2013-11-15T10:22:50-06:00 2012-12-31 221478099 COHNREZNICK LLP 1212 6TH AVENUE NEW YORK NY 10036 990 2012-01-01 111631781 FLUSHING HOSPITAL MEDICAL CENTER FLUS 7186705000 4500 PARSONS BLVD FLUSHING NY 11355 MOUNIR F DOSS 7186705000 2013-11-14 1 THOMAS LANNING P00851654 2122970400 2012 2016-03-07 17:11:31Z MOUNIR F DOSS 4500 PARSONS BLVD FLUSHING NY 11355 245335731 0 X FLUSHINGHOSPITAL.ORG X 1884 NY ACUTE CARE HOSPITAL 13 13 2175 238 0 0 878300 3749929 236796072 232760152 468868 782535 3536645 5221594 241679885 242514210 0 0 0 0 153256406 156128592 0 0 90465 95158636 95270787 248415042 251399379 -6735157 -8885169 139130842 130375339 172573180 172168471 -33442338 -41793132 ACUTE CARE HOSPITAL 0 0 198896403 232760152 HOSPITAL SERVICES - OUTPATIENT CLINIC - EMERGENCY SERVICESCERTIFIED BEDS +325 198896403 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 436 0 1 2175 1 0 0 0 0 0 1 1 0 0 0 0 X 13 13 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 0 0 0 NY X CAROLE KING 7186705000 4500 PARSONS BLVD FLUSHING NY 11355 X AHMED MOIDEEN 2.00 X 0 0 0 ALVIN ORLIAN 2.00 X 0 0 0 ANTHONY FEDERICI 2.00 X 0 0 0 CHARLES BALDUCCI 2.00 X 0 0 0 CHRIS Y HWANG 2.00 X 0 0 0 DAVID PAGAN 2.00 X 0 0 0 DINO GUIDICCI 2.00 X 0 0 0 MAX KUPFERBERG 2.00 X 0 0 0 MICHAEL RUSSO 2.00 X X 0 0 0 PATRICK SUN 2.00 X 0 0 0 ROBERT REICHENBACH 2.00 X X 0 0 0 SAMG KI HAN 2.00 X 0 0 0 VICTOR GUARNERI 2.00 X 0 0 0 VICTOR ORIOLI 2.00 X 0 0 0 BRUCE J FLANZ 15.00 50.00 X 0 1383052 24107 MOUNIR F DOSS 15.00 50.00 X 0 1174355 24107 ROBERT LEVINE 40.00 X 347114 0 24058 CHIEN-JUNG CHU 40.00 X 311225 0 20513 NAGESWARA MANDAVA MD 40.00 X 443325 0 21804 ORLANDO SANTANDREU MD 40.00 X 319906 0 20514 ROBERT CRUPI MD 40.00 X 315708 0 21554 SUSANA RAPAPORT-SOMLO MD 40.00 X 287401 0 21550 2024679 2557407 178207 194 0 1 0 THE CODERS NETWORK 261 W 231 ST BRONX NY 10463 PROFESSIONAL SERVICES 306445 WOUND CARE CENTER PO BOX 637114 CINCINNATI OH 45263 PROFESSIONAL SERVICES 267081 PRICEWATERHOUSECOOPERS LLP PO BOX 7247-8001 PHILADELPHIA PA 10819 PROFESSIONAL SERVICES 260530 ZETLIN REICH MD PLLC 69-60 108TH ST FOREST HILLS NY 11375 PHYSICIAN SERVICES 203540 VIRTUAL RADIOLOGIC PROF PO BOX 673398 DETROIT MI 48267 PROFESSIONAL SERVICES 169369 9 123571 3432818 193540 3749929 PATIENT REVENUE 621400 231451222 231451222 TEACHING INCOME 611600 1308930 1308930 232760152 722548 722548 299075 0 299075 299075 299075 2831000 19885 2790898 0 40102 19885 59987 59987 35442 123571 30623 4819 4819 EHR INCENTIVE 621400 1964132 1964132 INSURANCE RECOVERY 900099 633659 633659 2319909 2319909 4917700 242514210 237677852 0 1086429 371172 371172 116474963 90837676 25592287 45000 7687734 5985597 1702137 22693544 17653629 5025065 14850 8901179 6924744 1976435 5499996 4278766 1221230 240359 186989 53370 379308 295086 84222 50839 50839 21030013 16360468 4669545 2485983 2024990 460993 3917850 3047923 869927 89058 69283 19775 1171861 911659 260202 9271879 7213133 2058746 8058921 6269502 1789419 MEDICAL & SURGICAL SUPP 16574219 12894047 3680172 BAD DEBT 15146106 15100733 45373 PHARMACY 4123260 3207723 915537 EQUIPMENT 658684 512429 146255 6572451 5071187 1470649 30615 251399379 198896403 52412511 90465 1655123 2187372 3439749 609524 32850823 32192106 2942347 3326659 1701499 1667137 192213790 139742437 48969242 52471353 47572059 37921188 139130842 130375339 60530842 40995129 9689613 11958666 102352725 119214676 172573180 172168471 X -33442338 -41793132 -33442338 -41793132 139130842 130375339 -8885169 294710 239665 0 