2017-09-29T11:05:05-07:00 2016-12-31 990 2016-01-01 160743905 ARNOT OGDEN MEDICAL CENTER ARNO 6077374235 600 ROE AVENUE ELMIRA NY 14905 Ronald Kintz Senior VP/Chief Financial Officer 6077374235 2017-09-29 162.223.206.130 2016 2021-01-29 14:40:06Z Robert Lambert 600 Roe Avenue Elmira NY 14905 303956001 0 X www.arnothealth.org X 1889 NY Arnot Ogden Medical Center is a community based hospital with an open emergency room and selected highly specialized services that are part of a high quality health care delivery system that serves Chemung County, NY and the Twin Tier Regions of New York and Pennslyvania. 15 13 2853 335 -311356 -315731 2466614 1737448 261603821 275516613 12557453 7293655 638160 2106784 277266048 286654500 0 0 0 0 196689212 202058953 0 0 0 92697987 91902284 289387199 293961237 -12121151 -7306737 261243394 250313124 98196597 90804264 163046797 159508860 Arnot Ogden Medical Center is an independent, not-for-profit, 225-bed tertiary medical facility with more than 115 physicians from over 50 specialties. Arnot Ogden Medical Center offers specialty services at the Falck Cancer Center, Heart and Vascular Institute, Stroke Care, Maternity, Surgery. 0 0 246887434 0 275070870 The Arnot Ogden Medical Center continues to provide of health care related services since it opened in 1889, serving Chemung County and the Twin Tier Regions of New York and Pennsylvania. The Medical Center specialzied in the fields of Cardiology, Oncology, Renal, Neonatology, Bariatrics and Emergency Care. Other sub specialized services include but are not limited to Anesthesiology, Surgery, Laboratory, Imaging, Physical Therapy, Obstetrics, and Gynecology. In 2016 the Medical Center's 2,124 Full-time equivalent of employees cared for 10,918 inpatient admissions in its 225 staffed beds. The Medical Center provided Outpatient Services to approximately 332,015 Outpatient Visits in its subspecialty services. The approximately 115 Full-time equivalent of physicans provided for 306,687 office visits in the areas of primary care and specialty services. 969548 0 445744 The Arnot Ogden Medical Center School of Nursing began in 1889 and continues to offer a three year diploma program accredited by the National League for Nursing with approximately 65 students enrolled in 2016. The Arnot Ogden School of Radiologic Sciences began in 1953 continues to offer a two year certificate program which is accredited by the Joint Review Commission on Education in Radiologic Technology with approximately 18 students enrolled in 2016. Upon completion of their program of study, students are eligible to take the NYS licensing examinations for Registered Nurse or Radiologic Technologist. 0 0 0 247856982 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 1 1 0 0 1 1 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 1 0 0 0 1 311 0 1 2853 1 1 1 0 0 0 0 0 X 15 13 0 0 0 0 0 0 0 1 1 0 1 1 1 1 1 1 1 1 1 1 0 NY X X Ronald J Kintz 6077374235 600 ROE AVENUE ELMIRA NY 14905 Michael Hosey Chairman of the Board 1.5 0 X 0 0 0 Mark J Hagan Vice Chairman 2.5 0 X 0 0 0 Donald Quick Board Member 1 0 X 0 0 0 Louis DiFabio Board Member 1 0 X 0 0 0 Kathleen Lucke Board Member 1 0 X 0 0 0 David Dalrymple Board Member 1 0 X 0 0 0 Richard Simons Board Member 1 0 X 0 0 0 Scott Sprague Board Member 1 0 X 0 0 0 Jan van den Blink Board Member 2 0 X 0 0 0 Roy A Kyles Board Member 1 0 X 0 0 0 Robert McNamara Board Member 1 0 X 0 0 0 Mary Louise Mitchell Board Member 2 0 X 0 0 0 Alan Angell MD Board Member/Physician 41 0 X 430133 0 31653 Roger Schenone MD Board Member/Physician 41.00 0 X 295186 0 16146 Robert Lambert MD Board Member/Physician/CEO 62 3 X X 631140 0 38237 John R Alexander Secretary 1 0 X 0 0 0 Roberto deBara MD President AMS/Physician 40 0 X 446154 0 31652 Ronald J Kintz DHA Senior VP/Chief Financial Officer 37 16 X 372478 0 38237 Sandra McCarthy DNP Chief Nursing Officer 65 3 X 174156 0 19597 Nancy ODacre VP Planning 45 2 X 173840 0 27363 Kenneth Herzl Betz MD Senior VP/Medical Affairs/Physician 68 2 X 311377 0 31495 Richard Cleland Site Administrator IDMH 0 40 X 92314 0 1800 Vidyasagar Mokureddy MD Pain Mgmt Physician 45 0 X 913179 0 34077 Bruno Mazza MD Gastoentrologist 45 0 X 1078139 0 31653 Thomas Boman MD Orthopediac Surgeon 60 0 X 893411 0 35813 Matthew Brand MD Orthopediac Surgeon 65 0 X 831264 0 35513 Paul Tinsley MD ENT Physician 70 0 X 811837 0 31653 Kevin OConner MD Board Member/Physician 40 0 X 421685 0 38237 H Fred Farley PhD Chief Operating Officer 40 0 X 344734 0 14837 James Watson Site Administrator IDMH 0 40 X 56870 0 1424 8277897 0 459387 244 1 1 0 ABM Building Solutions 501 Technology Drive Suite 3000 Cannonsburg PA 15317 Energy Contractor 1987793 Weatherby Locums Inc P O Box 972633 Dallas TX 753972633 Physician Patient Services 1245328 ABM Healthcare Support Services PO Box 935695 Atlanta GA 311935695 Equipment Maintenance Service Contracts 2809659 Medicus Hospitalists Services 22 Roulston Road Windham Road NH 03087 Inpatient Physician Services 3346472 Associated Anesthesiologists Of the Finger Lakes P O Box 1253 Elmira NY 149021253 Surgical Anesthesia Services 1293499 181 0 0 0 0 484560 1252888 0 1737448 Net Patient Service Revenue Hospital 622110 212858505 212858505 0 0 Net Patient Service Revenue Physicians 621110 62212365 62212365 0 0 School of Nursing 611600 380311 380311 0 0 School of Radiologic Technology 611600 65432 65432 0 0 0 0 0 0 275516613 2066141 