2017-11-15T13:30:20-06:00 2016-12-31 131517563 LOEB & TROPER LLP 655 THIRD AVENUE 12TH FLOOR NEW YORK NY 10017 990 2016-01-01 111661359 CENTRAL SUFFOLK HOSPITAL CENT 6315486074 1300 ROANOKE AVENUE RIVERHEAD NY 11901 MICHAEL O'DONNELL CFO 6315486064 2017-11-15 1 AARON SHAPIRO P01333816 2128674000 38.98.118.70 2017-11-15 12:09:54 ES P D7076C0EC39B17C3336BFEA465ABF20A32036F2A 73A2BDB4DEE3E1301F7FB9DCBA9193E2BC5F7900 2016 2017-02-10 21:41:12Z PECONIC BAY MEDICAL CENTER MICHAEL O'DONNELL 1300 ROANOKE AVENUE RIVERHEAD NY 11901 173488648 0 X WWW.PBMEDICALCENTER.ORG X 1951 NY CSH IS A NOT-FOR-PROFIT HOSPITAL, A SKILLED NURSING FACILITY, AND A CERTIFIED HOME CARE AGENCY. 23 19 1450 148 0 0 3978117 4123873 157038154 166771248 155383 295683 2706564 1190935 163878218 172381739 0 0 0 0 84994439 90856131 0 0 171590 76894175 68207516 161888614 159063647 1989604 13318092 129946015 154621810 105482981 103283827 24463034 51337983 CENTRAL SUFFOLK HOSPITAL (CSH) D/B/A PECONIC BAY MEDICAL CENTER (PBMC) IS A NOT-FOR-PROFIT HOSPITAL CONSISTING OF 140 ACUTE CARE BEDS, A 60-BED SKILLED NURSING FACILITY AND A CERTIFIED HOME CARE AGENCY. CSH PROVIDES A FULL RANGE OF HEALTH CARE SERVICES TO THE LOCAL COMMUNITY. 0 0 122292391 166771248 COMPREHENSIVE HEALTHCARE SERVICES INCLUDING EMERGENCY, SURGICAL, MEDICAL, ICU AND OBSTETRICS/GYNECOLOGICAL. TOTAL PATIENT DAYS FOR ALL INPATIENT SERVICES WERE 49,484. TOTAL OUTPATIENT VISITS WERE 86,293. 122292391 1 1 0 1 0 0 0 1 0 1 1 0 0 1 1 1 1 1 0 0 0 0 0 0 1 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 1 57 1 1 1450 1 0 0 0 0 0 1 1 0 0 0 0 X 23 19 0 0 1 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X MICHAEL F O'DONNELL 6315486074 1300 ROANOKE AVENUE RIVERHEAD NY 11901 ANDREW J MITCHELL CEO / PRESIDENT 22.50 15.00 X X 1098832 0 54872 SHARON PATTERSON BOARD CHAIR 15.00 X X 0 0 0 ANDREW S MENDELSON VICE CHAIR 15.00 X X 0 0 0 J GORDON HUSZAGH VICE CHAIR & TREASURER 15.00 10.00 X X 0 0 0 REV GEORGE SUMMERS SECRETARY 15.00 X X 0 0 0 MARC ALESSI ESQ BOARD MEMBER 1.00 X 0 0 0 THELMA BOOKER PRESIDENT OF AUXILIARY 1.00 X 0 0 0 AGOSTINO CERVONE MD BOARD MEMBER 1.00 X 0 0 0 MICHAEL DEMPSEY MD BOARD MEMBER 1.00 X 0 0 0 FATHER LARRY DUNCKLEE BOARD MEMBER 1.00 X 0 0 0 ROBERT GAFFNEY ESQ BOARD MEMBER 1.00 X 0 0 0 RICHARD D GOLDSTEIN BOARD MEMBER 1.00 2.00 X 0 0 0 RICHARD ISRAEL BOARD MEMBER 1.00 1.00 X 0 0 0 JOAN LEVAN BOARD MEMBER 1.00 1.00 X 0 0 0 AMY LOEB EDD BOARD MEMBER/CHIEF NURSING OFFICER 37.50 X X 223024 0 40281 KAREEM MASSOUD BOARD MEMBER 1.00 X 0 0 0 RICHARD V MUSTO MD BOARD MEMBER 1.00 X 0 0 0 RALPH NAPPI BOARD MEMBER 1.00 2.00 X 0 0 0 ANNE K NOLON BOARD MEMBER 1.00 X 0 0 0 STEVEN OUZOUNIAN MD BOARD MEMBER 1.00 X 0 0 0 GEORGE RUGGIERO DO BOARD MEMBER 1.00 X 0 0 0 RICHARD L WINSLOW PHD BOARD MEMBER 1.00 1.00 X 0 0 0 STANLEY ZINBERG MD BOARD MEMBER 1.00 1.00 X 0 0 0 GERARD ZUNNO RN COO / SVP OF PATIENT CARE 37.50 X 124978 0 19027 MICHAEL F O'DONNELL CHIEF FINANCIAL OFFICER 37.50 X 387955 0 45916 SAMANTHA VIGLIOTTA VP FOUNDATION & EXTERNAL AFFAIRS 18.75 18.75 X 152258 0 37303 RONALD MCMANUS SVP OF PECONIC BAY MEDICAL 27.50 10.00 X 282402 0 27253 RICHARD KUBIAK CHIEF MEDICAL OFFICER 37.50 X 340611 0 36036 ARTHUR CROWE CIO / VP OF HOSPITAL SERVI 37.50 X 252112 0 44372 MONICA RAULS VP OF HUMAN RESOURCES 37.50 X 193321 0 13386 CHERYL MAKOSKE VP FINANCE 37.50 X 235886 0 31100 PETER SULTAN MD PHYSICIAN 37.50 X 960051 0 73308 DAVID PRENTISS MD PHYSICIAN 37.50 X 301791 0 15900 MAHMOOD AFGHANI MD PHYSICIAN 37.50 X 275517 0 33674 STEPHEN JOHN MD PHYSICIAN 37.50 X 348186 0 23304 KENNETH MAYER MD PHYSICIAN 37.50 X 231998 0 41243 5408922 0 536975 126 0 1 0 CERNER HEALTH PO BOX 959167 ST LOUIS MO 63195 INFORMATION TECHNOLOGY 2444013 SODEXO 500 ROSS STREET PITTSBURGH PA 15262 CAFETERIA SERVICES 1851999 KRAUSS EUGENE 20 HORSESHOE ROAD