2020-11-14T09:21:40-06:00 2019-12-31 161226221 FUST CHARLES CHAMBERS LLP 5784 WIDEWATERS PARKWAY SYRACUSE NY 13214 990 2019-01-01 150533578 LITTLE FALLS HOSPITAL LITT 3158231000 140 BURWELL STREET LITTLE FALLS NY 13365 JAMES VIELKIND CFO 3158231000 2020-11-12 1 KELLY A REDMOND P00443718 3154463600 2020-11-12 67.242.7.99 2020-11-12 16:38:43 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 D2E8F385EE88BD29EFAB248CF612B9DA1F974714 2019 2021-01-29 14:40:06Z JAMES VIELKIND 140 BURWELL STREET LITTLE FALLS NY 13365 38882143 0 X WWW.BASSETT.ORG X 1893 NY LITTLE FALLS HOSPITAL IS A CRITICAL ACCESS HOSPITAL PROVIDING ACCESS TO HEALTH CARE SERVICES TO RESIDENTS OF HERKIMER COUNTY, AND WESTERN PORTIONS OF MONTGOMERY AND FULTON COUNTIES. LITTLE FALLS HOSPITAL EMERGENCY DEPARTMENT IS STAFFED WITH PHYSICIANS ON A 24/7 BASIS. TWENTY FIVE BEDS ARE USED FOR INPATIENT AND SKILLED NURSING CARE. AMBULATORY SURGERY SERVICES ARE PROVIDED FOR A VARIETY OF PROCEDURE SPECIALTIES. PERFORMANCE IMPROVEMENT AND HIGH QUALITY OF CARE IS DEMONSTRATED WITHIN THE HOSPITAL CONSUMER ASSESSMENT OF HEALTHCARE PROVIDERS AND SYSTEMS (HCAHPS) AS REPORTED ON MEDICARE.GOV HOSPITAL COMPARE. 15 11 387 0 0 0 739625 1265539 32939635 33439501 590377 438892 0 0 34269637 35143932 0 0 0 0 15786356 15784280 0 0 118637 18937262 18099302 34723618 33883582 -453981 1260350 30364498 33323096 9257548 9825312 21106950 23497784 X LITTLE FALLS HOSPITAL IS A VOLUNTARY, NOT-FOR-PROFIT COMMUNITY HEALTHCARE SYSTEM WHOSE MISSION IS TO OFFER QUALITY CARE WITH COMPASSION, TO ALL WHO NEED OUR SERVICES. 1 0 9076769 7635287 INPATIENT SERVICESTHE INPATIENT OCCUPANCY RATE FOR INPATIENT AND OBSERVATION SERVICES WAS 59% FOR AN AVERAGE DAILY INPATIENT DAILY CENSUS OF 15 PATIENTS. AS A CRITICAL ACCESS HOSPITAL (CAH) PROVIDER, OUR INPATIENT DAILY SERVICES INCLUDE; OBSERVATION CARE, EXTENDED SWINGBED REHAB SERVICES, AND ACUTE CARE SERVICES. THIS DIVERSITY OF PATIENT CARE ALLOWS FOR OUR RESIDENTS TO REMAIN LOCAL FOR MEDICALLY APPROPRIATE SERVICES. IN 2019, ACUTE CARE LENGTH OF STAY WAS 3.4 DAYS COMPARED WITH 3.7 IN 2018. THIS LOWER LENGTH OF STAY HIGHLIGHTS THE QAULITY AND COORDINATION OF CARE FOR PATIENT AT LITTLE FALLS HOSPITAL. 9084739 10410098 LITTLE FALLS HOSPITAL OPERATES AN EMERGENCY DEPARTMENT WITH TWENTY FOUR HOURS OF PHYSICIAN COVERAGE, SEVEN DAYS PER WEEK. THE EMERGENCY DEPARTMENT PROVIDED ACCESS TO CARE FOR APPROXIMATELY 15,000 PATIENTS IN 2019. LITTLE FALLS HOSPITAL EXPANDED THE EMERGENCY DEPARTMENT PARTICIPATED IN A NYS MEDICAID ACCELERATED EXCHANGE (MAX) PROGRAM TO REDUCE AVOIDABLE VISITS TO AN EMERGENCY DEPARTMENT. IN ADDITION A PARTNERSHIP WITH SALVATION ARMY AND THEIR COMMUNITY "PATHWAY TO HOPE" PROGRAM WAS FORMALIZED TO ASSIST IN PATIENT CARE MANAGMENT ACTIVITIES. THESE SERVCIES EMBEDDED IN OUR EMERGENCY ROOM PROVIDES ASSITANCE FOR PATIENTS TO MAKE MEDICAL APPOINTMENTS, OBTAIN INSURANCE COVERAGE, OR APPLY FOR COMMUNITY ASSISTANCE PROGRAMS. 9686305 14278569 TOTAL AMBULATORY OUTPATIENT SERVICE VISITS WERE APPROXIMATELY 33,500 IN 2019. OUR AMBULATORY SERVICES INCLUDE REHAB / WELLNESS PROGRAM, AMBULATORY SURGERY / GI SERVICES, WOMENS IMAGING SERVICE, DIAGNOSTIC IMAGING SERVICES, RURAL HEALTH CLINIC RIMARY CARE SERVICES. IN 2019, THE HOSPITAL COMPLETED A MRI CAPITAL REPALCEMENT PROJECT OF $1.6M TO UPDATE TECHNOLOGY AND SERVICES PROVIDED LOCALLY. 1437182 1115547 THE HOSPITAL CONTINUED EFFORTS WITH SUPPORTING OUR ROLE AS A NYS DEFINED SAFETY-NET PROVIDER. IN 2019 PALNNING WAS INITIATED TO EXPAND RURAL HEALTH CLINIC LOCATIONS. RURAL HEALTH CLINICS WILL ALLOW FOR ENHANCING SUPPORT FOR PRIMARY CARE SERVCIES AND ENSURING ACCESS TO PRIMARY CARE IN RURAL COMMUNITES. 1437182 1115547 29284995 1 1 0 1 0 0 0 0 0 1 1 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 66 0 387 1 0 0 0 0 0 0 0 0 0 0 0 0 X 15 11 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X JAMES G VIELKIND 3158235281 140 BURWELL STREET LITTLE FALLS NY 13365 CHRISTINE REYNOLDS THIRD VICE CHAIRMAN 2.00 X X 0 0 0 PHYLLIS SPINNER TRUSTEE 2.00 X 0 0 0 TIMOTHY DALY CHAIRMAN 2.00 X X 0 0 0 ANTHONY DELUCA FIRST VICE CHAIRMAN 2.00 X X 0 0 0 GERARD J SNYDER SECRETARY 2.00 X X 0 0 0 KEVIN CROSLEY TRUSTEE 2.00 X 0 0 0 JUSTIN R HUMMEL SECOND VICE CHAIRMAN 2.00 X X 0 0 0 AMY GRACE MD PRESIDENT OF MEDICAL STAFF 2.00 40.00 X X 0 261214 17750 ROBERT CASULLO TRUSTEE 2.00 X 0 0 0 KATE READ LAVALLA TRUSTEE 2.00 X 0 0 0 LISA BETRUS TRUSTEE 2.00 40.00 X X 0 230556 17649 KATHLEEN SELLERS TRUSTEE 2.00 X 0 0 0 CHRISTINA CAIN TRUSTEE 2.00 X 0 0 0 DAVID CASULLO TRUSTEE 2.00 X 0 0 0 MICHAEL OGDEN PRESIDENT & CEO 40.00 X 0 226428 0 JAMES G VIELKIND CHIEF FINANCIAL OFFICER 40.00 X 30320 192500 976 HEIDI CAMARDELLO DIRECTOR OF NURSING 40.00 X 139194 0 10659 LOREEN E SHEPARDSON DIRECTOR OF PHARMACY 40.00 X 142497 0 3377 PAUL L TRZEPACZ CLINICAL LAB COORDINATOR 40.00 X 117634 0 20709 LINDA BELDEN ADVANCE CARE PRACTITIONER 40.00 X 107805 0 20475 JODI POLLITT NURSE SUPERVISOR 40.00 X 116479 0 10122 653929 910698 101717 12 0 1 0 E 4 H ENVIRONMENTS 185 TALCOTT RD WILLISTON VT 05495 ARCHITECT SERVICES 118251 DM CONSULTING PO BOX 4715 UTICA NY 13504 INFORMATION