2013-11-13T09:26:33-06:00 2012-12-31 990 2012-01-01 146019179 PUTNAM HOSPITAL CENTER % HEALTH QUEST PUTN 8452795711 670 STONELEIGH AVENUE Suite CARMEL NY 10512 MARYANN KEPPLE 8454759500 2013-11-13 2012 2016-02-24 21:20:13Z MAUREEN ZIPPARO PRESIDENT 670 STONELEIGH AVE CARMEL NY 10512 163568184 false X www.putnamhospital.org X NY PROVIDE ALL ASPECTS OF PATIENT CARE TO THE COMMUNITY 15 12 1141 312 6712 -3142 1245894 624842 161294799 157250731 2660688 1641203 3222393 4051408 168423774 163568184 0 0 0 0 74193295 70034877 0 0 0 78770013 85474068 152963308 155508945 15460466 8059239 151869092 157549263 90470952 92820979 61398140 64728284 X PHC IS DEDICATED TO PROVIDING THE HIGHEST QUALITY PATIENT CARE WITH ATTENTION TO SERVICE EXCELLENCE, PATIENT SAFETY, PHYSICIAN COLLABORATION AND INNOVATION TO ASSURE THAT WE MEET THE NEEDS OF THE COMMUNITIES WE SERVE. false false 62717400 83050940 INPATIENT SERVICES: PATIENTS ADMITTED FOR ACUTE CARE - NUMBER OF PATIENTS 6,394; NUMBER OF PATIENT DAYS 28,255 THE HOSPITAL PROVIDED APPROXIMATELY $1,657,384 IN UNCOMPENSATED CARE (AT COST) TO THE REGIONS UN-INSURED AND UNDER-INSURED POPULATION. 4438859 5877976 INPATIENT PSYCHIATRIC SERVICES: PSYCHIATRIC PATIENTS ADMITTED FOR TREATMENT - NUMBER OF PATIENTS 636; NUMBER OF PATIENT DAYS 5,825 51144551 68242342 OUTPATIENT SERVICES: PATIENTS WHO RECEIVED MEDICAL EMERGENCY, ASU AND VARIOUS ANCILLIARY SERVICES - TOTAL EMERGENCY VISITS 21,417; TOTAL AMBULATORY SURGERY VISITS 5,696 ALL OTHER VISITS/PROCEDURES 188,820 THE HOSPITAL PROVIDED APPROXIMATELY $1,718,933 IN UNCOMPENSATED CARE (AT COST) TO THE REGIONS UN-INSURED AND UNDER-INSURED POPULATION. 449886 79473 Home Care 449886 79473 118750696 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 8 0 1141 true true true false false false false false false false false false false false X 15 12 false false false false true true true true true false true true true true true true true true true true true true NY X HEALTH QUEST 8454759500 1351 ROUTE 55 LAGRANGEVILLE NY 12540 KEIREN M FARQUHAR 2.0 X 0 0 0 JAMES P DUSENBURY 1.0 X 0 0 0 KAREN FLEMING 1.0 X 0 0 0 JEFFREY J REDFIELD 2.0 X 0 0 0 JOEL S BUCHALTER MD 1.0 X 0 0 0 PAUL A CAMARDA 2.0 X 0 0 0 ROBERT P MORINI 2.0 X 0 0 0 WAYNE RYDER 1.0 X 0 0 0 MAUREEN ZIPPARO 0.0 60.0 X X 0 316628 40083 RAYMOND DURKIN 1.0 X 0 0 0 WILLIAM GERSTNER 1.0 X 0 0 0 LORETTA MOLINARI 1.0 X 0 0 0 MITCHELL COHN MD 1.0 X 0 0 0 MICHAEL T WEBER 1.0 65.0 X X 0 1006627 53723 ROBERT WAEGELEIN 1.0 X 0 0 0 MARYANN KEPPLE 0.0 60.0 X 0 506786 20505 FREDERICK THOMAS 0.0 70.0 X 0 368198 21891 JEFFREY KELLOGG 0.0 50.0 X 0 245996 33891 JEAN CHELALA MD 38.0 X 332154 0 59080 SHARON GILCHRIST 40.0 X 173349 0 24347 JOAQUIN MAXINO 40.0 X 166690 0 41355 GARIE GALARAGA 40.0 X 157559 0 38514 MAUREEN PACE 35.0 X 159357 0 14629 989109 2444235 348018 5 false true false 0 624842 624842 INPATIENT SERVICE REVENUE 900099 88928916 88928916 OUTPATIENT SERVICE REVENUE 900099 68242342 68242342 HOMECARE SERVICE REVENUE 621610 79473 79473 157250731 609480 609480 0 0 2040783 2040783 0 2040783 2040783 1031723 1031723 0 0 0 MEANINGFUL USE REVENUE 900099 610575 610575 CAFETERIA/MEAL SALES 900099 536848 536848 MANAGEMENT REVENUE 900099 218135 218135 645067 638355 6712 2010625 163568184 159254644 6712 3681986 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 49859748 42926186 6933562 