2012-11-12T11:26:18-06:00 2011-12-31 KPMG LLP 345 Park Avenue New York NY 101540102 990 2011-01-01 146049030 CATSKILL REGIONAL MEDICAL CENTER % MITCHELL AMADO CFO CATS 8457943300 PO BOX 800 HARRIS NY 12742 MITCHELL AMADO 2012-11-06 true KPMG LLP 2127589700 2011 2016-02-24 21:20:13Z FREDERICK KURIGER CEO C/O CRMC PO BOX 800 HARRIS NY 12742 129023837 false X WWW.CRMCNY.ORG X 1967 NY TO IMPROVE THE HEALTH OF OUR COMMUNITY BY PROVIDING EXCEPTIONAL HEALTH CARE. 13 9 1024 163 573448 92545 1470724 7708071 104717254 101071562 161062 182996 213918 77359 106562958 109039988 0 0 0 0 55956674 56047999 0 0 0 47027170 44048275 102983844 100096274 3579114 8943714 66729604 74353602 65804317 65256613 925287 9096989 X SEE SCHEDULE O false false 37724297 50513610 EXPENSES INCURRED WHILE PROVIDING INPATIENT MEDICAL SURGICAL SERVICES, OBSTETRICS, NEW BORN CARE SERVICES, AND BIO-CHEMICAL DEPENDENCY CARE SERVICES TO 5,278 PATIENTS IN THE SURROUNDING COMMUNITY. 9102309 3710792 CRMC PROVIDES OUTPATIENT CLINICAL SERVICES THROUGHOUT ITS CLINICS SPECIALIZED IN CARDIOLOGY, ENDOCRINOLOGY, WOUND CARE, ONCOLOGY/HEMATOLOGY, FAMILY HEALTH AND WOMEN'S HEALTH SERVICES. EXPENSES INCURRED WHILE PROVIDING OUTPATIENT CLINICAL SERVICES TO 19,909 PATIENTS IN THE SURROUNDING COMMUNITY. 13309578 11459030 EXPENSES INCURRED WHILE PROVIDING REFERRED AMBULATORY SERVICES SUCH AS LABORATORY, IMAGING, CANCER SCREENING, CARDIAC CARE, AND REHABILITATION THERAPY SERVICES TO PATIENTS IN THE SURROUNDING COMMUNITY. 26877933 35388130 87014117 true true false true false false false false false true true false false true true true true false false false false false false false true false true true false false true true false false false false false false false false true true false false false false false true false false false false true 154 0 true 1024 true true true false false false false true true false false false false X 13 9 true true false false true true true true true false false false true true true true true true true false NY X MITCHELL AMADO CFO 8457943300 PO BOX 800 HARRIS NY 12742 X MARC BAEZ 3.0 X X 0 0 0 DARREL SUPAK 3.0 X X 0 0 0 JOAN FARROW 3.0 X 0 0 0 JEFFREY GRAY 3.0 X 0 0 0 GERALD SKODA 3.0 X X 0 0 0 RICHARD LANDER 3.0 X 0 0 0 JACQUELINE RICCIANI 3.0 X 0 0 0 LOUIS RODRIGUES MD 3.0 X 0 0 0 ALLAN SCOTT 3.0 X 0 0 0 JOSEPH LOUGHLIN 3.0 X 0 0 0 ANDREW PAVLOFF 3.0 X X 0 0 0 BARBARA BLAKEY 3.0 X 0 0 0 MICHAEL WASCHITZ 3.0 X 0 0 0 STEVEN RUWOLDT 40.0 X 372607 0 16118 ROBERT E FISHER 40.0 X 149664 0 15976 MARC MENDELSOHN 40.0 X 97394 0 1813 BARBARA GENTILE 40.0 X 150718 0 27188 PETER PANZARINO 40.0 X 287405 0 23627 MITCHELL AMADO 10.0 X 0 529560 91649 JOSEPH M ANESI 10.0 X 0 329613 45520 SCOTT BATULIS 10.0 X 0 1110681 175766 DEBORAH CARR 10.0 X 0 264501 61729 ROSEMARY FRADO 10.0 X 0 460462 91184 SYEB S RAB 10.0 X 0 301914 52159 STEPHEN SUGRUE 10.0 X 0 201058 44486 ROSEMARY A BACZEWSKI 10.0 X 0 92197 8737 JEFFREY F LIETO 10.0 X 0 103726 6712 ABDUL SHAHZAD 40.0 X 455211 0 45122 IRVELYNE CAMILLE 40.0 X 248844 0 21811 FLORENCE JEAN-LOUIS 40.0 X 226884 0 31065 KHORSHEDA B ALI 40.0 X 246914 0 33242 STUART TASHMAN 40.0 X 222086 0 30836 2457727 3393712 824740 51 false true false WILLIAM H LANE 113 COURT STREET BINGHAMTON NY 13901 CONSTRUCTION SERV. 4154518 MCKESSON INFORMATION