2023-11-11T10:02:17-06:00 2022-12-31 161226221 FUSTCHARLES LLP 220 S WARREN STREET SYRACUSE NY 13202 990 2022-01-01 141731786 ADIRONDACK MEDICAL CENTER ADIR 5188914141 PO BOX 471 2233 STATE ROUTE 86 SARANAC LAKE NY 12983 WILLIS GRANT INTERIM CFO 5188914141 2023-11-06 1 WILLIS GRANT 999009999 1 DESIREE M BENNETT P01263666 3154463600 2023-11-06 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z WILLIS GRANT PO BOX 471 2233 STATE ROUTE 86 SARANAC LAKE NY 12983 135711028 0 X WWW.ADIRONDACKHEALTH.ORG X 1991 NY THE MEDICAL CENTER PROVIDES ACUTE, SKILLED NURSING AND OUTPATIENT SERVICES TO RESIDENTS OF THE LOCAL GEOGRAPHIC REGION. 16 13 1083 16 0 0 5255708 1087583 132342061 115385057 465991 814178 2368002 2091734 140431762 119378552 0 0 0 0 72995370 67878936 0 0 0 64507051 64252518 137502421 132131454 2929341 -12752902 124890673 100557905 61990096 51946336 62900577 48611569 X THE MEDICAL CENTER PROVIDES ACUTE, SKILLED NURSING AND OUTPATIENT SERVICES TO RESIDENTS OF THE LOCAL GEOGRAPHICAL AREA. 0 1 29235102 30065223 ADIRONDACK MEDICAL CENTER IS A 95-BED ACUTE CARE FACILITY IN SARANAC LAKE. IT PROVIDES A FULL RANGE OF INPATIENT SERVICES (SURGICAL, MATERNITY AND PEDIATRIC) AS WELL AS MAINTAINS A 60 BED LONG-TERM CARE FACILITY. 86847330 87594219 REFERRED AMBULATORY, AMBULATORY SURGERY AND EMERGENCY SERVICES IN SARANAC LAKE, LAKE PLACID, TUPPER LAKE, ST. REGIS FALLS AND KEENE. 1719110 MISCELLANEOUS PROGRAM SERVICE REVENUE DERIVED FROM SUPPORT OF ADIRONDACK MEDICAL CENTER, INCLUDING: DIETARY REVENUE, REBATES AND REFUNDS, PURCHASE DISCOUNTS AND OTHER REVENUE. 1719110 116082432 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 1 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 1 304 0 1 1083 1 0 0 0 0 0 0 0 0 0 0 0 0 X 16 13 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X X ROBERT LABA 5188914141 PO BOX 471 2233 STATE ROUTE 86 SARANAC LAKE NY 12983 SUSAN DELEHANTY CHAIR 4.00 X X 0 0 0 GLENN KEET VICE CHAIR 4.00 X X 0 0 0 CRAIG SHELDON SECRETARY/TREASURER 4.00 X 0 0 0 ERNEST STRETTON PHD TRUSTEE 3.00 X 0 0 0 MICHAEL BETTMANN MD TRUSTEE 3.00 X 0 0 0 JANET BLISS TRUSTEE 3.00 X 0 0 0 REBECCA LEAHY TRUSTEE 3.00 X 0 0 0 ELIZABETH BUCK MD TRUSTEE 3.00 X 39761 0 34400 JON PLEHN MD TRUSTEE 3.00 X 0 0 0 RANDY QUAYLE PHD TRUSTEE 3.00 X 0 0 0 TIM REILLY CPA TRUSTEE 3.00 X 0 0 0 HARRIS SEMEGRAM TRUSTEE 3.00 X 0 0 0 WILLIAM SMITH MD TRUSTEE 3.00 X 60544 0 50050 KATHY WOUGHTER TRUSTEE 3.00 X 0 0 0 IRWIN LIEB MD EX-OFFICIO MED STAFF PRES 3.00 X 348450 0 17439 DAN KELLEHER EX-OFFICIO CHAIR, AH FOUND 3.00 X 0 0 0 AARON KRAMER CEO/PRESIDENT 40.00 X 355932 0 13438 ROBERT LABA CFO 40.00 X 270029 0 11755 DARCI BEIRAS CMO 40.00 X 426255 0 64373 DAVID MADER CNO 40.00 X 208540 0 26640 DANIEL HILL COO (STARTING 10/25/2021) 40.00 X 197583 0 25896 ANTHONY TRAMONTANO PHYSICIAN 40.00 X 643185 0 29027 EVE BURNS PHYSICIAN 40.00 X 672422 0 64652 CLAUDE ROLAND PHYSICIAN 36.00 X 557019 0 12418 HENRI GABORIAU PHYSICIAN 40.00 X 460186 0 29183 JOHN ESPER PHYSICIAN 40.00 X 486529 0 33868 SYLVIA GETMAN PRESIDENT/CEO (UNTIL 07/21) 40.00 X 100000 0 0 4826435 0 413139 145 1 1 0 AHSA LLC 10126 E CHERRY BEND RD TRAVERSE CITY MI 49684 CONTRACTED LABOR 3695516 PREMIER ANESTHESIA ON NEW YORKPC 2655 NORTHWINDS PARKWAY ALPHARETTA GA 30368 ANESTHESIA SERVICES 2436347 ADIRONDACK GASTROINTESTINAL AND COLORECT 2249 NY-86 2 SARANAC LAKE NY 12983 GASTROENTEROLOGY SERVICES 1728749 LABORATORY CORPORATION OF AMERICA PO BOX 12140 BURLINGTON NC 27216 LAB SERVICES 899971 WEATHERBY LOCUM INC PO BOX 972633 DALLAS TX 75397 PHYSICIAN SERVICES 800373 34 662238 151583 273762 1087583 NET PATIENT SERVICE REVENUE 900099 119938236 119938236 LOSS ON DISCONTINUED OPERATIONS O 900099 -4553179 -4553179 115385057 111372 111372 372624 0 372624 372624 372624 17034732 550 16329629 2847 705103 -2297 702806 702806 340B CONTRACT PHARMACIES 900099 720967 720967 DIETARY REVENUE 900099 486077 486077 REBATES & REFUNDS 900099 179116 179116 332950 332950 1719110 119378552 117104167 0 1186802 X 1819692 760609 1059083 55468999 48329880 7139119 1622869 1484717 138152 5022818 5245079 -222261 3944558 3600268 344290 454152 15278 438874 91206 91206 94586 94586 26626 26626 21941657 16541810 5399847 189638 189638 1130712 731090 399622 1878301 1721381 156920 141416 118056 23360 835014 835014 4870700 4870700 1131856 1131856 MEDICAL SUPPLIES 23806836 23800990 5846 BAD DEBT 3225679 3225679 FOOD COSTS 794170 794170 MINOR EQUIPMENT 391354 242140 149214 3248615 2444077 804538 132131454 116082432 16049022 0 3415428 -122616 17395664 5510399 17648690 