2015-05-15T12:59:37-05:00 2014-06-30 861065772 DELOITTE TAX LLP 1700 MARKET STREET 25TH FLOOR PHILADELPHIA PA 191033984 990 2013-07-01 141338386 SUNNYVIEW HOSPITAL AND REHABILITATION CENTER SUNN 5182713446 1270 BELMONT AVENUE SCHENECTADY NY 123082104 RICHARD PETTERSON CFO 5182713446 2015-05-13 1 WILLIAM J HOMER P00994519 2152462300 2013 2016-02-25 16:41:14Z RICHARD PETTERSON 1270 BELMONT AVENUE SCHENECTADY NY 123082104 52876754 0 X WWW.SPHP.COM X 1929 NY SUNNYVIEW HOSPITAL & REHABILITATION'S MISSION IS TO IMPROVE THE LIVES OF PEOPLE WITH DISABILITIES AND THE LIVES OF THEIR FAMILIES BY: A) PROVIDING COMPREHENSIVE MEDICAL REHABILITATION SERVICES TO PERSONS OF ALL AGES IN OUR REGION, B) PROMOTING ADVOCACY AND COMMUNITY EDUCATION ABOUT DISABILITIES, THEIR MANAGEMENT AND PREVENTION AND C) SERVE AS A CENTER FOR THE EDUCATION AND TRAINING OF REHABILITATION PROFESSIONALS. SUNNYVIEW HAS A COMMITMENT TO PROVIDE QUALITY REHABILITATION FOR ALL WHO HAVE DEMONSTRATED A NEED FOR OUR SERVICES AND WHO CAN BENEFIT FROM THEM. CHARITY CARE ACCOUNTS FOR PATIENTS WHO QUALIFY BY INCOME LEVEL AND PATIENTS WHO INCUR CATASTROPHIC EXPENSES THEY CANNOT AFFORD TO PAY.FOR THE 2013-2014 PERIOD (JULY 2013-JUNE 2014), SUNNYVIEW HOSPITAL HAD INPATIENT DISCHARGES TOTALING 2,468, TOTAL PATIENT DAYS OF 32,049 AND OUTPATIENT VISITS TOTALING 60,137. 22 15 836 225 0 0 414348 1308496 23080890 48352210 1583498 1167475 549187 2048573 25627923 52876754 0 0 0 0 15423214 31593533 0 0 276191 7267308 14947173 22690522 46540706 2937401 6336048 44681297 49202131 22778032 17001477 21903265 32200654 X SUNNYVIEW HOSPITAL & REHABILITATION'S MISSION IS TO IMPROVE THE LIVES OF PEOPLE WITH DISABILITIES AND THE LIVES OF THEIR FAMILIES BY: A) PROVIDING COMPREHENSIVE MEDICAL REHABILITATION SERVICES TO PERSONS OF ALL AGES IN OUR REGION, B) PROMOTING ADVOCACY AND COMMUNITY EDUCATION ABOUT DISABILITIES, THEIR MANAGEMENT AND PREVENTION AND C) SERVE AS A CENTER FOR THE EDUCATION AND TRAINING OF REHABILITATION PROFESSIONALS. SUNNYVIEW HAS A COMMITMENT TO PROVIDE QUALITY REHABILITATION FOR ALL WHO HAVE DEMONSTRATED A NEED FOR OUR SERVICES AND WHO CAN BENEFIT FROM THEM. CHARITY CARE ACCOUNTS FOR PATIENTS WHO QUALIFY BY INCOME LEVEL AND PATIENTS WHO INCUR CATASTROPHIC EXPENSES THEY CANNOT AFFORD TO PAY.FOR THE 2013-2014 PERIOD (JULY 2013-JUNE 2014), SUNNYVIEW HOSPITAL HAD INPATIENT DISCHARGES TOTALING 2,468, TOTAL PATIENT DAYS OF 32,049 AND OUTPATIENT VISITS TOTALING 60,137. 0 0 31184513 38291687 HOSPITAL INPATIENT SERVICES SPECIALIZING IN REHABILITATION MEDICINE, INPATIENT UNITS INCLUDE BRAIN INJURY, PEDIATRIC, NEUROLOGICAL, PHYSICAL MEDICINE, CARDIAC, PULMONARY AND ORTHOPEDIC. INPATIENT DISCHARGES 2,468. TOTAL PATIENT DAYS 32,049. 5887515 7229322 HOSPITAL OUTPATIENT SERVICES INCLUDING PHYSICAL THERAPY, OCCUPATIONAL THERAPY, AUDIOLOGY, SPEECH AND PSYCHOLOGY. TOTAL OUTPATIENT VISITS 60,137. 1399564 1718535 PHYSICAL MEDICINE & REHABILITATION PHYSICIAN PRACTICE PROVIDING INPATIENT & OUTPATIENT SERVICES. 2574495 3598044 THERAPY SERVICES TO NURSING HOMES, COMMUNITY HEALTH PROGRAMS AND OTHER MISCELLANEOUS REVENUE: EXPENSES $2,574,495. INCLUDING GRANTS OF $0. REVENUE $3,598,044. 2574495 3598044 41046087 1 1 0 1 0 0 0 0 0 0 1 1 0 1 1 0 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 1 0 0 1 3 0 836 0 0 0 0 0 0 0 0 0 0 0 0 X 22 15 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X KRISTIN SIGNOR 5183863590 1270 BELMONT AVENUE SCHENECTADY NY 123082104 ROBERT BYLANCIK CONSULTANT 0.50 14.50 X 50002 0 1000 JOHN FILIPPONE MD TRUSTEE 0.50 37.00 X 0 425672 28562 ALAN SANDERS MD CHIEF - DEPT OF MEDICINE 0.50 14.50 X 0 43821 89 BARBARA CORTELL TRUSTEE 0.50 14.50 X 0 0 0 SUSAN DAKE TRUSTEE 0.50 14.50 X 0 0 0 ANN DISARRO TRUSTEE 0.50 14.50 X 0 0 0 REV KENNETH DOYLE TRUSTEE 0.50 14.50 X 0 0 0 HAROLD GORDON ESQ 2ND VICE CHAIR 0.50 14.50 X 0 0 0 RONALD L GUZIOR TRUSTEE 0.50 14.50 X 0 0 0 GEORGE HEARST III TRUSTEE 0.50 14.50 X 0 0 0 SR PHYLLIS HERBERT TRUSTEE 0.50 14.50 X 0 0 0 ROBERT W JOHNSON III ESQ TRUSTEE 0.50 14.50 X 0 0 0 SYDNEY TUCKER JONES III TRUSTEE 0.50 14.50 X 0 0 0 BEVERLY KARPIAK TRUSTEE 0.50 14.50 X 0 0 0 MICHAEL KEEGAN TRUSTEE 0.50 14.50 X 0 0 0 JOHN M LANG TRUSTEE 0.50 14.50 X 0 0 0 NORMAN MASSRY TRUSTEE 0.50 14.50 X 0 0 0 SR KATHLEEN NATWIN TRUSTEE 0.50 14.50 X 0 0 0 GEORGE PHILIP 1ST VICE CHAIR 0.50 14.50 X 0 0 0 CURTIS POWELL TRUSTEE 0.50 14.50 X 0 0 0 JAMES SLAVIN MD TRUSTEE 0.50 14.50 X 0 0 0 ANTHONY P TARTAGLIA MD SECRETARY 0.50 14.50 X 0 0 0 LISA THORN MD TRUSTEE 0.50 14.50 X 0 54284 0 SR KATHLEEN TURLEY TRUSTEE 0.50 14.50 X 0 0 0 JAMES K REED MD PRESIDENT - CEO SPH/MCCO 1.00 36.50 X X 0 1004730 44251 THOMAS SCHUHLE VP & CEO-CFO & TREASURER 1.00 36.50 X 0 541755 33444 JOHN COLLINS VP & CMO/CONTINUING CARE 1.00 36.50 X 0 365676 25515 JO-ANN CONSTANTINO VP CONTINUING CARE 1.00 36.50 X 0 458132 19308 RICHARD PETTERSON CFO - CONTINUING CARE 1.40 38.60 X 0 254899 33371 EDWARD EISENMAN VP 40.00 0.00 X 216388 0 20917 LYNNE NICOLSON VP & CMO 40.00 0.00 X 342043 0 29883 KENNITH SHAPIRO PHYSICIAN 40.00 0.00 X 357715 0 33276 VINCENT SOMAIO PHYSICIAN 40.00 0.00 X 267217 