2016-08-16T09:01:31-05:00 2015-12-31 BDO USA LLP 100 PARK AVENUE NEW YORK NY 100175001 990 2015-01-01 111667765 SOUTHAMPTON HOSPITAL ASSOCIATION % CHRISTOPHER SCHULTHEIS SOUT 6317268301 240 MEETING HOUSE LANE SOUTHAMPTON NY 11968 CHRISTOPHER SCHULTHEIS CFO 6314234580 2016-08-15 true Paul Hammerschmidt P01384178 2128858000 2015 2017-02-10 21:41:12Z ROBERT S CHALONER 240 MEETING HOUSE LANE SOUTHAMPTON NY 11968 150453706 false X www.southamptonhospital.org X 1909 NY TO PROVIDE AND ENSURE THE HIGHEST QUALITY OF HEALTHCARE SERVICES FOR ITS ENTIRE COMMUNITY. 22 21 1227 25 3263661 11272875 5486201 130907809 138558938 1094544 813291 941126 1012662 144216354 145871092 0 0 0 0 83145144 89750094 0 0 0 51888924 55128284 135034068 144878378 9182286 992714 112332163 120793141 82418298 92946090 29913865 27847051 X THE VISION OF SOUTHAMPTON HOSPITAL ASSOCIATION IS TO MEET THE EVOLVING HEALTHCARE NEEDS OF ITS EASTERN LONG ISLAND COMMUNITY BY PROVIDING ACCESS TO A CONTINUUM OF HIGH QUALITY CLINICAL SERVICES. TO ACHIEVE THIS, THE HOSPITAL WILL FOCUS RESOURCES ON CONTINUOUSLY IMPROVING CLINICAL OUTCOMES, PATIENT SAFETY, SERVICE EXCELLENCE AND PROMOTING EDUCATIONAL OUTREACH AND PROFESSIONAL DEVELOPMENT OF ITS STAFF. THE ORGANIZATION IS A MEMBER OF THE EAST END HEALTH ALLIANCE, THE ARTICLE 28 PARENT OF EASTERN LONG ISLAND HOSPITAL, PECONIC BAY MEDICAL CENTER AND SOUTHAMPTON HOSPITAL. CONSISTENT WITH THE MISSION OF THE ORGANIZATION, THE GOALS OF THE ALLIANCE ARE AS FOLLOWS: 1) TO COLLABORATIVELY DEVELOP HIGH QUALITY, COMPREHENSIVE AND ACCESSIBLE HEALTH CARE SERVICES TO MEET THE NEEDS OF THE COMMUNITY SERVED; 2) TO RATIONALIZE HEALTH CARE SERVICES ACROSS THE SYSTEM; AND 3) TO REALIZE MANAGEMENT EFFICIENCIES. SOUTHAMPTON HOSPITAL IS CURRENTLY AFFILIATED WITH STONY BROOK MEDICINE. THE TWO INSTITUTIONS ARE false false 122966280 0 135295277 SOUTHAMPTON HOSPITAL ASSOCIATION OFFERS A FULL CONTINUUM OF AMBULATORY AND INPATIENT SERVICES RANGING FROM PRIMARY MEDICAL CARE TO SPECIALIZED SURGICAL PROCEDURES, AND IS STAFFED BY MORE THAN 280 PHYSICIANS, DENTISTS AND ALLIED HEALTH PROFESSIONALS REPRESENTING 44 MEDICAL SPECIALTIES. THE ORGANIZATION has developed numerous services and outreach, detailed below, to respond to the needs of its patients, including recruiting additional primary care and specialty physicians, RNs, NPs, and PAs. The graduate medical education program is training physicians for primary and family practice, as well as surgery, and a gratifying number of these doctors are staying within the Hospital's service area. It is anticipated that the Affordable Care Act and the insurance exchanges will result in many more people accessing primary care and the Hospital continues to prepare for this inevitability through its medical education program. SINCE THE ORGANIZATION'S SERVICE AREA EXTENDS FROM WESTHAMPTON BEACH TO MONTAUK, THE HOSPITAL HAS A NUMBER OF SATELLITE OFFICES TO PROVIDE CONVENIENT, SPECIALIZED CARE TO THESE COMMUNITIES. THESE INCLUDE: A) MEETING HOUSE LANE MEDICAL PRACTICE - the practice continues to add new offices in primary, internal medicine, and specialty care on the South Fork. Specialty care services include rheumatology, nephrology, neurology, allergy/asthma, pulmonology, psychiatry, infectious disease, gastroenterology, as well as nutritional and diabetes education. In Southampton, an office was added to the four existing sites, bringing the total to five and a surgical specialty office was also opened in 2015, offering general, orthopedic and bariatric surgery. Other offices include locations in Amagansett, East Hampton (two offices), Hampton Bays (three offices), Montauk, Riverhead, Sag Harbor, Wainscott, and Water Mill. B) WESTHAMPTON PRIMARY CARE CENTER - PROVIDING CARE FOR THE WESTHAMPTON, WESTHAMPTON BEACH, QUOGUE, AND REMSENBURG COMMUNITIES. C) LABORATORY AND IMAGING SERVICES - PROVIDING SERVICES IN EAST HAMPTON, HAMPTON BAYS AND SOUTHAMPTON. D) REGIONAL DIALYSIS CENTER - SERVICE TO DIALYSIS PATIENTS IS PROVIDED BY A DEDICATED INTERDISCIPLINARY TEAM OF BOARD-CERTIFIED NEPHROLOGISTS, CERTIFIED DIALYSIS RNS, LPNS AND DIALYSIS TECHNICIANS, CERTIFIED SOCIAL WORKERS, AND A NYS REGISTERED DIETITIAN. 24-HOUR EMERGENCY SERVICE IS ALSO AVAILABLE. E) CENTER FOR PHYSICAL THERAPY AND SPORTS REHABILITATION - PROVIDING CARE FOR THE WESTHAMPTON, WESTHAMPTON BEACH, EAST QUOGUE, QUOGUE, AND REMSENBURG COMMUNITIES. F) THE SHINNECOCK INDIAN HEALTH CLINIC - SINCE APRIL OF 1995, SOUTHAMPTON HOSPITAL HAS WORKED WITH THE SHINNECOCK NATION TO PROVIDE SERVICES AT THE SHINNECOCK INDIAN HEALTH CLINIC THROUGH A CONTRACT WITH THE NEW YORK STATE DEPARTMENT OF HEALTH. ON AN ANNUAL BASIS, THE CLINIC PROVIDES APPROXIMATELY 2,100 MEDICAL AND 1,000 DENTAL VISITS FOR ELIGIBLE MEMBERS OF THE SHINNECOCK NATION. DENTAL SERVICES, INCLUDING COMMUNITY EDUCATION, SCREENING, RADIOLOGICAL EXAMS, DENTAL HYGIENE AND RESTORATIVE CARE ARE PROVIDED THROUGH A SUBCONTRACT WITH STONY BROOK UNIVERSITY SCHOOL OF DENTAL MEDICINE. CURRENTLY, DENTAL SERVICES ARE AVAILABLE EIGHT DAYS PER MONTH FOR ADULTS AND TWO DAYS FOR CHILDREN. IN ADDITION TO PRIMARY CARE, DENTAL SERVICES, NUTRITIONAL COUNSELING, PRENATAL CARE AND ENDOCRINE SERVICES, THE CLINIC PROVIDES MENTAL HEALTH AND SUBSTANCE ABUSE COUNSELING. HEALTH SCREENING DAY IS ALSO HELD ANNUALLY IN COLLABORATION WITH LOCAL HEALTHCARE PROVIDERS AND INSTITUTIONS. G) THE DAVID E. ROGERS CENTER FOR HIV/AIDS CARE (DRC) provides comprehensive HIV medical care, with 24/7 on call service; mental health counseling; psychiatry care; medical case management with treatment adherence; nutritional counseling; Hepatitis C treatment; Pre-Exposure Prophylaxis (PrEP) care; Post-Exposure Prophylaxis (PEP) care; free HIV testing; help with advocacy, case management, entitlements, and legal service; Wellness Fund, financial support for patient's special needs; and other support services to people living with HIV/AIDS. The Center also provides education and outreach to affected friends and families. From initial diagnosis of HIV through all stages of illness, our medical team of credentialed HIV specialists provides state-of-the-art care. SINCE 1994 THE DRC HAS PROVIDED HIV CARE TO RESIDENTS OF THE EAST END OF LONG ISLAND, A GEOGRAPHIC AREA PREVIOUSLY UNDERSERVED DESPITE A HIGH HIV PREVALENCE RATE. FROM ITS INCEPTION, THE DRC HAS ENJOYED THE COOPERATIVE EFFORTS OF ITS PARTNER ORGANIZATIONS SOUTHAMPTON HOSPITAL AND THE STONY BROOK UNIVERSITY MEDICAL CENTER AS WELL AS THE SUPPORT OF THE COMMUNITIES OF THE EAST END. THE CENTER HAS MET ITS OBJECTIVES BY PROVIDING CONTINUITY AND ACCESSIBILITY OF CARE BY ESTABLISHING LINKAGES BETWEEN THE HOSPITALS AND WITH COMMUNITY BASED ORGANIZATIONS AND THE COMMUNITY AT LARGE. THE DRC DEPENDS ON THE COOPERATIVE EFFORTS OF ALL HEALTH & HUMAN SERVICE AGENCIES FOR OUTREACH, TO ENSURE A CONTINUITY OF CARE FOR OUR PATIENTS, AND TO PROVIDE SERVICES FOR THE EAST END COMMUNITY. Annually the DRC provides approximately: 844 Medical visits; 56 Hepatitis C visits; 561 Mental Health/Social Work visits; 229 Psychiatry visits; 32 Nutritional Counseling visits; 21 HIV Testing visits; 14 Pre-Exposure Prophylaxis (PrEP) visits; 4 Occupational Exposure visits; 10 Post Exposure Prophylaxis (PEP) visits; for a total of 1,771 visits provided for 219 active patients. H) CENTER FOR PRENATAL CARE - THE CENTER FOR PRENATAL CARE AT GREENPORT PROVIDES COMPREHENSIVE PRENATAL, GYNECOLOGIC