2018-11-15T13:45:01-06:00 2017-12-31 420714325 RSM US LLP 4 TIMES SQUARE NEW YORK NY 10036 990 2017-01-01 111631759 KINGSBROOK JEWISH MEDICAL CENTER KING 7186045532 585 SCHENECTADY AVENUE BROOKLYN NY 11203 JOHN SCHMITT CFO 7186045532 2018-11-15 1 LYNNE JOHNSON P00757336 2123721000 108.171.131.186 2018-11-15 11:10:50 ES P 3C00C606A388A9D35E45825560E1E247C6D1AB27 FCD310BFBCE88C3C431CDA5F749D98DF0DBABEAA 2017 2019-02-21 02:37:17Z LINDA BRADY MD 585 SCHENECTADY AVENUE BROOKLYN NY 11203 241288977 0 X WWW.KINGSBROOK.ORG X 1926 NY OUR MISSION IS TO PARTNER WITH OUR CULTURALLY DIVERSE COMMUNITIES TO PROVIDE A CONTINUUM OF OUTSTANDING HEALTH CARE SERVICES TO INDIVIDUALS AND FAMILIES THROUGH A CARING AND TRUSTWORTHY STAFF. 8 7 2442 139 1623 0 45173174 58582977 168415570 181330885 527169 117320 1625831 1257795 215741744 241288977 0 0 0 0 140317052 148460847 0 0 254277 60458614 65510105 200775666 213970952 14966078 27318025 189935579 81985029 115783498 121965182 74152081 -39980153 OUR MISSION IS TO PARTNER WITH OUR CULTURALLY DIVERSE COMMUNITIES TO PROVIDE A CONTINUUM OF OUTSTANDING HEALTH CARE SERVICES TO INDIVIDUALS AND FAMILIES THROUGH A CARING AND TRUSTWORTHY STAFF. 0 0 189044226 181330885 THE KINGSBROOK JEWISH MEDICAL CENTER ("KJMC") IS A 303-BED MULTI-SPECIALTY TEACHING HOSPITAL LOCATED IN BROOKLYN, NEW YORK, WHICH PROVIDES A FULL RANGE OF INPATIENT AND OUTPATIENT SERVICES, MEDICAL AND SURGICAL TREATMENT, REHABILITATION MEDICINE AND GERIATRIC PSYCHIATRIC MEDICINE, AS WELL AS AN AMBULATORY SURGERY CENTER, 24-HOUR EMERGENCY ROOM AND OUTPATIENT GENERAL AND SPECIALTY CLINICS. 189044226 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 271 0 1 2442 1 1 1 0 0 0 0 0 0 0 0 0 X 8 7 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 1 0 NY X JOHN SCHMITT 7186045532 585 SCHENECTADY AVENUE BROOKLYN NY 11203 VICTOR AYALA PHD BOARD TRUSTEE 2.00 3.00 X 0 0 0 VALERIE BYNOE-KASDEN ESQ TREASURER (THRU MAR 2017) 1.00 1.00 X X 0 0 0 JEFFREY DUNSTON BOARD TRUSTEE 1.00 0.00 X 0 0 0 SEEMA GOLDSTEIN SECRETARY 1.50 2.00 X X 0 0 0 ERICA GRUEN BOARD TRUSTEE 1.00 0.00 X 0 0 0 EDWARD LIEBERSTEIN BOARD TRUSTEE 1.00 3.00 X 0 0 0 LEIBESH NASH BOARD TRUSTEE 1.00 0.00 X 0 0 0 ROBERT REISS BOARD TRUSTEE (THRU MAR 2017) 1.50 2.00 X 0 0 0 HENNA WHITE BOARD CHAIR 3.00 5.50 X X 0 0 0 LINDA BRADY MD PRESIDENT & BOARD DIRECTOR 40.00 0.50 X 1408435 0 63606 JOHN SCHMITT CPA ASSISTANT TREASURER & CFO 35.00 13.60 X 517692 0 63606 ROBERT DUBICKI SENIOR VP OF STRATEGIC PLANNING 40.00 0.00 X 378612 0 61100 JANE LEDERER CHIEF NURSING OFFICER 40.00 0.00 X 333185 0 56928 SIBTE BURNEY MD CHIEF MEDICAL OFFICER 40.00 0.00 X 486273 0 57218 KURT KODROFF CEO KJMC 40.00 0.00 X 653577 0 61925 MARC ROSS MD CHAIR REHAB MED 40.00 0.00 X 512674 0 64425 WILLIAM LOIS CHAIR SURGERY 40.00 0.00 X 460573 0 56949 VIJAY AKKAPEDDI CHAIR EMERGENCY DEPT 40.00 0.00 X 435949 0 61106 NICHOLAS POST PHYSICIAN 40.00 0.00 X 603042 0 17885 OLALEKAN BADIRU PHYSICIAN 40.00 0.00 X 488735 0 11355 6278747 0 576103 362 0 1 0 CERNER HEALTH SERVICES PO BOX 959167 ST LOUIS MO 631959167 IT SERVICES / BILLING SYSTEM 2581657 NORTH AMERICAN PARTNERS IN ANESTHESIA L 68 S SERVICE RD STE 350 MELVILLE NY 11747 MEDICAL SERVICE - ANESTHESIA 1962446 EMPIRE GENERAL CONTRACTING AND PAINTING 74 MAIN STREET STE 2 TUCKAHOE NY 10707 CONSTRUCTION SERVICES 1716545 PATHWAY SYSTEMS 7100 NEW HORIZONS BLVD NORTH AMITYVILLE NY 11701 IT SERVICES 1354945 BIK ORTHOPEDICS PC 585 SCHENECTADY AVENUE BROOKLYN NY 11203 MEDICAL SERVICE - ORTHOPEDICS 1171881 39 58116024 466953 58582977 NET PATIENT SERVICE RE 621300 174839183 174839183 AFFIL INCOME - ST. GEO 621300 4097940 4097940 AFFIL INCOME - AUA MED 621300 1083420 1083420 AFFIL INCOME - MED STU 621300 583093 583093 1% INCENTIVE 900099 529972 529972 197277 197277 181330885 1623 1623 373633 0 373633 373633 373633 115697 0 115697 115697 115697 MISC. INCOME 900099 884162 884162 884162 241288977 181330885 1623 1373492 4008377 3523363 485014 102099240 89538914 12354008 206318 9394827 8245192 1136774 12861 24823898 21803591 3003692 16615 8134505 7136487 984275 13743 2190737 1781069 409668 133911 133911 379107 308214 70893 13840382 11361100 2479282 3921280 3188001 733279 174659 141998 32661 294150 239144 55006 5940401 4829546 1110855 772927 628390 144537 MEDICAL & PHARMACEUTICA 18903029 18903029 BAD DEBT EXPENSE 7554000 7554000 MAINT & REPAIRS 6858870 5576261 1282609 FOOD COSTS 2365373 2365373 2181279 1920554 255985 4740 213970952 189044226 24672449 254277 4776046 3263016 2259879 2396315 23595799 28118486 2628520 2737932 1689280 2565212 225400796 189859245 36855087 35541551 621417 625765 117509551 6736752 189935579 81985029 55336888 58916087 8097708 10451082 52348902 52598013 115783498 121965182 X 74152081 -39980153 74152081 -39980153 189935579 81985029 X 27318025 -141450259 X 0 1 X 1 1 1 X 0 0 0 0 0 0 1 223050 0 1 156057 379107 0 PART II-B, LINE 1: OTHER ACTIVITIES DESCRIPTION: KINGSBROOK JEWISH MEDICAL CENTER PAYS DUES TO THE HEALTHCARE ASSOCIATION OF NEW YORK STATE (HANYS), GREATER NY HOSPITAL ASSOCIATION AND THE LEAGUE OF VOLUNTEER HOSPITALS. IN ACCORDANCE WITH SECTION 6033(E) OF THE INTERNAL REVENUE CODE, AND AS REPORTED BY THE DUES RECIPIENTS, A PORTION OF THESE DUES ARE ATTRIBUTABLE TO LOBBYING ACTIVITIES. THE LOBBYING ACTIVITIES APPLICABLE TO THE 2017 ANNUAL DUES WAS $156,057. ADDITIONALLY, THE ORGANIZATION HAS CONTRACTS WITH LOBBYISTS WHO WERE ENGAGED TO LOBBY LEGISLATORS ON BEHALF OF THE ORGANIZATION REGARDING POLICIES WHICH IMPACT THE ORGANIZATION'S EXEMPT PURPOSE AND WHICH PERTAIN TO PUBLIC HEALTH CARE. DURING 2017 KINGSBROOK JEWISH MEDICAL CENTER PAID $223,050 IN CONNECTION WITH THESE SERVICES. 1286989 1286989 66008558 46994652 19013906 50493284 45871011 4622273 107611965 96993582 10618383 35541551 OTHER RECEIVABLES 5458705 INTEREST IN KJMC FOUNDATION 1278047 6736752 SELF INSURANCE LIABILITIES 20869000 ESTIMATED THIRD PARTY SETTLEMENTS 18852488 FIN 47 LIABILITY 2631840 INCENTIVE/RETENTION LIABILITY 2169856 SECURITY DEPOSITS - OTHER 713294 ACCRUED POSTRETIREMENT BENEFIT COST 1225672 ACCRUED PENSION LIABILITY 6135863 52598013 X PART X, LINE 2: THE COMPANY IS EXEMPT FROM INCOME TAXES UNDER SECTIONS 501(C)(3) OF THE INTERNAL REVENUE CODE (THE "CODE"). ADDITIONALLY, THE COMPANY, AS A NONPROFIT ENTITY, IS SUBJECT TO UNRELATED BUSINESS INCOME TAX ("UBIT"), IF APPLICABLE. FOR THE TAX YEARS ENDED DECEMBER 31, 2017 AND 2016, THE COMPANY DID NOT OWE ANY UBIT. MANAGEMENT EVALUATED THE COMPANY'S TAX POSITIONS FOR ALL OPEN TAX YEARS AND HAS CONCLUDED THAT THE COMPANY HAD TAKEN NO UNCERTAIN TAX POSITIONS THAT REQUIRE ADJUSTMENT TO THE FINANCIAL STATEMENTS TO COMPLY WITH THE PROVISIONS OF FINANCIAL ACCOUNTING STANDARDS BOARD ("FASB") ACCOUNTING STANDARDS CODIFICATION ("ASC") 740, ACCOUNTING FOR INCOME TAXES. GENERALLY, THE COMPANY IS SUBJECT TO U.S. FEDERAL AND STATE EXAMINATIONS BY TAX AUTHORITIES FOR FISCAL YEARS ENDED DECEMBER 31, 2014 AND THEREAFTER. PER THE REQUIREMENT TO ASSESS FOR TAX UNCERTAINTY, MANAGEMENT HAS DETERMINED THAT IT DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS REQUIRED TO BE REPORTED. 