TECHNOLOGY 117832 FUST CHARLES CHAMBERS 5784 WIDEWATERS PKWY SYRACUSE NY 13214 ACCOUNTING SERVICES 107427 3 594581 670958 1265539 OUTPATIENT SERVICES 623000 24685465 24685465 INPATIENT HOSPITAL 621930 7635287 7635287 OTHER OPERATING REVENUE 900099 508793 508793 PROGRAM SERVICE LEASE 532000 457634 457634 HOSPITAL CAFETERIA 900099 152322 152322 33439501 119430 119430 4057673 3738211 319462 319462 319462 35143932 33439501 0 438892 31296 31296 12620296 11083943 1486149 50204 666285 584568 79069 2648 1523081 1334517 182518 6046 943322 826499 113079 3744 61249 61249 57017 57017 8769 8769 879492 244484 635008 29822 29822 3285584 3237040 48544 1664187 1546355 117832 656299 571485 81161 3653 26902 15769 10600 533 23419 15834 7510 75 152704 23382 129322 2178189 1844659 333530 229314 219077 10237 PURCHASE SERVICES 5795853 4983866 776987 35000 PROVISION FOR BAD DEBT 1677414 1677414 NEW YORK STATE ASSESSME 101839 101839 1271249 944442 310073 16734 33883582 29284995 4479950 118637 976567 2342352 1675789 1761517 974357 936170 2534018 2723301 562367 637130 473592 966166 48814355 31230165 15198828 17584190 3648642 2875766 1596915 1789027 1397951 940883 1325472 766594 30364498 33323096 3286547 3758010 215663 397112 3533810 1683693 2388724 2221528 1597773 9257548 9825312 X 15193191 17755767 5913759 5742017 21106950 23497784 30364498 33323096 X 1260350 379310 751174 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 8769 8769 0 PART II-B, LINE 1: AMOUNTS FOR GENERAL LOBBYING ACTIVITIES ARE $8,769 COMPRISED FROM THE HEALTHCARE ASSOCIAITON MEMBERSHIPS AS FOLLOWS: HEALTHCARE ASSOCIATION OF NEW YORK STATE 17.97% OF DUES PAID OF $6,582. AMERICAN HOSPITAL ASSOCIATION 23.32% OF DUES PAID OF $16,732. IROQUOIS HEALTHCARE ALLIANCE 39.7% OF DUES PAID OF $9,280 5913759 482000 87791 3771 737762 5742017 4914943 487332 512484 -1000 5913759 4609617 305326 4914943 4460686 148931 4609617 4590711 14514 -144539 4460686 0.18790 0.81210 0 1 1 402942 402942 32083003 19020544 13062459 16328410 12209621 4118789 17584190 ELSA O'BRIEN CHARITABLE REMAINER TR 1789027 F 1789027 ACCRUED PENSION LIABILITY 1075422 OTHER LIABILITIES 522351 1597773 X 33845828 379310 379310 33466518 1677414 1677414 35143932 32206168 0 32206168 1677414 1677414 33883582 PART V, LINE 4: ENDOWMENT FUNDS DISTRIBUTE INCOME FOR PURPOSES OF CAPITAL INVESTMENT. TEMPORARY ENDOWMENTS ARE USED BASED ON THE INTENT OF THE DONATION WHICH IS TYPICALLY FOR CAPITAL INVESTMENTS. PART X, LINE 2: THE HOSPITAL QUALIFIES AS AN ORGANIZATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL INCOME TAXES PURSUANT TO SECTION 501(A) OF THE INTERNAL REVENUE CODE. AS OF DECEMBER 31, 2019 AND 2018, THE HOSPITAL DID NOT HAVE ANY UNRECOGNIZED TAX BENEFITS OR ANY RELATED ACCRUED INTEREST OR PENALTIES. THE TAX YEARS OPEN TO EXAMINATION BY FEDERAL AND NEW YORK STATE TAXING AUTHORITIES ARE 2016 THROUGH 2019. PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT 1,677,414. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT 1,677,414. PART VI, LINE 1E INCLUDED IN BUILDINGS AND EQUIPMENT IS $2,351,493 OF ASSETS NOT IN USE. THESE ASSETS ARE ASSOCIATED WITH THE DOLGEVILLE PRIMARY CARE FACILITY THATA WAS COMPLETED IN FEBRUARY 2020. 1 1 1 X 300.000000000000 0 1 1 0 1 1 94 149505 52092 97413 0.00300 13565 6464158 5103717 1360441 0.04220 13659 6613663 5155809 1457854 0.04520 43356 1415 41941 0.00130 22 25136 0 25136 0.00080 1754 984395 609448 374947 0.01160 1776 1052887 610863 442024 0.01370 15435 7666550 5766672 1899878 0.05890 7416 7416 0.00020 64035 64035 0.00200 71451 71451 0.00220 1 1677414 28340 8035571 8271776 -236205 X 1 1 1 1 LITTLE FALLS HOSPITAL 140 BURWELL STREET LITTLE FALLS NY 13365 BASSETT.ORG 2129700H X X INCLUDES 25 INPATIENT BEDS, LITTLE FALLS HOSPITAL 1 0 0 1 X X X X X X X X X 19 1 1 1 1 X WWW.BASSETT.ORG X WWW.BASSETT.ORG X 1 19 1 WWW.BASSETT.ORG 0 1 X 300.000000000000 1 1 X X X X 1 X WWW.BASSETT.ORG X WWW.BASSETT.ORG X WWW.BASSETT.ORG X X X X X 1 X 0 X X X X 1 X 0 0 PART V, SECTION A: LITTLE FALLS HOSPITAL HAS PRIMARY CARE HEALTH CENTERS IN DOLGEVILLE, NY (ZIP CODE 13329) AND NEWPORT, NY (ZIP CODE 13416). IN DECEMBER 2019 LITTLE FALLS HOSPITAL BECAME THE OPERATOR OF FOUR RURAL HEALTH CLINICS OPERATED IN THE COMMUNITES OF WEST WINFIELD (ZIP CODE 13491), RICHFIELD SPRINGS (ZIP CODE 13439), ST. JOHNSVILLE (ZIP CODE 13452), AND LITTLE FALLS (ZIP CODE 13365). LITTLE FALLS HOSPITAL PART V, SECTION B, LINE 5: LITTLE FALLS HOSPITAL COLLABORATED WITH BASSETT RESEARCH INSTITUTE'S MOHAWK VALLEY POPULATION HEALTH IMPROVEMENT PROGRAM AND HERKIMER COUNTY PUBLIC HEALTH TO IDENTIFY STAKEHOLDERS FOR COMPLETING THE 2019 COMMUNITY HEALTH NEEDS ASSESSMENT. THE COMMUNITY HEALTH NEEDS ASSESSMENT PROVIDES THE HOSPITAL, LOCAL COUNTY HEALTH DEPARTMENT, AND KEY INFORMANTS WITH DATA AND RESPONSES SO THAT THEY MAY IDENTIFY, PRIORITIZE, AND ADDRESS HEALTH CARE CHALLENGES FACING THEIR COMMUNITIES. MVPHIP COLLABORATED WITH HERKIMER COUNTY PUBLIC HEALTH, HERKIMER COUNTY OFFICE FOR THE AGING, AND LITTLE FALLS HOSPITAL TO COMPILE A LIST OF KEY INFORMANTS IN THE SERVICE REGION. THOSE KEY INFORMANTS REPRESENT A BROAD RANGE OF SECTORS, COMMUNITY