OLD WESTBURY NY 11568 PROFESSIONAL MEDICAL SERVICES 962878 CROTHALL FACILITIES 955 CHESTERBROOK BOULEVARD WAYNE PA 19087 HOUSEKEEPING SERVICES 734952 AXIS 125 LASER COURT HAUPPAUGE NY 11788 CONSTRUCTION SERVICES 579376 29 175650 1683223 2265000 4123873 PATIENT CARE 621400 166627075 166627075 PROVISION OF MEDICAL SERVICES BY 621110 144173 144173 166771248 102377 102377 1200299 1006993 193306 193306 193306 104440 175650 99916 4524 4524 CAFETERIA 624210 601137 601137 NASSAU SUFFOLK WAGE INDEX 900099 328810 328810 CLINIC REVENUE 621110 256464 256464 1186411 172381739 166771248 0 1486618 X 3640925 3640925 69584416 53941526 15642890 4707470 3624752 1082718 8090536 6227098 1863438 4832784 3720256 1112528 839500 839500 219004 219004 9376 9376 71142 71142 17180660 15160699 2019961 656824 485234 171590 23176921 17842827 5334094 2357067 2357067 2368447 2368447 96175 74035 22140 1554934 1554934 5371198 5371198 3089125 3089125 NEW YORK STATE ASSESSME 857285 857285 10359858 7974975 2384883 159063647 122292391 36599666 171590 19099939 30648824 6440565 1414879 1000000 3624618 13774061 13392599 4155951 1510721 3299772 3926870 1563089 600846 85940763 5431028 65773543 80509735 3986461 4113560 1352452 1366262 5230000 9500182 8282896 129946015 154621810 25646835 28377389 31765000 29355000 9907562 9458540 38163584 36092898 105482981 103283827 X 21177844 43950876 2498282 6600199 786908 786908 24463034 51337983 129946015 154621810 X 13318092 13556857 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 9376 9376 0 PART II-B, LINE 1: THE PORTION OF MEMBERSHIP DUES TO TRADE ASSOCIATIONS THAT ARE ASSOCIATED WITH LOBBYING ACTIVITIES. X 0 786908 786908 786908 786908 786908 10306 10306 786908 786908 100483 100483 786908 786908 36084 36084 786908 1.00000 0 0 14235739 14235739 29467721 1585730 27881991 36847182 3425298 33421884 5390121 420000 4970121 80509735 EQUITY INTEREST IN THE CENTRAL SUFFOLK HOSPITAL FOUNDATION/ DBA PECONIC BAY 5919663 ESTIMATED DUE FROM THIRD PARTY PAYORS 2363233 8282896 ESTIMATED MALPRACTICE COSTS 11756766 ESTIMATED DUE TO THIRD-PARTY PAYORS 10075497 DUE TO AFFILIATE 3991735 SWAP LIABILTY 6055752 ACCRUED PENSION COSTS 3605914 DUE TO NORTHWELL HEALTH 607234 36092898 X 190085732 17775135 17775135 172310597 71142 71142 172381739 159063647 0 159063647 0 159063647 PART III, LINE 4: THE DONATED ARTWORK PROVIDES A SOOTHING AND CALMING ENVIRONMENT TO THE PATIENTS AND THEIR FAMILIES WHEN THEY ATTEND CSH FOR MEDICAL SERVICES. CSH HOPES THAT WITH A GOOD EXPERIENCE, THEIR PATIENTS CONTINUE TO UTILIZE CSH TO PROVIDE MEDICAL SERVICES. PART V, LINE 4: ENDOWMENT FUNDS HAVE BEEN RESTRICED BY DONORS TO BE MAINTAINED BY CSH IN PERPETUITY. PART X, LINE 2: CSH HAS DETERMINED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS THAT REQUIRE RECOGNITION OR DISCLOSURE IN THE FINANCIAL STATEMENTS. PERIODS ENDING DECEMBER 31, 2013 AND SUBSEQUENT REMAIN SUBJECT TO EXAMINATION BY APPLICABLE TAXING AUTHORITIES. PART XI, LINE 2D - OTHER ADJUSTMENTS: PENSION ADJUSTMENTS 225,410. CHANGE IN EQUITY INTEREST IN CENTRAL SUFFOLK HOSPITAL FOUNDATION 2,270,541. NET ASSETS RELEASED FROM RESTRICTIONS -1,000,000. GAIN ON SWAP 1,189,345. PUSHDOWN ACCOUNTING ADJUSTMENT 15,089,839. SPRING GALA 280090 175650 104440 15000 690 10000 32272 12450 29504 280090 175650 104440 15000 690 10000 32272 12450 29504 99916 4524 1 1 X 1 X 1 X 500.000000000000 1 1 1 0 1 1 5186078 1336669 3849409 0.02420 28872928 16020699 12852229 0.08080 34059006 17357368 16701638 0.10500 5030914 3935671 1095243 0.00690 22699687 20322197 2377490 0.01490 27730601 24257868 3472733 0.02180 61789607 41615236 20174371 0.12680 1 3158669 50125340 61923731 -11798391 X 1 1 1 1 PECONIC BAY MEDICAL CENTER 1300 ROANOKE AVENUE RIVERHEAD NY 11901 HTTP://WWW.PBMCHEALTH.ORG X X X X PECONIC BAY MEDICAL CENTER 1 0 0 1 X X X X X X X X X 16 