STATE OF NEW YORK
PUBLIC HEALTH AND HEALTH PLANNING COUNCIL
STANDING COMMITTEES
November 17, 2011
10:15 a.m.
Albany Marriott
189 Wolf Road
Albany, New York 12205
I. COMMITTEE ON ESTABLISHMENT AND PROJECT REVIEW
Christopher Booth, Vice Chair
A. Applications for Construction of Health Care Facilities
Acute Care Services - Construction
Exhibit #1
Number
Applicant/Facility
1.
102167 C
Lincoln Medical and Mental Health Center
(Bronx County)
2.
111334 C
Lawrence Hospital Center
(Westchester County)
3.
112030 C
Corning Hospital
(Steuben County)
4.
112120 C
Coler-Goldwater Specialty Hospital and Nursing Facility
(New York County)
Hospice – Construction
Exhibit #2
Number
Applicant/Facility
1.
111548 C
Hospice of Orange & Sullivan Counties, Inc.
(Orange County)
2.
112069 C
Hospice Buffalo, Inc.
(Erie County)
Residential Health Care Facilities Ventilator Beds – Construction
1.
Exhibit #3
Number
Applicant/Facility
072112 C
Oakwood Operating Co., LLC d/b/a Affinity Skilled Living and
Rehabilitation Center
(Suffolk County)
2.
071024 C
Long Beach Memorial Nursing Home, Inc. d/b/a Komanoff Center for
Geriatric and Rehabilitation Medicine
(Nassau County)
3.
112096 C
Nesconset Acquisition, LLC d/b/a Nesconset Center for Nursing
and Rehabilitation
(Suffolk County)
4.
071077 C
North Sea Associates, LLC d/b/a The Hamptons Center for
Rehabilitation and Nursing
(Suffolk County)
Residential Health Care Facilities - Construction
Number
Applicant/Facility
1.
102376 C
Albany County Nursing Home
(Albany County)
2.
111061 C
Shorefront Jewish Geriatric Center
(Kings County)
Exhibit #4
B. Applications for Establishment and Construction of Health Care
Facilities/Agencies
Acute Care Services – Establish/Construct
1.
Exhibit #5
Number
Applicant/Facility
112194 E
Northeast Health, Inc.
(Rensselaer County)
Ambulatory Surgery Center - Establish/Construct
Exhibit #6
Number
Applicant/Facility
1.
092069 B
WNY Medical Management, LLC
(Erie County)
2.
111362 B
Upstate Gastroenterology, LLC d/b/a University Gastroenterology
at the Philip G. Holtzapple Endoscopy Center
(Onondaga County)
3.
111488 B
Yorkville Endoscopy, LLC d/b/a Yorkville Endoscopy Center
(New York County)
2
Dialysis Services - Establish/Construct
Exhibit #7
Number
Applicant/Facility
1.
111504 B
Mills Pond Dialysis Center, LLC
(Suffolk County)
2.
111475 B
USRC Lake Plains, Inc.
(Orleans County)
Residential Health Care Facilities - Establish/Construct
1.
Number
Applicant/Facility
111540 E
Fulton Operations Associates, LLC d/b/a Fulton Center for Rehabilitation and
Healthcare
(Fulton County)
Certified Home Health Agencies – Establish/Construct
1.
Exhibit #8
Exhibit #9
Number
Applicant/Facility
112023 E
District Nursing Association of Northern Westchester County d/b/a Visiting
Nurse Association of Hudson Valley
(Westchester County)
C. Certificates
Certificate of Amendment of the Certificate of Incorporation
Applicant
1.
ODA Primary Health Care Center, Inc.
2.
Samaritan Foundation of Northern New York, Inc.
3.
Auburn Memorial Hospital
4.
Auburn Hospital System Foundation, Inc.
3
Exhibit #10
Certificate of Dissolution
Exhibit #11
Applicant
1.
Hudson Valley Health Specialties, Inc.
2.
Brooklyn Cares, Inc.
3.
The Albert Lee Memorial Hospital a/k/a A.L. Lee Memorial Hospital
D. Home Health Agency Licensures
Home Health Agency Licensures
Exhibit #12
Number
Applicant/Facility
1758 L
Comfort Home Care, LLC
(Nassau, Suffolk Queens and Westchester
Counties)
1778 L
Restoration Home Care Agency, Inc.
(Kings, New York, Queens and Richmond
Counties)
1826 L
Marian E. Howell d/b/a Golden Age Home Care
(Bronx, New York, Queens, Kings, Richmond and
Westchester Counties)
1852 L
Five Star Home Health Care Agency, Inc.
(Bronx, Kings, New York, Queens, Richmond and
Westchester Counties)
1952 L
Paramount Homecare Agency, Inc.
(Bronx, Kings, Nassau, New York, Queens and
Richmond Counties)
1911 L
The Gerry Homes
(Chautauqua County)
1947 L
Surfside Manor Home for Adults, LLC d/b/a
Surfside Manor LHCSA
(Queens County)
2050 L
Delaware County Public Health Services
(Delaware County)
4
2051 L
Madison County Department of Health
(Madison County)
2058 L
Wayne County Public Health
(Wayne County)
2067 L
Herkimer County Public Health Nursing Service
(Herkimer County)
1705 L
Bestcare, Inc.
(Nassau, Suffolk, Kings, Richmond, Queens,
New York, Bronx, Dutchess, Rockland, Putnam,
and Westchester Counties)
2073 L
VNA Home Health Services, Inc.
(Westchester and Putnam Counties)
II. COMMITTEE ON CODES, REGULATIONS AND LEGISLATION
John Palmer, Ph.D., Vice Chair
Exhibit #13
For Emergency Adoption
11-29 Section 760.5 – (CHHA Establishment – Determination of Public Need)
11-27 Amendment of Section 401.2 of Part 401 of Title 10 NYCRR
(Amendment to Limitations of Operating Certificates)
For Discussion
11-27 Amendment of Section 401.2 of Part 401 of Title 10 NYCRR
(Amendment to Limitations of Operating Certificates)
09-17 Addition of New Part 403 and Amendment of Sections 700.2, 763.13 and
766.11 of Title 10 NYCRR; Amendment of Sections 505.14 and
505.23 of Title 18 NYCRR (Home Care Services Worker Registry)
Amendment of 10 NYCRR Part 710 CON Notice Submissions
For Adoption
11-17 Amendment of Section 405.19 of Part 405 of Title 10 NYCRR
(Observation Unit Operating Standards)
11-03 Amendment of Sections 405.1, 700.2, 720.1, and 755.2 of Title 10 NYCRR
(Accreditation of General Hospitals and Diagnostic and Treatment Centers)
5
III. COMMITTEE ON HEALTH PLANNING
Dr. John Rugge, Chair
A.
Request for Stroke Center Designation
Anna Colello, Director, Division of Quality Assurance and Surveillance for
Nursing Homes and ICF/MRs
Applicant
Columbia Memorial Hospital
B.
Update from the Office of Health Information Technology Transformation
Rachel Block, Deputy Commissioner, Office of Health Information
Technology Transformation
C. CON Stakeholder Input
Dr. John Rugge, Chair
IV. COMMITTEE ON PUBLIC HEALTH
Dr. Jo Ivey Boufford, Chair
6
Exhibit #14
New York State Department of Health
Public Health and Health Planning Council
November/December 2011
ATTACHMENTS
APPLICATIONS for ACUTE CARE SERVICES-CONSTRUCTION
Acute Care Services - Construction
Number
Applicant/Facility
1.
102167 C
Lincoln Medical and Mental Health Center
(Bronx County)
2.
111334 C
Lawrence Hospital Center
(Westchester County)
3.
112030 C
Corning Hospital
(Steuben County)
4.
112120 C
Coler-Goldwater Specialty Hospital and Nursing Facility
(New York County)
Exhibit #1
BFA Attachment A
NEW YORK CITY HEALTH AND 1I0SPITALS CORPORATION
(A Componenl Unil or the City of New York)
Managcl1lcJ1I'~ Di~cLlssi()n
and
Analysi~
June 30, 20 I 0 and 2009
Financial AnalysIs
Summary
0
r As~cts,
Hlne
Li'lbi i i Ile~, and Nci
30, 2010,2009, and
ASSGlS (Dd'iC:ll)
200R
(Ill lhollsands)
2010 - 2009
Percentage
2010
AssCls:
Current assets
Capi lal assels. net
Other assels
'I'olnl assels
Liabllllies:
ClllTClt1 Ji<lbililic~
$
Ncr asscts (dcficll):
Invesled in capital assels,
nel 0 f' I'C luted debt
Restricted
Unrestricted
Tolal nel assets (dct'icil)
ZOO8
change
2,606,943
2,810,720
2,609,459
2,667,792
2,632,233
2,545,63]
207,4S I
249,61 ti
150,635
$
5,025, I 14
5,526,Ui9
5,328,50 I
I ,g 'Y;,
:s
I ,J 64,501
1,441,145
1,ILl),SI4
901,352
952,885
90S,29S
N.6'~/,)
(S.4 )
3,688,635
:1,182,574
2,927,039
159
:£
6, I 54,488
5,576,604
4,961,851
10 A'Y,)
$
1,S7 1.925
209.950
(2,611,257)
1,704,747
203,3:11
(1,957,013)
1,574,650
161,727
( 1,369,727)
9 S"I"
3.3
(529,374)
(49,735)
Long-term debl, nel
Poslemploymcnl benefits
ob Iigalion, other'than
pension, nel or currenl
portion
TOlallillbilllics
2009
:6
366,650
(0.1)";(,
5.4
( 16,9)
3 J ,4
%4 A'!';'
BFA Attochmcnt A (cont.)
NEW YORK CITY HEALTH AND HOSPITALS CORPORATJON
(A Componcnt Unit of the City or New York)
Management \ Discuss ion and 'Analys is
June 30,20 JOan d 2009
Financial
Analy~is
S 11l11rnary of Revenucs, Expenses, and Changes in Net Assels (Ddici t)
Years ended June 30, 20 I 0,2009, and
200~
(1n thousands)
·2010
Opcrati ng revenues:
Net patient service rtvcnue
Appropriations from (rcmittances to)
City of New York, net
Prctll iLIm rcvenue
Grants revenue
Other rcvt:I111t:
<t
.w
4,778).(45
n7,04l)
1,107,197
220, 152
47,323
Total operating revenucs
Opcrati ng expenses:
1\';l"sonal scrvices, fringes benclits,
and employer p,lyroll taxes
Olher than per~()nal ~crvico;s
I'ostcmploymcnt bene fils,
other than pension
A ffi Iialion coni meted sCI-vice~
Depreciation
Total operating expenses
Opera!i ng loss
Nonoperating expcnses, net
2009
4,73[),872
~2.460
l)IJ6,g72
240,194
36,530
2008
4,/-;75,931
(74,251 )
779.6 [ 1
279,024
3O,%1
2010-2009
Percentage
change
1J)'V<,
248.1
16.9
(8.3 )
20.5
6,440,S65
6-036.928
5.iN7 )7(,
6 7
3.572,129
3,470,311
I ,~3 7 ,224
J ,146,42U
3.194.523
1.647.965
29
5.2
602,623
B25,375
42l\,213
738,031
224,915
B1.0
6.9
253,4 19
332,933
771,958
240.834
7.090,770
6,562,456
6.233,647
5.2
~.
1
((150.205 )
(5)5,52S)
(336,371)
23.7
(91,922)
(91,493)
(61.%3)
0.5
(742.127)
«(,17,021)
(391\,3}4 )
'10.3
262,4Xk
210,85 I
155,679
24.5
(479.639)
(406,170)
(242,655)
10.1
J (,(j,(, S0
()()9,30S
Loss be rore other
ch~lngC's in net a:-:.:;eh~
Other changes in net asscls -,
capilal conlributions
l)ccrC(l~C
net
in
a~sets
Nel a,scts (deficit), beginning or year, as
preViously rC[lorted
(19.735)
En'ecl of adoplion of accOllnll ng
principle
f'1e! a~;.'~et~:, beginning oj" year.
r~stated
Nr.:t
i\s~els
(10,215)
( 1136)
(I UOO)
lLi
(deficit). end ofyr.:ar
$
(49,735)
356,435
009,305
(52'),374)
(49,735)
366,650
(I i 4.(1)
%44%
Hortley Pork
BHFP Attachment Map:
CON # 102167
Bronx County Hospitals
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BFA Attachment A
Corning Hospital and Affiliate
. Consolidated Balance Sheets
December 31,2010 and 2009
2010
Assets
Current assets
Cash and cash equivalents
Patient accounts receivable, net of estimated
uncollectibles of $7,770,966 and $7,000,907
for 2010 and 2009, respectively
Inventories
Prepaid expenses and oth~r assets
$
Assets limited as to use
Trustee held funds under indenture agreement
Board-designated funds, temporarily and permanently restrIcted
and self-insured trust funds
rotal assets limited as to use
Other assets, net
Total assets
Liabilities and Net Assets
Current IiGlbilitles
Current maturities of long-term obligations
Note payable - related party
Due to related parties, net
Accounts payable and accrued expenses
Accrued payroll, taxes, and vacation
Estimated third-party payable, net
Total currefllll<:sbilities
$
7,585,230
1,292,955
Total current assets
Investments
Property and equipment, net
8,759,514
2009
10,836,149
1,322,524
1,635,250
1,696,468
19,272,949
16POO,879
1,065,622
1,065,505
21,792,630
20,753 1173
21,818,678
43,777,359
23,157.595
168,012
$104,922,523
22,858,252
53,839,85$
22,000,089
160,441
$118,131,590
$
2,145,738
3,770,000
180,792
187,619
$
105,000
178,801
50,843
3,840,762
3,983,206
2,533,007
4,546,063
2.737,876
4,793,958
11,849.684
15,058,243
Long~term
liabilitIes
Long-term obligations, net of current maturities
Note payable - related party, net of current portion
Accrued .pension cost, net
.
Self-insured liabilities, net of current portion
Asset retirement obligation
Totalliabllitles
3,770,000
1,408,046
1,227.255
4,549,917
16,127,922
9,211,721
46,'75,058
47,810,983
70,735,877
56,011,096
392,230
828,425
828,425
71,956 1532
$ 118,131,590
$ 104,922,523
5,~85,207
16,559,131
8,838,915
Net assets
Unrestricted
Temporarily restricted
Permanently restricted
Total net assets
Total Habilities and net assets
272,010
.57,111,540
BFA Attachment A (cant.)
Corning Hospital and Affiliate
Consolidated Statements of Operations
Years Ended December 31] 2010 and 2009
Unrestricted revenue
Net patient service revenue
Other operating revenue
Total revenues
2010
2009
$ 73,467,250
$ 78,454,397
2,763,173
76.230,423
2,514,385
80,968,782
23,206,685
9,807,929
10,774,339
11,212,982
5,790,980
23,232,849
8,736.032
11,808,634
11,668,231
. 6,749,506.
Expenses
Salaries and wages
Fmplayee benefits
Purchased services
Supplies
Other expenses
Accretion for a~set r~tlrernent obligation
Depreciation and amortization
Interest
Provision for bad debts
Total expenses
Income from operations
Other income, net
Excess of revenues over expenses
4110,207
422,749
3,763,158
97,880
3,009,191
68,103,351
8,127,072
6,291,471
$ 14,418,543
3,573,111
119,582
6,880,534
73,191,228
7,777,554
9,728,197
$ 17,505,751
BFA Attachment B
Guthrie Health and Affiliates
Consolidated Balance Sheets
June 30, 2010 and 2009
(in thousands of doflars)
2010
2009
Assets
Current assets
Cash and cash equivalents
Patient accounts receivable, net of estimated
uncollectibles of $48.81 9 and $40,785
Inventories
Prepaid expenses and other assets
$
Total current assets
Assets limited as to use
Trustee held funds under indenture agreement
Board-desIgnated funds
Other
Investments
Property and equipment, net
Other assets, net
Total assets
$
16,589
58,438
8,985
10,641
60,624
7,764
10,507
94,653
92,991
. 15,865
102,310
108,735
16,169
100,419
95,640
226,910
212,228
333,626
273,231
163,197
3,056
160,325
2,750
$
14,096
818,264
$
744,703
6,220
$
5,930
28,328
liabilities and Net Assets
Currl:lllllli;lbilitit:l:;i
Current maturltles of long-term obligations
Accounts payable and accrued expenses
Accrued payroll, taxes, and vacation
Estimated third-party payable, net
Other
$
29,366
32,802
17,516
2.940
31,549
18,655
3,896
88,844
88,358
Long-term obligations, net of current
. maturities, bond discount and bond premium
148,428
154,674
Accrued pension cost
Asset retirement obligation
Other
26,862
14,618
106,884
11,236
14,846
100,247
Total liabilities
385,636
369,361
386,091
43,734
2,803
331,459
41,119
432,628
375,342
Total current liabilities
Net assets
Unrestricted
Temporarily restricted
Permanently restrIcted
Total net assets
Total liabilities and net assets
$
818,264
2,764
$
F
744.703 ..
BFA Attachment B (cont.)
Guthrie Health and Affiliates
Consolidated Statements of Operations and Changes in Net Assets
Years Endeq June 30,2010 and 2009
(in thousands of dollars)
Unrestricted' revenues
Net patient service revenue
Other operating revenue
Gain on early retirement of debt
2010
$
Total revenues
Expenses
Salaries and wages
Employee benefits
Purchased services
Supplies
Other expenses
Depreciatron and amortizatfon
Interest
Provision for bad debts
$
541,043
553,056
227,380
53,679
219,842
27,415
3,575
30,860
511,265
30,678
32.125
93,531
52,025
26,817
6,594
28,543
506,601
46,455
38,984
(65,900)
47,124
42,980
28,579
Income from operations
other lncome (loss), net
$
510,722
11,410
30,924
96,897
Totar expenses
Excess (deficiency) of revenues over expenses
529,775
12,168
2009
69,662
$
(19,445)
BFA Attachment C
Coml", Ho.pllal
COmpllrd.... BllarK:.e ShlIolIl
For th. Period Ending Ju... M. 2llH
O8I3Oo'2OtO
Curronl AIIMt4
Cnh Ind Cash EquivalenlJ
1'1010. Recol"abl~ • Almal!l
Accourtb; RecellI8b1e, Net. ti 1I11owilI'Q fer dOlJblful
DeimInd No1II
~1Ib1e. ~
CI!rlIc LId.
cap/l8I $l,lbl8Ue Reallwble • G\.ltI"(jll Clinic Ua.
RfIOt!Ivllhlll fIom Guthrie Cllnlc lid.
D~ Irt>m AmlllllM
Total CUrrllnt Au4llc
AuetI. Amiled ... to "'":
I ~ - TIU5lee Held
Board Dcalgrated FUl'lCIt
Tomporarlly ~d PerlTllll1."tiy R&stricllld F1.Jnd.
3..1( 1""".-.1lCO TfLlool fund.
Petleot E«row
Total A&a8ls HmIlliId ill Ie U...
Oto.r Asleb
In,,wslrnWlt
LT - A1fi~aw., net of C'.JIRIl'lt portion
NolIMI RecaivBbIe, rl8t (If r;;unwot por1lon
.
Capllal SUblNM RecelVIoblll, nel of CU~l porflQO
Rawbl. from Gullvie CllnIc, net or Cl.Il"Illnl por1Ion
F''''~' Pion! & c...ulp<nun~ net
Propeld P."lIon. Cos!
other Atsets, net
Tolal Other A5'68!i
News
7,132
100
7,661
aceounl5
Notea RooeiYabI a
Inven10rleI
Prepaid ~ and Oth« AP8t.s
Recalva~.
