2016-11-09T08:54:11-06:00 2015-12-31 ERNST & YOUNG US LLP 5 TIMES SQUARE NEW YORK NY 10036 990 2015-01-01 462916938 MONTEFIORE MOUNT VERNON HOSPITAL % DAVID INGBER - MONTEFIORE MONT 9143498400 12 North Seventh Avenue Mount Vernon NY 10550 COLLEEN M BLYE EXECUTIVE VP & CFO 7189207602 2016-11-06 CHRISTOPHER B BOGGS P00032493 2127733000 2015 2017-02-10 21:41:12Z STEVEN SAFYER MD 111 East 210th Street Bronx NY 10467 80673376 false X http://www.montefiorehs.org/landing.cfm?id=17 X 2013 NY TO HEAL, TO TEACH, TO DISCOVER AND TO ADVANCE THE HEALTH OF THE COMMUNITIES WE SERVE. 43 42 690 87 0 14847329 14884265 55736673 63113094 0 0 2616402 2676017 73200404 80673376 0 0 0 0 48111272 49764814 0 0 0 31256231 33452812 79367503 83217626 -6167099 -2544250 27525637 27231414 35301912 37551939 -7776275 -10320525 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. MONTEFIORE MOUNT VERNON HOSPITAL IS A 176-BED, COMMUNITY-BASED, TEACHING HOSPITAL THAT SERVES THE MEDICAL NEEDS OF ITS COMMUNITIES AND REGION. MONTEFIORE MOUNT VERNON HOSPITAL PROVIDES INPATIENT, CRITICAL CARE AND AMBULATORY SERVICES. THE HOSPITAL IS PART OF MONTEFIORE HEALTH SYSTEM,INC., THE UNIVERSITY HOSPITAL SYSTEM FOR THE ALBERT EINSTEIN COLLEGE OF MEDICINE. MONTEFIORE MOUNT VERNON HOSPITAL IS A NEW YORK STATE-DESIGNATED STROKE CENTER AND HIV/AIDS CENTER, AND IT IS HOME TO THE BEALE CHRONIC WOUND TREATMENT AND HYPERBARIC CENTER. false false 73845022 63113094 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. MONTEFIORE MOUNT VERNON HOSPITAL (MVH) IS A LICENSED 176-BED HOSPITAL COMPRISED OF 124 MEDICAL/SURGICAL BEDS, INCLUDING A DEPARTMENT OF CORRECTIONS UNIT, 8 CORONARY CARE BEDS, 12 INTENSIVE CARE BEDS, 22 PSYCHIATRY BEDS AND 10 AIDS BEDS. AS A COMMUNITY-BASED TEACHING HOSPITAL, MVH HAS BEEN SERVING THE MEDICAL NEEDS OF THE COMMUNITY AND REGION. DURING 2015, MONTEFIORE MOUNT VERNON HOSPITAL PROVIDED INPATIENT CARE TO 3,221 PATIENTS. MONTEFIORE MOUNT VERNON HOSPITAL also provides ambulatory care services. During 2015, Montefiore Mount Vernon Hospital provided 48,766 AMBULATORY VISITS, COMPRISED OF 18,732 EMERGENCY DEPARTMENT VISITS, 16,135 ADULT AND PEDIATRIC MEDICAL AND SPECIALTY CLINIC VISITS, 12,278 PRIVATE REFERRED VISITS AND 1,621 AMBULATORY SURGERY PROCEDURES. 73845022 true false false true false false false false false false 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 10 0 true 690 true false false false false false false false false false false X 43 42 true false false false true true true true true false false true true true true true true false false false NY X DAVID INGBER - MONTEFIORE 9143498400 HLTH SYS INC 555 S BDWY TARRYTOWN NY 10591 ODED ABOODI VICE CHAIRMAN & TREASURER 0.2 2.3 X 0 0 0 JAY B ABRAMSON TRUSTEE 0.2 2.3 X 0 0 0 MARGARET HAYES ADAME TRUSTEE 0.2 1.8 X 0 0 0 GEORGE ASCH TRUSTEE 0.2 1.3 X 0 0 0 JOSEPH W BARTLETT TRUSTEE 0.2 1.3 X 0 0 0 PATRICIA BAUMAN TRUSTEE 0.2 1.3 X 0 0 0 JAMES M BUTLER TRUSTEE 0.2 2.3 X 0 0 0 GEORGE CAMPBELL JR PHD TRUSTEE 0.2 2.3 X 0 0 0 BRUCE DONIGER TRUSTEE 0.2 1.3 X 0 0 0 RUTH L GOTTESMAN EDD TRUSTEE 0.2 1.3 X 0 