2011-11-10T13:53:44-06:00 2010-12-31 O'CONNOR DAVIES MUNNS & DOBBINS LLP 500 MAMARONECK AVENUE - SUITE 301 HARRISON NY 105281633 990 2010-01-01 111667765 SOUTHAMPTON HOSPITAL ASSOCIATION SOUT 6317238301 240 MEETING HOUSE LANE SOUTHAMPTON NY 11968 CHRISTOPHER SCHULTHEIS 6317238301 2011-11-10 1 GARRETT M HIGGINS 9143818900 2010 2016-02-24 21:20:13Z CHRISTOPHER SCHULTHEIS 240 MEETING HOUSE LANE SOUTHAMPTON NY 11968 126341707 0 X WWW.SOUTHAMPTONHOSPITAL.ORG X 1909 NY SOUTHAMPTON HOSPITAL OFFERS A FULL CONTINUUM OF AMBULATORY AND INPATIENT SERVICES RANGING FROM 29 27 1043 33 1091008 -90102 8456311 4082097 99057831 106304350 -248465 385561 1594001 37093 108859678 110809101 0 0 0 0 57652607 62678644 0 0 0 47193085 47309251 104845692 109987895 4013986 821206 81074223 87206773 83749471 79512614 -2675248 7694159 X THE MISSION OF SOUTHAMPTON HOSPITAL IS TO PROVIDE AND ENSURE THE HIGHEST QUALITY OF HEALTHCARE SERVICES FOR ITS ENTIRE COMMUNITY. [SEE CONTINUATION OF MISSION STATEMENT ON PAGES 73-75 OF SCHEDULE O] 0 0 93598895 106304350 THE SOUTHAMPTON HOSPITAL ASSOCIATION IS A NOT-FOR-PROFIT 125 LICENSED BED ACUTE-CARE FACILITY THAT PROVIDES INPATIENT AND OUTPATIENT SERVICES TO PATIENTS.SOUTHAMPTON HOSPITAL 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 HOSPITAL 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 HOSPITAL'S SERVICE AREA EXTENDS FROM WESTHAMPTON BEACH TO MONTAUK, THE HOSPITAL HAS A NUMBER OF SATELLITE CARE OFFICES TO PROVIDE CONVENIENT, SPECIALIZED CARE TO THE COMMUNITY. THESE INCLUDE: WESTHAMPTON PRIMARY CARE CENTER: PROVIDING CARE IN THE WESTHAMPTON, WESTHAMPTON BEACH, QUOGUE, AND REMSENBURG COMMUNITIES.LABORATORY AND IMAGING SERVICES:PROVIDING SERVICES IN EAST HAMPTON, HAMPTON BAYS AND SOUTHAMPTON.CENTER FOR PHYSICAL THERAPY AND REHABILITATION: PROVIDING CARE IN THE WESTHAMPTON, WESTHAMPTON BEACH, QUOGUE, AND REMSENBURG COMMUNITIES.THE SHINNECOCK INDIAN HEALTH CLINIC: SINCE APRIL OF 1995, SOUTHAMPTON HOSPITAL HAS WORKED WITH THE SHINNECOCK NATION TO PROVIDE SERVICES AT THE SHINNECOCK INDIAN HEALTH CLINIC THROUGH A CONTRACT WITH THE NEW YORK STATE DEPARTMENT OF HEALTH. ON AN ANNUAL BASIS, THE CLINIC PROVIDES APPROXIMATELY 1,600 MEDICAL AND 1,500 DENTAL 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 UNIVERSITY SCHOOL OF MEDICINE. CURRENTLY, DENTAL SERVICES ARE AVAILABLE EIGHT DAYS PER MONTH FOR ADULTS AND TWO DAYS FOR CHILDREN. THE DAVID E. ROGERS MD CENTER FOR HIV/AIDS CARE: ANOTHER IMPORTANT COLLABORATION BETWEEN SOUTHAMPTON HOSPITAL, STONY BROOK UNIVERSITY MEDICAL CENTER AND TOWN AND COMMUNITY ORGANIZATIONS OF THE EAST END OF LONG ISLAND. MAJOR FUNDING IS PROVIDED THROUGH RYAN WHITE PART A FEDERAL FUNDS AND TO PROVIDE SUPPORT SERVICES AND PREVENTION EDUCATION TO PARTNERS AND FAMILY MEMBERS AFFECTED BY AIDS. THE CENTER IS A MEMBER OF THE PECONIC COMMUNITY COUNCIL, A NOT-FOR-PROFIT COALITION OF ORGANIZATIONS AND INDIVIDUALS DEDICATED TO THE PROMOTION AND PRESERVATION OF HEALTH AND HUMAN SERVICES FOR THE ENTIRE EAST END COMMUNITY.CENTER FOR PRENATAL CARE: LOCATED IN GREENPORT ON THE EASTERN END OF LONG ISLANDS NORTH FORK, 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 HOSPITALS KATHLEEN D. ALLEN MATERNITY CENTER.SOUTHAMPTON HOSPITAL IS PROUD OF THE EXCEPTIONAL SPECIALTY SERVICES IT PROVIDES TO THE COMMUNITY. THESE INCLUDE:THE ELLEN HERMANSON BREAST CENTER OFFERS A WIDE SPECTRUM OF BREAST HEALTH SERVICES, INCLUDING EDUCATION, EARLY DETECTION SCREENINGS AND BREAST CANCER TREATMENT AND SUPPORT. THE CENTER UTILIZES STATE-OF-THE-ART DIAGNOSTIC TECHNIQUES, INCLUDING COMPUTER-ASSISTED MAMMOGRAPHY, ULTRASOUND AND BREAST BIOPSY. THE ED & PHYLLIS DAVIS WELLNESS INSTITUTE OFFERS THE ONLY HOSPITAL-BASED INTEGRATIVE MEDICINE ON LONG ISLAND'S EAST END. INTEGRATIVE MEDICINE COMBINES MODERN SCIENCE, PSYCHOLOGY, NUTRITION, AND EXERCISE TO ENHANCE THE NATURAL HEALING CAPACITY OF THE BODY. SPECIAL PROGRAMS ARE AVAILABLE FOR PATIENTS SUFFERING FROM CHRONIC ILLNESS AND CLASSES IN YOGA, TAI CHI, PILATES, SMOKING CESSATION, STRESS MANAGEMENT, ARE OFFERED, AS WELL AS NUTRITIONAL AND WEIGHT LOSS COUNSELING, MASSAGE THERAPY, AND MUCH MORE.THE JENNY AND JOHN PAUSON 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. 93598895 1 1 0 1 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 186 0 1 1043 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 29 27 0 0 0 0 0 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 NY X X CHRISTOPHER SCHULTHEIS 6317268301 240 MEETING HOUSE LANE SOUTHAMPTON NY 11968 X PETER M LARSEN 1.30 X X 0 0 0 RICHARD J HIEGEL ESQ 1.30 X X 0 0 0 KENNETH B WRIGHT 1.30 X X 0 0 0 STANLEY D FRIEDMAN 1.30 X X 0 0 0 LAWRENCE A WILLIS 1.30 X X 0 0 0 PATRICIA STEWART 1.30 X X 0 0 0 JOHN WAMBOLD 1.30 X 0 0 0 RICHARD BRUCE 1.30 X 0 0 0 JAMES FORBES 1.30 X 0 0 0 CHARLES HOLMES 1.30 X 0 0 0 MICHAEL B ISRAEL MD 38.80 X 177077 0 30055 GEORGE P KAZDIN 1.30 X 0 0 0 LISA KOMBRINK 1.30 X 0 0 0 JACK LENTZ - TRUSTEE 1.30 X 0 0 0 JOHN MCGOWAN 1.30 X 0 0 0 STEPHEN H SHAPOFF 1.30 X 0 0 0 R TIMOTHY MARAN 1.30 X 0 0 0 PHILLIP A PIRO JR MD 1.30 X 0 0 0 DOROTHY LEWIS 1.30 X 0 0 0 JEAN REMMEL FITZSIMMONS 1.30 X 0 0 0 JOHN E GRIM III 1.30 X 0 0 0 PETER COLLINS 1.30 X 0 0 0 STEVEN R GOLDFARB MD 1.30 X 0 0 0 FLORENCE ROLSTON MD 1.30 X 0 0 0 MARTIN L STONE MD 1.30 X 0 0 0 MICHAEL F SMITH 1.30 X 0 0 0 GEORGE F BIONDO ESQ 1.30 X 0 0 0 JAY K LEVINE 1.30 X 0 0 0 ROBERT S CHALONER 38.80 X X 615461 0 39804 HOWARD M LORBER 1.30 X 0 0 0 FREDERIC I WEINBAUM 37.50 X 419788 0 36265 CHRISTOPHER J SCHULTHEIS 37.50 X 191863 0 30745 PATRICIA A DARCEY 37.50 X 192438 0 30495 PAUL R DAVIN 37.50 X 190347 0 30261 EDNA KAPENHAS-VALDES 37.50 X 312370 0 34008 CHARLES ARCOLEO 37.50 X 247829 0 33694 ANGELA SOTERIOU 37.50 X 193954 0 18637 ALEX APONTE 37.50 X 189736 0 30738 TOVIA LENT 37.50 X 192376 0 29016 2923239 0 343718 10 0 1 0 MORRISON MANAGEMENT SPECIALIST 4721 MORRISON DRIVE STE 300 MOBILE AL 36609 FOOD SERVICE MGMT & SUPPLIES 928873 HAMPTONS GYNECOLOGY OB 595 HAMPTON ROAD SOUTHAMPTON NY 11968 OB COVERAGE & PRECEPTING 896990 CANDESCENT HEALING INC 220 WHITE PLAINS ROAD TARRYTOWN NY 10591 OUTPATIENT SERVICES 624614 LONG ISLAND PATHOLOGY PC PO BOX 2098 SOUTHAMPTON NY 11968 PATHOLOGY SERVICES 431520 BDO SEIDMAN LLP PO BOX 642743 PITTSBURGH