2013-11-14T15:52:04-07:00 2012-12-31 990 2012-01-01 141338547 SARATOGA HOSPITAL SARA 5185878421 211 Church Street Saratoga Springs NY 128661090 GARY FOSTER 5185838421 2013-11-15 2012 2016-02-24 21:20:13Z Angelo Calbone 211 Church Street Saratoga Springs NY 12866 234691856 0 X www.saratogahospital.org X 1891 NY To serve the people of the Saratoga region by providing them access to excellence in healthcare in a supportive and caring environment. 16 13 2224 299 4861328 403775 1941156 2480975 209699417 218520389 358072 1215178 3344241 7083343 215342886 229299885 0 0 0 0 104312741 112157921 0 0 235937 95147289 99008065 199460030 211165986 15882856 18133899 229876622 252807558 100209263 102308136 129667359 150499422 To serve the people of the Saratoga region by providing them access to excellence in healthcare in a supportive and caring environment. 0 0 192113969 218520389 The foremost commitment of the Hospital is to provide superior quality healthcare to the people of our community, regardless of their ability to pay. Saratoga Hospital is the largest healthcare provider and only hospital located in Saratoga County. The services provided by the Hospital to the community are broad and varied. Following is a listing of some of the most significant of those services: * The Hospital operates the only emergency department in Saratoga County 24 hours per day, 365 days per year. During 2012, the hospital emergency department facilitated 40,406 patient visits. * The Hospital represents the only inpatient acute care facility in Saratoga County. During 2012, the Hospital had 8,092 admissions for inpatient adult and pediatric care. These admissions included 819 births, 707 admissions to our inpatient mental health unit and 64 admissions for Hospice care. Total adult and pediatric inpatient days for the Hospital during 2012 were 41,888 which included 4,038 days of inpatient care in the Critical Care Unit. * The Hospital operates a 36-bed skilled nursing facility on its campus. During 2012, 12,525 patient days of skilled nursing care were provided. * The hospital maintains a charity care policy, eligibility for benefit from which is determined by the Hospital's patient financial services department based upon the financial means of the patient and/or patient's family. The amount of charity care benefit provided to patients is based on the comparison of their documented income versus annual Federal Poverty Level (FPL) standards. The following is a sliding scale of benefits (as a percentage of charges) available to patients with varying levels of income: o FPL x 250% or below- 100% discount o FPL x 300%- 75% discount o FPL x 350% - 50% discount o FPL x 400%- 25% discount In addition to the means-tested charity care benefit program described above, beginning January 1, 2008, the Hospital began providing an automatic 35% discount from charges for any uninsured patients receiving care at any of the hospital's locations. This discount applies regardless of a patient's ability to pay. The discount is shown clearly on any bills sent to the patient in order to enhance awareness of the availability of this benefit. Effective January 1, 2009, the Hospital began providing discounted rates to uninsured patients receiving care at its two urgent care sites. Uninsured patients are required to pay a flat fee per visit, regardless of the amount of charges to their account. Each patient is classified into one of three tiers based on the level of services provided, with a progressively higher all-inclusive fee for each tier. The first tier is for urgent care visits consisting of only an office visit, the second tier is for visits including and office visit and any laboratory or x-ray procedures and the third tier is for visits including an office visit and CT or MRI scans. During 2012, the benefits provided under these policies, measured on the basis of costs, amounted to approximately $ 2,755,000. * The Hospital has two sites providing urgent care services to the community. Many patients in the community are unable to access primary care on a timely basis if at all. The Hospital has continually expanded access to these urgent care sites, including nights and weekends in order to meet community need. As a result, our urgent care sites have became a significant portal of access to care for the community. During 2012, our urgent care sites accommodated 50,736 patient visits. * During 2012 the hospital incurred bad debt expense of approximately $9,147,206 measured on the basis of charges, which represented an increase from the previous year. The bad debt expense continues to be largely comprised of patients having no or insufficient insurance, and also of patients using our emergency department and urgent care facilities, where uninsured patients will often utilize as an option to receiving no care at all. * As the largest healthcare provider in the community, the Hospital serves a significant number of Medicare and Medicaid insured patients. Losses incurred from providing services to Medicare and Medicaid patients during 2012 were approximately $7,092,000 and $6,490,000, respectively. * The Hospital is the community leader in assessing community healthcare needs and working to bring the needed services into the community. These efforts include the following: o Subscriptions to databases providing demographics for the communities served. Based on information such as age, gender, etc. anticipated needs by physician specialty and type of inpatient or outpatient care are determined. o Continuous patient satisfaction surveys are conducted in order to gain patient feedback regarding the quality of care received and perceptions of their overall experience as patients. o "Secret shopper" calls are conducted whereby Hospital personnel call physician practices in the community in order to determine accessability to physician care in terms of days wait to be seen for acute and chronic problems. o Community input is obtained through information gathering sessions held with human resources representatives of local business, as well as representatives from other not-for-profit and governmental agencies operating in the community. In addition to discussion occurring at the sessions, those whose attend as well as those who are unable to attend are asked to return written surveys to the Hospital. The surveys include questions regarding the availability and quality of health care services in the community. o Ongoing dialogue with medical staff members regarding their perceptions regarding quality of care and areas of need for the community. o Formalized tracking processes for patient communications and complaints. * As a result of its leadership role in identifying community healthcare needs, the Hospital is also the key resource in its community for recruiting physicians practicing in areas of medicine identified as underserved in the community. A component of this recruitment effort includes the extension of relocation incentives to physicians in the targeted need areas. The