0 27484 RADANA DOOLEY PHYSICIAN 40.00 0.00 X 205764 0 29404 ROSANN DEMEO CNO 40.00 0.00 X 129553 0 14223 ROBERT GILLEN CHIEF - NEUROPSYCHOLOGY 40.00 0.00 X 116165 0 25347 JAMES GAVIN FORMER CFO 0.00 0.00 X 0 1095254 5658 STEVEN BOYLE FORMER TRUSTEE, CEO 0.00 0.00 X 0 473955 7500 1684847 4718178 379232 9 1 1 0 ELLIS HOSPITAL 600 MCCLELLAN STREET SCHENECTADY NY 12304 LAB SERVICES 1002784 U W MARX CONSTRUCTION COMPANY 20 GURLEY AVENUE TROY NY 12181 CONSTRUCTION 336072 D AND B ACOUSTICAL CORP 1764 COLUMBIA TURNPIKE EAST GREENBUSH NY 12061 CONSTRUCTION AND BUILDING MAINTENANCE 328412 CALLANAN INDUSTRIES PO BOX 15097 SCHENECTADY NY 12303 PAVEMENT OF PARKING LOT 264900 MORRISON MANAGEMENT SPECIALIST 5801 PEACHTREE DUNWOODY RD ATLANTA GA 303421503 FOOD SERVICES 206474 13 859069 449427 1308496 HOSPITAL PATIENT SERVI 621400 48352210 48352210 48352210 1167475 1167475 COST RECOVERIES 900099 1902965 1902965 145608 145608 2048573 52876754 50400783 0 1167475 660233 660233 26633958 25632143 826471 175344 38424 36113 2093 218 2327665 2187669 126787 13209 1933253 1816979 105304 10970 323796 323796 2136502 1869813 266689 68789 151 55091 13547 3117397 2583892 489176 44329 151148 132495 9990 8663 1048522 1048066 456 90278 90278 35993 33342 2651 74465 17033 57432 1636966 1630486 6480 207973 198656 8174 1143 NEH HOME OFFICE ALLOCAT 2578046 0 2578046 0 DRUGS & LAB SERVICES 2191250 2191250 0 0 NYS ASSESSMENTS 654843 654843 0 0 DIETARY FOOD & SUPPLIES 525158 499456 25702 0 106047 99626 4133 2288 46540706 41046087 5218428 276191 1752 987939 656022 6402973 6202884 646028 967582 41104247 27846286 13369737 13257961 9411055 17828076 4200725 3798337 9662840 6489517 44681297 49202131 3608838 3604198 10400000 0 8769194 13397279 22778032 17001477 X 18276979 28329185 1139007 1384190 2487279 2487279 21903265 32200654 44681297 49202131 6336048 3961341 0 X 0 0 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 0 1 1254 0 0 1254 0 PART II-B, LINE 1: THE CEO OF SUNNYVIEW HOSPITAL AND REHABILITATION CENTER VISITED WITH OUR CONGRESSIONAL REPRESENTATIVES OR THEIR STAFF TO DISCUSS REGULATORY OR POLICY ISSUES THAT HAVE AN IMPACT ON REHABILITATION AND SPECIFICALLY SUNNYVIEW HOSPITAL. SUCH VISITS WERE THE EXTENT OF OUR LOBBYING ACTIVITIES IN THE PERIOD JULY 2013 - JUNE 2014. 335669 335669 18986277 12539162 6447115 238925 41901 197024 19924427 14607780 5316647 1618949 657443 961506 13257961 3798337 F 3798337 COLLATERAL ACCOUNT 473634 NET ASSETS IN FOUNDATION 5504492 PREPAID PENSION 311105 WORKERS COMPENSATION 200286 6489517 THIRD PARTY SETTLEMENTS 873170 A/R CREDIT BALANCES 173018 ACCRUED INTEREST PAYABLE 52360 ASSET RETIREMENT OBLIGATION 169014 OTHER RESERVES 246911 PENSION & POST RETIREMENT OBLIG. 278733 SWAP LIABILITY 1161936 HEALTH CLAIMS RESERVE 163709 NOTES PAYABLE 10166740 DUE TO AFFILIATES 111688 13397279 1 1 X 1 X 1 X 1 1 1 0 1 1 77783 0 77783 0.00170 5056605 3523982 1532623 0.03290 5134388 3523982 1610406 0.03460 121995 33515 88480 0.00190 53110 53110 0.00110 265929 1070 264859 0.00570 441034 34585 406449 0.00870 5575422 3558567 2016855 0.04330 1 350000 28445722 26808303 1637419 X 1 1 1 1 SUNNYVIEW HOSPITAL & REHAB CENTER 1270 BELMONT AVENUE SCHENECTADY NY 123082104 WWW.NEHEALTH.COM/MEDICAL_CARE/SUNNYVIE 4601004H X X REHABILITATION HOSPITAL SUNNYVIEW HOSPITAL AND REHABILITATION 1 1 X X X X X X X X 13 1 1 1 ` X X X X X X X X X X 0 0 1 1 200.000000000000 1 400.000000000000 1 X X X X X X X X 1 1 X X X X X 1 0 0 X X 0 0 SUNNYVIEW HOSPITAL AND REHABILITATION PART V, SECTION B, LINE 3: SUNNYVIEW HOSPITAL AND REHABILITATION CENTER COMMUNITY BENEFITS PROGRAM IS BASED ON THE COMMUNITY HEALTH NEEDS ASSESSMENT ("CHNA") CONDUCTED BY THE HEALTHY CAPITAL DISTRICT INITIATIVE ("HCDI"). HCDI IS CONSORTIUM OF ORGANIZATIONS JOINED TOGETHER TO PRIORITIZE AND ADDRESS SIGNIFICANT COMMUNITY HEALTH ISSUES. THE CHNA BENEFITED FROM THE REVIEW AND INPUT OF THE MEMBERS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT WORKGROUP OF THE HEALTHY CAPITAL DISTRICT INITIATIVE. THESE INDIVIDUALS ARE SUBJECT MATTER EXPERTS FROM THE AREA COUNTY PUBLIC HEALTH DEPARTMENTS OF ALBANY, RENSSELAER, AND SCHENECTADY; AND OF EACH OF THE CAPITAL REGION HOSPITALS, ALBANY MEDICAL CENTER, ALBANY MEMORIAL HOSPITAL, SUNNYVIEW HOSPITAL AND REHABILITATION CENTER, ST. MARY'S HOSPITAL, SAMARITAN HOSPITAL, AND ELLIS HOSPITAL. THEY WERE JOINED BY REPRESENTATIVES FROM COMMUNITY BASED ORGANIZATIONS, BUSINESSES, CONSUMERS, SCHOOLS, ACADEMICS, AND DISEASE GROUPS FOR A TOTAL OF 34 DIFFERENT ORGANIZATIONS IN OUR CAPITAL REGION SUCH AS CATHOLIC CHARITIES, WHITNEY M. YOUNG, JR. FEDERALLY QUALIFIED HEALTH CENTER ("FQHC"), CAPITAL DISTRICT PHYSICIANS HEALTH PLAN, FIDELIS CARE HEALTH PLAN, UNIVERSITY OF ALBANY SCHOOL OF PUBLIC HEALTH, YMCA, COMMUNITY GARDENS, AND SENIOR HOUSING ORGANIZATIONS. REPRESENTATIVES OF THE HCDI DETERMINED THE PROCESS FOR COMPLETING THE NEEDS ASSESSMENT, REVIEWED THE COLLECTED DATA. THE CHNA IS THE RESULT OF OVER A YEAR OF MEETINGS WITH MEMBER ORGANIZATIONS AND COMMUNITY INPUT THROUGH OUR SURVEY OF OVER 3,000 RESIDENTS OF THE CAPITAL DISTRICT. DRAFTS OF THE SECTIONS WERE SENT