2016-11-11T07:48:55-06:00 2015-12-31 990 2015-01-01 141338467 NORTHERN DUTCHESS HOSPITAL % KATHERINE BACHER VP FIN OPS NORT 8454759500 PO BOX 5112 RHINEBECK NY 12572 GARY ZMRHAL HQ SVP & CFO 8454759500 2016-11-11 2015 2017-02-10 21:41:12Z DENISE GEORGE PRESIDENT PO BOX 5112 RHINEBECK NY 12572 95060289 false X WWW.HEALTHQUEST.ORG X 1924 NY TO PROVIDE COMPREHENSIVE PRIMARY HEALTH CARE SERVICES 14 12 670 136 71441 -95593 519547 541457 85431540 92570686 261790 157461 2496344 1790685 88709221 95060289 15840 18000 0 0 33299620 35635214 0 0 0 42818406 46322223 76133866 81975437 12575355 13084852 126668304 145677092 65334966 71159079 61333338 74518013 THE NORTHERN DUTCHESS HOSPITAL'S MISSION IS TO MEET THE HEALTH NEEDS OF PEOPLE WHO RESIDE IN OR VISIT OUR PRIMARY SERVICE REGION, WHICH INCLUDES THE COMMUNITIES OF NORTHERN DUTCHESS AND SOUTHERN COLUMBIA COUNTIES AND PARTS OF ULSTER COUNTY, NEW YORK. OUR COMMITMENT TO THESE COMMUNITIES SHALL BE EVIDENCED BY OUR PERFORMANCE AS PROVIDERS, EDUCATORS, AND ADVOCATES. WE SHALL PROVIDE COMPREHENSIVE, PRIMARY HEALTH CARE SERVICES AND PROGRAMS TO INDIVIDUALS IN THE COMMUNITY REGARDLESS OF THEIR ECONOMIC OR SOCIAL STATUS. WE SHALL ACT AS A RESOURCE IN PROVIDING EDUCATIONAL OPPORTUNITIES AND HEALTH PROMOTION PROGRAMS TO THE COMMUNITY AND ALSO ADVANCE THE MEDICAL AND TECHNICAL SKILLS OF OUR HOSPITAL STAFF THROUGH REGULAR IN-SERVICE TRAINING. WE SHALL ADVOCATE FOR, AND TAKE ACTION WHERE POSSIBLE, TO MEET THE NEEDS OF OUR ELDERLY, FOR THOSE INITIATING FAMILY LIFE AND, ALWAYS, FOR THE DISADVANTAGED. false false 36692356 53505257 INPATIENT SERVICES: PATIENTS ADMITTED FOR ACUTE CARE - NUMBER OF PATIENTS 5,130; NUMBER OF PATIENT DAYS 18,363 THE HOSPITAL PROVIDED APPROXIMATELY $344,948 IN UNCOMPENSATED CARE (AT COST) TO THE REGIONS UN-INSURED AND UNDER-INSURED POPULATION 26642584 18000 38850553 OUTPATIENT SERVICES: EMERGENCY VISITS 16,508; AMBULATORY SURGERY VISITS 2,405 ALL OTHER VISTIS/PROCEDURES 98,966 THE HOSPITAL PROVIDED APPROXIMATELY $888,435 IN UNCOMPENSATED CARE (AT COST) TO THE REGIONS UN-INSURED AND UNDER-INSURED POPULATION 147355 214876 AFFILIATE RENTAL INCOME 63482295 true true false true false false false false true true false false true true false false true false false false false false false false false true true true false true true false false false false false false false true false false false false false false false true false false false true 1 0 670 true true true false false false false false false false false false false false false X 14 12 false false false false true true true true true false true true true true true true true true true true false NY X KATHERINE BACHER VP FIN OPS 8454759500 1351 ROUTE 55 SUITE 200 LAGRANGEVILLE NY 12540 DENISE GEORGE NDH PRESIDENT 1.0 40.0 X X 0 580848 40615 SUE CRANE LIFE TRUSTEE 1.0 0.0 X 0 0 0 LEWIS RUGE LIFE TRUSTEE, SECRETARY, TREAS 1.0 0.0 X 0 0 0 GEORGE VERRILLI MD LIFE TRUSTEE 1.0 0.0 X 0 0 0 M NADER KAYAL JR MD LIFE TRUSTEE 1.0 0.0 X 0 0 0 EVAN MELTZER TRUSTEE (PAST CHAIR) 1.0 0.0 X 0 0 0 WILLIAM CARROLL TRUSTEE 1.0 0.0 X 0 0 0 JOHN HORISZNY MD TRUSTEE 1.0 0.0 X 0 0 0 KEVIN M SHEEHAN CHAIRMAN 1.0 0.0 X 0 0 0 FRANCIS FLYNN FIRST AND SECOND VICE CHAIR 1.0 0.0 X 0 0 0 EDWARD PRUITT TRUSTEE 1.0 0.0 X 0 0 0 JOHN L MCGUINNESS HQ CEO 1.0 40.0 X X 0 1842562 30815 DOUGLAS KROLL MD MEDICAL STAFF PRESIDENT 1.0 0.0 X 0 0 0 CHRISTY CARIDI TRUSTEE 1.0 0.0 X 0 0 0 KAREN GIEK TRUSTEE 1.0 0.0 X 0 0 0 KATHERINE BACHER INTERIM ASSISTANT TREASURER 1.0 40.0 X 0 417990 16660 GARY ZMRHAL ASST. TREASURER 0.0 40.0 X 0 586089 0 MICHAEL HOLZHUETER ASST. SECRETARY 0.0 40.0 X 0 659918 23656 JOHN SABIA MD VP MEDICAL AFFAIRS - NDH 40.0 0.0 X 454031 0 35386 CONNIE REGAN PHARMACY CLINICAL COORDINATOR 40.0 0.0 X 168660 0 30042 SANDRA HELMES LEAD DIAGNOSTIC MED SONOGRAPHE 40.0 0.0 X 157358 0 15693 VALERIE KOCZARA VP PATIENT CARE SVCS INTERIM 40.0 0.0 X 182119 0 0 LAWRENCE O'CONNELL ASSISTANT NURSE MANAGER 40.0 0.0 X 164724 0 30409 PAMELA RHODES CNO/VP PATIENT CARE SVCS 40.0 0.0 X 210144 0 14080 MICHAEL T WEBER FORMER CEO 0.0 0.0 X 0 188642 0 1337036 4276049 237356 6 true true false 0 227457 314000 541457 NET INPATIENT REVENUE 900099 53505257 53505257 NET OUTPATIENT REVENUE 900099 38850553 38850553 AFFILIATE RENTAL INCOME 900099 214876 214876 92570686 151270 151270 0 0 155321 155321 0 155321 155321 6191 6191 0 0 0 MEANINGFUL USE REVENUE 900099 782999 782999 CAFETERIA REVENUE 900099 428344 428344 OTHER MISC. REVENUE 900099 424021 352580 71441 424021 352580 71441 1635364 95060289 94134609 71441 312782 18000 18000 0 0 0 454031 408628 45403 0 27197676 24615610 2582066 1047671 936034 111637 4850296 4333464 516832 2085540 1863311 222229 0 0 0 0 0 0 117293 117293 0 2302372 956818 1345554 78781 66567 12214 0 1276344 1073183 203161 77313 45523 31790 0 22702 22702 1425057 1198225 226832 0 4337560 3647132 690428 1244413 1046335 198078 MEDICAL SUPPLIES 12379238 12379238 PURCHASED SERVICES 16189976 4716807 11473169 PHYSICIAN FEES 2898502 2898502 BAD DEBT 1733936 1733936 2238736 1404987 833749 81975437 63482295 18493142 0 10581858 29537651 0 0 0 0 8328287 7824791 0 0 0 0 0 0 1474024 1338523 933542 1076731 133258827 64127235 40507545 69131592 5134253 5244774 0 0 0 0 0 0 59708795 31523030 126668304 145677092 6526457 8837326 0 0 0 0 49416574 48320516 0 0 0 0 68475 0 0 0 9323460 14001237 65334966 71159079 X 53722602 63489662 6115332 9532947 1495404 1495404 61333338 74518013 126668304 145677092 X 13084852 -239795 339618 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false false false 1495404 1495404 1495404 1495404 1495404 1495404 1495404 1495404 1495404 1495404 1.00000 false false 109930 109930 51813042 25088923 26724119 46340311 37942680 8397631 34995543 1095631 33899912 69131592 DUE FROM AFFILIATES 6493211 RETIREMENT INVESTMENTS 140083 DEFERRED FINANCING 296237 2007 SERIES B BONDS PREMIUM 718709 2007 DSRF SERIES B BONDS 1633460 MISC RECEIVABLES 189114 ESTIMATED THIRD PARTY ADJMNTS 1432004 INTEREST IN NDH FOUNDATION LT 9269469 DUE FROM AFFILIATE LT 5907894 2014 SER A BONDS DEF FINANCING 351730 2014 SER B BONDS DEF FINANCING 55492 DSRF 2014 CONSTRUCTION FUND 4054634 DSRF 2014 CAP INTEREST 980993 31523030 0 RETIREMENT INVESTMENTS 140083 FIN 47 LIABILITY 1561162 RETRO PAYABLE TO 3RD PARTY PAY 2788982 DUE TO AFFILIATES 3199610 DUE TO HQ L/T 411012 MED MALPRACTICE INSURANCE LIAB 5900388 14001237 SCHEDULE D PART V LINE 4 - ENDOWMENT FUNDS THE ORIGINAL CONTRIBUTION IS BEING HELD FOR THE BENEFIT OF THE HOSPITAL. true true X true X true X true true true false false 1866837 1113046 753791 0.00920 11247335 6937523 4309812 0.05260 13114172 8050569 5063603 0.06180 10 2207 11290 11290 0.00010 11 2257 11290 11290 0.00010 11 2257 13125462 8050569 5074893 0.06190 true 1733936 29895185 35200196 -5305011 true true 1 1 NORTHERN DUTCHESS HOSPITAL 6511 SPRINGBROOK AVENUE RHINEBECK NY 12572 WWW.HEALTHQUEST.ORG 1327000H X X X NORTHERN DUTCHESS HOSPITAL 1 false false true X X X X X X 13 true true true true X WWW.HEALTHQUEST.ORG X X true 14 true WWW.HEALTHQUEST.ORG false false true X 200. 