2016-11-11T09:00:29-07:00 2015-12-31 990 2015-01-01 141338547 THE SARATOGA HOSPITAL SARA 5185873222 211 Church Street Saratoga Springs NY 128661090 GARY FOSTER VICE PRESIDENT & CFO 5185838421 2016-11-15 2015 2017-02-10 21:41:12Z Angelo Calbone 211 Chruch Street Saratoga Springs NY 12866 296594029 0 X www.saratogahospital.org X 1891 NY To serve the people of the Saratoga region by providing them access to excellence in healthcare in a supportive and caring environment. 16 13 2708 250 3891281 633214 4612511 1651111 248273854 264122177 3147979 1032454 11795899 14428653 267830243 281234395 0 0 0 0 137774013 153025036 0 0 360896 111044912 112506665 248818925 265531701 19011318 15702694 303227947 319478338 116089540 116999490 187138407 202478848 X To serve the people of the Saratoga region by providing them access to excellence in healthcare in a supportive and caring environment. 1 0 244649896 0 264122172 The foremost commitment of the Hospital is to provide superior quality healthcare to the people of our community, regardless of their ability to pay. Saratoga Hospital is the largest healthcare provider and only hospital located in Saratoga County. The services provided by the Hospital to the community are broad and varied. Following is a listing of some of the most significant of those services: * The Hospital operates the only emergency department in Saratoga County 24 hours per day, 365 days per year. During 2015, the hospital emergency department facilitated 35,913 patient visits. * The Hospital represents the only inpatient acute care facility in Saratoga County. During 2015, the Hospital had 8,705 admissions for inpatient adult and pediatric care. These admissions included 742 births, 603 admissions to our inpatient mental health unit and 60 admissions for Hospice care. Total adult and pediatric inpatient days for the Hospital during 2014 were 42,593 which included 4,306 days of inpatient care in the Critical Care Unit. * The Hospital operates a 36-bed skilled nursing facility on its campus. During 2015, 11,936 patient days of skilled nursing care were provided. * The hospital maintains a Financial Assistance policy, eligibility for benefit from which is determined by the Hospital's patient financial services department based upon the financial means of the patient and/or patient's family. The amount of charity care benefit provided to patients is based on the comparison of their documented income versus annual Federal Poverty Level (FPL) standards. The following is a sliding scale of benefits (as a percentage of patient responsibility for reimbursement) available to patients with varying levels of income: o FPL x 250% or below- 100% discount o FPL x 300%- 75% discount o FPL x 350% - 50% discount o FPL x 400%- 25% discount In addition to the means-tested financial assistance program described above, the Hospital provides an automatic discount from charges (76% for 2015) for any uninsured patients receiving care at any of the hospital's locations. The discount percentage is determined annually and is designed to result in uninsured patients being billed no more for services than the Hospital would be reimbursed by Medicare for the same services. This discount applies regardless of a patient's ability to pay. The discount is shown clearly on any bills sent to the patient in order to enhance awareness of the availability of this benefit. The Hospital also provides discounted rates to uninsured patients receiving care at its emergency department or urgent care site. Uninsured patients are asked to pay a flat fee per visit, regardless of the amount of charges to their account. Each patient is classified into one of three tiers based on the level of services provided, with a progressively higher all-inclusive fee for each tier. The first tier is for urgent care visits consisting of only an office visit, the second tier is for visits including and office visit and any laboratory or x-ray procedures and the third tier is for visits including an office visit and CT or MRI scans. During 2015, the benefits provided under these policies, measured on the basis of costs, amounted to approximately $3,444,000. * The Hospital has one site providing urgent care services to the community. Many patients in the community are unable to access primary care on a timely basis if at all. The Hospital has continually expanded access to the urgent care site, including nights and weekends in order to meet community need. As a result, our urgent care site has become a significant portal of access to care for the community. During 2015, our urgent care site accommodated 33,110 patient visits. * During 2015 the hospital incurred bad debt expense of approximately $4,355,000 measured on the basis of charges. The bad debt expense continues to be largely comprised of patients having no or insufficient insurance, and also of patients using our emergency department and urgent care facilities, which uninsured patients will often utilize as an option as opposed to receiving no care at all. * As the largest healthcare provider in the community, the Hospital serves a significant number of Medicare and Medicaid insured patients. Losses incurred from providing services to Medicare and Medicaid patients during 2015 were approximately $7,313,000 and $15,378,000, respectively. * The Hospital is the community leader in assessing community healthcare needs and working to bring the needed services into the community. These efforts include the following: o Subscriptions to databases providing demographics for the communities served. Based on information such as age, gender, etc. anticipated needs by physician specialty and type of inpatient or outpatient care are determined. o Continuous patient satisfaction surveys are conducted in order to gain patient feedback regarding the quality of care received and perceptions of their overall experience as patients. o "Secret shopper" calls are conducted whereby Hospital personnel call physician practices in the community in order to determine accessability to physician care in terms of days wait to be seen for acute and chronic problems. o Community input is obtained through information gathering sessions held with human resources representatives of local business, as well as representatives from other not-for-profit and governmental agencies operating in the community. In addition to discussion occurring at the sessions, those whose attend as well as those who are unable to attend are asked to return written surveys to the Hospital. The surveys include questions regarding the availability and quality of health care services in the community. o Ongoing dialogue with medical staff members regarding their perceptions regarding quality of care and areas of need for the community. o Formalized tracking processes for patient communications and complaints. * As a result of its leadership role in identifying community healthcare needs, the Hospital is also the key resource in its community for recruiting physicians practicing in areas of medicine identified as underserved in the community. A component of this recruitment effort includes the extension of relocation incentives to physicians in the targeted need areas. The incentives exist in the form of income guarantees that are provided in an effort to make practice start-up financially palatable for relocating physicians. After an initial period during which funds are advanced to physicians as they have shortfalls versus a targeted income amount, the accumulated advances are converted to promissory notes. Should the physician remain in practice in the community for a contractually agreed-upon number of years after the initial benefit period, the note will be forgiven in full. During 2015, the Hospital forgave advances plus accrued interest amounting to approximately $224,000 relating to these arrangements. * The Hospital is the lead agency in Saratoga County for administering the State of New York's Cancer Services Program (CSP). In the role of CSP administrator for the County, Hospital personnel actively seek out low-income members of the community who possess certain risk factors, such as age or gender, and facilitate cancer screenings and, if necessary, treatment services for eligible individuals. The services are provided at no cost to the individuals. The State reimburses the Hospital for any screening or treatment services provided to these patients based on Medicaid reimbursement rates. The State reimburses the Hospital for a portion of the administrative costs incurred by the Hospital in identifying eligible individuals and coordinating screening and treatment services. During 2015, unreimbursed costs of administering the program were approximately $39,000. * Hospital personnel take a leading role in development and maintenance of a County-wide emergency preparedness and response plan, including corresponding with law enforcement, fire, emergency medical services and other relevant agencies to develop, test and maintain a plan for managing the public health effects of a large-scale natural disaster or other significant community-wide crisis. 