2012-11-14T13:24:10-06:00 2011-12-31 161226221 FUST CHARLES CHAMBERS LLP 5784 WIDEWATERS PARKWAY SYRACUSE NY 13214 990 2011-01-01 141364513 ELIZABETHTOWN COMMUNITY HOSPITAL ELIZ 5188736377 75 PARK STREET ELIZABETHTOWN NY 12932 RODNEY BOULA 5188736377 2012-11-13 1 JOSEPH J SCHLEGEL P00301329 3154463600 2011 2016-02-24 21:20:13Z ALAN R CHARDAVOYNE 75 PARK STREET ELIZABETHTOWN NY 12932 20435264 0 X ECH.ORG X 1926 NY MISSION: TO PROMOTE WELLNESS IN THE COMMUNITIES WE SERVE BY PROVIDING QUALITY HEALTHCARE WITH SKILL, COMPASSION AND DIGNITY. 12 12 238 30 0 0 255291 269901 16453886 17500241 38702 178996 313633 946998 17061512 18896136 0 0 0 0 10164583 10783978 0 0 0 6566571 7289857 16731154 18073835 330358 822301 19616487 19525674 10116145 9791120 9500342 9734554 X THE MISSION OF ECH IS TO PROMOTE HEALTH AND WELLNESS IN THE COMMUNITY AND TO PROVIDE QUALITY HEALTHCARE WITH SKILL, COMPASSION AND DIGNITY. IN CREATING OUR COMMUNITY BENEFITS PLAN WE KEEP THIS MISSION IN MIND, CONTINUALLY LOOKING FOR WAYS TO MEET COMMUNITY HEALTH NEEDS AND TO BE A GOOD NEIGHBOR. ECH IS DRIVEN BY PEOPLE WHO LIVE IN THE SERVICE AREA AND WHO WANT TO SEE THEIR FRIENDS AND NEIGHBORS GET THE CARE AND SERVICES THEY NEED. 0 0 4169277 5879450 INPATIENT ACUTE UNIT, SUBACUTE REHABILITATIVE AND LONG TERM CARE INPATIENT PROGRAM:A 25-BED NURSING UNIT PROVIDING ACUTE, SUB ACUTE AND LONG-TERM CARE. THE SMALLER ATMOSPHERE CREATES A CLOSER BOND BETWEEN THE PATIENT AND PROFESSIONALS ENCOURAGING OPTIMAL HEALING AND COMPASSIONATE CARE. THE SUB-ACUTE PROGRAM IS VITAL TO AREA RESIDENTS BECAUSE FOLLOWING A HIP-REPLACEMENT, KNEE-SURGERY OR CARDIAC OPERATION, RECUPERATION AND THERAPY CAN BE DONE AT ELIZABETHTOWN COMMUNITY HOSPITAL, SAVING THE FAMILY THE TIME AND EXPENSE OF TRAVEL. THE PROGRAM PROVIDES ONE-ON-ONE THERAPEUTIC CARE. 3837948 4007874 CLINIC SERVICES:ECH OPERATES THE ELIZABETHTOWN COMMUNITY HEALTH CENTER, WESTPORT HEALTH CENTER LOCATED IN WESTPORT AND THE HIGH PEAKS HEALTH CENTER LOCATED IN WILMINGTON, NY. ECH OPERATES AN OUTPATIENT CHEMOTHERAPY PROGRAM, WHICH INCLUDES UPDATED INFUSION EQUIPMENT MAKING IT POSSIBLE TO PROVIDE SAFE AND EFFICIENT METHODS FOR CHEMOTHERAPY AND BLOOD-RELATED INFUSIONS. IN ADDITION, THE NEW SPECIALIZED VENTILATING HOOD ENABLES THE PREPARATION OF CHEMOTHERAPY SOLUTIONS ON-SITE. THIS IS A GREAT CONVENIENCE FOR CANCER PATIENTS, SAVING THEM THE 90-MINUTE ROUND-TRIP DRIVE TO THE CLOSEST CHEMOTHERAPY FACILITY. 