2014-11-14T15:56:53-06:00 2013-12-31 161226221 FUST CHARLES CHAMBERS LLP 5784 WIDEWATERS PARKWAY SYRACUSE NY 13214 990 2013-01-01 150533578 LITTLE FALLS HOSPITAL LITT 3158231000 140 BURWELL STREET LITTLE FALLS NY 13365 JAMES VIELKIND CFO 3158231000 2014-11-14 1 JOSEPH J SCHLEGEL P00301329 3154463600 2013 2015-11-30 17:44:51Z JAMES VIELKIND 140 BURWELL STREET LITTLE FALLS NY 13365 34558310 0 X LFHNY.ORG X 1893 NY LITTLE FALLS HOSPITAL IS A CRITICAL ACCESS HOSPITAL PROVIDING ACCESS TO HEALTH CARE SERVCIES TO RESIDENTS OF HERKIMER COUNTY, AND WESTERN PORTIONS OF MONTGOMERY AND FULTON COUNTIES. LITTLE FALLS HOSPITAL EMERGENCY DEPARTMENT IS STAFFED WITH PHYSICIANS ON A 24/7 BASIS. TWENTY FIVE BEDS ARE USED FOR INPATIENT AND SKILLED NURSING CARE. AMBULATORY SURGERY SERVCIES ARE PROVIDED FOR A VARIETY OF SPECIALTIES. PERFORMANCE IMPROVEMENT AND HIGH QUALITY OF CARE IS DEMOSTRATED WITHIN THE HOSPITAL CONSUMER ASSESSMENT OF HEALTHCARE PROVIDERS AND SYSTEMS (HCAHPS) AS REPORTED IN HOSPITAL COMPARE. 16 12 348 27 0 0 589094 411685 28142900 29807878 61421 460212 0 0 28793415 30679775 0 0 0 0 14326208 14777416 9250 0 65825 14047264 15316593 28382722 30094009 410693 585766 34802499 34633842 15228007 11534264 19574492 23099578 X LITTLE FALLS HOSPITAL IS A VOLUNTARY, NOT-FOR-PROFIT COMMUNITY HEALTHCARE SYSTEM WHOSE MISSION IS TO OFFER QUALITY CARE WITH COMPASSION, TO ALL WHO NEED OUR SERVICES. 0 1 7896230 8438791 INPATIENT SERVICESLITTLE FALLS HOSPITAL INPATIENT SERVICES IMPLEMENTED THE EPIC ELECTRONIC HEALTH RECORD IN FEBRUARY 2013. THE USE OF AN ELECTRONIC HEALTH RECORD ALLOWED FOR NEW WORK-FLOW PATIENT CENTERED DESIGNED SYSTEMS TO IMPROVE QUALITY OF SERVICES AND PROVIDE MORE EFFICIENT CARE OF PATIENTS. THE HOSPITAL IMPROVED THE HOSPITAL CONSUMER ASSESSMENT OF HEALTHCARE PROVIDERS AND SYSTEMS (HCAHPS) RATING TO 82 FROM 74 FOR PATIENTS RECOMMENDING THE HOSPITAL, USING INDEPENDENT SURVEY METHODS. THE INPATIENT OCUUPANCY RATE FOR INPATIENT AND OBSERVAITON SERVICES WAS 76% FOR AN AVERAGE DAILY INPATIENT DAILY CENSUS OF 19 PATIENTS. AS A CRITIACL ACCESS HOSPITAL (CAH) PROVIDER OUR INPATIENT DAILY CENSUS IS LIMITED TO 25 PATIENTS PER DAY. 8363856 8896506 LITTLE FALLS HOSPITAL OPERATES AN EMERGENCY DEPARTMENT WITH TWENTY FOUR HOURS OF PHYSICIAN COVERAGE SEVEN DAYS PER WEEK. THE EMERGENCY DEPARTMENT PROVIDED ACCESS TO CARE FOR APPROXIMATELY 15,000 PATIENTS IN 2013. THESE SERVCIES ARE PROVIDED TO ALL PATIENTS REGARDLESS OF ABILITY TO PAY. THE HOSPITAL WAS AWARDED NEW YORK STATE VITAL ACCESS PROVIDER DESIGNATION BASED ON THE HIGH SAFETY NEED OF THE SERVICE AREA. A PLAN WAS APPROVED BY NEW YORK STATE DEPARTMENT OF HEALTH IN 2013 TO DEVELOP PATIENT ALTERNATIVE PROGRAMS AND RELATED EDUCATION FOR OPTIONS OTHER THAN USING AN EMERGENCY DEPARTMENT FOR SERVICES DEEMED AS AMBULATORY CARE SENSITIVE. 7891463 10142640 TOTAL AMBULATORY OUTPATIENT SERVICE VISITS WERE APPROXIMATELY 34,000 VISITS IN 2013. THE HOSPITAL COMPLETED A TWELVE MILLION DOLLAR RENOVATION OF THE AMBULATORY SERVICE AREAS. THIS INVESTMENT HAS ALLOWED FOR PATIENT CONVENIENCE FOR EASE OF ACCESS,REDUCED WAITING TIMES FOR SERVICES, AND IMPROVED PRIVACY. THESE AMBULATORY SERVICE AREAS INCLUDE REHAB / WELLNESS PROGRAM, AMBULATORY SURGERY / GI SERVIES, WOMENS IMAGING SERVICE, DIAGNOSTIC IMAGING SERVICES, AND PATIENT ACCESS SERVICE AREA. 1411893 2708266 THE HOSPITAL RECEIVED NYS MEDICAID AND CMS MEDICARE FUNDS FOR "MEANINGFUL USE" ASSOCIATED WITH IMPLEMENTATION OF THE ELECTRONIC HEALTH RECORD OF $199,000 IN 2013. 1411893 2708266 25563442 1 1 0 0 0 0 0 0 0 1 1 1 1 0 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 54 0 1 348 1 0 0 0 0 0 0 0 0 0 0 X 16 12 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X JAMES G VIELKIND 3158235281 140 BURWELL STREET LITTLE FALLS NY 13365 JOHN BULLIS CHAIRMAN 2.00 1.50 X X 0 0 0 JOAN S CONBOY TRUSTEE 2.00 X 0 0 0 TIMOTHY DALY TRUSTEE 2.00 X 0 0 0 ANTHONY DELUCA FIRST VICE CHAIRMAN 2.00 X X 0 0 0 JOY MALONE TRUSTEE 2.00 X 0 0 0 GERARD J SNYDER SECRETARY 2.00 X X 0 0 0 JENNIFER VANWAGONER SECOND VICE CHAIRMAN 2.00 X X 0 0 0 RANBIR SODHI MD TRUSTEE 2.00 X 0 0 0 AUGUST LEINHART MD TRUSTEE 2.00 40.00 X 0 539284 25981 NICHOLAS J NICOLETTA TREASURER 2.00 51.50 X X 0 427411 29283 JEFFREY WOEPPEL THIRD VICE CHAIRMAN 2.00 48.00 X X 0 215179 24045 KEVIN CROSLEY TRUSTEE 2.00 X 0 0 0 JUSTIN HUMMEL TRUSTEE 2.00 X 0 0 0 AMY GRACE MD PRESIDENT OF MEDICAL STAFF 