0 0 0 244649896 1 0 0 1 0 0 0 0 0 1 1 1 0 0 1 1 1 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 1 0 0 0 1 0 1 0 1 0 0 0 0 0 1 0 1 0 1 125 0 1 2708 1 1 1 1 CJ 0 0 0 0 X 16 13 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X X MICHAEL BATTLE 5185838498 The Saratoga Hospital 211 Church Street Saratoga Springs NY 12866 Janice M White Chairperson 2.5 0 X 0 0 0 David M Mastrianni MD Co-Vice Chairperson 2.5 0 X 0 0 0 Donna Montalto Board Member 2.5 0 X 0 0 0 Michael H Iacolucci Treasurer 2.5 0 X 0 0 0 Theresa M Skaine Secrectary 2.5 0 X 0 0 0 Dennis A Brobston Board Member 2.5 0 X 0 0 0 Judith A Ekman Board Member 2.5 0 X 0 0 0 Eugene K Merecki MD Board Member 2.5 0 X 0 0 0 Alan C Oppenheim Board Member 2.5 0 X 0 0 0 George E Silver MD Board Member 2.5 0 X 0 0 0 William R Stanley Board Member 2.5 0 X 0 0 0 N Keith Stewart Board Member 2.5 0 X 0 0 0 Michael J Toohey Board Member 2.5 0 X 0 0 0 Frank L Messa Board Member 2.5 0 X 0 0 0 Michael D West Board Member 2.5 0 X 0 0 0 Angelo G Calbone President/CEO 38 0 X X X 761845 0 32344 Gary Foster VP & CFO 38 0 X X 334655 0 16644 Richard Falivena VP Chief Medical and Physician Integration Officer 38 0 X 406732 0 21823 Mary Jo LaPosta SVP Patient Care and Organizational Excellence and Chief Nursing Officer 38 0 X 365271 0 21091 Kevin Ronayne VP Operations/Facilities 38 0 X 279517 0 30372 John Mangona VP Chief Information and Compliance Officer 38 0 X 284957 0 15182 Jeffrey Methven VP Ambulatory Serv &HR 38 0 X 297032 0 29982 Gordan Kuhar Physician 38 0 X 1093446 0 12284 Theodoros Laddis Physician 38 0 X 650720 0 10096 Gary Idelchik Physician 38 0 X 649306 0 16403 Dmitri Baranov Physician 38 0 X 546023 0 15781 Rachid Daoui Physician 38 0 X 531490 0 26224 6200994 0 248226 179 0 1 0 AOW Associates Inc 30 Essex Street Albany NY 12206 Construction 10246961 Saratoga Emergency Physicians PC The Saratoga Hospital 211 Church Street Saratoga Springs NY 12866 Physicians 3224860 Laboratory Corp of America 2975 W CORPORATE LAKES BLVD WESTON FL 333313626 Medical Laboratory Testing 1643936 STRATEGIC SOLUTIONS 3 CORPORATE DRIVE SUITE 100 CLIFTON PARK NY 12065 Medical Billing 1581624 HYPERTYPE INC 39 HALADA DR LAKE GEORGE NY 12845 Transcription Service 1069059 35 0 0 0 1191906 459205 0 0 1651111 Not For Profit Hospital 622000 148928352 148928352 0 0 Medicare,Traditional and MC 622000 97960178 97960178 0 0 Medicaid, Traditional and MC 622000 13330014 13330014 0 0 Specimen Drop Offs 621500 3903633 0 3903633 0 0 0 0 0 264122177 869931 0 -12352 882283 10139 0 0 10139 0 0 0 0 22920 0 60390 0 -37470 0 -37470 -37470 0 0 15254333 0 15091649 10300 162684 -10300 152384 152384 0 0 13999 0 8279 5720 0 5720 0 0 0 0 0 0 650239 189016 461223 0 0 461223 Contracted Services 621110 6623999 6623999 0 0 Cafeteria 722210 1275527 0 0 1275527 EMR Incentive 900099 813291 813291 0 0 5286363 5286363 0 0 13999180 281234395 273057111 3891281 2634892 0 0 0 0 0 0 0 0 2886918 0 2886918 0 0 0 0 0 121890776 113126977 8590000 173799 4229585 3840010 389575 0 15637138 14196845 1440293 0 8380619 7608703 771916 0 109747 109747 0 0 556131 0 556131 0 112821 0 112821 0 30288 0 30288 0 0 0 93778 0 93778 0 16165445 14774810 1390635 0 873576 21804 851772 0 14031311 12081771 1861545 87995 2594396 2452846 141550 0 0 0 0 0 6991916 6719412 181320 91184 18782 16988 1794 0 0 0 0 0 665943 608475 49550 7918 77305 77305 0 0 0 0 0 0 13023418 12312860 710558 0 1788087 1778966 9121 0 Bad Debt 4355000 4355000 0 0 Medical Supplies 50110464 50110464 0 0 908257 456913 451344 265531701 244649896 20520909 360896 34150438 26806806 16209912 24846610 0 0 27564755 28374083 0 0 0 0 2427380 2559137 6119825 6560768 4649412 4790241 302185530 173331266 114432700 128854264 59785012 50941122 28570967 37166151 15001 15001 0 0 9302545 8564155 303227947 319478338 24264967 28769732 0 0 0 0 75269767 73245106 0 0 0 0 4382105 5401208 3450000 3250000 8722701 6333444 116089540 116999490 X 181745152 196182673 3817963 4944403 1575292 1351772 187138407 202478848 303227947 319478338 15702694 -362253 0 0 0 0 X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 30288 30288 0 Schedule C, Part II-B, Line 1 A portion of the annual dues paid by the Hospital for its memberships in three organizations: American Hospital Association, Iroquois Healthcare Alliance and Healthcare Association of New York State, are used by those organizations for lobbying purposes. The portion of annual dues determined to relate to those organizations' lobbying activities is determined by the Hospital based on documentation received from those organizations. 11026699 701682 -39754 0 0 0 11688627 9804371 157093 1065235 0 0 0 11026699 8002591 857164 944616 0 0 0 9804371 7412104 67000 523487 0 0 0 8002591 7880460 90942 -559298 0 0 0 7412104 0.88 0.12 0 0 0 0 15108598 15108598 0 76448614 36376020 40072594 0 3528003 3435739 92264 0 193442253 126698564 66743689 0 13658062 6820943 6837119 128854264 Limited Partnership Investment-Balanced Strategy 27236073 F Limited Partnership Investment-Healthcare Strategy 1500644 F Limited Partnership Investment-Absolute Return Strategy 7032339 F Limited Partnership Investment-Private Equity 1397095 F 37166151 33402 Estimated Third Party Settlements 3215000 Other Long-Term Liabilities 3085042 6333444 X 274479868 -362251 0 0 -4146853 -4509104 278988972 596867 1648556 2245423 281234395 260279329 0 0 0 60390 60390 260218939 596867 4715895 5312762 265531701 Schedule D, Part V, Line 4 Permanent endowment funds are restricted to support specific programs, such as The Community Health Center or general operations of the Hospital. Board-designed endowment funds are not restricted for any specific purpose and can be used to support hospital projects or operations at the discretion of the Board of Trustees. Schedule D, Part X, Line 2 The Hospital has been determined by the Internal Revenue Service to be an organization described in Internal Revenue Code (the Code) Section 501(c)(3) and, therefore, is exempt from federal income taxes on related income pursuant to Section 501 (a) of the Code. The Hospital recognizes the effect of income tax positions only if those positions are more likely than not of being sustained. Recognized income tax positions are measured at the largest amount that is greater than fifty percent likely of being realized upon settlement. Changes in recognition in measurement are reflected in the period in which the change in judgment occurs. The Hospital did not recognize the effect of any uncertain income tax positions in either 2015 or 2014 Schedule D, Part XI, Line 2d Net Assets Released from Restriction for Operations $208,145 and Provision for Bad Debts ($4,355,000). Schedule D, Part XI, Line 4b Rental Expenses ($60,390). Restricted Gifts $1,238,023, and Hospital Guild Revenue $470,923. Schedule D, Part XII, Line 2d Rental Expenses $60,390. Schedule D, Part XII, Line 4b Provision for Bad Debts $4,355,000 and Hospital Guild Expenses $360,900. 1 1 1 X 2.50 1 X 1 1 0 1 1 0 0 3053273 1119599 1933674 0.00728 0 0 26761733 11383838 15377895 0.05791 0 0 0 0 0 0 0 0 29815006 12503437 17311569 0.06519 13 1554 3175562 1837578 1337984 0.00504 11 475 148281 0 148281 0.00056 0 0 0 0 0 0 0 0 0 0 0 0 1 0 23585 0 23585 0.00009 25 2029 3347428 1837578 1509850 0.00569 25 2029 33162434 14341015 18821419 0.07088 0 0 0 0 0 0 1 0 25000 0 25000 0.0001 1 0 930 0 930 0.00001 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 0 223531 0 223531 0.00085 0 0 0 0 0 0 6 0 249461 0 249461 0.00096 1 675115 337558 50514420 57827770 -7313350 X 1 1 1 1 Saratoga Hospital 211 Church Street Saratoga Springs NY 12866 www.saratogahospital.org 4501000H X X X Saratoga Hospital 1 0 0 1 X X X X X X X X 13 1 1 1 1 X www.saratogahospital.org X www.arhn.com X 1 13 1 www.saratogahospital.org 0 0 1 X 250 400 X X X X 1 1 X X X X 1 X www.saratogahospital.org X www.saratogahospital.org X www.saratogahospital.org X X X X 1 X X X 0 X X X X 1 X 0 0 Schedule H, Part V, Section B, Line 5-Saratoga Hospital A Community Health Needs Assessment (CHNA) was conducted in 2013 in collaboration with more than 15 partners, including the region's hospitals and local health departments. The CHNA surveyed over 300 organizations and individuals to determine the most pressing health needs for the Adirondack region and Saratoga County. The results of the CHNA show that, for the residents of Saratoga County, the following are current health challenges: * Increase access to high-quality chronic preventive care and management in both clinical and community settings o The rate of diabetes deaths in Saratoga county is increasing o Heart disease and cancer are the leading causes of death in Saratoga County o The community does not have adequate access to the full continuum of care o Almost 30% of adults 18 years and older are obese * Prevent vaccine-preventable diseases o Too few very young children receive the recommended vaccinations o Pertussis cases are increasing o Too few teenage girls receive HPV vaccinations * Prevent healthcare-associated infections o The number of patients contracting infections due to contact with the healthcare system is increasing * Improve child health o Too few low-income children in Saratoga County make well-child visits to the doctor o Too many children have untreated tooth decay o Too few children are being screened for lead exposure * Prevent substance abuse and other mental, emotional, and behavioral disorders o Alcohol abuse is a problem for many residents o Mental illness is a problem for many residents Schedule H, Part V, Section