2016-11-14T16:12:37-06:00 2015-12-31 ERNST & YOUNG US LLP 5 TIMES SQUARE NEW YORK NY 10036 990 2015-01-01 131740119 NYACK HOSPITAL % RONALD RATIGAN NYAC 8453486522 160 NORTH MIDLAND AVENUE NYACK NY 10960 JOHN BURKE VP & CFO 2016-11-09 CHRISTOPHER B BOGGS P00032493 2127733000 2015 2017-02-10 21:41:12Z MARK GELLER MD 160 NORTH MIDLAND AVENUE NYACK NY 10960 227007748 false X NYACKHOSPITAL.ORG X 1895 NY TO PROVIDE COMPETENT, INNOVATIVE AND ACCESSIBLE EMERGENCY AND ACUTE CARE SERVICES FOR THE RESIDENTS OF ROCKLAND COUNTY AND SURROUNDING AREAS. 24 19 1780 180 0 3971537 6365638 206742474 216210881 161206 168330 6355960 4262899 217231177 227007748 0 0 0 0 125814852 130763264 0 0 0 91852572 97348203 217667424 228111467 -436247 -1103719 101015708 103929689 70100179 75861749 30915529 28067940 TO PROVIDE COMPETENT, INNOVATIVE AND ACCESSIBLE EMERGENCY AND ACUTE CARE SERVICES TO THE RESIDENTS OF ROCKLAND COUNTY AND SURROUNDING AREAS. false false 206835836 220013512 PROGRAM SERVICE ACCOMPLISHMENTS: NYACK HOSPITAL IS COMMITTED TO MEETING THE HEALTH CARE NEEDS OF THE RESIDENTS OF ROCKLAND COUNTY, NEW YORK AND OTHER SURROUNDING AREAS. NYACK HOSPITAL IS DEDICATED TO PROVIDING THE HIGHEST QUALITY HEALTHCARE SERVICES TO THE ROCKLAND COMMUNITY. DURING 2015, NYACK HOSPITAL PROVIDED HIGH QUALITY HEALTHCARE SERVICES FOR 13,511 ADMISSIONS, ACCOUNTING FOR 67,454 DAYS OF PATIENT CARE. NYACK HOSPITAL PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. FOR THE YEAR ENDED DECEMBER 31, 2015, NYACK HOSPITAL PROVIDED $17,010,770 IN INDIGENT AND CHARITY WRITE-OFFS UNDER ITS CHARITY CARE POLICY. NYACK HOSPITAL ALSO PROVIDES 24 HOUR EMERGENCY DEPARTMENT SERVICES. FOR 2015, NYACK HOSPITAL HAD 55,983 EMERGENCY DEPARTMENT VISITS. 206835836 true true false true false false false false false true true false false true true false false true false false false false false false false false true true false false true false false false false false false false false false false false false false true true true false false true 122 0 true 1780 true false false false false false false false false false false X 24 19 false false false false true true true true true false false true true true true true true true true false NY X RONALD RATIGAN 8453486522 160 NORTH MIDLAND AVENUE NYACK NY 10960 MARISA S BARBIERI BOARD MEMBER 1.0 0.0 X 0 0 0 MITCHELL COHN MD BOARD MEMBER 1.0 0.0 X 0 0 0 HOWARD J FELDFOGEL DO BOARD MEMBER 1.0 0.0 X 0 0 0 MARK GELLER MD PRESIDENT & CEO 40.0 0.0 X X 812127 0 31768 JAMES K GERSTLEY MD BOARD MEMBER 1.0 0.0 X 0 0 0 RICHARD A GOLDMAN SECRETARY 1.0 0.0 X X 0 0 0 SUSAN GREEN-LORENZEN TRUSTEE 1.0 59.0 X 0 1194177 296068 LISA HAYES VICE CHAIR 1.0 0.0 X X 0 0 0 KEVIN HOBBS BOARD MEMBER 1.0 0.0 X 0 0 0 THOM KLEINER SECRETARY 1.0 0.0 X X 0 0 0 RICHARD KOHLHAUSEN CHAIR 1.0 0.0 X X 0 0 0 JEFFREY LUBATKIN BOARD MEMBER 1.0 0.0 X 0 0 0 MICHAEL MAHON BOARD MEMBER 1.0 0.0 X 0 0 0 JOHN MECCHELLA VICE CHAIR 1.0 0.0 X X 0 0 0 JEFFREY MENKES TRUSTEE 1.0 59.0 X 0 701277 17000 ENRIQUE PABON BOARD MEMBER 1.0 0.0 X 0 0 0 JOEL A PERLMAN TRUSTEE 1.0 59.0 X 0 1529529 51011 ROGER RAICHELSON MD BOARD MEMBER 1.0 0.0 X 0 0 0 LAWRENCE SIMON MD BOARD MEMBER 1.0 0.0 X 0 0 0 MARY K SHINICK ASSISTANT SECRETARY 40.0 0.0 X X 292390 0 64055 WILLIAM SHUM BOARD MEMBER 1.0 0.0 X 0 0 0 WILLIAM M TRUST JR BOARD MEMBER 1.0 0.0 X 0 0 0 ROBERT W VAN CURA BOARD MEMBER 1.0 0.0 X 0 0 0 GERALD C WALSH BOARD MEMBER 1.0 0.0 X 0 0 0 DAVID H FREED PRESIDENT & CEO 40.0 0.0 X 57864 0 0 JOHN S BURKE VP & CFO 40.0 0.0 X 419074 0 47528 JOHN VOLANTO CHIEF OPERATING OFFICER 40.0 0.0 X 350858 0 55221 CELESTE BETHON CHIFE NURSING OFFICER 40.0 0.0 X 224111 0 48601 MICHAEL RADER MD VP & MEDICAL DIRECTOR 40.0 0.0 X 436416 0 66421 GREGORY GWOZDZ REGISTERED NURSE 40.0 0.0 X 221417 0 25367 VAHAN KOYOUMDJIAN MD CHIEF OF PSYCHIATRY 40.0 0.0 X 289927 0 9539 RONALD RATIGAN DIRECTOR OF FINANCE 40.0 0.0 X 191636 0 47257 IQBAL Q SHEIK MD PSYCHIATRY 40.0 0.0 X 257328 0 31704 JOSEPH VITTORIO MD MEDICAL DIRECTOR RECOVERY CTR 40.0 0.0 X 198919 0 32415 3752067 3424983 823955 244 false true false HUDSON VALLEY OBSTETRICAL 258 HIGH AVENUE NYACK NY 10960 OBSTETRIC MD SERVICE 1791000 INPATIENT MEDICAL ASSOCIATES OF NY 3 CENTRUY DRIVE PARSIPPANY NJ 07054 INPATIENT MD SERVICE 1448959 EMERGENCY MEDICAL ASSOCIATES OF NY 3 CENTURY DRIVE PARSIPPANY NJ 07054 EMERGENCY MD SVCS 1185093 HORIZON HEALTH 412 SUMMIT AVENUE JERSEY CITY NJ 07306 BEHAVIORAL HEALTH 706787 SCHIAVETTI CORGAN DiEDWARDS WEIN 709 WESTCHESTER AVENUE STE 205 WHITE PLAINS NY 10604 ATTORNEY FEES 579788 29 717781 5583361 64496 6365638 NET PATIENT REVENUE SERVICE 622000 216210881 216210881 0 0 216210881 180920 180920 0 0 460268 460268 0 460268 460268 -12590 -12590 -12590 -12590 0 0 0 CAFETERIA 722514 763102 763102 0 340B CONTRACT REVENUE 900099 570196 570196 0 0 LAB CORP PROF FEE 900099 507879 507879 1961454 1961454 0 0 3802631 227007748 220013512 0 628598 0 0 0 0 0 0 0 0 2906433 