0 5761969 4960702 801267 0 10524883 9061279 1463604 0 3888277 3347568 540709 0 0 0 0 0 0 0 0 0 0 0 0 0 7551 0 7551 0 0 0 0 0 0 0 217980 217980 882 150 732 0 3489187 2136339 1352848 0 147932 88174 59758 0 0 0 0 0 4157014 3469533 687481 0 25221 11506 13715 0 0 0 0 0 36820 12254 24566 0 1968160 1642669 325491 0 0 0 0 0 8515289 7107043 1408246 0 1248541 1042059 206482 0 PURCHASED SERVICES 30030461 8633378 21397083 0 MEDICAL SUPPLIES 23135103 23134487 616 0 BAD DEBT 4798775 4798775 0 PHYSICIAN FEES 3677029 3677029 0 4018123 2483585 1534538 155508945 118750696 36758249 0 0 0 0 0 141384 183476 9323426 7051958 0 0 19300449 17730191 0 0 0 0 75794 39520 1816272 1987125 1187123 974664 165420253 94848615 72620750 70571638 18198721 20056123 0 0 0 0 0 0 29205173 38954568 151869092 157549263 17009603 16283814 0 0 0 0 36510143 35917812 0 0 0 0 2431146 1834353 0 0 34520060 38785000 90470952 92820979 X 54276582 58013417 6300920 5892128 820638 822739 61398140 64728284 151869092 157549263 X 8059239 921139 -5650234 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 7551 7551 false SCHEDULE C, PART II-B, LINE 1I LOBBYING ACTIVITIES 14.6% OF NORMET DUES PAID BY PUTNAM HOSPITAL CENTER ARE USED FOR POLITICAL EXPENDITURES 820638 2101 822739 823470 -2832 820638 821692 1778 823470 809499 12193 821692 809499 809499 1.00000 false false 1193282 1193282 75528480 28927244 46601236 85465407 64508145 20957262 3233084 1413226 1819858 70571638 DAVITA RESTRICTED CASH 632623 REFINANCING FEES 62391 INTEREST IN PHC FOUNDATION 11084502 DSRF 2007 SERIES B BONDS 5548143 DSRF 2007 SERIES C BONDS 993043 DUE FROM AFFILIATES 9326266 MISC RECEIVABLES 825617 DSRF TELP LOAN TDBANK GENERAL 1449253 DEF FINANCING 2007 SERIES B 1127520 DEF FINANCING 2007 SERIES C 128207 2007 SERIES C BOND PREMIUM 494360 DUE TO HQ LT 6858252 DUE FROM THIRD PARTIES 424391 38954568 0 RETRO PAYABLE TO 3RD PARTY PAY 4630791 PENSION BENEFIT OBLIGATION 24228107 DUE TO AFFILIATES HQ LT 810417 FIN 47 LIABILTY 399921 HITNY LIABILITY 1666076 MED MALL INSURANCE LIABILITY 6858252 DUE TO AFFILIATES 190926 DEFERRED COMPENSATION 510 38785000 159245782 921139 -5243541 -4322402 163568184 163568184 155508945 155508945 155508945 ADDITIONAL PENSION LIABILITY SCHEDULE D PART XI LINE 2D Pension related changes other than net periodic pension costs ($5,133,775) TRANSFER OF EQUITY SCHEDULE D PART XI LINE 2D TRANSFER OF EQUITY ($838,051) INTEREST IN PHC FOUNDATION SCHEDULE D PART XI LINE 2D INTEREST IN PHC FOUNDATION $728,285 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 false true true 4869302 1946037 2923265 0.01880 9683427 7188153 2495274 0.01600 14552729 9134190 5418539 0.03480 3 80 50525 50525 0.00030 3 80 50525 50525 0.00030 3 80 14603254 9134190 5469064 0.03510 true 2399388 1199694 51399175 66003619 -14604444 X true true 4 1 PUTNAM HOSPITAL CENTER

670 STONELEIGH AVENUE CARMEL NY 10512

WWW.HEALTH-QUEST.ORG X A 2 PHC OUTPATIENT REHABILITATION SERVICE

2985 NAVAJO ROAD YORKTOWN NY 10598

WWW.HEALTH-QUEST.ORG X A 3 PUTNAM HOSPITAL CENTER OP REHAB CTR

551 ROUTE 22 PAWLING NY 12564

WWW.HEALTH-QUEST.ORG X A 4 PUTNAM HOSPITAL CENTER OUTPATIENT

160 HARRIS ROAD BEDFORD HILLS NY 10507

