2013-02-01T15:32:24-06:00 2011-12-31 HUR SANDY FEMA 4085-DR Charles A Barragato & Co LLP 950 Third Avenue - 20th FL New York NY 10022 990 2011-01-01 131740119 NYACK HOSPITAL % RONALD RATIGAN NYAC 8453486522 160 NORTH MIDLAND AVENUE NYACK NY 10960 JOHN BURKE 2013-02-01 true Angelo Pirozzi CPA 2123714446 2011 2016-02-25 16:41:14Z DAVID H FREED 160 NORTH MIDLAND AVENUE NYACK NY 10960 212549364 false X NYACKHOSPITAL.ORG X 1895 NY THE MISSION OF NYACK HOSPITAL IS TO PROVIDE COMPETENT, INNOVATIVE AND ACCESSIBLE EMERGENCY AND ACUTE CARE SERVICES FOR THE RESIDENTS OF ROCKLAND COUNTY, NEW YORK. 22 18 1851 241 0 289836 664736 193022479 204613074 51008 35848 5430176 7235706 198793499 212549364 0 0 0 0 115489951 122995121 0 0 0 80108864 84309554 195598815 207304675 3194684 5244689 68536615 77868968 71373650 81163021 -2837035 -3294053 X THE MISSION OF NYACK HOSPITAL IS TO PROVIDE COMPETENT, INNOVATIVE AND ACCESSIBLE EMERGENCY AND ACUTE CARE SERVICES FOR THE RESIDENTS OF ROCKLAND COUNTY, NEW YORK. false false 185281194 206759431 NYACK HOSPITAL IS COMMITTED TO MEETING THE HEALTH CARE NEEDS OF THE RESIDENTS OF ROCKLAND COUNTY, NEW YORK AND OTHER SURROUNDING AREAS. NYACK HOSPITAL IS DEDICATED TO PROVIDING THE HIGHEST QUALITY HEALTHCARE SERVICES TO THE ROCKLAND COMMUNITY. DURING 2011, NYACK HOSPITAL PROVIDED HIGH QUALITY HEALTHCARE SERVICES FOR 16,491 ADMISSIONS, ACCOUNTING FOR 72,126 DAYS OF PATIENT CARE. NYACK HOSPITAL PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. FOR THE YEAR ENDED DECEMBER 31, 2011, NYACK HOSPITAL PROVIDED $17,478,191 IN INDIGENT AND CHARITY WRITE-OFFS UNDER ITS CHARITY CARE POLICY. NYACK HOSPITAL ALSO PROVIDES 24 HOUR EMERGENCY DEPARTMENT SERVICES. FOR 2011, NYACK HOSPITAL HAD 57,622 EMERGENCY DEPARTMENT VISITS. 185281194 true true false true false false false false false true true false false true true false 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 120 0 true 1851 true false false false false false false false false false false X 22 18 false false false false true true true true true false false true true true true true true true true false NY X RONALD RATIGAN 8453486522 160 NORTH MIDLAND AVENUE NYACK NY 10960 X WILLIAM M TRUST JR 1.0 X X RICHARD KOHLHAUSEN 1.0 X X KEVIN CONWAY 1.0 X X CATHY SHEA 1.0 X X MARISA S BARBIERI 1.0 X DONALD BARNES 1.0 X LAURENCE J BERGER 1.0 X 396712 42068 MITCHELL D COHN MD 1.0 X ALAN FELDSTEIN 1.0 X BILL GUERCI 1.0 X LISA HAYES 1.0 X MARK JACOBS 1.0 X RITA L KOKKORIS 1.0 X ELIOT J LAZAR MD 1.0 X 831953 157418 MARC J LEVINE MD 1.0 X JOHN MECCHELLA 1.0 X STEPHEN M MENITOVE MD 1.0 X WAYNE M OSTEN 1.0 X 887900 215706 ENRIQUE PABON 1.0 X WILLIAM SHUM 1.0 X COREY M TURNER 1.0 X DAVID H FREED 40.0 X X 687565 24812 MICHAEL RADER MD 40.0 X 451685 32796 JOHN S BURKE 40.0 X 410815 36335 JOHN VOLANTO 40.0 X 311292 25253 MARY K SHINICK 40.0 X 275228 31732 MARYANN ANDERSON 40.0 X 283702 20179 JOSEPH VITTORIO MD 40.0 X 197932 13758 RONALD RATIGAN 40.0 X 178389 36169 ALICE VALLEN CRONIN 40.0 X 177691 34952 DAVID SEITZ MD 40.0 X 185511 26114 PATRICIA JOSEPH MD 40.0 X 299612 40644 3459422 2116565 737936 163 false true false LAB CORP 20 JOHNSON DRIVE RARITAN NJ 08869 LAB MGMT SERVICES 3188564 HUDSON VALLEY OBSTETRICAL 258 HIGH AVENUE NYACK NY 10960 OBSTETRIC MD SERVICE 1690131 HOSPITALIST EMO OF NY 651 W MT PLEASANT AVE LIVINGSTON NJ 07039 MD SERVICE 1625593 DICTAPHONENUANCE PO BOX 7247-6924 PHILADELPHIA PA 19170 TRANSCRIPTION SVCS 506393 SCHIAVETTI CORGAN SOSCIA DIEDWAR 709 WESTCHESTER AVENUE WHITE PLAINS NY 10604 ATTORNEY SERVICES 460024 17 629532 35204 664736 PATIENT SERVICE REVENUE 621300 204613074 204613074 204613074 16740 16740 0 0 778112 778112 778112 778112 19108 19108 19108 19108 0 0 0 CLINIC REVENUE 900099 1415080 1415080 EHR MEANINGFUL USE INCOME 900099 1357272 1357272 INSURANCE PROCEEDS 900099 1020405 1020405 2664837 731277 1933560 6457594 212549364 206759431 5125197 0 0 0 0 2591394 2591394 0 93057362 83751626 9305736 9021701 8119531 902170 10974808 9877327 1097481 7349856 6614870 734986 6411174 5770057 641117 1346339 1211705 134634 342919 308627 34292 50368 45331 5037 0 0 6774543 6097089 677454 403446 363101 40345 11550179 10395161 1155018 1532989 1379690 153299 0 2423424 2181082 242342 231331 208198 23133 0 316359 284722 31637 1217066 1095359 121707 332416 299174 33242 5633052 5069747 563305 1028266 925439 102827 MEDICAL SUPPLIES 16956566 