PA 152642743 ACCOUNTING 215266 17 114753 2399326 1409416 158602 4082097 INPATIENT SERVICES 900099 55471355 55471355 EMERGENCY RM & OUTPATI 900099 48729942 48729942 LABORATORY EXTENDED SE 621500 1091008 1091008 LABORATORY REVENUE 900099 607726 607726 BREAST CTR REVENUE 900099 193927 193927 210392 210392 106304350 126358 126358 467740 436720 31020 31020 31020 15352531 2558 15095886 256645 2558 259203 259203 TELEPHONE REVENUE 900099 52601 52601 VENDOR REBATES 900099 26775 26775 MISCELLANEOUS 900099 17916 17916 -91219 -91219 6073 110809101 105213342 1091008 422654 1778066 1778066 45219072 38888402 6330670 2866444 2465142 401302 9390533 8075858 1314675 3424529 2945095 479434 769587 661845 107742 140934 140934 250409 250409 43486 37398 6088 11435 9834 1601 13495240 11605906 1889334 626592 538869 87723 2867194 2465787 401407 158083 158083 5144 5144 2897623 2491956 405667 4171159 3587197 583962 2347906 2019199 328707 BAD DEBTS 8406000 8406000 OTHER PURCHASE SERVICES 4842065 4164176 677889 OTHER PROFESSIONAL SERV 3361298 2890716 470582 OTHER DIRECT EXPENSES 1530845 1316527 214318 MISCELLANEOUS 710526 355263 355263 673725 673725 109987895 93598895 16389000 0 4228363 1064887 1075153 8276962 13025057 11221858 2744016 1396307 1426697 198721 224215 126828225 91916023 29498686 34912202 27403543 26969470 1504377 3110482 81074223 87206773 22206091 16191326 36317011 35558409 7653718 8916102 17572651 18846777 83749471 79512614 X -10420273 -374818 4911008 5234960 2834017 2834017 -2675248 7694159 81074223 87206773 X 821206 9548201 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 43486 0 0 0 43486 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: SOUTHAMPTON HOSPITAL PAYS MEMBERSHIP DUES TO THE ORGANIZATIONS LISTED BELOW. 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 $ 14,040 NASSAU SUFFOLK HOSPITAL COUNCIL 1,297 GREATER NY HOSPITAL ASSOCIATION 28,149 --------- $ 43,486 ========= 3943577 371238 95021 6028 4213766 4031782 73511 23873 137843 3943577 4235635 -146059 30806 26988 4031782 0.32000 0.68000 0 0 1335585 1335585 37906615 15718387 22188228 10854427 3086703 7767724 76731598 73110933 3620665 34912202 SHORT TERM INVESTMENTS 1071240 F ASSETS SUBJECT TO DONOR RESTRICTIONS 8068977 F DEBT SERVICE RESERVE FUND 5706009 F MALPRACTICE SELF INSURANCE-FUND 5718000 F INVESTMENT IN SHA PROPERTIES 6300000 C INVESTMENT IN JOINT VENTURE - HAMPTON IMAGING LLC 105244 F 26969470 DUE FROM RELATED PARTY - MEETINGHOUSE LANE MEDICAL PRACTICE 2080612 UNAMORTIZED BOND DISCOUNT & ISSUE COST 1029870 3110482 MALPRACTICE SELF-INSURANCE 5718000 DUE FROM THIRD PARTY PAYORS 5374442 PENSION LIABILITY 7430050 DUE FROM RELATED PARTY - MEETINGHOUSE LANE MEDICAL PRACTICE 324285 18846777 110809101 109987895 821206 581461 1390345 7576395 9548201 10369407 114293425 581461 3576588 4158049 110135376 673725 673725 110809101 109907806 593636 593636 109314170 673725 673725 109987895 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: SOUTHAMPTON HOSPITAL CURRENTLY REPORTS ENDOWMENT FUNDS WITHIN ITS DECEMBER 31, 2010 FINANCIAL STATEMENTS. THE GOVERNING BODY INTENDS TO USE THESE FUNDS TO OFFSET THE COST OF INDIGENT CARE, EMERGENCY SERVICES AND NURSING EDUCATION. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE HOSPITAL IS INCORPORATED IN THE STATE OF NEW YORK AND IS EXEMPT FROM FEDERAL, STATE AND LOCAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE "CODE"), AND THEREFORE HAVE MADE NO PROVISION FOR INCOME TAXES IN THE ACCOMPANYING FINANCIAL STATEMENTS. THE HOSPITAL EARNS INCOME FROM ITS LABORATORY EXTENDED SERVICES PROGRAM. SUCH INCOME IS CLASSIFIED AS UNRELATED BUSINESS INCOME ("UBI") BY THE CODE AND IS SUBJECT TO INCOEM TAXES. UBI IS DEFINED AS INCOME DERIVED FROM AN ACTIVITY THAT CONSTITUTES A TRADE OR BUSINESS THAT IS REGULARLY CARRIED ON AND IS NOT SUBSTANTILALLY RELATED TO THE ORGANIZATION'S TAX-EXEMPT PURPOSE. THE LABORATORY EXTENDED SERVICES PROGRAM HAS BEEN OPERATING AT A LOSS AND, ACCORDINGLY, THERE IS NO UBI TAX RECORDED FOR THE YEAR ENDED DECEMBER 31, 2010. THE HOSPITAL HAVE NOT TAKEN AN UNSUNSTANTIATED TAX POSITION THAT WOULD REQUIRE PROVISION OF A LIABILIOTY UNDER ASC 740-10. PART XI, LINE 8 - OTHER ADJUSTMENTS: CHANGE IN MINIMUM PENSION LIABILITY - $1,266,824 NET ASSETS REL FROM RESTRICTIONS - CAPITAL ACQUIS FOUNDATION - $5,993,546 CHANGE IN EXPECTED INTEREST IN TRUSTS CHANGE IN VALUE OF POOLED INCOME FUND OTHER ADJUSTMENTS PART XII, LINE 2D - OTHER ADJUSTMENTS: RELATED PARTY INCOME - S.H.A PRPERTIES, INC. - $374,091 INTEREST IN SOUTHAMPTON HOSPITAL FOUNDATION M- $2,441,825 RENTAL EXPENSES REPORTED ON FORM 990, PART VIII, LINE 6B - $436,720 CHANGE IN EXPECTED INEREST IN TRUSTS - $317,933 CHANGE IN VALUE OF POOLED INCOME FUND - $6,019 PART XII, LINE 4B - OTHER ADJUSTMENTS: NET PATIENT SERVICE REVENUE RECLASSIFICATION - $673,725 PART XIII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES REPORTED ON FORM 990, PART VIII, LINE 6B - $436,720 RELATED PARTY EXPENSES - S.H.A PROPERTIES, INC. - $156,916 PART XIII, LINE 4B - OTHER ADJUSTMENTS: NET PATIENT SERVICE REVENUE RECLASSIFICATION - $673,725 PART XI, LINE 7 - EXPLANATION FOR PRIOR PERIOD ADJSUTMENTS: THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS FOR 2009 HAVE BEEN RESTATED TO CORRECT AN UNDERSTATEMENT OF UNRESTRICTED NET ASSETS AS A RESULT OF CONSOLIDATION OF THE MEETING HOUSE LANE MEDICAL PRACTICE PC, WHICH WAS CREATED IN 2008, BUT EXCLUDED FROM THE CONSOLIDATED FINANCIAL STATEMENTS. 1 1 X 1 X 400.000000000000 1 X 0 1 1 0 1 1 1 703 2111421 1274481 836940 0.00760 10147209 6064511 4082698 0.03720 1 703 12258630 7338992 4919638 0.04480 3396595 885893 2510702 0.02230 2 543 580717 680319 -99602 0.00530 2 543 3977312 1566212 2411100 0.02760 3 1246 16235942 8905204 7330738 0.07240 360289 360289 0.00350 360289 360289 0.00350 1 8406000 0 139924937 102192979 37731958 X 1 1 1 HAMPTONS IMAGING RADIOLOGY SERVICES 0.50000 0.00000 0.00000 2 MEETINGHOUSE LANE PRACTICE PRIMARY/SPECIALTY PHYSICIAN PATIENT CARE 1.00000 0.00000 0.00000 3 EAST HAMPTON MSO LLC URGENT CARE PATIENT SERVICES 0.50000 0.00000 0.00000 4 SHA PROPERTIES INC REAL ESTATE HOLDING COMPANY 1.00000 0.00000 0.00000 5 OLD TOWN MEDICAL PRACTICE PC PRACTICE OF MEDICINE 1.00000 0.00000 0.00000 15 1 SOUTHAMPTON HOSPITAL

