2014-11-17T09:55:17-06:00 2013-12-31 Charles A Barragato & Co LLP 950 Third Avenue - 20th FL New York NY 10022 990 2013-01-01 111631837 Wyckoff Heights Medical Center % FRANK VUTRANO WYCK 7189636702 374 Stockholm Street Suite Brooklyn NY 11237 FRANK VUTRANO CFO 7189636702 2014-11-15 true Angelo Pirozzi CPA P00446022 7189636702 2013 2015-11-30 17:44:51Z RAMON RODRIGUEZ 374 STOCKHOLM STREET BROOKLYN NY 11237 277551959 false X WWW.WYCKOFFHOSPITAL.ORG X 1889 NY THE MISSION OF WYCKOFF HEIGHTS MEDICAL CENTER IS TO PROVIDE EXCELLENCE IN CARE THROUGH PREVENTION, EDUCATION, AND TREATMENT IN A SAFE ENVIRONMENT. 12 9 2208 610 0 4345242 5194852 246165550 241356174 73869 233542 30941465 30725891 281526126 277510459 0 0 0 0 167680947 162825318 0 0 0 108472326 113687846 276153273 276513164 5372853 997295 180595537 158890213 276982566 254253691 -96387029 -95363478 X THE MISSION OF WYCKOFF HEIGHTS MEDICAL CENTER IS TO PROVIDE EXCELLENCE IN CARE THROUGH PREVENTION, EDUCATION, AND TREATMENT IN A SAFE ENVIRONMENT. false false 192448702 270805390 WYCKOFF HEIGHTS MEDICAL CENTER PROVIDES INPATIENT MEDICAL, SURGICAL, OBSTETRIC, PEDIATRIC CARE AND OFFERS EMERGENCY, AMBULATORY SURGERY AND OUTPATIENT CLINICAL SERVICES. WYCKOFF HAS BEEN PROVIDING MEDICAL CARE TO THE COMMUNITY SINCE 1889. WYCKOFF DISCHARGED 15,841 PATIENTS IN 2013. THE HOSPITAL DELIVERS 1,375 BABIES OF WHICH 125 WERE FROM NEONATAL INTENSIVE CARE UNIT. WYCKOFF SEES 201,428 OUTPATIENT VISITS WHICH INCLUDES PEDIATRIC/ADULT EMERGENCY DEPARTMENT AND AMBULATORY SURGERY. THE HOSPITAL OFFERS SERVICES TO THOUSANDS AT ITS NETWORK OF COMMUNITY AMBULATORY CARE CENTERS AND PRESENTS EXTENSIVE COMMUNITY HEALTH EDUCATION AND SCREENING PROGRAMS. FOR FURTHER INFORMATION, PLEASE VISIT THE WEBSITE AT WWW.WYCKOFFHOSPITAL.ORG. 192448702 true true false true false false false false false false true false false true true true false true false false false false false false false false true true false false true false false false false false true false true false false false false false true true true false false true 160 0 true 2208 true false false false false false false false false false false X 12 9 false false false false false false false true true false false true true true true true true true true false NY X FRANK VUTRANO 7189636702 374 STOCKHOLM STREET BROOKLYN NY 11237 GARY GOFFNER Chairman 1.0 3.0 X X 0 0 Vincent Arcuri Vice Co-Chairman 1.0 3.0 X X 0 0 0 Fred T Haller Esq Secretary 1.0 3.0 X X 0 0 0 John H Cook Esq Trustee 1.0 3.0 X 0 0 0 Vito J D'Alessandro Trustee/Dir. Quality Assurance 22.0 3.0 X 106125 0 749 Adam Figueroa Trustee 1.0 3.0 X 0 0 0 Andrew Boisselle Trustee 1.0 3.0 X 0 0 0 MOUNZER TCHLEBI Trustee 1.0 3.0 X 0 0 0 RAMON RODRIGUEZ PRESIDENT/CEO 32.0 3.0 X X 861910 0 13032 Agnieszka Poslednik Esq Trustee 1.0 3.0 X 0 0 0 Edmondo Modica Trustee 1/1/13 - 5/26/13 1.0 3.0 X 35800 0 0 Herman Hochberg Vice Co-Chairman 1.0 3.0 X X 0 0 0 Albert Wiltshire Trustee 1.0 3.0 X 0 0 0 FRANK VUTRANO EVP/CFO 32.0 3.0 X 386618 0 4093 DAVID ROCK EVP/COO 35.0 0.0 X 320635 0 1430 GUSTAVO DEL TORO EVP/CMO 35.0 0.0 X 369966 0 7549 Frances Heaney EVP/COO 1/1/13 - 5/1/13 35.0 0.0 X 454994 0 2063 KEVIN SMYLEY VP/LEGAL COUNSEL 35.0 0.0 X 266260 0 11471 MARGARET CORNELIUS VP OF HR 35.0 X 221931 0 2154 JEBASHINI JERURASA VP/CIO 35.0 0.0 X 183257 0 6262 MARGARET PELKOWSKI CNO 1/1/13 - 8/27/13 35.0 0.0 X 189837 0 3764 ROSETTA MELVIN ACTING CNO 35.0 0.0 X 148084 0 3764 Stephen Carryl Physician 40.0 0.0 X 902037 0 6262 GORDON ANDERSON Physician 35.0 0.0 X 437925 0 0 WILLIAM THELMO Physician 35.0 0.0 X 381186 0 7549 SANJIVAN PATEL PHYSICIAN 35.0 0.0 X 384867 0 6262 CALIXTO CAZANO PHYSICIAN 35.0 0.0 X 352825 0 4093 6004257 0 80497 225 false true false PRICEWATERHOUSECOOPERS LLP PO BOX 7247-8001 PHILADELPHIA PA 191708001 professional svcs 1188320 Arnold Porter LLP PO BOX 759451 BALTIMORE MD 212759451 legal services 2055360 ASHACK HAJEK LEHRMAN PLLC 