2018-11-12T13:35:24-06:00 2017-12-31 ERNST & YOUNG US LLP 5 TIMES SQUARE NEW YORK NY 10036 990 2017-01-01 131740119 MONTEFIORE NYACK HOSPITAL formerly known as The Nyack Hospital % RONALD RATIGAN MONT 8453486522 160 NORTH MIDLAND AVENUE NYACK NY 109601912 JOHN BURKE VP & CFO 8453482107 2018-11-08 true CHRISTOPHER B BOGGS P00032493 2127733000 164.57.159.254 26308520183165000014 2018-11-12 P 24558E047A149CE0743DDA4F89040DC2FD5B7974 D7645E384763AEB8339B885771554B833BC3ADBE 2017 2019-02-21 02:37:17Z MARK GELLER MD 160 NORTH MIDLAND AVENUE NYACK NY 109601912 252357677 false X NYACKHOSPITAL.ORG X 1895 NY TO PROVIDE COMPETENT, INNOVATIVE AND ACCESSIBLE EMERGENCY AND ACUTE CARE SERVICES FOR THE RESIDENTS OF ROCKLAND COUNTY AND SURROUNDING AREAS. 27 23 1879 118 0 0 5198767 17007442 225625195 233013018 361560 521510 2493201 1763905 233678723 252305875 0 0 0 0 137134365 145164938 0 0 0 106325267 117868393 243459632 263033331 -9780909 -10727456 106535657 106061504 87072690 96576588 19462967 9484916 TO PROVIDE COMPETENT, INNOVATIVE AND ACCESSIBLE EMERGENCY AND ACUTE CARE SERVICES TO THE RESIDENTS OF ROCKLAND COUNTY AND SURROUNDING AREAS. WE ARE CARING PEOPLE OPERATING AN EXTRAORDINARY COMMUNITY HOSPITAL. false false 225104133 0 233013018 Montefiore NYACK HOSPITAL IS a 375-bed community acute care medical and surgical hospital that is affiliated with the Montefiore Health System. Montefiore Nyack Hospital is COMMITTED TO MEETING THE HEALTH CARE NEEDS OF THE RESIDENTS OF ROCKLAND COUNTY, NEW YORK AND OTHER SURROUNDING AREAS and is DEDICATED TO PROVIDING THE HIGHEST QUALITY HEALTHCARE SERVICES TO THE COMMUNITY. The hospital provides a robust list of both inpatient and outpatient services including addiction services, bariatric, behavioral health, joint replacement, pain management, Wound care, Sleep Medicine, Home care and much more. We offer Centers of excellence that include the Breast Center, delivering Comprehensive cancer care close to home, and the trauma center, allowing first responders to communicate in real-time with the trauma team so they can prepare quickly and efficiently for incoming patients. Montefiore Nyack Hospital runs an emergency department that provides high-quality emergency care 24 hours a day in addition to other ambulatory services. The emergency Department at Nyack Hospital is one of the nation's best for safety, quality of care, efficiency and patient satisfaction and is a designated Area Trauma Center. Our 30-minute ER service standard assures that all patients are seen by a professional, caring health care provider within 30 minutes of their arrival. The ER department prides ourselves as being a "senior-friendly"child-friendly" facility with experts who know how to care for the needs of these special patients. We are also adept at caring for the unique needs of individuals requiring special accommodations for size and mental health needs. Montefiore Nyack hospital has received numerous awards and accreditations for meeting or exceeding rigorous standards set forth by various private, state and federal agencies. Among the honors are The Joint commission Gold seal of approval for hip and knee joint replacement, Breast Imaging Center of Excellent designation, American College of Surgeons outstanding achievement award, among others. Montefiore Nyack Hospital has also been designated as a New York state stroke center, area trauma center and Level II special care nursery. Montefiore Nyack Hospital offers many events, classes and support groups to enrich the lives of our neighbors. Some support groups and classes offered are: living with MS, Lose to Win, Diabetes and Cancer support groups, Yoga for Cancer and MS patients, Look Good feel better workshops, Food addicts in Recovery anonymous and maternity and childbirth educational programs. During 2017, Montefiore Nyack Hospital had 12,887 patient discharges that included 1,598 newborns and 50,870 emergency department visits among other ambulatory services. 