15051719 3273923 3441353 5127794 3627395 151287677 91488462 64753399 59799215 8125683 7354558 5150092 5895882 124890673 100557905 20107960 19155959 2092508 1084043 27059638 24483028 1172000 1172000 11557990 6051306 61990096 51946336 X 61911529 47617608 989048 993961 62900577 48611569 124890673 100557905 -12752902 -1536106 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 94586 94586 0 PART II-B, LINE 1: THE AMOUNT REFLECTED ON PART II-B, LINE 1I REPRESENTS THE PORTION OF MEMBERSHIP DUES PAID TO HEALTH CARE ASSOCIATION OF NYS (HANYS), IROQUOIS HEALTHCARE, AMERICAN HOSPITAL ASSOCIATION (AHA), NATIONAL RURAL HEALTH ASSOCIATION (NRHA), LEADING AGE, AND OSTROFF ASSOCIATES ATTRIBUTABLE TO LOBBYING ACTIVITIES. 989048 4913 993961 988665 383 989048 988287 378 988665 987886 401 988287 993598 2390 8102 987886 0.94070 0.05930 0 0 254702 254702 89089433 39137153 49952280 58952970 51210290 7742680 2990572 1141019 1849553 59799215 OTHER RECEIVABLES 3949376 RESIDENT FUNDS 39750 DUE FROM AFFILIATES 73712 RIGHT OF USE ASSET 875583 ASSETS HELD FOR SALE 957461 5895882 DEBT-CURRENT 3440105 RESIDENT FUNDS LIABILITY 39750 ASSET RETIREMENT AND OTHER LT 815267 ESTIMATED THIRD PARTY LIABILITY 307715 CAPITAL LEASE PAYABLE 1448469 6051306 X 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. PART X, LINE 2: ADIRONDACK HEALTH (PREVIOUSLY DEFINED AS THE COLLECTIVE ENTITY) QUALIFIES AS NOT-FOR-PROFIT CORPORATIONS AND ARE EXEMPT ORGANIZATIONS UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. ADIRONDACK HEALTH AND THE FOUNDATION HAVE BEEN CLASSIFIED BY THE INTERNAL REVENUE SERVICE (IRS) AS ENTITIES THAT ARE NOT PRIVATE FOUNDATIONS. AS OF DECEMBER 31, 2022 AND 2021, ADIRONDACK HEALTH DID NOT HAVE ANY UNRECOGNIZED TAX BENEFITS OR LIABILITIES OR ANY RELATED ACCRUED INTEREST OR PENALTIES. ADIRONDACK HEALTH DOES NOT ANTICIPATE THAT THE TOTAL UNRECOGNIZED TAX BENEFITS OR LIABILITIES WILL CHANGE IN THE NEXT TWELVE MONTHS. THE TAX YEARS OPEN TO EXAMINATION BY FEDERAL STATE TAXING AUTHORITIES ARE 2019 THROUGH 2022. 1 1 X 1 X 1 X 1 1 0 1 1 101469 3391 98078 0.00080 25707800 11478585 14229215 0.11040 25809269 11481976 14327293 0.11120 500960 0 500960 0.00390 5775936 2840811 2935125 0.02280 6276896 2840811 3436085 0.02670 32086165 14322787 17763378 0.13790 1 1317043 483424 27534798 37272252 -9737454 X 1 1 2 1 ADIRONDACK MEDICAL CENTER 2233 STATE ROUTE 86-PO BOX 471 SARANAC LAKE NY 12983 X X 95 ACUTE BEDS; NURSING HOME WITH 60 BEDS; NURSING HOME WITH 157 BEDS A 2 ADIRONDACK MEDICAL CENTER-LAKE PLACID 203 OLD MILITARY ROAD LAKE PLACID NY 12946 X X OUTPATIENT SERIVCES, EMERGENCY ROOM A FACILITY REPORTING GROUP - A 0 0 1 X X X X X X X X X 22 1 1 1 1 X WWW.ADIRONDACKHEALTH.ORG X AHIHEALTH.ORG X 1 22 1 WWW.ADIRONDACKHEALTH.ORG 0 1 X 150.000000000000 400.000000000000 X X 1 1 X X X 1 X WWW.ADIRONDACKHEALTH.ORG X WWW.ADIRONDACKHEALTH.ORG X WWW.ADIRONDACKHEALTH.ORG X X X X X X 0 0 X X X 1 X 0 0 PART V, SECTION B FACILITY REPORTING GROUP A FACILITY REPORTING GROUP A CONSISTS OF: - FACILITY 1: ADIRONDACK MEDICAL CENTER, - FACILITY 2: ADIRONDACK MEDICAL CENTER-LAKE PLACID GROUP A-FACILITY 1 -- ADIRONDACK MEDICAL CENTER PART V, SECTION B, LINE 5: ADIRONDACK MEDICAL CENTER AND OUR COLLABORATING PARTNERS, COUNTY PUBLIC HEALTH DEPARTMENTS AND REGIONAL HOSPITALS, WORKED THROUGH THE ADIRONDACK RURAL HEALTH NETWORK (ARHN) TO CONDUCT A SURVEY THAT GAVE US INPUT FROM STAKEHOLDERS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITIES WE SERVE. THE ADIRONDACK RURAL HEALTH NETWORK (ARHN) REGION INCLUDES CLINTON, ESSEX, FRANKLIN, FULTON, HAMILTON, WARREN, AND WASHINGTON COUNTIES. THERE ARE HEALTH PROFESSIONAL SHORTAGE AREAS WITHIN THE COUNTIES, RESULTING IN SIGNIFICANT DISPARITIES IN ACCESS TO CARE AND THE POPULATION. LOW-INCOME AND INCONSISTENT ACCESS TO SUPERMARKETS IS SIGNIFICANTLY HIGHER THAN THE ARHN REGION AND UPSTATE NEW YORK. THE WELL-BEING OF THE COMMUNITY IS REFLECTED THROUGH A WIDE ARRAY OF FACTORS, INCLUDING ACCESS TO MEDICAL SERVICES, INDIVIDUAL BEHAVIORS, SOCIO-DEMOGRAPHIC CHARACTERSTICS, AND THE ENVIRONMENT IN WHICH ONE LIVES. ARHN'S 2022 COMMUNITY STAKEHOLDER SURVEY WAS DRAFTED BY THE ORGANIZATION'S AD-HOC DATA SUBCOMMITTEE.THE SURVEY IS CREATED WITH SUPPORT FROM NYS DOH AND HEALTH RESOURCES AND SERVICES ADMINISTRATION. THE SURVEY WAS ADMINISTERED ELECTRONICALLY USING A WEB-BASED SURVEY PROGRAM AND DISTRIBUTED TO A REGIONAL EMAIL CONTACT LIST OF 806 COMMUNITY STAKEHOLDERS. ULTIMATELY, 263 SURVEYS WERE COMPLETED DURING THE EIGHT-WEEK SURVEY PERIOD, A RESPONSE RATE OF 32.63 PERCENT. COMMUNITY