2021-10-27T09:36:46-05:00 2020-12-31 161131146 BONADIO & CO LLP 171 SULLYS TRAIL PITTSFORD NY 14534 990 2020-01-01 150622079 CARTHAGE AREA HOSPITAL CART 3154931000 1001 WEST STREET CARTHAGE NY 13619 ROB BLOOM CHIEF FINANCIAL OFFICER 3154931000 2021-10-26 1 ROB BLOOM 999009999 JONATHAN MILLER P01322027 5853811000 3 AAL1 IAL1 2020 2022-09-23 18:48:47Z RICHARD DUVALL 1001 WEST STREET CARTHAGE NY 13619 50147243 0 X HTTP://WWW.CARTHAGEHOSPITAL.COM/ X 1921 NY PROVIDE QUALITY, COMPREHENSIVE HEALTHCARE SERVICES, IN A COMMUNITY SETTING. 11 11 572 50 0 0 2930687 5232353 50144340 44075140 150349 0 2029537 839750 55254913 50147243 0 0 0 0 34816041 36628909 0 0 10177 18895882 19466606 53711923 56095515 1542990 -5948272 30976159 37020576 22625611 34198986 8350548 2821590 CARTHAGE AREA HOSPITAL PROVIDES QUALITY COMPREHENSIVE HEALTHCARE SERVICES, PRIMARILY IN JEFFERSON COUNTY, PERSONALIZING QUALITY HEALTHCARE IN PARTNERSHIP WITH VARIOUS COMMUNITIES THROUGHOUT THE AREA. 0 0 50725826 44667211 CARTHAGE AREA HOSPITAL IS A NOT-FOR-PROFIT, CRITICAL ACCESS HOSPITAL, LOCATED IN CARTHAGE, NEW YORK. THE HOSPITAL PROVIDES QUALITY INPATIENT AND OUTPATIENT HEALTHCARE SERVICES. THE HOSPITAL HAS 25 CERTIFIED BEDS, COMPRISED OF 10 MEDICAL/SURGICAL, 4 INTENSIVE CARE, 3 PEDIATRIC, AND 8 MATERNITY. THE HOSPITAL PROVIDES OUTPATIENT ANCILLARY SERVICES SUCH AS GENERAL AND ORTHOPEDIC SURGERIES, LAB TESTS, MEDICAL IMAGING, EMERGENCY ROOM SERVICES, AND RESPIRATORY SERVICES. THE HOSPITAL HAD 127,541 OUTPATIENT VISITS AND 4,112 PATIENT DAYS OF CARE IN 2020. THE HOSPITAL ALSO HAS AN EXTENSIVE NETWORK OF PRIMARY CARE, SPECIALTY CARE, AND SCHOOL-BASED CLINICS AND HOME HEALTH SERVICES LOCATED PRIMARILY IN JEFFERSON COUNTY. 50725826 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 0 0 0 1 45 0 1 572 1 0 0 0 0 0 0 0 0 0 0 0 0 X 11 11 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X ROB BLOOM 3154931000 1001 WEST STREET CARTHAGE NY 13619 GARY ROWE PRESIDENT 1.00 X X 0 0 0 DALE KLOCK VICE PRESIDENT 1.00 X X 0 0 0 TIM STURICK TREASURER 1.00 X X 0 0 0 LAWRENCE HASSELER SECRETARY 1.00 X X 0 0 0 JAMIE VANDERVEEKEN DIRECTOR 1.00 X 0 0 0 DR MIRZA ASHRAF DIRECTOR 1.00 X 0 0 0 DR KENNETH FISH DIRECTOR 1.00 X 0 0 0 PETER TURNER DIRECTOR UNTIL JANUARY 2020 1.00 X 0 0 0 ADAM FULLER DIRECTOR 1.00 X 0 0 0 ANNE ROHR DIRECTOR 1.00 X 0 0 0 PATTIE EARL DIRECTOR 1.00 1.00 X 0 0 0 JENNIFER PREMO DIRECTOR 1.00 X 0 0 0 RICHARD DUVALL CHIEF EXECUTIVE OFFICER 40.00 