B, Line 6a-Saratoga Hospital A Community Health Needs Assessment (CHNA) was conducted in spring 2013 in collaboration with more than 15 partners, including the region's hospitals and local health departments. The other regional Hospitals include Elizabethtown Community Hospital, Nathan Littauer Hospital, and Glens Falls Hospital. Schedule H, Part V, Section B, Line 6b-Saratoga Hospital ACAP, Inc. EHS/HS ACAP/OneWorkSource Adirondack Health Institute -- Adirondack Rural Health Network Akwesasne Housing Authority Alice Hyde Medical Center American Red Cross ASAPP's Promise Association of Senior Citizens BHSN Bolton Central School Brushton-Moira Central School Cancer Services Program of Fulton & Montgomery Counties Capital District Child Care Coordinating Council CAPTAIN Youth and Family Services Catholic Charities of Fulton & Montgomery Counties Center for Disability Services Center for Lung and Chest Surgery Chateauguay Central School Child Care Coordinating Council of the North Country, Inc. Church of the Messiah Citizen Advocates, Inc., North Star Behavioral Health Services City of Plattsburgh Clinton County Child Advocacy Center Clinton County Department of Health, Healthy Neighborhoods Program Clinton County Health Department Clinton County Health Dept. WIC Program Clinton County MH and AS Clinton County Office for the Aging Clinton County Office of Emergency Services Clinton County Social Services Clinton County Veterans Service Agency Clinton County Youth Bureau Community Health Center of the North Country Community Link Community, Work and Independence,, Inc. Cornell Cooperative Extension - Essex County Cornell Cooperative Extension Franklin County Cornell Cooperative Extension in Fulton & Montg. Co. Cornell Cooperative Extension Saratoga County Cornell Cooperative Extension, Hamilton County council for prevention of alcohol and substance abuse CVPH Medical Center Eastern Adirondack Health Care Network Elizabethtown-Lewis Central School Essex County Department of Social Services Essex County Mental Health Services Essex County Office for the Aging Essex County Public Health Nursing Services Families First in Essex County Family YMCA of the Glens Falls Area Fort Edward Internal Medicine Fort Hudson Health System Franklin Co. Public Health Franklin Community Center Franklin County Department of Social Services Franklin County Public Health Services Fulmont Community Action Agency, Inc. Fulton County Department of Social Services Fulton County Mental Health Fulton County Office for Aging Fulton County Public Health Fulton County YMCA Fulton-Montgomery Community College Gloversville Enlarged School District Gloversville Housing Authority Greater Johnstown School District Hadley-Luzerne CSD Hamilton County Community Action Agency Hamilton County Community Services Hamilton County Public Health Nursing Service Harrietstown Housing Authority HCPHNS HCR Home Care HFM Prevention Council HM AHEC Hudson Headwaters Health Network Inter-Lakes Health Joint Council for Economic Opportunity of Clinton and Franklin Counties, Inc. Keene Central School Lake George Central Schools Lake Placid Middle High School Literacy Volunteers of Clinton County Literacy Volunteers of Essex/Franklin Counties Long Lake Central School Malone Central School District Mayfield Central School District Mental Health Assoc. of Clinton & Franklin Counties Mental Health Association In Fulton & Montgomery Counties Mercy Care for the Adirondacks Minerva Central School Moriah Central School Mountain Lake Services Mountain Valley Hospice Newcomb Central School District North Country Behavioral Healthcare Network North Country Chamber of Commerce North Country Community College North Country Healthy Heart Network, Inc. North Country Workforce Investment Board NYS Assembly NYS Department of Labor NYSDOH Office for the Aging in Franklin Co. Office of Community Services for Warren and Washington Counties Oppenheim-Ephratah Central School District Parent to Parent of NYS Planned Parenthood Mohawk Hudson Planned Parenthood of the North Country New York Plattsburgh One Worksource/NYSDOL Manager PRIDE of Ticonderoga, Inc. Queensbury Union Free School District Reality Check of Hamilton, Fulton, and Montgomery Counties Saint Regis Mohawk Tribe Saranac Lake Central School Saratoga Bridges NYSARC , Inc. Saratoga Chapter Saratoga County Community Services Board / Mental Health Center Saratoga County EOC - WIC Saratoga County EOC Head Start Saratoga County Office for the Aging Saratoga County Public Health Nursing Service Saratoga County Youth Bureau Saratoga Springs City School District Senior Citizen Service Center of Gloversville and Fulton County, Inc Senior Citizens Council of Clinton County Inc. Shelters of Saratoga, Inc Shenendehowa Central School District Skidmore College SMSA St Regis Mohawk Health Services St. Joseph's Addiction Treatment & Recovery Centers St. Joseph's Community School St. Mary's Healthcare St. Regis Falls Central School St. Regis Mohawk Health Services A/CDP Outpatient STARS Stillwater CSD STOP Domestic Violence/BHSN SUNY PLATTSBURGH The Adirondack Arc The Development Corporation The Family Counseling Center Ticonderoga central school Ticonderoga Revitalization Alliance Town of Kingsbury Recreation Town of Queensbury Town of White Creek Tri County United Way Upward Bound Wait House Warren County Employment & Training Warren County Health Services Warren County WIC Warren County Youth Bureau Warren Washington Association for Mental Health Warren-Hamilton Counties Office for the Aging Warren-Washington ARC Warren-Washington Office of Community Services Washington County ADRC Washington County CARES Washington County Economic Opportunity Council, Inc. Washington County Public health Washington County WIC Washington-Saratoga-Warren-Hamilton-Essex BOCES Wells Central School Whitehall Family Medicine WIC Willsboro Central School YMCA Schedule H, Part V, Section B, Line 11-Saratoga Hospital Saratoga Hospital, along with the other collaborating members of the 2013 CHNA, is addressing the needs that were identified in the latest CHNA. Since 2013, the Hospital has been developing a Community Service Plan that outlines the challenges, strategies, activities, and outcomes for each of the five identified health challenges. In 2015, the Hospital Service Plan included the following updates and outcomes for those five areas of need, which can be found on the Hospital website referenced in Schedule H, Part V, line 10a.The first focus area of need was to Prevent Chronic Disease by increase access to high-quality chronic-disease preventive care and management in both clinical and community settings. There are three chronic disease areas that the Hospital is focusing on which are (1) Diabetes, (2) Heart Disease, Cancer and Obesity, and (3) Continuum of Care. Through the Saratoga Center for Endocrinology and Diabetes, Saratoga Hospital continued to meet the needs of diabetic patients in the community. Saratoga Hospital continued to increase screening rates for diabetes by providing the diabetes risk-assessment "quiz" to communities at health fairs, the Community Health Center, the Backstretch Clinic, and referred at-risk patients to primary care providers for follow-up. In 2015, The Center for Endocrinology and Diabetes had 2,500 diabetes patient visits which exceed 2014 volumes by over 18%. Saratoga Hospital continued to offer high-quality diabetes education and support for all diabetes patients using evidence-based resources by offering ten Diabetes Self-Management education programs and one support group. To reduce disparities, Saratoga Hospital improved access to diabetes management programs for residents of outlying areas and included provision of nutrition and diabetes education services in plans for the new Church Street Outpatient Center. To improve access to diabetes management education for low-income patients, Saratoga Hospital offered nutrition and diabetes education services at the new Saratoga Community Health Center and the Hospital's three family health centers. For Heart Disease, Cancer and Obesity area of focus for Chronic Diseases, Heart disease and cancer are the leading causes of death in Saratoga County, which Heart disease and cancer patients in Saratoga County need more access to high-quality care and support services. In addressing Heart Disease, in 2015, Saratoga Hospital continued to work toward offering PCI services in our Cardiac Catheterization Laboratory. Efforts to integrate the care processes driven by interventional services also continued and Saratoga Hospital's relationship with Albany Medical Center for cardiology services were strengthened. For addressing the need of Cancer for Chronic diseases, Saratoga Hospital is continuing the NYSDOH grant-funded Cancer Screening Program, which engages community partners in providing a robust program of outreach to build demand for cancer screening utilizing the existing partnerships of 31 providers to offer screening services, such as Low Dose CT exams, and continue to build new partnerships and facilities that ensures coverage for all residents of Saratoga County. Saratoga Hospital continues to help cancer patients find support services through the services of an American Cancer Society (ACS) Patient Navigator dedicated to assisting Saratoga