2019-08-15T12:22:49-05:00 2018-09-30 161226221 FUST CHARLES CHAMBERS LLP 5784 WIDEWATERS PARKWAY SYRACUSE NY 13214 990 2017-10-01 141364513 ELIZABETHTOWN COMMUNITY HOSPITAL ELIZ 5188736377 75 PARK STREET PO BOX 277 ELIZABETHTOWN NY 12932 ALAN R CHARDAVOYNE CHIEF FINANCIAL OFFICER 5188736377 2019-08-14 1 DEBORAH STUCK P01281391 3154463600 2019-08-14 24.39.85.114 2019-08-14 11:15:16 ED P FD62137317EE26C9F26E40FD83CAC65FE1294EC8 843BD1CBF118E88B8E0E68794B0017FE904C4146 2017 2019-02-21 02:37:17Z JOHN REMILLARD 75 PARK STREET PO BOX 277 ELIZABETHTOWN NY 12932 43388074 0 X ECH.ORG X 1926 NY MISSION: TO PROMOTE WELLNESS IN THE COMMUNITIES WE SERVE BY PROVIDING QUALITY HEALTHCARE WITH SKILL, COMPASSION AND DIGNITY. 13 13 396 20 138095 137095 276841 4560918 29041789 34419456 90954 84267 2629388 4080255 32038972 43144896 0 0 0 0 17532168 19601663 0 0 3012 11919732 16563817 29451900 36165480 2587072 6979416 40866283 59335476 17755070 28949321 23111213 30386155 X THE MISSION OF ECH IS TO PROMOTE HEALTH AND WELLNESS IN THE COMMUNITY AND TO PROVIDE QUALITY HEALTHCARE WITH SKILL, COMPASSION AND DIGNITY. IN CREATING OUR COMMUNITY BENEFITS PLAN WE KEEP THIS MISSION IN MIND, CONTINUALLY LOOKING FOR WAYS TO MEET COMMUNITY HEALTH NEEDS AND TO BE A GOOD NEIGHBOR. ECH IS DRIVEN BY PEOPLE WHO LIVE IN THE SERVICE AREA AND WHO WANT TO SEE THEIR FRIENDS AND NEIGHBORS GET THE CARE AND SERVICES THEY NEED. 1 0 8099464 8188668 INPATIENT ACUTE UNIT AND SUBACUTE REHABILITATIVE (SWING BED) INPATIENT PROGRAM:A 25-BED NURSING UNIT PROVIDING ACUTE AND SUB ACUTE (SWING BED)CARE. THE SMALLER ATMOSPHERE CREATES A CLOSER BOND BETWEEN THE PATIENT AND PROFESSIONALS ENCOURAGING OPTIMAL HEALING AND COMPASSIONATE CARE. THE SUB-ACUTE PROGRAM IS VITAL TO AREA RESIDENTS BECAUSE FOLLOWING A HIP-REPLACEMENT, KNEE-SURGERY OR CARDIAC OPERATION, RECUPERATION AND THERAPY CAN BE DONE AT ELIZABETHTOWN COMMUNITY HOSPITAL, SAVING THE FAMILY THE TIME AND EXPENSE OF TRAVEL. THE PROGRAM PROVIDES ONE-ON-ONE THERAPEUTIC CARE. 11208683 7948128 CLINIC SERVICES:ECH OPERATES THE ELIZABETHTOWN COMMUNITY HEALTH CENTER, WESTPORT HEALTH CENTER LOCATED IN WESTPORT,NY, THE HIGH PEAKS HEALTH CENTER LOCATED IN WILMINGTON, NY, THE SMITH HOUSE HEALTH CENTER LOCATED IN WILLSBORO, NY, THE AU SABLE FORKS HEALTH CENTER, LOCATED IN AU SABLE FORKS, NY, AND CROWN POINT HEALTH CENTER, LOCATED IN CROWN POINT, NY. ECH OPERATES AN OUTPATIENT CHEMOTHERAPY PROGRAM, WHICH INCLUDES UPDATED INFUSION EQUIPMENT MAKING IT POSSIBLE TO PROVIDE SAFE AND EFFICIENT METHODS FOR CHEMOTHERAPY AND BLOOD-RELATED INFUSIONS. IN ADDITION, THE NEW SPECIALIZED VENTILATING HOOD ENABLES THE PREPARATION OF CHEMOTHERAPY SOLUTIONS ON-SITE. THIS IS A GREAT CONVENIENCE FOR CANCER PATIENTS, SAVING THEM THE 90-MINUTE ROUND-TRIP DRIVE TO THE CLOSEST CHEMOTHERAPY FACILITY. 9933421 8827362 EMERGENCY ROOM SERVICES:ECH'S PRIOR YEARS EXPANSION OF THE EMERGENCY ROOM ADDED NEW STATE OF THE ART TRAUMA ROOMS, A TELEMENTRY SYSTEM FOR PATENT MONITORING, A REGISTRATION AREA DESIGNED FOR PATIENT PRIVACY AND CONFIDENTIALITY AND NEW WAITING AREAS FOR FAMILIES AND THEIR LOVED ONES.THE HOSPITAL OPERATES AN ALL-DIGITAL RADIOLOGY DEPARTMENT, ALLOWING TECHNOLOGISTS TO OBTAIN PATIENT IMAGES ANYWHERE IN THE HOSPITAL. IN THE EVENT OF A SIGNIFICANT EMERGENCY WITH MULTIPLE TRAUMAS, THE UNIT CAN BE USED ANYWHERE IN THE BUILDING. WHEN THE HOSPITAL IS FACED WITH AN UNUSUAL SURGE IN EMERGENCY ROOM TRAUMA CASES, HOSPITAL PROCEDURES ENABLE STAFF TO TRIAGE IN NONTRADITIONAL AREAS OF THE HOSPITAL. IN APRIL 2018, ECH TOOK OVER MOSE-LUDINGTON HOSPITAL AND STATED OPERATING AS THE ELIZABETHTOWN COMMUNITY HOSPITAL TICONDEROGA CAMPUS. 