Community Benefit Insight - Tax-exempt hospital

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Orange Regional Medical Center

707 East Main Street

Middletown, NY 10940

EIN: 141364536

The hospital that you have selected is part of a multi-facility organization that reports community benefit expenditures in the aggregate and not by individual hospital. The data shown below are for the multi-facility organization. We encourage you to contact the individual hospital directly if you would like community benefit information on the hospital.Learn more

Individual Facility Details: Horton Memorial Hospital

60 Prospect Ave
Middletown, NY 10940

2 hospitals in organization:
(click a facility name to update Individual Facility Details panel)

Horton Memorial Hospital

Garnet Health Medical Center

Bed count	286	Medicare provider number	330001	Member of the Council of Teaching Hospitals	NO	Children's hospital	NO

Orange Regional Medical CenterDisplay data for year:

Community Benefit Spending- 2011
(as % of functional expenses, which all tax-exempt organizations report on Form 990 Schedule H)

4.76%

Spending by Community Benefit Category- 2011
(as % of total functional expenses)

* = CBI denoted preventative categories

Community Benefit Spending Compared to Functional Expenses, 2010-2011

Additional data

Community Benefit Expenditures: 2011

All tax-exempt organizations file a Form 990 with the IRS for every tax year. If the tax-exempt organization operates one or more hospital facilities during the tax year, the organization must attach a Schedule H to Form 990. On Part I of Schedule H, the organization records the expenditures it made during the tax year for various types of community benefits; 9 types are shown on this web tool. By default, this web tool presents community benefit expenditures as a percentage of the organization’s functional expenses, which it reports on Form 990, Part IX, Line 25, Column A. (The more commonly heard term, ‘total operating expenses’, which organizations report to CMS, is generally about 90% of the ‘functional expenses’). The user may change the default to see the dollar expenditures.
Amount spent in the following IRS community benefit categories:

Financial Assistance at cost as % of operating expenses	$ 1,141,936 0.33 %
Medicaid as % of operating expenses	$ 5,858,368 1.70 %
Costs of other means-tested government programs as % of operating expenses	$ 9,057,939 2.63 %
Health professions education as % of operating expenses	$ 0 0 %
Subsidized health services as % of operating expenses	$ 0 0 %
Research as % of operating expenses	$ 0 0 %
Community health improvement services and community benefit operations* as % of operating expenses Note: these two community benefit categories are reported together on the Schedule H, part I, line 7e.	$ 351,890 0.10 %
Cash and in-kind contributions for community benefit* as % of operating expenses	$ 7,000 0.00 %
Community building* as % of operating expenses	$ 0 0 %

* = CBI denoted preventative categories

Community building activities details:

Did tax-exempt hospital report community building activities?	Not available
Number of activities or programs (optional)	0
Physical improvements and housing	0
Economic development	0
Community support	0
Environmental improvements	0
Leadership development and training for community members	0
Coalition building	0
Community health improvement advocacy	0
Workforce development	0
Other	0
Persons served (optional)	0
Physical improvements and housing	0
Economic development	0
Community support	0
Environmental improvements	0
Leadership development and training for community members	0
Coalition building	0
Community health improvement advocacy	0
Workforce development	0
Other	0
Community building expense as % of operating expenses	$ 0 0 %
Physical improvements and housing as % of community building expenses	$ 0
Economic development as % of community building expenses	$ 0
Community support as % of community building expenses	$ 0
Environmental improvements as % of community building expenses	$ 0
Leadership development and training for community members as % of community building expenses	$ 0
Coalition building as % of community building expenses	$ 0
Community health improvement advocacy as % of community building expenses	$ 0
Workforce development as % of community building expenses	$ 0
Other as % of community building expenses	$ 0
Direct offsetting revenue	$ 0
Physical improvements and housing	$ 0
Economic development	$ 0
Community support	$ 0
Environmental improvements	$ 0
Leadership development and training for community members	$ 0
Coalition building	$ 0
Community health improvement advocacy	$ 0
Workforce development	$ 0
Other	$ 0