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 50839 0 0 50839 0 PART IV, SUPPLEMENTAL INFORMATION: PART II-B FLUSHING HOSPITAL MEDICAL CENTER IS A MEMBER OF AN ASSOCIATION OF WHICH SOME OF THEIR DUES ARE ALLOCATED TO GRASS ROOTS LOBBYING IN REGARD TO THEIR NEEDS IN SERVICING AND PROVIDING HEALTHCARE TO THE GENERAL PUBLIC. HEALTHCARE ASSOCIATION OF NEW YORK STATE $50,839 5375000 5375000 72364247 54388797 17975450 1363459 1230264 133195 102017545 78416493 23601052 11093539 5706883 5386656 52471353 DEFERRED FINANCING 53580 DUE FROM THIRD PARTY 2961209 ESCROW RESERVE 217896 OTHER ASSETS 3217098 BOARD DESIGNATION FUNDS 6804621 OTHER RECEIVABLES CAPITALIZATION CONTRACTS 5393905 INSURANCE RECEIVABLE 2629621 INSURANCE RECEIVABLE LT 14181529 DEPRECIATION RESERVE FUND 2461729 37921188 MEDICAL MALPRACTICE 32285575 DUE TO RELATED ORGANIZATIONS 76982397 DUE TO THIRD PARTY 9946704 119214676 X 261733732 294710 2351723 2646433 259087299 -16573089 -16573089 242514210 269853372 18453993 18453993 251399379 0 251399379 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: THE MEDICAL CENTER QUALIFIES AS A TAX-EXEMPT NONPROFIT CORPORATION UNDER THE PROVISIONS OF SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE CODE) AND ARE EXEMPT FROM FEDERAL, STATE, AND LOCAL INCOME TAXES PURSUANT TO SECTION 501(A) OF THE CODE. PART XI, LINE 2D - OTHER ADJUSTMENTS: REVENUE DERIVED FROM SECOND CENTURY SERVICES CORP 2,351,723. PART XI, LINE 4B - OTHER ADJUSTMENTS: CAPITATION EXPENSE ADDED TO REVENUE -31,514,849. BAD DEBT 14,941,760. PART XII, LINE 2D - OTHER ADJUSTMENTS: SECOND CENTURY SERVICES CORP EXPENSES 1,880,904. CAPITATION EXPENSE ADDED TO REVENUE 31,514,849. BAD DEBT -14,941,760. CELEBRATION 2012 140346 118459 21887 585 28988 1050 GOLF OUTING 29000 15445 13555 169346 133904 35442 585 28988 1050 30623 4819 PART II, COLUMN D: SOME CONTRIBUTIONS WERE RECEIVED AFTER THE YEAR END FOR THE EVENTS. THESE CONTRIBUTIONS WILL BE REPORTED ON SCHEDULE G BUT NOT ON FORM 990, PART VIII, LINE 1F. SCHEDULE G (PART II, LINE 2) OF $133,904 REPRESENTS THE TOTAL CONTRIBUTIONS RECEIVED FOR THIS YEAR EVENTS OF WHICH $10,333 WAS NOT RECEIVED AND WILL NOT REPOTED ON PART VIII. PART II, COLUMN B: THE GOLF OUTING IS A JOINT FUNDRAISER WITH JAMAICA HOSPITAL MEDICAL CENTER. FLUSHING HOSPITAL MEDICAL CENTER RECEIVES A PORTION OF THE CONTRIBUTIONS BUT JHMC PAYS ALL OF THE EXPENSES. THEREFORE, THERE ARE NO EXPENSES LISTED ON THIS SCHEDULE G. 1 1 1 X 1 X 1 1 0 1 1 10165189 6517761 3647428 0.01540 85006010 72630358 12375652 0.05230 95171199 79148119 16023080 0.06770 14 60048 331992 205860 126132 0.00050 34259642 13090396 21169246 0.08950 25372349 17561618 7810731 0.03300 14 60048 59963983 30857874 29106109 0.12300 14 60048 155135182 110005993 45129189 0.19070 1 14941760 10669463 51198831 45756342 5442489 X 1 1 1 1 FLUSHING HOSPITAL MEDICAL CENTER

4500 PARSONS BLVD FLUSHING NY 11355

X X X FLUSHING HOSPITAL MEDICAL CENTER 1 1 1 100.000000000000 1 300.000000000000 1 X X X X X X 1 1 X X X X X 1 0 1 X 0 0 PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 14941760. PART II: COMMUNITY BUILDING ACTIVITIESFLUSHING HOSPITAL PROGRAMS SUPPORT THE CITY OF NEW YORK'S TAKE CARE NEW YORK (TCNY) PROGRAM IN THE FOLLOWING WAYS:1. HAVE A REGULAR DOCTOR OR OTHER HEALTH CARE PROVIDER: FLUSHING'S AMBULATORY CARE SERVICES ARE DESIGNED TO PROMOTE CONTINUITY OF CARE BY ALLOWING PATIENTS TO CHOOSE A PHYSICIAN WHO WILL BE DESIGNATED AS THEIR PRIMARY CARE PROVIDER. THE DESIGNATED PROVIDER IS RESPONSIBLE FOR ENSURING THAT