STATE OF NEW YORK
PUBLIC HEALTH AND HEALTH PLANNING COUNCIL
STANDING COMMITTEES
January 19, 2012
10:00 a.m.
90 Church Street
4th Floor, Room 4A & 4B
New York City
I. JOINT MEETING OF THE COMMITTEE ON PUBLIC HEALTH AND COMMITTEE ON
HEALTH PLANNING
Jo Ivey Boufford, M.D., Chair, Committee on Public Health
John Rugge, M.D., Chair, Committee on Health Planning
II. COMMITTEE ON ESTABLISHMENT AND PROJECT REVIEW
Jeffrey Kraut, Chair
A. Applications for Construction of Health Care Facilities
Acute Care Services - Construction
Exhibit #1
Number
Applicant/Facility
1.
112059 C
New York Presbyterian Hospital – New York Weill Medical Center
(New York County)
2.
112074 C
University Hospital
(Suffolk County)
3.
112259 C
North Shore University Hospital
(Nassau County)
Diagnostic and Treatment Center - Construction
Exhibit #2
Number
Applicant/Facility
1.
101018 C
Doctors United, Inc.
(New York County)
2.
112250 C
Smile New York Outreach, LLC d/b/a Smile Program Mobile Dentists
(Queens County)
Long Term Home Health Care Program – Construction
Number
Applicant/Facility
1.
112116 C
Dominican Sisters Family Health Service, Inc.
(Westchester County)
Residential Health Care Facilities Ventilator Beds – Construction
1.
Number
Applicant/Facility
111435 C
The Wartburg Home
(Westchester County)
Transitional Care Units - Construction
1.
112206 T
Exhibit #3
Exhibit #4
Exhibit #5
St. Mary’s Healthcare
(Montgomery County)
B. Applications for Establishment and Construction of Health Care
Facilities/Agencies
Acute Care Services – Establish/Construct
1.
Exhibit #6
Number
Applicant/Facility
112185 E
Inter-Lakes Health, Inc.
(Essex County)
Ambulatory Surgery Center - Establish/Construct
Exhibit #7
Number
Applicant/Facility
1.
111552 B
The Surgery Center of Bayside, LLC
(Queens County)
2.
112032 B
PBGS, LLC d/b/a Downtown Brooklyn Gynecology Center
(Kings County)
3.
112244 E
Unity Linden Oaks Surgery Center, LLC
(Monroe County)
2
Diagnostic and Treatment Centers - Establish/Construct
Number
Applicant/Facility
1.
101164 B
Mobile Health Services, LLC
(New York County)
2.
112142 E
Primary Health Care Plus, Inc.
(Nassau County)
Dialysis Services - Establish/Construct
1.
Exhibit #8
Exhibit #9
Number
Applicant/Facility
111234 B
Dumont Care, LLC
(Westchester County)
Residential Health Care Facilities - Establish/Construct
Exhibit #10
Number
Applicant/Facility
1.
101068 E
Guilderland Center Rehabilitation and Extended
Care Facility Operating Company, LLC d/b/a
Guilderland Center Rehabilitation and Extended Care Facility
(Albany County)
2.
112218 E
Waterfront Health Care Center, Inc.
(Erie County)
Certified Home Health Agencies – Establish/Construct
1.
Exhibit #11
Number
Applicant/Facility
102239 E
North Shore University Hospital, Inc., d/b/a North Shore Home Care
(Nassau County)
3
C. Certificates
Certificate of Amendment of the Certificate of Incorporation
Exhibit #12
Applicant
1.
BMA, Medical Foundation, Inc.
Certificate of Dissolution
Exhibit #13
Applicant
1.
Mary McClellan Hospital, Inc.
D. Home Health Agency Licensures
Home Health Agency Licensures
Exhibit #14
Number
Applicant/Facility
1640 L
Acute Care Experts, Inc.
(Bronx, Queens, Kings, Richmond, Nassau, and
New York Counties)
1956 L
Advantage Management Associates, Inc.
d/b/a Advantage Homecare Agency
(New York, Westchester, Kings, Queens, Bronx,
and Richmond Counties)
1678 L
Amazing Grace Home Care Services, LLC
(New York, Bronx, Kings, Richmond, and Queens
Counties)
1696 L
Diana’s Angels, Inc.
(Putnum, Bronx, Westchester and Dutchess
Counties)
1957 L
Evergreen Choice, LLC
(New York, Bronx, Kings, Richmond and Queens
Counties)
1668 L
Five Borough Home Care, Inc.
(Bronx, Kings, New York, Richmond, and Queens
Counties)
4
1733 L
Heritage Homecare Services, Inc.
(New York, Kings, Queens, Bronx, Nassau,
Suffolk and Richmond Counties)
1994 L
Independent Living for Seniors, Inc.
(Monroe and Wayne Counties)
1835 L
Longevity Care, LLC
(Westchester County)
1959 L
Stat Staff Professionals, Inc.
(Saratoga, Warren, Albany, Greene, Franklin,
Washington, Rensselaer, Columbia, Clinton,
Fulton, Otsego, Ulster, Essex, Montgomery,
Schoharie, Hamilton, Schenectady, and Delaware
Counties)
2004 L
Long Island Living Center, LLC d/b/a Long Island
Living Center
(Bronx, Kings, and Queens Counties)
2079 L
Metrostar Home Care, LLC
(Kings, Bronx, Queens, Richmond, New York and
Nassau Counties)
1875 L
ALJUD Licensed Home Care Services, LLC
(Nassau and Suffolk Counties)
5
STATE OF NEW YORK
PUBLIC HEALTH AND HEALTH PLANNING COUNCIL
COMMITTEES ON CODES REGULATIONS AND LEGISLATION
February 2, 2012
9:15 a.m.
90 Church Street
4th Floor, Room 4A & 4B
New York City
COMMITTEE ON CODES, REGULATIONS AND LEGISLATION
Angel Gutiérrez, M.D., Chair
For Emergency Adoption
11-27 Amendment of Section 401.2 of Part 401 of Title 10 NYCRR
(Amendment to Limitations of Operating Certificates)
For Adoption
11-27 Amendment of Section 401.2 of Part 401 of Title 10 NYCRR
(Amendment to Limitations of Operating Certificates)
For Discussion
11-24 Amendment of Parts 763 and 766 of Title 10 NYCRR
(Certified Home Health Agency (CHHA) and Licensed Home Care
Services Agency (LHCSA) Requirements)
6
New York State Department of Health
Public Health and Health Planning Council
January/February 2012
ATTACHMENTS
Acute Care Services - Construction
Exhibit #1
Number
Applicant/Facility
1.
112059 C
New York Presbyterian Hospital – New York Weill Medical Center
(New York County)
2.
112074 C
University Hospital
(Suffolk County)
3.
112259 C
North Shore University Hospital
(Nassau County)
BFA Attachment A
The New York and Presbyterian Hospital
Statements of Financial Position
December 31
2010
2009
(In Thousands)
Assets
Current assets:
Cash, cash equivalents and short-term investments
Cash and cash equivalents
Short-term investments
Total cash, cash equivalents and short-tenn inve.<::tments
$
195,947
287,348
$
265,763
66,330
483,295
331,093
394,553
421,427
54,041
22,522
55,192
18,709
Patient accounts receivable, less allowance for
1.lncollectibles (2010 - $189,417; 2009 - $192,342)
Other current assets
Assets limited as to use ~ current portion
Due from related organizations - net
Beneficial interest in net assets held by related
organizations - current portion
Total current assets
1,696
54,340
54,950
1,010,447
882,371
624,686
515,485
70
34,164
1,442
Assets limited as to use - noncurrent
Fundt;u depn:ciatioll
Capital acquisition under mortgage agreement
Capital acquisition under lease agreements
Mortgage reserve funds under loan agreements
Total assets limited as to use - noncurrent
Property, buildings and equipment - net
Other noncurrent assets - net
Beneficial interest in net assets held by related
organizations - noncurrent
Total assets
152,643
157,163
777,399
708,254
1,761,111
85,227
1,736,209
27,813
1,283,597
1,244,441
$ 4,917,781
$ 4,599,088
BFA Attachment A (cant.)
December 31
2010
2009
(In Thousands)
Liabilities and net assets
Current liabilities:
Long-term debt - current portion
Accounts payable and accrued expenses
Accrued salaries and related liabilities
Due to related organizations - net :
Pension and postretirement benefit
liabilities - current portion,
Other current liabilities
Total current liabilities
$
77,792
230,779
169,018
$
71,084
218,277
155,311
7,70n
10,000
10,531
111,774
110,408
599,363
573,317
T~ong-tenn cleht
751,262
801,145
Estimated self-insurance and other professional liabilities
Pension liability
143,217
141,113
136,708
143,605
30,062
35,033
7,767
111,946
9,699
112,179
1,784,730
1,811,686
1,794,091
1,481,988
Postretirement beneht liability
Deferred revenue
Other noncurrent JIamlities .
Total liabilities
Commitments and contingencies
Net assets:
Unrestricted
T~lIlpurari1y rt:~llh;lt:d:
Temporarily restricted - held by Hospital
Temporarily restricted - held by related organization
Total temporarily restricted
Permanently restricted - held by related organizations
Total net assets
Total liabilities and net assets
6,023
1,088,419
1,094,442
210,972
~133,051 __2-,---,7-,---87.:. .;:.,-,---40;.; ;2_
$ 4,917,781
$ 4,599,088
1,023
1,123,309
1,124,332
214,628
BFA Attachment A (cont.)
The New York and Presbyterian Hospital
Statements of Operations
Year Ended December 31
2010
2009
(In Thousands)
Operating revenues
Net patient service revenue
Other revenue,
Total operating revenues
$ 3,266,191
188,749
3,454,940
$ 3,049,625
171,567
3,221,192
1,585,323
413,772
1,079,796
51,416
209,800
3,340,107
1,489,980
373,155
1,048,087
35,939
191,997
3,139,158
114,833
82,034
Operating expenses
Salaries and wages
Employee benefits
Supplies and other expenses
Interest and amortization of deferred financing fees
Depreciation and amortization
Total operating expenses
Operating income
Investment return
Excess of revenues over expenses before accrual
of net medical resident tax rduuu
83,211
92,780
198,044
174,814
Accrual of net medical resident tax refund:
Excess of revenues over expenses
14,279
212,323
l'/4,tn4
92,610
91,109
7,170
312,103
33,800
299,723
Other changes in unrestricted net assets:
Distributions from New York-Presbyterian Fund, Inc. tor
the purchase of fixed assets
Change in pension and postretirement oenefit liabilities to
be recognized in future periods
Change in unrestricted net assets
$
$
l\E\'\' YORK-PRESBYTKRIAN HOSPITAL
Sta!"IJI"nt of Fi~JlIlcilil Position
As of JUlie 30, 201111~d Dl'Cember 31,2010
(In Thousands)
UNAUDITED
.... .
I,·
UabiHties arId net assets
Asse:'s
Current liabilities;
Current assets:
Cash and cash (:qui\'alcIlls
Short-krlll investments
$~23,439
371,871
S595,31O
PatiC;;::lL accounts receivable. net
(Allcr Cll1TClll ass""
A:-;~c~~ limited 3S t,) usc .. ~urrcul porlioll
Beneficial intercst in nct aSSCISlc1d by
rditled organizations-current
Due -from rcla1cd (organizations
Total
ellrJ"CIl!
$195,947
28',348
483,295
62:712
394,553
54,041
~2,207
:::522
58,874
54,34ll
419,(i07
.\ecounts payable ~nd :lCClUCd cxpenscs
Accrued salaIies and related liabilities
C un-en I p011ion of long-tem1 obligntiom
Due to relakd organizatiOIl;
Currcnt porti<'D of pension and postretir~t11entliabilitl'~s
Other currcnt liabilitics
S264.428
15l,846
79527
5,31.3
lO,OOO
113,963
$230,779
169.018
77.792
10,000
111,774
td
crj
>
L6%
asset,
;J>
1,01(1,447
1,158,710
Total currmt Habilitks
625,077
II
599,363
I
I
rt
rt
lD
('l
Lei~n'e i;,r
As",ts
Wl105C
UnckT debt
self-insUi :mce liabilities
144,549
II
143,217
I
§
I ro
:::I
usc is limited:
(lgrccll,cnl~
15~.,643
137,981
998
CapiLlI :-iCquisition under lease u.grcc11lcnt
Board designatc::d dcprc<.::iation j:l1nd
Postr;:ircnent bellefh liabilities
29,221
30,062
:\ccrucd penSion liability
133,465
141,1.13
Other long-kIm liabilities
142,180
111,946
6,545
7,767
732,109
751,262
1,813,146
1,784,730
1,942,068
1,115,309
511
219,161
3,277,049
1,794,091
1,123,309
1,023
21.4,628
3,l33,051
S5,{190,195
$4,9J 7,781
70
659)71
62~,686
7~8.350
77i,399
DefcrTcd
Total ,,"sels whost, liS" is limit"d
rCVC l1UC
Long-termoblig(~lions-~ks~ (:un\.~llt portion
Olher I lOll-current a~scts
Pr"perty, plant and cquipment, nel
S2~556
85,227
1,774,9S3
L76L111
Totailillbilitics
i'i ct assets:
V nreslrictcd
Asset, held by rehte(J organizlti"tl
In"/cstmcnts, l(~ss GJlTcnt portion
Pkdg:.:s weei vablc
Total 'lssets held b, l"Chled org:nization
Total mscts
-----
I
972-076
959 742
3,)3,520
1.275,5%
323,855
1,283,597
$5,O?H,195
1
II
$4,917,781 ..J
Temporarily restricted - hc:d by relakd
Tcmporarily restricted - hc:d by Hospital
Fermanently restricred - heki by related
Toilll nt'! assets
Total liabilities and net issets
I
I
rt
t;O
NEW YORK-PRESBYTERIA N HOSPITAL
STATEMENT OF CHAl'iGES IN UNRESTRICTED NET ASSETS
Jun.. 3(, 2011
(IN THOUSANDS)
UNAUDITED
p'"
····c'::,. ,/: ::::cL:RRt~1'i\l6::\!tll':~ >;::::::::<:.::,::: ",,]
C'c'" ,,,,. ):,:~.:.,., c::'T'i>~:y¢~~:r(I'(ii\'rr;>'::::'»<'
rn M~[l;AL"~:~J~El{ '1'\~\'~&~;i?N); ~~l?;lllIr~;tf:
,., "'{I]]
f~~l* \f:,~IV
EN¢(DEC),
HfVEi"lTJi:
$23J,57:::
S229.4{l3
S,L175
$22],182
512,396
11,347,038
$1)56,466
SI,105,942
$81,0%
Nrd (H1L]Ji!1-1~nt r~":t:nw::
{~6A50
(i4,~4(;
1,60-
6l,94il
4,5I1J
373,461
371,020
2,441
341U3~
32,62:;
OLh<.:[ [(''r.'t'Tme
11.c:i-H)
;0,174
2/.(1(L
1l,"59
1.38i
72,089
5~)25
13,36·1
(0,299
11,790
:3 t2/6S
304.423
8.245
29USI
I ~.2~7
1."92.5S8
l,n6,211
6,T71
1,6t7 ,079
115>50~
170.Hl
174,9n
4.2;.5:
15~,2jS
11.386
~
0/,715
'H.494
3.77~
t-P,222
~:{;t inpat~cfll re','en lie
Total n:,'enEU:
($9,42')
JD:T'FNSES
S~Jbries ~ll!d b~rLti.h
Sllpplk~;
[Ind oth.:-:r expen~c-;~
Dt'im'i.:.j;Jti()l1 i1nJ anlonization
19,232
19,232
. : Ul.:ll
';,l~S
'24~
,01;),645
1.057,408
28,76J
9f9.233
59,41:
tJ:I
(1,507)
525,041
54 l l,058
19,nll
5(8,80(;
Hi.23S
r»
17,7(J5
1,467
116,033
116,038
1\:7,132
g,~5(,
(649)
1311)
~5>105
26JI71
31,055
96~
24.002
1,111'
(31(1)
.f,7i7
5,17()
'15~
+,691
3,028
30,095
2Sl;':>1?
1~5.11U
8.76'
:n';'.9(il
il,3S6
29.7R5
l,724,r,H
1,271l
T(}1.31':;'(IH'n;)~·~
1,774,630
5nJlIo
1,639,318
85,1%
orFeH,\TlNG INCOME (LOSS)
2(d2f
9,313
",OC,
'1,<0
6,901
6, ,974
11 ,5B I
56.393
27,'GI
40,21:
fI1tt:n~q
Lcase~
and n::nl:!l:s
'Tl
j):>
rt
rt
P>
()
g
CD
::J
:'t'i(lr ye.:)l~
S~Ul<:;':fn~nt:
and
2:>:
126
~)tl;~r Ikm.s
1,13~'
3,087
(91 Ii
3.0S'
6,8~0
(3,19,)
rt
tJ:I
~--
/\I'JLS"l ED
OI'Ei~ATI:-;G ["iCOMIC
(i.aSS)
jn\o',~t;lmen1 hKOlJl<..'
26.547
9.3]]
17.13"::
2·L557
(9,047)
2,]{15
(I1,4U
OA41!
5,990
71,(161
11,531
59,4S11
34/>41
36,42('
(5561
35,105
16,21~
13,8i)'
(15,973)
51>O7~
73,36'
Ig.668
87A9~
'ilT GAI"i(LOSSj
li,SUD
l]
;67~
6,73
(W,901)
70,63:
:"5,927
120,S'~')
5.B2~
5,4-34-
106,166
(7.95:)
(:25.325;
17,373
6,731
':';,853
(4,6361
35,080
n
--,-~.
27,799
OIHf:!( OIANG,:S IN U:\HESTRICTEI) \li:TASSKfS
(7,95.::n
Ch:mg\' in ;:lddullmat tlllmm;!I11 p:n;;:ollliabih.y
Coni rlbul.lit1.:::; fi'(m N ,:,w 'y ()rk.I"J::sbyr.l;I'i~U1 FlmQ,
p~lh-,-h'l.:;l· \)f n"":Cl :.l~"~[:'
in,~.
fiJI" th.;
') :217
L\CREASE i (lJECREASEJ 1\
UNRESTiHCTEll ,\lET ASSETS
$1 i,!fi5
51 J.67S
,s,
(,'.406)
$18,171
N(-1(' - Exp~m.lit:m..~s ftJr donO! spec-ifit"d purposes Y"ere $J.2S2 for tilt, lI10nth and $29.437 year to dak. fur the same p~riod bst year the \';;.penditures \V~re $5A73
$147.977
f()j
0
P
.
rt
_._c._____
11,0(,6
,....,
.~~
$27,799
'<20,178
the month and S25,015 year to date.
$ID fJ93
o
$137.2~4
'.../
BFA Attar.hment: A
.STONY 13ROOKUNIVERSITY HOSPITAL,
STON"i BROOK UN1YERSITY
Balance Sheets
December 3J, 2DIO nnd 2009
(in fhdusm1(knfr1()Il(jrA~'
Assets
Cuncntassets:
124;772
CashiRntfcash heldbyfue State
ACCOP1}ts receivable. net ofaUowance for uncollectible .
. accounts 6lappr6xifuately$94,251 arid $'I1O,1081n
20 10 a.rld .2Q()9~.tespectively
140,55()
145,$5:4
4,(593
18;374
41336
11,771
Due frOlll.thircL-palty payQrs.
25;46.4
23,476
Current portion of appropriations receivable ~ malpractice
ASSt;t~ I,vhose u::;eis Hmltt:lq:
W,OOO
10,000
Inventories
Prepaid expenses and oth6:rcurtentassets
Intem~Hy de.sign~ted
Unexpended bond proceeds
34,000
10,997
Capi t~lizcd"leMc agreeri1el1t
7,5J3
Total
20,~45
638
Due from Clinical Practice Management Plan C'CPMP")
~UI1·ellt.a8sets.
341,054
Capital assets~ net
Appropriations receivable ~ malpractice, net of currenl p0rlion
Long-term patient receivables, net
Other assets
Due from third-partypayors
ASsets whose use is limited; net of cun-cut portion:
Internally designated
Total non-current assets
Total assets
$
364,995
349 l 9l6
151,.635
173,97&
8~900
9i 300
16,560
8;454
574
5,677
49,869
66,630
592,533
613,955
976,430
:5
==='==
BFA Attachment A (cont.)
LiilbiIhies and Net Assets
Current liabilities:
Current maturities of long-term debt and cHpitallease
obligations
;\ccounts payable, w~crued expenses and other
Accru.ed salaries and wages
Accrued employee benefits
2010
$
24,231
58,764
27,821
2009
$
29,269
2,694
Accrued interest payahle
Current portion ofestimated malpractice and general
llability claims
23,818
45,076
25.658
27,315
2,971)
10,000
DHc to State ofNc\v York
10,000
24,567
Due to Clinical Practice Management Plan C'CPMP")
Due to third-party payors
10,723
81
11,744
188,069
157,694
206)38
16,275
200,228
29,587
222,413
229,815
28,053
24,962
151,635
21,961
16,417
173,978
628,548
638,336
186,729
182,349
161,153
134,324
347,882
316,673
Total c1.lrrenl liabilities
11,024
L,ong-tonn debt:
Obligation to Dormitory Authority of the State of New York
Capital 1easc. obllgalions
Accrued employee bcnei1ts, net of current portion
Estimated malpractice and general iiability claims) net of
current portion
Due to third-party payors, net of current portion
Due to State of New ~"(ork, net of current portlOn
Total liabilities
Net assets:
Invested 111 capital assets, net oC related debt
Unrestricted
Total net assets
23,830
18,057
Commitments and contingencies (
Total Iiabi lities and net assets
.$
976,430
$
955,009
BFA Attachment A (cant.)
STONY BROOK UNIVERSITY HOSI>ITAL,
STONY BROOK UNIVERSITY
Statements dfRevenues, Expenses and Changes in Net Assets
Ycars ended December 31 , 20 I0 and 2009
(in thousands ofdollars)
Operating revenue:
Netpatient service revenue (net of provision for bad debts of
approximately $82,595 i1l201 0 nnd :ii76/WO in 2009)
Other operating revenue
Total operating revenue
Operating expenSes:
Salaries nnd wages
Employee health and welfare benefits
Supplies and other expenses
Depreciation and an1orliz~ltion
$
810,593 $
21,962
749,542
17,622
832,555
/67,164
388,106
365,725
140,181
118,047
241,482
261,840
38,978
Tot31 operating expenses
Operating income (loss)
Non-operating revenue (expense):
State of New Yark appropriations
Interest expense on capital~rcl(1tcd debt
Interest income
45,843
829,105
771,097
3,450
(3,933)
36,587
(l0,362)
1,534
48,085
(10,530)
1,105
~------
27,759
38,660
net assets
31,209
34,727
Beginning of year
316,673
281,946
End of year
347,882
'rotal non-operating revenue
Excess of revenues over
expcn~e5 and
increase in
Net assets:
$
316,673
North Shore-Long Island Jewish Health System, Inc.
Combining Statement of Financial Position -Obligated Group Only
Decembe131,2010
(In Thousands)
lota!
ObUgated
Group_~
_Eilmlnatlous
N"rth Shore
L<>og 101",,1
J.wish
Univen:Uy
Med1~~l
Ho.pltal
C.nt~r
Glen CO\:e
~
Ho,~_
Plaln..:lew
Hosp:!al
Forert Hill.!
Hmpltal
North Shore
Unlv....ity Hospital
Stem Family Cent~;­
for Extended Care
ani Rebabilitado-n
Assets
Current as.s~t5:
Cash and cash eqUlvaleD~
Milfkctatle securities and other
inve:irm~nlS
AccoulllSreceivable for s~rvices 10 patient - hospitalnnd cursing facilities, net of allowanc~ for
doubtfil1 accounts
'
Accountsrcceivc'lbJe for p:lysician practice scnrict.5, net
A.sselS linited a'i to use, c'J.rtem pott..ion
Orner CLUrent assets
Tolal curre[t assets
Due from nlfJliates, net
Asset~ llto.irAi
as to use,
Dct
o)f current portion
Other asse!.S
Current p"rtion of !ong.teIm debt
Cmrent p1l.rUOA of malpractice and other inmraoce liabllitie~
Current pilrtion of estim.aud payable [0 rh.ird-party payers
Total curren: liabilities
Due to .affilhlt'.$, net
Accrued retirement benefits, [let of Cl.l.l'T"Cnt po:tion
Capital1cas'1' oblfgatiorn:, Detaf current portiol
Long·tcnn ilibl, net of currert portion
Net ass.ets (ddicit);
Unresrrlct.xI
TempOJmilY re..,tricled
PermaneDQy restricted
Total net ass:ts (deficit)
TOlalliBbjJities and ne[ l1S&ers(deficil)
124,707
24,215
49,89]
23,585
774,]90
81l
163,650
398,433
58,038
1,395,322
132,995
11,7#
]0,09)
24,21»
495,26l
4,965
411,561
697,356
99,42,
l,709,583
-
(23,144)
$
S
l>O
76
109
10,514
12MI
2,8'2
1,365
2,)04
16,386
27,m
2,152
34,118
607
81,180
19,232
1
2,768
1,628
23,738
s
73
57,196'
t:d
3J~ _
S
73,841
38,6,5
8,]\9
50,0,0
335
InUI
S
1,713
51,893
1,133
~477
6,298
853
74
7,298
6,642
14,228
12,938
197
Lil,303
"':I
;J>
;J>
rt
rt
III
n
§
I'D
::J
rt
;J>
Cmrenl polrtlon ofcapitHllease obligations
liabilit,es
305,837
35,965
67,815
55,574
1,391,921
55;267
603,709
159,736
Liabilit1e~ lOud net a!sets (dffidt)
Curreot liabilities:
Shart-tcm borro'rVings
A~ountsp<lyable and accruea expemes
Accrued salaries aud relat~d benefits
Tot<l~
80,4lJl
236,829
3,4S5,O~.J_ _ -.1.._(2~!,1.±l)
Tota] .assets
Malpractice md other im~lraltCC imbilitzes,
105,829
445,157
1,2~,418
Property, phnt ilnd equ.ipmeBt:.lle~
Oilier longLterm liabillties
186,S48
140,182
Del of current p-orUc.n
15,54D
217,701
212,186
1,178
18,594
13,322
1:12,28]
7')0,804
$
S
(23,J44)
-
1~10,375
20,456
914,227
2J8,755
2'4,351
2,218,968
(23,144)
917,298
2:0,105
,8,680
I,J06,08]
3,4i5,051
(23,144) _$_
$
11,900
101,147
86,073
1.130
14,871
9,638
92,675
][7,434
$
18,201
41
6,57.
10,84'
67,203
262,954
77,679
6,157
240,875
103,979
83,386
829,510
507,600
40,550
17,662
565,812
1,395,]22 ~_
],64'1
95,439
77,32i
14,299
600,251
102,05~
_ _ ~~~
~ 1,151,511
2,701
881
5,795
]4,101
1,:78
530
9,431
35,182
13,M;
16,155
,,481
:,426
1',713
40,544
2:,,144
i,521
12,473
9,721
12,471
20,,48
7,,93
J7,,31
98,109
31,752
15,698
15,765
l2!,424
857
22,720
(17,3]9)
410
(41,124)
177
17,794
789
89~ __ (16,929)
~947)
18,583
S 41,]03
78,712
8,125
2,660
_~~~Q67
1,709,583
14,:04
10,039
81~~
389,655
160,054
8,358
~S
13,969
10,740
$
171~S
81,180
The combining schedules Q~ prf:SeJI/e.dfor .:upptementary i;ifprrnational purposes. Due to the effects ofiJjt~rco171pilny fran:acn"ons, 'Whi~h lire ~lit1Jinated ill combination, ~e schedules art not intended Ie present theflm:'hcin.l
position Dr results ofopernt:oJ1.S a/the. indiv.dual entities.
~1,895
H,029
_S__ 79,477
2,147
2,492
781
4,%5
9,885
3,950
8,028
North Shore-LJng Island jewish Health System,
me.
Combiring Statemmt of Operations - Ob-igated GrolP Only
Y far Ended December 31, 2C 10
(Ill Tho'isandsj
Total
ObUgated
Group
Long Island
Jewish
Medical
Center
North Shore
University
Hospital
EJminations
Glen Cove
Hospital
PJaimiew
Operating rcvC'nuc~
Net pathnt service revenue-hospital:md Ilursing facilities
Physkkn praclice revenue
Olher operating revenue
r~ ct alisef:s released from restrictions used for operations
Total openting revenue
Operating expenses:
Solarie'
Employee benefits
-Supplies and CXpCI1SCS
Bad deb: expense
Deprcci<ttion and amortization
In1cresl
Total openting expenses
Excess of opcmting
reVf.::ffilC
o....er operating expen.ses.
2,>54,343:';
409, i 49
66,899
14,275
3,444,666
S 1,278,968
212,068
(48,637)
76,581
L0,Q99
(48.637L
1,577,626
1,l16,SE4
156,913
33,121
__ -----'h266
1,3 J 1,184
1,593,947
446,085
1,096,428
53,757
136,649
36,364
3,333,230
(21,937)
707,526
185,975
523,492
33,526
48,176
14,457
1,513,152
1ll,436
29,838
(26,700)
(48,637)
:';
S
102212
:7403
2,953
Fons! Hills
[("pital
Hos~ital
:';
168,590
lL,527
1,412
s
'1ortb Shore
University lio,pill)
Stel1l Family Center
for Extended Care
and Reba bili!atin>
192,337
10,238
953
35,352
516
b:I
181,529
-'03,528
35,868
621,123
169,360
419,497
15,022
41,437
17,211
1,283,650
89,859
25,272
54,424
1,031
5,773
1,029
177,388
87,007
2'1,320
5:1,151
1,120
'.155
,252
18:,105
89,910
29,993
60,882
2,834
5,934
1,916
191,469
20,459
6,165
6,682
224
1,074
499
35,103
rt
64,474
27,534
5,180
:,424
12,059
765
;p
18,697
8,715
2,1J42
57
101
225
:P
:P
rt
rt
ill
()
if
(\l
:::J
,-...
Non-opcnr.ing gains and .losses:
Jr.lVe:;t((}(llt income
()
Change in nct uruealizeU gains and IGs-ics. and change in value of cquJty
o
::J
53,287
34,719
24,96J
Other non.---operating ,ga.trs and losses
Total non~{lpcra(ing gains: and losses
(5,251)
38,254
4,674
130,802
15,391
87
68,894
(5,251)
22,59)
4,503
55,511
5,563
84
142
376
309
Excess of .r;\'~mllC and gains and losses o,'er expenses
2n,238
133,368
83,051
10,743
1,566
12,435
1,074
Net assets Iekilscd fcom restrictions for capital asset acqLJisitions
Change i3 fair value ofintcrcst rate swap agreements dc:.fgnated as -cash flow hedges
RecDyery of faj r vaiuc of endowment co.r:Jus.