300. true true X true X WWW.HEALTHQUEST.ORG X WWW.HEALTHQUEST.ORG X WWW.HEALTHQUEST.ORG X X X X true X false X X X X true X false false PART V, SECTION B, LINE 5 Northern Dutchess Hospital was part of the Integrated Community Assessment Workgroup (ICA) which consists of individuals from Dutchess County Department of Health, Dutchess County Community and Family Services, Dutchess County Department of Mental Hygiene, Dutchess County Department of Probation, Dutchess County Department of Planning & Development, Dutchess County Office for the Aging and Dutchess Country Veterans Services, as well as the Mental Health Association, the Dyson Foundation, the Foundation for Community Health, Health Quest and Mid-Hudson Regional Medical Center (formerly Saint Francis Hospital). PART V, SECTION B, LINE 6A The NDH CHNA was conducted in conjunction with Vassar Brothers Medical Center and the Mid-Hudson Regional Medical (formerly Saint Francis Hospital). PART V, SECTION B, LINE 6B Northern Dutchess Hospital was part of the Integrated Community Assessment Workgroup (ICA) which consists of individuals from Dutchess County Department of Health, Dutchess County Community and Family Services, Dutchess County Department of Mental Hygiene, Dutchess County Department of Probation, Dutchess County Department of Planning & Development, Dutchess County Office for the Aging and Dutchess Country Veterans Services, as well as the Mental Health Association, the Dyson Foundation, the Foundation for Community Health, Health Quest and the Mid-Hudson Regional Medical Center (formerly Saint Francis Hospital). PART V, SECTION B, LINE 7D The CHNA was also printed and distributed throughout the hospital, including the main lobby, patient waiting areas and hospital administration. PART V, SECTION B, LINE 11 Dutchess County identified four priority areas: 1) reduce childhood obesity, 2) increase access to preventative healthcare and improve management of chronic disease, 3) reduce tick and insect-related disease and 4) reduce substance abuse. NDH elected to focus on vaccination of preventable diseases and tick and insect-borne illnesses. NDH does address obesity and management of chronic diseases through a formal pre-diabetes program and a robust program of support groups and lectures designed to improve management of chronic disease. The pre-diabetes program launched in 2014 has been so successful that NDH has been identified as a model program for other organizations and will be used as a reference to other hospitals. There were two session in 2015 and they consistently have a waiting list for this class. Substance abuse was not a priority at this time because Mid-Hudson Regional Medical Center (formerly Saint Francis Hospital) has licensed substance abuse beds. Vaccination of preventable diseases During the 2014-2015 Flu Season, NDH continued to enforce protocols to screen all ED admits for vaccination and provide vaccine according to state recommendations. An educational campaign around flu prevention and education was launched in November and supplemented with a blog post that stayed on our website. Additionally, we partnered with CVS in Rhinebeck to offer a flu clinic at Wells Manor, our subsidized senior citizen houseing development located a quarter mile from NDH. Barriers to this initiative include timing of vaccination availability to NDH, as well as community pharmacies receive bulk shipments long before the hospital. We have concluded that many seniors want the vaccination as soon as it is available, making local pharmacies a first choice to many. We have also found it very difficult to obtain the data needed for measurement from community pharmacies. In addition to our patients, we focused on increasing the vaccination rates of our employees, providers and volunteers. During the 2014-2015 season, the overall vaccination rate for this group was 87 percent, up 4 percent from the previous season. Ninety-one percent of employees, 98 percent of volunteers and 70 percent of providers who see at least one patient were vaccinated. Tick and insect-borne illnesses In 2015, Northern Dutchess Hospital focused on education for the patient. Educational displays were placed in our Emergency Department and all ED patients were provided educational materials from the NYS DOH. Hospital staff and management participated in a summer social media educational event in which they 'Took a Bite out of Lyme' by taking a bite of a lime and sharing messages and educational tips about Lyme disease. We reinforced this campaign with additional posts on Lyme disease prevention. In addition, our employed physicians authored blog and community articles on tick education and awareness for our website and local newspapers. In the summer of 2015, Health Quest partnered with the Dutchess County Department of Behavior and Community Health to sponsor tick-removal kits that were distributed at the Dutchess County Fair. During the fair, 250 kits were handed out. An additional 100 kits were distributed at NDH health fairs during the year. Staff and physician education was offered at VBMC in May. PART I, LINE 6A NORTHERN DUTCHESS HOSPITAL PREPARED A COMMUNITY SERVICE PLAN IN 2013, AND INITIATED THE IMPLEMENTATION STRATEGIES THROUGHOUT 2014 AND 2015, AND WILL CONTINUE INTO 2016. PART I, LINE 7 COLUMN F TOTAL BAD DEBT EXPENSE - $1,733,936 PART I, LINE 7 THE COST TO CHARGE RATIO PERCENTAGE, BASED ON THE MEDICARE COST REPORT, WAS USED AS THE COSTING METHODOLOGY IN DETERMINING THE AMOUNTS REPORTED. PART III, SECTION A, LINE 2, 3 AND 4 LINE 2 - NDH FOLLOWS GENERALLY ACCEPTED ACCOUNTING PRINCIPLES IN ITS RECOGNITION OF BAD DEBT EXPENSE. PATIENT ACCOUNT BALANCES WERE ONLY CONSIDERED FOR BAD DEBT AFTER APPLYING ALL CONTRACTUAL DISCOUNTS AND PAYMENTS, AND SCREENING FOR CHARITY ELIGIBILITY. LINE 3 - NDH DOES RECOGNIZE THAT THERE WAS SOME BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS WHO WERE ELIGIBLE UNDER THE ORGANIZATION'S CHARITY POLICY. WE DID NOT HAVE A REASONABLE BASIS FOR ESTIMATING THE AMOUNT OF BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER OUR FINANCIAL ASSISTANCE POLICY. PATIENTS WHO WERE ELIGIBLE UNDER OUR FINANCIAL ASSISTANCE POLICY WERE ACCOUNTED FOR UNDER CHARITY CARE RATHER THAN BAD DEBT. LINE 4 - FOOTNOTE ON AUDITED FINANCIALS - THE FOOTNOTE TO THE ORGANIZATION'S FINANCIAL STATEMENTS THAT DESCRIBES BAD DEBT EXPENSE CAN BE FOUND ON PAGE 15 OF THE HEALTH QUEST SYSTEMS CONSOLIDATED AUDITED FINANCIAL STATEMENTS. FEDERAL AND STATE LAW REQUIRES THAT HOSPITALS PROVIDE EMERGENCY SERVICES REGARDLESS OF A PATIENT'S ABILITY TO PAY. UNINSURED PATIENTS SEEN IN THE EMERGENCY DEPARTMENT, INCLUDING PATIENTS SUBSEQUENTLY ADMITTED FOR INPATIENT SERVICES, OFTEN DO NOT PROVIDE INFORMATION NECESSARY TO ALLOW THE COMPANY TO QUALIFY SUCH PATIENTS FOR CHARITY CARE. UNCOLLECTIBLE AMOUNTS DUE FROM SUCH UNINSURED PATIENTS REPRESENT THE SUBSTANTIAL PORTION OF THE PROVISION FOR BAD DEBTS REFLECTED IN THE ACCOMPANYING CONSOLIDATED STATEMENTS OF OPERATIONS. PART III, SECTION B, LINE 8 THE MEDICARE SHORTFALL SHOULD BE CONSIDERED A COMMUNITY BENEFIT BECAUSE THE ORGANIZATION IS RELIEVING A GOVERNMENT BURDEN BY PROVIDING CARE IN EXCESS OF THE COMPANY'S COSTS FOR THE PATIENTS IN THE COMMUNITY. THE COSTING METHODOLOGY USED TO CALCULATE THE SHORTFALL WAS THE COST TO CHARGE RATIO FROM THE MEDICARE COST REPORT. PART III, SECTION C, LINE 9B BEFORE A DELINQUENT ACCOUNT WAS REFERRED TO A COLLECTION AGENCY, THE ACCOUNT WAS REVIEWED TO DETERMINE WHETHER THE PATIENT QUALIFIED FOR CHARITY CARE, OR FINANCIAL ASSISTANCE UNDER OUR CHARITY CARE POLICY. IF IT WAS DETERMINED THAT THE PATIENT WAS ELIGIBLE FOR CHARITY CARE, OR FINANCIAL ASSISTANCE, THE ACCOUNT WAS ADJUSTED TO CHARITY, AND WAS NOT PURSUED WITH A COLLECTION AGENCY. IF A PATIENT APPEALLED THE DETERMINATION, THE ACCOUNT WAS NOT REFERRED TO A COLLECTION AGENCY UNTIL A FINAL DETERMINATION HAD BEEN MADE WITH RESPECT TO THE APPEAL. PATIENTS STILL HAD THE OPPORTUNITY TO APPLY FOR A DISCOUNT UNDER THE CHARITY CARE POLICY EVEN AFTER THE ACCOUNT HAD BEEN SENT TO A COLLECTION AGENCY. PART VI LINE 2 NEEDS ASSESSMENT Northern Dutchess Hospital participated in community needs assessments and community health improvement plans