1 1 1 X 1 X 1 0 1 1 5091964 1469095 3622869 0.01690 57484801 42092104 15392697 0.07190 62576765 43561199 19015566 0.08880 55038266 55000000 38266 0.00020 18180270 11783429 6396841 0.02990 454781 454781 0.00210 73673317 66783429 6889888 0.03220 136250082 110344628 25905454 0.12100 38266 38266 0.00020 38266 38266 0.00020 1 7554000 60877854 64546270 -3668416 X 1 1 1 1 KINGSBROOK JEWISH MEDICAL CENTER 585 SCHENECTADY AVENUE BROOKLYN NY 11203 WWW.KINGSBROOK.ORG X X X X KINGSBROOK JEWISH MEDICAL CENTER 1 0 0 1 X X X X X X X X 17 1 0 1 1 X WWW.KINGSBROOK.ORG X 1 16 1 SEE PART V 0 1 X 200.000000000000 300.000000000000 X 1 1 X X X X 1 X SEE PART V X X X X 1 X 0 X X X 1 0 0 KINGSBROOK JEWISH MEDICAL CENTER PART V, SECTION B, LINE 5: ENGAGING THE COMMUNITY: AS IN PRIOR YEARS, KINGSBROOK JEWISH MEDICAL CENTER ("KINGSBROOK") DID A REVIEW OF ITS PATIENT DATABASE AND DETERMINED THAT TO BEST MEET THE NEEDS OF ITS COMMUNITY, THE HOSPITAL WOULD CONTINUE TO FOCUS ON THE AREAS WHERE THE MAJORITY OF THE PATIENTS RESIDE. AS SUCH, THE IMMEDIATE CATCHMENT AREA OF THE HOSPITAL CONTINUED TO CONSIST OF THE FOLLOWING NEIGHBORHOODS OF BROOKLYN - CROWN HEIGHTS (11213), BROWNSVILLE (11212), FLATBUSH (11203) AND CANARSIE (11236). THIS AFFIRMATION OF THE CATCHMENT AREA WAS DONE IN CONSULTATION WITH THE KJMC COMMUNITY ADVISORY BOARD AS WELL AS THE HEALTH ASSESSMENT NEEDS REPORT DEVELOPED BY COMMUNITY BOARDS 9 AND 17 (BROOKLYN).ONCE ITS CATCHMENT AREA WAS DETERMINED, KINGSBROOK REVIEWED THE LATEST HEALTH, SOCIOECONOMIC AND SOCIO-DEMOGRAPHIC INFORMATION FROM THE 2010 CENSUS. THAT INFORMATION, ALONG WITH REPORTS PRODUCED BY THE NEW YORK STATE DEPARTMENT OF HEALTH ("NYS DOH") AND THE NEW YORK CITY DEPARTMENT OF HEALTH ("NYC DOH") SUCH AS THE COUNTY HEALTH RANKINGS FOR KINGS COUNTY 2015, ALLOWED KINGSBROOK TO IDENTIFY KEY AREAS ON WHICH TO FOCUS. THE RESULT OF THIS ASSESSMENT GAVE US THE FOLLOWING STATISTICAL INFORMATION: 1. 12% OF OUR COMMUNITY MEMBERS LIVE WITH DIABETES2. IN OUR CATCHMENT AREA OF CENTRAL BROOKLYN, 35% OF HIV DIAGNOSES ARE LATE STAGE3. 32% OF THE RESIDENTS IN OUR CATCHMENT AREA HAVE BEEN DIAGNOSED WITH HIGH BLOOD PRESSURE4. 26% OF THE RESIDENTS IN OUR CATCHMENT AREA HAVE BEEN DIAGNOSED WITH HIGH CHOLESTEROLBASED UPON THESE FACTS, KINGSBROOK WORKED WITH THE FOLLOWING GROUPS TO BEST DETERMINE THE NEEDS OF OUR COMMUNITY:1. CARIBBEAN WOMEN'S HEALTH ASSOCIATION, INC. (CWHA): THIS ASSOCIATION WAS FOUNDED IN 1982. FOR OVER TWENTY YEARS CWHA HAS SERVED AS AN ADVOCACY GROUP AND SERVICE PROVIDER IN THE COMMUNITY. CWHA STRONGLY RELIES ON COMMUNITY INVOLVEMENT IN PLANNING, IMPLEMENTATION AND EVALUATION OF PROGRAMS THAT MEET THE HEALTH AND SOCIAL SUPPORT NEEDS OF THE COMMUNITY. THERE IS CONTINUOUS INTERACTION WITH THE COMMUNITY TO REVIEW THE APPROPRIATENESS OF THE EDUCATIONAL AND PROMOTIONAL MATERIALS PRODUCED BY CWHA. CWHA IS ACCREDITED BY THE UNITED NATIONS ECONOMIC AND SOCIAL COUNCIL. THE AGENCY'S EXCELLENCE IN SERVICE DELIVERY IS WIDELY ACCLAIMED AND RECOGNIZED FOR THE QUALITY, BREADTH AND IMPACT OF ITS WORK. THIS ORGANIZATION IS LOCATED IN KINGSBROOK'S PRIMARY SERVICE AREA.2. BROOKLYN PERINATAL NETWORK (BPN): ESTABLISHED IN 1988 FROM A COMMUNITY TASK FORCE TO ADDRESS HIGH INFANT MORTALITY, THE PURPOSE OF THE ORGANIZATION IS TO PREVENT AND REDUCE INFANT/MATERNAL ILLNESS AND DEATH, WHICH FOR SEVERAL YEARS HAVE BEEN EXCESSIVELY HIGH IN THE COMMUNITY. BY ENABLING AT-RISK RESIDENTS TO ACCESS VITAL INFORMATION, COORDINATE CARE, SUPPORTIVE HEALTH AND SOCIAL SUPPORTIVE SERVICES AND ASSISTING FAMILIES TO SECURE PUBLIC HEALTH BENEFITS AND RESOURCES NEEDED TO MAINTAIN HEALTH. THE ORGANIZATION HAS SEEN A SIGNIFICANT REDUCTION IN INFANT DEATH AND IMPROVED MATERNAL AND CHILD HEALTH STATUS. BPN IS A NETWORK OR COLLABORATIVE OF SEVERAL COMMUNITY ORGANIZATIONS THAT PROVIDE MEDICAL CARE, OFFERING A WIDE RANGE OF PRIMARY PREVENTATIVE AN CLINICAL SERVICES INCLUDING PREGNANCY, OB/GYN CARE, PEDIATRIC, ADOLESCENT HEALTH CARE, GENERAL FAMILY PRACTICE AND ADULT MEDICINE; AS WELL AS SPECIALTY CARE IN AREAS SUCH AS MENTAL HEALTH, FAMILY PLANNING, SUBSTANCE ABUSE TREATMENT AND COUNSELING, HIV/AIDS CARE AND MORE. THIS ORGANIZATION IS LOCATED IN KINGSBROOK'S PRIMARY SERVICE AREA. 3. BROWNSVILLE MULTI SERVICE CENTER (BMS): A COMMITMENT TO TREATING THE "WHOLE PERSON" IS REFLECTED IN BMS' "INTEGRATED PRIMARY CARE COMMUNITY BASED HEALTH SERVICE MATRIX;" A MODEL OF PRIMARY CARE THAT IS PATTERNED ON A PROGRESSIVE PRIVATE PRACTICE. EACH MEDICAL TEAM TAKES AN INTERDISCIPLINARY AND INTEGRATIVE APPROACH TO COORDINATE THE PATIENT'S CARE. THE ON-SITE CLINICAL AREAS INCLUDE: ADULT INTERNAL MEDICINE, INFECTIOUS DISEASE, PEDIATRICS, OB/GYN, DENTISTRY, PSYCHOLOGY, PSYCHIATRY, SOCIAL SERVICES. THIS ORGANIZATION IS LOCATED IN KINGSBROOK'S PRIMARY SERVICE AREA. ON A WEEKLY BASIS, KINGSBROOK STAFFS AN HOURLY PULMONARY/ASTHMA CLINIC WITH ONE OF OUR STAFF PHYSICIANS.4. BROOKLYN DISTRICT PUBLIC HEALTH OFFICE (DPHO), NYC DOH: THE MISSION OF THIS OFFICE IS TO REDUCE HEALTH DISPARITIES AND PROMOTE HEALTHY EQUITY BY TARGETING RESOURCES, PROGRAMS AND ATTENTION TO HIGH-NEED NEIGHBORHOODS IN NORTH AND CENTRAL BROOKLYN. 5. THE DELIVERY SYSTEM REFORM INCENTIVE PROGRAM (DSRIP): THE GOAL OF THE DSRIP PROGRAM IS TO PROMOTE COMMUNITY-LEVEL COLLABORATIONS AND FOCUS ON SYSTEM REFORM IN ORDER TO REDUCE AVOIDABLE INPATIENT ADMISSIONS AND UNNECESSARY EMERGENCY ROOM VISITS BY 25% OVER 5 YEARS FOR THE MEDICAID AND UNINSURED POPULATIONS IN NEW YORK STATE. EFFORTS INCLUDE A FOCUS ON: CLINICAL SUPPORT BACKUP, ACCESS TO AN ELECTRONIC HEALTH COORDINATOR DASHBOARD, AND PCMH RECOGNITION SUPPORT. 6. COMMUNITY CARE OF BROOKLYN (CCB): SINCE 2009, KINGSBROOK HAS PARTNERED WITH SUNY DOWNSTATE AND SEVERAL OTHER REGIONAL MEDICAL FACILITIES TO FORM A COALITION OF 29 MEMBERS FOCUSED ON LOCAL HEALTH PLANNING INITIATIVES. MEMBERS RANGE FROM HOSPITALS AND COMMUNITY BOARDS TO COMMUNITY-BASED ORGANIZATIONS AND HEALTH INSURANCE PLANS. THIS FORUM FOCUSES ON THE CREATION OF A UNIQUE AND CURRENTLY UNAVAILABLE INVENTORY OF PRIMARY CARE SERVICES PROVIDERS AND A UTILIZATION DATABASE FOR CENTRAL BROOKLYN. THIS PROJECT SUPPORTS EFFECTIVE COMMUNITY LEVEL PLANNING AND WILL PROVIDE THE COALITION WITH THE NECESSARY INFORMATION TO MAKE RECOMMENDATIONS TO THE NEW YORK STATE DOH ON THE SERVICES NEEDED IN OUR COMMUNITIES.WORKING IN CONJUNCTION WITH THE NYS DOH AND THE AFOREMENTIONED GROUPS, KINGSBROOK HAS FOCUSED ITS RESOURCES ON TWO MAIN AREAS. FIRST, IS TO WORK ON THE PREVENTION OF CHRONIC DISEASE BY INCREASING THE ACCESS TO HIGH QUALITY CHRONIC DISEASE PREVENTION CARE AND MANAGEMENT IN BOTH CLINICAL AND COMMUNITY SETTINGS. THIS IS DONE THROUGH THE HOSPITAL'S CLINICS. SECOND IS THE PREVENTION OF INFECTIOUS DISEASE AND THE CONTINUING CARE OF CURRENTLY INFECTED HIV PATIENTS. THIS IS BEING DONE TO HELP DECREASE HIV MORBIDITY AND INCREASE EARLY ACCESS TO AND RETENTION OF HIV CARE THROUGH OUR DESIGNATED AIDS CENTER (DAC).ADDITIONALLY, KINGSBROOK IS JOINING WITH INTERFAITH MEDICAL CENTER AND