2017, total services amounted to $81,989. We submitted an extension to ensure that information submitted was complete and accurate and to ensure Board of Directors have time to review. Extensions were filed timely and extensions granted by the IRS to extend filing date to November 15, 2018.