2015-11-16T13:05:29-06:00 2014-12-31 420714325 RSM US LLP 1185 AVENUE OF THE AMERICAS NEW YORK NY 100362602 990 2014-01-01 111631759 KINGSBROOK JEWISH MEDICAL CENTER KING 7186045532 585 SCHENECTADY AVENUE BROOKLYN NY 11203 JOHN SCHMITT CFO 7186045532 2015-11-16 1 STEVEN LAPSKER P00850484 2123721000 2014 2016-02-25 16:41:14Z LINDA BRADY MD 585 SCHENECTADY AVENUE BROOKLYN NY 11203 194105682 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. 13 11 2668 171 0 -1501 4502772 26042299 176268481 166247875 86942 165751 1952884 1649757 182811079 194105682 0 0 0 0 127146890 120658351 0 0 181255 61511037 59691286 188657927 180349637 -5846848 13756045 125228842 147408847 97056494 108870001 28172348 38538846 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 157046020 166247875 THE KINGSBROOK JEWISH MEDICAL CENTER ("KJMC") IS A 303-BED MULTI-SPECIALTY TEACHING HOSPITAL BASED IN BROOKLYN, NY. KJMC PROVIDES A WIDE RANGE OF INPATIENT AND OUTPATIENT SERVICES, MEDICAL AND SURGICAL DIAGNOSTIC TREATMENT SERVICES, PHYSICAL MEDICINE AND REHABILITATION, GERIATRIC PSYCHIATRIC MEDICINE, AS WELL AS AN AMBULATORY SURGERY CENTER, A 24-HOUR EMERGENCY ROOM, AND OUTPATIENT GENERAL AND SPECIALTY CLINICS. 157046020 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 1 221 0 1 2668 1 0 0 0 0 0 0 0 0 0 0 X 13 11 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 X VICTOR AYALA PHD BOARD TRUSTEE 2.00 3.00 X 0 0 0 LINDA BRADY MD PRESIDENT & BOARD DIRECTOR 35.00 13.50 X X 888644 0 67642 VALERIE BYNOE-KASDEN ESQ BOARD TRUSTEE 1.00 1.00 X 0 0 0 PATRICK COONAN RN EDD BOARD TRUSTEE 1.00 X 0 0 0 JEFFREY DUNSTON BOARD TRUSTEE 1.00 X 0 0 0 SEEMA GOLDSTEIN SECRETARY 1.50 2.00 X X 0 0 0 ERICA GRUEN BOARD TRUSTEE 1.00 X 0 0 0 EDWARD LIEBERSTEIN BOARD TRUSTEE 1.00 3.00 X 0 0 0 LEIBESH NASH BOARD TRUSTEE 1.00 X 0 0 0 GEOFFREY PATRICE MD BOARD TRUSTEE 1.00 X 7466 0 0 MICHAEL PORETSKY TREASURER 2.00 1.00 X 0 0 0 ROBERT REISS BOARD TRUSTEE 1.50 2.00 X 0 0 0 HENNA WHITE BOARD CHAIR 3.00 5.50 X X 0 0 0 JOHN SCHMITT CPA ASSISTANT TREASURER & CFO 35.00 13.50 X 364468 0 67642 MICHAEL MCDERMOTT THRU 52014 ASS'T SECRETARY & GENERAL COUNSEL 35.00 13.50 X 107005 0 27578 HAROLD MCDONALD THRU 42014 COO 35.00 12.00 X 155140 0 941 SIBTE BURNEY MD CHIEF MEDICAL OFFICER 40.00 X 414154 0 60827 KURT KODROFF VICE PRESIDENT 40.00 X 421117 0 69574 ROBERT DUBICKI SENIOR VP 40.00 X 348579 0 63752 JANE LEDERER CHIEF NURSING OFFICER 40.00 X 234440 0 43430 MARC ROSS MD DIR REHAB MED 40.00 X 499319 0 67642 WILLIAM LOIS DIRECTOR SURGERY 40.00 X 461898 0 60827 VIJAY AKKAPEDDI CHAIR EMERGENCY DEPT 40.00 X 424731 0 67642 LEON VALBRUN PSYCHIATRIST 40.00 X 292346 0 61001 ADRIAN CRISTIAN DEPUTY MED DIR, REHAB MEDICINE 40.00 X 286437 0 61687 