2015-11-16T13:09:36-06:00 2014-12-31 161226221 FUST CHARLES CHAMBERS LLP 5784 WIDEWATERS PARKWAY SYRACUSE NY 13214 990 2014-01-01 150532054 AUBURN COMMUNITY HOSPITAL AUBU 3152557011 17 LANSING STREET AUBURN NY 13021 JASON LESCH CHIEF FINANCIAL OFFICER 3152557011 2015-11-13 1 JOSEPH J SCHLEGEL P00301329 3154463600 2014 2016-03-07 17:11:31Z JASON LESCH 17 LANSING STREET AUBURN NY 13021 100097527 0 X WWW.AUBURNHOSPITAL.ORG X 1878 NY THE MISSION OF AUBURN COMMUNITY HOSPITAL IS TO PROVIDE COMPASSIONATE, QUALITY CARE AND IMPROVE THE HEALTH OF OUR COMMUNITY INCLUDING RESIDENTS OF AUBURN, NY AS WELL AS SURROUNDING AREAS. 14 9 974 100 0 0 359846 5529795 91004462 94217105 3969 25137 2253759 325490 93622036 100097527 0 0 0 0 50913075 54518674 0 0 23792 41758633 45248381 92671708 99767055 950328 330472 60938602 62914051 28988240 30633217 31950362 32280834 OUR MISSION IS TO PROVIDE COMPASSIONATE, QUALITY CARE AND IMPROVE THE HEALTH OF OUR COMMUNITY INCLUDING AUBURN, NY AS WELL AS SURROUNDING AREAS. 0 0 87066485 94567732 THE PURPOSE OF AUBURN COMMUNITY HOSPITAL IS TO MEET THE HEALTH CARE NEEDS OF THE COMMUNITY BY PROVIDING NECESSARY INPATIENT AND OUTPATIENT SERVICES. TO THAT END, THE HOSPITAL TREATED 4,950 INPATIENTS FOR A TOTAL OF 50,277 PATIENT DAYS AND A TOTAL OF 144,494 OUTPATIENTS IN 2014. 87066485 1 1 0 0 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 1 148 0 1 974 1 0 0 0 0 0 0 0 0 0 0 X 14 9 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X JASON LESCH CFO 3152557245 17 LANSING STREET AUBURN NY 13021 JOSEPH RUNKLE TRUSTEE 1.00 X 0 0 0 PATSY IANNOLO MD TRUSTEE 1.00 X 0 0 0 RAMA GODISHALA MD TRUSTEE 1.00 X 0 0 0 JOHN RICCIO MD TRUSTEE 20.00 5.00 X 121726 0 5851 LISA RYERSON TRUSTEE 1.00 X 0 0 0 WILLIAM SIMMONDS TRUSTEE 1.00 X 0 0 0 LOREN VANRIPER MD TRUSTEE 1.00 40.00 X 161200 355343 23494 DEMETRA VOUNAS MD TRUSTEE 1.00 X 0 62916 6590 ERIC R ALLYN TRUSTEE 1.00 2.00 X 0 0 0 JOSEPH BARTOLOTTA CHAIRMAN 1.00 X X 0 0 0 ANTHONY D FRANCESCHELLI VICE CHAIRMAN/TREASURER 1.00 X X 0 0 0 WILLIAM DORR SECRETARY 1.00 X X 0 0 0 JD PABIS TRUSTEE 1.00 X 0 0 0 LINDA RICE TRUSTEE 1.00 X 0 0 0 SCOTT BERLUCCHI PRESIDENT & CEO 25.00 13.00 X 437742 0 23819 PATRICK FACTEAU FORMER CHIEF FINANCIAL OFFICER 31.00 7.00 X 152925 0 16516 JASON LESCH CFO 36.00 2.00 X 52817 0 2893 ADAM DUCKETT MD HOSPITALIST 38.00 X 275829 0 12904 MARY BAKER HOSPITALIST 38.00 X 280106 0 12521 GREGORY SERFER HOSPITALIST 38.00 X 202123 0 15868 JOSEPH APONE MD HOSPITALIST 38.00 