2011-11-10T11:39:56-07:00 2010-12-31 990 2010-01-01 160743024 FREDERICK FERRIS THOMPSON HOSPITAL FRED 5853966124 350 Parrish Street Canandaigua NY 14424 Mark Prunoske 5853966490 2011-11-10 2010 2016-03-07 17:11:31Z Linda Farchione 350 Parrish Street Canandaigua NY 14424 90706065 0 X www.thompsonhealth.org X 1904 NY FF Thompson Hospital Inc. is a community hospital which exists to serve the healthcare needs of the people in partnership with regional healthcare providers. FF Thompson Hospital serves as the center of a healthcare network to provide a full range of health care services and to improve community health. 19 17 1633 275 270837 -78509 495114 2397558 84311266 84131783 19374 -126813 1251718 1092661 86077472 87495189 0 0 0 0 44994870 47125197 0 0 352507 38709438 38693224 83704308 85818421 2373164 1676768 74360488 82680732 40625053 49093828 33735435 33586904 FF Thompson Hospital Inc. is a community hospital which exists to serve the healthcare needs of the people in partnership with regional healthcare providers. FF Thompson Hospital serves as the center of a healthcare network to provide a full range of healthcare services and to improve community health. 0 0 71922437 0 84131783 Inpatient Care: 5,087 Inpatient discharges, 19,875 Inpatient days. Outpatient: 880,252 Lab visits/tests, 25,667 ED visits, 64,607 Diagnostic Imaging, 11,518 Urgent Care, 15,114 Rehabilitation Services, and 5,507 Surgical Services. Charity Care was provided in the amount of $1,091,359 (at cost), Community Benefit was $2,406,132. Uncompensated care was $2,467,747 (at cost) 0 0 0 71922437 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 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 0 0 0 0 1 179 0 1 1633 1 1 1 0 0 0 0 0 0 0 0 0 X 19 17 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X FF Thompson Hospital 5853966124 350 Parrish Street Canandaigua NY 14424 Linda M Farchione 32.75 X X 0 405737 153891 Ellie Fralick 1 X 0 0 0 Dr Ronald Hainen MD 1 X 0 0 0 Richard Cutri 1 X 0 0 0 William R Kenyon 1 X X 0 0 0 George W Hamlin IV 1 X X 0 0 0 R Douglas Alling MD 2 X X 12800 0 0 Robert Sands 1 X X 0 0 0 Ronald Knight 1 X X 0 0 0 Reverend Thomas Mull 1 X 0 0 0 James H Barr CPA 1 X 0 0 0 Paul Hudson 1 X 0 0 0 Richard Bottorf 1 X 0 0 0 Brian Meath 1 X X 0 0 0 Richard H Hawks Jr 1 X 0 0 0 Thomas Kubiak 1 X 0 0 0 Dr Carl Sahler MD 1 X 0 0 0 Deborah Price 1 X 0 0 0 Dianne Cooney Miner PhD 1 X 0 0 0 Deborah K Weymouth 32.75 X 24809 236255 90016 Carlos Ortiz MD 35 X 0 260154 75770 Christopher B Mahan 12 X 41229 114666 57382 Jennifer DeVault 40 X 114484 0 39262 Mark Prunoske 29.75 X 56002 85681 36958 Hazel Robertshaw 40 X 110275 0 19206 Dr Anthony Geraci MD 40 X 283752 0 87549 Dr Vijay Bansal MD 40.50 X 266653 0 29362 Dr David Baum MD 42.12 X 285005 0 83943 Dr Timothy Pitler MD 43.91 X 299054 0 126271 Dr Sunil Bansal MD 43.03 X 287646 0 52596 Dr Tamara Prull MD 40.71 X 277592 0 34568 2059301 1102493 886774 33 0 1 0 LeChase Construction 300 Trolley Blvd Rochester NY 14606 Construction 1407130 Francis Cauffman Hoffman Architects LTD 2120 Arch Street Philadelphia PA 19103 Construction 1004443 Laboratory Corporation of America Holdings P O Box 12140 Burlington NC 272162140 Reference Lab Services 800810 Canandaigua Medical Group PC 335 Parrish Street Canandaigua NY 14424 On Call Services 319796 Canandaigua Orthopaedic Associate PC 514 S Main Street Canandaigua NY 14424 On Call Services 300000 16 0 0 0 2252814 144744 0 0 2397558 Community Health Service 622000 66246940 65976103 270837 0 Medicare/Medicaid Payments 622000 17884843 17884843 0 0 0 0 0 0 84131783 89683 0 0 89683 0 0 0 0 0 0 0 0 0 0 690438 2303942 659508 2551368 30930 -247426 -216496 0 0 -216496 0 Associate/Patient Support 622000 1092661 0 0 1092661 0 0 0 0 1092661 87495189 83860946 270837 965848 630551 0 630551 0 37513842 33021142 4492700 0 1526737 1328261 198476 0 4670018 4062916 607102 0 2784049 2422123 361926 0 1517543 1339185 178358 0 327917 0 327917 0 78473 0 78473 0 0 0 0 0 0 0 0 0 4530364 3421806 1108558 0 51755 0 51755 0 13904645 13539628 365017 0 1904486 1221399 683087 0 0 0 0 0 2030860 1917156 113704 0 145228 78414 66814 0 0 0 0 0 243451 200132 43319 0 