2013-08-15T13:19:24-07:00 2012-12-31 990 2012-01-01 160743163 ST JOSEPHS HOSPITAL STJO 6077336541 555 ST JOSEPHS BLVD ELMIRA NY 14901 RONALD KINTZ 6077374100 2013-08-15 2012 2016-02-24 21:20:13Z RONALD J KINTZ SENIOR VP CFO 600 ROE AVENUE ELMIRA NY 14905 64536622 0 X www.stjosephs.org X 1908 NY MINISTERS TO INPATIENTS AND OUTPATIENTS, SERVING AS A PRIMARY CARE AND SPECIALTY REFERRAL CENTER 20 17 841 195 133490 0 15682196 2517990 62218399 59780826 9416 1200 943181 1949974 78853192 64249990 0 0 0 0 37622814 37685535 0 0 0 29257647 24274750 66880461 61960285 11972731 2289705 32764477 53522993 24222851 38026362 8541626 15496631 MINISTERS TO INPATIENTS AND OUTPATIENTS, SERVING A PRIMARY CARE AND SPECIALTY REFERRAL CENTER FOR PEOPLE FROM ALL FAITHS LIVING IN CHEMUNG COUNTY AND THE SURROUNDING COUNTIES OF NEW YORK AND PENNSYLVANIA 0 0 19834879 19259318 ST JOSEPHS ACUTE CARE UNITS COMBINE ADVANCED TECHNOLOGY WITH HIGHLY TRAINED STAFF TO MEET THE MEDICAL AND SURGICAL NEEDS OF OUR INPATIENTS. OUR STAFF IS DEDICATED TO PROVIDING PHYSICAL, EMOTIONAL AND SPIRITUAL CARE TO ALL PATIENTS BOTH DURING AND AFTER THEIR HOSPITAL STAY 7348661 5606625 OUR 71 BED SKILLED NURSING FACILITY IS RESPONSIBLE FOR DELIVERING NURSING CARE TO SHORT TERM PATIENTS AND LONG TERM RESIDENTS BY PROVIDING PREVENTATIVE, THERAPEUTIC, AND REHABILITATION SERVICES. OUR NURSING STAFF ASSISTS RESIDENTS IN MAINTAINING AND OR REGAINING THE HIGHEST POSSIBLE LEVEL OF WELLNESS 3495512 4437506 REHABILITATION IS THE FIRST STEP TOWARDS RECOVERY FOR ST JOSPHS INPATIENTS. OUR REHABILITATION TEAM OF MEDICAL PROFESSIONALS, SERVING A 7 COOUNTY AREA, IS DEDICATED TO RESTORING THE INDEPENDENCE OF EACH PATIENT, THROUGH RETRAINING PROGRAMS AND ACTIVE PARTICIPATION. 15720907 30477377 MISCELLANEOUS OTHER PROGRAM SERVICES INCLUDING, BUT NOT LIMITED TO, EMERGENCY SERVICES, INTENSIVE CARE UNIT, SURGICAL SERVICES, MEDICAL IMAGINING AND RADIOLOGY, ADDICTION REHABILITATION UNIT, LABORATORY SERVICES, ENDOSCOPY, PRIMARY CARE OFFICES, BEHAVIORAL SCIENCE UNIT, PHARMACY, RESPIRATORY THERAPY. 15720907 0 30477377 46399959 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 1 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 1 851 0 1 841 1 1 1 0 0 0 0 0 X 20 17 1 1 1 0 1 0 0 1 1 0 1 1 1 1 1 1 1 1 1 1 0 NY X X RONALD KINTZ 6077374100 555 ST JOSEPHS BLVD ELMIRA NY 14901 Ronald J Kintz 20 35 X 0 360608 0 Anthony Cooper 20 35 X 0 667160 0 Roger Schenone 40 2 X 0 315037 0 Wesley Blauvelt 16 32 X 0 221752 0 Brian Forrest 16 34 X X 0 144197 0 H Fred Farley 20 35 X 0 390276 0 William Huffner 20 35 X 0 348104 0 Debra Martin 20 35 X 0 158053 0 Gregg Martin 20 35 X 0 162110 0 Kathy Hale 20 20 X 0 114357 0 Richard Hoffman 10 30 X 0 162412 0 Marc Rustici 20 35 X 0 160304 0 Joseph Braunschiedel 20 20 X 0 165142 0 Mark Dworsky 20 20 X 0 136483 0 Mary Vosburgh 20 20 X 0 159006 0 James Watson 2 48 X 0 219720 0 Kimberly Panosian 40 10 X 0 198195 0 Vidyasagar Mokureddy 1 40 X 0 1143010 0 William DeLuccia 1 40 X 0 745326 0 Ravi Akula 1 40 X 0 685680 0 S Jan Eberhard 2 6 X 0 0 0 Joseph P Manning 1 1 X 0 0 0 John R Alexander 1 1 X 0 0 0 Daniel J Burke 1 1 X 0 0 0 Francisco Corbalan 20 5 X 0 0 0 David Dalrymple 1 1 X 0 0 0 Christine M Deschamps 1 1 X 0 0 0 John