2012-11-13T15:45:32-07:00 2011-12-31 990 2011-01-01 160743905 ARNOT OGDEN MEDICAL CENTER ARNO 6077374235 600 ROE AVENUE ELMIRA NY 14905 Ronald Kintz 6077374235 2012-11-12 2011 2016-02-24 21:20:13Z RONALD J KINTZ SENIOR VP CFO 600 ROE AVENUE ELMIRA NY 14905 290725602 0 X www.aomc.org X 1889 NY Arnot Ogden Medical Center is a community based hospital with an open emergency room and selected highly specialized services that are part of a high quality health care delivery system that serves Chemung County, NY and the Twin Tier Regions of New York and Pennslyvania. 20 18 2503 600 297281 0 4791116 2953037 247194768 257725224 2067402 415497 3487719 6597412 257541005 267691170 0 0 0 0 157332459 167747671 0 0 0 93751657 90037042 251084116 257784713 6456889 9906457 239983947 245234878 88286519 97381862 151697428 147853016 Arnot Ogden Medical Center is an independent, not-for-profit, 256-bed tertiary medical facility with more than 300 physicians from over 50 specialties. Arnot Ogden Medical Center offers specialty services at the Falck Cancer Center, Heart and Vascular Institute, Stroke Care, Maternity, Surgery. 0 0 213149251 855578 257288810 The Arnot Ogden Medical Center continues to provide a variety of health care related services since it opened in 1889, serving Chemung County and the Twin Tier Regions of New York and Pennslyvania. The Medical Center specializes in the fields of Cardiology, Oncology, Renal, Neonatology, Bariatrics and Emergency Care. Other sub specialized services include but are not limited to Anesthesiology, Surgery, Laboratory, Imaging, Physical Therapy, Obstetrics, and Gynecology. In 2011 the Medical Center's 2,503 employees cared for 12,463 Inpatients in its 261 staffed beds. The Medical Center provided Outpatient Services to approximately 365,319 Patient Visits in its subspecilalty services. The approximately 120 physicians provided for 368,455 office visits in the areas of primary care and specalty services. 1020552 0 436414 The Arnot Ogden Medical Center School of Nursing began in 1889 and continues to offer a three year diploma program accredited by the National League for Nursing with approximately 70 students enrolled. The Arnot Ogden School of Radiologic Sciences began in 1953 and continues to offer a two year certificate program which is accredited by the Joint Review Commission on Education in Radiologic Technology with approximately 14 students enrolled. Upon completion of their program of study, students are eligible to take the NYS Licensing examinations for Registered Nurse or Radiologic Technologist. 0 0 0 214169803 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 0 0 0 0 0 0 1 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 497 0 1 2503 1 1 1 0 0 0 0 0 0 0 0 0 X 20 18 1 1 1 0 0 0 0 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 NY X X RONALD J KINTZ 6077374235 ACCOUNTING DEPARTMENT 600 ROE AVENUE ELMIRA NY 14905 Daniel J Burke 1 X 0 0 0 David Dalrymple 2 X 0 0 0 Christine M Deschamps 1 X 0 0 0 John T Gough 2 X 0 0 0 Mark J Hagan 1 X 0 0 0 Michael Hosey 0.5 X 0 0 0 Roy A Kyles 0.5 X 0 0 0 Randy S Lehman 1 X 0 0 0 Ben E Lynch 6 X 0 0 0 Robert McNamara 0.3 X 0 0 0 Mary Louise Mitchell 2 X 0 0 0 John F O'Mara 1 X 0 0 0 Donald Quick 2 X 0 0 0 Patrick J Rogers 0.5 X 0 0 0 Melinda Sartori 0.5 X 0 0 0 Roger Schenone 0.5 X 0 273823 9074 Gregory Schultz 40 X 178543 0 31583 Margaret B Streeter 1 X 0 0 0 S Jan Eberhard 10 X X 0 0 0 Joseph P Manning 4 X X 0 0 0 John R Alexander 1 X X 0 0 0 Ronald J Kintz 60 X X 348994 0 42798 Anthony J Cooper 51 X 602951 0 44098 H Fred Farley 55 X 332945 0 44098 William Huffner 53 X 330726 0 25720 Robert Lambert 53 X 427238 0 36798 Deborah Martin 40 X 154628 0 22319 Gregg Martin 52 X 160152 0 33133 Marc Rustici 50 X 153485 0 31169 Wesley Blauvelt 45 X 187356 0 36448 Joseph Braunschiedel 40 X 152681 0 10152 Kim Panosian 40 X 200481 0 9810 Vidyasagar Mokureddy 40 X 1050014 0 11948 William DeLuccia 40 X 745314 0 27495 Paul Hicks 40 X 744594 0 22555 Nishith Amin 40 X 742806 0 26631 Ravi Akula 40 X 687310 0 26631 7200218 273823 492460 156 0 1 0 Associated Anesthesiologist of the Finger Lakes PO Box 1253 Elmira NY 14902 Radiologist Services 2397741 HHA Services 2622 Harper St Claire Shores MI 48080 Management Services 941451 Streeter Associates PO Box 118 Elmira NY 14902 Construction Services 801229 CPS Inc 6409 Quail Hollow Road Memphis TN 38120 Management Services 729244 