2012-11-13T10:15:26-07:00 2011-12-31 990 2011-01-01 141338547 SARATOGA HOSPITAL SARA 5185878421 211 Church Street Saratoga Springs NY 128661090 GARY FOSTER 5185838421 2012-11-13 2011 2016-02-24 21:20:13Z Angelo Calbone 211 Church Street Saratoga Springs NY 12866 220459306 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 14 2094 302 4647191 740843 1174461 1941156 192492647 209699417 994040 358072 2828194 3344241 197489342 215342886 0 0 0 0 95125265 104312741 0 0 0 91113077 95147289 186238342 199460030 11251000 15882856 213762195 229584486 98103545 99878298 115658650 129706188 X To serve the people of the Saratoga region by providing them access to excellence in healthcare in a supportive and caring environment. 1 0 181725254 0 209699417 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 2011, the hospital emergency department facilitated 38,903 patient visits. * The Hospital represents the only inpatient acute care facility in Saratoga County. During 2011, the Hospital had 9,135 admissions for inpatient adult and pediatric care. These admissions included 773 births,712 admissions to our inpatient mental health unit and 43 admissions for Hospice care. Total adult and pediatric inpatient days for the Hospital during 2011 were 48,033 which included 4,018 days of inpatient care in the Critical Care Unit. * The Hospital operates a 36-bed skilled nursing facility on its campus. During 2011, 12,354 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 2011, the benefits provided under these policies, measured on the basis of costs, amounted to approximately $ 2,473,000. * 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 2011, our urgent care sites accommodated 45,854 patient visits. * During 2011 the hospital incurred bad debt expense of approximately $8,196,991 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 2011 were approximately $10,262,000 and $6928,000, 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 2011, the Hospital forgave advances plus accrued interest amounting to approximately $ 92,000 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 2011,unreimbursed costs of administering the program were approximately $15,000. * 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 181725254 1 0 0 1 0 0 0 0 0 1 1 0 0 0 1 0 1 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 1 0 0 1 0 1 149 0 1 2094 1 1 1 1 VI CJ 0 0 0 0 0 0 0 0 0 0 X 16 14 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 Dennis A Brobston 2.5 X 0 0 0 Brian T Fredette 2.5 X 0 0 0 Michael H Iacolucci 2.5 X 0 0 0 David M Mastrianni MD 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 Donna Montalto 2.5 X 0 0 0 William O'Connor MD 2.5 X 0 0 0 Deane Pfeil 2.5 X 0 0 0 Jonathan Rubenstein 2.5 X 0 0 0 Richard Schumaker 2.5 X 0 0 0 Theresa Skaine 2.5 X 0 0 0 William R Stanley 2.5 X 0 0 0 Michael D West 2.5 X 0 0 0 Janice M White 2.5 X 0 0 0 Angelo Calbone 31 X X X 493926 79875 92173 Gary L Foster 35 X X 268086 15800 30049 Mary Jo Laposta 38 X 272170 0 29426 John Mangona 38 X 231606 0 24211 Jeffrey Methven 37 X 232638 425 34362 Joyce L Peabody 37 X 353725 650 38888 Kevin Ronayne 37.5 X 243186 0 37346 Gordan Kuhar 38 X 780057 0 9190 Bradley Sexauer 38 X 201265 56800 32172 Paul J Okosky 38 X 256838 0 28600 Kenneth Schwartz 38 X 248247 0 31100 Carl Sgambati 38 X 235504 0 8839 3817248 153550 396356 82 0 1 0 AOW Associates Inc 30 Essex Street Albany NY 12206 Construction Management 3866750 Saratoga Emergency Physicians PC The Saratoga Hospital 211 Church Street Saratoga Springs NY 12866 Physicians 8000454 Laboratory Corporation of America PO Box 12140 Burlington NC 272162140 Lab Services 1383561 Hypertype 84 Calvert Street Harrison NY 10528 Transcription Services 1239200 IP Logic 17 British American Blvd Latham NY 12110 Information Support Services 693025 37 0 0 0 1119703 455966 365487 0 1941156 Not for Profit Hospital 622000 124488531 124488531 0 0 Medicare,Traditional and MC 622000 66561826 66561826 0 0 Medicaid, Traditional and MC 622000 14002396 14002396 0 0 Specimen Drop Offs 621500 4646664 0 4646664 0 0 0 0 0 209699417 860403 0 527 859876 134849 0 0 134849 0 0 0 0 156638 0 186488 0 -29850 0 -29850 -29850 0 0 4230025 62727 4927694 2238 -697669 60489 -637180 -637180 0 0 0 0 0 0 0 0 Cafeteria 722210 1117191 0 0 1117191 MHU Contracted Services 621112 1251772 1251772 0 0 Real Property Rent 532000 235958 235958 0 0 769170 769170 0 0 3374091 215342886 206642623 4647191 2111916 2381790 2381790 82611221 75295915 7315306 0 3006839 2663780 343059 0 10201993 9038018 1163975 0 6110898 5413688 697210 0 52728 52728 257629 257629 96087 96087 98506 98506 85098 85098 19596373 18319629 1276744 618570 17149 601421 42550945 41539135 1011810 1386324 1296758 89566 6993709 6354709 639000 