2015-11-13T10:08:54-06:00 2014-12-31 KPMG LLP 515 Broadway 4th Floor Albany NY 122072974 990 2014-01-01 141338413 Glens Falls Hospital % LAURA PASCO ASST CONTROLLER GLEN 100 Park Street Glens Falls NY 12801 Mitch Amado CFO 5189265005 2015-11-12 true JEFFREY STAGG P01326885 5184274600 2014 2016-03-07 17:11:31Z DIANNE SHUGRUE 100 Park Street Glens Falls NY 12801 326877440 false X glensfallshospital.org X 1897 NY SEE SCHEDULE O 15 15 3241 638 1527632 611464 3247969 3073526 296044019 302012567 4254979 4601269 4497791 1260983 308044758 310948345 0 0 0 0 180449695 172407198 0 0 391976 126133251 132515609 306582946 304922807 1461812 6025538 250993804 260963700 126647945 129685726 124345859 131277974 X SEE SCHEDULE O false false 244309381 301259431 Glens Falls Hospital provides a comprehensive health care system that stretches across 3,000 square miles in upstate NY. We provide high quality care to people, regardless of their ability to pay. We are a 410 bed facility with more than 225 certified physicians in over 25 specialties. Our services include, but are not limited to, emergency care, surgical services, mental health, cancer care, primary care and preventative health education. In 2014, we had 67,789 patient days and 14,004 discharges. The Emergency Care Center provided care to 50,338 patients. Our Mental Health department provided 60,572 outpatient treatments and 6,372 inpatient days. Our Surgery Center performed 12,369 procedures. 244309381 true true false true false false false false false true true false false false true true false true false false false false false false false false true true false false true true false false false false false false false true false false false false false false false true true true true false true 231 0 true 3241 true true true false false false false false false false false false X 15 15 false false false false false false false true true true false false true true true true true true true true true NY X LAURA PASCO ASST CONTROLLER 5189265012 100 PARK STREET GLENS FALLS NY 12801 X DIANNE SHUGRUE PRESIDENT/CEO 40.0 0.0 X X 425390 0 10842 MICHAEL B CLARKE CHAIRMAN 1.0 0.0 X X 0 0 0 GLENDA KELMAN RN VICE CHAIRMAN 1.0 0.0 X X 0 0 0 JOSEPH F RACCUIA SECRETARY 1.0 0.0 X X 0 0 0 JOHN C BIENIEK DIRECTOR 1.0 0.0 X 0 0 0 MICHAEL T BITTEL DIRECTOR 1.0 0.0 X 0 0 0 WILLIAM BORGOS DIRECTOR 1.0 0.0 X 0 0 0 TENEE' CASACCIO DIRECTOR 1.0 0.0 X 0 0 0 JAMES E CULLUM DIRECTOR 1.0 0.0 X 0 0 0 KATHIE L DUNCAN DIRECTOR 1.0 0.0 X 0 0 0 KEVIN J HERLIHY MD DIRECTOR 1.0 0.0 X 0 0 0 GARY R HICKS DIRECTOR 1.0 0.0 X 0 0 0 THOMAS J MURPHY DIRECTOR 1.0 0.0 X 0 0 0 WILLIAM H REYNOLDS MD DIRECTOR 1.0 0.0 X 0 0 0 SHARON RUGGI DIRECTOR 1.0 0.0 X 0 0 0 DAVID WESTFALL MD DIRECTOR 1.0 0.0 X 0 0 0 MITCH AMADO CFO 40.0 0.0 X 286008 0 5587 PAUL SCIMECA SR VP STRAT. PLANNING 40.0 0.0 X 243774 0 17349 MARK HOLTZ SR VP OPERATIONS 40.0 0.0 X 228666 0 14986 KYLE BROCK VP HUMAN RESOURCES 40.0 0.0 X 230000 0 378 ROBERT PRINGLE MD VP MED AFFAIRS & CO 40.0 0.0 X 212544 0 10488 DONNA KIRKER VP PATIENT SERVICES 40.0 0.0 X 207322 0 8200 ED HANCHETT VP CLINICAL SERVICES 40.0 0.0 X 160696 0 14150 JOHN B KELLEHER CIO 40.0 0.0 X 132138 0 3368 JOHN P STOUTENBURG MD CANCER CTR PHYS 40.0 0.0 X 615787 0 16227 PATRICK ROWLEY MD CARDIAC PHYSICIAN 40.0 0.0 X 563487 0 18874 SCOTT MUNRO MD CARDIAC PHYSICIAN 40.0 0.0 X 565788 0 18273 John Layden MD CARDIAC PHYSICIAN 40.0 0.0 X 566780 0 18874 IQBAL BASHIR MD CARDIAC PHYSICIAN 40.0 0.0 X 566419 0 18873 5004799 0 176469 196 false true false HUDSON HEADWATERS HEALTH NETWORK 9 CAREY RD QUEENSBURY NY 12804 MEDICAL SERVICES 2533701 DCCS Consulting Services LLC 205 Hackney Circle WILMINGTON DE 19803 Mgt Consulting Serv 1281994 LEADERS FOR TODAY 981 WORCESTER STREET WELLESLEY MA 02482 CONTRACT LABOR 928336 LAB CORP PO Box 12141 BURLINGTON NC 27216 Lab services 739219 Healogics Wound Care Services 3087 Momentum Place CHICAGO IL 60689 Wound care services 645563 26 421965 2651561 0 0 3073526 PATIENT SERVICE REVENUE 900099 289304503 289304503 HOSPITAL LAB SERVICES 621500 931605 931605 MEANINGFUL USE 900099 4043195 4043195 OUTPATIENT PHARMACY 900099 2710211 2710211 PHYSICIAN ANSWERING SERVICE 900099 276057 251564 24493 4746996 4746996 302012567 1375772 1375772 0 0 0 0 0 19148426 6166 15897879 31216 3250547 -25050 3225497 3225497 0 0 0 GAIN ON INVESTMENT IN ISNENY 621990 340635 340635 INVESTMENT IN NO. COUNTRY EYE CENTER 900099 -137673 -137673 ALL OTHER REVENUE 900099 1058021 571534 486487 1260983 310948345 301259431 1527632 5087756 0 0 0 0 2211886 