2019-11-14T10:26:50-07:00 2018-12-31 990 2018-01-01 141338465 NATHAN LITTAUER HOSPITAL ASSOCIATION NATH 5187258621 99 East State Street Gloversville NY 12078 Mike Ostrander Vice President of Finance & CFO 5187735480 2019-11-08 208.125.81.163 2018 2020-03-31 21:24:44Z Nathan Littauer Hospital and Nursing Home Laurence E Kelly 99 East State Street Gloversville NY 12078 129424832 0 X www.nlh.org X 1894 NY Nathan Littauer Hospital & Nursing Home and its family of health services is committed to providing safe high quality health and wellness services and improving the health of our communities in a caring, contemporary environment. 15 12 1168 129 547762 0 784916 696752 101508219 103521436 1786353 4171972 4075642 9611163 108155130 118001323 0 0 0 0 66440347 68078851 0 0 276211 35967252 37560000 102407599 105638851 5747531 12362472 94577042 105410056 26019521 28403031 68557521 77007025 X Nathan Littauer Hospital & Nursing Home and its family of health services is committed to providing safe high quality health and wellness services and improving the health of our communities in a caring, contemporary environment. 0 0 58522416 0 75724775 74 bed general medical surgical hospital providing inpatient and outpatient services with the following service statistics for 2018; 7,692 inpatient days, 900 observation visits, 815 new born days, 2,393 admissions, 365 nursery admissions, 23,868 emergency room visits, 93,135 outpatient visits and 5,525 day surgery visits. 29750771 0 18938199 The Nathan Littauer Hospital and Specialty Care Centers provide care for the whole family. Our nine conveniently located centers offer a range of services and specialties that include urology, obstetrics, gynecology, podiatry, pulmonology, gastroenterology, pediatrics, and neurology along with direct access to state-of-the-art technology available at Nathan Littauer Hospital. Several Centers are located in remote rural parts of our service area. The Centers employ 38 physicians and over 27 other healthcare professionals. During 2018, the Centers collectively incurred 141,444 patient visits. 9514803 0 8669856 The Nathan Littauer Nursing Home located on the Nathan Littauer Hospital campus is a short and long-term residential healthcare facility that provides a wide range of medical services with 84 beds. In 2018, the facility had a total of 30,067 patient days. 664067 0 9347979 HealthLink is Nathan Littauer Hospital's Wellness Education Center located in downtown Johnstown. HealthLink's role is to promote wellness by promoting prevention and providing resources to promote healthy lifestyle choices. Since its launch in 1989, HealthLink has served 9,014 area residents with 277,454 free or low-cost education programs and health screenings. Our wide varieties of programs are chosen based on the interests and the health needs of the community. Program categories: include Health & Wellness, Mind & Body, Childbirth & Parenting, Health Screenings, Support Groups, Chronic Disease Self-Management Workshops, and Fitness Classes. Programs and presentations on a variety of topics are offered throughout our service area at places such as local businesses, schools, churches and other organizations in order to better serve this rural community. HealthLink's resources include: fair and festival activities, trained employees and contracted staff, numerous brochures on a wide variety of health & wellness related topics available at no cost, as well as an array of health magazines, books and DVDs for loan. The Hospital also offers a Lifeline Program. Lifeline is a personal emergency response system providing immediate assistance 24 hours a day 7 days a week. A total of 430 subscribers are members of NLHs Lifeline Program. Other community services include community health fairs, speakers bureau, organ donation program and New Visions Program for high school students. Health Insurance Counseling: Nathan Littauer Hospital was awarded and continues to be the Lead Agency for the grant entitled: "Consumer Assistant for the NYS of Health Benefit Exchange" covering Fulton and Montgomery County. During the year of 2018 Nathan Littauer Hospital as Lead Agency the program's was able to enroll a total of 4,544 individuals with the following breakdown: Children's Medicaid - 1,217, Child Health Plus Program - 463, Adult Medicaid - 1,893, Adult Quality Health Plan - 337, Essential Plans - 634. Also included here is other operating revenue of $8,668,365. 