2011-11-15T13:48:43-06:00 2010-12-31 BONADIO & CO LLP 171 SULLYS TRAIL SUITE 201 PITTSFORD NY 14534 990 2010-01-01 160743905 ARNOT OGDEN MEDICAL CENTER ARNO 6077374235 600 ROE AVENUE ELMIRA NY 149051676 RONALD J KINTZ 6077374235 2011-11-14 1 JONATHAN MILLER 5853811000 2010 2016-02-24 21:20:13Z RONALD J KINTZ CFO 600 ROE AVENUE ELMIRA NY 149051676 279163322 0 X WWW.AOMC.ORG X 1889 NY COMMUNITY HOSPITAL WITH HIGH QUALITY HEALTH CARE DELIVERY SYSTEM IN CHEMUNG COUNTY, NEW YORK 17 15 2565 618 178258 -91277 1825204 4791116 230756704 247194768 861659 2067402 3257096 3487719 236700663 257541005 0 0 0 0 139576357 157332459 0 0 0 87288181 93751657 226864538 251084116 9836125 6456889 231470295 239983947 92930862 88286519 138539433 151697428 X HOSPITAL WITH OPEN EMERGENCY ROOM - PROVISION OF QUALITY MEDICAL CARE. ARNOT OGDEN MEDICAL CENTER, A COMMUNITY HOSPITAL WITH SELECTED, HIGHLY SPECIALIZED SERVICES, OPERATES AS PART OF A HIGH-QUALITY HEALTH CARE DELIVERY SYSTEM THAT SERVES CHEMUNG COUNTY, NEW YORK AND THE TWIN TIERS REGION OF NEW YORK. 0 0 198238642 245892028 THE ARNOT OGDEN MEDICAL CENTER CONTINUES TO PROVIDE A VARIETY OF HEALTH CARE RELATED SERVICES SINCE IT OPENED IN 1889, SERVING THE CHEMUNG AND TWIN TIER REGIONS OF NEW YORK AND PENNSYLVANIA. 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 2010, THE MEDICAL CENTER'S 1,931 EMPLOYEES CARED FOR 12,142 INPATIENTS IN ITS 276 CERTIFIED BEDS. THE MEDICAL CENTER PROVIDED OUTPATIENT SERVICES APPROXIMATELY 328,966 PATIENT VISITS IN ITS SUBSPECIALTY SERVICES. THE APPROXIMATELY 120 PHYSICIANS PROVIDED FOR 358,717 OFFICE VISITS IN THE AREAS OF PRIMARY CARE AND SPECIALTY SERVICES. 819969 415681 THE ARNOT OGDEN SCHOOL OF NURSING BEGAN IN 1889 AND CONTINUES TO OFFER A THREE YEAR DIPLOMA PROGRAM ACCREDITED BY THE NATIONAL LEAGUE FOR NURSING WITH APPROXIMATELY 50 STUDENTS ENROLLED. THE ARNOT OGDEN SCHOOL OF RADIOLOGIC TECHNOLOGY 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. UPON COMPLETION OF THEIR PROGRAM OF STUDY, STUDENTS ARE ELIGIBLE TO TAKE THE NYS LICENSING EXAMINATIONS FOR REGISTERED NURSES OR RADIOLOGIC TECHNOLOGIST. 1659138 887059 THE MEDICAL CENTER HAS BEEN AWARDED SEVERAL GRANTS TO SUPPORT ITS WORK IN A NUMBER OF AREAS INCLUDING BIOTERRORISM PREPAREDNESS, OCCUPATIONAL MEDICINE, AND HIV, THAT SUPPORT OUT COMMUNITY HEALTH EFFORTS IN THESE AREAS. THE MEDICAL CENTERS COMMUNITY OUTREACH HAS BEEN SUPPORTED WITH GRANTS FOR TOBACCO CESSATION AND EDUCATION FOR ADULTS AND AT RISK YOUTH. THE MEDICAL CENTER PROVIDES NUMEROUS EDUCATIONAL, WELLNESS PROMOTION, AND HEALTH SCREENING PROGRAMS TO THE COMMUNITY. IN COLLABORATION WITH SCHUYLER COUNTY WELLNESS FOCUS GROUP, STEUBEN COUNTY WELLNESS COLLABORATION AND THE CHEMUNG VALLEY HEALTH NETWORK THE MEDICAL CENTER HAS WORKED TO ASSESS THE HEALTH CONCERNS AND NEEDS OF THE COMMUNITIES IT SERVES. 