2020-11-05T19:29:42-06:00 2019-12-31 ERNST & YOUNG US LLP 1101 NEW YORK AVENUE NW WASHINGTON DC 20005 990 2019-01-01 150552726 MARGARETVILLE MEMORIAL HOSPITAL % ERIN NAGY MARG 8459436084 42084 STATE ROUTE 28 MARGARETVILLE NY 12445 DR MICHAEL DOYLE EXEC. DIRECTOR/CMO 8459436024 2020-11-03 true JUSTIN LOWE P01866796 2023276000 173.68.23.158 26308520203105000027 2020-11-05 P 8C0075DE128CBD006CA99682002307B42C2396E3 047C777BBD395ADD529156C75D94AFF56594489C 2019 2021-01-29 14:40:06Z DR MICHAEL DOYLE 396 BROADWAY KINGSTON NY 12401 13959484 false X https://www.margaretvillehosp.org/ X 1930 NY To operate a critical access hospital for quality medical care and diagnostic services to medically undeserved communities in the area. 19 15 148 15 0 0 1731638 1645847 10522404 10396672 2395 2981 2049061 1889774 14305498 13935274 0 0 0 0 8570991 8616374 0 0 0 6186385 6864586 14757376 15480960 -451878 -1545686 5391412 4988619 4174327 5617160 1217085 -628541 To operate a critical access hospital for quality medical care and diagnostic services to medically underserved communities in the area. false false 12146813 10471597 Margaretville Memorial Hospital is a critical access hospital that provides acute health care services to residents and visitors to the communities served. Margaretville Memorial Hospital recorded 1,048 patient days, 3,543 emergency room visits, 141 outpatient surgeries, 230 discharges and 199 infusion therapies in 2019. 12146813 true true false true false false false false false false true false false true true false false true false false false false false false true false true true false false true false false false false false false false false false false false false false true true true false false true 30 0 true 148 true false false false false false false false false false false false false X 19 15 false false false false true true true true true false false true true true true true true false false false NY X ERIN NAGY 8459436084 741 GRANT AVENUE LAKE KATRINE NY 12449 Robert Ross EXEC. VP (resigned 12/31/19) 1.0 39.0 X 0 746325 78632 David Scarpino FORMER CEO (RESIGNED 12/31/18) 0.0 0.0 X 0 520041 28911 Catherine Allen MD TRUSTEE (EFF. 5/1/19) 1.0 39.0 X 385427 0 12461 Joseph Marsicovete Chief Operating Officer 2.0 38.0 X 0 321847 20272 Paul Llobet MD TRUSTEE (RESIGNED 9/2/2019) 1.0 39.0 X 0 273652 5826 Thomas Brunelle TRUSTEE (RESIGNED 9/28/19) 2.0 38.0 X 0 254482 15091 MARK POHAR EXEC DIR/ex-officio trustee 20.0 20.0 X 0 233640 31736 Eileen King CLINICAL COORDINATOR 40.0 0.0 X 236826 0 27059 Brian Callahan Nurse Practitioner 40.0 0.0 X 227329 0 27782 NANETTE TREADWELL PHYSICIAN ASSISTANT 40.0 0.0 X 207782 0 21254 Michael Doyle MD EXEC DIR/CMO (eff. 9/28/19) 2.0 38.0 X 0 222821 239 JANE ULRICH SR. VP OF NURSING 2.0 38.0 X 0 193388 24654 CHRISTOPHER ESOLA trustee 1.0 39.0 X 0 115441 6351 Carey Wagner CHAIR 1.0 4.0 X 0 0 0 JANE Piasek Trustee 1.0 1.0 X 0 0 0 Fred Marguiles Secretary 1.0 1.0 X 0 0 0 Arthur Martello Trustee 1.0 1.0 X 0 0 0 Jenny Morrill-Liddle Vice Chair 1.0 1.0 X 0 0 0 Thomas O'Brien TRUSTEE (RESIGNED 3/10/19) 1.0 1.0 X 0 0 0 David Riordan Trustee 1.0 1.0 X 0 0 0 Nancy Slauson Trustee 1.0 1.0 X 0 0 0 Kent Garrett Trustee 1.0 1.0 X 0 0 0 Thomas Collins TRUSTEE 1.0 4.25 X 0 0 0 James Howie Trustee 1.0 1.0 X 0 0 0 KRISTIN FLACHS TRUSTEE 1.0 1.0 X 0 0 0 KAREN KOLAR TRUSTEE 1.0 2.0 X 0 0 0 ARNIE SCHWARTZ TRUSTEE 1.0 1.0 X 0 0 0 Josefina Rubio TRUSTEE (EFF. 3/1/19) 1.0 1.0 X 0 0 0 Marta Weisz-Margiotta TRUSTEE (EFF. 3/1/19) 1.0 1.0 X 0 0 0 1057364 2881637 300268 12 true true false Laboratory Corp of America PO Box 12140 BURLINGTON NC 27216 Laboratory Services 594101 Seco Physical Occupational Therap Eaton Center 26 Conkey Ave Suite NORWICH NY 13815 CONSULTING 231148 CROSS COUNTRY STAFFING INC PO BOX 404674 ATLANTA GA 30384 STAFFING AGENCY 106611 3 1616453 29394 1645847 NET PATIENT SERVICE REVENUE 621300 10396672 10396672 10396672 2981 2981 0 0 76075 10438 65637 0 65637 65637 0 35886 13772 22114 22114 0 0 0 0 0 0 PHARMACY REVENUE 446110 1545812 1545812 AMBULANCE REVENUE 621300 74925 74925 AUXILIARY REVENUE 900099 103803 103803 77483 77483 1802023 13935274 10471597 1817830 0 0 0 0 397888 397888 0 6310374 4901024 1409350 14857 11143 3714 1443376 1082532 360844 449879 337409 112470 0 162 162 81300 81300 2078 2078 0 0 2294588 1981512 313076 6984 6984 494027 278439 215588 0 0 202631 7313 195318 39036 39036 0 68830 65265 3565 27949 27949 0 408436 408436 132107 132107 MEDICAL SUPPLIES 1572940 1570608 2332 EQUIPMENT SVC CONTRACTS 1020108 992991 27117 CONTRACTED SERVICES 326338 326338 INPATIENT ALLOWANCES 91265 91265 95807 20988 74819 15480960 12146813 3334147 0 250785 340409 0 0 613541 835350 1277479 1173414 0 0 0 0 0 0 332443 331568 74915 148937 22568435 20933887 1713163 1634548 0 0 0 0 0 0 0 0 1129086 524393 5391412 4988619 2589907 3564592 0 0 141188 243021 0 0 0 0 0 0 0 0 0 0 1443232 1809547 4174327 5617160 X 1217085 -628541 0 0 1217085 -628541 5391412 4988619 X -1545686 -299940 X X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 2078 2078 false false SCHEDULE C, PART II-B, LINE 1I MARGARETVILLE MEMORIAL HOSPITAL PAYS DUES TO THE IROQUOIS HEALTHCARE ALLIANCE OF NEW YORK STATE (IHA). IN ACCORDANCE WITH SECTION 6033(E) OF THE INTERNAL REVENUE CODE, AND AS REPORTED BY IHA, A PORTION OF THESE DUES ARE ATTRIBUTABLE TO LOBBYING ACTIVITIES. THE LOBBYING ACTIVITIES APPLICABLE TO 2019 IHA ANNUAL DUES WERE $2,078. 