SOUTHAMPTON HOSPITAL ASSOCIATION: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- SOUTHAMPTON HOSPITAL ASSOCIATION (EIN 11-1667765)
- Tax period
- 2012-01-01 to 2012-12-31
- Filed
- 2013-11-15
- IRS object ID
- 201323199349300122
- Schema version
- 2012v2.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-11-15T08:58:23-06:00 | Timestamp |
| Tax Period End Date | 2012-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BDO USA LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 PARK AVENUE | AddressLine1 |
| City | NEW YORK | City |
| State | NY | State |
| ZIP Code | 10017 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 111667765 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SOUTHAMPTON HOSPITAL ASSOCIATION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of Name | % CHRISTOPHER SCHULTHEIS | InCareOfName |
| Name Control | SOUT | NameControl |
| Phone | 6317268301 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 240 MEETING HOUSE LANE | AddressLine1 |
| Address Line2 | Suite | AddressLine2 |
| City | SOUTHAMPTON | City |
| State | NY | State |
| ZIP Code | 11968 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | CHIRSTOPHER J SCHULTHEIS | Name |
| Title | CHIEF FINANCIAL OFFICER | Title |
| Phone | 6317268301 | Phone |
| Date Signed | 2013-11-13 | DateSigned |
| Authorize Third Party | true | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Paul Hammerschmidt | Name |
| Phone | 2128858000 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2016-02-25 16:41:14Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | ROBERT S CHALONER | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 240 MEETING HOUSE LANE | AddressLine1 |
| City | SOUTHAMPTON | City |
| State | NY | State |
| ZIP Code | 11968 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 124601773 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | www.southamptonhospital.org | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1909 | YearFormation |
| State Legal Domicile | NY | StateLegalDomicile |
| Activity Or Mission Description | To provide and ensure the highest quality of healthcare services for its entire community. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 28 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 27 | NbrIndependentVotingMembers |
| Total Nbr Employees | 1129 | TotalNbrEmployees |
| Total Nbr Volunteers | 36 | TotalNbrVolunteers |
| Total Gross UBI | 2489671 | TotalGrossUBI |
| Contributions Grants Prior Year | 4889480 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 8661471 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 101425895 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 111096334 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 424256 | InvestmentIncomePriorYear |
| Investment Income Current Year | 540384 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | -428517 | OtherRevenuePriorYear |
| Other Revenue Current Year | 686898 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 106311114 | TotalRevenuePriorYear |
| Total Revenue Current Year | 120985087 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 66468243 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 75775431 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 38025175 | OtherExpensePriorYear |
| Other Expenses Current Year | 42354547 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 104493418 | TotalExpensesPriorYear |
| Total Expenses Current Year | 118129978 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 1817696 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 2855109 | RevenuesLessExpensesCY |
| Total Assets BOY | 87464223 | TotalAssetsBOY |
| Total Assets EOY | 97667974 | TotalAssetsEOY |
| Total Liabilities BOY | 82870381 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 89364891 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 4593842 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 8303083 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | The Vision of Southampton Hospital Association is to meet the evolving healthcare needs of its Eastern Long Island community by providing access to a continuum of high quality clinical services. To achieve this, the Hospital will focus resources on continuously improving clinical outcomes, patient safety, service excellence and promoting educational outreach and professional development of its staff. The organization is a member of the East End Health Alliance, the Article 28 parent of Eastern Long Island Hospital, Peconic Bay Medical Center and Southampton Hospital. Consistent with the Mission of The organization, the goals of the Alliance are as follows: 1) To collaboratively develop high quality, comprehensive and accessible health care services to meet the needs of the community served; 2) To rationalize health care services across the system; and 3) To realize management efficiencies. The organization is also affiliated with Stony Brook Medicine, along with the other two East End | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 102407642 | Expense |
| Grants | 0 | Grants |
| Revenue | 111096334 | Revenue |
| Description | Southampton Hospital Association offers a full continuum of ambulatory and inpatient services ranging from primary medical care to specialized surgical procedures, and is staffed by more than 230 physicians, dentists and allied health professionals representing 44 medical specialties. The organization has developed numerous services and outreach, detailed below, to respond to the needs of their patients, including recruiting additional primary care physicians and implementing a graduate medical education program that will hopefully attract these young physicians to stay and practice in the community. Since The organization's service area extends from Westhampton Beach to Montauk, The organization has a number of satellite care offices to provide convenient, specialized care to the community. These include: A) Meeting House Lane Medical Practice - providing primary care at seven locations in East Hampton, Hampton Bays, Montauk, Sag Harbor, Southampton, Wainscott, and Water Mill. B) Westhampton Primary Care Center - providing care in the Westhampton, Westhampton Beach, Quogue, and Remsenburg communities. C) Laboratory and Imaging Services - providing services in East Hampton, Hampton Bays and Southampton. D) Regional Dialysis Center - service to dialysis patients is provided by a dedicated interdisciplinary team of Board-certified Nephrologists, certified dialysis RNs, LPNs and dialysis technicians, certified social workers, and a NYS Registered Dietitian. 24-hour emergency service is also available. E) Center for Physical Therapy and Rehabilitation - providing care in the Westhampton, Westhampton Beach, East Quogue, Quogue, and Remsenburg communities. F) THE SHINNECOCK INDIAN HEALTH CLINIC - SINCE APRIL OF 1995, SOUTHAMPTON HOSPITAL HAS WORKED WITH THE NATION TO PROVIDE SERVICES AT THE SHINNECOCK INDIAN HEALTH CLINIC THROUGH A CONTRACT WITH THE NEW YORK STATE DEPARTMENT OF HEALTH. ON AN ANNUAL BASIS, THE CLINIC PROVIDES APPROXIMATELY 2,700 MEDICAL, 1,200 DENTAL AND 400 DENTAL HYGIENE VISITS FOR ELIGIBLE MEMBERS OF THE SHINNECOCK NATION. DENTAL SERVICES, INCLUDING COMMUNITY EDUCATION, SCREENING, RADIOLOGICAL EXAMS, DENTAL HYGIENE AND RESTORATIVE CARE (CROWNS, FILLINGS AND BRIDGES) ARE PROVIDED THROUGH A SUBCONTRACT WITH STONY BROOK SCHOOL OF DENTAL MEDICINE. CURRENTLY, DENTAL SERVICES ARE AVAILABLE EIGHT DAYS PER MONTH FOR ADULTS AND TWO DAYS PER MONTH FOR CHILDREN. IN ADDITION TO PRIMARY CARE, DENTAL SERVICES, NUTRITIONAL COUNSELING, PRENATAL CARE AND ENDOCRINE SERVICES, THE CLINIC PROVIDES SOCIAL WORK, MENTAL HEALTH AND SUBSTANCE ABUSE COUNSELING. MAMMOGRAPHY SCREENING DAY IS ALSO HELD ANNUALLY IN COLLABORATION WITH THE HOSPITAL'S ELLEN HERMANSON BREAST CENTER. G) The David E. Rogers Center for HIV/AIDS Care (DRC) - provides comprehensive outpatient medical care, medical case management, mental health, psychiatric services, nutritional counseling, and psychosocial support to people living with HIV/AIDS. The Center also provides free HIV testing, post-exposure prophylaxis care, support services, health education/risk reduction, and prevention education and outreach to the East End community. Since 1994 the DRC has provided HIV care to residents of the East End of Long Island, a geographic area previously underserved despite a high HIV prevalence rate. From its inception, the DRC has enjoyed the cooperative efforts of its partner organizations Southampton Hospital and the Stony Brook University Medical Center as well as the support of the communities of the East End. The Center has met its objectives by providing continuity and accessibility of care by establishing linkages between the hospitals and with community based organizations and the community at large. The DRC depends on the cooperative efforts of all health & human service agencies for outreach, to ensure a continuity of care for our patients, and to provide services for the East End community. Annually the DRC provides approximately 812 medical, 421 mental health, and 169 psychiatry visits for 181 active patients. H) Center for Prenatal Care - THE CENTER FOR PRENATAL CARE AT GREENPORT PROVIDES COMPREHENSIVE PRENATAL, GYNECOLOGIC AND FAMILY PLANNING SERVICES FOR WOMEN AND IS AN IMPORTANT OUTREACH ACTIVITY THAT PERMITS THE HOSPITAL TO TAILOR ITS PROGRAMS TO COMMUNITY NEEDS. The Center's staff provides extensive education and counsel to their patients in the areas of nutrition, domestic violence, as well as drug and alcohol abuse, while also providing immediate access to Medicaid assistance, for mothers meeting the eligibility requirements, through the Prenatal Care Assistance Program (PCAP). THE CENTER HAS SUCCESSFULLY WORKED WITH THE LOCAL TOWN GOVERNMENT TO OBTAIN THE AGREEMENT OF LOCAL GROCERS TO ACCEPT WIC VOUCHERS. STAFF ALSO UTILIZES FLYERS, BROCHURES, AND POSTERS TO INCREASE AWARENESS OF HOSPITAL SERVICES AND OFFERS TRANSLATION SERVICES TO THE SIGNIFICANT NUMBER OF HISPANIC WOMEN SEEKING CARE AT THE CENTER. The Center's staff provides extensive education and counsel to their patients in the areas of nutrition, domestic violence, as well as drug and alcohol abuse, while also providing immediate access to Medicaid assistance, for mothers meeting the eligibility requirements, through the Prenatal Care Assistance Program (PCAP). The Center provides prenatal care to approximately 50 mothers annually in an underserved and geographically remote area. A majority of these babies are born at Southampton Hospital's Kathleen D. Allen Maternity Center. The organization is proud of the exceptional specialty services it provides to the community. These include: 1) The Ellen Hermanson Breast Center offers a wide spectrum of breast health services, including education, early detection screenings, surgery, breast cancer treatment and support. The Center utilizes state-of-the-art diagnostic techniques, including computer-assisted mammography, ultrasound and breast biopsy. 2) The Ed & Phyllis Davis Wellness Institute offers the only hospital-based integrative medicine on Long Island's East End. A satellite site in Hampton Bays was opened in late 2011 and wellness programs are now offered in Montauk. Integrative medicine combines modern science, psychology, nutrition, and exercise to enhance the natural healing capacity of the body. Special programs are available for patients suffering from chronic illness. Classes in yoga, tai chi, pilates, zumba, are available. Programs in stress management, nutritional and weight loss counseling, smoking cessation, massage therapy, and acupuncture are also available. 3) The Jenny and John Paulson Department of Emergency Medicine serves more than 25,000 emergency patients annually and is the only hospital-based emergency care on the South Fork of Long Island. Staffed 24/7 by Board-certified emergency physicians and specialty-trained nurses and staff, it has the most sophisticated, non-invasive cardiac diagnostic and monitoring technology available and, as a New York State-designated Stroke Center, it is the destination of ambulances when a heart attack or stroke is suspected. 4) Physical Therapy and Rehabilitation Services including Acute Care, Cardiac, Lymphedema Therapy, Massage Therapy, Occupational Therapy, Hand Therapy, Pulmonary Rehabilitation, Sports Rehabilitation, Vestibular Rehabilitation, and therapy for Speech, Swallowing and Voice Disorders. | Description |
