2012-10-18T16:49:16-05:00 2011-12-31 161226221 FUST CHARLES CHAMBERS LLP 5784 WIDEWATERS PARKWAY SYRACUSE NY 13214 990 2011-01-01 141731786 ADIRONDACK MEDICAL CENTER ADIR 5188914141 PO BOX 471 2233 STATE ROUTE 86 SARANAC LAKE NY 12983 CYNTHIA K MCGUIRE 5188914141 2012-10-02 1 ANGELA M FRANCO P00589741 3154463600 2011 2016-02-24 21:20:13Z CYNTHIA K MCGUIRE PO BOX 471 2233 STATE ROUTE 86 SARANAC LAKE NY 12983 105444153 0 X WWW.AMCCARES.ORG X 1991 NY THE MEDICAL CENTER PROVIDES ACUTE, SKILLED NURSING AND OUTPATIENT SERVICES TO RESIDENTS OF THE LOCAL GEOGRAPHIC REGION. 14 12 1135 128 0 0 1253165 2358987 92294398 99812547 197419 155840 1125535 1658935 94870517 103986309 0 0 0 0 48400727 52454934 0 0 0 44731548 50812477 93132275 103267411 1738242 718898 66473797 66671140 26253729 26581240 40220068 40089900 THE MEDICAL CENTER PROVIDES EXCELLENT HEALTHCARE CLOSE TO HOME. 0 0 23004204 33986259 ADIRONDACK MEDICAL CENTER IS A 97-BED ACUTE CARE FACILITY. IT PROVIDES A FULL RANGE OF INPATIENT (SURGICAL, MATERNITY AND PEDIATRIC). 48841186 57868497 REFERRED AMBULATORY, AMBULATORY SURGERY AND EMERGENCY SERVICES. 6791502 9230694 FREE STANDING NURSING HOME THAT HAS 156 BEDS. 78636892 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 0 1 68 0 1 1135 1 0 0 0 0 0 0 0 0 0 0 X 14 12 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X CYNTHIA K MCGUIRE 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 284307 0 39540 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 163430 0 29482 WILLIAM VISCARDO MD 40.00 X 210852 0 24190 ANTHONY DOWIDOWICZ 40.00 X 272432 0 23687 MAJEED SIDDIQUI 32.00 X 281176 0 24546 NICHOLAS BRODYN 40.00 X 446564 0 17852 STEVEN SONNENBERG 40.00 X 214078 0 23731 MATTHEW HINGE 40.00 X 211692 0 27759 2084531 0 210787 45 0 1 0 PREMIER ANESTHESIA 2655 NORTHWINDS PARKWAY ALPHARETTA GA 30368 MANAGEMENT FIRM 1133545 HEALTHTECH MANAGEMENT SERVICES INC 405 DUKE DRIVE SUITE 10 FRANKLIN TN 37067 MANAGEMENT FIRM 816566 MATRIX HEALTH SYSTEMS 86 LAKE STREET BURLINGTON VT 05401 MANAGEMENT FIRM 719658 INSIGHT HEALTH CORP PO BOX 847689 DALLAS TX 75284 MRI SERVICE 530213 MEDICAL SEARCH INTERNATIONAL PO BOX 535213 ATLANTA GA 30353 PHYSICIANS 388283 18 1987500 371487 2358987 NET PATIENT SERVICE RE 900099 99812547 99812547 99812547 53584 53584 386032 0 386032 386032 386032 1560100 1436557 21287 123543 -21287 102256 102256 DIETARY REVENUE 900099 178261 178261 PURCHASE DISCOUNTS 900099 157355 157355 REBATES & REFUNDS 900099 59768 59768 877519 877519 1272903 103986309 101085450 0 541872 X 2295318 1867364 427954 40521134 29829457 10691677 1074976 795800 279176 5494004 4067186 1426818 3069502 2272338 797164 203196 203196 274210 274210 435380 244264 191116 784654 784654 4775337 4775337 899116 899116 MEDICAL SUPPLIES 15602654 15602654 EQUIPMENT RENTAL/MAINTE 8448720 4842504 3606216 BAD DEBT 5438014 5438014 NON MEDICAL SUPPLIES 2930468 629938 2300530 11020728 