Hospital's Radiation Oncology Center (ROC) patients. The ROC social worker meets with every new patient seen at the ROC to determine if there are services that can be provided for them. Additionally in 2015, Saratoga Regional Medical Group hired a dedicated breast surgeon to provide, among other procedures, mastectomies, lumpectomies, breast-conserving surgery and surgical breast biopsies. In 2015, for addressing the Chronic Disease of Obesity, Saratoga Hospital continued to offer a comprehensive obesity prevention and management program through the Saratoga Bariatric Surgery and Weight Loss Program, which provides evidence-based services and outreach programs to address weight management. Monthly meetings of Bariatric Support Groups included presentations by guest speakers on topics relating to weight management, nutrition, exercise, psychology and plastic surgery. Informational and educational sessions about bariatric surgery were offered on a bi-monthly basis and there is an on-line Bariatric Support Group as well. The last Chronic Disease focus area is Continuum of Care. For Continuum of Care, the community does not have adequate access to the full continuum of care and healthcare providers need to form more strategic partnerships to address these gaps. Saratoga Hospital is addressing this by continuing to explore and establish partnerships with other providers. Saratoga Hospital has engaged in physician-centered dialogues regarding coverage of critical care. Saratoga Hospital is successfully working with Albany Medical Center Hospital (AMCH) to standardize the process for the transfer of cardiac patients (PCI) to higher levels of care, along with discussion for other collaborative efforts with AMCH such as joint training and quality improvement for cardiac services. Saratoga Hospital also starting working on improving Neurology services in the community by adding a new Neurologist to the Saratoga Regional Medical Group. In 2015, Saratoga Hospital began the opening phase of our new Operating Suite. The second focus area of need was to Vaccine-Preventable Diseases by focusing on Petussis. Pertussis cases are increasing; adults and children are not receiving adequate vaccinations against pertussis. In 2015, Saratoga Hospital addressed this area by continuing its program to increase pertussis vaccination rates by vaccinating parents and other caregivers of infants born at Saratoga Hospital. The third focus area of need was Healthcare-Associated Infections and overuse of antibiotics. The number of patients contracting infection due to contact with the healthcare system is increasing. Overuse of antibiotics is resulting in the emergence of antibiotic-resistant strains of disease. Infection control measures on the part of healthcare providers must be constantly taught, improved, and enforced. Infection can be spread by the use of medical devices. Saratoga Hospital addressed this by continuing to encourage the reduction of antibiotic use at Saratoga Hospital and in the community by developing programs, policies, and procedures aimed at reducing the use of antibiotics. The need for an Antibiotic Stewardship Pharmacist has been identified and work continues on that front. Saratoga Hospital continues to include infection control education as part of mandatory staff education. Infection control education is mandatory for all employees through the Hospital's HealthStream Education system where there are two safety topics relating specifically to infection control. Hand hygiene and isolation practices are closely monitored at Saratoga Hospital. The fourth focus are of need is Child Health. Children in Saratoga County, especially low-income children, do not receive adequate preventive healthcare. Saratoga Hospital's service area covers a large geographic area, and some rural areas or areas located outside population centers, have insufficient access to preventive care. Almost 40% of all 3rd graders in Saratoga County have untreated tooth decay. This is especially true for low-income children. In 2015, Saratoga Hospital continued to address this area by improving access to ambulatory care services throughout the community. Plans continued to expand this network of outpatient sites to improve access to care. Saratoga Hospital continued to offer high-quality dental care for low-income members of the community at the Saratoga Community Health Center. Saratoga Hospital continued to assist low-income families obtain health insurance through our Health Insurance Navigation Program. The fifth focus area of need is Mental Health within Saratoga County. Alcohol abuse poses a threat to the health and well-being of residents of Saratoga County. Too many adults engage in binge drinking. Rates of alcohol-related accidents are higher than expected, and too many residents die of alcohol-related injuries. Many residents suffer from serious mental illness. Rates for treatment of children and teens in the emergency department are above the stateside benchmarks. Rates of suicide and self-inflected injuries in Saratoga County are also above statewide benchmarks. Saratoga Hospital continued to address the increase access to quality outpatient mental health services by providing comprehensive mental health counseling at Saratoga Community Health Center. Saratoga Hospital continued to work with our community to address mental health and substance abuse issues such as the rising acuity of mental health patients presenting at the Saratoga Hospital Emergency Department. Schedule H, Part V, Section B, Line 13h-Saratoga Hospital Additional eligibility criteria for the Hospital's financial assistance policy include the following. If a patient is homeless, they are automatically eligible for the Hospital's financial assistance. Services that subsequently receive Medicaid coverage that may fall outside of the scope of payment by Medicaid are automatically eligible for financial assistance. Another criterion for services to be automatically eligible for financial assistance is for patients that are filing for Chapter 7 bankruptcy protection. Schedule H, Part V, Section B, Line 22d-Saratoga Hospital The hospital maintains a financial assistance policy (FAP). Under the FAP, the Hospital provides an automatic discount from charges (76% for 2015) for any uninsured patients receiving care at any of the Hospital's locations. The Hospital defines uninsured patients as those patients having no third-party insurance coverage. This automatic discount applies regardless of a patient's ability to pay. The automatic discount is shown clearly on any bills sent to the patient in order to enhance awareness of the availability of this benefit. The automatic discount is intended to ensure that any uninsured patients, and by extension any patients who are FAP-eligible, are not charged more for emergency or any other medically-necessary care than the amounts Medicare would reimburse the Hospital for the same services. The Hospital also provides a "Means-Tested" financial assistance benefits, eligibility for which is determined by the Hospital's patient financial services department based upon the financial means of the patient and/or patient's family. The amount of means-tested benefit provided to patients is based on a comparison of their documented income to annual Federal Poverty Level (FPL) standards. The following is a sliding scale of benefits (as a percentage of charges) available to patients with varying levels of income: o FPL x 250% or below- 100% discount o FPL x 300%- 75% discount o FPL x 350% - 50% discount o FPL x 400%- 25% discount These means-tested discounts are available to uninsured patients, as well as to insured patients who encounter difficulty in paying amounts owed (ex. co-pays, deductibles) after their insurer pays the Hospital. Exceptions to the automatic discount policy described above are for services provided to uninsured patients in the Hospital Emergency Department and the Hospital's Urgent Care site at Wilton Medical Arts. Special tiered discount programs are in place for services provided at those locations, and these are described below: * Emergency Department Services: o Tier 1- available for patients receiving any services during an outpatient Emergency Department visit, unless the services include a CT and/or MRI scan. The discounted patient payment for this level of Emergency Department services is $300 plus a surcharge the New York State Department of Health (DOH) requires hospitals to add to services provided to uninsured patients. o Tier 2- available for outpatient Emergency Department visits when the visit includes a CT and/or MRI scan. The discounted patient payment for this level of Emergency Department services is $700 plus the DOH surcharge. * Urgent Care Services (Wilton Medical Arts): o Tier 1- available for patients receiving any services during an Urgent Care visit unless those services include a lab test and/or any imaging test. The discounted patient payment for this level of Urgent Care services is $180 plus the DOH surcharge. o Tier 2- available for patients receiving any services during an Urgent Care visit if those services include a lab test and/or any imaging test, unless the imaging tests include a CT and/or MRI scan. The discounted patient payment for this level of Urgent Care