2014-11-17T15:24:42-06:00 2013-12-31 BDO USA LLP 100 PARK AVENUE NEW YORK NY 10017 990 2013-01-01 111667765 SOUTHAMPTON HOSPITAL ASSOCIATION % CHRISTOPHER SCHULTHEIS SOUT 6317268301 240 MEETING HOUSE LANE Suite SOUTHAMPTON NY 11968 ROBERT S CHALONER PRESIDENT/CEO 6317268301 2014-11-17 true Paul Hammerschmidt P01384178 6317268301 2013 2015-11-30 17:44:51Z ROBERT S CHALONER 240 MEETING HOUSE LANE SOUTHAMPTON NY 11968 142460725 false X www.southamptonhospital.org X 1909 NY TO PROVIDE AND ENSURE THE HIGHEST QUALITY OF HEALTHCARE SERVICES FOR ITS ENTIRE COMMUNITY. 25 24 1168 26 2365572 -62307 8661471 14246386 111096334 118993172 540384 4569836 686898 983671 120985087 138793065 0 0 0 0 75775431 81639605 0 0 0 42354547 46682031 118129978 128321636 2855109 10471429 97667974 106330964 89364891 83493537 8303083 22837427 X THE VISION OF SOUTHAMPTON HOSPITAL ASSOCIATION IS TO MEET THE EVOLVING HEALTHCARE NEEDS OF ITS EASTERN LONG ISLAND COMMUNITY BY PROVIDING ACCESS TO A CONTINUUM OF HIGH QUALITY CLINICAL SERVICES. TO ACHIEVE THIS, THE HOSPITAL WILL FOCUS RESOURCES ON CONTINUOUSLY IMPROVING CLINICAL OUTCOMES, PATIENT SAFETY, SERVICE EXCELLENCE AND PROMOTING EDUCATIONAL OUTREACH AND PROFESSIONAL DEVELOPMENT OF ITS STAFF. THE ORGANIZATION IS A MEMBER OF THE EAST END HEALTH ALLIANCE, THE ARTICLE 28 PARENT OF EASTERN LONG ISLAND HOSPITAL, PECONIC BAY MEDICAL CENTER AND SOUTHAMPTON HOSPITAL. CONSISTENT WITH THE MISSION OF THE ORGANIZATION, THE GOALS OF THE ALLIANCE ARE AS FOLLOWS: 1) TO COLLABORATIVELY DEVELOP HIGH QUALITY, COMPREHENSIVE AND ACCESSIBLE HEALTH CARE SERVICES TO MEET THE NEEDS OF THE COMMUNITY SERVED; 2) TO RATIONALIZE HEALTH CARE SERVICES ACROSS THE SYSTEM; AND 3) TO REALIZE MANAGEMENT EFFICIENCIES. THE ORGANIZATION IS ALSO AFFILIATED WITH STONY BROOK MEDICINE, ALONG WITH THE OTHER TWO EAST END false false 108802332 0 118993172 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. 108802332 true true false true false false false false false true true true false false true true false true false false false false false false false false true true false false true false false false false false false false false false false false false false true true true false false true 256 0 true 1168 true true true false false false false false false false false false X 25 24 false false false false true true true true true false false true true true true true true true true true false NY X X CHRISTOPHER SCHULTHEIS 6317268301 240 MEETING HOUSE LANE SOUTHAMPTON NY 11968 X PETER M LARSEN CHAIRMAN 1.25 X X 0 0 0 RICHARD J HIEGEL ESQ CO-CHAIR 1.25 X X 0 0 0 KENNETH B WRIGHT CO-CHAIR 1.25 X X 0 0 0 STANLEY D FRIEDMAN VICE PRESIDENT 1.25 X X 0 0 0 LAWRENCE A WILLIS TREASURER 1.25 X X 0 0 0 PATRICIA STEWART SECRETARY 1.25 X X 0 0 0 GEORGE F BIONDO ESQ TRUSTEE 1.25 X 0 0 0 BARBARA BORSACK TRUSTEE 1.25 X 0 0 0 RICHARD BRUCE TRUSTEE 1.25 X 0 0 0 JEAN LITTLE FITZSIMMONS TRUSTEE 1.25 X 0 0 0 JAMES FORBES