SOLUTIONS POBOX 98347 CHICAGO IL 606938347 COMPUTER SERVICES 1794096 MORRISON MANAGEMENT SOLUTIONS PO BOX 102289 ATLANTA GA 30368 FOOD SERVICE 1634579 CARDINAL HEALTH PO BOX 13862 NEWARK NJ 071880862 MEDICAL SERVICES 1239279 CRYSTAL RUN HEALTHCARE LLP 155 CRYSTAL RUN ROAD MIDDLETOWN NY 10940 MEDICAL SERVICES 1224702 64 93775 2918648 4579258 116390 7708071 INPATIENT REVENUE 623990 44147761 44147761 SNU INPATIENT REVENUE 623000 6305176 6305176 PSYCH INPATIENT REVENUE 623000 4148445 4148445 INDIGENT CARE POOL REVENUE 623000 7730417 7730417 OUTPATIENT REVENUE 621990 34721198 34147750 573448 4018565 4018565 101071562 145772 145772 0 0 68532 68532 68532 68532 19676830 320443 19678002 282047 -1172 38396 37224 37224 17771 93775 23800 -6029 -6029 0 0 REBATES & REFUNDS 900099 14856 14856 14856 109039988 100498114 573448 260355 0 0 0 0 1142510 1029005 113505 132398 119245 13153 41335491 37228938 4106553 2543327 2290655 252672 7652189 6891968 760221 3242084 2919993 322091 871286 59019 812267 285976 285976 324602 324602 40019 40019 0 0 13809193 9716805 4092388 233462 9267 224195 559366 457772 101594 0 0 2580692 2528728 51964 52566 44653 7913 0 0 1767181 1470648 296533 0 3706339 3084415 621924 447402 447402 MEDICAL SUPPLIES 10704923 10563421 141502 BAD DEBTS 4857273 4857273 POSTAGE AND SHIPPING 161751 109437 52314 OTHER EXPENSES 3646244 3185473 460771 100096274 87014117 13082157 0 7162260 7307533 3879314 2411639 324809 2691414 10213044 10693689 0 0 0 0 0 0 1107902 1223827 1113600 1164303 119151441 93292301 20442887 25859140 14514672 14523696 0 0 0 0 0 0 7971116 8478361 66729604 74353602 12457107 14262336 0 0 1725 0 41474048 38059926 0 0 0 0 450000 356972 1877185 1456844 9544252 11120535 65804317 65256613 X -2600435 4585889 2068017 3052395 1457705 1458705 925287 9096989 66729604 74353602 X 8943714 -772012 X false true true X false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 40019 40019 false PART II-B, LINE 1I PERCENTAGE OF DUES PAID TO THE HOSPITAL ASSOCIATION OF NEW YORK (HANYS), NORTHERN METROPOLITAN HOSPITAL ASSOCIATION (NORMET) AND 1199 SEIU ALLOCATED TO LOBBYING. 1457705 1000 1458705 1457705 1457705 1457705 1457705 1457705 1457705 1.00000 false true true 888426 888426 30445260 24309941 6135319 10524893 2731140 7793753 55359911 46619454 8740457 21932951 19631766 2301185 25859140 DEFERRED FINANCING FEES 940925 INTEREST IN CRMC FOUNDATION 2247942 INSURANCE RECEIVABLE 2526236 THIRD PARTY RECEIVABLE 2644827 OTHER RECEIVABLE 118431 8478361 0 DUE TO THIRD PARTY PAYORS 5213599 ESTIMATED MALPRACTICE LIABILITY 5581955 OTHER LIABILITY 324981 11120535 109039988 100096274 8943714 78573 -850586 -772013 8171701 108291775 78573 -826786 -748213 109039988 109039988 100120074 23800 23800 100096274 100096274 SCHEDULE D, PART V INTENDED USE OF ENDOWMENT FUNDS THE ORGANIZATION HAS A PERMANENT ENDOWMENT FUND. THE INTEREST EARNED ON THIS FUND, IF ANY, CAN BE USED TO PURCHASE PATIENT EQUIPMENT. SCHEDULE D- PART X LINE 2 - FIN 48 FOOTNOTE THE CENTER IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE CODE) AND IS EXEMPT FROM FEDERAL, STATE, AND LOCAL INCOME TAXES PURSUANT TO SECTION 501(A) OF THE CODE. MANAGEMENT IS REQUIRED TO REVIEW AND DETERMINE IF THERE ARE UNCERTAINTIES IN INCOME TAXES RECOGNIZED IN AN ENTERPRISE'S FINANCIAL STATEMENTS AND APPLY A