2011-11-15T15:38:12-06:00 2010-12-31 FUST CHARLES CHAMBERS LLP 5784 WIDEWATERS PARKWAY SYRACUSE NY 13214 990 2010-01-01 150533578 LITTLE FALLS HOSPITAL LITT 3158231000 140 BURWELL STREET LITTLE FALLS NY 13365 JAMES VIELKIND 3158231000 2011-11-11 1 JOSEPH J SCHLEGEL 3154463600 2010 2016-02-24 21:20:13Z JAMES VIELKIND 140 BURWELL STREET LITTLE FALLS NY 13365 32621481 0 X LFHNY.ORG X 1893 NY LITTLE FALLS HOSPITAL IS A CRITICAL ACCESS HOSPITAL PROVIDING ACCESS TO HEALTH CARE SERVCIES TO RESIDENTS OF HERKIMER COUNTY, AND WESTERN PORTIONS OF MONTGOMERY AND FULTON COUNTIES. LITTLE FALLS HOSPITAL EMERGENCY DEPARTMENT IS STAFFED WITH PHYSICIANS ON A 24/7 BASIS. TWENTY FIVE BEDS ARE USED FOR INPATIENT AND SKILLED NURSING CARE. AMBULATORY SURGERY SERVCIES ARE PROVIDED FOR A VARIETY OF SPECIALTIES, PERFORMANCE IMPROVEMENT AND HIGH QUALITY OF CARE IS DEMOSTRATED WITHIN THE HOSPITAL CONSUMER ASSESSMENT OF HEALTHCARE PROVIDERS AND SYSTEMS (HCAHPS) AS REPORTED IN HOSPITAL COMPARE. 14 11 322 12 0 0 564537 5752533 23687455 25897565 -20309 87394 0 0 24231683 31737492 0 0 0 0 12600064 12649682 0 0 31079 12536208 13563673 25136272 26213355 -904589 5524137 20834725 29965668 9394366 11102428 11440359 18863240 X LITTLE FALLS HOSPITAL IS A VOLUNTARY, NOT-FORPROFIT COMMUNITY HEALTHCARE SYSTEM WHOSE MISSION IS TO OFFER QUALITY CARE WITH COMPASSION, TO ALL WHO NEED OUR SERVICES. 1 0 7727936 7681910 LITTLE FALLS HOSPITAL EXPANDED THE HOSPITALIST PROGRAM IN 2010 TO INCLUDE A PHYSICIAN. THE HOSPITALIST MODEL PROVIDES FOR INCREASED EFFICIENCY FOR PHYSICIANS AND IMPROVED QUALITY OF CARE IN THE MANAGEMENT FOR INPATIENT NEEDS. IN 2010 ADMISSIONS INCREASED TO 1,349 FROM 1,287. THE HOSPITAL OCCUPANCY WAS 76%. 6502909 5537039 LITTLE FALLS HOSPITAL OPERATES AN EMERGENCY DEPARTMENT WITH TWENTY FOUR HOURS OF PHYSICIAN COVERAGE SEVEN DAYS PER WEEK. THE EMEGENCY DEPARTMENT PROVIDES ACCESS TO CARE FOR APPROXMIATELY 15,000 PATIENTS IN 2010. THE NUMBER OF PATIENTS REQUIRING INPATIENT HOSPITAL CARE AS RESULT OF THE VISIT TO THE EMERGENCY DEPARTMENT WAS APPROXMIATELY 1,800. THESE SERVCIES ARE PROVIDED TO ALL PATIENTS REGARDLESS OF ABILITY TO PAY. IN 2010 THE TRIAGE SYSTEM WAS IMPROVED TO PROVIDE A MORE EFFICIENT PATIENT TREATMENT SYSTEM. NEW PATEINT SAFETY AND OUTCOMES MEASUREMENTS WERE DEPLOYED TO STANDARDIZE PATIENT CARE PROTOCOLS. 7382106 8369640 LITTLE FALLS HOSPITAL EXPANDED OUTPATIENT ANCILLARY SERVICES BY IMPLEMENTING A NEW CLINICAL LABORATORY AND THE ADDITION OF A MOBILE MAGNETIC RESONANCE IMAGING (MRI) UNIT. TOTAL AMBULATORY OUTPATIENT VISITS INCREASED APPROXMIATELY 9% TO 34,000 VISITS. 682227 636514 A LOCAL NURSING HOME BEGAN A NEW ADULT DAY HEALTHCARE PROGAM AT THE HOSPITAL. THIS PROGRAM PROVIDES DAILY ACTIVITY AND MEDICAL DAY CARE FOR PATIENTS WHO CONTINUE TO LIVE AT HOME. ADULT DAY HEALTHCARE PROGRAMS ARE AN ALTERNATIVE TO INSITUTION BASED LONG TERM CARE SERVICES. 