WWW.HEALTH-QUEST.ORG X A PUTNAM HOSPITAL CENTER 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 PUTNAM HOSPITAL CENTER 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 = $4,798,775 PART I, LINE 7 PART I, LINE 7 COST TO CHARGE RATIO 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 FINANICALS - FEDERAL AND STATE LAW REQUIRES THE HOSPITALS TO PROVIDE EMERGENCY SERVICES REGARDLESS OF A PATIENT'S ABILITY TO PAY. UNINSURED 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 PATIENT'S 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 USED TO CALCULATE THE SHORTFALL IS COST TO CHARGE RATIO AND WORKSHEET #2 WAS USED. 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 SUCH 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 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 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 Putnam County Putnam Hospital Center In 2013, The Putnam County Department of Health (PCDOH) initiated and facilitated the Mobilizing for Action through Planning and Partnerships (MAPP) strategic planning process with its community partners. The PCDOH has had a long-standing history of working with the community through its Live Healthy Putnam Coalition and Bioterrorism/Disaster Preparedness Task Force. These coalitions formed the basis to reach out to those individuals both at the organizational and individual level who wanted to participate in the MAPP planning process. Representatives from seventy agencies participated, including the Mental Health Association, American Cancer Society, Planned Parenthood, Putnam ARC, the United Way of Westchester & Putnam County, the Visiting Nurse Service, the Veterans Task Force, and multiple school districts, physician practices and hospitals. The MAPP process uses four unique assessments to determine community priorities. The four assessments are: Community Health Status, Local Public Health System, Community Themes and Strengths, and Forces of Change. These four assessments inform the development of the Community Health Improvement Plan (CHIP). The public was engaged through Web-based electronic surveys. Paper surveys were provided to individuals without computer access and to residents in waiting rooms, at local events and meetings. Focus groups were conducted with targeted groups that represented a section of the Putnam population that were identified as high risk. In June of 2013, the Putnam County Health Department and Putnam Hospital Center hosted a well-attended community health summit. Representatives from many community agencies were presented with survey and focus group results and then broken into groups to determine priorities and best-practice interventions. Through the MAPP process two overarching priorities were identified and served as a foundation for developing Putnam County's CHIP. They are: 1. Prevent Chronic Diseases 2. Promote Mental Health and Prevent Substance Abuse Two Steering Committees, made up of dedicated community partners were formed under the guidance of the PCDOH. Committee members worked to develop a formal CHIP Action Plan to address specific areas within each priority to focus on over the next five years (2013-2017). Strategies and activities were identified with corresponding timelines and responsible parties to achieve specific measurable objectives. With the input of Putnam Hospital Center and other community partners, the Putnam County Department of Health developed the following focus areas based on the identified chronic disease health