4905744 0 720185 260 0 1 0 NORTH AMERICAN PARTNERS IN ANESTHESIA L 68 SOUTH SERVICE ROAD SUITE 350 MELVILLE NY 11747 MEDICAL SERVICE - ANESTHESIA 1442375 BIK ORTHOPEDICS PC 585 SCHENECTADY AVENUE BROOKLYN NY 11203 MEDICAL SERVICE - ORTHOPEDICS 1127279 ASPEN ADVISORS LLC 22337 MEADOW VIEW ROAD MORRISON CO 80465 CONSULTING SERVICE 794778 NEW YORK RADIOLOGY ALLIANCE 25983 NETWORK PLACE CHICAGO IL 606731259 MEDICAL SERVICE - RADIOLOGY 597755 JZANUS CONSULTING INC 515 HEMPSTEAD TURNPIKE WEST HEMPSTEAD NY 11552 REVENUE CYCLE - CODING SERVICES 594336 52 25566449 475850 26042299 NET PATIENT SERVICE REVENUE 621300 161281354 161281354 AFFIL INCOME - AUA MEDICAL 900099 2927617 2927617 AFFIL INCOME - ST. GEORGE U 900099 1047850 1047850 INCENTIVE INCOME 900099 825531 825531 AFFIL INCOME - MED STUDENT 900099 135027 135027 30496 30496 166247875 7051 7051 435120 0 435120 435120 435120 158700 0 158700 158700 158700 MISC. INCOME 900099 1214637 1214637 1214637 194105682 166247875 0 1815508 3258541 2867516 391025 85124261 74765382 10214911 143968 5407517 4749636 648902 8979 19882588 17485780 2385911 10897 6985444 6137924 838253 9267 3210727 2462628 748099 -40952 -40952 362926 278364 84562 12243200 9359124 2884076 576011 433656 134211 8144 3929433 3013875 915558 132159 101366 30793 571625 438436 133189 7746242 5941368 1804874 688198 527848 160350 MEDICAL & PHARMACEUTICA 16401557 16401557 MAINT & REPAIRS 6271066 4809908 1461158 BAD DEBT EXPENSE 3315508 3315508 FOOD COSTS 2220707 2220707 2062879 1735437 327442 180349637 157046020 23122362 181255 167324 5373836 5288578 2867225 19754720 20998867 2837926 2796804 2501620 2068042 213184847 171832150 37094698 41352697 620443 620443 56963533 71330933 125228842 147408847 46785493 47878077 177031 121110 5268820 3697653 5181815 4472950 39643335 52700211 97056494 108870001 X 28172348 38538846 28172348 38538846 125228842 147408847 X 13756045 -3389547 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 217636 0 1 145290 362926 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 2014 ANNUAL DUES WAS $145,290. 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 2014 KINGSBROOK JEWISH MEDICAL CENTER PAID $217,636 IN CONNECTION WITH THESE SERVICES. 1129749 1129749 64016819 40656035 23360784 48226301 43307803 4918498 99811978 87868312 11943666 41352697 DUE FROM RELATED ORGANIZATION 65772934 DEBT SERVICE RESERVE FUND 2434589 RECEIVABLE - INV. IN HEALTHFIRST 67937 OTHER RECEIVABLES 1102806 INTEREST IN KJMC FOUNDATION 1952667 71330933 SELF INSURANCE LIABILITIES 18847000 ESTIMATED THIRD PARTY SETTLEMENTS 19446636 FIN 47 LIABILITY 2125994 INCENTIVE/RETENTION LIABILITY 931851 SECURITY DEPOSITS - OTHER 2250394 ACCRUED POSTRETIREMENT BENEFIT COST 1877896 ACCRUED