ELIZABETHTOWN COMMUNITY HOSPITAL: Form 990, tax year 2019

View the entire original 990 at ProPublica ↗

Organization: ELIZABETHTOWN COMMUNITY HOSPITAL (EIN 14-1364513)
Tax period: 2019-10-01 to 2020-09-30
Filed: 2021-08-13
IRS object ID: 202102259349300405
Schema version: 2019v5.2
Source: Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header
Form 990
Schedule A
Schedule B
Schedule D
Schedule H
Schedule J
Schedule K
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Return	2021-08-13T07:18:19-05:00	ReturnTs
Tax Period End	2020-09-30	TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Field	Value	IRS element (for citing)
Preparer Firm EIN	161226221	PreparerFirmEIN

Preparer Firm Name PreparerFirmName

Field	Value	IRS element (for citing)
Business Name Line1	FUST CHARLES CHAMBERS LLP	BusinessNameLine1Txt

Preparer US Address PreparerUSAddress

Field	Value	IRS element (for citing)
Address Line1	5784 WIDEWATERS PARKWAY	AddressLine1Txt
City	SYRACUSE	CityNm
State Abbreviation	NY	StateAbbreviationCd
ZIP	13214	ZIPCd

Field	Value	IRS element (for citing)
Return Type	990	ReturnTypeCd
Tax Period Begin	2019-10-01	TaxPeriodBeginDt

Filer Filer

Field	Value	IRS element (for citing)
EIN	141364513	EIN

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	ELIZABETHTOWN COMMUNITY HOSPITAL	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Business Name Control	ELIZ	BusinessNameControlTxt
Phone	5188736377	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	75 PARK STREET PO BOX 277	AddressLine1Txt
City	ELIZABETHTOWN	CityNm
State Abbreviation	NY	StateAbbreviationCd
ZIP	12932	ZIPCd

Business Officer BusinessOfficerGrp

Field	Value	IRS element (for citing)
Person	ALAN R CHARDAVOYNE	PersonNm
Person Title	CHIEF FINANCIAL OFFICER	PersonTitleTxt
Phone	5188736377	PhoneNum
Signature	2021-08-12	SignatureDt
Discuss With Paid Preparer	Yes (1)	DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

Field	Value	IRS element (for citing)
Preparer Person	THOMAS J GIUFRE	PreparerPersonNm
PTIN	P00841958	PTIN
Phone	3154463600	PhoneNum
Preparation	2021-08-12	PreparationDt

Field	Value	IRS element (for citing)
Tax	2019	TaxYr
Build TS	2022-09-23 18:48:47Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Principal Officer	JOHN REMILLARD	PrincipalOfficerNm

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	75 PARK STREET PO BOX 277	AddressLine1Txt
City	ELIZABETHTOWN	CityNm
State Abbreviation	NY	StateAbbreviationCd
ZIP	12932	ZIPCd

Field	Value	IRS element (for citing)
Gross Receipts	$54,480,597	GrossReceiptsAmt
Group Return For Affiliates	0	GroupReturnForAffiliatesInd
Organization501c3	Yes (X)	Organization501c3Ind
Website Address	ECH.ORG	WebsiteAddressTxt
Type Of Organization Corp	Yes (X)	TypeOfOrganizationCorpInd
Formation	1926	FormationYr
Legal Domicile State	NY	LegalDomicileStateCd
Activity Or Mission	MISSION: TO PROMOTE WELLNESS IN THE COMMUNITIES WE SERVE BY PROVIDING QUALITY HEALTHCARE WITH SKILL, COMPASSION AND DIGNITY.	ActivityOrMissionDesc
Voting Members Governing Body	12	VotingMembersGoverningBodyCnt
Voting Members Independent	12	VotingMembersIndependentCnt
Total Employee	397	TotalEmployeeCnt
Total Volunteers	0	TotalVolunteersCnt
Total Gross UBI	-$277,946	TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm	-$277,946	NetUnrelatedBusTxblIncmAmt
PY Contributions Grants	$882,552	PYContributionsGrantsAmt
CY Contributions Grants	$8,462,318	CYContributionsGrantsAmt
PY Program Service Revenue	$41,273,639	PYProgramServiceRevenueAmt
CY Program Service Revenue	$40,110,011	CYProgramServiceRevenueAmt
PY Investment Income	$43,393	PYInvestmentIncomeAmt
CY Investment Income	$68,801	CYInvestmentIncomeAmt
PY Other Revenue	$5,034,533	PYOtherRevenueAmt
CY Other Revenue	$5,446,650	CYOtherRevenueAmt
PY Total Revenue	$47,234,117	PYTotalRevenueAmt
CY Total Revenue	$54,087,780	CYTotalRevenueAmt
PY Grants And Similar Paid	$0	PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid	$0	CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members	$0	PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members	$0	CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid	$25,845,475	PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid	$24,414,852	CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns	$0	PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns	$0	CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense	$0	CYTotalFundraisingExpenseAmt
PY Other Expenses	$18,316,750	PYOtherExpensesAmt
CY Other Expenses	$21,619,025	CYOtherExpensesAmt
PY Total Expenses	$44,162,225	PYTotalExpensesAmt
CY Total Expenses	$46,033,877	CYTotalExpensesAmt
PY Revenues Less Expenses	$3,071,892	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	$8,053,903	CYRevenuesLessExpensesAmt
Total Assets BOY	$59,892,741	TotalAssetsBOYAmt
Total Assets EOY	$81,320,640	TotalAssetsEOYAmt
Total Liabilities BOY	$26,299,317	TotalLiabilitiesBOYAmt
Total Liabilities EOY	$39,293,909	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	$33,593,424	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	$42,026,731	NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part III	Yes (X)	InfoInScheduleOPartIIIInd
Mission	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.	MissionDesc
Significant New Program Srvc	0	SignificantNewProgramSrvcInd
Significant Change	0	SignificantChangeInd
Expense	$6,777,388	ExpenseAmt
Revenue	$8,040,172	RevenueAmt
Desc	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.	Desc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

Field	Value	IRS element (for citing)
Expense	$8,333,067	ExpenseAmt
Revenue	$10,120,528	RevenueAmt
Desc	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.	Desc

Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp

Field	Value	IRS element (for citing)
Expense	$9,952,533	ExpenseAmt
Revenue	$9,402,563	RevenueAmt
Desc	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.	Desc

Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp

Field	Value	IRS element (for citing)
Expense	$14,438,962	ExpenseAmt
Revenue	$18,247,391	RevenueAmt