TO LOCAL SUBJECT MATTER EXPERTS FOR REVIEW IN THE HEALTH DEPARTMENTS OF ALBANY, RENSSELAER, AND SCHENECTADY COUNTIES AND IN ST. PETER'S HEALTH PARTNERS, ALBANY MEDICAL CENTER, ELLIS HOSPITAL, AND INTERFAITH PARTNERSHIP FOR THE HOMELESS. COMMENTS WERE ADDRESSED AND CHANGES WERE INCORPORATED INTO THE FINAL DOCUMENT. THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS COMPLETED AND APPROVED IN JUNE 2013. IN SCHENECTADY, WHERE SUNNYVIEW IS LOCATED, THIS WORK WAS FURTHER INFORMED BY THE ACTIVITIES OF THE SCHENECTADY COALITION FOR A HEALTHY COMMUNITY. SUNNYVIEW HOSPITAL AND REHABILITATION PART V, SECTION B, LINE 4: SUNNYVIEW HOSPITAL AND REHABILITATION CENTER CONDUCTED ITS CHNA IN COLLABORATION WITH THE FOLLOWING HOSPITAL FACILITIES- ALBANY MEDICAL CENTER, ALBANY MEMORIAL HOSPITAL, ELLIS HOSPITAL, ST. MARY'S HOSPITAL, AND SAMARITAN HOSPITAL, ST. PETER'S HOSPITAL AND BURDETT CARE CENTER. SUNNYVIEW HOSPITAL AND REHABILITATION PART V, SECTION B, LINE 5D: THE CHNA IS AVAILABLE AT - HTTP://WWW.NEHEATH.COM/ABOUT_US/COMMUNITY_HEALTH_NEEDS_ASSESSMENT SUNNYVIEW HOSPITAL AND REHABILITATION PART V, SECTION B, LINE 7: OF THE TEN AREAS IDENTIFIED AS PROBLEMS THROUGH THE COMMUNITY HEALTH NEEDS ASSESSMENT FOR THE CAPITAL DISTRICT, THE ORGANIZATION ALONG WITH COMMUNITY PARTNERS PRIORITIZED (I) THE PREVENTION OF CHRONIC DISEASE WITH AN EMPHASIS ON ASTHMA AND DIABETES/OBESITY AND (II) THE PROMOTION OF MENTAL HEALTH AND PREVENTION OF SUBSTANCE ABUSE. WHILE THE ORGANIZATION WILL CONTINUE TO OFFER SERVICES ADDRESSING OTHER PRESSING HEALTH NEEDS, IT FELT THAT THE INCREASED FOCUS ON THE SELECTED AREAS REPRESENTS THE BEST USE OF RESOURCES AND EXPERTISE. OTHER HEALTH CARE FACILITIES SERVING OUR COMMUNITY WILL CONTINUE TO ADDRESS THE OTHER AREAS AS WELL. THUS, CANCER, SUDDEN INFANT DEATH, HIV, SEXUALLY TRANSMITTED DISEASES, UNINTENDED DEATH, AUTOMOBILE DEATHS, SUICIDE, CHILDHOOD VACCINES, AND PNEUMONIA VACCINE AMONG SENIORS ARE BEING WORKED ON AT BOTH THE COUNTY LEVEL AND AT THE STATE LEVEL. THE TWO FOCUS AREAS WERE CHOSEN ACCORDING TO THE RESULTS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT- WE LOOKED AT DISEASE PREVALENCE RATES, WHICH CONDITIONS AFFECTED DISPARATE POPULATIONS MOST, AND THE AVAILABILITY OF EVIDENCE BASED INTERVENTIONS TO ADDRESS THE PROBLEM, AS DIRECTED BY THE NY STATE PREVENTION AGENDA. SUNNYVIEW HOSPITAL AND REHABILITATION PART V, SECTION B, LINE 12I: THE HOSPITAL RECOGNIZES THAT NOT ALL PATIENTS ARE ABLE TO PROVIDE COMPLETE FINANCIAL AND/OR SOCIAL INFORMATION. THEREFORE, APPROVAL FOR FINANCIAL SUPPORT MAY BE DETERMINED BASED ON AVAILABLE INFORMATION. THE FOLLOWING PATIENTS ARE DEEMED TO HAVE APPLIED FOR FINANCIAL ASSISTANCE: HOMELESS PATIENTS, MEDICAID RECIPIENTS WHO RECEIVE MEDICALLY NECESSARY SERVICES COVERED UNDER THE FAP WHEN MEDICAID DEEMS THE SERVICE NON-COVERED, MEDICAID RECIPIENTS WITH UNSATISFIED SPEND DOWNS, PATIENTS WITH A DIAGNOSIS OF MENTAL ILLNESS WHO RECEIVE SERVICES IN A MENTAL HEALTH OR ADDICTIONS UNIT, AND CHILDREN WHO RECEIVE SERVICES FROM THE RONALD MCDONALD CARE MOBILE VAN. SUNNYVIEW HOSPITAL AND REHABILITATION PART V, SECTION B, LINE 20D: NO PERSON WHO IS FOUND ELIGIBLE FOR FINANCIAL ASSISTANCE WILL BE CHARGED MORE FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE THAN THE AMOUNTS GENERALLY PAID FOR THE SAME SERVICES BY ST. PETER'S HEALTH PARTNERS HIGHEST VOLUME COMMERCIAL PAYER. 4 SUNNYVIEW HOSPITAL & REHAB CTR 3757 CARMAN ROAD SCHENECTADY NY 12303 PT, OT & SPEECH OUTPATIENT CLINIC SUNNYVIEW HOSPITAL & REHAB CTR 427 GUY PARK AVENUE AMSTERDAM NY 12010 SPEECH AND HEARING OUTPATIENT CLINIC SUNNYVIEW THERAPY SERVICES 579 TROY SCHENECTADY ROAD - LATHAM FARMS LATHAM NY 12110 PT OUTPATIENT CLINIC SUNNYVIEW THERAPY SERVICES SOCHA PLAZA 115 SARATOGA ROAD SUITE 100 GLENVILLE NY 12302 PT OUTPATIENT CLINIC PART I, LINE 6A: SUNNYVIEW HOSPITAL AND REHABILITATION REPORTS ITS COMMUNITY BENEFIT INFORMATION AS PART OF THE CONSOLIDATED COMMUNITY BENEFIT INFORMATION REPORTED BY TRINITY HEALTH (EIN 35-1443425) IN ITS AUDITED FINANCIAL STATEMENTS, AVAILABLE AT WWW.TRINITY-HEALTH.ORG. IN ADDITION, IT INCLUDES A COPY OF ITS MOST RECENTLY FILED SCHEDULE H ON TRINITY HEALTH'S WEBSITE. PART I, LINE 7: THE BEST AVAILABLE DATA WAS USED TO CALCULATE THE COST AMOUNTS REPORTED IN ITEM 7. FOR CERTAIN CATEGORIES, PRIMARILY TOTAL CHARITY CARE AND MEANS-TESTED GOVERNMENT PROGRAMS, SPECIFIC COST-TO-CHARGE RATIOS WERE CALCULATED AND APPLIED TO THOSE CATEGORIES. THE COST-TO-CHARGE RATIO WAS DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES. IN OTHER CATEGORIES, THE BEST AVAILABLE DATA WAS DERIVED FROM THE HOSPITAL'S COST ACCOUNTING SYSTEM. PART I, LN 7 COL(F): THE COSTING METHOLOGY USED TO CALCULATE THE AMOUNTS REPORTED IN THE TABLE WAS A COST-TO-CHARGE RATIO DERIVED FROM SUNNYVIEW HOSPITAL AND REHABILITATION CENTER'S 2013 - 2014 (JULY 2013-JUNE 2014) CMS-2552 REPORT. PART III, LINE 2: ANY DISCOUNTS PROVIDED OR PAYMENTS MADE TO A PARTICULAR PATIENT ACCOUNT ARE APPLIED TO THAT PATIENT ACCOUNT PRIOR TO ANY BAD DEBT WRITE-OFF AND ARE THUS NOT INCLUDED IN BAD DEBT EXPENSE. AS A RESULT OF THE PAYMENT AND