2011-11-15T17:36:57-06:00 2010-12-31 JH COHN LLP 1212 6TH AVENUE NEW YORK NY 10036 990 2010-01-01 111631746 BROOKDALE HOSPITAL MEDICAL CENTER BROO 7182405000 ONE BROOKDALE PLAZA BROOKLYN NY 11236 MOUNIR F DOSS 7182405000 2011-11-14 1 THOMAS LANNING 2122970400 2010 2016-02-24 21:20:13Z MOUNIR F DOSS ONE BROOKDALE PLAZA BROOKLYN NY 11236 479673718 0 X WWW.BROOKDALE.EDU X 1914 NY THE BROOKDALE HOSPITAL MEDICAL CENTER OPERATES A 530 BED HOSPITAL IN BROOKLYN, NY. 22 18 3683 0 0 0 6603304 7748591 382961957 382527070 10477879 4993815 69635110 69110157 469678250 464379633 0 0 0 0 295870864 290038511 0 0 349403 205779791 217594571 501650655 507633082 -31972405 -43253449 194052131 178989271 439928637 458918654 -245876506 -279929383 THE BROOKDALE HOSPITAL MEDICAL CENTER OPERATES A 530 BED HOSPITAL IN BROOKLYN, NEW YORK. 0 0 406657929 382527070 THE BROOKDALE HOSPITAL MEDICAL CENTER OPERATES A 530 BED HOSPITAL IN BROOKLYN, NEW YORK. IN 2010, BROOKDALE HAD 19,797 ADMISSIONS, 19,759 DISCHARGES, 98,160 OUTPATIENT EMERGENCY ROOM VISITS WHICH RESULTED IN 14,812 ADMISSIONS AND 224,479 OTHER OUTPATIENT SERVICE VISITS. 406657929 1 1 0 1 0 0 0 0 0 1 1 0 1 1 0 0 1 0 0 0 0 0 0 1 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 318 1 1 3683 1 0 0 0 0 0 1 1 0 0 0 0 X 22 18 1 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X MOUNIR F DOSS EXECUTIVE VP & CFO 7182405773 101-01 AVE D BROOKLYN NY 11236 X ALEX ROVT 1.00 X X 0 0 0 ALLEN B SWERDLICK 1.00 X 0 0 0 ALVIN I KAHN MD 40.00 X X 297852 0 62954 ASCHER L MESTEL MD 1.00 X 0 0 0 DARRYL TOWNS 1.00 X 0 0 0 DAVID P ROSEN 80.00 X X 0 1737965 71372 DAVID R WILKES 1.00 X 0 0 0 DAVID SCHLANG 1.00 X 0 0 0 DIANE SIMON 1.00 X 0 0 0 EDWARD BIRNBAUM 1.00 X 0 0 0 EDWIN SCHULMAN 1.00 X 0 0 0 HUGH GREENBERG 1.00 X 0 0 0 IRINA BENFELD 1.00 X 0 0 0 LAURENCE C ZALE 1.00 X X 0 0 0 LESLIE STEPHEN 1.00 X 0 0 0 LEWIS MARHALL 1.00 X X 386250 0 58789 LOWELL M RUBIN 1.00 X 0 0 0 RC HUGH NELSON 1.00 X 0 0 0 RICHARD FOGLER 1.00 X X 632683 0 56293 RICHARD RADUTZKY 1.00 X X 0 0 0 STEVEN PLOTNICK ESQ 1.00 X 0 0 0 BRUCE J FLANZ 80.00 X 0 1340143 70165 DAVID SCHACHNE 1.00 X 0 0 0 MOUNIR F DOSS 80.00 X 0 1382657 72404 AARON REICHMAN 40.00 X 441459 0 38906 ARASH GOHARI 40.00 X 505993 0 15472 ARTHUR FINK MD 40.00 X 447068 0 62485 ERIC S MINKIN MD 40.00 X 473582 0 60349 MAYANK SHUKLA 40.00 X 526647 0 39289 PARESH KOTAHRY 40.00 X 0 0 0 3711534 4460765 608478 362 0 1 0 OHRENSTEIN & BROWN LLP 1010 FRANKLIN AVENUE GARDEN CITY NY 11530 LEGAL 1373792 QUEST DIAGNOSTICS 12436 COLLECTIONS CENTER DRIVE CHICAGO IL 60693 LAB SERVICES 682833 PRICEWATERHOUSECOOPERS LLP 300 MADISON AVE 24TH FLOOR NEW YORK NY 10017 ACCOUNTING 661621 SIEMENS MEDICAL SOLUTIONS USA 2 PENN PLAZA SUITE 1900 NEW YORK NY 10021 CONSTRUCTION SERVICES 644578 BSK PEDIATRIC SURGERY ASSOCIATES PC 1300 UNION TPKE NEW HYDE PARK NY 11040 PHYSICIANS 600000 36 254751 3846244 3647596 7748591 NET PATIENT REVENUE 621400 355774800 355774800 CAPITATION FEE 621400 26752270 26752270 382527070 4885112 4885112 522820 522820 522820 522820 15131267 107365 15129929 1338 107365 108703 107365 1338 182700 254751 164156 18544 18544 SVC PROVIDED TO AFFILI 900099 40833159 40833159 PHYSICIAN BILLING 621110 13266901 13266901 PHARMACY REVENUE 900099 5066195 5066195 9402538 80000 9322538 68568793 464379633 382714435 0 73916607 1494821 1194400 298600 1821 209319684 167223688 41805922 290074 9126180 7300944 1825236 54472482 