2014-11-17T10:02:43-06:00 2013-12-31 454051133 FREED MAXICK CPAS PC 424 MAIN STREET SUITE 800 BUFFALO NY 142023508 990 2013-01-01 150346515 ALICE HYDE MEDICAL CENTER ALIC 5184833000 133 PARK STREET MALONE NY 12953 DOUGLAS DIVELLO PRESIDENT 5184833000 2014-11-06 1 MARY MADONIA P00405803 7168472651 2013 2015-11-30 17:44:51Z DOUGLAS DIVELLO 133 PARK STREET MALONE NY 12953 76251875 0 X WWW.ALICEHYDE.COM X 1905 NY TO SERVE THE COMMUNITY THROUGH ACUTE, LONG TERM AND PRIMARY HEALTHCARE. 13 12 700 53 0 0 2372179 9472295 67247947 64979554 101036 207838 -59353 -102661 69661809 74557026 0 0 0 0 42464846 41415481 0 0 68367 26314357 26293207 68779203 67708688 882606 6848338 39770508 77817559 16620003 47746219 23150505 30071340 ALICE HYDE MEDICAL CENTER WILL DISTINGUISH ITSELF AS A TRUSTED AND RESPECTED HEALTH CARE LEADER AND PROVIDER OF CHOICE, EXCEEDING EXPECTATIONS THROUGH SERVICE EXCELLENCE. 0 0 57030806 64979554 PATIENT CARE, GENERAL MEDICAL/SURGICAL HOSPITAL, PROVIDED INPATIENT SERVICES FOR 2,435 PEOPLE, OUTPATIENT SERVICES FOR 816,891 VISITS, AND PROVIDED 26,869 DAYS OF SKILLED NURSING FACILITY CARE. 57030806 1 1 0 1 0 0 0 0 0 1 1 1 0 0 1 1 1 0 0 0 0 0 0 0 1 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 26 0 700 1 0 0 0 0 0 0 0 0 0 0 X 13 12 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 NY X SEAN CURTIN VP OF FINANCE 5184833000 133 PARK STREET MALONE NY 12953 X ANJNI BHAGAT MD DIRECTOR 10.00 X 41452 0 0 WILLIAM BOND REV DIRECTOR 10.00 X 0 0 0 DANIEL CLARK VICE-CHAIRMAN 10.00 X X 0 0 0 WAYNE DUSO DIRECTOR 10.00 X 0 0 0 JERRY GRIFFIN DIRECTOR 10.00 X 0 0 0 BRYAN J HUGHES DIRECTOR 10.00 X 0 0 0 DEAN JOHNSTON CHAIRMAN 10.00 X X 0 0 0 BENSON KELLY MD DIRECTOR 10.00 X 0 0 0 CRAIG LAVIGNE SECRETARY 10.00 X X 0 0 0 THOMAS LEITZ DIRECTOR 10.00 X 0 0 0 BRIAN MONETTE TREASURER 10.00 X X 0 0 0 SHARON NOREAULT DIRECTOR 10.00 X 0 0 0 PAUL KOEHLER DIRECTOR 10.00 X 0 0 0 DOUG DIVELLO PRESIDENT/CEO 40.00 X 258802 0 3433 LEONARDO DISHMAN MD CHIEF MEDICAL OFFICER 40.00 X 185160 0 5537 SEAN CURTIN VP OF FINANCE - JUNE-DEC 40.00 X 77165 0 0 D CHRIS FRAUENHOFER VP OF FINANCE - JAN-MAY 40.00 X 97138 0 3978 DRAGOS MACELARU MD PHYSICIAN 40.00 X 789585 0 9720 MARCO BERARD MD PHYSICIAN 40.00 X 697503 0 8342 RAHUL GUPTA MD PHYSICIAN 40.00 X 462297 0 7904 NIKALESH REDDY MD PHYSICIAN 40.00 X 398740 0 8190 VARGHESE NOEL MD PHYSICIAN 40.00 X 400812 0 7853 3408654 0 54957 12 0 1 0 PC CONSTRUCTION 193 TILLEY DRIVE SOUTH BURLINGTON VT 05403 CONSTRUCTION SERVICES 2294670 RLPS II 250 VALLEYBROOK DRIVE LANCASTER PA 17601 ARCHITECTURAL