STAKEHOLDERS WERE ASKED TO INDICATE ONE SECTOR THAT BEST DESCRIBED THEIR ORGANIZATION. OF THE 198 ORGANIZATIONS THAT RESPONDED, 153 REPORTED PROVIDING A VARIETY OF SERVICES INCLUDING EDUCATION, HEALTH CARE, SOCIAL SERVICES, PUBLIC HEALTH, AND HEALTH BASED COMMUNITY BASED ORGANIZATIONS, AMONG MANY OTHERS. BELOW, TABLE A.1 SHOWS THE PRIMARY FUNCTIONS SELECTED BY RESPONDENTS. HEALTH CARE AND EDUCATIONAL AGENCIES ARE WELL REPRESENTED, AND THE MAJORITY PROVIDES SERVICES TO CHILDREN AND ADOLESCENTS, AS WELL AS PEOPLE LIVING AT OR NEAR THE POVERTY LEVEL.TABLE A.1. PRIMARY FUNCTIONS INDICATED BY SURVEY RESPONDENTS ORGANIZATION PRIMARY FUNCTION / PERCENT OF ALL APPLICANTS NOTE: RESPONDENTS COULD SELECT MORE THAN ONE PRIMARY FUNCTION.BUSINESS: 1CIVIC ASSOCIATION: 2COLLEGE/UNIVERSITY: 1DISABILITY SERVICES: 6EARLY CHILDHOOD: 6ECONOMIC DEVELOPMENT: 2EMPLOYMENT/JOB TRAINING: 0FAITH-BASED: 0FOOD/NUTRITION: 4FOUNDATION/PHILANTHROPY: 0HEALTH BASED CBO: 1HEALTHCARE PROVIDER: 49HEALTH INS. PLAN: 0HOUSING: 2LAW ENFORCEMENT: 7LOCAL GOVERNMENT: 22MEDIA: 1MENTAL, EMOTIONAL, BEHAVIORAL HEALTH PROVIDER: 13PUBLIC HEALTH: 26RECREATION: 3SCHOOL (K-12): 58SENIORS/ELDERS: 12SOCIAL SERVICES: 12TRANSPORTATION: 0TRIBAL GOVERNMENT: 0VETERANS: 1 GROUP A-FACILITY 1 -- ADIRONDACK MEDICAL CENTER PART V, SECTION B, LINE 6A: OUR COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED WITH OUR PARTNERS AT THE ESSEX COUNTY HEALTH DEPARTMENT, FRANKLIN COUNTY PUBLIC HEALTH, UVM HEALTH NETWORK - ALICE HYDE MEDICAL CENTER, UVM HEALTH NETWORK - ELIZABETHTOWN COMMUNITY HOSPITAL, AND ADIRONDACK RURAL HEALTH NETWORK. GROUP A-FACILITY 1 -- ADIRONDACK MEDICAL CENTER PART V, SECTION B, LINE 6B: SEE QUESTION 6A ABOVE GROUP A-FACILITY 1 -- ADIRONDACK MEDICAL CENTER PART V, SECTION B, LINE 11: ADIRONDACK HEALTH STRIVES TO MEET AS MANY OF THE HEALTH NEEDS OF OUR COMMUNITY MEMBERS AS POSSIBLE. IN MANY CASES, WE PARTNER WITH APPROPRIATE ORGANIZATIONS AND AGENCIES TO ADDRESS NEEDS THAT ADIRONDACK HEALTH ALONE CANNOT. ON INITIATIVES THAT ARE NOT HOSPITAL-LED, ADIRONDACK HEALTH PARTNERS AND WORKS WITH LOCAL HEALTH DEPARTMENTS, SOCIAL SERVICES, BEHAVIORAL HEALTH PROVIDERS, SUBSTANCE ABUSE PREVENTION AND TREATMENT PROVIDERS, HOME CARE, AND MANY OTHERS TO ENSURE THAT THE NEEDS OF OUR COMMUNITY MEMBERS ARE MET.THE FOLLOWING ARE THE NYS PREVENTION AGENDA ITEMS THAT ADIRONDACK HEALTH DOES NOT DIRECTLY ADDRESS IN OUR IMPLEMENTATION STRATEGY:PROMOTE A HEALTHY AND SAFE ENVIRONMENTFOCUS AREA: INJURIES, VIOLENCE AND OCCUPATIONAL HEALTH THE RATE OF CRIME AND ASSAULT ARE LOW IN ADIRONDACK HEALTH'S SERVICE AREA. FALLS IN THE HOME AND OCCUPATIONAL HEALTH ARE ISSUES THAT COMMUNITY PARTNERS ARE BETTER POSITIONED TO ADDRESS.FOCUS AREA: OUTDOOR AIR QUALITYAIR QUALITY INDICATORS ARE GOOD. DATA INDICATES THAT IT IS ONLY A FEW DAYS EACH YEAR THAT OUTDOOR AIR QUALITY IS POOR, AND THE LIKELY CAUSE OF THIS IS INDUSTRIAL POLLUTION FROM THE MID-WEST CARRIED HERE ON THE JET STREAM. ADIRONDACK HEALTH DOES NOT HAVE A STRATEGY TO DIRECTLY ADDRESS THIS AT THIS TIME, BUT NATIONAL GROUPS HAVE MADE PROGRESS AND ARE STILL WORKING TO IMPROVE OUTPUTS FROM THESE INDUSTRIAL AREAS.FOCUS AREA: BUILT AND INDOOR ENVIRONMENTSIN OUR SERVICE AREA, MUCH OF THIS WORK IS BEING DONE BY COALITIONS TO WHICH ADIRONDACK HEALTH BELONGS. THE COALITIONS, LED BY PUBLIC HEALTH AND THE NORTH COUNTRY HEALTHY HEART NETWORK, ARE WORKING TOWARD PASSING COMPLETE STREETS POLICIES, IMPROVING PARKS AND OTHER RECREATIONAL AREAS, AND PASSING TOBACCO FREE GROUNDS POLICIES. THESE EFFORTS IMPROVE THE BUILT ENVIRONMENT SO COMMUNITY MEMBERS OF ALL LEVELS OF MOBILITY CAN FEEL SAFE AS PEDESTRIANS AND USING ALTERNATIVE FORMS OF TRANSPORTATION.FOCUS AREA: WATER QUALITYWATER QUALITY INDICATORS ARE GOOD, THOUGH DRINKING WATER VIOLATIONS WERE REPORTED IN BOTH COUNTIES (2019).FOCUS AREA: FOOD AND CONSUMER PRODUCTSIN OUR SERVICE AREA, MUCH OF THIS WORK IS BEING DONE BY COALITIONS TO WHICH ADIRONDACK HEALTH BELONGS. THE COALITIONS, LED BY PUBLIC HEALTH AND THE NORTH COUNTRY HEALTHY HEART NETWORK, ARE WORKING TOWARD IMPROVING ACCESS TO FRESH FRUITS AND VEGETABLES IN STORES AND RESTAURANTS, AND OTHER PROJECTS THAT IMPROVE ACCESS TO HEALTHY FOODS.PROMOTE HEALTHY WOMEN, INFANTS, AND CHILDRENFOCUS AREA: MATERNAL AND WOMEN'S HEALTHIN OUR SERVICE AREA, MUCH OF THIS WORK IS BEING DONE BY COALITIONS AND COUNTY HEALTH DEPARTMENTS. ADIRONDACK HEALTH DELIVERES MORE THAN 180 BABIES ANNUALLY, OFFERS FREE COMMUNITY CHILDBIRTH CLASSES, LACTATION CONSULTS FOR ADIRONDACK HEALTH PATIENTS, AND PROMOTES