1790 BROADWAY 77TH FLOOR NEW YORK NY 10019 LEGAL SERVICES 1182513 SODEXHO MARRIOTT SERVICES BOX 360170 PITTSBURGH PA 152516170 Management 1812056 THE MAX GROUP LLC 7 PONDFIELD BRONXVILLE NY 10708 CONSULTING 1134397 29 5078681 116171 5194852 NET PATIENT SERVICE REVENUE 621300 259571446 259571446 PROVISION FOR BAD DEBTS 621300 -18215272 -18215272 241356174 43703 43703 0 0 47549 47549 0 47549 47549 231339 41500 189839 189839 189839 0 0 0 PHYSICIAN BILLINGS 900099 20473769 20473769 EHR & FICA REFUND 900099 2873346 2161215 712131 STUDENT TRAINING 900099 6460251 6460251 870976 353981 516995 30678342 277510459 270805390 1510217 X 0 0 0 0 3565947 3565947 0 116316728 77932208 38384520 0 7730872 5179684 2551188 0 25606687 17156480 8450207 0 9605084 6435406 3169678 0 0 4197978 2812645 1385333 0 332740 222936 109804 0 0 0 0 49407675 33103142 16304533 92318 61853 30465 0 9660554 6472571 3187983 0 0 0 7264477 4867200 2397277 0 171655 115009 56646 0 0 84075 56330 27745 0 341129 228557 112572 0 0 9057218 6068336 2988882 0 364473 244197 120276 0 MEDICAL SUPPLIES 29012318 29012318 REPAIRS AND MAINTENANCE 3531098 2365836 1165262 MISCELLANEOUS EXPENSE 38778 25982 12796 EDUCATION 131360 88012 43348 276513164 192448702 84064462 0 5857614 2921503 133203 1255853 2515968 1719707 32151936 25511352 0 0 0 0 0 0 3373225 3665823 1494214 2013119 282107036 226126681 60251690 55980355 0 0 0 0 0 0 0 0 74817687 65822501 180595537 158890213 62007646 51011807 0 0 0 1054423 96399596 89594596 0 0 0 0 3810311 2912299 0 0 114765013 109680566 276982566 254253691 X -96387029 -95363478 0 0 0 0 -96387029 -95363478 180595537 158890213 X 997295 65208 29 -38981 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 61316 61316 false false PART II-B, LINE 1I - OTHER ACTIVITIES DESCRIPTION WYCKOFF HEIGHTS MEDICAL CENTER PAYS DUES TO GREATER NEW YORK HOSPITAL ASSOCIATION (GNYHA), LOCAL 1199 - HEALTH EDUCATION PROJECT (LOCAL 1199), AND HEALTHCARE ASSOCIATION OF NEW YORK STATE (HANYS). IN ACCORDANCE WITH CODE SECTION 6033(E) OF THE INTERNAL REVENUE CODE, AND AS REPORTED BY GNYHA/LOCAL 1199 AND HANYS, A PORTION OF THESE DUES ARE ATTRIBUTABLE TO LOBBYING ACTIVITIES. THE LOBBYING ACTIVITIES APPLICABLE TO 2013 GNYHA/LOCAL 1199 AND HANYS ANNUAL DUES WERE $16,677 AND $44,639, RESPECTIVELY. 6075373 6075373 104600530 69316704 35283826 314092 176557 137535 168926769 155365029 13561740 2190272 1268391 921881 55980355 ASSETS LIMITED AS TO USE 19623060 DEFERRED FINANCING FEES 230032 DUE FROM RELATED PARTIES 6065824 DUE FROM THIRD PARTY PAYORS 6126672 OTHER LONG TERM ASSETS 125000 OTHER RECEIVABLES 4681747 INSURANCE CLAIMS RECEIVABLE 25405000 SELF INSURED MALPRACTICE FUND 3565166 65822501 0 ACCRUED INTEREST PAYABLE 1784084 DUE TO RELATED ORGANIZATIONS 2870509 DUE TO THIRD PARTY PAYORS 36845842 ESTIMATED PROFESSIONAL LIABILI 35507131 OTHER LIABILITIES FOR INSURANC 25405000 CARITAS SETTLEMENT 7268000 109680566 X PART X - FASB ASC 740 FOOTNOTE Under FASB ASC Topic 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 be sustained. The Medical Center does not believe there are any material uncertain tax positions and, accordingly, it will not recognize any liability for unrecognized tax benefits. The Medical Center has filed for and received income tax exemptions in the jurisdictions where required. true true true true X true true true false true true 1200000 1200000 0.00430 105420135 105890025 -469890 0.00170 106620135 105890025 730110 0.00260 6645265 6645265 0.02400 28889876 20529154 8360721 0.03020 35535141 20529154 15005986 0.05420 142155276 126419179 15736096 0.05680 2377808 1535750 842058 0.00300 19295 19295 0.00010 2397103 1535750 861353 0.00310 true 18215272 53674308 27680214 25994094 X true 1 1 Wyckoff Heights Medical Center 374 Stockholm Street Brooklyn NY 11237 WWW.WYCKOFFHOSPITAL.ORG X X X X Wyckoff Heights Medical Center 1 true X X X X X X X X X 13 true false true X www.wyckoffhospital.org X X X X X X