2022-08-15T15:39:48-05:00 2021-09-30 161226221 FUST CHARLES CHAMBERS LLP 5784 WIDEWATERS PARKWAY SYRACUSE NY 13214 990 2020-10-01 141364513 ELIZABETHTOWN COMMUNITY HOSPITAL ELIZ 5188736377 75 PARK STREET PO BOX 277 ELIZABETHTOWN NY 12932 ALAN R CHARDAVOYNE CHIEF FINANCIAL OFFICER 5188733136 2022-08-09 1 ALAN CHARDAVOYNE 999009999 THOMAS J GIUFRE P00841958 3154463600 2022-08-09 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z ROBERT ORTMYER 75 PARK STREET PO BOX 277 ELIZABETHTOWN NY 12932 55058492 0 X ECH.ORG X 1926 NY MISSION: TO PROMOTE WELLNESS IN THE COMMUNITIES WE SERVE BY PROVIDING QUALITY HEALTHCARE WITH SKILL, COMPASSION AND DIGNITY. 12 12 395 0 -247443 0 8462318 3123307 40110011 45465960 68801 192441 5446650 5886761 54087780 54668469 0 0 0 0 24414852 24676319 0 0 0 21619025 26016125 46033877 50692444 8053903 3976025 81320640 83172080 39293909 35545645 42026731 47626435 X THE MISSION OF ECH IS TO PROMOTE HEALTH AND WELLNESS IN THE COMMUNITY AND TO PROVIDE QUALITY HEALTHCARE WITH SKILL, COMPASSION AND DIGNITY. IN CREATING OUR COMMUNITY BENEFITS PLAN WE KEEP THIS MISSION IN MIND, CONTINUALLY LOOKING FOR WAYS TO MEET COMMUNITY HEALTH NEEDS AND TO BE A GOOD NEIGHBOR. ECH IS DRIVEN BY PEOPLE WHO LIVE IN THE SERVICE AREA AND WHO WANT TO SEE THEIR FRIENDS AND NEIGHBORS GET THE CARE AND SERVICES THEY NEED. 0 0 6840263 7652994 INPATIENT ACUTE UNIT AND SUBACUTE REHABILITATIVE (SWING BED) INPATIENT PROGRAM:A 25-BED NURSING UNIT PROVIDING ACUTE AND SUB ACUTE (SWING BED)CARE. THE SMALLER ATMOSPHERE CREATES A CLOSER BOND BETWEEN THE PATIENT AND PROFESSIONALS ENCOURAGING OPTIMAL HEALING AND COMPASSIONATE CARE. THE SUB-ACUTE PROGRAM IS VITAL TO AREA RESIDENTS BECAUSE FOLLOWING A HIP-REPLACEMENT, KNEE-SURGERY OR CARDIAC OPERATION, RECUPERATION AND THERAPY CAN BE DONE AT ELIZABETHTOWN COMMUNITY HOSPITAL, SAVING THE FAMILY THE TIME AND EXPENSE OF TRAVEL. THE PROGRAM PROVIDES ONE-ON-ONE THERAPEUTIC CARE. 7324411 11555328 CLINIC SERVICES:ECH OPERATES THE ELIZABETHTOWN COMMUNITY HEALTH CENTER, WESTPORT HEALTH CENTER LOCATED IN WESTPORT,NY, THE HIGH PEAKS HEALTH CENTER LOCATED IN WILMINGTON, NY, THE SMITH HOUSE HEALTH CENTER LOCATED IN WILLSBORO, NY, THE AU SABLE FORKS HEALTH CENTER, LOCATED IN AU SABLE FORKS, NY, AND CROWN POINT HEALTH CENTER, LOCATED IN CROWN POINT, NY. ECH OPERATES AN OUTPATIENT CHEMOTHERAPY PROGRAM, WHICH INCLUDES UPDATED INFUSION EQUIPMENT MAKING IT POSSIBLE TO PROVIDE SAFE AND EFFICIENT METHODS FOR CHEMOTHERAPY AND BLOOD-RELATED INFUSIONS. IN ADDITION, THE NEW SPECIALIZED VENTILATING HOOD ENABLES THE PREPARATION OF CHEMOTHERAPY SOLUTIONS ON-SITE. THIS IS A GREAT CONVENIENCE FOR CANCER PATIENTS, SAVING THEM THE 90-MINUTE ROUND-TRIP DRIVE TO THE CLOSEST CHEMOTHERAPY FACILITY. 10645730 11274326 EMERGENCY ROOM SERVICES:ECH'S PRIOR YEARS EXPANSION OF THE EMERGENCY ROOM ADDED NEW STATE OF THE ART TRAUMA ROOMS, A TELEMENTRY SYSTEM FOR PATENT MONITORING, A REGISTRATION AREA DESIGNED FOR PATIENT PRIVACY AND CONFIDENTIALITY AND NEW WAITING AREAS FOR FAMILIES AND THEIR LOVED ONES.THE HOSPITAL OPERATES AN ALL-DIGITAL RADIOLOGY DEPARTMENT, ALLOWING TECHNOLOGISTS TO OBTAIN PATIENT IMAGES ANYWHERE IN THE HOSPITAL. IN THE EVENT OF A SIGNIFICANT EMERGENCY WITH MULTIPLE TRAUMAS, THE UNIT CAN BE USED ANYWHERE IN THE BUILDING. WHEN THE HOSPITAL IS FACED WITH AN UNUSUAL SURGE IN EMERGENCY ROOM TRAUMA CASES, HOSPITAL PROCEDURES ENABLE STAFF TO TRIAGE IN NONTRADITIONAL AREAS OF THE HOSPITAL. 18345012 21084444 18345012 21084444 43155416 1 1 0 0 0 0 0 0 0 1 1 1 0 0 1 1 1 1 0 0 0 0 0 0 1 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 21 0 1 395 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 12 12 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X ALAN CHARDAVOYNE CFO ECH 5188733136 75 PARK STREET PO BOX 277 ELIZABETHTOWN NY 12932 DOMINIC EISINGER PHD CHAIR 0.80 X X 0 0 0 MEGAN MURPHY BOARD MEMBER 0.80 X 0 0 0 MARTIN NEPHEW BOARD TREASURER 0.80 X X 0 0 0 SUSAN ALLOTT RN VICE CHAIR 0.80 X X 0 0 0 H NICOLAS MULLER III PHD BOARD SECRETARY 0.80 X X 0 0 0 GAYLE ALEXANDER BOARD MEMBER 