PENSION LIABILITY 7220440 52700211 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, 2014 AND 2013, 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, 2011 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 5346967 2261862 3085105 0.01710 54205253 58945182 -4739929 0.00000 59552220 61207044 -1654824 0.01710 16248938 16248938 0.09010 13101569 10048935 3052634 0.01690 472500 472500 0.00260 29823007 10048935 19774072 0.10960 89375227 71255979 18119248 0.12670 64335 64335 0.00040 64335 64335 0.00040 1 3315508 65291071 64985086 305985 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 13 1 0 1 1 X WWW.KINGSBROOK.ORG X 1 14 1 SEE PART V 0 0 1 X 200.000000000000 300.000000000000 X 1 1 X X X X 1 X X X X X 1 0 X X X 1 X 0 0 KINGSBROOK JEWISH MEDICAL CENTER PART V, SECTION B, LINE 5: ENGAGING THE COMMUNITYAS 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 COMMUNITY1. 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. BROOKLYN HEALTHCARE IMPROVEMENT PROJECT (BHIP) 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). 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 TE SAME. THE CURRENT ECONOMY HAS ALTERED OUR ABILITY TO GROW OUR FOUNDATIONAL SUPPORT FOR NO-COST SCREENING EFFORTS.KINGSBROOK/DAILY NEWS PROSTATE CANCER INITIATIVES:THE PROGRAM HAS BEEN GREATLY IMPACTED BY THE NATIONAL SCRUTINY OF PSA TESTING WHICH QUESTIONS THE ACCURACY AND POTENTIAL FALSE POSITIVES TEST CAN POTENTIALLY GENERATE. AS SUCH, THE NEW YORK DAILY NEWS HAS DISCONTINUED THE PROGRAM AS OF 2013, DUE TO THE LACK OF SUPPORT FROM HOSPITAL PARTNERS IN THE REGION.CANCER SERVICES PROGRAM PREVIOUSLY KNOWN AS THE BROOKLYN HEALTHY LIVING PARTNERSHIP:KINGSBROOK'S PARTNERSHIP WITH THE CANCER SERVICE PROGRA (CSP), PROVIDED FREE MAMMOGRAPHY SERVICES TO OVER 200 WOMEN FROM MARCH 2012 - APRIL 2013. THE FUNDING FOR THIS PROGRAM HAS DECREASED ANNUALLY SINCE 2007.ADDITIONAL INFORMATION IS INCLUDED IN THE FULL IMPLEMENTATION STRATEGY ATTACHED TO THIS RETURN. SCHEDULE H, PART V, SECTION B, LINE 10 IMPLEMENTATION STRATEGY WEBSITE URL:WWW.KINGSBROOK.ORG/ABOUT-US/COMMUNITY-IMPLEMENTATION-REPORT.ASPX SCHEDULE H, PART V, SECTION B, LINE 16 FAP WEBSITE:WWW.KINGSBROOK.ORG/FOR-PATIENTS-VISITORS/FINANCIAL-ASSISTANCE-PROGRAM.ASPX PART V, SECTION B, LINE 16 FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY KINGSBROOK JEWISH MEDICAL CENTER PART V, SECTION B, LINE 16A WEBSITE: SEE PART V 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 2014 NEW YORK STATE INSTITUTIONAL COST REPORT AND THE 2014 (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 LINE 7. PART III, LINE 4: EXPLANATION OF FINANCIAL STATEMENT FOOTNOTES THAT DESCRIBES BAD DEBT EXPENSE:SEE ATTACHED FINANCIAL STATEMENTS FOOTNOTE 3, PP. 12-14. 