2209119 3137618 EMERGENCY ROOM SERVICES:ECH'S RECENT EXPANSION OF THE EMERGENCY ROOM ADDED NEW STATE OF THE ART TRAUMA ROOMS, A TELEMENTRY SYSTEM FOR PATENT MONITORING, A REGISTRATION AREA DESIGNED FOR PATIENT PRIVACY AND CONFIDENTIALITY AND NEW WAITING AREAS FOR FAMILIES AND THEIR LOVED ONES.THE HOSPITAL OPERATES AN ALL-DIGITAL RADIOLOGY DEPARTMENT, ALLOWING TECHNOLOGISTS TO OBTAIN PATIENT IMAGES ANYWHERE IN THE HOSPITAL. IN THE EVENT OF A SIGNIFICANT EMERGENCY WITH MULTIPLE TRAUMAS, THE UNIT CAN BE USED ANYWHERE IN THE BUILDING. WHEN THE HOSPITAL IS FACED WITH AN UNUSUAL SURGE IN EMERGENCY ROOM TRAUMA CASES, HOSPITAL PROCEDURES ENABLE STAFF TO TRIAGE IN NONTRADITIONAL AREAS OF THE HOSPITAL. 5265602 5536328 5265602 5536328 15481946 1 1 0 0 0 0 0 0 0 1 1 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 24 0 1 238 1 0 0 0 0 0 0 0 0 0 0 X 12 12 0 0 0 0 1 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 NY X ALAN CHARDAVOYNE CFO ECH 5188733136 75 PARK STREET ELIZABETHTOWN NY 12932 FRAN FILSHIE 0.80 X 0 0 0 NICOLE BRYANT 0.80 X X 0 0 0 REV FRED SHAW 0.80 X 0 0 0 PATTY BASHAW 0.80 X X 0 0 0 ULRICH HOFFMAN 2.00 X X 0 0 0 ALAN HIPPS 0.80 X 0 0 0 GEORGE SALG 0.80 X 0 0 0 PATRICIA HICKEY 0.80 X 0 0 0 DAPHNE HALLOWELL 0.80 X 0 0 0 JIM FORCIER 0.80 X X 0 0 0 LAURA SELLS-DOYLE 0.80 X 0 0 0 ROBERT A PERKINS 0.80 X 0 0 0 RODNEY BOULA CEOPRESIDENT 40.00 X 221286 0 40698 ALAN CHARDAVOYNE 40.00 X 130223 0 6897 ROB DEMURO MD MEDICAL DIRECTOR 40.00 X 272222 0 30288 PASQUALINO CAPUTO MD 40.00 X 263904 0 29977 NICOLE CONGER 40.00 X 129422 0 9617 DIANA HOUSE 40.00 X 115568 0 9827 PATRICK JOHNSTON 40.00 X 140931 0 7117 TRACI DIMARCO 40.00 X 191765 0 23720 1465321 0 158141 8 0 1 0 0 10593 189321 69987 269901 CRITICAL ACCESS HOSPIT 900099 17500241 17500241 17500241 64965 64965 1618578 19900 1451389 73058 167189 -53158 114031 114031 14681 10593 14681 0 OTHER OPERATING REV. 900099 946998 946998 946998 18896136 18561270 0 64965 690739 491497 199242 8257830 6780605 1477225 331021 258498 72523 871844 721642 150202 632544 500449 132095 61911 6100 55811 194961 194961 83970 83970 186482 97985 88497 59116 23783 35333 56530 24159 32371 301663 301663 1322104 1322104 199631 199631 CONTRACTED, LINEN & PUR 1351722 1244338 107384 BAD DEBT EXPENSE 976141 976141 DRUGS SUPPLIES, GASES & 798173 798173 MAINTENANCE AND UTILITI 776072 733381 42691 921381 722866 198515 18073835 15481946 2591889 0 649668 2510511 1332579 1106917 189703 135476 2932167 2965656 224809 216160 305916 351516 19349557 9065075 10954463 10284482 1476957 1562338 1550225 392618 19616487 19525674 1641637 1191808 6355000 6160000 1272746 1216336 846762 1222976 10116145 9791120 X 8424857 8962769 1060745 757045 14740 14740 9500342 9734554 19616487 19525674 X 822301 -588089 X X 0 1 0 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1075485 231296 256 535252 771785 982946 243135 181 150777 1075485 1777277 796072 -558 1589845 982946 924319 1120729 