Field	Value	IRS element (for citing)
Total Other Prog Srvc Expense	$14,438,962	TotalOtherProgSrvcExpenseAmt
Total Other Prog Srvc Revenue	$18,247,391	TotalOtherProgSrvcRevenueAmt
Total Program Service Expenses	$39,501,950	TotalProgramServiceExpensesAmt
Described In Section501c3	Yes (1)	DescribedInSection501c3Ind
Schedule B Required	Yes (1)	ScheduleBRequiredInd
Political Campaign Acty	0	PoliticalCampaignActyInd
Lobbying Activities	0	LobbyingActivitiesInd
Subject To Proxy Tax	0	SubjectToProxyTaxInd
Donor Advised Fund	0	DonorAdvisedFundInd
Conservation Easements	0	ConservationEasementsInd
Collections Of Art	0	CollectionsOfArtInd
Credit Counseling	0	CreditCounselingInd
Donor Rstr Or Quasi Endowments	Yes (1)	DonorRstrOrQuasiEndowmentsInd
Report Land Building Equipment	Yes (1)	ReportLandBuildingEquipmentInd
Report Investments Other Sec	0	ReportInvestmentsOtherSecInd
Report Program Related Invst	0	ReportProgramRelatedInvstInd
Report Other Assets	0	ReportOtherAssetsInd
Report Other Liabilities	Yes (1)	ReportOtherLiabilitiesInd
Include FIN48 Footnote	Yes (1)	IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt	Yes (1)	IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt	Yes (1)	ConsolidatedAuditFinclStmtInd
School Operating	0	SchoolOperatingInd
Foreign Office	0	ForeignOfficeInd
Foreign Activities	0	ForeignActivitiesInd
More Than5000 K To Org	0	MoreThan5000KToOrgInd
More Than5000 K To Individuals	0	MoreThan5000KToIndividualsInd
Professional Fundraising	0	ProfessionalFundraisingInd
Fundraising Activities	0	FundraisingActivitiesInd
Gaming Activities	0	GamingActivitiesInd
Operate Hospital	Yes (1)	OperateHospitalInd
Audited Financial Stmt Att	Yes (1)	AuditedFinancialStmtAttInd
Grants To Organizations	0	GrantsToOrganizationsInd
Grants To Individuals	0	GrantsToIndividualsInd
Schedule J Required	Yes (1)	ScheduleJRequiredInd
Tax Exempt Bonds	Yes (1)	TaxExemptBondsInd
Invest Tax Exempt Bonds	0	InvestTaxExemptBondsInd
Escrow Account	0	EscrowAccountInd
On Behalf Of Issuer	0	OnBehalfOfIssuerInd
Engaged In Excess Benefit Trans	0	EngagedInExcessBenefitTransInd
PY Excess Benefit Trans	0	PYExcessBenefitTransInd
Loan Outstanding	0	LoanOutstandingInd
Grant To Related Person	0	GrantToRelatedPersonInd
Business Rln With Org Mem	0	BusinessRlnWithOrgMemInd
Business Rln With Fam Mem	0	BusinessRlnWithFamMemInd
Business Rln With35 Ctrl Ent	0	BusinessRlnWith35CtrlEntInd
Deductible Non Cash Contri	0	DeductibleNonCashContriInd
Deductible Art Contribution	0	DeductibleArtContributionInd
Terminate Operations	0	TerminateOperationsInd
Partial Liquidation	0	PartialLiquidationInd
Disregarded Entity	0	DisregardedEntityInd
Related Entity	Yes (1)	RelatedEntityInd
Related Organization Ctrl Ent	0	RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org	0	TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp	0	ActivitiesConductedPrtshpInd
Schedule O Required	Yes (1)	ScheduleORequiredInd
IRP Document	24	IRPDocumentCnt
IRP Document W2 G	0	IRPDocumentW2GCnt
Backup Wthld Compliance	Yes (1)	BackupWthldComplianceInd
Employee	397	EmployeeCnt
Employment Tax Returns Filed	Yes (1)	EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit	Yes (1)	UnrelatedBusIncmOverLimitInd
Form990 T Filed	Yes (1)	Form990TFiledInd
Foreign Financial Account	0	ForeignFinancialAccountInd
Prohibited Tax Shelter Trans	0	ProhibitedTaxShelterTransInd
Taxable Party Notification	0	TaxablePartyNotificationInd
Nondeductible Contributions	0	NondeductibleContributionsInd
Quid Pro Quo Contributions	0	QuidProQuoContributionsInd
Form8282 Property Disposed Of	0	Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct	0	RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct	0	PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services	0	IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt	0	SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc	0	SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VI	Yes (X)	InfoInScheduleOPartVIInd
Governing Body Voting Members	12	GoverningBodyVotingMembersCnt
Independent Voting Member	12	IndependentVotingMemberCnt
Family Or Business Rln	0	FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties	0	DelegationOfMgmtDutiesInd
Change To Org Documents	0	ChangeToOrgDocumentsInd
Material Diversion Or Misuse	0	MaterialDiversionOrMisuseInd
Members Or Stockholders	Yes (1)	MembersOrStockholdersInd
Election Of Board Members	Yes (1)	ElectionOfBoardMembersInd
Decisions Subject To Approva	Yes (1)	DecisionsSubjectToApprovaInd
Minutes Of Governing Body	Yes (1)	MinutesOfGoverningBodyInd
Minutes Of Committees	Yes (1)	MinutesOfCommitteesInd
Officer Mailing Address	0	OfficerMailingAddressInd
Local Chapters	0	LocalChaptersInd
Form990 Provided To Gvrn Body	Yes (1)	Form990ProvidedToGvrnBodyInd
Conflict Of Interest Policy	Yes (1)	ConflictOfInterestPolicyInd
Annual Disclosure Covered Prsn	Yes (1)	AnnualDisclosureCoveredPrsnInd
Regular Monitoring Enfrc	Yes (1)	RegularMonitoringEnfrcInd
Whistleblower Policy	Yes (1)	WhistleblowerPolicyInd
Document Retention Policy	Yes (1)	DocumentRetentionPolicyInd
Compensation Process CEO	Yes (1)	CompensationProcessCEOInd
Compensation Process Other	Yes (1)	CompensationProcessOtherInd
Investment In Joint Venture	0	InvestmentInJointVentureInd
States Where Copy Of Return Is Fld	NY	StatesWhereCopyOfReturnIsFldCd
Upon Request	Yes (X)	UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	ALAN CHARDAVOYNE CFO ECH	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Phone	5188733136	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	75 PARK STREET PO BOX 277	AddressLine1Txt
City	ELIZABETHTOWN	CityNm
State Abbreviation	NY	StateAbbreviationCd
ZIP	12932	ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (22 entries)

