Form990
Click to see list of attachments
Department of the TreasuryInternal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private
foundations)
MediumBullet Do not enter social security numbers on this form as it may be made public.
MediumBullet Information about Form 990 and its instructions is at www.IRS.gov/form990.
OMB No. 1545-0047
2015
Open to Public Inspection
A For the 2015 calendar year, or tax year beginning 01-01-2015 , and ending 12-31-2015
BCheck if applicable:
CName of organization
ARNOT OGDEN MEDICAL CENTER
 
 
Doing business as
 
 
Number and street (or P.O. box if mail is not delivered to street address)
600 ROE AVENUE
 
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
ELMIRA, NY14905
D Employer identification number

16-0743905
E Telephone number

G Gross receipts $ 287,341,767
F Name and address of principal officer:
Robert Lambert
600 Roe Avenue
Elmira,NY14905
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
www.arnothealth.org
H(a)
Is this a group return for
subordinates?
H(b)
Are all subordinates
included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:  
L Year of formation: 1889
M State of legal domicile: NY
Part I
Summary
Activities  & Governance 1 Briefly describe the organization’s mission or most significant activities: 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.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 18
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 15
5 Total number of individuals employed in calendar year 2015 (Part V, line 2a) ...... 5 2,866
6 Total number of volunteers (estimate if necessary) ............. 6 490
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a -403,489
b Net unrelated business taxable income from Form 990-T, line 34 ......... 7b 0
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 1,188,532 2,466,614
9 Program service revenue (Part VIII, line 2g) ......... 270,538,688 261,603,821
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 9,031,350 12,557,453
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 1,609,679 638,160
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12) 282,368,249 277,266,048
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 0 0
14 Benefits paid to or for members (Part IX, column (A), line 4)..... 0 0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 183,155,636 196,689,212
16a Professional fundraising fees (Part IX, column (A), line 11e) ..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 94,601,166 92,697,987
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 277,756,802 289,387,199
19 Revenue less expenses. Subtract line 18 from line 12....... 4,611,447 -12,121,151
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 277,712,820 261,243,394
21 Total liabilities (Part X, line 26)............. 100,718,728 98,196,597
22 Net assets or fund balances. Subtract line 21 from line 20..... 176,994,092 163,046,797
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title
Paid Preparer Use Only
Print/Type preparer's name
Preparer's signature
Date
PTIN
Firm's name MediumBullet
Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ..........
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y Form 990 (2015)
Form 990 (2015)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response or note to any line in this Part III ..............
1
Briefly describe the organization’s mission: Arnot Ogden Medical Center is an independent, not-for-profit, 201-bed tertiary medical facility with more than 120 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.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? .....................
If "Yes," describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program
services? ...........................
If "Yes," describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 236,711,757 including grants of $ 1,324,508 ) (Revenue $ 261,159,837 )
The Arnot Ogden Medical Center continues to provide of health care related services since it opened in 1889, serving Chemung County and the Twin Tier Regions of New York and Pennsylvania. The Medical Center specialzied 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 2015 the Medical Center's 2,121 Full-time equivalent of employees cared for 11,235 inpatient admissions in its 201 staffed beds. The Medical Center provided Outpatient Services to approximately 319,757 Outpatient Visits in its subspecialty services. The approximately 115 Full-time equivalent of physicans provided for 306,642 office visits in the areas of primary care and specialty services.
4b (Code:   ) (Expenses $ 1,071,276 including grants of $ 0 ) (Revenue $ 456,177 )
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 65 students enrolled in 2015. The Arnot Ogden School of Radiologic Sciences began in 1953 continues to offer a two year certificate program which is accredited by the Joint Review Commission on Education in Radiologic Technology with approximatedly 21 students enrolled in 2015. Upon completion of their program of study, students are eligible to take the NYS licensing examinations for Registered Nurse or Radiologic Technologist.
4c (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4d Other program services (Describe in Schedule O.)
(Expenses $ 0 including grants of $ 0 ) (Revenue $ 0 )
4e Total program service expensesMediumBullet237,783,033
Form 990 (2015)
Form 990 (2015)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If "Yes," complete Schedule AClick to see attachment.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)? Click to see attachment...
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If "Yes," complete Schedule C, Part I.............
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If "Yes," complete Schedule C, Part IIClick to see attachment..............
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If "Yes," complete Schedule C, Part III.................
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If "Yes," complete Schedule D, Part I..................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If "Yes," complete Schedule D, Part II...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If "Yes," complete Schedule D, Part III .............
8
 
No
9
Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If "Yes," complete Schedule D, Part IV..............
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If "Yes," complete Schedule D, Part VClick to see attachment......
10
Yes
 
11
If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable.
a
Did the organization report an amount for land, buildings, and equipment in Part X, line 10?
If "Yes," complete Schedule D, Part VI.Click to see attachment...................
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VII.......
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIII.......
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part IXClick to see attachment............
11d
Yes
 
e
Did the organization report an amount for other liabilities in Part X, line 25? If "Yes," complete Schedule D, Part XClick to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If "Yes," complete Schedule D, Part XClick to see attachment
11f
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If "Yes," complete Schedule D, Parts XI and XII Click to see attachment.................
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If "Yes," and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States? .....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If "Yes," complete Schedule F, Parts I and IV.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or for any foreign organization? If “Yes,” complete Schedule F, Parts II and IV.....
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other assistance to or for foreign individuals? If “Yes,” complete Schedule F, Parts III and IV...
16
 
No
17
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If "Yes," complete Schedule G, Part I (see instructions) ....
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If "Yes," complete Schedule G, Part II............ Click to see attachment
18
Yes
 
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If "Yes," complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospital facilities? If "Yes," complete Schedule H....Click to see attachment
20a
Yes
 
b
If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return? Click to see attachment
20b
Yes
 
Form 990 (2015)
Form 990 (2015)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants or other assistance to any domestic organization or domestic government on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II.....
21
 
No
22
Did the organization report more than $5,000 of grants or other assistance to or for domestic individuals on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........
22
 
No
23
Did the organization answer "Yes" to Part VII, Section A, line 3, 4, or 5 about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If "Yes," complete Schedule J....................... Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24b through 24d and complete Schedule K. If “No,” go to line 25a...............Click to see attachment
24a
Yes
 
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
No
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds? ...............
24c
 
No
d
Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year?...
24d
 
No
25a
Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If "Yes," complete Schedule L, Part I............
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If "Yes," complete Schedule L, Part I ...................
25b
 
No
26
Did the organization report any amount on Part X, line 5, 6, or 22 for receivables from or payables to any current or former officers, directors, trustees, key employees, highest compensated employees, or disqualified persons? If "Yes," complete Schedule L, Part II ................
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If "Yes," complete Schedule L, Part III.........
27
 
No
28
Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L,
Part IV
........................
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L, Part IV.....................
28b
 
No
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or direct or indirect owner? If "Yes," complete Schedule L, Part IV... Click to see attachment
28c
Yes
 
29
Did the organization receive more than $25,000 in non-cash contributions? If "Yes," complete Schedule M..
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If "Yes," complete Schedule M .............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If "Yes," complete Schedule N, Part I.
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If "Yes," complete Schedule N, Part II ...........
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If "Yes," complete Schedule R, Part I ........
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If "Yes," complete Schedule R, Part II, III, or IV, and Part V, line 1.........................Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
 
No
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If "Yes," complete Schedule R, Part V, line 2 ...
35b
 
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If "Yes," complete Schedule R, Part V, line 2.............
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If "Yes," complete Schedule R, Part VI
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2015)
Form 990 (2015)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response or note to any line in this Part V...........
Yes
No
1a
Enter the number reported in Box 3 of Form 1096 Enter -0- if not applicable ..
1a
2,866
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable .
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
 
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return ..................
2a
2,866
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
Yes
 
b
If “Yes,” has it filed a Form 990-T for this year? If “No” to line 3b, provide an explanation in Schedule O...
3b
Yes
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)? ..
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR).
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year? ..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If "Yes," to line 5a or 5b, did the organization file Form 8886-T? ............
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions? ...
6a
 
No
b
If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible? ......................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor? ....................
7a
 
 
b
If "Yes," did the organization notify the donor of the value of the goods or services provided? .....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282? .........................
7c
 
 
d
If "Yes," indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?
7e
 
 
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? ..
7f
 
 
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required? ......................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C? ..........................
7h
 
 
8
Sponsoring organizations maintaining donor advised funds.
Did a donor advised fund maintained by the sponsoring organization have excess business holdings at any time during the year? .........................
8
 
 
9a
Did the sponsoring organization make any taxable distributions under section 4966?...
9a
 
 
b
Did the sponsoring organization make a distribution to a donor, donor advisor, or related person?...
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ..........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If "Yes," enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note.
See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans ....
13b
 
c
Enter the amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If "No," provide an explanation in Schedule O..
14b
 
 
Form 990 (2015)
Form 990 (2015)
Page 6
Part VI
Governance, Management, and Disclosure For each "Yes" response to lines 2 through 7b below, and for a "No" response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response or note to any line in this Part VI ..............
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year
1a
18
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent
1b
15
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? ...........................
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
 
No
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
 
No
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
 
No
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .......................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If "Yes," provide the names and addresses in Schedule O.......
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
Yes
 
b
If "Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
Yes
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If "No," go to line 13.......
12a
Yes
 
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If "Yes," describe in Schedule O how this was done...................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes" to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
 
No
b
If "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
NY
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how) the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, address, and telephone number of the person who possesses the organization's books and records:
MediumBulletRonald J KintzAccounting Department600 Roe AvenueElmira,NY14905 (607) 737-4235
Form 990 (2015)
Form 990 (2015)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response or note to any line in this Part VII ..............
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
(A)
Name and Title
(B)
Average hours per week (list any hours for related organizations below dotted line)
(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee)
(D)
Reportable compensation from the organization (W- 2/1099-MISC)
(E)
Reportable compensation from related organizations (W- 2/1099-MISC)
(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(1) Michael Hosey......................................................................
Chairman of the Board
1
.................
1
X           0 0 0
(2) Mark J Hagan......................................................................
Vice Chairman
2
.................
1
X           0 0 0
(3) Daniel J Burke......................................................................
Board Member
1
.................
1
X           0 0 0
(4) Kathleen Lucke......................................................................
Board Member
1
.................
1
X           0 0 0
(5) David Dalrymple......................................................................
Board Member
1
.................
1
X           0 0 0
(6) Richard Simons......................................................................
Board Member
1
.................
1
X           0 0 0
(7) S Jan Eberhard......................................................................
Board Member
3
.................
1
X           0 0 0
(8) Scott Sprague......................................................................
Board Member
1
.................
1
X           0 0 0
(9) Jan van den Blink......................................................................
Board Member
1
.................
1
X           0 0 0
(10) Roy A Kyles......................................................................
Board Member
1
.................
1
X           0 0 0
(11) Robert McNamara......................................................................
Board Member
1
.................
1
X           0 0 0
(12) Mary Louise Mitchell......................................................................
Board Member
1
.................
1
X           0 0 0
(13) Pat Rodgers......................................................................
Board Member
1
.................
1
X           0 0 0
(14) Donald Quick......................................................................
Board Member
1
.................
1
X           0 0 0
(15) Melinda Sartori......................................................................
Board Member
1
.................
1
X           0 0 0
(16) Alan Angell......................................................................
Board Member/Physician
40.00
.................
1.00
X           437,674 0 93,002
(17) Roger Schenone......................................................................
Board Member/Physician
40.00
.................
1
X           355,697 0 11,456
Form 990 (2015)
Form 990 (2015)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title
(B)
Average hours per week (list any hours for related organizations below dotted line)
(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee)
(D)
Reportable compensation from the organization (W- 2/1099-MISC)
(E)
Reportable compensation from related organizations (W- 2/1099-MISC)
(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(18) Kevin OConnor........................................................................
Board Member/Physician
40.00
.......................1
X           317,649 0 139,751
(19) Robert Lambert........................................................................
Board Member/President
45.00
.......................5.00
X   X       527,380 0 140,068
(20) John R Alexander........................................................................
Secretary
1
.......................1
    X       0 0 0
(21) Roberto deBara........................................................................
President AMS
40
.......................0
    X       293,868 0 139,038
(22) Ronald J Kintz........................................................................
Senior VP/CFO
45
.......................5.00
    X       331,952 0 97,340
(23) H Fred Farley........................................................................
Hospital President COO
40.00
.......................10.00
    X       353,789 0 77,377
(24) Nancy ODacre........................................................................
VP Strategic Planning
45.00
.......................5.00
    X       63,346 0 7,907
(25) James Watson........................................................................
President IDMH
1.00
.......................40.00
    X     X 227,391 0 9,740
(26) Kenneth HerzlBetz........................................................................
Senior VP/Medical Affairs
50.00
.......................8.00
    X       303,141 0 30,344
(27) Vidyasagar Mokureddy........................................................................
Pain Mgmt Physician
40
.......................0
        X   869,325 0 93,202
(28) Bruno Mazza........................................................................
Gastoentrologist
40
.......................0
        X   720,821 0 173,262
(29) Thomas Boman........................................................................
Orthopediac Surgeon
40
.......................0
        X   782,382 0 72,201
(30) Matthew Brand........................................................................
Orthopediac Surgeon
40
.......................0
        X   761,218 0 76,573
(31) Paul Tinsley........................................................................
ENT Physician
40
.......................0
        X   730,383 0 57,812
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)...........MediumBullet 7,076,016 0 1,219,073
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organization MediumBullet212
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If "Yes," complete Schedule J for such individual ..............
3
Yes
 