BROOKDALE MEDICAL CENTER TO FORM ONE BROOKLYN HEALTH MEDICAL SYSTEM. WITH CAPITAL FUNDING PROVIDED BY NEW YORK STATE DEPARTMENT OF HEALTH, ONE BROOKLYN HEALTH IS LOOKING TO STRENGTHENED HEALTHCARE TO AN UNDERSERVED BROOKLYN COMMUNITY. AS ENVISIONED BY THE FRAMEWORK ESTABLISHED BY THE DEPARTMENT OF HEALTH, KINGSBROOK WILL BE TRANSFORMING INTO A MEDICAL VILLAGE WITH A BIGGER EMPHASIS ON OUTPATIENT AND FOLLOW-UP CARE. KINGSBROOK JEWISH MEDICAL CENTER PART V, SECTION B, LINE 6B: - CARIBBEAN WOMEN'S HEALTH ASSOCIATION, INC. (CWHA)- BROOKLYN PERINATAL NETWORK (BPN)- BROWNSVILLE MULTI SERVICE CENTER (BMS)- BROOKLYN DISTRICT PUBLIC HEALTH OFFICE (DPHO)- THE DELIVERY SYSTEM REFORM INCENTIVE PROGRAM (DSRIP)- COMMUNITY CARE OF BROOKLYN (CCB)SEE ADDITIONAL DETAIL IN PART V, SECTION B, LINE 5: ENGAGING THE COMMUNITY KINGSBROOK JEWISH MEDICAL CENTER PART V, SECTION B, LINE 11: AREAS WHERE KJMC'S IMPLEMENTATION STRATEGY IS NOT ADDRESSING ALL OF THE NEEDS ADDRESSED IN THE MOST RECENTLY CONDUCTED CHNA AND WHY:COMMUNITY SCREENINGS/CHRONIC DISEASE PREVENTION - IN THE COMMUNITY SETTING:THE OVERALL SCOPE OF OUR PROGRAM HAS REMAINED THE SAME. THE CURRENT ECONOMY HAS ALTERED OUR ABILITY TO GROW OUR FOUNDATIONAL SUPPORT FOR NO-COST SCREENING EFFORTS. KINGSBROOK JEWISH MEDICAL CENTER PART V, SECTION B, LINE 13B: KINGSBROOK JEWISH MEDICAL CENTER'S FINANCIAL ASSISTANCE PROGRAM IS BASED UPON UP TO 300% OF THE JANUARY 2017 DEPARTMENT OF HEALTH AND HUMAN SERVICES FEDERAL POVERTY GUIDELINES. SCHEDULE H, PART V, SECTION B, LINE 10A IMPLEMENTATION STRATEGY WEBSITE URL:HTTP://WWW.KINGSBROOK.ORG/ABOUT-US/COMMUNITY-IMPLEMENTATION-REPORT.ASPX SCHEDULE H, PART V, SECTION B, LINE 16A FAP WEBSITE:WWW.KINGSBROOK.ORG/FOR-PATIENTS-VISITORS/FINANCIAL-INFORMATION/FINANCIAL-ASSISTANCE-PROGRAM.ASPX PART I, LINE 3C: NOT APPLICABLE PART I, LINE 7G: 24 HOUR EMERGENCY ROOM, 911 AMBULANCE SERVICES AND CLINICS PART I, LN 7 COL(F): KINGSBROOK JEWISH MEDICAL CENTER'S COSTING METHODOLOGY WAS BASED UPON THE 2017 NEW YORK STATE INSTITUTIONAL COST REPORT AND THE 2017 (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 COST-TO-CHARGE, WAS USED FOR THE VARIOUS SUB-LINE ITEMS OF PART I, LINE 7. PART II, COMMUNITY BUILDING ACTIVITIES: AS PART OF ITS COMMUNITY OUTREACH INITIATIVE, KINGSBROOK JEWISH MEDICAL CENTER OFFERS ITS SPEAKER'S BUREAU PROGRAM TO COMMUNITY ORGANIZATIONS IN NEED OF HEALTH AND WELLNESS INFORMATION. COMPRISED OF THE FACILITIES BEST DOCTORS, NURSES, PHARMACISTS AND MEDICAL SPECIALISTS, THE BUREAU TRAVELS ALL PARTS OF BROOKLYN SPEAKING ON A NUMBER OF ISSUES THAT AFFECT THE HEALTH AND WELL-BEING OF COMMUNITY MEMBERS.THIS ESSENTIAL PROGRAM IS GEARED TOWARDS PROVIDING HEALTH SEMINARS AND DISCUSSIONS TO COMMUNITY-BASED ORGANIZATIONS SUCH AS LIBRARIES, SENIOR CITIZEN CENTERS, SCHOOLS, CHURCHES AND HEALTH-BASED ORGANIZATIONS. THIS PROGRAM GIVES COMMUNITY MEMBERS AN OPPORTUNITY TO SPEAK WITH MEDICAL AND HEALTH EDUCATION SPECIALISTS DIRECTLY ABOUT PROGRAMS AND TREATMENTS PERTINENT TO THEIR WELL-BEING. PART III, LINE 4: EXPLANATION OF FINANCIAL STATEMENT FOOTNOTES THAT DESCRIBES BAD DEBT EXPENSE: SEE ATTACHED FINANCIAL STATEMENTS FOOTNOTE 4, PP. 14-16. PART III, LINE 8: COSTING METHODOLOGY: THE AMOUNT REPORTED ON LINE 7 WAS DERIVED BY USING THE MEDICARE ALLOWABLE COSTS AS REPORTED ON THE HOSPITAL'S NEW YORK STATE INSTITUTIONAL COST REPORT AND THE APPLICABLE ADJUSTMENT FROM WORKSHEET B. PART III, LINE 9B: PROVISION ON COLLECTION PRACTICES FOR QUALIFIED PATIENTS -POLICY: IT IS THE POLICY OF KINGSBROOK JEWISH MEDICAL CENTER TO PROVIDE COMPREHENSIVE QUALITY HEALTH CARE AND MEDICALLY ESSENTIAL SERVICES WITHOUT REGARD TO A PATIENT'S ABILITY TO PAY OR THEIR IMMIGRATION STATUS. KINGSBROOK JEWISH MEDICAL CENTER RECOGNIZES THAT THERE ARE TIMES WHEN PATIENTS IN NEED OF MEDICAL CARE MAY HAVE DIFFICULTY PAYING FOR THE SERVICES PROVIDED. KINGSBROOK JEWISH MEDICAL CENTER'S FINANCIAL ASSISTANCE PROGRAM PROVIDES DISCOUNTS TO QUALIFYING INDIVIDUALS BASED ON YOUR INCOME. IN ADDITION, WE CAN HELP YOU APPLY FOR FREE OR LOW-COST INSURANCE IF YOU QUALIFY. KINGSBROOK JEWISH MEDICAL CENTER HAS IMPLEMENTED A FINANCIAL ASSISTANCE PROGRAM WHICH EVALUATES THOSE WHO ARE UNDERINSURED, HAVE EXHAUSTED THEIR INSURANCE BENEFITS OR ARE FULLY UNINSURED. CURRENT CLINIC PATIENTS WITHOUT ADEQUATE FINANCIAL RESOURCES CAN RECEIVE CARE IN OUR PRIMARY / SPECIALTY CLINICS FOR FEE SCHEDULES BASED ON THEIR INCOME AND FAMILY SIZE. A DETERMINATION WILL BE MADE IF THE PATIENT IS ELIGIBLE FOR REDUCED FEES. NON-CLINIC PATIENTS SEEN IN THE EMERGENCY DEPARTMENT, INPATIENT, OR FOR OUTPATIENT SERVICES CAN APPLY FOR ASSISTANCE, BASED ON FINANCIAL NEED, THROUGH THE FINANCIAL ASSISTANCE PROCESS IN PATIENT ACCOUNTS, PATIENT ACCESS SERVICES/FINANCIAL COUNSELING OR AMBULATORY CARE.PROCEDURES:ESTABLISHED CLINIC PATIENT- THE FINANCIAL ASSISTANCE FEE SCHEDULE MUST BE USED TO ESTABLISH A FEE SCALE FOR NEW CLINIC PATIENTS WHO HAVE NO APPLICABLE INSURANCE COVERAGE.- PATIENTS ARE INFORMED, AT THE TIME OF SCHEDULING, TO BRING THE FOLLOWING DOCUMENTATION, AS AVAILABLE OR APPLICABLE, TO THEIR FIRST VISIT IN ORDER TO BE ASSIGNED A FEE SCALE:- PICTURE IDENTIFICATION- PROOF OF ADDRESS (LETTER/BILL MAILED TO THE PATIENT AT THEIR ADDRESS)- INCOME TAX 1040 (TO VERIFY DEPENDENTS)- PROOF OF INCOME- 4 MOST RECENT PAY STUBS (OR)- A LETTER FROM THE PATIENT'S EMPLOYER (OR)- A STATEMENT FROM THE PATIENT STATING INCOME (OR)- IF THE PATIENT DOES NOT WORK, A LETTER FROM THE PERSON SUPPORTING THEM- THE HIGHEST INCOME LEVEL ON THE FINANCIAL ASSISTANCE FEE SCHEDULE IS 300% OF THE FEDERAL POVERTY LEVEL.- WHEN AN EXISTING CLINIC PATIENT PRESENTS FOR THEIR FIRST VISIT UNDER THIS POLICY, THE REGISTRAR WILL FEE SCALE THE PATIENT USING THE FINANCIAL ASSISTANCE FEE SCHEDULE AND INPUT "CHC" AS THE REGISTRATION FINANCIAL CLASS AND COMMENT IN GNE NOTES.- ALL FEE SCALES FOR CLINIC PATIENTS MUST BE RE-EVALUATED ANNUALLY USING THE FINANCIAL ASSISTANCE FEE SCHEDULE.- A FEE SCALE APPROVAL IS GOOD FOR 1 YEAR FROM THE DATE OF APPLICATION AND MUST BE NOTED AS SUCH IN THE INSURANCE COMMENTS BY THE APPROVING CLINIC REGISTRAR.- MOST ANCILLARY TESTING RELATED TO A CLINIC VISIT IS INCLUDED IN THE KJMC FINANCIAL ASSISTANCE PROGRAM. EXCLUSIONS ARE PET SCANS, MRI'S, CT SCANS AND ULTRASOUNDS.- ALL ANCILLARY TESTING RELATED TO A CLINIC VISIT, PERFORMED ON THE SAME DAY AS THE CLINIC VISIT, MUST BE PUT ON THE CLINIC ACCOUNT.- ALL ANCILLARY TESTING DONE ON A DAY BESIDES THE CLINIC VISIT, THE REGISTRAR WILL PERFORM A DISTINCT P/A REGISTRATION AND ASSIGN THE "CHC" FINANCIAL CLASS AND ADD IN GNE NOTES THE DATE OF THE RELATED CLINIC VISIT. CLINIC PATIENTS (WITH ESTABLISHED FEE SCALES) SCHEDULED FOR AMBULATORY SURGERY PROCEDURES - WHEN A CLINIC PATIENT, WHO IS ALREADY QUALIFIED FOR FINANCIAL ASSISTANCE, SCHEDULES AN AMBULATORY SURGERY PROCEDURE THE PATIENT IS RESPONSIBLE FOR A PERCENTAGE OF THE ESTIMATED SELF-PAY/MEDICAID RATE. THE RATES ARE AS FOLLOWS:- ALL AMBULATORY SURGICAL PROCEDURES = $2,500.00- COLONOSCOPY, ENDOSCOPY, BRONCHOSCOPY = $1,000.00 - THE PERCENTAGE OF THE MEDICAID RATE THE PATIENT WILL BE RESPONSIBLE FOR IS DETERMINED BY THE PATIENT'S FAMILY SIZE AND TOTAL FAMILY INCOME.