200717749 1 1 0 0 0 0 0 0 0 1 1 1 0 1 1 1 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 781 0 1 2565 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 X 17 15 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X RONALD J KINTZ CFO 6077374235 600 ROE AVENUE ELMIRA NY 149051676 DR S JAN EBERHARD 3.00 X 0 0 0 MR DAVID DALRYMPLE 2.00 X 0 0 0 MR DOUGLAS TIFFT 2.00 X 0 0 0 MR RICHARD AMIR 2.00 X 0 0 0 MR DANIEL BURKE 2.00 X 0 0 0 MS CHRISTINE DECHAMPS 2.00 X 0 0 0 MR MARK HAGEN 2.00 X 0 0 0 MR MICHAEL HOSEY 2.00 X 0 0 0 MR ROY KYLES 2.00 X 0 0 0 MR BEN LYNCH 2.00 X 0 0 0 MR JOHN MEIER 2.00 X 0 0 0 MS MARGARET STREETER 2.00 X 0 0 0 MR RANDY LEHMAN 2.00 X 0 0 0 MR PATRICK ROGERS 2.00 X 0 0 0 MR JOHN ALEXANDER 2.00 X 0 0 0 MR WESLEY BLAUVELT 40.00 X 177694 0 35640 MR ANTHONY COOPER 55.00 X 535831 0 43913 DR FRED FARLEY 55.00 X 361754 0 43913 DR WILLIAM HUFFNER 55.00 X 323697 0 25535 DR RONALD KINTZ 55.00 X 354051 0 43409 DR ROBERT LAMBERT 72.00 X 404535 0 36613 DR VIDYASAGAR MOKUREDDY 60.00 X 934927 0 11948 DR WILLIAM DELUCCIA 60.00 X 745963 0 27319 DR PAUL HICKS 60.00 X 747579 0 22485 DR NISHITH AMIN 60.00 X 742745 0 26465 DR MATTHEW BRAND 60.00 X 715461 0 26465 6044237 0 343705 151 0 1 0 AAFL PO BOX 1253 ELMIRA NY 149021253 HEALTHCARE STAFFING 2250169 ALLIANCE HEALTHCARE SERVICE PO BOX 96485 CHICAGO IL 606936485 DIAGNOSTIC SERVICES 767550 HHA SERVICES INC 22622 HARPER ST CLAIR SHORES MI 48080 MANAGEMENT SERVICES 750815 QUEST DIAGNOSTICS 27027 TOURNEY ROAD VALENCIA CA 91355 DIAGNOSTIC SERVICES 748030 INSIGHT HEALTH CORP PO BOX 847689 DALLAS TX 752847689 DIAGNOSTIC SERVICES 503554 27 48087 4027517 715512 4791116 NET PATIENT SERVICE RE 900099 205292348 205292348 NET PATIENT SERVICE RE 621110 41496475 41496475 NURSING SCHOOL REVENUE 611600 342004 342004 RADIOLOGY SCHOOL REVEN 611600 63941 63941 247194768 1642435 1642435 510 510 364227 678720 -314493 -314493 -314493 20053656 19610229 18970 443427 -18970 424457 424457 29619 48087 29619 0 566030 1284779 -718749 -718749 LAUNDRY 812300 112114 112114 MEDICAL WASTE AND HOUS 562000 63724 63724 ANSWERING SERVICES 541900 2420 2420 4342703 4342703 4520961 257541005 247194768 178258 5376863 3440029 979186 2460843 118119364 101850521 16268843 4438484 4438484 23901705 23901705 7432877 6253276 1179601 3781824 1964209 1817615 252278 3529 248749 91953 5275 86678 412816 412816 5920519 5257021 663498 769648 