2012-11-14T17:01:35-06:00 2011-12-31 161226221 FUST CHARLES CHAMBERS LLP 5784 WIDEWATERS PARKWAY SYRACUSE NY 13214 990 2011-01-01 161492011 ONEIDA HEALTH SYSTEMS ONEI 3153636000 321 GENESEE STREET ONEIDA NY 13421 DEWEY ROWLANDS 3153636000 2012-11-13 1 JOSEPH J SCHLEGEL P00301329 3154463600 2011 2016-02-24 21:20:13Z ONEIDA HEALTHCARE CENTER DEWEY ROWLANDS 321 GENESEE STREET ONEIDA NY 13421 90728089 0 X WWW.ONEIDAHEALTHCARE.ORG X 1995 NY ONEIDA HEALTHCARE CENTER (OHC) IS A 101-BED ACUTE CARE HOSPITAL AND A 160-BED SKILLED NURSING FACILITY (ECF) LICENSED BY THE STATE OF NEW YORK AND OPERATED BY ONEIDA HEALTH SYSTEMS, INC., A NEW YORK NOT-FOR-PROFIT CORPORATION. THE HOSPITAL IS JOINT COMMISSION ACCREDITED. AS A HEALTHCARE ORGANIZATION, ONEIDA HEALTHCARE CENTER IS GUIDED BY A MISSION OF EXCELLENCE:IN 2011 ONEIDA HEALTH SYSTEMS SERVED 3,639 INPATIENTS AND 141,923 OUTPATIENTS. THE RESIDENTIAL CARE FACILITY PROVIDED CARE TO 150 RESIDENTS ON A DAILY BASIS.THE MISSION OF THE ONEIDA HEALTHCARE CENTER IS TO PLAN, PROVIDE AND COORDINATE THE HIGHEST QUALITY PROGRESSIVE AND COMPREHENSIVE HEALTH CARE SERVICES FOR THE GREATER ONEIDA AREA AND SURROUNDING COMMUNITIES. 12 9 1100 106 357757 -184331 897147 333479 76196811 78020903 650609 1005062 622478 692520 78367045 80051964 0 0 0 0 42856414 42759058 0 0 74239 31439691 32643675 74296105 75402733 4070940 4649231 101550577 112128126 54371254 67514631 47179323 44613495 X THE MISSION OF ONEIDA HEALTH SYSTEMS IS TO PLAN, PROMOTE, PROVIDE AND COORDINATE THE HIGHEST QUALITY PROGRESSIVE AND COMPREHENSIVE HEALTH CARE SERVICES FOR THE GREATER ONEIDA AREA AND SURROUNDING COMMUNITIES. 0 0 70882456 78480864 ONEIDA HEALTHCARE CENTER (OHC) IS A 101-BED ACUTE CARE HOSPITAL AND A 160-BED SKILLED NURSING FACILITY (ECF) LICENSED BY THE STATE OF NEW YORK AND OPERATED BY ONEIDA HEALTH SYSTEMS, INC., A NEW YORK NOT-FOR-PROFIT CORPORATION. THE HOSPITAL IS JOINT COMMISSION ACCREDITED. AS A HEALTHCARE ORGANIZATION, ONEIDA HEALTHCARE CENTER IS GUIDED BY A MISSION OF EXCELLENCE:THE MISSION OF THE ONEIDA HEALTHCARE CENTER IS TO PLAN, PROVIDE AND COORDINATE THE HIGHEST QUALITY PROGRESSIVE AND COMPREHENSIVE HEALTH CARE SERVICES FOR THE GREATER ONEIDA AREA AND SURROUNDING COMMUNITIES.EACH YEAR THE PLANNING & DEVELOPMENT COMMITTEE OF THE BOARD OF TRUSTEES REVIEWS THE OHC MISSION STATEMENT AND STRATEGIC PLAN TO ASSURE THE MISSION IS CURRENT AND RELEVANT, AND THE STRATEGIC PLAN REFLECTS BOTH THE ORGANIZATION'S STRATEGIC PRIORITIES AND ITS MISSION. THE PURPOSE OF THIS PROCESS IS TO FOCUS THE EFFORTS OF THE ORGANIZATION ON KEY INITIATIVES SELECTED TO STRENGTHEN OHC'S ABILITY TO SERVE ITS COMMUNITY. 70882456 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 1 0 0 0 0 1 73 0 1100 1 1 1 0 0 0 0 0 0 0 0 0 X 12 9 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X ONEIDA HEALTHCARE CENTER D ROWLANDS 3153636000 321 GENESEE STREET ONEIDA NY 13421 VICTOR J SIRCHIA CHAIR 2.00 X X 0 0 0 AMANDA LARSON SECRETARY 2.00 X X 0 0 0 MICHAEL R KALLET VICE CHAIR 2.00 X X 0 0 0 MACDOUGALL JOHN 2.00 X 0 0 0 DANIEL M RATNARAJAH MD 2.00 X 56100 0 0 PETER F HEDGLON ESQ 2.00 X 0 0 0 WILLIAM F LINDSEY MD 2.00 X 528 0 0 STEVEN J POTTER 2.00 X 0 0 0 ELIZABETH METZGER 2.00 X 0 0 0 O PERRY TOOKER III 2.00 X 0 0 0 ALTHEA DAVIS 2.00 X 0 0 0 GENE MORREALE 40.00 X X 328417 0 30674 REX A NILES 2.00 X 0 0 0 DEWEY ROWLANDS 40.00 X 197260 0 27456 PAUL SCOPAC 40.00 X 164105 0 32955 DANA VICK 40.00 X 229903 0 26480 VINCENT MANEEN 40.00 X 202622 0 23989 JOHN G MARGO 40.00 X 176037 0 30226 VIGLIOTTI ANTHONY 40.00 X 150272 0 24151 CRONIN LAURIE 40.00 X 141318 0 21446 KOHLBRENNER JANIS 40.00 X 146812 0 4403 EHLINGER BRYAN G 40.00 X 134307 0 21861 WILLIS SHARON 40.00 X 125259 0 24478 2052940 0 268119 19 0 1 0 CHIRUMAMILLA HSIEH HTUN 467 FOXWOOD TERRACE ONEIDA NY 13421 PHYSICIAN SERVICES 1475940 CHIRUMAMILLA MD PC 467 FOXWOOD TERRACE ONEIDA NY 13421 PHYSICIAN SERVICES 645157 TRI-VALLEY FAMILY PRACTICE 3 CURTIS ROAD VERNON NY 13476 PHYSICIAN SERVICES 255390 FRANCISCAN MANAGEMENT 333 BUTTERNUT DRIVE DEWITT NY 13214 STAFFING SERVICES 234332 ROTHMAN ROBERT 120 EAST WASHINGTON STREET SUITE 1 SYRACUSE NY 13202 COLLECTION AGENCY 219926 8 78307 170105 85067 333479 OUTPATIENT 623000 24673028 24673028 INPATIENT ACUTE CARE 623000 18738791 18738791 EXTENDED CARE FACILITY 623000 13711887 13711887 OTHER NET PATIENT SERV 623000 13526452 13526452 EMERGENCY ROOM 623000 7370745 7370745 78020903 825614 825614 212694 337892 -125198 -125198 -125198 10508007 9674 10317015 21218 190992 -11544 179448 179448 LAUNDRY 812300 357757 357757 CAFETERIA 722210 333712 333712 OTHER INCLUDING TOBACC 900099 123123 123123 3126 3126 817718 80051964 78480864 357757 879864 1526755 919883 582096 24776 31409063 29623321 1749017 36725 3272661 3040027 231202 1432 4070076 3781429 280994 7653 2480503 2302110 174740 3653 163284 81642 81642 52530 26265 26265 169586 169586 5006503 4680774 325729 216278 216278 598262 518226 80036 821379 616034 205345 1432485 1211604 220881 139431 135122 4309 28633 24888 3745 1633793 1633793 5336381 5336381 1072033 1072033 MEDICAL SUPPLIES INCLUD 7458291 7384684 73607 BAD DEBT 4386864 4386864 EQUIPMENT AND REPAIRS 2129518 1963187 166331 NYS ASSESSMENT 960509 960509 1037915 967402 70513 75402733 70882456 4446038 74239 5805893 6485424 4946814 4324891 1106968 647609 8391493 9146990 518682 474751 3451323 7840132 102551494 57053430 41220953 45498064 34421276 34263781 1687175 3446484 101550577 112128126 3885626 9741355 30672180 29419679 3616161 5506950 16197287 22846647 54371254 67514631 X 46764089 44505255 348959 41965 66275 66275 47179323 44613495 101550577 112128126 X 4649231 -7215059 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 415234 197447 -939 -503502 108240 749703 480480 2210 -817159 415234 1779166 2151959 4360 -3185782 749703 1180994 1071306 -1956 -471178 1779166 0.07000 0.61400 0.31600 0 1 1 410847 410847 52443320 28179452 24263868 2543957 1385364 1158593 39073871 27488614 11585257 8079499 8079499 45498064 THIRD PARTY PAYOR SETTLEMENTS 4200383 PENSION PLAN LIABILITY 17985337 BLUE CROSS ADVANCE 612000 CHARITABLE GIFT ANNUITY 48927 22846647 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: PART V, LINE 4: THE ENDOWMENT FUNDS ARE TO BE USED FOR THE MAINTENANCE OF A FREE BED IN THE NAME OF A LOVED ONE PREDESIGNATED BY THE DONOR. THE PURPOSE OF THE BED IS TO ASSIST PATIENTS WHOSE NEEDS MEET SPECIFICATIONS LISTED IN THE VERBIAGE OF THE DONATION LETTER. ONEIDA HEALTHCARE FOUNDATION HOLDS $7,726 IN RESTRICTED FUNDS. ENDOWMENT FUNDS ARE FOR CONSTRUCTION IMPROVEMENTS AND EQUIPMENT FOR THE FACILITY. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: ONEIDA HEALTH SYSTEMS IS A NOT-FOR-PROFIT CORPORATION AND HAS BEEN RECOGNIZED AS TAX-EXEMPT PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. AS OF DECEMBER 31,2011 THE CENTER DID NOT HAVE ANY UNRECOGNIZED TAX BENEFITS. 1 1 X 1 X 1 X 1 1 1 0 0 667158 235778 431380 0.00570 20407685 17640531 2767154 0.03670 21074843 17876309 3198534 0.04240 16258 16258 0.00020 71746 71746 0.00100 1334 1334 0.00000 89338 89338 0.00120 21164181 17876309 3287872 0.04360 437 437 0.00000 2735 2735 0.00000 5308 5308 0.00010 8480 8480 0.00010 0 1270874 207343 12726767 15918333 -3191566 X 1 1 1 1 ONEIDA HEALTH SYSTEMS INC