682227 636514 22295178 1 1 0 0 0 0 0 0 1 1 1 1 0 1 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 37 0 1 322 1 0 0 0 0 0 0 0 0 0 0 X 14 11 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 0 0 NY X JAMES G VIELKIND 3158235281 140 BURWELL STREET LITTLE FALLS NY 13365 JOHN BULLIS 2.00 X 0 0 0 JOAN S CONBOY 2.00 X 0 0 0 TIMOTHY DALY 2.00 X 0 0 0 ANTHONY DELUCA 2.00 X X 0 0 0 STAN DICKSON 2.00 X X 0 0 0 JOY MALONE 2.00 X 0 0 0 MARSHA MASON 2.00 X 0 0 0 GERALD J SNYDER 2.00 X X 0 0 0 JENNIFER VANWAGONER 2.00 X 0 0 0 RANBIR SODHI MD 2.00 X 0 0 0 AUGUST LEINHART MD 2.00 X 0 428768 24180 NICHOLAS J NICOLETTA 2.00 X X 0 371809 26961 JEFFREY WOEPPEL 2.00 X X 0 188872 20998 MICHAEL OGDEN 40.00 X 0 150706 462 JAMES G VIELKIND 40.00 X 124560 0 0 RICHARD NOCELLA MD 40.00 X 162561 0 12358 287121 1140155 84959 3 0 1 0 SUNBELT STAFFING PO BOX 1024640 ATLANTA GA 303684640 PROFESISONAL STAFFING 239235 CTL CONSULTING LLC 705B SE MELODY LANE LEES SUMMIT MO 64063 PROFESSIONAL NURSING 128000 HOLT ARCHITECTS PC 217 N AURORA STREET ITHACA NY 14850 ARCHITECT SERVICES 114035 DM CONSULTING PO BOX 4715 UTICA NY 13504 INFORMATION TECHNOLOGY 104990 MEDSPAR LLC PO BOX 830 BINGHAMTON NY 139020830 BILLING SERVICES 101514 5 190934 5561599 5752533 INPATIENT HOSPITAL 621930 16381083 16381083 OUTPATIENT SERVICES 623000 9094604 9094604 PROGRAM SERVICE LEASE 532000 231642 231642 HOSPITAL CAFETERIA 900099 132668 132668 OTHER OPERATING REVENU 900099 57568 57568 25897565 53910 53910 917473 883989 33484 33484 33484 31737492 25897565 0 87394 297049 172254 124795 9742346 8280265 1442671 19410 658436 555641 101507 1288 1217765 1023213 192169 2383 734086 617615 115046 1425 64351 64351 17024 6288 10736 60878 4081 56797 671496 531025 140471 40080 40080 2140349 2063373 75393 1583 693289 513551 179738 944378 793013 150601 764 23379 11878 11114 387 19348 9947 9332 69 35453 31110 4318 25 1409360 1236721 171646 993 252140 235329 16811 PURCHASED MEDICAL SERVI 3821026 3821026 PROVISION FOR BAD DEBT 1961391 1961391 ADMINISTRATIVE SERVICES 819061 819061 OTHER COSTS 517110 313817 200541 2752 NEW YORK STATE CASH REC 73560 73560 26213355 22295178 3887098 31079 377011 598947 1061327 664289 5258493 2538831 2860833 417164 369023 720439 166266 24565781 15808184 9372118 8757597 2675360 1539459 3771280 5482641 2472438 298233 1398644 20834725 29965668 3283438 2968638 18436 20668 1895821 4117756 4196671 3995366 9394366 11102428 X 5893277 6706244 4857467 11408912 689615 748084 11440359 18863240 20834725 29965668 X 5524137 1898744 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 5547082 5230555 1782439 403080 12156996 2664349 174329 3874661 1166257 5547082 4951188 327877 -202282 2412434 2664349 