2025-02-26T12:40:07-06:00 2024-06-30 161131146 BONADIO & CO LLP 171 SULLYS TRAIL PITTSFORD NY 14534 990 2023-07-01 160743310 ST JAMES HOSPITAL STJA 6073248110 7329 SENECA ROAD NORTH HORNELL NY 14843 CHRISTOPHER GRAHAM CHIEF FINANCIAL OFFICER 6073248110 2025-02-25 1 1 AIMEE JOZIC P01329472 5853811000 2025-02-25 2023 2025-03-06 01:10:19Z WENDY DISBROW 7329 SENECA ROAD NORTH HORNELL NY 14843 62149825 0 X HTTPS://WWW.URMC.ROCHESTER.EDU/ST-JAMES X 1921 NY ST. JAMES HOSPITAL IS COMMITTED TO THE HEALTH AND WELLNESS OF THE COMMUNITIES WE SERVE BY PROVIDING THE HIGHEST QUALITY OF CARE IN A COMPASSIONATE AND TRUSTED ENVIRONMENT. 15 12 462 15 0 0 4715595 3137823 46250137 57651630 119234 32019 770724 1170714 51855690 61992186 0 0 0 0 23386364 25336660 0 0 0 35550131 34708356 58936495 60045016 -7080805 1947170 91621468 94899002 31286451 32891247 60335017 62007755 ST. JAMES HOSPITAL IS COMMITTED TO THE HEALTH AND WELLNESS OF THE COMMUNITIES WE SERVE BY PROVIDING THE HIGHEST QUALITY OF CARE IN A COMPASSIONATE AND TRUSTED ENVIRONMENT. 0 0 47670228 58822344 ST. JAMES HOSPITAL IS AN ACUTE HEALTHCARE FACILITY PROVIDING ROUTINE, AMBULATORY AND ANCILLARY SERVICES. MAJOR SERVICES INCLUDE MEDICAL, SURGICAL, RADIOLOGY AND LABORATORY. TOTAL ACUTE DISCHARGES FOR THE HOSPITAL WERE 937. OUPATIENT REGISTRATIONS FOR THE HOSPITAL WERE 307,369. ST. JAMES HOSPITAL OPERATES SEVERAL PHYSICIAN PRACTICES. TOTAL OFFICE VISITS WERE 70,186 INCLUDING URGENT CARE. 47670228 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 0 0 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 0 1 1 1 0 0 1 38 0 1 462 1 0 0 0 0 0 0 0 0 0 0 0 0 X 15 12 1 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X CHRISTOPHER GRAHAM 6072472200 7329 SENECA ROAD NORTH HORNELL NY 14843 SHAWN HOGAN BOARD MEMBER 1.00 X 0 0 0 PETER WALL BOARD CHAIR 1.00 X X 0 0 0 JOHN WEYAND BOARD MEMBER 1.00 X 0 0 0 GREG SAMMONS SECRETARY 1.00 X X 0 0 0 SPENCER ANNABEL MD BOARD MEMBER 1.00 X 0 0 0 STEVEN GOLDSTEIN BOARD MEMBER 1.00 71.00 X 0 1633548 214557 MICHAEL KAMALI MD BOARD MEMBER 1.00 55.00 X 0 734199 80127 NICK KELLEY TREASURER 1.00 X X 0 0 0 ISMAIL MEHR MD BOARD MEMBER 1.00 X 0 0 0 BILAL AHMED BOARD MEMBER 1.00 55.00 X 0 769782 33229 CARRIE COKELY BOARD MEMBER 1.00 X 0 0 0 JENNIFER DONLON BOARD MEMBER 1.00 X 0 0 0 JEREMY PALOTTI BOARD MEMBER 1.00 X 0 0 0 MELISSA PONTICELLO BOARD MEMBER 1.00 X 0 0 0 MARK WHITMAN BOARD MEMBER 1.00 X 0 0 0 WENDY DISBROW CHIEF EXECUTIVE OFFICER 40.00 1.00 X 245100 0 8280 DEBRA MICHALEK INTERIM CFO UNTIL 8/31/23 20.00 1.00 X 0 0 0 CHRISTOPHER GRAHAM CFO EFFECTIVE 10/02/23 40.00 1.00 X 32507 0 1775 DENISE BECHER EXECUTIVE VICE PRESIDENT 40.00 X 152642 0 13983 SACHIN MANTHURUTHIL PHYSICIAN 40.00 X 270039 0 3012 HEATHER COX ADVANCED PRACTICE PROVIDER 40.00 X 268344 0 22337 CHRISTOPHER JOHN ADVANCED PRACTICE PROVIDER 40.00 X 216153 0 175 MATTHEW WALTON ADVANCED PRACTICE