43577986 10894496 15625344 12500275 3125069 6000000 4800000 1200000 4666168 3732934 933234 576285 461028 115257 4253847 3370945 842736 40166 14797598 11825881 2956472 15245 2243965 1795172 448793 9482760 7586208 1896552 437486 349989 87497 166761 133409 33352 10616880 8493504 2123376 10602792 8482234 2120558 35088833 28071067 7017766 MEDICAL SUPPLIES 44194753 35355802 8838951 BAD DEBT - PATIENT RELA 30366646 30366646 PHYSICIAN FEES 17846252 17846252 BAD DEBT - RELATED PART 11014493 11014493 EQUIP RENTAL & MAINT 7319779 5854146 1463536 2097 7919273 6335419 1583854 507633082 406657929 100625750 349403 15119985 13263941 55052345 48333524 3893310 3420888 8666437 13503984 285042810 237353226 52881523 47689584 31713374 22107216 26725157 30670134 194052131 178989271 91759835 101495849 110632029 100961785 237536773 256461020 439928637 458918654 X -246876506 -279929383 1000000 0 -245876506 -279929383 194052131 178989271 X -43253449 9200572 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 0 0 0 0 0 1 170741 0 0 170741 0 PART IV, SUPPLEMENTAL INFORMATION: PART II-B BROOKDALE HOSPITAL MEDICAL CENTER IS A MEMBER OF TWO ASSOCIATIONS OF WHICH SOME OF THEIR DUES ARE ALLOCATED TO GRASS ROOTS LOBBYING IN REGARD TO THEIR NEEDS IN SERVICING AND PROVIDING HEALTHCARE TO THE GENERAL PUBLIC. HEALTHCARE ASSOCIATION OF NEW YORK STATE $44,845 GREATER NEW YORK HOSPITAL ASSOCIATION $125,896 1068657 1068657 77634083 61810499 15823584 174649431 151873192 22776239 31690639 23669535 8021104 47689584 GUARANTEED INSURANCE CONTRACTS 12141475 F TREASURY BILLS 399960 F GOVERNMENT BONDS 6191182 F LETTER OF CREDIT 1671000 F INTEREST - CCC INVESTMENT POOL 1703599 F 22107216 DUE FROM THIRD PARTY PAYORS 12394960 DEFERRED FINANCE CHARGES 408588 CAPITATION RECEIVABLE 14606607 DUE FROM AFFILIATES - SSI 3000000 ACCRUED INTEREST - AWUIL 259979 30670134 ESTIMATED WORKERS COMP LIABILITY 17260000 MALPRACTICE PAYABLE 157800049 DUE TO THIRD PARTIES 28175891 DUE TO RELATED PARTIES 22939930 ACCRUED PENSION PAYABLE 30285150 256461020 464379633 507633082 -43253449 2411 9198161 9200572 -34052877 518938576 2412 2670143 2672555 516266021 -51886388 -51886388 464379633 561736507 2217037 2217037 559519470 -51886388 -51886388 507633082 PART XII, LINE 2D - OTHER ADJUSTMENTS: BROOKDALE HOSPITAL CENTER HEGEMAN 3,577,052. ELIMINATION ENTRY -906,909. PART XII, LINE 4B - OTHER ADJUSTMENTS: SPECIAL EVENTS EXPENSE -164,156. COSTS RELATED TO CAPITATION -51,722,232. PART XIII, LINE 2D - OTHER ADJUSTMENTS: BROOKDALE HOSPITAL CENTER HEGEMAN 3,123,946. ELIMINATING ENTRY -906,909. PART XIII, LINE 4B - OTHER ADJUSTMENTS: SPECIAL EVENTS EXPENSE -164,156. COSTS RELATED TO CAPITATION -51,722,232. GOLF & TENNIS EVENT 125701 84436 41265 29420 4890 GALA 311750 170315 141435 102279 27567 437451 254751 182700 131699 32457 164156 18544 1 1 1 X 1 X 1 1 1 0 1 1 12058993 3684685 8374308 0.01650 168085010 147036137 21048873 0.04150 180144003 150720822 29423181 0.05800 14 46306 4507751 4024972 46306 0.00010 73451915 38846284 34605631 0.06820 44422625 44422625 0.08750 14 46306 122382291 42871256 79074562 0.15580 14 46306 302526294 193592078 108497743 0.21380 1 17112108 2600229 63409605 56974564 6435041 X 1 1 1 1 BROOKDALE HOSPITAL AND MEDICAL CENTER

ONE BROOKDALE PLAZA BROOKLYN NY 11236