35,952
(1,405)
703
(8,248)
1,025
210,265
1,373
(506)
204
17,501
4,542
156,482
29,459
(8m
221
6,034
(108)
117,759
method investments
Change in fair value ofintcrcst rate S\vap agrccmc;1ls designated as
dcnva:J','c instrurnent~
Medical resident lax recovery
TITlllSfers (10) from affiliates
Pension and other postreth:ment liflbiIity adjustmeDts
Increl1.se (dc:crcas~) in un..rcslrictcd net assets
~
I P,2,568
$
$
-
S
3,521
2
I
84
rt
'-'
273
$
l,l49
178
(1,134)
11,636 S
3,271
(1,578)
(12)
$
(lI,783)
(238)
(16,315)
$
(359)
715
lYle comhillillg scheff/des are pre.sellte.(J for suppleme;ltary itifornlatlOnal P!il]JOSes_ DfJe fD the ~ffects of fnler,:omparly trallSJctions, which are elimina.ted in combination. (he schedu:es are not intmded (0 present the jillGlIcic/
position or results ()f operlJ-thms- o/the imfiv;dua/ entities.
BFA Attachment B
North Shore-Long Island Jewish Health System, Inc.
Consolidated Statements of Financial Position
September 30,2011 and December 31, 2010 (In Thousands)
Assets
Current assets:
Cash and cash equivalents
Marketable securities and other investments
Accounts receivable for services to patients, net of
allowance for doubtful accounts
Account:; receivable for physician aeli vitie:;, net
Assets limited as to use, current portion
Pledges receivable, current portion
Insurance claims receivable, current portion
Other current assets
Total current assets
Assets limited as to use, net of current portion
Pledges receivable, net of current portion
Property, plant and equipment, net
Insurance claims receivable, net of current portion
Other a:;:;et5
Total assets
Liabilities and net assets
Current liahilities:
Short-term borrowings
Accounts payable and accrued expenses
Accrued ~al",ies and related benenL~
Current portion of capital lease obligations
Current portion of long~term debt
Current portion of malpractice and other insurance li:lhi[iti,'"
Current portion of insurance claims liability
Current portion of tbird-party payer structured liabilities
Current portion of estimated payable to third-party payers
Totul current liabilities
(Unaudited)
September 30,
(Audited)
December 31,
2011
2010
$
$
$
418,103
$
1,039,124
584,075
48,116
100,514
41,024
10g,'BO
139,559
2,523,723
570,360
45,392
96,774
41,316
678,42J1
117,357
2,868,810
356,225
234,777
6,779,316
75,540
498,5 [9
405,764
4,820
49,828
123,261
2,326,480
757,038
120,[50
2,674,349
$
$
233,273
6,111,290
[5,540
508,288
369,976
5,008
48,R99
39,352
39,352
108,430
4,657
353,982
1,540,892
6,724
254,500
1,248,287
360,7 19
82,573
1,248,601
563,777
356,225
Accrued retirement benefits, net of current portion
Capital lease obligations, net of current portion
LUlig-lenn debe net of current porttOll
Malpractice and other insurance liabilities, net of current portion
Insurance claims liability, net of current portion
Third-party payer structured liabilities, nN of current p011ion
Other long-term liabilities
Total liabilities
410,253
1,083,902
442,298
85,400
1,283,339
502,826
31,200
34,592
427,923
4,611.910
409,703
4,006,445
1,745,492
297.589
124,325
2,167,406
1,677,074
306,053
12[,718
2,104,845
6.111,290
rnn1:rnitn1cnts and contingencicf;
Net assets:
Unrestricted
Telll1JOlarily restricted
Permanently restricted
Total net assets
Total liabilities and net assets
Sf-:e accompanying I"{ofes<
$
6,779,3 J 6
$
BFA Attachment B (cont.)
North Shore-Long Island Jewish Health System, Inc.
Consolidated Statements of Operations
For the Nine Months Ended September 30, 2011 and 2010 (Tn
Thom;~nds)
(Unaudited)
(Unaudited)
2010 (1)
2011
Operating revenue:
Net patient service revenue
Physician practice revenue
Other operating revenue
Net assets released from restrictions used for operations
Total operating revenue
$
Operating expenses:
Salaries
Employee benefits
Supplies and expenses
Bad debt expense
Depreciation and amortization
Interest
Total operating expenses
3,949,337
454,989
246,218
38,384
4,688,928
$
3,504,052
358,669
1t;5,426
36,168
4,084,315
2,229,279
651,563
1,395,275
84,947
],918,784
540,520
1,234,047
75,615
1RR,n??
160,088
46,296
4,595,982
45,814
3,974,868
92,946
109,447
3L,4U
17,116
(61,355)
39,080
(14,533)
(16,682)
7,271
(36,204)
448,689
2,646
490,849
Excess of revenue and gains and losses over expenses
56,742
600,296
Net assets released from restrictions for capital asset acquisitions
Change in fair value of interest rate swap agreement:> designated
as cash flow hedges
(Loss) recovery of fair value of endowment corpus
$
Increase in unrestricted net assets
13,507
9,681
(1,059)
(772)
(2,733)
320
607,564
Excess of operating revenue over operating expenses
Non-operating gains and losses:
Invc:-;tment income
Change in net unrealized gains and losses and change in
value of equity method investments
Change in fair value of imerest rate swap agreements
designated as derivative instruments
Contribution received in the acquisition of Lenox Hill
Hospital and Subsidianes
Other non-operating gains and losses
Total non-operating gains and losses
68,418
$
See au.:oll1panying notes.
(1) On May 19,2010, North Shore-Long Island Jewish Health System acquired Lenox Hill Hospital and
Subsidiaries. The results of Lenox Hill Hospital and Subsidiaries' operations arc included in the Consolidated
SlMf'1l1f'nt of Operations from th1s date.
"ortll Shore-Long hland J,wish Hellith System, Inc.
Consolidating Statement of FinaJldal Position
September 3~, 2011 (Unaudited and III T:lOusnnds)
:--iorth ShoreLr,ng Island
J e,-ish Health
S):.:teml Inc.
Total
~iorlh
Eiimin.atlons
Shore,
Long [sland
Jelrish
Obligated
Group
Hospict
Care
i'[etwork, :nc.
The Fei Ilstein
Jnstilut~ for
?'tIedical
Real Estate
Rcsca:ch
Companies.
:-iorth ShoreLcng Island
Je"';sh Health
System
Fourldat[oIl~
Inc.
North Slwn;·
Long Island
Jewish Health
System
Laboratories
North Shore
Health Sysccm
Enterpris~s,
Insunnce
Inc.
(Combin<d)
Comp.anies
(Comb:ned)
Olher
Health Sy'stem
Entities
Assets
CUITclH a5SelS:
Cash ;:nd ca5h el..):uivalems.
Marketable s(cnnties and ot~er in ve~hncn1S
Accounls rec~iv~lbic for services 10 patients, net of
aHo\~'nnce for doubtful aCCDtmls
Accounts rec-eivable for ph)'sician activiLies, net
Assets limiter <n to use, current ponion
Pledges r~cel"abk, cmr~nt p,)nion
Insurance claims reccivabJc> "::urrent portion
Othc{ cu rrent assets
Total currCIJI CEsset:.;
Due fl'Oll1 affililtes, nei
A:ssets Ilmit~d as to U:i-C, Het ofcUITcnt portion
PleJge-s rec~i\'fble> net of CLHT,~n! portion
Propeny, planland c'1oipmenl.net
lmurancc claim; receivable, n~.t of -current pOltiun
:)ther i-t:');;.ClS
1'01,11
as;;et~
$4IS,103
1,083,902
534.075
48.116
100.514
41,024
108,430
139.559
2,523,723
678,424
117,357
2,868,310
356,225
234.777
S6,779316
$-
(16,916)
(16,916)
S335,7m
1,048,8,5
$13,935
4,H3
566,239
39,.+31
100.514
1,614
124,713
117 163
2,334,339
5,058
$33
$686
;02
'94
350
~·::H~52
(262.690)
( 186,502)
135,544
669,964
2,2)9
2.768,095
(83,318)
(64,904)
(5614,330)
437,0~5
1,631
:36
1,:48
,61
256,753
S6,603,999
::25
528,:53
125
13,950
14.108
4
1,087
un
$21,924
12,939
37,859
19
G8
72,809
1-
$1
7,30"
5.D16
81
208
915
6,140
61,396
489
SI3I,749
20,727
15
471
$22,990
$25,227
332
453
8,685
1,449
1,97S
9,369
Z99
5;.756
$;0,550
17,300
38,874
113,280
620
74
7,341
317
,13
$125,657
$17,027
$8,)20
555
38,405
3,492
39,640
126,484
91,876
363
9,825
1,302
5.515
9
254
$56,908
768
41,978
$29&,743
t;l:I
>-:rj
~
~
rt
rt
~
D
:T
S
ro
;:I
rt
Lii..lbiHtics andnet assets (deficit)
~tllTcnt iiabili!i::-:s:
Shorl-tc-fm borrowillg~
Accounts payrbIe and accrued expenses
Accrued salaric:; and related benefits
Current portio;l of capital Ieme oblig.-:tion::;
Cllrrcnl portiol of IOllg-rcrm ~kbt
Cllfrent ponro 101' malpractice and other inSlnlllcc liabiJitles
CIHli?,nt pOrtio1 of insurance claims liability
Cum:-:llt ~lorlio] of third-parlY payer structureJ Iiabiliries
Ctlrrt::nt pOrtio] of estimated. ray,tblc to third·pany payers
Toril] ('urrc-ml!,bilitks
t;l:I
S75,5~0
498,519
405,764
4,820
49,828
39352
LOS,430
S[,OS5
Dul' to afhIi"tc,<,;
Accrued [cliJen-ent benefits, n.c:! of current pOItion
Capil<'t] lease obligatiDJls, net af current portim
Long-tenn debt, net of Current ponioH
:.f;:Jpr~:ctice and other insunmce Eabi!i(i~s, net of CUJ'r'ellt P')r1iJD
rn~urancc claim; liabillty, !let of current portio:!
','hird-pany payoel' structured Hobilities, nd Df current p0r~i01l
Other lung-term liabilities
1,248.60l
563~ 777
(27,755)
(16,916)
Total liabilities
'~.611.910
1,745A91
297,589
124,325
2,167,406
56.779.316
(43,586)
1.~88
$1,614
4,530
S3.663
146
S165
634
$
11.266
4,339
$3,147
1,1)12
$1,682
$3,070
()
6,5~0
::J
45
49,S:8
3S.--!C7
124.713
4.657
352.+11
194
125
4
19
81
208
lA97,734
5,211
12,269
3.813
818
500
16,186
5,61
JO
44.740
8,152
856
1,329
fl24,629)
31,700
"9~
2'~7
3),382
9.904
69.522
8:::,132
82,573
(6,922)
(111,453)
183,318)
441
6,922
1,2~8,601
433,1S7
437,065
242,043
751
489
15
74
317
1;13
63
17.895
5,\74
27:,425
(868)
2,[46
23,318
(863)
SI7,027
2,046
$8,02D
23,318
5298,743
31,100
31;200
427,913
1369.9(8)
42>,879
4,513,517
'.J4
6,)46
103
5;,601
262
12,241
3,893
5.646
(55.501)
(t69,467)
(19,454)
(244,422)
(8614,330)
1,]49,19,
286,701
54.585
2,O90,48l
86,603,99;
t9,836
1.793
3'8
2" ,007
528,553
1"-499
23,234
36,415
74,148
$131,749
10,748
23,716
148,295
48,000
22D,011
__$225,657
174
86,972
Commitments and conlin,gencic."-,
:-~'el
_assds (deficit):
Umesrric(cd
Temporarily re.-.tricrcd
Peml~U1cJ]lly rcs!ricted
Total net <ls:sets. Ideficit)
10131
~iabiljties
md [lei
L1..~SCLS
{(dicit)
0
rt
'--'
3W.719
360.719
356.225
$3.529
,-L7IS
~t>6:57
35'.98"
1,)40,892
S75,5 e O
463.2'8
387,0;5
10,748
S22,990
(41,497)
7,033
4,400
(30,064)
$56,908
l'iorth S110reLor1g Is1and Jell'jsh Hearth
Sy~lem,
Inc.
Cumbining Slatement of Firulhd~l Position· OlJljgated Group On\,.St!-llem1}('r J)~ 2011 (Unaudited and In Thousands)
~orth Shore
Vniversity
Hospital Stern
Family Center
lor Extended
Norlh Shore·
Long lsl'oi
Tohil
Obligaled
Group
Eliminations:
Jewish
Health
.1\orth Sho;,e
C4:lre. Inc.
Hospi_t~_1
t:nh'~TSit)
Long IsJan::l
Je\tish
!\.tedical
Center
Gll:n Co¥-e
Hospi~_
P~ajnview
HospiM
Forest Hills
Care and
Bun[jngton
Hospital
Stalen Istand
Fnmklin
Assuciation _ f:lo5pital
_tJt)sflita~b~bllitatio]~
Southside
Hospi~_
UlhersHy
Ltnox lliU
Hospit::l1
Eospi"tal
As~ct~
ClJrr~nt
a,Sscts.
Cash and cas] equivaleJ1ts
:-'larkctable :;'~i.:1.lri[ies 2nd oLher investll1em~
AO:OlJnt:'. reC'2:l-..:abk for "icrvices to p:.lClemS ~ llDSpiLal il.:ld
[ll.n~lng
faciIi[ics-, nel of allO'\'illlce fOi rJQUblfuI aCCOllllt.:;
AccmllllS rcc:'l\'<cblc for phy_~ician practic~ ~er\iccs> net
Asset:. lim] LE:d ;is to USc, curre1t pD!1ion
Pkdgcs rccc.i~"able. ClllTtnt p,nion
rrJ~urancc cl.:HJ1JS recei\.'rlblc, current ponioo
Other current .1SSttS
T O[,tl Curn~1li a:i-SC!5
5335,781
1,04S,885
$-
566,23~
61
39,431
100514
1,611
124,713
l17,16J
2,33433')
O,OOJ)
0.001)
8A"7
i5,47J)
O:he:- <lS5-cts
256,7~~;
(j42.3J9)
a~<;.er,
,6,603,99 0
(5500.71>9)
Pkdge,) rel..:elv,lblc,
t"l~l
of Currelt pDllion
Pmpeny, pl;u~laliu equipment, ~el
Insurance clains rec-eiv<!b1e. m:' af currem ponioll
Tow:
Liabml}es and net assets
$123,165
438,0)3
5107,87~
$118
21J.17~
54,71 7
146,943
143.51 !
lO3~.f.
17,35,
16,98,
53,5~2
417
7,9"9
135,544
669,96+
2,239
2,76S,095
437.U65
Due from illTibues, net
As~ets limiLl:"d LIS to use, lIet of 'UiT~Jlt port~on
5W
35.6~3
32.6:9
840,3,4
38,5~3
122,0--;6
~S7.1(6
':37.0~9
1,634
597,137
$794.331
123.H8
57.318
$1,618,6C8
$266
55]
$264
$1,291
I !l.751
$189
$723
1,961
$99,364
54,530
52,449
164,719
10,967
1,047
2,970
14,526
1,451
9,065
25,729
3,054
26,208
6571
3,132
69,307
943
8.723
492
1,166
86,121
1.590
20,073
2,192
3,145
6,863
29.567
25,053
568,519
3,681
3,>67
76.867
3,924
2.795
24,552
4,251
1.612
31,346
155
88
10,515
4,235
4,926
150,986
4.519
3,015
I8,I0-!
8,291
8,256
55,142
18,000
275,300
7,087
1,614
12,000
>0,031
277.207
9.450
362.711
44,872
5,541
26,290
2.921
5,392
6,934
14,907
3,793
24,464
812.19:
102,393
98.163
$1,953,438
49,191
12,806
J4,217
13,677
624
5102,281
47,281
14.809
1,092
599,920
12.827
609
182
$45,974
6,170
21,015
767
114,223
14,842
898
5308,901
39,372
15.692
865
100,976
29.593
2,754
1212,929
48.541
675
228,935
62,622
6,935
%23.008
8,725
58.592
797
704,677
45,200
32,823
51, 12g.021
:!S1
51 S9,558
,~77,826
IOA22
Current panic-r. of long·lenn debt
Current POrt l'C:n of ma1practice and other in~ur.1J1C"C liilb~li~ie~
(urrerH portiori of insurance {b.ims liability
C\ll1"~nt porrii.J!l. of lhird·pafiy pycr .sU'ucItJ:red I:abilities
Currem portim of esti milred p~)·uble to tbird·rarry payers
To:a] nHcra jiJbililic:s
$75,54('
nN of (';llfTCflt ponion
j,
$-
463,29~
73,63i
3S7,07:
4.77'
38.72-llAB
(6:)
49.S2~
35,407
4,657
352,44 I
1,497,734
360,719
82.132
1,248,601
433,lS7
437,065
31,200
.122.879
4,513,517
57.5OJ
102,5OJ
i06,25~
1.13D
15,82~
124,713
afiiJj:l,!l"~
Acc.::nJcd (ctirc[llent benefils, :JerofClJrrcrJl port:OrJ
Capi!l1.J !t:4J.se l)tltga!LOJlS, net of ~ll\TCIlt ponion
Lnng·rwn dcb~, net of (;urrerH p-)11ic}H
Malpr~nicc- ,1r1~ o[h~( illwr;lm::e tiabiLitle.:;, llet ofcurrcnl pmttQJl
Insurilnce diiirrs liabiE,y, net ofcum:lll ponion
1ii.lb,:llle~.
417
12,216
512,974
10,795
$9,472
16,1l3
2,670
887
3,631
1,166
530
3,924
2,4&4
1,426
4,251
515.3~3
$2.6~6
$-
2,254
18,932
18,228
781
2.iSO
155
1.1l8
4,235
$10.594
14,327
$22.854
21.046
995
1.045
4,519
2,535
1,535
8,291
112,255
400,771
97,751
386,240
7.670
42,467
15,8,9
45.238
11,232501,978
4.361
10.197
11,142
55,835
10,208
41,688
20,785
77,046
8.S6~
S1.~31
55,407
9,869
12.762
7.056
921
3,050
63,897
30.749
481
29,689
23,956
74,14!
5.27+
236,420
113,601
1~,263
59..\..539
102,393
31,673
13,614
14,809
39,095
11.139
123, lS~
20,840
7,571
13.677
8,025
1.634
12,477
10,170
12,806
609
14,R~2
14,395
14,641
15.692
46,495
18,182
29,593
4.87]
2&-UT
S3,47S
lOS.6J 9
1.366.50.\
12,5 13
100.302
17,239
1,0-14.174
17.327
15,772
138,823
857
22,738
15,793
200,601
12,560
130.206
19,779
244,740
516,36'
416,743
161,833
8,3<8
586,934
$1.953,-138
SL61S
4,971
2,667
89,256
5 1~9,558
( 15,456)
410
(39,080)
177
22.502-
i53.730)
1,337
1~7,153)
(15,U46)
$102,281
(38,903)
$99,920
23,'36
$45.974
103,122
3,J55
1,163
108,300
$308;901
i6;)
114,lSl
(131.607)
60,6n
(19,995)
(l5I,67])
9,638
35,673
568,04C
9U,77'
81.60S
4,
7,61,
10,841
29,567
!O5,0~3
~
$-
$,
TOI'l.I
lEfl.btli[it:~
mrJ net ",ssds {ddlc[t)
Pi
(l
1.74:;,195
286,70 I
54.586
",090,482
SD,6UJ,999
(45,6051
,61.38,
45,60;
(22,9591
22,95~
17,901
529,9·fi
574,4Jo::
$794,J~4
$1,618,~OE
(330.5521
1399,1161
(S550,7091
..tOJ69
734
15,342
13
152.380)
$77.826
(31,811)
SH2.9Z9
:::J
("'t
~7,42S
56,148
38,178
1,553
9,548
3,928
18,000
4,657
25.951
149,243
2.7.332
to
698
4,028
(l
~A59
12,()00
15,237
119.902
3,441
4,057
95,979
52,909
62,622
31,200
42,615
442,066
170.204
9,254
1,484
180,942
~62J,008
0
>:l
.
("'t
100,071
4.395
148,663
86,1 17
45,200
~8,784
593.J32
Commitmems and cOlllingencie.:;
0Ct il:;.selS (ddl,ir}
lJri:-eslrJcttd
TC(;1pL)r:Iri.~y rtstricted
I'e!lllilre:l:ly n:SLr~CEeJ
TNa! nel a~ser_~ :dcilcit)
("'t
("'t
ro
Sbon-ttrm bcrrowings
ACCl)lHm p:J.y~ble 21ld accruedexptmcs
Acc~cd salarit:-s and reialcd berJdH.:;
OHc:ll ponicn {)r c<tpilill h~O--st: obligations
TJlird·p-'1I1,Y pay~r structured
Oihe.:- !ung-tcm lir:bi1ilie~
Tota! tiabiri6!.\;
:J;>
§
(den~it)
Cun"cnt liabHi!.es
Due to
td
bj
:J;>
'62,570
~9.119
23,000
514,689
$1, I 28,021
'-'
:\orlb Shore-Long Island .I e"ish Health S),tem, Inc.
COllsolidoting Statement of Opera!i oilS
For tbe "inc Mmlbs Ended September 30,2011 (Unaudited and In Thousands)
1'\>rtb ShoreLong Island
Je,vish Health
System, Inc.
Total
Oper.at~ng
Eii mina lions
Long Islalld
Jewish
Obligated
Group
Hospice
CHe
~etw(l-rk, Ene,
The Feinstein
Ins:itu.e for
Medical
R~S"ear("h
Real Estate
Companies
:-;orth ShoreLong Island
Jewish Health
System
Fawn] ation l 1m:.
North Sh~reLong Isl&nd
Jewish H'altl'
S)'stern
Laboratories
Nortt Shore
Health System
Enterprises,
be.
(Combined)
Insurance
Compani.es
(C.mbined)
Other
H'alth Systerol
EntLtics
revenU{':
Net patiem scrdce reyenu~
Physic-jan practice revenue
Other ope.rating rtvcnne
Net assets rclCfsed ffom ft2:slri,:tJons
Tl;"tal D~raling revenue
us~d
53,949,337
454,989
246,218
38,384
4,688,928
for )perations
EmpJoyee benefits
Supplies llnu opens"Cs
Bad debt expellse
Dcprcci;Ition ani amoninltioll
Intere;;(
Teial QpeL'aling c:\p.~-nscs
Ex:::cs~ (deftden(:~')
($4,859,
(J 21 ,S64~
(126,723:
S3,892,207
405,849
11:',342
2(1.881
4,43:.279
535,313
$316
525
41,596
]7,041
58,953
20,905
84,010
416
38,514
20,905
84,010
23,802
38,514
2, I L(i,43S
611,178
1,2SS,209
84.167
18(,766
J2,527
2,774
17,892
50
398
31,669
9,622
21,664
1,411
463
17,527
4,063
J,477
3
20,881
30,867
&,556
36,984
466
1,250
13,445
3.479
7,386
265
154
78.123
24,729
24
5887
35.838
S-
$
$-
$23.386
$-
$2,974
49,L40
68,774
462
121~
Cd
Operating expen~t_s:
SaJaries
of operating levenue over Of crating expenses
Changejn net 1l1rcnIized gainscmllo:).'ics (':nd :hange in
equity methoc i IIvcslmell ts
Chang!; in fnir \allle of interest r{lte
(120,316)
4,128,990
33.641
67,018
92,946
(6,407)
101289
2,197
(8,065)
(28,179:
(2,659;
(89,475;
0;
4E,232
(927)
38,730
38,730
(216)
57,lOl
11,150
55,358
2
514
61
124,L86
(2,836)
~~\,'a]J
gi.lin~
29.lO2
76
30
(61,355)
(59613)
(242)
(24)
200
3,005
~
~
rt
rt
(ll
n
::::r
El
ro
:::J
rt
and
lDs~;es
o-,,-er expcns;s
(343)
as CJsh flow hetlgt:s
of (air value (If endo\'.-ml:111 corpus
(14,533)
7,271
(36,204)
1,495
1,495
(14,533)
9.847
(35.197)
56,742
(4,912)
68092
.
'..../
500
334
2.53J
(4,625)
(5,55S)
6
(8,059)
13.507
9562
3.945
(1,059)
(772)
11 059)
1632\
(5804)
3,897
Tramfct"s (to) from .::.ffilii:\lCS
fncCflse (decreasc~' in unrestricted net aSjCIS
n
:::J
l"t
24
(5,55~:)
54
2,716
5,887
(927)
(2J6)
(120)
agreeJllmt~ dcslgnated
Lo~~
,.-."
0
(1,J3J)
agn::-enlcnts desigJ13red
<:Isseis re1ea~ed from resu'ietrrns for capilal a~set acquisi[iol1~
C!J;lnge in fair valle of interest rille swap
32,413
\"a~ucof
as derivalive instrumenl~,
Other nOll-operating gains and !o~ses
To"nl non·operMing gail1s and los~es
Excess (de£lciency) of revenue: anJ
fTj
2,229,:'79
651,563
1,395.275
84,947
18S,622
46,296
4,595,982
Cd
:'{r.n-op-eratll1g ~ains <Ind losses:
!nvestmcn! tnccme
~c-,
~orrh Shere-
3,576
568.41 S
(51.336)
$70.159
(14(')
,2531
(5217)
(242)
(S218)
(5,135)
($5.698)
$,52
($927)
2,001
1,907
$J,785
$1,787
BFA Attachment C
North Shore University Hospital MaternitY/OB Renovations-Expenses- CON 112259
Current Year
Operating
Capital
Total
Inpatient
Discharges
Cost per Discharge
$43,348,000
$5,253,500
$48,601.500
6,542
$7,429
$45,846,000
$11,240,000
$57,086,000
6,810
$8.383
$46,489,700
$11,153,100
$57,642,800
7.000
$8,235
First Year Budgets-Incremental
Operating
Capital
Total
Third Year BUdgets-Incremental
Operating
Capital
Total
nz<II
If)
~~
:.::.~
~~()?",,1i)r ~ P~"~)ft1
CA)f,-~'_~;1n~tl[ji1
-<
('}
(;)
~'
r
()
[}j.
~.)
Proposed Organizg.1.ion Chan
North Shore-Long Island Jewish Health ~ystemJ Inc.
L"!
~5r
~,..,.,
it: l~
Juru; 27, 20ll
@o
kLfe
;:"o~c~h SI10"("-~;.;' 0~:::ra~~ J:~ns~, '1
,_
&--'
~-=
_
:tl'~
';;-~'
''''",,'j
ti
s·.......,
V;;$V'ij1l
Health System l Inc.
=".....
~I
_'l'll~~=_
~
"C
)11.';:
"t:! '"
's:. S'
...
0" (ii
.
~ft"
I\l ::
"'*
{'f
;:j
j
}- ----~-i
.~. -~-~.~.-~~,~
____.-1.. _
_.....,
Ii
1North Shore
;
~"
=
it
Long Island
Hl1alth Care; inc.
--=--,'"
,
a
J~lJh
I
!
~....--r._~
6]
r::.:
-;:::t~ r~nca;e~
"~
'i';,,:··
:
Inc.
I
•
i~_,-"""""",~
".:\~,
,>;':"F (,(
'.
i'"~~'J L~ r·;=J L=J l.···-'
,. ::,\.'
~
UO',lfl.',k
J
_I
/
,:,:/~~,=\
1,:\ ..."
HOSPt""~J
\,.
\,
'L......
I
CHHA
i"-,
.
r-;-;/ \
I f
.... \b~1I;
,
i I ~=
Hoop1m!
I
._J
5t
t.d
Cl:j
~
tJ>
rt
rt
III
()
§
ro
::!
rt
t:J
1
=~l
C
.."
:t
North
W Labs, Inc.
~~
~1d9 t
I~;u t
FmnlltJm
H
!_J!
rJ--
If;:,
'\1en~~ed
Cllro
'.~.
.\.-....
r.!\~'" •
New York State Department of Health
Public Health and Health Planning Council
January/February 2012
ATTACHMENTS
Diagnostic and Treatment Center - Construction
Exhibit #2
Number
Applicant/Facility
1.
101018 C
Doctors United, Inc.
(New York County)
2.
112250 C
Smile New York Outreach, LLC d/b/a Smile Program Mobile Dentists
(Queens County)
101018 C
Doctors United, Inc.
(New York County)
There are no attachments for this project.
BFA Attachment B
Smile New York Outreach, LLC
Pro-Forma Balance Sheet
Beginnning
of Year One
ASSETS
CURRENT ASSETS
Cash Balances
$
Accounts Receivable - Net
TOTAL CURRENT ASSETS
$
944,182
$
944,182
CON Fees
$
6,673
Equipment (net of depreciation)
$
849,657
TOTAL OTHER ASSETS
$
856,330
OTHER ASSETS
TOTAL ASSETS
$ 1,800,512
LIABILITIES AND NET ASSETS
CURRENT LIABILITIES
$
TOTAL CURRENT LIABILITIES
$
LONG-TERM LIABILITIES
Capital Leases
$
Working Capital Loan
TOTAL LONG-TERM LIABILITIES
$
429,274
$ 1,199,971
770,697
TOTAL LIABILITIES
$ 1,199,971
LLC CAPITAL
$
TOTAL LIABILITIES AND LLC CAPITAL
600,540
$ 1,000,512
BFA Attachment C
ReachOut Healtllcare Holdings Inc. and Subsidiary and Consolidated Affiliates
Consolidated Balance Sheet
December 31,2010
ASSETS,
CURRENT ASSETS
Cash and cash equIvalents
Patient accounts receivable, net:
Inventory
Prepaid expenses and other current assets
Total current assets
$
4,840,433
6,828,662
1,897.288
3,234,148
16,800,531
PROPERTY AND EQUIPMENT
Dental equipment
3,187,064
Other eqUipment and fixtures
1,692,416
Vehicles
1.1.95,306
6,074,786
Property and equipment
OTHER ASSETS
Deposits
Deferred financing costs :
Identified intangible assets I
Goodwill
Total other assets
Total assets
41,370
3,574,545
49;546,495
114,634,234
167,796,644
$ 190,671,961
BFA Attachment C (cant,)
LIABILITIES AND STOCKHOLDERS' EQUITY
CURRENT LIABILITIES
Accounts payable
Accrued payroll and other;
Current portion of long-term debt
Deferred tax liabilities
Total current liabilities
DEFERRED TAX LIABILITIES I
REVOLVING CREDIT FACILITY:
$
1,339,785
6,742,686
1,500.000
62,000
9,644,471
12,115,000
1,400,000
LONG-TERM DEBT, less current portion.
