2019-11-15T12:58:09-06:00 2018-12-31 161226221 FUST CHARLES CHAMBERS LLP 5784 WIDEWATERS PARKWAY SYRACUSE NY 13214 990 2018-01-01 150533578 LITTLE FALLS HOSPITAL LITT 3158231000 140 BURWELL STREET LITTLE FALLS NY 13365 JAMES VIELKIND CFO 3158231000 2019-11-14 1 KELLY A REDMOND P00443718 3154463600 2019-11-14 24.39.85.114 2019-11-14 14:28:11 ES P FD62137317EE26C9F26E40FD83CAC65FE1294EC8 95BF4D66B926A32327CE7D91ADC759B9DBEEFFE9 2018 2020-03-31 21:24:44Z JAMES VIELKIND 140 BURWELL STREET LITTLE FALLS NY 13365 36555092 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 11 390 20 0 2486 253157 739625 31574158 32939635 188805 590377 0 0 32016120 34269637 0 0 0 0 15234452 15786356 0 0 111808 17333310 18937262 32567762 34723618 -551642 -453981 31793288 30364498 9451037 9257548 22342251 21106950 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. 0 0 8273149 8790613 INPATIENT SERVICESTHE INPATIENT OCCUPANCY RATE FOR INPATIENT AND OBSERVATION SERVICES WAS 67% FOR AN AVERAGE DAILY INPATIENT DAILY CENSUS OF 17 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 2018, LITTLE FALLS HOSPITAL WAS ALSO RATED A FOUR STAR (****) HOSPITAL BY "HOSPITAL CONSUMER ASSESSMENT OF HEALTHCARE PROVIDERS AND SYSTEMS" (HCAHPS). A FOUR STAR RATING INDICATES HIGH PATIENT SATISFACTION IN THEIR PATIENT CARE AS MEASURED BY PATIENT SURVEY INSTRUMENTS. IN 2018 NEW TECHNOLOGY WAS PURCHASED AS AN ADVANCED NURSE CALL SYSTEM TO IMPROVE PATIENT SAFETY. THIS SYSTEM AIMS TO CONNECT STAFF WITH PATIENT SERVICE NEEDS TO LIMIT RISK FOR FALLS AND IMPROVE RESPONSES TO PATIENTS CALLS FOR ASSISTANCE. 9145275 9163740 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 2018. THE EMERGENCY DEPARTMENT PARTICIPATED IN A NYS MEDICAID ACCELERATED EXCHANGE (MAX) PROGRAM TO REDUCE AVOIDABLE VISITS TO AN EMERGENCY DEPARTMENT. IN ADDITION PATIENT NAVIGATION WAS IMPLEMENTED FOR EMERGENCY DEPARTMENT PATIENTS WHICH PROVIDES PATIENTS ACCESS TO RESOURCES FOR OBTAINING MEDICAID AND ALSO GETTING ACCESS TO CARE MANAGEMENT SERVICES. THESE CARE RE-DESIGN MEASURES AND CARE MANAGEMENT INITIATIVES ARE CONSISTENT WITH NYS DEPARTMENT OF HEALTH MEDICAID CARE RE-DESIGN INITIATIVES, ADMINISTERED UNDER THE "DELIVERY SYSTEM REFORM INCENTIVE PAYMENT (DSRIP) PROGRAM". A GOAL OF THIS PROGRAM IS TO REDUCE BY 25% OVER FIVE YEARS, AVOIDABLE HOSPITAL EMERGENCY DEPARTMENT VISITS AND HOSPITAL ADMISSIONS. OUR PLANS CONTINUE TO IMPLEMENT NEW INITIATIVES FOR IMPROVING CARE FOR PATIENTS WITH CONSITENT OUTSTANDING COMMITTMENT FOR THE HIGHEST QUALITY CARE. 10179890 13225543 TOTAL AMBULATORY OUTPATIENT SERVICE VISITS WERE APPROXIMATELY 33,000 IN 2018. OUR AMBULATORY SERVICES INCLUDE REHAB / WELLNESS PROGRAM, AMBULATORY SURGERY / GI SERVICES, WOMENS IMAGING SERVICE, DIAGNOSTIC IMAGING SERVICES, AND PRIMARY CARE SERVICES. IN 2018 THE HOSPITAL INITIATED PLANS FOR REPLACING THE DOLGEVILLE PRIMARY CARE CENTER TO MODERNIZE THE FACILITY AND EXPAND CAPACITY FOR PRIMARY CARE AND PREVENTATIVE SERVICES. WITH FUNDING IN PLACE THIS FACILITY WILL BECOME OPERATIONAL IN 2020. MANY OF OUR SERVICE AREA COMMUNITIES ARE WITHIN HEALTH PROVIDER SHORTAGE AREAS (HPSA). THIS NEW FACILITY WILL CONTINUE TO DEVELOP SERVICES IN A HPSA REGION. 