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If "Yes," complete Schedule J for such
individual
...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If "Yes," complete Schedule J for such person ........
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address
(B)
Description of services
(C)
Compensation
ABM Building Solutions

501 Technology Drive
Suite 3000
Cannonsburg,PA15317
Energy Contractor 5,675,585
Streeter Associates

P O Box 118
Elmira,NY14902
Construction Contractor 4,598,768
Navigant Consulting Inc

4511 Paysphere Circle
Chicago,IL60674
Physician Billing Consulting 2,515,240
Medicus Hospitalists Services

22 Roulston Road
Windham Road,NH03087
Inpatient Physician Services 1,702,289
Associated Anesthesiologists
Of the Finger Lakes
P O Box 1253
Elmira,NY149021253
Surgical Anesthesia Services 1,685,242
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet61
Form 990 (2015)
Form 990 (2015)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response or note to any line in this Part VIII .............
(A)
Total revenue
(B)
Related or
exempt
function
revenue
(C)
Unrelated
business
revenue
(D)
Revenue
excluded from
tax under sections
512-514
Contributions, Gifts, GrantAmt and OtherAmt Similar Amounts 1a Federated campaigns..1a 0
b Membership dues..1b 0
c Fundraising events..1c 0
d Related organizations1d 0
e Government grants (contributions)1e 654,252
f All other contributions, gifts, grants, and similar amounts not included above1f 1,812,362
g Noncash contributions included in lines 1a-1f:$ 0
h Total.Add lines 1a-1f.......MediumBullet 2,466,614
 Program Service RevenueAmt Business Code
2a Hospital Net Patient Service Revenue 622110 211,190,666 211,190,666 0 0
b Physician Net Patient Service Revenue 621110 49,969,171 49,969,171 0 0
c School of Nursing 611600 362,148 362,148 0 0
d School of Radiologic Technology 611600 81,836 81,836 0 0
e
f All other program service revenue. 0 0 0 0
g Total.Add lines 2a–2f.....MediumBullet 261,603,821
 OtherAmt RevenueAmt 3 Investment income (including dividends, interest, and othersimilar amounts) ..........MediumBullet 3,241,961 0 0 3,241,961
4 Income from investment of tax-exempt bond proceedsMediumBullet 0 0 0 0
5 Royalties...........MediumBullet 0 0 0 0
(ii) Personal (i) Real
6a Gross rents 0 573,120
b Less: rental expenses 0 667,468
c Rental income or (loss) 0 -94,348
d Net rental income or (loss)......MediumBullet -94,348 283,722 -378,070 0
(ii) Other (i) Securities
7a Gross amount from sales of assets other than inventory 6,587,114 9,846,562
b Less: cost or other basis and sales expenses 1,428,747 5,689,437
c Gain or (loss) 5,158,367 4,157,125
d Net gain or (loss).....MediumBullet 9,315,492 0 0 9,315,492
8a Gross income from fundraising events (not including $ 0of contributions reported on line 1c). See Part IV, line 18 ....
a 88,493
b Less: direct expenses ...b 36,805
c Net income or (loss) from fundraising events..MediumBullet 51,688 0 51,688
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities..MediumBullet 0   0 0
10a Gross sales of inventory, less
returns and allowances ..
a 856,631
b Less: cost of goods sold ..b 2,253,262
c Net income or (loss) from sales of inventory..MediumBullet -1,396,631 0 0 -1,396,631
Business Code Miscellaneous Revenue
11a Rebates/Discounts 900000 710,779 710,779 0 0
b Delivery System Reform Incentive - DSRIP 921190 670,256 670,256 0 0
c            
d All other revenue .... 696,416 625,800 -25,419 96,035
e Total. Add lines 11a–11d ...... MediumBullet 2,077,451
12 Total revenue. See Instructions......MediumBullet 277,266,048 263,894,378 -403,489 11,308,545
Form 990 (2015)
Form 990 (2015)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).Check if Schedule O contains a response or note to any line in this Part IX ..............
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII.
(A)
Total expenses
(B)
Program service expenses
(C)
Management and general expenses
(D)
Fundraising expenses
1 Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 0 0
2 Grants and other assistance to individuals in the United States. See Part IV, line 22 0 0
3 Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16 0 0
4 Benefits paid to or for members 0 0
5 Compensation of current officers, directors, trustees, and key employees .... 2,602,685 0 2,602,685 0
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .... 0 0 0 0
7 Other salaries and wages 147,540,275 125,324,492 22,215,783 0
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 6,683,765 0 6,683,765 0
9 Other employee benefits ....... 30,715,603 3,240 30,712,363 0
10 Payroll taxes ........... 9,146,884 7,496,517 1,650,367 0
11 Fees for services (non-employees):        
a Management ...... 2,532,880 936,385 1,596,495 0
b Legal ......... 601,272 147,742 453,530 0
c Accounting ........... 56,365 7,989 48,376 0
d Lobbying ........... 29,069 0 29,069 0
e Professional fundraising services. See Part IV, line 17 0 0
f Investment management fees ...... 389,596 0 389,596 0
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) 11,866,199 11,142,850 723,349 0
12 Advertising and promotion .... 1,458,367 97,636 1,360,731 0
13 Office expenses ....... 4,277,575 2,500,090 1,777,485 0
14 Information technology ...... 5,363,237 649,929 4,713,308 0
15 Royalties .. 0 0 0 0
16 Occupancy ........... 3,666,846 703,500 2,963,346 0
17 Travel ............ 903,363 636,976 266,387 0
18 Payments of travel or entertainment expenses for any federal, state, or local public officials . 0 0 0 0
19 Conferences, conventions, and meetings .... 170,812 148,949 21,863 0
20 Interest ........... 1,463,541 0 1,463,541 0
21 Payments to affiliates ....... 0 0 0 0
22 Depreciation, depletion, and amortization .. 11,002,745 5,528,378 5,474,367 0
23 Insurance ... 3,965,979 2,003,979 1,962,000 0
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a Medical/Surgical/Pharmaceutical Supplies 37,957,423 37,970,902 -13,479 0
b Maintenance Contracts/Purchased Services 13,615,250 8,308,690 5,306,560 0
c Allocation of Expenses to Affiliates -11,221,581 167,993 -11,389,574 0
d Benefit Allocation 0 31,214,053 -31,214,053 0
e All other expenses 4,599,049 2,792,743 1,806,306 0
25 Total functional expenses. Add lines 1 through 24e 289,387,199 237,783,033 51,604,166 0
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2015)
Form 990 (2015)
Page 11
Part X
Balance Sheet
Check if Schedule O contains a response or note to any line in this Part IX ..............
(A)
Beginning of year
(B)
End of year
Assets 1 Cash–non-interest-bearing ........ 13,159 1 12,773
2 Savings and temporary cash investments ......... 2,665,564 2 1,127,333
3 Pledges and grants receivable, net ...... 117,827 3 54,376
4 Accounts receivable, net ............. 37,484,672 4 31,968,814
5 Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L
0 5 0
6 Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
0 6 0
7 Notes and loans receivable, net .... 18,197,728 7 703,049
8 Inventories for sale or use ........ 1,351,031 8 1,346,735
9 Prepaid expenses and deferred charges ...... 2,042,646 9 1,781,294
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 278,002,189
b Less: accumulated depreciation 10b 173,942,922 92,322,410 10c 104,059,267
11 Investments—publicly traded securities . 66,578,874 11 61,592,375
12 Investments—other securities. See Part IV, line 11 ..... 0 12 0
13 Investments—program-related. See Part IV, line 11 .. 0 13 0
14 Intangible assets ............... 726,661 14 830,368
15 Other assets. See Part IV, line 11 ........... 56,212,248 15 57,767,010
16 Total assets. Add lines 1 through 15 (must equal line 34)... 277,712,820 16 261,243,394
Liabilities 17 Accounts payable and accrued expenses ..... 21,482,622 17 19,225,641
18 Grants payable ... 0 18 0
19 Deferred revenue ......... 3,855 19 145,331
20 Tax-exempt bond liabilities ......... 25,469,532 20 28,821,800
21 Escrow or custodial account liability. Complete Part IV of Schedule D 0 21 0
22 Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L.. 0 22 0
23 Secured mortgages and notes payable to unrelated third parties .. 8,621,386 23 7,195,649
24 Unsecured notes and loans payable to unrelated third parties .. 0 24 0
25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D 45,141,333 25 42,808,176
26 Total liabilities. Add lines 17 through 25.. 100,718,728 26 98,196,597
Net Assets or Fund Balance Organizations that follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets 163,059,272 27 150,656,612
28 Temporarily restricted net assets ........... 10,840,886 28 9,420,430
29 Permanently restricted net assets 3,093,934 29 2,969,755
Organizations that do not follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds .....   30  
31 Paid-in or capital surplus, or land, building or equipment fund ...   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ........... 176,994,092 33 163,046,797
34 Total liabilities and net assets/fund balances ........ 277,712,820 34 261,243,394
Form 990 (2015)
Form 990 (2015)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response or note to any line in this Part XI ..............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
277,266,048
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
289,387,199
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
-12,121,151
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
176,994,092
5
Net unrealized gains (losses) on investments ...............
5
-6,198,973
6
Donated services and use of facilities .................
6
0
7
Investment expenses .....................
7
0
8
Prior period adjustments .....................
8
0
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
4,372,829
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))
10
163,046,797
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response or note to any line in this Part XII .............
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?
2a
 
No
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If "Yes," to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133?
3a
 
No
b
If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits.
3b
 
 
Form 990 (2015)
Form 990 (2015)
Additional Data


Software ID: 15000352
Software Version: v1.00
Form 990, Special Condition Description:
Special Condition Description
SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
right arrow Attach to Form 990 or Form 990-EZ.
right arrow Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2015
Open to Public
Inspection
Name of the organization
ARNOT OGDEN MEDICAL CENTER
 
Employer identification number

16-0743905
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4


5
6
7
8
9
10
11
a
b
c
d
e
f
Enter the number of supported organizations ..............  

g
Provide the following information about the supported organization(s).
(i)Name of supported organization (ii) EIN (iii) Type of organization (described on lines 1- 9 above (see instructions)) (iv) Is the organization listed in your governing document? (v) Amount of monetary support (see instructions) (vi) Amount of other support (see instructions)
Yes No
Total      