2615790 290643 0 0 0 0 0 94725369 85252832 9472537 0 6462239 5906015 556224 0 19518046 17566241 1951805 0 7151177 6436059 715118 0 7499260 6749340 749920 0 1570700 1413630 157070 0 340166 306149 34017 0 19529 17811 1718 0 0 0 0 0 0 0 18063496 16189146 1874350 0 458179 412361 45818 0 7089311 6380380 708931 0 3554490 3199041 355449 0 0 0 0 0 2625010 2362509 262501 0 166467 148656 17811 0 0 0 0 0 219936 197942 21994 0 663653 597288 66365 0 420000 378000 42000 0 8751861 7876675 875186 0 907847 817062 90785 0 PHARMACEUTICALS 21375912 19238321 2137591 0 MEDICAL SUPPLIES 15641375 15641375 0 0 MAINTENANCE & REPAIRS 2584839 2326355 258484 0 DUES BOOK & SUBSCRIPTIONS 1173318 1055986 117332 0 4222854 3750872 471982 228111467 206835836 21275631 0 0 0 0 227198 1238624 0 0 23198297 26201655 0 0 0 0 0 0 3791565 3885519 1193430 1074920 72073712 12951462 62300494 59122250 0 0 0 0 0 0 0 0 10304724 12406721 101015708 103929689 31382456 36440088 0 0 3441146 1816858 0 0 0 0 0 0 6743595 8900648 0 0 28532982 28704155 70100179 75861749 X 30696030 27848441 0 0 219499 219499 30915529 28067940 101015708 103929689 X -1103719 0 0 0 -1743870 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false 0 false 0 false 0 false 0 false 0 false 0 true 19529 19529 SCHEDULE C, PART II-B, Line 1I OTHER ACTIVITIES: NYACK HOSPITAL PAID DUES TO THE LOCAL 1199 - HEALTHCARE EDUCATION PROJECT (HEP), THE HEALTHCARE ASSOCIATION OF NEW YORK STATE (HANYS) AND THE HOMECARE ASSOCIATION OF NYS (HCA). IN ACCORDANCE WITH SECTION 6033(E) OF THE INTERNAL REVENUE CODE, AND AS REPORTED BY HEP, HANYS AND HCA, A PORTION OF THESE DUES ARE ATTRIBUTABLE TO LOBBYING ACTIVITIES. THE LOBBYING ACTIVITIES APPLICABLE TO 2015 HEP, HANYS AND HCA ANNUAL DUES WERE $580, $17,179 AND $1,770, RESPECTIVELY. 219499 219499 219499 219499 219499 219499 219499 219499 219499 219499 1.00000 false false 0 5150000 5150000 0 46074322 5002538 41071784 0 67920 0 67920 0 3880965 1815505 2065460 0 16900505 6133419 10767086 59122250 Assets limited as to use 264014 Due from related parties 165852 Other receivables 7747855 Intangible asset 4229000 12406721 0 Accrued post retirement benefit 221400 Malpractice liability 8824000 Pension liabililty 11296343 Third party liabilities 3061067 Due to related party 836382 28704155 SCHEDULE D, PART V, LINE 4 INTENDED USES OF ENDOWMENT FUND: THE INTENDED USE OF THE HOSPITALS'S ENDOWMENT IS TO PROVIDE FUNDS TO BE USED FOR INDIGENT CARE BREAST HEALTH. true true X true X true X true true true false true true 3806026 2226500 1579542 0.00690 59709412 37635981 21773668 0.09550 63515438 39862481 23353210 0.10240 69405 500 68905 0.00030 174840 84871 62079 0.00030 244245 85371 130984 0.00060 63759683 39947852 23484194 0.10300 true 6106433 68389078 76390390 -8001312 X true true 1 1 Nyack Hospital 160 North Midland Ave Nyack NY 10960 http://www.nyackhospital.org/ LICENSE 4324000H X X X Nyack Hospital 1 false false true X X X X X X X X X 14 true true true true X www.nyackhospital.org true 13 true www.nyackhospital.org false false true X 100 400. X X X true true X X X X true X NYACKHOSPITAL.ORG X NYACKHOSPITAL.ORG X NYACKHOSPITAL.ORG X X X X X true X false X X X true X false false PART V, LINE 5 INPUT FROM PERSONS WHO REPRESENT THE COMMUNITY NYACK HOSPITAL WORK CLOSELY WITH THE LOCAL HEALTH DEPARTMENT IN IDENTIFYING THE PREVENTION AGENDA PRIORITIES. NYACK HOSPITAL IS AN ACTIVE MEMBER OF THE ROCKLAND COUNTY HEALTH CARE PRIORITIES STEERING COMMITTEE WHICH REPRESENTS TWENTY-TWO LOCAL COMMUNITY BASED ORGANIZATIONS. NYACK HOSPITAL AND OTHER MEMBERS OF THIS GROUP CONDUCTED SURVEYS AND FOCUS GROUPS TO OBTAIN FEEDBACK FROM COMMINUTY MEMBERS TO IDENITFY UNMET HEALTHCARE NEEDS. NYACK HOSPITAL COLLABORATED WITH ROCKLAND COUNTY HEALTH DEPARTMENT'S EPIDEMIOLOGIST, WHO IS RESPONSIBLE FOR DEVELOPING THE OVERALL ROCKLAND COUNTY DEPARTMENT OF HEALTH ("RCDOH") COMMUNITY HEALTH NEEDS ASSESSMENT TO FURTHER DEFINE CURRENT STATUS OF HOSPITAL ACTIVITIES ADDRESSING ALL FIVE PREVENTION AGENDA ITEMS AND IDENTIFYING FURTHER OPPORTUNITIES TO IMPROVE THE HEALTH OF OUR COMMUNITY. PART V, LINE 6A OTHER HOSPITALS: GOOD SAMARITAN HOSPITAL PART V, LINE 6B ORGANIZATIONS OTHER THAN HOSPITAL FACILITIES: ROCKLAND COUNTY PUBLIC HEALTH PRIORITIES COMMITTEE OF TWENTY TWO LOCAL ORGANIZATIONS. PART V, LINE 7A HTTP://WWW.NYACKHOSPITAL.ORG/COMMUNITY-SERVICE-PLAN PART V, LINE 10 HTTP://WWW.NYACKHOSPITAL.ORG/COMMUNITY-SERVICE-PLAN PART V, LINE 11 THE MOST RECENT CHNA WAS CONDUCTED IN 2014. WE ARE ADDRESSING THE SIGNIFICANT NEEDS IDENTIFIED IN THE CHNA. THE NYACK HOSPITAL JUDITH H. TRUST CENTER OPENED IN 2014 AT THE REQUEST OF THE ROCKLAND COUNTY HEALTH DEPARTMENT OFFICE OF MENTAL HEALTH. AT THAT TIME THE COUNTY WAS CLOSING THEIR ACUTE CARE MENTAL HEALTH FACILITY CREATING A POTENTIALLY SERIOUS LACK OF ACUTE SERVICES FOR PERSONS WITH MENTAL HEALTH DISORDERS. THE CENTER REPRESENTS A PRIMARY PSYCHIATRIC TREATMENT RESOURCE FOR PEOPLE EXPERIENCING