1 1 1 1 X WWW.NORTHWELL.EDU X 1 16 1 WWW.NORTHWELL.EDU/ABOUT/OUR-ORGANIZATION/OFFICE-COMMUNITY-AND-PUBLIC-HEALTH 0 1 X 100.000000000000 500.000000000000 X X X X 1 1 X X X 1 X WWW.PBMCHEALTH.ORG X WWW.PBMCHEALTH.ORG X WWW.PBMCHEALTH.ORG X X X X X X X 1 X 0 X X X X X 1 X 0 0 PECONIC BAY MEDICAL CENTER PART V, SECTION B, LINE 5: THE CHNA WAS FACILITATED BY COMMITTEES ESTABLISHED WITHIN EACH COUNTY SERVED BY NORTHWELL AND ITS HOSPITALS. THESE WERE COMPRISED OF PARTICIPANTS SUCH AS DEPARTMENTS OF HEALTH; COMMUNITY BASED ORGANIZATIONS (CBOS); NORTHWELL; LOCAL BUSINESSES; AND FAITH-BASED ORGANIZATIONS; AND A "VOICE OF THE COMMUNITY" (I.E. THE COMMUNITY'S PERCEPTION OF NEED). QUALITATIVE DATA WAS COLLECTED FROM DIVERSE COMMUNITY ORGANIZATIONS THAT SERVE THE POPULATION-AT-LARGE, AS WELL AS THOSE COMMUNITIES WITH SIGNIFICANT HEALTH DISPARITIES. COMMUNITY PARTNERS WERE INVITED TO PARTICIPATE VIA SURVEYS AND KEY INFORMANT INTERVIEWS. EMPHASIS WAS PLACED ON THE FOLLOWING POPULATIONS: MINORITIES/UNDERSERVED COMMUNITIES, SENIORS, WOMEN AND CHILDREN, SPECIAL POPULATIONS, AND INDIVIDUALS WITH DISEASE-SPECIFIC CONDITIONS. PRIMARY DATA WAS OBTAINED THROUGH QUALITATIVE ANALYSIS OF CBO INFORMANT INTERVIEWS, CBO SURVEYS, INDIVIDUAL COMMUNITY MEMBER SURVEYS, AND PARTICIPATION IN THE COLLABORATIVE PARTNER LISTENING SESSIONS. FOR FURTHER DETAIL GO TO WEB LINK: HTTPS://WWW.NORTHWELL.EDU/ABOUT/OUR-ORGANIZATION/OFFICE-COMMUNITY-AND-PUBLIC-HEALTH/REPORTS. PECONIC BAY MEDICAL CENTER PART V, SECTION B, LINE 6A: FOR A DETAILED LISTING OF OTHER HOSPITAL FACILITIES GO TO WEB LINK: HTTPS://WWW.NORTHWELL.EDU/ABOUT/OUR-ORGANIZATION/OFFICE-COMMUNITY-AND-PUBLIC-HEALTH/REPORTS PECONIC BAY MEDICAL CENTER PART V, SECTION B, LINE 6B: FOR A DETAILED LISTING OF OTHER THAN HOSPITAL FACILITIES GO TO WEB LINK: HTTPS://WWW.NORTHWELL.EDU/ABOUT/OUR-ORGANIZATION/OFFICE-COMMUNITY-AND-PUBLIC-HEALTH/REPORTS PECONIC BAY MEDICAL CENTER PART V, SECTION B, LINE 11: THE HOSPITAL IDENTIFIED AND ADDRESSED PRIMARY NEEDS BASED ON AN ASSESSMENT OF THE HIGHEST RANKED HEALTH PRIORITIES OF THE COMMUNITY, REGULATORY INPUT (I.E. THE NYC DEPARTMENT OF HEALTH PREVENTION PRIORITY AGENDA), AND RESOURCES AVAILABLE. FOR FURTHER INFORMATION GO TO WEB LINK: HTTPS://WWW.NORTHWELL.EDU/ABOUT/OUR-ORGANIZATION/OFFICE-COMMUNITY-AND-PUBL IC-HEALTH/REPORTS PECONIC BAY MEDICAL CENTER PART V, SECTION B, LINE 13H: THE HOSPITAL ALSO USES HOUSEHOLD SIZE. PECONIC BAY MEDICAL CENTER PART V, SECTION B, LINE 16J: THE POLICY IS INCLUDED IN THE HOSPITAL'S COMMUNITY SERVICE PLAN AND PROVIDED AT HEALTH FAIRS AND PRESENTATIONS OPEN TO THE COMMUNITY AT NO COST, IN ADDITION TO MAILING FINANCIAL POLICY SUMMARY BROCHURES. PECONIC BAY MEDICAL CENTER PART V, SECTION B, LINE 20E: BEFORE INITIATING ANY OF THE ACTIONS, THE HOSPITAL FACILITY SENDS LETTERS, MAKES TELEPHONE CALLS AND UTILIZES PRESUMPTIVE ELIGIBILITY. 1 1 - RIVERHEAD MANAGEMENT CORPORATION 1300 ROANOKE AVENUE REVERHEAD NY 11901 MANAGEMENT SERVICE ORGANIZATION PART I, LINE 3C: THIS HOSPITAL IS AN AFFILIATED ENTITY OF NORTHWELL HEALTH INC. ("NORTHWELL"). NORTHWELL USES FPG TO DETERMINE ELIGIBILITY AND UTILIZES THE NEW YORK STATE DEPARTMENT OF HEALTH (NYSDOH) GUIDELINES REGARDING THE CONSIDERATION OF ASSETS. ASSET TESTS CANNOT BE USED TO DENY FINANCIAL ASSISTANCE, BUT ONLY TO "UPGRADE" A PATIENT'S LEVEL OF OBLIGATION, UP TO THE LEGAL MAXIMUM PERMITTED UNDER THE FINANCIAL ASSISTANCE LAW. PART I, LINE 6A: THE COMMUNITY BENEFIT REPORT IS PREPARED BY THE HOSPITAL, IN CONJUNCTION WITH AN AFFILIATED ENTITY (NORTHWELL) OF THE HOSPITAL. THE COMMUNITY BENEFIT REPORT IS ACCESSIBLE TO THE PUBLIC AND CAN BE ACCESSED ON THE NORTHWELL WEBSITE: HTTP://WWW.NORTHWELL.EDU. PART I, LINE 7: ROW (A) THE COST OF CHARITY CARE WAS DETERMINED BY UTILIZING THE RATIO OF COST TO CHARGES (RCC) CALCULATED ON WORKSHEET 