1492220 13387426 1492220 13387426 30733788 1 1 0 0 0 0 0 0 0 1 1 1 0 0 1 1 1 1 0 0 0 0 0 0 1 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 35 0 1 396 1 1 1 0 0 0 0 0 0 0 0 0 X 13 13 0 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X ALAN CHARDAVOYNE CFO ECH 5188733136 75 PARK STREET PO BOX 277 ELIZABETHTOWN NY 12932 JIM FORCIER BOARD MEMBER 0.80 X 0 0 0 DOMINIC EISINGER PHD CHAIR 0.80 X X 0 0 0 MEGAN MURPHY BOARD MEMBER 0.80 X 0 0 0 MARTIN NEPHEW BOARD TREASURER 0.80 X X 0 0 0 SUSAN ALLOTT RN BOARD MEMBER 0.80 X 0 0 0 ROBERT A PERKINS VICE CHAIR 0.80 X X 0 0 0 H NICOLAS MULLER III PHD BOARD SECRETARY 0.80 X X 0 0 0 GAYLE ALEXANDER BOARD MEMBER 0.80 X 0 0 0 STEVE CACCHIO BOARD MEMBER 0.80 X 0 0 0 MARGARET EMERY-GINN BOARD MEMBER 0.80 X 0 0 0 ROLAND J ALLEN BOARD MEMBER 0.80 X 0 0 0 MICHAEL G DISKIN BOARD MEMBER 0.80 X 0 0 0 DAVID SHELMIDINE BOARD MEMBER 0.80 X 0 0 0 ALAN CHARDAVOYNE CFO 40.00 X 244838 0 12948 NOLAN MATTHEW COO 40.00 X 201347 0 10271 JULIE TROMBLEE CNO 40.00 X 187778 0 9711 JOHN REMILLARD PRESIDENT 40.00 X 409512 0 13872 DARRIN GOODROW CIO 40.00 X 193367 0 9919 ROB DEMURO MD PHYSICIAN 40.00 X 387053 0 41995 PASQUALINO CAPUTO PHISICIAN 40.00 X 294557 0 42039 PATRICK JOHNSTON PHYSICIANS ASSISTANT 40.00 X 307205 0 14010 MARY HALLORAN PHYSICIAN 40.00 X 314403 0 42108 VANESSA DESMARAIS PHYSICIAN 40.00 X 201394 0 37585 2741454 0 234458 32 0 1 0 0 8617 1679113 2873188 4560918 CRITICAL ACCESS HOSPITAL 900099 34419456 34419456 34419456 102823 102823 363121 214994 148127 148127 138095 10032 12222 6334 -12222 -6334 -18556 -18556 7858 8617 9628 -1770 -1770 1770 0 1770 1770 340B REVENUE 900099 1860676 1860676 VITAL ACCESS PROVIDER PROGRAM 900099 1485013 1485013 MEANINGFUL USE INCOME 900099 336089 336089 250350 250350 3932128 43144896 38351584 138095 94299 1293562 1293562 13897773 12235870 1661903 754040 681673 72367 2381311 1868057 513254 1274977 1053223 221754 72142 72142 56878 56878 48726 48726 49619 49619 508870 405372 100486 3012 203863 132482 71381 99644 78104 21540 462827 356689 106138 2740440 2314842 425598 195878 195878 CONTRACTED, LINEN & PUR 5473506 4834005 639501 DRUGS SUPPLIES, GASES & 2017096 2017096 MAINTENANCE AND UTILITI 1745916 1683139 62777 BAD DEBT EXPENSE 1558756 1558756 1329656 1212105 117551 36165480 30733788 5428680 3012 7443595 4096435 3647623 8958453 303673 1947872 4027220 5872846 354229 547278 804513 743894 45419601 11715638 21628532 33703963 2584688 3392525 72210 72210 40866283 59335476 3424227 4990931 530425 251270 4870000 4635000 4887943 11743771 4042475 7328349 17755070 28949321 X 22312555 28754547 783918 1287802 14740 343806 23111213 30386155 40866283 59335476 X 6979416 87973 207553 X X 0 1 X 1 0 X 798658 3288805 41288 2497143 1631608 812126 276416 17163 307047 798658 777996 1219217 1764 1186851 812126 742509 307055 2 271570 777996 729071 307873 11 294446 742509 0.21070 0.78930 0 0 1209387 1209387 30748138 6238529 24509609 10629249 5346450 5282799 2832827 130659 2702168 33703963 MUTUAL FUNDS 3392525 F 3392525 DUE TO AFFILIATES 210175 INTEREST RATE SWAP LIABILITY 187086 WC/MALPRACTICE LIABILITY 72210 THIRD PARTY PAYOR SETTLEMENTS 6487109 SERP LIABILITY 48871 L/T AP - TICONDEROGA 322898 7328349 X 43320792 224622 224622 43096170 48726 48726 43144896 36341376 224622 224622 36116754 48726 48726 36165480 PART V, LINE 4: THE ENDOWMENT FUNDS (ASSETS WHOSE USE IS LIMITED) ARE TO BE USED FOR HOSPITAL EXPANSION AND RENOVATION AND PURCHASING HOSPITAL EQUIPMENT. PART X, LINE 2: THE HOSPITAL IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS GENERALLY EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. AS OF SEPTEMBER 30, 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 STATE TAXING AUTHORITIES ARE 2015 THROUGH 2018. PART XI, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 214,994. FUNDRAISING EXPENSES 9,628. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 214,994. FUNDRAISING EXPENSEE 9,628. GOLF TOURNAMENT 16475 8617 7858 1042 900 7450 236 16475 8617 7858 1042 900 7450 236 9628 -1770 1 1 1 X 1 X 1 1 1 0 1 1 276182 276182 0.00800 5590665 2406445 3184220 0.09200 138687 138687 0.00400 6005534 2406445 3599089 0.10400 18531077 15906567 2624510 0.07580 18531077 15906567 2624510 0.07580 24536611 18313012 6223599 0.17980 1 1558756 137495 15907320 15814335 92985 X 1 1 1 1 ELIZABETHTOWN COMMUNITY HOSPITAL 75 PARK STREET PO BOX 277 ELIZABETHTOWN NY 12932 X X X 25 BEDS (ACUTE & SWING), 5 HEALTHCENTERS, CT, LAB, PHARM. PT. AMB SURG. ELIZABETHTOWN COMMUNITY HOSPITAL 1 0 0 1 X X X X X X X X 16 1 1 1 1 X WWW.ECH.ORG/DATA/FILES/CHA-CHIP-CSP-2016-ESSEXCOUNTYHEALTHPARTNERS.PDF