2024-05-14T16:22:01-05:00 2023-06-30 161131146 BONADIO & CO LLP 171 SULLYS TRAIL PITTSFORD NY 14534 990 2022-07-01 222807681 MEMORIAL HOSPITAL OF WILLIAM F AND GERTRUDE F JONES INC MEMO 5855931100 191 NORTH MAIN STREET WELLSVILLE NY 14895 BOYD CHAPPELL CHIEF FINANCIAL OFFICER 5855931100 2024-05-14 1 BOYD CHAPPELL 999009999 1 AIMEE JOZIC P01329472 5853811000 2024-05-14 0 AAL1 IAL1 2022 2023-04-26 12:10:37Z BOYD CHAPPELL 191 NORTH MAIN STREET WELLSVILLE NY 14895 81092437 0 X WWW.URMC.ROCHESTER.EDU/JONES-MEMORIAL-HOSPITAL X 1921 NY JONES MEMORIAL HOSPITAL IS COMMITTED TO ENSURING ACCESS TO THE HIGHEST QUALITY HEALTHCARE FOR OUR COMMUNITY IN A CARING MANNER. 14 10 566 60 0 0 5809365 13960894 51301572 60738877 265106 -96679 4729875 3514431 62105918 78117523 0 0 0 0 29313593 31298540 0 0 0 31616653 42769016 60930246 74067556 1175672 4049967 59496738 72495461 22165019 28936099 37331719 43559362 JONES MEMORIAL HOSPITAL PROVIDES THE HIGHEST QUALITY HEALTHCARE IN A CARING MANNER TO IMPROVE THE QUALITY OF LIFE FOR OUR COMMUNITIES. 0 0 60539537 63932061 QUALITY OF HEALTH CARE: THE MEMORIAL HOSPITAL OF WILLIAM F. & GERTRUDE F. JONES, INC. A/K/A JONES MEMORIAL HOSPITAL IS A SOLE COMMUNITY PROVIDER WITH 49 ACUTE CARE BEDS, NOT FOR PROFIT, LOCATED IN RURAL WELLSVILLE NY IN A PROFESSIONALLY UNDERSERVED AREA. WE PROVIDE PRIMARY CARE, AMBULATORY CARE, EMERGENCY CARE AND ACUTE (MEDICAL, SURGICAL, PEDIATRIC, OB AND GYN) AND INTENSIVE CARE PLUS COMMUNITY OUTREACH PROGRAMS. WE ADMITTED 1,520 PATIENTS PLUS 392 BIRTHS. THE HOSPITAL HAS PROVIDED CHARITY CARE TO INDIGENT PATIENTS TOTALING $1,265,078. 60539537 1 1 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 59 0 1 566 1 0 0 0 0 0 0 0 0 0 0 0 0 X 14 10 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X BOYD CHAPPELL 5855964002 191 N MAIN ST WELLSVILLE NY 14895 KAROL MARCIANO CHAIRPERSON 2.00 55.00 X X 0 116730 21644 DANIEL JOHNSON VICE CHAIRMAN 2.00 0.00 X X 0 0 0 JENNY BILOTTA TREASURER 2.00 0.00 X X 0 0 0 MARY KATE COLE SECRETARY 2.00 0.00 X X 0 0 0 STEVEN GOLDSTEIN BOARD MEMBER 2.00 71.00 X 0 3306549 209673 MARK TAUBMAN BOARD MEMBER 2.00 75.00 X 0 1783432 176973 MICHAEL APOSTOLAKOS BOARD MEMBER 2.00 64.00 X 0 701264 107783 SAMANTHA GILKEY BOARD MEMBER 2.00 0.00 X 0 0 0 RICHARD EWELL BOARD MEMBER 2.00 0.00 X 0 0 0 IAN JONES BOARD MEMBER 2.00 0.00 X 0 0 0 JAMES KNAPP BOARD MEMBER 2.00 0.00 X 0 0 0 RHIANNON SISSON BOARD MEMBER 2.00 0.00 X 0 0 0 STEVEN MAURO BOARD MEMBER 2.00 0.00 X 0 0 0 ANDRES RUBERT MD CHIEF OF MEDICAL STAFF 40.00 0.00 X 356923 0 24320 ROBERT GILFERT BOARD MEMBER 