Dispelling the Myths

Dispelling the Myths New York s Finances: Another View

Executive Summary New York s hospitals, in recent years, have complained that health plans in the state are on solid financial footing while overall hospital finances have been on the decline. However, as may be expected, the way in which you look at things can dramatically alter the view. A closer look at hospital figures over the past several years shows the picture is not as bleak as first presented. When presenting their financial overview, hospitals like to compare plan profits to hospital losses. This profit versus loss picture presents a skewed view of New York s health care market. By comparing total health plan finances including statutory reserve requirements, investment income and other resources that may produce revenues to only the net operating income of hospitals, the hospitals purposely neglect to include investment income, ancillary business revenues, charitable contributions or other revenues that contribute to positive finances. An examination of these data shows: New York s hospitals had net income of nearly $903 million in 2003. Two-thirds of New York hospitals generated profits in 2003. Also exposing the flaws in the picture painted by the hospitals is the fact that nearly a decade after deregulating New York s hospital payment system to encourage more competition, New York government continues to heavily subsidize the overall hospital system, thereby propping up some hospitals that are losing significant sums of money on an annual basis to the detriment of other competing hospitals which would be considerably stronger today if deregulation had resulted in a restructuring of the acute care hospital system in New York, as was anticipated. Now, the Commission on Health Care Facilities in the 21 st Century has been charged with specifically examining this very issue. Financial Facts: New York s hospitals had net income of nearly $903 million in 2003 Two-thirds of New York hospitals generated profits in 2003. Some key facts to consider: New York s move to a deregulated system was designed to be a move away from the status quo; it was expected to create winners and losers. The current Health Care Reform Act (HCRA) maintains New York s historic system of hospital subsidies; significant unequal support that encourages inefficiencies and, in turn, weaken the system as a whole. Creation of the Commission on Health Care Facilities in the 21 st Century is government recognition that inefficiencies in our health care system that cannot be sustained; the Commission s recommendations for restructuring New York s system will undoubtedly include recommendations for consolidation and closing of some facilities. As we saw with health plan consolidations in recent years, when restructuring and downsizing is allowed to occur, the remaining players will be stronger, thereby strengthening the system as a whole. New York s health care system is a complex arrangement of providers, payers and patients. In order to have a system that treats all parties fairly, the New York Health Plan Association (HPA) believes the views and demands of one segment cannot be allowed to dominate the discussions of the future of our health care system. 1

New York s Health Care System Our old health care system in New York was a made-in-albany bureaucratic model which needed fundamental reform. With those words, Governor George Pataki, in 1996, announced the creation of the Health Care Reform Act HCRA to replace the heavily regulated, highly bureaucratic New York Prospective Reimbursement Methodology (NYPHRM) system. When first envisioned, HCRA was supposed to substantially change the way New York financed its health care system. Indeed, the new HCRA system eliminated the system of state-set rates for health care services charged by hospitals to commercial insurers, in favor of the negotiated rates approach of 48 other states. The new HCRA system was also designed to introduce other significant changes in New York s approach to financing health care changes aimed at promoting competition in the marketplace, reducing inefficiencies and improving health care affordability for more New Yorkers. In the years since moving to HCRA, many of these goals remain unrealized. Data showing operating margins only, leaving out positive contributions to the bottom line, distorts the picture. The Commission on Health Care Facilities in the 21 st Century (the Commission), established by Governor George Pataki and the New York State legislature, is government recognition that continued inefficiencies in our health care system are costly and ultimately harmful to the system overall. The Commission along with six regional advisory committees has been charged with conducting an independent review of health care capacity and resources in New York and making recommendations to reconfigure and right-size the supply of hospitals and nursing homes. The Commission recently noted, New York is struggling to maintain a 20 th century institutional structure in the face of mounting costs, excess capacity, and unmet need for community based alternatives. The existing institutional infrastructure is neither affordable nor flexible. 1 When it presents the Governor and legislature with its final recommendation in December of 2006, it is expected those recommendations will include possible consolidation, closure, conversion and restructuring of facilities, and reallocation of local and statewide resources. s: The sky is falling. Year after year, the hospital community has painted a bleak picture, using phrases such as on the brink, on life support and crisis in relation to hospitals viability. The picture presented by the hospitals is distorted. In its annual hospital finance reports, the Healthcare Association of New York State (HANYS) uses data showing operating margins only, omitting hospital operations such as investments, government grants and other business revenues that are positive contributions to the bottom line. Analysis of hospital revenue data provided by NYSDOH to the Commission offers a decidedly different view, showing a nearly $903 million net profit for New York hospitals in 2003. 1 Planning for the Future: Capacity Needs in a Changing Health Care System ; Commission on Health Care Facilities in the 21 st Century; February 2006. 2