THRESHOLD OF MORE-LIKELY THAN-NOT FOR RECOGNITION AND DERECOGNITION OF TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN. THERE WAS NO MATERIAL IMPACT TO THE CENTER'S ACCOMPANYING FINANCIAL STATEMENTS AS A RESULT OF APPLYING THE MORE-LIKELY THAN-NOT THRESHOLDS. SCHEDULE D,PART XI, LINE 8 CHANGE IN THE INTEREST IN NET ASSETS OF THE CATSKILL REGIONAL MEDICAL CENTER FOUNDATION, INC.: (850,586) SCHEDULE D PART XII LINE 2D - OTHER ADJUSTMENTS SPECIAL EVENTS DIRECT EXPENSES: $23,800 CHANGE IN THE INTEREST IN NET ASSETS OF THE CRMC FOUNDATION,INC: (850,586) SCHEDULE D PART XIII LINE 2D - OTHER ADJUSTMENTS SPECIAL EVENTS DIRECT EXPENSES: $23,800 BERN MEMORIAL 72330 58164 14166 2821 3136 6644 561 RISE 26041 26041 2081 2 13175 9570 3605 290 3051 5216 111546 93775 17771 3111 3136 9695 7858 23800 -6029 true true X true X true true true false true true 5368760 2203495 3165265 0.03320 25187322 20708087 4479235 0.04700 30556082 22911582 7644500 0.08020 48967 48967 0.00050 13359 13359 0.00010 6411233 3162836 3248397 0.03410 12250 12250 0.00010 6485809 3162836 3322973 0.03480 37041891 26074418 10967473 0.11500 2547 0 2547 2547 0 2547 true 2113482 0 28094344 30294173 -2199829 X true true 2 1 CATSKILL REGIONAL MEDICAL CTR-HARRIS DIV

68 HARRIS-BUSHVILLE ROAD HARRIS NY 12742

X X X SOLE COMMUNITY HOSP. 2 CATSKILL REGIONAL MED CTR-GROVER HER

ROUTE 97 CALLICOON NY 12723

X X X CATSKILL REGIONAL MEDICAL CTR-HARRIS DIV 1 true true 100 true 101. true X X true true X X X X X true false X X X X X true X false false CATSKILL REGIONAL MED CTR-GROVER HER 2 true true 100 true 101. true X X true true X X X X X true false X X X X X true X false false PART VI - SUPPLEMENTAL INFORMATION PART I LINE 6A - COMMUNITY BENEFIT REPORT IS PREPARED BY THE CENTER. PART I LINE 7 - COSTING METHODOLOGY USED TO CALCULATE THE AMOUNT REPORTED ON THE PART I, LINE 7 TABLE WAS THE RATIO OF COST TO CHARGES. BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COL. (A) BUT EXCLUDED FOR PURPOSES OF CALCULATING FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS AT COST WAS $4,857,273. PART I LINE 7G - CRMC IS REPORTING AS SUBSIDIZED HEALTH SERVICES THE LOSSES FROM VARIOUS PHYSICIAN CLINICS NECESSARY TO PROMOTE HEALTH IN OUR RURAL AREA. WITHOUT THESE CLINICS, THE ACCESS TO HEALTH SERVICES WOULD BE EXTREMELY LIMITED OR NON-EXISTENT. PART II - COMMUNITY BUILDING ACTIVITIES: CRMC ESTABLISHED A MULTIDISCIPLINARY COMMUNITY ADVISORY BOARD THAT IS COMPRISED OF 33 CONSUMER AND PROVIDER REPRESENTATIVES WHO CONTINUE MEETING QUARTERLY TO PROVIDE FEEDBACK ON HOSPITAL PERFORMANCE, AS WELL AS TO PROVIDE INPUT ON SULLIVAN COUNTY COMMUNITY HEALTH NEEDS, ISSUES AND PRIORITIES. THE HOSPITAL ADVISORY BOARD IDENTIFIED THE PREVENTION , CARE AND TREATMENT OF CHRONIC DISEASES INCLUDING DIABETES AND CARDIOVASCULAR, AS WELL AS BEHAVIORAL HEALTH ISSUES INCLUDING MENTAL HEALTH AND SUBSTANCE ABUSE, AS THE HIGHEST PRIORITY OF UNMET HEALTH CARE NEEDS THROUGHOUT SULLIVAN COUNTY. PART III LINE 4 - BAD DEBT EXPENSES - COSTING METHODOLOGY USED TO CALCULATE BAD DEBT EXPENSES WAS THE RATIO OF COST TO CHARGES. PART III LINE 3 - N/A PART III LINE 4 - THE CENTER PROVIDES CHARITY CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY, TO PATIENTS WHO ARE UNINSURED, AND TO PATIENTS WHO ARE UNDERINSURED AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. BECAUSE THE CENTER DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, THEY ARE NOT REPORTED AS REVENUE. FEDERAL AND STATE LAW REQUIRES THAT HOSPITALS PROVIDE EMERGENCY SERVICES REGARDLESS OF A PATIENT'S ABILITY TO PAY. UNINSURED PATIENTS SEEN IN THE EMERGENCY DEPARTMENT, INCLUDING PATIENTS SUBSEQUENTLY ADMITTED FOR INPATIENT SERVICES, OFTEN DO NOT PROVIDE NECESSARY INFORMATION TO ALLOW THE CENTER TO QUALIFY SUCH PATIENTS FOR CHARITY CARE. UNCOLLECTIBLE AMOUNTS DUE FROM SUCH UNINSURED PATIENTS REPRESENT A SUBSTANTIAL PORTION OF THE PROVISION FOR BAD DEBTS REFLECTED IN THE ACCOMPANYING STATEMENTS OF OPERATIONS. COSTING METHODOLOGY USED WAS THE RATIO OF COST TO CHARGES. PART III LINE 6 - MEDICARE ALLOWABLE COST WERE CALCULATED USING THE MEDICARE REIMBURSEMENT METHODOLOGY AS REQUIRED FOR THE MEDICARE 2552 ANNUAL COST REPORT. PART VI - PART III, LINE 8 - MEDICARE INDIVIDUALS UTILIZE HOSPITAL SERVICES AS A PRIMARY CARE PROVIDER HOWEVER, MEDICARE REIMBURSEMENT DOES NOT COVER THE ACTUAL OPERATING COSTS FOR PROVIDING CARE FOR MEDICARE PATIENTS. THEREFORE, ANY SHORTFALL REPORTED ON SCHEDULE H, PART III, LINE 7, SHOULD BE TREATED AS COMMUNITY BENEFIT AS IT IS THE HOSPITAL'S MISSION TO PROVIDE QUALITY CARE TO ALL PATIENTS REGARDLESS OF THEIR INSURANCE COVERAGE AND ABILITY TO PAY. THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS REPORTED ON WAS THE COST TO CHARGE RATIO. PART III LINE 9B - ALL PATIENTS WHO ARE UNCERTAIN ABOUT THEIR ABILITY TO PAY FOR THE HOSPITAL SERVICES THEY RECEIVE ARE ENCOURAGED TO APPLY FOR FINANCIAL ASSISTANCE. CRMC SHALL ENSURE THAT NOTIFICATION OF THE FINANCIAL ASSISTANCE POLICY BE INSERTED IN RELEVANT BILLINGS. PATIENTS WHO HAVE NOT RECEIVED FINANCIAL ASSISTANCE AND DO NOT PAY THEIR BILLS ARE EVENTUALLY SUBJECT TO A COLLECTION PROCESS THAT MAY INVOLVE THE USE OF AN OUTSIDE COLLECTION AGENCY AND MAY AFFECT THE PATIENT'S PERSONAL CREDIT RATING. IN ADDITION, THE PATIENT MUST CONSENT TO APPLY FOR MEDICAID COVERAGE AND TAKE ALL STEPS NECESSARY TO PREPARE A COMPLETE AND ACCURATE MEDICAID APPLICATION. CONSIDERATION WILL BE GIVEN TO PROVIDING FINANCIAL ASSISTANCE ON A CASE BY CASE BASIS TO PATIENTS WHO HAVE EXHAUSTED THEIR INSURANCE BENEFITS AND/OR WHO EXCEED FINANCIAL ELIGIBILTY CRITERIA BUT FACE EXTRAORDINARY MEDICAL COSTS. FINANCIAL ASSISTANCE IS NOT A SUBSITUTE FOR EMPLOYER-SPONSORED, PUBLIC, OR INDIVIDUALLY PURCHASED INSURANCE. PATIENTS WHO DO NOT PAY THEIR BIILS WHO HAVE BEEN NOTIFIED OF THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY AND EITHER FAIL TO APPLY FOR ASSISTANCE OR APPLIED FOR ASSISTANCE BUT HAVE BEEN DETERMINED INELIGIBLE FOR ASSISTANCE, EVENTUALLY MAY BE SUBJECT TO A COLLECTION PROCESS THAT MAY INVOLVE THE USE OF AN OUTSIDE COLLECTION AGENCY AND MAY AFFECT THE PATIENT'S PERSONAL CREDIT RATING. SECTION B PART V LINE 11H: OTHER FACTORS - CALCULATION OF FINANCIAL ASSISTANCE ELIGIBILITY WAS BASED ON FAMILY SIZE. SECTION B LINE 17E: OTHER BILLING AND COLLECTIONS EFFORTS - FINANCIAL ASSISTANCE POLICY POSTED ON CRMC WEBSITE. SECTION B PART V LINE 19D: THE HOSPITAL FACILITY USED PERCENTAGE OF MEDICAID RATES WHEN CALCULATING THE MAXIMUM AMOUNTS THAT CAN BE CHARGED. PART VI, LINE 2: NEEDS ASSESSMENT: A COMMUNITY NEEDS ASSESSMENT WAS CONDUCTED