23128 23128 5042550 3997471 1045079 16942649 16507555 435094 560108 428861 131247 1634548 OTHER RECEIVABLE 520035 ASSETS LIMITED AS TO USE 4358 524393 0 OTHER NON-CURRENT LIABILITIES 518004 DUE TO RELATED PARTIES 1291543 1809547 HARVEST MOON 33071 33071 5280 750 4927 FLEA MARKET 2815 2815 0 0 2815 0 35886 35886 5280 750 7742 13772 22114 true true X true X true X true true false true true 111530 22354 89176 0.00580 2151734 1851202 300532 0.01940 2263264 1873556 389708 0.02520 7543 50 7493 0.00050 5350306 3370658 1979648 0.12790 5357849 3370708 1987141 0.12840 7621113 5244264 2376849 0.15360 true 615078 4431656 3369164 1062492 X true true 1 1 MARGARETVILLE MEMORIAL HOSPITAL 42084 STATE ROUTE 28 MARGARETVILLE NY 12455 WWW.HAHV.ORG 1226701C X X X X MARGARETVILLE MEMORIAL HOSPITAL 1 false false true X X X X X X X X X 19 true true true true X SEE SECTION C X true 19 true SEE SECTION C false true X 150. 300. X X true true X X X true X SEE SECTION C X SEE SECTION C X SEE SECTION C X X X X X X true X false X X true X false false PART V, SECTION B, LINE 3E: Through the collaboration and partnership with Delaware County Public Health Department, Margaretville Hospital, in accordance with New York State Prevention Agenda mandate, has chosen to align with our community partners in focusing on two priority areas: a. Prevent Chronic Diseases b. Promote Healthy Women, Infants, and Children Margaretville Hospital involved key members of the Hospital Team in the assessment and selection of its health priorities. After identification of the criteria for priority selection, a work group was convened by the Delaware County Public Health Department which included Margaretville Hospital affiliated with Health Alliance of the Hudson Valley and Westchester Medical Center Health, Delaware Valley Hospital affiliated with United Health Services, Bassett Healthcare Network O'Connor Hospital, as well as the Southern Tier PHIP. Through this work group, the data from the community engagement sessions, as well as the hospital and county health department community health assessments, were aligned with the priorities outlined by the NYS 2019-2024 Prevention Agenda. Additionally, the rationale for choice of priorities was based on available resources and capacity to address the priority. Opportunity for development of collaborative interventions by Margaretville Hospital, the Delaware County Public Health Department and other community partners, was also considered. Through the collaboration described above with county public health and community-based organizations, Margaretville Hospital aligned together to select two Prevention Agenda Priorities: a. Prevent Chronic Diseases b. Promote Well-Being and Prevent Mental and Substance Use Disorders Both of the Community Health Needs Assessment (CHNA) 2019 priorities are from the NYS Prevention Agenda 2019-2024. Margaretville Hospital participated in a workgroup consisting of the three local health systems and the county Public Health department to identify focus areas, and objectives for each of the Agenda Priorities jointly identified by the hospital and collaborators: The New York State Prevention Agenda outlines three other priority areas that were not selected as priorities for the Margaretville hospital 2019-2021 Community Service Plan: Promote a Healthy and Safe Environment, Promote Healthy Women, Infants and Children, and Prevent Communicable Diseases. Although all of these merit focus for improving population health, they were not selected due to the limited amount of resources available to address these issues and the relative severity of need demonstrated for the priority areas that were chosen. Part V, Section B, Line 5: Margaretville Memorial Hospital (Margaretville Hospital), an affiliate of HealthAlliance of the Hudson Valley, a member of the Westchester Medical Center Health Network (WMCHealth) was an active member of a comprehensive Delaware County Community Health Needs Assessment which includes 3 hospitals and the Delaware County Public Health Department. Margaretville Hospital staff was heavily involved in the collaborative and contributed immensely towards the creation of the assessment. The primary proactive means for receiving community input was through the Regional Assessment conducted by the Southern Tier Population Health Improvement Program (PHIP). In the Southern Tier, PHIP covers five counties including Delaware County. In order to inform the direction of the Southern Tier PHIP, also known as Health Action Priorities Network (HAPN), the team conducted a regional health assessment utilizing stakeholder interviews and consumer focus groups. The information/data from the Delaware County assessment was utilized to direct the selection of the public health priorities for Margaretville Hospital. From June 2018 through January 2019, structured interviews in Delaware County were conducted with professionals working in diverse fields such as health care, education, transportation, economic development, mental health, law enforcement and elected officials, among others. The interview focused on 10 key questions and five secondary questions centered on health disparities, key barriers to addressing them, and gaps in service provision. Consumers' input was sought through focus groups which were conducted from January through March of 2019. Population Health Coordinators met with pre-existing groups including support groups, service clubs, parent groups and senior meals. HAPN/PHIP Southern Tier conducted focus groups in