2018-11-12T13:34:28-06:00 2017-12-31 ERNST & YOUNG US LLP 5 TIMES SQUARE NEW YORK NY 10036 990 2017-01-01 462916938 MONTEFIORE MOUNT VERNON HOSPITAL % EVAN RESNICK MONT 9143498455 12 NORTH SEVENTH AVENUE MOUNT VERNON NY 105502026 COLLEEN M BLYE EXEC V.P. & C.F.O. 7189207602 2018-11-02 true CHRISTOPHER B BOGGS P00032493 2127733000 164.57.159.254 26308520183165000019 2018-11-12 P 24558E047A149CE0743DDA4F89040DC2FD5B7974 D7645E384763AEB8339B885771554B833BC3ADBE 2017 2019-02-21 02:37:17Z STEVEN SAFYER MD 111 EAST 210TH STREET BRONX NY 104672401 86404275 false X http://www.montefiorehs.org X 2013 NY TO HEAL, TO TEACH, TO DISCOVER AND TO ADVANCE THE HEALTH OF THE COMMUNITIES WE SERVE. 44 43 688 10 0 0 26345293 15146677 67917403 70894596 0 0 611371 352768 94874067 86394041 0 2050 0 0 50489123 54203435 0 0 0 34514873 44296983 85003996 98502468 9870071 -12108427 27887014 40976302 32893825 58091540 -5006811 -17115238 MISSION: TO HEAL, TO TEACH, TO DISCOVER AND TO ADVANCE THE HEALTH OF THE COMMUNITIES WE SERVE. VALUES: HUMANITY, INNOVATION, TEAMWORK, DIVERSITY AND EQUITY - OUR VALUES DEFINE OUR PHILOSOPHY OF CARE. THEY SHAPE OUR ACTIONS AND MOTIVATE AND INSPIRE US TO PURSUE EXCELLENCE AND ACHIEVE OUR GOALS. false false 82164909 2050 70894596 Montefiore Mount Vernon Hospital is a 121 licensed bed, community-based, teaching hospital that has been serving the medical needs of the community and region. Montefiore Mount Vernon provides inpatient, critical care and ambulatory services to residents of lower Westchester County. The hospital is part of Montefiore Health System, the University hospital for the Albert Einstein College of Medicine. Montefiore MOUNT VERNON HOSPITAL BEGAN OPERATIONS ON NOVEMBER 6, 2013. MONTEFIORE MOUNT VERNON'S MISSION IS TO HEAL, TO TEACH, TO DISCOVER AND TO ADVANCE THE HEALTH OF THE COMMUNITIES IT SERVES. To this mission Montefiore Mount Vernon brings a unique synergy of strengths and resources that has helped define healthcare delivery in the area and have earned Mount Vernon the distinction of being a designated New York stroke and HIV/aids Center. Mount Vernon hospital is also home to the Beale Chronic Wound treatment and hyperbaric center and the Montefiore School of Nursing. During, 2017 Montefiore Mount Vernon hospital had 3,371 admissions and provided over 49,000 ambulatory services. 82164909 true true false true false false false false false false true false false true 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 12 0 true 688 true false false false false false false false false false false X 44 43 false false true false true true true true true false false true true true true true true false false false NY X EVAN RESNICK 9143498455 555 SO BROADWAY BLDG A FL 1 TARRYTOWN NY 105916301 ODED ABOODI VICE CHAIRMAN & TREASURER 0.3 2.2 X 0 0 0 JAY B ABRAMSON TRUSTEE 0.3 2.2 X 0 0 0 MARGARET HAYES ADAME TRUSTEE 0.2 1.55 X 0 0 0 GEORGE ASCH TRUSTEE 0.2 1.05 X 0 0 0 JOSEPH W BARTLETT TRUSTEE (Emeritus 6/20/17) 0.2 1.05 X 0 0 0 PATRICIA BAUMAN TRUSTEE 0.2 1.05 X 0 0 0 JAMES M BUTLER CHAIRMAN 0.5 4.0 X 0 0 0 BRUCE DONIGER TRUSTEE 0.2 1.05 X 0 0 0 RUTH L GOTTESMAN EDD TRUSTEE 0.2 1.55 X 0 0 0 BARRY W GRAY TRUSTEE 0.2 1.05 X 0 0 0 PATRICIA GREEN TRUSTEE 0.2 1.05 X 0 0 0 THOMAS L HARRISON TRUSTEE 0.2 1.05 X 0 0 0 JOHN HEFFER TRUSTEE 0.3 2.2 X 0 0 0 LEWIS HENKIND SECRETARY 0.3 2.7 X 0 0 0 HELEN A JOHNSON TRUSTEE 0.3 1.7 X 0 0 0 DAVID B KEIDAN TRUSTEE 0.2 1.05 X 0 0 0 ALAN M KLEIN TRUSTEE 0.4 3.1 X 0 0 0 STACEY R LANE TRUSTEE 0.3 2.2 X 0 0 0 JAY B LANGNER TRUSTEE/CHAIRMAN EMERITUS 0.2 1.05 X 0 0 0 MARGARET S NATHAN TRUSTEE 0.2 1.05 X 0 0 0 PETER J NEUFELD TRUSTEE 0.2 1.05 X 0 0 0 GAYLE F ROBINSON TRUSTEE 0.2 1.05 X 0 0 0 JON W ROTENSTREICH TRUSTEE 0.2 1.05 X 0 0 0 HON FELICIA K SHEA TRUSTEE 0.2 1.05 X 0 0 0 EDWIN H STERN III TRUSTEE 0.2 1.05 X 0 0 0 DAVID A TANNER TRUSTEE 