2013-11-13T09:08:32-06:00 2012-12-31 990 2012-01-01 141338467 NORTHERN DUTCHESS HOSPITAL % HEALTHQUEST NORT 8458763001 PO BOX 5112 Suite RHINEBECK NY 12572 MARYANN KEPPLE 8454759500 2013-11-13 2012 2016-02-24 21:20:13Z TIMOTHY CLEARY INTERIM PRES PO BOX 5112 RHINEBECK NY 12572 74231799 false X WWW.HEALTH-QUEST.ORG X NY TO PROVIDE COMPREHENSIVE PRIMARY HEALTH CARE SERVICES 14 11 598 126 86290 -61642 706743 210414 70063121 71839103 201578 107579 1336128 2074703 72307570 74231799 0 0 0 0 28064530 29855238 0 0 0 34356215 37822965 62420745 67678203 9886825 6553596 67086872 69633672 29574328 28568209 37512544 41065463 THE NORTHERN DUTCHESS HOSPITAL'S MISSION IS TO MEET THE HEALTH NEEDS OF PEOPLE WHO RESIDE IN OR VISIT OUR PRIMARY SERVICE REGION, WHICH INCLUDES THE COMMUNITIES OF NORTHERN DUTCHESS AND SOUTHERN COLUMBIA COUNTIES AND PARTS OF ULSTER COUNTY, NEW YORK. OUR COMMITMENT TO THESE COMMUNITIES SHALL BE EVIDENCED BY OUR PERFORMANCE AS PROVIDERS, EDUCATORS, AND ADVOCATES. WE SHALL PROVIDE COMPREHENSIVE, PRIMARY HEALTH CARE SERVICES AND PROGRAMS TO INDIVIDUALS IN THE COMMUNITY REGARDLESS OF THEIR ECONOMIC OR SOCIAL STATUS. WE SHALL ACT AS A RESOURCE IN PROVIDING EDUCATIONAL OPPORTUNITIES AND HEALTH PROMOTION PROGRAMS TO THE COMMUNITY AND ALSO ADVANCE THE MEDICAL AND TECHNICAL SKILLS OF OUR HOSPITAL STAFF THROUGH REGULAR IN-SERVICE TRAINING. WE SHALL ADVOCATE FOR, AND TAKE ACTION WHERE POSSIBLE, TO MEET THE NEEDS OF OUR ELDERLY, FOR THOSE INITIATING FAMILY LIFE AND, ALWAYS, FOR THE DISADVANTAGED. false false 28608838 39674566 INPATIENT SERVICES: PATIENTS ADMITTED FOR ACUTE CARE - NUMBER OF PATIENTS 4,199; NUMBER OF PATIENT DAYS 16,468 THE HOSPITAL PROVIDED APPROXIMATELY $469,293 IN UNCOMPENSATED CARE (AT COST) TO THE REGIONS UN-INSURED AND UNDER-INSURED POPULATION 23193449 32164537 OUTPATIENT SERVICES: EMERGENCY VISITS 13,261; AMBULATORY SURGERY VISITS 2,797 ALL OTHER VISTIS/PROCEDURES 86,397 THE HOSPITAL PROVIDED APPROXIMATELY $771,368 IN UNCOMPENSATED CARE (AT COST) TO THE REGIONS UN-INSURED AND UNDER-INSURED POPULATION 51802287 true true false true false false false false true true false false true true false true true false false false false false false false false true true false false true true false false false false false false false false false false false false false false false true false false false true 3 0 598 true true true false false false false false false false false false false false false X 14 11 false false false false true true true true true false true true true true true true true true true true false NY X HEALTHQUEST 8454759500 1351 ROUTE 55 SUITE 200 LAGRANGEVILLE NY 12540 JAMES BRUDVIG 2.0 X 0 0 0 DENISE GEORGE 1.0 63.0 X X 0 434005 44124 SUE CRANE 1.0 X 0 0 0 DRAYTON GRANT 1.0 X 0 0 0 LEWIS RUGE 1.0 X 0 0 0 GEORGE VERRILLI MD 1.0 X 0 0 0 M NADER KAYAL JR MD 1.0 X 0 0 0 EVAN MELTZER 2.0 X 0 0 0 WILLIAM CARROLL 1.0 X 0 0 0 SUSAN KOCHANOWSKI PHD 1.0 X 0 0 0 JOHN HORISZNY MD 1.0 X 0 0 0 KEVIN M SHEEHAN 2.0 X 0 0 0 MICHAEL T WEBER 1.0 65.0 X X 0 1006627 53723 RUSSELL TIGGES MD 1.0 X 0 0 0 MARYANN KEPPLE 0.0 60.0 X 0 506786 20505 JOHN SABIA MD 0.0 55.0 X 0 226511 40083 CONNIE REGAN 39.0 X 161511 0 11008 BOGUMILA LANG 40.0 X 127823 0 31869 TIMOTHY GOVEL 38.0 X 129918 0 498 GAIL RICHARDSON 50.0 X 124705 0 24322 PAUL KING 45.0 X 137089 0 12347 681046 2173929 238479 5 false true false 0 85414 125000 210414 NET INPATIENT REVENUE 900099 39674566 39674566 NET OUTPATIENT REVENUE 900099 32164537 32164537 71839103 93436 93436 0 0 300692 300692 0 300692 300692 14143 14143 0 0 0 AFFILIATE REVENUE 900099 709246 709246 MEANINGFUL USE REVENUE 900099 447218 447218 MEANINGFUL USE REVENUE 900099 323036 323036 294511 208221 86290 1774011 74231799 73526824 86290 408271 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 22192479 19827718 2364761 0 1096137 979336 116801 0 4783351 4273652 509699 0 1783271 1593251 190020 0 0 0 0 0 0 0 0 0 0 0 0 0 3355 0 3355 0 0 0 0 0 0 0 75029 75029 0 0 0 0 1857739 1012874 844865 0 73661 42505 31156 0 0 0 0 0 1304075 1069180 234895 0 39312 32314 6998 0 0 0 0 0 239 239 0 0 677448 555423 122025 0 0 0 0 0 3890100 3189400 700700 0 855352 701283 154069 0 MEDICAL SUPPLIES 10491960 10461898 30062 PURCHASED SERVICES 12578180 2766349 9811831 PHYSICIAN FEES 1994728 1994728 BAD DEBT 2022373 2022373 1959414 1204735 754679 67678203 51802287 15875916 0 0 0 0 0 65065 4661604 1604378 0 0 0 7703568 7353967 0 0 0 0 2877 36336 1058035 1151031 693636 667733 85538028 52407503 34535099 33130525 3367675 3764129 0 0 0 0 0 0 18056539 18868347 67086872 69633672 6060469 6400749 0 0 0 0 13220195 12432324 0 0 0 0 873622 437126 0 0 9420042 9298010 29574328 28568209 X 33664710 37166689 2352430 2403370 1495404 1495404 37512544 41065463 67086872 69633672 X 6553596 304492 -3305169 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 3355 3355 false SCHEDULE C, PART II-B, LINE 1I LOBBYING ACTIVITIES 14.6% OF NORMET ASSOCIATION DUES WERE ALLOCATED TO POLITICAL ACTIVITIES, RELATED TO LOBBYING. 