priority: 1. Focus Area One: Reduce Obesity in Children and Adults 2. Focus Area Two: Promote Chronic Disease Self-Management education, including disparate populations 3. Focus Area Three: Reduce Illness, Disability and Death Related to Tobacco Use and secondhand smoke exposure The following focus areas were developed in response to the identified mental health priority: 1. Focus Area One: Promote Mental, Emotional and Behavioral (MEB) Well-Being in Communities 2. Focus Area Two: Prevent Suicides Among Youth and Adults Putnam Hospital Center: Three Year Plans of Action Putnam Hospital has chosen its two Prevention Agenda Initiatives based largely on its well-developed mental health program. 1. Prevent Suicides Among Youth and Adults. PHC already has screening for suicide risk in place for inpatients. Our objectives involve expanding the screenings to emergency patients, conforming to best practices and increasing community awareness. Priority Area: Promote Mental Health and Prevent Substance Abuse Goal: Increase Suicide Risk Assessment, Prevention and Intervention Reduce the suicide rate of adults in Putnam County Performance Measures Objective 1: Increase Internal Screening and Communication to include outpatients Indicator Source 100% of PHC patients will be screened for suicide risk Internal EMR data 100% of PHC patients with a positive screening will receive a mental health consult and appropriate referral Internal EMR data Objective 2: Increase community awareness of warning signs of suicide and available resources Indicator Source 90% of class/lecture attendees demonstrate increased knowledge of subject matter Survey Results Action Plan Objective 1 Activity Target Date Partners Change EMR to include best-practice Columbia Suicide Severity Rating Scale 12/31/2013 None Required Develop protocols for referrals for positive screenings Med-Surg done; ED 12/31/2013 None required Add suicide hotline information to discharge materials given to all patients. 12/31/2014 PCDOH, Mental Health Association Develop a process for education and training of nurses who provide care and treatment to people at risk for suicide (in psychiatric setting) 12/31/2014 PCDOH, Mental Health Association Objective 2 Activity Target Date Partners Host or sponsor at least 1 SAFE talk, 1 ASSIST, and 1 Project Connect community class in year one. 12/31/2014 PCDOH, Mental Health Association, Putnam Family and Community Services Host or sponsor at least 1 SAFE talk, 1 ASSIST, and 1 Project Connect community class in year two. 12/31/2015 PCDOH, Mental Health Association, Putnam Family and Community Services Host or sponsor at least 1 SAFE talk, 1 ASSIST, and 1 Project Connect community class in year three. 12/31/2016 PCDOH, Mental Health Association, Putnam Family and Community Services Host at least one professional education event in year one 12/31/2014 Community Health providers, PCDOH Host at least one professional education event in year two 12/31/2015 Community Health providers, PCDOH Host at least one professional education event in year three 12/31/2016 Community Health providers, PCDOH 2. Reduce Illness, Disability and Death Related to Tobacco Use and secondhand smoke exposure Priority Area: Prevent Chronic Diseases Goal: Reduce Illness, Disability and Death Related to Tobacco Use and Secondhand Smoke Exposure