ADJUSTMENT ACTIVITY BEING POSTED TO BAD DEBT ACCOUNTS, WE ARE ABLE TO REPORT BAD DEBT EXPENSE NET OF THESE TRANSACTIONS. PART III, LINE 4: SUNNYVIEW HOSPITAL AND REHABILITATION CENTER IS INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF ST. PETER'S HEALTH PARTNERS. THE FOLLOWING IS THE TEXT OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS FOOTNOTE FROM PAGE 17 OF THOSE STATEMENTS: "THE CORPORATION RECOGNIZES A SIGNIFICANT AMOUNT OF PATIENT SERVICE REVENUE AT THE TIME THE SERVICES ARE RENDERED EVEN THOUGH THE CORPORATION DOES NOT ASSESS THE PATIENT'S ABILITY TO PAY AT THAT TIME. AS A RESULT, THE PROVISION FOR BAD DEBTS IS PRESENTED AS A DEDUCTION FROM PATIENT SERVICE REVENUE (NET OF CONTRACTUAL PROVISIONS AND DISCOUNTS). FOR UNINSURED AND UNDERINSURED PATIENTS THAT DO NOT QUALIFY FOR CHARITY CARE, THE CORPORATION ESTABLISHES AN ALLOWANCE TO REDUCE THE CARRYING VALUE OF SUCH RECEIVABLES TO THEIR ESTIMATED NET REALIZABLE VALUE. THIS ALLOWANCE IS ESTABLISHED BASED ON THE AGING OF ACCOUNTS RECEIVABLE AND THE HISTORICAL COLLECTION EXPERIENCE BY RHM AND FOR EACH TYPE OF PAYOR. A SIGNIFICANT PORTION OF THE CORPORATION'S PROVISION FOR DOUBTFUL ACCOUNTS RELATES TO SELF-PAY PATIENTS, AS WELL AS CO-PAYMENTS AND DEDUCTIBLES OWED TO THE CORPORATION BY PATIENTS WITH INSURANCE." AS OF JUNE 30, 2014 THE CORPORATION'S ALLOWANCE FOR DOUBTFUL ACCOUNT FOR SELF-PAY WAS 59%. THIS CHANGE WAS PRIMARILY DUE TO THE FLUCTUATIONS DUE TO THE VOLUME OF SELF-PAY BUSINESS UNITS, AMOUNT OF PATIENTS SCREENED DURING TIME OF ADMISSION, AND CALCULATION FOR POTENTIAL COLLECTABILITY. PART III, LINE 8: MEDICARE ALLOWABLE COSTS WERE DERIVED BY TAKING THE INPATIENT ALLOWABLE COST FROM THE 2013-2014 (JULY, 2013-JUNE, 2014) CMS-2552, WORKSHEET D-1, PART II FOR THE HOSPITAL AND THE REHABILITATION CENTER (IRF) PLUS THE TOTAL OF ALL OUTPATIENT CHARGES FROM THE PS & R MULTIPLIED BY THE RATIO OF COSTS TO CHARGES TAKEN FROM THE 2013-2014 (JULY, 2013-JUNE, 2014) CMS-2552, WORKSHEET S-10, LINE 1. PART III, LINE 9B: SUNNYVIEW HOSPITAL AND REHABILITATION CENTER COLLECTION POLICY CONTAINS CRITERIA FOR FINANCIAL ASSISTANCE, AND THE VENDOR WILL PERFORM COLLECTION SERVICES IN ACCORDANCE WITH THE POLICIES AND PROCEDURES OF SUNNYVIEW HOSPITAL AND REHABILITATION CENTER RELEVANT TO BILLING, COLLECTION, AND FINANCIAL SUPPORT OF PATIENTS WITH PAYMENT OBLIGATIONS.IF A PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE, THEIR ACCOUNT WILL NOT BE SUBJECT TO THE USUAL COLLECTION PRACTICES DURING THIS PROCESS. IF THE PATIENT DOES NOT SUBMIT THE NECESSARY DOCUMENTATION WITHIN 90 DAYS, THEN THEIR ACCOUNT COULD BE FORWARDED TO COLLECTIONS. PART VI, LINE 2: THE HEALTH INDICATORS SELECTED FOR THE CHNA WERE BASED ON A REVIEW OF AVAILABLE PUBLIC HEALTH DATA AND NEW YORK STATE PRIORITIES PROMULGATED THROUGH THE PREVENTION AGENDA FOR A HEALTHIER NEW YORK. UPON EXAMINATION OF THESE KEY RESOURCES, IDENTIFICATION OF ADDITIONAL INDICATORS OF IMPORTANCE WITH DATA AVAILABLE, AND DISCUSSION WITH PUBLIC HEALTH AS WELL AS HEALTH CARE PROFESSIONALS IN THE CAPITAL DISTRICT, IT WAS DECIDED THAT BUILDING UPON THE 2008-2012 AND 2013-2017 PREVENTION AGENDAS WOULD PROVIDE THE MOST COMPREHENSIVE ANALYSIS OF AVAILABLE PUBLIC HEALTH NEEDS AND BEHAVIORS FOR THE REGION. THE COLLECTION AND MANAGEMENT OF THIS DATA HAS BEEN SUPPORTED BY THE STATE FOR AN EXTENDED PERIOD OF TIME AND ARE VERY LIKELY TO CONTINUE TO BE SUPPORTED. THIS PROVIDES US WITH BOTH RELIABLE AND COMPARABLE DATA OVER TIME AND ACROSS THE STATE. THESE MEASURES INCLUDE HEALTH CARE UTILIZATION AND CHILDREN'S HEALTH, WHICH, WHEN COMPLIMENTED BY BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM AND PREVENTION QUALITY INDICATORS, PROVIDE HEALTH INDICATORS THAT CAN BE POTENTIALLY IMPACTED IN THE SHORT-TERM. THE FINGER LAKES HEALTH SYSTEMS AGENCY PROVIDED COUNTY AND ZIP CODE LEVEL ANALYSES OF MORTALITY, HOSPITALIZATIONS, AND EMERGENCY ROOM UTILIZATION, FOR ALL RESIDENTS, BY GENDER, RACE AND ETHNICITY. THE SOURCE OF THESE REPORTS WAS 2006-2010 VITAL STATISTICS AND STATEWIDE PLANNING AND RESEARCH COOPERATIVE SYSTEM ("SPARCS") DATA. ADDITIONAL DATA WAS EXAMINED FROM A WIDE VARIETY OF SOURCES AND A LIST IS OUTLINED IN THE CHNA REPORT. THE DATA SOURCES WERE SUPPLEMENTED BY A COMMUNITY HEALTH SURVEY. THE 2013 COMMUNITY HEALTH SURVEY WAS CONDUCTED FROM DECEMBER 2012 TO FEBRUARY 2013 WITH ASSISTANCE FROM THE UNIVERSITY AT ALBANY SCHOOL OF PUBLIC HEALTH ("SPH"). THE SURVEY WAS PROMOTED THROUGH E-MAIL DISTRIBUTION AND PROMOTIONAL FLYERS BY LARGE EMPLOYERS, COMMUNITY ORGANIZATIONS, AND PRIMARY CARE OFFICES. RESPONDENTS WERE ADULT RESIDENTS OF ALBANY, RENSSELAER, AND SCHENECTADY COUNTIES. THIS CONSUMER SURVEY WAS CONDUCTED TO LEARN ABOUT THE HEALTH AND HEALTH SERVICE ACCESS NEEDS OR CONCERNS OF RESIDENTS IN THE CAPITAL DISTRICT. A TOTAL OF 3,059 RESIDENTS OF ALBANY, RENSSELAER, OR SCHENECTADY COUNTIES COMPLETED SURVEYS. OVERSAMPLING WAS DONE IN ZIP CODES IDENTIFIED AS "HIGH NEEDS AREAS" THAT EXPERIENCE GREATER HEALTH DISPARITIES AND CONTAIN LOW-INCOME, MEDICALLY UNDERSERVED, AND MINORITY POPULATIONS. PART VI, LINE 3: SUNNYVIEW HOSPITAL