1495404 1495404 1495404 1495404 1495400 1495400 1495000 1495000 1495000 1495000 1.00000 false false 109930 109930 44659481 21108796 23550685 38860799 30305590 8555209 1907818 993116 914702 33130526 DUE FROM AFFILIATES 7569461 DEFERRED COMPENSATION ASSET 177268 DEFERRED FINANCING 435832 2007 SERIES B BONDS PREMIUM 720008 2007 DSRF SERIES B BONDS 1632104 MISC RECEIVABLES 520877 ESTIMATED THIRD PARTY ADJMNTS 336068 DSRF TELP LOAN TDBANK GENERAL 139850 INTEREST IN NDH FOUNDATION LT 2088545 DUE FROM AFFILIATE LT 5248334 18868347 0 HITNY LIABILITY 623244 DEFERRED COMP LIABILITY 177268 FIN 47 LIABILITY 257499 RETRO PAYABLE TO 3RD PARTY PAY 2627549 DUE TO AFFILIATES 65554 DUE TO HQ L/T 298562 MED MALPRACTICE INSURANCE LIAB 5248334 9298010 71180158 304492 -3356133 -3051641 74231799 74231799 67678203 67678203 67678203 TRANSFER OF EQUITY SCHEDULE D PART XI LINE 2D TRANSFER OF EQUITY - ($3,356,133) ENDOWMENT FUNDS SCHEDULE D, PART V, LINE 4 THE ORIGINAL CONTRIBUTION IS BEING HELD FOR THE BENEFIT OF THE HOSPITAL. true true X true X true X true true true false true true 1722640 986480 736160 0.01090 5601188 3801322 1799866 0.02660 7323828 4787802 2536026 0.03750 6 347 15140 15140 0.00020 6 347 15140 15140 0.00020 6 347 7338968 4787802 2551166 0.03770 1 2824 32140 150 31990 0.00050 1 2824 32140 150 31990 0.00050 true 1443178 721589 23142421 28681543 -5539122 X true true 3 1 NORTHERN DUTCHESS HOSPITAL

6511 SPRINGBROOK AVENUE RHINEBECK NY 12572

WWW.HEALTH-QUEST.ORG X A 2 HYDE PARK SATELLITE HEALTH CENTER

11 CRUM ELBOW ROAD HYDE PARK NY 12538

WWW.HEALTH-QUEST.ORG X A 3 STANDFORDVILLE COMM HEALTH CLINIC

3 GRISTMILL LANE STANDFORD NY 12581

WWW.HEALTH-QUEST.ORG X A NORTHERN DUTCHESS HOSPITAL 1 true true 200. true 300. true X X X X X X true true X X true X X X true X X X X X X X true X false false PART I, LINE 3C PART I, LINE 3C N/A PART I, LINE 6A PART I, LINE 6A NORTHERN DUTCHESS HOSPITAL PREPARES A COUNTY WIDE COMMUNITY SERVICE REPORT. PART I, LINE 7 COLUMN F PART I, LINE 7, COLUMN F TOTAL BAD DEBT EXPENSE EXCLUDED FROM COLUMN F PERCENTAGE - $2,022,373 PART I, LINE 7 PART I, LINE 7 COST TO RATIO PERCENTAGE WAS USED AS THE COSTING METHODOLOGY. WORKSHEET #2 WAS USED TO DERIVE THE PERCENTAGE. PART III, LINE 4 PART III, LINE 4 BAD DEBT EXPENSE WAS GROSSED UP TO GROSS CHARGES AND THEN THE COST TO CHARGE RATIO PERCENTAGE DERIVED FROM WORKSHEET #2 WAS USED TO CALCULATE THE VALUE AT COST. SELF PAY ACCOUNTS, ONCE DETERMINED A LACK OF INSUFFICIENCY OF INSURANCE AND ONCE THE PATIENT HAS RECEIVED GOVERNMENT PAYOR DENIAL, THE ACCOUNTS ARE ADJUSTED DOWN TO THE HIGHEST VOLUME COMMERCIAL PAYOR RATE. AFTER THE ACCOUNT IS DEEMED UNCOLLECTIBLE, THE ACCOUNT IS WRITTEN OFF TO BAD DEBT EXPENSE AT ADJUSTED CHARGES LESS ANY PAYMENTS MADE ON THE ACCOUNT. 50% OF THESE PATIENTS WOULD MOST LIKELY QUALIFY FOR CHARITY CARE IF THEY WERE COOPERATIVE IN FILING THE PAPERWORK, ASSOCIATED WITH GOVERNMENT ASSISTANCE. FOOTNOTE ON AUDITED FINANCIALS - FEDERAL AND STATE LAW REQUIRES THE HOSPITALS TO PROVIDE EMERGENCY SERVICES REGARDLESS OF A PATIENT'S ABILITY TO PAY. UNINSURED PATIENTS SEEN IN THE EMERGENCY DEPARTMENT, INCLUDING PATIENTS SUBSEQUENTLY ADMITTED FOR INPATIENT SERVICES, OFTEN DO NOT PROVIDE INFORMATION NECESSARY TO ALLOW THE HOSPITAL TO QUALIFY SUCH PATIENTS FOR CHARITY CARE. UNCOLLECTIBLE AMOUNTS DUE FROM SUCH UNINSURED PATIENTS REPRESENT THE SUBSTANTIAL PORTION OF THE PROVISION FOR BAD DEBTS REFLECTED IN THE ACCOMPANYING STATEMENT OF OPERATIONS. PART III, LINE 8 PART III, LINE 8 THE MEDICARE SHORTFALL SHOULD BE INCLUDED IN OUR COMMUNITY BENEFIT PERCENTAGE BECAUSE WE ARE INCURRING THE FULL COST OF CARE FOR THE PATIENTS IN OUR COMMUNITY AND OUR REIMBURSEMENT FROM GOVERNMENT PROGRAMS, INCLUDING MEDICARE, DOES NOT COVER THE HOSPITALS COST TO PROVIDE HIGH QUALITY PATIENT CARE. THE COSTING METHODOLOGY TO CALCULATE THE SHORTFALL IS COST TO CHARGE RATIO AND WORKSHEET #2 WAS USED. COST TO CHARGE RATIO - USED WORKSHEET #2 PART III, LINE 9B PART III, LINE 9B HEALTH QUEST MAY CHOOSE TO SEND ANY DELIQUENT ACCOUNT TO A COLLECTION AGENCY, HOWEVER, BEFORE REFERRING A DELIQUENT ACCOUNT TO A COLLECTION AGENCY, HEALTH QUEST WILL REVIEW THE ACCOUNT TO DETERMINE WHETHER THE PATIENT HAS APPLIED FOR A DISCOUNT UNDER THE CHARITY CARE POLICY AND THE STATUS OF THE APPLICATION. IF THE PATIENT HAS APPLIED FOR A DISCOUNT, THE ACCOUNT MAY NOT BE REFERRED TO A COLLECTION AGENCY UNTIL A FINAL DETERMINATION OF SUCH APPLICATION IS MADE AND IF ANY APPEAL OF SUCH DETERMINATION IS PROVIDED FOR IN THE CHARITY CARE POLICY, A FINAL DETERMINATION HAS BEEN MADE WITH RESPECT TO SUCH APPEAL. PATIENTS MAY STILL APPLY FOR A DISCOUNT UNDER THE CHARITY CARE POLICY EVEN AFTER THE ACCOUNT HAS BEEN SENT TO A COLLECTION AGENCY. PART V, LINE 20D PART V, LINE 20D THE HOSPITAL FACILITY USES THE HIGHEST VOLUME COMMERCIAL PAYOR RATE TO BILL INDIVIDUALS WHO DO NOT HAVE INSURANCE. PART