2013-11-07T16:32:37-06:00 2012-12-31 161226221 FUST CHARLES CHAMBERS LLP 5784 WIDEWATERS PARKWAY SYRACUSE NY 13214 990 2012-01-01 141731786 ADIRONDACK MEDICAL CENTER ADIR 5188914141 PO BOX 471 2233 STATE ROUTE 86 SARANAC LAKE NY 12983 GREG MOORE 5188914141 2013-10-18 1 ANGELA M FRANCO P00589741 3154463600 2012 2016-02-25 16:41:14Z GREG MOORE PO BOX 471 2233 STATE ROUTE 86 SARANAC LAKE NY 12983 103060224 0 X WWW.ADIRONDACKHEALTH.ORG X 1991 NY THE MEDICAL CENTER PROVIDES ACUTE, SKILLED NURSING AND OUTPATIENT SERVICES TO RESIDENTS OF THE LOCAL GEOGRAPHIC REGION. 14 13 1152 118 0 0 2358987 897941 99812547 97784775 155840 -675069 1658935 3399208 103986309 101406855 0 0 0 0 52454934 56776608 0 0 0 50812477 47700596 103267411 104477204 718898 -3070349 66671140 67870297 26581240 30406779 40089900 37463518 THE MEDICAL CENTER PROVIDES EXCELLENT HEALTHCARE CLOSE TO HOME. 0 0 25460740 29975569 ADIRONDACK MEDICAL CENTER IS A 97-BED ACUTE CARE FACILITY IN SARANAC LAKE AND A 2-BED FACILITY IN LAKE PLACID. IT PROVIDES A FULL RANGE OF INPATIENT SERVICES(SURGICAL, MATERNITY AND PEDIATRIC) AS WELL AS MAINTAINS A 60 BED LONG-TERM CARE FACILITY. 50427744 59363573 REFERRED AMBULATORY, AMBULATORY SURGERY AND EMERGENCY SERVICES. 7074069 8445633 FREE STANDING NURSING HOME THAT HAS 156 BEDS. 82962553 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 1 0 1 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 67 0 1 1152 1 0 0 0 0 0 0 0 0 0 0 X 14 13 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X GREG MOORE 5188914141 PO BOX 471 2233 STATE ROUTE 86 SARANAC LAKE NY 12983 JOHN HOPKINSON PHD 1.00 X X 0 0 0 LAURIE BERGAMINI 1.00 X 0 0 0 BARRY BROGAN 1.00 X 0 0 0 JULIE CONNORS 1.00 X 0 0 0 CHARLES CARROLL 1.00 X 0 0 0 EDWARD H ROETMAN 1.00 X 0 0 0 MARY SPARKS 1.00 X 0 0 0 JOAN KELLY 1.00 X 0 0 0 JEANNIE CROSS 1.00 X 0 0 0 JOHN BRODERICK MD 40.00 X 287151 0 31121 SUSAN M DELEHANTY 1.00 X X 0 0 0 STANLEY T URBAN 1.00 X X 0 0 0 REV CARLOS J CAGUIAT 1.00 X 0 0 0 RICHARD M MOCCIA MD 1.00 X 0 0 0 CHANDLER M RALPH 40.00 X 0 0 0 PATRICK FACTEAU 40.00 X 124983 0 20423 DAVID BRITTON 40.00 X 122400 0 0 GREG MOORE 40.00 X 63577 0 10472 WILLIAM VISCARDO MD 40.00 X 243414 0 26986 CYNTHIA MCGUIRE 40.00 X 156069 0 25002 ANTHONY DOWIDOWICZ 40.00 X 268264 0 19364 MAJEED SIDDIQUI 32.00 X 324924 0 28003 NICHOLAS BRODYN 40.00 X 497526 0 29811 WOODS MCCAHILL 32.00 X 225806 0 26471 FRANK NOCILLA 40.00 X 226108 0 22199 2540222 0 239852 47 0 1 0 MATRIX HEALTH SYSTEMS 86 LAKE STREET BURLINGTON VT 05401 PHYSICIAN FEES 777108 PREMIER ANESTHESIA 2655 NORTHWINDS PARKWAY ALPHARETTA GA 30368 PHYSICIAN FEES 708476 HEALTHTECH MANAGEMENT SERVICES INC 405 DUKE DRIVE SUITE 10 FRANKLIN TN 37067 MANAGEMENT SERVICES 654454 INSIGHT HEALTH CORP PO BOX 847689 DALLAS TX 75284 MRI SERVICE 504670 LABORATORY CORPORATION OF AMERICA PO BOX 12140 BURLINGTON NC 27216 LAB SERVICES 457122 30 540014 357927 897941 NET PATIENT SERVICE RE 900099 97784775 97784775 97784775 47547 47547 427564 0 427564 427564 427564 930753 882653 770716 48100 -770716 -722616 -722616 DIETARY REVENUE 900099 199635 199635 PURCHASE DISCOUNTS 900099 149434 149434 REBATES & REFUNDS 900099 49836 49836 2572739 2572739 2971644 101406855 100756419 0 -247505 X 1111599 318273 793326 44886438 36731511 8154927 1123660 917915 205745 6354542 5176261 1178281 3300369 2662696 637673 654454 654454 229694 229694 109994 109994 10565122 7279471 3285651 189356 870 188486 1636275 687522 948753 2522150 3222 2518928 411260 245470 165790 774787 774787 4811931 4811931 935860 935860 MEDICAL SUPPLIES 15138449 15138449 BAD DEBT 3873427 3873427 LEASE EXPENSE 1143425 920436 222989 CASH ASSESSMENT 1107565 1107565 3596847 2312747 1284100 104477204 82962553 21514651 0 8164030 11257449 13318293 14128496 1830619 1964432 3406362 3587422 87468159 54934322 33531187 32533837 3368975 3214620 3051674 1184041 66671140 67870297 8049390 11596903 947292 1163791 11805346 13327680 933000 933000 4846212 3385405 26581240 30406779 X 39102721 36472103 52117 56353 935062 935062 40089900 37463518 66671140 67870297 X -3070349 155160 178476 110331 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 987179 4236 991415 987165 4018 -4004 987179 982116 5049 987165 0.94300 0.05700 0 0 328539 328539 42827931 20730583 22097348 43202852 33321947 9880905 1108837 881792 227045 32533837 DEBT-CURRENT 1263823 RESIDENT FUNDS LIABILITY 93406 ASSET RETIREMENT AND OTHER LT 946883 ESTIMATED THIRD PARTY LIABILITY 1081293 3385405 X DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THE SYSTEM'S ENDOWMENTS CONSIST OF FUNDS ESTABLISHED FOR A VARIETY OF PURPOSES. ITS ENDOWMENTS INCLUDE DONOR-RESTRICTED ENDOWMENT FUNDS AND FUNDS DESIGNATED BY THE BOARD OF TRUSTEES TO FUNCTION AS AN ENDOWMENT. AS REQUIRED BY GENERALLY ACCEPTED ACCOUNTING PRINCIPLES, NET ASSETS ASSOCIATED WITH ENDOWMENT FUNDS, INCLUDING FUNDS DESIGNATED BY THE BOARD OF TRUSTEES TO FUNCTION AS ENDOWMENTS, ARE CLASSIFIED AND REPORTED BASED ON THE EXISTENCE OR ABSENCE OF DONOR-IMPOSED RESTRICTIONS. TEMPORARILY RESTRICTED FUNDS ARE AVAILABLE FOR NURSING EDUCATION & OTHER PROGRAMS. PERMANENTLY RESTRICTED FUNDS ARE TO BE HELD IN PERPETUITY, THE INCOME FROM WHICH IS EXPENDABLE FOR VARIOUS HEALTHCARE SERVICES. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: THE STANDARDS FOR ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES ESTABLISH A RECOGNITION THRESHOLD AND MEASUREMENT FOR INCOME TAX POSITIONS RECOGNIZED IN ADIRONDACK HEALTH'S CONSOLIDATED FINANCIAL STATEMENTS. THESE STANDARDS HAD NO IMPACT ON THE ACCOMPANYING FINANCIAL STATEMENTS. THE TAX YEARS OPEN TO EXAMINATION BY FEDERAL AND STATE TAXING AUTHORITIES ARE 2009 THROUGH 2012. 1 1 X 1 X 1 X 0 1 0 1 1 136237 14789 121448 0.00120 21233453 21147730 85723 0.00090 21369690 21162519 207171 0.00210 179648 179648 0.00180 432436 432436 0.00430 19351188 15919405 3431783 0.03410 2362 2362 0.00000 19965634 15919405 4046229 0.04020 41335324 37081924 4253400 0.04230 5923 5923 0.00010 15745 15745 0.00020 21668 21668 0.00030 1 1990249 1001230 27547830 28547710 -999880 X 1 1 2 1 ADIRONDACK MEDICAL CENTER