AND FAMILY PLANNING SERVICES FOR WOMEN AND IS AN IMPORTANT OUTREACH ACTIVITY THAT PERMITS THE HOSPITAL TO TAILOR ITS PROGRAMS TO COMMUNITY NEEDS. THE CENTER'S STAFF PROVIDES EXTENSIVE EDUCATION AND COUNSEL TO THEIR PATIENTS IN THE AREAS OF NUTRITION, CHILDBIRTH EDUCATION, DOMESTIC VIOLENCE, AS WELL AS DRUG AND ALCOHOL ABUSE, WHILE ALSO PROVIDING IMMEDIATE ACCESS TO MEDICAID ASSISTANCE, FOR MOTHERS MEETING THE ELIGIBILITY REQUIREMENTS, THROUGH THE PRENATAL CARE ASSISTANCE PROGRAM (PCAP). THE CENTER HAS SUCCESSFULLY WORKED WITH THE LOCAL TOWN GOVERNMENT TO OBTAIN THE AGREEMENT OF LOCAL GROCERS TO ACCEPT WIC VOUCHERS. STAFF ALSO UTILIZES FLYERS, BROCHURES, AND POSTERS TO INCREASE AWARENESS OF HOSPITAL SERVICES AND OFFERS TRANSLATION SERVICES TO THE SIGNIFICANT NUMBER OF HISPANIC WOMEN SEEKING CARE AT THE CENTER. THE CENTER RECENTLY STARTED IMPLEMENTING GENETIC SCREEING, WHICH IS AVAILABLE TO ALL ITS PATIENTS AND CAN BE PERFORMED AT 10 WEEKS GESTATION. THE SCREENING INCLUDES TESTING FOR DOWN SYNDROME CF, AS WELL AS PROVIDING THE SEX OF THE CHILD. THE CENTER PROVIDES PRENATAL CARE TO APPROXIMATELY 50 MOTHERS ANNUALLY IN AN UNDERSERVED AND GEOGRAPHICALLY REMOTE AREA. ALL OF THESE BABIES ARE BORN AT SOUTHAMPTON HOSPITAL. IN ADDITION, THE ORGANIZATION IS PROUD OF THE EXCEPTIONAL SPECIALTY SERVICES IT PROVIDES TO THE COMMUNITY. THESE INCLUDE: 1) Audrey and Martin Gruss Heart & Stroke Center - opened in April 2015, providing vascular surgery and diagnostics in a state-of-the-art operating suite. This is particularly critical to the Hospital's service area since the nearest tertiary medical center is 46 miles away in Stony Brook, NY. 2) Tick-Borne Disease Resource Center - established in 2014, was created in response to a growing concern for diseases that are prevalent in the East End population due to several varieties of ticks found in the area. The Resource Center educates the public, promotes collaboration in the medical community, and facilitates access to diagnosis and treatment of tick-borne diseases. We maintain a dedicated phone "help" line for advice, include information about the complex set of tick-borne diseases on the Hospital website, and raise public awareness by presenting educational programs throughout the East End community. 3) THE ELLEN HERMANSON BREAST CENTER - OFFERS A WIDE SPECTRUM OF BREAST HEALTH SERVICES, INCLUDING EDUCATION, EARLY DETECTION SCREENINGS, SURGERY, BREAST CANCER TREATMENT AND SUPPORT. ACCREDITED BY THE AMERICAN COLLEGE OF RADIOLOGY, THE CENTER UTILIZES STATE-OF-THE-ART DIAGNOSTIC TECHNIQUES, INCLUDING COMPUTER-ASSISTED MAMMOGRAPHY, TOMOSYNTHESIS, ULTRASOUND AND BREAST BIOPSY. 4) THE ED & PHYLLIS DAVIS WELLNESS INSTITUTE - OFFERS THE ONLY HOSPITAL-BASED INTEGRATIVE MEDICINE ON LONG ISLAND'S EAST END. INTEGRATIVE MEDICINE COMBINES MODERN SCIENCE, PSYCHOLOGY, NUTRITION, AND EXERCISE TO ENHANCE THE NATURAL HEALING CAPACITY OF THE BODY. SPECIAL PROGRAMS ARE AVAILABLE FOR PATIENTS SUFFERING FROM CHRONIC ILLNESS. CLASSES IN YOGA, TAI CHI, PILATES, ZUMBA, ARE AVAILABLE. PROGRAMS IN STRESS MANAGEMENT, NUTRITIONAL AND WEIGHT LOSS COUNSELING, SMOKING CESSATION, MASSAGE THERAPY, AND ACUPUNCTURE ARE ALSO AVAILABLE. 5) THE JENNY AND JOHN PAULSON DEPARTMENT OF EMERGENCY MEDICINE - SERVES MORE THAN 25,000 EMERGENCY PATIENTS ANNUALLY AND IS THE ONLY HOSPITAL-BASED EMERGENCY CARE ON THE SOUTH FORK OF LONG ISLAND. STAFFED 24/7 BY BOARD-CERTIFIED EMERGENCY PHYSICIANS 122966280 true true false true false false false false false true true true false true true true false true false false false false false false false false true true false false true true false false false false false false false false false false false false false false false true true true false false true 286 0 true 1227 true true true false false false false false false false false false X 22 21 false false false false true true true true true false false true true true true true true true true true false NY X X CHRISTOPHER SCHULTHEIS 6317268301 240 MEETING HOUSE LANE SOUTHAMPTON NY 11968 X ROBERT S CHALONER PRESIDENT & CEO 38.5 0.5 X X 679836 0 40186 KENNETH B WRIGHT CHAIRMAN 1.25 0.0 X X 0 0 0 RICHARD J HIEGEL ESQ VICE CHAIR 1.25 0.0 X X 0 0 0 STANLEY D FRIEDMAN THRU 715 VICE PRESIDENT 1.25 0.0 X X 0 0 0 LAWRENCE A WILLIS TREASURER 1.25 0.0 X X 0 0 0 PATRICIA STEWART SECRETARY 1.25 0.0 X X 0 0 0 GEORGE F BIONDO ESQ TRUSTEE 1.25 0.0 X 0 0 0 BARBARA BORSACK TRUSTEE 1.25 0.0 X 0 0 0 RICHARD BRUCE TRUSTEE 1.25 0.0 X 0 0 0 JEAN FITZSIMMONS THRU 1215 TRUSTEE 1.25 0.0 X 0 0 0 JAMES FORBES TRUSTEE 1.25 0.0 X 0 0 0 RALPH M GIBSON MD THRU 515 TRUSTEE 1.25 0.0 X 0 0 0 DAVID GILLESPIE TRUSTEE 1.25 0.0 X 0 0 0 GILBERT W HARRISON TRUSTEE 1.25 0.0 X 0 0 0 GEORGE P KAZDIN TRUSTEE 1.25 0.0 X 0 0 0 LISA CLARE KOMBRINK ESQ TRUSTEE 1.25 0.0 X 0 0 0 JAY K LEVINE TRUSTEE 1.25 0.0 X 0 0 0 DOROTHY LEWIS THRU 1215 TRUSTEE 1.25 0.0 X 0 0 0 HOWARD M LORBER TRUSTEE 1.25 0.0 X 0 0 0 R TIMOTHY MARAN TRUSTEE 1.25 0.0 X 0 0 0 JOHN MCGOWAN TRUSTEE 1.5 0.0 X 0 0 0 FLORENCE ROLSTON MD TRUSTEE 1.25 0.0 X 0 0 0 STEPHEN H SHAPOFF TRUSTEE 1.25 0.0 X 0 0 0 MICHAEL F SMITH TRUSTEE 1.25 0.0 X 0 0 0 JOHN WAMBOLD TRUSTEE 1.25 0.0 X 0 0 0 DARIN G WIGGINS MD TRUSTEE 1.25 0.0 X 0 0 0 CHIRSTOPHER J SCHULTHEIS CHIEF FINANCIAL OFFICER 37.5 0.5 X 308833 0 40331 FREDERIC I WEINBAUM CHIEF MEDICAL OFFICER & COO 37.5 0.0 X 495145 0 43614 PATRICIA A DARCEY CHIEF NURSING OFFICER 37.5 0.0 X 231013 0 41596 STEVEN GEORGOPOULOS PHYSICIAN 37.5 0.0 X 766622 0 43372 KRISTIN P NASO PHYSICIAN 37.5 0.0 X 499465 0 43372 NEEMA POURTAHERI PHYSICIAN 37.5 0.0 X 458045 0 43372 MICHAEL ELLIS PHYSICIAN 37.5 0.0 X 428325 0 38399 EDNA KAPENHAS DIRECTOR/BREAST SURGEON 37.5 0.0 X 399396 0 40967 4266680 0 375209 128 false true false E4 SERVICES LLC 60 NORTH CAROLINA AVENUE SINKING SPRINGS PA 19608 HEALTHCARE SERVICES 1193958 EW HOWELL CO LLC 245 NEWTOWN ROAD SUITE 600 PLAINVIEW NY 11803 CONSTRUCTION 1052130 MORRISON HEALTHCARE PO BOX 102289 ATLANTA GA 30368 FOOD SERVICES 606441 HAMPTONS GYNECOLOGY OB 595 HAMPTON ROAD SOUTHAMPTON NY 11968 MEDICAL 507500 HIM ON CALL 1033 HAMILTON ROAD ALLENTOWN PA 18101 CONSULTING 308930 28 154999 3836837 1337758 156607 5486201 INPATIENT SERVICES 624200 71097679 71097679 OUTPATIENT SERVICES 624200 69793025 69793025 LABORATORY EXTENDED SERVICES 621500 2825351 2825351 LESS: PROVISION FOR UNCOLLECTIBLES, NET 624200 -6400000 -6400000 LABORATORY REVENUE 621500 675848 675848 567035 128725 438310 138558938 262256 262256 0 0 851116 851116 0 851116 851116 5133649 4582614 551035 551035 551035 0 0 0 SHINNECOCK 3RD PARTY 900099 34388 34388 VENDOR REBATES 900099 6940 6940 FILM COPIES 900099 5816 5816 114402 114402 161546 145871092 135295277 3263661 1825953 0 0 0 0 1880554 1880554 0 65418405 56914012 8504393 4875532 4241713 633819 12869163 11196172 1672991 4706440 4094603 611837 841623 732212 109411 620724 620724 310362 310362 27711 24108 3603 0 104955 104955 5884315 5119354 764961 6979 6072 907 17731744 15426617 2305127 2105230 1831550 273680 0 1832595 1594358 238237 323800 323800 0 6258 6258 1501747 1306520 195227 0 6954633 6050531 904102 2443424 2125779 317645 OTHER PURCHASE SERVICES 10113736 8798950 1314786 UTILITIES 1981661 1724045 257616 OTHER DIRECT EXPENSES 1652136 1437358 214778 MISCELLANEOUS 684651 342326 342325 144878378 122966280 21912098 0 3966458 1032639 1979735 5682148 0 0 18825248 18258115 0 0 0 0 0 0 2178899 3088612 553011 838534 178298208 119503786 57061494 58794422 0 0 26787892 26118484 0 0 0 0 979426 6980187 112332163 120793141 21142884 25155912 0 0 0 0 33500000 33500000 0 0 0 0 6794600 8344501 0 0 20980814 25945677 82418298 92946090 X 26211281 24209575 868566 803459 2834018 2834017 29913865 27847051 112332163 120793141 X 992714 -745749 -2313779 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false true 27711 false false false 27711 false false PART II-B, LINE 1F: SOUTHAMPTON HOSPITAL ASSOCIATION PAYS MEMBERSHIP DUES TO THE BELOW MENTIONED ORGANIZATIONS. A PERCENTAGE OF THESE DUES ARE THEN USED TO REIMBURSE THE ORGANIZATION FOR THE COST OF LOBBYING ACTIVITIES PERFORMED ON BEHALF OF THE HOSPITAL. THE FUNDS ARE USED FOR LOBBYING PURPOSES IN CONNECTION WITH NEW YORK STATE AND FEDERAL POLICY ISSUES. MEMBERSHIP DUES PAID TO OTHER ORGANIZATIONS AND USED FOR LOBBYING PURPOSES: Healthcare Association of New York State........