15260909 1695657 BAD DEBT 10392401 10392401 PHARMACEUTICAL 8520857 7668771 852086 OTHER PURCHASED SERVICES 4799153 4319238 479915 4046706 3642039 404667 207304675 185281194 22023481 0 0 0 3540896 931258 0 0 20495976 25592889 0 0 0 0 0 0 3483193 2971207 410470 766053 155713634 115709314 36850448 40004320 0 0 0 0 0 0 0 0 3755632 7603241 68536615 77868968 32008292 37866358 0 0 412157 332015 0 0 0 0 0 0 14205529 14354062 0 0 24747672 28610586 71373650 81163021 X -3056534 -3513552 0 0 219499 219499 -2837035 -3294053 68536615 77868968 X 5244689 -5701707 X false true true X false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 50368 50368 PART II-B, LINE 1I - OTHER ACTIVITIES DESCRIPTION NYACK HOSPITAL PAID DUES TO THE LOCAL 1199 - HEALTHCARE EDUCATION PROJECT (HEP) THE HEALTHCARE ASSOCIATION OF NEW YORK STATE (HANYS), AND THE HOME CARE ASOCIATION OF NYS (HCA). IN ACCORDANCE WITH SECTION 6033 (E) OF THE INTERNAL REVENUE CODE, AND AS REPORTED BY HEP, HANYS, AND HCA, A PORTION OF THESE DUES ARE ATTRIBUTABLE TO LOBBYING ACTIVITIES. THE LOBBYING ACTIVITIES APPLICABLE TO 2011 HEP, HANYS, AND HCA ANNUAL DUES WAS $29,864, $16,613, AND $3,891 RESPECTIVELY. 219499 219499 219499 219499 219499 219499 219499 219499 1.00000 false false 651548 651548 49159693 25518969 23640724 0 0 96207895 87847537 8360358 9694498 2342808 7351690 40004320 ASSETS LIMITED AS TO USE 263783 DEFERRED FINANCING COSTS 45652 DUE FROM RELATED PARTIES 1759735 OTHER RECEIVABLE 5534071 7603241 0 ACCRUED POST RETIREMENT BENEFITS 564100 MALPRACTICE LIABILITY 8509279 OTHER LIABILITIES 5089991 PENSION LIABILITY 12254286 THIRD PARTY LIABILITIES 2192930 28610586 PART V, LINE 4 - INTENDED USES OF ENDOWMENT FUND THE INTENDED USE OF THE HOSPITAL'S ENDOWMENT FUNDS IS TO PROVIDE FUNDS TO BE USED FOR UNINSURED WOMEN. true true true X true X true true true false true true 4301930 1844663 2457267 0.01210 37570506 29772838 7797668 0.03850 41872436 31617501 10254935 0.05060 250464 140146 110318 0.00050 21690186 16561629 5128557 0.02530 21940650 16701775 5238875 0.02580 63813086 48319276 15493810 0.07640 true 10392401 62704700 66200592 -3495892 X true true 1 1 NYACK HOSPITAL

160 NORTH MIDLAND AVENUE NYACK NY 10960

X X X NYACK HOSPITAL 1 true true 100 true 400. true X X X X X true true X X X X true false true X false false EXPLANATION OF COSTING METHODOLOGY PART I, LINE 7 NYACK HOSPITAL'S COSTING METHODOLOGY WAS BASED UPON THE 2011 NEW YORK STATE INSTITUTIONAL COST REPORT AND THE 2011 MEDICARE (FORM 2552) COST REPORT. THESE COST REPORTS ARE FILED WITH THE NEW YORK STATE DEPARTMENT OF HEALTH AND THE APPLICABLE CMS INTERMEDIARY, RESPECTIVELY. THE COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGE, WAS USED FOR THE VARIOUS SUB-LINE ITEMS OF LINE #7. BAD DEBT EXPENSE PART III, LINE 4 A/F/S FOOTNOTE - ORGANIZATION AND SIGNIFICANT ACCOUNTING POLICIES - PATIENT ACCOUNTS RECEIVABLE/ALLOWANCE FOR DOUBTFUL ACCOUNTS. PATIENT ACCOUNTS RECEIVABLE RESULT FROM THE HEALTH CARE SERVICES PROVIDED BY THE HOSPITAL. ADDITIONS TO THE ALLOWANCE FOR DOUBTFUL ACCOUNTS RESULT FROM THE PROVISION FOR BAD DEBTS. ACCOUNTS WRITTEN OFF AS UNCOLLECTIBLE ARE DEDUCTED FROM THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. THE AMOUNT OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IS BASED ON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS, BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN MEDICARE AND MEDICAID HEALTH CARE COVERAGE AND OTHER COLLECTION INDICATORS. BAD DEBT EXPENSE PER THE AUDITED FINANCIAL STATEMENTS IS $10,392,401. EXPLANATION OF SHORTFALL AS COMMUNITY BENEFIT PART III, LINE 8 THE AMOUNT REPORTED ON LINE 6 WAS DERIVED BY USING THE MEDICARE ALLOWABLE COSTS AS REPORTED ON THE HOSPITAL'S NEW YORK STATE INSTITUTIONAL COST REPORT AND THE APPLICABLE ADJUSTMENTS FROM WORKSHEET B. PROVISIONS ON COLLECTION PRACTICES FOR QUALIFIED PATIENTS PART III, LINE 9B PURPOSE: TO RELIEVE THE ACCOUNTS RECEIVABLE OF ACCOUNTS DEEMED UNCOLLECTIBLE BY INTERNAL OR EXTERNAL PRE-COLLECTION PROCESSES. POLICY: TO REFER APPROPRIATE ACCOUNTS TO COLLECTION AGENCIES AND/OR THIRD PARTY BILLING AGENCIES AND TO INSURE AGENCY PRODUCTIVITIES IN ACCORDANCE WITH HOSPITAL POLICY. PROCEDURES: SECTION 1 -SMALL BALANCE WRITE OFF TO RELIEVE THE ACCOUNTS RECEIVABLE OF BALANCES WHICH ARE UNPROFITABLE TO PURSUE ON A MONTHLY BASIS. A. SMALL BALANCES IS DEFINED AS AN AMOUNT OF $24.99 AND LESS