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 PATIENTSPOLICY: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. 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.PROCEDURE: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 COMMUNITY1. 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. BROOKLYN HEALTHCARE IMPROVEMENT PROJECT (BHIP) 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 2013 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 $43.60 TO $501.60, 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 2009-2013 AMERICAN COMMUNITY SURVEY 5-YEAR ESTIMATES ON THE US CENSUS BUREAU-AMERICAN FACTFINDER WEBSITE , THIS CATCHMENT AREA HAS A TOTAL POPULATION OF 323,368 PEOPLE, WHICH BREAKS DOWN TO 8.7% WHITE, 84.7% BLACK AND 6.6% OTHER. ADDITIONALLY, 22.3% 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 2014 UPDATED CHNA, WITHIN OUR PRIMARY SERVICES AREAS (CENTRAL BROOKLYN, EAST NEW YORK AND FLATBUSH) CLOSE TO 12% OF ADULTS HAVE DIABETES. ADDITIONALLY, 29% OF THE ADULT POPULATION IN CENTRAL BROOKLYN IS CONSIDERED OBESE WHICH CAN ALSO LEAD TO A VARIETY OF HEALTH PROBLEMS INCLUDING HEART DISEASE AND DIABETES. THE HIV RELATED DEATH RATE IN THIS REGION IS STILL MORE THAN TWICE BOTH THE BROOKLYN AND NEW YORK CITY OVERALL RATES. IN TOTAL, THERE ARE OVER 7,000 PERSONS LIVING WITH HIV/AIDS IN OUR PRIMARY SERVICE AREA. ADDITIONALLY, HIGH BLOOD PRESSURE AND HIGH CHOLESTEROL CONTRIBUTE TO HEART DISEASE. AS SUCH, 32% OF RESIDENTS WITHIN OUR PRIMARY SERVICE AREA HAVE BEEN DIAGNOSED WITH HIGH BLOOD PRESSURE AND 26% WITH HIGH CHOLESTEROL. 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:PROMOTION OF COMMUNITY HEALTH - ACCESS TO QUALITY HEALTH CARERESIDENTS 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.SCREENINGINCREASED 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 50-60 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: WOMEN IN NEED, GIRLS SCOUTS OF AMERICA, PS 326, PS 316, PS 243, BROOKLYN ADULT LEARNING CENTER, EAST NEW YORK LEARNING CENTER, BROOKLYN ADULT LEARNING CENTER, ST. GABRIEL'S SENIOR CENTER, MARTIN LUTHER KING CONCERT SERIES, BETHEL TABERNACLE, NEW DIMENSION, NEW GENESIS CHRISTIAN CHURCH, 25TH STREET BLOCK ASSOCIATION, GLENWOOD SENIOR CENTER, VICTORIOUS CHURCH GOD, CHRISTIAN CULTURAL CENTER, PANAMANIAN ASSOCIATION, BEULAH CHURCH OF NAZARENE, CHURCH OF ST. MARK'S, ST. STEPHENS CHURCH, WOMEN OF FAITH, ANGLICAN CHURCH, ST. AUGUSTINE'S, BEDFORD CENTRAL PRESBYTERIAN, MT. OLIVES, AND GOD'S BATTALION OF PRAYER. IN 2014, KINGSBROOK PROVIDED EARLY DETECTION OPPORTUNITIES TO OVER 4,175 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) MODULEKINGSBROOK HAS ADOPTED THE NCQA 'S PATIENT-CENTERED MEDICAL HOME (PCMH) MODULE, AN