2211886 0 139720506 120410926 19135930 173650 3623504 3075915 543153 4436 17397895 14841152 2535340 21403 9453407 8024795 1417039 11573 3851298 1398334 2452964 494944 494944 232031 20000 197081 14950 27269 27269 0 0 23146966 12345359 10746273 55334 969290 23788 945502 67688350 63178490 4485255 24605 5251883 94745 5157138 0 4328885 1475301 2853584 289640 172086 117554 0 341256 225302 115734 220 3431122 2440257 990865 0 14162248 11796577 2365671 3395470 2761122 634348 OTHER EXPENSES 4904957 2025232 2793920 85805 304922807 244309381 60221450 391976 13372935 24784983 6990317 9923637 0 0 29441548 27389293 0 0 0 0 213106 235833 3462331 3260555 1445342 2379228 291458571 187672748 111728395 103785823 72805424 79003896 0 0 0 0 0 0 11534406 10200452 250993804 260963700 43913381 46288353 0 0 0 0 54505000 53010000 0 0 0 0 15867941 15425721 0 0 12361623 14961652 126647945 129685726 X 118737276 125639745 4101911 4131557 1506672 1506672 124345859 131277974 250993804 260963700 X 6025538 906577 X X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 27269 27269 false false Part IIB, Line 1i IN 2014, GLENS FALLS HOSPITAL PAID DUES TO THE AMERICAN HOSPITAL ASSOCIATION AND THE HOSPITAL ASSOCIATION OF NEW YORK, A PORTION OF WHICH WENT TOWARDS LOBBYING EXPENSES, AS DETERMINED BY THE ASSOCIATIONS. 1506672 0 355034 16000 53115 285919 1506672 1506672 0 284363 12810 45395 226158 1506672 1506672 0 114227 12000 20545 81682 1506672 1506672 0 44224 16900 27324 1506672 1506672 0 90709 12000 6333 72376 1506672 1.00000 false false 7525825 7525825 165708996 95589906 70119090 118223750 92082842 26140908 103785823 0 DEFERRED COMP PAYABLE 5754652 SELF INSURED LIABILITY RESERVE 8708645 ASSET RETIREMENT OBLIGATION 498355 14961652 Part V, Line 4 Permanently restricted net assets are investments to be held in perpetuity, the income from which is expendable to support the following: Dental Free Care 1,053,285 Indigent Care 148,927 Gen. Operating Expenses 169,975 Health Education 134,485 Total 1,506,672 Part X, Line 2 The Hospital recognizes the effect of income tax positions only if those positions are more likely than not of being sustained. Recognized income tax positions are measured at the largest amount that is greater than fifty percent likely of being realized upon settlement. Changes in recognition in measurement are reflected in the period in which the change in judgement occurs. The hospital did not recognize the effect of any uncertain tax positions in 2014. Part XI, Line 2d Additional net actuarial loss on accrued post retirement benefit obligations $ (144,313) Net assets released from restrictions used for purchases of property & Equipment $ 2,010,527 Restricted gifts and distributions from GFH Foundation $ 2,333,131 Change in interest in net assets of GFH Foundation $ (25,695) Restricted gain income $ 164,839 Net assets released from restrictions $(2,432,492) Part XI Line 2d Total = $ 1,905,997 true true true X 130. true X 330. true true false true true 2844651 1824386 1020265 0.00330 42870954 28890702 13980252 0.04580 45715605 30715088 15000517 0.04910 1450850 1002867 447983 0.00150 194165 194165 0.00060 3425719 3348508 77212 0.00030 131045 24939 106106 0.00030 166028 166028 0.00050 5367807 4376314 991494 0.00320 51083412 35091402 15992011 0.05230 124166 40000 84166 0.00030 378396 378396 0.00120 502562 40000 462562 0.00150 true 892998 1527131 69492339 76449304 -6956965 X true false Imaging Serv NENY Diagnostic Radiology 0.50000 0.50000 0.50000 North Country Eye Ce Eye center 0.30000 0.30000 0.30000 1 1 Glens Falls Hospital 100 Park Street Glens Falls NY 12801 glensfallshospital.org 5601000H X Glens Falls Hospital 1 false false true X X X X X X X X X 13 true false false true X GLENSFALLSHOSPITAL.ORG/SERVICES/HEALTH- PROMOTION-CENTER.CFM X true 14 true GLENSFALLSHOSPITAL.ORG/SERVICES/HEALTHPROMOTI false false true X 130. 