AND REHABILITATION CENTER IS COMMITTED TO:- PROVIDING ACCESS TO QUALITY HEALTHCARE SERVICES WITH COMPASSION, DIGNITY AND RESPECT FOR THOSE WE SERVE, PARTICULARLY THE POOR AND THE UNDERSERVED IN OUR COMMUNITIES- CARING FOR ALL PERSONS, REGARDLESS OF THEIR ABILITY TO PAY FOR SERVICES- ASSISTING PATIENTS WHO CANNOT PAY FOR PART OR ALL OF THE CARE THEY RECEIVE- BALANCING NEEDED FINANCIAL ASSISTANCE FOR SOME PATIENTS WITH BROADER FISCAL RESPONSIBILITIES IN ORDER TO SUSTAIN VIABILITY AND PROVIDE THE QUALITY AND QUANTITY OF SERVICES FOR ALL WHO MAY NEED CARE IN A COMMUNITYIN ACCORDANCE WITH AMERICAN HOSPITAL ASSOCIATION RECOMMENDATIONS, SUNNYVIEW HOSPITAL AND REHABILITATION CENTER HAS ADOPTED THE FOLLOWING GUIDING PRINCIPLES WHEN HANDLING THE BILLING, COLLECTION AND FINANCIAL SUPPORT FUNCTIONS FOR OUR PATIENTS: - PROVIDE EFFECTIVE COMMUNICATIONS WITH PATIENTS REGARDING HOSPITAL BILLS- MAKE AFFIRMATIVE EFFORTS TO HELP PATIENTS APPLY FOR PUBLIC AND PRIVATE FINANCIAL SUPPORT PROGRAMS- OFFER FINANCIAL SUPPORT TO PATIENTS WITH LIMITED MEANS- IMPLEMENT POLICIES FOR ASSISTING LOW-INCOME PATIENTS IN A CONSISTENT MANNER- IMPLEMENT FAIR AND CONSISTENT BILLING AND COLLECTION PRACTICES FOR ALL PATIENTS WITH PATIENT PAYMENT OBLIGATIONSSUNNYVIEW HOSPITAL AND REHABILITATION CENTER COMMUNICATES EFFECTIVELY WITH PATIENTS REGARDING PATIENT PAYMENT OBLIGATIONS. FINANCIAL COUNSELING IS PROVIDED TO PATIENTS ABOUT THEIR PAYMENT OBLIGATIONS AND HOSPITAL BILLS. INFORMATION ON HOSPITAL-BASED FINANCIAL SUPPORT POLICIES AND EXTERNAL PROGRAMS THAT PROVIDE COVERAGE FOR SERVICES ARE MADE AVAILABLE TO PATIENTS DURING THE PRE-REGISTRATION AND REGISTRATION PROCESSES AND/OR THROUGH COMMUNICATIONS WITH PATIENTS SEEKING FINANCIAL ASSISTANCE. FINANCIAL COUNSELORS MAKE AFFIRMATIVE EFFORTS TO HELP PATIENTS APPLY FOR PUBLIC AND PRIVATE PROGRAMS FOR WHICH THEY MAY QUALIFY AND THAT MAY ASSIST THEM IN OBTAINING AND PAYING FOR HEALTHCARE SERVICES. EVERY EFFORT IS MADE TO DETERMINE A PATIENT'S ELIGIBILITY PRIOR TO OR AT THE TIME OF ADMISSION OR SERVICE. HOWEVER, DETERMINATION FOR FINANCIAL SUPPORT CAN BE MADE DURING ANY STAGE OF THE PATIENT'S STAY AFTER STABILIZATION OR COLLECTION CYCLE. SUNNYVIEW HOSPITAL AND REHABILITATION CENTER OFFERS FINANCIAL SUPPORT TO PATIENTS WITH LIMITED MEANS. THIS SUPPORT IS AVAILABLE TO UNINSURED AND UNDERINSURED PATIENTS WHO DO NOT QUALIFY FOR PUBLIC PROGRAMS OR OTHER ASSISTANCE. NOTIFICATION ABOUT FINANCIAL ASSISTANCE, INCLUDING CONTACT INFORMATION, IS AVAILABLE THROUGH PATIENT BROCHURES, MESSAGES ON PATIENT BILLS, POSTED NOTICES IN PUBLIC REGISTRATION AREAS INCLUDING EMERGENCY ROOMS, ADMITTING AND REGISTRATION DEPARTMENTS, AND OTHER PATIENT FINANCIAL SERVICES OFFICES. SUMMARIES OF HOSPITAL PROGRAMS ARE MADE AVAILABLE TO APPROPRIATE COMMUNITY HEALTH AND HUMAN SERVICES AGENCIES AND OTHER ORGANIZATIONS THAT ASSIST PEOPLE IN NEED. INFORMATION REGARDING FINANCIAL ASSISTANCE PROGRAMS IS ALSO AVAILABLE ON HOSPITAL WEBSITES. IN ADDITION TO ENGLISH, THIS INFORMATION IS ALSO AVAILABLE IN SPANISH OR OTHER LANGUAGES, REFLECTING OTHER PRIMARY LANGUAGES SPOKEN BY THE POPULATION SERVICED BY OUR HOSPITAL. SUNNYVIEW HOSPITAL AND REHABILITATION CENTER HAS ESTABLISHED A WRITTEN POLICY FOR THE BILLING, COLLECTION AND SUPPORT FOR PATIENTS WITH PAYMENT OBLIGATIONS. SUNNYVIEW HOSPITAL AND REHABILITATION CENTER MAKES EVERY EFFORT TO ADHERE TO THE POLICY AND IS COMMITTED TO IMPLEMENTING AND APPLYING THE POLICY FOR ASSISTING PATIENTS WITH LIMITED MEANS IN A PROFESSIONAL, CONSISTENT MANNER. PART VI, LINE 4: SUNNYVIEW IS LOCATED IN THE CITY OF SCHENECTADY WHICH IS CENTRALLY LOCATED IN SCHENECTADY COUNTY WITH A POPULATION OF 155,124, IS GEOGRAPHICALLY, THE SECOND SMALLEST COUNTY IN UPSTATE NEW YORK. THE COUNTY CONSISTS OF FIVE TOWNS, TWO PRIMARILY RURAL AND THREE PRIMARILY SUBURBAN, SURROUNDING THE CENTRALLY-LOCATED CITY OF SCHENECTADY (POPULATION: 66,078). THE COUNTY IS LOCATED IMMEDIATELY WEST OF THE STATE CAPITAL OF ALBANY AND MANY OF ITS RESIDENTS COMMUTE TO JOBS IN ALBANY AND THE OTHER COUNTIES THAT MAKE UP NEW YORK'S CAPITAL REGION. RESIDENTS OF THE CITY OF SCHENECTADY ARE GENERALLY LESS AFFLUENT AND LESS HEALTHY THAN RESIDENTS OF THE SURROUNDING TOWNS, WHILE RESIDENTS OF THE COUNTY AS A WHOLE ARE LESS AFFLUENT THAN THE STATE AS A WHOLE, BUT THE COUNTY'S POVERTY RATE IS BELOW THAT OF THE STATE. THE MEDIAN HOUSEHOLD INCOME FOR THE CITY, AT $37,436, IS ONLY ABOUT TWO-THIRDS THAT OF THE COUNTY AS A WHOLE ($55,587), WHICH IS BELOW THAT OF THE STATE ($56,951). THE POVERTY RATE IN THE CITY (22.6%) IS NEARLY DOUBLE THAT OF THE COUNTY AS A WHOLE (12.0%). STATE HEALTH DEPARTMENT DATA SHOW THAT HOSPITALIZATIONS FOR CONDITIONS WHICH COULD HAVE BEEN TREATED IN THE COMMUNITY ("PREVENTION QUALITY INDICATORS") RANGE AS HIGH AS 202% OF THE EXPECTED RATE IN CERTAIN CITY NEIGHBORHOODS, BUT ARE AS LOW AS 49% OF THE EXPECTED RATE IN THE RURAL TOWNS. IN ONE DRAMATIC DISPARITY, HOSPITALIZATIONS FOR CONDITIONS RELATED TO DIABETES RANGE FROM 604/100,000 IN THE CITY'S HAMILTON HILL NEIGHBORHOOD TO 62/100,000 IN THE NEARBY SUBURB OF NISKAYUNA.OVERALL, HOWEVER, SCHENECTADY