240 MEETING HOUSE LANE SOUTHAMPTON NY 11968

X 2 DIALYSIS CENTER

184 W MONTAUK HIGHWAY HAMPTON BAYS NY 11946

X DIALYSIS TREATMENT FACILITY 3 GREENPORT PRENATAL

300 ATLANTIC AVENUE GREENPORT NY 11944

X PRENATAL/WOMEN'S SERVICES 4 LAB EAST

200 PANTIGO PLACE EAST HAMPTON NY 11937

X LABORATORY SERVICES 5 IMAGING - EH

200 PANTIGO PLACE EAST HAMPTON NY 11937

X RADIOLOGY SERVICES 6 WESTHAMPTON PRIMARY CARE

80 OLD RIVERHEAD ROAD WESTHAMPTON BEACH NY 11978

X PRIMARY CARE PRACTICE 7 WESTHAMPTON SPORTS REHAB

74 OLD RIVERHEAD ROAD WESTHAMPTON BEACH NY 11978

X SPORTS RHAB/PHYSICAL THERAPY SERVICES 8 LAB SOUTH

325 MEETING HOUSE LANE SOUTHAMPTON NY 11968

X LABORATORY SERVICES 9 ATRIUM LAB

182 W MONTAUK HIGHWAY HAMPTONS BAYS NY 11946

X LABORATORY SERVICES 10 DAVID ROGERS CENTER

335 D MEETINGHOUSE LANE SOUTHAMPTON NY 11968

X HIV/AIDS CARE 11 SHINNECOCK HEALTH

CHURCH STREET SOUTHAMTPON NY 11968

X PRIMARY CARE/DENTAL SERVICES 12 SOUTHAMPTON CARE CENTER

240 MEETINGHOUSE LANE SOUTHAMPTON NY 11968

NURSING HOME (FACILITY CLOSED) 13 HAMPTONS IMAGING

182 W MONTAUK HIGHWAY HAMPTONS BAYS NY 11946

X RADIOLOGY SERVICES 14 MEETINGHOUSE LANE PRACTICE

PO BOX 2340 SOUTHAMPTON NY 11968

X PRIMARY/SPECIALTY PHYSICIAN PATIENT CARE 15 EAST HAMPTON MSO LLC

470 PANTIGO ROAD EAST HAMPTON NY 11937

X URGENT CARE PATIENT SERVICES NOT REQUIRED 1 0 0 0 0 0 0 0 0 0 0 0 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 IN THE COUNTIES OF SUFFOLK OR NASSAU AT THE TIME OF SERVICE. ELIGIBLE SERVICES FOR A PRIMARY SERVICE AREA PATIENT:A PRIMARY SERVICE AREA PATIENT WHO MEETS THE FINANCIAL REQUIREMENTS IS ELIGIBLE FOR THE FOLLOWING MEDICALLY NECESSARY SERVICES: INPATIENT, AMBULATORY, EMERGENCY ROOM, EMERGENCY TRANSFERS UNDER THE EMERGENCY MEDICAL TREATMENT AND LABOR ACT (EMTALA), OUTPATIENT, AND DIAGNOSTIC CARE. UNDERINSURED PRIMARY SERVICE AREA PATIENTS ARE ELIGIBLE FOR FINANCIAL ASSISTANCE ON MEDICARE AND COMMERCIAL INSURANCE CARRIER CO-INSURANCES FOR ALL ABOVE LISTED SERVICES. ELIGIBLE SERVICES FOR A NON-PRIMARY SERVICE AREA PATIENT:A NON-PRIMARY SERVICE AREA PATIENT WHO MEETS THE FINANCIAL REQUIREMENTS IS ELIGIBLE FOR THE FOLLOWING MEDICALLY NECESSARY SERVICES: EMERGENCY ROOM, EMERGENT ADMISSIONS, AND EMERGENCY TRANSFERS UNDER THE EMERGENCY MEDICAL TREATMENT AND LABOR ACT (EMTALA). UNDERINSURED NON-PRIMARY SERVICE AREA PATIENTS ARE ELIGIBLE FOR FINANCIAL ASSISTANCE ON MEDICARE AND COMMERCIAL INSURANCE CARRIER CO-INSURANCES FOR ALL ABOVE LISTED SERVICES.INELIGIBLE SERVICES:THE FOLLOWING SERVICES AND/OR ITEMS ARE NOT COVERED BY CHARITY CARE FOR ANY PATIENT: NOT MEDICALLY NECESSARY SERVICES AS DETERMINED BY MEDICARE (E.G. COSMETIC SURGERY, BARIATRIC SURGERY), INSURANCE CO-PAYMENTS, INSURANCE DEDUCTIBLES, 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) AND HAVE ASSETS LESS THAN OR EQUAL TO THE ALLOWABLE LIMIT AS DESCRIBED IN THE ASSET LEVEL PASSAGE. [SEE ASSETT LEVEL PASSAGE DESCRIBED ON PAGE 40 OF THE TAX RETURN]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.ASSETS:THE FOLLOWING ASSETS WILL BE CONSIDERED WHEN DETERMINING A PATIENT'S CHARITY CARE ELIGIBILITY: CHECKING ACCOUNTS, SAVINGS ACCOUNTS, NON-PRIMARY RESIDENCES OR PROPERTY, CARS AND/OR VEHICLES NOT USED FOR PRIMARY TRANSPORTATION BY THE PATIENT OR HOUSEHOLD, STOCKS, BONDS, TRUSTS, AND OTHER MISCELLANEOUS ASSETS. THE FOLLOWING ASSETS WILL NOT BE CONSIDERED WHEN DETERMINING A PATIENT'S CHARITY CARE ELIGIBILITY: THE PATIENT'S PRIMARY RESIDENCE, CARS AND/OR VEHICLES REGULARLY USED FOR PRIMARY TRANSPORTATION BY THE PATIENT OR HOUSEHOLD, ASSETS HELD IN A TAX-DEFERRED OR COMPARABLE RETIREMENT SAVINGS ACCOUNT, IRA'S, BULK-PAYMENT PENSIONS, OR COLLEGE SAVINGS ACCOUNTS.ASSET LEVELS:PATIENTS WITH A GROSS FAMILY INCOME AT OR BELOW 150% OF THE FPG MAY NOT HAVE ASSETS TOTALING OVER THE AMOUNT LISTED ON THE CHART BELOW. (EFFECTIVE JANUARY 1, 2009)PATIENTS WITH A GROSS FAMILY INCOME OVER 150% OF THE FPG MAY NOT HAVE ASSETS TOTALING OVER THE AMOUNT LISTED ON THE CHART BELOW. (EFFECTIVE IMMEDIATELY)SIZE OF FAMILY MAX ALLOWABLE ASSETS1 $4,2002 $5,4003 $6,6004 $6,6505 $6,7006 $6,8007 $7,6508 $8,500EACH ADDITIONAL $850ASSET SPEND-DOWN :A PATIENT HAVING LIQUID ASSETS OVER THE ALLOWABLE LIMIT BUT OTHERWISE QUALIFYING FOR CHARITY CARE MAY SPEND-DOWN THEIR ASSET LEVEL TOWARD THEIR SOUTHAMPTON HOSPITAL BILL(S). ONCE THEIR ASSETS ARE WITHIN THE ALLOWABLE LIMITS, THEY WOULD BE FULLY ENTITLED TO THE CHARITY CARE DISCOUNT TO WHICH THEIR FAMILY INCOME LEVEL CORRELATES. FINANCIAL DOCUMENTATION REQUIREMENTS:A PATIENT MUST BE ABLE TO PROVE THEIR STATED FAMILY/HOUSEHOLD INCOME AND ASSET LEVEL. THE FOLLOWING DOCUMENTS ARE ACCEPTABLE AS PROOF: FEDERAL INCOME TAX FORM FOR THE PREVIOUS YEAR, COPIES OF SIX CONSECUTIVE RECENT PAY STUBS (THREE FOR BI-WEEKLY PAY PERIODS), A RECENT UNEMPLOYMENT OR DISABILITY STATEMENT. IF NONE OF THE ABOVE IS AVAILABLE, A STATEMENT ON COMPANY LETTERHEAD FROM THE PERSON'S EMPLOYER MAY BE ACCEPTABLE IN CERTAIN CIRCUMSTANCES AND WILL BE ACCEPTED AT SOUTHAMPTON HOSPITAL'S DISCRETION. A PATIENT MAY BE REQUIRED TO SUBMIT ADDITIONAL DOCUMENTATION AT SOUTHAMPTON HOSPITAL'S REQUEST IN ORDER TO SUBSTANTIATE THEIR STATED INCOME OR ASSET LEVEL SUCH AS BANKING STATEMENTS. A PATIENT'S FAILURE TO SUBSTANTIATE THEIR STATED INCOME OR ASSET LEVEL IS GROUNDS FOR THE DENIAL OF THEIR CHARITY CARE APPLICATION. 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% 9%>125% TO 150% 15%>150% TO 175% 21%>175% TO 200% 27%>200% TO 225% 33%>225% TO 250% 39%>250% TO 275% 45%>275% TO 300% 51%>300% TO 325% 57%>325% TO 350% 63%>350% TO 375% 69%>375% TO 400% 75% PART I, LINE 6A: RELATED PARTY INDENTIFICATION: PLEASE SEE FORM 990, SCHEDULE R FOR MORE RELATED PARTY INFORMATION.