0.4 3.35 X 0 0 0 CYNTHIA KING VANCE TRUSTEE 0.3 2.2 X 0 0 0 JIDE J ZEITLIN TRUSTEE (Resigned 6/20/17) 0.2 1.05 X 0 0 0 JENNIE EMIL TRUSTEE 0.2 1.05 X 0 0 0 JONATHAN A LIPTON TRUSTEE 0.2 1.3 X 0 0 0 ZITA G ROSENTHAL TRUSTEE 0.2 1.05 X 0 0 0 GREGG S HYMOWITZ TRUSTEE (Resigned 6/20/17) 0.2 1.05 X 0 0 0 NATHAN GANTCHER TRUSTEE 0.2 2.3 X 0 0 0 CATHERINE KLEMA TRUSTEE 0.2 1.3 X 0 0 0 MELISSA CERIALE TRUSTEE 0.4 3.1 X 0 0 0 BARRY S BLATTMAN TRUSTEE 0.2 1.3 X 0 0 0 MARK E BROSSMAN TRUSTEE 0.2 1.05 X 0 0 0 MATTHEW H NORD TRUSTEE 0.2 1.3 X 0 0 0 MICHAEL A STOCKER MD TRUSTEE 0.3 2.7 X 0 0 0 ROGER EINIGER TRUSTEE 0.2 2.3 X 0 0 0 JOEL BRAUN TRUSTEE 0.2 1.05 X 0 0 0 EMANUEL CHIRICO TRUSTEE 0.2 1.05 X 0 0 0 W NORMAN MILNER TRUSTEE 0.2 1.05 X 0 0 0 STEVEN M SAFYER MD PRESIDENT & CEO 5.0 55.0 X X 0 5417628 43471 ALISA R DOCTOROFF TRUSTEE (ELECTED 3/21/17) 0.2 1.8 X 0 0 0 JOHN P GUTFREUND TRUSTEE (ELECTED 3/21/17) 0.2 1.05 X 0 0 0 RONALD L MOELIS TRUSTEE (ELECTED 3/21/17) 0.2 1.05 X 0 0 0 PHILIP O OZUAH MDPHD EXECUTIVE VP & COO 5.0 55.0 X 0 2578552 1226969 CHRISTOPHER S PANCZNER Assistant Secretary 5.0 55.0 X 0 1211511 599277 COLLEEN BLYE EXEC VP & CFO 5.0 55.0 X 0 1521625 577343 SUSAN GREEN-LORENZEN RN System SENIOR VP-OPERATIONS 5.0 55.0 X 0 3344342 41544 LYNN RICHMOND Exec VP-Chief Strategy Officer 5.0 55.0 X 0 1451131 588672 Jaccel Kouns VP & Exc Director MMV 60.0 0.0 X 0 368110 42312 Bentley A Ogoke MD Anesthesiologist 60.0 0.0 X 472088 0 29020 BALASA PRASAD MD CHAIRMAN-ANESTHESIA 60.0 0.0 X 464518 0 6800 FRANCIS AGBONKPOLO MD ANESTHESIOLOGIST 60.0 0.0 X 403387 0 23447 Nadeem Hussain MD Psychiatrist 60.0 0.0 X 420891 0 22967 CLAUS P VON SCHORN MD PHYSICIAN 60.0 0.0 X 307737 0 14736 JOEL A PERLMAN former officer 0.0 1.0 X 0 500700 43294 2068621 16393599 3259852 104 true true false Excel Emergency Physician Services 484 Temple Hill Road Suite 102 NEW WINDSOR NY 12553 Physician Services 1985878 Cauldwell Wingate Co LLC 380 Lexington Avenue NEW YORK NY 10168 Construction 863663 Radiology Advantage New Jersey PA 3805 East Bell Road Suite 5500 PHOENIX AZ 85032 Radiology Services 754114 Healogics Wound Care Hyperbaric 28525 Network Place CHICAGO IL 606731285 Hyperbaric Services 711262 Century Protective Serivces Inc 150 Grand Street 4th Floor WHITE PLAINS NY 10601 Security Services 665980 18 15110177 36500 0 15146677 INPATIENT SERVICES 623000 46379331 46379331 0 0 OUTPATIENT SERVICES 621400 22177933 22177933 0 0 RENTAL INCOME FROM EXEMPT AFFILIATE 531120 1308000 1308000 0 0 MEDICAL EDUCATION 611699 690800 690800 0 0 OTHER HEALTH CARE SERVICES REVENUE 621999 338532 338532 0 0 70894596 0 0 0 38045 10234 27811 0 27811 27811 0 0 0 0 0 0 0 0 0 0 CAFETERIA/COFFEE SHOP & VENDING INCOME 722514 220840 0 0 220840 PARKING INCOME 812930 95260 0 0 95260 COPIES OF MEDICAL RECORDS 541900 8682 0 0 8682 175 0 0 175 324957 86394041 70894596 0 352768 2050 2050 0 0 0 0 0 40377863 37579375 2798488 0 2587169 2415159 172010 0 8232448 7685106 547342 0 3005955 2806101 199854 0 26658 26658 0 0 96141 4118 92023 0 77256 0 77256 0 0 0 0 7116541 6347978 768563 0 1720 1720 0 0 4762668 4216886 545782 0 2463869 1870598 593271 0 0 3603800 3036215 567585 0 52290 45080 7210 0 0 16334 16334 0 0 881320 881320 0 0 0 1666712 1370610 296102 0 3568866 3494809 74057 0 INTERCOMPANY ADMIN OVERHEAD 8929719 0 8929719 0 MEDICAL SUPPLIES 7844460 7843912 548 0 UNPROCESSED INVOICES 1391742 1239542 152200 0 MEMBERSHIP FEES 1101238 840395 260843 0 695649 440943 254706 98502468 82164909 16337559 0 650 700 399082 2477712 2041505 157193 4414064 4220682 0 0 0 0 0 0 1262344 971310 252112 358274 18723685 5942947 12999251 12780738 0 0 0 0 0 0 0 0 6518006 20009693 27887014 40976302 17713928 20191563 0 0 0 299823 0 0 0 0 0 0 0 0 0 0 15179897 37600154 32893825 58091540 X -5006811 -17115238 0 0 0 0 -5006811 -17115238 27887014 40976302 -12108427 X false true X true true true X false false false false false false false false true 24233 24233 false Schedule C, Part II-B, Line 1i THE other activities includes indirect lobbying cost for a PERCENTAGE OF MEMBERSHIP DUES PAID TO THE GREATER NEW YORK HOSPITAL ASSOCIATION, THE HEALTH CARE ASSOCIATION OF NYS and 1199/SEIU - GNYHA Health Education Project THAT were USED FOR LOBBYING EFFORTS. 