0 0 BARRY W GRAY TRUSTEE 0.2 1.3 X 0 0 0 PATRICIA GREEN TRUSTEE 0.2 1.3 X 0 0 0 JOHN H GUTFREUND TRUSTEE(trustee emeritus 6/15) 0.2 1.3 X 0 0 0 THOMAS L HARRISON TRUSTEE 0.2 1.3 X 0 0 0 JOHN HEFFER TRUSTEE 0.2 2.3 X 0 0 0 LEWIS HENKIND SECRETARY 0.2 3.3 X 0 0 0 HELEN A JOHNSON TRUSTEE 0.2 2.3 X 0 0 0 DAVID B KEIDAN TRUSTEE 0.2 1.3 X 0 0 0 ALAN M KLEIN TRUSTEE 0.2 3.3 X 0 0 0 STACEY R LANE TRUSTEE 0.2 2.3 X 0 0 0 JAY B LANGNER TRUSTEE/CHAIRMAN EMERITUS 0.2 1.3 X 0 0 0 MARGARET S NATHAN TRUSTEE 0.2 1.3 X 0 0 0 PETER J NEUFELD TRUSTEE 0.2 2.3 X 0 0 0 GAYLE F ROBINSON TRUSTEE 0.2 1.3 X 0 0 0 JON W ROTENSTREICH TRUSTEE 0.2 1.3 X 0 0 0 HON FELICIA K SHEA TRUSTEE 0.2 1.3 X 0 0 0 EDWIN H STERN III TRUSTEE 0.2 1.3 X 0 0 0 DAVID A TANNER CHAIRMAN 0.2 7.8 X 0 0 0 CYNTHIA KING VANCE TRUSTEE 0.2 2.3 X 0 0 0 JIDE J ZEITLIN TRUSTEE 0.2 1.3 X 0 0 0 JENNIE EMIL TRUSTEE 0.2 1.3 X 0 0 0 JONATHAN A LIPTON TRUSTEE 0.2 1.3 X 0 0 0 ZITA G ROSENTHAL TRUSTEE 0.2 1.3 X 0 0 0 GREGG S HYMOWITZ TRUSTEE 0.2 1.3 X 0 0 0 NATHAN GANTCHER TRUSTEE 0.2 1.3 X 0 0 0 CATHERINE KLEMA TRUSTEE 0.2 1.3 X 0 0 0 MELISSA CERIALE TRUSTEE 0.2 1.3 X 0 0 0 MARK MLOTEK TRUSTEE 0.2 1.3 X 0 0 0 BARRY S BLATTMAN TRUSTEE 0.2 1.3 X 0 0 0 MARK E BROSSMAN TRUSTEE 0.2 1.3 X 0 0 0 MATTHEW H NORD TRUSTEE 0.2 1.3 X 0 0 0 MICHAEL A STOCKER MD TRUSTEE 0.2 1.3 X 0 0 0 ROGER EINIGER TRUSTEE 0.2 1.3 X 0 0 0 STEVEN M SAFYER MD PRESIDENT & CEO 1.0 59.0 X X 0 4283893 51255 DAVID C GOTTLIEB TRUSTEE (RESIGNED 6/15) 0.2 1.3 X 0 0 0 BRUCE J KLATSKY TRUSTEE (RESIGNED 2/15) 0.2 1.3 X 0 0 0 CHRISTOPHER D MCFADDEN TRUSTEE (RESIGNED 11/15) 0.2 1.3 X 0 0 0 PHILIP O OZUAH MDPHD EXECUTIVE VP & COO 1.0 59.0 X 0 2285645 697133 CHRISTOPHER S PANCZNER SENIOR VP & GENERAL COUNSEL 1.0 59.0 X 0 1110866 232140 JOEL A PERLMAN EXECUTIVE VICE PRESIDENT & CFO 1.0 59.0 X 0 1529529 51011 SUSAN GREEN-LORENZEN RN SENIOR VP-OPERATIONS 1.0 59.0 X 0 1194177 296068 LYNN RICHMOND Executive Vice President 1.0 59.0 X 0 1256752 282642 Bentley A Ogoke MD Anesthesiologist 60.0 0.0 X 467046 0 36662 BALASA PRASAD MD ANESTHESIOLOGIST 60.0 0.0 X 467484 0 6800 FRANCIS AGBONKPOLO MD ANESTHESIOLOGIST 60.0 0.0 X 405845 0 29108 RICHARD PETRILLO MD CHAIRMAN-DEPT OF MEDICINE 60.0 0.0 X 305676 0 7524 CLAUS P VON SCHORN MD PHYSICIAN 60.0 0.0 X 309824 0 15107 1955875 11660862 1705450 97 false true false Excel Emergency Physn Svcs Hud Val 484 Temple Hill Road Suite 102 NEW WINDSOR NY 12553 Emergency medical 980492 Fastaff Inc PO Box 911452 DENVER CO 80291 Traveling nurse 1208742 Quest Diagnostic Inc 7402 Collection Center Drive CHICAGO IL 60693 Medical lab testing 876758 McRoberts Protective Agency Inc 46 Throckmorton Street FREEHOLD NJ 07728 Security 762509 Healogics Wound Care Hyperbaric S 3087 Momentum Place CHICAGO IL 60689 Wound care 654814 27 14884265 14884265 INPATIENT SERVICES 623000 43265408 43265408 OUTPATIENT SERVICES 623000 19847686 19847686 63113094 0 0 0 0 0 0 0 0 0 0 MISCELLANEOUS INCOME 900099 804715 804715 CAFETERIA/COFFEE SHOP & VENDING INCOME 722514 260462 260462 PARKING INCOME 812930 112487 112487 1498353 1498353 2676017 