SOUTHAMPTON HOSPITAL ASSOCIATION: Form 990, tax year 2013
View the entire original 990 at ProPublica ↗
- Organization
- SOUTHAMPTON HOSPITAL ASSOCIATION (EIN 11-1667765)
- Tax period
- 2013-01-01 to 2013-12-31
- Filed
- 2014-11-17
- IRS object ID
- 201443219349309089
- Schema version
- 2013v3.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2014-11-17T15:24:42-06:00 | ReturnTs |
| Tax Period End | 2013-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BDO USA LLP | BusinessNameLine1 |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 PARK AVENUE | AddressLine1 |
| City | NEW YORK | City |
| State | NY | State |
| ZIP Code | 10017 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2013-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 111667765 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SOUTHAMPTON HOSPITAL ASSOCIATION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of | % CHRISTOPHER SCHULTHEIS | InCareOfNm |
| Business Name Control | SOUT | BusinessNameControlTxt |
| Phone | 6317268301 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 240 MEETING HOUSE LANE | AddressLine1 |
| Address Line2 | Suite | AddressLine2 |
| City | SOUTHAMPTON | City |
| State | NY | State |
| ZIP Code | 11968 | ZIPCode |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | ROBERT S CHALONER | PersonNm |
| Person Title | PRESIDENT/CEO | PersonTitleTxt |
| Phone | 6317268301 | PhoneNum |
| Signature | 2014-11-17 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Paul Hammerschmidt | PreparerPersonNm |
| PTIN | P01384178 | PTIN |
| Phone | 6317268301 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2013 | TaxYr |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | ROBERT S CHALONER | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 240 MEETING HOUSE LANE | AddressLine1 |
| City | SOUTHAMPTON | City |
| State | NY | State |
| ZIP Code | 11968 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $142,460,725 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.southamptonhospital.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1909 | FormationYr |
| Legal Domicile State | NY | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE AND ENSURE THE HIGHEST QUALITY OF HEALTHCARE SERVICES FOR ITS ENTIRE COMMUNITY. | ActivityOrMissionDesc |
| Voting Members Governing Body | 25 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 24 | VotingMembersIndependentCnt |
| Total Employee | 1168 | TotalEmployeeCnt |
| Total Volunteers | 26 | TotalVolunteersCnt |
| Total Gross UBI | $2,365,572 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | -$62,307 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $8,661,471 | PYContributionsGrantsAmt |
| CY Contributions Grants | $14,246,386 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $111,096,334 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $118,993,172 | CYProgramServiceRevenueAmt |
| PY Investment Income | $540,384 | PYInvestmentIncomeAmt |
| CY Investment Income | $4,569,836 | CYInvestmentIncomeAmt |
| PY Other Revenue | $686,898 | PYOtherRevenueAmt |
| CY Other Revenue | $983,671 | CYOtherRevenueAmt |
| PY Total Revenue | $120,985,087 | PYTotalRevenueAmt |
| CY Total Revenue | $138,793,065 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $75,775,431 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $81,639,605 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $42,354,547 | PYOtherExpensesAmt |
| CY Other Expenses | $46,682,031 | CYOtherExpensesAmt |
| PY Total Expenses | $118,129,978 | PYTotalExpensesAmt |
| CY Total Expenses | $128,321,636 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $2,855,109 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $10,471,429 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $97,667,974 | TotalAssetsBOYAmt |
| Total Assets EOY | $106,330,964 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $89,364,891 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $83,493,537 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $8,303,083 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $22,837,427 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | THE VISION OF SOUTHAMPTON HOSPITAL ASSOCIATION IS TO MEET THE EVOLVING HEALTHCARE NEEDS OF ITS EASTERN LONG ISLAND COMMUNITY BY PROVIDING ACCESS TO A CONTINUUM OF HIGH QUALITY CLINICAL SERVICES. TO ACHIEVE THIS, THE HOSPITAL WILL FOCUS RESOURCES ON CONTINUOUSLY IMPROVING CLINICAL OUTCOMES, PATIENT SAFETY, SERVICE EXCELLENCE AND PROMOTING EDUCATIONAL OUTREACH AND PROFESSIONAL DEVELOPMENT OF ITS STAFF. THE ORGANIZATION IS A MEMBER OF THE EAST END HEALTH ALLIANCE, THE ARTICLE 28 PARENT OF EASTERN LONG ISLAND HOSPITAL, PECONIC BAY MEDICAL CENTER AND SOUTHAMPTON HOSPITAL. CONSISTENT WITH THE MISSION OF THE ORGANIZATION, THE GOALS OF THE ALLIANCE ARE AS FOLLOWS: 1) TO COLLABORATIVELY DEVELOP HIGH QUALITY, COMPREHENSIVE AND ACCESSIBLE HEALTH CARE SERVICES TO MEET THE NEEDS OF THE COMMUNITY SERVED; 2) TO RATIONALIZE HEALTH CARE SERVICES ACROSS THE SYSTEM; AND 3) TO REALIZE MANAGEMENT EFFICIENCIES. THE ORGANIZATION IS ALSO AFFILIATED WITH STONY BROOK MEDICINE, ALONG WITH THE OTHER TWO EAST END | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $108,802,332 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $118,993,172 | RevenueAmt |
| Desc | SOUTHAMPTON HOSPITAL ASSOCIATION OFFERS A FULL CONTINUUM OF AMBULATORY AND INPATIENT SERVICES RANGING FROM PRIMARY MEDICAL CARE TO SPECIALIZED SURGICAL PROCEDURES, AND IS STAFFED BY MORE THAN 230 PHYSICIANS, DENTISTS AND ALLIED HEALTH PROFESSIONALS REPRESENTING 44 MEDICAL SPECIALTIES. THE ORGANIZATION HAS DEVELOPED NUMEROUS SERVICES AND OUTREACH, DETAILED BELOW, TO RESPOND TO THE NEEDS OF ITS PATIENTS, INCLUDING RECRUITING ADDITIONAL PRIMARY CARE AND SPECIALTY PHYSICIANS, RNS, NPS, AND PAS. THE GRADUATE MEDICAL EDUCATION PROGRAM THAT HAS BEEN IN PLACE FOR SEVERAL YEARS IS TRAINING PHYSICIANS FOR PRIMARY AND FAMILY PRACTICE, AS WELL AS SURGERY, AND A GRATIFYING NUMBER OF THESE DOCTORS ARE STAYING WITHIN THE HOSPITAL'S SERVICE AREA. IT IS ANTICIPATED THAT THE AFFORDABLE CARE ACT AND THE INSURANCE EXCHANGES WILL RESULT IN MANY MORE PEOPLE ACCESSING PRIMARY CARE AND THE HOSPITAL CONTINUES TO PREPARE FOR THIS INEVITABILITY THROUGH ITS MEDICAL EDUCATION PROGRAM. SINCE THE ORGANIZATION'S SERVICE AREA EXTENDS FROM WESTHAMPTON BEACH TO MONTAUK, THE HOSPITAL HAS A NUMBER OF SATELLITE OFFICES TO PROVIDE CONVENIENT, SPECIALIZED CARE TO THESE COMMUNITIES. THESE INCLUDE: A) MEETING HOUSE LANE MEDICAL PRACTICE - PROVIDING PRIMARY AND SPECIALTY CARE AT THE FOLLOWING LOCATIONS INCLUDING AMAGANSETT, EAST HAMPTON (TWO OFFICES), HAMPTON BAYS (TWO OFFICES), MONTAUK, SAG HARBOR, SOUTHAMPTON (FOUR OFFICES), WAINSCOTT, AND WATER MILL. B) WESTHAMPTON PRIMARY CARE CENTER - PROVIDING CARE FOR THE WESTHAMPTON, WESTHAMPTON BEACH, QUOGUE, AND REMSENBURG COMMUNITIES. C) LABORATORY AND IMAGING SERVICES - PROVIDING SERVICES IN EAST HAMPTON, HAMPTON BAYS AND SOUTHAMPTON. D) REGIONAL DIALYSIS CENTER - SERVICE TO DIALYSIS PATIENTS IS PROVIDED BY A DEDICATED INTERDISCIPLINARY TEAM OF BOARD-CERTIFIED NEPHROLOGISTS, CERTIFIED DIALYSIS RNS, LPNS AND DIALYSIS TECHNICIANS, CERTIFIED SOCIAL WORKERS, AND A NYS REGISTERED DIETITIAN. 24-HOUR EMERGENCY SERVICE IS ALSO AVAILABLE. E) CENTER FOR PHYSICAL THERAPY AND REHABILITATION - PROVIDING CARE IN THE WESTHAMPTON, WESTHAMPTON BEACH, EAST QUOGUE, QUOGUE, AND REMSENBURG COMMUNITIES. F) THE SHINNECOCK INDIAN HEALTH CLINIC - SINCE APRIL OF 1995, SOUTHAMPTON HOSPITAL HAS WORKED WITH THE SHINNECOCK NATION TO PROVIDE SERVICES AT THE SHINNECOCK INDIAN HEALTH CLINIC THROUGH A CONTRACT WITH THE NEW YORK STATE DEPARTMENT OF HEALTH. ON AN ANNUAL BASIS, THE CLINIC PROVIDES APPROXIMATELY 2,900 MEDICAL AND 1,200 DENTAL VISITS FOR ELIGIBLE MEMBERS OF THE SHINNECOCK NATION. DENTAL SERVICES, INCLUDING COMMUNITY EDUCATION, SCREENING, RADIOLOGICAL EXAMS, DENTAL HYGIENE AND RESTORATIVE CARE (CROWNS, FILLINGS AND BRIDGES) ARE PROVIDED THROUGH A SUBCONTRACT WITH STONY BROOK UNIVERSITY SCHOOL OF MEDICINE. CURRENTLY, DENTAL SERVICES ARE AVAILABLE EIGHT DAYS PER MONTH FOR ADULTS AND TWO DAYS FOR CHILDREN. IN ADDITION TO PRIMARY CARE, DENTAL SERVICES, NUTRITIONAL COUNSELING, PRENATAL CARE AND ENDOCRINE SERVICES, THE CLINIC PROVIDES SOCIAL WORK, MENTAL HEALTH AND SUBSTANCE ABUSE COUNSELING. MAMMOGRAPHY SCREENING DAY IS ALSO HELD ANNUALLY IN COLLABORATION WITH THE HOSPITAL'S ELLEN HERMANSON BREAST CENTER. G) THE DAVID E. ROGERS CENTER FOR HIV/AIDS CARE (DRC) - PROVIDES COMPREHENSIVE OUTPATIENT MEDICAL CARE, MEDICAL CASE MANAGEMENT, MENTAL HEALTH, PSYCHIATRIC SERVICES, NUTRITIONAL COUNSELING, AND PSYCHOSOCIAL SUPPORT TO PEOPLE LIVING WITH HIV/AIDS. THE CENTER ALSO PROVIDES FREE HIV TESTING, POST-EXPOSURE PROPHYLAXIS CARE, SUPPORT SERVICES, HEALTH EDUCATION/RISK REDUCTION, AND PREVENTION EDUCATION AND OUTREACH TO THE EAST END COMMUNITY. SINCE 1994 THE DRC HAS PROVIDED HIV CARE TO RESIDENTS OF THE EAST END OF LONG ISLAND, A GEOGRAPHIC AREA PREVIOUSLY UNDERSERVED DESPITE A HIGH HIV PREVALENCE RATE. FROM ITS INCEPTION, THE DRC HAS ENJOYED THE COOPERATIVE EFFORTS OF ITS PARTNER ORGANIZATIONS SOUTHAMPTON HOSPITAL AND THE STONY BROOK UNIVERSITY MEDICAL CENTER AS WELL AS THE SUPPORT OF THE COMMUNITIES OF THE EAST END. THE CENTER HAS MET ITS OBJECTIVES BY PROVIDING CONTINUITY AND ACCESSIBILITY OF CARE BY ESTABLISHING LINKAGES BETWEEN THE HOSPITALS AND WITH COMMUNITY BASED ORGANIZATIONS AND THE COMMUNITY AT LARGE. THE DRC DEPENDS ON THE COOPERATIVE EFFORTS OF ALL HEALTH & HUMAN SERVICE AGENCIES FOR OUTREACH, TO ENSURE A CONTINUITY OF CARE FOR OUR PATIENTS, AND TO PROVIDE SERVICES FOR THE EAST END COMMUNITY. ANNUALLY THE DRC PROVIDES APPROXIMATELY 907 MEDICAL, 437 MENTAL HEALTH, AND 205 PSYCHIATRY VISITS FOR 186 ACTIVE PATIENTS. H) CENTER FOR PRENATAL CARE - THE CENTER FOR PRENATAL CARE AT GREENPORT PROVIDES COMPREHENSIVE PRENATAL, GYNECOLOGIC AND FAMILY PLANNING SERVICES FOR WOMEN AND IS AN IMPORTANT OUTREACH ACTIVITY THAT PERMITS THE HOSPITAL TO TAILOR ITS PROGRAMS TO COMMUNITY NEEDS. THE CENTER'S STAFF PROVIDES EXTENSIVE EDUCATION AND COUNSEL TO THEIR PATIENTS IN THE AREAS OF NUTRITION, DOMESTIC VIOLENCE, AS WELL AS DRUG AND ALCOHOL ABUSE, WHILE ALSO PROVIDING IMMEDIATE ACCESS TO MEDICAID ASSISTANCE, FOR MOTHERS MEETING THE ELIGIBILITY REQUIREMENTS, THROUGH THE PRENATAL CARE ASSISTANCE PROGRAM (PCAP). THE CENTER HAS SUCCESSFULLY WORKED WITH THE LOCAL TOWN GOVERNMENT TO OBTAIN THE AGREEMENT OF LOCAL GROCERS TO ACCEPT WIC VOUCHERS. STAFF ALSO UTILIZES FLYERS, BROCHURES, AND POSTERS TO INCREASE AWARENESS OF HOSPITAL SERVICES AND OFFERS TRANSLATION SERVICES TO THE SIGNIFICANT NUMBER OF HISPANIC WOMEN SEEKING CARE AT THE CENTER. THE CENTER PROVIDES PRENATAL CARE TO APPROXIMATELY 50 MOTHERS ANNUALLY IN AN UNDERSERVED AND GEOGRAPHICALLY REMOTE AREA. A MAJORITY OF THESE BABIES ARE BORN AT SOUTHAMPTON HOSPITAL. THE ORGANIZATION IS PROUD OF THE EXCEPTIONAL SPECIALTY SERVICES IT PROVIDES TO THE COMMUNITY. THESE INCLUDE: 1) THE ELLEN HERMANSON BREAST CENTER OFFERS A WIDE SPECTRUM OF BREAST HEALTH SERVICES, INCLUDING EDUCATION, EARLY DETECTION SCREENINGS, SURGERY, BREAST CANCER TREATMENT AND SUPPORT. ACCREDITED BY THE AMERICAN COLLEGE OF RADIOLOGY, THE CENTER UTILIZES STATE-OF-THE-ART DIAGNOSTIC TECHNIQUES, INCLUDING COMPUTER-ASSISTED MAMMOGRAPHY, TOMOSYNTHESIS, ULTRASOUND AND BREAST BIOPSY. 