$ 9,757. American Hospital Association...................$ 6,616. Nassau Suffolk Hospital Council.................$ 1,897. Greater NY Hospital Association.................$ 8,494. 1199 HEP FUND...................................$ 947. Total...........................................$27,711. 11858782 -20898 407500 11430384 10808731 698598 351153 11858482 4527461 5500000 781270 10808731 4115379 412082 4527461 4213766 -98387 4115379 0.75210 0.24790 false false 1683775 1683775 44563894 39245620 5318274 115447847 79322382 36125465 16602692 935784 15666908 58794422 SHORT TERM INVESTMENTS 9040008 F RESTRICTIONS 3637476 F INVESTMENTS IN SHA PROPERTIES 6300000 C MALPRACTICE SELF INSURANCE-FD 7141000 F 26118484 DUE FROM AFFILIATE 3127067 DUE TO THIRD-PARTY PAYORS 3033025 BOND ISSUANCE COSTS, NET 807617 OTHER ASSETS 12478 6980187 0 ACCRUED PENSION LIABILITY 8757894 DUE TO THIRD-PARTY PAYORS, NET 7046783 MALPRACTICE SELF-INSURANCE LIABILITY 7141000 DUE TO AFFILIATE 3000000 25945677 X 142770986 -745749 -2249402 -2995151 145766137 104955 104955 145871092 144773423 144773423 104955 104955 144878378 PART V, LINE 4: SOUTHAMPTON HOSPITAL ASSOCIATION CURRENTLY REPORTS ENDOWMENT FUNDS WITHIN ITS DECEMBER 31, 2015 FINANCIAL STATEMENTS. THE GOVERNING BODY INTENDS TO USE THESE FUNDS TO OFFSET THE COST OF INDIGENT CARE, EMERGENCY SERVICES AND NURSING EDUCATION. PART X, LINE 2: SOUTHAMPTON HOSPITAL ASSOCIATION (THE "REPORTING ORGANIZATION") HAS NOT TAKEN AN UNSUBSTANTIATED TAX POSITION THAT WOULD REQUIRE PROVISION OF A LIABILITY UNDER ASC 740. UNDER ASC 740, AN ORGANIZATION MUST RECOGNIZE THE TAX BENEFIT ASSOCIATED WITH TAX POSITIONS TAKEN FOR TAX RETURN PURPOSES WHEN IT IS MORE-LIKELY-THAN-NOT THAT THE POSITION WILL NOT BE SUSTAINED UPON EXAMINATION. THE REPORTING ORGANIZATION DOES NOT BELIEVE THERE ARE ANY MATERIAL UNCERTAIN TAX POSITIONS AND, ACCORDINGLY, HAS NOT RECOGNIZED ANY LIABILITY FOR UNRECOGNIZED TAX BENEFITS. THE REPORTING ORGANIZATION HAS FILED IRS FORM 990 TAX RETURNS, AS REQUIRED, AND ALL OTHER APPLICABLE RETURNS IN JURISDICTIONS WHEN IT IS REQUIRED. FOR THE YEAR ENDED DECEMBER 31, 2015, THERE WAS NO INTEREST OR PENALTIES RECORDED OR INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS. THE REPORTING ORGANIZATION BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR THE YEARS PRIOR TO 2012, WHICH IS THE STATUTE OF LIMITATION LOOK BACK PERIOD. PART XI, LINE 2D: CHANGE IN UNFUNDED PENSION OBLIGATION true true X true X 400. true X false true true false true true 277 2395332 -2175885 219447 0.00150 22714149 11283622 11430527 0.07890 277 25109481 9107737 11649974 0.08040 8808652 4094856 4713796 0.03250 4 46041659 35628461 10413199 0.08110 4 54850311 39723317 15126995 0.11360 4 277 79959792 48831054 26776969 0.19400 64129 64129 64129 64129 true 6400000 2624314 38092076 43044006 -4951930 X true true MEETINGHOUSE LN PRAC PRIMARY/SPECIALTY 1.0 14 1 SOUTHAMPTON HOSPITAL ASSOCIATION 240 MEETINGHOUSE LANE SOUTHAMPTON NY 11968 X A 2 DIALYSIS CENTER 184 W MONTAUK HIGHWAY HAMTPON BAYS NY 11946 X DIALYSIS TREATMENT FACILITY B 3 GREENPORT PRENATAL 300 ATLANTIC AVENUE GREENPORT NY 11944 X PRENATAL/WOMEN'S SERVICES B 4 LAB EAST 200 PANTIGO PLACE EAST HAMPTON NY 11944 X LABORATORY SERVICES B 5 IMAGING - EH 200 PANTIGO PLACE EAST HAMPTON NY 11937 X RADIOLOGY SERVICES B 6 WESTHAMPTON PRIMARY CARE 72 OLD RIVERHEAD ROAD WESTHAMPTON BEACH NY 11978 X PRIMARY CARE PRACTICE B 7 WESTHAMPTON SPORTS REHAB 74 OLD RIVERHEAD ROAD WESTHAMPTON BEACH NY 11978 X SPORTS REHAB/ PHYSICAL THERAPY SERVICES B 8 LAB SOUTH 325 MEETINGHOUSE LANE SOUTHAMPTON NY 11968 X LABORATORY SERVICES B 9 ATRIUM LAB 182 W MONTAUK HIGHWAY HAMPTON BAYS NY 11946 X LABORATORY SERVICES B 10 DAVID ROGERS CENTER 335 D MEETINGHOUSE LANE SOUTHAMPTON NY 11968 X HIV/AIDS CARE B 11 SHINNECOCK HEALTH CHURCH STREET SOUTHAMPTON NY 11968 X PRIMARY CARE/DENTAL SERVICES B 12 SOUTHAMPTON CARE CENTER 240 MEETINGHOUSE LANE SOUTHAMPTON NY 11968 X NURSING HOME (FACILITY CLOSED) B 13 IMAGING - HAMPTON BAYS 182 W MONTAUK HIGHWAY HAMPTON BAYS NY 11946 X RADIOLOGY SERVICES B 14 MEETINGHOUSE LANE PRACTICE PO BOX 2340 SOUTHAMPTON NY 11968 X PRIMARY/SPECIALTY PHYSICIAN PATIENT CARE B A 1 false false true X X X X X X X X X 15 true false false true X WWW.SOUTHAMPTONHOSPITAL.ORG X true 14 true WWW.SOUTHAMPTONHOSPITAL.ORG false false true 400. 400. X X true true X X X true X WWW.SOUTHAMPTONHOSPITAL.ORG X 0 X X X X X X true false true X false false B false false false false true 400. 400. X X true true X X X true X WWW.SOUTHAMPTONHOSPITAL.ORG X 0 X X X X X X true false true X false false PART V, SECTION B, LINE 4: THE HOSPITAL CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT ("CHNA") FOR THE PERIOD 2015 - 2017. THE CHNA WAS DEEMED CONDUCTED IN 2015 WHEN IT WAS MADE "WIDELY AVAILABLE" TO THE PUBLIC AND THE WRITTEN REPORT AND IMPLEMENTATION STRATEGY WERE FINALIZED, APPROVED, AND ACCEPTED BY THE HOSPITAL'S GOVERNING BODY, IN ACCORDANCE WITH IRS NOTICE 2011-52. PART V, SECTION B, LINE 5: SEE SCHEDULE H, PART VI, LINE 2 NEEDS ASSESSMENT LANGUAGE. PART I, LINE 3C: THERE ARE TWO LEVELS OF CHARITY CARE COVERAGE: PRIMARY SERVICE AREA AND NON-PRIMARY SERVICE AREA. A PRIMARY SERVICE AREA PATIENT IS A PATIENT WHO RESIDED IN NEW YORK STATE WITHIN THE COUNTIES OF SUFFOLK OR NASSAU AT THE TIME OF SERVICE. A NON-PRIMARY SERVICE AREA PATIENT IS A PATIENT WHO RESIDED IN NEW YORK STATE BUT NOT WITHIN THE COUNTIES OF SUFFOLK OR NASSAU AT THE TIME OF SERVICE. ELIGIBLE SERVICES FOR A PRIMARY SERVICE AREA PATIENT: A PRIMARY SERVICE AREA PATIENT WHO MEETS THE FINANCIAL REQUIREMENTS IS ELIGIBLE FOR THE FOLLOWING MEDICALLY NECESSARY SERVICES: INPATIENT, AMBULATORY, EMERGENCY ROOM, EMERGENCY TRANSFERS UNDER THE EMERGENCY MEDICAL TREATMENT AND LABOR ACT (EMTALA), OUTPATIENT, AND DIAGNOSTIC CARE. UNDERINSURED PRIMARY SERVICE AREA PATIENTS ARE ELIGIBLE FOR FINANCIAL ASSISTANCE ON MEDICARE AND COMMERCIAL INSURANCE CARRIER CO-INSURANCES FOR ALL ABOVE LISTED SERVICES. ELIGIBLE SERVICES FOR A NON-PRIMARY SERVICE AREA PATIENT: A NON-PRIMARY SERVICE AREA PATIENT WHO MEETS THE FINANCIAL REQUIREMENTS IS ELIGIBLE FOR THE FOLLOWING MEDICALLY NECESSARY SERVICES: EMERGENCY ROOM, EMERGENT ADMISSIONS, AND EMERGENCY TRANSFERS UNDER THE EMERGENCY MEDICAL TREATMENT AND LABOR ACT (EMTALA). UNDERINSURED NON-PRIMARY SERVICE AREA PATIENTS ARE ELIGIBLE FOR FINANCIAL ASSISTANCE ON MEDICARE AND COMMERCIAL INSURANCE CARRIER CO-INSURANCES FOR ALL ABOVE LISTED SERVICES. INELIGIBLE SERVICES: THE FOLLOWING SERVICES