Other Useful Tax-exempt Hospital Information: 2011

In addition to community benefit and community building expenditures, the Schedule H worksheet includes sections on what percentage of bad debt can be attributable to patients eligible for financial assistance, and questions on the tax-exempt hospital's debt collection policy. When searching a specific tax-exempt hospital in this web tool, Section II provides information about bad debt and the financial assistance policy, and whether the state in which the tax-exempt hospital resides has expanded Medicaid coverage under the federal ACA.

Of the tax-exempt hospital’s overall operating expenses, amount reported as bad debt as % of operating expenses	$ 3,547,161 1.03 %
Is the tax-exempt hospital considered a "sole community hospital" under the Medicare program?	NO

Information about the tax-exempt hospital's Financial Assistance Policy and Debt Collection Policy
The Financial Assistance Policy section of Schedule H has changed over the years. The questions listed below reflect the questions on the 2009-2011 Schedule H forms and the answers tax-exempt hospitals provided for those years. The Financial Assistance Policy requirements were changed under the ACA. In the future, as the Community Benefit Insight web site is populated with 2021 data and subsequent years, the web tool will also be updated to reflect the new wording and requirements. In the meantime, if you have any questions about this section, we encourage you to contact your tax-exempt hospital directly.

Does the organization have a written financial assistance (charity care) policy?	YES
Did the tax-exempt hospital rely upon Federal Poverty Guidelines (FPG) to determine when to provide free or discounted care for patients?	YES
Amount of the tax-exempt hospital’s bad debt (at cost) attributed to patients eligible under the organization’s financial assistance (charity care) policy as % of operating expenses	$ 0 0 %

Did the tax-exempt hospital, or an authorized third party, take any of the following collection activities before determining whether the patient was eligible for financial assistance:

Reported to credit agency	Not available
Filed lawsuit	Not available
Placed liens on residence	Not available
Issue body attachments? (an order by the court commanding a sheriff or other official to physically bring before the court a person who is guilty of contempt of court)	Not available

Under the ACA, states have the choice to expand Medicaid eligibility for their residents up to 138% of the federal poverty guidelines. The Medicaid expansion provision of the ACA did not go into effect until January 2014, so data in this web tool will not reflect each state's current Medicaid eligibility threshold. For up to date information, please visit the Terms and Glossary under the Resources tab.
The federal poverty guidelines (FPG) are set by the government and used to determine eligibility for many federal financial assistance programs. Tax-exempt hospitals often use FPG guidelines in their Financial Assistance policies to determine which patients will qualify for free or discounted care.
In addition to the federal requirements, some states have laws stipulating community benefit requirements as a result of tax-exemption. The laws vary from state to state and may require the tax-exempt hospitals to submit community benefit reports. Data on this web tool captures whether or not a state had a mandatory community benefit reporting law as of 2011. For more information, please see Community Benefit State Law Profiles Comparison at The Hilltop Institute.

Community Health Needs Assessment Activities: 2011

The ACA requires all 501(c)(3) tax-exempt hospitals to conduct a Community Health Needs Assessment (CHNA) every three years, starting with the hospital's tax year beginning after March 23, 2012. The 2011 Schedule H included an optional section of questions on the CHNA process. This web tool includes responses for those hospitals voluntary reporting this information. The web tool will be updated to reflect changes in these questions on the 2012 and subsequent Schedule H forms.

Did the tax-exempt hospital report that they had conducted a CHNA?	Not available
Did the CHNA define the community served by the tax-exempt hospital?	Not available
Did the CHNA consider input from individuals that represent the broad interests of the community served by the tax-exempt hospital?	Not available
Did the tax-exempt hospital make the CHNA widely available (i.e. post online)?	Not available
Did the tax-exempt hospital adopt an implementation strategy to address the community needs identified by the CHNA?	Not available
Did the tax-exempt hospital execute the implementation strategy?	Not available
Did the tax-exempt hospital participate in the development of a community-wide plan?	Not available

Supplemental Information: 2011

This section presents qualitative information submitted by the hospital, verbatim from the 990H record.

