2014-11-10T16:47:59-06:00 2013-12-31 990 2013-01-01 141338467 NORTHERN DUTCHESS HOSPITAL % KATHERINE BACHER INTERIM CF NORT 8458763001 PO BOX 5112 Suite RHINEBECK NY 12572 KATHERINE BACHER INTERIM CFO/SVP 8454759500 2014-11-10 2013 2015-11-30 17:44:51Z DENISE GEORGE PRESIDENT PO BOX 5112 RHINEBECK NY 12572 82665060 false X WWW.HEALTH-QUEST.ORG X 1924 NY TO PROVIDE COMPREHENSIVE PRIMARY HEALTH CARE SERVICES 15 12 629 142 83105 -66631 210414 773164 71839103 79387151 107579 153961 2074703 2350784 74231799 82665060 0 11330 0 0 29855238 30280128 0 0 0 37822965 41736350 67678203 72027808 6553596 10637252 69633672 76390268 28568209 27631880 41065463 48758388 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 31759809 45503805 INPATIENT SERVICES: PATIENTS ADMITTED FOR ACUTE CARE - NUMBER OF PATIENTS 4,487; NUMBER OF PATIENT DAYS 17,606 THE HOSPITAL PROVIDED APPROXIMATELY $459,070 IN UNCOMPENSATED CARE (AT COST) TO THE REGIONS UN-INSURED AND UNDER-INSURED POPULATION 23649201 11330 33883346 OUTPATIENT SERVICES: EMERGENCY VISITS 13,708; AMBULATORY SURGERY VISITS 2,743 ALL OTHER VISTIS/PROCEDURES 84,602 THE HOSPITAL PROVIDED APPROXIMATELY $833,671 IN UNCOMPENSATED CARE (AT COST) TO THE REGIONS UN-INSURED AND UNDER-INSURED POPULATION 55409010 true true false true false false false false true true false false true true false true true false false false false false false false false true true true false true true false false false false false false false false false true false false false false false true false false false true 1 0 629 true true true false false false false false false false false false false false false X 15 12 false false true false true true true true true false true true true true true true true true true true false NY X KATHERINE BACHER INTERIM CF 8454759500 1351 ROUTE 55 SUITE 200 LAGRANGEVILLE NY 12540 JAMES BRUDVIG TRUSTEE 1.0 X 0 0 0 SUE CRANE LIFE TRUSTEE 1.0 X 0 0 0 LEWIS RUGE LIFE TRUSTEE AND SECRETARY 1.0 X 0 0 0 GEORGE VERRILLI MD LIFE TRUSTEE 1.0 X 0 0 0 M NADER KAYAL JR MD LIFE TRUSTEE 1.0 X 0 0 0 EVAN MELTZER CHAIRMAN 2.0 X 0 0 0 WILLIAM CARROLL TRUSTEE 1.0 X 0 0 0 SUSAN KOCHANOWSKI PHD SECOND VICE CHAIRMAN 2.0 X 0 0 0 JOHN HORISZNY MD TRUSTEE 1.0 X 0 0 0 KEVIN M SHEEHAN FIRST VICE CHAIRMAN 2.0 X 0 0 0 RUSSELL TIGGES MD MEDICAL STAFF PRESIDENT 1.0 X 0 0 0 TIM CLEARY INTERIM PRESIDENT/COO 1.0 55.0 X X 0 266791 40419 FRANCIS FLYNN TRUSTEE 1.0 X 0 0 0 EDWARD PRUITT TRUSTEE 1.0 X 0 0 0 JOHN L MCGUINNESS CEO 0.0 20.0 X X 0 71179 0 DENISE GEORGE PRESIDENT 0.0 68.0 X 0 692991 45583 MARYANN KEPPLE TREASURER 0.0 65.0 X 0 569163 23061 JOHN SABIA MD CMO 0.0 55.0 X 0 257662 40240 CONNIE REGAN PHARMACY CLINICAL COORDINATOR 40.0 X 171601 0 13236 BOGUMILA LANG PHARMACIST 40.0 X 131936 0 0 TIMOTHY GOVEL PHARMACIST 40.0 X 133994 0 2283 PAUL KING DIRECTOR OF DIAGNOSTIC SVCS 45.0 X 138256 0 10175 LAWRENCE O'CONNELL ASST. NURSE MANAGER 45.0 X 123814 0 21009 MICHAEL T WEBER FORMER CEO 0.0 40.0 X 0 1652081 42700 699601 3509867 238706 5 true true false 0 411388 361776 773164 NET INPATIENT REVENUE 900099 45503805 45503805 NET OUTPATIENT REVENUE 900099 33883346 33883346 79387151 102206 102206 0 0 341499 341499 0 341499 341499 51755 51755 0 0 0 AFFILIATE REVENUE 900099 117006 117006 MEANINGFUL USE REVENUE 900099 1098902 1098902 CAFETERIA REVENUE 900099 336397 336397 456980 373875 83105 2009285 82665060 