321 GENESEE STREET ONEIDA NY 13421

X X X ONEIDA HEALTH SYSTEMS INC 1 1 1 100.000000000000 1 300.000000000000 1 X X X 1 1 X X X X X X 1 0 1 X 0 0 7 ONEIDA HEALTHCARE CENTER ECF

323 GENESEE ST ONEIDA NY 13421

EXTENDED CARE FACILITY CANASTOTA LENOX HEALTH CENTER

115 CENTER STREET CANASTOTA NY 13032

HOSPITAL BASED HEALTH CENTER CHITTENANGO FAMILY CARE

1372 ROUTE 5 CHITTENANGO NY 13037

HOSPITAL BASED HEALTH CENTER OB CLINIC

447 NORTH MAIN STREET ONEIDA NY 13421

HOSPITAL BASED PCAP CENTER ONEIDA HEALTHCARE REHABILITATION CENTER

221 BROAD STREET ONEIDA NY 13421

REHABILITATION FACILITY/MEDICAL OFFICES ALICE GORMAN IMAGING CENTER

139 FIELDS DRIVE ONEIDA NY 13421

IMAGING CENTER ALICE GORMAN IMAGING CENTER - CAMDEN

9562 STATE ROUTE 13 CAMDEN NY 13316

IMAGING CENTER PART I, LINE 7: FINANCIAL ASSISTANCE IS CALCULATED USING A COST TO CHARGE RATIO. DIRECT OFFSETTING REVENUE FOR FINANCIAL ASSISTANCE IS CALCULATED BY TAKING REVENUES AND A PERCENT OF THE POOL PAYMENTS BASED ON THE LOSS. PART I, L7 COL(F): PERCENT OF TOTAL EXPENSE IS CALCULATED BY TAKING THE NET COMMUNITY BENEFIT EXPENSES DIVIDED BY TOTAL FUNCTIONAL EXPENSES EXCLUDING BAD DEBT EXPENSE PART II: COMMUNITY BUILDING ACTIVITIESIN FISCAL YEAR 2011 OHC PROVIDED EDUCATIONAL ACTIVITIES FOR COMMUNITY MEMBERS IN AREAS INCLUDING WELLNESS, DIABETES EDUCATION AND SUPPORT AND A VARIETY OF OTHER HEALTH TOPICS. OHC PROVIDES MEETING SPACE FOR NUMEROUS SUPPORT GROUPS FOR INDIVIDUALS FACING EMOTIONAL AND PHYSICAL HEALTH CHALLENGES SUCH AS CANCER, SCLERODERMA, OBESITY AND PRE NATAL CARE. OHC IS AN IMPORTANT PART OF MADISON COUNTY'S PUBLIC HEALTH INFRASTRUCTURE AND BY DEVELOPING A MORE ACTIVE PARTNERSHIP WITH MADISON COUNTY'S DEPARTMENT OF HEALTH; WE ULTIMATELY CONTRIBUTE TO THE VALUE AND STRENGTH OF THE PUBLIC HEALTH SYSTEM.CONSEQUENTLY, ONEIDA HEALTHCARE CENTER PLAYED AN ACTIVE ROLE IN THE COUNTY-WIDE MAPP PROCESS, WHICH INVOLVED COMPLETION OF THE FOLLOWING FOUR ASSESSMENTS:PRIORITY STRATEGIC AREASACCESS TO HEALTH SYSTEMS: GOAL: IMPROVE ACCESS TO COMPREHENSIVE, HIGH QUALITY HEALTH CARE SERVICESCOMMUNITY ECONOMIC DEVELOPMENT:GOAL: IMPROVE ECONOMIC OPPORTUNITIES AND SOCIAL CONDITIONS IN A SUSTAINABLE WAY.HEALTH LITERACY:GOAL: IMPROVE THE DEGREE TO WHICH PEOPLE CAN OBTAIN AND PROCESS BASIC HEALTH INFORMATION AND SERVICES THEY NEED TO MAKE APPROPRIATE HEALTH DECISIONS.PUBLIC POLICY:GOAL: IMPROVE THE HEALTH OF THE COMMUNITY THROUGH LEGISLATIVE ACTION AT THE FEDERAL, STATE AND LOCAL LEVELS.AS A RESULT OF THIS COLLABORATIVE EFFORT, DATA WAS COMPILED INTO A MEANINGFUL RESOURCE THAT IDENTIFIES LOCALLY IMPORTANT PUBLIC HEALTH ISSUES AND CAN BE USED TO PLAN FOR FUTURE COMMUNITY HEALTH SERVICES. THIS DATA WAS REVIEWED AND DISCUSSED AT A "HEALTH SUMMIT" IN JULY OF 2009, RESULTING IN A CONSENSUS ON THE FOUR PRIORITY ISSUES. EXCEPT FOR ACCESS TO HEALTH SYSTEMS, MADISON COUNTY'S ISSUES DIFFER FROM THE STATE'S AGENDA ITEMS. HOWEVER, THROUGH THE MAPP PROCESS, THE COMMUNITY PARTNERS WERE IN AGREEMENT THAT TO MAKE SUBSTANTIAL IMPROVEMENTS IN THE HEALTH OF OUR RESIDENTS WE NEED TO FOCUS OUR EFFORTS TO EFFECT SYSTEMIC CHANGE. THE TEAM CONCLUDED THAT THE STRATEGIC ISSUES IDENTIFIED THROUGH OUR ASSESSMENT ACTIVITIES BEST REFLECT WHERE THESE CHANGES NEED TO OCCUR, REGARDLESS OF THE SPECIFIC HEALTH ISSUE (E.G. CHRONIC DISEASE). IN AUGUST, 2009 THE TEAM MET TO FORMULATE THE STRATEGIES THAT WILL BE USED TO ADDRESS THE FOUR STRATEGIC PRIORITIES AND THE FOLLOWING THREE PREVENTION AGENDA ITEMS.1.ACCESS TO QUALITY HEALTH CARE2.CHRONIC DISEASE & CANCER3.HEALTHY ENVIRONMENTSTHE COMMUNITY PARTNERS BELIEVED THAT WE COULD INCORPORATE THE AGENDA ITEMS INTO THE DEVELOPMENT AND TACTICAL IMPLEMENTATION OF THE STRATEGIES IDENTIFIED FOR THE PRIORITY ISSUES. FOR EXAMPLE: STRATEGIC AREA:HEALTH LITERACYSTRATEGY:IMPROVE USABILITY OF HEALTH INFORMATIONPREVENTION AGENDA:CHRONIC DISEASE & CANCERTACTICAL APPROACH:IMPROVE USABILITY OF HEALTH INFORMATION SPECIFIC TO CHRONIC DISEASE AND CANCER.ACCESS TO QUALITY HEALTHCARE AND CHRONIC DISEASES & CANCER ARE EXISTING COMMUNITY PRIORITIES THAT WILL EMPHASIZE THE ENHANCEMENT OF EXISTING PROGRAMS AS WELL AS FOCUS UPON CREATING NEW INITIATIVES WITHIN BOTH THAT CAN IMPROVE THE STATUS OF RESIDENTS. HEALTHY