TRUSTEE 1.25 X 0 0 0 DAVID GILLESPIE TRUSTEE 1.25 X 0 0 0 JOHN E GRIM III THRU 313 TRUSTEE 1.25 0.5 X 0 0 0 GILBERT W HARRISON TRUSTEE 1.25 X 0 0 0 MICHAEL ISRAEL MD PHYSICIAN/TRUSTEE 1.25 0.5 X 206834 0 20813 GEORGE P KAZDIN TRUSTEE 1.25 X 0 0 0 LISA CLARE KOMBRINK ESQ TRUSTEE 1.25 X 0 0 0 JAY K LEVINE TRUSTEE 1.25 X 0 0 0 DOROTHY LEWIS TRUSTEE 1.25 X 0 0 0 HOWARD M LORBER TRUSTEE 1.25 0.5 X 0 0 0 R TIMOTHY MARAN TRUSTEE 1.25 X 0 0 0 JOHN MCGOWAN TRUSTEE 1.25 X 0 0 0 PHILIP A PIRO JR MD TRUSTEE (THRU 6/13) 1.25 X 0 0 0 FLORENCE ROLSTON MD TRUSTEE 1.25 X 0 0 0 STEPHEN H SHAPOFF TRUSTEE 1.25 X 0 0 0 MICHAEL F SMITH TRUSTEE 1.25 X 0 0 0 JOHN WAMBOLD TRUSTEE 1.25 X 0 0 0 ROBERT S CHALONER PRESIDENT & CEO 38.8 0.5 X 665402 0 38016 CHIRSTOPHER J SCHULTHEIS CHIEF FINANCIAL OFFICER 37.5 0.5 X 275874 0 36703 FREDERIC I WEINBAUM CHIEF MEDICAL OFFICER & COO 37.5 X 485389 0 39789 PATRICIA A DARCEY CHIEF NURSING OFFICER 37.5 X 199738 0 36536 GEORGE KECKEISEN PHYSICIAN 37.5 X 359346 0 39789 EDNA KAPENHAS DIRECTOR, BREAST SURGEON 37.5 X 399410 0 38016 STEVEN GEOROGPOULOS PHYSICIAN 37.5 X 594072 0 35721 KRISTIN P NASO MEDICAL STAFF PHYSICIAN 37.5 X 546781 0 38371 SHAWN CANNON PHYSICIAN/GME PROGRAM ADMIN. 37.5 X 313310 0 35216 4046156 0 358970 79 false true false MORRISON MANAGEMENT SPECIALIST 4721 MORRISON DRIVE SUITE 300 MOBILE AL 36609 FOOD SERVICES 601055 HAMPTONS GYNECOLOGY OB 595 HAMPTONS ROAD SOUTHAMPTON NY 11968 MEDICAL 318333 PROSKAUER ROSE LLP 11 TIMES SQUARE NEW YORK NY 100368299 LEGAL 290820 SOUTHAMPTON PULMONARY MEDICINE 325 MEETING HOUSE LANE SOUTHAMPTON NY 11968 MEDICAL 273720 LOCUMTENENSCOM 2655 NORTHWINDS PARKWAY ALPHARETTA GA 30009 PHYSICIAN RECRUITMEN 252627 21 104400 3525052 4985873 5631061 14246386 INPATIENT SERVICES 624200 58290997 58290997 OUTPATIENT SERVICES 624200 61368265 61368265 LABORATORY EXTENDED SERVICES 621500 1868577 1868577 LESS: PROVISION FOR UNCOLLECTIBLES, NET 624200 -4600000 -4600000 LABORATORY REVENUE 621500 784880 784880 1280453 783458 496995 118993172 218645 218645 0 0 522275 522275 0 522275 522275 4345208 3673643 3667660 677548 3673643 4351191 4351191 0 0 0 SHINNECOCK 3RD PARTY 900099 47754 47754 VENDOR REBATES 900099 21535 21535 SALES OF SUPPLIES 900099 16450 16450 375657 375657 461396 138793065 116627600 2365572 5553507 0 0 0 0 2005094 2005094 0 57063152 49824888 7238264 5462014 4761870 700144 12924524 11252525 1671999 4184821 3640794 544027 803486 699033 104453 592455 592455 300349 300349 19108 16624 2484 0 74675 74675 4168237 3626366 541871 14637 12734 1903 15080607 12447668 2632939 2170367 1888219 282148 0 1281382 1114802 166580 156873 156873 0 33060 33060 2711041 2358606 352435 0 0 5327467 5307356 20111 0 2099055 1826178 272877 0 OTHER PURCHASE SERVICES 7192813 6257747 935066 UTILITIES 2161577 1880572 281005 OTHER DIRECT EXPENSES 1726830 1502342 224488 MISCELLANEOUS 768012 384008 384004 128321636 108802332 19519304 0 9976113 92989 1847513 