2233 STATE ROUTE 86-PO BOX 471 SARANAC LAKE NY 12983

X X 97 ACUTE BEDS; NURSING HOME WITH 60 BEDS; NURSING HOME WITH 157 BEDS A 2 ADIRONDACK MEDICAL CENTER-LAKE PLACID

29 CHURCH STREET LAKE PLACID NY 12946

X X 2 ACUTE BEDS; OUTPATIENT SERIVCES, EMERGENCY ROOM A FACILITY REPORTING GROUP - A 1 X X X X X X X X X 10 1 1 1 X X X X X 0 0 1 1 200.000000000000 1 400.000000000000 1 X X X X 1 1 X X X 1 X X 0 X X X 1 X 0 0 6 TUPPER LAKE MEDICAL OFFICE BUILDING

7 STETSON ROAD TUPPER LAKE NY 12986

CLINIC; LABORATORY; RADIOLOGY MOUNTAIN HEALTH CENTER

2841 NYS ROUTE 73 KEENE NY 12942

CLINIC UIHLEIN LIVING CENTER

185 OLD MILITARY ROAD LAKE PLACID NY 12946

NURSING HOME WITH 156 BEDS MERCY LIVING CENTER

114 WAWBEEK AVENUE TUPPER LAKE NY 12986

NURSING HOME WITH 60 BEDS; DIALYSIS, REHABILITATION LAKE PLACID HEALTH CENTER

29 CHURCH STREET LAKE PLACID NY 12946

CLINC; ER; LABORATORY; RADIOLOGY; REHABILITATION WOUND CARE MEDICAL OFFICE BUILDING

285 COUNTY ROUTE 47 SARANAC LAKE NY 12983

CLINIC PART I, LINE 7: AMOUNTS CALCULATED USING COST-TO-CHARGE RATIO FROM WORKSHEET 2 (TOTAL OPERATING EXPENSE MINUS MEDICAID/PROVIDER TAXES, TOTAL COMMUNITY BENEFIT EXPENSE, AND TOTAL COMMUNITY BUILDING EXPENSE DIVIDED BY GROSS PATIENT CHARGES), AND ADDRESSES ALL PATIENT SEGMENTS. PART I, L7 COL(F): BAD DEBT EXPENSE, REMOVED FROM DENOMINATOR, EQUALS 3,873,427. PART II: THE CEO ATTENDED AMERICAN HOSPITAL ASSOCIATION BOARD MEETINGS. THIS IS A MEMBERSHIP ORGANIZATION THAT HELPS HOSPITALS TO HELP THEIR COMMUNITIES TO ACHIEVE THE HIGHEST MEASURE OF HEALTH THROUGH EDUCATION, RESEARCH, SUPPORT SYSTEMS, DISSEMINATION OF BEST CLINICAL QUALITY PRACTICES, AND COALITION BUILDING TO IMPROVE THE HEALTH OF OUR COMMUNITIES. ALSO, THE CEO ATTENDED ADIRONDACK HEALTH INSTITUTE MEETINGS. AHI IS A REGIONAL ORGANIZATION THAT INCLUDES THE TRI-LAKES, PLATTSBURGH, AND GLENNS FALLS COMMUNITIES WHOSE PURPOSE IS TO IMPROVE THE OVERALL HEALTH OF THESE ADIRONDACK COMMUNITIES BY WORKING TOGETHER ON A REGIONAL BASIS. THE CHIEF NURSING OFFICER SPENT TIME EDUCATING LOCAL, STATE, AND FEDERAL LEGISLATORS ABOUT IMPORTANT ISSUES IN HEALTHCARE AND COMMUNITY HEALTH. THE CHIEF MEDICAL OFFICER SPENT TIME AT A LOCAL IRON MAN COMPETITION TO PROVIDE MEDICAL COVERAGE OF THE ATHLETES AND PROMOTE HEALTHY EXERCISE ROUTINES. PART III, LINE 4: "IN EVALUATING THE COLLECTIBILITY OF PATIENT ACCOUNTS RECEIVABLE, ADIRONDACK HEALTH ANALYZES PAST PAYMENT HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND PROVISION FOR BAD DEBTS. FOR RECEIVABLES ASSOCIATED WITH PATIENTS WHO HAVE THIRD-PARTY COVERAGE, ADIRONDACK HEALTH ANALYZES CONTRACTUALY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY. FOR RECEIVABLES ASSOCIATES WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), ADIRONDACK HEALTH RECORDS A PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNT RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS."PART III, LINE 3:THE ORGANIZATION'S BAD DEBT EXPENSES IS CALCULATED USING A PERCENTAGE OF BAD DEBT THAT CONTAINS POSSIBLE CHARITY CARE CASES AND APPLYING IT TO LINE 2. RATIONALE FOR WHAT PORTION OF BAD DEBT SHOULD CONSTITUTE COMMUNITY BENEFIT: THE PROVISION OF HEALTH CARE IS DIFFERENT FROM PROVIDING OTHER SERVICES, IN THAT HOSPITALS, ALTHOUGH THEY MAY ATTEMPT TO OBTAIN FINANCIAL