2 APPLIED TO GROSS CHARGES WRITTEN OFF FOR PATIENTS QUALIFYING FOR CHARITY UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. BAD DEBT WAS NOT REPORTED IN ANY ROW OF PART I, LINE 7. ROW (B) THE RATIO OF COST TO CHARGES METHOD (OR RCC) IS USED TO DETERMINE THE COST OF ANCILLARY SERVICES. A RCC IS DEVELOPED FROM THESE COSTS, AND THAT RCC IS APPLIED TO TOTAL MEDICAID GROSS ANCILLARY SERVICES CHARGES TO DETERMINE THE COST OF SERVICES PROVIDED TO MEDICAID PATIENTS. ROW (E) COSTS ASSOCIATED WITH COMMUNITY HEALTH IMPROVEMENT SERVICES WERE DETERMINED BY ADDING INDIRECT OR OVERHEAD COSTS TO THE DIRECT COSTS OF THE ACTIVITY. INDIRECT COSTS WERE CALCULATED AS A PERCENTAGE OF DIRECT COSTS. DIRECT COSTS FOR STAFF EXPENSES WERE CALCULATED USING AVERAGE SYSTEM HOURLY RATES, AND WERE ADJUSTED TO ACCOUNT FOR FRINGE BENEFITS, USING A BLENDED RATE BASED ON THE RATIO OF TOTAL EMPLOYEE BENEFIT EXPENSES TO TOTAL SALARY AND WAGES. ROW (F) THE BAD DEBT EXPENSE THAT APPEARS ON FORM 990, PART IX, LINE 25 COLUMN (A), BUT NOT INCLUDED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS EQUAL TO THE AMOUNT REPORTED ON FORM 990, PART X. THE COSTS RELATED TO HEALTH PROFESSIONS EDUCATION WERE DETERMINED BY UTILIZING THE STEP DOWN METHOD OF COST FINDING. ROW (H) COSTS ASSOCIATED WITH RESEARCH ACTIVITIES WERE DETERMINED BY ADDING INDIRECT, OR OVERHEAD, COSTS TO THE DIRECT COSTS OF THE ACTIVITY. INDIRECT COSTS WERE CALCULATED AS A PERCENTAGE OF COSTS. ROW (I) THE COST OF IN-KIND CONTRIBUTIONS TO COMMUNITY GROUPS IS COMPRISED OF THE DIRECT COSTS OF PERSONNEL WHOSE COMPENSATED TIME WAS DONATED TO VARIOUS CHARITIES AND COMMUNITY GROUPS. THE SALARIES AND WAGES WERE ADJUSTED TO INCLUDE BENEFITS USING A RATE BASED ON THE RATIO OF TOTAL EMPLOYEE BENEFIT EXPENSES TO TOTAL SALARY AND WAGES. INDIRECT COSTS WERE CALCULATED AS A PERCENTAGE OF DIRECT COSTS. COLUMN (F) FOR ROWS (C)-(K) THE PERCENTAGE OF NET COMMUNITY BENEFIT EXPENSE DIVIDED BY TOTAL EXPENSE FOR THE HOSPITAL (TO CALCULATE THE PERCENT OF TOTAL EXPENSE).NOTE: FOR THE ENTIRE NORTHWELL HEALTH INC. AND AFFILIATES, PART I, LINE 7 (ROW K, COLUMN F) IS APPROXIMATELY 11.29 AS A PERCENTAGE OF EXPENSES. PART II, COMMUNITY BUILDING ACTIVITIES: NORTHWELL WORKS TO PROMOTE COMMUNITY HEALTH THROUGH EDUCATION, COMMUNITY ADVOCACY, PARTNERSHIPS, AND PROGRAMS THAT RESULT IN IMPROVED ACCESS TO CARE AND HEALTH OUTCOMES. THE ACTIVITIES AND STRATEGIES FOR ACHIEVING THIS GOAL INCLUDE: ESTABLISHING COLLABORATIVE PARTNERSHIPS WITH LOCAL CBOS, HEALTH-RELATED ORGANIZATIONS, BUSINESS, AND GOVERNMENT TO IDENTIFY AND ADDRESS COMMUNITY HEALTH NEEDS; ADVOCATING FOR POLICIES THAT BENEFIT THE BROADER COMMUNITY AT STATE AND LOCAL LEVELS; PROVIDING COMMUNITY HEALTH PROGRAMS AND SERVICES BASED ON IDENTIFIED COMMUNITY HEALTH NEEDS/PRIORITIES; DELIVERING PREVENTIVE CARE SERVICES AND EDUCATION; CONDUCTING COMMUNITY OUTREACH AND ENGAGEMENT ACTIVITIES AND EXPANDING COMMUNITY MEMBER REPRESENTATION AND INVOLVEMENT ON COMMITTEES/BOARDS FOR PROGRAMMING AND EDUCATIONAL EVENTS. NORTHWELL HOSPITALS PARTICIPATE IN THE DELIVERY SYSTEM REFORM INCENTIVE PAY (DSRIP) PROGRAM WHOSE PRIMARY GOAL IS TO ALLOCATE MEDICAID PAYOUTS BASED UPON ACHIEVING PREDEFINED RESULTS IN THE TRANSFORMATION, CLINICAL MANAGEMENT, AND POPULATION HEALTH. NORTHWELL PROVIDES COMMUNITY RESIDENTS WITH A BROAD ARRAY OF COMMUNITY HEALTH PROGRAMS, SUCH AS: ACCESS TO HEALTHCARE SERVICES AND CARING FOR THE MEDICALLY UNDERSERVED; SCREENINGS AND IMMUNIZATIONS; HEALTH FORUMS AND HEALTH FAIRS; COMMUNITY EDUCATION AND OUTREACH PROGRAMS; SUPPORT GROUPS AND COUNSELING AND EMERGENCY MEDICAL SERVICES. A COMPREHENSIVE LIST OF PROGRAMS CAN BE FOUND IN THE COMMUNITY SERVICE PLANS LOCATED ON THE NORTHWELL PUBLIC WEBSITE. NORTHWELL RECOGNIZES THAT, TO HAVE AN IMPACT ON COMMUNITY HEALTH STATUS, IT MUST COLLABORATE, TO