2016-03-30T09:20:36-07:00 2014-12-31 990 2014-01-01 141338465 NATHAN LITTAUER HOSPITAL ASSOCIATION NATH 5187258621 99 East State Street Gloversville NY 12078 Mike Ostrander Vice President of Finance & CFO 5187735480 2015-11-13 2014 2016-08-17 19:52:53Z X Nathan Littauer Hospital and Nursing Home Laurence E Kelly 99 East State Street Gloversville NY 12078 105321890 0 X www.nlh.org X 1894 NY Nathan Littauer Hospital and 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. 16 13 1118 177 910299 0 726102 707909 87616715 90374183 2605029 1499411 3447183 4362182 94395029 96943685 0 0 0 0 58527947 59108719 0 0 250515 31178481 32118606 89706428 91227325 4688601 5716360 71956673 79486276 25941220 31184175 46015453 48302101 Nathan Littauer Hospital and 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 51028671 0 67717399 74 bed general medical surgical hospital providing inpatient and outpatient services with the following service statistics for 2014; 10,643 inpatient days, 1,251 observation visits, 833 new born days, 2,728 adult and pediatric admissions, 352 nursery admissions, 22,766 emergency room visits, 94,623 outpatient visits and 4,019 day surgery visits. 23754217 0 15595355 The Nathan Littauer Primary and Specialty Care Centers provide care for the whole family. Our eight conveniently located centers offer a range of services and specialties with direct access to the specialists and 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 31 physicians and over 30 other healthcare professionals During 2014 the Centers collectively incurred 123,516 patient visits. 9457848 0 6859917 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 2014 the facility had a total of 30,399 patient days. 609156 0 3929513 HealthLink is Nathan Littauer Hospital's Wellness Education Center located in downtown Johnstown. HealthLink's role is to promote wellness by increasing community awareness and providing resources for those wishing to make positive, healthy lifestyle changes. Since its launch in 1989, HealthLink has served 187,613 area residents with 7,604 free or low-cost education programs and health screenings. Our wide variety of programs are chosen based on the interests and needs of the community. Program categories include Health & Wellness, Mind & Body, Childbirth & Parenting, Health Screenings, Support Groups, Special Events, and Vitality Plus (ViP)...especially for adults 50+. We also offer Worksite Wellness programs, including health screenings and wellness education programs, to promote health & wellness on the job. Speakers are available for presentations to schools, churches, community groups, organizations, etc., on a variety of topics. HealthLink's resources include 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 DVD's for loan. The Hospital also offers a Lifeline Program. Lifeline is a personal emergency response system which connects subscribers to an emergency response center through a telephone based communication system. A total of 500 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 new grant entitled: "Consumer Assistant for the NYS of Health Benefit Exchange" covering Fulton and Montgomery County. During the year of 2014 Nathan Littauer Hospital as Lead Agency for both the previous and current grant program's was able to enroll a total of 2,536 individuals with the following breakdown: Children's Medicaid - 537, Child Health Plus Program - 314, Adult Medicaid - 1,215, Quality Health plan - 470. Also included here is the Meaningful Use Funds received (EHR) of $2,233,005 and other operating revenue of $1,700,263. 609156 0 3929513 84849892 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 1 0 0 0 0 0 0 0 1 1 1 0 0 1 37 0 1 1118 1 1 1 0 0 0 0 0 0 0 0 0 X 16 13 0 0 0 0 1 0 1 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X Michael Redcross 5187735481 99 East State Street Gloversville NY 120781293 Brian Hanaburgh Chair 0.5 0 X 0 0 0 Gregory Truckenmiller Phd Vice Chair 0.5 0 X 0 0 0 Susan Johnson Esq Treasurer 0.5 0 X 0 0 0 Holly Chamberlin Esq Secretary 0.5 0 X 0 0 0 Anita Ashelman Member 0.5 0 X 0 0 0 Michael Bowker Member 0.5 0 X 0 0 0 Paul Connelie Member 0.5 0 X 0 0 0 Dianna Downing Member 0.5 0 X 0 0 0 John Fox DDS Member 0.5 0 X 11500 0 0 Lawrence Horowitz Member 0.5 0 X 0 0 0 Neil McGovern Member 0.5 0 X 0 0 0 Kamini Ramani Member 0.5 0 X 0 0 0 David Seward Esq Member 0.5 0.2 X 0 0 0 Shriraj Shah MD Member 0.5 