2011-10-24T13:15:32-07:00 2010-12-31 990 2010-01-01 141338547 SARATOGA HOSPITAL SARA 5185878421 211 Church Street Saratoga Springs NY 128661090 GARY FOSTER 5185838421 2011-10-27 2010 2016-03-07 17:11:31Z Angelo Calbone 211 Church Street Saratoga Springs NY 12866 200726701 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 1976 261 3902816 0 4167084 1174461 181030754 192492647 -161751 994040 2167036 2828194 187203123 197489342 0 0 0 0 90948725 95125265 0 0 0 82936816 91113077 173885541 186238342 13317582 11251000 204278254 213762195 101099687 98103545 103178567 115658650 To serve the people of our community by responding to their health care needs in a supportive and caring environment. 0 0 170356564 0 192492647 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 2010, the hospital emergency department facilitated 36,080 patient visits. * The Hospital represents the only inpatient acute care facility in Saratoga County. During 2010, the Hospital had 8,933 admissions for inpatient adult and pediatric care. These admissions included 823 births, 731 admissions to our inpatient mental health unit and 29 admissions for Hospice care. Total adult and pediatric inpatient days for the Hospital during 2010 were 48,597 which included 4,053 days of inpatient care in the Critical Care Unit. * The Hospital operates a 36-bed skilled nursing facility on its campus. During 2010, 12,246 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 2010, the benefits provided under these policies, measured on the basis of costs, amounted to approximately $ 2,518,000. * 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 2010, our urgent care sites accommodated 40,628 patient visits. * During 2010 the hospital incurred bad debt expense of approximately $9,128,074 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 2010 were approximately $9,488,000 and $8,699,000, 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 2010, the Hospital forgave advances plus accrued interest amounting to approximately $166,000 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 2010,unreimbursed costs of administering the program were approximately $19,000. * 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 170356564 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 1 148 0 1 1976 1 1 1 1 VI CJ 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 MIKE BATTLE 5185838498 The Saratoga Hospital 211 Church Street Saratoga Springs NY 12866 Deane S Pfeil 2.5 X 0 0 0 Jonathan L Rubenstein 2.5 X 0 0 0 Douglas N Young 2.5 X 0 0 0 Michele J Mehler 2.5 X 0 0 0 William W O'Connor MD 2.5 X 0 0 0 Richard E Schumaker Jr 2.5 X 0 0 0 Michael D West 2.5 X 0 0 0 Brian Fredette 2.5 X 0 0 0 David M Mastrianni MD 2.5 X 0 0 0 Janice M White 2.5 X 0 0 0 William R Stanley 2.5 X 0 0 0 Dennis A Brobston 2.5 X 0 0 0 Michael H Iacolucci 2.5 X 0 0 0 Eugene K Merecki MD 2.5 X 0 0 0 Donna Montalto 2.5 X 0 0 0 Angelo Calbone 31.00 X X X 398598 59169 70420 Gary L Foster 35 X X 268493 12624 29727 Joyce L Peabody 37.00 X 344629 1508 35151 Mary Jo Laposta 38.00 X 257836 0 25401 John Mangona 38 X 238895 0 27195 Kevin Ronayne 38 X 236081 0 34138 Jeffrey Methven 37.00 X 226075 1267 28494 Bradley Sexauer 30.00 X 220767 44291 27928 Gordan Kuhar 38 X 852213 0 8698 Jon Allison 38 X 273321 0 8698 Carl Sgambati 38 X 226308 0 8015 Russell Loeber 38 X 190622 0 14609 William Malone 38 X 160587 0 13707 3894425 118859 332181 68 0 1 0 AOW Associates Inc 30 Essex Street Albany NY 12206 Construction Management 6171212 Saratoga Emergency Physicians PC The Saratoga Hospital 211 Church Street Saratoga Springs NY 12866 Physicians 8854903 Laboratory Corporation of America PO Box 12140 Burlington NC 272162140 Lab Services 1417359 Hypertype 84 Calvert Street Harrison NY 10528 Transcription Services 1024899 Prometheus Laboratories PO Box 7738 San Francisco CA 94120 Lab Services 553594 31 0 0 0 937528 221910 15023 0 1174461 Specimen Drop Offs 621500 3903308 0 3903308 0 Not for Profit Hospital 622000 114094327 114094327 0 0 Medicare,Traditional and MC 622000 63184467 63184467 0 0 Medicaid, Traditional and MC 622000 11310545 11310545 0 0 0 0 0 0 192492647 781381 0 -492 781873 134586 0 0 134586 0 0 0 0 155237 0 180947 0 -25710 0 -25710 0 0 -25710 3125370 9115 3024358 32054 101012 -22939 78073 -22939 0 101012 0 Cafeteria 722210 1146471 0 0 1146471 Real Property 532000 229049 0 0 229049 Rebates and Refunds 900099 256325 256325 0 0 1222059 1222059 0 0 2853904 197489342 190044784 3902816 2367281 2469827 2469827 74452677 68612830 5839847 0 2774278 2548296 225982 0 9813372 8679553 1133819 0 5615111 5008530 606581 0 0 0 0 0 206947 0 206947 0 99404 0 99404 0 97453 0 97453 0 0 0 86670 0 86670 0 18577939 17409632 1168307 0 647482 21587 625895 0 40141032 39148401 992631 0 1143562 1067938 75624 0 0 0 0 0 6746962 6111915 635047 0 22003 16432 5571 0 0 0 0 0 288818 210273 78545 0 26805 25032 1773 0 0 0 0 0 11826759 11044657 782102 0 1016095 