VI, LINE 2 PART VI, LINE 2 NEEDS ASSESSMENT The Community Health Needs Assessment Process Northern Dutchess Hospital participated in a CHNA with the Dutchess County Department of Health. The Integrated Community Assessment Workgroup (ICA) was established in 2008 by the Integrated Community Planning Workgroup (ICP) to implement a countywide integrated assessment. Its goal is to examine the local health and human services system including all aspects of the local environment - i.e. physical, legal, social, economic, and health. The assessment was achieved by conducting a survey reaching out to a representative sample of Dutchess County residents. The ICP consists of health and human services public agency representatives, and the ICA consists of a smaller group of individuals from the lead agencies - Dutchess County Department of Health, Dutchess County Community and Family Services, Dutchess County Department of Mental Hygiene, Dutchess County Department of Probation, Dutchess County Department of Planning & Development; Dutchess County Office for Aging, Dutchess County Veterans Services; as well as the Mental Health Association, the Dyson Foundation, the Foundation for Community Health, Health Quest, and St Francis Hospital. The ICP has been building upon other community assessment data, including the Many Voices One Valley Report, a project of the Dyson Foundation and the Marist College Institute for Public Opinion to examine residents' priorities for the Mid-Hudson Region (http://www.manyvoicesonevalley.org/). Several independent assessments have been conducted over the years, notably: o An annual countywide data document capturing available economic, educational and health data that impact children, youth, families and adults o A community health assessment report issued every three years for selected indicators In 2009, the County issued its first systematic and integrated assessment, accomplished via survey administration to a representative sample of Dutchess County residents. The results of the 2009 integrated assessment have fed the strategic planning process of each department involved, as well as the ICP. It also ensures that the Health and Human Services planning process is responsive to community strengths and needs and results in a plan that can be implemented successfully, where clear indicators can be tracked and benchmarked. In 2012, members of the ICA reviewed the questions from the 2009 survey. While some questions were discarded or added, care was taken to insure that survey results would be compatible with the 2009 results for trending purposes. Once the survey questions were finalized, the group issued an RFP and retained a firm to conduct the survey. The firm made 11,227 calls between November 31, 2012 and January 18, 2013. They achieved a 10% response rate, including both land lines and cell phones. The raw data was submitted to the Dutchess Department of Health, where it was analyzed and compiled by their epidemiologist. On September 17, 2013, the Dutchess County Department of Health hosted a county-wide Community Health Improvement Plan Design Forum. The purpose of the forum was to review the results of the recent survey and develop a locally relevant, comprehensive action plan to improve the health and lives of the residents of Dutchess County. Representatives from various agencies attended, including staff, management and physician representation from Health Quest, VBMC and NDH. As a result of the survey and subsequent analysis, Dutchess County identified the following four priority areas: 1. Reduce Childhood and Adult Obesity 2. Increase Access to preventative healthcare and improve management of chronic disease 3. Reduce Tick and Insect-related Diseases 4. Reduce Substance Abuse While insect-related disease does not appear to fit into any of the Preventive Agenda's categories, it was by far the biggest health concern for Dutchess County residents who responded to the survey. We have, in order to be consistent with the Prevention Agenda structure, considered it to be in the Safe and Healthy Environment category. Northern Dutchess Hospital: Three Year Plans of Action 1. Vaccinate Preventable Diseases - Decrease the Burden of Influenza: In choosing its first initiative, Northern Dutchess Hospital deviated slightly from the DCDOH priorities. NDH is a small hospital (68 beds) with limited resources. In NDH's service area, 18% of its population is over 65, a number projected to rise to 23% in the next 10 years. NDH has a strong focus on caring for the senior community, with its affiliated 100-bed skilled nursing facility, its Center for Healthy Aging, and its commitment to orthopedic and rehabilitative services. The hospital itself is a hub for senior activity and a natural location for outreach to the senior population. While the most recent rates of immunization available meet the NYS 2017 objective, the county