0 0 2066141 0 0 0 0 0 0 0 0 540872 0 481262 0 59610 0 59610 0 -311356 370966 19741230 12600 14526316 0 5214914 12600 5227514 0 0 5227514 85946 0 26761 59185 0 59185 0 0 0 0 0 0 910847 2267162 -1356315 0 0 -1356315 Education 611600 113642 113642 0 0 Rebates & Discounts 900099 612712 612712 0 0 DSRIP - Delivery System Reform Incentive 921190 1396589 1396589 0 0 1221361 1221361 0 0 3344304 286654500 278860917 -311356 6367491 0 0 0 0 0 0 0 0 2602685 0 2602685 0 0 0 0 0 153649661 131119271 22530390 0 4771818 0 4771818 0 31460889 31460889 0 9573900 7854160 1719740 0 2348265 728667 1619598 0 344874 46961 297913 0 185471 0 185471 0 20056 0 20056 0 0 0 210604 0 210604 0 13063708 11857558 1206150 0 684481 148126 536355 0 4232472 2506190 1726282 0 5859217 1032176 4827041 0 0 0 0 0 3388663 661787 2726876 0 943514 820098 123416 0 0 0 0 0 240365 217821 22544 0 1095810 0 1095810 0 0 0 0 0 11310422 5139044 6171378 0 3744810 2235238 1509572 0 Medical/Surgical/Pharmaceutical Supplies 39800032 39770611 29421 0 Maintenance Contracts/Purchased Services 13419340 8361712 5057628 0 Benefit Allocation 0 30404560 -30404560 0 Intercompany -12948240 2068012 -15016252 0 3958420 2884990 1073430 0 293961237 247856982 46104255 0 12773 11582 1127333 2730361 54376 35708 31968814 34290191 0 0 0 0 703049 296860 1346735 1467436 1781294 1787433 287650651 182018685 104059267 105631966 61592375 51082082 0 0 0 0 830368 0 57767010 52979505 261243394 250313124 19225641 21071255 0 0 145331 153908 28821800 27645400 0 0 0 0 7195649 6182476 0 0 42808176 35751225 98196597 90804264 X 150656612 146139647 9420430 10392258 2969755 2976955 163046797 159508860 261243394 250313124 X -7306737 -675315 0 0 0 4444115 X 1 X 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 20056 20056 0 Schedule C, Part II-B, Line 1 Schedule C, Part II-B, Line 1 - Arnot Ogden Medical Center pays annual dues to the Hospital Association of New York State - HANYS, and Rochester Regional Healthcare Association - RRHA, of which a percentage is for lobbying fees. The total lobbying fees paid to all in 2016 was $20,056. 2969755 7200 0 0 0 0 2976955 3093934 0 0 0 124179 0 2969755 2947754 3326 142854 0 0 0 3093934 2827204 0 120550 0 0 0 2947754 2827204 0 0 0 0 0 2827204 0 1 0 0 0 6410329 0 6410329 129205509 0 62215581 66989928 951364 0 918336 33028 151083449 0 118884768 32198681 0 0 0 0 105631966 Assets whose use is limited 28204359 Investment in subsidiaries 4192874 Interest in Net Assets of Foundation 19600608 Due from Third Party Payors 220188 Due from Related Parties 761476 52979505 0 Third Party Liability Reserves 2136002 Self Insurance Reserves 8122147 Minimum Pension Liability 8150537 457 Plan Liabilty 5571481 notes Payable Investment Funds Held for Affiliates 11774610 Deferred Income Covenant Not to Compete 286875 Due to Related Parties -290427 35751225 X 287966187 0 0 0 0 0 287966187 210609 -1522296 -1311687 286654500 296525811 0 0 0 0 0 296525811 210609 -2775183 -2564574 293961237 Schedule D, Part V, Line 4 The organization has interpreted the NYS Prudent Management of Institutional Funds Act Law, NYPMIFA as requiring the preservation of the historical dollar value of the corpus of the permanent restricted endowment funds absent of donor stipulations to the contrary. The net appreciation of the permanent restricted endowment funds absent of the donor stipulations to the contrary. The net appreciation of the permanently restricted net assets is considered temporarily restricted net assets until those amounts are appropriated for expenditure by the Organization in a manner consistent with the standard of prudence prescribed by NYPMIFA. If the fair value of the investments assets falls below the level of the donor, NYSMIFA requires the Center to retain the fund in perpetual duration. There were no such deficiencies as of December 31, 2016. To ensure the preservation of the corpus of the permanently restricted endowment funds, the total fair value of all commingled investment assets are classified first to the level of the permanently restricted endowment funds corpus, an endowment fund deficiency receivable from the unrestricted net assets would be recognized until the deficiency is recovered. Schedule D, Part X, Line 2 Income Taxes: Arnot Ogden Medical Center, AOMC Foundation, the Auxiliary, Ira Davenport, Keuka and SJH are organized as not-for-profit corporations as described in Section 501(c)(3) of the Internal Revenue Code (the Code) and accordingly, are exempt from Federal income taxes on related income pursuant to Section 501(a) of the Code. Ivy Street is a C-Corporation and files corporate tax returns. The Organization accounts for uncertain tax positions in accordance with US GAAP, which requires the recognition and measurement of uncertain tax positions that the Organization has taken or expects to take in the Organization's tax returns. Management believes there are no significant uncertain tax positions not reflected in the accompanying consolidated financial statements as of December 31, 2016 and 2015. Schedule D, Part XI, Line 4b Expenses to offset revenue include: Fund Raising Expenses $(26,760), Rental Expenses $(481,262), Cost of providing Nutritional Services Cafeteria Expenses for patient and employees to provide meals in the amount of $(2,267,162). Donations for Equipment from our Foundation $808,983 recorded as Net Assets, and Donations from Temporarily Restricted Net Assets