AN ACUTE EPISODE OF MENTAL ILLNESS IN ROCKLAND COUNTY. MENTAL HEALTH CRISIS SERVICES ARE NOW AVAILABLE IN DEDICATED SPACE ADJACENT TO NYACK HOSPITAL'S EMERGENCY DEPARTMENT, AND ARE SUPPORTED BY A FULL CONTINUUM OF INPATIENT ACUTE CARE SERVICES IN EXPANDED AND RENOVATED SPACE. THE HOSPITAL HAS SUCCEEDED IN ITS ENDEAVOR TO PROVIDE ACUTE HEALTH SERVICES FOR PERSONS IN CRISIS. THE CURRENT GOAL OF THE BEHAVIORAL HEALTH UNIT IS TO INCREASE PROGRAMS FOR THE COMMUNITY WHICH WILL HELP PROMOTE MENTAL, EMOTIONAL AND BEHAVIORAL (MEB) WELL-BEING IN COMMUNITIES. THE TRUST CENTER HAS A COMMUNITY OUTREACH EDUCATOR WHO IS WORKING CLOSELY WITH LOCAL COMMUNITY ORGANIZATIONS TO CONDUCT EVIDENCE-BASED PRACTICES FOR PREVENTION OF MENTAL HEALTH DISORDERS, SUCH AS SUBSTANCE ABUSE AND DEPRESSION SUPPORT GROUPS, LECTURES, ETC. THE GOAL IS TO ALERT THE PUBLIC TO AVAILABLE SERVICES AND TO PROMOTE PUBLIC AWARENESS, EARLY DETECTION, TREATMENT AND PERHAPS PREVENTION OF ACUTE CRISIS FOR THOSE PERSONS SUFFERING FROM MENTAL HEALTH DISORDERS. PREVENT CHRONIC DISEASE: BREAST CANCER, OBESITY, DIABETES THE BREAST CENTER AT NYACK HOSPITAL COLLABORATES WITH NUMEROUS ORGANIZATIONS SUCH AS SUSAN G. KOMEN, HUDSON VALLEY REGION CANCER SERVICES, NATIONAL ASSOCIATION OF NURSE PRACTITIONERS IN WOMEN'S HEALTH, ROCKLAND COUNTY LEGISLATURE, AND THE LOCAL HEALTH DEPARTMENT IN ADDRESSING THESE PRIORITIES. IN 2014 THE BREAST CENTER PROVIDED EDUCATION THROUGH LECTURES, HEALTH FAIRS AND OTHER VENUES THROUGHOUT THE COUNTY. THE BREAST CENTER RECEIVED THE 2014 SUSAN G. KOMEN GRANT TO FUND PATIENT NAVIGATION SERVICES. THIS GENEROUS GRANT ALLOWS THE BREAST CENTER TO HIRE A RN PATIENT NAVIGATOR WHO ASSISTS WOMEN DURING THEIR BREAST CARE FROM THE TIME OF DIAGNOSIS THROUGHOUT THEIR TREATMENT. OF THE 323 UNINSURED OR UNDERINSURED WOMEN WHO RECEIVED MAMMOGRAMS, CLINICAL BREAST EXAMS AND/OR CERVICAL CANCER SCREENING, 50 WERE RECALLED FOR FURTHER DIAGNOSTIC STUDIES, 3 BIOPSIES WERE PERFORMED, AND NO CANCER WAS DETECTED. OBESITY: THE HOSPITAL CONTINUES ITS LOSE TO WIN (LTW) PROGRAM FACILITATOR TRAINING. OUR GOAL TO INCREASE THE NUMBER OF PROGRAMS CONDUCTED AND THE NUMBER OF PERSONS PARTICIPATING IN THE PROGRAM WAS NOT REACHED. OUR DATA SHOWS A 40% REDUCTION IN THE NUMBER OF PROGRAMS AND NUMBER OF PARTICIPANTS. ANECDOTAL RESPONSES FROM FACILITATORS CITE OTHER RESPONSIBILITIES LIMIT THE TIME THEY CAN ALLOCATE TO FACILITATE MORE PROGRAMS. HOWEVER, OUR GOAL TO INCREASE THE NUMBER OF SITES IN UNDERSERVED AREAS HAS SUCCEEDED. THERE ARE NOW LTW PROGRAMS CONDUCTED ON A REGULAR BASIS IN SPRING VALLEY, HAVERSTRAW AND NYACK. WE NOW HAVE SEVERAL BILINGUAL FACILITATORS. THE OUTCOMES OF PERSONS WHO DID ATTEND THE 13 COMMUNITY BASED LTW PROGRAMS WERE FAVORABLE. 83% OF THE 119 ATTENDEES REDUCED THEIR BMI, THERE WAS AN AVERAGE WEIGHT LOSS OF FOUR POUNDS, 43% INCREASED THEIR VEGETABLE CONSUMPTION, 27% INCREASED THEIR FRUIT CONSUMPTION AND 31% INCREASED THEIR PHYSICAL ACTIVITY. THIS YEAR EFFORTS WILL FOCUS ON INCREASING THE NUMBER OF PROGRAMS STARTING WITH A PRESENTATION TO ROCKLAND COUNTY'S PUBLIC HEALTH PRIORITIES COMMITTEE, A GROUP THAT MEETS MONTHLY AND REPRESENTS A DIVERSE POPULATION WITHIN THE COUNTY. PREVENT CHRONIC DISEASE AND PROMOTE HEALTH WOMEN, INFANTS AND CHILDREN: THE MAMAS MARAVILLOSA PROGRAM IS A TYPE 2 DIABETES PREVENTION PROGRAM FOR POST-PARTUM LATINA WOMEN TAUGHT BY A BILINGUAL CERTIFIED DIABETES EDUCATOR. THE CHALLENGES FACED RESULTED IN SIMPLIFYING HANDOUTS AND CHANGING LOCATION, DAY AND TIME OF THE WEEKLY PROGRAM. WE EXPECT THE PROGRAM WILL GROW AS WE MAKE THESE CHANGES. THE DATA COLLECTED SHOWS THESE WOMEN ARE INCORPORATING HEALTHY BEHAVIORS INTO THEIR DAILY ROUTINE. WE CONTINUE OUR COLLABORATION WITH OTHER ORGANIZATIONS WITHIN THE COUNTY. THESE GROUPS PROVIDE EXPERTISE AND EDUCATE THE PARTICIPANTS ON A VARIETY OF HEALTH RELATED TOPICS. THESE INCLUDE HUDSON VALLEY PERINATAL NETWORK, LACTATION CONSULTANT FROM THE ROCKLAND COUNTY DEPARTMENT OF HEALTH, PRIVATE PHYSICIAN PRACTICES, HUDSON VALLEY HEALTHCARE, CATHOLIC CHARITIES, CORNELL COOPERATIVE EXTENSION, AND HACSO (HAITIAN AMERICAN CULTURAL AND SOCIAL ORGANIZATION). PART V, LINE 16A & 16B THE FINANCIAL ASSISTANCE POLICY AND FINANCIAL ASSISTANCE POLICY APPLICATION FORM ARE AVAILABLE AT: https://www.nyackhospital.org/financial-aid-policy PART V, LINE 22 INPATIENT RATES USE THE MEDICAID DRG RATE AND OUTPATIENT RATES USE THE MEDICARE APC RATE. Part I, Line 7 EXPLANATION OF COSTING METHODOLOGY: NYACK HOSPITAL'S COSTING METHODOLOGY WAS BASED UPON THE 2015 NEW YORK STATE INSTITUTIONAL COST REPORT AND THE 2014 MEDICARE (FORM 2552) COST REPORT. THESE COST REPORTS ARE FILED WITH THE NEW YORK STATE DEPARTMENT OF HEALTH AND THE APPLICABLE CMS INTERMEDIARY, RESPECTIVELY. THE COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGE, WAS USED FOR THE VARIOUS SUB-LINE ITEMS OF LINE #7. Part III, Lines 2 & 4 THE AMOUNT REPORTED ON LINE 2 IS EQUAL TO