X WWW.CO.ESSEX.NY.US., HTTPS://AHIHEALTH.ORG/ARHN X X 1 16 1 WWW.ECH.ORG/DATA/FILES/ESSEX_COMBINED_CHIP_CSP_PROGRESS_REPORT%202017.PDF 0 1 X 200.000000000000 350.000000000000 X 1 1 X X X X 1 X WWW.ECH.ORG/DATA/FILES/2018_FINANCIAL_ASSISTANCE_APPLICATION_ECH.PDF X WWW.ECH.ORG/DATA/FILES/2018_FINANCIAL_ASSISTANCE_APPLICATION_ECH.PDF X WWW.ECH.ORG/DATA/FILES/2018_FINANCIAL_ASSISTANCE_APPLICATION_ECH.PDF X X X X 1 0 X X X X 1 X 0 1 ELIZABETHTOWN COMMUNITY HOSPITAL PART V, SECTION B, LINE 5: EXECUTIVES FROM THE FOLLOWING INSTITUTIONS: ADIRONDACK HEALTH, INTER-LAKES HEALTH, MOSES-LUDINGTON HOSPITAL, ADIRONDACK RURAL HEALTH NETWORK AND ESSEX COUNTY PUBLIC HEALTH. ELIZABETHTOWN COMMUNITY HOSPITAL PART V, SECTION B, LINE 6B: COUNTY HEALTH DEPARTMENT ELIZABETHTOWN COMMUNITY HOSPITAL PART V, SECTION B, LINE 7D: ESSEX COUNTY PUBLIC HEALTH ELIZABETHTOWN COMMUNITY HOSPITAL PART V, SECTION B, LINE 11: COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION STRATEGY:COMMUNITY SERVED - ELIZABETHTOWN COMMUNITY HOSPITAL'S PRIMARY SERVICE AREA IS COMPOSED OF TWENTY-TWO ZIP CODES IN NORTHEASTERN ESSEX COUNTY. THE HOSPITAL IS LOCATED 45-60 MINUTES AWAY FROM ANY OTHER HOSPITAL, THROUGH A MOUNTAINOUS REGION AND MOSTLY ALONG A SERIES OF SECONDARY ROADS. THE REGION BOASTS A ROBUST SEASONAL POPULATION, SWELLING SIGNIFICANTLY THROUGHOUT THE SUMMER AND WINTER MONTHS, DUE TO THE CONSIDERABLE NUMBER OF SECOND HOMEOWNERS IN THE REGION, ALONG WITH INCREASED TOURISM.DEMOGRAPHICS OF ESSEX COUNTY: - APPROXIMATELY 40,000 RESIDENTS- NEARLY 20% ARE 65 YEARS OF AGE OR OLDER- OVER 90.0% OF THE POPULATION IS WHITE, NON-HISPANIC, COMPARED TO BLACK/AFRICAN AMERICAN, NON-HISPANICS AT 2.8% AND HISPANIC/LATINOS AT 2.8%- 84% ADULTS HAVE HEALTH INSURANCESIGNIFICANT HEALTH NEEDS IDENTIFIED IN 2016 CHNA:- CHRONIC DISEASE- OBESITY- ACCESS TO HEALTHY FOOD- ACCESS TO CARE- SUBSTANCE ABUSE- BEHAVIORAL HEALTHNEEDS SELECTED FOR 2016 IMPLEMENTATION STRATEGY:- ACCESS TO CARE- OBESITY- CHRONIC DISEASE- ACCESS TO HEALTHY FOODNEEDS NOT SELECTED - RATIONALE: - SUBSTANCE ABUSE & BEHAVIORAL HEALTH ARE A RECOGNIZED NEED BUT RESOURCES ARE VERY LIMITED IN THIS RURAL AREA. ECH IS WORKING WITH MENTAL HEALTH TO RESOLVE THESE SHORTAGE OF TREATMENT ISSUES. THIS IS EXPECTED TO BE ADDRESSED WITH THE NEXT CHNA AND IMPLEMENTATION PLAN. HIGHLIGHTS FROM 2016 IMPLEMENTATION STRATEGY:- ACCESS TO CARE - NEW PRIMARY CARE CLINIC IN CROWN POINT - ADDITIONAL PROVIDER OPENED 6/6/2017. - ADDED ADDITIONAL PROVIDER IN DECEMBER 2017 - 748 NEW PATIENTS ESTABLISHED WITH ADDITION OF CROWN POINT HEALTH CENTER-SCREENING OF BODY MASS INDEX OF ALL PRIMARY CARE CLINIC PATIENTS AND EDUCATION PROVIDED FOR A BMI OVER 25. - 50% OF PATIENTS SEEN WITH BMI>25 HAD A DOCUMENTED PLAN WITH REFERRALS AS INDICATED. - EMBEDDED RN CARE MANAGER IN CONJUNCTION WITH MEDICAL HOME IN MARCH 2018- HEALTHY LIVING WORKSHOPS FOR CHRONIC DISEASE SELF-MANAGEMENT - FOUR HELD (2-2016, 2-2017) AT ECH-ACCESS TO HEALTHY FOOD - WORKING ON WELLNESS RX IMPLEMENTATION PLANNING - WORKING ON FOOD PANTRY AT PRIMARY CARE HEALTH CENTERESTIMATED COMPLETION DATE FOR NEXT CHNA AND IMPLEMENTATION STRATEGY: - CHNA: DECEMBER 2019 - IMPLEMENTATION STRATEGY: JANUARY 2020METHODS PLANNED FOR QUALITATIVE RESEARCH FOR NEXT CHNA: - TO BE DONE AS JOINT DOCUMENT WITH ESSEX COUNTY PUBLIC HEALTH DEPARTMENT BASED ON RESULTS OF COMMUNITY STAKEHOLDER SURVEYMETHODS PLANNED FOR QUANTITATIVE RESEARCH FOR NEXT CHNA: - ADIRONDACK RURAL HEATH NETWORK (AHRN) TO ASSIST WITH DATA COLLECTION AND INTERPRETATION AS WELL AS COMMUNITY STAKEHOLDER SURVEY ELIZABETHTOWN COMMUNITY HOSPITAL PART V, SECTION B, LINE 24: THE ORGANIZATION USES A GLOBAL FEE SCHEDULE. IF THE PATIENT APPLIED AND WAS DEEMED ELIGIBLE, THE APPROPRIATE DISCOUNTS WERE GRANTED. 