Sayles Evans One West Church Street Elmira NY 14901 Legal Services 691936 27 0 0 0 900692 2052345 0 0 2953037 Net Patient Service Revenue - Hospital 900099 213858812 213858812 0 0 Net Patient Service Revenue - Physician Offices 621110 43429998 43429998 0 0 Nursing School Revenue 611600 363540 363540 0 0 Radiology School Revenue 611600 72874 72874 0 0 0 0 0 0 257725224 1532785 0 0 1532785 327 0 0 327 0 0 0 0 349739 0 660602 0 -310863 0 -310863 0 0 -310863 19825369 0 20934242 8742 -1108873 -8742 -1117615 0 0 -1117615 94587 0 26323 68264 0 68264 0 0 0 0 0 0 592690 1404523 -811833 0 0 -811833 Medical Waste & Housekeeping 562000 55868 0 55868 0 Answering Service Revenue 561421 236876 0 236876 0 All Other Revenue 541900 4537 0 4537 0 7354563 0 0 7354563 7651844 267691170 257725224 297281 6715628 0 0 0 0 0 0 0 0 4133672 1065712 3067960 0 0 0 0 0 123430834 106611419 16819415 0 5495357 0 5495357 0 26845389 0 26845389 0 7842419 6471684 1370735 0 2955894 1276661 1679233 0 851126 77659 773467 0 161132 -90 161222 0 0 0 0 0 0 0 449994 0 449994 0 5757069 5021801 735268 0 502437 154349 348088 0 44736970 44376507 360463 0 3323949 3061261 262688 0 0 0 0 0 3181738 433838 2747900 0 309900 241030 68870 0 0 0 0 0 199919 142611 57308 0 1767765 0 1767765 0 0 0 0 0 11871765 7235454 4636311 0 2517140 1726049 791091 0 Other 8820796 6324993 2495803 0 Maintenance Contracts 2629448 2015060 614388 0 Benefit Allocation 0 27933805 -27933805 0 0 0 0 0 257784713 214169803 43614910 0 7187 7742 6074755 8466886 3063900 489994 33592888 37269051 0 0 0 0 3844620 7745562 2507678 1655177 2038287 2095679 223606445 134502412 92098568 89104033 49066064 48466708 0 0 0 0 813614 851045 46876386 49083001 239983947 245234878 18687404 21352761 0 0 118362 14280 29637825 28890794 0 0 0 0 7103855 5070608 8127457 9611992 24611616 32441427 88286519 97381862 X 145082916 140838664 4183166 4187148 2431346 2827204 151697428 147853016 239983947 245234878 X 9906457 -13750869 X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 25560 25560 0 SchC_P2B_S00_L01 Schedule C, Part II-B, Line 1 Line 1i - Arnot Ogden Medical Center pays annual dues to the American Hospital Association, AHA and the Hospital Association of New York State, HANYS of which a percentage is for lobbying fees. The total lobbying fees paid to both in 2011 is $25,560. 2431346 0 395858 0 0 0 2827204 2430246 1100 0 0 0 0 2431346 2429726 520 0 0 0 0 2430246 2429026 700 0 0 0 0 2429726 0 1 0 0 1 1 0 4415546 4415546 1825687 90461533 44538112 47749108 0 1349012 893345 455667 0 121819121 88049272 33769849 0 3735546 1021683 2713863 89104033 Investments Held for 457 Plans & Physician Practice Purchases 2231382 Interest in Net Assets of Foundations 10761395 Investment & Advances in Subsidiary 4217876 Assets Whose Use is Limited - Depreciation Fund 10219488 Assets Whose Use is Limited - Self Insurance Fund 18154350 Assets Whose Use is Limited - Debt Service Reserve & Bond Payment Fund 3498510 49083001 0 Accrued Estimated Reimbursement Payable 3188727 Self Insurance Reserve 9720916 Accrued Pension Cost 19531784 32441427 267691170 257784713 9906457 533983 0 0 0 -14284852 -13750869 -3844412 268753397 0 0 0 0 0 268753397 370386 -1432613 -1062227 267691170 259409921 0 0 0 1995595 1995595 257414326 370387 0 370387 257784713 SchD_P05_S00_L04 Schedule D, Part V, Line 4 The Organization has interpreted New York State Prudent Managment of Institutional Funds Act Law (NYPMIFA) as requiring the preservation of the historical dollar value of the corpus of the permanent restricted endowment funds absent of donor stipulations to the contrary. The net appreciation of the permanently restricted net assets is considered temporarily restricted net assets until those amounts are appropriated for expenditure by the Organization in a manner consistent with the standard of prudence prescribed by NYPMIFA. If the fair value of the investment assets falls below the level of the donor or NYPMIFA requires the Center is to retain the fund in perpetual duration. There were no such deficiences as of December 31, 2011 and 2010. To ensure the preservation of the corpus of the permanently restricted endowment funds, the total fair value of all commingled investment assets are classified first to the level of the permanently restricted endowment funds corpus, an endowment fund deficiency receivable from the unrestricted net assets would be recognized until the deficiency is