THE PROVISION FOR BAD DEBTS PER THE AUDITED FINANCIAL STATEMENTS (AFS). THE EXPLANATION OF THE METHODOLOGY USED TO ESTIMATE THIS AMOUNT CAN BE FOUND IN FOOTNOTE 1 ON PAGE 9 OF THE ATTACHED AFS. Part III, LIne 8 THE AMOUNT REPORTED ON LINE 6 WAS DERIVED BY USING THE MEDICARE ALLOWABLE COSTS AS REPORTED ON THE HOSPITAL'S NEW YORK STATE INSTITUTIONAL COST REPORT AND THE APPLICABLE ADJUSTMENTS FROM WORKSHEET B. Part III, Line 9B PURPOSE: TO RELIEVE THE ACCOUNTS RECEIVABLE OF ACCOUNTS DEEMED UNCOLLECTIBLE BY INTERNAL OR EXTERNAL PRE-COLLECTION PROCESSES. POLICY: TO REFER APPROPRIATE ACCOUNTS TO COLLECTION AGENCIES AND/OR THIRD PARTY BILLING AGENCIES AND TO INSURE AGENCY PRODUCTIVITIES IN ACCORDANCE WITH HOSPITAL POLICY. PROCEDURES: SECTION 1 - SMALL BALANCE WRITE OFF TO RELIEVE THE ACCOUNTS RECEIVABLE OF BALANCES WHICH ARE UNPROFITABLE TO PURSUE ON A MONTHLY BASIS A. SMALL BALANCES IS DEFINED AS AN AMOUNT OF $24.99 AND LESS THAT IS CONSIDERED PATIENT LIABILITY. B. SMALL BALANCES MUST EXIST FOR 30 DAYS BEFORE THEY QUALIFY FOR WRITE-OFF. C. PATIENT MUST HAVE RECEIVED AT LEAST ONE STATEMENT. D. SMALL BALANCE INCLUDES CREDIT BALANCES OF $24.99 OR LESS (THIS AMOUNT WILL BE WRITTEN OFF SYSTEMATICALLY UNLESS PATIENT REQUESTS A REFUND). E. AT MONTH END SMALL BALANCE WRITE-OFF REPORT WILL BE PRODUCED FROM THE PARAGON SYSTEM FOR ALL ACCOUNTS SELECTED. F. A SEPARATE REPORT IS TO BE GENERATED FROM THE SYSTEM USING THE TRIAL BALANCE TO IDENTIFY ACCOUNTS NOT SELECTED SYSTEMATICALLY BY THE SYSTEM. SECTION 2 - BAD DEBT WRITE OFF PROCESS A. PATIENTS MUST RECEIVE A PRESCRIBED NUMBER OF STATEMENTS BEFORE BEING REFERRED TO COLLECTION (MINIMUM 3 STATEMENTS IN 120 DAYS UNLESS RETURNED MAIL FOR BAD ADDRESS OR PATIENT IS DECEASED). B. ACCOUNT BALANCE MUST RESIDE IN PATIENT BUCKET TO QUALIFY FOR BAD DEBT WRITE-OFF. C. A POTENTIAL BAD DEBT WRITE OFF REPORT IS PRODUCED ON A MONTHLY BASIS FOR ACCOUNTS THAT MAY BE MANUALLY TRANSFERRED TO THE BAD DEBT FILE. THIS LIST IS REVIEWED ACCOUNT BY ACCOUNT TO DELETE INAPPROPRIATE REFERRALS PRIOR TO WRITE OFF. D. PRE-APPROVAL OF HIGH BALANCE WRITE-OFFS: GREATER THAN $5,000.00 APPROVED BY SUPERVISOR, GREATER THAN $10,000.00 APPROVED BY MANAGER AND GREATER THAN $25,000.00 APPROVED BY ADMINISTRATOR. E. ACCOUNTS ARE REDUCED TO A SELF PAY RATE AND ARE REFERRED TO AGENCIES AT THIS RATE UNLESS OTHERWISE NOTED BASED ON DISCUSSIONS WITH THE PATIENT OR DESIGNATED REPRESENTATIVE. F. AT MONTH END, A CUMULATIVE BAD DEBT REPORT CONTAINING ALL WRITE-OFFS IN THAT CALENDAR MONTH WILL BE CREATED ALONG WITH AGENCY REFERRAL FILE. G. THE CUMULATIVE WRITE OFF TOTAL FOR ANY CALENDAR MONTH MUST BE APPROVED BY THE MANAGER IN CONJUNCTION WITH THE ADMINISTRATORS OF PATIENT FINANCIAL SERVICES AND FINANCE. SECTION 3 - COLLECTION AGENCY A. REFERRALS 1. ACCOUNTS ARE REFERRED SYSTEMATICALLY AND BY ALPHA BREAKDOWN WITHIN PATIENT TYPE TO AGENCIES ON AN EQUITABLE DISTRIBUTION. THE AGENCIES RECEIVE A FILE AND ALSO A COMPUTER GENERATED LIST OF ACCOUNTS. 2. ACCOUNTS REFERRED TO AGENCIES MAY BE AT THE SELF-PAY RATES ESTABLISHED IN THE CHARITY CARE POLICY. 3. SECONDARY REFERRALS MAY BE ASSIGNED TO SELECTED AGENCIES AFTER PRIMARY AGENCY CLOSEOUT. 4. AGENCIES MUST ADHERE TO HOSPITAL FINANCIAL ASSISTANCE (CHARITY CARE) POLICIES. 5. AGENCIES WILL PERFORM ASSET TEST ON ALL ACCOUNTS EXCEEDING $1,500. B. REPORTING 1. AGENCIES SEND ACKNOWLEDGEMENT REPORTS, WHICH ARE RECONCILED AGAINST THE REFERRALS (NUMBER OF ACCOUNTS, DOLLAR AMOUNT). 2. AGENCIES SUBMIT STATUS REPORTS ON A MONTHLY BASIS, WHICH ARE RECONCILED TO DETAILED REPORT TO INSURE THE ACCURACY OF THE BAD DEBT FILE. 3. A REMITTANCE REPORT ACCOMPANIES THE CHECK THE AGENCY SENDS WHICH REPORTS ALL PAYMENTS COLLECTED. THIS IS RECONCILED TO THE PAYMENTS POSTED TO THE PARAGON SYSTEM IN THE BAD DEBT FILE. 4. CLOSE OUT REPORT IS A LIST OF ALL THE ACCOUNTS THAT THE AGENCIES DEEM UNCOLLECTIBLE. WE ASSIGN SECONDS FROM THE CLOSE OUT REPORT OR WE CLOSE OUT THE ACCOUNTS. 5. IF AN ACCOUNT IS REFERRED BY A COLLECTION AGENCY FOR LEGAL ACTION, IT MUST BE APPROVED BY THE MANAGER OR ADMINISTRATOR OF THE PATIENT FINANCIAL SERVICES DEPARTMENT. 6. A RECONCILIATION REPORT MAY BE REQUESTED TO CORRELATE OUR A/R AGAINST AGENCY A/R. 7. A PLACEMENT ANALYSIS REPORT IS REQUIRED ON A MONTHLY BASIS FROM EACH AGENCY DETAILING ITS COLLECTION PERFORMANCE YEAR TO DATE BY REFERRAL DATE AND PRODUCT LINE (I.E.: INPATIENT, OUTPATIENT, INPATIENT SECONDS, ETC.), FOR THE CURRENT CALENDAR YEAR AND THE PRIOR YEARS CALENDAR REFERRALS. SECTION 4 - DEPARTMENTAL WORKFLOWS A. ACCOUNTS ARE REFERRED TO BAD DEBT SYSTEMATICALLY (ALPHA BREAKDOWN WITHIN PATIENT TYPE). B. THE REPRESENTATIVE DESIGNATED AS THE LIAISON WITH THE COLLECTION AGENCIES, AND REVIEWS APPROPRIATELY ADDRESSED OR REFERRED TO AGENCY CORRESPONDENCE PERTAINING TO BAD DEBT. C. AGENCY LIAISON SCREENS PATIENT INQUIRIES RELATING TO BAD DEBT ACCOUNTS AND REFERS TO APPROPRIATE AGENCY. SECTION 5 - LIAISON