2011-11-11T15:19:27-06:00 2010-12-31 JH COHN LLP 1212 6TH AVENUE NEW YORK NY 10036 990 2010-01-01 131725076 PHELPS MEMORIAL HOSPITAL ASSOCIATION PHEL 9143663000 701 NORTH BROADWAY SLEEPY HOLLOW NY 105911020 KEITH F SAFIAN 9143663000 2011-11-04 1 THOMAS LANNING 2122970400 2010 2016-03-07 17:11:31Z KEITH F SAFIAN 701 NORTH BROADWAY SLEEPY HOLLOW NY 105911020 191649068 0 X PHELPSHOSPITAL.ORG X 1952 NY TAX EXEMPT HOSPITAL PROVIDING A FULL RANGE OF COMPREHENSIVE CARE IN A SAFE MODERN ENVIRONMENT TO IMPROVE THE HEALTH OF OUR SURROUNDING COMMUNITY. 22 19 1782 350 388963 0 2149582 1711337 174195389 181970030 398986 530808 5997524 6015921 182741481 190228096 30000 48000 0 0 109214442 115219052 34677 36754 1212362 67560355 68724970 176839474 184028776 5902007 6199320 153941393 164017197 64039519 67271871 89901874 96745326 X IMPROVE THE HEALTH OF OUR SURROUNDING COMMUNITY, BY PROVIDING COMPREHENSIVE CARE IN A SAFE MODERN ENVIROMENT WHERE ADVANCED MEDICAL TECHNIQUES ARE COUPLED WITH A STRONG TRADITION OF COURTESY AND CARING. 0 0 81865745 73933938 PHELPS MEMORIAL HOSPITAL ASSOCIATION PROVIDES ACUTE AND REHABILITATION INPATIENT HEALTH CARE SERVICES TO MEMBERS OF THE COMMUNITY REGARDLESS OF AN ABILITY TO PAY. THE HOSPITAL HAD 7,886 ACUTE CARE ADMISSIONS AND 162 REHABILITATION ADMISSIONS. PHELPS MEMORIAL HOSPITAL ASSOCIATION PROVIDED $3,584,498 IN CHARITY CARE FOR ACUTE AND REHABILIATION INPATIENT HEALTH CARE SERVICES. 63260362 90171722 PHELPS MEMORIAL HOSPITAL ASSOCIATION PROVIDES OUTPATIENT HEALTH CARE SERVICES TO MEMBERS OT THE COMMUNTIY REGARDLESS OF ABILITY TO PAY. THE HOSPITAL PROVIDED $4,880,720 IN CHARITY CARE FOR OUTPATIENT HEALTH SERVICES. PHELPS MEMORIAL HOSPITAL ASSOCIATION'S LARGER OUPATIENT PROGRAMS INCLUDE THE FOLLOWING SERVICES:EMERGENCY SERVICES 25,070 VISITSRADIOLOGY SERVICES 41,224 PROCEDURESWOUND AND DIABETIC CARE 6,770 VISITSPHYSICAL THERAPY, ACQUA THERAPY AND OCCUPATIONAL THERAPY 66,899 PROCEDURES HYPERBARIC TREATMENTS 9,296 PROCEDURESHOSPICE HOME CARE 12,496 VISITS 22583460 17864370 PHELPS MEMORIAL HOSPITAL ASSOCIATION PROVIDES INPATIENT AND OUTPATIENT BEHAVORIAL HEALTH SERVICES TO MEMBERS OF THE COMMUNITY REGARDLESS OF ABILITY TO PAY. THE HOSPITAL PROVIDED $1,126,862 IN CHARITY CARE FOR BEHAVORIAL HEALTH SERVICES. PHELPS MEMORIAL HOSPITAL ASSOCIATION HAD 1,342 BEHAVORIAL HEALTH ADMISSIONS AND 50,332 OUTPATIENT BEHAVORIAL HEALTH VISITS. 167709567 1 1 0 1 0 0 0 0 1 1 1 0 0 1 1 0 1 0 0 0 0 0 1 1 0 1 0 0 1 1 1 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 1 0 0 0 1 108 0 1 1782 1 1 1 0 0 0 0 1 1 0 0 0 0 X 22 19 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X PHELPS MEMORIAL HOSPITAL ASSOCIATION 9143663000 701 NORTH BROADWAY SLEEPY HOLLOW NY 10591 ANDREW C MERRYMAN 1.00 X X 0 0 0 BARD BUNAES 1.00 X X 0 0 0 BRUCE HECKMAN MD 1.00 X X 67008 0 0 DAVID COULAM 1.00 X X 0 0 0 ELIO IPPOLITO MD 1.00 X 0 0 0 FRANKLIN H ZIMMERMAN 1.00 X 0 0 0 GAY BERGER 1.00 X 0 0 0 GLENN D KAUFMAN 1.00 X 0 0 0 HSIN CHENG CHAO MD 1.00 X 0 0 0 JAMES GOLDSMITH 1.00 X 0 0 0 JOHN CURRAN PHD 1.00 X 0 0 0 JOSE A CHEVERE 1.00 X 0 0 0 KATHERINE