PROVIDER 40.00 X 192180 0 20744 MARIAH RITTWAGE ADVANCED PRACTICE PROVIDER 40.00 X 172070 0 34122 1549035 3137529 432341 38 0 1 0 ABADAN MEDICAL PLLC 325 CLEVELAND AVENUE HORNELL NY 14843 ANESTHESIOLOGY 591017 MEDICAL SOLUTIONS LLC PO BOX 850737 MINNEAPOLIS MN 55485 NURSE STAFFING 263420 MS HALL AND ASSOCIATES PO BOX 564 SYRACUSE NY 13205 FINANCIAL CONSULTING 128423 SCI ANESTHESIA PLLC 1240 JEFFERSON RD STE C ROCHESTER NY 14623 MEDICAL CLINIC 119598 4 179910 2944886 13027 3137823 NET PATIENT REVENUE 621990 57651630 57651630 57651630 81416 81416 108242 157639 -49397 -49397 -49397 OTHER REVENUE 900099 1170714 1170714 1170714 61992186 58822344 0 32019 344251 86063 258188 20594661 16495297 4099364 489305 396451 92854 2240566 1774195 466371 1667877 1321213 346664 5526 5526 249021 249021 27548 2309 25239 173179 173179 155288 54110 101178 33376 3870 29506 2013773 1647913 365860 41887 31696 10191 16632 8879 7753 295401 131786 163615 5854613 3813574 2041039 309019 137861 171158 PHYSICIAN FEES 11128480 11128480 PURCHASED SERVICES 6810510 3646254 3164256 MEDICAL SUPPLIES 3616712 3644537 -27825 DRUGS 2407644 2401738 5906 1569747 938476 631271 60045016 47670228 12374788 0 6127793 14628786 17326 17405 47662 65191 6028860 7001256 5441600 5441600 1114751 1054762 243121 157463 75517309 23155697 57050366 52361612 15549989 14170927 91621468 94899002 9403027 9176579 8171531 8373935 13711893 15340733 31286451 32891247 X 59553105 61263135 781912 744620 60335017 62007755 91621468 94899002 X 1947170 -274432 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 1 945 0 945 0 PART II-B, LINE 1, LOBBYING ACTIVITIES AS A MEMBER OF HEALTHCARE ASSOCIATION OF NEW YORK STATE, INC., A PORTION OF MEMBERSHIP DUES REPRESENTS AMOUNTS DESIGNATED FOR LOBBYING ACTIVITIES. THIS ASSOCIATION ORGANIZATION, OF WHICH THE HOSPITAL IS A MEMBER, PERFORMS DIRECT LOBBYING AND ADVOCACY ACTIVITIES ON BEHALF OF ITS MEMBERS. 26366 26366 26366 26366 26366 26366 26366 26366 26366 26366 1.00000 0 1 1 935597 935597 54421248 9938216 44483032 1057129 183342 873787 19028006 13034139 5993867 75329 75329 52361612 OTHER RECEIVABLES - CURRENT 3454460 OTHER RECEIVABLES - NONCURRENT 2349241 RIGHT OF USE ASSET 7313063 OTHER INVESTMENTS 710077 ASSETS LIMITED AS TO USE - CURRENT -769965 THIRD-PARTY PAYOR RECEIVABLES 1114051 14170927 OTHER LIABILITIES - CURRENT 117075 OTHER LIABILITIES - NONCURRENT 416491 THIRD PARTY PAYOR LIABILITIES 3614790 RIGHT TO USE LIABILITY 8908594 DUE TO AFFILIATES 2283783 15340733 PART V, LINE 4: THE FOUNDATION HOLDS DONOR RESTRICTED NET ASSETS ON BEHALF OF THE HOSPITAL. WITH THE HELP OF COMMUNITY MEMBERS, BUSINESS PARTNERS, EMPLOYEES, PROVIDERS, FRIENDS, AND DONORS, ST. JAMES HOSPITAL FOUNDATION RAISES CHARITABLE GIFTS TO MAKE POSSIBLE A RANGE OF FACILITIES IMPROVEMENTS, CAPITAL EQUIPMENT AND PROGRAM INITIATIVES. 