0.14000 0.86000 1 0 267471 267471 14905045 9147895 5757150 9393265 6660289 2732976 8757597 MARY LEARY CHARITABLE REMAINDER TR 1833613 F ELSA O'BRIEN CHARITABLE REMAINER TR 3649028 F 5482641 DIRECT FINANCE LEASE 2472438 C 2472438 ACCRUED PENSION LIABILITY 3218797 ACCRUED SALARIES, PAYROLL TAXES AND FRINGE BENEFITS 776569 3995366 31737492 26213355 5524137 206057 1692687 1898744 7422881 33636236 206057 1692687 1898744 31737492 0 31737492 26213355 0 26213355 0 26213355 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: ENDOWMENT FUNDS DISTRIBUTE INCOME FOR PURPOSES OF CAPITAL INVESTMENT. TEMPORARY ENDOWMENTS ARE USED BASED ON THE INTENT OF THE DONATION. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE HOSPITAL QUALIFIES AS AN ORGANIZATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL INCOME TAXES PURSUANT TO SECTION 501(A) OF THE INTERNAL REVENUE CODE. 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 NEW YORK STATE TAXING AUTHORITIES ARE 2007 THROUGH 2010. PART XI, LINE 8 - OTHER ADJUSTMENTS: PENSION RELATED CHANGES OTHER THAN NET PERIODIC BENEFIT COST -18,674. CHANGES IN VALUE OF BENEFICIAL INTEREST IN CHARITABLE REMAINDER TRUST 1,711,361. PART XII, LINE 2D - OTHER ADJUSTMENTS: PENSION RELATED CHANGES OTHER THAN NET PERIODIC BEBEFIT COST -18,674. CHANGES IN VALUE OF BENEFICIAL REMAINDER TRUST 1,711,361. 1 1 1 X 300.000000000000 0 1 1 0 1 1 164 111580 84168 27412 0.00100 11763 4542436 3368159 1174277 0.04480 11927 4654016 3452327 1201689 0.04580 52679 5187 47492 0.00180 52679 5187 47492 0.00180 11927 4706695 3457514 1249181 0.04760 1 876674 57315 8722607 8637287 85320 X 1 1 1 1 LITTLE FALLS HOSPITAL

140 BURWELL STREET LITTLE FALLS NY 13365

X X INCLUDES 25 INPATIENT BEDS, LITTLE FALLS HOSPITAL 1 1 X X X X X X X X 09 1 1 1 X X X X X 1 1 1 300.000000000000 0 1 X 0 1 X X X X X X 1 X 1 X X X X X X X 1 X 0 1 PART I, LINE 3C: LITTLE FALLS HOSPITAL DID NOT PROVIDE CHARITY CARE OR DISCOUNTED CARE TO PATIENTS WITH INSURANCE BENEFITS. PART I, LINE 7: COST FOR CHARITY CARE PATIENTS WAS CALCULATED USING RATIO OF COST TO CHARGES. COST ASSOCIATED WITH MEDICAID REPRESENTS AGGREGATE ALLOWABLE COST AND TOTAL GROSS CHARGES USED TO CALCULATE A FACILITY LEVEL OF COST TO CHARGE RATIO. THIS FACILITY LEVEL COST TO CHARGE RATIO WAS APPLIED TO TOTAL MEDICAID CHARGES TO ARRIVE AT TOTAL MEDICAID COST. PART I, LINE 7G: LITTLE FALLS HOSPITAL DOES NOT PROVIDE DISCOUNTED CARE FOR PATIENTS WITH INSURANCE. HARDSHIP CASES ARE REVIEWED ON AN INDIVIDUAL BASIS. PART I, L7 COL(F): LITTLE FALLS HOSPITAL REMOVED $1,961,391 OF BAD DEBT EXPENSE TO CALCULATE COST OF PATIENT CARE. PART III, LINE 4: (J)NET PATIENT SERVICE REVENUE AND RELATED RECEIVABLESTHE 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 IS ESTIMATED BY MANAGEMENT BASED ON PERIODIC REVIEWS OF THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE CONSIDERING HISTORICAL EXPERIENCE AND PREVAILING ECONOMIC CONDITIONS.REVENUE FROM THE MEDICARE AND MEDICAID PROGRAMS, INCLUDING THE HMO PROGRAMS OFFERED BY THESE PAYORS, ACCOUNTED FOR APPROXIMATELY 69% AND 68% OF THE HOSPITAL'S NET PATIENT SERVICE REVENUE FOR THE YEARS 2010 AND 2009, RESPECTIVELY. LAWS AND REGULATIONS GOVERNING THE MEDICARE AND MEDICAID PROGRAMS ARE EXTREMELY COMPLEX AND SUBJECT TO INTERPRETATION.DESCRIPTION OF ORGANIZATION AND SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES, CONTINUED(J)NET PATIENT SERVICE REVENUE AND RELATED RECEIVABLES, CONTINUEDAS A RESULT, THERE IS AT LEAST A REASONABLE POSSIBILITY THAT RECORDED ESTIMATES WILL CHANGE BY A MATERIAL AMOUNT IN THE NEAR TERM. IN 2010 AND 2009, NET PATIENT SERVICE REVENUE INCREASED (DECREASED) BY APPROXIMATELY $137,000 AND $(156,000), RESPECTIVELY, RELATED TO EITHER SETTLEMENT OF PRIOR YEAR ISSUES OR CHANGES IN ESTIMATES ASSOCIATED WITH THIRD-PARTY ISSUES.THE HOSPITAL GRANTS UNSECURED CREDIT TO ITS PATIENTS, MOST OF WHOM ARE LOCAL RESIDENTS AND ARE INSURED UNDER THIRD-PARTY PAYOR AGREEMENTS. THE MIX OF RECEIVABLES FROM PATIENTS AND THIRD-PARTY PAYORS AT DECEMBER 31 WAS AS FOLLOWS: 2010 2009MEDICARE 39% 32%MEDICAID 16% 20%PRIVATE PAYORS 16% 19%INSURANCE AND ALL OTHERS 29% 29% 100% 100% PART III, LINE 8: LITTLE FALLS HOSPITAL COSTING METHODOLOGY CONSIST OF INFORMATION FROM MEDICARE COST REPORT. AS A CRITICAL ACCESS HOSPITAL PAYMENT IS BASED ON 101 % OF MEDICARE ALLOWABLE COST, PART III, LINE 9B: COLLECTION AND CHARITY CARE POLICY SPECIFY ACCOUNTS WITH ACTIVE CARE APPLICATIONS WILL NOT GO TO COLLECTION AGENCIES WHILE IN REVIEW. PART V, SECTION A: LITTLE FALLS HOSPITAL HAS BEEN A CRITICAL ACCESS HOSPITAL SINCE OCTOBER 1, 2004. INPATIENT SERVICES CONSIST OF TWENTY FIVE BEDS SERVING ACUTE CARE AND SWING BEDS. A TWENTY FOUR HOUR SEVEN DAY PER WEEK PHYSICIAN STAFF EMERGENCY DEPARTMENT SERVES A WIDE GEOGRAPHIC AREA. OTHER SERVCIES INCLUDE TWO PRIMARY CARE OFFICES LOCATED IN DOLGIVILLE AND NEWPORT RESPECTIVELY. SPECIALTY SERVICES INCLUDE AMBULATORY SURGERY WITH ENDOSCOPY PROCEDURE CAPABILITY, FULLY ATUOMATED LABORATORY, AND FULL ARRAY OF DIAGNOSTIC IMAGING PROCEDURE CAPABILITIES. LITTLE FALLS HOSPITAL PART V, SECTION B, LINE 3: HOSPITAL SERVICE AREA LITTLE FALLS HOSPITAL'S PRIMARY SERVICE AREA ENCOMPASSESS ALL OF HERKIMER COUNTY, WITH A POPULATION OF 62,200, FULTON COUNTY, WITH A POPULATION OF 55,024 AND MONTGOMERY COUNTY WITH A POPULATION OF 48,679 (ACCORDING TO U.S. CENSUS 2008 ESTIMATE), AND A PORTION OF ONEIDA COUNTY.LITTLE FALLS HOSPITAL HELPED TO IDENTIFY PREVENTION AGENDA PRIORITIES AND ESTABLISH PLANS TO ADDRESS THEM THROUGH PARTICIPATION IN A SERIES OF COMMUNITY FORUMS, ROUNDTABLE MEETINGS AND FOCUS GROUPS