2011-11-15T15:38:12-06:00 2010-12-31 FUST CHARLES CHAMBERS LLP 5784 WIDEWATERS PARKWAY SYRACUSE NY 13214 990 2010-01-01 141364513 ELIZABETHTOWN COMMUNITY HOSPITAL ELIZ 5188736377 75 PARK STREET ELIZABETHTOWN NY 12932 RODNEY BOULA 5188736377 2011-11-14 1 JOSEPH J SCHLEGEL 3154463600 2010 2016-03-07 17:11:31Z ALAN R CHARDAVOYNE 75 PARK STREET ELIZABETHTOWN NY 12932 17654522 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. 10 10 287 0 0 0 824714 255291 14783093 16453886 -17103 38702 187602 313633 15778306 17061512 0 0 0 0 9583973 10164583 0 0 0 5576173 6566571 15160146 16731154 618160 330358 18932628 19616487 9755900 10116145 9176728 9500342 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 3821934 5162549 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. 3775703 2520361 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. TOTAL 2010 OUT-PATIENT CHEMOTHERAPY VISITS MEDICARE 364 MEDICAID 25 NON PROFIT INDEMNITY 105 COMMERCIAL 40 2416801 3032116 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.TOTAL 2010 VISITS 262MEDICARE 77 MEDICAID 22 NON PROFIT INDEMNITY 107 OTHER 7COMMERCIAL 44 UNINSURED/SP 5 4360746 6029166 4360746 6029166 14375184 1 1 0 0 0 0 0 0 1 1 1 0 1 1 1 1 0 0 0 0 0 0 0 0 0 1 0 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 1 287 1 0 0 0 0 0 0 0 0 0 0 X 10 10 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 0 0 0 PHIL HUTCHINS 0.80 X 0 0 0 NOEL MERRIHEW 0.80 X 0 0 0 REV FRED SHAW 0.80 X 0 0 0 PATTY BASHAW 0.80 X 0 0 0 ULRICH HOFFMAN 2.00 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 0 0 0 LAURA SELLS-DOYLE 0.80 X 0 0 0 RODNEY BOULA CEOPRESIDENT 40.00 X 191890 0 38012 ALAN CHARDAVOYNE 40.00 X 127577 0 7474 ROB DEMURO MD MEDICAL DIRECTOR 40.00 X 252216 0 28929 HARRY DAVIS MD 40.00 X 269409 0 24152 PASQUALINO CAPUTO MD 40.00 X 203649 0 25885 NICOLE CONGER 40.00 X 131257 0 10090 JESSICA CRANE 40.00 X 102065 0 9080 DIANA HOUSE 40.00 X 106569 0 9124 PATRICK JOHNSTON 40.00 X 136031 0 7551 CECILIA LAWLOR 40.00 X 103335 0 9114 1623998 0 169411 10 0 1 0 0 11344 243947 255291 CRITICAL ACCESS HOSPIT 900099 16453886 16453886 16453886 62029 62029 554122 577449 -23327 -23327 -23327 15561 11344 15561 0 OTHER OPERATING REV. 900099 313633 313633 313633 17061512 16744192 0 62029 1044741 725274 319467 7444241 6190438 1253803 340875 274798 66077 744312 613540 130772 590414 476722 113692 31463 27043 4420 73310 63011 10299 82578 82578 167127 87313 79814 56603 26826 29777 68009 46341 21668 301607 301607 1218690 1218690 207468 178321 29147 CONTRACTED, LINEN & PUR 1321546 1254107 67439 BAD DEBT EXPENSE 835477 835477 MAINTENANCE AND UTILITI 716572 668591 47981 DRUGS SUPPLIES, GASES & 593372 593372 MEDICAL AND NON MEDICAL 552799 552791 8 339950 158344 181606 16731154 14375184 2355970 0 1103353 649668 1259853 1332579 496270 189703 2856886 2932167 184487 224809 140611 305916 20468992 9514529 10872320 10954463 1301704 1476957 717144 1550225 18932628 19616487 1038889 1641637 6545000 6355000 1395829 1272746 776182 846762 9755900 10116145 X 8193782 8424857 968206 1060745 14740 14740 9176728 9500342 18932628 19616487 X 330358 -6744 X 0 1 0 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 982946 243135 181 150777 1075485 1777277 796072 -558 1589845 982946 924319 1120729 12713 