4A (Expenses $ 285071334 including grants of $ 0) (Revenue $ 284057412)
Montefiore Nyack Hospital is a 391-bed acute-care medical and surgical hospital serving Rockland County and the Lower Hudson Valley region that has met the critical needs of the people in the community for more than 125 years. What started as a two-story house with nine beds, an operating room, nurse's parlor, reception area, and dining room has today become a premier academic community hospital. The Hospital provides extensive inpatient and outpatient services, including addiction services, behavioral health, breast and women's health, cancer, cardiac care, clinical genetics, clinical trials, drug allergy and desensitization, diabetes, emergency medicine, hematology and oncology, home care services, imaging, infusion, joint replacement, maternity, multiple sclerosis care, pain management, pediatrics, pride, sleep medicine, stroke, transitional care, trauma and wound care. Montefiore Nyack Hospital has recently undergone a $22 million Transformation Project to enhances its health care delivery system. On July 27, 2021, Montefiore Nyack Hospital hosted a dedication and ribbon-cutting ceremony for the highly anticipated Phase Two opening of the new Emergency Center. The new space is home to a separate pediatric emergency unit, an express care area for non-life threatening emergency cases, three separate evaluation and procedure rooms and dedicated imaging suites. This new facility provides a comfortable space sensitive to the unique medical and emotional needs of our patients. In 2021, Montefiore Nyack Hospital was again at the forefront of the fight against the resurgent waves of the COVID-19 virus that continued relentlessly throughout 2021. The Hospital continued to provide life-saving treatments and therapies to the community along with newfound hope with the advent of the COVID Vaccine. The Hospital has received numerous awards and accreditations for meeting or exceeding rigorous standards set forth by various private, state, and federal agencies. Among the honors are The Joint Commission's Gold Seal of Approval for hip and knee joint replacement; American College of Radiology Breast Imaging Center of Excellence designation; American College of Surgeons Commission on Cancer Outstanding Achievement Award; and American Heart Association/American Stroke Association's Get With The Guidelines-Stroke Gold Plus with Honor Roll Elite Quality Achievement Award, among others. Montefiore Nyack Hospital is also an American College of Surgeons Level III Trauma Center, NY State Designated Stroke Center, a New York State Level II special care nursery, and a Wound Care Center of distinction. Montefiore Nyack Hospital offers many events, classes, and support groups to enrich the lives of the community. Some support groups and classes offered are: Caregivers Support Group, Diabetes Support Groups and education programs; Fall Prevention Program; Life with Cancer Support group; Mamas Maravillosas, a Spanish language support group; Maternity and Childbirth Education programs; and New Moms Circle Support Group. As of June 2020, most community wellness and education sessions transitioned to a virtual event called Community Chats, all available for viewing on the Hospital's Community Education YouTube channel.

Schedule H, PART V, Section B, LINE 5
The process for preparing the 2019-2021 Community Health Needs Assessment was an inter-organizational and community collaborative process, initiated with the goal of developing an assessment that was reflective of the needs of the community. The Montefiore Nyack Hospital Community Health Needs Assessment was compiled using specific data provided from Mid-Hudson Region Community Health Assessment 2019-2021, and used as Montefiore Nyack Hospital primary data collection source. The Mid-Hudson Region Community Health Assessment 2019-2021 was compiled and written by HealtheConnections and was inclusive of data pertaining to the seven counties within the Mid-Hudson Region. This assessment originated from a Collaborative that was formed in 2017 from the seven local Health Departments across the Mid-Hudson Region, with a goal of creating the first ever regional community health survey. The seven local Health Departments included Orange County Department of Health, Putnam County Department of Health, Rockland County Department of Health, Dutchess County Department of Behavioral & Community Health, Sullivan County Public Health Services, Ulster County Department of Health and Mental Health and Westchester Department of Health. There were 17 local hospitals who contributed funds for the Collaborative to contract with the Siena College Research Institute, to conduct a randomized digital dial community health survey between April and September 2018 to supplement the Regional Community Health Assessment. To further assess the broad interests of the community, following the regional assessment, several focus groups were created to gain insight of the underrepresented populations in the community, including those who are seniors, low income, veterans, LGBTQ members, those experiencing homelessness, and residents with a mental health diagnosis. Twelve focus groups, with members of the providers who serve these populations were created collaboratively with Human Service providers throughout the region. Prior to the focus group, a survey was sent to providers in each county in an effort to supply additional background regarding local factors that influence community Health. Along with the primary data collected through the survey and focus groups, secondary data was compiled to further supplement the data collected and show health indicators for the Region. To capture an up-to-date high-level view of the health status of Rockland County residents, there was an evaluation of temporal trends, differences between Rockland County and other Mid-Hudson Region Counties, New York State excluding New York City and New York City for more than 20 measures, including: obesity, preterm births, teen pregnancy rates, poverty, access to primary care, insurance status, smoking, flu immunizations, cancer screening, HIV incidence, lung, colorectal, prostrate and breast cancer incidence rates, and hospitalization for asthma, diabetes, heart attacks and falls. Subsequent meetings between Montefiore Nyack Hospital and leaders of the Rockland County Department of Health and Good Samaritan Hospital helped to further determine the health priorities of the County and the various interventions that were needed. Montefiore Nyack Hospital is an active member of different community groups and steering committees. These committees include Rockland County Health Care Priorities (HCP), Rockland County Immunization Coalition, EMS of Rockland, Rockland County Emergency Response Team, Local Chapter of the American Cancer Society, and the Susan G. Komen Fund among others. The Rockland County Healthcare Priorities is a committee comprised of twenty-two organizations that meet monthly to discuss the needs of the local communities. Forum member agencies offer relevant advice, expertise, and assistance on Healthcare needs and gaps in services. The committee addresses current healthcare priorities, examines progress made, and determines if modifications are necessary in the development of healthcare priorities for the county. Additionally, The Patient and Community Education Department at the Hospital identify concerns from the public based on feedback that it receives from lectures, public contact via the Hospital website and phone conversations.