X BROOKDALE HOSPITAL AND MEDICAL CENTER 1 PART III, LINE 9B: THE HOSPITAL OFFERS INSTALLMEN PLANS FOR THE PAYMENT OF OUTSTANDING BALANCES FOR PATIENTS APPROVED FOR FINANCIAL AID. THE HOSPITAL DOES NOT MANDATE THAT THE MONTHLY INSTALLEMENT PAYMENT ARRANGEMENT EXCEED 10% OF THE APPLICANT'S GROSS MONTHLY INCOME OR AN INTEREST RATE THAT EXCEEDS THE RATE FOR A 90 DAY SECURITY ISSUED BY THE US DEPARTMENT OF TREASURY, PLUS .5%. THERE IS NO ACCELERATOR OR SIMILAR CLAUSE UNDER WHICH A HIGHER RATE OF INTEREST IS TRIGGERED WHEN A PATIENT MISSES MAKING A PAYMENT. THE HOSPITAL INCLUDES A WRITTEN NOTICE ON PATIENTS' BILLS AND STATEMENTS AT LEAST30 DAYS PRIOR TO REFERRING THE ACCOUNT TO COLLECTION. THE HOSPITAL REQUIRES THAT ANY COLLECTIONS AGENCIES WITH WHICH THEY CONTRACT FOLLOW THE FINANCIAL ASSISTANCE POLICIES OF THE HOSPITAL. THE HOSPITAL DOES NOT FORCE THE SALE OR FORCLOSURE OF A PATIENT'S PRIMARY RESIDENCE TO COLLECT ON AN OUTSTANDING BILL. COLLECTION IS PROHIBITED AGAINST ANY PATIENT WHO WAS ELIGIBLE FOR MEDICAID AT THE TIME SERVICES WERE RENDERED. FINALLY, THE CONTRACTED COLLECTIONS AGENCIES MUST OBTAIN THE HOSPITAL'S WRITTEN CONSENT BEFORE COMMENCING A LEGAL ACTION. MISSION STATEMENTTHE BROOKDALE UNIVERSITY HOSPITAL AND MEDICAL CENTER IS COMMITTED TO BEING THE FOCUS OF A HEALTHY COMMUNITY, STRESSING THE ORGANIZATION'S VALUES OF CARING AND RESPECT FOR EVERYONE.SERVICE AREASINCE 1921, BROOKDALE UNIVERSITY HOSPITAL AND MEDICAL CENTER SITS ON THE BORDER OF COMMUNITY DISTRICT #16 (BROWNSVILLE) AND COMMUNITY DISTRICT #17 (EAST FLATBUSH) IN EASTERN BROOKLYN, NY 11212. THE HOSPITAL AND MEDICAL CENTER SERVES THREE PRIMARY SERVICE AREAS: CENTRAL BROOKLYN, EAST NEW YORK AND NEW LOTS, AND CANARSIE AND FLATLANDS, AND ONE SECONDARY SERVICE AREA - FLATBUSH. THE TOTAL SERVICE AREA HAS OVER ONE MILLION RESIDENTS, 71% BEING BLACK/AFRICAN AMERICAN AND 38% BEING FOREIGN BORN. EACH NEIGHBORHOOD IS SOMEWHAT DIFFERENT IN TERMS OF ITS RACIAL AND ETHNIC MAKE-UP. MUCH OF THE HOSPITAL'S SERVICE AREA SUFFERS FROM POVERTY, WITH 35% MEDICAID ELIGIBLE, AND MANY UNINSURED RESIDENTS, AS WELL AS MANY DOCUMENTED AND UNDOCUMENTED IMMIGRANTS, SOME OF WHOM SPEAK LIMITED OR NO ENGLISH. SELECTED SERVICE OFFERINGS - 2008 530-BED ACUTE CARE TEACHING FACILITY STATE DESIGNATED LEVEL I TRAUMA CENTER, STATE DESIGNATED AIDS CENTER, STATE DESIGNATED LEVEL 3 PERINATAL CENTER AND STATE DESIGNATED STROKE CENTER CHRONIC RENAL DIALYSIS CORONARY ANGIOPLASTY SERVICE 70 SPECIALTY CLINICS, A COMMUNITY MENTAL HEALTH CENTER, AN AMBULATORY SURGERY CENTER AND 6 COMMUNITY-BASED FAMILY CARE CENTERS CERTIFIED HOME HEALTH AGENCY BROOKDALE SPONSORS 9 RESIDENCY PROGRAMS, AND 3 FELLOWSHIP PROGRAMS, AND PARTICIPATES IN 6 OTHER RESIDENCY PROGRAMS AND 3 FELLOWSHIPS PROGRAMS WITH A TOTAL OF 265 RESIDENTS. OPERATES 12 DAILY TOURS IN THE NYC 911 SYSTEM, WITH 4 AMBULANCES 24 HOURS PER DAY AFFILIATED LONG TERM CARE FACILITIES - ASSISTED LIVING AND INDEPENDENT HOUSING (ARLENE AND DAVID SCHLANG PAVILION), NURSING HOME (SCHULMAN AND SCHACHNE INSTITUTE FOR NURSING AND REHABILITATION), AND ADULT DAY HEALTH CARE CENTERPATIENTS SERVED - 2009 OVER 26,000 DISCHARGES, INCLUDING ALMOST 1,200 NEWBORNS OVER 99,000 EMERGENCY DEPARTMENT VISITS, INCLUDING ADMISSIONS TO THE HOSPITAL TOGETHER WITH ITS AFFILIATED DIAGNOSTIC AND TREATMENT CENTERS, ALMOST 233,000 AMBULATORY CARE VISITS INCLUDING GENERAL MEDICAL AND PEDIATRIC SERVICE, MENTAL HEALTH AND DENTAL SERVICES MANY OTHER AMBULATORY CARE SERVICES, INCLUDING RADIOLOGY EXAMS, LABORATORY TESTS, RENAL DIALYSIS AND AMBULATORY SURGERY