For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2015

Schedule A (Form 990 or 990-EZ) 2015
Page 2
Part II
Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year (or fiscal year beginning in) right arrow (a) 2011 (b) 2012 (c) 2013 (d) 2014 (e) 2015 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any unusual grants.) ....            
2 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......            
3 The value of services or facilities furnished by a governmental unit to the organization without charge..            
4 Total. Add lines 1 through 3            
5 The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..  
6 Public support. Subtract line 5 from line 4.  
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2011 (b) 2012 (c) 2013 (d) 2014 (e) 2015 (f) Total
7 Amounts from line 4..            
8 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...            
9 Net income from unrelated business activities, whether or not the business is regularly carried on..            
10 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..            
11 Total support. Add lines 7 through 10.  
12
12
 
13
First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................right arrow
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow
Schedule A (Form 990 or 990-EZ) 2015

Schedule A (Form 990 or 990-EZ) 2015
Page 3
Part III
Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year (or fiscal year beginning in) right arrow (a) 2011 (b) 2012 (c) 2013 (d) 2014 (e) 2015 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .            
2 Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......            
3 Gross receipts from activities that are not an unrelated trade or business under section 513...            
4 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...            
5 The value of services or facilities furnished by a governmental unit to the organization without charge..            
6 Total. Add lines 1 through 5.            
7a Amounts included on lines 1, 2, and 3 received from disqualified persons...            
b Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.            
c Add lines 7a and 7b..            
8 Public support. (Subtract line 7c from line 6.)  
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2011 (b) 2012 (c) 2013 (d) 2014 (e) 2015 (f) Total
9 Amounts from line 6...            
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.            
c Add lines 10a and 10b.            
11 Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.            
12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) ..            
13 Total support. (Add lines 9, 10c, 11, and 12.)..            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2015

Schedule A (Form 990 or 990-EZ) 2015
Page 4
Part IV
Supporting Organizations
(Complete only if you checked a box on line 11 of Part I. If you checked 11a of Part I, complete Sections A and B. If you checked 11b of Part I, complete Sections A and C. If you checked 11c of Part I, complete Sections A, D, and E. If you checked 11d of Part I, complete Sections A and D, and complete Part V.)
Section A. All Supporting Organizations
Yes
No
1
Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.
1
 
 
2
Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).
2
 
 
3a
Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.
3a
 
 
b
Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.
3b
 
 
c
Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.
3c
 
 
4a
Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 11a or 11b in Part I, answer (b) and (c) below.
4a
 
 
b
Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.
4b
 
 
c
Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.
4c
 
 
5a
Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).
5a
 
 
b
Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?
5b
 
 
c
Substitutions only. Was the substitution the result of an event beyond the organization's control?
5c
 
 
6
Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.
6
 
 
7
Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .
7
 
 
8
Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).
8
 
 
9a
Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.
9a
 
 
b
Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.
9b
 
 
c
Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.
9c
 
 
10a
Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.
10a
 
 
b
Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).
10b
 
 
Schedule A (Form 990 or 990-EZ) 2015

Schedule A (Form 990 or 990-EZ) 2015
Page 5
Part IV
Supporting Organizations (continued)
Yes
No
11
Has the organization accepted a gift or contribution from any of the following persons?
a
A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?
11a
 
 
b
A family member of a person described in (a) above?
11b
 
 
c
A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.
11c
 
 
Section B. Type I Supporting Organizations
Yes
No
1
Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.
1
 
 
2
Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.
2
 
 
Section C. Type II Supporting Organizations
Yes
No
1
Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).
1
 
 
Section D. All Type III Supporting Organizations
Yes
No
1
Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?
1
 
 
2
Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).
2
 
 
3
By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.
3
 
 
Section E. Type III Functionally-Integrated Supporting Organizations
1
Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):
a
b
c
2
Activities Test. Answer (a) and (b) below.
Yes
No
a
Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.
2a
 
 
b
Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.
2b
 
 
3
Parent of Supported Organizations. Answer (a) and (b) below.
a
Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.
3a
 
 
b
Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.
3b
 
 
Schedule A (Form 990 or 990-EZ) 2015

Schedule A (Form 990 or 990-EZ) 2015
Page 6
Part V
Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations
1
Section A - Adjusted Net Income (A) Prior Year (B) Current Year
(optional)
1 Net short-term capital gain 1    
2 Recoveries of prior-year distributions 2    
3 Other gross income (see instructions) 3    
4 Add lines 1 through 3 4    
5 Depreciation and depletion 5    
6 Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) 6    
7 Other expenses (see instructions) 7    
8 Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) 8    

Section B - Minimum Asset Amount (A) Prior Year (B) Current Year
(optional)
1 Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): 1
a Average monthly value of securities 1a    
b Average monthly cash balances 1b    
c Fair market value of other non-exempt-use assets 1c    
d Total (add lines 1a, 1b, and 1c) 1d    
e Discount claimed for blockage or other factors
(explain in detail in Part VI):  
2 Acquisition indebtedness applicable to non-exempt use assets 2    
3 Subtract line 2 from line 1d 3    
4 Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). 4    
5 Net value of non-exempt-use assets (subtract line 4 from line 3) 5    
6 Multiply line 5 by .035 6    
7 Recoveries of prior-year distributions 7    
8 Minimum Asset Amount (add line 7 to line 6) 8    

Section C - Distributable Amount Current Year
1 Adjusted net income for prior year (from Section A, line 8, Column A) 1  
2 Enter 85% of line 1 2  
3 Minimum asset amount for prior year (from Section B, line 8, Column A) 3  
4 Enter greater of line 2 or line 3 4  
5 Income tax imposed in prior year 5  
6 Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) 6  
7
Schedule A (Form 990 or 990-EZ) 2015

Schedule A (Form 990 or 990-EZ) 2015
Page 7
Part V
Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations (continued)
Section D - Distributions Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes  
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in
excess of income from activity
 
3 Administrative expenses paid to accomplish exempt purposes of supported organizations  
4 Amounts paid to acquire exempt-use assets  
5 Qualified set-aside amounts (prior IRS approval required)  
6 Other distributions (describe in Part VI). See instructions  
7Total annual distributions. Add lines 1 through 6.  
8 Distributions to attentive supported organizations to which the organization is responsive (provide
details in Part VI). See instructions
 
9 Distributable amount for 2015 from Section C, line 6  
10 Line 8 amount divided by Line 9 amount  

Section E - Distribution Allocations (see instructions) (i)
Excess Distributions
(ii)
Underdistributions
Pre-2015
(iii)
Distributable
Amount for 2015
1 Distributable amount for 2015 from Section C, line
6
 
2 Underdistributions, if any, for years prior to 2015
(reasonable cause required--see instructions)
 
3 Excess distributions carryover, if any, to 2015:
a
b
c
d From 2013.......  
e From 2014.......  
fTotal of lines 3a through e  
g Applied to underdistributions of prior years  
h Applied to 2015 distributable amount  
i Carryover from 2010 not applied (see
instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.  
4Distributions for 2015 from Section D, line 7:
$  
a Applied to underdistributions of prior years  
b Applied to 2015 distributable amount  
c Remainder. Subtract lines 4a and 4b from 4.  
5 Remaining underdistributions for years prior to
2015, if any. Subtract lines 3g and 4a from line 2
(if amount greater than zero, see instructions)
 
6 Remaining underdistributions for 2015. Subtract
lines 3h and 4b from line 1 (if amount greater than
zero, see instructions)
 
7 Excess distributions carryover to 2016. Add lines
3j and 4c.
 
8 Breakdown of line 7:
a
b
c Excess from 2013.......  
d From 2014.......  
e From 2015.......  
Schedule A (Form 990 or 990-EZ) (2015)

Schedule A (Form 990 or 990-EZ) 2015
Page 8
Part VI
Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Return Reference Explanation
Schedule A (Form 990 or 990-EZ) 2015


Additional Data


Software ID: 15000352
Software Version: v1.00
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
Arrow Bullet Information about Schedule B (Form 990, 990-EZ, or 990-PF) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2015
Name of the organization
ARNOT OGDEN MEDICAL CENTER
 
Employer identification number

16-0743905
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule
Special Rules
......... Arrow Bullet $  
Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on its Form 990PF, Part I, line 2, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.
Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2015)
Schedule B (Form 990, 990-EZ, or 990-PF) (2015) Page 2
Name of organization
ARNOT OGDEN MEDICAL CENTER
 
Employer identification number
16-0743905
Part I
Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
RESTRICTED
 
 

   
 
 
  ,    

$ RESTRICTED


(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2015)
Schedule B (Form 990, 990-EZ, or 990-PF) (2015)
Page 3
Name of organization
ARNOT OGDEN MEDICAL CENTER
 
Employer identification number

16-0743905
Part II
Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a)
No.from Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
 
$    
(a)
No.from Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
 
$    
(a)
No.from Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
 
$    
(a)
No.from Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
 
$    
(a)
No.from Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
 
$    
(a)
No.from Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
 
$    
Schedule B (Form 990, 990-EZ, or 990-PF) (2015)
Schedule B (Form 990, 990-EZ, or 990-PF) (2015)
Page 4
Name of organization
ARNOT OGDEN MEDICAL CENTER
 
Employer identification number

16-0743905
Part III
Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
Use duplicate copies of Part III if additional space is needed.
(a)
No.from Part I
(b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a)
No.from Part I
(b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a)
No.from Part I
(b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a)
No.from Part I
(b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Additional Data


Software ID: 15000352
Software Version: v1.00
SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet Complete if the organization is described below. SchCMd Bullet Attach to Form 990 or Form 990-EZ.
SchCMd BulletInformation about Schedule C (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2015
Open to Public
Inspection
If the organization answered "Yes" on Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" on Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
ARNOT OGDEN MEDICAL CENTER
 
Employer identification number

16-0743905
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization’s direct and indirect political campaign activities in Part IV.
2
Political expenditures ......................................................................................................................SchCMd Bullet
$  
3
Volunteer hours .............................................................................................................................
 

Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955 ................................SchCMd Bullet
$  
2
Enter the amount of any excise tax incurred by organization managers under section 4955 .......................SchCMd Bullet
$  
3
If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................
4a
Was a correction made? ......................................................................................................................
b
If "Yes," describe in Part IV.
Part I-C
Complete if the organization is exempt under section 501(c), except section 501(c)(3).
1
Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... SchCMd Bullet
$  
2
Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................SchCMd Bullet

$  
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b...........SchCMd Bullet

$  
4
Did the filing organization file Form 1120-POL for this year? ...................................................................
5
Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.
(a) Name (b) Address (c) EIN (d) Amount paid from filing organization's funds. If none, enter -0-. (e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.
1
2
3
4
5
6
For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2015

Schedule C (Form 990 or 990-EZ) 2015
Page 2
Part II-A
Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).
A Check SchCMd Bulletexpenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.)
(a) Filing
organization's
totals
(b) Affiliated group totals
1a Total lobbying expenditures to influence public opinion (grass roots lobbying) ...............................................    
b Total lobbying expenditures to influence a legislative body (direct lobbying) ...........................................    
c Total lobbying expenditures (add lines 1a and 1b) .......................................................................    
d Other exempt purpose expenditures .........................................................................................    
e Total exempt purpose expenditures (add lines 1c and 1d) ....................................................................    
f Lobbying nontaxable amount. Enter the amount from the following table in both
columns.
   
If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
Not over $500,00020% of the amount on line 1e.
Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
Over $17,000,000$1,000,000.
g Grassroots nontaxable amount (enter 25% of line 1f) ..........................................................................    
h Subtract line 1g from line 1a. If zero or less, enter -0-. ..........................................................................    
i Subtract line 1f from line 1c. If zero or less, enter -0-. ...........................................................................    
j If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting
section 4911 tax for this year? ..............................................................................................................

4-Year Averaging Period Under section 501(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five
columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
Calendar year (or fiscal year
beginning in)
(a) 2012 (b) 2013 (c) 2014 (d) 2015 (e) Total
2a Lobbying nontaxable amount          
b Lobbying ceiling amount
(150% of line 2a, column(e))
 
c Total lobbying expenditures          
d Grassroots nontaxable amount          
e Grassroots ceiling amount
(150% of line 2d, column (e))
 
f Grassroots lobbying expenditures          
Schedule C (Form 990 or 990-EZ) 2015


Schedule C (Form 990 or 990-EZ) 2015
Page 3
Part II-B
Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).
For each "Yes" response on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.
(a)
No
Yes
(b)
Amount
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? ...........................................................................................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........
 