2) THE ED & PHYLLIS DAVIS WELLNESS INSTITUTE OFFERS THE ONLY HOSPITAL-BASED INTEGRATIVE MEDICINE ON LONG ISLAND'S EAST END. INTEGRATIVE MEDICINE COMBINES MODERN SCIENCE, PSYCHOLOGY, NUTRITION, AND EXERCISE TO ENHANCE THE NATURAL HEALING CAPACITY OF THE BODY. SPECIAL PROGRAMS ARE AVAILABLE FOR PATIENTS SUFFERING FROM CHRONIC ILLNESS. CLASSES IN YOGA, TAI CHI, PILATES, ZUMBA, ARE AVAILABLE. PROGRAMS IN STRESS MANAGEMENT, NUTRITIONAL AND WEIGHT LOSS COUNSELING, SMOKING CESSATION, MASSAGE THERAPY, AND ACUPUNCTURE ARE ALSO AVAILABLE. 3) THE JENNY AND JOHN PAULSON DEPARTMENT OF EMERGENCY MEDICINE SERVES MORE THAN 24,000 EMERGENCY PATIENTS ANNUALLY AND IS THE ONLY HOSPITAL-BASED EMERGENCY CARE ON THE SOUTH FORK OF LONG ISLAND. STAFFED 24/7 BY BOARD-CERTIFIED EMERGENCY PHYSICIANS AND SPECIALTY-TRAINED NURSES AND STAFF, IT HAS THE MOST SOPHISTICATED, NON-INVASIVE CARDIAC DIAGNOSTIC AND MONITORING TECHNOLOGY AVAILABLE AND, AS A NEW YORK STATE-DESIGNATED STROKE CENTER, IT IS THE DESTINATION OF AMBULANCES WHEN A HEART ATTACK OR STROKE IS SUSPECTED. 4) PALLIATIVE CARE - A JOINT COMMISSION-CERTIFIED PROGRAM DEDICATED TO PROVIDING SPECIALIZED CARE TO PATIENTS FACING SERIOUS ILLNESS. OUR PATIENT-CENTERED PHILOSOPHY ENCOMPASSES ALL ASPECTS OF THE PATIENT'S EXPERIENCE. THE FOCUS OF OUR PALLIATIVE CARE SERVICE IS TO REDUCE THE SEVERITY OF DISEASE SYMPTOMS AND THE GOAL IS TO RELIEVE SUFFERING AND IMPROVE QUALITY OF LIFE. OUR TEAM INCLUDES DOCTORS, NURSES, SOCIAL WORKERS, AND CHAPLAINS SPECIALIZING IN PALLIATIVE CARE. MASSAGE THERAPISTS, PHARMACISTS, NUTRITIONISTS, ACUPUNCTURISTS, AND OTHERS MAY ALSO PLAY A ROLE. ALL CAREGIVERS WORK CLOSELY WITH A PATIENT'S PRIMARY PHYSICIAN. 5)KATHLEEN D. ALLEN MATERNITY CENTER - DESIGNED TO MEET THE INDIVIDUAL NEEDS OF OUR MOTHERS AND THEIR FAMILIES. PRIVATE LABOR/DELIVERY ROOMS PROVIDE A SUPPORTIVE, COMFORTABLE AND MEDICALLY SAFE BIRTHING ENVIRONMENT. EACH IS EQUIPPED WITH STATE-OF-THE-ART MONITORING CAPABILITIES FOR MOTHER AND BABY. SPECIALTY-TRAINED ANESTHESIOLOGISTS ASSIST WITH PAIN RELIEF, LABOR AND DELIVERY RNS HAVE COMPETENCY IN FETAL MONITORING, AND ALL MATERNITY STAFF IS COMPETENT IN NEONATAL RESUSCITATION. SHOULD A CAESARIAN SECTION BE NECESSARY, A DEDICATED, SPECIALLY-EQUIPPED STATE-OF-THE-ART OPERATING SUITE IS LOCATED WITHIN THE MATERNITY CENTER. | Desc |
| Total Program Service Expenses | $108,802,332 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (true) | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Temp Or Permanent Endowments | Yes (true) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | Yes (true) | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (true) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | false | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (true) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (true) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 256 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 1168 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (true) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (true) | Form990TFiledInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 25 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 24 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (true) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (true) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (true) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | Yes (true) | InvestmentInJointVentureInd |
| Written Policy Or Procedure | false | WrittenPolicyOrProcedureInd |
| States Where Copy Of Return Is Fld | NY | StatesWhereCopyOfReturnIsFldCd |
| Other Website | Yes (X) | OtherWebsiteInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | CHRISTOPHER SCHULTHEIS | PersonNm |
| Phone | 6317268301 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 240 MEETING HOUSE LANE | AddressLine1 |
| City | SOUTHAMPTON | City |
| State | NY | State |
| ZIP Code | 11968 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (36 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|---|
| PETER M LARSEN | |||||||||
| CHAIRMAN | 1.25 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| RICHARD J HIEGEL ESQ | |||||||||
| CO-CHAIR | 1.25 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| KENNETH B WRIGHT | |||||||||
| CO-CHAIR | 1.25 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| STANLEY D FRIEDMAN | |||||||||
| VICE PRESIDENT | 1.25 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| LAWRENCE A WILLIS | |||||||||
| TREASURER | 1.25 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| PATRICIA STEWART | |||||||||
| SECRETARY | 1.25 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| GEORGE F BIONDO ESQ | |||||||||
| TRUSTEE | 1.25 | Yes (X) | $0 | $0 | $0 | ||||
| BARBARA BORSACK | |||||||||
| TRUSTEE | 1.25 | Yes (X) | $0 | $0 | $0 | ||||
| RICHARD BRUCE | |||||||||
| TRUSTEE | 1.25 | Yes (X) | $0 | $0 | $0 | ||||
| JEAN LITTLE FITZSIMMONS | |||||||||
| TRUSTEE | 1.25 | Yes (X) | $0 | $0 | $0 | ||||
| JAMES FORBES | |||||||||
| TRUSTEE | 1.25 | Yes (X) | $0 | $0 | $0 | ||||
| DAVID GILLESPIE | |||||||||
| TRUSTEE | 1.25 | Yes (X) | $0 | $0 | $0 | ||||
| JOHN E GRIM III THRU 313 | |||||||||
| TRUSTEE | 1.25 | Yes (X) | $0 | $0 | $0 | 0.5 | |||
| GILBERT W HARRISON | |||||||||
| TRUSTEE | 1.25 | Yes (X) | $0 | $0 | $0 | ||||
| MICHAEL ISRAEL MD | |||||||||
| PHYSICIAN/TRUSTEE | 1.25 | Yes (X) | $206,834 | $0 | $20,813 | 0.5 | |||
| GEORGE P KAZDIN | |||||||||
| TRUSTEE | 1.25 | Yes (X) | $0 | $0 | $0 | ||||
| LISA CLARE KOMBRINK ESQ | |||||||||
| TRUSTEE | 1.25 | Yes (X) | $0 | $0 | $0 | ||||
| JAY K LEVINE | |||||||||
| TRUSTEE | 1.25 | Yes (X) | $0 | $0 | $0 | ||||
| DOROTHY LEWIS | |||||||||
| TRUSTEE | 1.25 | Yes (X) | $0 | $0 | $0 | ||||
| HOWARD M LORBER | |||||||||
| TRUSTEE | 1.25 | Yes (X) | $0 | $0 | $0 | 0.5 | |||
| R TIMOTHY MARAN | |||||||||
| TRUSTEE | 1.25 | Yes (X) | $0 | $0 | $0 | ||||
| JOHN MCGOWAN | |||||||||
| TRUSTEE | 1.25 | Yes (X) | $0 | $0 | $0 | ||||
| PHILIP A PIRO JR MD | |||||||||
| TRUSTEE (THRU 6/13) | 1.25 | Yes (X) | $0 | $0 | $0 | ||||
| FLORENCE ROLSTON MD | |||||||||
| TRUSTEE | 1.25 | Yes (X) | $0 | $0 | $0 | ||||
| STEPHEN H SHAPOFF | |||||||||
| TRUSTEE | 1.25 | Yes (X) | $0 | $0 | $0 | ||||
| MICHAEL F SMITH | |||||||||
| TRUSTEE | 1.25 | Yes (X) | $0 | $0 | $0 | ||||
| JOHN WAMBOLD | |||||||||
| TRUSTEE | 1.25 | Yes (X) | $0 | $0 | $0 | ||||
| ROBERT S CHALONER | |||||||||
| PRESIDENT & CEO | 38.8 | Yes (X) | $665,402 | $0 | $38,016 | 0.5 | |||
| CHIRSTOPHER J SCHULTHEIS | |||||||||
| CHIEF FINANCIAL OFFICER | 37.5 | Yes (X) | $275,874 | $0 | $36,703 | 0.5 | |||
| FREDERIC I WEINBAUM | |||||||||
| CHIEF MEDICAL OFFICER & COO | 37.5 | Yes (X) | $485,389 | $0 | $39,789 | ||||
| PATRICIA A DARCEY | |||||||||
| CHIEF NURSING OFFICER | 37.5 | $199,738 | $0 | $36,536 | Yes (X) | ||||
| GEORGE KECKEISEN | |||||||||
| PHYSICIAN | 37.5 | $359,346 | $0 | $39,789 | Yes (X) | ||||
| EDNA KAPENHAS | |||||||||
| DIRECTOR, BREAST SURGEON | 37.5 | $399,410 | $0 | $38,016 | Yes (X) | ||||
| STEVEN GEOROGPOULOS | |||||||||
| PHYSICIAN | 37.5 | $594,072 | $0 | $35,721 | Yes (X) | ||||
| KRISTIN P NASO | |||||||||
| MEDICAL STAFF PHYSICIAN | 37.5 | $546,781 | $0 | $38,371 | Yes (X) | ||||
| SHAWN CANNON | |||||||||
| PHYSICIAN/GME PROGRAM ADMIN. | 37.5 | $313,310 | $0 | $35,216 | Yes (X) | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $4,046,156 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $358,970 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 79 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1 | CityContractorAddress/USAddress/City | StateContractorAddress/USAddress/State | ZIP CodeContractorAddress/USAddress/ZIPCode | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| MORRISON MANAGEMENT SPECIALIST | |||||
| 4721 MORRISON DRIVE SUITE 300 | MOBILE | AL | 36609 | FOOD SERVICES | $601,055 |
| HAMPTONS GYNECOLOGY OB | |||||
| 595 HAMPTONS ROAD | SOUTHAMPTON | NY | 11968 | MEDICAL | $318,333 |
| PROSKAUER ROSE LLP | |||||
| 11 TIMES SQUARE | NEW YORK | NY | 100368299 | LEGAL | $290,820 |
| SOUTHAMPTON PULMONARY MEDICINE | |||||
| 325 MEETING HOUSE LANE | SOUTHAMPTON | NY | 11968 | MEDICAL | $273,720 |
| LOCUMTENENSCOM | |||||
| 2655 NORTHWINDS PARKWAY | ALPHARETTA | GA | 30009 | PHYSICIAN RECRUITMEN | $252,627 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 21 | CntrctRcvdGreaterThan100KCnt |
| Federated Campaigns | $104,400 | FederatedCampaignsAmt |
| Related Organizations | $3,525,052 | RelatedOrganizationsAmt |
| Government Grants | $4,985,873 | GovernmentGrantsAmt |
| All Other Contributions | $5,631,061 | AllOtherContributionsAmt |
| Total Contributions | $14,246,386 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| INPATIENT SERVICES | 624200 | $58,290,997 | $58,290,997 | |
| OUTPATIENT SERVICES | 624200 | $61,368,265 | $61,368,265 | |
| LABORATORY EXTENDED SERVICES | 621500 | $1,868,577 | $1,868,577 | |
| LESS: PROVISION FOR UNCOLLECTIBLES, NET | 624200 | -$4,600,000 | -$4,600,000 | |
| LABORATORY REVENUE | 621500 | $784,880 | $784,880 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,280,453 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $783,458 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $496,995 | UnrelatedBusinessRevenueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $118,993,172 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $218,645 | TotalRevenueColumnAmt |
| Exclusion | $218,645 | ExclusionAmt |
Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Royalties Revenue RoyaltiesRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $522,275 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $522,275 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $522,275 | TotalRevenueColumnAmt |
| Exclusion | $522,275 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $4,345,208 | SecuritiesAmt |
| Other | $3,673,643 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $3,667,660 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $677,548 | SecuritiesAmt |