THAT IS CONSIDERED PATIENT LIABILITY. B. SMALL BALANCES MUST EXIST FOR 30 DAYS BEFORE THEY QUALIFY FOR WRITE-OFF. C. PATIENT MUST HAVE RECEIVED AT LEAST ONE STATEMENT. D. SMALL BALANCE INCLUDES CREDIT BALANCES OF $24.99 OR LESS (THIS AMOUNT WILL BE WRITTEN OFF SYSTEMATICALLY UNLESS PATIENT REQUESTS A REFUND). E. AT MONTH END SMALL BALANCE WRITE-OFF REPORT WILL BE PRODUCED FROM THE PARAGON SYSTEM FOR ALL ACCOUNTS SELECTED. F. A SEPARATE REPORT IS TO BE GENERATED FROM THE SYSTEM USING THE TRIAL BALANCE TO IDENTIFY ACCOUNTS NOT SELECTED SYSTEMATICALLY BY THE SYSTEM. SECTION 2 - BAD DEBT WRITE OFF PROCESS A. PATIENTS MUST RECEIVE A PRESCRIBED NUMBER OF STATEMENTS BEFORE BEING REFERRED TO COLLECTION (MINIMUM 3 STATEMENTS IN 120 DAYS UNLESS RETURNED MAIL FOR BAD ADDRESS OR PATIENT IS DECEASED). B. ACCOUNT BALANCE MUST RESIDE IN PATIENT BUCKET TO QUALIFY FOR BAD DEBT WRITE-OFF. C. A POTENTIAL BAD DEBT WRITE OFF REPORT IS PRODUCED ON A MONTHLY BASIS FOR ACCOUNTS THAT MAY BE MANUALLY TRANSFERRED TO THE BAD DEBT FILE. THIS LIST IS REVIEWED ACCOUNT BY ACCOUNT TO DELETE INAPPROPRIATE REFERRALS PRIOR TO WRITE OFF. D. PRE APPROVAL OF HIGH BALANCE WRITE-OFFS: GREATER THAN $5000.00 APPROVED BY SUPERVISOR, GREATER THAN $10,000.00 APPROVED BY MANAGER AND GREATER THAN $25,000.00 APPROVED BY ADMINISTRATOR. E. ACCOUNTS ARE REDUCED TO A SELF PAY RATE AND ARE REFERRED TO AGENCIES AT THIS RATE UNLESS OTHERWISE NOTED BASED ON DISCUSSIONS WITH THE PATIENT OR DESIGNATED REPRESENTATIVE. F. AT MONTH END, A CUMULATIVE BAD DEBT REPORT CONTAINING ALL WRITE-OFFS IN THAT CALENDAR MONTH WILL BE CREATED ALONG WITH AGENCY REFERRAL FILE. G. THE CUMULATIVE WRITE OFF TOTAL FOR ANY CALENDAR MONTH MUST BE APPROVED BY THE MANAGER IN CONJUNCTION WITH THE ADMINISTRATORS OF PATIENT FINANCIAL SERVICES AND FINANCE. SECTION 3 -COLLECTION AGENCY A. REFERRALS 1. ACCOUNTS ARE REFERRED SYSTEMATICALLY AND BY ALPHA BREAKDOWN WITHIN PATIENT TYPE TO AGENCIES ON AN EQUITABLE DISTRIBUTION. THE AGENCIES RECEIVE A FILE AND ALSO A COMPUTER GENERATED LIST OF ACCOUNTS. 2. ACCOUNTS REFERRED TO AGENCIES MAY BE AT THE SELF-PAY RATES ESTABLISHED IN THE CHARITY CARE POLICY. 3. SECONDARY REFERRALS MAY BE ASSIGNED TO SELECTED AGENCIES AFTER PRIMARY AGENCY CLOSEOUT. 4. AGENCIES MUST ADHERE TO HOSPITAL FINANCIAL ASSISTANCE (CHARITY CARE) POLICIES. 5. AGENCIES WILL PERFORM ASSET TEST ON ALL ACCOUNTS EXCEEDING $1,500. B. REPORTING 1. AGENCIES SEND ACKNOWLEDGEMENT REPORTS, WHICH ARE RECONCILED AGAINST THE REFERRALS (NUMBER OF ACCOUNTS, DOLLAR AMOUNT). 2. AGENCIES SUBMIT STATUS REPORTS ON A MONTHLY BASIS, WHICH ARE RECONCILED TO AN HBOC DETAIL REPORT TO INSURE THE ACCURACY OF THE BAD DEBT FILE. 3. A REMITTANCE REPORT ACCOMPANIES THE CHECK THE AGENCY SENDS WHICH REPORTS ALL PAYMENTS COLLECTED. THIS IS RECONCILED TO THE PAYMENTS POSTED TO THE PARAGON SYSTEM IN THE BAD DEBT FILE. 4. CLOSE OUT REPORT IS A LIST OF ALL THE ACCOUNTS THAT THE AGENCIES DEEM UNCOLLECTIBLE. WE ASSIGN SECONDS FROM THE CLOSE OUT REPORT OR WE CLOSE OUT THE ACCOUNTS. 5. IF AN ACCOUNT IS REFERRED BY A COLLECTION AGENCY FOR LEGAL ACTION, IT MUST BE APPROVED BY THE MANAGER OR ADMINISTRATOR OF THE PATIENT FINANCIAL SERVICES DEPARTMENT. 6. A RECONCILIATION REPORT MAY BE REQUESTED TO CORRELATE OUR A/R AGAINST AGENCY A/R. 7. A PLACEMENT ANALYSIS REPORT IS REQUIRED ON A MONTHLY BASIS FROM EACH AGENCY DETAILING ITS COLLECTION PERFORMANCE YEAR TO DATE BY REFERRAL DATE AND PRODUCT LINE (I.E.: INPATIENT, OUTPATIENT, INPATIENT SECONDS, ETC.), FOR THE CURRENT CALENDAR YEAR AND THE PRIOR YEARS CALENDAR REFERRALS. SECTION 4 -DEPARTMENTAL WORKFLOWS A. ACCOUNTS ARE REFERRED TO BAD DEBT SYSTEMATICALLY (ALPHA BREAKDOWN WITHIN PATIENT TYPE). B. THE REPRESENTATIVE DESIGNATED AS THE LIAISON WITH THE COLLECTION AGENCIES, AND REVIEWS APPROPRIATELY ADDRESSED OR REFERRED TO AGENCY CORRESPONDENCE PERTAINING TO BAD DEBT. C. AGENCY LIAISON SCREENS PATIENT INQUIRIES RELATING TO BAD DEBT ACCOUNTS AND REFERS TO APPROPRIATE AGENCY. SECTION 5 -LIAISON INTERDISCIPLINARY WORKFLOWS A. INTERACTS WITH AGENCIES TO OBTAIN ACCOUNT STATUS. B. INTERACTS WITH OTHER PATIENT FINANCIAL SERVICE SECTIONS TO INSURE THE ACCURACY OF THE BAD DEBT FILE. C. REVIEWS AND RECONCILES ALL AGENCY REPORTS INCLUDING REMITTANCE REPORT; SUPPORTS AND DIRECTS ACTIVITY OF AGENCY LIAISON. SECTION 6 -END OF MONTH REPORTS A. CUMULATIVE BAD DEBT WRITE OFF FROM ACCOUNTS