664067 0 9347979 98452057 1 1 0 1 0 0 0 0 0 1 1 0 0 1 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 1 1 0 0 1 34 0 1 1168 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 15 12 0 0 0 0 1 0 1 1 1 0 0 0 1 1 1 1 1 1 1 0 NY X Michael Redcross 5187735481 99 East State Street Gloversville NY 12078 Gregory Truckenmiller PhD Chair 0.5 0.25 X 0 0 0 Stephen Tomlinson Vice Chair 0.5 0.25 X 0 0 0 Susan Johnson Esq Treasurer 0.5 0.25 X 0 0 0 Holly Chamberlin Esq Secrerary 0.5 0.25 X 0 0 0 Thomas Ciaccio Member 0.5 0.25 X 0 0 0 Paul Connelie Member 0.5 0.25 X 0 0 0 John Fox DDS Member 0.5 0.25 X 0 0 0 Brian Hanaburgh Member 0.5 0.25 X 0 0 0 Laurence Horowitz MD Member/Employed Physician 0.5 0.25 X 155336 0 6046 John Mastrangelo MD Member 0.5 0.25 X 0 0 0 Amy Pedrick Member 0.5 0 X 0 0 0 G Jeremiah Ryan PhD Member 0.5 0.25 X 0 0 0 David Seward Esq Member 0.5 0.25 X 0 0 0 Shriraj Shah Member/Employed Physician 40 0 X 233788 0 28324 Laurence E Kelly President and CEO 40 0.25 X X 728740 0 88512 Mike Ostrander Vice President of Finance and CFO 40 0.25 X 294969 0 22833 Kamini Ramani MD Physician 40 0 X 752145 0 31296 Luz Alvarez MD Physician 40 0 X 568938 0 17854 Paul Husson MD Physician 40 0 X 532299 0 29198 Verma Shri MD Physician 40 0 X 653128 0 27379 Wasiczko Robert MD Physician 40 0 X 427025 0 17926 4346368 0 269368 101 0 1 0 Sodexo Operations PO Box 905374 Charlotte NC 28290 Dietary Services 2257272 Gloversville Physician Medicine PC PO Box 82368 Lafayette LA 70598 Physician Services 1248179 Alliance Healthcare Services PO Box 964485 Chicago IL 60693 MRI Imaging 1216800 MLB Construction Services LLC 1 Stone Break Road Malta NY 12020 Construction Services 902735 Quest Diagnostics 1 Malcolm Avenue Teterboro NJ 07608 Diagnostic Services 875834 19 0 0 0 200000 491008 5744 0 696752 Inpatient and Outpatient Services 622110 75724775 75593350 131425 0 Primary Care Centers 621400 18938199 18938199 0 0 Nursing Home 623000 8669856 8669856 0 0 Lifeline 621990 164612 164612 0 0 Healthlink 611710 23994 23994 0 0 0 0 0 0 103521436 3950946 0 3586 3947360 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 11642341 2194 11423509 0 218832 2194 221026 0 0 221026 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Retail Pharmacy 446110 412751 0 412751 0 340b Program 900099 3858117 3858117 0 0 Cafeteria Sales 722212 419416 419416 0 0 4920879 4881840 0 39039 9611163 118001323 112549384 547762 4207425 0 0 0 0 0 0 0 0 1023709 0 1023709 0 0 0 0 0 53027976 50295654 2520747 211575 3048368 2881577 158328 8463 7368223 7001631 337715 28877 3610575 3417738 176652 16185 553791 553791 0 0 74950 0 74950 0 140916 0 140916 0 29111 0 29111 0 0 0 0 0 0 0 2190318 2073630 116688 0 217364 576 216788 0 4454909 4053080 401829 0 818376 764642 53734 0 0 0 0 0 1086000 1084937 1063 0 321509 287927 33582 0 0 0 0 0 0 0 0 0 152472 152472 0 0 0 0 0 0 3836817 3678922 157895 0 1660050 1660050 0 0 Medical Supplies 11449243 11448968 275 0 Non-Medical Expenses 1365693 1357462 8231 0 Purchased Services 5821916 5000758 821158 0 Food 987932 987932 0 0 2398633 1750310 637212 11111 105638851 98452057 6910583 276211 4953457 5946653 4114904 4491685 71360 71360 12001398 11614731 0 0 0 0 0 0 630442 792191 959133 953378 94158355 67775695 26332671 26382660 38796691 49734077 0 0 0 0 0 0 6716986 5423321 94577042 105410056 7064979 7810531 0 0 362363 362363 0 0 0 0 0 0 0 0 0 18592179 20230137 26019521 28403031 X 68203661 76653165 71360 71360 282500 282500 68557521 77007025 94577042 105410056 X 12362472 -4119239 0 0 0 206271 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 29111 29111 0 Schedule C, Part II-B, Line 1 A portion of the organizations dues for the American Hospital Association, Healthcare Association of New York State and the Iroquois Healthcare Consortium is used for Lobbying purposes. Also the organization engaged a law firm to seek an extension of the Medicare Dependent Hospital Designation as part of a group effort with other rural Hospitals. 438438 0 -42336 0 0 999 395103 374009 0 66039 0 0 1610 438438 328971 0 46558 0 0 1520 374009 347080 0 -16633 0 0 1476 328971 416864 0 31838 0 100000 1622 347080 0 1 0 0 0 0 853543 853543 0 44622515 29500457 15122058 0 2106131 1494995 611136 0 41545925 34507173 7038752 0 5030241 2273070 2757171 26382660 AWUIL by Board Designation 648569 Agency Fund 52462 Miscellaneous Receivable 74809 Other Assets 352102 Deferred Asset - 1199 434342 Deferred Asset - 457 plans 3304293 Software License 556744 5423321 0 Due to Third Parties 4674839 Asset Retirement Obligation 393394 Long-Term Pension Obligation 5761669 Section 457 Plans 3706789 Due to 1199 434342 EHR Reserve 503711 Promissory Notes 4755393 20230137 X 