ENVIRONMENTS IS A NEW INITIATIVE FOR MADISON COUNTY. OHC CURRENTLY OFFERS A NUMBER OF PUBLIC HEALTH PROGRAMS INTENDED TO ADDRESS THE PRIORITIES THAT WERE ADDRESSED IN THE MAPP ASSESSMENT PROCESS. THESE PROGRAMS ARE DESCRIBED IN THE FOLLOWING LIST.PRIMARY CARE CENTERS IN CHITTENANGO AND CANASTOTA WHERE 47.5% OF THE PATIENTS SERVED ARE MEDICAID, UNDERINSURED AND LIMITED OR NO PAY PATIENTSOPERATION OF A PRE-NATAL CLINIC THAT SERVES A PATIENT POPULATION OF PREDOMINANTLY YOUNG, UNMARRIED WOMEN WITH LIMITED RESOURCES AND ACCESS TO ROUTINE MEDICAL CAREEMERGENCY DEPARTMENT THAT SERVES AS A SAFETY NET FOR PATIENT ACCESS TO SERVICESHEALTHY WOMEN'S PARTNERSHIP, A PROGRAM THAT PROVIDES MAMMOGRAMS AND CLINICAL BREAST EXAMINATIONS TO LOW INCOME WOMENOPERATION OF OFFSITE PHLEBOTOMY STATIONS TO INCREASE ACCESS TO THESE SERVICES AND PATIENT CONVENIENCEDIABETES EDUCATION SERVICES AND PARTICIPATION IN THE SHINE DIABETES RESEARCH STUDY SPONSORED BY SUNY MEDICAL UNIVERSITY TO IMPROVE OUTCOMES FOR DIABETES THROUGH EDUCATIONAL AND WEIGHT LOSS PROTOCOLSMEMBER OF TRI-COUNTY QUITS SMOKING CESSATION CONSORTIUM THAT PROVIDES SMOKING CESSATION PROGRAMS TO THE COMMUNITYPROVIDING FREE FLU SHOT CLINICS IN CAMDEN, CHITTENANGO AND CANASTOTAPROVIDING A VARIETY OF HEALTH EDUCATION SERVICES DIRECTLY AND THROUGH PARTICIPATION IN COMMUNITY HEALTH FAIRS AND SCREENINGSOPERATING THE BABY WEIGH STATION THAT PROVIDES LACTATION CONSULTATION TO NEW MOTHERS, EDUCATION ABOUT BREAST FEEDING, AND ONGOING WEIGHT MONITORING PROGRAMS FOR NEWBORN INFANTSPATIENT SUPPORT GROUPS INCLUDING CANCER SUPPORT, LAMAZE CLASSES AND OTHERSPROVIDING THE SERVICES OF TRAINED AND CERTIFIED SEXUAL ASSAULT NURSE EXAMINERS (SANE) IN OUR EMERGENCY DEPARTMENTPROVIDING LOCAL ACCESS TO HOSPITAL BASED PRIMARY AND SECONDARY CARE SERVICES AND ACCESS TO SPECIALTY CARE THROUGH AFFILIATIONS WITH SPECIALIST PHYSICIAN GROUPS AND REFERRAL HOSPITALS. PART III, LINE 4: SIGNIFICANT ESTIMATES MADE BY THE CENTER INCLUDE BUT ARE NOT LIMITED TO, THE ESTIMATED CARRYING VALUE OF INVESTMENT SECURITIES, ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND THIRD PARTY PAYER CONTRACTUAL ADJUSTMENTS, ESTIMATED THIRD PARTY PAYABLES, AND ASSUMPTIONS USED IN DETERMINING PENSION AND POSTRETIREMENT LIABILITIES AND RESULTANT BALANCES. THE CURRENT ECONOMIC ENVIRONMENT HAS INCREASED THE DEGREE OF UNCERTAINTY INHERENT IN THOSE ESTIMATES AND ASSUMPTIONS.THE ALLOWANCE FOR DOUBTFUL ACCOUNTS RECEIVABLE IS CALCULATED BY MANAGEMENT USING THE AGING METHODOLOGY. IN GENERAL, THE LONGER AN ACCOUNT BALANCE IS OVERDUE, THE LESS LIKELY THE DEBT IS TO BE PAID. THE HOSPITAL MAINTAINS AN ACCOUNTS RECEIVABLE AGING SCHEDULE, WHICH CATEGORIZES EACH PATIENT'S ACCOUNT BY THE LENGTH OF TIME THEY HAVE BEEN OUTSTANDING. EACH AGED CATEGORY'S OVERALL BALANCE IS MULTIPLIED BY AN ESTIMATED PERCENTAGE OF UNCOLLECTIBILITY FOR THAT CATEGORY, AND THE TOTAL OF ALL SUCH CALCULATIONS SERVES AS THE ESTIMATE OF BAD DEBTS. THE ACCOUNTS RECEIVABLE AGING SCHEDULE IS CATEGORIZED BY SERVICE INCLUDING INPATIENT, EMERGENCY ROOM, REFERRED AMBULATORY, AMBULATORY SURGERY, SERIES AND NURSING HOME. EACH SERVICE IS THEN SUB-CATEGORIZED BY FINANCIAL CLASS AND AGED CATEGORY. EACH AGED CATEGORY IS DELINEATED BY 30 DAY INCREMENTS UP TO 180 DAYS OUTSTANDING THEN 180 TO 360 AND OVER 361 DAYS OUTSTANDING. THE ALLOWANCE FOR DOUBTFUL ACCOUNTS RECEIVABLE CALCULATION IS THE RESULT OF THE FOLLOWING:FOR ALL ACCOUNTS RECEIVABLE EXCLUSIVE OF SELF PAY, 10% OF THE EXPECTED PAYMENT FOR ALL ACCOUNTS THAT ARE BETWEEN 0 AND 180 DAYS OUTSTANDING ARE RESERVED FOR BAD DEBT AT 90% OF THE EXPECTED PAYMENT. FOR ALL ACCOUNTS THAT ARE OVER 181 DAYS OUTSTANDING, THE RESERVE FOR BAD DEBT IS 90%. THIS CALCULATION IS USED PRIMARILY TO ESTIMATE THE UNCOLLECTIBILITY OF DEDUCTIBLES AND COINSURANCE AFTER INSURANCE PAYMENTS.FOR ALL SELF PAY PATIENTS BETWEEN 0 AND 120 DAYS OLD, 75% OF THE EXPECTED PAYMENT OUTSTANDING IS RESERVED FOR BAD DEBT AND FOR ALL SELF PAY ACCOUNTS OVER 121 DAYS OLD, 91% OF THE EXPECTED SELF PAY PAYMENT IS RESERVED FOR BAD DEBT.THE ALLOWANCE FOR BAD DEBT RESERVE THAT IS CALCULATED MONTHLY IS COMPARED TO THE ACTUAL RESERVE PER THE GENERAL LEDGER AND ADJUSTED ACCORDINGLY.THE COSTING METHODOLOGY