AND/OR ITEMS ARE NOT COVERED BY CHARITY CARE FOR ANY PATIENT: NOT MEDICALLY NECESSARY SERVICES AS DETERMINED BY MEDICARE(E.G. COSMETIC SURGERY, BARIATRIC SURGERY), INSURANCE CO-PAYMENTS/CO-INSURANCES/DEDUCTIBLES, MEDICAID SPEND-DOWN AMOUNTS, NON-COVERED SERVICES AS DETERMINED BY THE PATIENT'S INSURANCE CARRIER, PRIVATE ROOM RATES, AND PRIVATE PHYSICIAN FEES WHICH ARE NOT BILLED BY SOUTHAMPTON HOSPITAL (E.G. RADIOLOGY, PATHOLOGY, ANESTHESIOLOGY, EMERGENCY). FAMILY INFORMATION REQUIREMENTS: A PATIENT MUST PROVIDE ON THEIR CHARITY CARE APPLICATION A LIST OF THE FAMILY/HOUSEHOLD MEMBERS AND OR DEPENDENTS WITH WHOM THE PATIENT RESIDES. IF THE PATIENT IS AN ADULT, THE PATIENT MUST LIST THEIR SPOUSE OR DOMESTIC PARTNER, CHILDREN UNDER THE AGE OF 21, AND ANY CLAIMED DEPENDENTS OR OTHER HOUSEHOLD MEMBERS THAT LIVE WITH THE PATIENT. IF THE PATIENT IS A CHILD UNDER THE AGE OF 21, THE APPLICANT MAY LIST THE PATIENT'S PARENTS, SIBLINGS UNDER THE AGE OF 21, AND ANY CLAIMED DEPENDENTS OR OTHER HOUSEHOLD MEMBERS THAT LIVE WITH THE PATIENT. A CLAIMED DEPENDENT IS DEFINED AS A PERSON WHO IS LISTED OR WOULD BE LISTED AS A DEPENDENT FOR THE PURPOSES OF AN INCOME TAX SUBMISSION TO THE IRS. FINANCIAL REQUIREMENTS: TO BE FINANCIALLY ELIGIBLE TO RECEIVE CHARITY CARE, A PATIENT MUST HAVE A GROSS FAMILY/HOUSEHOLD INCOME LESS THAN OR EQUAL TO 400% OF THE FEDERAL POVERTY LEVEL GUIDELINE (FPG). ELIGIBLE INCOME: THE FOLLOWING INCOME ITEMS WILL BE USED TO DETERMINE A PATIENT'S INCOME: EARNINGS FROM EMPLOYMENT, UNEMPLOYMENT COMPENSATION, WORKERS COMPENSATION, DISABILITY, SOCIAL SECURITY, ANNUITIZED PENSION PLAN, CHILD SUPPORT, ALIMONY, DIVIDENDS, INTEREST, RENTALS, ESTATES, TRUSTS, SALE OF ASSETS, AND OTHER MISCELLANEOUS INCOME. SOLE PROPRIETORSHIP, PARTNERSHIP, AND S CORPORATION INCOME WILL BE CALCULATED BY ITS GROSS PROFIT OR TOTAL INCOME PRIOR TO EXPENSES AND DEDUCTIONS; HOWEVER, COST OF GOODS SOLD MAY BE DEDUCTED FROM GROSS SALES. SALE OF ASSETS, SUCH AS REPORTED ON A SCHEDULE D OR ITS EQUIVALENT, WILL BE CALCULATED BY THEIR SALE PRICE AND NOT BY THEIR GAIN OR LOSS. FINANCIAL DOCUMENTATION REQUIREMENTS: A PATIENT MUST PROVIDE FINANCIAL DOCUMENTATION TO SUPPORT THEIR CURRENT STATED INCOME. THE FOLLOWING DOCUMENTS ARE ACCEPTABLE AS PROOF: COPIES OF RECENT PAY STUBS (SEVERAL CONSECUTIVE ARE PREFERRED WHEN AVAILABLE), A RECENT UNEMPLOYMENT OR DISABILITY STATEMENT, A LETTER FROM AN EMPLOYER, OR A SELF-ATTESTATION LETTER. A PATIENT MAY BE REQUIRED TO SUBMIT ADDITIONAL DOCUMENTATION AT SOUTHAMPTON HOSPITAL'S REQUEST IN ORDER TO SUBSTANTIATE THEIR STATED INCOME. IF A PATIENT IS CLAIMING ZERO INCOME, THE PATIENT WILL BE REQUIRED TO SUBMIT A VERIFICATION OF NON-FILING LETTER FROM THE IRS. THIS LETTER IS OBTAINED THROUGH IRS FORM 4506-T WHICH WILL BE MADE AVAILABLE TO THE PATIENT UPON REQUEST. THE PATIENT MUST ALSO SUBMIT A LETTER DESCRIBING THE MEANS BY WHICH THEY ARE SUPPORTED. IF THE PATIENT IS UNABLE TO FILE IRS FORM 4506-T DUE TO NOT HAVING A SOCIAL SECURITY NUMBER, THE PATIENT MUST SUBMIT THE ABOVE-MENTIONED LETTER. APPLICABLE RATES: THE APPLICABLE RATE FOR AN INPATIENT VISIT IS THE MEDICARE DIAGNOSIS RELATED GROUP (DRG) RATE FOR THAT VISIT. THE APPLICABLE RATE FOR AN AMBULATORY, EMERGENCY ROOM, OUTPATIENT, OR DIAGNOSTIC CARE VISIT IS THE MEDICARE HCPCS/CPT PAYMENT PLUS MINIMUM UNADJUSTED CO-PAYMENT FOR THAT VISIT. THE APPLICABLE RATE FOR LAB TESTS ON OUTPATIENT AND EMERGENCY ROOM VISITS WILL BE 10% OF THE CHARGE PER TEST. SELF-PAY DISCOUNT: SOUTHAMPTON HOSPITAL OFFERS A SELF-PAY DISCOUNT TO UNINSURED PATIENTS FOR SERVICES AND PROCEDURES PROVIDED AND BILLED BY SOUTHAMPTON HOSPITAL. A) ELIGIBLE SERVICES - THE FOLLOWING SERVICES PERFORMED BY SOUTHAMPTON HOSPITAL ARE ELIGIBLE FOR A SELF-PAY DISCOUNT: INPATIENT, AMBULATORY, EMERGENCY ROOM, EMERGENCY TRANSFERS UNDER THE EMERGENCY MEDICAL TREATMENT AND LABOR ACT (EMTALA), OUTPATIENT, AND DIAGNOSTIC CARE. B) INELIGIBLE SERVICES - THE FOLLOWING SERVICES AND ITEMS ARE NOT ELIGIBLE FOR A SELF-PAY DISCOUNT: OUTPATIENT CARDIAC REHABILITATION, OUTPATIENT NUTRITIONAL COUNSELING, WELLNESS CENTER SERVICES/PROGRAMS, OUTPATIENT PHYSICAL THERAPY, PRIVATE PHYSICIAN FEES NOT BILLED BY SOUTHAMPTON HOSPITAL (E.G. RADIOLOGY, PATHOLOGY, ANESTHESIOLOGY, EMERGENCY). C) DISCOUNT - SELF-PAY ACCOUNTS ARE DISCOUNTED AT A RATE OF 75% OFF TOTAL CHARGES. A. AUTOMATIC DISCOUNTING - THE SELF-PAY DISCOUNT WILL BE CALCULATED AND APPLIED TO THE PATIENTS' ACCOUNT AUTOMATICALLY BY THE HOSPITAL INFORMATION SYSTEM (HIS). B. MANUAL DISCOUNTING - THE SELF-PAY DISCOUNT MAY NEED TO BE MANUALLY CALCULATED AND APPLIED IN CERTAIN CIRCUMSTANCES (E.G. LATE CHARGES) AND WILL BE HANDLED BY PATIENT FINANCIAL SERVICES. D) ADDITIONAL FINANCIAL ASSISTANCE - PATIENTS WHO ARE UNABLE TO PAY FOR A SELF-PAY DISCOUNTED BILL MAY STILL APPLY FOR OTHER TYPES OF FINANCIAL ASSISTANCE SUCH AS CHARITY CARE. APPLYING FOR ANOTHER TYPE OF FINANCIAL ASSISTANCE WILL NOT RESULT IN THE LOSS OF THE OFFERED SELF-PAY DISCOUNT, HOWEVER, IF ACCEPTED INTO ANOTHER FINANCIAL ASSISTANCE PROGRAM, THAT PROGRAMS CALCULATION METHODOLOGY WILL BE DONE INDEPENDENTLY OF THE SELF-PAY DISCOUNTED AMOUNT (I.E. FINANCIAL ASSISTANCE PROGRAMS ARE MUTUALLY EXCLUSIVE). PART III, LINE 3: SOUTHAMPTON HOSPITAL UTILIZED THE AUDITED FINANCIAL STATEMENT AMOUNT REPORTED FOR BAD DEBT OF $6,400,000 AS ITS STARTING POINT. THIS AMOUNT WAS MULTIPLIED BY A COST TO CHARGE RATIO OF 100% (DETERMINED ON SCHEDULE H WORKSHEET 2) RESULTING IN A COST OF BAD DEBT OF $6,400,000. THIS COST WAS THEN MULTIPLIED BY 41.0049% - THE SELF PAY PERCENTAGE AS DETERMINED BY THE 2015 INSTITUTIONAL COST REPORT. THIS RESULTED IN A COST OF BAD DEBT FOR PATIENTS ELIGIBLE UNDER THE HOSPITAL'S CHARITY CARE POLICY OF $2,624,314. PART III, LINE 4: THE ORGANIZATION DETERMINE EXPECTED BAD DEBT WRITE-OFFS BASED ON ACTUAL ACCOUNTS, NET OF AN EXPECTED RATE OF RECOVERY. IT'S NOT BASED ON A PERCENTAGE OF REVENUE. PART III, LINE 8: SOUTHAMPTON HOSPITAL UTILIZED THE 2552 COST REPORT PREPARED ANNUALLY FOR MEDICARE TO DETERMINE THE TOTAL REVENUE RECEIVED FROM MEDICARE, AS WELL AS THE MEDICARE ALLOWABLE COSTS RELATING TO THE REVENUE REPORTED. MEDICARE ALLOWABLE COSTS OF $43,044,006 ARE GREATER THAN THE TOTAL MEDICARE REVENUE OF $38,092,076 FOR 2015; THEREFORE THE SHORTFALL OF $4,951,930 MAY BE DEEMED A COMMUNITY BENEFIT. PART III, LINE 9B: ACCOUNTS WITH UNCOLLECTABLE BALANCES ARE ACCOUNTS FOR A PATIENT (GUARANTOR) WHO HAS NOT RESPONDED TO REQUESTS FOR PAYMENT OR WHO HAS DEMONSTRATED AN EXEMPTION FROM PAYMENT. THE REQUEST FOR PAYMENT &/OR THE EXEMPTION MUST MEET THE FOLLOWING CRITERIA: 1. AT LEAST FOUR (4) CONSECUTIVE 120-DAY BILLS MUST HAVE BEEN GENERATED (OR NO LESS THAN 120 DAYS FROM FIRST BILL) AND SENT WITHOUT RESPONSE FROM THE PATIENT (GUARANTOR) BEFORE BEING SENT TO A COLLECTION AGENCY; OR 2. THE PATIENT (GUARANTOR) HAS DECLARED BANKRUPTCY (DISCHARGE OF DEBT OR MUST HAVE BEEN RECEIVED); OR 3. THE ESTATE OF THE PATIENT (GUARANTOR) HAS BEEN SETTLED AND THERE WERE NO FUNDS FOR PAYMENT LEFT IN THE ESTATE; OR 4. MAIL HAS BEEN RETURNED AND OTHER METHODS OF CONTACTING THE PATIENT (GUARANTOR) HAVE FAILED. THE ACCOUNT IS THEN CONSIDERED AND HANDLED AS A BAD DEBT ACCOUNT. PATIENT FINANCIAL SERVICES MAY ELECT TO SEND THE ACCOUNT TO AN OUTSIDE AGENCY, UP TO AND INCLUDING LEGAL ACTION. BAD DEBT ACCOUNTS ARE PURE SELF PAY ACCOUNTS FOR A PATIENT (GUARANTOR) WHO HAS NOT RESPONDED TO REQUESTS FOR PAYMENT. THE REQUEST