7487382 3533346 103267411 78636892 24630519 0 6355126 8164030 15042538 13318293 1724890 1830619 2812872 3406362 84081530 50550343 33909059 33531187 3547102 3368975 3082210 3051674 66473797 66671140 6547321 8049390 786182 947292 12678666 11805346 2933000 933000 3308560 4846212 26253729 26581240 X 39232903 39102721 52103 52117 935062 935062 40220068 40089900 66473797 66671140 X 718898 -849066 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 987165 4018 -4004 987179 982116 5049 987165 0.05280 0.94720 0 0 185039 185039 40341464 18934891 21406573 40497628 30757178 9740450 3057399 858274 2199125 33531187 DEBT-CURRENT 879463 LINE OF CREDIT 2939633 RESIDENT FUNDS LIABILITY 108572 ASSET RETIREMENT AND OTHER LT 918544 4846212 103986309 103267411 718898 -255062 -594004 -849066 -130168 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: THE STANDARDS FOR ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES ESTABLISH A RECOGNITION THRESHOLD AND MEASUREMENT FOR INCOME TAX POSITIONS RECOGNIZED IN THE SYSTEM'S 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 2008 THROUGH 2011. PART XI, LINE 8 - OTHER ADJUSTMENTS: CHANGE IN SICK LEAVE BENEFIT -570,000. NET ASSETS RELEASED FROM RESTRICTION -4,004. TRANSFER TO FOUNDATION -20,000. TOTAL TO SCHEDULE D, PART XI, LINE 8: -594,004. 1 1 X 1 X 1 X 0 1 0 1 1 401315 401315 0.00410 14649582 11159176 3490406 0.03570 15050897 11159176 3891721 0.03980 111818 111818 0.00110 394269 394269 0.00400 2795519 1658802 1136717 0.01160 125 125 0.00000 1513 1513 0.00000 3303244 1658802 1644442 0.01670 18354141 12817978 5536163 0.05650 28636 28636 0.00030 138 138 0.00000 28774 28774 0.00030 1 2920214 1259936 26215987 32466228 -6250241 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 2 ADIRONDACK MEDICAL CENTER-LAKE PLACID

29 CHURCH STREET LAKE PLACID NY 12946

X X 2 ACUTE BEDS; OUTPATIENT SERIVCES, EMERGENCY ROOM ADIRONDACK MEDICAL CENTER 1 1 X X X X X X X X X 10 1 1 1 X X X X X 0 1 1 200.000000000000 1 400.000000000000 1 X X X X 1 1 X X X 1 X X 1 X X X X X 1 X 0 0 ADIRONDACK MEDICAL CENTER - LAKE PLACID 2 1 X X X X X X X X X 10 1 1 1 X X X X X 0 1 1 200.000000000000 1 400.000000000000 1 X X X X 1 1 X X X 1 X X 1 X X X X X 1 X 0 0 4 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 157 BEDS MERCY LIVING CENTER

114 WAWBEEK AVENUE TUPPER LAKE NY 12986

NURSING HOME WITH 60 BEDS; DIALYSIS, REHABILITATION PART I, LINE 7: AMOUNTS CALCULATED USING COST-TO-CHARGE RATIO FROM WORKSHEET 2 (TOTAL OPERATING EXPENSE MINUS BAD DEBT AND MEDICAID/PROVIDER TAXES DIVIDED BY GROSS PATIENT CHARGES), AND ADDRESSES ALL PATIENT SEGMENTS. PART I, L7 COL(F): BAD DEBT EXPENSE, REMOVED FROM DENOMINATOR, EQUALS 5,438,014. 