2.00 40.00 X 10950 184666 14093 ROBERT CASULLO TRUSTEE 2.00 X 0 0 0 DUANE SIDNEY TRUSTEE 2.00 X 0 0 0 MICHAEL OGDEN PRESIDENT & CEO 40.00 X 0 188485 10249 JAMES G VIELKIND CHIEF FINANCIAL OFFICER 40.00 X 132795 0 4203 RICHARD NOCELLA PRIMARY CARE PHYSICIAN 40.00 X 144888 0 18281 288633 1555025 126135 5 0 1 1 BIVENS & ASSOCIATES ARCHITECTS 528 PLUM STREET SUITE 200 SYRACUSE NY 132041473 ARCHITECT SERVICES 208425 MEDSPAR LLC PO BOX 830 BINGHAMTON NY 139020830 BILLING SERVICES 143590 DM CONSULTING PO BOX 4715 UTICA NY 13504 INFORMATION TECHNOLOGY 116984 TWO BROTHERS CONTRACTING 185 MOHAWK STREET WHITESBORO NY 13501 CONTRACTOR SERVICES 105929 4 200033 211652 411685 OUTPATIENT SERVICES 623000 20774204 20774204 INPATIENT HOSPITAL 621930 8438791 8438791 PROGRAM SERVICE LEASE 532000 375735 375735 HOSPITAL CAFETERIA 900099 134401 134401 OTHER OPERATING REVENUE 900099 84747 84747 29807878 61383 61383 4277364 3878535 398829 398829 398829 30679775 30268090 0 0 147948 10950 136998 11136242 9550592 1540939 44711 735251 625850 106451 2950 1930412 1636881 285888 7643 827563 701366 122914 3283 94609 94609 53314 24167 29147 60968 60968 745302 484539 260763 44768 44768 2095392 2022276 71991 1125 943920 852273 91647 611340 534351 76440 549 56053 21619 33639 795 164933 147966 16950 17 1817734 1630743 186809 182 250400 236311 14089 PURCHASED MEDICAL SERVI 4271705 4271705 PROVISION FOR BAD DEBT 2319023 2319023 ADMINISTRATIVE SERVICES 1115598 1115598 NEW YORK STATE ASSESSME 87511 87511 584023 360551 218902 4570 30094009 25563442 4464742 65825 1265667 748500 1146049 1406653 4009271 448936 3044932 3074852 394976 480659 1607890 746146 39294645 19106736 13259854 20187909 4883639 1936332 2429906 2651120 2299567 2091047 460748 861688 34802499 34633842 4192044 3133077 31431 266146 5119529 4583864 5885003 3551177 15228007 11534264 X 9475082 18836002 9327867 3381689 771543 881887 19574492 23099578 34802499 34633842 X 585766 138190 2801130 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 8380 8380 0 PART II-B, LINE 1: A PERCENTAGE OF MEMBERSHIP DUES PAID TO HEALTHCARE ASSOCIATION OF NEW YORK STATE (28%), IROQUOIS HEALTHCARE ALLIANCE (42.8%) AND AMERICAN HOSPITAL ASSOCIATION (23.65%) ARE USED SPECIFICALLY FOR LOBBYING PURPOSES. 10099410 720 361656 6198210 4263576 12753313 12870 1085526 3752299 10099410 12156996 623347 -27030 12753313 5547082 5230555 1782439 403080 12156996 2664349 174329 3874661 1166257 5547082 0.20680 0.79320 1 0 380386 380386 23703285 11019424 12683861 15210974 8087312 7123662 20187909 MARY LEARY CHARITABLE REMAINDER TR 1127931 F ELSA O'BRIEN CHARITABLE REMAINER TR 1523189 F 2651120 DIRECT FINANCE LEASE 2091047 C 2091047 ACCRUED PENSION LIABILITY 2421537 ACCRUED SALARIES, PAYROLL TAXES AND FRINGE BENEFITS 920955 OTHER LIABILITIES 208685 3551177 X 31039179 138190 221214 359404 30679775 0 30679775 30094009 0 30094009 0 30094009 PART V, LINE 4: ENDOWMENT FUNDS DISTRIBUTE INCOME FOR PURPOSES OF CAPITAL INVESTMENT. TEMPORARY ENDOWMENTS ARE USED BASED ON THE INTENT OF THE DONATION. PART X, LINE 2: THE HOSPITAL QUALIFIES AS AN ORGANIZATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL INCOME TAXES PURSUANT TO SECTION 501(A) OF THE INTERNAL REVENUE CODE AS OF DECEMBER 31, 2013 AND 2012, AS OF DECEMBER 31, 2013 AND 2012, THE HOSPITAL DID NOT HAVE ANY UNRECOGNIZED TAX BENEFITS OR ANY RELATED ACCRUED INTEREST OR PENALTIES. THE TAX YEARS OPEN TO EXAMINATION BY FEDERAL AND NEW YORK STATE TAXING AUTHORITIES ARE 2010 THROUGH 2013. THE HOSPITAL DOES NOT ANTICIPATE THAT THE TOTAL UNRECOGNIZED TAX BENEFITS WILL CHANGE IN THE NEXT TWELVE MONTHS. PART XI, LINE 2D - OTHER ADJUSTMENTS: CHANGES IN VALUE OF BENEFICIAL REMAINDER TRUST 221,214. PART VI, LINE 1B BUILDINGS INCLUDES CONSTRUCTION IN PROGRESS OF $284,582 FOR 2013 AND $5,696,846 FOR 2012. 