RECEIVABLE TO BAD DEBT BY AGENCY. B. CUMULATIVE BAD DEBT WRITE OFF FROM ACCOUNTS RECEIVABLE TO BAD DEBT BY FINANCIAL CLASS. C. COLLECTION AGENCY STATISTIC REPORT FOR THE FILE. D. TAPE GENERATED BY INFORMATION TECHNOLOGY GIVEN TO AGENCIES. INDIVIDUALS ELIGIBILITY FOR FINANCIAL ASSISTANCE PART V, LINE 19 WE USE MEDICAID RATES FOR INPATIENT AND MANAGED CARE RATES FOR OUTPATIENT. NEEDS ASSESSMENT PART VI PURSUANT TO NEW YORK STATE PUBLIC HEALTH LAW SECTION 2803-L, NYACK HOSPITAL ("NYACK") IS REQUIRED TO FILE A COMPREHENSIVE COMMUNITY SERVICE PLAN ("CSP") WITH THE NEW YORK STATE DEPARTMENT OF HEALTH ("DOH") EVERY 3 YEARS. A COPY OF NYACK'S CSP CAN BE FOUND ON THE HOSPITAL'S WEBSITE AT WWW.NYACKHOSPITAL.ORG UNDER THE "ABOUT US" TAB. THE COMPREHENSIVE DATA AND INFORMATION CONTAINED IN THIS CSP WILL EXHAUSTIVELY ADDRESS PART VI OF THIS SCHEDULE H, AND ITS CONTENTS ARE INCORPORATED HEREIN BY REFERENCE. SPECIFICALLY, THE NYACK CSP WILL ADDRESS THE PART VI (2) NEEDS ASSESSMENT; PART VI (3) PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE; PART VI (4) COMMUNITY INFORMATION; PART VI (5) COMMUNITY BUILDING ACTIVITIES AND PART VI (6) TO (7), AS APPLICABLE. THE TEXT OF NEW YORK STATE PUBLIC HEALTH LAW SECTION 2803-L IS AS FOLLOWS: COMMUNITY SERVICE PLANS. (1) THE GOVERNING BODY OF A VOLUNTARY NON-PROFIT GENERAL HOSPITAL MUST ISSUE AN ORGANIZATIONAL MISSION STATEMENT IDENTIFYING AT A MINIMUM THE POPULATIONS AND COMMUNITIES SERVED BY THE HOSPITAL AND THE HOSPITAL'S COMMITMENT TO MEETING THE HEALTH CARE NEEDS OF THE COMMUNITY. (2) THE GOVERNING BODY MUST AT LEAST EVERY THREE YEARS: (I) REVIEW AND AMEND AS NECESSARY THE HOSPITAL MISSION STATEMENT; (II) SOLICIT THE VIEWS OF THE COMMUNITIES SERVED BY THE HOSPITAL ON SUCH ISSUES AS THE HOSPITAL'S PERFORMANCE AND SERVICE PRIORITIES; (III) DEMONSTRATE THE HOSPITAL'S OPERATIONAL AND FINANCIAL COMMITMENT TO MEETING COMMUNITY HEALTH CARE NEEDS, TO PROVIDE CHARITY CARE SERVICES AND TO IMPROVE ACCESS TO HEALTH CARE SERVICES BY THE UNDERSERVED; AND (IV) PREPARE AND MAKE AVAILABLE TO THE PUBLIC A STATEMENT SHOWING ON A COMBINED BASIS A SUMMARY OF THE FINANCIAL RESOURCES OF THE HOSPITAL AND RELATED CORPORATIONS AND THE ALLOCATION OF AVAILABLE RESOURCES TO HOSPITAL PURPOSES INCLUDING THE PROVISION OF FREE OR REDUCED CHARGE SERVICES. (3) THE GOVERNING BODY MUST AT LEAST ANNUALLY PREPARE AND MAKE AVAILABLE TO THE PUBLIC AN IMPLEMENTATION REPORT REGARDING THE HOSPITAL'S PERFORMANCE IN MEETING THE HEALTH CARE NEEDS OF THE COMMUNITY, PROVIDING CHARITY CARE SERVICES, AND IMPROVING ACCESS TO HEALTH CARE SERVICES BY THE UNDERSERVED. (4) THE GOVERNING BODY SHALL FILE WITH THE COMMISSIONER ITS MISSION STATEMENT, ITS ANNUAL IMPLEMENTATION REPORT, AND AT LEAST EVERY THREE YEARS A REPORT DETAILING AMENDMENTS TO THE STATEMENT AND REFLECTING CHANGES IN THE HOSPITAL'S OPERATIONAL AND FINANCIAL COMMITMENT TO MEETING THE HEALTH CARE NEEDS OF THE COMMUNITY, PROVIDING CHARITY CARE SERVICES, AND IMPROVING ACCESS TO HEALTH CARE SERVICES BY THE UNDERSERVED. THE ABOVE-REFERENCED CSP REQUIREMENT WAS ENHANCED BY THE DOH'S PREVENTION AGENDA INITIATIVE. THIS INITIATIVE IS A PROCESS THAT ASKS HOSPITALS SUCH AS NYACK TO WORK WITH LOCAL HEALTH DEPARTMENTS AND COMMUNITY PARTNERS TO ASSESS COMMUNITY HEALTH NEEDS, JOINTLY DEVELOP PLANS TO ADDRESS TWO OR THREE OF THE IDENTIFIED NEEDS AND INCLUDE THIS COLLABORATIVE WORK IN NYACK'S CSP UPDATE SUBMITTED TO DOH. INFORMATION ON THE NEW YORK STATE DOH PREVENTION AGENDA CAN BE FOUND AT WWW.HEALTH.STATE.NY.US/PREVENTION/PREVENTION_AGENDA. PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE PART VI ALL PATIENTS RECEIVE A FINANCIAL AID SUMMARY THAT EXPLAINS NYACK HOSPITAL'S FINANCIAL AIDE PROGRAM. ALTHOUGH OBLIGATED TO OFFER ASSISTANCE TO PATIENTS WITH INCOMES LESS THEN 300% OF THE FEDERAL POVERTY LEVEL (FPL), NYACK HOSPITAL CONSIDERS ALL PATIENTS WHO RECEIVE EMERGENCY OR MEDICALLY NECESSARY NON-EMERGENCY CARE WITH INCOMES LESS THAN 400% OF THE FEDERAL POVERTY LEVEL. NYACK HOSPITAL WILL CONSIDER PATIENTS FOR FIANANCIAL AID WHO RESIDE OUTSIDE OF ITS SERVICE AREA ON AN EXCEPTION BASIS. COMMUNITY INFORMATION PART VI NYACK HOSPITAL DEFINES ITS TOTAL SERVICE AREA FOR THE PURPOSES OF COMMUNITY/LOCAL HEALTH PLANNING AS ALL OF ROCKLAND COUNTY. NINE ROCKLAND COUNTY COMMUNITIES COMPRISE THE HOSPITAL'S PRIMARY SERVICE AREA. SEE COMMUNITY SERVICE PLAN FOR DELINEATION OF