| FORM 990, PART III, LINE 4D: |
1) RENAL DIALYSIS - TOTAL VISITS: 32,244. TOTAL EXPENSES: $11,841,785. TOTAL REVENUE: $9,732,587. 2) HOME HEALTH AGENCY - PROVIDES CERTIFIED HOME HEALTH AND LONG TERM CARE TO THE COMMUNITY. TOTAL VISITS: 58,657. TOTAL EXPENSES: $8,945,692. TOTAL REVENUE: $7,954,475. 3) HOME PROGRAM DIALYSIS (CAPD) - TOTAL VISITS: 884. TOTAL EXPENSES: $4,837,668. TOTAL REVENUE: $606,864. 4) REFERRED AMBULATORY - TOTAL VISITS: 21,729. TOTAL EXPENSES: $3,341,894. TOTAL REVENUE: $6,529,804. 5) HOSPICE - TOTAL DAYS: 11,158. TOTAL EXPENSES: $2,797,077. TOTAL REVENUE: $2,071,478. 6) MENTAL HEALTH AND CHEMICAL DEPENDENCY OUTPATIENT CLINICS - TOTAL VISITS: 18,245. TOTAL EXPENSES: $2,666,853. TOTAL REVENUE: $1,748,938. 7) ALL OTHER CLINICS (WOUND CARE, HYPERBARIC, SLEEP, CARDIAC, CATH, AND CARDIAC REHAB). TOTAL VISITS: 22,777. TOTAL EXPENSES: $11,713,126. TOTAL REVENUE: $12,288,913. |
| FORM 990, PART VI, SECTION A, LINE 2: |
L. ROSE AND F. ROSE ARE BOARD MEMBERS AND HAVE A FAMILY RELATIONSHIP. |
| FORM 990, PART VI, SECTION A, LINES 6 AND 7A: |
The Foundation (Brookhaven Health Care Services Corporation) is the sole member of Brookhaven Memorial Hospital Medical Center. The Foundation elects the board of Brookhaven Memorial Hospital Medical Center and appoints the President of Brookhaven Memorial Hospital Medical Center. |
| FORM 990, PART VI, SECTION B, LINE 11B: |
DRAFT FORM 990 WAS PROVIDED TO MANAGEMENT FROM BDO. A FINAL DRAFT WAS PRESENTED TO JOINT MEETING OF FINANCE AND AUDIT COMMITTEES FOR REVIEW, AND THEN PROVIDED TO ALL BOARD MEMBERS, VIA THE BOARD PORTAL, WITH AN OPPORTUNITY FOR THEM TO COMMENT OR MAKE INQUIRY BEFORE IT WAS FILED WITH THE INTERNAL REVENUE SERVICE. |
| FORM 990, PART VI, SECTION B, LINE 12C: |
Members of the Board of Directors, Administrators, Department Heads and medical staff working for or on behalf of Brookhaven MEMORIAL HOSPITAL MEDICAL CENTER are required to complete and sign the Conflict of Interest Disclosure Statement annually and whenever new information or changes arise that may require different responses from those included in the previous Conflict of Interest Disclosure Statement. Individuals are required to notify the Compliance Officer when they believe changes in the responses may be necessary or when they believe a transaction may involve an actual or potential conflict of interest. The Hospital By-Laws require that anyone with an actual or potential conflict of interest immediately disclose this fact to the Board of Directors or to a designated board committee for their review and evaluation. Further, the by-laws prohibit any individual or entity deemed to have an actual or potential conflict of interest from participating in any evaluation or decision making process regarding products or services provided by or through that individual or entity or from using this relationship to obtain goods or services on terms that are not available to individuals who are not affiliated with the hospital. The Board of Directors is responsible for enforcement of the aforementioned policy and report any conduct that it believes in good faith to be a violation of the Conflict of Interest Policy. |
| FORM 990, PART VI, SECTION B, LINES 15A AND 15B: |
The Executive Compensation Committee is comprised of the Chief Executive Officer, the Chairperson of the Board of Directors and selected Members of the Board of Directors. An Executive Compensation Consultant is invited to present data and trends to this Committee for their review and evaluation of the current salaries and fringe benefits of the CEO and other officers and key employees of BMHMC as compared to other organizations. In setting compensation levels for each executive, the Committee compares each base salary and total cash compensation level to market comparison data (based on healthcare systems with comparably sized operational budgets), organizational success against predetermined objectives, and individual performance against predetermined operational goals, as well as the data provided by the Consultant. The CEO, will be excused from the meeting of the Executive Compensation Committee, for a review of the CEO's compensation. Again, the Committee will use Industry Standards from comparably sized operational budgets, organizational success against predetermined objectives, and individual performance against predetermined operational goals, to establish the CEO's compensation. The Executive Compensation Committee will make the final approval of all compensation. The information is presented to the Overall brookhaven memorial hospital medical center Board, subject to ratification of the Board of Directors. |
| FORM 990, PART VI, SECTION C, LINE 19: |
UPON REQUEST, THE ORGANIZATION WILL MAKE AVAILABLE ONLY THOSE DOCUMENTS REQUIRED TO BE DISCLOSED UNDER THE PUBLIC INSPECTION LAWS. |
| FORM 990, PART XI, LINE 9: |
change in minimum pension liability.......................$ 940,229. changes in net assets of BMH Foundation...................$1,929,832. appropriation of temporary restricted net assets for operations.............................................$ (182,003) Total.....................................................$2,688,058. |
Attach to Form 990 or 990-EZ.