12713 280484 1777277 0.98090 0.01910 0 0 123758 123758 12128259 4572227 7556032 6676646 4200372 2476274 420894 292476 128418 10284482 U.S. GOVERNMENT AND AGENCY OBLIGATIONS 130921 F MUTUAL FUNDS 624093 F ASSETS BACKED SECURITIES 74771 F MARKETABLE EQUITY SECURITIES 732553 F 1562338 DUE TO AFFILIATES 229328 INTEREST RATE SWAP LIABILITY 928748 WC/MALPRACTICE LIABILITY 64900 1222976 18896136 18073835 822301 -206898 -381191 -588089 234212 18733703 -162433 -162433 18896136 0 18896136 18073835 0 18073835 0 18073835 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE HOSPITAL IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS GENERALLY EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE STANDARDS FOR ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES ESTABLISH A RECOGNITION THRESHOLD AND MEASUREMENT FOR INCOME TAX POSITIONS RECOGNIZED IN A HOSPITAL'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: CHANGES IN FAIR VALUE OF INTEREST RATE SWAP -381,191. GOLF TOURNAMENT 25274 10593 14681 3734 5049 5783 115 25274 10593 14681 3734 5049 5783 115 14681 0 1 1 1 X 1 X 1 1 0 1 1 46000 46000 0.00250 1089545 66189 1023356 0.05660 596381 596381 0.03300 1731926 66189 1665737 0.09210 1731926 66189 1665737 0.09210 1 478309 8475205 8391292 83913 X 1 1 1 1 ELIZABETHTOWN COMMUNITY HOSPITAL

75 PARK STREET PO BOX 277 ELIZABETHTOWN NY 12932

X X X 25 BEDS (ACUTE & SWING) 3 HEALTHCENTERS, CT, LAB, PHARM. PT. AMB SURG. ELIZABETHTOWN COMMUNITY HOSPITAL 1 1 1 300.000000000000 1 15.000000000000 1 X 1 1 X X X X 1 X X 0 1 0 1 PART II: THE HOSPITAL STAFF PARTICIPATES IN MANY LOCAL EVENTS THAT PROVIDE COMMUNITY MEMBERS THE OPPORTUNITY TO LEARN ABOUT THE HOSPITAL AND ABOUT IMPORTANT HEALTH SCREENINGS. IN ADDITION, THE HOSPITAL HOSTS EVENTS AND OFFERS TRAINING AND SUPPORT SERVICES TO OTHER HEALTH-ORIENTED ORGANIZATIONS. ECH PARTICIPATES IN THE FOLLOWING:(1)PROVIDES ADVANCED LIFE SUPPORT TRAINING FOR REGIONAL EMERGENCY MEDICAL TECHNICIANS. (2)PROVIDES MEDICAL DIRECTORSHIP TO SEVERAL LOCAL EMS AGENCIES, PROVIDES MONTHLY COURSES AND EDUCATION FOR CME CREDITS. (3)PROVIDES MEDICAL DIRECTORSHIP TO ST. JOSEPH'S ADDICTION TREATMENT & RECOVERY CENTER (4)SPONSORS AN ANNUAL DIABETES HEALTH FAIR AT THE HOSPITAL. (5)LENDS SPACE TO THE NORTH COUNTRY REGIONAL BLOOD DONOR CENTER FOR BLOOD DRIVES. (6)THE HOSPITAL AUXILIARY PROVIDES VOLUNTEERS FOR THE LAKE PLACID IRON MAN EVENT EACH JULY. (7)MEETING SPACE IS DONATED ON A MONTHLY BASIS TO EMS SQUADS. TECHNOLOGICAL CAPABILITIES ALLOW FOR DISTANCE TRAINING / EDUCATION. (8)WORKS WITH THE CANCER SCREENING PROGRAM TO PROVIDE INFORMATION ABOUT MAMMOGRAMS AND BONE DENSITY SCREENING AT THE ANNUAL BREAST CANCER AWARENESS EVENT. (9)FREE