2014-11-07T15:35:48-06:00 2013-12-31 454051133 FREED MAXICK CPAS PC 424 MAIN STREET SUITE 800 BUFFALO NY 142023508 990 2013-01-01 150532245 ST ELIZABETH MEDICAL CENTER STEL 3157988151 2209 GENESEE STREET UTICA NY 135015999 LOUIS AIELLO CFO 3157988151 2014-11-03 1 MARY MADONIA P00405803 7168472651 2013 2016-03-07 17:11:31Z RICHARD KETCHAM 2209 GENESEE STREET UTICA NY 135015999 197289538 0 X WWW.STEMC.ORG X 1861 NY ST. ELIZABETH MEDICAL CENTER COMMUNITY, INSPIRED BY ST. FRANCIS OF ASSISI AND FAITHFUL TO THE TEACHINGS OF THE ROMAN CATHOLIC CHURCH, IS COMMITTED TO EXCELLENCE IN HEALTHCARE AND EDUCATION. 12 10 2172 174 323090 -70241 8059917 1391042 189765421 190380839 155586 687863 6423776 4727821 204404700 197187565 0 0 0 0 121029866 122443106 0 0 0 79970651 79645326 201000517 202088432 3404183 -4900867 142139366 131947713 141635641 99487681 503725 32460032 X ST. ELIZABETH MEDICAL CENTER COMMUNITY, INSPIRED BY ST. FRANCIS OF ASSISI AND FAITHFUL TO THE TEACHINGS OF THE ROMAN CATHOLIC CHURCH, IS COMMITTED TO EXCELLENCE IN HEALTHCARE AND EDUCATION. 0 0 100428821 107573337 INPATIENT SERVICES- ST ELIZABETH MEDICAL CENTER IS A FULL SERVICE GENERAL HOSPITAL WITH 201 LICENSED BEDS. THE HOSPITAL PROVIDES A FULL RANGE OF ROUTINE AND ANCILLARY SERVICES, INCLUDING CARDIAC SURGERY AND ANGIOPLASTY. DISBURSEMENTS MADE BY THE HOSPITAL ARE EXCLUSIVELY FOR SERVICES AND MATERIALS USED IN PERFORMING THE HOSPITAL'S EXEMPT FUNCTIONS. ST. ELIZABETH MEDICAL CENTER PROVIDES CARE TO EVERYONE REGARDLESS OF RACE, RELIGION OR ABILITY TO PAY. 24903112 29462207 AMBULATORY SURGERY- ST. ELIZABETH MEDICAL CENTER HAS A FULL RANGE OF AMBULATORY SURGERY SERVICES ON ITS CAMPUS FOR PATIENTS THAT DO NOT REQUIRE OVERNIGHT OR LONG INPATIENT STAYS. ST. ELIZABETH MEDICAL CENTER PROVIDES SERVICES TO EVERYONE REGARDLESS OF RACE, RELIGION, OR ABILITY TO PAY. 14953764 14573710 COMMUNITY MEDICINE- THE HOSPITAL IN ADDITION TO HAVING OUTPATIENT VISITS ON SITE HAS THIRTEEN OFF-SITE CLINICS TO PROVIDE PATIENTS WITH CONVENIENT MEDICAL CARE AT A LOWER COST THAN IN THE HOSPITAL SETTING. THE OFF-SITE CLINICS HAD A TOTAL OF 80,765 VISITS IN 2013 COMPARED TO 69,682 FOR 2012, AN INCREASE OF 15.9%. THE OFF-SITE CLINICS INCLUDE CLINICS, FAMILY PRACTICE AND COMMUNITY MEDICINE.65 39929809 42570254 OTHER PROGRAM SERVICES INCLUDE EMERGENCY ROOM, REFERRED AMBULATORY, CLINICS, FAMILY PRACTICE, SPORTS MEDICINE CENTER, COLLEGE OF NURSING, INTERNS AND RESIDENTS, AND HOME HEALTH AGENCY. 39929809 42570254 180215506 1 1 0 1 0 0 1 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 0 0 1 0 0 0 0 0 1 1 1 0 0 1 167 0 2172 1 1 1 0 0 0 0 0 0 0 0 0 X 12 10 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 0 NY X X ST ELIZABETH MEDICAL CENTER 3157988151 2209 GENESEE STREET UTICA NY 13501 X SR DONNA MCGARTLAND TRUSTEE 1.00 X 0 0 0 CATHERINE COMINSKY SECRETARY 1.00 X X 0 0 0 GREGORY P EVANS VICE CHAIR 2.00 X X 0 0 0 SYMEON TSOUPELIS TRUSTEE 1.00 X 0 0 0 RAYMOND MEIER ESQ TRUSTEE 1.00 X 0 0 0 HON NORMAN I SIEGEL CHAIR 2.00 X X 0 0 0 RICHARD F ZWEIFEL TREASURER 1.00 X X 0 0 0 ANDREW S KOWALCZYK III TRUSTEE 1.00 X 0 0 0 MARK WARFEL MD TRUSTEE 1.00 X 342793 0 26422 BARBARA BRODOCK TRUSTEE 1.00 1.00 X 0 0 0 WILLIAM BORRILL ESQ TRUSTEE 1.00 1.00 X 0 0 0 ERIC YOSS MD TRUSTEE 1.00 X 20505 0 0 ROBERT SCHOLEFIELD COO 40.00 X 222247 0 24033 RICHARD KETCHAM CEO 40.00 1.00 X 403875 0 21042 LOU AIELLO CFO 40.00 X 272670 0 23647 ALBERT D'ACCURZIO MD MEDICAL DIRECTOR 40.00 X 290410 0 26142 VARINYA SHEPPARD CHIEF NURSING OFFICER 40.00 X 176366 0 14280 ERIC FREIBERGER MD PHYSICIAN 40.00 X 349595 0 22191 ASHRAF ALY MD PHYSICIAN 40.00 X 309367 0 23554 CLIFFORD SOULTS MD PHYSICIAN 40.00 X 706164 0 24762 VIGNESWAREN KANDIAH MD PHYSICIAN 40.00 X 