| Other | $3,673,643 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $4,351,191 | TotalRevenueColumnAmt |
| Exclusion | $4,351,191 | ExclusionAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|---|
| SHINNECOCK 3RD PARTY | 900099 | $47,754 | $47,754 |
| VENDOR REBATES | 900099 | $21,535 | $21,535 |
| SALES OF SUPPLIES | 900099 | $16,450 | $16,450 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $375,657 | TotalRevenueColumnAmt |
| Exclusion | $375,657 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $461,396 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $138,793,065 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $116,627,600 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $2,365,572 | UnrelatedBusinessRevenueAmt |
| Exclusion | $5,553,507 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Foreign Grants ForeignGrantsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Benefits To Members BenefitsToMembersGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,005,094 | TotalAmt |
| Management And General | $2,005,094 | ManagementAndGeneralAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $57,063,152 | TotalAmt |
| Program Services | $49,824,888 | ProgramServicesAmt |
| Management And General | $7,238,264 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,462,014 | TotalAmt |
| Program Services | $4,761,870 | ProgramServicesAmt |
| Management And General | $700,144 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,924,524 | TotalAmt |
| Program Services | $11,252,525 | ProgramServicesAmt |
| Management And General | $1,671,999 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,184,821 | TotalAmt |
| Program Services | $3,640,794 | ProgramServicesAmt |
| Management And General | $544,027 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $803,486 | TotalAmt |
| Program Services | $699,033 | ProgramServicesAmt |
| Management And General | $104,453 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $592,455 | TotalAmt |
| Management And General | $592,455 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $300,349 | TotalAmt |
| Management And General | $300,349 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $19,108 | TotalAmt |
| Program Services | $16,624 | ProgramServicesAmt |
| Management And General | $2,484 | ManagementAndGeneralAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $74,675 | TotalAmt |
| Management And General | $74,675 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,168,237 | TotalAmt |
| Program Services | $3,626,366 | ProgramServicesAmt |
| Management And General | $541,871 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,637 | TotalAmt |
| Program Services | $12,734 | ProgramServicesAmt |
| Management And General | $1,903 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,080,607 | TotalAmt |
| Program Services | $12,447,668 | ProgramServicesAmt |
| Management And General | $2,632,939 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,170,367 | TotalAmt |
| Program Services | $1,888,219 | ProgramServicesAmt |
| Management And General | $282,148 | ManagementAndGeneralAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,281,382 | TotalAmt |
| Program Services | $1,114,802 | ProgramServicesAmt |
| Management And General | $166,580 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $156,873 | TotalAmt |
| Management And General | $156,873 | ManagementAndGeneralAmt |
Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $33,060 | TotalAmt |
| Management And General | $33,060 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,711,041 | TotalAmt |
| Program Services | $2,358,606 | ProgramServicesAmt |
| Management And General | $352,435 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,327,467 | TotalAmt |
| Program Services | $5,307,356 | ProgramServicesAmt |
| Management And General | $20,111 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,099,055 | TotalAmt |
| Program Services | $1,826,178 | ProgramServicesAmt |
| Management And General | $272,877 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| OTHER PURCHASE SERVICES | $7,192,813 | $6,257,747 | $935,066 |
| UTILITIES | $2,161,577 | $1,880,572 | $281,005 |
| OTHER DIRECT EXPENSES | $1,726,830 | $1,502,342 | $224,488 |
| MISCELLANEOUS | $768,012 | $384,008 | $384,004 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $128,321,636 | TotalAmt |
| Program Services | $108,802,332 | ProgramServicesAmt |
| Management And General | $19,519,304 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,976,113 | BOYAmt |
| EOY | $92,989 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,847,513 | BOYAmt |
| EOY | $8,336,913 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,493,397 | BOYAmt |
| EOY | $18,130,683 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,689,021 | BOYAmt |
| EOY | $1,786,889 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $411,890 | BOYAmt |
| EOY | $437,340 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $152,095,604 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $106,497,560 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $39,278,958 | BOYAmt |
| EOY | $45,598,044 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $27,972,839 | BOYAmt |
| EOY | $30,869,856 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $998,243 | BOYAmt |
| EOY | $1,078,250 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $97,667,974 | BOYAmt |
| EOY | $106,330,964 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,424,599 | BOYAmt |
| EOY | $21,460,814 | EOYAmt |
Grants Payable GrantsPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $33,866,206 | BOYAmt |
| EOY | $32,927,605 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,550,963 | BOYAmt |
| EOY | $12,430,276 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,523,123 | BOYAmt |
| EOY | $16,674,842 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $89,364,891 | BOYAmt |
| EOY | $83,493,537 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$109,955 | BOYAmt |
| EOY | $19,102,681 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,579,020 | BOYAmt |
| EOY | $900,728 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,834,018 | BOYAmt |
| EOY | $2,834,018 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,303,083 | BOYAmt |
| EOY | $22,837,427 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $97,667,974 | BOYAmt |
| EOY | $106,330,964 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $10,471,429 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $1,231,907 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $2,831,008 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Grassroots Lobbying | TotalGrassrootsLobbyingGrp | |
| Total Direct Lobbying | TotalDirectLobbyingGrp | |
| Total Lobbying Expend | TotalLobbyingExpendGrp | |
| Other Exempt Purpose Expend | OtherExemptPurposeExpendGrp | |
| Total Exempt Purpose Expend | TotalExemptPurposeExpendGrp | |
| Lobbying Nontaxable Amount | LobbyingNontaxableAmountGrp | |
| Grassroots Nontaxable | GrassrootsNontaxableGrp | |
| Tot Lbbyng Grassroot Mns Non Tx | TotLbbyngGrassrootMnsNonTxGrp | |
| Tot Lbby Expend Mns Lbbyng Non Tx | TotLbbyExpendMnsLbbyngNonTxGrp | |
| Volunteers | false | VolunteersInd |
| Paid Staff Or Management | false | PaidStaffOrManagementInd |
| Media Advertisements | false | MediaAdvertisementsInd |
| Mailings Members | false | MailingsMembersInd |
| Publications Or Broadcast | false | PublicationsOrBroadcastInd |
| Grants Other Organizations | Yes (true) | GrantsOtherOrganizationsInd |
| Grants Other Organizations | $19,108 | GrantsOtherOrganizationsAmt |
| Direct Contact Legislators | false | DirectContactLegislatorsInd |
| Rallies Demonstrations | false | RalliesDemonstrationsInd |
| Other Activities | false | OtherActivitiesInd |
| Total Lobbying Expenditures | $19,108 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | false | NotDescribedSection501c3Ind |
| Form4720 Filed4912 Tax | false | Form4720Filed4912TaxInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1F: | FormAndLineReferenceDesc |
| Explanation | SOUTHAMPTON HOSPITAL PAYS MEMBERSHIP DUES TO THE ABOVE MENTIONED ORGANIZATIONS. A PERCENTAGE OF THESE DUES ARE THEN USED TO REIMBURSE THE ORGANIZATION FOR THE COST OF LOBBYING ACTIVITIES PERFORMED ON BEHALF OF THE HOSPITAL. THE FUNDS ARE USED FOR LOBBYING PURPOSES IN CONNECTION WITH NEW YORK STATE AND FEDERAL POLICY ISSUES. MEMBERSHIP DUES PAID TO OTHER ORGANIZATIONS AND USED FOR LOBBYING PURPOSES: Healthcare Association of New York State........$10,696. American Hospital Association...................$6,832. Nassau Suffolk Hospital Council.................$1,140. Greater NY Hospital Association.................$440. Total...........................................$19,108. | ExplanationTxt |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amounts | ArtPublicExhibitionAmountsGrp | |
| Held Works Art | HeldWorksArtGrp |
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $4,527,461 | BeginningYearBalanceAmt |
| Contributions | $5,500,000 | ContributionsAmt |
| Investment Earnings Or Losses | $781,270 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $10,808,731 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $4,115,379 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $412,082 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $4,527,461 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $4,213,766 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | -$98,387 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $4,115,379 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $3,943,577 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $371,238 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $95,021 | OtherExpendituresAmt |
| Administrative Expenses | $6,028 | AdministrativeExpensesAmt |
| End Year Balance | $4,213,766 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $4,031,782 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $73,511 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $23,873 | OtherExpendituresAmt |
| Administrative Expenses | $137,843 | AdministrativeExpensesAmt |
| End Year Balance | $3,943,577 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.73780 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.26220 | PrmnntEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | false | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | false | EndowmentsHeldRelatedOrgInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,366,275 | OtherCostOrOtherBasisAmt |