1377498 1759739 THE HOSPITAL CONTINUED EFFORTS WITH SUPPORTING OUR ROLE AS A NYS DEFINED SAFETY-NET PROVIDER. IN 2018 WE RECEIVED VITAL ACCESS PROVIDER (VAP) AWARDS TO STRENGTHEN OUR PATIENT DELIVERY SYSTEMS. SOME OF THESE INITIATIVES CONTINUE TO RELY ON RECRUITMENT OF PRIMARY CARE PROVIDERS TO OUR REGION. WE ARE ALSO A PARTNER IN THE LEATHERSTOCKING COLLABORATIVE HEALTH PARTNERS (LCHP), LLC WHOSE ACTIVITIES ARE ASSOCIATED WITH COORDINATING IMPROVEMENTS IN POPULATION HEALTH OUTCOMES OUTLINED IN THE NYS DEPARTMENT OF HEALTH "DELIVERY SYSTEM REFORM INCENTIVE PAYMENT" (DSRIP) PROGRAM. OUR ACTIVITIES FOR IMPROVING POPULATION HEALTH INCLUDED INCREASING WELLNESS VISITS IN OUR HEALTH CENTERS, EDUCATION PROTOCOLS USED FOR ASTHMATIC PATIENTS, AND INCREASING MENTAL HEALTH SCREENS. CARE NAVIGATION SERVICES WERE PROVIDED TO THE EMERGENCY DEPARTMENT SO PATIENTS COULD HAVE ACCESS TO A TRAINED FACILITATOR ENROLLER FOR MEDICAID OR NYS INSURANCE MARKET PLACE INSURANCE PRODUCT. A REGIONAL HUB FOR HERKIMER COUNTY WAS FORAMLIZED IN 2018 FOR COORDINATING AND COLLABORATING ON INITIATIVES FOR IMPROVING CONNECTIVITY WITH PATIENTS THUS ASSISTING THE HOSPITAL PREPARE FOR VALUE BASED PAYMENT SYSTEMS. 1377498 1759739 28975812 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 0 390 1 1 1 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 AUGUST LEINHART MD TRUSTEE 2.00 40.00 X 0 406391 31007 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 250009 21631 ROBERT CASULLO TRUSTEE 2.00 X 0 0 0 KATE READ LAVALLA TRUSTEE 2.00 X 0 0 0 LISA BETRUS THIRD VICE CHAIRMAN 2.00 X X 0 202736 16467 KATHLEEN SELLERS TRUSTEE 2.00 X 0 0 0 MICHAEL TENGERES TREASURER 1.00 40.00 X X 0 147864 6965 CHRISTINA CAIN TRUSTEE 2.00 X 0 0 0 MICHAEL OGDEN PRESIDENT & CEO 40.00 X 0 214000 15429 JAMES G VIELKIND CHIEF FINANCIAL OFFICER 40.00 X 167534 0 5375 RICHARD NOCELLA PRIMARY CARE PHYSICIAN 40.00 X 148640 0 25508 316174 1221000 122382 2 0 1 0 SUNBELT STAFFING LOCKBOX DEPT CH 14430 PALATINE IL 60055 TEMPORARY STAFFING AGENCY 516222 STATSTAFF PROFESSIONALS 18 DIVISION STREET SARATOGA NY 12866 STAFFING AGENCY 322433 DM CONSULTING PO BOX 4715 UTICA NY 13504 INFORMATION TECHNOLOGY 117832 3 533028 206597 739625 OUTPATIENT SERVICES 623000 22399605 22399605 INPATIENT HOSPITAL 621930 8790613 8790613 OTHER OPERATING REVENUE 900099 1161607 1161607 PROGRAM SERVICE LEASE 532000 442590 442590 HOSPITAL CAFETERIA 900099 145220 145220 32939635 206369 206369 2669463 2285455 384008 384008 384008 34269637 32939635 0 590377 172936 172936 12613013 10988220 1584438 40355 588745 510501 76369 1875 1466522 1261183 200707 4632 945140 812595 129561 2984 72707 72707 59912 59912 9720 9720 1377025 969216 407809 35639 35639 3550903 3503525 47378 1422169 1304337 117832 671249 589576 78955 2718 24343 12543 9207 2593 36122 17472 13700 4950 229084 159585 69499 2158840 1503900 654940 199211 182736 16475 PURCHASE SERVICES 6086024 4473286 1577738 35000 PROVISION FOR BAD DEBT 1660354 1660354 NEW YORK STATE ASSESSME 101720 101720 1242240 889424 336115 16701 34723618 28975812 5635998 111808 1869521 976567 1891040 1675789 185652 974357 3073557 2534018 548188 562367 827187 473592 44545939 29347111 16056752 15198828 3617203 3648642 1764166 1596915 1599244 1397951 360778 1325472 31793288 30364498 3320279 3286547 273552 215663 4167830 3533810 1689376 2221528 9451037 9257548 X 17427308 15193191 3900063 4973391 1014880 940368 22342251 21106950 31793288 30364498 X -453981 -872965 91645 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 9720 9720 0 PART II-B, LINE 1: AMOUNTS FOR GENERAL LOBBYING ACTIVITIES ARE $9,720 COMPRISED FROM THE HEALTHCARE ASSOCIAITON MEMBERSHIPS AS FOLLOWS: HEALTHCARE ASSOCIATION OF NEW YORK STATE 17.51% OF DUES PAID OF $13,164. AMERICAN HOSPITAL ASSOCIATION 22.73% OF DUES PAID OF $16,831. IROQUOIS HEALTHCARE ALLIANCE 39.3% OF DUES PAID OF $9,132 4914943 487332 512484 -1000 5913759 4609617 305326 4914943 4460686 148931 4609617 4590711 14514 -144539 4460686 4263576 137 326998 4590711 0 1 1 380386 380386 29646836 17673883 11972953 14518717 11673228 2845489 15198828 MARY LEARY CHARITABLE REMAINDER TR 69180 F ELSA O'BRIEN CHARITABLE REMAINER TR 1527735 F 1596915 ACCRUED PENSION LIABILITY 1868455 OTHER LIABILITIES 397972 DEBT ISSUNANCE COST -44899 2221528 X 32609283 0 32609283 1660354 1660354 34269637 33063264 0 33063264 1660354 1660354 34723618 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, 2018 AND 2017, 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 2015 THROUGH 2018. PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT 1,660,354. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT 1,660,354. PART VI, LINE 1E INCLUDED IN BUILDINGS AND EQUIPMENT IS $548,892 OF ASSETS NOT IN USE. THESE ASSETS ARE CURRENT PROJECTS TO IMPROVE NURSE CALL SYSTEM, CONSTRUCT A NEW FACILITY IN DOLGEVILLE, AND REPLACE LAB CHEMISTRY ANALYZER. THESE ASSETS WILL BE COMPLETED AND IN USE IN 2019 AND 2020 RESPECTIVELY. 1 1 1 X 300.000000000000 0 1 1 0 1 1 88 156294 56005 100289 0.00290 14241 6202786 4249789 1952997 0.05620 14329 6359080 4305794 2053286 0.05910 45677 675 45002 0.00130 22 29818 29818 0.00090 2518 593396 509382 84014 0.00240 2540 668891 510057 158834 0.00460 16869 7027971 4815851 2212120 0.06370 4944 4944 0.00010 64035 64035 0.00180 68979 68979 0.00190 1 1660354 81970 9742557 10059095 -316538 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 16 1 1 1 1 X WWW.BASSETT.ORG X WWW.BASSETT.ORG X 1 16 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 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). EXTENDED EVENING HOURS ARE PROVIDED TWO NIGHTS PER WEEK IN THE DOLGEVILLE, NY PRIMARY CARE CENTER. 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 2016 COMMUNITY HEALTH NEEDS ASSESSMENT. THE RESULT WAS 135 REPRESENTATIVES FROM VARIOUS CONSTITUENCIES WERE INCLUDED IN A SURVEY PROCESS TO IDENTIFY THEIR TOP TWO HEALTH PRIORITIES. THE PARTICIPANTS WERE SENIOR SERVICES, BEHAVIORAL SERVICES, LOCAL BUSINESSES, EARLY CHILDHOOD SERVICES, EDUCATION, EMPLOYMENT TRAINING, FAITH BASED ORGANIZATIONS, HEALTH CARE PROVIDERS, HOUSING SERVICES, IMMIGRANT AND REFUGEE SERVICES, DEVELOPMENTAL DISABILITIES, LAW ENFORCEMENT, MUNICIPAL GOVERNMENTS, SOCIAL SERVICES, AND STI/HIV PREVENTION. LITTLE FALLS HOSPITAL PART V, SECTION B, LINE 6A: THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS DEVELOPED AS PART OF A MULTI-HOSPITAL PLANNING PROCESS. THE HOSPITALS INCLUDED IN THIS PLANNING PROCESS ARE: BASSETT MEDICAL CENTER AND LITTLE FALLS HOSPITAL. 