X true false true true 300. true 300. true X true true X X X X X true false true X false false Section B, Line 20d A sliding fee scale for Hospital based services and flat fees for Clinic visits will be granted to families with resources up to 300% of the poverty level. Charity Care patients will be granted a percentage discount for extensive dental procedures when the procedure is performed in the clinic. Special consideration will be given to patients with extenuating circumstances. Section B, Line 3 The Community Health Needs Assessment included a community member survey and meetings with community stakeholders to obtain input, prioritize needs, and develop strategies for the Community Service Plan. These stakeholders included local community-based organizations, and members of the local community board. PART I, LINE 7 WYCKOFF HEIGHTS MEDICAL CENTER'S COSTING METHODOLOGY WAS BASED UPON THE 2013 NEW YORK STATE INSTITUTIONAL COST REPORT AND THE 2013 MEDICARE (FORM 2552) COST REPORT. THESE COST REPORTS ARE FILED WITH THE NEW YORK STATE DEPARTMENT OF HEALTH AND THE APPLICABLE CMS INTERMEDIARY, RESPECTIVELY. THE COST-TO-CHARGE RATIO DERIVED FROM THE NEW YORK STATE INSTITUTIONAL COST REPORT WAS USED FOR THE VARIOUS SUB-LINE ITEMS OF LINE #7. PART III, LINE 2 THE AMOUNT REPORTED ON LINE 2 IS EQUAL TO THE PROVISION FOR BAD DEBTS PER THE AUDITED FINANCIAL STATEMENTS ("AFS"). THE EXPLANATION OF THE METHODOLOGY USED TO ESTIMATE THIS AMOUNT CAN BE FOUND IN FOOTNOTE (3)(e) on page 8 and footnote (3)(q) ON PAGE 11 OF THE ATTACHED AFS. PART III, LINE 4 THE TEXT OF THE FOOTNOTES THAT DESCRIBE BAD DEBT EXPENSE CAN BE FOUND ON PAGES 8 AND 11 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS. PART III, LINE 8 THE AMOUNT REPORTED ON LINE 6 WAS DERIVED BY USING THE MEDICARE ALLOWABLE COSTS AS REPORTED ON THE HOSPITAL'S NEW YORK STATE INSTITUTIONAL COST REPORT AND THE APPLICABLE ADJUSTMENTS FROM WORKSHEET B. PART III, LINE 9B WYCKOFF HEIGHTS MEDICAL CENTER'S ("WHMC") COLLECTION POLICY FOLLOWS THE GUIDELINES ESTABLISHED BY NEW YORK STATE LAW. WHMC'S COLLECTION POLICY, IN CONJUNCTION WITH THE HOSPITAL'S CHARITY CARE AND FINANCIAL ASSISTANCE POLICY, ENSURES THAT EVERY EFFORT IS MADE TO IDENTIFY PATIENTS WHO ARE ELIGIBLE FOR CHARITY CARE. WHMC HAS A WRITTEN DEBT COLLECTION POLICY - ALL SELF-PAY BALANCES ARE OUTSOURCED TO A DESIGNATED SELF-PAY AGENCY FOR COLLECTION. TRUE SELF-PAYS WILL BE FORWARDED ON DAY ONE FROM FINAL BILL. SELF-PAY AFTER INSURANCE PAYMENT OR FINAL INSURANCE DENIAL WILL BE TRANSFERRED TO THE OUTSOURCE COMPANY AS SOON AS THE ACCOUNT IS IDENTIFIED AS HAVING A SELF-PAY BALANCE. ACCOUNTS WILL BE WORKED BY THE OUTSOURCE (EARLY OUT) COMPANY FOR ONE HUNDRED TWENTY (120) DAYS. THE EARLY OUT AGENCY WILL ALSO IDENTIFY ACCOUNTS THAT QUALIFY FOR CHARITY CARE BASED ON NEW YORK GUIDELINES. IF UNPAID AT THE END OF THE CYCLE THE ACCOUNT WILL BE TRANSFERRED TO A DESIGNATED BAD DEBT COLLECTION AGENCY. THE BAD DEBT AGENCIES WILL WORK THE ACCOUNTS FOR SIX (6) MONTHS. IF THE AGENCY FAILS IN THEIR COLLECTION EFFORT, THE ACCOUNT WILL BE RETURNED TO THE HOSPITAL AS UNCOLLECTIBLE WITH THE EXCEPTION OF ACCOUNTS WITH ACTIVE PAYMENT ARRANGEMENTS. ITEMIZED BILLS WILL BE AVAILABLE TO PATIENTS UPON REQUEST. PROCEDURE: 1. ALL PATIENTS WITH A SELF-PAY BALANCE (TRUE SELF-PAY OR SELF-PAY BALANCE AFTER INSURANCE) WILL BE TRANSFERRED TO A DESIGNATED SELF-PAY AGENCY FOR PROCESSING. THE AGENCY WILL: A. IDENTIFY AND RETURN ACCOUNTS THAT QUALIFY FOR CHARITY CARE PER NEW YORK GUIDELINES. B. PROCESS A LETTER SERIES (THREE LETTERS) WITHIN ONE HUNDRED TWENTY (120) DAYS. IN ADDITION TO WRITTEN STATEMENTS, PATIENTS WILL RECEIVE A MINIMUM OF THREE (3) PHONE CALLS IN AN ATTEMPT TO COLLECT UPON THEIR OPEN ACCOUNT. C. IDENTIFY ACCOUNTS WITH RETURN MAIL/NO CURRENT PHONE NUMBER THAT CAN NOT BE LOCATED AND RETURN THE ACCOUNT TO BE PLACED IN BAD DEBT. D. AFTER THE ONE HUNDRED TWENTY (120) DAY PERIOD AND THERE HAS BEEN NO PAYMENT RECEIVED, THE ACCOUNT WILL BE RETURNED TO THE HOSPITAL TO BE REVIEWED FOR BAD DEBT PLACEMENT. NOTE: ACCOUNTS WITH PAYMENT ARRANGEMENTS WILL REMAIN AT THE AGENCY UNTIL THEY ARE PAID-IN-FULL. AGENCY WILL CLOSE AND RETURN ACCOUNTS THAT HAVE BROKEN PAYMENT ARRANGEMENTS. 