INTERDISCIPLINARY WORKFLOWS A. INTERACTS WITH AGENCIES TO OBTAIN ACCOUNT STATUS. B. INTERACTS WITH OTHER PATIENT FINANCIAL SERVICE SECTIONS TO INSURE THE ACCURACY OF THE BAD DEBT FILE. C. REVIEWS AND RECONCILES ALL AGENCY REPORTS INCLUDING REMITTANCE REPORT; SUPPORTS AND DIRECTS ACTIVITY OF AGENCY LIAISON. SECTION 6 - END OF MONTH REPORTS A. CUMULATIVE BAD DEBT WRITE OFF FROM ACCOUNTS RECEIVABLE TO BAD DEBT BY AGENCY. B. CUMULATIVE BAD DEBT WRITE OFF FROM ACCOUNTS RECEIVABLE TO BAD DEBT BY FINANCIAL CLASS. C. COLLECTION AGENCY STATISTIC REPORT FOR THE FILE. D. TAPE GENERATED BY INFORMATION TECHNOLOGY GIVEN TO AGENCIES. Part VI, Line 2 PURSUANT TO NEW YORK STATE PUBLIC HEALTH LAW SECTION 2803-l, NYACK HOSPITAL ("NYACK") IS REQUIRED TO FILE A COMPREHENSIVE COMMUNITY SERVICE PLAN ("CSP") WITH THE NEW YORK STATE DEPARTMENT OF HEALTH ("DOH") EVERY 3 YEARS. A COPY OF NYACK'S CSP CAN BE FOUND ON THE HOSPITAL'S WEBSITE AT WWW.NYACKHOSPITAL.ORG UNDER THE "ABOUT US" TAB. THE COMPREHENSIVE DATA AND INFORMATION CONTAINED IN THIS CSP WILL EXHAUSTIVELY ADDRESS PART VI OF THIS SCHEDULE H, AND ITS CONTENTS ARE INCORPORATED HEREIN BY REFERENCE. SPECIFICALLY, THE NYACK CSP WILL ADDRESS THE PART VI (2) NEEDS ASSESSMENT; PART VI (3) PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE; PART VI (4) COMMUNITY INFORMATION; PART VI (5) COMMUNITY BUILDING ACTIVITIES AND PART VI (6) TO (7), AS APPLICABLE. THE TEXT OF NEW YORK STATE PUBLIC HEALTH LAW SECTION 2803-L IS AS FOLLOWS: COMMUNITY SERVICE PLANS (1) THE GOVERNING BODY OF A VOLUNTARY NON-PROFIT GENERAL HOSPITAL MUST ISSUE AN ORGANIZATIONAL MISSION STATEMENT IDENTIFYING AT A MINIMUM THE POPULATIONS AND COMMUNITIES SERVED BY THE HOSPITAL AND THE HOSPITAL'S COMMITMENT TO MEETING THE HEALTH CARE NEEDS OF THE COMMUNITY. (2) THE GOVERNING BODY MUST AT LEAST EVERY THREE YEARS: (I) REVIEW AND AMEND AS NECESSARY THE HOSPITAL MISSION STATEMENT; (II) SOLICIT THE VIEWS OF THE COMMUNITIES SERVED BY THE HOSPITAL ON SUCH ISSUES AS THE HOSPITAL'S PERFORMANCE AND SERVICE PRIORITIES; (III) DEMONSTRATE THE HOSPITAL'S OPERATIONAL AND FINANCIAL COMMITMENT TO MEETING COMMUNITY HEALTH CARE NEEDS, TO PROVIDE CHARITY CARE SERVICES AND TO IMPROVE ACCESS TO HEALTH CARE SERVICES BY THE UNDERSERVED; AND (IV) PREPARE AND MAKE AVAILABLE TO THE PUBLIC A STATEMENT SHOWING ON A COMBINED BASIS A SUMMARY OF THE FINANCIAL RESOURCES OF THE HOSPITAL AND RELATED CORPORATIONS AND THE ALLOCATION OF AVAILABLE RESOURCES TO HOSPITAL PURPOSES INCLUDING THE PROVISION OF FREE OR REDUCED CHARGE SERVICES. (3) THE GOVERNING BODY MUST AT LEAST ANNUALLY PREPARE AND MAKE AVAILABLE TO THE PUBLIC AN IMPLEMENTATION REPORT REGARDING THE HOSPITAL'S PERFORMANCE IN MEETING THE HEALTH CARE NEEDS OF THE COMMUNITY, PROVIDING CHARITY CARE SERVICES, AND IMPROVING ACCESS TO HEALTH CARE SERVICES BY THE UNDERSERVED. (4) THE GOVERNING BODY SHALL FILE WITH THE COMMISSIONER ITS MISSION STATEMENT, ITS ANNUAL IMPLEMENTATION REPORT, AND AT LEAST EVERY THREE YEARS A REPORT DETAILING AMENDMENTS TO THE STATEMENT AND REFLECTING CHANGES IN THE HOSPITAL'S OPERATIONAL AND FINANCIAL COMMITMENT TO MEETING THE HEALTH CARE NEEDS OF THE COMMUNITY, PROVIDING CHARITY CARE SERVICES, AND IMPROVING ACCESS TO HEALTH CARE SERVICES BY THE UNDERSERVED. THE ABOVE-REFERENCED CSP REQUIREMENT WAS ENHANCED BY THE DOH'S PREVENTION AGENDA INITIATIVE. THIS INITIATIVE IS A PROCESS THAT ASKS HOSPITALS SUCH AS NYACK TO WORK WITH LOCAL HEALTH DEPARTMENTS AND COMMUNITY PARTNERS TO ASSESS COMMUNITY HEALTH NEEDS, JOINTLY DEVELOP PLANS TO ADDRESS TWO OR THREE OF THE IDENTIFIED NEEDS AND INCLUDE THIS COLLABORATIVE WORK IN NYACK'S CSP UPDATE SUBMITTED TO DOH. INFORMATION ON THE NEW YORK STATE DOH PREVENTION AGENDA CAN BE FOUND AT WWW.HEALTH.STATE.NY.US/PREVENTION/PREVENTION_AGENDA. Part VI, Line 3 ALL PATIENTS RECEIVE A FINANCIAL AID SUMMARY THAT EXPLAINS NYACK HOSPITAL'S FINANCIAL AID PROGRAM. ALTHOUGH OBLIGATED TO OFFER ASSISTANCE TO PATIENTS WITH INCOMES LESS THEN 300% OF THE FEDERAL POVERTY LEVEL (FPL), NYACK HOSPITAL CONSIDERS ALL PATIENTS WHO RECEIVE EMERGENCY OR MEDICALLY NECESSARY NON-EMERGENCY CARE WITH INCOMES LESS THAN 400% OF THE FEDERAL POVERTY LEVEL. NYACK HOSPITAL WILL CONSIDER PATIENTS FOR FIANANCIAL AID WHO RESIDE OUTSIDE OF ITS SERVICE AREA ON AN EXCEPTION BASIS. Part VI, Line 4 NYACK HOSPITAL DEFINES ITS TOTAL SERVICE AREA FOR THE PURPOSES OF COMMUNITY/LOCAL HEALTH PLANNING AS ALL OF ROCKLAND, WESTCHESTER, ORANGE AND PUTNAM COUNTIES. NINE ROCKLAND COMMUNITIES COMPRISE THE HOSPITAL'S PRIMARY SERVICE AREA. SEE COMMUNITY SERVICE PLAN FOR DELINEATION OF PRIMARY AND SECONDARY SERVICE AREAS. Part VI, Line 5 NYACK HOSPITAL WAS A MAJOR PARTICIPANT IN THE COMMUNITY HEALTH ASSESSMENT (CHA) PROCESS CONDUCTED BY ROCKLAND COUNTY. THE ADMINISTRATOR OF HOME CARE AND COMMUNITY SERVICES AND THE COORDINATOR OF PATIENT/COMMUNITY EDUCATION ARE STANDING MEMBERS OF THE ROCKLAND COUNTY PUBLIC HEALTH PRIORITIES (PHP) STEERING COMMITTEE. THE PURPOSE OF THIS COMMITTEE IS TO DETERMINE THE EXTENT TO WHICH EXISTING PRIORITIES ARE BEING MET, TO ASSESS THE NEED FOR NEW/REVISED PRIORITIES, AND TO COLLABORATE WITH OTHER HEALTH PROVIDERS/ORGANIZATIONS IN ORDER TO IMPLEMENT PROGRAMS AND SERVICES THAT WILL MEET THE IDENTIFIED NEEDS. THE COMMITTEE SERVES AS A GUIDE TO THE DEVELOPMENT OF THE CHA. THE PHP COMMITTEE IS COMPOSED OF REPRESENTATIVES FROM: - COUNTY DEPARTMENTS OF HEALTH, SOCIAL SERVICES, MENTAL HEALTH, AS WELL AS THE OFFICES FOR AGING, COMMUNITY RELATIONS, AND PEOPLE WITH DISABILITIES. - COMMUNITY BASED AGENCY REPRESENTATIVES FROM THE AMERICAN CANCER SOCIETY, IMMIGRATION COALITION, VOLUNTEER COUNSELING SERVICES, AMERICAN HEART ASSOCIATION AND A NUMBER OF OTHER NON-PROFIT ORGANIZATIONS. - LOCAL HOSPITALS (NYACK, GOOD SAMARITAN) - 4 FEDERALLY QUALIFIED HEALTH CENTERS - 2 LOCAL COLLEGES (DOMINICAN AND ROCKLAND COUNTY COMMUNITY) THE FULL COMMITTEE MEETS MONTHLY AND SUB-COMMITTEE MEETINGS ARE HELD AS NEEDED. AN OUTCOME OF THIS COMMITTEE WAS A 2008 COUNTY NEEDS ASSESSMENT, WHICH SERVED AS A STARTING POINT FOR THE COUNTY'S 2010-2013 COMMUNITY HEALTH ASSESSMENT. IN ADDITION TO HAVING REPRESENTATIVES ACTIVELY PARTICIPATE ON THE PHP COMMITTEE, NYACK HOSPITAL COLLABORATED WITH THE COUNTY HEALTH DEPARTMENT TO IMPLEMENT 3 PROVIDER AND CONSUMER FOCUS GROUPS AS PART OF THE CHA PROCESS. DETAILS ARE PROVIDED IN THE COMMUNITY SERVICE PLAN. Part VI, Line 7 NEW YORK. X X X X X X true true false false false false false false false MARK GELLER MD PRESIDENT & CEO 808515 0 0 0 3612 0 900 0 30868 0 843895 0 0 0 SUSAN GREEN-LORENZEN RN TRUSTEE 0 785243 0 386900 0 22034 0 263986 0 32082 0 1490245 0 0 JEFFREY MENKES TRUSTEE 0 506827 0 164400 0 30050 0 17000 0 0 0 718277 0 0 JOEL A PERLMAN TRUSTEE 0 1018981 0 507500 0 3048 0 17000 0 34011 0 1580540 0 0 MARY K SHINICK ASSISTANT SECRETARY 286797 0 0 0 5593 0 38260 0 25795 0 356445 0 0 0 JOHN S BURKE VP & CFO 417517 0 0 0 1557 0 7950 0 39578 0 466602 0 0 0 JOHN VOLANTO CHIEF OPERATING OFFICER 344501 0 0 0 6357 0 39898 0 15323 0 406079 0 0 0 CELESTE BETHON CHIFE NURSING OFFICER 222640 0 0 0 1471 0 34198 0 14403 0 272712 0 0 0 MICHAEL RADER MD VP & MEDICAL DIRECTOR 427363 0 0 0 9053 0 39900 0 26521 0 502837 0 0 0 GREGORY GWOZDZ REGISTERED NURSE 221417 0 0 0 0 0 10547 0 14820 0 246784 0 0 0 VAHAN KOYOUMDJIAN MD CHIEF OF PSYCHIATRY 289001 0 0 0 926 0 5632 0 3907 0 299466 0 0 0 RONALD RATIGAN DIRECTOR OF FINANCE 190415 0 0 0 1221 0 11508 0 35749 0 238893 0 0 0 IQBAL Q SHEIK MD PSYCHIATRY 255102 0 0 0 2226 0 29610 0 2094 0 289032 0 0 0 JOSEPH VITTORIO MD MEDICAL DIRECTOR RECOVERY CTR 197644 0 0 0 1275 0 30062 0 2353 0 231334 0 0 0 SCHEDULE J, PART I, LINE 4A CELESTE BETHON RECIEVED $53,222 IN SERVERANCE PAYMENTS IN 2015. SCHEDULE J, PART II - COLUMNS (B) (I), (II) AND (III) THE COMPENSATION COMMITTEE REVIEWS AND APPROVES ALL FORMS OF COMPENSATION AND BENEFITS PROVIDED TO EACH EXECUTIVE WITH THE ASSISTANCE OF A NATIONAL INDEPENDENT COMPENSATION CONSULTING FIRM. THE CONSULTING FIRM ASSISTS THE COMPENSATION COMMITTEE WITH ITS DECISION-MAKING PROCESS TO ENSURE EXECUTIVE COMPENSATION LEVELS ARE REASONABLE AND APPROPRIATE RELATIVE TO THOSE OF OTHER SIMILAR ORGANIZATIONS. BASE SALARIES IN COLUMN B(I) ARE DETERMINED BASED ON COMPETITIVE MARKET PRACTICES FOR COMPARABLE POSITIONS WITH SIMILAR SIZE ORGANIZATIONS AND SCOPE OF RESPONSIBILITIES. BONUS AND INCENTIVE COMPENSATION IN COLUMN B(II) IS BASED ON THE ACHIEVEMENT OF PERFORMANCE GOALS. THE EXECUTIVES' COMPENSATION PROGRAM HAS A SIGNIFICANT PAY-AT-RISK COMPONENT TO ENSURE THE ALIGNMENT OF PAY AND ORGANIZATIONAL PERFORMANCE. GOALS ARE SET IN ADVANCE IN AREAS SUCH AS QUALITY OF CARE, PATIENT SATISFACTION, COMMUNITY SERVICES AND FINANCIAL PERFORMANCE. COMPENSATION IS AT RISK IF THE GOALS ESTABLISHED BY THE COMPENSATION COMMITTEE ARE NOT MET. OTHER REPORTABLE COMPENSATION IN COLUMN B(III) INCLUDES DISTRIBUTIONS FROM THE SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN. IN A MANNER DESIGNED TO QUALIFY FOR THE "REBUTTABLE PRESUMPTION OF REASONABLENESS" THE COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES EXPRESSLY REVIEWED AND APPROVED THESE RETIREMENT BENEFIT ARRANGEMENTS FOR SENIOR EXECUTIVES IN A MANNER THAT QUALIFIED UNDER THE INTERMEDIATE SANCTIONS RULES OF THE FEDERAL TAX LAW, AND IN RECOGNITION OF (A) THE EXECUTIVES' YEARS OF SERVICE TO THE ORGANIZATION AND (B) THE SIGNIFICANT CONTRIBUTIONS TO ENHANCING THE ABILITY OF THE ORGANIZATION TO ACHIEVE ITS CHARITABLE MISSION IN A MANNER CONSISTENT WITH FINANCIAL SOLVENCY. ACCORDINGLY, THIS BENEFIT SHOULD BE VIEWED AS APPLYING TO YEARS OF SERVICE FOR THE ORGANIZATION. THE TRUSTEES LISTED IN PART II LINES 2(II), 3(II) AND 4(II) ARE NOT EMPLOYEES OF THIS FILING ORGANIZATION, NYACK HOSPITAL. THESE INDIVIDUALS ARE EMPLOYED AND THEIR COMPENSATION IS PAID BY MONTEFIORE HEALTH SYSTEM, INC. EIN 20-1615393. * CHRISTOPHER PANCZNER - ACCRUED AND UNPAID SERVICE COSTS OF $215,140. * LYNN RICHMOND - ACCRUED AND UNPAID SERVICE COSTS OF $232,178. FORM 990, PART VI, LINES 4 & 6 PRIOR TO AUGUST 1, 2014, THE HOSPITAL AND NEW YORK-PRESBYTERIAN HEALTHCARE SYSTEM, INC., A NEW YORK NOT-FOR-PROFIT CORPORATION, HAD A CORPORATE RELATIONSHIP AGREEMENT. UNDER THIS AGREEMENT, THE HOSPITAL WAS A CORPORATE MEMBER OF THE NEW YORK-PRESBYTERIAN HEALTHCARE SYSTEM. ON AUGUST 1, 2014 (THE ACQUISITION DATE), MONTEFIORE HEALTH SYSTEM, INC. (THE HEALTH SYSTEM) AND ITS MEMBER CORPORATIONS AND OTHER AFFILIATED ENTITIES (COLLECTIVELY ALSO REFERRED TO AS THE HEALTH SYSTEM) ENTERED INTO A MEMBERSHIP TRANSACTION AGREEMENT, WHEREBY THE HEALTH SYSTEM BECAME THE SOLE MEMBER OF THE HOSPITAL. THE HEALTH SYSTEM IS AN INTEGRATED HEALTH CARE DELIVERY SYSTEM IN THE BRONX AND WESTCHESTER COUNTIES IN NEW YORK. THE HOSPITAL ALSO AMENDED ITS CERTIFICATE OF INCORPORATION AND BYLAWS TO REFLECT THE MEMBERSHIP TRANSACTION AGREEMENT. THE AMENDED BYLAWS WERE EFFECTIVE AS OF APRIL 15, 2016. THE HOSPITALS MEMBER ELECTS THE HOSPITALS BOARD OF TRUSTEES. FORM 990, PART VI, LINE 7A MONTEFIORE HEALTH SYSTEM, INC., AS SOLE CORPORATE MEMBER, HAS THE AUTHORITY TO ELECT THE HOSPITAL'S BOARD OF TRUSTEES. FORM 990, PART VI, LINE 7B MONTEFIORE HEALTH SYSTEM, INC. IS THE SOLE MEMBER OF NYACK HOSPITAL. THE APPROVAL OF THE MEMBER SHALL BE REQUIRED FOR (1) THE REMOVAL BY THE BOARD OF THE PRESIDENT AND CEO, (2) THE BOARD'S SELECTION OF THE PRESIDENT AND CEO AND (3) THE AMENDMENT OF THE CERTIFICATE OF INCORPORATION, AND (4) THE AMENDMENT OF THE BYLAWS. FORM 990, PART VI, LINE 11B THE ACCOUNTING MANAGER, DIRECTOR OF FINANCE, AND THE ENTIRE FINANCE TEAM ARE VERY INVOLVED IN THE PREPARATION AND REVIEW OF THE FORM 990. ONCE THE DIRECTOR OF FINANCE HAS COMPLETED HIS REVIEW, THE CFO REVIEWS THE FORM 990 IN DETAIL, INCLUDING ALL SCHEDULES. THE FORM 990 IS THEN UPLOADED TO THE NYACK HOSPITAL WEBSITE FOR THE FULL BOARD REVIEW IN THE "BOARD ONLY" SECTION. ONLY BOARD MEMBERS CAN ACCESS WITH A PASSWORD. FORM 990, PART VI, LINE 12C IN AN EFFORT TO ENSURE THAT ALL TRANSACTIONS OCCURRING BETWEEN THE ORGANIZATION AND A THIRD PARTY DO NOT INURE TO THE BENEFIT OF ANY INDIVIDUAL OR CORPORATION, NYACK HOSPITAL MAINTAINS A CONFLICT OF INTEREST POLICY. UNDER THIS POLICY, OFFICERS, TRUSTEES AND EMPLOYEES MUST DISCLOSE ANY RELATIONSHIPS THAT MAY RESULT IN CONFLICT DUE TO TRANSACTIONS OCCURRING BETWEEN THE ORGANIZATION AND AN INDIVIDUAL. ALL EMPLOYEES AND TRUSTEES HAVE A DUTY TO DISCLOSE ANY FINANCIAL INTEREST WHICH MAY POSE A CONFLICT WITH THEIR HOSPITAL RESPONSIBILITIES. THIS DISCLOSURE IS CONFIRMED BY THE DISTRIBUTION OF A QUESTIONNAIRE ON AN ANNUAL BASIS. IN COMPLETING THE QUESTIONNAIRE, THE EMPLOYEE OR TRUSTEE IS RESPONSIBLE FOR DISCLOSING HIS OR HER RELATIONSHIP TO ANY ENTITY DOING BUSINESS WITH THE ORGANIZATION UNLESS SUCH INTEREST DOES NOT REPRESENT A SIGNIFICANT PORTION OF THE INDIVIDUAL'S NET WORTH. ADDITIONALLY, SHOULD THE EMPLOYEE OR TRUSTEE BECOME AWARE OF SUCH A RELATIONSHIP SUBSEQUENT TO THE ADMINISTRATION OF THE OUESTIONNAIRE, HE OR SHE SHOULD DISCLOSE THE RELATIONSHIP TO THE APPROPRIATE DEPARTMENT HEAD OR COMMITTEE CHAIRPERSON. IN THE EVENT OF A POTENTIAL CONFLICT, THE INDIVIDUAL IS ASKED TO ABSTAIN FROM PARTICIPATING IN ANY DECISIONS RELATED TO THE TRANSACTION IN QUESTION UNTIL THE ORGANIZATION CAN DETERMINE IF A CONFLICT OF INTEREST EXISTS AND MAKES AN APPROPRIATE DECISION TO DETERMINE HOW THE CONFLICT WILL BE RESOLVED. FORM 990, PART VI, LINE 15A THE COMPENSATION OF THE CHIEF EXECUTIVE OFFICER AND SENIOR EXECUTIVES IS REVIEWED ANNUALLY BY THE EXECUTIVE COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES. AN INDEPENDENT OUTSIDE CONSULTANT WITH EXPERTISE IN HOSPITAL EXECUTIVE COMPENSATION ASSESSES THE EXECUTIVE COMPENSATION AS COMPARED TO SIMILAR POSITIONS IN THE NEW YORK AREA AND RECOMMENDS A RANGE. THE COMMITTEE SETS THE EXECUTIVE COMPENSATION FOR THE COMING YEAR WITHIN THE FAIR MARKET VALUE RANGE RECOMMENDED BY THE CONSULTANT. BOARD DECISIONS ARE CONTEMPORANEOUSLY DOCUMENTED IN BOARD MINUTES. FORM 990, PART VI, LINE 15B THE COMPENSATION OF THE OFFICERS AND KEY EMPLOYEES IS REVIEWED ANNUALLY BY THE COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES. AN INDEPENDENT OUTSIDE CONSULTANT WITH EXPERTISE IN HOSPITAL EXECUTIVE COMPENSATION ASSESSES THE COMPENSATION AS COMPARED TO SIMILAR POSITIONS IN THE NEW YORK AREA AND RECOMMENDS A RANGE. THE COMMITTEE SETS THE COMPENSATION FOR THE COMING YEAR WITHIN THE RANGE RECOMMENDED BY THE CONSULTANT. BOARD DECISIONS ARE CONTEMPORANEOUSLY DOCUMENTED IN BOARD MINUTES. FORM 990, PART VI, LINE 19 UPON REQUEST, THE ORGANIZATION WILL MAKE AVAILABLE ONLY THOSE DOCUMENTS REQUIRED TO BE DISCLOSED UNDER THE PUBLIC INSPECTION LAWS. FORM 990, PART XI, LINE 9 OTHER CHANGES IN NET ASSETS OR FUND BALANCES: Change in pension and postretirement liabilities other than net periodic benefit cost: ($1,743,870) MMC