225104133 true true false true false false false false false true true false false false true false false true false false false false false false false false true true false false true false false false false false false false false false false false false false true true true false false true 151 0 true 1879 true false false false false false false false false false false X 27 23 false false true false true true true true true false false true true true true true true true true false NY X RONALD RATIGAN 8453486522 160 NORTH MIDLAND AVENUE NYACK NY 109601912 MARISA S BARBIERI BOARD MEMBER (Resigned 3/2017) 1.0 0.0 X 0 0 0 MITCHELL COHN MD BOARD MEMBER (Resigned 3/2017) 1.0 1.0 X 0 0 0 HOWARD J FELDFOGEL DO BOARD MEMBER 1.0 0.0 X 0 0 0 MARK GELLER MD PRESIDENT & CEO 49.0 1.0 X X 901057 0 57210 JAMES K GERSTLEY MD BOARD MEMBER (Resigned 3/2017) 1.0 0.0 X 0 0 0 RICHARD A GOLDMAN Vice Chair 1.0 0.0 X X 0 0 0 SUSAN GREEN-LORENZEN RN Board Member 1.0 59.0 X 0 3344342 41544 KEVIN HOBBS BOARD MEMBER (Resigned 3/2017) 1.0 0.0 X 0 0 0 THOM KLEINER Secretary 1.0 0.0 X X 0 0 0 RICHARD KOHLHAUSEN CHAIRMAN 1.0 0.0 X X 0 0 0 JEFFREY LUBATKIN BOARD MEMBER 1.0 0.0 X 0 0 0 MICHAEL MAHON BOARD MEMBER 1.0 0.0 X 0 0 0 JOHN MECCHELLA VICE CHAIR (Resigned 3/2017) 1.0 0.0 X X 0 0 0 JEFFREY MENKES Board Member 1.0 59.0 X 0 1099916 17000 ENRIQUE PABON BOARD MEMBER (Resigned 3/2017) 1.0 0.0 X 0 0 0 JOEL A PERLMAN Board Member 1.0 0.0 X 0 500700 43294 ROGER RAICHELSON MD BOARD MEMBER 1.0 1.0 X 0 0 0 LAWRENCE SIMON MD BOARD MEMBER 1.0 0.0 X 0 0 0 WILLIAM SHUM BOARD MEMBER (Resigned 3/2017) 1.0 0.0 X 0 0 0 WILLIAM M TRUST JR BOARD MEMBER 1.0 0.0 X 0 0 0 ROBERT W VAN CURA Vice Chair 1.0 0.0 X X 0 0 0 GERALD C WALSH BOARD MEMBER 1.0 0.0 X 0 0 0 Vincent Abbatecola Board Member 1.0 0.0 X 0 0 0 David Dwyer board member 1.0 0.0 X 0 0 0 Paul Adler Esq Board Member 1.0 1.0 X 0 0 0 Hector May Board Member 1.0 0.0 X 0 0 0 Guillermo Rosa Board Member 1.0 0.0 X 0 0 0 Steven Silverstein Board Member 1.0 0.0 X 0 0 0 Robert Van Pelt Board Member 1.0 0.0 X 0 0 0 Raja Amar Board Member (effect 6/16/17) 1.0 0.0 X 0 0 0 Merna Binns Board Member (Effect 6/16/17) 1.0 0.0 X 0 0 0 Tanya Drake RN Board Member (Effect 6/16/17) 1.0 0.0 X 0 0 0 Jason Fond MD Board Member (effect 6/16/17) 1.0 0.0 X 0 0 0 Dennis Troy Board Member (Effect 6/16/17) 1.0 0.0 X 0 0 0 MARY K SHINICK ASSISTANT SECRETARY/VP HR 50.0 0.0 X 384203 0 42949 JOHN S BURKE VP & CFO 49.0 1.0 X 559511 0 49070 JOHN VOLANTO VP & COO 50.0 0.0 X 456661 0 43034 Anthony Matejicka MD VP & Medical Director 50.0 0.0 X 613692 0 53809 Kathy Lunney Chief Nursing Officer 50.0 0.0 X 201670 0 1530 GREGORY GWOZDZ RN REGISTERED NURSE 40.0 0.0 X 250524 0 22761 RONALD RATIGAN DIRECTOR OF FINANCE 40.0 0.0 X 203358 0 49528 JOSEPH VITTORIO MD MEDICAL DIRECTOR RECOVERY CTR 40.0 0.0 X 198919 0 13877 Michael Miksad Director of Plant & Facilities 40.0 0.0 X 206508 0 36277 Mark Scher MD Medical Director 40.0 0.0 X 371919 0 44270 4348022 4944958 516153 286 false true false Hudson Center for Women 258 High Avenue NYACK NY 10960 Obstetric MD Svcs 1902940 Inpatient Medical Associates of NY 7032 Collection Center Drive CHICAGO IL 60693 Emergency MD Svcs 1728800 Nyack Emergency Medical Associates 7032 Collection Center Drive CHICAGO IL 60693 Inpatient MD svcs 1363982 Horizon Health PO Box 840839 DALLAS TX 75284 Behavioral Hlth Mgmt 1254637 Med-Metrix LLC 9 Entin Road PARSIPPANY NJ 07054 Consulting Services 548162 20 878942 16031032 97468 17007442 PATIENT SERVICE REVENUE 622110 229857825 229857825 0 0 OTHER HEALTHCARE RELATED SERVICES 621999 3155193 3155193 0 0 233013018 521510 0 0 521510 0 0 204536 51802 152734 0 152734 0 0 152734 0 0 0 0 0 0 0 0 0 0 CAFETERIA 722514 778505 0 0 778505 INTERCOMPANY ADMINISTRATION FEES 561000 380524 0 380524 PURCHASE DISCOUNT 900099 179027 0 179027 273115 0 0 273115 1611171 252305875 233013018 0 2285415 0 0 0 0 3364396 870701 2493695 0 0 105508141 94757458 10750683 0 4653836 4142990 510846 0 23722558 20986275 2736283 0 7916007 6964838 951169 0 7629992 7290729 339263 0 3195655 2587242 608413 0 352604 0 352604 0 0 0 0 20223571 18019446 2204125 0 561176 200 560976 0 7365529 6532120 833409 0 3617025 0 3617025 0 0 5496838 5365266 131572 0 218662 208348 10314 0 0 117074 82621 34453 0 939320 929882 9438 0 0 7258597 6238038 1020559 0 1044988 979394 65594 MEDICAL SUPPLIES 38407988 38407988 0 0 INTERCOMP SHARED SERVICES 9876088 0 9876088 0 PHYSICIAN PRACTICES LOSSES 8364360 8364360 0 0 INTERCOMP MEMBERSHIP DUES 800004 0 800004 0 2398922 2376237 22685 263033331 225104133 37929198 0 0 2550 1054158 610964 0 0 33845762 35322370 0 0 0 0 0 0 