1 1 1 X 1 X 1 1 0 0 1200826 690425 510401 0.00850 12171154 10190656 1980498 0.03300 13371980 10881081 2490899 0.04150 377965 251151 126814 0.00250 21166 21166 0.00040 399131 251151 147980 0.00290 13771111 11132232 2638879 0.04440 0 1661560 4642 8404748 8938414 -533666 X 1 1 1 1 ST JAMES HOSPITAL 411 CANISTEO STREET HORNELL NY 14843 WWW.URMC.ROCHESTER.EDU/ST-JAMES 5002001H X X X ST JAMES HOSPITAL 1 0 0 1 X X X X X X X X X 22 1 1 1 1 X SEE SUPPLEMENTAL INFORMATION 1 22 1 SEE SUPPLEMENTAL INFORMATION 0 1 X 200.000000000000 400.000000000000 X X X X X 1 1 X X X X 1 X SEE SUPPLEMENTAL INFORMATION X SEE SUPPLEMENTAL INFORMATION X SEE SUPPLEMENTAL INFORMATION X X X X X X 1 X 0 X X 1 0 0 ST. JAMES HOSPITAL PART V, SECTION B, LINE 5: THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) WAS CONDUCTED IN 2022 IN COLLABORATION WITH STEUBEN COUNTY PUBLIC HEALTH. THIS INCLUDED THE THREE HOSPITALS LOCATED WITHIN THE COUNTY. A VARIETY OF PARTNERS WERE ENGAGED THROUGHOUT THE PROCESS INCLUDING REPRESENTATIVES FROM ACADEMIA, NOT-FOR-PROFIT ORGANIZATIONS, BUSINESSES, THE GENERAL PUBLIC AND LOCAL GOVERNMENT. THE PARTNERS WERE ENGAGED THROUGHOUT THE ASSESSMENT PERIOD VIA AN ONLINE SURVEY AND FOCUS GROUPS. A FULL LIST OF PARTICIPANTS CAN BE FOUND IN THE STEUBEN COUNTY CHNA LOCATED ON THE ST. JAMES HOSPITAL (SJH) WEBSITE. ST. JAMES HOSPITAL PART V, SECTION B, LINE 6A: ARNOT HEALTH - IRA DAVENPORT MEMORIAL HOSPITAL, GUTHRIE CORNING HOSPITAL, ST. JAMES HOSPITAL ST. JAMES HOSPITAL PART V, SECTION B, LINE 6B: STEUBEN COUNTY PUBLIC HEALTH, COMMUNITY HEALTH, OAK ORCHARD HEALTH, PIVITAL PUBLIC HEALTH PARTNERSHIP, PREGNANCY RESOURCE CENTER OF THE VALLEYS, GUTHRIE CLINIC, STEUBEN PREVENTION COALITION, COMMON GROUND HEALTH, VA MEDICAL CENTER, SOUTHERN TIER LIBRARY SYSTEM, PROACTION, FINGER LAKES COMMUNITY HEALTH, HORNELL YMCA, STEUBEN RURAL HEALTH NETWORK AT THE INSTITUTE FOR HUMAN SERVICES INC, SOUTHERN TIER TOBACCO AWARENESS COALITION, WEGMANS, COUNTY LEGISLATURE, CATHOLIC CHARITIES/STEUBEN COUNCIL ON ADDICTIONS, COMMUNITY SERVICES/SUICIDE PREVENTION, CORNING COMMUNITY COLLEGE, UR PRIMARY CARE. ST. JAMES HOSPITAL PART V, SECTION B, LINE 11: PREVENT CHRONIC DISEASE/INCREASE SKILLS AND KNOWLEDGE TO SUPPORT HEALTH FOOD AND BEVERAGE CHOICES: SJH WILL WORK WITH HORNELL SCHOOL DISTRICT, HORNELL AREA YMCA AND CONCERN FOR YOUTH TO IDENTIFY WAYS TO DECREASE COSTS FOR ACTIVITIES AND INCREASE EDUCATION ABOUT HEALTHY FOOD CHOICES FOR KIDS. SJH WILL DISCUSS WITH HORNELL SCHOOL DISTRICT THE ITEMS OFFERED IN VENDING MACHINES AND AT MEAL TIMES. SJH WILL WORK WITH THOSE PARTNERS TO IDENTIFY CURRICULUMS TO USE IN SCHOOL DISTRICTS TO EDUCATE STUDENTS ON HEALTHY EATING. THE PARTNERS WILL WORK TO INCREASE THE NUMBER OF FREE OR LOW/COST SPORT/ACTIVITY PROGRAMS FOR CHILDREN IN THE HORNELL AREA.PROMOTE WELL-BEING AND PREVENT MENTAL AND SUBSTANCE USE DISORDERS/SUBSTANCE ABUSE DISORDERS SJH WILL REGISTER AS A NYS OPIOID OVERDOSE PREVENTION