2016-11-08T10:04:39-07:00 2015-12-31 990 2015-01-01 160743024 FREDERICK FERRIS THOMPSON HOSPITAL FRED 5853966000 350 Parrish Street Canandaigua NY 14424 Mark Prunoske Sr VP Finance/CFO 5853966280 2016-11-08 2015 2017-02-10 21:41:12Z Michael F Stapleton Jr 350 Parrish Street Canandaigua NY 14424 120998890 0 X www.thompsonhealth.org X 1904 NY FF Thompson Hospital is a community hospital which exists to serve the healthcare needs of the people in partnership with regional healthcare providers. FF Thompson Hospital serves as the center of a healthcare network to provide a full range of healthcare services and to improve community health. 24 18 1339 241 738707 0 1408255 3011264 109633847 113917930 118379 167579 2905173 3103793 114065654 120200566 0 0 0 0 62580422 66828410 0 0 0 47697518 49764945 110277940 116593355 3787714 3607211 117309695 120450070 74706547 75664874 42603148 44785196 FF Thompson Hospital is a community hospital which exists to serve the health care needs of the people in partnership with regional health care providers. FF Thompson Hospital serves as the center of a health care network to provide a full range of health care services and to improve community health. 0 0 92470931 0 115029359 Inpatient care: 5,818 Inpatient discharges, 23,222 Inpatient Days. Outpatient: 1,302,043 Lab visits/tests, 26,494 ED visits, 64,675 Diagnostic Imaging, 17,760 Urgent Care, 30,267 Rehabilitation Services, and 5,779 Surgical Services. Charity Care was provided in the amount of $371,310 (at cost). Community Benefit was $2,417,931. Uncompensated Care was $3,648,536. 0 0 0 92470931 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 1 0 0 0 1 X 174 0 1 1339 1 1 1 0 0 0 0 0 0 0 0 0 X 24 18 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X FF Thompson Hospital Roberta Spezzano 5853966000 350 Parrish Street Canandaigua NY 14424 X James H Barr CPA Board Vice Chair 1 1 X X 0 0 0 Richard Cutri Board Member 0.5 0.5 X 0 0 0 Randall Farnsworth Board Member 0.5 0.5 X 0 0 0 Ellie Fralick Board Member at Large 0.5 0.5 X 0 0 0 Roger Friedlander Board Member 0.5 0.5 X 0 0 0 Daniel Fuller Board Member 0.5 0.5 X 0 0 0 Steven Goldstein Board Member 0.5 71 X 0 899082 895783 Frank Hamlin ESQ Board Member 0.5 0.5 X 0 0 0 Richard H Hawks Jr Board Chair 1 1 X X 0 0 0 Dale Hunt Board Member 1 1 X 0 0 0 William R Kenyon ESQ Board Member 0.5 0.5 X 0 0 0 Ronald Knight Board Member 0.5 0.5 X 0 0 0 Thomas Kubiak Board Member 0.5 0.5 X 0 0 0 Raymond Mayewski MD Board Member 0.5 60 X 0 664346 117603 John McGuire MD Board Member President of the Medical Staff 40 0 X X 207586 0 34531 Brian Meath Board Secretary 1 1 X X 0 0 0 Reverend Thomas Mull Board Member 0.5 0.5 X 0 0 0 Deborah Price Board Member 0.5 0.5 X 0 0 0 Carl Sahler MD Board Member 0.5 0.5 X 0 0 0 Robert Sands Board Treasurer 1 1 X X 0 0 0 Michael F Stapleton JR President/CEO 2 38 X X 0 464873 83625 Mark Taubman MD Board Member 0.5 75 X 0 889885 303168 Cynthia Teerlinck MD Board Member 0.5 0.5 X 0 0 0 Lori Van Dusen Board Member 0.5 0.5 X 0 0 0 David Baum MD SVP Medical Affairs & Emergency Physician 20 20 X 277122 84433 56561 Jennifer DeVault VP Associate Services and Wellness 36 4 X 132119 0 26660 Kurt Koczent EVP/COO 38 2 X 181254 45314 54336 Mark Prunoske Senior VP & CFO 2 38 X 0 272993 55467 Hazel Robertshaw VP Patient Care Services/CNO 40 0 X 142879 0 16046 Elizabeth Talia VP Legal & Regulatory Affairs and General Counsel 25.5 14.5 X 0 154606 29120 Vijay Bansal MD Physician 40 0.00 X 391437 0 24900 Peter Fenton MD Physician 41 0.00 X 299444 0 32090 Jason McClung MD Physician 41 0 X 328700 0 37266 Matthew Osborne MD Physician 41 0.00 X 336902 0 43282 Timothy Pitler MD Physician 43 0.00 X 352689 0 74513 Carlos R Ortiz MD Former Officer SVP Medical Services 0.5 0.5 X 0 172616 8216 2650132 3648148 1893167 64 1 1 0 Mckesson Technologies Inc PO Box 98347 Chicago IL 606938347 Support and fees 1403168 Honor Medical Staffing 21415 Civic Center Dr Number 211 Southfield MI 48076 Medical Staffing 814711 Philips Healthcare PO Box 100355 Atlanta GA 303840355 Service Agreement 580132 Weatherby Locums Inc P O Box 972633 Dallas TX 753972633 Medical Staffing 505044 Philips Healthcare Informatics PO Box 403831 Atlanta GA 303843831 IRAD & IVAULT (read/archive-DX) & T1 line Maint fees 487649 30 0 0 0 2709835 286429 15000 0 3011264 Community Health Service 622000 97969420 97230713 738707 0 Medicare/Medicaid Payments 622000 15948510 15948510 0 0 0 0 0 0 113917930 114798 0 0 114798 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 414319 436786 337558 460766 76761 -23980 52781 0 0 52781 0 Associate/Patient Support 622000 1992364 0 0 1992364 Meaningful Use 622000 1111429 1111429 0 0 3103793 120200566 114290652 738707 2159943 X 0 0 0 0 0 0 0 0 940960 484708 456252 0 0 0 0 0 52955213 43673075 9282138 0 3103737 2545064 558673 0 6078151 4984084 1094067 0 3750349 3075286 675063 0 114838 6544 108294 0 163567 0 163567 0 122020 0 122020 0 0 0 0 0 0 0 0 0 0 0 6132798 4860687 1272111 0 23110 0 23110 0 18567277 18080157 487120 0 3787624 1595070 2192554 0 0 0 0 0 1812026 1682122 129904 0 75686 39791 35895 0 0 0 0 0 133889 125790 8099 0 1728331 0 1728331 0 0 0 0 0 7123274 5841085 1282189 0 1283223 0 1283223 0 Health System member Assessment 2862092 1144837 1717255 0 Provision for Uncollectable Accounts 3648536 3648536 0 0 New York State Cash Assessment 417173 0 417173 0 Facility Services 997441 0 997441 0 772040 684095 87945 0 116593355 92470931 24122424 0 3174 3325 24246470 26574604 0 0 7212684 7462286 0 0 0 1828919 