THROUGHOUT 2009. THE INFORMATION GATHERED CULMINATED IN A REGIONAL HEALTH SUMMIT TO DETERMINE THE PREVENTION AGENDA PRIORITY AREAS.UPDATEAS A RESULT OF THE REGIONAL HEALTH SUMMIT ON MARCH 26, 2009, SUBCOMMITTEES FOR EACH OF THE FIVE SELECTED PREVENTION AGENDA PRIORITY AREAS FOR HERKIMER AND ONEIDA COUNTIES HAVE BEEN FORMED. THESE SUBCOMMITTEES HAVE DECIDED TO CONTINUE MEETING BIMONTHLY ON A REGIONAL LEVEL WITH THE GOAL OF IMPROVING OUTCOMES IN THE FIVE AREAS OF: HEALTHY MOTHERS/BABIES/CHILDREN, MENTAL HEALTH AND SUBSTANCE ABUSE, CHRONIC DISEASE, ACCESS TO CARE, AND PHYSICAL ACTIVITY & NUTRITION (OBESITY PREVENTION). SELECTED PREVENTION AGENDA PRIORITIES- ACCESS TO QUALITY HEALTHCARE- CHRONIC DISEASEOVERALL GOALS- INCREASE ACCESS TO CANCER SCREENINGS- INCREASE ACCESS TO EARLY PRENATAL CARE; REDUCE RATES OF TEEN PREGNANCY AND INFANT MORTALITY- PREVENT OR DELAY THE ONSET OF DIABETES IN PEOPLE WHO ARE AT HIGH RISKUPDATECANCER SCREENING ACCESS: WITH REGARD TO INCREASING ACCESS TO CANCER SCREENINGS SPECIFICALLY, LITTLE FALLS HOSPITAL COLLABORATES WITH THE BASSETT CANCER INSTITUTE AND THE CANCER SERVICES PROGRAM OF ONEIDA, HERKIMER AND MADISON COUNTIES TO OFFER CANCER SCREENINGS. THESE SCREENINGS INCLUDE CLINICAL BREAST EXAMS, MAMMOGRAMS, PAP/PELVIC EXAMS AND IN-HOME COLORECTAL SCREENINGS TO AID THE UNDERINSURED AND UNINSURED MEN AND WOMEN BETWEEN THE AGES OF 40-64 YEARS OF AGE. TO INCREASE AWARENESS OF SERVICES, A REPRESENTATIVE OF LITTLE FALLS HOSPITAL SITS ON AN AD-HOC COMMITTEE TO BRING AWARENESS OF THE SERVICES TO REMOTE AREAS.ACCESS TO EARLY PRENATAL CARE: EDUCATIONAL AND REFERRAL INFORMATION IS AVAILABLE AT COMMUNITY HEALTH SCREENINGS ON WOMEN'S HEALTH AND PRENATAL CARE.DIABETES PREVENTION AND AWARENESS: THE NUMBER OF NEW YORKERS WITH DIABETES HAS MORE THAN DOUBLED IN THE LAST DECADE WITH NEARLY TWO MILLION STATE RESIDENTS LIVING WITH DIABETES, AND IT'S A TREND WE'RE SEEING MIRRORED IN OUR OWN RURAL CENTRAL NEW YORK POPULATION. FOUR YEARS AGO, BASSETT HEALTHCARE LAUNCHED CHALLENGE DIABETES, A PROGRAM AIMED AT REDUCING THE INCIDENCE OF DIABETES IN THE COUNTIES SERVED BY THE BASSETT HEALTHCARE NETWORK. AS A BASSETT AFFILIATE, LFH IS PARTICIPATING IN THIS PROGRAM BY:- WORKING WITH A DIABETES EDUCATION COORDINATOR TO WORK WITH AT RISK PATIENTS AND PATIENTS LIVING WITH DIABETES EDUCATING THE GENERAL PUBLIC AND STAFF ABOUT DIABETES PREVENTION THROUGH LUNCH & LEARN PATIENT EDUCATION SESSIONS- SCREENING PATIENTS FOR DIABETES OR AT RISK OF DEVELOPING DIABETES AND REFERRING THOSE PATIENTS FOR APPROPRIATE FOLLOW-UPNON-PREVENTION AGENDA PROGRAMS: IN ADDITION TO THE WORK DESCRIBED ABOVE, LITTLE FALLS HOSPITAL CONTINUES TO OFFER A VARIETY OF PUBLIC HEALTH AND SCREENING PROGRAMS CALLED "KNOW YOUR NUMBERS" THAT TACKLE HEALTH ISSUES OUTSIDE THE SELECTED