PROGRAM TO DISTRIBUTE NALOXONE FROM THE EMERGENCY DEPARTMENT TO PATIENTS AT RISK OF OVERDOSE. SJH WILL INCREASE THE NUMBER OF HOSPITAL STAFF TRAINED TO PROVIDE NARCAN TO MEMBERS OF THE COMMUNITY AND INCREASE THE NUMBER OF PROVERS WITH X-WAIVERS. SCHEDULE H, PART V, SECTION B, LINE 7A HTTPS://WWW.URMC.ROCHESTER.EDU/ST-JAMES/PATIENTS-VISITORS SCHEDULE H, PART V, SECTION B, LINE 10A HTTPS://WWW.URMC.ROCHESTER.EDU/ST-JAMES/PATIENTS-VISITORS SCHEDULE H, PART V, SECTION B, LINE 16A HTTPS://WWW.URMC.ROCHESTER.EDU/PAY-A-BILL/FINANCIAL-ASSISTANCE/ST-JAMES-HOSPITAL-FINANCIAL-ASSISTANCE SCHEDULE H, PART V, SECTION B, LINE 16B HTTPS://WWW.URMC.ROCHESTER.EDU/PAY-A-BILL/FINANCIAL-ASSISTANCE/ST-JAMES-HOSPITAL-FINANCIAL-ASSISTANCE SCHEDULE H, PART V, SECTION B, LINE 16C HTTPS://WWW.URMC.ROCHESTER.EDU/PAY-A-BILL/FINANCIAL-ASSISTANCE/ST-JAMES-HOSPITAL-FINANCIAL-ASSISTANCE PART III, LINE 4: IMPLICIT PRICE CONCESSIONS FURTHER REDUCE CUSTOMER ACCOUNTS TO THEIR NET REALIZABLE VALUE AT THE TIME THEY ARE RECORDED AND REPRESENT ESTIMATED UNCOLLECTIBLE BALANCES OF SELF-PAY, DEDUCTIBLES AND CO-PAYMENTS EXTENDED PRIMARILY TO UNINSURED OR UNDER-INSURED CUSTOMERS. ESTIMATES OF IMPLICIT PRICE CONCESSIONS ARE DETERMINED BASED ON HISTORICAL COLLECTION EXPERIENCE WITH THESE CLASSES OF CUSTOMERS USING A PORTFOLIO APPROACH AS A PRACTICAL EXPEDIENT TO ACCOUNT FOR CUSTOMER CONTRACTS AS COLLECTIVE GROUPS RATHER THAN AS INDIVIDUAL CONTRACTS. THE FINANCIAL STATEMENT EFFECTS OF USING THE PRACTICAL EXPEDIENT ARE NOT MATERIALLY DIFFERENT FROM AN INDIVIDUAL CONTRACT APPROACH. SCHEDULE H, PART I, LINE 7 THE COST-TO-CHARGE RATIO IS USED TO FIND 7A AND 7B, COMPUTED BY TAKING TOTAL EXPENSES DIVIDED BY TOTAL GROSS PATIENT REVENUE. SCHEDULE H, PART III, SECTION A, LINE 2 THE COSTING METHODOLOGY USED IN DETERMINING THE AMOUNTS REPORTED ON LINES 2 AND 3 ARE BASED ON ACTUAL CHARGES WRITTEN OFF (AMOUNTS THAT ARE DEEMED TO BE UNCOLLECTIBLE AND RECORDED AS IMPLICIT PRICE CONCESSIONS UNDER NEW ACCOUNTING PRONOUNCEMENT ASC606). THE TEST OF THE IMPLICIT PRICE CONCESSIONS (BAD DEBT EXPENSE) FOOTNOTE CAN BE FOUND ON THE ATTACHED AUDITED FINANCIAL STATEMENTS. SCHEDULE H, PART III, SECTION A, LINE 8 TO DETERMINE MEDICARE ALLOWABLE COSTS REPORTABLE IN THE MEDICARE COST REPORT, THE COST-TO-CHARGE RATIO IS APPLIED TO GROSS PATIENT REVENUE ASSOCIATED WITH SERVICES PERFORMED FOR PATIENTS WHO ARE ELIGIBLE FOR MEDICARE. CONSISTENT WITH THE CHARITABLE HEALTHCARE MISSION OF THE HOSPITAL AND THE COMMUNITY BENEFIT STANDARD SET FORTH IN IRS REVENUE RULING 69545, THE HOSPITAL PROVIDES CARE FOR ALL PATIENTS COVERED BY MEDICARE SEEKING MEDICAL CARE. SUCH CARE IS PROVIDED REGARDLESS OF WHETHER THE REIMBURSEMENT PROVIDED FOR SUCH SERVICES MEETS OR EXCEEDS THE COSTS INCURRED BY THE HOSPITAL TO PROVIDE SUCH SERVICES. SCHEDULE H, PART III, SECTION C, LINE 9B A BAD DEBT RESULTS FROM A PATIENT ACCOUNT BALANCE