109440 660208 45950388 45176293 774095 1929242 1929242 3205670 430224 2775446 661780 535595 126185 210734 165878 44856 1639747 1639747 11319069 50000 11269069 4012022 1695264 2316758 OTHER 11171085 8067141 3103944 MAINTENANCE CONTRACTS 2422882 1808823 614059 BENEFIT ALLOCATION 0 24436832 -24436832 251084116 200717749 50366367 0 6787 7187 11364683 6074755 1750205 3063900 32033869 33592888 5748474 3844620 1754905 2507678 2339615 2038287 216639727 124541159 87398573 92098568 45640900 49066064 849354 813614 42582930 46876386 231470295 239983947 16086274 18687404 8862 131430 118362 31026149 29637825 7972282 7103855 7486867 8127457 30218998 24611616 92930862 88286519 X 132323381 145082916 3785806 4183166 2430246 2431346 138539433 151697428 231470295 239983947 X 6456889 6701106 X X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2430246 1100 2431346 2429726 520 2430246 2429026 700 2429726 1.00000 0 1 1 4144862 4144862 1736189 88735356 41853168 48618377 1352303 852736 499567 116935471 81080397 35855074 3735546 754858 2980688 92098568 INVESTMENTS HELD FOR 457 PLANS AND PHYSICIAN PRACTICE PURCHASES 2331038 INTEREST IN NET ASSETS OF FOUNDATIONS 8684138 INVESTMENTS IN SUBSIDIARIES 4129818 ASSETS WHOSE USE IS LIMITED - DEPRECIATION FUND 10251754 ASSETS WHOSE USE IS LIMITED - SELF INSURANCE FUND 17982200 ASSETS WHOSE USE IS LIMITED - DEBT SERVICE RESERVE & BOND PAYMENT FUND 3497438 46876386 ACCRUED ESTIMATED REIMBURSEMENT PAYABLE 4675145 SELF INSURANCE WC/MALPRACTICE RESERVE 8665811 ACCRUED PENSION COST 9443284 457 PLAN LONG TERM LIABILITY 1781159 FEDERAL STUDENT LOAN FUND LIABILITY 46217 24611616 257541005 251084116 6456889 7482269 -781163 6701106 13157995 272108827 14915854 14915854 257192973 353257 -5225 348032 257541005 265847887 15117007 15117007 250730880 353236 353236 251084116 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: IN JUNE 2006, THE FINANCIAL ACCOUNTING STANDARDS BOARD (FASB) ISSUED INTERPRETATION NO. 48, ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES - AN INTERPRETATION OF FASB NO. 109, ACCOUNTING FOR INCOME TAXES (FIN 48). (FIN 48 IS NOW KNOWN AS ACCOUNTING STANDARDS CODIFICATION (ASC) SECTION 740). THIS INTERPRTATION ADDRESSES THE DETERMINATION OF WHETHER TAX BENEFITS CLAIMED OR EXPECTED TO BE CLAIMED ON A TAX RETURN SHOULD BE RECORDED IN THE FINANCIAL STATEMENTS. FOR TAX-EXEMPT ENTITIES, TAX-EXEMPT STATUS ITSELF IS DEEMED TO BE AN UNCERTAINTY, SINCE EVENTS COULD POTENTIALLY OCCUR TO JEOPARDIZE THEIR TAX-EXEMPT STATUS. ASC SECTION 740 PROVIDES GUIDANCE ON DERECOGNITION, CLASSIFICATION, INTEREST AND PENALTIES, ACCOUNTING IN INTERIM