58,500,000
STOCK APPRECIATION RIGHTS
300,000
81,959,471
Total liabilities
COMMITMENTS AND CONTINGENCIES.
STOCKHOLDERS' EQUITY'
Common stock, $0.01 par value; authorized 7,500,000 shares;
issued and outstanding, 5,841,126 shares
Additional paid-in capital
Retained deficit
Total ReachOut Healthcare Holdings Inc. equity
Noncontrofling interest in Consolidated Affiliates
Total stockholders' equity
58,411
111,046,327
(2,425,455)
108,679,283
33,207
108.712,490
$ 190.671,961
BFA Attachment C (cont.)
ReachOut Healthcare Holdings Inc. and Subsidiary and Consolidated Affiliates
Consolidated Statement of Income
Year Ended December 31,2010
Predecessor
Net operating revenues
68,312.726
$
Operating expenses:
Salarie:>,
benefi~
and contracted services
38,755.880
Dental supplies
2,623,650
General and administrative
Provision for doubLFuJ
18,733,205
accoun~
4,024,965
Amortization :
2,766,947
Depreciation
Total operating expenses
1,772,485
66,677,132
"
Operating loss
(364,406)
Nonoperating expense:
Interest expense.
Amortization and write-off of deferred financing costs
(5,859,264)
(2,180, '199)
Loss before income taxes
(8,403,869)
Income tax benefit
(1,196,365)
Net loss
(7,207,504)
Less net income attributable to the noncontrolling interest in
Consolidated Affiliates
(278,700)
Net loss attributable to ReachOut Healthcare
Holdings Inc. and Subsidiary
$
(7,486,204)
$
(2,425,455)
$
(2,425,455)
Successor
Operating expenses:
Professional fees and transaction costs
Income tax benefit
Net loss
ReachOut Healthcare Holdings Inc. and Subsidiary and Consolidated Affiliates
Consolidated Statement of Stockholders' Equity
Year Ended December 31,2010
Additional
Paid-In
Capital
Stock Issued
Preferred
Common
Balance, December 31, 2009
$
276
$
31,209
$
35,010,710
ti
Total
. Noncontroling
Retained
Eamings
(Deficit)
Interest in
Affiliates
1,754,677
$
247,268
Stockholders'
Equity
$
37,044,140
t:d
Stock based compensation to fully
"'i
vest outstanding stock options
-
·
-
-
368,346
368,346
Sale of 120,110 shares of common stock from
stock option exercise
Redemption of 3,241 ,072 shares of common
stock
Redemption of 27,606 shares of preferred stock
1,201
·
(32,410)
Fair value of retained stock options related to
the stock purchase
Push down accounting adjustment
Beginning deficit of Affiliates at time of
consol idaticn
Distributions 10 nonconlrolfing interests
Net (loss) income from predecessor
Net loss from successor
.$
.
482,186
-
-
-
(64,431,229)
(6,926,996)
(8,255,627)
(27,605,615)
·
58,411
106.171,143
-
-
4,875,184
-
-
-
-.
-
·
-
·
-
-
·
-
-
;J>
rt
rt
483,367
Pl
0
::J
(276)
Sale of 5,841126 shares of common stock
Balance, December 31,2010
·
>
$
58,41~
-
77,089,752
-
-
-
$ 111,046,327
(151,761 )
(341,000)
278,700
(7,486,204)
(2,425,455)
$
(2,425,455)
$
33,207
~
(72,719,266)
(34,532,887)
106,229,554
4,875,184
77,089,752
(151,761 )
(341,000)
(7,207,504)
(2,425,455)
$ 108,712,490
ro
::J
rt
(]
,-.,
rJ
0
:::l
.
'-"
rt
RellChOut Holdings Ine. and Subsidiary .nd Consolillated Affiliates
Co~sotid ated
Balance Sheet
Octllber 31, 2011
Assets
Cum:nt Assets
Cash and =h equivalen~
Patient accounts receivable, net
Military accounts receivable
Other receivables
Inventory
Prepaid exp~nses and other
Total rorrent loIssets
Property and Equipment
Dental Equipment
Other Equipl1ent and Fix:ures
Vehicles
October 31, tOll
S
Less accumulated depreciation
financing fees, net
Intmgible Asset:;, net
Goodwill
Deferred Tax Asset
Other Assets
Total ~ssets
S
3,327,174
8,41'1,918
62\,136
2,1H,I70
1,74),716
6OZ,078
17,495,193
$
4,8~0,433
S
5,379,485
1,1)6,951
3,210,373
1,897,287
319,700
16,&14,229
4,753,467
1,683,110
2,650,709
9,087,286
2,215,332
6,871,954
$
2,993,489
46,626,059
[14,148,032
856,548
40,682
189,031,957
],531,677
3,241,467
861,203
2,665,457
8,299,804
Deferred Income Liabilities
Reyolving Credi: Facility
LQDg-Tenn Debt, less current portion
Stock Appreciation Rights
Other Long Tem Liabilities
Total Bablllties
12,170,632
2,600,000
57,415.977
300,000
2/8,240
81.064,653
*Tlese financial statements lISe unaudited.
S
1
1
3,535,826
1,134,947
1,526,430
6,797,202
722,418
6,074,785
3,574,545
49,546,496
114,634,235
37,667
190,671,957
t:l:l
'"':I
i:l>
i:l>
rt
rt
Pl
n
§
(P
l::l
rt
0
Liabilities and Shareholders' Equity
Current Liabilities
CuTTent portion of long-term debt
Accounts payable
Accrued Income Taxes
Accrued pa)roll and other
Total current liabilities
Shareholders' E<jllity
Common Stock
Additional paid-in capital
Non-Cootrol1ed Interest
RetUned earnings (defiei1)
Total sharehOlders' equity
Totlllliabilities and shlolreholders' equity
December 31, 2010
S
12,115,000
1,400,000
58,579.461
300.000
284,173
81,$59,466
58.356
lJ 0.946,382
(655,400)
(2.3~2,O33)
$
$
107,9E7,304
189,031,957
1,536,923
5,987,239
62.000
1,694,670
9,280,832
S
$
58,411
111,(46,327
33,208
(2,425.455)
1O&,JI2,491
190,01,957
RellchOut Holdings Inc. and Subsidiary alld Consolillated Affiliates
Consolidated Statements of Income
For YTD Ended October 2011
I"
qu<".;.; .···'L..
~ ;1j~i(1)et·
Current
Production
Dental Services Revenue
Nursing Home Revenue
Military Revenue
Other Revenue
Contract Allowances and Other Adjustments
Net Revenue
$
100,029,020
1,127,358
3,457,5~0
257,5DO
~8,650,530)
$
56,220,948
$
22,870,063
2,531,802
i·e: .....:• .;' ':
Last Year
$ 99,735,213
665,305
2,429,162
0
(50,574,242)
$ 52,255,437
,A
Change
$
293,~07
$
462,()63
1,02:8,428
257,500
1,92:3,712
3,965,511
$
3,068,170
Di~ect
Expenses
Slianes and Benefits
Dental Supplies
Other Direct Expenses
GDSS Contribution
Overhead Expense
Salaries and Benefits
Other G&A Expenses
Depreciation
Net Contribu:ion
Other (lncome)/Expense
Net Interest Expense
Loss (Gain) on Sale of Assel~
Management Fees and Board Expenses
Other Expense
Amortization of Intangibles
Provision forJncome Tax
Non-Controlled Interest
Net Income (Loss)
*These financial statemmts are unaudited.
$
1,482,314
$
$
26,884,li9
29,336,769
$
$
19,801 ,8~3
2,231,386
1,219,149
23,252,427
29,003,010
30tO,417
$
$
263,166
3,631,752
333,759
tJj
"':I
~
~
rt
rt
III
n
§
$
$
10,822,131
9,163,631
1,584,939
21,570,701
7,766,068
$
$
9,031,303
7,644,291
1,449,284
18,]24,879
10,878,131
$
$
1,790,828
1,519,340
135,655
3,445,822
(3,112,063)
ro
;::i
rt
t:1
,-...
()
0
~
rt
$
$
4,114,188
(28,713)
91,036
29,662
3,489,381
27,093
43,422
$
4,599,232
(23,638)
398,182
39],075
2,50],806
1,099,527
(125,499)
$
2,037,447
$
(485,044)
(5,075)
(307,146)
(361,413)
987,575
(1,072,434)
125,499
(1,743,(26)
=t=-~~~;;;,:;f,
-
'-'
Sn1ileNew York Outreach, LLC
Big Smiles
Dena! New York,
PLLC
Americ",I
Reacho,,!
r Icnllhcarc LId.
Memher
/
Dcnlal Director
:;t>
Smile New York 0""".1011. L L c j
rt
rt
III
Dentists, Hygienists.
Dcnlal Assistants
tJj
~
(")
I
-
g
co
P
rt
t>:I
Administr<!tor
Attachment F
ESTABLISHMENT CHECKLIST FOR DIAGNOSTIC AND TREATMENT CENTER
APPLICATION: CON 112250 Smile New York Outreach, LLC
NATURE OF APPLICATION:
AUSPICE:
PRIMARY CARE
Mobile Dental Program
xx
NON PROFIT
xx
PROPRIETARY
PUBLIC
- Limited Liability Company
AFFILIATIONS:
None
YEAR ONE
UNIT COST:
OPERATING
CAPITAL
TOTAL
PAYOR SOURCE:
$ 125.67
$ 12.74
$ 1;Jtj.41
YEAR ONE
MEDICAID-FFS
MEDICAID-MC
COMMERCIAL-FFS
CHARITY
55.0%
20.0%
15.0%
10.0%
YEAR THREE
$
$
117.64
6.77
$
124.41
New York State Department of Health
Public Health and Health Planning Council
January/December 2012
ATTACHMENTS
Long Term Home Health Care Program – Construction
1.
Number
Applicant/Facility
112116 C
Dominican Sisters Family Health Service, Inc.
(Westchester County)
Exhibit #3
BFA Attachment A
BFA Attachment A (cont.)
BFA Attachment A (cont.)
DOMlNICAN SISTERS FAMILY HEALTH SERVICE, INC.
Stalemenb of Activity
Cor the yean mdedDtumber 31, 2018 and 200'9
Uprestricted
Revenue. gains and other support
Net patient service revenue
Contributions
Net assetS released from
restrictions
Investment income
Other revenues
$ 29~933,374
Temporarily
2010
Restricted
Total
$
430,800
413,608
496,815
(496.815)
$ 29~933J74
$
844,408
113,866
13,131
173,866
13,131
Tot.al revenue. gains and other
support
Expenses and nonrecurring item
ProfessionaJ care of patients
Adm.inistnstive and general
Occupancy
Depreciation
Total expenses
.Excess (deficiency) of .revenue over expens~
31,047,986
26,383,160
3.422.354
569,070
172.355
172,355
30.546,939
30,546,939
501,047
(24A58)
Change in nd assets
476.589
Net assets. end of year
30~964.779
26,383,160
3.422,354
569.070
Other changes
Change in net unrealized (losses)
on securities
Net assets, beginning of year
(83,207)
(83.207)
(24,458)
(83.207)
2,5H.808
$ 2.988.397
417,840
$
393,382
441,60.7
2,959,415
364.400
S 3;352,797
BFA Attachment A (cont.)
2009
Total
Unrestricted
$ 28,756.553
$
$ 2&,156.553
437,054
566,615
483,070
130.932
27,188
1,003,669
(483.070)
130,93227,188
29,834,797
29,918,342
25,955.927
25.955,927
3.254.123
548,799
221,698
3.254,123
548,199
221,698
29..980,547
29,980..547
(145.750)
83.545
(62.205)
(10.256)
(156,006)
83.545
2,667.8:14
:$
364.062
3.031.876
447,607
$ 2.959.415
]1-----DOMIi'iICA.'i" SISTERS FA.:\JJLY HEALTH SERVICES. P'c.
BA.LA...'~E SHEETS
OCTOBER 31, 20n A,,1) DECEMBER 31, 2ClO
ASSEIi
!:!..-~'-~L~'ffi
LTABILTlES A:'I'D ni'<'D BALAJ'C.E
JO/:11 ell
1::.,Glf10
S380J51
688114
3-S3350S
ll05
S27i.6n
U00397
GBi'1:RAL n"12
JZ,JlIl~
$2,059.125
1,950.893
264.801
57,0:·8
48.3:4
906,,515
SU68,Oil
46,508
_ _])30A92
5.286,706
4562.4'>3.
CUlTCOllli~bilities
Current -:l.5Sets
Dsh JDd cash e[jul'ilk;'!.ts.
l;nrc:strictcd InvestlTen:
Accollilts rccc;v~blc" tlet
P1ed8'
10/31.:11
rec~-:ivablcs
Acco:mts payable
Accrued salaries md e."..p-euses
Cu~rent portion ofPrns;or. LO;D Pa)'lbie
Cu;rent portion ofEqt:i;>ment leasc P~yabk
Cu.,ent portion of Computer Lrase' Pay<ili!e
Du~ to thiTd-;>:>rt: payor's
2.7:>0,337
[7.865
~30,4S7
Grants receivable
OL~er :-eC::1 vabtes
234.420
169D31
Depos:rs. and -:::.dY'aCc::s
139103
155.785
136,889
5.145A32
5,199,.142
To~1. CllJTent Jiabilities
Total Current assets
1,50 L66l
252,698
63m3
ttl
'":I
.~scts whose
~
use is limicd
~
Boord Designat~d Fmds :
Cash ~ Dcvclopmenl Program Fund
<)
o
486
..S6
Cash - Family 2000
<)
o
o
o
Mory Wolsh
C:lSh - Dominican Mer.lOriol Fund
Cash ~
Plont Replacement Fund
lnveSlrlenl:s - DcveIcpmcul Program Fu."d
Cash
lnvcstocnts· DOlOlini= Program FLtnd
Inv=cnts - Family 2000
bvcslrlents - M;-,., Walsh
lnveslnents - Pfant RepJacem~Tlt Filld
Tom! as:ets whose llSCis li:nited
780.727
193M2
457,680
11..!38
731550
o
9J6,200
224361
534352
11,E8
Fbced 3sseIS
l=h)Jd improvem:nts
583,:m
Furniture ;md f:xrures
344,)32
576A73
J3Z,O.J.3
2,433.054
Other A5scls
Depo:;iLS
Ad',rance recelvnblc
Tot:tl Other j\s.iCts
T"~",,,="md~,",
______.__,.__~~~
269359
3_699,)85
3,065.)79
634.}o6
293513
230.763
52~276
'"-,,8.m
Total Noncttrrent flabilities
::r
::;l
33A~6
361.SC9
669.983
td
~
Net Assets:
Umcstricted
Tenporarily Resticted
Total Net Assets
2.68&,225
2,938.409
142,047
364395
2,830,272
3352,804
I
!l
I
36.013
Sscm30
(1)
~
rt
I
~
269.359
3.610.929
2.920.952
689,977
.147.613
283.,626
("'l
550.017
46.047
73.919
32:>323
725,648
2,.\12,185
2502.521
IJ)
Pension Loan Payabk,. net ofcurrent portior:
Complier Lease Pay;lbie, net of CtnTent portion
Equipment I.=e Pa)<ilile. net of current ;>ortioD
o
2,175,~73
Comp:1erizltion
PropCT1)' and Building
Total assets
Less: aC~WlluIatcd deprcciadon
Net Fixed asscts
rt
rt
NOnClL'Tent liabilities
I
I
I
I
Total general fund :iabiljtit:$
~dfimd""'~"
SW8.7S1
sss~~
I1
DOMiNICAN SISTERS FAi\IIlL Y HEAL TN SERVICES, INC.
SiA7E::MENT OF ACTMTY
YTO October 2011
CHHA
i
i
I
201&
ACTUo.L
2011
ACT'JAL
2011
BUDGET
I
1'_
~--------
2011
(UNDER)
-
LTHfie
i
VAR
(%)
L
BUDGEr
I'
2010
I ACTUAL
2011
ACTUAL
2011
BUDGET
~
TOTALCHHA&LT-IHC
2011
(UNDER)
BU:)G~_
VAR
(%)
ZC10
I
i
!
1
ACTUAL
2)11
ACruAL
2011
BUDGET
__
2011
VAR
(UNDER)
BUDGET
(%)
I
I
I
I
R~E;NUE
PATIENT SERViCE POVENUE:
!
,i
I
~:lJrsing
Phys'cal ther3PY
,
Hom,~ health 81des
Soci~,!
work
Spce;h therilpy
Oceu~ational c'>erapy
P"rso~<31 Core
'/'/8iv~rcd Ser\-iC8S
~
},,'1edjC8~ supplic~
, TOT,At PATIENT SERif, REVENLE:
I1'-''-'_". C,.
.......
:::~s-
59,753279
4,79' ,423
3,820,696
485,083
132,255
422,091
0
0
301',317
$19, 72~,144
4-,iSS
3%
24.':;'90
3.152,7'31
709,645
'}?~
14,460
S2,1D4.554
4.~2,260
$~~
3,320,740
552,610
$0,6)9,595
3£5,319
333,601
12,218
0
0
244,970
$'17,5L3,317
0
0
23:5,633
517,415,306
0
0
773,990
1)0,003
$939,793
1,096,963
(75,776)
$1,021,137
14'1%
S16,5)6,013
($873,676)
4,355,319
3.316,S22
413,673
110,564
593,143
(HO,394)
207,321
37,:>96
(26,011)
(.;v,ow)
5;47,51;
gO'/
"
-,4°/"
~
,
Q-I
"
$10,413,879 $10,330,467
32,033,374
3,1)39,624
SH,751
4,054
24',012
3,003,150
6;3,047
24.070
$9:38,"1<l1
$:5,050
28,825
(193, ~97)
:>8,150
(566)
323
7 i 9,236
53,572
i9,610)
$642,236
~;7,651
~%
:;%
-}'%
7%
-1 L %
~O)'
,
"
2"%
~%
-4(%
7%
to
'O\,~t·."lrt=.s'
,.I-'.I-~
~.
~
ConlJ<)cttl~f
Free care
TOTAC- ALLOWANCES:
S1,5ilZ,195
1,875,953
115,027
$1,990,980
I-;ET OP:;:PATlt"G RE'/ENUE:
$18,21<',849
515,632,337
1
-24%
52,,03>,.24
.:46,477
2,341,327
552,90'1
3,4-38
2",335
3,722,+36
636,6:9
1:·~
-3%
&>,7C7,738
4,214,925
3,5:(;4243
4::1,069
34,553
1,381,563
OPEPA-ING EXPENSES:
11~,532
S17,77/,966
$,6,373,094
$16,4')6,795
(5->3,701)
$')9,219
($8:>9,975)
\05%
3,123,124
0
$3,123,124
3,213,84S
0
$3,213,&48
2,974,131
0
$2,974,131
239,717
0
5209,717
~%
_.5.01:
,D
S7,2'JO,755
S7,156,6i9
$6,761.,050
$402,569
6%.
$111,451
r,ol':
-4D%
O~'O
$7,324,261
$0,911,053
$6,789,602
~
~,%,
",0
~
rt
rt
$25,5('9,704
$25,102,227
$22,798S;56
$23,2$4,147
$23.270,063
(~71,107)
,2%
po
0%
§
S23:196,394
$B7,753
573,669
(5558,860)
20,132
72,9'12
5,673
20,687
95,167
$2H,571
288241
{374,995)
374,996
288,241
20,202
(11,540)
(5,212)
4,489
(21,096)
($13,157)
(572,01 B)
21,846
(244,192)
(794,364)
(11,436)
($305.800)
1(0%
-11>%
-S2%
($42,069)
($847,868)
~O%
("l
(ll
ExcP-SS (defic:t) of Operating
$44(',983-
(S740,757)
IOTHERNON-0PERATING REVENUE
I Contrbutions
FurxJ Raising
Unit.ac Way
EXC=:S.S. o~
R~VEN'J:'
TE.',~?ORAFJL.'i'
ChaO£e in unrealiz",j gair-J(loss) on securities
[gHANGE IN NIT A.$S:rS
!E~
!lQIa
$407,477
1~4.248
O'JER I;XPENSES
EXC£SS OF ~"'IE."lUE OVE:=\ EXP:::N$ES tNClUCl~0
l§?EcrAL ;;::Ui\I[)$
S2S1,118
o
Asse~ released iron restrictions
Temporarily Restricted Income
i
($25,552)
36
Other Revenue
!nVesl11errt Income
ON-oPERATING REVENUE
I
S2:55,566
29,696
113,637
i
!
!
($.'\3,506)
RF.STPJeTED
I~KCM~
$309,000
716,477
(424,976)
341,361
032,862
(11,941)
$620,921
($14,8$9)
$476,032
(S<S5,191)
40,334
61,372
461
25,176
74,071
$201,414
(233,777)
(353,149)
'30,803
(506,123)
:11,4-36)
($517,559)
$'42,756
($'47,727)
($522,530)
o
$288,241
($105,658)
$182,~B2
;:::i
rt
td
r--.
()
o
~2%
::i
·22%
rt
.-8%
'-'
·6%
-€5%
!
I
New York State Department of Health
Public Health and Health Planning Council
January/February 2012
ATTACHMENT
Residential Health Care Facilities Ventilator Beds – Construction
1.
Number
Applicant/Facility
111435 C
The Wartburg Home
(Westchester County)
Exhibit #4
BFA Attachment A
THE WARTBURG HOME OF THE EVANGELICAL LUTHERAN CHURCH
STATEMENT OF ACT1VlTIES
FOR THE YEAR ENDED DECEMBER 31,2009
(With Comparative Totals for 2008)
2008
(Restated)
2009
Temporarily
Restricted
Unrestricted
OPERATING REVENUE:
Net resident service revenue
Purch3sed seNices agreement
Misce laneous
$ 39,643,039
$
453,654
1,348
40,098,041
Total operating revenue
Peimanently
Restricted
-
Total
$
$
-
39,643,039
453,654
1,348
-
40,098,041
TJtal
$
38,227,252
568,488
625
38,796,365
I:\:j
bj
OPERATING EXP:::NSES:
Directcare of residents
Service departments
Administrative
Non-d'3partmentat
19,576,258
5,758,740
5,203,003
13,049,223
-
-
-
19,576,268
f',758,740
5,203,003
1~,,049,223
18,146,558
5,847,703
4,491,984
11,289,582
4::,587,234
39,775,837
:>
:>
rr
rr
PJ
()
§
C1l
43,587,234
Total operating expenses
(3,489-,1S@)
LOSS FROM OPERATIONS
(2,489,193)
-------
(979,472)
::l
r-t
:>
,......
()
0
::l
rr
NON-OPERATiNG REVENUE (EXPENSE):
Contributions and other revenue
Investment income, net
Chani;e in value of trusts held by third parties
Loss en disposal of property and equipment
Tetal non-operating revenue, net
782,088
198,8:J9
1,124
(11,2)3)
27,500
970,9)8
17,592
33,559
1,022,059
496,831
17,592
33,559
(2,467,134)
(482,641)
1,456,383
170,433
CHANGE IN NET ASSETS
(2,518,235)
NET ASSETS - beginning of yea 1", as previously reported
16,319,1')3
(9,908)
33,559
-
655,598
(76,560)
(82,207)
17,945,924
18,610,565
-
PRIOR PERIOD ADJUSTMENTS
1,456,38B
16,319,103
NET ASSETS - beginning of year, as restated
NET ASSETS - end of year
809,588
198,899
24,775
(11,203)
-
$
13,800,818
$
1,473,980
(i82,000)
170,433
$
203,992
17945,924
$
15478,790
18,428,565
l
17,945,924
BFA Attachment A (cont.)
The Wartburg Home ofthe Evangelical Lutheran Church
Statement of Financial Position
December 31, 2010
ASSETS
Current Assets
Cash and cash equivalents
Investments
Accounts receivable, net
Prepaid expenses and other current assets
Due from affiliated. companies
Restricted cash - residents' funds
$
5,494,421
1,949,155
6,367,098
753,274
1,142,826
167,072
Total Current Assets
15,873,846
Due from affiliated companies
Assets limited as to use
Land, building and equipment, net
Assets of pooled income fund
Beneficial interest in trusts held by third parties
1,881,398
8,319,721
7.814,962
201,410
288,095
$ 34,379,432
LIABILITIES AND NET ASSETS
Current Liabilities
Current portion of Iong"term debt
A~~olmts payable and accrued expenses
Accrued salaries and related benefits
Due to third party payors
Due to The Wartburg F oundatioll, Inc.
Deferred income
Resident funds and deposits
$
387,729
2,571,121
1,722,193
2,443,111
~2,826
1,071,145
167,072
Total Current Liabilities
8,445,197
Long-term debt, net of current portion
Due to third party payors
Note payable to The Wartburg Foundation, Inc.
12,579,873
406,147
750,786
Tnt'l] T.1;;JhHities
22,182,003
Net Assets
Unrestricted, undesignated
UmtsLricted, board designated
8,843,209
2,635,251
Total Unrestricted Net Assets
Temporarily restricted
Permanently restricted
11,478,460
556,492
162,477
Total Net Assets
12,197,429
$
34,379,433,
BFA Attachment A (cont.)
The Wartburg Home of tile Evangelical Lutllcran Church
Statement of Operations and Changes in Net Assets
Year Ended Decemh",.'1, ?OW
UNRESTRICTED NET ASSETS
Operating Revenue
1'--let patient 3er:r'iCe rC",'cnuc
$ 37,893,270
investment income, net
Purchased services agreement
Other revenue
Net assers released tram restrictions
. 123,837
391,408
362,667
135,26]
Total Operating Revenue
Operating Expenses
38,906,443
Salaries
Employee benefits
Fees, supplies and other expenses
Depreciation and amortization
Tnterest
Provision for bad debts
New York Slate cash receipts assessment
Total Operating Expenses
17,687,664
6,280,651
13,379,843
2,074,396
704,%6
I,009,21l
1,368,252
~43,O04,983.
Deficiency ofOpeTllting Revenue Over Operating Expenses
(4,098,540)
Non-operating Revenue
General contributions
Umealized gain on investments
Total Non-operating Revenue
588,612
46,409
635,021
Reclassification ofnet assets
1,141,161
Change in Unrestricted Net Assets
(2,322,358)
UNRESTRICTED NET ASSETS
Beginning ofyear
End of year
TEMPQRARILY RESTRICTED NET ASSETS
Conuibutlons
Change in vallJe of trusts beld by third parties and pooled income deferred contribution
Reclassification ofnet assets
Net assets released from restrictions
13,800,818
$ 11,478,460
$
m,087
133,326
(1,086,640)
(135,261 >
Change in temporarily restricted net assets
(917,488)
Temporaril y Restricted Net Assets
Beginning ofvear
End of year
FERMANENTLY RESTRICTED NET ASSETS
!Change in v"ll1~ "ftT11~to hdti hy third parties
Reclassification ofnct assets
1,47:),980
$
$
Beg,lnniug ofy",,,
Change in Net Assets
13,006
(54,521)
(41,515)
Change in permanently restricted net assets
Permanently Restricted Net Assets
End ofycar
556,492
203,992
$
$
162,477
(3,231,361)
NET ASSETS
Beginning of year
End of year
15,478,790
$
12,197,42c).
BFA Attachment B
THE WARTBURG FOUNDATION, INC.
STATEMENTS OF FINANCIAL POSITION
ASSETS
LIABILITIES AND NET ASSETS
Accounts payable and accrued expenses
Due to Wartburg Home
Due to Wartburg Senior Housing
..
Net assets:
Unrestricted
Unrestricted ~ board designated
Total unrestricted
Tempqrarily restricted
Permanentfy restricted
$
108,457
$
118,610
4.495
10,008
118,465
123,105
16,251,317
6,830,296
15,432,250
6,204,692
23,081,613
1,820,564
21,636,942
2,175,944
2,1n,844
27,078,121
24,178,150
$ 27,196,586
$ 24,301,255
417,364
.
~.........
,~
,.!
'"t
_;i~ij;j~
;
·,t
THE WARTBURG FOUNDATION,l N C . ' 3
STATEMENTS OF ACTIVITlES
BFA Attachment C
Financial Summary
The Wartburg Home of the Evangelical Lutheran Church
FISCAL PERIOD ENDED
draft
8f31/11
12f31f10
12/31/09
$18,742,284
$15,873,846
17,559,499
15,505,086
EQUITY
8,013,658
13,758,027
14,530,098
8,445,197
13,736,806
12,197,420
$19,037,656
17,487,554
7,672,670
13,373,750
15,478,790
INCOME
EXPENSE
NET INCOME/LOSS
$25,559,508
26,903,916
(1,344,408)
$38,906,443
43,00./1.,983
(4,098,540)
$40,098,041
43,587,234
(3,489,193)
ASSETS - CURRENT
ASSETS - FIXED AND OTHER
LIABILITIES - CURRENT
LIABILITIES - LONG-TERM
OPERATOR/RELATIVE SALARIES
NUMBER OF BEDS
PERCENT OF OCCUPANCY (DAYS)
PERCENT OCCUPANCY (DAYS):
MEDICAID
MEDICARE
PRIVATE/OTH ER
MEDICAID RATE BREAKDOWN:
OPERATING
CAPITAL
TOTAL
$0
$0
$0
240
95.0%
240
95.0%
240
96.0%
71.7%
70,9%
70.3%
13.4%
15.8"10
11.~%
14.9%
13.3%
12.4%
gQ1!
6Q1Q
2009
$221.23
$219.28
31.47
$250.75
$221.37
31A7
$252.70
28.86
$250.23
New York State Department of Health
Public Health and Health Planning Council
January/February 2012
ATTACHMENT
Transitional Care Units - Construction
1.