1010615 5480 0 Miscellaneous Expenses 1057072 312799 744273 0 Bad Debt Expense 9128074 9128074 0 0 186238342 170356564 15881778 0 34401784 8446299 9078 26020697 0 23115334 22052533 0 0 0 0 1069070 1860715 4097600 4919790 2275796 2571028 215876333 117064871 94554833 98811462 32107758 36700041 5631660 6330889 15001 15001 0 7000340 6033740 204278254 213762195 19204884 19406421 0 0 0 0 65515676 63109386 0 0 0 0 2946408 2554758 6795091 6066588 6637628 6966392 101099687 98103545 X 94478327 109627488 8134738 5465660 565502 565502 103178567 115658650 204278254 213762195 X 11251000 1229083 X 0 1 1 X 0 X 0 1 0 0 0 0 1 0 0 1 97453 97453 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, and to determine whether the Hospial 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 Healthcare Association of New York State, are used by those organizations for lobbying purposes. The portion of annual dues determined to relate to those organizations' lobbying activities is determined by the Hospital based on documentation received from those organizations. 7101991 31967 746502 0 0 0 7880460 5797719 53656 1250616 0 0 0 7101991 7636033 231000 -2069314 0 0 0 5797719 0.93 0.07 0 0 0 0 14279409 14279409 0 58365768 22197016 36168752 0 3528003 2927463 600540 0 131628403 87551836 44076567 0 8074750 4388556 3686194 98811462 Estimated Third-Party Settlements 3494000 Construction Costs Payable 506728 Other Long-term liabilities 2965664 6966392 197489342 186238342 11251000 2038862 0 0 0 -809781 1229081 12480081 198743174 2038863 0 0 138669 2177532 196565642 197096 726604 923700 197489342 186222192 0 0 0 180947 180947 186041245 197097 0 197097 186238342 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_P11_S00_L08 Schedule D, Part XI, Line 8 Distribution to Saratoga Care, Inc. $ 809,781 SchD_P12_S00_L02d Schedule D, Part XII, Line 2d Net assets released from restrictions $138,669 SchD_P12_S00_L04b Schedule D, Part XII, Line 4b Rental Expenses ($180,947) and Restricted Gifts $907,551 SchD_P13_S00_L02d Schedule D, Part XIII, Line 2d Rental Expenses $ 180,947 1 1 1 X 2.5 1 X 1 1 1 0 0 2518138 393286 2124852 0.012 17009579 8311006 8698573 0.0491 0 0 19527717 8704292 10823425 0.0611 118 203189 181006 22183 0 347535 0 347535 0.00196 24320 0 24320 0 0 118 575044 181006 394038 0.00196 0 118 20102761 8885298 11217463 0.06306 165860 0 165860 0.00093 0 0 165860 0 165860 0.00093 1 3063302 1531651 35289436 44777345 -9487909 X 1 1 1 1 Saratoga Hospital

211Church Street Saratoga Springs NY 12866

X X X Saratoga Hospital 1 SchH_P01_S00_L07 Schedule H, Part I, Line 7 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_P01_S00_L072f Schedule H, Part I, Line 7, Column f Bad Debt Expense, in the amount of $9,128,074 is reported in Part IX, Statement of Functional Expenses. 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 2010, the Hospital forgave advances plus accrued interest amounting to approximately $166,000 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. Most patients who apply for the financial assistance benefit and provide the requested documentation do ultimately 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 2010 were divided by total charges to all patients during 2010. 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_P03_S0C_L09b Schedule H, Part III, Section C, Line 9b The process described in the question on Part V, Line 17e of Schedule H is put on hold while the Hospital is working with a patient to provide financial assistance, Medicaid enrollment, CHP, or a payment plan. However, should the patient fail to comply with information requests for the financial assistance or Medicaid qualification process or should the patient fail to adhere to the monthly payment plan, in the absence of any meaningful communication from the patient regarding the outstanding balance, the process described above will be restarted unless subsequent contact is made by the patient. In cases where the patient is unable to comply with a repayment plan, the patient is re-evaluated for qualification for the Hospital's financial assistance policy. SchH_P05_S0B_L09 Schedule H, Part V, Section B, Line 9 The process described in the question on Part V, Line 17e of Schedule H is put on hold while the Hospital is working with a patient to provide financial assistance, Medicaid enrollment, CHP, or a payment plan. However, should the patient fail to comply with information requests for the financial assistance or Medicaid qualification process or should the patient fail to adhere to the monthly payment plan, in the absence of any meaningful communication from the patient regarding the outstanding balance, the process described above will be restarted unless subsequent contact is made by the patient. In cases where the patient is unable to comply with a repayment plan, the patient is re-evaluated for qualification for the Hospital's financial assistance policy. SchH_P06_S00_L02 