332914 0 22344 FRANCIS CONSTANTINE PHYSICIAN 40.00 X 309290 0 24624 3736196 0 253041 89 0 1 0 MCKESSON PO BOX 98347 CHICAGO IL 60693 COMPUTER SERVICES 2734007 UPTOWN ANESTHESIA ASSOCIATES 2405 GENESEE STREET UTICA NY 13501 ANESTHESIA SERVICES 1153508 SODEXO OPERATIONS LLC PO BOX 81049 WOBURN MA 018131049 CAFETERIA AND FOOD 895533 MAYO COLLABORATIVE SERVICES PO BOX 9146 MINNEAPOLIS MN 55480 LABORATORY TESTING 887004 CLARUS LINEN SYSTEMS 414 WEST TAYLOR STREET SYRACUSE NY 13202 LAUNDERING SERVICES 868188 44 490352 817956 82734 1391042 MEDICARE/MEDICAID PATIENT REVENUE 900099 106184930 106184930 PATIENT SERVICE REVENUE 900099 83922074 83922074 NURSING HOME LAB TESTING 621500 186404 186404 CYTOLOGY LAB TESTING 621500 87431 87431 190380839 514479 514479 655317 0 655317 655317 49255 606062 275357 50061 51912 225296 -51912 173384 173384 OTHER INCOME 900099 4072504 4072504 4072504 197187565 194179508 323090 1293925 1728866 1538691 190175 2092327 1869431 222896 92702672 82655298 10047374 4034601 3598461 436140 14948567 13332627 1615940 6936073 6186284 749789 36710 32742 3968 118001 104429 13572 32236 28751 3485 14834580 13230962 1603618 363533 324235 39298 41473916 36990535 4483381 655878 584978 70900 101070 90144 10926 182080 162397 19683 1543364 1376526 166838 9991798 8911615 1080183 1787867 1594599 193268 EQUIPMENT RENTAL AND MA 5593765 4989079 604686 UTILITIES 1825162 1627862 197300 DEBT ASSESSMENT 577557 515123 62434 TELEPHONE 362842 323619 39223 164967 147118 17849 202088432 180215506 21872926 0 3893710 4317991 25900114 27379539 4826746 4878801 610984 538577 189244506 113970042 77012079 75274464 9666042 8835398 20229691 10722943 142139366 131947713 25051849 27050143 33352676 28121684 5407734 2386593 1568712 1437987 76254670 40491274 141635641 99487681 X -7755197 30882215 7345598 712920 913324 864897 503725 32460032 142139366 131947713 X -4900867 85732 36771442 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 32236 32236 0 PART II-B, LINE 1: ACTIVITIES INCLUDE THE PORTION OF DUES PAID TO THE HEALTH CARE ASSOCIATION OF NEW YORK STATE. X 1 20.00 0 0 0 1 0 0.00 0 1 8258921 414801 13894 23550 7569278 1094788 1107810 6950372 11275 16270 -205734 8258921 910691 1288400 16768 16380 1091669 1107810 1264143 2090040 16876 32345 2428023 910691 1650930 976103 17145 18750 1361285 1264143 0.34880 0.65120 0 1 1 6631751 6631751 75904335 44147288 31757047 106708420 69822754 36885666 75274464 GRANT AND TUITION RECEIVABLES 1726654 ASSETS WHOSE USE IS LIMITED- BOND FUNDS 2839763 INTEREST IN NET ASSETS OF SEMC FOUNDATION 4109012 INVESTMENTS RESTRICTED BY DONORS 944813 BONDS ISSUANCE COSTS 842465 457 DEFERRED COMPENSATION PLAN 260236 10722943 ACCRUED PENSION LIABILITY 32590753 LIABILITY TO THIRD PARTY PAYORS 5890285 PROFESSIONAL LIABILITY DEDUCTIBLE 510236 LINE OF CREDIT 1500000 40491274 X PART II, LINE 9: AMOUNT OF CONSERVATION EASEMENT IS IMMATERIAL TO FINANCIAL STATEMENTS AND THEREFORE, IS NOT RECORDED AS PART OF TOTAL ASSETS. PART V, LINE 4: ENDOWMENT FUNDS - PART V THE INTENDED PURPOSE OF THE MEDICAL CENTER'S ENDOWMENT FUNDS ARE TO PROVIDE FUTURE SCHOLARSHIP AWARDS FOR STUDENTS IN THE COLLEGE OF NURSING PROGRAMS. PART X, LINE 2: THE MEDICAL CENTER IS A NOT-FOR-PROFIT ORGANIZATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS GENERALLY EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE MEDICAL CENTER FILES ITS RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX IN THE U.S. FEDERAL JURISDICTION. THE TAX YEARS 2010-2012 GENERALLY REMAIN OPEN TO EXAMINATION IN TAXING JURISDICTIONS IN WHICH THE MEDICAL CENTER IS SUBJECT TO THE FILING REQUIREMENTS OF THOSE JURISDICTIONS. 