2.00 X 0 0 0 JAMES HELMS CEO 40.00 0.00 X 220834 0 13048 BOYD CHAPPELL CFO 40.00 0.00 X 78654 0 468 PAUL AXTELL MD ORTHOPAEDIC SURGEON 40.00 0.00 X 718000 0 26095 HEATHER LANPHERE MD OB/GYN 40.00 0.00 X 407978 0 24571 ANNA HARING MD OB/GYN 40.00 0.00 X 388077 0 20823 NISHANT CHAUDHARY MD HOSPITALIST 40.00 0.00 X 359215 0 18231 SADDAN YASIN HOSPITALIST 40.00 0.00 X 347535 0 18173 2877216 5907975 661802 42 0 1 0 DELPHI HOSPITALIST SERVICES 2701 CULVER ROAD ROCHESTER NY 14622 STAFFING 1618611 DELPHI HEALTHCARE 2701 CULVER ROAD ROCHESTER NY 14622 STAFFING 1031822 PICCO PULMONARY & INTERNAL MEDICINE 11 MAIN STREET HORNELL NY 14843 MEDICAL PHYSICIAN 812494 GEON KIM 25427 PLANTING FIELD DRIVE CHANTILLY VA 20152 CRNA 353750 SODEXO US 9801 WASHINGTON BLVD GAITHERSBURG MD 30878 MANAGEMENT SERVICES FOR DIETARY AND ENVI 325750 7 1399640 12187503 373751 13960894 PATIENT SERVICE REVENUE 621990 60738877 60738877 60738877 102154 102154 108087 42888 65199 65199 65199 2733193 2932026 -198833 -198833 -198833 340B CONTRACT PHARMACY 900099 2171023 2171023 OTHER INCOME 900099 1022161 1022161 CAFETERIA 722514 250485 250485 5563 5563 3449232 78117523 63932061 0 224568 X 313004 313004 26133387 21606245 4527142 206000 168311 37689 4646149 3733027 913122 11868 11868 124480 124480 14479704 13176609 1303095 93062 93062 121901 212 121689 413147 11970 401177 785773 737897 47876 23309 21411 1898 40109 26504 13605 240717 240717 2886166 1574412 1311754 601571 601571 SUPPLIES 15769888 15514863 255025 PURCHASED SERVICES 5270535 2254504 3016031 REPAIRS AND MAINTENANCE 891241 822748 68493 OTHER EXPENSES 626085 60642 565443 389460 228611 160849 74067556 60539537 13528019 0 6506941 6963473 119527 2119823 1172147 649468 9223587 8165795 1716116 1651186 264218 62701 67464759 33406686 22695581 34058073 5001343 3024645 12797278 15800297 59496738 72495461 13210549 17905908 449759 8504711 11030191 22165019 28936099 X 33475994 39569904 3855725 3989458 37331719 43559362 59496738 72495461 X 4049967 244076 1933600 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 4543 4543 0 PART II-B, LINE 1: AS A MEMBER OF AMERICAN HOSPITAL ASSOCIATION, INC. AND HEALTHCARE ASSOCIATION OF NEW YORK STATE, INC., A PORTION OF MEMBERSHIP DUES REPRESENTS AMOUNTS DESIGNATED FOR LOBBYING ACTIVITIES. THIS ASSOCIATION ORGANIZATION, OF WHICH THE HOSPITAL IS A MEMBER, PERFORMS DIRECT LOBBYING AND ADVOCACY ACTIVITIES ON BEHALF OF ITS MEMBERS. 