| Book Value | $1,366,275 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $44,542,527 | OtherCostOrOtherBasisAmt |
| Depreciation | $34,977,093 | DepreciationAmt |
| Book Value | $9,565,434 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Leasehold Improvements | LeaseholdImprovementsGrp |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $97,102,857 | OtherCostOrOtherBasisAmt |
| Depreciation | $70,584,683 | DepreciationAmt |
| Book Value | $26,518,174 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $9,083,945 | OtherCostOrOtherBasisAmt |
| Depreciation | $935,784 | DepreciationAmt |
| Book Value | $8,148,161 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $45,598,044 | TotalBookValueLandBuildingsAmt |
| Financial Derivatives | FinancialDerivativesGrp | |
| Closely Held Equity Interests | CloselyHeldEquityInterestsGrp |
Other Securities OtherSecuritiesGrp (5 entries)
| DescDesc | Book ValueBookValueAmt | Method ValuationMethodValuationCd |
|---|---|---|
| SHORT TERM INVESTMENTS | $9,824,832 | F |
| RESTRICTIONS | $3,734,746 | F |
| INVESTMENTS IN SHA PROPERTIES | $6,300,000 | C |
| DEBT SERVICE FUND | $5,805,278 | F |
| MALPRACTICE SELF INSURANCE-FD | $5,205,000 | F |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Securities | $30,869,856 | TotalBookValueSecuritiesAmt |
| Federal Income Tax Liability | $0 | FederalIncomeTaxLiabilityAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| ACCRUED PENSION LIABILITY | $4,531,857 |
| DUE TO THIRD-PARTY PAYORS, NET | $6,937,985 |
| MALPRACTICE SELF-INSURANCE LIA | $5,205,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $16,674,842 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $147,589,088 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $1,231,907 | NetUnrealizedGainsInvstAmt |
| Other Revenue | $7,638,791 | OtherRevenueAmt |
| Revenue Not Reported | $8,870,698 | RevenueNotReportedAmt |
| Revenue Subtotal | $138,718,390 | RevenueSubtotalAmt |
| Investment Expenses Not Incld | $74,675 | InvestmentExpensesNotIncldAmt |
| Revenue Not Reported Fincl Stmt | $74,675 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $138,793,065 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $128,376,452 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $129,491 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $129,491 | ExpensesNotReportedAmt |
| Expenses Subtotal | $128,246,961 | ExpensesSubtotalAmt |
| Investment Expenses Not Incld2 | $74,675 | InvestmentExpensesNotIncld2Amt |
| Expenses Not Rpt Fincl Stmt | $74,675 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $128,321,636 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART V, LINE 4: | SOUTHAMPTON HOSPITAL ASSOCIATION CURRENTLY REPORTS ENDOWMENT FUNDS WITHIN ITS DECEMBER 31, 2013 FINANCIAL STATEMENTS. THE GOVERNING BODY INTENDS TO USE THESE FUNDS TO OFFSET THE COST OF INDIGENT CARE, EMERGENCY SERVICES AND NURSING EDUCATION. |
| PART X, LINE 2: | SOUTHAMPTON HOSPITAL ASSOCIATION (THE "REPORTING ORGANIZATION") HAS NOT TAKEN AN UNSUBSTANTIATED TAX POSITION THAT WOULD REQUIRE PROVISION OF A LIABILITY UNDER ASC 740. UNDER ASC 740, AN ORGANIZATION MUST RECOGNIZE THE TAX BENEFIT ASSOCIATED WITH TAX POSITIONS TAKEN FOR TAX RETURN PURPOSES WHEN IT IS MORE-LIKELY-THAN-NOT THAT THE POSITION WILL NOT BE SUSTAINED UPON EXAMINATION. THE REPORTING ORGANIZATION DOES NOT BELIEVE THERE ARE ANY MATERIAL UNCERTAIN TAX POSITIONS AND, ACCORDINGLY, HAS NOT RECOGNIZED ANY LIABILITY FOR UNRECOGNIZED TAX BENEFITS. THE REPORTING ORGANIZATION HAS FILED IRS FORM 990 TAX RETURNS, AS REQUIRED, AND ALL OTHER APPLICABLE RETURNS IN JURISDICTIONS WHEN IT IS REQUIRED. FOR THE YEAR ENDED DECEMBER 31, 2013, THERE WAS NO INTEREST OR PENALTIES RECORDED OR INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS. THE REPORTING ORGANIZATION BELIEVES THEY ARE NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR THE YEARS PRIOR TO 2010, WHICH IS THE STATUTE OF LIMITATION LOOK BACK PERIOD. |
| PART XI, LINE 2D: | SHA PROPERTIES INCOME.........$203,227. PENSION OBLIGATION............$7,435,564. TOTAL.........................$7,638,791. |
| PART XII, LINE 2D: | SHA PROPERTIES EXPENSES.......$129,491. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
Free Care Oth Percentage FreeCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Free Care Other | 400. | FreeCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
| Percent400 | Yes (X) | Percent400Ind |
| Free Care Medically Indigent | false | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (true) | ExpensesExceedBudgetInd |
| Unable To Provide Care | false | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (true) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (true) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 575 | PersonsServedCnt |
| Total Community Benefit Expns | $2,242,983 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | -$1,485,122 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $757,861 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00590 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $13,993,212 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,980,237 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $7,012,975 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05470 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 575 | PersonsServedCnt |
| Total Community Benefit Expns | $16,236,195 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,495,115 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $7,770,836 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06060 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $7,036,767 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,211,855 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,824,912 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02980 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 4 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $42,732,475 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $34,463,227 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $8,269,248 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07000 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 4 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $49,769,242 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $37,675,082 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $12,094,160 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.09980 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 4 | ActivitiesOrProgramsCnt |
| Persons Served | 575 | PersonsServedCnt |
| Total Community Benefit Expns | $66,005,437 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $43,170,197 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $19,864,996 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.16040 | TotalExpensePct |
Workforce Development WorkforceDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $279,739 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $279,739 | NetCommunityBenefitExpnsAmt |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $279,739 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $279,739 | NetCommunityBenefitExpnsAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $4,600,000 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $1,079,121 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $37,819,772 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $39,232,922 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$1,413,150 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost Accounting System | Yes (X) | CostAccountingSystemInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | FinancialAssistancePrvsnInd |
Management Co And Jnt Ventures ManagementCoAndJntVenturesGrp
Entity Name EntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MEETINGHOUSE LN PRAC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Primary Activities | PRIMARY/SPECIALTY | PrimaryActivitiesTxt |
| Org Profit Or Ownership | 1.00000 | OrgProfitOrOwnershipPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facilities | 14 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp (14 entries)
| FacilityFacilityNum | Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | Licensed HospitalLicensedHospitalInd | Facility Reporting GroupFacilityReportingGroupCd | General Medical And SurgicalGeneralMedicalAndSurgicalInd | OtherOtherDesc |
|---|---|---|---|---|---|---|---|---|
| SOUTHAMPTON HOSPITAL ASSOCIATION | ||||||||
| 1 | 240 MEETINGHOUSE LANE | SOUTHAMPTON | NY | 11968 | Yes (X) | A | ||
| DIALYSIS CENTER | ||||||||
| 2 | 184 W MONTAUK HIGHWAY | HAMTPON BAYS | NY | 11946 | B | Yes (X) | DIALYSIS TREATMENT FACILITY | |
| GREENPORT PRENATAL | ||||||||
| 3 | 300 ATLANTIC AVENUE | GREENPORT | NY | 11944 | B | Yes (X) | PRENATAL/WOMEN'S SERVICES | |
| LAB EAST | ||||||||
| 4 | 200 PANTIGO PLACE | EAST HAMPTON | NY | 11944 | B | Yes (X) | LABORATORY SERVICES | |
| IMAGING - EH | ||||||||
| 5 | 200 PANTIGO PLACE | EAST HAMPTON | NY | 11937 | B | Yes (X) | RADIOLOGY SERVICES | |
| WESTHAMPTON PRIMARY CARE | ||||||||
| 6 | 72 OLD RIVERHEAD ROAD | WESTHAMPTON BEACH | NY | 11978 | B | Yes (X) | PRIMARY CARE PRACTICE | |
| WESTHAMPTON SPORTS REHAB | ||||||||
| 7 | 74 OLD RIVERHEAD ROAD | WESTHAMPTON BEACH | NY | 11978 | B | Yes (X) | SPORTS REHAB/ PHYSICAL THERAPY SERVICES | |
| LAB SOUTH | ||||||||
| 8 | 325 MEETINGHOUSE LANE | SOUTHAMPTON | NY | 11968 | B | Yes (X) | LABORATORY SERVICES | |
| ATRIUM LAB | ||||||||
| 9 | 182 W MONTAUK HIGHWAY | HAMPTON BAYS | NY | 11946 | B | Yes (X) | LABORATORY SERVICES | |
| DAVID ROGERS CENTER | ||||||||
| 10 | 335 D MEETINGHOUSE LANE | SOUTHAMPTON | NY | 11968 | B | Yes (X) | HIV/AIDS CARE | |
| SHINNECOCK HEALTH | ||||||||
| 11 | CHURCH STREET | SOUTHAMPTON | NY | 11968 | B | Yes (X) | PRIMARY CARE/DENTAL SERVICES | |
| SOUTHAMPTON CARE CENTER | ||||||||
| 12 | 240 MEETINGHOUSE LANE | SOUTHAMPTON | NY | 11968 | B | Yes (X) | NURSING HOME (FACILITY CLOSED) | |
| Imaging Hampton Bays | ||||||||
| 13 | 182 W MONTAUK HIGHWAY | HAMPTON BAYS | NY | 11946 | B | Yes (X) | RADIOLOGY SERVICES | |
| MEETINGHOUSE LANE PRACTICE | ||||||||
| 14 | PO BOX 2340 | SOUTHAMPTON | NY | 11968 | B | Yes (X) | PRIMARY/SPECIALTY PHYSICIAN PATIENT CARE | |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp (2 entries)