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 GLENS FALLS COMMUNITIES WHOSE PURPOSE IS TO IMPROVE THE OVERALL HEALTH OF THESE ADIRONDACK COMMUNITIES BY WORKING TOGETHER ON A REGIONAL BASIS. THE CHIEF MEDICAL OFFICER SPENT TIME EDUCATING LOCAL, STATE, AND FEDERAL LEGISLATORS ABOUT IMPORTANT ISSUES IN HEALTHCARE AND COMMUNITY HEALTH. PART III, LINE 4: "THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IS ESTABLISHED AS LOSSES ARE ESTIMATED TO HAVE OCCURED THROUGH A PROVISION FOR DOUBTFUL ACCOUNTS CHARGED TO EARNINGS. DOUBTFUL ACCOUNTS ARE CHARGED AGAINST THE ALLOWANCE WHEN MANAGEMENT BELIEVES THE UNCOLLECTIBILITY OF A RECEIVABLE BALANCE IS CONFIRMED. SUBSEQUENT RECOVERIES, IF ANY, ARE CREDITED TO THE ALLOWANCE. THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IS EVALUATED ON A REGULAR BASIS BY MANAGEMENT AND IS BASED UPON MANAGEMENT'S PERIODIC REVIEW OF THE COLLECTIBILITY OF THE RECEIVABLES IN LIGHT OF HISTORICAL EXPERIENCE, THE NATURE AND VOLUME OF THE RECEIVABLES, OR ADVERSE SITUATION THAT MAY AFFECT THE PATIENT OR RESIDENTS ABILITY TO REPAY AND PREVAILING ECONOMIC CONDITIONS."THE ORGANIZATION'S BAD DEBT EXPENSE IS CALCULATED USING COST-TO-CHARGE RATIO FROM WORKSHEET 2 AND BAD DEBT EXPENSE.THE ESTIMATED AMOUNT OF THE ORGANIZATION'S BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY WAS 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 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%. ADIRONDACK MEDICAL CENTER PART V, SECTION B, LINE 1J: IN 2009 AND IN 2010 AMC PARTICIPATED IN TWO DIFFERENT COMMUNITY HEALTH PLANNING INITIATIVES. DUE TO THE SIZE OF AMC'S SERVICE AREA, IN 2009 THE HOSPITAL PARTICIPATED IN TWO REGIONAL COMMUNITY HEALTH ASSESSMENT INITIATIVES. ONE WAS A SIX COUNTY INITIATIVE FACILITATED BY THE ADIRONDACK RURAL HEALTH NETWORK (ARHN) FOCUSED ON OUR SOUTHERN SERVICE AREA. THE OTHER WAS A THREE COUNTY INITIATIVE LED BY THE COUNTY HEALTH DEPARTMENTS FOCUSED ON OUR NORTHERN SERVICE AREA. THESE INITIATIVES USED SIMILAR PROCESSES TO DETERMINE COMMUNITY HEALTH PRIORITIES. IN 2010, AMC COMPLETED ITS THREE YEAR STRATEGIC PLAN, 2011-2013. AN IMPORTANT PART OF THE STRATEGIC PLANNING PROCESS IS TO ASSESS COMMUNITY HEALTH NEEDS AND ADDRESS THEM IN THE STRATEGIC PRIORITIES FOR THE ORGANIZATION. ADIRONDACK MEDICAL CENTER - LAKE PLACID PART V, SECTION B, LINE 1J: IN 2009 AND IN 2010 AMC PARTICIPATED IN TWO DIFFERENT COMMUNITY HEALTH PLANNING INITIATIVES. DUE TO THE SIZE OF AMC'S SERVICE AREA, IN 2009 THE HOSPITAL PARTICIPATED IN TWO REGIONAL COMMUNITY HEALTH ASSESSMENT INITIATIVES. ONE WAS A SIX COUNTY INITIATIVE FACILITATED BY THE ADIRONDACK RURAL HEALTH NETWORK (ARHN) FOCUSED ON OUR SOUTHERN SERVICE AREA. THE OTHER WAS A THREE COUNTY INITIATIVE LED BY THE COUNTY HEALTH DEPARTMENTS FOCUSED ON OUR NORTHERN SERVICE AREA. THESE INITIATIVES USED SIMILAR PROCESSES TO DETERMINE COMMUNITY HEALTH PRIORITIES. IN 2010, AMC COMPLETED ITS THREE YEAR STRATEGIC PLAN, 2011-2013. AN IMPORTANT PART OF THE STRATEGIC PLANNING PROCESS IS TO ASSESS COMMUNITY HEALTH NEEDS AND ADDRESS THEM IN THE STRATEGIC PRIORITIES FOR THE ORGANIZATION. 