of $443,905. Schedule D, Part XII, Line 4b Expenses moved to offset Revenue include: Fundraising $(26,760), Rental $(481,262), and Nutritional Services $(2,267,162) Golf Tournament 57933 0 57933 0 4341 6000 3168 0 1264 Moonlight & Miracles 18826 0 18826 0 0 142 6229 2300 253 3 9187 0 9187 0 0 0 0 275 2788 85946 0 85946 0 4341 6142 9397 2575 4305 26760 59186 1 1 X 1 X 1 X 1 1 0 1 1 739 901848 20294 881554 0.01 8620 10664733 2952165 7712568 0.02 47548 47506708 23576711 23929997 0.08 0 56907 59073289 26549170 32524119 0.11 6 5342 31531 5376 26155 0 93 847 7943125 554128 7387997 0.02 0 0 0 0 0 0.0 0 0 0 0 0 0 1 0 60 0 60 0 100 6189 7974716 559504 7414212 0.02 100 63096 67048005 27108674 39938331 0.13 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 0 0 0 0 0 1 0 417 0 417 0 0 0 0 0 0 0 0 0 0 0 0 0 7 0 417 0 417 0 0 14295679 0 31986020 63017483 -31031463 X 1 1 Ivy Street Development Corp Collection of Services & Rentals 1 0 0 1 1 Arnot Ogden Medical Center 600 Roe Avenue Elmira NY 14905 www.arnothealth.org 0701000H X X X X Hospital with Open Emergency Room. A 2 Arnot Ogden Medical Center Health Center for Women 600 Fitch Street Elmira NY 14905 www.arnothealth.org X Hospital Extension Clinic - Diagnostic Radiology A 3 Arnot Ogden Medical Center Horseheads Campus 100 John Rommelt Drive Horseheads NY 14845 www.arnothealth.org X Clinical Laboratory Service & Radiology Diagnostic Outpatient. A A 0 0 1 X X X X X X X X 15 1 1 1 1 X www.arnothealth.org X 1 16 1 www.arnothealth.org 0 0 1 X 150 400 X X X 1 1 X X X 1 X www.arnothealth.org X www.arnothealth.org X www.arnothealth.org X X X X X 1 X 0 X X X 1 0 1 Schedule H, Part V, Section B, Line 5-Group A Beginning in the Fall of 2015 , Arnot Health participated in a comprehensive assessment of community needs across county lines with partners such as the Chemung County Health Department, Steuben County Public Health, other hospitals and healthcare agencies in Chemung, Steuben and Schuyler Counties, along with a diverse collaborative of community partners and community residents. The year-long process of assessing community health needs was facilitated by consultants contracted by the Chemung County Health Department from the S2AY Rural Health Network. Arnot Health, in partnership with this dual-county collaborative network , used the MAPP process (Mobilizing for Action through Planning and Partnership) to collect and analyze data from a variety of sources. Valuable input was gained from data retrieved and analyzed by the Finger Lakes Health System Agency from the New York State Prevention Agenda Dashboard, multi-payer claims data, EBRFSS, SPARCS and additional sources. Also, input was gained from diverse community focus groups made up of both Chemung and Steuben County residents. The focus group meetings were facilitated by S2AY, Chemung and Steuben County Health Departments, Arnot Health and other partnership members. The residents were engaged in discussions concerning their current health status, and opinions on specific county-wide health challenges. Areas of disparity were assessed within each county. Findings from the Community Health Assessment (CHA) data and community focus groups identified some overlapping areas of public health concerns and disparities in Chemung and Steuben Counties, including the following : : Prevent chronic disease by reducing illness, disability, and death related to hypertension, tobacco use and secondhand smoke, and obesity in adults and children. Promote Mental Health and Prevent Substance Abuse, Promote Mental Health and Prevent Substance Abuse, Decrease the percentage of tobacco use in low income populations. Schedule H, Part V, Section B, Line 6a-Group A Arnot Ogden Medical Center prepares the Community Benefit Report for three hospitals- Arnot Ogden Medical Center, St. Joseph's Hospital, both in Elmira, NY and also for Ira Davenport Memorial Hospital in Bath, NY. Schedule H, Part V, Section B, Line 6b-Group A The Chemung County Health Department, Arnot Health, and the Chemung County Health Priorities Partnership, a multi-disciplinary group of community organizations, worked together with facilitation provided by the S2AY Rural Health Network, to complete this assessment. The Health Priorities Partnership members will work together to address the health priorities of Chemung County residents as outlined in this document and the attached Community Health Improvement Plan. Arnot Health participated in a comprehensive assessment of community needs across county lines with partners such as the Chemung County Health Department, Steuben County Public Health, other hospitals and healthcare agencies in Chemung, Steuben and Schuyler Counties, along with a diverse collaborative of community partners and community residents. Schedule H, Part V, Section B, Line 7d-Group A The 2016-2018 Chemung and Steuben CHNAs and CHIPs are available on the Arnot Health website Community Service Plans page at http://www.arnothealth.org/community-service-plans . Schedule H, Part V, Section B, Line 11-Group A In the 2016 Community Health Improvement Plan Arnot Health worked diligently to partner with organizations throughout the service area in an effort to enhance healthcare services for the most vulnerable residents. Arnot Health is committed to outreach in underserved populations and preventing chronic disease in the community through free community lectures, preventive