114088355 -4119239 0 0 206271 -3912968 118001323 0 0 0 118001323 105638851 0 0 0 0 0 105638851 0 0 0 105638851 Schedule D, Part V, Line 4 The principle donation is permanently restricted, income generated by the fund can be used toward operations of the hospital. Schedule D, Part X, Line 2 The Hospital is a not-for-profit organization, as described in Section 501c 3 of the Internal Revenue Code (the Code) and is exempt from federal income taxes on related income pursuant to Section 501 (a) of the Code. The Hospital recognizes income tax positions when its more-likely than not that position will be sustainable based on the merits of the position. Recognized tax liabilities are not material to the financial statements as of December 31, 2018 or 2017. Schedule D, Part XI, Line 2d Pension related changes other than periodic pension cost ($206,271). 1 1 1 X 1 X 1 1 0 1 1 645 287251 38581 248670 0.0024 72920 24026396 16054799 7971597 0.0755 0 73565 24313647 16093380 8220267 0.0779 32 42637 798939 473233 325706 0.0031 1 152 154430 0 154430 0.0015 1 141444 22284114 15859184 6424930 0.0608 0 0 0 0 0 3 380 19479 0 19479 0.0002 37 184613 23256962 16332417 6924545 0.0656 37 258178 47570609 32425797 15144812 0.1435 1 5517125 0 11401323 13119596 -1718273 X 1 1 1 1 Nathan Littauer Hospital Association 99 East State Street Gloversville NY 12078 www.nlh.org 1701000H X X X Nathan Littauer Hospital Association 1 0 0 1 X X X X X X X X 16 1 1 1 1 X www.nlh.org X 1 16 1 www.nlh.org 0 0 1 X 100 300 1 1 X X X X 1 X www.nlh.org X www.nlh.org X www.nlh.org X X X X X X 1 X 0 X X X 1 X 0 0 Schedule H, Part V, Section B, Line 5-Nathan Littauer Hospital Association In conducting the CHNA, non-profit hospitals are required to take into account input from persons who represent the broad interests of the community served, including those with special knowledge or expertise in public health. In addition, member, leaders or representatives of medically underserved, low-income, minority populations should be consulted. In March and April of 2016, NLH coordinated with Fulton, Essex, Hamilton, Franklin, Clinton, Warren and Washington County Public Health, in addition to Adirondack Health, Inter-Lakes Health and Moses Ludington Hospital, Glens Falls Hospital, UVM Health Network-Alice Hyde Medical Center, UVM Health Network- Champlain Valley Physician Hospital, UVM Health Network-Elizabethtown Community Hospital to conduct a survey of selected stakeholders representing health care and service-providing agencies within the region. Respondents to the survey indicated they represent a wide array of sectors including: Day Program Services, Education, Employment, Training, Health Care Services, Prevention/Wellness Services, Healthy Environment, Housing/Residential and Social Services. The results of the survey provided an overview of regional needs and priorities, to inform planning and the development of a regional health care agenda. The survey results were presented at both the county and regional levels. We also were able to use the data from our membership on the Mohawk Valley Population Health Improvement Program. That data and partnership allows us to share data including, outcome, claims and utilization data and identifying appropriate, available sources, that include public health, regional health information organizations and other qualified entities. Mohawk Valley PHIP Bassett Research Institute staff and Healthy Communities Institute gather data on everything from unemployment rates, poverty levels, and smoking rates to targeted disease related emergency room visits and hospitalizations. De-identified electronic medical records and insurance claims will enable the data team to track how health care services are utilized and develop regional capability for hospitals to use their existing data for improvement. In order to promote standardization, this data plan also addresses development of metrics for performance evaluation and outcome measurement that are consistent with, to the tracks the metrics the Mohawk Valley PHIP has prioritized. Additionally, we met at a local level to review local priorities. Members of that extent possible, the Delivery System Reform Incentive Payment (DSRIP) metrics. Interrupted time series analysis meeting included AHI, Fulton County Public Health, Hamilton County Public Health, the data collection firm, Healthlink Littauer and Nathan Littauer Hospital. Nathan Littauer's Board of Directors also reviewed the data and findings in October of 2016. After reviewing the data, we were able to focus