SERVICES 1181992 APOGEE 2525 E CAMELBACK ROAD PHOENIX AZ 85016 HOSPITALIST PROFESSIONAL 904454 WEATHERBY LOCUMS 6440 MILLROC DRIVE SALT LAKE CITY UT 84121 LOCUMS SERVICES 605368 MEDICAL SVCS SUFFOLK COUNTY PO BOX 27701 ATLANTA GA 30384 EMERGENCY MEDICINE 586830 1 40979 9285051 146265 9472295 PATIENT CARE 622000 64979554 64979554 64979554 34225 34225 167639 263342 -95703 -95703 -95703 1586992 1413379 173613 173613 173613 11170 40979 18128 -6958 -6958 74557026 64979554 0 105177 770891 41452 729439 32662516 28115879 4509950 36687 976126 839468 136658 4680729 4025427 655302 2325219 1996888 325531 2800 1300291 1041060 259231 263743 263743 129601 129601 33117 33117 74154 63222 10382 550 361170 310606 50564 1436311 1235227 201084 148601 127775 20804 22 336130 289072 47058 2968883 2553239 415644 743626 639518 104108 DIRECT EXPENSES 8792736 7333445 1430983 28308 MEDICAL SUPPLIES & IMPL 3601444 3097242 504202 PHARMACEUTICALS 3297106 2835511 461595 UTILITIES 1362270 1171552 190718 1444024 1314223 129801 67708688 57030806 10609515 68367 1162831 2112878 9210679 8731088 1190757 6674594 617856 628092 566612 2355903 76211287 43259414 23614650 32951873 2366366 2437939 1040757 21925192 39770508 77817559 9504770 16950815 2759082 26899131 4356151 2712715 0 1183558 16620003 47746219 X 22332059 29150582 634500 736812 183946 183946 23150505 30071340 39770508 77817559 6848338 72497 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 33117 33117 0 PART II-B, LINE 1: THE ORGANIZATION RETAINS AN OUTSIDE LOBBYIST FOR CONTACT WITH STATE AND FEDERAL ELECTED OFFICIALS REGARDING HEALTH CARE ISSUES AND GRANT FUNDING OPPORTUNITIES. 183946 183946 183946 183946 183946 183946 183946 183946 183946 183946 1.00000 0 0 364054 364054 34718039 23733919 10984120 27731923 19525495 8206428 13397271 13397271 32951873 RESTRICTED PROJECT FUND - BONDS 21925192 C 21925192 LINE OF CREDIT 1183558 1183558 X 74647649 72495 18128 90623 74557026 0 74557026 67726816 18128 18128 67708688 0 67708688 PART X, LINE 2: THE MEDICAL CENTER IS A NOT-FOR-PROFIT ORGANIZATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE CODE), AND ACCORDINGLY, IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. ACCORDINGLY, NO PROVISION FOR INCOME TAXES HAS BEEN REFLECTED IN THE ACCOMPANYING FINANCIAL STATEMENTS. THE MEDICAL CENTER ACCOUNTS FOR UNCERTAIN TAX POSITIONS IN ACCORDANCE WITH U.S. GAAP, WHICH REQUIRES THE RECOGNITION AND MEASUREMENT OF UNCERTAIN INCOME TAX POSITIONS THAT THE MEDICAL CENTER HAS TAKEN OR EXPECTS TO TAKE IN THE MEDICAL CENTER'S TAX RETURN. THE MEDICAL