1 1 1 X 1 X 1 1 1 0 1 1 856747 46889 809858 0.00400 31070478 28233904 2836574 0.01400 4908595 2977832 1930763 0.00960 36835820 31258625 5577195 0.02760 677786 279588 398198 0.00200 7101586 4804600 2296986 0.01140 17847847 17086450 761397 0.00380 147842 109186 38656 0.00020 25775061 22279824 3495237 0.01740 62610881 53538449 9072432 0.04500 1 3666541 863000 56824935 62115077 -5290142 X 1 1 1 MVHI CARDIAC SERVICES 0.70000 0.00000 0.00000 2 MVEC GASTROENTEROLOGY SRVCS 0.20000 0.00000 0.00000 3 ST ELIZABETH HEALTH SUPPORT DURABLE MEDICAL EQUIPMENT 0.40000 0.00000 0.00000 1 1 ST ELIZABETH MEDICAL CENTER 2209 GENESEE STREET UTICA NY 13501 X X X ST ELIZABETH MEDICAL CENTER 1 1 X X X X X X X X 13 1 1 1 X WWW.STEMC.ORG X X X X X X X X 1 0 1 1 200.000000000000 1 300.000000000000 1 X 1 1 X X X X X X 1 0 X X X X 1 X 0 1 ST ELIZABETH MEDICAL CENTER PART V, SECTION B, LINE 3: A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA), HELD ON MAY 20, 2013, MARKED THE FORMAL LAUNCH OF THE CHA PROCESS. THE PARTICIPANTS WORKED IN SMALL GROUPS TO IDENTIFY AND PRIORITIZE KEY HEALTH SYSTEM AND HEALTH STATUS ISSUES. THE TOP TWO HEALTH SYSTEM ISSUES IDENTIFIED WERE PROVIDER SHORTAGES-MENTAL HEALTH AND PROVIDER SHORTAGES-COST OF CARE. THE TOP TWO HEALTH STATUS ISSUES IDENTIFIED WERE LIFESTYLES-CHRONIC DISEASE AND ORAL HEALTH-BEHAVORIAL HEALTH. PARTICIPANTS WERE ALSO ASKED TO DESCRIBE THE ATTRIBUTES OF A HEALTHY COMMUNITY AND DRAW A PICTURE OF A HEALTHY ONEIDA COUNTY (THESE DRAWINGS ARE INCORPORATED IN APPENDIX 1 OF THE CHNA REPORT.) THE RESULTS OF THE FORUM HELPED TO FRAME THE KEY ISSUES TO EXAMINE DURING THE COURSE OF THE PROCESS. THIS COLLABORATIVE PROCESS ENSURED BROAD PARTICIPATION IN THE ANALYSIS OF DATA AND SELECTION OF PRIORITY AREAS. ST ELIZABETH MEDICAL CENTER PART V, SECTION B, LINE 4: THE HOSPITAL FACILITY'S CHNA WAS CONDUCTED WITH FAXTON ST. LUKE'S HEALTHCARE AND ROME MEMORIAL HOSPITAL FACILITIES. ST ELIZABETH MEDICAL CENTER PART V, SECTION B, LINE 20D: DURING THE YEAR OUR FACILITY DETERMINED THE MAXIMUM AMOUNTS THAT CAN BE CHARGED TO FAP ELIGIBLE INDIVIDUALS FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE BY ANNUALLY COMPARING THE TOP 10 PAYER RATES AND TAKING OUT THE HIGHEST AND LOWEST, THEN AVERAGING THE REST. ST ELIZABETH MEDICAL CENTER PART V, SECTION B, LINE 22: INITIALLY, ALL PATIENTS WITHOUT INSURANCE RECEIVE A SUBSTANTIAL DISCOUNT OFF OF THE GROSS CHARGES. OUR FACILITY HAS CHARGED SOME OF ITS FAP ELIGIBLE PATIENTS AN AMOUNT EQUAL TO THE GROSS CHARGES FOR SERVICES PROVIDED, IF A PATIENT CHOSE NOT TO PAY THE DISCOUNTED RATES THE DISCOUNTED CHARGES ARE GROSSED UP AND ACCOUNT IS THEN SENT INTO A COLLECTION AGENCY AT THE GROSS AMOUNT. 17 SEMC AT FAMILY PRACTICE CENTER 120 HOBART STREET UTICA NY 13501 OUTPATIENT PHYSICIAN CLINIC WOMEN & CHILDREN'S FAMILY HEALTH CENTER 2212 GENESEE STREET UTICA NY 13502 OUTPATIENT PHYSICIAN CLINIC MARIAN MEDICAL IMAGING 2211 GENESEE STREET UTICA NY 13501 OUTPATIENT LAB/ XRAY CLINIC LITTLE FALLS FAMILY PRACTICE 500 MAIN STREET LITTLE FALLS NY 13365 OUTPATIENT PHYSICIAN CLINIC COMMUNITY MEDICINE-EAST UTICA 1256 CULVER AVE UTICA NY 13501 OUTPATIENT PHYSICIAN CLINIC WOUND CARE SERVICES 4401 MIDDLE SETTLEMENT ROAD NEW HARTFORD NY 13413 OUTPATIENT PHYSICIAN CLINIC FAMILY PRACTICE NEW HARTFORD 4401 MIDDLE SETTLEMENT ROAD NEW HARTFORD NY 13413 OUTPATIENT PHYSICIAN CLINIC NORTH UTICA COMMUNITY HEALTH CENTER 417 TRENTON ROAD UTICA NY 13502 OUTPATIENT PHYSICIAN CLINIC SAUQUOIT COMMUNITY MEDICINE 2888 ONEIDA STREET SAUQUOIT NY 13456 OUTPATIENT PHYSICIAN CLINIC CLINTON FAMILY HEALTH CENTER 101 COLLEGE STREET CLINTON NY 13323 OUTPATIENT PHYSICIAN CLINIC WATERVILLE FAMILY HEALTH CENTER 117 WEST MAIN STREET WATERVILLE NY 13480 OUTPATIENT PHYSICIAN CLINIC COMMUNITY MEDICAL SERVICES-MOHAWK 5 ANN STREET MOHAWK NY 13407 