Reduce the percentage of County Residents who self-report as a smoker. Disparity: Reduce the percentage of those with poor mental health who smoke. Performance Measures Objective 1: Increase the number of PHC patients calling the NYS Quitline by 10% Indicator Source Improvement over baseline of calls tagged with PHC NYS Quitline Objective 2: Increase the number of PHC mental health patients who seek assistance to quit smoking by 15% Indicator Source IP and partial program patients who call the Quitline will increase by 10% over baseline Internal data, NYS Quitline Objective 3: Obtain a 25% rate of support group attendees who are smoke-free after six months 25% of support group attendees will be smoke-free after 6 months Internal data/phone survey Action Plan Objective 1 Activity Target Date Partners Adopt 5A questions into EMR 12/31/2014 VBMC, NDH Obtain baseline data from NYS Quitline 12/31/2013 NYS, PCDOH Insure that all smoking patients are referred to NYS Quitline None required Increase calls to Quitline from PHC patients 4% over baseline by end of year one. 12/31/2014 PCDOH Increase calls to Quitline from PHC patients 7% over baseline by end of year two. 12/31/2015 PCDOH Increase calls to Quitline from PHC patients 10% over baseline by end of year three. 12/31/2016 PCDOH Objective 2 Activity Target Date Partners Develop protocol to screen all partial program patients for smoking and NYS Quitline use to determine baseline. 12/31/2013 Develop pre- and post- program questionnaire using Likert scale. 12/31/2013 Develop protocol to refer all partial program patients who self report as smokers to the NYS Quitline and the PHC support group. 12/31/2013 Increase calls to Quitline from partial program patients 4% over baseline by end of year one. 12/31/2014 Increase calls to Quitline from PHC patients 7% over baseline by end of year two. 12/31/2015 Increase calls to Quitline from PHC patients 10% over baseline by end of year three. 12/31/2016 Objective 3 Activity Target Date Partners Notes Work with community partners to identify appropriate facilitator and best practices for support group 12/31/2013 PCDOH, POW'R Cessation Center, Open Door Obtain a first year enrollment of 20 smokers with 25% smoke-free after six months 12/31/2014 PCDOH, POW'R Cessation Center, Open Door Goal subject to facilitator's input Obtain a second year enrollment of 25 smokers with 25% smoke-free after six months 12/31/2015 PCDOH, POW'R Cessation Center, Open Door Goal subject to facilitator's input Obtain a third-year enrollment of 30 smokers with 25% smoke-free after six months 12/31/2016 PCDOH, POW'R Cessation Center, Open Door Goal subject to facilitator's input Priorities Not Formally Addressed It is important to note that, while not formally chosen for detailed inclusion in this report, Putnam Hospital Center engages in many community benefit activities, some of which touch upon priorities identified during the CHNA process. We remain committed to our par 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 VI, LINE 4 PART VI, LINE 4 COMMUNITY INFORMATION PUTNAM HOSPITAL CENTER'S PRIMARY SERVICE AREA INCLUDES THE EASTERN HALF OF PUTNAM COUNTY WITH THE SERVICE AREA EXTENDING NORTH TO THE SOUTHEAST CORNER OF DUTCHESS COUNTY AND SOUTH TO SELECT BORDERING ZIP CODES IN NORTHERN WESTCHESTER COUNTY. 