1739765 3089905 3468495 142217274 78780177 63683664 63437097 970774 959820 0 0 0 0 0 0 16274105 16804678 117309695 120450070 12702709 13372875 0 0 0 0 38249733 37134733 0 0 0 0 1339262 662827 0 0 22414843 24494439 74706547 75664874 X 38256082 42473399 4347066 2311797 0 0 42603148 44785196 117309695 120450070 X 3607211 -187149 0 0 0 -1238014 X 0 1 X 1 0 X 8410147 39879 -52633 20000 416752 0 7960641 8160115 60504 440305 0 250777 0 8410147 7571403 13176 1114484 0 538948 0 8160115 6934130 167545 769935 0 300207 0 7571403 6239690 863280 44331 0 213171 0 6934130 0.93 0.07 0 0 1 1 0 58076 58076 0 77714298 33902221 43812077 0 1523017 339883 1183134 0 58587833 42699420 15888413 0 4334050 1838653 2495397 63437097 Other Assets 7489071 Due from Affiliates 589976 Assets Limited as to Use 4545190 Beneficial Interest in Charitable Remainder Trust 358646 Deferred Financing Costs, net 1523551 Beneficial Interest in net assets of FFTH Foundation 2298244 16804678 0 Accrued Pension Liability 13631666 Charitable Gift Annuity Payment Liability 97901 Interest Rate Swap Liability 375509 Third Party Payor Accrual 2924333 Other Non-Current Liabilities Acc Ins reserve 879561 Due from Affiliates/CARO 776874 Other Non-Current Liabilities MCIC Tail Liability 523387 Other Non-Current Liabilities Workers Comp 5285208 24494439 117662460 0 0 0 90725 90725 117571735 0 2628831 2628831 120200566 112944819 0 0 0 0 0 112944819 0 3648536 3648536 116593355 Schedule D, Part V, Line 4 The funds are held by the Foundation for the benefit of FF Thompson Health System, Hospital, Senior Communities, and Continuing Care Center. The Foundation continuously evaluates the needs of these organizations and attempts to meet those needs. Schedule D, Part XI, Line 2d Net Assets released from restrictions used for operations $90,725 Schedule D, Part XI, Line 4b Contributions from the FF Thompson Foundation Inc $2,628,831 Schedule D, Part XII, Line 4b Provision for bad debts $3,648,536 1 1 X 1 X 1 X 1 1 1 0 1 1 660670 289360 371310 0.0033 14715577 11469338 3246239 0.0287 0 0 15376247 11758698 3617549 0.0320 603824 77617 526207 0.0047 5132764 4394765 737999 0.0065 31073 0 31073 0.0003 0 0 5767661 4472382 1295279 0.0115 0 0 21143908 16231080 4912828 0.0435 239768 0 239768 0.0025 38532 0 38532 0.0004 52010 34 51976 0.0005 906189 330 905859 0.0093 0 0 1236499 364 1236135 0.0127 1 3648536 72971 16142698 18856813 -2714115 X 1 1 1 1 The Fredrick Ferris Thompson Hospital 350 Parrish Street Canandaigua NY 14424 www.thompsonhealth.org 3429000H X X X The Fredrick Ferris Thompson Hospital 1 0 0 1 X X X X X X X X X 13 1 1 1 1 X http://www.thompsonhealth.com/Portals/0/_News%20Room/Publications/ X http://www.co.ontario.ny.us/DocumentCenter/View/3186 X 1 13 1 http://www.thompsonhealth.com/Portals/0/_News Room/Publications/Community Service Plan/Co 0 0 1 X 100 400 X X X X 1 1 X X X 1 X http://www.thompsonhealth.com/Portals/ 0/Patients%20and%20Visitors/ Financial%20Services/Documents/ X http://www.thompsonhealth.com/Portals/ 0/Patients%20and%20Visitors/ Financial%20Services/Documents/ X http://www.thompsonhealth.com/Portals/ 0/Patients%20and%20Visitors/ Financial%20Services/Documents/ X X X X X 1 X 0 X X X X 1 X X 0 0 Schedule H, Part V, Section B, Line 5-The Fredrick Ferris Thompson Hospital ONTARIO COUNTY PUBLIC HEALTH WAS CHARGED WITH WORKING WITH LOCAL HOSPITALS AND OTHER KEY PARTNER AGENCIES TO SELECT TWO KEY HEALTH PRIORITIES AND ONE DISPARITY TO ADDRESS IN THE COMMUNITY. TO THIS END, WE PARTNERED WITH ONTARIO COUNTY PUBLIC HEALTH, THE S2AY RURAL HEALTH NETWORK IN A COMPREHENSIVE PROCESS INVOLVING OTHER LOCAL HOSPITALS, COMMUNITY ORGANIZATIONS, AND COUNTY RESIDENTS. WE LAUNCHED A 22- MONTH LONG PROCESS TO COLLECT DATA, SOLICIT OPINIONS, FACILITATE A PROCESS AND GUIDE A DISCUSSION TO DETERMINE NOT ONLY WHAT THE MOST PRESSING PROBLEMS FACING OUR COUNTY ARE, BUT ALSO WHAT WE CAN EFFECTIVELY AND EFFICIENTLY ADDRESS. LED BY THE S2AY RURAL HEALTH NETWORK, ONTARIO COUNTY PUBLIC HEALTH DEPARTMENT WITH LOCAL HOSPITALS AND COMMUNITY PARTNERS UTILIZED THE MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIP (MAPP) PROCESS TO DETERMINE TWO PRIORITIES AND A DISPARITY FROM THE 2013 - 2017 PREVENTION AGENDA. ORGANIZATIONS THAT PARTICIPATED IN THE COMMUNITY HEALTH ASSESSMENT PROCESS INCLUDED: ONTARIO COUNTY PUBLIC HEALTH DEPARTMENT, CLIFTON SPRINGS HOSPITAL AND CLINIC, FF THOMPSON HOSPITAL, GENEVA GENERAL HOSPITAL, S2AY RURAL HEALTH NETWORK, GENEVA HOUSING AUTHORITY, CHURCHES IN ACTION, ONTARIO COUNTY YOUTH BUREAU, ONTARIO COUNTY OFFICE OF THE AGING, ONTARIO COUNTY DSS, ONTARIO COUNTY SHERIFF'S OFFICE, ONTARIO COUNTY MENTAL HEALTH DEPARTMENT, ONTARIO UNITED WAY, ONTARIO COUNTY WORKFORCE DEVELOPMENT, ONTARIO COUNTY CORRECTIONAL FACILITY, FINGER LAKES VISITING NURSE SERVICES, COURTS OF ONTARIO COUNTY, CANANDAIGUA RED CROSS, THE SALVATION ARMY RUSHVILLE HEALTH CENTER (RPCN), GENEVA HEAD START, CANANDAIGUA VETERANS AFFAIRS MEDICAL CENTER, FINGER LAKES CEREBRAL PALSY/HAPPINESS HOUSE, NAACP - GENEVA GENEVA COMMUNITY HEALTH, ONTARIO COUNTY ARC, CATHOLIC CHARITIES, THE MONROE PLAN FOR MEDICAL CARE, LIFETIME CARE, FINGER LAKES ADDICTIONS COUNSELING AND REFERRAL AGENCY (FLACRA), CORNELL COOPERATIVE EXTENSION, PARTNERSHIP FOR ONTARIO COUNTY COUNCIL ON ALCOHOLISM & ADDICTIONS IN THE FINGER LAKES, COUNCIL OF CHURCHES, OUR LADY OF PEACE PARISH, SUCCESS FOR GENEVA'S CHILDREN, FINGER LAKES COMMUNITY COLLEGE FINGER LAKES WIC PROGRAM, TOWN OF HOPEWELL, TOBACCO COALITION OF THE FINGER LAKES YOUTH FOR YOUTH, ONTARIO