health screenings, health promotion presentation, and provisions of wellness education. In 2016 Arnot Health provided health promotion programs and screenings for children, adolescents, adults and seniors. Screenings included blood pressure, blood glucose, body fat analysis, body mass index, diabetes risk assessments, COPD, carboxyhemoglobin, vascular and skin screenings. Arnot Health's Graduate Medical Education Program collaborates with Tulane University's Culinary Medicine Program to implement the Healthy Kitchens Program, providing classes to community members. The classes offer hands on education about preventing chronic conditions through preparation of healthy and affordable meals. Health Kitchens: The Arnot Health's Graduate Medical Education Program continues to collaborate with the Goldring Center for Culinary Medicine at Tulane University and community partners to implement the Healthy Kitchens program. Through this program Arnot Health's medical residents and medical students from Lake Erie College of Osteopathic Medicine (LECOM) learn basic culinary skills and how to prepare nutritious meals based on the Mediterranean and DASH diets. This program aims to prevent and manage chronic conditions such as hypertension, diabetes, and hyperlipidemia. After completion of the nine-module Healthy Kitchens curriculum, the medical students are required to provide classes to community members. These classes offer hands-on education about preventing chronic conditions through preparation of healthy and affordable meals. The community version of the Healthy Kitchens program was held twice during 2016. This year, the facilitator training for Health Kitchens included senior nursing students from Elmira College in addition to LECOM medical students. Arnot Health 's Heart and Vascular Institute (HVI) offers free vascular screening examinations that consist of a blood pressure check and a non-invasive ultrasound examination of the carotid arteries, abdominal aorta, and evaluation of the circulation in lower extremities. Experienced staff from Arnot Ogden Medical Center performs the screening. Arnot Health serves on the Elmira City School District Wellness Committee. The committee meets three to four times a year. In 2016, Arnot Health participated in a shared decision -making process to select new health education curriculums for middle school students. Committee members also participate in the evaluation of wellness policies for the School District. Arnot Health is committed to increasing access to care for vulnerable populations , including children. Arnot Health's Graduate Medical Education and Population Health Department collaborated with Elmira City School District, Gerould 's Pharmacy , community navigators from AIM Independent Living Center, Fidelis Care, United Health Care and Mothers & Babies Perinatal Network to develop a school-based sick care clinic at Beecher Elementary School. The main goals of the sick care clinic are to decrease absenteeism related to common illnesses and to increase access to healthcare. Patients are seen, treated and referred for follow up with their own physicians. If the patient does not have a physician, a referral will be made to a local provider. Community insurance navigators are on-site weekly to assist families with health insurance. Arnot Health partners with the Southern Tier Cancer Services program to provide free cancer screenings for breast, cervical and colorectal cancers for individuals who do not have health insurance . Over one hundred people were served in 2016 . The Falck Cancer Center provides cancer care treatment services for the Southern Tier. Annually, the cancer center offers free skin cancer screening. In April 2016, the Cancer Committee offered a Palliative Care presentation for both community residents and healthcare providers. The presentation provided an overview of the Palliative Care program for inpatient and community settings. Schedule H, Part V, Section B, Line 20e-Group A Self pay collection staff reviews any prior accounts to check for commercial insurance or Medicaid that may need to applied to current self pay accounts. These accounts are reviewed using the self pay work list. If insurance is located, the self pay collector must verify eligibility for the dates of service. The self pay staff will change the health plan to the correct plan for all covered dates of service and Arnot billing will submit the claim or claims. If no insurance is located, confirm if a patient may have qualified for Medicaid. If Medicaid coverage is approved self pay staff will change the health plan to Medicaid for all covered dates of service and follow correct billing processes. Self Pay Collection Staff attempts to collect the full balance due by check or credit card. If they are unable to make the full payment, the self pay staff will attempt to make payment arrangements and to notify the patient about the Arnot Ogden Medical Center Community Care Program. If the patient wants to apply for the community care program, the patients will be sent an application for the community care program and will be informed of documentation they will need to submit with the application. The self pay collectors document all activity in Sorian, and enter any necessary hold to support resolution. Self pay collections staff enters the payment plan and document comments in Sorian. Payment plan