Schedule H, Part VI, Line 2 This response expands upon the community health needs assessment process more broadly described in response to the question at Schedule H, Part VI, Line 2. Specifically, the ARHN assessment process took into account input from persons representing the community via the following means: * 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. * 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. SchH_P06_S00_L03 Schedule H, Part VI, Line 3 The Hospital publishes a brochure which outlines the benefits available uninsured or underinsured members of the community through the Hospital's charity care program. The brochure contains information on eligibility for the program as well as whom can be contacted to begin the process of qualifying for the program's benefits. Hospital staff who register patients provide any uninsured patients with a copy of this brochure, and copies of the brochure are prominently available at all patient registration locations. For uninsured patients, or to patients whose insurance have made their required payments to the Hospital for patients, any bills sent to the patients include a message and contact information regarding the Hospital's financial assistance program. 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 2010 was approximately 70,100. 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 2010 population of these communities was estimated at approximately 86,500. Total Service Area Population 2010 %of Age Cohort Population Total 0-17 33,975 21.7% 18 -24 14,476 9.3% 25 -44 43,927 28.0% 45 -64 43,930 28.0% 65+ 20,373 13.0% Total 156,681 100.0% Females 15 -44 32,790 21.0% Median household income for Saratoga County was $80,200 in 2010, as compared to $79,200 and $71,000 for Ney York State and the United States, respectively, during 2009. The unemployment rate for Saratoga County was 6.8% during 2010, as compared to 8.6% for New York State. SchH_P06_S00_L05 Schedule H, Part VI, Line 5 The Hospital also promotes community health through the following activities: * Open medical staff * Board of Trustees comprised primarily of independent persons from the community * Subsidization of community education forums, at no cost to the public, including: o Childbirth education- monthly classes o Community wellness classes- including education for prevention and management of chronic diseases such as diabetes and asthma, and updates on new treatment pathways available for common ailments o Facilitation of monthly support groups for issues including weight loss, cancer survivors and grief management. * Schedules and topical information for community education forums are made available on the Hospital's website and are also provided in a free quarterly newsletter, ACCESS. ACCESS also includes short articles written by medical staff regarding current health issues. These articles are also posted on the Hospital's website. * The Hospital provides 24-hour call center services, HealthSource, at no cost. * Any surplus generated by the Hospital is reinvested into the Hospital through expansion of operations, by purchase of space and equipment, and hiring of personnel needed to support programs that have been identified as needs for the community the Hospital serves. * A high level of management and employee engagement in the community. The Hospital team has annually been the largest fundraiser for the American Heart Association's North Country Heart Walk (over $24,000 raised in 2010). Additionally, Hospital management employees raised over $24,000 for United Way programs during 2010. In both cases, the amounts represent the largest contributions by a hospital staff from a hospital of any size in our region X X X X 0 0 0 0 0 1 1 0 0 Angelo Calbone 322972 59169 69991 0 5634 0 62204 0 8217 0 469018 59169 Gary L Foster 221451 12624 41037 0 6005 0 26977 0 2750 0 298220 12624 Joyce L Peabody 297543 1508 47086 0 0 0 31454 0 3697 0 379780 1508 Bradley Sexauer 176885 44291 35587 0 8295 0 23752 0 4177 0 248696 44291 Mary Jo Laposta 219089 0 38747 0 0 0 21595 0 3807 0 283238 0 Kevin Ronayne 203272 0 32809 0 0 0 22808 0 11330 0 270219 0 0 John Mangona 200211 0 31496 0 7188 0 24144 0 3051 0 266090 0 0 Jeffrey Methven 193520 1267 32555 0 0 0 19897 0 8596 0 254568 1267 Gordan Kuhar 852213 0 0 0 0 0 8698 0 0 0 860911 0 0 Jon Allison 273321 0 0 0 0 0 8698 0 0 0 282019 0 Carl Sgambati 226308 0 0 0 0 0 8015 0 0 0 234323 0 0 Russell Loeber 190622 0 0 0 0 0 6763 0 7846 0 205231 0 0 William Malone 155587 0 5000 0 0 0 5860 0 7846 0 174293 0 0 SchJ_P01_S00_L06 Schedule J, Part I, Line 6 The Hospital administers an incentive compensation program under which members of Hospital management are eligible to earn up to a percentage of their base salaries in incentive compensation.Overall incentive compensation is based on measurable achievement against a menu of organizational goals, including financial results,patient