T Gough 1 1 X 0 0 0 Mark J Hagan 1 1 X 0 0 0 Michael Hosey 1 1 X 0 0 0 Roy A Kyles 1 1 X 0 0 0 Randy S Lehman 1 1 X 0 0 0 Ben E Lynch 3 4 X 0 0 0 Robert McNamara 1 1 X 0 0 0 Mary Louise Mitchell 1 3 X 0 0 0 John F O'Mara 1 1 X 0 0 0 Donald Quick 1 1 X 0 0 0 Patrick J Rogers 1 1 X 0 0 0 Melinda Sartori 1 1 X 0 0 0 Roger Schenone 45 2 X 0 0 0 Gregory Schultz 45 2 X 0 0 0 Margaret B Streeter 1 1 X 0 0 0 Gregory Schultz 40 2 X 0 185269 0 Robert Lambert 20 30 X 0 467257 0 Paul Hicks 3 40 X 0 747430 0 Nishith Amin 3 40 X 0 744135 0 Michael Keller 40 0 X 199553 0 0 Mary Ann Mahajan 40 0 X 137675 0 0 Behrooz Ebrahimi Fard 40 0 X 305803 0 0 Oliver McKeithan 40 0 X 115136 0 0 Lynda Overstrom 40 0 X 116868 0 0 875035 8801023 0 6 0 1 0 Welliver-McGuire Inc 250 North Genesee Street Montour Falls NY 14865 Construction Services 2279031 Delphi Hospitalist Services 1880 East Ridge Road Suite 6 Upper Level Rochester NY 14622 Emergency Physicians 1224162 Alliance Healthcare Services PO Box 96485 Chicago IL 60693 Medical Services 885739 Team Health East PO Box 634850 Cincinnati OH 45263 Medical Services 832579 NY Acute Care Specialists PO Box 634850 Cincinnati OH 45263 Medical Services 467160 18 0 0 0 0 2447490 70500 0 2517990 NET PATIENT SERVICE REVENUE HOSPITAL 900099 59780826 59780826 0 0 0 0 0 0 59780826 0 0 0 0 0 0 0 0 0 0 0 0 175800 0 42310 0 133490 0 133490 0 133490 0 0 1200 0 0 0 1200 1200 0 0 1200 0 0 0 0 0 0 0 0 0 0 0 0 301666 244322 57344 0 0 57344 1759140 757308 0 1001832 1759140 64249990 60538134 133490 1060376 0 0 0 0 0 0 0 0 0 0 0 0 0 29391818 23493552 5898266 0 1784171 330 1783841 0 4646174 0 4646174 0 1863372 1540403 322969 0 709562 283058 426504 0 61236 2519 58717 0 15000 0 15000 0 0 0 0 0 0 0 5262 0 5262 0 3059249 2729768 329481 0 973 0 973 0 7880738 7433083 447655 0 270491 18888 251603 0 0 0 0 0 1125044 57981 1067063 0 32042 28960 3082 0 0 0 0 0 12424 6163 6261 0 41056 0 41056 0 0 0 0 0 2348644 0 2348644 0 880057 13019 867038 0 License Fees 308472 307970 502 0 Maintenance Contracts 493483 231466 262017 0 Lease 1834132 1207961 626171 0 Benefit Allocation 0 5110116 -5110116 0 5196885 3934722 1262163 0 61960285 46399959 15560326 0 1150 31652 536540 2214380 97707 1647536 8008439 10670956 0 0 3130191 8763634 597362 850076 141368 313344 109197664 84612626 16705624 24585038 1263216 1883092 0 0 0 2282880 2563285 32764477 53522993 7310110 4740285 0 0 0 0 0 0 0 0 0 0 643559 4668825 300000 0 15969182 28617252 24222851 38026362 X 7209309 14157666 1166532 1173180 165785 165785 8541626 15496631 32764477 53522993 X 2289705 0 0 0 329547 4335753 X 1 X 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 9609 9609 0 SchC_P2B_S00_L01 Schedule C, Part II-B, Line 1 ST JOSEPHS PAYS ANNUAL DUES TO HEALTH ASSOCIATION OF NEW YORK PART FO THE DUES ARE USED FOR LOBBYING EXPENSES 48141 0 0 0 1299 0 46842 48141 0 0 0 0 0 48141 43141 6000 0 0 1000 0 48141 44141 41000 0 0 42000 0 43141 40713 6777 0 0 3349 0 44141 0.3 0.7 0 0 0 0 1287657 1287657 0 29106093 19977145 9128948 0 0 0 0 0 72611721 63121007 9490714 0 6192193 1514474 4677719 24585038 0 DUE TO AOMC 13394030 MINIMUM PENSION LIABILITY 10168103 WORKERS COMPENSATION RESERVE 3795242 THIRD PARTY REIMBURSEMENT PAYABLES 1259877 28617252 X 