services is $500 plus the DOH surcharge. The special tiered discounts available for Emergency Department and Urgent care services are intended to provide uninsured patients an automatic discount for these services that exceeds the standard discount for all other services to uninsured patients. Patients are not required to take any action in order to receive the automatic discount and the special Emergency Department and Urgent Care discounts. These adjustments are automatically made to patient bills before the bills are sent. 18 Wilton Campus 3040 - 3050 Route 50 Saratoga Springs NY 12866 Urgent Care/Imaging/Lab Services/Pain Mgmt/Family Medicine/Free Standing Ambulatory surgery Malta Campus 6 Medical Park Drive Malta NY 12020 Emergent&Urgent Care/Lab Services/Family Medicine/Hematology/Oncology/Imaging/Infusion/Cardiology Regional Therapy Center at The Springs on Weibel Ave 9 Hampstead Place Suite 107 Saratoga Springs NY 12866 Rehabilitation (OT/PT) Regional Therapy Center at Washington Street 225 Washington Street Saratoga Springs NY 12866 Rehabilitation (OT/PT) Scotia-Glenville Family Medicine 112 Charlton Road Ballston Lake NY 12019 Family Medicine 6 Care Lane 6 Care Lane Saratoga Springs NY 12866 Rehabilitation (OT/PT)/Nephrology/Neurology/Pulmonary Medicine Corporate Health Services 2388 Route 9 Malta NY 12020 Corporate Health Services Saratoga Hospital Medical Oncology Hematology 3 Care Lane Saratoga Springs NY 12866 Oncology Hematology Regional Therapy Center at Malta Commons Business Park 100 Saratoga Village Blvd Suite 34 Ballston Spa NY 12020 Rehabilitation (OT/PT) Saratoga Regional Urology Associates 19 West Avenue Suite 103 Saratoga Springs NY 12866 Urology 1 West Ave 1 West Avenue Suite 125 Saratoga Springs NY 12866 Minimally Invasive Surgery/Bariatric Surgery Saratoga Community Health Center 24 Hamilton Street Saratoga Springs NY 12866 Family Medicine/Dentistry/Internal Medicine/Mental Health Milton Health Center 510 Geyser Road Ballston Spa NY 12020 Family Medicine/Physical Therapy Cardiology Specialy Services 254 Church Street 2nd Floor Saratoga Springs NY 12866 Cardiology Saratoga Family Health 119 Lawrence Street Saratoga Springs NY 12866 Family Medicine Galway Family Health 5344 Sacandaga Road PO Box 190 Galway NY 12074 Family Medicine Schuylerville Family Health 200 Broad Street Schuylerville NY 12871 Family Medicine Saratoga Midwifery and Women's Primary Care 2911 Route 9 Ballston Spa NY 12020 Midwifery and Women's Primary Care Schedule H, Part I, Line 7 Line 7a -The costing methodology used to determine the amount reported on line 7a is as follows. The total financial assistance, on the basis of charges, per the Hospital's financial statements was multiplied by the cost to charge ratio from the Hospital's 2015 Medicare cost report. The resulting amount was then reduced by any directly offsetting revenues. Offsetting revenues for the purposes of this calculation consist of payments New York State provides the Hospital from a pool, that are intended to offset a portion of the Hospital's charity care and bad debt costs. These payments were split between charity care and bad debt on a pro rata basis and netted against the respective costs. Line 7b -The costing methodology used to determine the amount reported on line 7b column c is as follows. Total Medicaid charges per the Hospital's patient accounting system were multiplied by the cost to charge ratio from the Hospital's 2015 Medicare cost report. Line 7e includes the Hospital's costs to administer federally and State funded grants. The Hospital administers the New York State Department of Health Health Insurance Navigation Program, Family Health Plus and, Medicaid Facilitated Enrollment Program for Saratoga County. This program focuses on enrolling eligible individuals in low or no cost insurance programs provided by the State. The Hospital also administers the New York State Cancer Services Program for Saratoga County, which provides uninsured and underinsured patients with routine screening for certain types of cancers. Costs associated with free screening programs are obtained from the Hospital's cost accounting system. With regards to costs for administering grant programs, the Hospital establishes a distinct general ledger cost center for each grant program it administers. Costs reported for the grant programs represent the costs accumulated in those grant-specific cost centers during 2015. Grant program costs have been offset by State funding received to offset the Hospital's costs to administer the programs. In 2013 the Hospital opened its Community Health Center, serving primarily uninsured and under-insured patients. Revenues and costs for the Community Health Center are accumulated and tracked in distinct cost centers on the Hospital's General Ledger. Amounts reported for the Community Health Center were derived from the accounts in those General Ledger cost Centers. Line 7f -The costing methodology used to determine the amount reported on line 7f is as follows. A database is kept for all health professional programs for students and interns that spend time at the Hospital. Within the database, the total direct employee hours spent with the students and interns, as well as, administration hours spent for oversight, are calculated and multiplied by the average hourly rate for the hospital to develop the total community benefit cost. Line 7i - Costs accumulated on line 7i were obtained from Hospital general ledger and accounts payable records for contributions made to other organizations in the community whose missions align with that of the Hospital. Schedule H, Part II Part II, Line 2 Starting in 2015, and continuing over the next five years, the Hospital has engaged with the local economic development community to help bring in additional jobs and resources to its community. As a community leader, the Hospital believes that engaging in this action for the recruitment of additional jobs is an opportunity to educate and improve the community's health. Part II, Line 3 As part of Community Support, the Hospital is helping a local organization track, store, and analyze its membership and survey data. As a result of the Hospital's actions, they are helping to retain and grow nursing providers within the local community. Part II, Line 8 As a result of its leadership role in identifying community healthcare needs, the Hospital is also the key resource in its community for recruiting physicians practicing in areas of medicine identified as underserved in the community. A component of this recruitment effort included the extension of relocation incentives to physicians in the targeted need areas. The incentives were provided in the form of income guarantees that were provided in an effort to make practice start-up financially palatable for relocating physicians. After an initial period during which funds were advanced to physicians as they had shortfalls versus a targeted income amount, the accumulated advances were converted to promissory notes. Should the physician remain in practice in the community for a contractually agreed-upon number of years after the initial benefit period, the note will be forgiven in full. During 2015, the Hospital forgave advances plus accrued interest amounting to approximately $223,531 relating to these arrangements. Schedule H, Part III, Section A, Line 4 Part III, Line 2 The costing methodology used to determine the amount reported on line 2 is as follows. The total bad debt expense per the Hospital's financial statements was multiplied by the same cost to charge ratio that was used to determine Financial Assistance and Medicaid costs reported on Schedule H, lines 7a and 7b, column c. The resulting amount was then reduced by any directly offsetting revenues. Offsetting revenues for the purposes of this calculation consist of payments New York State provides the Hospital from a pool, that are intended to offset a portion of the Hospital's charity care and bad debt costs. These payments were split between charity care and bad debt on a pro rata basis and netted against the respective costs. Part III, Line 3 The rationale for including bad debt amounts in community benefit related to the nature of the question posed on Schedule H, Part III, line 3. A large portion of patients whose account balances end up as bad debt write-offs likely would qualify to receive benefits under the Hospital's financial assistance program were those patients to apply for the benefit and provide the documentation required to assess their ability to qualify. Despite efforts to publicize the availability of the financial assistance program, patient interest and willingness to comply with the documentation requirements remain a challenge for the Hospital. The vast majority of patients who apply for the financial assistance benefit and provide the requested documentation ultimately qualify for and receive the benefit as an end result. As such, in most cases the only difference between reporting an unpaid account balance as a charity care allowance as opposed to a bad debt write off results from our adherence to Healthcare Financial Management Association Statement No. 15 in terms of appropriate reporting of amounts as bad debt expense or charity care when a patient does not apply for financial assistance