33375 28256 5119 355991 277417 78574 10886 10183 703 12398265 11597249 801016 1207473 1202973 4500 Bad Debt Expense 8196991 8196991 0 0 1208339 420676 787663 199460030 181725254 17734776 0 8446299 14871175 26020697 28380148 0 0 22052533 24755890 0 0 0 0 1860715 1731132 4919790 5087441 2571028 2649613 230469847 129292552 98811462 101177295 36700041 35618947 6330889 9390128 15001 15001 0 0 6033740 5907716 213762195 229584486 19406421 20411152 0 0 0 0 63109386 60388100 0 0 0 0 2554758 2375415 6066588 8120722 6966392 8582909 98103545 99878298 X 109627488 125765923 5465660 3356687 565502 583578 115658650 129706188 213762195 229584486 X 15882856 -1835318 X 0 1 1 X 0 X 0 1 0 0 0 0 0 0 1 98506 98506 0 SchC_P2B_S00_L01 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 membership in three organizations; American Hospital Association,Iroquois Healthcare Alliance and Healtcare 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. 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 0.92 0.08 0 0 0 14329793 0 14329793 62888517 0 24992402 37896115 3528003 0 3138240 389763 137397071 0 96423392 40973679 12326463 0 4738518 7587945 101177295 0 Estimated third-party settlements 3958000 Other long-term liabilities 4624909 8582909 215342886 199460030 15882856 -1655741 0 0 0 0 -1655741 14227115 212329162 -1655741 0 0 156754 -1498987 213828149 230946 1283791 1514737 215342886 199415573 0 0 0 186488 186488 199229085 230945 0 230945 199460030 SchD_P05_S00_L04 Schedule D, Part V, Line 4 Permanent endowment funds are intended to support the general operations of the Hospital.Board-designated 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_P12_S00_L02d Schedule D, Part XII, Line 2d Net assets released restrictions $ 156,754 SchD_P12_S00_L04b Schedule D, Part XII, Line 4b Rental Expenses ($186,488) and Restricted Gifts $1,470,279 SchD_P13_S00_L02d Schedule D, Part XIII, Line 2d Rental Expenses $ 186,488 1 1 1 X 2.5 1 X 1 1 1 0 0 3040389 567792 2472597 0.0124 17647904 10719782 6928122 0.0347 0 0 20688293 11287574 9400719 0.0471 1306 395989 421571 25582 0.00012 441420 441420 0.00221 19914 0 19914 0.0001 0 1306 857323 421571 486916 0.00243 0 1306 21545616 11709145 9887635 0.04953 70439 0 70439 0.0035 0 0 70439 0 70439 0.0035 1 2023771 1011886 50489322 40227750 10261572 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 2011 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 2011 Medicare cost report. Line 7e 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 2011. Grant program costs have been offset by State funding received to offset the Hospital's costs to administer the programs. 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_P01_S00_L07g Schedule H, Part I, Line 7g The amount presented in Schedule H, Part I, line 7g, represents the shortfall between cost and reimbursement for the Hospital's inpatient mental health unit and Hospital-based endocrinology physician practice. The amount was calculated by determining total costs and total reimbursement for the service areas, and then backing out any costs and reimbursement associated with Medicaid and Medicare insured patients, as the impact of these reimbursement shortfalls to related costs are reflected on Schedule H Part I, line 7f and Schedule H, Part III, line 7, respectively. Additionally, any costs, including bad debt expense, and reimbursement associated with patients served in these areas who received charity care or had their accounts written off to bad debt were also backed out of the totals to arrive at the amount presented on Schedule H, Part I, line 7g. The impact of these charity care and bad debt amounts are presented on Schedule H, Part 1, line 7a and Schedule H, Part III, line 2, respectively. SchH_P02_S00_L00 Schedule H, Part II 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 2011, the Hospital forgave advances plus accrued interest amounting to approximately $ 70,439 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 2011 were divided by total charges to all patients during 2011. 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_L19 Schedule H, Part V, Section B, Line 19 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 2011 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 2011 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. X X X X 0 0 0 0 0 1 1 0 0 Angelo Calbone 307413 79875 82684 0 103829 0 79840 0 12333 0 586099 79875 0 0 Gary L Foster 224757 15800 41650 0 1679 0 28778 0 1271 0 298135 15800 0 0 Joyce L Peabody 302623 650 51102 0 0 0 32623 0 6266 0 392614 650 0 0 Mary Jo Laposta 232454 0 39716 0 0 0 22812 0 6614 0 301596 0 0 0 Kevin Ronayne 209559 0 33627 0 0 0 23185 0 14161 0 280532 0 0 0 John Mangona 201220 0 30386 0 0 0 23490 0 721 0 255817 0 0 0 Jeffrey