X 241033 0 27143 CHRISTOPHER RYAN CHIEF INFORMATION OFFICER 38.00 X 161238 0 10819 2086739 418259 158418 23 0 1 0 EASTERN FINGERLAKES EMERGENCY PO BOX 346 5180 WEST TAFT RD NORTH SYRACUSE NY 13212 EMERGENCY ROOM PHYSICIANS 1403076 SYRACUSE PSYCHIATRIC SERVICE LLC 109 SOUTH WARREN STREET SYRACUSE NY 13202 PSYCHIATRIC PHYSICIANS 750000 AUBURN MEDICAL PC 17 LANSING STRET AUBURN NY 13021 ANESTHESHIA COVERAGE 649187 ALLIANCE HEALTHCARE SERVICES 100 BAYVIEW CIRCLE SUITE 400 NEWPORT BEACH CA 92660 MRI SERVICES 581575 RAMA M GODISHALA 281 GRANT AVENUE AUBURN NY 13021 CARDIOLOGY COVERAGE 412406 23 139288 5023520 366987 5529795 PATIENT SERVICE 623000 93377448 93377448 VA CLINIC SERVICE 623000 839657 839657 94217105 23810 23810 1327 1327 DIETARY INCOME 623000 298176 298176 OTHER REVENUE 623000 27314 27314 325490 100097527 94567732 0 0 814289 814289 38535617 34372777 4145668 17172 2127731 1858607 268195 929 10175561 8888516 1282604 4441 2865476 2503040 361186 1250 284709 284709 292890 292890 317183 278412 38771 4386294 3850140 536154 178377 156573 21804 226629 198927 27702 373397 373397 4352718 4352718 1462552 681925 780627 SUPPLIES 12457412 10934693 1522719 PURCHASED SERVICES 9884986 8676705 1208281 BAD DEBT 6481288 6481288 OTHER FEES 4549946 3458767 1091179 99767055 87066485 12676778 23792 1271363 2338432 11104640 9832663 14125852 21000180 1941698 3002764 556255 956938 91264288 68983059 24895201 22281229 7043593 3501845 60938602 62914051 15236076 16415327 13303321 13756702 448843 461188 28988240 30633217 X 31818294 31764199 132068 516635 31950362 32280834 60938602 62914051 330472 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 132068 915275 530708 516635 90347 352670 310949 132068 72372 120842 102867 90347 2153040 1086795 3167463 72372 58431 2496008 401399 2153040 1.00000 0 0 823418 823418 34980768 21972604 13008164 1558283 1457646 100637 53517440 45552809 7964631 384379 384379 22281229 AGENCY RELATIONSHIPS/ INSURANCE RECEIVABLE 846304 ESTIMATED THIRD PARTY SETTLEMENTS 369554 PLEDGE RECEIVABLE, NET 56387 UNAMORTIZED DEBT ISSUANCE COST/ ASSETS LIMITED AS TO USE 2229600 3501845 FUNDS HELD FOR OTHERS 179280 ASSET RETIREMENT OBLIGATION 281908 461188 X PART X, LINE 2: THE HOSPITAL, EXCEPT FOR AMPC, QUALIFIES AS TAX EXEMPT ORGANIZATIONS. AS OF DECEMBER 31, 2014 AND 2013, THE HOSPITAL DID NOT HAVE ANY UNRECOGNIZED TAX BENEFITS OR ANY RELATED ACCRUED INTEREST OR PENALTIES. THE TAX YEARS OPEN TO EXAMINATION BY FEDERAL AND STATE TAXING AUTHORITIES ARE 2011 THROUGH 2014. THE HOSPITAL DOES NOT ANTICIPATE THAT THE TOTAL UNRECOGNIZED TAX BENEFITS WILL CHANGE IN THE NEXT TWELVE MONTHS. 