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 ASLO OUR COMMUNITY MEMBERS. 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 ASLO OUR COMMUNITY MEMBERS. 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. 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. ADIRONDACK MEDICAL CENTER PART V, SECTION B, LINE 5C: IN 2009, TWO COMPREHENSIVE CHA DOCUMENTS 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 WEB SITE. ADIRONDACK MEDICAL CENTER - LAKE PLACID PART V, SECTION B, LINE 5C: IN 2009, TWO COMPREHENSIVE CHA DOCUMENTS 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 WEB SITE. 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 IS NOT POSSIBLE FOR AN ORGANIZATION THE SIZE OF AMC TO ADDRESS ALL COMMUNITY HEALTH ISSUES SIMULATANEOUSLY. 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. 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 IS NOT POSSIBLE FOR AN ORGANIZATION THE SIZE OF AMC TO ADDRESS ALL COMMUNITY HEALTH ISSUES SIMULATANEOUSLY. 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. ADIRONDACK MEDICAL CENTER PART V, SECTION B, LINE 19D: 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%. ADIRONDACK MEDICAL CENTER - LAKE PLACID PART V, SECTION B, LINE 19D: 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%. ADIRONDACK MEDICAL CENTER PART V, SECTION B, LINE 21: PATIENTS THAT DID NOT COMPLY WITH MEDICAID SCREENING WERE CHARGED 100%. ADIRONDACK MEDICAL CENTER - LAKE PLACID PART V, SECTION B, LINE 21: PATIENTS THAT DID NOT COMPLY WITH MEDICAID SCREENING WERE CHARGED 100%. PART VI, LINE 2: ADIRONDACK MEDICAL CENTER ("AMC") USES A NUMBER OF ASSESSMENT METHODS TO DETERMINE HOW WELL WE ARE MEETING COMMUNTIY 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-GAINEY, 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 OUT COMMUNITY. THE MAJORITY OF AMC'S STRATEGIC INITIATIVES ARE DRIVEN BY A THREE-YEAR STATEGIC 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 77.3% OF THE 23,113 RESIDENTS IN OUR PRIMARY SERVICE AREA AND 26.2% OF THE 12,690 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. - BREAST CANCER: 3 OUT OF 5 COUNTIES EXCEED THE AVERAGE RATE IN NYS (NYSDOH) - HIGHER THAN AVERAGE INCIDENCE OF URINARY BLADDER, COLORECTAL, ORAL, AND PHARYNX CANCER IN BOTH MEN AND WOMEN (NYSDOH) - HIGHER THAN AVERAGE RATES OF DIABETES, ASTHMA, TOBACCO USE, AND ALCOHOL USE (STATE UNIVERSITY OF NY, POTSDAM) - LOW POPULATION GROWTH (US CENSUS) > 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 GROUPSTHE AVERAGE UNEMPLOYMENT RATE IN 2011 FOR NEW YORK STATE WAS 8.2% AND THE UNEMPLOYMENT RATES IN THE COUNTIES THAT WE SERVE WAS ABOUT 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. - PARTNERED WITH FRANKLIN COUNTY PUBLIC HEALTH TO PROVIDE LOW-COST/FREE 6 WEEK CHRONIC DISEASE SELF-MANAGEMENT COURSES FOR COMMUNITY MEMBERS. - IN MAY 2011 AMC BEGAN A FREE, MONTHLY HEALTH LECTURE SERIES. LECTURE TOPICS HAVE