| Total Program Service Expense | 102407642 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | true | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | true | LobbyingActivities |
| Subject To Proxy Tax | false | SubjectToProxyTax |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | true | TermOrPermanentEndowments |
| Report Land Bldg Equip | true | ReportLandBldgEquip |
| Report Invest Oth Securities | true | ReportInvestOthSecurities |
| Report Prog Rel Invest | false | ReportProgRelInvest |
| Report Other Assets | false | ReportOtherAssets |
| Report Other Liabilities | true | ReportOtherLiabilities |
| Report Fin48 Footnote | true | ReportFin48Footnote |
| Independent Audit Financial Stmt | false | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | true | ConsolidatedAuditFinancialStmt |
| School | false | School |
| Foreign Office | false | ForeignOffice |
| Foreign Activities | false | ForeignActivities |
| More Than5000 K To Organizations | false | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividuals |
| Professional Fundraising | false | ProfessionalFundraising |
| Fundraising Activities | false | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | true | Hospital |
| Financial Stmt Attached | true | FinancialStmtAttached |
| Grants To Organizations | false | GrantsToOrganizations |
| Grants To Individuals | false | GrantsToIndividuals |
| Schedule J Required | true | ScheduleJRequired |
| Tax Exempt Bonds | false | TaxExemptBonds |
| Excess Benefit Transaction | false | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | false | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | false | LoanToOfficerOrDQP |
| Grant To Related Person | false | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | false | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | false | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | false | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | false | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | false | DisregardedEntity |
| Related Entity | true | RelatedEntity |
| Related Org Controlled Entity | true | RelatedOrgControlledEntity |
| Transaction Related Entity | true | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | false | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 255 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | true | ComplianceWithBackupWitholding |
| Number Of Employees | 1129 | NumberOfEmployees |
| Employment Tax Returns Filed | true | EmploymentTaxReturnsFiled |
| Unrelated Business Income | true | UnrelatedBusinessIncome |
| Form990-T Filed | true | Form990-TFiled |
| Foreign Financial Account | false | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| Taxable Party Notification | false | TaxablePartyNotification |
| Non Deductible Contributions | false | NonDeductibleContributions |
| Quid Pro Quo Contributions | false | QuidProQuoContributions |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | false | FundsToPayPremiums |
| Premiums Paid | false | PremiumsPaid |
| Indoor Tanning Services | false | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 28 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 27 | NumberIndependentVotingMembers |
| Family Or Business Relationship | false | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | false | DelegationOfManagementDuties |
| Changes To Organizing Docs | false | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | true | MembersOrStockholders |
| Election Of Board Members | true | ElectionOfBoardMembers |
| Decisions Subject To Approval | true | DecisionsSubjectToApproval |
| Minutes Of Governing Body | true | MinutesOfGoverningBody |
| Minutes Of Committees | true | MinutesOfCommittees |
| Officer Mailing Address | false | OfficerMailingAddress |
| Local Chapters | false | LocalChapters |
| Form990 Provided To Governing Body | true | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | true | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | true | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | true | RegularMonitoringEnforcement |
| Whistleblower Policy | true | WhistleblowerPolicy |
| Document Retention Policy | true | DocumentRetentionPolicy |
| Compensation Process CEO | true | CompensationProcessCEO |
| Compensation Process Other | true | CompensationProcessOther |
| Investment In Joint Venture | true | InvestmentInJointVenture |
| Written Policy Or Procedure | false | WrittenPolicyOrProcedure |
| States Where Copy Of Return Is Filed | NY | StatesWhereCopyOfReturnIsFiled |
| Other Website | X | OtherWebsite |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | CHRISTOPHER SCHULTHEIS | NamePerson |
| Telephone Number | 6317268301 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 240 MEETING HOUSE LANE | AddressLine1 |
| City | SOUTHAMPTON | City |
| State | NY | State |
| ZIP Code | 11968 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (39 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Average Hours Per Week RelatedAverageHoursPerWeekRelated | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|---|
| PETER M LARSEN | |||||||||
| CHAIRMAN | 1.25 | X | X | 0 | 0 | 0 | |||
| RICHARD J HIEGEL ESQ | |||||||||
| CO-CHAIR | 1.25 | X | X | 0 | 0 | 0 | |||
| KENNETH B WRIGHT | |||||||||
| CO-CHAIR | 1.25 | X | X | 0 | 0 | 0 | |||
| STANLEY D FRIEDMAN | |||||||||
| VICE PRESIDENT | 1.25 | X | X | 0 | 0 | 0 | |||
| LAWRENCE A WILLIS | |||||||||
| TREASURER | 1.25 | X | X | 0 | 0 | 0 | |||
| PATRICIA STEWART | |||||||||
| SECRETARY | 1.25 | X | X | 0 | 0 | 0 | |||
| GEORGE F BIONDO ESQ | |||||||||
| TRUSTEE | 1.25 | X | 0 | 0 | 0 | ||||
| BARBARA BORSACK | |||||||||
| TRUSTEE | 1.25 | X | 0 | 0 | 0 | ||||
| RICHARD BRUCE | |||||||||
| TRUSTEE | 1.25 | X | 0 | 0 | 0 | ||||
| JEAN LITTLE FITZSIMMONS | |||||||||
| TRUSTEE | 1.25 | X | 0 | 0 | 0 | ||||
| JAMES FORBES | |||||||||
| TRUSTEE | 1.25 | X | 0 | 0 | 0 | ||||
| DAVID GILLESPIE | |||||||||
| TRUSTEE | 1.25 | X | 0 | 0 | 0 | ||||
| STEVEN R GOLDFARB MD | |||||||||
| TRUSTEE | 1.25 | X | 4880 | 0 | 0 | ||||
| JOHN E GRIM III | |||||||||
| TRUSTEE | 1.25 | X | 0 | 0 | 0 | 0.5 | |||
| GILBERT W HARRISON | |||||||||
| TRUSTEE | 1.25 | X | 0 | 0 | 0 | ||||
| MICHAEL ISRAEL MD | |||||||||
| PHYSICIAN/TRUSTEE | 1.25 | X | 226298 | 0 | 21033 | 0.5 | |||
| GEORGE P KAZDIN | |||||||||
| TRUSTEE | 1.25 | X | 0 | 0 | 0 | ||||
| LISA CLARE KOMBRINK ESQ | |||||||||
| TRUSTEE | 1.25 | X | 0 | 0 | 0 | ||||
| JAY K LEVIN | |||||||||
| TRUSTEE | 1.25 | X | 0 | 0 | 0 | ||||
| DOROTHY LEWIS | |||||||||
| TRUSTEE | 1.25 | X | 0 | 0 | 0 | ||||
| HOWARD M LORBER | |||||||||
| TRUSTEE | 1.25 | X | 0 | 0 | 0 | 0.5 | |||
| R TIMOTHY MARAN | |||||||||
| TRUSTEE | 1.25 | X | 0 | 0 | 0 | ||||
| JOHN MCGOWAN | |||||||||
| TRUSTEE | 1.25 | X | 0 | 0 | 0 | ||||
| PHILIP A PIRO JR MD | |||||||||
| TRUSTEE | 1.25 | X | 0 | 0 | 0 | ||||
| FLORENCE ROLSTON MD | |||||||||
| TRUSTEE | 1.25 | X | 0 | 0 | 0 | ||||
| STEPHEN H SHAPOFF | |||||||||
| TRUSTEE | 1.25 | X | 0 | 0 | 0 | ||||
| MICHAEL F SMITH | |||||||||
| TRUSTEE | 1.25 | X | 0 | 0 | 0 | ||||
| MARTIN L STONE MD THRU 1012 | |||||||||
| TRUSTEE | 1.25 | X | 0 | 0 | 0 | ||||
| JOHN WAMBOLD | |||||||||
| TRUSTEE | 1.25 | X | 0 | 0 | 0 | ||||
| ROBERT S CHALONER | |||||||||
| PRESIDENT & CEO | 38.8 | X | 581354 | 0 | 36243 | 0.5 | |||
| CHIRSTOPHER J SCHULTHEIS | |||||||||
| CHIEF FINANCIAL OFFICER | 37.5 | X | 274580 | 0 | 35003 | 0.5 | |||
| FREDERIC I WEINBAUM | |||||||||
| CHIEF MEDICAL OFFICER & COO | 37.5 | X | 430706 | 0 | 37900 | ||||
| PATRICIA A DARCEY | |||||||||
| CHIEF NURSING OFFICER | 37.5 | 196464 | 0 | 35057 | X | ||||
| PAUL R DARVIN | |||||||||
| DIRECTOR, HUMAN RESOURCES | 37.5 | 214688 | 0 | 33095 | X | ||||
| GEORGE KECKEISEN | |||||||||
| PHYSICIAN | 37.5 | 409167 | 0 | 37900 | X | ||||
| EDNA KAPENHAS | |||||||||
| DIRECTOR, BREAST SURGEON | 37.5 | 373775 | 0 | 36243 | X | ||||
| DANIEL M VANARSDALE | |||||||||
| PHYSICIAN | 37.5 | 293424 | 0 | 37900 | X | ||||
| STEVEN GEOROGPOULOS | |||||||||
| PHYSICIAN | 37.5 | 296391 | 0 | 22900 | X | ||||
| CHARLES ARCOLEO | |||||||||
| DIRECTOR/PHYSICIAN | 37.5 | 275793 | 0 | 37900 | X | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 3577520 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 371174 | TotalOtherCompensation |
| Number Individuals GT100 K | 11 | NumberIndividualsGT100K |
| Formers Listed | false | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| MORRISON MANAGEMENT SPECIALIST | |||||
| 4721 MORRISON DRIVE SUITE 300 | MOBILE | AL | 36609 | FOOD SERVICES | 1079873 |
| HAMPTONS GYNECOLOGY OB | |||||
| 595 HAMPTONS ROAD | SOUTHAMPTON | NY | 11968 | MEDICAL | 749144 |
| LONG ISLAND PATHOLOGY PC | |||||
| PO BOX 2098 | SOUTHAMPTON | NY | 11969 | PATHOLOGY | 431520 |
| SOUTH SHORE NEUROLOGIC ASSOCIATES | |||||
| 77 MEDFORD AVENUE | PATCHOGUE | NY | 11772 | MEDICAL | 256638 |
| SOUTHAMPTON PULMONARY MEDICINE | |||||
| 325 MEETING HOUSE LANE | SOUTHAMPTON | NY | 11968 | MEDICAL | 231105 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 13 | NumberOfContractorsGT100K |
| Federated Campaigns | 117312 | FederatedCampaigns |
| Related Organizations | 3350305 | RelatedOrganizations |
| Government Grants | 5053827 | GovernmentGrants |
| All Other Contributions | 140027 | AllOtherContributions |
| Total Contributions | 8661471 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (5 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | Unrelated Business RevenueUnrelatedBusinessRevenue |
|---|---|---|---|---|