statements are demanded and sent to the patient. If the patient does not enter into a payment plan agreement, or fails to pay as agreed, the account will go through the standard dunning and collection agency activity. Our Collection Agents are also required to provide written notice explaining extraordinary collection efforts. Schedule H, Part V, Section B, Line 24-Group A Participants in the Medicare System are required to charge all patients the same amount for services regardless of insurance per the Medicare participation guidelines. Schedule H, Part I, Line 6a Arnot Health partners with the Chemung County Health Department, Steuben County Public Health, and other health care agencies in Chemung, Steuben and Schuyler counties along with a diverse collaborative of community partners and residents to participate in a comprehensive assessment of community needs across county lines. The group accesses community health needs in a dual county collaborative network using the MAPP Process to collect and analyze data from a variety of sources. Schedule H, Part I, Line 7 Arnot Health uses a Cost to Charges ratio to calculate the Financial Assistance and Community Benefit Section. The organization offers a variety of services to the community it serves as part of an integrated delivery system. It is necessary to financially subsidize some of these services as the revenue generated does not cover the cost of providing the services. Schedule H, Part I, Line 7, Column f Arnot Ogden Medical Center excluded $14,295,679 in bad debt expense from the calculation. Schedule H, Part II Beyond involvement in the aforementioned health collaboratives, Arnot Health participates in a number of community efforts aimed at improving health across the continuum. Arnot Health is committed to outreach in underserved populations and preventing chronic disease in the community through free community lectures, preventive health screenings, health promotion presentations , and provision of wellness education. In 2016, Arnot Health provided health promotion programs and screenings for children, adolescents, adults, and seniors. Screenings included blood pressure , blood glucose, body fat analysis, body mass index, diabetes risk assessments, COPD (Lung Age), Carboxyhemoglobin , vascular and skin screenings. Arnot Health participated in community forums and focus groups to assist in the development of strategic plans to increase economic development in the Finger Lakes and Southern Tier regions , reduce poverty in Elmira, and revitalize Elmira Downtown. In collaboration with community partners, Arnot Health continued to plan and offer programs to promote physical activity and healthy choices in the community. Arnot Health participated in the following events during 2016: Step it Up Community Walking Program, Hunt for Gold Shoes, Fit Families of the Southern Tier, Strong Kids Safe Kids (Chemung, Steuben, and Schuyler Counties), Chemung County Summer Cohesion Travel Program, Girls on the Run of the Southern Tier, Ira Davenport and Taylor Run, Wineglass Marathon. Arnot Health, in collaboration with Southern Tier Pediatrics, also offers Fit Families in the Southern Tier (FFIST). This eight-week program is designed to teach obese children and their families healthy nutrition habits and physical activity. Each child must have a family member participate with them . To measure progress , staff assess pre- and post-program weight and BMI, and conduct strength and fitness testing. On average, participants experience 70 percent improvement in at least one area measured. Schedule H, Part III, Section A, Line 4 The Organization's allowance for doubtful accounts increased from 14.3% of gross accounts receivable at December 31, 2015 to 17.5% of gross accounts receivable at December 31, 2016. In addition, the Organization's bad debt write-offs decreased from $11,252,073 for fiscal year 2015 to $11,130,875 in fiscal year 2016. The Organization has not changed its charity care or uninsured discount policies during the fiscal year 2015 or 2016. The Organization does not maintain a material allowance for doubtful accounts from third party payers, nor did it have significant write-offs from third party payers. Schedule H, Part III, Section B, Line 8 Arnot Health uses a Cost to Charges ratio to calculate the Financial Assistance and Community Benefit Section. The organization offers a variety of services to the community it serves as part of an integrated delivery system. It is necessary to financially subsidize some of these services as the revenue generated does not cover the cost of providing the services. Schedule H, Part III, Section C, Line 9b Self-pay collection staff reviews any prior accounts to check for commercial insurance or Medicaid that may need to be applied to current self-pay accounts. These accounts are reviewed using the self-pay work list. If insurance is located, the self-pay collector must verify eligibility for the dates of service. The self-pay staff will change the health plan to the correct plan for all covered dates of service and Arnot billing will submit the claim or claims. If no insurance is located, confirm if a patient may have qualified for Medicaid. If Medicaid coverage is approved self-pay staff will change the health plan to Medicaid for all covered dates of service and follow correct billing processes. Self-Pay Collection Staff attempts