660687 0 660687 0 352507 0 0 352507 5709982 4967684 742298 0 890425 59757 830668 0 Provision for Uncollectable Accounts 2553254 2553254 0 0 New York State Cash Assessment 290946 0 290946 0 Health System Member Assessment 3105060 1490429 1614631 0 Equipment & Maintenance 234709 223916 10793 0 Dues & Subscriptions 160932 75235 85697 0 0 0 0 0 85818421 71922437 13543477 352507 2985 3035 14252379 15197985 5416301 4998183 1453558 1353903 1022737 1149549 92873895 54051907 38463619 38821988 627289 683632 13121620 20472457 74360488 82680732 9814559 11772293 12800000 11700000 4197472 7429744 13813022 18191791 40625053 49093828 X 25816718 22786988 7918717 10799916 0 0 33735435 33586904 74360488 82680732 X 1676768 -1825299 X 0 1 1 X 0 X 5619137 72378 814801 0 266626 0 6239690 4831696 57312 976186 0 246057 0 5619137 7159761 267354 -2251021 0 344398 0 4831696 0.91 0.09 0 0 0 0 58076 58076 0 45645901 23634285 22011616 0 360818 156673 204145 0 40245991 28873257 11372734 0 6563109 1387692 5175417 38821988 Other Assets 80938 Due from Affiliates 2111937 Assets Limited as to Use 5504097 Beneficial Interest in Charitable Remainder Trust 337426 Deferred Financing Costs, net 1975569 Beneficial Interest in net assets of FFTH Foundation 10462490 20472457 0 Conditional Asset Retirement Obligation 1429676 Accrued Pension Liability 8672210 Charitable Gift Annuity Payment Liability 174298 Interest Rate Swap Liability 620765 Third Party Payor Accrual 7294842 18191791 87495189 85818421 1676768 156650 0 0 0 -1981949 -1825299 -148531 85448732 0 0 0 0 0 85448732 0 2046457 2046457 87495189 85465915 0 0 0 0 0 85465915 0 352506 352506 85818421 SchD_P05_S00_L04 Schedule D, Part V, Line 4 The funds are for the benefit of FF Thompson Health System, Hospital, Senior Communities, and Continuing Care Center. The Foundation continuously evaluates the needs of these organizations and attempts to meet those needs. SchD_P10_S00_L02 Schedule D, Part X, Line 2 The Hospital adopted the provisions of ASC Section 740 on January 1, 2009, and there was no impact on the Hospital's financial statements. As of December 31, 2010 the Hospital does not have a liability for unrecognized tax benefits. SchD_P11_S00_L08 Schedule D, Part XI, Line 8 Change in value of interest rate swap -$230,314, Change in value of charitable gift annuities -$31,169, Change in funded status of pension plan -$4,601,665, Change in beneficial interest in charitable remainder trust -$37,769, Change in beneficial interest in the net assets of the FF Thompson Foundation Inc. $2,918,968 SchD_P12_S00_L04b Schedule D, Part XII, Line 4b FFTH Foundation and other income $2,252,814, Net Assets released from restrictions used for operations -$79,544, Investment Income $120,613, Loss on disposal of equipment -$247,426 SchD_P13_S00_L04b Schedule D, Part XIII, Line 4b Contribution to The FF Thompson Foundation Inc $352,506 1 1 1 X 1 X 1 1 1 0 1 1 1383481 292122 1091359 0.0132 7891516 6121034 1770482 0.0214 0 0 0 0 0 0 9274997 6413156 2861841 0.0346 773067 89627 683441 0.0082 0 0 0 0 2652327 3195891 543564 0.0066 0 0 0 0 114322 853 113469 0.0014 0 0 3539716 3286371 1340474 0.0162 0 0 12814713 9699527 4202315 0.0508 271687 3620 268067 0.0032 106205 0 106205 0.0013 125949 0 125949 0.0015 565437 0 565437 0.0068 0 0 1069278 3620 1065658 0.0128 1 2467747 42452 15217101 16185819 -968718 X 1 1 1 1 The Fredrick Ferris Thompson Hospital

350 Parrish Street Canandaigua NY 14424

X X X The Fredrick Ferris Thompson Hospital 1 SchH_P01_S00_L03c Schedule H, Part I, Line 3c N/A SchH_P01_S00_L07 Schedule H, Part I, Line 7 Patient Cost to Charge system from the worksheets. SchH_P01_S00_L072f Schedule H, Part I, Line 7, Column f The amount of bad debt expense included in Form 990, Part IX, line 25, column (A) is $2,553,254 and is removed for the purposes of calculating the percentage on Schedule H, Part I, Line 7, column (f). SchH_P01_S00_L07g Schedule H, Part I, Line 7g There are no physician clinic costs included in these services. SchH_P02_S00_L00 Schedule H, Part II Thompson health maintains many links and affiliations with community and health organizations to enhance its ability to develop and deliver