HIS/HER PATIENTS ARE GIVEN AGE APPROPRIATE SCREENING, IMMUNIZATION AND EDUCATION.2. BE TOBACCO-FREE: SMOKING CESSATION IS ONE OF THE HOSPITAL'S PREVENTION PRIORITIES AND WAS DISCUSSED IN THE PREVIOUS SECTION.3. KNOW YOUR HIV STATUS: THE HOSPITAL PROVIDES HIV COUNSELING AND TESTING WITH STAFF THAT ROUTINELY PERFORMS THIS FUNCTION IN BOTH THE EMERGENCY DEPARTMENT AND CLINICS. IF REQUIRED, PATIENTS ARE REFERRED FOR SERVICES TO JAMAICA HOSPITAL'S INFECTIOUS DISEASE CLINIC OR TO OTHER COMMUNITY PROGRAMS.4. GET HELP FOR DEPRESSION: FLUSHING HOSPITAL'S MEDICAL PROVIDERS INCORPORATE DEPRESSION SCREENING DURING ROUTINE MEDICAL EXAMINATIONS AND ONGOING CARE. CHILDREN AND ADULTS NEEDING FURTHER SERVICES ARE REFERRED TO FLUSHINGS FULL SERVICE PSYCHIATRY DEPARTMENT OR OTHER COMMUNITY PROGRAMS.5. LIVE FREE OF DEPENDENCE ON ALCOHOL AND DRUGS: DURING ROUTINE MEDICAL EXAMINATIONS PATIENTS HAVE THE OPPORTUNITY TO RECEIVE SCREENING FOR ALCOHOL AND DRUG USE. AS NECESSARY, PATIENTS WILL BE GIVEN PREVENTIVE COUNSELING AND TREATMENT OPTIONS, INCLUDING FLUSHING HOSPITAL'S IN-PATIENT AND OUT-PATIENT TREATMENT PROGRAMS FOR CHEMICAL DEPENDENCY.6. GET CHECKED FOR CANCER: FLUSHING HOSPITAL IS A MEMBER OF THE STATE'S HEALTHY LIVING PARTNERSHIP PROGRAM, WHICH PROVIDES COVERAGE FOR CERVICAL, BREAST, AND COLON CANCER SCREENINGS TO UNINSURED AND UNDERINSURED PATIENTS WHO MEET THE ELIGIBILITY AND SCREENING CRITERIA. THE HOSPITAL RECEIVES GRANT FUNDING FOR BREAST HEALTH CARE FROM THE AVON FOUNDATION AND KOMEN FOUNDATION TO HELP SUPPORT CASE MANAGEMENT, OUTREACH AND BREAST CARE SERVICES TARGETED TO THE ASIAN AND SOUTH ASIAN POPULATIONS. FLUSHING HOSPITAL WAS PRIVILEGED TO BE PART OF THE "COLONOSCOPY SCREENING NAVIGATOR PROGRAM," WHICH RECEIVED ONE YEAR SEED FUNDING BY THE NYCDOH. THE PROGRAM HAS BEEN SHOWN TO BE EFFECTIVE AND THE HOSPITAL HAS MADE A COMMITMENT TO CONTINUE THE PROGRAM WITHOUT GRANT FUNDING.7. THE HOSPITAL PARTICIPATES IN THE NYCS VACCINE FOR CHILDREN PROGRAM (VFC) PROVIDING IMMUNIZATIONS TO CHILDREN UP TO 19 YEARS OF AGE AGAINST CHILDHOOD DISEASES AND INFLUENZA TO ELIGIBLE CHILDREN INCLUDING THOSE WITHOUT HEALTH COVERAGE SEEN IN OUR AMBULATORY CARE NETWORK. INFLUENZA VACCINE IS OFFERED TO ADULTS DURING RECOMMENDED VACCINATION MONTH.8. HAVE A SAFE AND HEALTH HOME: ANTICIPATORY GUIDANCE ON SAFETY IN THE HOME IS PROVIDED BY THE HOSPITAL'S PEDIATRIC, FAMILY MEDICINE AND REHABILITATION PROFESSIONALS. AT HEALTH FAIRS IN THE COMMUNITY, FIRE, HOME AND AUTOMOTIVE SAFETY INFORMATION IS ROUTINELY MADE AVAILABLE TO ATTENDEES.9. HAVE A HEALTHY BABY: THE HOSPITAL FOLLOWS PRENATAL CARE GUIDELINES ADOPTED BY THE NEW YORK STATE DEPARTMENT OF HEALTH. THESE PROGRAMS ASSIST PREGNANT WOMEN AND THEIR FAMILIES TO OBTAIN NECESSARY MEDICAL CARE AND SUPPORTIVE SERVICES, WITH THE GOAL OF IMPROVING BIRTH OUTCOMES AND REDUCING CHILD ABUSE.10. BREAST FEEDING: THE HOSPITAL IS SUPPORTING BREASTFEEDING MOTHERS BY PARTICIPATING IN "LATCH ON NYC," A NEW CITY-WIDE INITIATIVE. FLUSHING HOSPITAL IS WELL ON ITS WAY TO BEING DESIGNATED AS A "BABY FRIENDLY" HOSPITAL, A GLOBAL INITIATIVE THAT PROMOTES, PROTECTS, AND SUPPORTS BREASTFEEDING THROUGH TEN STEPS TO SUCCESSFUL BREASTFEEDING. WE HAVE REGISTERED WITH BABY FRIENDLY USA TO BEGIN THE PROCESS IN THE "4-D PATHWAY TO BABY-FRIENDLY DESIGNATION." WE HAVE COMPLETED THE DISSEMINATION PHASE AND HAVE STARTED THE SECOND PHASE, THE DESIGNATION PHASE. MANY STAFF MEMBERS HAVE TAKEN THE CERTIFIED LACTATION COUNSELOR (CLC) COURSE PROVIDED BY THE NYCDOH. WE OFFER