with the Dutchess County Department of Health. The Integrated Community Assessment Workgroup (ICA) was established in 2008 by the Integrated Community Planning Workgroup (ICP) to implement a countywide integrated assessment. Its goal is to examine the local health and human services system including all aspects of the local environment i.e. physical, legal, social, economic, and health. The assessment was achieved by conducting a survey reaching out to a representative sample of Dutchess County residents. The ICP consists of health and human services public agency representatives, and the ICA consists of a smaller group of individuals from the lead agencies Dutchess County Department of Health, Dutchess County Community and Family Services, Dutchess County Department of Mental Hygiene, Dutchess County Department of Probation, Dutchess County Department of Planning & Development; Dutchess County Office for Aging, Dutchess County Veterans Services; as well as the Mental Health Association, the Dyson Foundation, the Foundation for Community Health, Health Quest, and Mid-Hudson Regional Medical Center (formerly St Francis Hospital). The ICP has been building upon other community assessment data, including the Many Voices One Valley Report, a project of the Dyson Foundation and the Marist College Institute for Public Opinion to examine residents priorities for the Mid-Hudson Region (http://www.manyvoicesonevalley.org/). Several independent assessments have been conducted over the years, notably: An annual countywide data document capturing available economic, educational and health data that impact children, youth, families and adults A community health assessment report issued every three years for selected indicators In 2009, the County issued its first systematic and integrated assessment, accomplished via survey administration to a representative sample of Dutchess County residents. The results of the 2009 integrated assessment have fed the strategic planning process of each department involved, as well as the ICP. It also ensures that the Health and Human Services planning process is responsive to community strengths and needs and results in a plan that can be implemented successfully, where clear indicators can be tracked and benchmarked. In 2012, members of the ICA reviewed the questions from the 2009 survey. While some questions were discarded or added, care was taken to insure that survey results would be compatible with the 2009 results for trending purposes. Once the survey questions were finalized, the group issued an RFP and retained a firm to conduct the survey. The firm made 11,227 calls between November 31, 2012 and January 18, 2013. They achieved a 10% response rate, including both land lines and cell phones. The raw data was submitted to the Dutchess Department of Health, where it was analyzed and compiled by their epidemiologist. On September 17, 2013, the Dutchess County Department of Health hosted a county-wide Community Health Improvement Plan Design Forum. The purpose of the forum was to review the results of the recent survey and develop a locally relevant, comprehensive action plan to improve the health and lives of the residents of Dutchess County. Representatives from various agencies attended, including staff, management and physician representation from Health Quest, VBMC and NDH. As a result of the survey and subsequent analysis, Dutchess County identified the following four priority areas: 1. Reduce Childhood and Adult Obesity 2. Increase Access to Preventative Healthcare and Improve Management of Chronic Disease 3. Reduce Tick and Insect-related Diseases 4. Reduce Substance Abuse While insect-related disease does not appear to fit into any of New York States Preventive Agenda categories, it was by far the biggest health concern for Dutchess County residents who responded to the survey. We have, in order to be consistent with the Prevention Agenda structure, considered it to be in the Safe and Healthy Environment category. Northern Dutchess Hospital: Three Year Plan of Action 1. Vaccinate Preventable Diseases Decrease the Burden of Influenza: In choosing its first initiative, Northern Dutchess Hospital deviated slightly from the DCDOH priorities. NDH is a small hospital (68 beds) with limited resources. In NDHs service area, 18% of its population is over 65, a number projected to rise to 23% in the next 10 years. NDH has a strong focus on caring for the senior community, with its affiliated 100-bed skilled nursing facility, its Center for Health Aging, and its commitment to orthopedic and rehabilitative services. The hospital itself is a hub for senior activity and a natural location for outreach to the senior population. While the most recent rates of immunization available meet the NYS 2017 objective, the county lags behind the statewide rate. NDHs implementation plan is designed to build on its existing policy of screening and immunizing all inpatients by expanding screening efforts to the emergency department. It will also gauge the need for community flu clinics, which appear to be less in demand due to inexpensive vaccines being offered by pharmacies. Priority Area: Vaccinate Preventable Diseases Goal: Decrease the burden of influenza disease Increase flu immunization rates by 10%. Disparity: Increase flu immunization rates among residents 65 and older by 10%. Performance Measures Objective 1: Increase screening and vaccination of NDH patients by targeting outpatients Indicators are listed below, followed by the source for tracking the effectiveness of the program. Percentage of NDH patients vaccinated for influenza will increase by 20% over three years Internal data Objective 2: Increase community awareness of benefits of vaccine and community resources to receive vaccinations Indicators are listed below, followed by the source for tracking the effectiveness of the program. Attendance at community flu clinics will rise 10% over baseline (dependent on community need) over three years Internal data, Regional pharmacy data Action Plan Objective 1 Listed below are the activities, followed by target dates and partners for each program. Determine baseline % of NDH patients who have received the flu vaccine 4/31/2014 None required Enact protocols to screen all ED admits for vaccination and provide vaccine according to state recommendations 12/31/2013 VBMC, PHC, DCDOH Increase the percentage of patients who receive the vaccine by 8% 12/31/2014 DCDOH Increase the percentage of patients who receive the vaccine by 14% over baseline (cumulative) 12/31/2015 DCDOH Increase the percentage of patients who receive the vaccine by 20% over baseline (cumulative) 12/31/2016 DCDOH Objective 2 Listed below are the activities, followed by target dates and partners for each program. Develop at least one patient education campaign in year one 12/31/2014 DCDOH Develop at least one patient education campaign in year two 12/31/2015 DCDOH Develop at least one patient education campaign in year three 12/31/2016 DCDOH Provide outreach to senior groups through lectures, mailings and other forums. Ongoing DCDOH, Office of the Aging, Dutchess Connect Hold at least one community flu clinic in year one (determine baseline attendance) 12/31/2014 DCDOH Collaborate with community partners to offer flu clinics focused on the elderly. 