81313331 83105 495460 11330 11330 0 0 0 0 0 23137327 21039729 2097598 1124141 1004356 119785 4231370 3780488 450882 1787290 1596842 190448 0 7456 7456 0 1040 1040 0 0 426 426 0 1941233 1021457 919776 63788 55979 7809 0 1381370 1139960 241410 55430 41702 13728 0 3177 3177 616727 508947 107780 0 3837566 3166909 670657 930242 767672 162570 MEDICAL SUPPLIES 11338043 11338043 PURCHASED SERVICES 14740215 3706005 11034210 PHYSICIAN FEES 2344062 2344062 BAD DEBT 2585545 2585545 1890030 1296381 593649 72027808 55409010 16618798 0 4661604 13922211 0 0 0 0 7353967 8222576 0 0 0 0 36336 0 1151031 1373643 667733 647785 89653694 55971646 33130525 33682048 3764129 4529297 0 0 0 0 0 0 18868347 14012708 69633672 76390268 6400749 6213688 0 0 0 0 12432324 11600842 0 0 0 0 437126 148656 0 0 9298010 9668694 28568209 27631880 X 37166689 45074896 2403370 2188088 1495404 1495404 41065463 48758388 69633672 76390268 X 10637252 570199 -3514526 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 1040 1040 false SCHEDULE C, PART II-B, LINE 1I - LOBBYING ACTIVITIES 15.5% OF NORMET ASSOCIATION DUES WERE ALLOCATED TO POLITICAL ACTIVITIES, RELATED TO LOBBYING. 1495404 1495404 1495404 1495404 1495404 1495404 1495400 1495400 1495000 1495000 1.00000 false false 109930 109930 45517717 22407683 23110034 42288848 32532227 9756621 1737200 1031737 705463 33682048 DUE FROM AFFILIATES 3234005 DEFERRED COMPENSATION ASSET 170220 DEFERRED FINANCING 385850 2007 SERIES B BONDS PREMIUM 717103 2007 DSRF SERIES B BONDS 1632022 MISC RECEIVABLES 16854 ESTIMATED THIRD PARTY ADJMNTS 481783 INTEREST IN NDH FOUNDATION LT 1846566 DUE FROM AFFILIATE LT 5528305 14012708 0 DEFERRED COMP LIABILITY 170219 FIN 47 LIABILITY 256299 RETRO PAYABLE TO 3RD PARTY PAY 2768304 DUE TO AFFILIATES 626788 DUE TO HQ L/T 318779 MED MALPRACTICE INSURANCE LIAB 5528305 9668694 79936006 570199 -3299253 -2729054 82665060 82665060 72027808 72027808 72027808 SCHEDULE D PART XI LINE 2D - TRANSFER OF EQUITY TRANSFER OF EQUITY - ($3,299,253) 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 true true 1914657 869528 1045129 0.01450 6992156 5394277 1597879 0.02220 8906813 6263805 2643008 0.03670 1 104 1271 1271 1 11330 11330 2 104 12601 12601 2 104 8919414 6263805 2655609 0.03670 true 1758077 879038 26143239 30553604 -4410365 X true true 2 1 NORTHERN DUTCHESS HOSPITAL 6511 SPRINGBROOK AVENUE RHINEBECK NY 12572 WWW.HEALTH-QUEST.ORG X A 2 HYDE PARK SATELLITE HEALTH CENTER 11 CRUM ELBOW ROAD HYDE PARK NY 12538 WWW.HEALTH-QUEST.ORG X A NORTHERN DUTCHESS HOSPITAL 1 true X X X X X 13 true true true X WWW.HEALTH-QUEST.ORG X X X X X X X X X X false false true true 200. true 300. true X X X X X X X true true X X X X X true X X X true X X X X X X X true X false false PART V SECTION B LINE 3 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 former Saint Francis Hospital (now Mid-Hudson Regional Medical Center). PART V SECTION B LINE 4 The NDH CHNA was conducted in conjunction with Vassar Brothers Medical Center and the former Saint Francis Hospital (now Mid-Hudson Regional Medical Center). PART V SECTION B LINE 5D 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 7 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 diabetes program and a robust program of support groups and lectures designed to improve management of chronic disease. Substance abuse was not a priority at this time