Statement of Program Service Accomplishments
Description of the organization's program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.

4A (Expenses $ 151005494 including grants of $ 0) (Revenue $ 198820210)
SEE SCHEDULE O.

4B (Expenses $ 10206865 including grants of $ 0) (Revenue $ 9514813)
EXPENSES INCURRED WHILE PROVIDING MENTAL HEALTH MEDICAL CARE SERVICES TO 1,231 PATIENTS IN SURROUNDING COMMUNITY.

4C (Expenses $ 9880485 including grants of $ 0) (Revenue $ 12483458)
EXPENSES INCURRED WHILE PROVIDING REHABILITATION MEDICAL SERVICES TO 694 PATIENTS IN SURROUNDING COMMUNITY.

Supplemental Information

Schedule H (Form 990) Part VI

PART I, LINE 3C:
N/A

PART I, LINE 6A:
A COMMUNITY SERVICE PLAN IS PREPARED BY ORANGE REGIONAL MEDICAL CENTER. PART I, LINE 7: CALCULATION OF COST IS DONE UTILIZING THE RATIO OF PATIENT CARE COST TO CHARGES DEVELOPED ON WORKSHEET 2. THIS AMOUNT IS APPLIED TO THE GROSS CHARGES IDENTIFIED FROM ALLOWANCE CODES USED IN THE PATIENT ACCOUNTING SYSTEM.

PART I, LINE 7A:
BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT EXCLUDED FOR PURPOSES OF CALCULATING FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS AT COST: $12,993,265.

PART I, LINE 7G:
N/A

PART II:
N/A

PART III, LINE 4:
ORMC PROVIDES CHARITY CARE TO PATIENTS WHO MEETS CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY, TO PATIENTS WHO ARE UNINSURED AND TO PATIENTS WHO ARE UNDERINSURED AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. BECAUSE ORMC DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY, THEY ARE NOT REPORTED AS REVENUE. THE CALCULATION OF THE COST OF THESE SERVICES IS DONE UTILIZING THE RATIO OF PATIENT CARE COST TO CHARGES BASED UPON THE 2010 INSTITUTIONAL COST REPORT, APPLIED TO THE GROSS CHARITY RELATED ALLOWANCES AND BAD DEBT EXPENSE.

PART III, LINE 8:
THE MEDICARE SHORTFALL OF $32,686,800 COULD BE CONSIDERED A COMMUNITY BENEFIT EXPENSE TO THE EXTENT THAT IT IS IN EFFECT A SUBSIDY OF A GOVERNMENTAL HEALTHCARE PLAN WHICH ENABLES THE RECIPIENTS OF THESE BENEFITS TO RECEIVE HEALTHCARE. THE AMOUNT INDICATED ON LINE 6 AS MEDICARE ALLOWABLE COSTS RELATED TO MEDICARE PAYMENTS HAS BEEN CALCULATED BY APPLYING THE RATIO OF PATIENT CARE COST TO CHARGES TO GROSS CHARGES FOR MEDICARE AND MEDICARE ADVANTAGE PLAN LESS PAYMENTS. THIS RATIO IS CONSISTENT WITH THAT USED FOR MEDICAID AND OTHER PROVIDERS.

PART III, LINE 9B:
ORMC'S COLLECTION POLICY INDICATES THAT IF A PATIENT IS NOT ABLE TO PAY, THEY WILL BE REFERRED FOR MEDICAID ELIGIBILITY OR FINANCIAL AID. ALSO, CHARITY CARE ELIGIBILITY IS EXTENDED TO 350% OF THE FEDERAL POVERTY GUIDELINES (FPG) FOR THOSE PATIENTS WHO ARE INDIGENT BUT HAVE SOME INCOME AND DO NOT QUALITY FOR A 100% WRITE-OFF.