3707550 3999961 337940 361925 83686624 27062829 57434979 56623795 0 289153 0 0 0 0 4229000 4229000 5926268 4621786 106535657 106061504 42875585 45729437 0 0 1779752 1726254 0 0 0 0 0 0 13666557 14188824 0 0 28750796 34932073 87072690 96576588 X 19243468 9265417 0 0 219499 219499 19462967 9484916 106535657 106061504 X -10727456 749405 X false true X true false X false false false false false false false false true 10611 10611 SCHEDULE C, PART II-B, Line 1I The hospital's lobbying expenditures are a percentage of the membership dues paid to LOCAL 1199 - HEALTHCARE EDUCATION PROJECT (HEP), THE HEALTHCARE ASSOCIATION OF NEW YORK STATE (HANYS) AND THE HOMECARE ASSOCIATION OF NYS (HCA) that are used for lobbying efforts by these organizations. 219499 219499 219499 219499 219499 219499 219499 219499 219499 219499 0.00000 1.00000 0.00000 false false 5150000 5150000 47339119 5052538 42286581 67920 0 67920 23649893 20058619 3591274 7479692 1951672 5528020 56623795 0 ACCRUED POST RETIREMENT BENEFITS 221400 MALPRACTICE INSURANCE LIABILITIES 10700000 PENSION LIABILILTIES 8343728 THIRD PARTY LIABILITIES 1575931 DUE TO AFFILIATES 11411804 EST INSURANCE CLAIMS LIABILITIES 1900000 ASSET RETIREMENT OBLIGATION 779210 34932073 SCHEDULE D, PART V, LINE 4 INTENDED USES OF ENDOWMENT FUND: THE INTENDED USE OF THE HOSPITALS'S ENDOWMENT IS TO PROVIDE FUNDS TO BE USED FOR INDIGENT CARE BREAST HEALTH. true true X true X true X true true true false true true 9156367 2956926 6199441 0.02360 64422567 44196123 20226444 0.07690 73578934 47153049 26425885 0.10050 286824 27069 259765 0.00100 28490939 17591221 10899718 0.04140 28777763 17618290 11159483 0.04240 102356697 64771339 37585368 0.14290 false 1819781 0 61420842 73572291 -12151449 X true true 1 1 Montefiore Nyack Hospital 160 North Midland Ave Nyack NY 10960 http://www.nyackhospital.org/ 4324000H X X X Nyack Hospital 1 false false true X X X X X X X X X 16 true false false true X See Part V - Section C X true 16 true See Part V - Section C false true X 100 400. X X true true X X X true X See Part V - Section C X See Part V - Section C X See Part V - Section C X X X X X X true X false X X X X true X false false Schedule H, PART V, Section B, LINE 5 In 2014, a community needs assessment titled "One Region, One CNA" was conducted by Montefiore Health System, of which Montefiore Nyack Hospital is affiliated, in collaboration with other participating provider systems in the Hudson Valley region, as part of the Delivery System Reform Incentive Payment Program (DSRIP). Rockland County Department of Health (RCDOH) prepared a Community Health Needs Assessment and Community Health Improvement Plan 2014-2017. RCDOH reviewed the health status of the county, current health-related programs addressing the identified needs of their residents, and defined focus areas that align with the New York State Prevention Agenda. During 2016, Montefiore Nyack Hospital worked closely with the local Health Department in identifying the Prevention Agenda Priorities. Montefiore Nyack Hospital is an active member of the Rockland County Healthcare Priorities Committee, which represents 22 community organizations throughout the county. This group meets monthly with its primary objective being to define health care priorities for Rockland County that align with New York State Prevention Agenda Priorites. The Patient and Community Education Department at the hospital also used feedback from its lecture series, website and telephone contacts to identify health concerns of the public. Diabetes, pre-diabetes, cancer, obesity, maternal and infant care, and heart disease was found to be the public main concerns. Schedule H, Part V, Section B, Line 7a The Hospital's CHNA report in available at the direct website: https://www.montefiorenyack.org/sites/default/files/2016-2018_CommunitySer vicePlan.pdf vicePlan.pdf Schedule H, Part V, Section B, Line 10A The hospital's most recently adopted implementation strategy is posted on the website: https://www.montefiorenyack.org/sites/default/files/2016-2018_CommunitySer vicePlan.pdf Schedule H, Part V, Section B, Line 11 The New York State prevention agenda topics identified by the most recent CHNA are being addressed by Montefiore Nyack Hospital. The two priority areas identified that align with the