upon the areas of greatest need and our role in prevention. Schedule H, Part V, Section B, Line 6a-Nathan Littauer Hospital Association We coordinated with Adirondack Health, Inter-Lakes Health and Moses Ludington Hospital, Glens Falls Hospital, UVM Health Network-Alice Hyde Medical Center, UVM Health Network-Champlain Valley Physicians Hospital, UVM Health Network-Elizabethtown Community Hospital. Other entities included: Fulton, Essex, Hamilton, Franklin, Clinton, Warren and Washington County Public Health and Adirondack Health Institute. Schedule H, Part V, Section B, Line 6b-Nathan Littauer Hospital Association AHI and ARHN Center for Health and Workforce Studies, Fulton County Public Health, NYSDOH and Hamilton County Public Health. Schedule H, Part V, Section B, Line 11-Nathan Littauer Hospital Association We did not choose to focus on substance abuse, smoking cessation and mental health issues, although these needs were identified, we have partners who are addressing those health disparities. That is not to say that we do not address the above issues in a clinical setting, we simply did not choose to focus upon those health disparities as part of our CHNA. Priority #1 - Prevention of Chronic Disease by addressing colorectal cancer. To increase the percentage of adults 18 years and older who are screened for colorectal cancer. By improving colorectal awareness and screening, for more people we will be addressing an identified disparity: Access to Health Care. Colorectal cancer is the second leading cancer killer in the United States. Data collected by Adirondack Rural Health Network shows that the death rate from colorectal cancer is higher in Fulton County than in other counties across New York State. We are identifying community members age 50-75 years old and anyone who is at an increased risk and anyone that presents with symptoms or symptoms indicating a risk. Screening can find precancerous polyps-abnormal growth in the colon or rectum-so that they can be removed before turning in cancer. Screenings find cancer at an early stage, when treatment often leads to a cure. We are hoping to achieve, an increase Colorectal Cancer Screens, improved Community Education (date, topic, attendance), and targeted media campaigns. Our outcomes will include: Increased awareness of Colorectal Cancer prevention a 5% increase in Cancer Screenings for Colorectal cancer and ultimately, a decrease in the death rate from Colorectal Cancer since earlier detection will provide improved outcomes. Priority #2-Prevention of Chronic Disease through Promoting Breastfeeding. Fulton County has an obesity rate, asthma disease rate, ovarian cancer rate and death from ovarian cancer rate that is higher than that of other counties in New York State. There is a direct linkage to lowering these risks in addition to other benefits for breastfed children and their mothers. Infants who are breastfed are less likely to be obese, develop respiratory and G.I. infections, childhood cancers, asthma, and SIDS. Mothers who breastfeed have a decreased risk of breast and ovarian cancer, osteoporosis, postpartum depression and are more likely to return to their pre-pregnancy weight. We will be addressing this priority by obtaining a baseline number of infants who are exclusively breastfed during hospitalization. We will provide structured, comprehensive breastfeeding education and professional lactation counseling, including the use of Internal Board Certified Lactation Consultants (IBCLCs) during pregnancy, in the hospital and in the community. We will offer support groups that promote peer counselors, in Johnstown and Gloversville to increase access to care. We will recruit, train and support breastfeeding peer counselors, including WIC, La Leche League and community health workers, and explore ways to reimburse peer educators for breastfeeding education. Nathan Littauer Hospital Primary Care Centers will refer any pregnant woman to the Breastfeeding Specialist upon conception. We will also increase the areas for our own employees to breastfeed and pump, along with offering insurance options that promote breastfeeding. We will continue to partner with Albany Medical Center for perinatal outsource and best practices for breastfeeding and continue to partner with Community Health Center (CHC) in regards to Breastfeeding Bill of Rights. We hope to achieve the following: Increase the number of breastfed infants in our hospital by 10%. Increase the number of breastfed infants at 3 months of age. Increase the number of breastfed infants at 6 months of age. Schedule H, Part V, Section B, Line 20d-Nathan Littauer Hospital Association The hospital does not utilize a presumptive eligibility model to make determinations for its financial assistance program. 