COUNTY RESIDENTS ARE MORE LIKELY THAN THE AVERAGE NEW YORK STATE RESIDENT TO HAVE HEALTH INSURANCE AND A PRIMARY CARE PROVIDER. ALMOST ALL PRIMARY MEDICAL CARE AND DENTAL CARE FOR LOW-INCOME RESIDENTS IS PROVIDED BY HOMETOWN HEALTH AND THE COMMUNITY PRACTICES OF THE ELLIS MEDICAL GROUP. BOTH HAVE ACHIEVED RECOGNITION BY THE NATIONAL COMMITTEE FOR QUALITY ASSURANCE (NCQA) AS PATIENT-CENTERED MEDICAL HOMES (PCMH). PART VI, LINE 5: SUNNYVIEW IS A 115-BED HOSPITAL SPECIALIZING IN PHYSICAL REHABILITATION. EVERY YEAR, MORE THAN 15,000 INDIVIDUALS COME TO SUNNYVIEW FROM ACROSS THE CAPITAL REGION OF NEW YORK STATE AND BEYOND. NATIONALLY RECOGNIZED AS A LEADER IN NEUROLOGICAL PATIENT CARE, SUNNYVIEW'S NEURO-REHAB INSTITUE TREATS PATIENTS WITH A WIDE RANGE OF NEUROLOGICAL CONDITIONS, INCLUDING STROKE, TRAUMATIC BRAIN INJURY AND SPINAL CORD INJURY. SUNNYVIEW'S EXPERT STAFF IS DEVOTED TO ENHANCING THE DELIVERY OF PERSONALIZED, COMPREHENSIVE STATE-OF-THE-ART REHABILITATION TREATMENT THROUGH COORDINATED PATIENT CARE, EDUCATION, RESEARCH AND OUTREACH ACTIVITIES. OUR INTEGRATED AND INTENSELY TAILORED APPROACH IS SUPPORTED BY TECHNOLOGIES AT THE FOREFRONT OF MODERN SCIENCE. SUNNYVIEW CONDUCTS ITS ACTIVITIES AND ITS HEALTH CARE PURPOSE WITHOUT REGARD TO RACE, COLOR, CREED, RELIGION, GENDER, SEXUAL ORIENTATION, DISABILITY, AGE OR NATIONAL ORIGIN. ONE OF THE TOP HEALTH CARE ORGANIZATIONS IN UPSTATE NY, SUNNYVIEW, IS COMMITTED TO IMPROVING THE HEALTH AND WELLBEING OF OUR COMMUNITY, NOT ONLY AS A CARING COMMUNITY MEMBER, BUT ALSO AS A CATALYST FOR CHANGE. AS SUCH, WE PARTICIPATE IN MANY COMMUNITY PARTNERSHIPS AIMED AT ASSESSING THE CURRENT HEALTH STATUS OF OUR COMMUNITY AND IDENTIFYING OPPORTUNITIES TO MAKE A DIFFERENCE IN THE HEALTH OF OUR CITIZENS WITH PARTICULAR ATTENTION TO THOSE WHO ARE POOR AND VULNERABLE. AS WE HAVE DONE FOR MANY YEARS, WE CONTINUE TO PLAY A MAJOR ROLE IN THE HEALTHY CAPITAL DISTRICT INITIATIVE, AN ORGANIZATION DEDICATED TO IMPROVING THE HEALTH OF THE RESIDENTS OF ALBANY, RENSSELAER AND SCHENECTADY COUNTIES. OUR PARTNERS IN THIS ENDEAVOR ARE THE LOCAL COUNTY HEALTH DEPARTMENTS, OTHER HEALTH CARE PROVIDERS, INSURERS AND COMMUNITY MEMBERS. ST. PETER'S SUPPORTS MANY LOCAL COMMUNITY HEALTH SERVICES, CHURCHES, AND OTHER HEALTH CARE ORGANIZATIONS TO PROVIDE COMPREHENSIVE AND ACCESSIBLE HEALTH CARE SERVICES AND PROACTIVE HEALTH CARE PROGRAMS, THIS INCLUDES SITTING ON COMMUNITY BOARDS, COMMITTEES, AND ADVISORY GROUPS. SUNNYVIEW ALSO PROVIDES SERVICES FOR THE BROADER COMMUNITY AS A PART OF ITS OVERALL COMMUNITY BENEFIT. THE GREATEST SHARE OF THESE EXPENSES IS FOR EDUCATING HEALTH PROFESSIONALS, HELPING TO PREPARE FUTURE HEALTH CARE PROFESSIONALS IS A DISTINGUISHING CHARACTERISTIC OF NONPROFIT HEALTH CARE. THIS EDUCATION INCLUDES STUDENT INTERNSHIPS, CLINIC EXPERIENCE AND OTHER EDUCATION FOR PHYSICIANS, NURSES, PHYSICAL THERAPISTS AND OTHER HEALTH CARE STUDENTS. AS A NONPROFIT ORGANIZATION AND AS PART OF ST. PETER'S HEALTH PARTNERS, A REGIONAL GOVERNING BOARD COMPRISED LARGELY OF INDEPENDENT COMMUNITY MEMBERS REPRESENTING THE MAKEUP OF THE AREA WE SERVE GUIDES SUNNYVIEW HOSPITAL AND REHABILITATION CENTER. SUNNYVIEW HAS AN OPEN MEDICAL STAFF COMPRISED OF QUALIFIED PHYSICIANS WHO WORK TO PROVIDE CARE TO OUR COMMUNITIES. ALL MEDICAL STAFF MUST UNDERGO A THROUGH AND COMPREHENSIVE CREDENTIALING AND ORIENTATION PROCESS. NO PART OF THE INCOME OF SUNNYVIEW BENEFITS ANY PRIVATE INDIVIDUAL NOR IS ANY PRIVATE INTEREST BEING SERVED. ALL SURPLUS FUNDS ARE REINVESTED INTO THE FACILITY, EQUIPMENT, OR PROGRAMS OF THE HOSPITAL TO IMPROVE THE QUALITY OF PATIENT CARE, EXPAND OUR FACILITIES, AND ADVANCE OUR MEDICAL TRAINING, EDUCATION AND RESEARCH PROGRAMS. PART VI, LINE 6: SUNNYVIEW HOSPITAL AND REHABILITATION CENTER IS A MEMBER OF TRINITY HEALTH, ONE OF THE LARGEST CATHOLIC HEALTH CARE DELIVERY SYSTEMS IN THE COUNTRY. TRINITY HEALTH ANNUALLY REQUIRES THAT ALL MEMBER ORGANIZATIONS DEFINE - AND ACHIEVE - COMMUNITY BENEFIT GOALS THAT INCLUDE IMPLEMENTING NEEDED SERVICES OR EXPANDING ACCESS TO SERVICES FOR LOW-INCOME INDIVIDUALS. AS A NOT-FOR-PROFIT HEALTH SYSTEM, TRINITY HEALTH REINVESTS ITS PROFITS BACK INTO THE COMMUNITY THROUGH PROGRAMS SERVING THOSE WHO ARE POOR AND UNINSURED, HELPING MANAGE CHRONIC CONDITIONS LIKE DIABETES, PROVIDING HEALTH EDUCATION, PROMOTING WELLNESS AND REACHING OUT TO UNDERSERVED POPULATIONS. OVERALL, THE ORGANIZATION INVESTS MORE THAN $800 MILLION IN SUCH COMMUNITY BENEFITS AND WORKS TO ENSURE THAT ITS MEMBER HOSPITALS AND OTHER ENTITIES/AFFILIATES ENHANCE THE OVERALL HEALTH OF THE COMMUNITIES THEY SERVE BY ADDRESSING EACH COMMUNITY'S SPECIFIC NEEDS. FOR MORE INFORMATION ABOUT TRINITY HEALTH, VISIT WWW.TRINITY-HEALTH.ORG. PART VI, LINE 7, REPORTS FILED WITH STATES NY 1 1 0 0 0 0 0 0 0 JOHN FILIPPONE MD TRUSTEE 0 401920 0 22977 0 775 0 10200 0 18362 0 454234 0 0 JAMES K REED MD PRESIDENT - CEO SPH/MCCO 0 572376 0 287794 0 144560 0 16475 0 27776 0 1048981 0 0 THOMAS SCHUHLE VP & CEO-CFO & TREASURER 0 392195 0 121757 0 27803 0 12750 0 20694 0 575199 0 0 JOHN COLLINS VP & CMO/CONTINUING CARE 0 272159 0 