- EXISTING CLINIC PATIENTS, WHO ARE ALREADY QUALIFIED FOR FINANCIAL ASSISTANCE AND WHOSE INCOME AND FAMILY SIZE ARE ABOVE 300% OF THE POVERTY LEVEL WILL BE RESPONSIBLE FOR THE HIGHEST PERCENTAGE (35%) OF THE SELF-PAY/MEDICAID RATE.- THE CLINIC STAFF ARRANGING THE AMBULATORY SURGERY PROCEDURE WILL FILL OUT A RESPONSIBILITY CONTRACT AND INDICATE THE QUALIFIED LEVEL OF FINANCIAL ASSISTANCE THE PATIENT IS ELIGIBLE FOR AND FORWARD A COPY TO PATIENT ACCESS SERVICES. THE ORIGINAL FORM WILL BE KEPT ON FILE IN THE ORIGINATING CLINIC.- AT THE TIME OF PRE-REGISTRATION OR REGISTRATION FOR THE PROCEDURE, THE PATIENT ACCESS SCHEDULED IV STAFF WILL CONFIRM THE PATIENT'S CHARITY CARE STATUS AS A REGISTERED CLINIC PATIENT WITH A CURRENT VALID FINANCIAL ASSISTANCE PROGRAM APPROVAL.- THE PATIENT WILL BE REGISTERED WITH THE "CHC" FINANCIAL CLASS AND THE APPROPRIATE PAYMENT AMOUNT COLLECTED AT THE TIME OF SERVICE.- IF THERE IS NO RESPONSIBILITY CONTRACT ON FILE, THE PRE-REGISTRATION/REGISTRATION STAFF WILL REFER THE PATIENT TO PATIENT ACCESS FINANCIAL COUNSELING FOR A FINANCIAL ASSISTANCE ELIGIBILITY SCREEN.- THE PATIENT ACCESS FINANCIAL COUNSELING STAFF WILL REVIEW AND ENTER THEIR COMMENTS IN THE GNE NOTES. - IF QUALIFIED, THE STAFF WILL REGISTER THAT PATIENT WITH FINANCIAL CLASS "CHC AND NOTE THE SAME IN GNE. - THE REGISTRATION STAFF WILL ASK THE PATIENT FOR THE REDUCED PAYMENT AMOUNT AT THE TIME OF THE PROCEDURE/PST.- WHEN THE PATIENT HAS BEEN REGISTERED, THE REGISTRATION STAFF WILL FORWARD A COPY OF THE REGISTRATION FACE SHEET TO THE RESPECTIVE INPATIENT OR OUTPATIENT PATIENT FINANCIAL SERVICES MANAGER, WITH A COPY TO THE DIRECTOR OF PATIENT FINANCIAL SERVICES.- WHEN THE PROCEDURE HAS BEEN CODED, PATIENT ACCOUNTS WILL CONFIRM THE ALLOWANCE ON THE ACCOUNT TO THE PERCENTAGE OF THE MEDICAID RATE APPROVED.- THE BILL WILL GO OUT TO THE PATIENT AT THE REDUCED RATE. PART VI, LINE 2: DESCRIPTION OF HOW KINGSBROOK JEWISH MEDICAL CENTER ASSESSESS THE HEALTH CARE NEEDS OF THE COMMUNITY IT SERVES:AS IN PRIOR YEARS, KINGSBROOK JEWISH MEDICAL CENTER ("KINGSBROOK") DID A REVIEW OF ITS PATIENT DATABASE AND DETERMINED THAT TO BEST MEET THE NEEDS OF ITS COMMUNITY, THE HOSPITAL WOULD CONTINUE TO FOCUS ON THE AREAS WHERE THE MAJORITY OF THE PATIENTS RESIDE. AS SUCH, THE IMMEDIATE CATCHMENT AREA OF THE HOSPITAL CONTINUED TO CONSIST OF THE FOLLOWING NEIGHBORHOODS OF BROOKLYN - CROWN HEIGHTS (11213), BROWNSVILLE (11212), FLATBUSH (11203) AND CANARSIE (11236). THIS AFFIRMATION OF THE CATCHMENT AREA WAS DONE IN CONSULTATION WITH THE KJMC COMMUNITY ADVISORY BOARD AS WELL AS THE HEALTH ASSESSMENT NEEDS REPORT DEVELOPED BY COMMUNITY BOARDS 9 AND 17 (BROOKLYN).ONCE ITS CATCHMENT AREA WAS DETERMINED, KINGSBROOK REVIEWED THE LATEST HEALTH, SOCIOECONOMIC AND SOCIO-DEMOGRAPHIC INFORMATION FROM THE 2010 CENSUS. THAT INFORMATION, ALONG WITH REPORTS PRODUCED BY THE NEW YORK STATE DEPARTMENT OF HEALTH ("NYS DOH") AND THE NEW YORK CITY DEPARTMENT OF HEALTH ("NYC DOH") SUCH AS THE COUNTY HEALTH RANKINGS FOR KINGS COUNTY 2013, ALLOWED KINGSBROOK TO IDENTIFY KEY AREAS ON WHICH TO FOCUS. THE RESULT OF THIS ASSESSMENT GAVE US THE FOLLOWING STATISTICAL INFORMATION: 1. 12% OF OUR COMMUNITY MEMBERS LIVE WITH DIABETES2. IN OUR CATCHMENT AREA OF CENTRAL BROOKLYN, 35% OF HIV DIAGNOSES ARE LATE STAGE3. 32% OF THE RESIDENTS IN OUR CATCHMENT AREA HAVE BEEN DIAGNOSED WITH HIGH BLOOD PRESSURE4. 26% OF THE RESIDENTS IN OUR CATCHMENT AREA HAVE BEEN DIAGNOSED WITH HIGH CHOLESTEROLBASED UPON THESE FACTS, KINGSBROOK WORKED WITH THE FOLLOWING GROUPS TO BEST DETERMINE THE NEEDS OF OUR COMMUNITY:1. CARIBBEAN WOMEN'S HEALTH ASSOCIATION, INC. (CWHA): THIS ASSOCIATION WAS FOUNDED IN 1982. FOR OVER TWENTY YEARS CWHA HAS SERVED AS AN ADVOCACY GROUP AND SERVICE PROVIDER IN THE COMMUNITY. CWHA STRONGLY RELIES ON COMMUNITY INVOLVEMENT IN PLANNING, IMPLEMENTATION AND EVALUATION OF PROGRAMS THAT MEET THE HEALTH AND SOCIAL SUPPORT NEEDS OF THE COMMUNITY. THERE IS CONTINUOUS INTERACTION WITH THE COMMUNITY TO REVIEW THE APPROPRIATENESS OF THE EDUCATIONAL AND PROMOTIONAL MATERIALS PRODUCED BY CWHA. CWHA IS ACCREDITED BY THE UNITED NATIONS ECONOMIC AND SOCIAL COUNCIL. THE AGENCY'S EXCELLENCE IN SERVICE DELIVERY IS WIDELY ACCLAIMED AND RECOGNIZED FOR THE QUALITY, BREADTH AND IMPACT OF ITS WORK. THIS ORGANIZATION IS LOCATED IN KINGSBROOK'S PRIMARY SERVICE AREA.2. BROOKLYN PERINATAL NETWORK (BPN): ESTABLISHED IN 1988 FROM A COMMUNITY TASK FORCE TO ADDRESS HIGH INFANT MORTALITY, THE PURPOSE OF THE ORGANIZATION IS TO PREVENT AND REDUCE INFANT/MATERNAL ILLNESS AND DEATH, WHICH FOR SEVERAL YEARS HAVE BEEN EXCESSIVELY HIGH IN THE COMMUNITY. BY ENABLING AT-RISK RESIDENTS TO ACCESS VITAL INFORMATION, COORDINATE CARE, SUPPORTIVE HEALTH AND SOCIAL SUPPORTIVE SERVICES AND ASSISTING FAMILIES TO SECURE PUBLIC HEALTH BENEFITS AND RESOURCES NEEDED TO MAINTAIN HEALTH. THE ORGANIZATION HAS SEEN A SIGNIFICANT REDUCTION IN INFANT DEATH AND IMPROVED MATERNAL AND CHILD HEALTH STATUS. BPN IS A NETWORK OR COLLABORATIVE OF SEVERAL COMMUNITY ORGANIZATIONS THAT PROVIDE MEDICAL CARE, OFFERING A WIDE RANGE OF PRIMARY PREVENTATIVE AN CLINICAL SERVICES INCLUDING PREGNANCY, OB/GYN CARE, PEDIATRIC, ADOLESCENT HEALTH CARE, GENERAL FAMILY PRACTICE AND ADULT MEDICINE; AS WELL AS SPECIALTY CARE IN AREAS SUCH AS MENTAL HEALTH, FAMILY PLANNING, SUBSTANCE ABUSE TREATMENT AND COUNSELING, HIV/AIDS CARE AND MORE. THIS ORGANIZATION IS LOCATED IN KINGSBROOK'S PRIMARY SERVICE AREA. 3. BROWNSVILLE MULTI SERVICE CENTER (BMS): A COMMITMENT TO TREATING THE "WHOLE PERSON" IS REFLECTED IN BMS' "INTEGRATED PRIMARY CARE COMMUNITY BASED HEALTH SERVICE MATRIX;" A MODEL OF PRIMARY CARE THAT IS PATTERNED ON A PROGRESSIVE PRIVATE PRACTICE. EACH MEDICAL TEAM TAKES AN INTERDISCIPLINARY AND INTEGRATIVE APPROACH TO COORDINATE THE PATIENT'S CARE. THE ON-SITE CLINICAL AREAS INCLUDE: ADULT INTERNAL MEDICINE, INFECTIOUS DISEASE, PEDIATRICS, OB/GYN, DENTISTRY, PSYCHOLOGY, PSYCHIATRY, SOCIAL SERVICES. THIS ORGANIZATION IS LOCATED IN KINGSBROOK'S PRIMARY SERVICE AREA. ON A WEEKLY BASIS, KINGSBROOK STAFFS AN HOURLY PULMONARY/ASTHMA CLINIC WITH ONE OF OUR STAFF PHYSICIANS.4. BROOKLYN DISTRICT PUBLIC HEALTH OFFICE (DPHO), NYC DOH: THE MISSION OF THIS OFFICE IS TO REDUCE HEALTH DISPARITIES AND PROMOTE HEALTHY EQUITY BY TARGETING RESOURCES, PROGRAMS AND ATTENTION TO HIGH-NEED NEIGHBORHOODS IN NORTH AND CENTRAL BROOKLYN. 