2. A BAD DEBT PRE-LIST WILL BE REVIEWED WEEKLY AND ACCOUNTS PLACED WITH A DESIGNATED BAD DEBT AGENCY FOR A PERIOD OF SIX (6) MONTHS WILL BE CHANGED TO BDCLOSED - BAD DEBT CLOSED ACCOUNT IDENTIFIES THE ACCOUNT AS HAVING ALL COLLECTION EFFORTS EXHAUSTED. THE EXCEPTIONS FOR RETURNING ACCOUNTS AT SIX MONTHS ARE ACCOUNTS WITH ACTIVE PAYMENT ARRANGEMENTS. 3. ACCOUNTS RETURNED FROM THE BAD DEBT AGENCIES WILL BE REVIEWED: A. MEDICARE COPAY/DEDUCTIBLE AMOUNTS WILL BE DOCUMENTED. B. ACCOUNTS CLAIMED AS UNCOLLECTIBLE WILL BE CODED AS 'BAD DEBT RETURNS'(BDCLOSED), WHICH IDENTIFIES THE ACCOUNTS AS HAVING ALL COLLECTION EFFORTS EXHAUSTED. 4. MONTHLY-THE PATIENT ACCOUNTS MANAGER WHO OVERSEES OUTSOURCING WILL: A. RECONCILE THE INVENTORY B. CONDUCT AN AUDIT ON COMPLIANCE TO THIS POLICY AND REPORT THOSE RESULTS TO THE ASSOCIATE VICE-PRESIDENT PART VI, LINE 2 PURSUANT TO NEW YORK STATE PUBLIC HEALTH LAW SECTION 2803-L, WYCKOFF HEIGHTS MEDICAL CENTER ("WHMC") IS REQUIRED TO FILE A COMPREHENSIVE COMMUNITY SERVICE PLAN ("CSP") WITH THE NEW YORK STATE DEPARTMENT OF HEALTH ("DOH") EVERY 3 YEARS. THE TEXT OF NEW YORK STATE PUBLIC HEALTH LAW SECTION 2803-L IS AS FOLLOWS: COMMUNITY SERVICE PLANS. (1) THE GOVERNING BODY OF A VOLUNTARY NON-PROFIT GENERAL HOSPITAL MUST ISSUE AN ORGANIZATIONAL MISSION STATEMENT IDENTIFYING AT A MINIMUM THE POPULATIONS AND COMMUNITIES SERVED BY THE HOSPITAL AND THE HOSPITAL'S COMMITMENT TO MEETING THE HEALTH CARE NEEDS OF THE COMMUNITY. (2) THE GOVERNING BODY MUST AT LEAST EVERY THREE YEARS: (I) REVIEW AND AMEND AS NECESSARY THE HOSPITAL MISSION STATEMENT; (II) SOLICIT THE VIEWS OF THE COMMUNITIES SERVED BY THE HOSPITAL ON SUCH ISSUES AS THE HOSPITAL'S PERFORMANCE AND SERVICE PRIORITIES;(III) DEMONSTRATE THE HOSPITAL'S OPERATIONAL AND FINANCIAL COMMITMENT TO MEETING COMMUNITY HEALTH CARE NEEDS, TO PROVIDE CHARITY CARE SERVICES AND TO IMPROVE ACCESS TO HEALTH CARE SERVICES BY THE UNDERSERVED; AND (IV) PREPARE AND MAKE AVAILABLE TO THE PUBLIC A STATEMENT SHOWING ON A COMBINED BASIS A SUMMARY OF THE FINANCIAL RESOURCES OF THE HOSPITAL AND RELATED CORPORATIONS AND THE ALLOCATION OF AVAILABLE RESOURCES TO HOSPITAL PURPOSES INCLUDING THE PROVISION OF FREE OR REDUCED CHARGE SERVICES. (3) THE GOVERNING BODY MUST AT LEAST ANNUALLY PREPARE AND MAKE AVAILABLE TO THE PUBLIC AN IMPLEMENTATION REPORT REGARDING THE HOSPITAL'S PERFORMANCE IN MEETING THE HEALTH CARE NEEDS OF THE COMMUNITY, PROVIDING CHARITY CARE SERVICES, AND IMPROVING ACCESS TO HEALTH CARE SERVICES BY THE UNDERSERVED. (4) THE GOVERNING BODY SHALL FILE WITH THE COMMISSIONER ITS MISSION STATEMENT, ITS ANNUAL IMPLEMENTATION REPORT, AND AT LEAST EVERY THREE YEARS A REPORT DETAILING AMENDMENTS TO THE STATEMENT AND REFLECTING CHANGES IN THE HOSPITAL'S OPERATIONAL AND FINANCIAL COMMITMENT TO MEETING THE HEALTH CARE NEEDS OF THE COMMUNITY, PROVIDING CHARITY CARE SERVICES, AND IMPROVING ACCESS TO HEALTH CARE SERVICES BY THE UNDERSERVED. THE ABOVE-REFERENCED CSP REQUIREMENT WAS ENHANCED BY THE DOH'S PREVENTION AGENDA INITIATIVE. THIS INITIATIVE IS A PROCESS THAT ASKS HOSPITALS SUCH AS WHMC TO WORK WITH LOCAL HEALTH DEPARTMENTS AND COMMUNITY PARTNERS TO ASSESS COMMUNITY HEALTH NEEDS, JOINTLY DEVELOP PLANS TO ADDRESS TWO OR THREE OF THE IDENTIFIED NEEDS AND INCLUDE THIS COLLABORATIVE WORK IN THE WHMC'S CSP UPDATE SUBMITTED TO DOH. INFORMATION ON THE NEW YORK STATE DOH PREVENTION AGENDA CAN BE FOUND AT WWW.HEALTH.STATE.NY.US/PREVENTION/PREVENTION_AGENDA. WHMC LIES IN CULTURALLY DIVERSE QUEENS AND KINGS COUNTY OF NEW YORK CITY. WHMC DETERMINES ITS COMMUNITY HEALTH NEEDS BY PARTICIPATING WITH COMMUNITY GROUPS AND LOCAL