72349 0 21168 0 10200 0 15315 0 391191 0 0 JO-ANN CONSTANTINO VP CONTINUING CARE 0 342770 0 86770 0 28592 0 12750 0 6558 0 477440 0 0 RICHARD PETTERSON CFO - CONTINUING CARE 0 225968 0 5000 0 23931 0 12750 0 20621 0 288270 0 0 EDWARD EISENMAN VP 209468 0 5000 0 1920 0 8805 0 12112 0 237305 0 0 0 LYNNE NICOLSON VP & CMO 314285 0 17779 0 9979 0 12750 0 17133 0 371926 0 0 0 KENNITH SHAPIRO PHYSICIAN 332830 0 18210 0 6675 0 12750 0 20526 0 390991 0 0 0 VINCENT SOMAIO PHYSICIAN 233852 0 33000 0 365 0 10200 0 17284 0 294701 0 0 0 RADANA DOOLEY PHYSICIAN 192547 0 13000 0 217 0 8673 0 20731 0 235168 0 0 0 JAMES GAVIN FORMER CFO 0 0 0 44875 0 1050379 0 0 0 5658 0 1100912 0 0 STEVEN BOYLE FORMER TRUSTEE, CEO 0 0 0 0 0 473955 0 7500 0 0 0 481455 0 0 PART I, LINE 3 THE ORGANIZATION RELIED ON A RELATED SECTION 501(C)(3) ORGANIZATION THAT USED ONE OR MORE OF THE METHODS DESCRIBED BELOW TO ESTABLISH THE TOP MANAGEMENT OFFICIAL'S COMPENSATION: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - WRITTEN EMPLOYMENT CONTRACT - COMPENSATION SURVEY OR STUDY - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. PART I, LINES 4A-B LINE 4A: JAMES GAVIN RECEIVED A SEVERANCE PAYMENT IN THE AMOUNT OF $307,496. LINE 4B: SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN IS PROVIDED TO CERTAIN KEY EXECUTIVE EMPLOYEES. CONTRIBUTIONS MADE TO THE PLAN ON THEIR BEHALF ARE VESTED AND REFLECTED IN THEIR COMPENSATION AT THE TIME OF THE CONTRIBUTION. FORM 990, PART VI, SECTION A, LINE 6 NORTHEAST HEALTH, INC. IS THE SOLE MEMBER FORM 990, PART VI, SECTION A, LINE 7A YES. ST. PETER'S HEALTH PARTNERS ("SPHP") ELECTS THE MEMBERS OF THE GOVERNING BODY. FORM 990, PART VI, SECTION A, LINE 7B ST. PETER'S HEALTH PARTNERS AND CATHOLIC HEALTH EAST MAY HAVE LIMITED RESERVE POWERS TO APPROVE DECISIONS OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11 THE ORGANIZATION TOOK STEPS TO EDUCATE MANAGEMENT, MEMBERS OF THE BOARD AND MEMBERS OF APPROPRIATE SUBCOMMITTEES OF THE BOARD ON THE COMPLIANCE REQUIREMENTS MANDATED BY THE FORM 990. THE FORM 990 IS REVIEWED BY THE EXECUTIVE COMMITTEE OF THE BOARD OF TRUSTEES OF ST. PETER'S HEALTH PARTNERS. THE BOARD OF TRUSTEES IS UPDATED ON ALL MAJOR AREAS INCLUDED IN THE FILING. IN ADDITION, THE ANNUAL FILING OF FORM 990 IS PROVIDED TO THE ENTIRE BOARD OF TRUSTEES PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE SPHP CONFLICT OF INTEREST POLICY SETS FORTH THE ORGANIZATION'S CONFLICT-OF-INTEREST POLICY AND PROCESSES. ANNUALLY, ALL THOSE SERVING THE ORGANIZATION IN A FIDUCIARY CAPACITY, INCLUDING DIRECTORS, OFFICERS AND KEY EMPLOYEES RECEIVE A COPY OF THE POLICY AND ANNUAL DISCLOSURE STATEMENT TO BE COMPLETED. DISCLOSURES OF FINANCIAL INTEREST OR OTHER REPORTABLE CIRCUMSTANCES AS DEFINED IN THE POLICY ARE SUBMITTED AND REVIEWED BY THE ORGANIZATION'S CEO AND MEMBERS OF THE BOARD. SUMMARY INFORMATION IS REPORTED TO THE ENTIRE BOARD AND AVAILABLE TO THE BOARD THROUGHOUT THE YEAR AS BUSINESS COMES BEFORE THE BOARD OR MANAGEMENT FOR ACTION. THE POLICY CONTAINS A CONTINUING AFFIRMATIVE OBLIGATION ON ALL AFFECTED INDIVIDUALS TO DISCLOSE COMPENSATION OR OTHER CIRCUMSTANCES THROUGHOUT THE YEAR WHICH MAY RISE TO THE LEVEL OF AN ACTUAL OR APPARENT CONFLICT. THE DETERMINATION OF WHETHER A DISCLOSED FINANCIAL OR OTHER INTEREST CONSTITUTES A CONFLICT OF INTEREST IS MADE BY THE BOARD OR AN APPROPRIATE COMMITTEE THEREOF COMPRISED OF DISINTERESTED PERSONS AND WITHOUT THE PARTICIPATION OF THE AFFECTED INDIVIDUAL EXCEPT TO RESPOND TO QUESTIONS ABOUT THE DISCLOSURE. THE POLICY FURTHER ADDRESSES THE PROCEDURE FOR THE BOARD'S FURTHER CONSIDERATION OF THE PROPOSED TRANSACTION/MATTER WITHOUT THE PARTICIPATION OF THE AFFECTED PERSON AND THE DOCUMENTATION OF THE PROCEEDINGS. LASTLY, THE POLICY ADDRESSES POTENTIAL DISCIPLINARY ACTION FOR VIOLATIONS OF THE POLICY. THE POLICY IS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION RELIES ON CATHOLIC HEALTH EAST TO DETERMINE COMPENSATION FOR THE TOP MANAGEMENT OFFICIALS OF THE ORGANIZATION. THE CATHOLIC HEALTH EAST BOARD HAS AN INDEPENDENT COMMITTEE REVIEW AND APPROVE ALL ELEMENTS OF REMUNERATION FOR ALL DISQUALIFIED PARTIES, AS WELL AS OTHER KEY MANAGEMENT. THE BOARD/COMMITTEE HAS AN ESTABLISHED COMPENSATION PHILOSOPHY WHICH DETAILS THE OBJECTIVES OF MARKET POSITIONING AND PAY ELEMENTS. THE COMMITTEE ENGAGES WITH EXTERNAL CONSULTANTS TO PROVIDE MARKET DATA COMPARING THE ORGANIZATION'S ROLES TO SIMILARLY SIZED HEALTH SYSTEMS UTILIZING BOTH TITLE AND JOB CONTENT COMPARISONS. THE COMMITTEE REVIEWS THE MARKET ANALYSIS, APPROVES ANY SALARY ADJUSTMENTS FOR THE EXECUTIVE POPULATION, CONSIDERS BOTH REASONABLENESS AND EFFECTIVENESS OF ALL REMUNERATIVE PROGRAMS AND ESTABLISHES THE DETAILED PERFORMANCE EXPECTATIONS WHICH ARE INCORPORATED INTO THE INCENTIVE PLAN. ALL OF THESE DISCUSSIONS AND DECISIONS ARE DOCUMENTED THROUGH THE PROVISION OF MEETING MINUTES. THE COMPENSATION OF OTHER OFFICERS AND KEY EMPLOYEES OF THE ORGANIZATION ARE REVIEWED BY AN INDEPENDENT COMPENSATION CONSULTANT WHO REVIEWS THE SALARIES TO ENSURE THEY ARE WITHIN MARKET AND MARKET COMPETITIVE. THIS IS DONE ON AN ANNUAL