THE EXTENT POSSIBLE, WITH MULTIPLE PARTNERS WHO CAN ADDRESS DIFFERENT COMPONENTS OF PROGRAM DESIGN, INCLUDING: PROVIDING TRUST AND "REACH" INTO A COMMUNITY; ACCESS TO CAPITAL AND FUNDING; POLICY GUIDANCE AND BEST PRACTICES FOR PROGRAM DEVELOPMENT. SOME OF OUR PARTNERS INCLUDE: GOVERNMENT, NATIONAL/PROFESSIONAL ASSOCIATIONS, AREA BUSINESSES, OTHER AREA HEALTH CARE PROVIDERS, PHILANTHROPIES, CIVIC ORGANIZATIONS AND CBOS. PART III, LINE 2: FOR PATIENTS WHO WERE DETERMINED BY NORTHWELL TO HAVE THE ABILITY TO PAY BUT DID NOT, THE UNCOLLECTED AMOUNTS ARE RECORDED AS BAD DEBT EXPENSE. THE AMOUNT OF GROSS CHARGES WRITTEN OFF IS REDUCED BY ANY CHARITY CARE OR OTHER DISCOUNTS PROVIDED TO THE PATIENT, AS WELL AS ANY PAYMENTS RECEIVED. BAD DEBT EXPENSE REPORTED ON THIS LINE IS REPORTED NET OF GOVERNMENTAL OR PRIVATE OFFSETTING FUNDS. PART III, LINE 3: FOR PATIENTS WHO WERE DETERMINED BY NORTHWELL TO HAVE THE ABILITY TO PAY BUT DID NOT, THE UNCOLLECTED AMOUNTS ARE RECORDED AS BAD DEBT EXPENSE. PART III, LINE 4: BAD DEBT EXPENSES ON ACCOUNTS RECEIVABLE AND CONTRIBUTIONS RECEIVABLE ARE CHARGED IF THE RECEIVABLE IS DETERMINED TO BE UNCOLLECTIBLE BASED ON PERIODIC REVIEW BY MANAGEMENT. FACTORS USED TO DETERMINE WHETHER AN ALLOWANCE SHOULD BE RECORDED INCLUDE THE AGE OF THE RECEIVABLE AND A REVIEW OF PAYMENTS SUBSEQUENT TO YEAR END. PART III, LINE 8: MEDICARE COSTS ARE DETERMINED UTILIZING A COMBINATION OF THE STEP DOWN METHOD OF COST FINDINGS AND A COST PER UNIT OF SERVICE. COST PER UNIT OF SERVICE IS USED TO CALCULATE THE ROUTINE COST OF SERVICES PROVIDED TO MEDICARE PATIENTS. THE RATIO OF COST TO CHARGES METHOD (OR RCC) IS USED TO DETERMINE THE COST OF ANCILLARY SERVICES. AN RCC IS DEVELOPED FROM THESE COSTS, AND THAT RCC IS APPLIED TO TOTAL MEDICARE GROSS ANCILLARY SERVICES CHARGES TO DETERMINE THE COST OF SERVICES PROVIDED TO MEDICARE PATIENTS. PART III, LINE 9B: THE ORGANIZATION'S COLLECTION POLICY IS STANDARD TO ALL ACCOUNTS REGARDLESS OF INSURANCE STATUS (E.G. INSURED, UNDERINSURED, AND UNINSURED). THE HOSPITAL'S COLLECTION POLICY STATES THAT THEY WILL NOT SEND PATIENT ACCOUNTS TO COLLECTION IF A DECISION ON A FINANCIAL ASSISTANCE APPLICATION IS PENDING, OR IF A PATIENT IS DETERMINED TO BE ELIGIBLE FOR MEDICAID AT THE TIME SERVICES WERE RENDERED AND FOR WHICH SERVICES MEDICAID PAYMENT IS AVAILABLE. PART VI, LINE 2: THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IS PERFORMED ON AN ONGOING BASIS. NORTHWELL CONDUCTS AND PARTICIPATES IN POPULATION, DEMOGRAPHIC, AND HEALTH STATUS EVALUATIONS OF OUR RESPECTIVE HOSPITALS' SERVICE AREAS BASED ON COUNTY REGIONS AND THE COMMUNITIES WE SERVE. THERE IS A SPECIAL EFFORT TO INCLUDE INDIVIDUALS WITH HEALTH DISPARITIES AND ORGANIZATIONS WHO SERVE THESE COMMUNITIES IN THE CHNA PROCESS. THE CHNA INCLUDES THE ANALYSIS OF PRIMARY AND SECONDARY DATA. MULTI-YEAR ANALYSES, TRENDS AND PROJECTIONS ARE DEVELOPED, WHICH IDENTIFY AREAS OF NEED FOR THE CONTINUUM OF HEALTH CARE SERVICES. PRIMARY DATA IS OBTAINED THROUGH A COMBINATION OF QUALITATIVE ANALYSIS OF COMMUNITY-BASED ORGANIZATION (CBO), INFORMANT INTERVIEWS AND SURVEYS, INDIVIDUAL COMMUNITY MEMBER SURVEYS, AND PARTICIPATION IN COLLABORATIVE PARTNER MEETINGS. THESE MEETINGS INCLUDE REPRESENTATIVES FROM THE DEPARTMENTS OF HEALTH, CBOS, ACADEMIC INSTITUTIONS, GOVERNMENT AGENCIES, AND HOSPITALS. ONGOING INPUT CONCERNING OUR COMMUNITIES' NEEDS IS ALSO OBTAINED THROUGH: OUR BOARD OF TRUSTEES/DIRECTORS WHO ARE ALL AREA RESIDENTS AND LEADERS IN THEIR RESPECTIVE COMMUNITIES; FACILITY BASED ADVISORY BOARDS AND COUNCILS, AND; THE FEEDBACK RECEIVED BY OUR FACILITY ADMINISTRATORS AND CLINICIANS THAT SERVE ON LOCAL COMMUNITY AGENCY BOARDS. SECONDARY DATA ANALYSIS INCLUDES: INTERNAL HOSPITAL DATA, INCLUDING PREVENTION QUALITY INDICATORS (PQI); DEPARTMENT OF HEALTH COMMUNITY