0.80 X 0 0 0 STEVE CACCHIO BOARD MEMBER 0.80 X 0 0 0 MARGARET EMERY-GINN BOARD MEMBER 0.80 X 0 0 0 ROLAND J ALLEN BOARD MEMBER 0.80 X 0 0 0 MICHAEL G DISKIN BOARD MEMBER 0.80 X 0 0 0 DAVID SHELMIDINE BOARD MEMBER 0.80 X 0 0 0 EVAN GEORGE BOARD MEMBER 0.80 X 0 0 0 ALAN CHARDAVOYNE CFO 40.00 X 231166 0 10172 NOLAN MATTHEW COO 40.00 X 181007 0 6703 JOHN REMILLARD PRESIDENT 40.00 X 352548 0 9908 JULIE TROMBLEE CNO 40.00 X 175050 0 6625 DAVID CLAUSS MEDICAL DIRECTOR 40.00 X 323932 0 0 ROBERT ORTMYER PRESIDENT 40.00 X 0 0 0 ROB DEMURO MD PHYSICIAN 40.00 X 377423 0 35252 PASQUALINO CAPUTO PHISICIAN 40.00 X 305499 0 35641 MARY HALLORAN PHYSICIAN 40.00 X 314174 0 37871 DAVID MARKOWITZ ER PHYSICIAN 40.00 X 270550 0 695 JAMES RICE ER PHYSICIAN 40.00 X 258400 0 15219 2789749 0 158086 57 0 1 0 0 455590 2667717 3123307 CRITICAL ACCESS HOSPITAL 900099 45465960 45465960 45465960 187441 187441 156770 380109 -223339 -223339 -247443 24104 5000 0 5000 5000 5000 18882 9914 8968 8968 VITAL ACCESS PROGRAM 900099 2915939 2915939 340B REVENUE 900099 2468956 2468956 716237 716237 6101132 54668469 51567092 -247443 225513 1297110 1297110 17793244 15688197 2105047 951675 808784 142891 3102765 2692126 410639 1531525 1271260 260265 142420 142420 88146 88146 59414 59414 33783 33783 340516 249657 90859 86589 70061 16528 86326 80694 5632 518879 290873 228006 3720303 3527769 192534 223549 223549 CONTRACTED, LINEN & PUR 10951256 8527170 2424086 BAD DEBT EXPENSE 3605827 3605827 DRUGS SUPPLIES, GASES & 2992255 2992255 MAINTENANCE AND UTILITI 1711956 1653372 58584 1454906 1351893 103013 50692444 43155416 7537028 0 10692280 15409526 17103159 18072661 1713080 51750 4234210 4333641 649041 758014 1543377 1140616 57834718 21573257 38350785 36261461 3934207 4629254 3100501 2515157 81320640 83172080 4883282 4478187 2246613 66864 4135000 3865000 10708064 10184287 17320950 16951307 39293909 35545645 X 40367936 46396235 1658795 1230200 42026731 47626435 81320640 83172080 X 3976025 1623679 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1658795 3105896 115670 3650161 1230200 1644993 8433494 49870 8469562 1658795 1631608 864223 35904 886742 1644993 798658 3288805 41288 2497143 1631608 812126 276416 17163 307047 798658 0.27950 0.72050 0 0 1251625 1251625 40899024 11480579 29418445 12823924 9369468 3454456 2860145 723210 2136935 36261461 MUTUAL FUNDS 4629254 F 4629254 DUE TO AFFILIATES 367356 INTEREST RATE SWAP LIABILITY 31058 WC/MALPRACTICE LIABILITY 195000 THIRD PARTY PAYOR SETTLEMENTS 8528343 CONTRACT LIABILITY 5509393 OPERATING LEASE LIABILITY 2320157 16951307 X 51393253 390024 390024 51003229 3665240 3665240 54668469 47417228 390024 390024 47027204 3665240 3665240 50692444 PART V, LINE 4: THE ENDOWMENT FUNDS (ASSETS WHOSE USE IS LIMITED) ARE TO BE USED FOR HOSPITAL EXPANSION AND RENOVATION AND PURCHASING HOSPITAL EQUIPMENT. PART X, LINE 2: THE HOSPITAL IS INCORPORATED AND RECOGNIZED BY THE INTERNAL REVENUE SERVICE (IRS) AS TAX-EXEMPT UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (CODE). ACCORDINGLY, THE IRS HAS DETERMINED THAT THE HOSPITAL IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. NO PROVISION FOR FEDERAL INCOME TAXES HAS BEEN RECORDED IN THE ACCOMPANYING FINANCIAL STATEMENTS. THE HOSPITAL ACCOUNTS FOR RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS IN ACCORDANCE WITH ASC 740, INCOME TAXES, WHICH ADDRESSES HOW TO ACCOUNT FOR AND REPORT THE EFFECTS OF TAXES BASED ON INCOME. NO PROVISION FOR UNCERTAIN TAX POSITIONS HAS BEEN RECORDED IN THE ACCOMPANYING FINANCIAL STATEMENTS. THE TAX YEARS OPEN TO EXAMINATION BY FEDERAL AND STATE TAXING AUTHORITIES ARE 2018 THROUGH 2021. PART XI, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 380,109. FUNDRAISING EXPENSES 9,915. PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 3,605,826. INVESTMENT MANAGEMENT FEES 59,414. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 380,109. FUNDRAISING EXPENSES 9,915. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 3,605,826. INVESTMENT MANAGEMENT FEES 59,414. GOLF 18882 18882 1000 1552 3192 4170 18882 18882 1000 1552 3192 4170 9914 8968 1 1 1 X 1 X 1 1 1 0 1 1 303082 303082 0.00640 7713510 2578573 5134937 0.10910 170474 170474 0.00360 8187066 2578573 5608493 0.11910 39370649 33419156 5951493 0.12640 39370649 33419156 5951493 0.12640 47557715 35997729 11559986 0.24550 1 3605826 132608 17496083 17380289 115794 X 1 1 1 1 ELIZABETHTOWN COMMUNITY HOSPITAL 75 PARK STREET PO BOX 277 ELIZABETHTOWN NY 12932 X X X 25 BEDS (ACUTE & SWING), 6 HEALTHCENTERS, CT, LAB, PHARM. PT. AMB SURG. ELIZABETHTOWN COMMUNITY HOSPITAL 1 0 0 1 X X X X X X X X 19 1 1 1 1 X HTTPS://WWW.ECH.ORG/DATA/FILES/COMMUNITY%20SERVICE%20PLAN%20WITH%20COLLABOR X WWW.CO.ESSEX.NY.US., HTTPS://AHIHEALTH.ORG/ARHN X X 1 19 1 HTTPS://WWW.ECH.ORG/DATA/FILES/COMMUNITY%20SERVICE%20PLAN%20WITH%20COLLABOR 0 1 X 200.000000000000 350.000000000000 X 1 1 X X X X 1 X WWW.ECH.ORG/DATA/FILES/2019_FINANCIAL_ASSISTANCE_APPLICATION_ECH.PDF X WWW.ECH.ORG/DATA/FILES/2019_FINANCIAL_ASSISTANCE_APPLICATION_ECH.PDF X WWW.ECH.ORG/DATA/FILES/2019_FINANCIAL_ASSISTANCE_APPLICATION_ECH.PDF X X X X 1 0 X X X X 1 X 0 1 ELIZABETHTOWN COMMUNITY HOSPITAL PART V, SECTION B, LINE 5: EXECUTIVES FROM THE FOLLOWING INSTITUTIONS: ADIRONDACK HEALTH, ADIRONDACK MEDICAL CENTER, ADIRONDACK RURAL HEALTH NETWORK AND ESSEX COUNTY PUBLIC HEALTH. ELIZABETHTOWN COMMUNITY HOSPITAL PART V, SECTION B, LINE 6B: COUNTY HEALTH DEPARTMENT ELIZABETHTOWN COMMUNITY HOSPITAL PART V, SECTION B, LINE 7D: ESSEX COUNTY PUBLIC HEALTH ELIZABETHTOWN COMMUNITY HOSPITAL PART V, SECTION B, LINE 11: COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION STRATEGY:COMMUNITY SERVED - ELIZABETHTOWN COMMUNITY HOSPITAL'S PRIMARY SERVICE AREA IS COMPOSED OF TWENTY-TWO ZIP CODES IN NORTHEASTERN ESSEX COUNTY. THE HOSPITAL IS LOCATED 45-60 MINUTES AWAY FROM ANY OTHER HOSPITAL, THROUGH A MOUNTAINOUS REGION AND MOSTLY ALONG A SERIES OF SECONDARY ROADS. THE REGION BOASTS A ROBUST SEASONAL POPULATION, SWELLING SIGNIFICANTLY THROUGHOUT THE SUMMER AND WINTER MONTHS, DUE TO THE CONSIDERABLE NUMBER OF SECOND HOMEOWNERS IN THE REGION, ALONG WITH INCREASED TOURISM.DEMOGRAPHICS OF ESSEX COUNTY: - 38,233 RESIDENTS- 21% ARE 65 YEARS OF AGE OR OLDER- 92.8% OF THE POPULATION IS WHITE, 3.2% IS HISPANIC, AND 3.2% IS BLACK/AFRICAN AMERICAN- 84% ADULTS HAVE HEALTH INSURANCESIGNIFICANT HEALTH NEEDS IDENTIFIED IN 2019 CHNA:- CHRONIC DISEASE- OBESITY- ACCESS TO HEALTHY FOOD- ACCESS TO CARE- SUBSTANCE ABUSE- BEHAVIORAL HEALTHNEEDS SELECTED FOR 2019 IMPLEMENTATION STRATEGY:- PREVENT CHRONIC DISEASE- PROMOTE WELL-BEING AND PREVENT MENTAL AND SUBSTANCE ABUSE DISORDERS- PROMOTE HEALTHY WOMEN, INFANTS AND CHILDRENNEEDS NOT SELECTED:- PROMOTE A HEALTHY AND SAFE ENVIRONMENT- PREVENT COMMUNICABLE DISEASE RATIONALE: - WHILE NOT SELECTED FOR THE COMMUNITY SERVICE PLAN, THE TWO INTERVENTIONS ARE INCORPORATED INTO THE SELECTED PRIORITIESHIGHLIGHTS FROM 2019 IMPLEMENTATION STRATEGY:- PREVENT CHRONIC DISEASE - IN 2019 INPATIENT AND OUTPATIENT P.T. FACILITIES OPENED TO STAFF AT ECH AND TICONDEROGA CAMPUS, THESE WERE TEMPORARILY PAUSED IN 2020 DUE TO COVID-19 - WELLNESS RX PROGRAM CREATED AND BEGAN ACCEPTING REFERRALS 4/2019 (TO DATE 94 PARTICIPANTS). THERE WAS A BRIEF HOLD ON THIS PROGRAM BETWEEN 4/2020 AND 6/2020, DURING THIS TIME THE NUMBER OF REDEMPTION SITES INCREASED FROM 6 TO 10. - FOOD PANTRY IN CPHC OPENED IN 10/2019 AND FOOD PANTRY IN APHC OPENED IN 11/2019. JOINED THE REGIONAL FOOD BANK IN 9/2020 - EVENTS HELD IN 2020 - HEART HEALTH - WOMEN'S HEALTH - HUNTER'S SCREENING - STROKE READINESS - TELEHEALTH INCREASE - OUTPATIENT VISITS FOR PRIMARY CARE ADDED IN 2020. - CHRONIC DISEASE WELLNESS COACH - CERTIFIED AND TO BEGIN DIABETES PREVENTION PROGRAM- PROMOTE WELL-BEING AND PREVENT MENTAL AND SUBSTANCE USE DISORDER - SBIRT IMPLEMENTED IN BOTH HOSPITAL CAMPUSES AND ALL 6 PRIMARY CARE SITES - CREATION OF MEDICAL VILLAGE IN PRIMARY CARE. (ADDITION OF PRIMARY CARE 2021) - NARCAN KITS IN BOTH ED'S - 2 PROVIDERS TRAINED IN MAT AND ABLE TO PRESCRIBE - OPIOID STEWARDSHIP CREATED. PROVIDERS WILL BE MONITORED FOR PRESCRIBING PATTERNS.