64536622 0 0 0 0 0 64536622 0 -286632 -286632 64249990 62246883 0 0 0 286598 286598 61960285 0 0 0 61960285 SchD_P05_S00_L04 Schedule D, Part V, Line 4 Permanently Restricted Endowment Fund SchD_P10_S00_L02 Schedule D, Part X, Line 2 There are no notes in the audited financial statements for this line. SchD_P11_S00_L04b Schedule D, Part XI, Line 4b Nutritional Services expenses were moved to off set the cost of goods sold in the cafeteria in the amount of $244,325. Rental expenses of $42,307 were moved to offset the rental income. SchD_P12_S00_L02d Schedule D, Part XII, Line 2d COST OF GOODS SOLD NUTRITIONAL SERVICES 244,322 AND RENTAL EXPENSE 42,276 1 1 X 1 X 1 X 1 1 1 0 1 1 0 226 1009139 -16221 1025360 0.0165 0 18224 12383561 7576997 4806564 0.0776 0 242 0 -3073345 3073345 0.0496 0 18692 13392700 4487431 8905269 0.1437 80 5748 100591 0 100591 0.0016 0 7 11485 0 11485 0.0002 8 70339 28905309 28704264 201045 0.0032 0 0 0 0 0 0 0 0 27695 0 27695 0.0004 88 76094 29045080 28704264 340816 0.0054 88 94786 42437780 33191695 9246085 0.1491 3 6769 0 6769 0.0001 4 2 15 24 0 6769 0 6769 0.0001 0 5472996 0 12744144 11920889 823255 X 1 0 ARNOT OGDEN MEDICAL CENTER ADMINISTRATION & CONSULTING 0 0 0 1 1 ST JOSEPHS HOSPITAL

555 ST JOSEPHS BOULEVARD ELMIRA NY 14901

X X X SKILLED NURSING FACILITY ST JOSEPHS HOSPITAL 1 1 X X X X X X X 09 1 1 1 X X X X X X X X X X X X 1 0 1 1 150 1 400 1 X X X X X X X 1 1 X X X X X X 1 X X X 1 X X X X X X 1 X 0 0 SchH_P01_S00_L04 Schedule H, Part I, Line 4 ST. JOSEPH'S HOSPITAL SERVES RESIDENTS OF CHEMUNG, STEUBEN AND SCHUYLER COUNTIES IN NEW YORK AND ALSO BRADFORD AND TIOGA COUNTIES IN PENNSYLVANIA. THE COUNTIES ARE CLASSIFIED AS URBAN AND RURAL. ST. JOSEPH'S HOSPITAL IS LOCATED IN CHEMUNG COUNTY, NEW YORK, WHICH HAS A POPULATION OF APPROXIMATELY 88,000, AND 50.4% FEMALE AND 49.6% MALE. THE MEDIAN AGE IS 39.1 YEARS OF AGE, WITH 22% AGE 18 AND UNDER, 63% AGE 19 TO 64, AND 15% OVER THE AGE OF 65. THE AVERAGE HOUSEHOLD INCOME IS $40,000 AND 87% HAVE A HIGH SCHOOL OR GREATER EDUCATION. 16% OF THE POPULATION IS BELOW THE FEDERAL POVERTY GUIDELINES. THE RACE BREAKDOWN IS 81% CAUCASIAN, 12% AFRICAN-AMERICAN, 4% HISPANIC, 1% ASIAN, AND ALL OTHER 2%. SchH_P01_S00_L07 Schedule H, Part I, Line 7 THE HOSPITAL PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER IT'S FINANCIAL ASSISTANCE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ESTABLISHED RATES. BECAUSE THE HOSPITAL DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, THEY ARE NOT SHOWN AS REVENUE. THE HOSPITAL MAINTAINS RECORDS TO IDENTIFY AND MONITOR THE LEVEL OF CHARITY CARE IT PROVIDES. THESE RECORDS INCLUDE THE AMOUNT OF CHANGES FORGONE FOR SERVICES FURNISHED UNDER ITS FINANCIAL ASSISATANCE PRGRAM. SchH_P02_S00_L00 Schedule H, Part II SEVERAL HOSPITAL STAFF MEMBERS TAKE PART IN MANY LOCAL COALITION GROUPS THAT HAVE BEEN ORGANIZED TO ADDRESS THOSE CRITICAL HEALTH CARE ISSUES FACING THE COMMUNITY. THE COALITIONS WHICH INCLUDED COMMUNITY MEMBERS MET ON A REGULAR BASIS TO DISCUSS AND ADDRESS BARRIERS OR GAPS IN SERVICE IN THE COMMUNITY. ST JOSEPHS EMPLOYEE REPRESENTATION WAS PRESENT ON THE FOLLOWING COALITIONS. LINE 6 COALITION BUILDING HEALTH AND PLANNING BOARD/COMMITEE MEMBERSHIP CENTRAL NY