recovered. SchD_P10_S00_L02 Schedule D, Part X, Line 2 The Medical Center, The Foundation, Falck, the Auxiliary, Ira Davenport and Keuka are organized as not-for-profit corporations as described in Section 501(c)(3) of the Internal Revenue Code (the code) and accordingly, are exempt from Federal income taxes on related income pursuant to Sections 501(a) of the Code. AMS, Ivy Street, and 722 West Water Street file federal corporate tax returns. For federal tax purposes, the Organization has net operating loss carry fowards of appproximately $396,000 from for-profit operations. The Organization accounts for uncertain tax positions in accordance with US GAAP, which requires the recognition and measurement of uncertain tax positions that the Organization has taken or expects to take in the Organization's tax returns. Management believes there are no significant uncertain tax postions not reflected in the accompanying financial statements. The Organization is no longer subject to federal and NYS income tax examination for years prior to 2008. SchD_P11_S00_L08 Schedule D, Part XI, Line 8 Net Realized Gain/Loss on investments in Specific Purpose Funds, $-225,269, Pension Charge to Equity, $-12,558,767, Heal Grant Net Asset Transfer to Affiliate, $-2,026,714, Donations for Capital Funding, $1,176,917, Change in Foundation Accounting for Temp Restricted Funds, $-2,257,349, Increase in Investment of Affiliate Company, $63,056, Changes in Net Assets of Falck Foundation, $-6,393, and Change in Net Assets of AOMC Foundation, $2,083,650, totaling $-13,750,869. SchD_P12_S00_L04b Schedule D, Part XII, Line 4b Donations for Capital Funding, $900,692, Rental Expenses to offset income, $-660,602, Nutritional Services Expenses to offset cost of goods sold, $-1,404,523, Net Assets Released from Restriction to Revenue, $-268,180, and Investment Fees to offset Investment Income, $370,386, totaling $-1,062,227. SchD_P13_S00_L02d Schedule D, Part XIII, Line 2d Cost of Goods Sold offset to Revenue, $-1,404,523, Rental Expense to offset Rental Income, $-660,602, Audited Financial Statement Error, $69,530, totaling $-1,995,595. GOLF TOURNAMENT 38437 0 38437 0 988 5812 2320 0 8979 PHYSICIAN & COMPANY DINNER 30749 0 30749 0 0 0 1245 0 6499 1 25401 0 25401 0 0 0 0 0 480 94587 0 94587 0 988 5812 3565 0 15958 26323 68264 1 1 1 X 1 X 1 1 0 1 1 0 661 3150347 49668 3100679 0.012 0 43298 30307008 21281407 9025601 0.035 0 3807 432391 303374 129018 0.0005 0 47766 33889746 21634449 12255298 0.0475 333 15619 1233212 102076 1131136 0.0044 77 407 1172925 523754 649171 0.0025 7 10828 8901766 8755791 145975 0.0006 0 0 0 0 0 0 0 0 294544 0 294544 0.0011 417 26854 11602447 9381621 2220826 0.0086 417 74620 45492193 31016070 14476124 0.0561 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2467 0 2467 0 0 0 0 0 0 0 0 0 0 0 0 0 17 0 213710 0 213710 0.0008 13 0 0 0 0 0 1 0 9000 0 9000 0 16 0 0 0 0 0 47 0 225177 0 225177 0.0008 0 14829267 0 69378477 77300340 -7921863 X 1 1 Ivy Street Development Corp Collection of Services & Rentals 1 0 0 1 1 Arnot Ogden Medical Center

600 Roe Avenue Elmira NY 14905

X X X 2 Arnot Ogden Medical Center Health Center for Women

600 Fitch Street Elmira NY 14905

Hospital Extension Clinic - Diagnostic Radiology 3 Arnot Ogden Medical Center Horseheads Campus

100 John Rommelt Drive Horseheads NY 14845

Clinical Laboratory Service & Radiology Diagnostic Outpatient. 4 Arnot Ogden Medical Center Dialysis Center

8 West Pultney Street Corning NY 14830

Hospital Extension Clinic providing Outpatient Hemodialysis services Arnot Ogden Medical Center 1 1 1 100 1 400 1 X X X 1 1 X X X 1 X X X 1 X X X X X X 1 X 0 1 Arnot Ogden Medical Center Health Center for Women 2 Arnot Ogden Medical Center Horseheads Campus 3 Arnot Ogden Medical Center Dialysis Center 4 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 SchH_P01_S00_L07 Schedule H, Part I, Line 7 Arnot Ogden Medical Center used a "Cost to Charges" ratio to calculate the Financial Assistance and Community Benefit Section. The Medical Center offers a variety of services to the communities it serves as part of an integrated delivery system. It is necessary to financially subsisdized some of these services as the revenue generated does not cover the cost of providing the services. SchH_P01_S00_L072f Schedule H, Part I, Line 7, Column f The Medical Center offers a variety of services to the communities it serves as