Rockland County Department of Health, New York State Prevention Agenda and the Montefiore's Hudson Valley Collaborative DSRIP were to Prevent Chronic Disease and Promote Healthy Women, Infants and Children. Preventing Chronic disease is one priority area with the focus of increase access to high quality chronic disease preventive care and management in both clinical and community settings. Montefiore Nyack Hospital conducts several programs that address this priority to reduce cardiovascular disease by reducing obesity and preventing diabetes. Our Cancer Center is targeting colorectal cancer screening for the high risk population of Latino men, 50 to 75 years in age. The New York State Prevention Agenda Dashboard reflects Rockland's County's overall colorectal cancer screening rate at 71.4% based on NYS Expanded Behavioral Risk Factor Surveillance System. However, the Village of Haverstraw, West Haverstraw, and Spring Valley have been identified as areas where according to published data, the screening rate may be as low as 57% for these areas. New York State Prevention Agenda 2016-2018 goal is to increase the percentage of adults 50 to 75 years who receive a colorectal cancer screening based on the most recent guidelines by 5% or 71%. This is aligned with Healthy People 2020 target of 70.6%. Montefiore Nyack Hospital has joined the American Cancer Society's initiative "80% by 2018". Montefiore Nyack Hospital is joining forces with the Cancer Services Program in setting up this screening program. Under the second priority area Promoting healthy women, infants and children, The New York State's Prevention Agenda Dashboard reflects Rockland County's percentage of infants exclusively breastfed in the hospital at 45.4%. In January of 2016, the percentage of women exclusively breastfeeding in the hospital was 14%. Best practices employed by Nyack includes implementing "Ten Steps to Successful Breastfeeding" a WHO/UNICEF initiative with a specific focus on Skin to skin practice and promoting rooming-in exclusivity in the overnight hours. Scripting suggestions were provided to staff for patient education to handle requests for routine formula supplementation to dissuade this practice. Policies were reviewed to clarify RN role in promoting exclusive breastfeeding while hospitalized and to continue for at least the first six months of life. Within 10 months, the rate for exclusively breastfeeding while hospitalized had risen to 28%. The breast center at Montefiore Nyack Hospital continues to offer comprehensive services to women of Rockland County. The Breast Center promotes self-breast and bone-health awareness for both women and men and provides screening for breast and cervical cancer for uninsured and underinsured women and men. Schedule H, Part V, Section B, Line 13H Family size is factored into the eligibility criteria for financial assistance. Schedule H, Part V, Section B, Lines 16a - 16c The hospital's Financial aid policy, application and summary is available on the website: https://www.montefiorenyack.org/financial-aid-policy Schedule H, Part V, Section B, Line 22 The hospital determines the maximum amount that can be charged to FAP-eligible individuals for emergency or other medically necessary care based on the type of service rendered. THE MEDICAID DRG RATE is used for admissions while the MEDICARE APC RATE is used for ambulatory services. 1. Part I, Line 7 The cost-to charge ratio methodology was utilized to calculate the amount included in the table. The calculation of this ratio was derived from ratio of patient care cost-to-charge. 1. Part III, Lines 2 The cost of bad debt expense is estimated based on the bad debt provision at charge, applied to the ratio of total patient care expense to total charges for all services rendered. Any payments or discounts are excluded from bad debt expense. 