229814 23031 252845 267607 -37793 229814 212182 55425 267607 205000 7182 212182 1.00000 0.00000 0 1 1 393177 393177 17101848 14393360 2708488 1083835 851416 232419 30982058 18161910 12820148 17903841 17903841 34058073 ESTIMATED THIRD-PARTY PAYOR RECEIVABLES 2260000 BENEFICIAL INTEREST IN PERPETUAL TRUST 1876487 BENEFICIAL INTEREST IN FOUNDATION 1946537 GOODWILL 2230000 OTHER RECEIVABLES 1669977 INSURANCE CLAIMS RECEIVABLE 1825439 OPERATING RIGHT OF USE ASSET 1512979 EQUITY INVESTMENTS 740171 DUE FROM AFFILIATES 1738707 15800297 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS, NET 775842 LINE OF CREDIT - RELATED PARTY 5000000 ASSET RETIREMENT OBLIGATION 585944 OPERATING LEASE LIABILITY 1566016 PENSION LIABILITY 1502894 OTHER LIABILITIES 1599495 11030191 PART V, LINE 4: TO SUPPORT JONES MEMORIAL HOSPITAL 1 1 1 X 1 X 1 1 1 0 1 1 394633 394633 0.00530 15262006 10732076 4529930 0.06120 26383 26383 0.00040 15683022 10732076 4950946 0.06690 1 9 788 788 0.00000 1 9 788 788 0.00000 1 9 15683810 10732076 4951734 0.06690 1 1154343 0 4346444 11372680 -7026236 X 1 1 1 1 JONES MEMORIAL HOSPITAL 191 NORTH MAIN STREET WELLSVILLE NY 14895 HTTPS://WWW.URMC.ROCHESTER.EDU/JONES-M X X X JONES MEMORIAL HOSPITAL 1 0 0 1 X X X X X X X X X 22 1 1 1 1 X 1 22 1 HTTPS://WWW.URMC.ROCHESTER.EDU/JONESMEMORIALHOSPITAL.ASPX 0 1 X 50.000000000000 300.000000000000 1 1 X X X 1 X HTTPS://WWW.URMC.ROCHESTER.EDU/JONESMEMORIALHOSPITAL.ASPX X HTTPS://WWW.URMC.ROCHESTER.EDU/JONESMEMORIALHOSPITAL.ASPX X HTTPS://URMC.ROCHESTER.EDU/JONESMEMORIALHOSPITAL.ASPX X X X X X 1 X 0 X X X X 1 X 0 0 JONES MEMORIAL HOSPITAL PART V, SECTION B, LINE 5: PLEASE SEE SCHEDULE H, PART VI, LINE 2 SUPPLEMENTAL INFORMATION. JONES MEMORIAL HOSPITAL PART V, SECTION B, LINE 6A: CUBA MEMORIAL HOSPITAL. JONES MEMORIAL HOSPITAL PART V, SECTION B, LINE 6B: ALLEGANY COUNTY DEPARTMENT OF HEALTH, ALLEGANY COUNTY COMMUNITY WELLNESS COMMITTEE AND CUBA MEMORIAL HOSPITAL. JONES MEMORIAL HOSPITAL PART V, SECTION B, LINE 7D: PLEASE SEE SCHEDULE H, PART VI, LINE 2 SUPPLEMENTAL INFORMATION. JONES MEMORIAL HOSPITAL PART V, SECTION B, LINE 11: FOR PRIORITY AREA: PREVENT CHRONIC DISEASE, FOCUS AREA HEALTHY EATING AND FOOD SECURITY. INCREASE ACCESS TO HEALTHY AND AFFORDABLE FOODS AND BEVERAGES. BY DECEMBER 2024, INCREASE REDEMPTION PERCENTAGE OF FARMERS' MARKET (FM) COUPONS IN ALLEGANY COUNTY. INCREASE SKILLS AND KNOWLEDGE TO SUPPORT HEALTHY FOOD AND BEVERAGE CHOICES. BY DECEMBER 2024, DECREASE THE PERCENTAGE OF CHILDREN WITH OBESITY (AMONG PUBLIC SCHOOL STUDENTS IN NYS EXCLUSIVE OF NEW YORK CITY). FOR PRIORITY AREA: PREVENT CHRONIC DISEASE, FOCUS AREA TOBACCO PREVENTION. PROMOTE TOBACCO USE CESSATION. BY DECEMBER 2024, DECREASE THE