OUTPATIENT PHYSICIAN CLINIC COMMUNITY MEDICAL SERVICES- S UTICA 6 HAMPDEN PLACE UTICA NY 13501 OUTPATIENT PHYSICIAN CLINIC ADIRONDACK SPORTS MEDICINE 4401 MIDDLE SETTLEMENT ROAD NEW HARTFORD NY 13413 OUTPATIENT REHAB SERVICES KERNAN ELEMENTARY SCHOOL 926 YORK STREET UTICA NY 13502 SCHOOL BASED HEALTH CENTER MEDICAL ARTS 4401 MIDDLE SETTLEMENT ROAD NEW HARTFORD NY 13413 OUTPATIENT LAB/ XRAY CLINIC TOWN OF WEBB HEALTH CENTER 114 SOUTH SHORE ROAD OLD FORGE NY 13413 OUTPATIENT PHYSICIAN CLINIC PART I, LINE 7: COSTING METHODOLOGY-CHARITY CARETHE COST TO CHARGE RATIO THAT WAS USED TO COMPLETE THE CHART FOR LINE 7 WAS DERIVED FROM THE WORKSKEET 2 CALCULATION. PART III, LINE 4: THE MEDICAL CENTER PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. THE CENTER'S POLICY IS NOT TO PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE: THEREFORE, THESE AMOUNTS ARE NOT REPORTED IN NET OPERATING REVENUES OR IN PROVISIONS FOR DOUBTFUL ACCOUNTS. THE ESTIMATED COST OF PROVIDING UNCOMPENSATED CARE TO PATIENTS WAS APPROXIMATELY $1,999,000 OF CHARGES AND $863,000 OF COST FOR THE YEAR ENDED DECEMBER 31, 2013.THE MEDICAL CENTER GRANTS CREDIT WITHOUT COLLATERAL TO PATIENTS, MOST OF WHOM ARE LOCAL RESIDENTS AND ARE INSURED UNDER THIRD-PARTY AGREEMENTS. ADDITIONS TO THE ALLOWANCE FOR DOUBTFUL ACCOUNTS ARE MADE BY MEANS OF THE PROVISION FOR DOUBTFUL ACCOUNTS. ACCOUNTS WRITTEN OFF AS UNCOLLECTIBLE ARE DEDUCTED FROM THE ALLOWANCE AND SUBSEQUENT RECOVERIES ARE ADDED. THE AMOUNT OF THE PROVISION FOR DOUBTFUL ACCOUNTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL EXPECTED NET COLLECTIONS, BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN FEDERAL AND STATE GOVERNMENT HEALTH CARE COVERAGE AND OTHER COLLECTION INDICATORS. SERVICES RENDERED TO INDIVIDUALS WHEN PAYMENT IS EXPECTED AND ULTIMATELY NOT RECEIVED ARE WRITTEN OFF TO THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. PART III, LINE 8: THE COSTING METHODOLOGY USED TO DETERMINE THE AMOUNT REPORTED ON LINE 6 IS COST TO CHARGE RATIO. THE SHORTFALL REPORTED IS COMMUNITY BENEFIT EXPENSE BECAUSE THIS AMOUNT REPRESENTS THE UNREIMBURSED COSTS TO THE MEDICAL CENTER FOR PROVIDING CARE FOR THE COMMUNITY'S ELDERLY AND DISABLED. PART III, LINE 9B: COLLECTION POLICY PROVISIONSPATIENTS THAT QUALIFY FOR THE MEDICAL CENTER'S CHARITY CARE PROGRAM HAVE THE CHARGES ON THEIR ACCOUNTS FORGIVEN AS THEY ARE PLACED IN CHARITY CARE AND THE BALANCES ARE WRITTEN OFF. THE MEDICAL CENTER'S CHARITY CARE PROGRAM USED THE FEDERAL POVERTY GUIDELINES (FPG) AS A GUIDE WITH HIGH-END LIMITS AT 300% OF THE FPG. IN THOSE SITUATIONS WHERE THE PATIENT'S INCOME IS BETWEEN 200% - 300% OF THE FPG, A SMALL COST SHARE WOULD BE THE ONLY AMOUNT NOT INCLUDED IN CHARITY CARE. ADDITIONALLY THIS SMALL COST SHARE WOULD BE THE ONLY AMOUNT TURNED OVER TO COLLECTION WITH THE OPPORTUNITY OF EVENTUALLY BEING WRITTEN OF TO BAD DEBT IF NOT PAID. PART VI, LINE 2: NEEDS ASSESSMENTTHE MEDICAL CENTER ASSESSES HEALTHCARE NEEDS OF THE COMMUNITIES IT SERVES BY COLLABORATING WITH ONEIDA AND HERKIMER COUNTIES' DEPARTMENTS OF HEALTH ON COMMUNITY HEALTH ASSESSMENTS. DATA WAS COLLECTED IN 2013 THROUGH A MAPP PROCESS, AROUND THE NYS PREVENTION AGENDA ISSUES. FIVE RESULTING PRIORITY WORK GROUPS THAT CONTAIN MEDICAL CENTER EMPLOYEES CONTINUE TO ASSESS CHANGES AND ADDRESS PRIORITY AREAS. THESE WORK GROUPS ALSO REPORT TO THE SEMC COMMUNITY DESIGN TEAM, WHICH REGULARLY HEARS ABOUT HEALTHCARE NEEDS THROUGH THOSE IN AREA COMMUNITIES. PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCETHIS IS COMMUNICATED THROUGH SEMC'S FACILITATED ENROLLMENT PROGRAM AND THE MOTHER BERNARDINA CHARITY CARE PROGRAM. INFORMATION IS INCLUDED IN THE PATIENT INFORMATION GUIDES PRESENTED TO INPATIENTS