2003 Net Income for All s by Region Non-Public Public Regional Totals Hudson Valley $71,808,273 $(73,602,036) $(1,793,763) NYC $(14,083,255) $357,246,129 $343,162,874 Northern $111,440,253 n/a $111,440,253 Central $164,408,408 $23,093,620 $187,502,028 Western $26,883,879 $1,106,408 $27,990,287 Long Island $205,525,884 $28,675,000 $234,200,884 $565,983,442 $336,519,121 $902,502,563 Excludes non-comparable data $392,000,000.00 $342,000,000.00 $292,000,000.00 $242,000,000.00 $192,000,000.00 $142,000,000.00 $92,000,000.00 2003 Net Income for All s by Region NYS DOH Data to NY Health Care Commission $65,351,174 (includes public hospitals) $111,440,253 $188,892,340 $234,200,884 $345,276,874 $42,000,000.00 $(8,000,000.00) $(1,793,763) Hudson Valley Western Northern Central Long Island NYC $12,000,000 $10,000,000 $8,000,000 2003 Average Net Income by Region NYSDOH Data Provided to NY Health Care Commission (includes public hospitals; excludes non-comparable data) $6,863,257 $10,645,495 $6,000,000 $4,000,000 $2,000,000 $(57,863) $1,272,286 $4,360,512 $4,457,610 $- $(2,000,000) Hudson Valley Western Central Northern NYC Long Island Source: NYSDOH report to the Commission on Health Care Facilities in the 21 st Century; www.nyhealthcarecommission.org 3

Operating Margins Grim The most recent HANYS report on hospital finances 2 states: Two-thirds of hospitals are losing money, breaking even, or operating with positive fiscal margins of 1% or less. That statement, however, reflects operating income only. Looking at data that reflect net income reveals a different picture one that shows things are not as grim first portrayed. HPA s analysis of the 2003 hospital income reports shows two-thirds of New York s hospitals generated profits. Of the hospitals that had losses, 15 hospitals comprised more than 75% of the total losses for New York. For many of the hospitals with notable earnings, factors such as documented efforts to improve management, reduced lengths of stay and investment income undoubtedly contribute to their financial success. Top 25 Earners in 2003 2003 Net Income North Shore - Long Island Jewish $130,277,000 New York-Presbyterian $108,314,000 St. Francis $48,175,000 Erie County Medical Center $37,360,887 University and Medical Center SUNY at Stonybrook $37,179,000 Strong Memorial $30,847,940 Vassar Brothers Medical Center $27,444,795 Cayuga Medical Center at Ithaca $24,085,202 University SUNY Health Science Center (Syracuse) $23,093,620 Mary Imogene Bassett $22,411,980 New York Methodist $20,408,000 Winthrop-University $20,366,903 Niagara Falls Memorial Medical Center $20,011,347 Albany Medical Center $19,844,146 University of Brooklyn SUNY Health Science Center $19,188,129 Montefiore Medical Center $18,599,000 South Nassau Communities $18,211,533 Rochester General $17,800,061 St. Barnabas $17,293,372 Kaleida Health System $17,106,000 Wyckoff Heights Medical Center $16,023,000 St. Peter's, Albany $15,553,000 Arnot-Ogden Medical Center $15,291,871 United Health Services s $14,976,944 Monroe Community $12,951,783 Source: NYSDOH report to Commission on Health Care Facilities in the 21 st Century (excludes HHC) www.nyhealthcarecommission.org 2 s on Life Supports: Seven Straight Years of Losses, page 3; Health Care Association of New York State; January 2006. 4