lags behind the statewide rate. NDH's implementation plan is designed to build on its existing policy of screening and immunizing all inpatients by expanding screening efforts to the emergency department. It will also gauge the need for community flu clinics, which appear to be less in demand due to inexpensive vaccines being offered by pharmacies. Priority Area: Vaccinate Preventable Diseases Goal: Decrease the burden of influenza disease Increase flu immunization rates by 10%. Disparity: Increase flu immunization rates among residents 65 and older by 10%. Performance Measures Objective 1: Increase screening and vaccination of NDH patients by targeting outpatients Indicator Source Percentage of NDH patients vaccinated for influenza will increase by 20% over three years Internal data Objective 2: Increase community awareness of benefits of vaccine and community resources to receive vaccinations Indicator Source Attendance at community flu clinics will rise 10% over baseline (dependent on community need) over three years Internal data, Regional pharmacy data Action Plan Objective 1 Activity Target Date Partners Determine baseline % of NDH patients who have received the flu vaccine 4/31/2014 None required Enact protocols to screen all ED admits for vaccination and provide vaccine according to state recommendations 12/31/2013 VBMC, PHC, DCDOH Increase the percentage of patients who receive the vaccine by 8% 12/31/2014 DCDOH Increase the percentage of patients who receive the vaccine by 14% over baseline (cumulative) 12/31/2015 DCDOH Increase the percentage of patients who receive the vaccine by 20% over baseline (cumulative) 12/31/2016 DCDOH Objective 2 Activity Target Date Partners Develop at least one patient education campaign in year one 12/31/2014 DCDOH Develop at least one patient education campaign in year two 12/31/2015 DCDOH Develop at least one patient education campaign in year three 12/31/2016 DCDOH Provide outreach to senior groups through lectures, mailings and other forums. Ongoing DCDOH, Office of the Aging, Dutchess Connect Hold at least one community flu clinic in year one (determine baseline attendance) 12/31/2014 DCDOH Collaborate with community partners to offer flu clinics focused on the elderly. 12/31/2014 DCDOH, Office of the Aging, Dutchess Connect Hold at least one community flu clinic in year two, with attendance = 5% over baseline 12/31/2015 DCDOH Hold at least one community flu clinic in year three, with attendance = 10% over baseline 12/31/2016 DCDOH 2. Lyme and Other Insect-Borne Diseases: Dutchess County residents have significantly higher rates of tick-borne diseases than NYS residents overall. In both the 2009 and 2012 Dutchess Community Surveys, Lyme disease and other insect-related diseases were identified by two thirds of respondents as the top environmental concern. While VBMC's initiative focuses on education of providers, NDH will focus on education of the patient. This two-pronged approach is hoped to have a positive impact on awareness and treatment. 2011 Tick-borne Illness Rates per 100,000 Population Disease Dutchess County New York State Lyme disease 147.9 64.9 Anaplasmosis 23.9 2.8 Erlichiosis 0.7 0.4 Babesiosis 17.8 3.2 Source: DCDOH, NYSDOH Priority Area: Promote a Healthy and Safe Environment Goal: Prevent Tick-Borne Diseases in Dutchess County. Promote Use of Evidence-based Care to Manage Insect-borne Disease. Performance Measures Objective 1: Educate NDH patients on tick attachment prevention and treatment options Indicator Source 90% of people attending educational events will demonstrate increased knowledge of subject matter Pre and post testing Action Plan Objective 1 Activity Target Date Partners Collaborate with DCDOH staff to create or adopt informational pamphlet for patients 12/31/2014 DCDOH, Tick Task Force Develop protocol to disseminate information to all ED patients during tick season 12/31/2013 DCDOH, Tick Task Force Conduct at least one patient education event in year one 12/31/2014 DCDOH, Tick Task Force Conduct at least one patient education event in year two 12/31/2015 DCDOH, PART VI, LINE 3 PART VI, LINE 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE FINANCIAL ASSISTANCE POSTERS ARE HUNG UP IN VARIOUS AREAS OF THE HOSPITAL. FOR PATIENTS THAT INQUIRE ABOUT FINANCIAL ASSISTANCE, THE POLICY IS PROVIDED TO THE PATIENT ALONG WITH ASSISTANCE IN COMPLETING THE APPLICATIONS. PART IV, LINE 4 PART IV, LINE 4 COMMUNITY INFORMATION NORTHERN DUTCHESS HOSPITAL'S PRIMARY SERVICE AREA COVERS HYDE PARK AND NORTHERN DUTCHESS COUNTY. IT ALSO INCLUDES SEVERAL ADJACENT ZIP CODES IN ULSTER COUNTY AND SOME OF THE SOUTHERNMOST TOWNS IN COLUMBIA COUNTY WHICH RESIDES TO THE NORTH OF THE HOSPITAL. THE HOSPITAL'S SERVICE AREAS ARE PREDOMINATELY WHITE AND SKEWING SLIGHTLY OLDER THAN THE NATIONAL AVERAGES. HIGHER PERCENTAGE OF COLLEGE DEGREES THAN THE NATIONAL AVERAGE, WITH AVERAGE HOUSEHOLD