community programs. Through our provider network and existing partnerships in the community, Thompson Health has established a diverse array of community health programs to meet the community's specific needs. Some of our affiliations include work with the county, schools, and colleges, industry, chambers of commerce and related service groups, as well as other non-profit community organizations. SchH_P03_S0A_L04 Schedule H, Part III, Section A, Line 4 As noted in the financial statement's footnote, "An allowance for doubtful accounts receivable is estimated by management based on periodic reviews of the collectability of accounts receivable considering historical experience and prevailing economic conditions." Bad Debt expense is not included in the Community Benefit number or treated as community benefit. Bad debt expenses are calculated by converting the net expense per the audited financials back to gross charges. Gross charges are then reduced to cost using the cost to charge ratio calculated on Worksheet A of the 2010 schedule H 990 form. SchH_P03_S0B_L08 Schedule H, Part III, Section B, Line 8 Medicare payments are converted to Medicare gross charges. The cost to charge ratio computed on worksheet 2, line 11 is then applied. Medicare shortfalls are not included in or considered community benefit. SchH_P03_S0C_L09b Schedule H, Part III, Section C, Line 9b Patient balance-due accounts that are not Medicare primary, which include patients that qualify for charity care or financial assistance that are not paid in full or are not subject of an agreed-upon payment arrangement or in the process of review for financial aid or pending Medicaid are eligible to be referred to a collection agency when they reach a delinquency status of 90 days old from date of first self-pay bill. Self-pay bills which are a result of medicare coinsurance and/or deductible are eligibile to be referred to a collection agency when they reach a delinquency status of 120 days old from date of first self pay bill. SchH_P06_S00_L02 Schedule H, Part VI, Line 2 Based on its commitment to the community, FF Thompson hospital completed a community health assessment to better understand the needs of the community members. The following identifies the participants in the process of conducting the community health assessments. Participants: The hospital worked with a broad-base of area community agencies known as "The Ontario County Partners for Community Solutions" to continue actions and implement the community health assessment. The participants in this committee included FF Thompson health, the Ontario County Department of Public Health, the Ontario County Office of Aging, the Ontario County Youth Bureau, the United Way, and the Canandaigua Churches in Action (a local church consortium.) Together this group developed and implemented a community health assessment to determine the ongoing needs of the county and to continue laying the groundwork for a county plan to address these needs. SchH_P06_S00_L03 Schedule H, Part VI, Line 3 The Thompson Health Community Care Program is communicated in appropriate detail in several mediums. All efforts to provide information at a variety of locations using a variety of media and techniques is attempted. Thompson Health makes its best effort to make the program information available to patients prior to them receiving services, however; it is recognized that in many cases patients will investigate the Financial Aid/Community Care program after services are rendered. Thompson Health makes its best efforts to verbally communicate the program through its associates recognizing that there are levels of associate involvement. Patient registration staff verbally inform all self pay patients of this available benefit. There are pamphlets and informational sheets available for all patients in the registration area. Thmpson Health associates are given information sheets to assist them with the ability to communicate this program to patients. Translation services are available as needed for any population that reaches 5% of total population visits per year. A variety of written communications are