10 Nathan Littauer Hospital Nursing Home 99 East State Street Gloverville NY 12078 84 Bed Nursing Home. Nathan Littauer Hospital Primary Care 99 East State Street Gloversville NY 12078 Primary/Specialty Care Center (Clinic) Perth Primary Care Center 4100 State Highway 30 Amsterdam NY 12110 Primary/Specialty Care Center (Clinic). Johnstown Primary Care Center 23 South Perry Street Johnstown NY 12095 Primary/Specialty Care Center (Clinic). Mayfield Primary Care Center 2497 State Highway 30 Mayfield NY 12117 Primary/Specialty Care Center (Clinic). Kingsboro GI Center 434 South Kingsboro Ave Extension Johnstown NY 12095 Primary/Specialty Care Center (Clinic). Decker Drive Primary Care Center 9 Decker Drive Johnstown NY 12095 Primary/Specialty Care Center (Clinic). Steele Avenue Primary Care Center 182 Steele Avenue Gloversville NY 12078 Primary/Specialty Care Center (Clinic). Speculator Primary Care Center Route 8 Speculator NY 12164 Primary/Specialty Care Center (Clinic). Caroga Lake Primary Care Center 1840 State Highway 10 Caroga Lake NY 12032 Primary/Specialty Care Center (Clinic). Fonda Primary Care Center 46 East Main Street Fonda NY 12068 Primary/Specialty Care Center (Clinic). Schedule H, Part I, Line 7 The costing methodology used to calculate the amounts reported in the Table for Lin 7 is the ratio of patient cost to patient care charges. Schedule H, Part I, Line 7, Column f Bad Debt Expense was not included in Form 990, Part IX, line 25, column (A), and not subtracted for purposes of calculating the percentage in Schedule H Part I, Line 7, column (f). Schedule H, Part I, Line 7g Subsidized health series reported included details from the Primary/Specialty Care Centers and licensed clinics. The Centers operate despite financial losses to the Organization for at least the last fifteen years. The Hospital is committed to operate the Centers as a benefit to the community in order to address an identified need and to improve access to healthcare, including our remote rural communities. Schedule H, Part III, Section A, Line 2 In evaluating the collectability of patient accounts receivable, the Hospital analyzes its past collection history, business and economic conditions, trends in governmental and employee health care coverage and other collection indicators for each of its major categories of revenue by payor to estimate the appropriate allowance for estimated uncollectible accounts. Schedule H, Part III, Section A, Line 4 In evaluating the collectability of patient accounts receivable, the Hospital analyzes its past collection history, business and economic conditions, trends in governmental and employee health care coverage and other collection indicators for each of its major categories of revenue by payor to estimate the appropriate allowance for estimated uncollectible accounts. Patient accounts receivables are reflected net of an allowance for estimated uncollectible accounts. In evaluating the collectability of patient accounts receivable, the Hospital analyzes its past collection history, business and economic conditions, trends in governmental and employee health care coverage and other collection indicators for each of its major categories of revenue by payer to estimate the appropriate allowance for estimated uncollectible accounts. Management regularly reviews data about these major categories of revenue in evaluating the sufficiency of the allowance for estimated uncollectible accounts. Throughout the year, the Hospital, after all reasonable collection efforts have been exhausted, will write off the difference between the standard rates (or discounted rates if applicable) and the amounts actually collected against the allowance for estimated uncollectible accounts. In addition to the review of the categories of revenue, management monitors the write offs against established allowances to determine the appropriateness of the underlying assumptions used in estimating the allowance for estimated uncollectible accounts. Schedule H, Part III, Section B, Line 8 Medicare allowable costs were calculated using a cost to charge ratio based upon the cost finding methodology in the Medicare 2252-10 Cost Report. Community Benefit rationale: The Medicare shortfall should be considered a community benefit because our mission is to promote health in the community