CUlTllnl UablIltJ8lI
Not.. Payable. Une of Ct1dlt
C.manl maluolu... uf ivnlf"1<!o',n oblllf"'w"
Noles Pll)'llble • AIfillq • Currenl
Due In AlTiIliltM
OeJ3Cl1'2OOi
1,820
9~
0
11,229
D
1,502
~,374
1.1!lO
1,357
0
D
o
l)
D
1,303
o
un
20
5
(288)
88
17.718
(4)
13,0150
IlIlS
MA
. '~,142
o
17.7~
f8l
. 1,1N
ta,S«
1,os.!
~,7W
3,1110
1.713
2,434
22,740
0
21$71
tUM
IH,~
4ll....S3
37,3&4
2,G20
1172
;71/:
I)
l)
0
0
o
o
o
o
111,281
o
o
63,ne
o
o
o
o
"
0
0
17,03
UI,7S7
0
0
e.4
~7
e7.~15
65,100
10 e,!11
!I7,3OS
0
0
-'\()
-10
0
D
0
I)
At;t;N.d Ex~O"" & At:ttur1t, P')'WIll
5,00
15,121
4,269
AccrullCll"lyro/l. Taxlls en~ 0111."
t,lJt,l1l
1,l/tIl
1.775
o
1,&el
1,$1e;
1
6.1119
15,ooa
Aooruwd V.... tI.lo
A.cx:n>ed Intorest
third Party Pay.bl.
otIer
. Tatal CUlT'8fl1 Ullbllltlcs
OlherU,bl/itltll
Du. 10 AflIlialMi
Oem.fId Noto. P~bIl> • AmllmM, net 0( com>n/ poItion
Long TItf1l1 DtbtS
~~tloJ>lE~
~
P.nllon Co.ls
Other 1I.bllltie:ll
Total Olher Llllblllll6e
o
1~,332
o
o
0
'4.~
1.l/13
1
3,~2
0
10,ng
I)
0
o
1,4215
0
1,~15
4.~
. 7,~02
oI,lal
2:5,302
2M03
36.030
2"3.106
"o,~
~O!I30
650814
233
112:l
68,935
-«l.~
47,100
100.511
87,305
Total u.o~mc.
D
~,:J,5()
NelAstfl\1l
UnnI..!licl«I
r errporarlly Als1sicled
PClwancmUy f06l;i(;;\bj
,(Ita! Net ANelI
77,587
J3Z
1126
.
C«N\gHo.~
~~.....FOf" 11M _l!ndtng.lura 30, 2011
"'--oJ
C!!!"l P Mod
"~g
Adl»I
InPlliwl(~
0a11'riotrll~1le
~
... 0p.nIng
R8nr....
BudIIII
,.~
PIIorY_
Ra\'WJ.M
~.337
23.~
.,m
U.~
4,3(5
130M!
71.11'
1~1I
72.2%
11,Qll4
0
15,421
•
~R_
Y_loc.
0,0'%
"
2B2To
71.8"4
.. O\ltrdnll
'lI.0pwnIn1l
~
Ac\IIl
sq.-
~
lW,~
ZU%
611,150
1~1J,1Z3
7U~
1<I1I,lll!3
... OpGntIno
I"rlorY_
RMw'UtI
2£1.2%
~',566
71.~
H$,8112
(I
O.~
0
0.0%
2llJ.l»1
1011.]%
~"&15
11IO.ll%
415
1IS.IlI!I2
122,8!:!
~U%
t21f,l101
81.1"'.
, 17,11l2
100.0'lI0
eo.4%
1MI.~
1'1,8104
1l7,~
tIt,roo
94.8%
:l!i.6%
7-4.2%
O.2'lIo
~&oM:oo_
1~,3of!
100.0~
17l z:J1
0.0%
nJ).l!'S
C<rbdvaI rd QIfI... ~
11,~1
&lI.~
W,§;~
~1.II")l,
MOO
O.OT.
100.0'Il0
82.2"10
'''1'
~s.~
.,Ai
Ill.a%.
5.lI2!l
94.5%
78,lM
305
'.5%
214
:1.1'llo
~
Sli",
3.2%
2,722
9
0.0%
0
O.O'Ilt
0
llA
2,501
0
3~
".O~
2MO
0
0»%
(I
3.'"
O.K
N.t~s...aR_1>t
~'rog R_8ndStpj>(lrt
Gooincrl~CIf~
6,72;1
1oo.~
t,g
110.0%
t,1M
100.0%
1IQJ7I
1«1.g!:
W111
100.0%
7!,4%2
100,l)'f"
-w.o-
lp'l
3S1
:lIl.7'4
ueo
31.1%
17,7%
:m.1%
2:!~
29~
7~
U%
~s.w:.
P~F . .
1,la
7llIl
588
lI.7%
121%
11.0%
134
:z.~
SuppIM
1.Hlt
17.7'l.
170
1,o&l
IB.24'
1,ns
10,"'
e,JMD
1:1.8""
'u""
10,ll3:ll
lI,043
2t.1%
1.U%
~0611
a7B
1,1111
1.001
23,4115
~
17.1~
20.'%
'2.K
<5.4%
134
llII3
lU~
lIDll
fI~
1,1)3<1
TrMl 0pInIlng ~
S;llariM
'emI>l_ a..,~
e-,~
2.5'10
"ro
~1Il1c1~
-..ot~
m
4.4",
1m
4.7%
:1S>4
0
O.D~
O~
1
ProWIoo1Ior 8acI Dolll
.IlN
·O.4'l'o
(333)
9
9.0"1.
OJ)'I.
1
708
0
0'"'
II
3,2-11
t2.ft
M8S
!5.3%
5,401
482
1.:z"
S~
U~
(1l8!j
-12.9'l.
lllI
(34:ll
-6.7"-
4llt
~
O.ll'l'
-~)
-~~
"wty~t1Ao.bl
Op8mI"lE_ _
~From~
NO" ~1Iog G*lI
Exeec:> lttIIttlf'l Bef<Jt. ~IIW'/
~
~1Wos
~~Mw~n¥tlfjm.
1.1"
11.0%
18.8%
4.$%
0.0%
06.4"
11.'
2.'""
U72
2.11..
2.2"1
12,4117
2..1"15.4%
12,M1
15.0'll.
10.1%
7~
50'72
4.1","
.,TI5
. 3,414
II
0.1)"
3,l118
12
111.3%
e.1%
4.'%
11,.2
"'42
~
II
11.5%
4••%
D.O'llo
10.3%
.5,M7
7.a""
OJ)lll,
...
SA"
D.'' '
O.O'lIo
0
111.1%
11,5&1
!l8J1%
78MI
P4,n
1S,1tIlJ
n,,,,,
7S1
,2.3%-
',211
11.4""
• ,.2IlI
$..2%
8,255
7.9%
1.3%
(;SDI
-4.1%
8,!lOO
U'lI.
'pse!
1.3%
'6,478
8.2%
1l0'lC0
. 1111
1t3"
17,l111
2''''''
5,,320
6.~
'I:l.132
111.0%
0
O,~
0
0.0%
0
00%
0
O.lI'llo
II
0.0%
~
6.0'l'
611
83
11;18
21,3%
6,320
8.5%
12.132
18,0%
4,:1112
,,sIN
"
0.0%
to
:;
>
rt
rt
P>
(")
:::t
S
(tl
:::l
rt
CJ
...-.(")
0
::l
rt
.
'-./
Guthrie Health
Consolidating Balance Sheet
(In Thousands)
Guthrie Health
Consolidating Balance Sheet
(In Thousands)
Guthrie Health
Consolidated statement of Revenue &. Expense
For Year-To-Date June 30,2011
(In Thousands)
% Operating
Actual
Patieflt Service Revenue
Contractual and Other Allowances
Budget
Revenue
1,409,802
%OperaUn~
Pr\Qr
Revenue
Year
% Operating
Revef1ue
100.0%
60.0%
1,422.775
867,212
100.0%
61.0%
1,312,764786,566
100.0%
845,239
564,563
97.5%
555,563
97.9%
526,198
97.8%
11,209
3,271
1.9%
0.6%
11,847
12,037
2.2%
0
2.1%
0.0%
0
0.0%
TotaJ Operating Revem..es
579,042
100.0%
567,410
100.0%
538,234
100.O'Y.
Salarles·Non-Provlder
Safarles-Provider
25.4%
145,153
93,158
56,929
25.6%
137,484
16.4%
88,212
25.5%
16.4%
Employee Berefits
147,180
93,094
5:4,613
Purchased Services
Physician Fees
Supplies
23,18G
4,762
102,884
4.0%
0.8%
17.8%
9.4%
18,173
5,116
101,732
.10.0%
3.3%
53,095
20,632
6,217
96,567
42,791
5.1%
32,355
6,957
38,643
1.2%
31,842
1.2%
5.5%
548,481
94.7%
Income (Loss) From Operations
30,561
Non Operating Geins
Excess Margin
Net Patient Service Revenue
Operating Revenues and Support
Gain on Retirement of Debt
other Expenses
Depreciation and Amortization
Interest Expanse
ProvlsiQn for Bad Debt
Operating ExfK!nses
"Sayre
HOUSE
54,562
29.600
6,6804
16.1%
9.4%
57,040
0.9%
17.9%
10.1%
5.7%
59.9%
9.9%
3.9%
~
~
rt
rt
ru
()
~
(\)
::l
rt
t;j
,,-..
12%
()
17.9%
I:j
8.0%
5.3%
1.3%
6.8%
28,401
7,150
30,774
555,854
98.0%
511,522
95.0%
5.3%
11,556
2.0%
26.712
5.0%
58,997
10.2%
5,892
1.0%
42,5n
1.9%
69,558
15.5%
17,448
3,1%
69,284
12.9%
is presented as D:scoounued Operations.
tx:I
5.7%
0
.
rt
'-'
ComIng Hospltal
Balance Sheet
(In Thouaaoo.)
[
2l'l10
Current ,Assets
Casll and Cash Equivalents
Notes receivable - affiliate
Aco:Jums receivable, net of allowance for doubtful 9COJunts
Notes reeeivab'e
Inwntories
Prep.aid expenses and Oth!f assets
Dernand Note Receivable - Guthtle ClInic Ltd.
Capital Sublease Receivable· Guthrie Cllnlc ltd.
Receivable from Guthrie Clink: Ltd.
Due from affiliates
Total Current Assets
I
Actual
2011
7,132
100
7,661
BLidget
2012
1,861
102
8,039
0
:2013
1,3n
1,374
1,300
1,584
1,861
0
9,222
0
1,595
1,414
0
0
0
0
0
5
68
17;718
0
0
(9)
e9}
53
:53
12,929 _ _11,136
2016
2014
1,661
0
1,730
1,456
1,661
0
9,916
0
1,873
1,500
0
0
0
9,550
0
a
(9)
(9)
53
14,641
53
15,254 _ _
2016
2017
1,661
1,861
1,861
0
0
11 ..4 93
0
2,187
1,591
0
11,930
0
2,325
1,639
0
0
0
0
0
(9)
53
(9)
0
(9)
53
53
16,~90
11,1n
11,799
11,082
0
2,059
1.545
l::d
~
P>
rt
rt
III
n
::r'
!3
Assets limited as to use:
Investment - Trustee Held
Boord Designated Funds
T amporarily arel Permanently Restrlc:led Funds
Self Insurance Trust Funds
~9
0
0
0
0
0
0
0
15,84-4
1,054
3,610
11,556
1,169
3,663
11,530
1,115
4,145
18,263
1,160
4,311
18.993
1,206
4,483
19,153
1.254
4,663
20,543
1,304
4,849
21,365
1,357
5,043
Pat ent EsCl"OVl
Noncurrent ~ limited lIS to use
21,~!Z
0 0 0 0 0 0 0
. 22,3~
22,820
23,733
24,682
25,610
26,697
27,764
0
Otlier~
Investment
DlJEl from Affiliates, net of current portion
Noles Receivable, l T - Affiliates, net of current portion
Noles recelvable,
net of cJlTlmt portion
Capital SUblease Receivable, net of current portion
ReteivBble fro:n Guthrie Clink:. oot of current portion
Property, planl & equipment (net)
Prepak:l Pension Cost, net
Other assets (l1et)
49,453
63,145
67,459
49,069
(1,531)
3,071
12,406
22,422
0
0
0
()
0
(J
0
0
872
0
0
2,920
0
0
0
0
0
0
108,532
0
661
0
0
0
0
167,054
0
0
0
0
151,889
0
0
0
0
143,555
0
0
134,859
831
801
0
206,291
198,D2~
0
772
0
200,505
0
742
0
203,586
0
0
0
0
16,498
0
21,823
0
64
0
0
106,511
117,880
0
17,026
0
Total Assets
1~l!,23JL
_1Jl6.836
0
0
(D
~
rt
i:'j
~
Corning· Hos pital
!3alanc~ Sh~et
(jrlThou~arids)
'L
201()
Current Liabilities
Not~s pay"ble - line of Credrt
Cur"e.n! maturities of long-term obligations
Notes payable - affiliate - current
Due to affiliates
A=unts payaJle and accrued expenses
Aco:uedpayroll, taxes and other
Accrued vacatbn
Accrued interest
Third party payable
Other
Total Current Liabilities
I
,HistoriC
20.11
2012
,0
0
4.0
0
0
0
5,121
1,881
1,515
1.
5,988
a
14,546
ra~.,;~1_t11iA'f~_~I:1
Budget
0
(35)
4;968
2,035
1,412
0
5,424
0
13,804
2013
0
0
0
2
5,720
1,239
1,342
0
5,424
0
13,727
2014
2015
2016
0
0
0
0
832
0
877
2
6,545
1,234
1,450
0
5,477
0
2
6,129
1,204
1,3"94
0
5,394
0
15,014
926
2
6,733
1,204
1,508
0
5,751
0
0
15;5E\5
16,1~4
21117
0
0
fJ77
2
7,118
1,174
1,569
0
5,79!;l
.0
1$,539
0
0
1,030
2
7,527
1,144
1,633
0
5,855
a
17,191
1:0
t-:l:j
:J>
~
M"
M"
Il>
()
Other liEbilities
Due to affili<)tes
Denand Notes Payable - Affiliates, n3t of current portion
Long term debts
Patent Escrov.
Accrued Pensi,)n Cost
Other
To~al
liabilities
Net Assets
Unrestricted
Tenporarilyre;;tricled
Pennanently restricted
Tol31 Net Ass€ts'
TO(31 Liabilities and Net Assets
::r
0
0
0
a
a
0
0
1,425
0
0
0
7,802.
25,8.03
0
7,219
25,885
49,576
55,874
233
82B
56;935
106,M1
0
57,606
0
0
56;629
0
7,301
26,902
59,409
0
0
7,163·
27,710
0
58,531
0
0
6,995
28,534
0
6,762
18,828
0
6,688
HI,688
0
55,599
0
0
6,839
20,568
46,907
47:930
109,295
109,645
99,320
99,644
100,197
69,770
37L
77,093
388
95,338
101,931
629
. 78,:~O9
'96;645
97,346
527
B2B
98,701
99555
. 577
828
70,972
86,280
432
828
87,541
100,~$1
~03,389
117,880
·126,239
~~6,836
2El6,~91
198,021
20D;605
203,586
328
479
8~8
0
a2a·
828
a
(l)
;:;s
M"
tt:I
,-....
n
0
::l
.r1'
'-'
Coming Hospital
Statement of Revenue & Expente
(1rJ Thousands)
I
2Q12
Patiunt Service Re~rlue
AllclY..mCl!S and Uncollectible Accounts
I
Actual
~~~~1~~;~~J~~;}}t!.~~~JL~*~~Hq;mm~fl~~.~~fEt~~~~~~~%~fl1~~~t;~~:;r::S;~:;#:~~~;q~'i~;:;:'~';_\':'
BUdget
~
Wi
ZQH
2015
ZQ1Z
ZQl§
193,862
117,162
206,533
128,273
222,881
140,074
zm,299
1~L32
267,679
171,431
263,341
122,006
183,403
300,073
196,224
76,700
75,497
78,260
82,807
86,567
96,246
99,938
103,6411
2,7'22
0
2,540
0
634
0
589
0
747
608
0
872
0
939
0
79,422
78,037
78,894
83,497
87,315
97,056
100,810
104,788
Salaritt&-Non-Provider
Sa !ar\e$-Provlder
23,058
23,518
22,349
a
Employee Benefrts
Pu rcham Servlces
9,324
9,502
25,194
0
10,114
26,216
0
10,520
11,815
12,509
2,129
19,488
6,964
0
12,029
2,063
18.336
6,671
11,954
3,219
6,363
0
13,007
Supplies
Other Expenses
Deprecia'km and Amortization
Interest Expense
Provision fur Bad Dflbl
Earty Extinguishment of Debt
10,938
8,849
2,264
11,892
6,715
3,474
9
5,967
J
0
9,233
24,181
0
9,672
27,282
0
23,246
0
0
7,269
12,318
3,115
7,OB7
0
operallng Ex.pen SM
73,166
~,I72_
B1,139
95,943
~,n6
103,~1
6,255
6,265
4,S51
5,611 .
6,176
1,113
1,094
847
6,401
2,202
3,560
2,886
878
0
0
17
0
0
1,099
0
0
1,512
0
0
17
17
J7
2,8_62
894
1,116
1,528
9,<>5tI
2,aoa
---.b210
2,376
7.1%
1.1%
1.1%
0.6%
Net Patient Sen/ice Revenue
Operating Revenues and Support
Gain Oil Retirement of Debt
Tolal Operating
R~nue.s
Physician Fees
Income
('_~)
From OpclQlions
Net I nveJ>bnerrt Income
Change in FaIr ValU!l of Derivative Ins1tumlmt
Gain (LOIS) on Derivative InslrLmenl
Other Gains (L0158M)
Non Operating Gains
Excess of Revenue Over Expense
Openrtirg Margin %
197,503
2013
1,715
11,749
7,405
3,570
5
9,299
11,496
1,939
15,671
7,074
3,817
0
5,3440
10,445
1,879
14,448
6,725
4,920
3,974
0
4,989
64
0
14,043_
5,725
1.188
0
0
75
(4961
17
6,476
7,431
12,T.i2
13,696
~,o~
7.9%
8.0%
6,1%
o
o
o
77,886
0
~ 0
1_7
~294__3,577.
_ _ --.et.188
6.7%
2,000
18,963
7,349
3,510
0
5,647
12,009
3,168
6,714
0
0
10,944
2,196
20,724
t:d
""l
;l>
;l>
rt
rt
Pol
()
;:T
S
ct>
::l
rt
""l
Corning HoIipltai
atawn.nt of CMtl Flaws
!IIuNM {Dee""'lln eMit" ll1W1trllef1t1
(In TlIouaandl1)
I
Caotlllawsfrom ~ adMi8s:
Net Inrome (loss) !rom 0pem!Xl0s
Add: ~ not IlIql.Rlg casf1 ~ tl1e r.:IUBft peOOj
3,~7"
Loss from Diso:ootk'lued Op«lotlona
0
PMsioo~
0!tl0l"
~
in DpQr1Ifilg
~
(3,30:2)
(l7)
_
IobiIlIeo;:
~~
1.569
I~
(22B)
PJ1lPElklI!J:ll6l'AS lWld Di.hefasseb
AccDtrn Psyoole & Aa:ru9d Expenses
~/olaUlII
Due toIIrom MIbtes
""'" C&h provided by operallrg 0IClIvltles
il.oU) 0<1 _
Nolet RectIMltll8
of IIxDd
5,811
0
0
3,570
&4
0
3.974
0
0
(17'!»