Schedule H, Part V, Section B, Line 7a
The Hospital's CHNA report in available at the direct website: https://www.montefiorenyack.org/community-health-needs-assessment-0

Schedule H, Part V, Section B, Line 10A
The hospital's most recently adopted implementation strategy is posted on the website: https://www.montefiorenyack.org/community-health-needs-assessment-0

Schedule H, Part V, Section B, Line 11
The New York State Prevention Agenda Health Improvement plan for 2019 established the following prevention agenda Priority areas: - Prevent chronic diseases - Promote a healthy and safe environment - Promote healthy women, infants and children - Promote well-being and prevent mental substance use disorders - Prevent communicable disease. Montefiore Nyack Hospital has partnered with Rockland County Department of Health and Mental Hygiene, community-based organizations and member of the community in planning and developing initiatives aimed at improving the health of the people of Rockland based on these needs. Prevent Chronic Diseases - Pre-Diabetes, Diabetes & Obesity: Diabetes is a chronic disease increasing risk of heart disease, retinopathy, nephropathy, neuropathy, and sexual dysfunction to name just a few. Diabetes prevention and diabetes management have been identified by the CDC, New York State Department of Health, and Rockland County Department of Health as healthcare priorities. Diabetes is among the 20 most prevalent discharge diagnosis. Montefiore Nyack Hospital is addressing this healthcare priority across the continuum of care starting in the community through diabetes risk assessment screenings, Pre-Diabetes and Diabetes lectures, outpatient diabetes self-management training programs, monthly day and evening diabetes support groups, the annual Diabetes Symposium, and inpatient diabetes counseling by certified diabetes educators. The obesity epidemic is a public health issue with serious health implications that is particularly true for women of childbearing age. Pregnant women who are overweight or obese are at greater risk for adverse birth outcomes such as birth defects, fetal or infant death or other complications. Their offspring are also at higher risk for childhood and adulthood obesity, diabetes, and heart disease. Appropriate nutritional intake before and during pregnancy for the moms and breastfeeding and proper introduction of solid foods for the babies reduce these risks. The Montefiore Nyack Hospital Prenatal Center is addressing this issue by providing comprehensive perinatal care to low income, high-risk women in a culturally sensitive and competent manner. Bilingual services are offered to patients whose primary language is not English to help reduce health disparities. The hospital is also attempting to combat obesity in the community by employing two registered dietitians in its Community Education Department that go out into the community to perform nutrition workshops in educating the public on how to eat right to avoid obesity. Promote a Healthy and Safe Environment: Montefiore Nyack Hospital will work closely with the department of health and other community organizations to promote a healthy environment sponsoring and participating in streets, parks and wells cleaning events and fairs that promote safety education. The hospital will connect adults and people with disabilities with evidence-based falls prevention programs to help reduce falls among the elders and the at risk population. Promote Healthy Women, Infants and Children: The Montefiore Nyack Hospital Pre-Natal Center meets regularly with community partners to assess health and well-being needs of women of childbearing age and their families across the continuum. In an effort to prevent, recognize and treat conditions associated with maternal and infant mortality and morbidity, timely access to care is provided, including referral to appropriate levels of prenatal care based on the patient's assessed risk status. Additionally, bilingual health, nutrition, lactation, and childbirth education are provided by professional staff based on individual needs. Breastfeeding is highly encouraged and support is provided pre-and post-partum. The Center is staffed by bilingual Registered Nurses, Prenatal Techs, a Nutritionist, a bilingual Board Certified Lactation Consultant, a Certified Diabetes Educator and a Social Worker as well as bilingual clerical and administrative personnel. Together with a team of experienced and dedicated Certified Nurse Midwives and an Obstetrician, the Pre-Natal Center provides optimum, cost-effective and culturally sensitive prenatal and