INCOMES SIGNIFICANTLY HIGHER THAN NATIONAL INCOME. PART IV, LINE 5 PART IV, LINE 5 PROMOTION OF COMMUNITY HEALTH ALL HOSPITALS SERVE AS COMMUNITY LEADERS IN HEALTH RELATED FUNDRAISERS, SUCH AS RELAY FOR LIFE AND THE MARCH OF DIMES. EXECUTIVES AND EMPLOYEES VOLUNTEER AND SERVE ON THE BOARDS OF MANY COMMUNITY ORGANIZATIONS AND USE HOSPITAL RESOURCES TO ASSIST COALITIONS AND MEET A BROAD DEFINITION FOR HEALTH WHICH INCLUDES EDUCATION AND HOUSING. ALL HOSPITALS OFFER SCREENING AND LECTURES TO EDUCATE THE COMMUNITY AND ENCOURAGE PREVENTATIVE MEDICINE. PART VI, LINE 6 PART VI, LINE 6 AFFILIATE HEALTH CARE SYSTEM HEALTH QUEST SYSTEMS, INC (DBA HEALTH QUEST) IS THE ACTIVE PARENT COMPANY TO ALL AFFILIATED HOSPITALS. HEALTH QUEST ACTS ON BEHALF OF THE HOSPITALS IN SOME COMMUNITY ASSESSMENT ACTIVITIES. HEALTH QUEST HAS TRANSITIONED TO A MODEL IN WHICH IT WILL SUPERVISE BOARD COMMITTEES AT EACH HOSPITAL AS THEY ASSESS COMMUNITY NEEDS, PLAN APPROPRIATE PROGRAMS AND MONITOR THEM FOR EFFECTIVENESS. PART VI, LINE 7 PART VI, LINE 7 STATE FILING OF COMMUNITY BENEFIT REPORT NORTHERN DUTCHESS HOSPITAL FILES A COUNTY-WIDE COMMUNITY SERVICE PLAN WITH NYS DEPARTMENT OF HEALTH PART V, LINE 14G PART V, LINE 14G FINANCIAL ASSISTANCE POSTERS ARE HUNG UP IN VARIOUS AREAS OF THE HOSPITAL STATING WHO TO CONTACT REGARDING THE POLICY. FOR PATIENTS THAT INQUIRE ABOUT FINANCIAL ASSISTANCE, THE POLICY IS PROVIDED TO THE PATIENT ALONG WITH ASSISTANCE IN COMPLETING THE APPLICATIONS. PART II PART II N/A X X X X X false false false false false false false false false DENISE GEORGE 0 296879 0 112892 0 24234 0 15000 0 29124 0 478129 0 14700 JOHN SABIA MD 0 211303 0 15208 0 0 0 15000 0 25083 0 266594 0 14700 CONNIE REGAN 160462 0 0 0 1049 0 10430 0 578 0 172519 0 10585 0 BOGUMILA LANG 127823 0 0 0 0 0 8414 0 23455 0 159692 0 8203 0 MICHAEL T WEBER 0 685867 0 206535 0 114225 0 15000 0 38723 0 1060350 0 0 MARYANN KEPPLE 0 395910 0 68741 0 42135 0 15000 0 5505 0 527291 0 0 A DORMITORY AUTHORITY - STATE OF NEW YORK 146000293 649903UK5 2007-09-06 15718408 PURCHASE OF EQUIPMENT false false false A 1589913 0 16419184 1126871 319526 0 216413 247657 0 13176836 0 1331881 2008 false false false true A false false false false 0 A false false false true false false 0 false 0 true false A false BOND ISSUES PART I, LINE A, COLUMN E TOTAL ISSUE PRICE PER IRS FORM 8038 - $61,974,071.30 ALLOCATED BETWEEN THREE ORGANIZATIONS PROCEEDS PART II, LINE 3 THE TOTAL PROCEEDS DO NOT AGREE TO THE ISSUE PRICE IN PART I, COLUMN E DUE TO INVESTMENT EARNINGS. ARBITRAGE PART IV, LINE 2C (A) ISSUER NAME: DORMITORY AUTHORITY - STATE OF NEW YORK DATE THE REBATE COMPUTATION WAS PERFORMED: 12/31/2011 PRIVATE BUSINESS USE PART III, LINE 9 THE HOSPITAL HAS RETAINED THE SERVICES OF OUTSIDE LEGAL COUNSEL TO ASSIST IN ESTABLISHING WRITTEN PROCEDURES TO ENSURE THAT ALL NONQUALIFIED BONDS OF THE ISSUE ARE REMEDIATED IN ACCORDANCE WITH THE REQUIREMENTS UNDER REGULATIONS SECTIONS 1.141-12 AND 1.145-2. ARBITRAGE PART IV, LINE 7 THE HOSPITAL HAS RETAINED THE SERVICES OF OUTSIDE LEGAL COUNSEL TO ASSIST IN ESTABLISHING WRITTEN PROCEDURES TO MONITOR THE REQUIREMENTS OF SECTION 148. RELATED TAX EXEMPT ORGANIZATIONS SCHEDULE R, PART II - RELATED TAX EXEMPT ORGANIZATIONS Entity Tax ID# Primary Activity Legal Domicile Exempt Code Status Public Charity Status Direct controlling Entity Vassar Brothers Medical Center 14-1338586 Hospital NY 501c3 Box 3 HQ The Foundation for Vassar Brothers Medical Center 14-1736429 Fundraising NY 501c3 Box 9 HQ Riverside Diversified Services, Inc (Parent) 14-1675545 Education NY 501c3 Box 9 HQ Alamo Ambulance Service, Inc 14-1745417 Transport NY 501c3 Box 9 HQ Hudson Valley Home Care, Inc (Certified) 14-1788412 Home Health NY 501c3 Box 9 HQ Hudson Valley Home Care, Inc (Licensed) 14-1788410 Home Health NY 501c3 Box 9 HQ Northern Duchess Hospital 14-1338467 Hospital NY 501c3 Box 3 HQ Northern Dutchess Residential Health Care Facility 22-3129608 Nursing Home NY 501c3 Box 9 HQ NDH Foundation 14-1776208 Fundraising NY 501c3 Box 9 HQ Putnam Hospital Center 14-6019179 Hospital NY 501c3 Box 3 HQ Putnam Hospital Center Foundation 06-1399319 Fundraising NY 501c3 Box 9 HQ Health Quest Medical Practice, PC 56-2669185 Medical Care NY 501c3 Box 3 HQ Health Quest Urgent Medical Practice, PC 80-0152047 Medical Care NY 501c3 Box 3 HQ Health Serve Information Technologies, LLC 14-1797086 IT Support NY 501c3 Box 3 HQ Health Quest Laboratory Support Services, LLC 45-4370644 Medical Laboratory NY 501c3 Box 3 HQ One Columbia Street, LLC 46-1626016 Real Estate Mgmt NY 501c3 Box 3 HQ GOVERNING FORM 990 PART VI SECTION A LINE 6, 7A AND 7B LINE 6 - THE SOLE MEMBER OF NDH IS HEALTH QUEST SYSTEMS, INC. LINE 7A - APPOINTMENT/ELECTION OF DIRECTORS NOMINEES TO THE BOARD OF DIRECTORS OF NDH SHALL BE NOMINATED IN THE FOLLOWING MANNER: NDH'S EXECUTIVE COMMITTEE MAY PREPARE A SLATE OF NOMINEES TO PRESENT TO THE HEALTH QUEST EXECUTIVE COMMITTEE