1 1 1 X 300.000000000000 0 1 1 0 1 1 286 187643 141200 46443 0.00170 1320 976278 951634 24644 0.00090 9928 4381822 2467345 1914477 0.06890 11534 5545743 3560179 1985564 0.07150 23 41076 41076 0.00150 4384 627791 513948 113843 0.00410 4407 668867 513948 154919 0.00560 15941 6214610 4074127 2140483 0.07710 25000 3311 21689 0.00080 50000 50000 0.00180 75000 3311 71689 0.00260 1 903977 69148 9285925 9251780 34145 X 1 1 1 1 LITTLE FALLS HOSPITAL 140 BURWELL STREET LITTLE FALLS NY 13365 LFHNY.ORG 2129700H X X INCLUDES 25 INPATIENT BEDS, LITTLE FALLS HOSPITAL 1 1 X X X X X X X X 13 1 1 1 X WWW.LFHNY.ORG X WWW.BASSETT.ORG X X X X X X X X X 1 0 1 1 300.000000000000 0 1 X 1 1 X X X X X X 1 0 X X X X 1 X 0 0 PART V, SECTION A: LITTLE FALLS HOSPITAL HAS PRIMARY CARE CLINICS IN DOLGEVILLE, NY AND NEWPORT,NY. EXTENDED EVENING HOURS ARE PROVIDED ONE NIGHT PER WEEK IN THE DOLGEVILLE, NY PRIMARY CARE CENTER. LITTLE FALLS HOSPITAL PART V, SECTION B, LINE 4: THIS COMMUNITY HEALTH NEEDS ASSESSMENT WAS DEVELOPED AS PART OF A MULTI-HOSPITAL PLANNING PROCESS. THE HOSPITALS INCLUDED IN THIS PLANNING PROCESS ARE: BASSETT MEDICAL CENTER, COOPERSTOWN NEW YORK;AUREILA OSBORN FOX MEMORIAL HOSPITAL, ONENONTA NEW YORK; TRI TOWN REGIONAL HOSPITAL, SYNDEY NEW YORK; COBLESKILL REGIONAL HOSPITAL, COBLESKILL NEW YORK; O'CONNOR HOSPITAL, DELHI NEW YORK. LITTLE FALLS HOSPITAL PART V, SECTION B, LINE 12I: LITTLE FALLS HOSPITAL CHARGES FOR SERVICES BASED ON RELATIONSHIPS OF COST OF SERVICES, AND AGGREGATE MARGINS REQUIRED FOR HEALTHCARE SERVICES. LITTLE FALLS HOSPITAL PART V, SECTION B, LINE 20D: LITTLE FALLS HOSPITAL CHARGES UNIFORM CHARGES TO ALL PAYERS REGARDLESS OF RESPONSIBLE PARTY FOR THE BILL. FOR QUALIFIED UNINSURED WITHIN 300% OF FEDERAL POVERTY GUIDELINES A 100% DISCOUNT FROM CHARGES IS APPLIED. PART V, SECTION B, LINE 3 THIS COMMUNITY HEALTH NEEDS ASSESSMENT HAS TAKEN INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVED BY LITTLE FALLS HOSPITAL. ALL ORGANIZATIONS PROVIDING INPUT INTO THIS ASSESSMENT, INCLUDING THE NAME AND TITLE OF THOSE INDIVIDUALS REPRESENTATIVE OF THE ORGANIZATION IS PROVIDED IN APPENDIX 1. THIS INCLUDES INPUT FROM INDIVIDUALS WITH EXPERTISE IN PUBLIC HEALTH, INCLUDING THE DIRECTOR OF THE HERKIMER COUNTY PUBLIC HEALTH DEPARTMENT. THOSE INDIVIDUALS ARE LISTED BY NAME, TITLE, AND AFFILIATION IN APPENDIX 1. A BRIEF DESCRIPTION OF THEIR SPECIAL KNOWLEDGE OR EXPERTISE IS ALSO PROVIDED. IN ADDITION TO COMMUNITY COMMENTS AND INPUT GATHERED IN RESPONSE TO POSTING OF THE COMMUNITY HEALTH NEEDS ASSESSMENT OF BOTH THE HOSPITAL'S AND BASSETT'S HEALTHCARE NETWORK'S WEBSITES, THE PRIMARY PROACTIVE MEANS FOR RECEIVING COMMUNITY INPUT WAS THROUGH A COMMUNITY-WIDE STAKEHOLDER MEETING HOSTED BY LITTLE FALLS HOSPITAL ON NOVEMBER 7, 2012. THE PURPOSE OF THE STAKEHOLDER MEETING WAS THREEFOLD: 1) TO ELICIT GENERAL COMMENTS ON THE DRAFT CHNA; 2) TO SEEK COMMUNITY INPUT ON THE PRIORITY HEALTH NEEDS IDENTIFIED BY THE CHNA; AND 3) TO SEEK COMMUNITY INPUT ON POTENTIAL IMPLEMENTATION STRATEGIES. TWENTY-ONE INDIVIDUALS REPRESENTING 13 HEALTH PROVIDER AND COMMUNITY SERVICE ORGANIZATIONS ATTENDED THE SESSION. A SUMMARY OF COMMENTS ON THE CHNA AND THE AREA'S HEALTH PRIORITIES IS PROVIDED IN SECTION V OF THIS ASSESSMENT. A SUMMARY OF SUGGESTED IMPLEMENTATION STRATEGIES IS PROVIDED IN THE IMPLEMENTATION STRATEGY FOR THIS CHNA.IN ADDITION TO THE PROCESS AND COMMUNITY PARTICIPATION SPECIFICALLY USED IN DEVELOPING THIS COMMUNITY HEALTH NEEDS ASSESSMENT, SIGNIFICANT PROCESSES AND COMMUNITY PARTICIPATION WERE INVOLVED IN COMPILING THE LITTLE FALLS HOSPITAL COMMUNITY SERVICES PLAN AND THE HERKIMER, FULTON AND MONTGOMERY COUNTIES' HEALTH ASSESSMENTS. EACH OF THESE EFFORTS INCLUDED THEIR OWN PROCESS AND METHODS FOR IDENTIFYING COMMUNITY HEALTH NEEDS. EACH ALSO PROVIDED NUMEROUS OPPORTUNITIES FOR COMMUNITY INPUT AND PARTICIPATION IN REVIEWING AND INFLUENCING THE SELECTION OF PRIORITY HEALTH NEEDS. APPENDIX 1 - TITLE, ORGANIZATION- DIRECTOR, HERKIMER COUNTY PUBLIC HEALTH- EXECUTIVE DIRECTOR, HERKIMER HEALTHNET- MEDICAL DIRECTOR, TRI-COUNTY MEDICAL- COMMUNITY LIAISON, AT HOME CARE- CEO, UNITED WAY- ASSISTANT, HERKIMER HEALTHNET- ASSISTANT ADMINISTRATOR, VALLEY HEALTH SERVICES- COORDINATOR, HERKIMER COUNTY MENTAL HEALTH- OFFICE MANAGER, HERKIMER COUNTY WIC- NUTRITIONIST, HERKIMER COUNTY WIC- VP RESIDENTIAL, HERKIMER COUNTY ARC- EXECUTIVE DIRECTOR, HERKIMER COUNTY CATHOLIC CHARITIES- ASSISTANT EXECUTIVE DIRECTOR, HERKIMER COUNTY CATHOLIC CHARITIES- PRESIDENT & CEO, LITTLE FALLS HOSPITAL- DIRECTOR OF COMMUNITY RELATIONS, LITTLE FALLS HOSPITAL- CHAIRMAN OF BOARD, LITTLE FALLS HOSPITAL- BOARD MEMBER, LITTLE FALLS HOSPITAL- BOARD MEMBER, LITTLE FALLS HOSPITAL- MEDICAL DIRECTOR, LITTLE FALLS HOSPITAL- DIRECTOR OF PUBLIC & MEDIA RELATIONS, BASSETT MEDICAL CENTER- PRESIDENT, RURAL HEALTH DEVELOPMENTSELECTED HEALTH PRIORITIESTHE LITTLE FALLS HOSPITAL COMMUNITY HEALTH NEEDS ASSESSMENT IDENTIFIED THREE HEALTH PRIORITIES AND NINE TARGETED HEALTH OBJECTIVES. THE