NATURAL, VAGINAL BIRTHS, WHILE RESPECTING AND FACILITATING EVERY MOTHER'S WISHES, AS CLINICALLY SAFE AND APPROPRIATE.FOCUS AREA: PERINATAL AND INFANT HEALTHIN OUR SERVICE AREA, MUCH OF THIS WORK IS BEING DONE BY COALITIONS (INCLUDING THE BIRTH-TO-THREE ALLIANCE) AND COUNTY HEALTH DEPARTMENTS.FOCUS AREA: CHILD AND ADOLESCENT HEALTHIN OUR SERVICE AREA, MUCH OF THIS WORK IS BEING DONE BY COALITIONS AND COUNTY HEALTH DEPARTMENTS.FOCUS AREA: CROSS CUTTING HEALTHY WOMEN, INFANTS, AND CHILDRENIN OUR SERVICE AREA, MUCH OF THIS WORK IS BEING DONE BY COALITIONS AND COUNTY HEALTH DEPARTMENTS.PREVENT COMMUNICABLE DISEASESFOCUS AREA: VACCINE PREVENTABLE DISEASESTHE RATE OF INFLUENZA VACCINATIONS IN FRANKLIN COUNTY (46) IS EQUAL TO THE STATE AS A WHOLE (46), THOUGH LOWER THAN TOP U.S. PERFORMERS (52). THE RATE OF INFLUENZE VACCINATIONS IN ESSEX COUNTY (52) IS HIGHER THAN THE STATE AS A WHOLE (46), AND EQUAL TO TOP U.S. PERFORMERS (52). FOCUS AREA: HUMAN IMMUNODEFICIENCY VIRUS (HIV)THE RATE OF HIV IS FAIRLY LOW IN ADIRONDACK HEALTH'S SERVICE AREA. ADIRONDACK HEALTH'S PROVIDERS CONTINUE TO WORK WITH PUBLIC HEALTH AND OTHER PROVIDERS TO DELIVER THE HIGHEST LEVEL OF CARE TO PATIENTS WITH HIV.FOCUS AREA: SEXUALLY TRANSMITTED INFECTIONS (STI)THE RATE OF SEXUALLY TRANSMITTED INFECTIONS IN FRANKLIN COUNTY (193.4) AND ESSEX COUNTY (129.9) ARE SIGNIFICANTLY LOWER THAN NEW YORK STATE AS A WHOLE (552.8)FOCUS AREA: HEPATITIS C VIRUS (HCV)HEPATITIS C VIRUS DID NOT RATE AS A HIGH CONCERN IN THE 2022 STAKEHOLDER SURVEY, WITH FOUR RESPONDEES (OUT OF 263 TOTAL) SCORING HCV AS A "TOP FIVE" HEALTH CONCERN.FOCUA AREA: ANTIBIOTIC RESISTANCE AND HEALTHCARE ASSOCIATED INFECTIONSANTIBIOTIC RESISTANCE AND HEALTHCARE ASSOCIATED INFECTIONS DID NOT APPEAR IN THE RESPONSE COUNTS FOR THE 2022 STAKEHOLDER SURVEY. GROUP A-FACILITY 1 -- ADIRONDACK MEDICAL CENTER PART V, SECTION B, LINE 16J: AN INTERPRETER IS AVAILABLE TO ASSIST LEP POPULATIONS AND STAFF IS AVAILABLE TO HELP PATIENTS FILL OUT DOCUMENTATION AND ANSWER ANY QUESTIONS. GROUP A-FACILITY 2 -- ADIRONDACK MEDICAL CENTER - LAKE PLACID PART V, SECTION B, LINE 5: ADIRONDACK MEDICAL CENTER AND OUR COLLABORATING PARTNERS, COUNTY PUBLIC HEALTH DEPARTMENTS AND REGIONAL HOSPITALS, WORKED THROUGH THE ADIRONDACK RURAL HEALTH NETWORK (ARHN) TO CONDUCT A SURVEY THAT GAVE US INPUT FROM STAKEHOLDERS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITIES WE SERVE. THE ADIRONDACK RURAL HEALTH NETWORK (ARHN) REGION INCLUDES CLINTON, ESSEX, FRANKLIN, FULTON, HAMILTON, WARREN, AND WASHINGTON COUNTIES. THERE ARE HEALTH PROFESSIONAL SHORTAGE AREAS WITHIN THE COUNTIES, RESULTING IN SIGNIFICANT DISPARITIES IN ACCESS TO CARE AND THE POPULATION. LOW INCOME AND INCONSISTENT ACCESS TO SUPERMARKETS IS SIGNIFICANTLY HIGHER THAN THE ARHN REGION AND UPSTATE NEW YORK. THE WELL-BEING OF THE COMMUNITY IS REFLECTED THROUGH A WIDE ARRAY OF FACTORS, INCLUDING ACCESS TO MEDICAL SERVICES, INDIVIDUAL BEHAVIORS, SOCIO-DEMOGRAPHIC CHARACTERSTICS, AND THE ENVIRONMENT IN WHICH ONE LIVES. ARHN'S 2022 COMMUNITY STAKEHOLDER SURVEY WAS DRAFTED BY THE ORGANIZATION'S AD-HOC DATA SUBCOMMITTEE.THE SURVEY IS CREATED WITH SUPPORT FROM NYS DOH AND HEALTH RESOURCES AND SERVICES ADMINISTRATION. THE SURVEY WAS ADMINISTERED ELECTRONICALLY USING A WEB-BASED SURVEY PROGRAM AND DISTRIBUTED TO A REGIONAL EMAIL CONTACT LIST OF 806 COMMUNITY STAKEHOLDERS. ULTIMATELY, 263 SURVEYS WERE COMPLETED DURING THE EIGHT-WEEK SURVEY PERIOD, A RESPONSE RATE OF 32.63 PERCENT. COMMUNITY STAKEHOLDERS WERE ASKED TO INDICATE ONE SECTOR THAT BEST DESCRIBED THEIR ORGANIZATION. OF THE 198 ORGANIZATIONS THAT RESPONDED, 153 REPORTED PROVIDING A VARIETY OF SERVICES INCLUDING EDUCATION, HEALTH CARE, SOCIAL SERVICES, PUBLIC HEALTH, AND HEALTH BASED COMMUNITY BASED ORGANIZATIONS, AMONG MANY OTHERS. SURVEY PARTICIPANTS REPRESENTED A DIVERSE ARRAY OF DIFFERENT AGENCIES, POPULATION GROUPS, AND SERVICE-AREAS WITHIN THE OVERALL SEVEN-COUNTY ARHN REGION. BELOW, TABLE A.1 SHOWS THE PRIMARY FUNCTIONS SELECTED BY RESPONDENTS. HEALTH CARE AND EDUCATIONAL AGENCIES ARE WELL REPRESENTED, AND THE MAJORITY PROVIDES SERVICES TO CHILDREN AND ADOLESCENTS, AS WELL AS PEOPLE LIVING AT OR NEAR THE POVERTY LEVEL.TABLE A.1. PRIMARY FUNCTIONS INDICATED BY SURVEY RESPONDENTS ORGANIZATION PRIMARY FUNCTION / PERCENT OF ALL APPLICANTS NOTE: RESPONDENTS COULD SELECT MORE THAN ONE PRIMARY FUNCTION.BUSINESS: 1CIVIC ASSOCIATION: 2COLLEGE/UNIVERSITY: 1DISABILITY SERVICES: 6EARLY CHILDHOOD: 6ECONOMIC DEVELOPMENT: 2EMPLOYMENT/JOB TRAINING: 0FAITH-BASED: 0FOOD/NUTRITION: 