330. X X X true true X X X X true X X X X X true X false X X X X true X false false PART V LINE 5 In 2013-2014, GFH WORKED WITH THE ADIRONDACK REGIONAL HEALTH NETWORK (ARHN) TO CONDUCT A SURVEY OF STAKEHOLDERS REPRESENTING HEALTH CARE AND SERVICE PROVIDING AGENCIES WITHIN THE EIGHT COUNTY REGION. THE RESULTS OF THE SURVEY PROVIDE AN OVERVIEW OF REGIONAL HEALTH NEEDS AND PRIORITIES, AND INFORM FUTURE PLANNING AND THE DEVELOPMENT OF A REGIONAL HEALTH CARE AGENDA. THE SURVEY RESULTS WERE PRESENTED AT BOTH THE COUNTY AND REGIONAL LEVELS. RESPONDENTS OF THE SURVEY REPRESENT A WIDE RANGE OF ORGANIZATIONS FROM HEALTH PROVIDERS, PLANNED PARENTHOOD, WIC PROGRAMS, YMCA, FAMILY COUNSELING, NURSING HOMES, SCHOOLS, SENIOR CITIZENS, COUNTY HEALTH OFFICES, MENTAL HEALTH PROVIDERS AND MANY MORE. ARHN provides guidance and technical assistance to the Community Health Planning Committee (CHPC), a regional forum for hospitals, county health departments and community partners, who provide oversight of planning and assessment activities. The group is further comprised of subcommittees developed to address areas specific to hospital, public health and data-specific requirements. Regular meetings of each subcommittee and the full CHPC have resulted in a systematic approach to community health planning and the development of regional and local strategies to address health care priorities. PART V LINE 11 GLENS FALLS HOSPITAL ADDRESSES THE HIGHEST NEEDS OF THE COMMUNITIES SERVED BASED ON RESOURCES AVAILABLE TO THE HOSPITAL. WE ARE CONTINUALLY EXPLORING PARTNERSHIPS TO MEET ADDITIONAL NEEDS AND TO PROVIDE PATIENTS INCREASE ACCESS TO HEALTH SERVICES. WE ARE CURRENTLY WORKING TO REASSESS THE BEHAVORIAL HEALTH SERVICE LINE TO ENSURE LONG TERM SUSTAINABILITY AND MAXIMUM CAPACITY. WE ARE ADDRESSING SOME OF THE NEEDS THROUGH THE MEDICAID HEALTH HOME INITIATIVE AND THE INTEGRATED BEHAVORIAL HEALTH IN PRIMARY CARE INITIATIVE. THROUGH THE CREATION OF THE MEDICAL STAFF DEVELOPMENT PLAN, GFH WILL ENSURE ADEQUATE RESOURCES FOR OBSTETRICS AND PEDIATRICS THROUGH AN EMPHASIS ON THE UTILIZATION OF MID-LEVEL PROVIDERS AND ADVANCED PRACTICED NURSES. UNFORTUNATELY, GLENS FALLS HOSPITAL IS UNABLE TO ADDRESS ALL OF THE IDENTIFIED NEEDS OF THE COMMUNITIES WE SERVE. IT WOULD NOT BE PRUDENT TO SPREAD HOSPITAL AND COMMUNITY RESOURCES ACROSS TOO MANY INITIATIVES. GLENS FALLS HOSPITAL WILL NOT BE DIRECTLY ADDRESSING ALL THE NEEDS IN REGARDS TO BEHAVORIAL HEALTH AND SUBSTANCE ABUSE. GLENS FALLS HOSPITAL IS NOT EXPLICITLY ADDRESSING THE PRIORITY AREA OF PROMOTE HEALTHY WOMEN, INFANTS, AND CHILDREN, BUT IS CONTINUOUSLY WORKING TO SUPPORT THE NEEDS OF THESE PATIENTS. WITH RESPECT TO THE PRIORITY AREA PROMOTE A HEALTHY AND SAFE ENVIRONMENT, THE MAJORITY OF THESE FOCUS AREAS ARE BEYOND THE CAPACITY AND SCOPE OF THE EXPERTISE OF GFH AND THE HEALTHCARE SECTOR. EFFORTS TO ADDRESS THESE AREAS ARE BETTER LEAD BY POLICY MAKERS AND OTHER COMMUNITY STAKEHOLDERS THROUGH COLLABORATION AND SUPPORT OF THE HEALTHCARE SECTOR. GFH WILL CONTINUE TO SUPPORT THE COUNTIES AS THE PUBLIC HEALTH DEPARTMENTS DEVELOP AND MAINTAIN RELEVANT PROGRAMS FOR THESE FOCUS AREAS. 24 Advanced Imaging at Baybrook 22 Willowbrook Road Queensbury NY 12804 Hosp. Extension Clinic - Diagnostic OP Radiology CT Scanner Behavioral Health ServicesRidge Commons 1 Lawrence Street Glens Falls NY 12801 Hosp. Extension Clinic - O/P Mental Health Services Cambridge Family Health Clinic 35 Gilbert Street Cambridge NY 12816 Hosp. Extension Clinic - Primary Medical Care, O/P Radiology, MHU, PT Center for Recovery 101 Ridge Street Glens Falls NY 12801 Hosp. Extension Clinic - Chemical dependence, O/P Rehab Evergreen Health Center Evergreen Plaza 13 Palmer Avenue Corinth NY 12822 Hosp. Extension Clinic - Primary Medical Care, O/P Radiology, PT Fort Edward Family Medicine 327 Broadway Fort Edward NY 12828 HOsp. Extension Clinic - Primary Medical Care O/P GFH Outpatient Renal Dialysis Center 3 Broad Street Glens Falls NY 12801 HOsp. Extension Clinic - O/P Renal Dialysis, Home Dialysis training GFH Sleep Lab 92 Broad Street Glens Falls NY 12801 Hosp. Extension Clinic - Primary Medical Care, Sleep studies GFH Broad Street Campus 2 Broad Street Glens Falls NY 12801 HOsp. Extension Clinic - Primary Medical Care GFH Cardiac Rehab 6 Hearts Way Queensbury NY 12804 Hosp. Extension Clinic - Cardiac Rehab GRANVILLE HEALTH CENTER 79 North Street Granville NY 12832 Hosp. Extension Clinic - Primary Medical Care, O/P Radiology, Lab, PT Greenwich Family Health Center 1112 County Rt 29 Greenwich NY 12834 Hosp. Extension Clinic - Primary Medical Care, O/P Radiology, PT Hoosick Falls Family Health Center 16 Danforth Street Hoosick Falls NY 12090 HOsp. Extension Clinic - Primary Medical Care, O/P Radiology, PT Hudson Falls Internal Medicine 325 Main Street Hudson Falls NY 12839 Hosp. Extension Clinic - Primary Medical Care Main Street Physical Therapy 17 Main Street Glens Falls NY 12801 Hosp. Extension Clinic - Physical Therapy O/P Mobile Pediatric Dental Van 100 Park Street Glens Falls NY 12801 Hosp. Extension Clinic - O/P Dental Services Salem Family Health Center 213 Main Street Salem NY 12865 Hosp. Extension Clinic - Primary Medical