MACKIE 1.00 X X 0 0 0 KEITH F SAFIAN 37.50 X X 889322 0 251724 LINDA MARTIN 1.00 X 0 0 0 LOUIS J POULIN 1.00 X 0 0 0 RICHARD SINNI 1.00 X 0 0 0 ROBERT A GOLDSCHMIDT 1.00 X 0 0 0 SALEEM MIR MD 1.00 X 38800 0 0 SEAN F X DUGAN 1.00 X X 0 0 0 WILLIAM O MELVIN JR 1.00 X X 0 0 0 BARBARA ALLAR 37.50 X 352519 0 57011 BRUCE DAVIDOW 37.50 X 576620 0 78193 DANIEL BLUM 37.50 X 310685 0 53030 JOANNE STURANS 37.50 X 206645 0 44121 KERRY PISANO 37.50 X 336081 0 33577 LAWRENCE FALTZ 37.50 X 656574 0 72952 LEONARD FOGEL 37.50 X 471967 0 65216 LUCY ENGELHARDT 37.50 X 453494 0 61825 VINCENT DESANTIS 37.50 X 607987 0 78129 EMIL NIGRO 37.50 X 661126 0 37695 GASPAR PARRINO 37.50 X 474166 0 41178 MICHAEL KYI 37.50 X 472291 0 33516 STEPHEN HEIER 37.50 X 952470 0 47846 VARGHESE MATTHEW 37.50 X 427334 0 39115 7955089 0 995128 145 0 1 0 ENT AND ALLERGY ASSOCIATES 560 WHITE PLAINS ROAD TARRYTOWN NY 10591 SLEEP DIAGNOSTICS 638560 CHILDREN & WOMAN'S PHYSICIANS OF WESTCHE NY MEDICAL COLLEGE VALHALLA NY 10595 PHYSICIANS 439603 GARFUNKEL WILD & TRAVIS PC 111 GREAT NECK ROAD GREAT NECK NY 11021 ATTORNEYS 393172 HEALTH CAROUSEL LLC 4500 COOPER RD SUITE101 CINCINNATI OH 45242 NURSE RECRUITMENT 289350 TRITECH HEALTHCARE MANAGEMENT LLC 125 NEWTOWN RD SUITE 200 PLAINVIEW NY 11803 RECEIVABLE COLLECTION 248966 7 391265 6500 128964 1184608 57076 1711337 PATIENT SERVICE REVENU 623000 181581067 181581067 LAB OUTREACH INCOME 621500 388963 388963 181970030 530808 530808 1928221 1184921 743300 743300 743300 139096 391265 236051 -96955 -96955 COMMUNITY PHARMACY 446110 2591016 2591016 CAFETERIA INCOME 722210 563283 563283 OMH & OASIS 623000 385460 385460 1829817 1431157 398660 5369576 190228096 185988700 388963 2139096 48000 48000 5763481 2676976 2676975 409530 86870495 79453542 6931814 485139 3876175 3444580 409567 22028 12753023 11331032 1347280 74711 5955878 5283169 628180 44529 471474 447900 23574 195886 195886 82718 82718 36754 36754 11519458 10798582 720876 2683954 2286253 258030 139671 2490525 2368369 122156 4220589 3540313 680276 208878 154302 54576 7025 3512 3513 1268596 1141736 126860 10272487 10272487 5519684 5519684 PHARMACEUTICALS 8666676 8666676 MEDICAL SUPPLIES 7181974 7181974 PROSTHESIS 6266877 6266877 EQUIP RENTAL & MAINT 3604079 2738030 866049 BAD DEBT 1672923 1672923 2391167 2134046 257121 184028776 167709567 15106847 1212362 8976361 419817 4700848 23166505 919015 588530 21621365 22226010 36318 17926 1709117 1844824 915094 1181602 230755842 128714090 104212883 102041752 10200391 11770537 650001 759694 153941393 164017197 14238204 15559723 25290000 24510000 5121275 3949422 19390040 23252726 64039519 67271871 X 85170204 91897249 2823974 2945247 1907696 1902830 89901874 96745326 153941393 164017197 X 6199320 644132 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 82718 82718 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: PHELPS MEMORIAL HOSPITAL ASSOCIATION COMPENSATED ITS LOBBYIST FOR BUDGET, REGULATORY AND LEGISLATIVE ISSUES PERTAINING TO HEALTHCARE AND HOSPITALS. NY STATE EXECUTIVE AND LEGISLATIVE BRANCHES WERE LOBBIED. 