PREVENTION AGENDA PRIORITIES. AMONG THE AREAS ADDRESSED ARE PHYSICAL ACTIVITY AND NUTRITION, INFECTIOUS DISEASES, MENTAL HEALTH AND SUBSTANCE ABUSE SCREENINGS. LUNCH AND LEARN EDUCATIONAL PROGRAMS ARE HELD EACH MONTH FOR THE PUBLIC ON A VARIETY OF TOPICS INCLUDING: A SHOT OF PREVENTION - H1N1; CHOLESTEROL/GLUCOSE/BMI/BP SCREENINGS; HOSPITALIST PROGRAM; WELLNESS PROGRAM; IRRITABLE BOWEL SYNDROME; DIALYSIS; CARDIAC SURGERY; DIABETICS; LAP BAND SURGERY; NUTRITION. LITTLE FALLS HOSPITAL PART V, SECTION B, LINE 11H: LITTLE FALLS HOSPITAL CHARGES FOR SERVICES BASED ON RELATIONSHIPS OF COST OF SERVICES, AND AGGREGATE MARGINS REQUIRED FOR HEALTHCARE SERVICES. LITTLE FALLS HOSPITAL PART V, SECTION B, LINE 13G: LITTLE FALLS HOSPITAL BILLING FORMS INCLUDE A STATEMENT TO INQUIRE ABOUT FINANCIAL ASSISTANCE WITH A PHONE NUMBER TO CALL. UNINSURED PATEINTS ARE MAILED AN APPLICATION FOR THEIR COMPLETION. LITTLE FALLS HOSPITAL PART V, SECTION B, LINE 15E: THE HOSPITAL REFERRED COLLECTION MATTERS TO A THIRD PARTY AGENCY. LITTLE FALLS HOSPITAL PART V, SECTION B, LINE 19D: LITTLE FALLS HOSPITAL CHARGES UNIFORM CHARGES TO ALL PAYERS REGARDLESS OF RESPONSIBLE PARTY FOR THE BILL. LITTLE FALLS HOSPITAL PART V, SECTION B, LINE 21: LITTLE FALLS HOSPITAL CHARGES UNIFORM CHARGES TO ALL PAYERS REGARDLESS OF RESPONSIBLE PARTY FOR THE BILL. PART VI, LINE 6: LITTLE FALLS HOSPITAL ACTIVELY PLANS AND IMPLEMENTS COORDINATED HEALTH CARE RESOURCES WITH BASSETT HEALTHCARE NETWORK. THIS SYNERGY ALLOWS FOR GREATER ACCESS, MINIMIZES DUPLICATION OF SERVICES, AND RESULTS WITH HIGH QUALITY CARE. LITTLE FALLS HOSPITAL SERVES ALL PATIENTS WITHOUT CONSIDERATION OF PAYMENT SOURCES. IN 2010 THE AGGREGATE OUTPATIENT GOVERMENT AND UNINSURED SPONSORED PAYMENT PERCENTAGE WAS 63.7%. TO MANAGE CARE MORE APPROPRATELY EMPHASIS HAS BEEN PREVALENT IN QUALITY OF CARE MEASUREMENTS. THIS HAS RESULTED IN IMPROVING FEWER PATIENTS REQUIRING RE-ADMISSION TO THE HOSPITAL AFTER 30 DAYS. IN ADDITION THE NUMBER OF PATIENTS CONNECTED WITH FOLLOW - UP COMMUNICATIONS HAS SHOWN IMPROVED SHORT AND LONG TERM HEALTH STATUS BENEFITS. CONTINUED EFFORTS TO EXPAND THE PRIMARY CARE PROVIDER BASE WILL FURTHER IMPROVE ACCESS TO PRIMARY CARE RESULTING IN A MORE PATIENT CENTERED DELIVERY OF CARE MODEL. IN 2011 - 2012 THE IMPLEMENTATION OF THE "ELECTRONIC HEALTH RECORD" WILL RESULT IN A MORE SIGNIFICANT ADOPTION OF CARE DOCUMENTATION PROTOCOLS TO FURTHER IMPROVE THE HEALTH STATUS OF OUR PATIENTS. PART VI, LINE 7: LITTLE FALLS HOSPITAL IS A MEMBER OF THURSTON CORPORATION (DBA BASSETT HEALTHCARE NETWORK)THAT PROVIDES HEALTH SERVICES IN MORE THAN 20 COMMUNITIES SPANNING 5,600 SQUARE MILES AND NINE COUNTIES. THE NETWORK FOCUSES ITS COMMUNITY SERVICES PROGRAMS IN THE COUNTIES WHERE THE SIX AFFILIATED HOSPTITALS AND GREATEST