FOR ITS REVIEW AND APPROVAL NOT LESS THAN THIRTY DAYS (30) PRIOR TO THE ANNUAL MEETING OF NDH IN THE CASE OF VACANCIES CREATED BY THE EXPIRATION OF NDH DIRECTORS TERMS OF OFFICE, OR IN THE CASE OF ALL VACANCIES, AS SOON AS REASONABLY POSSIBLE. THE EXECUTIVE COMMITTEE OF HEALTH QUEST MUST APPROVE SLATES OF NOMINEES BY A MAJORITY VOTE OF THE ENTIRE HEALTH QUEST EXECUTIVE COMMITTEE. ONCE HEALTH QUEST'S EXECUTIVE COMMITTEE APPROVES THE SLATE OF NOMINEES BY MAJORITY VOTE, HEALTH QUEST'S EXECUTIVE COMMITTEE SHALL INFORM THE NDH BOARD OF DIRECTORS AND PRESENT THE SLATE OF NOMINEES TO THE BOARD OF TRUSTEES OF HEALTH QUEST FOR APPROVAL. LINE 7B - MANNER OF ACTING/VOTE REQUIRED FOR CERTAIN SPECIFIC ACTIONS EXCEPT AS OTHERWISE SPECIFIED IN THE CERTIFICATE OF INCORPORATION OF NDH, OR THESE BYLAWS, OR THE BYLAWS OF HEALTH QUEST, OR PROVIDED BY LAW, THE ACTS OF A MAJORITY OF THE DIRECTORS PRESENT AND VOTING AT A MEETING AT WHICH A QUORUM IS PRESENT SHALL BE THE ACTS OF THE BOARD OF DIRECTORS. THERE SHALL BE NO VOTING BY PROXY. THE POWERS TO BE EXERCISED BY THE NDH BOARD OF DIRECTORS THAT ARE (I) SUBJECT TO THE SUBSEQUENT APPROVAL OF HEALTH QUEST, OR (II) TO BE UNDERTAKEN IN COLLABORATION WITH HEALTH QUEST,ARE SET FORTH IN PARAGRAPHS (C), (D) AND (E) BELOW. THE POWERS SET FORTH IN PARAGRAPH (F) BELOW REQUIRE THE VOTE OF TWO-THIRDS OF SOLELY THE NDH BOARD OF DIRECTORS. UNLESS OTHERWISE SPECIFIED, ALL OTHER ACTIONS THAT REQUIRE NDH BOARD APPROVAL REQUIRE A MAJORITY VOTE OF SOLELY THE NDH BOARD OF DIRECTORS. PARAGRAPH (C) - ACTIONS REQUIRING HOSPITAL BOARD MAJORITY VOTE & AT LEAST NINE (9) HEALTH QUEST TRUSTEES. THE VOTE OF A MAJORITY OF THE NDH DIRECTORS PRESENT AND VOTING AT A MEETING AT WHICH A QUORUM IS PRESENT SHALL BE REQUIRED TO APPROVE THE FOLLOWING ACTIONS: (I) TERMINATION OF HEALTH QUEST'S RELATIONSHIP TO NDH AS THE SOLE MEMBER OF NDH; (II) APPROVAL OF THE ABANDONMENT OR MATERIAL DIMINUTION OF ANY SERVICE, PROGRAM OR CAMPUS OF NDH; PROVIDED HOWEVER, THAT THE ACTIONS LISTED ABOVE IN THIS ARTICLE V, SECTION 16(C) SHALL REQUIRE THE AFFIRMATIVE VOTE OF AT LEAST NINE (9) OF THE TRUSTEES OF HEALTH QUEST THEN IN OFFICE. PARAGRAPH (D) - ACTIONS REQUIRING TWO-THIRDS OF ENTIRE HOSPITAL BOARD & AT LEAST NINE (9) HEALTH QUEST TRUSTEES. THE TWO-THIRDS (2/3) OF THE ENTIRE BOARD OF NDH ("ENTIRE BOARD" SHALL MEAN THE TOTAL NUMBER OF DIRECTORS ENTITLED TO VOTE WHICH NDH WOULD HAVE IF THERE WERE NOT VACANCIES.) SHALL BE REQUIRED TO APPROVE THE FOLLOWING ACTIONS: (I) REORGANIZATION, MERGER, DISSOLUTION OF NDH; AND (II) THE SALE, LEASE OR MORTGAGE OF SUBSTANTIALLY ALL THE ASSETS OF NDH; PROVIDED HOWEVER, THAT THE ACTIONS LISTED ABOVE IN THIS ARTICLE V, SECTION 16(D) SHALL REQUIRE THE AFFIRMATIVE VOTE OF AT LEAST NINE (9) OF THE TRUSTEES OF HEALTH QUEST THEN IN OFFICE. PARAGRAPH (E) - ACTIONS REQUIRING MAJORITY OF HOSPITAL BOARD & COLLABORATION WITH HEALTH QUEST TRUSTEES. THE VOTE OF A MAJORITY OF THE NDH DIRECTORS PRESENT AND VOTING AT A MEETING AT WHICH A QUORUM IS PRESENT SHALL BE REQUIRED TO APPROVE THE FOLLOWING ACTIONS: (I) OVERSIGHT OF NDH'S QUALITY IMPROVEMENT PROCESSES, INCLUDING, BUT NOT LIMITED TO, POLICIES AND PROCEDURES AND PHYSICIAN CREDENTIALING; (II) DELIVERY OF CLINICAL SERVICES; (III) ESTABLISHMENT AND MAINTENANCE OF A COORDINATED PROGRAM WHICH INTEGRATES THE REVIEW ACTIVITIES OF ALL HOSPITAL SERVICES FOR THE PURPOSE OF ENHANCING THE QUALITY OF PATIENT CARE AND IDENTIFYING AND PREVENTING MALPRACTICE; (IV) OVERSIGHT OF NDH'S CORPORATE COMPLIANCE PROCESSES; AND (V) THE BOARD OF DIRECTORS MAY NOT AUTHORIZE ANY ORGANIZATION OR GROUP TO FUNCTION IN THE NAME OR ON BEHALF OF THE CORPORATION ABSENT THE PRIOR APPROVAL OF HEALTH QUEST; PROVIDED HOWEVER, THE ACTIONS LISTED ABOVE SHALL BE COORDINATED AND UNDERTAKEN IN COLLABORATION WITH, AND AS AN AFFILIATED MEMBER OF, THE HEALTH QUEST SYSTEM. PARAGRAPH (F) - ACTIONS REQUIRING TWO-THIRDS OF ENTIRE HOSPITAL BOARD. THE VOTE OF TWO-THIRDS (2/3) OF THE ENTIRE BOARD OF NDH SHALL BE REQUIRED TO APPROVE THE FOLLOWING: (I) SALE, MORTGAGE OR LEASE OF REAL PROPERTY BY NDH. POLICIES PART VI SECTION B LINE 11A, 12C, 15A AND 15B LINE 11A - A COPY OF THE FORM 990 WAS EMAILED TO ALL MEMBERS OF THE BOARD. THE CHAIR OF THE HQ EXECUTIVE COMPENSATION COMMITTEE REVIEWED ALL SECTIONS RELATED TO EXECUTIVE COMPENSATION. A 3RD PARTY WAS HIRED TO PREPARE SCHEDULE K. PRICEWATERHOUSE COOPERS WAS CONSULTED IN THE PREPARATION OF SCHEDULE H. LINE 12C - ON AN ANNUAL BASIS OFFICERS, DIRECTORS, TRUSTEES AND KEY EMPLOYEES ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST FILING WHICH IS REVIEWED BY THE HQ VP OF COMPLIANCE AND INTERNAL AUDIT. ALL POTENTIAL CONFLICTS OF INTEREST ARE REVIEWED BY THE HQ BUSINESS ETHICS COMMITTEE ON BEHALF OF NDH. LINE 15 A/B - COMPENSATION OF THE CEO, TOP MANAGEMENT AND OTHER KEY EMPLOYEES IS ESTABLISHED BY THE HQ EXECUTIVE COMPENSATION COMMITTEE BASED ON INFORMATION AND RECOMMENDATIONS OF AN INDEPENDENT