12/31/2014 DCDOH, Office of the Aging, Dutchess Connect Hold at least one community flu clinic in year two, with attendance = 5% over baseline 12/31/2015 DCDOH Hold at least one community flu clinic in year three, with attendance = 10% over baseline 12/31/2016 DCDOH 2. Lyme and Other Insect-Borne Diseases: Dutchess County residents have significantly higher rates of tick-borne diseases than NYS residents overall. In both the 2009 and 2012 Dutchess Community Surveys, Lyme disease and other insect-related diseases were identified by two thirds of respondents as the top environmental concern. While VBMCs initiative focuses on education of providers, NDH will focus on education of the patient. This two-pronged approach is hoped to have a positive impact on awareness and treatment. Priority Area: Promote a Healthy and Safe Environment Goal: Prevent Tick-Borne Diseases in Dutchess County. Promote Use of Evidence-based Care to Manage Insect-borne Disease. Performance Measures Objective 1: Educate NDH patients on tick attachment prevention and treatment options Indicators are listed below, followed by the source for tracking the effectiveness of the program. 90% of people attending educational events will demonstrate increased knowledge of subject matter Pre and post testing Action Plan Objective 1 Listed below are the activities, followed by target dates and partners for each program. Collaborate with DCDOH staff to create or adopt informational pamphlet for patients 12/31/2014 DCDOH, Tick Task Force Devel PART VI LINE 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE We have a Health Quest wide financial assistance policies and procedures that has been in place at each hospital. The HQ Financial Assistance policy/worksheet is displayed on the back of each patient statement, there are financial assistance posters hanging within the registration areas, and the HQ Financial Assistance policy is displayed on the HQ website. In addition, the financial counselors, at each hospital, attempt to contact each self-pay patient to screen the patient for Financial Assistance and make the patient aware of their options. The folder given to each patient in the ED contains literature about the financial assistance policy. Our customer service reps are all educated on the Financial Assistance policy and explain this to the patients if they ask. PART IV LINE 4 COMMUNITY INFORMATION Northern Dutchess Hospital's service area includes Dutchess County from Hyde Park and north. It also includes several adjacent zip codes in Ulster County and some of the southernmost towns in Columbia County to the north. Like the neighboring VBMC service area, population growth is projected to be limited to people aged 65 and older. PART IV LINE 5 PROMOTION OF COMMUNITY HEALTH NDH is a 68-bed community hospital. Its board of trustees is composed of prominent citizens who live and work in the community. Medical staff privileges in the hospital are available to all qualified physicians in the area, consistent with the size and nature of the facility. The hospital has 49 doctors on its active staff and 201 doctors on its courtesy staff. NDH currently rents space in its hospital to physicians. NDH opened a medical office building with additional space for doctors in early 2016. Any member of its active medical staff has the privilege of leasing available office space. Rent is derived from a fair market value analysis provided by an independent party. The hospital operates a 24 hour emergency room where no one requiring medical attention is denied care. Any income over expenses is reinvested into the hospital, its staff and the community. NDH realizes this is necessary to achieve and maintain high quality standards, keep up with the rapid advancement in technology, provide start-up capital for new programs, and expand existing facilities and programs in order to provide quality care to the community. PART VI LINE 6 AFFILIATE HEALTH CARE SYSTEM Health Quest is a nonprofit organization dedicated to the wellbeing of the communities it serves. Health Quest was formed through an affiliation of three local hospitals: Northern Dutchess Hospital (Rhinebeck, NY), Putnam Hospital Center (Carmel, NY) and Vassar Brothers Medical Center (Poughkeepsie, NY). In addition to the hospitals and their foundations, Health Quest also counts among its many partners long-term care facilities, a free-standing radiation oncology center, a cardiology center, urgent care centers, a multi-specialty medical practice, a skilled nursing facility, and a home care service. Together, they provide the healthcare needs of the entire region. Health Quest hospitals meet on a regular basis with community agencies and stakeholders. Each hospital has a board comprised of staff and community members who oversee the Community Health Needs Committee. Each committee oversees the development of community health needs assessments and health improvement plans. Health Quest participates in many community-based health fairs and events throughout the year. Hospital staff provides information on a variety of health topics, including heart health, stroke prevention, diabetes, nutrition, tobacco cessation and injury prevention. Some of the health fairs Health Quest participated in during 2015 include the Marist College Wellness Fair, American Heart Associations Dutchess-Ulster Heart Walk Health Expo and state Sen. Sue Serino's Golden Gathering. Throughout the year, Health Quest actively sponsors a number of health-related fundraisers for other nonprofit organizations, including regional chapters of the American Heart Association, American Cancer Society and Alzheimers Association. Employees are also active members of their communities volunteering and serving on the local boards of various agencies, in addition to performing public benefit outreach initiatives on behalf of Health Quest. During the summer months of 2015, a mobile farmers market in the City of Poughkeepsie brought fresh fruits and vegetables from local farms to consumers in areas where access to quality produce is limited. Health Quest was excited to sponsor this initiative and provide registered dietitians onsite to answer food-related questions and provide recipe ideas. In 2014, Health Quest launched a fitness challenge, partnering with the Walkway Over the Hudson, to offer the public the Get Fit HV initiative in both the spring and fall. In 2015, the program was expanded to include the Putnam County Trailway. The program urges residents to walk, bike and/or run for at least 30 minutes as many times as possible on the Walkway or Trailway during the six-week challenge. Health Quest also partners with physicians who are on the medical staff at the three hospitals to offer public lecture series in the spring and fall. The seminars engage participants on a variety of medical topics from prevention to the latest treatment options and to learn from leading doctors in their field. In addition, Health Quest partnered with the Dutchess County Office of the Aging to provide expert resources for their Matter of Balance Clinic. This award-winning program is designed to reduce the fear of falling and increase the activity levels of older adults who have concerns about falls. Health Quest employees donate time as volunteer coaches to teach the eight two-hour sessions. PART VI LINE 7 STATE FILING OF COMMUNITY BENEFIT REPORT - NEW YORK true AMERICAN HEART ASSOCIATION 301 MANCHESTER ROAD SUITE 105 POUGHKEEPSIE NY 12603 135613797 501(c)3 6000 RESEARCH AND DEVELOPMENT OF CARDIAC PROGRAMS WALKWAY OVER THE HUDSON 82 WASHINGTON STREET POUGHKEEPSIE NY 12601 141753502 501(c)3 5760 SUPPORT OF WALKWAY FOR COMMUNITY PART 1 LINE 2 Sponsorship Policy: Y Criteria for Sponsoring a Community Organization: Health Quest (HQ) recognizes the value and benefits of sponsoring other community organizations throughout the year. The