5. THE DELIVERY SYSTEM REFORM INCENTIVE PROGRAM (DSRIP): THE GOAL OF THE DSRIP PROGRAM IS TO PROMOTE COMMUNITY-LEVEL COLLABORATIONS AND FOCUS ON SYSTEM REFORM IN ORDER TO REDUCE AVOIDABLE INPATIENT ADMISSIONS AND UNNECESSARY EMERGENCY ROOM VISITS BY 25% OVER 5 YEARS FOR THE MEDICAID AND UNINSURED POPULATIONS IN NEW YORK STATE. EFFORTS INCLUDE A FOCUS ON: CLINICAL SUPPORT BACKUP, ACCESS TO AN ELECTRONIC HEALTH COORDINATOR DASHBOARD, AND PCMH RECOGNITION SUPPORT. DSRIP SPECIAL PROJECT FOCUSES ARE:6. COMMUNITY CARE OF BROOKLYN (CCB): SINCE 2009, KINGSBROOK HAS PARTNERED WITH SUNY DOWNSTATE AND SEVERAL OTHER REGIONAL MEDICAL FACILITIES TO FORM A COALITION OF 29 MEMBERS FOCUSED ON LOCAL HEALTH PLANNING INITIATIVES. MEMBERS RANGE FROM HOSPITALS AND COMMUNITY BOARDS TO COMMUNITY-BASED ORGANIZATIONS AND HEALTH INSURANCE PLANS. THIS FORUM FOCUSES ON THE CREATION OF A UNIQUE AND CURRENTLY UNAVAILABLE INVENTORY OF PRIMARY CARE SERVICES PROVIDERS AND A UTILIZATION DATABASE FOR CENTRAL BROOKLYN. THIS PROJECT SUPPORTS EFFECTIVE COMMUNITY LEVEL PLANNING AND WILL PROVIDE THE COALITION WITH THE NECESSARY INFORMATION TO MAKE RECOMMENDATIONS TO THE NEW YORK STATE DOH ON THE SERVICES NEEDED IN OUR COMMUNITIES.WORKING IN CONJUNCTION WITH THE NYS DOH AND THE AFOREMENTIONED GROUPS, KINGSBROOK HAS FOCUSED ITS RESOURCES ON TWO MAIN AREAS. FIRST, IS TO WORK ON THE PREVENTION OF CHRONIC DISEASE BY INCREASING THE ACCESS TO HIGH QUALITY CHRONIC DISEASE PREVENTION CARE AND MANAGEMENT IN BOTH CLINICAL AND COMMUNITY SETTINGS. THIS IS DONE THROUGH THE HOSPITAL'S CLINICS. SECOND IS THE PREVENTION OF INFECTIOUS DISEASE AND THE CONTINUING CARE OF CURRENTLY INFECTED HIV PATIENTS. THIS IS BEING DONE TO HELP DECREASE HIV MORBIDITY AND INCREASE EARLY ACCESS TO AND RETENTION OF HIV CARE THROUGH OUR DESIGNATED AIDS CENTER (DAC). PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: IT IS THE POLICY OF KINGSBROOK JEWISH MEDICAL CENTER TO PROVIDE COMPREHENSIVE QUALITY HEALTH CARE AND MEDICALLY ESSENTIAL SERVICES WITHOUT REGARD TO A PATIENT'S ABILITY TO PAY OR THEIR IMMIGRATION STATUS. KINGSBROOK JEWISH MEDICAL CENTER RECOGNIZES THAT THERE ARE TIMES WHEN PATIENTS IN NEED OF MEDICAL CARE MAY HAVE DIFFICULTY PAYING FOR THE SERVICES PROVIDED. KINGSBROOK JEWISH MEDICAL CENTER'S FINANCIAL ASSISTANCE PROGRAM PROVIDES DISCOUNTS TO QUALIFYING INDIVIDUALS BASED ON YOUR INCOME. IN ADDITION, WE CAN HELP YOU APPLY FOR FREE OR LOW-COST INSURANCE IF YOU QUALIFY. PLEASE CONTACT OUR FINANCIAL COUNSELOR'S AT (718) 604-5499 OR GO TO THE ADMISSIONS DEPARTMENT (PATIENT ACCESS SERVICES DEPARTMENT), LOCATED IN THE KATZ BUILDING, FIRST FLOOR FOR FREE, CONFIDENTIAL ASSISTANCE.WHO QUALIFIES FOR A DISCOUNT?KINGSBROOK JEWISH MEDICAL CENTER HAS IMPLEMENTED A FINANCIAL ASSISTANCE PROGRAM WHICH EVALUATES THOSE WHO ARE UNDERINSURED, HAVE EXHAUSTED THEIR INSURANCE BENEFITS OR ARE FULLY UNINSURED. CURRENT CLINIC PATIENTS WITHOUT ADEQUATE FINANCIAL RESOURCES CAN RECEIVE CARE IN OUR PRIMARY / SPECIALTY CLINICS FOR FEE SCHEDULES BASED ON THEIR INCOME AND FAMILY SIZE. A DETERMINATION WILL BE MADE IF THE PATIENT IS ELIGIBLE FOR REDUCED FEES. NON-CLINIC PATIENTS SEEN IN THE EMERGENCY DEPARTMENT, INPATIENT, OR FOR OUTPATIENT SERVICES CAN APPLY FOR ASSISTANCE, BASED ON FINANCIAL NEED, THROUGH THE FINANCIAL ASSISTANCE PROCESS IN PATIENT ACCOUNTS, PATIENT ACCESS SERVICES/FINANCIAL COUNSELING OR AMBULATORY CARE.EVERYONE IN NEW YORK STATE WHO NEEDS EMERGENCY SERVICES CAN RECEIVE CARE AND GET A DISCOUNT IF THEY MEET THE INCOME LIMITS. ANY INDIVIDUALS RESIDING IN KINGSBROOK JEWISH MEDICAL CENTER'S PRIMARY SERVICE AREA, WHICH IS DEFINED AS: EAST FLATBUSH, FLATBUSH, CANARSIE, FLATLANDS, BEDFORD-STUYVESANT, CROWN HEIGHTS AND/OR EAST NEW YORK (ZIP CODES 11203, 11236, 11213, 11226, 11212, 11208, 11207, 11225, 11216), CAN GET A DISCOUNT ON NON-EMERGENCY, MEDICALLY NECESSARY SERVICES AT KINGSBROOK JEWISH MEDICAL CENTER IF THEY MEET THE INCOME LIMITS. KINGSBROOK JEWISH MEDICAL CENTER WILL NEVER DENY MEDICALLY NECESSARY CARE BECAUSE YOU MAY NEED FINANCIAL ASSISTANCE. YOU MAY APPLY FOR A DISCOUNT REGARDLESS OF YOUR IMMIGRATION STATUS.WHAT ARE THE INCOME LIMITS?THE AMOUNT OF THE DISCOUNT VARIES BASED ON YOUR INCOME AND THE SIZE OF YOUR FAMILY. KINGSBROOK JEWISH MEDICAL CENTER'S FINANCIAL ASSISTANCE PROGRAM IS BASED UPON UP TO 300% OF THE JANUARY 2017 DEPARTMENT OF HEALTH AND HUMAN SERVICES FEDERAL POVERTY GUIDELINES. (CHART PROVIDED)WHAT IF I DO NOT MEET THE INCOME LIMITS?IF YOU CANNOT PAY YOUR BILL, KINGSBROOK JEWISH MEDICAL CENTER OFFERS AN EXTENDED, INTEREST-FREE, PAYMENT PLAN TO THOSE PATIENTS THAT MEET THE INCOME LIMITS. THE AMOUNT OF YOUR PAYMENT INSTALLMENT DEPENDS ON AMOUNT OF YOUR INCOME AND ABILITY TO PAY.CAN SOMEONE EXPLAIN THE DISCOUNT? CAN SOMEONE HELP ME APPLY?YES, FREE, CONFIDENTIAL HELP IS AVAILABLE. PLEASE CONTACT OUR FINANCIAL COUNSELOR'S AT (718) 604-5499 OR GO TO THE ADMISSIONS DEPARTMENT (PATIENT ACCESS SERVICES DEPARTMENT, LOCATED IN THE KATZ BUILDING, FIRST FLOOR FOR FREE, CONFIDENTIAL ASSISTANCE. IF YOU DO NOT SPEAK ENGLISH, SOMEONE WILL HELP YOU IN YOUR OWN LANGUAGE. THE FINANCIAL COUNSELOR CAN TELL YOU IF YOU QUALIFY FOR FREE OR LOW-COST INSURANCE, SUCH AS MEDICAID, CHILD HEALTH PLUS AND FAMILY HEALTH PLUS. IF THE FINANCIAL COUNSELOR FINDS THAT YOU DON'T QUALIFY FOR LOW-COST INSURANCE OR MEDICAID, THEY WILL ASSIST YOU IN ACCESSING THE MEDICAL CENTER'S FINANCIAL ASSISTANCE PROGRAM FOR ANY APPLICABLE DISCOUNTS, INCLUDING HELPING YOU WITH THE APPROPRIATE FORMS AND DOCUMENTATION REQUIREMENTS.WHAT DO I NEED TO APPLY FOR A DISCOUNT?PATIENTS ARE REQUESTED TO PROVIDE THE FOLLOWING DOCUMENTATION, AS AVAILABLE OR APPLICABLE, IN ORDER TO BE EVALUATED FOR FINANCIAL ASSISTANCE:- PICTURE IDENTIFICATION- PROOF OF ADDRESS (LETTER/BILL MAILED TO THE PATIENT AT THEIR ADDRESS)- INCOME TAX 1040 (TO VERIFY DEPENDENTS)- PROOF OF INCOME- FOUR (4) MOST RECENT PAY STUBS (AND/OR)- A LETTER FROM THE PATIENT'S EMPLOYER (AND/OR)- A STATEMENT FROM THE PATIENT STATING INCOME (AND/OR) - IF THE PATIENT DOES NOT WORK, A LETTER FROM THE PERSON SUPPORTING THEMIF YOU CANNOT PROVIDE ANY OF THESE DOCUMENTS, PLEASE LET US KNOW SO WE CAN DETERMINE HOW TO HELP YOU APPLY FOR FINANCIAL ASSISTANCE.WHAT SERVICES ARE COVERED?ALL MEDICALLY NECESSARY SERVICES PROVIDED BY KINGSBROOK JEWISH MEDICAL CENTER ARE COVERED BY THE FINANCIAL ASSISTANCE PROGRAM. THIS INCLUDES OUTPATIENT SERVICES, EMERGENCY CARE AND INPATIENT ADMISSIONS. CHARGES FROM PRIVATE DOCTORS WHO PROVIDE SERVICES IN THE HOSPITAL MAY NOT BE COVERED BY THIS PROGRAM. YOU SHOULD TALK TO PRIVATE DOCTORS TO SEE IF THEY OFFER A DISCOUNT OR PAYMENT PLAN. HOW MUCH DO I HAVE TO PAY?THE AMOUNT FOR OUTPATIENT SERVICE OR THE EMERGENCY ROOM STARTS FROM $54.00 TO $621.00, DEPENDING ON YOUR FINANCIAL ASSISTANCE QUALIFICATION CATEGORY. OUR FINANCIAL COUNSELOR WILL GIVE YOU THE DETAILS ABOUT YOUR SPECIFIC DISCOUNT(S) ONCE YOUR APPLICATION IS PROCESSED. HOW DO I GET THE DISCOUNT? YOU HAVE TO FILL OUT AN APPLICATION FORM. AS SOON AS WE HAVE PROOF OF YOUR INCOME, WE CAN PROCESS YOUR APPLICATION FOR A DISCOUNT ACCORDING TO YOUR INCOME LEVEL. YOU CAN APPLY FOR A DISCOUNT BEFORE YOU HAVE AN APPOINTMENT, WHEN YOU COME TO THE HOSPITAL TO GET CARE, OR WHEN THE BILL COMES IN THE MAIL.SEND THE COMPLETED FORM AND SUPPORTING DOCUMENTATION TO OUR FINANCIAL COUNSELOR'S IN THE PATIENT ACCESS SERVICES (ADMISSIONS) DEPARTMENT OR BRING IT TO THE PATIENT ACCESS SERVICES (ADMISSIONS) DEPARTMENT, LOCATED IN THE KATZ BUILDING, FIRST FLOOR.HOW WILL I KNOW IF I WAS APPROVED FOR THE DISCOUNT?KINGSBROOK JEWISH MEDICAL