CENTER HAS NOT RECORDED ANY AMOUNTS RELATING TO UNCERTAIN TAX POSITIONS. IN ADDITION, THE MEDICAL CENTER IS NO LONGER SUBJECT TO FEDERAL AND NYS INCOME TAX EXAMINATION FOR YEARS PRIOR TO 2010. PART XI, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES NETTED AGAINST REVENUE 18,128. PART XII, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES NETTED AGAINST REVENUE 18,128. GOLF BENEFIT 31304 25137 6167 200 6168 5029 GALA 20845 15842 5003 3004 800 2927 52149 40979 11170 200 6168 3004 800 7956 18128 -6958 1 1 1 X 1 X 1 1 1 0 1 1 2132155 1175812 956343 0.01410 14639913 9316585 5323328 0.07860 16772068 10492397 6279671 0.09270 63304 3021 60283 0.00090 63304 3021 60283 0.00090 16835372 10495418 6339954 0.09360 1 2397645 1389975 15410729 14264982 1145747 X 1 1 1 1 ALICE HYDE MEDICAL CENTER 133 PARK STREET MALONE NY 12953 ALICEHYDE.COM 1624000H X X X ALICE HYDE MEDICAL CENTER 1 1 X X X X X X X X X 13 1 0 1 X HTTP://ALICEHYDE.COM X X X X X 1 0 1 1 300.000000000000 0 1 X X X X X 1 1 X X X X X 1 X X 1 X X X X X X 1 X 0 0 ALICE HYDE MEDICAL CENTER PART V, SECTION B, LINE 3: IN CONDUCTING ITS MOST RECENT CHNA, THE HOSPITAL RECEIVED INPUT FROM:JOSY DELANEY - ALICE HYDE COMMUNITY WELLNESSADIRONDACK MEDICAL HOME/PEDIATRIC OBESITY INITIATIVEADIRONDACK RURAL HEALTHCARE NETWORKADIRONDACK TOBACCO FREE NETWORKBREASTFEEDING COUNCIL OF MALONECANCER SERVICES PROGRAMEASTERN ADIRONDACK HEALTH CARE NETWORKMALONE COMPLETE STREETS PARTNERSHIPNORTH COUNTRY HEALTHCARE PROVIDERSNORTH COUNTRY HEALTHY HEART NETWORK ALICE HYDE MEDICAL CENTER PART V, SECTION B, LINE 11: ANY PATIENT WIHOUT INSURANCE IS GIVEN A DISCOUNT EQUAL TO THE LOWEST NEGOCIATED COMMERICAL INSURANCE RATE. 1 ALICE HYDE NURSING HOME 133 PARK STREET MALONE NY 12953 SKILLED NURSING FACILITY PART I, LINE 7: UTILIZED IRS WORKSHEETS FOR SCHEDULE H AND RATIO OF COST TO CHARGES. PART I, LN 7 COL(F): BAD DEBT WAS NOT INCLUDED IN CALCULATIONS IN SCHEDULE H, PART I, LINE 7. PART III, LINE 4: THE MEDICAL CENTER RECOGNIZES PATIENT SERVICE REVENUE ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY PAYOR COVERAGE ON THE BASIS OF CONTRACTUAL RATES FOR THE SERVICES RENDERED. FOR UNINSURED PATIENTS THAT DO NOT QUALITY FOR CHARITY CARE, THE MEDICAL CENTER RECOGNIZES REVENUE ON THE BASIS OF ITS STANDARD RATES FOR SERVICES PROVIDED (OR ON THE BASIS OF DISCOUNTED RATES, IF NEGOTIATED OR PROVIDED BY POLICY). BASED UPON HISTORICAL EXPERIENCE, A SIGNIFICANT PORTION OF THE MEDICAL CENTER'S UNINSURED PATIENTS WILL BE UNABLE OR UNWILLING TO PAY FOR THE SERVICES PROVIDED. THUS, THE MEDICAL