| INPATIENT SERVICES | 624200 | 60178234 | 60178234 | |
| OUTPATIENT SERVICES | 624200 | 51074159 | 51074159 | |
| LABORATORY EXTENDED SERVICES | 621500 | 2092762 | 2092762 | |
| LESS: PROVISION FOR UNCOLLECTIBLES, NET | 624200 | -4000000 | -4000000 | |
| LABORATORY REVENUE | 621500 | 752884 | 752884 |
Total Oth Program Service Revenue TotalOthProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 998295 | TotalRevenueColumn |
| Related Or Exempt Function Income | 601386 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 396909 | UnrelatedBusinessRevenue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 111096334 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 175356 | TotalRevenueColumn |
| Exclusion | $175,356 | ExclusionAmount |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Royalties Revenue RoyaltiesRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 658907 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 658907 | Real |
| Personal | 0 | Personal |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 658907 | TotalRevenueColumn |
| Exclusion | $658,907 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 3964214 | Securities |
| Other | 17500 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 3616686 | Securities |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 347528 | Securities |
| Other | 17500 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 365028 | TotalRevenueColumn |
| Exclusion | $365,028 | ExclusionAmount |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income From Gaming NetIncomeFromGaming
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount |
|---|---|---|---|
| VENDOR REBATES | 900099 | 8764 | $8,764 |
| SALES OF SUPPLIES | 900099 | 7500 | $7,500 |
| FILM COPIES | 900099 | 6003 | $6,003 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 5724 | TotalRevenueColumn |
| Exclusion | $5,724 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 27991 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 120985087 | TotalRevenueColumn |
| Related Or Exempt Function Income | 108606663 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 2489671 | UnrelatedBusinessRevenue |
| Exclusion | $1,227,282 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Foreign Grants ForeignGrants
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Benefits To Members BenefitsToMembers
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1875087 | Total |
| Management And General | 1875087 | ManagementAndGeneral |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 52425412 | Total |
| Program Services | 46658617 | ProgramServices |
| Management And General | 5766795 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4856976 | Total |
| Program Services | 4322709 | ProgramServices |
| Management And General | 534267 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 12670870 | Total |
| Program Services | 11277074 | ProgramServices |
| Management And General | 1393796 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3947086 | Total |
| Program Services | 3512907 | ProgramServices |
| Management And General | 434179 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 775321 | Total |
| Program Services | 690036 | ProgramServices |
| Management And General | 85285 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 150160 | Total |
| Management And General | 150160 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 325576 | Total |
| Management And General | 325576 | ManagementAndGeneral |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 24645 | Total |
| Program Services | 21934 | ProgramServices |
| Management And General | 2711 | ManagementAndGeneral |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 60460 | Total |
| Management And General | 60460 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3321194 | Total |
| Program Services | 2955863 | ProgramServices |
| Management And General | 365331 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 30690 | Total |
| Program Services | 27314 | ProgramServices |
| Management And General | 3376 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 13558487 | Total |
| Program Services | 12067053 | ProgramServices |
| Management And General | 1491434 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1709336 | Total |
| Program Services | 1521309 | ProgramServices |
| Management And General | 188027 | ManagementAndGeneral |
Royalties Royalties
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1523466 | Total |
| Program Services | 1355885 | ProgramServices |
| Management And General | 167581 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 256146 | Total |
| Management And General | 256146 | ManagementAndGeneral |
Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 36171 | Total |
| Management And General | 36171 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2730430 | Total |
| Program Services | 2430083 | ProgramServices |
| Management And General | 300347 | ManagementAndGeneral |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4912866 | Total |
| Program Services | 4372451 | ProgramServices |
| Management And General | 540415 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2048335 | Total |
| Program Services | 1823018 | ProgramServices |
| Management And General | 225317 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| OTHER PURCHASE SERVICES | 6426496 | 5719581 | 706915 |
| UTILITIES | 1932964 | 1720338 | 212626 |
| OTHER DIRECT EXPENSES | 1706588 | 1518863 | 187725 |
| MISCELLANEOUS | 825216 | 412607 | 412609 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 118129978 | Total |
| Program Services | 102407642 | ProgramServices |
| Management And General | 15722336 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9392332 | BOY |
| EOY | 9976113 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1533510 | BOY |
| EOY | 1847513 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12735489 | BOY |
| EOY | 15493397 | EOY |
Receivables From Officers Etc ReceivablesFromOfficersEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Receivables From Disqual Persons ReceivablesFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1587149 | BOY |
| EOY | 1689021 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 246167 | BOY |
| EOY | 411890 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 140449051 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 101170093 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 34291598 | BOY |
| EOY | 39278958 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 26702806 | BOY |
| EOY | 27972839 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 975172 | BOY |
| EOY | 998243 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 87464223 | BOY |
| EOY | 97667974 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 17777052 | BOY |
| EOY | 19424599 | EOY |
Grants Payable GrantsPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 34744808 | BOY |
| EOY | 33866206 | EOY |
Escrow Account Liability EscrowAccountLiability
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Loans From Officers Directors LoansFromOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8433046 | BOY |
| EOY | 12550963 | EOY |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 21915475 | BOY |
| EOY | 23523123 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 82870381 | BOY |
| EOY | 89364891 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -3483874 | BOY |
| EOY | -109955 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5243699 | BOY |
| EOY | 5579020 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2834017 | BOY |
| EOY | 2834018 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4593842 | BOY |
| EOY | 8303083 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 87464223 | BOY |
| EOY | 97667974 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 2855109 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | 780394 | ReconciliationUnrealizedInvest |
| Reconcilation Other Changes | 73738 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | true | AuditCommittee |
| Federal Grant Audit Required | false | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Grassroots Lobbying | TotalGrassrootsLobbying | |
| Total Direct Lobbying | TotalDirectLobbying | |
| Total Lobbying Expenditures | TotalLobbyingExpenditures | |
| Other Exempt Purpose Expenditures | OtherExemptPurposeExpenditures | |
| Total Exempt Purpose Expenditures | TotalExemptPurposeExpenditures | |
| Lobbying Nontaxable | LobbyingNontaxableAmount | |
| Grassroots Nontaxable | GrassrootsNontaxableAmount | |
| Tot Lobbying Grassroot Minus Non Tx | TotLobbyingGrassrootMinusNonTx | |
| Tot Lobby Expend Mns Lobbying Nontx | TotLobbyExpendMnsLobbyingNontx | |
| Volunteers | false | Volunteers |
| Paid Staff Or Management | false | PaidStaffOrManagement |
| Media Advertisements | false | MediaAdvertisements |
| Mailings Members | false | MailingsMembers |
| Publications Or Broadcast | false | PublicationsOrBroadcast |
| Grants Other Organizations | true | GrantsOtherOrganizations |
| Grants Other Organizations | $24,645 | GrantsOtherOrganizationsAmount |
| Direct Contact Legislators | false | DirectContactLegislators |
| Rallies Demonstrations | false | RalliesDemonstrations |
| Other Activities | false | OtherActivities |
| Total Lobbying Expenditures IIB | 24645 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | false | NotDescribedIn501c3 |
| Form4720 Filed4912 Tax | false | Form4720Filed4912Tax |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | PART II-B, LINE 1F: | Identifier |
| Explanation | Southampton Hospital Association pays membership dues to the below mentioned organizations. A percentage of these dues are then used to reimburse the organization for the cost of lobbying activities performed on behalf of the Hospital. The funds are used for lobbying purposes in connection with New York State and Federal policy issues. Membership dues paid to other organizations and used for lobbying purposes: Healthcare Association of New York State........$11,710 American Hospital Association....................$6,792 Greater NY Hospital Association..................$5,129 Nassau Suffolk Hospital Council..................$1,014 Total...........................................$24,645 | Explanation |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amts | ArtPublicExhibitionAmts | |
| Held Works Of Art Amts | HeldWorksOfArtAmts |
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 4115379 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 412082 | InvestmentEarningsOrLosses |
| End Of Year Balance | 4527461 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 4213766 | BeginningOfYearBalance |
| Investment Earnings Or Losses | -98387 | InvestmentEarningsOrLosses |
| End Of Year Balance | 4115379 | EndOfYearBalance |
Current Year Minus2 Years CurrentYearMinus2Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 3943577 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 371238 | InvestmentEarningsOrLosses |