INCLUDED-VITAMINS, MINERALS, AND YOU; YOUR FEET. THE MOST NEGLECTED PART OF YOUR ANATOMY; EMBRACING AN ACTIVE LIFE: TOP 5 THINGS FOR BETTER HEALTH: HEALTH SUMMER SIDES COOKING DEMONSTRATION; YOUR MOUTH, YOUR BODY, YOUR HEALTH; AND TEEN DEPRESSION. WE HAVE DRAWN ON LOCAL, REGIONAL, AND NATIONAL EXPERTS. LECTURE ATTENDANCE HAS RANGED FROM 25 TO OVER 50 PEOPLE. - IN 2011, AMC'S SPORTS MEDICINE AND REHABILITATION DEPARTMENT SPONSORED THREE RUNNER SPORTS CLINICS TO HELP PARTICIPANTS AVOID INJURIES AND STAY HEALTHY WHILE PARTICIPATING IN RECREATIONAL AND COMPETITIVE SPORTS OPPORTUNITIES. 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. REPORTS FILED WITH STATES PART VI, LINE 7 NY 1 X X X X 0 0 0 0 0 0 0 0 0 JOHN BRODERICK MD 266751 0 17556 0 0 0 9767 0 29773 0 323847 0 0 0 PATRICK FACTEAU 163430 0 0 0 0 0 6488 0 22994 0 192912 0 0 0 WILLIAM VISCARDO MD 210852 0 0 0 0 0 2092 0 22098 0 235042 0 0 0 ANTHONY DOWIDOWICZ 255877 0 16555 0 0 0 7405 0 16282 0 296119 0 0 0 MAJEED SIDDIQUI 227033 0 54143 0 0 0 2270 0 22276 0 305722 0 0 0 NICHOLAS BRODYN 446564 0 0 0 0 0 0 0 17852 0 464416 0 0 0 STEVEN SONNENBERG 206578 0 7500 0 0 0 1892 0 21839 0 237809 0 0 0 MATTHEW HINGE 195387 0 16305 0 0 0 7754 0 20005 0 239451 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. ALL OTHER FUNCTIONAL EXPENSES FORM 990, PART X, LINE 24E UTILITIES: PROGRAM SERVICE EXPENSES 2,363,041. MANAGEMENT AND GENERAL EXPENSES 350,759. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,713,800. PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 2,403,729. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,403,729. OTHER EXPENSES: PROGRAM SERVICE EXPENSES 1,606,645. MANAGEMENT AND GENERAL EXPENSES 563,631. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,170,276. PROFESSION FEES: PROGRAM SERVICE EXPENSES 750,469. MANAGEMENT AND GENERAL EXPENSES 852,441. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,602,910. ASSESSMENT FEE: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 1,066,702. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,066,702. CONTRACTED LABOR: PROGRAM SERVICE EXPENSES 363,448. MANAGEMENT AND GENERAL EXPENSES 158,091. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 521,539. CONSULTING FEES: PROGRAM SERVICE EXPENSES 50. MANAGEMENT AND GENERAL EXPENSES 336,931. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 336,981. LAUNDRY: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 204,791. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 204,791. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -255,062. CHANGE IN SICK LEAVE BENEFIT -570,000. NET ASSETS RELEASED FROM RESTRICTION -4,004. TRANSFER TO FOUNDATION -20,000. TOTAL TO FORM 990, PART XI, LINE 5: -849,066. 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 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 31030 0.50000 0 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0