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: LITTLE FALLS HOSPITAL COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) WORKING WITH COMMUNITY STAKEHOLDERS WILL CONTINUE TO FOCUS ON PREVENTING CHRONIC DISEASE WITH AN EMPHASIS ON PREVENTATIVE CARE MANAGEMENT IN BOTH CLINICAL AND COMMUNITY SETTINGS. SPECIFIC FOCUS FOR INTERVENTIONS IS ON DIABETES AND HEART DISEASE CHRONIC CARE CONDITIONS. ADDITIONALLY, LITTLE FALLS HOSPITAL WILL ADDRESS REDUCING OBESITY IN ADULTS AND CHILDREN. LITTLE FALLS HOSPITAL WILL ALSO PARTNER WITH HERKIMER COUNTY PUBLIC HEALTH TO STRENGTHEN MENTAL HEALTH AND SUBSTANCE ABUSE PREVENTION SERVICES. CHRONIC CARE PREVENTION PLAN ENCOMPASSES INCREASING SCREENING RATES BY 5% FOR CARDIOVASCULAR DISEASE, DIABETES, BREAST, CERVICAL, AND COLORECTAL CANCERS, ESPECIALLY AMONG LOWER INCOME POPULATIONS. TO ACCOMPLISH THESE RESULTS, INCREASES OF AWARENESS FOR SCREENINGS IS A PRIORITY. COLLABORATION AMONG COMMUNITY BASED ORGANIZATIONS AND INCREASING THE NUMBER OF SCREENING PROGRAMS HAVE BEEN IDENTIFIED AS KEY COMPONENTS TO MEET THE TARGET PERFORMANCE INCREASE OF 5% RECEIVING SCREENING SERVICES. THESE EFFORTS INCLUDE 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. THE INCREASE IN FOCUS OF REDUCING CHILD AND ADULT OBESITY WAS ALSO IDENTIFIED AS A PRIORITY IN THE 2016 CHNA. THE TARGET OBJECTIVE IS A 5% INCREASE FOR CLINICAL PROVIDERS TO PERFORM WEIGHT ASSESSMENTS TO IDENTIFY PATIENTS AT RISK FOR OBESITY. PRIMARY CARE PROVIDERS WILL BE TRAINED ON APPROACHES FOR WEIGHT IMPROVEMENT PROGRAMS. 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 COORDIANTING 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. THIS PROGRAM IS DESIGNED FOR CARE TRANSITION TEAMS TO WORK ON ELEVEN PROJECTS FOR THE PURPOSE OF REDUCING UNNECCESSARY VISITS TO EMERGENCY DEPARTMENTS AND UNNECCESSARY INPATIENT ADMISSIONS. IN 2016, OUR INTIATIVES FOR THE CHNA AND DSRIP WERE AS FOLLOWS:1.)ORGANIZING THE DOLGEVILLE AND NEWPORT HEALTH CENTERS AS "PATIENT CENTERED MEDICAL HOMES" (PCMH). ACHIEVING PCMH WAS COMPLETED IN 2017 BASED ON AN APPLICATION PROCESS AND APPROVAL BY A NATIONAL COMMITTEE FOR QUALITY ASSURANCE (NCQA). DURING THIS APPLICATION PROCESS, FOCUS ON PATIENT CASE MANAGEMENT, CARE COORDINATION, TEAM-BASED CARE, AND IMPROVING USES OF THE ELECTRONIC HEALTH RECORD, ARE MAJOR PERFORMANCE IMPROVEMENTS FOR PATIENT CARE. IN 2016, OUR HEALTH CENTERS PERFORMED APPROXIMATELY 1,000 WELLNESS VISITS FOR PATIENTS IN ALL AGE CLASSIFICATIONS. 2.)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. IN 2016, THE ELECTRONIC HEALTH RECORD ASTHMA TREATMENT TEMPLATES ARE BEING TRACKED FOR COMPLIANCE WITH PROTOCOLS. 3.) INTRODUCED THE NYS MEDICAID ACCELERATED EXCHANGE (MAX) PROCESS TO USE PATIENT CENTERED PROCESSES TO REDUCE USE OF EMEGENCY 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. IN 2017 THE USE OF PHYTEL AUTOMATED TECHNOLOGY EXPANDED OUR 2016 BASELINE AWARENESS OF INTEGRATING HEALTH AWARENESS TOPICS WITH OUR PATIENTS. THIS AUTOMATED SYSTEM ALLOWS OUR CARE MANAGERS TO INTERACT WITH PATIENTS MORE EFFICIENTLY. PHYTEL ENABLES CLOSER RELATIONSHIPS WITH PROVIDERS AND PATIENTS TO SHARE IN TREATMENT PLANS. 