FOR PAYMENT MUST MEET THE FOLLOWING CRITERIA: AT LEAST FOUR (4) CONSECUTIVE 30-DAY BILLS MUST HAVE BEEN GENERATED AND SENT WITHOUT RESPONSE FROM THE PATIENT (GUARANTOR); OR MAIL HAS BEEN RETURNED AND ALL OTHER METHODS OF CONTACTING THE PATIENT(GUARANTOR) HAVE FAILED. ONCE IT IS DETERMINED AN ACCOUNT BALANCE CANNOT BE COLLECTED BY PATIENT FINANCIAL SERVICES, THE ACCOUNT MAY BE TURNED OVER FOR COLLECTION BY AN OUTSIDE AGENCY, UP TO AND INCLUDING LEGAL ACTION. THE OUTSIDE COLLECTION AGENCY, AFTER DUE DILIGENCE, MAY DETERMINE THE BALANCE ON AN ACCOUNT CANNOT BE COLLECTED, THE ACCOUNT BALANCE MAY BE WRITTEN OFF USING THE APPROPRIATE CODE FOR THE ACCOUNT. PART VI, LINE 2: Online Key Informant Survey: To solicit input from key informants, those individuals who have a broad interest in the health of the community, an Online Key Informant Survey was also implemented as part of this process. A list of recommended participants was provided by Southampton Hospital; this list included names and contact information for physicians, public health representatives, other health professionals, social service providers, and a variety of other community leaders. Potential participants were chosen because of their ability to identify primary concerns of the populations with whom they work, as well as of the community overall. Key informants were contacted by email, introducing the purpose of the survey and providing a link to take the survey online; reminder emails were sent as needed to increase participation. In all, 133 community stakeholders took part in the Online Key Informant Survey, as outlined below: Online Key Informant Survey Participation Key Informant Type Number Invited Number Participating Physician 24 11 Public Health Representative 2 2 Other Health Provider 63 28 Social Services Provider 61 18 Community/Business Leader 144 74 Final Participation included representatives of the organizations outlined below: 91 Hill LLC; Adele Macmillan, LCSW-R, Private Practitioner; Amaden Gay Agencies; Barth Counseling; Bartky HealthCare Center; Bellringer Communications, Inc.; Blumenfield & Fleming, LLC; Bridgehampton Citizens Advisory Committee; Bridgehampton UFSD; Brookhaven Memorial Hospital Outpatient Behavioral Health; Coalition for Women's Cancers at Southampton Hospital; David E. Rogers Center; Development Officer; East End Clinical Connections; East End Counseling; East End DBT; East End Pediatrics; East End Regional Intervention Court; East Hampton Family Medicine; East Hampton Healthcare Foundation; East Hampton Lions Club Foundation; East Hampton Town Police Department; East Hampton Union Free School District; East Hampton Village Ambulance Association; East Quogue Fire Department; Eastern Suffolk BOCES Employee Assistance Program; ELIHO; Family Service League; Fighting Chance; First Presbyterian Church; Hampton Bays Public Library; Hampton Counseling; Hamptons Gynecology and Obstetrics; Indian Health/ACS; I-TRI Inspirational Triathlon Racing International; Maggie Bloomfield, LCSW, CASAC, MFA; Montauk Fire Department; Montauk Library; OLA of Eastern Long Island; Our Lady of the Hamptons School; Peer Recovery Services; Private Provider; Public Library; Remsenburg-Speonk UFSD; Retired Educator; Rogers Memorial Library; School District; Seafield Center; Shelter Island School; Shinnecock Indian Health Service; Southampton Business Alliance; Southampton Hospital; Southampton Pediatric Associates; Southampton Town Police Department; Southampton Volunteer Ambulance; Suffolk County Department of Health Services; The Retreat; Town of East Hampton Department of Human Services; Town of Southampton Youth Bureau; Tuckahoe Common School District; Village of Southampton; Westhampton Beach Police Department; Westhampton Primary Care. Through this process, input was gathered from several individuals whose organizations work with low-income, minority populations (including abused families, African-Americans, Asians, Caribbean Islanders, Central Americans, children with learning disabilities, Columbians, the disabled, Eastern Europeans, Ecuadorians, Hispanics, immigrants, LGBT community, low income residents, Medicaid/Medicare beneficiaries, Native Americans, non-English speaking individuals, Portuguese people, South Americans, undocumented persons, the uninsured/underinsured, and veterans), or other medically underserved populations (including African-Americans, cancer patients, children, children and young adults, the disabled, the elderly, Hispanics, HIV positive individuals, The homeless, immigrants, LGBT community, those living alone, low income residents, Medicaid/Medicare beneficiaries, the mentally ill, Native Americans, non-English speaking individuals, pregnant teens, substance abusers, undocumented persons, unemployed residents, the uninsured/underinsured, veterans, women, and young adults). In the online survey, key informants were asked to rate the degree to which various health issues are a problem in their own community. Follow-up questions asked them to describe why they identify problem areas as such, and how these might be better addressed. Results of their ratings, as well as their verbatim comments, are included throughout this report as they relate to the various other data presented. NOTE: These findings represent qualitative rather than quantitative data. The Online Key Informant Survey was designed to gather input from participants regarding their opinions and perceptions of the health of the residents in the area. Thus, these findings are based on perceptions, not facts. Benchmark Data: New York Risk Factor Data - Statewide risk factor data are provided where available as an additional benchmark against which to compare local survey findings; these data are reported in the most recent BRFSS (Behavioral Risk Factor Surveillance System) Prevalence and Trend Data published by the Centers for Disease Control and Prevention and the US Department of Health & Human Services. Nationwide Risk Factor Data - Nationwide risk factor data, which are also provided in comparison charts, are taken from the 2013 PRC National Health Survey; the methodological approach for the national study is identical to that employed in this assessment, and these data may be generalized to the US population with a high degree of confidence. Healthy People 2020 - Healthy People provides science-based, 10-year national objectives for improving the health of all Americans. The Healthy People initiative is grounded in the principle that setting national objectives and monitoring progress can motivate action. For three decades, Healthy People has established benchmarks and monitored progress over time in order to: - Encourage collaborations across sectors. - Guide individuals toward making informed health decisions. - Measure the impact of prevention activities. Healthy People 2020 is the product of an extensive stakeholder feedback process that is unparalleled in government and health. It integrates input from public health and prevention experts, a wide range of federal, state and local government officials, a consortium of more than 2,000 organizations, and perhaps most importantly, the public. More than 8,000 comments were considered in drafting a comprehensive set of Healthy People 2020 objectives. Determining Significance - Differences noted in this report represent those determined to be