0 X 25000 0 0 Stephen Tomlinson Member 0.5 0 X 0 0 0 Laurence E Kelly President & CEO & Member 40 0.2 X X 387790 0 202084 Mike Ostrander Vice President of Finance & CFO 40 0 X 208171 0 8309 Susan Behar MD Physician 40 0 X 391192 0 21069 Paul Moberg MD Physician 40 0 X 401290 0 27614 Paul Husson MD Physician 40 0 X 394585 0 25416 Peter Dowling MD Physician 40 0 X 301767 0 26207 Bennet Togbe MD Physician 40 0 X 311022 0 27614 2432317 0 338313 63 0 1 0 Sodexho Operations PO Box 905374 Charlotte NC 28290 Dietary Services 1774587 Alliance Healthcare Services PO Box 96485 Chicago IL 60693 MRI Imaging Servies 1314283 Gloversville Physician Medicine PC PO Box 82368 Lafayette LA 70598 Physician Services 1223574 Quest Diagnostics 1 Malcolm Avenue Teterboro NJ 07608 Laboratory Services 624281 AOW Associates 30 Essex Albany NY 12206 Construction Services 387316 17 0 0 0 200000 504279 3630 0 707909 Inpatient and Outpatient Services 622110 67717399 67507890 209509 0 Primary Care Centers 622110 15595355 15595355 0 0 Nursing Home 623000 6859917 6859917 0 0 Lifeline 621990 194207 194207 0 0 Healthlink 611710 7305 7305 0 0 0 0 0 0 90374183 559840 0 0 559840 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 9307690 10086 8378205 0 929485 10086 939571 0 0 939571 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Retail Pharmacy 446110 599997 0 599997 0 340b Program 900099 512112 512112 0 0 Cafeteria Sales 722212 438091 438091 0 0 2811982 2677005 100793 34184 4362182 96943685 93791882 910299 1533595 0 0 0 0 0 0 0 0 594221 0 594221 0 0 0 0 0 45261144 42772493 2288447 200204 2945581 2661770 276443 7368 7165910 6827318 309740 28852 3141863 2966797 160975 14091 492646 492646 0 0 271877 0 271877 0 162860 0 162860 0 30931 0 30931 0 0 0 0 0 0 0 1416646 1199399 217247 0 303269 621 302648 0 3462550 3130531 332019 0 512721 489360 23361 0 0 0 0 0 1148615 1146111 2504 0 251062 215469 35593 0 0 0 0 0 0 0 0 0 499399 499399 0 0 0 0 0 0 3756407 3580988 175419 0 1487299 1487299 0 0 Medical Supplies 9661605 9661475 130 0 Non-Medical Supplies 1214356 1202158 12198 0 Purchased Services 4827987 4364894 463093 0 Food 1057516 1057516 0 0 1560860 1093648 467212 0 91227325 84849892 6126918 250515 4749525 4454511 1967547 4300586 311937 311937 10513240 11308844 0 0 0 0 0 0 685616 739932 1037578 791660 78924378 55112054 24478653 23812324 22453799 27462700 0 0 0 5758778 6303782 71956673 79486276 6207917 6491793 0 0 16000 16000 3741091 3275723 0 0 0 0 5388079 4115572 0 0 10588133 17285087 25941220 31184175 X 45421016 47707664 311937 311937 282500 282500 46015453 48302101 71956673 79486276 X 5716360 -51776 0 0 0 -3377936 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 30931 30931 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. 416864 0 31838 0 100000 1622 347080 318595 0 99793 0 0 1524 416864 265320 0 54663 0 0 1388 318595 303299 0 -36431 0 0 1548 265320 261573 0 43367 0 0 1641 303299 0 1 0 0 0 0 404197 404197 0 36481612 24140232 12341380 0 1866325 1153336 712989 0 35287044 26274528 9012516 0 4885200 3543958 1341242 23812324 AWUIL by Debt & Lease Agreement 1611323 AWUIL by Board Designation 185409 Agency Funds 27106 Miscellaneous Receivable 415693 Other Assets 395506 Software License 390583 Deferred Financing 165086 Deferred Asset - 1199 827394 Deferred Asset - 457 Plans 2285682 6303782 0 Due to third Parties 4440103 Asset Retirement Obligation 119172 Long-Term Pension Obligation 8415330 Section 457 Plans 2285683 Due to 1199 827394 EHR Reserve 347405 Promissory Note 850000 17285087 X 100269845 -51776 0 0 3377936 3326160 96943685 0 0 0 96943685 91227325 0 0 0 0 0 91227325 0 0 0 91227325 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 501(c) 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. Management has concluded that there are no material tax liabilities that need to be recorded as of December 31, 2014 or 2013. Schedule D, Part XI, Line 2d Pension related changes other than net periodic pension expense and contribution of capital asset. 