8336913 0 0 15493397 18130683 0 0 0 0 0 0 1689021 1786889 411890 437340 152095604 106497560 39278958 45598044 0 0 27972839 30869856 0 0 0 0 998243 1078250 97667974 106330964 19424599 21460814 0 0 0 0 33866206 32927605 0 0 0 0 12550963 12430276 0 0 23523123 16674842 89364891 83493537 X -109955 19102681 5579020 900728 2834018 2834018 8303083 22837427 97667974 106330964 X 10471429 1231907 2831008 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false true 19108 false false false 19108 false false PART II-B, LINE 1F: 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. 4527461 5500000 781270 10808731 4115379 412082 4527461 4213766 -98387 4115379 3943577 371238 95021 6028 4213766 4031782 73511 23873 137843 3943577 0.73780 0.26220 false false 1366275 1366275 44542527 34977093 9565434 97102857 70584683 26518174 9083945 935784 8148161 45598044 SHORT TERM INVESTMENTS 9824832 F RESTRICTIONS 3734746 F INVESTMENTS IN SHA PROPERTIES 6300000 C DEBT SERVICE FUND 5805278 F MALPRACTICE SELF INSURANCE-FD 5205000 F 30869856 0 ACCRUED PENSION LIABILITY 4531857 DUE TO THIRD-PARTY PAYORS, NET 6937985 MALPRACTICE SELF-INSURANCE LIA 5205000 16674842 X 147589088 1231907 7638791 8870698 138718390 74675 74675 138793065 128376452 129491 129491 128246961 74675 74675 128321636 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. true true X true X 400. true X false true true false true true 575 2242983 -1485122 757861 0.00590 13993212 6980237 7012975 0.05470 575 16236195 5495115 7770836 0.06060 7036767 3211855 3824912 0.02980 4 42732475 34463227 8269248 0.07000 4 49769242 37675082 12094160 0.09980 4 575 66005437 43170197 19864996 0.16040 279739 279739 279739 279739 true 4600000 1079121 37819772 39232922 -1413150 X true true MEETINGHOUSE LN PRAC PRIMARY/SPECIALTY 1.00000 14 1 SOUTHAMPTON HOSPITAL ASSOCIATION 240 MEETINGHOUSE LANE SOUTHAMPTON NY 11968 X A 2 DIALYSIS CENTER 184 W MONTAUK HIGHWAY HAMTPON BAYS NY 11946 X DIALYSIS TREATMENT FACILITY B 3 GREENPORT PRENATAL 300 ATLANTIC AVENUE GREENPORT NY 11944 X PRENATAL/WOMEN'S SERVICES B 4 LAB EAST 200 PANTIGO PLACE EAST HAMPTON NY 11944 X LABORATORY SERVICES B 5 IMAGING - EH 200 PANTIGO PLACE EAST HAMPTON NY 11937 X RADIOLOGY SERVICES B 6 WESTHAMPTON PRIMARY CARE 72 OLD RIVERHEAD ROAD WESTHAMPTON BEACH NY 11978 X PRIMARY CARE PRACTICE B 7 WESTHAMPTON SPORTS REHAB 74 OLD RIVERHEAD ROAD WESTHAMPTON BEACH NY 11978 X SPORTS REHAB/ PHYSICAL THERAPY SERVICES B 8 LAB SOUTH 325 MEETINGHOUSE LANE SOUTHAMPTON NY 11968 X LABORATORY SERVICES B 9 ATRIUM LAB 182 W MONTAUK HIGHWAY HAMPTON BAYS NY 11946 X LABORATORY SERVICES B 10 DAVID ROGERS CENTER 335 D MEETINGHOUSE LANE SOUTHAMPTON NY 11968 X HIV/AIDS CARE B 11 SHINNECOCK HEALTH CHURCH STREET SOUTHAMPTON NY 11968 X PRIMARY CARE/DENTAL SERVICES B 12 SOUTHAMPTON CARE CENTER 240 MEETINGHOUSE LANE SOUTHAMPTON NY 11968 X NURSING HOME (FACILITY CLOSED) B 13 Imaging Hampton Bays 182 W MONTAUK HIGHWAY HAMPTON BAYS NY 11946 