and we do not limit the care available to any patient, including those covered by Medicare. We are relieving a government burden by providing care to Medicare patients even though costs exceed reimbursements by $1,718,273. Tax exempt hospital are expected to participate in the Medicare program. For many of the medical services provided by the Hospital, Medicare does not provide sufficient reimbursement to cover the cost of providing care to our patients, forcing the Hospital to use other funds to cover the deficit. Medicare Cost Reports that hospitals are required to file do not include the costs required to treat all Medicare patients. Therefore, the amount reflected on the Medicare Cost Report differs from actual losses. In 2018 the Hospital realized an additional shortfall of $2,601,359 resulting from Medicare Advantage and non-PPS Medicare patients. The total shortfall for all types of Medicare patients was $4,319,632. Schedule H, Part III, Section C, Line 9b Requests for Financial Assistance may be made at any point before, during or after the provision of care. Anyone seeking Financial Assistance will be given an application. Financial Assistance requests may be proposed by sources other than the patient, such as patient's physician, family members, social services or hospital personnel. Pending final eligibility determination, Nathan Littauer Hospital will not initiate collection efforts or requests for deposits provided that the responsible party is cooperative with Nathan Littauer Hospital's efforts to get payment from other sources. If initial screening does not disqualify someone for Financial Assistance they will be given an application, which includes instructions on how to apply. Schedule H, Part VI, Line 2 Assessment of Public Health Priorities with AHI facilitating the process the Community Health Planning Committee (the Committee) was formed with representation from all six of the hospitals and all six of local health departments in the region Members of the Committee participated in a collaborative approach to community health assessment and planning, relying on regional information gathered and analyzed by AHI as well as information specific to each hospital's service area, each AHI hospital prepared a Community Service Plan in collaboration with the other participating hospitals and local health departments. Schedule H, Part VI, Line 3 NLH educates our patient population for our Financial Assistance policy in the following ways: NLH has provided a "Frequently Asked Question" section on our website (www.nlh.org) to answer questions our patients may have. We have posted the complete Charity/Financial assistance policy on our website (www.nlh.org). NLH posts in their registration areas the availability of Financial Assistance and the appropriate contact information to obtain and complete the application process. NLH also provides pamphlets in all of our inpatient and outpatient registration areas literature providing information on insurances and again, providing information on our Financial Assistance program and contact information. NLH has four facilitated enrollers available to assist patients with their application for Medicaid, Quality Health Plan and Child Health Plus. They will also assist patients in completing our charity care application. Our staff has been trained in assisting our patients with obtaining application and providing direction and contact information for the completion of same. Our in-patient statements and our billing agency provides information advising patients to contact our offices to request the application and assistance in its completion. Schedule H, Part VI, Line 4 Nathan Littauer Hospital and Nursing Home is located in a rural area in Upstate New York. Our primary service area is Fulton County with additional services in neighboring Hamilton and Montgomery counties. Within our main service area, Fulton County, 2018 data shows a population of 53,591 a 3.5% decrease since 2010. Of those reporting one race, 95.2% of those residents identified themselves as white. 50.2% of our population are women. Over 19.6% of the population has a median age of 65 or older. The median household income in Fulton County is $48,033. Our county has 15.9% of its residents living below the poverty level. 