2015-11-16T22:01:28-06:00 2014-12-31 BDO USA LLP 100 PARK AVENUE NEW YORK NY 10017 990 2014-01-01 111667765 SOUTHAMPTON HOSPITAL ASSOCIATION % CHRISTOPHER SCHULTHEIS SOUT 6317268301 240 MEETING HOUSE LANE SOUTHAMPTON NY 11968 CHIRSTOPHER J SCHULTHEIS CHIEF FINANCIAL OFFICER 6317268301 2015-11-16 true Paul Hammerschmidt P01384178 2128858000 2014 2016-02-25 16:41:14Z ROBERT S CHALONER 240 MEETING HOUSE LANE SOUTHAMPTON NY 11968 147834915 false X www.southamptonhospital.org X 1909 NY TO PROVIDE AND ENSURE THE HIGHEST QUALITY OF HEALTHCARE SERVICES FOR ITS ENTIRE COMMUNITY. 26 25 1178 26 2661086 -78867 14246386 11272875 118993172 130907809 4569836 1094544 983671 941126 138793065 144216354 0 0 0 0 81639605 83145144 0 0 0 46682031 51888924 128321636 135034068 10471429 9182286 106330964 112332163 83493537 82418298 22837427 29913865 X THE VISION OF SOUTHAMPTON HOSPITAL ASSOCIATION IS TO MEET THE EVOLVING HEALTHCARE NEEDS OF ITS EASTERN LONG ISLAND COMMUNITY BY PROVIDING ACCESS TO A CONTINUUM OF HIGH QUALITY CLINICAL SERVICES. TO ACHIEVE THIS, THE HOSPITAL WILL FOCUS RESOURCES ON CONTINUOUSLY IMPROVING CLINICAL OUTCOMES, PATIENT SAFETY, SERVICE EXCELLENCE AND PROMOTING EDUCATIONAL OUTREACH AND PROFESSIONAL DEVELOPMENT OF ITS STAFF. THE ORGANIZATION IS A MEMBER OF THE EAST END HEALTH ALLIANCE, THE ARTICLE 28 PARENT OF EASTERN LONG ISLAND HOSPITAL, PECONIC BAY MEDICAL CENTER AND SOUTHAMPTON HOSPITAL. CONSISTENT WITH THE MISSION OF THE ORGANIZATION, THE GOALS OF THE ALLIANCE ARE AS FOLLOWS: 1) TO COLLABORATIVELY DEVELOP HIGH QUALITY, COMPREHENSIVE AND ACCESSIBLE HEALTH CARE SERVICES TO MEET THE NEEDS OF THE COMMUNITY SERVED; 2) TO RATIONALIZE HEALTH CARE SERVICES ACROSS THE SYSTEM; AND 3) TO REALIZE MANAGEMENT EFFICIENCIES. Southampton Hospital is currently affiliated with Stony Brook Medicine. The two institutions are false false 113347833 0 130907809 SOUTHAMPTON HOSPITAL ASSOCIATION OFFERS A FULL CONTINUUM OF AMBULATORY AND INPATIENT SERVICES RANGING FROM PRIMARY MEDICAL CARE TO SPECIALIZED SURGICAL PROCEDURES, AND IS STAFFED BY MORE THAN 280 PHYSICIANS, DENTISTS AND ALLIED HEALTH PROFESSIONALS REPRESENTING 44 MEDICAL SPECIALTIES. THE ORGANIZATION has developed numerous services and outreach, detailed below, to respond to the needs of its patients, including recruiting additional primary care and specialty physicians, RNs, NPs, and PAs. The graduate medical education program is training physicians for primary and family practice, as well as surgery, and a gratifying number of these doctors are staying within the Hospital's service area. It is anticipated that the Affordable Care Act and the insurance exchanges will result in many more people accessing primary care and the Hospital continues to prepare for this inevitability through its medical education program. SINCE THE ORGANIZATION'S SERVICE AREA EXTENDS FROM WESTHAMPTON BEACH TO MONTAUK, THE HOSPITAL HAS A NUMBER OF SATELLITE OFFICES TO PROVIDE CONVENIENT, SPECIALIZED CARE TO THESE COMMUNITIES. THESE INCLUDE: A) MEETING HOUSE LANE MEDICAL PRACTICE - the practice continues to add new offices in primary, internal medicine, and specialty care on the South Fork. Specialty care services include rheumatology, nephrology, neurology, allergy/asthma, pulmonology, psychiatry, infectious disease, gastroenterology, as well as nutritional and diabetes education. In Southampton, an office was added to the four existing sites, bringing the total to five and a surgical specialty office was also opened in 2015, offering general, orthopedic and bariatric surgery. Other offices include locations in Amagansett, East Hampton (two offices), Hampton Bays (three offices), Montauk, Riverhead, Sag Harbor, Wainscott, and Water Mill. B) WESTHAMPTON PRIMARY CARE CENTER - PROVIDING CARE FOR THE WESTHAMPTON, WESTHAMPTON BEACH, QUOGUE, AND REMSENBURG COMMUNITIES. C) LABORATORY AND IMAGING SERVICES - PROVIDING SERVICES IN EAST HAMPTON, HAMPTON BAYS AND SOUTHAMPTON. D) REGIONAL DIALYSIS CENTER - SERVICE TO DIALYSIS PATIENTS IS PROVIDED BY A DEDICATED INTERDISCIPLINARY TEAM OF BOARD-CERTIFIED NEPHROLOGISTS, CERTIFIED DIALYSIS RNS, LPNS AND DIALYSIS TECHNICIANS, CERTIFIED SOCIAL WORKERS, AND A NYS REGISTERED DIETITIAN. 24-HOUR EMERGENCY SERVICE IS ALSO AVAILABLE. E) CENTER FOR PHYSICAL THERAPY AND SPORTS REHABILITATION - PROVIDING CARE FOR THE WESTHAMPTON, WESTHAMPTON BEACH, EAST QUOGUE, QUOGUE, AND REMSENBURG COMMUNITIES. F) THE SHINNECOCK INDIAN HEALTH CLINIC - SINCE APRIL OF 1995, SOUTHAMPTON HOSPITAL HAS WORKED WITH THE SHINNECOCK NATION TO PROVIDE SERVICES AT THE SHINNECOCK INDIAN HEALTH CLINIC THROUGH A CONTRACT WITH THE NEW YORK STATE DEPARTMENT OF HEALTH. ON AN ANNUAL BASIS, THE CLINIC PROVIDES APPROXIMATELY 2,100 MEDICAL AND 1,000 DENTAL VISITS FOR ELIGIBLE MEMBERS OF THE SHINNECOCK NATION. DENTAL SERVICES, INCLUDING COMMUNITY EDUCATION, SCREENING, RADIOLOGICAL EXAMS, DENTAL HYGIENE AND RESTORATIVE CARE ARE PROVIDED THROUGH A SUBCONTRACT WITH STONY BROOK UNIVERSITY SCHOOL OF MEDICINE. CURRENTLY, DENTAL SERVICES ARE AVAILABLE EIGHT DAYS PER MONTH FOR ADULTS AND TWO DAYS FOR CHILDREN. IN ADDITION TO PRIMARY CARE, DENTAL SERVICES, NUTRITIONAL COUNSELING, PRENATAL CARE AND ENDOCRINE SERVICES, THE CLINIC PROVIDES MENTAL HEALTH AND SUBSTANCE ABUSE COUNSELING. HEALTH SCREENING DAY IS ALSO HELD ANNUALLY IN COLLABORATION WITH LOCAL HEALTHCARE PROVIDERS AND INSTITUTIONS. G) THE DAVID E. ROGERS CENTER FOR HIV/AIDS CARE (DRC) provides comprehensive HIV medical care, with 24/7 on call service; mental health counseling; psychiatry care; medical case management with treatment adherence; nutritional counseling; Hepatitis C treatment; Pre-Exposure Prophylaxis (PrEP) care; Post-Exposure Prophylaxis (PEP) care; free HIV testing; help with advocacy, case management, entitlements, and legal service; Wellness Fund, financial support for patient's special needs; and other support services to people living with HIV/AIDS. The Center also provides education and outreach to affected friends and families. From initial diagnosis of HIV through all stages of illness, our medical team of credentialed HIV specialists provides state-of-the-art care. SINCE 1994 THE DRC HAS PROVIDED HIV CARE TO RESIDENTS OF THE EAST END OF LONG ISLAND, A GEOGRAPHIC AREA PREVIOUSLY UNDERSERVED DESPITE A HIGH HIV PREVALENCE RATE. FROM ITS INCEPTION, THE DRC HAS ENJOYED THE COOPERATIVE EFFORTS OF ITS PARTNER ORGANIZATIONS SOUTHAMPTON HOSPITAL AND THE STONY BROOK UNIVERSITY MEDICAL CENTER AS WELL AS THE SUPPORT OF THE COMMUNITIES OF THE EAST END. THE CENTER HAS MET ITS OBJECTIVES BY PROVIDING CONTINUITY AND ACCESSIBILITY OF CARE BY ESTABLISHING LINKAGES BETWEEN THE HOSPITALS AND WITH COMMUNITY BASED ORGANIZATIONS AND THE COMMUNITY AT LARGE. THE DRC DEPENDS ON THE COOPERATIVE EFFORTS OF ALL HEALTH & HUMAN SERVICE AGENCIES FOR OUTREACH, TO ENSURE A CONTINUITY OF CARE FOR OUR PATIENTS, AND TO PROVIDE SERVICES FOR THE EAST END COMMUNITY. Annually the DRC provides approximately: 802 Medical visits; 384 Mental Health - Social Work visits; 109 Mental Health Counseling visits; 190 Psychiatry visits; 45 Nutritional Counseling visits; 28 HIV Testing visits; 7 Post Exposure Prophylaxis (PEP) visits; for a total of 1,565 visits provided for 199 active patients. H) CENTER FOR PRENATAL CARE - THE CENTER FOR PRENATAL