1 1 X 1 X 1 X 1 1 1 0 1 1 222945 222945 0.00240 22740558 16472140 6268418 0.06720 22963503 16472140 6491363 0.06960 22963503 16472140 6491363 0.06960 1 6481288 222945 35691216 41180410 -5489194 X 1 1 1 1 AUBURN COMMUNITY HOSPITAL 17 LANSING STREET AUBURN NY 13021 X X X AUBURN COMMUNITY HOSPITAL 1 0 0 1 X X X X X X X X X 13 1 0 0 1 X WWW.AUBURNHOSPITAL.ORG X 1 13 1 WWW.AUBURNHOSPITAL.ORG 0 0 1 X 100.000000000000 300.000000000000 X X X 1 1 X X X X 1 X X X 1 X 0 X X X X 1 X 0 0 AUBURN COMMUNITY HOSPITAL PART V, SECTION B, LINE 5: THE ACH PHYSICIAN ADVISORY BOARD, WHICH INCLUDES TWO PEDIATRIC PHYSICIANS, THREE PRIMARY CARE PHYSICIANS, TWO GENERAL SURGEONS, TWO OBGYN PHYSICIANS, AN ANESTESHIOLOGIST, A HOSPITALIST, A CARDIOLOGIST, AN ORTHOPEADIC PHYSICIAN, A NEUROLOGIST, AND AN EMERGENCY MEDICINE PHYSICIAN, AS WELL AS LOCAL COMMITTEE LEADERS AND BUSINESS LEADERS WERE INTERVIEWED FOR THEIR INPUT. AUBURN COMMUNITY HOSPITAL PART V, SECTION B, LINE 11: AUBURN COMMUNITY HOSPITAL HAS BEEN EXECUTING ITS RURAL INTEGRATED DELIVERY SYSTEM THAT WAS DEVELOPED IN 2013. AUBURN COMMUNITY HOSPITAL IS A FOUNDING PARTNER IN THE CNY DSRIP COLLABORATIVE CARE SYSTEM WITH FAXTON ST. LUKES, ST. JOSEPH'S AND SUNY. AUBURN COMMUNITY HOSPITAL PART V, SECTION B, LINE 22D: AUBURN COMMUNITY HOSPITAL USED THE HIGHEST VOLUME COMMERCIAL PAYOR TO DETERMINE THE MAXIMUM AMOUNTS THAT CAN BE CHARGED TO FAP ELIGIBLES. PART V, SECTION B, LINE 16 FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY AUBURN COMMUNITY HOSPITAL PART V, SECTION B, LINE 16A WEBSITE: WWW.AUBURNHOSPITAL.ORG 3 FINGER LAKES CENTER FOR LIVING 20 PARK AVENUE AUBURN NY 13021 SHORT-TERM REHABILITATION AND LONG-TERM RESIDENTIAL CARE CENTER FINGER LAKES MEDICAL CARE CENTER 303 GRANT AVENUE AUBURN NY 13021 URGENT CARE CENTER URGENT MEDICAL CARE OF SKANEATELES 803 GENESEE STREET SKANEATELES NY 13152 URGENT CARE CENTER PART I, LINE 7: THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS IN THE TABLE IS A COST-TO-CHARGE RATIO. THIS COST-TO-CHARGE RATIO WAS DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 6,481,288. PART III, LINE 4: SEE FOOTNOTE 3(K) ON PAGES 10-12 IN THE ATTACHED AUDITED FINANCIAL STATEMENTS. PART III, LINE 8: THE SHORTFALL SHOWN ABOVE SHOULD BE CONSIDERED A COMMUNITY BENEFIT AS ALL PATIENTS WILL BE SEEN AND TREATED AT AUBURN COMMUNITY HOSPITAL