PERIODS, DISCLOSURES, AND TRANSITION. THE ORGANIZATION ADOPTED THE PROVISIONS OF ASC SECTION 740 ON JANUARY 1, 2008, AND THERE WAS NO IMPACT ON THE ORGANIZATION'S FINANCIAL STATEMENTS. AS OF THE DATE OF ADOPTION AND AS OF DECEMBER 31, 2009, THE ORGANIZATION DOES NOT HAVE A LIABILITY FOR UNRECOGNIZED TAX BENEFITS. PART XI, LINE 8 - OTHER ADJUSTMENTS: PENSION CHARGE TO EQUITY 556,769. TRANSFER OF HEAL GRANTS TO IRA DAVENPORT MEMORIAL HOSPITAL -2,618,911. SPECIFIC PURPOSE GAIN/LOSS TO FUND BALANCE -186,522. CHANGE IN FUND BALANCE OF FOUNDATIONS 902,892. DONATIONS FOR CAPITAL FUNDING 412,323. PERMANENT IMPAIRMENT RECOVERY FROM PRIOR YEAR 147,061. LIFE TO DATE K-1 ADDED TO NET ASSETS 5,225. PART XII, LINE 2D - OTHER ADJUSTMENTS: DONATIONS OF EQUIPMENT -348,214. RENTAL EXPENSES MOVED TO OFFSET RENTAL INCOME 678,720. CAFETERIA EXPENSES MOVED TO OFFSET CAFETERIA SALES 1,284,779. BAD DEBT EXPENSE MOVED TO OFFSET PATIENT REVENUE 13,153,508. PERMANENT IMPAIRMENT RECOVERY FROM PRIOR YEAR 147,061. PART XII, LINE 4B - OTHER ADJUSTMENTS: INVESTMENT LOSS -5,225. PART XIII, LINE 2D - OTHER ADJUSTMENTS: BAD DEBT EXPENSE MOVED TO OFFSET PATIENT REVENUE 13,153,508. RENT EXPENSE 678,720. CAFETERIA EXPENSES MOVED TO OFFSET CAFETERIA SALES 1,284,779. PART XIII, LINE 4B - OTHER ADJUSTMENTS: EXPENSE RELATED TO SALE OF INVENTORY OTHER REVENUE - 1. DONATIONS FROM FUND BALANCE, $1,069,408 2. RENTAL EXPENSES, $(698,703), 3. COST OF GOODS SOLD, $(1,304,342), 4. BAD DEBTS, $(13,855,724), 5. RECOGNITION OF LOSS, $(225,685) OTHER EXPENSES - 1. BAD DEBTS, $(13,855,724) 2. EXPENSES RELATED TO RENTALS, $(698,703) 3. EXPENSES RELATED TO SALE OF INVENTORY, $(1,304,342) CHANGE IN NET ASSETS - 1. PENSION CHARGE TO EQUITY, $9,320,971 2. SPECIFIC PURPOSE GAIN/LOSS TO FUND BALANCE, $(230,359) 3. RECOVERY OF PERMANENT IMPAIRMENT, $225,685 4. CHANGE IN NET ASSETS OF FOUNDATIONS, $1,330,944 5. LIFE TO DATE K-1 ADDED TO NET ASSETS, $2,310,266 GOLF TOURNAMENT 46963 48087 -1124 700 700 5560 3479 6364 MIRACLE FEST 12590 12590 600 6370 4491 500 375 27 18153 18153 480 77706 48087 29619 700 1300 11930 7970 500 7219 29619 0 1 1 X 1 X 1 X 1 1 1 0 1 1 725 2672563 399859 2272704 0.00910 35667 26442145 18634320 7807825 0.03110 2726 39118 29114708 19034179 10080529 0.04020 193 15743 1303931 726722 577209 0.00230 97 1406 1726951 442856 1284095 0.00510 10 79676 75713592 47162320 28551272 0.11370 28 40509 40509 0.00020 328 96825 78784983 48331898 30453085 0.12130 328 135943 107899691 67366077 40533614 0.16150 11 15 139652 139652 0.00060 1 49458 49458 0.00020 17 44 189110 189110 0.00080 1 6059645 60498809 65772868 -5274059 X 1 1 1 IVY STREET DEVELOPMENT CORP COLLECTION SERVICES & OFFICE RENTALS 1.00000 0.00000 0.00000 4 1 ARNOT OGDEN MEDICAL CENTER