because the former Saint Francis Hospital (now Mid-Hudson Regional Medical Center) has licensed substance abuse beds. PART V SECTION B LINE 20D IN 2013, THE SELF-PAY RATE WAS EQUIVALENT TO THE HOSPITAL'S HIGHTEST VOLUME COMMERCIAL PAYOR'S REIMBURSEMENT FOR THE SERVICE IN QUESTION. PART I, LINE 3C N/A PART I, LINE 6A NORTHERN DUTCHESS HOSPITAL PREPARES A COUNTY WIDE COMMUNITY SERVICE REPORT. PART I, LINE 7 COLUMN F TOTAL BAD DEBT EXPENSE - $2,585,545 PART I, LINE 7 COST TO RATIO PERCENTAGE WAS USED AS THE COSTING METHODOLOGY. WORKSHEET #2 WAS USED TO DERIVE THE PERCENTAGE. PART III, LINE 2,3 AND 4 LINE 2 - BAD DEBT EXPENSE WAS GROSSED UP TO GROSS CHARGES AND THEN THE COST TO CHARGE RATIO PERCENTAGE DERIVED FROM WORKSHEET #2 WAS USED TO CALCULATE THE VALUE AT COST. SELF PAY ACCOUNTS, ONCE DETERMINED A LACK OF INSUFFICIENCY OF INSURANCE AND ONCE THE PATIENT HAS RECEIVED GOVERNMENT PAYOR DENIAL, THE ACCOUNTS ARE ADJUSTED DOWN TO THE HIGHEST VOLUME COMMERCIAL PAYOR RATE. AFTER THE ACCOUNT IS DEEMED UNCOLLECTIBLE, THE ACCOUNT IS WRITTEN OFF TO BAD DEBT EXPENSE AT ADJUSTED CHARGES LESS ANY PAYMENTS MADE ON THE ACCOUNT. LINE 3 - 50% OF THESE PATIENTS WOULD MOST LIKELY QUALIFY FOR CHARITY CARE IF THEY WERE COOPERATIVE IN FILING THE PAPERWORK, ASSOCIATED WITH GOVERNMENT ASSISTANCE. LINE 4 - FOOTNOTE ON AUDITED FINANCIALS - FEDERAL AND STATE LAW REQUIRES THE HOSPITALS TO 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 HOSPITAL 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 STATEMENT OF OPERATIONS. PART III, LINE 8 THE MEDICARE SHORTFALL SHOULD BE INCLUDED IN OUR COMMUNITY BENEFIT PERCENTAGE BECAUSE WE ARE INCURRING THE FULL COST OF CARE FOR THE PATIENTS IN OUR COMMUNITY AND OUR REIMBURSEMENT FROM GOVERNMENT PROGRAMS, INCLUDING MEDICARE, DOES NOT COVER THE HOSPITALS COST TO PROVIDE HIGH QUALITY PATIENT CARE. THE COSTING METHODOLOGY TO CALCULATE THE SHORTFALL IS COST TO CHARGE RATIO AND WORKSHEET #2 WAS USED. COST TO CHARGE RATIO - USED WORKSHEET #2 PART III, LINE 9B HEALTH QUEST MAY CHOOSE TO SEND ANY DELIQUENT ACCOUNT TO A COLLECTION AGENCY, HOWEVER, BEFORE REFERRING A DELIQUENT ACCOUNT TO A COLLECTION AGENCY, HEALTH QUEST WILL REVIEW THE ACCOUNT TO DETERMINE WHETHER THE PATIENT HAS APPLIED FOR A DISCOUNT UNDER THE CHARITY CARE POLICY AND THE STATUS OF THE APPLICATION. IF THE PATIENT HAS APPLIED FOR A DISCOUNT, THE ACCOUNT MAY NOT BE REFERRED TO A COLLECTION AGENCY UNTIL A FINAL DETERMINATION OF SUCH APPLICATION IS MADE AND IF ANY APPEAL OF SUCH DETERMINATION IS PROVIDED FOR IN THE CHARITY CARE POLICY, A FINAL DETERMINATION HAS BEEN MADE WITH RESPECT TO SUCH APPEAL. PATIENTS MAY STILL APPLY FOR A DISCOUNT UNDER THE CHARITY CARE POLICY EVEN AFTER THE ACCOUNT HAS 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 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: o An annual countywide data document capturing available economic, educational and health data that impact children, youth, families and adults o 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 State's 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 NDH's 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. NDH's 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 Indicator Source 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 Indicator Source 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 Activity Target Date