FINGER LAKES BOCES, HOBART WILLIAM SMITH COLLEGES, HUBBS HEALTH CENTER, FINGER LAKES HEALTH, CHILD AND FAMILY RESOURCES, INC. Schedule H, Part V, Section B, Line 6a-The Fredrick Ferris Thompson Hospital THE FREDERICK FERRIS THOMPSON HOSPITAL CONDUCTED ITS CHNA JOINTLY WITH GENEVA GENERAL HOSPITAL (FINGER LAKES HEALTH) AND CLIFTON SPRINGS HOSPITAL. Schedule H, Part V, Section B, Line 6b-The Fredrick Ferris Thompson Hospital ORGANIZATIONS THAT PARTICIPATED IN THE COMMUNITY HEALTH ASSESSMENT PROCESS INCLUDED: ONTARIO COUNTY PUBLIC HEALTH DEPARTMENT, CLIFTON SPRINGS HOSPITAL AND CLINIC, FF THOMPSON HOSPITAL, GENEVA GENERAL HOSPITAL, S2AY RURAL HEALTH NETWORK, GENEVA HOUSING AUTHORITY, CHURCHES IN ACTION, ONTARIO COUNTY YOUTH BUREAU, ONTARIO COUNTY OFFICE OF THE AGING, ONTARIO COUNTY DSS, ONTARIO COUNTY SHERIFF'S OFFICE, ONTARIO COUNTY MENTAL HEALTH DEPARTMENT, ONTARIO UNITED WAY, ONTARIO COUNTY WORKFORCE DEVELOPMENT, ONTARIO COUNTY CORRECTIONAL FACILITY, FINGER LAKES VISITING NURSE SERVICES, COURTS OF ONTARIO COUNTY, CANANDAIGUA RED CROSS, THE SALVATION ARMY RUSHVILLE HEALTH CENTER (RPCN), GENEVA HEAD START, CANANDAIGUA VETERANS AFFAIRS MEDICAL CENTER, FINGER LAKES CEREBRAL PALSY/HAPPINESS HOUSE, NAACP - GENEVA GENEVA COMMUNITY HEALTH, ONTARIO COUNTY ARC, CATHOLIC CHARITIES, THE MONROE PLAN FOR MEDICAL CARE, LIFETIME CARE, FINGER LAKES ADDICTIONS COUNSELING AND REFERRAL AGENCY (FLACRA), CORNELL COOPERATIVE EXTENSION, PARTNERSHIP FOR ONTARIO COUNTY COUNCIL ON ALCOHOLISM & ADDICTIONS IN THE FINGER LAKES, COUNCIL OF CHURCHES, OUR LADY OF PEACE PARISH, SUCCESS FOR GENEVA'S CHILDREN, FINGER LAKES COMMUNITY COLLEGE FINGER LAKES WIC PROGRAM, TOWN OF HOPEWELL, TOBACCO COALITION OF THE FINGER LAKES YOUTH FOR YOUTH, ONTARIO FINGER LAKES BOCES, HOBART WILLIAM SMITH COLLEGES, HUBBS HEALTH CENTER, FINGER LAKES HEALTH, CHILD AND FAMILY RESOURCES, INC. Schedule H, Part V, Section B, Line 7a-The Fredrick Ferris Thompson Hospital http://www.thompsonhealth.com/Portals/0/_News%20Room/Publications/Community%20Service%20Plan/CommunityServicePlan2015.pdf?ver=2016-07-05-162719-383 Schedule H, Part V, Section B, Line 7b-The Fredrick Ferris Thompson Hospital HTTP://WWW.S2AYNETWORK.ORG/UPLOADS/2/9/6/7/29678331/ONTARIO_CHA_2014-2017.PDF Schedule H, Part V, Section B, Line 7d-The Fredrick Ferris Thompson Hospital YEARLY COMMUNITY BENEFIT REPORT BOOKLET MAILING Schedule H, Part V, Section B, Line 10a-The Fredrick Ferris Thompson Hospital http://www.thompsonhealth.com/Portals/0/_News%20Room/Publications/Community%20Service%20Plan/CommunityServicePlan2015.pdf?ver=2016-07-05-162719-383 Schedule H, Part V, Section B, Line 11-The Fredrick Ferris Thompson Hospital THE HANLON METHOD WAS USED TO RANK THE ISSUES. THIS METHOD OF RANKING FOCUSES MOST HEAVILY ON HOW EFFECTIVE ANY INTERVENTIONS MIGHT BE. THE HANLON METHOD UTILIZES THE FOLLOWING FORMULA TO RANK PRIORITIES: (A & 2B) X C WHERE A= THE SIZE OF THE PROBLEM, B= THE SEVERITY OF THE PROBLEM AND C=THE EFFECTIVENESS OF THE SOLUTION. THE EFFECTIVENESS OF THE SOLUTION IS GIVEN A LOT MORE WEIGHT THAN THE SIZE OR SERIOUSNESS OF THE PROBLEM, WITH THE HOPE OF MAKING WISE USE OF LIMITED RESOURCES BY TARGETING SOLUTIONS THAT ARE KNOWN TO BE EFFECTIVE. PARTICIPANTS ALSO CONSIDER THE WEIGHT OF THE PROPRIETY, ECONOMIC FEASIBILITY, ACCEPTABILITY, RESOURCES AND LEGALITY (PEARL) OF ISSUES IN THIS RANKING SYSTEM. NUMERICAL VALUES WERE DETERMINED BY EACH PARTICIPANT FOR SIZE, SEVERITY AND EFFECTIVENESS, AND THEN PLUGGED INTO THE FORMULA ALONG WITH AVERAGE PEARL SCORES. IT IS IMPORTANT TO NOTE THAT WHILE THE HANLON METHOD OFFERS A NUMERICAL AND SYSTEMATIC METHOD OF RANKING PUBLIC HEALTH PRIORITIES, IT IS STILL A METHOD THAT IS LARGELY SUBJECTIVE, BUT WHICH REPRESENTS A QUANTITATIVE WAY TO RANK QUALITATIVE AND NON-COMPARABLE QUANTITATIVE INFORMATION. SINCE RESPONDENTS RANKED EACH COMPONENT (SIZE, SERIOUSNESS AND EFFECTIVENESS OF THE SOLUTION) INDIVIDUALLY USING A PAPER RANKING FORM, THE RANKINGS WERE NOT HEAVILY INFLUENCED BY GROUP DYNAMICS. BASED UPON THE RANKING THROUGH THE HANLON METHOD, ONTARIO COUNTY'S SCORES ON THE TOP HEALTH RELATED ISSUES IN THE COUNTY WERE: CEREBROVASCULAR DISEASE (STROKE, HYPERTENSION), CANCER (LUNG, OVARIAN, PROSTATE), POOR NUTRITION (UNHEALTHY EATING), OBESITY (INCLUDING LACK OF PHYSICAL ACTIVITY & FITNESS), BEHAVIORAL PROBLEMS IN CHILDREN, DENTAL HEALTH, DEPRESSION/OTHER MENTAL ILLNESSES, SMOKING/TOBACCO USE/SECONDHAND SMOKE, ACCESS TO SPECIALTY HEALTH CARE, DRUG & ALCOHOL ABUSE, ABUSE OF PRESCRIPTION DRUGS, CLRD (COPD) AND UNINTENTIONAL INJURIES. COMMUNITY PARTNERS DISCUSSED ALL THE IDENTIFIED NEEDS BUT CONCENTRATED ON THE TOP RANKED ONES. THE ASSEMBLAGE ACKNOWLEDGED THERE WERE OTHER AREAS OF NEED THAT WOULD REQUIRE ATTENTION OR IN SOME CASES, THE NEED WAS ALREADY BEING ADDRESSED. THE GROUP WAS ALSO MINDFUL OF THE NEW YORK STATE PREVENTION AGENDA FOCUSED AREAS. AFTER REVIEWING, DISCUSSING AND CONSIDERING COUNTY ASSESSMENTS, DATA, PREVIOUS INITIATIVES, ALONG WITH AVAILABLE RESOURCES, THE GROUP DECIDED TO FOCUS ON THE TWO AREAS IN WHICH THEY FELT THEY COULD HAVE THE MOST IMPACT ON AS A COLLABORATING BODY. 1. OBESITY 2. HYPERTENSION AND THE FOLLOWING DISPARITY: OBESITY IN THE LOW-INCOME POPULATION. THE GROUP THEN SAT DOWN TOGETHER AND DEVELOPED THEIR COMMUNITY SERVICE PLAN / COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP) INITIATIVES. THE FOCUSED AREAS LISTED ABOVE HAVE SEVERAL ACTION ITEMS LISTED OUT ON THE COMMUNITY SERVICE PLAN FOR BOTH AREAS AND CITES WHAT SPECIFICALLY IS BEING