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 RECRUIMENT PLANS IN COORDINATION WITH BASSETT MEDICAL CENTER, HERKIMER COUNTY PUBLIC HEALTH, AND LITTLE FALLS HOSPITAL.IN 2018 LITTLE FALLS HOSPITAL PLANNED FOR 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 2018, 72 PATIENTS WERE ENROLLED BY A LITTLE FALLS HOSPITAL EMPLOYED FACILITATOR INTO A NYS MARKETPLACE PLAN. 2 1 - DOLGEVILLE HEALTH CENTER 9 GIBSON STREET DOLGEVILLE NY 13329 CLINIC 2 - NEWPORT HEALTH CENTER BRIDGE STREET NEWPORT NY 13416 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 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. THESE CENTERS PROVIDE 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. IN 2017, 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. PART I, LN 7 COL(F): LITTLE FALLS HOSPITAL EXCLUDED $1,660,354 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 THE HERKIMER CHAMBER OF COMMERCE, HERKIMER COUNTY HEALTHNET, AMERICAN HEART ASSOCIAITON 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 2018, LITTLE FALLS HOSPITAL WAS A LICENSED PRACTICAL NURSES (LPN)PRECEPTOR TRANING 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 2018 THIS PROGRAM SUPPORTED THE CLINICAL DEVELOPMENT OF 10 LPN'S. PART III, LINE 3: AN ESTIMATE FOR POTENTIAL CHARITY CARE WAS BASED ON THE DENIED APPLICATIONS PROCESSED IN 2018 COMPARED WITH THOSE APPROVED APPLICATIONS. THIS AMOUNTED TO AN 13.6% DENIAL RATE FOR CHARITY CARE APPLICATIONS WHICH IF APPROVED WOULD HAVE INCREASED THE AMOUNT OF CHARITY CARE AT COSTED AMOUNTS BY $8,228. PART III, LINE 4: THE HOSPITAL FOOTNOTE DESCRIBING PATIENT ACCOUNTS RECEIVABLES IS IN THE ATTACHED AUDITED FINANCIAL STATEMENTS NOTE (1)(L) PAGES 9 - 14. PART III, LINE 8: IN 2018, OUR OPERATING DEFICIT, WITH THE MEDICARE PART A&B PROGRAMS, WAS $316,538. 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 $2.0M. 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 REQUIRMENTS 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: BASSETT RESEARCH INSTITUTE'S MOHAWK VALLEY POPULATION HEALTH IMPROVEMENT PROGRAM (MVPHIP), A GRANT FUNDED PROGRAM FROM NEW YORK STATE DEPARTMENT OF HEALTH, 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 2013-2018, THE HOSPITALS, LOCAL COUNTY HEALTH DEPARTMENT, AND STAKEHOLDERS CAN SELECT INTERVENTIONS WHICH TARGET THOSE IDENTIFIED NEEDS.THE HERKIMER COUNTY PUBLIC HEALTH TEAM IS DEDICATED TO THE PROTECTION AND PROMOTION OF RESIDENTS' HEALTH THROUGH THE PROVISION OF HIGH QUALITY, COMPREHENSIVE, INDIVIDUALIZED SERVICES, IN ALL PHASES OF THE LIFE CYCLE. OBJECTIVES SHALL INCLUDE SURPASSING COMMUNITY STANDARDS AND STRIVING TO MEET THE NEEDS AND EXPECTATIONS OF THE PEOPLE IN HERKIMER COUNTY. ALL AVAILABLE RESOURCES WILL BE UTILIZED TO INSURE THE MISSION STATEMENT IS CARRIED OUT. STAFF, PATIENT, AND FAMILY EDUCATION WILL BE PROVIDED WHILE OPEN AND CONTINUOUS QUALITY IMPROVEMENT WILL BE ENCOURAGED AND RECOGNIZED.MVPHIP COLLABORATED WITH THE LOCAL HEALTH DEPARTMENT AND 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 WHICH REPRESENT THE MEDICALLY UNDERSERVED, LOW-INCOME AND MINORITY POPULATIONS. THE KEY INFORMANTS WERE INVITED TO PARTICIPATE IN AN ONLINE SURVEY FROM JULY THROUGH SEPTEMBER 9, 2016.IN ADDITION TO THE KEY INFORMANT RESPONSES, THE ASSESSMENT INCLUDES QUANTITATIVE DATA SOURCES FROM OVER 300 DIFFERENT HEALTH INDICATORS COLLECTED AND PUBLISHED BY NEW YORK STATE, AS WELL AS, 175 HEALTH INDICATORS INCLUDED ON THE MVPHIP WEBSITE COMPILED BY HEALTHY COMMUNITIES INSTITUTE. THE MVPHIP WEBSITE BRINGS NON-BIASED DATA, LOCAL RESOURCES, AND REPORTING TOOLS TO ONE ACCESSIBLE, USER-FRIENDLY LOCATION. THE SITE INCLUDES A COMPREHENSIVE DASHBOARD OF COMMUNITY INDICATORS COVERING OVER 20 TOPICS IN THE AREAS OF HEALTH, SOCIAL