Methven 199849 425 32789 0 0 0 22307 0 12055 0 267000 425 0 0 Gordan Kuhar 757977 0 157 0 21923 0 8698 0 492 0 789247 0 0 0 Bradley Sexauer 164436 56800 34329 0 2500 0 24522 0 7650 0 233437 56800 0 0 Paul J Okosky 256681 0 157 0 0 0 8698 0 19902 0 285438 0 0 0 Kenneth Schwartz 248090 0 157 0 0 0 8698 0 22402 0 279347 0 0 0 Carl Sgambati 235347 0 157 0 0 0 8347 0 492 0 244343 0 0 0 SchJ_P01_S00_L06 Schedule J, Part I, Line 6 The Hospital administers an incentive compensation program under which members of Hospital manangement 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 financial portion of incentive compensation represented 20% of the overall incentive compensation available during 2011, and was based on achievement of "minimum,meets and maximum" levels relative to the Hospital's operating margin percentage for the year. IDA Series 2003 A 521310482 803482BW7 2003-08-07 13986954 Refinance Revenue Bonds 0 0 0 IDA Series 2003B1 521310482 803482BY3 2003-08-07 12151053 Construction Ambulatory Surgery 0 0 0 IDA Series 2004A 521310482 803482C55 2004-09-21 11421269 Construction ROC and Cafe Addition 0 0 0 IDA Series 2007A 521310482 803482DF2 2007-12-21 15790000 ED Construction 0 0 0 1275000 0 13986954 1003944 0 3700390 404750 814008 8096440 3414871 0 0 2004 1 0 1 1 970000 0 12161871 883013 632353 0 411796 717490 0 9449724 0 0 2004 0 0 1 1 7245000 0 12597378 1142127 482790 0 397602 0 0 10424485 0 0 2005 0 0 1 1 0 1245000 19613197 0 1121735 0 180370 31000 0 17814548 0 0 2009 0 0 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 1 Merrill Lynch 4.25 1 0 0 0 0 0 1 Merrill Lynch 4.25 1 0 0 0 0 0 1 Merrill Lynch 4.25 1 0 0 0 1 0 0 0 0 IDA Series 2007B 521310482 803482DE5 2007-12-12 18406490 ED Construction & Renovation 0 0 0 1320000 0 22398635 1371700 423697 0 629754 0 0 19777065 0 0 2009 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 William O'Connor Board Trustee 336423 Leasing of property,Trustee has 20% interest 0 F990_P03_S00_L02 Form 990, Part III, Line 2 During 2011, Saratoga Hospital added the following services: * In August 2011, 2 general surgeons on the Hospital's medical staff became directly employed by the Hospital so that their services could be kept in the community. * In October 2011, a pulmonologist was directly hired in order to address a physician shortage identified in the Hospital's service area. * The Hospital took over operation of a cardiac rehabilitation program located in the community in order to maintain this service for patients in the Hospital's service area. * During 2011, operations of the Saratoga Care Family Health Centers (Centers) were absorbed into Saratoga Hospital. This was done pursuant to a plan of closure for the Centers being approved by the New York State Department of Health (DOH), with DOH simultaneously approving the Hospital's application for the Centers to become licensed as extension clinics operated by the Hospital. This change occurred effective April 1, 2011. The Centers were previously operated as a separate legal entity under common control with the Hospital entity under Saratoga Care, Inc. The Centers consist of six primary care providers located at three sites throughout the Hospital's service area. F990_P06_S0B_L11b Form 990, Part VI, Section B, Line 11b A draft of the Form 990 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 of Financial Accounting and Vice President/Chief Financial Officer in order to ensure compliance with applicable instructions.The inital 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 Compliace 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 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 provide 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 2011, 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. 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 the total compensation. Data purchased from vendors or obtained from industry publications by the Human Resources department relevant to the compensation package for each executive is also used in the analysis. 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_L05 Form 990, Part XI, Line 5 Net unrealized losses on investments $ 1,655,741 and Distributions to Saratoga Care,Inc. $ 179,577 Saratoga Care Inc 211 Church Street Saratoga Springs NY 12866 141775218 Promoting Health NY 501(c)(3) 3 N/A 0 Saratoga Care Family Health Centers Inc 201 Church Street Saratoga Springs NY 12866 141364476 Free Standing Diagnostic & Treatment Centers NY 501(c)(3) 3 N/A 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 Saratoga Care Inc c 1219707 FMV Saratoga Care Inc p 691292 FMV Saratoga Care Inc q 179576 FMV Saratoga Care Inc q 467675 FMV Saratoga Care Family Health Centers Inc r 731980 FMV and cost