AND ENCOURAGE OUR PATIENTS TO ATTEND FREE BREASTFEEDING SUPPORT GROUPS HELD ON A WEEKLY BASIS. FREE LACTATION COUNSELING IS OFFERED TO ALL PATIENTS AFTER DISCHARGE.WE ARE WORKING CLOSELY WITH THE NYCDOH BY EDUCATING AND ENCOURAGING THE IMMUNIZATION OF ALL HEALTHCARE PERSONNEL THAT ARE IN CONTACT WITH WOMEN OF CHILDBEARING AGE, NEWBORNS AND CHILDREN WITH TDAP TO PREVENT THE TRANSMISSION OF PERTUSSIS. ALL PREGNANT AND POSTPARTUM WOMEN ARE OFFERED THE VACCINE AS A STANDING ORDER AND IN NOVEMBER 2012, 85% OF OUR POSTPARTUM PATIENTS RECEIVED THE VACCINE. ADDITIONALLY, ALL FAMILY MEMBERS ARE INSTRUCTED ON THE IMPORTANCE OF RECEIVING THE VACCINE. PART III, LINE 4: FINANCIAL STATEMENTS BAD DEBT & CHARITY CARE FOOTNOTE:FLUSHING HOSPITAL PROVIDES CARE TO ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. AS A MATTER OF POLICY, FLUSHING HOSPITAL PROVIDES SIGNIFICANT AMOUNTS OF PARTIALLY OR TOTALLY UNCOMPENSATED PATIENT CARE. FOR ACCOUNTING PURPOSES, SUCH UNCOMPENSATED CARE IS TREATED AS CHARITY CARE. FLUSHING HOSPITAL PROVIDES CHARITY CARE IN THE AMOUNT OF THE DIFFERENCE BETWEEN ITS CUSTOMARY CHARGES AND THE DISCOUNTED RATES GIVEN TO PATIENTS IN NEED OF FINANCIAL ASSISTANCE. SINCE PAYMENT OF THIS DIFFERENCE IS NOT SOUGHT, CHARITY CARE ALLOWANCES ARE NOT REPORTED AS REVENUE. REMAINING UNCOLLECTED BALANCES AFTER CHARITABLE ALLOWANCES FOR THESE PATIENTS ARE CATEGORIZED AS BAD DEBTS. THE ESTIMATED COSTS OF PROVIDING CHARITY SERVICES ARE BASED ON A CALCULATION WHICH APPLIES A RATIO OF COST TO CHARGES TO THE GROSS UNCOMPENSATED CHARGES ASSOCIATED WITH PROVIDING CARE TO CHARITY PATIENTS. TOTAL FORGONE CHARGES FOR CHARITY CARE TOTALED $22,754,104 AND $20,063,266 FOR THE YEARS ENDED DECEMBER 31, 2012 AND 2011, RESPECTIVELY. THIS EQUATED TO AN APPROXIMATE COST OF $9,102,346 AND $8,667,331 FOR THE YEARS ENDED DECEMBER 31, 2012 AND 2011, RESPECTIVELY.COSTING METHODOLOGY FOR CALCULATING LINE 2 & 3:BAD DEBT EXPENSE IS ESTIMATED BASED ON AGING OF THE ACCOUNTS RECEIVABLE AND GETS ADJUSTED BASED ON ACTUAL WRITE OFF. ACTUAL ACCOUNT WRITE OFF IS AS FOLLOWS: PATIENTS WHO ARE ENTITLED TO FINANCIAL ASSISTANCE ARE GIVEN DISCOUNT BASED ON OUR CHARITY CARE POLICY (MEDICAID RATE). IF THE PATIENT DOESN'T PAY THE BALANCE OF THEIR ACCOUNT AFTER RECEIVING 3 BILLS THEN THE ACCOUNT BALANCE GETS TRANSFER TO THE COLLECTION AGENCY. IF THE COLLECTION AGENCY CAN'T COLLECT AFTER EXHAUSTING THEIR EFFORTS THEN THE ACCOUNT GETS RETURNED AS UNCOLLECTIBLE AND THE HOSPITAL WRITES OFF THE ACCOUNT AS BAD DEBT. BAD DEBT RELATED TO LINE 3: BAD DEBT EXPENSE IS ALLOCATED TO THE PATIENTS WHO ARE ENTITLED TO FINANCIAL AID BASED ON CHARITY CARE VOLUME PATIENTS. PART III, LINE 8: ALLOWABLE COSTS ARE FROM THE HOSPITAL COST REPORT THAT GETS FILED WITH MEDICARE EVERY YEAR. COST METHODOLOGY THAT IS USED TO CALCULATE MEDICARE ALLOWABLE COST IS RATIO OF COST TO CHARGES BASED ON MEDICARE GUIDELINES. MEDICARE ALLOWABLE COST ON LINE 6 DOESN'T INCLUDE COST OF RESIDENCY PROGRAM AND SUPERVISORY PHYSICIAN COST WHICH IS OVER $34 MILLION. EXCLUSION OF THESE COSTS RESULTED IN A SURPLUS ON LINE 7. PART III, LINE 9B: THE HOSPITAL OFFERS INSTALLMENT PLANS FOR THE PAYMENT OF OUTSTANDING BALANCES FOR PATIENTS APPROVED FOR FINANCIAL AID. THE HOSPITAL DOES NOT MANDATE THAT THE MONTHLY INSTALLMENT PAYMENT ARRANGEMENT EXCEED 10% OF THE APPLICANT'S GROSS MONTHLY INCOME. THERE IS NO ACCELERATOR OR SIMILAR CLAUSE UNDER WHICH A HIGHER RATE OF INTEREST IS TRIGGERED WHEN A PATIENT MISSES MAKING A PAYMENT.THE HOSPITAL INCLUDES A