(1) SHA PROPERTIES, INC, - 11-2563612(2) SOUTHAMPTON CARE CENTER - 11-2658403(3) THE SOUTHAMPTON HOSPITAL FOUNDATION - 11-3466516(4) EAST HAMPTON MSO LLC C/O 24/7 EMERGENCY CARE PC - 26-2636086(5) HAMPTON IMAGING, LLC - 20-1353646(6) MEETING HOUSE LANE PRACTICE - 20-8853938(7) OLD TOWN MEDICAL PRACTICE, P.C. - 45-2430883 PART I, LINE 7G: HEALTHCARE INFORMATION: SOUTHAMPTON HOSPITAL PROVIDES FREE HEALTH EDUCATION/ INFORMATION PROGRAMS THROUGH ITS WELL-ATTENDED "HEALTH INSIGHTS" PROGRAM. PATIENT SATISFACTION SURVEYS: IN ADDITION, SOUTHAMPTON HOSPITAL CONTINUALLY SOLICITS PATIENT INPUT THROUGH ITS PATIENT SATISFACTION SURVEY PROCESS, WHICH INCLUDES EVERY INPATIENT, AMBULATORY SURGERY PATIENT AND EMERGENCY ROOM PATIENT. THE DATA COLLECTED FROM THESE COMPREHENSIVE SURVEYS PROVIDES VALUABLE INFORMATION ON A WIDE RANGE OF QUALITY INDICATORS AND AREAS OF INTEREST TO THE HOSPITAL'S PATIENTS. RESULTS FROM THESE SURVEYS ARE REGULARLY DISTRIBUTED TO HOSPITAL AND MEDICAL STAFFS AND THE BOARD OF DIRECTORS. THE QUALITY MANAGEMENT AND PUBLIC AFFAIRS DEPARTMENTS, AS WELL AS THE OFFICE OF THE PRESIDENT, CAREFULLY REVIEW CORRESPONDENCE FROM PATIENTS AND THE COMMUNITY AT LARGE. A MEMBER OF THE HOSPITAL STAFF PERSONALLY ANSWERS ALL CORRESPONDENCE. THE DAVID E. ROGERS CENTER FOR HIV/AIDS CARE (DRC): THE DRC IS ANOTHER IMPORTANT COLLABORATIVE EFFORT BETWEEN SOUTHAMPTON HOSPITAL, STONY BROOK UNIVERSITY MEDICAL CENTER AND TOWN AND COMMUNITY ORGANIZATIONS OF THE EAST END OF LONG ISLAND. MAJOR FUNDING FOR THE DRC IS PROVIDED THROUGH RYAN WHITE PART A FEDERAL FUNDS AND PROVIDES SUPPORT SERVICES AND PREVENTION EDUCATION TO PARTNERS AND FAMILY MEMBERS AFFECTED BY AIDS. THE DRC IS A MEMBER OF THE PECONIC COMMUNITY COUNCIL, A NOT-FOR-PROFIT COALITION OF ORGANIZATIONS AND INDIVIDUALS DEDICATED TO THE PROMOTION AND PRESERVATION OF HEALTH AND HUMAN SERVICES FOR THE ENTIRE EAST END COMMUNITY. THE CENTER FOR PRENATAL CARE: THE CENTER FOR PRENATAL CARE AT GREENPORT IS AN IMPORTANT OUTREACH ACTIVITY THAT PERMITS THE HOSPITAL TO TAILOR ITS PROGRAMS TO COMMUNITY NEEDS. THE CENTER REACHES OUT TO THE COMMUNITY THROUGH COLLABORATIVE EFFORTS WITH A NUMBER OF LOCAL ORGANIZATIONS, INCLUDING CAST, A LOCAL SOUTHOLD SOCIAL SERVICE AGENCY, THE PERINATAL COALITION, EASTERN LONG ISLAND HOSPITAL, SUFFOLK COUNTY DEPARTMENT OF HEALTH AND LOCAL CHURCHES. 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. COMMUNITY ORGANIZATION PARTICIPATION: 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: AMERICAN ACADEMY OF DERMATOLOGY LONG ISLAND BLOOD SERVICES AMERICAN CANCER SOCIETY LUCIA'S ANGELS AMERICAN HEART/LUNG/DIABETES ASSOC. NASSAU-SUFFOLK CARE NETWORK CATHOLIC CHARITIES NASSAU-SUFFOLK HOSPITAL COUNCIL CHAMBERS OF COMMERCE NEW YORK ORGAN DONORS CHILDREN MUSEUM OF EAST END SOUTH FORK BREAST HEALTH COALITION DOMINICAN SISTERS SOUTH FORK COMMUNITY HEALTH INITIATIVE EAST END HOSPICE SOUTHAMPTON SCHOOL BOARD EAST END ONCOLOGY PARTNERSHIP SPECIAL EVENTS SALON (BREAST CANCER) EAST HAMPTON HEALTHCARE FOUNDATION ST. ROSALIE CHARITY CARE ELLEN'S RUN SUFFOLK COMMUNITY COLLEGE ELLEN'S WELL SCDHS EMERGENCY MEDICAL CORPS SUFFOLK COUNTY OFFICE FOR THE AGING FAMILY SERVICE LEAGUE TOWN OF EAST HAMPTON FIGHTING CHANCE TOWN OF SOUTHAMPTON LION'S EYE BANK WOMEN'S HEALTH PARTNERSHIP OF LONG ISLAND ALZHEIMER'S FOUNDATION SUFFOLK COUNTY ROGERS MEMORIAL LIBRARYSOUTHAMPTON HOSPITAL ALSO SPONSORS A MONTHLY PUBLIC ACCESS TELEVISION SHOW ON SEA-TV, FOCUS ON: SOUTHAMPTON HOSPITAL, THAT COVERS INFORMATION RANGING FROM DIALYSIS CARE TO BREAST CARE TO CARDIAC REHABILITATION SERVICES AND OTHER HEALTHCARE SERVICES PROVIDED BY THE 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. 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 COMMITTEE HAS EXPANDED ITS MEMBERSHIP TO INCLUDE MORE TRUSTEE AND PHYSICIAN REPRESENTATION AND HAS BEGUN TO DETERMINE WHAT THE COMMUNITY NEEDS OF THE EAST END HEALTH ALLIANCE'S SERVICE WILL BE OVER THE NEXT THREE YEARS. THE COMMITTEE WILL BE ASSESSING THESE NEEDS THROUGH MEANS OF THE FOLLOWING: *ANALYSIS OF SPARCS DATA *REVIEW OF PREVENTION QUALITY INDICATORS *EVALUATION OF REPORTS FROM COMMUNITY, LOCAL, STATE, AND FEDERAL GOVERNMENT AGENCIES *COMMUNICATION AND COLLABORATION WITH THE SUFFOLK COUNTY DEPARTMENT OF HEALTH *COMMUNICATION AND COLLABORATION WITH SUFFOLK COUNTY OFFICE FOR HE AGING *ASSESSMENT OF INFORMATION SOLICITED FROM PATIENTS THROUGH PATIENT SATISFACTION SURVEYS *REVIEW OF HOSPITAL GENERATED STATISTICAL INFORMATION *REVIEW OF CURRENT INDUSTRY JOURNALS, PERIODICALS AND NEWSLETTERS *ANALYSIS OF TRENDS IDENTIFIED IN HEALTHCARE JOURNALS AND PERIODICALS *ONGOING ADMINISTRATIVE STAFF PLANNING SESSION *MONTHLY BOARD OF TRUSTEE MEETINGS PART I, L7 COL(F): THE ORGANIZATION BASE BAD DEBTS OFF EXPECTED WRITE-OFFS OF ACTUAL ACCOUNTS, NET OF EXPECTED RATE OF RECOVERY. IT'S NOT BASED ON A PERCENTAGE OF REVENUE. PART II: 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. THE HOSPITAL'S SATELLITE CARE CENTERS, INCLUDING THE SHINNECOCK INDIAN HEALTH CLINIC, THE DAVID E. ROGERS, M.D. 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. THE HOSPITAL'S WEB SITE, "WWW.SOUTHAMPTONHOSPITAL.ORG," PROVIDES INFORMATION ABOUT HOSPITAL SERVICES AND PROGRAMS. THE SITE ALLOWS FOR PHYSICIAN SEARCHES, ON-LINE INQUIRIES AND ON-LINE JOB APPLICATIONS. IN MARCH 2010, THE HOSPITAL LAUNCHED A NEW AND IMPROVED WEBSITE. THE NEW SITE BOASTS A CLEANER DESIGN, GREATER EASE OF NAVIGATION, AND IS A PATIENT-FRIENDLY RESOURCE GUIDE. THE SITE IS UPDATED WEEKLY, AND ENCOURAGES THE END USER TO CONTACT THE HOSPITAL FOR ANY ADDITIONAL INFORMATION NEEDED.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 WAS ESTABLISHED TO ENHANCE COMMUNICATION BETWEEN THE HOSPITAL AND THE COMMUNITIES IT SERVES. MEMBERS OF THE COMMITTEE INCLUDE A CROSS-SECTION OF PHYSICIANS, NURSES, HOSPITAL MANAGEMENT, HOSPITAL EMPLOYEES AND COMMUNITY VOLUNTEERS. THE HOSPITAL ALSO ROUTINELY SEEKS FEEDBACK FROM COMMUNITY MEMBERS WHO PARTICIPATE IN OUR COMMUNITY OUTREACH PROGRAMS. HEALTH FAIRS: SOUTHAMPTON HOSPITAL'S BREAST HEALTH CENTER PROVIDES EXTENSIVE OUTREACH TO WOMEN IN THE HOSPITAL'S COMMUNITY, INCLUDING BREAST CANCER SURVIVORS, AS DESCRIBED BELOW. THIS OUTREACH IS BASED ON THE HOSPITAL'S ASSESSMENT OF COMMUNITY NEED FROM ANALYSIS OF CANCER INCIDENCE AND FROM INPUT FROM THE COMMUNITY. THE PROGRAMS OUTREACH COORDINATOR REVIEWS RESULTS FROM SURVEYS, COMPLETED BY EVENT PARTICIPANTS, TO IDENTIFY WHAT TYPES OF INFORMATION AND SERVICES WOULD BE HELPFUL. THE HOSPITAL THEN MODIFIES PROGRAMS AS APPROPRIATE BASED ON THIS INPUT. *HEALTH FAIR, FITNESS PROGRAM AND LONG ISLAND TWO DAY WALK (JUNE) *HEALTH FAIR, LOOK GOOD, FEEL BETTER PROGRAM (APRIL) *GENETIC COUNSELING LECTURE, WELLNESS PROGRAM, SPANISH OUTREACH (MARCH) *HEALTH FAIR, CELEBRATING SURVIVORSHIP, LOOK GOOD FEEL BETTER PROGRAM (FEBRUARY) *HEALTH FAIR, WELLNESS PROGRAM, PINK TUESDAY (JANUARY) ADDITIONAL HEALTH FAIRS WERE HELD AS A PART OF THE HOSPITAL'S INFECTIOUS DISEASE OUTREACH AT THE EAST HAMPTON AND WESTHAMPTON BEACH HIGH SCHOOLS. THE HOSPITAL ALSO SPONSORS A LECTURE SERIES FOR EMS AND OBTAINS