HANYS s effort to paint the picture of dire fiscal conditions for all hospitals does lead to questions about the future viability of the subset of institutions that are, in fact, incurring significant net losses. As the Commission has noted, the financial strength or weakness of hospitals is a major factor that must be considered as part of the Commission s work. Occupancy trends and lengths of stay for hospitals losing money will undoubtedly be considered in contrast to competitors in the region. Top 25 s Losing Money in 2003 2003 Net Income St. James Mercy $(3,700,389) Mount St. Mary's $(3,930,000) Our Lady of Victory $(4,727,809) New York Westchester Square Medical Center $(5,520,000) Mercy Medical Center $(6,106,000) St. Clare's (Schenectady) $(6,169,699) Our Lady of Mercy Medical Center $(6,373,000) Our Lady of Lourdes Memorial $(7,157,000) St. Charles and Rehabilitation Center $(7,770,000) Nassau University Medical Center $(8,504,000) Brooklyn Center $(8,532,000) St. Joseph's (Yonkers) $(8,871,450) Flushing Medical Center $(10,994,000) Corning $(11,196,251) Seton Health System $(12,275,000) NYU Downtown $(14,816,000) Franklin Medical Center $(15,339,000) St. Catherine of Siena Medical Center $(15,783,000) North General $(19,155,788) St. Luke's-Roosevelt Center $(25,937,000) Memorial for Cancer and Allied Diseases $(31,281,000) Staten Island University $(38,405,000) SVCMC/St. Vincent's and Medical Center $(40,951,000) Mount Sinai -Manhattan/Queens $(41,715,000) Westchester County Medical Center $(80,100,654) Source: NYSDOH report to Commission on Health Care Facilities in the 21 st Century www.nyhealthcarecommission.org Operating vs. Total Margins As noted previously, citing operating margins magnifies the losses reported by the hospital community. Operating margins don t tell the whole story though. Total margins reflect all revenue and costs including non patient-related revenue such as investment income, real estate income, government grants, and other ancillary operating income (lab services, collection agencies, parking garages, gift shops, cafeterias, etc.) received by the hospital. 5

According to the HANYS report, operating losses for New York hospitals in 2003 were $391 million. DOH data provide a completely different picture for both operating income and net income. While the HANYS report alleges an operating loss, DOH data shows operating profits of more than $103 million dollars and net income of nearly $903 million 3, comparable to the profits of New York health plans of which HANYS is so critical. Trend in Health Plan and Profit over Time (Includes public hospitals; excludes non-comparable data) $1,200,000,000 $1,000,000,000 $800,000,000 $600,000,000 $400,000,000 $200,000,000 $- $(200,000,000) 1998 1999 2000 2001 2002 2003 $(400,000,000) $(600,000,000) Operating Income Net Income HMO Margin HANYS own report, however, cannot hide two compelling facts: Operating losses shrank from $391 million in 2003 to a $127 million loss in 2004 4 a $264 million improvement in one year. When comparing 2004 operating losses to total margins, the $127 million loss represented an operating margin of minus 0.3%, while the reported total margins or the bottom line shows a net profit of 1.3%. 5 3 NYSDOH report to Commission on Health Care Facilities of the 21 st Century; all hospital data, excluding data from noncomparable category. 4 s on Life Supports: Seven Straight Years of Losses, page 3; Health Care Association of New York State; January 2006. 5 s on Life Supports: Seven Straight Years of Losses, page 7; Health Care Association of New York State; January 2006. 6

s vs. HMOs Profit vs. Surplus The hospital report chooses to compare hospital operating losses with HMO profits. This however is not an apples-to-apples type of comparison because it compares hospital operating margins to overall health plan finances. Moreover, New York law requires health plans operating in the state to maintain substantial financial reserves there is no similar requirement for hospitals. Under recently revised Subpart 98-1 Regulation governing HMO and prepaid health services plans operations, the reserve requirements have been substantially increased and HMOs will have to have a minimum of 12.5% of their annual net premium income in reserve, up from the previous requirement of 5%. In recent years, plans in the state have been building reserves in order to meet the new requirements. Additionally, heath plans reinvest much of their surplus back into the health care system. In recent years, plans have been investing significant dollars in health information technology (HIT) and the development of HIT systems that will benefit both providers and payers such as clinical data sharing projects and electronic health records. At the same time, plans are also seeking to respond to consumer and employer demands for greater health coverage. These efforts include expanding geographical areas as well as offering new coverage options by developing an increasing number of products that will better meet the needs of New York s diverse population while also providing health care affordability. Spending Growth Continues Spending on hospital services both inpatient and outpatient continues to rise. In fact, increases for hospital costs consistently outpace the rate of inflation. In 2004, hospital price increases accelerated for the seventh year in a row and the growth for spending on hospital services was more than double the rate of inflation. The increased Health Care Cost Drivers - 2004 spending on inpatient and outpatient services combined Inpatient Prescription accounted for 54% of 20% Drugs the total increase in 21% all health care spending. (Moreover, it was the fourth year in a row spending on hospital care accounted for more than 50% of the overall growth in health spending.) 6 care Physician Services 24% Outpatient 34% 54% Source: Tracking Health Care Costs Spending Growth Stabilizes at High Rate in 2004 ; Data Bulletin No. 29; Center for Studying Health Systems Change; June 2005 6 Tracking Health Care Costs: Spending Growth Stabilizes at High Rate in 2004 ; Data Bulletin No. 29; Center for Studying Health Systems Change; June 2005 7