WRITTEN NOTICE ON PATIENTS' BILLS AND STATEMENTS AT LEAST 40 DAYS PRIOR TO REFERRING THE ACCOUNT TO COLLECTION. THE HOSPITAL REQUIRES THAT ANY COLLECTIONS AGENCIES WITH WHICH THEY CONTRACT FOLLOW THE FINANCIAL ASSISTANCE POLICIES OF THE HOSPITAL. THE HOSPITAL DOES NOT FORCE THE SALE OR FORECLOSURE OF A PATIENT'S PRIMARY RESIDENCE TO COLLECT ON AN OUTSTANDING BILL. COLLECTION IS PROHIBITED AGAINST ANY PATIENT WHO WAS ELIGIBLE FOR MEDICAID AT THE TIME SERVICES WERE RENDERED. FINALLY, THE CONTRACTED COLLECTIONS AGENCIES MUST OBTAIN THE HOSPITALS WRITTEN CONSENT BEFORE COMMENCING A LEGAL ACTION. FLUSHING HOSPITAL MEDICAL CENTER PART V, SECTION B, LINE 20D: FHMC WOULD CHARGE 80% OF THE CURRENT MEDICAID RATE. PART VI, LINE 2: NEEDS ASSESSMENTNON-PREVENTION PRIORITIES CONSIDERED IN ASSESSMENT PROCESSMANY OF THE PROGRAMS AND SERVICES AT FLUSHING HOSPITAL ARE CONSISTENT WITH AND SUPPORTIVE OF THE TAKE CARE NEW YORK PROGRAM PROMOTED BY NYCDOH & MENTAL HYGIENE. THE HOSPITAL HAS BEEN FOCUSING ON THE CITY'S TEN HEALTH AREAS FROM TREATMENT AND PREVENTION PERSPECTIVES. THE HOSPITAL HAS BEEN AUGMENTING ITS FOCUS ON PREVENTION, ESPECIALLY IN THE PRIORITY AREAS OF SMOKING CESSATION AND FLU VACCINATION, BOTH OF WHICH ARE TCNY PRIORITIES. PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCEPOLICY: TO PROVIDE ACCESS TO GOVERNMENT ASSISTANCE APPLICATIONS AND/OR FINANCIAL AID FOR THE QUALIFIED UNINSURED.PURPOSE: TO PROVIDE ACCESSIBLE AND AFFORDABLE CARE TO UNINSURED PATIENTS AND TO IDENTIFY METHODS BY WHICH PATIENTS AND/OR FAMILY MEMBERS ARE NOTIFIED OF THE FLUSHING HOSPITAL FINANCIAL AID POLICY.PROCEDURE: NOTIFICATION TO PATIENTS:FLUSHING HOSPITAL DEVELOPED AND HAS PUBLICLY AVAILABLE A CLEAR AND UNDERSTANDABLE WRITTEN SUMMARY OF ITS FINANCIAL ASSISTANCE POLICIES AND ENSURES THAT EVERY PATIENT IS MADE AWARE OF THE EXISTENCE OF THE POLICIES. THE HOSPITAL HAS A 24-HOUR EMERGENCY DEPARTMENT AND NOTIFIES PATIENTS THAT FINANCIAL ASSISTANCE IS AVAILABLE DURING THE INTAKE AND REGISTRATION PROCESS THROUGH THE POSTING OF CONSPICUOUS AND LANGUAGE APPROPRIATE INFORMATION AND THROUGH INFORMATION ON ALL BILLS AND STATEMENTS SENT TO PATIENTS. PART VI, LINE 4: COMMUNITY INFORMATIONHOSPITAL SERVICE AREASINCE 1884, FLUSHING HOSPITAL HAS PROVIDED QUALITY HEALTHCARE TO ITS COMMUNITY. THE HOSPITAL IS LOCATED AT 4500 PARSONS BOULEVARD IN FLUSHING, QUEENS COUNTY, NEW YORK, IN ONE OF THE MOST ETHNICALLY-DIVERSE SECTIONS OF NEW YORK CITY'S MOST CULTURALY-DIVERSE BOROUGH. FLUSHING HOSPITAL SERVES ONE PRIMARY SERVICE AREA NORTH QUEENS, AND SEVEN SECONDARY SERVICE AREAS - NORTH EAST QUEENS, NORTH WEST QUEENS, WEST QUEENS, WEST CENTRAL QUEENS, CENTRAL QUEENS, JAMAICA, AND SOUTH WEST QUEENS. THE TOTAL SERVICE AREA HAS A TOTAL OF ALMOST 2 MILLION RESIDENTS, 43% BEING WHITE AND 48% BEING FOREIGN BORN. EACH NEIGHBORHOOD IS SOMEWHAT DIFFERENT IN TERMS OF ITS RACIAL AND ETHNIC MAKE-UP. MUCH OF THE HOSPITAL'S SERVICE AREA SUFFERS FROM POVERTY, WITH 22% MEDICAID ELIGIBLE, AND MANY UNINSURED RESIDENTS, AS WELL AS MANY DOCUMENTED AND UNDOCUMENTED IMMIGRANTS, SOME OF WHOM SPEAK LIMITED OR NO ENGLISH PART VI, LINE 5: PROMOTION OF COMMUNITY HEALTHSELECTED SERVICE OFFERINGS 2012293 - BED COMMUNITY TEACHING FACILITY, INCLUDING 18 ADULT PSYCHIATRIC BEDS, 30 CHEMICAL DEPENDENCY BEDS, QUEENS' ONLY INPATIENT GERIATRIC MEDICAL UNIT, HOSPICE UNIT AND TCU.STATE-DESIGNATED LEVEL 3 PRENATAL CENTERSTATE-DESIGNATED STROKE CENTERAN AMBULATORY CARE CENTER WITH 40 GENERAL AND SPECIALTY CLINICS INCLUDING A SMOKING