INTERESTS, AND INCLUDED ORGANIZATIONS THAT REPRESENT THE MEDICALLY UNDERSERVED, LOW-INCOME, AND MINORITY POPULATIONS. LITTLE FALLS HOSPITAL, HERKIMER COUNTY OFFICE FOR THE AGING, AND HERKIMER COUNTY PUBLIC HEALTH INVITED KEY INFORMANTS TO ATTEND A HERKIMER COUNTY DATA PRESENTATION AND TO GIVE FEEDBACK ON THEIR PRIORITY FOCUS AREAS BASED ON THE 2019-2024 NEW YORK STATE PREVENTION AGENDA ACTION PLANS. THOSE KEY INFORMANTS WHO WERE UNABLE TO ATTEND IN PERSON WERE SENT THE INFORMATION ELECTRONICALLY AND ASKED TO FILL OUT A SHORT SURVEY.HERKIMER COUNTY OFFICE OF THE AGING HERKIMER COUNTY OFA'S ADVISORY COUNCILHERKIMER COUNT LEGISLATORSHERKIMER COUNTY ADMINISTRATOR BRIAN MILLER, NYS ASSEMBLYLITTLE FALLS COMMUNITY OUTREACHHERKIMER COUNTY WORKFORCE DEVELOPMENT CENTRAL ASSOCIATIONS OF THE BLINDHERKIMER COUNTY HOUSING AUTHORITYHOSPICE OF HERKIMER & ONEIDA COUNTIESCOMMUNITY FOUNDATION OF HERKIMER & ONEIDA COUNTIESTOWN OF HERKIMERHERKIMER COUNTY CLERKCHRIS REYNOLDS, PRESIDENT HEALTHNET VALLEY HEALTH SERVICESMOHAWK VALLEY COMMUNITY ACTION AGENCYARC HERKIMERHERKIMER COUNTY PUBLIC HEALTHREGIONAL PRIMARY CARE NETWORKCORNELL COOPERATIVE EXTENSION OF HERKIMER COUNTYRCIL (LIFE@RCIL)JOHN SCARANO COMMUNITY MEMBERSHERKIMER COUNTY BOCESBRIDGES TO PREVENT TOBACCOHERKIMER COUNTY DSS COMMISSIONERLITTLE FALLS HOSPITALHERKIMER COUNTY MENTAL HEALTH SERVICESCATHOLIC CHARITIES OF HERKIMER COUNTY LITTLE FALLS HOSPITAL PART V, SECTION B, LINE 6A: THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS DEVELOPED AS PART OF A MULTI-HOSPITAL PLANNING PROCESS IN COORDINATION WITH BASSETT HEALTHCARE RESEARCH, BASSETT HEALTHCARE NETWORK, AND BASSETT MEDICAL CENTER AND LITTLE FALLS HOSPITAL. LEAD COMMUNITY AGENCY WAS HERKIMER COUNTY PUBLIC HEALTH. LITTLE FALLS HOSPITAL PART V, SECTION B, LINE 6B: THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) INLCUDED COMMUNITY ORGANIZATIONS SUCH AS: HERKIMER COUNTY PUBLIC HEALTH, HERKIMER HEALTHNET, HERKIMER COUNTY MENTAL HEALTH, BASSETT MEDICAL CENTER, LEATHERSTOCKING COLLABORATIVE HEALTH PARTNERS, MOHAWK VALLEY POPULATION HEALTH IMPROVEMENT PROGRAM, AND CANCER CENTER SERVICES OF ONEIDA, MADISON, AND HERKIMER COUNTY. LITTLE FALLS HOSPITAL PART V, SECTION B, LINE 11: THE LITTLE FALLS HOSPITAL COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) WORKING WITH COMMUNITY STAKEHOLDERS WILL CONTINUE TO FOCUS ON PREVENTING CHRONIC DISEASE, WELL BEING FOR LIMITING MENTAL HEALTH EPISODIC EVENTS, AND IMPROVING A HEALTH SAFETY LIFE STYLE. THE CHRONIC CARE DISEASE MANAGEMENT WILL USE MORE METHODS TO COMMUNICATE WITH RESIDENTS AND PROVIDERS FOR TRACKING PREVENTATIVE HEALTH SCREENINGS FOR PREVENTATIVE WOMEN'S HEALTH CARE. THE WELL BEING INITIATIVES WILL UNITE EFFORTS TO BUILD TRUSTWORTHY RELATIONSHIPS FOR PATIENTS REQUIRING SUPPORTS LEVELS FOR MENTAL HEALTH SERVICES. OUR INITIATIVE TO HAVE A HEALTHIER AND SAFER LIVING ENVIRONMENT EXTENDS TO MANY OPPORTUNITIES OF HEALTH CARE INTERACTIONS. WE WILL FOCUS ON EDUCATION OF AGE COHORTS TO HAVE A HEALTHIER AND SAFER HOME, AND LIFE STYLE. THESE THREE INITIATIVES ARE SUPPORTED BY THE COLLECTIVE COMMUNITY ASSETS OF COMMUNITY-BASED ORGANIZATIONS WHO HAVE ADOPTED AND PARTNERED WITH LITTLE FALLS HOSPITAL AND HERKIMER COUNTY HEALTH DEPARTMENT. THE ESTABLISHED WORKPLAN WILL BE THE GUIDELINES FOR MONITORING PROGRESS AND ALIGNMENT OF SERVICES TO MEET THESE OBJECTIVES. THE COMMUNITY HEALTH NEEDS ASSESSMENT BUILDS UPON THE PRIOR PLAN OF 2016 - 2018. THESE INITIATIVES INCLUDED PROMOTING MENTAL, EMOTIONAL AND BEHAVIORAL HEALTH, PREVENTING SUBSTANCE ABUSE, REDUCING OBESITY IN ADULTS AND CHILDREN, PREVENTING DIABETES, AND PREVENTING HEART DISEASE. THE PROGRESS TO DATE REFLECTS THE STRONG COMMITMENT OF SUPPORT FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT ACROSS MANY STAKEHOLDERS. LITTLE FALLS HOSPITAL, BASSETT MEDICAL CENTER, AND OTHER LOCAL HEALTH PROVIDERS HAVE INCREASED USE OF MEDIA TO IMPROVE PUBLIC AWARENESS OF ACCESS FOR SCREENING SERVICES, USE OF CLINICAL EDUCATORS ON THE BENEFITS OF HEALTH SCREENINGS, AND PARTNERING WITH PROVIDERS TO IMPROVE THEIR USE OF SCREENINGS FOR CHRONIC CARE ILLNESS. LITTLE FALLS HOSPITAL WILL PARTNER WITH HERKIMER COUNTY PUBLIC HEALTH ON STRENGTHENING RESOURCES AVAILABLE FOR MENTAL HEALTH BEHAVIORAL PATIENTS. MENTAL HEALTH SERVICES ARE CURRENTLY UNDERSTAFFED WITH CLINICAL PROVIDERS IN OUR SERVICE AREA. WORKING WITH THE LEATHERSTOCKING COLLABORATIVE HEALTH PARTNERS, PRIMARY CARE PROVIDERS ARE PERFORMING MENTAL HEALTH SCREENINGS AND TRACKING INFORMATION IN THE ELECTRONIC HEALTH RECORD. THIS ALLOWS FOR PRIMARY CARE AND MENTAL HEALTH PROVIDERS TO COLLABORATE ON MEDICAL AND MENTAL HEALTH CARE PLANS. LITTLE FALLS HOSPITAL, BASSETT MEDICAL CENTER, AND HERKIMER COUNTY PUBLIC HEALTH ARE COORDINATING RECRUITMENT OF ADDITIONAL MENTAL HEALTH PROVIDERS. LITTLE FALLS HOSPITAL IS A PARTNER IN THE LEATHERSTOCKING COLLABORATIVE HEALTH PARTNERS (LHCP), LLC. THIS ORGANIZATION REPRESENTS A REGIONAL ORGANIZATION, ESTABLISHED IN PARTNERSHIP WITH NYS DEPARTMENT OF HEALTH, UNDER A CMS REFERENCED DELIVERY SYSTEM REFORM INCENTIVE PAYMENT (DSRIP) PROGRAM. WHILE THIS PROGRAM ENDED IN 2019, BASSETT HEALTHCARE NETWORK CONTINUES TO SUPPORT THE HERKIMER COUNTY HUB FOR PLANNING AND ORGANIZING HEALTH IMPROVEMENT RESOURCES. SOME CURRENT ON-GOING INITIATIVES ARE AS FOLLOWS:1.) EDUCATING HEALTH CENTER PROVIDERS ON USING ASTHMA TREATMENT PLANS TO SUPPORT PATIENTS. IMPROVE ACCESS TO ASTHMA SPECIALISTS WITH THE ELECTRONIC HEALTH RECORD FOR SHARING CARE PLANS WITH COMMUNITY AGENCIES WHEN APPROPRIATE. 