Application

171204
Number:
Facility Name: Sisters of Charity Hospital
Project Relocate an existing extension clinic from 3730 Sheridan Drive, Amherst to
Description: 910 Millersport Highway, Amherst

Architectural and Engineering Facility

Created By:
Planning on 03/21/2017
Correspondence Type: Request for Additional Information
Recipient: Applicant
Correspondence
All
Visible To:
Message:
Please submit an Architectural Narrative, per Schedule 6 and 10 CRR-NY 710.2, descriptive
of the program and the proposed provisions to comply with applicable construction standards
and other pertinant regulation. Thank you.

Created By: Applicant on 03/31/2017

Correspondence Type: Request for Additional Information
Recipient: Architectural and Engineering Facility Planning
Correspondence Visible To: All
Message:
Architectural narrative attached.
Attachments:
Schedule LRA 6 Architectural Narrative.doc **

Architectural and Engineering Facility

Created By:
Planning on 04/11/2017
Waiting for Information
Correspondence Type: Request for Additional Information
Recipient: Applicant
Correspondence Visible To: All
Message:
Please respond to the attached request for additional information, including 10 comments. In preparing your response,
please repeat each enumerated comment and place your written response beneath that item. Please identify specific
drawing numbers and details showing information that may be referenced in your reply. Thank you.
Attachments:
RFAI-1_DSG_171204_2017-04-11_10 items.pdf **
 Application
171204
Number:
Facility Name: Sisters of Charity Hospital
Project Relocate an existing extension clinic from 3730 Sheridan Drive, Amherst to
Description: 910 Millersport Highway, Amherst

Financial Analysis and

Created By:
Review on 03/21/2017
Correspondence Type: Request for Additional Information
Recipient: Applicant
Correspondence
All
Visible To:
Message:
Please revise the lease, it appears that there is a typo in the annual lease amount, it is showing
as $858,000 when it looks like it should be $85,800. Please revise and resubmit an executed
lease.

Created By: Applicant on 03/21/2017

Correspondence Type: Request for Additional Information
Recipient: Financial Analysis and Review
Correspondence Visible To: All
Message:
The amount of $858,000 is not the annual lease amount, it reflects the 10 year gross lease amount with no
escalations. Monthly payment are $7,150.00.

Created By: Financial Analysis and Review on 03/21/2017

Correspondence Type: Request for Additional Information
Recipient: Applicant
Correspondence Visible To: All
Message:
What is the budget for years 1 and 3 based on is that in addition to current years operations or is it total operations of the
the mobile unit.

Created By: Applicant on 03/22/2017

Correspondence Type: Request for Additional Information
Recipient: Financial Analysis and Review
Correspondence Visible To: All
Message:
Currently the clinic at 3730 Sheridan Drive is authorized for methadone treatment on our Operating Certificate, but we are
providing this service at that location. With our relocation 3/10 of a mile to 910 Millersport Highway, we plan on providing
methadone treatment at our new location. With daily treatments for methadone, the visits and revenue increase
accordingly.

Created By: Applicant on 03/22/2017

Correspondence Type: Request for Additional Information
Recipient: Financial Analysis and Review
Correspondence Visible To: All
Message:
Currently the clinic at 3730 Sheridan Drive is authorized for methadone treatment on our Operating
Certificate, but we are NOT providing this service at that location. With our relocation 3/10 of a mile to
910 Millersport Highway, we plan on providing methadone treatment at our new location. With daily
treatments for methadone, the visits and revenue increase accordingly.

Please disregard earlier reply. Thank you.

Created By: Financial Analysis and Review on 03/22/2017

Correspondence Type: Request for Additional Information
Recipient: Gallo, James
Correspondence Visible To: All
Message:
That doesn't answer the question. The question is if the year one and three data is incremental or not. We need to know if
this is for the full operation of the facility or not.

Created By: Applicant on 03/29/2017

Correspondence Type: Request for Additional Information
Recipient: Financial Analysis and Review
Correspondence Visible To: All
Message:
We have updated Schedule LRA_7. This updated schedule now reflects Year 1 & Year 3 incremental: visits, revenue and
expense.