PRIMARY AND SECONDARY SERVICE AREAS. COMMUNITY BUILDING ACTIVITIES PART VI NYACK HOSPITAL WAS A MAJOR PARTICIPANT IN THE COMMUNITY HEALTH ASSESSMENT (CHA) PROCESS CONDUCTED BY ROCKLAND COUNTY. THE ADMINISTRATOR OF HOME CARE AND COMMUNITY SERVICES AND THE COORDINATOR OF PATIENT/COMMUNITY EDUCATION ARE STANDING MEMBERS OF THE ROCKLAND COUNTY PUBLIC HEALTH PRIORITIES (PHP) STEERING COMMITTEE. THE PURPOSE OF THIS COMMITTEE IS TO DETERMINE THE EXTENT TO WHICH EXISTING PRIORITIES ARE BEING MET, TO ASSESS THE NEED FOR NEW/REVISED PRIORITIES, AND TO COLLABORATE WITH OTHER HEALTH PROVIDERS/ORGANIZATIONS IN ORDER TO IMPLEMENT PROGRAMS AND SERVICES THAT WILL MEET THE IDENTIFIED NEEDS. THE COMMITTEE SERVES AS A GUIDE TO THE DEVELOPMENT OF THE CHA. THE PHP COMMITTEE IS COMPOSED OF REPRESENTATIVES FROM: -COUNTY DEPARTMENTS OF HEALTH, SOCIAL SERVICES, MENTAL HEALTH, AS WELL AS THE OFFICES FOR AGING, COMMUNITY RELATIONS, AND PEOPLE WITH DISABILITIES. -COMMUNITY BASED AGENCY REPRESENTATIVES FROM THE AMERICAN CANCER SOCIETY, IMMIGRATION COALITION, VOLUNTEER COUNSELING SERVICES, AMERICAN HEART ASSOCIATION AND A NUMBER OF OTHER NON-PROFITS. -LOCAL HOSPITALS (NYACK, GOOD SAMARITAN) -4 FEDERALLY QUALIFIED HEALTH CENTERS -2 LOCAL COLLEGES (DOMINICAN AND ROCKLAND COUNTY COMMUNITY) THE FULL COMMITTEE MEETS MONTHLY AND SUB-COMMITTEE MEETINGS ARE HELD AS NEEDED. AN OUTCOME OF THIS COMMITTEE WAS A 2008 COUNTY NEEDS ASSESSMENT, WHICH SERVED AS A STARTING POINT FOR THE COUNTY'S 2010-2013 COMMUNITY HEALTH ASSESSMENT. IN ADDITION TO HAVING REPRESENTATIVES ACTIVELY PARTICIPATE ON THE PHP COMMITTEE, NYACK HOSPITAL COLLABORATED WITH THE COUNTY HEALTH DEPARTMENT TO IMPLEMENT 3 PROVIDER AND CONSUMER FOCUS GROUPS AS PART OF THE CHA PROCESS. DETAILS ARE PROVIDED IN THE COMMUNITY SERVICE PLAN. STATES WHERE COMMUNITY BENEFIT REPORT FILED PART VI NEW YORK. X X X X X X false false false false false false false false false LAURENCE J BERGER 300047 62292 34373 17150 24918 438780 0 ELIOT J LAZAR MD 527048 267443 37462 114732 42686 989371 0 WAYNE M OSTEN 502861 322439 62600 190543 25163 1103606 0 DAVID H FREED 476616 102309 108640 14700 10112 712377 0 MICHAEL RADER MD 333280 66404 52001 14700 18096 484481 0 JOHN S BURKE 296276 65484 49055 10391 25944 447150 0 JOHN VOLANTO 221120 48633 41539 14700 10553 336545 0 MARY K SHINICK 190637 44198 40393 13850 17882 306960 0 MARYANN ANDERSON 202429 42280 38993 14456 5723 303881 0 JOSEPH VITTORIO MD 188519 0 9413 11862 1896 211690 0 RONALD RATIGAN 147786 0 30603 10759 25410 214558 0 ALICE VALLEN CRONIN 130240 16784 30667 9694 25258 212643 0 DAVID SEITZ MD 173586 0 11925 1498 24616 211625 0 PATRICIA JOSEPH MD 265356 0 34256 14700 25944 340256 0 PART III - ADDITIONAL INFORMATION CERTAIN OFFICERS AND KEY EMPLOYEES OF THE NEW YORK AND PRESBYTERIAN HOSPITAL THAT ARE IDENTIFIED IN PART VII AS OFFICERS OR TRUSTEES OF NYACK HOSPITAL ARE RESPONSIBLE FOR EXECUTING THE MISSION AND MANAGEMENT OF THE NEW YORK AND PRESBYTERIAN HOSPITAL (NYP) AND ITS AFFILIATED ENTITIES. Compensation for 2011 of these upper level executives includes the payout of an annual incentive plan and a long-term incentive plan. This performance-oriented program conditions payments upon the achievement of multiple individual and group performance measures. Measures to monitor performance include: operational and financial strength, patient quality and safety, patient satisfaction, advancement of patient care, and people development and partnership. Incentive awards may only be granted if the organization achieves a financial surplus. Even if all relevant performance measurements are achieved, the NYP Board of Trustees retains full discretion to make or not make any incentive awards, or to reduce the amount of any incentive award. This initiative is critical to assuring that NYP has the requisite leadership to create and manage a highly motivated and engaged workforce, to drive superior performance throughout the organization and to achieve top tier medical center status. As a separate matter, due to restrictions imposed by the Internal Revenue Code, upper level executives are limited in the amount of benefits received under a tax-qualified retirement plan. Like many employers, NYP supplements these executives' pension benefits through a supplemental ("nonqualified") retirement plan. The supplemental executive retirement plan (SERP) is subject to