also used such as: Information sheets - located in the same areas as the signs will be information sheets regarding the availability of a financial aid/community care program identifying key contacts for further information. Application & Directions - these documents provide the patient with the program application and directions as to how to complete the application and the additional information required for a complete application. These applications are handed out in the Emergency Department to self-pay patients. Patient Bills & Collection Correspondence - patient billing statements include a statement regarding the existence of the program and who to contact. Simliar information is included in the "collection" letters. Electronic Media: Intranet - Thompson Health's intranet includes this policy and directions in the Policy & Procedure Manual on the intranet making the policy and program available to all associates. Internet Web Site - Thompson Health incorporates general information about the policy, sliding fee application and directions on its web site. Non-Patient Communication - Financial counselors communicate the program with community health & human service agencies and social service organizations and agencies. (i.e. Office of the Aging, etc.) as well as companies it utilizies in its collection efforts (i.e. collection agencies.) SchH_P06_S00_L04 Schedule H, Part VI, Line 4 The method by which FF Thompson hospital defines its service area includes an analysis of its primary and secondary service area as well as the area demographics. The following defines the service areas and provides a demographic summary of the region. Definition of primary and secondary service areas: Thompson health provides services to persons in Ontario County and parts of Wayne, Monroe, Livingston, Yates, and Seneca counties. Thompson health defines its primary service area as including those zip codes that cumulatively add up to 70% of its inpatient admissions and where we receive greater than 50% of the market share. At the 70th percentile the remaining zip codes (up to the 90th percentile) comprise the secondary service area. Distribution by age group for the community is as follows: 29% 35 - 54, 18% 0 - 14, 13% 55 - 64, 12% 25 - 34, 10% 18 - 24, 8% 15 - 17. The current household incomes fall into the following groups: 27% $25-50k, 22% $50k - 75k, 19% Over $100k, 14% $75k - 100k, 18% under $25k. Population distribution by race/ethnicity is 94% White, Non-Hispanic, 3% Hispanic, 2% Black, 1% All others. SchH_P06_S00_L05 Schedule H, Part VI, Line 5 A majority of Thompson Health's governing body is comprised of persons who reside in our primary service area and are neither employees, contractors, or family members therof. Our organization extends priviledges to all qualified physicians in our community for all departments. All surplus funds are rolled into a fund balalnce for future year capital growth purposes which ensures improvement of our patient care areas. Thompson Hospital is committed to staying connected to our community members. Each of our executives and many of our directors serve on at least one or two boards of directors for the businesses in our community. Also in response to a national shortage of physicians, Thompson continutes to recruite new physicians specializing in several arenas as well as additional family practitioners ensuring physician coverage for our community members. FF Thompson Hospital was designated a second time in Februrary 2010 as a Magnet facility for the excellence of its nursing services by the American Nurses Credentialing Cetner. Thompson Hospital is a New York State Department of Health designated Stroke Center. We strive to use our resources effectively and efficiently to promote health and to reduce the overall cost of health care, address a multitude of issues and populations, address the health needs of the individual that go beyond medical and physical issues, and to ensure services are locally based. Our community building activities promote health in many ways. With over ten support groups that meet at least monthly, Thompson provides essential education to