AREA HEALTH EDUCATION CTR, ROCHESTER REGIONAL HOSPITAL ASSOC, EMSTAR, CHEMUNG CO MEDICAL SOCIETY, SO TIER REGIONAL EMS LINE 7 COMMUNITY HEALTH IMPROVEMENT ADVOCACY HEALTH AND PLANNING BOARD/COMMUNITY CHEMUNG CO SCHOOL READINESS ADVISORY, IMMUNIZATION COALITION, STRONG KIDS SAFE KIDS, RSVP OF CHEMUNG COUNTY, UNITED WAY OF THE SO TIER, LAKE ERIE COLLEGE OF OSTEOPATHIC MEDICINE, NYS EMERGENCY MEDICAL ADVISORY COMMITTEE SchH_P03_S0A_L04 Schedule H, Part III, Section A, Line 4 Based upon the historical experience, a significant portion of the Organization's uninsured patients will be unable or unwilling to pay for the services provided. Thus, the Organization records a significant provision for bad debt related to uninsured patients in the period the services are provided. The bad debt expense is recorded at a Cost to Charges ratio. SchH_P03_S0B_L08 Schedule H, Part III, Section B, Line 8 Based upon the historical experience, a significant portion of the Organization's uninsured patients will be unable or unwilling to pay for the services provided. Thus, the Organization records a significant provision for bad debt related to uninsured patients in the period the services are provided. The bad debt expense is recorded at a Cost to Charges ratio. SchH_P03_S0C_L09b Schedule H, Part III, Section C, Line 9b PATIENTS ENROLLED IN THE FINANCIAL ASSISTANCE PROGRAM WOULD BE TREATED THE SAME AS ALL PATIENTS HAVING A FINANCIAL RESPONSIBILITY (AFTER FINANCIAL ASSISTANCE DISCOUNTS) AND NOT MAKING ARRANGEMENTS TO SATISFY OBILGATION. SchH_P05_S0B_L03 Schedule H, Part V, Section B, Line 3 SJH, AND IDMH, AS PART OF ARNOT HEALTH SYSTEM, PARTICIPATED IN A COMMUNITY HEALTH NEEDS ASSESSMENT IN COLLABORATION WITH PARTNERS SUCH AS THE LOCAL HEALTH DEPARTMENT, OTHER HEALTHCARE AGENCIES, MENTAL HEALTH PROFESSIONALS, SCHOOL DISTRICTS AND COMMUNITY MEMBERS. THE COMMUNITY WAS SURVEYED ABOUT THEIR HEALTH. DATA FROM THESE SURVEYS AND NYSDOH WERE ANALYZED, AND PUBLIC HEALTH PRIORITIES WERE SELECTED THROUGH THE MOBILIZING FOR ACTION THROUGH PARTNERSHIP AND PLANNING (MAPP) PROCESS. SchH_P05_S0B_L04 Schedule H, Part V, Section B, Line 4 ST. JOSEPH'S HOSPITAL IS PART OF ARNOT HEALTH, INC., WHICH ALSO HAS THE ARNOT OGDEN MEDICAL CENTER AS AN AFFILIATE. SINCE BOTH FACILITIES ARE IN ELMIRA, NEW YORK, THE POPULATION SERVED AND THE NEEDS OF THAT POPULATION ARE THE SAME. SchH_P05_S0B_L05 Schedule H, Part V, Section B, Line 5 IN ADDITION TO WEBSITE, THE HEALTHCARE SYSTEM USES A VARIETY OF METHODS TO DISSEMINATE THE COMMUNITY SERVICE PLAN, INFORMATION ABOUT COMMUNITY HEALTH PROGRAMS AND THE AVAILABILITY OF FINANCIAL ASSISTANCE TO THE PUBLIC. SOME OF THESE METHODS INCLUDE PRESENTATIONS THE COMMUNITY HEALTH DEPARTMENT PROVIDES EDUCATION ABOUT THE HEALTHCARE SYSTEMS COMMUNITY SERVICE PLAN AND COMMUNITY OUTREACH STRATEGIES TO ADDRESS PUBLIC HEALTH PRIORITIES THROUGH PRESENTATIONS AT COMMUNITY EVENTS, REGIONAL AND STATE CONFERENCES, TO DEPARTMENT MANAGERS AND THE HEALTHCARE SYSTEM'S JOINT BOARD OF DIRECTORS. LOCAL MEDIA OUTLETS: WORK WITH A VARIETY OF LOCAL MEDIA OUTLETS TO DISSEMINATE INFORMATION ABOUT COMMUNITY OUTREACH PROGRAMS AND SERVICES, AND SERVICES, AND CONTINUALLY ASSESS THE EFFECTIVENESS OF EACH OF THOSE