DONE TO ADDRESS EACH AREA. Schedule H, Part V, Section B, Line 16a-The Fredrick Ferris Thompson Hospital http://www.thompsonhealth.com/Portals/0/_Patients%20and%20Visitors /_Financial% 20Services/_Documents/Financial%20Aid_Community%20Care%20Policy2-12-2016.pdf?ver=2016-03-02-150257-460 Schedule H, Part V, Section B, Line 16b-The Fredrick Ferris Thompson Hospital http://www.thompsonhealth.com/Portals/0/_Patients%20and%20Visitors/ _Financial%20Services/_Documents/SlidingFeeGuideApplicationWorksheet-2016.pdf?ver=2016-03-02-150257-603 Schedule H, Part V, Section B, Line 16c-The Fredrick Ferris Thompson Hospital http://www.thompsonhealth.com/Portals/0/_Patients%20and%20Visitors/_Financial% 20Services/_Documents/FinancialAidSummary_1-1-2016.pdf Schedule H, Part V, Section B, Line 22d-The Fredrick Ferris Thompson Hospital ALL UNINSURED PATIENTS RECEIVE A DISCOUNT. INPATIENT DISCOUNT IS APPLIED TO CHARGES TO BRING TO THE MEDICARE INPATIENT DRG REIMBURSEMENT. A 50% DISCOUNT TO CHARGES IS APPLIED FOR ALL OUTPATIENT SERVICES. IF THE PATIENT QUALIFIED FOR ADDITIONAL FINANCIAL AID, THE REDUCTION WOULD BE TAKEN OFF THE ALREADY REDUCED CHARGES. FOR ALL INSURED PATIENTS WHO QUALIFY FOR ADDITIONAL FINANCIAL ASSISTANCE THE APPROPRIATE DISCOUNT WOULD BE APPLIED TO THE PATIENT'S RESPONSIBILITY CITED BY THEIR INSURANCE. WITH CURRENT POLIES AND PROCEDURES, NO PATIENTS ARE BILLED AT 100% OF HOSPITAL CHARGES. Schedule H, Part I, Line 3c ALL PATIENTS WITH NO INSURANCE RECEIVE A DISCOUNT. INPATIENT DISCOUNT IS APPLIED TO CHARGES TO BRING TO THE MEDICARE INPATIENT DRG REIMBURSEMENT. A 50% DISCOUNT TO CHARGES IS APPLIED FOR ALL OUTPATIENT SERVICES. Schedule H, Part I, Line 7 PATIENT COST TO CHARGE CALCULATED ACCORDING TO THE IRS 990 SCHEDULE H WORKSHEET INSTRUCTIONS. Schedule H, Part I, Line 7, Column f BAD DEBT IN THE AMOUNT OF $3,648,536 WHICH IS INCLUDED IN PART IX IS REMOVED FOR THE PURPOSES OF CALCULATING THE PERCENTAGE ON SCHEDULE H, PART I, LINE 7, COLUMN F. Schedule H, Part I, Line 7g THERE ARE NO PHYSICIAN CLINIC COSTS INCLUDED IN THESE SERVICES Schedule H, Part II Refer to Schedule H, Part VI, line 2 Schedule H, Part III, Section A, Line 4 AS STATED IN THE FOOTNOTES TO FINANCIAL STATEMENTS, "AN ALLOWANCE FOR DOUBTFUL ACCOUNTS RECEIVABLE IS ESTIMATED BY MANAGEMENT BASED ON PERIODIC REVIEWS OF COLLECTABILITY OF ACCOUNTS RECEIVABLE CONSIDERING HISTORICAL EXPERIENCE AND PREVAILING ECONOMIC CONDITIONS." BAD DEBT EXPENSE IS NOT INCLUDED IN THE COMMUNITY BENEFIT NUMBER OR TREATED AS COMMUNITY BENEFIT. BAD DEBT EXPENSES ARE REPORTED NET OF RECOVERIES AND PER THE AUDITED FINANCIALS. Schedule H, Part III, Section B, Line 8 MEDICARE PAYMENTS ARE CONVERTED TO MEDICARE GROSS CHARGES. THE COST TO CHARGE RATIO COMPUTED ON WORKSHEET 2, LINE 11 IS THEN APPLIED. MEDICARE SHORTFALLS ARE NOT INCLUDED IN OR CONSIDERED COMMUNITY BENEFIT. Schedule H, Part III, Section C, Line 9b COLLECTION PRACTICES ARE THE SAME FOR INSURED AND UNINSURED PATIENTS. PATIENTS ARE BILLED FOR ANY BALANCE DUE AFTER INSURANCE. PATIENTS WHO ARE UNINSURED ARE BILLED AT THE INPATIENT AND OUTPATIENT DISCOUNTED RATES. PATIENTS WHO ARE KNOWN TO QUALIFY FOR FINANCIAL ASSISTANCE ARE IDENTIFIED ON THE PATIENT ACCOUNT AND ANY COLLECTION ACTIVITY IS SENT TO THE PATIENT, ONLY AFTER ANY FINANCIAL ASSISTANCE HAS BEEN PROVIDED. FOR PATIENTS WHO HAVE APPLIED FOR ADDITIONAL FINANCIAL AID, COLLECTION ON THESE ACCOUNTS IS DISCONTINUED UNTIL THE FINANCIAL AID APPLICATION IS REVIEWED AND EITHER APPROVED OR DENIED. PATIENTS RECEIVING PARTIAL FINANCIAL AID WILL CONTINUE WITH THE COLLECTION PROCESS FOR THE BALANCE DUE AFTER FINANCIAL AID DISCOUNTS HAVE BEEN APPLIED. PATIENTS DENIED FURTHER FINANCIAL AID ASSISTANCE WILL CONTINUE WITH THE COLLECTION PROCESS. ALL PATIENTS RECEIVED BALANCE DUE STATEMENTS FOR 120 DAYS IN 30 DAY CYCLES. PAYMENT ARRANGEMENTS ARE AVAILABLE TO PATIENTS. IF PAYMENT ARRANGEMENTS ARE MADE PATIENTS WILL RECEIVED A MONTHLY STATEMENT WITH THE ARRANGED MONTHLY PAYMENT. Schedule H, Part VI, Line 2 BASED ON ITS COMMITMENT TO THE COMMUNITY, FF THOMPSON HOSPITAL COMPLETED A COMMUNITY HEALTH ASSESSMENT TO BETTER UNDERSTAND THE NEEDS OF THE COMMUNITY MEMBERS. THE FOLLOWING IDENTIFIES THE PARTICIPANTS IN THE PROCESS OF CONDUCTING THE COMMUNITY HEALTH ASSESSMENTS. PARTICIPANTS: THE HOSPITAL WORKED WITH A BROAD-BASE OF AREA COMMUNITY AGENCIES KNOWN AS "THE ONTARIO COUNTY PARTNERS FOR COMMUNITY SOLUTIONS" TO CONTINUE ACTIONS AND IMPLEMENT THE COMMUNITY HEALTH ASSESSMENT. THE PARTICIPANTS IN THIS COMMITTEE INCLUDED FF THOMPSON HEALTH, THE ONTARIO COUNTY DEPARTMENT OF PUBLIC HEALTH, THE ONTARIO COUNTY OFFICE OF AGING, THE ONTARIO COUNTY YOUTH BUREAU, THE UNITED WAY, AND THE CANANDAIGUA CHURCHES IN ACTION (A LOCAL CHURCH CONSORTIUM.) TOGETHER THIS GROUP DEVELOPED AND IMPLEMENTED A COMMUNITY HEALTH ASSESSMENT TO DETERMINE THE ONGOING NEEDS OF THE COUNTY AND TO CONTINUE LAYING THE GROUNDWORK FOR A COUNTY PLAN TO ADDRESS THESE NEEDS. THOMPSON HEALTH MAINTAINS MANY LINKS AND AFFILIATIONS WITH COMMUNITY AND HEALTH ORGANIZATIONS TO ENHANCE ITS ABILITY TO DEVELOP AND DELIVER COMMUNITY PROGRAMS. THROUGH THESE PARTNERSHIPS THOMPSON HEALTH HAS ESTABLISHED A DIVERSE ARRAY OF COMMUNITY HEALTH PROGRAMS TO MEET THE COMMUNITIES' SPECIFIC NEEDS. SOME OF OUR PARTNERSHIPS INCLUDE WORK WITH THE COUNTY, SCHOOL DISTRICTS, COLLEGES AND INDUSTRY AS WELL AS OTHER NON-PROFIT COMMUNITY ORGANIZATIONS. Schedule H, Part VI, Line 3 THE THOMPSON HEALTH COMMUNITY CARE PROGRAM IS COMMUNICATED IN APPROPRIATE DETAIL IN SEVERAL