FEEDBACK TO RESPOND TO THE NEEDS OF THE LOCAL CORPS. HEALTHCARE INFORMATION: SOUTHAMPTON HOSPITAL PROVIDES FREE HEALTH EDUCATION/ INFORMATION PROGRAMS THROUGH ITS WELL-ATTENDED "HEALTH INSIGHTS" PROGRAM. THIS LECTURE SERIES FOR 2010, DETAILED BELOW, PROVIDES AN IMPORTANT OPPORTUNITY TO PROVIDE THE COMMUNITY WITH RELEVANT INFORMATION AND TO COLLECT INFORMATION PROVIDED BY THE EVALUATION FORMS THAT ARE DISTRIBUTED AFTER EACH LECTURE TO ENSURE THAT THE HOSPITAL IS RESPONDING TO COMMUNITY NEEDS. THE PROGRAM SCHEDULE FOR 2010 IS: *MIDWIVES (MARCH)*TICK ILLNESS (APRIL)*KIDNEYS (APRIL)*STROKE (MAY)*GENETIC COUNSELING (MAY)*SLEEP DISORDERS (MAY)*OSTEOPOROSIS (JUNE)*IMPORTANCE OF LIGHT (OCTOBER)THE LECTURE SERIES IS DEVELOPED IN PARTNERSHIP WITH ORGANIZATIONS SUCH AS FIGHTING CHANGE, ELLEN'S RUN, THE AMERICAN HEART ASSOCIATION, EAST HAMPTON LIONS CLUB, NEW YORK ORGAN DONOR NETWORK, AND SOUTHAMPTON'S ROGERS MEMORIAL LIBRARY. THESE ORGANIZATIONS DEMONSTRATE THAT THEY ARE CONNECTED TO THE COMMUNITY AND THEIR NEEDS. PATIENT SATISFACTION SURVEYS: THE 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. SURVEY RESULTS ARE REGULARLY DISTRIBUTED TO HOSPITAL AND MEDICAL STAFFS AND THE BOARD OF DIRECTORS. THE QUALITY MANAGEMENT AND PUBLIC AFFAIRS DEPARTMENTS, AS WELL AS THE OFFICE OF THE PRESIDENT, CAREFULLY REVIEW CORRESPONDENCE FROM PATIENTS AND THE COMMUNITY AT LARGE. A MEMBER OF THE HOSPITAL STAFF PERSONALLY ANSWERS ALL CORRESPONDENCE. 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 PAYMENTS RECEIVED FROM MEDICARE ($139,924,937) TO CALCULATE THE TOTAL REVENUE RECEIVED FROM MEDICARE. MEDICARE ALLOWABLE COSTS WERE CALCULATED USING MEDICARE GROSS CHARGES (WHICH ARE 300% OF THE MEDICARE FEE SCHEDULE) MULTIPLIED BY A COST TO CHARGE RATIO OF 30%. (TOTAL MEDICARE GROSS CHARGES OF $139,924,937 MULTIPLIED BY 30% TO ARRIVE AT $41,977,481 OF MEDICARE ALLOWABLE COSTS FOR THE CALENDAR YEAR OF 2010.) THEREFORE, THE SHORTFALL OF $4,245,523 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;OR2. THE PATIENT (GUARANTOR) HAS DECLARED BANKRUPTCY (DISCHARGE OF DEBTOR MUST HAVE BEEN RECEIVED); OR3. THE ESTATE OF THE PATIENT (GUARANTOR) HAS BEEN SETTLED AND THERE WERE NO FUNDS FOR PAYMENT LEFT IN THE ESTATE; OR4. 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);ORMAIL 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: ASSESSMENT OF PUBLIC HEALTH PRIORITIES SOUTHAMPTON HOSPITAL WAS AN ACTIVE PARTICIPANT IN THE COLLABORATIVE PLANNING PROCESS WITH THE SUFFOLK COUNTY DEPARTMENT OF HEALTH AND COMMUNITY PARTNERS TO ASSESS COMMUNITY HEALTH NEEDS, TO IDENTIFY HEALTH PRIORITIES, AND TO DEVELOP PUBLIC HEALTH PROGRAMS TO MEET THE IDENTIFIED NEEDS. THIS COLLABORATIVE GROUP MET FROM THE FALL OF 2008 THROUGH AUGUST OF 2009, AND SELECTED TOBACCO USE AND UNINTENTIONAL INJURY AS THE TWO HEALTH PRIORITIES IDENTIFIED IN THE NEW YORK STATE PREVENTION AGENDA TOWARD THE HEALTHIEST STATE. SMOKING CESSATION UPDATEWE OFFER TOBACCO CESSATION PROGRAMS TO THE COMMUNITY AND EMPLOYEES THREE TIMES PER YEAR. THE PROGRAM IS BASED ON THE FORMAT USED BY THE SUFFOLK COUNTY DEPARTMENT OF HEALTH. IT IS A SIX-WEEK PROGRAM THAT INCLUDES CONSULTATION WITH A NURSE PRACTITIONER AND MAKES TOBACCO REPLACEMENT THERAPIES (NICOTINE GUM, LOZENGES, AND PATCHES) AND PRESCRIPTIONS AVAILABLE TO PARTICIPANTS. THE PROGRAMS ARE FREE FOR EMPLOYEES. BY ENCOURAGING OUR EMPLOYEES AND COMMUNITY MEMBERS TO BECOME TOBACCO-FREE AND BY SUPPORTING THEM IN THEIR EFFORTS TO BECOME TOBACCO-FREE, WE FEEL THAT WE ARE CONTRIBUTING TO AN IMPROVEMENT IN COMMUNITY HEALTH BY REDUCING THE RISK ASSOCIATED WITH SMOKING AND EXPOSURE TO SECOND-HAND SMOKE.FALL PREVENTION UPDATESOUTHAMPTON HOSPITAL TREATS A NUMBER OF OUR SENIOR PATIENTS AT HIGH RISK FOR FALLS BOTH WITHIN THE COMMUNITY AND AS INPATIENTS AT THE HOSPITAL. ALL PATIENTS ADMITTED TO SOUTHAMPTON HOSPITAL ARE ASSESSED FOR FALL RISK AND AS NEEDED RECEIVE FALL PREVENTION INFORMATION, PHYSICAL THERAPY AND A DISCHARGE PLAN AIMED AT MEETING THEIR NEEDS. WITHIN THE HOSPITAL SETTING FALL PREVENTION BECAME AN ORGANIZATIONAL OBJECTIVE IN LATE 2006. A MULTIDISCIPLINARY TEAM WAS ESTABLISHED TO DECREASE THE NUMBER OF FALLS AND THE NUMBER OF FALLS WITH INJURY. IN 2008 OUR FALL PREVENTION PROGRAM NOT ONLY SIGNIFICANTLY DECREASED THE NUMBER OF FALLS AND THE NUMBER OF INJURY, IT RECEIVED RESIGNATION AS HONORABLE MENTION FOR THE HANYS PINNACLE AWARD. TODAY OUR PROGRAM CONTINUOUSLY AIMS AT KEEPING OUR PATIENTS SAFE AND IN 2010 WE BEGAN AN IHI MENTOR HOSPITAL FOR FALL PREVENTION.2009 AND PRIOR WORK GROUPSTHESE TWO PRIORITIES WILL BE A MAJOR OPERATIONAL COMMITMENT OF SOUTHAMPTON HOSPITAL OVER THE NEXT THREE YEARS. THE HOSPITAL WILL CONTINUE TO COLLABORATE WITH THE SUFFOLK COUNTY DEPARTMENT OF HEALTH AND COMMUNITY PARTNERS IN ENSURING THAT WE REACH THE GOALS SET FOR THESE TWO PRIORITY AREAS, MEASURE PROGRESS IN ACHIEVING THESE GOALS AND ELIMINATING RACIAL, ETHNIC AND SOCIOECONOMIC HEALTH DISPARITIES WHERE THEY EXIST. ONCE THE PLANNING GROUP ADOPTED THESE PRIORITIES, REPRESENTATIVES FROM THE SUFFOLK COUNTY DEPARTMENT OF HEALTH, SUFFOLK COUNTY HOSPITALS, INCLUDING SOUTHAMPTON HOSPITAL, AND COMMUNITY REPRESENTATIVES DIVIDED INTO TWO WORK GROUPS. EACH WORK GROUP WAS CHARGED WITH DEVELOPING A SET OF RECOMMENDATIONS TO IMPLEMENT EFFECTIVE STRATEGIES TO ADDRESS BOTH HEALTH CARE PRIORITIES. UNINTENTIONAL INJURY WORK GROUP THIS WORK GROUP WAS CHARGED WITH DEVELOPING STRATEGIES TO PREVENT UNINTENTIONAL INJURIES, WITH A FOCUS ON FALL PREVENTION IN THOSE AGED SIXTY-FIVE AND OLDER. THE WORK GROUP ASSIGNED TO DEVELOP A WORK PLAN FOR ADDRESSING UNINTENTIONAL INJURIES HAD THE FOLLOWING MEMBERSHIP: DR. HUMAYUN CHAUDHRY, D.O., COMMISSIONER, SUFFOLK COUNTY DEPARTMENT OF HEALTH JANE CORRARINO, CHAIR, WORKING GROUP, PUBLIC HEALTH NURSE DR. ED NADEL, BIOSTATISTICIAN ADELE H. KLENK, AARP PAMELA ASH, DIRECTOR, DOMINICAN SISTERS FAMILY HEALTH SERVICE MARY JEAN MCKEVENY, COMMUNITY REPRESENTATIVE JULIET FORDELLA, EASTERN LONG ISLAND HOSPITAL (FOR SOUTHAMPTON HOSPITAL) DALE CHAIKIN, NORTH SHORE- LIJ HEALTH SYSTEM JUDY BEIZER, PHARMACIST MIRANDA CORCORAN, ST. CATHERINE'S HOSPITAL BILL HANNIGAN, ST. CHARLES REHABILITATION HOSPITAL LAUREL BREEN, ST. JOSEPH'S COLLEGE DR. CATHERINE NICASTRI, STONY BROOK UNIVERSITY MEDICAL CENTER THE GROUP ADOPTED BY THE FOLLOWING RECOMMENDATIONS FOR ACTION RELATED TO REDUCING UNINTENTIONAL FALLS: I. DESIGN AND DEVELOP