COLLABORATIVELY WITH SULLIVAN COUNTY PUBLIC HEALTH SERVICES, THE LOCAL HEALTH DEPARTMENT. PUBLIC PARTICIPATION WAS SOUGHT THROUGH A MULTITUDE OF VEHICLES INCLUDING FOUR COMMUNITY HEALTH FORUMS CONDUCTED IN CONJUNCTION WITH SULLIVAN COUNTY PUBLIC HEALTH SERVICES. CRMC AND THE SULLIVAN COUNTY PUBLIC HEALTH DEPARTMENT JOINTLY CONTRACTED WITH NEW YORK MEDICAL COLLEGE TO CARRY OUT A REGIONAL NEEDS ASSESSMENT SURVEY OF HEALTH CARE PROVIDERS IN THE COUNTY. CRMC RECEIVED HEALTH CARE PROVIDER INPUT AND FEEDBACK FROM MEMBERS OF THE SULLIVAN COUNTY RURAL HEALTH NETWORK. PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILTY FOR ASSISTANCE: HOSPITAL POSTS SIGNS DESCRIBING THE FINANCIAL ASSISTANCE PROGRAM. ALL PATIENTS WITH NO INSURANCE ARE ASKED TO APPLY FOR MEDICARE AND/OR FINANCIAL ASSISTANCE. PART VI, LINE 4: COMMUNITY INFORMATION: THE CENTER'S SERVICE AREA FOR COMMUNITY/LOCAL HEALTH PLANNING INCLUDES ALL FIFTEEN TOWNSHIPS WITHIN RURAL SULLIVAN COUNTY, NEW YORK. THE HOSPITAL'S SERVICE AREA WITHIN SULLIVAN COUNTY IS INTO PRIMARY AND SECONDARY SERVICE AREAS. THE PRIMARY SERVICE AREAS ARE THOSE SULLIVAN COUNTY TOWNSHIP AND ZIP CODES WHICH ARE EITHER CLOSER TO CRMC THAN ANY OTHER HOSPITAL FACILITY OR WHERE CRMC HAS A PREDOMINANT MARKET SHARE. THE SULLIVAN COUNTY TOWNSHIPS IN THE PRIMARY SERVICE AREA ARE BETHEL, CALLICOON, COCHECTON, DELAWARE, FALLSBURG, FORESTBURGH, FREMONT, LIBERTY, NEVERSINK, ROCKLAND, THOMPSON AND TUSTEN. THE FOLLOWING DEMOGRAPHICS CHARACTERIZE SULLIVAN COUNTY'S RURAL SERVICE AREA: (1) EXTENSIVE AND GROWING GERIATRIC POPULATION; (2) HIGHER PROPORTIONS OF BLACK AND HISPANIC POPULATIONS WHEN COMPARED WITH MOST UPSTATE NEW YORK RURAL COMMUNITIES; (3) VILLAGES OF MONTICELLO AND LIBERTY SURROUNDED BY GEOGRAPHICALLY DISPERSED RURAL POPULATIONS; (4) ECONOMIC BASE PREDOMINANTELY COMPRISED OF AGRICULTURE AS WELL AS SERVICES FOCUSING UPON HEALTH CARE, TOURISM, GOVERNMENT AND EDUCATION AND; (5) EXTENSIVE MEDICALLY INDIGENT POPULATION WITH HIGH PROPORTION OF INDIVIDUALS EITHER ON MEDICAID OR TOTALLY LACKING HEALTH INSURANCE COVERAGE. PART VI, LINE 5: OTHER INFORMATION: CRMC HAS SHOWN ITS ONGOING COMMITMENT TOWARDS ENHANCING THE HEALTH STATUS OF SULLIVAN COUNTY IN SEVERAL WAYS. THE OVERWHELMING MAJORITY OF CRMC'S BOARD OF DIRECTORS ARE COMPRISED OF LOCAL HEALTH CARE CONSUMERS WHO PROVIDE EXPERTISE IN IDENTIFYING SULLIVAN COUNTY HEALTH CARE NEEDS AND PRIORITIES. CRMC'S MEDICAL STAFF IS AN OPEN MEDICAL STAFF WHEREBY ANY JUSTIFIED SULLIVAN COUNTY PHYSICIAN IS ENCOURAGED TO APPLY, AND OVER 90% OF LOCAL PHYSICIAN RETAIN MEDICAL STAFF MEMBERSHIP. THE HOSPITAL'S HEALTH SCIENCE LIBRARY SUBSIDIZED FROM CRMC OPERATIONAL FUNDING PROVIDES BOTH COMMUNITY HEALTH EDUCATION TO SULLIVAN COUNTY CONSUMERS AND PATIENTS, AS WELL AS MEDICAL EDUCATION TO LOCAL PHYSICIANS. PART VI, LINE 6: AFFILIATED HEALTH CARE SYSTEM: N/A PART VI, LINE 7: STATE FILING OF COMMUNITY BENEFIT REPORT - CRMC PERFORMS A COMMUNITY SERVICE PLAN EVERY THREE YEARS. X X X X true true false false false false false true false STEVEN RUWOLDT 323416 0 41715 0 7476 0 7986 0 8132 0 388725 0 0 0 ROBERT E FISHER 145760 0 0 0 3904 0 7085 0 8891 0 165640 0 0 0 BARBARA GENTILE 150322 0 0 0 396 0 9243 0 17945 0 177906 0 0 0 PETER PANZARINO 245393 0 41250 0 762 0 15043 0 8584 0 311032 0 0 0 ABDUL