X 0 0 0 ROB BLOOM CHIEF FINANCIAL OFFICER 40.00 X 487316 0 18711 MICHAEL GORDON CHIEF MEDICAL OFFICER 40.00 X 1208953 0 22200 NATALIE BURNHAM CHIEF OPERATING OFFICER 40.00 X 190785 0 19862 NATA PARNES MEDICAL STAFF REPRESENTATI 40.00 X 900226 0 22200 BRYAN VENERUS PHYSICIAN 40.00 X 417758 0 8898 KINGSLEY MALCOLM CRNA 40.00 X 459845 0 20049 FELIX OBEN CLINICAL PROVIDER 40.00 X 713581 0 2924 REBECCA TAN ALBERTO MD-ANESTHESIA 40.00 X 475353 0 22200 RICCARDO TURRIN PHYSICIAN 40.00 X 711866 0 19587 5565683 0 156631 58 0 1 0 DELPHI HOSPITALIST SERVICES 7785 N STATE STREET LOWVILLE NY 13367 STAFFING 1323706 LABCORP OF AMERICA HOLDINGS 600 E GENESEE ST 305 SYRACUSE NY 13202 LABORATORY SERVICES 757418 MEDICAL SOLUTIONS LLC 1010 N 102ND STREET SUITE 300 OMAHA NE 68114 STAFFING 728995 SURGICALIST OF NEW YORK PC 1001 WEST STREET CARTHAGE NY 13619 MEDICAL SERVICES 397718 BARTON AND ASSOCIATES INC 300 JUBILEE DRIVE PEABODY MA 01960 ENGINEERING CONSULTANT 375268 27 10000 5192230 30123 8612 5232353 NET PATIENT SERVICE REVENUE 900099 44035091 44035091 40049 40049 44075140 207630 0 207630 207630 207630 OTHER REVENUE 900099 632120 632120 632120 50147243 44667211 0 247679 2869376 2185103 684273 26480304 25306991 1163313 10000 1730740 1639095 91645 3568927 2967997 600930 1979562 1857161 122401 432778 432778 323511 323511 4877985 4498025 379960 220516 12566 207950 6292984 6077072 215738 174 4682321 3979011 703310 62697 38317 24377 3 51239 51239 1305216 1305216 830109 575737 254372 DUES AND LICENSES 301360 202452 98908 MISCELLANEOUS EXPENSES 85890 29844 56046 56095515 50725826 5359512 10177 1845001 1898707 6828542 16571614 1798278 4046396 2938238 1265011 1419371 898957 879895 46832421 35167350 12545167 11665071 1748807 1647680 30976159 37020576 10460466 17629610 1044615 863809 11120530 15705567 22625611 34198986 X 8350548 2821590 8350548 2821590 30976159 37020576 X -5948272 419314 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 0 1 3321 0 1 16467 19788 0 PART II-B, LINE 1: MEMBERS OF MANAGEMENT MET WITH VARIOUS STATE AND FEDERAL LEGISLATORS IN ORDER TO ADVOCATE FOR LEGISLATION FOR THE BENEFIT OF THE HEALTHCARE INDUSTRY. ADDITIONALLY, A PORTION OF MEMBERSHIP DUES PAID TO THE HEALTHCARE ASSOCIATION OF NEW YORK STATE, THE AMERICAN HOSPITAL ASSOCIATION, AND IROQUOIS HEALTHCARE ASSOCIATION ARE USED BY THOSE ASSOCIATIONS SPECIFICALLY FOR LOBBYING ACTIVITIES. 