112206 T
St. Mary’s Healthcare
(Montgomery County)
Exhibit #5
BFA Attachment A
St. l\Jlary's Hospital at Amsterdam
Consolidated Balance Sheets
(Dollars in Thousands)
December 31
2010
2009
Assets
Current assets:
Cash and cash equivalents
Accounts receivable, less allo\vances for uncollectible
accounts ($5,851 and $5,491 in 2010
and 2009, respectively)
Inventories
Estimated third-party payor settlements
Other
$
5,164
$ 5,959
14,506
1,131
1,393
2,405
19,487
1,189
264
Tnt31 current 3ssets
24,599
2,020
28,919
Board-designated investments
36,617
31,973
Other long-term investments
21,968
8,538
8,767
65,636
545
(24,503)
8,762
63,541
Property and equipment:
Land and improvements
Building and equipment
Construction in progress
Less accumulated depreciation
Total property and equipment, net
Other assets:
Interest in neT assets of Foundation
Other
Total other assets
Total assets
50,445
$
8,947
565
9,512
143,141
670
09,587)
53,386
2,107
405
2,512
$ 125,328
BFA Attachment A (cant.)
St. w[ary's Hospital at Amsterdam
Consolidated Balance Sheets (continued)
(Dollars in Thousands)
December 31
2010
2009
Liabilities and net assets
Current liabilities:
Current portion of long-term debt
$
Accnrmt" pnynhle 8nn "ccf1.leclliabilitics
Salaries, wages, and related items
Estimated third-party payor settlements
Other
Total current liabilities
$
62
4,076
6,292
6,860
242
17,532
121
3,638
5,306
4,705
211
13,983
Noncurrent liabilities:
Long-term debt
Pension
Asset retirement obligation
Self-insurance
Other
Total noncurrent liabilities
Total liabilities
22,326
1,544
.24,069
39,858
38,052
Net assets:
Unre:> LricLeJ
94,336
85,169
1,444
8,870
9,920
1,500
1,500
280
305
1,731
Temporarily restricted
Permanently restricted
2,480
6,467
663
103,283
Total net assets
Total Eo bilities and net assets
8,859
11,886
$
143,141
S
87.276
125.328
BFA Attachment A (cont.)
St. Mary's Hospital at Amsterdam
Consolidated Statements of Operations
and Changes in Net Assets
(Dollars in Thousands)
Years Ended December 31,
2010
2009
Operating revenue:
Net patient service
reVf':n!lf~
127,895
4A30
132,325
$
Other revenue
Total operating revenue
Operating expenses:
Salaries and wages
Employee benefits
Purchased services
Professional fees
Supplies
Insurance
Bad debts
Interest
Depreciation
NYS Assessment
Other
Total operating expenses
Income from operations before nonrecurring items
$
114,244
5,553
119,797
57,608
13,080
Q
,77
-"
.. I
I
,~
1,478
Nonrecurring items:
Impairment
Income from operations
Nonoperating gains (losses):
Investment income
Other
Total nonoperating gains, net
Excess of revenue over expenses
2,031
7,349
7,165
(69)
"S
7,096
8,394
(1042.._
$
7,245
9,276
BFA Attachment B
ST. MARY'S HO$PITAL AT AMSTERDAM
STATEMENT OF OPERATIONS-CALENDAR YEAR
September-11
Sep-11
AGILIAL
PATIENT SERVICE REVENUE:
INPATIENT ROUTINE
INPATIENT ANCILLARY
OUTPATIENT ANCILLARY
SKILLED NURSING FACIUTY REVENGE
c;ROSS REVENUE
DEDUCTIONS
MEDICARE
MEDICAID
CIIARITY
UNINSURED DISCOUNT
OTHER
TOTAL DEDUCTIONS
NET PATIENT SERVICE REVENUE
OTHER OPERATING REVENUE
GRANT REVENUE
TOTAL OTHER OPERATING REVENUE
TOTAL OPERATING REVENUE
9,3%
4.2%
10.2%
4.0%
?",731.73~
(~Nn.113)
?'"-2;1,44tl,00.G
1,048,080
13,307,784
O. 5~/~
8.6%,
6,776,623
3,839,722
10O,370
160,358
4,151,289
(661,003)
(124,170)
(29,094)
(39,472)
62,260
63,418,430
31,653,446
1,257,435
1,581.716
35,494,173
'1,632.304
1,416,376
2B%
4.7%
15,033,362
(791,479)
133,405,200
10,698,375
~_.JJ 98,635)
98,038,895
108.153
2.595,839
(2/75)
(46.684)
1.121,391
4.367,215
2. -/03,992
(49,459)
5,488.606
__
1::.>,~O2,367
(249,004)
103,627,801
~.9~.:l7.._
228,862
1,399,200
818,799
504,029
27,844
430,281
742,608
12,488
TOTAL NONOPERATING REVENUE
EXCl::,sS
or
Rl::Vl::NUr: OVCR EXPCNses
PY%
VAR
VAR
-8.6%
-3.6%
3.4%
0,6%
EMPLQY"tc r!e:Ntr-IIS
NONOPERAYrNG GAINS (LOSSES):
iNVESTME.NT INCOf,IE
UNREALIZED GAIN/LOSS
(1THFR NONOP!"RATINr., INrO~~r:
NET RENTAL INCOME/LOSS
Y-T-~%
2,089,808
1,803,037
13,965,152
449,787
MEDICAL AND OTHER PROFESSIONAL FEES
SUPPLIES
PURCHASED SERVICES
prtQVISION FQr{ DOUBTFUL ACCOUNTS
INTEREST
DEPRECIATION AND AMOI~TIZATION
OTHER EXPENSES
NY 8TATE FEE ASSESS)I1ENT
NET OPERATING INCOME(LOSS)
PRIOR YEAR
VAK1ANCE
(2,314,155)
(1,638,488)
4,935,020
65,703
1 ,UO,l~U
IMP,d,!RMENT CHARGES
NON RECURRING ITEMS
Y+D
VAklANl:!:o
24,621,405
44,352,423
150,796,235
11,674,032
5,341,721
54,089
OPERATING INCOMEILOSSj
BEFORE NON-RECURRING CHARGES
Y·T·D
A(,;]UAL
(301,181)
(162,361)
(524,218)
(2,354)
2,530,067
4,695,031
17,150,993
OPERATING EXPENSES:
SAI.ARIES AND WAGES
CONTRACT LABOR
TOTAL OPERATING EXPENSES
Sep·11
VAklANCE
-1Q.835,70::'
50,585,130
414,438
(81,!UI)
11 ,Jue,! 18
66,211
2,062,986
12,316,200
90,691
7,320,929
(241)
4,492,523
(63,093)
263,781
(1803)
3,580,639
262
6,199,642
31,109
J~~,1!L11_,~__ J35,905
(250,916)
46,118
. (258.229)
99,279,951
2,566.665
10,135
4,247,550
49,706
49,706
.~ __.110,969
34,227
2,516,959
48,OliO
(3,327,650)
!)')1
(5,0821
~(3,2H3,1.2.2L
(700,102\
_l3~5712
4,002,355
(9~,133)
2,597,164
(3,950,077)
(3,461,100)
8,485,934
4,843,466
(33",459)
49,925
2,758-441
~14.:5%
-8.2%
-1.5%
15.4%
18.1%
-21.2%
3.3%
8.4%
2.154,260
15,799,30L
1.6%
13,4%
(1.106,179)
2,508,477
.1.1%
2.6%
72.354
17.014
35,420
?J!4"j04
5.9%1
33%
0.4%
119.2~o,
89.368
2409.923
1.7%
78.3%
_.:.,018,400
-1.0%
5.0%
1,880,113
(346.575)
0.0%
1124,2%
·5,9%
32.0%,
5.70/Q
0.1%
,10,1%
-1.3%
,1,3%
-3.0%
-25.7%
3.9%
-45.5%
-5.6%,
15.8%
8,9%
6.0%
-4.1%
14.3%
-5.7%
--4.5%
-8.9%
-09%
1.9~![l
2.5%
-271.9%
(212,1;55)
(141,761)
(539,805)
11,016,8~.!.L
16,805
~)iJO,585
(1,1U4,o/Uj
500,fi(i1
666,276
10,4,,2
(881,680)
(3,S:j4)
(46,858)
(193,093)
(254,341)
282,056
1,005,746
4'\5,444
(204,336)
32,996
(215,219)
(290,801)
(12,139)
(809, 29~L_J. ,~1.3, 078
(107,516)
34,227
210,969
(352,711)
1,398,702
(5,042,133)
8,188
8,188
(3,739\
(74,169j
8.817
(3,558,422)
(lAme94)
(3,1326,426)
(:1,[;97,992)
2,50:),401
P979-:~2.n
551
(0/4,2UI)
3,105,322
34,227
21O,2§2,,"__
2,860,127
544,603
(5,907,DSS)
(7,207)
7,6611
.... -~1.% .... "._2~(),,:1Y?
116.7%
-461.7°t:
#D!\//Ol
26.5%
-3018%
--16,8%
~]2c6%
~9A%
(5361,995J
-164.3%
-136.0%
__ "J.2,CJ01,DOG)
-00.0"/0
-49.2%
~,;.=~,=
ST. MARY'S HOSPITAL AT AMSTERDAM
B~LANCE SHEET
SEPTEMBER 2011 AND DECEMBER 2010
SEPTEMBER
~
ASSETS
2010
liABILITIES AND NET ASSETS
2~
DECEMBER
2010
CURRENT:
CURRENT:
CA~iH
SEPTEM6ER
DECEMBER
fo,NO CASH [QUIY/'.LENTS
PATIENT RECE1VABLE~ [LESS AcLOWANCES fUR
DOUBTFUL !,CCOUNTS
3,474,327
5,093,813
16.343,717
14.506,192
OTHEr-< RECEIVA3LES
4, 1~2JE6
1,115,880
INVENTORIES
1,093,815
1.130,321
OTHEF; CURRENT ASSHS
1,260,1(3
1.231,888
478,443
1.383,292
64203
62,302
."CCOliNTS PAY"SLE AND ACCRUED LIABILITIES
4.567732
4.138,292
SALARIES, WAGES AND REL"TED L1ABILTIES
7,286257
E,29U74
ESTIMATED PA~A8LES TO TI-IRD·PARTY Po,YORS
6,44790D
E,859,567
91707
242,193
ClRRENT MATLRITIES OF LeNG-TERIVI CE3T
OTHER LIABILITIES
ESTIMIHED 3RD I'ARTY SETTLEMENr
---TOTAL CURRENT liABIliTIES
-----~
TOTAL CURRENT ASSETS
26,803,1<1
18,467~46
-~---
17,594,329
24.526,387
ttl
Crj
Notl-CURRENT:
ASSETS LIMITED AS TO USE:
INTERN!'.LLY DES1GNAIED BY SOARD
FOR CAPITAL REPLACEMENT
INTERNA.LLY OESIG~IATED FOR
cor~MUtliTY SERVICE
OTHER INVESTMENTS
SELF-INSURANCE LIABILITY
2,147,026
~
313172
304.947
35.5<:,1,901
LONG-TERM DEBT LESS CURRENT MATURITIES
8,868,509
6,870,469
ACCRUED PENSION COST
9,769.469
9,9'19.853
ASSET RETIREM':NT LIABILITY
1,500.000
1.500,000
OTHER
1,5RlJi2
1.730,497
2~.325.183
~-i2.325,768
~
rt
rt
i'JJ
()
263.438
292,6':0
~2,4E2
21.354.584
g
ro
i::l
rt
TOTi\L N'S ETS LlMITED AS TO USE
62,052,976
60.222,130
TOTAL NON-CUR'.ENT LlABILI-IES
PROPERTY, PLANT & E:lUIPMENT
LAND AND lMPf,OVEMENTS
BUILDINGS
[QUH'MErH
()
5767.376
..:1S,D8S,49D
13,296,529
"CCIJML1ATED DtYRECI.ATION
, (2JA5~.
45,693,8W
CONSTRJCTION IN PFOGRESS
NET PROPERTY, PLANT & EQUIPMENT
6,767,376
47.871.1[>0
15,460,534
i23.123,8'4)
<:8.975,227
42,890
45,735~9Q
48975,227
8.2<:3.167
S,947.424
OTHER ASSETS:
INTFREST IN NET ASSETS 01' FOliND/,TIO"
CI,.PITAI.Z~:l COM='UTER
SOFTWARE, NET
146,042
I'CTANGIBL:: PENSION ASSET
4S--;',8C9
341,939
~2.923
223,297
145721~8C5
143,181,358
TOTAL ASSETS
o
i::l
rt
NET ASSETS
'-/
Uf,RESTRICTED
TEMPORARILY F:ESTRICTED I~TEREST IN fOUNDATION
PERMANENTLY ~~ESiRICTED INTEREST IN "OUNDATION
'1.770,357
6,472,807
34,913,840
2,480mO
&,467,413
TOTAL NET ASSETS
104,928,679
103,861,263
TOIAL L1ASILlTlES AND NET ASSETS
145,721,B08
143781.358_
96,685,515
9~~>961
SOFTWARE IN PROGRESS
OTHER
ttl
,-..,
544,954
New York State Department of Health
Public Health and Health Planning Council
January/February 2012
ATTACHMENTS
Acute Care Services – Establish/Construct
1.
Number
Applicant/Facility
112185 E
Inter-Lakes Health, Inc.
(Essex County)
Exhibit #6
BFA Attachment A
INTER-Lr\K.l~~ Ijl:~i\U
1-1, INC. I\.ND SUBSIDIARIES
Combined B~lance Sheets
D<.:c<.:mb<.:r 31,
2001)
2010
Assets
Current asset's:
Cash and cash equivalents
Shof[-tt'rnl
'\CCOllt11S
$
1,855,291
$<
910,797
'l.,61tUQ5
1,054,.318
lnVCSrmf'1l1\;
rcc<.:ivable, l1el of estimrm:d uncoUecriblcs
of$1,5'l7,OOO and $1,150,000
Crant~ and ocher [cccivalJks
Supph<.:s
1, 67,335
49,102
1,775, loll)
369,295
359,226
63,566
303,740
171,677
5,499,081
S,891,24U
Propcrl}' and equipmcnt, net'
8,966,680
9,071,050
!\ss<.:t's limitcd as [() llS<.:
6,236,683
5,953,698
637,807
5:ri,789
8 ',920
13U,lOX
21,42<},171
$ 21,583,885
Prepaid expenses
Ddt:rr<.:d financing costs
Otht:r asst'ts
$
Liabilities and Net Assets
Currellt liani1 i ric- .."
Currt'nt portion of long-Icrm debt'
$
259,393
~
353,752
r\ccnlCd p:lyrolland rthred uabiuucs
721,630
024,137
76S,475
Othcr accrucd expenses
429,120
310,628
1,397,361
4,017,221
4,220,949
Long-refm debr
023,394,092
23,031,019:'
Othef liabtlJrtcs
88,920
130,108
'\CCOlllliS
payable
1~$tirnared lhml-parry payor serrlcm<.:nts
1,209,717
1,863,957
Ncr assets:
Unn,:slncrcd:
Boaru t!e:lgnatcd for capnal
Uth<.:r
0jOe ITlporanl}' rcsl r1Clt'd
Pcrman<.:nrly rcsl ric lloLi
394- 53
(6,838,306)
43,325
329,066
(6,071,062)
$ 21,429,171
J91,028
(6,557,51 ~)
3'(,,771
32(),U66
(5,79B,(j(JCJ)
$ 21 ,5!33,885
BFA Attachment A (cant.)
IN'] I,:R I .. \KI:~; 111,.\1.'['11, INC. ,\ND SUnSJlJl:\!\JES
Combiiied Sta~ments of Op~rations and Changes in Net Assets
I 'or ,he yc<II's l'l1t1ed [)ccl'mbcr :) I,
')IIOC)
2010
UfllC"llicleu lIt'l u!;;scrs:
Revel1ue:
I-Jel paliel1t sl'l'vice revel1ue
19,468,971
721,596
20,]90,567
$
Oil,cr r<';VTlIlI,'
'['olal revcllue
1(),:lS3,077
$
i)·I-+Y'2
ZO, I CJ7 ,l~ l)
J '::<IKIl~<';,"
r':lllp!o!,ec bt'I1(:,'lls
I'urch,,,ul
SUppltl'S
'<';1 V 1<.;,'"
:llld ol!ln' l'XpetlSes
i\kcllcall11:dpraclice COSls
l)'I"<:U:lI!Oll
H,i) l,t,021
9,095,232
2,317,267
2,176,594
3,555,461
210,349
1,20],314
21,l:l41
1,179,373
20,557,43J
Salaries al1d wages
alld lllnol'lizallOI1
1111<:1'1,,,1
ProvislOI1 ror bad debts
TUlaI1'xp1'I1S1'S
2,--I~I)"IH0
I,(>77,5.>H
\M-Hipn
22,1,21 S
1,2:-Q,I--I2
0,1(',-1211
I, I :)(),'>~3
20,--I(,-I,H()O
(2(,7,.1-1 I)
(366,864)
Loss from operation!;;
ollOpl'l'a,il1g g:lIIlS:
11l'1
I nV<..·:il rnC1l1
(2\,11(,)
a~sct'~:
4,552
ill<':"JlnC (llJ:-'~)
Cil:'tlgt: ill IlCI aSS1'Is
NCl ;'~SCt6 -
2-1'1,025
(276,948)
EXl'<.:,.,. of cxpcnsc" "vcr revenuc
Tcmporarily restrictcd nct
C) I,772
152,253
73,287
16,629
89,916
InH;I'l;SI 111 C'-l 1111'
COil I ribllti()l1:i ;\nd otlll.I,
(,:nJing
$
(., ,(II)l)
(272,396)
(27,-+25)
(5,798,666)
(5,771,2-1 I)
(6,071,062)
.
(5,7 C)o,6()(»
~
:1
Ii
II--
Inter-Lakes Health, Inc.
~
II
Health"~
Inter-Lakes
II
Foundation
(inactive)
II
l.'==
il
II
. -~=,JJ
i,
III!
."
, M 1se-,;;-Ll,uH,gtcn
'I
I'
,:
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Car-,n~a;:5
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=i:8slde-::tin.1 :-iealthcar['
:1'I
~I
I~
:i
I,
!I r/loses-Ludington il
II Adult Cue !i
II
II
lLu
!
~
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ill
rLord Howe
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HOsPital~
II
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rt
rt
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n
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RANKLIN
II
j
BHFP Attachment Map:
CON #: 112185
Inter Lakes Health Inc.
(Moses Ludington Hospital and
Heritage Commons RHCF).
!
'Adirondack Medical Center-Saranac Lake Site
,",",Beds
95
=(
Adirondack
Beds;; (156)
I
i
l~--
ESSEX
~)
Vermont
<'\ .L~_~'AC_'-'_l
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'v
l_~".
_________ ~-
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if·'
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Adirondack Tri-County Nursing and Rehabilitation Center, Inc
Beds =(82)
~
\\11
"~i
\\
'\\
J:
If
Ii
u
1/U
h
WAR R i=,{/N
lj
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The Orchard Nursing and Rehabilitation Centre
Beds;; ( 88) .•
i
New York State Department of Health
Public Health and Health Planning Council
January/February 2012
ATTACHMENT
Ambulatory Surgery Center - Establish/Construct
Exhibit #7
Number
Applicant/Facility
1.
111552 B
The Surgery Center of Bayside, LLC
(Queens County)
2.
112032 B
PBGS, LLC d/b/a Downtown Brooklyn Gynecology Center
(Kings County)
3.
112244 E
Unity Linden Oaks Surgery Center, LLC
(Monroe County)
BFA Attachment A
NYEEQASC, LlC
Qrgyoizatlonal Chi!rtand Ust of MeJJlbers
Continuum HElalth P.liners Inc.
New York Eye and Ear Infirmary
Class A Managers
Class B Manager
See Attached Ust
ThomasJ. Bombardier, M.D.
Class C Managers
Allan H, Fine
Charles Fi gliozzi
BFA Attachment A (cont.)
Members of NYEEQASC, LtC
(New York Eye and Ear Infirmary Surgery Center
of Bayside, Queens, LLC)
Class A Members'"
j'First Name
Andrew
------ --.,-_.
Last Name
Blank
Chan
---~-.....,
9raga
Draga
>__
Ed
Units
. ......
.-
~§sia ..
Irene
. ..
Donald
=
% Own.
2.4500%
-_._---
2.4500%
--- -_._--
.~-'
1.0000
._ __ 05000~
EdeiStein-- oa~~ __..~
Fox
:~
1._0000
--
0.5000
122~
1.2250%
0.5000
1.2?~
1.0000
2.4500%
~~~nan -l~-;-:-=-f~~~~
=;~~~. ~~~ryl
'~"f~6~§t- ~::~=
• '-"':'
~
.. _~:~
._1.00~L_~~OO%
Laroche ...:._~.nlel "
,-1.:Q.~_QQl.__-.?:.4500%
Lichtenstein
Eric
1.4082
3.4500%
r---'
r-'~-'---"----'---'-------.'
MashKevlch
Greg
0.5000
1.2250%
- - - " - ·_---_·-I--------_····_-·---~I
Menger
Peter
1.0000
2.4500%
------....'Nyquist
Gurston
1.0000 . _ ...__."--,.2.4500%
..
Patel
Nilesh
1.0000
2.4500%
-
~----'----_._-+------_ -I-._~-_
I--·---···--·~·-------------I--c__:_"..__:_
Perrone
... _~Q..000 ~...~~4500'1'~
Stephen
Silberman
Deborah
1.2250%
---------1-'
. - - - "0,5000
- - - -"-'---'-Suh
Gerald
1.0000
2.4500%
_.--'--------+-'-._-_._ _
......._....
-----.._ ...
Ukrainsky
Gene
1.0000
2.4500%
.._._-._,,--"
Wald
Ken
0.5000
1.2250%
- - -.... -~- •..- - - . - - - - " -.•---.-_c_____-......-.-O>--._~ ~
_~'
----_.-I--._--_.~-I--"_._._
VVu
(Zhenqing) Brett
Class A Total
Class B Members
1.0000
2,4500%
20.4082
50.0000%
._
~;~b~~[~~~~~~:me=~.~ u~~~ ~6~;~O~~
Lambert
Brent
f---'--"~-""--''''''-''-''''
Lambert
Luke
_
._-_._.- ---"
Violin
George
Class B Total
2.4490
~-_._--•.-._-1-0.8163
2,4490
Class C Member"""
~
NT EEl Holding Corp.
l
6.0000%
2.0000%6.0000%
. --.- .. ---.---~_._--~--.
8.1633
nvFi"_ _
TOTAL
t-
20,0000%
._J__Unlts
I __% 0Y':'.!:!.:12..24491 30.0000%
40.8163
100.0000%
*AIl Class A members are Class A Managers
**Class B Manager
***Class C Managers are Allan Fine and Charles Figliozzi
BFA Attachment B
BFA Attachment B (cant.)
The New York Eye and Ear Infirmary and Affiliates
Consolidated Statements of Operations
Years Ended December 31,2010 and 2009
(in thousands of dollars)
2010
Revenue
Net patient service revenue
Other operating revenue
Net assets released from restriction· operations
Total revenue
5,513
130,087
104,562
12,047
1,980
5,022
123,611
Expenses
Salaries and wages
Employee benefits
Supplies and other expenses
Provision for bad debts
Depreciation
Total expenses
Operating income
52,299
17,445
45,489
3,346
6,471
125,050
5,037
49,917
16,211
44,471
3,885
6,437
120,921
2,690
173
5,210
526
3,216
425
(1,329)
11,147
$
$
1,706
Investment income
Other income
Unrestricted Contributions
Excess of revenue over expenses
Net assets released from restrIction - capital
Pension-related changes other than net periodic pension costs
Increase in unrestricted net assets
110,544
12,324
2009
$
4,306
1,000
$
15,363
BFA Attachment D
NYEEgASC, LLC
ESTABLISH & CONSTRUCT A MULTI·SPECIALTY FASC
PRO FORMA BALANce SHEET
ASSETS
Cash
Leasehold Improvements
$893,843
$4,864,104
Equipment
$2,524,000
TOTAL ASSETS
$8,281,947
LIABILITIES AND MEMBER EQUITY
LIABILITIES
Capital Loan
~6,649
TOTAL LIABILITIES
$6,649,294
MEMBER EQUITY
~1,632,653
TOTAL LIABILITIES AND
MEMBER EQUITY
$8,281,947
Note: As a newly formed entity, the corporation has no assets and liabilities.
294
BFA Attachment E
BFA Attachment E (cont.)
SPECIALTY SURGERY CENTER OF CENTRAL NEW YORK
Consolidated Statements of Income
Years Ended December 31,2010 and 2009
Net patient service revenue
2010
2009
$ 9,847,482
$9,289,862
36,364
5,581
12,448
17,730
32,551
19,908
8,500
60,429
334,584
5,158
5,110
1,636
10,006
76,861
188,058
2,502
23,723
122,339
3,009
20,000
2,202,737
7,175
40,800
66,917
1,509
2,176;176
8,003
156,366
16.036
271,236
4,214
56,837
16,219
18,174
Operating expenses:
Accounting
Advertising and promotion
Bad.debt expense
Billing charges and credit carn fee~
Cleaning services
Consultants
Charitable contributions
Cuntrm;t labor
Depreciation
Dues and subscriptions .
Education/seminars
Employee benefits
Entertainmen~ and meals·
Equipment repairs, maintenance and rental
Insurance
Lab fees
Laundry
Legal and professional
Licenses, pelTIlits, and fees
Management fee
Medical supplies and lab fees
Medical wllste dispm:H 1
401(k.) plan contribution
Office supply and expense
Partnership filing fees
Paywll
Payroll processing
Payroll taxes
Postage and delivel}'
Rent
Sales tax
Service contracts
Taxes - other
Telephone
Transportation
. Travel
Uniform
Total operating expenses
Income from operations
15,189
32,216
16,070
20,800
65,582
301,003
5,063
2,588
2,167
7,423
45,659
148,400
2,618
24,629
114,592
4,025
20,000
2,018,005
4,446
36,868
74,536
1,500
1,876,665
99,017
6,274
138,203
15,613
240,721
5,735
65,807
166,673
130,412
8,680
11,459
21,551
6,252,666
9,364
14,953
6,192
16,453
5,581,001
3,594,816
3,708,861
7,520
Other income (expense):
Interest income
Interest expense
O!ht:r incoille
Net income
764
(43,894)
980,
$ 3,552,666
439
(35,215)
5,::10'/
$3,679,592
BFA Attachment F
Melville SC, LLC
Balance Sheets
December 31,
2009
2010
Curnmt Assets
Cash and cash equivalents
$
46,677
$
96,498
Accounts receivable, net of allowance for contractual
adjustments and lUlcol1ectible accOlmts:
2010 - $5,708,000; 2009 - $5,520,000
Prepaid expenses
Supplies
Total Current Assets
1,044,018
23,870
279,780
899,427
27,299
158,387
1,394,345
1,181,611
1,689,220
1,464,3]4
57,614
1,39],260
3.138.094
(1,169,898)
57,614
1,385,162
2,907,090
(739,793)
1,968,196
2,167,297
16,394
150,000
15,757
150,000
j5,lR4
35,1&4
201,578
200,941
Equipment and Improvements
Equipment
Furniture and fixtures
Leasehold improvements
Total
Accumulated depreciation
Net Equipment and Improvements
Otber Assets
Loan costs, net of ~ccumu1ated amortization;
2010 - $3,618; 2009 . $2,689
Certificate of need
Security deposits
Total Other Assets
Total Assets
$
3,564,119
$
3,549,849
BFA Attachment F (cont.)
2009
2010
Liabilities and Members' Equity
Current Liabilities
Line of credit
Current portion of long-tenn debt
$
633,553
221,861
35,743
100,517
633,553
141,235
24,960
891,157
900,265
1,039,518
1,673,077
1,930,675
2,573,342
1,633,444
976,507
$
Ace-aunts payahle
Accrued expenses
Total Current Liabilities
Long-Term Debt, Net of Current Portion
Commitments and Contingencies (Note E)
Total Liabilities
Members' Equity
Total Liabilities and Members' Equity
$
3,564,119
$
3,549,849
BFA Attachment F (cont.)
Melville SC, LLC
SiatemPntft ofOpnations and Memhers' Equity
For the Years Ended December 31,
2010
Net Patient Service Revenue
$
10,379,298
2009
$
9,156,574
Operating Expenses
6,236;078
5,732,197
Income from Operations
4,143,220
3,424,377
Other Income (Expense)
Interest expense
Other income (expense)
Total Other Expense
Net Income
Members' equity, beginning of year
Member::;' contributions
Members'distributions
Members' Equity, End of Year
$
(74,363)
3,104
(89,772)
(52,922)
(71,259)
(142,694)
4,071,96\
3,281,683
976,507
154,354
(3,569,378)
854,457
258,432
(3,4] 8,065)
1,633,444
$
976,507
BFA Attachment G
ESTABLISHMENT CHECKLIST FOR AMBULATORY CARE SITES
APPLICATION: 111552 NYEEQASC, LLC d/b/a New York Eye & Ear Infirmary
Surgery Center Bayside Queens, LLC (Queens County)
NATURE OF APPLICATION:
x
PRI MARY CARE
MULTI - SPECIALTY
IF SPECIALTY - TYPE
Otolaryngology, orthopedics
and ophthalmology
AUSPICE:
x
NON PROFIT
PROPRIETARY
PUBLIC
AFFILIATIONS: Queens Hospital Center
UNIT COST:
OPERATING
CAPITAL
TOTAL
PAYOR
YEAR ONE
YEAR THREE
$530,74
226.20
$756,94
$522.81
199.39
$722.20
YEAR ONE AND THREE
SOURCE:
Commercial Fee for Service
Commercial Managed Care
Medicare Fcc for Service
Medicare Managed Care
Medicaid Fee for Service
Medicaid Managed Care
Private Pay
Charity Care
15%
50%
25%
2%
2%
3%
1%
2%
...... ~,T',;c;;:;~~S2~~2~=~:-.=-_".:c~m---------
~Ro/l(~
- - ~_~--
;/.-<',~~-~
ork
BHFP Attachment Map:
CON # 111552
The Surgery Center of Bayside,
I
~
NASSAU
-------
~
Hillside Diagnostic and Treatment Center, LLC
------
_./~:
.
.
-~ ~~
..
KIN G S
~'
;l.'~f'
'\
&
~....~...:_-.\
.,"'_~~,
\,~,,"
, .. J,,,,""-';,','.::..'-----'--'--'
~._
~'6j',1,\i:k"'"
._<__ ,..