0
(378)
("7)
0
(1.1804)
3,Il17
0
0
17
n
(209)
(1,250)
(642)
(BO)
111,146
(5)
802
8,123
3,690
2,524
Zl17
. 1l,11ll
0
1.113
1,094
0
0
3,510
0
11.954
0
o.
a
12.009
0
0
0
17
17
17
847
0
12,318 .
0
0
0
0
0
(~
(143)
(1,105)
(1115)
(~12)
(295)
(328)
(13S)
17
0
(438)
170
(421
(044)
(32)
31H
(129)
(46)
300
152
0
552
13,625
(138)
(48)
649
161
0
555
13,924
n
128
37
0
0158
lI,Oll
(345)
Jl,038
3,:1.02
4,276
1.188
3,SOE
0
0
0
0
0
C
(3,7~
(3,0+0)
0
(Z3)
(00,526;
2,365
(9,300)
0
0
3,022
(.5,090)
o
....w
27
118
C8Sh 1Io:Nos from 1'rax:iv ~
F'r'oaeda from Iong-lofm obIga!I<nI
Payrr.enb of Ionlrwm ob!JgaIionII
Nolet Paytlbl8 - .mlale
EqUty Tl"lIflSf£Irs (10) from atfI.am
RestrlcbId ~ racetted
R~.,.j~~·
CMh LJri8l:I in Ilnalldng .:tlYIlca
Nel (deae8ae) IncrMse h cash
",851
0
211111
2015
m'
(015)
258
13-4
0
547
10,1:1:9
143
0
(9999)
2,150
2,ll12
0
lI28
0
0
0
('62,032)
(3,816)
7,027
0
0
.,137
-:l ~
ea.n and n.-tmeots II beginning of peOod
Cub and l~ at E.'ld Of P8rlod
z,59!!
(2,050)
c'
. 0
0
0
a
(66,1121\
{59,120)
C>
1,ISO .
ll'lVllmJJenl - Trustoe HelcI
Boeo1l 0esIg1'\Olte<1 Fundf;
Ternpcnriy and P1lrm1lllllf1lly RM!I1cled Fund1l
IfMmmonI
~
;J>
nn-
1.li64
::J'
0
0
0
0
(3,674)
(3,622)
ro
~
n-
0
a
0
0
(z,526)
0
0
(2,058)
Q
0
0
~
0
0
a
0
(40)
(1,~
0
(832)
(Il17)
(9211)
(1177)
0
0
289
0
0
0
6O,24ll
0
0
1,267
0
0
0
0
0
0
0
224
0
0
Q
Q
13Z
0
0
0
0
&I,2~
(632)
0
[877)
(92fi)
(977)
I)
112
381
(1,110)
7ll
1,345
19.105
9,378
4,2M
(17.ll43l
(49,823)
M10
10,175
10,800
55,247
7~,352
83,130
87.1I9Il
70,352
20,529
25.939
36.114
1",m
53,730
17~
7Cl,35%
2O,m
25,n8
38,114
47,004
7,132
1,8&1
1,861
0
17,556
1,159
83,145
I)
17,560
1,115
67,4501
1,881
0
18,269
1,1M
1,861
0
1!l,1Ill3
1,201l
t.8s1
0
19,763
1,881
BeQ
49,~
(1,~1)
U,~
87,99&
3,071
J5,Il3i
1,1161
0
21,36!;
1,357
22,422
47,1104
Summ.o.ryofCah&.lmIMtmetlts
Opc-othg C"""
Cd
()
Hoot cash l.ed n htesling IIClIvties
t~
2014
I
Ib
Cash Il<:Jwo from ~ aclMt!e&:
Ir!wtl1mowrt Income
Net ~ gaO (lossM) on Inv&slJneIU
Gairo/(bu} on DtIrMJIl"oe IrllrtnJ I'Jl«lt
Adcitbm II> Propertf, Plant & EqLljlmeot
DlapoaaIs of f'to!-1y, plorrt & E~
~
2013
6,265
(H)
7,100
(1.11I1)
2,522
Othec
Ei'ff~2 ~:~S~~~_'-,~~-0-iifiii-,~,j:~'i ·i't_~.{J:i~~~A'~~~ :£-ir;'.f~-t.tK~;%-~~~t~<1't~t,W~:t'i':!~}':;~S;~f:;:3tii,.:;;:,i,:;(
B.udget
21112
2011
1l,255
~j o j AmOfllzatlcn
I
Ac:tuEIII
2010
1S,S«
1,054
49,453
74,352
7D,3lil_ . _._u___ 20,529
1~
0
20,543
1,304
12,406
38,114
S
0
.&Q1Q
2011
~
2012
2015
2014
M2.
2017
Discharges
MedlcallSu~ical!1CUfPads
Obstetrics
Total
3,702
486
4,596
3~ass
428
4,711
4,147
370
4,918
4,238
370
4,976
4,298
370
5,038
4,367
4,327
493
5,353
5,297
485
4,287
478
5,243
Obstetrics
Total
Patient Days
MedicaVSurgicaVlCUlPeds
Obstetncs
Total
91
8
99
12,314
1,077
14,2.37
91
91
91
58
58
!=I
8
99
8
91
8
68
B
99
7
99
65
7
65
~
rt
99
7
65
14,013
917
13,547
15,691
15,344
14,630
955
16,427
14,82.6
955
16,62.5
14,944
1,360
17,664
14,73\
1,375
17,481
14,681
1,310
17,301
44.05%
32.71%
45.46%
44.64%
32.71%
46.01%
70.59%
69.58%
53.82%
73.68%
69.35%
51.27%
72.92%
3.45
2.58
3.30
3.45
2.58
3.42
2.76
3.30
3.40
2.84
3.42
2.74
3.30
3.30
955
37.07%
36.86%
42.19"k
Obslelrics
Total
39.4[)%
43.42%
40.79%
32.71%
42.46%
3.33
2.22
3.10
3.64
2.14
3.33
3.27
2.58
3.12
length of Stay
MedlcallSur;JicaVICUl?eds
Obstetrics
Total
31.40%
(1) Designated Pediatric beds will be decertified with the opening of the New Hospital In 2015
(2) Nursery patient days are excluded
rt
rt
;;r'
Occupancy
MedicaliSurgicalllCU/Peds
:;t>
~
()
Number of Beds
(1) MedicaVSurgicaVlCUlPeds
t;;I
CI:j
::t>:
3.30
53.23%
74.45%
(l>
p:;
-:)
2010
CT
Emergency Dept (Treat and Release)
Unear Accelerator
Magnetic Resonance ImagIng
Nuclear Medicine
Radkiology - Diagnostic
SurgeI)' - Ambulatory
Therapy - Occupational
Therapy - Physical
Other (LabiMammolEndoscopyJPulmonary)
Total
6Qll
2012
29.14
2013
2015
7,885
7,885
7,885
7,885
16,980
3,532
3,245
810
18,B72
2,857
2,063
22,013
65,865
17,880
3,822
3,336
17,880
4,135
810
3,429
B1D
18,627
2,554
1,985
21,006
64,548
17,505
3,162
3,245
810
18,872
2,857
2,063
22,013
65,865
18,872
2,857
2,094
22,497
65,865
18,872
2,857
2,125
22,992
65,865
816
23,575
4,515
2,421
25,408
67,182
142,275
144,277
144,122
145,917
148,851
164,795
7,980
17,558
3,953
3,213
793
9,536
23.555
4,478
3,311
2016
2017
td
9,488
23,390
4,651
3,357
9,457
23,229
4,828
819
824
n
23,693
4,542
rT
25,958
67,854
23,8544,571
2,745
29,075
68,525
167,321
170,523
2,569
3,413
~
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New York State Department of Health
Public Health and Health Planning Council
November/December 2011
ATTACHMENTS
Hospice –Construction
Exhibit #2
Number
Applicant/Facility
1.
111548 C
Hospice of Orange & Sullivan Counties, Inc.
(Orange County)
2.
112069 C
Hospice Buffalo, Inc.
(Erie County)
BFA Attachment A
HOSPICE OF ORANGE AND SULLIVAN COUNTIES, INC.
Statements of Financial Position
December 31,
ASSETS
Restated
2009
2010·
Current Assets
Cash and Cash Equivalents
$
Investments
Accounts Receivable
Pledges Receivable
Grants Receivable
Other Current Assets
701,884
1,707,620
1,638,976
227,213
19,000
103,771
$
863,783
1,291,897
1,141,202
195,708
0
92,371
4,398,464
3,584,961
Land and Land Improvements
Building and Building Improvements
Furniture, Fixtures and Equipment
417,668
5,179,406
962,522
6,559,596.
413,303
5,167,906
968,651
6,549,860
Less: Accumulated Depreciation
1,431,923
1,328,814
Fixed Assets, Net
5,127,673
5,221,046
Other Assets
Long-Term Investments
Long-Term Pledges Receivable
Security Deposits
3,350,581
212,100
3,546
3,222,115
364,608
3,494
Total OtherAssets
3,566,227
3,590,217
Total Current Assets
Fixed Assets
Total Assets
$
13,092,364
$
12,396,224
BFA Attachment A (cont.)
BFA Attachment A (cant.)
THE CENTEF: FOR HOSPICE & PALLlATIV~ CARE, INC.
AND RELATEO ENTITlES
CONSOLIDATING STATEMENT OF Flf\ANCIAL POSmON
December 31,2009
The Ce:nt~r
Palliative
ASSETS
Current assets:
Cash and ~ash equivale:lts
Pa Uent and third-party a~counts receivable, net
Hospice
Home Care
foundation
Buffalo
$
919,370
$
79.479
48,149
Hospjc~
1
Buffak·
$
Accounts r~ceivable from related enti! es
3,002
A~counls r~Geivable - other
--
_I
4,520,460
3,507,D82
7,470,D64
6,)01
Care Institute
(fomWlyeMI)
$
for
Hospic~·&
Caring
Life
Saunders
Hearts
TransHiol1s
Properties
Eliminating
COllsqlidate(
Center
ofWNY
Entries
Total
_PaHiatlve Care__ Horne Care
$
11.123
329,110
19,704
528,466
$
6,696;829
248,110
24,334
85,026
57,877
$
41,151
12,245
$
26.378
$
$
435,635
13.197
31,385
("4,553.880) (1\)
64~
43$,542
87.140
7,999,087
8,/44
1,371,204
136,372
15,534,992
10,092
409,2;65
359,937
195
2n,6.~l
52,291
4:lM3f
:;~,51a
529
.9,303
116,637
167,766
537;174
IQMBi
80,091
11,212,20e
(14,553,880)
245,267
Pledges receivable
245.387
4P9
Land, buildings and equipment, net
.nveslments
15.514,225
Other assets
62,000
$
17,197,475
6,150,70'
3,652,59;
53.29~
Granls rec~ivable
Pledges receivable
Prepaid expenses
ethel CUll ell I assets
Tolal cumnt assets
Tolal assets
I
6,535,633
18,103
2,619
312.950
7,293441 t:d
'ltM53
>
>
$. 33,465,207
p;-
.
(870.685) (A)
14,643,540
8,653
S
146,464
:Ii 15,953,010
$
359.937
$
14:534,72Q
$
';70,385
$
134,740
$
393,041
$ (15,424,565)
>-rj
~
rJ
~
CD
UA8JUTJES AND NET ASSETS
Current liabililles:
Accollnts payable and acc.·ued expenses
ACCOUnts pa'iabfe to relatej entities
ACGrued compensation
Deferred reVEnue
Other current Jrabilities
$
62,100
1,502,;194
70,512
6,984
$
23,994
2,713,712
46,675
1,982
-
$
1.758,945
$
$
1,169,666
459,529
7,857,051
620,615
13,459
$
32,396
$
96.284
11,108
2,000.594
24,249
32,167
$
2,107
479,529
1,642,6~O
2,786,363
9,005,1 13
2,949,887
2,068,118
128,680
482,686
:::l
2,O28,O1l2
:J>
54,592
22,026
(54,488) (AI
(14,608. 36B)
4,455,~59
[816,197) (A;
816,187
Long-term debt
2,350,~79
(1<.553,8BO) (A)
750
21,2:6
54,4~8
Current porUm oflong term debt
Total currenlliabilities
S
$
N~t Assets:
Unrestricted
TOlal unresticted
5,652,645
6,731.947
12,384;592
Temporarily re3fricted
Fermanen(Jy restricted
Total net assets
1,615,815
1,554,418
15,554,825
Board deslgmied
Totai liabilites and nel a5sels
$17,197,475
(A) To eliminate inlercompan·y receivables 30d payable~.
(2.639.899)
13,003,123
359.937
4,713,380
41,705
(1,933,378)
(89,045)
(2639.899)
13,003,123
359,937
4,713,38D
41,705
(1,933,378)
(89,E45)
.
(2,639,899)
$
146,464
359,937
13,003,123
S 15,953,on
:Ii
359,937
4,713,380
--
$ H,53c4.72O
1.9,107,868
6,731,S47
25,83 9i 1rl 5
1,915,815
1,554;418
(1,933,378)
~1,705
$
'170.385
$
134,740
29,O10;O~8
«(19.645)
$
393,041
$ (15,42.4,565)
$ 33,465,2;)7
~
THE CENTER 'OR HOSPICE ~ pALLIATIVE CARE, INC.
AND RELATEQ ENnTIES
CONSOLlOmNG STATa'ENT OF ACTlVlTlES AND CHAIIGES IN NET ASSETS
For ltl!!; Ye::u" Ended D,fc-ember 31~ 2:009
-==
~
==
UtlflistriCtJ)d
$
Speca! events
PtoglJm SflN:ce ra'ltlnJO
O:hef incoma
p.dmi~Jsl.ra~we- seNices
--,
$
1,916218
B61;Ju4
S
S
S
5/8,660
2,499,671
961,984
4,793
2,689
Ho.pj..
Buffolo
rotal
ott1-er support
Nel pUUllt se,..,..ice rev~nue
ConllFbulions, granls o:.nd b€iqL.'esIS
F'<lci~i",
Res!rlcted
!.
~ome Car~
PCIlTI<l:fentJy
Restri;ted
BuffolO!
S
290,620 '
22,467
42.126."57
29,724
29,422
servlC-9.$
3,388.~99
71.252
,,464,344
4,193
Palfj~ti\le
fhspi.e
{f""".,o/eMi)
1s
paillaUve Ca re
I
1,2,IB5,BJ3
527,949
30,061,8 i 8 (
'10,387
,j
Profe.ssiDnaf Care of p~l:en~5
Progr;;m &elVicas
Cost speciilol lJvel1!s
M;lnagemeili ar}d g1:lnat.l1
6~J.t,33
Fundr"is'flg
761,,41
496,075
3l7,m
or
$
$
176,I~G
204.3:1O
49,8];
49,67,
2,312,040
~956
(1,8tc,554)
(49(,075)
(o),(EI
(6,775,087)
(1,499,750)
(C)
(C)
$
(8)
43,081,202
2,uoi,I12
S61,984
271,075
99,327
7,048
{10,5M.466)
1,451,076
376,116
,i
5.600,841
~
24,253
3,601,346
47,089,358
FacimJ~$
~rlMres~
955
15,212
2,257,0,)6
Dcprec;alion
T(}ta!OXPi:lrJ5~5
lrlcorn;:- (f;)I;$) 1Iam opDration3
l,131,2n
4,793
71.252
22,138
985
15,222
2,257,000
21,124
935,718
l,207,338
(622,831)
10,529 ,
1,003,763
f
l
i
,j
,I
291
,!
4,375,61"1
,'r
303,i11
(303,111)
2.187.273
(230,287)
-
775 ';
934,943 ,:
37 ,809.992
~:
3,315,455
374,363
4,793
3.694,6i1
(621,856)
No::l a.ssets • beginning of y.:l'C:i
9,076.821
1,299,>40
1,484,250
11,B80.214
(2,018,043)\
Net ;,ssets· lJlld of year
17,481)
12,3B4,59!
(57,.588)
$
1,615,315
,
To t1li.m~a:te foundation jf!Veilue and corresponding e-xpe:rdilurEs due !o dI;~flblltiOil
1.554,118
S
15,554,825
317,512
4,753581>
761441
1,297191
1,237,573
401849
1,375,359
S
(2,839,899) ~
24.544
51,434
897,840
8,818,543
1,158
2.270,867
95.843
36,988
41.173
75,53.1=
86.;;(2
999.8701
(25.85E)
(618,918)
10,619
(882199)
[78,863)
(295,027)
46,1'98
(G)
(C)
ZI'IR,OS6
(C)
1,O55~~5
51.4301
4,533,160
~
rt
11,140:
,-..
(1)
~
!6,7M
16,592
8,601,151
2,270,86 7
75,534
2,100
997,714
a3,603
55,360
41,173
(25,858)
(616,758)
6,961,106
276,334
4,657,000
532
(53,787)
(1,318,52Cl)
22,022;142
800
!1
r51.~34)
('l
2,455,165
40,102,/52
(e)
(10,584,166)
0
::l
rt
i
,
------
----S
359,937
or reslrcted funds from the Fou.ll(iati~n,
To e~~m~a~e revenue ana8Xpenses related to tile a-UocatlO1 of home oftka costs. faciliUes 8'Jd occupancy reated expenses.
To c.,:m.11,ale r!)'.,IErJue aIldexpenses dUfj 10 bereav'Sml?nl services. provill~d by lile TransUlol'is Center. tnc. and home health aide selitices provided by Garing _iearts Home Ca-e,
TI} CIIITJ~late rE::veflJ;.e iJrtdE.';(penses due llJ Home Hoatl.h Aides services ~tQV;dcd by Caring :'COlr!.S to Hospice Buffalo and Homo C<=lre Buffalo.,
P-l
§
~J
!
~
rt
rt
-42,556,178
(2.240)
1;
13,OO3.123
~
~35,900)
1
S
t;Ij
'-rj
('l
'",
8,627,312
~
65,975
S
(C{
:~
4.375,611 j
{c
S
(6,775,087)
31,110,184
;j
1
Chan,gO in net .as.sflts
aSS-'"f 1r3.{fsfer
(B)
j
"
2,184.1(2
72,:J.I4
44,049
20.85i
25,391
26.4'4
{loss) all dispos-al of assets
.l3nd other gains
1
317,665
37,6Q9.912
O~her g<1l~s (lo.3S'!l-I1):
Realize-c: aoo uMealize-d gains on
irlVcsme:nls .sod fnVBsmsnt return
489.2'.
1,297,191
1,237,573
401.849
1,331,310
I
22,ll8
793,2012
(e). (0). (E)
(491)075)
;~
t
Or'...cupmcy
(2,10~649)
377.930
.~
MarKolil9
(8)
(C)
(0)
(E)
2,301,333
10,707
Totll
~---
4:1O
6,857,531
EduCQL'Ort
N~t
$
Con$ol~d4t(,ld
Eliminarng
Elltries
I
496,075
317.512
643,833
761,441
F"iil;)!Jcal sel\licfr:s
TQli:I~ il'xpQna2i'~
life
'fmnsWons
Center
1
Expon.s.ts:
G~in
Saunders
Prope:!rties
ofWNY
213.000
14.424
6,775,087
1,457,122
52,312
I
313,OB7
Cartng
H••""
HomQCare
397,898
56.07:.1
~
a.
s
,
=.~~
-~~,==
Tht! Centor for
C4'ln? IO-i-titute
j
2,689
,
Tobi roVQnl.!Il'''-
-=
I
,
HOSPICE FOUNDATION
Tl:!mpol"2rf~Y
R~\lenIrO. Ur.:En!.s anD
=1
1
tilC.
$
4,713.380
S
41,705
$
(89,6451
$ (1.$33.379f
$
~
29,010,048
THE CENTER FOR HOSPICE & PALLIATiVE CARE, INC.