INFORMATION BEFORE SERVICE IS PROVIDED, FOCUS ON PROVIDING THE PATIENT WITH NEEDED HEALTH CARE AND LATER TRY TO OBTAIN PAYMENT. IN OTHER INDUSTRIES, THE SERVICE PROVIDER CAN CHECK THE CUSTOMER'S CREDIT RATING, ASK FOR PAYMENT IN ADVANCE, ETC AND IS USUALLY ASKING THIS INFORMATION WHEN THE CONSUMER IS NOT IN A HEALTH CRISIS AND UNDER GREAT STRESS AND WORRY. AT A LATER TIME, WHEN THE PROVIDER ATTEMPTS TO COLLECT PAYMENT AND FINDS THE PATIENT UNWILLING TO PAY, THEIR OPTIONS ARE AGAIN LIMITED GIVEN THE NATURE OF THE SERVICE PROVIDED AND THE INABILITY TO REPOSSESS THE SERVICE.PART III, LINE 2:THE ORGANIZATION'S BAD DEBT EXPENSE IS CALCULATED USING COST-TO-CHARGE RATIO FROM WORKSHEET 2 AND BAD DEBT EXPENSE. PART III, LINE 8: CALCULATED USING COST-TO-CHARGE RATIO FROM WORKSHEET 2 AND APPLYING IT TO GROSS MEDICARE CHARGES. SHORTFALL SHOULD BE TREATED AS A COMMUNITY BENEFIT BECAUSE MEDICARE PATIENT SERVICES ARE PROVIDED AT A COST THAT IS GREATER THAN REIMBURSEMENT. PART III, LINE 9B: ACCORDING TO OUR CHARITY CARE POLICY, FAP-ELIGIBLE PATIENTS ARE WRITTEN-OFF AT 100% SO NO COLLECTION PRACTICES ARE NECESSARY. PART VI, LINE 2: ADIRONDACK MEDICAL CENTER USES A NUMBER OF ASSESSMENT METHODS TO DETERMINE HOW WELL WE ARE MEETING COMMUNITY NEEDS AND WHAT ADDITIONAL SERVICES WE CAN OFFER OUR COMMUNITY MEMBERS. AMC USES THE PRESS-GANEY PATIENT SATISFACTION SURVEY FOR CONTINUAL PATIENT FEEDBACK. THE SURVEYS ARE MAILED TO RANDOMLY SELECTED PATIENTS BY PRESS-GANEY, A NATIONALLY RECOGNIZED PATIENT SURVEY FIRM, AND PRESS-GANEY PROCESSES THE RESULTS. THEY GIVE AMC THE RESULTS BENCHMARKED AGAINST OTHER HOSPITALS TO HELP US UNDERSTAND HOW WELL WE ARE SERVING OUR COMMUNITY. THE MAJORITY OF AMC'S STRATEGIC INITIATIVES ARE DRIVEN BY A THREE-YEAR STRATEGIC PLAN, WHICH IS DEVELOPED THROUGH THE COLLABORATION OF THE BOARD, MEDICAL STAFF, AMC STAFF AND COMMUNITY MEMBERS. THE GOALS THAT ARE SET FORTH EVERY THREE YEARS IN THE STRATEGIC PLAN ARE INCORPORATED INTO AMC'S MANAGEMENT ACTION PLAN (MAP), WHICH IS REVIEWED AND REVISED EACH YEAR. AT THE BEGINNING OF EACH YEAR EVERY DEPARTMENT CREATES A MAP THAT OUTLINES THE CONCRETE STEPS THAT THE DEPARTMENT WILL ACCOMPLISH IN MOVING THE HOSPITAL CLOSER TO COMPLETING THE STRATEGIC PLAN GOALS. THE SUCCESS OF AMC, EACH DEPARTMENT, AND EACH EMPLOYEE IS MEASURED BY THE MAP AND THE PROGRESS MADE TOWARD ACCOMPLISHING THE GOALS SET OUT IN THE STRATEGIC PLAN. FOR NEW SERVICES, AMC STAFF DEVELOPS A NEEDS ASSESSMENT USING A VARIETY OF DATA INCLUDING REGIONAL DEMAND FOR THE SPECIFIC SERVICE, DEMOGRAPHICS, AND FINANCIAL ANALYSIS. THE BOARD OF TRUSTEES CAREFULLY REVIEWS THE ANALYSIS AND EITHER SUPPORTS THE RECOMMENDATION OR ASKS FOR FURTHER INFORMATION. AMC ALSO PARTICIPATES WITH ESSEX COUNTY PUBLIC HEALTH AND FRANKLIN COUNTY PUBLIC HEALTH IN THEIR COMMUNITY HEALTH ASSESSMENT (CHA) PROCESS. THIS IS A FORMAL PROCESS, WITH RESULTS REQUIRED BY THE NEW YORK STATE DEPARTMENT OF HEALTH. THE CHA IS AN IMPORTANT PART OF AMC'S STRATEGIC PLANNING AND SERVICE LINE PLANNING PROCESSES. PART VI, LINE 3: ANY PATIENT THAT CONTACTS SCHEDULING OR PRESENTS TO ANY AMC DEPARTMENT (INCLUDING ADMITTING, EMERGENCY ROOM, ETC.) THAT DOES NOT IDENTIFY AN INSURANCE COMPANY OR IDENTIFIES THEMSELVES AS SELF-PAY ARE INFORMED OF OUR SELF-PAY PROCESS. THIS