CENTER RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS RELATED TO UNINSURED PATIENTS IN THE PERIOD THE SERVICES ARE PROVIDED. PART III, LINE 8: THE MEDICARE BENEFICIARIES WHO ALICE HYDE PROVIDES SERVICES TO ARE PART OF OUR COMMUNITY OF MALONE, NEW YORK, AND THEREFORE, SHOULD BE TREATED AS A COMMUNITY BENEFIT. THE SOURCE FOR THE COST METHODOLOGY IS THE 2013 MEDICARE COST REPORT. PART III, LINE 9B: THE CENTER PROVIDES CARE TO CLIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. THE CENTER'S POLICY IS NOT TO PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE; THEREFORE THESE AMOUNTS ARE NOT REPORTED IN NET OPERATING REVENUES OR IN PROVISIONS FOR DOUBTFUL ACCOUNTS. THE ESTIMATED COST OF PROVIDING UNCOMPENSATED CARE TO PATIENTS WAS APPROXIMATELY $1,086,000 FOR THE YEAR ENDED DECEMBER 31, 2013 ($1,000,000 - 2012), AS MEASURED UTILIZING A CALCULATED RATIO OF COSTS TO CHARGES. PART III, LINE #2 OUR BAD DEBT METHODOLOGY IS BASED ON HISTORICAL AMOUNTS WHICH WERE TYPICALLY 3.3% OF NET REVENUE. PART III, LINE #3 WE USE THE BAD DEBT EXPENSE AND ALLOCATE BASED ON THE ACTUAL WRITE-OFFS. PART VI, LINE 3: THE ALICE HYDE MEDICAL CENTER (AHMC) BELIEVES THAT FEAR OF A MEDICAL BILL SHOULD NOT PRECLUDE A RESIDENT OF ITS COMMUNITY FROM SEEKING OR OBTAINING ESSENTIAL HEALTH CARE SERVICES. TO HELP THOSE WHO ARE UNINSURED, AHMC PARTNERS WITH VARIOUS ORGANIZATIONS, INCLUDING THE FRANKLIN COUNTY DEPARTMENT OF SOCIAL SERVICES, PUBLIC HEALTH, FIDELIS, AND EXCELLUS, TO ENSURE ACCURATE INFORMATION AND RESOURCES ARE AVAILABLE THROUGHOUT THE COMMUNITY, INCLUDING A FACILITATED ENROLLMENT PROGRAM FOR ITS UNINSURED. THIS PROGRAM ASSISTS THE INDIVIDUAL IN APPLYING FOR STATE SPONSORED HEALTH INSURANCE, INCLUDING MEDICAID, CHILD HEALTH PLUS AND FAMILY HEALTH PLUS. THE GOAL OF THIS INITIATIVE IS TO PROVIDE CONVENIENT LOCATION FOR PATIENTS AND COMMUNITY MEMBERS TO ACCESS THE PROGRAM AND TO PROVIDE ASSISTANCE IN COMPLETING HEALTH INSURANCE APPLICATIONS. THESE GOALS ARE MET THROUGH A PATERNERSHIP BETWEEN AHMC AND UPPER HUDSON PRIMARY CARE CONSORTIUM. AHMC HAS AN EMPLOYEE DEDICATED TO FINANCIAL COUNSELING AND ASSISTANCE. PART VI, LINE 4: ALICE HYDE MEDICAL CENTER (AHMC) PRIMARILY SERVES TOWNS, VILLAGES, AND THE NATIVE AMERICAN RESERVATION IN FRANKLIN COUNTY. AHMC'S PRIMARY SERVICE AREA COVERS THE FOLLOWING TOWNS (BY ZIP CODE) - MALONE (12953), NORTH BANGOR (12966), CHATEAUGAY (12920), CONSTABLE (12926), BRUSHTON (12916), MOIRA (12957), BURKE (12917), FORT COVINGTON (12937), HOGANSBURG (13655), SAINT REGIS FALLS (12980), BOMBAY (12914), OWLS HEAD (12969), DICKINSON CENTER (12930). THE SECONDARY SERVICE AREAS SERVED BY AHMC INCLUDE CHURUBUSCO (12923), ELLENBURG CENTER (12934), NORTH LAWERENCE (12967), LYON MOUNTAIN (12955), NICHOLVILLE (12965). IN ADDITION, AHMC PROVIDES SERVICES TO THE INMATE POPULATION FOR THE FRANKLIN COUNTY JAIL AND THE CLINTON, FRANKLIN, UPSTATE, BAREHILL, CHATEAUGAY, ALTONA AND ADIRONDACK CORRECTIONAL FACILITIES. PART VI, LINE 7, REPORTS FILED WITH STATES NY X X X 0 0 0 0 0 0 0 0 0 DOUG DIVELLO PRESIDENT/CEO 253802 0 5000 0 0 0 2181 0 1252 0 262235 0 0 0 LEONARDO DISHMAN MD CHIEF MEDICAL OFFICER 185160 0 0 0 0 0 5537 0 0 0 190697 0 0 0 DRAGOS MACELARU MD PHYSICIAN 539585 0 250000 0 0 0 7650 0 2070 0 799305 0 0 0 MARCO BERARD MD PHYSICIAN 447503 0 250000 0 0 0 7650 0 692 0 705845 0 0 0 RAHUL GUPTA MD PHYSICIAN 462297 0 0 0 0 0 7650 0 254 0 470201 0 0 0 NIKALESH REDDY MD PHYSICIAN 398740 0 0 0 0 0 7650 0 540 0 406930 0 0 0 VARGHESE NOEL MD PHYSICIAN 250812 0 150000 0 0 0 7356 0 497 0 408665 0 0 0 A FRANKLIN COUNTY CIVIC DEVELOPMENT CORP 800627350 35313PAA0 2013-10-31 27375000 CONSTRUCTION OF 135 BED SKILLED NURSING FACILITY. 0 0 0 A 27375000 20380946 1675004 2620242 2698808 2014 0 0 0 1 A 0 0 0 0 0 0 0 0 0 FORM 990, PART VI, SECTION A, LINE 2 BOARD MEMBERS WAYNE DUSO AND BRIAN MONETTE HAVE A FAMILY RELATIONSHIP. BOARD MEMBERS CRAIG LAVIGNE AND BRIAN MONETTE HAVE A BUSINESS RELATIONSHIP. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS PREPARED BY AN INDEPENDENT OUTSIDE ACCOUNTING FIRM. IT IS PROVIDED TO THE FULL BOARD OF DIRECTORS FOR REVIEW PRIOR TO SUBMISSION. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY IS MONITORED AND ENFORCED BY THE BOARD OF DIRECTORS. SPECIFICALLY, THE POLICY REQUIRES A DISCLOSURE OF ANY POTENTIAL CONFLICT TO THE BOARD OF DIRECTORS. THE BOARD OF DIRECTORS THEN REFERS THE POTENTIAL CONFLICT TO THE AUDIT AND COMPLIANCE COMMITTEE TO REVIEW THE MATTER. THE AUDIT AND COMPLIANCE COMMITTEE REVIEWS THE PROPOSED TRANSACTION OR ARRANGEMENT TO DETERMINE IF REASONABLE ATLTERNATIVES TO THE PROPOSED TRANSACTION EXIST. BASED ON REVIEW, THE AUDIT AND COMPLIANCE COMMITTEE SHALL APPROVE OR DISAPPROVE THE TRANSACTION. ALL FINDINGS AND ACTIONS TAKEN BY THE AUDIT AND COMPLIANCE COMMITTEE ARE REPORTED TO THE BOARD AT THE NEXT REGULARLY SCHEDULED MEETING OF THE BOARD OF DIRECTORS. IN ADDITION, THE AUDIT AND COMPLIANCE COMMITTEE AND THE ORGANIZATION COMPLIANCE OFFICER IS RESPONSIBLE FOR REVIEWING AND RETAINING ANNUAL DISCLOSURE STATEMENTS COMPLETED BY EACH DIRECTOR, OFFICER, COMMITTEE MEMBER AND KEY