FROM WHICH PAYMENT WAS ANTICIPATED FROM THE PATIENT, CREDIT EXTENDED AND THEN ACCOUNT LATER DEEMED TO BE UNCOLLECTIBLE. A BAD DEBT DOES NOT MEET THE CRITERIA FOR CHARITY CARE, THAT IS, BAD DEBT PATIENTS ARE CONSIDERED TO HAVE THE FINANCIAL CAPABILITY AND ABILITY TO PAY BUT ARE UNWILLING TO PAY. COLLECTION ACTIVITIES ARE ONLY PURSUED WITH RESPECT TO AMOUNTS THAT PATIENTS ARE ABLE TO PAY AS DETERMINED BY THE HOSPITAL'S CHARITY CARE POLICY. NO COLLECTION ACTIVITIES TAKE PLACE WITH RESPECT TO AMOUNTS THAT PATIENTS ARE NOT EXPECTED TO PAY UNDER THIS POLICY. THE CHARITY CARE POLICY IN PLACE WOULD BE EXHAUSTED BEFORE A PATIENT BALANCE WOULD BE DEEMED SELF-PAY. UNDER THE CHARITY CARE POLICY, CHARITY CARE/FINANCIAL ASSISTANCE IS PROVIDED TO A PATIENT WITH DEMONSTRATED INABILITY TO PAY. A PATIENT IS ELIGIBLE FOR CHARITY CARE/FINANCIAL ASSISTANCE CONSIDERATION BASED UPON MEETING CERTAIN INCOME ELIGIBILITY CRITERIA AS ESTABLISHED BY THE FEDERAL POVERTY GUIDELINE SLIDING SCALE. PER NYS PUBLIC HEALTH LAW 2807-K, THIS CONSIDERS PATIENTS WHOSE HOUSEHOLD INCOME IS UP TO 300% OF THE MOST RECENT FEDERAL POVERTY GUIDELINES. ALL UNINSURED, LOW-INCOME PATIENTS WHO CAN DEMONSTRATE AN INABILITY TO PAY MAY APPLY FOR CHARITY CARE/FINANCIAL ASSISTANCE FOR ADJUSTMENT TO THEIR BALANCES FOR ALL MEDICALLY NECESSARY HEALTHCARE SERVICES PROVIDED THAT A MEMBER IN GOOD STANDING OF THE SJH MEDICAL STAFF DETERMINES THE NEED FOR SUCH MEDICAL CARE. SCHEDULE H, PART VI, LINE 2 ST. JAMES HOSPITAL (SJH) CONDUCTS A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) EVERY THREE YEARS IN CONJUNCTION WITH STEUBEN COUNTY PUBLIC HEALTH. IN ADDITION TO THAT, SJH USES THE FOLLOWING TO DETERMINE THE HEALTH NEEDS OF THE COMMUNITY: SURVEYING PARTICIPANTS AT PUBLIC HEALTH EDUCATION PROGRAMS, LOCAL CASE MANAGEMENT MEETINGS, AND INFORMATION SHARED AT PHYSICIAN OFFICES. BASED ON THE CHNA AND OTHER INFORMATION GATHERED, THE COUNTY'S HEALTHCARE PRIORITIES, STRATEGIES AND PROGRAMS ARE DETERMINED. SJH CREATES AN ACTION PLAN BASED ON THE CHNA. THE PROGRESS OF THESE INITIATIVES ARE REPORTED ANNUALLY TO THE NYS DEPARTMENT OF HEALTH. SCHEDULE H, PART VI, LINE 3 FINANCIAL COUNSELING STARTS AT THE POINT OF REGISTRATION. REGISTRARS WILL ASK ALL UNINSURED PATIENTS IF THEY WOULD LIKE TO SPEAK WITH A FINANCIAL COUNSELOR. IF REQUESTED, THE COUNSELOR WILL THEN CONTACT THE PATIENT WITHIN 24 HOURS. THEY ARE ALSO AVAILABLE FOR PATIENTS TO COME ONSITE TO REVIEW THEIR DOCUMENTS AND FINANCIAL SITUATION. FINANCIAL COUNSELING SERVICES INCLUDE: ASSISTANCE WITH NAVIGATION OF NYS OF HEALTH ENROLLERS FOR MEDICAID APPLICATIONS, ASSISTANCE WITH CHARITY CARE APPLICATIONS, ASSISTANCE WITH OTHER DISCOUNT POLICIES FOR INPATIENTS AND HIGH COST SERVICES, FLEXIBLE PAYMENT ARRANGEMENTS AND ANSWERING QUESTIONS REGARDING PATIENT STATEMENTS. SCHEDULE H, PART VI, LINE 4 THE PRIMARY SERVICE AREA FOR SJH IS THE 15-MILE RADIUS