7 1 - ELIZABETHTOWN COMMUNITY HEALTH CENTER 66 PARK STREET ELIZABETHTOWN NY 12932 PRIMARY CARE HEALTH CENTER 2 - HIGH PEAKS HEALTH CENTER 7 COMMUNITY CIRCLE WILMINGTON NY 12997 PRIMARY CARE HEALTH CENTER 3 - SMITH HOUSE HEALTH CENTER 39 FARRELL ROAD WILLSBORO NY 12996 PRIMARY CARE HEALTH CENTER 4 - WESTPORT HEALTH CENTER 6097 NYS ROUTE 9N WESTPORT NY 12993 PRIMARY CARE HEALTH CENTER 5 - AU SABLE FORKS HEALTH CENTER 15 PLEASANT STREET AU SABLE FORKS NY 12912 PRIMARY CARE HEALTH CENTER 6 - CROWN POINT HEALTH CENTER 17 MILLER ROAD CROWN POINT NY 12928 PRIMARY CARE HEALTH CENTER 7 - TICONDEROGA CAMPUS 1019 WICKER STREET TICONDEROGA NY 12883 PRIMARY CARE HEALTH CENTER PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 1,558,756. PART II, COMMUNITY BUILDING ACTIVITIES: THE HOSPITAL STAFF PARTICIPATES IN MANY LOCAL EVENTS THAT PROVIDE COMMUNITY MEMBERS THE OPPORTUNITY TO LEARN ABOUT THE HOSPITAL AND ABOUT IMPORTANT HEALTH SCREENINGS. IN ADDITION, THE HOSPITAL HOSTS EVENTS AND OFFERS TRAINING AND SUPPORT SERVICES TO OTHER HEALTH-ORIENTED ORGANIZATIONS. ECH PARTICIPATES IN THE FOLLOWING:(1)PROVIDES ADVANCED LIFE SUPPORT TRAINING FOR REGIONAL EMERGENCY MEDICAL TECHNICIANS. (2)PROVIDES MEDICAL DIRECTORSHIP TO SEVERAL LOCAL EMS AGENCIES, PROVIDES MONTHLY COURSES AND EDUCATION FOR CME CREDITS. (3)PROVIDES MEDICAL DIRECTORSHIP TO ST. JOSEPH'S ADDICTION TREATMENT & RECOVERY CENTER (4)OFFERS FREE DIABETES HEALTH SCREENINGS AT COMMUNITY HEALTH EVENTS. (5)LENDS SPACE TO THE NORTH COUNTRY REGIONAL BLOOD DONOR CENTER FOR BLOOD DRIVES. (6)MEETING SPACE IS DONATED ON A MONTHLY BASIS TO EMS SQUADS. TECHNOLOGICAL CAPABILITIES ALLOW FOR DISTANCE TRAINING / EDUCATION. (7)WORKS WITH THE CANCER SCREENING PROGRAM TO PROVIDE INFORMATION ABOUT MAMMOGRAMS AND BONE DENSITY SCREENING AT THE ANNUAL BREAST CANCER AWARENESS EVENT. (8)HOSTS THE ESSEX COUNTY DIABETES SUPPORT GROUP MEETINGS IN THE HOSPITAL BOARDROOM. (9)EMPLOYEES FROM THROUGHOUT THE HOSPITAL USE HOSPITAL PAID TIME TO LEND THEIR EXPERTISE AND INCREASE THEIR INTERESTS IN SUCH AREAS AS THE ESSEX CO. HEALTHY LIVING PARTNERSHIP, BEHAVIOR HEALTH SERVICES NORTH, RETIRED SENIOR VOLUNTEER PROGRAM, TASK FORCE AGAINST DOMESTIC VIOLENCE, KIWANIS AND NORTH COUNTRY LIFE FLIGHT. (10)ECH'S CLINICAL STAFF COMPLETES ADDITIONAL TRAINING EACH YEAR (ACLS, PALS, BLS, VARIOUS RN / NURSING TRAINING PROGRAMS, CHEMOTHERAPY EDUCATION, PHYSICIAN EDUCATION, INFECTION CONTROL TRAINING, RADIOLOGY DEPARTMENT CONTINUING EDUCATION, LAB STAFF EDUCATION, ETC.) (11) MEETING SPACE FOR AA AND NA. (12)ON SEPTEMBER 20, 2018, FOR NATIONAL FALL PREVENTION DAY, ECH HELD A FALL AWARENESS FAIR FOR THE PUBLIC. THERE WAS A TOTAL OF 10 PARTICIPANTS. (13)THE COMMUNITY HEALTH FAIR HELD ON APRIL 7, 2018 ALLOWED FOR COMMUNITY MEMBERS TO LEARN ABOUT AVAILABLE RESOURCES PERTAINING TO HEALTH AND WELLNESS. ELIZABETHTOWN COMMUNITY HOSPITAL WAS ABLE TO EDUCATE 42 PARTICIPANTS ABOUT THE SERVICES OFFERED AT THE HOSPITAL AND SIX PRIMARY CARE SITES. CLINICAL STAFF WAS ON SITE CONDUCTING BLOOD PRESSURE SCREENS, ISS TEAM MEMBERS WERE AVAILABLE FOR PEOPLE WANTING TO ENROLL IN THE PATIENT PORTAL. HEALTHY REFRESHMENTS WERE PROVIDED AND NUTRITION EDUCATION WAS AVAILABLE WITH A DIABETIC EDUCATOR. EACH YEAR, THE HOSPITAL ALSO HOSTS EVENTS THAT OFFER FREE HEALTH SCREENINGS TO LOCAL RESIDENTS. THE COMMUNITY HEALTH SCREENINGS ARE COORDINATED BY PUBLIC RELATIONS STAFF BUT ARE DEPENDENT UPON CLINICAL STAFF TO PERFORM EXAMS AND INTERPRET THE RESULTS. EACH EVENT IS STAFFED BY 5-8 CLINICAL STAFF MEMBERS FOR APPROXIMATELY 3-4 HOURS PER EVENT. (1)HUNTERS' HEALTH SCREENING (SEPTEMBER) IS A FREE, ANNUAL EVENT SPONSORED BY THE HOSPITAL. PARTICIPANTS RECEIVE A BASIC PHYSICAL / HEALTH SCREENING (EKG, BLOOD WORK, BLOOD PRESSURE, LAB TESTING, PHYSICIAN REVIEW AND REPORTING) AT NO COST. EVENT IS ARRANGED, COORDINATED AND PROMOTED BY ECH PUBLIC RELATIONS STAFF. IN 2018, THERE WERE APPROXIMATELY 20 PARTICIPANTS. (2)IN OCTOBER THE HOSPITAL HOSTS AN EVENT CO-SPONSORED BY THE CANCER SERVICES SCREENING PROGRAM OF ESSEX AND FRANKLIN COUNTIES AND THE HOSPITAL'S AUXILIARY. THE EVENING FEATURES A SPEAKER, ALONG WITH THE OPPORTUNITY TO TAKE PART IN A FREE HEALTH SCREENING. WOMEN WHO QUALIFIED (UN- OR UNDER-INSURED) WERE ABLE TO RECEIVE A CLINICAL BREAST EXAM AND MAMMOGRAM AT NO COST TO THEM, THROUGH THE CANCER SERVICES SCREENING PROGRAM OF ESSEX AND FRANKLIN COUNTIES. IN 2018, 4 FREE MAMMOGRAMS AND 4 OSTEOPOROSIS SCREENING EXAMS WERE CONDUCTED AS PART OF THESE