Care, O/P Physical Therapy The Center for Recovery 340 Main Street Glens Falls NY 12801 Hosp. Extension Clinic - Chemical dependency O/P Rehab THE MEDICAL CENTER AT WILTON 135 North Road Gansevoort NY 12831 Hosp. Extension Clinic - PRIMARY MEDICAL CARE, O/P RADIOLOGY, LAB, PT THE REHAB CENTER & HEARING CENTER 2 Country Club Rd Queensbury NY 12804 Hosp. Extension Clinic - PT, OT, Speech, Audiology Whitehall Health Center 65 Poultney Street Whitehall NY 12887 Hosp. Extension Clinic - Primary Medical Care, O/P Radiology, Rehab Wilton Health Center 11 Carpenter Lane Wilton NY 12866 HOsp. Extension Clinic - Primary Medical Care, Lab Services Stuart M Townsend Middle School 27 Hyland Drive Lake Luzerne NY 12846 School Based HOsp. Ext.Clinic- Health Ed, Immunology, Screenings Whitehall Elementary School Buckley Road Whitehall NY 12887 School Based HOsp. Ext.Clinic- Health Ed, Immunology, Screenings Part 1, Line 6a GLENS FALLS HOSPITAL PROVIDES AN ANNUAL REPORT TO THE COMMUNITY WHICH INCLUDES A COMPREHENSIVE OVERVIEW OF OUR COMMUNITY BENEFIT PROGRAM DESCRIPTIONS. The report is mailed to donors, Board Members and members of the community. In addition, hard copies of the report are available at the Glens Falls Hospital Foundation office and at various locations throughout the community. Part 1, Line 7 THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS REPORTED IN THE TABLE WAS A COST-TO-CHARGE RATIO AS DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TOCHARGES. Part II, Community Building Activities Glens Falls Hospital regularly assesses the makeup of the region's physician population, paying particular attention to physicians who may be approaching retirement age and specialties that may have a physiCian shortage due to retirement or relocation. To insure that there is never a shortage of physicians across all specialties the Hospital now employs a physician recruiter. The position actilvely recruits for vacancies and shortages among hospital employed physicians, and partners with independent practices to help them keep a full complement of physicians across specialties. The Hospital also monitors and actively engages in preventing the spread of infectious disease through school based health and the Hospital's infection control program. This includes vaccinations for children, and access to flu vaccines for the residents of our service area, (free or at a significantly reduced cost), including an annual HPODS drill. The Hospital meets regularly with community groups in planning for emergency preparedness. Coordinating with police depts, fire departments, EMS and county officials. Emergency drills are carried out for such things as natural disasters, terrorism, accidents with mass casualties and bio hazards. Community members play an active roll in these drills. Part III, Section A, Line 2 Glens Falls Hospital considers 100% of the amount reported in Part III, line 2 & 3 a community benefit. Glens Falls Hospital is the only comprehensive acute-care hospital serving a predominately rural, 3,000-square mile area of upstate New York that encompasses Warren, Washington, Hamilton, Essex and northern Saratoga counties. In a very real sense, it is the safety-net hospital for the patients in these communities. THE HOSPITAL PROVIDES SERVICES TO ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY AND GRANTS CREDIT TO ALL PATIENTS REGARDLESS OF CREDITWORTHINESS AND WITHOUT COLLATERAL. WHILE THE HOSPITAL PRUSUES COLLECTIONS OF AMOUNTS OWED INCLUDING THE USE OF COLLECTION AGENCIES, IT DOES SO IN A MANNER THAT IS RESPECTFUL OF THE NEEDS OF OUR PATIENTS, IN ADHERENCE WITH ALL APPLICABLE LAWS AND IS REFLECTIVE OF OUR VALUES AND PUBLIC MISSION. WE ENTERTAIN REASONABLE SETTLEMENT OFFERS, INCLUDING PROVIDING DISCOUNTS FOR PAYMENT AND OFFERING PAYMENT PLANS WHERE WE ACCEPT REASONABLE MONTHLY INSTALLMENTS BASED ON THE INDIVIDUAL'S MEANS. LITIGATION IS COMMENCED SELECTIVELY AND ONLY AS A LAST RESORT. APPROXIMATELY 60% OF THE AMOUNTS WRITTEN OFF AS BAD DEBT ARE FOR PATIENTS WHO HAVE NO INSURANCE COVERAGE FOR THE SERVICES PROVIDED. THE HOSPITAL APPROVES 98% OF APPLICATIONS IT RECIEVES FOR PATIENT ASSISTANCE. THE COSTING METHODOLOGY USED TO DETERMINE THE AMOUNT REPORTED ON PART III, LINE 2 IS AS FOLLOWS. GROSS BAD DEBT PER THE GENERAL LEDGER IS MULTIPLIED BY THE RATIO OF COST TO CHARGES TO GET AN ESTIMATED COST OF BAD DEBT ATTRIBUTABLE TO PATIENT ACCOUNTS. EXPECTED POOL PAYMENTS ARE ADDED TO THIS RESULT TO GET A TOTAL COMMUNITY BENEFIT. THIS ESTIMATED COMMUNITY BENEFIT IS