4FOUNDATION/PHILANTHROPY: 0HEALTH BASED CBO: 1HEALTHCARE PROVIDER: 49HEALTH INS. PLAN: 0HOUSING: 2LAW ENFORCEMENT: 7LOCAL GOVERNMENT: 22MEDIA: 1MENTAL, EMOTIONAL, BEHAVIORAL HEALTH PROVIDER: 13PUBLIC HEALTH: 26RECREATION: 3SCHOOL (K-12): 58SENIORS/ELDERS: 12SOCIAL SERVICES: 12TRANSPORTATION: 0TRIBAL GOVERNMENT: 0VETERANS: 1 GROUP A-FACILITY 2 -- ADIRONDACK MEDICAL CENTER - LAKE PLACID PART V, SECTION B, LINE 6A: OUR COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED WITH OUR PARTNERS AT THE ESSEX COUNTY HEALTH DEPARTMENT, FRANKLIN COUNTY PUBLIC HEALTH, UVM HEALTH NETWORK - ALICE HYDE MEDICAL CENTER, UVM HEALTH NETWORK - ELIZABETHTOWN COMMUNITY HOSPITAL, AND ADIRONDACK RURAL HEALTH NETWORK. GROUP A-FACILITY 2 -- ADIRONDACK MEDICAL CENTER - LAKE PLACID PART V, SECTION B, LINE 6B: SEE QUESTION 6A ABOVE GROUP A-FACILITY 2 -- ADIRONDACK MEDICAL CENTER - LAKE PLACID PART V, SECTION B, LINE 11: ADIRONDACK HEALTH STRIVES TO MEET AS MANY OF THE HEALTH NEEDS OF OUR COMMUNITY MEMBERS AS POSSIBLE. IN MANY CASES, WE PARTNER WITH APPROPRIATE ORGANIZATIONS AND AGENCIES TO ADDRESS NEEDS THAT ADIRONDACK HEALTH ALONE CANNOT. ON INITIATIVES THAT ARE NOT HOSPITAL-LED, ADIRONDACK HEALTH PARTNERS AND WORKS WITH LOCAL HEALTH DEPARTMENTS, SOCIAL SERVICES, BEHAVIORAL HEALTH PROVIDERS, SUBSTANCE ABUSE PREVENTION AND TREATMENT PROVIDERS, HOME CARE, AND MANY OTHERS TO ENSURE THAT THE NEEDS OF OUR COMMUNITY MEMBERS ARE MET.THE FOLLOWING ARE THE NYS PREVENTION AGENDA ITEMS THAT ADIRONDACK HEALTH DOES NOT DIRECTLY ADDRESS IN OUR IMPLEMENTATION STRATEGY:PROMOTE A HEALTHY AND SAFE ENVIRONMENTFOCUS AREA: INJURIES, VIOLENCE AND OCCUPATIONAL HEALTH THE RATE OF CRIME AND ASSAULT ARE LOW IN ADIRONDACK HEALTH'S SERVICE AREA. FALLS IN THE HOME AND OCCUPATIONAL HEALTH ARE ISSUES THAT COMMUNITY PARTNERS ARE BETTER POSITIONED TO ADDRESS.FOCUS AREA: OUTDOOR AIR QUALITYAIR QUALITY INDICATORS ARE GOOD. DATA INDICATES THAT IT IS ONLY A FEW DAYS EACH YEAR THAT OUTDOOR AIR QUALITY IS POOR, AND THE LIKELY CAUSE OF THIS IS INDUSTRIAL POLLUTION FROM THE MID-WEST CARRIED HERE ON THE JET STREAM. ADIRONDACK HEALTH DOES NOT HAVE A STRATEGY TO DIRECTLY ADDRESS THIS AT THIS TIME, BUT NATIONAL GROUPS HAVE MADE PROGRESS AND ARE STILL WORKING TO IMPROVE OUTPUTS FROM THESE INDUSTRIAL AREAS.FOCUS AREA: BUILT AND INDOOR ENVIRONMENTSIN OUR SERVICE AREA, MUCH OF THIS WORK IS BEING DONE BY COALITIONS TO WHICH ADIRONDACK HEALTH BELONGS. THE COALITIONS, LED BY PUBLIC HEALTH AND THE NORTH COUNTRY HEALTHY HEART NETWORK, ARE WORKING TOWARD PASSING COMPLETE STREETS POLICIES, IMPROVING PARKS AND OTHER RECREATIONAL AREAS, AND PASSING TOBACCO FREE GROUNDS POLICIES. THESE EFFORTS IMPROVE THE BUILT ENVIRONMENT SO COMMUNITY MEMBERS OF ALL LEVELS OF MOBILITY CAN FEEL SAFE AS PEDESTRIANS AND USING ALTERNATIVE FORMS OF TRANSPORTATION.FOCUS AREA: WATER QUALITYWATER QUALITY INDICATORS ARE GOOD, THOUGH DRINKING WATER VIOLATIONS WERE REPORTED IN BOTH COUNTIES (2019).FOCUS AREA: FOOD AND CONSUMER PRODUCTSIN OUR SERVICE AREA, MUCH OF THIS WORK IS BEING DONE BY COALITIONS TO WHICH ADIRONDACK HEALTH BELONGS. THE COALITIONS, LED BY PUBLIC HEALTH AND THE NORTH COUNTRY HEALTHY HEART NETWORK, ARE WORKING TOWARD IMPROVING ACCESS TO FRESH FRUITS AND VEGETABLES IN STORES AND RESTAURANTS, AND OTHER PROJECTS THAT IMPROVE ACCESS TO HEALTHY FOODS.PROMOTE HEALTHY WOMEN, INFANTS, AND CHILDRENFOCUS AREA: MATERNAL AND WOMEN'S HEALTHIN OUR SERVICE AREA, MUCH OF THIS WORK IS BEING DONE BY COALITIONS AND COUNTY HEALTH DEPARTMENTS. ADIRONDACK HEALTH DELIVERES MORE THAN 180 BABIES ANNUALLY, OFFERS FREE COMMUNITY CHILDBIRTH CLASSES, LACTATION CONSULTS FOR ADIRONDACK HEALTH PATIENTS, AND PROMOTES NATURAL, VAGINAL BIRTHS, WHILE RESPECTING AND FACILITATING EVERY MOTHER'S WISHES, AS CLINICALLY SAFE AND APPROPRIATE.FOCUS AREA: PERINATAL AND INFANT HEALTHIN OUR SERVICE AREA, MUCH OF THIS WORK IS BEING DONE BY COALITIONS (INCLUDING THE BIRTH-TO-THREE ALLIANCE) AND COUNTY HEALTH DEPARTMENTS.FOCUS AREA: CHILD AND ADOLESCENT HEALTHIN OUR SERVICE AREA, MUCH OF THIS WORK IS BEING DONE BY COALITIONS AND COUNTY HEALTH DEPARTMENTS.FOCUS AREA: CROSS CUTTING HEALTHY WOMEN, INFANTS, AND CHILDRENIN OUR SERVICE AREA, MUCH OF THIS WORK IS BEING DONE BY COALITIONS AND COUNTY HEALTH DEPARTMENTS.PREVENT COMMUNICABLE DISEASESFOCUS AREA: VACCINE PREVENTABLE DISEASESTHE RATE OF INFLUENZA VACCINATIONS IN FRANKLIN COUNTY (46) IS EQUAL TO THE STATE AS A WHOLE (46), THOUGH LOWER THAN TOP U.S. PERFORMERS (52). THE RATE OF INFLUENZE VACCINATIONS IN ESSEX COUNTY (52) IS HIGHER