0 0 343688 343688 23373781 14755659 8618122 22229779 20411691 1818088 885173 885173 11665071 ESTIMATED AMOUNTS DUE TO THIRD PARTY PAYORS 8415264 ACCRUED PENSION LIABILITY 2446783 INSURANCE CLAIMS LIABILITY 4843520 15705567 1 1 X 1 X 1 X 1 1 1 0 1 1 686716 307257 379459 0.00680 13057280 7609031 5448249 0.09710 13743996 7916288 5827708 0.10390 35699481 30375883 5323598 0.09490 35699481 30375883 5323598 0.09490 49443477 38292171 11151306 0.19880 91490 91490 0.00160 50 50 0.00000 91540 91540 0.00160 1 3961815 1997904 11293363 11186420 106943 X 1 1 1 1 CARTHAGE AREA HOSPITAL 1001 WEST STREET CARTHAGE NY 13619 HTTP://WWW.CARTHAGEHOSPITAL.COM/ 2238700C X X X X CARTHAGE AREA HOSPITAL 1 0 0 1 X X X X X X X 19 1 1 1 1 X HTTP://WWW.CARTHAGEHOSPITAL.COM/ABOUT/COMMUNITY-SERVICE-PLAN/ X 1 19 1 HTTP://WWW.CARTHAGEHOSPITAL.COM/ABOUT/COMMUNITY-SERVICE-PLAN/ 0 1 X 200.000000000000 300.000000000000 1 1 X X X X 1 X HTTP://WWW.CARTHAGEHOSPITAL.COM/PATIENTS-VISITORS/BILLING-INSURANCE/ X HTTP://WWW.CARTHAGEHOSPITAL.COM/PATIENTS-VISITORS/BILLING-INSURANCE/ X HTTP://WWW.CARTHAGEHOSPITAL.COM/PATIENTS-VISITORS/BILLING-INSURANCE/ X X X X X X 1 X 0 X X X 1 X 0 0 CARTHAGE AREA HOSPITAL PART V, SECTION B, LINE 5: CARTHAGE AREA HOSPITAL UTILIZES OTHER DATA SOURCES AS NECESSARY INCLUDING PATIENT SATISFACTION SURVEYS, COMMUNITY WORKSHOP EVELUATIONS, AND COMMUNITY EVENT SURVEYS. CARTHAGE AREA HOSPITAL PART V, SECTION B, LINE 6A: THE 2019-2021 JEFFERSON COUNTY COMMUNITY HEALTH ASSESSMENT WAS PERFORMED IN COOPERATION WITH RIVER HOSPITAL AND SAMARITAN MEDICAL CENTER. CARTHAGE AREA HOSPITAL PART V, SECTION B, LINE 6B: CARTHAGE AREA HOSPITAL'S SERVICE LOCATION IS WITHIN JEFFERSON COUNTY. THE 2019-2021 JEFFERSON COUNTY COMMUNITY HEALTH ASSESSMENT PREPARED BY FORT DRUM REGIONAL HEALTH PLANNING ORGANIZATION WAS PERFORMED IN COOPERATION WITH JEFFERSON COUNTY PUBLIC HEATH SERVICES AND NORTH COUNTRY HEALTH COMPASS PARTNERS. CARTHAGE AREA HOSPITAL PART V, SECTION B, LINE 11: CARTHAGE AREA HOSPITAL DEVELOPED AND IMPLEMENTED A COMMUNITY SERVICE PLAN WHICH ALIGNED WITH THE MOST RECENT CHNA. CARTHAGE ARE HOSPITAL FOCUSED ON TWO PRIORITIES ADDRESSING COMMUNITY NEEDS. 