REDUCED BY RECOVERIES, REVENUE FROM UNCOMPENSATED CARE POOLS AND MEDICARE BAD DEBT REIMBURSEMENT TO ARRIVE AT A NET COMMUNITY BENEFIT REPORTABLE ON LINE 2. PART III, SECTION A, LINE 3 A LARGE PORTION OF PATIENT ACCOUNT BALANCES THAT END UP AS BAD DEBT WOULD LIKELY QUALIFY FOR BENEFITS UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM, BUT NOT ALL PATIENTS TAKE THE OPPORTUNITY TO APPLY FOR SUCH BENEFITS OR SUPPLY DOCUMENTATION ALLOWING US TO ASSESS THEIR ABILITY TO QUALIFY. AN ESTIMATE OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY IS ARRIVED AT BY TAKING TOTAL CHARITY CARE CHARGES FROM THE ICR, REDUCED BY THE FREE CARE ALLOWANCE ON THE ICR. THIS RESULT IS MULTIPLIED BY A RATIO OF COST TO CHARGES. THE NET RESULT IS FURTHER REDUCED BY PAYMENTS FOR UNCOMPENSATED CARE PARTIAL PAYMENTS BY PATIENTS APPROVED FOR CHARITY CARE. Part III, Section A, Line 4 FOOTNOTE G OF THE AUDITED FINANCIAL STATEMENTS STATES THAT THE HOSPITAL PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS PATIENT FINANCIAL ASSISTANCE PROGRAM WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. BECAUSE THE HOSPITAL DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, THEY ARE NOT REPORTED AS PATIENT SERVICE REVENUE. THE HOSPITAL MAINTAINS RECORDS TO IDENTIFY AND MONITOR THE LEVEL OF CHARITY CARE IT PROVIDES. THE COST OF CHARITY CARE WAS DETERMINE BASED ON THE APPLICATION OF A RATIO OF OVERALL HOSPITAL COSTS TO PATIENT CHARGES. THE HOSPITAL GRANTS CREDIT WITHOUT COLLATERAL TO PATIENTS, MOST OF WHOM ARE LOCAL RESIDENTS AND ARE INSURED UNDER THIRD PARTY AGREEMENTS. ADDITIONS TO THE ALLOWANCE FOR ESTIMATED UNCOLLECTIBLE ACCOUNTS ARE MADE BY MEANS OF THE PROVISION FOR BAD DEBTS. ACCOUNTS WRITTEN OFF AS UNCOLLECTIBLE ARE DEDUCTED FROM THE ALLOWANCE. THE AMOUNT OF THE PROVISION FOR BAD DEBTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL EXPECTED NET COLLECTIONS, BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN FEDERAL AND STATE GOVERNMENTAL HEALTH CARE COVERAGE, AND OTHER COLLECTION INDICATORS. SERVICES RENDERED TO INDIVIDUALS WHEN PAYMENT IS EXPECTED AND ULTIMATELY NOT RECEIVED ARE WRITTEN OFF TO THE ALLOWANCE FOR ESTIMATED UNCOLLECTIBLE ACCOUNTS. Part III, Section B, Lines 5,6,7 In addition to the amount included in the Medicare Cost Report and reported on lines 5,6 & 7, the hospital incurred losses on services provided to Medicare patients and paid for under the Part B fee schedule and not reportable on the Medicare Cost Report. A complete reconciliation of amounts reportable in Section B. Total revenues included on the Medicare Cost Report, reported on line 5 $69,492,339 Total revenues from Medicare Part B services, not reported on line 5 $1,117,527 ---------------------------------------------------------------- Total revenues for Medicare services $70,609,866 Total costs included on the Medicare Cost report, reported on line 6 $76,449,304 Total costs from Medicare Part B services, not reported on line 6 $ 1,423,299 ----------------------------------------------------------------- Total costs from Medicare services $ 77,872,603 Total (shortfall) included on the Medicare Cost Report, reported on line 7 $ 6,956,965 Total (shortfall) from Medicare Part B services, not reported on line 7 $ 305,772 ------------------------------------------------------------------ Total (Shortfall) for Medicare services $ 7,262,737 Part III, Line 8 The costing methodology used to determine the Medicare allowable costs reported in the organization's Medicare Cost Report, as reflected on line 6, is the methodology prescribed by Medicare in the completion for Form CMS-2552-96 and conforms to the requirements and principals set forth in 42 CFR, Part 412, 42 CFR, Part 413 and in the Provider Reimbursement manual, Part 1. GLENS FALLS HOSPITAL CONSIDERS 100% OF THE AMOUNT REPORTED IN PART III, LINE 7 A COMMUNITY BENEFIT. GLENS FALLS HOSPITAL IS THE ONLY COMPREHENSIVE ACUTE-CARE HOSPITAL SERVING A PREDOMINATELY RURAL, 3,000 SQUARE MILE AREA OF UPSTATE NEW YORK THAT ENCOMPASSES WARREN, WASHINGTON, HAMILTON, ESSEX AND NORTHERN SARATOGA COUNTIES. IN A VERY REAL SENSE, IT IS THE SAFETY NET HOSPITAL FOR THE MEDICARE PATIENTS IN THESE COMMUNITIES. DESPITE THE FACT THAT THE PAYMENTS RECEIVED FROM MEDICARE FOR THE SERVICES PROVIDED ARE GENERALLY BELOW THE RATES THAT THE HOSPITAL RECEIVES FROM MANAGED CARE PAYERS AND PRIVATE INSURERS THE HOSPITAL REMAINS COMMITTED TO SERVING ELDERLY PATIENTS AND IMPROVING THE HEALTH STATUS OF THE ELDERLY. Part III, Section C, Line 9b It is Glens Falls Hospital