87.0% of the population has a high school degree or higher. The leading industries remain Educational services, health care and social assistance org employing 26% of the workforce followed by manufacturing employing 15%. Unemployment rates for 2018 are about 5.8%. Major health issues for our region remain, respiratory diseases/childhood asthma, cancers of the lung and colon, lack of physical fitness and nutrition, unintentional injuries, tobacco use, lead poisoning and chronic diseases of the lung and the heart. Of particular note is our aging population and poverty levels, which are much higher than the state average. Our mission is in keeping with the community need as we strive to provide care that is effective, clinically astute, safe and accessible. Schedule H, Part VI, Line 5 The Board of Directors of Nathan Littauer Hospital and Nursing Home is made up of medical and business professionals, all of whom reside in our primary service area. These volunteers give countless hours to the organization in their oversight role. They are involved in the community needs assessment process, in fundraising and in general stewardship. Littauer utilizes excess funds to reinvest in our technology, computerization and facilities to keep our organization safe, efficient and accessible as well as to ensure quality patient care. For example, we used excess funds to support free and low cost education programs offered by Healthlink Littauer. Built a new a Primary Care Center in Fonda NY, added a new Interventional Radiology department among other capital equipment acquisitions and projects in 2017. Most of the funds needed for these projects and purchases were made with operational gains. Schedule H, Part VI, Line 7 New York State X X X X 0 1 0 0 0 0 0 0 0 Laurence E Kelly President and CEO 728740 0 0 0 0 0 65961 0 22551 0 817252 0 0 0 Mike Ostrander Vice President of Finance and CFO 294969 0 0 0 0 0 22833 0 0 0 317802 0 0 0 Kamini Ramani MD Physician 752145 0 0 0 0 0 11000 0 20296 0 783441 0 0 0 Luz Alvarez MD Physician 568938 0 0 0 0 0 11000 0 6854 0 586792 0 0 0 Paul Husson MD Physician 532299 0 0 0 0 0 11000 0 18198 0 561497 0 0 0 Verma Shri MD Physician 653128 0 0 0 0 0 11000 0 16379 0 680507 0 0 0 Wasiczko Robert MD Physician 427025 0 0 0 0 0 11000 0 6926 0 444951 0 0 0 Laurence Horowitz MD Member/Employed Physician 155336 0 0 0 0 0 6046 0 0 0 161382 0 0 0 Shriraj Shah Member/Employed Physician 233788 0 0 0 0 0 9600 0 18724 0 262112 0 0 0 Schedule J, Part I, Line 4 Payments of $54,961 were made on behalf of the CEO, Laurence E. Kelly to a 457(f) plan in 2018. Form 990, Part I, Line 6 Total volunteer hours for 2018 were 10,92 based upon the annual report of the Nathan Littauer Hospital Auxiliary. This included Auxilians, Candy Stripers and Junior Volunteers. Form 990, Part I, Line 7b The Hospital's unrelated business taxable income for 2018 included $37,606 in expenses incurred to maintain employee parking spaces. Under Section 512(a)(7), such expenses are included in unrelated business taxable income as amounts paid for disallowed fringes and are therefore reflected in Part I, Line 7b. Form 990, Part III, Line 4d HealthLink is Nathan Littauer Hospital's Wellness Education Center located in downtown Johnstown. HealthLink's role is to promote wellness by promoting prevention and providing resources to promote healthy lifestyle choices. Since its launch in 1989, HealthLink has served 9,014 area residents with 277,454 free or low-cost education programs and health screenings. Our wide variety of programs are chosen based on the interests and the health needs of the community. Program categories: include Health & Wellness, Mind & Body, Childbirth & Parenting, Health Screenings, Support Groups, Chronic Disease Self-Management Workshops, and Fitness Classes. Programs and presentations on a variety of topics are offered throughout our service area at places such as local businesses, schools, churches and other organizations in order to better serve this rural community. HealthLink's resources include: fair and festival activities, trained employees and contracted staff, numerous brochures on a wide variety of health & wellness related topics available at no cost, as well as an array of health magazines, books and DVDs for loan. The Hospital also offers a Lifeline Program. Lifeline is a personal emergency response system providing immediate assistance 24 hours a day 7 days a week. A total of 430 subscribers are members of NLHs Lifeline Program. Other community services include community health fairs, speakers bureau, organ donation program and New Visions Program for high school students. Health Insurance Counseling: Nathan Littauer Hospital was awarded and continues to be the Lead Agency for the grant entitled: "Consumer Assistant for the NYS of Health Benefit