CENTER WILL SEND YOU A LETTER, WITHIN 30 BUSINESS DAYS, AFTER RECEIPT OF YOUR COMPLETED APPLICATION AND SUPPORTING DOCUMENTATION, TELLING YOU IF YOU HAVE BEEN APPROVED FOR FINANCIAL ASSISTANCE AND THE LEVEL OF DISCOUNT YOU ARE ELIGIBLE FOR. WHAT IF I RECEIVE A BILL WHILE I'M WAITING TO HEAR IF I CAN GET A DISCOUNT?YOU CANNOT BE REQUIRED TO PAY A HOSPITAL BILL WHILE YOUR APPLICATION FOR A DISCOUNT IS BEING CONSIDERED. IF YOUR APPLICATION IS TURNED DOWN, KINGSBROOK JEWISH MEDICAL CENTER WILL TELL YOU WHY AND PROVIDE YOU WITH A WAY TO APPEAL THIS DECISION TO A HIGHER LEVEL WITHIN THE HOSPITAL.WHAT IF I HAVE A PROBLEM I CANNOT RESOLVE WITH THE HOSPITAL?YOU MAY CALL THE NEW YORK STATE DEPARTMENT OF HEALTH COMPLAINT HOTLINE AT 1-800-804-5447. PART VI, LINE 4: DESCRIPTION OF COMMUNITY INFORMATION: KINGSBROOK JEWISH MEDICAL CENTER ("KINGSBROOK") IS LOCATED IN BROOKLYN, NEW YORK. KINGSBROOK IS DEDICATED TO MEETING THE HEALTHCARE NEEDS OF ONE OF BROOKLYN'S MOST CULTURALLY DIVERSE COMMUNITIES. LOCATED IN THE EAST FLATBUSH SECTION OF CENTRAL BROOKLYN, KINGSBROOK WAS FOUNDED IN 1925 AS A CHRONIC CARE FACILITY TO SERVE THE JEWISH COMMUNITY WITHIN A CULTURAL CONTEXT. WHILE STILL RETAINING TIES TO THE SURROUNDING SHRINKING JEWISH COMMUNITY, KINGSBROOK HAS EXPANDED ITS PROGRAMS AND SERVICES TO MEET THE NEEDS OF THE LARGE IMMIGRANT AND ETHNIC MINORITY POPULATION IN ITS CATCHMENT AREA, INCLUDING A SIGNIFICANT NUMBER OF CARIBBEAN AND AFRICAN-AMERICANS.KINGSBROOK'S CURRENT SERVICE AREA CONSISTS OF THE FOLLOWING ZIP CODES: 1) 11203 - FLATBUSH; 2) 11212 - BROWNSVILLE; 3) 11213 - CROWN HEIGHTS; 4) 11236 - CANARSIE. BASED UPON UPDATED DEMOGRAPHICS INFORMATION TAKEN FROM THE LATEST COMMUNITY HEALTH PROFILE PRODUCED BY THE NEW YORK CITY DEPARTMENT OF HEALTH AND MENTAL HYGIENE, OUR CATCHMENT AREA HAS A TOTAL POPULATION OF 537,513 PEOPLE, WHICH BREAKS DOWN TO 71.7% BLACK, 13.3% WHITE, 10.7% HISPANIC AND 4.3% OTHER. ADDITIONALLY, 20.1% OF THIS POPULATION IS SHOWN AS BEING BELOW THE FEDERAL POVERTY LEVEL.CENTRAL BROOKLYN RESIDENTS EXPERIENCE MORE BARRIERS TO HEALTH CARE ACCESS THAN THOSE IN NYC OVERALL. ADDITIONALLY, THE UNDERINSURED POPULATION IN THIS REGION HAS NEARLY DOUBLED WITHIN THE PAST FEW YEARS. LIMITED ACCESS TO HEALTHCARE SERVICES CONTRIBUTE TO THE OVERWHELMING DISEASE RATES, WHICH ARE MORE THAN DOUBLE THE STATE AND NATIONAL AVERAGES FOR THE LOWER INCOME RACIALLY DIVERSE RESIDENTS OF CENTRAL BROOKLYN. REPORTS, SUCH AS "TAKE CARE NEW YORK" PREPARED BY NEW YORK CITY DEPARTMENT OF HEALTH IDENTIFY MANY OF THE KEY ISSUES CONCERNING HEALTHCARE IN CENTRAL BROOKLYN. THE AFOREMENTIONED REPORT SHOWS THAT CENTRAL BROOKLYN RESIDENTS EXPERIENCE MORE BARRIERS TO HEALTHCARE ACCESS THAN THOSE IN NYC OVERALL, WITH NEARLY 3 IN 10 RESIDENTS NOT HAVING A REGULAR DOCTOR.BASED UPON OUR 2016 UPDATED CHNA, WITHIN OUR PRIMARY SERVICES AREAS OF EAST NEW YORK, CROWN HEIGHTS, BROWNSVILLE AND FLATBUSH, AREA RESIDENTS EXPERIENCED MORE BARRIERS TO HEALTHCARE THAN THOSE IN NYC OVERALL. THE UNDERINSURED POPULATION AND THOSE WITH LIMITED ACCESS TO HEALTHCARE SERVICES CONTRIBUTE TO THE OVERWHELMING DISEASE RATES, WHICH ARE HIGHER THAN THE STATE AND NATIONAL AVERAGES. IN EAST FLATBUSH 24% OF RESIDENTS ARE UNINSURED WITH 14% GOING WITHOUT NEEDED MEDICAL CARE. IN CANARSIE 17% ARE UNINSURED WITH 9% GOING WITHOUT NEEDED MEDICAL CARE, CROWN HEIGHTS REFLECTS 20% OF RESIDENTS ARE UNINSURED WITH 14% GOING WITHOUT NEED MEDICAL CARE AND IN BROWNSVILLE IT IS REPORTED THAT 18% OF THE COMMUNITY IS UNINSURED WITH 11% GOING WITHOUT NEEDED MEDICAL CARE. THE LEADING CAUSES OF DEATH IN THIS AREA OF BROOKLYN ARE (1) HEART DISEASE (2) CANCER (3) FLU (4) DIABETES. FURTHER REPORTS INDICATE THAT CENTRAL BROOKLYN IS ONE OF THE EPICENTERS OF DIABETES IN NYC REFLECTING THE FOLLOWING RATES WITH THE FOLLOWING BREAKDOWNS IN OUR CATCHMENT AREA - EAST FLATBUSH 12%, CROWN HEIGHTS 16%, CANARSIE 15% AND BROWNSVILLE 15%. . ADDITIONALLY, OBESITY RATES ARE FOUR TIMES HIGHER THAN MOST AREAS IN THE CITY - EAST FLATBUSH 30%, CROWN HEIGHTS 33%, CANARSIE 32% AND BROWNSVILLE 32%. THE HIV RELATED DEATH RATE IN THIS REGION IS STILL MORE THAN TWICE BOTH THE BROOKLYN AND NEW YORK CITY OVERALL RATES. AND MOST HIV DIAGNOSES ARE LATE STAGE (HIV ALREADY PROGRESSED TO AIDS). IN TOTAL, THERE ARE OVER 7,000 PERSONS LIVING WITH HIV/AIDS IN OUR PRIMARY SERVICE AREA. IN AN EFFORT TO COMBAT THESE DISPARITIES, OUR CENTRAL FOCUSES ARE ACCESS TO QUALITY HEALTH CARE, CHRONIC DISEASE MANAGEMENT AND INFECTIOUS DISEASE COUNSELING. PART VI, LINE 5: DESCRIPTION OF COMMUNITY HEALTH PROMOTION:ACCESS TO QUALITY HEALTH CARE - RESIDENTS IN OUR SERVICE REGION OF CENTRAL BROOKLYN FACE HEALTH DISPARITIES THAT SURPASS STATE AND NATIONAL AVERAGES IN THE AREAS OF DIABETES, STROKE, HYPERTENSION AND ASTHMA. ADDITIONALLY, THE UNDERINSURED POPULATION IN THIS REGION HAS DOUBLED WITHIN THE PAST FEW YEARS. IN ORDER TO ADDRESS THIS HEALTH CRISIS, KINGSBROOK, INDEPENDENTLY AND SOMETIMES IN CONJUNCTION WITH LOCAL COMMUNITY ORGANIZATIONS, OFFERS A NUMBER OF SCREENING AND PREVENTIVE SERVICES TO HELP ALLEVIATE SOME OF THE PRESSING HEALTHCARE ISSUES. OUR EFFORTS INCLUDE OFF-SITE EVENTS IN PARTNERSHIP WITH LOCAL CLERGY, SCHOOLS AND COMMUNITY BASED ORGANIZATIONS, AS WELL AS ON-SITE EVENTS BASED ON A PUBLISHED YEAR-LONG SCREENING CALENDAR, WITH SERVICES PROVIDED AT OUR MAIN HOSPITAL CAMPUS AS WELL AS OUR OFF-SITE PIERRE TOUSSAINT FAMILY HEALTH CENTER. FINALLY, KINGSBROOK HAS INITIATED A PATIENT PORTAL PROGRAM WHICH ALLOWS OUR PATIENT ACCESS TO THEIR MEDICAL RECORD AND OTHER PERTINENT INFORMATION.SCREENING - INCREASED SCREENING AND EDUCATIONAL OPPORTUNITIES FOR OUR COMMUNITY RESIDENTS IS VITAL TO THE TREATMENT AND MANAGEMENT OF CHRONIC DISEASE. ALL KJMC FREE SCREENINGS SPEAK TO THE CHRONIC DISEASE ISSUES MOST PREVALENT IN OUR COMMUNITY WHICH INCLUDE HYPERTENSION, DIABETES, CHOLESTEROL, STROKE, ASTHMA AND PROSTATE. TO ACHIEVE THESE OBJECTIVES, KINGSBROOK COLLABORATES WITH OTHER COMMUNITY PROVIDERS, NOT-FOR-PROFIT ENTITIES, MEDIA OUTLETS AND FOUNDATIONS TO PROVIDE THESE SCREENING AND PREVENTATIVE TREATMENT SERVICES TO ITS COMMUNITY MEMBERS.UNDERSTANDING THE NEED FOR ADDITIONAL EARLY DETECTION SERVICES AND HEALTH CARE INFORMATION, THE PUBLIC AFFAIRS DIVISION AT KINGSBROOK WORKS TO PROVIDE A CONSISTENT SCHEDULE OF SCREENINGS THROUGHOUT THE YEAR. SCREENINGS ARE COORDINATED MONTHLY VIA OUR ON-SITE AND OFF-SITE AMBULATORY CARE CENTERS. ADDITIONALLY, FOR THOSE IN THE COMMUNITY WHO ARE UNABLE TO ATTEND THE SCHEDULED SCREENINGS EFFORTS, WE OFFER AN ON-LINE FREE SCREENING COUPON. THIS COUPON ALLOWS FOR PRIVATE SCREENING APPOINTMENTS VIA OUR AMBULATORY CARE DIVISION, COORDINATED IN CONJUNCTION WITH THE DEPARTMENT OF PUBLIC AFFAIRS. LASTLY, KINGSBROOK PARTICIPATES IN BETWEEN 40-50 HEALTH FAIRS, EDUCATIONAL SESSIONS AND COMMUNITY EVENTS ANNUALLY WITH A MYRIAD OF SCREENING OPTIONS. THESE EVENTS ARE COORDINATED BY OUR COMMUNITY PARTNERS, LOCAL CLERGY AND ELECTED OFFICIALS. THESE EFFORTS ALLOW US A BROADER ARENA BY WHICH TO PROVIDE EARLY DETECTION AND HEALTH