X RADIOLOGY SERVICES B 14 MEETINGHOUSE LANE PRACTICE PO BOX 2340 SOUTHAMPTON NY 11968 X PRIMARY/SPECIALTY PHYSICIAN PATIENT CARE B A 1 true X X X X X X 11 true true true X www.southamptonhospital.org X X X X X X X X true false true true 400. true 400. true X X X true true X X X X X X true false true X false false B false true true 400. true 400. true X X X true true X X X X X X true false true X false false 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). 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. X true true X X X false false false false false false false false false ROBERT S CHALONER PRESIDENT & CEO 510000 0 108035 0 47367 0 15300 0 22716 0 703418 0 0 0 CHIRSTOPHER J SCHULTHEIS CHIEF FINANCIAL OFFICER 229645 0 46000 0 229 0 13987 0 22716 0 312577 0 0 0 FREDERIC I WEINBAUM CHIEF MEDICAL OFFICER & COO 395389 0 54996 0 35004 0 15300 0 24489 0 525178 0 0 0 PATRICIA A DARCEY CHIEF NURSING OFFICER 198958 0 0 0 780 0 12047 0 24489 0 236274 0 0 0 MICHAEL ISRAEL MD PHYSICIAN/TRUSTEE 189126 0 0 17708 0 11400 0 9413 0 227647 0 0 0 GEORGE KECKEISEN PHYSICIAN 298174 0 60000 0 1172 0 15300 0 24489 0 399135 0 0 0 EDNA KAPENHAS DIRECTOR, BREAST SURGEON 399036 0 0 0 374 0 15300 0 22716 0 437426 0 0 0 STEVEN GEOROGPOULOS PHYSICIAN 557674 0 0 0 36398 0 11232 0 24489 0 629793 0 0 0 KRISTIN P NASO MEDICAL STAFF PHYSICIAN 498185 0 0 0 48596 0 13882 0 24489 0 585152 0 0 0 SHAWN CANNON PHYSICIAN/GME PROGRAM ADMIN. 304907 0 0 0 8403 0 12500 0 22716 0 348526 0 0 0 PART I, LINE 1A: THE SOUTHAMPTON HOSPITAL ASSOCIATION PROVIDES THE FOLLOWING SPECIAL ALLOWANCES/PERQUISITES TO THE PRESIDENT & CEO, AS WELL AS TO CERTAIN KEY EXECUTIVES. THESE ALLOWANCES FOR HOUSING AND AUTOMOBILE ARE STIPULATED IN THE EXECUTIVES EMPLOYMENT AGREEMENT/TERMS AT TIME OF HIRE. ALL PAYMENTS OF THESE PERQUISITES ARE MADE ON A BI-WEEKLY BASIS WITH THE EMPLOYEE'S REGULAR PAYCHECK AND THEY ARE MADE IN ACCORDANCE WITH THE GUIDELINES OF A NON-ACCOUNTABLE EXPENSE PLAN. ANNUAL ALLOWANCES ARE AS LISTED BELOW: ROBERT CHALONER, PRESIDENT & CEO - Housing Allowance: $38,000. Auto Allowance: $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. 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. SOUTHAMPTON CARE CENTER 240 MEETING HOUSE LANE SOUTHAMPTON NY 11968 112658403 NURSING HOME NY 501(c)(3) 9 false THE SOUTHAMPTON HOSPITAL FOUNDATION 240 MEETING HOUSE LANE SOUTHAMPTON NY 11968 113466516 SRVC PROVIDER NY 501(C)(3) 7 false MEETINGHOUSE LANE MEDICAL PRACTICE PO BOX 2340 SOUTHAMPTON NY 11968 208853938 PATIENT CARE NY NA C 397159 1847515 1.00000 true SHA PROPERTIES 240 MEETING HOUSE LANE SOUTHAMPTON NY 11968 112563612 REAL ESTATE NY NA C 203227 2488506 1.00000 true OLD TOWN MEDICAL PRACTICE PC 240 MEETING HOUSE LANE SOUTHAMPTON NY 11968 452430883 MEDICAL PRACT NY NA C 0 0 1.00000 true false false true true true false false false false false false true true true false false false false SHA PROPERTIES E 1771136 FMV