| FacilityFacilityNum | CHNA ConductedCHNAConductedInd | Community DefinitionCommunityDefinitionInd | Community DemographicsCommunityDemographicsInd | Existing ResourcesExistingResourcesInd | Community Health NeedsCommunityHealthNeedsInd | Community Hlth Needs Id ProcessCommunityHlthNeedsIdProcessInd | Consulting ProcessConsultingProcessInd | CHNA ConductedCHNAConductedYr | Take Into Account Others InputTakeIntoAccountOthersInputInd | CHNA Conducted With Other FcltsCHNAConductedWithOtherFcltsInd | CHNA Report Widely AvailableCHNAReportWidelyAvailableInd | Rpt Available On Own WebsiteRptAvailableOnOwnWebsiteInd | Own Website URLOwnWebsiteURLTxt | Rpt Available Upon RequestRptAvailableUponRequestInd | Adopt Implementation StrategyAdoptImplementationStrategyInd | Exec Implementation StrategyExecImplementationStrategyInd | Develop Community Wide PlanDevelopCommunityWidePlanInd | Exec Community Wide PlanExecCommunityWidePlanInd | Include Operational PlanIncludeOperationalPlanInd | Prioritize Health NeedsPrioritizeHealthNeedsInd | Prioritize ServicesPrioritizeServicesInd | All Needs AddressedAllNeedsAddressedInd | Organization Incur Excise TaxOrganizationIncurExciseTaxInd | Elig Criteria ExplainedEligCriteriaExplainedInd | FPG Used Deter Elig Free CareFPGUsedDeterEligFreeCareInd | FPG Family Incm Lmt Free CareFPGFamilyIncmLmtFreeCarePct | FPG Used Determ Elig Dscnt CareFPGUsedDetermEligDscntCareInd | FPG Family Incm Lmt Dscnt CareFPGFamilyIncmLmtDscntCarePct | Explained BasisExplainedBasisInd | Insurance StatusInsuranceStatusInd | Uninsured DiscountUninsuredDiscountInd | State RegulationStateRegulationInd | App Financial Asst ExplnAppFinancialAsstExplnInd | Includes Publicity MeasuresIncludesPublicityMeasuresInd | Posted On WebsitePostedOnWebsiteInd | Attached To InvoiceAttachedToInvoiceInd | Posted In Emergency RoomPostedInEmergencyRoomInd | Posted In Admission OfficePostedInAdmissionOfficeInd | Provided On AdmissionProvidedOnAdmissionInd | Available On RequestAvailableOnRequestInd | FAP Actions On NonpaymentFAPActionsOnNonpaymentInd | Collection ActivitiesCollectionActivitiesInd | Nondis Emergency Care PolicyNondisEmergencyCarePolicyInd | Medicare RatesMedicareRatesInd | Amounts Generally BilledAmountsGenerallyBilledInd | Gross ChargesGrossChargesInd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| A | ||||||||||||||||||||||||||||||||||||||||||||||
| 1 | Yes (true) | Yes (X) | Yes (X) | Yes (X) | Yes (X) | Yes (X) | Yes (X) | 11 | Yes (true) | Yes (true) | Yes (true) | Yes (X) | www.southamptonhospital.org | Yes (X) | Yes (X) | Yes (X) | Yes (X) | Yes (X) | Yes (X) | Yes (X) | Yes (X) | Yes (true) | false | Yes (true) | Yes (true) | 400. | Yes (true) | 400. | Yes (true) | Yes (X) | Yes (X) | Yes (X) | Yes (true) | Yes (true) | Yes (X) | Yes (X) | Yes (X) | Yes (X) | Yes (X) | Yes (X) | Yes (true) | false | Yes (true) | Yes (X) | false | false |
| B | ||||||||||||||||||||||||||||||||||||||||||||||
| false | Yes (true) | Yes (true) | 400. | Yes (true) | 400. | Yes (true) | Yes (X) | Yes (X) | Yes (X) | Yes (true) | Yes (true) | Yes (X) | Yes (X) | Yes (X) | Yes (X) | Yes (X) | Yes (X) | Yes (true) | false | Yes (true) | Yes (X) | false | false | |||||||||||||||||||||||
Supplemental Information SupplementalInformationGrp (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART V, SECTION B, LINE 2: | THE HOSPITAL CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT ("CHNA") FOR THE PERIOD 2010 - 2013. THE CHNA WAS DEEMED CONDUCTED IN 2011 WHEN IT WAS MADE "WIDELY AVAILABLE" TO THE PUBLIC AND THE WRITTEN REPORT AND IMPLEMENTATION STRATEGY WERE FINALIZED, APPROVED, AND ACCEPTED BY THE HOSPITAL'S GOVERNING BODY, IN ACCORDANCE WITH IRS NOTICE 2011-52. PART V, SECTION B, LINE 3: SEE SCHEDULE H, PART VI, LINE 2 NEEDS ASSESSMENT LANGUAGE. |
| PART V, SECTION B, LINE 4: | THE HOSPITAL FACILITY'S CHA WAS CONDUCTED WITH PECONIC BAY MEDICAL CENTER, EASTERN LONG ISLAND HOSPITAL (PBMC ELIH). |
Supplemental Information Detail SupplementalInformationDetail (10 entries)
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| PART I, LINE 3C: | THERE ARE TWO LEVELS OF CHARITY CARE COVERAGE: PRIMARY SERVICE AREA AND NON-PRIMARY SERVICE AREA. A PRIMARY SERVICE AREA PATIENT IS A PATIENT WHO RESIDED IN NEW YORK STATE WITHIN THE COUNTIES OF SUFFOLK OR NASSAU AT THE TIME OF SERVICE. A NON-PRIMARY SERVICE AREA PATIENT IS A PATIENT WHO RESIDED IN NEW YORK STATE BUT NOT WITHIN THE COUNTIES OF SUFFOLK OR NASSAU AT THE TIME OF SERVICE. ELIGIBLE SERVICES FOR A PRIMARY SERVICE AREA PATIENT: A PRIMARY SERVICE AREA PATIENT WHO MEETS THE FINANCIAL REQUIREMENTS IS ELIGIBLE FOR THE FOLLOWING MEDICALLY NECESSARY SERVICES: INPATIENT, AMBULATORY, EMERGENCY ROOM, EMERGENCY TRANSFERS UNDER THE EMERGENCY MEDICAL TREATMENT AND LABOR ACT (EMTALA), OUTPATIENT, AND DIAGNOSTIC CARE. UNDERINSURED PRIMARY SERVICE AREA PATIENTS ARE ELIGIBLE FOR FINANCIAL ASSISTANCE ON MEDICARE AND COMMERCIAL INSURANCE CARRIER CO-INSURANCES FOR ALL ABOVE LISTED SERVICES. ELIGIBLE SERVICES FOR A NON-PRIMARY SERVICE AREA PATIENT: A NON-PRIMARY SERVICE AREA PATIENT WHO MEETS THE FINANCIAL REQUIREMENTS IS ELIGIBLE FOR THE FOLLOWING MEDICALLY NECESSARY SERVICES: EMERGENCY ROOM, EMERGENT ADMISSIONS, AND EMERGENCY TRANSFERS UNDER THE EMERGENCY MEDICAL TREATMENT AND LABOR ACT (EMTALA). UNDERINSURED NON-PRIMARY SERVICE AREA PATIENTS ARE ELIGIBLE FOR FINANCIAL ASSISTANCE ON MEDICARE AND COMMERCIAL INSURANCE CARRIER CO-INSURANCES FOR ALL ABOVE LISTED SERVICES. INELIGIBLE SERVICES: THE FOLLOWING SERVICES AND/OR ITEMS ARE NOT COVERED BY CHARITY CARE FOR ANY PATIENT: NOT MEDICALLY NECESSARY SERVICES AS DETERMINED BY MEDICARE(E.G. COSMETIC SURGERY, BARIATRIC SURGERY), INSURANCE CO-PAYMENTS/CO-INSURANCES/DEDUCTIBLES, MEDICAID SPEND-DOWN AMOUNTS, NON-COVERED SERVICES AS DETERMINED BY THE PATIENT'S INSURANCE CARRIER, PRIVATE ROOM RATES, AND PRIVATE PHYSICIAN FEES WHICH ARE NOT BILLED BY SOUTHAMPTON HOSPITAL (E.G. RADIOLOGY, PATHOLOGY, ANESTHESIOLOGY, EMERGENCY). FAMILY INFORMATION REQUIREMENTS: A PATIENT MUST PROVIDE ON THEIR CHARITY CARE APPLICATION A LIST OF THE FAMILY/HOUSEHOLD MEMBERS AND OR DEPENDENTS WITH WHOM THE PATIENT RESIDES. IF THE PATIENT IS AN ADULT, THE PATIENT MUST LIST THEIR SPOUSE OR DOMESTIC PARTNER, CHILDREN UNDER THE AGE OF 21, AND ANY CLAIMED DEPENDENTS OR OTHER HOUSEHOLD MEMBERS THAT LIVE WITH THE PATIENT. IF THE PATIENT IS A CHILD UNDER THE AGE OF 21, THE APPLICANT MAY LIST THE PATIENT'S PARENTS, SIBLINGS UNDER THE AGE OF 21, AND ANY CLAIMED DEPENDENTS OR OTHER HOUSEHOLD MEMBERS THAT LIVE WITH THE PATIENT. A CLAIMED DEPENDENT IS DEFINED AS A PERSON WHO IS LISTED OR WOULD BE LISTED AS A DEPENDENT FOR THE PURPOSES OF AN INCOME TAX SUBMISSION TO THE IRS. FINANCIAL REQUIREMENTS: TO BE FINANCIALLY ELIGIBLE TO RECEIVE CHARITY CARE, A PATIENT MUST HAVE A GROSS FAMILY/HOUSEHOLD INCOME LESS THAN OR EQUAL TO 400% OF THE FEDERAL POVERTY LEVEL GUIDELINE (FPG). ELIGIBLE INCOME: THE FOLLOWING INCOME ITEMS WILL BE USED TO DETERMINE A PATIENT'S INCOME: EARNINGS FROM EMPLOYMENT, UNEMPLOYMENT COMPENSATION, WORKERS COMPENSATION, DISABILITY, SOCIAL SECURITY, ANNUITIZED PENSION PLAN, CHILD SUPPORT, ALIMONY, DIVIDENDS, INTEREST, RENTALS, ESTATES, TRUSTS, SALE OF ASSETS, AND OTHER MISCELLANEOUS INCOME. SOLE PROPRIETORSHIP, PARTNERSHIP, AND S CORPORATION INCOME WILL BE CALCULATED BY ITS GROSS PROFIT OR TOTAL INCOME PRIOR TO EXPENSES AND DEDUCTIONS; HOWEVER, COST OF GOODS SOLD MAY BE DEDUCTED FROM GROSS SALES. SALE OF ASSETS, SUCH AS REPORTED ON A SCHEDULE D OR ITS EQUIVALENT, WILL BE CALCULATED BY THEIR SALE PRICE AND NOT BY THEIR GAIN OR LOSS. FINANCIAL DOCUMENTATION REQUIREMENTS: A PATIENT MUST PROVIDE FINANCIAL DOCUMENTATION TO SUPPORT THEIR CURRENT STATED INCOME. THE FOLLOWING DOCUMENTS ARE ACCEPTABLE AS PROOF: COPIES OF RECENT PAY STUBS (SEVERAL CONSECUTIVE ARE PREFERRED WHEN AVAILABLE), A RECENT UNEMPLOYMENT OR DISABILITY STATEMENT, A LETTER FROM AN EMPLOYER, OR A SELF-ATTESTATION LETTER. A PATIENT MAY BE REQUIRED TO SUBMIT ADDITIONAL DOCUMENTATION AT SOUTHAMPTON HOSPITAL'S REQUEST IN ORDER TO SUBSTANTIATE THEIR STATED INCOME. IF A PATIENT IS CLAIMING ZERO INCOME, THE PATIENT WILL BE REQUIRED TO SUBMIT A VERIFICATION OF NON-FILING LETTER FROM THE IRS. THIS LETTER IS OBTAINED THROUGH IRS FORM 4506-T WHICH WILL BE MADE AVAILABLE TO THE PATIENT UPON REQUEST. THE PATIENT MUST ALSO SUBMIT A LETTER DESCRIBING THE MEANS BY WHICH THEY ARE SUPPORTED. IF THE PATIENT IS UNABLE TO FILE IRS FORM 4506-T DUE TO NOT HAVING A SOCIAL SECURITY NUMBER, THE PATIENT MUST SUBMIT THE ABOVE-MENTIONED LETTER. APPLICABLE RATES: THE APPLICABLE RATE FOR AN INPATIENT VISIT IS THE MEDICARE DIAGNOSIS RELATED GROUP (DRG) RATE FOR THAT VISIT. THE APPLICABLE RATE FOR AN AMBULATORY, EMERGENCY ROOM, OUTPATIENT, OR DIAGNOSTIC CARE VISIT IS THE MEDICARE HCPCS/CPT PAYMENT PLUS MINIMUM UNADJUSTED CO-PAYMENT FOR THAT VISIT. THE APPLICABLE RATE FOR LAB TESTS ON OUTPATIENT AND EMERGENCY ROOM VISITS WILL BE 10% OF THE CHARGE PER TEST. CO-INSURANCE: PATIENTS WHO ARE ELIGIBLE FOR A DISCOUNT ON MEDICARE OR COMMERCIAL INSURANCE CARRIER CO-INSURANCES WILL HAVE THOSE BALANCES REDUCED ACCORDING TO THE FOLLOWING SCALE. PERCENTAGE OF FPG: PERCENT OF CO-INSURANCE RESPONSIBLY: 0% TO 100%........0% >100% TO 125%....10% >125% TO 150%....20% >150% TO 175%....28% >175% TO 200%....36% >200% TO 225%....44% >225% TO 250%....52% >250% TO 275%....60% >275% TO 300%....68% >300% TO 325%....76% >325% TO 350%....84% >350% TO 375%....92% >375% TO 400%...100% SELF-PAY DISCOUNT: SOUTHAMPTON HOSPITAL OFFERS A SELF-PAY DISCOUNT TO UNINSURED PATIENTS FOR SERVICES AND PROCEDURES PROVIDED AND BILLED BY SOUTHAMPTON HOSPITAL. A) ELIGIBLE SERVICES - THE FOLLOWING SERVICES PERFORMED BY SOUTHAMPTON HOSPITAL ARE ELIGIBLE FOR A SELF-PAY DISCOUNT: INPATIENT, AMBULATORY, EMERGENCY ROOM, EMERGENCY TRANSFERS UNDER THE EMERGENCY MEDICAL TREATMENT AND LABOR ACT (EMTALA), OUTPATIENT, AND DIAGNOSTIC CARE. B) INELIGIBLE SERVICES - THE FOLLOWING SERVICES AND ITEMS ARE NOT ELIGIBLE FOR A SELF-PAY DISCOUNT: OUTPATIENT CARDIAC REHABILITATION, OUTPATIENT NUTRITIONAL COUNSELING, WELLNESS CENTER SERVICES/PROGRAMS, OUTPATIENT PHYSICAL THERAPY, PRIVATE PHYSICIAN FEES NOT BILLED BY SOUTHAMPTON HOSPITAL (E.G. RADIOLOGY, PATHOLOGY, ANESTHESIOLOGY, EMERGENCY). C) DISCOUNT - SELF-PAY ACCOUNTS ARE DISCOUNTED AT A RATE OF 70% OFF TOTAL CHARGES. A. AUTOMATIC DISCOUNTING - THE SELF-PAY DISCOUNT WILL BE CALCULATED AND APPLIED TO THE PATIENTS' ACCOUNT AUTOMATICALLY BY THE HOSPITAL INFORMATION SYSTEM (HIS). B. MANUAL DISCOUNTING - THE SELF-PAY DISCOUNT MAY NEED TO BE MANUALLY CALCULATED AND APPLIED IN CERTAIN CIRCUMSTANCES (E.G. LATE CHARGES) AND WILL BE HANDLED BY PATIENT FINANCIAL SERVICES. D) ADDITIONAL FINANCIAL ASSISTANCE - PATIENTS WHO ARE UNABLE TO PAY FOR A SELF-PAY DISCOUNTED BILL MAY STILL APPLY FOR OTHER TYPES OF FINANCIAL ASSISTANCE SUCH AS CHARITY CARE. APPLYING FOR ANOTHER TYPE OF FINANCIAL ASSISTANCE WILL NOT RESULT IN THE LOSS OF THE OFFERED SELF-PAY DISCOUNT, HOWEVER, IF ACCEPTED INTO ANOTHER FINANCIAL ASSISTANCE PROGRAM, THAT PROGRAMS CALCULATION METHODOLOGY WILL BE DONE INDEPENDENTLY OF THE SELF-PAY DISCOUNTED AMOUNT (I.E. FINANCIAL ASSISTANCE PROGRAMS ARE MUTUALLY EXCLUSIVE). |