No
c
Media advertisements? ...................................................................................................
 
No
 
d
Mailings to members, legislators, or the public? .............................................................................
 
No
 
e
Publications, or published or broadcast statements? ...........................................................
 
No
 
f
Grants to other organizations for lobbying purposes? ..........................................................
 
No
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? .......................
 
No
 
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................
 
No
 
i
Other activities? ...................................................................................................................
 
No
 
j
Total. Add lines 1c through 1i ....................................................................................................
0
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 ...........................................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................
 
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? ........................
 
 
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members? ...............................................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................
2
 
 
3
Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."
1
Dues, assessments and similar amounts from members ......................................................................
1
 
2
Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).
a
Current year .............................................................................................................................
2a
 
b
Carryover from last year ............................................................................................................
2b
 
c
Total ...........................................................................................................................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ......................................................................................................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) .........................................
5
 
Part IV
Supplemental Information
Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.
Return Reference Explanation
Schedule C, Part II-B, Line 1 Arnot Ogden Medical Center pays annual dues to the American Hospital Association, AHA and the Hospital Association of New York State, HANYS, and Rochester Regional Healthcare Association, RRHA, of which a percentage is for lobbying fees. The total lobbying fees paid to all in 2015 was $29,069.
Schedule C (Form 990 or 990EZ) 2015


Additional Data


Software ID: 15000352
Software Version: v1.00

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet Attach to Form 990.
Information about Schedule D (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2015
Open to Public Inspection
Name of the organization
ARNOT OGDEN MEDICAL CENTER
 
Employer identification number

16-0743905
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year ....    
2 Aggregate value of contributions to (during year)    
3 Aggregate value of grants from (during year)    
4 Aggregate value at end of year ....    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ...........
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ............................
Part II
Conservation Easements. Complete if the organization answered "Yes" on Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ...................... 2a  
b Total acreage restricted by conservation easements .................... 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register ... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............
6
Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................
9
In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:
(i)
Revenue included on Form 990, Part VIII, line 1 .........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:
a
Revenue included on Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 52283D
Schedule D (Form 990) 2015

Schedule D (Form 990) 2015
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?...
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b If "Yes," explain the arrangement in Part XIII and complete the following table: Amount
c Beginning balance ............................. 1c  
d Additions during the year ............................ 1d  
e Distributions during the year .......................... 1e  
f Ending balance ................................ 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability?
b
If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ........
Part V
Endowment Funds. Complete if the organization answered "Yes" on Form 990, Part IV, line 10.
(a)Current year (b)Prior year (c)Two years back (d)Three years back (e)Four years back
1a Beginning of year balance .... 3,093,934 2,947,754 2,827,204 2,827,204 2,431,346
b Contributions ... 0 3,326 0 0 0
c Net investment earnings, gains, and losses 0 142,854 120,550 0 395,858
d Grants or scholarships ... 0 0 0 0 0
e Other expenditures for facilities
and programs ...
124,179 0 0 0 0
f Administrative expenses .... 0 0 0 0 0
g End of year balance ...... 2,969,755 3,093,934 2,947,754 2,827,204 2,827,204
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet0 %
b
Permanent endowment SchDMd Bullet100 %
c
Temporarily restricted endowment SchDMd Bullet0 %
The percentages on lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations .................
3a(i)
 
No
(ii) related organizations .................
3a(ii)
 
No
b
If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
Describe in Part XIII the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis
(investment)
(b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land ... 4,676,771 0 4,676,771
b Buildings 120,870,247 0 57,274,550 63,595,697
c Leasehold improvements 953,320 0 906,838 46,482
d Equipment ... 148,440,287 0 114,111,036 34,329,251
e Other ... 3,061,564 0 1,650,498 1,411,066
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..SchDMdBullet 104,059,267
Schedule D (Form 990) 2015

Schedule D (Form 990) 2015
Page 3
Part VII
Investments—Other Securities. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)
(b)Book value (c)Method of valuation:
Cost or end-of-year market value
(1)Financial derivatives    
(2)Closely-held equity interests    
(3)Other
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet  
Part VIII
Investments—Program Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.
(a) Description of investment (b) Book value (c) Method of valuation:
Cost or end-of-year market value
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.
(a) Description (b) Book value
(1) Assets limited as to use 29,003,229
(2) Investment in subsidiaries 4,192,874
(3) Interest in net assets of foundations 18,551,068
(4) Due from related parties 6,019,839
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet 57,767,010
Part X
Other Liabilities. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.
1.(a) Description of liability (b) Book value
(1) Federal income taxes 0
Third Party Liability Reserves 4,289,645
Self Insurance Reserves 10,143,291
Minimum Pension Liability 12,516,016
457 Plan Liability 4,828,228
Notes Payable Investment Funds held Affiliates 10,689,920
Deferred Income Covenant Not to Compete 320,625
Miscellaneous long term liabilities 20,451
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 42,808,176
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII
Schedule D (Form 990) 2015

Schedule D (Form 990) 2015
Page 4
Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1 Total revenue, gains, and other support per audited financial statements ....... 1 279,773,796
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains (losses) on investments .... 2a 0
b Donated services and use of facilities ......... 2b 0
c Recoveries of prior year grants ........... 2c 0
d Other (Describe in Part XIII.) ............ 2d 2,949,028
e Add lines 2a through 2d ..................... 2e 2,949,028
3 Subtract line 2e from line 1.................. 3 276,824,768
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a 389,592
b Other (Describe in Part XIII.) ........... 4b 51,688
c Add lines 4a and 4b.................... 4c 441,280
5 Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5 277,266,048
Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1 Total expenses and losses per audited financial statements ........... 1 291,983,432
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities ......... 2a 0
b Prior year adjustments ............ 2b 0
c Other losses ................ 2c 0
d Other (Describe in Part XIII.) ............ 2d 0
e Add lines 2a through 2d.................... 2e 0
3 Subtract line 2e from line 1................... 3 291,983,432
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a 389,592
b Other (Describe in Part XIII.) ............ 4b -2,985,825
c Add lines 4a and 4b..................... 4c -2,596,233
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5 289,387,199

Part XIII
Supplemental Information
Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.
Return Reference Explanation
Schedule D, Part V, Line 4 Schedule D, Part V, Line 4 - Schedule D Part V Line 4 - The organization has interpreted the NYS Prudent Management 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 permanent restricted endowment funds absent of the 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 investments assets falls below the level of the donor, NYSMIFA requires the Center to retain the fund in perpetual duration. There were no such deficiencies as of December 31, 2015. 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.
Schedule D, Part X, Line 2 Income Taxes: Arnot Ogden Medical Center, AOMC Foundation, the Auxiliary, Ira Davenport, Keuka, SJH, and SJH Foundation 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 Section 501(a) of the Code. During the year ended December 31, 2014 AMS applied for not-for-profit status. AMS had previous been treated as a Corporation for tax purposes. Ivy Street files corporate tax returns. 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 positions not reflected in the accompanying consolidated financial statements as of December 31, 2015 and 2014.
Schedule D, Part XI, Line 2d Expenses for Cost of providing Nutritional Services Food to Cafeteria for patient and employee meals in the amount of $2,253,262. Expenses of $667,468 for the Cost of Rental repairs and services. Expenses of $28,298 for providing answering services to physician offices.
Schedule D, Part XI, Line 4b Childrens Miracle Network Temporarily Restricted Fundraising moved from Fund Balance to Fund Raising Income and Expenses moved to offset the income.
Schedule D, Part XII, Line 4b Rental Expenses of $695,766, Fundraising Expenses of $36,805, and Nutritional Services Expenses of $2,253,262 all moved to offset Revenue reported.
Schedule D (Form 990) 2015


Additional Data


Software ID: 15000352
Software Version: v1.00




SCHEDULE G (Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Supplemental Information Regarding
Fundraising or Gaming Activities
Complete if the organization answered "Yes" on Form 990, Part IV, lines 17, 18, or 19, or if the organization entered more than $15,000 on Form 990-EZ, line 6a. right arrowAttach to Form 990 or Form 990-EZ.
right arrowInformation about Schedule G (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2015
Open to Public Inspection
Name of the organization
ARNOT OGDEN MEDICAL CENTER
 
Employer identification number

16-0743905
Part I
Fundraising Activities. Complete if the organization answered "Yes" on Form 990, Part IV, line 17.
Form 990-EZ filers are not required to complete this part.
1
Indicate whether the organization raised funds through any of the following activities. Check all that apply.
a e
b f
c g
d
2a
Did the organization have a written or oral agreement with any individual (including officers, directors, trustees
or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services?
b
If "Yes," list the ten highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is
to be compensated at least $5,000 by the organization.


(i) Name and address of individual
or entity (fundraiser)
(ii) Activity (iii) Did fundraiser have custody or control of contributions? (iv) Gross receipts
from activity
(v) Amount paid to
(or retained by)
fundraiser listed in
col. (i)
(vi) Amount paid to
(or retained by)
organization
Yes No
             
             
             
             
             
             
             
             
             
             
Total . . . . . . . . . . . . . . . . . . . . right arrow      
3
List all states in which the organization is registered or licensed to solicit contributions or has been notified it is exempt from registration or licensing.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 50083H
Schedule G (Form 990 or 990-EZ) 2015
Schedule G (Form 990 or 990-EZ) 2015
Page 2
Part II
Fundraising Events. Complete if the organization answered "Yes" on Form 990, Part IV, line 18, or reported more than $15,000 of fundraising event contributions and gross income on Form 990-EZ, lines 1 and 6b. List events with gross receipts greater than $5,000.




VerticalRevenue
(a) Event #1

Golf Tournament
(event type)
(b) Event #2

Moonlight & Miracles
(event type)
(c) Other events

3
(total number)
(d) Total events
(add col. (a) through col. (c))

1

Gross receipts . . . . .

50,791

26,059

13,143

89,993

2

Less: Contributions . . . .

0

1,500

0

1,500
3 Gross income (line 1 minus
line 2) . . . . . .

50,791

24,559

13,143

88,493



VerticalDirectExpenses
4 Cash prizes . . . . . 0 0 0 0
5 Noncash prizes . . . . 152 0 0 152
6 Rent/facility costs . . . . 9,711 295 0 10,006
7 Food and beverages . . . 5,289 6,597 0 11,886
8 Entertainment . . . . 0 3,355 0 3,355
9 Other direct expenses . . . 5,308 3,637 2,461 11,406
10 Direct expense summary. Add lines 4 through 9 in column (d) . . . . . . . . . . right arrow 36,805
11 Net income summary. Subtract line 10 from line 3, column (d). . . . . . . . . . right arrow 51,688
Part III
Gaming. Complete if the organization answered "Yes" on Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a.
VerticalRevenue
(a) Bingo (b) Pull tabs/Instant
bingo/progressive bingo
(c) Other gaming (d) Total gaming (add col.(a) through col.(c))

1

Gross revenue . . . . .

 

 

 

 
VerticalDirectExpenses

2

Cash prizes . . . . .

 

 

 

 

3

Noncash prizes . . . .

 

 

 

 

4

Rent/facility costs . . . .

 

 

 

 

5

Other direct expenses . . .