AND RELATEO ENilllES
CONSOLlDATING STAfEMENT OF ANANCIAL posmON
P.rembar 31, 2lyn
I!
ASSI:.TS
:;urrent
aS8et~:
Cash aod cash equlvalenls
PaHenl and third.party accounls ,eCB)vabl" net
Accounlsre:elvable from rolaled enlities
Accounts re:eivable -elhel
Granls recs'vable
PledSesrec,ivable
Prepaid 8Xp9nses
.O!h&.wrrenl assels
Tolal cut'ent essels
Hospice
',llda's
Home Gare
Foundation
Club
Buffalo
::;
1,414,696
$
62,720.$
I
I
I
19,808 j $
43,469 l
!
45
,'ledges rsceivabJB
_and, bulJdlngs nnd equipmont, net
1
7,753
375,231
4,313
215,150
4,746
1,794,287
290,369
494,284
37,579
1,260
-,,361,917
I
3,000
10,296 1
76,573 !
Hospice
Pallilli~e
Buffalo
Care IrstllUte
5,065,834.$
3,222,:,60
10,355,<55.
5,:'71 "
20,029,188
Other aseets
62,000
5,809
$ 22,381,019
S ',695,674
Total assals
L1ABILIllES AND NET ,\SSETS
Currentllab!lW8e:
Accounls P"iable and .ccrJad expenses
39,316
2,582,892
51,178
4,683
"
2,578,069
Ufe
Hearts
Transition..
Center
Home Care
$
iO,332,555
35,991
25,708
.$
17,519
84,505"4
Saunders
Properties
"fWNY
.$
22889
5,806
Tofal
$
$
1,344
EO
1,270
7,566
·,1,1
i ·
1
~
'
I
5,932
531,863
.1
540,<71
6,243,627
1,462
13,165
2,043,811;1
10,211,873
.~
I1
$
$
[!l1B,197) (A)
.i
8,e,181'-,
~
32,505! $ 1S,226,€95! $
!
:;
i
--=-_.
252,644
$
7,359,534
$
»
606,573
'0,512,006
-
694,738
1,627
2,698,710 'i
57,705
11,932,649
\ '
756,492
l
114.065
$
45,13,
$ 2,075,317
$ 41,512,135
$ (21.720,757)
S
36,804
13,733
91,39'1
141,926
$
5,697
2,352,923
7,015
15,4TJ
2,381,11\
$
15,564
2,164,361
2,200,525
$
$
2,216,657
(20,904,560) (A)
6,742,047
956,938
(3,170,108,;
16,527.~85i
6,959,312,
15,701,359
956,938
(3,170,108:1
18,527,~85)
Temporarilyreslricled
Permanenllyras\rided
Tolall18t assets
2,446,503
1,555,088
i9,702,950
(57,705) (A)
(20,952,265)
(758,492) (Al
956,938
22,381,019
$1,695,674
Telal iebilltles and net assels
$.
(fI) To cltminall intercompany receivables "r,d payable•.
252,644
::52,644
4,668,393
4,868,393
[27,863)
[27,863)
(2,335,972)
(2,335,972)
(124,908)
(124,908)
1124,908)
2,446,5113
1,556,088
36,450,059
$
(3)170,10B~:
82,505 ~
$ 19,226,695!
'-
$
252,644
4,666,393
252&1.4
~n_.1i',359,534
(27,863)
(2,335,972)
....L...J.1'l,.Q65 _L~9...
$ 2,075,617
$. (2t,720,7571.
rt
~
~
636,745
25,469,156
6,959,312
3.2,446,466
"
. :,1
16,527,$85,
~
2,103,171::r'
24,650
S
6a,OOD
~
24,853
rt
4,431,331
ilet A s s e t s : , .
Unreslricled
Board d9slgoaled
Tolal unrEStricted
~
~
i,
3,252,6131
76,427
$
rt
22,673! $ 1,486,<22:1 $
3,198,039;;;
29,031
1,212.~88!;
2,870 2
~
,I
60,000
24,853
107,991
19,212,991
-:._
1
!
17,330
6,974,644
3,350,428
51,670
14,300
5903!l1
386:632
10S,128
j "
$
Consolidated
Eliminating
Entries
(20,W4,560) (A)
1,100
349,157
98,630
252,6~4
l
630,745
Long.term dott
299,374
Caring
14,3CO
18,677,606
~
Accounls patabl" 10 rolated enlilies
206,550
~
1ll,oWj
1
I
Accrued campensallon
Deferred re,enue
Demand not, payable
Currentporte~ ofro~g Isrrr debt
Tolal curJsnlliabifiliBs
46,094:;
,i
~
:nvestments
n .• Center
for ,icspice &
PaUatlve Care
..t1 1 ,512,135
r-
g
~
rt
.:..
THECENTEll FOR HOSPICE& PI.LUATIVECARE, NC.
;NO llElJITEO EN1lTlES
CONSQUMTINO STATEMENT OF AcnvmE' ANO cHANGEs IN NET ASSETS
For ~h«
Unf1J.strfcl~d
ne''1~n\)l':'Jg~.. ls BmI othai ,;upJ:n:nJ
Nal
j:8~!e-l1i semcCl reVCRUC
Cantributfon:r. grant'9 tml
bequ~~tJ>
Sped,,1 e\lentl>
~opm,~~r~w~
Ra3trlr:;I~.r:J
~
S
2,235;99,j.
1.023,691
Olhe~ ~.,nH!~
Ad"mhJstrlltNe l;erncee:
Glld~'s
Rtl::trict'l1d
t.05J}~61
S
:$:
670
CIl.1b
$
l,.4.9S,.212
1.023.59'\
5g.7~&
58
3,OZ8
!I
~
:EH.:ff<tro
:$
3,301,-525
En-dr!d D.,C"~mbr;r 31 1 2lJ1Q.
Horna CD.ra
WC$I~rn f1,",w ')ork
Total
5&
1$
1
I
I
15
.,
~~~!~~~
(~~~.:;~;
~
. .--....
.........
on,
~ ~ ~ "'.~
..
.......
or ~ut:.nt5
"M
429.715
-4-29,715
)t-l>p.rJcla-l C'\len~$
Me!Klllt:n1Mt9rJdg.Ell'i.e.rd
FundtalJilng
331,77~
~31,17-1
55~.651
558,6,1
014,020
~14.020
F~nardOiI
!
291,923
3-99"\S~<
II
,;;:cmces.
Edll\C~tiOl1
F!lck1~l!I:s
3-fl,7~3
D~p/~clntioo
I'Jlilf-c-}tp~Ilj,I',;"~
Incomn Ilof,s) from _OPl'lF£l~f:»IS
OU1Q[
23,8.eZ
23,6El:lt
92.4
91-4
9,;11
238
'!l,C15
.e,615
42,1""1
95,114
2,167 ;761
2,167.7-81
6Q..l:!'3~J
a1~,6o-7
2.157,.93
956.072
(53','36)
6U.l<S
1,522,fi11l
670
Re~hcd
Clung>:! 1i1 J:t;at 11);~n1!1.
NE'lt as.~~hL
bl::llil'1f1~lg
'Of yOIl:
Net .u~elt: - end of 1<"1.,
CariiJ§;l
Hlltll"ts.
H(Jm~ Garu
P:l1II~Uv0" CI)["1l!I
$
301.987
2.720.116
690
Saunders
Prop!!rtler;:
Life
Tr-i\rl$llIcnz
~Urnln.l:I,tinll
pi WNY
Cent-er'
Entrln
'S
S
65,27.1
167,645.
$
1
7~~
~~OO
11,8£.5
13.112
(1!\2.9,71/j)
<,197,99<
l.13'.~H
2J,678
15701,351
.
~1:1B5,03G
$
>31
!
"1.l64,927 !
J
_ _ Jd~1..-418
15,554 825
r2,6~~.6991
13)03, 123
1
1555086
S
19,702950
955,938
$
{J,17~
to Harne He;;'l1f.hA~de.ji:lervlcl!3 proMt!d by Caring H!!<l.rts loHOIpl.C<! BUffalo ar:d Hom-e Car" 8ullalo.
970.696
J09,098
16,:127,965
1S
11,50MOO)
(C)
(2,472,908)
(.29,'/1.)
<C).(D},(E)
(7,18D,S99)
(e)
J7,O~1
3J,671,456
(6)
,511,8n
,5.-389,607
1,339.42'5
i,~96j9~$
'.1~~.9"9S
364,996
14,+56
M26
27.oQU
21,H6
ZI,817
9,237,257
1,l37
2,790.• 69
43,98a
\39,58a
35,3.'
625,512
(S6.302)
(69,6Q3)
(35.263)
[402,594)
(926,529)
(73,420)
(131M6)
(I 1,3 "'?!)
~a,362
7-6° 1-'83
(107,2'3)
IC}
IC)
IC)
t">j
:;l>
3~1,J3'
4~,Hl
U~3-2,2t7
.S,467,.9s
48.382
5,404,31),
(1,491)
~5
132.510
12.716
9,225,942
2,790,4~4
139,588
,25,612
(W7,293)
(4~.9a7)
159,se8)
(35,263)
(.02,594)
7.'40,011
41,705
/89 a.5)
(1,933,37B)
29,010Mil
~59,937
202,644
(~a,3e21
(C)
1,'51,105
44 611 1702.
(ll,266.35Sf
ttl
36'MHli-&
1•.5351113
(1,~01)
109
S
(eJ
1,339,~25
1,~21.91.
!
3,52.,862
$
4,101,23~
i
3.5ZU
(530,209)
2,446503
258.243
(7,160,599')
1i2.U.902
132,61.
9SE,9:?l\
1&1?~15
1J2.610
I
~.H8.125
8~0,GOe
1,791.027
I
I
570
(195.5~~)
12 "J~4 592
I
'.629
317,973
3,316.767
46,65J,1aBi
.t:"'7il,7&B
41,901;
104,204
I
31ll
SOM17
195,5-13
S
m~~
1,436,167
~
1,99MJ2
I 77,H6
1,794,00'
373,692
(0), IE)
{B}
31
~''''51.1
309,n;!)
f
(2,t52,,sS1)
C.m.!lolldated
~
1,OaJ.~cs
(B} To llfinil1l'1~t1 Foundo!lQno'l\l'l)J1l1C l:lnd ~."ra:.'pon(Hn~ el(p~nditU1e-&" dill'llo dbllibtttJ~n o!r~5W"c1ed fufKis; frQm 1M Fi:l\Jfl{fl\ffin.
(q To crl71[n~~e revenue ttnl E>;<p:or,s/H!- JelatRdlo '!tie lI~(H;al~an nt hom~ Glllco'cW:lJ, 'tI~!$ljllS ilnd O~ClfPi'1ncy ra/sled -I!llpen;lI:~.
(0) To .::rillk1a~ofI rev.erKI/l ant (!.;<pe(l.:'C-e'S du!!.lo hI6:av~ml!r;t l'icrvkc:s provitlod b~ ur(lTrt\~jjClmo C.enter, m. 3,lld tlomo heifLh aide SCMCe!l p:o'Med by Ceiling hllaJ1$ Hamil- Caf~l.he.
(E) To ~Umlni:lk.: fe\renUr: tUl-C ~~pJ:n:lei5> dul::'
T'leCenterfcr
Hcsplce.&
-$
"I
7,731
I
~n
dispm.Etf of tlu-e:.3
nhd ltllre:z.D:zed ,aim. 00
~ ...cslt11tnt'5 nnd Irwes.tnefll r~hJm
Tll'ul O:i:pc.ntiollS .jl.ndolh-llr g3ln~
I
;.15~
~alll$ n"'~l;2:':f;
l<;t:'l:e
$-
"\-4,775,127
6,931
, , ..... " .......
I
27,9~
MtuhUnl]
Occup,mcy
Tnterel<l
F.o\m"tI... ~
C;::I',fl' rmtaule
.
;
SOl,5n
P(QQf.llm:o:c.rvicc1!'
CCl:l-~
I
Ho~plcs
I
Expcll5-es:
?,<)(es~lonal CDfO
.
j
BL/(Alo
~
245-,261
.(2,493
I
7.180,5,9:9
Fac"~.eMc"
Nel1l5sels:lele~'}~d rron fI;~trtcUop;
HOS?IGEFOUNDATION
T..,.mporarHy
Pemun-ently
(~'M
j
:;J>
rt
rt
III
(")
g
(1)
~
rt
:;l>
,....."
(")
-4.7n.380
4,56~,393
:
(27.~63'
>
(124,90at _;
l2,~35,9I2)
_3
$
4
36 50 ,059
0
::l
.
rt
'-'
New York State Department of Health
Public Health and Health Planning Council
November/December 2011
ATTACHMENTS
Residential Health Care Facilities Ventilator Beds- Construction
Exhibit #3
Number
Applicant/Facility
1.
072112 C
Oakwood Operating Co., LLC d/b/a Affinity Skilled Living and
Rehabilitation Center
(Suffolk County)
2.
071024 C
Long Beach Memorial Nursing Home, Inc. d/b/a Komanoff Center for
Geriatric and Rehabilitation Medicine
(Nassau County)
3.
112096 C
Nesconset Acquisition, LLC d/b/a Nesconset Center for Nursing
and Rehabilitation
(Suffolk County)
4.
071077 C
North Sea Associates, LLC d/b/a The Hamptons Center for
Rehabilitation and Nursing
(Suffolk County)
1-\
(
Project
#O~~~~ Affl
y Skilled Living and Rehabilitation Cen1er
("./.f.
?
f
!I
•
r-~
I, )
'\.C>j j'f. JA~
r~ '..,.".". . •.•. '.~
,)~ ~-..:::- '""J'
, fjJrJy"·
. )f C)
,/
I...
•. ,_3
~~---------
--
et Center br Nursing and Rehabilitation
pions Cenlerfor Rehabi itation and Nursing
New York State Department of Health
Public Health and Health Planning Council
November/December 2011
ATTACHMENT
Residential Health Care Facilities - Construction
Number
Applicant/Facility
1.
102376 C
Albany County Nursing Home
(Albany County)
2.
111061 C
Shorefront Jewish Geriatric Center
(Kings County)
Exhibit #4
Financial Summary
BFA Attachment A
Albany County Nursing Home
FISCAL PERIOD ENDED
2010
2009
2008
ASSETS - CURRENT
ASSETS· FIXED AND OTHER
LIABILITIES - CURRENT
LIABILITIES - LONG-TERM
EQUITY
$10,425.560
1,672,884
5,727,950
18,291,692
($11,921,198)
$6,343,586
1,974,655
7,799,602
14,243,988
($13,725,349)
$3,568,254
2,179,789
6,652,292
10,170,630
($11,074,879)
INCOME
EXPENSE
OPERATING EXCESS REVENUES OVER EXPENSES
NON OPERATING REVENUE*
COUNTY SUBSIDY
EXCESS OF REVENUES OVER EXPENSES
DEPRECIATION
$19,669,751
38,372,820
($18,703,069)
8,339,712
$20,899,624
$16,609,804
42,802,312
41,76-1,54-1
($21,902,688)
8,403,843
($25,151,737)
172,799
12,107,508
10,848,375
19,195,980
$1,804,151
$354,343
($2,650,470)
$379,028
($5,782,958)
$394,894
NUMBER OF BEDS
PERCENT OF OCCUPANCY (DAYS)
250
95.25%
250
93.96%
250
92.75%
PERCENT OCCUPANCY (DAYS):
MEDICAID
MEDICARE
PRIVATE/OTHER
89.47%
4.41%
6.12%
87.71%
8.10%
4.19%
92.17%
6.31%
1.52%
*Non operating revenenues include intergovernmental transfer funds of
2010- $8,247,689
2009· $8,247,689
2008- $0
MEDICAID RATE BREAKDOWN:
OPERATINC
CAPITAL
TOTAL
2010
$185.78
5.22
$191.00
BFA Attachment A
Financial Summary
Shorefront Jewish Geriatric Center
12/31/2010
Internals
12/31/2009
12/31/2008
ASSETS· CURRENT
ASSETS· FIXED AND OTHER
LIABILITIES - CURRENT
LIABILITIES - LONG-TERM
EQUITY
$29,413,573
39,105,780
19,873,239
24,263,860
$24,382,254
$30,425,033
37,950,566
.. 18,806,799
24,933,402
$24,635,398
$33,072,580
40,092,926
21,977,920
28,089,015
$23,098,571
INCOME
EXPENSE
NET INCOME
$43,987,313
44,063,293
$43,961,630
45,682,613
$88,451,489
95,892,582
($1,720,983)
($7,441,093)
OPERATOR/RELATIVE SALARIES
NUMBER OF BEDS
PERCENT OF OCCUPANCY (DAYS)
*PERCENT OCCUPANCY (DAYS):
MEDICAID
MEDICARE
PRIVATE/OTHER
($75,980)
$329,328
N/A
360
97.92%
74.99%
16.78%
8.23%
MEDICAID RATE BREAKDOWN:
OPERATING
CAPITAL
TOTAL
2010
$280.63
32.16
$312.79
N/A
360
97.92%
98.35%
74.99%
16.78%
8.23%
76.73%
15.11%
8.16%
360
BFA Attachment B
PARTICIPATING AGENCIES OFT'HE METROPOLITAN JEWISH HEALTH SYSTEM
SKILLED NURSING FACiLITIES - RESULTS OF OPERATIONS
December 31, 2010 and 2009
2009
2010
Op"ratlng
Chrmge
l\!V~fll""
$
$
MJG Nursing Home Co., inc.
44,302,948
5horefrontJewish Geriatric Center, Inc.
43,973,030
43,317,117
655,913
Men<>r"h Hnm" tlnd Hospital for the A~ed and lnflrm
4l,148,567
38,196,8'58
2,951,709
129,424,545
123,832.,112
5,592,433
Total skilled nursing revenues
.* Adult 0 ay Care - MJGNH
Adult Day Care - Menorah
Total adult day C"dre H:venU8S
Total
42,318,137
1,984,811
6,981,576
7,045,690
(64,114)
1,561,984
350,826
1,211,158
8,543,560
_ _ _7!396,516
$
l37,968,105
$
131,228,628
.$
'15,928,532
$
4~,G40,44:1
J..,147,~~~
$
6,739,477
operating expenses
MJG Nursing Home Co•• Inc.
Shorefrontjewlsh GeriatriC Center, Inc.
44,013,928
44,948,961
(935,033\
Menorah Home and Hospital for the Aged and Infirm
46,504,745
44,375,525
2,129,220
136,447,205
134,964,935
1,482,270
5,430,153-
6.001,3-44
874,995
569,631
6,305,148
6,570,975
Total skilled nursing expenses
.;j-
298,o8a
Adult EJ"y C~rc
. MJGNH
Adult Day Care. Menorah
Tot<:J1 :;..duit
d~v
(";A(P
pxpenSES
Totol
$ 141,535,910--,
$ 142,752,353-
=-~
~'.! ;"'.
.
r' .'"
,".~"
.(571,191)
305,364
___
{2,?.5,82Zl
$
1,216,443-
\ .
'..
OperaCing iflcome/(loss)
$
(1,62.5,584)
MJG Nursing Home Co., Inc.
5horefront Jewisl1 Geriatric ceot",r, InC.