THIRD PARTY. DISCLOSURE FORM 990 PART VI SECTION C LINE 19 LINE 19 - POLICIES AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. THE DOCUMENTS ARE PROVIDED EITHER ELECTRONICALLY OR PAPER COPIES. IN ADDITION, CERTAIN FINANCIAL INFORMATION IS AVAILABLE ON VARIOUS WEBSITES DUE TO REGULATORY FILINGS SUCH AS THE 990 AND BOND HOLDER REQUIREMENTS. SCHEDULE K PART 1, LINE A, COLUMN E TOTAL ISSUE PRICE PER IRS FORM 8038 - $61,974,071.30, ALLOCATED AS FOLLOWS NORTHERN DUTCHESS HOSPITAL - $15,718,407.82 PUTNAM HOSPITAL CENTER - $28,161,750.86 VASSAR BROTHERS MEDICAL CENTER - $18,093,912.82 ALLOCATION METHODOLOGY FOR HQ SCHEDULE R, PART V, LINE 2 (1) Health Quest Systems, Inc Allocation of Support Services/Shared Expenses/Cash Funding General: The following services are considered shared services for Health Quest affiliates and the cost to provide these services are allocated to each entity which benefits from the service based on a pre defined allocation methodology: 1. Specialty Staffing a. VBMC Surgical b. Radiology c. Oncology d. VBMC Sleep Lab e. PT/OT/ST f. Cardiac Rehab 2. Clinical Management a. Emergency Room b. Pharmacy c. Cardiac d. Oncology 3. Revenue Cycle including health information management, budgets and reimbursement, revenue cycle, system business office, patient access oversight, financial clearance center, managed care and decision support 4. Facilities including courier service, construction, property management, facility operations, food service management and security 5. Business Development including strategic planning, marketing and public relations, answering service and community education 6. Corporate Finance including accounts payable, payroll, general accounting, purchasing, supply chain and mailroom, practice management billing and management engineering 7. Internal Audit and Compliance 8. Practice management operations including physician recruitment, physician management and centralized scheduling 9. Human Resources and learning and development 10. Administrative including Executive office, Hospital Support and risk management 11. Legal Counsel 12. Information Technology and Medical Technology Services (MTS) Description of Services: 1. Specialty staffing a. Provides non union staffing services for various specialties to the hospitals, offsite ancillary locations and the Fishkill Medical Mall 2. Clinical management includes management oversight to system consolidated clinical services 3. Revenue Cycle - a. Health Information Management functions includes coding and transcription of medical records for all 3 hospitals b. Budget functions include preparation of annual budgets, variance reporting and maintenance of the budget module Reimbursement functions include preparation of annual cost reports, analysis of third party rate accounts and third party audits c. Revenue cycle functions include charge master analysis and development of revenue producing charges, compliance with CPT coding and establishment of appropriate charges d. System business office services includes producing claims for third party payers and private pay patients, payment processing, periodic reporting, accounts receivable analysis, charity care application process, denial management, collection and follow up for the hospitals. Patient access and financial clearance center includes oversight of all centralized registration areas at the hospitals and pre-authorization for numerous hospital services to insure compliance with third party regulations e. Managed Care functions include contract negotiations and analysis of contract terms f. Decision Support functions include cost accounting reporting, maintenance of HBI (Horizon Business Insight) reporting and the contract management system 4. Facilities - a. Courier service provides delivery services internally throughout the HQ system and bank deposit drop offs b. Construction and property management functions include contracting services for Health Quest projects and property management of all HQ facilities c. Facility operations include management oversight of the engineering departments for the hospitals d. Food Service management includes management oversight of food and nutrition departments for the hospitals e. Security functions include management oversight of all facilities to ensure the safest environment 5. Business Development - a. Strategic Planning functions include CON submissions, market data analysis and assistance with business plans b. Marketing includes advertising services, coordination of joint Health Quest advertisements and reduction of expenses associated with larger campaigns c. Public relations functions include coordination of Health Quest communication to external customers, patients and media d. Oversight of the outsourced answering services for physicians affiliated with the hospitals and HQMP e. Community education functions include training classes specific to life saving