CARE AT GREENPORT PROVIDES COMPREHENSIVE PRENATAL, GYNECOLOGIC AND FAMILY PLANNING SERVICES FOR WOMEN AND IS AN IMPORTANT OUTREACH ACTIVITY THAT PERMITS THE HOSPITAL TO TAILOR ITS PROGRAMS TO COMMUNITY NEEDS. THE CENTER'S STAFF PROVIDES EXTENSIVE EDUCATION AND COUNSEL TO THEIR PATIENTS IN THE AREAS OF NUTRITION, CHILDBIRTH EDUCATION, DOMESTIC VIOLENCE, AS WELL AS DRUG AND ALCOHOL ABUSE, WHILE ALSO PROVIDING IMMEDIATE ACCESS TO MEDICAID ASSISTANCE, FOR MOTHERS MEETING THE ELIGIBILITY REQUIREMENTS, THROUGH THE PRENATAL CARE ASSISTANCE PROGRAM (PCAP). THE CENTER HAS SUCCESSFULLY WORKED WITH THE LOCAL TOWN GOVERNMENT TO OBTAIN THE AGREEMENT OF LOCAL GROCERS TO ACCEPT WIC VOUCHERS. STAFF ALSO UTILIZES FLYERS, BROCHURES, AND POSTERS TO INCREASE AWARENESS OF HOSPITAL SERVICES AND OFFERS TRANSLATION SERVICES TO THE SIGNIFICANT NUMBER OF HISPANIC WOMEN SEEKING CARE AT THE CENTER. THE CENTER RECENTLY STARTED IMPLEMENTING GENETIC SCREEING, WHICH IS AVAILABLE TO ALL ITS PATIENTS AND CAN BE PERFORMED AT 10 WEEKS GESTATION. THE SCREENING INCLUDES TESTING FOR DOWN SYNDROME CF, AS WELL AS PROVIDING THE SEX OF THE CHILD. THE CENTER PROVIDES PRENATAL CARE TO APPROXIMATELY 50 MOTHERS ANNUALLY IN AN UNDERSERVED AND GEOGRAPHICALLY REMOTE AREA. ALL OF THESE BABIES ARE BORN AT SOUTHAMPTON HOSPITAL. IN ADDITION, THE ORGANIZATION IS PROUD OF THE EXCEPTIONAL SPECIALTY SERVICES IT PROVIDES TO THE COMMUNITY. THESE INCLUDE: 1) Audrey and Martin Gruss Heart & Stroke Center - opened in April 2015, providing vascular surgery and diagnostics in a state-of-the-art operating suite. This is particularly critical to the Hospital's service area since the nearest tertiary medical center is 46 miles away in Stony Brook, NY. 2) Tick-Borne Disease Resource Center - established in 2014, was created in response to a growing concern for diseases that are prevalent in the East End population due to several varieties of ticks found in the area. The Resource Center educates the public, promotes collaboration in the medical community, and facilitates access to diagnosis and treatment of tick-borne diseases. We maintain a dedicated phone "help" line for advice, include information about the complex set of tick-borne diseases on the Hospital website, and raise public awareness by presenting educational programs throughout the East End community. 3) THE ELLEN HERMANSON BREAST CENTER - OFFERS A WIDE SPECTRUM OF BREAST HEALTH SERVICES, INCLUDING EDUCATION, EARLY DETECTION SCREENINGS, SURGERY, BREAST CANCER TREATMENT AND SUPPORT. ACCREDITED BY THE AMERICAN COLLEGE OF RADIOLOGY, THE CENTER UTILIZES STATE-OF-THE-ART DIAGNOSTIC TECHNIQUES, INCLUDING COMPUTER-ASSISTED MAMMOGRAPHY, TOMOSYNTHESIS, ULTRASOUND AND BREAST BIOPSY. 4) THE ED & PHYLLIS DAVIS WELLNESS INSTITUTE - OFFERS THE ONLY HOSPITAL-BASED INTEGRATIVE MEDICINE ON LONG ISLAND'S EAST END. INTEGRATIVE MEDICINE COMBINES MODERN SCIENCE, PSYCHOLOGY, NUTRITION, AND EXERCISE TO ENHANCE THE NATURAL HEALING CAPACITY OF THE BODY. SPECIAL PROGRAMS ARE AVAILABLE FOR PATIENTS SUFFERING FROM CHRONIC ILLNESS. CLASSES IN YOGA, TAI CHI, PILATES, ZUMBA, ARE AVAILABLE. PROGRAMS IN STRESS MANAGEMENT, NUTRITIONAL AND WEIGHT LOSS COUNSELING, SMOKING CESSATION, MASSAGE THERAPY, AND ACUPUNCTURE ARE ALSO AVAILABLE. 5) THE JENNY AND JOHN PAULSON DEPARTMENT OF EMERGENCY MEDICINE - SERVES MORE THAN 25,000 EMERGENCY PATIENTS ANNUALLY AND IS THE ONLY HOSPITAL-BASED EMERGENCY CARE ON THE SOUTH FORK OF LONG ISLAND. STAFFED 24/7 BY BOARD-CERTIFIED EMERGENCY PHYSICIANS AND SPECIALTY-TRAINED NURSES AND STAFF, IT HAS THE MOST SOPHISTICA 113347833 true true false true false false false false false true true true false false true true false true false false false false false false false false true true false false true true false false false false false false false false false false false false false false false true true true false false true 256 0 true 1178 true true true false false false false false false false false false X 26 25 false false false false true true true true true false false true true true true true true true true true false NY X X CHRISTOPHER SCHULTHEIS 6317268301 240 MEETING HOUSE LANE SOUTHAMPTON NY 11968 X ROBERT S CHALONER PRESIDENT & CEO 38.8 0.5 X X 667335 0 39886 KENNETH B WRIGHT CHAIRMAN 1.25 0.0 X X 0 0 0 PETER M LARSEN THRU 714 CHAIRMAN 1.25 0.0 X X 0 0 0 RICHARD J HIEGEL ESQ VICE CHAIR 1.25 0.0 X X 0 0 0 STANLEY D FRIEDMAN VICE PRESIDENT 1.25 0.0 X X 0 0 0 LAWRENCE A WILLIS TREASURER 1.25 0.0 X X 0 0 0 PATRICIA STEWART SECRETARY 1.25 0.0 X X 0 0 0 GEORGE F BIONDO ESQ TRUSTEE 1.25 0.0 X 0 0 0 BARBARA BORSACK TRUSTEE 1.25 0.0 X 0 0 0 RICHARD BRUCE TRUSTEE 1.25 0.0 X 0 0 0 JEAN LITTLE FITZSIMMONS TRUSTEE 1.25 0.0 X 0 0 0 JAMES FORBES TRUSTEE 1.25 0.0 X 0 0 0 RALPH M GIBSON MD FROM 414 TRUSTEE 1.25 0.0 X 0 0 0 DAVID GILLESPIE TRUSTEE 1.25 0.0 X 0 0 0 GILBERT W HARRISON TRUSTEE 1.25 0.0 X 0 0 0 GEORGE P KAZDIN TRUSTEE 1.25 0.0 X 0 0 0 LISA CLARE KOMBRINK ESQ TRUSTEE 1.25 0.0 X 0 0 0 JAY K LEVINE TRUSTEE 1.25 0.0 X 0 0 0 DOROTHY LEWIS TRUSTEE 1.25 0.0 X 0 0 0 HOWARD M LORBER TRUSTEE 1.25 0.5 X 0 0 0 R TIMOTHY MARAN TRUSTEE 1.25 0.0 X 0 0 0 JOHN MCGOWAN TRUSTEE 1.25 0.0 X 0 0 0 FLORENCE ROLSTON MD TRUSTEE 1.25 0.0 X 0 0 0 STEPHEN H SHAPOFF TRUSTEE 1.25 0.0 X 0 0 0 MICHAEL F SMITH TRUSTEE 1.25 0.0 X 0 0 0 JOHN WAMBOLD TRUSTEE 1.25 0.0 X 0 0 0 DARIN G WIGGINS MD FROM 114 TRUSTEE 1.25 0.0 X 0 0 0 CHIRSTOPHER J SCHULTHEIS CHIEF FINANCIAL OFFICER 37.5 0.5 X 287130 0 38577 FREDERIC I WEINBAUM CHIEF MEDICAL OFFICER & COO 37.5 0.0 X 493951 0 42534 PATRICIA A DARCEY CHIEF NURSING OFFICER 37.5 0.0 X 220138 0 40199 STEVEN GEORGOPOULOS PHYSICIAN 37.5 0.0 X 894761 0 42534 KRISTIN P NASO PHYSICIAN 37.5 0.0 X 532464 0 42534 NEEMA POURTAHERI PHYSICIAN 37.5 0.0 X 461982 0 17018 GEORGE KECKEISEN PHYSICIAN 37.5 0.0 X 400230 0 42534 EDNA KAPENHAS DIRECTOR/BREAST SURGEON 37.5 0.0 X 399396 0 39886 4357387 0 345702 102 false true false MORRISON MANAGEMENT SPECIALIST 4721 MORRISON DRIVE SUITE 300 MOBILE AL 36609 FOOD SERVICES 1263276 HAMPTONS GYNECOLOGY OB 595 HAMPTONS ROAD SOUTHAMPTON NY 11968 MEDICAL 574577 CROTHALL HEALTHCARE SERVICES 1500 LIBERTY RIDGE DRIVE 210 WAYNE PA 19087 HEALTHCARE SERVICES 357722 PROSKAUER ROSE LLP 11 TIMES SQUARE NEW YORK NY 10036 LEGAL 352757 SOUTHAMPTON RADIOLOGY PC 240 MEETING HOUSE LANE SOUTHAMPTON NY 11968 RADIOLOGY 270031 23 112188 6780982 3584943 794762 11272875 INPATIENT SERVICES 624200 67237645 67237645 OUTPATIENT SERVICES 624200 64329830 64329830 LABORATORY EXTENDED SERVICES 621500 2270087 2270087 LESS: PROVISION FOR UNCOLLECTIBLES, NET 624200 -4800000 -4800000 SURGICAL PROFESSIONAL INSTITUTE 624200 720000 720000 1150247 759248 390999 130907809 247371 247371 0 0 747198 747198 0 747198 747198 4465734 3618561 847173 847173 847173 0 0 0 SHINNECOCK 3RD PARTY 900099 47535 47535 VENDOR REBATES 900099 40261 40261 FILM COPIES 900099 4610 4610 101522 101522 193928 144216354 128246723 2661086 2035670 0 0 0 0 1829750 1829750 0 60000585 51640972 8359613 4025080 3463394 561686 12959100 11151732 1807368 4330629 3724341 606288 850262 731225 119037 532031 532031 289150 289150 17943 15431 2512 0 107772 107772 5128206 4410257 717949 6695 5758 937 15856352 13636463 2219889 1175614 1011028 164586 0 1630169 1401945 228224 266933 266933 0 2572 2572 2459961 2115566 344395 0 6430566 