Corporation 111 East 210th street BRONX NY 10467 133430322 real estate NY 501(C)(3) 11 Type I MMC true MMC Residential Corp No 1 Inc 3411 Wayne Avenue BRONX NY 10467 911943271 staff housing NY 501(C)(2) MMC true Montefiore Hosp Housing Section II Inc 3450 wayne avenue BRONX NY 10467 237160641 staff housing NY 501(C)(2) MMC true Mosholu Preservation Corporation 3400 reservoir oval East BRONX NY 10467 133109387 Community Ser NY 501(C)(3) 11 type II MMC true Gunhill MRI PC 200 East Gunhill Road BRONX NY 10467 133734486 diag services NY 501(C)(3) 11 type I MMC true Montefiore Health System Inc 555 South Broadway Tarrytown NY 10591 201615393 parent NY 501(C)(3) 11 type III MMAHS false Montefiore North Ambulatory Care Center 4134 Bronx Blvd BRONX NY 10466 010796859 amb services NY 501(C)(3) 3 MHS true Montefiore New Rochelle Hospital 16 Guion Place New Rochelle NY 10801 462931956 Hospital NY 501(C)(3) 3 MHS true Montefiore Mount Vernon Hospital 12 North Seventh Avenue Mount Vernon NY 10550 462916938 Hospital NY 501(C)(3) 3 MHS true Schaffer Extended Care Center 16 Guion Place New Rochelle NY 10801 462929888 Nursing Home NY 501(C)(3) 9 MHS true MONTEFIORE FOUNDATION INC 111 EAST 210TH STREET BRONX NY 10467 471600439 FOUNDATION NY 501(C)(3) 11 TYPE I MHS true Albert Einstein College of Medicine Inc 1300 Morris Park Avenue BRONX NY 10461 472209056 Med School NY 501(C)(3) 2 MMAHS false MONTEFIORE MEDICINE ACAD HLTH SYS INC 555 SOUTH BROADWAY TARRYTOWN NY 10591 471582973 Sys Parent NY 501(C)(3) 11 Type III NA false White Plains Hospital Medical Center 41 East Post Road White Plains NY 10601 131740130 Hospital NY 501(c)(3) 3 MHS true MONTEFIORE MEDICAL CENTER 111 EAST 210TH STREET BRONX NY 10467 131740114 ACAD MED CTR NY 501(C)(3) 3 MHS true Einstein Staff Housing Co Inc 1300 Morris Park Avenue BRONX NY 10461 237075620 Staff Housing NY 501(C)(2) MMAHS false Montefiore CERC Operations Inc 111 East 210th Street BRONX NY 10467 474853506 Rehab Center NY Pending MMC true White Plains Hospital Foundation 41 East Post Road Davis Ave White Plains NY 10601 133281507 FUNDRAISING NY 501(C)(3) 11 TYPE I WPH false Nyack Hospital Foundation 160 North Midland Avenue NYACK NY 10960 133245804 FUNDRAISING NY 501(C)(3) 11 TYPE I Nyack Hosp true The Montefiore IPA Inc 111 East 210th street bronx NY 10467 134114915 Managed Care NY NA C CORP false MMC GI Holdings East Inc 111 East 210th street bronx NY 10467 721610013 holding company NY NA C CORP false MMC GI Holdings West Inc 111 East 210th street bronx NY 10467 721610015 holding company NY NA C CORP false Montefiore Behavioral Care IPA No 1 inc 111 East 210th street bronx NY 10467 133952750 Integ prov assos NY NA C CORP false BRONX ACCOUNTABLE CARE NETWORK IPA INC 111 EAST 210TH STREET BRONX NY 10467 300689571 Managed care NY NA C CORP false MONTEFIORE CONSOLIDATED VENTURES INC 111 EAST 210TH STREET BRONX NY 10467 611728539 holding company NY NA C CORP false MMC CONTRACT MANGEMENT ORG NO 1 INC 111 EAST 210TH STREET BRONX NY 10467 133859895 CONTRACT MGMT NY NA C CORP false MONTEFIORE INSURANCE COMPANY INC 111 EAST 210TH STREET BRONX NY 10467 320436594 Insurance Company NY NA C CORP false MONTEFIORE COMMUNITY NETWORK LLC 111 EAST 210TH STREET BRONX NY 10467 461374475 Community Network NY NA C CORP false HUDSON VALLEY IPA INC 111 EAST 210TH STREET BRONX NY 10467 383978087 MANAGED cARE NY NA C CORP false MONTEFIORE INNOVATIONS INC 111 EAST 210TH STREET BRONX NY 10467 475106910 holding company NY NA C CORP false HIGHLAND MEDICAL PC 160 NORTH MIDLAND NYACK NY 10960 134034481 PHYSICIAN SERV NY Nyack Hosp C CORP 11915287 2476808 1.00000 true 8 LONGVIEW DEVELOPMENT CORP DAVIS AVENUE AT EAST POST ROAD WHITE PLAINS NY 10601 263321278 hOUSING NY NA C CORP false WHITE PLAINS MEDICAL DIAGNOSTIC SERV PC 41 EAST POST ROAD WHITE PLAINS NY 10601 453164626 PROFESSIONAL SERV NY NA C CORP false CANCER AND BLOOD MEDICAL SERVICES OF NY 41 EAST POST ROAD WHITE PLAINS NY 10601 462021804 PROFESSION SERV NY NA C CORP false NH MANAGEMENT INC 160 N MIDLAND AVENUE NYACK NY 10960 134026486 MANAGEMENT SERV NY Nyack Hosp C CORP 0 0 1.00000 true DAVIS AVENUE CORPORATION DAVIS AVENUE AT EAST POST ROAD WHITE PLAINS NY 10601 133331643 HEALTHCARE SERV NY NA C CORP false POST DEVELOPMENT CORPORATION DAVIS AVENUE AT EAST POST ROAD WHITE PLAINS NY 10601 222605281 REAL ESTATE NY NA C CORP false WHITE PLAINS MANAGEMENT CO INC 41 EAST POST ROAD WHITE PLAINS NY 10601 133331641 MANAGEMENT SERV NY NA C CORP false WPHC BUILDING CORPORATION 41 EAST POST ROAD WHITE PLAINS NY 10601 133676932 REAL ESTATE NY NA C CORP false false false true true false false false false false false false true false true true false false false false NYACK HOSPITAL FOUNDATION L 58982 COST NYACK HOSPITAL FOUNDATION O 161000 COST HIGHLAND MEDICAL PC N 296796 COST MONTEFIORE MEDICAL CENTER C 300000 COST NYACK HOSPITAL FOUNDATION C 417781 COST HIGHLAND MEDICAL PC D 3351845 COST