80673376 63113094 2676017 0 0 0 0 0 0 38112433 32922425 5190008 0 8944291 7919381 1024910 2708090 2383119 324971 1456165 1220681 235484 0 0 19898 19898 0 0 6856952 6799837 57115 0 3253131 2531800 721331 91529 91529 0 7360206 5948416 1411790 0 0 0 670071 670071 0 1545444 1545444 3589782 3589782 MEDICAL SUPPLIES & EXPENSES 8242067 8222537 19530 COLLECTION FEES 17172 17172 MEMBERSHIP DUES 350395 350395 83217626 73845022 9372604 0 1241287 2901909 0 0 0 0 16037952 10471688 0 0 0 0 0 0 1118079 1888444 121150 126205 14336882 2493714 9007169 11843168 0 0 0 0 0 0 0 0 0 0 27525637 27231414 16971539 11317072 0 0 0 0 0 0 0 0 0 0 0 0 0 0 18330373 26234867 35301912 37551939 X -7776275 -10320525 0 0 0 0 -7776275 -10320525 27525637 27231414 -2544250 X false true X true true true X false false false false false false true 19898 false false 19898 false PART II-B, LINE G THE HOSPITAL'S LOBBYING EXPENDITURES ARE A PERCENTAGE OF MEMBERSHIP DUES PAID TO THE GREATER NEW YORK HOSPITAL ASSOCIATION AND THE HEALTH CARE ASSOCIATION OF NYS THAT ARE USED FOR LOBBYING EFFORTS. 1511751 70192 1441559 11532422 2423508 9108914 1292695 1292695 11843168 0 LINE OF CREDIT - PARENT 3998309 EQUIPMENT LOAN - PARENT 10214745 DUE TO RELATED COMPANIES 12021813 26234867 true true X true X true X 500. true true true false true true 3244625 7905576 0 0.00000 33020222 19674641 13345581 0.15720 36264847 27580217 13345581 0.15720 4387142 2465014 1922128 0.02260 9582983 7410492 2172491 0.02560 13970125 9875506 4094619 0.04820 50234972 37455723 17440200 0.20540 false 1569453 1401522 11396804 8673124 2723680 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 13 true false false true X MONTEFIORE.ORG X true 13 true MONTEFIORE.ORG false false true X 100 500. true true X true X www.montefiorehealthsystem.org X www.montefiorehealthsystem.org X same as above X X X X true X false X X X X true X false false PART V, SECTION B, LINE 5: Montefiore Mount Vernon Hospital WIC Community Advisory Group was utilized to gather input from community stakeholders on the health of the community. This key stakeholder group is made up of consumer participants as well as a select number of members from civic, municipal and non-governmental service providers, leaders in the business and faith communities and non-affiliated community residents. The community advisory group participated in an extensive data review session examining over 400 data categories specifically related to the indicators overall health status as well as indicators of the social, environmental, and economic determinants of health. Montefiore Mount Vernon Hospital also met with the Deputy Commissioner, Diane Atkins to gain a greater understanding of the process for the county in selecting health priorities. PART V, SECTION B, LINE 11: The two areas of most significant need that were identified in the CHNA were following: (1) The prevention of chronic disease. (2) The promotion of healthy women, Infants, and children. Prevention of Chronic Disease: Montefiore Mount Vernon Hospital has selected to focus on reducing the racial disparities