| PART III, LINE 3: | SOUTHAMPTON HOSPITAL UTILIZED THE AUDITED FINANCIAL STATEMENT AMOUNT REPORTED FOR BAD DEBT OF $4,600,000 AS ITS STARTING POINT. THIS AMOUNT WAS MULTIPLIED BY A COST TO CHARGE RATIO OF 30.1% (DETERMINED ON SCHEDULE H WORKSHEET 2) RESULTING IN A COST OF BAD DEBT OF $1,383,517. THIS COST WAS THEN MULTIPLIED BY 78.00% - THE SELF PAY PERCENTAGE AS DETERMINED BY THE 2013 INSTITUTIONAL COST REPORT. THIS RESULTED IN A COST OF BAD DEBT FOR PATIENTS ELIGIBLE UNDER THE HOSPITAL'S CHARITY CARE POLICY OF $1,079,121. |
| PART III, LINE 4: | THE ORGANIZATION DETERMINE EXPECTED BAD DEBT WRITE-OFFS BASED ON ACTUAL ACCOUNTS, NET OF AN EXPECTED RATE OF RECOVERY. IT'S NOT BASED ON A PERCENTAGE OF REVENUE. |
| PART III, LINE 8: | SOUTHAMPTON HOSPITAL UTILIZED THE 2552 COST REPORT PREPARED ANNUALLY FOR MEDICARE TO DETERMINE THE TOTAL REVENUE RECEIVED FROM MEDICARE, AS WELL AS THE MEDICARE ALLOWABLE COSTS RELATING TO THE REVENUE REPORTED. MEDICARE ALLOWABLE COSTS OF $39,232,922 ARE GREATER THAN THE TOTAL MEDICARE REVENUE OF $37,819,772 FOR 2013; THEREFORE THE SHORTFALL OF $1,413,150 MAY BE DEEMED A COMMUNITY BENEFIT. |
| PART III, LINE 9B: | ACCOUNTS WITH UNCOLLECTABLE BALANCES ARE ACCOUNTS FOR A PATIENT (GUARANTOR) WHO HAS NOT RESPONDED TO REQUESTS FOR PAYMENT OR WHO HAS DEMONSTRATED AN EXEMPTION FROM PAYMENT. THE REQUEST FOR PAYMENT &/OR THE EXEMPTION MUST MEET THE FOLLOWING CRITERIA: 1. AT LEAST FOUR (4) CONSECUTIVE 120-DAY BILLS MUST HAVE BEEN GENERATED (OR NO LESS THAN 120 DAYS FROM FIRST BILL) AND SENT WITHOUT RESPONSE FROM THE PATIENT (GUARANTOR) BEFORE BEING SENT TO A COLLECTION AGENCY; OR 2. THE PATIENT (GUARANTOR) HAS DECLARED BANKRUPTCY (DISCHARGE OF DEBT OR MUST HAVE BEEN RECEIVED); OR 3. THE ESTATE OF THE PATIENT (GUARANTOR) HAS BEEN SETTLED AND THERE WERE NO FUNDS FOR PAYMENT LEFT IN THE ESTATE; OR 4. MAIL HAS BEEN RETURNED AND OTHER METHODS OF CONTACTING THE PATIENT (GUARANTOR) HAVE FAILED. THE ACCOUNT IS THEN CONSIDERED AND HANDLED AS A BAD DEBT ACCOUNT. PATIENT FINANCIAL SERVICES MAY ELECT TO SEND THE ACCOUNT TO AN OUTSIDE AGENCY, UP TO AND INCLUDING LEGAL ACTION. BAD DEBT ACCOUNTS ARE PURE SELF PAY ACCOUNTS FOR A PATIENT (GUARANTOR) WHO HAS NOT RESPONDED TO REQUESTS FOR PAYMENT. THE REQUEST FOR PAYMENT MUST MEET THE FOLLOWING CRITERIA: AT LEAST FOUR (4) CONSECUTIVE 30-DAY BILLS MUST HAVE BEEN GENERATED AND SENT WITHOUT RESPONSE FROM THE PATIENT (GUARANTOR); OR MAIL HAS BEEN RETURNED AND ALL OTHER METHODS OF CONTACTING THE PATIENT(GUARANTOR) HAVE FAILED. ONCE IT IS DETERMINED AN ACCOUNT BALANCE CANNOT BE COLLECTED BY PATIENT FINANCIAL SERVICES, THE ACCOUNT MAY BE TURNED OVER FOR COLLECTION BY AN OUTSIDE AGENCY, UP TO AND INCLUDING LEGAL ACTION. THE OUTSIDE COLLECTION AGENCY, AFTER DUE DILIGENCE, MAY DETERMINE THE BALANCE ON AN ACCOUNT CANNOT BE COLLECTED, THE ACCOUNT BALANCE MAY BE WRITTEN OFF USING THE APPROPRIATE CODE FOR THE ACCOUNT. |
| PART VI, LINE 2: | NEEDS ASSESSMENT/PROMOTION OF COMMUNITY HEALTH: SOUTHAMPTON HOSPITAL HAS AN EXTENSIVE PROGRAM OF COMMUNITY OUTREACH, COMPLEMENTED BY THE EAST END HEALTH ALLIANCE, THE HOSPITAL'S ACTIVE PARENT. COMMUNITY SERVICE PLAN INPUT IS RECEIVED FROM BOTH INTERNAL AND EXTERNAL SOURCES. NEEDS ARE ASSESSED ANNUALLY BY THE BOARD OF TRUSTEES, HOSPITAL MANAGEMENT AND STAFF, VOLUNTEERS, AND LEADERS OF LOCAL NOT-FOR-PROFIT ORGANIZATIONS AND GOVERNMENTAL AGENCIES. THE HOSPITAL HAS SIGNIFICANT REPRESENTATION ON A WIDE-RANGE OF COMMUNITY ORGANIZATIONS THAT FACILITATE INPUT FROM RESIDENTS, CORPORATE AND COMMUNITY LEADERS, PATIENTS AND ALLIED HEALTH PROFESSIONS. THESE COMMUNITY PARTNERSHIPS ARE LISTED BELOW. THE HOSPITAL PRESIDENT AND CHIEF EXECUTIVE OFFICER AND OTHER SENIOR STAFF REGULARLY MEET WITH COMMUNITY GROUPS FROM THE EAST END REGION OF LONG ISLAND TO KEEP AREA RESIDENTS INFORMED ABOUT HOSPITAL PROGRAMS AND TO RECEIVE FEEDBACK AND FIELD QUESTIONS FROM THE COMMUNITY. SOUTHAMPTON'S COMMUNITY PARTNERS INCLUDE THE FOLLOWING: A) EMERGENCY MEDICAL SQUADS (EAST HAMPTON AND SOUTHAMPTON TOWNS; INCORPORATED VILLAGES ON FOUTH FORK) B) LONG ISLAND BLOOD SERVICES C) CHAMBERS OF COMMERCE (EAST HAMPTON, SOUTHAMPTON, SAG HARBOR, WESTHAMPTON BEACH) D) LOCAL SCHOOL DISTRICTS IN THE TOWNS OF EAST HAMPTON AND SOUTHAMPTON E) LOCAL SERVICE ORGANIZATIONS (EAST HAMPTON, SOUTHAMPTON, HAMPTON BAYS) F) AMERICAN HEART ASSOCIATION G) NASSAU SUFFOLK HOSPITAL COUNCIL H) NEW YORK ORGAN DONOR NETWORK I) SOUTH FORK BREAST HEALTH COALITION J) FIGHTING CHANCE K) SUFFOLK COUNTY DEPARTMENT OF HEALTH L) SUFFOLK COUNTY OFFICE FOR THE AGING M) UNITE WAY OF LONG ISLAND THE HOSPITAL ALSO RECEIVES INPUT FROM THE COMMUNITY THROUGH HOSPITAL STAFF AND HOSPITAL TRUSTEE PARTICIPATION ON COMMUNITY SERVICE ORGANIZATIONS AND OPEN DIALOGUE WITH RESPECTED COMMUNITY LEADERS. PARTICIPATION INCLUDES: Long Island Blood Services, LI 2-Day Walk, American Cancer Society, American Heart Association, American Lung Association, American Diabetes Association, Nassau-Suffolk Care Network, Catholic Charities, Dominican Sisters Family Health Services, South Fork Community Health Initiative, East End Hospice, New York Organ Donor Network, East Hampton Healthcare Foundation, Ellen's Run, Ellen's Well, Suffolk County Department of Health Services, Suffolk County Community College, Suffolk County Office for the Aging, Family Service League, Fighting Chance, Town of East Hampton, Town of Southampton, Emergency Medical Corps, Women's Health Partnership of Long Island, Alzheimer's Foundation of Suffolk County, Rogers Memorial Library, Southampton Hampton Bays Library, Southampton Rotary, East Hampton Lions and Coalition for Women's Cancers at Southampton Hospital. IN COLLABORATION WITH THE EAST END HEALTH ALLIANCE, THE HOSPITALS HAVE ALSO USED A NUMBER OF RESOURCES TO ASSESS COMMUNITY NEED AND PROVIDED THIS INFORMATION THROUGH A NUMBER OF ORGANIZED ADVISORY BOARDS WITH PARTICIPATION FROM PHYSICIAN GROUPS THAT INCLUDE A STRATEGIC PLANNING COMMITTEE WITH REPRESENTATIVES FROM COMMUNITY TRUSTEES, LEADERSHIP FROM THE HOSPITALS' MEDICAL STAFF, PHYSICIAN TRUSTEES AND CHIEF MEDICAL OFFICERS. THE ALLIANCE ALSO HAS A CANCER ADVISORY COMMITTEE AND A CARDIAC ADVISORY COMMITTEE TO ASSESS COMMUNITY NEEDS AND RECOMMEND STRATEGIES TO ADDRESS THESE HEALTH CARE NEEDS. THE HOSPITALS HAVE PROVIDED THESE GROUPS WITH INFORMATION RELATED TO THE INCIDENCE AND PREVALENCE OF DISEASE IN THE SERVICE AREA, PREVENTABLE QUALITY INDICATORS, PATTERNS OF ACCESSING HEALTH CARE SERVICES AND USE RATES. The Cancer Committee continues to work with both primary care physicians and oncologists in supporting a robust tumor board and developing a business plan for creating improved organizational and clinical infrastructure for patients with cancer. In addition, the three Hospitals are in the process of implementation of a core clinical laboratory that will serve all three Hospital's and their affiliated physicians and nursing homes. Furthermore, the Hospital and the Alliance are working closely with the medical leadership of the three Hospitals to implement the information technology necessary to improve the clinical integration of care across the entire spectrum of health care services accessed by residents of the East End of Long Island. To that end, the Hospital and the Alliance have made a significant investment in a physician electronic medical record program (EMR), and the development of a clinical portal that will permit physicians, ancillary care providers and Hospitals to share patient information. In addition, the Hospitals are all working in a coordinated way to ensure that the Hospitals have in place the systems necessary to work with Physician EMR and to meet the requirements for meaningful use. THE HOSPITAL'S SATELLITE CARE CENTERS, INCLUDING THE SHINNECOCK INDIAN HEALTH CLINIC, THE DAVID E. ROGERS CENTER FOR HIV/AIDS CARE, THE EAST HAMPTON HEALTHCARE CENTER, AND HOSPITAL REGIONAL DIALYSIS CENTER CLOSELY COLLABORATE WITH COMMUNITY ADVISORY COMMITTEES THAT HELP WITH PLANNING AND DECISION MAKING RELATED TO THE SERVICES OFFERED. STRATEGIC PLANNING COMMITTEE: THE STRATEGIC PLANNING COMMITTEE HAS BEEN MEETING SINCE THE BEGINNING OF THE FORMATION OF THE EAST END HEALTH ALLIANCE AND ADOPTED A STRATEGIC PLAN THAT FOCUSED ON NEAR AND MID-TERM OPPORTUNITIES FOR IMPROVING MANAGEMENT EFFICIENCIES AND STRATEGIES FOR WORKING MORE CLOSELY WITH OUR RESPECTIVE PHYSICIAN COMMUNITIES. THE STRATEGIES IDENTIFIED IN THE FIRST STRATEGIC PLAN ARE WELL ON THEIR WAY TO COMPLETION. THE HOSPITAL'S STRATEGIC PLANNING COMMITTEE CONTINUES TO ROUTINELY ASSESS THE HEALTH CARE NEEDS OF THE COMMUNITY SERVED BY THE HOSPITAL AND ITS AFFILIATED MEDICAL STAFFS BASED ON PUBLICALLY AVAILABLE INFORMATION, INCLUDING THE ANALYSIS OF THE FOLLOWING INFORMATION: A) SPARCS DATA B) PREVENTION QUALITY INDICATORS C) REPORT EVALUATIONS - LOCAL, STATE AND FEDERAL AGENCIES D) PATIENT SATISFACTION SURVEYS E) INDUSTRY JOURNALS AND NEWSLETTERS F) TRENDS IN HEALTHCARE JOURNALS AND PERIODICALS THE HOSPITAL'S EXTENSIVE OUTREACH ALSO INCLUDES PARTICIPATION IN VARIOUS PROGRAMS SPONSORED BY COMMUNITY ORGANIZATIONS INCLUDING SCHOOL HEALTH FAIRS, SENIOR CITIZEN CENTERS, SERVICE ORGANIZATIONS (ROTARY, KIWANIS, LIONS, ELKS), NEW YORK ORGAN DONOR NETWORK, LECTURES AT LOCAL LIBRARIES, AND FUNDRAISING EVENTS. RECENT EXAMPLES INCLUDE: LI2-DAY WALK (IN SUPPORT OF BREAST CANCER), ELLEN'S RUN (IN SUPPORT BREAST CANCER), DIABETES LECTURE AT EAST HAMPTON NUTRITION CENTER, FLU IMMUNIZATION, AND BLOOD DONATION DRIVES. VARIOUS WELLNESS PROGRAMS THROUGH THE HOSPITAL'S ED & PHYLLIS DAVIS WELLNESS INSTITUTE IN SOUTHAMPTON, HAMPTON BAYS, AND MONTAUK INCLUDE SMOKING CESSATION, NUTRITIONAL AND WEIGHT LOSS COUNSELING, DIABETES MANAGEMENT, MIND-BODY, CANCER AND CARDIAC WELLNESS, FUNCTIONAL FITNESS FOR SENIORS, SUPPORT SERVICES FOR HIV/AIDS, STRESS MANAGEMENT, MASSAGE THERAPY AND VARIOUS EXERCISE CLASSES. THE HOSPITAL'S "IMPORTANT MEDICAL INFORMATION" (VIAL OF LIFE) PROGRAM HAS REACH THOUSANDS OF COMMUNITY MEMBERS WITH MEDICAL CONCERNS THROUGH LOCAL EMERGENCY MEDICAL SERVICE ORGANIZATIONS, PHYSICIAN OFFICES, AND HOSPITAL DISTRIBUTION. ASSESSMENT OF PUBLIC HEALTH PRIORITIES: Southampton Hospital participated in the collaborative planning process with the Suffolk County Department of Health, the two other Alliance Hospitals, and community partners to assess community health needs and identified the following health priorities: smoking cessation and fall prevention. While the County Health Department has not organized additional coordinated meetings, Southampton Hospital continues the Hospital's focus on addressing these two health priorities through the following initiatives: 2012/2013 SMOKING CESSATION UPDATE: DECREASE TOBACCO USE A) THE HOSPITAL'S SMOKE FREE CAMPUS PROGRAM WENT INTO EFFECT ON NOVEMBER 18, 2010; B) THE HOSPITAL PROVIDES TAILORED SMOKING CESSATION COUNSELING FOR PATIENTS THROUGH THE HOSPITAL'S RESPIRATORY THERAPY DEPARTMENT AND ITS ED AND PHYLLIS DAVIS WELLNESS INSTITUTE; C) THE HOSPITAL PROVIDES NICOTINE WITHDRAWAL TO PATIENTS WHO SMOKE; D) THE HOSPITAL RUNS A SMOKING CESSATION PROGRAM FOR BOTH HOSPITAL EMPLOYEES AND THE PUBLIC AT LARGE; AND E) THE HOSPITAL ALSO HAS A SIGNIFICANT OUTREACH PROGRAM AIMED AT SMOKING CESSATION, PROVIDING INFORMATION THROUGH DISSEMINATION OF POSTERS, SIGNAGE, AND PUBLIC INFORMATION THROUGH PRESS RELEASES, PUBLIC SERIVCE ANNOUNCEMENTS, AND THE HOSPITAL'S WEBSITE. 2012/2013 FALL PREVENTION UPDATE: A) IN OCTOBER 2009, SOUTHAMPTON HOSPITAL WAS RECOGNIZED BY NASSAU SUFFOLK HOSPITAL COUNCIL WITH AN AWARD FOR OUR PROGRAM "ORGANIZATIONAL APPROACH TO FALL PREVENTION;" B) IN 2010, SOUTHAMPTON WAS ASKED BY THE INSTITUTE FOR HEALTHCARE IMPROVEMENT (IHI) TO BE A MENTOR TO OTHER HOSPITALS IN THE AREA OF FALLS PREVENTION; AND, C) OUTCOME: IN 2009, WE FURTHER DECREASED (IN LEVEL 2 OR ABOVE) INJURIES BY 50% (ONLY ONE FALL RESULTED IN AN INJURY OF LEVEL 2 OR ABOVE); PLUS AN ADDITIONAL DECREASE IN THE NUMB |
