2011-11-11T22:01:28-06:00 2010-12-31 990 2010-01-01 146019179 PUTNAM HOSPITAL CENTER PUTN 8452795711 670 STONELEIGH AVENUE CARMEL NY 10512 MARYANN KEPPLE 2011-11-11 2010 2016-02-24 21:20:13Z 156690797 false X www.putnamhospital.org X NY PROVIDE ALL ASPECTS OF PATIENT CARE TO THE COMMUNITY 15 13 1203 444 13199 -187806 1378181 2079457 147709024 150437550 -145618 1107828 2790690 3065962 151732277 156690797 0 0 0 0 72049191 74962823 0 0 0 72738486 73678892 144787677 148641715 6944600 8049082 133198123 141401787 84855417 83330208 48342706 58071579 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 58269547 77618124 INPATIENT SERVICES: PATIENTS ADMITTED FOR ACUTE CARE - NUMBER OF PATIENTS 7,557; NUMBER OF PATIENT DAYS 35,014 THE HOSPITAL PROVIDED APPROXIMATELY $1,245,810 IN UNCOMPENSATED CARE (AT COST) TO THE REGIONS UN-INSURED AND UNDER-INSURED POPULATION. 9894829 13352918 INPATIENT PSYCHIATRIC SERVICES: PSYCHIATRIC PATIENTS ADMITTED FOR TREATMENT - NUMBER OF PATIENTS 620; NUMBER OF PATIENT DAYS 5,932 38354767 56489271 OUTPATIENT SERVICES: PATIENTS WHO RECEIVED MEDICAL EMERGENCY, ASU AND VARIOUS ANCILLIARY SERVICES - TOTAL EMERGENCY VISITS 21,605; TOTAL AMBULATORY SURGERY VISITS 5,680 ALL OTHER VISITS/PROCEDURES 196,531 THE HOSPITAL PROVIDED APPROXIMATELY $1,024,546 IN UNCOMPENSATED CARE (AT COST) TO THE REGIONS UN-INSURED AND UNDER-INSURED POPULATION. 3423398 2977237 Home Care 3423398 2977237 109942541 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 false false false true true false false false false false false false false false true false false false false false true false false false false true 7 0 1203 true true true false false false false false false false false false false false X 15 13 true false true false true true true true true false true true true true true true true true true true false NY X HEALTH QUEST 8454759500 1351 ROUTE 55 LAGRANGEVILLE NY 12540 JOHN NEUBAUER 1.0 X 0 0 KEIREN M FARQUHAR 2.0 X JAMES P DUSENBURY 1.0 X KAREN FLEMING 2.0 X JEFFREY J REDFIELD 2.0 X JOEL S BUCHALTER MD 1.0 X PAUL A CAMARDA 2.0 X KEVIN DWYER 1.0 X ROBERT P MORINI 2.0 X WAYNE RYDER 1.0 X RAYMOND DURKIN 1.0 X WILLIAM GERSTNER 1.0 X JANUSZ RUDNICKI MD 1.0 X LORETTA MOLINARI 1.0 X DONNA M MCGREGOR 62.5 X 604011 35401 ANTHONY MIRDITA 45.0 X 173363 33329 LEWIS KOHL MD 50.0 X 356891 32270 MAUREEN ZIPPARO 40.0 X 248636 38040 JEFFREY KELLOGG 50.0 X 223393 31720 JEAN CHELALA MD 37.5 X 327942 53168 HANNA PENG 50.0 X 193400 45029 SHARON GILCHRIST 50.0 X 179760 23413 JOAQUIN MAXINO 50.0 X 160366 36747 GARIE GALARAGA 50.0 X 159462 32853 1020930 1606294 361970 120 false true false 0 532807 1546650 2079457 INPATIENT SERVICE REVENUE 900099 90971042 90971042 OUTPATIENT SERVICE REVENUE 900099 56489271 56489271 HOMECARE SERVICE REVENUE 621610 2977237 2977237 150437550 558215 558215 0 0 1997077 1997077 1997077 1997077 549613 549613 0 0 0 DIETARY CATERING 722320 443 443 CARDIO FITNESS CENTER 713940 10625 10625 OUTSIDE WASTE REMOVAL 562000 2131 2131 1055686 1055686 1068885 156690797 151493236 13199 3104905 0 0 0 0 0 0 54682248 44690800 9991448 0 5411592 4422795 988797 10688211 8735279 1952932 4180772 3416868 763904 0 0 0 3770 3770 0 0 6297390 5331698 965692 5969 5969 23227327 22520882 706445 0 0 4081199 3332190 749009 44149 12802 31347 0 56241 33160 23081 2184392 1783498 400894 0 7880354 6434098 1446256 163203 163203 EQUIPMENT RENTAL/MAINTENANCE 1334028 888649 445379 BAD DEBT 4783756 4783756 LICENSES,TAXES 1097090 28710 1068380 OTHER PURCHASED SERVICES 19690178 1466714 18223464 PHYSICIAN FEES 2421793 1815084 606709 408053 82355 325698 148641715 109942541 38699174 0 3142475 190952 2603067 16278265 18276232 101836 101836 1610243 1988265 547748 784631 151857730 77840248 62944949 74017482 14581437 17359260 33991170 26080062 133198123 141401787 22182885 21219887 38237178 37511580 3417640 2999620 21017714 21599121 84855417 83330208 X 40245144 50325657 7275870 6922452 821692 823470 48342706 58071579 133198123 141401787 X 8049082 1679791 X false true true X