USED IN DETERMINING THE AMOUNTS REPORTED ON LINES 2 AND 3: THE RATIO OF COST TO CHARGES.THE RATIONALE FOR INCLUDING OTHER BAD DEBT AMOUNTS IN COMMUNITY BENEFIT IS BECAUSE ONEIDA HEALTHCARE CENTER (OHC) HAS SEEN A SUBSTANTIAL INCREASE IN THE VOLUME OF SELF PAY PATIENTS DUE TO EMPLOYERS CLOSING, REDUCING STAFF OR REDUCING THE HEALTH INSURANCE BENEFITS THAT THEY OFFER THEIR EMPLOYEES. DEDUCTIBLE AND CO-INSURANCE AMOUNTS HAVE INCREASED OVER THE PAST FEW YEARS, MUCH TO THE SURPRISE OF OUR PATIENTS. OHC HAS SEEN AN INCREASE IN PATIENT PHONE CALLS, ON SITE VISITS AND CONCERNS RELATIVE TO BALANCE BILLING. OHC STAFF IS AVAILABLE TO DISCUSS PATIENT OPTIONS TO RESOLVE THEIR OUTSTANDING BALANCES. THE HOSPITAL OFFERS FINANCIAL ASSISTANCE BASED ON 300% OF THE FEDERAL POVERTY GUIDELINES. PATIENTS RECEIVE A PAMPHLET OUTLINING THE FINANCIAL ASSISTANCE PROGRAM AND ALLOWANCES WITH EACH ORIGINAL STATEMENT. APPLICATIONS CAN BE OBTAINED AT THE HOSPITAL, HOSPITAL CLINICS, REGISTRATION DEPARTMENT AND THE BUSINESS OFFICE. OHC ALSO WORKS WITH AN OUTSIDE AGENCY, AHC, TO ASSIST PATIENTS IN APPLYING FOR MEDICAID OR OTHER STATE RUN PROGRAMS FOR LOW INCOME FAMILIES. OHC ALSO OFFERS PAYMENT PLANS FOR THOSE PATIENTS WHO ARE UNABLE TO PAY A BALANCE IN FULL. HOSPITAL REPRESENTATIVES WORK WITH PATIENTS TO DEVELOP A PAYMENT PLAN THAT IS AFFORDABLE BY THE PATIENT AND IS REASONABLE FOR THE HOSPITAL. ASSISTANCE WITH ANY FINANCIAL ASPECT IS OFFERED BY THE HOSPITAL BUSINESS OFFICE STAFF. A BUSINESS OFFICE EMPLOYEE IS ALSO LOCATED IN THE HOSPITAL'S REGISTRATION DEPARTMENT, MONDAY THROUGH FRIDAY FROM 9:00 A.M. TO 5:00 P.M. PATIENTS ARE ABLE TO SCHEDULE APPOINTMENTS WITH BUSINESS OFFICE REPRESENTATIVES TO DISCUSS THEIR OPTIONS. THE BUSINESS OFFICE HAS ALSO ASSISTED PATIENTS WITH BILLINGS THEY MAY HAVE FROM OTHER PROVIDERS WHEN THE PATIENT JUST DOES NOT KNOW OR UNDERSTAND HOW TO HANDLE THE RESOLUTION OF THE ACCOUNTS.IN MANY CASES PATIENTS UTILIZE OUR EMERGENCY ROOM SERVICES FOR TREATMENT OF NON-EMERGENT CARE. UNINSURED PATIENTS ARE ROUTINELY UNEMPLOYED PATIENTS AND THEREFORE IT IS DIFFICULT TO COLLECT PAYMENT FOR SERVICES RENDERED. PATIENTS WHO ARE UNINSURED OFTEN DO NOT SEEK CARE UNTIL IT IS ABSOLUTELY NECESSARY, THEREFORE CREATING A LARGE BALANCE DUE FOR EMERGENCY ROOM SERVICES. BECAUSE PROVIDERS CANNOT ASK FOR PREVIOUS TAX RETURNS TO MAKE DETERMINATIONS FOR FINANCIAL ASSISTANCE IT IS DIFFICULT AT TIMES TO ACCURATELY DETERMINE PERCENTAGES FOR FINANCIAL ASSISTANCE. OHC DECISIONS FOR FINANCIAL ASSISTANCE ARE MADE IN FAVOR OF THEIR PATIENTS WHEN IN DOUBT. OHC HAS RECENTLY UPDATED THE FINANCIAL ASSISTANCE POLICIES WITH PARAMETERS THAT ALLOW MORE PATIENTS TO QUALIFY FOR THIS ASSISTANCETHERE ARE TIMES WHEN PATIENTS DO NOT WANT TO APPLY FOR ASSISTANCE AS THEY DO NOT WANT ANYONE TO KNOW THEY NEED THE ASSISTANCE. OHC HAS MADE DECISIONS TO APPROVE FINANCIAL ASSISTANCE FOR PATIENTS BASED ON A CASE BY CASE SITUATION WHERE IT IS CLEARLY EVIDENT THE PATIENT NEEDS HELP.COSTLY CARE, UNDER FUNDED RATES FROM PAYERS, DELAYS IN PAYMENTS AND INCREASED DENIALS HAVE PUT A BURDEN ON ALL HEALTH CARE FACILITIES.ONEIDA HEALTHCARE OFFERS FREE, CONFIDENTIAL ASSISTANCE. ALL PATIENTS CAN CONTACT OUR FINANCIAL COUNSELORS AT 361-2087 OR 361-2048. PART III, LINE 8: THE EXTENT TO WHICH ANY SHORTFALL REPORTED IN LINE 7 SHOULD BE TREATED AS A COMMUNITY BENEFIT IS BECAUSE THE CURRENT HEALTHCARE OPERATING ENVIRONMENT IS VERY CHALLENGING IN GENERAL WITH GREAT UNCERTAINTY ABOUT THE IMPACT OF REFORM AND THE CURRENT ECONOMIC SITUATION. LIKE MANY RURAL HOSPITALS, ONEIDA HEALTHCARE FACES THESE AND OTHER CHALLENGES TO ITS ABILITY TO CONTINUE TO SUPPORT ITS SERVICES. RECRUITMENT OF PHYSICIANS TO RURAL AREAS IS A HUGE CHALLENGE FOR HOSPITALS LIKE ONEIDA. OUR LONG TERM ABILITY TO IMPROVE ACCESS TO CARE IS HIGHLY DEPENDENT ON SUCCESSFULLY RECRUITING PHYSICIANS. RECRUITMENT HAS BECOME MORE DIFFICULT AND IS LIKELY TO CONTINUE TO BE A HUGE CHALLENGE GOING FORWARD. NEVERTHELESS, IT IS A HIGH PRIORITY FOR ONEIDA HEALTHCARE. THE HOSPITAL CURRENTLY OFFERS A NUMBER OF PUBLIC HEALTH PROGRAMS INTENDED TO ADDRESS THE PRIORITIES THAT WERE ADDRESSED IN THE MAPP ASSESSMENT PROCESS. THESE PROGRAMS ARE DESCRIBED IN THE FOLLOWING LIST.PRIMARY