2014-11-17T14:22:06-06:00 2013-12-31 161226221 FUST CHARLES CHAMBERS LLP 5784 WIDEWATERS PARKWAY SYRACUSE NY 13214 990 2013-01-01 150532054 AUBURN COMMUNITY HOSPITAL AUBU 3152557011 17 LANSING STREET AUBURN NY 13021 SCOTT A BERLUCCHI CHIEF EXECUTIVE OFFICER / PRESIDENT 3152557011 2014-11-14 1 JOSEPH J SCHLEGEL P00301329 3154463600 2013 2015-11-30 17:44:51Z SCOTT A BERLUCCHI 17 LANSING STREET AUBURN NY 13021 93622036 0 X WWW.AUBURNHOSPITAL.ORG X 1878 NY THE MISSION OF AUBURN MEMORIAL HOSPITAL IS TO PROVIDE COMPASSIONATE, QUALITY CARE AND IMPROVE THE HEALTH OF OUR COMMUNITY INCLUDING RESIDENTS OF AUBURN, NY AS WELL AS SURROUNDING AREAS. 13 9 1000 100 0 0 346088 359846 88347253 91004462 6909 3969 3442826 2253759 92143076 93622036 0 0 0 0 51099726 50913075 0 0 31616 37632346 41758633 88732072 92671708 3411004 950328 60976727 60938602 28998721 28988240 31978006 31950362 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 80419565 93262190 THE PURPOSE OF AUBURN MEMORIAL HOSPITAL IS TO TREAT THE ILL AND INJURED OF AUBURN, NY AND THE IMMEDIATE ENVIRONS. TO THAT END, THE HOSPITAL TREATED 4,980 INPATIENTS FOR A TOTAL OF 50,558 PATIENT DAYS AND A TOTAL OF 140,402 OUTPATIENTS IN 2013. 80419565 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 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 1 114 0 1 1000 1 0 0 0 0 0 0 0 0 0 0 X 13 9 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X MOLLY LALONDE 3152557245 17 LANSING STREET AUBURN NY 13021 ELANE M DALY TRUSTEE 1.00 X 0 0 0 PETER J EMERSON TRUSTEE 1.00 X 0 0 0 RAMA GODISHALA MD TRUSTEE 1.00 X 0 0 0 JOHN RICCIO MD TRUSTEE 1.00 X 61919 0 1393 LISA RYERSON TRUSTEE 1.00 X 0 0 0 WILLIAM SIMMONDS MDM TRUSTEE 1.00 X 0 0 0 LOREN VANRIPER MD TRUSTEE 1.00 40.00 X 214000 343262 23623 DEMETRA VOUNAS MD TRUSTEE 1.00 X 0 0 0 ERIC R ALLYN CHAIRMAN 1.00 X X 0 0 0 JOSEPH BARTOLOTTA VICE CHAIRMAN 1.00 X X 0 0 0 ANTHONY D FRANCESCHELLI 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 MICHAEL RIFANBURG TRUSTEE 1.00 X 0 0 0 WILLIAM DUGAN III TRUSTEE 1.00 X 0 0 0 PATRICK FACTEAU CHIEF FINANCIAL OFFICER 38.00 X 173744 0 19441 SCOTT BERLUCCHI PRESIDENT & CEO 38.00 X 416243 0 23181 ADAM DUCKETT MD HOSPITALIST 38.00 X 294506 0 4687 TODD LENTZ MD HOSPITALIST 38.00 X 284374 0 12750 WILLIAM CHILDRES MD HOSPITALIST 38.00 X 298126 0 21585 JOSEPH APONE MD HOSPITALIST 38.00 X 273665 0 16257 MARY BAKER HOSPITALIST 38.00 X 257319 0 4666 2273896 343262 127583 20 0 1 0 AUBURN MEDICAL PC 17 LANSING STRET AUBURN NY 13021 ANESTHESHIA COVERAGE 750000 SYRACUSE PSYCHIATRIC SERVICE LLC 109 SOUTH WARREN STREET SYRACUSE NY 13202 PHYSCIATRIC PHYSICIANS 747500 EASTERN FINGERLAKES EMERGENCY PO BOX 346 5180 WEST TAFT RD NORTH SYRACUSE NY 13212 EMERGENCY ROOM PHYSICIANS 513204 ALLIANCE HEALTHCARE SERVICES 100 BAYVIEW CIRCLE SUITE 400 NEWPORT BEACH CA 92660 MRI SERVICES 478761 SUNBELT STAFFING PO BOX 1024640 ATLANTA GA 30368 NURSING COVERAGE 442399 16 167231 127000 65615 359846 PATIENT SERVICE 623000 91004462 91004462 91004462 3969 3969 OTHER REVENUE 623000 2253759 2253759 2253759 93622036 93262190 0 0 695920 695920 37473418 33270682 4179040 23696 2156549 1881948 273261 1340 7927996 6918495 1004574 4927 2659192 2320587 336952 1653 178107 178107 196597 196597 280540 245267 35273 4139972 3619447 520525 52888 46238 6650 272007 237807 34200 675035 675035 3695182 3695182 1394753 670244 724509 SUPPLIES 13438818 11749134 1689684 PURCHASED SERVICES 8730038 7632397 1097641 OTHER FEES 4478510 3230916 1247594 BAD DEBT 4226186 4226186 92671708 80419565 12220527 31616 4725950 1271363 10270764 11104640 10970676 14125852 2425549 1941698 813241 556255 90056567 65161366 25682848 24895201 6087699 7043593 60976727 60938602 15091579 15236076 13477418 13303321 429724 448843 28998721 28988240 X 31887659 31818294 90347 132068 31978006 31950362 60976727 