PROCESS INCLUDES INFORMATION ABOUT AMC'S CHARITY CARE POLICY AND THE BENEFITS OF VISITING WITH A CERTIFIED FACILITATED ENROLLER WHO CAN CHECK THE PATIENT'S ELIGIBILITY FOR STATE AND FEDERAL HEALTH INSURANCE PROGRAMS. PART VI, LINE 4: ADIRONDACK MEDICAL CENTER IS LOCATED IN THE HEART OF THE ADIRONDACK PARK IN RURAL, UPSTATE NEW YORK. THE ADIRONDACK PARK IS A UNIQUE, SIX MILLION ACRE PATCHWORK OF PUBLIC AND PRIVATE LAND. IT IS BEST KNOWN FOR ITS MOUNTAINS - THE HIGHEST IN NEW YORK STATE - AND ITS LAKES. THE REGION HAS AN AVERAGE SEASONAL SNOWFALL IN EXCESS OF 90 INCHES AND THE AVERAGE MEAN TEMPERATURE IN JANUARY IS 16 DEGREES FAHRENHEIT.AMC IS DESIGNATED A SOLE COMMUNITY PROVIDER HOSPITAL WITH THE CLOSEST COMPARABLE FACILITY 50 MILES AWAY FROM OUR MAIN CAMPUS IN SARANAC LAKE. AMC IS AN INTEGRAL PART OF THE COMMUNITY AS THE ONLY ACUTE CARE FACILITY, THE PREDOMINANT PROVIDER OF AMBULATORY SERVICES, AND THE LARGEST PRIVATE EMPLOYER IN THE ADIRONDACK PARK. AMC PROVIDES CARE FOR 70.7% OF THE 22,595 RESIDENTS IN OUR PRIMARY SERVICE AREA AND 25.1% OF THE 12,455 RESIDENTS IN OUR SECONDARY SERVICE AREA. THIS SERVICE AREA COVERS OVER 1,200 SQUARE MILES, HAS AN AVERAGE OF JUST OVER 30 PEOPLE PER SQUARE MILE, AND INCLUDES PORTIONS OF 5 COUNTIES.THE HOSPITAL'S SERVICE AREA IS DESIGNATED AS THE FOLLOWING FEDERAL HEALTH PROFESSIONAL SHORTAGE AREAS (HPSA):- PRIMARY CARE- DENTAL- PSYCHIATRYAMC IS SERVING AN AGING POPULATION WITH HIGH CANCER AND CHRONIC DISEASE RATES, AND VERY LOW INCOME LEVELS. THE PERCENTAGE OF THE POPULATION THAT FALLS INTO THE "BABY BOOMER" AGE GROUP, 55-64 YEARS OF AGE, IS INCREASING, WITH A CORRESPONDING DECREASE IN YOUNGER AGE GROUPS.NEW YORK STATE DEPARTMENT OF HEALTH DATA SHOWS THAT ESSEX AND FRANKLIN COUNTIES ARE WORSE THAN THE STATE OR NATIONAL RATE/PERCENTAGE FOR THE FOLLOWING:- ALL CANCER DEATHS PER 100,000, CORONARY HEART DISEASE PREMATURE DEATHS (AGES 35 64) PER 100,000, CEREBROVASCULAR (STROKE) DEATHS PER 100,000, ADULTS 18+ WHO SMOKE, ADULTS 18+ WHO ARE OBESE, THE AVERAGE UNEMPLOYMENT RATE IN 2012 FOR NEW YORK STATE WAS 8.5% AND THE UNEMPLOYMENT RATES IN THE COUNTIES THAT WE SERVE WAS A SLIGHTLY MORE THAN ONE PERCENTAGE POINT ABOVE THAT AVERAGE. THE NYS DEPARTMENT OF LABOR INDICATES THAT THE PER CAPITA INCOME FOR THE COUNTIES THAT AMC SERVES IS BETWEEN 35% AND 44% BELOW THE STATE AVERAGE. PART VI, LINE 5: AS THE LARGEST EMPLOYER AND ONLY FULL SERVICE HOSPITAL IN THE ADIRONDACK PARK AMC IS AN IMPORTANT PARTNER IN COMMUNITY BUILDING ACTIVITIES THAT PROMOTE THE HEALTH OF OUR COMMUNITY MEMBERS. - BEGAN A PROGRAM SENDING OUR MOBILE DENTAL CLINIC TO SCHOOLS TO PROVIDE DENTAL SEALANTS FOR CHILDREN- CONTINUED THE FREE, MONTHLY HEALTH LECTURE SERIES. LECTURE TOPICS HAVE INCLUDED A WIDE RANGE OF TOPICS SUCH AS SKIN CANCER AWARENESS, SUICIDE, WHOLE FOODS, AND BULLYING. WE HAVE DRAWN ON LOCAL, REGIONAL, AND NATIONAL EXPERTS. LECTURE ATTENDANCE HAS RANGED FROM 25 TO OVER 50 PEOPLE. PART VI, LINE 6: AMC'S BOARD OF TRUSTEES IS COMPRISED OF COMMUNITY MEMBERS WHO LISTEN CLOSELY TO THEIR NEIGHBORS, FRIENDS AND FAMILY MEMBERS, WHO ARE OUR PATIENTS. THIS IS AN ACTIVE BOARD WITH MEMBERS SITTING ON MANY OF THE HOSPITAL COMMITTEES. THIS CIRCLE OF INTERACTION HELPS INFORM OUR STAFF AND ENABLES THEM TO MAKE CONTINUOUS IMPROVEMENTS BASED ON COMMUNITY INPUT.AS THE LARGEST EMPLOYER AND ONLY FULL SERVICE HOSPITAL IN THE ADIRONDACK PARK AMC IS AN IMPORTANT PARTNER IN COMMUNITY BUILDING ACTIVITIES THAT PROMOTE THE HEALTH OF OUR COMMUNITY MEMBERS.