5,308

3,637

2,461

11,406


6


Volunteer labor . . . .
%
%
%


7

Direct expense summary. Add lines 2 through 5 in column (d) . . . . . . . . . . right arrow

 

8

Net gaming income summary. Subtract line 7 from line 1, column (d). . . . . . . . . right arrow

 

9
Enter the state(s) in which the organization conducts gaming activities:
a
Is the organization licensed to conduct gaming activities in each of these states? . . . . . . . .
b
If "No," explain:
 
10a
Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? . . .
b
If "Yes," explain:
 
Schedule G (Form 990 or 990-EZ) 2015
Schedule G (Form 990 or 990-EZ) 2015
Page 3
11
Does the organization conduct gaming activities with nonmembers? . . . . . . . . . . .
12
Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity
formed to administer charitable gaming? . . . . . . . . . . . . . . . . .
13
Indicate the percentage of gaming activity conducted in:
a
The organization's facility . . . . . . . . . . . . . . . . . .
13a
%
b
An outside facility . . . . . . . . . . . . . . . . . . . .
13b
%
14
Enter the name and address of the person who prepares the organization's gaming/special events books and records:
Name right arrow
Address right arrow
15a
Does the organization have a contract with a third party from whom the organization receives gaming
revenue? . . . . . . . . . . . . . . . . . . . . . . . .
b
If "Yes," enter the amount of gaming revenue received by the organization right arrow $   and the
amount of gaming revenue retained by the third party right arrow $   .
c
If "Yes," enter name and address of the third party:
Name right arrow
Address right arrow
 
 
16
Gaming manager information:
Name right arrow
Gaming manager compensation right arrow $  
Description of services provided right arrow
 
17
Mandatory distributions:
a
Is the organization required under state law to make charitable distributions from the gaming proceeds to
retain the state gaming license? . . . . . . . . . . . . . . . . . . .
b
Enter the amount of distributions required under state law distributed to other exempt organizations or spent
in the organization's own exempt activities during the tax year right arrow$  
Part IV
Supplemental Information. Provide the explanations required by Part I, line 2b, columns (iii) and (v); and Part III, lines 9, 9b, 10b, 15b, 15c, 16, and 17b, as applicable. Also complete this part to provide any additional information (see instructions).
Return Reference Explanation
Schedule G (Form 990 or 990-EZ) 2015
Additional Data


Software ID: 15000352
Software Version: v1.00
SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet Attach to Form 990.
MediumBullet Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2015
Open to Public Inspection
Name of the organization
ARNOT OGDEN MEDICAL CENTER
 
Employer identification number

16-0743905
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .
1a
Yes
 
b
If "Yes," was it a written policy? ......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
%
b
Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate
which of the following was the family income limit for eligibility for discounted care: . . . . . . . .
3b
Yes
 
%
c
If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .
5b
 
No
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .
5c
 
 
6a
Did the organization prepare a community benefit report during the tax year? . . . . . . . . .
6a
Yes
 
b
If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance and
Means-Tested
Government Programs
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) . . .
1 826 986,496 17,718 968,778 0.33 %
b Medicaid (from Worksheet 3, column a) . . . . . 1 8,196 10,899,959 4,034,354 6,865,605 2.37 %
c Costs of other means-tested government programs (from Worksheet 3, column b) . . 1 43,462 40,708,665 20,884,624 19,824,041 6.85 %
d Total Financial Assistance and Means-Tested Government Programs . . . . . 3 52,484 52,595,120 24,936,696 27,658,424 9.55 %
Other Benefits
e Community health improvement services and community benefit operations (from Worksheet 4). 8 16,989 495,585 59,882 435,703 0.1 %
f Health professions education (from Worksheet 5) . . . 3 542 7,652,725 5,440,407 2,212,318 0.76 %
g Subsidized health services (from Worksheet 6) . . . . 103 630,202 144,746,741 95,689,514 49,057,227 16.95 %
h Research (from Worksheet 7) . 0 0 0 0 0 0 %
i Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .   3,693 9,723 0 9,723 0 %
j Total. Other Benefits . . 114 651,426 152,904,774 101,189,803 51,714,971 17.81 %
k Total. Add lines 7d and 7j . 117 703,910 205,499,894 126,126,499 79,373,395 27.36 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2015
Schedule H (Form 990) 2015
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue
(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing 0 0 0 0 0 0 %
2 Economic development 0 0 0 0 0 0 %
3 Community support 1   9,521   9,521 0 %
4 Environmental improvements 0 0 0 0 0 0 %
5 Leadership development and
training for community members
1 0 1,074,917 670,256 404,661 0.14 %
6 Coalition building 1 0 50,695 0 50,695 0.02 %
7 Community health improvement advocacy 1 1,439 5,375 0 5,375 0 %
8 Workforce development 2 0 154,528 0 154,528 0 %
9 Other 0 0 0 0 0 0 %
10 Total 6 1,439 1,295,036 670,256 624,780 0.16 %
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
 
No
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
14,550,590
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......
3
0
4
Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
28,906,840
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
40,146,390
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-11,239,550
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

9b

Yes

 
Part IV
Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)
(a) Name of entity (b) Description of primary
activity of entity
(c) Organization's
profit % or stock
ownership %
(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership %
(e) Physicians'
profit % or stock
ownership %
1Ivy Street Development Corp
 
Collection of Services & Rentals 100 % 0 % 0 %
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2015
Schedule H (Form 990) 2015
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest—see instructions)
How many hospital facilities did the organization operate during the tax year?1
Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital ResearchGrp Facility ER-24Hours ER-Other Other (Describe) Facility reporting group
1 Arnot Ogden Medical Center
600 Roe Avenue
Elmira,NY14905
www.arnothealth.org
0701000H
X X   X     X   Hospital with Open Emergency Room. A
2 Arnot Ogden Medical Center
Health Center for Women
600 Fitch Street
Elmira,NY14905
www.arnothealth.org
              X Hospital Extension Clinic - Diagnostic Radiology A
3 Arnot Ogden Medical Center
Horseheads Campus
100 John Rommelt Drive
Horseheads,NY14845
www.arnothealth.org
              X Clinical Laboratory Service & Radiology Diagnostic Outpatient. A
Schedule H (Form 990) 2015
Schedule H (Form 990) 2015
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
A
Name of hospital facility or letter of facility reporting group  
Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):
 
Yes No
Community Health Needs Assessment
1 Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................ 1   No
2 Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C............... 2   No
3 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12...................... 3 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20 15
5 In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted ................. 5 Yes  
6 a Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C.................................. 6a Yes  
b Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................ 6b Yes  
7 Did the hospital facility make its CHNA report widely available to the public?.............. 7 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............
8 Yes  
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20 15
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10 Yes  
a If "Yes" (list url): www.arnothealth.org
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b   No
11 Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.
12a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?............................... 12a   No
b If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2015
Schedule H (Form 990) 2015
Page 5
Part VFacility Information (continued)

Financial Assistance Policy (FAP)
A
Name of hospital facility or letter of facility reporting group  
Yes No
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13 Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care? 13 Yes  
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
b
c
d
e
f
g
h
14 Explained the basis for calculating amounts charged to patients?................. 14 Yes  
15 Explained the method for applying for financial assistance?................... 15 Yes  
If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):
a
b
c
d
e
16 Included measures to publicize the policy within the community served by the hospital facility?........ 16 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
www.arnothealth.org
b
www.arnothealth.org
c
d
e
f
g
h
i
Billing and Collections
17 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon non-payment?.................................. 17 Yes  
18 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:
a
b
c
d
e
Schedule H (Form 990) 2015
Schedule H (Form 990) 2015
Page 6
Part VFacility Information (continued)