THAN THE STATE AS A WHOLE (46), AND EQUAL TO TOP U.S. PERFORMERS (52). FOCUS AREA: HUMAN IMMUNODEFICIENCY VIRUS (HIV)THE RATE OF HIV IS FAIRLY LOW IN ADIRONDACK HEALTH'S SERVICE AREA. ADIRONDACK HEALTH'S PROVIDERS CONTINUE TO WORK WITH PUBLIC HEALTH AND OTHER PROVIDERS TO DELIVER THE HIGHEST LEVEL OF CARE TO PATIENTS WITH HIV.FOCUS AREA: SEXUALLY TRANSMITTED INFECTIONS (STI)THE RATE OF SEXUALLY TRANSMITTED INFECTIONS IN FRANKLIN COUNTY (193.4) AND ESSEX COUNTY (129.9) ARE SIGNIFICANTLY LOWER THAN NEW YORK STATE AS A WHOLE (552.8)FOCUS AREA: HEPATITIS C VIRUS (HCV)HEPATITIS C VIRUS DID NOT RATE AS A HIGH CONCERN IN THE 2022 STAKEHOLDER SURVEY, WITH FOUR RESPONDEES (OUT OF 263 TOTAL) SCORING HCV AS A "TOP FIVE" HEALTH CONCERN.FOCUA AREA: ANTIBIOTIC RESISTANCE AND HEALTHCARE ASSOCIATED INFECTIONSANTIBIOTIC RESISTANCE AND HEALTHCARE ASSOCIATED INFECTIONS DID NOT APPEAR IN THE RESPONSE COUNTS FOR THE 2022 STAKEHOLDER SURVEY. GROUP A-FACILITY 2 -- ADIRONDACK MEDICAL CENTER - LAKE PLACID PART V, SECTION B, LINE 16J: AN INTERPRETER IS AVAILABLE TO ASSIST LEP POPULATIONS AND STAFF IS AVAILABLE TO HELP PATIENTS FILL OUT DOCUMENTATION AND ANSWER ANY QUESTIONS. PART V, SECTION B, LINE 20A: FINANCIAL ASSISTANCE IS NOT OFFERED AT THE SNF FACILITY AND ECAS ARE NOT PERFORMED AT THE HOSPITAL. 8 2 - LAKE PLACID HEALTH CENTER 203 OLD MILITARY ROAD LAKE PLACID NY 12946 PRIMARY CARE AND BEHAVIORAL HEALTH CLINICS; EMERGENCY SERVICES; RADIOLOGY 3 - SARANAC LAKE HEALTH CENTER 285 COUNTY ROUTE 47 SARANAC LAKE NY 12983 PRIMARY CARE, BEHAVIORAL HEALTH AND WOUND CARE CLINICS 4 - TUPPER LAKE HEALTH CENTER 7 STETSON ROAD TUPPER LAKE NY 12986 PRIMARY CARE, WOMEN'S HEALTH AND BEHAVIORAL HEALTH CLINIC; LAB AND RADIOLOGY 5 - WOMEN'S HEALTH CENTER 309 OLD LAKE COLBY ROAD SARANAC LAKE NY 12983 WOMEN'S HEALTH CLINIC 6 - ADIRONDACK HEALTH DENTAL CARE 55 BARN RD LAKE PLACID NY 12946 DENTAL CLINIC 7 - KEENE HEALTH CENTER 2841 NYS ROUTE 73 KEENE NY 12942 PRIMARY CARE CLINIC 8 - ST REGIS FALLS HEALTH CENTER 6 NORTH MAIN STREET ST REGIS FALLS NY 12980 PRIMARY CARE CLINIC 9 - COSMETIC CLINIC 309 COUNTY ROAD 47 SUITE 2 SARANAC LAKE NY 12983 COSMETIC AND RECONSTRUCTIVE SURGERY PART I, LINE 7: AMOUNTS CALCULATED USING COST-TO-CHARGE RATIO FROM WORKSHEET 2 (TOTAL OPERATING EXPENSE MINUS MEDICAID/PROVIDER TAXES, TOTAL COMMUNITY BENEFIT EXPENSE, AND TOTAL COMMUNITY BUILDING EXPENSE DIVIDED BY GROSS PATIENT CHARGES), AND ADDRESSES ALL PATIENT SEGMENTS. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 3,225,679. PART II, COMMUNITY BUILDING ACTIVITIES: ADIRONDACK HEALTH STAFF 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. PART III, LINE 2: THE ORGANIZATION'S BAD DEBT EXPENSE OF $1,317,043 IS CALCULATED USING THE COST-TO-CHARGE RATIO FROM WORKSHEET 2 AND BAD DEBT EXPENSE. PART III, LINE 3: THE ORGANIZATION'S BAD DEBT EXPENSE IS CALCULATED USING A PERCENTAGE OF BAD DEBT THAT CONTAINS POSSIBLE CHARITY CARE CASES AND APPLYING IT TO LINE 2. RATIONALE FOR WHAT PORTION OF BAD DEBT SHOULD CONSTITUTE COMMUNITY BENEFIT: THE PROVISION OF HEALTH CARE IS DIFFERENT FROM PROVIDING OTHER SERVICES, IN THAT HOSPITALS, ALTHOUGH THEY MAY ATTEMPT TO OBTAIN FINANCIAL INFORMATION BEFORE SERVICE IS PROVIDED, FOCUS ON PROVIDING THE PATIENT WITH NEEDED HEALTH CARE AND LATER TRY TO OBTAIN PAYMENT. IN OTHER INDUSTRIES, THE SERVICE PROVIDER CAN CHECK THE CUSTOMER'S CREDIT RATING, ASK FOR PAYMENT IN ADVANCE, ETC AND IS USUALLY ASKING THIS INFORMATION WHEN THE CONSUMER IS NOT IN A HEALTH CRISIS AND UNDER GREAT STRESS AND WORRY. AT A LATER TIME, WHEN THE PROVIDER ATTEMPTS TO COLLECT PAYMENT AND FINDS THE PATIENT UNWILLING TO PAY, THEIR OPTIONS ARE AGAIN LIMITED GIVEN THE NATURE OF THE SERVICE PROVIDED AND THE INABILITY TO REPOSSESS THESERVICE. PART III, LINE 4: IN EVALUATING THE COLLECTIBILITY OF PATIENT ACCOUNTS RECEIVABLE, ADIRONDACK HEALTH ANALYZES PAST PAYMENT HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND PROVISION FOR BAD DEBTS. FOR RECEIVABLES ASSOCIATED WITH PATIENTS WHO HAVE THIRD-PARTY COVERAGE, ADIRONDACK HEALTH ANALYZES CONTRACTUALY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), ADIRONDACK HEALTH RECORDS A PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNT RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. PART III, LINE 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, THE LARGEST NUMBER OF OUR FAP-ELIGIBLE PATIENTS ARE WRITTEN-OFF AT 100% SO NO COLLECTION EFFORTS ARE NECESSARY. PART VI, LINE 2: ADIRONDACK MEDICAL CENTER USES A NUMBER OF ASSESSMENT METHODS TO DETERMINE HOW WELL WE ARE MEETING COMMUNITY NEEDS AND WHAT ADDITIONAL SERVICES WE CAN OFFER OUR COMMUNITY MEMBERS.AMC USES THE PRESS-GANEY PATIENT SATISFACTION SURVEY FOR CONTINUAL PATIENT FEEDBACK. THE SURVEYS ARE MAILED TO RANDOMLY SELECTED PATIENTS BY PRESS-GANEY, A NATIONALLY RECOGNIZED PATIENT SURVEY FIRM, AND PRESS-GANEY PROCESSES THE RESULTS. THEY GIVE AMC THE RESULTS BENCHMARKED AGAINST OTHER HOSPITALS TO HELP US UNDERSTAND HOW WELL WE ARE SERVING OUR COMMUNITY.THE MAJORITY OF AMC'S STRATEGIC INITIATIVES ARE DRIVEN BY A THREE-YEAR STRATEGIC PLAN, WHICH IS DEVELOPED THROUGH THE COLLABORATION OF THE HOSPITAL BOARD OF TRUSTEES, 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. 