CESSATION PROGRAM, AND WITH A 5-CHAIR DENTAL SUITEASIAN AND SOUTH ASIAN BEHAVIORAL HEALTH CLINICSOPERATES 14 TOURS IN NYC 911 SYSTEM, WITH 5 AMBULANCESFLUSHING HOSPITAL SPONSORS A NUMBER OF RESIDENCY PROGRAMS AND HOSTS RESIDENTS IN OTHER SPECIALTIES WHO ROTATE FROM OTHER PROGRAMS.PATIENTS SERVED 2012OVER 18,309 DISCHARGES, INCLUDING ALMOST 2,603 NEWBORNSOVER 48,600 EMERGENCY DEPARTMENT VISITS, INCLUDING ADMISSIONS TO THE HOSPITALALMOST 98,500 AMBULATORY CARE VISITS, INCLUDING GENERAL MEDICAL AND PEDIATRIC SERVICES, MENTAL HEALTH, CHEMICAL DEPENDENCY, AND DENTAL SERVICESMANY OTHER AMBULATORY CARE SERVICES, INCLUDING RADIOLOGY EXAMS,LABORATORY TESTS AND AMBULATORY SURGERYIN 2012, STAFF FROM FLUSHING HOSPITAL PARTICIPATED IN OVER 28 COMMUNITY EVENTS. MORE THAN 6,400 PEOPLE WERE IN ATTENDANCE AND RECEIVED HEALTH INFORMATION AND OVER 1,073 PEOPLE RECEIVED FREE SCREENINGS. PART VI, LINE 6: AFFILIATED HEALTH CARE: MEDISYS HEALTH SYSTEM REPORTS FILED WITH STATES PART VI, LINE 7 NY 0 0 0 0 0 0 0 0 0 BRUCE J FLANZ 0 1240398 0 0 0 142654 0 6250 0 18074 0 1407376 0 0 MOUNIR F DOSS 0 1096513 0 0 0 77842 0 6250 0 18074 0 1198679 0 0 ROBERT LEVINE 347114 0 0 0 0 0 6250 0 17808 0 371172 0 0 0 CHIEN-JUNG CHU 311225 0 0 0 0 0 6250 0 14263 0 331738 0 0 0 NAGESWARA MANDAVA MD 443325 0 0 0 0 0 6250 0 15554 0 465129 0 0 0 ORLANDO SANTANDREU MD 319906 0 0 0 0 0 6250 0 14264 0 340420 0 0 0 ROBERT CRUPI MD 315708 0 0 0 0 0 6250 0 15304 0 337262 0 0 0 SUSANA RAPAPORT-SOMLO MD 287401 0 0 0 0 0 6250 0 15300 0 308951 0 0 0 FORM 990, PART VI, SECTION A, LINE 6 MEDISYS HEALTH NETWORK IS THE SOLE MEMBER. FORM 990, PART VI, SECTION A, LINE 7A MEDISYS HEALTH NETWORK, AS SOLE MEMBER CAN APPOINT THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 AND APPROPRIATE SCHEDULES, AS REQUIRED (FORM 990), IS PREPARED BY OUTSIDE ACCOUNTANT AND REVIEWED INTERNALLY BY MANAGEMENT, AT WHICH TIME IT IS CONSIDERED THE FINAL DRAFT. THE FINAL DRAFT OF THE FORM 990 IS PRESENTED TO THE TRUSTEES VIA EMAIL AND OR A BOARD MEETING. ONCE THE REVIEW OF THE FORM 990 HAS BEEN COMPLETED TO THE BOARD'S SATISFACTION AND THE BOARD IS COMFORTABLE WITH ITS CONTENTS, THE FORM 990 IS THEN MAILED TO ALL BOARD MEMBERS AS READY TO FILE, SUBSEQUENTLY IT IS FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C DISCLOSURE IN ACCORDANCE WITH THE CONFLICT OF INTEREST POLICY BY EMPLOYEES THAT SATISFY THE CRITERIA TO BE CONSIDERED AN "INTERESTED PERSON" IS SUBMITTED UPON HIRING AND ANNUALLY THEREAFTER. THE AUDIT & COMPLIANCE COMMITTEE REVIEWS THE SUBMISSIONS FOR CONFLICTS AND THE DEPARTMENT OF INTERNAL AUDIT MONITORS COMPLIANCE. EXECUTIVE COMPENSATION POLICY THE BOARD OF MEDISYS HEALTH NETWORK HAS CREATED AN INDEPENDENT COMPENSATION COMMITTEE WHOSE CHARGE IS TO REVIEW AND APPROVE THE COMPENSATION OF EXECUTIVES AT ALL ORGANIZATIONS WITHIN THE MEDISYS HEALTH NETWORK SYSTEM, WHO MEET THE REQUIREMENTS OF A DISQUALIFIED PERSON FOR INTERMEDIATE SANCTIONS TREASURY REGULATIONS. THE COMMITTEE HAS RETAINED AN INDEPENDENT COMPENSATION CONSULTANT TO PROVIDE COMPENSATION COMPARABILITY INFORMATION AND ADVISE THE COMMITTEE IN ITS DETERMINATION OF APPROPRIATE EXECUTIVE COMPENSATION AND BENEFIT LEVELS FOR EXECUTIVES FOR WHOM THIS PROCESS APPLIES. IT IS POLICY THAT EXECUTIVE COMPENSATION DECISIONS WILL BE MADE IN LIGHT OF AND CONSISTENT WITH THE EXECUTIVE COMPENSATION PHILOSOPHY STATEMENT, COMPENSATION (BASE SALARY, INCENTIVE COMPENSATION AND BENEFITS), AFTER OBTAINING COMPARABILITY DATA FROM THE INDEPENDENT COMPENSATION CONSULTANT, IN