incentives exist in the form of income guarantees that are provided in an effort to make practice start-up financially palatable for relocating physicians. After an initial period during which funds are advanced to physicians as they have shortfalls versus a targeted income amount, the accumulated advances are converted to promissory notes. Should the physician remain in practice in the community for a contractually agreed-upon number of years after the initial benefit period, the note will be forgiven in full. During 2012, the Hospital forgave advances plus accrued interest amounting to approximately $ 45,000 relating to these arrangements. * During 2008, the Hospital became the lead agency in Saratoga County for administering the State of New York's Cancer Services Program (CSP). In the role of CSP administrator for the County, Hospital personnel actively seek out low-income members of the community who possess certain risk factors, such as age or gender, and facilitate cancer screenings and, if necessary, treatment services for eligible individuals. The services are provided at no cost to the individuals. The State reimburses the Hospital for any screening or treatment services provided to these patients based on Medicaid reimbursement rates. The State reimburses the Hospital for a portion of the administrative costs incurred by the Hospital in identifying eligible individuals and coordinating screening and treatment services. During 2012, unreimbursed costs of administering the program were approximately $26,000. * Hospital personnel have taken a leading role in development of a County-wide emergency preparedness and response plan, including corresponding with law enforcement, fire, emergency medical services and other relevant agencies to develop and test a plan for managing the public health effects of a large-scale natural disaster or other significant community-wide crisis. 0 0 0 192113969 1 0 0 1 0 0 0 0 0 1 1 1 0 0 1 1 1 1 0 0 0 0 0 0 1 0 1 1 0 0 1 1 0 0 0 0 0 1 0 1 0 1 0 0 0 0 0 1 0 1 0 1 142 0 1 2224 1 1 1 1 VI CJ 0 0 0 0 X 16 13 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X X MIKE BATTLE 5185838498 The Saratoga Hospital 211 Church Street Saratoga Springs NY 12866 Michael D West 2.5 X 0 0 0 Janice M White 2.5 X 0 0 0 David M Mastrianni MD 2.5 X 0 0 0 Michael H Iacolucci 2.5 X 0 0 0 Donna Montalto 2.5 X 0 0 0 Dennis A Brobston 2.5 X 0 0 0 Judith Ekman 2.5 X 0 0 0 Brian T Fredette 2.5 X 0 0 0 Michele J Mehler 2.5 X 0 0 0 Eugene K Merecki MD 2.5 X 0 0 0 William O'Connor MD 2.5 X 0 0 0 Alan Oppenheim 2.5 X 0 0 0 Deane Pfeil 2.5 X 0 0 0 William R Stanley 2.5 X 0 0 0 Theresa Skaine 2.5 X 0 0 0 Angelo Calbone 32 6 X X X 479195 84900 114340 Gary L Foster 36 2 X X 287638 15600 33238 Mary Jo Laposta 38 X 313313 0 31510 John Mangona 38 X 254181 0 27077 Jeffrey Methven 38 X 250242 0 35906 Joyce L Peabody 38 X 368339 0 41339 Kevin Ronayne 38 X 250864 0 38344 Gordan Kuhar 38 X 883492 0 8875 Richard Duff 38 X 376749 0 17652 Gregory Tillou 38 X 271441 0 20051 John Delmonte 38 X 296676 0 9070 Bradley Sexauer 30 8 X 208621 56200 32074 4240751 156700 409476 104 0 1 0 Saratoga Emergency Physicians PC The Saratoga Hospital 211 Church Street Saratoga Springs NY 12866 Physicians 8501547 Saratoga Cardiology Associates PC 6 Care Lane Saratoga Springs NY 12866 Physicians 1675537 Laboratory Corp of America 2975 W CORPORATE LAKES BLVD WESTON FL 333313626 Medical Laboratory Testing 1640747 Hypertype Inc 84 Calvert Street Harrison NY 10528 Transcription Services 1413993 Jersen Industries Inc 6 Industry Drive Waterford NY 12188 Construction Management 1349770 51 1740023 653177 87775 2480975 Not for Profit Hospital 621000 124156727 124156727 0 0 Meidicare, Traditional and MC 622000 74808312 74808312 0 0 Medicaid, Tradintional and MC 622000 14661580 14661580 0 0 Specimen Drop Offs 621500 4893770 0 4893770 0 0 0 0 0 218520389 794088 0 -6511 800599 132292 0 0 132292 0 0 0 0 229297 0 173827 0 55470 0 55470 81401 -25931 0 3905749 1415112 4550548 481515 -644799 933597 288798 288798 0 0 32349 12333 20016 20016 616099 173748 442351 442351 EMR Incentive 900099 2637720 2637720 0 0 Caferteria 722210 1189080 0 0 1189080 MHU Contracted Services 621112 1348187 1348187 0 0 1390519 1389015 0 1504 6565506 229299885 219371740 4861328 2585842 2524464 2524464 88718511 81120049 7598462 3318388 2950230 368158 11080816 9851458 1229358 6515742 5792855 722887 530734 530734 145300 145300 99998 99998 81082 81082 20324085 19064272 1259813 680843 18577 662266 12492781 11134575 1122269 235937 1764737 1643756 120981 6331879 5782504 549375 39785 34657 5128 362456 294685 67771 25394 25394 0 12233416 11394757 838659 1214183 1209329 4854 Medical Supplies 32210716 32210716 0 0 Bad Debt Expense 9147206 9147206 0 1323470 438949 884521 211165986 192113969 18816080 235937 14958736 27452969 28485445 20861170 0 0 24755890 20858113 0 678178 0 1731132 3093274 5113201 5496737 2649613 2994634 242645415 137476821 101209357 105168594 35618947 35778698 9390128 24948599 15001 15001 0 5949172 5461591 229876622 252807558 20542117 24864310 0 0 0 0 60388100 56951812 0 0 0 0 2375415 6071480 8120722 4350000 8782909 10070534 100209263 102308136 X 125727094 146928649 3356687 2872281 583578 698492 129667359 150499422 229876622 252807558 X 18133899 2458015 0 0 0 240149 X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 99998 99998 0 SchC_P2B_S00_L01 Schedule C, Part II-B, Line 1 Schedule C, Part II-B, Line 1 - The Hospital has entered into an agreement with a firm that specializes in government relations and public affairs, in an effort to ensure the impact on the Hospital of proposed State and Federal legislation are clearly communicated to elected representatives. Also, to determine whether the hospital may be eligible for any additional funding sources for developing and delivering service programs to its community. Additionally, a portion of the annual dues paid by the Hospital for its memberships in three organizations: American Hospital Association, Iroquois Healthcare Alliance and Healthcare Association of New York State, are used by those organizations for lobbying purposes. The portion of annual dues determined to relate to those organizations' lobbying activities is determined by the Hospital based on documentation received from those organizations. 