| Other Expenditures | 95021 | OtherExpenditures |
| Administrative Expenses | 6028 | AdministrativeExpenses |
| End Of Year Balance | 4213766 | EndOfYearBalance |
Current Year Minus3 Years CurrentYearMinus3Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 4031782 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 73511 | InvestmentEarningsOrLosses |
| Other Expenditures | 23873 | OtherExpenditures |
| Administrative Expenses | 137843 | AdministrativeExpenses |
| End Of Year Balance | 3943577 | EndOfYearBalance |
Current Year Minus4 Years CurrentYearMinus4Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 4235635 | BeginningOfYearBalance |
| Investment Earnings Or Losses | -146059 | InvestmentEarningsOrLosses |
| Other Expenditures | 30806 | OtherExpenditures |
| Administrative Expenses | 26988 | AdministrativeExpenses |
| End Of Year Balance | 4031782 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated EOY Balance | 0.37404 | BoardDesignatedEOYBalance |
| Permanent Endowment EOY Balance | 0.62596 | PermanentEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | false | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | false | EndowmentsHeldByRelatedOrgs |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1366275 | OtherCostOrOtherBasis |
| Book Value | 1366275 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 44542527 | OtherCostOrOtherBasis |
| Depreciation | 33227553 | Depreciation |
| Book Value | 11314974 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Leasehold Improvements | LeaseholdImprovements |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 90143216 | OtherCostOrOtherBasis |
| Depreciation | 67006756 | Depreciation |
| Book Value | 23136460 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 4397033 | OtherCostOrOtherBasis |
| Depreciation | 935784 | Depreciation |
| Book Value | 3461249 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 39278958 | TotalOfBookValueLandBuildings |
| Financial Derivatives | FinancialDerivatives | |
| Closely Held Equity Interests | CloselyHeldEquityInterests |
Other Securities OtherSecurities (5 entries)
| DescriptionDescription | Book ValueBookValue | Method Of ValuationMethodOfValuation |
|---|---|---|
| SHORT TERM INVESTMENTS | 2685651 | F |
| RESTRICTIONS | 8413038 | F |
| INVESTMENTS IN SHA PROPERTIES | 6300000 | C |
| DEBT SERVICE FUND | 5766150 | F |
| MALPRACTICE SELF INSURANCE-FD | 4808000 | F |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Securities | 27972839 | TotalOfBookValueSecurities |
| Federal Income Tax Liability | 0 | FederalIncomeTaxLiability |
Other Liabilities OtherLiabilities (3 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| ACCRUED PENSION LIABILITY | $11,272,089 |
| DUE TO THIRD-PARTY PAYORS, NET | $7,443,034 |
| MALPRACTICE SELF-INSURANCE LIAB. | $4,808,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 23523123 | TotalOfAmounts |
| Footnote In Part XIII | X | FootnoteInPartXIII |
| Tot Revenue Etc Audited Fincl Stmt | 121927796 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | 780394 | NetUnrealizedGainsInvestments |
| Other Revenues | 222775 | OtherRevenues |
| Revenue Not Rptd F990 | 1003169 | RevenueNotRptdF990 |
| Revenue Subtotal | 120924627 | RevenueSubtotal |
| Investment Expenses Not Included | 60460 | InvestmentExpensesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 60460 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 120985087 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 118218555 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 149037 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 149037 | ExpensesNotRptdF990 |
| Expenses Subtotal | 118069518 | ExpensesSubtotal |
| Investment Expenses Not Included2 | 60460 | InvestmentExpensesNotIncluded2 |
| Expenses Not Rptd On Fin Stmt | 60460 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 118129978 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII (4 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| PART V, LINE 4: | Southampton Hospital Association currently reports Endowment Funds within its December 31, 2012 financial statements. The governing body intends to use these funds to offset the cost of indigent care, emergency services and nursing education. |
| PART X, LINE 2: | Southampton Hospital Association has not taken an unsubstantiated tax position that would require provision of a liability under ASC 740. Under ASC 740, an organization must recognize the tax benefit associated with tax positions taken for tax return purposes when it is more-likely-than-not that the position will not be sustained. The organization does not believe there are any material uncertain tax positions and, accordingly, have not recognized any liability for unrecognized tax benefits. The organization has filed IRS Form 990 tax returns, as required, and all other applicable returns in jurisdictions when it is required. For the year ended December 31, 2012, there was no interest or penalties recorded or included in the consolidated financial statements. The organization believe it is no longer subject to income tax examinations for the years prior to 2009, which is the statute of limitation look back period. |
| PART XI, LINE 2D: | SHA PROPERTIES INCOME.............................264,825 PENSION OBLIGATION................................(42,050) TOTAL.............................................222,775 |
| PART XII, LINE 2D: | SHA PROPERTIES EXPENSES |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | true | CharityCarePolicy |
| Written Policy | true | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | true | FPGReferenceFreeCare |
Other Percentage OtherPercentage
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Free Other Percentage | 400. | FreeOtherPercentage |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | true | FPGReferenceDiscountedCare |
| Pcent400 | X | Pcent400 |
| Free Disc Care Medically Indigent | false | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | true | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | true | ExpensesExceededBudget |
| Unable To Provide Care | false | UnableToProvideCare |
| Annual Community Benefit Report | true | AnnualCommunityBenefitReport |
| Report Publically Available | true | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 2 | NumberOfActivitiesOrPrograms |
| Persons Served | 6727 | PersonsServed |
| Total Community Benefit Expense | 4830189 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | -1865995 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2964194 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02510 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 12500540 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 7815860 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 4684680 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03970 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 2 | NumberOfActivitiesOrPrograms |
| Persons Served | 6727 | PersonsServed |
| Total Community Benefit Expense | 17330729 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 5949865 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 7648874 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.06480 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 6751528 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2907339 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3844189 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03250 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 8 | NumberOfActivitiesOrPrograms |
| Total Community Benefit Expense | 40565482 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 28577933 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 11987549 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.11110 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 8 | NumberOfActivitiesOrPrograms |
| Total Community Benefit Expense | 47317010 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 31485272 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 15831738 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.14360 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 10 | NumberOfActivitiesOrPrograms |
| Persons Served | 6727 | PersonsServed |
| Total Community Benefit Expense | 64647739 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 37435137 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 23480612 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.20840 | PercentOfTotalExpense |
Workforce Development WorkforceDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 253017 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 253017 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00220 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 253017 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 253017 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00220 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | true | BadDebtExpenseReported |
| Bad Debt Expense | $4,000,000 | BadDebtExpenseAmount |
| Amount Attributable To | 833056 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 33596907 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 34504100 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -907193 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost Accounting System | X | CostAccountingSystem |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | true | WrittenDebtCollectionPolicy |
| Provision For Charity Care | true | ProvisionForCharityCare |
Form990 Schedule H Part IV Form990ScheduleHPartIV (2 entries)
| Description Ent Primary ActivityDescriptionEntPrimaryActivity | Organization Profit Or OwnershipOrganizationProfitOrOwnership |
|---|---|
| HAMPTON IMAGING LLC | |
| RADIOLOGY SERVICES | 0.50000 |
| MEETINGHOUSE LN PRAC | |
| PRIMARY/SPECIALTY | 1.00000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Hospital Facilities | 14 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA (14 entries)
| Facility NumberFacilityNumber | Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Licensed HospitalLicensedHospital | Facility Reporting GroupFacilityReportingGroup | General Medical And SurgicalGeneralMedicalAndSurgical | OtherOther |
|---|---|---|---|---|---|---|---|---|
| SOUTHAMPTON HOSPITAL ASSOCIATION | ||||||||
| 1 | 240 MEETINGHOUSE LANE | SOUTHAMPTON | NY | 11968 | X | A | ||
| DIALYSIS CENTER | ||||||||
| 2 | 184 W MONTAUK HIGHWAY | HAMTPON BAYS | NY | 11946 | B | X | DIALYSIS TREATMENT FACILITY | |
| GREENPORT PRENATAL | ||||||||
| 3 | 300 ATLANTIC AVENUE | GREENPORT | NY | 11944 | B | X | PRENATAL/WOMEN'S SERVICES | |
| LAB EAST | ||||||||
| 4 | 200 PANTIGO PLACE | EAST HAMPTON | NY | 11944 | B | X | LABORATORY SERVICES | |
| IMAGING - EH | ||||||||
| 5 | 200 PANTIGO PLACE | EAST HAMPTON | NY | 11937 | B | X | RADIOLOGY SERVICES | |
| WESTHAMPTON PRIMARY CARE | ||||||||
| 6 | 72 OLD RIVERHEAD ROAD | WESTHAMPTON BEACH | NY | 11978 | B | X | PRIMARY CARE PRACTICE | |