Delaware County. The group attendants were asked about their experiences with health and health care delivery. Responses from the focus groups were collected by note-takers and summarized qualitatively by the Population Health Coordinators. In addition, Margaretville Hospital is an active participant in Delaware County's Community Health Improvement Plan process. This process included input and suggestions from Delaware County Public Health, Delaware Valley Hospital, Margaretville Hospital, O'Connor Hospital, and the Southern Tier PHIP. In May of 2019, the PHIP Population Health Coordinators worked with the Delaware County committee to hold a community roundtable event at SUNY Delhi, located in Delhi NY, Delaware County. All Health and Human Services providers that received the survey were invited, as well as the community residents who provided their names and contact information electronically via the survey. The event was also promoted via email and social media communications. Hospital and Public Health representatives shared the invitation with their Boards of Directors. The roundtable event was attended by 40 people, and included a presentation on the survey data by the PHIP Coordinators. In addition, Delaware County's Director of Public Health and the Director of Operational Support from O'Connor Hospital (located in Delhi and affiliated with the Bassett Healthcare system) presented on the NY State and Federal requirements for completion of the Community Health Assessment, Community Health Improvement Plan, and the hospitals' Community Service Plans. PART V, SECTION B, LINE 6A: The CHNA was conducted with Delaware Valley Hospital (DVH), an affiliate of United Health Services (UHS) system; Margaretville Hospital (MH), which is a part of the Health Alliance of the Hudson Valley and a member of the Westchester Medical Center Health Network; and O'Connor Hospital (OCH), of the Bassett Healthcare Network. PART V, SECTION B, LINE 6B: Margaretville Hospital worked very closely with Delaware County Public Health. PART V, SECTION B, LINE 7: The CHNA has been widely available to the public through the website at HTTPS://WWW.HAHV.ORG/UPLOADS/PUBLIC/DOCUMENTS/HEALTHALLIANCE%20PDFS/COMMUN ITY%20HEALTH/MH%20CSP_CHNA%202019_2021.PDF PART V, SECTION B, LINE 10: Margaretville Hospital has adopted an implementation strategy that will address the significant community health needs outlined in the hospital's CHNA which can be found on our website at HTTPS://WWW.HAHV.ORG/UPLOADS/PUBLIC/DOCUMENTS/HEALTHALLIANCE%20PDFS/COMMUN ITY%20HEALTH/MH%20CSP_CHNA%202019_2021.PDF PART V, SECTION B, LINE 11: Through the collaboration and partnership with Delaware County Public Health Department, Margaretville Hospital, in accordance with New York State Prevention Agenda mandate, has chosen to align with our community partners in focusing on two priority areas: a. Prevent Chronic Diseases b. Promote Healthy Women, Infants, and Children Margaretville Hospital involved key members of the Hospital Team in the assessment and selection of its health priorities. After identification of the criteria for priority selection, a work group was convened by the Delaware County Public Health Department which included Margaretville Hospital affiliated with Health Alliance of the Hudson Valley and Westchester Medical Center Health, Delaware Valley Hospital affiliated with United Health Services, Bassett Healthcare Network O'Connor Hospital, as well as the Southern Tier PHIP. Through this work group, the data from the community engagement sessions, as well as the hospital and county health department community health assessments, were aligned with the priorities outlined by the NYS 2019-2024 Prevention Agenda. Additionally, the rationale for choice of priorities was based on available resources and capacity to address the priority. Opportunity for development of collaborative interventions by Margaretville Hospital, the Delaware County Public Health Department and other community partners, was also considered. Through the collaboration described above with county public health and community-based organizations, Margaretville Hospital aligned together to select two Prevention Agenda Priorities: a. Prevent Chronic Diseases b. Promote Well-Being and Prevent Mental and Substance Use Disorders Both of the Community Health Needs Assessment (CHNA) 2019 priorities are from the NYS Prevention Agenda 2019-2024. Margaretville Hospital participated in a workgroup consisting of the three local health systems and the county Public Health department to identify focus areas, and objectives for each of the Agenda Priorities jointly identified by the hospital and collaborators: The New York State Prevention Agenda outlines three other priority areas that were not selected as priorities for the Margaretville hospital 2019-2021 Community Service Plan: Promote a Healthy and Safe Environment, Promote Healthy Women, Infants and Children, and Prevent Communicable Diseases. Although all of these merit focus for improving population health, they were not selected due to the limited amount of resources available to address these issues and the relative severity of need demonstrated for the priority areas that were chosen. AREAS OF FOCUS: Margaretville decided to address the county's health needs through the following implementation plan in guidance of NYS Prevention Agenda. Priority 1: Prevent Chronic Disease Focus Area 1: Healthy eating and food security