HEALTH FAIRS. PART III, LINE 4: THE BAD DEBT INCLUDED ON LINE 2 IS DETERMINED AT COST. FINANCIAL STATEMENT FOOTNOTE FOR BAD DEBT EXPENSE:PATIENT ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTIBILITY OF PATIENT ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES PAST PAYMENT HISTORY AND IDENTIFIES TRENDS FOR EACH MAJOR PAYOR SOURCE OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. FOR RECEIVABLES ASSOCIATED WITH PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS AND FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS, THE HOSPITAL ALSO ANALYZES AMOUNTS DUE AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE BASED ON PAST EXPERIENCE, INCLUDING CONSIDERATION OF CURRENT BUSINESS AND ECONOMIC CONDITIONS. WHEN THE HOSPITAL ESTABLISHES THE ALLOWANCE FOR DOUBTFUL ACCOUNTS THE HOSPITAL TAKES INTO CONSIDERATION THE FACT THAT MANY SELF-PAY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. THE HOSPITAL'S ALLOWANCE FOR DOUBTFUL ACCOUNTS WAS 15.9% AND 14.1% OF THE RELATED PATIENT ACCOUNTS RECEIVABLE, NET OF CONTRACTUAL ALLOWANCES AT SEPTEMBER 30, 2018 AND 2017, RESPECTIVELY. PART III, LINE 8: USED MEDICARE ONLY TOTAL CHARGES FROM REVENUE REPORT FOR 2018 AND APPLIED THE RATIO OF COST TO CHARGES FROM THE 2017 COST REPORT DATA. PART III, LINE 9B: THE ELIZABETHTOWN COMMUNITY HOSPITAL'S HELPING HANDS PROGRAM OFFERS FREE OR REDUCED CARE TO OUR PATIENTS WHO ARE UNINSURED OR UNDERINSURED AND MEET THE INCOME ELIGIBILITY CRITERIA SET BY THE FOLLOWING GUIDELINES. THE FREE OR REDUCED CARE APPLIES ONLY TO THE SERVICES PROVIDED BY THE ELIZABETHTOWN COMMUNITY HOSPITAL, WESTPORT HEALTH CENTER, ELIZABETHTOWN COMMUNITY HEALTH CENTER, HIGH PEAKS HEALTH CENTER, AU SABLE FORKS HEALTH CENTER, SMITH HOUSE HEALTH CENTER, AND CROWN POINT HEALTH CENTER. PART VI, LINE 2: A NUMBER OF COMMUNITY PARTNERS ARE INVOLVED IN ASSESSING COMMUNITY HEALTH NEEDS WITHIN THE HOSPITAL'S SERVICE AREA.IN ADDITION TO ITS ESTABLISHED RELATIONSHIPS WITH OTHER HOSPITALS, COMMUNITY ORGANIZATIONS AND HEALTHCARE-BASED ORGANIZATIONS (EMS, PUBLIC HEALTH, MENTAL HEALTH, ETC.), ELIZABETHTOWN COMMUNITY HOSPITAL HAS PARTNERED WITH TWO REGIONAL GROUPS TO ASSESS THE REGION'S COMMUNITY HEALTH NEEDS - THE MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIPS COMMITTEE, AND THE ADIRONDACK RURAL HEALTH NETWORK.MOBILIZING FOR ACTION THROUGH PLANNING & PARTNERSHIP (MAPP): AGENCY REPRESENTATIVES FROM CLINTON, ESSEX, AND FRANKLIN COUNTIES MEET TO APPLY COMMUNITY BASED APPROACHES TO LOCAL HEALTH ISSUES. THE MAPP GROUP HAS WORKED TO CULL INFORMATION THROUGH ASSESSMENTS OF THE LOCAL PUBLIC HEALTH SYSTEMS, A CDC LOCAL PUBLIC HEALTH INDICATOR SURVEY, A QUALITY OF LIFE SURVEY OF SENIORS AND PARENTS WITH CHILDREN, AND FOCUS GROUPS. THE MAPP GROUP SHARES UPDATED INFORMATION ON A CONTINUAL BASIS TO REASSESS PRIORITIES AND GAUGE PROGRAM SUCCESS.ADIRONDACK RURAL HEALTH NETWORK (ARHN): THE ADIRONDACK RURAL HEALTH NETWORK IS A PARTNERSHIP OF PUBLIC, PRIVATE AND NON-PROFIT ORGANIZATIONS IN UPSTATE NEW YORK. ARHN MEMBERS COLLABORATE TO DEVELOP STRATEGIES ALONG WITH IMPLEMENTING, MONITORING AND EVALUATING VARIOUS INITIATIVES. THIS GROUP CONTINUES TO MEET ON A (ROUGHLY) MONTHLY BASIS IN ORDER TO SHARE INFORMATION, STATISTICS, SUCCESSES, CHALLENGES AND OUTCOMES. ELIZABETHTOWN COMMUNITY HOSPITAL (ECH): IN ADDITION TO PARTNERSHIPS WITH THE ARHN AND THE MAPP PROCESSES, ECH INDEPENDENTLY SEEKS THE VIEWS OF COMMUNITY MEMBERS TO GAIN THEIR THOUGHTS REGARDING HEALTH CARE IN THEIR COMMUNITY AND GAIN FEEDBACK REGARDING ECH SERVICES. THROUGHOUT 2016-2017 MANY DIFFERENT METHODS WERE USED TO COMMUNICATE WITH AREA RESIDENTS. EACH YEAR THE HOSPITAL ADMINISTRATOR ATTENDS TOWN BOARD MEETINGS THROUGHOUT ESSEX COUNTY IN AN EFFORT TO UPDATE TOWN LEADERS AND COMMUNITY MEMBERS ABOUT THE HOSPITAL, ITS PLANS FOR THE FUTURE; AND TO ADDRESS ANY QUESTIONS. ANNUALLY, THE ADMINISTRATOR MEETS WITH EMS AND FIRE DEPARTMENTS WITHIN THE HOSPITAL SERVICE AREA TO ENCOURAGE OPEN COMMUNICATION AND FOSTER A GOOD WORKING RELATIONSHIP. THE ECH BOARD OF DIRECTORS IS COMPOSED OF 14 REPRESENTATIVES OF EITHER A SPECIFIC COMMUNITY AND/OR