A
Name of hospital facility or letter of facility reporting group  
Yes No
19 Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............ 19   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
20 Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.................. 21 Yes  
If "No," indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
22 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
23 During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ............................... 23   No
If "Yes," explain in Section C.
24 During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ........................... 24 Yes  
If "Yes," explain in Section C.
Schedule H (Form 990) 2015
Schedule H (Form 990) 2015
Page 7
Part V
Facility Information (continued)
Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16i, 18d, 19d, 20e, 21c, 21d, 22d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference Explanation
Schedule H, Part V, Section B, Line 5-Group A Arnot Health remains committed to preventing chronic disease in the community through free preventative health screenings, health promotion programs and wellness education. In 2015 Arnot Health participated in over 100 community events and served over 2,500 individuals in Chemung, Steuben and Schuyler Counties. Free health screenings included: blood pressure, blood glucose, diabetes risk assessment, stroke assessments, body fat analysis, body mass index, tobacco use screening, carboxyhemoglobin, and lung age. In addition to community outreach events Arnot Health serves populations at risk for developing chronic disease by offering free monthly health screenings in medically underserved locations such as soup kitchens and senior centers within a medically underserved area. Arnot Health Heart Vascular Institute also offers free weekly blood pressure screenings for the community. Community Health and outreach also includes working with local schools and summer programs to offer highly interactive educational programs on topics such as nutrition, sun safety, physical activity, injury prevention and tobacco use prevention. Arnot Health continues to serve on the Elmira City School District Wellness Committee and collaborated with the school district to develop new wellness policies that included healthier options in vending machines and increased physical activity during class time. Arnot Health continued to inform school officials on important health issues impacting the community and contributed topics for discussion at student forums and interactive community activities. Arnot Health collaborated with health and human service agencies to provide the Graduate Medical Education Residents with community rotations such as Arnot Health HIV Primary Care and Disease Management, Economic Opportunity Program Inc, Head Start Program, Comprehensive Interdisciplinary Developmental Services Inc, Chemung County Home Health Agency and Community Immunization Clinics. Arnot Health's Health Center for Women and the Falck Cancer Center includes working collaboratively with the New York State Cancer Services Program to provide free breast, cervical and colorectal screenings for the un/underinsured. Other cancer prevention strategies include annual skin cancer screenings and a lung cancer screening program for community members with a history of long term tobacco use. Falck Cancer Center offers a wide range of free monthly support groups for cancer survivors in the community. Arnot Health Diabetes Center provides diabetes education, support and management, and served over 350 community members in 2015. Other services provided by the Diabetes Center include insulin pump instruction and nutritional counseling. All diabetes education offered by Arnot Health is provided by Certified Diabetes Educators and is in accordance with the American Diabetes Association Standards of Care. Arnot Health has a leadership role in the multicounty Southern Tier Diabetes Coalition and in the planning and implementation of an annual Diabetes Fair in the fall of each year. In 2015 over 300 community members received diabetes prevention and management education and preventative health screenings. Education and screening opportunities included blood pressure, body fat and blood glucose screenings; foot care education; diabetes risk assessments; nutrition education meal planning and information on diabetes medications and equipment; and information about support groups and chronic disease self management classes. pneumovax and influenza vaccines were also provided. Arnot Health continues to collaborate with preventative health partners in Chemung and Steuben Counties and participates in the promotion and facilitation of evidence based programs such as the Chronic Disease Self Management Program, the Diabetes Self Management Program, and the National Diabetes Prevention Program, and Living Healthy workshops. Lower socioeconomic status is associated with an increased risk of smoking initiation and progression to regular smoking, and a decreased likelihood of successful smoking cessation. Arnot Health is working with local health departments and diverse multicounty partnerships to update the 2013 Community Health Needs Assessment, and engage community members in identifying public health priorities and unmet needs in the community. The process will be completed and an updated Community Health Improvement Plan will be available to the community in December 2016. The following are the obesity prevention strategies implemented and the accomplishments of the CHP partnership over the last five years. Arnot Health and the CHP partnership rehabilitated, maintained and promoted parks and recreation facilities in underserved residential areas to offer safe and accessible opportunities for physical activity for persons of all ages and abilities. CHP partners and the City of Elmira enhanced parks and playgrounds for children to make them safe and accessible in the following locations: McKinnon Park, Grove Park, Millers Pond Park, Eldridge Park, McCanns Park, Blandford Park, Pulaski Park, Quatrano Park, Frank Rhode Park, Woodlawn Playground, and Mark Twain Riverfront Park. CHP partnership worked to improve a seven mile stretch of the Lackawanna Rail Trail by installing a fitness station, solar lights and a informational kiosk with Get Active Elmira maps that were created by the partnership to highlight the 23 parks and playgrounds. Safety assessments of parks and playgrounds were conducted by organizations serving the developmentally disabled populations, seniors and the visually impaired. Other strategies implemented to promote safe access to open spaces for physical activity include installation of visual impact signage at parks, playgrounds, trails and street crossings, installation of video cameras, improved street lighting, installation of cross walks and ADA compliant curb cut outs and tactile ramps and speed reduction with playground warning signs for traffic. To increase access to fresh fruit and vegetables, the CHP partnership created community gardens and enhanced existing vegetable gardens by working with community planning boards, neighborhood associations, schools, persons with disabilities, and senior and low income housing developments. Provided schools and youth community centers with community gardens, installed a tool shed and provided gardening supplies to establish and maintain community gardens in underserved areas, supported the development of a community garden for persons with developmental disabilities and supported the Food Bank of the Southern Tier with fresh fruits and vegetables grown in the community gardens. Community Gardens were established or enhanced in the following locations: Near Westside Victorian Garden, Katy Leary Park, Quatrano Park, and Economic Opportunity Program at Ernie Davis Community Center, Woodlawn Community Garden and the Elmira City School District. Strategies implemented by restaurants and the CHP partnership to prevent obesity and educate the community about healthier eating choices include developing 3 different long running TV ads promoting healthy eating at restaurants, table top displays of eating out health tips for each partnering restaurant and distributed educational materials on healthy food options at community outreach events. Worked with hospital system to adopt Healthy Meeting policy and offer daily Well Being meals in the hospitals cafeterias for employees and the public. Examples of programs offered in 2015 include Community Walking Program, Fit Families of the Southern Tier, Strong Kids Safe Kids, Girls on the Run of the Southern Tier and the Wineglass Marathon. Participants in the free six week Step it Up Community Walking Program receive pre and post program health screenings and over the last five years have had consistent outcomes averaging: 65% reduction in blood pressure, 41% reduction in blood glucose, 69% reduction in weight, 71% reduction in body fat or BMI, 55% reported making healthier food choices as a result of the program. Arnot Health offers the FFIST Program for obese children and their families to teach children how to make healthier food choices, and increase their physical activity through fun activities such as games and active play. Children in the eight week FFIST program also receive pre and post program weight, BMI and strength and endurance fitness testing. As a result of the program, children have shown gains in strength and endurance, and report making healthier food choices. Arnot Health serves on the Chemung County Board of Health, the Community Services Board, the Healthcare Association of New York State Community Health Taskforce and the New York State Department of Health Community Health Needs Assessment Ad Hoc Group.
Schedule H, Part V, Section B, Line 6a-Group A Arnot Health is comprised of three hospitals: Arnot Ogden Medical Center and St. Joseph's Hospital in Elmira; and Ira Davenport Memorial Hospital in Bath, New York. Arnot Health provides diagnostic, ambulatory, secondary and tertiary acute care, as well as substance abuse, psychiatric, rehabilitative, and wellness services to meet the needs of residents in Chemung, Steuben, and Schuyler Counties in the Southern Tier of New York, and Bradford and Tioga Counties in the Northern Tier of Pennsylvania. Arnot Ogden Medical Center, located in Elmira, NY and founded in 1888, is a not-for-profit, 256-bed tertiary medical facility offering specialty services including, cardiovascular care, cancer care, women's health services, emergency medicine and surgical services. Ira Davenport Memorial Hospital, located in Bath, NY and founded in 1910, is a not-forprofit 38-bed acute care hospital offer ancillary services and emergency medicine. The campus also hosts a 120-bed skilled nursing facility, Taylor Health Center. St. Joseph's Hospital, located in Elmira, NY and founded in 1908 by the Sisters of St. Joseph of Rochester, New York, is a not-for-profit Catholic 79 acute care hospital specializing in orthopedic care, physical rehabilitation, geriatric medicine, behavioral science and alcohol rehabilitation. The campus also hosts a 111 bed skilled nursing facility. Arnot Medical Services is a multispecialty physician group associated with Arnot Health offering care throughout the Southern Tier of New York and Northern Tier of Pennsylvania in the areas of Cardiology, Cardiovascular Surgery, Endocrinology, ENT, Family Practice, Gastroenterology, Infectious Diseases, Internal Medicine, Nephrology, Neurology, Orthopedics, Pain Management, Rheumatology, Women's Health and Wound Care.
Schedule H, Part V, Section B, Line 6b-Group A In 2013, Arnot Health in collaboration with the Chemung County Health Department, Steuben County Public Health and a diverse community partnership conducted a comprehensive Community Health Needs Assessment (CHNA) to identify public health priorities in Chemung and Steuben Counties. The CHNA identified some overlapping areas of public health concerns in Chemung and Steuben Counties.
Schedule H, Part V, Section B, Line 7d-Group A Arnot Ogden Medical Center will use a variety of methods to disseminate the community Service Plan for Arnot Ogden Medical Center, St. Joseph's Hospital and Ira Davenport Memorial Hospital, and the CHIPs for Chemung and Steuben Counties: Web site documents will be posted on the healthcares system web site at the following URL: http://www.arnothealth.org/about us. Arnot Health developed a section of the system's web site dedicated to community outreach in 2016, budget permitting to bring community service work to a more prominent place within the website. This can be accessed at: https://www.arnothealth.org/community-service-plans. Partner web sites Chemung and Steuben counties will post links to their CHA and CHIP on their web sites. Presentations at Arnot Health's Community Health Department provide education about the healthcare system and community outreach strategies.
Schedule H, Part V, Section B, Line 11-Group A Arnot Health promotes and supports the health in the community in many ways. The system hosts a variety of programs and activities in their facilities to meet specific needs within the community, and donates meeting space for activities such as: Blood Drives, Cancer survivor support groups, Community lectures, health screenings and workshops, Melanoma Monday Skin Cancer Screenings, Maternal, Child Health Education and Breastfeeding Classes, Community lactation rooms , CPR classes, Alcoholics Anonymous meetings, Women's Narcotics Anonymous, Narcotics Anonymous, Community Interfaith Chaplaincy training programs, Suicide prevention trainings, Celiac Disease Support Group, Widow Support Group, Child Life Grief Support Program, Focus groups to gain insight on community needs, Annual MASH Camp for students interested in health professions, Osteopathic Medicine Manipulation Clinics, Healthy Kitchens Program, Amputee Support Group, Hip and Knee Seminars, Functional Assessment Workshops. In addition, Arnot Health aims to improve the health of the community through active participation and leadership in local, regional and state level preventative health coalitions and taskforces. Arnot Health serves on the Chemung County Board of Health, the Community Services Board, the Economic Opportunity Program Board, the Healthcare Association of New York State's (HANYS) Community Health Taskforce and the New York State Department of Health's (NYSDOH) Community Health Needs Assessment Ad Hoc Group. Arnot Health has a leadership role in the Southeastern region of the Finger Lakes Performing Provider System (FLPPS) and the planning and implementation of eleven DSRIP projects designed to meet the complex and challenging medical and social needs of the Medicaid population. Arnot Health's leadership in regional and state initiatives informs key stakeholders of the needs in our community and leverages a broad set of resources to meet those needs.
Schedule H, Part V, Section B, Line 20e-Group A Self pay collection staff review all prior accounts to check for commercial insurance or Medicaid that may need to be applied to current self pay accounts. These accounts are reviewed using the self pay worklist in the Sorian billing system. If insurance is located, the self pay collector must verify eligibility for the date of service. The self pay staff will change the health plan to the correct one for all covered dates of service and Arnot billing will submit claim or claims. If no insurance is located, confirm if a patient may have qualified for Medicaid. If Medicaid coverage is approved self pay staff will change the health plan to Medicaid for all covered dates of service and follow correct billing procedures. Self Pay collections staff attempt to collect the full balance due by check of credit card. If they are unable to make the full payment, self pay staff will attempt to make payment arrangements and to notify the patient about the Arnot Ogden Medical Center Community Care Program. If the patient wants to apply for the Community Care Program, the patient will be sent an application for the Community Care Program and will be informed of the documentation they will need to submit with the application. The self pay collectors document all activity in Sorian, and enter any necessary holds to support resolution. Self pay collections staff enters the payment plan and documents into Sorian. The payment plan statement is demanded and sent to the patient. If the patient does not enter into a payment plan agreement, or fails to pay as agreed, the account or accounts will go through the standard dunning and collection agency activity. See Guarantor Billing and Collections.
Schedule H, Part V, Section B, Line 22d-Group A FAP eligible patients receive a percentage discount either charges for the uninsured or patient responsibility for the insured.
Schedule H, Part V, Section B, Line 24-Group A Participants in the Medicare System are required to charge all patients the same amount regardless of insurance per the Medicare Participant Guidelines.
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2015
Schedule H (Form 990) 2015
Page 8
Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, from largest to smallest)
How many non-hospital health care facilities did the organization operate during the tax year?  
Name and address Type of Facility (describe)
1
2
3
4
5
6
7
8
9
10
Schedule H (Form 990) 2015
Schedule H (Form 990) 2015
Page 9
Part VI
Supplemental Information
Provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
Form and Line Reference Explanation
Schedule H, Part I, Line 6a Arnot Ogden Medical Center prepares the Community Benefit Report for three hospitals, Arnot Ogden Medical Center, St. Joseph's Hospital, both in Elmira, NY and also for Ira Davenport Memorial Hospital in Bath, NY.
Schedule H, Part I, Line 7 Arnot Ogden Medical Center uses a Cost to Charges ratio to calculate the Financial Assistance and Community Benefit Section. The Medical Center offers a variety of services to the community it serves as part of an integrated delivery system. It is necessary to financially subsidize some of these services as the revenue generated does not cover the cost of providing the services.
Schedule H, Part I, Line 7, Column f Arnot Ogden Medical Center excluded $14,550,590 in bad debt expense from the calculation.
Schedule H, Part II Arnot Ogden Medical Center provided the following screenings and educational programs to the community in 2015: Blood Glucose Screenings, Blood Pressure Screenings, Cancer Support Groups for Women, Cancer Community Support and Outreach, Skin Cancer Screenings, Childbirth and Breastfeeding Education Classes, Diabetes Education and Awareness, HIV Prevention and Education, Influenza Clinics, Pulmonary Function Screenings, Tobacco Cessation and Tobacco Cessation Carboxymeter Screenings, Transportation Support Services and Health Education Events. The hospital also particiated in Fit Families in the Southern Tier, Step It Up Walking Program, Strong Kids Safe Kids, Summer Cohesion Program, and Human Motion Institute Community Events.
Schedule H, Part III, Section A, Line 4 The Organization's allowance for doubtful accounts decreased from 11.1% of gross accounts receivable at December 31, 2014 to 10.5% of gross accounts receivable at December 31, 2015. In addition, the Organization's bad debt write-offs decreased from $22,828,514 for fiscal year 2014 to $14,550,590 in fiscal year 2015. The decrease in bad debt write-offs is to account for trends experienced in the collection of amounts from self-pay patients in fiscal year 2015. The Organization has not changed its charity care or uninsured discount policies during the fiscal year 2014 or 2015. The Organization does not maintain a material allowance for doubtful accounts from third party payors, not did it have significant write-offs from third party payors.
Schedule H, Part III, Section B, Line 8 Arnot Ogden Medical Center uses a Cost to Charges ratio for calculate the Financial Assistance and Community Benefit Section. The Medical Center offers a variety of services to the community it serves as part of an integrated delivery system. It is necessary to financially subsidize some of these services as the revenue generated does not cover the cost of providing the services.
Schedule H, Part III, Section C, Line 9b Self pay collection staff reviews any prior accounts to check for commercial insurance or Medicaid that may need to applied to current self pay accounts. These accounts are reviewed using the self pay worklist. If insurance is located, the self pay collector must verify eligibility for the dates of service. The self pay staff will change the health plan to the correct plan for all covered dates of service and Arnot billing will submit the claim or claims. If no insurance is located, confirm if a patient may have qualified for Medicaid. If Medicaid coverage is approved self pay staff will change the health plan to Medicaid for all covered dates of service and follow correct billing processes. Self Pay Collection Staff attempts to collect the full balance due by check or credit card. If they are unable to make the full payment, the self pay staff will attempt to make payment arrangements and to notify the patient about the Arnot Ogden Medical Center Community Care Program. If the patient wants to apply for the community care program, the patients will be sent an aplication for the community care program and will be informed of documentation they will need to submit with the application. The self pay collectors document all activity in Sorian, and enter any necessary hold to support resolution. Self pay collections staff enters the payment plan and document comments in Sorian. Payment plan statements are demanded and sent to the patient. If the patient does not enter into a payment plan agreement, or fails to pay as agreed, the account will go through the standard dunning and collection agency activity.
Schedule H, Part VI, Line 2 2015 Update to the Community Health Improvement Plan In 2013, Arnot Health in collaboration with the Chemung County Health Department, Steuben County Public Health and a diverse community partnership conducted a comprehensive Community Health Needs Assessment (CHNA) to identify public health priorities in Chemung and Steuben Counties. The CHNA identified some overlapping areas of public health concerns in Chemung and Steuben Counties. Chemung County Priority: Prevent Chronic Disease 1. Focus area: Reduce obesity in children and adults; and 2. Focus area: Reduce illness, disability, and death related to tobacco use and secondhand smoke exposure. Disparity: Reduce percentage of lower income individuals who smoke, including those with mental health and substance abuse issues. Steuben County Priority: Prevent Chronic Disease 1. Focus area: Reduce obesity in children and adults; and 2. Focus area: Reduce illness, disability and death related to heart disease and hypertension. Disparity: Promote tobacco cessation, especially among low socioeconomic populations and those with mental health illness. Over the last two years, Arnot Health and partners have been implementing and monitoring the effectiveness of the CHIP in Chemung and Steuben Counties. Since implementation of the 2013 CHIP, progress has been made in preventing chronic disease through strategies aimed at reducing obesity in children and adults, and reducing tobacco use. CHIP strategies to prevent chronic disease continued to focus on three key areas: 1) Health promotion activities to encourage healthy living and limit the onset of chronic diseases; 2) Early detection opportunities that include screening populations at risk; 3) Successful management strategies for existing diseases and related complications. Action plan strategies such as increasing physical activity, improving nutrition, and decreasing tobacco use from the core of the Preventing Chronic Diseases Action Plan for the New York State Prevention Agenda have been implemented (http://www.health.ny.gov/prevention/prevention_agenda/2013-2017/docs/prevent_chronic_diseases.pdf).
Schedule H, Part VI, Line 3 The Arnot Ogden Medical Center communicates our Community Care Program in the following ways: Signage in waiting rooms, brochures in waiting rooms and Admission Packets, notations on billing notices, staff education so they can share availability of program and contact information with patients. Communication and education of our Certified Application Counselor for patient insurance enrollment so they are informed of the program details and contact information. Communication of programs with collection agencies and collection attorneys so they can share the availability of the program and contact information with prospective enrollees. The information is also posted on our website at: www.arnothealth.org.
Schedule H, Part VI, Line 4 Arnot Health is comprised of three hospitals, Arnot Ogden Medical Center, St. Joseph's Hospital in Elmira, NY, and Ira Davenport Memorial Hospital in Bath, NY. Arnot Health provides diagnostic, ambulatory, secondary and tertiary acute care, as well as substance abuse, psychiatric, rehabilitative and wellness services to meet the needs of residents in Chemung, Steuben and Schuyler Counties in the Southern Tier of New York and Bradford and Tioga Counties in the Northern Tier of Pennsylvania. The distribution of patients from this service area, as measured by total patient encounters from system's hospitals is as follows: Chemung 65.0 percent, Steuben 21.0 percent, Schuyler 4.6 percent, Tioga 3.4, Bradford 2.9 percent and all other 3.0 percent.
Schedule H (Form 990) 2015
Additional Data