postpartum care to at-risk residents of Rockland County. Promote Well Being and Prevent Mental Substance Use Disorders: Montefiore Nyack Hospital is very aware of the shortage of behavioral health providers in Rockland County and the lack of services. For this reason, a behavioral health committee comprised of key stakeholders of different specialties is being created to support behavioral health patients in connecting with the available resources of the community. As many behavioral related issues originates from lack of support and abundance of unmet social needs, the aim of this committee is to create a safety network for these patients in offering support and community connections. The Hospital is addressing this need through its Behavioral Health Center that provides a full spectrum of acute psychiatric and medical care focusing on the combined needs of the patient. The Center provides a continuum of care that includes emergency treatment, hospitalization, and the appropriate discharge. The Recovery Center at Montefiore Nyack Hospital offers help and hope to those struggling with addiction providing a full range of treatment options in a culturally sensitive and judgment-free environment to assist individuals on their road to recovery. The Center is staffed by Addiction Counselors, Licensed Social Workers and Mental Health Counselors, Medical and Psychiatric personnel that are sensitive to the needs of the patients. Services at the Center are tailored to the needs of the individual and are administered with dignity and respect. Community outreach includes educating general practitioners in discussing availability of mental health services to their clients, raising awareness of mental health issues in our community and taking steps to reduce the stigma, shame, and barriers in seeking help. Montefiore Nyack Hospital is providing screening tools and resources for depression awareness and Suicide Assessment. We are also promoting awareness and information on seeking help that is provided at health fairs and schools throughout our community. Prevent Communicable Diseases: Montefiore Nyack Hospital offers screening, preventive services and counseling to all persons who are diagnosed with communicable diseases. Nyack Hospital partners with the Rockland County Office of the Aging conducting flu clinics throughout the area for Seniors of Rockland County and continues to collaborate with Senator Carlucci's office in providing flu shots to persons who are underinsured or uninsured. Getting individuals vaccinated, not only with flu vaccines but also with other vaccines, continues to be a challenge in our community. More education is needed to help Rockland residents understand the importance of vaccination for disease prevention. The Community Education department working in collaboration with Infection Prevention will be offering education materials at health fairs and workshops in community organizations and schools to help increase awareness around this topic. The goal is to increase the number of people receiving vaccines every year while reducing the number of cases of flu and measles. Without our various community partnership, Montefiore Nyack Hospital would not be able to address all the needs of the community. Although the hospital counts with an array of program and resources, the resources of our community partners are essential for the successful intervention in meeting the needs of the community and creating community-based services to prevent disease, enhance well-being and enact social changes that go beyond the traditional health care system.

Schedule H, Part V, Section B, Line 13h
Family size is factored into the eligibility criteria for financial assistance.

Schedule H, Part V, Section B, Lines 15d & 15e
Montefiore Nyack Hospital has internal resources available for assistance with the FAP application process. Financial Counselors are available to assist any individual requiring help in completing the Financial Aid application. The Phone number for Financial Counseling is given in the FAP and at the bottom of all hospital bills.

Schedule H, Part V, Section B, Lines 16a - 16b
The hospital's Financial aid policy, application and summary is available on the website: https://www.montefiorenyack.org/financial-aid-policy

Schedule H, Part V, Section B, Line 22
The hospital determines the maximum amount that can be charged to FAP-eligible individuals for emergency or other medically necessary care based on the type of service rendered. THE MEDICAID DRG RATE is used for admissions while the MEDICARE APC RATE is used for ambulatory services.