by decreasing the percentage of Blacks and Hispanics dying prematurely from heart related diseases by concentrating on reducing tobacco and nicotine consumption among these populations in the service area. Tobacco and nicotine consumption, among these populations in the service area is a leading causal indicator in heart related disease. The strategic plan is to increase screening rates for cardiovascular disease as well as for diabetes, breast, cervical, and colorectal cancers. In conjunction with the screening process the plan is to influence patients to quit smoking and to reduce the prevalence of smoking in the service area. By providing 100% of the inpatient population with information on the New York State Quit Line, by expanding the smoke free campus to all locations, and by being an ardent supporter of supplemental nicotine replacement therapy there is a strong likelihood of reducing the racial disparity of rates of premature death from heart related and other diseases. Promotion of Healthy Women, Infants, and Children: The increase in the proportion of infants that are exclusively breastfed for the first six months of life is an important factor in the promotion of healthy women, infants, and children. The Montefiore Westchester Hospitals are committed to achieving the goals of the Baby Friendly Hospital initiative. The following objectives have been identified to achieve this initiative: 1. Enforcement of New York State Hospital regulation to not supplement breastfeeding infants with formula feeding unless medically indicated and documented within the infants medical record. 2. Provide physical restrictions to infant formula by hospital staff including the tracking of infant formula distribution with the Health Department. 3. Discontinue the distribution of free promotional formula 4. Prohibit the display and distribution of infant formula promotion materials in any hospital location. Montefiore Mount Vernon Hospital will support the Mount Vernon commitment to support mothers who choose to breastfeed by providing additional resources to breastfeeding mothers and to minimize practices that can interfere with that choice such as supplementing breastfeeding infants with formula, unless medically indicated or at the mother's specific request. PART V, SECTION B, LINE 22D: CONSISTENT WITH THE PROVISIONS OF THE JUNE 22, 2012 IRS RULE REGARDING THE ESTABLISHMENT AND IMPLEMENTATION OF FINANCIAL AID POLICIES (FAPS) UNDER SECTION 501 (R) OF THE INTERNAL REVENUE CODE, THE HOPITAL USES THE LOOK-BACK METHOD TO CALCULATE A SEPARATE AMOUNTS GENERALLY BILLED (AGB) PERCENTAGE FOR EACH CATEGORY OF CARE PROVIDED TO FAP-ELIGIBLE INDIVIDUALS. THE HOSPITAL LIMITS THE MAXIMUM AMOUNTS THAT CAN BE CHARGED TO FAP-ELIGIBLE INDIVIDUALS FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE AT THE FOLLOWING LEVELS: - FOR PATIENTS BELOW 100% OF THE FEDERAL POVERTY LEVEL (FPL) - CAPPED AT THE LOWER OF THE AGB OR NOMINAL PAYMENT AMOUNT SET FORTH IN THE NEW YORK STATE HOSPITAL FINANCIAL ASSISTANCE LAW (HFAL) PURSUANT TO SUBDIVISION 9-A OF SECTION 2807-K OF THE NEW YORK PUBLIC HEALTH LAW. - FOR PATIENTS BETWEEN 100% AND 300% OF FPL - CAPPED AT THE LOWER OF THE AGB OR SLIDING FEE SCALE AMOUNTS RANGING FROM 20% TO 100% OF THE AVERAGE MEDICAID RATE CONSISTENT WITH THE PROVISIONS OF THE NEW YORK STATE HOSPITAL FINANCIAL ASSISTANCE LAW. - FOR PATIENTS BETWEEN 300% AND 500% OF FPL - CAPPED AT THE AMOUNTS GENERALLY BILLED. 