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 AFFILIATED 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 BENEFITS REPORT PUTNAM HOSPITAL CENTER FILES A COUNTY WIDE COMMUNITY SERVICE PLAN WITH NYS DEPARTMENT OF HEALTH. PART II PART II N/A STATE FILING OF COMMUNITY BENEFIT REPORT 990 SCHEDULE H, PART VI NY, X X X X X false false false false false false false false false MAUREEN ZIPPARO 0 300476 0 16152 0 0 0 15000 0 25083 0 356711 0 14700 JEAN CHELALA MD 310866 0 21288 0 0 0 29399 0 29681 0 391234 0 28974 0 JEFFREY KELLOGG 0 195383 0 14561 0 36052 0 12597 0 21294 0 279887 0 12610 SHARON GILCHRIST 164680 0 8669 0 0 0 13158 0 11189 0 197696 0 13217 0 JOAQUIN MAXINO 166690 0 0 0 0 0 18429 0 22926 0 208045 0 18373 0 GARIE GALARAGA 157559 0 0 0 0 0 9880 0 28634 0 196073 0 0 0 MAUREEN PACE 146162 0 11774 0 1421 0 4331 0 10298 0 173986 0 0 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 FREDERICK THOMAS 0 301771 0 42179 0 24248 0 15000 0 6891 0 390089 0 0 A DORMITORY AUTHORITY - STATE OF NEW YORK 146000293 649903UK5 2007-09-06 28161751 CONSTRUCTION OF FACILITY false false false A 2848554 0 30073144 2018948 572477 0 387734 443713 655855 23608165 0 2386253 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, COLUMNE 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 LEGAL COUNSEL TO ASSIST IN ESTABLISHING WRITTEN PROCEDURES TO MONITOR THE REQUIREMENTS OF SECTION 148. PROGRAM SERVICE ACCOMPLISHMENTS Form 990 Part III Line 4D Home Health care: Provide Homecare to patients in the community. Total Homecare visits: 840 PHC DISCONTINUED THIS SERVICE LINE IN MARCH 2012. GOVERNING FORM 990 PART VI SECTION A LINE 6, 7A AND 7B LINE 6 - THE SOLE MEMBER OF PHC IS HEALTH QUEST SYSTEMS, INC LINES 7A - Appointment/Election of Directors. Nominees to the Board of Directors of PHC shall be nominated in the following manner: The PHC Executive Committee may prepare a slate of nominees to present to Health Quests Executive Committee for its review and approval not less than thirty (30) days prior to the annual meeting of PHC in the case of vacancies created by the expiration of PHC Directors terms of office, or in the case of all other vacancies, as soon as reasonably possible. The Executive Committee of Health Quest must approve slates of nominees by a majority vote of the entire Executive Committee. Once Health Quests Executive Committee approves the slate of nominees by majority vote, Health Quests Executive Committee shall inform the PHC Board and present the slate of nominees to the Board of Trustees of Health Quest for approval. LINE 7B - MANNER OF ACTING. EXCEPT AS OTHERWISE SPECIFIED IN THE CERTIFICATE OF INCORPORATION OF PHC, 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. THE POWERS TO BE EXERCISED BY THE PHC 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 PHC BOARD OF DIRECTORS. UNLESS OTHERWISE SPECIFIED, ALL OTHER ACTIONS THAT REQUIRE PHC BOARD APPROVAL REQUIRE A MAJORITY VOTE OF SOLELY THE PHC 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 PHC 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 PHC AS THE SOLE MEMBER OF PHC; AND (II) APPROVAL OF THE ABANDONMENT OR MATERIAL DIMINUTION OF ANY SERVICE, PROGRAM OR CAMPUS OF PHC; PROVIDED HOWEVER, THAT THE ACTIONS LISTED ABOVE IN THIS ARTICLE IV, SECTION 12(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 VOTE OF