HEALTH PRIORITIES SELECTED INCLUDED IMPROVING ACCESS TO QUALITY HEALTH CARE, PREVENTING CHRONIC DISEASE AND PROMOTING HEALTHY WOMEN, INFANTS AND CHILDREN. IMPROVING ACCESS TO QUALITY HEALTH CAREIMPROVING ACCESS TO QUALITY HEALTH CARE IS THE FIRST PRIORITY IDENTIFIED THROUGH BY THE CHNA. THIS PRIORITY WAS SELECTED BY LITTLE FALLS HOSPITAL IN ITS COMMUNITY SERVICES PLAN, AS WELL AS BY THE HERKIMER, FULTON AND MONTGOMERY COUNTY HEALTH DEPARTMENTS IN THEIR RESPECTIVE COMMUNITY HEALTH ASSESSMENTS. IN ADDITION, THE UPSTATE HEALTH AND WELLNESS SURVEY DATA SUPPORTS THE SELECTION OF THIS PRIORITY FOR THE LITTLE FALLS SERVICE AREA, WHERE ONLY 81 PERCENT OF ADULTS REPORTED THEY HAD A PRIMARY CARE PROVIDER. THE FOCUS IN SELECTING THIS PRIORITY IS TO IMPROVE ACCESS TO PRIMARY CARE WITHIN THE SERVICE AREA. PREVENTING CHRONIC DISEASEPREVENTING CHRONIC DISEASE IS THE SECOND PRIORITY IDENTIFIED IN OUR CHNA. THIS PRIORITY WAS SELECTED BY LITTLE FALLS HOSPITAL IN ITS COMMUNITY SERVICES PLAN AND ALSO BY HERKIMER AND FULTON COUNTIES IN THEIR RESPECTIVE COMMUNITY HEALTH ASSESSMENTS. IN ADDITION, THE UPSTATE HEALTH AND WELLNESS SURVEY REPORTED THAT RATES OF SELECTED TYPES OF CANCER SCREENING IN THE LITTLE FALLS SERVICE AREA ARE SIGNIFICANTLY BELOW HEALTHY PEOPLE 2020 GOALS. THE SURVEY REPORTED THAT UNDER 67 PERCENT OF WOMEN 18 YEARS AND OLDER HAD A PAP SMEAR IN THE PREVIOUS 3 YEARS, LESS THAN 61 PERCENT OF WOMEN 40 YEARS AND OLDER HAD A MAMMOGRAM IN THE PAST 2 YEARS AND LESS THAN 54 PERCENT OF ADULTS 50 YEARS AND OLDER HAD A COLONOSCOPY IN THE PAST 5 YEARS. THE SURVEY SHOWED LEVELS OF CANCER SCREENING IN THE LITTLE FALLS HOSPITAL SERVICE AREA WERE GENERALLY LOWER (FOR ALL FORMS OF SCREENING) THAN LEVELS FOR THE BASSETT NETWORK SERVICE AREA. THE SURVEY ALSO ESTIMATED THAT NEARLY 30 PERCENT OF ADULTS IN THE LITTLE FALLS SERVICE AREA WERE OBESE. PROMOTING HEALTHY WOMEN, INFANTS AND CHILDRENPROMOTING HEALTHY WOMEN, INFANTS AND CHILDREN IS THE THIRD PRIORITY IDENTIFIED THROUGH THE CHNA. THIS PRIORITY WAS SELECTED BY LITTLE FALLS HOSPITAL IN ITS COMMUNITY SERVICE PLAN. IT WAS ALSO A PRIORITY SELECTED BY THE HERKIMER COUNTY COMMUNITY HEALTH ASSESSMENT AND AS AN AREA OF IMPORTANCE BY THE FULTON COUNTY COMMUNITY HEALTH ASSESSMENT. IN ADDITION, THE UPSTATE HEALTH AND WELLNESS SURVEY SUPPORTED THE SELECTION OF THIS PRIORITY. THE SURVEY REPORTED THAT GREATER THAN 36 PERCENT OF CHILDREN IN THE LITTLE FALLS SERVICE AREA ARE OBESE OR AT RISK FOR OBESITY. THE FOCUS OF THIS PRIORITY WILL BE ON PROVIDING EARLY PRENATAL CARE, REDUCING TEEN PREGNANCY, INCREASING IMMUNIZATION RATES FOR CHILDREN AND REDUCING OBESITY OF CHILDREN.THIS INFORMATION IS FROM LITTLE FALLS HOSPITAL 2013 COMMUNITY HEALTH NEEDS ASSESSMENT PAGES 6-7, APPENDIX 1 PAGE 22, AND IMPLEMENTATION STRATEGY FOR COMMUNITY HEALTH NEEDS ASSESSMENT PAGES 3-4. PART I, LINE 3C: LITTLE FALLS HOSPITAL DID NOT PROVIDE CHARITY CARE OR DISCOUNTED CARE TO PATIENTS WITH INSURANCE BENEFITS. PART I, LINE 7: COST FOR CHARITY CARE PATIENTS WAS CALCULATED USING RATIO OF COST TO CHARGES. COST ASSOCIATED WITH MEDICAID AND MEDICAID HMO PROGRAMS REPRESENTS AGGREGATE ALLOWABLE COST AND TOTAL GROSS CHARGES USED TO CALCULATE A FACILITY LEVEL COST TO CHARGE RATIO. THIS FACILITY LEVEL COST TO CHARGE RATIO WAS APPLIED TO TOTAL MEDICAID AND MEDICAID HMO CHARGES TO ARRIVE AT TOTAL MEDICAID COST. COST OF OTHER MEANS TESTED PROGRAMS IS COMPRISED OF MEDICAID HMO AND NYS FAMILY HEALTH PLUS INSURANCE PROGRAMS. PART I, LINE 7G: LITTLE FALLS HOSPITAL OPERATES TWO PRIMARY CARE CENTERS LOCATED IN DOLGEVILLE AND NEWPORT NEW YORK. THESE CENTERS PROVIDE PRIMARY CARE SERVICES INCLUDING VACCINATIONS, WELL CARE VISITS, PRIMARY CARE FOLLOW-UP APPOINTMENTS. USING AN ELECTRONIC HEALTH RECORD ENABLES PATIENTS TO HAVE ACCESS TO THEIR PERSONAL HEALTH INFORMATION IN A TIMELY MANNER. PART I, LN 7 COL(F): LITTLE FALLS HOSPITAL EXCLUDED $2,319,023 OF BAD DEBT EXPENSE TO CALCULATE COST OF PATIENT CARE. PART II, COMMUNITY BUILDING ACTIVITIES: COMMUNITY BUILDING ACTIVITIES ARE ASSOCIATED WITH ADMINISTERING THE COMMUNITY SERVICE PLAN, DEVELOPING HEALTH EDUCATION PROGRAMS FOR THE COMMUNITY, AND WORKING ON THE IMPLEMENTATION FOR THE INITIATIVES WITHIN THE COMMUNITY SERVICE PLAN. OUR DIRECTOR FOR COMMUNITY AFFAIRS WORK WITH COMMUNITY AGENCIES IN THIS PROCESS ALONG WITH BASSETT HEALTHCARE NETWORK STAFF TO COORDINATE THESE ACTIVITIES. PART III, LINE 2: BAD