~
_ _ ~ "..>U'(
BFA Attachment A
ORGANIZATIONAL CHART
BFA Attachment C
PEGS, LLC
AMBULATORY SURGERY CENTER
PRO FORMA BALANCE SHEET
ASSETS
Cash
Capitalized Project Costs
Equipment
$431,906
$2,467,937
$403,96?_
TOTAL ASSETS
$3,303,805
LIABILITIES AND MEMBER EQUITY
LIABILITIES
Capilalloan (Construction)
Working Capital Loan
$2,575,000
$215,953
TOTAL LIABILITIES
$2.790,953
MEMBER EQUITY
TOTAL LIABILITIES AND
MEMBER EQUITY
$512,853
$3,303,805
BFA Attachment D
ESTABLISHMENT CHECKLIST FOR AMBULATORY CARE SITES
APPLICATION:CON 112032 PBGS, LLC d/b/a Downtown Brooklyn Gynecology Center
NATURE OF APPLICATION:
X
PRI MARY CARE
SPECIALTY:
Gynecology/Abortion
X
NON PROFIT
PROPRIETARY
PUBLIC
AUSPICE:
YEAR ONE
UNIT COST:
OPERATING
CAPITAL
TOTAL
$463.33
98.13
$561.46
YEAR THREE
$452.57
83.07
$535.64
PAYOR SOURCE:
YEAR ONE
Commercial-FFS
Commercial- M/C
MEDICARE-FFS
MEDICAID-FFS
MEDICAID-M/C
SELF PAY
Charity Care
12.1%
22.5%
0.3%
9.6%
45.5%
8.0%
2.0%
YEAR THREE
11.7%
22.5%
0.3%
9.6%
45.9%
8.0%
2.0%
I
1100
BFA Attachment A
,'"
Unity Health System, Inc. and Subsidiaries
Consolidated Balance Sheets
December 31
2010
2009
---------".
(In Thousands)
Assets
Current assets:
Cash and cash equivalents
Current portion of assets limited as to use
Accounts receivable, less allowance for uncollectible
accounts (2010, $12,022; 2009, $10,817)
Other current assets
Total current assets
$
Assets limited as to use:
. Under bontlindenture and mortgage agreements
34,024
8,767
$
40,875
39,509
46,368
14,197
103,356
50,022
14,896
]45,302
181,459
40,253
Under regulatory agreements
2,806
2,639
Under regulations for workers' compensation
84
2,201
101
4,563
6,453
5,423
9,323
]8,801
6,654
9,757
By Board designation for capital projects
By Board designation for professional liability
By Board designation for deferred compensation
Restricted by donor
!l~~f'Js
221,127
119,390
Amounts classified as current
Assets limited as to use, less current portion
(8,767)
2]2,360
(39,509)
29,881
Property imd'equipment, net
]99,312
157,769
Other assets:
Deferre4 financing costs, net
Goodwill
Intangible assets, net
Other
Total other assets
Total assets
13,043
] 9,961
759
1,556
.35,319
550,347
5,139
20,485
1,452
1,656
28,732
361,684
Totl'll
limited a" to lJ."e
$
$
,
.
BFA Attachment A (cont.)
Unity Health System, Inc. and Subsidiaries
Consolidated Balance Sheets (Continued)
,
.,
BFA Attachment A (cont.)
Unity Health System, Inc. and Subsidiaries
Consolidated Statements of Operations and ChaIlges in Net Assets
Years Ended December 31
2010
2009
(In Thousands)
Operating revenues
Net patient service revenue
$
446,127
$
48,743
Other revenue
494,870
Total operating revenues
Operating expenses
Salaries and wages
Employee benefits
Professional fees
Supplies
Insurance
Provision for bad debts
224,414
17,802
30,543
469.869
219,253
48,732
29,718
92,212
4,482
11,637
8,678
16,503
26,426
457.641
25,001
21,814
39
33
385
48,463
27,636
94,777
4,338
11,076
10,820
Interest and fees
Depreciation and amortization
Other
Total operating expenses
Income from operations
Nonoperating gains (losses)
Investment income
Noncontrolling interest in net losses of subsidiaries
430,398
49,057
479,455
353
(6,808)
(6,142)
Total net nonoperating gains (losses), net
(6,416)
(5,724)
Excess of rl'veJlIIPS over e"pf'n"es hefflre adjustment of financing costs
18,585
16,090
Olher
(2,637)
Write-off of deferred financing costs and swap settlement
Excess of revenues over expenses
$
15,948
$
16,090
,
,
BFA Attachment A (cont.)
Unity Health System, Inc. and Subsidiaries
Consolidated Statements of Operations and Changes in Net Assets. (continued)
Unaudited
Unity Health System. Inc. and Subsidiaries
Details of Consolidated Balance Sheet
September 30, 2011
(1" Thou.and.)
Unity
Health Clr.
.Group ._..
Unity
Health
Sy.te~In...
Unity
HGllJilag
PlU(, In...
and
.Grollp._ __ ---.!!!!>.Idlarl.. _
Park Rldt"
ChUd Car.
Ullty
HealthSyatem
~""ll!r,lri"
_
~uD~lltlon_. __
1011
COll""Udated
Total Prlor to
....J!!LmID.t1on•. ~tII!!>"t1o,.
A ... n
CUlWlt .asets:
Cult lIlld cash. eq1dvalentli
Curent portion of us.els limited l.6 to use
-
$
$
25,061
2,,238
2,940
-
1,18~
10,838
178
4114
l,I8fj
93,198
3,311
4.j,D60
A1.counta :l'e-ceivahle~ :uet
Oibor=tllBliftll
Tolll1 euuent ll5!letB
S
S
4,717
-
13,914
:U,1:l2
1.3
S
-
3,~;H
S
38
61
136
-
$
32,S78
11,238
",152
~
1<;,006
Hil
US,274
-
$
S
32,878
21,238
55,152
16.006
l25,274
t;cI
b:j
iP
iP
rt
rt
Pl
(j
::r'
i=l
(D
::l
IT
A:t!I"Cu litnited as to Ui.c:
29!
Uader bond inderture and mortgagc agrcemeats
Uader .(egul.tmy .greement.
UJUlerregulolionsfoI workers' compeoaatiGo
ByDoard deaigwtion£or capital :projects
BJ Bo..d desigrntiOll for profealliooalliahility
1,048"1
-
-
.,716
3,928
By BOIl.I;d dc.iglllllioo for defcuod <ompella.tioo
R<strloted by donor
295
TOtalasll.ftli llmited EW to ut>.e
Am"",,!.Il
-
~,329
17,753
543
147,66(1
-
claa.'IifW1 .. WIrent
Aasels fuo.i~d lIS 10 "'lc.1cas ourrenl ~ortion
161,110
AccUIllwated depIecution
ToW P"Operty and equipment, net
1/1,296
106
-
-
\2,,2381
-
-
18,296
100
1l,22~
29~,1l59
22.,:m
(1,389)
20,831
354,889
(181,203)
161,686
54,3~
-
-
-
-
100
14S,lI82
.,525
Bllildings and e'lupment
CDos=tion-ill-progre.'ia
-
2.9~
Prop,rty and cquip=
Lwd lIJld improvements
--
4,482
49-'95
4,810
58,947
(22,2011)
36,739
17,216
17,216
17,216
213
22,515
22,728
(14,262)
8,S26
262
1,207
343
l,8lZ
(986)
826
589
1,741
2,330
(1.757)
5"
16$,708
1,87<1
165,708
2,872
1,487
1,~87
6,716
9,034
n,216
203,033
(:U,lJ8)
181,795
-
14,071
JlI9,JJ7
59,518
462,916
(127,745)
235,181
-
-
6,716
9,034
17,116
203,ll33
121,238)
181,795
14,071
389,337
59,518
462,926
1227,745)
23S,181
Otllera:lget~:
Due (10) from affiliote.
(1,96<)
D,fem:d finanoing C00l9, nel
Goodwill
1,6S2
131
11,271
1,480
12,940
20,164
371
fulimgible asset
Oilier
3,033
Total Jibei' BBsets
Totoll!lsets
! -
--.r4;89~-$- ··-·-~5$-~lI;33g-S-
~tI3;o~s-
-
·-.-8-63-$-·~f-cS.--1ilf3,J17
.L-=_
(1.40@9fS
36,508
578;'158
t;cI
Unaudited
unity Health System, Inc. and Subsidiaries
Details of Consolidated Balance Sheet (continued)
September 30, 2011
(I11 Th""sands)
Unity
Hoalth
Slll"""I"':-_.
UDIlY
UoltJ'
BGillIlaJ
G....up
HeJl1th Care
n
.•
Grou.l'..-
PlUl,Iuc.
ud
Sub.llIlarl..
ParilBWllo
a.id 01..
Cent...,1=
tI:I
Ullity
lI-..Jlh Syll....
Io....dsUO..
Total Prior to
EUlIllllatloDl
E1II11IDsll,n.
rt
rt
129
1,677
2,On
n7
SO,~fl
$
$
Current p.o"iOll ofoblignti0fJ8 lu:der .capital je~
Ac",rued liabHititB;. including ~unt1. payahle
036
$
946
Totai CUIV:fit liabiUtill/'l
$
1,48~
-
1$1'740
EstiUllll4ld third.pBrtjl payor setll,menlll, net
70,009
2,122
160,1175
2,179
471
24,3l7
60,608
J1S
104
61,D37
~,~
$
-
-
-
$
~16
~
1
11,415
71
-
-
-
14~O
71
217
5,543
-
103
2,117
_
',660
86
86
103
5,iI&l
2,301
64,111
15,740
87,616
S
--
$
-
5,36~
2,301
04,211
15,740
87,616
III
[1
§
CD
::l
rt
t;d
Noncurrent HBbm1ie~:
L;tng-tenn Qflbt,. Bel of cuuoot pocti:on
12,982
Obligations Wide," capitwleasEla;. aet of curren! p.crtion
htere:it rate: Bwaf contract
<'lccrued pensionllabllity
l:ofc<red compcnaution
1,l169
7~1
C1her
Total nonmurent lia1iHuca
!!,!j67j
:11,584
1,(98
295,768
:H,368
60,1J78
(4,ll31)
31,091.
7m!
21,368
6O,1J73
(4,sal)
31,092
705
l2~16
U6,u.
25.2<i1
471
28,424
7,5!l!
(765)
-
387.17~
-
-
15,164
4'7
28,414
7,551
(765)
187,178
Wet ..,.ts:
Vn;rantrict.ed
TemporArily refftUct.ed
Pmnanently [e3I.ric[~
Total net lili8sets cfTJ.aity Henlth Sy~tdn
Nou,,<:tntrolling inte:re-st in net ~i6Ui ,){ SUbiidie.ri~s.
Toto' not Basel.
Tota UabiJitiea and ret BS3etf1
~
I>
LlabUldea and net IW~
Curnn; liabilities.:
Currenl maluriti.. oflong-torm ,obt
2011
CBu.nlldat...
_1,l1!1l.
f-
21,368
44,898 $-
60,err8
4lS-;-795
$
~1_l_- _ _
-60,338-$--
3l,On~
7~
2,302
10,047
S,75a
13,1111
~8JllL __.
110,713
10,047
(24,559)
-
5,751
(14,559)
116,513
:;t,OU
__ !~M2L
86,154
10,047
5,753
101,11.54
-
1,OUI
.. _{24,559L~---.!~111
-578;'158-
~--$-- ----.J63-s--~$---'jj3,3ir$--12.4:!i59n-
r--.
('l
o
::I
rt
'-'
Unaudited
Unity Health System. Inc. and Subsidiaries
Details ofConsolidated Statement of Operations and Changes in Unrestricted Net Assets
Fer the Period Ended September ~,O, 2011
'In Thousands)
Unlly
Dolly
lIealth
Health care
SJateUJ~!J:!a.._
..
Op<ratJoR .....""D..
Net plltient flervice revenl10
s
.$
Othor revenue
5,!36
ToW operating revc:nUe:s
5,S36
---.9~
Uolly
HOoWDg
~r~p-
310,478 $
ll,443
318,911
8,503
.$
PRB,It.£.-
P,..kRldi!"
u ..Uy
and
S.baldlarJ..
CblldCore
Ce.nter1 1nc.
a....llb s,y.tem
32,111
.$
3Z,6157__
64,939
583
9,OB6
~
--!1.9
819
1;011
ToliRl Prior tv
EU",h",lIl1DI
FoondalloD
- S
_4,996
4,996
351;263
Cmoolldated
Ellml""t1oo1
$
$
-
__
$l;Q,l~_ _ -l!~9~
4041.97
(U,391)
351,1;63
41,642
392,905
1,783
4U
634
Sol",i"" IlIld wag""
Employee, b'Ctmfit8
PtO-leBaional ftlCB
6
Supplies
lnrn;nmce
P.ro'Yision for bod ckbta
1,626
832
Inlereel IlIld fee.
Depreciation and .o.r:wftizution
Oth,r
Tow operating expmse..lnC'lIffil.'l from opoml~ons
956
6,248
(712)
151,102
35,494
23,641
49,401
3,011
7,635
5,311
11,293
17,439
313,737
!I,Ill4
3,096
755
57
604
25
5
1,740
l,378
1,379_
9,039
47
H,138
543
482
3,314
30,633
189
1,189
119
-
117
11
S3B
4
4
18
3,745
401.10
23,743
811.04
3,051
7,644
3,866
14,852
_JS~.
_"~9
67
~93,l!J!l
11;1.58
;U
1
oU
~69Q_
1~
i&;2!j,--
833
(14)
6,686
178,144
(199)
__ (11,193)
17ll,H4
40,120
23,743
81,264
3,051
7,644
8,667
14,85l
:!.4,l22
~.(l~_~li..£!
U,2SB
NQllopuatlng &&lnt VOl8CI}
:Uvestmellt inoone
).loncon1:roUing interest in net laJsea ofcombine,:I oob31diRriea
T~t.aJ nonopbtating iWnQ (lOB.!ItlQ)
Excess OfI'8V8nu.ea aver expense» befo[~ adjw.tment
offiDa.n(l.~g Ct'31.s
UII
3
-
-
127
-
1;64
(498j
-
"",-_ _
"
264
-
:164
~L
-
{~
(712)
(4)
{4}
5,180
(712)
5,180
(~)
4,305
6&0
Cllh.r
W.riki~offQi dcfelred fin.anoing C(tit3
(106)3
(~l
6,689
_
(14)
67
(10!)
11,151
(14)
67
11,151
127
-
(107)
11,151
ond .swap settiement
of 1"00V!CnUe8 :Jver exp.m1JCS
6,689
11,151
Oth!l.r J;~aDa:.e. 111 a::lr~lrldiNJ lUll IlIlIet,
llonubons:for cl(litai acquisitiolUl.
Change in fairvalu'O ofil1vcWnenbl
Change in funde:l statu. of pen'ion and posu.,urem""t pllllljj
Change in fnir"Value ofintareat [ate Elwapa
ChlU'lga in non~cnt::roUin8inter~
Other
ChalgC in unrestricted net alllseli
Unf<stricted not .. ",Ill at beg;noingofye",
Uon~trlc~ed ne1 8S11:lti; il.t end <:Jfyea:
~
tJ>
rt
rt
P>
n
::::r
Opel:'attRB eJ:plllDJIRL
~iJ
b:I
2011
5,185
{11J}
-
35
-
-
-
_
1~82)
-
(141)
(7112)
(312)
-
(1,414)
22.781
9.,060
51.618
-
(594)
27
t:l........,
186
6,:166
24.~~~
_
S~~
_
(78)
',141)
(312)
(1.2~li)
'::182)
111:2
14:221
2~OO
!l/l1l96
-
-
700
(300)
400
~!'!.9~ ..
5,185
(78)
(141)
(3U) -
{S96}
(SU)
14,621
13,537
:::;
(1)
:::J
rt
Cd
"'"
('l
o
::l
rt
'--'
BFA Attachment C
LINDEN OAKS SURGERY CENTER, INC
BALANCE SHEETS
DECEMBER 31, 2010 AND 2009
ASSETS
Current assets
Cash and cash equivalents
Accounts receivable, net of allowance tor doubtful
accounts of$379,696 in 2010 and $360,653 in 2009
Inventories
Prepaid expenses
$
56.901
$
41.396
633,737
198,670
41,156
751,342
265,302
56,248
Total current assets
930,164
1,111,288
Property and equipment, n.et
467,183
493,842
1,227,790
o
1,807,790
385,987
1,227,790
2,193,777
Other assets
Loan to stockholder
Oue from affiliates
$
2,625,437
$
3,801,907
BFA Attachment C (cont.)
LIABILITIES AND STOCKHOLDER'S EQUITY (DEFICIT)
2010
Current liabilities
Line of credit
Current portion of debt
Current portion of capital lease obligations
Accounts payable
Accrued expenses
$
325.000
576,300
16,124
942,705
142,180
2009
$
297,003
1,408,580
16,124
691,553
195,438
2,002,309
2,608,698
Long-term liabilities
Non-current portion of capital lease obligations
Due to affiliates
27,123
677,485
38,051
707,458
Totollong-term liabilities
704,608
745,509
80,225
(161,705)
80,225
367,175
(81,480)
447,700
Total current liabilitie..-
Stockholder's equity (deficit)
Cummun slu<.;k, no par value; 200 shares authorized,
issued and outstanding
Retained earnings (deficit)
Total stockholder's equity (deficit)
$
2,625,437
$
3,801,907
BFA Attachment C (cont,)
LINDEN OAKS SURGERY CENTER, INC.
STATEMENTS OF OPERATIONS AND RETAINED EARNINGS (DEFICIT)
FOR THE YEARS ENDED DECEMBER 31, 2010 AND 2009
2010
Sales, net
$
2009
8,653,529
$
11,153,002
Cost of sales
6,459,342
6,784,981
Gross profit
2,194,187
4,368,021
Selling, general and administrative expenses
1.731.396
1.420,280
462,791
2,947,741
Income from operations
Other income (expense)
Interest income
Other inc.ome
Interest expense
(67,794)
17
'197
(83,216)
Total other income (expense)
(66,870)
(82,702)
Net income before provision for income taxes
395,921
2,865,039
3,000
6,020
Net income
392,921
2,859,UI9
Retained earnings - beginning
367,475
173,711
924
0
Provision for income taxes
Stockholder distributions
Retained earnings (deficit) - ending
(922,101)
$
(161,705) $
(2,665,255)
367,475
BFA Attachment D
Linden Oaks Surgery Center, Inc.
Balance Sheet
As of June 30, 2011
11;26 AM
07/2612011
Accrual Basis
Jun 30, 11
ASSETS
Current Assets
ChcckinglSavlngll
M&T lOSe Checking
Petty Cash
Total Checking/Savings
67,767,76
400,00
68,167.76
Other Current Assets
Acco unts/Receivable
Accounts Receivable
Aiiowance for Doubtful ACCOUilts
1,153,128,93
-392,063.33
Total Accounts/Receivable
761,065.10
Inventory Hagen Drive
214,228.31
Inventory Pharmacy
27,236.93
Prepaid Expense
42,413.82
Total Other Current Assets
Total Current Assets
1,044,944,16
1,113,111 ,92
Fb,,,rt A,,,.,,h\
Architectural Fees
22,699.77
Computers
35,399.07
Equipment
2,112,040.17
Furnllur" .. ,,!J Flxlwe&
50,91G.12
Accumulated Depreciation
-1,654,942,07
Sottware
Accumulated Amortlzatfon
-78,909,91
Total Fixed Assets
79,181,78
566,384,93
1,679,496.85
TOTAL ASSETS
LIABILITIES & EaUITY
Liabilities
Current Liabilities
Accounts Payable
Accounts Payable
Total Accounts Payable
1,057,632.21
1,057,632,21
Other Current Liabi IIties
NlPAHS, LLC
NIP LOSe Mgmnt LLC
M&T Line of Credit
5,212.50
10,957.70
400,000.00
Accrued Expenses
20,432.97
Accrued Payroll & Expenses
85,767.33
Accrued Pension Plan Benelil
NIP Mgmt fee PLLC
55,193.70
0.00
BFA Attachment D (cont.)
.Jun 30, 11
NIP Ouatels (PLLC)
Pool Tax Payable
629,635.74
1,930.00
Sales & Use Tax Payable
663.33
Total Other Current LiabHities
1,209,813.27
Total Current Liabilities
2,267,445.46
Long Term Liabilities
M&T C-Arm Loan
M&T Equip Loan 1-2011
Capital Lease Obligation-Mini C
M&T Loan
Total Long Term Liabilities
Total Liabilities
89,833.32
243,039.56
29,719.21
168,889.00
531,481.09
2,798,926.57
Equity
Ctlpital
Draw
Retained Earnings
Net Income
Total Equity
TOTAL LIABILITIES & EOUllY
60,224.50
·2,149,890.52
639,746.11
110,490.19
-1,119,429.72
1,679,496.85
BFA Attachment D (cont.)
Linden Oaks Surgery Center, Inc.
11:2.SAM
Profit & Loss Prey Year Comparison
D7~11
January through June 2011
I\:cn.u.l
BI~~
TOTAL
O'"""'"....... t.-...~m~~._
....
~
~
~
6i'1,ru.94
n.2',819.::2
-M,985_3S
-173.00
-2,3-«_00
",1&5.067
.....l'l·.,IoJl111
~
SChug:
I""",,'
Med~~FI«rotd.
_..
Pool'tn
Raj""',
246.~
-5/)1).00
-',7"40.'£
-2,9'J6.8:J.
To!lll!ln;:om.
Cc~
7-3.50
.:1',a«.OO
~
~
173,'0
1.057<55
311.35
1,2850.79
-1A6
~>150. ~53.e.S
865.1).1
·12,029,00
·10,3M,S{)
A,368,91B.16
1.613,'8
...-9.:251.00
-9.1133.30
~ ~ ~
"218,754,90'
·eoe..14
,2,77~.OO
-1.206,50
·222,547.55
01 Goads ScHd
HSA:ERCl)t1;lribtlUon
PMlta.Iiin:Dl.A'ancl
Pl-ub~1ty In..... I'IC:.
~
.... ",~
.....
PeMion Plan
Wulii.Cotnp
..,,,
EqtMpm..-nt f1mUlt
1,12.5.15
6,2S<1.01
1,wa.:32
-1¥l.2S
2,5.25.35
e,172.17
O,9:;C."i~
:i.Of
::<:1,00:.<:11
~,-'OO~
·~,ez.-o-.or
3,500.00
-.4!'1i.71
111,579.7"
21,400.00
'2,m,2S-
~
~
7,E-4fI.49
18,781.12
~
~
·'1,139.23
.23,HXI.89
17,8.53_28
~
·~,S65.39
• .00
Ui.40.2,ro
Equlptn$n.lA~5r
S,S45.~
9J~'.93
--<l,""'5.6-4
5S.~.37
2,M5E"_OO
3,&14$0
-1,038.042
15,834.90
a2.7t6,B-1
20,559.75
~,"600,02
1OB.745.7S
-104,145.73
-1,64-t.61
21.69
556.621..87
585,639JlS
2,SOSJ.2&
~,"22,63
-7,536.10
155,160.05
222.972,$
.-
·19fj.,J7
o.~,o-t
J,t8~c~,
• .00
"'__Ionee
-1,:00.20
·1,91-90.16
l,r05.29
:3,'13.29
f-4,$17.!3~
Tol.al~:Mf1tli
-225.24
-61.02
~~.BO
~3t.eo
·Hi,W.OJ
·.c!7.3a2.4<'
.....724.as
P",.,rol
f'lIl'roITul'$
..,.,."
l'_" .... m~h'Io ..IT1
-
Tu l.ll?l.)'toii
Im~"
t~'S¢fub.
Pha!'TllACy
a,96a.S7
10.505ZEl
352.01
33ll:l2
3G.S5\l.€4
j32,~27,j'"
'S-S,716,i)So
... '"
·23.iBa,£'5
98.476.e5
r.E!8,10a,32
-ag,631.47
29,0104.1>4
Te<h
Supph.
$u1"iJk:aISuppliol..
Tot.1 Soopphl
lo"'COGS
"'''
4.761.37
~,"'51.12
316.25
7,922,55
-3.:502.31
-",,368.76
-1'15.186_29
~
~
~
~ ~
27!M61.56
GrouProfJt
""""8..c DeI:l~ E.KpetlM
1~,321,SS
215,49.... 12
...,
-1-D-1,OQ
......20,24
1-43:S53.1SJ
7\,101li:J
63,98".44
~,4!i6,21
1.ZT\I,:lQ
~ ~
n.s,6&VI2
2'l.6S9..III:2
76,950.<49
581."'55,SQo
·1.29,017.3S
-25,39J.fr.B
...
."
'5;>.812.$1
-1.;i:7a.oa
·<:l~,.w+.3-01
138.200.82
-:2,:2-'0.40
700 100.99
-31,m,B2
70.505,41
OCJO,619.805
·IQ.ol,~32,B7
1.6:!8,461.32
~
37.9S0.63
~ ~
·247,033.&2
j
S•...cS.08
1.:S47,2B2.67
1,S23,79G.M
2J,0486.~7
••00
•.00
•.00
0.00
-76,3.$1.::'"
76,3-41.2"
',960,01
&H.1£
10.742.59
3,4Q6.2{i
-<00,00
0.00
4.041.07
7,S-35_36
:dj;.17
',~.0.2
~,M2.70
3<3~..3:l"
35.04:37.55
2,004.71
3,l!.IO.B'9
0.00
"7,2·4fUI{j
"',218.55
2,13MO
7,336.33
t,lM6.30
••00
11.97
MS.92
• .00
',33S.:1S
-2IU7
Adm~ltraUw
[H*PO_I·u.dlellW• •
c"..,IAMS\ltJlIC~
Lk........nd ... rmlte
Mt.c.lIal'l«Xll
Otf.k:.Buppw-
""-"""""'-
T_
_
Prof~lMIl~onI
Adl\1~.tntMI
Tot..1
1,:5SJ1,o4ti.
750.504
76~.2ti
~26.:!5
&49.04'"
"'.00
·2M.~
5.100.0~
~
~
615.... :3
~
1,lgo,61
H.5.4-·U·S
e,5<i&.59
5.9'79.3'3
~.96!3.g4
76.5113.71
~
7:3,B09.t1
<t, 12~,<t7
269,17
-11,60&..31
""'"
2,96a.,~
-1,1l3~,79
2,707,60
BahkChlltgft
B"l1lo~C~.
M'I'f'1lhllnl C.rd F...
Tot..I8&'-':C~.
ea..lJon.
Eq,tJlpmtl1fEx:pfinM
1&1_&3
619.e1
-1!M,A2
009....8
2e9.011
·2~9'.67
1,007.01
~,:146.01
~,61
1,552."0
~75,60
~,S21.£1
~
~
~
0.00
2.25-4.05
0.00
3,128.35
0.00
2.5'Xt{ll)
3,000.00
'500,00
'1.4704.30
l1,!\.4tl.16
2:I,004.i.17
-9,1~5,2'
2,-ID3J36
•.00
910.91
"'56.8]
1.1192.95
6.'00.70
0156.85
7,684.046
-1
2,7-w,98
'2,$1, IS
2.162.45
2,152_""
0.02
~ ~ ~
'3,800',89
~
~
->2099
",.,.....
HIo:l:""td lIn-..anoC.
L'-bIIttylnalfaoce
L1reln.urall(J.
Tolalln-.mr.nc.
u.bor"IotoryF-...
360.41
380.41
:2.1604.27
1,12!l-.15
-"'55,83
0.00
,52~,76
2<.00
:37.80
-12.80
''''2_70
14-1).lJl
'59l3,21
·Hl,.fJ.5.00
10,0453.46
-16.~5
GS.389.00
6",~.B2
3,500,18
M.lMo«"d
FHIIoAHSi L'l..C
Adrnl!nl*U'atfw Pal'roI
M.~'lM'I .....tFM
foUll Man..own.nl
.....
7.9'53.00
6,sao.77
9"7::.,09
4ii'.080.!l~
003,4~.29
,oe,8-4!l'.5S
112,!5{J8.9Q
~
~
~
~
~
•.00
0.00
0.00
0.00
0.00
---0.00-
..j,B5!l'.2i1
47,895.1'3
~O,a1!i,12
.ol-4{i,19lJS6
217,:<.'6<.13
~
100,2<111,<19
..".
Ad"V"'lIIng
0.00
To161 Mtrt:.Ung
3,229.00
-3,2':2'9-,00
~
-3,:22S,OO
MiK.........
.. nLl
~,4l:J.:.'",<:1'
I.WI.b"f
....,• • Em«Ullnmoll'll
lHoIl-La-a1 Ef.'. IncMktd
W. .is-ill Ef'1I 1'lO~ !i1c:lrJdod
1i.5..Ul2
9-36.81
·~e.2_79
0.00
193.93
4S04Ji'j
3O"'.w
om
'504,063
T..",
oII~.61
1BI1l1& ~Nn.nt· OtMr
600.1/1
0.00
6-OJ.t1J
683.46
1.03-4_1;4
T,,"-'lu.-la"~....t
f.711.!l1
~
.I?1"l.'I:?
5."1!!.4~
~
....,.
a,954.38
92,51
Q:-:
-.3,535,9-5
·;2~O,SS
590,S7
Ss:J,f.4
u_
C_TV
Gnl!nld
e-.::rne
TolI.ll,ltlllUet:
~nrtO\Il-OItlk
ToQ-lJIi :wt.e".MQ'JS'
12:1.96
6.156.39
115.98
7,275..23
•.<:0
130.68
589.613
~1,OO
·SI9.3'"
~
::J3,e39,OO
.2,~54,89
~ ~ ~
0.00
!l.711.~
~
8,6J3.65
1'0.124.1'7
~
000
om
0.00
0.00
78.30
<9.05-3.1:2
"7,236,55
1,S-2E-M
-3,9-40,00
2,~,8S'
Pro1~FMIo
"'''''''''''''''
~,e.50.00
500.00
",2&0.00
12,100.0\1
t6.O.oIO.rXI
fA1:00
&,1"1.75
'1,5:.30.75
~5,284.92
~.c,:i76.56
T'"""'--"""P;l4f1
Pro1-.iaBlT Fon - OttMr
~~~,~
l,$Q~,7T
"",-",
~
~
SOIl,.
,~,'~;','J7
~
~
___
0.00_
'6,00
BFA Attachment D (cont.)
TOTAL
Tolill
Pnlorfln()M~ FHfi,
".,n
~ ~
7.7~.26
47,705.53
4,355.45
.oI',IOI.~
~
:3.~8S.-eo
""'.90
~ ~
SCtulnsll!
"I, ~e.s,2S
42.550.815
",<162,51
zs.5,ZJ.3,18
282,HI1.81
<'I,04:5,:17
;j.1~1l.~0<
:>,t:i>1,5:,j
~.Hi
.ii79_5ll
41B.9S
-479.S2
...c2...U
~
-521.95
li'l4IpB1Ro
DW""'''''''r1'lI ..... htl
CornflwwrA~tl'l;
0.00
000......