Exchange" covering Fulton and Montgomery County. During the year of 2018 Nathan Littauer Hospital as Lead Agency the program's was able to enroll a total of 4,544 individuals with the following breakdown: Children's Medicaid - 1,217, Child Health Plus Program - 463, Adult Medicaid - 1,893, Adult Quality Health Plan - 337, Essential Plans - 634. Also included here is other operating revenue of $8,668,365. Form 990, Part VI, Section A, Line 6 The sole member of the Nathan Littauer Hospital Association is Colonial Healthcare Corp. which shall be represented at all meetings of the Association by the President of the Board of Directors of Colonial Healthcare Corp. or such person designated by the President in writing. Form 990, Part VI, Section A, Line 7b Colonial Healthcare Corp. the sole member of the Nathan Littauer Hospital Association must consent to any changes to the Hospital's bylaws. Form 990, Part VI, Section B, Line 11b The draft form 990 was presented at a regular meeting of the Board of Directors on October 22, 2019 by Mike Ostrander, Vice President of Finance and CFO and Laurence Kelly, President and CEO prior to the filing of the form. Form 990, Part VI, Section B, Line 12c The Hospital's Conflict of Interest policy requires the filing of an annual disclosure statement by covered persons. Covered persons are defined as "Any director, officer, member of a committee with governing board delegated powers, or any member of the Capital Acquisition Committee, Pharmacy & Therapeutics Committee. Value Analysis Committee and Hospital employees who have a position which involves the acquisition of equipment and supplies or who authorize payments for such material. The Board or Committee is informed annually of any possible conflicts. The covered person has a duty to disclose the possible conflict when a matter is brought before or the Board or Committee and Board or Committee makes the determination if a conflict actually exists. The conflicted party will not participate in the discussion of the matter at hand and will leave the meeting which a vote of the disinterested parties takes place. The Corporate Compliance Officer and the Chairman of the Board or Committee are responsible for compliance with policy. Form 990, Part VI, Section B, Line 15 The Hospital's Compensation Committee is composed of the Chairman, Vice Chairman and immediate past Chairman of the Board of Directors. All members are independent directors. The Committee utilizes comparable compensation data in its determinations. The compensation of the President (CEO) of the hospital is in the form of a recommendation to the full Board of Directors in an Executive Session of the meeting. Only independent directors are present at the meeting. The Compensation committee also advises and assists the President (CEO) in determining the compensation for senior management of the Hospital using comparative compensation data. Form 990, Part VI, Section C, Line 19 The Hospital publishes an annual report distributed by mail and made available for distribution through a number of public outlets such as civic and social organizations. The report includes condensed financial statements and various statistical data relative to services provided to the community including free clinics, education programs, health fairs, ect. The form 990 is available to the public upon request. The Hospital's governing documents, conflict of interest policy and internal financial statements are not available to the public. Form 990, Part XI, Line 9 Pension related changes other than periodic pension expense. Gloversville Extended Care & Nursing Home Co Inc 99 East State Street Gloversville NY 12078 237065255 Leasing a 84 bed Skilled Nursing Facility NY 501(c)3 Schedule A Line 3 Nathan Littauer Hospital Association 1 NLH Realty Corp 99 East State Street Gloversville NY 12078 141641020 Realty Holding Company NY 501(c)2 Nathan Littauer Foundation 0 Nathan Littauer Foundation 99 East State Street Gloversville NY 12078 141638991 Support the Hospital and promote healthcare NY 501(c)3 Schedule A Line 7 Colonial Healthcare Corporation 0 Nathan Littauer Hospital Auxiliary 99 East State Street Gloversville NY 12078 146086641 Assisting Hospital in promoting healthcare NY 501(c)3 Schedule A Line 12 N/A 0 Colonial Healthcare Corportation PO Box 586 Gloversville NY 12078 141670605 Support & Supplement the activities and goals NY 501(c)3 Schedule A Line 7 N/A 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 Nathan Littauer Foundation c 200000 Payment to Hospital. N/A