techniques 6. Finance - a. Accounts payable functions include scheduling vendor payments, insuring flow of goods and services, maintaining days cash on hand goals and maintaining days in accounts payable b. Payroll functions include biweekly employee payments and tax filings in accordance with Human Resources and Payroll policies c. General Accounting functions include preparation of financial statements, account analysis, contract reconciliation, tax filings, investment coordination, insurance coordination and coordination of internal and external audit functions d. Purchasing, supply chain and mailroom functions include procurement services, contract negotiations, price negotiations, capital purchase negotiations, management/distribution of hospital inventory, and central mailroom management e. Practice management billing functions include producing all claims for third party payers and private pay patients, payment processing, periodic reporting, accounts receivable analysis, charity care application process, denial management, collection and follow up services for all employed HQ physicians f. Management Engineering functions include evaluating each area within HQ to ensure compliance with various productivity benchmarks optimizing staffing ratios 7. Internal Audit and Compliance includes oversight of the corporate compliance program, internal audit, HIPAA compliance, contract review and compliance 8. Human Resource and learning and development functions include recruitment, compensation, benefit administration and employee training 9. Physician management operations functions include oversight of all HQ physician practices, physician recruitment functions, and the centralized scheduling office 10. Administrative functions include oversight of the Health Quest system, hospital management and risk management 11. Legal Counsel functions include internal legal services for HQ and coordination of all outsourced legal initiatives 12. Information Technology and MTS - a. IT provides information technology support for all applications and telephony support within HQ. In addition provides project management services for all new and upgrades to current IT applications. b. MTS/Biomed includes technical services provided to each hospital for equipment repair and maintenance Shared Expenses: In addition to services provided by support departments, certain insurance policies are consolidated for all Health Quest entities. These include property insurance, travel, crime, environmental, cyber risk and Directors and Officers insurance. Affiliate Cash Shortfalls: Affiliate cash shortfalls are funded by the entity(s) benefiting from the affiliate services. Examples include Health Quest Medical Practice and the Thompson House. The cash shortfall funding is based on the percentage of benefit received (percentage of revenue by division for HQMP and admissions to the Thompson House from the hospitals) Allocation Methodology: Net Revenue - lab management, budgets, revenue cycle, managed care, decision support, all facilities (excluding construction), business development, general accounting, management engineering, internal audit and compliance, executive office, legal, information technology and MTS # of visits/procedures - staffing specialties Historical trends - health information management, clinical management and hospital support Cash collections - patient accounting and the financial clearance center # of FTE's - payroll and human resources Non payroll expenses - accounts payable and purchasing Project based - construction # of FTE's allocated to physician sites - Practice management billing, operations and physician practice management System Benefits: 1. Financial planning 2. Revenue enhancement 3. Improved cash collections 4. Enhanced managed care contract rates 5. Optimized medical records coding 6. Savings for supplies, contracts, insurance and capital purchases 7. Staffing reduction through shared services 8. Enhanced employee benefit programs Health Quest Laboratory Support Services, LLC provides clinical diagnostic services to affiliate hospitals. NDH covers lab services performed for both their inpatient and outpatient services. RECONCILIATION OF NET ASSETS 990 PART XI LINE 9 TRANSFER OF EQUITY - ($3,356,133); INTEREST IN FOUNDATION - $195,384; NET ASSETS FROM RESTRICTIONS USED FOR OPERATIONS - ($144,443); PERM RESTRICTED MISC $23 OMB CIRCULAR A-133 AUDIT FORM 990, PART XII LINE 3A NORTHERN DUTCHESS HOSPITAL DID NOT RECEIVE MORE THAN $500,000 IN FEDERAL AWARDS IN 2012, AND DID NOT QUALIFY FOR AN A-133 AUDIT. HEALTH QUEST SYSTEMS INC 45 READE PLACE POUGHKEEPSIE NY 12601 141678068 SUPPORT SERV BOX 9 HQ SEE SCHEDULE O N/A false false false false false false false false false false false false false false true false false false HEALTH QUEST SYSTEMS INC P 10071181 SEE SCHEDULE O HEALTH QUEST LABORATORY SUPPORT SERVICES LLC P 1612168 SEE SCHEDULE O