satisfaction,quality of care, employee satisfaction and retention, and growth in services. The financial portion of incentive compensation represented 20% of the overall incentive compensation available during 2010, and was based on achievement of "minimum,meets and maximum' levels relative to the Hospital's operating margin percentage for the year. SERIES 2003 A IDA 521310482 803482BW7 2003-08-07 13986954 Refinance Revenue Bonds 0 0 0 SERIES 2003B1 IDA 521310482 803482BY3 2003-08-07 12151053 Construction Ambulatory Surgery 0 0 0 SERIES 2004A IDA 521310482 803482C55 2004-09-21 11421269 Construction ROC and Cafe Addition 0 0 0 SERIES 2007A IDA 521310482 803482DF2 2007-12-21 15790000 ED Construction 0 0 0 0 0 13986954 1003944 0 3700390 404750 814008 8096440 3414871 0 0 2004 1 0 1 1 0 0 12161871 883013 632353 0 411796 717490 0 9449724 0 0 2004 0 0 1 1 0 0 12597378 1142127 482790 0 397602 0 0 10424485 0 0 2005 0 0 1 1 0 0 19613197 0 1121735 0 180370 31000 0 17814548 0 0 2009 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 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 SERIES 2007B IDA 521310482 803482DE5 2007-12-12 18406490 ED Construction & Renovation 0 0 0 0 0 22398635 1371700 423697 0 629754 0 0 19777065 0 0 2009 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 William O'Connor Board Trustee 212137 Leasing of property, Trustee has 16% interest 0 F990_P06_S0B_L11a Form 990, Part VI, Section B, Line 11a A draft of the Form 990 and any required supplemental schedules (collectively the "Form 990") is completed by the Hospital's Fiscal Services Department, with input from other Hospital departments obtained as needed. The completed Form 990 is then reviewed by the Director, Financial Accounting and Vice President/Chief Financial Officer in order to ensure compliance with applicable instructions. The initial phase of review by the Hospital's Board of Trustees occurs through a submission of the draft Form 990 to the Board Audit and Corporate Compliance Committee (AC). Members of the AC are provided with drafts of the Form 990 prior to a quarterly meeting. At the quarterly meeting, an agenda item is devoted to providing the AC members with time to ask management questions regarding any disclosures in the form 990 and to provide and comments or suggestions. Management evaluates the AC suggestions and comments and amends the Form 990. Subsequently, copies of the revised draft Form 990 are provided to all members of the Hospital Board of Trustees. Board members are asked to provide any comments on the form 990 at the monthly Board meeting occurring after the draft Form 990 has been distributed. Any applicable comments or suggestions are incorporated into the Form 990, and a final version is filed with the IRS. F990_P06_S0B_L12c Form 990, Part VI, Section B, Line 12c The Hospital maintains two conflict of interest policies. One applies to members of the Board of Trustees, Hospital officers, certain members of the medical staff and all employees whose compensation exceeds $100,000. A second conflict of interest policy applies to all members of management, employees and volunteers of the Hospital, as well as persons serving in those roles for corporations affiliated with the Hospital who are not covered by the first policy. The policies provider clear explanations as to who is covered by each policy, what family members and/or ownership interests (including non-financial interests) must be considered in assessing compliance with the policy, definitions of compensation (including non-monetary compensation) and examples of conflicts including activities that must always be avoided. On an annual basis a conflict of interest disclosure questionnaire process is undertaken. All members of the Board of Trustees and management, all non-management employees whose compensation exceeds $100,000, and all members of the Hospital's medical staff are required to complete and file the questionnaire with the Hospital's Chief Compliance Officer. Additionally, members of Hospital management are required to identify any additional employees under their supervision who have the ability to influence purchasing decisions aggregating to $100,000 or more annually. These employees are also required to complete and file the questionnaire. Inquiries included on the questionnaire are designed to allow respondents to provide yes/no answers that will allow a determination to be made as to whether any non-compliance with the applicable conflict of interest policy has occurred, or whether there are any situations that may require further investigation. Responses to the questionnaires are tracked by the Chief Compliance Officer and are reported to the Audit and Corporate Compliance Committee of the Board of Trustees at its quarterly meetings. On an annual basis the Fiscal Services department reviews all responses submitted by members of the Board of Trustees as well as