600 ROE AVENUE ELMIRA NY 14905

X 2 AOMC - RADIOLOGY DIAGNOSTIC

600 FITCH STREET ELMIRA NY 14905

RAIOLOGY DIAGNOSTIC/OUTPATIENT CLINIC 3 AOMC - CLINICAL LABRADIOLOGY

100 JOHN ROMMELT DRIVE HORSEHEADS NY 14845

CLINICAL LAB/SERVICE OUTPATIENT/RADIOLOGY DIAGNOSTIC 4 AOMC - RENTAL DIALYSIS CHRONIC OP

8 WEST PULTNEY STREET CORNING NY 14830

RENTAL DIALYSIS/TREATMENT FACILITY ARNOT OGDEN MEDICAL CENTER 1 1 X X X X X X X X 09 1 1 1 X X X X X X X X X X X X 1 1 1 100.000000000000 1 400.000000000000 1 X X X 1 1 X X X X 1 X X X 1 X X X X X X 1 X 0 1 1 AOMC - RENTAL DIALYSIS CHRONIC OP

1879 DAVIS STREET ELMIRA NY 14901

RENTAL DIALYSIS TREATMENT FACILITY PART I, LINE 3C: THE MEDICAL CENTER USES THE FEDERAL POVERTY GUIDELINES IN ESTABLISHING CRITERIA FOR FREE AND DISCOUNTED HEALTH SERVICES. PART I, LINE 6A: THE MEDICAL CENTER PREPARES AN ANNUAL WRITTEN REPORT THAT DESCRIBES THE ORGANIZATIONS PROGRAMS AND SERVICES THAT PROMOTE THE HEALTH OF THE COMMUNITY OR COMMUNITIES SERVED BY THE ORGANIZATION. AN ABBREVIATED VERSION OF THE REPORT IS AVAILABLE ON THE WEB. PART I, LINE 7: ALLOCATIONS OF EXPENSES OVER GROSS CHARGES. PART I, LINE 7G: 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 OF THESE SERVICES AS THE REVENUE THEY GENERATE DOES NOT COVER THE COST OF PROVIDING THE SERVICES. PART III, LINE 4: 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 TYPE. THE MEDICAL CENTER AND IRA DAVENPORT FOLLOW ESTABLISHED GUIDELINES FOR PLACING CERTAIN PAST DUE PATIENT BALANCES WITH COLLECTION AGENCIES, SUBJECT TO THE TERMS OF CERTAIN RESTRICTIONS ON COLLECTION EFFORTS AS DETERMINED BY THE MEDICAL CENTER AND IRA DAVENPORT. THE RATIO OF COST TO CHARGES METHODOLOGY WAS USED TO DETERMINE THE "COST" OF THE 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. PART III, LINE 8: 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 OF THESE SERVICES (SEE PART I, LINE 7G) AS THE REVENUE THEY GENERATE DOES NOT COVER THE COST OF PROVIDING THE SERVICES. THESE SERVICES INCLUDE; MEDICAL & SURGICAL, MATERNITY, NURSERY, NEONATAL INTENSIVE CARE AND SKILLED NURSING INPATIENTS. THE SUBSIDIZED OUTPATIENT SERVICES INCLUDE; WOUND & HYPERBARIC THERAPY, RENAL DIALYSIS, AND THE HIV CLINIC. THE MEDICAL CENTER HAS INCLUDED THE MEDICARE PORTION OF SUCH SERVICES IN THIS AREA AS THE SERVICES ARE BELIEVED TO BE IMPORTANT TO THE COMMUNITIES SERVED. PART III, LINE 9B: PATIENTS QUALIFYING FOR FREE CARE UNDER THE CHARITY CARE PROGRAM ARE NOT PURSUED FOR PAYMENT FOR THE SERVICES