2014-11-12T12:53:56-07:00 2013-12-31 990 2013-01-01 160835446 IRA DAVENPORT MEMORIAL HOSPITAL INC IRAD 6077768500 7571 State Route 54 Bath NY 14810 Ronald Kintz CFO 6077374325 2014-11-12 2013 2015-11-30 17:44:51Z RONALD J KINTZ SENIOR VP CFO 600 ROE AVENUE ELMIRA NY 14905 21254808 0 X www.arnothealth.org X 1910 NY IRA DAVENPORT MEMORIAL HOSPITAL IS DEDICATED TO ENHANCING THE QUALITY OF LIFE WITHIN THEIR RURAL COMMUNITY. 12 12 388 38 -74418 -74418 624349 523806 19940140 18741812 222199 369211 1804715 1429825 22591403 21064654 0 0 0 0 13460211 14249891 0 0 0 9078524 8790072 22538735 23039963 52668 -1975309 20682549 22542881 4105837 8181194 16576712 14361687 IRA DAVENPORT MEMORIAL HOSPITAL IS DEDICATED TO ENHANCING THE QUALITY OF LIFE WITHIN THEIR RURAL COMMUNITY BY PROVIDING LOCAL HIGH QUALITY PRIMARY, ACUTE, RESTORATIVE AND RESIDENTIAL HEALTH SERVICES. 0 0 16107392 369211 21064654 IRA DAVENPORT PROVIDED BOTH ACUTE CARE AND LONG-TERM CARE SERVICES TO PATIENTS DURING 2013. LONG-TERM CARE DAYS WERE 39,707 AND THE HOSPITAL HAD 506 DISCHARGES. THE FRED AND HARRIETT TAYLOR HEALTH CARE CENTER IS A 120 BED LONG-TERM CARE/SKILLED NURSING FACILITY. THE HEALTH CENTER PROVIDES A COMMUNITY FOR PEOPLE WHO REQUIRE ASSISTANCE WITH DAILY LIVING OR AROUND-THE-CLOCK NURSING SERVICES. THE HEALTH CARE CENTER ALSO PROVIDES DAY CARE SERVICES AND REHABILITATION SERVICES. 0 0 0 16107392 1 1 0 1 0 0 0 0 0 0 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 0 0 0 1 0 0 1 388 1 1 1 0 0 0 0 0 X 12 12 1 1 0 0 0 0 1 1 1 0 0 1 1 1 1 1 1 1 0 0 NY X X RONALD KINTZ 6077374325 600 ROE AVENUE ELMIRA NY 14905 Roger Schenone MD Board Member 0 1 X 0 347995 12500 Gregory Schultz MD Board Member/President Medical Staff 0 1 X 0 172802 38284 Margaret B Streeter Board Member 0 1 X 0 0 0 Robert Lambert MD President Arnot Health 0 53 X X 0 469681 41456 Ronald J Kintz DHA Senior VP/CFO 0 54 X 0 365381 46533 Anthony Cooper System President/CEO 0 45 X 0 635293 46400 H Fred Farley PHD President COO 0 56 X 0 388474 47635 William Huffner MD SVP Chief Medical Officer 0 45 X 0 389966 15186 Wesley Blauvelt SVP Planning 0 45 X 0 233571 38885 Brian Forrest VP Human Resources 0 45 X 0 149393 31774 Debra Martin VP Operations 0 45 X X 0 173939 24535 Gregg Martin Chief Information Officer 0 46 X 0 165231 36667 Kathy Hale VP Quality Mgmt CQO 0 45 X 0 119491 21261 Richard Hoffman VP Operations 0 45 X 0 119383 33960 Marc Rustici VP Finance 0 45 X 0 163046 35207 Joseph Braunschiedel VP Operations 0 45 X 0 173457 29249 Mark Dworsky VP Process Enhancement 0 45 X 0 156384 28485 Mary Vosburgh Chief Nursing Officer 0 50 X 0 165016 26769 Kimberly Panosian AMS Medical Director 0 40 X 0 224346 28717 James Watson Chief Operating Officer IDMH 0 45 X 0 221061 10227 Michael Adams Certified Registered Nurse Anesthetist 0 40 X 232262 0 1339 Kevin Murray Director Pharmacy 0 40 X 145246 0 5586 Kimi Archer Director Rehab Services 0 40 X 103097 0 2295 Michael Slovak Vice President 1 0 X 0 0 0 Bernard Burns Secretary 1 0 X 0 0 0 W Neal Wrinkle Treasurer 1 0 X 0 0 0 Jeffrey Albright Director 1 0 X 0 0 0 Mary Hope Benedict Director 1 0 X 0 0 0 Werner Brammer MD Director 1 0 X 0 0 0 Lois Gyr Director 1 0 X 0 0 0 Mark Hagan Director 1 0 X 0 0 0 Bridgette Lanphere Director 1 0 X 0 0 0 Kelli Mannon Guilford Director 1 0 X 0 0 0 Joseph Meade III Director 1 0 X 0 0 0 Scott Sprague Director 1 0 X 0 0 0 Patrick Rogers President 1 0 X 0 0 0 480605 