part of an integrated delivery system. It is necessary to financially "subsidize" some services as the revenue they generate does not cover the cost of providing the services. SchH_P02_S00_L00 Schedule H, Part II The following is an excerpt from our 2011 Community Service Plan. Please see our website aomc.org for the full report: Which partners have you worked with in planning, implementation and evaluation of CSP? Healthcare partners Diverse partnership of community based organizations Elected officials Employers and businesses Faith based organizations Local health departments Schools Chemung and Steuben County Rural Health Networks 7. How do you work with partners? (Give 2 brief examples) * Aware of services offered by our partner * Share data for planning purposes * Plan programs together * Implement programs together * Evaluate programs together * Coordinate outreach to the community Example #1: Arnot Health works collaboratively with the Chemung County Health Department, Chemung Valley Rural Health Network, Cornell Cooperative Extension, other area hospitals, faith based organizations, and community partners to assess public health needs within the community. Programs to prevent obesity and diabetes, such as a free 6-week community walking program called "Step It Up", are planned, implemented and evaluated in partnership. Pre and post program health screening data is shared between agencies, and outreach efforts are coordinated to maximize reach and community health impact. Example #2: Arnot Health has a leadership role in the NYSDOH grant-funded Creating Healthy Places to Live, Work and Play partnership. This diverse collaborative of over 30 community partners across public, private and non-profit sectors is working together to plan, implement and evaluate environmental, policy and systems changes to promote physical activity and nutrition. The Creating Healthy Places partnership's goal is to prevent obesity and diabetes through rehabilitating Elmira parks and playgrounds, increasing safe access to open public places for physical activity, building community gardens to increase access to fresh fruits and vegetables and working with local restaurants to offer healthier options on their menus. SchH_P03_S0A_L04 Schedule H, Part III, Section A, Line 4 In July 2011, the FASB issued guidance which amends the current presentation and disclosure requirements for health care entities that recognize significant amounts of patient service revenue at the time the services are rendered without assessing the patient's ability to pay. This guidance requires health care entities to reclassify the provision for bad debts from an operating expense to a deduction from patient service revenues. In addition, this guidance requires more disclosure on the policies for recognizing revenue, assessing bad debts, as well as quantitative and qualitative information regarding changes in the allowance for doubtful accounts. This guidance is applied retrospectively to all prior periods presented and is effective during interim and annual periods beginning after December 15, 2011. The adoption of this guidance is not expected to have material impact on the Organization's financial position, results of operations or cash flows. The Organization early adopted this guidance during the year ended December 31, 2011 and reclassified the provision for bad debts related to prior period service revenue from operating expenses to a reduction in revenue. The Organization records an allowance for doubtful accounts in anticipation of future write-offs. The allowance for doubtful accounts is based on past collection experience as well as analysis of receivable aging and payor type. The Medical Cneter follows established guidelines for placing certain past due patient balances with collection agencies, as determined by the Medical Center. The Ratio of Cost to Charges methodology was used determine the "cost" of bad debts. Bad Debts should be considered as community benefit because the Medical Center does not turn away any patients needing emergency or non-elective medical care based on their ability to pay. SchH_P03_S0B_L08 Schedule H, Part III, Section B, Line 8 The Medical Center provides Emergency, Stroke, Cardiac, Dialysis, Wound Care, Hyperbaric and other services that help prevent loss of life and extensive severity due to prompt treatment which benefits the community. 