policy to delay final collections efforts while a patient financial assistance application is in process. A final determination is required before outside collection efforts are initiated. Part V, Line 22d The hospital determined in 2014 the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care based on the amounts paid by the hospital's highest volume contracted payor. Part VI, Line 2 Glens Falls Hospital completes a NY State Department of Health required Community Needs Assessment in partnership with the Public Health Departments of the counties we serve (Warren, Washington, Hamilton, Essex, and Saratoga)and the NYS Department of Health. This assessment is available via PDF (http://www.arhn.org/regional-health-assessment.php), through the county public health department. Part VI, Line 3 Patient education of eligibility for assistance - Brochures are given at the point of service. All patient's statements advertise charity care programs. Customer Service reps are trained to outline and encourage participation in the program. Vender Medicaid eligibility process includes charity care screening step for all inpatient and outpatient. Website contains information on charity care programs and web portal gives the ability to complete an online application. Part VI, Line 4 Community information - The Glens Falls Hospital healthcare system serves a large area of upstate New York that includes all or portions of the following counties: Warren, Washington, Hamilton, Essex and Northern Saratoga. The service area covers approximately 400,000 people; the population is largely white, non-Hispanic (93.5%). Approximately 40% of the female population is of child-bearing age. People over the age of 65 constitute 13.9% of the population; children under the age of 15 make up 16.8% of the population. The average household income is $67,708, essentially equal to the national average of $67,918. One in four people has obtained a Bachelor's degree or higher level of education (25.7%). By 2015 the population of this area is expected to grow by 3.4%. Two age groups that will see the greatest growth are people aged 55 to 65 years and older. It is estimated that these two segments of the population together will constitute 29.1 % of the total population by 2015. Part VI, Line 5 PROMOTION OF COMMUNITY HEALTH GFH IS GOVERNED BY AN 15 MEMBER BOARD OF GOVERNORS, ALL OF WHOM LIVE IN THE HOSPITAL'S SERVICE AREA. ANY AND ALL PHYSICIANS LIVING IN THE SERVICE AREA WHO ARE QUALIFIED, AND WHO MEET REQUIREMENTS AS DOCUMENTED IN THE MEDICAL STAFF BYLAWS, ARE EXTENDED PRIVILEGES. FUND IN EXCESS OF EXPENSES ARE ALLOCATED FOR CAPITAL PROJECTS, MEDICAL RESEARCH AND CLINICAL TRIALS, PATIENT CARE IMPROVEMENTS AND SYSTEM IMPROVEMENTS. CAPITAL PROJECTS ARE PRIORITIZED BY AN INTERDISCIPLINARY COMMITTEE, CONSISTING OF PHYSICIAN FROM DIFFERENT SPECIALTIES, AS WELL AS HOSPITAL MANAGEMENT. Part VI, Line 7 STATE IN WHICH THE ORGANIZATION FILES A COMMUNITY BENEFIT REPORT NEW YORK STATE X X X X X X true false false false false false false true false DIANNE SHUGRUE PRESIDENT/CEO 423584 0 0 0 1806 0 10123 0 719 0 436232 0 0 0 JOHN P STOUTENBURG MD CANCER CTR PHYS 592890 0 22448 0 449 0 10400 0 5827 0 632014 0 0 0 PATRICK ROWLEY MD CARDIAC PHYSICIAN 386406 0 176451 0 630 0 10400 0 8474 0 582361 0 0 0 SCOTT MUNRO MD CARDIAC PHYSICIAN 386317 0 178841 0 630 0 9799 0 8474 0 584061 0 0 0 John Layden MD CARDIAC PHYSICIAN 386317 0 178235 0 2228 0 10400 0 8474 0 585654 0 0 0 IQBAL BASHIR MD CARDIAC PHYSICIAN 386317 0 179682 0 420 0 10400 0 8473 0 585292 0 0 0 MITCH AMADO CFO 274274 0 6000 0 5734 0 0 0 5587 0 291595 0 0 0 PAUL SCIMECA SR VP STRAT. PLANNING 241992 0 0 0 1782 0 10006 0 7343 0 261123 0 0 0 MARK HOLTZ SR VP OPERATIONS 203977 0 0 0 24689 0 10006 0 4980 0 243652 0 0 0 KYLE BROCK VP HUMAN RESOURCES 210000 0 20000 0 0 0 0 0 378 0 230378 0 0 0 ROBERT PRINGLE MD VP MED AFFAIRS & CO 208646 0 0 0 3898 0 7805 0 2683 0 223032 0 0 0 DONNA KIRKER VP PATIENT SERVICES 206664 0 0 0 658 0 7647 0 553 0 215522 0 0 0 ED HANCHETT VP CLINICAL SERVICES 159283 0 0 0 1413 0 6600 0 7550 0 174846 0 0 0 Part 1, Line 4a In 2014 Mark Holtz recieved a severance payment of $ 11,538. Part 1, Line 7 Physicians are eligible and did receive additional compensation through participation in an incentive program that addressed quality, patient satisfaction and their personal productivity. A Warren Washington Cty IDA Series A 144085209 934651AS9 2003-10-16 35871377 Hospital expansion & equipment false false false B Warren Washington Cty IDA