BASIS, REVIEWED BY EITHER THE ORGANIZATION'S OR A RELATED ORGANIZATION'S COMPENSATION COMMITTEE AND COMMUNICATED TO THE OTHER OFFICERS AND KEY EMPLOYEES. FORM 990, PART VI, SECTION C, LINE 19 ORGANIZATIONAL ARTICLES OF INCORPORATION, CORPORATE BYLAWS, GOVERNANCE POLICIES BELIEVED TO BE OF INTEREST TO THE PUBLIC, CONFLICT-OF-INTEREST POLICY AND IRS FORM 990 ARE AVAILABLE UPON REQUEST. DISCLOSURE STATEMENT RELATED TO FORM 5471 UNDER THE CONSTRUCTIVE OWNERSHIP RULES OF INTERNAL REVENUE CODE SECTIONS 318(A) AND 958(B), THE ORGANIZATION IS REQUIRED TO FILE FORM 5471, INFORMATION RETURN OF U.S. PERSONS WITH RESPECT TO CERTAIN FOREIGN CORPORATIONS, AS A CATEGORY 4 AND/OR CATEGORY 5 FILER WITH RESPECT TO STELLA MARIS INSURANCE COMPANY LIMITED, CHESTNUT RISK SERVICES, LTD, AND VENZKE INSURANCE COMPANY, LTD (COLLECTIVELY, THE "FOREIGN CORPORATIONS"). THIS FILING REQUIREMENT IS, OR WILL BE, SATISFIED THROUGH THE FILING OF FORMS 5471 WITH RESPECT TO THE FOREIGN CORPORATIONS ON THE ORGANIZATION'S BEHALF BY THE U.S. ORGANIZATIONS IDENTIFIED BELOW. FOREIGN CORPORATION: STELLA MARIS INSURANCE COMPANY U.S. ORGANIZATION: CATHOLIC HEALTH EAST ADDRESS: 3805 WEST CHESTER PIKE, SUITE 100, NEWTOWN SQUARE, PENNSYLVANIA 19073 IDENTIFYING NUMBER OF U.S. TAX RETURN WITH WHICH FORM 5471 WAS FILED: 23-2929748 IRS SERVICE CENTER WHERE U.S. RETURN WAS FILED: OGDEN, UT FOREIGN CORPORATION: CHESTNUT RISK SERVICES, LTD U.S. ORGANIZATION: SAINT MICHAEL'S MEDICAL CENTER ADDRESS: 111 CENTRAL AVENUE, NEWARK, NEW JERSEY 07102 IDENTIFYING NUMBER OF U.S. TAX RETURN WITH WHICH FORM 5471 WAS FILED: 26-2616046 IRS SERVICE CENTER WHERE U.S. RETURN WAS FILED: OGDEN, UT FOREIGN CORPORATION: VENZKE INSURANCE COMPANY, LTD U.S. ORGANIZATION: TRINITY HEALTH - MICHIGAN ADDRESS: 20555 VICTOR PARKWAY, LIVONIA, MI 48152 IDENTIFYING NUMBER OF U.S. TAX RETURN WITH WHICH FORM 5471 WAS FILED: 38-2113393 IRS SERVICE CENTER WHERE U.S. RETURN WAS FILED: OGDEN, UT BEECHWOOD INC 2212 BURDETT AVE TROY NY 12180 141651563 REAL ESTATE HOLDING NY 501(C)(2) N/A LTC (EDDY) INC 1 BEVERWYCK INC 40 AUTUMN DRIVE SLINGERLANDS NY 12159 141717028 INDEPENDENT/ASSISTED LIVING RETIREMENT COMMUNITY NY 501(C)(3) LINE 9 LTC (EDDY) INC 1 CAPITAL REGION GERIATRIC CENTER INC 421 WEST COLUMBIA ST COHOES NY 12047 141701597 NURSING HOME NY 501(C)(3) LINE 9 LTC (EDDY) INC 1 EDDY LICENSED HOME CARE AGENCY 433 RIVER ST SUITE 3000 TROY NY 12180 141818568 HOME HEALTH NY 501(C)(3) LINE 3 LTC(EDDY) INC 1 EMPIRE HOME INFUSION SERVICE INC 10 BLACKSMITH DRIVE MALTA NY 12020 141795732 HOME CARE NY 501(C)(3) LINE 9 HOME AID SERVICE OF EASTERN NEW YORK INC 1 GLEN EDDY INC ONE GLEN EDDY DRIVE NISKAYUNA NY 12309 141794150 INDEPENDENT/ASSISTED LIVING COMMUNITY NY 501(C)(3) LINE 9 LTC (EDDY) INC 1 HAWTHORNE RIDGE INC 30 COMMUNITY WAY EAST GREENBUSH NY 12061 800102840 INDEPENDENT/ASSISTED LIVING RETIREMENT COMMUNITY NY 501(C)(3) LINE 9 LTC (EDDY) INC 1 HERITAGE HOUSE NURSING CENTER INC 2920 TIBBITS AVE TROY NY 12180 141725101 NURSING HOME NY 501(C)(3) LINE 9 LTC (EDDY) INC 1 HOME AID SERVICE OF EASTERN NEW YORK INC 433 RIVER ST SUITE 3000 TROY NY 12180 141514867 HOME CARE NY 501(C)(3) LINE 9 LTC (EDDY) INC 1 JAMES A EDDY MEMORIAL GERIATRIC CENTER INC 2256 BURDETT AVE TROY NY 12180 222570478 NURSING HOME NY 501(C)(3) LINE 9 LTC (EDDY) INC 1 LTC (EDDY) INC 2212 BURDETT AVE TROY NY 12180 222564710 ELDERLY HEALTH/HOUSING SUPPORTING ORG NY 501(C)(3) LINE 11B, II NORTHEAST HEALTH INC 1 MEMORIAL HOSPITAL ALBANY NY 600 NORTHERN BLVD ALBANY NY 12204 141338457 GENERAL HOSPITAL NY 501(C)(3) LINE 3 NORTHEAST HEALTH INC 1 NORTHEAST HEALTH INC 2212 BURDETT AVE TROY NY 12180 042450756 SUPPORTING ORGANIZATION NY 501(C)(3) LINE 11B, II ST PETER'S HEALTH PARTNERS 1 OUR LADY OF MERCY LIFE CENTER 2 MERCYCARE LANE GUILDERLAND NY 12084 141743506 NURSING HOME FACILITY NY 501(C)(3) LINE 3 ST PETER'S HEALTH CARE SERVICES 1 SAMARITAN CHILD CARE CENTER INC 2213 BURDETT AVE TROY NY 12180 141710225 CHILD DAY CARE NY 501(C)(3) LINE 9 NORTHEAST HEALTH INC 1 SAMARITAN HOSPITAL OF TROY NEW YORK 2215 BURDETT AVE TROY NY 12180 141338544 GENERAL HOSPITAL NY 501(C)(3) LINE 3 NORTHEAST HEALTH INC 1 SENIOR CARE CONNECTION INC 504 STATE ST SCHENECTADY NY 12305 141708754 PACE PROGRAM NY 501(C)(3) LINE 9 LTC (EDDY) INC 1 SETON AUXILIARY INC 1300 MASSACHUSETTS AVENUE TROY NY 12180 141505031 SUPPORTING ORGANIZATION NY 501(C)(3) LINE 9 SETON HEALTH SYSTEM INC 1 SETON HEALTH AT SCHUYLER RIDGE RESIDENTIAL HEALTHCARE 1 ABELE BLVD CLIFTON PARK NY 12065 141756230 SKILLED NURSING NY 501(C)(3) LINE 9 SETON HEALTH SYSTEM INC 1 SETON HEALTH FOUNDATION 1300 MASSACHUSETTS AVENUE TROY NY 12180 222345416 SUPPORTING ORGANIZATION NY 501(C)(3) LINE 11A, I SETON HEALTH SYSTEM INC 1 SETON HEALTH SYSTEM INC 1300 MASSACHUSETTS AVENUE TROY NY 12180 141776186 HOSPITAL NY 501(C)(3) LINE 3 ST PETER'S HEALTH PARTNERS 1 ST PETER'S AUXILIARY 315 SOUTH MANNING BLVD ALBANY NY 01228 222843206 AUXILIARY NY 501(C)(3) LINE 11A, I ST PETER'S HEALTH CARE SERVICES 1 ST PETER'S HEALTH CARE SERVICES 315 SOUTH MANNING BLVD ALBANY NY 12208 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