following section outlines the criteria for when it is appropriate to do so: Marketing Opportunity - Health Quest will sponsor community events when the benefits provided to our organization allow for a significant amount of marketing, name recognition and general publicity. The desired amount of marketing for HQ will determine the sponsorship level chosen. Relative to Healthcare - Health Quest will sponsor organizations and their events that directly relate to our mission as a healthcare system. HQ Executive is a member of the Organization's Board - Health Quest will sponsor community events when our Executives serve on the organization's board and feel it is of value to provide support to them. The Honoree of the Event is Linked to HQ - Health Quest will sponsor community events when the honoree(s) of the event are directly related to Health Quest (ie: one of our employees, board members, etc.) true false false false false false false false false DENISE GEORGE NDH PRESIDENT 0 405609 0 124613 0 50626 0 15900 0 24715 0 621463 0 15600 JOHN SABIA MD VP MEDICAL AFFAIRS - NDH 395377 0 57946 0 708 0 15900 0 19486 0 489417 0 0 15600 CONNIE REGAN PHARMACY CLINICAL COORDINATOR 168660 0 0 0 0 0 11134 0 18908 0 198702 0 11593 0 MICHAEL T WEBER FORMER CEO 0 0 0 0 0 188642 0 0 0 0 0 188642 0 0 JOHN L MCGUINNESS HQ CEO 0 1270523 0 360000 0 212039 0 11520 0 19295 0 1873377 0 0 KATHERINE BACHER INTERIM ASSISTANT TREASURER 0 325538 0 91875 0 577 0 15900 0 760 0 434650 0 15600 SANDRA HELMES LEAD DIAGNOSTIC MED SONOGRAPHE 157358 0 0 0 0 0 6301 0 9392 0 173051 0 8600 0 GARY ZMRHAL ASST. TREASURER 0 586089 0 0 0 0 0 0 0 0 0 586089 0 0 MICHAEL HOLZHUETER ASST. SECRETARY 0 501192 0 87910 0 70816 0 0 0 23656 0 683574 0 0 VALERIE KOCZARA VP PATIENT CARE SVCS INTERIM 158168 0 23951 0 0 0 0 0 0 0 182119 0 0 0 LAWRENCE O'CONNELL ASSISTANT NURSE MANAGER 151139 0 13585 0 0 0 12945 0 17464 0 195133 0 0 0 PAMELA RHODES CNO/VP PATIENT CARE SVCS 184934 0 23935 0 1275 0 12532 0 1548 0 224224 0 0 0 SCH J PART I LINE 4A IN 2014, HQ UNDERWENT A MAJOR EXECUTIVE MANAGEMENT RESTRUCTURING. INCLUDED IN THE WAGES LISTED ON SCHEDULE J FOR FORMER EMPLOYEES ARE RETENTION BONUSES, SEVERANCE PAYMENTS (LISTED IN DETAIL BELOW) AND TAX DEFERRED DISTRIBUTIONS. LINE 4A - SEVERANCE PAYMENTS WERE MADE FROM A RELATED ORGANIZATION FOR ONE OFFICER MICHAEL T. WEBER (HQ CEO)- 24 MONTHS, EFFECTIVE TERM DATE 03/11/2013 - $188,642 PAID IN 2015 SCH J PART I LINE 3 NDH RELIED ON HEALTH QUEST SYSTEMS, A RELATED TAX EXEMPT ORGANIZATION, WHICH USED AN EXECUTIVE COMPENSATION COMMITTEE, AND AN INDEPENDENT THIRD PARTY TO GATHER COMPARABLE DATA TO APPROVE AND DETERMINE COMPENSATION FOR THE CEO, TOP MANANGEMENT AND OTHER KEY EMPLOYEES. A DORMITORY AUTHORITY - STATE OF NEW YORK 146000293 649903UK5 2007-09-06 15718408 PURCHASE OF EQUIPMENT false false false B DUTCHESS COUNTY LOCAL DEVELOPMENT CORPORATION 273106797 267045DW9 2014-05-14 33770225 ACQUIRE, CONSTRUCT & EQUIP FACILIT false false false A 2856230 0 16421813 1126435 319526 0 216413 247657 0 13176836 0 1334946 2008 false false false true B 0 0 33787635 0 1748330 0 477697 0 0 27846608 0 3715000 false false false true A false false false false 0 true B false false false false 0 true A false false false true false false 0 false 0 true true B false true false false false false 0 false 0 false true A false B false BOND ISSUES PART I, LINE A, COLUMN E - TOTAL ISSUE PRICE PER IRS FORM 8038 - $61,974,071.30 ALLOCATED BETWEEN THREE ORGANIZATIONS. PROCEEDS PART II, LINE 3 - THE TOTAL PROCEEDS DO NOT AGREE TO THE ISSUE PRICE IN PART I, COLUMN E DUE TO INVESTMENT EARNINGS. ARBITRAGE SCHEDULE K, PART IV, ARBITRAGE, LINE 2C (A) ISSUER NAME: DORMITORY AUTHORITY - STATE OF NEW YORK DATE THE REBATE COMPUTATION WAS PERFORMED: 12/31/2011 GEORGE VERRILLI TRUSTEE 950000 SALE OF MEDICAL OFFICE BLDG false SCHEDULE R PART II - RELATED TAX EXEMPT ORGANIZATIONS Entity Tax ID# Primary Activity Legal Domicile Exempt Code Status Public Charity Status Direct controlling Entity Vassar Brothers Medical Center 14-1338586 Hospital NY 501c3 Box 3 HQ The Foundation for Vassar Brothers Medical Center 14-1736429 Fundraising NY 501c3 Box 9 HQ Riverside Diversified Services, Inc (Parent) 14-1675545 Education NY 501c3 Box 9 HQ Alamo Ambulance Service, Inc 14-1745417 Transport NY 501c3 Box 9 HQ Health Quest Home Care, Inc (Certified) 14-1788412 Home Health NY 501c3 Box 9 HQ Health Quest Home Care, Inc (Licensed) 14-1788410 Home Health NY 501c3 Box 9 HQ Northern Duchess Hospital 14-1338467 Hospital NY 501c3 Box 3 HQ Northern Dutchess Residential Health Care Facility 22-3129608 Nursing Home NY 501c3 Box 9 HQ NDH Foundation 14-1776208 Fundraising NY 501c3 Box 9 HQ Putnam Hospital Center 14-6019179 Hospital NY 501c3 Box 3 HQ Putnam Hospital Center Foundation 06-1399319 Fundraising NY 501c3 Box 9 HQ Health Quest Medical Practice, PC 56-2669185 Medical Care NY 501c3 Box 3 HQ Health Quest Urgent Medical Practice, PC 80-0152047 Medical Care NY 501c3 Box 3 HQ Health Serve Information Technologies, LLC 14-1797086 IT Support NY 501c3 Box 3 HQ Health Quest Laboratory Support Services, LLC 45-4370644 Medical Laboratory NY 501c3 Box 3 HQ One Columbia Street, LLC 46-1626016 Real Estate Mgmt NY 501c3 Box 3 HQ Hudson Valley Cardiovasular Practice, PC 46-3756713 Medical Care NY 501c3 Box 3 HQ FORM 990 PART VI SECTION A LINE 6, 7A AND 7B - GOVERNING LINE 6 - THE SOLE MEMBER OF NDH IS HEALTH QUEST SYSTEMS, INC. LINE 7A - APPOINTMENT/ELECTION OF GOVERNING BODY 6.01 Officers. The Officers of NDH shall be a Chair, First Vice-Chair, Second Vice-Chair, Secretary/Treasurer, and President/Chief Operating Officer. From time to time, the Board of Trustees may appoint such other Officers with powers and duties not inconsistent with these Bylaws. Any two or more offices may be held by the same person, except the offices of Chair, President/Chief Operating Officer and Secretary/Treasurer. 6.02 Election. The Chair of the Board, First Vice-Chair, Second Vice-Chair and the President/Chief Operating Officer shall be elected by Health Quest. The Secretary/Treasurer and other Officers shall be elected by a vote of the majority of the entire Board of Trustees at a meeting of the Board of Trustees. All Officers shall serve for a term of two (2) years until successors are elected and qualified, such term commencing at the close of the meeting at which they are elected. Officers may be elected for no more than one (1) term. 6.03 Vacancies. A vacancy occurring in any office during the year may be filled by a vote of a majority of the entire Board of Trustees for the remainder of the term thereof at the next Annual Meeting or any regular meeting of the Board or at a special meeting called for such purpose, provided that a vacancy in the office of Chair of the Board, First Vice-Chair, Second Vice-Chair or President/Chief Operating Officer may be filled only by Health Quest. 6.04 Removal. Any Officer may be removed from office, with or without cause, by an affirmative vote of two-thirds (2/3) of the entire Board of Trustees at any meeting of the Board, except the Chair of the Board, First Vice-Chair, Second Vice-Chair and the President/Chief Operating Officer may be removed only by Health Quest. 