ORGANIZATION, INCLUDING THE ESSEX COUNTY OFFICE FOR THE AGING, TOWN OF ELIZABETHTOWN SUPERVISORS OFFICE, AND ESSEX COUNTY MENTAL HEALTH. A PLANNING COMMITTEE, COMPRISED OF BOARD MEMBERS, IDENTIFIES GAPS IN SERVICE AND DEVELOPS GOALS TO FILL THESE NEEDS. PATIENT SATISFACTION SURVEYS ARE CONDUCTED FOR EACH DEPARTMENT ON A CONTINUAL BASIS. PART VI, LINE 4: ELIZABETHTOWN COMMUNITY HOSPITAL'S PRIMARY SERVICE AREA HAS REMAINED UNCHANGED FOR 2017 PLANNING PURPOSES. IT IS COMPOSED OF TWENTY-TWO ZIP CODES IN NORTHEASTERN ESSEX COUNTY. THE HOSPITAL IS LOCATED 45-60 MINUTES AWAY FROM ANY OTHER HOSPITAL; THROUGH A MOUNTAINOUS REGION AND MOSTLY ALONG A SERIES OF SECONDARY ROADS.BASED ON U.S. CENSUS FOR 2010, 39,370 PEOPLE LIVE WITHIN ESSEX COUNTY OF WHICH 51.8% ARE MALE AND 48.2% ARE FEMALE. PEOPLE OVER THE AGE OF 65 CONSTITUTE 18.1% OF THE POPULATION AND CHILDREN UNDER THE AGE OF 18 MAKE UP 19.3% OF THE POPULATION.ETHNICALLY, 94.4% OF THE POPULATION IS WHITE, NON-HISPANIC. BY 2013 THE POPULATION OF THIS AREA IS EXPECTED TO DECLINE BY AN ESTIMATED 1.5%. PART VI, LINE 5: THE HOSPITAL STAFF PARTICIPATES IN MANY LOCAL EVENTS THAT PROVIDE COMMUNITY MEMBERS THE OPPORTUNITY TO LEARN ABOUT THE HOSPITAL AND ABOUT IMPORTANT HEALTH SCREENINGS. IN ADDITION, THE HOSPITAL HOSTS EVENTS AND OFFERS TRAINING AND SUPPORT SERVICES TO OTHER HEALTH-ORIENTED ORGANIZATIONS. ECH PARTICIPATES IN THE FOLLOWING:(1)PROVIDES ADVANCED LIFE SUPPORT TRAINING FOR REGIONAL EMERGENCY MEDICAL TECHNICIANS. (2)PROVIDES MEDICAL DIRECTORSHIP TO SEVERAL LOCAL EMS AGENCIES, PROVIDES MONTHLY COURSES AND EDUCATION FOR CME CREDITS. (3)PROVIDES MEDICAL DIRECTORSHIP TO ST. JOSEPH'S ADDICTION TREATMENT & RECOVERY CENTER (4)OFFERS FREE DIABETES HEALTH SCREENINGS AT COMMUNITY HEALTH EVENTS. (5)LENDS SPACE TO THE NORTH COUNTRY REGIONAL BLOOD DONOR CENTER FOR BLOOD DRIVES. (6)MEETING SPACE IS DONATED ON A MONTHLY BASIS TO EMS SQUADS. TECHNOLOGICAL CAPABILITIES ALLOW FOR DISTANCE TRAINING / EDUCATION. (7)WORKS WITH THE CANCER SCREENING PROGRAM TO PROVIDE INFORMATION ABOUT MAMMOGRAMS AND BONE DENSITY SCREENING AT THE ANNUAL BREAST CANCER AWARENESS EVENT. (8)HOSTS THE ESSEX COUNTY DIABETES SUPPORT GROUP MEETINGS IN THE HOSPITAL BOARDROOM. (9)EMPLOYEES FROM THROUGHOUT THE HOSPITAL USE HOSPITAL PAID TIME TO LEND THEIR EXPERTISE AND INCREASE THEIR INTERESTS IN SUCH AREAS AS THE ESSEX CO. HEALTHY LIVING PARTNERSHIP, BEHAVIOR HEALTH SERVICES NORTH, RETIRED SENIOR VOLUNTEER PROGRAM, TASK FORCE AGAINST DOMESTIC VIOLENCE, KIWANIS AND NORTH COUNTRY LIFE FLIGHT. (10)ECH'S CLINICAL STAFF COMPLETES ADDITIONAL TRAINING EACH YEAR (ACLS, PALS, BLS, VARIOUS RN / NURSING TRAINING PROGRAMS, CHEMOTHERAPY EDUCATION, PHYSICIAN EDUCATION, INFECTION CONTROL TRAINING, RADIOLOGY DEPARTMENT CONTINUING EDUCATION, LAB STAFF EDUCATION, ETC.) (11) MEETING SPACE FOR AA AND NA. (12)ON SEPTEMBER 20, 2018, FOR NATIONAL FALL PREVENTION DAY, ECH HELD A FALL AWARENESS FAIR FOR THE PUBLIC. THERE WAS A TOTAL OF 10 PARTICIPANTS. (13)THE COMMUNITY HEALTH FAIR HELD ON APRIL 7, 2018 ALLOWED FOR COMMUNITY MEMBERS TO LEARN ABOUT AVAILABLE RESOURCES PERTAINING TO HEALTH AND WELLNESS. ELIZABETHTOWN COMMUNITY HOSPITAL WAS ABLE TO EDUCATE 42 PARTICIPANTS ABOUT THE SERVICES OFFERED AT THE HOSPITAL AND SIX PRIMARY CARE SITES. CLINICAL STAFF WAS ON SITE CONDUCTING BLOOD PRESSURE SCREENS, ISS TEAM MEMBERS WERE AVAILABLE FOR PEOPLE WANTING TO ENROLL IN THE PATIENT PORTAL. HEALTHY REFRESHMENTS WERE PROVIDED AND NUTRITION EDUCATION WAS AVAILABLE WITH A DIABETIC EDUCATOR. EACH YEAR, THE HOSPITAL ALSO HOSTS EVENTS THAT OFFER FREE HEALTH SCREENINGS TO LOCAL RESIDENTS. THE COMMUNITY HEALTH SCREENINGS ARE COORDINATED BY PUBLIC RELATIONS STAFF BUT ARE DEPENDENT UPON CLINICAL STAFF TO PERFORM EXAMS AND INTERPRET THE RESULTS. EACH EVENT IS STAFFED BY 5-8 CLINICAL STAFF MEMBERS FOR APPROXIMATELY 3-4 HOURS PER EVENT. (1)HUNTERS' HEALTH SCREENING (SEPTEMBER) IS A FREE, ANNUAL EVENT SPONSORED BY THE HOSPITAL. PARTICIPANTS RECEIVE A BASIC PHYSICAL / HEALTH SCREENING (EKG, BLOOD WORK, BLOOD PRESSURE, LAB TESTING, PHYSICIAN REVIEW AND REPORTING) AT NO COST. EVENT IS ARRANGED, COORDINATED