Partners 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 Activity Target Date Partners 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 VBMC's 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 Indicator Source 90% of people attending educational events will demonstrate increased knowledge of subject matter Pre and post testing Action Plan Objective 1 Activity Target Date Partners Collaborate with DCDOH staff to create or adopt informational pamphlet for patients 12/31/2014 DCDOH, Tick Task Force Develop protocol to disseminate information to all ED patients during tick season 12/31/2013 DCDOH, Tick Task Force Conduct at least one patient education event in year one 12/31/2014 DCDOH, Tick Task Force Conduct at least one patient education event in year two 12/31/2015 DCDOH, Tick Task Force Conduct at least one patient education event in year three 12/31/2016 DCDOH, Tick Task Force Prepare a display for the ED in year one 12/31/2014 DCDOH, Tick Task PART VI LINE 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE We have a Health Quest wide financial assistance policies and procedures that are 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 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 Health Quest is a nonprofit organization that effectively serves as a leader in the promotion of community health. 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 providing for the healthcare needs of our entire region. Health Quest hospitals meet on a regular basis with community agencies and stakeholders. Each hospital has a Community Health Needs Committee with representation from throughout the organization and the community. Each committee oversees the development of community health needs assessments and community health improvement plans. Health Quest employees serve as leaders in the promotion of community health. Many regularly venture into the community to provide educational lectures and health screenings that encourage preventative medicine. Health Quest actively sponsors a number of health-related fundraisers for other nonprofit organizations, including regional chapters of the Heart Association, American Cancer Society and Alzheimer's Association, throughout each year. Employees are also active members of the community and serve as volunteers and community board members, and do outreach for public benefit on behalf of Health Quest. PART VI LINE 6 AFFILIATE HEALTH CARE SYSTEM HEALTH QUEST SYSTEMS, INC (DBA HEALTH QUEST) IS THE ACTIVE PARENT COMPANY TO ALL AFFILIATED HOSPITALS. HEALTH QUEST ACTS ON BEHALF OF THE HOSPITALS IN SOME COMMUNITY ASSESSMENT ACTIVITIES. HEALTH QUEST HAS TRANSITIONED TO A MODEL IN WHICH IT WILL SUPERVISE BOARD COMMITTEES AT EACH HOSPITAL AS THEY ASSESS COMMUNITY NEEDS, PLAN APPROPRIATE PROGRAMS AND MONITOR THEM FOR EFFECTIVENESS. PART VI LINE 7 STATE FILING OF COMMUNITY BENEFIT REPORT NORTHERN DUTCHESS HOSPITAL FILES A COUNTY-WIDE COMMUNITY SERVICE PLAN WITH NYS DEPARTMENT OF HEALTH true AMERICAN HEART ASSOCIATION 229 MANCHESTER ROAD POUGHKEEPSIE NY 12603 5500 RESEARCH AND DEVELOPMENT OF CARDIAC PROGRAMS 1 PART 1 LINE 2 Sponsorship Policy: 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.) X X X X X true false false false false false false false false DENISE GEORGE PRESIDENT 0 541478 0 98712 0 52801 0 15300 0 30283 0 738574 0 15000 JOHN SABIA