to collect the full balance due by check or credit card. If they are unable to make the full payment, the self-pay staff will attempt to make payment arrangements and to notify the patient about the Arnot Ogden Medical Center Community Care Program. If the patient wants to apply for the community care program, the patients will be sent an application for the community care program and will be informed of documentation they will need to submit with the application. The self-pay collectors document all activity in our billing system, Soarian, and enter any necessary hold to support resolution. Self-pay collections staff enters the payment plan and document comments in Soarian. Payment plan statements are demanded and sent to the patient. If the patient does not enter into a payment plan agreement, or fails to pay as agreed, the account will go through the standard dunning and collection agency activity. Schedule H, Part VI, Line 2 Arnot Health works diligently to partner with the organizations throughout the service area in an effort to enhance healthcare services for the most vulnerable residents. Due to the rural nature of Chemung and Steuben Counties, the high percentage of low-income residents and the limited resources available in the community, Arnot Health understands the need to create meaningful partnerships to best serve the community at large. Arnot Health has formed collaborative relationships with organizations throughout Chemung and Steuben Counties to address health concerns across the continuum. Chemung and Steuben Counties maintain coalitions to collaboratively meet the healthcare needs of the community. The Chemung County Health Priority Partnership (HP2) has expanded to include insurance navigators. The Steuben County Health Priority Team (SHPT) worked to brand their coalition and has the new name, Smart Steuben. Both coalitions include organizations that are committed to improving the health of Chemung and Steuben County residents. The groups have met on a bi-monthly basis in Chemung County and monthly basis in Steuben County since Fall of 2015 to conduct a Community Health Needs Assessment (CHNA) and develop a Community Health Improvement Plan (CHIP)/Community Service Plan (CSP). The members of HP2 and Smart Steuben have agreed to continue expanding their partnerships, and meet on a regular basis to ensure that the initiatives outlined in the Community Health Improvement and Community Service Plans are implemented, monitored, and evaluated. Schedule H, Part VI, Line 3 The Arnot Ogden Medical Center communicates our Community Care Program in the following ways: Signage in waiting rooms, brochures in waiting rooms and Admission Packets, notations on billing notices, staff education so they can share availability of program and contact information with patients. Communication and education of our Certified Application Counselor for patient insurance enrollment are done so they are informed of the program details and contact information. Communication is also done with collection agencies and collection attorneys so they can also share the availability of the program and contact information with prospective enrollees. The information is also posted on our website at: www.arnothealth.org. Schedule H, Part VI, Line 4 Arnot Health's three hospitals are located in two counties. Arnot Ogden Medical Center and St. Joseph's Hospitals are located in Chemung County; Ira Davenport Memorial Hospital is situated in Steuben County. Together, Chemung and Steuben Counties make up approximately 1,801 square miles of geographical area in the Southern Tier of New York. The City of Elmira serves as Chemung County's seat and the primary metropolitan area. The county is characterized as 76 percent urban and 24 percent rural. Steuben County is a rural county, and with a land area of 1,393 miles, it is the seventh largest county in NYS. (http://www.city-data.com/county/Chemung _County-NY.html) Schedule H, Part VI, Line 6 Arnot Health is comprised of three hospitals: Arnot Ogden Medical Center and St. Joseph's Hospital in Elmira; and Ira Davenport Memorial Hospital in Bath, New York. Arnot Health provides diagnostic, ambulatory, secondary and tertiary acute care, as well as substance abuse, psychiatric, rehabilitative, and wellness services to meet the needs of residents in Chemung, Steuben, and Schuyler Counties in the Southern Tier of New York, and Bradford and Tioga Counties in the Northern Tier of Pennsylvania. Arnot Ogden Medical Center, located in Elmira, NY and founded in 1888, is a not-for-profit, 256-bed tertiary medical facility offering specialty services including, cardiovascular care, cancer care, women's health services, emergency medicine and surgical services. Ira Davenport Memorial Hospital, located in Bath, NY and founded in 1910, is a not-for profit 38-bed acute care hospital offer ancillary services and emergency medicine. The campus also hosts a 120-bed skilled nursing facility, Taylor Health Center. St. Joseph's Hospital, located in Elmira, NY and founded in 1908 by the Sisters of St. Joseph of Rochester, New York, is a not-for-profit Catholic 79 acute care hospital specializing in orthopedic care, physical rehabilitation, geriatric medicine, behavioral science and alcohol rehabilitation. The campus also hosts a 111 bed skilled nursing facility. Arnot Medical Services is a multispecialty physician group