5530287 900279 3501031 3010887 490144 OTHER PURCHASE SERVICES 8883160 7639518 1243642 UTILITIES 2203546 1895049 308497 OTHER DIRECT EXPENSES 1918052 1649525 268527 MISCELLANEOUS 628909 314455 314454 135034068 113347833 21686235 0 92989 3966458 8336913 1979735 0 0 18130683 18825248 0 0 0 0 0 0 1786889 2178899 437340 553011 169769383 112707889 45598044 57061494 0 0 30869856 26787892 0 0 0 0 1078250 979426 106330964 112332163 21460814 21142884 0 0 0 0 32927605 33500000 0 0 0 0 12430276 6794600 0 0 16674842 20980814 83493537 82418298 X 19102681 26211281 900728 868566 2834018 2834018 22837427 29913865 106330964 112332163 X 9182286 136645 -2242493 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false true 17943 false false false 17943 false false PART II-B, LINE 1F: SOUTHAMPTON HOSPITAL PAYS MEMBERSHIP DUES TO THE BELOW MENTIONED ORGANIZATIONS. A PERCENTAGE OF THESE DUES ARE THEN USED TO REIMBURSE THE ORGANIZATION FOR THE COST OF LOBBYING ACTIVITIES PERFORMED ON BEHALF OF THE HOSPITAL. THE FUNDS ARE USED FOR LOBBYING PURPOSES IN CONNECTION WITH NEW YORK STATE AND FEDERAL POLICY ISSUES. MEMBERSHIP DUES PAID TO OTHER ORGANIZATIONS AND USED FOR LOBBYING PURPOSES: Healthcare Association of New York State........$ 9,037. American Hospital Association...................$ 6,718. Nassau Suffolk Hospital Council.................$ 1,212. Greater NY Hospital Association.................$ 976. Total...........................................$17,943. 10808731 698598 351153 11858482 4527461 5500000 781270 10808731 4115379 412082 4527461 4213766 -98387 4115379 3943577 371238 95021 6028 4213766 0.76101 0.23899 false false 1366274 1366274 44580150 37016565 7563585 111337042 74755540 36581502 12485917 935784 11550133 57061494 SHORT TERM INVESTMENTS 9856726 F RESTRICTIONS 3702584 F INVESTMENTS IN SHA PROPERTIES 6300000 C DEBT SERVICE FUND 104222 F MALPRACTICE SELF INSURANCE-FD 6774000 F IDB PROJECT FYND 50360 F 26787892 0 ACCRUED PENSION LIABILITY 6363288 DUE TO THIRD-PARTY PAYORS, NET 7843526 MALPRACTICE SELF-INSURANCE LIAB. 6774000 20980814 X 140113261 136645 -4131966 -3995321 144108582 107772 107772 144216354 135007841 81545 81545 134926296 107772 107772 135034068 PART V, LINE 4: SOUTHAMPTON HOSPITAL ASSOCIATION CURRENTLY REPORTS ENDOWMENT FUNDS WITHIN ITS DECEMBER 31, 2014 FINANCIAL STATEMENTS. THE GOVERNING BODY INTENDS TO USE THESE FUNDS TO OFFSET THE COST OF INDIGENT CARE, EMERGENCY SERVICES AND NURSING EDUCATION. PART X, LINE 2: SOUTHAMPTON HOSPITAL ASSOCIATION (THE "REPORTING ORGANIZATION") HAS NOT TAKEN AN UNSUBSTANTIATED TAX POSITION THAT WOULD REQUIRE PROVISION OF A LIABILITY UNDER ASC 740. UNDER ASC 740, AN ORGANIZATION MUST RECOGNIZE THE TAX BENEFIT ASSOCIATED WITH TAX POSITIONS TAKEN FOR TAX RETURN PURPOSES WHEN IT IS MORE-LIKELY-THAN-NOT THAT THE POSITION WILL NOT BE SUSTAINED UPON EXAMINATION. THE REPORTING ORGANIZATION DOES NOT BELIEVE THERE ARE ANY MATERIAL UNCERTAIN TAX POSITIONS AND, ACCORDINGLY, HAS NOT RECOGNIZED ANY LIABILITY FOR UNRECOGNIZED TAX BENEFITS. THE REPORTING ORGANIZATION HAS FILED IRS FORM 990 TAX RETURNS, AS REQUIRED, AND ALL OTHER APPLICABLE RETURNS IN JURISDICTIONS WHEN IT IS REQUIRED. FOR THE YEAR ENDED DECEMBER 31, 2014, THERE WAS NO INTEREST OR PENALTIES RECORDED OR INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS. THE REPORTING ORGANIZATION BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR THE YEARS PRIOR TO 2011, WHICH IS THE STATUTE OF LIMITATION LOOK BACK PERIOD. PART XI, LINE 2D: SHA PROPERTIES INCOME.........$ 30,447 PENSION OBLIGATION............$(2,940,069) BOND EXTINGUISHMENT...........$(1,222,344) TOTAL.........................$(4,131,966) PART XII, LINE 2D: SHA PROPERTIES EXPENSES.......$81,545 true true X true X 400. true X false true true false true true 361 2519132 -1842952 676180 0.00500 19125463 8618033 10507429 0.07780 361 21644595 6775081 11183609 0.08280 7441194 4149131 3292063 0.02440 5 41093169 28748677 12344492 0.09140 5 48534363 32897808 15636555 0.11580 5 361 70178958 39672889 26820164 0.19860 209281 209281 209281 209281 true 4800000 3259658 36259701 41210869 -4951168 X true true MEETINGHOUSE LN PRAC PRIMARY/SPECIALTY 1.00000 14 1 SOUTHAMPTON HOSPITAL ASSOCIATION 240 MEETINGHOUSE LANE SOUTHAMPTON NY 11968 X A 2 DIALYSIS CENTER 184 W MONTAUK HIGHWAY HAMTPON BAYS NY 11946 X DIALYSIS TREATMENT FACILITY B 3 GREENPORT PRENATAL 300 ATLANTIC AVENUE GREENPORT NY 11944 X PRENATAL/WOMEN'S SERVICES B 4 LAB EAST 200 PANTIGO PLACE EAST HAMPTON NY 11944 X LABORATORY SERVICES B 5 IMAGING - EH 200 PANTIGO PLACE EAST HAMPTON NY 11937 X RADIOLOGY SERVICES B 6 WESTHAMPTON PRIMARY CARE 72 OLD RIVERHEAD ROAD WESTHAMPTON BEACH NY 11978 X PRIMARY CARE PRACTICE B 7 WESTHAMPTON SPORTS REHAB 74 OLD RIVERHEAD ROAD WESTHAMPTON BEACH NY 11978 X SPORTS REHAB/ PHYSICAL THERAPY SERVICES B 8 LAB SOUTH 325 MEETINGHOUSE LANE SOUTHAMPTON NY 11968 X LABORATORY SERVICES B 9 ATRIUM LAB 182 W MONTAUK HIGHWAY HAMPTON BAYS NY 11946 X LABORATORY SERVICES B 10 DAVID ROGERS CENTER 335 D MEETINGHOUSE LANE SOUTHAMPTON NY 11968 X HIV/AIDS CARE B 11 SHINNECOCK HEALTH CHURCH STREET SOUTHAMPTON NY 11968 X PRIMARY CARE/DENTAL SERVICES B 12 SOUTHAMPTON CARE CENTER 240 MEETINGHOUSE LANE SOUTHAMPTON NY 11968 X NURSING HOME (FACILITY CLOSED) B 13 IMAGING - HAMPTON BAYS 182 W MONTAUK HIGHWAY HAMPTON BAYS NY 11946 X RADIOLOGY SERVICES B 14 MEETINGHOUSE LANE PRACTICE PO BOX 2340 SOUTHAMPTON NY 11968 X PRIMARY/SPECIALTY PHYSICIAN PATIENT CARE B A 1 false false true X X X X X X 14 true true false true X WWW.SOUTHAMPTONHOSPITAL.ORG X true 14 true WWW.SOUTHAMPTONHOSPITAL.ORG false false true 400. 400. X X true true X X X true X X X X X X X X X true false true X false false B false false false false true 400. 400. X X true true X X X true X X X X X X X X X true false true X false false PART V, SECTION B, LINE 4: THE HOSPITAL CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT ("CHNA") FOR THE PERIOD 2014 - 2017. THE CHNA WAS DEEMED CONDUCTED IN 2014 WHEN IT WAS MADE "WIDELY AVAILABLE" TO THE PUBLIC AND THE WRITTEN REPORT AND IMPLEMENTATION STRATEGY WERE FINALIZED, APPROVED, AND ACCEPTED BY THE HOSPITAL'S GOVERNING BODY, IN ACCORDANCE WITH IRS NOTICE 2011-52. PART V, SECTION B, LINE 5: SEE SCHEDULE H, PART VI, LINE 2 NEEDS ASSESSMENT LANGUAGE. PART I, LINE 3C: THERE ARE TWO LEVELS OF CHARITY CARE COVERAGE: PRIMARY SERVICE AREA AND NON-PRIMARY SERVICE AREA. A PRIMARY SERVICE AREA PATIENT IS A PATIENT WHO RESIDED IN NEW YORK STATE WITHIN THE COUNTIES OF SUFFOLK OR NASSAU AT THE TIME OF SERVICE. A NON-PRIMARY SERVICE AREA PATIENT IS A PATIENT WHO RESIDED IN NEW YORK STATE BUT NOT WITHIN THE COUNTIES OF SUFFOLK OR NASSAU AT THE TIME OF SERVICE. ELIGIBLE SERVICES FOR A PRIMARY SERVICE AREA PATIENT: A PRIMARY SERVICE AREA PATIENT WHO MEETS THE FINANCIAL REQUIREMENTS IS ELIGIBLE FOR THE FOLLOWING MEDICALLY NECESSARY SERVICES: INPATIENT, AMBULATORY, EMERGENCY ROOM, EMERGENCY TRANSFERS UNDER THE EMERGENCY MEDICAL TREATMENT AND LABOR ACT (EMTALA), OUTPATIENT, AND DIAGNOSTIC CARE. UNDERINSURED PRIMARY SERVICE AREA PATIENTS ARE ELIGIBLE FOR FINANCIAL ASSISTANCE ON MEDICARE AND COMMERCIAL INSURANCE CARRIER CO-INSURANCES FOR ALL ABOVE LISTED SERVICES. ELIGIBLE SERVICES FOR A NON-PRIMARY SERVICE AREA PATIENT: A NON-PRIMARY SERVICE AREA PATIENT WHO MEETS THE FINANCIAL REQUIREMENTS IS