HEALTH ASSESSMENTS; LOCAL REGIONAL NYS PREVENTION AGENDA DATA SOURCES; AND STATEWIDE PLANNING AND RESEARCH SYSTEM (SPARCS) DATA.THE COMMITTEE ON COMMUNITY HEALTH, A COMMITTEE OF THE BOARD OF TRUSTEES, PROVIDES RECOMMENDATIONS THAT CONCERN NORTHWELL'S COMMUNITY HEALTH PRIORITIES AND INTERVENTIONS BASED ON THE CHNA. COMMITTEE DISCUSSIONS FOCUS ON NEW YORK STATE (NYS) PREVENTION AGENDA PRIORITY AREAS, INCLUDING STRATEGIES AND INTERVENTION OUTCOMES RELATED TO CHRONIC DISEASE PREVENTION, WOMEN AND CHILDREN'S HEALTH, HEALTHY SAFE ENVIRONMENTS, HEALTH ACCESS, MENTAL HEALTH AND SUBSTANCE ABUSE, HIV/AIDS/STDS AND COMMUNITY IMMUNIZATIONS. REGIONAL DEPARTMENTS OF HEALTH (I.E. NASSAU COUNTY DEPARTMENT OF HEALTH, SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES, AND NYC DEPARTMENT OF HEALTH AND MENTAL HYGIENE) PERFORM ADDITIONAL COMMUNITY HEALTH ASSESSMENTS (CHA) WITH THE INPUT OF HOSPITAL AND COMMUNITY STAKEHOLDERS. THESE REGIONAL PARTNERS USE STRATEGIES SUCH AS COMMUNITY MEMBER SURVEYS, CBO SURVEYS, AND PUBLIC LISTENING SESSIONS TO SOLICIT INFORMATION ON COMMUNITY NEEDS. TOGETHER WITH OTHER HEALTHCARE ORGANIZATIONS AND CBOS, NORTHWELL PARTICIPATES IN MEETINGS ORGANIZED BY THESE REGIONAL DEPARTMENTS OF HEALTH ACADEMIC ORGANIZATIONS TO DISCUSS THE SHARED RESPONSIBILITY OF PUBLIC HEALTH PLANNING WITHIN THE NYS PREVENTION AGENDA. THESE MEETINGS PROVIDE AN OPPORTUNITY FOR GENERAL DISCUSSION REGARDING THE PUBLIC HEALTH GOALS OF THE NYS PREVENTION AGENDA AND THE SELECTION OF SHARED PRIORITIES FOR COLLABORATIVE REGIONAL PLANNING. THE PARTNERSHIP AMONG LOCAL HEALTH DEPARTMENTS, HOSPITALS AND CBOS, ENABLES REGION WIDE LEVERAGING OF RESOURCES, CONSENSUS ON HEALTH PRIORITIES AND COLLABORATION ON HEALTH PROMOTION STRATEGIES. IN COMPLIANCE WITH IRS CODE 501(R)(3), A CHNA IS FILED WITH THE IRS EVERY THREE YEARS. PART VI, LINE 3: NORTHWELL HEALTH IS COMPLIANT WITH IRS CODE 501(R) AND HAS DEVELOPED OF FINANCIAL ASSISTANCE POLICY FOR THE UNINSURED AND UNDERINSURED IN ITS SERVICE AREA. NORTHWELL'S FINANCIAL ASSISTANCE POLICY PROVIDES REDUCED FEES FOR PATIENTS WITH HOUSEHOLD INCOMES UP TO 500% OF THE FPL. WHILE THE FEE SCHEDULE SERVES AS A GUIDE, ALL HARDSHIP CASES ARE EVALUATED ON A CASE-BY-CASE BASIS, TAKING INTO ACCOUNT THE INDIVIDUAL'S FINANCIAL AND PERSONAL CIRCUMSTANCES. ALL MEDICALLY NECESSARY SERVICES ARE COVERED UNDER THE FINANCIAL ASSISTANCE POLICY AND THE PUBLIC IS NOTIFIED OF THE AVAILABILITY OF THE POLICY THROUGH: MULTILINGUAL SIGNAGE AND EDUCATIONAL BROCHURES; CENTRALIZED PROGRAM ADMINISTRATION ACCESSIBLE VIA PHONE; STAFF OUTREACH, AND ALL BILLS INCLUDE A NOTICE ABOUT THE FINANCIAL ASSISTANCE POLICY. THE HEALTHCARE ACCESS CENTER (HAC), STAFFED BY BILINGUAL EMPLOYEES, ASSISTS COMMUNITY RESIDENTS' WITH REFERRALS FOR ENROLLMENT INTO GOVERNMENT-SUBSIDIZED INSURANCE PROGRAMS SUCH AS MEDICAID, CHILD HEALTH PLUS AND FAMILY HEALTH PLUS. IN ADDITION, THE HAC STAFF REFERS PATIENTS TO THE MEDICAID PRENATAL CARE PROGRAM AND TO THE SENIOR NAVIGATOR PROGRAM WITHIN NORTHWELL FOR ASSISTANCE WITH MEDICAID FOR PREGNANT WOMEN AND MEDICARE ENROLLMENT FOR SENIORS. PART VI, LINE 4: THE NORTHWELL'S SERVICE AREA COVERS LONG ISLAND AND THE METROPOLITAN AREA BOROUGHS OF BROOKLYN, MANHATTAN, QUEENS, AND STATEN ISLAND, AND PARTS OF WESTCHESTER COUNTY. THE DEMOGRAPHICS OF THE COMMUNITY SHOW A BROAD RANGE OF CULTURAL AND ETHNIC DIVERSITY AND INCREASE IN THE UNDERINSURED AND UNINSURED. BY 2018, OUR SERVICE AREA POPULATION 65 AND OLDER WILL GROW BY 14.5%, WHILE RESIDENTS UNDER 65 WILL DECLINE LESS THAN 1% (THOMSON REUTERS, MARKET PLANNER PLUS). THE SERVICE AREA HAS ALSO SHOWN HIGH RATES OF OBESITY, DIABETES, ASTHMA AND HEART/CEREBROVASCULAR DISEASE MORTALITY. PART VI, LINE 6: THE HOSPITAL IS AN AFFILIATE OF NORTHWELL HEALTH INC., AN INTEGRATED HEALTH CARE DELIVERY SYSTEM WHICH