SHAHZAD 438573 0 0 0 16638 0 27860 0 17262 0 500333 0 0 0 IRVELYNE CAMILLE 232344 0 0 0 16500 0 15000 0 6811 0 270655 0 0 0 FLORENCE JEAN-LOUIS 210330 0 0 0 16554 0 13803 0 17262 0 257949 0 0 0 KHORSHEDA B ALI 230324 0 0 0 16590 0 15075 0 18167 0 280156 0 0 0 STUART TASHMAN 210776 0 0 0 11310 0 13504 0 17332 0 252922 0 0 0 MITCHELL AMADO 0 371312 0 56422 0 101826 0 71808 0 19841 0 621209 0 0 JOSEPH M ANESI 0 260287 0 37739 0 31587 0 27179 0 18341 0 375133 0 0 SCOTT BATULIS 0 613413 0 207839 0 289429 0 157425 0 18341 0 1286447 0 0 DEBORAH CARR 0 195376 0 30789 0 38336 0 42538 0 19191 0 326230 0 0 ROSEMARY FRADO 0 314944 0 38586 0 106932 0 70311 0 20873 0 551646 0 0 SYEB S RAB 0 238050 0 32763 0 31101 0 33818 0 18341 0 354073 0 0 STEPHEN SUGRUE 0 164046 0 22127 0 14885 0 22645 0 21841 0 245544 0 0 LINE 4A FILING ORGANIZATION: _STEVEN T. RUWOLDT, CEO, RECEIVED $153,462, IN SEVERANCE COMPENSATION IN 2011. _ MARC MENDELSOHN, CCO, RECEIVED $84,705, IN SEVERANCE COMPENSATION IN 2011 _ROBERT E. FISHER, CFO, RECEIVED $35,000, IN SEVERANCE COMPENSATION IN 2011. PART I, LINE 4B THE FOLLOWING PAYMENTS WERE MADE FROM GHVHS, A RELATED TAX EXEMPT ORGANIZATION: NONQUALIFIED RETIREMENT PLAN MITCHELL AMADO III 40,353 JOSEPH ANESI 17,022 SCOTT BATULIS 135,375 DEBORAH CARR 12,176 ROSEMARY FRADO 33,254 SYED RAB 16,653 STEPHEN SUGRUE 9,810 DORMITORY AUTHORITY STATE OF NY 146000293 2004-12-16 54518326 REFINANCING OF MORTGAGE LOAN false false false 14615000 0 54518326 5140500 0 47070653 2307173 0 0 0 0 0 2004 true false true true false false true false false true 0.00000 0.00000 0.00000 true true true false NA false false false NA false false false ANDREAS BAEZ SEE SCHEDULE L PART V 40628 EMPLOYMENT false JUDITH SKORDINSKI SEE SCHEDULE L PART V 91770 EMPLOYMENT false ML ZAGER PC SEE SCHEDULE L PART V 141139 CONTRACTED SERVICES false CRYSTAL RUN HEALTHCARE SEE SCHEDULE L PART V 1224702 MEDICAL SERVICES false PART IV, COLUMN(B) COLUMN(B) - RELATIONSHIP BETWEEN INTERESTED PERSON AND THE ORGANIZATION ANDRES BAEZ IS A FAMILY MEMBER OF MARC BAEZ. JUDITH SKORDINSKI IS A FAMILY MEMBER OF LOUIS RODRIGUES. JOSEPH LOUGHLIN - BUSINESS RELATIONSHIP WITH M.L. ZAGER P.C. - OWNS 50% OF THE LAW FIRM. JEFFREY GRAY - PARTNER IN CRYSTAL RUN HEALTHCARE LLP. FORM 990 PART III - ORGANIZATION'S MISSION LINE 1: THE CENTER'S MISSION STATEMENT IS TO IMPROVE THE HEALTH OF OUR COMMUNITY BY PROVIDING EXCEPTIONAL HEALTH CARE. CENTER'S VISION IS TO BE THE BEST COMMNUNITY HOSPITAL IN NEW YORK STATE BY PROVIDING OUTSTANDING SERVICE TO ALL. CRMC'S VALUES REFLECT OUR MISSION AND VISION BY FOCUSING SPECIFICALLY ON CARE AND COMPASSION, SAFETY AND PRIVACY, RESPECT AND INTEGRITY AS WELL AS QUALITY AND INNOVATION. FORM 990 PART III - OTHER PROGRAM SERVICES DESCRIPTIONS LINE 4D: EXPENSES ARE INCURRED WHILE PROVIDING OTHER SERVICES SUCH AS LONG TERM CARE, AMBULATORY SERVICES, ADULT DAY CARE PROGRAM AND A 24/7 EMERGENCY ROOM TO RESIDENTS AND VISITORS IN THE SURROUNDING COMMUNITY. FORM 990 PART VI - BUSINESS AND FAMILY RELATIONSHIPS LINE 2: JOSEPH LOUGHLIN - BUSINESS RELATIONSHIP WITH M.L. ZAGER P.C. - OWNS 50% OF THE LAW FIRM. JEFFREY GRAY - PARTNER IN CRYSTAL RUN HEALTHCARE LLP. JOAN FARROW AND JOSEPH LOUGHLIN - FAMILY RELATIONSHIP. FORM 990 PART VI LINE 6 - DESCRIPTION OF DELEGATED DUTIES TO