Attachments:
LRA Schedule 7 Revised 3-29-2017.pdf **
 Page 1 of 1

Application Number:171204

Facility Name: Sisters of Charity Hospital

Project Description: Relocate an existing extension clinic from 3730 Sheridan Drive, Amherst to 910
Millersport Highway, Amherst

Executive Summary

Sisters of Charity Hospital is requesting to relocate their extension clinic. It is currently located at 3730
Sheridan Drive and wish to move 3/10 of a mile around the corner to 910 Millersport Highway. Both
locations are within the 14226 zip code and Town of Amherst, NY. All services on the operating
certificate are moving to the new site. The new location will be called: Sisters Health Center
Amherst.

https://commerce.health.state.ny.us/doh2/applinks/nysecon/projectExecutiveSummary.action 4/19/2017
 Outpatient Services Total Current Year First Year Incremental Third Year Incremental
Source of Revenue Net Revenue* Net Revenue* Net Revenue*
Visits Visits Visits
Yo Dollars($) % Dollars($) % Dollars($)
Commercial Fee for
Service
1,744 44.7 144,530 4,273 25.2 106,665 8,348 24.2 196,939
Managed
Care
Medicare Fee for
Service
384 9.8 31,823 2,277 11.8 50,068 4,518 11.9 97,067
Managed
Care
173 4.4 14,337 645 3.7 15,581 1,262 3.5 28,871
Medicaid Fee for
Service
1,181 30.3 97,872 10,019 50.8 214,934 19,924 51.6 420,431
Managed
ICare
286 7.3 23,702 723 3.5 14,906 1,458 3.8 30,887
Private Pay 136 3.5 11,271 967 5.0 20,984 1,922 5.0 40,881
OASAS
bMH
Charity Care
Bad Debt
IAII Other
!Total 3,904 100% 323,535 18,904 100% 423,138 37,432 100% 815,076

Total of Inpatient and

Outpatient Services

Title of Attachment Filename of attachment

1. In an attachment, provide the basis
and supporting calculations for all
revenues by payor.
2. In an attachment, provide the basis
for charity care.

*Net of Deductions from Revenue

(Rev. 7/2015)

3
 Outpatient Services Total Current Year First Year Incremental Third Year Incremental
Source of Revenue Net Revenue* Net Revenue* Net Revenue*
Visits Visits Visits
Yo Dollars($) % Dollars($) % Dollars($)
Commercial Fee for
1,744 44.7 144,530 6,017 33.6 251,194 10,092 30.0 341,469
Service
Managed
Care
Medicare Fee for
384 9.8 31,823 2,661 11.0 81,891 4,902 11.3 128,890
Service
Managed
173 4.4 14,337 818 4.0 29,918 1,435 3.8 43,208
Care
Medicaid Fee for
1,181 30.3 97,872 11,200 41.9 313,135 21,105 45.5 518,692
Service
Managed
286 7.3 23,702 1,009 5.2 38,607 1,744 4.8 54,589
Care
Private Pay 136 3.5 11,271 159 4.3 32,255 168 4.6 52,152
PASAS
PMH
Charity Care
Bad Debt
All Other
rrotal 3,904 100% 323,535 21,864 100% 747,000 39,446 100% 1,139,000

Total of Inpatient and

Outpatient Services

Title of Attachment Filename of attachment

1. In an attachment, provide the basis
and supporting calculations for all
revenues by payor.
2. In an attachment, provide the basis
for charity care.

*Net of Deductions from Revenue

(Rev. 7/2015)

3
Schedule LRA 6 CON #171204 Schedule 6
State of New York Department of Health/Office of Health Systems Management
Catholic Health System Facility Planning Project No.: 2016-183-FP-HOS-SOC-STR

Architectural Narrative

Instructions: The purpose of the Project Narrative is to give the reviewer a conceptual understanding of the proposal.
The Narrative should summarize the key elements of the proposed project. Details will be contained in the appropriate
schedules of the application.

Project: Scope of Work for the Renovation of 3,808 gross square feet

Interim Life Safety Plan Narrative: Not Applicable. The building will not be occupied with any tenants during its
renovation.

The work in this narrative is a description of the Work to be accomplished by the landlord. No building construction of
any type will be implemented the Catholic Health System or Sisters of Charity Hospital.

The overall project consists of a renovation of a single story 3,808 gross square foot building that is being developed for
lease by the landlord for lease as general office space for substance abuse counseling and treatment. The work by the
landlord includes the demolition of the entire interior plan. The construction will include all new partitions and repairs to
the exterior as required. In addition, there will be installed new Heating, Ventilating and Air Conditioning equipment
(HVAC), completely new electrical wiring and equipment panels, and plumbing fixtures. Significant site work improvements
in the form of repaired pavement, increased landscape elements and board-on-board wood fencing.