DETERMINANTS OF HEALTH, AND QUALITY OF LIFE.STAKEHOLDERS HAD TWO OPPORTUNITIES TO IDENTIFY HEALTH PRIORITIES. FIRST IN COLLABORATION WITH LITTLE FALLS HOSPITAL AND THE HERKIMER COUNTY PUBLIC HEALTH, THE MVPHIP CONVENED A LOCAL STAKEHOLDER MEETING IN SEPTEMBER 2016 TO EXAMINE THE DATA AND TO SELECT THE TOP TWO PREVENTION AGENDA PRIORITIES FOR THE SERVICE REGION. DURING THE MEETING STAKEHOLDERS RANKED THE HEALTH CARE PRIORITIES FIRST BY THE NUMBER OF PEOPLE AFFECTED AND THEN BY THE AVAILABLE COMMUNITY RESOURCES TO IMPACT THESE IDENTIFIED NEEDS. SECOND, PRIOR TO THE STAKEHOLDER MEETING KEY INFORMANTS RANKED THEIR PRIORITIES IN THE SURVEY.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 FIVE FOCUS AREAS ARE TIED TO THE TOP TWO SELECTEDPRIORITIES:1. PROMOTING MENTAL, EMOTIONAL AND BEHAVIORAL HEALTH2. PREVENTING SUBSTANCE ABUSE3. REDUCING OBESITY IN ADULTS AND CHILDREN4. PREVENTING DIABETES AND RELATED RISK FACTORS5. PREVENTING HEART DISEASEIN 2012, THE NEW YORK STATE PUBLIC HEALTH AND HEALTH PLANNING COUNCIL'S PUBLIC HEALTH COMMITTEE SET UP AN AD HOC COMMITTEE TO DEVELOP A FIVE YEAR STATE HEALTH IMPROVEMENT PLAN. THE COMMITTEE ASSESSED THE CURRENT HEALTH STATUS OF NEW YORK STATE'S POPULATION, AND THE PROGRESS TO DATE ON PREVENTION AGENDA 2008-2012 GOALS. THE COMMITTEE DEVELOPED FIVE PRIORITY SPECIFIC ACTION PLANS TO BE USED AS THE BLUEPRINT BY LOCAL HEALTH DEPARTMENTS AND HOSPITALS TO IMPROVE THE HEALTH OF NEW YORKERS AND MARCH 15, 2015 AN ADDITIONAL ACTION PLAN WAS ADDED TO IMPROVE HEALTH AND REDUCE HEALTH DISPARITIES. THE SIX ACTION PLANS PRIORITIES ARE:1. IMPROVE HEALTH STATUS AND REDUCE HEALTH DISPARITIES2. PREVENT CHRONIC DISEASES3. PROMOTE A HEALTHY AND SAFE ENVIRONMENT4. PROMOTE HEALTHY WOMEN, INFANTS AND CHILDREN5. PROMOTE MENTAL HEALTH AND PREVENT SUBSTANCE ABUSE6. PREVENT HIV, SEXUALLY TRANSMITTED DISEASES, VACCINE-PREVENTABLE DISEASES AND HEALTHCARE-ASSOCIATED INFECTIONSEACH ACTION PLAN INCLUDES SPECIFIC FOCUS AREAS, GOALS AND INTERVENTIONS 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 HAS MULTIPLE INITIATIVES TO ACHIEVE THE "TRIPLE AIM." THE TRIPLE AIM FOCUSES ON THREE DIMENSIONS: IMPROVING PATIENT EXPERIENCE, IMPROVING POPULATION HEALTH AND REDUCING HEALTH CARE COSTS. EACH OF THESE INITIATIVES CONTRIBUTES TO THE PURSUIT OF THOSE DIMENSIONS.ACCOUNTABLE CARE ORGANIZATIONS:ACCOUNTABLE CARE ORGANIZATIONS (ACOS) ARE GROUPS OF DOCTORS, HOSPITALS, AND OTHER HEALTH CARE PROVIDERS, WORKING TOGETHER TO PROVIDE HIGHER-QUALITY COORDINATED CARE TO THEIR PATIENTS WHILE HELPING TO SLOW HEALTH CARE COST GROWTH. ACOS SHARE WITH MEDICARE SAVINGS GENERATED FROM LOWERING THE GROWTH IN HEALTH CARE COSTS WHEN THEY MEET STANDARDS FOR HIGH QUALITY CARE. BASSETT HEALTHCARE NETWORK'S BASSETT ACCOUNTABLE CARE PARTNERS, LLC WAS SELECTED AS ONE OF 89 NEW MEDICARE SHARED SAVING PROGRAMS BEGINNING JANUARY 1, 2015. LITTLE FALLS HOSPITAL IS A BASSETT ACCOUNTABLE CARE PARTNERS, LLC PARTICIPANT.DELIVERY SYSTEM REFORM INCENTIVE PAYMENT (DSRIP) PROGRAMSON APRIL 14, 2014 GOVERNOR CUOMO ANNOUNCED THAT CENTER OF MEDICAID AND MEDICARE SERVICES APPROVED NEW YORK'S WAIVER REQUEST TO REINVEST THE $8 BILLION GENERATED BY MEDICAID REDESIGN TEAM (MRT) REFORMS. DSRIP'S PURPOSE IS TO FUNDAMENTALLY RESTRUCTURE THE HEALTH CARE DELIVERY SYSTEM BY REINVESTING IN THE MEDICAID PROGRAM