HEALTH EDUCATION MATERIALS TO PREVENT FALLS IN THE ELDERLY THAT: A. INCLUDE IDEAS FROM BOTH THE TARGET POPULATION AND FROM EXPERTS AND COMMUNITY MEMBERS B. INCORPORATE STRATEGIES KNOW TO BE EFFECTIVE FOR THOSE WITH LOW LITERACY SKILLS C. DEVELOP COMPANION BOOKLETS, POSTERS AND CALENDARS (WITH PREVENTION STRATEGIES OUTLINED EACH MONTH OF CALENDAR YEAR) D. DEVELOP MATERIALS FOR ALL THE PARTNER AGENCIES WITH SPACE FOR THE LOGO OF A GIVEN ORGANIZATION/AGENCY WHO MAY BE PRINTING THE MATERIALS FOR THEMSELVES TO PROVIDE TO THEIR GIVEN TARGET GROUP OR COMMUNITY E. CONDUCT PRE AND POST-TESTING TO ENSURE THAT EDUCATIONAL INFORMATION IS EFFECTIVE IN INCREASING KNOWLEDGE II. INCORPORATE THESE MATERIALS INTO A COMMUNITY OUTREACH PLAN. THIS PLAN SHOULD BE COMMUNITY FOCUSED, WITH PARTICIPATION FROM ALL HOSPITALS, THE HEALTH DEPARTMENT, AND COMMUNITY AGENCIES AND ORGANIZATIONS III. COORDINATE THE ACTIVITY BETWEEN THE PARTNERS IV. THE OUTREACH PLAN SHOULD INCLUDE A. EDUCATION AT SENIOR CENTERS, MEALS ON WHEELS, ETC. B. EDUCATION OF PROVIDERS (E.G. PHYSICIANS, PHARMACISTS, NURSES, ETC.) C. DISTRIBUTION AND OUTREACH VIA SUPERMARKETS D. PARTICIPATION BY HOME HEALTH AGENCIES, HOSPITAL, ADULT DAY CARE E. ORGANIZATIONAL NEWSLETTERS AND MARKETING PLANS V. DEVELOP A DATA SUBCOMMITTEE THAT WILL ANALYZE PERTINENT SUFFOLK COUNTY DATA REGARDING DEMOGRAPHICS AND HIGH-RISK AREAS, IN ORDER TO TARGET HIGH-RISK AREAS AND SUBPOPULATIONS. SPECIFIC ASSISTANCE AND EXPERTISE FOR MOVING FORWARD WAS OFFERED AS FOLLOWS: DR. NICASRI, FROM STONY BROOK UNIVERSITY MEDICAL CENTER, OFFERED TO OVERSEE MEDICAL RESIDENTS AND FELLOWS WHO WILL BE AVAILABLE TO CONDUCT PROFESSIONAL AND COMMUNITY TEACHING. DR. BELZER OFFERED TO ASSIST WITH SESSION SIMILAR TO "BROWN BAG DAYS" AND "MEDICATION CHATS" THAT SHE CONDUCTS IN OTHER LOCALES. MS. CORRARINO OFFERED TO DESIGN HEALTH EDUCATION MATERIALS. MS. RHODES-TEAGUE OFFERED TO COORDINATE EFFORTS WITH SENIOR CENTERS AND NUTRITION SITES. IN ADDITION, THE GROUP WILL EXPLORE THE ABILITY OF HOME HEALTH AGENCIES TO BILL MEDICARE FOR ALL PREVENTION ACTIVITIES IN THE HOME. THE WORK GROUP WILL CONTINUE TO MEET. THEY WILL MEET IN SEPTEMBER TO REVIEW THE HEALTH EDUCATION MATERIALS THAT HAVE BEEN DEVELOPED AND CONTINUE TO MOVE FORWARD AND SOLIDIFY PLANS. SMOKING CESSATION WORK GROUP THIS GROUP WAS CHARGED WITH DEVELOPING STRATEGIES TO REDUCE THE NUMBER OF SUFFOLK COUNTY RESIDENTS WHO SMOKE. THE GROUP ASSIGNED TO REDUCE TOBACCO USE INCLUDED THE FOLLOWING: GRACE SPARACINO, ST. CHARLES HOSPITAL SABRA BOUGHTON, STONY BROOK UNIVERSITY MEDICAL CENTER JACK HOFFMAN, EASTERN LONG ISLAND HOSPITAL PAT FOLAN, NORTH SHORE-LONG ISLAND JEWISH HEALTH SYSTEM STEPHANIE PERFER, NORTH SHORE-LONG ISLAND JEWISH HEALTH CARE SYSTEM NANCE BODNAR, JOHN T. MATHER HOSPITAL ANN CUCCIA, SOUTHAMPTON HOSPITAL DONNA LOY MURINO, SOUTHSIDE HOSPITAL FELICE JONES LEE, SOUTHSIDE HOSPITAL JULIA MACCHIAROLI, HUNTINGTON HOSPITAL MARTHA KAHAN, EASTERN SUFFOLK BOCES SUSAN KENNEDY, TOBACCO ACTION COALITION OF LONG ISLAND LORI BENINCASA, SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES WENDY D. DARWELL, NASSAU-SUFFOLK HOSPITAL COUNCIL, INC. LORI GINSBERG, NORTH SHORE-LONG ISLAND JEWISH HEALTH SYSTEM CRAIG HOMIS, SOUTHAMPTON HOSPITAL MICHAEL THOM, BROOKHAVEN NATIONAL LABORATORY. THE TOBACCO CESSATION WORKING GROUP DEVELOPED A RECOMMENDED TEMPLATE FOR A TOBACCO CONTROL POLICY TO BE CONSIDERED AND ADOPTED BY THE SUFFOLK COUNTY HOSPITALS. THE TEMPLATE IS AS FOLLOWS: I. POLICY STATEMENT (TO INCLUDE) A. WHY I. COMMITMENT TO HEALTH/STATISTICS - THE COST OF TOBACCO USE IN MORBIDITY, MORTALITY AND FINANCIAL LOSS II. HOSPITALS NEED TO SET EXAMPLE, LEAD THE WAY III. BASELINE DATA. CURRENT POLICIES AND PROCEDURES. RATES OF TOBACCO USE AND/OR CESSATION B. WHO I. POLICY MAY COVER STAFF, PATIENTS, VISITORS, COMMUNITY MEMBERS C. WHERE I. HOSPITAL II. COMPLETE BAN ON GROUNDS OR PARTIAL III. OTHER BUILDINGS AND/OR CLINICS LOCATED OFF SITE IV. EFFECTIVE DATA D. WHAT I. RESTRICTIONS - ALL TOBACCO PRODUCTS? II. PROCEDURES FOR IMPLEMENTATION - BRIEFLY WILL BE COVERED FULLY IN II III. EDUCATIONAL GOALS IV. COMMUNITY OUTREACH II. PROCEDURES A. COMMUNICATION OF POLICY I. EMPLOYEES 1. EXISTING 2. NEW - WILL TOBACCO USE AFFECT HIRING? II. PATIENTS 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. DESPITE OUR COMMITMENT AND DETERMINATION, OUR CHARITY CARE POLICY IS NOT WITHOUT ITS CHALLENGES, AND AT TIMES, WEAKNESSES. HOWEVER, OUR GREATEST WEAKNESS IS NOT TREATED AS A WEAKNESS; IT IS TREATED AS A CHALLENGE. OUR GREATEST CHALLENGE IS TO ENSURE THAT ALL PATIENTS AT SOUTHAMPTON HOSPITAL RECEIVE THE SAME LEVEL OF DETAILED SCRUTINY OF THEIR APPLICATION TO KEEP THE PROCESS FAIR AND BALANCED FOR ALL APPLICANTS. THE CHALLENGE IS GREATEST WHEN PROCESSING APPLICATIONS FROM UNDOCUMENTED ALIENS WHOSE STATED INCOME LEVEL IS $0. PUBLIC INFORMATION SOUTHAMPTON HOSPITAL WILL DISSEMINATE A WRITTEN SUMMARY OF THE COMMUNITY SERVICE PLAN TO THE PUBLIC THROUGH PRODUCTION OF EITHER A BROCHURE OR PAMPHLET. THE PLAN WILL BE POSTED BOTH ON THE HOSPITAL'S WEB SITE AND ON THE EAST END HEALTH ALLIANCE'S WEB SITE. THE SUMMARY WILL INCLUDE FINANCIAL DATA THAT DEMONSTRATES OUR CURRENT AND FUTURE COMMITMENT TO PUBLIC HEALTH PROGRAMS AND FINANCIAL ASSISTANCE AND WILL HIGHLIGHT KEY INFORMATION REGARDING OUR PUBLIC HEALTH PROGRAMS, INCLUDING OUR TWO PREVENTION AGENDA PRIORITIES. PART VI, LINE 4: AS THE MAP BELOW INDICATES, 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 97,000 RESIDENTS. THE AREA IS PROJECTED TO SEE A SIGNIFICANT INCREASE IN POPULATION, MORE THAN 5.8 PERCENT OVER THE NEXT THREE YEARS. DEMOGRAPHIC CHARACTERISTICS SELECTED AREA USA 2000 TOTAL POPULATION 97,063 281,421,906 2010 TOTAL POPULATION 97,426 309,038,974 2015 TOTAL POPULATION 103,145 321,675,005 % CHANGE 2010 - 2015 5.54% 3.93% AVERAGE HOUSEHOLD INCOME $92,648 $71,071 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 AGE GROUP 2010 % OF TOTAL 2015 % OF TOTAL USA 2010 % OF TOTAL 0-14 15,425 15.8% 15,595 15.1% 20.1% 15-17 3,858 4.0% 3,790 3.7% 4.2% 18-24 8,170 8.4% 8,923 8.7% 9.7% 25-34 9,949 10.2% 11,164 10.8% 13.3% 35-54 27,620 28.3% 26,064 25.3% 28.1% 55-64 13,846 14.2% 16,034 15.5% 11.5% 65+ 18,558 19.0% 21,575 20.9% 13.2% TOTAL 97,426 100.0% 103,145 100.0% 100.0% THE HOSPITAL HAS DEVELOPED NUMEROUS SERVICES AND OUTREACH, DETAILED BELOW, 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. 