EDUCATION SERVICES. ADDITIONALLY, WE HAVE ENGAGED ADDITIONAL COMMUNITY PARTNERS TO HELP DRIVE THIS PREVENTION AGENDA FOCUS AND ASSIST US IN CO-PARTNERING EFFORTS TO EXTEND OUR REACH FOR CHRONIC DISEASE EARLY DETECTION SERVICES. THESE PARTNERSHIPS HAVE PROVIDED US THE ABILITY TO OFFER BREAST CANCER WORKSHOPS, EXTERNAL EDUCATIONAL EFFORTS FOR DIABETES, STROKE, HYPERTENSION AND KIDNEY DISEASE. OUR GOAL IS TO CONTINUE EXTENDING THESE PARTNERSHIP OPPORTUNITIES WITHIN THE COMMUNITY. SOME OF THE CURRENT GROUPS AND EVENTS WHICH WE HAVE PARTNERED WITH INCLUDE: CLUB ST. VINCENT, CUNY - BROOKLYN COLLEGE, CARIBBEAN WOMEN'S HEALTH, CHURCH OF THE REDEEMER, PS 91, ST. ALBANS COMMUNITY LEADERSHIP COUNCIL, BROOKLYN SEVENTH DAY ADVENTIST CHURCH, ST. THERESE OF LISIEUX ROMAN CATHOLIC CHURCH, ARTHUR ASHE INSTITUTE FOR URBAN HEALTH, TRINITY BAPTIST CHURCH, BROOKLYN YOUTH SUMMIT, BROOKLYN METROPOLIS LIONS CLUB, BAYVIEW HOUSES, MT. ZION HEALTH FAIR, REMSEN CHURCH OF GOD, ST ANTHONY, BARBADIAN NURSES ASSOCIATION, EAST FLATBUSH COMMUNITY RESEARCH SCHOOL, AND WESLEYN BAPTIST CHURCH.IN 2017, KINGSBROOK PROVIDED EARLY DETECTION OPPORTUNITIES TO OVER 7,096 INDIVIDUALS. SCREENINGS FOR ASTHMA, STROKE DIABETES, HYPERTENSION, HIV, PROSTATE AND BREAST CANCER WERE OF SPECIAL FOCUS. DESPITE THE EVER GROWING FINANCIAL CHALLENGES FOR HEALTHCARE ORGANIZATIONS, KINGSBROOK HAS BEEN ABLE TO MAINTAIN ITS AGGRESSIVE OUTREACH AND ANNUAL SCREENING SCHEDULE FACILITATING A NUMBER OF PRIVATE AND PARTNERED EVENTS IN EFFORT TO ADDRESS THE COMMUNITY'S ACCESS TO QUALITY CARE AND INTERVENTION FOR CHRONIC DISEASES, AS WE HAVE DETAILED OUT FURTHER BELOW. PATIENT-CENTERED MEDICAL HOME (PCHM) - KINGSBROOK HAS BEEN RECOGNIZED BY NCQA AS A LEVEL 3 PCMH PRACTICE PROVIDING PRIMARY CARE AND CHRONIC DISEASE TREATMENT VIA A SET OF STANDARDS THAT DESCRIBE CLEAR AND SPECIFIC CRITERIA INCLUDING ORGANIZING CARE AROUND PATIENTS, WORKING IN TEAMS AND COORDINATING AND TRACKING CARE OVER TIME. THE NCQA PCMH STANDARDS STRENGTHEN AND ADD TO THE ISSUES ADDRESSED BY NCQA'S ORIGINAL PROGRAM. AS SUCH, WE WILL BE COMMITTED TO THIS MODEL BEYOND 2017. PCMH IS A HEALTH CARE SETTING THAT FACILITATES PARTNERSHIPS BETWEEN INDIVIDUAL PATIENTS AND THEIR PERSONAL PHYSICIANS, AND WHEN APPROPRIATE, THE PATIENT'S FAMILY. CARE IS FACILITATED BY REGISTRIES, INFORMATION TECHNOLOGY, HEALTH INFORMATION EXCHANGE AND OTHER MEANS TO ASSURE THAT PATIENTS GET THE INDICATED CARE WHEN AND WHERE THEY NEED AND WANT IT IN A CULTURALLY AND LINGUISTICALLY APPROPRIATE MANNER.THE OVERALL GOAL FOR KINGSBROOK'S PCMH PROGRAMS IS TO IMPROVE THE QUALITY AND CONTINUITY OF CARE THAT PATIENTS RECEIVE WHILE ENHANCING THE AMBULATORY TRAINING EXPERIENCE OF THE PRIMARY CARE RESIDENTS. THE PCMH PROGRAM IS CENTRAL TO SEVERAL DSRIP INITIATIVES TO IMPROVE OUTCOMES AND ACCESS FOR THE RESIDENTS OF BROOKLYN WHO REQUIRE CARE FOR CARDIOVASCULAR DISEASE, SINGLE CHRONIC DISEASE, BEHAVIORAL HEALTH INTEGRATION, PALLIATIVE CARE AND ASTHMA. TO MEET THESE GOALS, THIS PROGRAM WILL IMPROVE THE CONTINUITY TRAINING EXPERIENCE FOR RESIDENT PHYSICIANS AND SUPPORT IMPROVEMENTS IN THE INTEGRATION AND COORDINATION OF CARE WHILE REDUCING AVOIDABLE INPATIENT HARM. THE PROVISION OF SUPPORT FOR TRANSFORMING DELIVERY SYSTEMS TO DELIVER A PATIENT CENTERED MEDICAL HOME CARE MODEL, PLACING A FOCUS ON MEASUREABLE IMPROVEMENTS IN QUALITY AND SAFETY, IS A CENTRAL STRATEGY OF THIS PROGRAM. CHRONIC DISEASE FOCUSES INCLUDE: COMPREHENSIVE DIABETES CARE: BLOOD PRESSURE/NEPHROPATHY MONITORING/HBA1 CONTROL, MONITORING COLORECTAL CANCER SCREENINGS, MU TOBACCO USE/SMOKING CESSATION, CERVICAL CANCER SCREENING, MU BREAST CANCER SCREENING, POST SPECIALTY CARE VISITS/WAIT TIMES, REFERRALS & INADEQUATE DOCUMENTATION.COMMUNICATION TO ENHANCE ACCESS - IN 2017, KINGSBROOK WORKED IN COLLABORATION WITH SEVERAL COMMUNITY ORGANIZATIONS TO DISCUSS OPTIONS FOR EDUCATION, OUTREACH, EARLY DETECTION AND WAYS BY WHICH TO INCREASE COMMUNITY HEALTH AWARENESS. DURING 2017, OVER 1,628 PEOPLE ATTENDED OUR EVENTS. THE PARTNERSHIPS PRODUCED COLLABORATIVE EVENTS THAT INCLUDED THE FOLLOWING: - CARIBBEAN WOMEN'S HEALTH ASSOCIATION/BREAST HEALTH EDUCATION PARTNERSHIP - TARGETING SPECIAL FOCUS GROUPS ORGANIZED BY THIS LOCAL HEALTH ORGANIZATION, KINGSBROOK'S BREAST HEALTH TEAM COORDINATED SEVERAL EDUCATIONAL SEMINARS ON BREAST CANCER AND HELPED GUIDE WOMEN IN NEED TOWARD PROGRESSIVE TESTING AND TREATMENT. - 8TH ANNUAL GOSPEL FEST - TARGETING THE LARGER SPIRITUAL COMMUNITY OF CENTRAL BROOKLYN, THIS EVENT FOCUSED ON THE IMPORTANCE OF PHYSICAL AND SPIRITUAL WELLNESS IN ONES OVERALL HEALTH. SCREENINGS AND INFORMATION WERE PROVIDED ALONG WITH A THREE HOUR CONCERT LINE UP DRAWING OVER 3000 PEOPLE. SCREENINGS AND EDUCATION FOR DIABETES, HYPERTENSION AND ASTHMA WERE AVAILABLE FOR GUESTS. THIS EVENT WAS HELD ON OCTOBER 8TH 2017.- PIERRE TOUSSAINT OPEN HOUSE EVENTS - IN AN EFFORT TO TARGET MORE VOLUME IN OUR AMBULATORY CARE DIVISIONS, PIERRE TOUSSAINT HELD SEVERAL OPEN HOUSE EVENTS TO THE COMMUNITY OFFERING FREE SCREENINGS SUCH AS: DIABETES, HIV/AIDS, HYPERTENSION AND ASTHMA. - THE BEST HEALTH SCHOOL - IN 2017, KJMC OFFERED A NEW COMMUNITY PROGRAM CALLED THE BEST HEALTH SCHOOL. THIS PROGRAM IS A NEW PREVENTION AND WELLNESS INITIATIVE THAT PROVIDES A FREE, YEAR-LONG HEALTH AND WELLNESS CURRICULUM FOR THE COMMUNITY. THIS UNIQUE MODEL PROVIDES A WIDE RANGE OF WELLNESS EDUCATION TO CHOOSE FROM, INCLUDING ESSENTIAL CLASSES FOR CPR AND STROKE AWARENESS. THE PROGRAM IS DESIGNED TO BUILD A HEIGHTENED AWARENESS TO HEALTH DISPARITIES AND RISK FACTORS, AND IT OFFERS A CERTIFICATE OF COMPLETION TO PARTICIPANTS. THIS EFFORT IS SUPPORTED AND CHAMPIONED BY KINGSBROOK'S COMMUNITY LEADERSHIP COUNCIL, WHICH IS COMPRISED OF MEMBERS OF THE COMMUNITY, FAITH LEADERS, AND HEALTH PARTNERS WHO SHARE OUR MISSION OF PROVIDING THE VERY BEST PREVENTION AND WELLNESS MODULES TO OUR COMMUNITY. WE OFFER CLASSES ON SITE AS WELL AS IN THE COMMUNITY AND ORGANIZATIONS UPON REQUEST. DURING 2017, KJMC HELP 59 PRESENTATIONS WHICH OFFERED 16 DIFFERENT CLASSES WITH TOPICS RANGING FROM OBESITY, DIABETIC FOOT CARE, STRESS MANAGEMENT FOR WOMEN AND STROKE/VASCULAR EDUCATION. OVER 1,750 PEOPLE ATTENDED THESE EVENTS. PART VI, LINE 6: AFFILIATED HEALTH CARE SYSTEM:KINGSBROOK JEWISH MEDICAL CENTER IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. PART VI, LINE 7, REPORTS FILED WITH STATES NY X X X X 0 0 0 0 0 0 0 0 0 LINDA BRADY MD PRESIDENT & BOARD DIRECTOR 1371296 0 0 0 37139 0 24000 0 39606 0 1472041 0 0 0 JOHN SCHMITT CPA ASSISTANT TREASURER & CFO 490898 0 0 0 26794 0 24000 0 39606 0 581298 0 0 0 ROBERT DUBICKI SENIOR VP OF STRATEGIC PLANNING 356038 0 0 0 22574 0 24000 0 37100 0 439712 0 0 0 JANE LEDERER CHIEF NURSING OFFICER 327470 0 0 0 5715 0 23646 0 33282 0 390113 0 0 0 SIBTE BURNEY MD CHIEF MEDICAL OFFICER 460043 0 0 0 26230 0 24000 0 33218 0 543491 0 0 0 KURT KODROFF CEO KJMC 615998 0 0 0 37579 0 24000 0 37925 0 715502 0 0 0 MARC ROSS MD CHAIR REHAB MED 511639 0 0 0 1035 0 24000 0 40425 0 577099 0 0 0 WILLIAM LOIS CHAIR SURGERY 457603 