Goal 1.3: Increase food security Objective 1.13: Increase the % of adults with perceived food security. Community Based Strategy and Commitment of Resources: The dietary department at Margaretville Hospital/MRCC will design and implement a food program designed to address food insecurity for inpatients (acute, observation and swing bed). The goal is for the dietitians, upon interview and screening, to identify patients with limited food access or possible food insecurity. They will establish a patient referral process to public health nutrition program such as WIC, SNAP or local food emergency services or food pantry prior to patients discharge. Focus Area 3: Tobacco Prevention Goal 3.2: Promote tobacco use cessation Objective: 3.2.2 Use health communications and media opportunities to promote the treatment of tobacco dependence by targeting smokers with emotional evocative and graphic messaging to encourage evidence-based quit attempts and increase awareness of available cessation benefits. Community Based Strategy and Commitment of Resources: Margaretville Hospital will partner with the HealthAlliance Marketing Department and Tobacco-Free Action Coalition to develop annual campaigns targeting current tobacco users in the community and our own facilities on the harm of smoking. In addition, we provide information through various messaging channels to include email, social media, earned media, and message boards. Focus Area 4: Preventive Care and management. Goal 4.4: In the community setting, improve self-management skills for individuals with chronic diseases, including asthma, arthritis, cardiovascular disease, diabetes and pre-diabetes and obesity. Objective 4.4.1: Increase the % of adults with chronic conditions who have taken a course or class to learn how to manage their condition. Community Based Strategy and Commitment of Resources: Margaretville Hospital will provide COPD education classes including a focus on self-management. Margaretville Hospital will also promote and support the Chronic Disease Self-Management Program (CDSMP) classes taking place in Delaware County. Priority 2: Promote Well-Being and Prevent Mental Health and Substance Use Disorders Focus Area 2: Mental and Substance Use Disorders Prevention Goal 2.2: Prevent opioid and other substance misuse and deaths. Objective 2.2.4: Reduce all E.D. visits (including outpatient and admitted patients) involving one opioid overdose. Community Based Strategy and Commitment of Resources: Margaretville Hospital will actively participate in the Catskills Addiction Coalition as the fiduciary member and recipient of the Rural Communities Opioid Response Planning grant for 2019 to 2020. In addition, the hospital will participate in the Delaware County Opioid Task Force and openly share OCH data with the Delaware County Public Health Department on number of patients reporting to E.D. with substance abuse issues for collaboration and appropriate access to services among community partners. Additionally, work towards receiving a three-year HRSA implementation grant to implement programs of the Catskills Addiction Coalition. Devote resources and attention of staff and leadership to collaborating with other community organizations on creative solutions. Focus Area 2: Mental and Substance Use Disorders Prevention Goal 2.3: Prevent and address adverse childhood experiences (ACES) Objective 2.3.3: Increase communities reached by opportunities to build resilience by at least 10 percent Community Based Strategy and Commitment of Resources: Margaretville Hospital will partner with HealthAlliance's Youth Mental Health First Aid Program to deliver the training to a variety of organizations and overall public through a variety of outreach and network building. In addition, the ultimate goal is to help drive referrals of youth needing additional support from clinicians. Focus Area 2: Promote Well-Being and Prevent Substance Use Disorders Goal 2.5: Prevent Suicides Objective 2.5.4: Build support systems to care for opioid users or at risk of an overdose Community Based strategy and Commitment of Resources: Margaretville Hospital will host QPR training at least once annually for Margaretville Hospital staff and four times annually throughout Delaware County in conjunction with the Delaware County Suicide Prevention. We will assess and identify the appropriate community organizations and internal staff for preventative steps to be taken. PART V, SECTION B, LINE 16A, B AND C: The hospital's financial assistance policy and application are available at the following link: https://www.hahv.org/financial-assistance PART I, LINE 7: Margaretville Memorial Hospital's costing methodology was based upon worksheet S-10 of the Medicare cost report. The cost-to-charge ratio was used for the various sub-line items of line # 7. PART I, LINE 7G: The costs on line 7g do not include any costs attributable to physician clinics. Part III, Line 2: Methodology Used to Estimate Amount of Bad Debt Expense The amount reported on line 2 is equal to the provision for bad debt expense per the audited financial statements. The explanation of the methodology used to estimate this amount can be found in footnote #2 on pages 16-17 of the attached audited financial statements. Part III, Line 4: Description of Bad Debt Expense The text of the footnote that describes bad debt expense can be found on pages 16-17 of the attached audited financial statements. Part III, Line 8: Costing Methodology Since Margaretville Memorial Hospital is a critical access hospital, the hospital receives 101% of its cost for most of its services; therefore Margaretville should always have a surplus from Medicare. The amount reported on Line 6 was derived by using the Medicare allowable costs as reported on the Medicare cost report and the applicable adjustments from Worksheet A. For 2019, Margaretville Memorial Hospital does not have a loss from Medicare therefore it is not considered a community benefit. PART III LINE 9B: Collection Practices The credit and collection policy for self-pay balances provides that, in some cases, non-insured patients that do not qualify for medicaid qualify for charity care. In those instances, the credit and collection department will follow the guidelines as set forth in the charity care policy. The charity care policy provides that the financial counselor evaluates the information provided in patients' charity care applications in conjunction with federal income poverty guidelines to determine the write-off percentage. If the patient/guarantor qualifies for charity care based on the sliding scale, the patient will be required to pay the outstanding amount. A payment plan is established not to exceed 10% of the guarantor's gross monthly income. PART VI, LINE 2: NEEDS ASSESSMENT For the community based strategies, Margaretville hospital will continue to actively participate in a work group consisting of the public health department and three other local hospitals for the purposes of maintaining engagement with local partners over the next three year period. Initially, meetings will be held on a quarterly basis; however frequency will be revisited throughout the timeframe to ensure that the meetings are meeting the needs of all partners. Progress will be tracked by the work group Margaretville hospital is actively participating in. Annually hospital leadership presents an update to the hospital's board of trustees noting specific achievements and barriers to implementation. Anecdotal feedback will be in work group meetings, meetings involving health and wellness groups such as the suicide prevention network of Delaware County, and from patients and individuals participating in interventions, allowing continual review of the community service plan tasks and mid-course corrections when required. Periodic public notices will be posted on the hospital website. Finally, as available, local, state and national health status indicators will be reviewed. PART VI, LINE 3: The hospital informs the patient of the availability of charity care several ways: 1. notice is on every patient bill with an application on the back of the bill 2. on the hospital website 3. all members of the patient accounting department are trained to screen patients for charity care when discussing bills and concerns regarding inability to pay 4. fliers are posted in registration areas of the hospital 5. registration clerks will identify patients without a pay source and refer the patient to a financial counselor and hand the patient a financial assistance form 6. financial counselors assist patients in securing Medicaid and screen for charity care 7. the collection agencies that HAHV engages with are aware of the charity care policy and assist patients in applying up to 180 days post-placement with them HealthAlliance is committed to: - Providing access to quality healthcare services with compassion, dignity and respect for those we serve, particularly the poor and the underserved in our communities. - Caring for all persons, regardless of their ability to pay for services. - Assisting patients who cannot pay for part or all of the care they receive. - Balancing needed financial assistance for some patients with broader fiscal responsibilities in order to sustain viability and provide the quality and quantity of services for all who may need care in a community. In accordance with AHA recommendations, HealthAlliance adopted the following guiding principles when handling the billing, collection and financial support functions for our patients: - provide effective communications with patients regarding hospital bills - make affirmative efforts to help patients apply for public and private financial support programs - offer financial support to patients with limited means - implement policies for assisting low-income patients in a consistent manner - implement fair and consistent billing and collection practices for all patients with patient payment obligations HealthAlliance effectively communicates with patients regarding patient payment obligations. Financial counseling is provided to patients about their payment obligation and hospital bills. Information on hospital-based financial support policies and external programs that provide coverage for services are made available to patients during the pre-registration and registration processes and in response to patients seeking financial assistance. Information regarding the financial assistance is also provided by the onsite financial counseling staff in both inpatient and outpatient areas. Patient accounting also supports the financial counseling program by providing patients with information and applications while handling customer service calls. Financial counselors and county Medicaid workers also provide guidance regarding the financial assistance program when necessary. Financial assistance is available on the back of every