2969273 7746 386175 2301 3360893 2479718 76638 427708 14791 2969273 3480267 10000 -566216 444333 2479718 0.37520 0.62480 0 0 579734 579734 134646660 59583304 75063356 132536 26761 105775 81688804 65008970 16679834 13708108 4095055 9613053 102041752 OTHER ALTERNATIVE INVESTMENTS 700322 F OTHER INVT IN MEDICAL OFFICE BUILDING 1610882 C OTHER INVESTMENTS 9459333 F 11770537 THIRD PARTY LIABILITY 7059628 ACCRUED PAYROLL AND RELATED EXPENSES 10555236 OTHER LIABILITIES 1900000 DEFERRED COMPENSATION PLANS 2987862 MALPRACTICE CONTINGENCY 750000 23252726 190228096 184028776 6199320 607976 36156 644132 6843452 191892423 607979 -13000 594979 191297444 -1069348 -1069348 190228096 185029026 1184921 1184921 183844105 184671 184671 184028776 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: ALL INTEREST EARNED ON THE ENDOWMENT SUPPORT THE GENERAL OPERATION OF THE HOSPITAL. BOARD DESIGNATED FUNDS SUPPORT THE HOSPICE PROGRAM. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: PMHA, IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE CODE AND IS EXEMPT FROM FEDERAL, STATE, AND LOCAL INCOME TAXES PURSUANT TO SECTION 501(A) OF THE CODE. NO PROVISION FOR INCOME TAXES HAS BEEN MADE IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS FOR THE PARTNERSHIP SINCE SUCH LIABILITY IS THE RESPONSIBILITY OF THE INDIVIDUAL PARTNERS. THERE ARE CERTAIN TRANSACTIONS THAT COULD BE DEEMED "UNRELATED BUSINESS INCOME" AND WOULD RESULT IN A TAX LIABILITY. MANAGEMENT REVIEWS TRANSACTIONS TO ESTIMATE POTENTIAL TAX LIABILITIES USING A THRESHOLD OF MORE LIKELY THAN NOT. IT IS MANAGEMENT'S ESTIMATION THAT THERE ARE NO MATERIAL TAX LIABILITIES, WHICH NEED TO BE RECORDED. PART XI, LINE 8 - OTHER ADJUSTMENTS: CHANGE IN VALUATION OF PLEDGES 17,000. ELIMINATIONS 15,000. ROUNDING 4,156. PART XII, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN VALUATION OF PLEDGES 17,000. INVESTMENT INCOME ELIMINATIONS -30,000. PART XII, LINE 4B - OTHER ADJUSTMENTS: RENTAL EXPENSES -1,184,921. AUXILIARY REVENUE 115,573. PART XIII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSE 1,184,921. PART XIII, LINE 4B - OTHER ADJUSTMENTS: AUXILIARY EXPENSES 136,671. NURSING SCHOLARSHIPS 48,000. X X X X 1 ARLENE JOHNSON 7 HEATON LANE WAPPINGERS FALL NY 12570 GOLF CLASSIC 0 131121 7829 123292 KETCHUM INC 5151 BELR LINE ROAD DALLAS TX 75254 STRATEGY 0 0 28925 -28925 131121 36754 94367 NY CHAMPAGNE BALL 389190 304954 84236 67914 20500 55417 GOLF CLASSIC 131121 83261 47860 9812 55043 8427 1 10050 3050 7000 9150 4886 4902 530361 391265 139096 9812 132107 25386 68746 236051 -96955 1 1 1 X 1 X 500.000000000000 1 1 0 1 1 5247837 5247837 0.02850 32109374 22585791 9523583 0.05180 37357211 22585791 14771420 0.08030 1364959 1364959 0.00740 801043 211666 589377 0.00320 2166002 211666 1954336 0.01060 39523213 22797457 16725756 0.09090 1 600272 300136 64381687 80405794 -16024107 X 1 1 1 PHELPS PROFESSIONAL CONSTRUCT, DEVELOP, OWN, 0.62140 0.37860 2 BUILDING CO LP OPERATE AND MAINTAIN A 3 MEDICAL OFFICE BUILDING 4 ON THE CAMPUS OF PHELPS 5 MEMORIAL HOSPITAL ASSOCIATION. 1 1 PHELPS MEMORIAL HOSPITAL ASSOCIATION