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 that obligation. SchH_P05_S0B_L04 Schedule H, Part V, Section B, Line 4 The Community Service Plan explains in detail the involvement of members of the community in determining & identifying community needs. St. Joseph's Hospital in Elmira, NY and Ira Davenport Memorial Hospital in Bath, NY were included in the Community Service Plan. The Community Service Plan is available on our website, www.aomc.org. SchH_P05_S0B_L05 Schedule H, Part V, Section B, Line 5 In addition to Arnot Health's 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: Arnot Health's 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 Arnot Health's department managers and the healthcare system's joint Board of Directors. Local Media Outlets: Arnot Health works with a variety of local media outlets to disseminate information about community outreach programs and services, and disseminate information about community outreach programs 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. Health on Demand Call Center: The public may call the Health on Demand Call Center to receive a copy of the Community Service Reports and all updates Insight Newsletter: Information about accessing Arnot Health's Community Service Plan and request for community input will be published annually in Insight, a monthly publication for employees, retirees and volunteers of the Arnot Health System. 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 (Figure 5 and Figure 6). Targeted Mailings: Arnot Ogden Medical Center used targeted mailings to disseminate the Community Service Plan in past years. Moving forward, Arnot Health will identify ways to effectively communicate with residents in the service area to solicit input and provide an update to the plan of action. SchH_P05_S0B_L06 Schedule H, Part V, Section B, Line 6 8. Public Health Priorities: Which did you choose? Arnot Health's Public Health Priorities remain unchanged from the development of the 2009 three-year Prevention Agenda strategic plan. Arnot Ogden Medical Center * Physical activity and nutrition as it relates to disease prevention * Tobacco use as it relates to chronic disease * Access to quality healthcare * Chronic disease * Tobacco use 9. Goals and Measures: Arnot Ogden Medical Center (Adapted from Arnot Ogden Medical Center's 2009-2011 Community Service Plans) 1. Priority: Physical Activity and Nutrition as it relates to disease prevention Objectives: * Raise awareness of the importance of physical activity and nutrition in regard to disease prevention. * Increase awareness of opportunities for physical activity. * Promote healthy food choices. * Facilitate weight loss. * Reduce incidence of chronic disease. * Reduce the risk of complications from preexisting health conditions. Goals: * By the year 2013, reduce the percentage of overweight and obese adults over age 18 to no more than 15% (Healthy People 2010 Goal). * Increase the number of Chemung County residents who are physically active by offering interactive programs and educational events that focus on disease prevention through exercise and healthy food choices. * Continue to collaborate with Chemung County Health Department, hospitals, other healthcare agencies and community partners to create environmental, policy and systems changes to promote physical activity and the consumption of fresh fruits and vegetables. 2. Priority: Tobacco Cessation as it relates to chronic disease Objectives: * Discourage tobacco use. * Raise awareness of tobacco cessation resources. * Promote understanding of how tobacco relates to chronic disease. Goals: * Maintain collaborations with Arnot Ogden Medical Center Tobacco Cessation Center and Southern Tier Tobacco Awareness Community Partnership to promote healthy behaviors and discourage tobacco use. * By the year 2013, reduce the prevalence of smoking in adults to no more than 12% (Healthy People 2010 Goal). * 3. Priority: Access to Quality Healthcare Objectives: * Increase access to care for medically underserved populations. * Improve continuity of care across the care continuum. Goals: * Increase access to preventative health programs to decrease incidence of chronic disease. * Provide disease management tools to promote management of chronic disease and reduce risk of complications from chronic disease. 