280484 1777277 0.98630 0.01370 0 0 83758 83758 12075156 4012997 8062159 7129295 5245333 1883962 1180783 256199 924584 10954463 U.S. GOVERNMENT AND AGENCY OBLIGATIONS 167268 F MUTUAL FUNDS 320499 F ASSETS BACKED SECURITIES 104037 F MARKETABLE EQUITY SECURITIES 399337 F CLOSED END FUNDS & EXCHANGE TRADED SECURITIES 485816 F 1476957 DEBT ISSUANCE COSTS 201835 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 1348390 1550225 DUE TO AFFILIATES 299205 INTEREST RATE SWAP LIABILITY 547557 846762 17061512 16731154 330358 106462 -113206 -6744 323614 17061512 0 17061512 0 17061512 16731154 0 16731154 0 16731154 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 2007 THROUGH 2010. PART XI, LINE 8 - OTHER ADJUSTMENTS: CHANGES IN FAIR VALUE OF INTEREST RATE SWAP -113,206. GOLF TOURNAMENT 26905 11344 15561 2560 12649 122 230 26905 11344 15561 2560 12649 122 230 15561 0 1 1 1 X 1 X 1 1 0 1 1 36750 36750 0.00220 1254955 345815 909140 0.05430 655259 655259 0.03920 1946964 345815 1601149 0.09570 1946964 345815 1601149 0.09570 1 409383 7379080 7306019 73061 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. NA 1 0 0 0 0 0 0 0 0 0 0 0 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 TWO 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 2010, 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 2010, THERE WERE 50 PARTICIPANTS. 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 2010 AND APPLIED THE RATIO OF COST TO CHARGES FROM THE 2010 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. 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 2009-2010 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 12 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. PATIENTS RECEIVE A SURVEY IN THE MAIL AFTER USING HOSPITAL SERVICES. 886 SURVEYS WERE RETURNED BETWEEN JANUARY 2009 AND JUNE 2010. IN SPRING OF 2010, THE HOSPITAL CONDUCTED A COMMUNITY SURVEY TO EVALUATE THE NEEDS AND GARNER FEEDBACK ABOUT ECH. THE SURVEYS WERE CONDUCTED ONLINE THROUGH THE HOSPITAL WEBSITE AND WITH A DIRECT MAIL REQUEST. A TOTAL OF 262 RESPONSES (22%) WERE RECEIVED. PART VI, LINE 4: ELIZABETHTOWN COMMUNITY HOSPITAL'S PRIMARY SERVICE AREA HAS REMAINED UNCHANGED FOR 2010 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 6: 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 TWO 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 2010, 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 2010, THERE WERE 50 PARTICIPANTS. 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 191890 0 0 0 0 0 8197 0 29815 0 229902 0 0 0 ROB DEMURO MD MEDICAL DIRECTOR 252216 0 0 0 0 0 10720 0 18209 0 281145 0 0 0 HARRY DAVIS MD 269409 0 0 0 0 0 11337 0 12815 0 293561 0 0 0 PASQUALINO CAPUTO MD 203649 0 0 0 0 0 8794 0 17091 0 229534 0 0 0 ESSEX COUNTY INDUSTRIAL DEVELOPMENT AGENCY 141630643 296823CH8 2007-03-15 6915000 HOSPITAL RENOVATION AND EXPANSION 0 0 0 6915000 238921 6676079 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 GAINS ON INVESTMENTS: 106,462. CHANGES IN FAIR VALUE OF INTEREST RATE SWAP -113,206. TOTAL TO FORM 990, PART XI, LINE 5: -6,744. CVPH MEDICAL CENTER 75 BECKMAN STREET PLATTSBURGH NY 12901 141338471 HOSPITAL PATIENT CARE NY 501(C)(3) 3 CPI 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 1 1 0 0