7412104 67000 523487 0 0 0 8002591 7880460 90942 -559298 0 0 0 7412104 7101991 31967 746502 0 0 0 7880460 5797719 53656 1250616 0 0 0 7101991 7636033 231000 -2069314 0 0 0 5797719 0.93 0.07 0 0 0 0 15018598 15018598 0 69067452 27659622 41407830 0 3528003 3271189 256814 0 143580660 101326040 42254620 0 11450702 5219970 6230732 105168594 Limited Partnership Investments-balanced strategy 16000013 F Limited Partnership Investments- Absolute Return Strategy 6117171 F Limited Partnership Investments-Global Macro Strategy 1361220 F Limited Partnership Investments- Real Asset Strategy 822532 F Private Equity 647663 F 24948599 Estimated Third Party Settlements 6256000 Other Long-Term Liabilities 3814534 10070534 X 220416272 2458015 0 0 -8980918 -6522903 226939175 248164 2112546 2360710 229299885 201708505 0 0 0 173827 173827 201534678 248164 9383144 9631308 211165986 SchD_P05_S00_L04 Schedule D, Part V, Line 4 Permanent endowment funds are intended to support the general operations of the Hospital. Board-designed endowment funds are not restricted for any specific purpose and can be used to support hospital projects or operations at the discretion of the Board of Trustees. SchD_P10_S00_L02 Schedule D, Part X, Line 2 From 990, Part IV, Line 11F - The Hospital has been determined by the Internal Revenue Service to be an organization described in Internal Revenue Code (the Code) Section 501(c)(3) and, therefore, is exempt from federal income taxes on related income pursuant to Section 501 (a) of the Code. The Hospital recognizes the effect of income tax positions only if those positions are more likely than not of being sustained. Recognized income tax positions are measured at the largest amount that is greater than fifty percent likely of being realized upon settlement. Changes in recognition in measurement are reflected in the period in which the change in judgment occurs. The Hospital did not recognize the effect of any uncertain income tax positions in either 2012 or 2011. SchD_P11_S00_L02d Schedule D, Part XI, Line 2d Net assets released from Restriction $166,289 and Bad Debts ($9,147,206). SchD_P11_S00_L04b Schedule D, Part XI, Line 4b Rental Expenses ($173,827), Restricted Gifts $1,850,122, and Hopsital Guild Revenue $436,251 SchD_P12_S00_L02d Schedule D, Part XII, Line 2d Rental Expenses $173,827 SchD_P12_S00_L04b Schedule D, Part XII, Line 4b Bad Debts $9,147,207 and Hospital Guild Expenses $235,937 SunnyView 10145 0 10145 0 0 0 0 0 7583 Holiday 5346 0 5346 0 0 0 118 0 1209 12 16858 0 16858 0 0 0 0 0 3423 32349 0 32349 0 0 0 118 0 12215 12333 20016 1 1 1 X 2.50 1 X 1 1 1 0 0 3428145 900125 2528020 0.012 19419484 12929376 6490108 0.0307 0 0 22847629 13829501 9018128 0.0427 16 2499 838169 668886 169283 0.008 2 8 35000 35000 0.0002 7 103 23322 23322 0.0001 25 2610 896491 668886 227605 0.0083 25 2610 23744120 14498387 9245733 0.0510 4 2000 4816 4816 66654 0 66654 0.0003 4 2000 71470 0 71470 0.0003 1 1894211 992106 41852980 48945160 -7092180 X 0 1 1 Saratoga Hospital

211 Church Street Saratoga Springs NY 12866

X X X Saratoga Hospital 1 1 1 250 1 400 1 X X X X 1 1 X X X 0 0 X X X X 1 X 0 0 SchH_P01_S00_L07 Schedule H, Part I, Line 7 Line 7a -The costing methodology used to determine the amount reported on line 7a is as follows. The total financial assistance, on the basis of charges, per the Hospital's financial statements was multiplied by the cost to charge ratio from the Hospital's 2012 Medicare cost report. The resulting amount was then reduced by any directly offsetting revenues. Offsetting revenues for the purposes of this calculation consist of payments New York State provides the Hospital from a pool, that are intended to offset a portion of the Hospital's charity care and bad debt costs. These payments were split between charity care and bad debt on a pro rata basis and netted against the respective costs. Line 7b -The costing methodology used to determine the amount reported on line 7b is as follows. Total Medicaid charges per the Hospital's patient accounting system were multiplied by the cost to charge ratio from the Hospital's 2012 Medicare cost report. Line 7e includes costs associated with free health screening provided by the Hospital as well as the Hospital's costs to administer federally and State funded grants. The Hospital administers the New York State Department of Health Child Health Plus, Family Health Plus and Medicaid Facilitated Enrollment Program for Saratoga County, as well as five other neighboring Counties. This program focuses on enrolling eligible individuals in low or no cost insurance programs provided by the State. The Hospital also administers the New York State Cancer Services Program for Saratoga County, which provides uninsured and underinsured patients with routine screening for certain types of cancers. Costs associated with free screening programs are obtained from the Hospital's cost accounting system. With regards to costs for administering grant programs, the Hospital establishes a distinct general ledger cost center for each grant program it administers. Costs reported for the grant programs represent the costs accumulated in those grant-specific cost centers during 2012. Grant program costs have been offset by State funding received to offset the Hospital's costs to administer the programs. During 2012 the Hospital acquired a building at which a Community Health Center, serving primarily uninsured and under-insured patients, will be located. The facility is expected to be open in September 2013. The hospital incurred costs associated with the acquisition and preparation of the facility during 2012. Line 7i - Costs accumulated on line 7i were obtained from Hospital general ledger and accounts payable records for contributions made to other organizations in the community whose missions align with that of the Hospital. SchH_P02_S00_L00 Schedule H, Part II Line 8. As a result of its leadership role in identifying community healthcare needs, the Hospital is also the key resource in its community for recruiting physicians practicing in areas of medicine identified as underserved in the community. A component of this recruitment effort includes the extension of relocation incentives to physicians in the targeted need areas. The incentives exist in the form of income guarantees that are provided in an effort to make practice start-up financially palatable for relocating physicians. After an initial period during which funds are advanced to physicians as they have shortfalls versus a targeted income amount, the accumulated advances are converted to promissory notes. Should the physician remain in practice in the community for a contractually agreed-upon number of years after the initial benefit period, the note will be forgiven in full. During 2012, the Hospital forgave advances plus accrued interest amounting to approximately $66,654 relating to these arrangements. SchH_P03_S0A_L04 Schedule H, Part III, Section A, Line 4 The following represents text from the footnotes to the Hospital's audited financial statements regarding bad debt expense: The Hospital grants credit without collateral to patients, most of whom are local residents and are insured under third party agreements. Additions to the allowance for estimated uncollectible accounts are made by means of the provision for bad debts. Accounts written off as uncollectible are deducted from the allowance and subsequent recoveries are added. The amount of the provision for bad debts is based upon management's assessment of historical and expected net collections, business and economic conditions, trends in Federal and state governmental healthcare coverage and other collection indicators. Services rendered to individuals when payment is expected and ultimately not received