Software ID: 15000352
Software Version: v1.00
Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
SchJMediumBullet Attach to Form 990.
SchJMediumBullet Information about Schedule J (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2015
Open to Public Inspection
Name of the organization
ARNOT OGDEN MEDICAL CENTER
 
Employer identification number

16-0743905
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .........
1b
Yes
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked in line 1a? ..
2
Yes
 
3
Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
4
During the year, did any person listed on Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ................
4a
 
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
 
No
c
Participate in, or receive payment from, an equity-based compensation arrangement? .........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.
5
For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
No
b
Any related organization?
5b
 
No
If "Yes," on line 5a or 5b, describe in Part III.
6
For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization?
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," on line 6a or 6b, describe in Part III.
7
For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
Yes
 
8
Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2015

Schedule J (Form 990) 2015
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.
For each individual whose compensation must be reported on Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.
(A) Name and Title (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits
(E) Total of columns
(B)(i)-(D)
(F) Compensation in column(B) reported as deferred on prior Form 990
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
1Michael HoseyChairman of the Board (i)

(ii)
0
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
2Mark J HaganVice Chairman (i)

(ii)
0
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
3John R AlexanderSecretary (i)

(ii)
0
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
4Daniel J BurkeBoard Member (i)

(ii)
0
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
5Kathleen LuckeBoard Member (i)

(ii)
0
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
6David DalrympleBoard Member (i)

(ii)
0
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
7Richard SimonsBoard Member (i)

(ii)
0
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
8S Jan EberhardBoard Member (i)

(ii)
0
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
9Scott SpragueBoard Member (i)

(ii)
0
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
10Jan van den BlinkBoard Member (i)

(ii)
0
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
11Roy A KylesBoard Member (i)

(ii)
0
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
12Robert McNamaraBoard Member (i)

(ii)
0
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
13Mary Louise MitchellBoard Member (i)

(ii)
0
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
14Donald QuickBoard Member (i)

(ii)
0
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
15Melinda SartoriBoard Member (i)

(ii)
0
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
16Alan AngellBoard Member/Physician (i)

(ii)
437,674
-------------
0
62,569
-------------
0
0
-------------
0
0
-------------
0
30,433
-------------
0
530,676
-------------
0
0
-------------
0
17Roger SchenoneBoard Member/Physician (i)

(ii)
355,697
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
11,456
-------------
0
367,153
-------------
0
0
-------------
0
18Kevin OConnorBoard Member/Physician (i)

(ii)
317,649
-------------
0
102,925
-------------
0
0
-------------
0
0
-------------
0
36,826
-------------
0
457,400
-------------
0
0
-------------
0
19Robert LambertBoard Member/President (i)

(ii)
527,380
-------------
0
103,241
-------------
0
0
-------------
0
0
-------------
0
36,827
-------------
0
667,448
-------------
0
0
-------------
0
20Ronald J KintzSenior VP/CFO (i)

(ii)
331,952
-------------
0
60,516
-------------
0
0
-------------
0
0
-------------
0
36,827
-------------
0
429,295
-------------
0
0
-------------
0
21H Fred FarleyHospital President COO (i)

(ii)
353,789
-------------
0
40,550
-------------
0
0
-------------
0
0
-------------
0
36,827
-------------
0
431,166
-------------
0
0
-------------
0
22Nancy ODacreVP Strategic Planning (i)

(ii)
63,346
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
7,907
-------------
0
71,253
-------------
0
0
-------------
0
23James WatsonPresident IDMH (i)

(ii)
227,391
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
9,740
-------------
0
237,131
-------------
0
0
-------------
0
24Kenneth HerzlBetzSenior VP/Medical Affairs (i)

(ii)
303,141
-------------
0
3,600
-------------
0
0
-------------
0
0
-------------
0
26,744
-------------
0
333,485
-------------
0
0
-------------
0
25Roberto deBaraPresident AMS (i)

(ii)
293,868
-------------
0
125,000
-------------
0
0
-------------
0
0
-------------
0
14,038
-------------
0
432,906
-------------
0
0
-------------
0
26Vidyasagar MokureddyPain Mgmt Physician (i)

(ii)
869,325
-------------
0
60,536
-------------
0
0
-------------
0
0
-------------
0
32,666
-------------
0
962,527
-------------
0
0
-------------
0
27Bruno MazzaGastoentrologist (i)

(ii)
720,821
-------------
0
142,828
-------------
0
0
-------------
0
0
-------------
0
30,434
-------------
0
894,083
-------------
0
0
-------------
0
28Thomas BomanOrthopediac Surgeon (i)

(ii)
782,382
-------------
0
37,607
-------------
0
0
-------------
0
0
-------------
0
34,594
-------------
0
854,583
-------------
0
0
-------------
0
29Matthew BrandOrthopediac Surgeon (i)

(ii)
761,218
-------------
0
41,979
-------------
0
0
-------------
0
0
-------------
0
34,594
-------------
0
837,791
-------------
0
0
-------------
0
30Paul TinsleyENT Physician (i)

(ii)
730,383
-------------
0
26,894
-------------
0
0
-------------
0
0
-------------
0
30,918
-------------
0
788,195
-------------
0
0
-------------
0
Schedule J (Form 990) 2015

Schedule J (Form 990) 2015
Page 3
Part III
Supplemental Information
Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.
Return Reference Explanation
Schedule J, Part I, Line 1a The CEO and CFO have their dues paid at the Elmira Country Club. The personal use portion is reported under taxable income.
Schedule J, Part I, Line 3 Compensation for the President and Vice Presidents are set pursuant to a policy and compensation philosophy adopted by the Board of Directors. The Board has a compensation committee consisting of outside directors. 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 New York and Western Pennsylvania. The Compensation Committee recommends adjustments to the Executive Committee of the Board which reviews the recommendations and approves or disapproves without employees present in the room. This action then is reviewed with the entire Board in executive session.
Schedule J, Part I, Line 7 Officer compensation has a variable component based upon patient experience, quality, and efficiency. Physician compensation has a variable component based upon volume, quality and patient satisfaction scores.
Schedule J (Form 990) 2015
Additional Data


Software ID: 15000352
Software Version: v1.00
Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
SchKMediumBullet Attach to Form 990.

SchKMediumBulletInformation about Schedule K (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2015
Open to Public
Inspection
Name of the organization
ARNOT OGDEN MEDICAL CENTER
 
Employer identification number
16-0743905
Part I
Bond Issues
(a) Issuer name (b) Issuer EIN (c) CUSIP # (d) Date issued (e) Issue price (f) Description of purpose (g) Defeased (h) On
behalf of
issuer
(i) Pool
financing
Yes No Yes No Yes No
A Chemung County Industrial Developmental Agency
 
16-6209017 000164019 03-10-2004 19,912,203 Series A Construction Bond   X   X   X
B Chemung County Industrial Developmental Agency
 
16-6209017 000164019 03-10-2004 16,959,701 Series B Facility Renovation   X   X   X
C Chemung County Capital Resource Corp
 
61-1684035 000000000 06-25-2015 29,410,000 Payoff Series A & B Bonds/Energy Infrastructure Upgrade   X   X   X
Part II
Proceeds
A B C D
1 Amount of bonds retired .................. 19,912,203 16,959,701 588,200  
2 Amount of bonds legally defeased .............. 0 0 0  
3 Total proceeds of issue .................. 19,912,203 16,959,701 29,410,000  
4 Gross proceeds in reserve funds ............. 0 0 0  
5 Capitalized interest from proceeds ............. 0 4,561,742 0  
6 Proceeds in refunding escrows ............... 0 0 0  
7 Issuance costs from proceeds ............... 419,500 328,213 847,745  
8 Credit enhancement from proceeds ............. 0 0 0  
9 Working capital expenditures from proceeds ............. 1,802,477 0 0  
10 Capital expenditures from proceeds ............. 16,377,225 10,287,552 8,066,714  
11 Other spent proceeds ............. 0 0 0  
12 Other unspent proceeds ............. 0 0 1,280,128  
13 Year of substantial completion ............. 2006 2005 2015
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue? ....   X   X X      
15 Were the bonds issued as part of an advance refunding issue? .....   X X     X    
16 Has the final allocation of proceeds been made? .......... X   X   X      
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? .................. X   X   X      
Part III
Private Business Use
A B C D
Yes No Yes No Yes No Yes No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? .............   X   X   X    
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............   X   X   X    
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2015

Schedule K (Form 990) 2015
Page 2
Part III
Private Business Use (Continued)
A B C D
Yes No Yes No Yes No Yes No
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............   X   X   X    
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?                
c Are there any research agreements that may result in private business use of bond-financed property? .............   X   X   X    
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?                
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....SchKMediumBullet     0 %  
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government ......... SchKMediumBullet     0 %  
6 Total of lines 4 and 5 ............. 0 % 0 % 0 %  
7 Does the bond issue meet the private security or payment test? ... X   X   X      
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............   X   X   X    
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..        
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............                
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under
Regulations sections 1.141-12 and 1.145-2? ........
X   X   X      
Part IV
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ... X     X   X    
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......       X   X    
b Exception to rebate? ........       X   X    
c No rebate due? .........       X   X    
If "Yes" to line 2c, provide in Part VI the date the rebate
computation was performed ......
3 Is the bond issue a variable rate issue? .....   X   X X      
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?   X   X   X    
b Name of provider ..........  
 