1. Part I, Line 7
The cost-to charge ratio methodology was utilized to calculate the amount included in the table. The calculation of this ratio was derived from the ratio of patient care cost-to-charge. In calculating the patient care cost for the ratio, the organization reduced its operating expenses for its non-patient care costs and cost of its community benefits and building activities not relying on the RCC factor for costing purposes. In 2021, the organization received additional funding from the Cares Acts Provider Relief Fund and FEMA for direct reimbursement of COVID-19 expenses. The organization further adjusted its patient care cost to exclude these expenses in the calculation of its cost to charge ratio. 1. Part I, Line 7g The hospital has reported a physician clinic as part of its subsidized health services. The clinic is part of the integrated health care services provided by Montefiore Nyack Hospital to the community and operated by the hospital at a substantial loss to the organization. This clinic provides much needed health care services to the hospital's large Medicare and Medicaid populations helping to alleviate a gap in services due to physicians who are unwilling to accept these payors. For 2021, the cost included in Part I, line 7g for this subsidized health care service was $8,301,095.

1. Part III, Lines 2
"The cost of bad debt expense is estimated based on the bad debt provision at charge, applied to the ratio of total patient care expense to total charges for all services rendered. Any payments or discounts are excluded from bad debt expense. 1. Part III, Lines 4 As Reported in Montefiore Nyack Hospital and Subsidiaries audited financial statements, bad debt is described as follows: ""Subsequent changes to the estimate of the transaction price (determined on a portfolio basis when applicable) are generally recorded as adjustments to patient service revenue in the period of the change. For the year ended December 31, 2021 and 2020, changes in the Hospital's estimates of expected payments for performance obligations satisfied in prior years were not significant. Portfolio collection estimates are updated based on collection trends. Subsequent changes that are determined to be the result of an adverse change in the patient's ability to pay (determined on a portfolio basis when applicable) are recorded as bad debt expense. Bad debt expense for the year ended December 31, 2021 and 2020, was not significant""."

1. Part III, Line 8
THE AMOUNT REPORTED ON LINE 6 WAS DERIVED USING THE MEDICARE ALLOWABLE costs as REPORTED ON THE HOSPITAL'S NEW YORK STATE INSTITUTIONAL COST report. The Medicare Shortfall should be considered a community benefit, since the organization is rendering much needed health services to a population, for the most part, that is poor with limited means. Over time, The Medicare reimbursement has not kept pace with rising Medicare costs thus shifting the burden for the difference to the organization for services rendered mainly to a frail, elderly population that has great health needs.

1. Part III, Section C, Line 9B
For patients who are known to qualify for financial assistance, all collection activity is halted and the patient is referred for financial aid. If an account is in collection and the patient requests financial aid or if the agency determines that the patient is eligible for financial assistance, the account is referred back to the hospital where the patient is provided assistance with completing an application for assistance. Hospital clinic patients are evaluated for financial assistance upon initial registration. Applications for Hospital clinic patients are completed and determinations made as part of the registration process unless additional information is needed. The organization also uses predictive analysis to assist in charity care determination in the absence of completed financial aid application. Financial screening/presumption charity used financial information that is contains in a patient's credit report and other patient specific attributes to estimate a patient income level and where they are in relation to the Federal poverty level to qualify under the Hospital's Charity Care Policy. If a patient is a Medicaid recipient receiving medically necessary non-covered services or inpatient services for non-covered charges for days exceeding a length-of-stay limit, the patient's Medicaid enrollment will be proof of financial need and the patient will be presumptively eligible for Charity Care/Financial Aid.

2. Needs Assessment
Montefiore Nyack Hospital assesses community needs by working closely with the local health departments as well as its community partners. Montefiore Nyack Hospital is an active member of the Rockland County Healthcare Priorities Committee, which represents 22 community organizations throughout the county. The group meets monthly to set Health care priorities for Rockland County. Montefiore Nyack Hospital also participated in the Mid-Hudson Regional Community Health Assessment 2019-2021 with seven local health departments across the Mid-Hudson Valley in assessing the health care needs of the Mid-Hudson Communities from primary and secondary data collections. In addition, several focus groups were created to further assess the broad interest of the community and gain the insights of the under representative population in the community including those who are seniors, low income, veterans, LGBTQ members, those experiencing homelessness and residents with a mental health capacity. Additionally, the Patient and Community Education Department at the hospital identify concerns from the public based on feedback it receives from lectures, public contact via the hospital website and phone conversations.

6. Affiliated Health Care
Montefiore Nyack Hospital is an affiliate of Montefiore Health System. The health system is a leader in community health and has a long standing history of developing innovative approaches to care and creating programs to best serve the changing needs of its community. These include, but are not limited to the following: Community service plan, community service strategy, accountable care organization, patient-centered medical home, disease management programs and community outreach. The integration of these innovative approaches supports the Health System well in its provision of service to the community.

7. State Filing of Community Benefit report
Montefiore Nyack Hospital files a community service plan with the State of New York.