New York s Higher Costs Many of the contributing factors to the less than rosy finances of New York hospitals are rooted in the fact that the system is so entrenched it has resisted change at almost every turn. Average length of stay (ALOS) remains stubbornly high and use rates are well above national levels. New York s ALOS is nearly 37% higher than the national average 7. High cost academic medical centers and a larger number of such centers than elsewhere in the nation. Discretionary spending by hospital management continues to soar as they seek to compete in a technological arms race a me too syndrome whereby every hospital feels it needs the very latest in equipment and programs. Failure (or unwillingness) to integrate and consolidate clinical and business operations. Increased bond indebtedness. A recent report from the state Comptroller shows New York s debt has grown from $14.4 billion in 1990 to $46.9 billion in 2004, with $43 billion of that debt bonded through public authorities. 8 The state Dormitory Authority is carrying more than $8 billion in bonds, loans and mortgage insurance for private, non-profit hospitals and nursing homes. A provision included in the 2005-06 state budget added another $750 million to that debt total. Another factor in hospital losses cited by the hospital community itself is reduced reimbursement from Medicare and Medicaid payers. Medicaid and Medicare account for approximately 50% of all hospital discharges in New York. 9 Therefore, reduced Medicaid and Medicare payments would impact hospitals bottom line. Although many hospitals point to the blow caused by the Balanced Budget Act of 1997, which sought to reduce the overall rate of increasing Medicare costs, it should be noted that what was reduced is the amount of the anticipated increase in reimbursements. States, including New York, have similarly reduced Medicaid reimbursements in an effort to control growth in the program. New York s Health Care System A Changing Landscape For nearly a decade, New York lawmakers and policy makers have been working to reshape the landscape of the state s health care system. Some reshaping has been occurring naturally. The past decade has seen tremendous clinical advances in medicine. Greater use of pharmaceuticals coupled with emerging technologies and many other factors have contributed to the migration of care out of the hospital and into less intensive settings. Despite the shifting landscape, and even as occupancy rates continue to decline, the hospital community has largely resisted change. 7 2003 data: New York State Department of Health report to the Commission on Health Care Facilities in the 21 st Century, November 2005; and Agency for Healthcare Research and Quality. 8 New York State s Debt Policy, A Need for Reform, Office of the New York State Comptroller, February 2005 9 New York State Department of Health, Statewide Planning and Research Cooperative System (SPARCS), 2003 hospital patient discharges. 8

representatives repeatedly denounce cuts in state funding, claiming such cuts are deteriorating the hospital system, threatening the viability of many institutions, and causing many to simply close. A closer look at the lengthy lists provided as proof of the impact of reduced funding, however, reveals that many of the closings were actually consolidations as hospital systems developed, as well as a shift from acute care beds to other treatment facilities behavioral health, diagnostic and treatment centers, rehabilitation and clinic sites. Additionally, at the same time hospitals were closing, there was a boom in the number of ambulatory surgery centers that now provide services and procedures that used to be done in hospital settings. The evolution of the health care landscape should result in some natural downsizing and continued consolidations. The hospital community should not be any different than the health plans, which have seen significant changes in recent years. Just a few years ago, the hospital community criticized health plans whose financial reserves fell below New York s statutory requirements, calling on state regulators to step up oversight efforts. During this time, there were numerous plan consolidations in New York. New higher reserve levels have also been imposed. As a result of these factors, the plans remaining in the state are stronger financially. Ironically, hospitals are now critical of plans that have improved their fiscal standings. Changing Landscape of New York Health Plans: Closings, Mergers & Consolidations 1996-2006 Travelers & MetLife merge become MetraHealth, then UnitedHealth Care Kaiser and Community Health Plan (CHP) merge Aetna and US Healthcare merge BetterHealth Plan and Fidelis Care merge CHUBB and HealthSource merge HealthCarePlan and Prepaid Health Plan (PHP) merge, becoming Univera Aetna US Healthcare announces purchase of NYLCare and Prudential Kaiser announces it is closing all Northeast operations; Capital District Physicians Plan (CDPHP) absorbs Kaiser s New York membership Partners announces it will close mid-2000 GENESIS and The Bronx Health Plan announce affiliation and joint operation by one owner, becomes Affinity Health Insurance Plan of New York (HIP) acquires Vytra Health Plans BlueCross BlueShield (BCBS) of the Rochester area, BCBS Utica Watertown and BCBS Finger Lakes combine as Excellus Excellus acquires Univera Excellus acquires Support Services Alliance (SSA) UnitedHealth Care acquires AmeriChoice AmeriGroup acquires CarePlus UnitedHealth Care and Oxford Health Plan merge HIP and Group Health Inc. (GHI) announce plans to merge MVP and PreferredCare announce merger Fidelis Care acquires CenterCare 9