DEBT CONSIST OF UNPAID BILLS FROM PATIENTS WITHOUT INSURANCE AND AMOUNTS OWED AFTER INSURANCE BENEFITS ARE APPLIED ASSOCIATED WITH DEDUCTIBLES AND COPAYMENTS. THE GROSS AMOUNT FOR UNPAID BILLS WAS $2,319,023 OF WHICH WHEN COST FACTORS ARE APPLIED BASED ON TYPES OF SERVICES THE COST OF PROVIDING THESE SERVICES IS $903,977. PART III, LINE 3: AN ESTIMATE OF $69,148 WAS DETERMINED TO BE CLASSIFIED AS BAD DEBT VERSUS COVERED BY COMMUNITY ASSISTANCE CHARITY CARE PROGRAM. THE ASSUMPTIONS USED FOR THIS ESTIMATE INCLUDES A REDUCTION IN THE DENIAL OF APPLICATIONS FROM INCOMPLETE INFORMATION AND MEASURING THE GROWTH IN USE OF THE PROGRAM TO CONTINUE. (NOTE: IN 2013 THE GROWTH IN CHARITY CARE SERVICES WAS A 23% INCREASE FROM 2012.) PART III, LINE 4: THE HOSPITAL FOOTNOTE DESCRIBING PATIENT ACCOUNTS RECEIVABLES IS IN THE ATTACHED AUDITED FINANCIAL STATEMENTS NOTE (1)(J) PAGES 7 - 9. PART III, LINE 8: LITTLE FALLS HOSPITAL COSTING METHODOLOGY CONSISTS OF INFORMATION FROM MEDICARE COST REPORT. AS A CRITICAL ACCESS HOSPITAL PAYMENT IS BASED ON 101 % OF MEDICARE ALLOWABLE COST. THE AMOUNTS REFLECT 2% REDUCTION FOR SEQUESTRATION POLICY EFFECTIVE FOR APRIL 1, 2013. ALSO MEDICARE MEANINGFUL USE INCENTIVE PAYMENTS FOR ACHIEVING ELECTRONIC MEDICAL RECORD TECHNOLOGY UNDER PHASE I ARE INCLUDED IN OUR 2013 MEDICARE PAYMENTS. PART III, LINE 9B: COLLECTION AND CHARITY CARE POLICY SPECIFY ACCOUNTS WITH ACTIVE CARE APPLICATIONS WILL NOT GO TO COLLECTION AGENCIES WHILE IN REVIEW. PART VI, LINE 2: A. COMMUNITY HEALTH NEEDS ASSESSMENT DEVELOPMENT PROCESSTHE PROCESS FOR DEVELOPING THIS COMMUNITY HEALTH NEEDS ASSESSMENT ENTAILED THE COMPLETION OF A FOURTEEN-STEP PROCESS OVER A PERIOD FROM APRIL 2012 TO MARCH 2013. THE PROCESS BEGAN WITH THE DEVELOPMENT AND AGREEMENT ON A WORK PLAN FOR THE PROJECT THAT DEFINED BOTH ITS SCOPE AND TIME FRAME. IT INVOLVED GAINING A COMMON UNDERSTANDING OF THE PROJECT AND THE NECESSARY BUY-IN FOR ITS COMPLETION AND INCLUDED CHARGING A BASSETT NETWORK-WIDE ADVISORY GROUP WITH PROVIDING OVERALL GUIDANCE FOR DEVELOPING THE CHNA. THIS GROUP INCLUDED REPRESENTATION FROM EACH OF THE SIX HOSPITALS. IN ADDITION TO PROVIDING OVERALL GUIDANCE DURING THE PROCESS, THE ADVISORY GROUP WAS CHARGED WITH: - AGREEING ON A COMMON TEMPLATE FOR A COMMUNITY HEALTH NEEDS ASSESSMENT AS A METHOD FOR INTEGRATING THE DATA AND INFORMATION FROM THE COMMUNITY SERVICE PLAN AND COUNTY COMMUNITY HEALTH ASSESSMENTS;- CONSIDERING CURRENT HEALTH PRIORITIES OF THE COMMUNITY SERVICE PLAN AND RELATED COMMUNITY HEALTH ASSESSMENTS;- CONSIDERING THE DATA AND FINDINGS FROM THE UPSTATE HEALTH AND WELLNESS SURVEY;- SELECTION OF FUTURE HEALTH PRIORITIES FOR THIS COMMUNITY HEALTH NEEDS ASSESSMENT;- IDENTIFYING TARGETED OBJECTIVES FOR ADDRESSING SELECTED HEALTH PRIORITIES;- APPROVING THE CHNA AND RECOMMENDATION FOR PUBLICATION AND DISSEMINATION;- CONSIDERING PUBLIC AND KEY STAKEHOLDER INPUT ON THE CHNA;- REVIEWING AND ADVISING ON IMPLEMENTATION STRATEGIES BASED ON THE CHNA; AND - APPROVING A FINAL CHNA AND IS REPORT FOR SUBMISSION TO THE RESPECTIVE BOARDS OF THE SIX BASSETT HEALTHCARE NETWORK HOSPITALSONCE THE DRAFT CHNA WAS APPROVED BY THE BASSETT NETWORK-WIDE ADVISORY GROUP, IT WAS PUBLISHED ON EACH RESPECTIVE HOSPITAL'S WEBSITE, AS WELL AS ON THE BASSETT HEALTHCARE NETWORK WEBSITE. IT WAS ALSO DISTRIBUTED TO KEY STAKEHOLDERS IN THE AREA. THIS WAS FOLLOWED BY A MEETING WITH KEY STAKEHOLDERS IN THE LITTLE FALLS HOSPITAL SERVICE AREA. KEY STAKEHOLDERS INCLUDED REPRESENTATIVES OF AREA COMMUNITIES, SOCIAL SERVICES, PUBLIC HEALTH, HOSPITALS AND OTHER AREA HEALTH PROVIDERS. B. PRIMARY INFORMATION AND DATA SOURCESTHIS COMMUNITY HEALTH NEEDS ASSESSMENT IS BASED ON AND INCORPORATES EFFORTS OF LITTLE FALLS HOSPITAL, BASSETT HEALTHCARE AND SERVICE AREA COUNTY HEALTH DEPARTMENTS TO IDENTIFY COMMUNITY HEALTH NEEDS AS REQUIRED BY THE NEW YORK STATE DEPARTMENT OF HEALTH. SPECIFICALLY THROUGH LITTLE FALLS HOSPITAL'S COMMUNITY SERVICE PLAN FOR 2011-12 AND HERKIMER, FULTON AND MONTGOMERY COUNTIES' COMMUNITY HEALTH ASSESSMENT FOR 2010-2013. IT ALSO DRAWS UPON THE UPSTATE HEALTH AND WELLNESS SURVEY CONDUCTED IN 2009 BY BASSETT'S RURAL RESEARCH INSTITUTE. THE UPSTATE HEALTH AND WELLNESS SURVEY PROVIDES A PRIMARY DATA SOURCE FOR IDENTIFYING THE HEALTH STATUS OF RESIDENTS IN A SEVEN-COUNTY AREA SERVED BY BASSETT HEALTHCARE NETWORK AND ITS AFFILIATE HOSPITALS AND OTHER PROVIDERS (CHENANGO, DELAWARE, HERKIMER, MADISON, MONTGOMERY, OTSEGO AND SCHOHARIE). THE UPSTATE HEALTH & WELLNESS SURVEY, CONDUCTED IN 2009 BY THE BASSETT'S RURAL RESEARCH INSTITUTE, CONSISTED OF SEPARATE SURVEYS COVERING THE TOPICS OF: (1) HOUSEHOLD HEALTH; (2) ACCESS TO HEALTH CARE; (3) CHILD LIFESTYLE AND BEHAVIOR CHOICES; (4) ADULT LIFESTYLE AND BEHAVIOR CHOICES; AND (5) HEALTH AND HEALTH NEEDS OF THE RURAL ELDERLY. THE SURVEY WAS DESIGNED TO PROVIDE BASELINE DATA TO: 1) ASSESS THE RURAL REGION IN TERMS OF 27 PRIORITY HEALTH INDICATORS ESTABLISHED IN 2008 BY THE COMMISSIONER OF THE NEW YORK STATE DEPARTMENT OF HEALTH; 2) IDENTIFY KEY GEOSPATIAL, SOCIAL AND DEMOGRAPHIC FACTORS RELATED TO LIVING IN RURAL AREAS THAT MAY EXPLAIN RURAL-URBAN HEALTH DIFFERENCES; AND 3) IDENTIFY THE NEED FOR EXISTING AND NEW COMMUNITY HEALTH PROMOTION PROGRAMS THROUGHOUT THE REGION. THE FIVE SEPARATE SURVEYS WERE EACH DESIGNED TO MEET ADDITIONAL AIMS. DIFFERENT SAMPLING FRAMES WERE USED FOR THE FIVE SURVEYS CONDUCTED IN 2009. THREE OF THE SURVEYS (HOUSEHOLD HEALTH; ACCESS TO HEALTH CARE; CHILD LIFESTYLE AND BEHAVIOR CHOICES) WERE ADMINISTERED TO RANDOM SAMPLES OF HOUSEHOLDS IN THE SEVEN-COUNTY STUDY REGION BASED ON A LIST OF HOUSEHOLD ADDRESSES. THE SAMPLING FRAMES FOR THE OTHER TWO SURVEYS (ADULT LIFESTYLE AND BEHAVIOR CHOICES; HEALTH AND HEALTH NEEDS OF THE RURAL ELDERLY) WERE DERIVED FROM A RANDOM SAMPLE OF THE ROSTER OF PARTICIPANTS IN A PREVIOUS HEALTH CENSUS CONDUCTED IN 1999. A RANDOM SAMPLE OF INDIVIDUALS WITH A BMI VALUE FROM THE 1999 HEALTH CENSUS WAS SELECTED FOR THE SURVEY ON ADULT LIFESTYLE AND BEHAVIOR CHOICES. THE SAMPLE FOR THE SURVEY ON THE RURAL ELDERLY INCLUDED ALL FARMERS FROM PRIOR HEALTH CENSUSES CONDUCTED IN 1989 AND 1999 WHO WOULD BE AT LEAST 50 YEARS OF AGE IN 2009 AND A RANDOM SAMPLE OF NON-FARMERS FROM THE 1989 OR 1999 HEALTH CENSUS WHO MET THE SAME AGE CRITERION. THE RANDOM HOUSEHOLD SURVEYS CONDUCTED IN EACH OF THE SEVEN COUNTIES OF BASSETT'S SERVICE AREA ARE SHOWN IN THE TABLE BELOW. THE SURVEYS CONDUCTED IN HERKIMER AND MONTGOMERY COUNTIES (WITHIN LITTLE FALLS HOSPITAL SERVICE AREA) INCLUDED 1,822, AND 1,692 RESPONDENTS RESPECTIVELY FOR THE HOUSEHOLD SURVEY, 92 AND 80 RESPONDENTS RESPECTIVELY FOR THE ACCESS SURVEY AND 153 AND 107 RESPONDENTS RESPECTIVELY FOR THE CHILD LIFESTYLE AND BEHAVIORAL CHOICES SURVEY. THE SURVEY WAS NOT CONDUCTED IN FULTON COUNTY WHICH ALSO INCLUDES SOME OF LITTLE FALLS SERVICE AREA. IN ADDITION, FOR THE PURPOSES OF THIS ASSESSMENT, THE SURVEY DATA WAS RE-AGGREGATED ALONG THE SERVICE AREA FOR LITTLE FALLS HOSPITAL AS DEFINED BY ZIP-CODES. A) - REGION, B) - HOUSEHOLD HEALTH (ALL RESPONDENTS/RESPONDENTS 18+), C) - ACCESS TO CARE (PRIMARY RESPONDENT), D) - CHILD LIFESTYLE (KIDS 2-18) A B C DALL REGIONS 13,226/11,009 1,784 979 SCOHARIE 1,847/1,542 95 144OTSEGO 2,663/2,235 80 163MONTGOMERY 1,692/1,386 80 107MADISON 1,840/1,478 412 138HERKIMER 1,822/1,548 92 153DELAWARE 1,373/1,153 545 125CHENANGO 1,989/1,667 480 149WHILE THE OVERALL GOAL OF DETERMINING THE GENERAL HEALTH STATUS OF BASSETT'S RURAL SERVICE REGION REMAINED CONSTANT, THE 2009 UPSTATE HEALTH & WELLNESS SURVEY EXPANDED ON PREVIOUS EFFORTS BY: 1) UNDERTAKING AN EXTENSIVE PRE-STUDY COLLABORATIVE PLANNING PROCESS WITH LOCAL HEALTH DEPARTMENTS AND THE PUBLIC; 2) COLLABORATING WITH PUBLIC HEALTH RESEARCHERS FROM AREA UNIVERSITIES; AND 3) INCLUDING PHYSICAL MEASUREMENTS ON SOME PARTICIPANTS TO CONFIRM THE VALIDITY OF SELF-REPORTS. IN ADDITION TO PROVIDING DESCRIPTIVE EPIDEMIOLOGIC DATA ON THE PREVALENCE OF HEALTH BEHAVIORS AND CONDITIONS, THE 2009 SURVEY WAS DESIGNED TO TEST A NUMBER OF HYPOTHESES IN THE AREAS OF OBESITY, AGING, HEALTH CARE ACCESS, CHRONIC DISEASE, MENTAL HEALTH, AND OTHER CONCERNS IDENTIFIED BY THE COMMUNITY.THIS INFORMATION IS FROM LITTLE FALLS HOSPITAL 2013 COMMUNITY HEALTH NEEDS ASSESSMENT PAGES 4-6. PART VI, LINE 3: LITTLE FALLS HOSPITAL PROVIDES ACCESS AND EDUCATION ON THE COMMUNITY SERVICE PROGRAM WITH CONTACT INFORMATION FOR PATIENTS TO CALL AND MAKE APPOINTMENTS FOR COMPLETING INFORMATION FOR CHARITY CARE. AT ALL PATIENT ACCESS POINTS WHERE SERVICES ARE PROVIDED APPLICAITONS FOR ASSISTANCE ARE AVAILABLE. THE WWW.LFHNY.ORG WEBSITE INCLUDES A LINK ON INFORMATION FOR COMPLETING AN APPLICATION. IN 2013 THE AMOUNT OF ASSISTANCE FOR UNINSURED PATIENTS INCREASED BY APPROXMIATELY $89,000 OR 23% FORM 2012. PART VI, LINE 4: LITTLE FALLS HOSPITAL SERVES AN ESTIMATED POPULATION OF OVER 54,000 PEOPLE IN 10 COMMUNITIES THROUGHOUT HERKIMER COUNTY AND SECTIONS OF FULTON AND MONTGOMERY COUNTIES. THE SERVICE AREA POPULATION IS COMPRISED OF INDIVIDUALS AND FAMILIES FROM ALL SOCIO-ECONOMIC AND EDUCATIONAL LEVELS. THE POPULATION IS 97 PERCENT WHITE, 51 PERCENT FEMALE AND 49 PERCENT MALE. THE AGE DISTRIBUTION OF THE POPULATION IS SIMILAR TO OTHER UPSTATE NEW YORK AREAS WITH 5.4 PERCENT OF THE POPULATION UNDER 5 YEARS OF AGE, 21 PERCENT UNDER THE AGE OF 18 AND 16.2PERCENT AGED 65 AND OLDER. NEARLY 80 PERCENT OF THE POPULATION OVER 25 HAS GRADUATED FROM HIGH SCHOOL. PER CAPITA INCOME LEVELS ARE $16,141, LOWER THAN NEW YORK STATE'S AVERAGE OF $23,389 AND MEDIAN HOUSEHOLD INCOME AT $40,106 ARE ALSO BELOW THE STATE MEDIAN OF $55,980. IT ESTIMATED THAT 14 PERCENT OF THE POPULATION IS BELOW THE FEDERAL POVERTY LEVEL, HIGHER THAN BOTH THE STATE (13.7) AND U.S. (13.3) AVERAGES AND AN ESTIMATED 14.4 PERCENT OF THE COUNTY'S POPULATION IS UNINSURED. IN ADDITION, THERE ARE NUMEROUS HEALTH STATUS INDICATORS THAT SHOW THAT MANY PRIMARY CARE NEEDS OF THE POPULATION RESIDING IN AREA REMAIN UNMET. THESE INCLUDE COMPARATIVELY: LOWER PERCENTAGES OF PREGNANT WOMEN WITH EARLY PRENATAL CARE, ANEMIA AND OBESITY; HIGHER PERCENTAGES OF CHILDREN WITH ANEMIA; HIGHER PERCENTAGES OF ADULTS WHO ARE OVERWEIGHT, SMOKE AND DRINK EXCESSIVELY; HIGHER RATES OF DEATH AND HOSPITALIZATION FROM CARDIOVASCULAR AND HEART DISEASES; A HIGHER INCIDENCE OF CANCER OF THE LUNGS; HIGHER DEATH RATES DUE TO CIRRHOSIS AND DIABETES; HIGHER HOSPITALIZATIONS DUE TO PNEUMONIA AND FLU; AND HIGHER RATES OF DEATH AND HOSPITALIZATION FROM SUICIDE, SELF INFLICTED AND UNINTENTIONAL INJURIES. PART VI, LINE 5: LITTLE FALLS HOSPITAL IMPLEMENTS COORDINATED HEALTH CARE RESOURCES WITH BASSETT HEALTHCARE NETWORK. MAJOR AREAS OF CONCENTRAITON FOR 2013 INCLUDED IMPLEMENTATION OF A SHARED ELECTRONIC MEDICAL RECORD, PLANNING FOR INCREASES IN RECRUITMENT OF PRIMARY CARE PROVIDERS, RECEIVING APPROVAL FROM NYS DEPARTMENT OF HEALTH TO IMPLEMENT INITIATIVES TO REDUCE OCCURRENCES OF LOW ACUITY VISITS TO THE EMERGENCY DEPARTMENT, AND LOWERING NUMBER OF REPEAT ADMISSIONS. IN 2013 THE IMPLEMENTATION OF THE "NEW YOR STATE INSURANCE EXCHANGE" AS PART OF THE AFFORDABLE CARE ACT WAS COORDINATED WITH BASSETT MEDICAL CENTER TO HAVE TRAINED CERTIFIED EXCHANGE ENROLLERS. THIS RESULTED IN A HIGHER LEVEL OF INSURED FAMILIES AND INDIVIDUALS IN OUR SERVICE AREA. PART VI, LINE 6: LITTLE FALLS HOSPITAL IS A MEMBER OF THURSTON CORPORATION (DBA BASSETT HEALTHCARE NETWORK) THAT PROVIDES HEALTH SERVICES IN MORE THAN 20 COMMUNITIES SPANNING 5,600 SQUARE MILES AND SEVEN COUNTIES. THE NETWORK FOCUSES ITS COMMUNITY SERVICES PROGRAMS IN THE COUNTIES WHERE THE SIX AFFILIATED HOSPITALS AND GREATEST PATIENT POPULATIONS ARE LOCATED. OTSEGO COUNTY - POPULATION 61,709; DELAWARE COUNTY - POPULATION 47,276; HERKIMER COUNTY - POPULATION 64,508; SCHOHARIE COUNTY - POPULATION 32,099 (ACCORDING TO THE 2012 U.S. CENSUS ESTIMATES). THE MARY IMOGENE BASSETT HOSPITAL, AN ACUTE CARE INPATIENT TEACHING FACILITY IN COOPERSTOWN, OTSEGO COUNTY, O'CONNOR HOSPITAL, A CRITICAL ACCESS HOSPITAL IN DELHI, DELAWARE COUNTY, COBLESKILL REGIONAL HOSPITAL, AN ACUTE CARE FACILITY IN COBLESKILL, SCHOHARIE COUNTY, LITTLE FALLS HOSPITAL, A CRITICAL ACCESS HOSPITAL IN LITTLE FALLS, HERKIMER COUNTY, TRI TOWN REGIONAL HOSPITAL A 24/7 EMERGENCY CARE FACILITY IN SIDNEY, DELAWARE COUNTY, AUREILA OSBORN FOX MEMORIAL HOSPITAL, AN ACUTE CARE FACILITY IN ONEONTA, OTSEGO COUNTY, THE BASSETT CLINIC, AN OUTPATIENT PRIMARY AND SPECIALTY CARE CENTER IN COOPERSTOWN, A REGIONAL NETWORK OF 26 COMMUNITY BASED HEALTH CENTERS, 19 SCHOOL BASED HEALTH CENTERS, TWO AMBULATORY SURGERY CENTERS, VALLEY HEALTH SERVICES A RESIDENTIAL HEALTH CARE AND REHABILITATION FACILITY, AT HOME CARE, A CERTIFIED HOME CARE AGENCY AND FIRST COMMUNITY CARE OF BASSETT, A MEDICAL SUPPLY COMPANY, ALL OF WHICH MAKE UP THE BASSETT HEALTHCARE NETWORK AND PROVIDE HEALTH SERVICES TO THIS NINE COUNTY REGION IN CENTRAL NEW YORK. PART VI, LINE 7, REPORTS FILED WITH STATES NY X 0 0 X X X X 0 0 0 0 0 0 0 0 0 AUGUST LEINHART MD TRUSTEE 0 468488 0 0 0 70796 0 23502 0 2479 0 565265 0 0 NICHOLAS J NICOLETTA TREASURER 0 397411 0 0 0 30000 0 23502 0 5781 0 456694 0 0 JEFFREY WOEPPEL THIRD VICE CHAIRMAN 0 207179 0 8000 0 0 0 18552 0 5493 0 239224 