| PART VI, LINE 3: | FINANCIAL AID PROGRAM: SOUTHAMPTON HOSPITAL'S COMMITMENT AND DETERMINATION TO PROVIDE QUALITY HEALTHCARE AT AFFORDABLE RATES HAS LEAD US TO DESIGN A CHARITY CARE PROGRAM THAT GOES "ABOVE AND BEYOND" THE EXPECTATIONS AND MINIMUM REQUIREMENTS SET FORTH BY NEW YORK STATE LAW. IT IS THE HOSPITAL'S "ABOVE AND BEYOND" ATTITUDE THAT IS OUR PROGRAMS GREATEST STRENGTH AND CAN BEST BE SEEN IN OUR POLICY TO PROVIDE CHARITY CARE DISCOUNTED RATES TO PATIENTS MAKING UP TO 400% OF THE FEDERAL POVERTY LEVEL GUIDELINE (FPG) RATHER THAN THE MINIMUM REQUIREMENT OF 300% FPG. IN ADDITION, THE HOSPITAL INCLUDES A FORM TO APPLY FOR CHARITY CARE IN EVERY SELF-PAY BILL TO BE RETURNED TO PATIENT FINANCIAL SERVICES. SELF-PAY PATIENTS ARE GIVEN A 70% DISCOUNT OF CHARGES, AS WELL. SOUTHAMPTON HOSPITAL CONTINUES TO FACE FINANCIAL CHALLENGES INCLUDING CONTINUED REDUCTIONS IN NEW YORK STATE AND FEDERAL REIMBURSEMENT RATES AT THE SAME TIME THAT HOSPITAL FACES THE INCREASING COST OF PROVIDING CARE, INCLUDING DOUBLE DIGIT EXPENSES INCREASES IN SOME CATEGORIES. WHILE THE HOSPITAL WAITS TO UNDERSTAND THE IMPACT ON ITS CHARITY POLICIES THAT MAY RESULT FROM EXPANDING RESIDENT ACCESS TO HEALTH CARE INSURANCE THAT IS PART OF HEALTH CARE REFORM, THE HOSPITAL REMAINS CONCERNED THAT A SIGNIFICANT PART OF THE INDIGENT CARE THE HOSPITAL PROVIDES TO UNDOCUMENTED WORKERS WILL NOT BE COVERED. |
| PART VI, LINE 4: | SOUTHAMPTON'S SERVICE AREA EXTENDS FROM MONTAUK TO THE EAST TO WESTHAMPTON BEACH TO THE WEST AND THE SOUTHERN AREA OF RIVERHEAD IN THE CENTER OF THE EAST END OF LONG ISLAND. THE SERVICE AREA ACCOUNTS FOR APPROXIMATELY EIGHT-FIVE (85) PERCENT OF TOTAL ADMISSIONS TO THE HOSPITAL AND INCLUDES THE FOLLOWING ZIP CODES: EAST HAMPTON (11937); BRIDGEHAMPTON (11932); SOUTHAMPTON (11968); HAMPTON BAYS (11946); SAG HARBOR (11963); SAGAPONACK (11962); MONTAUK (11954); RIVERHEAD (11901); EAST QUOGUE (11942); QUOGUE (11959); REMSENBURG (11960); WATER MILL (11976); WESTHAMPTON BEACH (11978); AND WESTHAMPTON (11977). AS THE TABLE BELOW INDICATES, THIS SERVICE AREA HAS A YEAR ROUND POPULATION OF APPROXIMATELY 85,000 RESIDENTS. THE AREA IS PROJECTED TO SEE A SIGNIFICANT INCREASE IN POPULATION, MORE THAN 4 PERCENT OVER THE NEXT FIVE YEARS. DEMOGRAPHIC CHARACTERISTICS SELECTED AREA USA 2010 TOTAL POPULATION............64,886............308,745,538 2013 TOTAL POPULATION............65,894............314,861,807 2018 TOTAL POPULATION............67,518............325,322,277 % CHANGE 2013 - 2018...............2.5%...................3.3% AVERAGE HOUSEHOLD INCOME.......$120,403................$69,637 THE POPULATION ON THE HOSPITAL'S SERVICE AREA, A RESORT DESTINATION, MORE THAN DOUBLES DURING THE SUMMER SEASON WHEN TOURISTS FROM ALL OVER THE WORLD VISIT THE SOUTH FORK OF LONG ISLAND. AS A RESULT, DEMAND FOR SOUTHAMPTON HOSPITAL SERVICES INCREASES SIGNIFICANTLY DURING THE SUMMER, IN PARTICULAR DEMAND FOR THE HOSPITAL'S EMERGENCY SERVICES. THE HOSPITAL HAS RESPONDED TO THIS NEED BY MAKING A CAPITAL INVESTMENT IN EXPANDING AND RENOVATING THE EMERGENCY DEPARTMENT AND IMPLEMENTING A STATE-OF-THE-ART EMERGENCY DEPARTMENT INFORMATION SYSTEMS THAT PERMITS THE HOSPITAL TO TRACK PATIENTS, AND READ AND INTERPRET LABORATORY AND RADIOLOGICAL RESULTS. AS THE TABLE BELOW INDICATES, THE SERVICE AREA HAS A SIGNIFICANT PERCENTAGE OF THEIR POPULATION AGED FIFTY-FIVE (55) AND OVER, A POPULATION THAT HAS GREATER NEED FOR HEALTH CARE SERVICES. AGE DISTRIBUTION: USA 2013 AGE GROUP 2013 % OF TOTAL 2018 % OF TOTAL % OF TOTAL 0-14 10,712 16.3% 10,873 16.1% 19.6% 15-17 2,428 3.7% 2,432 3.6% 4.1% 18-24 5,040 7.6% 5,286 7.8% 10.0% 25-34 7,166 10.9% 7,186 10.6% 13.1% 35-54 18,372 27.9% 17,100 25.3% 26.9% 55-64 9,689 14.7% 10,656 15.8% 12.4% 65+ 12,487 19.0% 13,985 20.7% 13.9% TOTAL 65,894 100.0% 67,518 100.0% 100.0% THERE ARE NO FIRM ESTIMATES OF THE NUMBER OF MIGRANT AGRICULTURAL WORKERS THAT COME INTO THIS AREA. AGRICULTURE IS ONE OF SUFFOLK COUNTY'S LEADING INDUSTRIES. ITS SUCCESS RELIES ON WORKERS WHO MOVE THROUGH THE EASTERN UNITED STATES IN RESPONSE TO THE AVAILABILITY OF SEASONAL WORK. SOUTHAMPTON HOSPITAL RECOGNIZES THAT THIS POPULATION PRESENTS SERIOUS HEALTH PROBLEMS AND IS COMMITTED TO PROVIDING CARE FOR ITS CULTURALLY DIVERSE PATIENT POPULATION. MANY OF THESE INDIVIDUALS ARE UNINSURED AND UNABLE TO SPEAK ENGLISH. THEY RELY ON THE HOSPITAL'S EMERGENCY DEPARTMENT, AS WELL AS THE SUFFOLK COUNTY HEALTH CLINIC, LOCATED ON THE HOSPITAL'S CAMPUS, FOR HEALTH CARE. AS ARESULT, THE HOSPITAL'S OFFICE OF CULTURAL DIVERSITY PROVIDES TRANSLATION AND INTERPRETATION SERVICES, AS WELL AS COUNSELING ON MEDICAL INSURANCE AND BILLING FOR THOSE INDIVIDUALS WHO DO NOT SPEAK ENGLISH. THE HOSPITAL PROVIDES BI-LINGUAL PUBLICATIONS AND SIGNAGE AND ACTIVELY ASSISTS THE CULTURALLY DIVERSE COMMUNITIES IT CARES FOR. RACE/ETHNICITY: RACE/ETHNICITY DISTRIBUTION RACE/ETHNICITY 2013 POP % OF TOTAL USA % OF TOTAL WHITE NON-HISPANIC 45,825 69.5% 62.3% BLACK NON-HISPANIC 1,872 2.8% 12.3% HISPANIC 15,879 24.1% 17.3% ASIAN & PACIFIC IS. 855 1.3% 5.1% ALL OTHERS 1,463 2.2% 2.9% TOTAL 70,978 100.0% 100.0% |
| PART VI, LINE 5: | SOUTHAMPTON HOSPITAL SPONSORS "FOCUS ON SOUTHAMPTON HOSPITAL" ON SEA-TV, A MONTHLY PUBLIC ACCESS INTERVIEW PROGRAM FOR THE TOWNS OF EAST HAMPTON AND SOUTHAMPTON THAT COVERS HEALTH-RELATED INFORMATION OF INTEREST TO THE COMMUNITY AND PROVIDES INFORMATION ON HEALTHCARE SERVICES AVAILABLE AT SOUTHAMPTON HOSPITAL. THE HOSPITAL HAS DEVELOPED NUMEROUS SERVICES AND OUTREACH TO RESPOND TO THE NEEDS OF THESE PATIENTS, INCLUDING RECRUITING ADDITIONAL PRIMARY CARE PHYSICIANS AND IMPLEMENTING A GRADUATE MEDICAL EDUCATION PROGRAM THAT WILL HOPEFULLY ATTRACT THESE YOUNG PHYSICIANS TO STAY AND PRACTICE IN THE COMMUNITY. THE HOSPITAL'S WEBSITE, WWW.SOUTHAMPTONHOSPITAL.ORG, PROVIDES INFORMATION ON HOSPITAL SERVICES, SPECIAL PROGRAMS AND EVENTS. THE SITE ENABLES PATIENTS TO FIND PHYSICIANS IN DIFFERENT SPECIALTIES, ALLOWS ON-LINE INQUIRIES THAT ARE ANSWERED DAILY, AND PROVIDES ACCESS TO AVAILABLE EMPLOYMENT OPPORTUNITY AND JOB APPLICATIONS. SERVICES FOR SHORT-TERM AND LONG-TERM CARE FOR CHRONIC AND ACUTE ILLNESS ARE CONTINUALLY EVALUATED THROUGH STATISTICAL DATA THAT INCLUDE QUALITY INDICATORS AND PATIENT OUTCOMES. THIS DATA IS COMPARED NATIONALLY WITH OTHER HEALTH FACILITIES AND INFORMS THE HOSPITAL'S STRATEGIC PLAN AND COMMUNITY SERVICE PLAN. THE HOSPITAL'S STRATEGIC PLANNING COMMITTEE INCLUDES COMMUNITY MEMBERS, HOSPITAL STAFF AND HOSPITAL AND FOUNDATION BOARD MEMBERS WHO WORK COLLABORATIVELY TO ASSESS COMMUNITY NEEDS AND DEVELOP STRATEGIES TO MEET THESE NEEDS. THE HOSPITAL'S PUBLIC AFFAIRS COMMITTEE IS RESPONSIVE TO COMMUNITY INTERESTS AND CONCERNS. MEMBERSHIP IS A CROSS-SECTION OF PHYSICIANS, HOSPITAL MANAGEMENT, BOARD MEMBERS AND HOSPITAL EMPLOYEES. BASED ON THE HOSPITAL'S ASSESSMENT OF INTEREST IN THE COMMUNITY, A NUMBER OF HEALTH LECTURES AND PROGRAMS ARE PROVIDED THROUGHOUT THE YEAR. THESE PROGRAMS ARE SOMETIMES SPONSORED THROUGH OUR PARTNERSHIPS WITH LOCAL ORGANIZATIONS INCLUDING FIGHTING CHANCE, NEW YORK ORGAN DONOR NETWORK, COMMUNITY LIBRARIES, AND SERVICE CLUBS (LIONS, KIWANIS, ELKS). THE 2013 OUTREACH SCHEDULE INCLUDED THE FOLLOWING PROGRAMS AT: SOUTHAMPTONS ROGERS MEMORIAL LIBRARY STRESS REDUCTION, MIGRAINE HEADACHE BRIDGEHAMPTONS HAMPTON LIBRARY HEALING POWER OF THERAPEUTIC MASSAGE, MENOPAUSE AND BEYOND, KIDNEY HEALTH WESTHAMPTON FREE LIBRARY KIDNEY HEALTH, BENEFITS OF TAI CHI, EYE DISEASE AND THE AGING, DIABETES, WOMENS HEALTH, FOOT AND HEEL PAIN, VASCULAR DISEASE PUBLIC INFORMATION: SOUTHAMPTON HOSPITAL UNDERSTANDS THE IMPORTANCE OF EDUCATING THE COMMUNITY ABOUT ITS AVAILABLE SERVICES. BROCHURES DETAILING THESE SERVICES ARE DISTRIBUTED AND DISPLAYED ON EVERY FLOOR OF THE HOSPITAL, AT COMMUNITY AND SCHOOL HEALTH FAIRS, AND AT HOSPITAL SATELLITE FACILITIES AND PHYSICIAN OFFICES ACROSS THE SOUTH FORK. IN ADDITION, THIS INFORMATION, ALONG WITH THE HOSPITALS 2013 COMMUNITY SERVICE PLAN, IS AVAILABLE ON THE HOSPITALS WEBSITE, WWW.SOUTHAMPTONHOSPITAL.ORG. |
| GENERAL INFORMATION: | PATIENT SATISFACTION SURVEYS: IN ADDITION, SOUTHAMPTON HOSPITAL CONTINUALLY SOLICITS PATIENT INPUT THROUGH ITS PATIENT SATISFACTION SURVEY PROCESS, WHICH INCLUDES EVERY INPATIENT, AMBULATORY SURGERY PATIENT AND EMERGENCY ROOM PATIENT. THE DATA COLLECTED FROM THESE COMPREHENSIVE SURVEYS PROVIDES VALUABLE INFORMATION ON A WIDE RANGE OF QUALITY INDICATORS AND AREAS OF INTEREST TO THE HOSPITAL'S PATIENTS. RESULTS FROM THESE SURVEYS ARE REGULARLY DISTRIBUTED TO HOSPITAL AND MEDICAL STAFFS AND THE BOARD OF DIRECTORS. THE QUALITY MANAGEMENT AND PUBLIC AFFAIRS DEPARTMENTS, AS WELL AS THE OFFICE OF THE PRESIDENT, CAREFULLY REVIEW CORRESPONDENCE FROM PATIENTS AND THE COMMUNITY AT LARGE. A MEMBER OF THE HOSPITAL STAFF PERSONALLY ANSWERS ALL CORRESPONDENCE. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Housing Allowance Or Residence | Yes (X) | HousingAllowanceOrResidenceInd |
| Written Policy Ref T And E Expnss | Yes (true) | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | Yes (true) | SubstantiationRequiredInd |
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | false | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (10 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ROBERT S CHALONER | ||||||||||||||