a multi-year vesting requirement which places an executive's supplemental retirement benefit at risk of forfeiture if the vesting requirements are not satisfied. Once vested, however, provisions of the Internal Revenue Code require that the vested executive include in current income the value of his or her vested supplemental retirement benefit. Notwithstanding the legal requirement to recognize the vested value of the supplemental retirement benefit as current income, the supplemental retirement benefit will not be distributed to the executive until the executive actually retires from NYP (although, as permitted by the Internal Revenue Code, the supplemental retirement plan will effect a distribution of an amount necessary to satisfy the executive's tax liability resulting from the income recognition upon vesting). As noted, this supplemental retirement benefit will not be distributed to the executive until the executive actually retires from NYP. There are constantly changing legal, tax, accounting, and public disclosure rules for a SERP (supplemental executive retirement plan) in not-for-profit organizations. The executive Compensation Committee continuously monitors these changes and incorporates any changes into the overall SERP plan design. In 2010, the plan was redesigned in anticipation of changes in deferred compensation rules in the not-for-profit environment and to make the value of the benefit easier to understand for participants. The redesigned plan maintains the target level of SERP benefits and modifies the vesting schedules to commence after five years of participation in the SERP, in prorated amounts through age 65. Consequently, for certain individuals, there is an increase in the amount reflected in the SERP compensation due to the change in the vesting and amortization periods. As noted, this supplemental retirement benefit will not be distributed to the executive until the executive actually retires from NYP. As in past years, the executive Compensation Committee of NYP requires a third party complete a review of the organization's compensation program to ensure its effectiveness in terms of government regulations, market conditions and the need to continually elevate organizational performance. The report also serves to meet the regulatory obligations to ensure that all elements of the executive compensation programs are reasonable. The individuals listed in Part VII that are compensated by New York Presbyterian Hospital devote an average of sixty hours per week to perform their responsibilities for the New York Presbyterian Hospital and other related organizations in the aggregate. EXPLANATION OF CLASSES OF MEMBERS OR SHAREHOLDERS FORM 990, PART VI, LINE 6 NYACK HOSPITAL (THE "ORGANIZATION") IS A MEMBERSHIP CORPORATION, WHOSE MEMBERS ARE APPOINTED BY NEW YORK-PRESBYTERIAN HEALTHCARE SYSTEM, INC.("SYSTEM INC."). SYSTEM INC. IS A TAX-EXEMPT ORGANIZATION WHOSE MEMBERS ARE APPOINTED BY NEW YORK PRESBYTERIAN FOUNDATION,INC., WHICH IS ALSO A TAX-EXEMPT ORGANIZATION. THE MEMBERS OF THE ORGANIZATION ELECT THE ORGANIZATION'S BOARD OF TRUSTEES. HOW MEMBERS OR SHAREHOLDERS ELECT GOVERNING BODY FORM 990, PART VI, LINE 7A AS SOLE CORP MEMBER, NEW YORK-PRESBYTERIAN HEALTHCARE SYSTEM, INC. DESIGNATED THE INITIAL MEMBERS, THEREAFTER, MEMBERS SHALL BE APPOINTED IN ACCORDANCE WITH THE NYACK BYLAWS. DECISIONS OF GOVERNING BODY APPROVAL BY MEMBERS OR STOCKHOLDERS FORM 990, PART VI, LINE 7B NEW YORK-PRESBYTERIAN HEALTHCARE SYSTEM, INC. ("SYSTEM INC.") IS THE SOLE MEMBER OF NYACK HOSPITAL. SYSTEM INC. HAS THE RESPONSIBILITY TO PROVIDE OVERSIGHT AND TO ASSIST IN THE LONG TERM PLANNING FOR THE BENEFIT OF BOTH NYACK HOSPITAL AND SYSTEM INC.. SUCH POWERS AND RESPONSIBILITIES INCLUDE THE PERIODIC REVIEW OF NYACK HOSPITAL'S FINANCIAL POSITION, ITS COMPLIANCE WITH LEGAL AND REGULATORY REQUIREMENTS, AND EVALUATION OF ITS PROGRAMS IN AN EFFORT TO ENSURE THE EXEMPT PURPOSE OF BOTH SYSTEM INC. AND NYACK HOSPITAL ARE BEING FULFILLED. SYSTEM INC. AND NYACK HOSPITAL WILL ALSO COORDINATE EFFORTS TO RECRUIT AND MAINTAIN SELECT KEY MANAGEMENT PERSONNEL AND PHYSICIANS. IN THE EVENT OF A VACANCY, SYSTEM INC. WILL BE PROVIDED THE OPPORTUNITY TO ASSIST IN A SEARCH COMMITTEE TO FILL SUCH VACANCY. ALL DAILY OPERATING AND MANAGEMENT DECISIONS ARE RETAINED BY NYACK HOSPITAL. FORM 990 REVIEW PROCESS FORM 990, PART