1 1 X 1 X 1 X 1 1 0 0 1103 405130 52018 353112 0.0039 64836 18937493 9445537 9491956 0.104 0 65939 19342623 9497555 9845068 0.1079 29 12089 764759 428773 335986 0.0037 1 39 115260 115260 0.0013 1 123516 15952353 12699702 3252651 0.0356 3 200 18220 18220 0.0002 34 135844 16850592 13128475 3722117 0.0408 34 201783 36193215 22626030 13567185 0.1487 1 8448487 0 12489454 15941135 -3451681 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 13 1 1 1 1 X www.nlh.org X 1 13 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 1 X 0 X X X X 1 X 0 0 Schedule H, Part V, Section B, Line 5-Nathan Littauer Hospital Association The process of identifying the important healthcare needs of the residents of Fulton County involved both data analysis and consultation with key members of the community. The data was collected from multiple sources including publicly available health indicator data and data collected from a survey conducted by the Adirondack Rural Health Network. The health indicator data is collected and published by New York State and contains over 300 different health indicators. Since 2003, The Adirondack Rural Health Network has been compiling this data for the region and producing reports to inform healthcare planning on a regional basis. ARHN undertook a project to systemize this data into a relational database to provide improved access and analysis. The results of this analysis provide a statistical assessment of the health status for the region and each county therein. In December 2012 and January 2013, the Adirondack Regional Health Network (ARHN) conducted a survey of selected stakeholders representing health care and service providing agencies within the eight county region. The results of the survey are intended to provide an overview of regional needs and priorities, to inform future planning and the development of a regional health care agenda. The survey results were presented at both the county and regional levels. Using the results of the indicator analysis and the surveys, a local stakeholder meeting was convened in May 2013 to review the data and to identify and prioritize the current healthcare challenges for the residents of Fulton County. The Community Health Assessment Team (CHAT) was convened in July 2013 to analyze the results of the data and information gained from the stakeholder meeting. Utilizing the dot method of prioritization the CHAT selected the Prevention Agenda priorities and focus areas to be addressed in our Community Health Improvement Plan (CHIP). The CHAT consisted of representatives from Nathan Littauer Hospital and Fulton County Public Health. STAKEHOLDER GROUP:Vicky Wheaton Saracini AHI and ARHN, Robert Martiniano Center for Health and Workforce Studies, Margaret Luck NLH Lifeline, Kim Conboy Montgomery County Public Health, Deborah Skivington Family Counseling Center, Michael Countryman Family Counseling Center, Dale Woods Fulton County Public Health, Christina Akey Fulton County Public Health, Don Van Patten NYSDOH, Denise C. Frederick Fulton County Public Health, Sue Fraiser Mountain Valley Hospice, Don Diefenbacher Mountain Valley Hospice, Heidi Parisi Nathan Littauer Hospital, Rachel Truckenmiller ASAPP's Promise, Ann Rhodes HFM Prevention, Dom Baggetta ASAPP's Promise, Denise Benton Catholic Charities, Michael Redcross Nathan Littauer Hospital, Fabrizia Rodriguez Centro Civico, Andrea Fettinger Fulton County Aging and Youth, Danielle Temp Community Health Center, Cheryl McGratten Nathan Littauer Hospital, Barbara Vickery CDCCCC, Sue Cridland Nathan Littauer, Anne Solar Futon County DSS Schedule H, Part V, Section B, Line 6a-Nathan Littauer Hospital Association Nathan Littauer Hospital Association - Nathan Littauer Hospital prepared the survey in conjunction with Adirondack Rural Health Network of whom the following hospitals are members: Adirondack Health, Alice Hyde Medical Center, CVPH Medical Center, Elizabeth Community Hospital, Glens Falls Hospital and Saratoga Hospital. Schedule H, Part V, Section B, Line 6b-Nathan Littauer Hospital Association AHI and ARHN Center for Health and Workforce Studies, Montgomery County Public Health, Family Counseling Center, Fulton County Public Health, NYSDOH, Mountain Valley Hospice, ASAPP's Promise, HFM Prevention, Catholic Charities, Centro Civico, Fulton County Aging and Youth Community Health Center, CDCCCC and Futon County DSS. Schedule H, Part V, Section B, Line 11-Nathan Littauer Hospital Association Nathan Littauer Hospital and 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. Our mission is accomplished not only through the efforts of our own dedicated employees, services and programs, but in cooperation with countless community partners. Following a Community Health Needs Assessment (CHNA), completed in 2013 in coordination with our local health department and with