series B 144085209 934651AZ3 2003-10-16 20038436 Hospital expansion & equipment false false false C Warren Washington Cty IDA series C 144085209 934651BR0 2003-10-16 12393178 Hospital expansion & equipment false false false A 4895000 0 36992048 2415978 0 0 717418 3527563 0 29715852 0 0 2005 false false true true B 6415000 0 20605878 1480800 0 0 400770 1856320 0 16454529 0 0 2005 false false true true C 4315000 0 12712855 775700 0 0 247684 972412 0 10500082 0 0 2005 false false true true A false false false false 0 false false false false B false false false false 0 false false false false C false false false false 0 false false false false A false false false true false false 0 false false false 0 false true B false false false true false false 0 false false false 0 false true C false false false true false false 0 false false false 0 false true A false B false C false Part v During Sept 2003, the counties of warren and washington industrial development agency (issuer) issued civic facility revenue bonds. series A 2003 $36,200,000; Series B, 2003, $20,000,000; and series c 2003, $12,435,000 for the purpose of financing the hospital's expansion and renovation construction of the northwest tower, refinancing the hospital's series 1975 and 1979 bonds issued by the dormitory authority of the state of new york, fund a debt services reserve and provided the funding for the financing expenses. The final maturity date is 12/01/35. The remaining balances of the bonds that were refinanced from the dormitory authority were $5,387,352. PART IV, LINE 2C The rebate computation was performed of 10/16/14. Michael Clarke Board chairman 368664 Loan from GFNB false Thomas J Murphy Director 368664 Loan from GFNB false James E Cullum Director 323075 Attorney false John C Bieniek Director 958852 Insurance Broker false mICHAEL cLARKE IS THE CHAIRMAN FOR THE gLENS FALLS HOSPITAL BOARD, WHO IS ALSO ON THE BOARD OF ARROW FINANCIAL GROUP, WHICH IS THE PARENT OF GLENS FALLS NATIONAL BANK. The Hospital did independent due diligence in selecting the financial institution that provided the most competitive rates. Thomas Murphy is a director on the Glens Falls Hospital Board who is also President of Glens Falls National Bank. Glens Falls Hospital has a business relationship with Glens Falls National Bank. The Hospital did independent due diligence in selecting the financial institution that provided the most competitive rates. John C. Bieniek is a director on the Glens Falls Hospital Board who is a V/P and partner at Cool Insuring Agency. The Hospital engages the Cool Insuring Agency for many of its business related insurance needs. James Cullum is a Director of the Glens Falls Hospital Board. Mr. Cullum is a partner with the law firm McPhillips, Fitzgerald & Cullum. Glens Falls Hospital engages McPhillips, Fitzgerald & Cullum for malpractice litigation. All of Glens Falls Hospital Board members are required to sign a conflict of interest policy, to ensure that the Hospital operates in a manner consistent with its charitable purposes. Activities, arrangements and services are the result of arms length bargaining reflecting reasonable payments for goods and services. Board bylaws stipulate that board members recuse themselves regarding any subject that pertains to a potential conflict of interest. Glens Falls Hospital Part I, Line 1 & Part III, Line 1 Glens Falls Hospital is an acute care facility and is the largest hospital between Albany and Montreal. It serves 6 counties and operates 24 regional care facilities. We have more than 225 affiliated, board certified physicians, ranging from primary care to surgical specialties. Glens Falls Hospital provides access to primary care and preventative health education and outreach activiites, services offered to the community for free or reduced costs including patient financial assistance and charity care. The mission of Glens Falls Hospital is to improve the health of the people in our region by providing access to exceptional, affordable, and patient-centered care every day and in every setting. Our fundamental values are C.A.R.E.S. Collaboration, Accountability, Respect, Excellence and Safety. Part VI, Section A, Line 9 Mark Holtz, c/o Waterbury Hospital, 64 Robbins St, Waterbury, CT 06721. Part VI, Section A, Line 11 A copy of Form 990 was given to the Hospital's audit and compliance committee to review and comment on at their regular meeting. The form was approved by the committee and filed on a timely basis. The form was also given