are written off against the allowance for estimated uncollectible accounts upon management's determination that the balance will likely not be collected. The costing methodology used to determine the amount reported on line 2 is as follows. The total bad debt expense per the Hospital's financial statements was multiplied by the same cost to charge ratio that was used to determine charity care and Medicaid costs reported on Schedule H, lines 7a and 7b, column c. The resulting amount was then reduced by any directly offsetting revenues. Offsetting revenues for the purposes of this calculation consist of payments New York State provides the Hospital from a pool, that are intended to offset a portion of the Hospital's charity care and bad debt costs. These payments were split between charity care and bad debt on a pro rata basis and netted against the respective costs. The rationale for including bad debt amounts in community benefit related to the nature of the question posed on Schedule H, Part III, line 4. A large portion of patients whose account balances end up as bad debt write-offs likely would qualify to receive benefits under the Hospital's financial assistance program were those patients to apply for the benefit and provide the documentation required to assess their ability to qualify. Despite efforts to publicize the availability of the financial assistance program, patient interest and willingness to comply with the documentation requirements remain a challenge for the Hospital. The vast majority of patients who apply for the financial assistance benefit and provide the requested documentation ultimately qualify for and receive the benefit as an end result. As such, in most cases the only difference between reporting an unpaid account balance as a charity care allowance as opposed to a bad debt write off results from our adherence to Healthcare Financial Management Association Statement No. 15 in terms of appropriate reporting of amounts as bad debt expense or charity care when a patient does not apply for financial assistance or comply with documentation requirements. SchH_P03_S0B_L08 Schedule H, Part III, Section B, Line 8 Medicare costs reported on Schedule H, Part III, line 6 were determined as follows. Total charges to Medicare-insured patients during 2012 were divided by total charges to all patients during 2012. The resulting ratio was multiplied by total Medicare allowable costs reported in the Hospital's annual Medicare Cost Report. Medicare allowable costs reported in Schedule H, Part I, line 7f were not deducted from total Medicare allowable costs as any costs associated with provided care to Medicare-insured patients in the Hospital service department reported in line 7f were not included in the shortfall calculation performed to determine the amount reported on that line. SchH_P05_S0B_L20 Schedule H, Part V, Section B, Line 20 The hospital maintains a financial assistance policy (FAP). Eligibility for FAP benefits is determined by the Hospital's patient financial services department based upon the financial means of the patient and/or patient's family. The amount of FAP benefit provided to patients is based on a comparison of their documented income to annual Federal Poverty Level (FPL) standards. The following is a sliding scale of benefits (as a percentage of charges) available to patients with varying levels of income: o FPL x 250% or below- 100% discount o FPL x 300%- 75% discount. o FPL x 350% - 50% discount. o FPL x 400%- 25% discount. These FAP discounts are available to uninsured patients, as well as to insured patients who encounter difficulty in paying amounts owed (ex. co-pays, deductibles) after their insurer pays the Hospital. In addition to the means-tested FAP benefit described above, the Hospital provides an automatic 35% discount from charges for any uninsured patients receiving care at any of the Hospital's locations. The Hospital defines uninsured patients as those patients having no third-party insurance coverage. This discount applies regardless of a patient's ability to pay. The discount is shown clearly on any bills sent to the patient in order to enhance awareness of the availability of this benefit. The standard 35% discount is intended to ensure that any uninsured patients, and by extension any patients who are FAP-eligible, are not charged more for emergency or any other medically-necessary care than the amounts generally billed to Medicare-insured individuals for the same care. Exceptions to the standard discount policy described above are for services provided to uninsured patients in the Hospital Emergency Department and the Hospital's Urgent Care sites at Wilton Medical Arts and Malta Medical Arts. Special tiered discount programs are in place for services provided at those locations, and these are described below: Emergency Department Services: o Tier 1- available for patients receiving any services during an outpatient Emergency Department visit, unless the services include a CT and/or MRI scan. The discounted patient payment for this level of Emergency Department services is $300 plus a surcharge the New York State Department of Health (DOH) requires hospitals to add to services provided to uninsured patients. o Tier 2- available for outpatient Emergency Department visits when the visit includes a CT and/or MRI scan. The discounted patient payment for this level of Emergency Department services is $700 plus the DOH surcharge. Urgent Care Services (Wilton Medical Arts/Malta Medical Arts): o Tier 1- available for patients receiving any services during an Urgent Care visit unless those services include a lab test and/or any imaging test. The discounted patient payment for this level of Urgent Care services is $100 plus the DOH surcharge. o Tier 2- available for patients receiving any services during an Urgent Care visit if those services include a lab test and/or any imaging test, unless the imaging tests include a CT and/or MRI scan. The discounted patient payment for this level of Urgent Care services is $160 plus the DOH surcharge. The discounted patient payment for this level of Urgent Care services is $560 plus the DOH surcharge. o Tier 3- available for patients receiving services during an Urgent Care visit when the visit includes a CT and/or MRI scan. The special tiered discounts available for Emergency Department and Urgent care services are intended to provide uninsured patients an automatic discount for these services that exceeds the standard 35% discount for all other services to uninsured patients. Patients are not required to take any action in order to receive the standard 35% discount and the special Emergency Department and Urgent Care discounts. These adjustments are automatically made to patient bills before the bills are sent. SchH_P06_S00_L02 Schedule H, Part VI, Line 2 The Hospital participates in, and provides financial support to, the Adirondack Rural Health Network (ARHN). ARHN is a partnership of public, private and non-profit organizations which