PART VI, LINE 2 - NEEDS ASSESSMENT:
ON MAY 19, 2009, IN ACCORDANCE WITH THE NEW YORK STATE PREVENTION AGENDA AND IN PARTNERSHIP WITH THE ORANGE COUNTY DEPARTMENT OF HEALTH AND THE MIDDLETOWN COMMUNITY HEALTH CENTER, ORANGE REGIONAL MEDICAL CENTER HOSTED THE ORANGE COUNTY REGION 2 TOWN HALL HEALTH MEETING TO SOLICIT PUBLIC INPUT FROM LOCAL COMMUNITY HEALTHCARE AGENCIES AND STAKEHOLDERS REGARDING HEALTHCARE NEEDS. REGION 2 ENCOMPASSES THE NORTH CENTRAL PORTION OF ORANGE COUNTY. PARTICIPANTS DISCUSSED THE FOLLOWING PREVENTION AGENDA PRIORITIES AS THEY RELATED TO ORANGE COUNTY REGION 2: * ACCESS TO QUALITY HEALTHCARE * HEALTHY MOTHERS/HEALTHY BABIES/HEALTHY CHILDREN * CHRONIC DISEASE * PHYSICAL ACTIVITY/NUTRITION * UNINTENTIONAL INJURY; HEALTHY ENVIRONMENT * TOBACCO USE * INFECTIOUS DISEASE * COMMUNITY PREPAREDNESS * MENTAL HEALTH/SUBSTANCE ABUSE IN ADDITION, THE ORANGE COUNTY DEPARTMENT OF HEALTH (OCDOH) HAS COLLABORATED WITH A VARIETY OF EDUCATIONAL, COMMUNITY, VOLUNTARY AND GOVERNMENT AGENCIES; HEALTHCARE FACILITIES AND PROVIDERS INCLUDING ORANGE REGIONAL MEDICAL CENTER; AND CONSUMER GROUPS TO COLLECTIVELY IDENTIFY PRIORITIES FOR IMPROVING COMMUNITY-WIDE HEALTH STATUS. IN CONDUCTING THE 2005-2010 ORANGE COUNTY COMMUNITY HEALTH ASSESSMENT, SEVERAL STRATEGIES WERE USED TO FACILITATE AND INVITE COMMUNITY INPUT IN ESTABLISHING COMMUNITY HEALTH PRIORITIES. ONE STRATEGY WAS TO ENCOURAGE ONGOING COMMUNICATION WITH AND CONSULTATION FROM THE COMMUNITY COLLABORATORS. ORANGE COUNTY DOH REPRESENTATIVES MEET WITH THESE GROUPS REGULARLY TO DISCUSS COMMUNITY-BASED HEALTH INITIATIVES AND EMERGING HEALTH AND SERVICE DELIVERY NEEDS. IN ADDITION, TWO VERSIONS OF A LOCAL HEALTH NEEDS SURVEY WERE DEVELOPED TO SOLICIT INPUT FROM COMMUNITY-BASED HEALTH SERVICES, COMMUNITY AGENCIES, AND RESIDENTS. THE COMMUNITY AGENCY VERSION OF THE LOCAL HEALTH NEEDS SURVEY WAS DESIGNED TO PROVIDE INPUT REGARDING NEEDS BOTH FROM THE AGENCY/HEALTHCARE FACILITY'S PERSPECTIVE AND THAT OF THE TARGET POPULATION SERVED BY EACH AGENCY. THE OTHER SURVEY, COMPLETED BY MORE THAN 750 ORANGE COUNTY RESIDENTS, WAS MADE AVAILABLE IN BOTH ENGLISH AND SPANISH ON THE COUNTY'S WEBSITE. A TOTAL OF 40 SURVEYS WERE COMPLETED BY HEALTHCARE FACILITIES AND AGENCIES INCLUDING ORANGE REGIONAL MEDICAL CENTER. THE FOLLOWING FINDINGS IDENTIFIED BY THE ORANGE COUNTY DEPARTMENT OF HEALTH'S SURVEY AND THE ORANGE COUNTY REGION 2 TOWN HALL HEALTH MEETING DIRECTLY FALL IN LINE WITH THE NEW YORK STATE DEPARTMENT OF HEALTH PREVENTION AGENDA. ORANGE REGIONAL MEDICAL CENTER CURRENTLY OFFERS SERVICES THAT ADDRESS THESE ISSUES. * BEHAVIORAL HEALTH (PREVENTION AGENDA ITEM): THERE WAS UNANIMOUS AGREEMENT THAT SIGNIFICANT NEED