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 HEALTH, LOCATED IN THE HEART OF THE ADIRONDACK PARK IN RURAL, UPSTATE NEW YORK. THE ADIRONDACK PARK IS A UNIQUE, SIX-(6)-MILLION-ACRE PATCHWORK OF PUBLIC AND PRIVATE LANDS. THE ADIRONDACK PARK CREATES A UNIQUE SETTING WHERE SMALL POPULATION CENTERS ARE SURROUNDED BY SUBSTANTIAL AREAS OF STATE-OWNED WILDERNESS AREAS. IT IS BEST KNOWN FOR ITS MOUNTAINS, THE HIGHEST IN NEW YORK STATE, AND ITS LAKES. THERE ARE EXPANSIVE AREAS OF BACKCOUNTRY INTERSPERSED WITH VILLAGES, PRIVATE HOMES, AND FARMS. ADIRONDACK HEALTH'S SERVICE AREA IS MAINLY COMPRISED OF TOWNS IN SOUTHERN FRANKLIN AND NORTHERN ESSEX COUNTIES, BUT ALSO INCLUDES PORTIONS OF SOUTHWESTERN CLINTON, NORTHERN HAMILTON, AND SOUTHEASTERN ST. LAWRENCE COUNTIES. FRANKLIN COUNTY'S POPULATION IS 46,373. SIMILAR TO THE REST OF UPSTATE NEW YORK, FRANKLIN COUNTY'S POPULATION IS VERY LIMITED IN ITS DIVERSITY, OVER 86% ARE WHITE/NON-HISPANICS, FOLLOWED BY 3.1% BLACK/AFRICAN AMERICAN, NON-HISPANICS AND 2.8% HISPANIC/LATINOS. NEARLY 20% OF THE POPULATION IS 65 YEARS OF AGE AND OLDER. ESSEX COUNTY'S POPULATION IS 36,910, MAKING IT THE SECOND LEAST POPULATED COUNTY IN THE ARHN REGION. SIMILAR TO THE REST OF UPSTATE NEW YORK, ESSEX COUNTY'S POPULATION IS VERY LIMITED IN ITS DIVERSITY, OVER 95% ARE WHITE/NON-HISPANICS, FOLLOWED BY 3.0% HISPANIC/LATINOS AND 2.1% BLACK/AFRICAN AMERICAN, NON-HISPANICS. OVER 26% OF THE POPULATION IS 65 YEARS OF AGE AND OLDER. WHILE THERE ARE NO SIGNIFICANT HEALTH DISPARITIES BASED ON RACE AND ETHNICITY IN FRANKLIN OR ESSEX COUNTIES, THERE ARE SIGNIFICANT ACCESS TO CARE ISSUES. PART VI, LINE 5: AMC IS A SOLE COMMUNITY HOSPITAL AND ALTHOUGH NOT AFFILIATED WITH A LARGER MEDICAL NETWORK, IS PART OF THE ADIRONDACK ACCOUNTABLE CARE ORGANIZATION, WHICH IS COMPRISED OF 450 PRIMARY AND SPECIALTY CLINICIANS THROUGH NEW YORK AND VERMONT. AMC IS A PARTNER IN THE ADIRONDACK HEALTH INSTITUTE PPS FOR DSRIP AND COLLABORATES CLOSELY WITH MANY COMMUNITY-BASED ORGANIZATIONS IN THE REGION, INCLUDING PUBLIC HEALTH AGENCIES IN BOTH FRANKLIN AND ESSEX COUNTIES AND BEHAVIORAL HEALTH AGENCIES TO FURTHER THE GOALS OF THE COMMUNITY SERVICE PLAN. EFFORTS INCLUDE: -COLLABORATION WITH THE NORTH COUNTRY HEALTHY HEART NETWORK TO PROVIDE CHRONIC DISEASE COACHING THAT FOCUSES ON COACHING PATIENTS WHO HAVE CHRONIC DISEASES OR ARE AT RISK FOR THEM LIKE COPD, HYPERTENSION, HEART DISEASE AND DIABETES. -ENGAGED IN QUALITY IMPROVEMENT INITIATIVES AIMED AT REDUCING HOSPITAL READMISSIONS. -UTILIZED CHRONIC DISEASE WELLNESS COACHES WHO WORK IN THE PRIMARY CARE SETTING TO CONNECT WITH AT-RISK, LOW-RISK INDIVIDUALS OF PRE-DIABETES, DIABETES AND OTHER CHRONIC ILLNESSSES TO MAKE LIFESTYLE CHANGES THAT IMPROVE HEALTH OUTCOMES. -OFFERED FREE ADVANCED CARE PLANNING TO ALL MEMBERS OF THE COMMUNITY TO DECREASE IN-HOSPITAL DEATHS, INCREASE THE USE OF HOPSICE CARE AND DECREASE UNNECESSARY MEDICAL TREATMENTS. -SPONSOR OF ADIRONDACK HEALTH PROGRAMS AND EMPLOYEE WELLNESS PROGRAMS TO ENCOURAGE PHYSICAL ACTIVITY AND HEALTHY LIFESTYLES. -PARTICIPATION IN DSRIP (DELIVERY SYSTEM REFORM INCENTIVE PAYMENT) WITH SEVEN PROJECTS ALL OF WHICH ARE PART OF A COMPREHENSIVE MEDICAID REFORM PROGRAM TO REDUCE AVOIDABLE HOSPITAL ADMISSIONS AND EMERGENCY DEPARTMENT ADMISSIONS BY 25% OVER 5 YEARS. THESE PROJECTS INCLUDE HOME TELEMONITORING EQUIPMENT, FACILITATOR TRAINING WITH RESPECTING CHOICES (A PALLIATIVE CARE INITIATIVE), CHRONIC DISEASE PREVENTION, INTEGRATING BEHAVIORAL HEALTH INTO PRIMARY CARE, HEALTH CENTER CERTIFICATION UNDER NCQA AND MANY OTHER POPULATION HEALTH EFFORTS. PART VI, LINE 6: THE ORGANIZATION IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. PART VI, LINE 7, REPORTS FILED WITH STATES NY X X X X 0 1 0 0 0 0 0 0 0 EVE BURNS PHYSICIAN 672422 0 0 0 0 0 64472 0 180 0 737074 0 240542 0 ANTHONY TRAMONTANO PHYSICIAN 643185 0 