PREVALENCE OF CIGARETTE SMOKING BY ADULTS' AGE 18 YEARS AND OLDER (AMONG ALL ADULTS).FOR PRIORITY AREA: PREVENT CHRONIC DISEASE, FOCUS AREA: PREVENTATIVE CARE AND MANAGEMENT. IN THE COMMUNITY SETTING, IMPROVE SELF-MANAGEMENT SKILLS FOR INDIVIDUALS WITH CHRONIC DISEASES INCLUDING ASTHMA, ARTHRITIS, CARDIOVASCULAR DISEASE, DIABETES AND PREDIABETES AND OBESITY. BY DECEMBER 2024, INCREASE THE PERCENTAGE OF ADULTS WITH CHRONIC CONDITIONS (ARTHRITIS, ASTHMA, CVD, DIABETES, CKD, CANCER) WHO HAVE TAKEN A COURSE OR CLASS TO LEARN HOW TO MANAGE THEIR CONDITION.FOR PRIORITY AREA: PROMOTE WELL BEING AND PREVENT MENTAL AND SUBSTANCE USE DISORDERS. PREVENT SUICIDE. REDUCE THE AGE-ADJUSTED SUICIDE MORTALITY RATE BY 10% BY 2024. PREVENT AND ADDRESS ADVERSE CHILDHOOD EXPERIENCES. REDUCE THE PERCENTAGE OF ADULTS EXPERIENCING TWO OR MORE ADVERSE CHILDHOOD EXPERIENCES (ACE'S) BY 2024. PART I, LINE 7: WORKSHEET 2 RATIO OF PATIENT CARE COST TO CHARGES CALCULATION WAS USED. DUE TO THE ADOPTION OF ACCOUNTING PRONOUNCEMENT ASC 606, CURRENT YEAR PRICE CONCESSIONS ARE TREATED AS A CONTRAREVENUE ITEM ON THE STATEMENT OF REVENUE. PART I, LINE 7G: JONES MEMORIAL HOSPITAL OPERATES A DIABETIC CLINIC AS A SERVICE TO THE PUBLIC DUE TO THE HIGH NEED FOR IT IN ALLEGANY COUNTY. PART III, LINE 2: PATIENT ACCOUNTS RECEIVABLE ARE DUE 30 DAYS AFTER THE DATE OF DISCHARGE. RECEIVABLES PAST DUE MORETHAN 120 DAYS ARE CONSIDERED DELINQUENT. DELINQUENT RECEIVABLES ARE GENERALLY WRITTEN OFF BASED ONINDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE PATIENT AND OTHER THIRD PARTY PAYERS. BADDEBT EXPENSE IS CALCULATED BY DEDUCTING BAD DEBT ADJUSTMENTS AND RECEIPTS FROM TRANSFERS TO THECOLLECTION AGENCY. IN ADDITION, AN ANALYSIS IS DONE MONTHLY BASED ON SELF PAY AGING AND ASSESSEDRESERVE PERCENTAGES IN ORDER TO DETERMINE REASONABLENESS. FURTHER INFORMATION IS ON PAGE 12 OF THEATTACHED AUDITED FINANCIAL STATEMENTS. PART III, LINE 4: PATIENT ACCOUNTS RECEIVABLE ARE DUE 30 DAYS AFTER THE DATE OF DISCHARGE. RECEIVABLES PAST DUE MORE THAN 120 DAYS ARE CONSIDERED DELINQUENT. DELINQUENT RECEIVABLES ARE GENERALLY WRITTEN OFF BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE PATIENT AND OTHER THIRD PARTY PAYERS. BAD DEBT EXPENSE IS CALCULATED BY DEDUCTING BAD DEBT ADJUSTMENTS AND RECEIPTS FROM TRANSFERS TO THE COLLECTION AGENCY. IN ADDITION, AN ANALYSIS IS DONE MONTHLY BASED ON SELF PAY AGING AND ASSESSED RESERVE PERCENTAGES IN ORDER TO DETERMINE REASONABLENESS. FURTHER INFORMATION IS ON PAGE 12 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS. PART III, LINE 