AND PROMOTED BY ECH PUBLIC RELATIONS STAFF. IN 2018, THERE WERE APPROXIMATELY 20 PARTICIPANTS. (2)IN OCTOBER THE HOSPITAL HOSTS AN EVENT CO-SPONSORED BY THE CANCER SERVICES SCREENING PROGRAM OF ESSEX AND FRANKLIN COUNTIES AND THE HOSPITAL'S AUXILIARY. THE EVENING FEATURES A SPEAKER, ALONG WITH THE OPPORTUNITY TO TAKE PART IN A FREE HEALTH SCREENING. WOMEN WHO QUALIFIED (UN- OR UNDER-INSURED) WERE ABLE TO RECEIVE A CLINICAL BREAST EXAM AND MAMMOGRAM AT NO COST TO THEM, THROUGH THE CANCER SERVICES SCREENING PROGRAM OF ESSEX AND FRANKLIN COUNTIES. IN 2018, 4 FREE MAMMOGRAMS AND 4 OSTEOPOROSIS SCREENING EXAMS WERE CONDUCTED AS PART OF THESE HEALTH FAIRS. PART VI, LINE 6: THE UNIVERSITY OF VERMONT HEALTH NETWORK, A NOT-FOR-PROFIT CORPORATION, IS THE SOLE MEMBER OF THE HOSPITAL, ELIZABETHTOWN COMMUNITY HOSPITAL, LOCATED IN ELIZABETHTOWN, NEW YORK. ADDITIONAL AFFILIATES INCLUDE CHAMPLAIN VALLEY PHYSICIANS HOSPITAL, ALICE HYDE MEDICAL CENTER, CENTRAL VERMONT MEDICAL CENTER, PORTER MEDICAL CENTER AND HOME HEALTH AND HOSPICE. PART VI, LINE 7, REPORTS FILED WITH STATES NY X X X X 0 0 0 0 0 0 0 0 0 ALAN CHARDAVOYNE CFO 244838 0 0 0 0 0 11018 0 1930 0 257786 0 0 0 NOLAN MATTHEW COO 201347 0 0 0 0 0 9061 0 1210 0 211618 0 0 0 JULIE TROMBLEE CNO 187778 0 0 0 0 0 8450 0 1261 0 197489 0 0 0 JOHN REMILLARD PRESIDENT 409512 0 0 0 0 0 12150 0 1722 0 423384 0 0 0 DARRIN GOODROW CIO 193367 0 0 0 0 0 8702 0 1217 0 203286 0 0 0 ROB DEMURO MD PHYSICIAN 379663 0 0 0 7390 0 12150 0 29845 0 429048 0 0 0 PASQUALINO CAPUTO PHISICIAN 294557 0 0 0 0 0 12150 0 29889 0 336596 0 0 0 PATRICK JOHNSTON PHYSICIANS ASSISTANT 307205 0 0 0 0 0 12150 0 1860 0 321215 0 0 0 MARY HALLORAN PHYSICIAN 303653 0 0 0 10750 0 12150 0 29958 0 356511 0 0 0 VANESSA DESMARAIS PHYSICIAN 201394 0 0 0 0 0 9063 0 28522 0 238979 0 0 0 PART I, LINE 3 IN ADDITION TO THE TOOLS AND PROCESSES IDENTIFIED IN PART I, ELIZABETHTOWN COMMUNITY HOSPITAL RECEIVES GUIDANCE REGARDING ITS PRESIDENT'S COMPENSATION FROM THE COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES OF THE UNIVERSITY OF VERMONT HEALTH NETWORK, WHICH IS THE SOLE MEMBER OF THE HOSPITAL. THAT NETWORK COMPENSATION COMMITTEE UTILIZES THE FOLLOWING METHODS TO ESTABLISH THAT GUIDANCE: -COMPENSATION COMMITTEE -INDEPENDENT COMPENSATION CONSULTANT -COMPENSATION SURVEY OR STUDY -APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE A ESSEX COUNTY INDUSTRIAL DEVELOPMENT AGENCY 141630643 2011-12-01 6160000 HOSPITAL RENOVATION AND EXPANSION 0 0 0 A 6160000 6160000 6160000 2009 1 0 1 1 A 0 0 0 0 0 0 1 A 0 0 0 0 0 0 0 0 0 A 0 SCHEDULE K, PART II ON MARCH 1, 2007, THE HOSPITAL ISSUED, THROUGH THE ESSEX COUNTY INDUSTRIAL DEVELOPMENT AGENCY, MULTI-MODE VARIABLE RATE DEMAND CIVIC FACILITY REVENUE BONDS, SERIES 2007A, IN THE AMOUNT OF $5,540,000 AND MULTI-MODE VARIABLE RATE DEMAND CIVIC FACILITY REVENUE REFUNDING BONDS, SERIES 2007B, IN THE AMOUNT OF $1,375,000. THE PROCEEDS FROM THE SERIES 2007A BONDS WERE USED FOR THE RENOVATION AND EXPANSION OF THE HOSPITAL. THE PROCEEDS FROM THE SERIES 2007B BONDS WERE USED TO REFINANCE THE MORTGAGE PAYABLE. ON DECEMBER 1, 2011, THE HOSPITAL REDEEMED THE SERIES 2007 BONDS IN THE AGGREGATE AMOUNT OF $6,160,000 (SERIES 2007A BONDS OF $5,330,000 AND SERIES 2007B BONDS OF $830,000) FUNDED BY THE PROCEEDS FROM THE ISSUANCE OF THE ESSEX COUNTY CAPITAL RESOURCE CORPORATION REVENUE BONDS, SERIES 2011 IN THE AMOUNT OF $6,160,000. THE SERIES 2011 BONDS WERE PURCHASED BY KEY BANK, N.A. UNDER A BOND PURCHASE AGREEMENT. THE BONDS ARE HELD BY KEY BANK, SECURED BY A MORTGAGE THAT KEY BANK HOLDS WITH THE HOSPITAL AND SECURITY INTEREST IN THE HOSPITAL'S GROSS RECEIPTS, SUBJECT TO OPTIONAL TENDER WITH 270 DAYS NOTICE BY KEY BANK FOR PURCHASE BY THE HOSPITAL AT A PRICE EQUAL TO THE PRINCIPAL PLUS ACCRUED AND UNPAID INTEREST. KEY BANK HAS AGREED NOT TO PROVIDE NOTICE OF TENDER THAT WOULD SUBJECT THE BONDS TO BE TENDERED PRIOR TO OCTOBER 1, 2019. FORM 990, PART III, LINE 2 IN APRIL 2018 ECH PURCHASED THE MOSES LUDINGTON HOSPITAL. WE HAVE CONTINUED TO PROVIDE OUTPATIENT SERVICES AT THE FACILITY. WE ALSO RECEIVED RENTAL INCOME FROM POST ACUTE