| WESTHAMPTON SPORTS REHAB | ||||||||
| 7 | 74 OLD RIVERHEAD ROAD | WESTHAMPTON BEACH | NY | 11978 | B | X | SPORTS REHAB/ PHYSICAL THERAPY SERVICES | |
| LAB SOUTH | ||||||||
| 8 | 325 MEETINGHOUSE LANE | SOUTHAMPTON | NY | 11968 | B | X | LABORATORY SERVICES | |
| ATRIUM LAB | ||||||||
| 9 | 182 W MONTAUK HIGHWAY | HAMPTON BAYS | NY | 11946 | B | X | LABORATORY SERVICES | |
| DAVID ROGERS CENTER | ||||||||
| 10 | 335 D MEETINGHOUSE LANE | SOUTHAMPTON | NY | 11968 | B | X | HIV/AIDS CARE | |
| SHINNECOCK HEALTH | ||||||||
| 11 | CHURCH STREET | SOUTHAMPTON | NY | 11968 | B | X | PRIMARY CARE/DENTAL SERVICES | |
| SOUTHAMPTON CARE CENTER | ||||||||
| 12 | 240 MEETINGHOUSE LANE | SOUTHAMPTON | NY | 11968 | B | X | NURSING HOME (FACILITY CLOSED) | |
| HAMPTONS IMAGING | ||||||||
| 13 | 182 W MONTAUK HIGHWAY | HAMPTON BAYS | NY | 11946 | B | X | RADIOLOGY SERVICES | |
| MEETINGHOUSE LANE PRACTICE | ||||||||
| 14 | PO BOX 2340 | SOUTHAMPTON | NY | 11968 | B | X | PRIMARY/SPECIALTY PHYSICIAN PATIENT CARE | |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB (2 entries)
| Hospital Facility NumberHospitalFacilityNumber | Eligibility Criteria ExplainedEligibilityCriteriaExplained | Uses FPG FreeUsesFPGFree | FPG Free PercentFPGFreePercent | Uses FPG DiscountedUsesFPGDiscounted | FPG Discount PercentFPGDiscountPercent | Explains BasisExplainsBasis | Insurance StatusInsuranceStatus | Uninsured DiscountUninsuredDiscount | State RegulationStateRegulation | Explains Application MethodExplainsApplicationMethod | Includes Publicity MeasuresIncludesPublicityMeasures | Posted On WebsitePostedOnWebsite | Attached To InvoicesAttachedToInvoices | Posted In Emergency RoomPostedInEmergencyRoom | Posted In Admission OfficePostedInAdmissionOffice | Provided On AdmissionProvidedOnAdmission | Available On RequestAvailableOnRequest | Actions On NonpaymentActionsOnNonpayment | Collection ActivitiesCollectionActivities | Nondiscrim Emergency Care PolicyNondiscrimEmergencyCarePolicy | Medicare RateMedicareRate | Amounts Generally BilledAmountsGenerallyBilled | Gross ChargesGrossCharges |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| A | |||||||||||||||||||||||
| 1 | true | true | 400. | true | 400. | true | X | X | X | true | true | X | X | X | X | X | X | true | false | true | X | false | false |
| B | |||||||||||||||||||||||
| true | true | 400. | true | 400. | true | X | X | X | true | true | X | X | X | X | X | X | true | false | true | X | false | false | |
Form990 Schedule H Part VI Form990ScheduleHPartVI (11 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| PART I, LINE 3C: | THERE ARE TWO LEVELS OF CHARITY CARE COVERAGE: PRIMARY SERVICE AREA AND NON-PRIMARY SERVICE AREA. A PRIMARY SERVICE AREA PATIENT IS A PATIENT WHO RESIDED IN NEW YORK STATE WITHIN THE COUNTIES OF SUFFOLK OR NASSAU AT THE TIME OF SERVICE. A NON-PRIMARY SERVICE AREA PATIENT IS A PATIENT WHO RESIDED IN NEW YORK STATE BUT NOT WITHIN THE COUNTIES OF SUFFOLK OR NASSAU AT THE TIME OF SERVICE. ELIGIBLE SERVICES FOR A PRIMARY SERVICE AREA PATIENT: A PRIMARY SERVICE AREA PATIENT WHO MEETS THE FINANCIAL REQUIREMENTS IS ELIGIBLE FOR THE FOLLOWING MEDICALLY NECESSARY SERVICES: INPATIENT, AMBULATORY, EMERGENCY ROOM, EMERGENCY TRANSFERS UNDER THE EMERGENCY MEDICAL TREATMENT AND LABOR ACT (EMTALA), OUTPATIENT, AND DIAGNOSTIC CARE. UNDERINSURED PRIMARY SERVICE AREA PATIENTS ARE ELIGIBLE FOR FINANCIAL ASSISTANCE ON MEDICARE AND COMMERCIAL INSURANCE CARRIER CO-INSURANCES FORALL ABOVE LISTED SERVICES. ELIGIBLE SERVICES FOR A NON-PRIMARY SERVICE AREA PATIENT: A NON-PRIMARY SERVICE AREA PATIENT WHO MEETS THE FINANCIAL REQUIREMENTS IS ELIGIBLE FOR THE FOLLOWING MEDICALLY NECESSARY SERVICES: EMERGENCY ROOM, EMERGENT ADMISSIONS, AND EMERGENCY TRANSFERS UNDER THE EMERGENCY MEDICAL TREATMENT AND LABOR ACT (EMTALA). UNDERINSURED NON-PRIMARY SERVICE AREA PATIENTS ARE ELIGIBLE FOR FINANCIAL ASSISTANCE ON MEDICARE AND COMMERCIAL INSURANCE CARRIER CO-INSURANCES FOR ALL ABOVE LISTED SERVICES. INELIGIBLE SERVICES: THE FOLLOWING SERVICES AND/OR ITEMS ARE NOT COVERED BY CHARITY CARE FOR ANY PATIENT: NOT MEDICALLY NECESSARY SERVICES AS DETERMINED BY MEDICARE(E.G. COSMETIC SURGERY, BARIATRIC SURGERY), INSURANCE CO-PAYMENTS/CO-INSURANCES/DEDUCTIBLES, MEDICAID SPEND-DOWN AMOUNTS, NON-COVERED SERVICES AS DETERMINED BY THE PATIENT'S INSURANCE CARRIER, PRIVATE ROOM RATES, AND PRIVATE PHYSICIAN FEES WHICH ARE NOT BILLED BY SOUTHAMPTON HOSPITAL (E.G. RADIOLOGY, PATHOLOGY, ANESTHESIOLOGY, EMERGENCY). FAMILY INFORMATION REQUIREMENTS: A PATIENT MUST PROVIDE ON THEIR CHARITY CARE APPLICATION A LIST OF THE FAMILY/HOUSEHOLD MEMBERS AND OR DEPENDENTS WITH WHOM THE PATIENT RESIDES. IF THE PATIENT IS AN ADULT, THE PATIENT MUST LIST THEIR SPOUSE OR DOMESTIC PARTNER, CHILDREN UNDER THE AGE OF 21, AND ANY CLAIMED DEPENDENTS OR OTHER HOUSEHOLD MEMBERS THAT LIVE WITH THE PATIENT. IF THE PATIENT IS A CHILD UNDER THE AGE OF 21, THE APPLICANT MAY LIST THE PATIENT'S PARENTS, SIBLINGS UNDER THE AGE OF 21, AND ANY CLAIMED DEPENDENTS OR OTHER HOUSEHOLD MEMBERS THAT LIVE WITH THE PATIENT. A CLAIMED DEPENDENT IS DEFINED AS A PERSON WHO IS LISTED OR WOULD BE LISTED AS A DEPENDENT FOR THE PURPOSES OF AN INCOME TAX SUBMISSION TO THE IRS. FINANCIAL REQUIREMENTS: TO BE FINANCIALLY ELIGIBLE TO RECEIVE CHARITY CARE, A PATIENT MUST HAVE A GROSS FAMILY/HOUSEHOLD INCOME LESS THAN OR EQUAL TO 400% OF THE FEDERAL POVERTY LEVEL GUIDELINE (FPG). ELIGIBLE INCOME: THE FOLLOWING INCOME ITEMS WILL BE USED TO DETERMINE A PATIENT'S INCOME: EARNINGS FROM EMPLOYMENT, UNEMPLOYMENT COMPENSATION, WORKERS COMPENSATION, DISABILITY, SOCIAL SECURITY, ANNUITIZED PENSION PLAN, CHILD SUPPORT, ALIMONY, DIVIDENDS, INTEREST, RENTALS, ESTATES, TRUSTS, SALE OF ASSETS, AND OTHER MISCELLANEOUS INCOME. SOLE PROPRIETORSHIP, PARTNERSHIP, AND S CORPORATION INCOME WILL BE CALCULATED BY ITS GROSS PROFIT OR TOTAL INCOME PRIOR TO EXPENSES AND DEDUCTIONS; HOWEVER, COST OF GOODS SOLD MAY BE DEDUCTED FROM GROSS SALES. SALE OF ASSETS, SUCH AS REPORTED ON A SCHEDULE D OR ITS EQUIVALENT, WILL BE CALCULATED BY THEIR SALE PRICE AND NOT BY THEIR GAIN OR LOSS. FINANCIAL DOCUMENTATION REQUIREMENTS: A PATIENT MUST PROVIDE FINANCIAL DOCUMENTATION TO SUPPORT THEIR CURRENT STATED INCOME. THE FOLLOWING DOCUMENTS ARE ACCEPTABLE AS PROOF: COPIES OF RECENT PAY STUBS (SEVERAL CONSECUTIVE ARE PREFERRED WHEN AVAILABLE), A RECENT UNEMPLOYMENT OR DISABILITY STATEMENT, A LETTER FROM AN EMPLOYER, OR A SELF-ATTESTATION LETTER. A PATIENT MAY BE REQUIRED TO SUBMIT ADDITIONAL DOCUMENTATION AT SOUTHAMPTON HOSPITAL'S REQUEST IN ORDER TO SUBSTANTIATE THEIR STATED INCOME. IF A PATIENT IS CLAIMING ZERO INCOME, THE PATIENT WILL BE REQUIRED TO SUBMIT A VERIFICATION OF NON-FILING LETTER FROM THE IRS. THIS LETTER IS OBTAINED THROUGH IRS FORM 4506-T WHICH WILL BE MADE AVAILABLE TO THE PATIENT UPON REQUEST. THE PATIENT MUST ALSO SUBMIT A LETTER DESCRIBING THE MEANS BY WHICH THEY ARE SUPPORTED. IF THE PATIENT IS UNABLE TO FILE IRS FORM 4506-T DUE TO NOT HAVING A SOCIAL SECURITY NUMBER, THE PATIENT MUST SUBMIT THE ABOVE-MENTIONED LETTER. APPLICABLE RATES: THE APPLICABLE RATE FOR AN INPATIENT VISIT IS THE MEDICARE DIAGNOSIS RELATED GROUP (DRG) RATE FOR THAT VISIT. THE APPLICABLE RATE FOR AN AMBULATORY, EMERGENCY ROOM, OUTPATIENT, OR DIAGNOSTIC CARE VISIT IS THE MEDICARE HCPCS/CPT PAYMENT PLUS MINIMUM UNADJUSTED CO-PAYMENT FOR THAT VISIT. THE APPLICABLE RATE FOR LAB TESTS ON OUTPATIENT AND EMERGENCY ROOM VISITS WILL BE 10% OF THE CHARGE PER TEST. CO-INSURANCE: PATIENTS WHO ARE ELIGIBLE FOR A DISCOUNT ON MEDICARE OR COMMERCIAL INSURANCE CARRIER CO-INSURANCES WILL HAVE THOSE BALANCES REDUCED ACCORDING TO THE FOLLOWING SCALE. PERCENTAGE OF FPG: PERCENT OF CO-INSURANCE RESPONSIBLY: 0% TO 100%........0% >100% TO 125%....10% >125% TO 150%....20% >150% TO 175%....28% >175% TO 200%....36% >200% TO 225%....44% >225% TO 250%....52% >250% TO 275%....60% >275% TO 300%....68% >300% TO 325%....76% >325% TO 350%....84% >350% TO 375%....92% >375% TO 400%...100% SELF-PAY DISCOUNT: SOUTHAMPTON HOSPITAL OFFERS A SELF-PAY DISCOUNT TO UNINSURED PATIENTS FOR SERVICES AND PROCEDURES PROVIDED AND BILLED BY SOUTHAMPTON HOSPITAL. A) ELIGIBLE SERVICES - THE FOLLOWING SERVICES PERFORMED BY SOUTHAMPTON HOSPITAL ARE ELIGIBLE FOR A SELF-PAY DISCOUNT: INPATIENT, AMBULATORY, EMERGENCY ROOM, EMERGENCY TRANSFERS UNDER THE EMERGENCY MEDICAL TREATMENT AND LABOR ACT (EMTALA), OUTPATIENT, AND DIAGNOSTIC CARE. B) INELIGIBLE SERVICES - THE FOLLOWING SERVICES AND ITEMS ARE NOT ELIGIBLE FOR A SELF-PAY DISCOUNT: OUTPATIENT CARDIAC REHABILITATION, OUTPATIENT NUTRITIONAL COUNSELING, WELLNESS CENTER SERVICES/PROGRAMS, OUTPATIENT PHYSICAL THERAPY, PRIVATE PHYSICIAN FEES NOT BILLED BY SOUTHAMPTON HOSPITAL (E.G. RADIOLOGY, PATHOLOGY, ANESTHESIOLOGY, EMERGENCY). C) DISCOUNT - SELF-PAY ACCOUNTS ARE DISCOUNTED AT A RATE OF 70% OFF TOTAL CHARGES. A. AUTOMATIC DISCOUNTING - THE SELF-PAY DISCOUNT WILL BE CALCULATED AND APPLIED TO THE PATIENTS' ACCOUNT AUTOMATICALLY BY THE HOSPITAL INFORMATION SYSTEM (HIS). B. MANUAL DISCOUNTING - THE SELF-PAY DISCOUNT MAY NEED TO BE MANUALLY CALCULATED AND APPLIED IN CERTAIN CIRCUMSTANCES (E.G. LATE CHARGES) AND WILL BE HANDLED BY PATIENT FINANCIAL SERVICES. D) ADDITIONAL FINANCIAL ASSISTANCE - PATIENTS WHO ARE UNABLE TO PAY FOR A SELF-PAY DISCOUNTED BILL MAY STILL APPLY FOR OTHER TYPES OF FINANCIAL ASSISTANCE SUCH AS CHARITY CARE. APPLYING FOR ANOTHER TYPE OF FINANCIAL ASSISTANCE WILL NOT RESULT IN THE LOSS OF THE OFFERED SELF-PAY DISCOUNT, HOWEVER, IF ACCEPTED INTO ANOTHER FINANCIAL ASSISTANCE PROGRAM, THAT PROGRAMS CALCULATION METHODOLOGY WILL BE DONE INDEPENDENTLY OF THE SELF-PAY DISCOUNTED AMOUNT (I.E. FINANCIAL ASSISTANCE PROGRAMS ARE MUTUALLY EXCLUSIVE). |
| PART I, LINE 7G: | The following physician practices were included in Schedule H, Part I, Line 7g: Family Planning - $263,794 Family Clinic - $1,710,205 |
| PART III, LINE 3: | Southampton Hospital utilized the audited financial statement amount reported for bad debt of $4,000,000 as its starting point. This amount was multiplied by a cost to charge ratio of 32.1% (determined on Schedule H Worksheet 2) resulting in a cost of bad debt of $1,282,538. This cost was then multiplied by 64.95% - the Self Pay percentage as determined by the 2012 Institutional Cost Report. This resulted in a cost of bad debt for patients eligible under the Hospital's Charity Care Policy of $833,056. |
| PART III, LINE 4: | THE ORGANIZATION DETERMINE EXPECTED BAD DEBT WRITE-OFFS BASED ON ACTUAL ACCOUNTS, NET OF AN EXPECTED RATE OF RECOVERY. IT'S NOT BASED ON A PERCENTAGE OF REVENUE. |
| PART III, LINE 8: | Southampton Hospital utilized the 2552 Cost Report prepared annually for Medicare to determine the total revenue received from Medicare, as well as the Medicare allowable costs relating to the revenue reported. Medicare allowable costs of $34,504,100 are greater than the total Medicare revenue of $33,596,907 for 2012; therefore the shortfall of $907,193 may be deemed a community benefit. |