ELIGIBLE FOR THE FOLLOWING MEDICALLY NECESSARY SERVICES: EMERGENCY ROOM, EMERGENT ADMISSIONS, AND EMERGENCY TRANSFERS UNDER THE EMERGENCY MEDICAL TREATMENT AND LABOR ACT (EMTALA). UNDERINSURED NON-PRIMARY SERVICE AREA PATIENTS ARE ELIGIBLE FOR FINANCIAL ASSISTANCE ON MEDICARE AND COMMERCIAL INSURANCE CARRIER CO-INSURANCES FOR ALL ABOVE LISTED SERVICES. INELIGIBLE SERVICES: THE FOLLOWING SERVICES AND/OR ITEMS ARE NOT COVERED BY CHARITY CARE FOR ANY PATIENT: NOT MEDICALLY NECESSARY SERVICES AS DETERMINED BY MEDICARE(E.G. COSMETIC SURGERY, BARIATRIC SURGERY), INSURANCE CO-PAYMENTS/CO-INSURANCES/DEDUCTIBLES, MEDICAID SPEND-DOWN AMOUNTS, NON-COVERED SERVICES AS DETERMINED BY THE PATIENT'S INSURANCE CARRIER, PRIVATE ROOM RATES, AND PRIVATE PHYSICIAN FEES WHICH ARE NOT BILLED BY SOUTHAMPTON HOSPITAL (E.G. RADIOLOGY, PATHOLOGY, ANESTHESIOLOGY, EMERGENCY). FAMILY INFORMATION REQUIREMENTS: A PATIENT MUST PROVIDE ON THEIR CHARITY CARE APPLICATION A LIST OF THE FAMILY/HOUSEHOLD MEMBERS AND OR DEPENDENTS WITH WHOM THE PATIENT RESIDES. IF THE PATIENT IS AN ADULT, THE PATIENT MUST LIST THEIR SPOUSE OR DOMESTIC PARTNER, CHILDREN UNDER THE AGE OF 21, AND ANY CLAIMED DEPENDENTS OR OTHER HOUSEHOLD MEMBERS THAT LIVE WITH THE PATIENT. IF THE PATIENT IS A CHILD UNDER THE AGE OF 21, THE APPLICANT MAY LIST THE PATIENT'S PARENTS, SIBLINGS UNDER THE AGE OF 21, AND ANY CLAIMED DEPENDENTS OR OTHER HOUSEHOLD MEMBERS THAT LIVE WITH THE PATIENT. A CLAIMED DEPENDENT IS DEFINED AS A PERSON WHO IS LISTED OR WOULD BE LISTED AS A DEPENDENT FOR THE PURPOSES OF AN INCOME TAX SUBMISSION TO THE IRS. FINANCIAL REQUIREMENTS: TO BE FINANCIALLY ELIGIBLE TO RECEIVE CHARITY CARE, A PATIENT MUST HAVE A GROSS FAMILY/HOUSEHOLD INCOME LESS THAN OR EQUAL TO 400% OF THE FEDERAL POVERTY LEVEL GUIDELINE (FPG). ELIGIBLE INCOME: THE FOLLOWING INCOME ITEMS WILL BE USED TO DETERMINE A PATIENT'S INCOME: EARNINGS FROM EMPLOYMENT, UNEMPLOYMENT COMPENSATION, WORKERS COMPENSATION, DISABILITY, SOCIAL SECURITY, ANNUITIZED PENSION PLAN, CHILD SUPPORT, ALIMONY, DIVIDENDS, INTEREST, RENTALS, ESTATES, TRUSTS, SALE OF ASSETS, AND OTHER MISCELLANEOUS INCOME. SOLE PROPRIETORSHIP, PARTNERSHIP, AND S CORPORATION INCOME WILL BE CALCULATED BY ITS GROSS PROFIT OR TOTAL INCOME PRIOR TO EXPENSES AND DEDUCTIONS; HOWEVER, COST OF GOODS SOLD MAY BE DEDUCTED FROM GROSS SALES. SALE OF ASSETS, SUCH AS REPORTED ON A SCHEDULE D OR ITS EQUIVALENT, WILL BE CALCULATED BY THEIR SALE PRICE AND NOT BY THEIR GAIN OR LOSS. FINANCIAL DOCUMENTATION REQUIREMENTS: A PATIENT MUST PROVIDE FINANCIAL DOCUMENTATION TO SUPPORT THEIR CURRENT STATED INCOME. THE FOLLOWING DOCUMENTS ARE ACCEPTABLE AS PROOF: COPIES OF RECENT PAY STUBS (SEVERAL CONSECUTIVE ARE PREFERRED WHEN AVAILABLE), A RECENT UNEMPLOYMENT OR DISABILITY STATEMENT, A LETTER FROM AN EMPLOYER, OR A SELF-ATTESTATION LETTER. A PATIENT MAY BE REQUIRED TO SUBMIT ADDITIONAL DOCUMENTATION AT SOUTHAMPTON HOSPITAL'S REQUEST IN ORDER TO SUBSTANTIATE THEIR STATED INCOME. IF A PATIENT IS CLAIMING ZERO INCOME, THE PATIENT WILL BE REQUIRED TO SUBMIT A VERIFICATION OF NON-FILING LETTER FROM THE IRS. THIS LETTER IS OBTAINED THROUGH IRS FORM 4506-T WHICH WILL BE MADE AVAILABLE TO THE PATIENT UPON REQUEST. THE PATIENT MUST ALSO SUBMIT A LETTER DESCRIBING THE MEANS BY WHICH THEY ARE SUPPORTED. IF THE PATIENT IS UNABLE TO FILE IRS FORM 4506-T DUE TO NOT HAVING A SOCIAL SECURITY NUMBER, THE PATIENT MUST SUBMIT THE ABOVE-MENTIONED LETTER. APPLICABLE RATES: THE APPLICABLE RATE FOR AN INPATIENT VISIT IS THE MEDICARE DIAGNOSIS RELATED GROUP (DRG) RATE FOR THAT VISIT. THE APPLICABLE RATE FOR AN AMBULATORY, EMERGENCY ROOM, OUTPATIENT, OR DIAGNOSTIC CARE VISIT IS THE MEDICARE HCPCS/CPT PAYMENT PLUS MINIMUM UNADJUSTED CO-PAYMENT FOR THAT VISIT. THE APPLICABLE RATE FOR LAB TESTS ON OUTPATIENT AND EMERGENCY ROOM VISITS WILL BE 10% OF THE CHARGE PER TEST. SELF-PAY DISCOUNT: SOUTHAMPTON HOSPITAL OFFERS A SELF-PAY DISCOUNT TO UNINSURED PATIENTS FOR SERVICES AND PROCEDURES PROVIDED AND BILLED BY SOUTHAMPTON HOSPITAL. A) ELIGIBLE SERVICES - THE FOLLOWING SERVICES PERFORMED BY SOUTHAMPTON HOSPITAL ARE ELIGIBLE FOR A SELF-PAY DISCOUNT: INPATIENT, AMBULATORY, EMERGENCY ROOM, EMERGENCY TRANSFERS UNDER THE EMERGENCY MEDICAL TREATMENT AND LABOR ACT (EMTALA), OUTPATIENT, AND DIAGNOSTIC CARE. B) INELIGIBLE SERVICES - THE FOLLOWING SERVICES AND ITEMS ARE NOT ELIGIBLE FOR A SELF-PAY DISCOUNT: OUTPATIENT CARDIAC REHABILITATION, OUTPATIENT NUTRITIONAL COUNSELING, WELLNESS CENTER SERVICES/PROGRAMS, OUTPATIENT PHYSICAL THERAPY, PRIVATE PHYSICIAN FEES NOT BILLED BY SOUTHAMPTON HOSPITAL (E.G. RADIOLOGY, PATHOLOGY, ANESTHESIOLOGY, EMERGENCY). C) DISCOUNT - SELF-PAY ACCOUNTS ARE DISCOUNTED AT A RATE OF 75% OFF TOTAL CHARGES. A. AUTOMATIC DISCOUNTING - THE SELF-PAY DISCOUNT WILL BE CALCULATED AND APPLIED TO THE PATIENTS' ACCOUNT AUTOMATICALLY BY THE HOSPITAL INFORMATION SYSTEM (HIS). B. MANUAL DISCOUNTING - THE SELF-PAY DISCOUNT MAY NEED TO BE MANUALLY CALCULATED AND APPLIED IN CERTAIN CIRCUMSTANCES (E.G. LATE CHARGES) AND WILL BE HANDLED BY PATIENT FINANCIAL SERVICES. D) ADDITIONAL FINANCIAL ASSISTANCE - PATIENTS WHO ARE UNABLE TO PAY FOR A SELF-PAY DISCOUNTED BILL MAY STILL APPLY FOR OTHER TYPES OF FINANCIAL ASSISTANCE SUCH AS CHARITY CARE. APPLYING FOR ANOTHER TYPE OF FINANCIAL ASSISTANCE WILL NOT RESULT IN THE LOSS OF THE OFFERED SELF-PAY DISCOUNT, HOWEVER, IF ACCEPTED INTO ANOTHER FINANCIAL ASSISTANCE PROGRAM, THAT PROGRAMS CALCULATION METHODOLOGY WILL BE DONE INDEPENDENTLY OF THE SELF-PAY DISCOUNTED AMOUNT (I.E. FINANCIAL ASSISTANCE PROGRAMS ARE MUTUALLY EXCLUSIVE). PART III, LINE 3: SOUTHAMPTON HOSPITAL UTILIZED THE AUDITED FINANCIAL STATEMENT AMOUNT REPORTED FOR BAD DEBT OF $4,800,000 AS ITS STARTING POINT. THIS AMOUNT WAS MULTIPLIED BY A COST TO CHARGE RATIO OF 100% (DETERMINED ON SCHEDULE H WORKSHEET 2) RESULTING IN A COST OF BAD DEBT OF $4,800,000. THIS COST WAS THEN MULTIPLIED BY 67.9095% - THE SELF PAY PERCENTAGE AS DETERMINED BY THE 2014 INSTITUTIONAL COST REPORT. THIS RESULTED IN A COST OF BAD DEBT FOR PATIENTS ELIGIBLE UNDER THE HOSPITAL'S CHARITY CARE POLICY OF $3,259,658. PART III, LINE 4: THE ORGANIZATION DETERMINE EXPECTED BAD DEBT WRITE-OFFS BASED ON ACTUAL ACCOUNTS, NET OF AN EXPECTED RATE OF RECOVERY. IT'S NOT BASED ON A PERCENTAGE OF REVENUE. PART III, LINE 8: SOUTHAMPTON HOSPITAL UTILIZED THE 2552 COST REPORT PREPARED ANNUALLY FOR MEDICARE TO DETERMINE THE TOTAL REVENUE RECEIVED FROM MEDICARE, AS WELL AS THE MEDICARE ALLOWABLE COSTS RELATING TO THE REVENUE REPORTED. MEDICARE ALLOWABLE COSTS OF $41,210,869 ARE GREATER THAN THE TOTAL MEDICARE REVENUE OF $36,259,701 FOR 2014; THEREFORE THE SHORTFALL OF $4,951,168 MAY BE DEEMED A COMMUNITY BENEFIT. PART III, LINE 9B: ACCOUNTS WITH UNCOLLECTABLE BALANCES ARE ACCOUNTS FOR A PATIENT (GUARANTOR) WHO HAS NOT RESPONDED TO REQUESTS FOR PAYMENT OR WHO HAS DEMONSTRATED AN EXEMPTION FROM PAYMENT. THE REQUEST FOR PAYMENT &/OR THE EXEMPTION MUST MEET THE FOLLOWING CRITERIA: 1. AT LEAST FOUR (4) CONSECUTIVE 120-DAY BILLS MUST HAVE BEEN GENERATED (OR NO LESS THAN 120 DAYS FROM FIRST BILL) AND SENT WITHOUT RESPONSE FROM THE PATIENT (GUARANTOR) BEFORE BEING SENT TO A COLLECTION AGENCY; OR 2. THE PATIENT (GUARANTOR) HAS DECLARED BANKRUPTCY (DISCHARGE OF DEBT OR MUST HAVE BEEN RECEIVED); OR 3. THE ESTATE OF THE