701 NORTH BROADWAY SLEEPY HOLLOW NY 10591

X X X PHELPS MEMORIAL HOSPITAL ASSOCIATION 1 7 PHELPS - ATS

22 ROCKLEDGE AVE OSSINING NY 10562

INTENSIVE OUTPATIENT AND SUBSTANCE ABUSE CLINIC PHELPS- CDT

315 SOUTH HIGHLAND AVE BRIARCLIFF MANOR NY 10510

SEVERLY AND PERSISTENT MENTALLY ILL OUTPATIENT CLINIC (SPMI) PHELPS - SCMICM

315 SOUTH HIGHLAND AVE BRIARCLIFF MANOR NY 10510

OUTPATIENT CLINIC FOR THE SPMI POPULATION LIVING IN THE COMMUNITY PHELPS COUNSELING

755 NORTH BROADWAY SLEEPY HOLLOW NY 10591

MENTAL HEALTH OUTPATIENT CLINIC OSSINING COUNSELING

22 ROCKLEDGE AVE OSSINING NY 10562

MENTAL HEALTH OUTPATIENT CLINIC PHELPS - THRESHOLD

155 WHITEPLAINS ROAD - SUITE 210 TARRYTOWN NY 10591

SUBSTANCE ABUSE OUTPATIENT CLINIC ECHO HILLS

457 BROADWAY HASTINGSONHUDSON NY 10706

MENTAL HEALTH OUTPATIENT CLINIC PART I, LINE 7G: THE HOSPTIAL PROVIDES PRE-NATAL CARE TO UNINSURED PATIENTS AND UNDOCUMENTED IMMIGRANTS. THIS SERVICE HAS BEEN IDENTIFIED AS A COMMUNITY NEED SERVICE. PART I, L7 COL(F): PHELPS MEMORIAL HOSPITAL HAS INCLUDED BAD DEBT EXPENSE IN THE AMOUNT OF $1,672,923 ON THE FORM 990, PART IX, LINE 25. THIS AMOUNT IS EXCLUDED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN SCHEDULE H, PART I, LINE 7 COLUMN F AS PER THE INSTRUCTIONS. PART III, LINE 4: PATIENTS' ACCOUNTS RECEIVABLEPATIENTS' ACCOUNTS RECEIVABLE ARE RECORDED AT THE CONTRACTED AMOUNT AND DO NOT BEAR INTEREST. THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IS PMHC'S BEST ESTIMATE OF THE AMOUNT OF PROBABLE CREDIT LOSSES IN PMHC'S EXISTING ACCOUNTS RECEIVABLE. PMHC DETERMINES THE ALLOWANCE BASED ON HISTORICAL WRITE-OFF EXPERIENCE. PMHC REVIEWS ITS ALLOWANCE FOR DOUBTFUL ACCOUNTS PERIODICALLY. PAST-DUE BALANCES ARE REVIEWED INDIVIDUALLY FOR COLLECTIBILITY. ACCOUNT BALANCES ARE CHARGED OFF AGAINST THE ALLOWANCE AFTER ALL MEANS OF COLLECTION HAVE BEEN EXHAUSTED AND THE POTENTIAL FOR RECOVERY IS CONSIDERED REMOTE. AMOUNTS REPORTED ON LINES 2 AND 3 WERE BASED UPON THE HOSPITAL'S COST TO CHARGE RATIO AS CALCULATED IN ACCORDANCE WITH WORKSHEET 2, RATIO OF PATIENT CARE COST TO CHARGES, INCLUDED IN THE SCHEDULE H INSTRUCTIONS. PART III, LINE 8: THE HOSPITAL IS GOVERNED BY A BOARD OF DIRECTORS COMPRISED OF INDEPENDENT PERSONS REPRESENTING THE COMMUNITY THE HOSPITAL SERVES. THE HOSPITAL OPERATES AN EMERGENCY DEPARTMENT THAT IS OPEN 24/7 TO ALL PEOPLE REGARDLESS OF ONE'S ABILITY TO PAY. THE MEDICAL STAFF IS OPEN TO ALL QUALIFIED PHYSICIANS. FINALLY, THE HOSPITAL PARTICIPANTS IN THE MEDICARE, MEDICAID AND ALL OTHER APPLICABLE GOVERNMENT-SPONSORED HEALTH PROGRAMS.TO PROVIDE READILY ACCESSIBLE, STATE-OF-THE-ART AND HIGHEST QUALITY CARE POSSIBLE TO ALL PATIENTS, THE BOARD OF DIRECTORS HAS EMBRACED THE NEED TO SUBSIDIZE THE COST OF CARE PROVIDED TO INDIVIDUALS COVERED BY GOVERNMENT-SPONSORED HEALTH PROGRAMS, SINCE IN MANY CASES THE REIMBURSEMENT DOES NOT COVER THE COST OF SERVICES. THEREFORE, SIMILAR TO THE UNREIMBURSED COST OF CARE PROVIDED TO MEDICAID COVERED PATIENTS, THE SHORTFALL ATTRIBUTABLE TO MEDICARE COVERED PATIENTS IS A MEASURE OF THE BENEFIT THE HOSPITAL PROVIDES TO ITS COMMUNITY. PART III, LINE 9B: THE HOSPITAL HAS ESTABLISHED A FINANCIAL COUNSELING GROUP THAT ASSISTS PATIENTS IN COMPLETING FORMS AND PROVIDING FINANCIAL DATA IN SUPPORT OF CHARITY CARE REQUESTS. THE GROUP FOLLOWS THE POLICIES AND PROCEDURES ESTABLISHED BY THE HOSPITAL IN PROVIDING THIS COMMUNITY BENEFIT. PART VI, LINE 2: NEEDS ASSESSMENT:PHELPS MEMORIAL HOSPITAL CENTER (PHMC) IS A 238-BED ACUTE CARE COMMUNITY HOSPITAL, LOCATED