| PART III, LINE 9B: | ACCOUNTS WITH UNCOLLECTABLE BALANCES ARE ACCOUNTS FOR A PATIENT (GUARANTOR) WHO HAS NOT RESPONDED TO REQUESTS FOR PAYMENT OR WHO HAS DEMONSTRATED AN EXEMPTION FROM PAYMENT. THE REQUEST FOR PAYMENT &/OR THE EXEMPTION MUST MEET THE FOLLOWING CRITERIA: 1. AT LEAST FOUR (4) CONSECUTIVE 120-DAY BILLS MUST HAVE BEEN GENERATED (OR NO LESS THAN 120 DAYS FROM FIRST BILL) AND SENT WITHOUT RESPONSE FROM THE PATIENT (GUARANTOR) BEFORE BEING SENT TO A COLLECTION AGENCY; OR 2. THE PATIENT (GUARANTOR) HAS DECLARED BANKRUPTCY (DISCHARGE OF DEBT OR MUST HAVE BEEN RECEIVED); OR 3. THE ESTATE OF THE PATIENT (GUARANTOR) HAS BEEN SETTLED AND THERE WERE NO FUNDS FOR PAYMENT LEFT IN THE ESTATE; OR 4. MAIL HAS BEEN RETURNED AND OTHER METHODS OF CONTACTING THE PATIENT (GUARANTOR) HAVE FAILED. THE ACCOUNT IS THEN CONSIDERED AND HANDLED AS A BAD DEBT ACCOUNT. PATIENT FINANCIAL SERVICES MAY ELECT TO SEND THE ACCOUNT TO AN OUTSIDE AGENCY, UP TO AND INCLUDING LEGAL ACTION. BAD DEBT ACCOUNTS ARE PURE SELF PAY ACCOUNTS FOR A PATIENT (GUARANTOR) WHO HAS NOT RESPONDED TO REQUESTS FOR PAYMENT. THE REQUEST FOR PAYMENT MUST MEET THE FOLLOWING CRITERIA: AT LEAST FOUR (4) CONSECUTIVE 30-DAY BILLS MUST HAVE BEEN GENERATED AND SENT WITHOUT RESPONSE FROM THE PATIENT (GUARANTOR); OR MAIL HAS BEEN RETURNED AND ALL OTHER METHODS OF CONTACTING THE PATIENT(GUARANTOR) HAVE FAILED. ONCE IT IS DETERMINED AN ACCOUNT BALANCE CANNOT BE COLLECTED BY PATIENT FINANCIAL SERVICES, THE ACCOUNT MAY BE TURNED OVER FOR COLLECTION BY AN OUTSIDE AGENCY, UP TO AND INCLUDING LEGAL ACTION. THE OUTSIDE COLLECTION AGENCY, AFTER DUE DILIGENCE, MAY DETERMINE THE BALANCE ON AN ACCOUNT CANNOT BE COLLECTED, THE ACCOUNT BALANCE MAY BE WRITTEN OFF USING THE APPROPRIATE CODE FOR THE ACCOUNT. |
| PART VI, LINE 2: | NEEDS ASSESSMENT/PROMOTION OF COMMUNITY HEALTH: SOUTHAMPTON HOSPITAL HAS AN EXTENSIVE PROGRAM OF COMMUNITY OUTREACH, COMPLEMENTED BY THE EAST END HEALTH ALLIANCE, THE HOSPITAL'S ACTIVE PARENT. COMMUNITY SERVICE PLAN INPUT IS RECEIVED FROM BOTH INTERNAL AND EXTERNAL SOURCES. NEEDS ARE ASSESSED ANNUALLY BY THE BOARD OF TRUSTEES, HOSPITAL MANAGEMENT AND STAFF, VOLUNTEERS, AND LEADERS OF LOCAL NOT-FOR-PROFIT ORGANIZATIONS AND GOVERNMENTAL AGENCIES. THE HOSPITAL HAS SIGNIFICANT REPRESENTATION ON A WIDE-RANGE OF COMMUNITY ORGANIZATIONS THAT FACILITATE INPUT FROM RESIDENTS, CORPORATE AND COMMUNITY LEADERS, PATIENTS AND ALLIED HEALTH PROFESSIONS. THESE COMMUNITY PARTNERSHIPS ARE LISTED BELOW. THE HOSPITAL PRESIDENT AND CHIEF EXECUTIVE OFFICER AND OTHER SENIOR STAFF REGULARLY MEET WITH COMMUNITY GROUPS FROM THE EAST END REGION OF LONG ISLAND TO KEEP AREA RESIDENTS INFORMED ABOUT HOSPITAL PROGRAMS AND TO RECEIVE FEEDBACK AND FIELD QUESTIONS FROM THE COMMUNITY. SOUTHAMPTON'S COMMUNITY PARTNERS INCLUDE THE FOLLOWING: A) EMERGENCY MEDICAL SQUADS (EAST HAMPTON AND SOUTHAMPTON TOWNS; INCORPORATED VILLAGES ON FOUTH FORK) B) LONG ISLAND BLOOD SERVICES C) CHAMBERS OF COMMERCE (EAST HAMPTON, SOUTHAMPTON, SAG HARBOR, WESTHAMPTON BEACH) D) LOCAL SCHOOL DISTRICTS IN THE TOWNS OF EAST HAMPTON AND SOUTHAMPTON E) LOCAL SERVICES ORGANIZATIONS (EAST HAMPTON, SOUTHAMPTON, HAMPTON BAYS ROTARY CLUBS; EAST HAMPTON AND SOUTHAMPTON LIONS CLUBS) F) AMERICAN HEART ASSOCIATION G) NASSAU SUFFOLK HOSPITAL COUNCIL H) NEW YORK ORGAN DONOR NETWORK I) SOUTH FORK BREAST HEALTH COALITION J) FIGHTING CHANCE K) SUFFOLK COUNTY DEPARTMENT OF HEALTH L) SUFFOLK COUNTY OFFICE FOR THE AGING M) UNITE WAY OF LONG ISLAND THE HOSPITAL ALSO RECEIVES INPUT FROM THE COMMUNITY THROUGH HOSPITAL STAFF AND HOSPITAL TRUSTEE PARTICIPATION ON COMMUNITY SERVICE ORGANIZATIONS AND OPEN DIALOGUE WITH RESPECTED COMMUNITY LEADERS. PARTICIPATION INCLUDES: Long Island Blood Services, LI 2-Day Walk, American Cancer Society, American Heart Association, American Lung Association, American Diabetes Association, Nassau-Suffolk Care Network, Catholic Charities, Dominican Sisters Family Health Services, South Fork Community Health Initiative, East End Hospice, New York Organ Donor Network, East Hampton Healthcare Foundation, Ellen's Run, Ellen's Well, Suffolk County Department of Health Services, Suffolk County Community College, Suffolk County Office for the Aging, Family Service League, Fighting Chance, Town of East Hampton, Town of Southampton, Emergency Medical Corps, Women's Health Partnership of Long Island, Alzheimer's Foundation of Suffolk County, Rogers Memorial Library, Southampton Hampton Bays Library, Southampton Rotary, East Hampton Lions and Coalition for Women's Cancers at Southampton Hospital. IN COLLABORATION WITH THE EAST END HEALTH ALLIANCE, THE HOSPITALS HAVE ALSO USED A NUMBER OF RESOURCES TO ASSESS COMMUNITY NEED AND PROVIDED THIS INFORMATION THROUGH A NUMBER OF ORGANIZED ADVISORY BOARDS WITH PARTICIPATION FROM PHYSICIAN GROUPS THAT INCLUDE A STRATEGIC PLANNING COMMITTEE WITH REPRESENTATIVES FROM COMMUNITY TRUSTEES, LEADERSHIP FROM THE HOSPITALS' MEDICAL STAFF, PHYSICIAN TRUSTEES AND CHIEF MEDICAL OFFICERS. THE ALLIANCE ALSO HAS A CANCER ADVISORY COMMITTEE AND A CARDIAC ADVISORY COMMITTEE TO ASSESS COMMUNITY NEEDS AND RECOMMEND STRATEGIES TO ADDRESS THESE HEALTH CARE NEEDS. THE HOSPITALS HAVE PROVIDED THESE GROUPS WITH INFORMATION RELATED TO THE INCIDENCE AND PREVALENCE OF DISEASE IN THE SERVICE AREA, PREVENTABLE QUALITY INDICATORS, PATTERNS OF ACCESSING HEALTH CARE SERVICES AND USE RATES. The Cancer Committee continues to work with both primary care physicians and oncologists in supporting a robust tumor board and developing a business plan for creating improved organizational and clinical infrastructure for patients with cancer. In addition, the three Hospitals are in the process of implementation of a core clinical laboratory that will serve all three Hospital's and their affiliated physicians and nursing homes. Furthermore, the Hospital and the Alliance are working closely with the medical leadership of the three Hospitals to implement the information technology necessary to improve the clinical integration of care across the entire spectrum of health care services accessed by residents of the East End of Long Island. To that end, the Hospital and the Alliance have made a significant investment in a physician electronic medical record program (EMR), and the development of a clinical portal that will permit physicians, ancillary care providers and Hospitals to share patient information. In addition, the Hospitals are all working in a coordinated way to ensure that the Hospitals have in place the systems necessary to work with Physician EMR and to meet the requirements for meaningful use. THE HOSPITAL'S SATELLITE CARE CENTERS, INCLUDING THE SHINNECOCK INDIAN HEALTH CLINIC, THE DAVID E. ROGERS CENTER FOR HIV/AIDS CARE, THE EAST HAMPTON HEALTHCARE CENTER, AND HOSPITAL REGIONAL DIALYSIS CENTER CLOSELY COLLABORATE WITH COMMUNITY ADVISORY COMMITTEES THAT HELP WITH PLANNING AND DECISION MAKING RELATED TO THE SERVICES OFFERED. STRATEGIC PLANNING COMMITTEE: THE STRATEGIC PLANNING COMMITTEE HAS BEEN MEETING SINCE THE BEGINNING OF THE FORMATION OF THE EAST END HEALTH ALLIANCE AND ADOPTED A STRATEGIC PLAN THAT FOCUSED ON NEAR AND MID-TERM OPPORTUNITIES FOR IMPROVING MANAGEMENT EFFICIENCIES AND STRATEGIES FOR WORKING MORE CLOSELY WITH OUR RESPECTIVE PHYSICIAN COMMUNITIES. THE STRATEGIES IDENTIFIED IN THE FIRST STRATEGIC PLAN ARE WELL ON THEIR WAY TO COMPLETION. THE HOSPITAL'S STRATEGIC PLANNING COMMITTEE CONTINUES TO ROUTINELY ASSESS THE HEALTH CARE NEEDS OF THE COMMUNITY SERVED BY THE HOSPITAL AND ITS AFFILIATED MEDICAL STAFFS BASED ON PUBLICALLY AVAILABLE INFORMATION, INCLUDING THE ANALYSIS OF THE FOLLOWING INFORMATION: A) SPARCS DATA B) PREVENTION QUALITY INDICATORS C) REPORT EVALUATIONS - LOCAL, STATE AND FEDERAL AGENCIES D) PATIENT SATISFACTION SURVEYS E) INDUSTRY JOURNALS AND NEWSLETTERS F) TRENDS IN HEALTHCARE JOURNALS AND PERIODICALS THE HOSPITAL'S EXTENSIVE OUTREACH ALSO INCLUDES PARTICIPATION IN VARIOUS PROGRAMS SPONSORED BY COMMUNITY ORGANIZATIONS INCLUDING SCHOOL HEALTH FAIRS, SENIOR CITIZEN CENTERS, SERVICE ORGANIZATIONS (ROTARY, KIWANIS, LIONS, ELKS), NEW YORK ORGAN DONOR NETWORK, LECTURES AT LOCAL LIBRARIES, AND FUNDRAISING EVENTS. RECENT EXAMPLES INCLUDE: LI2-DAY WALK (IN SUPPORT OF BREAST CANCER), ELLEN'S RUN (IN SUPPORT BREAST CANCER), DIABETES LECTURE AT EAST HAMPTON NUTRITION CENTER, FLU IMMUNIZATION, AND BLOOD DONATION DRIVES. VARIOUS WELLNESS PROGRAMS THROUGH THE HOSPITAL'S ED & PHYLLIS DAVIS WELLNESS INSTITUTE IN SOUTHAMPTON, HAMPTON BAYS, AND MONTAUK INCLUDE SMOKING CESSATION, NUTRITIONAL AND WEIGHT LOSS COUNSELING, DIABETES MANAGEMENT, MIND-BODY, CANCER AND CARDIAC WELLNESS, FUNCTIONAL FITNESS FOR SENIORS, SUPPORT SERVICES FOR HIV/AIDS, STRESS MANAGEMENT, MASSAGE THERAPY AND VARIOUS EXERCISE CLASSES. THE HOSPITAL'S "IMPORTANT MEDICAL INFORMATION" (VIAL OF LIFE) PROGRAM HAS REACH THOUSANDS OF COMMUNITY MEMBERS WITH MEDICAL CONCERNS THROUGH LOCAL EMERGENCY MEDICAL SERVICE ORGANIZATIONS, PHYSICIAN OFFICES, AND HOSPITAL DISTRIBUTION. ASSESSMENT OF PUBLIC HEALTH PRIORITIES: Southampton Hospital participated in the collaborative planning process with the Suffolk County Department of Health, the two other Alliance Hospitals, and community partners to assess community health needs and identified the following health priorities: smoking cessation and fall prevention. While the County Health Department has not organized additional coordinated meetings, Southampton Hospital continues the Hospital's focus on addressing these two health priorities through the following initiatives: 2012 SMOKING CESSATION UPDATE: DECREASE TOBACCO USE A) THE HOSPITAL'S SMOKE FREE CAMPUS PROGRAM WENT INTO EFFECT ON NOVEMBER 18, 2010; B) THE HOSPITAL PROVIDES TAILORED SMOKING CESSATION COUNSELING FOR PATIENTS THROUGH THE HOSPITAL'S RESPIRATORY THERAPY DEPARTMENT AND ITS ED AND PHYLLIS DAVIS WELLNESS INSTITUTE; C) THE HOSPITAL PROVIDES NICOTINE WITHDRAWAL TO PATIENTS WHO SMOKE; D) THE HOSPITAL RUNS A SMOKING CESSATION PROGRAM FOR BOTH HOSPITAL EMPLOYEES AND THE PUBLIC AT LARGE; AND E) THE HOSPITAL ALSO HAS A SIGNIFICANT OUTREACH PROGRAM AIMED AT SMOKING CESSATION, PROVIDING INFORMATION THROUGH DISSEMINATION OF POSTERS, SIGNAGE, AND PUBLIC INFORMATION THROUGH PRESS RELEASES, PUBLIC SERIVCE ANNOUNCEMENTS, AND THE HOSPITAL'S WEBSITE. 2012 FALL PREVENTION UPDATE: A) IN OCTOBER 2009, SOUTHAMPTON HOSPITAL WAS RECOGNIZED BY NASSAU SUFFOLK HOSPITAL COUNCIL WITH AN AWARD FOR OUR PROGRAM "ORGANIZATIONAL APPROACH TO FALL PREVENTION;" B) IN 2010, SOUTHAMPTON WAS ASKED BY THE INSTITUTE FOR HEALTHCARE IMPROVEMENT (IHI) TO BE A MENTOR TO OTHER HOSPITALS IN THE AREA OF FALLS PREVENTION; AND, C) OUTCOME: IN 2009, WE FURTHER DECREASED (IN LEVEL 2 OR ABOVE) INJURIES BY 50% (ONLY ONE FALL RESULTED IN AN INJURY OF LEVEL 2 OR A |