CCMlput.lr RGp;lIra. DtMt
)'oI.lIComput.lr Ao~1n
F'N1...IMKBI1....
!lftb~~E4u!'CI1
Flepaln·OItJl.r
ro~J~n
~
000
,...
479,52
~
0.00
~
-'119.52
.1_7·t7_~1
El.7E'4.00
0."
~
""'79,52
---.2:22.
0.00
9,4&(L15
0."
~
:3-750.:5:5
.d:.~~ln
~
040,;15;.27
A~.~;_~
"'<:7.';';'
0110
""'.03020
·3.96S.38
·18,308,45
~
3,:US.2S
3.117.'6i
260.51l
:22,232..9"3
~,54~_3'l
1Mw Yerk Slaw 541. . Tll:r
Ea3.33
4,338."1
.,312,73
~.55
57150
750,00
81.95
1/i_BO
3,801.00
"-""
601.33
5eU'O
0."
750.00
1,500.00
4.092.DS
75(1,00
~ ~ ~
2:2CV:iS
750.00
:::::3:!EE
~
~
~
Sl.ItIilielil r.str'IJmem.
Tallila
S....
To....llaln
Tot!li ExpoMIII
... _
w-.!'l...l~."._
~
GS,62.G.1"9
-2,10".11:)
(l,.1l.531.o-i;.
0.00
0.00
0.00
0.00
8.~9.S4
~
,:(I';"."~'OO
~,:;j~.O:;
112,6:1
""..,
Ott- 1nc«ri'*'ExP1'!"*
Otner lrK:om.
Olharl~.
lnt.r.sllncorn
Otl'lMtncom,~Othef
T01l!lIOn--lnl:om.
s..kloIA".d~
TolalOthermc.om•
000
0.00
~
----o:i))
-0:00
0.00
0.00
___'00_
----0:00 ---000
0,00
6,2Oe. 1 3
~
2!i.I~.S!!
~
0.00
---m--:-~3-
0>00
~
1,501.20
2;15,5\8.69
-tQt.Ol£.~
_.,
.
6,30!3,13
'-5,"'i00,3:3
2S.15S.~
30,554.91
................
nl,,-!l=yfW""_
,Ac(:r-d~llo;ln~
AmOf1l.zlIton Ex p«IM
~j.tIonE:r1*'"
Leglll FMlI
~nlfMn,,,,
OIMrE:lp«l_·OIhIK'"
T<llal Olh« ExpMl_
TotaIO~rEJI~
N..... OIMrI~ ..
I'Mrwa""l
267.93
21')_82
16.996,50
SS2.!>I}
-SB~.S7
1~.990S.5Q
0.00
0.00
,0.0,
I,007.SS
1:24.92
2,Ji66,7li
2",.fJ37,(Jj
U:'J(/_OO
_'0
5.~J.S5
-:2.0146.92
101,;79.00
1,7-3-4,3i
16,789,62
0,00
'.00
0.00
]33,7:3-
5,115.00
368.7-8
-3,501,42
n.3Qs.oo
;14.614.00
T243.ij.4
14,000,00
-S.265.67
35,66tl.37
-\5.876,15
~
323.69
-~:W
~
:25,15~,77
~
1Z8,569,1B
~
~
~
~
~
~
-3,lI95,00'
~
~
~
~ ~
34,550,00
~"rru;L"
~
~
1"",1-G:1,42
"'1.::l~.• .J
~
---
-_._ .._.-~.
__
. _ - - - - - -----
-------~------
---
.----._--
BFA Attachment E
Applicants' Organizational Chart
-~-----_.~--~_._-
.
· .: . ~:ri,]~*\8~·~~!~?:.,:~y§t~-m.i::.:;.·:·
2.,,_·....__,
"1
"'__ h'"'"';"'~
--[
I
[
.~~~,j
i
I
Ic:i;}~~~lff~~W~~~1~~i~~~~~~~~~}'j~;'.-1:J
!
BFA Attachment F
ESTABLISHMENT CHECKLIST FOR AMBULATORY CARE SITE
APPLICATION: CON 112244 Unity Linden Oaks Surgery Center, LLC
PRIMARY CARE
SPECIALTY
Multi-Specialty
NATURE OF APPLICATION:
xx
xx
AUSPICE:
NON PROFIT
PROPRIETARY
PUBLIC
- Limited Liability Company
AFFILIATIONS;
None
YEAR ONE
UNIT COST:
OPERATING
CAPITAL
TOTAL
$ 1,101.47
$ 1,145.67
$
m
170.74
$ 1,272.21
YEAR THREE
PAYOR SOURCE:
MEDICAID-FFS
MEDICAID-MC
MEDICARE-FFS
MEDICARE-MC
COMMERCIAL-FFS
COMMERCIALMC
ALL OTHER
CHARITY
YEAH THREE
1.3%
8.1%
8.8%
22.6%
24.7%
26.0%
5.7%
2.8%
$
123.46
1,269.13
New York State Department of Health
Public Health and Health Planning Council
January/February 2012
ATTACHMENTS
Diagnostic and Treatment Centers - Establish/Construct
Number
Applicant/Facility
1.
101164 B
Mobile Health Services, LLC
(New York County)
2.
112142 E
Primary Health Care Plus, Inc.
(Nassau County)
Exhibit #8
BFA AtlacllfTlent B
Pro Forma Balance Sheet of Mobile Health Services, LLC
ASSETS:
Cash
Prepaid Expenses
Receivables- related parties
Other receivables
TOTAL CURRENT ASSETS
Property and Equipment
Security DeposIts
Other
Deferred Taxes
TOTAL ASSETS
LIABILITIES:
Current Portion of Loans Payable
Accounts Payable
Accrued Expenses
$1,630,153
85.209
144,000
3,090,735
$4,950,097
$2,800,585
1f:1,397
89,055
(231,352)
$7,627,782
$264,307
2,301,782
223.943
TOTAL CURRENT LIABILITIES
$2,790,032
Noted Payable
TOTAL LIABILITIES
$1,817,601
$4,607,633
TOTAL CAPITAL
$3,ULU,148
BFA Attachment C
,rvJOBIrEll1.LALTH:'~A6::EME1'fT SERVIomiS,JriC.
BA:Lt\NC~'S.HEETS
·Assets
Current Assets
cash
;$'
1;57'9':
218:1\S;~85
'7J.,23~
OI)uerrom re1'atedpartles
..25J188
2j2&O~3'Tz
. :3~Oft~
.I'repaid expenses and other current assets
l44i6(:l7'
13~18Q
Accounts .teceivable.
Notes receivable -relatedparties,inc1udinginterest
0{$172,743 and $26,610
.
2467"',,425
? '
. :::>.', -'-"." .
Total CurrentAssets
'1'247 i63
J
.c~
Other Ass'ets
Deferred taX asset
922.4
...,
Security deposits
19)197
Tota,l Assets
528622
.
,~
10.~297 .
20>O~2
BFA Attachment C (cant.)
DECEMBER 317··2!(J0.9~A.'ND 20.'Q8 (RESTffiTE:Qf'
.-
".'
- -
.'2009
"
"
'.
~
--
~
Li~bilitiesll~tl>Sto.ckholdersrEqlijty
Ctii",r¢.ff Ll~1>iJi.nes.
Accountspa"yable
4hl~9'S
11j,09~'
$
AcerUedc:x~il$es and other curten:i liabilIties
Due t6 '(lffiliates
Loan fron:fMliMS p·~C:.
Defetred:tax H~bilities,
Current m.aturities of Ibng·temldebt
Z6... ' 9$8
, 130~.'733
63A'i.482 .
54;,1;07 '
j}067,9;62~
240~76
$QQ;{)@,(f
2. S9S:J:.Z7.'
.. .. ~ ..'.': .c"
Other Liabilities
-rent,payable:-'-' -_
·--~..'Deferred
L()ng~:!.~~·debt,·.]esscutreril
'
-
maturities.
Total Liabilities
Cummitment,sUDd Contingencies
Stockholders' Equity
COmmon.siock,nopqr y~ue; 20.0 shares' authorlzed~
I.OOsb:ares issu,ed. andpu!.standing
Additional paid.incapital
.
Retained 'earnings
Tot.al Btockhoider,s' E\luit,y
T()taI:Ljabi1itleS~'lld Sto~khoidets' EqlJity
'2549:369'
, .. _.",
-,
'
,
.
BFA AttachmentC (cont.)
Balance, Sheet
As. of. 12JSl12009
Moalt~HEA~'t8 Ml$.pjQ~!,.;$ERVjbE.:si,P~C,.{M?CJ'·
•
"
-'•
' - -,
..
.'
-
. c"
•
- .' ' . .
-
,~_
_
•
,....
"
_ .' . _ .
_"
'.,.;
'.
,-- - - •
•••
,. ".,:,
"
ASSETS
CASHJNaA""K~CHASt
$
CASH" CHAS6MMI<T
ACCOUNTs'RECE'IVJlSLE.cClNTFiOL
~~~~~~~~~~gi~~HEALTH
MGMT
UflPARCPLAOE 'bEV~L6PMENr
UR CI'lABP,iO'
LiR,JUSJAROUNOrHE C6RN~R
lJR;NV©S="'"
, ",.,.,
'PHEPAID,II'llSVAANOE
p-RePA1treoPJNSURANCE
pJ:lk~Aj6~MPLbY~~Ni~V~BINS;;
PREPArOWK$cOMP'JNSURANOE
,'
PREPAtDAutO INSURANCE
PREPAID EXPENSE'
,
Tolal ASSETS:
LlASfUTlES,
, :2'i6.19~'~~,
:2'i4;20S:il5'
AQCOUNTS PAYABLE-CONTROL
ACCHUEOU!l.BIUTY
Alp-MOBILE HEALTH MGr.1l"
'
,2;81q:~~~~Ql
,3;305;1;93.44
Tolal UABILIl)ES:
EQUITY
, Q9MM9NSTOC~
100;0(l
,
(51;2$3:Z9);
,ii3;8'l~h~3
FfETAINEO'EARNINGS- Pf{IOR
Reta i~d E:;,n:iin~s-CoiT<mt
V';lll
~~ _ _..~':'"~-~~'":"~--:'"-:~:':"' •• O,•••• J.~~:-.~:-:::~~:--.-':":""-~--
-------
TOlar 'EQUJTY:
--------_.~-
To.lBILJABIUTIE$ &,EQUITY~
1-:1
tor •
,
,"'
.-, : ..
. . ,~,' ~. ~,
S
3.259,31468
. , '- ,..
•
-_._----
.. _--' ... _ "
- - - -_ .. _-_ ..
_
MOBILE HEALTH MEOICAL SERVICES, P.C•
MOBILE HEALTH MGT SERVICES, INC.
COMBINED INCOME SljATEMENT .
..
I
!
i'
·-i--·---~·-·--T----'·
..... -- .. " .... --. .,.
,
J..
"FE8··I·-MM'--
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59 493 I S 119,416
• IS . . '•.
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'-'"
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S
5(57970
~
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S IIU7~
762llll
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114,3(;7
•
$ -470,469
S.i 76J>4'!'-ttS_~~~
S JI
5._.·
$ $.COSiO IS 621562
1:502110'$ 553.470
7O.s1l~ S
S
•. S
$ ~611$ 52M!i2 $ a50,oSS $5113.021
·i··- -+------ -_
. . --
486'722$' .7sT2t\' '$--537,255
S
$
$
•
1
I
I
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1
I
-'-"
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'-'--"-T . "---UMONTHSENDEO
I';
. ·12Jiili009r'T2ii.ii2OOi
.----!
JAN
APR
MAY JUNE
JUU-"j'---AUG-SEPT
OCT
1'-' NOV' ! jjec······-TciT~- 'TOTAl'1
..-".+--==~:-=-=--+-=::':'-+--':'::"':':-+---::::~+--=~H~-+-::::::':::-'+-~'-+----::~-+-~~+-~~~~=---1H--~~-1
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.-.
..~. "'Oldie... ! E>c;.;u"-'--- it· "4ii'2.'7u h ~2,236
R'''''''''J<J - On 5;1" PII~
B"ventU!l-MscalIsl'lltCltt$._.
;!
'T
_ •.
••- ••.- - •... - . - - - . - - - - - - '-'.'
FOR THE TWELVE MONTHS ENDED 12/3112009
.- - - . - - - - - - ..- - - - - - - - . - - - . - -... -- .....
-_.~.-...
- - - _n.
$
SSHI,111
'I
.=.. 1
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S· 48"7.265'$
T
S
7,1:863
•
$ 559128
$
5
74..455
•
$ 615099
$
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,
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S e127..»4
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$ 1764.289
;~t~~~t~~~~~--_·-·T--~~:~~l~--~.:·-;-·~':~--~~·-'5;28·J' 5.o54L ~:i~~'''$ I: is 5,309 ~:~~f~~ .-~~~, ~'-;~'-.-7';~ iS !l7.83~i IS 11511,1504
~ ;~~~~~~.. ......=. T1:~~i1+~~ "l'-}~~~~ .}-}~~~ .fHPob111 ~~1t ~:.,t~H~ :'l"}~~!fl~:~tf ~;;:n~i l'~~:~~"!I'l'
~
.,,600: t~~£il+~.:~ Lir.]:~.~~
p
--"$-'
5309
.~
ADP Charges
.
... Bookkooplng ~ ....:..
._ ..L
.£~~ _ _ ._._~....
_.t.261 IS
1,269
.~.L!.
.__ ~... _!.941IS
IT • Interface' .
S
,
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.~f:!::ProgrammlnglSoflwa'1l
".."",,rT·Webs!.e
800
32-4
S
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2,318.
$
563
5100
$
1199
2,~51 S
VB
IS
840
m
$
. 1,535
S ... 2,357
S·
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$
1,5:ffi.L. 1.539
s
1
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1._.. 2,205 ! . 2,872 $ 'I 2,26~
$''-.~.! ... ~ 1 .... 823 ~~522
640
$
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B40
S ,I
800
525,114,681
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11,779
S .. _
717
I
S
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S
7:17
$
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=--R. ril.:Ofl'ice.=-=--=-==----=~ . rlj~~·
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55,100
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t
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,
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5"",1,,100
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3..236
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$
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1,180 S
S
S
S
5.627: S
-
1.628
S
S
S
S
2. 154
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S •..~~~1 ~~.
1,645: 1>
2,151 1$
H_.~0.f_I,~._. 553js:
BOO L!- 640; 1i
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s
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$
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S
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$
199 S
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S
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$ I
Professlona F...... ·Consullirig
f-t~-:4.roo S
5,902 S
6.544 $
6,488 S
5,847 $
6,480 $! 15,635
Prof.."";",,,. FeM' ConsuMln\l:MAOS
$'
(311 S
$
2.~25 S
313 S
1,938 S
M75 $
5,025
Profession,,' Fees - ConlPJlllng.-Mgt
.._ S
S
_: _ $
•
s
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S
S
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3.1133 S .. _3,~33 ~,3.e33 $
3,633 S 18.633 $
3,075 SI 3.000
Pmr"sslon"IF-s:~_.__
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39B $.. 27,343 $13,,392 S 11.831 $
3,481 S
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.. OulsIMl!.'.2!~_~.~ . . . _
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S 34,311 S 1M89 $ 56,98'3 S 18,421 $ 43,031" S 27,8:31) $ II 39,392
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S 81172 $ ~]~ J.. H3.D94 S 81,598 $ 90,193 S 101,890
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IS 11,225 $ 18,952 S 17,231) S
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$
$
1,370 $
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S
•
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9 S II
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fI.4 $__
737. .!._
97 S
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126 I $.
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2. 111
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$
3.591 $
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1 ABO S
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MOBILE HEALTH MEDlCAU$ERVICES, P.C•.
MOBILE HEALTH NGT S§RVICES, IN9.~_:~_~-~.·
COMBINED INCOME SrtATEMENT
'T
--_.FOR THE TWELVE MONTHS ENDED 1213112009
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$
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$
Rent Experse - NYC l=adBty
$ (16.000 S ._(16,000.1iS.J!5,OOO)
Clllsultif'lgExpeMe-H.Freund ..
_.. _ ! __.__"_., s
-1'$ Consultlncl Referrals
$
S
S
ClnsulfrtlQ 11lCOITlO' BMRI
S 2e.ooo $ 25,000 S 25,000
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.. _5_ _-_.
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__
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_ .: ...
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300,000
-'-TiS s
1,388"~~
..
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--~
-=- ..
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•
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,
S
I
S
i $ 5712.2~3
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i
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1155.713
g
........
BFA Attachment D
BaJanceSheet
As of 12/31/2010
MOBILE HEALTH MEDICAL SERVICES, P.C (MPC)
ASSETS
$
CASHIN BANK-CHASE
126,670.15
CASH - CHASE MMKT
ACCOUNTS RECEIVABLE-CONTROL
DUE F~OM MOBILE HEALTH MGMT
1,007.71
517,814.86
1,412,495.31
UR BERT BRODSKY
UR PARC PLACE DEVELOPMENT
URCHABAD
lIA JUST AROUND THECORNE"R
UR<MAOS
PREPAID INSURANCE
PREPAID' MEDICAL SUPPLIES
1,000,000.UU
250,000.00
100,000:00
30d,OOCl.OO
5,000.00
18,554.25
32.794.84
Total ASSETS:
$
3,764,337.12
LIABILITIES
ACCOUNTS PAYABLE-CONTROL
444,509.59
ACCRUED LIABILITY
NP • MOBILE HEALTH MGMT
114,459."25
3,245,767;68
Total LIABILITIES:
3.804,736.62
EaUITy'
100.00
COMMON STOCK
RETAINED EARNINGS - PRIOR
(46.37~.76)
Retalm:td Ellmings,CIJrTent Year
5.87~.26
Total EQUITY~
(40,399.50)
Total LIABILITIES & EQUID:
-
$.
~~-_.
--~
--------
~
~-
~"~~
~-
3,764,337.12
ComparatIve Income Statement
For Period 12 Ending 12/31/2010
BFA Attachment D (cant,)
MOBILE HEALTH MEDlCAL SERVICES, P.C (MPC)
Prior
Yeerto 00\0
0/. of
ReVtilr'lu~
% of Revenue
VearloD:>te
REVENUE
$
REVENUE· MEDICAL EXAMS
REVENUE· ON SITE PAYMENTS
5,803,394,34
85.8 %
~
86.5 %
5,840,068.34
913,985.21
~b],:l67.3e
14.2
REVENUE·MISCEl LAN EOUS
0.00
212.30
0.0
INTEREST INCOME
0:00
0.0
0.0
1.37
0.0
TOlal REVENUE;
6,760,061.72'
100.0
6,754,267.22
100,0
GROSS PROFIT:
6,760,961.72
100.0
6,754.267.22
100.0
3.470,829.00
82.,468.38
1,697,222.73
51.3
1.2
25.1
3,730,700.00
67,830.74
1.324,567.58.
55.2
1.0
:).,615.19
0.1
7,507.20
19.6
0.1
444,555.88
1,053,2G9.89
0.00
6.6
15.6
0.0
13.5
EXPENSES
MANAGEMENT SVCS EXP·MOBILE
MEDlCAL DIRECTORS & PHYSICIANS
TECHNICAL & NON PHYSICIAN
FRINGES
MEDICAL SUPPLIES
LABORATORY FEES
331,061;66
4.9
984,-642.01
14.6
27,895:00
0.4
35;60
0.0
(150.00)
0.0
150.00
0.0
0.00
0.0
(400;00)0.0
33,658.93
0.5.
7,415.38
0.1
X·RAYFEES
OFFICE EXP[NSE
TELEPHONE
FEES 8. LICENSES
AUTotEASI~G E.XPE:NSE
AUTO EXPENSE
MEDICAl LIABILITY INSURANCE
BOP INSURANCE
EMPLOYMt:NT L1A6 INSURAI~CE
. "-cc,,,,,=~,,c"·~·'··WORKMEN'S·'¢O~l"lNSU~~·~:c.:._: ~---
'(42);0
0.0
0.0
0.0
159:ll0.
5.~O.COO.1
955.79
26,948.00
8,377.37
0.0
.-..•••_.::='C ...••.•5;9(lg,~::'::~_._.,-..::;Q;L_,;:.:~ .._.
0.00
0.00 .
0.0
0.4
0.1
2.6'59.30
._.
"~S.s.aa:la:.
0.0 .
__
...
J)~L::
2,727;31
. 14,100.00
18,000:00
0.0
0.2
U..3
20,9115.00
0.3
PROFESSIONAl. FE ES-LEGAL
17,582.50
0.3
898.75
BANK CHARGES
5,904:91
0.1
36,510.00
0.5
7;686.14
0.1
595.:00
0.0
7,121.690.1
3,896.18
21,730.00
5,122.00
0.0
0.1
0.3
0.1
0.0
0.0
AUTO INSURANCE
PROFESSIONAL FEES- CONSULTING
PROFESSIONALFEE$-ACCOUNTING
OUTSIDE INDEPENDENT r.ONTRACTORS
NYS CORPORATION T AX-1CT·3}
NYSCOR PORAliON TAX-(CT 3M14 M)
NYC CORPORATION TAX-(4S}
Tota) EXPENSES:
NET INCOME FROM OPERATIONS:
OTI-!{:;I'l
1,797;000.0
6,575.00
0.1
0.00
300.00.
6,755,083.90
~.9
1l,743,3S2.111
99.8
5.877.82
0.1
10,874.41
0.2
1-.44
0.0
0.12
0.0
INCOME AND EXPENSE
INTEREST INCOME
Total OTHER INCOME AND EXPENSE:
l:AHNINGS BEFORE INCOME TAX;
Nellncome (Loss):
S
1.44
0.0
0.12
0.0
5,a70.~6
0.1
10,874.53
0.2
5.879.26
0.1 % $
10,874.53
0.2 %
BFA Attachment D (cont.)
MOBILE HEALTH MANAGEMENT SERVICES, INC.
BALANCE SHEET
DECEMBER 31, 2010
Assets
Current Assets
Cash
Accounts receivable
$
25,050
3,596,749
33,044
40,902
Due from related pa.-rties
Prepaid expenses and other current assets
Notes receivable - related parties, including interest
652,965
of$271.578
Total Current Assets
$
1,634,&53
Property and Equipment, Net
....
'G-o~olJml)~=---=--
=..
=---=-_.. _=---=-=
-.,-=--=-_..
--=-- -=--- =---=_
.... _=_= ==
....=._=,-'--c-c-"".
7C_
~-~~~ .~. ~ _~
_
250,000
Intangjble Asset:!;, Net
Other Assets
Deferred tax assetSecurity deposits
224,716
36,767
Total Other Assets
Total Assets
4, 348,710
261,483
$
7,413,746
BFA Attachment D (cont.)
MOBILE HEALTH MANAGEMENT SERVICES, INC.
Bf\LANCESHEET
DECEMBER 31, 2{)} 0
Liabilities and Stockholders' Equity
Current Liabilities
Accounts payable
Accrued expenses and oHler current liabilities
$
38,352
57,224
Due to affiliates
2,104,424
Loan from Mf[MS Y.C. '
Deferreq tax liabilities
Current maturities of long-term debt
1,412A95
337,508
551,487
Total Current Liabilities
$
4,501,490
Long-Term Liabilities
Deferred rent payable
-------- ----- ,L--ong-t-e-rm.~debt,~less::Cllr.r:entmatUI;itil::s
356;702
1,174,589
Total Long-Term Liabilities
1,531,291
Total Liabilities
6,032,781
Commitments and Contingencies
Stockholders' Equit)'
Common stock, no par value; 200 shares authorized;
100 shares issued and outstanding
Additional paid in capital
Retained earnings
2,000
117,142
1,261,823
Total Stockholders' Equity
Total LialJiliUt:s and StocklJoldns' Equity
1,380,965
$
7,413,74~
BFA Attachment D (cont.)
MOBILE HEALTH MANAGEMENT SERVICES, INC.
STATEMENT OF OPERATIONS
FOR THE YEAR ENDED DECEMBER 31,2010
Revenues
Costs and E:xpenses
Operating
Selling, general and administrative
$
$
3,854,861
2.235.386
2,99S.;310
. Total Costs and Expenses
5,230,696
(1,375,835)
Loss From Operations
Other Income (Expense)
Interest ihcome
99,956
Interest expetlSe
(50,098)
.. ,. .. _~._
_..._-_ ... ,--_ .. ..
,
Loss Before Income Tax Benefit
(1,325,977)
131,689
Income Tax Benefit
Net Loss
49,858
$
(1,194,288)
Attachment E
CON# 101164
Mobile Health Services
Detailed Budget
Year 1
Operating
capital
Total Year 1 Expenses
Expenses
$692,126
Visits
8,99S
Cost Per Visit
$76.92
"12,837
8,998
1.43
$704,963
8~98
$78.35
10,649
Cost Per Visit
$73.22
Year 3
Operating
Capital
Total Expenses
Expenses
$779,738
Visits
1?837
10,649
1.21
$792,575
10,649
$74.43
BFA Attachment F
ESTABLISHMENT CHECKLIST FOR AMBULATORY CARE SITES
APPLICATION: CON#101164
Mobile Health Services, LLC
NATURE OF APPLICATION:
AUSPICE:
_ _..:. . ;X
PRIMARY CARE
SPECIALTY
IF SPECIALTY - TYPE:
x
NON PROFIT
PROPRIETARY
PUBLIC
Limited Liability Company
AFFILIATIONS: NA
UNIT COST:
YEAR ONE
YEAR THREE
OPERATING
CAPITAL
$76.92
1.42
$73.22
1.20
TOTAL
$78.34
$74.42
PAYOR SOURCE:
YEAR ONE
YEAR THREE
MEDICAID-M/C
24.60%
23.74%
MEDICAID-FFS
5.74%
5.55%
1.44%
2.45%
13.06%
30.25%
14.19%
5.19%
3.08%
1.27%
2.20%
12.48%
29.08%
16.47%
5.89%
3.32%
MEDICARE-MC
MEDICARE-FFS
COMMERCIAL FFS
COMMERCIAL MC
PRIVATE PAY
CHARITY CARE
OTHER
BHFP ATTACHMENT MAP:
CON # 101164
MOBILE HEALTH SERVICES
New Jersey
1
Mobile Health's Main site
Mobile Health's Extension Clinics
IL Existing D& rcs Main sites
{J,.
*
BFA Attachment A
PRIMARY HEALTH CARE PLUS, PC
(A CtJrpuratiou)
BALA..N'CE SHEETS
Dec.ember31, 2010 and 2{J09
ASSETS
CURRENT ASSETS
Cash (Overdraft)
$ 34,645
Accounts Receivable
140,107
10,5&7
Loans and Exchanges
Prepaid
$ (1:2 ,4.90)
Exp~nses
~Jf154,
166,592
3,517
_1Lm2
TOTAJ." (.'URREl\'T ASSETS
MAJOR MOVABLE EQUITMENT ~ NET
OTIIER ASSETS
Organization Cost· Net
Employee wan Receivable
96,806
_
108,306
900
TOTAL OTHER ASSETS
TOTAL ASSETS
LIABILITIES AND STOCKHOLDERS' EQUITY
CURRENT LlABILnn:s
Accrued Payroll
Accrued Expenses
Overdraft Line of Cred it
Lease'> Payable .. Current Portion
TOTAL CURllliNT LIAHlLlTLES
$ 22,137
23,424
4,417
9,532
_~~678
59510
_~7,G81
1l,Tlj
2l,ilo4
$ 19,689
41),362
7,952
LONG TERM LLABILnmS
Lease Payable - Less Current Portion
Due to Related Parties
Cre<:lit Line Paydble
TOTAL LONG TERM LIABILITIES
170,000
150,000
.... 23,969
.~?
205,742
1'0'1' Al. 1 ..I..AB:rIITlE'S
STOCKHOLDERS' EQUITY
Retained
E2cming~
TOTAL STOCKHOLDERS' EQUITY
TOTAL LIABTLITfES A.1'ffi STOCKROIJ)ERS' EQUITY
234,099
;); 534 '7§8
BFA Attachment A (cont.)
PRTh1ARY HEALTH CARE PLUS, PC
( A Corporation)
STATEMElYIS QF INCOME ,A,ND RETAINED EARNINGS
For the Years Ended December 31,2010 and 2009
2009
REVENlJES
Medical Income
$1,201,755
TOTAL REVENUES
1,261,840
1,201,755
609,624
OPERATING EXPENSES
Physi\;ian Fees
49,246
645,0&1
71,673
Employee Benefits (Schedule 1)
55,557
77,419
Salaries
Property Costs (Schedule II)
Administrative and General (Schedule IID
149,324
113,521
~393.152
446,357
1.226,903
-l.J2+,OSl
TOTAL OPERA'I'lI'{G EXPENSES
34,937
NET INCOME (LOSS)
RETAINED EARNINGS ~ BEGlNJ'ilNG ot\' YEAR
234,099
407,893
---l2..1.493)
STOCKllOLHER WITHDRAWALS
RETAINE]) EARNINGS - F:ND OF YEAR
(152,296)
,$
21i9,Q36
~t)34\092
BFA Attachment B
PRIMARY HEALTH CARE PLUS. INC.
Summary Balance Sheet
AfiJS¥ r.skJ,ftber 30. 2011
ASSETS
Curreni' Assets
Checking/Savings
Other Current Assets
Total Current Assets
27,904.84
21,130.35
49,035.19
Fixed Assets
247,406.81
Other Assets
110,666.00
TOTAL ASSETS
407,108.00
LIABILITIEs & EQUITY
Liabilities
Curt'ent !..Iabrliries
Other Current Liabilities
Total Current Liabilities
Long Term Liabilities
Total Uabillfles
Equity
TOTAL LIABILrTIES & EQUITY
282,629.82
282,629.82
76,567.40
359,197.22
47,910.78
407,108.00
BFA Attachment B (cant.)
PRIMARY HEALTH CARE PLUS, INC.