or comply with documentation requirements. Part III, Line 4. The following represents text from the footnotes to the Hospital's audited financial statements regarding bad debt expense: The Hospital grants credit without collateral to patient, most of whom are local residents and are insured under third-party agreements. Services rendered to individuals when payment is expected and ultimately not received are written off against the allowance for estimated uncollectible accounts upon management's determination that the balance will likely not be collected. Additions to the allowance for estimated uncollectible accounts are made by means of the provision for bad debts. Accounts written off as uncollectible are deducted from the allowance and subsequent recoveries are added. The amount of the provision for bad debts is based upon management's assessment of historical and expected net collections, business and economic conditions, trends in Federal and state governmental healthcare coverage and other collection indicators. Schedule H, Part III, Section B, Line 8 Medicare costs reported on Schedule H, Part III, line 6 were determined as follows. Total charges to Medicare-insured patients during 2015 were divided by total charges to all patients during 2015. The resulting ratio was multiplied by total Medicare allowable costs reported in the Hospital's annual Medicare Cost Report. Schedule H, Part III, Section C, Line 9b The Hospital has created and maintains a written debt and collection policy, which clearly states adjustments made to collection practices when a patient qualifies for the Hospital's Financial Assistance Program (FAP). The Hospital informs patients about the FAP by including the FAP summary in the admission and observation materials, making the FAP summary easily accessible on the Hospital website, included with every hospital bill is information about the availability of the FAP and how to access the FAP summary, placing posters about FAP in areas in the Hospital that are likely to be noticed by patients and visitors, and producing paper copies upon request. Once a patient has been informed of the FAP, the patient will then need to apply for Financial Assistance. A patient can apply by requesting an application and/or confidential assistance in completing the application from any registrar during registration, or by calling Patient Financial Services. After a patient has completed the application for Financial Assistance and meets all of the eligibility requirements, the patients bill is discounted based on the Federal Income Guideline level of income and the size of family. Along with discounting an uninsured patient's bill after they have been approve for the Hospital's Financial Assistance program, efforts are made by Hospital registration and Patient Financial Services personnel to link patients to the navigation program for assistance in obtaining health insurance coverage or obtaining benefits under the Hospital's FAP. The Hospital will make reasonable efforts to have assistance accessible so that uninsured and underinsured patients understand the FAP and how to apply for Financial assistance. These efforts include providing a plain language summary of its FAP and offer an application form, to the patient before discharge from the Hospital. The Hospital also includes information about the availability of Financial Assistance and about how to access the FAP Summary with all (at least three) billing statements for the care and all other written communications regarding the bill provided to the individual during the period of from the date of Hospitalization until 150 days after the first billing statement. The Hospital will inform the individual about the FAP in all oral communications with the individual regarding the amount due for the care that occurs during the notification period. The Hospital will provide the individual with at least one written notice that (i) informs the individual about the Extraordinary Collection Efforts the Hospital or other authorized party may take if the individual does not submit a FAP application or pay the amount due by a deadline specified in the notice, and (ii) is provided to the individual at least 30 days before the deadline specified in the written notice. This notice will not be sent any earlier than 120 days after the date of the first billing statement sent to the patient. With respect to a patient who submitted an incomplete FAP application, the Hospital will suspend extraordinary collection efforts against the patient, provide the patient with a written notice that describes the additional information and/or documentation required, and includes a copy of the FAP. The Hospital will similarly not permit a third party collection agent to commence an extraordinary collection effort against a person for an unpaid Hospital services bill unless and until a Hospital official has authorized the specific actions against the specific person. If a patient is uninsured and does not apply for Financial Assistance, the Hospital provides an automatic payment discount off of standard charges which is intended to bring the net charges billed down to the level of payment the Hospital would expect to receive from Medicare for the same services. Schedule H, Part VI, Line 2 The process of identifying the important healthcare needs of the residents of Saratoga County involved both data analysis and consultation with key members of the community. The data was collected from multiple sources including publically available health indicator data, data collected from a survey conducted by the Adirondack Rural Health Network and a survey conducted by Saratoga Hospital. The health indicator data is collected and published by New York State and contains over 300 different health indicators. Since 2003, The Adirondack Rural Health Network has been compiling this data for the region and producing reports to inform healthcare planning on a regional basis. In 2013, ARHN undertook a project to systemize this data into a relational database to provide improved access and analysis. The results of this analysis provide a statistical assessment of the health status for the region and each county therein. In December 2012 and January 2013, the Adirondack Regional Health Network (ARHN) conducted a survey of selected stakeholders representing health care and service-providing agencies within the eight-county region. The results of the survey provide an overview of regional needs and priorities, to inform future planning and the development of a regional health care agenda. The survey results were presented at both the County and regional levels. Saratoga Hospital also conducted a survey of the residents of Saratoga County to solicit information regarding attitudes about healthcare and healthcare challenges people face in their daily lives. Using the results of the indicator analysis and the surveys, a community health assessment team (CHAT) was convened to identify and prioritize the current healthcare challenges for the residents of Saratoga County. The CHAT consisted of representatives from Saratoga Hospital and the Saratoga County Public Health Nursing Service. Schedule H, Part VI, Line 3 The Hospital educates patients about eligibility for assistance under its Financial Assistance Program (FAP), as well as federal and State programs through the following means: * A supply of brochures containing a plain-language description of the Hospital's FAP and an application for the FAP is prominently displayed at all locations in Hospital facilities where patients register for services. * The FAP brochure and application are included in a packet that is provided to all patients being admitted to the Hospital for inpatient or observation stays. * If the Hospital patient financial services department makes a follow-up call to a patient regarding an unpaid bill, the patient is informed about the existence of the FAP. * Bills sent to patients for unpaid balances include a reference to the FAP as well as information on how to contact the Hospital about the FAP. * Information regarding the FAP is located on the Hospital's website, including the location and contact information for the Hospital patient financial services department. * The Hospital uses an external vendor to screen all uninsured inpatients in order to determine whether the patient may be eligible for Medicaid or any other governmental insurance programs, as well as the Hospital's FAP. Patients are then provided assistance in applying for and obtaining access to these programs. * The Hospital administers the New York State Department of Health Health Insurance Navigation Program for Saratoga County, as well as five other neighboring Counties. This program focuses on enrolling eligible individuals in low or no cost insurance programs provided by the State. Efforts are made by Hospital registration and Patient Financial Services personnel to link patients to the navigation program for assistance in obtaining health insurance coverage or obtaining benefits under the Hospital's FAP. Schedule H, Part VI, Line 4 The Hospital's primary service area is comprised of two communities, Saratoga Springs and Ballston Spa. Both are located in the central portion of Saratoga County. The primary service area population