Sisters of Charity Hospital will occupy the entire building and be the only tenant. The program space includes the following:
First Floor:
o Building Tenant Shared Support Spaces 3,808 gross square feet approximately
Vestibule (Main Entrance) C3
Waiting C4
Reception C5
Group Room 1 Directors Office
Group Room 2 Environmental Services Closet
Dispensary with Narcotics Safe Supply Room
Room Staff Break Room
Electrical / IT Closet Staff Toilet Male
Patient Toilet Rooms (2) Staff Toilet Female
Counseling Rooms Exam Room
C1 Clean Holding
C2 Soiled Holding

Construction within the new clinic shall include work in the following areas as they are related to the Master
Specification format. Work will be accomplished involving: Division 2 Site Work, Division 3 Concrete, Division 6 Wood
and Plastics, Division 7 Thermal and Moisture Protection, Division 8 Openings, Division 9 Finishes, Division 10 Specialties,
Division 12 Furnishings, Division 22 Plumbing, Division 23 HVAC, Division 26 Electrical, Division 27 Communications,
Division 28 Electrical Safety and Security, Division 31 Earthwork, and Division 32 Exterior Improvements.

The general construction pertaining to interior modifications will include new vinyl composition floor tile and resilient
base, new Class A suspended acoustic panel ceilings, 3-7 wood doors, painted and hollow metal doors with new frames
and hardware.

Page 1 of 3
Schedule LRA 6 CON #171204 Schedule 6
State of New York Department of Health/Office of Health Systems Management
Catholic Health System Facility Planning Project No.: 2016-183-FP-HOS-SOC-STR

Architectural Narrative

For areas including soiled holding, the interior modifications may include, but are not limited to, homogeneous resilient
sheet flooring, gypsum board partitions and gypsum board ceilings with latex paint.

Staff and visitor toilet rooms are planned to have vinyl composition floor tile, gypsum board partitions and ceilings of
acoustical tile.

The receptionist office will utilize all new vinyl composition floor tile and resilient base, and plastic laminate millwork
with plastic laminate counters.

Offices and Group Rooms will utilize level loop carpet.

Mechanical
Existing HVAC Unit with a gas fired furnace with an A/C coil.

Electrical
The existing service equipment will be replaced with new a 200Amp 3Phase4W 120/120BV electrical panel.

Fire Alarm System

Local smoke, fire and CO2 detectors will be placed as required by the applicable codes. Audio/visual devices will provide
coverage in all open areas, corridors, and restrooms.

Site Lighting
All existing building mounted lighting fixtures will be replaced. The fixture style will be coordinated with the architect
and owner. Additional exterior building mounted fixtures may be added to provide general and security lighting in areas
that are deficient.

Plumbing
Domestic Water System: Water shall be routed to the various fixtures and water heaters via piping systems. The existing
water service will provide for the buildings domestic hot and cold water. The water service shall be provided with a
water meter, strainer, and an approved Watts LF009-QT Reduced Pressure Zone (RPZ) Backflow Prevention device.

New high efficiency gas fired hot water heaters will be provided.

A complete domestic cold water system shall be provided throughout the building. Water piping shall be sized based on
the number of water fixture units connected, and the minimum flow pressure required at each fixture or piece of
equipment.

Cold water piping shall be insulated with fiberglass pipe insulation with vapor barrier to prevent sweating. Hot water
piping shall be insulated with molded sectional fiberglass pipe insulation to prevent heat loss in accordance with the
latest energy standards.

Waste and vent piping shall be sized based on the number of fixture units connected. Pipe is anticipated to be feed by
gravity to maintain a positive slope with a minimum velocity. Sanitary drainage system shall be routed by gravity to the
site sanitary sewer system.

Page 2 of 3
Schedule LRA 6 CON #171204 Schedule 6
State of New York Department of Health/Office of Health Systems Management
Catholic Health System Facility Planning Project No.: 2016-183-FP-HOS-SOC-STR

Architectural Narrative

Plumbing Fixtures
Water Closets shall be either floor mounted or wall hung, pressure flush toilet, elongated, with manual type flush valves
and carriers. Each public toilet room shall have a minimum of one fixture mounted for ADA compliance. Floor mounted
water closets flush siphon jet, elongated vitreous china with valves where indicated.

Lavatories shall be wall hung as indicated on the drawings. Faucet shall be chrome plated and manual type hardware.
Each toilet room shall have a minimum of one fixture mounted for ADA compliance and shall include water supply and
ADA compliant screening in front of plumbing.

Page 3 of 3