TitleTitleTxt	Average Hours Per WeekAverageHoursPerWeekRt	Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd	OfficerOfficerInd	Reportable Comp From OrgReportableCompFromOrgAmt	Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt	Other CompensationOtherCompensationAmt	Highest Compensated EmployeeHighestCompensatedEmployeeInd
DOMINIC EISINGER PHD
CHAIR	0.80	Yes (X)	Yes (X)	$0	$0	$0
MEGAN MURPHY
BOARD MEMBER	0.80	Yes (X)		$0	$0	$0
MARTIN NEPHEW
BOARD TREASURER	0.80	Yes (X)	Yes (X)	$0	$0	$0
SUSAN ALLOTT RN
VICE CHAIR	0.80	Yes (X)	Yes (X)	$0	$0	$0
H NICOLAS MULLER III PHD
BOARD SECRETARY	0.80	Yes (X)	Yes (X)	$0	$0	$0
GAYLE ALEXANDER
BOARD MEMBER	0.80	Yes (X)		$0	$0	$0
STEVE CACCHIO
BOARD MEMBER	0.80	Yes (X)		$0	$0	$0
MARGARET EMERY-GINN
BOARD MEMBER	0.80	Yes (X)		$0	$0	$0
ROLAND J ALLEN
BOARD MEMBER	0.80	Yes (X)		$0	$0	$0
MICHAEL G DISKIN
BOARD MEMBER	0.80	Yes (X)		$0	$0	$0
DAVID SHELMIDINE
BOARD MEMBER	0.80	Yes (X)		$0	$0	$0
EVAN GEORGE
BOARD MEMBER	0.80	Yes (X)		$0	$0	$0
ALAN CHARDAVOYNE
CFO	40.00		Yes (X)	$250,589	$0	$13,517
NOLAN MATTHEW
COO	40.00		Yes (X)	$206,457	$0	$10,495
JOHN REMILLARD
PRESIDENT	40.00		Yes (X)	$488,457	$0	$16,019
JULIE TROMBLEE
CNO	40.00		Yes (X)	$195,977	$0	$10,080
DAVID CLAUSS
MEDICAL DIRECTOR	40.00		Yes (X)	$398,570	$0	$0
ROB DEMURO MD
PHYSICIAN	40.00			$377,423	$0	$35,252	Yes (X)
PASQUALINO CAPUTO
PHISICIAN	40.00			$333,046	$0	$36,471	Yes (X)
PATRICK JOHNSTON
PHYSICIANS ASSISTANT	40.00			$402,393	$0	$14,632	Yes (X)
MARY HALLORAN
PHYSICIAN	40.00			$314,174	$0	$37,871	Yes (X)
VANESSA DESMARAIS
PHYSICIAN	40.00			$197,332	$0	$30,291	Yes (X)

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	$3,164,418	TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org	$0	TotReportableCompRltdOrgAmt
Total Other Compensation	$204,628	TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K	46	IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed	0	FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K	Yes (1)	TotalCompGreaterThan150KInd
Compensation From Other Srcs	0	CompensationFromOtherSrcsInd
Cntrct Rcvd Greater Than100 K	0	CntrctRcvdGreaterThan100KCnt
Government Grants	$7,355,876	GovernmentGrantsAmt
All Other Contributions	$1,106,442	AllOtherContributionsAmt
Total Contributions	$8,462,318	TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp

Field	Value	IRS element (for citing)
Desc	CRITICAL ACCESS HOSPITAL	Desc
Business	900099	BusinessCd
Total Revenue Column	$40,110,011	TotalRevenueColumnAmt
Related Or Exempt Func Income	$40,110,011	RelatedOrExemptFuncIncomeAmt

Field	Value	IRS element (for citing)
Total Program Service Revenue	$40,110,011	TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$68,801	TotalRevenueColumnAmt
Exclusion	$68,801	ExclusionAmt

Gross Rents GrossRentsGrp

Field	Value	IRS element (for citing)
Real	$138,824	RealAmt

Less Rental Expenses LessRentalExpensesGrp

Field	Value	IRS element (for citing)
Real	$392,817	RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Real	-$253,993	RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Total Revenue Column	-$253,993	TotalRevenueColumnAmt
Unrelated Business Revenue	-$277,946	UnrelatedBusinessRevenueAmt
Exclusion	$23,953	ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp (2 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
340B REVENUE	900099	$3,066,333	$3,066,333
VITAL ACCESS PROGRAM	900099	$2,253,587	$2,253,587

Miscellaneous Revenue MiscellaneousRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$380,723	TotalRevenueColumnAmt
Related Or Exempt Func Income	$380,723	RelatedOrExemptFuncIncomeAmt

Field	Value	IRS element (for citing)
Other Revenue Total	$5,700,643	OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$54,087,780	TotalRevenueColumnAmt
Related Or Exempt Func Income	$45,810,654	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	-$277,946	UnrelatedBusinessRevenueAmt
Exclusion	$92,754	ExclusionAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

Field	Value	IRS element (for citing)
Total	$1,590,159	TotalAmt
Management And General	$1,590,159	ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

Field	Value	IRS element (for citing)
Total	$17,191,929	TotalAmt
Program Services	$15,392,808	ProgramServicesAmt
Management And General	$1,799,121	ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

Field	Value	IRS element (for citing)
Total	$774,634	TotalAmt
Program Services	$632,284	ProgramServicesAmt
Management And General	$142,350	ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

Field	Value	IRS element (for citing)
Total	$3,372,455	TotalAmt
Program Services	$2,757,637	ProgramServicesAmt
Management And General	$614,818	ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

Field	Value	IRS element (for citing)
Total	$1,485,675	TotalAmt
Program Services	$1,226,395	ProgramServicesAmt
Management And General	$259,280	ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

Field	Value	IRS element (for citing)
Total	$168,741	TotalAmt
Program Services	$2,704	ProgramServicesAmt
Management And General	$166,037	ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

Field	Value	IRS element (for citing)
Total	$217,909	TotalAmt
Program Services	$217,909	ProgramServicesAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

Field	Value	IRS element (for citing)
Total	$61,309	TotalAmt
Management And General	$61,309	ManagementAndGeneralAmt

Advertising AdvertisingGrp

Field	Value	IRS element (for citing)
Total	$69,700	TotalAmt
Program Services	$69,700	ProgramServicesAmt

Office Expenses OfficeExpensesGrp

Field	Value	IRS element (for citing)
Total	$365,419	TotalAmt
Program Services	$217,172	ProgramServicesAmt
Management And General	$148,247	ManagementAndGeneralAmt

Travel TravelGrp

Field	Value	IRS element (for citing)
Total	$119,826	TotalAmt
Program Services	$92,794	ProgramServicesAmt
Management And General	$27,032	ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

Field	Value	IRS element (for citing)
Total	$85,981	TotalAmt
Program Services	$65,477	ProgramServicesAmt
Management And General	$20,504	ManagementAndGeneralAmt

Interest InterestGrp

Field	Value	IRS element (for citing)
Total	$547,875	TotalAmt
Program Services	$307,312	ProgramServicesAmt
Management And General	$240,563	ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

Field	Value	IRS element (for citing)
Total	$3,604,615	TotalAmt
Program Services	$3,453,987	ProgramServicesAmt
Management And General	$150,628	ManagementAndGeneralAmt