8: THE AMOUNT ON LINE 6 IS CALCULATED FROM WORKSHEET E PARTS A AND B ON THE COST REPORT. THE FULL LOSS SHOULD BE CONSIDERED A COMMUNITY BENEFIT. PART III, LINE 9B: PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE RECEIVE A DISCOUNT FROM A SLIDING FEE SCHEDULE BASED ON THE FEDERAL POVERTY GUIDELINES. FLEXIBLE PAYMENT PLANS ARE INCORPORATED AS APPROPRIATE. PART VI, LINE 2: THE HOSPITAL USES SEVERAL METHODS TO ASSESS THE HEALTHCARE NEEDS OF THOSE IN THE SERVICE AREA. PUBLIC SURVEY INCLUDES SOME DEMOGRAPHIC INFORMATION AND A RATINGS SYSTEM FOR 49 ITEMS IDENTIFIED AS HEALTH NEEDS. THE PUBLIC WAS NOTIFIED OF THE SURVEY PROCESS AND ENCOURAGED TO PARTICIPATE THROUGH PAID ADVERTISING IN THE WELLSVILLE DAILY REPORTER AND HORNELL EVENING TRIBUNE, PRESS RELEASES TO LOCAL NEWS AGENCIES, INVITATIONS ON THE HOSPITAL WEBSITE HOME PAGE, DISTRIBUTION OF PAPER SURVEYS THROUGH THE JMH MEDICAL PRACTICE SITES (SIX IN TOTAL THROUGHOUT ALLEGANY COUNTY) AND THROUGH EMAIL DISTRIBUTION OF THE SURVEY TO AGENCY LIST SERVES IN THE REGION. THE SURVEY WAS ALSO DISTRIBUTED VIA SURVEY MONKEY, AN ONLINE SURVEY TO ALLOW RECIPIENTS TO RECEIVE AND RESPOND VIA EMAIL. THE MOST RECENT SURVEY WAS MAY 5, 2023 - JUNE 30, 2023. THIS SURVEY IS COMPLETED EVERY 2-3 YEARS. PART VI, LINE 3: OUR PATIENT STATEMENTS PROVIDE A NOTICE INFORMING PATIENTS ABOUT OUR FINANCIAL ASSISTANCE PROGRAM. WE HAVE FINANCIAL COUNSELORS THAT CONTACT OUR SELF PAY POPULATION AND INFORM THEM OF OUR PROGRAM. THEY SEND LETTERS FOR THOSE THEY ARE UNABLE TO REACH BY TELEPHONE. WE HAVE SIGNAGE THROUGHOUT OUR CAMPUS INDICATING WE HAVE A FINANCIAL ASSISTANCE PROGRAM WITH THE CONTACT INFORMATION. EACH SELF PAY INPATIENT IS SEEN AND EDUCATED ABOUT OUR PROCESS FOR APPLYING FOR FINANCIAL ASSISTANCE. PART VI, LINE 4: THE HOSPITAL SERVICE AREA IS PRIMARILY ALLEGANY AND STEUBEN COUNTIES, WHILE 80 PERCENT OF THE INPATIENT AND OUTPATIENT VISITS ORIGINATE FROM WELLSVILLE, BOLIVAR, ANDOVER, BELMONT, SCIO, FRIENDSHIP, BELFAST, ANGELICA AND WHITESVILLE FOR THE PURPOSES OF COMMUNITY HEALTH NEED AND COLLABORATION EFFORTS. JONES MEMORIAL HOSPITAL VIEWS THE GREATER ALLEGANY COUNTY REGION AS THE SERVICE AREA. JONES MEMORIAL HOSPITAL IS THE ONLY ACUTE CARE HOSPITAL IN ALLEGANY COUNTY WITH HPSA DESIGNATION. PART VI, LINE 5: JONES MEMORIAL HOSPITAL PROMOTES COMMUNITY WELLNESS IN MANY WAYS. THE FOLLOWING ACTIVITIES WERE COMPLETED: 1. BLOOD PRESSURE CUFFS WERE DISTRIBUTED TO OUR PROVIDERS FOR PATIENTS IDENTIFIED WITH HYPERTENSION. THEY WERE GIVEN TO THE PATIENT AND INSTRUCTED TO MONITOR THEIR BLOOD PRESSURE TO ASSESS WHETHER ADJUSTMENTS TO MEDICATIONS OR DIET WERE NECESSARY. 