8014261 1114406 6899855 10408321 4828541 5579780 301103 0 301103 12780738 DUE FROM AFFILIATES 2129693 EST INSURANCE CLAIMS RECEIV 17880000 20009693 0 LOANS PAYABLE - PARENT 17091160 DUE TO THIRD PARTY PAYORS 2356332 MALPRACTICE INSURANCE LIABILITIES 272662 EST INSURANCE CLAIMS LIABILITIES 17880000 37600154 true true X true X true X 500. true true true false true true 3666626 7608000 0 0.00000 42417380 24458492 17958888 0.18230 46084006 32066492 17958888 0.18230 466728 0 466728 0.00470 6466456 2751557 3714899 0.03770 6276331 5128646 1147685 0.01170 0 0 0 0.00000 0 0 0 0.00000 13209515 7880203 5329312 0.05410 59293521 39946695 23288200 0.23640 false 849755 807267 17533696 13550834 3982862 X true true 1 1 Montefiore Mount Vernon Hospital 12 North Seventh Avenue Mount Vernon NY 10550 www.montefiorehealthsystem.org 5903001H X X X X Montefiore Mount Vernon Hospital 1 false false true X X X X X X X X 16 true true false true X See Part V - Section C X true 16 true See Part V - Section C false true X 100 500. X true true X 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 The process to identify the needs of the community involved the collection of both secondary and primary data. Multiple conversations and meetings were convened internally and with external partners and a thorough review of the data was conducted. Multiple data sources were used to support the identification and selection of the priority items which were identified, selected and reviewed with the partners. The collection of primary data from a sample of the Westchester County residents was an important element of the development of the Community Health Needs Assessment. Montefiore engaged with the Westchester County Department of Health's online Community Resident and Provider Health Surveys to facilitate the implementation of the primary data collection process for the Community Health Needs Assessment for Westchester County and to assist in the facilitation of these community level connections thereby alleviating additional surveying overload. An online survey was collaboratively developed and made available across Westchester County over the summer of 2016. During this process, Westchester County compiled feedback from over 1,300 responders and identified community concerns by municipality to support CHNA efforts of hospitals for inclusion into their implementation plans. in addition to collaborative input from the local Department of Health, Montefiore worked closely with it communities including the Mount Vernon Community Advisory Board, organized partnerships and collaboratives and other providers in lower Westchester as well as extensive work with representatives of the affected communities to help Montefiore to identify health care needs and determine the appropriate configuration of services. Schedule H, Part V, Section B, Line 6A MONTEFIORE MOUNT VERNON HOSPITAL CHNA WAS CONDUCTED ALONG WITH MONTEFIORE NEW ROCHELLE HOSPITAL. Schedule H, Part V, Section B, Line 7a The CHNA report is available to the public on Montefiore's website: http://www.montefiore.org/documents/communityservices/Community-Health-Nee ds-Assessment-MNR-MMV.pdf Schedule H, Part V, Section B, Line 10a The hospital facility's most recently adopted implementation strategy is posted on the website: http://www.montefiore.org/documents/communityservices/Community-Health-Nee ds-Assessment-MNR-MMV.pdf Schedule H, Part V, Section B, Line 11 Montefiore Mount Vernon Hopital's most recently