Conclusion As it continues its efforts to reconfigure and right-size New York s health care system the Commission on Health Care Facilities in the 21 st Century must look beyond a broad brush portrayal of an industry in which all hospitals are suffering financial loss, and recognize there are both winners and losers. The challenge and opportunity before us is to reshape our health care system into one that meets the needs of all New Yorkers and, while doing so, treats all parties providers, payers, and patients fairly. The challenge and task is tremendous, but by working together is attainable. 10

Appendices

HOSPITAL PROFITS IN 2003 (Includes public hospitals as reported; excludes non-comparable data) Health and s Corporation $338,058,000 North Shore - LIJ $130,277,000 NewYork-Presbyterian $108,314,000 St. Francis - Roslyn $48,175,000 Erie County Medical Center $37,360,887 Univ. Hosp. and Med. Ct.r SUNY at Stonybrook $37,179,000 Strong Memorial $30,847,940 Vassar Brothers Medical Center $27,444,795 Cayuga Medical Center at Ithaca $24,085,202 Univ. Hosp. SUNY Health Science Ctr (Syracuse) $23,093,620 Mary Imogene Bassett $22,411,980 New York Methodist $20,408,000 Winthrop-University $20,366,903 Niagara Falls Memorial Medical Center $20,011,347 Albany Medical Center $19,844,146 Univ. Hosp. of Brooklyn SUNY Hlth Science Center $19,188,129 Montefiore Medical Center $18,599,000 South Nassau Communities $18,211,533 Rochester General $17,800,061 St. Barnabas $17,293,372 Kaleida Health System $17,106,000 Wyckoff Heights Medical Center $16,023,000 St. Peter's, Albany $15,553,000 Arnot-Ogden Medical Center $15,291,871 United Health Services s $14,976,944 Monroe Community $12,951,783 Glens Falls $12,427,451 Lawrence $10,312,714 Huntington $10,136,000 Brookdale University and Medical Center $9,909,000 for Special Surgery $9,746,000 St. Joseph's Health Center (Syracuse) $9,728,970 Geneva General Hosp/Soldiers & Sailors $9,474,000 Cornwall $9,175,646 Bon Secours Community $9,069,449 Brookhaven Memorial Medical Center $9,007,390 Ellis $8,904,977 Crouse $8,021,956 Samaritan (Rensselaer) $7,702,000 Southside $7,601,219 Oneida Healthcare Center $7,248,616 Helen Hayes $6,498,618 St. Mary's at Amsterdam $6,476,000 Champlain Valley Physicians $6,468,424 Nyack $6,447,208 Highland of Rochester $6,329,672 White Plains Center $6,185,823 Massena Memorial $6,158,958 Saratoga $6,150,317 Lenox Hill $6,069,000 Maimonides Medical Center $5,968,000 Sunnyview and Rehabilitation Center $5,940,643 Phelps Memorial Center $5,759,000 Faxton-St. Luke's Healthcare $5,745,415 Bronx-Lebanon Center $5,702,500 Sound Shore Medical Center of Westchester $4,603,000 Episcopal Health Services (St John's Episcopal) $4,592,000 Hudson Valley Center $4,480,341 Kingsbrook Jewish Medical Center $4,076,000 Albany Memorial $3,923,000 New York Eye and Ear Infirmary $3,923,000 Good Samaritan Medical Center $3,896,000 Park Ridge - St. Mary's Hosp. of Sisters of Charity $3,889,000 Adirondack Medical Center $3,699,641 NYU s Center $3,675,000 Cortland Memorial $3,615,220 Columbia Memorial $3,582,334 Long Beach Medical Center $3,318,472 Orange Regional Medical Center $3,016,026 Victory Memorial $2,953,023 Interfaith Medical Center $2,816,000 John T. Mather Memorial $2,776,538 Kenmore Mercy $2,677,192 Oswego $2,481,984 Nicholas H. Noyes Memorial $2,452,157 Carthage Area $2,390,648 St. Francis -Poughkeepsie $2,248,705 St. John's Riverside Hosp - St. John's/Park Care $2,205,110 Long Island College $2,184,000 Lutheran Medical Center $2,114,000 F.F. Thompson $2,038,753 St. Vincent's Midtown $1,992,000 Nathan Littauer & Nursing Home $1,879,640 Northern Westchester $1,847,571 New York Community $1,739,000 Sisters of Charity $1,726,078 Capital Region Geriatric Center $1,697,300 Lewis County General $1,597,696 Alice Hyde $1,577,726 St. Joseph of Cheektowaga $1,494,692 Clifton Springs and Clinic $1,459,873 Albany Medical Center-South Clinical Campus $1,440,897 Putnam Center $1,330,326 Claxton-Hepburn Medical Center $1,167,308 River $1,152,372 Blythedale Children's $1,128,671 Roswell Park Cancer Institute $1,106,408 A.O. Fox Memorial $1,097,086 St. Joseph's (Elmira) $1,044,000 Mercy of Buffalo $909,580 Rome Memorial $901,478 Moses-Ludington $874,490 Burke Rehabilitation $830,490 Community Gen. Hosp of Greater Syracuse $745,042 Northern Dutchess $741,410 Calvary $688,100 Elizabethtown Community $686,909 Benedictine $684,385 Mount Vernon $628,714 Central Suffolk $591,107 Canton-Potsdam $582,362 Medina Memorial $416,247 Community Memorial $371,344 Bassett Regional of Schoharie County $370,375 Brooks Memorial $308,374 Inter-Community Memorial $276,894 Via Health of Wayne $250,344 Samaritan Medical Center $237,940 Westfield Memorial $185,456 Jamaica Medical Center $142,000 Community at Dobbs Ferry $122,506 Jones Memorial $115,666 Rockefeller University $92,807 Auburn Memorial $55,512 O'Connor $44,417 Data Source: NYSDOH data provided to the Commission on Health Care Facilities in the 21 st Century. www.nyhealthcarecommission.org