PATIENT POPULATIONS ARE LOCATED. OTSEGO COUNTY - POPULATION 61,962; DELAWARE COUNTY - POPULATION 46,085; HERKIMER COUNTY - POPULATION 62,200; SCHOHARIE COUNTY - POPULATION 31,910 (ACCORDING TO THE 2008 U.S. CENSUS ESTIMATES). THE MARY IMOGENE BASSETT HOSPITAL, AN ACUTE CARE INPATIENT TECHING FACILITY IN COOPERSTOWN, OTSEGO COUNTY, O'CONNOR HOSPITAL, A CRITICAL ACCESS HOSPITAL IN DELHI, DELAWARE COUNTY, COBLESKILL REGIONAL HOSPITAL, AN ACUTE CARE FACILITY IN COBLESKILL, SCHOHARIE COUNTY, LITTLE FALLS HOSPTAL, A CRITICAL ACCESS HOSPITAL IN LITTLE FALLS, HERKIMER COUNTY, TRI TOWN REGIOANL HOSPITAL A 24/7 EMERGENCY CARE FACILITY IN SIDNEY, DELAWARE COUNTY, AUREILA OSBORN FOX MEMORIAL HOSPITAL, AN ACUTE CARE FAILITY IN ONEONTA, OTSEGO COUNTY, THE BASSETT CLINIC, AN OUTPATIENT PRIMARY AND SPECIALTY CARE CENTER IN COOPERSTOWN, A REGIONAL NETWORK OF 26 COMMUNITY BASED HEALTH CENTERS, 18 SCHOOL BASED HEALTH CENTERS, TWO AMBULATORY SURGERY CENTERS, VALLEY HEALTH SERVICES A RESIDUAL HEALTH CARE AND REHABBILATION FACILITY, AT HOME CARE, A CERTIFIED HOME CARE AGENCY AND FIRST COMMUNITY CARE OF BASSETT A MEDICAL SUPPLY COMPANY, ALL OF WHICH MAKE UP THE BASSETT HEALTHCARE NETWORK AND PROVIDE HEALTH SERVICES TO THIS NINE COUNTY REGION IN CENTRAL NEW YORK. REPORTS FILED WITH STATES PART VI, LINE 7 NY X X X X 0 0 0 0 0 0 0 0 0 AUGUST LEINHART MD 0 330000 0 25000 0 73768 0 22678 0 1502 0 452948 0 0 NICHOLAS J NICOLETTA 0 341809 0 30000 0 0 0 22678 0 4283 0 398770 0 0 JEFFREY WOEPPEL 0 188872 0 0 0 0 0 16811 0 4187 0 209870 0 0 MICHAEL OGDEN 0 140500 0 9000 0 1206 0 0 0 462 0 151168 0 0 RICHARD NOCELLA MD 133261 0 0 0 29300 0 0 0 12358 0 174919 0 0 0 NEW PROGRAM SERVICES FORM 990, PART III, LINE 2 LITTLE FALLS HOSPITAL RECEIVED APPROVAL FROM NEW YORK STATE DEPARTMENT OF HEALTH TO PROVIDE MOBILE MAGNETIC RESONANCE IMAGING SERVICES. FORM 990, PART VI, SECTION B, LINE 11 LITTLE FALLS EXECUTIVE & FINANCE COMMITTEE OF THE BOARD REVIEWS AND APPROVES FORM 990. ALL TRUSTEES CAN REVIEW THE FORM 990 PRIOR TO SUBMISSION. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST STATEMENTS ARE MADE ANNUALLY. NEW BOARD MEMEBERS ARE REQUIRED TO DISCLOSE ON THEIR RESUME ALL AFFILIATED ORGANIZATIONS. FORM 990, PART VI, SECTION B, LINE 15A BOARD OF TRUSTEES COMPLETES A CEO EVALUATION ANNUALLY AND MAKES ADJUSTMENTS TO COMPENSATION ACCORDING TO PERFORMANCE AND INDUSTRY COMPENSATION LEVELS. FORM 990, PART VI, SECTION C, LINE 19 LITTLE FALLS HOSPITAL IS MAKES AVAILABLE THE 990 TO THE PUBLIC UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 206,057. PENSION RELATED CHANGES OTHER THAN NET PERIODIC BENEFIT COST -18,674. CHANGE IN VALUE OF BENEFICIAL REMAINDER CHARITABLE REMAINDER TRUST 1,711,361. TOTAL TO FORM 990, PART XI, LINE 5: 1,898,744. THURSTON CORPORATION ONE ROCKEFELLER