- PROMOTE HEALTHY WOMEN, INFANTS AND CHILDREN - TRANSITIONING FROM PEDIATRIC TO ADULT CARE PROCESS AND PROCEDURE INITIATIVE (PARTNERSHIP WITH AREA SCHOOLS) WAS PAUSED IN 2020 DUE TO COVID-19.ESTIMATED COMPLETION DATE FOR NEXT CHNA AND IMPLEMENTATION STRATEGY: - CHNA: DECEMBER 2022 - IMPLEMENTATION STRATEGY: JANUARY 2023METHODS PLANNED FOR QUALITATIVE RESEARCH FOR NEXT CHNA: - TO BE DONE AS JOINT DOCUMENT WITH ESSEX COUNTY PUBLIC HEALTH DEPARTMENT BASED ON RESULTS OF COMMUNITY STAKEHOLDER SURVEYMETHODS PLANNED FOR QUANTITATIVE RESEARCH FOR NEXT CHNA: - ADIRONDACK RURAL HEATH NETWORK (AHRN) TO ASSIST WITH DATA COLLECTION AND INTERPRETATION AS WELL AS COMMUNITY STAKEHOLDER SURVEY ELIZABETHTOWN COMMUNITY HOSPITAL PART V, SECTION B, LINE 13B: TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE FROM ELIZABETHTOWN COMMUNITY HOSPITAL, YOUR INCOME SHOULD BE AT OR BELOW THE YEARLY GUIDELINES BELOW. IF YOUR INCOME EXCEEDS THE GUIDELINES (350%) BUT YOU HAVE EXTENUATING CIRCUMSTANCES, AN APPLICATION MAY BE CONSIDERED WHEN SUBMITTED WITH A LETTER EXPLAINING YOUR EXTENUATING CIRCUMSTANCES. ELIZABETHTOWN COMMUNITY HOSPITAL PART V, SECTION B, LINE 24: THE ORGANIZATION USES A GLOBAL FEE SCHEDULE. IF THE PATIENT APPLIED AND WAS DEEMED ELIGIBLE, THE APPROPRIATE DISCOUNTS WERE GRANTED. 7 1 - ELIZABETHTOWN COMMUNITY HEALTH CENTER 66 PARK STREET ELIZABETHTOWN NY 12932 PRIMARY CARE HEALTH CENTER 2 - HIGH PEAKS HEALTH CENTER 18 COMMUNITY CIRCLE WILMINGTON NY 12997 PRIMARY CARE HEALTH CENTER 3 - SMITH HOUSE HEALTH CENTER 39 FARRELL ROAD WILLSBORO NY 12996 PRIMARY CARE HEALTH CENTER 4 - WESTPORT HEALTH CENTER 6097 NYS ROUTE 9N WESTPORT NY 12993 PRIMARY CARE HEALTH CENTER 5 - AU SABLE FORKS HEALTH CENTER 15 PLEASANT STREET AU SABLE FORKS NY 12912 PRIMARY CARE HEALTH CENTER 6 - CROWN POINT HEALTH CENTER 2679 MAIN STREET CROWN POINT NY 12928 PRIMARY CARE HEALTH CENTER 7 - ECH TICONDEROGA OUTPATIENT CAMPUS 101 ADIRONDACK DRIVE SUITE 1 TICONDEROGA NY 12883 MEDICAL FACILITY OP CAMPUS PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 3,605,826. PART II, COMMUNITY BUILDING ACTIVITIES: THE HOSPITAL STAFF PARTICIPATES IN MANY LOCAL EVENTS THAT PROVIDE COMMUNITY MEMBERS THE OPPORTUNITY TO LEARN ABOUT THE HOSPITAL AND ABOUT IMPORTANT HEALTH SCREENINGS. IN ADDITION, THE HOSPITAL HOSTS EVENTS AND OFFERS TRAINING AND SUPPORT SERVICES TO OTHER HEALTH-ORIENTED ORGANIZATIONS. ECH PARTICIPATES IN THE FOLLOWING:(1)PROVIDES ADVANCED LIFE SUPPORT TRAINING FOR REGIONAL EMERGENCY MEDICAL TECHNICIANS. (2)PROVIDES MEDICAL DIRECTORSHIP TO SEVERAL LOCAL EMS AGENCIES, PROVIDES MONTHLY COURSES AND EDUCATION FOR CME CREDITS. (3)PROVIDES MEDICAL DIRECTORSHIP TO ST. JOSEPH'S ADDICTION TREATMENT & RECOVERY CENTER (4)OFFERS FREE DIABETES HEALTH SCREENINGS AT COMMUNITY HEALTH EVENTS. (5)LENDS SPACE TO THE NORTH COUNTRY REGIONAL BLOOD DONOR CENTER FOR BLOOD DRIVES. (6)MEETING SPACE IS DONATED ON A MONTHLY BASIS TO EMS SQUADS. TECHNOLOGICAL CAPABILITIES ALLOW FOR DISTANCE TRAINING / EDUCATION. (7)WORKS WITH THE CANCER SCREENING PROGRAM TO PROVIDE INFORMATION ABOUT MAMMOGRAMS AND BONE DENSITY SCREENING AT THE ANNUAL BREAST CANCER AWARENESS EVENT. (8)HOSTS THE ESSEX COUNTY DIABETES SUPPORT GROUP MEETINGS IN THE HOSPITAL BOARDROOM. (9)EMPLOYEES FROM THROUGHOUT THE HOSPITAL USE HOSPITAL PAID TIME TO LEND THEIR EXPERTISE AND INCREASE THEIR INTERESTS IN SUCH AREAS AS THE ESSEX CO. HEALTHY LIVING PARTNERSHIP, BEHAVIOR HEALTH SERVICES NORTH, RETIRED SENIOR VOLUNTEER PROGRAM, TASK FORCE AGAINST DOMESTIC VIOLENCE, KIWANIS AND NORTH COUNTRY LIFE FLIGHT. (10)ECH'S CLINICAL STAFF COMPLETES ADDITIONAL TRAINING EACH YEAR (ACLS, PALS, BLS, VARIOUS RN / NURSING TRAINING PROGRAMS, CHEMOTHERAPY EDUCATION, PHYSICIAN EDUCATION, INFECTION CONTROL TRAINING, RADIOLOGY DEPARTMENT CONTINUING EDUCATION, LAB STAFF EDUCATION, ETC.) (11) MEETING SPACE FOR AA AND NA. (12) EACH YEAR, THE HOSPITAL ALSO HOSTS EVENTS THAT OFFER FREE HEALTH SCREENINGS TO LOCAL RESIDENTS. THE COMMUNITY HEALTH SCREENINGS ARE COORDINATED BY PUBLIC RELATIONS STAFF BUT ARE DEPENDENT UPON CLINICAL STAFF TO PERFORM EXAMS