HOSPITAL LOSSES IN 2003 15 HOSPITALS COMPRISE MORE THAN 75% OF ALL LOSSES (Includes public hospitals; excludes non-comparable data) Westchester County Medical Center $(80,100,654) Mount Sinai -Manhattan/Queens $(41,715,000) SVCMC/St. Vincent's and Medical Center $(40,951,000) Staten Island University $(38,405,000) Memorial for Cancer and Allied Diseases $(31,281,000) St. Luke's-Roosevelt Center $(25,937,000) North General $(19,155,788) St. Catherine of Siena Medical Center $(15,783,000) Franklin Medical Center $(15,339,000) NYU Downtown $(14,816,000) Seton Health System $(12,275,000) Corning $(11,196,251) Flushing Medical Center $(10,994,000) St. Joseph's (Yonkers) $(8,871,450) Brooklyn Center $(8,532,000) Nassau University Medical Center $(8,504,000) St. Charles and Rehabilitation Center $(7,770,000) Our Lady of Lourdes Memorial $(7,157,000) Kingston $(6,488,932) Our Lady of Mercy Medical Center $(6,373,000) St. Clare's (Schenectady) $(6,169,699) Mercy Medical Center $(6,106,000) New York Westchester Square Medical Center $(5,520,000) Our Lady of Victory $(4,727,809) Mount St. Mary's $(3,930,000) St. James Mercy $(3,700,389) New York Medical Center of Queens $(3,579,000) New Island $(3,547,429) Beth Israel Medical Center $(3,480,000) Olean General $(3,436,707) Brunswick Center $(3,124,082) Peninsula Center $(2,809,269) New York United Medical Center $(2,806,000) TLC Health Network $(2,491,458) Summit Park $(2,459,743) Woman's Christian Association $(2,217,956) Chenango Memorial $(2,125,125) Cabrini Medical Center $(1,968,000) Bellevue Maternity $(1,879,436) Catskill Regional Medical Center-Harris Div./Hermann Div $(1,877,162) Westchester-Ellenville $(1,708,713) St. Elizabeth Medical Center $(1,697,574) Southampton $(1,138,000) Margaretville Memorial $(1,017,055) Amsterdam Memorial $(943,948) Albert Lindley Lee Memorial $(889,638) (The) $(858,097) Lakeside Memorial $(705,530) Eastern Long Island $(615,767) Manhattan Eye, Ear & Throat $(514,000) Lockport Memorial $(498,012) Little Falls $(497,219) Cuba Memorial $(483,427) Schuyler $(442,240) Ira Davenport Memorial $(419,035) Delaware Valley $(366,465) for Joint Diseases Orthopaedic Institute $(366,000) Clifton-Fine $(326,312) Bertrand Chaffee $(303,239) United Memorial Medical Center $(233,508) Edward John Noble $(183,805) Data Source: NYSDOH data provided to the Commission on Health Care Facilities in the 21 st Century www.nyhealthcarecommission.org