CARE CENTERS IN CHITTENANGO AND CANASTOTA WHERE 46% OF THE PATIENTS SERVED ARE MEDICAID, UNDERINSURED AND LIMITED OR NO PAY PATIENTSOPERATION OF A PCAP PRE-NATAL CLINIC THAT SERVES A PATIENT POPULATION OF PREDOMINANTLY YOUNG, UNMARRIED WOMEN WITH LIMITED RESOURCES AND ACCESS TO ROUTINE MEDICAL CAREEMERGENCY DEPARTMENT THAT SERVES AS A SAFETY NET FOR PATIENT ACCESS TO SERVICESHEALTH WOMEN'S PARTNERSHIP, A PROGRAM THAT PROVIDES MAMMOGRAMS AND CLINICAL BREAST EXAMINATIONS TO LOW INCOME WOMENCOLORECTAL SCREENING PROGRAM THAT PROVIDED SERVICES TO LOW INCOME AND UNDERINSURED PEOPLEOPERATION OF OFFSITE PHLEBOTOMY STATIONS TO INCREASE ACCESS TO THESE SERVICES AND PATIENT CONVENIENCEDIABETES EDUCATION SERVICES AND PARTICIPATION IN THE SHINE DIABETES RESEARCH STUDY SPONSORED BY SUNY MEDICAL UNIVERSITY TO IMPROVE OUTCOMES FOR DIABETES THROUGH EDUCATIONAL AND WEIGHT LOSS PROTOCOLSMEMBER OF TRI-COUNTY QUITS SMOKING CESSATION CONSORTIUM THAT PROVIDES SMOKING CESSATION PROGRAMS TO THE COMMUNITYPROVIDING FREE FLU SHOT CLINICS IN CAMDEN, CHITTENANGO AND CANASTOTAPROVIDING A VARIETY OF HEALTH EDUCATION SERVICES DIRECTLY AND THROUGH PARTICIPATION IN COMMUNITY HEALTH FAIRS AND SCREENINGSOPERATING THE BABY WEIGH STATION THAT PROVIDES LACTATION CONSULTATION TO NEW MOTHERS, EDUCATION ABOUT BREAST FEEDING, AND ONGOING WEIGHT MONITORING PROGRAMS FOR NEWBORN INFANTSPATIENT SUPPORT GROUPS INCLUDING CANCER SUPPORT, LAMAZE CLASSES AND OTHERSPROVING THE SERVICES OF TRAINED AND CERTIFIED SEXUAL ASSAULT NURSE EXAMINERS (SANE) IN OUR EMERGENCY DEPARTMENTPROVIDING LOCAL ACCESS TO HOSPITAL BASED PRIMARY AND SECONDARY CARE SERVICES AND ACCESS TO SPECIALTY CARE THROUGH AFFILIATIONS WITH SPECIALIST PHYSICIAN GROUPS AND REFERRAL HOSPITALS.COSTING METHODOLOGY AND SOURCE FOR LINE 6: 2011 ICR EXHIBIT 46 AND TENTATIVE MEDICARE SETTLEMENT RATES. PART III, LINE 9B: IF THE PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE NO FURTHER COLLECTION ACTIONS ARE TAKEN. PART VI, LINE 2: NEEDS ASSESSMENT: ONEIDA HEALTHCARE CENTER (OHC) IS COMMITTED TO HELPING ASSESS AND ADDRESS THE HEALTHCARE NEEDS OF THE COMMUNITIES IT SERVES THROUGH ITS OWN PROGRAMS AND SERVICES, AND PARTNERSHIP WITH OTHERS. A COMMUNITY ASSESSMENT IS A POINT IN TIME EFFORT TO MEASURE THE HEALTH AND WELL BEING OF THE COMMUNITY. IT SERVES AS A BASIS FOR OHC'S STRATEGIC AND SUBSEQUENT ACTION PLANNING TO DEVELOP HEALTH POLICY, ALLOCATE RESOURCES, IMPROVE OR EXPAND EXISTING SERVICES, IMPLEMENT NEW PROGRAMS AND COLLABORATE WITH OTHER COMMUNITY HEALTHCARE PROVIDERS. THE COMMUNITY ASSESSMENT WILL SERVE AS A BENCHMARK FOR FUTURE ASSESSMENT OF RELATIVE PROGRESS TOWARD ESTABLISHED COMMUNITY HEALTH OBJECTIVES.OHC'S PARTICIPATION IN THE COMMUNITY ASSESSMENT WILL PROVIDE THE OPPORTUNITY TO:- GAIN INSIGHTS INTO THE NEEDS AND ASSETS OF THE COMMUNITIES' SERVED- IDENTIFY AND ADDRESS THE NEEDS OF VULNERABLE POPULATIONS WITHIN THE COMMUNITY- ENHANCE HOSPITAL / COMMUNITY RELATIONSHIPS AND THE OPPORTUNITY FOR COLLABORATIVE COMMUNITY ACTION INCLUDING INVOLVEMENT WITH PARTNERSHIPS, BOARDS, COMMITTEE, COMMISSIONS, ADVISORY GROUPS AND PANELS- PROVIDE THE INFORMATION REQUIRED FOR COMMUNITY OUTREACH PLANNING.THE COMMUNITY NEEDS ASSESSMENT PROCESS INVOLVES GATHERING OF TWO TYPES OF DATA: QUANTITATIVE (DEMOGRAPHICS, HEALTH INDICATORS, ETC.) AND QUALITATIVE (PUBLIC SURVEYS, FORUMS, FOCUS GROUPS). THE DATA WILL HELP SUPPORT SHORT TERM AND LONG TERM DECISIONS ABOUT ALLOCATION OF COMMUNITY HUMAN AND CAPITAL RESOURCES.OHC PARTICIPATED IN JANUARY 2008 WITH VARIOUS LOCAL AGENCIES AND ORGANIZATIONS CONVENED AT THE MADISON COUNTY DEPARTMENT OF HEALTH'S CONFERENCE ROOM TO EMBARK UPON A COMPREHENSIVE HEALTH IMPROVEMENT PROCESS FOR MADISON COUNTY. OCTOBER OF 2009 THE HEALTH IMPROVEMENT PLANNING REPORT FOR MADISON COUNTY WAS PUBLISHED. THE STRATEGIES IDENTIFIED DURING THE COMMUNITY HEALTH ASSESSMENT INCLUDED 1) ACCESS TO HEALTHCARE 2) CHRONIC DISEASE AND CANCER 3) HEALTHY ENVIRONMENTS. THE REPORT WILL PROVIDE THE BASIS OF THE SECOND PHASE OF THE MAPP PROCESS.OHC GATHERS VITAL SOCIO ECONOMIC AND DEMOGRAPHIC FACTORS TO SUPPORT INTERNAL DECISION MAKING FOR RESOURCE ALLOCATION AND TO DETERMINE GEOGRAPHIC LOCATION OF NEW PROGRAMS AND TO MEET EMERGING