officers of the Hospital. The questionnaire includes a section where respondents are asked, for any person or entity that has or may do business with the Hospital or one of its affiliates, to provide names of any external entities they have interests in or are employed by, as well as names of relatives and entities those relatives have interest or are employed by. Additionally, if a potential conflict is known of, but not disclosed on the questionnaire, these persons/entities are also identified by hospital management. Any persons or entities disclosed in this area or otherwise deemed to be potential conflicts are referenced against the accounts payable systems for the Hospital and its related entities in order to determine whether business was transacted with any of the disclosed entities during the past year. Materiality of any transactions identified is assessed and a determination is made as to whether the transaction of business with any of these entities was made in accordance with the Hospital's purchasing and conflict of interest policies (ex. competitively bid, removal of the conflicted person from the decision-making process). F990_P06_S0B_L15 Form 990, Part VI, Section B, Line 15 The Hospital maintains a written statement of executive compensation philosophy and practice that is used as a framework for establishing compensation for senior leaders as well as most of the department directors within the organization. The Hospital's Board of Trustees has formally delegated implementation of the executive compensation philosophy to its Executive Committee. During 2010, the Executive committee consisted of seven members of the Board of Trustees, all of whom were determined to be independent with respect to the guidelines set forth for completing Part VI, Line 1b of the Core Form 990. On an annual basis, the Executive Committee reviews the performance of the President/Chief Executive Officer (CEO) and makes a base salary recommendation to the full Board. The Executive Committee performs this task using a target percentile rank on a scale of amounts paid to similarly situated executives in the marketplace. However, the Executive Committee is provided leeway to deviate from this target somewhat where considerations relating to special skills, experience, competence and performance are relevant. Additionally, the Executive Committee sets annual performance criteria the CEO must meet in order to qualify for incentive compensation. At the end of each evaluation period, the Executive Committee determines whether the CEO has met the previously established performance criteria and makes a recommendation regarding payment of incentive compensation to the full Board accordingly. The CEO is responsible, with the oversight of the Executive Committee, for determining the base compensation for all other executives in the organization. These base salaries are also determined using a target percentile rank on a scale executives situated similarly by position within the marketplace, with acceptable deviations for the same considerations as described for determining CEO compensation. Incentive compensation for all other executives is also earned based upon a determination by the CEO as to whether the performance of the entire organization as well as the individual executive has met criteria previously established by the Executive Committee. The comparability data used by the Executive Committee and CEO as guidelines for setting executive compensation are derived from two sources use. First, on a least a bi-annual basis an independent valuation expert is retained by the Hospital's Human Resources department to assess the reasonableness of total, as well as other data purchased from vendors or obtained from industry publications by the Human Resources department relevant to the compensation package for each executive. Also used as a guideline are the requirements for invoking a rebuttable presumption of reasonableness in accordance with IRS intermediate sanction regulations, to the extent practicable. F990_P06_S0C_L19 Form 990, Part VI, Section C, Line 19 Currently the Hospital's governing documents, conflict of interest policy and financial statements are available to the public upon request. F990_P11_S00_L05 Form 990, Part XI, Line 5 Net unrealized gains on investments $2,038,862 and Distributions to Saratoga Care, Inc. -$809,781 Saratoga Care Inc 211 Church Street Saratoga Springs NY 12866 141775218 Promoting Health NY 501(c)(3) 3 N/A Saratoga Care Family Health Centers Inc 201 Church Street Saratoga Springs NY 12866 141364447 Free Standing Diagnostic & Treatment Centers NY 501(c)(3) 3 N/A 0 0 1 0 0 0 0 0 0 0 0 0 0 1 0 1 1 0 Saratoga Care Family Health Centers Inc n 36548 FMV Saratoga Care Inc q 809781 FMV Saratoga Care Family Health Centers Inc p 71877 FMV Saratoga Care Inc c 1810462 FMV Saratoga Care Inc q 527000 FMV Saratoga Care Inc p 681256 FMV