REGIONAL SUMMARY OF HOSPITAL NET INCOME FOR 2003 LONG ISLAND Net Income North Shore - LIJ $130,277,000 St. Francis - Roslyn $48,175,000 University and Med Ctr at Stonybrook $37,179,000 Winthrop-University $20,366,903 South Nassau Communities $18,211,533 Huntington $10,136,000 Brookhaven Memorial Medical Center $9,007,390 Southside $7,601,219 Episcopal Health Services (St John's Episcopal) $4,592,000 Good Samaritan Medical Center $3,896,000 Long Beach Medical Center $3,318,472 John T. Mather Memorial $2,776,538 Central Suffolk $591,107 Eastern Long Island $(615,767) Southampton $(1,138,000) Brunswick Center $(3,124,082) New Island $(3,547,429) Mercy Medical Center $(6,106,000) St. Charles and Rehabilitation Center $(7,770,000) Nassau University Medical Center $(8,504,000) Franklin Medical Center $(15,339,000) St. Catherine of Siena Medical Center $(15,783,000) WESTERN NEW YORK Net Income Erie County Medical Center $37,360,887 Niagara Falls Memorial Medical Center $20,011,347 Kaleida Health System $17,106,000 Kenmore Mercy $2,677,192 Sisters of Charity $1,726,078 St. Joseph of Cheektowaga $1,494,692 Roswell Park Cancer Institute $1,106,408 Mercy of Buffalo $909,580 Medina Memorial $416,247 Brooks Memorial $308,374 Inter-Community Memorial $276,894 Westfield Memorial $185,456 Jones Memorial $115,666 Wyoming County Community $(21,531) United Memorial Medical Center $(233,508) Bertrand Chaffee $(303,239) Cuba Memorial $(483,427) Lockport Memorial $(498,012) Woman's Christian Association $(2,217,956) TLC Health Network $(2,491,458) Olean General $(3,436,707) Mount St. Mary's $(3,930,000) Our Lady of Victory $(4,727,809) HUDSON VALLEY Net Income Vassar Brothers Medical Center $27,444,795 Lawrence $10,312,714 Cornwall $9,175,646 Bon Secours Community $9,069,449 Helen Hayes $6,498,618 Nyack $6,447,208 White Plains Center $6,185,823 Phelps Memorial Center $5,759,000 Sound Shore Medical Center of Westchester $4,603,000 Hudson Valley Center $4,480,341 Orange Regional Medical Center $3,016,026 St. Francis -Poughkeepsie $2,248,705 St. John's Riverside Hosp - St. John's/Park Care $2,205,110 Northern Westchester $1,847,571 Putnam Center $1,330,326 Blythedale Children's $1,128,671 Burke Rehabilitation $830,490 Northern Dutchess $741,410 Benedictine $684,385 Mount Vernon $628,714 Community at Dobbs Ferry $122,506 Delaware Valley $(366,465) (The) $(858,097) Margaretville Memorial $(1,017,055) Westchester-Ellenville $(1,708,713) Catskill Regional Med Ctr-Harris/Hermann Div $(1,877,162) Summit Park $(2,459,743) New York United Medical Center $(2,806,000) Kingston $(6,488,932) St. Joseph's (Yonkers) $(8,871,450) Westchester County Medical Center $(80,100,654) NORTHERN NEW YORK Net Income Mary Imogene Bassett $22,411,980 Albany Medical Center $19,844,146 St. Peter's, Albany $15,553,000 Glens Falls $12,427,451 Ellis $8,904,977 Samaritan (Rensselaer) $7,702,000 St. Mary's at Amsterdam $6,476,000 Champlain Valley Physicians $6,468,424 Saratoga $6,150,317 Sunnyview and Rehabilitation Center $5,940,643 Albany Memorial $3,923,000 Adirondack Medical Center $3,699,641 Columbia Memorial $3,582,334 Nathan Littauer & Nursing Home $1,879,640 Capital Region Geriatric Center $1,697,300 Alice Hyde $1,577,726 Albany Medical Center-South Clinical Campus $1,440,897 A.O. Fox Memorial $1,097,086 Moses-Ludington $874,490 Elizabethtown Community $686,909 Bassett Regional of Schoharie County $370,375 Amsterdam Memorial $(943,948) Bellevue Maternity $(1,879,436) St. Clare's (Schenectady) $(6,169,699) Seton Health System $(12,275,000) Data Source: NYSDOH data provided to the Commission on Health Care Facilities in the 21 st Century www.nyhealthcarecommission.org