4833910 602950 3 1 1 0 Welliver-McGuire Inc 250 North Genesee Street Montour Falls NY 14865 Construction Services 1500974 Delphi Hospitalist Services 1880 East Ridge Road Suite 6 Upper Level Rochester NY 14622 Emergency Physicians 458060 Kings Medical Group 1894 Georgetown Road Hudson OH 44236 Medical Services 388320 Dent Serv Dental Services PC 15 Canal Road Pelham Manor NY 10803 Dental Services 158824 Delphi Healthcare PLLC 1880 East Ride Road Suite 6 Upper Level Rochester NY 14622 ER Doctor coverage 517130 8 0 0 0 0 332094 191712 0 523806 Net Patient Services Revenue 622000 20317599 20317599 0 0 Bad Debts 622000 -1575787 -1575787 0 0 0 0 0 0 18741812 369211 369211 0 0 0 0 0 0 0 0 0 0 92759 0 167177 0 -74418 0 -74418 0 -74418 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 91688 22977 68711 68711 0 0 management information system 900099 1268661 1268661 0 0 Contracted Therapy 900099 20465 20465 0 0 146406 146406 0 0 1435532 21064654 20615266 -74418 0 11485996 8798256 2687740 223634 223634 1799285 2990 1796295 740976 616262 124714 718394 591069 127325 94017 94017 6500 6500 6967 6967 8818 8818 1212247 1066977 145270 15272 37 15235 2292173 2067858 224315 240264 12001 228263 318983 22302 296681 19700 8631 11069 11742 2706 9036 40561 40561 1417889 1417889 187589 187589 License 396325 396129 196 Maintenance Contracts 367288 273504 93784 Lease 120869 68749 52120 Benefit Allocation 0 1554758 -1554758 1314474 625163 689311 23039963 16107392 6932571 0 60287 43625 393033 230587 466410 300000 4064531 4481185 0 0 0 0 472344 1101724 414723 393632 54970 176026 32180500 19183389 11973179 12997111 0 0 0 0 0 0 0 0 2783072 2818991 20682549 22542881 1996637 2881304 0 0 0 0 0 0 0 0 0 0 847907 728170 0 0 1261293 4571720 4105837 8181194 X 13054469 10968210 3496631 3367865 25612 25612 16576712 14361687 20682549 22542881 X -1975309 -40571 0 0 0 -199145 X 1 X 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 7000 7000 0 Schedule C, Part II-B, Line 1 IDMH pays annual dues to American Hospital Associations, AHA and Healthcare Association of New York State, HANYS of which a percentage is for lobbying fees. The total fees paid to all in 2013 is $7,000 52925 0 52925 8903372 0 5911078 2992294 7093864 0 876962 6216902 15885133 0 12395349 3489784 245206 0 0 245206 12997111 The IDMH Children's Deptment Fund(Childeran Trust Fund) 2337029 Interest in Net Assets of Foundation 481962 2818991 0 Self Insurance Reserve 736128 Accrued Reimbursement Pay Net 35970 Accrued Pension Cost 245059 Due to Arnot Health 3554563 4571720 21116095 0 0 0 51441 51441 21064654 0 0 0 21064654 23230117 0 0 0 190154 190154 23039963 0 0 0 23039963 Schedule D, Part XI, Line 2d Nutritional Services Expense of 22,977 reclass to reduce Revenue in Cost of Goods Sold. Rental Expense of 74,418 reclassed to reduce Rental Income Schedule D, Part XII, Line 2d Rental Expenses of 167,177 offset Rental Income. Nutritional Services expense of 22,977 offset to Nutritional Service Income 1 1 1 X 1 X 1 1 0 1 1 680 129465 10196 119268 0.0052 6318 7197892 6364858 833034 0.0362 2577 928944 829175 99769 0.0043 0 9575 8256301 7204229 1052071 0.0457 7 1559 4094 0 4094 0.0002 1 86 1943 0 1943 0.0001 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8 1645 6037 0 6037 0.0003 8 11220 8262338 7204229 1058108 0.0460 0 0 0 0 0 0 0 0 0 0 0 0 1 0 846 0 846 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 846 0 846 0 0 1575787 0 3607501 