conducted CHNA illuminated two major categories of health needs that were important across the population surveyed, reflected in the data as critical, and in alignment with the New York State Prevention Agenda. The two priority areas identified were (1)Preventing Chronic Disease and (2)Promoting Healthy Women, Infants and Children. As part of the submission for the New York State Health Improvement Plan for 2016-2018, required by the New York State Department of Health, Montefiore has elected to retain these two priority areas, Prevent Chronic Disease and Promote Healthy Women, Infants and Children and has selected three broad focus areas to implement programs. These broad focus areas are (1)reducing obesity in children and adults, (2)Increase access to high quality chronic disease Preventive care and management in both clinical and community settings and (3) Improving maternal and infant Health. Across these focus areas, various goals, with specific interventions, performance measures and time frames, were delineated; - Create community environments that promote and support healthy food and beverage choices and physical activity; - Increase screening rates for cardiovascular disease, diabetes and breast, cervical and colorectal cancers, especially among disparate populations. - Reduce premature births. Despite the different methods and approached to primary data collection in gathering community input, there was a consistent focus on obesity and related behaviors and outcomes among the main community health concerns. Obesity and its related behaviors have significant impact on chronic disease, therefore, it is intended that the programs that are detailed specifically for the reduction of obesity will also impact the prevalence of diabetes, hypertension, asthma, cancer and cardiovascular disease in Westchester County. Montefiore has a vast portfolio of programs and services that address a majority of the significant community health needs identified in the Community Health Needs Assessment. The breadth and depth of the programs and services vary, but each address a need identified in the community. In particular, there are programs underway in collaboration with Hudson River Healthcare and Westchester Local Government units to work with bodegas on healthy snack displays and creating walking paths in parks and communities. In addition to the multiple resources that have been developed at Montefiore independently and through partnership with other organizations, there is an extensive need for community-based programs and resources that can augment Montefiore's program and services. Knowing how to access those resources is a particular challenge for the health care sector. However, since the last CHNA report in 2013, multiple free and low cost online search tools have been developed, such as www.auntbertha.com, www.hitesite.org, www.nowpow.com, among others. These are a much more comprehensive and practical alternative to the home-grown referral guides that many health care providers have had to use in the past. Those were hard to keep-up-to date and difficult to search, a problem that is largely addressed by the online version. Many Montefiore sites have been introduced to these new online resources and work is underway to more seamlessly integrate this kind of solution into the various workflows across the ambulatory, ED and inpatient settings. 