OUTLETS. HISTORICALLY REGIONAL NEWSPAPERS HAVE PROVEN AN EFFECTIVE WAY TO PROVIDE TIMELY INFORMATION TO THE PUBLIC, BASED ON CONSUMER FEEDBACK AT PROGRAMS AND EVENTS. OTHER METHODS INCLUDE TELEVISION, RADIO, PHONE BANKING, DIRECT MAIL AND OTHER COMMUNITY PUBLICATIONS. RECENT INSIGHT NEWSLETTERS FEATURED ARTICLES THAT ILLUSTRATE THE HEALTHCARE SYSTEM'S MISSION TO PROVIDE QUALITY PREVENTATIVE HEALTHCARE THROUGH COMMUNITY OUTREACH AND ONGOING ASSESSMENT OF PUBLIC HEALTH NEEDS. SchH_P05_S0B_L06 Schedule H, Part V, Section B, Line 6 FROM 2009-2011 ST JOSEPH'S AGREED TO FOCUS ON THE FOLLOWING THREE PUBLIC HEALTH PRIORITIES: ACHIEVE THE NEW YORK STATE HEALTH DEPARTMENT'S PREVENTION AGENDA FOR THE HEALTHIEST STATE 2008-2013 PHYSICAL ACTIVITY NUTRITIONAL GOAL RELATED TO OBESITY FOR CHILDREN AND ADULTS. REDUCE TOBACCO USE IN CHEMUNG COUNTY BY ACCOMPLISHING THE NEW YORK STATE HEALTH DEPARTMENT'S PREVENTION AGENDA FOR THE HEALTHIEST STATE 2008-2013 GOAL PERTAINING TO CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) HOSPITALIZATIONS IN CHEMUNG COUNTY AMONG ADULTS 18 YEARS OF AGE AND OLDER. ACCOMPLISH THE NEW YORK STATE HEALTH DEPARTMENT'S PREVENTION AGENDA FOR THE HEALTHIEST STAE 2008-2013 MENTAL HEALTH/SUBSTANCE ABUSE OBJECTIVES RELATED TO CHEMUNG COUNTY'S SUICIDE MORTALITY RATE. SchH_P05_S0B_L20 Schedule H, Part V, Section B, Line 20 HIGHEST NON-GOVERNMENT VOLUME PAYOR SchH_P06_S00_L02 Schedule H, Part VI, Line 2 IN 2009 ST. JOSEPH'S HOSPITAL SELECTED TWO OF ITS THREE PREVENTION AGENDA PRIORITIES WITH ARNOT OGDEN MEDICAL CENTER AND KEY MEMBERS OF THE HEALTHY LIVING PARTNERSHIP, INCLUDING THE CHEMUNG COUNTY HEALTH DEPARTMENT, CHEMUNG VALLEY RURAL HEALTH NETWORK, CORNELL COOPERATIVE EXTENSION, SOUTHERN TIER TOBACCO AWARENESS COMMUNITY PARTNERSHIP AND EAT WELL PLAY HARD. SINCE 2009, ST. JOSEPH'S HOSPITAL HAS CONTINUED TO COLLABORATE WITH THE CHEMUNG COUNTY HEALTH DEPARTMENT , ARNOT OGDEN MEDICAL CENTER AND OTHER HEALTHCARE AGENCIES TO ASSESS THE COMMUNITY NEEDS, PLAN AND IMPLEMENT EVIDENCE-BASED STRATEGIES TO ADDRESS PUBLIC HEALTH PRIORITIES AND TRACK OUTCOMES TO EVALUATE OUR INTERVENTIONS. SchH_P06_S00_L03 Schedule H, Part VI, Line 3 ST. JOSEPH'S HOSPITAL COMMUNICATES ITS COMMUNITY CARE PROGRAM IN THE FOLLOWING WAYS: SIGNAGE IN WAITING ROOMS - BROCHURES IN WAITING ROOMS AND ADMISSION PACKAGES - NOTATIONS ON BILLING NOTICES - STAFF EDUCATION SO THEY CAN SHARE AVAILABILITY OF PROGRAM AND CONTACT INFORMATION WITH PATIENTS - COMMUNICATION TO & EDUCATION OF SHARED COUNTY DEPT. OF SOCIAL SERVICES STAFF SO THEY ARE INFORMED OF THE PROGRAM DETAILS AND CONTACT INFORMATION - COMMUNICATION OF PROGRAM WITH COLLECTION AGENCIES & COLLECTION ATTORNEYS SO THEY CAN SHARE THE AVAILABILITY OF THE PROGRAM AND CONTACT INFORMATION WITH PROSPECTIVE ENROLLEES - INFORMATION ON MEDICAL CENTER'S WEB SITE SchH_P06_S00_L04 Schedule H, Part VI, Line 4 A not-for-profit acute care hospital and skilled nurisng facility located in Elmira, New York was founded in 1908 by the Sisters of St. Joseph of Rochester, New York in cooperation with the physicians and citizens of southern New York and northern Pennsylvania to provide medical care for all in need in accordance with the teachings of the Roman Catholic