to the CFO, the Controller, and the Assistant Controller to review and comment on. In addition, the form was reviewed by an independent accountant, KPMG, to make sure it was filled out completely and accurately. Part VI, Section B, Line 12b Each director, principal officer and member of a committee with board delegated powers shall annually sign a statement which affirms that such person a) has received a copy of the conflicts of interest policy, b) has read and understands the policy, c) has agreed to comply with the policy and d) understands that the corporation is a charitable organization and that in order to maintain its Federal exemption it must engage primarily in activities which accomplish one or more of its tax exempt purposes. To ensure that the corporation operates in a manner consistent with its charitable purposes and that it does not engage in activiites that could jeopardize its status as an organization exempt from federal income tax, periodic reviews shall be conducted. Reviews shall include the following subjects: A) whether compensation arrangements and benefits are reasonable and are the result of arm's length bargaining. B) whether acquisitions of physician practices and other provider services result in inurement or impermissible private benefit. C) whether partnership and joint venture arrangements and arrangements with management service organizations and physician hospital organizations conform to written policies, are properly recorded, reflect reasonable payments for goods and services, further the corporation's charitable purposes and do not result in inurement or impermissible private benefit. In conducting reviews, the corporation may use outside advisors. Part VI, Section B, Line 15b Glens Falls Hospital is committed to developing and maintaining a total compensation program that is competitive with programs offered by other health care organizations that are comparable to Glens Falls Hospital in revenue, structure, mission and scope of services. The compensation philosophy includes: base salary ranges positioned in the 50th percentile of a national and regional peer group, annual incentive opportunities tied to performance goals established by the Board, benefits delivered in the 50th percentile of a national peer group and total compensation positioned at approximately the 50th percentile for expected performance and somewhat above that for exceptional performance. Executive pay is reviewed annually by a third party consultant. This review includes comparison of Glens Falls Hospital executive pay practices with national and regional benchmark studies as appropriate. The consultant is engaged directly by the Glens Falls Hospital Board of Governors and reports their findings to the Board Personnel Committee for review and action. Part IV, Section C, Line 19 The organization makes its governing documents, conflicts of interest policy and financial statements available upon request. Part XI, Line 5 Unrestricted Net Assets: Net assets released from restrictions 2,010,527 Net actuarial (loss) on accrued post retirement benefits (144,313) Temporary Restricted Net Assets: Restricted gifts & distributions from GFH Foundation 2,333,131 Change in interest in net assets of GFH Foundation (25,695) Restricted income 164,839 Net Assets released from restrictions (2,432,492) Change in unrealized (losses) on investments (10,137) Net change in unrealized losses on trading investments (989,283) ---------------- Total 906,577 Glens Falls Hopital Foundation 100 Park Street Glens Falls NY 12801 141790805 Support Org NY 501(c)(3) 11,Type III NA false Adirondack Health Services Inc 100 Park Street Glens Falls NY 12801 141667492 Parent Org. NY 501(c)(3) 11, Type I NA false McGregor Realty Corporation 100 Park Street Glens Falls NY 12801 141560380 Property rent NY 501(c)(2) GFH true Greater Adirondack Home Aides 100 Park Street Glens Falls NY 12801 141491972 Home Health NY 501(c)(3) 7 NA false Lower Adirondack Wilderness Rescue 100 Park Street Glens Falls NY 12801 542082693 Wildrnes res. NY 501(c)(3) 7 NA false Imag Svc of NENY 100 Park Street Glens Falls NY 12801 141820955 Diag. radiology NY NA RELATED 363021 139043 false 0 false 0.50000 No Country Eye Ctr 465B Maple Ave Saratoga NY 128665531 453715451 Eye Center NY NA RELATED -35706 -150879 false 0 false 0.30000 false false false false false false false false false true true false false false false false false false McGregor Realty k 28500 Check Register McGregor Realty l 43200 Financial Stats