significant. For survey-derived indicators (which are subject to sampling error), statistical significance is determined based on confidence intervals (at the 95 percent confidence level) using question-specific samples and response rates. Information Gaps - While this assessment is quite comprehensive, it cannot measure all possible aspects of health in the community, nor can it adequately represent all possible populations of interest. It must be recognized that these information gaps might in some ways limit the ability to assess all of the communitys health needs. For example, certain population groups - such as homeless, instutionalized persons, or those who only speack a language other than English or Spanish - are not represented in the survey data. Other population groups - for example, pregnant women, lesbian/gay/bisexual/transgender residents, undocumented residents, and members or certain racial/ethnic or immigrant groups - might not be identifiable or might not be represented in numbers sufficient for independent analyses. In addition, this assessment does not include secondary data from existing sources which can provide relevant data collected through death certificates, birth certificates, or notifications or infectious disease cases in the community. In terms of content, this assessment was designed to provide a comprehensive and broad picture of the health of the overall community. However, there are certainly a great number of medical conditions that are not specifically addressed. Prioritization of Health Needs - On December 11, 2015, more than 30 individuals (representing local health providers, social service providers, and community leaders, as well as Southampton Hospital senior leaders and other internal stakeholders) met to evaluate, discuss and prioritize health issues for the community, based on findings of the 2015 PRC Community Health Needs Assessment (CHNA). Professional Research Consultants, Inc. (PRC) began the meetings with a presentation of key findings from the CHNA, highlighting the significant health issues identified from the research (see Areas of Opportunity above). Following the data review, PRC answered any questions and facilitated a group dialogue, allowing participants to advocate for any of the h PART VI, LINE 3: FINANCIAL AID PROGRAM: SOUTHAMPTON HOSPITAL'S COMMITMENT AND DETERMINATION TO PROVIDE QUALITY HEALTHCARE AT AFFORDABLE RATES HAS LEAD US TO DESIGN A CHARITY CARE PROGRAM THAT GOES "ABOVE AND BEYOND" THE EXPECTATIONS AND MINIMUM REQUIREMENTS SET FORTH BY NEW YORK STATE LAW. IT IS THE HOSPITAL'S "ABOVE AND BEYOND" ATTITUDE THAT IS OUR PROGRAMS GREATEST STRENGTH AND CAN BEST BE SEEN IN OUR POLICY TO PROVIDE CHARITY CARE DISCOUNTED RATES TO PATIENTS MAKING UP TO 400% OF THE FEDERAL POVERTY LEVEL GUIDELINE (FPG) RATHER THAN THE MINIMUM REQUIREMENT OF 300% FPG. IN ADDITION, THE HOSPITAL INCLUDES A FORM TO APPLY FOR CHARITY CARE IN EVERY SELF-PAY BILL TO BE RETURNED TO PATIENT FINANCIAL SERVICES. SELF-PAY PATIENTS ARE GIVEN A 75% DISCOUNT OF CHARGES, AS WELL. SOUTHAMPTON HOSPITAL CONTINUES TO FACE FINANCIAL CHALLENGES INCLUDING CONTINUED REDUCTIONS IN NEW YORK STATE AND FEDERAL REIMBURSEMENT RATES AT THE SAME TIME THAT HOSPITAL FACES THE INCREASING COST OF PROVIDING CARE, INCLUDING DOUBLE DIGIT EXPENSES INCREASES IN SOME CATEGORIES. WHILE THE HOSPITAL WAITS TO UNDERSTAND THE IMPACT ON ITS CHARITY POLICIES THAT MAY RESULT FROM EXPANDING RESIDENT ACCESS TO HEALTH CARE INSURANCE THAT IS PART OF HEALTH CARE REFORM, THE HOSPITAL REMAINS CONCERNED THAT A SIGNIFICANT PART OF THE INDIGENT CARE THE HOSPITAL PROVIDES TO UNDOCUMENTED WORKERS WILL NOT BE COVERED. PART VI, LINE 4: Southampton's Service area extends from Montauk to the East to Westhampton Beach to the West and the Southern area of Riverhead in the center of the East End of Long Island. The service area accounts for approximately eight-five (85) percent of total admissions to the Hospital and includes the following zip codes: Amagansett (11930); East Hampton (11937); Bridgehampton (11932); Southampton (11968); Hampton Bays (11946); Sag Harbor (11963); Sagaponack (11962); Montauk (11954); Riverhead (11901); East Quogue (11942); Quogue (11959); Remsenburg (11960); Water Mill (11976); Westhampton Beach (11978); and Westhampton (11977). In addition, the Hospital's service area is home to the Shinnecock Nation. Since April of 1995, Southampton Hospital has worked with the Nation to provide services at the Shinnecock Indian Health Clinic through a contract with the NYS Department of Health. On an annual basis, the Clinic provides approximately 2,100 medical and 1,000 dental visits for eligible members of the Shinnecock Nation. Southampton Hospital's service area has a year-round population of approximately 102,689 residents. The population in the Hospital's service area, a resort destination, more than doubles during the summer season when tourists and seasonal residents from all over the world come to the South Fork of Long Island. AS THE TABLE BELOW INDICATES, THIS SERVICE AREA HAS A YEAR ROUND POPULATION OF APPROXIMATELY 70,000 RESIDENTS. THE AREA IS PROJECTED TO SEE A SIGNIFICANT INCREASE IN POPULATION, MORE THAN 4 PERCENT OVER THE NEXT FIVE YEARS. DEMOGRAPHIC CHARACTERISTICS SELECTED AREA USA 2010 TOTAL POPULATION............65,013............308,745,538 2015 TOTAL POPULATION............66,786............319,459,991 2020 TOTAL POPULATION............68,584............330,689,365 % CHANGE 2015 - 2020...............2.7%...................3.5% AVERAGE HOUSEHOLD INCOME.......$115,280................$74,165 THE POPULATION ON THE HOSPITAL'S SERVICE AREA, A RESORT DESTINATION, MORE THAN DOUBLES DURING THE SUMMER SEASON WHEN TOURISTS FROM ALL OVER THE WORLD VISIT THE SOUTH FORK OF LONG ISLAND. AS A RESULT, DEMAND FOR SOUTHAMPTON HOSPITAL SERVICES INCREASES SIGNIFICANTLY DURING THE SUMMER, IN PARTICULAR DEMAND FOR THE HOSPITAL'S EMERGENCY SERVICES. THE HOSPITAL HAS RESPONDED TO THIS NEED BY MAKING A CAPITAL INVESTMENT IN EXPANDING AND RENOVATING THE EMERGENCY DEPARTMENT AND IMPLEMENTING A STATE-OF-THE-ART EMERGENCY DEPARTMENT INFORMATION SYSTEMS THAT PERMITS THE HOSPITAL TO TRACK PATIENTS, AND READ AND INTERPRET LABORATORY AND RADIOLOGICAL RESULTS. AS THE TABLE BELOW INDICATES, THE SERVICE AREA HAS A SIGNIFICANT PERCENTAGE OF THEIR POPULATION AGED FIFTY-FIVE (55) AND OVER, A POPULATION THAT HAS GREATER NEED FOR HEALTH CARE SERVICES. AGE DISTRIBUTION: USA 2015 AGE GROUP 2015 % OF TOTAL 2020 % OF TOTAL % OF TOTAL 0-14 10,755 16.1% 10,655 15.5% 19.1% 15-17 2,349 3.5% 2,456 3.6% 4.0% 18-24 5,159 7.7% 5,506 8.0% 9.9% 25-34 7,278 10.9% 7,254 10.6% 13.3% 35-54 18,112 27.1% 17,130 25.0% 26.3% 55-64 9,903 14.8% 10,584 15.4% 12.7% 65+ 13,230 19.8% 14,999 21.9% 14.7% TOTAL 66,786 100.0% 68,584 100.0% 100.0% THERE ARE NO FIRM ESTIMATES OF THE NUMBER OF MIGRANT AGRICULTURAL WORKERS THAT COME INTO THIS AREA. AGRICULTURE IS ONE OF SUFFOLK COUNTY'S LEADING INDUSTRIES. ITS SUCCESS RELIES ON WORKERS WHO MOVE THROUGH THE EASTERN UNITED STATES IN RESPONSE TO THE AVAILABILITY OF SEASONAL WORK. SOUTHAMPTON HOSPITAL RECOGNIZES THAT THIS POPULATION PRESENTS SERIOUS HEALTH PROBLEMS AND IS COMMITTED TO PROVIDING CARE FOR ITS CULTURALLY DIVERSE PATIENT POPULATION. MANY OF THESE INDIVIDUALS ARE UNINSURED AND UNABLE TO SPEAK ENGLISH. THEY RELY ON THE HOSPITAL'S EMERGENCY DEPARTMENT, AS WELL AS THE SUFFOLK COUNTY