| PRESIDENT & CEO | $510,000 | $0 | $108,035 | $0 | $47,367 | $0 | $15,300 | $0 | $22,716 | $0 | $703,418 | $0 | $0 | $0 |
| CHIRSTOPHER J SCHULTHEIS | ||||||||||||||
| CHIEF FINANCIAL OFFICER | $229,645 | $0 | $46,000 | $0 | $229 | $0 | $13,987 | $0 | $22,716 | $0 | $312,577 | $0 | $0 | $0 |
| FREDERIC I WEINBAUM | ||||||||||||||
| CHIEF MEDICAL OFFICER & COO | $395,389 | $0 | $54,996 | $0 | $35,004 | $0 | $15,300 | $0 | $24,489 | $0 | $525,178 | $0 | $0 | $0 |
| PATRICIA A DARCEY | ||||||||||||||
| CHIEF NURSING OFFICER | $198,958 | $0 | $0 | $0 | $780 | $0 | $12,047 | $0 | $24,489 | $0 | $236,274 | $0 | $0 | $0 |
| MICHAEL ISRAEL MD | ||||||||||||||
| PHYSICIAN/TRUSTEE | $189,126 | $0 | $0 | $17,708 | $0 | $11,400 | $0 | $9,413 | $0 | $227,647 | $0 | $0 | $0 | |
| GEORGE KECKEISEN | ||||||||||||||
| PHYSICIAN | $298,174 | $0 | $60,000 | $0 | $1,172 | $0 | $15,300 | $0 | $24,489 | $0 | $399,135 | $0 | $0 | $0 |
| EDNA KAPENHAS | ||||||||||||||
| DIRECTOR, BREAST SURGEON | $399,036 | $0 | $0 | $0 | $374 | $0 | $15,300 | $0 | $22,716 | $0 | $437,426 | $0 | $0 | $0 |
| STEVEN GEOROGPOULOS | ||||||||||||||
| PHYSICIAN | $557,674 | $0 | $0 | $0 | $36,398 | $0 | $11,232 | $0 | $24,489 | $0 | $629,793 | $0 | $0 | $0 |
| KRISTIN P NASO | ||||||||||||||
| MEDICAL STAFF PHYSICIAN | $498,185 | $0 | $0 | $0 | $48,596 | $0 | $13,882 | $0 | $24,489 | $0 | $585,152 | $0 | $0 | $0 |
| SHAWN CANNON | ||||||||||||||
| PHYSICIAN/GME PROGRAM ADMIN. | $304,907 | $0 | $0 | $0 | $8,403 | $0 | $12,500 | $0 | $22,716 | $0 | $348,526 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 1A: | THE SOUTHAMPTON HOSPITAL ASSOCIATION PROVIDES THE FOLLOWING SPECIAL ALLOWANCES/PERQUISITES TO THE PRESIDENT & CEO, AS WELL AS TO CERTAIN KEY EXECUTIVES. THESE ALLOWANCES FOR HOUSING AND AUTOMOBILE ARE STIPULATED IN THE EXECUTIVES EMPLOYMENT AGREEMENT/TERMS AT TIME OF HIRE. ALL PAYMENTS OF THESE PERQUISITES ARE MADE ON A BI-WEEKLY BASIS WITH THE EMPLOYEE'S REGULAR PAYCHECK AND THEY ARE MADE IN ACCORDANCE WITH THE GUIDELINES OF A NON-ACCOUNTABLE EXPENSE PLAN. ANNUAL ALLOWANCES ARE AS LISTED BELOW: ROBERT CHALONER, PRESIDENT & CEO - Housing Allowance: $38,000. Auto Allowance: $6,461. THE SOUTHAMPTON HOSPITAL ASSOCIATION PURCHASED A CAR FOR THE PRESIDENT & CEO IN OCTOBER 2013. THERE WAS A TAXABLE FRINGE BENEFIT OF $10,672 REPORTED. FREDRIC WEINBAUM, MD, EVP, COO & CMO - Housing Allowance: $30,000. Auto Allowance: $7,000. |
| PART II, COLUMN (B)(II): | THE PRESIDENT & CEO, EXECUTIVE VICE PRESIDENT/CHIEF MEDICAL OFFICER, AND CFO OF SOUTHAMPTON HOSPITAL WERE ELIGIBLE FOR A PERFORMANCE BONUS IN 2013 WHICH WAS BASED UPON CRITERIA THAT THE EXECUTIVE COMMITTEE OF THE BOARD ESTABLISHED. THE PRESIDENT & CEO'S BONUS IS AN ANNUAL BONUS SET FORTH IN HIS EMPLOYMENT AGREEMENT AND IS DETERMINED AFTER A REVIEW OF HOW WELL HE PERFORMED IN THE PRIOR YEAR AGAINST GOALS AND OBJECTIVES ESTABLISHED BY THE EXECUTIVE COMMITTEE. THE EXECUTIVE VICE PRESIDENT/CHIEF MEDICAL OFFICER AND CFO WERE AWARDED A PERFORMANCE BONUS BASED UPON THE RECOMMENDATION OF THE PRESIDENT & CEO AS WELL AS A REVIEW OF THEIR PERFORMANCE AGAINST GOALS AND OBJECTIVES ESTABLISHED BY THE PRESIDENT AND THE EXECUTIVE COMMITTEE. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINES 6, 7A AND 7B: | THE ORGANIZATION'S SOLE MEMBER IS EAST END HEALTH ALLIANCE, A NOT-FOR-PROFIT CORPORATION THAT CAN ELECT ONE OR MORE MEMBERS OF THE HOSPITAL'S GOVERNING BODY. THE EAST END HEALTH ALLIANCE, THE ARTICLE 28 PARENT OF EASTERN LONG ISLAND HOSPITAL, PECONIC BAY MEDICAL CENTER AND SOUTHAMPTON HOSPITAL, WAS CREATED IN RESPONSE TO THE RECOMMENDATIONS OF THE COMMISSION ON HEALTH CARE IN THE 21ST CENTURY. CONSISTENT WITH THE MISSION OF SOUTHAMPTON HOSPITAL, THE GOALS OF THE ALLIANCE ARE AS FOLLOWS: A) TO COLLABORATIVELY DEVELOP HIGH QUALITY, COMPREHENSIVE AND ACCESSIBLE HEALTH CARE SERVICES TO MEET THE NEEDS OF THE COMMUNITY SERVED; B) TO RATIONALIZE HEALTH CARE SERVICES ACROSS THE SYSTEM; AND C) TO REALIZE MANAGEMENT EFFICIENCIES. THE FOLLOWING DECISIONS MADE BY THE GOVERNING BODY OF SOUTHAMPTON HOSPITAL REQUIRE EAST END HEALTH ALLIANCE APPROVAL: ADOPTION OF OPERATING BUDGETS, APPLICATION FOR NEW CERTIFICATES OF NEED, AND CERTAIN BORROWING TRANSACTIONS. |
| FORM 990, PART VI, SECTION B, LINE 11B: | SOUTHAMPTON HOSPITAL ASSOCIATION HAS ITS FORM 990 PREPARED BY AN OUTSIDE ACCOUNTING FIRM AND HAS ESTABLISHED THE FOLLOWING REVIEW PROCESS TO ENSURE THAT THE INFORMATION REPORTED IS COMPLETE AND ACCURATE. UPON COMPLETION, THE FORM 990 IS REVIEWED BY MANAGEMENT AND IS THEN FORWARDED ELECTRONICALLY TO THE MEMBERS OF THE BOARD OF TRUSTEES FOR THEIR REVIEW. ANY QUESTIONS OR ISSUES ARE THEN ADDRESSED BY THE APPROPRIATE PARTIES PRIOR TO THE FILING OF THE RETURN. |
| FORM 990, PART VI, SECTION B, LINE 12C: | SOUTHAMPTON HOSPITAL CURRENTLY HAS A CONFLICT OF INTEREST POLICY AND A PROCEDURE FOR ANNUAL DISCLOSURE BY KEY EMPLOYEES, PHYSICIAN LEADERS, AND SENIOR MANAGEMENT. WHEN NEW/POTENTIAL CONFLICTS/RELATIONSHIPS ARE IDENTIFIED, THEY ARE INVESTIGATED BY THE CORPORATE COMPLIANCE OFFICER AND ANY RECOMMENDATIONS AND/OR CORRECTIVE ACTIONS ARE PRESENTED TO THE PRESIDENT AND CEO. AS APPROPRIATE, THESE POTENTIAL CONFLICTS/DISCLOSURES ARE ALSO REVIEWED WITH THE CFO AND MEDICAL DIRECTOR/COO. WHEN A POTENTIAL CONFLICT IS IDENTIFIED, THE STAFF MEMBER IS PROHIBITED FROM TAKING PART IN ANY HOSPITAL DECISIONS THAT MAY RELATE TO THE INTEREST OR RELATIONSHIP, UNTIL THE REVIEW IS COMPLETED AND A DETERMINATION IS MADE THAT THERE IS NO CONFLICT. SIMILARLY, ON AN ANNUAL BASIS, ALL MEMBERS OF THE BOARD OF DIRECTORS ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST FORM. ALL POTENTIAL CONFLICTS OF INTEREST THAT MAY EXIST MUST BE DISCLOSED. IF A POTENTIAL OR ACTUAL CONFLICT OF INTEREST EXISTS, THE AFFECTED MEMBER WILL BE NOTIFIED AND THE EXECUTIVE COMMITTEE OF THE BOARD WILL INVESTIGATE AND MAKE THE DETERMINATION AS TO WHAT, IF ANY RECUSAL OR OTHER CORRECTIVE ACTION MAY BE REQUIRED TO AVOID ANY POTENTIAL CONFLICT. THE RESULTS OF THE INVESTIGATION WILL THEN BE REPORTED TO THE GOVERNING BODY. IF AN ACTUAL CONFLICT OF INTEREST EXISTS, THE AFFECTED MEMBER WILL BE NOTIFIED OF THIS DETERMINATION AND THEIR PARTICIPATION IN RELATED MATTERS AND/OR VOTING RIGHTS, PERTAINING TO THE AREA OF CONFLICT, WILL BE RELINQUISHED. |
| FORM 990, PART VI, SECTION B, LINES 15A AND 15B: | SOUTHAMPTON HOSPITAL HAS ESTABLISHED AN EXECUTIVE COMPENSATION POLICY WHICH SETS FORTH THE TERMS AND CRITERIA FOR THE REVIEW OF THE COMPENSATION OF THE PRESIDENT & CEO, THE CHIEF MEDICAL OFFICER/COO AND THE VICE PRESIDENT OF FINANCE/CFO AS WELL AS OTHER EXECUTIVE LEADERS. THE POLICY OUTLINES THE PROCEDURES AND CRITERIA THE EXECUTIVE COMMITTEE WILL FOLLOW IN EVALUATING THE CEO'S, THE CMO/COO'S, AND THE CFO'S PERFORMANCE AGAINST ESTABLISHED GOALS. IT ALSO OUTLINES THE EXECUTIVE COMMITTEES' ROLE AND RESPONSIBILITY IN DETERMINING ALL ASPECTS OF THE CEO'S, CHIEF MEDICAL OFFICER/COO'S, AND CFO'S COMPENSATION INCLUDING ANY INCENTIVE OR BONUS COMPENSATION. THE COMMITTEE REVIEWS CONTRACT TERMS WHICH COVER COMPENSATION AND BENEFITS INCLUDING, BUT NOT LIMITED TO, HOUSING ALLOWANCES, AUTOMOBILE ALLOWANCES, SEVERANCE OR CHANGE OF CONTROL PAYMENTS. ON A PERIODIC BASIS, THE EXECUTIVE COMMITTEE MEETS TO REVIEW THE TERMS OF COMPENSATION AND REVIEWS EXTERNAL COMPENSATION DATA AND STUDIES TO ENSURE THAT COMPENSATION DECISIONS ARE REASONABLE AND CONSISTENT WITH FAIR MARKET VALUE. THE COMMITTEE DOCUMENTS THE FULL TERMS OF COMPENSATION APPROVED AND INCLUDES DATE OF THE DECISION, DETAILS OF THE COMPARABILITY DATA OBTAINED AND RELIED UPON, AND HOW THE DATA WAS OBTAINED. MEMBERS OF THE EXECUTIVE COMMITTEE MUST BE FREE FROM ANY CONFLICT OF INTEREST THAT MAY RELATE TO THE ARRANGEMENT. ALL MEMBERS OF THE COMMITTEE WHO WERE PRESENT DURING THE DISCUSSION OF THE ARRANGEMENT WILL BE DOCUMENTED IN THE MEETING MINUTES ALONG WITH THEIR VOTES. THE COMPENSATION REVIEW PROCESS FOR THE PRESIDENT & CEO, CHIEF MEDICAL OFFICER AND CFO WAS LAST UNDERTAKEN JULY 2, 2013. |
| FORM 990, PART VI, SECTION C, LINE 19: | SOUTHAMPTON HOSPITAL'S FORM 990, AS WELL AS ITS FINANCIAL STATEMENTS AND CONFLICT OF INTEREST POLICY, ARE AVAILABLE FOR PUBLIC INSPECTION UPON REQUEST, AS REQUIRED UNDER SECTION 6104 OF THE INTERNAL REVENUE CODE. INTERESTED PARTIES MAY REQUEST THE DOCUMENTS AT 240 MEETINGHOUSE LANE, SOUTHAMPTON, NY 11968 OR BY CALLING THE ORGANIZATION DIRECTLY AT (631)726-8200. |
| FORM 990, PART XI, LINE 9: | SHA PROPERTIES INCOME............$203,227. SHA PROPERTIES EXPENSES..........$(129,491.) PENSION OBLIGATION...............$7,435,564. PHILLIPS CHARITABLE REMAINDER TRUST DISTRIBUTION............$(5,500,000.) CHARITABLE TRUST REALIZED GAINS.........................$821,708. TOTAL............................$2,831,008. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|
| SOUTHAMPTON CARE CENTER | |||||||||
| 240 MEETING HOUSE LANE | SOUTHAMPTON | NY | 11968 | 112658403 | NURSING HOME | NY | 501(c)(3) | 9 | false |
| THE SOUTHAMPTON HOSPITAL FOUNDATION | |||||||||
| 240 MEETING HOUSE LANE | SOUTHAMPTON | NY | 11968 | 113466516 | SRVC PROVIDER | NY | 501(C)(3) | 7 | false |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (3 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Entity TypeEntityTypeTxt | Share Of Total IncomeShareOfTotalIncomeAmt | Share Of EOY AssetsShareOfEOYAssetsAmt | OwnershipOwnershipPct | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MEETINGHOUSE LANE MEDICAL PRACTICE | ||||||||||||
| PO BOX 2340 | SOUTHAMPTON | NY | 11968 | 208853938 | PATIENT CARE | NY | NA | C | $397,159 | $1,847,515 | 1.00000 | Yes (true) |
| SHA PROPERTIES | ||||||||||||
| 240 MEETING HOUSE LANE | SOUTHAMPTON | NY | 11968 | 112563612 | REAL ESTATE | NY | NA | C | $203,227 | $2,488,506 | 1.00000 | Yes (true) |
| OLD TOWN MEDICAL PRACTICE PC | ||||||||||||
| 240 MEETING HOUSE LANE | SOUTHAMPTON | NY | 11968 | 452430883 | MEDICAL PRACT | NY | NA | C | $0 | $0 | 1.00000 | Yes (true) |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (true) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | Yes (true) | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | Yes (true) | LoansOrGuaranteesFromOthOrgInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (true) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (true) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (true) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp
Other Organization Name OtherOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SHA PROPERTIES | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | E | TransactionTypeTxt |
| Involved | $1,771,136 | InvolvedAmt |
| Method Of Amount Determination | FMV | MethodOfAmountDeterminationTxt |