PATIENT (GUARANTOR) HAS BEEN SETTLED AND THERE WERE NO FUNDS FOR PAYMENT LEFT IN THE ESTATE; OR 4. MAIL HAS BEEN RETURNED AND OTHER METHODS OF CONTACTING THE PATIENT (GUARANTOR) HAVE FAILED. THE ACCOUNT IS THEN CONSIDERED AND HANDLED AS A BAD DEBT ACCOUNT. PATIENT FINANCIAL SERVICES MAY ELECT TO SEND THE ACCOUNT TO AN OUTSIDE AGENCY, UP TO AND INCLUDING LEGAL ACTION. BAD DEBT ACCOUNTS ARE PURE SELF PAY ACCOUNTS FOR A PATIENT (GUARANTOR) WHO HAS NOT RESPONDED TO REQUESTS FOR PAYMENT. THE REQUEST FOR PAYMENT MUST MEET THE FOLLOWING CRITERIA: AT LEAST FOUR (4) CONSECUTIVE 30-DAY BILLS MUST HAVE BEEN GENERATED AND SENT WITHOUT RESPONSE FROM THE PATIENT (GUARANTOR); OR MAIL HAS BEEN RETURNED AND ALL OTHER METHODS OF CONTACTING THE PATIENT(GUARANTOR) HAVE FAILED. ONCE IT IS DETERMINED AN ACCOUNT BALANCE CANNOT BE COLLECTED BY PATIENT FINANCIAL SERVICES, THE ACCOUNT MAY BE TURNED OVER FOR COLLECTION BY AN OUTSIDE AGENCY, UP TO AND INCLUDING LEGAL ACTION. THE OUTSIDE COLLECTION AGENCY, AFTER DUE DILIGENCE, MAY DETERMINE THE BALANCE ON AN ACCOUNT CANNOT BE COLLECTED, THE ACCOUNT BALANCE MAY BE WRITTEN OFF USING THE APPROPRIATE CODE FOR THE ACCOUNT. PART VI, LINE 2: Assessment and Selection of Prevention Agenda Priorities: Assessment - 1) Community Needs Assessment through Suffolk County Community Health Needs Assessments (CHNAs) - A summary report (April 2013) by Jane Corrarino, MD, Suffolk County Department of Health, provided relevant public health data from the NYS Department of Health Prevention Agenda. 2) Needs Assessment Public Participation As a member of Nassau/Suffolk Hospital Council (NSHC), Southampton Hospital is participating in the Long Island Health Collaborative (LIHC), a group organized by NSHC that includes representatives from 23 member hospitals, the Suffolk and Nassau County Health Departments, Long Island colleges and universities, school systems and various other agencies, including the YWMCA of Long Island, Western Suffolk BOCES, Asthma Coalition of Long Island, among others. - In preparation for submitting our individual Community Service Plans, the LIHC members met monthly, February-October 2013, to assess community health needs, review the results of a community survey, select prevention agenda priorities based on those results, discuss methods of data collection, and eventual analysis of our efforts. - At Southampton Hospital, a group that included our VP/Quality Assurance, Director of Rehabilitation Services, Cardiac Nurse Manager, Coordinator of Wellness Institute Services, and our Diabetes Educator met regularly to discuss local health needs in relation to the work being done at LIHC meetings. - The group re-worked a Suffolk County Health Department's (SCDOH) draft survey to give it a Community Based Organization (CBO) focus in order to seek input from the communities served and to engage these potential partners in implementation of the Community Health Improvement Plan. With input from the member hospitals, The Nassau-Suffolk Hospital Council created a master list of CBO contacts including school districts, BOCES, Patchogue Community Development Agency, South Fork Community Health Initiative, Catholic Charities, Cornell Cooperative Extension, American Lung Association, LI Youth Mentoring, LI Men's Center, chambers of commerce, fire departments, volunteer ambulance groups, libraries, civic associations, and senior centers. - The uniform survey was sent collectively to approximately 200 CBOs via Survey Monkey. The SCDOH distributed the same survey to about 100 additional contacts and each organization also sent the survey to its local CBO contacts. Duplicate surveys were eliminated from the tabulations. 102 unique responses were received for a response rate of 35%. Prevention Agenda Priorities: The selection of our priorities was informed by the results from the CBO survey, the health issues addressed in the Suffolk County Community Health Assessment 2014-2017 and the priorities set forth in the NYS Department of Health Prevention Agenda 2013-17. LICH members reached a consensus and selected Prevent Chronic Disease, with the focus areas of Reduce Obesity and Reduce the Risk for Diabetes. In addition, Southampton Hospital chose another priority of concern to our local community, Prevention of Mental Health Illness. PREVENT CHRONIC DISEASE: Focus Area 1: Reduce obesity in children and adults (NYS Prevention Agenda Focus Area) Obesity and overweight are currently the second leading preventable causes of death in the US. According to the Suffolk County, NY Student Weight Status Category Reporting System 2010-2012, 17.5% of children and adolescents in the County are categorized as obese. In the County Health Rankings & Roadmaps (Robert Wood Johnson Foundation) 25% of Suffolk County adults were overweight or obese. Rates of obesity in Suffolk County are recognized as a major public health challenge and the number one public health nutrition problem. 23% of County residents are physically inactive, a number that is remarkable considering 90% of Suffolk County residents report having access to physical activity options. According to the Youth Risk behavior Surveillance System (YRBSS), 73% of New York State high schools students drank a can, bottle or glass of sugar sweetened soda during the seven days before the survey, 21.4% drank one or more per day, and 14.3% drank two or more per day. In addition almost half of students did not meet minimum standards for physical activity. These children and their parents are in need of counseling and education to decrease their mortality rate and risk for chronic, life-threatening disease. - Purpose: Reduce obesity by modifying behaviors through education and access to primary healthcare. - Audience: school-age children and their parents in the Town of Southampton. - Objectives: modify behavioral risks by 1) encouraging and increasing physical activity, 2) encouraging healthy over unhealthy food choices through nutritional counseling programs and coordination with the school district, and 3) achieve a weight loss of 5-10% of the participant's initial weight. - Action: 1. Disseminate information about the consequences of obesity at community outreach events (lectures, school health fairs, library programs), in external communications (monthly Hospital e-newsletter to 5,000+ contacts, Patch.com blog, Facebook, Twitter) and to inpatients through the admitting process and the Hospital's Dietary Services Department. 2. Implement "Rethink the Drink" program in 2014. Reduce or eliminate sugar-sweetened beverages in Hospital vending machines and in the cafeteria (open to the public as well as Hospital staff), replacing them with water, seltzer, and milk. Educate staff to standardize the message that the healthy beverage program represents. Communicate the message to the community in the Hospital's monthly e newsletter, signage at the point-of-sale, social media, and the Hospital's internal monthly "Fast Facts" and quarterly "Pulse" newsletter. 3. Increase availability of healthy foods in Hospital vending machines and in the cafeteria. 4. Expand the role of the Hospital's Wellness Institute through programs for the QuarterBackers (Hospital supporters who are local business owners). 5. "Take the Stairs" (rather than the elevator) program for Hospital staff. 