WITH THE PRIMARY GOAL OF REDUCING AVOIDABLE HOSPITAL USE BY 25% OVER 5 YEARS. EACH DSRIP PROJECT HAS SPECIFIC MILESTONES AND METRICS WITH AN INCENTIVE BASED PAYMENT MODEL THAT ALLOCATES PAYOUT UPON ACHIEVING PREDEFINED RESULTS IN SYSTEM TRANSFORMATION, CLINICAL MANAGEMENT AND POPULATION HEALTH. ADDITIONALLY, A NUMBER OF QUALITY GOALS MUST BE ACHIEVED INCLUDING ACCESS MEASURES, PREVENTIVE CARE AND CARE COORDINATION. THE DSRIP PROGRAM COVERS A FIVE-YEAR PERIOD BEGINNING APRIL 1, 2015 AND ENDING MARCH 31, 2020.LITTLE 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.POPULATION HEALTH IMPROVEMENT PROGRAMS:THE POPULATION HEALTH IMPROVEMENT PROGRAMS (PHIP) WILL PROMOTE THE TRIPLE AIM OF: BETTER CARE, BETTER POPULATION HEALTH AND LOWER HEALTH CARE COSTS BY CONVENING REGIONAL STAKEHOLDERS AND ESTABLISHING NEUTRAL FORUMS FOR IDENTIFYING, DISSEMINATING, AND IMPLEMENTING BEST PRACTICES AND STRATEGIES TO PROMOTE POPULATION HEALTH AND REDUCE HEALTH CARE DISPARITIES IN THEIR RESPECTIVE REGIONS. THE PHIP WILL HELP ACHIEVE IMPROVEMENTS IN POPULATION HEALTH THROUGH STAKEHOLDER COLLABORATION, DATA-DRIVEN PRIORITIZATION, AND REGIONAL STRATEGIES FOR ADDRESSING HEALTH DISPARITIES. 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. FOLLOWING A CAREFUL REVIEW OF LOCAL HEALTH DATA AND EXTENSIVE DISCUSSION, THE MOHAWK VALLEY PHIP BOARD AND STAKEHOLDERS HAVE IDENTIFIED TWO REGIONAL POPULATION HEALTH PRIORITIES OF BEHAVIORAL HEALTH AND OBESITY. WORKGROUPS WERE FORMED TO TACKLE THESE HEALTH PRIORITIES.NY STATE HEALTH INNOVATION PLAN AND STATE INNOVATION MODEL:STATE HEALTH INNOVATION PLAN (SHIP) DRIVES THE EVOLUTION OF HEALTH DELIVERY AND PAYMENT SYSTEMS. THE GOAL IS TO IDENTIFY AND STIMULATE PROMISING INNOVATIONS IN HEALTH CARE DELIVERY AND PAYMENT WHICH RESULT IN OPTIMAL HEALTH OUTCOMES FOR ALL NEW YORKERS.THIS INFORMATION IS FROM LITTLE FALLS HOSPITAL 2016 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 INFORMATION FOR CHARITY CARE. 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 CHARITY CARE 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 54,000 PEOPLE IN 10 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, 21 PERCENT UNDER THE AGE OF 18, AND 19.2 PERCENT AGED 65 AND OLDER. NEARLY 89 PERCENT OF THE POPULATION OVER 25 HAS GRADUATED FROM HIGH SCHOOL. PER CAPITA INCOME LEVELS ARE $16,141, LOWER THAN NEW YORK STATE'S AVERAGE OF $23,389 AND MEDIAN HOUSEHOLD INCOME OF $40,106 ARE ALSO BELOW THE STATE MEDIAN OF $55,980. IT'S ESTIMATED THAT 16 PERCENT OF THE POPULATION IS BELOW THE FEDERAL POVERTY LEVEL. HEALTH CARE DELIVERY IS NEGATIVELY AFFECTED BY THE LACK OF PRIMARY CARE PROVIDERS. THERE IS CURRENTLY 41 PRIMARY CARE PROVIDERS PER 100,000 POPULATION IN HERKIMER COUNTY COMPARED WITH NYS AVERAGE OF 83 PROVIDERS PER 100,000 POPULATION. THIS SHORTAGE CONTRIBUTES TO LOWER HEALTH CARE STATUS INDICATORS OF INCREASES IN RESPIRATORY DISEASE, HIGHER CANCER RATES AND MORE PREVALANCE OF ARTHRITIS. THE HIGHER USE OF TOBACCO AND ALCOHOL ALSO ARE ATTRIBUTES FOR THESE HEALTH INDICATORS. 