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, Line 15E The organization's FAP provides addresses, locations and phone numbers for offices within Montefiore to assist with completing applications. The financial aid and Medicaid staff at these locations are also certified application counselors that assist with market place and Medicaid applications. Schedule H, Part V, Section B, Lines 16a-16c The direct website where the FAP is publicized: http://www.montefiorehealthsystem.org/body.cfm?id=68 3 MONTEFIORE MT VERNON METHADONE PROGRAM 3 SOUTH SIXTH AVENUE MOUNT VERNON NY 10550 SUBSTANCE ABUSE EXTENSION CLINIC MONTEFIORE MT VERNON ID CLINIC 16 GUION PLACE NEW ROCHELLE NY 10801 SPECIAL CARE EXTENSION CLINIC MONTEFIORE MT VERNON HOSP ACT PROGRAM 3 SOUTH SIXTH AVENUE MOUNT VERNON NY 10550 MENTAL HEALTH CLINIC 1. REQUIRED DESCRIPTIONS: 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 COSTS-TO-CHARGES. PART III, SECTION A, LINE 2: THE COST OF BAD DEBT EXPENSE WAS ESTIMATED BASED ON THE CHARGES, APPLIED TO THE RATIO OF TOTAL PATIENT CARE EXPENSES TO TOTAL CHARGES FOR ALL SERVICES RENDERED. ANY PAYMENTS OR DISCOUNTS ARE EXCLUDED FROM BAD DEBT EXPENSE. PART III, SECTION A, LINE 3: THE ESTIMATED AMOUNT OF BAD DEBT EXPENSE (AT COST) ATTRIBUTED TO PATIENTS UNDER THE ORGANIZATION'S CHARITY CARE POLICY WAS BASED ON RESULTS OF PREDICTIVE ANALYSIS. BAD DEBT SHOULD BE INCLUDED AS A COMMUNITY BENEFIT BECAUSE THE ORGANIZATION PROVIDES MUCH NEEDED HEALTH CARE SERVICES INDISCRIMINATELY TO THE COMMUNITY-AT-LARGE WITHOUT REGARD TO WHETHER OR NOT THE PATIENT HAS INSURANCE AND IF THE BILL WILL EVER BE PAID. PART III, SECTION A, LINE 4: AS REPORTED IN MONTEFIORE HEALTH SYSTEM'S AUDITED CONSOLIDATED FINANCIAL STATEMENTS, BAD DEBT EXPENSE IS DESCRIBED AS FOLLOWS: "THE COLLECTION OF PATIENT SERVICE REVENUE DUE FROM PATIENTS, INCLUDING COPAYMENTS AND DEDUCTIBLES, FROM THOSE WHO ARE INELIGIBLE FOR CHARITY CARE, IS SUBJECT TO UNCERTAINTY. THE Health System RECORDS BAD DEBT EXPENSE IN THE PERIOD SERVICES ARE RENDERED BASED ON PAST EXPERIENCE, TO ACCOUNT FOR AMOUNTS THAT PATIENTS MAY ULTIMATELY BE UNABLE OR UNWILLING TO PAY. FOR SELF-PAY PATIENTS, WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH COPAYMENTS AND DEDUCTIBLES AFTER THIRD-PARTY COVERAGE, THE HOSPITAL RECORDS AN ESTIMATE FOR BAD DEBT EXPENSE IN THE CURRENT PERIOD BASED ON PAST EXPERIENCE. AMOUNTS ULTIMATELY WRITTEN OFF AS UNCOLLECTIBLE AND RECOVERIES OF SUCH AMOUNTS ARE DEDUCTED FROM, OR ADDED TO, THE ALLOWANCE FOR DOUBTFUL ACCOUNTS." PART III, SECTON B, LINE 8: MEDICARE REVENUE AND ALLOWABLE COSTS REPORTED IN PART III, SECTION B, WERE DERIVED FROM THE MEDICARE COST REPORT. MEDICARE ALLOWABLE COSTS REPORTED ON PART III, LINE 6, PER SCHEDULE H INSTRUCTIONS, WERE DERIVED USING THE MEDICARE COST REPORT COST-FINDING METHODOLOGY, WHICH APPORTIONS ROUTINE COSTS TO MEDICARE USING DAYS AND ANCILLARY COSTS TO MEDICARE USING DEPARTMENTAL RATIOS OF COSTS TO CHARGES. THE FOLLOWING TABLE REPRESENTS A RECONCILIATION OF MEDICARE REVENUE AND COSTS INCLUDED ON LINES 5, 6, AND 7 IN PART III TO THE TOTAL ACTUAL MEDICARE REVENUE AND COSTS OF THE HOSPITAL. AS HIGHLIGHTED IN THIS TABLE, INCLUDING THE ADJUSTMENTS DESCRIBED BELOW WOULD HAVE RESULTED IN A MEDICARE Surplus OF $1,468,796. REVENUE ALLOWABLE COST Surplus PART III, LINE 5-7: $17,533,696 $13,550,834 $3,982,862 ADD: Cost not included: 897,966 (897,966) ADD: MEDICARE DME: 764,929 1,876,430 (1,111,501) ADD: MED. SUBSID. HLTH. 695,829 1,200,428 (504,599) Adjusted MEDICARE SURPLUS: $18,994,454 $17,525,658 $1,468,796 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 HOSPITAL WHERE THE PATIENT IS PROVIDED ASSISTANCE WITH COMPLETING AN APPLICATION FOR ASSISTANCE. 2. NEEDS ASSESSMENT: MONTEFIORE participates in a variety of organized partnership and collaborative, working with other providers in Westchester County, including the Westchester County Department of Health, community-based organizations and members of the community in planning and developing initiatives aimed at improving the health of the people of Westchester County. The process to identify the needs of the community also involved the collection of both primary and secondary data. Through multiple conversations and meetings with external partners, the data is reviewed and analyzed in the development of implementation strategies tailored to best serve the changing needs of the community. 3. PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: ALL INTAKE, REGISTRATION, AND COLLECTION AGENCY STAFF IS TRAINED ON THE HOSPITAL'S FINANCIAL AID POLICY AND HOW TO PROVIDE PATIENTS WITH ASSISTANCE. MONTEFIORE MOUNT VERNON 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. A REFERRAL IS MADE TO THE HOSPITAL'S FINANCIAL AID OFFICE AND A FINANCIAL COUNSELOR WILL HELP THE PATIENT APPLY FOR FREE OR LOW-COST INSURANCE. IF THE FINANCIAL COUNSELOR DETERMINES THAT THE PATIENT DOES NOT QUALIFY FOR LOW-COST INSURANCE, THE COUNSELOR WILL HELP THE PATIENT APPLY FOR A FINANCIAL AID DISCOUNT BASED ON INCOME LEVEL. THE HOSPITAL MAKES ITS FINANCIAL AID POLICY KNOWN TO THE PUBLIC BY PROVIDING WRITTEN INFORMATION AVAILABLE IN BOTH ENGLISH AND SPANISH, INCLUDING BROCHURES AT ALL PATIENT SERVICE AREAS, INFORMATION POSTED ON THE INTRANET AND INTERNET, AND INFORMATION SENT OUT ON PATIENTS' BILLS. THERE ARE ALSO SIGNS POSTED AT THE MAIN ENTRANCE TO THE HOSPITAL IN ENGLISH AND SPANISH ADVISING PATIENTS OF THE ROOM LOCATION FOR ASSISTANCE WITH FINANCIAL AID. 4. COMMUNITY INFORMATION: The city of Mount Vernon has the highest proportion of Black/African American residents in Westchester County at 66%, with 34% of all residents being foreign born. Additionally, it is the seat of Westchester County's homeless services and senior services programs housing a disporportionate number of economically challenged residents. The City is 4.4 square miles located north of the Bronx and is the 8th largest city and 2nd most populated city in the state of New York. The city has one of the highest percentage of resident living below poverty in Westchester County. The poverty rate is 17.1% compared to 9.7% countywide and the median income is $49,395 compared to $84,220 countywide. 22% of Mount Vernon children are living below poverty; higher than the countywide percentage of 13.3%. As of January 6, 2014, the New York State Education Department, through the Board of Regents at the request of the New York Department of Health reaffirmed the City of Mount Vernon to be an identified Primary Care Health Professions Shortage Areas. 5. PROMOTION OF COMMUNITY HEALTH: MONTEFIORE HEALTH SYSTEM, INC. IS A LEADER IN COMMUNITY HEALTH AND HAS A LONG HISTORY OF DEVELOPING INNOVATIVE APPROACHES TO CARE AND CREATING PROGRAMS TO BEST SERVE THE CHANGING NEEDS OF ITS COMMUNITY. MONTEFIORE's Office of Community & Population Health has a dedicated community educator who spearheads initiatives in the city of Mt Vernon. These events are focused on a variety of issues, ranging from chronic disease management and prevention, cancer screenings and promotion of healthy food consumption. Events range from farmers market walks, workshops in the community, walkathons, health fair and community-based health screens. The Mount Vernon Facility has focused its engagement across multiple health indicators; diabetes, breast, cervical and colorectal cancers while addressing cardiovascular disease in the older adult population. To increase screening rates for cardiovascular disease the team coordinates screening services and educational workshops to older adults at frequently occurring points of congregation, including senior centers and naturally occurring retirement communities. These workshops provide a gateway to engage the community in health programming that ensures that our work is targeted towards high needs/high impact activities. 6. AFFILIATED HEALTH CARE SYSTEM: MONTEFIORE MOUNT VERNON HOSPITAL IS AN AFFILIATE OF MONTEFIORE HEALTH SYSTEM, INC. The Health System is a leader in community and population health and has a long history of developing innovative approaches to care and tailoring 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 Montefiore well in its provision of service to the community. 