Church. SchH_P06_S00_L05 Schedule H, Part VI, Line 5 THE HOSPITAL WORKS WITH VARIOUS OTHER HEALTHCARE AND HEALTH PLANNING ORGANIZATIONS WITHIN ITS SERVICE AREA TO IDENTIFY COMMUNITY NEEDS AND BUILD PROGRAMS TO ADDRESS THESE NEEDS. THIS ANALYSIS IS EXTENSIVE AND IS REPORTED ANNUALLY IN THE "REPORT TO THE COMMUNITY" AND EVERY THREE YEARS IN A 'COMMUNITY NEEDS ASSESSMENT." THE MEDICAL CENTER'S COMMUNITY OUTREACH DEPARTMENT IS DEDICATED TO PROVIDING SCREENINGS, LECTURES, EDUCATIONAL EVENTS, ETC. TO THE COMMUNITY SEPARATELY OR IN CONJUNCTION WITH OTHER COMMUNITY OORGANIZATIONS AND AGENCIES. MANY OF THESE PROGRAMS PROMOTE COMMUNITY HEALTH AND WELLNESS AS WELL AS SUPPORT GROUPS AND PROGRAMS FOR THOSE MANAGING A DISEASE OR CARING FOR SOMEONE WITH A DISEASE. SchH_P06_S00_L06 Schedule H, Part VI, Line 6 IN 2011 ARNOT HEALTH INC. WAS ESTABLISHED TO SUPPORT THE AFFILIATES WITHIN THE ARNOT HEALTH SYSTEM. THE SYSTEM IS COMPRISED OF ARNOT OGDEN MEDICAL CENTER, ARNOT MEDICAL SERVICES, IRA DAVENPORT MEMORIAL HOSPITAL AND ST. JOSEPH'S HOSPITAL AS WELL AS THE RELATED FOUNDATIONS AND AUXILIARIES ASSOCIATED WITH THESE ORGANIZATIONS. THE SYSTEM IS WORKING TOWARD THE EFFICIENT AND EFFECTIVE DELIVERY OF HEALTHCARE WITHIN THE SERVICE AREA. THE SYSTEM ALSO PARTICIPATES WITH OTHER ORGANIZATIONS AND AGENCIES TO SERVICE THE COMMUNITY. X X X 0 0 0 0 0 0 0 0 0 Ronald J Kintz 0 299353 0 61255 0 0 0 24000 0 23593 0 408201 0 372744 Anthony Cooper 0 503377 0 163783 0 0 0 25300 0 23593 0 716053 0 628001 Roger Schenone 0 278668 0 36369 0 0 0 6984 0 5277 0 327298 0 272823 Gregory Schultz 0 167433 0 17836 0 0 0 17393 0 22579 0 225241 0 195461 Robert Lambert 0 377250 0 90007 0 0 0 18000 0 23593 0 508850 0 444988 Wesley Blauvelt 0 205722 0 16030 0 0 0 19907 0 22950 0 264609 0 205539 Brian Forrest 0 138197 0 6000 0 0 0 10310 0 21060 0 175567 0 0 H Fred Farley 0 324630 0 65646 0 0 0 25300 0 23593 0 439169 0 357995 William Huffner 0 311092 0 37012 0 0 0 9500 0 20955 0 378559 0 340036 Debra Martin 0 145000 0 13053 0 0 0 14859 0 9281 0 182193 0 169300 Gregg Martin 0 145400 0 16710 0 0 0 15272 0 22365 0 199747 0 175322 Kathy Hale 0 105310 0 9047 0 0 0 4471 0 19771 0 138599 0 0 Richard Hoffman 0 154440 0 7972 0 0 0 14260 0 22453 0 199125 0 0 Marc Rustici 0 143320 0 16984 0 0 0 13595 0 22345 0 196244 0 166755 Joseph Braunschiedel 0 157498 0 7644 0 0 0 6317 0 22483 0 193942 0 155795 Mark Dworsky 0 135013 0 1470 0 0 0 5229 0 22265 0 163977 0 0 Mary Vosburgh 0 154772 0 4234 0 0 0 6176 0 20250 0 185432 0 0 James Watson 0 200925 0 18795 0 0 0 8418 0 1949 0 230087 0 0 Kimberly Panosian 0 198195 0 0 0 0 0 7660 0 18899 0 224754 0 203595 Vidyasagar Mokureddy 0 676125 0 466885 0 0 0 9500 0 2638 0 1155148 0 1059324 William DeLuccia 0 737334 0 7992 0 0 0 9500 0 22490 0 777316 0 754624 Paul Hicks 0 737334 0 10096 0 0 0 14000 0 10512 0 771942 0 758344 Nishith Amin 0 737334 0 6801 0 0 0 9500 0 21387 0 775022 0 752116 Ravi Akula 0 569200 0 116480 0 0 0 9500 0 21387 0 716567 0 696620 F990_P06_S0A_L02 Form 990, Part VI, Section A, Line 2 KEY EMPLOYEES DEBORAH MARTIN AND GREGG MARTIN ARE BROTHER AND SISTER. F990_P06_S0A_L03 Form 990, Part VI, Section A, Line 3 HHA SERVICES INC. PROVIDES MANAGEMENT SERVICES FOR NUTRITIONAL SERVICES, PLANT