TWO-THIRDS (2/3) OF THE ENTIRE BOARD OF PHC ("ENTIRE BOARD" SHALL MEAN THE TOTAL NUMBER OF DIRECTORS ENTITLED TO VOTE WHICH PHC WOULD HAVE IF THERE WERE NO VACANCIES) SHALL BE REQUIRED TO APPROVE: (I) THE REORGANIZATION, MERGER, OR DISSOLUTION OF PHC; OR (II) THE SALE, LEASE OR MORTGAGE OF SUBSTANTIALLY ALL THE ASSETS OF PHC; PROVIDED HOWEVER, THAT THE ACTIONS LISTED ABOVE IN THIS ARTICLE IV, SECTION 12(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 PHC DIRECTORS PRESENT AND VOTING AT A MEETING AT WHICH A QUORUM IS PRESENT SHALL BE REQUIRED TO APPROVE THE FOLLOWING ACTIONS: (I) OVERSIGHT OF 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 THAT INTEGRATES THE REVIEW ACTIVITIES OF ALL HOSPITAL SERVICES FOR THE PURPOSE OF ENHANCING THE QUALITY PATIENT CARE AND IDENTIFYING AND PREVENTING MALPRACTICE; AND (IV) OVERSIGHT OF PHC'S CORPORATE COMPLIANCE PROCESSES; 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) - THE VOTE OF TWO-THIRDS (2.3) OF THE ENTIRE BOARD OF DIRECTORS OF PHC PRESENT AND VOTING AT A MEETING AT WHICH AT LEAST TWO-THIRDS (2/3) OF THE DIRECTORS ARE PRESENT SHALL BE REQUIRED TO APPROVE THE FOLLOWING: (I) THE SALE, MORTGAGE OR LEASE OF REAL PROPERTY BY PHC. POLICIES FORM 990 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 EXECUTIVE COMPENSATION COMMITTEE REVIEWED ALL SECTIONS RELATED TO EXECUTIVE COMPENSATION. A3RD PARTY WAS HIRED TO PREPARE SCHEDULE K. PRICEWATERHOUSE COOPERS WAS CONSULTED IN THE PREPARATION OF SCHEDULE H. LINE 12C - ON AN ANNUAL BASIS OFFICERS, DIRECTOR AND TRUSTEES ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST FILING WHICH IS REVIEWED BY THE HQ VP FOR COMPLIANCE AND INTERNAL AUDIT. ALL POTENTIAL CONFLICTS OF INTEREST ARE REVIEWED BY THE HQ BUSINESS ETHICS COMMITTEE ON BEHALF OF PHC. LINE 15A/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 FILING SUCH AS THE 990 AND BOND HOLDER REQUIREMENTS. RELATED TAX EXEMPT ORGANIZATIONS SCHEDULE R - PART II 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 Dutchess 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 SCHEDULE K SCHEDULE K PART 1, COLUMN E LINE A TOTAL ISSUE PRICE PER IRS FORM 8038 - $61,974.071.30, ALLOCATED AS FOLLOWS PUTNAM HOSPITAL CENTER - $28,161,750.68 NORTHERN DUTCHESS HOSPITAL - $15,718,407.82 VASSAR BROTHERS MEDICAL CENTER - $18,093,912.82 ALLOCATION METHODOLOGY FOR HQ AND HQ LAB SCHEDULE R PART V LINE 2(1) AND (2) 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. PHC covers the cost of lab services performed at PHC for both inpatient and outpatient services. RECONCILIATION OF NET ASSETS 990 PART XI, LINE 9 ADDITIONAL PENSION LIABILITY - ($5,133,775) TRANSFER OF EQUITY - ($838,052) INTEREST IN FOUNDATION - $728,285 NET ASSETS FROM RESTRICTIONS USED FOR OPERATIONS - ($406,692) OMB CIRCULAR A-133 AUDIT FORM 990, PART XIII LINE 3A PUTNAM HOSPITAL CENTER 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 1351 ROUTE 55 LAGRANGEVILLE NY 12540 141678068 SUPPORT SERV BOX 9 HQ SEE SCHEDULE O N/A MOUNT KISCO SURGERY CENTER LLC 34 SOUTH BEDFORD ROAD MOUNT KISCO NY 10549 134158313 SURGERY SERVI NY MKMG 346402 43036 true 0.20000 false false false false false false false false false false false false false false true false false false HEALTH QUEST SYSTEMS INC P 23267260 SEE SCHEDULE O HEALTH QUEST LABORATORY SUPPORT SERVICES LLC P 3024844 SEE SCHEDULE 0