AND OUTPATIENTS, AND IS AVAILABLE ON THE HOSPITAL'S WEBSITE. ST. ELIZABETH MEDICAL CENTER RECOGNIZES THAT PROVIDING EXCEPTIONAL HEALTHCARE SERVICE TO THE COMMUNITY IS A VITAL COMMUNITY RESOURCE. OUR ACHIEVEMENTS ARE NOT OURS ALONE, BUT ARE OBTAINED BY COLLABORATIVE EFFORTS WITH OUR COMMUNITY AND GOVERNMENT LEADERS WORKING TOGETHER TO IMPROVE THE "HEALTH" OF THE COMMUNITY. SEMC'S FACILITATED ENROLLMENT PROGRAMIN 2000, ST. ELIZABETH MEDICAL CENTER DEVELOPED AND IMPLEMENTED THE FACILITATED ENROLLMENT PROGRAM AS A RESULT OF THE UNIQUE COLLABORATION THAT WAS FORGED BETWEEN ST. ELIZABETH MEDICAL CENTER AND ONEIDA COUNTY SOCIAL SERVICE DEPARTMENT. THIS PROGRAM ALLOWS SEMC STAFF, PATIENT ACCOUNT REPRESENTATIVES, TO ACT AS AN AUTHORIZED REPRESENTATIVE OF THE PATIENT AT THE ONEIDA COUNTY DEPARTMENT OF SOCIAL SERVICES AND SUBMIT THE APPLICATION FOR BENEFITS. THIS SUCCESSFUL PROGRAM HAS EXPANDED THROUGHOUT THE PAST SEVERAL YEARS TO INCLUDE OUTPATIENTS AND EMERGENCY DEPARTMENT PATIENTS.SEMC'S MOTHER BERNARDINA CHARITY CARE PROGRAMTO SUPPORT OUR MISSION, THE ST. ELIZABETH MEDICAL CENTER HAS DEVELOPED THE MOTHER BERNARDINA CHARITY CARE PROGRAM. THE MEDICAL CENTER WILL MAKE AVAILABLE A REASONABLE AMOUNT OF UNCOMPENSATED SERVICES TO ELIGIBLE PERSONS. PART VI, LINE 4: COMMUNITY INFORMATIONST. ELIZABETH MEDICAL CENTER'S PRIMARY SERVICE AREA (PSA) CONSISTS OF THE ZIP CODES IN WHICH 80% OF ITS PATIENTS LIVE (MOSTLY ONEIDA COUNTY AND SOME WITHIN HERKIMER COUNTY). ITS SECONDARY SERVICE AREA (SSA) CONSISTS OF ZIP CODES IN WHICH THE REMAINING 10+% OF ITS PATIENTS LIVE (MOSTLY OUTLYING REGIONS OF ONEIDA AND HERKIMER COUNTIES, PLUS SOME ZIP CODES IN MADISON AND LEWIS COUNTIES). METHODS USED TO DETERMINE THE SERVICE AREA ARE ANALYSIS OF PATIENT ORIGIN, BASED ON HOME ZIP CODE. IT IS AN ETHNICALLY AND ECONOMICALLY DIVERSE REGION, WITH MANY IMMIGRANTS AND AN OLDER POPULATION THAN THE NATIONAL AVERAGE. PART VI, LINE 5: PROMOTION OF COMMUNITY HEALTHTHESE ACTIONS REPRESENT THE MEDICAL CENTER'S EMPLOYEE OUTREACH BEYOND THE HOSPITAL AND MEDICAL GROUP OFFICES INTO AREA COMMUNITIES, AND THEY SPAN A WIDE REACH OF EVENTS AND SITES. ALONG WITH HOSPITALS ACROSS THE STATE AND NATION, ST. ELIZABETH NOW MONITORS HOW OUR FAITHFULNESS TO THE REGIONAL POPULATION MEETS OUR LOCAL COMMUNITIES' UNIQUE HEALTH NEEDS. THEREFORE, COMMUNITY BENEFITS ARE PROGRAMS OR ACTIVITIES THAT PROVIDE TREATMENT AND/OR PROMOTE HEALTH AND HEALING AS A RESPONSE TO IDENTIFIED COMMUNITY NEEDS. OUR CATHOLIC TRADITION AND MEDICAL CENTER MISSION TEACH US TO PUT THE NEEDS OF THE POOR AND VULNERABLE FIRST.AMONG OUR COMMUNITY BENEFIT ACTIVITIES ARE:-CHARITY CARE FOR PEOPLE UNABLE TO AFFORD SERVICE-HEALTH EDUCATION AND ILLNESS PREVENTION-HEALTHCARE INITIATIVES FOR AT-RISK YOUTHS-FREE OR LOW-COST CLINICS AND-INITIATIVES TO RAISE AWARENESS AND RECEIVE PUBLIC INPUTMANY OF THESE ACTIVITIES ARE ADVANCED IN COLLABORATION WITH COMMUNITY MEMBERS AND OTHER ORGANIZATIONS TO IMPROVE HEALTH AND QUALITY OF LIFE. THE MEDICAL CENTER FURTHERS ITS EXEMPT PURPOSE BY PROMOTING THE HEALTH OF THE COMMUNITY THROUGH AN OPEN MEDICAL STAFF AND A COMMUNITY BOARD. SEMC FURTHER PROMOTES THE HEALTH OF THE COMMUNITY BY USING ITS SURPLUS FOR TRAINING AND EDUCATION OF ITS EMPLOYEES AND BY INVESTING IN HEALTHCARE TECHNOLOGY.PART VII, LINE 7: STATE FILING OF COMMUNITY BENEFIT REPORT NEW YORK STATE. X X X X X X 0 0 0 0 0 0 0 0 0 MARK WARFEL MD TRUSTEE 308598 0 34195 0 0 0 14130 0 12292 0 369215 0 0 0 ROBERT SCHOLEFIELD COO 222247 0 0 0 0 0 15837 0 8196 0 246280 0 0 0 RICHARD KETCHAM CEO 403875 0 0 0 0 0 12750 0 8292 0 424917 0 0 0 LOU AIELLO CFO 272670 0 0 0 0 0 15355 0 8292 0 296317 0 0 0 ALBERT D'ACCURZIO MD MEDICAL DIRECTOR 290410 0 0 0 0 0 17850 0 8292 0 316552 