OPERATIONS SERVICES, AND HOUSEKEEPING SERVICES. F990_P06_S0A_L04 Form 990, Part VI, Section A, Line 4 IN 2011 ARNOT OGDEN MEDICAL CENTER ENTERED INTO AN AFFILIATION AGREEMENT WITH ST. JOSEPH'S HOSPITAL IN ELMIRA, NEW YORK, AND FORMED A NEW ORGANIZATION, ARNOT HEALTH, INC., TO GOVERN BOTH ORGANIZATIONS. F990_P06_S0A_L06 Form 990, Part VI, Section A, Line 6 ST. JOSEPH'S HEALTH SYSTEM, INC. IS THE SOLE MEMBER OF ST. JOSEPH'S HOSPITAL. F990_P06_S0B_L11b Form 990, Part VI, Section B, Line 11b THE 990 WAS REVIEWED BY MANAGEMENT. F990_P06_S0B_L12c Form 990, Part VI, Section B, Line 12c EACH MEMBER OF THE BOARD OF DIRECTORS AND OTHER HOSPITAL INSIDERS MUST COMPLETE A CONFLICT OF INTEREST STATEMENT ANNUALLY. IN ADDITION, SITUATIONS WHICH CONSTITUTE, COULD CONSTITUTE, OR COULD BE PERCEIVED AS CONSTITUTING A CONFLICT OF INTEREST MUST BE REPORTED IMMEDIATELY TO THE HOSPITAL PRESIDENT. THE HOSPITAL PRESIDENT WILL THEN RELAY THE INFORMATION TO THE BOARD OF DIRECTORS. IF THE BOARD MEMBER OR INSIDER FAILS TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT, THE BOARD OF DIRECTORS MUST INVESTIGATE THE MATTER FULLY AND IF THE BOARD DETERMINES THAT A VIOLATION HAS OCCURRED, THE BOARD IS RESPONSIBLE FOR TAKING APPROPRIATE DISCIPLINARY AND/OR CORRECTIVE ACTION. F990_P06_S0B_L15 Form 990, Part VI, Section B, Line 15 THE EXECUTIVE AND FINANCE COMMITTEES OF THE BOARD WILL ESTABLISH THE COMPENSATION FOR THE CHIEF EXECUTIVE OFFICER. REPRESENTATIVES OF THESE COMMITTEES MAY CONSULT WITH THE DIRECTOR OF HUMAN RESOURCES REGARDING BENCHMARK SURVEY COMPENSATION DATA IN SETTING COMPENSATION FOR THE CHIEF EXECUTIVE OFFICER. THE COMPENSATION FOR THE CEO IS APPROVED BY THE ENTIRE BOARD OF DIRECTORS. F990_P06_S0C_L19 Form 990, Part VI, Section C, Line 19 The governing documents are made available upon written request. F990_P11_S00_L09 Form 990, Part XI, Line 9 Closing and transfer in of Net Assets of St. Joseph's Health System, $4,382,446, Pension Charge to Equity, $(220,096), Net Assets Released from Restriction, $(300). Net Assets of Foundation includes a profit of $180,618, and a Net Asset Released from Restriction of $(6,915). ST JOSEPH'S HOSPITAL MSO 571 ST JOSEPHS BLVD ELMIRA NY 14901 203240569 PHYSICIANS NY 444973 0 ST JOSEPHS HEALTH SYSTEM Arnot Ogden Medical Center Foundation Accounting Dept 600 Roe Avenue Elmira NY 14905 161109472 Affiliate NY 501(c)(3) 11E N/A 0 Arnot Ogden Medical Center Auxiliary 600 Roe Avenue Elmira NY 14905 510192902 Affiliate NY 501(c)(3) 11 N/A 0 The Falck Foundation Accounting Dept 600 Roe Avenue Elmira NY 14905 223055110 Affiliate NY 501(c)(3) 11E N/A 0 Ira Davenport Memorial Hospital Inc Accounting Dept 7571 State Route 54 Bath NY 14810 160835446 Affiliate NY 501(c)(3) 11 N/A 0 Keuka Health Care Foundation Accounting Dept 7571 State Route 54 Bath NY 14810 161461215 Affiliate NY 501(c)(3) 11 N/A 0 St Josephs Hospital Foundation Accounting Dept 571 St Josephs Blvd Elmira NY 14901 161265182 Fundraising NY 501 (c) 7 ST JOSEPHS HOSPITAL 0 St Josephs Health Systems Inc Accounting Dept 555 St Josephs Blvd Elmira NY 14901 223243418 Parent NY 501 (c) 11B N/A 0 Arnot Ogden Medical Center Accounting Dept 600 Roe Avenue Elmira NY 14905 160743905 Affiliate NY 501(c)(3) 