0 0 0 2970 0 24000 0 32949 0 517522 0 0 0 VIJAY AKKAPEDDI CHAIR EMERGENCY DEPT 432979 0 0 0 2970 0 24000 0 37106 0 497055 0 0 0 NICHOLAS POST PHYSICIAN 603042 0 0 0 0 0 0 0 17885 0 620927 0 0 0 OLALEKAN BADIRU PHYSICIAN 488735 0 0 0 0 0 0 0 11355 0 500090 0 0 0 FORM 990, PART VI, SECTION A, LINE 6 MEMBERS OR STOCKHOLDERS: KINGSBROOK HEALTHCARE SYSTEM ("KHS") IS THE SOLE MEMBER OF KINGSBROOK JEWISH MEDICAL CENTER. FORM 990, PART VI, SECTION A, LINE 7A MEMBERS OF THE GOVERNING BODY: MEMBERS MAY ELECT AND APPOINT MEMBERS OF THE GOVERNING BOARD AND BOARD OFFICERS OF THE CORPORATION. FORM 990, PART VI, SECTION A, LINE 7B DECISIONS OF THE GOVERNING BODY: KHS IS THE SOLE MEMBER OF KINGSBROOK JEWISH MEDICAL CENTER, AND IT HAS RESERVED POWERS THAT ARE DELINEATED IN THE BYLAWS OF KINGSBROOK JEWISH MEDICAL CENTER. FORM 990, PART VI, SECTION B, LINE 11B REVIEW PROCESS FOR FORM 990: THE CFO HAS CONDUCTED A REVIEW OF THE 990 WITH THE HOSPITAL'S TAX ACCOUNTANT AND ALL APPROPRIATE CHANGES HAVE BEEN MADE. DRAFT RETURNS WERE THEN PROVIDED TO THE BOARD MEMBERS OF THE FINANCE AUDIT AND COMPLIANCE COMMITTEE (FACC) FOR THEIR REVIEW FOR ANY ADDITIONAL COMMENTARY, OBSERVATIONS, OR RECOMMENDATIONS. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST POLICY ALL CONFLICTS OF INTEREST ARE REVIEWED BY THE COMPLIANCE OFFICER. ANY POTENTIAL CONFLICTS INVOLVING BOARD MEMBERS ARE REFERRED TO THE AUDIT AND COMPLIANCE COMMITTEE FOR REVIEW AND/OR ACTION, AS NECESSARY. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION POLICY CONSISTENT WITH BEST PRACTICES IN GOVERNANCE AND FIDUCIARY OVERSIGHT OF TAX EXEMPT FUNDS, KINGSBROOK JEWISH MEDICAL CENTER (KJMC) HAS INSTITUTED A WRITTEN EXECUTIVE COMPENSATION PHILOSOPHY AND COMPENSATION COMMITTEE CHARTER. THE COMPENSATION COMMITTEE IS AUTHORIZED BY THE BOARD TO DEVELOP AND RECOMMEND FOR BOARD APPROVAL THE COMPENSATION OF THE PRESIDENT AND CEO AND MEMBERS OF SENIOR MANAGEMENT (SENIOR VICE PRESIDENTS, VICE PRESIDENTS AND ASSISTANT VICE PRESIDENTS). ONLY INDEPENDENT MEMBERS OF THE BOARD SHALL PARTICIPATE IN COMPENSATION DELIBERATIONS AND DECISIONS (I.E., EMPLOYEES, MEMBERS OF THE MEDICAL STAFF AND CONSULTANTS ARE NOT DEEMED INDEPENDENT FOR THESE PURPOSES). ALL EXECUTIVE COMPENSATION DECISIONS ARE BASED ON COMPETITIVE MARKET DATA, ORGANIZATIONAL AND INDIVIDUAL PERFORMANCE RESULTS, AND ALIGNMENT WITH KJMC'S EXECUTIVE COMPENSATION PHILOSOPHY. THE BOARD'S COMPENSATION COMMITTEE REVIEWS AND APPROVES ALL EXECUTIVE COMPENSATION TO ENSURE LEGAL AND REGULATORY COMPLIANCE AND ADHERENCE TO GOVERNANCE BEST PRACTICES AND PROPER FIDUCIARY OVERSIGHT AS STEWARDS OF TAX EXEMPT ASSETS. THE EXECUTIVE COMPENSATION PHILOSOPHY STATES ITS INTENT IS TO MAINTAIN A COMPETITIVE EXECUTIVE COMPENSATION PROGRAM IN ORDER TO ATTRACT, RETAIN AND MOTIVATE QUALIFIED EMPLOYEES TO SUPPORT THE MISSION AND BUSINESS GOALS OF KJMC. THE COMPENSATION COMMITTEE RETAINS OUTSIDE LEGAL COUNSEL WHO REVIEWS COMPLIANCE WITH TAX AND REGULATORY REQUIREMENTS AS WELL AS THE SERVICES OF AN INDEPENDENT QUALIFIED COMPENSATION CONSULTANT WHO COMPILES AND ANALYZES PUBLISHED SURVEY DATA, ON AN ANNUAL BASIS, FOR BASE SALARIES AND TOTAL COMPENSATION PROVIDED BY TAX EXEMPT HOSPITALS AND MEDICAL CENTERS SIMILAR TO KJMC IN SIZE, OPERATIONS AND LOCATION. THE COMMITTEE'S REVIEW OF COMPENSATION OCCURS ANNUALLY SUCH THAT EXECUTIVE COMPENSATION AND BENEFITS CONTINUE TO BE COMPETITIVE AND REASONABLE. BY FOLLOWING THE PRECEDING GOVERNANCE AND FIDUCIARY PRACTICES, THE COMMITTEE QUALIFIES FOR THE REBUTTABLE PRESUMPTION OF REASONABLENESS UNDER THE INTERMEDIATE SANCTIONS REGULATIONS OF THE INTERNAL REVENUE CODE SUCH THAT THE TOTAL COMPENSATION PROVIDED TO THE EXECUTIVES IS COMPARED TO WHAT IS ORDINARILY PAID FOR LIKE SERVICES BY LIKE ENTERPRISES UNDER LIKE CIRCUMSTANCES", AS DEFINED IN THE INTERMEDIATE SANCTIONS REGULATIONS. BASE PAY FOR EACH EXECUTIVE IS EASED ON FACTORS INCLUDING MARKET DATA, TENURE, EXPERIENCE, AND INDIVIDUAL AND ORGANIZATIONAL PERFORMANCE. EXECUTIVE BASE PAY IS REVIEWED AND SET ANNUALLY BY THE INDEPENDENT MEMBERS OF THE COMPENSATION COMMITTEE OF THE INDEPENDENT DIRECTORS OF KINGSBROOK JEWISH MEDICAL CENTER [KJMC], BASED ON THE EXECUTIVE COMPENSATION PHILOSOPHY AND COMPENSATION COMMITTEE CHARTER. AS DESCRIBED IN KJMC'S EXECUTIVE COMPENSATION PHILOSOPHY AND COMPENSATION COMMITTEE CHARTER, KJMC SUPPORTS PERFORMANCE BASED COMPENSATION AND THEREFORE HAS IMPLEMENTED AN ANNUAL INCENTIVE PAY PROGRAM (EXECUTIVE MANAGEMENT ANNUAL INCENTIVE PLAN) FOR THE EXECUTIVES, WHICH IS CURRENTLY SUSPENDED, AND A LONG TERM INCENTIVE PAY PROGRAM (ANNUALIZED STRATEGIC PERFORMANCE INCENTIVE) FOR THE PRESIDENT AND CEO. THE ANNUAL AND LONG-TERM INCENTIVE PAY PROGRAMS ARE DESIGNED TO SUPPORT THE ATTAINMENT OF ANNUAL AND STRATEGIC PERFORMANCE OBJECTIVES AND REFLECT A COMBINATION OF FORMULAIC WEIGHTINGS PROVIDING FOR THRESHOLD, TARGET AND MAXIMUM BONUS LEVELS AND DISCRETIONARY JUDGMENT AS DETERMINED BY THE COMPENSATION COMMITTEE. THE PERFORMANCE MEASURES ARE SET PRIOR TO THE BEGINNING OF EACH PLAN YEAR AND PLAN PAYMENTS ARE DETERMINED BASED ON AUDITED FINANCIAL RESULTS AND OTHER MEASURES. FORM 990, PART VI, LINE 15B COMPENSATION REVIEW THE PROCESS USED FOR DETERMINING THE COMPENSATION OF THE CEO ALSO APPLIES TO MEMBERS OF THE EXECUTIVE STAFF, DEPARTMENT CHAIRS AND OTHER HIGHLY COMPENSATED STAFF EXCEPT THAT THE PRESIDENT AND CEO MAKES COMPENSATION RECOMMENDATIONS TO THE COMPENSATION SUBCOMMITTEE FOR THOSE EMPLOYEES. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS AVAILABLE FOR PUBLIC INSPECTION: THE ORGANIZATION MAKES ITS FORM 1023 AND FORM 990 AVAILABLE UPON REQUEST FOR THE SAME PERIOD OF DISCLOSURE AS SET FORTH IN SECTION 6104(D). FORM 990, PART XI, LINE 9: PENSION RELATED CHANGES OTHER THAN NET PERIODIC PENSION COSTS 957,000. TRANSFER TO AFFILIATE (RNH) -142,407,259. RUTLAND NURSING HOME INC 585 SCHENECTADY AVENUE BROOKLYN NY 11203 112164674 NURSING HOME NY 501(C)(3) LINE 10 KHS 0 KINGSBROOK JEWISH MEDICAL CENTER AUXILIARIES 585 SCHENECTADY AVENUE BROOKLYN NY 11203 113016121 SUPPORT ORG NY 501(C)(3) LINE 12A, I KJMC 0 KINGSBROOK HEALTHCARE SYSTEM INC (KHS) 585 SCHENECTADY AVENUE BROOKLYN NY 11203 030464734 SUPPORT ORG NY 501(C)(3) LINE 12A, I N/A 0 KINGSBROOK HEALTHCARE FOUNDATION INC 585 SCHENECTADY AVENUE BROOKLYN NY 11203 112845058 SUPPORT ORG NY 501(C)(3) LINE 12A, I KHS 0 KSI INC 585 SCHENECTADY AVENUE BROOKLYN NY 11203 562327654 INACTIVE NY KHS C 0 SINGULAB INC 585 SCHENECTADY AVENUE BROOKLYN NY 11203 562327669 INACTIVE DE KSI INC C 0 ATM NURSE REGISTRY 585 SCHENECTADY AVENUE BROOKLYN NY 11203 562327649 INACTIVE NY KSI INC 0 KINGSBROOK LTACH INC 585 SCHENECTADY AVENUE BROOKLYN NY 11203 800712226 INACTIVE NY KHS C 0 KINGSBROOK MEDICAL ASSOCIATES PC 585 SCHENECTADY AVENUE BROOKLYN NY 11203 452351859 BILLING & COLLECTION NY KJMC C 1.00000 1 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 0 1 1 1 KINGSBROOK MEDICAL ASSOCIATES PC S 4265000 ACTUAL AMOUNT RUTLAND NURSING HOME INC S 51152950 ACTUAL AMOUNT RUTLAND NURSING HOME INC R 142407259 ACTUAL AMOUNT