2. PEDIATRIC PATIENTS RECEIVED A BOOK TO ENCOURAGE READING. 3. JONES MEMORIAL HOSPITAL WAS A CORPORATE SPONSOR FOR A RAM (RURAL AREA MEDICAL) CLINIC. SEVERAL STAFF PARTICIPATED IN THE EVENT. STROKE AND HEALTH INFORMATION WAS DISPLAYED. 4. BLOOD PRESSURE MACHINE SUPPORT AT THE LOCAL YMCA AND IN THE OUTPATIENT LAB AREA AT JONES MEMORIAL HOSPITAL. 5. WELLNESS FAIR HELD AT NORTHERN LIGHTS CANDLES WHERE 100 INDIVIDUALS WERE SCREENED. 6. COUNTYWIDE WELLNESS MEETINGS TO SUPPORT THE COMMUNITY SERVICE PLAN. 7. PARTICIPATED IN LOCAL MAPLE FESTIVAL. SEVERAL PARTICIPANTS WHERE SCREENED. PART VI, LINE 6: THE HOSPITAL IS AFFLIATED WITH THE UNIVERSITY OF ROCHESTER MEDICAL CENTER (URMC). TOGETHER WITH THE HOSPITAL, URMC AND ITS OTHER HEALTH CARE AFFLIATES PROVIDE COMPREHENSIVE HEALTHCARE SERVICES IN NEW YORK STATE. THIS AFFLIATION PROVIDES ENHANCED CARE TO RESIDENTS OF THE HOSPITAL'S SERVICE AREA THROUGH ACCESS TO SPECIALISTS AND SPECIALTY SERVICES. THE UNIVERSITY OF ROCHESTER MEDICAL CENTER IS AN INTEGRATED ACADEMIC HEALTH CENTER THAT COMPRISES THE SCHOOL OF MEDICINE AND DENTISTRY, INCLUDING ITS FACULTY PRACTICE (UNIVERSITY OF ROCHESTER MEDICAL FACULTY GROUP) STRONG MEMORIAL HOSPITAL HIGHLAND HOSPITAL GOLISANO CHILDREN'S HOSPITAL JAMES P. WILMOT CANCER CENTER STRONG WEST SCHOOL OF NURSING EASTMAN INSTITUTE FOR ORAL HEALTH VISITING NURSE SERVICE HIGHLANDS AT PITTSFORD THE HIGHLANDS LIVING CENTER, INC., HIGHLANDS AT BRIGHTON, FF THOMPSON HEALTH SYSTEM, INC., JONES MEMORIAL HOSPITAL, NOYES HEALTH, ST. JAMES HOSPITAL AND ACCOUNTABLE HEALTH PARTNERS, LLC. UR MEDICAL CENTER AND THE AFFLIATED HEALTH CARE ENTITIES HAVE EMBRACED A COMPREHENSIVE APPROACH TO COMMUNITY HEALTH, WHICH EMPLOYS THE MULTIDISCIPLINARY SKILLS FOUND IN AN ACADEMIC MEDICAL CENTER TO BOTH PROVIDE IMPORTANT COMMUNITY SERVICES AND CONDUCT COMMUNITYBASED RESEARCH. THESE ACTIVITIES HELP INFORM POLICYMAKERS AND THE COMMUNITY ABOUT LOCAL HEALTH CHALLENGES, EVALUATE THE EFFECTIVENESS OF INTERVENTIONS, AND SERVE AS A FOUNDATION FOR EVIDENCEBASED PRACTICES TO IMPROVE HEALTH AND OVERALL QUALITY OF LIFE. PART VI, LINE 7: THE COMMUNITY BENEFIT REPORT IS FILED WITH NEW YORK STATE. X X X 0 1 0 0 0 0 0 0 0 STEVEN GOLDSTEIN BOARD MEMBER 0 1509252 0 0 0 1797297 0 188712 0 20961 0 3516222 0 1701400 MARK TAUBMAN BOARD MEMBER 0 1744544 0 0 0 38888 0 156577 0 20396 0 1960405 0 0 MICHAEL APOSTOLAKOS BOARD MEMBER 0 678734 0 0 0 22530 0 79312 0 28471 0 809047 0 0 PAUL AXTELL MD ORTHOPAEDIC SURGEON 718000 0 0 0 0 0 9150 0 16945 