6.05 Duties and Responsibilities. (a) Chair. The Chair shall preside at all meetings of the Board of Trustees. In accordance with Articles VII and VIII, the Chair also shall (i) appoint the Committee Chairs and members of all Committees of the Board (except the Executive Committee) and ad hoc committees, (ii) serve as an ex-officio member, with vote, on each Committee, and (iii) serve as the Chair of the Executive Committee. The Chair shall perform such other duties as may be provided for by law, these Bylaws, or resolution of the Board of Trustees. (b) First Vice-Chair. In the absence of the Chair, the First Vice-Chair shall preside at meetings of the Board of Trustees. When so acting as Chair, the First Vice-Chair shall have all the powers and authority of the Chair. The First Vice-Chair shall perform such other duties as may be provided for by the Board of Trustees. (c) Second Vice-Chair. In the absence of the Chair and First Vice-Chair, the Second Vice-Chair shall preside at meetings of the Board of Trustees. When so acting as Chair, the Second Vice-Chair shall have all the powers and authority of the Chair. The Second Vice-Chair shall perform such other duties as may be provided for by the Board of Trustees. (d) Secretary/Treasurer. (i) The Secretary/Treasurer shall be responsible for such books, documents, and papers as the Board may determine. The Secretary/Treasurer shall cause minutes to be kept for all meetings of the Board of Trustees, may sign any contracts or agreements with the Chair, the President/Chief Operating Officer, the First Vice-Chair or Second Vice-Chair in the name of NDH if so authorized or ordered by the Board, and may affix the seal of NDH to written instruments when so authorized or ordered by the Board. The Secretary/Treasurer shall perform such other duties as shall be assigned by the Board of Trustees and as are incidental to the office of secretary of a not-for-profit corporation. (ii) The Secretary/Treasurer shall either personally perform, or ensure that appropriate employees of NDH perform, the following functions: receive and care for all monies and properties belonging to NDH and dispose of the same under the direction of the Board of Trustees, receive and give receipts for all amounts due to NDH, endorse checks in its name and on its behalf, receive full discharge for the same in accordance with these Bylaws, and perform such other duties as assigned by the Board of Trustees and as are incidental to the office of treasurer of a not-for-profit corporation. (e) President/Chief Operating Officer. The President/Chief Operating Officer shall serve as the chief executive officer of NDH and shall have the authority and responsibility to manage and operate NDH in all its activities, subject to these Bylaws, the Certificate of Incorporation, and such policies as may be adopted from time to time by the Board of Trustees or Health Quest. The President/Chief Operating Officer's responsibilities shall include, but are not limited to, the following: (i) Acting under the direction of and being accountable to the Board of Trustees of NDH and Health Quest; (ii) Providing effective liaison between the Board of Trustees and management; (iii) Appointing (either personally or through delegation to responsible subordinates), and NDH shall employ, such personnel as may be required to conduct the affairs of NDH; (iv) Ensuring that all activities are properly organized, directed and accounted for as established by the Board of Trustees; (v) Providing reports to the Board of Trustees to keep the Board fully informed of the affairs of NDH; (vi) Performing all duties required by law; and (vii) Unless otherwise provided for herein, performing (either personally or through delegation to responsible subordinates) all acts and executing all documents necessary to carry out the duties of the position of President/Chief Executive Officer. LINE 7B - 4.01 Powers of the Board of Trustees. The business and property of NDH shall be managed by NDH's Board of Trustees and Health Quest, as the co-established operator of NDH. Although Health Quest may elect from time to time to delegate to and/or act jointly with the NDH Board of Trustees, Health Quest has the authority to exercise independently its established powers and rights in its capacity as the co-established operator. Any such delegated authority shall at all times remain subject to the oversight, modification or repeal of Health Quest as the co-established operator of NDH. Without limiting the foregoing powers, Health Quest will consult with the Chair of the NDH Board of Trustees before modifying or repealing any joint operating authority delegated under Section 4.02. 4.02 Joint Operating Authority Delegated to NDH. Subject to Sections 2.02 and 4.01, the Board of Trustees of NDH shall have the following operating authority as delegated by Health Quest: (a) Quality Assurance. Apply and execute the quality assurance standards and any quality assurance policies and plans adopted by Health Quest. (b) Medical Staff Credentialing and Bylaws. Apply and execute the Medical Staff credentialing standards and any policies adopted by Health Quest, which includes being responsible for: (i) Appointing the members of the Medical Staff; (ii) Approving any Medical Staff appointments such as Medical Staff officers or department chairs requiring Board approval; (iii) Pursuant to the procedures set forth in the Bylaws of the Medical Staff, dismissing any member of the Medical Staff, and approving, rejecting or modifying any corrective action taken or recommended by the Medical Staff for any member of the Medical Staff; and (iv) Approving the Medical Staff Bylaws, Rules and Regulations. (c) Strategic Planning. Provide input to the system-wide strategic planning process and NDH-specific strategic plan, as requested and approved by Health Quest, and monitor the implementation of such plan. (d) Statements of Deficiency and Legal Compliance. Respond to any statements of deficiency issued by any regulatory or accrediting authority and take all appropriate and necessary action to monitor and restore compliance with deficiencies in NDH's compliance with statutory, regulatory or accreditation requirements, including but not limited to monitoring the submission and implementation of all plans of correction. (e) Conflicts of Interest. Implement and comply with the written Conflict of Interest Policy as approved by Health Quest and as interpreted and directed by the Compliance and Audit Committee of Health Quest. (f) Community Health Needs. Implement the statement of mission approved by Health Quest by developing a Community Service Plan tailored specifically to the work of NDH in the community it serves and monitoring performance thereof. (g) Budgets and Financial Performance. Assist in developing and monitoring the budgets for NDH, as requested by Health Quest and, as approved, monitor the financial performance of NDH. (h) Physician Arrangements. Review and approve physician financial arrangements in accordance with and as permitted by a system-wide policy adopted by Health Quest. (i PART VI SECTION B LINE 11B, 12C, 15A AND 15B - POLICIES LINE 11B - PRIOR TO FILING, A DRAFT OF THE COMPLETED FORM 990 WAS REVIEWED BY INTERNAL MANAGEMENT. AFTER THAT REVIEW WAS COMPLETE, THE FORM 990 WAS PROVIDED TO THE BOARD OF DIRECTORS OF HQ (PARENT OF THE FILING ORGANIZATION) FOR ADITIONAL REVIEW AND COMMENT. CONTACT INFORMATION WAS PROVIDED SHOULD QUESTIONS ARISE. A 3RD PARTY WAS HIRED TO PREPARE SCHEDULE K. LINE 12C - ON AN ANNUAL BASIS OFFICERS, DIRECTORS, TRUSTEES AND KEY EMPLOYEES ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST FILING WHICH IS REVIEWED BY THE HQ VP OF COMPLIANCE AND INTERNAL AUDIT. ALL POTENTIAL CONFLICTS OF INTEREST ARE REVIEWED BY THE HQ BUSINESS ETHICS COMMITTEE ON BEHALF OF NDH. LINE 15 A/B - COMPENSATION OF THE CEO, TOP MANAGEMENT AND OTHER KEY EMPLOYEES IS ESTABLISHED BY THE HQ EXECUTIVE COMPENSATION COMMITTEE BASED ON INFORMATION AND SUPPORT OF AN