hospital bill as well as the hospital website at www.hahv.org. Financial counselors make affirmative efforts to help patients apply for public and private programs for which they may qualify and that may help them obtain and pay for healthcare services. The patient does not need to have an account with the hospital; they just have to be in a situation where they are in need of insurance coverage. Every effort is made to determine a patient's eligibility prior to or at the time of admission or service. However, determination for financial support can be made during any stage of the patient's stay after stabilization or collection cycle. HealthAlliance offers financial support to patients with limited means. This support is available to uninsured and underinsured patients who do not qualify for public programs or other assistance. Notification about financial assistance, including contact information, is available through the hospital website, hospital posters and flyers, financial assistance applications and hospital statements. The financial assistance policy (FAP) and application are available on our website at https://www.hahv.org/financial-assistance and are supplied in both English and Spanish as well as plain language summary format. If additional assistance is needed, HealthAlliance offers translation services for patients. HealthAlliance has an established written policy for the billing, collection and support for patients with payment obligations. The organization makes every effort to adhere to the policy and is committed to implementing and applying the policy for assisting patients with limited means in a professional, consistent manner. Educated staff members work closely with patients (including those working in patient registration and admitting, financial assistance, customer service, billing and collections) about these policies with an emphasis on treating all patients with dignity and respect regardless of their insurance status or their ability to pay for services. All patient registration staff receive in-service training regarding the financial assistance program. Patient accounting also receives information about the program and how to handle patients seeking financial assistance. Financial counselors receive in depth training to handle financial assistance requests, process applications, and manage outcomes. HealthAlliance provides several options for patients who either do not have insurance coverage or who have inadequate insurance coverage. Our many programs have been very successful and many have taken advantage of our offerings. Financial counseling offers a patient the opportunity to speak to a financial counselor to determine what assistance can be accessible based on family income. Patients often shop around for the most economical healthcare and we offer price quotes. This allows the patient to know their financial obligation up front and understand the competitive pricing being offered. Despite millions of dollars of charity care distributed to needy patients every year, a consistent challenge is patients not utilizing the programs we offer. Often they don't want to provide the necessary financial information to initiate the financial aid process. Continual outreach and education is occurring to minimize confusion and improve utilization. HealthAlliance is committed to providing the best possible healthcare and is very sensitive to low income patients' ability to pay. The call center offers the convenience of calling one telephone number for all billing inquiries regardless of which hospital the patient is calling about. PART VI, LINE 4: Community Description Margaretville Memorial Hospital (Margaretville Hospital), a member of HealthAlliance of the Hudson Valley and the Westchester Medical Center Health Network (WMCHealth) is a rural Critical Access Hospital whose mission is to provide immediate access to high quality medical care and diagnostic testing services to medically underserved areas in the Catskill Mountains. Margaretville Hospital provides linkages to high tech and specialty medical care through an active relationship with HealthAlliance and WMCHealth. Margaretville Hospital is the Delaware County affiliate of HealthAlliance of the Hudson Valley (HealthAlliance), a multi-campus health care system consisting of HealthAlliance Hospital's Mary's Ave. and Broadway campuses in Kingston, NY, and Margaretville Hospital, which is co-located on a single campus in Margaretville, NY (Delaware County), with the Mountainside Residential Care Center, a skilled nursing facility. HealthAlliance defines its primary service area by a federal definition that consists of the top 75% of hospital discharges from the lowest number of contiguous zip codes. Margaretville hospital serves the communities of Margaretville, Arkville, Andes, Fleischmanns, Roxbury, Halcott Center, Halcottsville, and New Kingston. Due to the geographical location of acute care hospitals affiliated with HealthAlliance, there are two distinct primary services areas within Ulster and Delaware Counties, though not encompassing all of each county. For operational and community needs development, HealthAlliance regards these two service areas as a single primary service area with the predominant population in Ulster County. However, for the purposes of this document, which will align with the Delaware County Community Health Assessment and the Community Health Improvement Plan, we will present the