4529712 -922211 X 1 1 ARNOT OGDEN MEDICAL CENTER ADMINISTRATION & CONSULTING 0 0 0 1 1 IRA DAVENPORT MEMORIAL HOSPITAL 7571 ROUTE 54 BATH NY 14810 www.arnothealth.org X IRA DAVENPORT MEMORIAL HOSPITAL 1 1 X X X X X X X X 09 1 1 1 X www.arnothealth.org X X X X X X X X 1 0 1 1 150 1 400 1 X X X X X X X 1 1 X X X X X X 1 X X X 1 X X X X X X X 1 X 0 0 Schedule H, Part V, Section B, Line 3-IRA DAVENPORT MEMORIAL HOSPITAL St Joseph's Hospital and Ira Davenport Memorial Hospital, Inc., as part of the Arnot Health system, participated in a community health needs assessment in collaboration with partners such as the local health department, other healthcare agencies, mental health professionals, school districts and community members. The community was surveyed about their health data from these surveys and NYSDOH were analyzed, and the public health priorities were selected through the mobilizing for action through partnership and planning (MAPP) process. Schedule H, Part V, Section B, Line 4-IRA DAVENPORT MEMORIAL HOSPITAL The Community Service Plan explains in detail the involvement of the 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 and is available on our website, www.arnothealth.org. Schedule H, Part V, Section B, Line 5-IRA DAVENPORT MEMORIAL HOSPITAL Needs Assessment information is included in the "report to the community" and other NYS Reports. Schedule H, Part V, Section B, Line 13-IRA DAVENPORT MEMORIAL HOSPITAL The policy was posted in the hospital's emergency rooms or waiting rooms. Schedule H, Part I, Line 6a The hospital made a community benefit report available to the public through the community service plan newsletter. This is also available on the hospital's website. Schedule H, Part I, Line 7 The hospital uses a ratio of cost (excluding bad debts) to charge ratio of determine cost. Schedule H, Part I, Line 7, Column f There was no bad debt expense subtracted on schedule H, Part I, line 7. Schedule H, Part II The organization participated in local emergency preparedness drills such as the DOH Finger Lakes Hurricane Drill Schedule H, Part III, Section A, Line 4 The hospital and Taylor Health Center advance credit to patients in the normal course of business. Self-pay balances that have no payment activity and have been outstanding for more than 90 days from the service date are fully reserved and sent to a collections agency. Allowances for doubtful accounts are recorded in anticipation of future write-offs. This amount is computed based on past experience as well as specific review of outstanding accounts. Accounts are written off in accordance with the facility's collections policy. Schedule H, Part III, Section B, Line 8 The loss could be related to the ratio of cost to charges expense estimation methodology. Schedule H, Part III, Section C, Line 9b Amounts viewed and qualifying for charity care have no further collection activity. Amounts owed in excess of charity care are treated the same as any general patient obligation. This includes a series of statements, collection notices, writeoffs, and sending to a collection agency. Schedule H, Part VI, Line 2 The organization assesses the healthcare needs of the community through evaluation of annual community survey results, analysis of data sparcs, and analysis of the Steuben county public health community health assessment. Schedule H, Part VI, Line 3 The financial aid program is being