PARTNERS FOR THE SPACE THAT IS UTILIZED AS THE NURSING HOME AND ADULT HOME. FORM 990, PART VI, SECTION A, LINE 4 PRIOR TO JANUARY 1, 2018, COMMUNITY PROVIDERS, INC. D/B/A THE UNIVERSITY OF VERMONT HEALTH NETWORK - ADIRONDACK REGION (UVM HEALTH NETWORK - ADIRONDACK REGION), A NOT-FOR-PROFIT CORPORATION, WAS THE SOLE MEMBER OF THE HOSPITAL, CHAMPLAIN VALLEY PHYSICIANS HOSPITAL MEDICAL CENTER D/B/A THE UNIVERSITY OF VERMONT HEALTH NETWORK - CHAMPLAIN VALLEY PHYSICIANS HOSPITAL (CVPH), LOCATED IN PLATTSBURGH, NEW YORK, AND ALICE HYDE MEDICAL CENTER D/B/A THE UNIVERSITY OF VERMONT HEALTH NETWORK - ALICE HYDE MEDICAL CENTER (AHMC), LOCATED IN MALONE, NEW YORK. EFFECTIVE JANUARY 1, 2018, THE UNIVERSITY OF VERMONT HEALTH NETWORK (UVMHN), WHICH IS THE PARENT ORGANIZATION OF THE UNIVERSITY OF VERMONT MEDICAL CENTER (UVMMC), LOCATED IN BURLINGTON, VERMONT, THE UNIVERSITY OF VERMONT HEALTH NETWORK - CENTRAL VERMONT MEDICAL CENTER (CVMC), LOCATED IN BERLIN, VERMONT, AND EFFECTIVE APRIL 1, 2017, THE UNIVERSITY OF VERMONT HEALTH NETWORK - PORTER MEDICAL CENTER, LOCATED IN MIDDLEBURY, VERMONT, BECAME THE SOLE MEMBER OF THE HOSPITAL, CVPH AND AHMC. FORM 990, PART VI, SECTION A, LINE 6 THE UNIVERSITY OF VERMONT HEALTH NETWORK (UVHN) IS THE SOLE MEMBER OF ELIZABETHTOWN COMMUNITY HOSPITAL. FORM 990, PART VI, SECTION A, LINE 7A UVMHN, INC., AS ELIZABETHTOWN COMMUNITY HOSPITAL'S SOLE MEMBER HAS RESERVE POWERS THAT ALLOW THE UNIVERSITY OF VERMONT HEALTH NETWORK AND UVMHN, INC, TO REFUSE THE ACCEPTANCE OF NEW BOARD MEMBERS APPOINTED BY THE ELIZABETHTOWN COMMUNITY HOSPITAL'S BOARD OF DIRECTORS IF UVMHN, INC., DOES NOT AGREE WITH THE CHOICE OF APPOINTMENTS. THE PROCESS OF APPOINTING MEMBERS TO THE GOVERNING BODY IS A COLLABORATION OF THE ELIZABETHTOWN COMMUNITY HOSPITAL BOARD OF DIRECTORS AND UVMHN, INC., AS A RESULT. FORM 990, PART VI, SECTION A, LINE 7B THE UNIVERSITY OF VERMONT HEALTH NETWORK THROUGH UVMHN, INC., HAS CERTAIN RESERVE POWERS THAT REQUIRE UVMHN, INC., TO APPROVE CERTAIN DECISIONS MADE BY THE ELIZABETHTOWN COMMUNITY HOSPITAL BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11B THE 990 WILL BE PROVIDED TO THE BOARD PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION HAS A WRITTEN CONFLICT OF INTEREST POLICY AND ALL MEMBERS ARE REQUIRED TO DISCLOSE ANY CONFLICTING INTERESTS OR STATE "NONE" ON THE ANNUAL CONFLICT OF INTEREST FORM. FORM 990, PART VI, SECTION B, LINE 15 THE GOVERNING BOARD IS PROVIDED AN INDEPENDENT REPORT OF COMPATIBLE HOSPITALS SALARY FOR THE CEO. THE GOVERNING BOARD ALSO REVIEWS VARIOUS PERFORMANCE MEASURES AND OTHER INFORMATION AND ARRIVES AT A SALARY AND BENEFIT PACKAGE FOR THE CEO. THE DIRECTOR OF HUMAN RESOURCES OBTAINS SALARY INFORMATION FROM AN INDEPENDENT SOURCE FOR LOCAL COMPATIBLE HOSPITALS FOR EACH HIGHER LEVEL POSITION AT THE HOSPITAL. THE INDEPENDENT INFORMATION CONTAINS SALARY LEVELS FOR EACH POSITION AT THE 25TH, 50TH AND 75TH PERCENTILE. THE CEO THEN CONSIDERS THIS INFORMATION AND THE PERFORMANCE FOR EACH OF THESE EMPLOYEES AND ARRIVES AT THE APPROPRIATE SALARY LEVEL. THE APPROACH AND METHODOLOGY IS ALSO PRESENTED TO THE GOVERNING BOARD. IN ADDITION TO THE TOOLS AND PROCESSES IDENTIFIED IN SCHEDULE J, PART I, ELIZABETHTOWN COMMUNITY HOSPITAL RECEIVES GUIDANCE REGARDING ITS PRESIDENT'S COMPENSATION FROM THE COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES OF THE UNIVERSITY OF VERMONT HEALTH NETWORK, WHICH IS THE SOLE MEMBER OF THE HOSPITAL. THAT NETWORK COMPENSATION COMMITTEE UTILIZES THE FOLLOWING METHODS TO ESTABLISH THAT GUIDANCE: -COMPENSATION COMMITTEE -INDEPENDENT COMPENSATION CONSULTANT -COMPENSATION SURVEY OR STUDY -APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE FORM 990, PART VI, SECTION C, LINE 19 THESE DOCUMENTS ARE AVAILABLE TO THE PUBLIC UPON WRITTEN REQUEST. FORM 990, PART XI, LINE 9: CHANGE IN FAIR VALUE OF INTEREST RATE SWAP 193,638. TRANSFER OF UVHN 13,915. FORM 990, PART XII, LINE 2C THE FINANCE COMMITTEE (BOARD OF DIRECTORS) ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT, AND SELECTION OF AN INDEPENDENT ACCOUNTANT. 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