INCLUDES 22 HOSPITALS, 3 SKILLED NURSING FACILITIES, A WORLD RENOWNED CHILDREN'S HOSPITAL, URGENT CARE CENTERS, POST-ACUTE SERVICES, AMBULATORY NETWORK, REHABILITATION NETWORK AND A FREESTANDING RESEARCH INSTITUTE, WHICH IS CHARTERED TO CONFER DOCTORAL (PHD) DEGREES THROUGH ITS ELMEZZI GRADUATE SCHOOL OF MOLECULAR MEDICINE. ALL NORTHWELL ENTITIES ARE CONSIDERED TO BE UNDER COMMON CONTROL FOR ANTITRUST AND OTHER LEGAL PURPOSES. EACH HOSPITAL FACILITY SHARES A COMMON BOARD AND MANAGEMENT IN NORTHWELL AND AS SUCH IS REFERRED TO AS BEING COMMONLY MANAGED. IN ADDITION, IN A JOINT VENTURE, THE DONALD AND BARBARA ZUCKER SCHOOL OF MEDICINE AT HOFSTRA/NORTHWELL PROVIDE AN ALLOPATHIC MEDICAL SCHOOL FOR THE BENEFIT OF THE COMMUNITY. IN KEEPING WITH ITS MISSION TO IMPROVE THE HEALTH AND CARING FOR THE COMMUNITIES IT SERVES, REGARDLESS OF THE ABILITY TO PAY, NORTHWELL ESTABLISHED THE OFFICE OF COMMUNITY HEALTH AND HEALTH SERVICES TO PROMOTE HEALTH AND WELLNESS BY IDENTIFYING THE OVERALL HEALTH NEEDS OF THE COMMUNITY AND MAKE RECOMMENDATIONS FOR THE POPULATION NORTHWELL SERVES. IN ADDITION, NORTHWELL HAS ESTABLISHED COMPREHENSIVE AND COORDINATED CLINICAL PROGRAMS THAT NOT ONLY PROVIDE A FULL CONTINUUM OF SERVICES AND SEAMLESS DELIVERY OF CARE, BUT OFFER COMMUNITY HEALTH ACTIVITIES, OUTREACH AND EDUCATION AS WELL; THEY INCLUDE: BEHAVIORAL HEALTH, CANCER, CARDIOVASCULAR SERVICES, DENTAL MEDICINE, EMERGENCY MEDICINE, FAMILY MEDICINE, HOSPICE CARE, IMAGING/RADIOLOGY, LABORATORY MEDICINE AND PATHOLOGY, MEDICINE, NEUROLOGY, NEUROSURGERY, OBSTETRICS/GYNECOLOGY, OPHTHALMOLOGY, ORTHOPEDIC SURGERY, OTOLARYNGOLOGY, PEDIATRICS, PHYSICAL MEDICINE & REHABILITATION, POPULATION HEALTH, SENIOR SERVICES, SURGERY, UROLOGY, AND WOMEN'S HEALTH. IN 2015, NORTHWELL EXPANDED INTO WESTCHESTER COUNTY THROUGH AFFILIATION AGREEMENTS WITH PHELPS MEMORIAL HOSPITAL ASSOCIATION AND NORTHERN WESTCHESTER HOSPITAL ASSOCIATION. AND BEGINNING IN 2016, NORTHWELL EXPANDED ITS PRESENCE IN SUFFOLK COUNTY THROUGH AN AFFILIATION AGREEMENT WITH PECONIC BAY MEDICAL CENTER. NORTHWELL'S HOSPITALS, PROGRAMS AND SERVICES SUPPORT ONE OF THE LARGEST RESIDENT AND FELLOWSHIP TRAINING PROGRAMS IN THE UNITED STATES. IT DIRECTLY SPONSORS APPROXIMATELY 120 ACCREDITED GRADUATE MEDICAL EDUCATION (GME) PROGRAMS AND TRAINS MORE THAN 1,600 MEDICAL RESIDENTS AND FELLOWS ANNUALLY. OUR HOSPITALS AND FACILITIES COLLECTIVELY SERVE AS TEACHING SITES FOR MEDICAL STUDENTS FROM SIX MEDICAL SCHOOLS. X X X X 0 1 0 1 0 0 0 1 0 ANDREW J MITCHELL CEO / PRESIDENT 774771 0 323287 0 774 0 33900 0 20972 0 1153704 0 0 0 AMY LOEB EDD BOARD MEMBER/CHIEF NURSING OFFICER 201515 0 21347 0 162 0 12265 0 28016 0 263305 0 0 0 MICHAEL F O'DONNELL CHIEF FINANCIAL OFFICER 338209 0 49332 0 414 0 15900 0 30016 0 433871 0 0 0 SAMANTHA VIGLIOTTA VP FOUNDATION & EXTERNAL AFFAIRS 152158 0 0 0 100 0 9480 0 27823 0 189561 0 0 0 RONALD MCMANUS SVP OF PECONIC BAY MEDICAL 281628 0 0 0 774 0 15900 0 11353 0 309655 0 0 0 RICHARD KUBIAK CHIEF MEDICAL OFFICER 339423 0 0 0 1188 0 15900 0 20136 0 376647 0 0 0 ARTHUR CROWE CIO / VP OF HOSPITAL SERVI 248198 0 3500 0 414 0 14870 0 29502 0 296484 0 0 0 MONICA RAULS VP OF HUMAN RESOURCES 192623 0 0 0 698 0 11740 0 1646 0 206707 0 0 0 CHERYL MAKOSKE VP FINANCE 235616 0 0 0 270 0 11964 0 19136 0 266986 0 0 0 PETER SULTAN MD PHYSICIAN 415481 0 544300 0 270 0 45900 0 27408 0 1033359 0 0 0 DAVID PRENTISS MD PHYSICIAN 296902 0 4475 0 414 0 15900 0 0 0 317691 0 0 0 MAHMOOD AFGHANI MD PHYSICIAN 271980 0 3393 0 144 0 6266 0 27408 0 309191 0 0 0 STEPHEN JOHN MD PHYSICIAN 308960 0 38812 0 414 0 5946 0 17358 0 371490 0 0 0 KENNETH MAYER MD PHYSICIAN 230659 0 1015 0 324 0 13835 0 27408 0 273241 0 0 0 PART I, LINE 3 CSH UTILIZES SALARY SURVEYS AND REVIEWS THEM WITH THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS. THE