60938602 X 950328 -977972 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 90347 352670 310949 132068 72372 120842 102867 90347 2153040 1086795 3167463 72372 58431 2496008 401399 2153040 58431 58431 1.00000 0 0 823418 823418 34865095 21077881 13787214 1500965 1435414 65551 50100781 42648071 7452710 2766308 2766308 24895201 AGENCY RELATIONSHIPS/ INSURANCE RECEIVABLE 2242802 ESTIMATED THIRD PARTY SETTLEMENTS 3326869 PLEDGE RECEIVABLE, NET 101672 UNAMORTIZED DEBT ISSUANCE COST/ ASSETS LIMITED AS TO USE 1372250 7043593 FUNDS HELD FOR OTHERS 166935 ASSET RETIREMENT OBLIGATION 281908 448843 X PART X, LINE 2: THE HOSPITAL, EXCEPT FOR AMPC, QUALIFIES AS TAX EXEMPT ORGANIZATIONS. AS OF DECEMBER 31, 2013 AND 2012, 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 2010 THROUGH 2013. 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 258571 258571 0.00290 18751545 15823009 2928536 0.03320 19010116 15823009 3187107 0.03610 19010116 15823009 3187107 0.03610 1 4226186 258571 33962718 40038599 -6075881 X 1 1 1 1 AUBURN COMMUNITY HOSPITAL 17 LANSING STREET AUBURN NY 13021 X X X AUBURN COMMUNITY HOSPITAL 1 1 X X X X X X X X X 13 1 0 1 X WWW.AUBURNHOSPITAL.ORG X X X X X 0 0 1 1 100.000000000000 1 300.000000000000 1 X X X X 1 1 X X X X 1 0 X X X X 1 X 0 0 AUBURN COMMUNITY HOSPITAL PART V, SECTION B, LINE 3: 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 7: AUBURN COMMUNITY HOSPITAL WAS NOT ABLE TO HIRE A COMMINUTY HEALTH DIRECTOR DUE TO FINANCIAL LIMITATIONS. AUBURN COMMUNITY HOSPITAL PART V, SECTION B, LINE 20D: AUBURN COMMUNITY HOSPITAL USED THE HIGHEST VOLUME COMMERCIAL PAYOR TO DETERMINE THE MAXIMUM AMOUNTS THAT CAN BE CHARGED TO FAP ELIGIBLES 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 $ 4,401,186. PART III, LINE 4: PATIENT ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF PATIENT ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES THE PAST PAYMENT HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. FOR RECEIVABLES ASSOCIATED WITH PATIENTS WHO HAVE THIRD- PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AND ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS AND FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF THE AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE BASED ON ITS PAST EXPERIENCE WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. PART III, LINE 8: THE 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 0 343262 0 0 214000 0 0 12750 0 10873 214000 366885 0 0 PATRICK FACTEAU CHIEF FINANCIAL OFFICER 168744 0 5000 0 0 0 8619 0 10822 0 193185 0 0 0 SCOTT BERLUCCHI PRESIDENT & CEO 381343 0 34900 0 0 0 12308 0 10873 0 439424 0 0 0 ADAM DUCKETT MD HOSPITALIST 276506 0 18000 0 0 0 0 0 4687 0 299193 0 0 0 TODD LENTZ MD HOSPITALIST 256374 0 28000 0 0 0 12750 0 0 0 297124 0 0 0 WILLIAM CHILDRES MD HOSPITALIST 270126 0 28000 0 0 0 10712 0 10873 0 319711 0 0 0 JOSEPH APONE MD HOSPITALIST 255665 0 18000 0 0 0 11858 0 4399 0 289922 0 0 0 MARY BAKER HOSPITALIST 229319 0 28000 0 0 0 0 0 4666 0 261985 0 0 0 RAMA GODISHALA OWNER OF RAMA GODISHALA, MD, PC 182534 PROVIDES CARDIOLOGY COVERAGE TO HOSPITAL 0 ERIC ALLYN OWNER OF WELCH ALLEN 109086 HOSPITAL EQUIPMENT 0 JOHN RICCIO OWNER OF AUBURN PATHOLOGY ASSOCIATES, PC 155773 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 XI, LINE 9: LOSS ON EXTINGUISHMENT OF DEBT -977,972. 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 0 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 0 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 0 AUBURN MEMORIAL MEDICAL SERVICES PC 17 LANSING STREET AUBURN NY 13021 261193842 PRACTICE OF MEDICINE NY 501(C)(3) LINE 11 AUBURN COMMUNITY HOSPITAL 0 AUBURN MEDICAL PC 17 LANSING STREET AUBURN NY 13021 205111805 ANESTHESIOLOGY SERVICES NY N/A C 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0