IN 2008, STAFF FROM BROOKDALE HOSPITAL PARTICIPATED AT OVER 23 COMMUNITY EVENTS. MORE THAN 4,760 PEOPLE WERE IN ATTENDANCE AND RECEIVED HEALTH INFORMATION AND OVER 577 PEOPLE RECEIVED FREE SCREENINGS. PREVENTION AGENDA IN 2009, NEW YORK STATE DEPARTMENT OF HEALTH (NYSDOH) ADDED NEW REQUIREMENTS FOR COMMUNITY SERVICE PLANS TO INCLUDE A PREVENTION AGENDA WITH A SPECIFIC ACTION PLAN. THE PLAN IS TO BE DEVELOPED IN CONJUNCTION WITH COMMUNITY PARTNERS. THE FOLLOWING IS A SUMMARY OF THE HOSPITAL'S ACCOMPLISHMENTS AND PREVENTION PLANS FOR THE FUTURE.PUBLIC PARTICIPATION IN APRIL OF 2009, A HOSPITAL WORKGROUP DISCUSSED POSSIBLE PRIORITIES FOR BROOKDALE HOSPITAL, THE NEEDS OF THE HOSPITAL'S SERVICE AREA, POTENTIAL PARTNERS, AND BARRIERS TO CARE/GAPS IN SERVICES. THE WORKGROUP UTILIZED DATA FROM THE NEW YORK CITY COMMUNITY HEALTH PROFILES, INCLUDING THE CITY'S TAKE CARE NEW YORK (TCNY) PREVENTION TARGETS, AS WELL AS PREVENTION QUALITY INDICATORS PROVIDED ON THE NYSDOH WEBSITE. IN ADDITION, THE WORKGROUP TOOK INTO CONSIDERATION THE SUGGESTION BY THE NYCDOH&MH COMMISSIONER THAT SMOKING CESSATION AND CANCER SCREENING BE TOP PRIORITIES FOR HOSPITALS IN THE CITY OF NEW YORK. IN MAY OF 2009, THE WORKGROUP'S RECOMMENDED PREVENTION PRIORITIES WERE SHARED WITH THE COMMUNITY ADVISORY BOARD (COMMUNITY BOARD). THE COMMUNITY BOARD IS AN ADVISORY GROUP WHICH SERVES AS A PUBLIC FORUM TO PROVIDE INFORMATION TO THE COMMUNITY AND RECEIVE FEEDBACK ON NEEDED SERVICES AND PROGRAMS THAT THE COMMUNITY FEELS THE HOSPITAL SHOULD PROVIDE. THE COMMUNITY BOARD CONSISTS OF MEMBERS FROM THE LOCAL NEW YORK CITY COMMUNITY PLANNING BOARDS SERVED BY BROOKDALE HOSPITAL AND REPRESENTATIVES FROM VARIOUS FAITH AND COMMUNITY BASED ORGANIZATIONS. THE TWO PRIORITIES CHOSEN WERE SMOKING CESSATION AND COLON CANCER SCREENING.IN JUNE 2009, THE SELECTED PRIORITIES WERE SHARED WITH THE HOSPITAL'S BOARD OF TRUSTEES AND DEPARTMENT HEADS AT THEIR RESPECTIVE MEETINGS. DURING THE SUMMER OF 2009, THE WORKGROUP DEVELOPED THE PREVENTION AGENDA THREE YEAR ACTION PLAN INCLUDING A MARKETING CAMPAIGN. MEMBER ORGANIZATIONS OF THE HOSPITAL'S COMMUNITY BOARD WILL PARTICIPATE BY PUBLICIZING AND DISSEMINATING CAMPAIGN MATERIAL, AND SCHEDULING SPEAKERS FROM THE HOSPITAL AT FORUMS TO BE ARRANGED BY THE COMMUNITY BOARD'S MEMBERS. SMOKING CESSATION PROGRAMBHMC HAS ADOPTED SMOKING CESSATION AS A PRIORITY FOCUS TO IMPROVE HEALTH OUTCOMES IN THE COMMUNITY. FOR THE PAST SEVERAL YEARS A REPRESENTATIVE FROM THE DEPARTMENT OF NURSING, HAS BEEN WORKING WITH BROOKLYN CARES IN AN EFFORT TO RAISE THE AWARENESS OF THE IMPORTANCE OF SMOKING CESSATION. THE HOSPITAL'S 3-YEAR PREVENTION ACTION PLAN INCLUDES THE FOLLOWING OBJECTIVES: IDENTIFY PATIENTS WHO SMOKE IDENTIFY EXISTING SMOKING CESSATION PROGRAMS WITHIN BHMC AND COORDINATE SERVICES WITH THEM EDUCATE PROVIDERS IN COUNSELING TECHNIQUES TO ENCOURAGE SMOKING CESSATION RAISE COMMUNITY AWARENESS ABOUT SMOKING CESSATION TRACK QUITTING SUCCESS RATE OF SMOKERS AND IDENTIFY EFFECTIVE TREATMENT MODALITIES AND PROGRAMS ENCOURAGE ONGOING INPUT AND SUPPORT FROM COMMUNITY PARTNERSCOLORECTAL CANCER AND NAVIGATOR PROGRAMBROOKDALE HOSPITAL HAS ALREADY EMBARKED ON A CAMPAIGN TO RAISE THE COMMUNITY'S AWARENESS OF COLON CANCER AND THE RELATIVE EASE WITH WHICH IT CAN BE DETECTED AND TREATED. AS SUCH, THE HOSPITAL CONTINUES TO SUPPORT A PATIENT NAVIGATION PROGRAM FORMERLY FUNDED THROUGH THE NEW YORK