INNOVATIVE PROGRAM FOR IMPROVING PRIMARY CARE; ESPECIALLY AS IT PERTAINS TO OUR CHRONIC DISEASE TREATMENT, VIA A SET OF STANDARDS THAT DESCRIBE CLEAR AND SPECIFIC CRITERIA, THE PROGRAM GIVES PRACTICES INFORMATION ABOUT ORGANIZING CARE AROUND PATIENTS, WORKING IN TEAMS AND COORDINATING AND TRACKING CARE OVER TIME. THE NCQA PATIENT-CENTERED MEDICAL HOME STANDARDS STRENGTHEN AND ADD TO THE ISSUES ADDRESSED BY NCQA'S ORIGINAL PROGRAM. AS SUCH, WE WILL BE COMMITTED TO THIS MODEL BEYOND 2017. THE PATIENT CENTERED MEDICAL HOME 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 HOSPITAL-MEDICAL HOME (H-MH) DEMONSTRATION PROGRAM IS TO IMPROVE THE QUALITY AND CONTINUITY OF CARE THAT MEDICAID BENEFICIARIES RECEIVE WHILE ENHANCING THE AMBULATORY TRAINING EXPERIENCE OF THE PRIMARY CARE RESIDENTS. 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 ACCESSIN 2014, 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 2014, OVER 1,110 PEOPLE ATTENDED OUR EVENTS. THE PARTNERSHIPS PRODUCED COLLABORATIVE EVENTS THAT INCLUDED THE FOLLOWING: - AIDS AWARENESS DAY - FEATURING A WEALTH OF INFORMATION ON THE DAC CENTERS SUPPORT SERVICES, WHICH INCLUDES; MEDICAL CARE COORDINATION, OUTPATIENT CASE MANAGEMENT, INPATIENT CASE MANAGEMENT, CASE MANAGEMENT PROGRAM OPERATIONS, SUPPORT GROUPS, FAMILY & INDIVIDUAL COUNSELING AND SUBSTANCE ABUSE COUNSELING (REFERRAL TO DETOX).- 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. - 5TH 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 300 PERSONS. SCREENINGS AND EDUCATION FOR DIABETES, HYPERTENSION AND ASTHMA WERE AVAILABLE FOR GUESTS. THIS EVENT WAS HELD ON OCTOBER 12TH 2014.- 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 2014, 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 2014, KJMC OFFERED 16 DIFFERENT CLASSES WITH TOPICS RANGING FROM OBESITY, DIABETIC FOOT CARE, STRESS MANAGEM 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 CONTINUATION OF DESCRIPTION OF COMMUNITY HEALTH PROMOTION MYKINGSBROOK PORTALIN AUGUST 2014, THE KINGSBROOK IT DEPARTMENT ROLLED OUT A NEW SERVICE THAT ALLOWS OUR PATIENTS TO ACCESS AND STAY IN CONTROL OF THEIR PERSONAL MEDICAL RECORD INFORMATION. THIS SERVICE, CALLED MYKINGSBROOK PORTAL, ALLOWS OUR PATIENT TO VIEW LAB RECORDS, REQUEST PRESCRIPTION REFILLS, AND SEND EMAILS TO REQUESTS APPOINTMENTS AND REFERRALS. KJMC HAD IT STAFF GO OUT ONTO THE HOSPITAL FLOORS TO SIGN PATIENTS UP, INCLUDING HELPING PATIENTS SET UP THEIR OWN EMAIL ACCOUNT IF THEY DID NOT PREVIOUSLY HAVE ONE. SINCE THIS PROGRAM WAS ROLLED OUT, KJMC HAS SIGNED UP APPROXIMATELY 1700 PATIENTS. X X X X 0 0 0 0 0 0 0 0 0 LINDA BRADY MD PRESIDENT & BOARD DIRECTOR 800153 0 0 0 88491 0 24700 0 42942 0 956286 0 0 0 JOHN SCHMITT CPA ASSISTANT