- BEGAN A PROGRAM SENDING OUR MOBILE DENTAL CLINIC TO SCHOOLS TO PROVIDE DENTAL SEALANTS FOR CHILDREN- CONTINUED THE FREE, MONTHLY HEALTH LECTURE SERIES. LECTURE TOPICS HAVE INCLUDED A WIDE RANGE OF TOPICS SUCH AS SKIN CANCER AWARENESS, SUICIDE, WHOLE FOODS, AND BULLYING. WE HAVE DRAWN ON LOCAL, REGIONAL, AND NATIONAL EXPERTS. LECTURE ATTENDANCE HAS RANGED FROM 25 TO OVER 50 PEOPLE. REPORTS FILED WITH STATES PART VI, LINE 7 NY PART V, LINE 8 FACILITY REPORTING GROUP A SEE BELOW FACILITY 1 -- ADIRONDACK MEDICAL CENTER PART V, SECTION B, LINE 1J: FACILITY 1 -- ADIRONDACK MEDICAL CENTER PART V, SECTION B, LINE 3: IN 2010, AS PART OF THE NEEDS ASSESSMENT OF THE STRATEGIC PLAN, AMC CONDUCTED FOUR COMMUNITY FOCUS GROUPS. THE FOCUS GROUPS WERE COMPRISED OF MEMBERS OF THE CLERGY, LOCAL BUSINESS AND AGENCY LEADERS, ELECTED OFFICIALS, AND LEADERS OF LOCAL HEALTH CARE ORGANIZATIONS. FORTY TWO PEOPLE PARTICIPATED IN THE FOCUS GROUPS. THE FOCUS GROUP RESULTS WERE GIVEN TO ALL OF THE STRATEGIC PLANNING PARTICIPANTS. ALSO, AMC SURVEYED STAFF USING AN ELECTRONIC SURVEY. SIXTY THREE STAFF MEMBERS PARTICIPATED IN THE SURVEY. AMC SERVES A RURAL AREA AND OUR STAFF MEMBERS, THEIR FAMILY MEMBERS AND FRIENDS ARE ALSO OUR COMMUNITY MEMBERS. FACILITY 1 -- ADIRONDACK MEDICAL CENTER PART V, SECTION B, LINE 4: IN 2009, AMC PARTICIPATED IN TWO COMMUNITY HEALTH ASSESSMENTS (CHA). IN THE SIX COUNTY CHA SIX HOSPITALS (INCLUDING AMC) AND SIX COUNTY HEALTH DEPARTMENTS PARTICIPATED IN THE ASSESSMENT. IN THE THREE COUNTY SURVEYS FOUR HOSPITALS (INCLUDING AMC) AND THREE COUNTY HEALTH DEPARTMENTS PARTICIPATED IN THE SURVEY. FACILITY 1 -- ADIRONDACK MEDICAL CENTER PART V, SECTION B, LINE 5C: IN 2009, TWO COMPREHENSIVE CHA DOCUMENT WERE COMPILED. BOTH CHAS CONSISTED OF THE COMMUNITY HEALTH ASSESSMENT DATA AND ALL PARTICIPATING HOSPITALS' COMMUNITY SERVICE PLANS. THESE DOCUMENTS ARE AVAILABLE IN HARD COPY, CD, AND AS A PDF FILE. THE CHAS WERE SUBMITTED TO THE NEW YORK STATE DEPARTMENT OF HEALTH, CAN BE FOUND ON ALL OF THE COUNTY HEALTH DEPARTMENTS' WEB SITES, THE PARTICIPATING HOSPITALS' WEB SITES, AND ON THE ADIRONDACK RURAL HEALTH NETWORK (ARHN) WEB SITE. IN 2010, AMC CREATED A SUMMARY OF THE STRATEGIC PLAN AND PUBLISHED IT IN THE LOCAL NEWSPAPERS. THE SUMMARY CAN ALSO BE FOUND ON THE AMC WEBSITE. FACILITY 1 -- ADIRONDACK MEDICAL CENTER PART V, SECTION B, LINE 7: NYS DEPARTMENT OF HEALTH REQUESTED THAT THE 2009 CHA USE THE NYS PREVENTION AGENDA TO STRUCTURE THE ASSESSMENT. BOTH CHA GROUPS CHOOSE PHYSICAL ACTIVITY AND NUTRITION AND THE FIRST PRIORITY ISSUE AND ACCESS TO CARE AS THE SECOND. AMC, WITH LOCAL PARTNERS, HAS MOVED FORWARD WITH STRATEGIES TO ADDRESS THESE PRIORITY ISSUES. THE CHA REQUIRED PRIORITIZATION, AND ALTHOUGH AMC IS WORKING ON PROJECTS THAT ADDRESS ALL TEN PREVENTION AGENDA ITEMS, IT NOT POSSIBLE FOR AN ORGANIZATION THE SIZE OF AMC TO ADDRESS ALL COMMUNITY HEALTH ISSUES SIMULTANEOUSLY. BY PRIORITIZING AND REPORTING BACK TO NYSDOH, AMC WILL CONTINUE TO WORK ON PRIORITY ISSUES, CONTINUE TO REASSESS, AND MOVE FORWARD WITH