Melwmh Home and Hospital for the Aged onci Infirm
(5,356,178)
.(6,178,667)
8<'.2,489
"
.. ' (11,132,, 8231
c
,
~'
4,l:l.O,lG3
•
l'::~~:~¥~\·-i;~:~~:;f~,~~::~~.';j{~::::~:)
Adult Day Cere - MIGNH
Adult Day Care· Menorah
Tot<J1 r1et operalng lncome' .du\t DBy
507,077
905,794
i~!:~l i¥~ i~ ,=.-<;, ;.,",-=.di~; ; :;"
"
S
1,696,7Z8
1,~',!I),~4b
"
Total
$
il,631,l:l44)
(7,022,6(;0)
Total net operating loss, skilled nursing
(3,322,312)
(40,6981
~f
1,412,871
,.5;523,034
New York State Department of Health
Public Health and Health Planning Council
November/December 2011
ATTACHMENT
Acute Care Services – Establish/Construct
1.
Number
Applicant/Facility
112194 E
Northeast Health, Inc.
(Rensselaer County)
Exhibit #5
I CONFIDENTIAL I
Catholic HealthEast";;
SPHP Organizational Chart
(A:'ter SPLITCA Membership Change)
St. Peter's Health Partners
NCR THEAST HEALTH
ST. PETER'S HEALTH CAR:::
SERVICES
St. Peter's Hospital
Foullda:ion, Inc,
Our Lady of Mttcy LIfe
Centerl"lHI
Samaritan Hospital of
Troy, New York C-l)
Mercy Cares for Kids, Inc.
..;cihifNr5rthfastHealth
(Dec)
;>:Foundatlon, Inc.
Warde Servi:es Corp
St Peter's Hospital
(SLlppons
Ill' QAS.'IS)
SETON HEALTH SYSTEM,
INC. (H + OASA~)
Affil iated Management
Services, Corp. (RE)
Memorial Hosptal,
Albany, NY (II)
Seton Health at Schuyler
Ridge Residential HC (NH)
Sarnaritan:ChildCare
I:d
~
C~nter,InC,<oCcY}.
~
rt
rt
jl)
Shaler Properties, Inc.
Sist~fj. ofT\1~rcy)
()
The Comrn unity Hospice,
Famil} Ufe rhfvfmatlDn
I~~cnlcr,
In.:
Inc.
(HOSP)
.
§
SU!.ny"i~' H(l~pitaland
It>
::l
RernbHilation ,Found.1.tion,
rt
Inc
~
Tht Comnilinity
MLry 1II1Cll~1~11];Ii~ db~
P::t¢(~ Nllr::i1lg &-
Ho~pice
Foundation, lne
Fdwhilil;llicm CC:-Hlt:r (NH)
Glen Eddy, Inc
{llU +EHP)
Hawi.home Rldgc_. Tnc
(ILL <All)
KEI'
".H
Acl~lllllotlN
CHHA
DCC
r.~rli fied
r:1l~
The Marjorie Dilyle Rockwell
ILl)
Inl~pend(;"nt Liyin~
II
IIO,P
l.J1CSA
LTJIIIP
!'bs-pnal
"II
Nill'sinC Home
OA:l.AS
PACE
RE
()(free of Alcohol t.. Subst~mct: Abll~ St:fyices
Progrflm of ,\ll Inclusi,,-c C<'tr~ fOf tht' ElderlY
R~J.~1 Est:llo.;
.
o
Cerner, [n::. (A1--I)
I 1011JC Hc~J111 Arcrlcy
Dw CurcCt'nler
Elrj..:hed Hou~il1g frognm
Uni l~
Be~c1~w(tod, he:.
Prorcrt~r'
dba Edd'/
Sen'ices
H')SP1Ci.:
L C":nsed Hume Ca-'.': Sen[cl'~ Agem:L·)fIg T~1'1l1 Hom..,; He;"I1~b Propmn
~:lt\-Mirflj[' BO::H'd-s
Empir~ HQ.m~ rnfu~ioll
S~(..-i.,c. illC,
Eddy Licemec Horne Care
AgcnCj.', IrK. (LHCSA)
NOTES'
}:-
>;..;0.):r
SPHP is the only new' entity deficted; aJ [ others currently exist
Chm1. depicts wrrent -organi7Atbnal rclationshipsofSI. Peter's
Health Care S~rvioCes_ Nor1heus' Health and Seton Hemth
System, inc, a1d each ofl.hcir sJbsidifl:ries:
All entities will have; minor bO"l'ds unJess othemoise indicnted
Not depicted: (I) Joinl \'cntmc.l and (2) less Ihan 100%
membership.
St. Peter's Ho~pitJ.l Foundation, Inc. is a nOn menlber
org.anl7.l1tion oosp~Le the solid iiRe to SPHCS,
M
BFA Attachment B
NORTHEAST HEALTH, INC. AND AFFILIATES
Combined Balance Sheets
. December 31, 2010 and 2009
(Dollars in thousands)
Assets
Current assets:
Cash and cash equivalents
Investments
Accounts receivable, less estimated uncollectible
amounts of$16,221 in 2010 and $16,136 in 2009
Prepaid expenses and other current assets
2010
$
Total current assets
Assets whose use is limited
Interest in Sunnyview Foundation
James A. Pddy Memorial Fonndation
Property and equipment, less accumulated depreciation,
and amortization
2009
57,119
35,587
47,781
34,958
31,457
13,159
31,043
137,322
126,185
68,653
4,127
66,917
3,639
17,122
j4A77
192,926
193,443
2,168
3,040
18
3,096
3,157
85
4,298
8,322
10,049
448,472
434,705
12,403
Other assets:
Deferred compensation agreements
Deferred financing costs, net
Intangible assets
Investment in partnerships and other assets
$
=====
2,509
BFA Attachment B (cant.)
Liabilities and Net Assets
2010
2009
Currcnt liabilitics:
Accounts payable and accrued expenses
Accrued salaries, wages, and related items
Other current liabilities
Estimated third-party settlements
Current portion of long-term debt
12,615
14,458
2,379
15,124
4,256
11,026
14,209
4,324
15,388
3,425
48,832
48,372
Other liabilities
Accrued pension obligation
14,930
18,110
13,428
18,796
Asset retirement obligations
2,535
2,572
47,667
47,088
3,178
3,132
50,845
50,220
1,069
12,829
55,855
1,447
14,997
56,750
69,753
73,194
4,256
3,425
65,497
69,769
196,936
183,570
25,966
7,573
8,016
33,539
8,016
11,156
34,47'2
6,092
5,490
17,248
39,962
247,723
231,548
448,472
434,705
$
Total current liabilities
Resident entrance fees:
Refundable entrance fees, net of current portion
Unearned entrance fees
Long-term debt:
Capital lease obligations
Mortgage notes payable
Bonds payable
Less portion classified as current
Net assets:
Unrestricted
Temporarily restricted:
James A. Eddy Foundation
Other
Permanently restricted:
James A. Eddy Foundation
Other
$
BFA Attachment B (cant.)
NORTHEAST HEALTH, INC. AND AFFILIATES
Combined Statements of Operations and Changes in Net Assets
Years ended December 31 , 2010 and 2009
(Dollars in thousands)
2010
2009
200,430
117,801
26,360
215,208
115,204
25,816
344,591
356,228
Unrestricted revenue, gains, and other support:
Net patient service revenue:
Acute care services
Long-term care services
Senior housing
Di15tribution from James A. Eddy Mellluridl FUUlIlldliuIl
Ot11er revenue and net assets released from restrictions
Investment income
Grants
Total operating revenue
Expenses:
Salaries and wages
Employee benef1ts
Supplies and other
Interest and financing fees
$
1.500
1,500
11,621
814
2,109
11,776
1,575
2,397
360,835
373,476
172,750
31,467
111,459
174,471
32,104
118,734
2,913
2,835
24,643
12,263
2
24,857
13,802
355,497
366,803
5,338
6,673
497
6,203
1,032
(806)
(96)
715
1,386
10,882
(1,964)
(541 )
Total nonoperating revenue, net
6,830
10,478
Excess of revenue over expenses
12,168
17,151
Depreciation and amortization
Provision for bad debts
Distributions to related parties
Total expenses
Operating margin
Nonoperating revenue (expenses):
Gifts and bequests, net
Investment income, net
Change in unrealized gains on trading investments
Nonrecurring expenses
Loss on disposal of property and equipment
(Continued)
New York State Department of Health
Public Health and Health Planning Council
November/December 2011
ATTACHMENTS
Ambulatory Surgery Center - Establish/Construct
Exhibit #6
Number
Applicant/Facility
1.
092069 B
WNY Medical Management, LLC
(Erie County)
2.
111362 B
Upstate Gastroenterology, LLC d/b/a University Gastroenterology
at the Philip G. Holtzapple Endoscopy Center
(Onondaga County)
3.
111488 B
Yorkville Endoscopy, LLC d/b/a Yorkville Endoscopy Center
(New York County)
BFA Attachment B
'. ' '. .' '. ".. ,.' ..::. :. ',:',::,. '. '.: PrO Forma Balance Sheet
.:
r
I
.
Paln
.
~,
~
."
\
I·
!
' .
' .
~
l
11
•
:
.:
Beginning Balance Sheet
Cash
$170,400.00
Moveable Equipment
$234,600.00
Owners' Equily
Total
$405,000.00
I
.
I
$405,000.00
$405,000.00
.\
.
.
.•
~
"
BFA Attachment C
ESTABLISHMENT CHECKLIST FOR AMBULATORY CARE SITES
APPLICATION: CON 092069-BWNY Medical Management, LLC
NATURE OF APPLICATION:
AUSPICE:
AFFILIATIONS:
PRI MARY CARE
SPECIALTY
- Pain Management
xx
NON PROFIT
PROPRI ETARY
PUBLIC
- limited liability
xx
Kaleida Health
YEARONE
UNIT COST:
OPERATING
CAPITAL
TOTAL
PAYOR SOURCE:
$ 312.22
$
58.01
$ 371.13
YEAR THREE
$ 270.25
$ 49.09
$ 319.34
YEAR ONE AND YEAR THREE
MEDICAID-FFS
COMMERCIAL-MC
COMMERCIAL-FFS
MEDICARE-FFS
MEDICARE-MC
SELF PAY
CHARITY CARE
2%
30%
40%
5%
20%
1%
2%
,._'-~
I
Lanca,~ter
,:-:.
Elma
I
,\
I
\':~.
i
;11'~i~g:~n I
Ileigllts
'/,
.~So~thtown~'womens
""
Erie
'Orchard
Park
,}~
Group
}.
-fW1E!~~~e?_E:':~~~~!'E.~~.~~~~; s~':;~es
Hamburg
0:
Quaker Rd
s·Ig Tree R.d
Von
'1,:>0
~
£:
l.IJ
I,
East!
Aurar'
BFA Attachment A
Department of Medicine Medical Sel'Vlce Group
COlY1para~v" Balance Sheet
at De<:ember 31 t 200S and December 31 , 201 C
December 31, 2010
December 31, 2009
Assets
Current Assets
Genel<ll Checking
(1,059,484.08)
(210,340.90)
400,466.62
(103,766.88)
84,202.58
358,8$4.58
363,486.42
571.432.51
348,494,36
1,523,518.22
1,534,941.30
333,843.90
2,W4,911.80
113,815.23
340,981.20
376,052,80
669,909.88
144,396.00
08,000.00
125,601.00
47,000.00
18,790.00
11,000.00
8A90.962,47
8,379,179.79
111,782.68
50,252.94
6,684.06
67,313.22
10,928.85
other Checking,Sweep Investments
Cash-ll'R
Cash,Horace White
(710,$89.73)
1,313,177.32
1,935,407,87
230,077.02
CDlllr~"l Recelvable~Shol1. Term
4.1q2.i;l~I.I:iO
other Short Term Recelvabies
Inventory.Onelda
Inventory-Oswego
Inventory,Hili MediC31 Cenler
Prop~ld In~urance
1, 111.826.0~
(29,512.65)
17,913.38
(12,586.38)
(98,527.37)
... Gener~1
Prepaid Insurance
Prepaid, Other
To\al Current Assets
Long-Term Assets
Capll<ll - Furniture 8< Fixtures
Capital. Equipment
Cap;wl - Compular Eq'Jlpm"nt
Capital- Medical EqUipment
Leasehold Improvements
R0<l1 Propetiy
Other Assets
(17,O80.28}
(4,244.79)
17,S3S.n
21.'300,17
(3,166041)
138,461.02
145,874.51
211,206.60
182,331.33
(72,72:5.58)
(36,456.82)
97,740.00
75.927.50
21,612.50
(112,141.41)
456,861>.26
569,007.07
8,S47,828.73
8.946,187,46
(358!3)-
Accounts Payable
Other Current Llabili11es Payable
Nole, Payable
Accrued Pension Contribution
1.799.55R20
32,442.16
2.133.108.43
42,537.45
(:<1l~,;;50,?!\)
Accrued L1abllltY'-Dean's Tax
Other Accrued Liabill1ies
441,174.26
3.528.455.18
370,748.61
3,241.097.60
70,425.65
285,:',5768
Total CUrrent Liabilities
5,799,629.80
5,837,492.04
(37,862.241
(896.92)
5,00
(901.92)
5,798.732.88
5.B37 ,197.04
(38.764.16)
961.843.24
114,452.76
1,534,841.35
(44,02;;;.20)
(16.3,739.46)
400,486.52
(154,298.43)
(1,079,245.39)
531,171.54
1,382,260.71
436,056.80
2,040,888.63
(416,718.78)
152,680.64
63,596,27
2,040,888.83
(4\6,718.78)
152,680.64
83,596.27
(2,OB4,913.83)
252,979.32
247,785.88
(217.892.70)
3,149,095_85
3,110,690.42
38,405,43
8,947,828.73
8,943,187.46
(358.73)
Tolal Long Term Assets
Tolal Assets
Liabilities and Equity
Curren~
L1abH\\ies
(10,095.29)
Long Tenn liabilities
Other Liabilities-General
Total Liabilities
Equity
Fund Balani;e·MSG
Fund BaIance-RF
Fund Balance-IFR
fund l:lalance-Horace White
Undlstributsd fund &llanC!<..MSG
Undistributed Fund 8alance-RF
Undistributed Fund Balance'iFR
Undistributed Fund 8slenca-Horace White
T01," Equity
JotalU"bililies and EqUity
499,653.07
BFA Attachment A (cont.)
Department of Medicine
Divisional SI51tements by C omp~ny
Year to Date - December. 2010
Department of Medlclml
• Combined
1005
100B
1007
1008
1009
MSG
RF
RF·Sponsored
S\ale
State' Other
Total
Revenue
PaUent Care Revenue
Palient Care Revenue
Pallen! Refunds
patient {;sre
Kev~nue.
• contract
ColiecHon Agency
Total Patient Care Revenue
543.124,964.55
(121,182.00)
3.001,673.54 .
19.599.60
$016.025,055.99.
~O.OO
$0.00
0.00
0.00
0.00
SO.OO
$0.00
0.00
0.00
0.00
s6.00
$0.00
0.00
0.00
0.00
$0.00
0.00
0.00
0.00
$0.00
$7g,721,1i
$43,124,964.85
(121,162.00)
3,001.673.54
19.59MO
$46,025.055.99
Olher Revenue
$(:'.C'O
$'0.00
$0.00
0.00
0.00
0.00
0.00
0.00
O.OD
0.00
$O.OD
0.00
0.00
0.00
0.00
0.00
5,:196.586.13
0.00
$5.396.566.13
0.00
0.00
825,310.05
1,265,182.63
0.00
0.00
75,420.26
$8,155.912.66
$79,72~.31
75,420,28
$21,679,624,67
$54,072. 660.36
$0.00
S5,396.566.13
$8.155.912.86
$79.7<1.31
$67,704,880.66
$9,197.073.16
0.00
0.00
0.00
474,313.06
$9,671.366.16
$0.00
1.354,060.B9
0.00
0.00
0.00
$1.354,060.89
$0.00
0.00
567.852.42
0.00
0.00
3551,852.42
$0.00
0.00
0.00
8,351,803,60
0.00
$6.351.603,60
SO.OO
0.00
0.00
0.00
0.00
30.00
$9.197.073.iO
1,354,060.89
551.852.42
6,351.603.60
474,313.06
$17,934 ,903.07
SO.OO
~O.OO
$0.00
$903.578.93
$0.00
S903,57a.93
0,00
s,8oS,002,OO
0.00
0.00
0.00
O,j89,60Z ..53
0.00
0,00
1,046,421,79
13.96843
1,250,718.90
0.00
0.00
0.00
0.00
0.00
0,00
0.00
89,782,04
0.00
0,00
0.00
0,00
0,00
SO.OO
1.250,718.90
1.391,Z98.48
1.046,421.79
13,9S8,43
89,762.04
510,086.171,40
$0.00
0.00
000
$0.00
0,00
0.00
0.00
0.00
0.00
0.00
430,294.57
0,00
0.00
1698.74964
0,00
0.00
0.00
0.00
0,00
0.00
0.00
0.00
SO.DO
so 00
$1,511,808.58
519,495.94
216,455.01
2,OO~, I07.7B
479,431.38
480.294,57
242.374.40
0.00
Contract Revenue
Sale of SONiee Revenue
Slate Salary Offset
MlsCtlllaneous Revenue
Grant Revenue
Stale Funded Revenue
Total Olher Revenue
Tolel Revenue
$91,on.G5
474,313.06
7,523,540,92
825,310.05
7,255.182.53
48,278.05
$1,17/..';4
474.313.06
7,523,640.92
0,00
0,00
48,276,05
0.00
0.00
$8,047,604.37
li"l1 .... r",,.;.~ R""ll';'I"U~
VA Income
0.00
0,00
0.00
0,00
0.00
0,00
0,00
5,~9S,.586.13
E~ponses
MSG Physician Salartes
RF PhysiCian Salaries
Grarit Physician Salartes
State Physician Salarios
VA Phy~lclM Salariee
Tolel Physician Salaries
State Staff SalBde~
n.r otatt Otltf.lrles
0.00
1,391,898.48
0.00
0.00
'0.00
0.00
0.00
$(060~390.2i·____$6,640,52f73__ ·
f091.896A8
RF Staff Salmles - Conlfact
Gram Starr Salane.
MedBest Staff S"leries
Temporal)' BONIee-Cierlcal
State Slaff Salarl03 - IFR
Tolal Staff Salarias
MSG Physician Bencf1lg
RF Physician Bencf1ts
Grunl Physician Benefils
0,00
0.00
242,374,4()
0,00
S1754182.98
SO,OO
519,498.94
0.00
2.oe5, t 07, n
479,431,38
0.00
0,00
0.00
S3.084.096~11
Pullen! Care Relatod ~xp~n.cs
Taaelling Related Expense$
Re6e~rch R~latad Expense$
Grant Research Relate<l Expenses
$18,617.00
168,074.87
13.206.05
0.00
SO.OO
0,00
0.00
0,00
Ar...:wJ-tllil11".; E:rlllallr..;t;:Hlt::iH
146,730,83
a.au
0,00
0.00
0.00
000
0.00
0.00
0.00
General Services
508.888.68
288.725.36
548,731.57
85,281.24
1.633,412.12
1.929,666.21
126.530.17
314,403.72
4.156,820,46
362,797,31
Medic<ll Supplies
1 ~.J~(. n2.~B
~f
;:;V,.1f(
$1,511.808.58
0.00
0.00
Be~ 1t::111~
0.00
Rf Slafr Benonls - Conlroej
Gran! Stlllf Ben"!i!s
Medeasl Staff Benefits
Fringe 8enofilt-0ther
Talai Benefits
P3yrcll Related Expanses
Recruiting
M~lpracll"" Ins~r~nC<1
Travol & Entertainment
Assessmont
8ililng & ColleC1lon
legal & A<x;ounting
Physiclan Coverage
Contmclval SOlVleas
Office Supplies
Occuponcy EXjlenBe
Furniture/Equipment
Gr311t EqUipment
Of her Pr!<l('.1k...n ~""rp.r'l~A
Grsnl Indirect Expense
Other Mise Expense
81.937.01
1,162.874,44
254,813,03
0.00
37,38"1.03
.103,3"2S,03
Total Nan·?a~roJi Expenses
0.00
262,550.61
11.150,000,00
S 41,630.726.20
Total
~
Tran~(er to
Expl;lf1~e:s
Nellncome
Researet1 Faundattol1
b4.110,~~","O
$0.00
0.00
216,455.07
1,454,4D8,21
u.uu
0,00
0.00
0.00
0.00
DOD
0.00
0.00
0.00
0.00
0.00
0.00
0.00
O,OD
0.00'
38.855,00
0.00
1.208,822,38
0,00
0.00
2,750.085.5S
0.00
1.490.80
(11.363.881.22)
$ (10.894,939,27)
l(iO.739,46
80.00
0.00
84,956.15
0,00
u.uu
0.00
0.00
0.00
0,00
000
0,00
836.44
80.826.92.