6. Continue "Hypnosis for Weight Loss" program for adults. 7. Partner with nutrition and physical activity programs in Southampton High School with female athletes and their families as the target group. After school and evening programs will include nutrition, mindfulness training, yoga/Tai Chi/Pilates. 8. Partner with community-organized annual walking events (Ellen's Run, Joe Koziarz Run, Hamptons Marathon, Bariatric Surgery Walk, LI2Day Walk, American Heart Association). - Outcome measurement: 1. Weekly health log will quantify data over the 6-week period and track progress for follow up assessment. 2. Weekly clinical evaluations will further track progress and customize program for individuals. 3. Assessment/questionnaire along with BMI screening and waist circumference measurements will quantify data for participation. Focus Area 2: Reduce risk for Diabetes (NYS Prevention Agenda Focus Area) Diabetes is the seventh leading cause of death based on US death certificates in 2007 and is suspected to be underreported. According to the Suffolk County Health Needs Assessment Report, two of the risk factors for the development of diabetes (type 2) include physical inactivity and overweight/obesity. - Purpose: Increase access to high quality chronic disease preventative care and management in both clinical and community settings and assess risk of diabetes in advance of diagnosis. - Audience: adults who are at risk and are patients of medical practices in the Town of Southampton. - Objectives: 1) educate patients on risk factors, 2) alert patients already at risk, 3) provide methods for self-management to improve blood sugar control, increase insulin sensitivity, reduce triglyceride levels, increase "good" HDL cholesterol levels, and lower blood pressure, and 4) improve post-intervention measures. - Action: 1. Southampton Hospital's ADA-certified program "Living with Diabetes," coordinated by a certified Diabetes Educator, enables patients to self-manage the disease through nutrition, exercise, medication, and blood glucose level monitoring. 2. Assist patients with coping mechanisms for stress and in making psychosocial adjustments. 3. Educate participants on how to detect and prevent chronic complications. 4. Provide free monthly lecture programs, individual and group counseling sessions, and educational materials. 5. Encourage participation in exercise and nutrition programs available at the Hospitals Ed & Phyllis Davis Wellness Institute. - Data Collection: 1. Participants will complete the Hospital's "Health Survey" (addendum) at the beginning of their participation in the program. 2. Results will be measured at completion of the program and post-program to determine if participants were able to sustain their behavioral changes. 3. Data will be collected by our ADA-certified Diabetes PART VI, LINE 3: FINANCIAL AID PROGRAM: SOUTHAMPTON HOSPITAL'S COMMITMENT AND DETERMINATION TO PROVIDE QUALITY HEALTHCARE AT AFFORDABLE RATES HAS LEAD US TO DESIGN A CHARITY CARE PROGRAM THAT GOES "ABOVE AND BEYOND" THE EXPECTATIONS AND MINIMUM REQUIREMENTS SET FORTH BY NEW YORK STATE LAW. IT IS THE HOSPITAL'S "ABOVE AND BEYOND" ATTITUDE THAT IS OUR PROGRAMS GREATEST STRENGTH AND CAN BEST BE SEEN IN OUR POLICY TO PROVIDE CHARITY CARE DISCOUNTED RATES TO PATIENTS MAKING UP TO 400% OF THE FEDERAL POVERTY LEVEL GUIDELINE (FPG) RATHER THAN THE MINIMUM REQUIREMENT OF 300% FPG. IN ADDITION, THE HOSPITAL INCLUDES A FORM TO APPLY FOR CHARITY CARE IN EVERY SELF-PAY BILL TO BE RETURNED TO PATIENT FINANCIAL SERVICES. SELF-PAY PATIENTS ARE GIVEN A 75% DISCOUNT OF CHARGES, AS WELL. SOUTHAMPTON HOSPITAL CONTINUES TO FACE FINANCIAL CHALLENGES INCLUDING CONTINUED REDUCTIONS IN NEW YORK STATE AND FEDERAL REIMBURSEMENT RATES AT THE SAME TIME THAT HOSPITAL FACES THE INCREASING COST OF PROVIDING CARE, INCLUDING DOUBLE DIGIT EXPENSES INCREASES IN SOME CATEGORIES. WHILE THE HOSPITAL WAITS TO UNDERSTAND THE IMPACT ON ITS CHARITY POLICIES THAT MAY RESULT FROM EXPANDING RESIDENT ACCESS TO HEALTH CARE INSURANCE THAT IS PART OF HEALTH CARE REFORM, THE HOSPITAL REMAINS CONCERNED THAT A SIGNIFICANT PART OF THE INDIGENT CARE THE HOSPITAL PROVIDES TO UNDOCUMENTED WORKERS WILL NOT BE COVERED. PART VI, LINE 4: Southampton's Service area extends from Montauk to the East to Westhampton Beach to the West and the Southern area of Riverhead in the center of the East End of Long Island. The service area accounts for approximately eight-five (85) percent of total admissions to the Hospital and includes the following zip codes: Amagansett (11930); East Hampton (11937); Bridgehampton (11932); Southampton (11968); Hampton Bays (11946); Sag Harbor (11963); Sagaponack (11962); Montauk (11954); Riverhead (11901); East Quogue (11942); Quogue (11959); Remsenburg (11960); Water Mill (11976); Westhampton Beach (11978); and Westhampton (11977). In addition, the Hospital's service area is home to the Shinnecock Nation. Since April of 1995, Southampton Hospital has worked with the Nation to provide services at the Shinnecock Indian Health Clinic through a contract with the NYS Department of Health. On an annual basis, the Clinic provides approximately 2,000 medical and 800 dental visits for eligible members of the Shinnecock Nation. Southampton Hospital's service area has a year-round population of approximately 115,536 residents. The population in the Hospital's service area, a resort destination, more than doubles during the summer season when tourists and seasonal residents from all over the world come to the South Fork of Long Island. AS THE TABLE BELOW INDICATES, THIS SERVICE AREA HAS A YEAR ROUND POPULATION OF APPROXIMATELY 85,000 RESIDENTS. THE AREA IS PROJECTED TO SEE A SIGNIFICANT INCREASE IN POPULATION, MORE THAN 4 PERCENT OVER THE NEXT FIVE YEARS. DEMOGRAPHIC CHARACTERISTICS SELECTED AREA USA 2010 TOTAL POPULATION............64,886............308,745,538 2013 TOTAL POPULATION............65,894............314,861,807 2018 TOTAL POPULATION............67,518............325,322,277 % CHANGE 2013 - 2018...............2.5%...................3.3% AVERAGE HOUSEHOLD INCOME.......$120,403................$69,637 THE POPULATION ON THE HOSPITAL'S SERVICE AREA, A RESORT DESTINATION, MORE THAN DOUBLES DURING THE SUMMER SEASON WHEN TOURISTS FROM ALL OVER THE WORLD VISIT THE SOUTH FORK OF LONG ISLAND. AS A RESULT, DEMAND FOR SOUTHAMPTON HOSPITAL SERVICES INCREASES SIGNIFICANTLY DURING THE SUMMER, IN PARTICULAR DEMAND FOR THE HOSPITAL'S EMERGENCY SERVICES. THE HOSPITAL HAS RESPONDED TO THIS NEED BY MAKING A CAPITAL INVESTMENT IN EXPANDING AND RENOVATING THE EMERGENCY DEPARTMENT AND IMPLEMENTING A STATE-OF-THE-ART EMERGENCY DEPARTMENT INFORMATION SYSTEMS THAT PERMITS THE HOSPITAL TO TRACK PATIENTS, AND READ AND INTERPRET LABORATORY AND RADIOLOGICAL RESULTS. AS THE TABLE BELOW INDICATES, THE SERVICE AREA HAS A SIGNIFICANT PERCENTAGE OF THEIR POPULATION AGED FIFTY-FIVE (55) AND OVER, A POPULATION THAT HAS GREATER NEED FOR HEALTH CARE SERVICES. AGE DISTRIBUTION: USA 2013 AGE GROUP 2013 % OF TOTAL 2018 % OF TOTAL % OF TOTAL 0-14 10,712 16.3% 10,873 16.1% 19.6% 15-17 2,428 3.7% 2,432 3.6% 4.1% 18-24 5,040 7.6% 5,286 7.8% 10.0% 25-34 7,166 10.9% 7,186 10.6% 13.1% 35-54 18,372 27.9% 17,100 25.3% 26.9% 55-64 9,689 14.7% 