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 A RESULT, 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 2010 POP % OF TOTAL USA % OF TOTAL WHITE NON-HISPANIC 70,409 72.3% 64.7% BLACK NON-HISPANIC 6,435 6.6% 12.1% HISPANIC 16,724 17.2% 15.8% ASIAN & PACIFIC IS. 1,271 1.3% 4.5% ALL OTHERS 2,587 2.7% 2.9% TOTAL 97,426 100.0% 100.0% IN ADDITION, THE HOSPITAL'S SERVICE AREA IS HOME TO THE SHINNECOCK NATION. SINCE APRIL OF 1995, SOUTHAMPTON HOSPITAL HAS WORKED WITH THE NATION TO PROVIDE SERVICES AT THE SHINNECOCK INDIAN HEALTH CLINIC THROUGH A CONTRACT WITH THE NEW YORK STATE DEPARTMENT OF HEALTH. ON AN ANNUAL BASIS, THE CLINIC PROVIDES APPROXIMATELY 2,000 MEDICAL, 800 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 MEDICINE. CURRENTLY, DENTAL SERVICES ARE AVAILABLE EIGHT DAYS PER MONTH FOR ADULTS AND TWO DAYS PER MONTH FOR CHILDREN. THESE SERVICES INCLUDE DENTAL SCREENING, PREVENTIVE TEACHING AND COMMUNITY EDUCATION, RADIOLOGICAL EXAMS, RESTORATIVE CARE INCLUDING CROWNS, FILLINGS AND BRIDGES AND DENTAL HYGIENE. 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 TO THE RESIDENTS OF THE RESERVATION. AN ANNUAL MAMMORAPHY SCREENING DAY WAS ALSO HELD, IN COLLABORATION WITH THE HOSPITAL'S ELLEN HERMANSON BREAST CENTER, AT THE SHINNECOCK NATION DURING SEPTEMBER OF 2010. X 1 1 X X X X 0 0 0 0 0 0 0 0 0 MICHAEL B ISRAEL MD 176658 0 0 0 419 0 22000 0 8055 0 207132 0 0 0 ROBERT S CHALONER 425000 0 140000 0 50461 0 14700 0 25104 0 655265 0 0 0 FREDERIC I WEINBAUM 334088 0 48700 0 37000 0 14700 0 21565 0 456053 0 0 0 CHRISTOPHER J SCHULTHEIS 188863 0 3000 0 0 0 11400 0 19345 0 222608 0 0 0 PATRICIA A DARCEY 189438 0 3000 0 0 0 11400 0 19095 0 222933 0 0 0 PAUL R DAVIN 183609 0 3000 0 3738 0 11143 0 19118 0 220608 0 0 0 EDNA KAPENHAS-VALDES 312053 0 0 0 317 0 14700 0 19308 0 346378 0 0 0 CHARLES ARCOLEO 240000 0 0 0 7829 0 14400 0 19294 0 281523 0 0 0 ANGELA SOTERIOU 191361 0 0 0 2593 0 11520 0 7117 0 212591 0 0 0 ALEX APONTE 189564 0 0 0 172 0 11510 0 19228 0 220474 0 0 0 TOVIA LENT 170687 0 0 0 21689 0 10320 0 18696 0 221392 0 0 0 PART I, LINE 1A THE HOSPITAL PROVIDES THE SPECIAL HOUSING AND/OR AUTOMOBILE ALLOWANCES/PERQUISITES TO THE PRESIDENT & CEO, AS WELL AS TO CERTAIN KEY EXECUTIVES. THESE ALLOWANCES FOR HOUSING AND AUTOMOBILE ARE STIPULATED IN THE EXECUTIVE'S EMPLOYMENT AGREEMENT AND TERMS AT THE TIME OF HIRE. ALL PAYMENTS OF THESE PERQUISITES ARE MADE IN 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. SUPPLEMENTAL INFORMATION PART III PART II, COLUMN (II) BONUS COMPENSATION: THE PRESIDENT / CEO, AND THE EXECUTIVE VICE PRESIDENT / CHIEF MEDICAL OFFICER OF SOUTHAMPTON HOSPITAL WERE BOTH ELIGIBLE FOR A PERFORMANCE BONUS IN 2010 WHICH WAS BASED UPON CRITERIA THAT THE EXECUTIVE COMMITTEE OF THE BOARD ESTABLISHED. THE PRESIDENT / CEOS 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 / CMO 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. DURING 2010, THE HOSPITAL PRESIDENT / CEO AWARDED BONUSES TO MANAGEMENT / DEPARTMENT HEADS WHO WERE ASSIGNED TO AN OPERATIONAL IMPROVEMENT TEAMS AND WHO SATISFACTORILY COMPLETED THEIR PROJECTS. THE FOCUS AND GOALS OF THESE PROJECTS ARE DEFINED BY THE PRESIDENT AND ARE OVERSEEN AND MONITORED BY AN "EXECUTIVE SPONSOR". THE EXECUTIVE VICE PRESIDENT / CHIEF MEDICAL OFFICER MET PERIODICALLY WITH EACH TEAM TO ENSURE THAT THE PROJECT SCOPE AND OBJECTIVES WERE CLEARLY DEFINED. THE PROGRESS OF THE TEAMS IS MONITORED AND AT THE END OF THE PROJECTS, THE TEAMS ACCOMPLISHMENTS ARE REVIEWED AND VALIDATED BY THE EXECUTIVE VICE PRESIDENT/CMO AS WELL AS THE CHIEF FINANCIAL OFFICER. BONUS PAYMENTS OF BETWEEN $1,000 AND $3,000 WERE AWARDED TO INDIVIDUAL TEAM MEMBERS BASED UPON THE TEAM'S OVERALL RESULTS. SUPPLEMENTAL INFORMATION PART III PART II, COLUMN (III) OTHER REPORTABLE COMPENSATION: SPECIAL PERQUISITES - ALLOWANCES: THE HOSPITAL PROVIDES THE FOLLOWING SPECIAL ALLOWANCES / PERQUISITES TO THE PRESIDENT & CEO, AS WELL AS TO CERTAIN KEY EXECUTIVES. THESE ALLOWANCES FOR HOUSING AND AUTOMOBILE ARE STIPULATED IN THE EXECUTIVES EMPLOYMENT AGREEMENT / TERMS AT TIME OF HIRE. ALL PAYMENTS OF THESE PERQUISITES ARE MADE ON A BI-WEEKLY BASIS WITH THE EMPLOYEES REGULAR PAYCHECK AND THEY ARE MADE IN ACCORDANCE WITH THE GUIDELINES OF A NON-ACCOUNTABLE EXPENSE PLAN. ANNUAL ALLOWANCES ARE AS LISTED BELOW: ROBERT CHALONER, PRESIDENT & CEO HOUSING ALLOWANCE: $38,000 AUTOMOBILE ALLOWANCE: $8,400 FREDRIC WEINBAUM,MD COO AND CMO HOUSING ALLOWANCE: $30,000 AUTOMOBILE ALLOWANCE: $7,000 PAUL DAVIN, VP, HUMAN RESOURCES AUTOMOBILE ALLOWANCE: $3,600 SIGNIFICANT ACTIVITES FOR 2010 CONTINUED: FORM 990, PART I, LINE 1: 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 HOSPITAL 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 HOSPITAL'S SERVICE AREA EXTENDS FROM WESTHAMPTON BEACH TO MONTAUK, THE HOSPITAL HAS A NUMBER OF SATELLITE CARE OFFICES TO PROVIDE CONVENIENT, SPECIALIZED CARE TO THE COMMUNITY. THESE INCLUDE: MEETING HOUSE LANE MEDICAL PRACTICE: PROVIDING PRIMARY CARE AT LOCATIONS IN MONTAUK, SAG HARBOR, SOUTHAMPTON, AND WAINSCOTT. WESTHAMPTON PRIMARY CARE CENTER: PROVIDING CARE IN THE WESTHAMPTON, WESTHAMPTON BEACH, QUOGUE, AND REMSENBURG COMMUNITIES. LABORATORY AND IMAGING SERVICES: PROVIDING SERVICES IN EAST HAMPTON, HAMPTON BAYS AND SOUTHAMPTON. CENTER FOR PHYSICAL THERAPY AND REHABILITATION: PROVIDING CARE IN THE WESTHAMPTON, WESTHAMPTON BEACH, QUOGUE, AND REMSENBURG COMMUNITIES. THE SHINNECOCK INDIAN HEALTH CLINIC: SINCE APRIL OF 1995, SOUTHAMPTON HOSPITAL HAS WORKED WITH THE SHINNECOCK NATION TO PROVIDE SERVICES AT THE SHINNECOCK INDIAN HEALTH CLINIC THROUGH A CONTRACT WITH THE NEW YORK STATE DEPARTMENT OF HEALTH. ON AN ANNUAL BASIS, THE CLINIC PROVIDES APPROXIMATELY 1,600 MEDICAL AND 1,500 DENTAL 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 UNIVERSITY SCHOOL OF MEDICINE. CURRENTLY, DENTAL SERVICES ARE AVAILABLE EIGHT DAYS PER MONTH FOR ADULTS AND TWO DAYS FOR CHILDREN. THE DAVID E. ROGERS MD CENTER FOR HIV/AIDS CARE: ANOTHER IMPORTANT COLLABORATION BETWEEN SOUTHAMPTON HOSPITAL, STONY BROOK UNIVERSITY MEDICAL CENTER AND TOWN AND COMMUNITY ORGANIZATIONS OF THE EAST END OF LONG ISLAND. MAJOR FUNDING IS PROVIDED THROUGH RYAN WHITE PART A FEDERAL FUNDS AND TO PROVIDE SUPPORT SERVICES AND PREVENTION EDUCATION TO PARTNERS AND FAMILY MEMBERS AFFECTED BY AIDS. THE CENTER IS A MEMBER OF THE PECONIC COMMUNITY COUNCIL, A