MEDIUMS. ALL EFFORTS TO PROVIDE INFORMATION AT A VARIETY OF LOCATIONS USING A VARIETY OF MEDIA AND TECHNIQUES ARE ATTEMPTED. THOMPSON HEALTH MAKES ITS BEST EFFORT TO MAKE THE PROGRAM INFORMATION AVAILABLE TO THE PATIENTS PRIOR TO THEM RECEIVING SERVICES; HOWEVER IT IS RECOGNIZED THAT IN MANY CASES PATIENTS WILL INVESTIGATE THE FINANCIAL AID/COMMUNITY CARE PROGRAM AFTER SERVICES ARE RENDERED. THOMPSON HEALTH MAKES ITS BEST EFFORTS TO VERBALLY COMMUNICATE THE PROGRAM THROUGH ITS ASSOCIATES RECOGNIZING THAT THERE ARE LEVELS OF ASSOCIATE INVOLVEMENT. PATIENT REGISTRATION STAFF VERBALLY INFORMS ALL SELF-PAY PATIENTS OF THE AVAILABLE BENEFIT. THERE ARE PAMPHLETS AND INFORMATION SHEETS AVAILABLE FOR ALL PATIENTS IN THE REGISTRATION AREA. THOMPSON HEALTH ASSOCIATES ARE GIVEN INFORMATION SHEETS TO ASSIST THEM WITH THE ABILITY TO COMMUNICATE THE PROGRAM TO PATIENTS. TRANSLATION SERVICES ARE AVAILABLE AS NEEDED THROUGH A TRANSLATION LINE. A VARIETY OF WRITTEN COMMUNICATIONS ARE ALSO USED; INFORMATION SHEETS - LOCATED IN THE SAME AREAS AS THE SIGNS WILL BE INFORMATIONAL SHEETS REGARDING THE AVAILABILITY OF A FINANCIAL AID/COMMUNITY CARE PROGRAM ALONG WITH IDENTIFYING CONTACTS FOR FURTHER INFORMATION. APPLICATION AND DIRECTIONS - THESE DOCUMENTS PROVIDE THE PATIENT WITH THE PROGRAM APPLICATION, DIRECTIONS ON HOW TO COMPLETE THE APPLICATION, AND THE ADDITIONAL INFORMATION REQUIRED FOR A COMPLETE APPLICATION. THESE APPLICATIONS ARE HANDED OUT IN THE EMERGENCY DEPARTMENT TO SELF-PAY PATIENTS. PATIENT BILLS AND COLLECTION CORRESPONDENCE - SELF-PAY PATIENTS ARE MAILED INFORMATION REGARDING THE PROGRAM WHEN THE FINANCIAL COUNSELORS VERIFY THEY HAVE NO OTHER INSURANCE. THE PATIENT BILLING STATEMENTS INCLUDE A STATEMENT REGARDING THE EXISTENCE OF THE PROGRAM AND WHO TO CONTACT. SIMILAR INFORMATION IS INCLUDED IN THE "COLLECTION" LETTERS. ELECTRONIC MEDIA: INTRANET - THOMPSON HEALTH'S INTRANET INCLUDES THIS POLICY AND DIRECTIONS IN THE POLICY & PROCEDURES MANUAL ON THE INTRANET MAKING THE POLICY AND PROGRAM AVAILABLE TO ALL ASSOCIATES. INTERNET WEB SITE - THOMPSON HEALTH INCORPORATES GENERAL INFORMATION ABOUT THE POLICY, SLIDING FEE APPLICATION, AND DIRECTIONS ON ITS WEB SET. NON-PATIENT COMMUNICATION - FINANCIAL COUNSELORS COMMUNICATE THE PROGRAM WITH COMMUNITY HEALTH & HUMAN SERVICES AGENCIES AND SOCIAL SERVICE ORGANIZATIONS AND AGENCIES (I.E. NAVIGATORS, OFFICE OF THE AGING, ETC.) AS WELL AS COMPANIES IT UTILIZES IN ITS COLLECTIONS EFFORTS. Schedule H, Part VI, Line 4 THE METHOD BY WHICH FF THOMPSON HOSPITAL DEFINES ITS SERVICE AREA INCLUDES AN ANALYSIS OF ITS PRIMARY AND SECONDARY SERVICE AREA AS WELL AS THE AREA DEMOGRAPHICS. THE FOLLOWING DEFINES THE SERVICE AREAS AND PROVIDES A DEMOGRAPHIC SUMMARY OF THE REGION. DEFINITION OF PRIMARY AND SECONDARY SERVICE AREAS: THOMPSON HEALTH PROVIDES SERVICES TO PERSONS IN ONTARIO COUNTY AND PARTS OF WAYNE, MONROE, LIVINGSTON, YATES, AND SENECA COUNTIES. THOMPSON HEALTH DEFINES ITS PRIMARY SERVICE AREA AS INCLUDING THOSE ZIP CODES THAT CUMULATIVELY ADD UP TO 70% OF ITS INPATIENT ADMISSIONS AND WHERE WE RECEIVE GREATER THAN 50% OF THE MARKET SHARE. AT THE 70TH PERCENTILE THE REMAINING ZIP CODES (UP TO THE 90TH PERCENTILE) COMPRISE THE SECONDARY SERVICE AREA. DISTRIBUTION BY AGE GROUP FOR THE COMMUNITY IS AS FOLLOWS: 29% 35 - 54, 18% 0 - 14, 13% 55 - 64, 12% 25 - 34, 10% 18 - 24, 8% 15 - 17. THE CURRENT HOUSEHOLD INCOMES FALL INTO THE FOLLOWING GROUPS: 27% $25-50K, 22% $50K - 75K, 19% OVER $100K, 14%. Schedule H, Part VI, Line 5 A MAJORITY OF THOMPSON HEALTH'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN OUR PRIMARY SERVICE AREA AND ARE NEITHER EMPLOYEES, CONTRACTORS, OR FAMILY MEMBERS THEREOF. OUR ORGANIZATION EXTENDS PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN OUR COMMUNITY FOR ALL DEPARTMENTS. ALL SURPLUS FUNDS ARE ROLLED INTO A FUND BALANCE FOR FUTURE YEAR CAPITAL GROWTH PURPOSES WHICH ENSURES IMPROVEMENT OF OUR PATIENT CARE AREAS. THOMPSON HOSPITAL IS COMMITTED TO STAYING CONNECTED TO OUR COMMUNITY MEMBERS. EACH OF OUR EXECUTIVES AND MANY OF OUR DIRECTORS SERVE ON AT LEAST ONE OR TWO BOARDS OF DIRECTORS FOR THE BUSINESSES IN OUR COMMUNITY. ALSO IN RESPONSE TO A NATIONAL SHORTAGE OF PHYSICIANS, THOMPSON CONTINUES TO RECRUIT NEW PHYSICIANS SPECIALIZING IN SEVERAL ARENAS AS WELL AS ADDITIONAL FAMILY PRACTITIONERS ENSURING PHYSICIAN COVERAGE FOR OUR COMMUNITY MEMBERS. THOMPSON HOSPITAL IS A NEW YORK STATE DEPARTMENT OF HEALTH DESIGNATED STROKE CENTER. WE STRIVE TO USE OUR RESOURCES EFFECTIVELY AND EFFICIENTLY TO PROMOTE HEALTH AND TO REDUCE THE OVERALL COST OF HEALTH CARE, ADDRESS A MULTITUDE OF ISSUES AND POPULATIONS ADDRESS THE HEALTH NEEDS OF THE INDIVIDUAL THAT GO BEYOND MEDICAL AND PHYSICAL ISSUES, AND TO ENSURE SERVICES ARE LOCALLY BASED. Schedule H, Part VI, Line 6 THE UNIVERSITY OF ROCHESTER MEDICAL CENTER IS AN INTEGRATED ACADEMIC HEALTH CENTER THAT COMPRISES THE SCHOOL OF MEDICINE AND DENTISTRY, INCLUDING ITS FACULTY PRACTICE (UNIVERSITY OF ROCHESTER MEDICAL FACULTY GROUP), STRONG MEMORIAL HOSPITAL, GOLISANO CHILDREN'S HOSPITAL, JAMES P WILMOT CANCER CENTER, SCHOOL OF NURSING, EASTMAN DENTAL CENTER, AND ITS AFFILIATES, HIGHLAND HOSPITAL, VISITING NURSE SERVICE, HIGHLANDS LIVING CENTER, HIGHLAND COMMUNITY DEVELOPMENT CORPORATION (D/B/A THE HIGHLANDS AT PITTSFORD), AND THE MEADOWS AT WESTFALL, INC (D/B/A THE HIGHLANDS AT BRIGHTON) - ONE OF THE NATION'S TOP ACADEMIC MEDICAL CENTERS, THE UNIVERSITY OF ROCHESTER MEDICAL CENTER FORMS THE CENTERPIECE OF THE UNIVERSITY'S HEALTH