3. Patient Education of Eligibility for Assistance
All intake, registration and collection staff is trained on the hospital's financial aid policy and how to provide patients with assistance. An in-service is provided to all areas with instructions on where to send patients that need assistance. For appropriate personnel, such training emphasize, among other things, the importance of determining the eligibility of patients for Charity Care/Financial Aid at the intake, billing and collection process, the conditions under which patient financial information will be sought from third parties, and the need to treat patient information in confidential and professional manner. The hospital makes it financial aid policy known to the public by providing information regarding the Hospital Charity Policy at patients service areas, information posted on the internet and information sent out on patient's bills. The information is available in several languages and are distributed to the Rockland County Public Health Priorities Committee and health-related events in the community.

4. Community Information
Montefiore Nyack Hospital's primary service area is Rockland County. For purposes of community/local health planning, Montefiore Nyack Hospital defines its total service area as all of Rockland, Westchester, Orange, and Putnam counties. Rockland county is located approximately 30 miles north of Manhattan, and on the west side of the Hudson River and bordered by Orange County to the North and New Jersey to the South west. It is comprised of 120,000 acres with more than 35,000 acres of preserved open space and parklands. The United States census Bureau estimated Rockland County's 2018 population at 325,695, representing a 4.5% increase in population from 2010. The county's population is 51% female, 62.7% white, 13.3% black, 18.0% Hispanic and 6.5% Asian. 21.4% of the residents are foreign-born and 38.4% of the population speaks a language other than English at home. Rockland County has a higher proportion of individuals living in poverty (13.6%) than its five peer counties. Those who are Hispanic (18.2%) and white (15.2%) are more likely to be living in poverty in Rockland County than those who are black (9.3%). Rockland County's population is growing and this trend is projected to continue over the next three decades. However, despite a growing aging population, the overall mortality rate in the county has decreased, suggesting a continued improvement of the overall health of Rockland's population. Heart disease and cancer remain the leading causes of death in the county. Rockland County ranked #3 for health outcomes in New York State County health Rankings in 2016. This category is based on an equal weighting of length and quality of life. Rockland County ranked #8 for health factors, based on weighted scores for health behaviors, clinical care, social and economic factors and the physical environment. Despite its overall high ranking, there is considerable room to improve population health in Rockland County, while also reducing health disparities throughout the multiple municipalities which are hotspots for both high-need populations and poorer health outcomes.

5. Promotion of Community Health
Montefiore Nyack Hospital promotes community health in a various of ways. The hospital's Community health and Education Department responds to requests from the community for lectures and blood pressure screenings. Recently various health fairs/lectures were conducted for the following organizations located throughout the service area: Heart Day by Montefiore Hospital, Teddy Bear Hospital at RCC, Diabetes Symposium, RP Connor Fit day, Redeeming Lord Christian Center, Nice Pak Safety, VISIONS, Senator Carlucci's Senior Awareness Event, Montebello Health Fair and St Thomas Aquinas College. The Breast Center at Montefiore Nyack Hospital continues to offer comprehensive services to women of Rockland County. The breast center promotes self-breast and bone-health awareness for both women and men and provides screenings for breast and cervical cancer for uninsured and underinsured women and men. In addition, the Breast Center provides public education through lectures, health fairs, and other venues throughout the county. Stroke is one of the leading causes of death and long-term disability in the United States. The Nyack Hospital Stroke Committee, which meets monthly is dedicated to raising awareness of the need to seek medical attention F.A.S.T. when signs and symptoms are noted. Our Educational team delivers lectures to various community members on stroke awareness and prevention and conducts blood pressure screening at various sites. Screening includes counseling on reduced risks of strokes through lifestyle changes including access to healthcare, blood pressure management, nutrition, and physical activity and recognition of stroke signs and symptoms. The Behavioral Health Centers at Montefiore Nyack Hospital provides community outreach programs that includes educating general practitioners in discussing availability of mental health services to their patients, raising awareness of mental health issues in the community and taking steps to reduce the stigma, shame and barriers in seeking help. Montefiore Nyack Hospital provides screening tools and resources for depression awareness and suicide assessment. Promoting Mental Health awareness and information on seeking help is also provided at health fairs and schools throughout our community. A focus is on disseminating information on the B4Stage4 Program, an anonymous, free, and confidential screening to start a conversation with a primary care provider or a trusted friend and begin to plan a course of action for addressing mental health. Other community health programs includes the AADE Diabetes self-management training program, the diabetes self-management training program for the blind, the lose to win program to combat obesity, among others.