0 0 0 VARINYA SHEPPARD CHIEF NURSING OFFICER 176366 0 0 0 0 0 12204 0 2076 0 190646 0 0 0 ERIC FREIBERGER MD PHYSICIAN 291054 0 58541 0 0 0 12334 0 9857 0 371786 0 0 0 ASHRAF ALY MD PHYSICIAN 283181 0 26186 0 0 0 12697 0 10857 0 332921 0 0 0 CLIFFORD SOULTS MD PHYSICIAN 655742 0 50422 0 0 0 11905 0 12857 0 730926 0 0 0 VIGNESWAREN KANDIAH MD PHYSICIAN 322739 0 10175 0 0 0 12487 0 9857 0 355258 0 0 0 FRANCIS CONSTANTINE PHYSICIAN 263701 0 45589 0 0 0 14767 0 9857 0 333914 0 0 0 A ONEIDA COUNTY IDA 166158201 682465AA7 2006-06-22 14000000 EMERGENCY ROOM & CAFETERIA PROJECT 0 0 0 A 14000000 280000 70817 13649183 2007 0 0 1 1 A 0 0 0 1 1 0.00000 0.00000 0.00000 1 0 0 A 0 0 0 0 1 0 0 0 0 A 0 PULMONARY CRITICAL CARE ASSOCIATES ERIC YOSS MD- TRUSTEE 276005 PULMONARY CARE- MEDICAL SERVICES 0 FORM 990, PART VI, SECTION A, LINE 2 THE MEDICAL CENTER FOUNDATION BOARD MEMBER MARLENE ANDERSON IS THE SISTER OF THE MEDICAL CENTER KEY EMPLOYEE DR. D'ACCURZIO. BARBARA BRODOCK, RICHARD KETCHAM AND WILLIAM BORRILL ARE VOTING MEMBERS OF ST. ELIZABETH MEDICAL CENTER FOUNDATION, A RELATED PARTY. FORM 990, PART VI, SECTION A, LINE 6 PARTNERS IN FRANCISCAN MINISTRIES, INC. FORM 990, PART VI, SECTION A, LINE 7A RESERVED POWERS TO PARTNERS IN FRANCISCAN MINISTRIES, INC. THE FOLLOWING POWERS SHALL BE RESERVED TO THE CORPORATE MEMBER TO EXERCISE AND SHALL BE REFERRED TO AS RESERVED POWERS: A. TO CHANGE THE PHILOSOPHY, MISSION, AND PURPOSE OF THE CORPORATION. B. TO APPOINT AND REMOVE THE PRESIDENT/CEO OF THE CORPORATION. C. TO APPOINT AND REMOVE THE BOARD OF DIRECTORS OF THE CORPORATION. D. TO APPROVE THE ARTICLES OF INCORPORATION AND BYLAWS OF THE CORPORATION. E. TO RECEIVE THE ANNUAL REPORT OF THE CORPORATION. F. TO TO APPROVE THE FORMATION OF SUBSIDIARIES, AFFILIATES, OR DIVISIONS OF THE CORPORATION. G. TO APPROVE A CHANGE IN THE NAME OF THE CORPORATION. H. TO RECEIVE, REVIEW AND MONITOR THE BUDGET OF THE CORPORATION AS DEEMED NECESSARY BY PARTNERS IN FRANCISCAN MINISTRIES, INC. I. TO RECEIVE THE ANNUAL AUDIT OF THE CORPORATION. J. TO RECEIVE, REVIEW AND MONITOR STRATEGIC, LONG RANGE PLANS OF THE CORPORATION AS DEEMED NECESSARY BY PARTNERS IN FRANCISCAN MINISTRIES, INC. K. TO APPROVE THE FINANCIAL TRANSACTIONS OF THE CORPORATION ACCORDING TO THE ANNUAL USCCB ALIENATION GUIDELINES. FORM 990, PART VI, SECTION A, LINE 7B RESERVED POWERS TO PARTNERS IN FRANCISCAN MINISTRIES, INC. THE FOLLOWING POWERS SHALL BE RESERVED TO THE CORPORATE MEMBER TO EXERCISE AND SHALL BE REFERRED TO AS RESERVED POWERS: A. TO CHANGE THE PHILOSOPHY, MISSION, AND PURPOSE OF THE CORPORATION. B. TO APPOINT AND REMOVE THE PRESIDENT/CEO OF THE CORPORATION. C. TO APPOINT AND REMOVE THE BOARD OF DIRECTORS OF THE CORPORATION. D. TO APPROVE THE ARTICLES OF INCORPORATION AND BYLAWS OF THE CORPORATION. E. TO RECEIVE THE ANNUAL REPORT OF THE CORPORATION. F. TO TO APPROVE THE FORMATION OF SUBSIDIARIES, AFFILIATES, OR DIVISIONS OF THE CORPORATION. G. TO APPROVE A CHANGE IN THE NAME OF THE CORPORATION. H. TO RECEIVE, REVIEW AND MONITOR THE BUDGET OF THE CORPORATION AS DEEMED NECESSARY BY PARTNERS IN FRANCISCAN MINISTRIES, INC. I. TO RECEIVE THE ANNUAL AUDIT OF THE CORPORATION. J. TO RECEIVE, REVIEW AND MONITOR STRATEGIC, LONG RANGE PLANS OF THE CORPORATION AS DEEMED NECESSARY BY PARTNERS IN FRANCISCAN MINISTRIES, INC. K. TO APPROVE THE FINANCIAL TRANSACTIONS OF THE CORPORATION ACCORDING TO THE ANNUAL USCCB ALIENATION GUIDELINES. FORM 990, PART VI, SECTION B, LINE 11 INFORMATION IS GATHERED FROM THE ACCOUNTING AND PAYROLL DEPARTMENTS, WHICH IS USED BY THE STAFF ACCOUNTANT TO PREPARE WORKSHEETS USED TO POPULATE THE FORM 990. MEMBERS OF AN EXTERNAL AUDIT AND TAX FIRM (CURRENTLY FREED MAXICK, CPAS, PC) INITIALLY DISCUSS, PREPARE AND REVIEW THE RETURN WITH THE STAFF ACCOUNTANT. THE SEMC MANAGEMENT TEAM REVIEWS THE DRAFT AND HAS THE OPPORTUNITY TO ASK QUESTIONS AND DISCUSS THE RETURN WITH FREED MAXICK CPAS, PC TAX STAFF. AFTER THE MANAGEMENT TEAM'S APPROVAL, THE FORM IS DISTRIBUTED TO THE GOVERNING BODY FOR THEIR REVIEW AND COMMENT PRIOR TO THE FILING OF THE FORM. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST POLICY PART VI, SECTION B, LINE 12C FIRST, EACH BOARD OF TRUSTEE MEMBER, THE PRESIDENT/CEO, CHIEF OPERATING OFFICER, AND EACH VICE PRESIDENT COMPLETE AN ANNUAL CONFLICT OF INTEREST QUESTIONNAIRE. THE RESULTS OF THE QUESTIONNAIRE ARE REVIEWED BY THE AUDIT COMMITTEE OF THE BOARD OF TRUSTEES WHICH IDENTITFIES ANY POTENTIAL CONFLICTS. AS PART OF THE POLICY, BOARD MEMBERS THAT HAVE A CONFLICT ARE UNABLE TO VOTE WHEN A SUBJECT THAT THEY HAVE A CONFLICT OF INTEREST IN COMES UP FOR A VOTE AT A BOARD MEETING. BOARD MEMBERS ARE NOT ALLOWED TO BE INVOLVED IN THE DISCUSSIONS RELATED TO THE ISSUE OTHER THAN TO MAKE A BRIEF COMMENT. STARTING IN SEPTEMBER OF 2010, THE MEDICAL CENTER BEGAN TO REQUIRE ALL DEPARTMENT MANAGERS TO COMPLETE A CONFLICT OF INTEREST QUESTIONNAIRE ON AN ANNUAL BASIS. STARTING IN SEPTEMBER OF 2010, ALL MEMBERS OF THE MEDICAL STAFF ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST QUESTIONNAIRE ONCE EVERY TWO YEARS, AS PART OF THE CREDENTIALING PROCESS. FOR ALL OTHER EMPLOYEES, A POLICY IS IN PLACE AS PART OF THE COMPLIANCE PLAN THAT REQUIRES EMPLOYEES TO DISCLOSE ANY CONFLICT OF INTEREST TO THEIR SUPERVISOR. THE SUPERVISOR IS THEN REQUIRED TO DISCLOSE THE INFORMATION TO THE COMPLIANCE OFFICER. BOARD MEMBERS OF SUBSIDIARIES ARE ALSO REQUIRED TO COMPLETE CONFLICT OF INTEREST QUESTIONNAIRES. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION POLICY PART VI, SECTION B, LINE 15A & 15B ST. ELIZABETH MEDICAL CENTER (SEMC) RECOGNIZES THAT STRONG AND EFFECTIVE EXECUTIVE LEADERSHIP IS NEEDED TO ACHIEVE ITS MISSION AND TO SERVE ITS COMMUNITY EFFECTIVELY. 1. THE CHAIRMAN OF THE BOARD OF TRUSTEES WILL APPOINT AN EXECUTIVE COMPENSATION COMMITTEE WHICH IS RESPONSIBLE FOR THE REVIEW AND APPROVAL OF ALL FORMS OF COMPENSATION BENEFITS PROVIDED TO THE PRESIDENT AND CEO OF THE MEDICAL CENTER. 2. IN ORDER TO RECRUIT AND RETAIN THE QUALITY OF LEADERSHIP NECESSARY IN A PRESIDENT AND CEO, SEMC WILL TARGET ITS TOTAL COMPENSATION PROGRAM FOR THE PRESIDENT AND CEO BY COMPARING SAME WITH SIMILARILY SIZED COMMUNITY HOSPITALS IN THE NORTHEASTERN UNITED STATES. 3. THE CEO SALARY RANGE WILL BE SET WITHIN THE RANGE FROM THOSE COMPARABLES. THE RANGE WILL BE REVIEWED PERIODICALLY AND ADJUSTMENTS WILL BE MADE WHEN MARKET CONDITIONS WARRANT AND WHEN FINANICAL PERFORMANCE OF THE MEDICAL CENTER ALLOWS. ANY ADJUSTMENT IN CEO SALARY WILL BE BASED ON THE PARTICULAR EXECUTIVE'S EXPERIENCE, PERFORMANCE, AND CONTRIBUTION TO SEMC, AS WELL AS ON THE COMPETITIVENESS OF THE EXECUTIVE'S SALARY WITHIN THE PEER GROUP. 4. SEMC'S CEO TOTAL COMPENSATION PROGRAM ALSO EMPHASIZES AND REWARDS OUTSTANDING PERFORMANCE THROUGH INCENTIVE AWARD OPPORTUNITIES. 5. THE EXECUTIVE COMPENSATION COMMITTEE WILL ANNUALLY REVIEW THE PRESIDENT AND CEO'S PERFORMANCE BASED UPON OBJECTIVE CRITERIA AND SUBJECTIVE CRITERIA IN AWARDING ANY ANNUAL INCENTIVE. THE COMMITTEE WILL CONSIDER VARIOUS FACTORS INCLUDING, BUT NOT LIMITED TO MEETING PREVIOUSLY APPROVED ANNUAL GOALS, THE OVERALL FINANCIAL PERFORMANCE OF THE MEDICAL CENTER, PATIENT SATISFACTION, QUALITY CARE INDICATORS, BOTH PUBLISHED AND NON-PUBLISHED, AND RESPONSE TO ANY OTHER UNUSUAL OR EXTRAORDINARY CIRCUMSTANCES OCCURRING DURING THE YEAR. THE PAYMENT OF THE INCENTIVE AWARD TO THE EXECUTIVE IS COMPLETELY CONTINGENT ON THE JUDGEMENT OF THE COMPENSATION COMMITTEE AS TO THE EXECUTIVE ACHIEVING PRE-ESTABLISHED GOALS AND TARGETS. IN ADDITION, THE POOL OF MONEY AVAILABLE FOR THE INCENTIVE IS ALSO CONTINGENT AND CONDITIONAL ON THE FINANCIAL PERFORMANCE OF THE MEDICAL CENTER. 