MAKING AN IMPACT ON IMPROVING THE HEALTH OF OUR COMMUNITY MEMBERS WITH OUR PARTNERS. FACILITY 1 -- ADIRONDACK MEDICAL CENTER PART V, SECTION B, LINE 20D: SELF-PAY PATIENTS THAT VISITED OUR MEDICAID SCREENER, AND WERE NOT DETERMINED TO BE FAP-ELIGIBLE, RECEIVED A 30% DISCOUNT. THOSE WHO WERE FAP-ELIGIBLE WERE WRITTEN OFF AT 100%. FACILITY 1 -- ADIRONDACK MEDICAL CENTER PART V, SECTION B, LINE 22: FACILITY 2 -- ADIRONDACK MEDICAL CENTER - LAKE PLACID PART V, SECTION B, LINE 3: IN 2010, AS PART OF THE NEEDS ASSESSMENT OF THE STRATEGIC PLAN, AMC CONDUCTED FOUR COMMUNITY FOCUS GROUPS. THE FOCUS GROUPS WERE COMPRISED OF MEMBERS OF THE CLERGY, LOCAL BUSINESS AND AGENCY LEADERS, ELECTED OFFICIALS, AND LEADERS OF LOCAL HEALTH CARE ORGANIZATIONS. FORTY TWO PEOPLE PARTICIPATED IN THE FOCUS GROUPS. THE FOCUS GROUP RESULTS WERE GIVEN TO ALL OF THE STRATEGIC PLANNING PARTICIPANTS. ALSO, AMC SURVEYED STAFF USING AN ELECTRONIC SURVEY. SIXTY THREE STAFF MEMBERS PARTICIPATED IN THE SURVEY. AMC SERVES A RURAL AREA AND OUR STAFF MEMBERS, THEIR FAMILY MEMBERS AND FRIENDS ARE ALSO OUR COMMUNITY MEMBERS. FACILITY 2 -- ADIRONDACK MEDICAL CENTER - LAKE PLACID PART V, SECTION B, LINE 4: IN 2009, AMC PARTICIPATED IN TWO COMMUNITY HEALTH ASSESSMENTS (CHA). IN THE SIX COUNTY CHA SIX HOSPITALS (INCLUDING AMC) AND SIX COUNTY HEALTH DEPARTMENTS PARTICIPATED IN THE ASSESSMENT. IN THE THREE COUNTY SURVEYS FOUR HOSPITALS (INCLUDING AMC) AND THREE COUNTY HEALTH DEPARTMENTS PARTICIPATED IN THE SURVEY. FACILITY 2 -- ADIRONDACK MEDICAL CENTER - LAKE PLACID PART V, SECTION B, LINE 5C: IN 2009, TWO COMPREHENSIVE CHA DOCUMENT WERE COMPILED. BOTH CHAS CONSISTED OF THE COMMUNITY HEALTH ASSESSMENT DATA AND ALL PARTICIPATING HOSPITALS' COMMUNITY SERVICE PLANS. THESE DOCUMENTS ARE AVAILABLE IN HARD COPY, CD, AND AS A PDF FILE. THE CHAS WERE SUBMITTED TO THE NEW YORK STATE DEPARTMENT OF HEALTH, CAN BE FOUND ON ALL OF THE COUNTY HEALTH DEPARTMENTS' WEB SITES, THE PARTICIPATING HOSPITALS' WEB SITES, AND ON THE ADIRONDACK RURAL HEALTH NETWORK (ARHN) WEB SITE. IN 2010, AMC CREATED A SUMMARY OF THE STRATEGIC PLAN AND PUBLISHED IT IN THE LOCAL NEWSPAPERS. THE SUMMARY CAN ALSO BE FOUND ON THE AMC WEBSITE. FACILITY 2 -- ADIRONDACK MEDICAL CENTER - LAKE PLACID PART V, SECTION B, LINE 7: NYS DEPARTMENT OF HEALTH REQUESTED THAT THE 2009 CHA USE THE NYS PREVENTION AGENDA TO STRUCTURE THE ASSESSMENT. BOTH CHA GROUPS CHOOSE PHYSICAL ACTIVITY AND NUTRITION AND THE FIRST PRIORITY ISSUE AND ACCESS TO CARE AS THE SECOND. AMC, WITH LOCAL PARTNERS, HAS MOVED FORWARD WITH STRATEGIES TO ADDRESS THESE PRIORITY ISSUES. THE CHA REQUIRED PRIORITIZATION, AND ALTHOUGH AMC IS WORKING ON PROJECTS THAT ADDRESS ALL TEN PREVENTION AGENDA ITEMS, IT NOT POSSIBLE FOR AN ORGANIZATION THE SIZE OF AMC TO ADDRESS ALL COMMUNITY HEALTH ISSUES SIMULTANEOUSLY. BY PRIORITIZING AND REPORTING BACK TO NYSDOH, AMC WILL CONTINUE TO WORK ON PRIORITY ISSUES, CONTINUE TO REASSESS, AND MOVE FORWARD WITH MAKING AN IMPACT ON IMPROVING THE HEALTH OF OUR COMMUNITY MEMBERS WITH OUR PARTNERS. FACILITY 2 -- ADIRONDACK MEDICAL CENTER - LAKE PLACID PART V, SECTION B, LINE 20D: SELF-PAY PATIENTS THAT VISITED OUR MEDICAID SCREENER, AND WERE NOT DETERMINED TO BE FAP-ELIGIBLE, RECEIVED A 30% DISCOUNT. THOSE WHO WERE FAP-ELIGIBLE WERE WRITTEN OFF AT 100%. 