NEEDS PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE OHC IS COMMITTED TO:1)PROVIDING ACCESS TO QUALITY HEALTHCARE SERVICES WITH COMPASSION, DIGNITY AND RESPECT FOR THOSE WE SERVE, PARTICULARLY THE POOR AND THE UNDERSERVED IN OUR COMMUNITIES.2)CARING FOR ALL PERSONS, REGARDLESS OF THEIR ABILITY TO PAY FOR SERVICES3)ASSISTING PATIENTS WHO CANNOT PAY FOR PART OR ALL OF THE CARE THEY RECEIVE4)BALANCING NEEDED FINANCIAL ASSISTANCE FOR SOME PATIENTS WITH BROADER FISCAL RESPONSIBILITIES IN ORDER TO SUSTAIN VIABILITY AND PROVIDE THE QUALITY AND QUANTITY OF SERVICES FOR ALL WHO MAY NEED CARE IN A COMMUNITY.IN ACCORDANCE WITH NEW YORK STATE RECOMMENDATIONS, OHC HAS ADOPTED THE FOLLOWING GUIDING PRINCIPLES WHEN HANDLING THE BILLING, COLLECTION AND FINANCIAL SUPPORT FUNCTIONS OF OUR PATIENTS:1)PROVIDE EFFECTIVE COMMUNICATIONS WITH PATIENTS REGARDING HOSPITAL BILLS.2)MAKE AFFIRMATIVE EFFORTS TO HELP PATIENTS APPLY FOR PUBLIC AND PRIVATE FINANCIAL SUPPORT PROGRAMS.3)OFFER FINANCIAL SUPPORT TO PATIENTS WITH LIMITED NEEDS.4)IMPLEMENT POLICIES FOR ASSISTING LOW INCOME PATIENTS IN A CONSISTENT MANNER5)IMPLEMENT FAIR AND CONSISTENT BILLING AND COLLECTION PRACTICES FOR ALL PATIENTS AND PATIENT PAYMENT OBLIGATIONS.OHC IS COMMITTED TO EFFECTIVELY COMMUNICATING WITH PATIENTS REGARDING PATIENT PAYMENT OBLIGATIONS. NOTIFICATION OF THE FINANCIAL ASSISTANCE POLICY WILL BE POSTED AT EACH REGISTRATION SITE INCLUDING BUT NOT LIMITED TO THE HOSPITAL REGISTRATION DEPARTMENT, THE EMERGENCY ROOM, LAB DRAW STATIONS, PHYSICAL THERAPY BUILDING, THE GORMAN BUILDING AND AT THE CLINICS. NOTIFICATION OF THE FINANCIAL ASSISTANCE POLICY WILL BE IDENTIFIED ON THE FIRST BILLING SENT TO ALL PATIENT/GUARANTORS WHO HAVE AN OPEN BALANCE WITH THE HOSPITAL. SIGNS INFORMING PATIENTS OF THE FINANCIAL ASSISTANCE PROGRAM, IN VARIOUS LANGUAGES, WILL ALSO BE POSTED AT EACH REGISTRATION INPUT AREA BASED ON THE SAMPLE LANGUAGE FORMAT FROM THE NEW YORK STATE DEPARTMENT OF HEALTH. THE BROCHURE PROVIDES INFORMATION REGARDING PAYMENT OPTIONS, FINANCIAL ASSISTANCE AND BILLING QUESTIONS. EVERY EFFORT IS MADE TO DETERMINE A PATIENTS ELIGIBILITY PRIOR TO OR AT THE TIME OF ADMISSION HOWEVER, DETERMINATION FOR FINANCIAL SUPPORT CAN BE MADE DURING ANY STAGE OF THE PATIENTS STAY AFTER STABILIZATION OR COLLECTION CYCLE. OHC OFFERS FINANCIAL SUPPORT TO PATIENTS WITH LIMITED MEANS. THIS SUPPORT IS AVAILABLE TO UNINSURED AND UNDERINSURED PATIENTS WHO DO NOT QUALIFY FOR PUBLIC PROGRAMS OR OTHER ASSISTANCE. NOTIFICATION ABOUT FINANCIAL ASSISTANCE IS AVAILABLE THROUGH VARIOUS MEANS, PATIENT BROCHURES, NOTICES OR MESSAGING INCLUDED ON PATIENT BILLS AND NOTICES IN PUBLIC REGISTRATION AREAS, INCLUDING EMERGENCY ROOM, OUTPATIENT CLINICS, ADMITTING AND REGISTRATION DEPARTMENTS AND PATIENT ACCOUNTING DEPARTMENTS. OHC HAS ESTABLISHED A COLLECTION CYCLE POLICY FOR THE BILLING, COLLECTION AND SUPPORT FOR PATIENTS WITH PAYMENT OBLIGATIONS. OHC MAKES EVERY EFFORT TO ADHERE TO THE POLICY AND IS COMMITTED TO IMPLEMENTING AND APPLYING THE POLICY FOR ASSISTING PATIENTS WITH LIMITED MEANS IN A PROFESSIONAL CONSISTENT MANNER. PART VI, LINE 4: COMMUNITY INFORMATIONOHC SERVES A FOUR COUNTY SERVICE AREA WITHIN A 25 MILE RADIUS STRETCHING IN EVERY DIRECTION FROM THE CITY OF ONEIDA. THE PRIMARY SERVICE ZIP CODES ARE LOCATED IN MADISON AND ONEIDA COUNTIES WHILE THE SECONDARY SERVICE ZIP CODES ARE LOCATED IN ONONDAGA AND OSWEGO COUNTIES. IN 2011 THE 4 COUNTY MARKET AREA SERVED HAD AN ESTIMATED POPULATION OF 121,000.THERE ARE NINE HOSPITALS WITHIN OHC'S SERVICE AREA THAT REPRESENT 95% OF THE MARKET PENETRATION. FOUR OF THE HOSPITALS PROVIDE PRIMARY HEALTH SERVICES WITHIN THE MARKET AREA SERVED BY OHC. WHILE THE OTHER FIVE HOSPITALS THREE TO THE WEST OF OHC BY FORTY FIVE MINUTES AND 2 TO THE EAST OF OHC BY 35 MINUTES PROVIDE TERTIARY CARE FOR THIS AREA.OHC'S MARKET SHARE FOR THE FOUR COUNTY SERVICE AREA IS STABLE AT 27 PERCENT AS REPORTED BY THE HOSPITAL ASSOCIATION OF NEW YORK.ACCORDING TO THE US CENSUS BUREAU OHC'S SERVICE AREA EXPERIENCED A .47 PERCENT INCREASE IN POPULATION FROM 2000-2009, THE 2014 POPULATION PROJECTION DOCUMENTS AN ADDITIONAL .53 PERCENT INCREASE. THE STRESS THAT THIS TREND PLACES ON THE PROVISION OF