facilitates formal health planning for a six-county region of upstate New York. This region includes Saratoga County, in which the Hospital is located. During 2008 and into 2009, ARHN carried out a community health assessment (CHA) and developed a community service plan (CSP), the results of which were published in September 2009. The process of developing and carrying out the CHA and CSP were guided by the ARHN Community Health Planning Committee (Committee). The Committee was comprised of representatives of the public health departments of each of the six counties in the ARHN area, representatives from six hospitals in the ARHN area (including a representative of Saratoga Hospital), as well as ARHN staff and representatives of other non-profit health-focused organizations in the ARHN area. The CHA process and development of the CHP were designed around a Prevention Agenda released in 2008 by the New York State Health Commissioner. The Prevention Agenda identifies ten priorities for improving the health of all New Yorkers and asks communities to work together to address them. The data collection in support of the ARHN CHA included six key components: * The results of a 2008 Behavioral Risk Factor Surveillance Survey conducted by the New York State Department of Health. * Telephone surveys administered by the Siena Research Institute to households in the region being assessed by ARHN. Survey respondents were for responses to questions regarding a broad range of health-related issues. * Disease incidence data obtained from various existing sources. * New York State Prevention Quality Indicator data. * Hospital utilization data from the Statewide Planning and Research Cooperative System. * A series of 24 stakeholder focus groups were held throughout the region being assessed by ARHN in order to gain community feedback on health issues. Participants were asked to identify barriers to accessing healthcare services, discuss and determine healthcare priorities and generate policy change ideas to be implemented in the community. The Committee then took the data collected during the CHA process and prioritized each of the ten Prevention Agenda areas based on the input obtained. As a result of the prioritization process, the Committee members agreed to focus on Physical Activity and Nutrition as a regional priority issue. The Committee identified a broad three year regional action plan of steps to be taken to address Physical Activity and Nutrition, including establishment of regional taskforce, evaluate evidence-based programs focusing on physical activity/nutrition, develop implementation schedules and budgets for action steps, implement the action steps and evaluate the results of the implementation. A copy of the September 2009 ARHN report can be located at www.arhn.org. The individual organizations represented on the Committee were also free to select additional Prevention Agenda issues as focus areas. In addition to the priority area identified by the Committee, the Hospital worked collaboratively with the Saratoga County Public Health Department to identify a second area of focus for the coming years. The area identified as an additional priority within Saratoga County was management of chronic disease, specifically diabetes. Using the broad three-year action plan outline by the Committee, the Hospital has developed Hospital-specific action plans to address the two focus areas over the next three years. These action plans include definition of measurable outcomes and when those outcomes are to be achieved by, strategies to reach the desired outcomes, and Hospital departments/personnel responsible for implementing each strategy as well as any regional and community partners for strategy implementation. A copy of the Saratoga Hospital Community Service Plan Update can be located at www.saratogacare.org in the "About Us" Section, under "Newsroom" and then "Community Reports". In addition to participation in ARHN, the Hospital uses several different methods to assess the healthcare needs of the communities it serves, including the following: * Subscriptions to databases providing demographics for the communities served. Based on information such as age, gender, etc. anticipated needs by physician specialty and type of inpatient or outpatient care are determined. The information regarding anticipated physician needs is used as guidance for focusing the physician recruitment efforts described in our response to Schedule H, Part VI, line 5. * Continuous patient satisfaction surveys are conducted in order to gain patient feedback regarding the quality of care received and perceptions of their overall experience as patients. *"Secret shopper" calls are conducted whereby Hospital personnel call physician practices in the community in order to determine accessibility to physician care in terms of days wait to be seen for acute and chronic problems. * Community input is obtained through information gathering sessions held on a continuous basis with representatives of local governments and business, as well as representatives from other not-for-profit and governmental agencies operating in the community. In addition to discussion occurring at the sessions, those whose attend as well as those who are unable to attend are asked to return written surveys to the Hospital. The surveys include questions regarding the availability and quality of health care services in the community. * Ongoing dialogue with medical staff members regarding their perceptions regarding quality of care and areas of need for the community. * Formalized tracking processes for patient communications and complaints. SchH_P06_S00_L03 Schedule H, Part VI, Line 3 The Hospital educates patients about eligibility for assistance under its financial assistance program, as well as federal and State programs through the following means: * A supply of brochures containing a plain-language description of the Hospital's financial assistance program (FAP) and an application for the FAP is prominently displayed at all locations in Hospital facilities where patients register for services. * The FAP brochure and application are included in a packet that is provided to all patients being admitted to the Hospital for inpatient or observation stays. * If the Hospital patient financial services department makes a follow-up call to a patient regarding an unpaid bill, the patient is informed about the existence of the FAP. * Bills sent to patients for unpaid balances include a reference to the FAP as well as information on how to contact the Hospital about the FAP. * Information regarding the FAP is located on the Hospital's website, including the location and contact information for the Hospital patient financial services department. * The Hospital uses an external vendor to screen all uninsured inpatients in order to determine whether the patient may be eligible for Medicaid or any other governmental insurance programs, as well as the Hospital's FAP. Patients are then provided assistance