HEALTH DEPARTMENT ACTIVITIES. THE HOSPITAL ANALYZES INTERNAL PATIENT SURVEY, UTILIZATION DATA AND BULLETINS AND REPORTS FROM NYS DEPARTMENT OF HEALTH, NYS VITAL STATISTICS, GNYHA AND HANYS TO UNDERSTAND THE DEMOGRAPHICS AND UNMET NEEDS WITHIN THE COMMUNITY. WHMC WORKS CLOSELY WITH THE LOCAL HEALTH DEPARTMENT AND COMMUNITY GROUPS. THE HOSPITAL IS ABLE TO CONSTANTLY MEET THE EMERGING HEALTH CARE NEEDS FROM THE COMMUNITY. THE HOSPITAL IDENTIFIES THE FOLLOWING NEEDS WITHIN THE COMMUNITY: THE NEED TO ACCESS ADVANCED QUALITY HEALTH CARE; THE NEED TO RECEIVE QUALITY CARE FOR THE UNDERSERVED BY OPEN ENROLLMENT OF MEDICAID AND MEDICAID MANAGED CARE PROGRAMS;THE NEED TO OBTAIN HEALTH EDUCATION, DISEASE PREVENTION AND DISEASE MANAGEMENT TO IMPROVE THE HEALTH STATUS OF THE COMMUNITY. IN SUMMARY, THE HOSPITAL FOCUS PRIMARILY ON POSITIVELY IMPACTING THE HEALTH OF OUR COMMUNITY WITH PROGRAMS THAT ARE CULTURALLY AND LINGUISTICALLY TAILORED TO MEET THE UNMET NEEDS OF WOMEN, INFANTS, SENIORS AND MINORITIES IN OUR COMMUNITY. PART VI, LINE 3 WYCKOFF HEIGHTS MEDICAL CENTER IS COMMITTED TO PROVIDE ACCESS TO THE HIGHEST LEVEL OF CARE WITH COMPASSION, DIGNITY AND RESPECT. WE ARE ALSO COMMITTED TO CARE ALL PERSONS REGARDLESS OF THEIR ABILITY TO PAY. WE NOT ONLY PROVIDE VARIOUS ASSISTANCES TO PATIENTS WHO CAN'T PAY FOR PART OR ALL OF THE CARE THEY RECEIVE BUT ALSO HELP PATIENTS WITH BROADER FISCAL RESPONSIBILITIES TO BALANCE THE NEEDED FINANCIAL ASSISTANCE. WYCKOFF HEIGHTS MEDICAL CENTER CURRENTLY HAS THE FOLLOWING PRINCIPALS WHEN HANDLING THE BILLING, COLLECTION AND FINANCIAL SUPPORT FUNCTIONS FOR OUR PATIENTS: *PROVIDE EFFECTIVE COMMUNICATIONS WITH PATIENTS REGARDING HOSPITAL BILLS *MAKE AFFIRMATIVE EFFORTS TO HELP PATIENTS APPLY FOR PUBLIC AND PRIVATE FINANCIAL SUPPORT PROGRAMS *OFFER FINANCIAL SUPPORT TO PATIENTS WITH LIMITED RESOURCES *IMPLEMENT POLICIES FOR ASSISTING LOW-INCOME PATIENTS IN A CONSISTENT MANNER *IMPLEMENT FAIR AND CONSISTENT BILLING AND COLLECTION PRACTICES FOR ALL PATIENTS WITH PAYMENT OBLIGATIONS WYCKOFF HEIGHTS MEDICAL CENTER PROVIDES FINANCIAL COUNSELING TO PATIENTS ABOUT THEIR OBLIGATIONS AND HOSPITAL BILLS. INFORMATION ON HOSPITAL POLICIES ON FINANCIAL SUPPORT AND FEDERAL, STATE AND LOCAL PROGRAMS THAT PROVIDE COVERAGE FOR SERVICES IS AVAILABLE TO PATIENTS THROUGH HOSPITAL'S WEBSITE, HOSPITAL POSTERS AND FLYERS. INFORMATION IS ALSO AVAILABLE IN SPANISH WHICH IS THE MAIN LANGUAGE SPOKEN IN THE COMMUNITY AND POSTED IN THE WAITING AREAS FOR THE EMERGENCY ROOM, THE WOMEN'S HEALTH, THE SECOND FLOOR MAIN CLINIC AREA AND THE OFFSITE CLINICS. FINANCIAL COUNSELORS MAKE EVERY EFFORT TO HELP PATIENTS APPLY FOR PUBLIC AND PRIVATE PROGRAMS FOR WHICH THEY MAY QUALIFY AND THAT MAY HELP THEM OBTAIN AND PAY FOR HEALTHCARE SERVICES. THE HOSPITAL HAS ONSITE MEDICAID ELIGIBILITY REPRESENTATIVES AND THEY MAKE BEDSIDE VISITS TO DETERMINE A PATIENT'S ELIGIBILITY PRIOR TO THE PATIENT'S DISCHARGE. WYCKOFF HEIGHTS MEDICAL CENTER HAS DEVELOPED A WRITTEN POLICY FOR THE BILLING,COLLECTION ON CHARITY CARE AND IS COMMITTED TO IMPLEMENTING AND APPLYING THE POLICY FOR ASSISTING PATIENTS IN NEED IN A PROFESSIONAL, CONSISTENT MANNER. WYCKOFF EDUCATES STAFF MEMBERS WHO WORK CLOSELY WITH PATIENTS (INCLUDING PATIENT REGISTRARS, FINANCIAL INVESTIGATORS, CUSTOMER SERVICE REPRESENTATIVES, AND BILLING AND COLLECTION REPRESENTATIVES) ABOUT THESE POLICIES WITH AN EMPHASIS ON TREATING ALL PATIENTS WITH DIGNITY AND RESPECT REGARDLESS OF THEIR INSURANCE STATUS OR ABILITY TO PAY FOR SERVICES. PART VI, LINE 4 WYCKOFF HEIGHTS MEDICAL CENTER IS A 324-BED ACUTE CARE ACADEMIC MEDICAL CENTER COMMITTED TO THE COMPLEX MISSION OF PATIENT CARE, TEACHING AND COMMUNITY SERVICE. THE HOSPITAL HAS ENSURED CONTINUED BROOKLYN AND QUEENS COUNTY COMMUNITY PARTICIPATION AND OUTREACH ACTIVITIES THROUGH LINKAGES WITH COMMUNITY BASED ORGANIZATIONS, LOCAL PHYSICIAN PRACTICES, D&T CENTERS, HOME CARE AGENCIES AND NURSING HOMES. WYCKOFF HEIGHTS MEDICAL CENTER'S PRIMARY AND SECONDARY SERVICE AREAS INCLUDE FIVE PRIMARY CARE HEALTH PROFESSIONAL SHORTAGE AREAS (HPSAS); BUSHWICK, WILLIAMSBURG, BEDFORD-STUYVESANT, EAST NEW YORK AND LONG ISLAND CITY. THE HOSPITAL IS LOCATED IN BROOKLYN NEAR THE BROOKLYN/QUEENS BORDER, AND SERVES THE BUSHWICK, BEDFORD-STUYVESANT, EAST NEW YORK AND GREENPOINT COMMUNITIES OF BROOKLYN, AS WELL AS THE RIDGEWOOD, GLENDALE, MASPETH AND MIDDLE VILLAGE COMMUNITIES OF QUEENS. THE HOSPITAL SERVICE AREAS HAVE A TOTAL POPULATION OF 430,000. 