SERVICES IS COMPOUNDED BY THE HIGHER THAN AVERAGE PROPORTION OF ELDERLY IN THE AREA. FOURTEEN PERCENT OF THE POPULATION IN THE SERVICE AREA WAS OVER AGE 65 IN 2011, COMPARED TO 13 PERCENT FOR THE NATION. THIS LARGE PERCENTAGE OF ELDERLY PRESENTS SPECIAL CHALLENGES TO HEALTH CARE PROVIDERS BECAUSE THE ELDERLY HAVE THE HIGHEST INCIDENCE OF DISEASE AND MORTALITY IN MOST CATEGORIES AND CORRESPONDINGLY, ARE THE BIGGEST USERS OF HEALTH CARE SERVICES. MEDICARE PAYMENT SHORTFALLS PRESENT AN ADDITIONAL BURDEN FOR RURAL HEALTH CARE PROVIDERS. FOR FISCAL YEAR 2011 28.7% OF OHC'S REVENUES WERE GENERATED FROM MEDICARE PATIENTS.THE AVERAGE HOUSEHOLD INCOME IN OHC'S SERVICE AREA IS ESTIMATED AT $50,296; INDIVIDUALS EARNING LESS THAN $25,000 COMPRISE TWENTY PERCENT OF THE POPULATION. OHC IS A DISPROPORTIONATE SHARE HOSPITAL. IN FISCAL YEAR 2011 OUR GENERAL ADMITTANCE PAYER MIX FOR MEDICARE (INCLUDING HMO MEDICARE) WAS FORTY SEVEN PERCENT AND TWENTY PERCENT FOR THE POOR AND UNDERSERVED. FOR FISCAL YEAR 2011 PAYER MIX FOR THE POOR AND UNDERSERVED IN EMERGENCY DEPARTMENT WAS THIRTY PERCENT. PRIORITIES OF OUR EMERGENCY ROOM PHYSICIANS INCLUDE AUGMENTING ACCESS TO CARE FOR UNINSURED AND UNDERINSURED INDIVIDUALS, FACILITATING CONNECTION WITH ONE OF OHC'S TWO ARTICLE 28 OUTPATIENT CLINICS AND THE PRIMARY CARE PHYSICIANS IN THE SURROUNDING AREAS.OHC WORKS IN COLLABORATION WITH LOCAL COMMUNITY ORGANIZATIONS TO ADDRESS THE PREVALENCE OF OBESITY, DIABETES, HEART DISEASE/STROKE, AND UNDER AGE PREGNANCY. OHC OFFERS A DISCOUNTED DIABETES PROGRAM. OHC PARTICIPATES IN A HEALTHY WOMEN'S PARTNERSHIP THAT PROVIDES MAMMOGRAMS AND CLINICAL BREAST EXAMS TO LOW INCOME WOMEN, COLORECTAL SCREENING TO LOW INCOME AND UNDER INSURED MEN, DIABETES EDUCATION SERVICES AND PARTICIPATION IN THE SHINE DIABETES RESEARCH STUDY SPONSORED BY SUNY MEDICAL UNIVERSITY TO IMPROVE OUTCOMES FOR DIABETES THROUGH EDUCATION AND WEIGHT CONTROL. OHC IS A MEMBER OF TRI-COUNTY QUITS SMOKING CESSATION CONSORTIUM THAT PROVIDES SMOKING CESSATION PROGRAMS TO THE COMMUNITY. PART VI, LINE 5: OTHER INFORMATION:ONE HUNDRED PERCENT OF OHC'S SURPLUS REVENUE IN INVESTED BACK INTO SUPPORTING THE ORGANIZATIONS MISSION AND VISION. OHC IS GOVERNED BY A TWELVE MEMBER BOARD WHO WORK AND LIVE WITHIN THE PRIMARY AND SECONDARY MARKET AREA OF THE HOSPITAL. OUR GOVERNANCE STRUCTURE ENSURES THAT THE COMMUNITY AND IT'S INTERESTS ARE STRONGLY REPRESENTED IN IMPORTANT DECISION MAKING. IN ADDITION, TWO SEATS ON OHC'S BOARD ARE ALLOCATED TO THE CITY OF ONEIDA, WHO HELP INSURE THE ORGANIZATION REMAINS TRUE TO ITS MISSION AND TAX EXEMPT PURPOSE.OHC MAINTAINS AN OPEN MEDICAL STAFF- MEDICAL STAFF PRIVILEGES ARE EXTENDED TO ALL QUALIFIED PHYSICIANS. OHC ACTIVELY RECRUITS, INCLUDING EMPLOYING WHEN NECESSARY. OHC HAS ASSISTED IN RECRUITING A PRIMARY CARE PHYSICIAN INTO A DESIGNATED UNDER SERVED AREA.OHC PROVIDES EMERGENCY SERVICES TO ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY FOR SERVICES. PART VI, LINE 6: ONEIDA HEALTH SYSTEM'S INC. (DBA ONEIDA HEALTHCARE CENTER) (OHC) IS A NEW YORK STATE NOT FOR PROFIT CORPORATION, TAX EXEMPT UNDER SECTION 501(3) OF THE IRC. THE SYSTEM INCLUDES ONE CAPTIVE PROFESSIONAL CORPORATION, ONEIDA MEDICAL P.C., A MULTI SPECIALTY PHYSICIAN GROUP. THE PC IS THE VEHICLE THROUGH WHICH PHYSICIANS ARE EMPLOYED TO SERVE THE COMMUNITY. REPORTS FILED WITH STATES PART VI, LINE 7 NY X X X X X 0 0 0 0 0 0 0 0 0 GENE MORREALE 274653 0 46458 0 7306 0 17390 0 13284 0 359091 0 0 0 DEWEY ROWLANDS 160248 0 28703 0 8309 0 14222 0 13234 0 224716 0 0 0 PAUL SCOPAC 140956 0 21337 0 1812 0 17321 0 15634 0 197060 0 0 0 DANA VICK 229879 0 0 0 24 0 14135 0 12345 0 256383 0 0 0 VINCENT MANEEN 112645 0 89935 0 42 0 22427 0 1562 0 226611 0 0 0 JOHN G MARGO 118545 0 54912 0 2580 0 16592 0 13634 0 206263 0 0 0 VIGLIOTTI ANTHONY 150010 0 250 0 12 0 6117 0 18034 0 174423 0 0 0 CRONIN LAURIE 137045 0 4250 0 23 0 8812 0 12634 0 162764 0 0 0 KOHLBRENNER JANIS 137957 0 8795 0 60 0 4403 0 0 0 151215 0 0 0 EHLINGER BRYAN G 107371 0 22718 0 4218 0 8380 0 13481 0 156168 0 0 0 MADISON COUNTY INDUSTRIAL DEVELOPMENT ASSOCIATION 521325841 2007-11-01 12800000 OR/ICU/ER RENOVATIONS 0 0 0 12800000 933288 493466 651279 2010 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 DR DANIEL RATNARAJAH PHYSICIAN INCOME GUARANTEE X 390507 18167 0 1 1 18167 ONEIDA SURGICAL GROUP PC ENTITY 25% OWNED BY WILLIAM F. LINDSEY, MD 182500 BOARD MEMBER WILLIAM F. LINDSEY, MD IS A MEMBER OF ONEIDA SURGICAL GROUP, PC. THE SURGICAL GROUP PROVIDES ON-CALL SERVICES TO THE HOSPITAL. 