IN CENTRAL WESTCHESTER COUNTY. SINCE ITS BEGINNING IN 1956, PHELPS MEMORIAL HAS STRIVED TO PROVIDE ITS COMMUNITY WITH THE FINEST QUALITY HEALTHCARE. THE EXTENT OF SERVICES MADE AVAILABLE TO THOSE WE SERVE RANGES FROM EMERGENCY SERVICES TO ACUTE CARE INPATIENT SERVICES, AS WELL AS A HOST OF OUTPATIENT SERVICES DESIGNED TO ADDRESS THE NEEDS OF THOSE WHO MAKE UP THE PHELPS SERVICE AREA.OUR STRUCTURE:PHELPS MEMORIAL HOSPITAL CENTER IS ONE OF THE FOUR MEMBERS OF THE STELLARIS HEALTH NETWORK. PHELPS WORKS COLLABORATIVELY WITH OPEN DOOR FAMILY HEALTH CENTERS TO PROVIDE PRENATAL CARE AND HAS AN AGREEMENT WITH WESTCHESTER MEDICAL CENTER TO PROVIDE CARE FOR HIGH-RISK MOTHERS AND NEONATES. CANCER CARE IS PROVIDED BY MEMORIAL SLOAN-KETTERING CANCER CENTER ON PHELPS' CAMPUS. THROUGH OUR CLINIC AFFILIATION WITH THE MOUNT SINAI MEDICAL CENTER, EXPERT SENIOR HEALTH SERVICES ARE ACCESSIBLE IN THE LOCAL COMMUNITY. THE HOSPITAL MAINTAINS AN EXTENSIVE NETWORK OF OUTPATIENT MENTAL HEALTH SERVICES, OUTPATIENT MEDICAL DIAGNOSTIC AND TREATMENT FACILITIES, AS WELL AS A HOME-BASED HOSPICE PROGRAM. OVERSIGHT IS PROVIDED BY A 22-MEMBER BOARD OF DIRECTORS, ALL OF WHOM VOLUNTEER THEIR TIME AND EXPERTISE.OUR MISSION:THE MISSION OF PHELPS IS TO:- IMPROVE THE HEALTH OF THE COMMUNITY- OFFER PREVENTATIVE, DIAGNOSTIC, AND TREATMENT SERVICES- EDUCATE THE COMMUNITY TO ACHIEVE OPTIMAL QUALITY OF LIFE- PROVIDE COMPREHENSIVE CARE IN A SAFE, MODERN ENVIRONMENTOUR ASSESSMENT:PHELPS MEMORIAL HOSPITAL CENTER ASSESSES COMMUNITY HEALTH NEEDS BY ANALYZING DATA COLLECTED BY THE WESTCHESTER COUNTY DEPARTMENT OF HEALTH, THE WESTCHESTER COUNTY DEPARTMENT OF COMMUNITY MENTAL HEALTH, AND THE NEW YORK OFFICE OF ALCOHOLISM AND SUSBTANCE ABUSE SERVICES.RECOGNIZING THAT PEOPLE WHO LIVE AND WORK IN OUR COMMUNITY PROVIDE VALUABLE INFORMATION, PHELPS SOLICITS FEEDBACK FROM PRE-HOSPITAL AND POST-HOSPITAL CARE PROVIDERS, INCLUDING PHYSICIANS, AMBULANCE CORPS, CLINICS, NURSING HOMES AND HOME HEALTH AGENCIES. THROUGH ONGOING DIALOGUE WITH SCHOOLS AND CHURCHES, COMMUNITY COALITIONS AND KEY COMMUNITY LEADERS, WE HAVE BEEN ABLE TO RECOGNIZE GAPS IN COMMUNITY HEALTH EDUCATION. MOST IMPORTANTLY, THE RESPONSE OF INDIVIDUALS TO SURVEYS AND FOCUS GROUPS HAS BROUGHT TO LIGHT THE NEED FOR NEW SERVICES OR IMPROVED ACCESS.BASED ON OUR ASSESSMENT, WE DEFINED THE FOLLOWING PRIORITIES: CRISIS RESPONSE, BEHAVIORAL HEALTH, WELLNESS PROMOTION AND FAMILY HEALTH. OUR GOALS ARE IN CONCERT WITH THE VISION OF THE NEW YORK STATE HEALTHIEST STATE INITIATIVE; NAMELY,- TO INCREASE QUALITY AND YEARS OF HEALTHY LIFE- TO ELIMINATE HEALTH DISPARITIES, INCREASING ACCESS TO PREVENTION AND EARLY DETECTION PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: THE HOSPITAL IS A LEADER IN THE DEVELOPMENT OF FINANCIAL ASSISTANCE PROGRAMS FOR THE UNINSURED. THE PROGRAM PROVIDES FOR REDUCED FEES FOR THE UNINSURED RESIDENTS OF ITS SERVICE AREA. THE CURRENT FEE SCHEDULE INCLUDES PATIENTS WITH HOUSEHOLD INCOMES UPTO 500% OF THE FPL. WHILE THE FEE SCHEDULE SERVES AS A GUIDE, ALL HARDSHIP CASES ARE EVALUATED ON A CASE-BY-CASE BASIS, TAKING INTO ACCOUNT THE INDIVIDUAL'S FINANCIAL AND PERSONAL CIRCUMSTANCES.ALL MEDICALLY NECESSARY SERVICES ARE COVERED UNDER THE FINANCIAL ASSISTANCE PROGRAM AND THE PUBLIC IS NOTIFIED OF THE AVAILABILITY OF THE PROGRAM THROUGH:"MULTILINGUAL EDUCATIONAL BROCHURES AT KEY POINTS OF PATIENT CONTACT SPECIFICALLY IN THE ADMITTING OFFICE AND EMERGENCY DEPARTMENT"CENTRALIZED PROGRAM ADMINISTRATION ACCESSIBLE VIA PHONE (914-366-3133)"STAFF