6. THE EXECUTIVE COMPENSATION COMMITTEE MAY ALSO ESTABLISH AN ANNUAL INCENTIVE COMPENSATION POOL FOR THE VICE PRESIDENTS. WHEN THIS OCCURS, IT IS EXPECTED THAT THE CEO WILL INCLUDE A TEAM COMPONENT, AS WELL AS AN INDIVIDUAL COMPONENT, TO BE CONSIDERED WHEN DISTRIBUTING THIS POOL TO THE SENIOR LEADERSHIP TEAM. 7. THE COMPENSATION COMMITTEE SHALL ALSO REVIEW THE CEO'S PARTICIPATION AND LEADERSHIP IN COMMUNITY AND PROFESSIONAL ORGANIZATIONS ON WHICH THE EXECUTIVE SERVES. SEMC VALUES THE EXECUTIVE'S PARTICIPATING IN COMMUNITY AND PROFESSIONAL ORGANIZATIONS BUT ALSO RECOGNIZES THAT THE RESPONSIBILITIES TO SEMC MUST BE HIS/HER FIRST PRIORITY. 8. SEMC RECOGNIZES ITS RESPONSIBILITY TO ENSURE THAT ITS EXECUTIVE COMPENSATION PROGRAM IS APPROPRIATE IN VIEW OF ITS STATUS AS A NON-FOR-PROFIT COMMUNITY HOSPITAL AND IN ACCORDANCE WITH ITS TAX-EXEMPT STATUS, AND THAT ITS COMPENSATION AND BENEFITS ARE REASONABLE AND NOT EXCESSIVE. TO THAT END, SEMC AND THE COMMITTEE WILL REVIEW AND APPROVE ALL FORMS OF EXECUTIVE COMPENSATION AND BENEFITS IN A MANNER NECESSARY TO QUALIFY FOR THE "REBUTTABLE PRESUMPTION OF REASONABLENESS" UNDER THE INTERMEDIATE SANCTION RULES OF SECTION 4958 OF THE INTERNAL REVENUE CODE. 9. THE COMPENSATION COMMITTEE SHALL ENSURE THAT ALL ELEMENTS OF COMPENSATION AND BENEFITS PROVIDED TO EXECUTIVES OF SEMC ARE DISCLOSED A) TO THE FULL BOARD ON A REGULAR BASIS, AND B) ON IRS FORM 990 TO THE EXTENT REQUIRED BY LAW. FORM 990, PART VI, SECTION C, LINE 19 PUBLIC DISCLOSURE PART VI, SECION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. THE ORGANIZATION'S FORM 990 IS POSTED ON WWW.GUIDESTAR.ORG. FORM 990, PART VII, LINE 1A SEMC DOES NOT COMPENSATE THE BOARD OF TRUSTEES FOR THEIR SERVICES AS BOARD MEMBERS. ANY COMPENSATION PAID TO BOARD MEMBERS IS NOT RELATED TO BOARD MEMBER'S SERVICE TO THE BOARD. FORM 990, PART XI, LINE 9: PENSION RELATED CHANGES 36,349,140. NET CHANGE IN FOUNDATION NET ASSETS 422,302. FORM 990, PART XII, LINE 2C THERE HAS BEEN NO CHANGE IN THE PROCESS BY WHICH THE ORGANIZATION OVERSEES ITS AUDIT OR THE PROCESS BY WHICH THE ORGANIZATION SELECTS ITS INDEPENDENT ACCOUNTANT. ST ELIZABETH MEDICAL CENTER FOUNDATION 2209 GENESSE STREET UTICA NY 13501 222562170 FUNDRAISING NY 501(C)(3) 9 ST ELIZABETH MEDICAL CENTER 1 SRS OF ST FRANCIS OF THE NEUMANN COMM 2500 GRANT BLVD SYRACUSE NY 13208 204292535 RELIGIOUS ORDER NY 501(C)(3) N/A N/A 0 MVHI 2209 GENESSE STREET UTICA NY 13501 161540184 OVERSEE CARDIAC SERVICES NY 501(C)(3) 9 FAXTON ST LUKE'S AND ST ELIZABETH MEDICAL CENTER 1 PARTNERS IN FRANCISCAN MINISTRIES 2500 GRANT BLVD SYRACUSE NY 132081797 452279986 SPONSORS MINISTRIES OF THE SISTERS OF ST. FRANCIS OF NEUMANN COMMUNITY NY 501(C)(3) 9 N/A 0 MVEC LLC 116 BUSINESS PARK DRIVE UTICA NY 135026213 GASTROENTEROLOGY SERVICES NY DIGESTIVE DISEASE MEDICINE FAXTON STLUKE'S & SEMC HAVE MINORITY OWNERSHIP RELATED 134000 0 0 0.20000 HEALTHCARE UNDERWRITERS MUTUAL RISK MA NY (UNINCORPORATED) 5687 MAIN STREET WILLIAMSVILLE NY 14221 161484203 TO ESTABLISH WORKERS COMP SELF-INSURANCE GROUP NY N/A T 0.25000 0 ST ELIZABETH HEALTH SUPPORT 7246 JANUS PARK DRIVE LIVERPOOL NY 13088 TO PROVIDE DURABLE MEDICAL EQUIPMENT NY N/A C 0.40000 0 1 0 1 0 1 0 0 0 1 0 0 1 1 1 1 0 1 1 1 ST ELIZABETH MEDICAL CENTER FOUNDATION INC A 86078 ACCOUNTING RECORDS ST ELIZABETH MEDICAL CENTER FOUNDATION INC N 230123 ACCOUNTING RECORDS ST ELIZABETH MEDICAL CENTER FOUNDATION INC L 404274 ACCOUNTING RECORDS HEALTHCARE UNDERWRITES MUTUAL RISK Q 142502 ACCOUNTING RECORDS