INDEPENDENT THIRD PARTY. FORM 990 PART VI SECTION C LINE 19 - DISCLOSURE LINE 19 - POLICIES AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. THE DOCUMENTS ARE PROVIDED EITHER ELECTRONICALLY OR PAPER COPIES. IN ADDITION, CERTAIN FINANCIAL INFORMATION IS AVAILABLE ON VARIOUS WEBSITES DUE TO REGULATORY FILINGS SUCH AS THE 990 AND BOND HOLDER REQUIREMENTS. SCHEDULE K PART I LINE A COLUMN E TOTAL ISSUE PRICE PER IRS FORM 8038 - $61,974,071.30, ALLOCATED AS FOLLOWS NORTHERN DUTCHESS HOSPITAL - $15,718,407.82 PUTNAM HOSPITAL CENTER - $28,161,750.86 VASSAR BROTHERS MEDICAL CENTER - $18,093,912.82 SCHEDULE R PART V LINE 2 (1) - ALLOCATION METHODOLOGY FOR HQ Health Quest Systems, Inc Allocation of Support Services/Shared Expenses/Cash Funding General: The following services are considered shared services for Health Quest affiliates and the cost to provide these services are allocated to each entity which benefits from the service based on a pre defined allocation methodology: 1. Specialty Staffing a. VBMC Surgical b. Radiology c. Oncology d. VBMC Sleep Lab e. PT/OT/ST f. Cardiac Rehab 2. Clinical Management a. Emergency Room b. Oncology 3. Revenue Cycle including health information management, budgets and reimbursement, revenue integrity, system business office, patient access oversight, financial clearance center, managed care and decision support 4. Facilities including courier service, construction, property management, facility operations, food service management and security management 5. Business Development including strategic planning, marketing and public relations, answering service and community education 6. Corporate Finance including accounts payable, payroll, general accounting, purchasing, supply chain and mailroom, practice management billing and management engineering 7. Internal Audit and Compliance 8. Practice management operations including physician recruitment, physician management and centralized scheduling 9. Human Resources and learning and development 10. Administrative including Executive office, Hospital Support and risk management 11. Legal Counsel 12. Information Technology and Medical Technology Services (MTS) Description of Services: 1. Specialty staffing a. Provides non union staffing services for various specialties to the hospitals, offsite ancillary locations and the Fishkill Medical Mall 2. Clinical management includes management oversight to system consolidated clinical services 3. Revenue Cycle a. Health Information Management functions includes coding and transcription of medical records for all 3 hospitals b. Budget functions include preparation of annual budgets, variance reporting and maintenance of the budget module Reimbursement functions include preparation of annual cost reports, analysis of third party rate accounts and third party audits c. Revenue Integrity functions include charge master analysis and development of revenue producing charges, compliance with CPT coding and establishment of appropriate charges d. System business office services includes producing claims for third party payers and private pay patients, payment processing, periodic reporting, accounts receivable analysis, charity care application process, denial management, collection and follow up for the hospitals. Patient access and financial clearance center includes oversight of all centralized registration areas at the hospitals and pre-authorization for numerous hospital services to insure compliance with third party regulations e. Managed Care functions include contract negotiations and analysis of contract terms f. Decision Support functions include cost accounting reporting, maintenance of HBI (Horizon Business Insight) reporting and the contract management system 4. Facilities a. Courier service provides delivery services internally throughout the HQ system and bank deposit drop offs b. Construction and property management functions include contracting services for Health Quest projects and property management of all HQ facilities c. Facility operations include management oversight of the engineering departments for the hospitals d. Food Service management includes management oversight of food and nutrition departments for the hospitals e. Security functions include management oversight of all facilities to ensure the safest environment 5. Business Development a. Strategic Planning functions include CON submissions, market data analysis and assistance with business plans b. Marketing includes advertising services, coordination of Health Quest advertisements and managementof the HQ website content c. Public relations functions include coordination of Health Quest communication to external customers, patients and media d. Oversight of the outsourced answering services for physicians affiliated with the hospitals and HQMP e. Community education functions include training classes specific to life saving techniques 6. Finance a. Accounts payable functions include scheduling vendor payments, insuring flow of goods and services, maintaining days cash on hand goals and maintaining days in accounts payable b. Payroll functions include biweekly employee payments and tax filings in accordance with Human Resources and Payroll policies c. General Accounting functions include preparation of financial statements, account analysis, contract reconciliation, tax filings, investment coordination, and coordination of internal and external audit functions d. Purchasing, supply chain and mailroom functions include procurement services, contract negotiations, price negotiations, capital purchase negotiations, management/distribution of hospital inventory, and central mailroom management e. Practice management billing functions include producing all claims for third party payers and private pay patients, payment processing, periodic reporting, accounts receivable analysis, charity care application process, denial management, collection and follow up services for all employed HQ physicians f. Management Engineering functions include evaluating each area within HQ to ensure compliance with various productivity benchmarks optimizing staffing ratios 7. Internal Audit and Compliance includes oversight of the corporate compliance program, internal audit, HIPAA compliance, contract review and compliance 8. Human Resource and learning and development functions include recruitment, compensation, benefit administration and employee training 9. Physician management operations functions include oversight of all HQ physician practices, physician recruitment functions, and the centralized scheduling office 10. Administrative functions include oversight of the Health Quest system, hospital management and risk management 11. Legal Counsel functions include internal legal services for HQ and coordination of all outsourced legal initiatives 12. Information Technology and MTS a. IT provides information technology support for all applications and telephony support within HQ. In addition provides project management services for all new and upgrades to current IT applications. b. MTS/Biomed includes technical services provided to each hospital for equipment repair and maintenance Shared Expenses: In addition to services provided by support departments, certain insurance policies are consolidated for all Health Quest entities. These include property insurance, travel, crime, environmental, cyber risk and Directors and Officers insurance. Affiliate cash shortfalls: Affiliate cash shortfalls are funded by the entity(s) benefiting from the affiliate services. Examples include Health Quest Medical Practice and The Thompson