REGIONAL SUMMARY OF HOSPITAL NET INCOME FOR 2003 NEW YORK CITY Net Income Health and s Corporation $338,058,000 NewYork-Presbyterian $108,314,000 New York Methodist $20,408,000 Univ. Hosp. of Brooklyn SUNY Health Science Ctr $19,188,129 Montefiore Medical Center $18,599,000 St. Barnabas $17,293,372 Wyckoff Heights Medical Center $16,023,000 Brookdale University and Medical Center $9,909,000 for Special Surgery $9,746,000 Lenox Hill $6,069,000 Maimonides Medical Center $5,968,000 Bronx-Lebanon Center $5,702,500 Kingsbrook Jewish Medical Center $4,076,000 New York Eye and Ear Infirmary $3,923,000 NYU s Center $3,675,000 Victory Memorial $2,953,023 Interfaith Medical Center $2,816,000 Long Island College $2,184,000 Lutheran Medical Center $2,114,000 St. Vincent's Midtown $1,992,000 New York Community $1,739,000 Calvary $688,100 Jamaica Medical Center $142,000 Rockefeller University $92,807 for Joint Diseases Orthopaedic Institute $(366,000) Manhattan Eye, Ear & Throat $(514,000) Cabrini Medical Center $(1,968,000) Peninsula Center $(2,809,269) Beth Israel Medical Center $(3,480,000) New York Medical Center of Queens $(3,579,000) New York Westchester Square Medical Center $(5,520,000) Our Lady of Mercy Medical Center $(6,373,000) Brooklyn Center $(8,532,000) Flushing Medical Center $(10,994,000) NYU Downtown $(14,816,000) North General $(19,155,788) St. Luke's-Roosevelt Center $(25,937,000) Memorial for Cancer and Allied Diseases $(31,281,000) Staten Island University $(38,405,000) SVCMC/St. Vincent's and Med. Ctr. $(40,951,000) Mount Sinai -Manhattan/Queens $(41,715,000) CENTRAL NEW YORK Net Income Strong Memorial $30,847,940 Cayuga Medical Center at Ithaca $24,085,202 Univ. Hosp. SUNY Health Science Ctr (Syracuse) $23,093,620 Rochester General $17,800,061 Arnot-Ogden Medical Center $15,291,871 United Health Services s $14,976,944 Monroe Community $12,951,783 St. Joseph's Health Center (Syracuse) $9,728,970 Geneva General Hosp./Soldiers & Sailors $9,474,000 Crouse $8,021,956 Oneida Healthcare Center $7,248,616 Highland of Rochester $6,329,672 Massena Memorial $6,158,958 Faxton-St. Luke's Healthcare $5,745,415 Park Ridge -St. Mary's Hosp. of Sisters of Charity $3,889,000 Cortland Memorial $3,615,220 Oswego $2,481,984 Nicholas H. Noyes Memorial $2,452,157 Carthage Area $2,390,648 F.F. Thompson $2,038,753 Lewis County General $1,597,696 Clifton Springs and Clinic $1,459,873 Claxton-Hepburn Medical Center $1,167,308 River $1,152,372 St. Joseph's (Elmira) $1,044,000 Rome Memorial $901,478 Community General of Greater Syracuse $745,042 Canton-Potsdam $582,362 Community Memorial $371,344 Via Health of Wayne $250,344 Samaritan Medical Center $237,940 Auburn Memorial $55,512 O'Connor $44,417 Edward John Noble $(183,805) Clifton-Fine $(326,312) Ira Davenport Memorial $(419,035) Schuyler $(442,240) Little Falls $(497,219) Lakeside Memorial $(705,530) Albert Lindley Lee Memorial $(889,638) St. Elizabeth Medical Center $(1,697,574) Chenango Memorial $(2,125,125) St. James Mercy $(3,700,389) Our Lady of Lourdes Memorial $(7,157,000) Corning $(11,196,251) Data Source: NYSDOH data provided to the Commission on Health Care Facilities in the 21 st Century www.nyhealthcarecommission.org

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