1. Part III, Lines 4 As Reported in Montefiore Nyack Hospital and Subsidiaries audited financial statements: Bad debt expense is described as follows: "Patient accounts receivable result from the health care services provided by the Hospital. Additions to the allowance for doubtful accounts result from the provision for bad debts. Accounts written off as uncollectible are deducted from the allowance for doubtful accounts. The amount of the allowance for doubtful accounts is based upon managements assessment of historical and expected net collections, business and economic conditions, trends in Medicare and Medicaid health care coverage and other collection indicators". "For receivables associated with self-pay patients which include both patients without insurance and patients with deductible and copayment balances due for which third-party coverage exists for part of the bill, the Hospital records a significant provision for bad debts in the period of service on the basis of its past experience, which indicates that many patients are unable or unwilling to pay the portion of their bill for which they are financially responsible. The difference between discounted rates and the amounts actually collected after all reasonable collection efforts have been exhausted is charged off against the allowance for doubtful accounts". 1. Part III, LIne 8 THE AMOUNT REPORTED ON LINE 6 WAS DERIVED USING THE MEDICARE ALLOWABLE COSTS AS REPORTED ON THE HOSPITAL'S NEW YORK STATE INSTITUTIONAL COST REPORT. The Medicare Shortfall should be considered a community benefit, since the organization is rendering much needed health services to a population, for the most part, that is poor with limited means. Over time, The medicare reimbursement has not kept pace with rising medicare costs thus shifting the burden for the difference to the organization for services rendered mainly to a frail, elderly population that has great health needs. 1. Part III, Section C, Line 9B For patients who are known to qualify for financial assistance, all collection activity is halted and the patient is referred for financial aid. If an account is in collection and the patient requests financial aid or if the agency determines that the patient is eligible for financial assistance, the account is referred back to the medical center where the patient is provided assistance with completing an application for assistance. 2. Needs Assessment Montefiore Nyack Hospital assesses community needs by working closely with the local health department as well as community partners. Montefiore Nyack Hospital is an active member of the Rockland County Healthcare Priorities Committee, which represents 22 community organization throughout the county. The group meets monthly to set health care priorities for Rockland County. Montefiore Health System, of which Nyack Hospital is affiliated, conducted a community needs assessment titled "One Region, One CNA" in collaboration with other participating provider systems in the Hudson Valley region, as part of the Delivery system reform incentive payment program (DSRIP). Community surveys were conducted as part of the "One Region, One CNA". Additionally, the Patient and Community Education Department at the hospital identify concerns from the public based on feedback it receives from lectures, public contact via the hospital website and phone conversations. 3. Patient Education of Eligibility for Assistance All intake, registration and collection staff is trained on the hospital's financial aid policy and how to provide patients with assistance. Montefiore Nyack Hospital has a policy that establishes guidelines for the billing office to follow when working with individuals who are having difficulty paying their medical bills. If a referral is made to the hospital's Financial aid office, the patient will be assisted in completing an application for financial assistance. The hospital makes it financial aid policy known to the public by providing all patients information regarding the hospital's charity care policy. The brochures are available in several languages and are posted on the hospital's website and distributed to the Rockland County Public Health Priorities Committee and health-related events in the community. 4. Community Information Montefiore Nyack Hospital's primary service area is Rockland County. For purposes of community/local health planning, Montefiore Nyack Hospital defines its total service area as all of Rockland, Westchester, Orange, and Putnam counties. Rockland county is located 30 miles north of Manhattan, and is comprised of 115,000 acres with more than 35,000 acres of preserved open space and parklands. The United States census Bureau estimated Rockland County's 2015 population at 326,037, representing a 4.6% increase in population from 2010. The county's population is 51% female, 77.5% white, 13.2% black, 17.4% Hispanic and 6.7% Asian. 