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 HOSPITAL 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 SHORTFALL OF $1,145,546. REVENUE ALLOWABLE SURPLUS COST (SHORTFALL) PART III, LINE 5-7: $11,396,804 $8,673,124 $2,723,680 ADD: MED. CENTERS COSTS: - 536,636 (536,636) ADD: MEDICARE DME: 1,164,373 1,986,866 (822,493) ADD: MED. CENTER EMPL. PHY.: 199,935 1,016,133 (816,198) ADD: MED. SUBSID. HLTH. SERV.: 3,070,375 4,764,274 (1,693,899) TOTAL OVERALL MEDICARE SHORTFALL:$15,831,847 $16,917,033 $(1,145,546) 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 MOUNT VERNON HOSPITAL INITIATED OPERATIONS ON NOVEMBER 6, 2013. AS A NEW FACILITY, BOTH A FORMAL COMMUNITY HEALTH NEEDS ASSESSMENT AND A NEW YORK COMMUNITY SERVICE PLAN OUTLINING COMMUNITY NEEDS WERE DEVELOPED AND COMPLETED BY DECEMBER 31, 2014. 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 DETAILED IDENTIFICATION OF THE COMMUNITY'S DEMOGRAPHICS AND SPECIFIC NEEDS ARE DOCUMENTED IN THE 2014 COMMUNITY HEALTH NEEDS ASSESSMENT. 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 MOUNT VERNON HOSPITAL'S COMMUNITY HEALTH PROGRAMS ARE IN DEVELOPMENT WITH THE OVERALL COMMUNITY HEALTH NEEDS ASSESSMENT. 6. AFFILIATED HEALTH CARE SYSTEM: MONTEFIORE MOUNT VERNON HOSPITAL IS AN AFFILIATE OF MONTEFIORE HEALTH SYSTEM, INC. 7. STATE FILING OF COMMUNITY BENEFIT REPORT: MONTEFIORE MOUNT VERNON` HOSPITAL FILES A COMMUNITY SERVICE PLAN WITH THE STATE OF NEW YORK. false true false false false false false false false PHILIP O OZUAH MDPHD EXECUTIVE VP & COO 0 1539345 0 619200 0 127100 0 663122 0 34011 0 2982778 0 0 CHRISTOPHER S PANCZNER SENIOR VP & GENERAL COUNSEL 0 697112 0 392200 0 21554 0 232140 0 0 0 1343006 0 0 JOEL A PERLMAN EXECUTIVE VICE PRESIDENT & CFO 0 1018981 0 507500 0 3048 0 17000 0 34011 0 1580540 0 0 Bentley A Ogoke MD Anesthesiologist 466014 0 0 0 1032 0 6800 0 29862 0 503708 0 0 0 BALASA PRASAD MD ANESTHESIOLOGIST 467484 0 0 0 0 0 6800 0 0 0 474284 0 0 0 FRANCIS AGBONKPOLO MD ANESTHESIOLOGIST 404813 0 0 0 1032 0 6800 0 22308 0 434953 0 0 0 RICHARD PETRILLO MD CHAIRMAN-DEPT OF MEDICINE 305676 0 0 0 0 0 6800 0 724 0 313200 0 0 0 CLAUS P VON SCHORN MD PHYSICIAN 308240 0 0 0 1584 0 6800 0 8307 0 324931 0 0 0 SUSAN GREEN-LORENZEN RN SENIOR VP-OPERATIONS 0 785243 0 386900 0 22034 0 263986 0 32082 0 1490245 0 0 LYNN RICHMOND Executive Vice President 0 782898 0 446300 0 27554 0 249178 0 33464 0 1539394 0 0 STEVEN M SAFYER MD PRESIDENT & CEO 0 1768651 0 1203200 0 1312042 0 17000 0 34255 0 4335148 0 0 PART I LINES 3, 4B & PART II - COLUMNS (B)(I), (II) AND (III) As it relates to Compensation from 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. Steven Safyer, MD - Pooled Supplemental