NOT-FOR-PROFIT COALITION OF ORGANIZATIONS AND INDIVIDUALS DEDICATED TO THE PROMOTION AND PRESERVATION OF HEALTH AND HUMAN SERVICES FOR THE ENTIRE EAST END COMMUNITY. CENTER FOR PRENATAL CARE: LOCATED IN GREENPORT ON THE EASTERN END OF LONG ISLANDS NORTH FORK, 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 HOSPITALS KATHLEEN D. ALLEN MATERNITY CENTER. SOUTHAMPTON HOSPITAL IS PROUD OF THE EXCEPTIONAL SPECIALTY SERVICES IT PROVIDES TO THE COMMUNITY. THESE INCLUDE: THE ELLEN HERMANSON BREAST CENTER OFFERS A WIDE SPECTRUM OF BREAST HEALTH SERVICES, INCLUDING EDUCATION, EARLY DETECTION SCREENINGS AND BREAST CANCER TREATMENT AND SUPPORT. THE CENTER UTILIZES STATE-OF-THE-ART DIAGNOSTIC TECHNIQUES, INCLUDING COMPUTER-ASSISTED MAMMOGRAPHY, ULTRASOUND AND BREAST BIOPSY. THE ED & PHYLLIS DAVIS WELLNESS INSTITUTE OFFERS THE ONLY HOSPITAL-BASED INTEGRATIVE MEDICINE ON LONG ISLAND'S EAST END. INTEGRATIVE MEDICINE COMBINES MODERN SCIENCE, PSYCHOLOGY, NUTRITION, AND EXERCISE TO ENHANCE THE NATURAL HEALING CAPACITY OF THE BODY. SPECIAL PROGRAMS ARE AVAILABLE FOR PATIENTS SUFFERING FROM CHRONIC ILLNESS AND CLASSES IN YOGA, TAI CHI, PILATES, SMOKING CESSATION, STRESS MANAGEMENT, ARE OFFERED, AS WELL AS NUTRITIONAL AND WEIGHT LOSS COUNSELING, MASSAGE THERAPY, AND MUCH MORE. THE JENNY AND JOHN PAUSON 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. MISSION STATEMENT CONTINUED: FORM 990, PART III, LINE 1: THE VISION OF SOUTHAMPTON HOSPITAL 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. SOUTHAMPTON HOSPITAL 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 SOUTHAMPTON HOSPITAL, THE GOALS OF THE ALLIANCE ARE AS FOLLOWS: 1. TO COLLABORATIVELY DEVELOP HIGH QUALITY, COMPREHENSIVE AND ACCESSIBLE HEALTH CARE SERVICES TO MEET THE NEEDS OF THE COMMUNITY SERVED; 2. TO RATIONALIZE HEALTH CARE SERVICES ACROSS THE SYSTEM; AND 3. TO REALIZE MANAGEMENT EFFICIENCIES. SOUTHAMPTON HOSPITAL IS ALSO AFFILIATED WITH STONY BROOK UNIVERSITY MEDICAL CENTER, ALONG WITH THE OTHER TWO EAST END HEALTH ALLIANCE HOSPITALS. THE THREE ALLIANCE HOSPITALS ARE ACTIVELY WORKING WITH THE UNIVERSITY TO IDENTIFY OPPORTUNITIES FOR DEVELOPING CLINICAL AND EDUCATIONAL RELATIONSHIPS THAT WILL IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE. SOUTHAMPTON HOSPITAL IS A 125-BED, VOLUNTARY, NOT-FOR-PROFIT FACILITY ACCREDITED BY THE JOINT COMMISSION ON ACCREDITATION OF HEALTHCARE ORGANIZATIONS. IT HAS RECEIVED 5-STAR RATINGS FROM HEALTHGRADES(TM), AN INDEPENDENT AUDITOR, IN HIP FRACTURE REPAIR, TREATMENT OF PNEUMONIA, AND GASTROINTESTINAL PROCEDURES AND SURGERIES, AND IS A RECIPIENT OF THE HEALTHGRADES PATIENT SAFETY AWARD IN 2008 AND 2010. IN ADDITION, THE HOSPITAL IS A BARIATRIC SURGERY CENTER OF EXCELLENCE. THE HOSPITAL 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. SOUTHAMPTON HOSPITAL HAS BEEN THE HEALTHCARE HEART OF ITS COMMUNITIES SINCE 1909, PROVIDING CRITICAL HEALTH CARE SERVICES FOR A GEOGRAPHICALLY ISOLATED REGION, WITH A POPULATION THAT MORE THAN DOUBLES DURING THE 3-MONTH SUMMER SEASON WITH PART-TIME RESIDENTS AND VISITORS TO THE SOUTH FORK OF LONG ISLAND. FORM 990, PART VI, SECTION A, LINE 7A SOUTHAMPTON HOSPITAL BECAME A MEMBER OF THE EAST END HEALTH ALLIANCE DURING 2007. THE EAST END HEALTH ALLIANCE (THE "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: TO COLLABORATIVELY DEVELOP HIGH QUALITY, COMPREHENSIVE AND ACCESSIBLE HEALTH CARE SERVICES TO MEET THE NEEDS OF THE COMMUNITY SERVED; TO RATIONALIZE HEALTH CARE SERVICES ACROSS THE SYSTEM; AND TO REALIZE MANAGEMENT EFFICIENCIES. AS A MEMBER OF THE EAST END HEALTH ALLIANCE, THE MEMBERS OF THE GOVERNING BOARD OF THE HOSPITAL ARE SUBJECT TO CONFIRMATION BY THE ALLIANCE. FORM 990, PART VI, SECTION A, LINE 7B THE HOSPITAL BECAME A MEMBER OF THE EAST END HEALTH ALLIANCE DURING 2007. 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: TO COLLABORATIVELY DEVELOP HIGH QUALITY, COMPREHENSIVE AND ACCESSIBLE HEALTH CARE SERVICES TO MEET THE NEEDS OF THE COMMUNITY SERVED; TO RATIONALIZE HEALTH CARE SERVICES ACROSS THE SYSTEM; AND 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 11 SOUTHAMPTON HOSPITAL 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, LINE 15 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 AND THE CMO / COO'S PERFORMANCE AGAINST ESTABLISHED GOALS. IT ALSO OUTLINES THE EXECUTIVE COMMITTEES' ROLE AND RESPONSIBILITY IN DETERMINING ALL ASPECTS OF THE CEO'S AND THE CHIEF MEDICAL OFFICER / COO'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 PRES. & CEO, CHIEF MEDICAL OFFICER AND TOP MANAGEMENT OFFICIALS WAS LAST UNDERTAKEN OCTOBER 21, 2010. 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)723-8301. HOURS DESCRIBED FOR RELATED ORGANIZATIONS: FORM 990, PART VII, SECTION A, AND COLUMN (A): THE FOLLOWING ORGANIZATION, INCLUDING THE FILING ORGANIZATION, SOUTHAMPTON HOSPITAL ASSOCIATION (THE "HOSPITAL") HAVE SIMILAR INDIVIDUALS, WHO ARE MENTIONED BELOW, SERVING ON THEIR BOARDS: THE SOUTHAMPTON HOSPITAL FOUNDATION, INC. MICHAEL ISRAEL, TRUSTEE OF THE HOSPITAL ALSO SERVES ON THE BOARD OF THE FOUNDATION AS TRUSTEE AND SPENDS ON AVERAGE .50 HOUR PER WEEK DEVOTED TO THIS POSITION. JEAN REMMEL FITZSIMMONS, TRUSTEE OF THE HOSPITAL ALSO SERVES AS SECRETARY OF THE BOARD ON THE FOUNDATION AND SPENDS ON AVERAGE .50 HOUR PER WEEK DEVOTED TO THIS POSITION. JOHN E. GRIM III, TRUSTEE OF THE HOSPITAL ALSO SERVES ON THE BOARD OF THE FOUNDATION AS TRUSTEE AND SPENDS ON AVERAGE .50 HOUR PER WEEK DEVOTED TO THIS POSITION. ROBERT S. CHALONER, PRESIDENT AND CEO OF THE HOSPITAL ALSO SERVES ON THE BOARD OF THE FOUNDATION AS TRUSTEE AND SPENDS ON AVERAGE .50 HOUR PER WEEK DEVOTED TO THIS POSITION. HOWARD M. LORBER, TRUSTEE OF THE HOSPITAL ALSO SERVES ON THE BOARD OF THE FOUNDATION AS TRUSTEE AND SPENDS ON AVERAGE .50 HOUR PER WEEK DEVOTED TO THIS POSITION. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 581,461. PRIOR PERIOD ADJUSTMENTS: 1,390,345. CHANGE IN MINIMUM PENSION LIABILITY - $1,266,824 1,266,824. NET ASSETS REL FROM RESTRICTIONS - CAPITAL ACQUIS FOUNDATION - $5,993,546 5,993,546. CHANGE IN EXPECTED INTEREST IN TRUSTS 317,933. CHANGE IN VALUE OF POOLED INCOME FUND 6,019. OTHER ADJUSTMENTS -7,927. TOTAL TO FORM 990, PART XI, LINE 5: 9,548,201. FORM 990, PART XI, LINE 2C: THE ORGANIZATION HAS A COMMITTEE THAT ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. 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