in applying for and obtaining access to these programs. * The Hospital administers the New York State Department of Health Child Health Plus, Family Health Plus and Medicaid Facilitated Enrollment Program for Saratoga County, as well as five other neighboring Counties. This program focuses on enrolling eligible individuals in low or no cost insurance programs provided by the State. Brochures regarding the facilities enrollment program are displayed in the same patient registration areas as the FAP brochure, and contact information for this program can also be obtained for the Hospital's website. SchH_P06_S00_L04 Schedule H, Part VI, Line 4 The Hospital's primary service area is comprised of two communities, Saratoga Springs and Ballston Spa. Both are located in the central portion of Saratoga County. The primary service area population in 2012 was approximately 70,500. The secondary service area extends to the northwestern border of Saratoga County and also extends southward. It is comprised of 14 communities, including Ballston Lake, Burnt Hills, Corinth, Galway, Gansevoort, Greenfield Center, Greenwich, Mechanicville, Middle Grove, Porter Comers, Rock City Falls, Round Lake, Schuylerville and Stillwater. The combined 2012 population of these communities was estimated at approximately 86,600. Total Service Area Population 2011 % of Age Cohort Population Total 0-17 34,500 22.0% 18 -24 14,400 9.2% 25 -44 39,800 25.4% 45 -64 46,600 29.6% 65+ 21,800 13.9% Total 157,100 100.0% Females 15 -44 26,600 17.0%. Median household income for Saratoga County was $76,500 in 2011, as compared to $75,100 and $67,500 for Ney York State and the United States, respectively, during 2009. The unemployment rate for Saratoga County was 6.6% during 2011, as compared to 8.2% for New York State. SchH_P06_S00_L05 Schedule H, Part VI, Line 5 The Hospital also promotes community health through the following activities: Open medical staff. Board of Trustees comprised primarily of independent persons from the community. Subsidization of community education forums, at no cost to the public, including: Childbirth education- monthly classes, Community wellness classes- including education for prevention and management of chronic diseases such as diabetes and asthma, and updates on new treatment pathways available for common ailments, Facilitation of monthly support groups for issues including weight loss, cancer survivors and grief management. Schedules and topical information for community education forums are made available on the Hospital's website and are also provided in a free quarterly newsletter, ACCESS. ACCESS also includes short articles written by medical staff regarding current health issues. These articles are also posted on the Hospital's website. The Hospital provides 24-hour call center services, HealthSource, at no cost. Any surplus generated by the Hospital is reinvested into the Hospital through expansion of operations, by purchase of space and equipment, and hiring of personnel needed to support programs that have been identified as needs for the community the Hospital serves. X X X X 0 1 0 1 0 1 1 0 0 Angelo Calbone 319645 84900 108365 0 51185 0 101640 0 12700 0 593535 84900 Gary L Foster 233040 15600 49807 0 4791 0 29875 0 3363 0 320876 15600 Joyce L Peabody 307229 0 61110 0 0 0 34085 0 7254 0 409678 0 Mary Jo Laposta 250819 0 62494 0 0 0 25541 0 5969 0 344823 0 Kevin Ronayne 208284 0 42580 0 0 0 24036 0 14308 0 289208 0 John Mangona 206039 0 40876 0 7266 0 25558 0 1519 0 281258 0 Jeffrey Methven 208727 0 41515 0 0 0 23656 0 12250 0 286148 0 Gordan Kuhar 601385 0 282107 0 0 0 8875 0 0 0 892367 0 Bradley Sexauer 163564 56200 45057 0 0 0 22905 0 9169 0 240695 56200 0 Richard Duff 321488 0 51904 0 3357 0 8875 0 8777 0 394401 0 Gregory Tillou 241587 0 29854 0 0 0 8875 0 11176 0 291492 0 John Delmonte 261515 0 35161 0 0 0 8875 0 195 0 305746 0 SchJ_P01_S00_L04 Schedule J, Part I, Line 4 During 2012, members of The Saratoga Hospital administrative team participated in a 457 F retirement plan. The following list is the participants of the Hospital administration that participated in or received a distribution from their 457 F retirement plan: Angelo Calbone - contributions $73,765 and received a distribution of $42,550, Gary Foster - contributions $266. SchJ_P01_S00_L05 Schedule J, Part I, Line 5 The Hospital administers an incentive compensation program under which members of the Hospital management are eligible to earn up to a percentage of their base salaries in incentive compensation. As part of the 2012 annual incentive compensation, 5% of the overall incentive compensation is related o achievement of revenue growth in certain portions of the Hospital's service area. SchJ_P01_S00_L06 Schedule J, Part I, Line 6 The Hospital administers an incentive compensation program under which members of the Hospital management are eligible to earn up to a percentage of their base salaries in incentive compensation. Overall incentive compensation is based on measurable achievement against a menu of organizational goals, including financial results, patient satisfaction, quality of care, employee satisfaction and retention, and growth in services. The portion of incentive compensation related to net earnings of the Hospital and its affliciates represented 20% of the overall incentive compensation available during 2012, and was based an achievement of "minimum, meets, and maximum" levels relative to the Hospital's operating margin percentage for the year. A IDA Series 2003 A 521310482 803482BW7 2003-08-07 13986954 Refinance Revenue Bonds 0 0 0 B IDA Series 2003B1 521310482 803482BY3 2003-08-07 12151053 Construction Ambulatory Surgery 0 0 0 C IDA Series 2004A 521310482 803482C55 2004-09-21 11421269 Construction ROC and Cafe Addition 0 0 0 D IDA Series 2007A 521310482 803482DF2 2007-12-21 15790000 ED Construction 0 0 0 A 1625000 0 13986954 1068377 0 3700390 279291 814008 0 7810920 378401 0 2004 1 0 1 1 B 1230000 0 12151054 939684 632353 0 230198 717490 0 9438906 249095 0 2004 0 0 1 1 C 8290000 200000 11421269 1215429 482790 0 228425 0 0 9327175 240752 0 2005 0 0 1 1 D 0 1695000 15790000 0 1121735 0 223475 53214 0 14391576 0 0 2009 0 0 1 1 A 0 0 0 0 0 0 0 0 0 1 B 0 0 0 0 0 0 0 0 0 1 C 0 0 0 0 0 0 0 0 0 1 D 0 0 0 0 0 0 0 0 0 1 A 0 0 0 1 0 0 1 Merrill Lynch 4.25 1 0 0 B 0 0 0 1 0 0 1 Merrill Lynch 4.25 1 0 0 C 0 0 0 1 0 0 1 Merrill Lynch 4.25 1 0 0 D 0 0 0 1 1 0 0 0 0 A 0 B 0 C 0 D 0 SchK_P04_S00_L02c Schedule K, Part IV, Line 2c Arbitrage rebate computation was performed on 1/30/2013 by an third party contractor, AMTEC an tax exempt compliance specialist, for bond issues as of 12/01/2012 resulting in no rebate liability for IDA Series 2003 A, IDA Series 2003 B1, IDA Series 2004 A, IDA Series 2007 A, and IDA Series 2007 B. A IDA Series 2007B 521310482 803482DE5 2007-12-12 18406490 ED Construction & Renovation 0 0 0 A 1320000 1080000 18406490 1371707 423697 0 262395 0 0 16348698 0 0 2009 0 0 1 1 A 0 0 0 0 0 0 0 0 0 1 A 0 0 0 1 0 0 0 0 0 A 0 David Mastrianni MD Board Trustee AR Purchases X 500000 500000 0 1 1 David Mastrianni MD Board Trustee Leased Oncologist X 283219 178178 0 1 1 678178 William O'Connor Board Trustee 286910 leasing of Property, Trustee has 20% interest in Lessor Entity 0 David Mastranni MD Board Trustee 732385 The Hospital and Dr. Mastrianni have negotiated purchase of the assets of his medical Oncology and Hematology practice. 