EXTENDING FROM HORNELL, NY IN STEUBEN COUNTY. THE SECONDARY SERVICE AREA IS THE 30-MILE RADIUS EXTENDING FROM HORNELL. PER CENSUS DATA, THE POPULATION IN THE AREA HAS NOT CHANGED SIGNIFICANTLY OVER THE PAST SEVERAL YEARS. THROUGH 2040, THE POPULATION OF STEUBEN COUNTY IS PROJECTED TO DECREASE BETWEEN 6-7%. THE POPULATION OF 65+ RESIDENTS IN THE REGION IS PROJECTED TO GROW BY 11% OVER THE NEXT FIVE YEARS. THE POPULATION IN STEUBEN COUNTY IS ETHNICALLY HOMOGENOUS WITH 94% RESIDENTS BEING WHITE. AN ESTIMATED 14% OF STEUBEN COUNTY RESIDENTS ARE LIVING BELOW THE POVERTY LEVEL. EDUCATIONAL ATTAINMENT OF POST-HIGH SCHOOL EDUCATION HAS INCREASED SLIGHTLY IN RECENT YEARS. SCHEDULE H, PART VI, LINE 5 SJH IS THE LEAD AGENCY FOR THE CANCER SERVICES PROGRAM (CSP) OF STEUBEN COUNTY. A COMMUNITY-BASED, GRANT-FUNDED PROGRAM OF NEW YORK STATE DEPARTMENT OF HEALTH (NYSDOH), THE CSP SERVES AGE ELIGIBLE, UNINSURED MEN AND WOMEN WITH NO-COST SCREENINGS FOR BREAST, CERVICAL, AND COLORECTAL CANCER. THE ORGANIZATION PARTICIPATES IN LOCAL HEALTH FAIRS AND WORKS WITH LOCAL BUSINESSES TO PROMOTE WORKPLACE WELLNESS. IN ADDITION, SJH OPERATES A CARDIAC REHAB PROGRAM AND COUMADIN CLINIC THAT PROVIDE OUTPATIENT BASED SERVICES TO THE COMMUNITY. SJH STAFF MEMBERS THROUGHOUT THE ORGANIZATION PARTICIPATE IN COMMUNITY INITIATIVES AND HOLD SEATS ON VARIOUS BOARDS OF NON-PROFIT ORGANIZATIONS WHOSE PRIMARY MISSION IS TO ASSESS AND ADDRESS COMMUNITY NEEDS. SCHEDULE H, PART VI, LINE 6 THE UNIVERSITY OF ROCHESTER MEDICAL CENTER (URMC) IS ONE OF THE NATION'S LEADING ACADEMIC MEDICAL CENTERS. IT FORMS THE CENTERPIECE OF THE UNIVERSITY OF ROCHESTER'S HEALTH RESEARCH, TEACHING AND PATIENT CARE MISSIONS. URMC IS A PRIVATE, COEDUCATIONAL, NONSECTARIAN, AND NONPROFIT UNIVERSITY. URMC CONSISTS OF EIGHT HOSPITALS LOCATED THROUGHOUT THE FINGER LAKES AND SOUTHERN TIER REGIONS: STRONG MEMORIAL, HIGHLAND, FF THOMPSON, NOYES MEMORIAL, GENEVA GENERAL HOSPITAL, SOLIDERS & SAILORS MEMORIAL HOSPITAL, JONES MEMORIAL AND ST. JAMES HOSPITALS AS WELL AS GOLISANO CHILDREN'S HOSPITAL, JAMES P WILMOT CANCER CENTER, EASTMAN INSTITUTE FOR ORAL HEALTH, UR MEDICINE HOME CARE, THE HIGHLANDS AT PITTSFORD AND HIGHLANDS AT BRIGHTON, NINE URGENT CARE CENTERS AND AN EXTENSIVE PRIMARY CARE NETWORK. SCHEDULE H, PART VI, LINE 7 NEW YORK STATE X X X X 0 1 0 0 0 0 0 0 0 STEVEN GOLDSTEIN BOARD MEMBER 0 1528811 0 0 0 104737 0 191337 0 23220 0 1848105 0 0 MICHAEL KAMALI MD BOARD MEMBER 0 663246 0 66950 0 4003 0 44837 0 35290 0 814326 0 0 BILAL AHMED BOARD MEMBER 0 763662 0 0 0 6120 0 31937 0 1292 0 803011 0 0 HEATHER COX ADVANCED PRACTICE PROVIDER 231584 0 0 0 36760 0 13840 0 8497 0 290681 0 0 0 SACHIN MANTHURUTHIL PHYSICIAN 270039 0 0 0 0 0 0 0 3012 0 273051 0 0 0 WENDY DISBROW CHIEF EXECUTIVE OFFICER 245100 0 0 0 0 0 7370 0 910 0 253380 0 0 0 CHRISTOPHER JOHN ADVANCED PRACTICE PROVIDER 216102 0 51 0 0 0 0 