true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED SCH C, PART II LOBBYING ACTIVITIES 26.7% OF NORMET DUES PAID BY PUTNAM HOSPITAL CENTER ARE USED FOR POLITICAL EXPENDITURES 821692 1778 823470 809499 12193 821692 809499 809499 1.00000 false false 1193282 1193282 63744380 21005680 42738700 83746133 55385862 28360271 3173934 1448705 1725229 74017482 DAVITA RESTRICTED CASH 632605 REFINANCING FEES 80392 INTEREST IN PHC FOUNDATION LT 10452976 DEFERRED COMP ASSET 437945 DSRF 2007 SERIES B BONDS 8519907 DSRF 2007 SERIES C BONDS 997408 DUE FROM AFFILIATES 733724 MISC RECEIVABLES 234926 DSRF TELP LOAN TDBANK GENERAL 2022764 DEF FINANCING 2007 SERIES B 1257601 DEF FINANCING 2007 SERIES C 202373 DEF FINANCING TELP LOAN 14934 2007 SERIES C BOND PREMIUM 492507 26080062 0 RETRO PAYABLE TO 3RD PARTY PAY 4987572 PENSION - ACCRUED CURRENT AND 13520570 DEFERRED COMP LIABILITY 438455 ACCRUED MALPRACTICE POLICY2002 100000 FIN 47 LIABILTY 585548 HITNY LIABILITY 1966976 21599121 156690797 148641715 8049082 2079265 -399474 1679791 9728873 158770062 2079265 2079265 156690797 156690797 148641715 148641715 148641715 ADDITIONAL PENSION LIABILITY PART XI LINE 8 Pension related changes other than net periodic pension costs (151,228) TRANSFER OF EQUITY PART XI LINE 8 TRANSFER OF EQUITY (1,422,860) INTEREST IN PHC FOUNDATION PART XI LINE 8 INTEREST IN PHC FOUNDATION 1,526,253 CHANGE IN RESTRICTED CONTRIBUTIONS (351,639) true true X true X true X true true false true true 4173773 2151018 2022755 0.01360 9448751 6259030 3189721 0.02150 13622524 8410048 5212476 0.03510 10 160125 57308 57308 0.00040 1 844 844 1 4260213 3820578 439635 0.00300 12 160125 4318365 3820578 497787 0.00340 12 160125 17940889 12230626 5710263 0.03850 true 1990467 995234 45710158 59072431 -13362273 X true true 1 1 PUTNAM HOSPITAL CENTER

670 STONELEIGH AVENUE CARMEL NY 10512

X 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 N/A PART I, LINE 6A HEALTH QUEST SYSTEMS, INC PREPARES THE COMMUNITY BENEFIT REPORT, HOWEVER, THE REPORT DOES DETAIL OUR SPECIFIC COMMUNITY BENEFITS FOR EACH FACILITY WITHIN HEALTH QUEST. PART I, LINE 7G LOSSES INCURRED IN RUNNING THE MENTAL HEALTH UNIT, NOT INCLUDING MEDICAID AND CHARITY CARE LOSSES. PART I, LINE 7, COLUMN F TOTAL BAD DEBT EXPENSE, EXCLUDED FROM COLUMN F PERCENTAGE = $4,783,756 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 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 COST TO CHARGE RATIO - USED WORKSHEET #2 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 13 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 19 THE HOSPITAL FACILITY USES THE HIGHEST VOLUME COMMERCIAL PAYOR RATE TO BILL INDIVIDUALS WHO DO NOT HAVE INSURANCE. PART VI, LINE 2 NEEDS ASSESSMENT IN THE HUDSON VALLEY, THE LOCAL HEALTH DEPARTMENTS FORMED A COALITION WHICH SPEARDHEADED THE COMMUNITY HEALTH ASSESSMENTS. HEALTH QUEST HOSPITALS PARTICIPATED IN THE PLANNING SESSION ALONG WITH NUMEROUS COMMUNITY AGENCIES, ALL OF WHICH MET IN A PLANNING SESSION IN 2010. IN ADDITION, UNDER THE NEW GOVERNANCE MODEL OF THE HOSPITALS, THE BOARDS WILL FOCUS ON COMMUNITY NEEDS ASSESSMENT, PRIORITIZATION AND PROGRAM DEVELOPMENT. HEALTH QUEST WILL BE FOCUSED ON THE FOLLOWING - 1 - ACCESS TO CARE, WITH A FOCUS ON OPENING A FEDERALLY FUNDED HEALTH FACILITY IN PUTNAM COUNTY AND BRINGING NEW SPECIALISTS INTO THE AREA. 2 - DIABETES AWARENESS AND MANAGEMENT, INCLUDING BRINGING NEEDED ENDOCRINOLOGISTS INTO THE AREA. 3 - HEALTHY AGING, ESPECIALLY IN THE NORTHERN PART OF DUTCHESS COUNTY WHERE THE POPULATION DEMANDS IT. 4 - MENTAL HEALTH, AS OUR PUTNAM HOSPITAL HAS AN INPATIENT UNIT AND IS A CENTER HUB OF COMMUNITY MENTAL HEALTH TREATMENT. 5 - TICK BORNE ILLNESSES, WHICH OCCUR IN HIGH RATES IN BOTH DUTCHESS AND PUTNAM COUNTIES. 