2.) INTRODUCED THE NYS MEDICAID ACCELERATED EXCHANGE (MAX) PROCESS TO USE PATIENT CENTERED PROCESSES TO REDUCE USE OF EMERGENCY DEPARTMENT BY CHRONIC CARE PATIENTS. LITTLE FALLS HEALTH CENTERS IN DOLGEVILLE AND NEWPORT PARTICIPATED IN THIS PROJECT AND IMPROVED THEIR CARE MANAGEMENT PLANS TO REDUCE EMERGENCY DEPARTMENT VISITS. 3.) THE SALVATION ARMY, LEATHERSTOCKING COLLABORATIVE HEALTH PARTNERS, AND LITTLE FALLS HOSPITAL DEVELOPED A CARE NAVIGATION PROGRAM TO ASSIST PATIENTS AND FAMILIES WITH HEALTH CARE DECISIONS. THIS SUPPORT EXTENDED ONE ON ONE TRAINING FOR ENCOURAGEMENT ON HAVING A SAFER AND MORE WELL-BEING IN THEIR LIVES. WE HAVE IDENTIFIED THE DIFFICULTY IN RECRUITING PRIMARY CARE AND UNDERSTAFFED MENTAL HEALTH PROVIDERS IN OUR REGION AS A BARRIER TO MEETING OUR CHNA GOALS. THIS SHORTAGE OF PROVIDERS IS BEING ADDRESSED IN RECRUITMENT PLANS IN COORDINATION WITH BASSETT MEDICAL CENTER, HERKIMER COUNTY PUBLIC HEALTH, AND LITTLE FALLS HOSPITAL. IN 2019 LITTLE FALLS HOSPITAL BECAME THE OPERATOR OF FOUR RURAL HEALTH CLINICS TO SUPPORT A NETWORK OF RURAL PROVIDERS AND CONTINUE ACCESS TO COMMUNITIES WITH PRIMARY CARE SERVICES. IN 2019 LITTLE FALLS HOSPITAL BEGAN DEVELOPMENT OF A NEW PRIMARY CARE OFFICE LOCATED IN DOLGEVILLE NEW YORK. THIS FACILITY WILL ENABLE MORE ACCESS TO CARE PROMOTE PREVENTATIVE HEALTH EDUCATION AND SERVICES. IN COLLABORATION WITH COMMUNITY AGENCIES THIS NEW FACILITY WILL BE COMPLETED IN 2020. THERE WILL BE EXPANDED SERVICES TO CONTINUE THE MISSION OF IMPROVING THE HEALTH CARE OF OUR PATIENTS. LITTLE FALLS HOSPITAL PART V, SECTION B, LINE 20E: LITTLE FALLS HOSPITAL PROVIDED MAILING INFORMATION TO UNINSURED PATIENTS FOR ENROLLING IN AN AFFORDABLE CARE ACT INSURANCE PRODUCT SPONSORED BY THE NYS HEALTH MARKETPLACE. LITTLE FALLS HOSPITAL ALSO ASSISTED PATIENTS WITH THE COMPLETION OF APPLICATIONS FOR ENROLLMENT INTO NYS MARKETPLACE PLANS. IN 2019, 92 PATIENTS WERE ENROLLED BY A LITTLE FALLS HOSPITAL EMPLOYED FACILITATOR INTO A NYS MARKETPLACE PLAN. 6 1 - DOLGEVILLE HEALTH CENTER 9 GIBSON STREET DOLGEVILLE NY 13329 CLINIC 2 - NEWPORT HEALTH CENTER BRIDGE STREET NEWPORT NY 13416 CLINIC 3 - LITTLE FALLS HEALTH CENTER 170 BURWELL STREET LITTLE FALLS NY 13365 CLINIC 4 - RICHFIELD SPRINGS HEALTH CENTER 8550 STATE HIGHWAY 28 RICHFIELD SPRINGS NY 13439 CLINIC 5 - WEST WINFIELD HEALTH CENTER 544 E MAIN STREET WEST WINFIELD NY 13491 CLINIC 6 - ST JOHNSVILLE HEALTH CENTER 8 PARK PLACE ST JOHNSVILLE NY 13452 CLINIC PART I, LINE 3C: LITTLE FALLS HOSPITAL PROVIDES SERVICES TO ALL PATIENTS, REGARDLESS OF THEIR ABILITY TO PAY. THE COMMUNITY SERVICE PROGRAM (CSP) IS AVAILABLE FOR PATIENTS WITHOUT INSURANCE COVERAGE FOR INCOMES UP TO 300% OF THE FEDERAL POVERTY INCOME GUIDELINES. OUR CSP COORDINATOR IS AN AUTHORIZED ENROLLMENT FACILITATOR FOR MEDICAID AND NEW YORK STATE INSURANCE EXCHANGE INSURANCE COVERAGES. PART I, LINE 6A: LITTLE FALLS HOSPITAL HEALTH COMMUNITY HEALTH NEEDS ASSESSMENT FOR THE PERIOD OF 2019 - 2021 IS COORDINATED WITH BASSETT HEALTHCARE NETWORK. BASSETT'S RESEARCH INSITITUTE'S MOHAWK VALLEY POPULATION IMPROVEMENT PROGRAM (MVPHIP) RECEIVED A GRANT FROM NEW YORK STATE DEPARTMENT OF HEALTH TO CONDUCT THE ASSESSMENT ON BEHALF OF BASSETT HEALTHCARE NETWORK'S LITTLE FALLS HOSPITAL AND THE HERKIMER COUNTY PUBLIC HEALTH. MVPHIP COLLABORATED WITH AGENCIES SUCH AS HERKIMER COUNTY PUBLIC HEALTH, HERKIMER COUNTY OFFICE FOR THE AGING, AND LITTLE FALLS HOSPITAL. THIS COORDINATED GROUP OF INTERESTED PARTIES ALSO INVITED KEY STAKEHOLDERS INTO THE DEVELOPMENT PROCESS OF THE COMMUNITY NEEDS ASSESSMENT FOR 2019 - 2021. PART I, LINE 7: COST FOR CHARITY CARE PATIENTS WAS CALCULATED USING RATIO OF COST TO CHARGES. COST ASSOCIATED WITH MEDICAID AND MEDICAID HMO PROGRAMS REPRESENTS AGGREGATE ALLOWABLE COST AND TOTAL GROSS CHARGES USED TO CALCULATE A FACILITY LEVEL COST TO CHARGE RATIO. THIS FACILITY LEVEL COST TO CHARGE RATIO WAS APPLIED TO TOTAL MEDICAID AND MEDICAID HMO CHARGES TO ARRIVE AT TOTAL MEDICAID COST. FOR SUBSIDIZED HEALTH SERVICES, THE LOSS DOES NOT INCLUDE GOVERNEMENT PAYERS LOSS INFORMATION IS REPORTED IN AGGREGATE AMOUNTS. PART I, LINE 7G: LITTLE FALLS HOSPITAL OPERATES TWO PRIMARY CARE HEALTH CENTERS LOCATED IN DOLGEVILLE AND NEWPORT NEW YORK. IN DECEMBER 2019 THE HOSPITAL BECAME THE OWNER OF FOUR RURAL HEALTH CLINICS LOCATED WITHIN OUR PRIMARY AND SECONDARY MARKET. WHILE THE ACTIVITY OF THESE FOUR RURAL HEALTH CLINICS WAS LIMITED BASED ON A TWO - WEEK BUSINESS CYCLE FOR 2019 THEY WERE INLCUDED IN OUR ANALYSIS OF THE COST FOR PROVIDING ACCESS TO CARE IN RURAL REGIONS. IN 2019 THE SIX PRIMARY CARE LOCATIONS PROVIDED PRIMARY CARE SERVICES INCLUDING VACCINATIONS, WELL CARE VISITS, AND PRIMARY CARE FOLLOW-UP APPOINTMENTS. USING