1 X X X X 1 0 0 0 0 0 0 0 0 JOHN BRODERICK MD 287151 0 0 0 0 0 9943 0 21178 0 318272 0 0 0 WILLIAM VISCARDO MD 243414 0 0 0 0 0 5808 0 21178 0 270400 0 0 0 CYNTHIA MCGUIRE 156069 0 0 0 0 0 6091 0 18911 0 181071 0 0 0 ANTHONY DOWIDOWICZ 268264 0 0 0 0 0 9970 0 9394 0 287628 0 0 0 MAJEED SIDDIQUI 324924 0 0 0 0 0 6897 0 21106 0 352927 0 0 0 NICHOLAS BRODYN 497526 0 0 0 0 0 9714 0 20097 0 527337 0 0 0 WOODS MCCAHILL 225806 0 0 0 0 0 7560 0 18911 0 252277 0 0 0 FRANK NOCILLA 226108 0 0 0 0 0 5294 0 16905 0 248307 0 0 0 FORM 990, PART VI, SECTION A, LINE 3 ADIRONDACK MEDICAL CENTER CONTRACTS WITH HEALTH TECH MANAGEMENT SERVICES TO FILL THE POSITION OF PRESIDENT/CEO. THE BOARD OF TRUSTEES PROVIDES DIRECT SUPERVISION. FORM 990, PART VI, SECTION B, LINE 11 THE 990 IS PRESENTED AND REVIEWED BY THE BOARD OF TRUSTEES PRIOR TO FILING THE 990. FORM 990, PART VI, SECTION B, LINE 12C ALL MEMBERS OF THE BOARD OF TRUSTEES ARE REQUIRED TO COMPLETE AND SIGN CONFLICT OF INTEREST STATEMENTS ANNUALLY. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION DECISIONS ARE DEVELOPED BASED ON THE USE OF NATIONAL, REGIONAL, AND HEALTH TECH CONSULTING DATA AND THE BOARD OF TRUSTEE'S INPUT. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. OTHER FEES FORM 990, PART IX, LINE 11G PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 2,066,924. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,066,924. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 801,152. MANAGEMENT AND GENERAL EXPENSES 1,100,852. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,902,004. CONSULTING FEES: PROGRAM SERVICE EXPENSES 2,900. MANAGEMENT AND GENERAL EXPENSES 484,836. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 487,736. LATE CHARGES/FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 2,341. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,341. LAUNDRY EXPENSE: PROGRAM SERVICE EXPENSES 224,660. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 224,660. CONTRACTED LABOR: PROGRAM SERVICE EXPENSES 316,951. MANAGEMENT AND GENERAL EXPENSES 8,940. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 325,891. CONTRACTED SERVICE: PROGRAM SERVICE EXPENSES 3,865,756. MANAGEMENT AND GENERAL EXPENSES 1,439,719. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,305,475. TRASH REMOVAL: PROGRAM SERVICE EXPENSES 1,128. MANAGEMENT AND GENERAL EXPENSES 152,363. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 153,491. COLLECTION AGENCY: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 96,600. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 96,600. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: OTHER 99,420. GIFT SHOP EQUITY 10,911. ADIRONDACK MEDICAL CENTER FOUNDATION PO BOX 471 LAKE COLBY DRIVE SARANAC LAKE NY 12983 161528554 SUPPORT AND ASSIST ADIRONDACK MEDICAL CENTER NY 501(C)3 BOX 11 ADIRONDACK MEDICAL CENTER 0 TRUDEAU HEALTH SYSTEMS LLC PO BOX 471 2233 STATE ROUTE 86 SARANAC LAKE NY 12983 141788211 CONTACTING - HEALTH SERVICES NY AMC AND TRUDEAU HEALTH SYSTEMS C 0.50000 0 TRUDEAU HEALTH SYSTEMS IPA PO BOX 471 2233 STATE ROUTE 86 SARANAC LAKE NY 12983 141795284 CONTACTING - HEALTH SERVICES NY AMC AND TRUDEAU HEALTH SYSTEMS C 31855 0.50000 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0