6 * Reduce emergency room utilization through intensive case management based on the Medical Home Model to increase services, reduce cost and make connections to other community services based on individual need. ____________________________________ Arnot Ogden Medical Center, St. Joseph's Hospital and Ira Davenport Memorial Hospital uses several strategies to track and measure progress in Arnot Health's selected priority areas. Measures of effectiveness include: * State and County Indicators for Tracking Public Health Priority Areas * New York State Prevention Quality Indicators (PQI) * New York State Department of Health's Prevention Agenda for Healthiest Sate * Healthy People 2020 * Chemung, Steuben and Schuyler County Health Assessments * Chemung County Community Health Assessment Report Card 2010 - 2013 8 * BRFSS * EBRFSS * Data from Health on Demand Regional Call Center * Number of community outreach events and preventative health screenings (graphs of results emailed separately as Appendix A and Appendix B) * Number of participants in programs that promote physical activity and nutrition * Number of participants with improved health outcomes such as blood glucose, blood pressure, BMI, body fat and diabetes risk indicators as a result of programs that promote physical activity and nutrition * Program analysis and evaluation * Participant surveys * Number of Individuals who have received tobacco cessation, disease prevention and management educational materials * Chemung County's Suicide Mortality Rate * Chemung County Crisis Service Hotline Telephone Calls * Number of Individuals who have received Suicide Prevention Training Programs SchH_P05_S0B_L19 Schedule H, Part V, Section B, Line 19 Participants in the Medicare System are required to charge all patients the same amount for services regardless of insurance per the Medicare Participation Guidelines. SchH_P05_S0B_L21 Schedule H, Part V, Section B, Line 21 Participants in the Medicare System are required to charge all patients the same amount for services regardless of insurance per the Medicare Participation Guidelines. SchH_P06_S00_L02 Schedule H, Part VI, Line 2 In 2009 Arnot Ogden Medical Center selected two of its three Prevention Agenda priorities in collaboration with St. Joseph's Hospital and key members from 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, Arnot Ogden Medical Center has continued to collaborate with the Chemung County Health Department, St. Joseph's Hospital and other healthcare agencies to access the community needs, plan and implement evidence-based strategies to address public health priorities and track outcomes to evaluate the impact of our interventions. SchH_P06_S00_L03 Schedule H, Part VI, Line 3 The AOMC communicates our 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 & 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 The Medical Center serves residents of Chemung, Steuben, and Schuyler Counties in NY and also Bradford and Tioga Counties in PA. The counties are classified as urban and rural. The Medical Center is located in Chemung County, NY which has a population of approximately 88,000, with 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 with 87% having a high school or greater education. 16% if the population is below the Federal Poverty Guidelines. The race breakdown is 81% caucasian, 12% african-american, 4% hispanic, 1% asian and all other total 2%. SchH_P06_S00_L05 Schedule H, Part VI, Line 5 The AOMC works with various other healthcare and health planning organizations within our 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 organizations and agencies. Many of these program 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 towards the efficient and effective delivery of healthcare within the service area. The System also participates with other organizations and agencies to service the community. SchH_P06_S00_L07 Schedule H, Part VI, Line 7 The Medical Center files the Community Report in NYS only. X X 1 1 X X X X 0 0 0 0 0 1 0 0 0 Anthony J Cooper 467569 0 135382 0 0 0 25050 0 19048 0 647049 0 0 0 H Fred Farley 277465 0 55480 0 0 0 25050 0 19048 0 377043 0 0 0 Ronald J Kintz 281033 0 67961 0 0 0 23750 0 19048 0 391792 0 0 0 William Huffner 302647 0 28079 0 0 0 9310 0 16410 0 356446 0 0 0 Robert Lambert 352590 0 74648 0 0 0 17750 0 19048 0 464036 0 0 0 Wesley Blauvelt 173400 0 13956 0 0 0 18183 0 18265 0 223804 0 0 0 Vidyasagar Mokureddy 862071 0 187943 0 0 0 9310 