VI, LINE 11B THE ACCOUNTING MANAGER, DIRECTOR OF FINANCE, AND THE ENTIRE FINANCE TEAM ARE HEAVILY INVOLVED IN THE PREPARATION AND REVIEW OF THE FORM 990. ONCE THE DIRECTOR OF FINANCE HAS COMPLETED HIS REVIEW, THE CFO REVIEWS THE FORM 990 IN DETAIL, INCLUDING ALL SCHEDULES. THE FORM 990 WAS THEN UPLOADED TO THE NYACK HOSPITAL WEBSITE FOR THE FULL BOARD REVIEW IN THE "BOARD ONLY" SECTION. ONLY BOARD MEMBERS CAN ACCESS WITH A PASSWORD. EXPLANATION OF MONITORING AND ENFORCEMENT OF CONFLICTS FORM 990, PART VI, LINE 12C IN AN EFFORT TO ENSURE THAT ALL TRANSACTIONS OCCURRING BETWEEN THE ORGANIZATION AND A THIRD PARTY DO NOT INURE TO THE BENEFIT OF ANY INDIVIDUAL OR CORPORATION, NYACK HOSPITAL MAINTAINS A CONFLICT OF INTEREST POLICY. UNDER THIS POLICY, OFFICERS, TRUSTEES AND EMPLOYEES MUST DISCLOSE ANY RELATIONSHIPS THAT MAY RESULT IN CONFLICT DUE TO TRANSACTIONS OCCURRING BETWEEN THE ORGANIZATION AND AN INDIVIDUAL. ALL EMPLOYEES AND TRUSTEES HAVE A DUTY TO DISCLOSE ANY FINANCIAL INTEREST WHICH MAY POSE A CONFLICT WITH THEIR HOSPITAL RESPONSIBILITIES. THIS DISCLOSURE IS CONFIRMED BY THE DISTRIBUTION OF A QUESTIONNAIRE ON AN ANNUAL BASIS. IN COMPLETING THE QUESTIONNAIRE, THE EMPLOYEE OR TRUSTEE IS RESPONSIBLE FOR DISCLOSING HIS OR HER RELATIONSHIP TO ANY ENTITY DOING BUSINESS WITH THE ORGANIZATION UNLESS SUCH INTEREST DOES NOT REPRESENT A SIGNIFICANT PORTION OF THE INDIVIDUAL'S NET WORTH. ADDITIONALLY, SHOULD THE EMPLOYEE OR TRUSTEE BECOME AWARE OF SUCH A RELATIONSHIP SUBSEQUENT TO THE ADMINISTRATION OF THE OUESTIONNAIRE, HE OR SHE SHOULD DISCLOSE THE RELATIONSHIP TO THE APPROPRIATE DEPARTMENT HEAD OR COMMITTEE CHAIRPERSON. IN THE EVENT OF A POTENTIAL CONFLICT, THE INDIVIDUAL IS ASKED TO ABSTAIN FROM PARTICIPATING IN ANY DECISIONS RELATED TO THE TRANSACTION IN QUESTION UNTIL THE ORGANIZATION CAN DETERMINE IF A CONFLICT OF INTEREST EXISTS AND MAKES AN APPROPRIATE DECISION TO DETERMINE HOW THE CONFLICT WILL BE RESOLVED. COMPENSATION REVIEW & APPROVAL PROCESS FOR CEO, EXEC DIRECTOR OR TOP MGMT FORM 990, PART VI, LINE 15A THE COMPENSATION OF THE CHIEF EXECUTIVE OFFICER AND SENIOR EXECUTIVES IS REVIEWED ANNUALLY BY THE EXECUTIVE COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES. AN INDEPENDENT OUTSIDE CONSULTANT WITH EXPERTISE IN HOSPITAL EXECUTIVE COMPENSATION ASSESSES THE EXECUTIVE COMPENSATION AS COMPARED TO SIMILAR POSITIONS IN THE NEW YORK AREA AND RECOMMENDS A RANGE. THE COMMITTEE SETS THE EXECUTIVE COMPENSATION FOR THE COMING YEAR WITHIN THE FAIR MARKET VALUE RANGE RECOMMENDED BY THE CONSULTANT. COMPENSATION REVIEW & APPROVAL PROCESS FOR OFFICERS & KEY EMPLOYEES FORM 990, PART VI, LINE 15B THE COMPENSATION OF THE OFFICERS AND KEY EMPLOYEES IS REVIEWED ANNUALLY BY THE COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES. AN INDEPENDENT OUTSIDE CONSULTANT WITH EXPERTISE IN HOSPITAL EXECUTIVE COMPENSATION ASSESSES THE COMPENSATION AS COMPARED TO SIMILAR POSITIONS IN THE NEW YORK AREA AND RECOMMENDS A RANGE. THE COMMITTEE SETS THE COMPENSATION FOR THE COMING YEAR WITHIN THE RANGE RECOMMENDED BY THE CONSULTANT. OTHER ORGANIZATION DOCUMENTS PUBLICLY AVAILABLE FORM 990, PART VI, LINE 19 UPON REQUEST, THE ORGANIZATION WILL MAKE AVAILABLE ONLY THOSE DOCUMENTS REQUIRED TO BE DISCLOSED UNDER THE PUBLIC INSPECTION LAWS. FORM 990, PART VII Certain officers and key employees of the New York and Presbyterian Hospital that are identified in Part VII as officers or Trustees of Nyack Hospital are responsible for executing the mission and management of The New York and Presbyterian Hospital (NYP) and its affiliated entities. Compensation for 2011 of these upper level executives includes the payout of an annual incentive plan and a long-term incentive plan. This performance-oriented program conditions payments upon the achievement of multiple individual and group performance measures. Measures to monitor performance include: operational and financial strength, patient quality and safety, patient satisfaction, advancement of patient care, and people development and partnership. Incentive awards may only be granted if the organization achieves a financial surplus. Even if all relevant performance measurements are achieved, the NYP Board of Trustees retains full discretion to make or not make any incentive awards, or to reduce the amount of any incentive award. This initiative is critical to assuring that NYP