associated with Arnot Health offering care throughout the Southern Tier of New York and Northern Tier of Pennsylvania in the areas of Cardiology, Cardiovascular Surgery, Endocrinology, ENT, Family Practice, Gastroenterology, Infectious Diseases, Internal Medicine, Nephrology, Neurology, Orthopedics, Pain Management, Rheumatology, Women's Health and Wound Care. Schedule H, Part VI, Line 7 Arnot Ogden Medical Center will use a variety of methods to disseminate the community Service Plan for Arnot Ogden Medical Center, St. Joseph's Hospital and Ira Davenport Memorial Hospital, and the CHIPs for Chemung and Steuben Counties: Web site documents will be posted on the healthcares system web site at the following URL: http://www.arnothealth.org/about us. Arnot Health developed a section of the system's web site dedicated to community outreach in 2016, budget permitting to bring community service work to a more prominent place within the website. This can be accessed at: https://www.arnothealth.org/community-service-plans. Partner web sites Chemung and Steuben counties will post links to their CHA and CHIP on their web sites. Presentations at Arnot Health's Community Health Department provide education about the healthcare system and community outreach strategies. X 1 1 X X X X X 1 0 0 0 0 0 0 1 0 Michael Hosey Chairman of the Board 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Mark J Hagan Vice Chairman 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Donald Quick Board Member 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Louis DiFabio Board Member 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Kathleen Lucke Board Member 0 0 0 0 0 0 0 0 0 0 0 0 0 0 David Dalrymple Board Member 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Richard Simons Board Member 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Scott Sprague Board Member 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Jan van den Blink Board Member 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Roy A Kyles Board Member 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Robert McNamara Board Member 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Mary Louise Mitchell Board Member 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Alan Angell MD Board Member/Physician 430133 0 0 0 0 0 9090 0 22563 0 461786 0 0 0 Roger Schenone MD Board Member/Physician 294402 0 784 0 0 0 9089 0 7057 0 311332 0 0 0 Kevin OConner MD Board Member/Physician 330473 0 91212 0 0 0 13250 0 24987 0 459922 0 0 0 John R Alexander Secretary 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Robert Lambert MD Board Member/Physician/CEO 573900 0 57240 0 0 0 13250 0 24987 0 669377 0 0 0 Roberto deBara MD President AMS/Physician 446154 0 0 0 0 0 9089 0 22563 0 477806 0 0 0 Ronald J Kintz DHA Senior VP/Chief Financial Officer 333618 0 38860 0 0 0 13250 0 24987 0 410715 0 0 0 Sandra McCarthy DNP Chief Nursing Officer 174156 0 0 0 0 0 2523 0 17074 0 193753 0 0 0 Nancy ODacre VP Planning 173840 0 0 0 0 0 5462 0 21901 0 201203 0 0 0 Kenneth Herzl Betz MD Senior VP/Medical Affairs/Physician 311377 0 0 0 0 0 9090 0 22405 0 342872 0 0 0 Richard Cleland Site Administrator IDMH 92314 0 0 0 0 0 0 0 1800 0 94114 0 0 0 H Fred Farley PhD Chief Operating Officer 344734 0 0 0 0 0 6483 0 8354 0 359571 0 0 0 James Watson Site Administrator IDMH 56870 0 0 0 0 0 1177 0 247 0 58294 0 0 0 Vidyasagar Mokureddy MD Pain Mgmt Physician 913179 0 0 0 0 0 9090 0 24987 0 947256 0 0 0 Bruno Mazza MD Gastoentrologist 782850 0 295289 0 0 0 9090 0 22563 0 1109792 0 0 0 Thomas Boman MD Orthopediac Surgeon 840452 0 52959 0 0 0 13250 0 22563 0 929224 0 0 0 Matthew Brand MD Orthopediac Surgeon 787350 0 43914 0 0 0 13250 0 22263 0 866777 0 0 0 Paul Tinsley MD ENT Physician 710021 0 101816 0 0 0 9090 0 22563 0 843490 0 0 0 Schedule J, Part I, Line 1a Schedule J, Part I, Line 1a - The CEO and CFO have their dues paid at the Elmira Country Club. The personal use portion is reported under taxable income. Schedule J, Part I, Line 3 Compensation for the President and Vice Presidents are set pursuant to a policy and compensation philosophy adopted by the Board of Managers. The Board has a Compensation Committee consisting of outside directors. The Compensation Committee uses a consultant, Yaffee Consulting, to advise it on compensation for the officers. The consultant collects and reports compensation on similar positions in similar nonprofit hospitals from upstate New York and Western Pennsylvania. The Compensation Committee recommends adjustments to the Executive Committee of the Board which reviews the recommendations and approves or disapproves without employees in the room. This action then is reviewed with the entire Board also in executive session. Schedule J, Part I, Line 4 Our Chief Operating Officer, H. Fred Farley received Severance Pay in the amount of $127,667. Schedule J, Part I, Line 7 Officer compensation has a variable component based upon patient experience, quality, and efficiency. Physician compensation has a variable component based upon volume, quality and patient satisfaction scores. A Chemung County Capital Resource Corp 611684035 000000000 2015-06-25 29410000 Payoff Series A & B Bonds/Energy Infrastructure Upgrade 0 0 0 A 1764600 0 29410000 0 0 0 847745 0 0 8066714 0 0 2015 1 0 1 1 A 0 0 0 0 0 0 0 1 0 1 A 0 0 0 0 1 0 0 0 1 A 1 David Dalrymple Board Member 1598091 Competitively bid