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. FOR 2016 -2018, LITTLE FALLS HOSPITAL WAS THE LEAD AGENCY IN DEVELOPING CARE INTERVENTIONS FOR REDUCING THE USE OF EMERGENCY DEPARTMENT. THE PROGRAM TITLED MEDICAID ACCELERATED EXCHANGE IS TO DEVELOP INNOVATIVE CARE INTERVENTIONS TO PROVIDE SUPPORT TO PATIENTS HIGH DEPENDENCY UPON EMERGENCY DEPARTMENT SERVICES FOR CARE MORE APPROPRIATE IN A PRIMARY CARE SETTING. THIS PROGRAM IS COORDINATED WITH CARE MANAGERS ACROSS FIVE PRIMARY CENTERS LOCATIONS IN OUR SERVICE AREA. THE LEATHERSTOCKING COLLABORATIVE HEALTH PARTNERS AND DEPARTMENT OF HEALTH SUPPORT THIS INITIATIVE BY PROVIDING BEST PRACTICE USE OF NEW CARE MODELS USED IN PATIENT CENTERED MEDICAL HOMES. IN 2018, A LARGER COMMUNITY HUB LED BY LITTLE FALLS HOSPITAL INLCUDED ADDITIONAL COMMUNITY AGENCIES TO COORDIANTE RESOURCES FOR ASSISTING PATIENTS WITH IMPROVING ACCESS TO HEALTH CARE. WITH THESE COMMUNITY AGENCIES ENAGAGED A HIGHER DEGREE OF PATIENT INTERACTION IS POSSIBLE TO ACHIEVE POSTIVE IMPACTS ON IMPROVING THEIR HEALTH CARE. 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 THE SIX AFFILIATED HOSPITALS AND GREATEST PATIENT POPULATIONS ARE LOCATED. OTSEGO COUNTY - POPULATION 61,709; DELAWARE COUNTY - POPULATION 47,276; HERKIMER COUNTY - POPULATION 64,508; SCHOHARIE COUNTY - POPULATION 32,099 (ACCORDING TO THE 2012 U.S. CENSUS ESTIMATES). THE MARY IMOGENE BASSETT HOSPITAL, AN ACUTE CARE INPATIENT TEACHING FACILITY IN COOPERSTOWN, OTSEGO COUNTY, O'CONNOR HOSPITAL, A CRITICAL ACCESS HOSPITAL IN DELHI, DELAWARE COUNTY, COBLESKILL REGIONAL HOSPITAL, AN ACUTE CARE FACILITY IN COBLESKILL, SCHOHARIE COUNTY, LITTLE FALLS HOSPITAL, A CRITICAL ACCESS HOSPITAL IN LITTLE FALLS, HERKIMER COUNTY, TRI TOWN REGIONAL HOSPITAL A 24/7 EMERGENCY CARE FACILITY IN SIDNEY, DELAWARE COUNTY, AUREILA OSBORN FOX MEMORIAL HOSPITAL, AN ACUTE CARE FACILITY IN ONEONTA, OTSEGO COUNTY, THE BASSETT CLINIC, AN OUTPATIENT PRIMARY AND SPECIALTY CARE CENTER IN COOPERSTOWN, A REGIONAL NETWORK OF OVER TWO DOZEN COMMUNITY BASED HEALTH CENTERS, 20 SCHOOL BASED HEALTH CENTERS, TWO AMBULATORY SURGERY CENTERS, VALLEY HEALTH SERVICES A RESIDENTIAL HEALTH CARE AND REHABILITATION FACILITY, 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 FOURTEEN YEARS AND CONTINUES TO PROVIDE RESIDENTS ACCESS TO A HIGH QUALITY CARE 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 AUGUST LEINHART MD TRUSTEE 0 401155 0 5236 0 0 0 25114 0 5893 0 437398 0 0 AMY GRACE MD PRESIDENT OF MEDICAL STAFF 0 223417 0 26592 0 0 0 14432 0 7199 0 271640 0 0 LISA BETRUS THIRD VICE CHAIRMAN 0 202736 0 0 0 0 0 0 0 0 0 202736 0 0 MICHAEL TENGERES TREASURER 0 147864 0 0 0 0 0 6245 0 720 0 154829 0 0 MICHAEL OGDEN PRESIDENT & CEO 0 204000 0 10000 0 0 0 13269 0 2160 0 229429 0 0 JAMES G VIELKIND CHIEF FINANCIAL OFFICER 157534 0 10000 0 0 0 5375 0 0 0 172909 0 0 0 RICHARD NOCELLA PRIMARY CARE PHYSICIAN 148640 0 0 0 0 0 25508 0 0 0 174148 0 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 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 -505,626. CHANGE IN VALUE OF BENEFICIAL INTEREST IN CHARITABLE REMAINDER TRUST 597,271. PENSION RELATED CHANGES OTHER THAN NET PERIODIC BENEFIT COST CHANGE IN VALUE OF BENEFICIAL INTEREST IN CHARITABLE REMAINDER TRUST 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 9 BASSETT HEALTHCARE NETWORK 0 BASSETT REGIONAL CORPORATION ONE ATWELL ROAD COOPERSTOWN NY 13326 133522783 PROVIDES EXCELLENCE IN THE COORDINATION PLANNING AND POLICY DIRECTION FOR NY 501 (C) 3 11(B) 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 0 0 1 0 0 0 0 0 0 1 0 1 1 0 1 0 1 0 0