information pertaining to the Margaretville Hospital service area, located in Delaware County and described in the beginning of this section. Other community health services and resources available in Delaware County include 23 ambulance services, mostly consisting of volunteer membership. In addition to Margaretville Hospital, there are three other hospitals, operated by two other healthcare systems: Delaware Valley Hospital affiliated with United Health Services, as well as O'Connor Hospital affiliated with the Bassett Healthcare Network. Additionally, there are three nursing homes in the county, 15 primary care offices including health centers and private physician offices, 15 locations and 9 full-time equivalent dentists, and two mental health clinics with multiple locations within the county. Delaware County covers 1,442 square miles in upstate New York, belonging to both the Southern Tier region and the Catskill Mountain range. Delaware County is the fourth largest county in New York by area and is the sixth most rural with a population density of 33 persons per square mile. The county includes the Catskill/Delaware Watershed, which is the largest unfiltered drinking water supply in the United States. The watershed region encompasses the central and eastern sections of Delaware County and includes roughly 65% of the county's land area and 11 of its 19 townships. Approximately 55% of Delaware County's population lies within the Watershed. Based on the 2010 Census, the population of Delaware County is 47,840, 50.2% male and 49.8% female. In 2013, the population decreased to 46,772, representing a 2.3% reduction in population (Table 1). At the time of the 2010 Census, 9,405 people were less than 18 (19.6%), 38,575 were 18 and over (80.4%) and 9,331, were 65 and over (19.4%). It is estimated that 46.5% of the total population is 45 years of age or older. PART VI, LINE 5: Promotion of Community Health Please see narrative for Schedule H, Part V, Section B, line 11 for a complete description of how the organization's hospital facilities furthers its exempt purposes by promoting the health of the community. PART VI, LINE 6: Affiliated Health Care System Health Alliance is the parent company to affiliate members HA Mary's Avenue campus, Broadway campus, Margaretville Memorial Hospital, a rural critical access hospital; Mountainside Residential Care Center, a skilled nursing facility. This integrated healthcare system is committed to providing quality and compassionate medical care for our patients, their families and our community. In addition to service consolidation between the two Kingston hospitals, HAHV also committed to streamlining operations and improving care at the other affiliate locations. PART VI, LINE 7: STATE FILING OF COMMUNITY BENEFIT REPORT NEW YORK true false false false false false false false false Eileen King CLINICAL COORDINATOR 236034 0 0 0 792 0 240 0 26819 0 263885 0 0 0 Joseph Marsicovete Chief Operating Officer 0 314013 0 0 0 7834 0 6750 0 13522 0 342119 0 0 Paul Llobet MD TRUSTEE (RESIGNED 9/2/2019) 0 215705 0 0 0 57947 0 5826 0 0 0 279478 0 0 MARK POHAR EXEC DIR/ex-officio trustee 0 213746 0 0 0 19894 0 5475 0 26261 0 265376 0 0 NANETTE TREADWELL PHYSICIAN ASSISTANT 206990 0 0 0 792 0 240 0 21014 0 229036 0 0 0 JANE ULRICH SR. VP OF NURSING 0 188242 0 0 0 5146 0 3802 0 20852 0 218042 0 0 Robert Ross EXEC. VP (resigned 12/31/19) 0 619700 0 107625 0 19000 0 39200 0 39432 0 824957 0 0 Catherine Allen MD TRUSTEE (EFF. 5/1/19) 384995 0 0 0 432 0 0 0 12461 0 397888 0 0 0 Thomas Brunelle TRUSTEE (RESIGNED 9/28/19) 0 235297 0 0 0 19185 0 0 0 15091 0 269573 0 0 Michael Doyle MD EXEC DIR/CMO (eff. 9/28/19) 0 222694 0 0 0 127 0 0 0 239 0 223060 0 0 Brian Callahan Nurse Practitioner 226813 0 0 0 516 0 0 0 27782 0 255111 0 0 0 David Scarpino FORMER CEO (RESIGNED 12/31/18) 0 0 0 0 0 520041 0 0 0 28911 0 548952 0 0 Schedule J, Part I, line 3 THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL (CEO) RETIRED EFFECTIVE 12/31/18 AND WAS PAID SEVERANCE IN 2019 FROM A RELATED ORGANIZATION. THE ORGANIZATION'S EXECUTIVE DIRECTOR RECEIVES COMPENSATION FROM A RELATED ORGANIZATION. IN ORDER TO ESTABLISH COMPENSATION PAYMENTS, THE ORGANIZATION TYPICALLY COMPLETES A COMPENSATION STUDY OR ENGAGES AN INDEPENDENT CONSULTANT. THE RESULTS OF SAID STUDY OF CONSULTANT'S FINDINGS ARE IMPLEMENTED INTO A WRITTEN EMPLOYMENT CONTRACT. ALL ACTIONS ABOVE ARE APPROVED BY THE BOARD OF DIRECTORS/COMPENSATION COMMITTEE PRIOR TO FINALIZATION. SCHEDULE J, PART I, LINE 4A DAVID SCARPINO RECEIVED SEVERANCE PAYMENTS OF $520,041 IN 2019 FROM A RELATED ORGANIZATION. PAUL LLOBET, MD RECEIVED SEVERANCE PAYMENTS OF $36,723 IN 2019 FROM A RELATED ORGANIZATION. FORM 990, PART VI, LINE 6 healthalliance, inc. is the sole corporate member of Margaretville memorial hospital. FORM 990, PART VI, LINE 7A HEALTHALLIANCE, INC., THE SOLE CORPORATE MEMBER OF MARGARETVILLE MEMORIAL HOSPITAL, HAS THE POWER TO ELECT ONE OR MORE MEMBERS OF THE LOCAL GOVERNING BODY OF THE HOSPITAL. FORM 990, PART VI, LINE 7B ALL DECISIONS MADE AT THE LOCAL BOARD LEVEL OF MARGARETVILLE MEMORIAL HOSPITAL, OTHER THAN THOSE RELATED TO QUALITY ASSURANCE AND BUILDING AND GROUNDS, ARE SUBJECT TO APPROVAL BY MEMBERS OF HEALTHALLIANCE, INC. BOARD OF TRUSTEES. THESE DECISIONS INCLUDE ELECTION AND REMOVAL OF MEMBERS OF THE LOCAL LEVEL GOVERNING BODY, APPOINTMENT/REMOVAL OF CORPORATE OFFICERS, APPROVAL OF BYLAW AMENDMENTS, REVIEW OF ANNUAL CAPITAL AND