0 744095 0 0 0 HEATHER LANPHERE MD OB/GYN 407978 0 0 0 0 0 9150 0 15421 0 432549 0 0 0 ANNA HARING MD OB/GYN 388077 0 0 0 0 0 6100 0 14723 0 408900 0 0 0 ANDRES RUBERT MD CHIEF OF MEDICAL STAFF 356923 0 0 0 0 0 9150 0 15170 0 381243 0 0 0 NISHANT CHAUDHARY MD HOSPITALIST 359215 0 0 0 0 0 3050 0 15181 0 377446 0 0 0 SADDAN YASIN HOSPITALIST 347535 0 0 0 0 0 3050 0 15123 0 365708 0 0 0 JAMES HELMS CEO 220834 0 0 0 0 0 6625 0 6423 0 233882 0 0 0 PART I, LINE 4B THE FOLLOWING INDIVIDUALS PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN AND RECEIVED EMPLOYER PAID AMOUNTS THAT ARE INCLUDED IN DEFERRED COMPENSATION: STEVEN GOLDSTEIN - SERP PLAN - $159,400 MARK TAUBMAN, MD - SERP PLAN - $127,265 MICHAEL APOSTOLAKOS, MD - SERP PLAN - $50,000 KELLIE ANDERSON - SERP PLAN - $25,000 THE FOLLOWING INDIVIDUALS PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN AND RECEIVED EMPLOYER PAID AMOUNTS THAT ARE INCLUDED IN OTHER REPORTABLE COMPENSATION: STEVEN GOLDSTEIN - 457 (F) PLAN - $1,701,400 FORM 990, PART VI, SECTION A, LINE 2 SOME OF THE TRUSTEES OF THE ORGANIZATION HAVE BUSINESS RELATIONSHIPS WITH EACH OTHER THROUGH THEIR EMPLOYMENT AND SERVICE AS OFFICER OF A RELATED ORGANIZATION THE UNIVERSITY OF ROCHESTER. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF THE HOSPITAL IS THE UNIVERSITY OF ROCHESTER. FORM 990, PART VI, SECTION A, LINE 7A THE UNIVERSITY OR ROCHESTER HAS THE AUTHORITY TO ELECT THE GOVERNING BODY OF THE HOSPITAL. FORM 990, PART VI, SECTION A, LINE 7B DECISIONS SUCH AS AMENDMENT OF THE CERTIFICATE OF INCORPORATION AND BYLAWS AND APPROVAL OF EXTRAORDINARY CORPORATE ACTIONS SUCH AS MERGER OR DISSOLUTION ARE SUBJECT TO THE APPROVAL OF THE UNIVERSITY OF ROCHESTER. FORM 990, PART VI, SECTION B, LINE 11B THE 990 WAS PRESENTED TO THE BOARD OF DIRECTORS PRIOR TO FILING. THE 990 IS REVIEWED BY THE VP OF FINANCE. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY, THE HOSPITAL REQUIRES ALL BOARD MEMBERS, SENIOR MANAGERS AND DEPARTMENT MANAGERS TO COMPLETE THE CONFLICT OF INTEREST STATEMENT TO IDENTIFY ACTUAL AND POTENTIAL CONFLICTS. THE STATEMENTS ARE REVIEWED BY THE HOSPITAL'S COMPLIANCE OFFICER FOR ANY POTENTIAL CONFLICTS. IF A CONFLICT IS IDENTIFIED, THE INDIVIDUAL WITH THE CONFLICT WILL NOT BE ALLOWED TO PARTICIPATE IN ANY DISCUSSION OR DECISION IN ANY AREA OF CONFLICT IDENTIFIED. FORM 990, PART VI, SECTION B, LINE 15 THE CEO'S SALARY IS SET FOR A SPECIFIC CONTRACT PERIOD BY THE BOARD OF DIRECTORS AND INCLUDES AN ESCALATION CLAUSE FOR INCREASES DURING THE CONTRACT PERIOD. THE PROCESS INCLUDES A REVIEW