CITY DEPARTMENT OF HEALTH.AS PART OF THIS CAMPAIGN BHMC HAS TARGETED ITS OUTREACH ACTIVITIES AT ITS AFFILIATED AMBULATORY CARE CENTERS, OTHER AMBULATORY CARE CENTERS, COMMUNITY HEALTH FAIRS, IN-PATIENT UNITS, HOSPITAL ADVISORY BOARD AND COMMUNITY BOARDS. THE HOSPITAL HAS IN-SERVICED STAFF THROUGHOUT THE FACILITY AND CHANGED ITS MEDICAL INTAKE (HISTORY AND PHYSICAL) FORM TO INCLUDE COLON/BREAST CANCER SCREENING HISTORY. THE HOSPITAL'S "DIRECT REFERRAL PROCESS" PERMITS A SHORTER WAITING TIME FOR ROUTINE SCREENING. THIS "OPEN ACCESS PROGRAM" HAS BEEN EMBRACED BY PRIMARY CARE PHYSICIANS AND IS SPEARHEADED BY THE PATIENT NAVIGATOR. THE ESSENTIAL CHARACTERISTIC OF A PATIENT NAVIGATOR IS THE COMBINATION OF WISDOM ABOUT THE COMMUNITY'S CULTURE WITH KNOWLEDGE OF THE HEALTH CARE SYSTEM. THE HOSPITAL'S 3-YEAR PREVENTION ACTION PLAN INCLUDES THE FOLLOWING OBJECTIVES: INCREASE REFERRALS OF COLORECTAL CANCER SCREENING AMONG PATIENTS OVER 50 AND HIGH RISK PATIENTS. PROMOTING COLORECTAL CANCER SCREENING AND AWARENESS WITHIN THE COMMUNITY AND WITHIN THE HOSPITAL. DECREASE THE RATE OF "NO SHOW" DECREASE THE RATE OF "POOR PREPARATION" ENCOURAGE ONGOING INPUT AND SUPPORT FROM COMMUNITY PARTNERS NON-PREVENTION PRIORITIES CONSIDERED IN ASSESSMENT PROCESS MANY OF THE PROGRAMS AND SERVICES AT BROOKDALE HOSPITAL ARE CONSISTENT WITH AND SUPPORTIVE OF THE TCNY PROGRAM PROMOTED BY NYCDOH&MH. AS DESCRIBED IN DETAIL IN THE 2008 COMMUNITY SERVICE PLAN, THE HOSPITAL HAS BEEN FOCUSING ON THE TEN HEALTH AREAS FROM TREATMENT AND PREVENTION PERSPECTIVES. GOING FORWARD, THE HOSPITAL WILL AUGMENT ITS FOCUS ON PREVENTION ESPECIALLY IN THE PRIORITY AREAS OF SMOKING CESSATION AND COLON CANCER SCREENING, BOTH OF WHICH ARE TCNY PRIORITIES. BROOKDALE HOSPITAL'S PROGRAMS SUPPORT TCNY IN THE FOLLOWING WAYS: 1. HAVE A REGULAR DOCTOR OR OTHER HEALTH CARE PROVIDER: BROOKDALE'S AMBULATORY CARE SERVICES ARE DESIGNED TO PROMOTE CONTINUITY OF CARE BY ALLOWING PATIENTS TO CHOOSE A PHYSICIAN WHO WILL BE DESIGNATED AS THEIR PRIMARY CARE PROVIDER. IN ADDITION TO ON-CAMPUS AMBULATORY CARE SERVICES, THERE ARE SIX CENTERS CONVENIENTLY LOCATED THROUGHOUT BROOKDALE'S SERVICE AREA. EVENING AND WEEKEND HOURS ALLOW RESIDENTS ACCESS FOR THOSE WHO FIND IT DIFFICULT TO SEEK CARE ON WEEKDAYS. THE DESIGNATED PROVIDER IS RESPONSIBLE FOR ENSURING THAT HIS/HER PATIENTS ARE GIVEN AGE APPROPRIATE SCREENING, IMMUNIZATION AND EDUCATION. THE HOSPITAL PLANS TO IMPLEMENT AN ELECTRONIC MEDICAL RECORD, WHICH WILL FURTHER ENHANCE ITS HEALTH PROMOTION EFFORTS VIA AUTOMATIC REMINDERS TO PHYSICIANS WHEN A PATIENT IS DUE FOR A TEST OR PROCEDURE.2. BE TOBACCO-FREE: SMOKING CESSATION IS ONE OF THE HOSPITAL'S PREVENTION PRIORITIES AND WAS DISCUSSED IN THE PREVIOUS SECTION.3. KEEP YOUR HEART HEALTHY: BROOKDALE'S PRIMARY CARE PHYSICIANS MONITOR PATIENTS CARDIOVASCULAR STATUS DURING ROUTINE VISITS AND AS INDICATED DURING ACUTE CARE VISITS, INCLUDING CHOLESTEROL TESTING AND EKGS. PHYSICIANS PROVIDE COUNSELING TO PATIENTS ON OBESITY AND NUTRITION AS PART OF THE ROUTINE HEALTH MAINTENANCE CHECK. CHILDREN AND ADULTS NEEDING FURTHER SERVICES ARE REFERRED TO BROOKDALE'S FULL-SERVICE ADULT AND PEDIATRIC CARDIOLOGY SERVICES, OR OTHER COMMUNITY RESOURCES.4. KNOW YOUR HIV STATUS: THE HOSPITAL PROVIDES HIV COUNSELING AND TESTING WITH STAFF THAT ROUTINELY PERFORMS THIS FUNCTION IN BOTH EMERGENCY DEPARTMENT AND CLINICS. PATIENTS WHO ARE HIV POSITIVE ARE REFERRED FOR SERVICES TO BROOKDALE'S STATE-DESIGNATED AIDS CENTER, OR OTHER COMMUNITY PROGRAMS. 