AND INTERPRET THE RESULTS. EACH EVENT IS STAFFED BY 5-8 CLINICAL STAFF MEMBERS FOR APPROXIMATELY 3-4 HOURS PER EVENT. (1)HUNTERS' HEALTH SCREENING (SEPTEMBER) IS A FREE, ANNUAL EVENT SPONSORED BY THE HOSPITAL. PARTICIPANTS RECEIVE A BASIC PHYSICAL / HEALTH SCREENING (EKG, BLOOD WORK, BLOOD PRESSURE, LAB TESTING, PHYSICIAN REVIEW AND REPORTING) AT NO COST. EVENT IS ARRANGED, COORDINATED AND PROMOTED BY ECH PUBLIC RELATIONS STAFF. IN 2021, THERE WERE 22 PARTICIPANTS AS THE EVENT REQUIRED APPOINTMENTS. (2)IN OCTOBER THE HOSPITAL HOSTS AN EVENT CO-SPONSORED BY THE CANCER SERVICES SCREENING PROGRAM OF ESSEX AND FRANKLIN COUNTIES. WOMEN WHO QUALIFIED (UN- OR UNDER-INSURED) WERE ABLE TO RECEIVE A CLINICAL BREAST EXAM AND MAMMOGRAM AT NO COST TO THEM, THROUGH THE CANCER SERVICES SCREENING PROGRAM OF ESSEX AND FRANKLIN COUNTIES. IN 2021, 6 FREE MAMMOGRAMS WERE COMPLETED DUE TO REQUIRED APPOINTMENTS. PART III, LINE 4: THE BAD DEBT INCLUDED ON LINE 2 IS DETERMINED AT COST. FINANCIAL STATEMENT FOOTNOTE FOR BAD DEBT EXPENSE:PATIENT ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTIBILITY OF PATIENT ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES PAST PAYMENT HISTORY AND IDENTIFIES TRENDS FOR EACH MAJOR PAYOR SOURCE OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. FOR RECEIVABLES ASSOCIATED WITH PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS AND FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS, THE HOSPITAL ALSO ANALYZES AMOUNTS DUE AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE BASED ON PAST EXPERIENCE, INCLUDING CONSIDERATION OF CURRENT BUSINESS AND ECONOMIC CONDITIONS. WHEN THE HOSPITAL ESTABLISHES THE ALLOWANCE FOR DOUBTFUL ACCOUNTS THE HOSPITAL TAKES INTO CONSIDERATION THE FACT THAT MANY SELF-PAY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. THE HOSPITAL'S ALLOWANCE FOR DOUBTFUL ACCOUNTS WAS 25.6% AND 21.7% OF THE RELATED PATIENT ACCOUNTS RECEIVABLE, NET OF CONTRACTUAL ALLOWANCES AT SEPTEMBER 30, 2021 AND 2020, RESPECTIVELY. PART III, LINE 8: USED MEDICARE ONLY TOTAL CHARGES FROM REVENUE REPORT FOR 2019 AND APPLIED THE RATIO OF COST TO CHARGES FROM THE 2018 COST REPORT DATA. PART III, LINE 9B: THE ELIZABETHTOWN COMMUNITY HOSPITAL'S HELPING HANDS PROGRAM OFFERS FREE OR REDUCED CARE TO OUR PATIENTS WHO ARE UNINSURED OR UNDERINSURED AND MEET THE INCOME ELIGIBILITY CRITERIA SET BY THE FOLLOWING GUIDELINES. THE FREE OR REDUCED CARE APPLIES ONLY TO THE SERVICES PROVIDED BY THE ELIZABETHTOWN COMMUNITY HOSPITAL, WESTPORT HEALTH CENTER, ELIZABETHTOWN COMMUNITY HEALTH CENTER, HIGH PEAKS HEALTH CENTER, AU SABLE FORKS HEALTH CENTER, SMITH HOUSE HEALTH CENTER, AND CROWN POINT HEALTH CENTER.AS AN ACCOMMODATION TO PATIENTS AND FAMILIES, COLLECTION ACTIVITY WAS SUSPENDED IN MARCH 2020 IN RECOGNITION OF THE FINANCIAL CHALLENGES ASSOCIATED WITH THE COVID-19 PANDEMIC. COLLECTION ACTIVITIES RESUMED IN JULY 2020. PART VI, LINE 2: A NUMBER OF COMMUNITY PARTNERS ARE INVOLVED IN ASSESSING COMMUNITY HEALTH NEEDS WITHIN THE HOSPITAL'S SERVICE AREA. MEETINGS CONTINUED VIRTUALLY EACH QUARTER IN 2020-2021.IN ADDITION TO ITS ESTABLISHED RELATIONSHIPS WITH OTHER HOSPITALS, COMMUNITY ORGANIZATIONS AND HEALTHCARE-BASED ORGANIZATIONS (EMS, PUBLIC HEALTH, MENTAL HEALTH, ETC.), ELIZABETHTOWN COMMUNITY HOSPITAL HAS PARTNERED WITH TWO REGIONAL GROUPS TO ASSESS THE REGION'S COMMUNITY HEALTH NEEDS - THE MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIPS COMMITTEE, AND THE ADIRONDACK RURAL HEALTH NETWORK.MOBILIZING FOR ACTION THROUGH PLANNING & PARTNERSHIP (MAPP): AGENCY REPRESENTATIVES FROM CLINTON, ESSEX, AND FRANKLIN COUNTIES MEET TO APPLY COMMUNITY BASED APPROACHES TO LOCAL HEALTH ISSUES. THE MAPP GROUP HAS WORKED TO CULL INFORMATION THROUGH ASSESSMENTS OF THE LOCAL PUBLIC HEALTH SYSTEMS, A CDC LOCAL PUBLIC HEALTH INDICATOR SURVEY, A QUALITY OF LIFE SURVEY OF SENIORS AND PARENTS WITH CHILDREN, AND FOCUS GROUPS. THE MAPP GROUP SHARES UPDATED INFORMATION ON A CONTINUAL BASIS TO REASSESS PRIORITIES AND GAUGE PROGRAM SUCCESS.ADIRONDACK RURAL HEALTH NETWORK (ARHN): THE