RESEARCH, TEACHING, PATIENT CARE, AND COMMUNITY OUTREACH MISSIONS WITH MORE THAN $145 MILLION IN FEDERAL RESEARCH FUNDING, UR SCHOOL OF MEDICINE RESEARCH FUNDING RANKS IN THE TOP ONE-QUARTER AMONG OF U S MEDICAL CENTERS WHILE THE SCHOOL OF NURSING RANKS 12TH HIGHEST IN FUNDING. THE UNIVERSITY'S HEALTH CARE DELIVERY NETWORK IS ANCHORED BY STRONG MEMORIAL HOSPITAL-A 800-BED, UNIVERSITY-OWNED TEACHING HOSPITAL. PATIENTS BENEFIT FROM THE MEDICAL CENTER'S ROBUST TEACHING AND BIOMEDICAL RESEARCH PROGRAMS - GOLISANO CHILDREN'S HOSPITAL, HOUSED IN STRONG MEMORIAL HOSPITAL, IS A 132-BED CHILDREN'S HOSPITAL THAT SERVES AS THE REFERRAL CENTER FOR UPSTATE NEW YORK, SURROUNDING STATES AND CANADA. IT COMBINES AWARD-WINNING RESEARCH, INTERNATIONALLY ACCLAIMED EDUCATION AND COMPASSIONATE CARE TO SERVE CHILDREN AND FAMILIES. PEDIATRIC SPECIALTIES INCLUDE ORTHOPEDICS, EUROLOGY/NEUROSURGERY, CANCER AND NEONATAL CARE - THE JAMES P WILMOT CANCER CENTER IS ORGANIZED AROUND A MULTIDISCIPLINARY CARE MODEL, WHICH LEADING CANCER EXPERTS BELIEVE IS THE GOLD STANDARD IN CANCER CARE IN THE 21ST CENTURY. ITS MODEL UNDERSCORES A COMMITMENT TO PROVIDE PATIENTS IN THE ROCHESTER AREA WITH THE MOST UP-TO-DATE INFORMATION AND AVAILABLE TREATMENTS, BASING ITS RECOMMENDATIONS ON THE BEST EVIDENCE IT IS ONE OF THE ONLY CENTERS IN WESTERN NEW YORK OFFERING THIS TEAM APPROACH TO CARE - EASTMAN DENTAL CENTER PROVIDES COMMUNITY DENTAL CARE IN A NUMBER OF CLINICS AS WELL AS CLINICAL EDUCATION TO DENTAL STUDENTS ENROLLED AT THE UNIVERSITY OF ROCHESTER SCHOOL OF MEDICINE AND DENTISTRY. IT OFFERS GENERAL DENTISTRY, PEDIATRIC AND ORTHODONTIC CLINICS AND HAS RECENTLY ADDED AN URGENT CARE DENTAL CLINIC THAT SEES APPROXIMATELY 50 PATIENTS A DAY - HIGHLAND HOSPITAL IS A FULL-SERVICES COMMUNITY HOSPITAL THAT ALSO OFFERS NUMEROUS SPECIALTY SERVICES THAT DRAW PATIENTS FROM THE REGION AND CANADA - BARIATRIC SURGERY, JOINT REPLACEMENT, GERIATRICS, WOMEN'S SERVICES AND MATERNITY. HIGHLAND HOSPITAL'S EVOLUTION AS A FULL-SERVICES COMMUNITY HOSPITAL, WITH A FULL COMPLEMENT OF SUBSPECIALTY SERVICES, ENABLES THE HOSPITAL TO ACCEPT PATIENTS FROM STRONG MEMORIAL'S ED AND FLOORS- IMPORTANT TO ASSURING ACCESS OF CARE, SINCE STRONG IS OFTEN AT OR NEAR FULL - VISITING NURSE SERVICE PROVIDES HOME COMMUNITY-BASED CARE TO MORE THAN 14,000 ANNUALLY, INCLUDING NURSING, THERAPY, PERSONAL CARE SUPPORT, AND MEALS ON WHEELS. FF THOMPSON HOSPITAL LOCATED IN CANANDAIGUA, NY IS A 113-BED ACUTE CARE COMMUNITY HOSPITAL SERVING ONTARIO COUNTY, NEW YORK, AND A 188-BED SKILLED NURSING FACILITY. FF THOMPSON ALSO OPERATES SATELLITE CLINICS PROVIDING URGENT CARE, PRIMARY CARE, RHEUMATOLOGY SERVICES AND TREATMENT OF SLEEP DISORDERS - THE HIGHLANDS AT PITTSFORD CAMPUS INCLUDES TWO SEPARATE CORPORATIONS WITH DIFFERENT ACTIVITIES OFFERING NURSING CARE AS WELL AS ASSISTED AND INDEPENDENT LIVING FOR SENIORS. THE HIGHLANDS CENTER IS A 122-BED SKILLED NURSING FACILITY THAT ALSO OFFERS AN ADULT DAY CARE PROGRAM. THE ASSISTED LIVING 171-BED INDEPENDENT AND COMMUNITY EDUCATION ARE PROVIDED BY COMMUNITY DEVELOPMENT CORPORATION THE HIGHLANDS AT PITTSFORD AND LAURELWOOD. THE HIGHLANDS OFFER A SERIES OF COMMUNITY EDUCATION ON CURRENT HEALTH TOPICS, INCLUDING HEALTH, NUTRITION, ORAL HEALTH AND PREVENTION, TO NAME A FEW - THE HIGHLANDS AT BRIGHTON IS A 145-BED SKILLED FACILITY THAT SPECIALIZES IN CARE FOR THE MEDICALLY COMPLEX CASES. Schedule H, Part VI, Line 7 NEW YORK X X X X X 1 1 0 0 0 0 0 1 0 Steven Goldstein Board Member 0 825325 0 0 0 73757 0 879451 0 16332 0 1794865 0 0 Raymond Mayewski MD Board Member 0 617854 0 0 0 46492 0 100551 0 17052 0 781949 0 0 Mark Taubman MD Board Member 0 870540 0 0 0 19345 0 280551 0 22617 0 1193053 0 0 John McGuire MD Board Member President of the Medical Staff 183187 0 19655 0 4744 0 19391 0 15140 0 242117 0 0 0 Michael F Stapleton JR President/CEO 0 326130 0 69525 0 69218 0 67385 0 16240 0 548498 0 0 David Baum MD SVP Medical Affairs & Emergency Physician 242236 73804 23237 7080 11650 3549 40238 12260 3114 949 320475 97642 0 0 Jennifer DeVault VP Associate Services and Wellness 120052 0 11099 0 968 0 12036 0 14625 0 158780 0 0 0 Kurt Koczent EVP/COO 155539 38885 25050 6263 665 166 30463 7636 12989 3247 224706 56197 0 0 Mark Prunoske Senior VP & CFO 0 193046 0 45824 0 34123 0 40263 0 15204 0 328460 0 0 Hazel Robertshaw VP Patient Care Services/CNO 133636 0 8643 0 601 0 13961 0 2085 0 158926 0 0 0 Elizabeth Talia VP Legal & Regulatory Affairs and General Counsel 0 142626 0 10994 0 985 0 12955 0 16165 0 183725 0 0 Vijay Bansal MD Physician 347064 0 30425 0 13948 0 17139 0 7761 0 416337 0 0 0 Peter Fenton MD Physician 289088 0 10192 0 164 0 18027 0 14063 0 331534 0 0 0 Jason McClung MD Physician 308900 0 19564 0 237 0 21866 0 15400 0 365967 0 0 0 Matthew Osborne MD Physician 309334 0 27257 0 311 0 27882 0 15400 0 380184 0 0 0 Timothy Pitler MD Physician 309968 0 30982 0 11739 0 60166 0 14347 0 427202 0 0 0 Carlos R Ortiz MD Former Officer SVP Medical Services 0 0 0 0 0 172616 0 0 0 8216 0 180832 0 0 Schedule J, Part I, Line 3 The CEO of the FF Thompson Hospital receives compensation from the Hospital. However because the Hospital is a common paymaster, the CEO's salary is allocated to an affiliate. In addition the affiliated entities collectively establish CEO compensation by the manner's described. Schedule J, Part I, Line 4 The following individuals participated in a supplemental nonqualified retirement plan and received employer paid amounts that are included in deferred compensation. 