EMPLOYEE. FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION AND BENEFITS OF THE PRESIDENT/CEO ARE REVIEWED ANNUALLY. THE BOARD OF DIRECTORS REVIEWS IN DEPTH THE RECOMMENDATIONS OF THE PRESIDENT/CEO EVALUATION AND COMPENSATION COMMITTEE ("COMPENSATION COMMITTEE") REGARDING THE PRESIDENT/CEO'S COMPENSATION AND BENEFITS. THE PRESIDENT/CEO IS NOT PRESENT AT THIS MEETING OR ANY OTHER MEETING AT WHICH HIS COMPENSATION IS CONSIDERED. AS PART OF ITS REVIEW AND DISCUSSION, THE FULL BOARD OF DIRECTORS DISCUSSES THE DATA PREVIOUSLY REVIEWED BY THE COMPENSATION COMMITTEE. THIS DATA INCLUDES, BUT IS NOT LIMITED TO, COMPARABILITY DATA COMPILED BY YAFFEE AND COMPANY, INC. AS PROVIDED TO AHMC BY THE IROQUOIS HOSPITAL ASSOCIATION. SPECIFICALLY, THE COMPENSATION COMMITTEE REVIEWS THE DATA AND REPORTS THE RESULTS OF THIS REVIEW TO THE BOARD OF DIRECTORS, CONCERNING BASE SALARY AND TOTAL COMPENSATION FOR ALL THE OFFICERS AT FACILITIES LOCATED WITHIN THE RANGE FOR SIMILARY SITUATED OFFICERS. THE COMPENSATION COMMITTEE ALSO REVIEWS DATA COMPILED BY THE IROQUOIS HEALTHCARE ASSOCIATION, ROCHESTER REGIONAL HOSPITAL ASSOCIATION, AND WESTERN NEW YORK HOSPITAL ASSOCIATION RELATED TO COMPARABLE CEO INCENTIVE PLANS, LIFE INSURANCE (BASIC AND SUPPLEMENTAL), LONG TERM DISABILITY PLANS, SUPPLEMENTAL/EXECUTIVE RETIREMENT PLANS, CONTRACT LENGTH INFORMATION, SEVERANCE PAY INFORMATION AND PREREQUISITES SUMMARY. IT IS THEN DETERMINED WHETHER THE PRESIDENT/CEO'S PROPOSED CONTRACT IS REASONABLE AND COMPARABLE IN LIGHT OF THE AFOREMENTIONED INFORMATION. THE PROCESS FOR DETERMINING THE COMPENSATION FOR KEY EMPLOYEES OF THE ORGANIZATION INCLUDES A REVIEW OF EXECUTIVE COMPENSATION SURVEYS. THIS REVIEW IS COMPLETED BY THE HUMAN RESOURCES DIRECTOR AND THE PRESIDENT/CEO. COMPENSATION IS DETERMINED BASED ON THE SPECIFIC RESPONSIBILIES DELEGATED TO THE POSITION HELD BY THE KEY EMPLOYEE. FORM 990, PART VI, SECTION C, LINE 18 THE COMPLETED FORMS 1023, 990, AND 5500 FOR THE MEDICAL CENTER ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, THE CONFLICT OF INTEREST POLICY, AND THE FINANCIAL STATEMENTS FOR THE MEDICAL CENTER ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VII, SECTION A ANJNI BHAGAT, MD AND BENSON KELLY, MD WERE BOTH COMPENSATED AS PHYSICIANS OF THE MEDICAL CENTER. NEITHER RECEIVED ANY COMPENSATION FOR THEIR ROLE AS BOARD MEMBERS. FORM 990, PART XI, LINE 2C THERE HAVE BEEN NO CHANGES FROM THE PRIOR YEAR TO THE PROCESS THAT THE ORGANIZATION HAS IN PLACE FOR THE OVERSIGHT OF THE AUDIT OR THE SELECTION OF AN INDEPENDENT ACCOUNTANT.