| PART VI, LINE 3: | FINANCIAL AID PROGRAM: SOUTHAMPTON HOSPITAL'S COMMITMENT AND DETERMINATION TO PROVIDE QUALITY HEALTHCARE AT AFFORDABLE RATES HAS LEAD US TO DESIGN A CHARITY CARE PROGRAM THAT GOES "ABOVE AND BEYOND" THE EXPECTATIONS AND MINIMUM REQUIREMENTS SET FORTH BY NEW YORK STATE LAW. IT IS THE HOSPITAL'S "ABOVE AND BEYOND" ATTITUDE THAT IS OUR PROGRAMS GREATEST STRENGTH AND CAN BEST BE SEEN IN OUR POLICY TO PROVIDE CHARITY CARE DISCOUNTED RATES TO PATIENTS MAKING UP TO 400% OF THE FEDERAL POVERTY LEVEL GUIDELINE (FPG) RATHER THAN THE MINIMUM REQUIREMENT OF 300% FPG. IN ADDITION, THE HOSPITAL INCLUDES A FORM TO APPLY FOR CHARITY CARE IN EVERY SELF-PAY BILL TO BE RETURNED TO PATIENT FINANCIAL SERVICES. SELF-PAY PATIENTS ARE GIVEN A 70% DISCOUNT OF CHARGES, AS WELL. SOUTHAMPTON HOSPITAL CONTINUES TO FACE FINANCIAL CHALLENGES INCLUDING CONTINUED REDUCTIONS IN NEW YORK STATE AND FEDERAL REIMBURSEMENT RATES AT THE SAME TIME THAT HOSPITAL FACES THE INCREASING COST OF PROVIDING CARE, INCLUDING DOUBLE DIGIT EXPENSES INCREASES IN SOME CATEGORIES. WHILE THE HOSPITAL WAITS TO UNDERSTAND THE IMPACT ON ITS CHARITY POLICIES THAT MAY RESULT FROM EXPANDING RESIDENT ACCESS TO HEALTH CARE INSURANCE THAT IS PART OF HEALTH CARE REFORM, THE HOSPITAL REMAINS CONCERNED THAT A SIGNIFICANT PART OF THE INDIGENT CARE THE HOSPITAL PROVIDES TO UNDOCUMENTED WORKERS WILL NOT BE COVERED. |
| PART VI, LINE 4: | SOUTHAMPTON'S SERVICE AREA EXTENDS FROM MONTAUK TO THE EAST TO WESTHAMPTON BEACH TO THE WEST AND THE SOUTHERN AREA OF RIVERHEAD IN THE CENTER OF THE EAST END OF LONG ISLAND. THE SERVICE AREA ACCOUNTS FOR APPROXIMATELY EIGHT-FIVE (85) PERCENT OF TOTAL ADMISSIONS TO THE HOSPITAL AND INCLUDES THE FOLLOWING ZIP CODES: EAST HAMPTON (11937); BRIDGEHAMPTON (11932); SOUTHAMPTON (11968); HAMPTON BAYS (11946); SAG HARBOR (11963); SAGAPONACK (11962); MONTAUK (11954); RIVERHEAD (11901); EAST QUOGUE (11942); QUOGUE (11959); REMSENBURG (11960); WATER MILL (11976); WESTHAMPTON BEACH (11978); AND WESTHAMPTON (11977). AS THE TABLE BELOW INDICATES, THIS SERVICE AREA HAS A YEAR ROUND POPULATION OF APPROXIMATELY 85,000 RESIDENTS. THE AREA IS PROJECTED TO SEE A SIGNIFICANT INCREASE IN POPULATION, MORE THAN 4 PERCENT OVER THE NEXT FIVE YEARS. DEMOGRAPHIC CHARACTERISTICS SELECTED AREA USA 2000 TOTAL POPULATION............67,527............281,421,906 2012 TOTAL POPULATION............70,978............313,095,504 2017 TOTAL POPULATION............72,541............325,256,835 % CHANGE 2012 - 2017...............2.2%...................3.9% AVERAGE HOUSEHOLD INCOME........$97,253................$67,315 THE POPULATION ON THE HOSPITAL'S SERVICE AREA, A RESORT DESTINATION, MORE THAN DOUBLES DURING THE SUMMER SEASON WHEN TOURISTS FROM ALL OVER THE WORLD VISIT THE SOUTH FORK OF LONG ISLAND. AS A RESULT, DEMAND FOR SOUTHAMPTON HOSPITAL SERVICES INCREASES SIGNIFICANTLY DURING THE SUMMER, IN PARTICULAR DEMAND FOR THE HOSPITAL'S EMERGENCY SERVICES. THE HOSPITAL HAS RESPONDED TO THIS NEED BY MAKING A CAPITAL INVESTMENT IN EXPANDING AND RENOVATING THE EMERGENCY DEPARTMENT AND IMPLEMENTING A STATE-OF-THE-ART EMERGENCY DEPARTMENT INFORMATION SYSTEMS THAT PERMITS THE HOSPITAL TO TRACK PATIENTS, AND READ AND INTERPRET LABORATORY AND RADIOLOGICAL RESULTS. AS THE TABLE BELOW INDICATES, THE SERVICE AREA HAS A SIGNIFICANT PERCENTAGE OF THEIR POPULATION AGED FIFTY-FIVE (55) AND OVER, A POPULATION THAT HAS GREATER NEED FOR HEALTH CARE SERVICES. AGE DISTRIBUTION: USA 2012 AGE GROUP 2012 % OF TOTAL 2017 % OF TOTAL % OF TOTAL 0-14 11,306 15.9% 10,895 15.0% 20.2% 15-17 2,750 3.9% 2,694 3.7% 4.3% 18-24 5,222 7.4% 5,907 8.1% 9.7% 25-34 6,794 9.6% 7,194 9.9% 13.5% 35-54 21,310 30.0% 19,238 26.5% 28.1% 55-64 10,307 14.5% 11,618 16.0% 11.4% 65+ 13,289 18.7% 14,995 20.7% 12.9% TOTAL 70,978 100.0% 72,541 100.0% 100.0% THERE ARE NO FIRM ESTIMATES OF THE NUMBER OF MIGRANT AGRICULTURAL WORKERS THAT COME INTO THIS AREA. AGRICULTURE IS ONE OF SUFFOLK COUNTY'S LEADING INDUSTRIES. ITS SUCCESS RELIES ON WORKERS WHO MOVE THROUGH THE EASTERN UNITED STATES IN RESPONSE TO THE AVAILABILITY OF SEASONAL WORK. SOUTHAMPTON HOSPITAL RECOGNIZES THAT THIS POPULATION PRESENTS SERIOUS HEALTH PROBLEMS AND IS COMMITTED TO PROVIDING CARE FOR ITS CULTURALLY DIVERSE PATIENT POPULATION. MANY OF THESE INDIVIDUALS ARE UNINSURED AND UNABLE TO SPEAK ENGLISH. THEY RELY ON THE HOSPITAL'S EMERGENCY DEPARTMENT, AS WELL AS THE SUFFOLK COUNTY HEALTH CLINIC, LOCATED ON THE HOSPITAL'S CAMPUS, FOR HEALTH CARE. AS ARESULT, THE HOSPITAL'S OFFICE OF CULTURAL DIVERSITY PROVIDES TRANSLATION AND INTERPRETATION SERVICES, AS WELL AS COUNSELING ON MEDICAL INSURANCE AND BILLING FOR THOSE INDIVIDUALS WHO DO NOT SPEAK ENGLISH. THE HOSPITAL PROVIDES BI-LINGUAL PUBLICATIONS AND SIGNAGE AND ACTIVELY ASSISTS THE CULTURALLY DIVERSE COMMUNITIES IT CARES FOR. RACE/ETHNICITY: RACE/ETHNICITY DISTRIBUTION RACE/ETHNICITY 2012 POP % OF TOTAL USA % OF TOTAL WHITE NON-HISPANIC 50,901 71.7% 62.8% BLACK NON-HISPANIC 1,994 2.8% 12.3% HISPANIC 15,644 22.0% 17.0% ASIAN & PACIFIC IS. 918 1.3% 5.0% ALL OTHERS 1,521 2.1% 2.9% TOTAL 70,978 100.0% 100.0% |
| PART VI, LINE 5: | SOUTHAMPTON HOSPITAL SPONSORS "FOCUS ON SOUTHAMPTON HOSPITAL" ON SEA-TV, A MONTHLY PUBLIC ACCESS INTERVIEW PROGRAM FOR THE TOWNS OF EAST HAMPTON AND SOUTHAMPTON THAT COVERS HEALTH-RELATED INFORMATION OF INTEREST TO THE COMMUNITY AND PROVIDES INFORMATION ON HEALTHCARE SERVICES AVAILABLE AT SOUTHAMPTON HOSPITAL. THE HOSPITAL HAS DEVELOPED NUMEROUS SERVICES AND OUTREACH TO RESPOND TO THE NEEDS OF THESE PATIENTS, INCLUDING RECRUITING ADDITIONAL PRIMARY CARE PHYSICIANS AND IMPLEMENTING A GRADUATE MEDICAL EDUCATION PROGRAM THAT WILL HOPEFULLY ATTRACT THESE YOUNG PHYSICIANS TO STAY AND PRACTICE IN THE COMMUNITY. THE HOSPITAL'S WEBSITE, WWW.SOUTHAMPTONHOSPITAL.ORG, PROVIDES INFORMATION ON HOSPITAL SERVICES, SPECIAL PROGRAMS AND EVENTS. THE SITE ENABLES PATIENTS TO FIND PHYSICIANS IN DIFFERENT SPECIALTIES, ALLOWS ON-LINE INQUIRIES THAT ARE ANSWERED DAILY, AND PROVIDES ACCESS TO AVAILABLE EMPLOYMENT OPPORTUNITY AND JOB APPLICATIONS. SERVICES FOR SHORT-TERM AND LONG-TERM CARE FOR CHRONIC AND ACUTE ILLNESS ARE CONTINUALLY EVALUATED THROUGH STATISTICAL DATA THAT INCLUDE QUALITY INDICATORS AND PATIENT OUTCOMES. THIS DATA IS COMPARED NATIONALLY WITH OTHER HEALTH FACILITIES AND INFORMS THE HOSPITAL'S STRATEGIC PLAN AND COMMUNITY SERVICE PLAN. THE HOSPITAL'S STRATEGIC PLANNING COMMITTEE INCLUDES COMMUNITY MEMBERS, HOSPITAL STAFF AND HOSPITAL AND FOUNDATION BOARD MEMBERS WHO WORK COLLABORATIVELY TO ASSESS COMMUNITY NEEDS AND DEVELOP STRATEGIES TO MEET THESE NEEDS. THE HOSPITAL'S PUBLIC AFFAIRS COMMITTEE IS RESPONSIVE TO COMMUNITY INTERESTS AND CONCERNS. MEMBERSHIP IS A CROSS-SECTION OF PHYSICIANS, HOSPITAL MANAGEMENT, BOARD MEMBERS AND HOSPITAL EMPLOYEES. BASED ON THE HOSPITAL'S ASSESSMENT OF INTEREST IN THE COMMUNITY, A NUMBER OF HEALTH LECTURES AND PROGRAMS ARE PROVIDED THROUGHOUT THE YEAR. THESE PROGRAMS ARE SOMETIMES SPONSORED THROUGH OUR PARTNERSHIPS WITH LOCAL ORGANIZATIONS INCLUDING FIGHTING CHANCE, NEW YORK ORGAN DONOR NETWORK, COMMUNITY LIBRARIES, AND SERVICE CLUBS (LIONS, KIWANIS, ELKS). THE 2011 SCHEDULE INCLUDED THE FOLLOWING: HEALTH FAIR, FITNESS PROGRAM (JUNE), HEALTH FAIR, "LOOK GOOD, FEEL BETTER" PROGRAM (APRIL), GENETIC COUNSELING LECTURE (IN CONJUNCTION WITH ROGERS MEMORIAL LIBRARY), WELLNESS PROGRAM, SPANISH OUTREACH (MARCH), HEALTH FAIR, CELEBRATING SURVIVORSHIP, "LOOK GOOD, FEEL BETTER" (FEBRUARY), HEALTH FAIR, WELLNESS PROGRAM, PINK TUESDAY (JANUARY), THE PROGRAM SCHEDULE FOR 2010 INCLUDED LECTURES ON MIDWIFERY, TICK-BORNE ILLNESSES, KIDNEY HEALTH, STROKE, GENETICS, SLEEP DISORDERS, OSTEOPOROSIS, AND THE AFFECT OF LIGHT ON OUR HEALTH. PUBLIC INFORMATION: SOUTHAMPTON HOSPITAL UNDERSTANDS THE IMPORTANCE OF LETTING THE COMMUNITY KNOW WHAT COMMUNITY SERVICES ARE AVAILABLE. AS A RESULT, THE HOSPITAL DISTRIBUTES COMMUNITY SERVICE BROCHURES THROUGHOUT ITS COMMUNITY AT EVERY OPPORTUNITY - HEALTH FAIRS, SPEAKERS BUREAU, CLUBS AND ORGANIZATIONS, INFORMATION BOOTHS, ETC. IN ADDITION, THIS INFORMATION, ALONG WITH THE 2010-2013 HOSPITAL'S COMMUNITY SERVICE PLAN IS AVAILABLE ON THE HOSPITAL'S WEB SITE WWW.SOUTHAMPTONHOSPITAL.ORG AND THROUGH A LINK ON THE ALLIANCE'S WEB SITE WWW.HEALLI.ORG. The community service brochure required by the NYS Department of Health that summarizes the Hospital's 2010-2013 Community Service Plan is posted on the www.healli.org web site, been distributed to community libraries within the Hospital's service area and to all Hospital donors. |
| GENERAL INFORMATION: | PATIENT SATISFACTION SURVEYS: IN ADDITION, SOUTHAMPTON HOSPITAL CONTINUALLY SOLICITS PATIENT INPUT THROUGH ITS PATIENT SATISFACTION SURVEY PROCESS, WHICH INCLUDES EVERY INPATIENT, AMBULATORY SURGERY PATIENT AND EMERGENCY ROOM PATIENT. THE DATA COLLECTED FROM THESE COMPREHENSIVE SURVEYS PROVIDES VALUABLE INFORMATION ON A WIDE RANGE OF QUALITY INDICATORS AND AREAS OF INTEREST TO THE HOSPITAL'S PATIENTS. RESULTS FROM THESE SURVEYS ARE REGULARLY DISTRIBUTED TO HOSPITAL AND MEDICAL STAFFS AND THE BOARD OF DIRECTORS. THE QUALITY MANAGEMENT AND PUBLIC AFFAIRS DEPARTMENTS, AS WELL AS THE OFFICE OF THE PRESIDENT, CAREFULLY REVIEW CORRESPONDENCE FROM PATIENTS ANDTHE COMMUNITY AT LARGE. A MEMBER OF THE HOSPITAL STAFF PERSONALLY ANSWERS ALL CORRESPONDENCE. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Housing Allowance Or Residence | X | HousingAllowanceOrResidence |
| Written Policy Re T And E Expenses | true | WrittenPolicyReTAndEExpenses |
| Substantiation Required | true | SubstantiationRequired |
| Compensation Committee | X | CompensationCommittee |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | false | SeverancePayment |
| Supplemental Nonqual Retire Plan | false | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | false | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | false | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | false | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | false | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | false | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | false | AnyNonFixedPayments |
| Initial Contract Exception | false | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (11 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ROBERT S CHALONER | ||||||||||||||
| PRESIDENT & CEO | 422536 | 0 | 106250 | 0 | 52568 | 0 | 15000 | 0 | 21243 | 0 | 617597 | 0 | 0 | 0 |
| CHIRSTOPHER J SCHULTHEIS | ||||||||||||||
| CHIEF FINANCIAL OFFICER | 228363 | 0 | 46000 | 0 | 217 | 0 | 13760 | 0 | 21243 | 0 | 309583 | 0 | 0 | 0 |
| FREDERIC I WEINBAUM | ||||||||||||||
| CHIEF MEDICAL OFFICER & COO | 340596 | 0 | 51130 | 0 | 38980 | 0 | 15000 | 0 | 22900 | 0 | 468606 | 0 | 0 | 0 |
| PATRICIA A DARCEY | ||||||||||||||
| CHIEF NURSING OFFICER | 195701 | 0 | 0 | 0 | 763 | 0 | 12157 | 0 | 22900 | 0 | 231521 | 0 | 0 | 0 |
| PAUL R DARVIN | ||||||||||||||
| DIRECTOR, HUMAN RESOURCES | 190802 | 0 | 0 | 0 | 23886 | 0 | 11852 | 0 | 21243 | 0 | 247783 | 0 | 0 | 0 |
| MICHAEL ISRAEL MD | ||||||||||||||
| PHYSICIAN/TRUSTEE | 224117 | 0 | 0 | 0 | 2181 | 0 | 12231 | 0 | 8802 | 0 | 247331 | 0 | 0 | 0 |
| GEORGE KECKEISEN | ||||||||||||||
| PHYSICIAN | 298174 | 0 | 110000 | 0 | 993 | 0 | 15000 | 0 | 22900 | 0 | 447067 | 0 | 0 | 0 |
| EDNA KAPENHAS | ||||||||||||||