0.00
76,441.20 .
309,00
64,005,78
0.00
103.008,28
SO,OO
0.00
0.00
a.OO
0,00
·t,628.27
0.00
56,474,25
0,00
0.00
0.00
·$593~~i30.97 -_.
$ 5,396.586. j 3
~ S ~~(j;I,O.26~~QLL..j163. 738.46\ $
•
·h~·
__
3
$0.00
0.00
0,00
0.00
81 M17.0D
168,074.37
98,162.20
1,454,408.21
118,790.83
508.9B3,68
288,726,36
548,731,57
65.291.24
U.uu
OM
0.00
0.00
0.00
Don
1,"33,412.12
0,00
0.00
0.00
0.00
0,00
000
0.00
13,533.00
1,929,868.21
127,366.61
395,330,64
4,156,820.46
446,888,76
18.357,4011.39
202,417,04
1,196.1.07.44
364.442.83
6,623,52
0.00
0.00
S8.~5S.00
0.00
0,00
0.00
4~O,G{j3.00
0.00
0.00
213.861.22
0,00
0,00
410,481.77
6 7,755,4016.34
S
$h5g,O?.Il.n
400,468,52
S
23~.O17.74
I ,206,B22.38
284,041.1.1
(0.00)
S 34,130.372,03
$
234,017.74
$ 67,666,475.23
U~54,298A31 $
3B,405.43
BFA ATTACHMENT B
Upstate Gastroenterology, LLC
Establish a FASC for Gastroenterology
Pro Forma Balance Sheet
Assets*
Cash
$175,090
New Leasehold Improvements/Other Assets
$??::',339
Existing EquipmenVOther Assets
Total Assets
$71,895
$469,324
Liabilities and Member Equity
Liabilities
Capital Loan
Working Capital Loan
Total Liabilities
$0
$0
$0
Member Equity
$469,324
Total Liabilities and Member Equity
$469,324
Note as a newly formed entity, the LLC currently has minimal assets and liabilities.
* Inclusive of the net depreciated value of eqUipment, leasehold improvement and other
a::;::;~ls 1Iial will bl:: l;ulllritJuleu by DOM lu Up::;lClte GClstroenterology, LLC through this
project.
BFA Attachment C
UPSTATE GASTROENTEROLOGY, LLC
ESTABLISHMENT OF FASC
ORGANIZADONAL CHART
Clinical Practice Management Plan
of the state University of New
York Upstate Medica! University
(Not-for-Profit Organization)
Department of Medicine, Medical Service Group
at SUNY Health Science Center at Syracuse, Inc.
(Not-for-Profit Organization)
Please refer to this attachment for
a list of Board Members and Officers
Upstate Gastroonterology, LLC
BFA ATTACHMENT D
ESTABLISHMENT CHECKLIST FOR AMBULATORY CARE SITES
APPLICATION:
Upstate Gastroenterology, LLC dlbla Upstate Gastroenterology at
the Philip G. Holtzapple Endoscopy Center,
NATURE OF APPLICATION:
_ _..:. . :X
PRIMARY CARE
SPECIALTY
IF SPECIALTY - TYPE:_eIHJoscor,JY
and colonoscopy services
NON PROFIT
PROPRIETARY
Limited Liability Company
PUBLIC
AUSPICE:
x
AFFILIATIONS:
YEAR ONE
UNIT COST:
YEAR THREE
OPERATING
CAPITAL
$386.57
$369.11
125.33
106.89
TOTAL
$511.90
$476.00
YEARS ONEand THREE
PAYOR SOURCE:
MEDICAID-FFS
MEDICAID-M/C
4.00%
6.00%
MEDICARE-FFS
35.00%
MEDICARE-M/C
COMMERCIAL-FFS
COMMERCIAL-M/C
PRIVATE PAY
CHARITY CARE
2.00%
15.00%
35.00%
1.00%
2.00%
Bridgeport
!/
~
"
1,[
Fabius
,i'
Tully
BFA AttachmentB
YORKVILLE ENDOSCOPY CENTER
AMBULATORY SURGERY CENTER
PRO FORMA BALANCE SHEET
ASSETS
Cash
Capitalized Project Costs
New Equipment
Existing (Donated) Equipment
$477,703
$1,096,019
TOTAL ASSETS
$1,885,736
$67,761
$244,264
LIABILITIES AND MEMBER EQUITY
LIABILITIES
Capital Loan (Renovation/New Equipment)
Working Capital Loan
TOTAL LIABILITIES
MEMBER EQUITY
TOTAL LIABILITIES AND
MEMBER EQUITY
$870,000
$238,851
$1,108,851
$776,885
$1,885,136
BFA Attachment C
ESTABLISHMENT CHECKLIST FOR AMBULATORY CARE SITE
APPLICATION: CON 111488 YORKVILLE ENDOSCOPY, INC.
NATURE OF APPLICATION:
AUSPICE:
AFFILIATIO!'JS:
PRIMARY CARE
SPECIALTY
Single-Specialty
Gastroenterology
xx
NON PROFIT
PROPRIETARY
PUBLIC
- Limited Liability Company
xx
None
YEAR ONE
UNIT COST:
OPERATING
CAPITAL
TOTAL
$ 413.92
$
$
$
$
48.52
462.44
YEAR ONE
PAYOR SOURCE:
MEDICAID-FFS
MEDICAID-Me
MEDICARE-FFS
MEDICARE-Me
COMMERCIAL-FFS
COMMERCIAL-MC
CHARITY
YEAR THREE
1.0%
1.6%
20.6%
3.4%
21.2%
50.2%
2.0%
$
399.97
72.69
472.66
'sociates .~._.
19 High Schoor'" - ..
--t/5
>,
'"
(9
New York State Department of Health
Public Health and Health Planning Council
November/December 2011
ATTACHMENTS
Dialysis Services - Establish/Construct
Number
Applicant/Facility
1.
111504 B
Mills Pond Dialysis Center, LLC
(Suffolk County)
2.
111475 B
USRC Lake Plains, Inc.
(Orleans County)
Exhibit #7
BFA Attachment B
MILLS POND DIALYSIS CENTER, lLC
PRO FORMA BALANCE SHEET
ASSETS
Cash
$490,132
TOTAL ASSETS
$490,132
LIABILITIES AND MEMBERS EQUITY
Working Capital Loan
$245,066
Total Liabilities
$245,066
Members Equity
$245,066
TOTAL LIABILITIES AND MEBERS FOUITY
$490,132
BFA Attachment C
Financial Summary
Barnwell Nursing and Rehabilitation Center, LLC
FISCAL PERIOD ENDED
ASSETS - CURRENT
ASSETS - FIXED AND OTHER
LIABILITIES - CURRENT
LIABILITIES - LONG-TERM
EQUITY
12/31/2010
12/31/2009
$7,240,808
2,672,178
7,693,160
744,071
$1,475,845
$3,405,181
2,278,508
3,366,667
810,519
$1,596,503
12/31/2008
$3,666,042
2,413,474
3,095,551
1,572,962
$1,411,003
$18,301,953 $19,226,278 $19,779,610
18,014,898
18,840,7'78
19,321,089
$287,055
$458,521
$385,500
INCOMF
EXPENSE
NET INCOME
DEPRECIATION
NUMBER OF BEDS
PERCENT OF OCCUPANCY (DAYS)
PERCENT OCCUPANCY
MEDICAID
MEDICARE
PRIVATEfOTHER
236
92.31%
236
93.91%
236
95.2%
70.26%
14.07%
15.67%
66,25%
12.28%
21.47%
67.1%
17.6%
15.3%
(DAY~):
tlt-A Attachment LJ
Financial Summary
Carillon Nursing and Rehabilitation Center, LLC
FISCAL PERIOD ENDED
12/3112010
12/31/2009
ASSETS - FIXED AND OTHER
LIABILITIES - CURRENT
LIABILITIES - LONG-TERM
EQUITY
$9,601,293
6,018,851
4,138,565
9,240.496
$2,241,083
$9,605,606
5,791,883
8,427,899
5.072.099
$1,897,491
$8,385,294
5,821,531
7,576,250
5.467.691
$1,162,884
INCOME
EXPENSE
NET INCOME
$35,946,127
35,530,885
$415,242
$37,132,771
36,060,867
$1,071,904
$36,566,492
36,041,341
$525,151
315
95.91 %
315
96.56%
315
96.3%
69.01 %
21.08%
68,05%
23.91%
68.1%
21.4%
9.91%
8.05%
10.5%
ASSETS - CURRENT
12/31/2008
DEPRECIATION
NUMBER OF BEDS
PERCENT OF OCCUPANCY (DAYS)
PERCENT OCCUPANCY (DAYS):
MEDICAID
MEDICARE
PRIVATE/OTHER
BFA Attachment E
Financial Summary
East Neck Nursing and Rehabilitation Center, LLC
FISCAL PERIOD ENDED
12/31/2010
ASSETS - CURRENT
12/31/2009
12/31/2008
ASSETS - FIXED AND OTHER
LIABILITIES - CURRENT
LIABILITIES - LONG-TERM
EQUITY
$10,373,507 $11,216,518
10,159,162
10,228,974
6,362,091
7,430,519
9,666,617
1O,O!'iP.,~04
$4,503,961
$3,956,669
INCOME
EXPENSE
NET INCOME
$35,732.173
35,184.88'1
$547,292
$35,845,777
34,552,120
$1,293,657
$36,448,330
36,511,915
($123,585)
300
93.97%
300
95.66%
300
96.4%
67.16%
25.86%
6.90%
67.90%
25.93%
6.17%
69.5%
25.4%
5.1 n/Q
$7,8'18,201
10,238,920
4,666,480
10,7Fi7,6?9
$2,663,012
DEPRECIATION
NUMBER OF BEDS
PERCENT OF OCCUPANCY (DAYS)
PERCENT OCCUPANCY (DAYS):
MEDICAID
MEDICARE
PRIVATC/OTIICR
BFA Attachment F
ESTABLISHMENT CHECKLIST FOR AMBULATORY CARE SITES
APPLICATION:
Mills Pond Dialysis Center, LLC,
NATURE OF APPLICATION:
x
PRIMARY CARE
SPECIALTY
IF SPECIALTY - TYPE:
end stage renal disease
dialysis service
AUSPICE:
NON PROFIT
PROPRIETARY
Limited Liability Company
PUBLIC
x
AFFILIATIONS:
UNIT COST:
YEAR ONE
OPERATING
CAPITAL
TOTAL
PAYOR SOURCE:
MEDICAID
MEDICARE
CO MM ERCIALIOTH ER
$252.92
107.73
$360.05
YEAR THREE
$204.63
44.42
$249.05
YEAR ONE
YEAR THREE
76.48%
11.76%
11.76%
77.56%
11.22%
11.22%
eroject number 111504
Belle
Old Field
+
Terre
Asharoken
Crab Meadow
.loyd
lartor
+
Fort Salonga
/c.~
n
V
,\
+
.
-tHuntlngton M~thadone
W~odbury
y.'
))
il
Ii
Coniinack
!!
Huntingt~w
Centereach
.... ' ~Opti-Healthcare
~
...
It
~'."
~orth Shore Surgi-Center Nesconset
' .
_.......,.._.-::_~~~"
~~\~~.=~/+ ~
Selden
P.8int
East
Shoreham
Wading
River
Cal\'erton
Ridge
Middle Island
+Gordon
Heights
Lake Grove
~
East Hauppauge
/}'F;milY Re~1~nces & Essential EnteDrises.
J'
(::.:c ::::::::3:;'::::"::::'~~~
South
CDram
+
'j\cd'
It
Carillon Dialysis LLC
:olc Spring
i G e'" I
..... ~ re n awn
Harbor
- ~
Huntington Artificial Kidney Center Ltd
Sinai
(( Kings Park
the Harbor
//
San Remo
/(
East
tJorthport
Rocky
TerryVille
oIstonybroe,k Dia Iys is Clinic
H d f
ea a
/--:;.J
. //'
..........
Hollow
Shoreham
FMS-Centra I Suffolk Artificial Kidney Center
Digestive Health Center of Huntington, Inc
Halesite
MOUlt
Setauket
Baiting
'Nading River
Landing
SJund
E.each
+
Upton
......~: .. '
.'<:'-" _ c~~
";:'M~norville
•. '
//~Suffolk Surgery Center, LLC
)'aphark
Huntington Artificial Kidney Centsr::::':>"
Farmingville
J
'J'
Ea5tpo
Re
".j::::::::~:::::::::::"'C;z:r:1idford';C::::-~:::'~·
"Ii
:::,.-;;::::::""l!.
, / .
.
. .,
..L
_=cc-:=-'-:';c~~-'--'
Holtsville
.;/
.
~Opli-Healt~car
Ultimate !,!ealth_~utcomes ~ Cllmc Islanola R o n k o n k o m a '
_ ,.-<' M:o<chr
r~~b_"" "iches
_~'.;.r/
Dlx·tlllls·--'-' T,\ ~.........
H lb
k
/;::,'---l!MSheliabargerSoBroo~ha1/enFHC
-~. , i;~L...,/~
.-<,
I I
Suffolk Kidney Center
0 roo
.' ,'"
Shirley
Monches
• .....-:.::',"
.--'
.-0;:::;"""''''/ Phoenix HOLses?f Long Island
.
... _".~..>'>'
..", ~'"
M I 'II"C"::::::::"
j!
Central
North
./:;;:::;>>!ISoces IlIBrookhaven Tech Cent..r
West tOld Mastic
/leVI
-:::::J__e vi e
ii Brenl[wlBre~twood Family Health Center
~ Pai:chogu~':'
Brookhaver
Half Ho!low
East
Dl
otIM.. lville Surgery Center
" Pine Aire
Bohemia
~.,.:-;:~:c.:~::.,~
"patchogue
Mastic
Old Beth~age
H ' ht' Deer Park
,!
.
/~ --'
Beach
. ~Ig • S .
;i
. ",,;:;;::.::::=c::::::::::r~Trp.
./;:-::'C5'C /'
Bell ort
je
Martin Luther Kmg Jr Comm H..alth ~,~nt!r.'::Y
'., <~~::'::.:.:::..=:>""
Ban,ort
p
II
_._~T£.rra\~
Blue Point
'I
~4'
,_<;::::::'::;;:>---~
.\
Oakdale
Sayville
,x'(j I
-,_...,'
North,,,,:",-;:>,.
--.."
Td,n
.,
FarmIlJ9., a e
/-:,~".", .~~.-'- --' Jl.--:::~-"Shor1South Shore Surgery Center
West Sayvill2
F'rogressiveSurgery Cerler, LLC Eabylo[1
,:;;,""
y
cast lSllp,\
.
L
.~;:. '.!~.J.L.Y'"
';::::~
J:7i\c",
i/
.-0'/
..
+ ..".""
.. "
,--"t"
ined e
9
*'
+/
r;;:;:""'_,J
bl~i~hh.. ~ters
_,---;::/
~Long Island ~fdical ~~sociates
/, .
L, ,Great:Rlver
Fire
::ComprehenSh/€ Care Management Diagnostic and Treatment Center
.
Island
Baby;~n ~\y\
\
Long Island Renal C a r e ,
\\
\\
pequC\!, Amityville
Amity H'arbor
Harbor Greel
V
\\:
GilgotOak
Ocean
Beach-Qaptree
Oak B~aCh
\\
\~
,e
Saltaire
Beach
BFA Attachment
1$
U.S. RENAL CARE, INC. AND SUBSIDIARIES
Cansol idated Balance Sheets
Decem bel' 3 I, 20 10 and 2009
Assets
2fllO
Cash and cash equivalents
Accounts receivable, net ofallowdnces of$13,458,494 and $8,460,232
Inventories
Other receiviJhk~
Deferred tax asset
Other current assets
9,537,]07
48,449,631
3,100,193
Y,Y94,938
6,215,457
2,636,244
2009
15,325,357
25,900,874
1,369,198
4,863,513
904,600
1,429,165
49,792,707
Total current assets
Property and equipment, net
Amortizable intangibles, net
Trade names
46,781,941
27,349,714
859,000
190,524,762
470,902
217,670
67,922,354
238,961
906,459
345,919,889
150,570,762
9,()45,119
24,248,618
2,924,662
125,000
),6'75,616
16,485,807
1,447,595
125,000
36,3'13,399
23,734,018
181,723,922
62,010,592
125,000
532,982
[nvcDtmcnl in affiliate
Goodwill
Other long-term assets
Deferred taxes
TotaJ assets
19,251,600
12,241,011
Liabilities and Equity
Accounts payable
Accrued expenses
Current portion of long-term debt and capital lease obi igations
Current portion of related-rarty notes payable
Total currcn1 liabilities
Long-term debt and capi LaJ lease obligations, ne:t of current ponion
Related-party n()tc~; payahle
Other long-v'I"m li"bilitics
Deferred tax liability
Preferred stock accrued di vidends
440,844
9,480,942
19,83 I ,208
14,736,426
101,139,0]8
Total liabilities
Commitments and contingencies
U.S. Rena! Care, Inc. equity:
PrelCrrcd stock A ($0.0 J Dar value. Authorized shnrr's j0,325,OOO;
issued and outstanding 12,350,000 and 12,350,000 shares)
Prderrcd stock Band B-] ($0.0 1 rOll' vulue. Authorized share:;
1,600,000; issued and outstanding 1,431 ,6G6 and 1,415,666 shares)
Preferred stock C ($0.0 I 11<11' value, AIIthnr;·/"r1 sh:Jr'~s 25,000,000;
issued and outstanding 24,500,962 and 24,500,962 shares)
Preferred stock D ($0.01 par value. Authorized shares 8,333,333;
issued and olltstanding 8,333,333 and shares)
Common stock ($0.01 par vnhli'. Authori7.,~d shares 53,525,000 und
52,525,000; issued and outstanding 7,074,324 and 7,074,324 shares)
Additional paid-in capital
Retained earnings
70,744
38,667,4 71
5,29lJ20
62,229
36,454,222
1,49 7 ,694
fotal U.S. Kenai Care, Inc. stockholders' equity
44,495,695
38,396,8] 2
°
Nonconlroll ing interests (incl udi Ilf', redecm,lble i ntcl"ests
values of S'lU,999,,128 and S23,600'()()O)
Total equity
TowlliabililiGs ullci ,quit)'
123,500
123,500
14,317
14,157
245,010
245,010
83,3 33
With n:dcrnptiol1
11,034,932
98,OlJ9,574
49,-131,744
345,919,81\9
150,570,762
BFA Attachment B (cont.)