PLAZA 31ST FLOOR NEW YORK NY 10020 133218680 NY 501 (C) 3 11 C N/A 0 FRIENDS OF BASSETT ONE ATWELL ROAD COOPERSTOWN NY 13326 237041610 NY 501 (C) 3 7 THURSTON CORPORATION 0 MARY IMOGENE BASSETT HOSPITAL ONE ATWELL ROAD COOPERSTOWN NY 13326 135596796 HEALTH CARE ORGANIZATION OFFERING INPATIENT AND OUTPATIENT SERVICES NY 501 (C) 3 3 THURSTON CORPORATION 0 AURELIA OSBORN FOX MEMORIAL HOSPITAL SOCIETY ONE NORTON AVENUE ONEONTA NY 13820 150539039 HEALTH CARE ORGANIZATION OFFERING INPATIENT AND OUTPATIENT SERVICES NY 501 (C) 3 3 THURSTON CORPORATION 0 TEMPLETON FOUNDATION ONE ATWELL ROAD COOPERSTOWN NY 13326 133317084 NY 501 (C) 3 9 THURSTON CORPORATION 0 BASSETT REGIONAL CORPORATION ONE ATWELL ROAD COOPERSTOWN NY 13326 133522783 PROVIDES EXCELLENCE IN THE COORDINATION PLANNING AND POLICY DIRECTION FOR NY 501 (C) 3 11 (B) THURSTON CORPORATION 0 BASSETT HOSPITAL OF SCHOHARIE CO 178 GRANDVIEW DRIVE COBLESKILL NY 12043 141772971 NY 501 (C) 3 3 BASSETT REGIONAL CORPORATION 0 O'CONNOR HOSPITAL 460 ANDES ROAD DELHI NY 13753 161540394 NY 501 (C) 3 3 BASSETT REGIONAL CORPORATION 0 TRI TOWN REGIONAL HEALTHCARE 43 PEARL STREET SYNDEY NY 13838 260169584 NY 501 (C) 3 3 BASSETT REGIONAL CORPORATION 0 VALLEY HEALTH SERVICES 690 GERMAN STREET HERKIMER NY 13350 222511614 NY 501 (C) 3 3 BASSETT REGIONAL CORPORATION 0 0 0 0 0 0 0 0 0 1 0 1 1 0 1 0 1 0 0 PRIMARY ACTIVITY FORM 264 990 R -2 SHEET 1 & SHEET 2 SHEET 1 / LINE 90 THURSTON CORPORATION - SUPPORTING ORGANIZATION TO THE MARY IMOGENE BASSETT HOSPITAL, FRIENDS OF BASSETT, BASSETT REGIONAL CORPORATION, AUREILA OSBORN FOX MEMORIAL HOSPITAL AND TEMPLETON FOUNDATION PURSUANT TO SECTION 509. SHEET 1 / LINE 93 FRIENDS OF BASSETT - PROMOTE THE WELFARE OF ALL THURSTON CORPORATION MEMBERS AND BASSETT REGIONAL CORPORATION SHEET 1/ LINE 102 TEMPLETON FOUNDATION - PROMOTE HEALTH CARE BY PROVIDING NECESSARY RESIDENTIAL FACILITIES AND OFFICE SPACE TO HOSPITALS AND HEALTH CARE ORGANIZATIONS. SHEET 2 / LINE 90 BASSETT REGIONAL CORPORATION - PROVIDE EXCELLENCE IN THE COORDINATION, PLANNING AND POLICY DIRECTION FOR BASSETT HOSP OF SCHOHARIE CO., O'CONNOR HOSP, VALLEY HEALTH SERVICES, LITTLE FALLS HOSPITAL AND TRI TOWN REGIONAL HEALTHCARE SHEET 2 / LINE 93 BASSETT HOSPITAL OF SCHOHARIE CO. - PROVIDE HEALTH CARE SERVICES TO SCHOHARIE COUNTY AND SURROUNDING REGION SHEET 2 / LINE 96 O'CONNOR HOSPITAL - A 23 BED CRITICAL ACCESS HOSPITAL PROVIDING HEALTH CARE SERVICES TO DELAWARE COUNTY AND SURROUNDING REGION SHEET 2 / LINE 99 TRI TOWN REGIONAL HEALTHCARE - HOSPITAL PROVIDING ACUTE CARE AND EMERGENCY SERVICES TO RESIDENTS OF THE TOWN OF SIDNEY AND TRI-TOWN COMMUNITY. SHEET 2 / LINE 102 VALLEY HEALTH SERVICES - NOT-FOR-PROFIT SKILLED NURSING FACILITY PROVIDING RESIDENTIAL HEALTH SERVICES TO HERKIMER COUNTY AND THE SURROUNDING AREA