Insurance InsuranceGrp

Field	Value	IRS element (for citing)
Total	$196,785	TotalAmt
Program Services	$196,785	ProgramServicesAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDesc	TotalTotalAmt	Program ServicesProgramServicesAmt	Management And GeneralManagementAndGeneralAmt
CONTRACTED, LINEN & PUR	$7,884,239	$6,764,516	$1,119,723
BAD DEBT EXPENSE	$2,923,954	$2,923,954
DRUGS SUPPLIES, GASES &	$2,304,677	$2,304,677
MAINTENANCE AND UTILITI	$1,646,771	$1,613,328	$33,443

All Other Expenses AllOtherExpensesGrp

Field	Value	IRS element (for citing)
Total	$1,421,224	TotalAmt
Program Services	$1,262,511	ProgramServicesAmt
Management And General	$158,713	ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$46,033,877	TotalAmt
Program Services	$39,501,950	ProgramServicesAmt
Management And General	$6,531,927	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

Field	Value	IRS element (for citing)
BOY	$6,534,438	BOYAmt
EOY	$10,692,280	EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

Field	Value	IRS element (for citing)
BOY	$7,256,559	BOYAmt
EOY	$17,103,159	EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$718,002	BOYAmt
EOY	$1,713,080	EOYAmt

Accounts Receivable AccountsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$4,985,277	BOYAmt
EOY	$4,234,210	EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

Field	Value	IRS element (for citing)
BOY	$600,333	BOYAmt
EOY	$649,041	EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

Field	Value	IRS element (for citing)
BOY	$1,233,039	BOYAmt
EOY	$1,543,377	EOYAmt

Field	Value	IRS element (for citing)
Land Bldg Equip Cost Or Other Bss	$56,205,502	LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec	$17,854,717	LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

Field	Value	IRS element (for citing)
BOY	$34,896,421	BOYAmt
EOY	$38,350,785	EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

Field	Value	IRS element (for citing)
BOY	$3,565,672	BOYAmt
EOY	$3,934,207	EOYAmt

Other Assets Total OtherAssetsTotalGrp

Field	Value	IRS element (for citing)
BOY	$103,000	BOYAmt
EOY	$3,100,501	EOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$59,892,741	BOYAmt
EOY	$81,320,640	EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

Field	Value	IRS element (for citing)
BOY	$4,374,440	BOYAmt
EOY	$4,883,282	EOYAmt

Deferred Revenue DeferredRevenueGrp

Field	Value	IRS element (for citing)
BOY	$142,300	BOYAmt
EOY	$2,246,613	EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$4,390,000	BOYAmt
EOY	$4,135,000	EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

Field	Value	IRS element (for citing)
BOY	$11,225,431	BOYAmt
EOY	$10,708,064	EOYAmt

Other Liabilities OtherLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$6,167,146	BOYAmt
EOY	$17,320,950	EOYAmt

Total Liabilities TotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$26,299,317	BOYAmt
EOY	$39,293,909	EOYAmt

Field	Value	IRS element (for citing)
Organization Follows FASB117	Yes (X)	OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$31,948,431	BOYAmt
EOY	$40,367,936	EOYAmt

Donor Restriction Net Assets DonorRestrictionNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$1,644,993	BOYAmt
EOY	$1,658,795	EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$33,593,424	BOYAmt
EOY	$42,026,731	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$59,892,741	BOYAmt
EOY	$81,320,640	EOYAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	Yes (X)	InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss	$8,053,903	ReconcilationRevenueExpnssAmt
Other Changes In Net Assets	$379,404	OtherChangesInNetAssetsAmt
Info In Schedule O Part XII	Yes (X)	InfoInScheduleOPartXIIInd
Method Of Accounting Accrual	Yes (X)	MethodOfAccountingAccrualInd
Accountant Compile Or Review	0	AccountantCompileOrReviewInd
FS Audited	Yes (1)	FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

Field	Value	IRS element (for citing)
Consol And Sep Basis Fincl Stmt	Yes (X)	ConsolAndSepBasisFinclStmtInd

Field	Value	IRS element (for citing)
Audit Committee	Yes (1)	AuditCommitteeInd
Federal Grant Audit Required	0	FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Hospital	Yes (X)	HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

Field	Value	IRS element (for citing)
Contributor	RESTRICTED	ContributorNum

Contributor Business Name ContributorBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	RESTRICTED	BusinessNameLine1

Contributor US Address ContributorUSAddress

Field	Value	IRS element (for citing)
Address Line1	RESTRICTED	AddressLine1
Address Line2	RESTRICTED	AddressLine2
City	RESTRICTED	City
State	RESTRICTED	State
ZIP Code	RESTRICTED	ZIPCode

Field	Value	IRS element (for citing)
Total Contributions	RESTRICTED	TotalContributionsAmt

Schedule D IRS990ScheduleD

CY Endwmt Fund CYEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$1,644,993	BeginningYearBalanceAmt
Contributions	$8,433,494	ContributionsAmt
Investment Earnings Or Losses	$49,870	InvestmentEarningsOrLossesAmt
Other Expenditures	$8,469,562	OtherExpendituresAmt
End Year Balance	$1,658,795	EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$1,631,608	BeginningYearBalanceAmt
Contributions	$864,223	ContributionsAmt
Investment Earnings Or Losses	$35,904	InvestmentEarningsOrLossesAmt
Other Expenditures	$886,742	OtherExpendituresAmt
End Year Balance	$1,644,993	EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$798,658	BeginningYearBalanceAmt
Contributions	$3,288,805	ContributionsAmt
Investment Earnings Or Losses	$41,288	InvestmentEarningsOrLossesAmt
Other Expenditures	$2,497,143	OtherExpendituresAmt
End Year Balance	$1,631,608	EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$812,126	BeginningYearBalanceAmt
Contributions	$276,416	ContributionsAmt
Investment Earnings Or Losses	$17,163	InvestmentEarningsOrLossesAmt
Other Expenditures	$307,047	OtherExpendituresAmt
End Year Balance	$798,658	EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$777,996	BeginningYearBalanceAmt
Contributions	$1,219,217	ContributionsAmt
Investment Earnings Or Losses	$1,764	InvestmentEarningsOrLossesAmt
Other Expenditures	$1,186,851	OtherExpendituresAmt
End Year Balance	$812,126	EndYearBalanceAmt

Field	Value	IRS element (for citing)
Prmnnt Endowment Balance EOY	0.20730	PrmnntEndowmentBalanceEOYPct
Term Endowment Balance EOY	0.79270	TermEndowmentBalanceEOYPct
Endowments Held Unrelated Org	0	EndowmentsHeldUnrelatedOrgInd
Endowments Held Related Org	0	EndowmentsHeldRelatedOrgInd

Land LandGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$1,251,625	OtherCostOrOtherBasisAmt
Book Value	$1,251,625	BookValueAmt

Buildings BuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$39,977,481	OtherCostOrOtherBasisAmt
Depreciation	$9,237,366	DepreciationAmt
Book Value	$30,740,115	BookValueAmt