House. The cash shortfall funding is based on the percentage of benefit received (percentage of revenue by division for HQMP and patient census for The Thompson House from the hospitals). Allocation Methodology: Net Revenue - lab management, budgets, revenue cycle, managed care, decision support, all facilities (excluding construction), business development, general accounting, management engineering, internal audit and compliance, executive office, legal, information technology and MTS # of visits/procedures - staffing specialties Historical trends - health information management, clinical management and hospital support Cash collections - patient accounting and the financial clearance center # of FTE's - payroll and human resources Non payroll expenses - accounts payable and purchasing Project based - construction # of FTE's allocated to physician sites - Practice management billing, operations and physician practice management System Benefits: 1. Financial planning 2. Revenue enhancement 3. Improved cash collections 4. Enhanced managed care contract rates 5. Optimized medical records coding 6. Savings for supplies, contracts, insurance and capital purchases 7. Staffing reduction through shared services 8. Enhanced employee benefit programs Health Quest Laboratory Support Services, LLC provides clinical diagnostic services to affiliate hospitals. NDH covers lab services performed for both their inpatient and outpatient services. FORM 990 PART XI LINE 9 - RECONCILIATION OF NET ASSETS TRANSFER OF EQUITY - ($3,078,013); INTEREST IN FOUNDATION - $0; CHANGE IN RESTRICTED CONTRIBUTIONS $3,417,631 FORM 990 PART XII LINE 3A - OMB CIRCULAR A-133 AUDIT NORTHERN DUTCHESS HOSPITAL DID NOT RECEIVE MORE THAN $500,000 IN FEDERAL AWARDS IN 2015, AND DID NOT QUALIFY FOR AN A-133 AUDIT. SCHEDULE R PART V LINE 4 - ALLOCATION METHODOLOGY FOR HQMP The hospital pays administrative fees and subsidies to Health Quest Medical Practice PC. These fees are for expenses incurred by the medical practice while providing the following services to NDH at cost. Hospitalists: The physicians employed by the Hospitalist program admit and provide care to inpatients at NDH allowing the patient's private/primary community physician to remain in their office. The care is provided on a continuous basis to the patient throughout the day, night and weekends. The specific requirements of the group are detailed below: 24/7 coverage, Medical Director administrative time: 18 hours per week includes: scheduling, payroll, recruitment, evaluation of growth, review financial records. Night coverage: 15 hour shift. 6 hours are spent on billable patient care, while the remaining 9 hours (63 hours per week) are involved with covering existing team and being available for ER evaluations or new consults. These hours are critical for excellent care and are not billable. Day MD administrative time: filling out forms, conferences with patients/family/staff beyond E/M billable time, signing charts. 1 hour each per provider or 3 hours per day- 21 hours per week, Case management advisor participates in QI programs at the hospital, and Chair of information management committee. Nursing Education directs and coordinates all clinical matters. Develop cost effective care, cost containment measures, assist in operating and capital budgets, including projections of revenue and expenditures, ensure the consistency and quality of services provided. Analyze clinical outcomes, and identify deficiencies. Resolve patient problems with the quality of services. Maintain written reports to outline goals, objectives and standards for services. Scheduling providers participate in community outreach programs and community education. Review financial reports and ensures that all providers are compliant. Intensivists: The physicians employed by the Intensivist (triple boarded) program provide care to critically ill patients in the intensive care and critical care units at VBMC. The appropriate level of care warranted by the acuity of the patient is provided on a continuous basis to the patient throughout the day, night and the weekends. The specific requirements of the group are detailed below: 24/7 coverage for code stats. Lead team, intubate, place lines, emergency pacemakers, etc. 24/7 rapid consultations available for medical staff. 24/7 availability to triage patients moving into, or out of, intensive care. 24/7 coverage of ED evaluations and urgent/emergent advice of critically ill adults. Mandated coverage for an average of 15 ICU patients/day, and direct and coordinate all clinical matters. Develop cost effective care, cost containment measures, assist in operating and capital budgets including projections of revenue and expenditures, and ensure the consistency and quality of services provided. Analyze clinical outcomes, and identify deficiencies. Resolve patient problems with the quality of services. Maintain written reports to outline goals, objectives and standards for services. Scheduling providers participate in community outreach programs and community education. Review financial reports and ensures that all providers are compliant. Surgical PA Program: The Physician Assistants employed by the Surgical PA program assist during surgical procedures at NDH. This service is extremely important to the community of surgeons due to a shortage (and aging) of general surgeons in Dutchess County. This program reduces the need for surgeons to double-up during procedures. The specific requirements of the group are detailed below: Direct and coordinate all clinical matters. Develop cost effective care, cost containment measures, assist in operating and capital budgets including projections of revenue and expenditures to ensure the consistency and quality of services provided. Analyze clinical outcomes, and identify deficiencies. Resolve patient problems with the quality of services. Recommends employment and termination of non-physician personnel. Maintain written reports to outline goals, objectives and standards for services. Scheduling providers participate in community outreach programs and community education. Review financial reports to ensure that all providers are compliant. CT Surgeons: The physicians and physician assistants employed by HQMP provide care for cardiac patients on both an outpatient basis (office visits) and an inpatient basis for surgical procedures and the associated post-operative care. The specific requirements of the group are detailed below: Direct and coordinate all clinical matters. Develop cost effective care, cost containment measures, assist in operating and capital budgets including projections of revenue and expenditures to ensure the consistency, quality of services provided. Analyze clinical outcomes, and identify deficiencies. Resolve patients and problems with the quality of services. Recommends employment and termination of non-physician personnel. Maintains written reports to outline goals, objectives and standards for services. Scheduling providers participate in community outreach programs and community education. Review financial reports to ensure that all providers are compliant. HEALTH QUEST SYSTEMS INC 45 READE PLACE POUGHKEEPSIE NY 12601 141678068 SUPPORT SERV BOX 9 HQ SEE SCHEDULE O N/A true false false false false false false false false false false false false false false true false false false HEALTH QUEST SYSTEMS INC P 11954361 SEE SCHEDULE O HEALTH QUEST LABORATORY SUPPORT SERVICES LLC P 2841381 SEE SCHEDULE O HEALTH QUEST MEDICAL PRACTICE PC A 214876 RENT AT COST HEALTH QUEST MEDICAL PRACTICE PC P 2900865 SEE SCHEDULE O