BLOOD PRESSURE CHECKS AND HEALTH INFORMATION ARE OFFERED AT THE ESSEX COUNTY FAIR. (10)HOSTS THE ESSEX COUNTY DIABETES SUPPORT GROUP MEETINGS IN THE HOSPITAL BOARDROOM. (11)HOSTS THE ANNUAL DIABETES HEALTH FAIR AT THE HOSPITAL. (12)EMPLOYEES FROM THROUGHOUT THE HOSPITAL USE HOSPITAL PAID TIME TO LEND THEIR EXPERTISE AND INCREASE THEIR INTERESTS IN SUCH AREAS AS THE ESSEX CO. HEALTHY LIVING PARTNERSHIP, WORKFORCE INVESTMENT BOARD, RETIRED SENIOR VOLUNTEER PROGRAM, SAFE KIDS ADIRONDACK, AND TASK FORCE AGAINST DOMESTIC VIOLENCE. (12)ECH'S CLINICAL STAFF COMPLETES ADDITIONAL TRAINING EACH YEAR (ACLS, PALS, BLS, VARIOUS RN / NURSING TRAINING PROGRAMS, CHEMOTHERAPY EDUCATION, PHYSICIAN EDUCATION, INFECTION CONTROL TRAINING, RADIOLOGY DEPARTMENT CONTINUING EDUCATION, LAB STAFF EDUCATION, ETC.) EACH YEAR, THE HOSPITAL ALSO HOSTS THREE EVENTS THAT OFFER FREE HEALTH SCREENINGS TO LOCAL RESIDENTS. (1)HUNTERS' HEALTH SCREENING (SEPTEMBER) IS A FREE, ANNUAL EVENT SPONSORED BY THE HOSPITAL. PARTICIPANTS RECEIVE A BASIC PHYSICAL / HEALTH SCREENING (EKG, BLOOD WORK, BLOOD PRESSURE, LAB TESTING, PHYSICIAN REVIEW AND REPORTING) AT NO COST. EVENT IS ARRANGED, COORDINATED AND PROMOTED BY ECH PUBLIC RELATIONS STAFF. IN 2011, THERE WERE APPROXIMATELY 25 PARTICIPANTS. (2)HEALTHY HEART DAY (FEBRUARY) IS ANOTHER FREE HEALTH SCREENING EVENT; AND IS CO-SPONSORED BY THE HOSPITAL AUXILIARY EACH YEAR. PARTICIPANTS RECEIVE HEART HEALTH EDUCATION, HEALTH SCREENINGS, LAB TESTING, PHYSICIAN REVIEW AND REPORTING. PARTICIPANTS CAN SPEAK TO EXPERTS DURING THE EVENT. IN 2011, THERE WERE 43 PARTICIPANTS. (3) IN THE FALL OF 2011, THE HOSPITAL HELD IT'S FIRST "WOMEN'S HEALTH NIGHT" CO-SPONSORED BY THE CANCER SERVICES SCREENING PROGRAM OF ESSEX AND FRANKLIN COUNTIES AND THE HOSPITAL'S AUXILIARY. THE EVENING FEATURED A SPEAKER, ALONG WITH THE OPPORTUNITY TO TAKE PART IN A FREE HEALTH SCREENING. WOMEN WHO QUALIFIED (UN- OR UNDER-INSURED) WERE ABLE TO RECEIVE A CLINICAL BREAST EXAM AND MAMMOGRAM AT NO COST TO THEM, THROUGH THE CANCER SERVICES SCREENING PROGRAM OF ESSEX AND FRANKLIN COUNTIES. IN 2011, 12 FREE MAMMOGRAMS WERE OFFERED TO WOMEN AS PART OF THIS HEALTH FAIR. THE NEXT IS SCHEDULED TO TAKE PLACE ON OCTOBER 30, 2012. PART III, LINE 4: THE BAD DEBT INCLUDED ON LINE 2 IS DETERMINED AT COST. FINANCIAL STATEMENT FOOTNOTE FOR BAD DEBT EXPENSE:THE HOSPITAL IS DESIGNATED AS A CRITICAL ACCESS HOSPITAL BY MEDICARE AND MEDICAID. THESE THIRD-PARTY PAYORS REIMBURSE THE HOSPITAL ON A COST BASIS. THE HOSPITAL ALSO HAS AGREEMENTS WITH OTHER THIRD-PARTY PAYORS. PAYMENT ARRANGEMENTS INCLUDE PROSPECTIVELY DETERMINED RATES PER DISCHARGE, COST-BASED REIMBURSEMENT, DISCOUNTED CHARGES