Equipment EquipmentGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$12,068,527	OtherCostOrOtherBasisAmt
Depreciation	$8,183,064	DepreciationAmt
Book Value	$3,885,463	BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$2,907,869	OtherCostOrOtherBasisAmt
Depreciation	$434,287	DepreciationAmt
Book Value	$2,473,582	BookValueAmt

Field	Value	IRS element (for citing)
Total Book Value Land Buildings	$38,350,785	TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (7 entries)

DescDesc	AmtAmt
DUE TO AFFILIATES	$224,469
INTEREST RATE SWAP LIABILITY	$159,734
WC/MALPRACTICE LIABILITY	$164,000
THIRD PARTY PAYOR SETTLEMENTS	$5,931,088
CONTRACT LIABILITY	$7,869,720
SERP LIABILITY	$35,438
OPERATING LEASE LIABILITY	$2,936,501

Field	Value	IRS element (for citing)
Total Liability	$17,320,950	TotalLiabilityAmt
Footnote Text	Yes (X)	FootnoteTextInd
Total Rev Etc Audited Fincl Stmt	$51,495,334	TotalRevEtcAuditedFinclStmtAmt
Other Revenue	$392,818	OtherRevenueAmt
Revenue Not Reported	$392,818	RevenueNotReportedAmt
Revenue Subtotal	$51,102,516	RevenueSubtotalAmt
Investment Expenses Not Incld	$61,309	InvestmentExpensesNotIncldAmt
Other Revenues Not Included	$2,923,955	OtherRevenuesNotIncludedAmt
Revenue Not Reported Fincl Stmt	$2,985,264	RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990	$54,087,780	TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt	$43,441,431	TotExpnsEtcAuditedFinclStmtAmt
Other Expenses Included	$392,818	OtherExpensesIncludedAmt
Expenses Not Reported	$392,818	ExpensesNotReportedAmt
Expenses Subtotal	$43,048,613	ExpensesSubtotalAmt
Investment Expenses Not Incld2	$61,309	InvestmentExpensesNotIncld2Amt
Other Expenses Not Included	$2,923,955	OtherExpensesNotIncludedAmt
Expenses Not Rpt Fincl Stmt	$2,985,264	ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990	$46,033,877	TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (6 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
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 2017 THROUGH 2020.
PART XI, LINE 2D - OTHER ADJUSTMENTS:	RENTAL EXPENSES 392,818.
PART XI, LINE 4B - OTHER ADJUSTMENTS:	BAD DEBT EXPENSE 2,923,955.
PART XII, LINE 2D - OTHER ADJUSTMENTS:	RENTAL EXPENSES 392,818.
PART XII, LINE 4B - OTHER ADJUSTMENTS:	BAD DEBT EXPENSE 2,923,955.

Schedule H IRS990ScheduleH

Field	Value	IRS element (for citing)
Financial Assistance Policy	Yes (1)	FinancialAssistancePolicyInd
Written Policy	Yes (1)	WrittenPolicyInd
FPG Reference Free Care	Yes (1)	FPGReferenceFreeCareInd
Percent200	Yes (X)	Percent200Ind
FPG Reference Discounted Care	Yes (1)	FPGReferenceDiscountedCareInd
Percent350	Yes (X)	Percent350Ind
Free Care Medically Indigent	Yes (1)	FreeCareMedicallyIndigentInd
Financial Assistance Budget	Yes (1)	FinancialAssistanceBudgetInd
Expenses Exceed Budget	Yes (1)	ExpensesExceedBudgetInd
Unable To Provide Care	0	UnableToProvideCareInd
Annual Community Bnft Report	Yes (1)	AnnualCommunityBnftReportInd
Report Publically Available	Yes (1)	ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$195,892	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$195,892	NetCommunityBenefitExpnsAmt
Total Expense	0.00450	TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$7,390,654	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$1,762,695	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$5,627,959	NetCommunityBenefitExpnsAmt
Total Expense	0.13050	TotalExpensePct

Unreimbursed Costs UnreimbursedCostsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$139,916	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$139,916	NetCommunityBenefitExpnsAmt
Total Expense	0.00320	TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$7,726,462	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$1,762,695	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$5,963,767	NetCommunityBenefitExpnsAmt
Total Expense	0.13820	TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$37,244,334	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$28,738,525	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$8,505,809	NetCommunityBenefitExpnsAmt
Total Expense	0.19730	TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$37,244,334	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$28,738,525	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$8,505,809	NetCommunityBenefitExpnsAmt
Total Expense	0.19730	TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$44,970,796	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$30,501,220	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$14,469,576	NetCommunityBenefitExpnsAmt
Total Expense	0.33550	TotalExpensePct

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	Yes (1)	BadDebtExpenseReportedInd
Bad Debt Expense	$2,923,955	BadDebtExpenseAmt
Bad Debt Expense Attributable	$55,976	BadDebtExpenseAttributableAmt
Reimbursed By Medicare	$16,942,760	ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr	$16,834,082	CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall	$108,678	MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

Field	Value	IRS element (for citing)
Cost To Charge Ratio	Yes (X)	CostToChargeRatioInd

Field	Value	IRS element (for citing)
Written Debt Collection Policy	Yes (1)	WrittenDebtCollectionPolicyInd
Financial Assistance Prvsn	Yes (1)	FinancialAssistancePrvsnInd
Hospital Facilities	1	HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

Field	Value	IRS element (for citing)
Facility	1	FacilityNum

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	ELIZABETHTOWN COMMUNITY HOSPITAL	BusinessNameLine1Txt

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	75 PARK STREET PO BOX 277	AddressLine1Txt
City	ELIZABETHTOWN	CityNm
State Abbreviation	NY	StateAbbreviationCd
ZIP	12932	ZIPCd

Field	Value	IRS element (for citing)
Licensed Hospital	Yes (X)	LicensedHospitalInd
Critical Access Hospital	Yes (X)	CriticalAccessHospitalInd
Emergency Room24 Hrs	Yes (X)	EmergencyRoom24HrsInd
Other	25 BEDS (ACUTE & SWING), 6 HEALTHCENTERS, CT, LAB, PHARM. PT. AMB SURG.	OtherDesc