ADIRONDACK RURAL HEALTH NETWORK IS A PARTNERSHIP OF PUBLIC, PRIVATE AND NON-PROFIT ORGANIZATIONS IN UPSTATE NEW YORK. ARHN MEMBERS COLLABORATE TO DEVELOP STRATEGIES ALONG WITH IMPLEMENTING, MONITORING AND EVALUATING VARIOUS INITIATIVES. THIS GROUP CONTINUES TO MEET ON A (ROUGHLY) QUARTERLY BASIS IN ORDER TO SHARE INFORMATION, STATISTICS, SUCCESSES, CHALLENGES AND OUTCOMES. ELIZABETHTOWN COMMUNITY HOSPITAL (ECH): IN ADDITION TO PARTNERSHIPS WITH THE ARHN AND THE MAPP PROCESSES, ECH INDEPENDENTLY SEEKS THE VIEWS OF COMMUNITY MEMBERS TO GAIN THEIR THOUGHTS REGARDING HEALTH CARE IN THEIR COMMUNITY AND GAIN FEEDBACK REGARDING ECH SERVICES. THROUGHOUT 2016-2017 MANY DIFFERENT METHODS WERE USED TO COMMUNICATE WITH AREA RESIDENTS. EACH YEAR THE HOSPITAL ADMINISTRATOR ATTENDS TOWN BOARD MEETINGS THROUGHOUT ESSEX COUNTY IN AN EFFORT TO UPDATE TOWN LEADERS AND COMMUNITY MEMBERS ABOUT THE HOSPITAL, ITS PLANS FOR THE FUTURE; AND TO ADDRESS ANY QUESTIONS. ANNUALLY, THE ADMINISTRATOR MEETS WITH EMS AND FIRE DEPARTMENTS WITHIN THE HOSPITAL SERVICE AREA TO ENCOURAGE OPEN COMMUNICATION AND FOSTER A GOOD WORKING RELATIONSHIP. THE ECH BOARD OF DIRECTORS IS COMPOSED OF 14 REPRESENTATIVES OF EITHER A SPECIFIC COMMUNITY AND/OR ORGANIZATION, INCLUDING THE ESSEX COUNTY OFFICE FOR THE AGING, TOWN OF ELIZABETHTOWN SUPERVISORS OFFICE, AND ESSEX COUNTY MENTAL HEALTH. A PLANNING COMMITTEE, COMPRISED OF BOARD MEMBERS, IDENTIFIES GAPS IN SERVICE AND DEVELOPS GOALS TO FILL THESE NEEDS. PATIENT SATISFACTION SURVEYS ARE CONDUCTED FOR EACH DEPARTMENT ON A CONTINUAL BASIS. PART VI, LINE 4: ELIZABETHTOWN COMMUNITY HOSPITAL'S PRIMARY SERVICE AREA HAS REMAINED UNCHANGED FOR 2017 PLANNING PURPOSES. IT IS COMPOSED OF TWENTY-TWO ZIP CODES IN NORTHEASTERN ESSEX COUNTY. THE HOSPITAL IS LOCATED 45-60 MINUTES AWAY FROM ANY OTHER HOSPITAL; THROUGH A MOUNTAINOUS REGION AND MOSTLY ALONG A SERIES OF SECONDARY ROADS.BASED ON U.S. CENSUS FOR 2010, 39,370 PEOPLE LIVE WITHIN ESSEX COUNTY OF WHICH 51.8% ARE MALE AND 48.2% ARE FEMALE. PEOPLE OVER THE AGE OF 65 CONSTITUTE 18.1% OF THE POPULATION AND CHILDREN UNDER THE AGE OF 18 MAKE UP 19.3% OF THE POPULATION.ETHNICALLY, 94.4% OF THE POPULATION IS WHITE, NON-HISPANIC. BY 2013 THE POPULATION OF THIS AREA IS EXPECTED TO DECLINE BY AN ESTIMATED 1.5%. PART VI, LINE 5: THE HOSPITAL STAFF PARTICIPATES IN MANY LOCAL EVENTS THAT PROVIDE COMMUNITY MEMBERS THE OPPORTUNITY TO LEARN ABOUT THE HOSPITAL AND ABOUT IMPORTANT HEALTH SCREENINGS. IN ADDITION, THE HOSPITAL HOSTS EVENTS AND OFFERS TRAINING AND SUPPORT SERVICES TO OTHER HEALTH-ORIENTED ORGANIZATIONS. ECH PARTICIPATES IN THE FOLLOWING:(1)PROVIDES ADVANCED LIFE SUPPORT TRAINING FOR REGIONAL EMERGENCY MEDICAL TECHNICIANS. (2)PROVIDES MEDICAL DIRECTORSHIP TO SEVERAL LOCAL EMS AGENCIES, PROVIDES MONTHLY COURSES AND EDUCATION FOR CME CREDITS. (3)PROVIDES MEDICAL DIRECTORSHIP TO ST. JOSEPH'S ADDICTION TREATMENT & RECOVERY CENTER (4)OFFERS FREE DIABETES HEALTH SCREENINGS AT COMMUNITY HEALTH EVENTS. (5)LENDS SPACE TO THE NORTH COUNTRY REGIONAL BLOOD DONOR CENTER FOR BLOOD DRIVES. (6)MEETING SPACE IS DONATED ON A MONTHLY BASIS TO EMS SQUADS. TECHNOLOGICAL CAPABILITIES ALLOW FOR DISTANCE TRAINING / EDUCATION. (7)WORKS WITH THE CANCER SCREENING PROGRAM TO PROVIDE INFORMATION ABOUT MAMMOGRAMS AND BONE DENSITY SCREENING AT THE ANNUAL BREAST CANCER AWARENESS EVENT. (8)HOSTS THE ESSEX COUNTY DIABETES SUPPORT GROUP MEETINGS IN THE HOSPITAL BOARDROOM. (9)EMPLOYEES FROM THROUGHOUT THE HOSPITAL USE HOSPITAL PAID TIME TO LEND THEIR EXPERTISE AND INCREASE THEIR INTERESTS IN SUCH AREAS AS THE ESSEX CO. HEALTHY LIVING PARTNERSHIP, BEHAVIOR HEALTH SERVICES NORTH, RETIRED SENIOR VOLUNTEER PROGRAM, TASK FORCE AGAINST DOMESTIC VIOLENCE, KIWANIS AND NORTH COUNTRY LIFE FLIGHT. (10)ECH'S CLINICAL STAFF COMPLETES ADDITIONAL TRAINING EACH YEAR (ACLS, PALS, BLS, VARIOUS RN / NURSING TRAINING PROGRAMS, CHEMOTHERAPY EDUCATION, PHYSICIAN EDUCATION, INFECTION CONTROL TRAINING, RADIOLOGY DEPARTMENT CONTINUING EDUCATION, LAB STAFF EDUCATION, ETC.) (11) MEETING SPACE FOR AA AND NA. (12)THE