REGARDLESS OF ABILITY TO PAY. THEREFORE, THE FACT THAT THE COSTS TO TREAT MEDICARE PATIENTS EXCEEDED THE REVENUES GENERATED FROM MEDICARE PATIENTS SHOULD ALL BE VIEWED AS A BENEFIT TO THE MEDICARE PATIENTS OF THE COMMUNITY. THE AMOUNT ABOVE WAS CALCULATED BY MULTIPLYING THE GROSS MEDICARE CHARGES FOR THE YEAR BY THE RATIO OF PATIENT CARE COST TO CHARGES AS CALULATED ON WORKSHEET 2. PART III, LINE 9B: PATIENTS ELIGIBLE ARE REASSESSED AT EACH ADMISSION AND NO FURTHER COLLECTIONS ARE DONE. PART VI, LINE 2: A STRATEGIC PLANNING PROCESS WHICH INCLUDES AN ANALYSIS BY TREO SOLUTIONS IS USED TO HELP DETERMINE THE NEEDS OF OUR GEOGRAPHIC AREA. THIS ANALYSIS HELPS AUBURN COMMUNITY HOSPITAL IN DETERMINING WHETHER WE HAVE ADEQUATE PHYSICIAN STAFFING TO PROVIDE THE APROPRIATE LEVEL OF CARE TO OUR COMMUNITY. PART VI, LINE 3: PATIENTS OF AUBURN COMMUNITY HOSPITAL ARE PROVIDED WITH FINANCIAL ASSISTANCE INFORMATION UPON BEING ADMITTED TO THE HOSPITAL, BOTH INPATIENT AND OUTPATIENT. FINANCIAL ASSISTANCE IS EVALUATED EVERY TIME A PERSON PRESENTS AT THE FACILITY. PACKETS ARE PROVIDED TO ANY PATIENT THAT IS DETERMINED TO NEED OR POTENTIALLY NEED FINANIAL ASSISTANCE. PART VI, LINE 4: AUBURN COMMUNITY HOSPITAL SERVES THE AUBURN, NY COMMUNITY AS WELL AS THE IMMEDIATE SURROUNDING AREAS. PART VI, LINE 5: AUBURN COMMUNITY HOSPITAL PROMOTES HEALTH TO THE COMMUNITY BY HOSTING EVENTS WHENEVER MONEY PERMITS. THIS INCLUDES AN ANNUAL HEART EXPO TO EDUCATE THE COMMUNITY ON HEART HEALTH. AUBURN COMMUNITY HOSPITAL ALSO PROMOTES WOMEN'S HEALTH CARE THROUGH THE WOMEN'S HEALTH INSTITUTE. PART VI, LINE 6: AUBURN COMMUNITY HOSPITAL IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. PART VI, LINE 7, REPORTS FILED WITH STATES NY X X X 0 0 0 0 0 0 0 0 0 LOREN VANRIPER MD TRUSTEE 161200 355343 0 0 0 0 0 13000 0 10494 161200 378837 0 0 SCOTT BERLUCCHI PRESIDENT & CEO 391542 0 40200 0 6000 0 13000 0 10819 0 461561 0 0 0 PATRICK FACTEAU FORMER CHIEF FINANCIAL OFFICER 144325 0 8600 0 0 0 7361 0 9155 0 169441 0 0 0 ADAM DUCKETT MD HOSPITALIST 275829 0 0 0 0 0 0 0 12904 0 288733 0 0 0 MARY BAKER HOSPITALIST 276723 0 3383 0 0 0 0 0 12521 0 292627 0 0 0 GREGORY SERFER HOSPITALIST 202123 0 0 0 0 0 0 0 15868 0 217991 0 0 0 JOSEPH APONE MD HOSPITALIST 241033 0 0 0 0 0 11879 0 15264 0 268176 0 0 0 CHRISTOPHER RYAN CHIEF INFORMATION OFFICER 153638 0 7600 0 0 0 0 0 10819 0 172057 0 0 0 A CAYUGA COUNTY DEVELOPMENT CORPORATION 522367265 149762AA4 2013-08-30 9380000 REFINANCING BONDS