FOR BEHAVIORAL HEALTH SERVICES THAT EXISTS IN REGION 2 AND COUNTY-WIDE, PARTICULARLY REGARDING PEDIATRIC AND ADOLESCENT BEHAVIORAL HEALTH. BARRIERS INCLUDE LACK OF TRANSPORTATION/ACCESS AND INSUFFICIENT METHODS OF COMMUNICATION REGARDING THE SERVICES AVAILABLE. * OBESITY: OBESITY IS AN INCREASING PROBLEM FOR ORANGE COUNTY RESIDENTS, IT IS OF SPECIAL CONCERN IN CHILDREN AND TEENS BECAUSE IT NOT ONLY INCREASES THE RISK OF CHRONIC DISEASES LATER IN LIFE, BUT CAN RESULT IN PSYCHOLOGICAL AND SOCIAL DIFFICULTIES AT A DEVELOPMENTALLY SENSITIVE STAGE. * CHRONIC DISEASE (PREVENTION AGENDA ITEM): FINDINGS SUGGEST THAT THERE IS A NEED TO BETTER ADDRESS THE UNDERLYING CAUSES OF CHRONIC DISEASES SUCH AS OBESITY, POOR NUTRITION, AND LACK OF PHYSICAL ACTIVITY IN THE COUNTY. THIS MAY BE ACHIEVED BY EXPANDING THE HEALTH EDUCATION AND PRIMARY PREVENTION SERVICE CAPACITY IN THE ORANGE COUNTY HEALTH DEPARTMENT AND THROUGHOUT COMMUNITY AGENCIES. * ACCESS TO CARE (PREVENTION AGENDA ITEM): IT WAS FELT THERE IS SIGNIFICANT NEED TO EXPAND ACCESS TO HEART DISEASE, CANCER, COPD/CLRD, ASTHMA, AND DIABETES PREVENTION AND EDUCATION INCLUDING ESPECIALLY FOR HIGH RISK MINORITY AND LOW INCOME RESIDENTS, SIGNIFICANT NEED ALSO EXISTS TO EXPAND ACCESS TO BREAST, PROSTATE, AND COLORECTAL SCREENING, ESPECIALLY FOR HIGH RISK MINORITY AND LOW INCOME RESIDENTS. EARLY DETECTION: IT WAS ALSO DETERMINED THAT ACCESSIBILITY AND USE OF EARLY DETECTION AND SCREENING SERVICES WERE LACKING FOR CHRONIC DISEASES, ESPECIALLY BY LOW-INCOME, MINORITY POPULATIONS. PRESENTLY ORANGE REGIONAL MEDICAL CENTER OFFERS SEVERAL PROGRAMS TO ADDRESS THE ISSUES ABOVE. THESE PROGRAMS WILL BE SUPPLEMENTED BY INPUT AND SUPPORT FROM THE LOCAL DEPARTMENT OF HEALTH AND FROM COMMUNITY PARTNERS. IN ADDITION TO SUPPORT THESE EFFORTS, ON AUGUST 18, 2011, ORANGE REGIONAL MEDICAL CENTER'S MANAGER OF PLANNING ATTENDED A SUMMIT WITH THE HUDSON VALLEY REGIONAL HEALTH OFFICER'S NETWORK (HVRHON). THIS IS A LOWER HUDSON VALLEY HEALTH PLANNING INITIATIVE FUNDED BY THE HEALTH CARE EFFICIENCY & AFFORDABILITY LAW (HEAL 9) GRANT PROGRAM. SEVEN COUNTIES ARE COLLABORATING IN THE EFFORT WITH HVRHON AND THE NYMC SCHOOL OF HEALTH PRACTICES & SCIENCES. THE COUNTIES INCLUDE DUTCHESS; ORANGE; PUTNAM; ROCKLAND; SULLIVAN; ULSTER AND WESTCHESTER. KEYNOTE SPEAKER AT THE SUMMIT WAS MICHELLE DAVIS, REGIONAL HEALTH ADMINISTRATOR, UNITED STATES DEPARTMENT OF HEALTH AND HUMAN SERVICES. THE HVRHON SCOPE OF WORK INCLUDES COMMUNITY HEALTH ASSESSMENT AND PRIORITIZATION OF NEEDS AND RECOMMENDATIONS INCLUDING: .Developing Regional Performance Monitoring Tool (RPMT) for a Needs Assessment of the three .Priority Areas (based on existing data and regional