AN ELECTRONIC HEALTH RECORD ENABLES PATIENTS TO HAVE ACCESS TO THEIR PERSONAL HEALTH INFORMATION IN A TIMELY MANNER. THROUGH AN ELECTONIC HEALTH RECORD SYSTEM, PATIENTS CAN ELECT TO HAVE PORTAL ACCESS FOR PORTIONS OF THEIR PERSONAL HEALTH INFORMATION. THESE HEALTH CENTERS ACHIEVED THE STATUS TO BE RECOGNIZED AS PATIENT CENTERED MEDICAL HOME (PCMH) UNDER THE NATIONAL COMMITTEE OF QUALITY ASSURANCE (NCQA) STANDARDS. AS A PCMH CARE COORDINATION AND MANAGEMENT OF PATIENT SOCIAL DETERMINANTS IS PART OF CARE PLANS FOR PATIENTS. GOVERNMENT PAYERS ARE EXCLUDED IN MEASURING SUBSIDIZED HEALTH CARE SERVICES TO ELIMINATE ANY DUPLICATION THAT WOULD OCCUR WHEN LOOKING AT DEFICITS INCURRED FROM GOVERNEMENT PAYERS. THE METHODOLOGY REVIEWS THE NON GOVERNMENT PATIENT ENCOUNTERS AND MEASURES DIRECT REVENUE RECEIVED FOR SERVICES. EXPENSES ALLOCATIONS ARE APPORTIONED BASED ON PATIENT ENCOUNTERS FOR SUBSIDIZED PATIENTS COMPARED TO TOTAL PATIENTS. IN FUTURE PERIODS OUR NEW RURAL HEALTH CLINICS WILL RECEIVE INCREASED PAYMENTS IN RECOGNITION OF THE HIGH FIXED COST OF RURAL HEALTHCARE PRIMARY CARE OPERATIONS. PART I, LN 7 COL(F): LITTLE FALLS HOSPITAL EXCLUDED $1,677,414 OF BAD DEBT EXPENSE TO CALCULATE COST OF PATIENT CARE. BAD DEBT IS REPORTED AS A FUNCTIONAL PROGRAM EXPENSE. PART II, COMMUNITY BUILDING ACTIVITIES: COMMUNITY BUILDING ACTIVITIES ARE ASSOCIATED WITH LITTLE FALLS HOSPITAL WORKING WITH COMMUNITY BUSINESSES THROUGH OUR MEMBERSHIP WITH LOCAL AGENCIES, SUCH AS HERKIMER COUNTY HEALTHNET, AMERICAN HEART ASSOCIATION, HOSPICE AND PALLIATIVE CARE INC. AND THE AREA HEALTH EDUCATION CENTERS (AHEC). THESE ACTIVITIES ALLOW FOR DIALOG ON CURRENT HEALTHCARE TOPICS, INSURANCE PROGRAMS, AND RECRUITMENT OF FUTURE EMPLOYEES. LITTLE FALLS HOSPITAL COLLABORATES WITH BASSETT MEDICAL CENTER ON RECRUITMENT INITIATIVES FOCUSING ON PRIMARY CARE. HERKIMER COUNTY HAS ONE OF THE LOWEST RATIOS OF PRIMARY CARE PROVIDERS TO RESIDENTS IN NEW YORK STATE. IN 2019, LITTLE FALLS HOSPITAL WAS A LICENSED PRACTICAL NURSES (LPN)PRECEPTOR TRAINING LOCATION SPONSORED WITH THE MOHAWK VALLEY BOARDS OF COOPERATIVE EDUCATIONAL SERVICES (BOCES). THIS TRAINING PROGRAM ENABLES FOR THE DEVELOPMENT OF FRONT-LINE HEALTH CARE WORKERS. IN 2019 THIS PROGRAM SUPPORTED THE CLINICAL DEVELOPMENT OF 7 LPN'S. PART III, LINE 2: BAD DEBTS INLCUDE INSURED AND UNINSURED BALANCES REFERRED TO COLLECTION AGENCIES FOR ATTEMPT TO SATISFY THE AMOUNT OUTSTANDING AFTER COLLECTIONS ON REFERRED ACCOUNTS. PART III, LINE 3: AN ESTIMATE FOR POTENTIAL CHARITY CARE WAS BASED ON THE DENIED APPLICATIONS PROCESSED IN 2019 COMPARED WITH THOSE APPROVED APPLICATIONS. THIS AMOUNTED TO AN 17.7% DENIAL RATE FOR CHARITY CARE APPLICATIONS WHICH IF APPROVED WOULD HAVE INCREASED THE AMOUNT OF CHARITY CARE AT COSTED AMOUNTS BY $28,340. PART III, LINE 4: THE HOSPITAL FOOTNOTE DESCRIBING PATIENT ACCOUNTS RECEIVABLES IS IN THE ATTACHED AUDITED FINANCIAL STATEMENTS NOTE (1)(L) PAGES 12 - 17. PART III, LINE 8: IN 2019, OUR OPERATING DEFICIT, WITH THE MEDICARE PART A & B PROGRAMS, WAS $236,205. MEDICARE REPRESENTS APPROXIMATELY 33% OF OUR TOTAL PATIENT REVENUE. LITTLE FALLS HOSPITAL IS A CRITICAL ACCESS HOSPITAL (CAH) WHICH IS PAID BY MEDICARE BASED ON COST OF CARE. THIS SHORTFALL IS DIFFICULT TO FUND WHEN CONSIDERING OUR ADDITIONAL MEDICAID DEFICIT OF APPROXMIATELY $1.4. OUR SAFETY NET HOSPITAL STATUS INDICATES WE ARE A NYS RURAL PROVIDER WITH A GREATER THAN 30% THRESHOLD FOR MEDICAID UTILIZATION OF OUR SERVICES. OUR HIGH VOLUME OF MEDICAID IS REPRESENTED ON IRS FORM 990 SCHEDULE H LINE 7B. PART III, LINE 9B: OUR COLLECTION AND CHARITY CARE POLICY SPECIFIES THAT ACCOUNTS WITH ACTIVE CHARITY CARE APPLICATIONS WILL NOT GO TO COLLECTION AGENCIES WHILE APPLICATIONS ARE IN REVIEW. WHILE A REQUEST FOR CHARITY CARE ASSISTANCE IS IN PROCESS, THESE ACCOUNTS ARE PLACED ON HOLD IN OUR BILLING SYSTEM. WE COMMUNICATE INFORMATION ON REQUIREMENTS FOR ASSISTANCE AND WILL COUNSEL PATIENTS ON PROVIDING THE INCOME INFORMATION TO DETERMINE IF THEY QUALIFY FOR CHARITY CARE USING 300% OF THE FEDERAL POVERTY INCOME GUIDELINES. (NOTE: OUR CHARITY CARE PROGRAM IS FOR THE UNINSURED PATIENT.) PART VI, LINE 2: LITTLE FALLS HOSPITAL PARTNERED WITH BASSETT RESEARCH INSTITUTE'S MOHAWK VALLEY POPULATION HEALTH IMPROVEMENT PROGRAM (MVPHIP), A GRANT FUNDED PROGRAM FROM NEW YORK STATE DEPARTMENT OF HEALTH, WHO CONDUCTED AN ASSESSMENT ON BEHALF OF BASSETT HEALTHCARE NETWORK'S LITTLE FALLS HOSPITAL AND THE HERKIMER COUNTY PUBLIC HEALTH. THE COMMUNITY HEALTH NEEDS ASSESSMENT PROVIDES THE HOSPITAL, LOCAL COUNTY HEALTH DEPARTMENT AND STAKEHOLDERS WITH DATA AND KEY INFORMANT SURVEY RESPONSES SO THAT THEY MAY IDENTIFY, PRIORITIZE AND ADDRESS HEALTH CARE CHALLENGES FACING THEIR COMMUNITIES. UTILIZING THE NEW YORK STATE'S PREVENTION AGENDA. MVPHIP COLLABORATED WITH THE LOCAL HEALTH DEPARTMENT AND LITTLE FALLS HOSPITAL TO COMPILE A LIST OF KEY INFORMANTS IN THE SERVICE REGION. THOSE TWENTY NINE KEY INFORMANTS REPRESENT A BROAD RANGE OF SECTORS, COMMUNITY INTERESTS AND INCLUDED ORGANIZATIONS WHICH REPRESENT THE MEDICALLY UNDERSERVED, LOW-INCOME AND MINORITY POPULATIONS. THE KEY