10,656 15.8% 12.4% 65+ 12,487 19.0% 13,985 20.7% 13.9% TOTAL 65,894 100.0% 67,518 100.0% 100.0% THERE ARE NO FIRM ESTIMATES OF THE NUMBER OF MIGRANT AGRICULTURAL WORKERS THAT COME INTO THIS AREA. AGRICULTURE IS ONE OF SUFFOLK COUNTY'S LEADING INDUSTRIES. ITS SUCCESS RELIES ON WORKERS WHO MOVE THROUGH THE EASTERN UNITED STATES IN RESPONSE TO THE AVAILABILITY OF SEASONAL WORK. SOUTHAMPTON HOSPITAL RECOGNIZES THAT THIS POPULATION PRESENTS SERIOUS HEALTH PROBLEMS AND IS COMMITTED TO PROVIDING CARE FOR ITS CULTURALLY DIVERSE PATIENT POPULATION. MANY OF THESE INDIVIDUALS ARE UNINSURED AND UNABLE TO SPEAK ENGLISH. THEY RELY ON THE HOSPITAL'S EMERGENCY DEPARTMENT, AS WELL AS THE SUFFOLK COUNTY HEALTH CLINIC, LOCATED ON THE HOSPITAL'S CAMPUS, FOR HEALTH CARE. AS ARESULT, THE HOSPITAL'S OFFICE OF CULTURAL DIVERSITY PROVIDES TRANSLATION AND INTERPRETATION SERVICES, AS WELL AS COUNSELING ON MEDICAL INSURANCE AND BILLING FOR THOSE INDIVIDUALS WHO DO NOT SPEAK ENGLISH. THE HOSPITAL PROVIDES BI-LINGUAL PUBLICATIONS AND SIGNAGE AND ACTIVELY ASSISTS THE CULTURALLY DIVERSE COMMUNITIES IT CARES FOR. RACE/ETHNICITY: RACE/ETHNICITY DISTRIBUTION RACE/ETHNICITY 2013 POP % OF TOTAL USA % OF TOTAL WHITE NON-HISPANIC 45,825 69.5% 62.3% BLACK NON-HISPANIC 1,872 2.8% 12.3% HISPANIC 15,879 24.1% 17.3% ASIAN & PACIFIC IS. 855 1.3% 5.1% ALL OTHERS 1,463 2.2% 2.9% TOTAL 70,978 100.0% 100.0% PART VI, LINE 5: SOUTHAMPTON HOSPITAL SPONSORS "FOCUS ON SOUTHAMPTON HOSPITAL" ON SEA-TV, A MONTHLY PUBLIC ACCESS INTERVIEW PROGRAM FOR THE TOWNS OF EAST HAMPTON AND SOUTHAMPTON THAT COVERS HEALTH-RELATED INFORMATION OF INTEREST TO THE COMMUNITY AND PROVIDES INFORMATION ON HEALTHCARE SERVICES AVAILABLE AT SOUTHAMPTON HOSPITAL. THE HOSPITAL HAS DEVELOPED NUMEROUS SERVICES AND OUTREACH TO RESPOND TO THE NEEDS OF THESE PATIENTS, INCLUDING RECRUITING ADDITIONAL PRIMARY CARE PHYSICIANS AND IMPLEMENTING A GRADUATE MEDICAL EDUCATION PROGRAM THAT WILL HOPEFULLY ATTRACT THESE YOUNG PHYSICIANS TO STAY AND PRACTICE IN THE COMMUNITY. THE HOSPITAL'S WEBSITE, WWW.SOUTHAMPTONHOSPITAL.ORG, PROVIDES INFORMATION ON HOSPITAL SERVICES, SPECIAL PROGRAMS AND EVENTS. THE SITE ENABLES PATIENTS TO FIND PHYSICIANS IN DIFFERENT SPECIALTIES, ALLOWS ON-LINE INQUIRIES THAT ARE ANSWERED DAILY, AND PROVIDES ACCESS TO AVAILABLE EMPLOYMENT OPPORTUNITY AND JOB APPLICATIONS. SERVICES FOR SHORT-TERM AND LONG-TERM CARE FOR CHRONIC AND ACUTE ILLNESS ARE CONTINUALLY EVALUATED THROUGH STATISTICAL DATA THAT INCLUDE QUALITY INDICATORS AND PATIENT OUTCOMES. THIS DATA IS COMPARED NATIONALLY WITH OTHER HEALTH FACILITIES AND INFORMS THE HOSPITAL'S STRATEGIC PLAN AND COMMUNITY SERVICE PLAN. THE HOSPITAL'S STRATEGIC PLANNING COMMITTEE INCLUDES COMMUNITY MEMBERS, HOSPITAL STAFF AND HOSPITAL AND FOUNDATION BOARD MEMBERS WHO WORK COLLABORATIVELY TO ASSESS COMMUNITY NEEDS AND DEVELOP STRATEGIES TO MEET THESE NEEDS. THE HOSPITAL'S PUBLIC AFFAIRS COMMITTEE IS RESPONSIVE TO COMMUNITY INTERESTS AND CONCERNS. MEMBERSHIP IS A CROSS-SECTION OF PHYSICIANS, HOSPITAL MANAGEMENT, BOARD MEMBERS AND HOSPITAL EMPLOYEES. BASED ON THE HOSPITAL'S ASSESSMENT OF INTEREST IN THE COMMUNITY, A NUMBER OF HEALTH LECTURES AND PROGRAMS ARE PROVIDED THROUGHOUT THE YEAR. THESE PROGRAMS ARE SOMETIMES SPONSORED THROUGH OUR PARTNERSHIPS WITH LOCAL ORGANIZATIONS INCLUDING FIGHTING CHANCE, NEW YORK ORGAN DONOR NETWORK, COMMUNITY LIBRARIES, AND SERVICE CLUBS (LIONS, KIWANIS, ELKS). THE 2014 OUTREACH SCHEDULE INCLUDED THE FOLLOWING PROGRAMS AT: A) SOUTHAMPTON'S ROGERS MEMORIAL LIBRARY - Defining Reflexology, Mindfulness: The Art of Calm. B) WESTHAMPTON FREE LIBRARY - Natural Solutions for Better Sleep, Headaches: the Cure, Seasonal Allergies, Defining Reflexology, Women's Health: Physical Therapy, Diagnosis of Heel and Foot Pain, Happy Legs: New Treatments for Varicose Veins. C) CUTCHOGUE/NEW SUFFOLK FREE LIBRARY - Lyme and Other Tick-Borne Disease, Healthy Eyes, Healthy Vision, Oh My Aching Back, Seasonal Allergies. D) HAMPTON BAYS PUBLIC LIBRARY - Lyme and Other Tick-Borne Disease, Headaches: the Cure, Oh My Aching Back. E) MONTAUK LIBRARY - Lyme and Other Tick-Borne Disease. F) RIVERHEAD LIBRARY - Lyme and Other Tick-Borne Disease. PUBLIC INFORMATION: SOUTHAMPTON HOSPITAL UNDERSTANDS THE IMPORTANCE OF EDUCATING THE COMMUNITY ABOUT ITS AVAILABLE SERVICES. BROCHURES DETAILING THESE SERVICES ARE DISTRIBUTED AND DISPLAYED ON EVERY FLOOR OF THE HOSPITAL, AT COMMUNITY AND SCHOOL HEALTH FAIRS, AND AT HOSPITAL SATELLITE FACILITIES AND PHYSICIAN OFFICES ACROSS THE SOUTH FORK. IN ADDITION, THIS INFORMATION, ALONG WITH THE HOSPITAL'S 2014-17 COMMUNITY SERVICE PLAN, IS AVAILABLE ON THE HOSPITAL'S WEBSITE, WWW.SOUTHAMPTONHOSPITAL.ORG. GENERAL INFORMATION: PATIENT SATISFACTION SURVEYS: IN ADDITION, SOUTHAMPTON HOSPITAL CONTINUALLY SOLICITS PATIENT INPUT THROUGH ITS PATIENT SATISFACTION SURVEY PROCESS, WHICH INCLUDES EVERY INPATIENT, AMBULATORY SURGERY PATIENT AND EMERGENCY ROOM PATIENT. THE DATA COLLECTED FROM THESE COMPREHENSIVE SURVEYS PROVIDES VALUABLE INFORMATION ON A WIDE RANGE OF QUALITY INDICATORS AND AREAS OF INTEREST TO THE HOSPITAL'S PATIENTS. RESULTS FROM THESE SURVEYS ARE REGULARLY DISTRIBUTED TO HOSPITAL AND MEDICAL STAFFS AND THE BOARD OF DIRECTORS. THE QUALITY MANAGEMENT AND PUBLIC AFFAIRS DEPARTMENTS, AS WELL AS THE OFFICE OF THE PRESIDENT, CAREFULLY REVIEW CORRESPONDENCE FROM PATIENTS AND THE COMMUNITY AT LARGE. A MEMBER OF THE HOSPITAL STAFF PERSONALLY ANSWERS ALL CORRESPONDENCE. X true true X X X false false false false false false false false false ROBERT S CHALONER PRESIDENT & CEO 507536 0 106250 0 53549 0 15600 0 24286 0 707221 0 0 0 CHIRSTOPHER J SCHULTHEIS CHIEF FINANCIAL OFFICER 237214 0 46991 0 2925 0 14291 0 24286 0 325707 0 0 0 FREDERIC I WEINBAUM CHIEF MEDICAL OFFICER & COO 395062 0 59909 0 38980 0 15600 0 26934 0 536485 0 0 0 PATRICIA A DARCEY CHIEF NURSING OFFICER 219253 0 0 0 885 0 13265 0 26934 0 260337 0 0 0 STEVEN GEORGOPOULOS PHYSICIAN 678071 0 0 0 216690 0 15600 0 26934 0 937295 0 0 0 KRISTIN P NASO PHYSICIAN 498174 0 0 0 34290 0 15600 0 26934 0 574998 0 0 0 NEEMA POURTAHERI PHYSICIAN 408982 0 6000 0 47000 0 7799 0 9219 0 479000 0 0 0 GEORGE KECKEISEN PHYSICIAN 298174 0 100000 0 2056 0 15600 0 26934 0 442764 0 0 0 EDNA KAPENHAS DIRECTOR/BREAST SURGEON 399036 0 0 0 360 0 15600 0 24286 0 439282 0 0 0 PART I, LINE 1A: THE SOUTHAMPTON HOSPITAL ASSOCIATION PROVIDES THE FOLLOWING SPECIAL ALLOWANCES/PERQUISITES TO THE PRESIDENT & CEO, AS WELL AS TO CERTAIN KEY EXECUTIVES. THESE ALLOWANCES FOR HOUSING AND AUTOMOBILE ARE STIPULATED IN THE EXECUTIVES EMPLOYMENT AGREEMENT/TERMS AT TIME OF HIRE. ALL PAYMENTS OF THESE PERQUISITES ARE MADE ON A BI-WEEKLY BASIS WITH THE EMPLOYEE'S REGULAR PAYCHECK AND THEY ARE MADE IN ACCORDANCE WITH THE GUIDELINES OF A NON-ACCOUNTABLE EXPENSE PLAN. ANNUAL ALLOWANCES ARE AS LISTED BELOW: ROBERT CHALONER, PRESIDENT & CEO - Housing Allowance: $38,000. Auto Allowance: $4,375. FREDRIC WEINBAUM, MD, EVP, COO & CMO - Housing Allowance: $30,000. Auto Allowance: $7,000. CHRISTOPHER J. SCHULTHEIS, CHIEF FINANCIAL OFFICER - AUTO ALLOWANCE: $2,585. NEEMA POURTAHERI, PHYSICIAN - HOUSING ALLOWANCE: $36,000. PART II, COLUMN (B)(II): THE PRESIDENT & CEO, EXECUTIVE VICE PRESIDENT/CHIEF MEDICAL OFFICER, AND CFO OF SOUTHAMPTON HOSPITAL WERE ELIGIBLE FOR A PERFORMANCE BONUS