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 COMMUNITY INFORMATION APPLIES TO ALL HOSPITAL SERVICE AREAS - 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 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 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 STATE FILING OF COMMUNITY BENEFITS REPORT HEALTH QUEST, THE PARENT COMPANY OF PUTNAM HOSPITAL CENTER, FILES A SYSTEM WIDE COMMUNITY SERVICE PLAN WITH NYS DEPARTMENT OF HEALTH. X X X X X false false false false false false false false false DONNA M MCGREGOR 417310 144789 41912 14700 20701 639412 529609 LEWIS KOHL MD 311066 45825 0 14531 17739 389161 288688 MAUREEN ZIPPARO 195402 28086 25148 17601 20439 286676 237515 ANTHONY MIRDITA 155741 17622 0 10401 22928 206692 167736 JEAN CHELALA MD 300561 27381 0 28663 24505 381110 464448 JEFFREY KELLOGG 167537 24498 31358 15830 15890 255113 203700 HANNA PENG 193400 0 0 23529 21500 238429 187097 SHARON GILCHRIST 169760 10000 0 13564 9849 203173 168924 JOAQUIN MAXINO 160366 0 0 17450 19297 197113 0 GARIE GALARAGA 159462 0 0 9559 23294 192315 0 DORMITORY AUTHORITY - STATE OF NEW YORK 146000293 649903UK5 2007-09-06 28161751 CONSTRUCTION FOR FACILITY false false false 1514496 0 30075855 2026143 572477 0 387734 443713 655855 21851327 0 4138606 2008 false false false true false false false false true 0.00000 0.00000 0.00000 true false false false false true false BOND ISSUES PART I, COLUNM E, LINE B TOTAL ISSUE PRICE PER IRS FORM 8038 - $61,974,071.30, ALLOCATED BETWEEN 3 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. JOEL BUCHALTER MD BAF CONSULTANTS 107029 ADMINISTRATIVE SERVICES false PROGRAM SERVICE ACCOMPLISHMENTS Form 990 Part III Line 4D Home Health care: Provide Homecare to patients in the community. Total Homecare visits: 15,122 GOVERNING FORM 990 PART VI SECTION A LINE 2A, 6, 7A, 7B, 8A AND 8B LINE 2A - RAYMOND DURKIN - BROTHER JAMES DURKIN IS A PHCF LIFE TRUSTEE KEVIN DWYER - BROTHER EDWARD DWYER IS A PHCF LIFE TRUSTEE LINE 4 - Health Quest Systems, Inc. ("HQ") - Bylaw Amendments - Summary of Changes. HQ / Hospitals - 2010 Bylaw Amendments. HQ amended its bylaws on July 19, 2010 in order to streamline HQ's governance and promote management and operational efficiencies. In addition, bylaw amendments were made by each of HQ's affiliated hospitals (Vassar Brothers Medical Center ("VBMC" - 5/14/2010), Northern Dutchess Hospital ("NDH" - 5/25/2010), and Putnam Hospital Center ("PHC" - 6/30/2010) (collectively referred to as the "Hospitals"). Key Elements of Hospital / HQ Bylaw Changes. The bylaw amendments made several key changes: first, they confirm and enable HQ's existing and available powers under New York law as the sole member and active parent of the Hospitals; second, they focus each Hospital's board on patient safety, quality of care, and community health needs including through the elimination of all but three (3) required Hospital committees (i.e., the (i) Executive, (ii) Quality, Patient Satisfaction and Medical Staff Credentialing and (iii) Community Health Needs Committees); and third, other governance streamlining changes are implemented through the HQ and Hospital Bylaw changes (for example, several HQ committees are combined, many Hospital committees are being eliminated, and HQ's role and power as the sole member and active parent of each Hospital has been confirmed and further enabled). LINE 6 - THE SOLE MEMBER OF PHC IS HEALTH QUEST SYSTEMS, INC LINES 7A AND 7B - 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. 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. POLICIES FORM 990 PART VI SECTION B LINE 11A, 12C, 15A/B LINE 11A - A COPY OF THE FORM 990 WAS PROVIDED TO ALL MEMBERS OF THE BOARD . THE CHAIR OF THE EXECUTIVE COMPENSATION COMMITTEE REVIEWED ALL SECTIONS RELATED TO EXECUTIVE COMPENSATION. 3RD PARTIES WERE HIRED TO ASSIST IN THE PREPARATION AND REVIEW OF SCHEDULE H AND SCHEDULE K. 