TREASURER & CFO 341434 0 0 0 23034 0 24700 0 42942 0 432110 0 0 0 HAROLD MCDONALD THRU 42014 COO 153453 0 0 0 1687 0 0 0 941 0 156081 0 0 0 SIBTE BURNEY MD CHIEF MEDICAL OFFICER 398499 0 0 0 15655 0 24700 0 36127 0 474981 0 0 0 KURT KODROFF VICE PRESIDENT 419430 0 0 0 1687 0 24700 0 44874 0 490691 0 0 0 ROBERT DUBICKI SENIOR VP 328876 0 0 0 19703 0 24700 0 39052 0 412331 0 0 0 JANE LEDERER CHIEF NURSING OFFICER 232753 0 0 0 1687 0 22772 0 20658 0 277870 0 0 0 MARC ROSS MD DIR REHAB MED 497632 0 0 0 1687 0 24700 0 42942 0 566961 0 0 0 WILLIAM LOIS DIRECTOR SURGERY 460211 0 0 0 1687 0 24700 0 36127 0 522725 0 0 0 VIJAY AKKAPEDDI CHAIR EMERGENCY DEPT 423044 0 0 0 1687 0 24700 0 42942 0 492373 0 0 0 LEON VALBRUN PSYCHIATRIST 292346 0 0 0 0 0 21365 0 39636 0 353347 0 0 0 ADRIAN CRISTIAN DEPUTY MED DIR, REHAB MEDICINE 286437 0 0 0 0 0 23264 0 38423 0 348124 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 11 REVIEW PROCESS FOR FORM 990: THE CFO HAS CONDUCTED A DETAIL REVIEW OF FORM 990 WITH THE HOSPITAL'S TAX ACCOUNTANT AND ALL APPROPRIATE CHANGES HAVE BEEN MADE. FORM 990 IS THEN REVIEWED WITH THE CEO FOR ANY ADDITIONAL COMMENTARY, OBSERVATIONS, OR RECOMMENDATIONS. FORM 990 IS THEN REVIEWED WITH THE CHAIRMAN OF THE AUDIT AND COMPLIANCE COMMITTEE AND THEN PRESENTED TO THE AUDIT AND COMPLIANCE COMMITTEE FOR REVIEW FOR ANY ADDITIONAL COMMENTARY, OBSERVATIONS, OR RECOMMENDATIONS. ONCE COMPLETED AND FILED, FORM 990 IS MADE AVAILABLE TO THE FULL BOARD BY THE CHAIRMAN OF THE AUDIT AND COMPLIANCE COMMITTEE. 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 UPON REQUEST, THE ORGANIZATION WILL MAKE AVAILABLE ONLY THOSE DOCUMENTS REQUIRED TO BE DISCLOSED UNDER THE PUBLIC INSPECTION LAWS. FORM 990, PART VII THE COMPENSATION RECEIVED BY DR. PATRICE WAS ON-CALL PAY FOR NEPHROLOGY COVERAGE. HE WAS NOT COMPENSATED FOR HIS BOARD SERVICE. FORM 990, PART XI, LINE 9: PENSION RELATED CHANGES OTHER THAN NET PERIODIC PENSION COSTS -3,389,547. RUTLAND NURSING HOME INC 585 SCHENECTADY AVENUE BROOKLYN NY 11203 112164674 NURSING HOME NY 501(C)(3) LINE 9 KHS 0 KINGSBROOK JEWISH MEDICAL CENTER AUXILIARIES 585 SCHENECTADY AVENUE BROOKLYN NY 11203 113016121 SUPPORT ORG NY 501(C)(3) LINE 11A, I KJMC 0 KINGSBROOK HEALTHCARE SYSTEM INC (KHS) 585 SCHENECTADY AVENUE BROOKLYN NY 11203 030464734 SUPPORT ORG NY 501(C)(3) LINE 11A, I N/A 0 KINGSBROOK HEALTHCARE FOUNDATION INC 585 SCHENECTADY AVENUE BROOKLYN NY 11203 112845058 SUPPORT ORG NY 501(C)(3) LINE 11A, 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 6847386 64717 1.00000 1 0 1 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 KINGSBROOK MEDICAL ASSOCIATES PC S 3878000 ACTUAL AMOUNT KINGSBROOK MEDICAL ASSOCIATES PC D 2074000 ACTUAL AMOUNT