COMMUNITY HEALTH FAIR HELD ALLOWED FOR COMMUNITY MEMBERS TO LEARN ABOUT AVAILABLE RESOURCES PERTAINING TO HEALTH AND WELLNESS. ELIZABETHTOWN COMMUNITY HOSPITAL WAS ABLE TO EDUCATE 120 PARTICIPANTS ABOUT THE SERVICES OFFERED AT THE HOSPITAL AND SIX PRIMARY CARE SITES. THE 2019 COMMUNITY HEALTH FAIR WAS CO-SPONSORED BY ADIRONDACK HEALTH INSTITUTE, FIDELIS, AND THE HOSPITAL'S AUXILIARY. CLINICAL STAFF WAS ON SITE CONDUCTING BLOOD PRESSURE SCREENS, ISS TEAM MEMBERS WERE AVAILABLE FOR PEOPLE WANTING TO ENROLL IN THE PATIENT PORTAL. HEALTHY REFRESHMENTS WERE PROVIDED AND NUTRITION EDUCATION WAS AVAILABLE WITH A DIABETIC EDUCATOR. EACH YEAR, THE HOSPITAL ALSO HOSTS EVENTS THAT OFFER FREE HEALTH SCREENINGS TO LOCAL RESIDENTS. THE COMMUNITY HEALTH SCREENINGS ARE COORDINATED BY PUBLIC RELATIONS STAFF BUT ARE DEPENDENT UPON CLINICAL STAFF TO PERFORM EXAMS AND INTERPRET THE RESULTS. EACH EVENT IS STAFFED BY 5-8 CLINICAL STAFF MEMBERS FOR APPROXIMATELY 3-4 HOURS PER EVENT. (1)HUNTERS' HEALTH SCREENING (SEPTEMBER) IS A FREE, ANNUAL EVENT SPONSORED BY THE HOSPITAL. PARTICIPANTS RECEIVE A BASIC PHYSICAL / HEALTH SCREENING (EKG, BLOOD WORK, BLOOD PRESSURE, LAB TESTING, PHYSICIAN REVIEW AND REPORTING) AT NO COST. EVENT IS ARRANGED, COORDINATED AND PROMOTED BY ECH PUBLIC RELATIONS STAFF. IN 2021, THERE WERE 22 PARTICIPANTS. (2)IN OCTOBER THE HOSPITAL HOSTS AN EVENT CO-SPONSORED BY THE CANCER SERVICES SCREENING PROGRAM OF ESSEX AND FRANKLIN COUNTIES AND THE HOSPITAL'S AUXILIARY. THE EVENING FEATURES A SPEAKER, ALONG WITH THE OPPORTUNITY TO TAKE PART IN A FREE HEALTH SCREENING. WOMEN WHO QUALIFIED (UN- OR UNDER-INSURED) WERE ABLE TO RECEIVE A CLINICAL BREAST EXAM AND MAMMOGRAM AT NO COST TO THEM, THROUGH THE CANCER SERVICES SCREENING PROGRAM OF ESSEX AND FRANKLIN COUNTIES. IN 2021 THERE WERE 6 PARTICIPANTS. PART VI, LINE 6: THE UNIVERSITY OF VERMONT HEALTH NETWORK, A NOT-FOR-PROFIT CORPORATION, IS THE SOLE MEMBER OF THE HOSPITAL, ELIZABETHTOWN COMMUNITY HOSPITAL, LOCATED IN ELIZABETHTOWN, NEW YORK. ADDITIONAL AFFILIATES INCLUDE CHAMPLAIN VALLEY PHYSICIANS HOSPITAL, ALICE HYDE MEDICAL CENTER, CENTRAL VERMONT MEDICAL CENTER, PORTER MEDICAL CENTER AND HOME HEALTH AND HOSPICE. PART VI, LINE 7, REPORTS FILED WITH STATES NY X X X X 0 1 0 0 0 0 0 0 0 ROB DEMURO MD PHYSICIAN 377423 0 0 0 0 0 11265 0 23987 0 412675 0 0 0 JOHN REMILLARD PRESIDENT 352548 0 0 0 0 0 6254 0 3654 0 362456 0 0 0 MARY HALLORAN PHYSICIAN 314174 0 0 0 0 0 12402 0 25469 0 352045 0 0 0 PASQUALINO CAPUTO PHISICIAN 305499 0 0 0 0 0 8377 0 27264 0 341140 0 0 0 DAVID CLAUSS MEDICAL DIRECTOR 323932 0 0 0 0 0 0 0 0 0 323932 0 0 0 JAMES RICE ER PHYSICIAN 258400 0 0 0 0 0 0 0 15219 0 273619 0 0 0 DAVID MARKOWITZ ER PHYSICIAN 270550 0 0 0 0 0 0 0 695 0 271245 0 0 0 ALAN CHARDAVOYNE CFO 231166 0 0 0 0 0 6818 0 3354 0 241338 0 0 0 NOLAN MATTHEW COO 181007 0 0 0 0 0 5332 0 1371 0 187710 0 0 0 JULIE TROMBLEE CNO 175050 0 0 0 0 0 5198 0 1427 0 181675 0 0 0 PART I, LINE 3 IN ADDITION TO THE TOOLS AND PROCESSES IDENTIFIED IN PART I, ELIZABETHTOWN COMMUNITY HOSPITAL RECEIVES GUIDANCE REGARDING ITS PRESIDENT'S COMPENSATION FROM THE COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES OF THE UNIVERSITY OF VERMONT HEALTH NETWORK, WHICH IS THE SOLE MEMBER OF THE HOSPITAL. THAT NETWORK COMPENSATION COMMITTEE UTILIZES THE FOLLOWING METHODS TO ESTABLISH THAT GUIDANCE: -COMPENSATION COMMITTEE -INDEPENDENT COMPENSATION CONSULTANT -COMPENSATION SURVEY OR STUDY -APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE PART I, LINE 4B JOHN REMILLARD - NO DISTRIBUTION A ESSEX COUNTY INDUSTRIAL DEVELOPMENT AGENCY 141630643 2011-12-01 6160000 HOSPITAL RENOVATION AND EXPANSION 0 0 0 A 6160000 6160000 6160000 2009 1 0 1 1 A 0 0 0 0 0 0 1 A 0 0 0 0 0 0 0 0 0 A 0 SCHEDULE K, PART II ON MARCH 1, 2007, THE HOSPITAL ISSUED, THROUGH THE ESSEX COUNTY INDUSTRIAL DEVELOPMENT AGENCY, MULTI-MODE VARIABLE RATE DEMAND CIVIC FACILITY REVENUE BONDS, SERIES 2007A, IN THE AMOUNT OF $5,540,000 AND MULTI-MODE VARIABLE RATE DEMAND CIVIC FACILITY REVENUE REFUNDING BONDS, SERIES 2007B, IN THE