177,000 RESIDENTS OR 41% OF THE POPULATION IS LATINO AND 47,400 RESIDENTS OR 11% OF THE POPULATION IS AFRICAN AMERICAN. THE HOSPITAL IS LOCATED IN THE 11237 ZIP CODE WHICH HAS A POPULATION THAT IS 75% LATINO. THE SERVICE AREAS ALSO INCLUDE RECENT IMMIGRANT POPULATIONS FROM LATIN AMERICA, THE CARIBBEAN, EASTERN/SOUTHERN EUROPE AND ASIA. MORE THAN 100,000 RESIDENTS ARE UNDER 18 YEARS OF AGE. IN THE BUSHWICK COMMUNITY 33% ARE 18 OR YOUNGER. MORE THAN 50% OF THE RESIDENTS HAVE INCOMES BELOW THE POVERTY LINE. PART VI, LINE 5 THE MISSION OF WYCKOFF HEIGHTS MEDICAL CENTER IS TO PROVIDE EXCELLENCE IN CARE THROUGH PREVENTION, EDUCATION AND TREATMENT IN A SAFE ENVIRONMENT. WYCKOFF PROVIDES COMPREHENSIVE PRIMARY AND SECONDARY LEVEL INPATIENT AND OUTPATIENT MEDICAL, SURGICAL, OBSTETRIC/GYNECOLOGIC AND PEDIATRIC CARE SERVICES. WYCKOFF PROVIDES TERTIARY HEALTHCARE SERVICES, INCLUDING RENAL DIALYSIS, MEDICAL ONCOLOGY SERVICES, NEUROSURGERY, GENETICS, NUCLEAR MEDICINE AND RADIATION ONCOLOGY. AMBULATORY PODIATRIC AND DENTAL SERVICES ARE ALSO AVAILABLE. IN OUR COMMITMENT TO PATIENT-CENTERED CARE, WYCKOFF POLICY EMPHASIZES AMBULATORY ALTERNATIVES TO INPATIENT CARE WHEN FEASIBLE TO PROMOTE RESPONSIBILITY AND PATIENT INDEPENDENCE. EXPANDED COMMUNITY OUTREACH PROGRAMS AND AMBULATORY CENTERS FACILITATE PATIENT ACCESS, WHILE PROMOTING OUR MANY ALLOPATHIC AND OSTEOPATHIC EDUCATIONAL AND TEACHING PROGRAMS. WYCKOFF HEIGHTS MEDICAL CENTER HAS CREATED THE FOLLOWING OBJECTIVES TO HELP US MEET OUR MISSION AND VISION: *PROVIDES THE HIGHEST LEVEL OF CARE FOR ALL PATIENTS, RECOGNIZING THE WORTH AND DIGNITY OF EACH INDIVIDUAL *IMPROVES THE HEALTH STATUS OF THE COMMUNITY BY ACTIVELY PARTICIPATING IN AN ORGANIZED, INNOVATIVE, INTEGRATED HEALTH CARE SYSTEM, USING A FOCUS ON MANAGED CARE *PROMOTES AND SUPPORTS ALL EFFORTS TO PROVIDE A SAFE ENVIRONMENT FOR OUR PATIENT, EMPLOYEES AND VISITORS *WORKS IN PARTNERSHIP WITH PHYSICIANS AND ALL HEALTH CARE PROVIDERS AND EMPLOYEES TO ENCOURAGE PROFESSIONAL GROWTH AND DEVELOPMENT, IN ORDER TO BETTER SERVE THE COMMUNITY AND TO UNDERSTAND AND MEET THE NEEDS OF OUR CULTURALLY DIVERSE POPULATION *IS COMMITTED TO THE ONGOING EMPLOYABILITY OF OUR EMPLOYEES THROUGH THEIR GROWTH AND DEVELOPMENT, DESPITE THE INABILITY TO GUARANTEE INDIVIDUAL JOBS IN A CHANGING HEALTH CARE ENVIRONMENT, BY WORKING TOGETHER RESPONSIBLY AND RESPECTING EACH ROLE HERE. *FOSTERS A SCHOLARLY ATMOSPHERE, SUPPORTING EDUCATIONAL PROGRAMS AND ENDOWMENTS THAT ENHANCE THE COMPETENCY OF ALL INDIVIDUALS WITHIN THE SYSTEM, TO PROMOTE DELIVERY OF HEALTH CARE THAT IS SAFE, EFFECTIVE, PATIENT-CENTERED, TIMELY, EFFICIENT AND EQUITABLE *IS CREATING HEALTH INFORMATION SYSTEMS AND NETWORKS DEDICATED TO MONITORING, STREAMLINING AND IMPROVING THE QUALITY OF CLINICAL AND SERVICE FUNCTIONS, WHILE MAINTAINING PATIENT CONFIDENTIALITY AND YET RESPONDING TO THE HEALTH CARE MARKET GROWTH, OPTIMAL FINANCIAL DEVELOPMENT AND WISE USE OF FINANCIAL ASSETS *PROVIDES MODERN, PROGRESSIVE HEALTH CARE TECHNOLOGIES THAT IMPROVE THE QUALITY OF CARE *PROVIDES OUTREACH TO MEMBERS OF THE COMMUNITY WITH SPECIAL NEEDS, INCLUDING INFANTS, YOUNG CHILDREN AND ADOLESCENTS, PERSONS WITH DISABILITIES, CHRONIC CONDITIONS AND LIFE-THREATENING DISORDERS SUCH AS HIV/AIDS AND SENIOR CITIZENS *PROMOTES AND SUPPORTS PREVENTIVE MEDICINE PROGRAMS THAT REDUCE OCCURRENCE OF DISEASE THROUGH EDUCATION AND