has the requisite leadership to create and manage a highly motivated and engaged workforce, to drive superior performance throughout the organization and to achieve top tier medical center status. As a separate matter, due to restrictions imposed by the Internal Revenue Code, upper level executives are limited in the amount of benefits received under a tax-qualified retirement plan. Like many employers, NYP supplements these executives' pension benefits through a supplemental ("nonqualified") retirement plan. The supplemental executive retirement plan (SERP) is subject to a multi-year vesting requirement which places an executive's supplemental retirement benefit at risk of forfeiture if the vesting requirements are not satisfied. Once vested, however, provisions of the Internal Revenue Code require that the vested executive include in current income the value of his or her vested supplemental retirement benefit. Notwithstanding the legal requirement to recognize the vested value of the supplemental retirement benefit as current income, the supplemental retirement benefit will not be distributed to the executive until the executive actually retires from NYP (although, as permitted by the Internal Revenue Code, the supplemental retirement plan will effect a distribution of an amount necessary to satisfy the executive's tax liability resulting from the income recognition upon vesting). As noted, this supplemental retirement benefit will not be distributed to the executive until the executive actually retires from NYP. There are constantly changing legal, tax, accounting, and public disclosure rules for a SERP (supplemental executive retirement plan) in not-for-profit organizations. The executive Compensation Committee continuously monitors these changes and incorporates any changes into the overall SERP plan design. In 2010, the plan was redesigned in anticipation of changes in deferred compensation rules in the not-for-profit environment and to make the value of the benefit easier to understand for participants. The redesigned plan maintains the target level of SERP benefits and modifies the vesting schedules to commence after five years of participation in the SERP, in prorated amounts through age 65. Consequently, for certain individuals, there is an increase in the amount reflected in the SERP compensation due to the change in the vesting and amortization periods. As noted, this supplemental retirement benefit will not be distributed to the executive until the executive actually retires from NYP. As in past years, the executive Compensation Committee of NYP requires a third party complete a review of the organization's compensation program to ensure its effectiveness in terms of government regulations, market conditions and the need to continually elevate organizational performance. The report also serves to meet the regulatory obligations to ensure that all elements of the executive compensation programs are reasonable. The individuals listed in Part VII that are compensated by New York Presbyterian Hospital devote an average of sixty hours per week to perform their responsibilities for the New York Presbyterian Hospital and other related organizations in the aggregate. OTHER CHANGES IN NET ASSETS OR FUND BALANCES FORM 990, PART XI, LINE 5 Change in Minimum Pension Liability $ -4,251,007. Other PENSION RELATED CHANGES -1,450,700. TOTAL: $ -5,701,707. HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:WILLIAM M. TRUST JR. TITLE:CHAIRMAN HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:LAURENCE J BERGER TITLE:BOARD MEMBER HOURS:60 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MITCHELL D. COHN, MD TITLE:BOARD MEMBER HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:LISA HAYES TITLE:BOARD MEMBER HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MARK JACOBS TITLE:BOARD MEMBER HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:ELIOT J LAZAR, MD TITLE:BOARD MEMBER HOURS:60 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:WAYNE M. OSTEN TITLE:BOARD MEMBER HOURS:60 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:DAVID H. FREED TITLE:PRESIDENT & CEO HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MICHAEL RADER, MD TITLE:VP & MEDICAL DIRECTOR HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JOHN S. 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