Executive Retirement Plan distribution of $1,300,859 based on more than 30 years of service at Montefiore. Christopher Panczner - Accrued and unpaid service costs of $215,140. Philip O. Ozuah, MD, PHD. - Accrued and unpaid service costs of $646,122. Susan Green Lorenzen, RN - Accrued and unpaid service costs of $246,986. Lynn Richmond - Accrued and unpaid service costs of $232,178. The Directors, Officers and Key Employees listed in Part II Lines 1(ii), 2(ii), 3(ii), 9(ii), 10(ii) and 11(ii) are not employees of this filing organization, Montefiore Mount Vernon Hospital. These individuals are employed and their compensation is paid by Montefiore Health System, Inc. EIN 20-1615393. FORM 990, PART VI, SECTION A, LINE 2: David C. Gottlieb (trustee - resigned 6/15) is related to Jay B. Langner (trustee) - Family relationship. 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, ACCOUNTING AND 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 CONFLICTS OF INTEREST POLICY BY MEANS OF A SURVEY THAT WAS DEVELOPED BY MONTEFIORE'S COUNSEL. MONTEFIORE MOUNT VERNON HOSPITAL'S BOARD OF TRUSTEES ADOPTED A POLICY THAT COMPORTS TO FEDERAL AND STATE CONFLICTS OF INTEREST REQUIREMENTS. THE GENERAL APPROACH WHEN A POTENTIAL CONFLICT OF INTEREST ARISES IS TO DISCLOSE THE POSSIBLE CONFLICT TO THE COMPLIANCE OFFICER. THE COMPLIANCE OFFICER WILL MAKE EVERY EFFORT TO PROVIDE GUIDANCE TO PERMIT RESOLUTION OF ANY ACTUAL OR POTENTIAL CONFLICTS OF INTEREST. THE COMPLIANCE OFFICER WILL TAKE APPROPRIATE ACTIONS, INCLUDING ADVISING MONTEFIORE MOUNT VERNON HOSPITAL'S BOARD OF TRUSTEES REGARDING PARTICULAR CONFLICTS OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15A & 15B: DETERMINATION OF OFFICER'S COMPENSATION: The Officers presented in Part VII and Schedule J are not employed and paid by the organization rather are employed and paid by Montefiore Health System, Inc. 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 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) 11 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) 11 TYPE II MMC true Gun Hill MRI PC 200 EAST GUNHILL ROAD BRONX NY 10467 133734486 DIAG SERVICES NY 501 (C)(3) 11 TYPE I MMC true Montefiore Health System Inc 555 SOUTH BROADWAY TARRYTOWN NY 10591 201615393 PARENT CO. NY 501 (C)(3) 11 TYPE III MMAHS false Montefiore Residential Corp 1 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 10801 462929888 Nursing Home NY 501 (C)(3) 3 MHS true Montefiore New Rochelle Hospital 16 Guion Place New Rochelle NY 10801 462931956 Hospital NY 501 (C)(3) 3 MHS true Albert College of Medicine Inc 111 East 210th Street Bronx NY 10467 472209056 MED COLLEGE NY 501 (C)(3) 2 MMAHS false Montefiore Medicine Acad Hlth SystInc 555 South Broadway Tarrytown NY 10591 471582973 SYS PARENT NY 501 (c)(3) 11 Type III NA false The Nyack Hospital 160 North Midland Avenue Nyack NY 10960 131740119 Hospital NY 501 (c)(3) 3 MHS true MONTEFIORE FOUNDATION INC 111 EAST 210TH STREET BRONX NY 10467 471600439 FOUNDATION NY 501 (C)(3) 11 TYPE I MHS true White Plains Hospital Medical Center 41 East Post