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

Field	Value	IRS element (for citing)
Business Name Line1	ELIZABETHTOWN COMMUNITY HOSPITAL	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Facility	1	FacilityNum
First Licensed CY Or PY	0	FirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PY	0	TaxExemptHospitalCYOrPYInd
CHNA Conducted	Yes (1)	CHNAConductedInd
Community Definition	Yes (X)	CommunityDefinitionInd
Community Demographics	Yes (X)	CommunityDemographicsInd
Existing Resources	Yes (X)	ExistingResourcesInd
How Data Obtained	Yes (X)	HowDataObtainedInd
Community Health Needs	Yes (X)	CommunityHealthNeedsInd
Other Health Issues	Yes (X)	OtherHealthIssuesInd
Community Hlth Needs Id Process	Yes (X)	CommunityHlthNeedsIdProcessInd
Consulting Process	Yes (X)	ConsultingProcessInd
CHNA Conducted	18	CHNAConductedYr
Take Into Account Others Input	Yes (1)	TakeIntoAccountOthersInputInd
CHNA Conducted With Other Fclts	Yes (1)	CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non Fclts	Yes (1)	CHNAConductedWithNonFcltsInd
CHNA Report Widely Available	Yes (1)	CHNAReportWidelyAvailableInd
Rpt Available On Own Website	Yes (X)	RptAvailableOnOwnWebsiteInd
Own Website URL	HTTPS://WWW.ECH.ORG/DATA/FILES/COMMUNITY%20SERVICE%20PLAN%20WITH%20COLLABOR	OwnWebsiteURLTxt
Other Website	Yes (X)	OtherWebsiteInd
Other Website URL	WWW.CO.ESSEX.NY.US., HTTPS://AHIHEALTH.ORG/ARHN	OtherWebsiteURLTxt
Paper Copy Public Inspection	Yes (X)	PaperCopyPublicInspectionInd
Rpt Available Thru Other Method	Yes (X)	RptAvailableThruOtherMethodInd
Implementation Strategy Adopt	Yes (1)	ImplementationStrategyAdoptInd
Implementation Strategy Adpt	18	ImplementationStrategyAdptYr
Strategy Posted Website	Yes (1)	StrategyPostedWebsiteInd
Strategy Website URL	HTTPS://WWW.ECH.ORG/DATA/FILES/COMMUNITY%20SERVICE%20PLAN%20WITH%20COLLABOR	StrategyWebsiteURLTxt
Organization Incur Excise Tax	0	OrganizationIncurExciseTaxInd
Elig Criteria Explained	Yes (1)	EligCriteriaExplainedInd
FPG Family Incm Lmt Free Dscnt	Yes (X)	FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care	200.000000000000	FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care	350.000000000000	FPGFamilyIncmLmtDscntCarePct
Income Level Criteria	Yes (X)	IncomeLevelCriteriaInd
Explained Basis	Yes (1)	ExplainedBasisInd
App Financial Asst Expln	Yes (1)	AppFinancialAsstExplnInd
Described Info	Yes (X)	DescribedInfoInd
Described Suprt Doc	Yes (X)	DescribedSuprtDocInd
Provided Hospital Contact	Yes (X)	ProvidedHospitalContactInd
Provided Nonprofit Contact	Yes (X)	ProvidedNonprofitContactInd
Includes Publicity Measures	Yes (1)	IncludesPublicityMeasuresInd
FAP Available On Website	Yes (X)	FAPAvailableOnWebsiteInd
FAP Available On Website URL	WWW.ECH.ORG/DATA/FILES/2019_FINANCIAL_ASSISTANCE_APPLICATION_ECH.PDF	FAPAvailableOnWebsiteURLTxt
FAP App Available On Website	Yes (X)	FAPAppAvailableOnWebsiteInd
FAP App Available On Website URL	WWW.ECH.ORG/DATA/FILES/2019_FINANCIAL_ASSISTANCE_APPLICATION_ECH.PDF	FAPAppAvailableOnWebsiteURLTxt
FAP Summary On Website	Yes (X)	FAPSummaryOnWebsiteInd
FAP Summary On Website URL	WWW.ECH.ORG/DATA/FILES/2019_FINANCIAL_ASSISTANCE_APPLICATION_ECH.PDF	FAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No Charge	Yes (X)	FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No Chrg	Yes (X)	FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No Chrg	Yes (X)	FAPSumAvlblOnRequestNoChrgInd
Notified FAP Copy Bill Display	Yes (X)	NotifiedFAPCopyBillDisplayInd
FAP Actions On Nonpayment	Yes (1)	FAPActionsOnNonpaymentInd
Collection Activities	0	CollectionActivitiesInd
Provided Written Notice	Yes (X)	ProvidedWrittenNoticeInd
Made Effort Orally Notify	Yes (X)	MadeEffortOrallyNotifyInd
Processed FAP Application	Yes (X)	ProcessedFAPApplicationInd
Made Presumptive Elig Determ	Yes (X)	MadePresumptiveEligDetermInd
Nondis Emergency Care Policy	Yes (1)	NondisEmergencyCarePolicyInd
Look Back Medicare Private	Yes (X)	LookBackMedicarePrivateInd
Amounts Generally Billed	0	AmountsGenerallyBilledInd
Gross Charges	Yes (1)	GrossChargesInd

Supplemental Information SupplementalInformationGrp (6 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
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 2020 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 24: THE ORGANIZATION USES A GLOBAL FEE SCHEDULE. IF THE PATIENT APPLIED AND WAS DEEMED ELIGIBLE, THE APPROPRIATE DISCOUNTS WERE GRANTED.
PART V, SECTION B, LINE 20B:	ON MARCH 23, 2020, THE ORGANIZATION SUSPENDED COLLECTION ACTIVITIES IN RESPONSE TO THE COVID-19 PANDEMIC, IN RECOGNITION OF THE FACT THAT MANY PATIENTS, STAFF AND MEMBERS OF THE WIDER COMMUNITY WOULD FACE FINANCIAL CHALLENGES IN ADDITION TO HEALTH CHALLENGES DURING THE PANDEMIC. COLLECTION ACTIVITIES RESUMED IN JULY 2020.

Field	Value	IRS element (for citing)
Facility	7	FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (7 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	FacilityFacilityTxt
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 MOSES LUDINGTON OP CAMPUS
101 ADIRONDACK DRIVE SUITE 1	TICONDEROGA	NY	12883	MEDICAL FACILITY OP CAMPUS

Supplemental Information Detail SupplementalInformationDetail (10 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
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 $ 2,923,955.
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 EVENS 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 2020, THERE WERE 12 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 2020, 3 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 21.7% AND 19.6% OF THE RELATED PATIENT ACCOUNTS RECEIVABLE, NET OF CONTRACTUAL ALLOWANCES AT SEPTEMBER 30, 2020 AND 2019, 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 2020, THERE WERE 12 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 2020 THERE WERE 3 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

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Compensation Committee	Yes (X)	CompensationCommitteeInd
Written Employment Contract	Yes (X)	WrittenEmploymentContractInd
Compensation Survey	Yes (X)	CompensationSurveyInd
Board Or Committee Approval	Yes (X)	BoardOrCommitteeApprovalInd
Severance Payment	0	SeverancePaymentInd
Supplemental Nonqual Rtr Plan	Yes (1)	SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm	0	EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org	0	CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs	0	CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org	0	CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs	0	CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments	0	AnyNonFixedPaymentsInd
Initial Contract Exception	0	InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (10 entries)