11 N/A 0 ADVANTAGE HEALTH MEDICAL SERVICE PC 517 ST JOSEPHS BLVD ELMIRA NY 14901 161455621 PHYSICIAN NY ST JOSEPHS HEALTH SYSTEM C 0 ST JOSEPHS HOUSING DEVELOPMENT FUND 555 ST JOSEPHS BLVD ELMIRA NY 14901 203240197 APARTMENTS NY ST JOSEPHS HEALTH SYSTEM C IVY STREET DEVELOPMENT CORPORATION ACCOUNTING DEPARTMENT 600 IVY STREET ELMIRA NY 14905 161009245 REAL ESTATE NY C 0 1 0 0 1 0 0 0 0 0 0 1 1 1 0 1 0 1 0 0 St Josephs Health Systems Inc a-i 94946 ST. JOSEPH'S HOSPITAL CHARGED INTEREST TO ST. JOSEPH'S HEALTH SYSTEMS INC. THE METHOD OF DETERMINING THE AMOUNT WAS INTEREST COMPOUNDED DAILY ON THE LOAN PRINCIPAL BALANCE. St Josephs Health Systems Inc d 125000 ADDITIONAL CASH ADVANCED FOR LOAN PRINCIPAL FEBRUARY 2012 St Josephs Health Systems Inc k -281696 ST. JOSEPH'S HOSPITAL RENTED SPACE IN A MEDICAL OFFICE BUILDING OWNED BY ST. JOSEPH'S HEALTH SYSTEMS INC. THE METHOD OF DETERMINING THE AMOUNT INVOLVED WAS THE FAIR MARKET VALUE OF SQUARE FEET. ADVANTAGE HEALTH MEDICAL SERVICE PC o -40000 ADVANTAGE HEALTH MEDICAL SERVICE PC PROVIDED EMPLOYEES TO ST. JOSEPH'S HOSPITAL. COST WAS THE METHOD OF DETERMINING THE AMOUNT. St Josephs Hospital Foundation k -37175 ST. JOSEPH'S HOSPITAL RENTED SPACE IN A BUILDING OWNED BY ST. JOSEPH'S HOSPITAL FOUNDATION. THE METHOD OF DETERMINING THE AMOUNT WAS THE FAIR MARKET VALUE OF THE SQUARE FEET. St Josephs Health Systems Inc o 66214 ST. JOSEPH'S HOSPITAL PROVIDED EMPLOYEES TO ST. JOSEPH'S HEALTH SYSTEMS INC. COST WAS THE METHOD OF DETERMINING THE AMOUNT. St Josephs Hospital Foundation o 34667 ST. JOSEPH'S HOSPITAL PROVIDED EMPLOYEES TO ST. JOSEPH'S HOSPITAL FOUNDATION. COST WAS THE METHOD OF DETERMINING THE AMOUNT. St Josephs Hospital Foundation l 26527 ST. JOSEPH'S HOSPITAL PROVIDED VARIOUS SERVICES TO ST. JOSEPH'S HOSPITAL FOUNDATION. COST WAS THE METHOD OF DETERMINING THE AMOUNT. St Josephs Health Systems Inc a-i -7705 ST. JOSEPH'S HEALTH SYSTEMS INC. CHARGED INTEREST TO ST. JOSEPH'S HOSPITAL. THE METHOD OF DETERMINING THE AMOUNT WAS INTEREST COMPOUNDED DAILY ON THE LOAN PRINCIPAL BALANCE. St Josephs Hospital Foundation a-i -2965 ST. JOSEPH'S HOSPITAL FOUNDATION CHARGED INTEREST TO ST. JOSEPH'S HOSPITAL. THE METHOD OF DETERMINING THE AMOUNT WAS INTEREST COMPOUNDED DAILY ON THE LOAN PRINCIPAL BALANCE. Arnot Ogden Medical Center o -3713604 ARNOT OGDEN MEDICAL CENTER PROVIDED EMPLOYEES TO ST. JOSEPH'S HOSPITAL FOR ADMINISTRATIVE, MEDICAL, MANAGEMENT INFORMATION, ACCOUNTING, AND VARIOUS OTHER SERVICES. THE METHOD OF DETERMINING THE AMOUNT WAS COST. Arnot Ogden Medical Center o 129160 ST. JOSEPH'S HOSPITAL PROVIDED EMPLOYEES TO ARNOT OGDEN MEDICAL CENTER FOR PASTORAL, THERAPEUTIC, AND RADIOLOGY SERVICES. THE METHOD OF DETERMINING THE AMOUNT WAS COST. Ira Davenport Memorial Hospital Inc o -69040 IRA DAVENPORT MEMORIAL HOSPITAL INC. PROVIDED ONE EMPLOYEE TO ST. JOSEPH'S HOSPITAL FOR HUMAN RESOURCES SERVICES. THE METHOD OF DETERMINING THE AMOUNT WAS COST. Arnot Ogden Medical Center m -2529502 ARNOT OGDEN MEDICAL CENTER PROVIDED ENDOSCOPY, ANESTHESIA SUPPORT, LAUNDRY, AND VARIOUS ADMINISTRATIVE SERVICES TO ST. JOSEPH'S HOSPITAL. THE METHOD OF DETERMINING THE AMOUNT WAS COST. ST. JOSEPH'S HOSPITAL FILED AN EXTENSION REQUEST, WHICH WAS GRANTED.