0 0 0 0 12281 0 16746 0 672212 0 0 0 CLAUDE ROLAND PHYSICIAN 557019 0 0 0 0 0 11550 0 868 0 569437 0 0 0 JOHN ESPER PHYSICIAN 486529 0 0 0 0 0 15250 0 18618 0 520397 0 0 0 DARCI BEIRAS CMO 403923 0 22332 0 0 0 47098 0 17275 0 490628 0 0 0 HENRI GABORIAU PHYSICIAN 460186 0 0 0 0 0 12077 0 17106 0 489369 0 0 0 AARON KRAMER CEO/PRESIDENT 326842 0 29090 0 0 0 13258 0 180 0 369370 0 0 0 IRWIN LIEB MD EX-OFFICIO MED STAFF PRES 348450 0 0 0 0 0 5845 0 11594 0 365889 0 0 0 ROBERT LABA CFO 245591 0 24438 0 0 0 11575 0 180 0 281784 0 0 0 DAVID MADER CNO 183790 0 24750 0 0 0 9149 0 17491 0 235180 0 0 0 DANIEL HILL COO (STARTING 10/25/2021) 187583 0 10000 0 0 0 9150 0 16746 0 223479 0 0 0 SYLVIA GETMAN PRESIDENT/CEO (UNTIL 07/21) 100000 0 0 0 0 0 0 0 0 0 100000 0 100000 0 PART 1, LINE 4B THE HOSPITAL HAS A DEFERRED COMPENSATION PLAN FOR PARTICIPATING PHYSICIANS WHO PROVIDE SERVICES THROUGH THE HOSPITAL'S "ON-CALL" PROGRAM. ELIZABETH BUCK, MD RECEIVED $39,761 FROM THIS DEFERRED COMPENSATION PLAN AND $34,400 WAS CONTRIBUTED TO THIS DEFERRED COMPENSATION PLAN ON BEHALF OF ELIZABETH. WILLIAM SMITH, MD RECEIVED $60,544 FROM THIS DEFERRED COMPENSATION PLAN AND $50,050 WAS CONTRIBUTED TO THIS DEFERRED COMPENSATION PLAN ON BEHALF OF WILLIAM. $34,800 WAS CONTRIBUTED TO THIS DEFERRED COMPENSATION PLAN ON BEHALF OF DARCI BEIRAS, MD. THE HOSPITAL ALSO HAD A 457(F) DEFERRED COMPENSATION PLAN FOR IT'S FORMER CEO, SYLVIA GETMAN. IN 2022 SYLVIA RECEIVED $100,000 FROM THIS DEFERRED COMPENSATION PLAN. A FRANKLIN COUNTY CIVIC DEVELOPMENT CORPORATION 800627350 2016-10-18 24455000 MULTI-MODE REVENUE BONDS FOR CAPITAL PROJECTS- REFINANCE 0 0 0 B ESSEX COUNTY CAPITAL RESOURCE CORPORATION 274698218 2017-10-05 9500000 MULTI-MODE REVENUE BONDS FOR CAPITAL PROJECTS 0 0 0 A 24455000 479474 14335658 349674 2019 1 0 1 1 B 9500000 190000 9238750 71250 2018 0 0 1 1 A 0 0 1 1 0 0 0 1 B 0 0 1 1 0 0 0 1 A 0 1 0 0 1 0 0 0 1 B 0 1 0 0 0 0 0 0 1 A 1 B 1 FORM 990, PART III, LINE 3 IN OCTOBER 2022, ADIRONDACK HEALTH ENTERED INTO A NON-BINDING LETTER OF INTENT TO SELL MERCY LIVING CENTER. THE PLANNED DIVESTITURE OF MERCY LIVING CENTER INCLUDES THE OPERATING LICENSE AND CERTAIN PROPERTY AND EQUIPMENT. ON JULY 17, 2023, ADIRONDACK HEALTH EXECUTED PURCHASING AND CONSULTING AGREEMENTS RELATED TO THE SALE OF THE PROPERTY AND EQUIPMENT ASSOCIATED WITH MERCY LIVING CENTER. FORM 990, PART VI, SECTION B, LINE 11B 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. THESE ARE THEN REVIEWED BY THE AUDIT AND COMPLIANCE COMMITTEE. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION DECISIONS ARE DEVELOPED BASED ON THE USE OF NATIONAL AND REGIONAL SALARY SURVEY DATA WHICH IS ANALYZED BY THE COMPENSATION COMMITTEE AND THEN APPROVED BY THE FULL BOARD. 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. FORM 990, PART IX, LINE 11G CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 4,323,878. MANAGEMENT AND GENERAL EXPENSES 4,542,756. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 8,866,634. PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 6,747,346. MANAGEMENT AND GENERAL EXPENSES 35,000. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,782,346. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 487,617. MANAGEMENT AND GENERAL EXPENSES 419,742. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 907,359. CONTRACT LABOR: PROGRAM SERVICE EXPENSES 4,303,472. MANAGEMENT AND GENERAL EXPENSES 71,494. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,374,966. CONSULTING FEES: PROGRAM SERVICE EXPENSES 158,972. MANAGEMENT AND GENERAL EXPENSES 210,412. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 369,384. LAUNDRY SERVICES: PROGRAM SERVICE EXPENSES 290,136. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 290,136. TRASH REMOVAL: PROGRAM SERVICE EXPENSES 230,389. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 230,389. COLLECTION AGENCIES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 120,443. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 120,443. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. ADIRONDACK MEDICAL CENTER FOUNDATION PO BOX 120 2233 STATE ROUTE 86 SARANAC LAKE NY 12983 161528554 SUPPORT AND ASSIST ADIRONDACK MEDICAL CENTER NY 501(C)3 BOX 11 ADIRONDACK MEDICAL CENTER 0 ADIRONDACK HEALTH REGIONAL MEDICAL PC PO BOX 471 2233 STATE ROUTE 86 SARANAC LAKE NY 12983 475676016 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 CONTRACTING - HEALTH SERVICES NY AMC AND TRUDEAU HEALTH SYSTEMS C 0.50000 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0