TitleTitleTxt	Base Compensation Filing OrgBaseCompensationFilingOrgAmt	Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt	Bonus Filing OrganizationBonusFilingOrganizationAmount	Bonus Related OrganizationsBonusRelatedOrganizationsAmt	Other Compensation Filing OrgOtherCompensationFilingOrgAmt	Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt	Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt	Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt	Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt	Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt	Total Compensation Filing OrgTotalCompensationFilingOrgAmt	Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt	Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt	Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
ALAN CHARDAVOYNE
CFO	$250,589	$0	$0	$0	$0	$0	$11,277	$0	$2,240	$0	$264,106	$0	$0	$0
NOLAN MATTHEW
COO	$206,457	$0	$0	$0	$0	$0	$9,291	$0	$1,204	$0	$216,952	$0	$0	$0
JOHN REMILLARD
PRESIDENT	$488,457	$0	$0	$0	$0	$0	$12,600	$0	$3,419	$0	$504,476	$0	$0	$0
JULIE TROMBLEE
CNO	$195,977	$0	$0	$0	$0	$0	$8,819	$0	$1,261	$0	$206,057	$0	$0	$0
DAVID CLAUSS
MEDICAL DIRECTOR	$398,570	$0	$0	$0	$0	$0	$0	$0	$0	$0	$398,570	$0	$0	$0
ROB DEMURO MD
PHYSICIAN	$377,423	$0	$0	$0	$0	$0	$11,265	$0	$23,987	$0	$412,675	$0	$0	$0
PASQUALINO CAPUTO
PHISICIAN	$333,046	$0	$0	$0	$0	$0	$11,200	$0	$25,271	$0	$369,517	$0	$0	$0
PATRICK JOHNSTON
PHYSICIANS ASSISTANT	$402,393	$0	$0	$0	$0	$0	$12,600	$0	$2,032	$0	$417,025	$0	$0	$0
MARY HALLORAN
PHYSICIAN	$314,174	$0	$0	$0	$0	$0	$12,402	$0	$25,469	$0	$352,045	$0	$0	$0
VANESSA DESMARAIS
PHYSICIAN	$197,332	$0	$0	$0	$0	$0	$8,845	$0	$21,446	$0	$227,623	$0	$0	$0

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDesc

ExplanationExplanationTxt

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

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd

Issuer Name IssuerName

Field	Value	IRS element (for citing)
Business Name Line1	ESSEX COUNTY INDUSTRIAL DEVELOPMENT AGENCY	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Bond Issuer EIN	141630643	BondIssuerEIN
Bond Issued	2011-12-01	BondIssuedDt
Issue Price	$6,160,000	IssuePriceAmt
Purpose	HOSPITAL RENOVATION AND EXPANSION	PurposeDesc
Defeased	0	DefeasedInd
On Behalf Of Issuer	0	OnBehalfOfIssuerInd
Pool Financing	0	PoolFinancingInd

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Retired	$6,160,000	RetiredAmt
Total Proceeds	$6,160,000	TotalProceedsAmt
Capital Expenditures	$6,160,000	CapitalExpendituresAmt
Substantial Completion	2009	SubstantialCompletionYr
Refunding Tax Exempt Bonds	Yes (1)	RefundingTaxExemptBondsInd
Refunding Taxable Bonds	0	RefundingTaxableBondsInd
Final Allocation Made	Yes (1)	FinalAllocationMadeInd
Adequate Books And Rec Maint	Yes (1)	AdequateBooksAndRecMaintInd

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Owning Bond Financed Property	0	OwningBondFinancedPropertyInd
Any Lease Arrangements	0	AnyLeaseArrangementsInd
Mgmt Contract Bond Fincd Prop	0	MgmtContractBondFincdPropInd
Any Research Agreements	0	AnyResearchAgreementsInd
Bond Iss Meet Prvt Sec Pymt Test	0	BondIssMeetPrvtSecPymtTestInd
Change In Use Bond Financed Prop	0	ChangeInUseBondFinancedPropInd
Procs Nonqualified Bond Remdtd	Yes (1)	ProcsNonqualifiedBondRemdtdInd

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Form8038 T Filed	0	Form8038TFiledInd
Rebate Not Due Yet	0	RebateNotDueYetInd
Exception To Rebate	0	ExceptionToRebateInd
No Rebate Due	0	NoRebateDueInd
Variable Rate Issue	0	VariableRateIssueInd
Hedge Identified In Bks And Rec	0	HedgeIdentifiedInBksAndRecInd
Gross Proceeds Invested In GIC	0	GrossProceedsInvestedInGICInd
Gross Proceeds Invested	0	GrossProceedsInvestedInd
Written Proc To Monitor Reqs	0	WrittenProcToMonitorReqsInd

Procedures Corrective Action ProceduresCorrectiveActionGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Procedures Corrective Action	0	ProceduresCorrectiveActionInd