21.7% of the residents are foreign-born and 37.6% of the population speaks a language other than English at home. Rockland County's population is growing and this trend is projected to continue over the next three decades. However, despite a growing aging population, the overall mortality rate in the county has decreased, suggesting a continued improvement of the overall health of Rockland's population. Heart disease and cancer remain the leading causes of death in the county. Rockland County ranked #3 for health outcomes in New York State County Health Rankings in 2016. This category is based on an equal weighting of length and quality of life. Rockland County ranked #8 for health factors, based on weighted scores for health behaviors, clinical care, social and economic factors and the physical environment. In both need assessments, certain geographical locations were identified as at risk for a variety of health issues and identifies as hot spots for health improvements. These locations include Spring Valley and Haverstraw both identified as medically underserved areas according to criteria used in the assessment. 5. Promotion of Community Health Montefiore Nyack Hospital promotes community health in a various of ways. The hospital's Community health and Education Department responds to requests from the community for lectures and blood pressure screenings. Recently various health fairs/lectures were conducted for the following organizations located throughout the service area: Heart Day by Montefiore Hospital, Teddy Bear Hospital at RCC, Diabetes Symposium, RP Connor Fit Day, Redeeming Lord Christian Center, Nice Pak Safety, VISIONS, Senator Carlucci's Senior Awareness Event, Montebello Health Fair and St Thomas Aquinas College. The Breast Center at Montefiore Nyack Hospital continues to offer comprehensive services to women of Rockland County. The breast center promotes self-breast and bone-health awareness for both women and men and provides screenings for breast and cervical cancer for uninsured and underinsured women and men. In addition, the Breast Center provides public education through lectures, health fairs, and other venues throughout the county. The Behavioral Health Centers at Montefiore Nyack Hospital provides community outreach programs that includes educating general practitioners in discussing availability of mental health services to their patients, raising awareness of mental health issues in the community and taking steps to reduce the stigma, shame and barriers in seeking help. Montifiore Nyack Hospital provides screening tools and resources for depression awareness and suicide assessment. Promoting Mental Health awareness and information on seeking help is also provided at health fairs and schools throughout our community. A focus is on disseminating information on the B4Stage4 Program, an anonymous, free, and confidential screening to start a conversation with a primary care provider or a trusted friend and begin to plan a course of action for addressing mental health. Other community health programs includes the AADE Diabetes self-management training program, the diabetes self-management training program for the blind, the lose to win program to combat obesity, among others. 6. Affiliated Health Care Montefiore Nyack Hospital is an affiliate of Montefiore Health System, Inc. The health system is a leader in community health and has a long standing history of developing innovative approaches to care and creating programs to best serve the changing needs of its community. These include, but are not limited to the following: Community service plan, community service strategy, accountable care organization, patient-centered medical home, disease management programs and community outreach. The integration of these innovative approaches supports the Health System well in its provision of service to the community. 