457(f) plan payments were: Michael Stapleton - $46,351, Mark Prunoske - $19,571, Kurt Koczent - $19,571, David Baum - $25,110, Steven Goldstein - $694,500 and Mark Taubman - $150,000. SERP plan payments were: Steven Goldstein - $159,400 and Raymond Mayewski - $75,000 and Mark Taubman - $105,000. These payments were made by a related organization. In addition, regarding line 4a, a former SVP of Medical Services received 52 weeks salary continuance plus a lump sum payment of $23,000 of severance. Schedule J, Part I, Line 7 The President/CEO, Executive VP/COO, and Senior VP of Finance/CFO are eligible for a variable % YE incentive based on predetermined goals. The goals are operational, financial and managerial in nature. The financial goal ties in part to the net earnings of the organization and its affiliates. A Ontario County Industrial Development Agency 521326077 683058AB7 2003-07-01 12800000 To construct an addition to and renovate portions of the hospital 0 0 0 B Ontario County Local Development Corporation 272435489 2010-08-10 29700000 To construct an addition to and renovate portions of the hospital 0 0 0 A 3000000 0 12800000 0 0 0 0 0 0 12800000 0 0 2004 0 0 1 1 B 2365267 0 29700000 652000 0 952000 0 0 28115000 0 0 2013 0 0 1 1 A 0 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 0 A 0 1 0 0 1 1 Keybank 10.00 0 0 0 0 0 B 0 1 0 0 0 0 0 0 0 A 0 B 0 Darcy Prunoske Family Member of Officer 33291 Wages 0 R Randall Farnsworth Greater than 35% owner of a Vendor 106230 Rent 0 Schedule L, Part IV Line 1 - Although The Frederick Ferris Thompson Hospital is the common paymaster for it's affiliates and the CFO's salary is allocated to the Health System, we are disclosing this transaction on the Hospital because the CFO's spouse's salary is a Hospital expense. See also further explanation on Schedule O Form 990, Part V, Line 2a Employees and certain officers, directors, and key employees of the Frederick Ferris Thompson Hospital's related organizations receive compensation from the Hospital, through a common paymaster. Because employees are included in the common paymaster, a portion of the salaries of these individuals is allocated to its affiliates and is included as part of other salary and wages on their statement of functional expenses. None of the board members of the Hospital are compensated for their board services. Form 990, Part VI, Section A, Line 2 Refer to Schedule O Form 990 Part VI, Section B, Line 12c note. Form 990, Part VI, Section A, Line 4 There have been no significant changes to the Hospital's governing documents since the last form 990 was filed. However, changes to the bylaws were approved by the Board in March 2016. Form 990, Part VI, Section A, Line 6 The sole member of Frederick Ferris Thompson Hospital is FF Thompson Health System Inc. (System). The System, the University of Rochester Medical Center and the University of Rochester (UR) are parties in an affiliation agreement whereby UR is the sole corporate member of the System. The System acting through its board of directors, has the authority to elect the governing body of Thompson Hospital and approve certain decisions. Such decisions include appointment of the Hospital President and CEO, amendment of the certificate of incorporations and bylaws, approval of extraordinary corporate actions such as merger or dissolution, approval of capital and operating budgets, strategic plans, and incurrence of certain debt. Form 990, Part VI, Section A, Line 7a Refer to Schedule O, Membership information, Form 990, Part VI, Section A, Line 6 Form 990, Part VI, Section A, Line 7b Refer to Schedule O, Membership information, Form 990, Part VI, Section A, Line 6 Form 990, Part VI, Section B, Line 11b The Director of Finance and CFO reviewed the return and then provided it to an independent accounting firm for their review as well. The return was made available to the Board members via a shared intranet website. At the Board meeting preceding the filing date, questions were entertained by management. There are several days after the Board meeting where members can also review the return and ask questions prior to the filing date. Form 990, Part VI, Section B, Line 12c Board members, officers and key employees complete conflict of interest disclosure statements annually and the statements are reviewed by the Audit Committee and General Counsel. The Audit Committee and General Counsel are responsible for monitoring compliance and follow-up with any potential conflicts, including developing a conflicts of interest management plan that identifies each conflict and potential conflict and how it will be addressed. In addition, each Board member, officer or key employee with a conflict or potential conflict receives a letter outlining how the conflict will be addressed. Form 990, Part VI, Section B, Line 15 Executive compensation at Thompson is established by the compensation committee of the Board of Directors. The committee uses an independent company to gather comparable data in determining compensation levels for the President/CEO and Senior level executives. The full Board of Directors is surveyed by the compensation committee on executive performance; this is considered in determining compensation levels. The compensation committee is also involved in goal setting for the CEO, which ties back to his performance reviews and incentive compensation rates. The year in which this process was last undertaken for each person was 2015. Form 990, Part VI, Section