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 - RELATED TAX EXEMPT ORGANIZATIONS Entity Tax ID# Primary Activity Legal Domicile Exempt Code Status Public Charity Status Directo controlling Entity Vassar Brothers Medical Center 14-1338586 Hospital NY 501c3 Box 3 HQ The Foundation for Vassar Brothers Medical Center 14-1736429 Fundraising NY 501c3 Box 9 HQ Riverside Diversified Services, Inc (Parent) 14-1675545 Education NY 501c3 Box 9 HQ Alamo Ambulance Service, Inc 14-1745417 Transport NY 501c3 Box 9 HQ Hudson Valley Home Care, Inc (Certified) 14-1788412 Home Health NY 501c3 Box 9 HQ Hudson Valley Home Care, Inc (Licensed) 14-1788410 Home Health NY 501c3 Box 9 HQ Northern Duchess Hospital 14-1338467 Hospital NY 501c3 Box 3 HQ Northern Dutchess Residential Health Care Facility 22-3129608 Nursing Home NY 501c3 Box 9 HQ NDH Foundation 14-1776208 Fundraising NY 501c3 Box 9 HQ Putnam Hospital Center 14-6019179 Hospital NY 501c3 Box 3 HQ Putnam Hospital Center Foundation 06-1399319 Fundraising NY 501c3 Box 9 HQ 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 SCHEDULE K (2) PART II, COLUMN C, LINE 5 ISSUANCE COSTS - $410,257.49, CREDIT ENHANCEMENT FEE - $443,713.27 ALLOCATION METHODOLOGY FOR HQ SCH R, PART V, LINE 2(1) Health Quest Systems, Inc Allocation of Support Services/Shared Expenses/Cash Funding General: The following services are considered shared services for Health Quest affiliates and the cost to provide these services are allocated to each entity which benefits from the service based on a pre defined allocation methodology: 1. Specialty Staffing a. VBMC Surgical b. Radiology c. Oncology d. VBMC Sleep Lab e. PT/OT/ST f. Cardiac Rehab 2. Lab Management 3. Pharmacy 4. 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 5. Facilities including courier service, construction, property management, facility operations, hotel management and security 6. Business Development including strategic planning, marketing and public relations, answering service and community education 7. Corporate Finance including accounts payable, payroll, general accounting, purchasing and supply chain, practice management billing and management engineering 8. Internal Audit and Compliance 9. Practice management operations including physician recruitment and physician management 10. Human Resources 11. Administrative including Executive office, Hospital Support and risk management 12. Legal Counsel 13. 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. Lab management includes oversight of the outsourced lab services for each hospital 3. Pharmacy management includes oversight of all pharmacy departments 4. 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 5. 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. Hotel Management functions include management oversight of food and nutrition departments for the hospitals e. Security functions include management oversight of all facilities to ensure the safest environment 6. 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 7. 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 and supply chain functions include procurement services, contract negotiations, price negotiations, capital purchase negotiations, including negotiations for maintenance contracts, upgrades to equipment, etc. 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 8. Internal Audit and Compliance includes oversight of the corporate compliance program, internal audit, HIPAA compliance and contract review and compliance 9. Human Resource functions include recruitment, compensation, benefit administration and employee training 10. Physician management operations functions include oversight of all HQ physician practices and physician recruitment functions 11. Administrative functions include oversight of the Health Quest system, hospital management and risk management 12. Legal Counsel functions include internal legal services for HQ and coordination of all outsourced legal initiatives 13. 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, general and professional liability, cyber insurance 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, pharmacy 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 SYSTEMS INC 1351 ROUTE 55 LAGRANGEVILLE NY 12540 141678068 SUPPORT SERV 501C3 BOX 9 HQ SEE SCHEDULE O N/A false false false false false false false false false false false false false false true false false false HEALTH QUEST SYSTEMS INC O 18913073