5. GET HELP FOR DEPRESSION: BROOKDALE HOSPITAL'S MEDICAL PROVIDERS INCORPORATE DEPRESSION SCREENING DURING ROUTINE MEDICAL EXAMINATIONS AND ONGOING CARE. CHILDREN AND ADULTS NEEDING FURTHER SERVICES ARE REFERRED TO BROOKDALE'S FULL SERVICE PSYCHIATRY DEPARTMENT OR OTHER COMMUNITY PROGRAMS. 6. LIVE FREE OF DEPENDENCE ON ALCOHOL AND DRUGS: DURING ROUTINE MEDICAL EXAMINATIONS PATIENTS ARE SCREENED FOR ALCOHOL AND DRUG USE AND GIVEN PREVENTIVE COUNSELING AND, AS NECESSARY, TREATMENT OPTIONS ARE DISCUSSED, INCLUDING FLUSHING HOSPITAL, BROOKDALE'S AFFILIATE, WHICH OFFERS BOTH IN-PATIENT AND OUT-PATIENT TREATMENT FOR CHEMICAL DEPENDENCY.7. GET CHECKED FOR CANCER: COLON SCREENING IS ONE OF THE HOSPITAL'S PREVENTION PRIORITIES AND WAS DISCUSSED IN THE PREVIOUS SECTION. REFERRALS FOR OTHER CANCER SCREENINGS, SUCH AS BREAST CANCER, ARE PART OF THE HOSPITAL'S ROUTINE PROTOCOLS. THE HOSPITAL PARTICIPATES IN THE BROOKLYN HEALTHY LIVING PARTNERSHIP WHICH PROVIDES FREE CANCER SCREENINGS AND TREATMENT FOR THE UNINSURED.8. GET THE IMMUNIZATIONS YOU NEED: THE HOSPITAL IS A "VACCINE FOR CHILDREN" RECIPIENT, PROVIDING FREE VACCINE TO UNINSURED, UNDERINSURED AND MEDICAID RECIPIENTS UP THROUGH 18 YEARS OF AGE. FLU VACCINATIONS ARE OFFERED TO AT RISK PATIENTS OF ALL AGES AND TO ALL STAFF. THIS YEAR WE ARE PARTICULARLY ACTIVE IN PLANNING A PROGRAM TO EFFECTIVELY AND EFFICIENTLY DISSEMINATE THE H1N1 VACCINE THROUGHOUT THE COMMUNITY AS SOON AS THE NEW VACCINE BECOMES AVAILABLE.9. HAVE A SAFE AND HEALTHY HOME: ANTICIPATORY GUIDANCE ON SAFETY IN THE HOME IS PROVIDED BY THE HOSPITAL'S PEDIATRIC, FAMILY MEDICINE AND REHABILITATION PROFESSIONALS. AT HEALTH FAIRS IN THE COMMUNITY, FIRE, HOME AND AUTOMOTIVE SAFETY INFORMATION IS ROUTINELY MADE AVAILABLE TO ATTENDEES.10. HAVE A HEALTHY BABY: THE HOSPITAL IS DESIGNATED AS A PRENATAL CARE ASSISTANCE PROGRAM (PCAP) PROVIDER. THE HOSPITAL OPERATES A HEALTHY FAMILIES PROGRAM AND A COMMUNITY HEALTH WORKER PROGRAM, BOTH FUNDED BY GRANTS FROM THE NYSDOH. THESE PROGRAMS ASSIST PREGNANT WOMEN AND THEIR FAMILIES TO OBTAIN NECESSARY MEDICAL CARE AND SUPPORTIVE SERVICES, WITH THE GOAL OF IMPROVING BIRTH OUTCOMES AND REDUCING CHILD ABUSE. THE HOSPITAL ALSO OPERATES A WOMEN, INFANT AND CHILDREN (WIC) PROGRAM WHICH PROVIDE FOOD VOUCHERS AND EDUCATION TO LOW INCOME PREGNANT WOMEN AND CHILDREN UP TO AGE FIVE.BROOKDALE HOSPITAL'S PUBLIC HEALTH EFFORTS ARE CONSTANTLY CHANGING WITH THE NEEDS OF ITS COMMUNITY. THE ABOVE LISTING DOES NOT INCLUDE ALL PROGRAMS, SOME OF WHICH ARE FUNDED BY GRANTS. FOR EXAMPLE, THE HOSPITAL RECENTLY RECEIVED A LARGE AWARD FROM THE ROBIN HOOD FOUNDATION (RHF) TO EXPAND ITS HEALTHY FAMILIES PROGRAM AND FOR THE SECOND CONSECUTIVE YEAR, RHF AWARDED A GRANT TO BROOKDALE'S PEDIATRIC OBESITY PROGRAM, "LIVE LIGHT-LIVE RIGHT". IN ADDITION, CLINICAL DEPARTMENTS OFTEN INITIATE THEIR OWN PREVENTION ACTIVITIES WITH THEIR PATIENTS AND WITHIN THE COMMUNITY. LASTLY, THE HOSPITAL PROVIDES HUNDREDS OF FREE HEALTH SCREENINGS AND OUTREACH EFFORTS EACH YEAR FOR A VARIETY OF DISORDERS. FINANCIAL AID PROGRAM OVER THE PAST THREE YEARS, THE HOSPITAL HAS IMPLEMENTED A FINANCIAL AID PROGRAM (THE PROGRAM) TO ENSURE THAT UNINSURED PATIENTS WHO ARE INTERESTED IN FINANCIAL ASSISTANCE CAN OBTAIN IT, WITH MINIMAL ELIGIBILITY BARRIERS. THE HOSPITAL HAS