HEALTH CLINIC, LOCATED ON THE HOSPITAL'S CAMPUS, FOR HEALTH CARE. AS ARESULT, THE HOSPITAL'S OFFICE OF CULTURAL DIVERSITY PROVIDES TRANSLATION AND INTERPRETATION SERVICES, AS WELL AS COUNSELING ON MEDICAL INSURANCE AND BILLING FOR THOSE INDIVIDUALS WHO DO NOT SPEAK ENGLISH. THE HOSPITAL PROVIDES BI-LINGUAL PUBLICATIONS AND SIGNAGE AND ACTIVELY ASSISTS THE CULTURALLY DIVERSE COMMUNITIES IT CARES FOR. RACE/ETHNICITY: RACE/ETHNICITY DISTRIBUTION RACE/ETHNICITY 2015 POP % OF TOTAL USA % OF TOTAL WHITE NON-HISPANIC 45,479 68.1% 61.8% BLACK NON-HISPANIC 1,917 2.9% 12.3% HISPANIC 16,945 25.4% 17.6% ASIAN & PACIFIC IS. 899 1.3% 5.3% ALL OTHERS 1,546 2.3% 3.1% TOTAL 66,786 100.0% 100.0% PART VI, LINE 5: SOUTHAMPTON HOSPITAL SPONSORS "FOCUS ON SOUTHAMPTON HOSPITAL" ON SEA-TV, A MONTHLY PUBLIC ACCESS INTERVIEW PROGRAM FOR THE TOWNS OF EAST HAMPTON AND SOUTHAMPTON THAT COVERS HEALTH-RELATED INFORMATION OF INTEREST TO THE COMMUNITY AND PROVIDES INFORMATION ON HEALTHCARE SERVICES AVAILABLE AT SOUTHAMPTON HOSPITAL. THE HOSPITAL HAS DEVELOPED NUMEROUS SERVICES AND OUTREACH TO RESPOND TO THE NEEDS OF THESE PATIENTS, INCLUDING RECRUITING ADDITIONAL PRIMARY CARE PHYSICIANS AND IMPLEMENTING A GRADUATE MEDICAL EDUCATION PROGRAM THAT WILL HOPEFULLY ATTRACT THESE YOUNG PHYSICIANS TO STAY AND PRACTICE IN THE COMMUNITY. THE HOSPITAL'S WEBSITE, WWW.SOUTHAMPTONHOSPITAL.ORG, PROVIDES INFORMATION ON HOSPITAL SERVICES, SPECIAL PROGRAMS AND EVENTS. THE SITE ENABLES PATIENTS TO FIND PHYSICIANS IN DIFFERENT SPECIALTIES, ALLOWS ON-LINE INQUIRIES THAT ARE ANSWERED DAILY, AND PROVIDES ACCESS TO AVAILABLE EMPLOYMENT OPPORTUNITY AND JOB APPLICATIONS. SERVICES FOR SHORT-TERM AND LONG-TERM CARE FOR CHRONIC AND ACUTE ILLNESS ARE CONTINUALLY EVALUATED THROUGH STATISTICAL DATA THAT INCLUDE QUALITY INDICATORS AND PATIENT OUTCOMES. THIS DATA IS COMPARED NATIONALLY WITH OTHER HEALTH FACILITIES AND INFORMS THE HOSPITAL'S STRATEGIC PLAN AND COMMUNITY SERVICE PLAN. THE HOSPITAL'S STRATEGIC PLANNING COMMITTEE INCLUDES COMMUNITY MEMBERS, HOSPITAL STAFF AND HOSPITAL AND FOUNDATION BOARD MEMBERS WHO WORK COLLABORATIVELY TO ASSESS COMMUNITY NEEDS AND DEVELOP STRATEGIES TO MEET THESE NEEDS. THE HOSPITAL'S PUBLIC AFFAIRS COMMITTEE IS RESPONSIVE TO COMMUNITY INTERESTS AND CONCERNS. MEMBERSHIP IS A CROSS-SECTION OF PHYSICIANS, HOSPITAL MANAGEMENT, BOARD MEMBERS AND HOSPITAL EMPLOYEES. BASED ON THE HOSPITAL'S ASSESSMENT OF INTEREST IN THE COMMUNITY, A NUMBER OF HEALTH LECTURES AND PROGRAMS ARE PROVIDED THROUGHOUT THE YEAR. THESE PROGRAMS ARE SOMETIMES SPONSORED THROUGH OUR PARTNERSHIPS WITH LOCAL ORGANIZATIONS INCLUDING FIGHTING CHANCE, NEW YORK ORGAN DONOR NETWORK, COMMUNITY LIBRARIES, AND SERVICE CLUBS (LIONS, KIWANIS, ELKS). THE 2015 OUTREACH SCHEDULE INCLUDED THE FOLLOWING PROGRAMS AT: A) SOUTHAMPTON'S ROGERS MEMORIAL LIBRARY - Heart Health-Know Your Numbers; Heart Health Exercise is Medicine; Natural Sleep Solutions B) WESTHAMPTON FREE LIBRARY - Key to a Healthy Heart; Shingles- What Vaccines Do Adults Need; Help with Shoulder Injuries and Arthritis; Back Pain; Healthy Kidneys-Healthy You; Lyme and Tick-Borne Disease; Baby Fair; Acupuncture Can Reveal Your True Self; Spa Days; Healthy At Any Age; Relax and Heal Using Therapeutic Massage; Breast Cancer Awareness; Living with Osteoporosis. C) HAMPTON BAYS LIBRARY - LIVING WITH OSTEOPOROSIS; HEALTHY KIDNEYS-HEALTHY YOU. D) QUOGUE LIBRARY - TREATMENTS FOR VARICOSE VEINS; LIVING WITH ARTHRITIS; KEY TO A HEALTHY HEART. E) HAMPTON LIBRARY IN BRIDGEHAMPTON - OH MY ACHING BACK! F) SHELTER ISLAND LIBRARY - TICK-BORNE DISEASE G) SAG HARBOR'S JOHN JERMAIN LIBRARY - HEART HEALTH - EXERCISE IS MEDICINE; DEFINING REFLEXOLOGY. H) CUTCHOGUE/NEW SUFFOLK LIBRARY - HEALTHY EYES, HEALTHY VISION; HEELAND FOOT PAIN; HYPNOSIS FOR PEAK PERFORMANCE, BEHAVIOR MODIFICATION, AND BETTER NIGHT'S SLEEP; HAND THERAPY FOR ARTHRITIS; LYME AND TICK-BORNE DISEASE. I) MATTITUCK/LAUREL LIBRARY - PREVENTING LYME AND TICK-BORNE DISEASE; LIVING WITH ARTHRITIS. J) SHINNECOCK INDIAN RESERVATION - STROKE AWARENESS K) CHILDREN'S MUSEUM OF THE EAST END IN BRIDGEHAMPTON - TRAIN YOUR EYES TO BE TICKWISE; PECONIC FAMILY FUND DAY TICK EDUCATION L) D.A.R. SOUTHAMPTON CHAPTER - HEALTHY AT ANY AGE M) ROTARY CLUB SOUTHAMPTON - TICK-BORNE DISEASE EDUCATION AND PREVENTION N) SOUTHAMPTON HOSPITAL - CAR SEAT SAFETY INSPECTON DAY IN CONJUNCTION WITH SOUTHAMPTON POLICE DEPARTMENT O) TICK-BORNE DISEASE PUBLIC EDUCATION - BAY STREET THEATER, SOUTHAMPTON HOSPITAL'S PARRISH HALL, EAST HAMPTON HEALTH FAIR P) EASTPORT ATLANTIC SHORES SENIOR COMMUNITY - RELAX AND HEAL USING THERAPEUTIC MASSAGE. PUBLIC INFORMATION: Southampton Hospital understands the importance of educating the community about its available services. Brochures detailing these services are distributed and displayed on every floor of the hospital, at community and school health fairs, and at hospital satellite facilities and physician offices across the North and South Forks. In addition, this information, along with the Hospitals 2015-17 Community Service Plan, is available on the Hospitals website, www.southamptonhospital.org. GENERAL INFORMATION: PATIENT SATISFACTION SURVEYS: IN ADDITION, SOUTHAMPTON HOSPITAL CONTINUALLY SOLICITS PATIENT INPUT THROUGH ITS PATIENT SATISFACTION SURVEY PROCESS, WHICH INCLUDES EVERY INPATIENT, AMBULATORY SURGERY PATIENT AND EMERGENCY ROOM PATIENT. THE DATA COLLECTED FROM THESE COMPREHENSIVE SURVEYS PROVIDES VALUABLE INFORMATION ON A WIDE RANGE OF QUALITY INDICATORS AND AREAS OF INTEREST TO THE HOSPITAL'S PATIENTS. RESULTS FROM THESE SURVEYS ARE REGULARLY DISTRIBUTED TO HOSPITAL AND MEDICAL STAFFS AND THE BOARD OF DIRECTORS. THE QUALITY MANAGEMENT AND PUBLIC AFFAIRS DEPARTMENTS, AS WELL AS THE OFFICE OF THE PRESIDENT, CAREFULLY REVIEW CORRESPONDENCE FROM PATIENTS AND THE COMMUNITY AT LARGE. A MEMBER OF THE HOSPITAL STAFF PERSONALLY ANSWERS ALL CORRESPONDENCE. X true true X X X false false false false false false false false false ROBERT S CHALONER PRESIDENT & CEO 510000 0 127500 0 42336 0 15900 0 24286 0 720022 0 0 0 CHIRSTOPHER J SCHULTHEIS CHIEF FINANCIAL OFFICER 254392 0 47636 0 6805 0 15264 0 25067 0 349164 0 0 0 FREDERIC I WEINBAUM CHIEF MEDICAL OFFICER & COO 399389 0 59908 0 35848 0 15900 0 27714 0 538759 0 0 0 PATRICIA A DARCEY CHIEF NURSING OFFICER 231364 0 0 0 -351 0 13882 0 27714 0 272609 0 0 0 STEVEN GEORGOPOULOS PHYSICIAN 707308 0 0 0 59314 0 15900 0 27472 0 809994 0 0 0 KRISTIN P NASO PHYSICIAN 500000 0 0 0 -535 0 15900 0 27472 0 542837 0 0 0 NEEMA POURTAHERI PHYSICIAN 434423 0 0 0 23622 0 15900 0 27472 0 501417 0 0 0 MICHAEL ELLIS PHYSICIAN 393923 0 0 0 34402 0 15900 0 22499 0 466724 0 0 0 EDNA KAPENHAS DIRECTOR/BREAST SURGEON 400000 0 0 0 -604 0 15900 0 25067 0 440363 0 0 0 PART I, LINE 1A: Southampton Hospital Association provides the following special allowances/perquisites to the President & CEO, as well as to certain key executives. These allowances for housing and automobile are stipulated in the executives Employment Agreement/terms at time of hire. All payments of these perquisites are made on a bi-weekly basis with the employees regular paycheck and they are made in accordance with the guidelines of a non-accountable expense plan. Annual allowances are as listed below: 1) ROBERT CHALONER, PRESIDENT & CEO - Housing Allowance: $38,000. 2) FREDRIC WEINBAUM, MD, EVP, COO & CMO - Housing Allowance: $30,000. Auto Allowance: $7,000. 