| DIRECTOR, BREAST SURGEON | 373504 | 0 | 0 | 0 | 271 | 0 | 15000 | 0 | 21243 | 0 | 410018 | 0 | 0 | 0 |
| DANIEL M VANARSDALE | ||||||||||||||
| PHYSICIAN | 293175 | 0 | 0 | 0 | 249 | 0 | 15000 | 0 | 22900 | 0 | 331324 | 0 | 0 | 0 |
| STEVEN GEOROGPOULOS | ||||||||||||||
| PHYSICIAN | 156391 | 0 | 140000 | 0 | 0 | 0 | 0 | 0 | 22900 | 0 | 319291 | 0 | 0 | 0 |
| CHARLES ARCOLEO | ||||||||||||||
| DIRECTOR/PHYSICIAN | 261054 | 0 | 0 | 0 | 14739 | 0 | 15000 | 0 | 22900 | 0 | 313693 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| PART I, LINE 1A: | The Southampton Hospital Association provides the following special allowances/perquisites to the President & CEO, as well as to certain key executives. These allowances for housing and automobile are stipulated in the executives Employment Agreement/terms at time of hire. All payments of these perquisites are made on a bi-weekly basis with the employee's regular paycheck and they are made in accordance with the guidelines of a non-accountable expense plan. Annual allowances are as listed below: Robert Chaloner, President & CEO - Housing Allowance: $38,000 Auto Allowance: $8,400 Fredric Weinbaum, MD, EVP, COO & CMO - Housing Allowance: $30,000 Auto Allowance: $7,000 Paul Davin, VP, Human Resources - Auto Allowance: $3,600 |
| PART II, COLUMN (B)(II): | The President & CEO and the Executive Vice President/Chief Medical Officer of Southampton Hospital were both eligible for a performance bonus in 2012 which was based upon criteria that the Executive Committee of the Board established. The President & CEO's bonus is an annual bonus set forth in his employment agreement and is determined after a review of how well he performed in the prior year against goals and objectives established by the Executive Committee. The Executive Vice President/Chief Medical Officer was awarded a performance bonus based upon the recommendation of the President & CEO as well as a review of his performance against goals and objectives established by the President and the Executive Committee. Dr. George Keckeisen was eligible for a performance bonus of $10,000 per month for the period of February 2012 through December 2012. Monthly bonus payment was based upon continued production of 110% of monthly RVU target. |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (6 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| FORM 990, PART VI, SECTION A, LINES 6, 7A AND 7B: | THE ORGANIZATION'S SOLE MEMBER IS EAST END HEALTH ALLIANCE, A NOT-FOR-PROFIT CORPORATION THAT CAN ELECT ONE OR MORE MEMBERS OF THE HOSPITAL'S GOVERNING BODY. THE EAST END HEALTH ALLIANCE, THE ARTICLE 28 PARENT OF EASTERN LONG ISLAND HOSPITAL, PECONIC BAY MEDICAL CENTER AND SOUTHAMPTON HOSPITAL, WAS CREATED IN RESPONSE TO THE RECOMMENDATIONS OF THE COMMISSION ON HEALTH CARE IN THE 21ST CENTURY. CONSISTENT WITH THE MISSION OF SOUTHAMPTON HOSPITAL, THE GOALS OF THE ALLIANCE ARE AS FOLLOWS: A) TO COLLABORATIVELY DEVELOP HIGH QUALITY, COMPREHENSIVE AND ACCESSIBLE HEALTH CARE SERVICES TO MEET THE NEEDS OF THE COMMUNITY SERVED; B) TO RATIONALIZE HEALTH CARE SERVICES ACROSS THE SYSTEM; AND C) TO REALIZE MANAGEMENT EFFICIENCIES. THE FOLLOWING DECISIONS MADE BY THE GOVERNING BODY OF SOUTHAMPTON HOSPITAL REQUIRE EAST END HEALTH ALLIANCE APPROVAL: ADOPTION OF OPERATING BUDGETS, APPLICATION FOR NEW CERTIFICATES OF NEED, AND CERTAIN BORROWING TRANSACTIONS. |
| FORM 990, PART VI, SECTION B, LINE 11B: | Southampton Hospital Association has its Form 990 prepared by an outside accounting firm and has established the following review process to ensure that the information reported is complete and accurate. Upon completion, the Form 990 is reviewed by management and is then forwarded electronically to the members of the Board of Trustees for their review. Any questions or issues are then addressed by the appropriate parties prior to the filing of the return. |
| FORM 990, PART VI, SECTION B, LINE 12C: | Southampton Hospital currently has a conflict of interest policy and a procedure for annual disclosure by key employees, Physician Leaders, and senior management. When new/potential conflicts/relationships are identified, they are investigated by the Corporate Compliance Officer and any recommendations and/or corrective actions are presented to the President and CEO. As appropriate, these potential conflicts/disclosures are also reviewed with the CFO and Medical Director/COO. When a potential conflict is identified, the staff member is prohibited from taking part in any Hospital decisions that may relate to the interest or relationship, until the review is completed and a determination is made that there is no conflict. Similarly, on an annual basis, all members of the Board of Directors are required to complete a Conflict of Interest Form. All potential conflicts of interest that may exist must be disclosed. If a potential or actual conflict of interest exists, the affected member will be notified and the Executive Committee of the Board will investigate and make the determination as to what, if any recusal or other corrective action may be required to avoid any potential conflict. The results of the investigation will then be reported to the governing body. If an actual conflict of interest exists, the affected member will be notified of this determination and their participation in related matters and/or voting rights, pertaining to the area of conflict, will be relinquished. |
| FORM 990, PART VI, SECTION B, LINES 15A AND 15B: | Southampton Hospital has established an Executive Compensation Policy which sets forth the terms and criteria for the review of the compensation of the President & CEO, the Chief Medical Officer/COO and the Vice President of Finance/CFO as well as other executive leaders. The policy outlines the procedures and criteria the Executive Committee will follow in evaluating the CEO's, the CMO/COO's, and the CFO's performance against established goals. It also outlines the Executive Committees' role and responsibility in determining all aspects of the CEO's, the Chief Medical Officer/COO's, and the CFO's compensation including any incentive or bonus compensation. The Committee reviews contract terms which cover compensation and benefits including, but not limited to, housing allowances, automobile allowances, severance or change of control payments. On a periodic basis, the Executive Committee meets to review the terms of compensation and reviews external compensation data and studies to ensure that compensation decisions are reasonable and consistent with fair market value. The Committee documents the full terms of compensation approved and includes date of the decision, details of the comparability data obtained and relied upon, and how the data was obtained. Members of the Executive Committee must be free from any conflict of interest that may relate to the arrangement. All members of the Committee who were present during the discussion of the arrangement will be documented in the Meeting minutes along with their votes. The compensation review process for the President & CEO, Chief Medical Officer and CFO was last undertaken November 29, 2012. |
| FORM 990, PART VI, SECTION C, LINE 19: | Southampton Hospital's Form 990, as well as its financial statements and conflict of interest policy, are available for public inspection upon request, as required under Section 6104 of the Internal Revenue Code. Interested parties may request the documents at 240 Meetinghouse Lane, Southampton, NY 11968 or by calling the organization directly at (631)726-8200. |
| FORM 990, PART XI, LINE 9: | SHA PROPERTIES INCOME.............................264,825 SHA PROPERTIES EXPENSES..........................(149,037) PENSION OBLIGATION................................(42,050) TOTAL..............................................73,738 |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|
| SOUTHAMPTON CARE CENTER | |||||||||
| 240 MEETING HOUSE LANE | SOUTHAMPTON | NY | 11968 | 112658403 | NURSING HOME | NY | 501(c)(3) | 9 | false |
| THE SOUTHAMPTON HOSPITAL FOUNDATION | |||||||||
| 240 MEETING HOUSE LANE | SOUTHAMPTON | NY | 11968 | 113466516 | SRVC PROVIDER | NY | 501(C)(3) | 7 | false |
Form990 Schedule R Part III Form990ScheduleRPartIII
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HAMPTONS IMAGING LLC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1333 ROANOKE AVENUE | AddressLine1 |
| City | RIVERHEAD | City |
| State | NY | State |
| ZIP Code | 11901 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 201353646 | EIN |
| Primary Activity | RADIOLOGY | PrimaryActivity |
| Legal Domicile State | NY | LegalDomicileState |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NA | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Predominant Income Type | RELATED | PredominantIncomeType |
| Share Of Total Income | -16321 | ShareOfTotalIncome |
| Share Of EOY Assets | 266370 | ShareOfEOYAssets |
| Disproportionate Allocations | false | DisproportionateAllocations |
| General Or Managing Partner | false | GeneralOrManagingPartner |
| Percentage Ownership | 0.50000 | PercentageOwnership |
Form990 Schedule R Part IV Form990ScheduleRPartIV (3 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Type Of EntityTypeOfEntity | Share Of Total IncomeShareOfTotalIncome | Share Of EOY AssetsShareOfEOYAssets | Percentage OwnershipPercentageOwnership | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|---|---|
| MEETINGHOUSE LANE MEDICAL PRACTICE | |||||||||||
| PO BOX 2340 | SOUTHAMPTON | NY | 11968 | 208853938 | PATIENT CARE | NY | C | 427707 | 1706070 | 1.00000 | false |
| SHA PROPERTIES | |||||||||||
| 240 MEETING HOUSE LANE | SOUTHAMPTON | NY | 11968 | 112563612 | REAL ESTATE | NY | C | 264825 | 2457341 | 1.00000 | false |
| OLD TOWNE MEDICAL PRACTICE PC | |||||||||||
| 240 MEETING HOUSE LANE | SOUTHAMPTON | NY | 11968 | 452430883 | MEDICAL PRACTICE | NY | C | 0 | 0 | 1.00000 | false |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | false | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | false | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | true | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | true | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | true | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | false | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | false | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | false | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | false | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | false | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | false | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | false | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | true | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | true | SharingOfFacilities |
| Sharing Of Paid Employees | true | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | false | OtherTransferToOtherOrg |
| Other Transfer From Other Org | false | OtherTransferFromOtherOrg |