Prof it & Loss
Ordinar-y Income/Expense
Income
January through N1'?2~"2d:h
Fees
Patient Fees
Total Fees
Refunds
&Returned Checks
Totol Income
1,348,642.68
1,348,642.68
(7,253.72)
1,341,388.96
Expense
Wages - Physicians
Wages - Physicians Assistants
Wages - Physical Thel"Clpist
Wages - Medical Staff
Wages - Office Manager
Wages - Office
Advertising
145,200.00
70,400.00
17,8?6.00
140,242.00
69,316.40
90,937,00
4,980,00
Auto Expense
1,86638
Auto Lease
Bank Service Charges
9,670.23
1,358,19
Cleaning & Saflitation
1~,UIU5
Computer Expense
Service Contracts & Support
Website
Computer Expense - Other
foTa! Computer Expense
Conferences & Education
Credit Card Processing Fees
Dues and Subscriptions
5,346.59
26.97
1,039.00
6,412.56
13,465.55
1,664.72
6,941.46
EquIpment RenTal
4,3~~.86
Equipment Repairs & Maintenance
3,944.50
930.73
2,234.94
Hazardous Waste Removal
Hoi iday Expense
Insurance
Ufe
Health
Malpractice Insurance
Other
Total Insurance
(61.84)
9,578.74
65,289.00
574.82
75,380.72
BFA Attachment B (cant.)
PRIMARY !--lEALTH CARE PLUS, INC.
Profit & Loss
January through .bit~m'bwP~d:b
Interest Expense
Loan Interest
Total Interest Expense
L.aboratory Fees
Licenses and Permits
Medj~Cl.id
POQI Surcharge
Medical SUpplies
Misce lIaneous
NY State Corporate Tax
616,12
616.12
977.00
3,276.00
5,938.00
93,695.42
1,953.64
1,000.00
Outside Billing Service
6,412.26
10,770.66
2,669.79
Outside Labor
Cicero Consulting Associates, V
14,822,77
Office Expense
Office Supplies
New York Cardiology. P.C.
Paola Puig
Steven Adler, M,D., LLC
Total Outside Labor
20,182,80
2,700.00
39,553,50
77,259.07
Payroll Expenses
Fica Medicare ExpenslE
NY State Unemployment Insurance
40,460.45
3,175,97
Federal Unemployment Insurance
1,219.15
NY Merrax
2,1:35.60
Total Payroll Expenses
46,991.17
Payroll Processing Fees
Printing & Reproduction
Postage & Delivery
2,997.93
21.73
3,683.50
Professional Fees
Accounting
37,535.35
Consultants
Consultant Fees
5,625.00
Doreen Tansl, RN
1,575.00
Joann Pannell, RN
1,875.00
750.00
peDe
Other
Consultants - Oth,er
TOTal Consultants
1,951.66
1,375.00
13,451.66
BFA Attachment B (cont.)
PRIMARY HEALTH CARE PLUS. INC.
Profit & L.oss
.TanuQl"'y through
~
Total Professional Fees
50,987.01
Rent
111,000.00
12,404.99
693.82
Repairs & Maintainence
Security
Telephone
Answering Service & Beeper
Telephone - Other
4,915.30
10,587.85
Total Telephone
15,503.15
Transcription Services
Travel & Ent
Entertainment
3,704.42
Meals
Tr'ovel
Travel & Ent - Other
1,429.60
3,357,03
5,351.14
940.18
Total Travel .& Ent
11,077.95
Uniforms & Laundry
1,587.46
Utilities
Electric
Coble.
Gas and Electric
Water
Utilities - Other
Total Utilities
Void Checks
13,657.94
845.01
2,574.88
375.52
2,806.65
20,260.00
0.00
Total Expense
1,171,679.48
Net Ordinary Income
169,709.48
Net Income
16'9,709.48
New York State Department of Health
Public Health and Health Planning Council
January/February 2012
ATTACHMENTS
Dialysis Services - Establish/Construct
1.
Number
Applicant/Facility
111234 B
Dumont Care, LLC
(Westchester County)
Exhibit #9
111234 B
Dumont Care, LLC
(Westchester County)
There are no attachments for the project.
New York State Department of Health
Public Health and Health Planning Council
January/February 2012
ATTACHMENTS
Residential Health Care Facilities - Establish/Construct
Exhibit #10
Number
Applicant/Facility
1.
101068 E
Guilderland Center Rehabilitation and Extended
Care Facility Operating Company, LLC d/b/a
Guilderland Center Rehabilitation and Extended Care Facility
(Albany County)
2.
112218 E
Waterfront Health Care Center, Inc.
(Erie County)
Financial Summary
BFA Attachment B
Guilderland Center Nursing Home
FISCAL PERIOD ENDED
2010
$3,307,105
5,966,132
559,166
7,769,790
$680,180
$944,281
$8,581,447
$8,432,098
$6,701,474
8,722,300
8,696,199
8,314,997
($140,859)
($264,101)
($1,613,523)
$152,803
$159,330
$1,613,743
5,876,054
1,177,190
7,817,798
EQUITY
($1,505,191)
INCOME
NET INCOME
OPERATOR/RELATIVE SALARIES
2008
$3,216,334
5,950,025
804,476
7,681,703
ASSETS w CURRENT
ASSETS w FIXED AND OTHER
LIABILITIES w CURRENT
LIABILITIES· LONG-TERM
EXPENSE
2009
$89,341
NUMBER OF BEDS
PERCENT OF OCCUPANCY (DAYS)
127
94.06%
127
89.42%
127
94,59%
PERCENT OCCUPANCY (DAYS):
MEDICAID
MEDICARE
PRIVATE/OTHER
82.31%
6.33%
11.37%
82.79%
8.02%
9.19%
79.89%
5.88%
14.24%
2011
OPERATING
CAPITAL
$131.05
9.73
TOTAL
$140.78
BFA Attachment C
Pro Forma Balance Sheet
ASSETS
Cash
Accounts Receivable
Equipment
TOTAL ASSETS
$1,518,516
975,000
174,208
$2,667,724
LIABILITIES
Payments to State of New York
TOTAL L!i\BILlT!ES
$1,406,000
MEMBERS EQUITY
$1,261,724
$1.406,000
Financial Summary
BFA Attachment D
Nyack Manor Nursing Home
FISCAL PERIOD ENDED
2010
ASSETS
w
CURRENT
ASSETS - FIXED AND OTHER
LIABILITIES
LIABILITIES
w
w
CURRENT
LONG·TERM
EQUITY
INCOME
EXPENSE
NET INCOME
PERCENT OCCUPANCY (DAYS):
MEDICAID
MEDICARE
PRIVATE/OTHER
$3,266,013
785,624
685,161
686,591
2,702,299
35,475
$1,321,318
2,195,517
0
$1,755,657
1,663,808
6,896
$2,255,847
$13,253,613
13,272,813
($19,200)
$13,589,676
13,571,178
$18,498
$14,175,029
$0
$264,246
$103,461
$3,239,960
14,235,363
($60,334)
160
82.53%
160
83.77%
160
85.84%
61.41%
64.96%
67.33%
16.96%
19.84%
17.44%
21.63%
15.21%
15.23%
MEDICAID RATE BREAKDOWN:
6Q1!
OPERATING
CAPITAL
TOTAL
200B
$3,273,468
OPERATOR/RELATIVE SALARIES
NUMBER OF BEDS
PERCENT OF OCCUPANCY (DAYS)
2009
$165.97
12.55
$178.52
BFA Attachment E
ESTABLISHMENT CHECKLIST FOR NURSING HOMES
APPLICATION: CON 101068 Guilderland Center Rehabilitation and Extended
Care Facility Operating Company, LLC
NATURE OF PROPOSAL: Change in ownership of Guilderland Center Nursing
Home.
EFFECT ON OPERATIONAL OWNERSHIP: Proposed members are: Aaron
Seligson 33.33%, Martin Rothman 33.33% and Patricia B"ruder 33.33%.
EFFECT ON REAL ESTATE OWNERSHIP:NA
FIXED ASSET PURCHASE PRICE: NA
FIXED ASSET MEDICAID VALUE: NA
CAPITAL REIMBURSEMENT:
Arms Length Lease
X_ _ Historic Cost Method
Shortfall; Average Annual Amount $400,133
BUSINESS PURCHASE PRICE: $1,425,000
BFA Attachment B
WATERFRONT OPERATIONS ASSOCIATES LLC
Doing Business As
WATERFRONT CENTER FOR REHABILITATION AND HEALTHCARE
PRO FORMA BALANCE SHEET
ASSETS
Working Capital
Accounts Receivable (Net of Acquisition)
Goodwill
Inventories
Prepaid Expenses
Resident Funds
TOTAL ASSETS
$1,748.234
$778.525
$100,000
$37,514
$94,992
$77,053
$2,836,318
LIABILITIES AND EqUITY
LIABILITIES
Accounts Payable
Working Capital Loan
Resident Funds
TOTAL LIABILITIES
$874,117
$77,053
$1.819.911
MEMBER EQUITY
$1,016,407
TOTAL LIABILITIES AND
MEMBER EQUITY
$2,836,318
$B68,741
BFA Attachment C
Financial Summary
Waterfront Health Care Center
FISCAL PERIOD ENDED
12/31/2010
1213112009
ASSETS - CURRENT
ASSETS - FIXED AND OTHER
LIABILITIES - CURRENT
LIABILITIES - LONG-TERM
EQUITY
$2,229,679
4,600,219
5,493,968
7,448,810
($6,112,880)
$2,411,207
8,054,596
3,812,325
7,541,836
($888,358)
INCOME
EXPENSE
NET INCOME
$10,552,656
15,777,178
($5,224,522)
12131/2008
$2,481,346
7,972,273
2,639,224
7,330,138
$484,257
$10,886,137 $11,084,842
12,258,752
11,831,210
($746,368)
($1,372,615)
DEPRECIATION
NUMBEn OF BEDS
NUMBER OF DAYS iN VR
MAX PATiENT BED DAYS
MEDICAID PATIENT DAYS REPORTED
MEDICARE PATIENT DAYS REPORTED
PRIVATE/OTHER PATIENT DAYS REPORTED
TOTAL PATIENT DAYS REPORTED
PERCENT OF OCCUP.8.NCY (DAYS)
PERCENT OCCUPANCY (DAYS):
MEDICAID
MEDICARE
PRIVATE/OTHER
160
365
58,400
47,549
5,543
2,871
55,963
95.83%
160
365
58,400
49,801
5,548
2,206
57,555
98.55%
0Ll. Q...,OI
86.53%
964°/"
3.83%
O .• ~/~·O
990°/",
5.13%
160
366
58,560
49,743
5,703
2,330
57,776
98.66%
86.10%
9.87%
4.03%
BFA Attachment D
Financial Summary
Dutchess Center for Rehabilitation and HealthCare
FISCAL PERIOD ENDED
12131/2010
12131/2009
12131/2008
ASSETS - CURRENT
ASSETS - FIXED AND OTHER
LIABILITIES - CURRENT
LIABILITIES - LONG~TERM
EQUITY
$1,497,821
INCOME
EXPENSE
NET INCOME
$11,315,724 $10,372,091
10,591,187
9,930,128
$724,537
$441,963
$10,701,744
10,546,300
$155,444
1')I'")
$2,597,547
6,903,061
4,094,458
$2,656,285
7,213,966
4,399,295
$2,592,567
7,704,183
5,066,383
3,908,329
4,023,225
4,374,598
$1,447,731
$855,769
DEPRECIATION
NUMBER OF BEDS
NUMBER OF DAYS IN YR
MAX PATIENT BED DAYS
MEDICAID PATIENT DAYS REPORTED
MEDICARE PATIENT DAYS REPORTED
PRIVATE/OTHER PATIENT DAYS REPORTED
TOTAL PATIENT DAYS REPORTED
PERCENT OF OCCUPANCY (DAYS)
PERCENT OCCUPANCY (DAYS):
MEDICAID
MEDICARE
PRIVATE/OTHER
122
365
365
44,530
33,745
6,033
44,530
32,344
7,384
122
366
44,652
32,679
6,635
2,840
3,343
3,180
42,618
95.71%
43,071
96.72%
42,494
95.17%
79.18%
14.16%
6.66%
75.09%
17.14%
7.76%
76.90%
15.61%
7.48%
""''''"
BFA Attachment E
Financial Summary
University Nursing Home
FISCAL PERIOD ENDED
12/31/2010 12/31/2009 12/31/2008
ASSETS - CURRENT
ASSETS - FIXED AND OTHER
LIABILITIES - CURRENT
LIABILITIES - LONG-TERM
EQUITY
INCOME
EXPENSE
NET INCOME
$1,122,518 $1,401,553 $1,354,621
3,203,109
2,628,235
2,568,663
1,340,874
1,176,480
789,780
587,089
106,396
73,992
$2,397,664 $3,133,612 $2,672,812
$4,179,106
3,915,054
$264,052
$4,330,700
3,869,901
$460,799
$4,360,748
3,838,663
$522,085
DEPRECIATION
NUMBER OF BEDS
NUMBER OF DAYS IN YR
MAX PATIENT BED DAYS
MEDICAID PATIENT DAYS REPORTED
MEDICARE PATIENT DAYS REPORTED
PRIVATE/OTHER PATIENT DAYS REPORTED
TOTAL PATIENT DAYS REPORTED
PERCENT OF OCCUPANCY (DAYS)
46
46
46
365
16,790
14,517
1,175
692
16,384
97,58%
365
16,790
13,275
2,287
839
16,401
97.68%
366
16,836
12,802
2,480
1,241
16,523
98.14%
PERCENT OCCUPA~'JCY (DAYS):
MEDICAID
MEDICARE
PRIVATE/OTHER
88.60%
7.17%
4.22%
80.94%
13.94%
5.12%
77.48%
15.01%
7.51%
BFA Attachment G
Financial Summary
Holliswood Care Center, Inc
FISCAL PERIOD ENDED
12/31/201 0
12131/2009
12/31/2008
ASSETS ~ CURRENT
ASSETS - FIXED AND OTHER
LIABILITIES - CURRENT
LIABILITIES - LONG-TERM
EQUITY
$4,647,463
1,255,377
4,084,775
218,"171
$1,599,594
$4,820,179
1;124,585
2,463,564
248,422
$3,232,778
$3,394,297
1,351,146
1,782,883
222,155
$2,740,405
INCOME
EXPENSE
NET INCOME
$20,087,725
19,953,006
$134,719
$19,828,350
18,981,971
$846,379
$20,005,245
19,371,042
$634,203
314
365
114,610
79,674
2,766
3,599
86,039
75.07%
314
365
114,610
79,534
2,591
4,743
86,868
75.79%
314
114,924
80,225
3,301
3,809
87,335
75.99%
92.60%
3.21%
4.18%
91.56%
2.98%
5.46%
91.86%
3.78%
4.36%
DEPRECIATION
NUMBER OF BEDS
NUMBER OF DAYS IN YR
MAX PATIENT BED DAYS
MEDICAID PATIENT DAYS REPORTED
MEDICARE PATIENT DAYS REPORTED
PRIVATE/OTHER PATIENT DAYS REPORTED
TOTAL PATIENT DAYS REPORTED
PERCENT OF OCCUPANCY (DAYS)
PERCENT OCCUPANCY (DAYS):
MEDICAID
MEDICARE
PRIVATE/OTHER
366
BFA Attachment H
Financial Summary
Queens Center for Rehabilitation and Residential Health Care
FISCAL PERIOD ENDED
12131/2009
12/31/2008
12/31/201 0
ASSETS - CURRENT
ASSETS - FIXED AND OTHER
LIABILITIES - CURRENT
LIABILITIES - LONG-TERM
EQUITY
$4,655,534
14,223,047
5,626,100
9,457,374
$3,795,107
$4,509,254
14,786,922
5,402,909
9,222,379
$4,670,888
$4,871,412
15,319,251
5,444,580
10,201,762
$4,544,321
INCOME
EXPENSE
NET INCOME
$21,578,591
21,036,667
$541,924
$21,828,556
21,301,987
$526,569
$21,101,778
20,472,215
$629,563
179
365
65,335
38,903
15,108
8,366
179
365
65,335
39,168
18,295
5,930
179
366
65,514
39,107
11,219
12,893
62,377
63,393
03,219
95.47%
97.03%
96.50%
62.37%
24.22%
13.41%
61.79%
28.86%
9.35%
61.86'%
17.75%
20.39%
DEPRECIATION
NUMBER OF BEDS
NUMBER OF DAYS IN YR
MAX Pil.TIENT BED DAYS
MEDICAID PATIENT DAYS REPORTED
MEDICARE PATIENT DAYS REPORTED
PRIVATE/OTHER PATIENT DAYS REPORTED
TOTAL PATIENT DAYS REPORTED
PERCENT OF OCCUPANCY (DAYS)
PERCENT OCCUPANCY (DAYS):
MEDICAID
MEDICARE
PRIVATE/OTHER
BFA Attachment I
Financial Summary
Brooklyn Center for Rehabilitation and Residential Health
FISCAL PERIOD ENDED
12131/201 0
12/31/2009 12131/2008
ASSETS - CURRENT
ASSETS· FIXED AND OTHER
LIABILITIES ~ CURRENT
LIABILITIES - LONG-TERM
EQUITY
$6,872,411
$5,206,901
$5,495,205
9,247,898
5,922,623
0,063A32
$2,134,254
9,320,437
6,029,843
$1,164,249
8,573,205
5,761,554
7.383A95
$923,361
INCOME
EXPENSE
NET INCOME
$21,447,040
20,193,034
$1,254,006
$19,414,322 $19,361,884
18,948,435
20,269,367
($907,483)
$465,887
7,333,246
DEPRECIATION
NUMBER OF BEDS
NUMBER OF DAYS IN YR
MAX PATIENT BED DAYS
MEDICAID PATIENT DAYS REPORTED
MEDICARE PATIENT DAYS REPORTED
PRIVATE/OTHER PATIENT DAYS REPORTED
TOTAL PATIENT DAYS REPORTED
PERCENT OF OCCUPANCY (DAYS)
PERCENT OCCUPANCY (DAYS):
MEDICAID
MEDICARE
PRIVATE/OTHER
215
365
78,475
215
365
78,475
215
366
78,690
65,953
7,679
66,308
8,739
65,009
8,008
2,353
1,991
3,949
75,985
96.83%
77,038
98.17%
76,966
97.81%
86.80%
10.11%
3.10%
86.07%
11.34%
2.58%
84.46%
10.40%
5.13%
BFA Attachment J
Financial Summary
Suffolk Center for Rehabilitation and Nursing
FISCAL PERIOD ENDED
12131/2010
ASSETS - CURRENT
ASSETS - FIXED AND OTHER
LIABILITIES - CURRENT
LIABILITIES - LONG-TERM
EQUITY
INCOME
EXPENSE
NET INCOME
$6,211,672
11,139,056
8,408,960
8,631,073
$310,695
$14,167,394
13,049,866
$1,117,528
12131/2009
12131/2008
$3,665,873
11,143,141
6,681,942
8,933,908
($806,836)
$3,123,232
6,163,117
6,723,217
3,427,586
($864,454)
$12,433,372 $11,320,327
12,275,756
12,226,935
($906,608)
$157,616
DEPRECIATION
NUMBER OF BEDS
NUMBER OF DAYS IN YR
MAX PATIENT BED DAYS
MEDICAID PATIENT DAYS REPORTED
MEDICARE PATIENT DAYS REPORTED
PRIVATE/OTHER PATIENT DAYS REPORTED
TOTAL PATIENT DAYS REPORTED
PERCENT OF OCCUPANCY (DAYS)
PERCENT OCCUPANCY (DAYS):
MEDICAID
MEDICARE
PRIVATE/OTHER
120
365
43,800
120
365
43,800
34,433
32,623
5,564
2,415
42,412
96.83%
7,688
2,287
42,598
97.26%
120
366
43,920
35,992
5,090
1,826
42,908
97.70%
81.19%
13.12%
5.69%
76.58%
18.05%
5.37%
83.88%
11.86%
4.26%
I:3t-A Attachment K
Financial Summary
Metropolitan Jewish Geriatric Center
FISCAL PERIOD ENDED
12/31/2010
ASSETS· CURRENT
ASSETS" FIXED AND OTHER
LIABILITIES - CURRENT
LIABILITIES - LONG-TERM
EQUITY
INCOME
EXPENSE
NET INCOME
12/31/2009
12/31/2008
$20,314,489
24,190,403
20,542,191
2,850.449
$21 ,112,252
$21,471,402
26,011,313
26,942,953
3,855.449
$16,684,313
$22,563,756
25,840,981
25,623,983
5,200.449
$17,580,305
$98,563,281
94,135,342
$4,427,939
$117,169,950
118,065,942
($895,992)
$113,614,369
112,127,847
$1,486,522
354
365
129,210
86,903
22,239
16,866
126,008
97,52%
354
365
129,210
87,221
25,042
14,032
126,295
97,74%
354
366
129,564
87,432
26,383
13,143
126,958
97.99%
68,97%
17.65%
13.38%
69.06%
19.83%
11.11%
68.87%
20,78%
10,35%
DEPRECIATION
NUMBER OF BEDS
NUMBER OF DAYS IN YR
MAX PATIENT BED DAYS
MEDICAID PATIENT DAYS REPORTED
MEDICARE PATIENT DAYS REPORTED
PRIVATE/OTHER PATIENT DAYS REPORTED
TOTAL PATIENT DAYS REPORTED
PERCENT OF OCCUPANCY (DAYS)
PERCENT OCCUPANCY (DAYS):
MEDICAID
MEDICARE
PRIVATE/OTHER
BrA Attachment M
Financial Summary
Stonehedge Health and Rehabilitation Center Rome
FISCAL PERIOD ENDED
1213112010 ·12131/2009
1213112008
ASSETS· CURRENT
ASSETS - FIXED AND OTHER
LIABILITIES - CURRENT
LIABILITIES - LONG-TERM
EQUITY
INCOME
EXPENSE
NET INCOME
$2,306,684
$3,118,216
$3,034,988
1,293,318
718,421
587,220
2,535,370
105,177
4,509,489
81,263
($754115'I
4,222,615
70,079
($670,486)
$11,002,831
11,248,265
$254,566
$11,156,073
10,705,657
$450,416
$959,455
$12,312,486
12,185,653
$126,833
\
l
DEPRECIATION
NUMBER OF RFns
NUMBER OF DAYS IN YR
MAX PATIENT BED DAYS
MEDICAID PATIENT DAYS REPORTED
MEDICARE PATIENT DAYS REPORTED
PRIVATE/OTHER PATIENT DAYS REPORTED
TOTAL PATIENT DAYS REPORTED
PERCENT OF OCCUPANCY (DAYS)
PI::RCENT OCCUPANCY (DAYS):
MEDICAID
MEDICARE
PRIVATE/OTH ER
160
160
160
365
58,400
365
58,400
366
58,560
42,703
45,453
43,922
8,894
5,658
57,255
98.04%
8,591
3,402
57,446
98.37%
6,884
5,231
56,037
95.69%
74.58%
15.53%
9.88%
79.12%
14.95%
5.92%
78.38%
12.28%
9.33%
BFA Attachment N
Financial Summary
Stonehedge Health and Rehabilitation Center Chittenango
FISCAL PERIOD ENDED
12/31/2010
12/31/2009
12/31/2008
ASSETS - CURRENT
ASSETS - FIXED AND OTHER
LIABILITIES - CURRENT
LIABILITIES - LONG-TERM
EQUITY
$1,465,951 $2,151,920 $1,873,285
569,864
553,953
433,323
1,335,865 2,927,696
2,390,663
22,622
81,263
18,767
$677,328 ($303,086)
($102,822)
INCOME
EXPENSE
NET INCOME
$6,730,591 $6,325,412
6,232,342 6,092,725
$498,249
$232,687
$6,767,031
6.130,799
$636,232
DEPRECIATION
NUMBER OF BEDS
NUMBER OF DAYS IN YR
MAX PATIENT BED DAYS
MEDICAID PATIENT DAYS REPORTED
MEDICARE PATIENT DAYS REPORTED
PRIVATE/OTHER PATIEf\JT DAYS REPORTED
TOTAL PATIENT DAYS REPORTED
PERCENT OF OCCUPANCY (DAYS)
80
365
29,200
19,512
3,921
80
365
29,200
19,795
4,840
80
366
29,280
18,818
4,528
5,164
3,774
4,706
28,597
97.93%
28,409
97.29%
28,052
95.81%
68.23%
13.71%
18.06%
69.68%
17.04%
13.28%
67.08%
16.14%
16.78%
PERCENT OCCUPANCY (DAYS):
MEDICAID
MEDICARE
PRIVATE/OTH ER
BFA Attachment 0
Financial Summary
Williamsbridge Manor Nursing Home
FISCAL PERIOD ENDED
12/31/2010 12/31/2009
12/3112008
ASSETS - CURRENT
ASSETS - FIXED AND OTHER
LIABILITIES - CURRENT
LIABILITIES - LONG-TERM
EQUITY
$1,870,747 $1,861,229 $1,071,364
2,269,700
962,622
964,545
1,734,511
1,416,674
1,795,170
786,429
819,533
2.104,478
($167,194)
$301,458
$209,148
INCOME
EXPENSE
NET INCOME
$7,971,179 $7,646,510
7,878,867
7,270,168
$92,312
$376,342
$7,308,347
7,024.564
$283,783
DEPRECIATION
NUMBER OF BEDS
NUMBER OF DAYS IN YR
MAX PATIENT BED DAYS
MEDICAID PATIENT DAYS REPORTED
MEDICARE PATIENT DAYS REPORTED
PRIVATE/OTHER PATIENT DAYS REPORTED
TOTAL PATIENT DAYS REPORTED
PERCENT OF OCCUPANCY (DAYS)
PERCENT OCCUPANCY (DAYS):
MEDICAID
MEDICARE
PRIVATE/OTHER
77
365
28,105
23,189
3,130
77
365
28,105
22,406
3,959
77
366
28,182
21,991
4,165
499
856
1,445
26,818
95.42%
27,221
96.85%
27,601
97.94%
86.47%
11.67%
1.86%
82.31%
14.54%
3.14%
79.67%
15.09%
5.24%
BFA Attachment P
Financial Summary
Bronx Center for Rehabilit?ltion and Health
FISCAL PERIOD ENDED
1213112009 12131/2008
12/31/2010
ASSF:TS - CURRENT
ASSETS - FIXED AND OTHER
LIABILITIES - CURRENT
LIABILITIES - LONG-TERM
EQUITY
$6,327,711
9,637,320
5,820,823
6,130,265
$4,013,943
$6,352,371
9,940,011
5,487,214
6,395,815
$4,409,353
$4,648,005
10,740,742
5,142,604
6,600,864
$3,645,279
INCOME
EXPENSE
NET INCOME
$23,000,073
21,736,085
$1,263,988
$21,934,099
20,865,071
$1,069,028
$21,279,712
20,221,917
$1,057,795
200
365
73,000
60,710
9,014
1,913
71,637
98.13%
200
365
73,000
60,545
9,466
1,910
71,921
98.52%
200
366
73,200
61,572
6,628
-1,233
72,433
98.95%
84.75%
84.18%
12.58%
13.16%
2.67%
2.66%
85.01%
9.15%
5.84%
DEPRECIATION
NUMBER OF BEDS
NUMBER OF DAYS IN YR
MAX PATIENT BED DAYS
MEDICAID PATIENT DAYS REPORTED
MEDICARE PATIENT DAYS REPORTED
PRIVATE/OTHER PATIENT DAYS REPORTED
TOTAL PATIENT DAYS REPORTED
PERCENT OF OCCUPANCY (DAYS)
PERCENT OCCUPANCY (DAYS):
MEDICAID
MEDICARE
PRIVATE/OTHER
WATERFRONT OPERATIONS ASSOCIATES LLC
Doloo Business As
W A'rERIt'RONT CENTER FOR Rl.;HA8ILITAnON AND HEALTHCARE
QRGANIZAlIeNAL CHART
WATERFRQ,,", OPERATIONS ASSOCIATES LLC
Members:
Kenneth Roze,berg - 60~
Jeremy Strauss - 30%
Jeffrey Sicklick • 10%
Cd
I-:lj
DOING BUSINESS AS
WATERFRONT CENTER FOR REHABILITAnON AND
HEALTHCARE
lease
-- " - - - - - - - - - - - • - -
II>
II>
E
WATERFRONT LAND ASSOC1ATES LLC
(RHCF Real Estate)
.
rt
rt
\l:l
o
I
§
(D
P
rt
,0
RHCF Administrator
Director of Nursing
Direct Care Staff
Support Staff
Clerical Staff
BFA Attachment R
ESTABLISHMENT CHECKLIST FOR NURSING HOMES
APPLICATION 112218 Watertront Operations Associates, LLC d/b/a Watertront
Center for Rehabilitation and Health Care (the Center) (Erie County)
NATURE OF PROPOSAL: Change in operational ownership
EFFECT ON OPERATIONAL OWNERSHIP: 100% transfer of membership
interest._New Owners: Kenneth Rozenberg 60%, Jeremy Strauss 30% and Jeffrey
Sicklick 10%
EFFECT ON REAL ESTATE OWNERSHIP:
N/A
FIXED ASSET PURCHASE PRICE:
N/A
FIXED ASSET MEDICAID VALUE:
N/A
CAPITAL REIMBURSEMENT:
Capitalized Lease
XH istoric Cost Method
Shortfall; $ Amount
BUSINESS PURCHASE PRICE: $806,718
New York State Department of Health
Public Health and Health Planning Council
January/February 2012
ATTACHMENT
Certified Home Health Agencies – Establish/Construct
1.
Exhibit #11
Number
Applicant/Facility
102239 E
North Shore University Hospital, Inc., d/b/a North Shore Home Care
(Nassau County)
Orga1t~zation
Chart
North Shore-Long Island Jewish Health System, Inc.
Not-for-Prcfit
Corporation
February 8, 2011
'.
0iViSion)
North Shore - Long Island Jewish
Health System, Inc.
Hospice Care
Network
to
~
North Shore - Long Island Jewish
Health Care, Inc.
:,t>
rt
rt
PJ
D
::r'
;j
:D
::l
,;-
iI>
Staten
Island
University
Hospital
Glen Cove
Hospital
North
Shore
University
Hospital
North Shore
University
Hospital
Stern Ctrfor
Extended
Care &
Rehab
Forest
Plainv:ew
Hills
Hospital
Hospital
Long
Island
Jewish
Medical
Center
Lenox Hill
Hospital
Southside
Hospital
Franklin
Hospital
Huntington
Hospital
BFA Attachment B
North Shore-Long Island Jewish Health
Sy~tpm,
Inc.