COVERED BY THE PROGRAM. PATIENTS QUALIFYING FOR DISCOUNTED SERVICES ARE EXPECTED TO PAY THE DISCOUNTED FEES. ARNOT OGDEN MEDICAL CENTER PART V, SECTION B, LINE 3: THE COMMUNITY SERVICE PLAN EXPLAINS IN DETAIL THE INVOLVEMENT OF MEMBERS OF THE COMMUNITY IN DETERMINING & IDENTIFYING COMMUNITY NEEDS. ARNOT OGDEN MEDICAL CENTER PART V, SECTION B, LINE 4: SAINT JOSEPH'S HOSPITAL, ELMIRA, NY AND IRA DAVENPORT MEMORIAL HOSPITAL, BATH, NEW YORK ARNOT OGDEN MEDICAL CENTER PART V, SECTION B, LINE 5C: COMMUNITY SERVICE PLAN AND NEWSLETTERS ARNOT OGDEN MEDICAL CENTER PART V, SECTION B, LINE 6I: COMMUNITY SERVICE PLAN ARNOT OGDEN MEDICAL CENTER PART V, SECTION B, LINE 19D: PARTICIPANTS IN THE MEDICARE SYSTEM ARE REQUIRED TO CHARGE ALL PATIENTS THE SAME AMOUNT FOR SERVICES REGARDLESS OF INSURANCE PER THE MEDICARE PARTICIPATION GUIDELINES. ARNOT OGDEN MEDICAL CENTER 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. X X 1 1 X X X X 0 0 0 0 0 1 0 1 0 MR WESLEY BLAUVELT 160000 0 17694 0 0 0 17692 0 17948 0 213334 0 0 0 MR ANTHONY COOPER 430500 0 105331 0 0 0 25050 0 18863 0 579744 0 0 0 DR FRED FARLEY 263000 0 98754 0 0 0 25050 0 18863 0 405667 0 0 0 DR WILLIAM HUFFNER 304113 0 19584 0 0 0 9310 0 16225 0 349232 0 0 0 DR RONALD KINTZ 262714 0 91337 0 0 0 23750 0 19659 0 397460 0 0 0 DR ROBERT LAMBERT 340000 0 64535 0 0 0 17750 0 18863 0 441148 0 0 0 DR VIDYASAGAR MOKUREDDY 934927 0 0 0 0 0 9310 0 2638 0 946875 0 0 0 DR WILLIAM DELUCCIA 745963 0 0 0 0 0 9310 0 18009 0 773282 0 0 0 DR PAUL HICKS 747579 0 0 0 0 0 13750 0 8735 0 770064 0 0 0 DR NISHITH AMIN 742745 0 0 0 0 0 9310 0 17155 0 769210 0 0 0 DR MATTHEW BRAND 705816 0 9645 0 0 0 9310 0 17155 0 741926 0 0 0 SUPPLEMENTAL INFORMATION PART III 1A. DR. HUFFNER IS ALLOWED TO TRAVEL FIRST CLASS TO ACCOMODATE HIS DISABILITY UNDER REASONABLE ACCOMODATIONS. THE CEO, COO, & CFO HAVE THEIR DUES PAID AT THE ELMIRA COUNTRY CLUB. THE PERSONAL USE PORTION IS REQUIRED UNDER TAXABLE INCOME. SUPPLEMENTAL INFORMATION PART III 4B. THE MEDICAL CENTER DOES NOT MAKE ANY ADDITIONAL PAYMENTS INTO A NON QUALIFIED PLAN, BUT THE EMPLOYEES ARE ABLE TO ELECT TO DEFER SOME OF THEIR SALARY IN A 457 PLAN AND 403B PLAN. SUPPLEMENTAL INFORMATION PART III 6A. THE MEDICAL CENTER HAS A GOOD ACHIEVEMENT (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 ON THE SIZE OR MAGNITUDE OF ANY NET EARNINGS. SUPPLEMENTAL INFORMATION PART III 7. INCLUDED IN PART II IS GOAL ACHIEVEMENT 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, ACCESS (PHYSICIAN RECRUITMENT), FACILITIES, PATIENT SATISFACTION, FINANCIAL VIABILITY AND THE JOINT COMMISSION PERFORMANCE. CHEMUNG