AMOUNT OF $1,375,000. THE PROCEEDS FROM THE SERIES 2007A BONDS WERE USED FOR THE RENOVATION AND EXPANSION OF THE HOSPITAL. THE PROCEEDS FROM THE SERIES 2007B BONDS WERE USED TO REFINANCE THE MORTGAGE PAYABLE. ON DECEMBER 1, 2011, THE HOSPITAL REDEEMED THE SERIES 2007 BONDS IN THE AGGREGATE AMOUNT OF $6,160,000 (SERIES 2007A BONDS OF $5,330,000 AND SERIES 2007B BONDS OF $830,000) FUNDED BY THE PROCEEDS FROM THE ISSUANCE OF THE ESSEX COUNTY CAPITAL RESOURCE CORPORATION REVENUE BONDS, SERIES 2011 IN THE AMOUNT OF $6,160,000. THE SERIES 2011 BONDS WERE PURCHASED BY KEY BANK, N.A. UNDER A BOND PURCHASE AGREEMENT. THE BONDS ARE HELD BY KEY BANK, SECURED BY A MORTGAGE THAT KEY BANK HOLDS WITH THE HOSPITAL AND SECURITY INTEREST IN THE HOSPITAL'S GROSS RECEIPTS, SUBJECT TO OPTIONAL TENDER WITH 270 DAYS NOTICE BY KEY BANK FOR PURCHASE BY THE HOSPITAL AT A PRICE EQUAL TO THE PRINCIPAL PLUS ACCRUED AND UNPAID INTEREST. KEY BANK HAS AGREED NOT TO PROVIDE NOTICE OF TENDER THAT WOULD SUBJECT THE BONDS TO BE TENDERED PRIOR TO OCTOBER 1, 2020. FORM 990, PART VI, SECTION A, LINE 6 THE UNIVERSITY OF VERMONT HEALTH NETWORK (UVHN) IS THE SOLE MEMBER OF ELIZABETHTOWN COMMUNITY HOSPITAL. FORM 990, PART VI, SECTION A, LINE 7A UVMHN, INC., AS ELIZABETHTOWN COMMUNITY HOSPITAL'S SOLE MEMBER HAS RESERVE POWERS THAT ALLOW THE UNIVERSITY OF VERMONT HEALTH NETWORK AND UVMHN, INC, TO REFUSE THE ACCEPTANCE OF NEW BOARD MEMBERS APPOINTED BY THE ELIZABETHTOWN COMMUNITY HOSPITAL'S BOARD OF DIRECTORS IF UVMHN, INC., DOES NOT AGREE WITH THE CHOICE OF APPOINTMENTS. THE PROCESS OF APPOINTING MEMBERS TO THE GOVERNING BODY IS A COLLABORATION OF THE ELIZABETHTOWN COMMUNITY HOSPITAL BOARD OF DIRECTORS AND UVMHN, INC., AS A RESULT. FORM 990, PART VI, SECTION A, LINE 7B THE UNIVERSITY OF VERMONT HEALTH NETWORK THROUGH UVMHN, INC., HAS CERTAIN RESERVE POWERS THAT REQUIRE UVMHN, INC., TO APPROVE CERTAIN DECISIONS MADE BY THE ELIZABETHTOWN COMMUNITY HOSPITAL BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11B THE 990 WILL BE PROVIDED TO THE BOARD PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION HAS A WRITTEN CONFLICT OF INTEREST POLICY AND ALL MEMBERS ARE REQUIRED TO DISCLOSE ANY CONFLICTING INTERESTS OR STATE "NONE" ON THE ANNUAL CONFLICT OF INTEREST FORM. FORM 990, PART VI, SECTION B, LINE 15 THE GOVERNING BOARD IS PROVIDED AN INDEPENDENT REPORT OF COMPATIBLE HOSPITALS SALARY FOR THE CEO. THE GOVERNING BOARD ALSO REVIEWS VARIOUS PERFORMANCE MEASURES AND OTHER INFORMATION AND ARRIVES AT A SALARY AND BENEFIT PACKAGE FOR THE CEO. THE DIRECTOR OF HUMAN RESOURCES OBTAINS SALARY INFORMATION FROM AN INDEPENDENT SOURCE FOR LOCAL COMPATIBLE HOSPITALS FOR EACH HIGHER LEVEL POSITION AT THE HOSPITAL. THE INDEPENDENT INFORMATION CONTAINS SALARY LEVELS FOR EACH POSITION AT THE 25TH, 50TH AND 75TH PERCENTILE. THE CEO THEN CONSIDERS THIS INFORMATION AND THE PERFORMANCE FOR EACH OF THESE EMPLOYEES AND ARRIVES AT THE APPROPRIATE SALARY LEVEL. THE APPROACH AND METHODOLOGY IS ALSO PRESENTED TO THE GOVERNING BOARD. IN ADDITION TO THE TOOLS AND PROCESSES IDENTIFIED IN SCHEDULE J, PART I, ELIZABETHTOWN COMMUNITY HOSPITAL RECEIVES GUIDANCE REGARDING ITS PRESIDENT'S COMPENSATION FROM THE COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES OF THE UNIVERSITY OF VERMONT HEALTH NETWORK, WHICH IS THE SOLE MEMBER OF THE HOSPITAL. THAT NETWORK COMPENSATION COMMITTEE UTILIZES THE FOLLOWING METHODS TO ESTABLISH THAT GUIDANCE: -COMPENSATION COMMITTEE -INDEPENDENT COMPENSATION CONSULTANT -COMPENSATION SURVEY OR STUDY -APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE FORM 990, PART VI, SECTION C, LINE 19 THESE DOCUMENTS ARE AVAILABLE TO THE PUBLIC UPON WRITTEN REQUEST. FORM 990, PART XI, LINE 9: CHANGE IN FAIR VALUE OF INTEREST RATE SWAP 128,676. TRANSFER FROM UVHN 924,225. CHANGE IN INTEREST OF INVESTMENT POOL 570,778. FORM 990, PART XII, LINE 2C THE FINANCE COMMITTEE (BOARD OF DIRECTORS) ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT, AND SELECTION OF AN INDEPENDENT ACCOUNTANT. 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