0 0 AMY GRACE MD PRESIDENT OF MEDICAL STAFF 10950 179616 0 5050 0 0 0 9652 0 4441 10950 198759 0 0 MICHAEL OGDEN PRESIDENT & CEO 0 176130 0 11796 0 559 0 9132 0 1117 0 198734 0 0 RICHARD NOCELLA PRIMARY CARE PHYSICIAN 144888 0 0 0 0 0 0 0 18281 0 163169 0 0 0 PART I, LINE 3 THE COMPENSATION PROCESS FOR TOP OFFICIAL THE CHIEF EXECUTIVE OFFICER'S SALARY IS PAID BY A RELATED ORGANIZATION UNDER A MANAGEMENT SERVICES AGREEMENT. THE LITTLE FALLS HOSPITAL BOARD OF TRUSTEE'S REVIEWS THE FORMAL PROCESS THAT IS USED TO DETERMINE THE BASE COMPENSATION OF THE CEO. THE CEO WORK PLAN AND ACCOMPLISHMENTS FOR THE YEAR ARE REVIEWED. SALARY CHANGES ARE BASED ON MARKET, WORK PLAN, AND ACCOMPLISHMENTS. THE CEO'S SALARY IS SUBMITTED AS PART OF THE MANAGEMENT SERVICES AGREEMENT WHICH IS APPROVED BY THE BOARD OF TRUSTEES. FORM 990, PART III, LINE 3 LITTLE FALLS HOSPITAL HAS IMPLEMENTED AN ELECTRONIC HEALTH RECORD ALONG WITH SECURE PATIENT PORTAL ACCESS FOR REVIEWING OF THEIR HEALTH INFORMATION. USE OF THE ELECTRONIC HEALTH RECORD INCLUDES ALL CLINCAL PRODUCT LINES ENCOMPASSING A FULL ARRAY OF INPATIENT AND AMBUALTORY CARE SERVICES. FORM 990, PART VI, SECTION B, LINE 11 LITTLE FALLS HOSPITAL PRESENTS THE DRAFT 990 TO THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS PRIOR TO FILING. ANY QUESTIONS ARE RAISED AND ONCE APPROVED, THE 990 CAN BE FILED. A COMPLETE COPY OF THE ORGANIZATION'S FINAL FORM 990, INCLUDING ALL REQUIRED SCHEDULES, AS ULTIMATELY FILED WITH THE IRS, IS AVAILABLE TO EACH MEMBER OF THE BOARD BEFORE ITS FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST STATEMENTS ARE MADE ANNUALLY. NEW BOARD MEMBERS ARE REQUIRED TO DISCLOSE ON THEIR RESUME ALL AFFILIATED ORGANIZATIONS. FORM 990, PART VI, SECTION B, LINE 15 THE CHIEF EXECUTIVE OFFICER'S SALARY IS PAID BY A RELATED ORGANIZATION UNDER A MANAGEMENT SERVICES AGREEMENT. THE LITTLE FALLS HOSPITAL BOARD OF TRUSTEES REVIEWS THE FORMAL PROCESS THAT IS USED TO DETERMINE THE BASE COMPENSATION OF THE CEO. THE CEO'S WORK PLAN AND ACCOMPLISHMENTS FOR THE YEAR ARE REVIEWED. SALARY CHANGES ARE BASED ON MARKET, WORKPLAN, AND ACCOMPLISHMENTS. THE CEO'S SALARY IS SUBMITTED AS PART OF THE MANAGEMENT SERVICES AGREEMENT WHICH IS APPROVED BY THE BOARD. FORM 990, PART VI, SECTION C, LINE 19 LITTLE FALLS HOSPITAL MAKES AVAILABLE THE IRS FROM 990 UPON REQUEST ALONG WITH INFORMATION INCLUDED WITHIN THE 990 SUCH AS FINANCIAL REPORTS, CONFLICT OF INTEREST POLICY, AND CODE OF CONDUCT. THE HOSPITAL ALSO PROVIDES THE ANNUAL OPERATING PLAN, AND CORPORATE VALUES IN PUBLIC AREAS OF THE FACILITY. FORM 990, PART XI, LINE 9: PENSION RELATED CHANGES OTHER THAN NET PERIODIC BENEFIT COST 2,579,916. CHANGE IN VALUE OF BENEFICIAL INTEREST IN CHARITABLE REMAINDER TRUST 221,214. THURSTON CORPORATION ONE ROCKEFELLER PLAZA 31ST FLOOR NEW YORK NY 10020 133218680 SUPPORTING ORGANIZATION NY 501 (C) 3 11 C N/A 0 FRIENDS OF BASSETT ONE ATWELL ROAD COOPERSTOWN NY 13326 237041610 FUND RAISING ORGANIZATION NY 501 (C) 3 7 THURSTON CORPORATION 0 MARY IMOGENE BASSETT HOSPITAL ONE ATWELL ROAD COOPERSTOWN NY 13326 135596796 HEALTH CARE ORGANIZATION OFFERING INPATIENT AND OUTPATIENT SERVICES NY 501 (C) 3 3 THURSTON CORPORATION 0 AURELIA OSBORN FOX MEMORIAL HOSPITAL SOCIETY ONE NORTON AVENUE ONEONTA NY 13820 150539039 HEALTH CARE ORGANIZATION OFFERING INPATIENT AND OUTPATIENT SERVICES NY 501 (C) 3 3 THURSTON CORPORATION 0 TEMPLETON FOUNDATION ONE ATWELL ROAD COOPERSTOWN NY 13326 133317084 FACILITIES / OFFICE SPACE NY 501 (C) 3 9 THURSTON CORPORATION 0 BASSETT REGIONAL CORPORATION ONE ATWELL ROAD COOPERSTOWN NY 13326 133522783 PROVIDES EXCELLENCE IN THE COORDINATION PLANNING AND POLICY DIRECTION FOR NY 501 (C) 3 11 (B) THURSTON CORPORATION 0 COBLESKILL REGIONAL HOSPITAL 178 GRANDVIEW DRIVE COBLESKILL NY 12043 141772971 HEALTHCARE SERVICES OFFERING INPATEINT AND OUTPATIENT SERVICES NY 501 (C) 3 3 BASSETT REGIONAL CORPORATION 0 O'CONNOR HOSPITAL 460 ANDES ROAD DELHI NY 13753 161540394 HEALTH CARE ORGANIZATION OFFERING INPATIENT AND OUTPATIENT SERVICES NY 501 (C) 3 3 BASSETT REGIONAL CORPORATION 0 TRI TOWN REGIONAL HEALTHCARE 43 PEARL STREET SYNDEY NY 13838 260169584 HEALTHCARE SERVICES OFFERING OUTPATIENT SERVICES NY 501 (C) 3 3 BASSETT REGIONAL CORPORATION 0 VALLEY HEALTH SERVICES 690 GERMAN STREET HERKIMER NY 13350 222511614 NURSING HOME NY 501 (C) 3 3 BASSETT REGIONAL CORPORATION 0 0 0 1 0 0 0 0 0 0 1 0 1 1 0 1 0 1 0 0