7. STATE FILING OF COMMUNITY BENEFIT REPORT: MONTEFIORE MOUNT VERNON HOSPITAL FILES A COMMUNITY SERVICE PLAN WITH THE STATE OF NEW YORK. true true false false false false false false false PHILIP O OZUAH MDPHD EXECUTIVE VP & COO 0 1594386 0 855885 0 128281 0 1200675 0 26294 0 3805521 0 0 CHRISTOPHER S PANCZNER Assistant Secretary 0 720193 0 469785 0 21533 0 599277 0 0 0 1810788 0 0 JOEL A PERLMAN former officer 0 0 0 0 0 500700 0 17000 0 26294 0 543994 0 0 Bentley A Ogoke MD Anesthesiologist 471056 0 0 0 1032 0 6800 0 22220 0 501108 0 0 0 BALASA PRASAD MD CHAIRMAN-ANESTHESIA 464518 0 0 0 0 0 6800 0 0 0 471318 0 0 0 FRANCIS AGBONKPOLO MD ANESTHESIOLOGIST 401803 0 0 0 1584 0 6800 0 16647 0 426834 0 0 0 Nadeem Hussain MD Psychiatrist 420619 0 0 0 272 0 6800 0 16167 0 443858 0 0 0 CLAUS P VON SCHORN MD PHYSICIAN 304689 0 0 0 3048 0 6800 0 7936 0 322473 0 0 0 SUSAN GREEN-LORENZEN RN System SENIOR VP-OPERATIONS 0 812981 0 346285 0 2185076 0 17000 0 24544 0 3385886 0 1462485 LYNN RICHMOND Exec VP-Chief Strategy Officer 0 917213 0 500385 0 33533 0 565475 0 23197 0 2039803 0 0 COLLEEN BLYE EXEC VP & CFO 0 1013757 0 506885 0 983 0 552424 0 24919 0 2098968 0 0 STEVEN M SAFYER MD PRESIDENT & CEO 0 1831679 0 1882500 0 1703449 0 17000 0 26471 0 5461099 0 0 Jaccel Kouns VP & Exc Director MMV 0 280558 0 75000 0 12552 0 17000 0 25312 0 410422 0 0 PART I, LINE 4a Joel Perlman, a former officer, was paid severance by a related organization in the amount of $497,770. PART I LINES 3, 4B & PART II - COLUMNS (B)(I), (II) AND (III) As it relates to Compensation from Montefiore Medicine Academic Health System, Inc. and Montefiore Health System, Inc. The Compensation Committee reviews and approves 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 expressly reviewed and approved these retirement benefit arrangements for 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. Pooled Supplemental Executive Retirement Plan distributions: Steven Safyer, M.D. - $1,696,025 Susan Green Lorenzen, R.N. - $2,163,042 Supplemental Executive Retirement Plan accrued and unpaid service costs: Christopher Panczner - $582,277 Philip O. Ozuah, MD, PH.D - $1,183,675 Lynn Richmond - $548,475 Colleen Blye - $535,424 The officers and Key Employees listed in Part II, Column A are not employees of this filing organization, Montefiore Mount Vernon Hospital. These individuals are employed and their compensation is paid by either Montefiore Medicine Academic Health System, Inc., EIN 47-1582973, or Montefiore Health System, Inc., EIN 20-1615393. FORM 990, PART VI, SECTION A, LINE 4: THE ORGANIZATION'S BYLAWS WAS AMENDED 12/2017 FOR THE REORGANIZATION OF ITS BOARD COMMITTEES. FORM 990, PART VI, SECTION A, lINE 6: MONTEFIORE HEALTH SYSTEM, INC IS THE SOLE MEMBER OF MONTEFIORE MOUNT VERNON HOSPITAL. FORM 990, PART VI, SECTION A, LINE 7A: THE BOARD OF TRUSTEES OF MONTEFIORE HEALTH SYSTEM, INC., THE SOLE MEMBER OF MONTEFIORE MOUNT VERNON HOSPITAL, HAS THE AUTHORITY TO APPOINT THE BOARD OF TRUSTEES OF MONTEFIORE MOUNT VERNON HOSPITAL. FORM 990, PART VI, SECTION A, LINE 7B: THE BOARD OF TRUSTEES OF MONTEFIORE HEALTH SYSTEM, INC., THE SOLE MEMBER OF MONTEFIORE MOUNT VERNON HOSPITAL, HAS THE AUTHORITY TO APPROVE THE OPERATING AND CAPITAL BUDGETS OF MONTEFIORE MOUNT VERNON HOSPITAL. FORM 990, PART VI, SECTION B, LINE 11B: THE FORM 990 WAS PREPARED BY MONTEFIORE HEALTH SYSTEM'S FINANCE DEPARTMENT WITH THE ASSISTANCE OF VARIOUS DEPARTMENTS. THE FORM 990 WAS REVIEWED AND APPROVED BY THE VICE PRESIDENT FINANCE - FINANCIAL REPORTING AND THE HOSPITAL'S SENIOR LEADERSHIP TEAM 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 FINANCE 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 MOUNT VERNON HOSPITAL'S GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 12C: ORGANIZATION