loans and Investment Income 0 Louis DiFabio Board Member 1598091 Competitively bid loans and Investments 0 Form 990, Part VI, Section B, Line 11b Upon completion of the Form 990 it is reviewed by the Medical Center's Senior Vice President of Finance and then made available to the Audit and Finance Committees of the Board of Managers. The return is made available to all Board Members for review and questions. Form 990, Part VI, Section B, Line 12c All members of the Board of Managers, Officers and Management employees are required annually to file a Disclosure Statement setting forth any respect in which such a person, or any person associated with such person, has or may have any interest in a transaction in which there may be, or appear to be, a conflict between the interests of such person and the Arnot Ogden Medical Center. An Associate included (1) a spouse, a descendant or an ancestor, or a spouse of a descendant or ancestor; (2) an organization in which the person or an associate is a partner or employee, or such person or an associate owns a more that 10% beneficial interest; (3) a trust in which such a person is a trustee, or such person or an associate holds a more than 10% beneficial interest; and (4) a corporation in which such person or an associate is an officer or director or employee, or such person or an associate is an owner of more that 10% of any class of securities. Form 990, Part VI, Section B, Line 15 Compensation for the President and Vice Presidents are set pursuant to a policy and compensation philosophy adopted by the Board of Managers. The Board has a Compensation Committee consisting of outside directors. The Compensation Committee uses a consultant, Yaffee Consulting, to advise on compensation for the officers. The consultant collects Benchmarks and Survey Data and reports compensation on similar positions in similar nonprofit hospitals from upstate New York and Western Pennsylvania. The Compensation Committee recommends adjustments to the Executive Committee of the Board which reviews the recommendations and approves or disapproves without employees in the room. This action then is reviewed with the entire Board also in executive session. Form 990, Part VI, Section C, Line 19 Form 990, Part VI, Section C, Line 18 - Upon request the 990 Form is made available to the public and also via www.guidestar.com. Financial Statements are posted to the Electronic Municipal Market Access website. Form 990, Part XI, Line 9 Loss on Temp Restricted Investment Funds $(37,505), Pension Charge to Equity $3,432,082, and Change in Net Assets of Foundation $1,049,538. Arnot Ogden Medical Center Foundation Accounting Dept 600 Roe Avenue Elmira NY 14905 161109472 Contribution Management NY 501(c)(3) 11B N/A 0 Arnot Ogden Medical Center Auxiliary 600 Roe Avenue Elmira NY 14905 510192902 Fund Raising NY 501(c)(3) 11B N/A 0 Ira Davenport Memorial Hospital Inc Accounting Dept 7571 State Route 54 Bath NY 14810 160835446 Affiliate NY 501(c)(3) 3 N/A 0 Keuka Health Care Foundation Accounting Dept 7571 State Route 54 Bath NY 14810 161461215 Affiliate NY 501(c)(3) 11B N/A 0 St Josephs Hospital Accounting Dept 555 St Josephs Blvd Elmira NY 14901 160743163 Affiliate NY 501(c)(3) 3 N/A 0 Arnot Health 600 Roe Avenue Elmira NY 14845 453049405 Parent Organization NY 501(c)(3) 11B Arnot Ogden Medical Center St Josephs Hospital 0 Ivy Street Development Corporation 600 Ivy Street Elmira NY 14905 161009245 Real Estate NY N/A C 1 0 1 0 1 0 0 0 0 0 0 1 1 0 1 1 1 1 1 1 1 Arnot Ogden Medical Center Foundation o 68100 Arnot Ogden Medical Center provided paid employees to Arnot Ogden Medical Center Foundation to perform Accounting, Administrative and Materials Management functions. The method of determining the amount involved was cost. Ivy Street Development Corporation o 3836 Arnot Ogden Medical Center provided paid employees to Ivy Street Development Corporation to perform Accounting, Administrative and Property Management Services. The method of determining the amount involved was cost. Ivy Street Development Corporation p 108957 Arnot Ogden Medical Center was reimbursed by Ivy Street Development Corporation for Utilities, Maintenance and Insurance expenses. The method of determining the amount involved was cost. Ivy Street Development Corporation k -453119 Arnot Ogden Medical Center leased facilities from Ivy Street Development Corporation. The method of determining the amount involved was cost. Ira Davenport Memorial Hospital Inc o 3454921 Arnot Ogden Medical Center provided paid employees to Ira Davenport Memorial Hospital to perform Accounting, Administrative and Management Information and various Medical Services. The method of determining the amount involved was cost. Keuka Health Care Foundation o 7512 Arnot Ogden Medical Center provided paid employees to Keuka Health Care Foundation to perform Accounting, Administrative functions. The method of determining the amount involved was cost. St Josephs Hospital o 9387935 Arnot Ogden Medical Center provided paid employees to Ira Davenport Memorial Hospital to perform Accounting, Administrative and Management Information and various Medical Services. The method of determining the amount involved was cost. Arnot Ogden Medical Center filed both the first and second extensions Form 8868 and received our approval extension letter to November 15, 2017. This letter is dated August, 17 2017.