0 FORM 990, PART VI, SECTION B, LINE 11 THE FOLLOWING DESCRIBES THE PROCESS BY ONEIDA HEALTH SYSTEMS PRIOR TO FILING THE FORM 990 REPORT: THE FORM 990 WHEN COMPLETED IS REVIEWED BY THE FINANCE COMMITTEE OF THE BOARD. THE MOST ESSENTIAL PARTS OF THE FORM 990 INCLUDING THE SECTIONS ON EXECUTIVE COMPENSATION AND CONFLICTS OF INTEREST ARE REVIEWED WITH THE EXECUTIVE COMMITTEE IN DETAIL. THE COMMUNITY BENEFIT AND FINANCIAL STATEMENT DATA IS PERIODICALLY REVIEWED WITH THE FINANCE COMMITTEE AND THE ENTIRE BOARD OF DIRECTORS. THE FORM 990 IS APPROVED BY THE BOARD ON A CONSENT AGENDA BEFORE FILING. FORM 990, PART VI, SECTION B, LINE 12C ONEIDA HEALTH SYSTEMS INC. REQUIRES ALL DIRECTORS AND KEY EMPLOYEES TO DISCLOSE ANNUALLY INTERESTS THAT COULD GIVE RISE TO CONFLICTS. THE CONFLICT OF INTEREST STATEMENTS ARE SUMMARIZED AND REVIEWED BY MANAGEMENT, COUNCIL AND THE EXECUTIVE COMMITTEE OF TRUSTEES TO IDENTIFY POTENTIAL CONFLICTS OF INTERESTS. WHEN A POTENTIAL CONFLICT IS IDENTIFIED (FOR EXAMPLE BY RECUSING INTERESTED PARTIES FROM CERTAIN BOARD VOTES OR ENGAGING IN COMPETITIVE BIDDING FOR CONTRACTS) ANY CONFLICT IS DOCUMENTED IN THE BOARD MINUTES. FORM 990, PART VI, SECTION B, LINE 15 ONEIDA HEALTH SYSTEMS INC. HAS AN EXECUTIVE COMMITTEE OF TRUSTEES TO REVIEW THE PERFORMANCE AND COMPENSATION OF THE PRESIDENT AND ALL VICE PRESIDENTS. THE COMPENSATION COMMITTEE UTILIZED COMPENSATION COMPARABILITY DATA FROM YAFEE AND COMPANY AND IROQUOIS HEALTH ASSOCIATION TO SUPPORT THE DETERMINATION OF SALARY FOR THE SELECTED POSITIONS AND CONTEMPORIOUS SUBSTANTIATION INCLUDING COMMITTEE MINUTES. RELATIVE TO OFFICERS AND KEY EMPLOYEES THE CEO UTILIZES COMPENSATION COMPARABILITY DATA FROM YAFEE AND COMPANY AND IROQUOIS HEALTHCARE ASSOCIATION ALONG WITH ANNUAL PERFORMANCE EVALUATIONS TO DETERMINE THE COMPENSATION OF THESE AFOREMENTIONED INDIVIDUALS. THE COMPENSATION SURVEY DATA UTILIZED ARE FROM COMPARABLE SIZED NOT FOR PROFIT HEALTHCARE FACILITIES LOCATED IN RELATIVELY THE SAME REGION AS ONEIDA HEALTH SYSTEMS INC. FORM 990, PART VI, SECTION C, LINE 19 ONEIDA HEALTH SYSTEMS INC. WILL MAKE ITS GOVERNING DOCUMENTS AVAILABLE TO THE PUBLIC UPON REQUEST AND PURSUANT TO INTERNAL REVENUE SERVICE GUIDELINES. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -773,944. FORGIVENESS OF TERM NOTE 368,532. CHANGE IN INTEREST IN NET ASSETS OF FOUNDATION -23,039. RETIREMENT PLAN OBLIGATION CHANGES OTHER THAN NET PERIODIC BENEFIT COST -5,830,115. CUMULATIVE EFFECT IN CHANGE IN ACCOUNTING PRINCIPLE -900,000. CHANGE IN GRANT -56,493. TOTAL TO FORM 990, PART XI, LINE 5: -7,215,059. ON JANUARY 1, 2011 ONEIDA HEALTH SYSTEMS ADOPTED ACCOUNTING STANDARDS UPDATE 2010-24, HEALTH CARE ENTITIES: PRESENTATION OF INSURANCE CLAIMS AND RELATED INSURANCE RECOVERIES. THE ASU REQUIRES THAT A HEALTH CARE ENTITY SHOULD NOT NET INSURANCE RECOVERIES AGAINST A RELATED CLAIM LIABILITY. THE AMOUNT OF THE LIABILITY SHOULD BE DETERMINED WITHOUT CONSIDERATION OF ANY INSURANCE RECOVERIES. PRIOR TO ADOPTION OF THE ASU, THE CENTER NETTED ANTICIPATED INSURANCE RECOVERIES AGAINST THE RELATED CLAIM LIABILITY. THE ASU DID NOT HAVE ANY EFFECT ON THE CENTER'S 2011 EXCESS OF REVENUE OVER EXPENSES; HOWEVER, IT RESULTED IN A CUMULATIVE EFFECT ADJUSTMENT TO 2011 BEGINNING UNRESTRICTED NET ASSETS AMOUNTING TO $900,000 AND REPRESENTS ANTICIPATED INSURANCE RECOVERIES AND RELATED CLAIM LIABILITIES ON A GROSS BASIS. ONEIDA HEALTHCARE CORPORATION 321 GENESEE STREET ONEIDA NY 13421 223093394 REAL PROPERTY HOLDING COMPANY FOR BENEFIT OF HOSPITAL NY 501 (C) (3) LINE 11A, I N/A 0 ONEIDA HEALTHCARE FOUNDATION PO BOX 705 ONEIDA NY 13421 237072767 FUNDRAISING FOR THE BENEFIT OF THE HOSPITAL NY 501 (C) (3) LINE 9 N/A 0 ONEIDA MEDICAL PRACTICE 221 BROAD STREET ONEIDA NY 13421 261147857 MEDICAL OFFICE NY ONEIDA HEALTH SYSTEMS C -2852912 569515 1.00000 0 0 1 1 0 0 0 0 0 1 0 0 0 0 0 1 0 0 ONEIDA MEDICAL PRACTICE P 2785549