3) CHRISTOPHER J. SCHULTHEIS, CFO & VP of Finance - AUTO ALLOWANCE: $8,400. 4) NEEMA POURTAHERI, PHYSICIAN - HOUSING ALLOWANCE: $22,157. 5) MICHAEL ELLIS, PHYSICIAN - HOUSING ALLOWANCE: $36,000. PART II, COLUMN (B)(II): THE PRESIDENT & CEO, EXECUTIVE VICE PRESIDENT/CHIEF MEDICAL OFFICER, AND CFO OF SOUTHAMPTON HOSPITAL WERE ELIGIBLE FOR A PERFORMANCE BONUS IN 2015 WHICH WAS BASED UPON CRITERIA THAT THE EXECUTIVE COMMITTEE OF THE BOARD ESTABLISHED. THE PRESIDENT & CEO'S BONUS IS AN ANNUAL BONUS SET FORTH IN HIS EMPLOYMENT AGREEMENT AND IS DETERMINED AFTER A REVIEW OF HOW WELL HE PERFORMED IN THE PRIOR YEAR AGAINST GOALS AND OBJECTIVES ESTABLISHED BY THE EXECUTIVE COMMITTEE. THE EXECUTIVE VICE PRESIDENT/CHIEF MEDICAL OFFICER AND CFO WERE AWARDED A PERFORMANCE BONUS BASED UPON THE RECOMMENDATION OF THE PRESIDENT & CEO AS WELL AS A REVIEW OF THEIR PERFORMANCE AGAINST GOALS AND OBJECTIVES ESTABLISHED BY THE PRESIDENT AND THE EXECUTIVE COMMITTEE. A SUFFOLK COUNTY ECONOMIC DEVELOPMENT CORPORATION 273722095 2014-10-02 33500000 refinance series 1999a and 1999b false false false A 0 0 33500000 0 0 28644501 607619 0 0 3931601 823269 0 true false false true A false false false false 0 0.01400 0.01400 false false false false A false true false false false false 0 false 0 false false A false FORM 990, PART VI, SECTION A, LINES 6, 7A AND 7B: THE ORGANIZATION'S SOLE MEMBER IS EAST END HEALTH ALLIANCE, A NOT-FOR-PROFIT CORPORATION THAT CAN ELECT ONE OR MORE MEMBERS OF THE HOSPITAL'S GOVERNING BODY. THE EAST END HEALTH ALLIANCE, THE ARTICLE 28 PARENT OF EASTERN LONG ISLAND HOSPITAL, PECONIC BAY MEDICAL CENTER AND SOUTHAMPTON HOSPITAL, WAS CREATED IN RESPONSE TO THE RECOMMENDATIONS OF THE COMMISSION ON HEALTH CARE IN THE 21ST CENTURY. CONSISTENT WITH THE MISSION OF SOUTHAMPTON HOSPITAL, THE GOALS OF THE ALLIANCE ARE AS FOLLOWS: A) TO COLLABORATIVELY DEVELOP HIGH QUALITY, COMPREHENSIVE AND ACCESSIBLE HEALTH CARE SERVICES TO MEET THE NEEDS OF THE COMMUNITY SERVED; B) TO RATIONALIZE HEALTH CARE SERVICES ACROSS THE SYSTEM; AND C) TO REALIZE MANAGEMENT EFFICIENCIES. THE FOLLOWING DECISIONS MADE BY THE GOVERNING BODY OF SOUTHAMPTON HOSPITAL REQUIRE EAST END HEALTH ALLIANCE APPROVAL: ADOPTION OF OPERATING AND CAPITAL BUDGETS, APPLICATION FOR NEW CERTIFICATES OF NEED, AND CERTAIN BORROWING TRANSACTIONS. FORM 990, PART VI, SECTION B, LINE 11B: SOUTHAMPTON HOSPITAL ASSOCIATION HAS ITS FORM 990 PREPARED BY AN OUTSIDE ACCOUNTING FIRM AND HAS ESTABLISHED THE FOLLOWING REVIEW PROCESS TO ENSURE THAT THE INFORMATION REPORTED IS COMPLETE AND ACCURATE. UPON COMPLETION, THE FORM 990 IS REVIEWED BY MANAGEMENT AND IS THEN FORWARDED ELECTRONICALLY TO THE MEMBERS OF THE BOARD OF TRUSTEES FOR THEIR REVIEW. ANY QUESTIONS OR ISSUES ARE THEN ADDRESSED BY THE APPROPRIATE PARTIES PRIOR TO THE FILING OF THE RETURN. FORM 990, PART VI, SECTION B, LINE 12C: SOUTHAMPTON HOSPITAL CURRENTLY HAS A CONFLICT OF INTEREST POLICY AND A PROCEDURE FOR ANNUAL DISCLOSURE BY KEY EMPLOYEES, PHYSICIAN LEADERS, AND SENIOR MANAGEMENT. WHEN NEW/POTENTIAL CONFLICTS/RELATIONSHIPS ARE IDENTIFIED, THEY ARE INVESTIGATED BY THE CORPORATE COMPLIANCE OFFICER AND ANY RECOMMENDATIONS AND/OR CORRECTIVE ACTIONS ARE PRESENTED TO THE PRESIDENT AND CEO. AS APPROPRIATE, THESE POTENTIAL CONFLICTS/DISCLOSURES ARE ALSO REVIEWED WITH THE CFO AND MEDICAL DIRECTOR/COO. WHEN A POTENTIAL CONFLICT IS IDENTIFIED, THE STAFF MEMBER IS PROHIBITED FROM TAKING PART IN ANY HOSPITAL DECISIONS THAT MAY RELATE TO THE INTEREST OR RELATIONSHIP, UNTIL THE REVIEW IS COMPLETED AND A DETERMINATION IS MADE THAT THERE IS NO CONFLICT. SIMILARLY, ON AN ANNUAL BASIS, ALL MEMBERS OF THE BOARD OF DIRECTORS ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST FORM. ALL POTENTIAL CONFLICTS OF INTEREST THAT MAY EXIST MUST BE DISCLOSED. IF A POTENTIAL OR ACTUAL CONFLICT OF INTEREST EXISTS, THE AFFECTED MEMBER WILL BE NOTIFIED AND THE EXECUTIVE COMMITTEE OF THE BOARD WILL INVESTIGATE AND MAKE THE DETERMINATION AS TO WHAT, IF ANY RECUSAL OR OTHER CORRECTIVE ACTION MAY BE REQUIRED TO AVOID ANY POTENTIAL CONFLICT. THE RESULTS OF THE INVESTIGATION WILL THEN BE REPORTED TO THE GOVERNING BODY. IF AN ACTUAL CONFLICT OF INTEREST EXISTS, THE AFFECTED MEMBER WILL BE NOTIFIED OF THIS DETERMINATION AND THEIR PARTICIPATION IN RELATED MATTERS AND/OR VOTING RIGHTS, PERTAINING TO THE AREA OF CONFLICT, WILL BE RELINQUISHED. FORM 990, PART VI, SECTION B, LINES 15A AND 15B: Southampton Hospital has established an Executive Compensation Policy which sets forth the terms and criteria for the review of the compensation of the President & CEO, the Chief Medical Officer/COO and the Vice President of Finance/CFO as well as other executive leaders. The policy outlines the procedures and criteria the Executive Committee will follow in evaluating the CEO's, the CMO/COO's, and the CFOs performance against established goals. It also outlines the Executive Committees' role and responsibility in determining all aspects of the CEO's, Chief Medical Officer/COO's, and CFOs compensation including any incentive or bonus compensation. The Committee reviews contract terms which cover compensation and benefits including, but not limited to, housing allowances, automobile allowances, severance or change of control payments. On a periodic basis, the Executive Committee meets to review the terms of compensation and reviews external compensation data and studies to ensure that compensation decisions are reasonable and consistent with fair market value. The Committee documents the full terms of compensation approved and includes date of the decision, details of the comparability data obtained and relied upon, and how the data was obtained. Members of the Executive Committee must be free from any conflict of interest that may relate to the arrangement. All members of the Committee who were present during the discussion of the arrangement will be documented in the Meeting minutes along with their votes. The compensation review process for the President & CEO, Chief Medical Officer and CFO was last undertaken September 17, 2015. FORM 990, PART VI, SECTION C, LINE 19: SOUTHAMPTON HOSPITAL'S FORM 990, AS WELL AS ITS FINANCIAL STATEMENTS AND CONFLICT OF INTEREST POLICY, ARE AVAILABLE FOR PUBLIC INSPECTION UPON REQUEST, AS REQUIRED UNDER SECTION 6104 OF THE INTERNAL REVENUE CODE. INTERESTED PARTIES MAY REQUEST THE DOCUMENTS AT 240 MEETINGHOUSE LANE, SOUTHAMPTON, NY 11968 OR BY CALLING THE ORGANIZATION DIRECTLY AT (631)726-8200. FORM 990, PART XI, LINE 9: PENSION OBLIGATION..................................$(2,249,402) CHARITABLE REALIZED GAINS/LOSSES & DISTRIBUTIONS....$ (64,377) TOTAL...............................................$(2,313,779) SOUTHAMPTON CARE CENTER 240 MEETING HOUSE LANE SOUTHAMPTON NY 11968 112658403 NURSING HOME NY 501(c)(3) 9 false THE SOUTHAMPTON HOSPITAL FOUNDATION 240 MEETING HOUSE LANE SOUTHAMPTON NY 11968 113466516 SRVC PROVIDER NY 501(C)(3) 7 false MEETINGHOUSE LANE MEDICAL PRACTICE PO BOX 2340 SOUTHAMPTON NY 11968 208853938 PATIENT CARE NY 501(C)(3) 11 false SHA PROPERTIES 240 MEETING HOUSE LANE SOUTHAMPTON NY 11968 112563612 REAL ESTATE NY NA C 0 13162 1.00000 true OLD TOWN MEDICAL PRACTICE PC 240 MEETING HOUSE LANE SOUTHAMPTON NY 11968 452430883 MEDICAL PRACTICE NY NA C 0 0 1.00000 true false false true true true false false false false false false false true true true false false false false