input from local health and human service providers, a three year Community Service Plan (2013 - 2015) was developed. We were tasked by the New York State Department of Health (as were all NYS hospitals and local health departments) to cooperatively prioritize our community needs and identify focus areas to address over the next three years. Our Community Service Plan is our guide to the future and our compass. The priorities we identified for action over the next three years were to "increase access to high-quality chronic disease preventive care and management in clinical and community settings" and "increase the use of comprehensive well child care." As described under each priority you will see a summary of the area of focus and progress we have made, as well as the challenges we have encountered. Priority #1 - Increase access to high-quality chronic disease preventive care and management in clinical and community settings, specifically, to increase the percentage of adults 18 years and older who are tested for high blood sugar or diabetes. By improving diabetes awareness and screening more people, we will also be addressing an identified disparity: access to care. According to NYS DOH data, an estimated 8% Fulton County adults have been diagnosed with diabetes, this equates to more than 3,400 people. While determining an accurate number of undiagnosed persons is not possible, we know that diabetes is more common in the elderly and those with a BMI of > 35. Earlier identification and treatment of diabetes may actually increase our incidence rate, but will reduce the chance of developing harmful and costly complications. Activities associated with increasing screening rates will also bring attention to the potential complications of poor diabetes control and the need for careful diabetes management. Accomplishments -Littauer Primary Care Centers (PCC) are seeking out and identifying those at risk for developing diabetes within their patient populations, and encouraging them to be tested -HealthLink & Fulton County Public Health are: working to increase community awareness of risk factors and need for testing by targeted outreach (ex, to senior centers & clubs and large employers) and through social media. using the American Diabetes Association "Diabetes Risk Test" at outreach sites and community events as an awareness tool, and referring at risk persons for follow up -The Diabetes Resource Center at Littauer continues to provide an ADA recognized "Diabetes Self-Management Education" program and support -HealthLink continues to offer ongoing community health & wellness education and referral, including cholesterol, glucose, blood pressure and BMI screening -Registered dieticians provide outpatient nutrition counseling (as requested by provider) as well as nutrition specific community education programs Challenges include Not having dedicated staff time to plan, implement, evaluate and track activities Engaging target population.. to accept that this is a serious problem for our community and that each person has the ability to do something about it Little access to practical, research based interventions and monitoring/tracking /process strategies Priority #2 - Increase the use of comprehensive well child care, specifically increase the proportion of NYS children who receive lead screening (as a key recommended preventive health services) as part of routine well-child care. Fulton County has extremely high rates of child lead poisoning. Increasing screening rates will allow at risk children to be identified and treated, reducing the number of children diagnosed with lead poisoning and its life changing long term effects. Providing POC (point of care) testing will improve access, a disparity identified in our CHNA. Activities associated with increasing screening rates will also bring attention to older housing stock and other causes of lead poisoning. Accomplishments -Coordinated efforts with Fulton County Public Health (FCPH), which has identified lead poisoning as an agency priority and has received a grant to help address it -Established a baseline number of tests using DOH Lead Web data and monitored over time -Established a baseline level of awareness of lead poisoning risk and dangers by e-survey -Expanded POC lead testing in our pediatric primary care offices from two sites to four in 2014 -In coordination with FCPH carried out: Media campaign including: billboards, social media, postcards mailed to all new moms, infomercial for public access, web sites peds waiting rooms Targeted outreach education at events such as home shows, rabies clinics or car seat checks; and to WIC, Day Care Centers, and Head Start sites, Navigators. -Worked to establish a broad based community task force comprised of health care, local government and business stake holders. Challenges include -Difficulty engaging target population -Difficulty engaging community leaders -Little access to practical, research-based interventions and monitoring/tracking /process strategies Schedule H, Part V, Section B, Line 16a-Nathan Littauer Hospital Association www.nlh.org Schedule H, Part V, Section B, Line 16b-Nathan Littauer Hospital Association www.nlh.org Schedule H, Part V, Section B, Line 16c-Nathan Littauer Hospital Association www.nlh.org 9 Nathan Littauer Hospital Nursing Home 99 East State Street Gloversville NY 12078 84 Bed Nursing Home. Nathan Littauer Hospital Primary Care Center 99 East State Street Gloversville NY 12078 Primary/Specility Care Center (Clinic). Perth-Broadalbin Primary Care Center 4100 State Highway 30 Amsterdam NY 12078 Primary/Specialty Care Center (Clinic). Johnstown Primary Care Center 23 South Perry Street Gloversville NY 12095 Primary/Specialty Care Center (Clinic). Mayfield Primary Care Center 2497 State Highway 30 Mayfield NY 12117 Primary/Specialty Care Center (Clinic). Steele Avenue Primary Care Center 182 Steele Avenue Gloversville NY 12078 Primary/Specialty Care Center (Clinic). Caroga Lake Primary Care Center 1840 State Highway 10 Caroga Lake NY 12032 Primary/Specialty Care Center (Clinic). Speculator Primary Care Center Route 8 Speculator NY 12164 Primary/Specialty Care Center (Clinic). Decker Drive Primary Care Center 110 Decker Drive Johnstown NY 12095 Primary/Specialty Care Center (Clinic). Schedule H, Part I, Line 7 The costing methodology used to calculate the amounts reported in the Table for Line 7 is ratio of patient care cost to 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 services reported included details from the Primary/Specialty Care Centers, licensed clinics. The Centers operated despite financial losses to the organization for at least the past eleven years. The Hospital is committed to operate the Centers as a benefit to the community in order to address an identified community need and to improve access to healthcare, including our remote rural communities. Schedule H, Part III, Section A, Line 4 Patient accounts receivable 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 payor 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 2552-10 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 $3,451,681. Tax exempt hospitals 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 2014 the Hospital realized an additional shortfall of $3,987,786 resulting from Medicare Advantage and non-PPS Medicare patients. The total shortfall for all types of Medicare patients was $7,439,467. 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 the 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. For non-Medicare patients, if the balance is under $100.00 for Primary Care and $500.00 for Hospital services, the Short Form Application can be utilized. Schedule H, Part VI, Line 2 Assessment of Public Health Priorities With ARHN facilitating the process the Community Health Planning Committee (the Committee) was formed with representatives from all six of the hospitals and all six of the 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 ARHN as well as information specific to each hospital's service area, each ARHN hospital prepared a Community Service Plan in collaboration with the other participating hospitals and local health departments. Schedule H, Part VI, Line 3 Nathan Littauer Hospital & Nursing Home 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 available in neighboring Hamilton and Montgomery Counties. Within our main service area, Fulton County, 2013 data shows a population of 54,586 a 1.7% decrease since 2010. Of those reporting one race, 95.7% of those residents identified themselves as white. 50.5% of our population are women. Over 17% of the population has a median age of 65 or older. The median household income in Fulton County is $45,333 (well below the national average of $56,951). Our county has 16.5% of its residents living below the poverty level. 