OF COMPARABLE DATA FOR THE MARKET AREA AND THE COMPLETE CONTRACT IS APPROVED BY THE BOARD OF DIRECTORS. COMPENSATION OF OTHER TOP MANAGEMENT OFFICIALS AND KEY EMPLOYEES IS DONE THROUGH A WAGE ANALYSIS PERFORMED BY THE HUMAN RESOURCES DIRECTOR. THE ANALYSIS COMPARES CURRENT WAGE TO MARKET DATA. THE CEO REVIEWS THE ANALYSIS. FORM 990, PART VI, SECTION C, LINE 19 THE HOSPITAL'S FORM 990 IS AVAILABLE UPON REQUEST. THE HOSPITAL'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND AUDITED FINANCIAL STATEMENTS ARE NOT ROUTINELY MADE AVAILABLE TO THE PUBLIC. THE HOSPITAL PUBLISHES AN ANNUAL FINANCIAL AND STATISTICAL REPORT IN THE LOCAL NEWSPAPER EACH SPRING. IT ALSO HAS THESE DOCUMENTS AVAILABLE FOR IN PERSON REVIEW OR WITHIN 30 DAYS OF A WRITTEN REQUEST FROM THE GENERAL PUBLIC. COPIES OF THESE DOCUMENTS ARE STORED IN THE ADMINISTRATIVE OFFICE OF THE HOSPITAL FOR THIS PURPOSE FORM 990, PART IX, LINE 11G PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 13,176,609. MANAGEMENT AND GENERAL EXPENSES 1,261,234. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 14,437,843. BANK FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 41,861. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 41,861. FORM 990, PART XI, LINE 9: CHANGE IN FUNDED STATUS OF PENSION PLAN 1,799,867. CHANGE IN VALUE OF BENEFICIAL INTEREST IN PERPETUAL TRUST 87,679. CHANGE IN VALUE OF BENEFICIAL INTEREST IN FOUNDATION 46,054. FORM 990, PART XII, LINE 2C: PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. UNIVERSITY OF ROCHESTER 910 GENESEE STREET STE 200 ROCHESTER NY 14611 160743209 SCHOOL NY 501(C)(3) LINE 2 UNIV OF ROCH 0 HIGHLAND HOSPITAL OF ROCHESTER 1000 SOUTH AVENUE ROCHESTER NY 14620 160743037 HOSPITAL NY 501(C)(3) LINE 3 SPHS 0 THE HIGHLAND FOUNDATION INC 1000 SOUTH AVENUE ROCHESTER NY 14620 237310662 FUNDRAISING NY 501(C)(3) LINE 12A, I HIGHLD HOSP 0 HIGHLAND FACILITIES DEVELOPMENT CORP 1000 SOUTH AVENUE ROCHESTER NY 14620 223039077 MEDICAL BLDG NY 501(C)(3) LINE 10 HIGHLD HOSP 0 HIGHLAND COMMUNITY DEVELOPMENT CORP 100 HAHNEMANN TRAIL PITTSFORD NY 14534 223154715 ELDER CARE NY 501(C)(3) LINE 10 SPHS 0 THE HIGHLANDS LIVING CENTER INC 500 HAHNEMANN TRAIL PITTSFORD NY 14534 223240227 HEALTHCARE NY 501(C)(3) LINE 10 SPHS 0 THE MEADOWS AT WESTFALL INC 5901 LAC DE VILLE BLVD ROCHESTER NY 14618 161502303 HEALTHCARE NY 501(C)(3) LINE 10 SPHS 0 STRONG PARTNERS HEALTH SYSTEM INC 601 ELMWOOD AVENUE BOX 706 ROCHESTER NY 14642 161499099 SUPPORT ORG NY 501(C)(3) LINE 12A, I UNIV OF ROCH 0 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