7. State Filing of Community Benefit report Montefiore Nyack Hospital files a community service plan with the State of New York. X X X X X X true true false false false false false false false MARK GELLER MD PRESIDENT & CEO 897445 0 0 0 3612 0 16200 0 41010 0 958267 0 0 0 SUSAN GREEN-LORENZEN RN Board Member 0 812981 0 346285 0 2185076 0 17000 0 24544 0 3385886 0 1462485 JEFFREY MENKES Board Member 0 509100 0 160400 0 430416 0 17000 0 0 0 1116916 0 127561 JOEL A PERLMAN Board Member 0 0 0 0 0 500700 0 17000 0 26294 0 543994 0 0 MARY K SHINICK ASSISTANT SECRETARY/VP HR 373324 0 0 0 10879 0 16200 0 26749 0 427152 0 0 0 JOHN S BURKE VP & CFO 557635 0 0 0 1876 0 8100 0 40970 0 608581 0 0 0 JOHN VOLANTO VP & COO 448454 0 0 0 8207 0 16200 0 26834 0 499695 0 0 0 GREGORY GWOZDZ RN REGISTERED NURSE 250524 0 0 0 0 0 6048 0 16713 0 273285 0 0 0 RONALD RATIGAN DIRECTOR OF FINANCE 202038 0 0 0 1320 0 12205 0 37323 0 252886 0 0 0 JOSEPH VITTORIO MD MEDICAL DIRECTOR RECOVERY CTR 197644 0 0 0 1275 0 11862 0 2015 0 212796 0 0 0 Michael Miksad Director of Plant & Facilities 205243 0 0 0 1265 0 11816 0 24461 0 242785 0 0 0 Anthony Matejicka MD VP & Medical Director 612432 0 0 0 1260 0 12808 0 41001 0 667501 0 0 0 Kathy Lunney Chief Nursing Officer 197674 0 0 0 3996 0 0 0 1530 0 203200 0 0 0 Mark Scher MD Medical Director 365701 0 0 0 6218 0 6750 0 37520 0 416189 0 0 0 SCHEDULE J, PART I, LINE 4a Joel Perlman, a former officer, was paid severance by a related organization in the amount of $497,770. SCHEDULE J, PART I, LINE 4b & Part II, Columns B(III) & (c) Supplemental Executive Retirement plan accrued and unpaid service cost provided by a related organization to a Board members and reflected in Part II, column (C) of Schedule J for his reportable compensation: Jeffrey Menkes - $406,366. Pooled Supplemental executive retirement plan distribution based on multiple years of service to a related organization paid to a Board member by a related organization and reflected in Part II, Column (B)(iii) of Schedule J for her reportable compensation: Susan Green-Lorenzen, R.N. - $2,163,042. $1,462,485 of this amount was reported in column (C) as deferred compensation on prior Form 990. This compensation benefit was reviewed and approved by the related organization's COMPENSATION COMMITTEE that oversees ALL FORMS OF COMPENSATION AND BENEFITS PROVIDED TO EACH EXECUTIVE WITH THE ASSISTANCE OF A NATIONAL INDEPENDENT COMPENSATION CONSULTING FIRM. THE CONSULTING FIRM ASSISTS THE COMPENSATION COMMITTEE WITH ITS DECISION-MAKING PROCESS TO ENSURE EXECUTIVE COMPENSATION LEVELS ARE REASONABLE AND APPROPRIATE RELATIVE TO THOSE OF OTHER SIMILAR ORGANIZATIONS. BASE SALARIES IN COLUMN B(I) ARE DETERMINED BASED ON COMPETITIVE MARKET PRACTICES FOR COMPARABLE POSITIONS WITH SIMILAR SIZE ORGANIZATIONS AND SCOPE OF RESPONSIBILITIES. BONUS AND INCENTIVE COMPENSATION IN COLUMN B(II) IS BASED ON THE ACHIEVEMENT OF PERFORMANCE GOALS. THE EXECUTIVES' COMPENSATION PROGRAM HAS A SIGNIFICANT PAY-AT-RISK COMPONENT TO ENSURE THE ALIGNMENT OF PAY AND ORGANIZATIONAL PERFORMANCE. GOALS ARE SET IN ADVANCE IN AREAS SUCH AS QUALITY OF CARE, PATIENT SATISFACTION, COMMUNITY SERVICES AND FINANCIAL PERFORMANCE. COMPENSATION IS AT RISK IF THE GOALS ESTABLISHED BY THE COMPENSATION COMMITTEE ARE NOT MET. OTHER REPORTABLE COMPENSATION IN COLUMN B(III) INCLUDES DISTRIBUTIONS FROM THE SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN. IN A MANNER DESIGNED TO QUALIFY FOR THE "REBUTTABLE PRESUMPTION OF REASONABLENESS" THE COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES of the related organization EXPRESSLY REVIEWED AND APPROVED THESE RETIREMENT BENEFIT ARRANGEMENTS FOR its SENIOR EXECUTIVES IN A MANNER THAT QUALIFIED UNDER THE INTERMEDIATE SANCTIONS RULES OF THE FEDERAL TAX LAW, AND IN RECOGNITION OF (A) THE EXECUTIVES' YEARS OF SERVICE TO THE ORGANIZATION AND (B) THE SIGNIFICANT CONTRIBUTIONS TO ENHANCING THE ABILITY OF THE ORGANIZATION TO ACHIEVE ITS CHARITABLE MISSION IN A MANNER CONSISTENT WITH FINANCIAL SOLVENCY. ACCORDINGLY, THIS BENEFIT SHOULD BE VIEWED AS APPLYING TO YEARS OF SERVICE FOR THE ORGANIZATION. FORM 990, PART VI, LINE 4 Montefiore NYACK HOSPITAL'S governing documents WERE AMENDED for a name change that took place in 2018 changing the name of the hospital from The Nyack Hospital to Montefiore Nyack Hospital. Form 990, Part VI, Line 6 Montefiore Health System, Inc. is the sole member of the Montefiore Nyack Hospital. FORM 990, PART VI, LINE 7A THE BOARD OF TRUSTEES