Road White Plains NY 10601 131740130 HOSPITAL NY 501 (C)(3) 3 MHS true Einstein College of Med Housing CoInc 1300 Morris Park Avenue Bronx NY 10461 237075620 STAFF HOUSING NY 501(C)(2) MMAHS false Montefiore CERC Operations Inc 111 East 210th Street Bronx NY 10467 474853506 REHAB CENTER NY 501 (C)(3) II TYPE I MMC true White Plains Hospital Center Foundation 41 East Post Road Davis Avenue White Plains NY 10601 133281507 FOUNDATION NY 501(C) (3) 7 WPH false Nyack Hospital Foundation 160 North Midland Avenue Nyack NY 10960 133245804 FOUNDATION NY 501(C) (3) 7 NYACK HOSP false 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 Managed Care NY NA C CORP true MMC GI HOLDINGS EAST INC 111 EAST 210TH STREET BRONX NY 10467 721610013 HOLDING COMPA NY NA C CORP true MMC GI HOLDINGS WEST INC 111 EAST 210TH STREET BRONX NY 10467 721610015 HOLDING COMPA NY NA C CORP true MONTEFIORE BEHAVIORAL CARE IPA NO 1INC 111 EAST 210TH STREET BRONX NY 10467 133952750 INTEG PROV AS NY NA C CORP true BRONX ACCOUNTABLE CARE NETWORK IPA INC 111 EAST 210TH STREET BRONX NY 10467 300689571 MANAGED CARE NY NA C CORP true Montefiore Consolidated Ventures Inc 111 East 210th Street Bronx NY 10467 611728539 Holding Compa NY NA C Corp true MMC Contract Management Org No 1 Inc 111 East 210th Street Bronx NY 10467 133859895 Contract Mgmt NY NA C Corp true Montefiore Insurance Company Inc 111 East 210th Street Bronx NY 10467 320436594 INSURANCE COMPANY NY NA C Corp true Montefiore Community Network LLC 111 East 210th Street Bronx NY 10467 461374475 COMMUNITY NETWORK NY NA C Corp true Hudson Valley IPA Inc 111 East 210th Street Bronx NY 10467 383978087 MANAGED CARE NY NA C CORP true Montefiore Innovations Inc 111 East 210th Street Bronx NY 10467 475106910 HOLDING COMPANY NY NA C CORP true Highland Medical PC 160 North Midland Nyack NY 10960 134034481 PHYSICIAN SERV NY NA C CORP true 8 Longview Development Corp Davis Avenue at East Post Road White Plains NY 10601 263321278 HOUSING NY NA C CORP true White Plains Medical Diagnostic Service 41 East Post Road White Plains NY 10601 453164626 PROFESSIONAL SERV NY NA C CORP true Cancer and Blood Medical Services of NY 41 East Post Road White Plains NY 10601 462021804 PROFESSIONAL SERV NY NA C CORP true NH Management Services Inc 160 N Midland Avenue Nyack NY 10960 134026486 MANAGEMENT SERV. NY NA C CORP true Davis Avenue Corp Davis Avenue at East Post Road White Plains NY 10601 133331643 HEALTHCARE SERV NY NA C CORP true Post Development Corporation Davis Avenue at East Post Road White Plains NY 10601 222605281 REAL ESTATE NY NA C CORP true White Plains Management Co Inc 41 East Post Road White Plains NY 10601 133331641 MANAGEMENT SERV. NY NA C CORP true WPHC Building Corp 41 East Post Road White Plains NY 10601 133676932 REAL ESTATE NY NA C CORP true false false false false true false false false false false true false true false false true false false true MONTEFIORE HEALTH SYSTEM INC K 821448 COST MONTEFIORE HEALTH SYSTEM INC M 1368154 COST MONTEFIORE MEDICAL CENTER M 1572318 COST MONTEFIORE MEDICAL CENTER S 618006 COST