OUTREACH"PATIENT BILLS - ALL BILLS INCLUDE A NOTICE ABOUT THE FNANCIAL ASSISTANCE PROGRAM.THE HOSPITAL INFORMS AND EDUCATES PATIENTS ON A VARIETY OF FINANCIAL ASSISTANCE PROGRAMS. IT HAS A FULLY STAFFED FINANCIAL ASSISTANCE SERVICES DEPARTMENT STAFFED WITH BI-LINGUAL FINANCIAL COUNSELORS (DEPUTIZED MEDICAID WORKERS) THAT HELP EDUCATE AND PROVIDE ASSISTANCE IN APPLYING FOR MEDICAID, CHILD HEALTH PLUS, FAMILY HEALTH PLUS, CHARITY CARE AND DISCOUNTED CARE. PART VI, LINE 4: COMMUNITY INFORMATION:THE PHELPS SERVICE AREA BY ZIP CODE INCLUDES THE FOLLOWING:10562 OSSINING 10548 MONTROSE 10591 TARRYTOWN10522 DOBBS FERRY 10510 BRIARCLIFF MANOR 10520 CROTON ON HUDSON10511 BUCHANAN 10566 PEEKSKILL 10706 HASTINGS ON HUDSON10596 VERPLANCK 10570 PLEASANTVILLE 10546 MILLWOOD10596 IRVINGTON 10545 MARYKNOLL 10503 ARDSLEY ON HUDSON10517 CROMPOND 10523 ELMSFORD 10521 CRUGERSFOR COMMUNITY HEALTH PLANNING, PHELPS HAS DEFINED A PRIMARY SERVICE AREA BASED UPON ZIP CODES OF RESIDENCE OF THE HIGHEST VOLUME OF MEDICAL-SURGICAL,PSYCHIATRIC AND OBSTETRICAL/GYNECOLOGICAL HOSPITAL DISCHARGES. THIS PRIMARY SERVICE AREA INCLUDES:10562 OSSINING 22.5% OF DISCHARGES POPULATION 29,52410591 TARRYTOWN 16.8% OF DISCHARGES POPULATION 20,30210520 CROTON 10.9% OF DISCHARGES POPULATION 7,60610510 BRIARCLIFF 7.5% OF DISCHARGES POPULATION 7,696WE HAVE ALSO INCLUDED 10545 MARYKNOLL, BECAUSE 82% OF THE RESIDENTS UTILIZE PHELPS FOR BOTH INPATIENT AND OUTPATIENT HEALTHCARE SERVICES. UNIQUE TO PHELPS, IS THE COLLABORATION WITH OPEN DOOR FAMILY MEDICAL CENTER FOR PERINATAL CARE. IN ADDITION TO SERVING THE OSSINING AND TARRYTOWN/SLEEPY HOLLOW COMMUNITY, WE HAVE INCORPORATED THE PORTCHESTER COMMUNITY FORMERLY SERVED BY UNITED HOSPITAL. WE ALSO SUPPORT PLANNED PARENTHOOD, WHICH BRINGS RESIDENTS OF GREENBERG. BEHAVIORAL REHABILITATION PATIENT ORIGIN IS WIDELY DISPERSED ACROSS THE TRI-STATE AREA, WITH NO ZIP CODE CONTRIBUTING MORE THAN 3% OF THE ANNUAL 700 DISCHARGES.COMMUNITY HEALTH PLANNINGANALYSIS OF DEMOGRAPHICS1. WESTCHESTER FACTS:- 1.8% INCREASE IN POPULATION- 14% > 65 YEARS OLD- 52.2% FEMALE- 71.3% WHITE- 14.2% BLACK- 4.5% ASIAN- 15.6% LATINO- 41% PERSONS > 25 YEARS OLD HAVE B.S. DEGREE OR HIGHER2. CHANGES:- LARGEST % CHANGE IN GROWTH OF THOSE > 60 YEARS OLD IS AMONG ASIANS- 75-85 YEARS OLD AND 85+ COHORTS INCREASED FROM 1990 TO 20003. OUR SERVICE AREA FACTS:- 75% BELONG TO A RELIGIOUS ORGANIZATION- 20-34 YEARDS OLD MOVE OUT OF COUNTY; THOSE HERE, GOT OLDER- ELDERLY ARE MOSTLY WHITE FEMALES; 36-40% OF FEMALES ARE LIVING ALONE- 55-59 YEARDS OLD ARE OUR LARGEST COHORT4. 1990 TO 2000 % CHANGE OF THOSE > 85+ (NOTE: ELDERLY STAY; YOUNG MOVING OUT):- BRIARCLIFF 63%- CROTON 25%- DOBBS FERRY 31%- IRVINGTON 46%- OSSINING 5%- PLEASANTVILLE 74%- SLEEPY HOLLOW 44%- TARRYTOWN 14% REPORTS FILED WITH STATES PART VI, LINE 7 NY 1 NURSING TUITION ASSISTANCE 6 48000 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: THE NURSING PROMISE PROGRAM AWARDS FINANCIAL ASSISTANCE IN THE FORM OF A FORGIVABLE LOAN TO COVER LIVING EXPENSES FOR ELIGIBLE EMPLOYEES WHO ARE ACCEPTED AND ENROLLED IN AN ACCREDITED REGISTERED NURSING SCHOOL. CONTINUED ELIGIBILITY IN THE PROGRAM IS SUBJECT TO THE NURSING PROMISE STUDENT SUCCESSFULLY COMPLETING EACH SEMESTER'S NURSING COURSE WORK AND MAINTAINING SATISFACTORY WORK PERFORMANCE AT PHELPS MEMORIAL HOSPITAL. NURSING PROMISE STUDENTS WHO START WORK AT PHELPS MEMORIAL HOSPITAL AS A GRADUATE NURSE OR R.N. WITH IN TWO MONTHS OF GRADUATION ARE ELIGIBLE TO EARN LOAN FORGIVENESS. THE NURSING PROMISE COORDINATOR AND