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	SCHEDULE K, PART II	FormAndLineReferenceDesc
Explanation	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.	ExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (9 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
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 51,617. TRANSFER FROM UVHN 72,921. CHANGE IN INTEREST OF INVESTMENT POOL 254,866.
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.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (21 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Exempt Code SectionExemptCodeSectionTxt	Public Charity StatusPublicCharityStatusTxt	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt	Controlled OrganizationControlledOrganizationInd	Direct Controlling NADirectControllingNACd
UVM HEALTH NETWORK MEDICAL GROUP INC
111 COLCHESTER AVE	BURLINGTON	VT	05401	030225105	PHYSICIAN SERVICES	VT	501(C)(3)	LINE 12B, II	UVMHN	Yes (1)
UVM GROUP-NEW YORK-PLLC
70 CONSTABLE STREET	MALONE	NY	129531324	203905216	PHYSICIAN SERVICES	NY	501(C)(3)	LINE 3	UVMHNMG	Yes (1)
UNIV OF VT MED CTR FOUNDATION INC
111 COLCHESTER AVE	BURLINGTON	VT	05401	263159849	FUNDRAISING	VT	501(C)(3)	LINE 12B, II	UVMMC	Yes (1)
UNIV OF VT MED CTR AUXILLIARY INC
111 COLCHESTER AVE	BURLINGTON	VT	05401	208022004	SERVICE	VT	501(C)(3)	LINE 12D, III-O		0	N/A
UNIV OF VT HEALTH NETWORK
111 COLCHESTER AVE	BURLINGTON	VT	05401	452880726	HOLDING COMPANY	VT	501(C)(3)	LINE 12B, II		0	N/A
CENTRAL VT MEDICAL CENTER
111 COLCHESTER AVE	BURLINGTON	VT	05401	222547186	HOSPITAL	VT	501(C)(3)	LINE 3	UVMHN	Yes (1)
UNIVERSITY HEALTH CENTER
111 COLCHESTER AVE	BURLINGTON	VT	05401	030229931	HOSPITAL	VT	501(C)(3)	LINE 12D, III-O	UVMHNMG	Yes (1)
COMMUNITY PROVIDERS INC
75 BEEKMAN STREET	PLATTSBURGH	NY	12901	222544844	HLTH SVC COORD	NY	501(C)(3)	LINE 12B, II	UVMHN	Yes (1)
CHAMPLAIN VALLEY PHYSICIANS HOSPITAL
75 BEEKMAN STREET	PLATTSBURGH	NY	12901	141338471	HOSPITAL	NY	501(C)(3)	LINE 3	UVMHN	Yes (1)
EMERGENCY MEDICAL TRANSPORT OF CVPH INC
75 BEEKMAN STREET	PLATTSBURGH	NY	12901	061718419	AMBULANCE SVC	NY	501(C)(3)	LINE 12C, III-FI	CPI	Yes (1)
CVPH MEDICAL CENTER FOUNDATION
75 BEEKMAN STREET	PLATTSBURGH	NY	12901	141727048	HLTH SVC COORD	NY	501(C)(3)	LINE 12C, III-FI	CVPH	Yes (1)
UNIVERSITY MEDICAL EDUCATION ASSOCIATES
89 BEAUMONT AVENUE	BURLINGTON	VT	05401	237107832	EDUCATIONAL	VT	501(C)(3)	LINE 11	UVMHNMG	Yes (1)
ALICE HYDE MEDICAL CENTER
133 PARK STREET	MALONE	NY	12953	150346515	HOSPITAL	NY	501(C)(3)	LINE 3	UVMHN	Yes (1)
PORTER MEDICAL CENTER INC
115 PORTER DRIVE	MIDDLEBURY	VT	05753	030310862	SUPPTG ORG	VT	501(C)(3)	LINE 12C, III-FI	UVMHN	Yes (1)
HELEN PORTER NURSING HOME
37 PORTER DRIVE	MIDDLEBURY	VT	05753	030306549	NURSING HOME	VT	501(C)(3)	LINE 3	PMC	Yes (1)
AUXILIARY OF PORTER MEDICAL CENTER
37 PORTER DRIVE	MIDDLEBURY	VT	05753	237363227	SUPPTG ORG	VT	501(C)(3)	LINE 12C, III-FI	PMC	Yes (1)
PORTER HOSPITAL INC
37 PORTER DRIVE	MIDDLEBURY	VT	05753	030181058	HOSPITAL	VT	501(C)(3)	LINE 3	PMC	Yes (1)
THE UNIVERSITY OF VERMONT MEDICAL CENTER INC
111 COLCHESTER AVE	BURLINGTON	VT	05401	030219309	HOSPITAL	VT	501(C)(3)	LINE 3		Yes (1)	N/A
UVMHN HOME HEALTH AND HOSPICE
1110 PRIM ROAD	COLCHESTER	VT	05446	030179603	HOME HEALTH CARE	VT	501(C)(3)	LINE 10	UVMHN	Yes (1)
LAKE CHAMPLAIN PHYSICIAN SERVICES
75 BEEKMAN STREET	PLATTSBURGH	NY	12901	273785445	PHYSICIAN SERVICES	NY	501(C)(3)	LINE 12A, I	CVPH	Yes (1)
VMC INDEMNITY COMPANY INC
95 ST PAUL ST	BURLINGTON	VT	05401	831102018	INSURANCE	VT	501(C)(3)	LINE 12A, I	UVMHN	Yes (1)

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (2 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Direct Controlling NADirectControllingNACd	Predominant Income TypePredominantIncomeTypeTxt	Disproportionate AllocationsDisproportionateAllocationsInd	General Or Managing PartnerGeneralOrManagingPartnerInd
ONECARE VT ACCOUNTABLE CARE
111 COLCHESTER AVE	BURLINGTON	VT	05401	455399218	ACCOUNTABLE CARE	VT	N/A	RELATED	0	0
ADIRONDACK ACO LLC
75 BEEKMAN STREET	PLATTSBURGH	NY	12901	462840926	ACCOUNTABLE CARE	NY	N/A	NA	0	0

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (9 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt	Entity TypeEntityTypeTxt	Controlled OrganizationControlledOrganizationInd	Address Line1ForeignAddress/AddressLine1Txt	CityForeignAddress/CityNm	CountryForeignAddress/CountryCd	Legal Domicile Foreign CountryLegalDomicileForeignCountryCd	Direct Controlling NADirectControllingNACd
UVMHN VENTURES INC
111 COLCHESTER AVE	BURLINGTON	VT	05401	043380045	HOLDING COMPANY	VT	UVMHN	C	0
VMC INDEMNITY COMPANY LTD
					CAPTIVE INSURANCE		UVMMC	C	0	PO BOX HM 3103	HAMILTON	BD	BD
UNIV OF VT MED HEALTH NETWORK CREDENTIALING & ENROLLMENT
111 COLCHESTER AVE	BURLINGTON	VT	05401	030333056	ADMIN SVC	VT	UVMHN VENTURES	C	0
CHARITABLE REMAINDER TRUST (5)
					SUPPORT	VT	UVMMCCVMC	T	0
PERPETUAL TRUST (4)
					SUPPORT	VT	UVMMC	T	0
CHARITABLE IRREVOCABLE TRUST (7)
					SUPPORT	VT	UVMMCCVMC	T	0
CHAMPLAIN VALLEY HEALTH NETWORK
75 BEEKMAN STREET	PLATTSBURGH	NY	12901	161586102	ADMIN SVC	NY		C	0					N/A
MEDIQUEST INC
PO BOX 1656	PLATTSBURGH	NY	12901	141663061	MED OFFICE LEASE	NY		C	0					N/A
YANKEE MEDICAL INC
276 NORTH AVENUE	BURLINGTON	VT	05401	030225363	HOME MEDICAL EQUIPMENT	VT	UVMHN	C	0

Field	Value	IRS element (for citing)
Receipt Of Int Annts Rnts Rylts	0	ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org	0	GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org	0	GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org	0	LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org	0	LoansOrGuaranteesFromOthOrgInd
Div Related Organization	0	DivRelatedOrganizationInd
Asset Sale To Other Org	0	AssetSaleToOtherOrgInd
Asset Purchase From Other Org	0	AssetPurchaseFromOtherOrgInd
Asset Exchange	Yes (1)	AssetExchangeInd
Rental Of Facilities To Oth Org	0	RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org	0	RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org	Yes (1)	PerformOfServicesForOthOrgInd
Perform Of Services By Other Org	Yes (1)	PerformOfServicesByOtherOrgInd
Sharing Of Facilities	0	SharingOfFacilitiesInd
Paid Employees Sharing	0	PaidEmployeesSharingInd
Reimbursement Paid To Other Org	Yes (1)	ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org	Yes (1)	ReimbursementPaidByOtherOrgInd
Transfer To Other Org	Yes (1)	TransferToOtherOrgInd
Transfer From Other Org	Yes (1)	TransferFromOtherOrgInd