IN 2014 WHICH WAS BASED UPON CRITERIA THAT THE EXECUTIVE COMMITTEE OF THE BOARD ESTABLISHED. THE PRESIDENT & CEO'S BONUS IS AN ANNUAL BONUS SET FORTH IN HIS EMPLOYMENT AGREEMENT AND IS DETERMINED AFTER A REVIEW OF HOW WELL HE PERFORMED IN THE PRIOR YEAR AGAINST GOALS AND OBJECTIVES ESTABLISHED BY THE EXECUTIVE COMMITTEE. THE EXECUTIVE VICE PRESIDENT/CHIEF MEDICAL OFFICER AND CFO WERE AWARDED A PERFORMANCE BONUS BASED UPON THE RECOMMENDATION OF THE PRESIDENT & CEO AS WELL AS A REVIEW OF THEIR PERFORMANCE AGAINST GOALS AND OBJECTIVES ESTABLISHED BY THE PRESIDENT AND THE EXECUTIVE COMMITTEE. A SUFFOLK COUNTY ECONOMIC DEVELOPMENT CORPORATION 273722095 2014-10-02 33500000 refinance series 1999a and 1999b false false false A 0 0 33500000 0 0 28644501 607619 0 0 3931601 272918 550351 true false false true A false false false false 0 0.01400 0.01400 false false false false A false true false false false false 0 false 0 false false A false FORM 990, PART VI, SECTION A, LINES 6, 7A AND 7B: THE ORGANIZATION'S SOLE MEMBER IS EAST END HEALTH ALLIANCE, A NOT-FOR-PROFIT CORPORATION THAT CAN ELECT ONE OR MORE MEMBERS OF THE HOSPITAL'S GOVERNING BODY. THE EAST END HEALTH ALLIANCE, THE ARTICLE 28 PARENT OF EASTERN LONG ISLAND HOSPITAL, PECONIC BAY MEDICAL CENTER AND SOUTHAMPTON HOSPITAL, WAS CREATED IN RESPONSE TO THE RECOMMENDATIONS OF THE COMMISSION ON HEALTH CARE IN THE 21ST CENTURY. CONSISTENT WITH THE MISSION OF SOUTHAMPTON HOSPITAL, THE GOALS OF THE ALLIANCE ARE AS FOLLOWS: A) TO COLLABORATIVELY DEVELOP HIGH QUALITY, COMPREHENSIVE AND ACCESSIBLE HEALTH CARE SERVICES TO MEET THE NEEDS OF THE COMMUNITY SERVED; B) TO RATIONALIZE HEALTH CARE SERVICES ACROSS THE SYSTEM; AND C) TO REALIZE MANAGEMENT EFFICIENCIES. THE FOLLOWING DECISIONS MADE BY THE GOVERNING BODY OF SOUTHAMPTON HOSPITAL REQUIRE EAST END HEALTH ALLIANCE APPROVAL: ADOPTION OF OPERATING AND CAPITAL BUDGETS, APPLICATION FOR NEW CERTIFICATES OF NEED, AND CERTAIN BORROWING TRANSACTIONS. FORM 990, PART VI, SECTION B, LINE 11B: SOUTHAMPTON HOSPITAL ASSOCIATION HAS ITS FORM 990 PREPARED BY AN OUTSIDE ACCOUNTING FIRM AND HAS ESTABLISHED THE FOLLOWING REVIEW PROCESS TO ENSURE THAT THE INFORMATION REPORTED IS COMPLETE AND ACCURATE. UPON COMPLETION, THE FORM 990 IS REVIEWED BY MANAGEMENT AND IS THEN FORWARDED ELECTRONICALLY TO THE MEMBERS OF THE BOARD OF TRUSTEES FOR THEIR REVIEW. ANY QUESTIONS OR ISSUES ARE THEN ADDRESSED BY THE APPROPRIATE PARTIES PRIOR TO THE FILING OF THE RETURN. FORM 990, PART VI, SECTION B, LINE 12C: SOUTHAMPTON HOSPITAL CURRENTLY HAS A CONFLICT OF INTEREST POLICY AND A PROCEDURE FOR ANNUAL DISCLOSURE BY KEY EMPLOYEES, PHYSICIAN LEADERS, AND SENIOR MANAGEMENT. WHEN NEW/POTENTIAL CONFLICTS/RELATIONSHIPS ARE IDENTIFIED, THEY ARE INVESTIGATED BY THE CORPORATE COMPLIANCE OFFICER AND ANY RECOMMENDATIONS AND/OR CORRECTIVE ACTIONS ARE PRESENTED TO THE PRESIDENT AND CEO. AS APPROPRIATE, THESE POTENTIAL CONFLICTS/DISCLOSURES ARE ALSO REVIEWED WITH THE CFO AND MEDICAL DIRECTOR/COO. WHEN A POTENTIAL CONFLICT IS IDENTIFIED, THE STAFF MEMBER IS PROHIBITED FROM TAKING PART IN ANY HOSPITAL DECISIONS THAT MAY RELATE TO THE INTEREST OR RELATIONSHIP, UNTIL THE REVIEW IS COMPLETED AND A DETERMINATION IS MADE THAT THERE IS NO CONFLICT. SIMILARLY, ON AN ANNUAL BASIS, ALL MEMBERS OF THE BOARD OF DIRECTORS ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST FORM. ALL POTENTIAL CONFLICTS OF INTEREST THAT MAY EXIST MUST BE DISCLOSED. IF A POTENTIAL OR ACTUAL CONFLICT OF INTEREST EXISTS, THE AFFECTED MEMBER WILL BE NOTIFIED AND THE EXECUTIVE COMMITTEE OF THE BOARD WILL INVESTIGATE AND MAKE THE DETERMINATION AS TO WHAT, IF ANY RECUSAL OR OTHER CORRECTIVE ACTION MAY BE REQUIRED TO AVOID ANY POTENTIAL CONFLICT. THE RESULTS OF THE INVESTIGATION WILL THEN BE REPORTED TO THE GOVERNING BODY. IF AN ACTUAL CONFLICT OF INTEREST EXISTS, THE AFFECTED MEMBER WILL BE NOTIFIED OF THIS DETERMINATION AND THEIR PARTICIPATION IN RELATED MATTERS AND/OR VOTING RIGHTS, PERTAINING TO THE AREA OF CONFLICT, WILL BE RELINQUISHED. FORM 990, PART VI, SECTION B, LINES 15A AND 15B: Southampton Hospital has established an Executive Compensation Policy which sets forth the terms and criteria for the review of the compensation of the President & CEO, the Chief Medical Officer/COO and the Vice President of Finance/CFO as well as other executive leaders. The policy outlines the procedures and criteria the Executive Committee will follow in evaluating the CEO's, the CMO/COO's, and the CFO's performance against established goals. It also outlines the Executive Committees' role and responsibility in determining all aspects of the CEO's, Chief Medical Officer/COO's, and CFO's compensation including any incentive or bonus compensation. The Committee reviews contract terms which cover compensation and benefits including, but not limited to, housing allowances, automobile allowances, severance or change of control payments. On a periodic basis, the Executive Committee meets to review the terms of compensation and reviews external compensation data and studies to ensure that compensation decisions are reasonable and consistent with fair market value. The Committee documents the full terms of compensation approved and includes date of the decision, details of the comparability data obtained and relied upon, and how the data was obtained. Members of the Executive Committee must be free from any conflict of interest that may relate to the arrangement. All members of the Committee who were present during the discussion of the arrangement will be documented in the Meeting minutes along with their votes. The compensation review process for the President & CEO, Chief Medical Officer and CFO was last undertaken July 2, 2014. FORM 990, PART VI, SECTION C, LINE 19: SOUTHAMPTON HOSPITAL'S FORM 990, AS WELL AS ITS FINANCIAL STATEMENTS AND CONFLICT OF INTEREST POLICY, ARE AVAILABLE FOR PUBLIC INSPECTION UPON REQUEST, AS REQUIRED UNDER SECTION 6104 OF THE INTERNAL REVENUE CODE. INTERESTED PARTIES MAY REQUEST THE DOCUMENTS AT 240 MEETINGHOUSE LANE, SOUTHAMPTON, NY 11968 OR BY CALLING THE ORGANIZATION DIRECTLY AT (631)726-8200. FORM 990, PART XI, LINE 9: SHA PROPERTIES INCOME...................$ 30,447 SHA PROPERTIES EXPENSES.................$ (81,545) SHA NET ASSETS TRANSFERRED TO SOUTHAMPTON HOSPITAL ASSOCIATION......$ 2,003,180 PENSION OBLIGATION......................$(2,940,069) LOSS ON BOND EXTINGUISHMENT.............$(1,222,344) CHARITABLE TRUST REALIZED GAINS.........$ (32,162) TOTAL...................................$(2,242,493) SOUTHAMPTON CARE CENTER 240 MEETING HOUSE LANE SOUTHAMPTON NY 11968 112658403 NURSING HOME NY 501(c)(3) 9 false THE SOUTHAMPTON HOSPITAL FOUNDATION 240 MEETING HOUSE LANE SOUTHAMPTON NY 11968 113466516 SRVC PROVIDER NY 501(C)(3) 7 false MEETINGHOUSE LANE MEDICAL PRACTICE PO BOX 2340 SOUTHAMPTON NY 11968 208853938 PATIENT CARE NY NA C 286501 1718535 1.00000 true SHA PROPERTIES 240 MEETING HOUSE LANE SOUTHAMPTON NY 11968 112563612 REAL ESTATE NY NA C 1632360 13162 1.00000 true OLD TOWN MEDICAL PRACTICE PC 240 MEETING HOUSE LANE SOUTHAMPTON NY 11968 452430883 MEDICAL PRACTICE NY NA C 0 0 1.00000 true false false true true true false false false false false false false true true true false false false true SHA PROPERTIES D 65260 FMV SHA PROPERTIES S 1601913 FMV