ACCORDANCE WITH INTERMEDIATE SANCTION TREASURY REGULATIONS AND OTHER FEDERAL AND STATE LAWS AND REGULATIONS. THE COMMITTEE REVIEWS AND APPROVES BASE SALARIES FOR EXECUTIVES WHO ARE DISQUALIFIED INDIVIDUALS BASED UPON THE AMOUNTS PAID TO SIMILARLY SITUATED EXECUTIVES WITHIN THE RELEVANT MARKETPLACE, WITH POSSIBLE ADJUSTMENTS MADE FOR SPECIAL SKILLS, EXPERIENCE, COMPETENCE AND PERFORMANCE, INCLUDING CONTRIBUTIONS TO THE SYSTEM AS A WHOLE. THE CEO RECOMMENDS TO THE COMPENSATION COMMITTEE ANY ADJUSTMENTS TO THE BASE SALARIES OF EXECUTIVES. THE COMPENSATION LEVELS APPROVED BY THE COMPENSATION COMMITTEE ARE REVIEWED AND PRESENTED FOR APPROVAL TO EACH ORGANIZATIONS BOARD. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS - CERTIFICATE OF INCORPORATION FILED WITH THE NYS DEPARTMENT OF STATE; CONFLICT OF INTEREST POLICY IS NOT PUBLICLY AVAILABLE. FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART VII, SECTION A, LINE 1B: FOR BRUCE FLANZ, PRESIDENT & CEO, MOUNIR DOSS, EXECUTIVE VICE PRESIDENT & CFO, THE HOURS REPORTED BELOW REFLECT THE TOTAL TIME WORKED AS OFFICERS FOR ALL OF THE RELATED ORGANIZATIONS SHOWN ON SCHEDULE R. TOTAL COMPENSATION IS REPORTED ON EACH ENTITYS FORM 990. COST ALLOCATION AMONG THE ENTITIES IS PERFORMED CONSISTENTLY WITH ACCOUNTING RULES AND APPLICABLE COST ALLOCATION METHODOLOGIES. ESTIMATED NUMBER OF HOURS WORKED PER WEEK FOR RELATED ORGANIZATIONS IS AS FOLLOWS: MEDISYS HEALTH NETWORK - 10 HOURS PER WEEK FLUSHING HOSPITAL MEDICAL CENTER - 15 HOURS PER WEEK JAMAICA HOSPITAL MEDICAL CENTER - 30 HOURS PER WEEK BROOKDALE HOSPITAL MEDICAL CENTER(THROUGH SEPTEMBER 2012) - 3.4 HOURS PER WEEK OTHER RELATED ENTITIES LISTED ON SCHEDULE R INCLUDING BROOKDALE RELATED ENTITIES THROUGH SEPTEMBER 2012 - 6.6 HOURS PER WEEK FORM 990, PART VII, COLUMN C: MANAGEMENT HAS IN THE PREPARATION OF ITS FORM 990 REVIEWED PERSONNEL IN THE INSTITUTION TO SEE IF ANYONE MEETS THE CRITERIA ESTABLISHED TO BE CONSIDERED A "KEY EMPLOYEE" FOR IRS PURPOSES OF FORM 990. IT IS THE CONTENTION OF MANAGEMENT THAT NO EMPLOYEE FULFILLS ANY OF THE SITUATIONS UNDER THE RESPONSIBILITY TEST IN THE FORM 990 INSTRUCTIONS TO BE CONSIDERED A KEY EMPLOYEE. THEREFORE, PART VII OF FORM 990 DOES NOT REPORT THE COMPENSATION OF ANY INDIVIDUALS WHO WOULD BE CONSIDERED A "KEY EMPLOYEE". FORM 990, PART XII, LINE 2C: THE OVERSIGHT AND SELECTION PROCESS DID NOT CHANGE FROM THE PRIOR YEAR. ADVANCED CENTER FOR PSYCHOTHERAPY 89-06 135TH STREET JAMAICA NY 11418 111864871 HEALTHCARE NY 501(C)(3) 9 MEDISYS HEALTH NETWORK 0 AMBOY PROPERTIES CORPORATION 101-10 AVENUE D BROOKLYN NY 11236 112814707 PARKING GARAGE NY 501(C)(3) 11A BROOKDALE HEALTH SYSTEM 0 BROOKDALE FAMILY CARE CENTER 101-10 AVENUE D BROOKLYN NY 11236 113237483 HEALTHCARE NY 501(C)(3) 3 BROOKDALE HEALTH SYSTEM 0 BROOKDALE HOSPITAL CENTER HEGEMAN AVENUE HOUSING COMPANY 101-10 AVENUE D BROOKLYN NY 11236 237082540 HOUSING NY 501(C)(2) N/A BROOKDALE HOSPITAL MEDICAL CENTER 0 BROOKDALE HOSPITAL MEDICAL CENTER ONE BROOKDALE PLAZA BROOKLYN NY 11212 111631746 HEALTHCARE NY 501(C)(3) 3 BROOKDALE HEALTH SYSTEM 0 BROOKDALE RESEARCH FOUNDATION INC ONE BROOKDALE PLAZA BROOKLYN NY 11212 311634638 INACTIVE NY 501(C)(3) 3 BROOKDALE HEALTH SYSTEM 0 INTERNATIONAL ASSOCIATION OF MEDICAL BIKE UNITS INC 8900 VAN WYCK EXPY JAMAICA NY 11418 113483140 INACTIVE NY 501(C)(3) 9 MEDISYS HEALTH NETWORK 0 JAMAICA HOSPITAL MEDICAL CENTER 8900 VAN WYCK EXPY JAMAICA NY 11418 111631788 HEALTHCARE NY 501(C)(3) 3 MEDISYS HEALTH NETWORK 0 JAMAICA HOSPITAL