0 2638 0 1061962 0 0 0 William DeLuccia 745314 0 0 0 0 0 9310 0 18184 0 772808 0 0 0 Paul Hicks 744594 0 0 0 0 0 13750 0 8805 0 767149 0 0 0 Nishith Amin 742806 0 0 0 0 0 9310 0 17321 0 769437 0 0 0 Ravi Akula 550000 0 137310 0 0 0 9310 0 17321 0 713941 0 0 0 Gregory Schultz 163435 0 15108 0 0 0 16918 0 14665 0 210126 0 0 0 Deborah Martin 145000 0 9628 0 0 0 14672 0 22319 0 191619 0 0 0 Gregg Martin 145400 0 14752 0 0 0 15170 0 17963 0 193285 0 0 0 Marc Rustici 143320 0 10165 0 0 0 13270 0 17899 0 184654 0 0 0 Joseph Braunschiedel 0 150010 0 2671 0 0 0 3114 0 7038 0 162833 0 0 Kim Panosian 0 200481 0 0 0 0 0 3114 0 6696 0 210291 0 0 Roger Schenone 0 272823 0 0 0 0 0 0 0 9074 0 281897 0 0 SchJ_P01_S00_L01a Schedule J, Part I, Line 1a 1A. Dr. Huffner is allowed to travel first class to accomodate his disability under reasonable accomodations. The CEO and COO have their dues paid at the Elmira Country Club. The personal use portion is required under taxable income. SchJ_P01_S00_L03 Schedule J, Part I, Line 3 The Medical Center has an Incentive Compensation Program for meeting the Organization's Board assigned goals. Part of the measure for financial viability is avoiding deficits are measured by margins. A small part of the compensation is based upon avoiding operating losses and financial viability and not on the size or magnitude of any net earnings. Included is also the Goal Acheivement Program payments for hitting board approved goals. These goals are set and approved by the Board, and reviewed by the compensation committee, based upon the strategic needs of the Organization. The goals cover the areas of quality improvement, physician recruitment, facilities, patient satisfaction surveys, financial viability and the DNV performance. SchJ_P01_S00_L06 Schedule J, Part I, Line 6 Line 6 - The Medical Center has an Incentive Compensation Program for meeting the Organization's Board Assigned Goals. Part of the measure for financial viability is avoiding deficits as measured by margins. A small part of compensation is based upon avoiding operating losses and financial viability and not the size or magniture of any net earnings. Chemung County Industrial Developmental Agency 166209017 000164019 2004-03-10 19912903 Series A Construction Bond 0 0 0 Chemung County Industrial Developmental Agency 166209017 000164019 2004-03-10 16959701 Series B Facility Renovation 0 0 0 0 0 19912203 1318000 0 0 419500 0 1802477 16377225 0 0 2006 0 0 1 1 0 0 16959701 1117195 4561742 0 328213 0 0 10287552 0 0 2005 0 1 1 1 0 0 0 0 0 1 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 F990_P06_S0A_L02 Form 990, Part VI, Section A, Line 2 Part VII - 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 provide Nutritional Services, Laundry, Plant Operations and Housekeeping Management 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, NY and formed a new organization, Arnot Health, Inc. with a board to govern both organizations. F990_P06_S0B_L11b Form 990, Part VI, Section B, Line 11b Once the 990 Form is complete it is reviewed by our Audit Firm, Freed Maxick and then presented by the Medical Center's Senior Vice President of Finance to the Audit and Finance Committes of the Board of Managers. The return is made available to all board members for review and questions. F990_P06_S0B_L12c Form 990, Part VI, Section B, Line 12c FORM 990, PART VI, SECTION B, LINE 12C: ALL MEMBERS OF THE BOARD OF MANAGERS, OFFICERS, AND MANAGEMENT EMPLOYEES SHALL BE REQUIRED ANNUALLY TO FILE A DISCLOSURE STATEMENT SETTING FORTH ANY RESPECT IN WHICH SUCH PERSON, OR ANY PERSON ASSOCIATED WITH SUCH PERSON, HAS OR MAY HAVE ANY INTEREST IN ANY TRANSACTION IN WHICH THERE MAY BE, OR APPEAR TO BE, A CONFLICT BETWEEN THE INTERESTS OF SUCH PERSON AND THE ARNOT OGDEN MEDICAL CENTER. AN ASSOCIATE INCLUDED (1) A SPOUSE, A DESCENDANT OR AN ANCESTOR, OR A SPOUSE OF A DESCENDANT OR ANCESTOR; (2) AN ORGANIZATION IN WHICH THE PERSON OR AN ASSOCIATE IS A PARTNER OR EMPLOYEE, OR SUCH PERSON OR AN ASSOCIATE OWNS A MORE THAN 10% BENEFICIAL INTEREST; (3) A TRUST IN WHICH SUCH PERSON IS A TRUSTEE, OR SUCH PERSON OR AN ASSOCIATE HOLDS A MORE THAN 10% BENEFICIAL INTEREST; AND (4) A CORPORATION IN WHICH SUCH PERSON OR AN ASSOCIATE IS AN OFFICER OR DIRECTOR OR EMPLOYEE, OR SUCH PERSON OR AN ASSOCIATE IS AN OWNER OF MORE THAN 10% OF ANY CLASS OF SECURITIES. F990_P06_S0B_L15 Form 990, Part VI, Section B, Line 15 