MD CMO 0 228239 0 28998 0 425 0 15300 0 24940 0 297902 0 15000 CONNIE REGAN PHARMACY CLINICAL COORDINATOR 169939 0 0 0 1662 0 11046 0 2190 0 184837 0 10430 0 MICHAEL T WEBER FORMER CEO 0 147819 0 312531 0 1191731 0 15300 0 27400 0 1694781 0 15000 MARYANN KEPPLE TREASURER 0 425345 0 97020 0 46798 0 15300 0 7761 0 592224 0 15000 TIM CLEARY INTERIM PRESIDENT/COO 0 222600 0 35604 0 8587 0 15300 0 25119 0 307210 0 0 SCHEDULE J, PART I 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 - $734,392, PAID IN 2013 A DORMITORY AUTHORITY - STATE OF NEW YORK 146000293 649903UK5 2007-09-06 15718408 PURCHASE OF EQUIPMENT false false false A 1992757 0 16419561 1126245 319526 0 216413 247657 0 13176836 0 1332883 2008 false false false true A false false false false 0 A false false false true false false 0 false 0 true true A false PART I, LINE A, COLUMN E TOTAL ISSUE PRICE PER IRS FORM 8038 - $61,974,071.30 ALLOCATED BETWEEN THREE ORGANIZATIONS PART II, LINE 3 THE TOTAL PROCEEDS DO NOT AGREE TO THE ISSUE PRICE IN PART I, COLUMN E DUE TO INVESTMENT EARNINGS. PART IV, LINE 2C (A) ISSUER NAME: DORMITORY AUTHORITY - STATE OF NEW YORK DATE THE REBATE COMPUTATION WAS PERFORMED: 12/31/2011 KEVIN SHEEHAN EMPLOYEE & SHAREHOLDER CH 2437845 UTILITIES TO HQ AND AFFILIATES 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 Hudson Valley Home Care, Inc (Certified) 14-1788412 Home Health NY 501c3 Box 9 HQ Hudson Valley 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 4, 6, 7A AND 7B - GOVERNING LINE 4 - BY-LAWS FOR NDH WERE RE-WRITTEN AND APPROVED BY THE BOARD ON 11/20/2013. THE BY LAWS CONTINUE TO SUPPORT THE TAX EXEMPT STATUS OF NDH. KEY COMPONENTS ARE DETAILED BELOW. LINE 6 - THE SOLE MEMBER OF NDH IS HEALTH QUEST SYSTEMS, INC. LINE 7A - 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. PART VI SECTION B LINE 11A, 12C, 15A AND 15B - POLICIES LINE 11A - A COPY OF THE FORM 990 WAS EMAILED TO ALL MEMBERS OF THE BOARD. THE CHAIR OF THE HQ EXECUTIVE COMPENSATION COMMITTEE REVIEWED ALL SECTIONS RELATED TO EXECUTIVE COMPENSATION. A 3RD PARTY WAS HIRED TO PREPARE SCHEDULE K. PRICEWATERHOUSE COOPERS WAS CONSULTED IN THE PREPARATION OF SCHEDULE H. 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 RECOMMENDATIONS 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. Pharmacy c. Cardiac d. Oncology 3. Revenue Cycle including health information management, budgets and reimbursement, revenue cycle, 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 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 cycle 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 joint Health Quest advertisements and reduction of expenses associated with larger campaigns 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, insurance 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 admissions to 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 - ($3,299,253); INTEREST IN FOUNDATION - $160,678; NET ASSETS FROM RESTRICTIONS USED FOR OPERATIONS - ($375,961); PERM RESTRICTED MISC $10 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 2012, AND DID NOT QUALIFY FOR AN A-133 AUDIT. 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 true false false false HEALTH QUEST SYSTEMS INC P 11334991 SEE SCHEDULE O HEALTH QUEST LABORATORY SUPPORT SERVICES LLC P 2661364 SEE SCHEDULE O HEALTH QUEST MEDICAL PRACTICE PC A 186236 RENT AT COST