provider/consumer survey) .IdentifYing and strengthening health systems partnerships and .collaboration .IdentifYing models of health care delivery and disease prevention strategies .Developing a Web-based health information portal to facilitate planning and information sharing .Sponsoring a regional summit for health leaders Key accomplishments of HVRHON presented at the summit were: .Priority areas identified (and analyzed at the August 18 summit) included: Access to Quality Health Care, Chronic Disease Prevention and Control. Maternal and Child Health .Regional Performance Monitoring Survey Tool developed .Surveyed consumers and providers .Administered survey across all counties .Utilized survey data to inform 2010-2013 Community Health Assessment .Counties conducted local focus groups with key providers and stakeholders to inform process PART VI, LINE 3 - PATIENT EDUCATION OF ELIGIBILTY FOR ASSISTANCE: TO INFORM AND EDUCATE OUR PATIENTS REGARDING THEIR ELIGIBILITY FOR FINANCIAL ASSISTANCE, ORANGE REGIONAL MEDICAL CENTER UTILIZES SEVERAL METHODS, INCLUDING PROVIDING A FINANCIAL AID SUMMARY AT REGISTRATION, POSTING SIGNS IN PATIENT AREAS, DETAILING THE INFORMATION ON THE ORGANIZATION'S WEBSITE, AND INCLUDING IT ON PATIENT STATEMENTS. Part VI, Line 4 - Community Information: Orange Regional Medical Center (ORMC) is a member of the Greater Hudson Valley Health System (GHVHS). ORMC, in Middletown, NY, expanded its service area to reflect its relationship with Catskill Regional Medical Center (also a member of GHVHS). The GHVHS service area includes all of Orange County and Sullivan County; an area that encompasses 1,828 square miles and approximately 450,000 residents. When it comes to health planning for primary care and core secondary level services, ORMC focuses on 29 zip codes that comprise its local health service area. This service area was determined by identifying the zip codes from which 85% of Orange Regional's discharges originate. Planning for specialty care services takes a more regional perspective and encompasses all of Orange and Sullivan Counties and the needs of their residents. Part VI, Line 5 - Promotion of Community Health The majority of ORMC's Board of Directors consists of local health care consumers who provide expertise in identifying the healthcare needs and priorities of the communities we serve. In addition, ORMC conducts, coordinates, and participates in a broad range of community outreach programs that allow community members the opportunity to interact directly with representatives from the hospital. Part VI, Line 6 - N/A Part VI, Line 7 - Community Service Plan: ORMC performs a community service plan every three years.