AND PER DIEM PAYMENTS. NET PATIENT SERVICE REVENUE AND THE RELATED PATIENT ACCOUNTS RECEIVABLE ARE REPORTED AT THE ESTIMATED NET REALIZABLE AMOUNTS FROM PATIENTS, THIRD-PARTY PAYORS AND OTHERS FOR SERVICES RENDERED, INCLUDING ESTIMATED RETROACTIVE ADJUSTMENTS DUE TO FUTURE AUDITS, REVIEWS AND INVESTIGATIONS. RETROACTIVE ADJUSTMENTS ARE CONSIDERED IN THE RECOGNITION OF REVENUE ON AN ESTIMATED BASIS IN THE PERIOD THE RELATED SERVICES ARE RENDERED AND ADJUSTED IN FUTURE PERIODS AS ADJUSTMENTS BECOME KNOWN OR AS YEARS ARE NO LONGER SUBJECT TO SUCH AUDITS, REVIEWS AND INVESTIGATIONS.AN ALLOWANCE FOR DOUBTFUL ACCOUNTS RECEIVABLE IS ESTIMATED BY MANAGEMENT BASED ON PERIODIC REVIEWS OF THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE CONSIDERING HISTORICAL EXPERIENCE AND PREVAILING ECONOMIC CONDITIONS. PART III, LINE 8: USED MEDICARE ONLY TOTAL CHARGES FROM REVENUE REPORT FOR 2011 AND APPLIED THE RATIO OF COST TO CHARGES FROM THE 2011 COST REPORT DATA. PART III, LINE 9B: THE ELIZABETHTOWN COMMUNITY HOSPITAL'S HELPING HANDS PROGRAM OFFERS FREE OR REDUCED CARE TO OUR PATIENTS WHO ARE UNINSURED OR UNDERINSURED AND MEET THE INCOME ELIGIBILITY CRITERIA SET BY THE FOLLOWING GUIDELINES. THE FREE OR REDUCED CARE APPLIES ONLY TO THE SERVICES PROVIDED BY THE ELIZABETHTOWN COMMUNITY HOSPITAL, WESTPORT HEALTH CENTER, ELIZABETHTOWN COMMUNITY HEALTH CENTER AND HIGH PEAKS HEALTH CENTER. ELIZABETHTOWN COMMUNITY HOSPITAL PART V, SECTION B, LINE 21: THE ORGANIZATION USES A GLOBAL FEE SCHEDULE. PART VI, LINE 2: A NUMBER OF COMMUNITY PARTNERS ARE INVOLVED IN ASSESSING COMMUNITY HEALTH NEEDS WITHIN THE HOSPITAL'S SERVICE AREA.IN ADDITION TO ITS ESTABLISHED RELATIONSHIPS WITH OTHER HOSPITALS, COMMUNITY ORGANIZATIONS AND HEALTHCARE-BASED ORGANIZATIONS (EMS, PUBLIC HEALTH, MENTAL HEALTH, ETC.), ELIZABETHTOWN COMMUNITY HOSPITAL HAS PARTNERED WITH TWO REGIONAL GROUPS TO ASSESS THE REGION'S COMMUNITY HEALTH NEEDS - THE MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIPS COMMITTEE, AND THE ADIRONDACK RURAL HEALTH NETWORK.MOBILIZING FOR ACTION THROUGH PLANNING & PARTNERSHIP (MAPP): AGENCY REPRESENTATIVES FROM CLINTON, ESSEX, AND FRANKLIN COUNTIES MEET TO APPLY COMMUNITY BASED APPROACHES TO LOCAL HEALTH ISSUES. THE MAPP GROUP HAS WORKED TO CULL INFORMATION THROUGH ASSESSMENTS OF THE LOCAL PUBLIC HEALTH SYSTEMS, A CDC LOCAL PUBLIC HEALTH INDICATOR SURVEY, A QUALITY OF LIFE SURVEY OF SENIORS AND PARENTS WITH CHILDREN, AND FOCUS GROUPS. THE MAPP GROUP SHARES UPDATED INFORMATION ON A CONTINUAL BASIS TO REASSESS PRIORITIES AND GAUGE PROGRAM SUCCESS.ADIRONDACK RURAL HEALTH NETWORK (ARHN): THE ADIRONDACK RURAL HEALTH NETWORK IS A PARTNERSHIP OF PUBLIC, PRIVATE AND