PROCESS WAS LAST PERFORMED IN 2016. PART I, LINE 4B ANDREW MITCHELL (NON-QUALIFIED RETIREMENT PLAN) - $18,000 PART I, LINE 5 CSH HAS A CONTRACTUAL ARRANGEMENT FOR A PHYSICIAN ENTITLING THE PHYSICIAN TO ADDITIONAL COMPENSATION BASED UPON CASH COLLECTIONS. PART I, LINE 7 PERFORMANCE BASED ON BOARD DISCRETION. A TOWN OF RIVERHEAD INDUSTRIAL DEVELOPMENT AGENCY 112560077 000000000 2015-05-06 34070000 REFUND BONDS (06/23/06 & 06/27/07) 0 0 0 A 4715000 34070000 34070000 2009 1 0 1 1 A 0 1 1 0 1 1 HSBC BANK 17.200000000000 0 0 0 0 0 A 0 RICHARD ISRAEL BOARD MEMBER 417353 RENTAL OF PROPERTY 0 STEVEN OUZOUNIAN MD BOARD MEMBER 75000 AGREEMENT FOR DIRECTORSHIP 0 FORM 990, PART VI, SECTION A, LINE 4 ON JANUARY 15, 2016, CSH ENTERED INTO AN AFFILIATION AGREEMENT WITH NORTHWELL HEALTH (NORTHWELL) ESTABLISHING NORTHWELL AS THE SOLE MEMBER OF CSH. FORM 990, PART VI, SECTION A, LINE 6 NORTHWELL HEALTH IS THE SOLE MEMBER OF CSH. FORM 990, PART VI, SECTION A, LINE 7A AS THE SOLE MEMBER OF CSH, NORTHWELL HEALTH HAS THE RIGHT TO ELECT OR ELECT ONE OR MORE MEMBERS OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11B THE CEO / PRESIDENT, COO AND CHIEF FINANCIAL OFFICER REVIEW THE FORM 990. A COPY OF THE FORM 990 IS PROVIDED TO THE BOARD OF DIRECTORS FOR REVIEW. IN THE EVENT OF ANY ISSUES WITH THE FORM 990, THE MATTERS ARE BROUGHT TO THE ATTENTION OF THE CHIEF FINANCIAL OFFICER. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICTS OF INTEREST POLICY APPLIES TO MEMBERS OF THE BOARD OF DIRECTORS, OFFICERS, VICE PRESIDENTS, ASSISTANT VICE PRESIDENTS, DEPARTMENT HEADS, CLINICAL DIRECTORS OF DEPARTMENTS, AND OTHER EMPLOYEES (INCLUDING PHYSICIANS) WHO ARE IN A POSITION TO INFLUENCE ANY SUBSTANTIVE BUSINESS DECISION BETWEEN CSH AND A VENDOR. THE DIRECTOR OF CORPORATE COMPLIANCE CONTINUOUSLY MONITORS ALL TRANSACTIONS TO DETERMINE IF ANY POTENTIAL CONFLICT EXISTS. IF IT IS DETERMINED THAT A POTENTIAL CONFLICT EXISTS, THE INDIVIDUAL IS PROHIBITED FROM PARTICIPATING IN THE DECISIONS OF THE TRANSACTION. FORM 990, PART VI, SECTION B, LINE 15 CSH UTILIZES SALARY SURVEYS AND REVIEWS THEM WITH THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS. THE PROCESS WAS LAST PERFORMED IN 2016. FORM 990, PART VI, SECTION C, LINE 19 CSH MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 802,382. MANAGEMENT AND GENERAL EXPENSES 159,431. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 961,813. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 10,245,137. MANAGEMENT AND GENERAL EXPENSES 1,063,767. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 11,308,904. SERVICE CONTRACTS: PROGRAM SERVICE EXPENSES 2,664,348. MANAGEMENT AND GENERAL EXPENSES 796,763. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,461,111. TEMPORARY AGENCIES: PROGRAM SERVICE EXPENSES 1,448,832. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,448,832. FORM 990, PART XI, LINE 9: GAIN ON SWAP 1,189,345. PENSION ADJUSTMENT TO REFLECT FUNDED STATUS 225,410. PUSHDOWN ACCOUNTING ADJUSTMENT 15,089,839. CHANGE IN EQUITY INTEREST IN CENTRAL SUFFOLK HOSPITAL FOUNDATION 2,270,541. NET ASSETS RELEASED FROM RESTRICTIONS -1,000,000. PHYSICIANS PRACTICES -4,218,278. FORM 990, PART XI, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THAT OF THE PRIOR YEAR. NORTHWELL HEALTH 972 BRUSH HOLLOW RD WESTBURY NY 11590 113418133 AFFILIATION AGREEMENT NY 501(C)(3) LINE 7 N/A 0 PECONIC BAY MEDICAL CENTER FOUNDATION 1300 ROANOKE AVE RIVERHEAD NY 11901 200714587 FUNDRAISING/PHILANTHROPIC NY 501(C)(3) LINE 7 PECONIC BAY HEALTH SYSTEM 0 PECONIC BAY HEALTH SYSTEM 1300 ROANOKE AVE RIVERHEAD NY 11901 112761795 PARENT COMPANY OF PBMC NY 0 RIVERHEAD MANAGEMENT CORPORATION 1300 ROANOKE AVENUE RIVERHEAD NY 11901 112800287 MANAGEMENT SERVICE ORGANIZATION NY N/A C 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 0 0