0 175 0 216328 0 0 0 MATTHEW WALTON ADVANCED PRACTICE PROVIDER 192180 0 0 0 0 0 15691 0 5053 0 212924 0 0 0 MARIAH RITTWAGE ADVANCED PRACTICE PROVIDER 158576 0 0 0 13494 0 18741 0 15381 0 206192 0 0 0 DENISE BECHER EXECUTIVE VICE PRESIDENT 152172 0 470 0 0 0 10863 0 3120 0 166625 0 0 0 PART I, LINE 4B THE FOLLOWING INDIVIDUALS PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN AND RECEIVED EMPLOYER PAID AMOUNTS THAT ARE INCLUDED IN DEFERRED COMPENSATION: STEVEN GOLDSTEIN - SERP PLAN - $159,400 MICHAEL KAMALI, MD - SERP PLAN - $12,900 THESE AMOUNTS REPRESENT EMPLOYEE DEFFERALS OF COMPENSATION, PLUS INVESTMENT EARNINGS, OVER SEVERAL YEARS THAT VESTED AND WERE PAID PURSUANT TO THE REQUIREMENTS OF THE PLAN. THE EMPLOYEE DEFERRALS WERE REPORTED AS DEFERRED COMPENSATION IN SCHEDULE J, PART II, COLUMN C IN PRIOR YEARS. FORM 990, PART VI, SECTION A, LINE 2 GIVEN THAT MANY OF OUR BOARD MEMBERS INCLUDE PROFESSIONALS IN INDUSTRIES SUCH AS BANKING, LAW, AND FINANCIAL ADVISEMENT, IT IS OUR UNDERSTANDING THAT SOME BOARD MEMBERS ENGAGE WITH EACH OTHER IN PROFESSIONAL BUSINESS ACTIVITIES. GIVEN THE COMPREHENSIVE CONFLICT OF INTEREST FORMS THE BOARD MEMBERS COMPLETE, WE DO NOT BELIEVE ANY SUCH RELATIONSHIP IMPACTS THEIR DECISION MAKING AS TO ST. JAMES ACTIVITIES AND TO THE EXTENT THERE IS A POTENTIAL CONFLICT OF INTEREST IS DISCLOSED BY A BOARD MEMBER, THE BOARD MEMBER IS INSTRUCTED TO FOLLOW OUR CONFLICT OF INTEREST POLICY. FORM 990, PART VI, SECTION A, LINE 3 A MANAGEMENT COMPANY WAS USED TO CONTRACT THE INTERIM CHIEF FINANCIAL OFFICER POSITION FOR ST. JAMES HOSPITAL AND AFFILIATES. THE AMOUNT THAT ST. JAMES HOSPITAL PAID TO THE MANAGEMENT COMPANY WAS $56,588. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF ST. JAMES HOSPITAL IS THE UNIVERSITY OF ROCHESTER (UR). AS SUCH, UR HAS THE AUTHORITY TO ELECT THE GOVERNING BODY OF ST. JAMES HOSPITAL AND CERTAIN DECISIONS OF ST. JAMES HOSPITAL ARE SUBJECT TO THE APPROVAL OF UR. SUCH DECISIONS INCLUDE AMENDMENT OF THE CERTIFICATE OF INCORPORATION AND BYLAWS AND APPROVAL OF EXTRAORDINARY CORPORATE ACTIONS SUCH AS MERGER OR DISSOLUTION. FORM 990, PART VI, SECTION A, LINE 7A THE SOLE MEMBER OF ST. JAMES HOSPITAL IS THE UNIVERSITY OF ROCHESTER (UR). AS SUCH, UR HAS THE AUTHORITY TO ELECT THE GOVERNING BODY OF ST. JAMES HOSPITAL AND CERTAIN DECISIONS OF ST. JAMES HOSPITAL ARE SUBJECT TO THE APPROVAL OF UR. SUCH DECISIONS INCLUDE AMENDMENT OF THE CERTIFICATE OF INCORPORATION AND BYLAWS AND APPROVAL OF EXTRAORDINARY CORPORATE ACTIONS SUCH AS MERGER OR DISSOLUTION. FORM 990, PART VI, SECTION A, LINE 7B THE SOLE MEMBER OF ST. JAMES HOSPITAL IS THE UNIVERSITY OF ROCHESTER (UR). AS SUCH, UR HAS THE AUTHORITY TO ELECT THE GOVERNING BODY OF ST. JAMES HOSPITAL AND CERTAIN DECISIONS OF ST. JAMES HOSPITAL ARE SUBJECT TO THE APPROVAL OF UR. SUCH DECISIONS INCLUDE AMENDMENT OF THE CERTIFICATE OF INCORPORATION AND BYLAWS AND APPROVAL OF EXTRAORDINARY CORPORATE ACTIONS SUCH AS MERGER OR DISSOLUTION. FORM 990, PART VI, SECTION B, LINE 11B A COPY OF THE FORM 990 WAS MADE AVAILABLE TO EACH BOARD MEMBER BEFORE IT WAS FILED. ST. JAMES HOSPITAL HAS DESIGNATED THE STRATEGIC PLANNING & FINANCE/AUDIT COMMITTEE AS THE GROUP TO BE EDUCATED AND TO REVIEW THE RETURN. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS, OFFICERS AND KEY EMPLOYEES (DETERMINED BY THE PRESIDENT & CEO) COMPLETE CONFLICT OF INTEREST (COI) FORMS ANNUALLY TO IDENTIFY ACTUAL AND POTENTIAL CONFLICTS OF INTEREST THAT MAY EXIST RELATIVE TO THEIR DUTIES WITH THE ORGANIZATION AND THE ORGANIZATION'S COI POLICY. THE CEO SHALL DISCLOSE TO THE BOARD OR APPROPRIATE COMMITTEE THEREOF ANY EMPLOYEE DISCLOSURE MADE RELEVANT TO THE MATTER AND THE EVALUATION THEROF. COPIES ARE PROVIDED TO THE CORPORATE COMPLIANCE OFFICER AND MAINTAINED BY THE EXECUTIVE ASSISTANT TO THE BOARD OF DIRECTORS AND CEO. IF A CONFLICT IS DISCLOSED, THAT PERSON SHALL LEAVE THE BOARD OR COMMITTEE MEETING WHILE THE DETERMINATION OF A COI IS DISCUSSED AND VOTED UPON. THE CHAIRPERSON OF THE BOARD OR COMMITTEE WILL DETERMINE IF A COI EXISTS. TO HELP ENSURE COMPLIANCE WITH THE COI POLICY, AMONG THE PROVISIONS THE PERSON WITH AN ACTUAL OR POTENTIAL COI WILL NOT BE ALLOWED TO PARTICIPATE IN ANY DISCUSSION OR DECISION ON ANY AREA OF THE CONFLICT IDENTIFIED AND LEAVE THE ROOM DURING DISCUSSION AND VOTE. THE CORPORATE RESPONSIBILITY AND COMPLIANCE COMMITTEE REVIEW THESE PROCEDURES EVERY TWO YEARS TO ASSESS THEIR EFFECTIVENESS AND RECOMMEND (OR MAKE) APPROPRIATE CHANGES AS NEEDED TO ENSURE THE COI POLICY IS CONSISTENLY AND EFFECTIVELY ENFORCED. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD HAS AN INDEPENDENT COMMITTEE REVIEW AND APPROVE ALL ELEMENTS OF REMUNERATION FOR ALL OFFICERS, AS WELL AS OTHER KEY MANAGEMENT. THE BOARD/COMMITTEE HAS AN ESTABLISHED COMPENSATION PHILOSOPHY WHICH DETAILS THE OBJECTIVES OF MARKET POSITIONING AND PAY ELEMENTS. THE COMMITTEE REVIEWS MARKET DATA, COMPARATIVE MARKET COMPENSATION DATA, APPROVES ANY SALARY ADJUSTMENTS FOR THE EXECUTIVE POPULATION, CONSIDERS BOTH REASONABLENESS AND EFFECTIVENESS OF ALL REMUNERATIVE PROGRAMS AND ESTABLISHES THE DETAILED PERFORMANCE EXPECTATIONS. ALL OF THESE DISCUSSIONS AND DECISIONS ARE DOCUMENTED THROUGH THE PROVISION OF MEETING MINUTES. FORM 990, PART VI, SECTION C, LINE 19 ST. JAMES HOSPITAL'S FORM 1023 AND FORM 990 ARE AVAILABLE UPON REQUEST. ST. JAMES HOSPITAL'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND AUDITED FINANCIAL STATEMENTS ARE NOT ROUTINELY MADE AVAILABLE TO THE PUBLIC. FORM 990, PART XI, LINE 9: CHANGE IN BENEFICIAL INTEREST IN NET ASSETS OF THE SJH FOUNDATION -274,432. FORM 990, PART XII, LINE 2C THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. 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VALUE OF FUNDS GIVEN