NON-PROFIT ORGANIZATIONS IN UPSTATE NEW YORK. ARHN MEMBERS COLLABORATE TO DEVELOP STRATEGIES ALONG WITH IMPLEMENTING, MONITORING AND EVALUATING VARIOUS INITIATIVES. THIS GROUP CONTINUES TO MEET ON A (ROUGHLY) MONTHLY BASIS IN ORDER TO SHARE INFORMATION, STATISTICS, SUCCESSES, CHALLENGES AND OUTCOMES. ELIZABETHTOWN COMMUNITY HOSPITAL (ECH): IN ADDITION TO PARTNERSHIPS WITH THE ARHN AND THE MAPP PROCESSES, ECH INDEPENDENTLY SEEKS THE VIEWS OF COMMUNITY MEMBERS TO GAIN THEIR THOUGHTS REGARDING HEALTH CARE IN THEIR COMMUNITY AND GAIN FEEDBACK REGARDING ECH SERVICES. THROUGHOUT 2010-2011 MANY DIFFERENT METHODS WERE USED TO COMMUNICATE WITH AREA RESIDENTS. EACH YEAR HOSPITAL ADMINISTRATOR ROD BOULA ATTENDS TOWN BOARD MEETINGS THROUGHOUT ESSEX COUNTY IN AN EFFORT TO UPDATE TOWN LEADERS AND COMMUNITY MEMBERS ABOUT THE HOSPITAL, ITS PLANS FOR THE FUTURE; AND TO ADDRESS ANY QUESTIONS. ANNUALLY, THE ADMINISTRATOR MEETS WITH EMS AND FIRE DEPARTMENTS WITHIN THE HOSPITAL SERVICE AREA TO ENCOURAGE OPEN COMMUNICATION AND FOSTER A GOOD WORKING RELATIONSHIP. THE ECH BOARD OF DIRECTORS IS COMPOSED OF 14 REPRESENTATIVES OF EITHER A SPECIFIC COMMUNITY AND/OR ORGANIZATION, INCLUDING THE ESSEX COUNTY OFFICE FOR THE AGING, TOWN OF ELIZABETHTOWN SUPERVISORS OFFICE, AND ESSEX COUNTY MENTAL HEALTH. A PLANNING COMMITTEE, COMPRISED OF BOARD MEMBERS, IDENTIFIES GAPS IN SERVICE AND DEVELOPS GOALS TO FILL THESE NEEDS. PATIENT SATISFACTION SURVEYS ARE CONDUCTED FOR EACH DEPARTMENT ON A CONTINUAL BASIS. PART VI, LINE 4: ELIZABETHTOWN COMMUNITY HOSPITAL'S PRIMARY SERVICE AREA HAS REMAINED UNCHANGED FOR 2011 PLANNING PURPOSES. IT IS COMPOSED OF TWENTY-TWO ZIP CODES IN NORTHEASTERN ESSEX COUNTY. THE HOSPITAL IS LOCATED 45-60 MINUTES AWAY FROM ANY OTHER HOSPITAL; THROUGH A MOUNTAINOUS REGION AND MOSTLY ALONG A SERIES OF SECONDARY ROADS.BASED ON U.S. CENSUS FOR 2010, 39,370 PEOPLE LIVE WITHIN ESSEX COUNTY OF WHICH 51.8% ARE MALE AND 48.2% ARE FEMALE. PEOPLE OVER THE AGE OF 65 CONSTITUTE 18.1% OF THE POPULATION AND CHILDREN UNDER THE AGE OF 18 MAKE UP 19.3% OF THE POPULATION.ETHNICALLY, 94.4% OF THE POPULATION IS WHITE, NON-HISPANIC. BY 2013 THE POPULATION OF THIS AREA IS EXPECTED TO DECLINE BY AN ESTIMATED 1.5%. PART VI, LINE 5: THE HOSPITAL STAFF PARTICIPATES IN MANY LOCAL EVENTS THAT PROVIDE COMMUNITY MEMBERS THE OPPORTUNITY TO LEARN ABOUT THE HOSPITAL AND ABOUT IMPORTANT HEALTH SCREENINGS. IN ADDITION, THE HOSPITAL HOSTS EVENTS AND OFFERS TRAINING AND SUPPORT SERVICES TO OTHER HEALTH-ORIENTED ORGANIZATIONS. ECH PARTICIPATES IN THE FOLLOWING:(1)PROVIDES ADVANCED LIFE SUPPORT TRAINING FOR REGIONAL EMERGENCY MEDICAL TECHNICIANS. (2)PROVIDES MEDICAL DIRECTORSHIP TO SEVERAL