0 David Mastranni MD Board Trustee 283219 Leased Oncologist to Dr. Mastrianni practice prior to asset purchase 0 SchL_P02_S00_L00 Schedule L, Part II Schedule L, Part IV - Saratoga Hospital absorbed the medical oncology/hematology practice of Dr. David Mastrianni, a longtime physician in the Saratoga Springs community, and a member of the Saratoga Hospital Board of Trustees. By a series of agreements dated December 31, 2012, the practice began operating as a service of the Hospital on that date. Prior to execution of these agreements the practice was analyzed by an external, independent consultant to validate the financial stability of the practice as well as the overall suitability of the practice for integration into the Hospital. Payment to Dr. Mastrianni, as a result of these agreements, were tied only to the value of the tangible assets of the practice. This included purchase of the fixed assets and pharmaceuticals owned by the practice on the date of the agreements, as well as a purchase of a portion of the accounts receivable resulting from patient services provided by the practice prior to the date of the agreements. The purchase price of $232,385 for fixed assets and pharmaceutical inventories were based on an inventory and appraisal of practice fixed assets by an independent third party, and an inventory of pharmaceuticals performed by Hospital staff. The value provided by the Hospital for pharmaceuticals was based on this inventory as well as the practice's actual invoice cost for the drugs. The accounts receivable purchased from the practice totaled $500,000. This amount is disclosed in Part II of this Schedule as required, although it is a short-term receivable rather than a loan. The Hospital subsequently recovered the full value provided for the practice's receivables shortly after year-end (by February 2013) through collections against the balances. As a result, no gain was realized by either the Hospital or Dr. Mastrianni as a result of the agreements resulting in integration of the practice. Prior to the execution of agreements to integrate the medical oncology/hematology practice into to the Hospital, the Hospital employed an oncologist and leased his services to the practice in order to ensure that both parties could provide adequate access to oncology/hematology services for the community served by the Hospital and practice, an in anticipation of the future integration of the practice into the Hospital. The Hospital-employed oncologist was leased to Dr. Mastrianni's practice based on the Hospital's cost to employ the oncologist (salary plus benefits). During 2012, the practice paid $105,401 to the Hospital under this arrangement. A final reconciliation in relation this agreement will be performed in 2013, with the intent that neither the Hospital nor Dr. Mastrianni will realize a financial gain as a result of the arrangement. F990_P06_S0B_L11b Form 990, Part VI, Section B, Line 11b A draft of the Form 990 and any required supplemental schedules (collectively the "Form 990") is completed by the Hospital's Fiscal Services Department, with input from other Hospital departments obtained as needed. The completed Form 990 is then reviewed by the Director, Financial Accounting and Vice President/Chief Financial Officer in order to ensure compliance with applicable instructions. The initial phase of review by the Hospital's Board of Trustees occurs through a submission of the draft Form 990 to the Board Audit and Corporate Compliance Committee (AC). Members of the AC are provided with drafts of the Form 990 prior to a quarterly meeting. At the quarterly meeting, an agenda item is devoted to providing the AC members with time to ask management questions regarding any disclosures in the form 990 and to provide and comments or suggestions. Management evaluates the AC suggestions and comments and amends the Form 990. Subsequently, copies of the revised draft Form 990 are provided to all members of the Hospital Board of Trustees. Board members are asked to provide any comments on the form 990 at the monthly Board meeting occurring after the draft Form 990 has been distributed. Any applicable comments or suggestions are incorporated into the Form 990, and a final version is filed with the IRS. F990_P06_S0B_L12c Form 990, Part VI, Section B, Line 12c The Hospital maintains two conflict of interest policies. One applies to members of the Board of Trustees, Hospital officers, certain members of the medical staff and all employees whose compensation exceeds $100,000. A second conflict of interest policy applies to all members of management, employees and volunteers of the Hospital, as well as persons serving in those roles for corporations affiliated with the Hospital who are not covered by the first policy. The policies provider clear explanations as to who is covered by each policy, what family members and/or ownership interests (including non-financial interests) must be considered in assessing compliance with the policy, definitions of compensation (including non-monetary compensation) and examples of conflicts including activities that must always be avoided. On an annual basis a conflict of interest disclosure questionnaire process is undertaken. All members of the Board of Trustees and management, all non-management employees whose compensation exceeds $100,000, and all members of the Hospital's medical staff are required to complete and file the questionnaire with the Hospital's Chief Compliance Officer. Additionally, members of Hospital management are required to identify any additional employees under their supervision who have the ability to influence purchasing decisions aggregating to $100,000 or more annually. These employees are also required to complete and file the questionnaire. Inquiries included on the questionnaire are designed to allow respondents to provide yes/no answers that will allow a determination to be made as to whether any non-compliance with the applicable conflict of interest policy has occurred, or whether there are any situations that may require further investigation. Responses to the questionnaires are tracked by the Chief Compliance Officer and are reported to the Audit and Corporate Compliance Committee of the Board of Trustees at its quarterly meetings. On an annual basis the Fiscal Services department reviews all responses submitted by members of the Board of Trustees as well as officers of the Hospital. The questionnaire includes a section where respondents are asked, for any person or entity that has or may do business with the Hospital or one of its affiliates, to provide names of any external