PROACTIVE MEASURES *MEASURES SUCCESS BY HOW WELL WE MEET OR EXCEED THE EXPECTATIONS OF OUR COMMUNITY AND PATIENTS *STRIVES TO CREATE A CULTURE OF SERVICE EXCELLENCE IN EVERY ASPECT OF PATIENT CARE. BY PROVIDING OUTSTANDING SERVICE CONSISTENTLY, WE SEEK TO ESTABLISH LIFELONG RELATIONSHIP WITH PATIENTS, EMPHASIZING THAT CARE FOR THE PATIENT ALWAYS COME FIRST WYCKOFF HEIGHTS MEDICAL CENTER'S MISSION AND COMMITMENT TO QUALITY SERVICE ENABLES THE HOSPITAL TO BECOME THE PREMIER HEALTH CARE PROVIDER FOR THE CULTURALLY DIVERSE COMMUNITY WE SERVE. PART VI, LINE 7 NY X X X true false false false false false false false RAMON RODRIGUEZ PRESIDENT/CEO 860265 0 0 0 1645 0 0 0 13032 0 874942 0 0 0 FRANK VUTRANO EVP/CFO 354163 0 30000 0 2455 0 0 0 4093 0 390711 0 0 0 DAVID ROCK EVP/COO 319315 0 0 0 1320 0 0 0 1430 0 322065 0 0 0 GUSTAVO DEL TORO EVP/CMO 369376 0 0 0 590 0 0 0 7549 0 377515 0 0 0 Frances Heaney EVP/COO 1/1/13 - 5/1/13 207610 0 0 0 247384 0 0 0 2063 0 457057 0 0 0 KEVIN SMYLEY VP/LEGAL COUNSEL 264478 0 0 0 1782 0 0 0 11471 0 277731 0 0 0 MARGARET CORNELIUS VP OF HR 221616 0 0 0 315 0 0 0 2154 0 224085 0 0 0 Stephen Carryl Physician 900795 0 0 0 1242 0 0 0 6262 0 908299 0 0 0 GORDON ANDERSON Physician 437427 0 0 0 498 0 0 0 0 0 437925 0 0 0 WILLIAM THELMO Physician 379693 0 0 0 1493 0 0 0 7549 0 388735 0 0 0 SANJIVAN PATEL PHYSICIAN 383652 0 0 0 1215 0 0 0 6262 0 391129 0 0 0 CALIXTO CAZANO PHYSICIAN 352273 0 0 0 552 0 0 0 4093 0 356918 0 0 0 JEBASHINI JERURASA VP/CIO 183105 0 0 0 152 0 0 0 6262 0 189519 0 0 0 MARGARET PELKOWSKI CNO 1/1/13 - 8/27/13 139091 0 0 0 50746 0 0 0 3764 0 193601 0 0 0 ROSETTA MELVIN ACTING CNO 147804 0 0 0 280 0 0 0 3764 0 151848 0 0 0 PART I, LINE 4 - RECEIVED SEVERANCE FRANCES HEANEY RECEIVED SEVERANCE PAYMENTS OF $246,154 IN 2013. MARGARET PELKOWSKI RECEIVED SEVERANCE PAYMENTS OF $50,283 IN 2013. GARY GOFFNER Chairman 140993 Rent expense false FORM 990, PART VI, LINE 11B - FORM 990 REVIEW PROCESS THE FINANCE DIRECTOR AND CFO UNDERTAKE A DETAILED REVIEW OF THE 990. IN ADDITION, BOARD MEMBERS OF THE FINANCE AND AUDIT COMMITTEES UNDERTAKE A REVIEW OF THE ORGANIZATION'S FORM 990 AND THEN REVIEW WITH THE CFO ANY COMMENTARY, OBSERVATIONS, AND RECOMMENDATIONS, AS APPROPRIATE. FORM 990, PART VI, LINE 12C - EXPLANATION OF MONITORING AND ENFORCEMENT BOARD OF TRUSTEES AUDIT AND COMPLIANCE COMMITTEE REVIEWS ALL ANNUAL CONFLICT OF INTEREST QUESTIONNAIRES AND MAKES RECOMMENDATIONS, IF NECESSARY, TO THE FULL BOARD. POSITIVE RESPONSES ARE REVIEWED AND ADDITIONAL INFORMATION IS GATHERED TO DETERMINE IF A CONFLICT EXISTS. IF A CONFLICT EXISTS, APPROPRIATE ACTION IS TAKEN TO ELIMINATE THE CONFLICT, INCLUDING SUCH STEPS AS REASSIGNMENT OF RESPONSIBILITIES OR ESTABLISHMENT OF PROTECTIVE AGREEMENTS. IF A MATTER INVOLVES A BOARD MEMBER OR OFFICER, APPROPRIATE ACTION, INCLUDING RECUSAL AND ADDITIONAL DISCLOSURES, WILL BE DETERMINED BY THE BOARD. FORM 990, PART VI, LINES 15A & 15B -COMPENSATION REVIEW & APPROVAL PROCESS EXECUTIVE COMPENSATION IS REVIEWED BY THE BOARD EXECUTIVE COMPENSATION COMMITTEE WHICH CONSISTS OF ONLY INDEPENDENT BOARD MEMBERS. THE COMMITTEE SOLICITS ASSISTANCE OF OUTSIDE LEGAL COUNSEL AND AN EXECUTIVE COMPENSATION CONSULTING FIRM WHO CONDUCTS STUDIES SHOWING COMPENSATION AT COMPARABLE INSTITUTIONS AND ADVISES THE COMMITTEE ACCORDINGLY. BOARD DECISIONS ARE CONTEMPORANEOUSLY DOCUMENTED IN BOARD MINUTES. FORM 990, PART VI, LINE 19 - OTHER ORGANIZATION DOCUMENTS PUBLICLY AVAIL UPON REQUEST, THE ORGANIZATION WILL MAKE AVAILABLE ONLY THOSE DOCUMENTS REQUIRED TO BE DISCLOSED UNDER THE PUBLIC INSPECTION LAWS. FORM 990, PART XI, LINE 9 - OTHER CHANGES IN NET ASSETS OR FUND BALANCES LOSSES ON UNCOLLECTIBLE GRANTS. . . . . . . . . . . . . $ -38,981 FORM 990 PART IX LINE 11G DESCRIPTION:PHYSICIAN FEES TOTAL FEES:32917545 FORM 990 PART IX LINE 11G DESCRIPTION:CONSULTING FEES TOTAL FEES:1225726 FORM 990 PART IX LINE 11G DESCRIPTION:PROFESSIONAL