LOCAL EMS AGENCIES, PROVIDES MONTHLY COURSES AND EDUCATION FOR CME CREDITS. (3)PROVIDES MEDICAL DIRECTORSHIP TO ST. JOSEPH'S ADDICTION TREATMENT & RECOVERY CENTER (4)SPONSORS AN ANNUAL DIABETES HEALTH FAIR AT THE HOSPITAL. (5)LENDS SPACE TO THE NORTH COUNTRY REGIONAL BLOOD DONOR CENTER FOR BLOOD DRIVES. (6)THE HOSPITAL AUXILIARY PROVIDES VOLUNTEERS FOR THE LAKE PLACID IRON MAN EVENT EACH JULY. (7)MEETING SPACE IS DONATED ON A MONTHLY BASIS TO EMS SQUADS. TECHNOLOGICAL CAPABILITIES ALLOW FOR DISTANCE TRAINING / EDUCATION. (8)WORKS WITH THE CANCER SCREENING PROGRAM TO PROVIDE INFORMATION ABOUT MAMMOGRAMS AND BONE DENSITY SCREENING AT THE ANNUAL BREAST CANCER AWARENESS EVENT. (9)FREE BLOOD PRESSURE CHECKS AND HEALTH INFORMATION ARE OFFERED AT THE ESSEX COUNTY FAIR. (10)HOSTS THE ESSEX COUNTY DIABETES SUPPORT GROUP MEETINGS IN THE HOSPITAL BOARDROOM. (11)HOSTS THE ANNUAL DIABETES HEALTH FAIR AT THE HOSPITAL. (12)EMPLOYEES FROM THROUGHOUT THE HOSPITAL USE HOSPITAL PAID TIME TO LEND THEIR EXPERTISE AND INCREASE THEIR INTERESTS IN SUCH AREAS AS THE ESSEX CO. HEALTHY LIVING PARTNERSHIP, WORKFORCE INVESTMENT BOARD, RETIRED SENIOR VOLUNTEER PROGRAM, SAFE KIDS ADIRONDACK, AND TASK FORCE AGAINST DOMESTIC VIOLENCE. (12)ECH'S CLINICAL STAFF COMPLETES ADDITIONAL TRAINING EACH YEAR (ACLS, PALS, BLS, VARIOUS RN / NURSING TRAINING PROGRAMS, CHEMOTHERAPY EDUCATION, PHYSICIAN EDUCATION, INFECTION CONTROL TRAINING, RADIOLOGY DEPARTMENT CONTINUING EDUCATION, LAB STAFF EDUCATION, ETC.) EACH YEAR, THE HOSPITAL ALSO HOSTS THREE EVENTS THAT OFFER FREE HEALTH SCREENINGS TO LOCAL RESIDENTS. (1)HUNTERS' HEALTH SCREENING (SEPTEMBER) IS A FREE, ANNUAL EVENT SPONSORED BY THE HOSPITAL. PARTICIPANTS RECEIVE A BASIC PHYSICAL / HEALTH SCREENING (EKG, BLOOD WORK, BLOOD PRESSURE, LAB TESTING, PHYSICIAN REVIEW AND REPORTING) AT NO COST. EVENT IS ARRANGED, COORDINATED AND PROMOTED BY ECH PUBLIC RELATIONS STAFF. IN 2011, THERE WERE APPROXIMATELY 25 PARTICIPANTS. (2)HEALTHY HEART DAY (FEBRUARY) IS ANOTHER FREE HEALTH SCREENING EVENT; AND IS CO-SPONSORED BY THE HOSPITAL AUXILIARY EACH YEAR. PARTICIPANTS RECEIVE HEART HEALTH EDUCATION, HEALTH SCREENINGS, LAB TESTING, PHYSICIAN REVIEW AND REPORTING. PARTICIPANTS CAN SPEAK TO EXPERTS DURING THE EVENT. IN 2011, THERE WERE 43 PARTICIPANTS. (3) IN THE FALL OF 2011, THE HOSPITAL HELD IT'S FIRST "WOMEN'S HEALTH NIGHT" CO-SPONSORED BY THE CANCER SERVICES SCREENING PROGRAM OF ESSEX AND FRANKLIN COUNTIES AND THE HOSPITAL'S AUXILIARY. THE EVENING FEATURED A SPEAKER, ALONG WITH THE OPPORTUNITY TO TAKE PART IN A FREE HEALTH SCREENING. WOMEN WHO QUALIFIED (UN- OR UNDER-INSURED) WERE ABLE TO RECEIVE A CLINICAL BREAST EXAM AND MAMMOGRAM AT NO