COMPLIANCE POLICY MONITORING AND ENFORCEMENT: The organization regularly and consistently monitors and enforces compliance with the disclosure policy by means of a survey developed by counsel and approved by the Montefiore Legal and Compliance Committees of the Board of Trustees. The survey is sent to all trustees, officers and key employees for completion. All survey responses are reviewed by the Compliance Officer. Any potential conflicts identified in the responses are discussed with senior management and/or the Legal and Compliance Committees of the Board of Trustees. Potential actions to be taken in response to a conflict is one or more of the following: 1)disclosure of conflict; 2)individual recusal from decisions for transactions where that individual may have a conflict; 3)request the individual to alleviate the conflict; OR 4)removal of the individual from the board of trustees. FORM 990, PART VI, SECTION B, LINE 15A & 15B: All officers and key employees are employed and paid by either Montefiore Medicine Academic Health System, Inc. or Montefiore Health System, Inc., The parent Companies of Montefiore Health Sytem, Inc. and Montefiore Mount Vernon Hospital, respectively. Montefiore Health System, Inc. 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 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 officers and certain key employees. 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 judegment factors, consistent with Montefiore's executive compensation philosophy. The Committee's decisions are made in the best interest of Montefiore, 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, SECTION C, LINE 19: THE CONFLICTS OF INTEREST POLICY AND GOVERNING DOCUMENTS ARE MADE AVAILABLE UPON REQUEST. MMC Corporation 111 East 210th Street Bronx NY 10467 133430322 Real Estate NY 501(C)(3) 12A TYPE I MMC true Montefiore Medical Center 111 East 210th Street Bronx NY 10467 131740114 acad med ctr NY 501(C)(3) 3 MHS true Montefiore Hospital Housing Sect IIInc 3450 Wayne Avenue Bronx NY 10467 237160641 Staff Housing NY 501(C)(2) MMC true Montefiore North Amb Care Ctr Inc 4234 Bronx Boulevard Bronx NY 10466 010796859 Amb Services NY 501(C)(3) 3 MHS true Mosholu Preservation Corporation 3400 Reservoir Oval East Bronx NY 10467 133109387 Community Ser NY 501(C)(3) 12A TYPE I MMC true Gun Hill MRI PC 200 EAST GUNHILL ROAD BRONX NY 10467 133734486 DIAG SERVICES NY 501(C)(3) 12A TYPE I MMC true Montefiore Health System Inc 555 SOUTH BROADWAY BLDG A FL 1 TARRYTOWN NY 10591 201615393 Support Serv NY 501(C)(3) 12B Type II MMAHS true MMC Residential Corp I Inc 3411 Wayne Avenue Bronx NY 10467 911943271 Staff Housing NY 501(C)(2) MMC true Schaffer Extended Care Center 16 Guion Place New Rochelle NY 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SLCHS true Amos and Sarah Holden Home 70 Dubois Street Newburgh NY 125504851 141365995 Asst Living NY 501(c)(3) PF SLCHS true Goldsmith D and Mary B Johnes Home 70 Dubois Street Newburgh NY 125504851 141364666 Home for Aged NY 501(c)(3) 10 SLCHS true UNIVERSITY BEHAVIORAL ASSOCIATES INC 111 EAST 210TH STREET BRONX NY 10467 133877781 MGMT SERVICES NY NA C Corp true THE MONTEFIORE IPA INC 111 EAST 210TH STREET BRONX NY 10467 134114915 Integ Provr Assoc NY NA C CORP true MMC GI HOLDINGS EAST INC 111 EAST 210TH STREET BRONX NY 10467 721610013 Holding Company NY NA C CORP true MMC GI HOLDINGS WEST INC 111 EAST 210TH STREET BRONX NY 10467 721610015 HOLDING COMPANY NY NA C CORP true MONTEFIORE BEHAVIORAL CARE IPA NO 1INC 111 EAST 210TH STREET BRONX NY 10467 133952750 INTEG PROVR ASSOC NY NA C CORP true BRONX ACCOUNTABLE CARE NETWORK IPA INC 111 EAST 210TH STREET BRONX NY 10467 300689571 Integ Provr ASSOC NY NA C CORP true Montefiore Consolidated Ventures Inc 111 East 210th Street Bronx NY 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