redesigned to replicate the Arnot Ogden Medical Center's Marianna Arnot Ogden Community Care Program. Amounts budgeted for charity care programs are based on community need. A screening process was implemented to screen patients prior to services and assist them with placement in the appropriate charity care program, to include the Marianna Arnot Odgen Community Care Program, Medicaid, Child Health Plus, and Healthy New York. The hospital communicates this program in a variety of ways including www. arnothealth.org: AOMC's website. The web site is a comprehensive online resource for adult and pediatric health information, and includes a complete listing of services, a physician directory, and information on the community care program. Schedule H, Part VI, Line 4 The Community Service Plan explains in detail the involvement of the 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 and is available on our website, www.arnothealth.org. X 0 0 0 0 0 0 0 0 0 Anthony Cooper System President/CEO 0 456932 0 178361 0 0 0 23581 0 46400 0 705274 0 0 Brian Forrest VP Human Resources 0 145893 0 3500 0 0 0 10104 0 31774 0 191271 0 0 Debra Martin VP Operations 0 160618 0 13321 0 0 0 14607 0 24535 0 213081 0 0 Gregg Martin Chief Information Officer 0 149762 0 15469 0 0 0 14064 0 36667 0 215962 0 0 Gregory Schultz MD Board Member/President Medical Staff 0 162889 0 9913 0 0 0 15540 0 38284 0 226626 0 0 H Fred Farley PHD President COO 0 334900 0 53574 0 0 0 23831 0 47635 0 459940 0 0 James Watson Chief Operating Officer IDMH 0 202823 0 18238 0 0 0 8261 0 10227 0 239549 0 0 Joseph Braunschiedel VP Operations 0 160638 0 12819 0 0 0 6531 0 29249 0 209237 0 0 Kathy Hale VP Quality Mgmt CQO 0 111593 0 7898 0 0 0 4432 0 21261 0 145184 0 0 Kevin Murray Director Pharmacy 144182 0 0 0 0 0 5586 0 5586 0 155354 0 0 0 Kimberly Panosian AMS Medical Director 0 201573 0 22773 0 0 0 7825 0 28717 0 260888 0 0 Kimi Archer Director Rehab Services 103097 0 0 0 0 0 2295 0 2295 0 107687 0 0 0 Marc Rustici VP Finance 0 147620 0 15426 0 0 0 12624 0 35207 0 210877 0 0 Mark Dworsky VP Process Enhancement 0 150822 0 5562 0 0 0 5953 0 28485 0 190822 0 0 Mary Vosburgh Chief Nursing Officer 0 157872 0 7144 0 0 0 6305 0 26769 0 198090 0 0 Michael Adams Certified Registered Nurse Anesthetist 232262 0 28 0 0 0 1339 0 1339 0 234968 0 0 0 Richard Hoffman VP Operations 0 114750 0 4633 0 0 0 11245 0 33960 0 164588 0 0 Robert Lambert MD President Arnot Health 0 425000 0 44681 0 0 0 17654 0 41456 0 528791 0 0 Roger Schenone MD Board Member 0 323077 0 24918 0 0 0 9861 0 12500 0 370356 0 0 Ronald J Kintz DHA Senior VP/CFO 0 314321 0 51060 0 0 0 22731 0 46533 0 434645 0 0 Wesley Blauvelt SVP Planning 0 211894 0 21677 0 0 0 19169 0 38885 0 291625 0 0 William Huffner MD SVP Chief Medical Officer 0 364893 0 25073 0 0 0 12750 0 15186 0 417902 0 0 Form 990, Part VI, Section A, Line 2 Bernard Burns Board Secretary He is Executive Director of Arc of Steuben, Taylor SNF and Adult Day Care contracts with Arc for Transportation. Mark Hagan Board Director. He is Employee of Perry & Carroll, Inc. Independent Insurance Agency that handles policies for Arnot Health Inc. Michael Slovak Board Director Health Ministry of Southern Tier purchases services in the areas of Lab, Radiology and Ultrasounds on behalf of the Ministry patients Form 990, Part VI, Section A, Line 3 as a result of Arnot Odgen Medical Center becoming the "active