in 2015 was approximately 70,600. These two communities accounted for 46.5% of the Hospital's inpatient discharges in 2015. The secondary service area extends to the northwestern border of Saratoga County and also extends southward. It is comprised of 15 communities, including Ballston Lake, Burnt Hills, Corinth, Galway, Gansevoort, Greenfield Center, Greenwich, Mechanicville, Middle Grove, Porter Corners, Rock City Falls, Round Lake, Schuylerville, Stillwater, and Victory Mills. The combined 2015 population of these communities was estimated at approximately 90,900. The secondary service area was the source of 31.6 % of the Hospital's inpatient discharges in 2015. Schedule H, Part VI, Line 5 The Hospital also promotes community health through the following activities: * Open medical staff * Board of Trustees comprised primarily of independent persons from the community * Subsidization of community education forums, at no cost to the public, including: o Childbirth education- monthly classes o Community wellness classes- including education for prevention and management of chronic diseases such as diabetes and asthma, and updates on new treatment pathways available for common ailments o Facilitation of monthly support groups for issues including weight loss, cancer survivors and grief management. * Schedules and topical information for community education forums are made available on the Hospital's website and are also provided in a free quarterly newsletter, ACCESS. ACCESS also includes short articles written by medical staff regarding current health issues. These articles are also posted on the Hospital's website. * The Hospital provides 24-hour call center services, HealthSource, at no cost. * Any surplus generated by the Hospital is reinvested into the Hospital through expansion of operations, by purchase of space and equipment, and hiring of personnel needed to support programs that have been identified as needs for the X X X X X 0 1 0 0 0 1 0 0 0 Angelo G Calbone President/CEO 477074 0 104550 0 180221 0 11528 0 20819 0 794192 0 0 0 Gary Foster VP & CFO 270219 0 44491 0 19945 0 15238 0 1406 0 351299 0 0 0 Richard Falivena VP Chief Medical and Physician Integration Officer 325122 0 58319 0 23291 0 9408 0 12415 0 428555 0 0 0 Mary Jo LaPosta SVP Patient Care and Organizational Excellence and Chief Nursing Officer 290761 0 52008 0 22502 0 11528 0 9563 0 386362 0 0 0 Kevin Ronayne VP Operations/Facilities 223538 0 39298 0 16681 0 13648 0 16724 0 309889 0 0 0 John Mangona VP Chief Information and Compliance Officer 228586 0 41289 0 15082 0 13648 0 1535 0 300140 0 0 0 Jeffrey Methven VP Ambulatory Serv &HR 240078 0 41455 0 15499 0 13648 0 16334 0 327014 0 0 0 Gordan Kuhar Physician 1092672 0 0 0 774 0 11528 0 756 0 1105730 0 0 0 Theodoros Laddis Physician 650250 0 0 0 470 0 9408 0 688 0 660816 0 0 0 Gary Idelchik Physician 649144 0 0 0 162 0 9408 0 6995 0 665709 0 0 0 Dmitri Baranov Physician 545843 0 0 0 180 0 9408 0 6374 0 561805 0 0 0 Rachid Daoui Physician 531076 0 0 0 414 0 9408 0 16816 0 557714 0 0 0 Schedule J, Part I, Line 4 During 2015, certain members of The Saratoga Hospital administrative team participated in a 457 F retirement plan. The following of the Hospital administration personnel participated in or received a payment from their 457 F retirement plan during 2015. Angelo Calbone - Contributions $103,753 and received a distribution of $49,511 Gary Foster - Contributions $1,171 Mary Jo LoPosta - Contributions $3,314 Richard Falivena - Contributions $4,133 Schedule J, Part I, Line 6 The Hospital administers an incentive compensation program under which members of Hospital management are eligible to earn up to a percentage of their base salaries in incentive compensation. Overall incentive compensation is based on measurable achievement against a menu of organizational goals, including financial results, patient satisfaction, quality of care, employee satisfaction and retention, and growth in services. The portion of incentive compensation related to operating margin of the Hospital and its affiliates represented 6.25% of the overall incentive compensation available during 2015, and was based an achievement of "minimum, meets, and maximum" levels relative to the Hospital's budgeted operating margin percentage for the year. A IDA Series 2007A 521310482 803482DF2 2007-12-21 15790000 ED Construction 0 0 0 B IDA Series 2007B 521310482 803482DE5 2007-12-12 18406490 ED Construction & Renovation 0 0 0 C IDA Series 2013 A 461520521 803481AS9 2013-02-07 24273094 Refinance Revenue Bonds 0 0 0 D IDA Series 2014 A 461520521 803481AT7 2014-01-16 25000000 ICU/OR Construction 0 0 0 A 0 3750000 15790000 0 1121735 0 223475 53214 0 14391576 0 0 2009 0 0 1 1 B 1320000 2090000 18406490 1373182 423697 0 262395 0 0 16348698 0 0 2009 0 0 1 1 C 2130000 0 24273094 1667627 0 22004520 485462 0 0 0 115599 0 2013 1 1 1 1 D 0 120000 25000000 0 617598 0 500000 230750 0 23490778 160874 0 2015 0 0 1 1 A 0 0 0 0 0 0 0 0 0 1 B 0 0 0 0 0 0 0 0 0 1 C 0 0 0 0 0 0 0 1 D 0 0 0 0 0 0 0 0 0 1 A 0 0 0 1 1 0 0 0 0 B 0 0 0 1 0 0 0 0 0 C 0 0 0 1 0 0 0 0 0 D 0 0 0 1 1 0 0 0 0 A 0 B 0 C 0 D 0 Schedule K, Part IV, Line 2c-12/21/2007 15,790,000 IDA Series 2007A Arbitrage rebate computation was performed on 12/1/15 by a third party contractor, AMTEC a tax exempt compliance specialist, for bond issues as of 12/01/15 resulting in no rebate liability for IDA Series 2007 A. Schedule K, Part IV, Line 2c-12/12/2007 18,406,490 IDA Series 2007B Arbitrage rebate computation was performed on 12/1/15 by a third party contractor, AMTEC a tax exempt compliance specialist, for bond issues as of 12/01/15 resulting in no rebate liability for IDA Series 2007 B. Schedule K, Part IV, Line 2c-02/07/2013 24,273,094 IDA Series 2013 A Arbitrage rebate computation was performed on 12/1/15 by a third party contractor, AMTEC a tax exempt compliance specialist, for bond issues as of 12/01/15 resulting in no rebate liability for IDA Series 2013 A. Schedule K, Part IV, Line 2c-01/16/2014 25,000,000 IDA Series 2014 A Arbitrage rebate computation was performed on 12/1/15 by a third party contractor, AMTEC a tax exempt compliance specialist, for bond issues as of 12/01/15 resulting in no rebate liability for IDA Series 2014 A. Healthcare Partners of Saratoga Inc Joint Venture Expenses paid X 432000 432000 0 1 1 Saratoga Regional Medical Subsidiary Expenses Paid X 1878000 1878000 0 1 1 2310000 David mastrianni MD Board Trustee 604076 The Hospital engages Dr. Mastrianni to provide clinical, administrative and medical direction services with respect to the Hospital's two hospital-based medical hematology/oncology clinics. 0 George Silver MD Board Trustee 225000 Trustee is also a Partner of OrthoNY, LLP 0 George Silver MD Board Trustee 168985 Trustee is a Partner of Boss Enterprises, LLP 0 Healthcare Partners of Saratoga LTD DBA MMEC Joint Venture with 50% control 750000 Capital Distribution 0 Healthcare Partners of Saratoga LTD DBA MMEC Joint Venture with 50% control 1340723 Reimbursement for expenses paid 0 Healthcare Partners of Saratoga LTD DBA MMEC Joint Venture with 50% control 5374000 Reimbursement for leased staffing services 0 Schedule L, Part IV David Mastrianni, MD - The Hospital engages Dr. Mastrianni to provide clinical, administrative and medical direction services with respect to the Hospital's two hospital-based medical hematology/oncology clinics. Dr. George Silver - Dr. Silver is a Partner (20%) of Boss Enterprises, LLP, which leases medical space to Hospital. Dr. Silver is also a Partner (20%) of OrthoNY, LLP, a company that the Hospital has a service agreement to provide administrative services for the Hospital's Orthopedic clinic. Joint Venture - In September 2010, Saratoga Hospital entered into a Memorandum of Agreement (MOA) with Albany Medical Center Hospital (AMCH) for the purpose of constructing a jointly owned and operated diagnostic and treatment center (DTC). The DTC is sited on a portion of the 140 acre parcel of land the Hospital owns in Malta, NY. Under the terms of the MOA, the DTC is operated as a separate not for profit corporation, Healthcare Partners of Saratoga, Inc. (D/B/A Malta Med Emergent Care(MMEC)), approved under Article 28 of New York State Public Health Law. The Hospital and AMCH are equal members of MMEC, with each entity able to appoint four members to the eight member Board of Directors of MMEC. MMEC obtained a Certificate of Incorporation from the New York State Department of State in April 2011. The New York State Department of Health (DOH) approved the Certificate of Need application for MMEC in August 2011, including approval to transfer services previously provided at the Hospitals extension clinic in Malta to MMEC. During 2015, MMEC transferred a total of $750,000 to the Hospital as an equity distribution. The Hospital's equity distribution from MMEC was a result of cash and net asset surpluses that had accumulated in MMEC through the date of equity distribution. MMEC had an operating surplus of approximately $2,174,000 during 2015. As a result, the amount by which the Hospital's investment was increased in 2015 was approximately $1,087,000. Accordingly the Hospital's net investment in MMEC stood at approximately $2,416,000 at December 31, 2015. Saratoga Hospital employs all non-provider