OF MONTEFIORE HEALTH SYSTEM, INC., THE SOLE MEMBER OF Montefiore NYACK HOSPITAL, HAS THE AUTHORITY TO appoint and remove, with or without cause, the elected members of the Board of Trustees and Honorary Trustees of the Corporation. FORM 990, PART VI, LINE 7B THE BOARD OF TRUSTEES OF MONTEFIORE HEALTH SYSTEM, INC., THE SOLE MEMBER OF Montefiore Nyack Hospital, HAS THE AUTHORITY TO APPROVE CERTAIN DECISIONS OF THE Nyack Hospital BOARD OF DIRECTORS. Such decisions include amendments to the Certificate of Incorporation and Bylaws, approval of the operating and capital budgets and any strategic plans of the corporation, managed care contracting, and certain administrative procedures, among others. FORM 990, PART VI, LINE 11 The Form 990 was prepared by the Montefiore's tax department working closely with Nyack's Finance team and assisted by various departments throughout the Health System. The Form 990 was reviewed and approved by Montefiore's Vice President-Finance and the Nyack's hospital senior leadership including the Chief Financial Officer. In addition, an independent accounting firm was engaged to review the Form 990. Upon completion of the various reviews, the Form 990 was presented to the Montefiore Nyack Hospital's Audit/Compliance Committee of the Board of Trustees for review and approval. Once approved by the Finance Committee of the Board of Trustees, the form 990 was provided to all members of Montefiore Nyack Hospital's governing body prior to filing. FORM 990, PART VI, LINE 12C The organization regularly and consistently monitors and enforces compliance with the conflict of interest policy by means of an annual conflict of interest disclosure form that all officers, trustees and key employees of the Montefiore Nyack Hospital are required to complete. Should a possible conflict of interest arise in their responsibilities to the Hospital, the employee or Board member is required to notify their supervisor or the Director of Compliance, if an employee, or the Chair of the Board, if a Board Member, and abstain from any participation in the matter until the Hospital can determine whether an actual conflict of interest exists and how that conflict shall be resolved. All identified conflicts are presented to the Board of Trustee's Audit and Compliance Committee for their review and decision when an actual conflict is determined. FORM 990, PART VI, LINE 15A & 15B Montefiore Nyack Hospital is committed to ensuring that its executive compensation program adheres to the highest standards of regulatory compliance and best corporate governance. The Board of Trustees has charged the Executive Compensation Committee of the Board (which is comprised of independent Board members with no conflicts of interest in regards to executive compensation) with making all decisions related to compensation for the Corporation's executives. All decisions made by the Compensation Committee are appropriately and timely documented in meeting minutes. The compensation committee's review process follows the Intermediate Sanctions guidelines for qualifying for the rebuttable presumption of reasonableness. The Committee retains an independent compensation consultant to assist it with this process. Compensation levels are established considering data for comparable organizations, an assessment of management performance (including the services provided to the community), and other business judgement factors, consistent with Nyack's executive compensation philosophy. The Committee's decisions are made in the best interest of Nyack, and are intended to ensure the recruitment and retention of key executive talent, consistent with the market practices of other not-for-profit healthcare organizations of comparable scope, mission and complexity. On an annual basis, the Committee provides the full Board of Trustees with a description of the committee's review and approval process and its decisions. FORM 990, PART VI, LINE 19 The Conflict of Interest Policy and governing documents are made available upon request. FORM 990, PART XI, LINE 9 The Other Changes in Net Assets increase of $749,405 was due to a decrease in defined pension and other postretirement plan liabilities to be recognized in future periods. 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