FOR CAPITAL IMPROVEMENT 0 0 0 A 12175000 9380000 187600 2013 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 0 0 1 0 0 0 0 1 A 0 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: CAYUGA COUNTY DEVELOPMENT CORPORATION DATE THE REBATE COMPUTATION WAS PERFORMED: 08/30/2013 RAMA GODISHALA OWNER OF RAMA GODISHALA, MD, PC 412406 PROVIDES CARDIOLOGY COVERAGE TO HOSPITAL 0 PATSY IANNOLO OWNER OF EASTERN FINGERLAKES EMERGENCY 1663655 EMERGENCY ROOM SERVICES 0 JOHN RICCIO OWNER OF AUBURN PATHOLOGY ASSOCIATES, PC 187804 PROVIDES LABORATORY SERVICES TO HOSPITAL 0 FORM 990, PART VI, SECTION B, LINE 11 990 IS REVIEWED BY THE BOARD OF TRUSTEES PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS, OFFICERS AND HIGHLY COMPENSATED EMPLOYEES ARE REQUIRED TO COMPLETE CONFLICT OF INTEREST FORMS AND SIGN THEM ANNUALLY. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD OF DIRECTORS DETERMINE THE PRESIDENT/ CEO COMPENSATION. OTHER TOP OFFICIALS' COMPENSATION IS DETERMINED BY THE BOARD OF DIRECTORS, CEO AND IS ALSO BASED OFF OF EXPERIENCE, COMPENSATION SURVEYS AND OTHER QUALIFICATIONS. FORM 990, PART VI, SECTION C, LINE 18 COPIES OF THE 990 WILL BE AVAILABLE TO THE PUBLIC UPON REQUEST FORM 990, PART VI, SECTION C, LINE 19 UPON REQUEST, COPIES OF DOCUMENTS WILL BE PROVIDED. FORM 990, PART XII, LINE 2C: THE PROCESSES RELATING TO THE COMMITTEE'S OVERSIGHT OF THE AUDIT HAS NOT CHANGED FROM PRIOR YEAR. AUBURN COMMUNITY COMPANIES INC 17 LANSING STREET AUBURN NY 13021 223271881 PROVIDES NURSING HOME ACCOMMODATIONS NY 501(C)(3) LINE 9 AUBURN COMMUNITY HOSPITAL 1 AUBURN COMMUNITY HOSPITAL FOUNDATION INC PO BOX 918 AUBURN NY 13021 161599892 PROVIDES FUNDS TO AUBURN COMMUNITY HOSPITAL, INC. AND RELATED ENTITIES NY 501(C)(3) LINE 11 AUBURN COMMUNITY HOSPITAL 1 ACH PROPERTIES INC 5-19 LANSING STREET AUBURN NY 13021 161335941 PROMOTE AND SUPPORT CHARITABLE PURPOSE OF AUBURN COMMUNITY HOSPITAL, INC. NY 501(C)(3) N/A AUBURN COMMUNITY HOSPITAL 1 AUBURN MEMORIAL MEDICAL SERVICES PC 17 LANSING STREET AUBURN NY 13021 261193842 PRACTICE OF MEDICINE NY 501(C)(3) LINE 11 AUBURN COMMUNITY HOSPITAL 1 AUBURN MEDICAL PC 17 LANSING STREET AUBURN NY 13021 205111805 ANESTHESIOLOGY SERVICES NY N/A C 1 0 0 1 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 AUBURN COMMUNITY HOSPITAL FOUNDATION INC C 139288 CASH AUBURN MEMORIAL MEDICAL SERVICES PC D 5459474 FMV AUBURN MEDICAL PC D 669187 FMV AUBURN COMMUNITY COMPANIES INC K 540521 FMV ACH PROPERTIES INC K 29435 FMV