those experiencing medical, behavioral, and emotional challenges. Also, the groups provide an opportunity for community members to connect with one another and to share valuable insights on how to overcome barriers to living in a state of optimal health and wellness. FF Thompson hospital either creates sponsors or facilitates innumerable health fairs throughout the year joining the community organizations to provide valued information on health and wellness to the community. Major events in 2010 include the community outreach event we was held at a local supermarket to celebrate wellness. The term "one-stop shopping" took on added meaning as Thompson Health partnered with Wegmans, taking its message of being proactive in regard to one's health to the stores in Canandaigua, Pittsford and Perinton. During events held in 2010, well over 100 Wegmans shoppers and employees received cholesterol/glucose testing, blood pressure screenings and consultations with cardiologists, as well as helpful information on stroke, nutrition and diabetes. With almost two-thirds of residents aged 45-64 overweight or obese, Thompson wants the community on track for a healthier future. Joining with Finger Lakes Health, Clifton Springs Hospital & Clinic and Ontario County, we helped develop a work plan to address chronic disease, physical activity/nutrition, and access to care. Through an initiative called Choose Health OntariO (CHOO), this team also shared healthy tips via mailings aimed at improving behaviors and making healthy choices. SchH_P06_S00_L06 Schedule H, Part VI, Line 6 Thompson Health is comprised of the following corporations: FF Thompson Hospital, a 113-bed acute care facility, MM Ewing Continuing Care Care Center, a 188-bed long term care facility, the FF Thompson Foundation, FFTH properties and services, and FFTH Senior Communities, which owns and operates a senior living community featuring independent and enriched living residences. Those within these corporations of Thompson Health promote its vision, which is "Bringing Confidence and Compassion to Every Healthcare Experience. With this vision as our foundation, Thompson Health's Board of Directors, medical staff, volunteers, and associates are committed to being directly involved in the health and well-being of our community by keeping the community healthy by providing excellence in our primary and secondary care services, wellness information, and community education. SchH_P06_S00_L07 Schedule H, Part VI, Line 7 New York X X X X 0 1 0 0 0 1 1 0 0 Linda M Farchione 0 314004 0 67500 0 24233 0 144616 0 9275 0 559628 0 0 Carlos Ortiz MD 0 236870 0 22110 0 1174 0 59100 0 16670 0 335924 0 0 Deborah K Weymouth 24809 198470 0 37302 0 483 10107 77488 279 2141 35195 315884 0 0 Mark Prunoske 44926 85681 6481 0 4596 0 8769 12058 6792 9339 71564 107078 0 0 Christopher B Mahan 41229 97276 0 12272 0 5118 16291 38433 792 1867 58312 154966 0 Dr Anthony Geraci MD 255420 0 18029 0 10303 0 64567 0 22982 0 371301 0 0 0 Dr Timothy Pitler MD 290696 0 5325 0 3034 0 109306 0 16965 0 425326 0 0 0 Dr Sunil Bansal MD 281238 0 0 0 6408 0 31026 0 21570 0 340242 0 0 0 Dr David Baum MD 273274 0 0 0 11731 0 66245 0 17698 0 368948 0 0 0 Dr Tamara Prull MD 266616 0 0 0 10976 0 26768 0 7800 0 312160 0 0 0 Dr Vijay Bansal MD 263880 0 0 0 2773 0 21562 0 7800 0 296015 0 0 0 Jennifer DeVault 104997 0 9345 0 142 0 19383 0 19879 0 153746 0 0 0 SchJ_P01_S00_L04 Schedule J, Part I, Line 4 The President/CEO and the Senior VP's participate in a 457(f) plan. Contributions to the plan for 2010 were $121,318 ($63,629 for Linda Farchione, $23,001 for Carlos Ortiz, $24,189 for Deborah Weymouth, and $10,499 for Chris Mahan) SchJ_P01_S00_L06 Schedule J, Part I, Line 6 President/CEO and Executive VP/COO are eligible for a variable % YE incentive based on predetermined goals. The goals are operational, financial and managerial in nature. The financial goal is tied in part to the net earnings of the organization. Ontario County Industrial Development Agency 521326077 683058AA9 2003-07-01 2000000 Retire outstanding debt of the hospital 0 0 0 Ontario County Industrial Development Agency 521326077 683058AB7 