INFORMANTS PARTICIPATED AT A CONFERENCE ON JUNE 20, 2019 TO DEVELOP PRIORTIES FOR COMMUNITY HEALTH IMPROVEMENT PROGRAMS FOR 2019 2021.BASED ON THE KEY INFORMANT SURVEY RESULTS, PARTICIPANTS RANKED PROMOTION OF MENTAL HEALTH AND PREVENTION OF SUBSTANCE ABUSE NUMBER ONE AND PREVENTION OF CHRONIC DISEASE RANKED NUMBER TWO. AFTER SELECTING THE PRIORITIES, SURVEY PARTICIPANTS WERE ASKED TO RANKED THEIR TOP FIVE FOCUS AREAS FROM ALL OF THE PREVENTION AGENDA PRIORITIES.BASED ON THE SURVEY RESULTS, THE FOLLOWING TOP SIX FOCUS AREAS ARE TIED TO THE TOP TWO SELECTED PRIORITIES FOR LITTLE FALLS HOSPTIAL WERE APPROVED. PRIORITIES:1. PREVENT MENTAL HEALTH AND SUBSTANCE USE DISORDERS2. PROMOTE WELL BEING3. TOBACCO PREVENTION 4. CHILD AND ADOLSCENT HEALTH5. PREVENTITIVE CARE MANAGEMENT 6. INJURIES, VIOLENCE OCCUPATIONAL HEALTH COORDINTED ACTION PLANS WERE DEVELOPED WITH USE OF COMMUNITY RESOURCES TO ADDRESS THE SIX IDENTIFIFED AREAS FOR HEALTH IMPROVEMENT. LITTLE FALLS HOSPITAL IMPLEMENTED ACTION PLANS ADDRESSING PROMOTION OF WELL BEING, PREVENTAITIVE CARE AND MANAGEMENT, AND INJURIES, VIOLENCE & OCCUPATIONAL HEALTH. EACH ACTION PLAN INCLUDES, GOALS AND INTERVENTIONS, PROCES MEASURES, AND PARTNER ROLES AND RESOURCES. GOALS ARE MEASURED FROM THE 2019 COMMUNITY HEALTH NEEDS ASSESSMENT TO ADDRESS IDENITIFED DISPARATE POPULATIONS. ALONG WITH HEALTH INDICATORS TO MEASURE PROGRESS TOWARD ACHIEVING THE GOALS, INCLUDING REDUCING HEALTH DISPARITIES FOR INDIVIDUALS WITH LOW SOCIO-ECONOMIC STATUS, DISABILITIES, RACIAL AND ETHNIC GROUPS, AS WELL AS OTHER POPULATIONS WHO EXPERIENCE THEM.COMMUNITY ASSETS AND RESOURCES:A. NEW YORK STATE HEALTH CARE TRANSFORMATION INITIATIVES:NEW YORK STATE DEPARTMENT OF HEALTH PRIORITIZES THE SIGNNIFACNT HEALTH NEEDS OF ALL COMMUNITIES ACROSS THE STATE THROUGH THE PEVENTION AGENDA. THIS IS THE THIRD CYCLE FOR THIS STATEWIDE INITIAITIVE THAT WAS INITIATED IN 2008. NEW TO 2019 2024 CYCLE IS THE INCORPORATION OF A HEALTH ACROSS ALL POLICIES APPROACH, WHICH CALLS ON ALL STATE AGENCIES TO IDENTIFY AND STRENGEN THE WAYS THEIR POLICIES AND PROGRAMS CAN HAVE A POSITIVE IMPACT ON HEALTH. EACH OF SIX PRIORITIES HAVE CONTRIBUTES TO THE PURSUIT OF THESE NEW YORK STATE POLICY APPROACHES. DELIVERY SYSTEM REFORM INCENTIVE PAYMENT (DSRIP) PROGRAMSLITTLE FALLS HOSPITAL AND HERKIMER COUNTY PUBLIC HEALTH ARE PARTICIPATING PARTNERS IN BASSETT HEALTHCARE NETWORK'S LEATHERSTOCKING COLLABORATIVE HEALTH PARTNERS (LCHP) PPS. LCHP INCLUDES PROVIDERS AND COMMUNITY BASED ORGANIZATIONS FROM DELAWARE, HERKIMER, MADISON, OTSEGO AND SCHOHARIE COUNTIES. DSRIP'S PURPOSE IS TO USE COLLABORATIVE APPORACHES TO REDESIGN AND REINVESTIGN IN THE MEDICAID PROGRAM.POPULATION HEALTH IMPROVEMENT PROGRAMS (PHIP):THE PHIP SUPPORTS AND ADVANCES THE ONGOING ACTIVITIES OF NEW YORK STATE PREVENTION AGENDA AND THE STATE HEALTH INNOVATION PLAN, AS WELL AS, SERVES AS A RESOURCE FOR THE LOCAL PERFORMING PROVIDERS SYSTEMS.LITTLE FALLS HOSPITAL AND HERKIMER COUNTY PUBLIC HEALTH ARE ACTIVE MEMBERS OF THE MOHAWK VALLEY PHIP BOARD. THE BASSETT HEALTHCARE NETWORK'S BASSETT RESEARCH INSTITUTE IS THE CONTRACTOR FOR THE MOHAWK VALLEY PHIP WHICH COMPRISES FULTON, HERKIMER, MONTGOMERY, OTSEGO AND SCHOHARIE COUNTIES. COMMUUNITY HEALTH NEEDS ASSESSMENT PRIOR TOPICS 2016 2018MEASUREMENT FOR PRIOR TOPICS OF THE LITTLE FALLS HOSPITAL AND HERKIMER COUNTY PUBLIC HEALTH COMMUNITY HEALTH NEEDS ASSESSMENT CONTINUES AS BEING A PART OF THE NEW SIX NEW HEALTH PRIORITIES FOR 2019 2021. THESE CONTINUED ACTIVITIES ARE TO MEASURE PREVENTATIVE HEALTH SCREENINGS FOR BREAST AND CERVICAL CANCER, COLORECTAL TESTING SCREENINGS, AND BLLOD GLUCOSE MONITORING. THESE COORDIANTED HEALTH INTERVENTIONS ARE ALSO SUPPORTED WITH EDUCATION WITH MEDICAL PROVIDERS TO SUPPORT THEIR ROLE IN IDENTYING PATIENTS REQUIRING SERVICES TO SUPPORT HEALTHIER LIFE STLES. INCREASES IN USE OF MEDIA FOR POPULATION AWARENESS OF PROGRAMS WAS ALSO EXTENDED USING MORE ELECTRONIC MEDIA. DURING THE PERIOD OF 2016 2018 MANY OF THE HEALTH EDUCATION AND SCREENING ASSESSMENTS ACCOMPLISHED HIGHER RATES OF PARTICIAPTION. THESE INITIATIVES WILL CONTINUE TO SUPPORT OUR NEEDS ASSESSMENT FOR THE CURRENT PERIOD OF 2019 2021. THIS INFORMATION IS FROM LITTLE FALLS HOSPITAL 2019 COMMUNITY HEALTH NEEDS ASSESSMENT PART VI, LINE 3: LITTLE FALLS HOSPITAL PROVIDES ACCESS AND EDUCATION ON THE COMMUNITY SERVICE PROGRAM WITH CONTACT INFORMATION FOR PATIENTS TO CALL AND MAKE APPOINTMENTS FOR COMPLETING APPLICATIONS FOR FINANCIAL ASSISTANCE. AT ALL PATIENT ACCESS LOCATIONS, APPLICATIONS FOR CHARITY CARE ASSISTANCE ARE AVAILABLE. THE WWW.BASSETT.ORG WEBSITE INCLUDES A LINK ON INFORMATION FOR COMPLETING AN APPLICATION AND OTHER RESOURCES CALLED "FINANCIAL ASSISTANCE RESOURCE GUIDE". OUR FINANCIAL ASSISTANCE COORDINATOR PROVIDES INSURANCE COVERAGE NAVIGATION SERVICES TO ASSIST RESIDENTS WITH ENROLLMENT IN GOVERNMENT SPONSORED HEALTH CARE COVERAGE PROGRAMS. A COMMUNITY NAVIGATOR IS ALSO PRESENT IN THE EMERGENCY DEPARTMENT TO ASSIST WITH APPLICATIONS FOR GOVERNMENT SPONSORED HEALTH CARE COVERAGE PROGRAMS OR TO COMPLETE APPLICATIONS FOR OUR FINANCIAL ASSISTANCE PROGRAM. OUR