OPERATING BUDGETS, REVIEW AND/OR MODIFICATIONS OF ANY CERTIFICATE OF NEED APPLICATIONS, REVIEW INCURRENCE OF DEBT AND DEVELOP AND IMPLEMENT JOINT MEDICAL STAFF APPOINTMENTS. FORM 990, PART VI, LINE 11B THE FORM 990 WAS PREPARED BY THE ORGANIZATIONS TAX ADVISORS WITH ASSISTANCE FROM THE ORGANIZATIONS FINANCE DEPARTMENT AND OTHER DEPARTMENTS THROUGHOUT THE ORGANIZATION. THE FORM 990 WAS REVIEWED BY SENIOR MANAGEMENT. UPON COMPLETION OF THE VARIOUS REVIEWS, THE FORM 990 WAS PROVIDED TO THE BOARD OF THE ORGANIZATION FOR APPROVAL PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, LINE 12C THE ORGANIZATION MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY BY MEANS OF A SURVEY DEVELOPED AND APPROVED BY THE CHIEF COMPLIANCE OFFICER. THE SURVEY IS SENT TO ALL TRUSTEES, OFFICERS, AND KEY EXECUTIVES FOR COMPLETION. ALL SURVEY RESPONSES ARE REVIEWED BY THE CHIEF COMPLIANCE OFFICER. ANY POTENTIAL CONFLICTS IDENTIFIED IN THE RESPONSES ARE DISCUSSED WITH SENIOR MANAGEMENT AND/OR REFERRED TO THE WMCHEALTH CONFLICTS OF INTEREST COMMITTEE FOR DISCUSSION. POTENTIAL ACTIONS TO BE TAKEN IN RESPONSE TO A CONFLICT CAN BE ONE OR MORE OF THE FOLLOWING: 1) DISCLOSURE OF THE CONFLICT, 2) INDIVIDUAL RECUSAL FROM DECISIONS FOR TRANSACTIONS WHERE THAT INDIVIDUAL MAY HAVE A CONFLICT, 3) REQUEST IN WRITING THE INDIVIDUAL ALLEVIATES THE CONFLICT, OR 4) REMOVAL OF THE INDIVIDUAL FROM EMPLOYMENT. FORM 990, PART VI, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9 TRANSFER TO RELATED PARTIES (299,940) FORM 990 PART IX LINE 11G DESCRIPTION:CONTRACTED SERVICES TOTAL FEES:1244132 FORM 990 PART IX LINE 11G DESCRIPTION:OTHER MANPOWER TOTAL FEES:131096 FORM 990 PART IX LINE 11G DESCRIPTION:BIOMEDICAL SERVICES TOTAL FEES:110189 FORM 990 PART IX LINE 11G DESCRIPTION:COLLECTION FEES TOTAL FEES:22163 FORM 990 PART IX LINE 11G DESCRIPTION:WASTE DISPOSAL TOTAL FEES:19511 FORM 990 PART IX LINE 11G DESCRIPTION:CONSULTING & MGT TOTAL FEES:26548 FORM 990 PART IX LINE 11G DESCRIPTION:PHYSICIAN FEES TOTAL FEES:740949 WMC HEALTH NETWORK - ROCKLAND INC 100 WOODS ROAD VALHALLA NY 10595 320467873 SUPPORTING NY 501(C)(3) 12A NA false WMC HEALTH NETWORK - ULSTER INC 100 WOODS ROAD VALHALLA NY 10595 320477183 SUPPORTING NY 501(C)(3) 12A WCHCC false WESTCHESTER COUNTY HEALTH CARE CORP 100 WOODS ROAD VALHALLA NY 10595 133964321 HEALTHCARE NY 115 N/A NA false WMC NEW YORK INC 100 WOODS ROAD VALHALLA NY 10595 134107894 FUNDRAISING NY 501(C)(3) 12A WCHCC false NORTH ROAD LHCSA INC 100 WOODS ROAD VALHALLA NY 10595 465293268 HOMECARE SVCS NY 501(C)(3) 10 WCHCC false MID-HUDSON VALLEY EARLY EDUCATION CENTER 100 WOODS ROAD VALHALLA NY 10595 465534882 PRESCHOOL NY 501(C)(3) 7 WCHCC false WESTCHESTER MEDICAL CENTER FOUNDATION 100 WOODS ROAD VALHALLA NY 10595 134095845 FUNDRAISING NY 501(C)(3) 7 WCHCC false HEALTHALLIANCE INC 741 GRANT AVENUE LAKE KATRINE NY 12449 261850453 SUPPORTING NY 501(C)(3) 12A WCHCC false HEALTHALLIANCE HOSPITAL BROADWAY CAMPUS 396 BROADWAY KINGSTON NY 12401 141349558 EXEMPT HOSP NY 501(C)(3) 3 HA INC false HEALTHALLIANCE HOSP MARY'S AVE CAMPUS 105 MARYS AVENUE KINGSTON NY 12401 141338470 EXEMPT HOSP NY 501(C)(3) 3 HA INC false MARGARETVILLE NURSING HOME INC 42158 STATE HIGHWAY 28 MARGARETVILLE NY 12455 223143565 NURSING HOME NY 501(C)(3) 10 MMH true MARGARETVILLE HEALTH FOUNDATION 42084 STATE HIGHWAY 28 MARGARETVILLE NY 12455 261998454 SUPPORT FDN NY 501(C)(3) 12A MMH true FASC FOUNDATION 741 GRANT AVENUE LAKE KATRINE NY 12449 264201295 SUPPORT FDN NY 501(C)(3) 7 HAH BWAY false GOOD SAMARITAN FDN FOR BETTER HEALTH 255 LAFAYETTE AVE SUFFERN NY 10901 133400353 SUPPORT FDN NY 501(C)(3) 7 BSCHSI false BON SECOURS COMMUNITY HOSPITAL FDN 255 LAFAYETTE AVE SUFFERN NY 10901 810667395 SUPPORT FDN NY 501(C)(3) 7 BSCHSI false BON SECOURS WARWICK HEALTH FOUNDATION 255 LAFAYETTE AVE SUFFERN NY 10901 141972807 SUPPORT FDN NY 501(C)(3) 7 BSCHSI false BON SECOURS CHARITY HEALTH SYSTEM INC 255 LAFAYETTE AVE SUFFERN NY 10901 912135195 SUPPORTING NY 501(C)(3) 12C, III-FI WCHCC false HealthAlliance Foundation Inc 741 GRANT AVENUE LAKE KATRINE NY 12449 222511450 FUNDRAISING NY 501(C)(3) 7 HA INC false HUDSON RIVER WEST INSURANCE (BARBADOS) 38 PINE ROAD BELLEVILLE ST MICHAEL BB CAP INSURANCE BB BSCHSI C CORP false KINGSTON INSURANCE (BARBADOS) LIMITED 38 PINE ROAD BELLEVILLE ST MICHAEL BB CAP INSURANCE BB HEALTHALLIANCE C CORP false NORTHEAST PROVIDER SOLUTIONS INC 100 WOODS ROAD VALHALLA NY 10595 133991673 MSO & HEARING NY NA c corp false WMC ADVANCED PHYSICIAN SERVICES PC 19 BRADHURST AVENUE HAWTHORNE NY 10595 264709927 PHYSICIAN OFF NY NA c corp false WESTCHESTER MEDICAL REGIONAL PHYS SVCS 241 NORTH ROAD POUGHKEEPSIE NY 10532 465522536 PHYSICIAN OFF NY NA c corp false WCHCC (BERMUDA) LIMITED VICTORIA HALL 11 VICTORIA STREET HAMILTON BD CAP INSURANCE BD NA c corp false KINGSTON REGIONAL HEALTH CARE ENTERPRISE 396 BROADWAY KINGSTON NY 12401 161514994 INVESTMENT NY HAH BWAY c corp false MID HUDSON PHYSICIANS PC 396 BROADWAY KINGSTON NY 12401 203564769 MEDICAL SVCS NY na c corp false bschs medical group pc 10 franklin turnpike mahwah NJ 07430 821632215 physician off NJ bschs c corp false false false false false false false false false false true true false true false true false false false false MARGARETVILLE NURSING HOME INC o 806939 COST SCHEDULE R, PART II, Bon Secours Charity Health System, Inc. (BSCHS) Margaretville Memorial Hospital has a brother-sister relationship with BSCHS's six subordinates in a group exemption within BSCHS.