 
 
 
 
 
 
c Term of hedge .........        
d Was the hedge superintegrated? ......                
e Was the hedge terminated? ........                
Schedule K (Form 990) 2015

Schedule K (Form 990) 2015
Page 3
Part IV
Arbitrage (Continued)
A B C D
Yes No Yes No Yes No Yes No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?   X   X   X    
b Name of provider ..........  
 
 
 
 
 
 
 
c Term of GIC .........        
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........                
6 Were any gross proceeds invested beyond an available temporary period?   X   X   X    
7 Has the organization established written procedures to monitor the requirements of section 148? ... X   X   X      
Part V
Procedures To Undertake Corrective Action
A B C D
Yes No Yes No Yes No Yes No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations? X   X   X      
Part VI
Supplemental Information. Provide additional information for responses to questions on Schedule K (see instructions).
Return Reference Explanation
Schedule K (Form 990) 2015

Additional Data


Software ID: 15000352
Software Version: v1.00

Schedule L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet Attach to Form 990 or Form 990-EZ.
MediumBulletInformation about Schedule L (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2015
Open to Public Inspection
Name of the organization
ARNOT OGDEN MEDICAL CENTER
 
Employer identification number

16-0743905
Part I
Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and 501(c)(29) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.
1(a) Name of disqualified person (b) Relationship between disqualified person and organization (c) Description of transaction (d) Corrected?
Yes No
2
Enter the amount of tax incurred by organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image$
 
3
Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ........ Bullet Image$
 

Part II
Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22
(a) Name of interested person (b) Relationship with organization (c) Purpose of loan (d) Loan to or from the organization? (e)Original principal amount (f)Balance due (g) In default? (h) Approved by board or committee? (i)Written agreement?
To From Yes No Yes No Yes No
Total ...............Small Bullet $  
Part III
Grants or Assistance Benefiting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of assistance (d) Type of assistance (e) Purpose of assistance
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 50056A
Schedule L (Form 990 or 990-EZ) 2015
Schedule L (Form 990 or 990-EZ) 2015
Page 2
Part IV
Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of transaction (d) Description of transaction (e) Sharing of organization's revenues?
Yes No
(1) David Dalrymple Board Member 1,255,396 Competitively Bid Loans & Investment Fees   No
Part V
Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).
Return Reference Explanation
Schedule L (Form 990 or 990-EZ) 2015


Additional Data


Software ID: 15000352
Software Version: v1.00




SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
MediumBullet Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2015
Open to Public
Inspection
Name of the organization
ARNOT OGDEN MEDICAL CENTER
 
Employer identification number

16-0743905
Return Reference Explanation
Form 990, Part VI, Section B, Line 11b Compensation for the President and Vice Presidents are set pursuant to a policy and compensation philosophy adopted by the Board of Directors. The Board has a Compensation Committee consisting of outside directors. 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 New York and Western Pennsylvania. 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 B, Line 12c All members of the Board of Directors, Officers and Management employees are required annually to file a Disclosure Statement setting forth any respect in which such a person, or any person associated with such person, has or may have any interest in a 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 has or may have a material financial transaction in excess of $10,000 with Arnot Health, Inc., or expect over the coming year, to receive an remuneration, other than salary if an employee, as a direct result of any business transaction with Arnot Health.
Form 990, Part VI, Section B, Line 15 Compensation for the President and Vice Presidents are set pursuant to a policy and compensation philosophy adopted by the Board of Directors. The Board has a Compensation Committee consisting of outside directors. 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 New York and Western Pennsylvania. 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 in executive session.
Form 990, Part VI, Section C, Line 18 Upon request the 990 Form is made available to the public and also via www.guidestar.com. Financial Statements are posted to the Electronic Municipal Market Access website
Form 990, Part VI, Section C, Line 19 Form 990, Part VI, Section C, Line 19 - Arnot Ogden Medical Center's Governing and Conflict of Interest Policies are available to the public upon request. The Financial Statements are available on Guide Star's website and also EMMA Bond Disclosure website and the 990 is available upon request.
Form 990, Part XI, Line 9 Pension charge to equity $3,133,150. Net assets released from restrictions $596,970. Net loss on temporarily restricted investments $(206,341). Donations to restricted investments $296,036. Change in net assets of foundation $641,498. CMN Fundraising revenue to income $(88,494).
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2015


Additional Data


Software ID: 15000352
Software Version: v1.00
SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBulletAttach to Form 990.
MediumBullet
Information about Schedule R (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047
2015
Open to Public Inspection
Name of the organization
ARNOT OGDEN MEDICAL CENTER
 
Employer identification number

16-0743905
Part I
Identification of Disregarded Entities Complete if the organization answered "Yes" on Form 990, Part IV, line 33.
(a)
Name, address, and EIN (if applicable) of disregarded entity


(b)
Primary activity


(c)
Legal domicile (state
or foreign country)

(d)
Total income


(e)
End-of-year assets


(f)
Direct controlling
entity











Part II
Identification of Related Tax-Exempt Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.
(a)
Name, address, and EIN of related organization


(b)
Primary activity


(c)
Legal domicile (state
or foreign country)

(d)
Exempt Code section


(e)
Public charity status
(if section 501(c)(3))

(f)
Direct controlling
entity

(g)
Section 512(b)(13) controlled entity?
Yes No
(1)Arnot Ogden Medical Center Foundation
Accounting Dept
600 Roe Avenue
Elmira,NY14905
16-1109472
Contribution Management NY 501(c)(3) 11B N/A
 
No
(2)Arnot Ogden Medical Center Auxiliary
600 Roe Avenue

Elmira,NY14905
51-0192902
Fund Raising NY 501(c)(3) 11B N/A
 
No
(3)Ira Davenport Memorial Hospital Inc
Accounting Dept
7571 State Route 54
Bath,NY14810
16-0835446
Affiliate NY 501(c)(3) 3 N/A
 
No
(4)Keuka Health Care Foundation
Accounting Dept
7571 State Route 54
Bath,NY14810
16-1461215
Affiliate NY 501(c)(3) 11B N/A
 
No
(5)St Josephs Hospital
Accounting Dept
555 St Josephs Blvd
Elmira,NY14901
16-0743163
Affiliate NY 501(c)(3) 3 N/A
 
No
(6)Arnot Health
600 Roe Avenue

Elmira,NY14845
45-3049405
Parent Organization NY 501(c)(3) 11B Arnot Ogden Medical Center
St Josephs Hospital
 
No


For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2015
Schedule R (Form 990) 2015
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.
(a)
Name, address, and EIN of
related organization



(b)
Primary activity




(c)
Legal
domicile
(state or foreign
country)


(d)
Direct controlling
entity



(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




(g)
Share of end-of-year
assets



(h)
Disproprtionate allocations?




(i)
Code V-UBI
amount in box 20 of
Schedule K-1
(Form 1065)
(j)
General or
managing
partner?



(k)
Percentage
ownership


Yes No Yes No












Part IV
Identification of Related Organizations Taxable as a Corporation or Trust Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.
(a)
Name, address, and EIN of
related organization
(b)
Primary activity
(c)
Legal
domicile
(state or foreign
country)
(d)
Direct controlling
entity
(e)
Type of entity
(C corp, S corp,
or trust)
(f)
Share of total income
(g)
Share of end-of-year
assets
(h)
Percentage
ownership
(i)
Section 512(b)(13) controlled entity?
Yes No
(1) Ivy Street Development Corporation

600 Ivy Street
Elmira,NY14905
16-1009245
Real Estate NY N/A
C 100 100 100 %    












Schedule R (Form 990) 2015
Schedule R (Form 990) 2015
Page 3
Part V
Transactions With Related Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.
Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity .....................
1a
 
No
b Gift, grant, or capital contribution to related organization(s) ............................
1b
 
No
c Gift, grant, or capital contribution from related organization(s) ............................
1c
Yes
 
d Loans or loan guarantees to or for related organization(s) ............................
1d
 
No
e Loans or loan guarantees by related organization(s) ............................
1e
 
No
f Dividends from related organization(s) ............................
1f
 
No
g Sale of assets to related organization(s) ............................
1g
 
No
h Purchase of assets from related organization(s) ............................
1h
 
No
i Exchange of assets with related organization(s) ............................
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) .......................
1j
Yes
 
k Lease of facilities, equipment, or other assets from related organization(s) ......................
1k
Yes
 
l Performance of services or membership or fundraising solicitations for related organization(s) .....................
1l
 
No
m Performance of services or membership or fundraising solicitations by related organization(s) .................
1m
Yes
 
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................
1n
Yes
 
o Sharing of paid employees with related organization(s) ............................
1o
Yes
 
p Reimbursement paid to related organization(s) for expenses ............................
1p
Yes
 
q Reimbursement paid by related organization(s) for expenses ............................
1q
Yes
 
r Other transfer of cash or property to related organization(s) ............................
1r
Yes
 
s Other transfer of cash or property from related organization(s) ............................
1s
Yes
 
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of related organization
(b)
Transaction
type (a-s)
(c)
Amount involved
(d)
Method of determining amount involved
(1) Arnot Ogden Medical Center Foundation

o 110,283 Arnot Ogden Medical Center provided paid employees to Arnot Ogden Medical Center Foundation to perform Accounting, Administrative and Materials Management functions. The method of determining the amount involved was cost.
(2) Ivy Street Development Corporation

o 22,660 Arnot Ogden Medical Center provided paid employees to Ivy Street Development Corporation to perform Accounting, Administrative and Property Management Services. The method of determining the amount involved was cost.
(3) Ivy Street Development Corporation

q 135,602 Arnot Ogden Medical Center was reimbursed by Ivy Street Development Corporation for Utilities, Maintenance and Insurance expenses. The method of determining the amount involved was cost.
(4) Ivy Street Development Corporation

k -641,746 Arnot Ogden Medical Center leased facilities from Ivy Street Development Corporation. The method of determining the amount involved was cost.
(5) Ira Davenport Memorial Hospital Inc

o 3,258,501 Arnot Ogden Medical Center provided paid employees to Ira Davenport Memorial Hospital to perform Accounting, Administrative and Management Information and various Medical Services. The method of determining the amount involved was cost.
(6) Keuka Health Care Foundation

o -11,602 Arnot Ogden Medical Center provided paid employees to Keuka Health Care Foundation to perform Accounting, Administrative functions. The method of determining the amount involved was cost.
(7) St Josephs Hospital

o 7,930,329 Arnot Ogden Medical Center provided paid employees to Ira Davenport Memorial Hospital to perform Accounting, Administrative and Management Information and various Medical Services. The method of determining the amount involved was cost.
(8) St Josephs Hospital

o -93,407 St. Joseph's Hospital provided paid employees to Arnot Ogden Medical Center to perform Environmental and Pastoral services. The method of determining the amount involved was cost.
Schedule R (Form 990) 2015
Schedule R (Form 990) 2015
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 37.
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity
(b)
Primary activity
(c)
Legal domicile
(state or foreign
country)
(d)
Predominant income (related, unrelated, excluded from tax under sections 512-514)

(e)
Are all partners
section
501(c)(3)
organizations?
(f)
Share of total income




(g)
Share of
end-of-year
assets
(h)
Disproprtionate allocations?
(i)
Code V-UBI
amount in box 20
of Schedule K-1
(Form 1065)
(j)
General or
managing
partner?
(k)
Percentage
ownership


Yes No Yes No Yes No






























Schedule R (Form 990) 2015
Schedule R (Form 990) 2015
Page 5
Part VII
Supplemental Information
Provide additional information for responses to questions on Schedule R (see instructions).
Return Reference Explanation
Schedule R (Form 990) 2015

Additional Data


Software ID: 15000352
Software Version: v1.00






TY 2015 ReasonableCauseExplanation
Name:
ARNOT OGDEN MEDICAL CENTER
EIN:
16-0743905
Software ID:
15000352
Software Version:
v1.00
Explanation:
Arnot Ogden Medical Center was granted a second extension until 11/15/2016.