U.S. RENAL CARE, INC. AND SUBSIDIARIES
Consolidated Statements of Operations
Years ended December 31, 2010 and 2009
Net operating revenues
$
Opcmtillg expenses:
Patient care costs
General and administrative
Provision for rl()I1btful accounts
Legal cost/settlement
Transaction costs
Depreciation and amortization
Total operating expenses
Operating income
Interest expense, net
Income before income taxes
income tax provision (benefit)
Net income
Less net income auri butable to noncontrollmg interests
Net income attributable to U.S. Renal Care, Inc.
$
2010
2009
237,606,328
153,164,637
154,284,195
20,207,561
6,898,682
(352,334)
9,076,731
14,655,411
98,842,829
15,601,927
4,585,251
286,647
460,465
,_.~J,~~,=~
204,770,246
127,734,420
32,836,082
25,430,217
10,192,698
2,923,456
22,643,384
22,506,761
5,826,130
(3,191,190)
16,817,254
25,697,951
13,023,628
10,103,151
3,793,626
15,594,800
Consolidated USRC
Balance Sheet Summary
Jun 2010
Sep 2010
Dec 2010
Mar 2011
_May 2011
Jun 2011
Assets
Current Assets
Cash
IVR, Net
Other Receivables
Inventory
Other Current Assets
22,653,752
41,463,433
E,340,719
4,336,702
E,112,947
11,636,942
50,216,933
6,526,585
3,099,105
4,W8,064
9,537,108
48,449,633
9,994,941
3,1(0,193
5,312,500
6,638,699
55,655,201
8,794,592
2,992,704
6,627,908
5,789,521
66,544,402
9,663,585
2,222,097
6,515,723
9,521,403
57,432,793
8,726,9::8
2,972,81'7
6,368,6::0
Total CLrrent Assets
79,907,553
76,387,629
76,394,373
80,709,104
90,735,328
85,022,652
PPB.E, Nel
Goodwill aild Other Intangibles, iJel
Other Assets
37,660,797
i 81 ,259,580
1,270,676
41,204,885
i 82,700,762
1.425,043
46,781,942
218,733,295
668,761
47,060,693
217,242556
786,802
45,942,708
218,673,268
754,E04
45,770,861
217,530,561
755,994
300,098,606
301,718,319
342,57B,371
34§29915§
11 659,474
13872,201
6493,236
3,106,095
7,606,037
23,920,456
7,648,767
3,058,840
9,045,119
18,91),923
7,90,923
2,572,188
3,522,367
21,124,258
8,385,948
2,939,079
Total Assets
__
356,105,1:08
_
349,080,068
Liabilities
Current Liabilities
Accounls Payable
Other A~crued Expenses
Accruec Payroll
Curren! Portion of Long Term Cebl
OHler CHren! Liabilities
Other GJrTent Liabilities
7,710,344
20,607,520
10,024,716
2,589,023
7,418,012
16,566,873
8,490,725
2,553,464
td
!oj
it>
iJ>
rt
rt
I\)
399,505
16,168
(3,523,033)
(3,526,430)
(3,523,033)
(3,521,948)
35,530,511
42,250,267
34,925,119
32,445,222
37,408,570
31,507,125
2,187,294
40,)00,000
131,192,937
9)00,000
2,261,498
2,010,086
40,410,5 4 9
130,188,715
7,000,000
9,678,621
3,914,195
40,612,901
129,835,182
7,000,000
9,678,621
37
0
438,328
415,294
3,438,090
40,672,901
129,835,182
7,000,000
9,678,621
0
821,783
4,022,22 L
484,397
1,933,115
40,204,751
130,525,129
9,000,000
2,261,498
285
461,156
"00,000,000
213,660,182
1,500,00e
9,6 7 8,621
(1)
923,091
185,126,126
184,385,934
189,726,336
191,456, '93
191,446,577
329,784,117
220,656,637
226,636,201
224,651,456
223,901,415
228,855,147
361,291,24::
466,160
63,999
63,048,595
15,886,677
(L26,424)
L02,961
4E6,160
64,667
53,315,894
16,821,551
(426,424)
4,840,271
46E,160
70,743
58,925.379
53,603,967
(426,424)
5,287,090
466,160
71,101
58,943,104
54,045,604
(426,424)
8,797.s95
466,9E3
71,286
58,730,186
56,529,564
(426,424)
11,879,085
469,910
76,224
(78,891,7551
57,293,727
(426,424,
9,267,143
79,441,968
75,082,118
117,926,915
121,897,741
127,250,661
(12,211,1751
300,098,606
301,718,319
342,578371
~45,799,156
3;>§,1()5,808
3 49,080,068
(l
;:r
S
(j)
Total Current Liabioities
Long Term liabilities
Capital Leases
Mezzdni18 Debt
Long To,m Debt - Term
Long TellTl Deb1 - LOC
Oefemcd Tax Liability
InlCicomp"ny Payable
OU'ier LT liabilities
Tot,,1 Long Term Liabi.ities
Total Liabilities
Equity
Total Preferrecl Stock
Common ,slack
Additional Paid in Capital
Minority Intarest
01rier Eauily
Retai:led Earnings
Equity
Total Liabilities & Equity
~
rt
(')
°
Consolidated US Renal Care, Inc.
Quarterly Income Statement
June 30, 2011
01'11
QJ'11
02'1\
Budget
Total Trectmel1ts
Net
R~vellue
-
Variance
V.an ance 0/0:.
YTD
YTD
Variance
Variance %
Budget
202M3
212,265
213327
(1,062)
(O,5%}
415,108
419,221
(4,113)
CI.O%)
73,232,,47
77,125,J31
78,313568
(1,188537)
(1.5%)
150,357,578
152,042,100
(1,684,522)
(1.1%)
18,578,:)81
4,333,992
12,018.660
1,725.115
18.7i.OJ23
19,J.37XiO
37,238,204
4,325,004
721,147
(209.586)
1,074,047
(16,1>\1)
[3.7'"-f~}
4,534,590
12,224)27
1772,104
2. 72~.?95
2,190,090
0
649,576
(376.177)
1.891.095
(4A%)
(225.370)
(198,281)
Facility Expenses
Lobor 8penses
MediCc=J StlppJies
Mmj:c~/jO'rS
r,.',ed\c..-=::r CirecLC'r fees
Rent
Bod DGbt E"<pe:nse
Man2gement Fee
OUEH i~~p.;n.::.<).s.
Totol Filcifity Expenses
Facili'Y EEITDA
As
<J
Percent of Revenue
Corporate Exponses
COT' L:~bor E..'j:lI=nses
C:Jrp
01he(E.;;r::~nses
Toted Corporate Expenses
As a Percent of Revenue
Corporale EBITDA
As a Per-cent of Revenue
2,273,~24
2,137.321
13,29S,074
1.75626-3
2,4-;7374
2,1275-:4
3,"'97,519
(306.421)
0.9%
12.70/,
37,937,780
8,492.405
26.133,762
3,469,355
'Ur98,119
4,772,748
(63176)
3.0%
4,328,011
4.129,730
0
14.1;47,084
0
173.138
0.0%
14:320.222
97,6:0,206
99,576,023
1,!05,817
1.9%
52.687,372
15.0%
52,466,077
34,5%
221,295
0.4%
6,522
219,620
;;26,142
0,10/(\
4.8%
1.8'%,
447,437
1.1%
4.8%
3,858,582
:8.1%)
2~.142.6B7
0
7,321,019
0
a.aGio-
7,225,:S9S
97,624
49,331,£24
50,635,)18
1,303,494
11.3%)
(2.6%)
24,943,865
34.1%
27,743,'07
27,528,550
35Y/,
114,957
0.4%
~. 163.354
3,909,179
4.191}6<~
8.072,533
2.469.·:65
-2.1%
4.3~9,335
5,043,2:4
6,378,644
2,203,;12
6,395:75
282,585
(266)53)
16,532
(o.7%J
t879,870
(0,3%)
1.3%
12,421,868
8.3%1
8,Q79.055
4,:,68.955
12,648,010
B.3(1/co
'O.6 Q/o
40,265,504
39,8'8,067
8.27~,698
7,517.501
9,97<,635
0
/221,099
48,283,632
36.0%.
8.3%
8.2%
8 Z'%.
18,900,6~1
21,364,833
27.7%
21,233,:74
27.1%
3.778,756
5,173,095
17<3~\>
4,274,553
9.846.083
177,834
1.908,033
4,376,454
20,582,967
26.7",
5.3S1 52J
781,886
1,010
7,814,844
10.0%
17,032,,48)
8.0°;"
2.340,60~
312,701
3,125,939
2,813,173
25.8%
c
131,489
0
18 ,164)
1,7%
7.2%
(0.2%)
(4,7%)
(48%)
12%
Non·Opera:ing Expense,
Interest E.mense
Deprcr:!aliQIl & Arnorlizaoor:
IG8ir.)loss en Sale of ASlets
Transactio, and Settlement Costs
Mir.orily
l/l~E;rest
Expense
TDt,d Nan-Os::erating Expenses
As a Perc,"! of Revenue
Nelln-co/i1c EMors Income Taxes
As a Percent of Revenue
4,000.140
4,601,170
45,015
400,686
4.002,110
13,049,121
j
4A66,e79
13,418,oJO
(495,002)
(4.672,S88)
(177,834)
(1,908.038)
(13,1%)
(903%)
90,225
2.0%
(7.1&4,"37)
(53.4%)
17.·%
1900%l
14,447,253
222.849
2,308,724
8,378,564
33,,32,088
',10.1%)
144.8%)
td
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;p.
rt
rt
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~
S
(1)
8,318,461
25,811,597
22.4%
17,0%
6,.,33,416
131996,470
:::l
rt
(7,363,O54-)
(52.6%1
(")
~
()
Income Tilxes
Net lncom-e
As a Pe rc:e-ot of Rev8 nuS"
Net
ReV-tHWe
3,510,915
469,1~5
4,688,9-)5
4.8%
0.6:;
6.0%
$361.0J
$363.34
$367.'1
14,219.770)
90.0%
(90,0%)
2.05],366
515~8,S87
2,9<5,221
(4,417,833)
3,9B'),050
8,3-£7,883
2,6%
5.5%
1$3.76)
$362.21
$3.2.58
(SO.46)
(V7)
1,09
1933
~J_50
:136
20.26
'234
0,67
(1.11)
3,94
(0.66)
(0.58)
0,00
0.07
$2,24
facility Expenses
L80cr E;qJe'l~e
Meoic;;al Suppiies
M,;,.:.Ji:ativ,lS
Rent
91.5-::
88 15
~1. ~J
21.37
21.3-5
2017
59.25
57.5~
62:>4
11.;3
c
0.00
00)
35,60
$238.06
34.04
34.:3
Total Facility Expenses
$232.64
$237.59
(4.:5)
l.se
0.35
0.:0
(0.:8!
($4.95)
Facility EBITDA
$122.97
$130.70
$129.51
$1.19
18.4;
11K
$30.0,
19,55
(123)
1;.45
10.33
$29.9~
1.J1
$0.07
1').':8
Totaf Corporate Expenses
2D,53
527
$29.7S
$29.92
19.27
1000
$3'J.17
:018)
0.42
SO,25
Corporate E61TDA
$93,18
$100.65
$99.53
$1.12
$97.00
$94.98
l2,O2
B:;3d Debt Expense
M:.1f1,agemen.t Fee
Oth ~r b:per.':8
Corporate E)penses
laoor Ex>::ense
O(i1:c:' F...xpens=
11.2';
128:\
~0.54
10.32
9.S7
om
~.g"O
0.00
:>1,80
$235.29
11.3-8
9.85
000
3487
$237.53
$12&.92
$125.15
51.77
12.O-d
10A3
52.6%
52.6%)
0
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tHA Attachment D
ORLEANS COMMUNITY HEALTH
Assets
Current assets:
Cash and casb eguivalents
$
205)488
$
95,844
590,708
584,890
4,180,798
3S7,473
3,110,075
533,086
483,806
55,382
5,922,935
50,366
4,366,469
Property and equipment, net
5,116,710
5,915,841
Net ilsset" of the ['oundallvlj
1,882,895
1,792,132
.A.ssets limited as to use
934,088
924,988
Other assets
265,911
303,898
$ 14,122,539
$ 13,308,328
1,992,868
$ .1,821,804
Sbort-term investments
.t\ccoun ts receivable, net of es tlmated uncollectibles
of $1,060,000 and $1,053,000
Other receivables
Supplies
Prepaid expenses and other
41,1 g8
Liabilities and Net Assets
Current liabilities:
Sburl-lerm borrowings
$
Current portion of long-term debt
1,073,556
394,416
Accounts payable and accrued expenses
Accrued payroll and bcnefits
Payable to Orchard Manor, Inc.
3,196,711
1,132,236
2,01 ?, ,:\g3
864
864
Estimated third-party payor scttlernents
37,668
669,539
7,733,903
6,804,843
Long-term debt
S()R,434
1,721,539
Other liabilities
153,701
186,055
3,763,606
1,902,895
5,666,501
2,783,759
"j ,812,132
4,595,891
$ 14,122,539
,$ 13,308,328
1,005,837
Net assets:
Unrestricted
Temporarily resu'lcted
l:H'A Attachment
j)
(cont.)
ORLEANS COl1lvfUNITY HEALTH
.. _... _ ... ~ FUL Lbe
2010
years ended December. 3], .
.2009·
... ' . "
Unrestricted revenue:
Net patient service revenue
$ 32,600,289
Other revenue
Total revenue
$
co.-
29,566,284
516,108
33,116,397
383,909
29,950,193
16,808,311
15,355,200
Expenses:
Salaries and wages
Employee benefits
3,529,778
3,076,622
Supplies
4,344,264
4,279,512
Professional fees
Other
3,783,764
4,248,J62
1,934,848
1,948,087
Depreciation
Interes I·
Provision for bad debts
Total expenses before nonrecurring items
1,058,576
141,812
1,088,565
141,947
788,588
805,791
32,389,944
30,944,286
-----"----'---
Income (loss) fn?£D operations before nomecurring items
726,453
169,781
Nonrecurring expenses
Income (loss) from operations
Other
(994,093)
556,672
(994/)93)
H1CQ1UC:
Investment income
Other, net
Total other income, net
Excess (deficiency) of revenue over expenses
Net assets released from restrictions
Government grants for property and equipment
Change in unrestricted net assets
$
14,918
6,233
11)r.,?()7
122,180
121,185
128,413
677,857
(p'(,~ /;8n)
13,785
288,205
301,919
979,847
77,941
$
(485,820)
BFA Attachment E
Orleans Community Health
Balance Sheet
September 30,2011
Assets
Current Assets:
Cash and Cash Equivalents
Investments
Accounts Receivable, Net
Other receivable
Due from Medina Health Care Foundation, Inc,
Inventories
Prepaid expenses and other assets
Total current assets
$
$
$
$
$
August 31, 2011
401,189
595,191
4,377,891
$
$
$
725,828
595,868
4,261,698
540,648
$
10,895
Difference
(324,636)
(680)
116,194
02,90J
$
$
$
:Ii
4,549
500,622
148,278
$
$
$
6,346
(11,467)
(4,230)
289,274
457,746
December 31,2010
$
Line #
1
$
$
205,488
590,708
4,180,798
$
3:.JS,!:J ('3
$
$
$
533,086
53,882
6
$
5,922,930
8
2
3
4
5
$
489,155
$
144,048
$
$
$
$
6559,018
$
6)310 1 746
:j:
$
$
$
921,099
$
914,088
9
(1,060)
$
$
20,000
934,088
10
$
$
$
$
:»
$
922,158
20,000
942,159
(1,OGO)
20,000
941,099
Deposits From Residents
$
25,1143
$
25,733
$
i 10
$
24,489
12
Land, bUildings, and eqUipment, net
$
5,140,978
$
4,809,697
$
331,281
$
5,116,710
13
Beneficial Interest in Medina Foundation
$
1,882,895
$
1882,895
'];
$
1 882,895
14
Other assets
$
244,053
$
243,823
9)
230
$
241,422
15
Total assets
$
14,793.885
$
14.??4,rl5?
'];
569,833
$
14,122,530
16
Liabilities and net assets
Current liabilities:
, Accounts payable and accrued expenses
Accrued compensation and payroll taxes
Due to Orchard Manor, Inc.
Bank Line of Credit
Margin Loan
Due to third-party payors
Current portion of long-term debt
Total current liabilities
$
$
$
$
$
$
$
$
3,085.753
1,505,232
552,367
$
3,163,646
1,422,364
550,818
$
(77,892)
$
$
82,868
1,548
$
$
$
$
$
$
$
3,496,711
1,132,063
538,155
536,000
010,577
37.841
1,073,556
7,733,904
Long-term debt, leSS current portion
Assets limited as to use:
For replacement of building and equipment·
funded depreciation
Temporarily restricted equipmont fund
1
7
11
17
18
19
912.708
707,854
416,715
7,180,630
$
$
$
$
$
$
$
911,?47
676,068
423,026
7,149,169
$
$
$
$
(539)
31,785
(6,310)
31,462
$
960,850
$
994,442
$
(33,592)
$
568,434
25
Deposits From Residents
Other liabilities
$
$
25,843
139,817
$
$
25,733
138701
$
110
$
1,116
$
24,489
129,212
26
'1>
Total liabilities
$
8,307,139
$
8,308,044
$
$
8,456,039
28
$
$
$
$
570,740
3)
3,672, 167
1,994,334
5,666501
30
$
3,921,673
1,994,334
5,916007
$
$
4,492,412
1,994,334
6,486,746
CD
14,793,885
$
14,224,052
$
559,834
$
14,122,539
32
Net assets:
UI Ht:;slricled
'Temporanly restricted
Total net assets
Total liabilities and net a""t:b
$
$
$
$
$
(904)
570,740
$
20
21
22
23
24
27
29
31
BFA Attachment E (cont.)
Orleans Community Health
Statement of Operations and Changes in Net Assets
YTD September 30, 2011 and 2010
BFA Attachment F
USRC Lake Plains - Medina Inc.
U.S. Renal Care Lake Plains - Medina Dialysis
Pro Forma Beginning Balance Sheet
Year 1
Assets
Cash
Accounts Receivable - patients
Allowance for Doubtful Accounts
AIR, net
Inventory
Other current assets
Total current assets
PP&E
Tpss
~("Cllmulated depreciation
P&E, net
Goodwill and Other Intangibles, net
Other assets
Total assets
Liabilities & Stockholder's Equity
Accounts payable
Other accrued expenses
Total Current liabiliLks
Capital leases
Bank debt
Long term debt
Total long term liabilities
Stockholder's Equity
Common stock
Retained Earnings
Stockholder's equity
Total liabilities & Stockholder's equity
305,204
o
o
o
41,310
o
346,514
426,741
(321,637)
105,104
585,424
o
1,037,042
o
o
o
13,265
o
1 ()4)O~?
177,297
859,745
o
859,745
1,037,042
BFA Attachment G
USRC Lake Plains - Batavia, Inc.