2003-07-01 12800000 To construct an addition to and renovate portions of the hospital 0 0 0 Ontario County Local Development Corporation 272435489 2010-08-10 29700000 To construct an addition to and renovate portions of the hospital 0 0 0 0 0 2000000 0 0 0 0 0 0 0 0 0 2004 1 0 1 1 0 0 12800000 0 0 0 0 0 0 0 0 0 2004 0 0 1 1 0 0 900224 0 9224 0 891000 0 0 0 0 28899776 2012 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 1 1 Keybank 10 0 0 0 0 0 0 1 1 Keybank 10.00 0 0 0 0 0 0 0 0 0 0 0 SchK_P02_S00_L03 Schedule K, Part II, Line 3 $29.7M of bank qualified tax exempt bonds were issued in August 2010. The only bond proceeds received in 2010 were $891,000 to cover closing costs and $9,224 of capitalized interest payments. F990_P06_S0B_L11a Form 990, Part VI, Section B, Line 11a The Director of Finance reviewed the return and consulted with the independent auditors on any areas of question. The return was presented at a Board meeting prior to filing, with an overview of the changes from prior year. The return was made available to the Board members via a shared intranet web-site. Questions were entertained by management prior to filing. F990_P06_S0B_L12c Form 990, Part VI, Section B, Line 12c The conflict of interest disclosure statements for the Board members are submitted annually to the Chair of the nominating committee and they are responsible for monitoring compliance and follow-up with any potential conflicts. For the Officers the statements are submitted annually to the CEO who is responsible for monitoring compliance and follow-up with any potential conflicts F990_P06_S0B_L15 Form 990, Part VI, Section B, Line 15 Executive compensation at Thompson is established by the compensation committee of the Board of Directors. The committee uses an Independent Company to gather comparable data in determining compensation levels for the President/CEO and Senior level executives. The full Board of Directors is surveyed by the compensation committee on executive performance; this is considered in determining compensation levels. The compensation committee is also involved in goal setting for the executive team, which ties back to their performance reviews and compensation rates. The year this process was last undertaken for each such person was 2009. F990_P06_S0C_L19 Form 990, Part VI, Section C, Line 19 These documents are available upon request by contacting the Administration office. F990_P11_S00_L05 Form 990, Part XI, Line 5 Change in value of interest rate swap -$230,314, Change in net unrealized gains (losses) on investments $156,650, Change in value of charitable gift annuities -$31,169, Change in funded status of pension plan -$4,601,665, Change in beneficial interest in charitable remainder trust -$37,769, Change in beneficial interest in the net assets of the FF Thompson Foundation Inc $2,918,968 FF Thompson Foundation Inc 350 Parrish Street Canandaigua NY 14424 222959984 Philanthropic support for the services and priority needs of the system NY 501(c)(3) 7 N/A FF Thompson Health System Inc 350 Parrish Street Canandaigua NY 14424 222959987 Parent to 7 separate organizations to support the health and well being of the community NY 501(c)(3) 11a N/A Ontario County Advanced Life Support Inc 350 Parrish Street Canandaigua NY 14424 161252661 Provider of mobile advanced life support services NY 501(c)(3) 3 N/A M M Ewing Continuing Care Center 350 Parrish Street Canandaigua NY 14424 237046583 Long-term, rehabilitative and related services to the community NY 501(c)(3) 3 N/A FF Thompson Senior Communities Inc One Ferris Hills Canandaigua NY 14424 161557494 Senior living environment providing independent and enriched apts and services NY 501(c)(3) 9 N/A Finger Lakes Community Care Network 350 Parrish Street Canandaigua NY 14424 161423442 Currently inactive NY N/A C FF Thompson Properties and Services Inc 350 Parrish Street Canandaigua NY 14424 161286518 Plans, develops, implements, owns and manages health related ventures NY N/A C 1 0 1 0 1 0 0 0 1 1 0 1 0 1 0 1 0 0 Additional time was needed due to delay in availability of Form 990 Schedule H, as well as managament and Board review of the 990.