entities they have interests in or are employed by, as well as names of relatives and entities those relatives have interest or are employed by. Additionally, if a potential conflict is known of, but not disclosed on the questionnaire, these persons/entities are also identified by hospital management. Any persons or entities disclosed in this area or otherwise deemed to be potential conflicts are referenced against the accounts payable systems for the Hospital and its related entities in order to determine whether business was transacted with any of the disclosed entities during the past year. Materiality of any transactions identified is assessed and a determination is made as to whether the transaction of business with any of these entities was made in accordance with the Hospital's purchasing and conflict of interest policies (ex. competitively bid, removal of the conflicted person from the decision-making process). F990_P06_S0B_L15 Form 990, Part VI, Section B, Line 15 The Hospital maintains a written statement of executive compensation philosophy and practice that is used as a framework for establishing compensation for senior leaders as well as most of the department directors within the organization. The Hospital's Board of Trustees has formally delegated implementation of the executive compensation philosophy to its Executive Committee. During 2012, the Executive committee consisted of seven members of the Board of Trustees, all of whom were determined to be independent with respect to the guidelines set forth for completing Part VI, Line 1b of the Core Form 990. On an annual basis, the Executive Committee reviews the performance of the President/Chief Executive Officer (CEO) and makes a base salary recommendation to the full Board. The Executive Committee performs this task using a target percentile rank on a scale of amounts paid to similarly situated executives in the marketplace. However, the Executive Committee is provided leeway to deviate from this target somewhat where considerations relating to special skills, experience, competence and performance are relevant. Additionally, the Executive Committee sets annual performance criteria the CEO must meet in order to qualify for incentive compensation. At the end of each evaluation period, the Executive Committee determines whether the CEO has met the previously established performance criteria and makes a recommendation regarding payment of incentive compensation to the full Board accordingly. The CEO is responsible, with the oversight of the Executive Committee, for determining the base compensation for all other executives in the organization. These base salaries are also determined using a target percentile rank on a scale executives situated similarly by position within the marketplace, with acceptable deviations for the same considerations as described for determining CEO compensation. Incentive compensation for all other executives is also earned based upon a determination by the CEO as to whether the performance of the entire organization as well as the individual executive has met criteria previously established by the Executive Committee. The comparability data used by the Executive Committee and CEO as guidelines for setting executive compensation are derived from two sources use. First, on a least a bi-annual basis an independent valuation expert is retained by the Hospital's Human Resources department to assess the reasonableness of total, as well as other data purchased from vendors or obtained from industry publications by the Human Resources department relevant to the compensation package for each executive. Also used as a guideline are the requirements for invoking a rebuttable presumption of reasonableness in accordance with IRS intermediate sanction regulations, to the extent practicable. F990_P06_S0C_L19 Form 990, Part VI, Section C, Line 19 Currently the Hospital's governing documents, conflict of interest policy and financial statements are available to the public upon request. F990_P11_S00_L09 Form 990, Part XI, Line 9 Capital Grant $240,149. Saratoga Care Inc 211 Church Street Saratoga Springs NY 12866 141775218 Promoting Health NY 501(c)(3) 3 N/A 0 Healthcare Partners of Saratoga LTD DBA MMEC 211 Church Street Saratoga Springs NY 12866 453303309 Emergent Care NY 501(c)(3) 3 N/A 0 Flower & Fruit Mission of the Saratoga Hospital 211 Church Street Saratoga Springs NY 12866 146049447 Equip & maintain the maternity unit of Saratoga Hospital NY 501(c)(3) 3 N/A 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 1 1 0 Saratoga Care Inc c 2099274 FMV Saratoga Care Inc q 908860 FMV Saratoga Care Inc r 506525 FMV of Transaction Saratoga Care Inc o 421902 FMV of Transaction Healthcare Partners of Saratoga LTD DBA MMEC q 498641 FMV Healthcare Partners of Saratoga LTD DBA MMEC d 16953292 Lease Contract SchR_P01_S00_L00 Schedule R, Part I In September 2010, Saratoga Hospital entered into a Memorandum of Agreement (MOA) with Albany Medical Center Hospital (AMCH) for the purpose of constructing a jointly owned and operated diagnostic and treatment center (DTC). The DTC will be sited on a portion of the 140 acre parcel of land the Hospital owns in Malta, NY. Under the terms of the MOA, the DTC will be established and operate as a separate not for profit corporation, Healthcare Partners of Saratoga, Inc. (D/B/A Malta Med Emergent Care(MMEC)), approved under Article 28 of New York State Public Health Law. The Hospital and AMCH are equal members of MMEC, with each entity able to appoint four members to the eight member Board of Directors of MMEC. MMEC obtained a Certificate of Incorporation from the New York State Department of State in April 2011. The New York State Department of Health (DOH) approved the Certificate of Need application for MMEC in August 2011, including approval to transfer services currently provided at the Hospital's extension clinic in Malta to MMEC. Construction costs for the MMEC facility are being financed by the developer building the facility. The developer is leasing the land on which the facility is being built from the Hospital under a 49-year ground lease which will commence once operation of the DTC begins. The DTC facility is expected to begin operations in June 2013. Amounts due from the developer in the form of annual payments to the Hospital under the ground lease are $86,000 for the years 2013 through 2017. MMEC will lease the portion of the building in which it will operate the DTC from the developer. The initial term of the lease is 18 years, beginning with the commencement of DTC operations, with options to extend the initial term by two consecutive five-year terms. Monthly lease payments under this arrangement begin at $73,447 and increase at a rate of 5% in each fifth year after the initial year of the lease has been completed. Both the Hospital and AMCH have provided joint and several guarantees of MMEC's payment of the DTC facility lease. The DTC facility lease amount for the Hospital total is $16,953,291.96.