NURSING HOME 90-28 VAN WYCK EXPY JAMAICA NY 11418 237216197 HEALTHCARE NY 501(C)(3) 3 MEDISYS HEALTH NETWORK 0 LINROC COMMUNITY SERVICE CORPORATION 101-10 AVENUE D BROOKLYN NY 11236 112814765 SUPPORT NY 501(C)(3) 11A BROOKDALE HEALTH SYSTEM 0 MEDISYS AMBULANCE SERVICE 8900 VAN WYCK EXPY JAMAICA NY 11418 542124788 HEALTHCARE NY 501(C)(3) 9 MEDISYS HEALTH NETWORK 0 MEDISYS HEALTH NETWORK 8900 VAN WYCK EXPY JAMAICA NY 11418 113316802 ADMIN NY 501(C)(3) 11A N/A 0 NEIGHBORHOOD HEALTH PROVIDERS INC 521 FIFTH AVE 3RD FLOOR NEW YORK NY 10175 943474115 MANAGED CARE PLAN NY 501(C)(3) 9 JAMAICA HOSPITAL MEDICAL CENTERLINROC COMMUNITY SERVICE CORP 0 ROCKREAL CORPORATION 101-10 AVENUE D BROOKLYN NY 11236 112814705 SUPPORT NY 501(C)(3) 11A BROOKDALE HEALTH SYSTEM 0 SAMUEL AND BERTHA SCHULMAN INSTITUTE FUND INC 101-10 AVENUE D BROOKLYN NY 11236 237270262 HEALTHCARE NY 501(C)(3) 7 SCHULMAN SCHACHNE INSTITUTE FOR NURSING 0 SCHLANG PAVILION DBA BROOKDALE RESIDENCE HOUSING DEVELOPMENT 101-10 AVENUE D BROOKLYN NY 11236 113324040 HOUSING NY 501(C)(3) 9 BROOKDALE HEALTH SYSTEM 0 SCHULMAN SCHACHNE INSTITUTE FOR NURSING 101-10 AVENUE D BROOKLYN NY 11236 237085986 HEALTHCARE NY 501(C)(3) 3 BROOKDALE HEALTH SYSTEM 0 THE JAMAICA HOSPITAL DIAG AND TREAT CTR 8900 VAN WYCK EXPY JAMAICA NY 11418 113340969 HEALTHCARE NY 501(C)(3) 3 MEDISYS HEALTH NETWORK 0 THE LINDEN FOUNDATION INC ONE BROOKDALE PLAZA BROOKLYN NY 11212 112814704 INACTIVE NY 501(C)(3) 9 BROOKDALE HEALTH SYSTEM 0 URBAN STRATEGIES 101-10 AVENUE D BROOKLYN NY 11236 113237480 HEALTHCARE NY 501(C)(3) 3 LINROC COMMUNITY SERVICE CORP 0 VWE PROPERTIES CORPORATION 8900 VAN WYCK EXPY JAMAICA NY 11418 113485165 PARKING GARAGE NY 501(C)(3) 11A MEDISYS HEALTH NETWORK 0 ALLIED HEALTH FOUNDATION OF QUEENS INC 4500 PARSONS BLVD FLUSHING NY 11355 112813535 PASSTHROUGH NY 501(C)(3) 9 0 NHP HOLDINGS LLC 521 FIFTH AVE 3RD FLOOR NEW YORK NY 10175 203418837 HOLDING COMPANY NY N/A ROYAL HEALTHCARE OF LONG ISLAND 521 FIFTH AVE 3RD FLOOR NEW YORK NY 10175 133887900 MANAGEMENT SERVICES ORG. NY N/A BHMC ENTERPRISES 101-01 AVENUE D BROOKLYN NY 11236 112855200 LEASEHOLDER OF MEDICAL OFFICE BUILDING/INACTIVE NY N/A C 0 BROOKDALE RX 101-01 AVENUE D BROOKLYN NY 11236 202041821 RETAIL PHARMACY NY N/A C 0 FRR RECOVERY SERVICES 80 MARCUS DRIVE MELVILLE NY 11747 113454555 COLLECTION AGENCY NY N/A C 0 HI TECH MEDICAL EQUIPMENT 103-51 101 ST OZONE PARK NY 11416 113313334 DURABLE MEDICAL EQUIPMENT COMPANY NY N/A C 0 JAMAICA RX 8900 VAN WYCK EXPRESSWAY JAMAICA NY 11418 205292781 RETAIL PHARMACY NY N/A C 0 LCSC HOLDINGS 101-01 AVENUE D BROOKLYN NY 11236 113357198 HOLDING COMPANY NY N/A C 0 MEDISYS HOME CARE SERVICE INC 8900 VAN WYCK EXPRESSWAY JAMAICA NY 11418 030474027 HOME CARE STAFFING/INACTIVE NY N/A C 0 MEDISYS IPA 8900 VAN WYCK EXPRESSWAY JAMAICA NY 11418 113452476 PHYSICIAN CONTRACTING/INACTIVE NY N/A C 0 MEDISYS SERVICE CORPORATION 8900 VAN WYCK EXPRESSWAY JAMAICA NY 11418 113479920 HOLDING COMPANY NY N/A C 0 MEDISYS VENTURES 111 STEWART AVE HICKSVILLE NY 11801 113431792 HOLDING COMPANY NY N/A C 0 MHN REALTY 8900 VAN WYCK EXPRESSWAY JAMAICA NY 11418 113458286 REAL ESTATE/INACTIVE NY N/A C 0 RAINBOW PHARMACY DBA FLUSHING RX 4500 PARSONS BLVD FLUSHING NY 11355 112843101 RETAIL PHARMACY NY N/A C 0 SECOND CENTURY SERVICE CORPORATION 4500 PARSONS BLVD FLUSHING NY 11355 112843101 RETAIL PHARMACY NY FLUSHING HOSPITAL MEDICAL CENTER C 1354827 631063 1.00000 0 1 0 0 0 1 0 0 0 0 1 1 1 1 1 1 1 1 0 0 FRR RECOVERY Q 19000 COST FLUSHING RX Q 231000 COST