NURSE EDUCATOR SERVE AS MENTORS TO THE NURSING PROMISE STUDENTS AND ARE RESPONSIBLE TO MONITOR EACH STUDENT'S COMPLIANCE WITH THE PROGRAM. MENTORS MEET WITH THE STUDENTS ON A REGULAR BASIS AND DISCUSS THE STUDENTS WORK PERFORMANCE WITH THE STUDENT'S SUPERVISOR. X X X X X 0 1 0 0 0 0 0 0 0 KEITH F SAFIAN 512375 0 324754 0 52193 0 224996 0 26728 0 1141046 0 0 0 BARBARA ALLAR 252280 0 77102 0 23137 0 33350 0 23661 0 409530 0 0 0 BRUCE DAVIDOW 405763 0 140144 0 30713 0 39512 0 38681 0 654813 0 0 0 DANIEL BLUM 268097 0 22917 0 19671 0 29820 0 23210 0 363715 0 0 0 JOANNE STURANS 166745 0 34552 0 5348 0 19114 0 25007 0 250766 0 0 0 KERRY PISANO 244478 0 69648 0 21955 0 32077 0 1500 0 369658 0 0 0 LAWRENCE FALTZ 483488 0 135854 0 37232 0 45767 0 27185 0 729526 0 0 0 LEONARD FOGEL 341196 0 100718 0 30053 0 38425 0 26791 0 537183 0 0 0 LUCY ENGELHARDT 333084 0 91875 0 28535 0 37606 0 24219 0 515319 0 0 0 VINCENT DESANTIS 443940 0 130018 0 34029 0 44330 0 33799 0 686116 0 0 0 EMIL NIGRO 477605 0 149742 0 33779 0 17464 0 20231 0 698821 0 0 0 GASPAR PARRINO 442998 0 17200 0 13968 0 17464 0 23714 0 515344 0 0 0 MICHAEL KYI 395464 0 66597 0 10230 0 17464 0 16052 0 505807 0 0 0 STEPHEN HEIER 765639 0 153000 0 33831 0 16266 0 31580 0 1000316 0 0 0 VARGHESE MATTHEW 358435 0 60296 0 8603 0 17464 0 21651 0 466449 0 0 0 PART I, LINE 4B PART I, LINE 4B: PHELPS MEMORIAL HOSPITAL MAKES CONTRIBUTIONS TO A 457(F)SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN ON BEHALF OF ITS EXECUTIVES. THESE CONTRIBUTIONS ARE NON TAXABLE AND REPORTED IN "RETIREMENT AND OTHER DEFERRED COMPENSATION". TOWN OF MOUNT PLEASANT INDUSTRIAL DEV AGENCY 136019835 2005-06-30 27440000 CONST & REN OF HOSP FACILITIES 0 0 0 27440000 478960 26961040 2007 0 0 1 1 0 0 0 0 1 0 0 0 0 0 1 MICHAEL MCCORMICKMD WORKING CAPITAL X 25000 17926 0 1 1 17926 X 7 46461 FMV X HOST PARTY 1 5161 COST X COMPUTERS 1 5454 COST 0 0 0 METHOD FOR DETERMINING NUMBER OF CONTRIBUTORS: PART I, COLUMN (B): CALCULATED BY HOW MANY PEOPLE MADE A NONCASH CONTRIBUTION. FORM 990, PART VI, SECTION A, LINE 6 PHELPS MEMORIAL HOSPITAL ASSOCIATION (PMHA) APPROVED AND EXECUTED AN AFFILIATION AGREEMENT WITH HEALTHSTAR NETWORK, INC D/B/A STELLARIS HEALTH NETWORK, INC (STELLARIS), A NEW YORK STATE NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE, EXEMPT FROM FEDERAL, STATE, AND LOCAL INCOME TAXES. THE AFFILIATION AGREEMENT RESULTED IN ESTABLISHING STELLARIS AS THE SOLE MEMBER OF PMHA. ALL APPOINTMENTS TO THE BOARD OF DIRECTORS ON PMHA ARE SUBJECT TO APPROVAL BY STELLARIS. STELLARIS IS QUALIFIED TO ORIGINATE AND TAKE PART IN THE DISCUSSION OF ANY SUBJECT THAT MAY PROPERLY COME BEFORE IT AND SHALL HAVE SUCH OTHER AND ADDITIONAL RIGHTS AND PRIVILEGES AND BE SUBJECT TO SUCH OTHER DUTIES AND RESTRICTIONS AS ARE SET FORTH IN THE NOT-FOR-PROFIT CORPORATION LAW OF THE STATE OF NEW YORK, THE CERTIFICATE OF INCORPORATION OF THE ASSOCIATION OR ITS BYLAWS. A VOTE OF AT LEAST EIGHTY PERCENT(80%) OF THE ENTIRE BOARD OF DIRECTORS THEN IN OFFICE SHALL BE REQUIRED TO APPROVE CERTAIN ACTIONS. FORM 990, PART VI, SECTION A, LINE 7A SEE EXPLANATION FOR LINE 6 FORM 990, PART VI, SECTION A, LINE 7B SEE EXPLANATION FOR LINE 6 FORM 990, PART VI, SECTION B, LINE 11 FOR THE YEAR ENDED DECEMBER 31, 2010 THE FORM 990 WAS PREPARED BY A CERTIFIED PUBLIC ACCOUNTING FIRM (PAID PREPARERS) BASED ON THE INFORMATION PROVIDED BY THE HOSPITAL'S MANAGEMENT. THE RETURN WAS THEN REVIEWED BY HOSPITAL'S MANAGEMENT PRIOR TO ITS FILING, A COPY OF THE FORM 990 WAS PROVIDED TO THE BOARD OF