U. S. Renal Care Lake Plains - Batavia Dialysis
Pro Forma Beginning Balance Sheet
Year 1
,
Assets
Cash
Accounts Receivable - patients
Allowance for Doubtful Accounts
AIR, net
Inventory
Other current assets
Total current assets
PP&E
Less accumulated depreciation
P&E, net
Goodwill and Other Intangibles, net
Other assets
Total assets
Liabilities & Stockholder's Equity
Accounts payable
Other accrued expenses
Tutal Currt:nt liabilities
Capital leases
Bank debt
Long term debt
Total long term liabilities
Stockholder's Equity
Common stock
Retained Earnings
Stockholder's equity
Totalliabilitit:s & StudJlUhler's t:yuity
537,568
o
o
o
87,210
o
624,778
900,897
(679,012)
221,886
1,235,894
o
2,082,558
o
o
o
28,003
o
292,914
320,917
1,761,641
o
1,761,641
2,082,558
Shehalyar S. Khokar, MO
I ,
\
Ala Dahan, MD
OJ
I-Ij
;.t>
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rt
rt
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(")
fIIedica/ Director Agre9ment
Ill(
I Administrative Services Agreement
""
S
rt>
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;::::
* A New York State not-far-profit 501 (c)(3) corporation
BFA Attachment I
BFA Attachment
ESTABLISHMENT CHECKLIST FOR AMBULATORY CARE SITES
APPLICATION: USRC Lake Plains, Inc. - 111475
NATURE OF APPLICATION:
PRIMARY CARE
X
SPECIALTY:
Dialysis
AUSPICE:
NON PROFIT
PROPRIETARY
PUBLIC
-L
UNIT COST:
Medina
YEAR ONE
$293.08
10.86
$303.94
$291.93
12.09
$304.02
OPERATING
CAPITAL
TOTAL
Batavia
YEAR THREE
YEAR ONE
OPERATING
CAPITAL
TOTAL
YEAR THREE
$20396
$266.29
11.05
$275.01
10.53
$276.82
PAYOR SOURCE:
Medina
COMMERCJAL-FFS
COMMERCIAL MIC
MEDICARE-FFS
MEDICARE-M/C
CHARITY/BAU DEBT
YEAR ONE
1.2%
70.9%
21.6%
2.5%
YEAR THREE
2.9%
4.3%
68.9%
21.0
2.9%
Batavia
COMMERCIAL-FFS
COMMERCIAL M/C
MEDICARE-FFS
MEDICARE-M/C
YEAR ONE
1.1%
YEAR THREE
2.9%
3.8%
4.6%
56.4%
26.9%
53.6%
26.7%
MEDICAID -FFS
1.2%
1.3%
CHARITY/BAD DEBT
OTHER
2.6%
8.0%
2.9%
8.0%
3.8%
New York State Department of Health
Public Health and Health Planning Council
November/December 2011
ATTACHMENTS
Residential Health Care Facilities - Establish/Construct
1.
Exhibit #8
Number
Applicant/Facility
111540 E
Fulton Operations Associates, LLC d/b/a Fulton Center for
Rehabilitation and Healthcare
(Fulton County)
Financial Summary
BFA Attachment B
Fulton County Residential Health Care Facility
FISCAL PERIOD ENDED
2009
2010
ASSETS - CURRENT
ASSETS· FIXED AND OTHER
LIABILITIES - CURRENT
LIABILITIES - LONG-TERM
EQUITY
INCOME
EXPENSE
NET INCOME
DEPRECIATION
NUMBER OF BEDS
2008
$7,832,828
9,874,742
7,509,884
8.063,432
$2,134,254
$9,029,451
1,927,737
3,129,854
4,982,813
$2,844,521
$9,706,836
2,093,418
2,295,539
2,976,236
$6,528,479
$11,919,388
$12,029,794
$11,741,771
16,965,901
16,561,212
15,171,665
($5,046,519)
($4,531,418)
($3,429,894)
$334,37~
176
$329,196
176
$301,085
176
PERCENT OF OCCUPANCY (DAYS)
91.98%
96.66%
97.53%
PERCENT OCCUPANCY (DAYS):
MEDICAID
MEDICARE
PRIVATE/OTHER
81.38%
6.96%
11.67%
82.09%
6.47%
11.44%
78.71%
5.55%
15.74%
MEDICAID RATE BREAKDOWN:
OPERATING
CAPITAL
TOTAL
2010
$157.97
5.37
$163.34
BFA Attachment C
Pro Forma Balance Sheet Of
Fulton Operations Associates, LLC
ASSETS
Cash
Goorlwill
TOTAL ASSETS
$1,894,466
?,020,OOO
$3,914,466
LIABILITIES
TOT,lI,L LIABILITIES
$1,150,000
947,233
$2,097,233
MEMBERS EQUITY
$1,817,233
Long Term Note
Working Capital Loan
Financial Summary
Attachment D
University Nursing Home
FISCAL PERIOD ENDED
ASSETS - CURRENT
ASSETS - FIXED AND OTHER
. LIABILITIES - CURRENT
LIABILITIES· LONG·TERM
EQUITY
INCOME
EXPENSE
NET INCOME
OPERATOR/RELATIVE SALARIES
12/31/10
12/31/09
12131108
$1,122,518
3,203,109
1,340,874
587,089
$2,397,664
$1,401,553
2,628,235
789,780
106,396
$3,133,612
$1,354,621
2,568,663
1,176,480
73,992
$3,645,279
$4,179,106
3,915,054
$264,052
$4,330,700
3,869,901
$460,799
$4,360,748
3,838,663
$522,085
N/A
NIA
N/A
NUMBER OF BEDS
PERCENT OF OCCUPANCY (DAYS)
46
97.58%
46
97.68%
98.14%
PERCENT OCCUPANCY (DAYS):
MEDICAID
MEDICARE
PRIVATE/OTHER
88.60%
7.17%
4.23%
80.94%
13.94%
5.12%
77.48%
15.01%
7.51%
MEDiCAID RATE BREAKDOWN:
OPERATING
CAPITAL
TOTAL
Ownership Interest
Kenneth Rozenberg
2010
$196.96
10.63
$207.59
98%
46
Financial Summary
Attachment E
Williamsbridge Manor Nursing Home
FISCAL PERIOD ENDED
12/31/10
12/31/09
12/31/08
ASSETS· CURRENT
ASSETS· FIXED AND OTHER
LIABILITIES - CURRENT
LIABILITIES - LONG-TERM
EQUITY
$1,870,247
2,269,700
1,734,511
2,104,478
$300,958
$1,861,229
962,622
1,795,170
819,533
$209,148
$1,071,364
964,545
1,416,674
786,429
($167,194)
INCOME
EXPENSE
NET INCOME
$7,911,179
7,878,867
$92,312
$7,646,510
7,270,168
376,342
$7,308,347
7,024,564
$283,783
OPERATOR/RELATIVE SALARIES
N/A
N/A
N/A
PERCENT OF OCCUPANCY (DAYS)
77
95.42%
77
96,85%
77
97.94%
PERCENT OCCUPANCY (DAYS):
MEDICAID
MEDICARE
PRIVATEfOTHER
86.47%
11.67%
1.86%
82.31%
14.54%
3.15%
79.67%
15.09%
5.24%
NUMBER OF BEDS
Kenneth Rozenberg 95.00%
Financial Summary
Attachment F
Dutchess Center for Rehabilitation
FISCAL PERIOD ENDED
ASSETS - CURRENT
ASSETS· FIXED AND OTHER
LIABILITIES· CURRENT
LIABILITIES. LONG.TERM
EQUITY
INCOME
EXPENSE
NET INCOME
OPERATOR/RELATIVE SALARIES
12/31/10
12/31/09
12/31/08
$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
$1,497,821
$1,447,731
$855,769
$11,315,724
10,591,187
$724,537
$10,372,091
9,930,128
441,963
$10,701,744
10,546,300
$155,444
$55,000
$55,000
$55,000
NUMBER OF BEDS
PERCENT OF OCCUPANCY (DAYS)
95.71%
122
96.72"10
122
95.17%
PERCENT OCCUPANCY (DAYS):
MEDICAID
MEDICARE
PRIVATE/OTHER
79.18%
14.16%
6.66%
75.09%
17.14%
7.77%
76.90%
15,61%
7,48%
Ownership Interest
Kenneth Rozenberg ·60%
Jeremy Strauss - 30%
122
Financial Summary
Attachment G
Brooklyn Center for Rehabilitation
Fiscal Period
ASSETS ~ CURRENT
ASSETS ~ FIXED AND OTHER
l.IABILITIES • CURRENT
LIABILITIES - LONG-TERM
EQUITY
INCOME
EXPENSE
NET INCOME
12f31/10
12f31109
12f31/08
$6,872,411
9,247,898
$5,206,901
9,320,437
$5,495,205
8,573,205
5,922,623
6,029,843
5,761,554
8,063,432
$2,134,254
7,333,246
$1,164,249
7,383,495
$923,361
$21,447,040
20,193,034
$1,254,006
$19,414,322
18,948,435
$465,887
OPERATORfREL,c\TIVE SALARIES
$74,013
$19,361,884
20,269,367
($907,483)
$74,013
NUMBER OF BEDS
PERCENT OF OCCUPANCY (DAYS)
215
96.83%
215
98.17%
215
97.81%
PERCENT OCCUPANCY (DAYS):
MEDICAID
MEDICARE
PRIVATEfOTHER
86.80%
10.10%
86.07%
11.34%
84,46%
10.40%
3.10%
2.59%
5.13%
MEDICAID RATE BREAKDOWN:
OPERATING
CAPITAL
TOTAL
Ownership Interest
Kenneth Rozenberg - 50%
Jeremy Strauss· 5%
2010
$194.55
W
$203.78
Financial Summary
Attachment H
Suffolk Center for Rehabilitation
FISCAL PERIOD ENDED
ASSETS· CURRENT
ASSETS· FIXED AND OTHER
LIABILITIES· CURRENT
LIABILITIES - LONG-TERM
EQUITY
INCOME
EXPENSE
NET INCOME
NUMBER OF BEDS
PERCENT OF OCCUPANCY (DAYS)
12/31/10
12131109
12131108
$6.211.972
11,139,056
8,408,960
8,631,073
$310,995
$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)
$14,167,394
$12,433,372
$11,320,327
13,049,866
12,275,756
12,226,935
$1,117,528
$157,616
($906,608)
215
96.83%
215
97.26%
215
97.81%
81.19%
13.12%
5.69%
76.58%
18.05%
5.37%
84.46%
10.40%
5.14%
PERCENT OCCUPANCY (DAYS):
MEDICAID
MEDICARE
PRIVATE/OTHER
MEDICAID RATE BREAKDOWN:
OPERATING
CAPITAL
TOTAL
Membership Interest
Jeremy Strauss - 50%
2010
$201.82
16.72
$218.54
Financial Summary
Attachment I
Queens Center for Rehabilitation
FISCAL PERIOD ENDED
12/31110
ASSETS - CURRENT
ASSETS - FIXED AND OTHER
LIABILITIES - CURRENT
LIABILITIES - LONG-TERM
EQUITY
INCOME
EXPENSE
NET INCOME
NUMBER OF BEDS
PERCENT OF OCCUPANCY (DAYS)
PERCENT OCCUPANCY (DAYS):
MEDICAID
MEDICARE
PRIVATE/OTHER
MEDICAID RATE BREAKDOWN:
OPERATING
CAPITAL
TOTAL
Ownership Interest
Kenneth Rozenberg- 88%
Jeremy Strauss - 5%
Jeffery Sicklick - 2%
12/31109
12/31/08
$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
$21,578,591
21,036,667
$21,828,556
21,301,987
$21,101,778
20,472,215
$541,924
526,569
$629,563
179
179
179
96.50%
95.47%
97.03%
62.37%
61.79%
64.39%
24.22%
13.41%
28.86%
9.35%
17.86%
17.75%
lQ.1Q
$234.57
~
$254.94
Financial Summary
Attachment J
Stonehedge Health and Rehabilitation - Ct Rome
Fiscal Period
ASSETS ~ CURRENT
ASSETS - FIXED AND OTHER
LIABILITIES - CURRENT
LIABILITIES - LONG-TERM
EQUITY
INCOME
EXPENSE
NET INCOME
12/31/10
12/31/09
$2,306,684
1,293,318
2,535,370
105,177
$959,455
$3,118,216
718,421
4,509,489
81,263
($754,115)
$12,312,486
12,185,653
$126,833
$11,502,831
11,248,365
$254,466
NUMBER OF BEDS
PERCENT OF OCCUPANCY (DAYS)
160
98.04%
160
97.29%
PERCENT OCCUPANCY (DAYS):
MEDICAID
MEDICARE
PRIVATE/OTHER
74.58%
15.53%
9.89%
69.68%
17.04%
13,28%
MEDICAID RATE BREAKDOWN:
OPERATING
CAPITAL
TOTAL
Ownership Interest
Kenneth Rozenberg - 70%
Jeremy Strauss - 20%
Jeffery Sicklick - 8%
Amir Abramchik - 2%
2010
$201.82
16.72
$218.54
Financial Summary
Attachment K
Stonehedge Health and Rehabilitation· Chittenango
Fiscal Period
12f31f10
12f31f09
ASSETS· CURRENT
ASSETS - FIXED AND OTHER
LIABILITIES - CURRENT
LIABILITIES - LONG-TERM
EQUITY
$1,465,951
569,864
1,335,865
22,622
$677,328
$2,151,920
553,953
2,927,696
81,263
($303,086)
INCOME
EXPENSE
NET INCOME
$6,730,591
6,232,342
$498,249
$6,325,412
6,092,725
$232,687
NUMBER OF BEDS
PERCENT OF OCCUPANCY (DAYS)
98.37%
98.04%
PERCENT OCCUPANCY (DAYS):
MEDICAID
MEDICARE
PRIVATE/OTHER
79.12%
14.95%
5.93%
74.79%
15.33%
9.88%
MEDICAID RATE BREAKDOWN:
OPERATING
CAPITAL
TOTAL
Ownership Interest
Kenneth Rozenberg - 70%
Jeremy Strauss. 20%
Jeffery Sicklick » 8%
Amfr Abramchik - 2%
80
80
2010
$201.82
16.72
$218.54
Financial Summary
Attachment L
Bronx Center for Rehabilitation & Health
Fiscal Period
12/31/10
12/31/09
12/31/08
EQUITY
$6,327,711
9,637,320
5,820,823
6,130,265
$4,013,943
$6,352,371
9,940,011
5,487,219
6,395,815
$4,409,348
$4,648,005
10,740,742
5,142,604
6,600,864
$3,645,279
INCOME
$21,279,712
$21,934,099
20,221,917
$1,057,795
20,865,071
$1,069,028
$21,279,712
20,221,917
$1,057,795
ASSETS CURRENT
ASSETS - FIXED AND OTHER
LIABILITIES - CURRENT
w
LIABILITIES - LONG-TERM
EXPENSE
NET INCOME
OPERATOR/RELATIVE SALARIES
N/A
N/A
N/A
NUMBER OF BEDS
PERCENT OF OCCUPANCY (DAYS)
200
98.13%
98.52%
87.37% .
PERCENT OCCUPANCY (DAYS):
MEDICAID
MEDICARE
PRIVATE/OTHER
84.75%
12.58%
2.67%
84.18%
13.16%
2.66%
85.01%
9.15%
5.84%
Ownership Interest
Kenneth Ro:zenberg
50%
200
200
BFA Attachment M
ESTABLISHMENTCHECKLIST FOR NURSING HOMES
APPLICATION: CON 111540-E
Fulton dperating Associates, LLC
NATURE OF PROPOSAL: Change in ownership of Fulton County Residential
Health Care Facility. The ownership is going from a public facility to a proprietary
facility.
EFFECT ON OPERATIONAL OWNERSHIP: Kenneth Rozenberg 62%; Jeremy
Strauss 25%; Jeremy Sicklick 3% and Amir Abrahamchik 10%.
EFFECT ON REAL ESTATE OWNERSHIP: Daryl Hagler 99% and Jon Hagler
1%.
FIXED ASSET PURCHASE PRICE: $1,500 1000
FIXED ASSET MEDICAID VALUE:$1,773,713
CAPITAL REIMBURSEMENT:
Arms Length Lease
X_ _Historic Cost Method
Shortfall; Average Annual Amount $13,625
BUSINESS PURCHASE PRICE: $2,020,000
(
J
BFA Attachment N
Pro Forma Balance Sheet Of
Fulton Land Associates, LLC
ASSETS
Land
Land Improvement
Building & Fixed Equipment
Moveable Equipment
TOTAL ASSETS
$20,890
86,298
1,521,645
284,819
$1,913,652
LIABILITIES
Long Term Note
$1,500,000
. TOTAL LIABILITIES
$1,500,000
MEMBERS EQUITY
$413,652
New York State Department of Health
Public Health and Health Planning Council
November/December 2011
ATTACHMENT
Certified Home Health Agencies – Establish/Construct
1.
Exhibit #9
Number
Applicant/Facility
112023 E
District Nursing Association of Northern Westchester County d/b/a
Visiting Nurse Association of Hudson Valley
(Westchester County)
BFA Attachment A
Proposed Organizaliunal Chart
Visiting Nurse Association of Hudson Valley
BFA Attachment B
VNA OF HUDSON VALLEY AND AFFILIATES
Tarrytown, New York
COMBINED BALANCE SHEETS
December 31, 20.10 and 2009
ASSETS
2010
2009
446,726
1,613,325
$ 604,100
1,415,987
3,594,207
2,590
98,920
5,755,768
3,596,044
801,623
807,211
Property and Equipment, Net of Accumulated Depreciation
of $2,575,782 and $2,314,135
719,204
846,023
Other Assets
146,739
169,659
$7,423,334
$7.534.754
Current Assets:
Cash and Cash EqUivalents
Investments
Accounts Receivable, Net of Allowance
for Doubtful Accounts of $506,000 and $672,000
Other Receivables
Prepaid Expenses
Total Current Assets
$
500
95.230
5,711,861
Assets Limited As To Use:
Cash and Cash Equivalents
Total Assets
LIABILITIES AND NET ASSETS
Current liabilities:
Current Portion of Insurance Assessment
Current Portion of Capital Lease Obligations
Accounts Payable and Accrued Expenses
Accrued Payroll and Related Wlthholdings
Deferred Revenue
Total Current Liabilities
Long-Term liabilities:
Insurance Assessment, Net of Current PortIon
Capital Lease Obligations, Net of Current Portion
Total Long-Term Liabilities
Total Uabirities
Net Assets:
Unrestricted
Temporarily Restricted
Total Net Assets
Total Liabilities and Net Assets
$
45,582
158,844
$
44,317
165,405
1,793,562
1,493,057
1,106,236
755,225
3,558,944
3,876,178
513,404
229,816
129,423
642,827
246 r25'1
476,067
4,201,771
4,352,245
3,177,332
3,128,820
44,231
3,221,563
3,182,509
$7.423,331
$7634,75A
1,014,729
858,165
53,689
BFA Attachment B (cont.)
VNA OF HUDSON VALLEY AND AFFILIATES
Ta.rrytown , New York
COMBINED STATEMENTS OF OPERATIONS
For the Years Ended December 31, 2010 and 2009
Revenue, Gains and Other Support:
Net Patient Service Revenue
United Way Alloca.tion
Contributions and Fund Raising, Net of Direct Expenses
Net Assets Released From Restrictions Used for Operations
Total Revenue, GaIns and Other Support
Expenses:
Salaries and Related Expenses
professional Fees and Contract Services
Supplies
Occupancy
TransportatIon
Other
Interest
Depreciation and Amortization
Bad Debt Expense (Recovery)
Total Expenses
I
2009
$23,121,248
24,287
344,271
9,458
23,499,264
$23,040,696
13,689
.545,601
30,297
23,630.283
16,104,357
15,380,427
4,826,048
796,727
579,328
372,550
1,470,695
38,477
4,155,145
714,416
597,316
394,422
1,377,288
28,335
289,062
11,469 )
23,648,872
287,258
(
95,876 )
23,655,634
25,351)
Operating Loss
149,608 )
Other Income (Loss):
Interest and Investment Income
Realized and Unrealized Gains
Loss on Dfsposalof Property and Equipment
Total Other Income (Loss)
156,460
2,992 )
45,733
242,730
41,293 )
198,120
247,170
Excess of Revenue Over Expenses
and Increase in Unrestricted Net Assets
:
2010
44,652
$
46,512
$
221,819