Consolidated Statements of Financial Position
September 30,2011 and December 31, 2010 (In Thousands)
(Unaudited)
(Audited)
September 30,
2011
Dpcpmh"r 31,
$
$
2010
Assets
Current assets:
Cash and cash equivalents
Marketable securities and other investments
Accounts receivable for services to patients, net of
allowance for doubtful accounts
Accounts ,eceivable fO!' physician activities, net
Assets limited as to use, current pmtion
Pledges receivable, current portion
Insurance claims receivable, current portion
Other current assets
Total current assets
Assets limited us to usc, net of current portion
Pledges receivable, net of current portion
Property, plant and equipment, net
Insurance claims receivable, net of current portion
Other assets
Total assets
Liabilities and net assets
Current liabilities:
Short-term borrowings
Accounts payable and accrued expenses
Accrued salaries and related benefits
Current portion of capital lease obligations
Current portion of long-term debt
Current portion of lTInlpracLicc and other insurance liabilitil's
Current portion of insurance claims liability
CUlTcnt portion of third-pmty payer structured liabilities
Current portion of estimated payable La third-party payers
Total current liabilities
41O,L)J
1,039,124
584,075
48,116
100,514
41,024
570,360
45,392
96,774
41,316
108,430
$
$
Accrued retirement benefits, net of current portion
Capitallcase obligations, net of current portion
Long-term debt, net of cun-ent portion
Malpractice and other insurance liabilities, net of current portion
Insurance claims liability, net of current portion
Third-party payer struclWl'l! liabilicies, net of CUlTent portion
Other long-term liabilities
Total liabilities
Commiunent~
418,103
1,083,902
139,559
2,523,723
123,261
2,326,480
678,424
'/y/ ,OJ~
Il7,357
2,868,810
356.225
234,777
6,779,316
120,150
2,674,349
75,540
498.519
405,764
4,820
49,828
$
$
233,273
6,111,290
15,540
508,288
369,976
5,008
48,899
39,352
39,Y.1L
108,430
4,657
353,982
1,540,892
6,724
254,SOO
1,248,287
360,719
442,298
8? ,573
85,400
1,248,601
563,777
356,225
31,200
427,923
4,611,910
1,283,339
502,826
34,592
409,703
4,006,445
1,74<;,49)
1,677,074
297,589
124,325
2,167,406
bJ/,)) 16
306,053
121,718
2,104,845
6,111,290
,md contingencies
Net assets:
Unrestricted
Temporarily restricted
Permanently restricted
Total net assets
Total liabilitics and net assets
See accompanying /lotes,
$
$
BFA Attachment B (cont.)
North
Shore~T,ong
Island Jewish Health System, Inc.
Consolidated Statements of Operations
For the Nine Months Ended September 30, 2011 and 2010 (Ill Thuusands)
(Unaudited)
(Unaudited)
2010 (1)
2011
Operatmg revenue:
Net patient service revenue
Physician practice revenue
Other operating revenue
Net assets released from restrictions used for operations
Total operating revenue
$
Operating expenses:
Salaries
Employee benefits
Supplies and expenses
Bad debt expense
Depreciation and amortization
Interest
Total operating expenses
3,949,337
454,989
246,218
38,384
4,688,928
$
3,504,052
358,669
185,426
36,168
4,084,315
2,229,279
651,563
1,395,275
84,947
1,234,047
75,615
] 88,622
160,088
46,296
4,595,982
45,814
3,974,868
92,946
109,447
32,4 13
17,116
(61,355)
39,080
(14,533)
(16,682)
7,271
(36,204)
448,689
2,646
490,849
Excess of revenue and gains and losses over expenses
56,742
600,296
Net assets released from restrictions for capital asset acquisitions
Change in fair value of interest rate swap agreements designated
as cash now hedges
(Loss) recovery of fair value of endowment corpus
Increase in unrN;tricted net assets
$
13,507
9,681
(l,059)
(772)
G8,41 S
(2,733)
320
Excess of operating revenue over operating expenses
Non-operating gains and losses:
Investment income
Change in net unrealized gains and losses and change in
value of equity method investments·
Change in fair value of interest rate swap agreements
designated as derivative instruments
Contribution received in the acquisition of Lenox Hill
Hospital and Subsidiaries
Other non-operating gains and losses
Total non-operating gains and losses
1,918,784
540,520
:$
607,564
(l) On May 19,2010, North Shore-Long Island lewish Health System acquired Lenox Hill Hospital and
Subsidiaries. The results of Lenox Hill Hospital and Subsidiaries' operations are included in the Consolidated
Statement of Opel aliullS frum lhis date.
2
~'orlh
Shore-Lollg Island Je',l'ish He"Hh Sjslem, Inc,
ConsolidotingS'olemenl of Fillandal Position
iieptember 30, 20ll (Unaudited and In Th"usallds)
----
i"iorth Shon:·
Long Island
North ShoreLong Island
JC1lish Health
SY5l~m,
Jewish
Inc.
Total
E:iminiltions
Obligated
Group
Hospice
Care
The Fein'tcin
Institute for
Medic,1
Nchlo'ork, Inc.
Resoear<:h
Je"i'h Health
Sys[em
'l"orth Shore·
Long Island
:ewish Health
Srstem
F oumJ alion, Inc.
Laboratories
Norh ShoreLorg Island
Real E'Ulte
Comprmies
North Shore
Heallh System
Entcrprise~,
Insurance
Inc,
(Combinedl
Companies
(Combined)
Ot',ler
HcalthSyslcm
Entities
,'.sscIS
Currenl ;lSS;::(S:
C;J.sh and cash equi\'l;iknls
:\1..vkelabie sewntics .md otha invcslmems
Accounts rccth'able for services to pil(lenls+ net or
aUO\vance fo~ doublfulaccolmls
Account$ rcce.. . . ab~e for physi(ian ac!i\'Ilies, nel
As~e!:-; ~imitcd 'IS to lise, current panion
Pledges recei vable. current pocliml
I!ISurflll\>~ clains. Teedvabk. C'Jrrent portion
Other current ~~~Sets
Total c.urr~r.1 aS5c!S
5418.103
1,083,9D2
584,075
48.116
100,514
41,024
108,430
1.19,559
2,523,723
Due from affiHates, net
A.ssets limited 'E to use, net of Curren! portion
F1edges. rt:c.clvabk, nct of currei'bl portion
Fropelly, plallt end equip11lCDI, ,1ct
I lsur<HlCC clnirm receivable, net of current parton
Other ..lss'.;ls
Tot-al a:;:s;cts
5-
678,424
117,357
2,868,810
356,225
234.777
56,779,3 J 6
( 16,916)
(16.916)
(262,690)
( 186,502)
(83,318)
(64,904)
(5614,3301
5335,78)
1,048,885
$13,935
4,4.3
566.231
39,431
100,511
1,614
124,7L\
) 17,163
2334,33"
5,0)8
L35,544669,964
2,239
2.768,095
437,065
256,753
56,603,999
102
194
3)0
24,052
$33
125
13,950
14,108
1,631
516
l,3c8
761
2:;5
52,756
528,553
SI3I,149
64.396
489
5686
4
l.087
i,777
2J.727
15
471
$21.990
$21,924
12,939
37,859
19
68
72,809
38.874
113,280
620
74
5225,657
5-
Sl
7.309
5,016
81
1,979
9,369
2)8
$20,550
17,300
525,227
332
453
8,685
1,449
7,341
317
517,027
915
6.140
555
38405
3,492
39,640
219
126484
91876
363
9,825
1,302
5,515
9
254
S56,908
7,,8
8[3
S8mO
41,978
5298,743
t:d
"":I
:J>
il>
rt
rt
'"
("l
§
OJ
::J
rt
U ... bilities and net assets (dcfkit)
b:;I
Currenl liabilities:
ShorHeml b-orlowings
ACCQUflt<; p~yab1e and accrucde:,,;pellses
"\ccnlc-d saiarlcs and related bt:nc[il:;'
:utTcnt ponlonof capital lease obligations
:urn:rH portion of l-ong-tenn debt
:::urrem portion of malprncliceand ollJer lnSllr,lIlCe liabilities
:urrt:rH portion of l~lSUr<1nCe chim~ EetbiLjly
·:='urrenl portion of thirdMpnny f,ay~r Solructured Ii abilll~es
Currelll portion of estimated piyable [0 third-r<J!'"IY p<J.yr;!rs
r)wl '.:~] lTenl liabilities
Due fa
$75,540
498.519
405,764
4,820
49,828
39.352
108,430
4.657
353,982
1,540,892
aff~liaT.es
Accrued retirement benefits, netof currem portion
C;lpltalle<ts-c obligations, net of currcm portion
Long-Iclln debt, let of currenl p·xtion
.Valprac[icc: al~d ,)ther insurance liabilities. nCl cf current panioo
rr:$urance. claims liability, net of Cllrrent ponion
Tlird-pany pare: SLruClUfCd Iiabillties. net of current portion
O:hcr ~Qng.lerm JiabiElies
THai liabilities
CorrulltLr'riCnlS
$-
i,085
575,540
463.29g
387,07l
4,77:>
57.614
4530
53.663
146
$165
634
$-
11,266
4,339
$.
3,147
1,02
$-
1,682
$3,070
6.540
45
49,S28
(27,755)
(16,916)
(43,536)
35,.10:
124.7 I:i
4,657
352,44,
1,497,73,
( 124.629)
360,719
82,513
1,248,601
563,777
356,225
31,200
427,923
4,611.910
$3,5:9
1,488
(6,922)
(111.453)
(83,318)
(369,908)
360,719
82,13:;
1,243,60i
433,18;
437,06:
31,20('
422,819
4,513,51,
JJ,700
1,4
125
~
19
81
208
5,211
12269
3.8i3
818
'00
16,186
7°4
5,161
30
44.740
!,152
856
1,329
2
33,382
247
9,904
69.522
441
6.922
242,')43
7El
489
544
6,546
103
57,601
IS
74
317
3,898
5,646
63
17,895
14.499
10,748
23,7 16
19,836
1.749,195
23,234
148,295
286,701
1,793
36,415
54,58e
378
48.000
74.148
W,148
22,007
220,011
2,090,482
S6,603,999 _~_825_J_ _ _
5ll!,~2._ _ _ 52;,99D _ _ _ _3225,657
262
1".242_ _ _
813
9
5,9i4
275,.12)
174
86,972
(868)
2,046
23,J18
(868)
$17,027
2,046
__ !~,O20
23,J18
5298,:43
an.J contjngencic.'l
Ntt assCIS (deficit);
Ullr~~trict~d
lemporarily rc:;:ridcd
fennalJelltly restricted
Tolal nel <lSSCI5 (deficit)
Te·!a! ri~bilities. und net assets (dEflcil)
:,745,492
297,589
124,325
:;,167,406
56,779.316
(55,501)
(J 69.467)
(19.454)
(244,422)
(5614,330)
141,497)
7,033
4,400
(30,064)
S56,908
"......,
("l
0
::J
rt
~orth
Shore-Lojlg I!:dalld Je\':ish
H~:lllh SYSU~JIl;
Inc.
Combining StltenH"flt of Fifl<Jndal Position ~Obljgatcd Group On1;ir
Sept-emlH:r 30, 2011 (Unaudited ;:md III Thou,ands)
Nor-thShore
Unh'.ersily
1"I'orth ShoreTol<ll
Obligated
G.(lup
Elimina tion'5
Long lsland
Jewish
Heallh
Car~, Inc.
long Island
;-';orth ShOlf
lJntHrsit)'
Hospital
Jenish
~fedi<al
Center
Glen Cove
Hospital
Plainl'iew
BospHill
fc,rest Hills
Hospital
Hospital Stern
Family Cenler
for Ext-ended
Care and
Rfjlabili~ation
Hunting(oll
flospilal
\.ssodalion
frankUn
SUl,Jthsjde
Hospital
HcspifaE
Slater} lsla I1d
Uni-,'crslly
H",pllal
Letl)X Hill
Hospital
ASSEts
CUfrt't'lt ~S:sel-s:
Cash and cash equivar~lI!$
Markcmb!e .'ie~Uril~es. and OThe! inveslmems
'--\':COllIllS r~ce;\'able for sen.'iets to pmlcnts . ho;pltal and
nursing faciiilics, net of allO\,'J.Ir:ce for doubtfu: accounts
:\CCOUIlIS rccc\'ilble for physic:an pr<lCltCe sC'r....ices. net
Asse.lS limited as lO use, curren portior.
Pledges. receinblc. current porion
Insural1ce claiDlS receivable, current por;:;on
O:heJ current ~ssel:o.
Tmal current n~"N~
Due from aifiJ lales. ncr
ASS-CIS iimi.tel.1 '-Ii- tD use, net of CLITclH pl)r1km
Pkdges rt'.cei\·able. net of Curren-, porrioIl
PrLtperty. plant <::l1d equ~pmenl, m1:
Jns .... rance claim. rece.ivable. net ,)r current pOllio,
O;her il'iSCL~
TOird ;iSs.et:;
Liahmnes <=Ind lie! 3ssets (clencH)
Current li;"lbnitics"
Shufl-lcm1 bormwings
Accounts payable and accrued e"::penses
AccrueJ sallU'jes and related bet cliiS
C\lrr~llI
jJorlioftQf c<:lpiiallea_~e i1bligalJOm
Cl!rrent portion of long-tCJ1li J~b!
Curr~m ponion of lllnlpnlCLke .nd other insurance liabjiilics
Cu ITellt portion of inSllr~lnCe diLin]s lillbilily
C\l;r~nl
p"nlon of [hird-party p,Wer s.ruclUrcd li,f)il.itie s
CllfTetiL portion Of esti m<lled pa}'Jblc t-o third-p.1f1 r' payers
To!aJ Current H<IbJ ilies
Due w:lffilii3-tes
,\ccrucd rC[lfcrnfnt benefirs. J1el of cLlfi'elil ponior.
(:llpif;ll kase oblig;Ltions. ne~ of cnTC~'H ponion
Long-[erm debr+ oel of Currer;( pOll:on
:,fillp:-:actic:e and otber insur-ance liabilities., net of CJITent P0r1iOll
h~llrancc claims liability, net of l:.Jrrcnl portion
~hird~pa.ny payustrucnIr\:d HOlbih:es, ne[ of c-u:-rcnt portion
Olher long. term li:iliilitics
TOlal it~bilitics
Co,anlilm~nts
~:el
and
5335,780
1,1).;8,885
566,239
39,431
100,514
1,614
124,713
117,163
2,334,339
135,544
669.964
;.
S 123,i65
438.03:;
5107.878
223,174
5118
54,717
5"66
553
$264
$1,291
111.751
SI89
S723
1.961
599.364
54.530
52,449
164,719
6;
146>9-+~
10,967
1.047
2,970
1<1.526
1.451
'15.729
3,054
26.208
6,571
3.132
69,307
9n
8,723
492
1,166
86,121
1.590
20,073
2,192
3,145
9,065
53,58;
148,5il
17,354
16,982
6,863
35.6?!
32,62\
840.354
29,567
25.053
568,519
3,681
3,367
76,867
3.924
2.795
24,552
4,251
1,632
31,346
155
88
10,515
4,235
4,926
150.986
4,519
3.015
18,104
8,291
8,256
55,l42
18,000
lO,422
275,300
7,087
1.614
12.000
20,031
Tl7.207
38.573
122,076
9,450
362,722
44.872
5.541
26,290
2,921
5.392
6,934
14,907
3.793
24,464
437,099
123.188
57.318
51,618,6D8
812.191
lQ2.l93
98,163
51.953,438
49,191
11,806
281
5189.558
34.117
13.677
47,281
14,809
1.091
S99,920
12.827
609
182
$45.974
6.170
21,015
767
lJ4,223
14.842
898
$308,901
39,371
15,692
865
577,826
100,976
29.593
2,754
5212,929
48,541
675
/28,935
62,622
6.935
Si23,008
8.725
58,592
797
TM,671
15,200
J2.823
51,l1S,02!
1O,32~
4ii
n.oool
(3,0001
7.94'
8,447
(5,4701
2.239
2,768,095
437,065
256.753
S6,6D3,999
5Z~
1.542,) 19'
(5550,iB9:
187,106
1,634
597,137
5794.324
62.:1
5102,281
rt
[ll
()
!':l
S75.540
463,298
387,075
·J,775
49,828
35,407
124,713
568.040
90,773
81,608
48
7.612
lQ,841
29,567
$15,343
417
$7.500
102,500
106.254
1,130
15,829
9,638
35,673
(67)
114.133
122,255
400,779
(13 I .607)
60.672
3,868
74,1,12
31.437
5,274
236,410
113,601
113,188
5-
5
(67)
73,634
38,724
1,413
12.216
S·
12,974
10.795
$9,472
16,113
2,670
887
3,681
1,166
530
3.924
97,751
386,240
7.670
42.467
15,849
55.407
1-1,263
594.539
105.043
102.393
9,869
s-
ro
S,
22,854
11.046
S2.646
2,254
518,932
18.228
2,4&4
1,426
4.251
781
155
2,180
1,118
4.235
995
1,045
4.519
2,535
1.535
8,29t
-1-5,238
21.232
54,978
4,361
10,197
11.142
55,835
10,208
41,688
10,705
17,046
12.762
7,056
921
3,050
63,397
30.749
48l
19,689
13,956
to.594
14,327
<+,657
351.~"
I
1,497,734
360,719
82,132
1,248,601
433,.187
437,065
31,::2.00
-121.879
4,513,517
(151.673)
4,373
264,377
83,475
1.044.]14
108,619
1.366,504
1,749,195
286,701
5·l.586
2,090,482
56,603,999
mO.552)
(45,605)
(22,959)
<'99. i 16)
($550.789)
461,333
45,605
22,959
529,947
$794,324
516,364
40.169
17,901
574,434
416,743
161,833
8.358
586.934
;1.953,438
(19.999)
1,634
12.477
10.170
12,806
20.840
7,57l
l),677
31,673
13,614
14.309
12.5iJ
100,302
17.239
117.327
15,772
138,823
81,61S
4,971
2.667
89,256
{15.456)
410
(39,030)
8,025
6D9
857
~2,73S
39.095
11,139
14,842
1·1,395
14.64 I
15.692
15.793
200.601
12,560
:30,206
19,779
2'4.740
153.730)
U37
13
(52.380)
577.826
(47,153)
15J42
'6.495
'8,182
::9,593
$.
47,428
38,178
1.553
9,548
3.928
18,000
4,657
25.951
1-19,243
$56,148
l;;d
698
4,028
4,459
r--
!2,OOO
::l
51,618,60£~
Li7
(15.0461
(38,903)
~189.558---.J.lQ~?81
~,220
22.502
734
23.236
____
S45.974
iOJ,782
3,355
1.163
108,300
$308.9QL_
(31,811)
$212,929
D
0
.
rt
15.237
119.902
3,441
52,61'2
ICO.07l
4,395
148,663
86.317
45,200
1I,"00
12.615
412,066
8\,784
593,332
170,204
9.154
1,484
110.942
$613,003
46l,57U
49,119
2),000
53",689
$1,1 2~.021
4,057
95,979
52.909
~
rt
~7.JJ2
cOlHillgencic~
C"nrcw1':leJ
rt
::r
<lssNs (deficil):
TemporJr-ily.resniclcd
Pem13Jitntly re~.ricted
10mt ner assets (de-fieil)
Tot,,1 !iaoLli,ies .. ml;e[ a~,>e'-S (deflCil)
l;;d
':I:j
:P
:P
'-'
'<orth Shore~Long Island le\fi5h Health System. Inc.
Consolidating Slntement of Op,rations
For the "ille Months Ended September 30, 2Jl1 (Unaudit,d anu In Thousands)
:>ortll Shore~
Long Island
J eW'sh HeJlllh
System, Inc.
Total
Eliminations
C'orth ShoreLong Island
Jewish
Obligated
Group
Hospice
Car-:-
The Feillstein
Instilute for
Medical
R.,r Estate
:\e I'work, Inc.
Re5~arch
Companies
t'orth ShoreLong Island
J ,wish Heallh
S}'stem
Foundatio1l, Inc.
:>orth ShorcLong Island
Jewish Health
Syslem
LabQratoti~s
Nor[h Shore
Health S!·,tem
Enterprises,
Inc.
(Combined)
Insurance
Companies
(Con:bined)
Other
Hea'.th Syslem
Enlit!cs
Opcratj ng revenue·
Net p.atient service revenue
Plysid,m practice revenue
ether oper.Hing revenlle
?\'et ilss.ets rt;leascd from resLrictions llsed for operations
Towl opirating: rev'Cnlle
53,949,337
454,989
246,218
38.384
4,688,928
($4,S59)
([21,864)
1126,723)
$-
$
$-
$3,892,207
405,H9
113,)42
20,&81
4,432,279
$35,313
$316
525
41.596
17,041
58,953
20,905
84,010
416
38.514
20,905
84,010
23,802
38,514
12,527
2,774
17,892
50
398
31,669
9,622
21,664
1,411
463
17,527
30,867
8,556
3,445
3,479
7,386
265
154
3),641
:,197
35,838
S1DS6
$-
$2,974
49.140
68) )4
462
121,350
b:I
Ore~ating
expemes
Salaries
Enp]oy"" beodi;s
Suppl ies and expmses
Bld debt ex PC""
D~preda(lon and arnortizlltion
IntereSI
Tala! operaring expenses
Excess (deficiency) of operming revenue over op~raling expenses
0'on-openHing ga][IS 3lld losses:
In'lcstmenr incotre
Cbange in ne! um:allzed gains ard Ioss~s and dL1nge in value o~·
~g\lit.Y nle thod i 1ycsOnenis
Cll3nge in fair Valle of imere:»1 r<:te swap agreenlenrs designmec
as derivative iJl;;trumenlS
Oti1tr non-opemting ga~ns Jnd 100ses
Total non·o~raiing gail1s and los~e;
E;-;ce;:; (deficiency) of revenue and
~ajns
and
loss.c~
over expenses
?>:d <lSsets. rel~ased from rt:$trict~ons for capjral assn ltcqnisilions
Change in fair value of ~nlefeS! rme i"\.lw';)P o.lgrccmcn:s designated
m cash now hed!cs
L05-$ )f fair value of E:ndOwmellL corpus
Tramfers (lO) from affiliates.
Increase (decrease) in unrestricted
11';( asseES
2.229,279
651,553
1,395,275
84,947
188,622
46,296
4,595,982
(120,316)
2,110,c38
618,178
1,289,,09
84,167
180,166
46,232
4,328.590
92,946
(6,407)
103,289
[28,179)
(2,659)
(89,475)
(3)
4,063
67,018
[8,065)
36,9~4
456
1,250
1,477
3
20_881
78,123
24
5,8S?
;4,729
(927)
l8,73!)
l8,730
(216)
57,101
11,150
55,358
2
514
61
124,186
(2,836)
":I:j
~
f,l>
rt
rt
PJ
()
P"
El
(D
::J
rt
tt:I
32,4 i3
29,102
(61,355)
(59,613)
(14,533)
7,271
(36,204)
1,495
1,495
( 14,533)
9,817
(35,m)
56,742
(4,912)
68.012
76
(242)
30
200
(24)
3,005
(1,133)
(343)
r-..
()
0
::J
.
rt
'-'
500
334
2,53!
(4,625)
(5,558)
6
(8,059)
24
13,507
9,552
3,945
(!,059)
(772)
(1,0_'9)
(632)
(5,81)4)
3.897
(242)
(S217)
(S218)
3,576
368.418
($1,336)
370,159
(5,55g)
54
2,716
5,S'7
(927)
(216)
(120)
(!40)
g531
(5,335)
~69~_ _ _ 1552
($9}')
2,001
1,907
SI,785
$1,787
t"c:rlh ShotC-Lonf Island Jewish f-IeaHh Systcm, [ne.
Cmnbjlling Staleruent ofOperath,ns - Obligated Group Onl)
For the Nine \lon~hs End~d Sepltmber 30~ 2011 '{)Jlaudit~d and Tn Thous::mds)
~orth Shore
Universil)'
:\or~h
Tolal
Obligated
Group
Lung Island
Jewish
Health
EHminalions
Hospir.e) Stern
Family Cent-er
Shore·
Care,lllc.
Long 1,land
North Shore
Jeuish
UniyersitJ
Hospital
M~dica~
GenLer
Glen Cove
Hospital
Plainview
Hospl!,1
forest Hills
Hospital
'or Extended
Care and
Huntington
Reh::.l)i1icarion
Association
Hospital
Franklin
Hospllal
$fJl.llhside
Hospital
Slalen IsJand
Unh"ersity
Hospital
Lenox Hilt
Hospital
Op,~r,Jting r~Ve'H.lE;
~';et plltiem service revenue Physk: L;!!n practice ~\'entle
Dlher operating
~~er
To:~l
as..s.tts
ho~p:tal
and nursing flciEties.
HVem.lC
telen.sM
from reslnclims used fot operalions
op.:rating revenue
n,B92,207
405,849
113.342
20,881
4.432.279
s'
5·
(405,623)
366,979
5989629
190,268
63,189
lUi'
(405,623)
36§,979
1.254,199
( 134,435)
(31,002)
(230,466)
(5.722)
129,598
33.518
581.807
161,824
390,169
31,501
39,501
10,658
1,215.460
5123,051
5.92,935
14,064
143,691
2,484
26,532
5,324
1,068,482 ~~-
$129,268
9,637
!.l08
$148,210
9,445
737
140,013
158,392
69,858
20,283
39,911
3.129
4,293
683
I3S,I07
67.015
12.701
42.657
1,617
3.291
900
138,181
1.442
I,S32
$35.571
5128,620
8,125
1.636
35.95~_
5201.295
10,055
1.627
226
213,203
71,112
23,079
43,350
4,304
5,072
1,398
148,315
18.1 SO
5,M2
6,199
170
859
370
31,420
96,711
33,579
59.386
4,438
9,'83
1.665
205,362
10.077
4,531
380
$552,012
5479,453
138.381
5212,163
20,564
1l,205
5
243,937
34,527
806
587,345
8,561
JA07
491.421
65,016
20,421
41,219
6.196
3.527
846
137,225
119,822
40,119
69,740
4,870
8,653
2,310
245,514
289,980
86,630
162,761
4,350
]],499
6,899
568,119
233,233
59,246
175.947
9,872
22,193
6,863
507,354
1,156
(1,577)
19.226
(15.933)
Opaa~in~ c:;,pcflses'
~alll.ri::')
[Illp!(lye~
2.110.438
618.178
1,289,209
84,167
180,766
46,232
4,328,990
benefj!;
Supp~it.s
tint! e;x:p~r1se.s
E"d debt expelise
De:prcclnticm andmlOrtiz,Hion
Imeres!
TOI~l op~nlling
expense.';
E:-:c:ss (Jefici~n(:'y) fJf oper::lting reVCDue over op·urlling expenses
!03,28Y
([.344)
(402,969)
12.654)
;67,4.22
34,904
4,267
369,709
(2.730)
33,739
502,541
142,138
320,914
19.+l1.
3U9J
10,717
1,027,IH
41.339
7.8~1
b:I
CJ:j
~
~
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rt
III
(l
~·l}r·op~rating gains
lnves.unern
Ol,m~e
:T
and lo:>ses:
jn(om~
12.994
7,432
1.496
63
142
(59,613)
(34,712J
19.987J
(3,668)
(71)
(175)
(14.533)
9,8-17
(35,197)
9
(21,709)
(13,125)
16
(15.614)
(2.172)
54
51
17,030
25.1'25
(730)
1,88]
9.562
195
2,8-15
(J ,059)
(432)
29.102
(27)
225
1.255
103
508
(2.529)
(104)
(27-1)
1,582
3.274
S
(ll
(706)
(7,338)
rt
in nel u.nrealized gains JI~dIQ.s~e.~ and ch,mie in value of
-::oq llit}' nl(=II~od il"...'e:~lments
013flgC tJ1 fair v;lhe of imeres! rate swap agreemcnB d~signaleJ:
i.lS derc .... ;}[i ......:- inslrumems
a.hcr ncn-opcrJtilg g<:ljm and
IQss~s
TOld nOIl-opl::t<lling ~llins and losses
(27)
(49)
~
to
(1,408)
(33)
176
371
(903)
(I)
8,177
8,411
(532)
1.220
(2,844)
,-."
(l
0
f:-:c:~s {c:I~ficJency)
d rc\'enue and gaillS ,md !-ossot':!;
<~e( lSs.er:;
fILH'E) n~slricllof]s f<lf
re!E:a:;ed
o\'~r
expenses
capital asset acql.l isillQ.lI5
Cnilngc ill fa:.r value r;f intcre:H nne ~\\'ap agreements d~signJh:d
as- cash How h~d~s
Loss offair vJlue of mdowrnent corp~5
Tr.HJ5.fcrs (10) from aflW<1lcs
IflC,UISe
(JecJensc) ir unresnicted
nel a~5-elS
68,092
(2.6~1)
(2,7301
(358)
(632)
(5.804)
570)59
2,681
$.
(1.271)
(5.,0011
OMI)
$8,7M
1627)
(112)
1743)
527.038
10.044
4,707
6,938
1
3,798
1,155
6,834
18,694
834
]52
1,347
51,989
$7,186
(18,777)
190
(162)
1.200
52,906
5J.~83
510,044
5.:t,i08
SB.1J8
520.041
(51 R,5B7J
~
.
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Attachment #
Medicaid Affidavit
New York State Department of Health
Certificate of Need Application
Schedule 48
Schedule 48 - Medicaid Affidavit
See Attachment # 8 for signed copy
AFFIDAVIT
or
IRobert S. Shapirol
State of New York
)
) 88:1_----J
County of Nassau
Robert S. Shapiro, being duly sworn, hereby deposes and says:
Re: CON Application No. 102239
1.
I am the Senior Vice President and Chief Financial Officer of the North
Shore University Hospital and am duly authorized to make and deliver this
affidavit on behalf of North Shore University Hospital. I submit this affidavit
in connection with the application of North Shore University Hospital for
certificate of need (CON) approval pursuant to Article 28 of the Public
Health Law and as a condition precedent to such approval.
2.
Notwithstanding any agreement, arrangement or understanding between
the North Shore University Hospital and the Saint Vincent's Catholic
Medical Center to the contrary, the North Shore University Hospital hereby
agrees that it will be liable and responsible for any Medicaid
overpayments made to the facility and/or any surcharges, assessments,
or foos duo from the Saint Vincent's Catholic Modical Center pursuant to
Article 28 of the Public Health Jaw with respect to the period of time prior
to the North Shore University Hospital acquiring its interest, without
releasing the Saint Vincent's Catholic Medical Center of its liability and
respons ibility.
3.
I declare under penalty of perjury that the foregoing is true and correct.
~IGN~
~RINT
DATE
p-{"
It ,.,
OR TYPE NAME
Robert S. Shapiro
TITLE
~enior Vice President and Chief Financial Officer
~T~R(
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...TEOFNEWYORK
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QUM.IF1ED IN SUFFOLK COUNTY
MY COMMISSION EXPIRES JUNE j, 2012
49
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