C, Line 19 These documents are available upon request by contacting the Administrative Office Form 990, Part VII, Section A, Line 1a Refer to Schedule O, Employment information, Form 990, Part V, Line 2a Form 990, Part IX, Line 7 Refer to Schedule O, Employment information, Form 990, Part V, Line 2a Form 990, Part XI, Line 9 Change in value of interest rate swap $132,466, Change in value of charitable gift annuities ($13,375), Change in funded status of pension plan $678,194, Change in beneficial interest in charitable remainder trust ($19,946), Change in beneficial interest in the net assets of the FF Thompson Foundation ($2,015,353). The FF Thompson Foundation Inc 350 Parrish Street Canandaigua NY 14424 222959984 Fundraising NY 501(c)(3) 7 FF Thompson Health System 0 FF Thompson Health System Inc 350 Parrish Street Canandaigua NY 14424 222959987 Support Org NY 501(c)(3) 11a University of Rochester Medical Center 0 M M Ewing Continuing Care Center 350 Parrish Street Canandaigua NY 14424 237046583 Healthcare NY 501(c)(3) 3 FF Thompson Health System 0 FF Thompson Senior Communities Inc 1 Ferris Hills Canandaigua NY 14424 161557494 Elder Care NY 501(c)(3) 9 FF Thompson Health System 0 University of Rochester 910 Genesee Street STE 200 Rochester NY 14611 160743209 School NY 501(c)(3) 2 N/A 0 Highland Hospital of Rochester 1000 South Avenue Rochester NY 14620 160743037 Hospital NY 501(c)(3) 3 Strong Partners Health System 0 The Highland Foundation Inc 1000 South Avenue Rochester NY 14620 237310662 Fundraising NY 501(c)(3) 11A, 1 Highland Hospital 0 Highland Facilities Development Corp 1000 South Avenue Rochester NY 14620 223039077 Medical Building NY 501(c)(3) 9 Highland Hospital 0 Highland Community Development Corp 100 Hahnemann Trail Pittsford NY 14534 223154715 Elder Care NY 501(c)(3) 9 Strong Partners Health System 0 The Highlands Living Center Inc 500 Hahnemann Trail Pittsford NY 14534 223240227 Healthcare NY 501(c)(3) 9 Strong Partners Health System 0 The Meadows at Westfall Inc 5901 Lac De Ville Blvd Rochester NY 14618 161502303 Healthcare NY 501(c)(3) 9 Strong Partners Health System 0 Strong Partners Health System Inc 601 Elmwood Avenue Box 706 Rochester NY 14642 161499099 Support Org NY 501(c)(3) 11A, 1 University of Rochester 0 Strong Home Care Group 2180 Empire Boulevard Webster NY 14580 222577664 Fundraising NY 501(c)(3) 7 University of Rochester 0 Visiting Nurse Srvc of Rochester & Monroe 2180 Empire Boulevard Webster NY 14580 160743215 Healthcare NY 501(c)(3) 9 Strong Home Care Group 0 Community Care of Rochester 2180 Empire Boulevard Webster NY 14580 161561691 Healthcare NY 501(c)(3) 9 Strong Home Care Group 0 Excell Partners Inc 160 Linden Oaks Suite E Rochester NY 14625 201862628 Economic Dev NY 501(c)(4) N/A University of Rochester 0 Rochester Bioventure Center Inc 601 Elmwood Avenue Box 706 Rochester NY 14642 202485999 Biotech Incub NY 501(c)(3) 11A, 1 University of Rochester 0 High Tech Rochester Inc 150 Lucius Gordon Drive Suite 100 West Henrietta NY 14586 161195028 Business Incu NY 501(c)(3) 7 University of Rochester 0 Crittenden Boulevard Housing Co Inc 249 Norton Village Lane Rochester NY 14609 237035414 Support Org NY 501(c)(3) 11B, II University of Rochester 0 University of Rochester Employee Ben Trs 910 Genesee Street Suite 200 Rochester NY 14611 161600112 Empl Ben Trst NY 501(c)(9) N/A University of Rochester 0 U of R Broadcasting Corporation 201 Wilson Commons Rochester NY 14627 160743209 Broadcast Lic NY 501(c)(4) N/A University of Rochester 0 UR Real Estate Corporation 263 Wallis Hall Rochester NY 14627 271140014 Support Org NY 501(c)(3) 11D, III-OTH University of Rochester 0 Framemed Foundation Inc 263 Wallis Hall Rochester NY 14627 161490497 Support Org NY 501(c)(3) 7 University of Rochester 0 Meliora Real Estate Corporation 263 Wallis Hall Rochester NY 14627 452464788 Support Org NY 501(c)(3) 11D, III-OTH University of Rochester 0 Finger Lakes Home Care Inc 756 Pre-Emption Road Geneva NY 14456 161489133 Healthcare NY 501(c)(3) 9 Visiting Nurse Srvc of Rochester & Monroe 0 Finger Lakes Visiting Nurse Service Inc 756 Pre-Emption Road Geneva NY 14456 223067627 Healthcare NY 501(c)(3) 9 Visiting Nurse Srvc of Rochester & Monroe 0 Frederick Ferris Thompson Hospital Guild 350 Parrish Street Canandaigua NY 14424 166053299 Assist & support the FF Thompson Health System and its tax-exempt affiliates NY 501(c)(3) 9 N/A 0 Excell Innovate NY Fund LP 222 West Ridge Road Bldg 28 Suite 156-1 Rochester NY 14615 462405519 Funding Start Ups NY N/A Finger Lakes Community Care Network 350 Parrish Street Canandaigua NY 14424 161423442 Inactive NY FF Thompson Health System C 0 FF Thompson Properties and Services Inc 350 Parrish Street Canandaigua NY 14424 161286518 Plans, develops, implements, owns and manages health related ventures NY FF Thompson Health System C 0 Medical Administrative Associates Inc 777 South Clinton Avenue Rochester NY 14620 161354319 Retail Pharmacy NY Highland Hospital C 0 UR Equity Holdings Inc 110 Office Park Way Pittsford NY 14534 273040889 Holding Co NY University of Rochester C 0 Excell Technology Ventures Inc 222 West Ridge Road Ste 156-1 Rochester NY 14615 800909149 Biotech Incubator NY Rochester Bioventure C 0 Accountable Health Partners LLC 135 Corporate Woods Ste 320 Rochester NY 14623 300787967 Acct Care Network NY University of Rochester C 0 0 0 1 0 1 0 0 0 0 1 1 0 1 0 1 0 1 0 0 Schedule R, Part I Part III - Line 1 - columns e, f, g, h, i, j, k are all not applicable.