83.4% of the population has a high school degree or higher. The leading industries remain: Educational services, health care and social assistance employing 26% of the workforce followed by manufacturing employing 15%. Unemployment rates for 2011 are at about 11%. 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. We have started a comprehensive community education effort with local stakeholders to address lead poisoning and diabetes awareness. The demographics and public health issues of our area clearly demonstrate why Nathan Littauer Hospital and Nursing Home and our eight Primary Care Centers are a vital resource in the communities we serve. Of particular note is our aging population and poverty levels, which are much higher than the state average. It is concluded that health issues affecting our population will continue to be addressed by our community hospital. 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 Littauer to our community. Renovated hospital corridors, began construction on an MRI addition, renovated the pharmacy department, updated HVAC units among other capital acquisitions and projects in 2014. Schedule H, Part VI, Line 7 New York State. X X X X X 0 1 0 0 0 0 0 0 0 Laurence E Kelly President & CEO & Member 386500 0 0 0 1290 0 183964 0 18120 0 589874 0 0 0 Mike Ostrander Vice President of Finance & CFO 207721 0 0 0 450 0 8309 0 0 0 216480 0 0 0 Susan Behar MD Physician 330962 0 0 0 230 0 10400 0 10669 0 352261 0 0 0 Paul Moberg MD Physician 400000 0 0 0 1290 0 10400 0 17214 0 428904 0 0 0 Paul Husson MD Physician 394315 0 0 0 270 0 10400 0 15016 0 420001 0 0 0 Peter Dowling MD Physician 300000 0 0 0 1767 0 10400 0 15809 0 327976 0 0 0 Bennet Togbe MD Physician 310722 0 0 0 300 0 10400 0 17214 0 338636 0 0 0 Schedule J, Part I, Line 4 Payments of $173,564 were made on behalf of the CEO to a 457 (f) plan during 2014. Shiraj Shah MD Board Member 25000 Physician Service Contract 0 Form 990, Header, Line B Schedule H Part III Section B Medicare Lines 5,6 and 7. Clerical input error, transposed entries for lines 5 and 6 on original submision. Line 5 - revenue should be $12,489,454. Line 6 - cost should be $15,941,135 resulting in a shortfall of $3,451,681. Form 990, Part I, Line 6 Total volunteer hours for 2014 were 13,766 based upon the annual report of the Nathan Littauer Hospital Auxiliary. This included Auxilians, Candy Stripers and Junior Volunteers. 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 Form 990 and any required supplemental schedules are prepared by the Finance Department with input from other Hospital departments as necessary. The draft Form 990 is then reviewed by the Director of Finance and the Vice President of Finance /Chief Financial Officer in order to ensure compliance with applicable instructions. The Vice President of Finance/Chief Financial Officer reviews the Form 990 with the Board of Directors and copies are provided to members during the meeting. Any comments from the members are evaluated by management and any necessary revisions are incorporated into the return. The committee members are then offered both a final draft of the 990 prior to its filing and the final 990 after it's filed. 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 the 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 net periodic pension expense and contribution of capital asset. Gloversville Extended Care & Nursing Home Co Inc 99 East State Street Gloversville NY 12078 237065255 Leasing an 84 bed Skilled Nursing Facility to Hospital NY 501(c)3 Schedule A Line 3 N/A 1 NLH Realty Corp 99 East State Street Gloversville NY 12078 141641020 Realty holding company NY 501(c)2 N/A 0 Nathan Littauer Foundation 99 East State Street Gloversville NY 12078 141638991 Support the Hospital & promote healthcare programs in the community through donations. NY 501(c)3 Schedule A Line 7 N/A 1 Nathan Littauer Hospital Auxiliary 99 East State Street Gloversville NY 12078 146086641 Assisting Hospital in promoting health & welfare of the community NY 501(c)3 Schedule A Line 11 N/A 0 Colonial Healthcare Corporation PO Box 586 Gloversville NY 12078 141670605 Support & Supplement the activities, goals and operations of Nathan Littauer Hospital Association. NY 501(c)3 Schedule A Line 7. N/A 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 Nathan Littauer Foundation c 200000 Payment to hospital.