COST TO THEM, THROUGH THE CANCER SERVICES SCREENING PROGRAM OF ESSEX AND FRANKLIN COUNTIES. IN 2011, 12 FREE MAMMOGRAMS WERE OFFERED TO WOMEN AS PART OF THIS HEALTH FAIR. THE NEXT IS SCHEDULED TO TAKE PLACE ON OCTOBER 30, 2012. REPORTS FILED WITH STATES PART VI, LINE 7 NY X X X X 0 0 0 0 0 0 0 0 0 RODNEY BOULA CEOPRESIDENT 221286 0 0 0 0 0 9432 0 31266 0 261984 0 0 0 ROB DEMURO MD MEDICAL DIRECTOR 272222 0 0 0 0 0 11433 0 18855 0 302510 0 0 0 PASQUALINO CAPUTO MD 263904 0 0 0 0 0 11084 0 18893 0 293881 0 0 0 TRACI DIMARCO 191765 0 0 0 0 0 2616 0 21104 0 215485 0 0 0 ESSEX COUNTY INDUSTRIAL DEVELOPMENT AGENCY 141630643 2011-12-01 6160000 HOSPITAL RENOVATION AND EXPANSION 0 0 0 6160000 125507 6034493 2009 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 FORM 990, PART VI, SECTION A, LINE 6 COMMUNITY PROVIDERS, INC. (CPI) IS THE SOLE MEMBER OF ELIZABETHTOWN COMMUNITY HOSPITAL. FORM 990, PART VI, SECTION B, LINE 11 DUE TO TIME CONSTRAINTS, THE 990 WAS NOT SUBMITTED TO THE BOARD PRIOR TO FILING. IT WILL BE DISTRIBUTED TO THE BOARD AT A SUBSEQUENT MEETING. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION HAS A WRITTEN CONFLICT OF INTEREST POLICY AND ALL MEMBERS ARE REQUIRED TO DISCLOSE ANY CONFLICTING INTERESTS OR STATE "NONE" ON THE ANNUAL CONFLICT OF INTEREST FORM. FORM 990, PART VI, SECTION B, LINE 15 THE GOVERNING BOARD IS PROVIDED AN INDEPENDENT REPORT OF COMPATIBLE HOSPITALS SALARY FOR THE CEO. THE GOVERNING BOARD ALSO REVIEWS VARIOUS PERFORMANCE MEASURES AND OTHER INFORMATION AND ARRIVES AT A SALARY AND BENEFIT PACKAGE FOR THE CEO. THE DIRECTOR OF HUMAN RESOURCES OBTAINS SALARY INFORMATION FROM AN INDEPENDENT SOURCE FOR LOCAL COMPATIBLE HOSPITALS FOR EACH HIGHER LEVEL POSITION AT THE HOSPITAL. THE INDEPENDENT INFORMATION CONTAINS SALARY LEVELS FOR EACH POSITION AT THE 25TH, 50TH AND 75TH PERCENTILE. THE CEO THEN CONSIDERS THIS INFORMATION AND THE PERFORMANCE FOR EACH OF THESE EMPLOYEES AND ARRIVES AT THE APPROPRIATE SALARY LEVEL. THE APPROACH AND METHODOLOGY IS ALSO PRESENTED TO THE GOVERNING BOARD. FORM 990, PART VI, SECTION C, LINE 19 THESE DOCUMENTS ARE AVAILABLE TO THE PUBLIC UPON WRITTEN REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -206,898. CHANGES IN FAIR VALUE OF INTEREST RATE SWAP -381,191. TOTAL TO FORM 990, PART XI, LINE 5: -588,089. FORM 990, PART XII, LINE 2C: THERE ARE NO CHANGES FROM THE PRIOR YEAR. CVPH MEDICAL CENTER 75 BECKMAN STREET PLATTSBURGH NY 12901 141338471 HOSPITAL PATIENT CARE NY 501(C)(3) 3 COMMUNITY PROVIDERS INC 0 COMMUNITY PROVIDERS INC 75 BECKMAN STREET PLATTSBURGH NY 12901 222544844 HEALTH CARE SERVICES NY 501(C)(3) 3 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 1 1 0 0