FORM 990, PART VI, SECTION B, LINE 15: COMPENSATION FOR THE PRESIDENT AND VICE PRESIDENT IS SET PURSUANT TO A POLICY AND COMPENSATION PHILOSOPHY ADOPTED BY THE BOARD. THE BOARD HAS A COMPENSATION COMMITTEE CONSISTING OF OUTSIDE DIRECTORS (AOMC BOARD MEMBERS ARE REFERRED TO AS "MANAGERS"). THE COMPENSATION COMMITTEE USES A CONSULTANT TO ADVISE IT ON COMPENSATION FOR THE OFFICERS. THE CONSULTANT COLLECTS AND REPORTS COMPENSATION ON SIMILAR POSITIONS IN SIMILAR NONPROFIT HOSPITALS FROM UPSTATE NY AND WESTERN PA. THE COMPENSATION COMMITTEE RECOMMENDS ADJUSTMENTS TO THE EXECUTIVE COMMITTEE OF THE BOARD WHICH REVIEWS THE RECOMMENDATIONS AND APPROVES OR DISAPPROVES WITHOUT EMPLOYEES IN THE ROOM. THIS ACTION THEN IS REVIEWED WITH THE ENTIRE BOARD ALSO IN EXECUTIVE SESSION. F990_P06_S0C_L19 Form 990, Part VI, Section C, Line 19 The Medical Center prepares a Community Benefit Report which is submitted to NYS Department of Health. The Medical Center uses a variety of methods and media in order to disseminate pertinent information regarding the hospitals public health programs and availability of financial assistance to the public. The Medical Center maintains our website: www.aomc.org which includes the Community Benefit Report and informaiton on adult and pediatric health information. A complete listing of services, physican directory and calendar of events are also available on the website. A "Healthy You" publication is distributed to over 30,000 households on a quarterly basis and request for public input is published annually. The Medical Center uses a variety of media outlets to disseminate information about community outreach programs and services. Historically the local newspaper has proven to be the most effective means for providing timely information to the public based on consumer feedback at programs and events. Other methods include television and radio. F990_P11_S00_L05 Form 990, Part XI, Line 5 Change in Unrealized Gains, $533,983, Donations for Capital Funding, $544,484, Sale of Subsidiary Company-722 West Water Street, $63,056, Change in Net Assets of AOMC Foundation, $2,083,650, Change in Net Assets of Falck Foundation, $-6,393, Net Realized Loss on Investment to Specific Purpose Fund Balance, $-225,269, Heal Grant Net Asset Transfer to Ira Davenport Memorial Hospital, an affiliate, $-1,928,184, Change in Accounting for AOMC Foundation Temporarily Restricted Funds, $-2,257,349, Pension Charge to Equity, $-12,558,767, totaling $13,750,869. Arnot Ogden Medical Center Foundation Accounting Dept 600 Roe Avenue Elmira NY 14905 161109472 Contribution Management NY 501(c)(3) 11E N/A 0 Arnot Ogden Medical Center Auxiliary 600 Roe Avenue Elmira NY 14905 510192902 Fund Raising NY 501(c)(3) 11 N/A 0 The Falck Foundation Accounting Dept 600 Roe Avenue Elmira NY 14905 223055110 Investments 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 Accounting Dept 555 St Josephs Blvd Elmira NY 14901 160743163 Affiliate NY 501(c)(3) 11 N/A 0 St Josephs Hospital Foundation Accounting Dept 571 St Josephs Blvd Elmira NY 14901 161265182 Affiliate NY 501 (c) 7 N/A 0 St Josephs Health Systems Inc Accounting Dept 555 St Josephs Blvd Elmira NY 14901 223243418 Affiliate NY 501 (c) 11B N/A 0 Fitch Street Association 600 Ivy Street Elmira NY 14905 161397356 Real Estate Rental NY Ivy Street Development Corporation Related 0 0 0 0 0 Ivy Street Development Corporation Accounting Department 600 Ivy Street Elmira NY 14905 161009245 Real Estate NY N/A C 233767 3711403 1 Advantage Health Medical Service PC 517 St Josephs Blvd Elmira NY 14901 161455621 Physician Practice NY St Josephs Health System C 0 0 0 0 1 1 0 0 1 1 0 0 1 1 0 1 1 0 1 0 0 Ivy Street Development Corporation Accounting Department i 7060 Lease agreement per contract. Ivy Street Development Corporation Accounting Department i 579100 Lease of Building per agreement. Ivy Street Development Corporation Accounting Department l 120498 Ivy Street Development Corporation Accounting Department a-i 33565 Bank Interest. Ira Davenport Memorial Hospital Inc k 1090844 Provide Laboratory, Cardiac Lab, Sleep Lab, Rehabilitative, Marketing, Management Information Services, Laundry, Clinical Engineering and Respiratory Services per Contract Agreement. St Josephs Hospital k 2517455 Provide Administrative, Endoscopy, Anesthesia Support, Laborabory, Materials Management, Dialysis, Laundry services per Contract Agreement.