POSTED INFORMATION ON THE PROGRAM, ON ITS WEBSITE, AND IN ALL PATIENT REGISTRATION AND INTAKE AREAS - IN ADDITION TO ALL SELF-PAY BILLS. OVER THE LIFE OF THE PROGRAM, THE HOSPITAL HAS INTEGRATED THE FULL RANGE OF OPTIONS FOR UNINSURED PATIENTS INTO A SEAMLESS PROCESS WHERE ALL PATIENTS ARE SIMULTANEOUSLY EVALUATED FOR ELIGIBILITY INTO THE MEDICAID, FAMILY HEALTH PLUS/CHILD HEALTH PLUS, AND/OR THE FINANCIAL AID PROGRAM., THUS ELIMINATING MULTIPLE TRIPS TO THE HOSPITAL TO APPLY FOR THE DIFFERENT PROGRAMS. IN ADDITION, A RECORD OF ALL APPLICANTS AND THE OUTCOME OF THEIR APPLICATIONS IS STORED IN A DATABASE FOR FUTURE REFERENCE. THE NUMBER OF ELIGIBLE APPLICANTS HAS INCREASED STEADILY SINCE THE PROGRAM WAS IMPLEMENTED IN 2006, DUE TO INCREASED PATIENT AWARENESS AS WELL AS POSITIVE FEEDBACK FROM ELIGIBLE FINANCIAL AID RECIPIENTS. DISSEMINATION OF THE REPORT TO THE PUBLICCOPIES OF THE COMPREHENSIVE 2009 COMMUNITY SERVICE PLAN REPORT CAN BE OBTAINED FROM THE DEPARTMENT OF PUBLIC AFFAIRS AT 718.206.6772 OR ON THE HOSPITAL'S WEBSITE: HTTP://WWW.BROOKDALEHOSPITAL.ORG/HTML/GENERAL_INFO/INDEX.HTMOTHER HOSPITAL ACCOMPLISHMENTS AND PLANS CAN BE FOUND AT HTTP://MEDISYS.TYPEPAD.COM/MEDISYS_NETWORK_NEWS/ARCHIVES.HTML PART VI, LINE 2: BROOKDALE HOSPITAL MEDICAL CENTER DOES NOT REPORT ANY SHORTFALL ON LINE 7 DUE TO THE FACT THAT THE HOSPITAL RECEIVES LARGE AMOUNT OF IME AND DSH PAYMENTS. BROOKDALE HOSPITAL SERVES A LARE MEDICAID POPULATION AND ALSO HAS A BIG TEACHING PROGRAM. IT DOES INCUR LOSSES IN PROVIDING CARE TO THE INDIGENT POPULATION WHICH ARE REPORTED ON THE OTHER SCHEDULES. PART VI, LINE 19D: THE HOSPITAL FACILITY USED MEDICAID RATES FOR THOSE SERVICES. X X X X X 0 0 0 0 0 0 0 0 0 ALVIN I KAHN MD 296456 0 0 0 1396 0 57756 0 5198 0 360806 0 0 0 DAVID P ROSEN 0 1378292 0 0 0 359673 0 57756 0 13616 0 1809337 0 0 LEWIS MARHALL 385008 0 0 0 1242 0 43317 0 15472 0 445039 0 0 0 RICHARD FOGLER 632439 0 0 0 244 0 45114 0 11179 0 688976 0 0 0 BRUCE J FLANZ 0 1091240 0 0 0 248903 0 57756 0 12409 0 1410308 0 0 MOUNIR F DOSS 0 1093356 0 0 0 289301 0 59969 0 12435 0 1455061 0 0 AARON REICHMAN 440919 0 0 0 540 0 28076 0 10830 0 480365 0 0 0 ARASH GOHARI 505639 0 0 0 354 0 0 0 15472 0 521465 0 0 0 ARTHUR FINK MD 444746 0 0 0 2322 0 45114 0 17371 0 509553 0 0 0 ERIC S MINKIN MD 473582 0 0 0 0 0 43317 0 17032 0 533931 0 0 0 MAYANK SHUKLA 526107 0 0 0 540 0 25670 0 13619 0 565936 0 0 0 FORM 990, PART VI, SECTION A, LINE 2 ALVIN KAHN, MD, TRUSTEE & CHAIRMAN, HAS A FAMILY RELATIONSHIP WITH DIANE SIMON, TRUSTEE. FORM 990, PART VI, SECTION A, LINE 6 MEDISYS HEALTH NETWORK IS THE SOLE MEMBER. FORM 990, PART VI, SECTION A, LINE 7A MEDISYS HEALTH NETWORK, AS SOLE MEMBER CAN APPOINT THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 AND APPROPRIATE SCHEDULES, AS REQUIRED (FORM 990), IS PREPARED BY OUTSIDE ACCOUNTANT AND REVIEWED INTERNALLY BY MANAGEMENT, AT WHICH TIME IT IS CONSIDERED THE FINAL DRAFT. THE FINAL DRAFT OF THE FORM 990 IS PRESENTED TO THE TRUSTEES VIA EMAIL AND OR A BOARD MEETING. ONCE THE REVIEW OF THE FORM 990 HAS BEEN COMPLETED TO THE BOARD'S SATISFACTION AND THE BOARD IS COMFORTABLE WITH ITS CONTENTS, THE FORM 990 IS THEN MAILED TO ALL BOARD MEMBERS AS READY TO FILE, SUBSEQUENTLY IT IS FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C DISCLOSURE IN ACCORDANCE WITH THE CONFLICT OF INTEREST POLICY BY EMPLOYEES THAT SATISFY THE CRITERIA TO BE CONSIDERED AN "INTERESTED PERSON" IS SUBMITTED UPON HIRING AND ANNUALLY THEREAFTER. THE AUDIT & COMPLIANCE COMMITTEE REVIEWS THE SUBMISSIONS FOR CONFLICTS AND THE DEPARTMENT OF INTERNAL AUDIT MONITORS COMPLIANCE FORM 990, PART VI, SECTION B, LINE 15 EXECUTIVE COMPENSATION POLICY - THE BOARD OF MEDISYS HEALTH NETWORK HAS CREATED AN INDEPENDENT COMPENSATION COMMITTEE WHOSE CHARGE IS TO REVIEW AND APPROVE THE COMPENSATION OF ALL INDIVIDUALS WHO MEET THE REQUIREMENTS OF A DISQUALIFIED PERSON FOR INTERMEDIATE SANCTION. THIS COMMITTEE IS EMPOWERED TO APPROVE COMPENSATION FOR ALL ENTITIES WITHIN THE MEDISYS HEALTH NETWORK SYSTEM. THE COMMITTEE HAS RETAINED AN INDEPENDENT COMPENSATION CONSULTANT TO APPLY ITS STANDARD METHODOLOGY FOR DETERMINATION OF APPROPRIATE EXECUTIVE COMPENSATION AND BENEFIT LEVELS FOR EXECUTIVES. IT IS POLICY TO TARGET THE TOTAL COMPENSATION (BASE SALARY, INCENTIVE COMPENSATION AND BENEFITS) OF EXECUTIVES AT THE MEDIAN OF THE DEFINED MARKETPLACE FOR SIMILARLY SITUATED EXECUTIVES IN CONSULTATION WITH AN INDEPENDENT COMPENSATION CONSULTANT IN A MANNER THAT COMPLIES WITH THE INTERMEDIATE SANCTION REGULATIONS AND OTHER FEDERAL AND STATE LAWS AND REGULATIONS. THE COMMITTEE SHALL APPROVE BASE SALARIES FOR EXECUTIVES AND ANY DISQUALIFIED INDIVIDUALS BASED UPON THE AMOUNTS PAID TO SIMILARLY SITUATED EXECUTIVES WITHIN THE RELEVANT MARKETPLACE, WITH POSSIBLE ADJUSTMENTS MADE FOR SPECIAL SKILL, EXPERIENCE, COMPETENCE AND PERFORMANCE, INCLUDING CONTRIBUTION TO THE SYSTEM AS A WHOLE. THE CEO SHALL RECOMMEND TO THE COMPENSATION COMMITTEE ANY ADJUSTMENTS TO THE BASE SALARIES OF EXECUTIVES. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS - CERTIFICATE OF INCORPORATION FILED WITH THE NYS DEPARTMENT OF STATE; CONFLICT OF INTEREST POLICY IS NOT PUBLICLY AVAILABLE. FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VII, SECTION A, LINE 1B: FOR DAVID ROSEN, PRESIDENT & CEO, MOUNIR DOSS, EXECUTIVE VICE PRESIDENT & CFO, AND BRUCE FLANZ, EXECUTIVE VICE PRESIDENT & COO, THE HOURS REPORTED REFLECT TOTAL TIME WORKED AS OFFICERS FOR ALL OF THE RELATED ORGANIZATIONS SHOWN ON SCHEDULE R. TOTAL COMPENSATION IS REPORTED ON EACH ENTITY'S FORM 990. COST ALLOCATION AMONG THE ENTITIES IS PERFORMED CONSISTENT WITH ACCOUNTING RULES AND APPLICABLE COST ALLOCATION METHODOLOGIES. ALVIN I. KAHN M.D., AND RICHARD FOGLER M.D., RECEIVED COMPENSATION FOR THE PERFORMANCE OF SERVICES AS A PHYSICIAN FOR BROOKDALE HOSPITAL MEDICAL CENTER. ALVIN I. KAHN M.D. AND RICHARD FOGLER M.D., DID NOT RECEIVE COMPENSATION AS A TRUSTEE FOR BROOKDALE HOSPITAL MEDICAL CENTER. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 2,411. CHANGE IN CCC INVESTMNENT TRUST 132,011. CHANGE IN MIN PENSION LIABILITY 9,066,150. TOTAL TO FORM 990, PART XI, LINE 5: 9,200,572. FORM 990, PART XI, LINE 2C: THE OVERSIGHT AND SELECTION PROCESSES DID NOT CHANGE FROM THE PRIOR YEAR. FORM 990, PART VII, COLUMN C: MANAGEMENT HAS IN THE PREPARATION OF ITS FORM 990 REVIEWED PERSONNEL IN THE INSTITUTION TO SEE IF ANYONE MEETS THE CRITERIA ESTABLISHED TO BE CONSIDERED A "KEY EMPLOYEE" FOR IRS PURPOSES. IT IS THE CONTENTION OF MANAGEMENT THAT NO EMPLOYEE FULFILLS ANY OF THE SITUATIONS UNDER THE RESPONSIBILITY TEST ESTABLISHED BY THE IRS TO MEET THE TITLE OF KEY EMPLOYEE. THEREFORE, PART VII OF FORM 990 DOES NOT HAVE ANY INDIVIDUALS WHO WOULD BE CONSIDERED A "KEY EMPLOYEE". 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