APPLICATION ALSO SPECIFIES ON-SITE PROVIDERS WHO DO NOT PARTICIPATE IN LITTLE FALLS HOSPITAL FINANCIAL ASSISTANCE PROGRAM PART VI, LINE 4: LITTLE FALLS HOSPITAL SERVES AN ESTIMATED POPULATION OF OVER 62,000 PEOPLE IN 17 COMMUNITIES THROUGHOUT HERKIMER COUNTY, AND SECTIONS OF FULTON AND MONTGOMERY COUNTIES. THE SERVICE AREA POPULATION IS COMPRISED OF INDIVIDUALS AND FAMILIES FROM ALL SOCIO-ECONOMIC AND EDUCATIONAL LEVELS. THE POPULATION IS 96 PERCENT WHITE, 51 PERCENT FEMALE AND 49 PERCENT MALE. THE AGE DISTRIBUTION OF THE POPULATION IS SIMILAR TO OTHER UPSTATE NEW YORK AREAS WITH 5.4 PERCENT OF THE POPULATION UNDER 5 YEARS OF AGE, 24 PERCENT UNDER THE AGE OF 18, AND 22.2 PERCENT AGED 65 AND OLDER. NEARLY 89 PERCENT OF THE POPULATION OVER AGE OF 25 HAS GRADUATED FROM HIGH SCHOOL. MEDIAN HOUSEHOLD INCOME OF $54,794 IS BELOW THE STATE MEDIAN OF $71,855. IT'S ESTIMATED THAT 10 PERCENT OF THE POPULATION IS BELOW THE FEDERAL POVERTY LEVEL. APPROXIMATELY 93% OF RESIDENTS HAVE HEALTH COVERAGE, AN IMPROVEMENT OF 6% SINCE 2013. PART VI, LINE 5: LITTLE FALLS HOSPITAL IMPLEMENTS COORDINATED HEALTH CARE RESOURCES WITH BASSETT HEALTHCARE NETWORK. THIS COLLABORATION INCLUDED PLANNING AND IMPLEMENTING INITIATIVES UNDER A NEW YORK STATE DELIVERY SYSTEM REFORM INCENTIVE PAYMENT (DSRIP) PROJECT. DSRIP ACTIVITIES ARE COORDINATED WITH COMMUNITY BASED ORGANIZATIONS TO DEVELOP CARE IMPROVEMENT PROGRAMS IN A COORDINATED MANNER. THE HERKIMER COUNTY HUB WAS ORGANIZED SO COMMUNITY AGENCIES COULD DEVELOP INITIATIVES FOR IMPROVING COMMUNICATIONS FOR REFERRALS TO PROGRAMS FOR HIGH NEED PATIENTS. WITH THESE COMMUNITY AGENCIES ENGAGED A HIGHER DEGREE OF PATIENT INTERACTION IS POSSIBLE TO ACHIEVE POSITIVE IMPACTS ON IMPROVING THEIR HEALTH CARE. LITTLE FALLS HOSPITAL PARTNERED WITH SALVATION ARMY FOR THEIR ASSISTANCE IN PROVIDING PATIENT NAVIGATION SERVICES. THESE NAVIGATION SERVICES PROVIDE PATIENTS AND FAMILY SUPPORT FOR MEDICAL AND SOCIAL ASSISTANCE TO IMPROVE A HEALTHIER LIFE STYLE. PART VI, LINE 6: LITTLE FALLS HOSPITAL IS A SUBSIDIARY OF BASSETT HEALTHCARE NETWORK THAT PROVIDES HEALTH SERVICES IN MORE THAN 20 COMMUNITIES SPANNING 5,600 SQUARE MILES AND SEVEN COUNTIES. THE NETWORK FOCUSES ITS COMMUNITY SERVICES PROGRAMS IN THE COUNTIES WHERE FIVE AFFILIATED HOSPITALS AND GREATEST PATIENT POPULATIONS ARE LOCATED. OTSEGO COUNTY - POPULATION 60,094; DELAWARE COUNTY - POPULATION 45,001; HERKIMER COUNTY - POPULATION 62,240; SCHOHARIE COUNTY - POPULATION 31,420 (ACCORDING TO THE 2017 U.S. CENSUS ESTIMATES). A.)THE MARY IMOGENE BASSETT HOSPITAL, AN ACUTE CARE INPATIENT TEACHING FACILITY IN COOPERSTOWN, NEW YORK. RELATED SERVCIES IS A REGIONAL NETWORK CONSITING OF 29 LOCATIONS FOR PRIMARY AND SPECIALTY CARE SERVICES, TWENTY SCHOOL BASED HEALTH CENTERS, AND TWO AMBULAORY SURGERY CENTERS.B.) O'CONNOR HOSPITAL, IS A CRITICAL ACCESS HOSPITAL IN DELHI, NEW YORK LOCATED IN DELAWARE COUNTY.C.) COBLESKILL REGIONAL HOSPITAL, IS A CRITICAL ACCESS HOSPITAL IN COBLESKILL, NEW YORK LOCATED IN SCHOHARIE COUNTY.D.) LITTLE FALLS HOSPITAL, IS A CRITICAL ACCESS HOSPITAL IN LITTLE FALLS, NEW YORK LOCATED IN HERKIMER COUNTY. LITTLE FALLS HOSPITAL INLCUDES FIVE RURAL HEALTH CLINICS AND ONE OUTPATIENT PRIMARY CARE CENTER. E.) TRI TOWN REGIONAL HOSPITAL A 24/7 EMERGENCY CARE FACILITY IN SIDNEY, DELAWARE COUNTY, OPERAITNG AS A DEPARTMENT OF AUREILA OSBORN FOX MEMORIAL HOSPITAL, AN ACUTE CARE FACILITY IN ONEONTA, OTSEGO COUNTY.F.) AURELIA OSBORN FOX HOSPITAL A SOLE COMMUNITY PROVIDER IN ONEONTA NEW YORK LOCATED IN OTSEGO COUNTY.G.) VALLEY HEALTH SERVICES A RESIDENTIAL HEALTH CARE AND REHABILITATION FACILITY LOCATED IN HERKIMER, NEW YORKOTHER COMPONENTS OF THE NETWORK, INCLUDES AT HOME CARE, A CERTIFIED HOME CARE AGENCY AND FIRST COMMUNITY CARE OF BASSETT, AND A MEDICAL SUPPLY COMPANY, ALL OF WHICH MAKE UP THE BASSETT HEALTHCARE NETWORK AND PROVIDE HEALTH SERVICES TO THIS NINE COUNTY REGION IN CENTRAL NEW YORK.LITTLE FALLS HOSPITAL COLLABORATES WITH BASSETT HEALTHCARE NETWORK AND BASSETT MEDICAL CENTER TO COORDIANTE THE EFFICIENT DELIVERY OF HEALTHCARE IN OUR SERVICE AREA. THIS RELATIONSHIP HAS DEVELOPED OVER A PERIOD OF FIFTEEN YEARS AND CONTINUES TO PROVIDE RESIDENTS ACCESS TO A HIGH QUALITY HEALTHCARE SYSTEM. OUR INTEGRATED ELECTRONIC HEALTH RECORD HAS ENABLED OUR PATIENTS TO RECEIVE IMPROVED COORDINDATED CARE AND ACCESS TO THEIR HEALTH INFORMATION NOT ROUTINELY SEEN IN RURAL HEALTH NETWORKS. OUR COLLABORTIVE PLANNING ON PROJECTS SUCH AS THE NYS DELIVERY SYSTEM REFORM INCENTIVE PAYMENT SYSTEM (DSRIP) AND RELATED MOHAWK VALLEY POPULATION HEALTH IMPROVEMENT PROGRAM ARE EXAMPLES OF OUR COLLABORATION TO IMPROVE THE HEALTHCARE SYSTEMS IN OUR SERVICE AREA. LITTLE FALLS HOSPITAL AS A LEADER WITH BASSETT HEALTHCARE NETWORK IN COORDINATION OF PATIENT ADVOCATE GROUPS IS MAKING A DIFFERENCE FOR IMPROVING HEALTHCARE. THESE INITIATIVES WITHIN THE DSRIP PROGRAM CONTINUE TO IMPROVE IN PATIENT INTERACTIONS TO SUPPORT ACCESS TO CARE, AND PREVENTATIVE CARE PLANS. THIS IS A NEW AREA OF EMPHASIS WITH CARE INNOVATION MODELS WHICH CREATE LEARNING PARTERSHIPS WITH PATIENTS AND PROVIDERS. PART VI, LINE 