DIRECTORS FOR REVIEW AND COMMENT. FORM 990, PART VI, SECTION B, LINE 12C ALL GOVERNING BOARD MEMBERS, SENIOR MANAGEMENT AND OTHER PERSONNEL WHO MIGHT FIND THEMSELVES IN A POSITION WHERE THEIR PERSONAL INTERESTS CONFLICT WITH THE INTERESTS OF PHELPS MEMORIAL HOSPITAL ARE REQUIRED TO FILE AN ANNUAL CONFLICT OF INTEREST DISCLOSURE STATEMENT WITH THE COMPLIANCE OFFICER AND IMMEDIATELY DISCLOSE TO THE COMPLIANCE OFFICER ANY POSSIBLE CONFLICTS OF INTERESTS AS THEY ARISE. IT IS THE RESPONSIBILITY OF THE COMPLIANCE OFFICER TO OBTAIN AND REVIEW CONFLICT OF INTEREST DISCLOSURE STATEMENTS AT LEAST ANNUALLY. THE COMPLIANCE OFFICER AS NECESSARY WILL CONSULT WITH OUTSIDE COUNSEL AND REPORT TO THE AUDIT COMMITTEE OF THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 15 THE CHAIRMAN OF THE BOARD APPOINTS AN EXECUTIVE COMPENSATION COMMITTEE. THE COMMITTEE ENGAGES AN INDEPENDENT COMPENSATION CONSULTANT, IE, ASTRON SOLUTIONS, TO PROVIDE CURRENT MARKET COMPENSATION DATA FOR EACH SENIOR EXECUTIVE POSITION. THIS IS UPDATED ON AN ANNUAL BASIS. THE COMMITTEE REVIEWS WRITTEN BOARD-APPROVED MANAGEMENT GOALS, WRITTEN DOCUMENTATION OF PROGRESS TOWARDS EACH GOAL, AND AN EXECUTIVE COMPENSATION SCORECARD THAT HAS PRE-DETERMINED WEIGHTS. THE COMMITTEE DELIBERATES IN AN EXECUTIVE SESSION WHEN THEY REVIEW THE PRESIDENT'S PERFORMANCE TOWARDS THE APPROVED GOALS AND THEN MAKES RECOMMENDATIONS DIRECTLY TO THE FULL BOARD OF DIRECTORS. THE PRESIDENT PRESENTS TO THE FULL BOARD OF DIRECTORS THE RECOMMENDED COMPENSATION FOR EACH SENIOR EXECUTIVE AND THE BOARD REVIEWS THEM. ONCE THE BOARD ENDORSES THE RECOMMENDATIONS, THEY ARE GRANTED TO THE INDIVIDUAL. THE PRESIDENT'S PERFORMANCE AND COMPENSATION IS REVIEWED IN AN EXECUTIVE SESSION OF THE FULL BOARD OF DIRECTORS, FROM WHICH THE PRESIDENT IS EXCUSED. THE FULL BOARD VOTES ON THE PRESIDENT'S COMPENSATION EACH YEAR. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE CONSIDERED PUBLIC INFORMATION. THEREFORE, THESE DOCUMENTS ARE ATTAINABLE BY THE PUBLIC UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 607,976. CHANGE IN VALUATION OF PLEDGES 17,000. ELIMINATIONS 15,000. ROUNDING 4,156. TOTAL TO FORM 990, PART XI, LINE 5: 644,132. FORM 990, PART XI, LINE 2C: THE OVERSIGHT AND SELECTION PROCESSES DID NOT CHANGE FROM PRIOR YEAR. PHELPS CHILD CARE CENTER 3 PHELPS LANE SLEEPY HOLLOW NY 10591 133467714 CHILD CARE NY 501(C)(3) 2 N/A 0 PHELPS COMMUNITY CORPORATION 701 NORTH BROADWAY SLEEPY HOLLOW NY 10591 133263295 FOUNDATION NY 501(C)(3) 11A N/A 0 HEALTHSTAR NETWORK DBA STELLARIS HEALTH 1 NORTH GREENWICH ROAD ARMONK NY 10504 133911773 HEALTHCARE NY 501(C)(3) 11B N/A 0 PHELPS PROFESSIONAL BLDB CO LP 777 NORTH BROADWAY SLEEPY HOLLOW NY 10591 133645137 REAL ESTATE NY N/A RELATED 281596 3198466 0 1 0.62142 PMHC REALTY CORP 701 NORTH BROADWAY SLEEPY HOLLOW NY 10591 133645135 REAL ESTATE NY N/A C 4078 14832 1.00000 HEALTH DELIVERY ANALYSIS INC 701 NORTH BROADWAY SLEEPY HOLLOW NY 10591 133352327 INACTIVE NY N/A C -29 1.00000 PHELPS MANAGEMENT SERVICES INC 701 NORTH BROADWAY SLEEPY HOLLOW NY 10591 131726635 INACTIVE NY N/A C -29 1.00000 PHELPS SERVICES INC 701 NORTH BROADWAY SLEEPY HOLLOW NY 10591 131742995 INACTIVE NY N/A C -29 1.00000 PHELPS MEDICAL SERVICES PC 701 NORTH BROADWAY SLEEPY HOLLOW NY 10591 274416017 HEALTHCARE NY N/A C -15 1.00000 0 0 0 0 0 0 0 0 1 1 0 0 0 1 0 1 1 1 PHELPS PROFESSIONAL BUILDING N 114239 PHELPS PROFESSIONAL BUILDING J 1384863 PHELPS PROFESSIONAL BUILDING R 187111 PHELPS PROFESSIONAL BUILDING R 246573 PHELPS PROFESSIONAL BUILDING I 51771