FEES TOTAL FEES:4854908 FORM 990 PART IX LINE 11G DESCRIPTION:OTHER FEES TOTAL FEES:9924446 FORM 990 PART IX LINE 11G DESCRIPTION:PURCHASES SERVICES TOTAL FEES:485050 BROOKLYN QUEENS HEALTH CARE 374 STOCKHOLM STREET BROOKLYN NY 11237 311650965 SUPPORT WHMC NY 501(c)(3) 11A NA true STOCKHOLM OBSTETRICS & GYNECOLOGICAL SVC 113318298 MEDICAL SVCS NY 501(c)(3) 11A WHMC true WYCKOFF ANESTHESIA MEDICAL SERVICES PC 113519417 ANESTHESIA NY 501(c)(3) 11A WHMC true WYCKOFF FAMILY MEDICAL SERVICES PC 374 STOCKHOLM STREET BROOKLYN NY 11237 113503139 MEDICAL SVCS NY 501(c)(3) 11A WHMC true WYCKOFF HEIGHTS DENTAL SERVICES PC 374 STOCKHOLM STREET BROOKLYN NY 11237 113440088 DENTISTRY NY 501(c)(3) 11A WHMC true WYCKOFF HEIGHTS MEDICAL CENTER FOUNDATIO 374 STOCKHOLM STREET BROOKLYN NY 11237 113626419 SUPPORT WHMC NY 501(c)(3) 11A WHMC true WYCKOFF IMAGING SERVICE PC 374 STOCKHOLM STREET BROOKLYN NY 11237 861061721 MED IMAGING NY 501(c)(3) 11A WHMC true WYCKOFF MEDICAL SERVICES PC 374 STOCKHOLM STREET BROOKLYN NY 11237 113459881 MEDICAL SVCS NY 501(c)(3) 11A WHMC true WYCKOFF NEONATAL SERVICES PC 374 STOCKHOLM STREET BROOKLYN NY 11237 113401138 MEDICAL SVCS NY 501(c)(3) 11A WHMC true WYCKOFF PROFESSIONAL MEDICAL SERVICES PC 374 STOCKHOLM STREET BROOKLYN NY 11237 113437602 ORTHOPEDICS NY 501(c)(3) 11A WHMC true WYCKOFF HEIGHTS HOSPITAL SELF INSURANCE 374 STOCKHOLM STREET BROOKLYN NY 11237 112513146 INACTIVE NY 501(c)(3) 11A WHMC true PREFERRED HEALTH VENTURES INC 374 STOCKHOLM STREET BROOKLYN NY 11237 112974960 INACTIVE NY SEE PART VII C CORP 0 497200 1.00000 true PREFERRED HEALTH VENTURES PHARMACY 374 STOCKHOLM STREET BROOKLYN NY 11237 112974935 INACTIVE NY SEE PART VII C CORP 0 112874 1.00000 true PREFERRED HEALTH VENTURES PLACEMENT INC 374 STOCKHOLM STREET BROOKLYN NY 11237 112973953 INACTIVE NY SEE PART VII C CORP 0 165113 1.00000 true PREFERRED HEALTH PROPERTIES INC 374 STOCKHOLM STREET BROOKLYN NY 11237 112974963 INACTIVE NY SEE PART VII C CORP 0 2900 1.00000 true WYCKOFF EMERGENCY MEDICINE SERVICES PC 374 STOCKHOLM STREET BROOKLYN NY 11237 113495935 MEDICAL SVCS NY SEE PART VII C CORP 6823326 344644 1.00000 true WYCKOFF PRACTICE MANAGEMENT CORP 374 STOCKHOLM STREET BROOKLYN NY 11237 113463990 MANAGEMENT NY SEE PART VII C CORP 348311 19862 1.00000 true WYCKOFF SURGICAL SERVICES PC 374 STOCKHOLM STREET BROOKLYN NY 11237 270837125 SURGICAL SVCS NY SEE PART VII C CORP 0 65362 1.00000 true STEPHEN CARRYL PC 374 STOCKHOLM STREET BROOKLYN NY 11237 MEDICAL SVCS NY SEE PART VII C CORP 173000 173000 1.00000 true false false false false false false false false false false false false false false true true false false STOCKHOLM OBSTETRICS & GYNECOLOGICAL SVC P 2238000 COST WYCKOFF ANESTHESIA MEDICAL SERVICES PC P 2163000 COST WYCKOFF FAMILY MEDICAL SERVICES PC P 255000 COST WYCKOFF HEIGHTS DENTAL SERVICES PC P 186000 COST WYCKOFF IMAGING SERVICE PC P 1725000 COST WYCKOFF NEONATAL SERVICES PC P 10000 COST WYCKOFF EMERGENCY MEDICINE SERVICES PC P 2152000 COST WYCKOFF HEIGHTS MEDICAL CENTER FOUNDATION P 750000 COST WYCKOFF PRACTICE MANAGEMENT CORP P 54000 COST WYCKOFF MEDICAL SERVICES PC Q 210000 COST PART IV, column (d) - Direct Controlling Entity NAME OF RELATED ORGANIZATIONS DIRECT CONTROLLING ENTITY PREFERRED HEALTH VENTURES INC: WYCKOFF HEIGHTS MEDICAL CENTER PREFERRED HEALTH VENTURES PHARMACY: PREFERRED HEALTH VENTURES INC PREFERRED HEALTH VENTURES PLACEMENT: PREFERRED HEALTH VENTURES INC PREFERRED HEALTH VENTURES PROPERTIES: PREFERRED HEALTH VENTURES INC WYCKOFF EMERGENCY MEDICINE SERVICES PC: WYCKOFF HEIGHTS MEDICAL CENTER WYCKOFF PRACTICE MANAGEMENT CORP: WYCKOFF HEIGHTS MEDICAL CENTER WYCKOFF SURGICAL SERVICES PC: WYCKOFF HEIGHTS MEDICAL CENTER STEPHEN CARRYL, P.C.: WYCKOFF HEIGHTS MEDICAL CENTER PART VII - SUPPLEMENTAL INFORMATION Respective PC's employ physicians and departmental chairs who provide professional services to the Wyckoff Heights Medical Center.