COUNTY INDUSTRIAL DEVELOPMENTAL AGENCY 166209017 000164019 2004-03-10 19912203 SERIES A - CONSTRUCTION 0 0 0 CHEMUNG COUNTY INDUSTRIAL DEVELOPMENTAL AGENCY 166209017 000164019 2004-03-10 16959701 SERIES B - FACILITY RENOVATION 0 0 0 19912203 1318000 419500 1802477 16377225 2006 0 0 1 1 328213 10287552 2005 0 1 1 1 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 FORM 990, PART VI, SECTION B, LINE 11 ONCE THE 990 IS IN FINAL FORM IT IS PRESENTED BY THE MEDICAL CENTER'S VICE PRESIDENT OF FINANCE TO THE AUDIT AND FINANCE COMMITTEES OF THE BOARD OF MANAGERS. THE RETURN IS MADE AVAILABLE TO ALL BOARD MEMBERS FOR REVIEW AND QUESTIONS. 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. 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. FORM 990, PART VI, SECTION C, LINE 19 ITEMS REQUIRED FOR PUBLIC DISCLOSURE ARE MADE AVAILABLE FOR THOSE WHO REQUEST THE INFORMATION. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 7,482,269. PENSION CHARGE TO EQUITY 556,769. TRANSFER OF HEAL GRANTS TO IRA DAVENPORT MEMORIAL HOSPITAL -2,618,911. SPECIFIC PURPOSE GAIN/LOSS TO FUND BALANCE -186,522. CHANGE IN FUND BALANCE OF FOUNDATIONS 902,892. DONATIONS FOR CAPITAL FUNDING 412,323. PERMANENT IMPAIRMENT RECOVERY FROM PRIOR YEAR 147,061. LIFE TO DATE K-1 ADDED TO NET ASSETS 5,225. TOTAL TO FORM 990, PART XI, LINE 5: 6,701,106. THE ORGANIZATION HAS NOT CHANGED ITS POLICY TO HAVE A COMMITTEE RESPONSIBLE FOR OVERSIGHT OF THE AUDIT AND SELECTION OF AN INDEPENDENT AUDITOR. ARNOT OGDEN MEDICAL CENTER FOUNDATION 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 EVENTS NY 501(C)(3) 11 N/A 0 THE FALCK FOUNDATION INC 600 ROE AVENUE ELMIRA NY 14905 223055110 INVESTMENTS NY 501(C)(3) 11E N/A 0 IRA DAVENPORT MEMORIAL HOSPITAL 7571 STATE ROUTE 54 BATH NY 14810 160835446 HOSPITAL NY 501(C)(3) 3 0 FITCH STREET ASSOICATION 600 IVY STREET ELMIRA NY 14905 161397356 REAL ESTATE RENTAL NY IVY STREET DEVELOPMENT CORPORATION 0 0 IVY STREET DEVELOPMENT CORPORATION 600 IVY STREET ELMIRA NY 14905 161009245 REAL ESTATE RENTAL NY N/A C -64081 3231310 1.00000 722 WEST WATER STREET CORP 600 ROE AVENUE ELMIRA NY 14905 160866677 REAL ESTATE RENTAL NY N/A C -45261 462494 1.00000 1 1 0 0 0 0 0 1 1 0 0 0 0 0 1 1 0 0 722 WEST WATER STREET CORPORATION A 7060 CONTRACTS IVY STREET DEVELOPMENT CORPORATION A 535660 SQUARE FOOTAGE % IVY STREET DEVELOPMENT CORPORATION I 523741 CONTRACT % IVY STREET DEVELOPMENT CORPORATION O 204351 SQUARE FOOTAGE % IVY STREET DEVELOPMENT CORPORATION P 58884 BANK % 722 WEST WATER STREET CORPORATION I 60535 SQUARE FOOTAGE % IRA DAVENPORT MEMORIAL HOSPITAL H 2618911 FMV OF ASSETS