staff who work at MMEC and leases the personnel to MMEC at cost. During 2015, the value of leased staffing services contracted to MMEC was $5,374,000. Also during 2015, MMEC reimbursed the Hospital approximately $1,341,000 for expenses paid for on behalf of MMEC. Form 990, Part III, Line 2 During 2015 the Hospital added the following services: Saratoga Hospital Center for Breast Care program, Breast Surgery, consisting of a board-certified, fellowship-trained breast surgeon, providing a full complement of surgical care. Saratoga Midwifery Care, consisting of six certified American College of Nurse Midwives. The care provided by this new service is care for normal, low-risk pregnancy, labor, and birth by a certified nurse midwife. Form 990, Part VI, Section B, Line 11b A draft of the Form 990 and any required supplemental schedules (collectively the "Form 990") is completed by the Hospital's Fiscal Services Department, with input from other Hospital departments obtained as needed. The completed Form 990 is then reviewed by the Director, Financial Accounting and Vice President/Chief Financial Officer in order to ensure compliance with applicable instructions. The initial phase of review by the Hospital's Board of Trustees occurs through a submission of the draft Form 990 to the Board Audit and Corporate Compliance Committee (AC). Members of the AC are provided with drafts of the Form 990 prior to a quarterly meeting. At the quarterly meeting, an agenda item is devoted to providing the AC members with time to ask management questions regarding any disclosures in the form 990 and to provide and comments or suggestions. Management evaluates the AC suggestions and comments and amends the Form 990 if necessary. Subsequently, copies of the revised draft Form 990 are provided to all members of the Hospital Board of Trustees. Board members are asked to provide any comments on the form 990 at the monthly Board meeting occurring after the draft Form 990 has been distributed. Any applicable comments or suggestions are incorporated into the Form 990, and a final version is filed with the IRS. Form 990, Part VI, Section B, Line 12c The Hospital maintains two conflict of interest policies. One applies to members of the Board of Trustees, Hospital officers, members of the medical staff and all employees whose compensation exceeds $100,000. A second conflict of interest policy applies to all members of management, employees and volunteers of the Hospital, as well as persons serving in those roles for corporations affiliated with the Hospital who are not covered by the first policy. The policies provide clear explanations as to who is covered by each policy, what family members and/or ownership interests (including non-financial interests) must be considered in assessing compliance with the policy, definitions of compensation (including non-monetary compensation) and examples of conflicts including activities that must always be avoided. On an annual basis a conflict of interest disclosure questionnaire process is undertaken. All members of the Board of Trustees and management, all non-management employees whose compensation exceeds $100,000, and certain members of the Hospital's medical staff are required to complete and file the questionnaire with the Hospital's Chief Compliance Officer. All members of the Hospital's medical staff are required to complete and file the questionnaire as part of their biennial credentialing process. Additionally, members of Hospital management are required to identify any additional employees under their supervision who have the ability to influence purchasing decisions aggregating to $100,000 or more annually. These employees are also required to complete and file the questionnaire. Inquiries included on the questionnaire are designed to allow respondents to provide yes/no answers that will allow a determination to be made as to whether any non-compliance with the applicable conflict of interest policy has occurred, or whether there are any situations that may require further investigation. Responses to the questionnaires are tracked by the Chief Compliance Officer and are reported to the Audit and Corporate Compliance Committee of the Board of Trustees at its quarterly meetings. On an annual basis the Fiscal Services department reviews all responses submitted by all respondents. The questionnaire includes a section where respondents are asked, for any person or entity that has or may do business with the Hospital or one of its affiliates, to provide names of any external entities they have interests in or are employed by, as well as names of relatives and entities those relatives have interest or are employed by. Additionally, if a potential conflict is known of, but not disclosed on the questionnaire, these persons/entities are also identified by hospital management. Any persons or entities disclosed in this area or otherwise deemed to be potential conflicts are referenced against the accounts payable systems for the Hospital and its related entities in order to determine whether business was transacted with any of the disclosed entities during the past year. Materiality of any transactions identified is assessed and a determination is made as to whether the transaction of business with any of these entities was made in accordance with the Hospital's purchasing and conflict of interest policies (ex. competitively bid, removal of the conflicted person from the decision-making process). Form 990, Part VI, Section B, Line 15 The Hospital maintains a written statement of executive compensation philosophy and practice that is used as a framework for establishing compensation for senior leaders as well as most of the department directors within the organization. The Hospital's Board of Trustees has formally delegated implementation of the executive compensation philosophy to its Executive Committee. During 2015, the Executive Committee consisted of eight members of the Board of Trustees, six of whom were determined to be independent with respect to the guidelines set forth for completing Part VI, Line 1b of the Core Form 990. On an annual basis, the Executive Committee reviews the performance of the President/Chief Executive Officer (CEO) and makes a base salary recommendation to the full Board. The Executive Committee performs this task using a target percentile rank on a scale of amounts paid to similarly situated executives in the marketplace as measures by external benchmark surveys. Additionally, the Executive Committee factors in relative skill mix, experience, competence and overall performance. The Executive Committee sets annual performance criteria the CEO must meet in order to qualify for incentive compensation and any recommendation for additional compensation is made annually. The CEO is responsible, with the oversight of the Executive Committee, for determining the base compensation for all other executives in the organization. These base salaries are also determined using a target percentile rank on a scale for executives situated similarly by position within the marketplace, with acceptable exceptions based on skill mix, experience and/or scope of responsibility. Incentive compensation for all other executives is determination by the CEO and based on organizational and individual performance measures and outcomes. For both CEO and executive compensation, the requirements for invoking a rebuttable presumption of reasonableness in accordance with IRS intermediate sanction regulations are used as a guideline, to the extent practicable. Form 990, Part VI, Section C, Line 19 Currently the Hospital's governing documents, conflict of interest policy and financial statements are available to the public upon request. Saratoga Care Inc 211 Church Street Saratoga Springs NY 12866 141775218 Promoting Health NY 501(c)(3) 3 N/A 0 Healthcare Partners of Saratoga LTD DBA MMEC 211 Church Street Saratoga Springs NY 12866 453303309 Emergent Care NY 501(c)(3) 3 N/A 0 Flower & Fruit Mission of the Saratoga Hospital 211 Church Street Saratoga Springs NY 12866 146049447 Equip & maintain the maternity unit of Saratoga Hospital NY 501(c)(3) 3 N/A 0 Saratoga Regional Medical 211 Church Street Saratoga Springs NY 12866 472468259 Provide Professional Healthcare services to the Saratoga Region NY The Saratoga Hospital Chief Medical Officer C 100 100 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 Saratoga Care Inc c 2381435 FMV of Cash Transaction Saratoga Care Inc o 308104 FMV of Cash Transaction Saratoga Care Inc q 602001 FMV of Cash Transaction Schedule R, Part IV At the time of filing, A form 1023 application for Recognition of Exemption has been submitted to the IRS for revaluation of Saratoga Regional Medical Professional Corporation (SRMPC) original distinction. SRMPC is a physician and midwifery practice formed in order to facilitate the Hospital's employment of Physicians and Midwives in circumstances where New York corporate practice of medicine doctrine would otherwise prohibit such employment. As such, SRMPC's mission aligns with the broader mission of the Hospital. The Chief medical and Physician Integration Officer is the sole shareholder in SRMPC. Hospital management has no reason to believe that SRMPC application for tax exemption will not be approved.