MANAGEMENT COMPANY: THROUGHOUT 2011, CRMC WAS SUBJECT TO A COMPREHENSIVE MANAGEMENT AGREEMENT WITH GREATER HUDSON VALLEY HEALTH SYSTEM, INC., WHICH IS ALSO CRMC'S SOLE MEMBER (A RELATED 501(C)(3) ORGANIZATION). FORM 990 PART VI LINE 3 - EXPLANATION OF CLASSES OF MEMBERS OR SHAREHOLDERS: GREATER HUDSON VALLEY HEALTH SYSTEM, INC., IS THE SOLE MEMBER OF CRMC. FORM 990 PART VI - HOW MEMBERS OF SHAREHOLDERS ELECT GOVERNING BODY. LINE 7A: GREATER HUDSON VALLEY HEALTH SYSTEM, INC. AS SOLE MEMBER, APPROVES ALL APPOINTMENTS TO THE CRMC BOARD OF DIRECTORS UPON RECOMMENDATION FROM CRMC BOARD OF DIRECTORS. FORM 990 PART VI LINE 7B DECISIONS OF GOVERNING BODY APPROVAL BY MEMBERS OR SHAREHOLDERS: THE FOLLOWING DECISIONS OF THE CRMC BOARD OF DIRECTORS ARE SUBJECT TO APPROVAL BY CRMC'S SOLE MEMBER, GREATER HUDSON VALLEY SYSTEM, INC.: (A) APPOINTMENT OF DIRECTORS; (B) APPROVAL OF CERTIFICATE OF NEED APPLICATIONS; (C) APPROVAL OF ANNUAL STRATEGIC PLAN; (D) APPROVAL OF AMENDMENTS TO THE BYLAWS OR CERTIFICATE OF INCORPORATION; (E) APPROVAL OF THE OPERATING AND CAPITAL BUDGETS; (F) APPROVAL OF ANY BORROWINGS, GUARANTEES, OR LEASES VALUED IN EXCESS OF $5 MILLION EACH OR IN THE ANNUAL AGGREGATE; (G) APPROVAL OF ANY MERGER, CONSOLIDATION OR NON-JUDICIAL DISSOLUTION; AND (H) APPROVAL OF ANY AFFILIATION OR MANAGEMENT CONTRACT WITH ANOTHER ENTITY. FORM 990 PART VI - FORM 990 REVIEW PROCESS LINE 11A: THE 990 IS FIRST PREPARED INTERNALLY BY THE FINANCE DEPARTMENT OF CATSKILL REGIONAL MEDICAL CENTER (CRMC) AND REVIEWED BY SENIOR MANAGEMENT AND THE CHIEF COMPLIANCE OFFICER OF CRMC. THE DRAFT RETURN AND SUPPORTING FINANCIAL INFORMATION IS PROVIDED TO CRMC'S TAX PREPARER TO PREPARE THE FINAL 990. THE FINAL VERSION OF THE ORGANIZATION'S FORM 990 IS THEN PROVIDED TO THE AUDIT COMPLIANCE COMMITTEE AND THE FULL BOARD OF DIRECTORS OF GHVHS PRIOR TO SUBMISSION OF THE RETURN TO THE INTERNAL REVENUE SERVICE. FORM 990 PART VI - EXPLANATION OF MONITORING AND ENFORCEMENT OF CONFLICTS LINE 12C: CATSKILL REGIONAL MEDICAL CENTER'S CONFLICT OF INTEREST (COI) POLICY APPLIES TO ALL DIRECTORS, COMMITTEE MEMBERS AND ALL EMPLOYEES WHO ARE IN A POSITION TO INFLUENCE ANY SUBSTANTIVE BUSINESS DECISION BY THE HOSPITAL OR ANY ENTITY CONTROLLED BY THE HOSPITAL. THE HOSPITAL HAS INSTITUTED A CORPORATE COMPLIANCE PROGRAM TO ENSURE THAT ALL OF ITS BUSINESS PRACTICES ARE IN COMPLIANCE WITH APPLICABLE CIVIL AND CRIMINAL LAWS, RULES AND REGULATIONS. THE CONFLICT POLICY REQUIRES ALL DIRECTORS AND COVERED EMPLOYEES TO READ AND UNDERSTAND THE POLICY AND REVIEW IT AT LEAST ANNUALLY IN ORDER TO BE ALERT TO SITUATIONS THAT COULD CREATE A CONFLICT OF INTEREST OR OTHERWISE BE CONTRARY TO HOSPITAL POLICY. THEY ARE ALSO REQUIRED ANNUALLY TO SIGN A CONFLICTS POLICY DISCLOSURE FORM. THE COMPLIANCE OFFICER MONITORS THE COI DISCLOSURES, AND IS PRESENT AT ALL BOARD MEETINGS TO ASSIST WITH ANY POTENTIAL CONFLICT ISSUES AND PROVIDE ADVICE ON ABSTENTION, RECUSAL, ETC. A SUMMARY OF THE COI DISCLOSURES IS PRODUCED FOR THE BOARD, AS IS ANNUAL UPDATES TO THE COI POLICY. FORM 990 PART VI COMPENSATION REVIEW AND APPROVAL PROCESS FOR OFFICERS AND KEY EMPLOYEES: LINE 15A/B: THE CATSKILL REGIONAL MEDICAL CENTER CHIEF EXECUTIVE OFFICER COMPENSATION WAS REVIEWED FOR COMPARABILTY BY AN INDEPENDENT COMPENSATION COMMITTEE