parent" of Ira Davenport Memorial Hospital the management of several departments were consolidated under a single manager Form 990, Part VI, Section A, Line 7b Ira Davenport Hospital Board of Directors can only elect the president and hire medical directors and board members at that facility. Affiliated Board of Directors of Arnot Health are responsible for operations of Ira Davenport Memorial Hospital. Form 990, Part VI, Section B, Line 11b once the 990 is in final form it is presented to the board committee and a copy 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 interest of such person and the Arnot Ogden Medical Center, an associated included (1) Spouse, a descendant or an ancestor, of a spouse of a descendant of ancestor; (2) an organization in which the person of an associated is a partner of employee, or such person is an associated owns a more than 10% beneficial interest; (3) a trust in which such person is a trustee, or such person or an associate holds more than 10% beneficial interest and (4) a corporations in which such person or an associate is an officer or a 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 boards. The AOMC 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 data on compensations for similar positions in similar nonprofit hospitals from upstate New York and western Pennsylvania. The compensation committee recommends any adjustments to the executive committee of the board which reviews the recommendations and approves them without employees in the room. This action is then 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 and shared with guidestar.org and EMMA web site Form 990, Part XI, Line 9 Keuka Foundation Net Income (58,877), Donations from Capital Funding 208,911, Net assets released from restrictions 16,904, Pension charge to equity (98,600), Net Assets Released from restriction (246,829), Donations 118,060, Rental expense adj (92,759), Cost of Inventory Adj (45,954) KEUKA HEALTH CARE FOUNDATION 7571 STATE ROUTE 54 BATH NY 14810 161461215 PROVIDE FINANCIAL NY 501(C)(3) 11 N/A 0 ARNOT OGDEN MEDICAL CENTER 600 ROE AVENUE ELMIRA NY 14905 160743905 AFFILIATE NY 501 (C)(3) 11 N/A 0 ARNOT OGDEN MEDICAL CENTER FOUNDATION 600 ROE AVENUE ELMIRA NY 14905 161109472 CONTRIBUTION MGT NY 501(C)(3) 11E N/A 0 ARNOT HEALTH INC 600 ROE AVENUE ELMIRA NY 14905 453049405 MANAGEMENT NY 501 (A)(3) N/A ARNOT HEALTH INC 0 ST JOSEPHS HOSPITAL 555 ST JOSEPHS BLVD ELMIRA NY 14901 160743163 AFFILIATE NY 501(C)(3) 11 N/A 0 IVY STREET DEVELOPMENT CORP 600 IVY STREET ELMIRA NY 14905 161009245 REAL ESTATE RENTAL NY N/A C 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0 ARNOT OGDEN MEDICAL CENTER o 1416659 Arnot Ogden Medical Center provided employees who provide medical, management information system, and various administrative services to Ira Davenport Memorial Hospital . The method of determining the amount was cost. ARNOT OGDEN MEDICAL CENTER p 573241 Ira Davenport Memorial Hospital reimbursed Arnot Odgen Medical Center cash for the cost of various charges for expenses. ST JOSEPHS HOSPITAL o 55016 Ira Davenport Memorial Hospital provided one employee to St Joseph's Hospital who provided human resources services. The method of determining the amount was cost. KEUKA HEALTH CARE FOUNDATION c 200000 A gift from Keuka Health Care Foundation to Ira Davenport Memorial Hospital for contribution to the Emergency Room Rebuild Project.