7, REPORTS FILED WITH STATES NY X 0 0 X X X X 0 0 0 0 0 0 0 0 0 AMY GRACE MD PRESIDENT OF MEDICAL STAFF 0 237517 0 23697 0 0 0 10254 0 7496 0 278964 0 0 LISA BETRUS TRUSTEE 0 226386 0 4170 0 0 0 11467 0 6182 0 248205 0 0 MICHAEL OGDEN PRESIDENT & CEO 0 210978 0 15450 0 0 0 9146 0 2240 0 237814 0 0 JAMES G VIELKIND CHIEF FINANCIAL OFFICER 30320 192500 0 0 0 0 910 0 66 0 31296 192500 0 0 PART I, LINE 3 THE COMPENSATION PROCESS FOR TOP OFFICIAL THE CHIEF EXECUTIVE OFFICER'S SALARY IS PAID BY A RELATED ORGANIZATION UNDER A MANAGEMENT SERVICES AGREEMENT. THE LITTLE FALLS HOSPITAL BOARD OF TRUSTEE'S REVIEWS THE FORMAL PROCESS THAT IS USED TO DETERMINE THE BASE COMPENSATION OF THE CEO. THE CEO WORK PLAN AND ACCOMPLISHMENTS FOR THE YEAR ARE REVIEWED. SALARY CHANGES ARE BASED ON MARKET, WORK PLAN, AND ACCOMPLISHMENTS. THE CEO'S SALARY IS SUBMITTED AS PART OF THE MANAGEMENT SERVICES AGREEMENT WHICH IS APPROVED BY THE BOARD OF TRUSTEES. FORM 990, PART III, LINE 2 LITTLE FALLS HOSPITAL BECAME THE OPERATOR OF FOUR RURAL HEALTH CLINICS IN THE COMMUNITIES OF LITTLE FALLS, ST. JOHNSVILLE, WEST WINFIELD, AND RICHFIELD SPRINGS. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF THE HOSPITAL IS BASSETT HEALTHCARE NETWORK. FORM 990, PART VI, SECTION A, LINE 7A BASSETT HEALTHCARE NETWORK, AS THE SOLE MEMBER, HAS THE POWER TO ELECT OR APPOINT ONE OR MORE MEMBERS OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11B LITTLE FALLS HOSPITAL PRESENTS THE DRAFT 990 TO THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS PRIOR TO FILING. ANY QUESTIONS ARE RAISED AND ONCE APPROVED, THE 990 CAN BE FILED. A COMPLETE COPY OF THE ORGANIZATION'S FINAL FORM 990, INCLUDING ALL REQUIRED SCHEDULES, AS ULTIMATELY FILED WITH THE IRS, IS AVAILABLE TO EACH MEMBER OF THE BOARD BEFORE ITS FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST STATEMENTS ARE MADE ANNUALLY. NEW BOARD MEMBERS ARE REQUIRED TO DISCLOSE ON THEIR RESUME ALL AFFILIATED ORGANIZATIONS. FORM 990, PART VI, SECTION B, LINE 15 THE CHIEF EXECUTIVE OFFICER'S SALARY IS PAID BY A RELATED ORGANIZATION UNDER A MANAGEMENT SERVICES AGREEMENT. THE LITTLE FALLS HOSPITAL BOARD OF TRUSTEES REVIEWS THE FORMAL PROCESS THAT IS USED TO DETERMINE THE BASE COMPENSATION OF THE CEO. THE CEO'S WORK PLAN AND ACCOMPLISHMENTS FOR THE YEAR ARE REVIEWED. SALARY CHANGES ARE BASED ON MARKET, WORKPLAN, AND ACCOMPLISHMENTS. THE CEO'S SALARY IS SUBMITTED AS PART OF THE MANAGEMENT SERVICES AGREEMENT WHICH IS APPROVED BY THE BOARD. FORM 990, PART VI, SECTION C, LINE 19 LITTLE FALLS HOSPITAL MAKES AVAILABLE THE IRS FROM 990 UPON REQUEST ALONG WITH INFORMATION INCLUDED WITHIN THE 990 SUCH AS FINANCIAL REPORTS, CONFLICT OF INTEREST POLICY, AND CODE OF CONDUCT. THE HOSPITAL ALSO PROVIDES THE ANNUAL OPERATING PLAN AND CORPORATE VALUES IN PUBLIC AREAS OF THE FACILITY. FORM 990, PART XI, LINE 9: PENSION RELATED CHANGES OTHER THAN NET PERIODIC BENEFIT COST 837,473. CHANGE IN VALUE OF BENEFICIAL INTEREST IN CHARITABLE REMAINDER TRUST 260,427. CHANGE IN INTEREST FRIENDS OF BASSETT -342,955. RELEASE OF SCHOLARSHIPS -3,771. FORM 990, PART XII, LINE 2C THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR BASSETT HEALTHCARE NETWORK ONE ATWELL ROAD COOPERSTOWN NY 13326 133218680 SUPPORTING ORGANIZATION NY 501 (C) 3 12 C NONE 0 FRIENDS OF BASSETT ONE ATWELL ROAD COOPERSTOWN NY 13326 237041610 FUND RAISING ORGANIZATION NY 501 (C) 3 7 BASSETT HEALTHCARE NETWORK 0 MARY IMOGENE BASSETT HOSPITAL ONE ATWELL ROAD COOPERSTOWN NY 13326 135596796 HEALTH CARE ORGANIZATION OFFERING INPATIENT AND OUTPATIENT SERVICES NY 501 (C) 3 3 BASSETT HEALTHCARE NETWORK 0 AURELIA OSBORN FOX MEMORIAL HOSPITAL SOCIETY ONE NORTON AVENUE ONEONTA NY 13820 150539039 HEALTH CARE ORGANIZATION OFFERING INPATIENT AND OUTPATIENT SERVICES NY 501 (C) 3 3 BASSETT HEALTHCARE NETWORK 0 TEMPLETON FOUNDATION ONE ATWELL ROAD COOPERSTOWN NY 13326 133317084 LANDLORD NY 501 (C) 3 10 BASSETT HEALTHCARE NETWORK 0 COBLESKILL REGIONAL HOSPITAL 178 GRANDVIEW DRIVE COBLESKILL NY 12043 141772971 HEALTHCARE SERVICES OFFERING INPATEINT AND OUTPATIENT SERVICES NY 501 (C) 3 3 BASSETT HEALTHCARE NETWORK 0 O'CONNOR HOSPITAL 460 ANDES ROAD DELHI NY 13753 161540394 HEALTH CARE ORGANIZATION OFFERING INPATIENT AND OUTPATIENT SERVICES NY 501 (C) 3 3 BASSETT HEALTHCARE NETWORK 0 TRI TOWN REGIONAL HEALTHCARE 43 PEARL STREET SYNDEY NY 13838 260169584 HEALTHCARE SERVICES OFFERING OUTPATIENT SERVICES NY 501 (C) 3 3 BASSETT HEALTHCARE NETWORK 0 VALLEY HEALTH SERVICES 690 GERMAN STREET HERKIMER NY 13350 222511614 NURSING HOME NY 501 (C) 3 3 BASSETT HEALTHCARE NETWORK 0 BASSETT PPS LLC 6181 STATE HIGHWAY 7 ONEONTA NY 13820 811749905 SUPPORTING ORGANIZATION NY 501 (C) 3 12 A MARY IMOGENE BASSETT HOSPITAL 0 AT HOME CARE INC 25 ELM STREET ONEONTA NY 13820 161287069 HOME CARE SERVICES NY 501 (C) 3 10 BASSETT HEALTHCARE NETWORK 0 AT HOME CARE PARTNERS INC 25 ELM STREET ONEONTA NY 13820 562398098 HOME CARE SERVICES NY 501 (C) 3 10 AT HOME CARE INC 0 VALLEY RESIDENTIAL SERVICES 690 GERMAN STREET HERKIMER NY 13350 463703838 ELDER CARE NY 501 (C) 3 10 BASSETT HEALTHCARE NETWORK 0 0 0 1 0 0 0 0 0 0 1 0 1 1 0 1 0 1 0 0