COMPRISED OF MEMBERS OF THE GREATER HUDSON VALLEY HEALTH SYSTEM BOARD OF DIRECTORS WORKING IN COOPERATION WITH AN OUTSIDE FIRM (INTEGRATED HEALTHCARE STRATEGIES) TO RECOMMEND THE CEO COMPENSATION. THE BOARD OF DIRECTORS OF CATSKILL REGIONAL MEDICAL CENTER USING THE RECOMMENDATION FROM THE GREATER HUDSON VALLEY HEALTH SYSTEM PLUS USING VARIOUS COMPENSATION SURVEYS PUBLISHED BY OUTSIDE ORGANIZATIONS SUCH AS YAFFE AND COMPANY AND OTHER HOSPITAL ORGANIZATIONS IN THE GEOGRAPHIC AREA APPROVES AND ESTABLISHES THE CEO COMPENSATION. ANNUAL REVIEWS ARE DONE ON THE CEO'S PERFORMANCE AGAINST ESTABLISHED GOALS FOR THE FISCAL YEAR. COMPENSATION FOR OTHER OFFICERS AND KEY EMPLOYEES IS DETERMINED IN A SIMILAR MANNER BY CRMC'S CHIEF EXECUTIVE OFFICER WORKING IN CONNECTION WITH THE CEO AND VICE PRESIDENT FOR HUMAN RESOURCES OF THE GHVHS USING PUBLISHED HEALTHCARE COMPENSATION SURVEYS BASED UPON LOCATION, SIZE OF OPERATION, EDUCATION, EXPERIENCE AND PERFORMANCE WITH ESTABLISHED GOALS OF THE ORGANIZATION. THE DISCUSSION AND ACTIONS TAKEN DURING BOARD MEETINGS REGARDING COMPENSATION REVIEW AND APPROVAL PROCESS ARE DOCUMENTED IN THE MINUTES FOR EACH SESSION. FORM 990. PART VI - OTHER ORGANIZATION DOCUMENTS PUBLICLY AVAILABLE LINE 19: ONCE A REQUEST IS MADE FOR THE CATSKILL REGIONAL MEDICAL CENTER TAX RETURN, A COPY IS SENT TO THE PERSON(S) REQUESTING THE DATA OR AS REQUIRED FOR VARIOUS STATE AND FEDERAL FILINGS THROUGH THE ADMINISTRATION OFFICE. PART XI - RECONCILIATION OF NET ASSETS LINE 5 - OTHER CHANGES IN NET ASSETS OR FUND BALANCES: CHANGE IN THE INTEREST IN NET ASSETS OF THE CRMC FOUNDATION, INC:(851,586) UNREALIZED LOSS ON INVESTMENTS: 78,573 CONTRIBUTION TO PERMANENT ENDOWMENT FUND: 1,000 SCHEDULE K PART I - BOND ISSUES CUSIP #'S: 64983TW25; 64983TW33; 64983TW41; 64983TW58; 6498TW66; 64983TW74; 64983TW82; 64983TW90; 64983TX24; 64983TX32; 64983TX40. HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JOAN FARROW TITLE:TRUSTEE HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MITCHELL AMADO TITLE:VP FINANCE/CFO HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JOSEPH M ANESI TITLE:VP/GENERAL COUNSEL HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:SCOTT BATULIS TITLE:PRESIDENT/CEO HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:DEBORAH CARR TITLE:VP HUMAN RESOURCES HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:ROSEMARY FRADO TITLE:INTERIM CEO & VP PLAN./MARKTG. HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:SYEB S RAB TITLE:VP/CIO HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:STEPHEN SUGRUE TITLE:VP COMPLIANCE HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:ROSEMARY A BACZEWSKI TITLE:VP QUALITY HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JEFFREY F LIETO TITLE:CHIEF PHYSICIAN STRATEGY OFF. HOURS:50 CRMC FOUNDATION INC PO BOX 800 HARRIS NY 12742 141742176 SUPPORT ORG. NY 501 (C) (3) 11 TYPE 1 NA false ORANGE REGIONAL MEDICAL CENTER 60 PROSPECT AVENUE MIDDLETOWN NY 10940 141364536 HEALTHCARE NY 501 (C) (3) 3 GHVHS false GREATER HUDSON VALLEY HEALTH SYSTEM C/O ORMC 60 PROSPECT MIDDLETOWN NY 10940 061488219 HEALTHCARE NY 501 (C) (3) 11-TYPE I NA false EAST MAIN STREET MANAGEMENT 60 PROSPECT AVENUE MIDDLETOWN NY 10940 203168346 ADMIN. 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