1) PREVENTING CHRONIC DISEASE; REDUCE OBESITY: OUR EMPLOYEES MADE REFERRALS TO NUTRITIONAL COUNSELING WITH A REGISTERED DIETITION FOR STUDENTS WHO WERE IDENTIFIED AS AT-RISK DURING THEIR ANNUAL PHYSICALS CONDUCTED THROUGH THE SCHOOL-BASED HEALTH CLINICS. THE HOSPITAL PARTNERED WITH A LOCAL FARMER TO USE LOCAL PRODUCE, AS AVAILABLE, IN THE HOSPITAL CAFETERIA AND ALSO OFFERED COOKING CLASSES ON HOW TO PREPARE HEALTHY FOODS AT HOME. THE HOSPITAL OFFERED COMMUNITY EDUCATION ON WEIGHT MANAGEMENT AND HEALTHY LIFESTYLES IN A "WEIGHT OF LIFE" EDUCATION SERIES. IN ADDITION TO THE COOKING CLASSES THE HOSPITAL INTRODUCED THE OPTION TO PURCHASE HEALTHY MEALS READY TO BE MADE IN SIMILAR STYLE OF "BLUE APRON AND "HELLO FRESH." OTHER PREVENTION AND WEIGHT MANAGEMENT PROGRAMS INCLUDED AN ANNUAL COMMUNITY HEALTH DAY AT A LOCAL PARK FOR ALL AGE GROUPS. 2) PROMOTE MENTAL HEALTH AND PREVENT SUBSTANCE ABUSE; STRENGTHEN INFRASTRUCTURE ACROSS SYSTEMS: THE HOSPITAL BEGAN TO INTEGRATE SCREENINGS FOR DEPRESSION DURING PRIMARY CARE VISITS AND REFERRING QUALIFYING HIGH RISK PATIENTS TO DEPRESSION CARE MANAGER. PROMOTE AWARENESS AND ACCESS TO MENTAL HEALTH TREATMENT AT COMMUNITY EVENTS AND CONTINUE TO RAISE AWARENESS REGARDING AVAILABLE SCHOOL-BASED MENTAL HEALTH PROGRAMS AS WELL AS BEHAVIORAL HEALTH CLINIC SERVICES. CARTHAGE AREA HOSPITAL ALSO PARTICIPATES IN THE DSRIP PROJECT WHICH ALIGNS WITH THESE NEEDS. 13 1 - CAH FAMILY MEDICAL CENTER 117 NORTH MECHANIC STREET CARTHAGE NY 13619 PRIMARY CARE CLINIC 2 - WOMEN'S WAY TO WELLNESS 117 NORTH MECHANIC STREET CARTHAGE NY 13619 OB/GYNO OUTPATIENT CLINIC 3 - TRI-COUNTY ORTHOPEDIC CENTER 3 BRIDGE STREET CARTHAGE NY 13619 OUTPATIENT ORTHOPEDIC CENTER 4 - CAH SURGERY CENTER 3 BRIDGE STREET CARTHAGE NY 13619 OUTPATIENT SURGERY CLINIC 5 - CAH BEHAVIORAL HEALTH CENTER 3 BRIDGE STREET CARTHAGE NY 13619 OUTPATIENT BEHAVIORAL HEALTH CLINIC 6 - PHILADELPHIA PHYSICAL THERAPY US ROUTE 11 PHILADELPHIA NY 13673 REHABILITATION CLINIC 7 - CARTHAGE HIGH SCHOOL CLINIC 36500 ROUTE 26 CARTHAGE NY 13619 OUTPATIENT SCHOOL CLINIC 8 - CARTHAGE MIDDLE SCHOOL CLINIC 21986 COLE ROAD CARTHAGE NY 13619 OUTPATIENT SCHOOL CLINIC 9 - BEAVER RIVER SCHOOL CLINIC 9508 ARTZ ROAD BEAVER FALLS NY 13305 OUTPATIENT SCHOOL CLINIC 10 - CAH THERAPHY SERVICES 3 BRIDGE STREET CARTHAGE NY 13619 REHABILITATION CLINIC 11 - COMPREHENSIVE WOMEN'S HEALTH SERVICES 622 WASHINGTON STREET WATERTOWN NY 13601 OB/GYNO OUTPATIENT CLINIC 12 - PHILADELPHIA MEDICAL CENTER 32787 US ROUTE 11 PHILADELPHIA NY 13673 RURAL HEALTH CLINIC 13 - LAFARGEVILLE SCHOOL-BASED HEALTH CLINIC 20414 SUNRISE AVE LAFARGEVILLE NY 13656 SCHOOL-BASED HEALTH CLINIC PART I, LINE 6A: CARTHAGE AREA HOSPITAL ROUTINELY PROVIDES THE COMMUNITY WITH INFORMATION ON THE COMMUNITY BENEFIT ACTIVITIES AND UTILIZATION OF CARTHAGE AREA HOSPITAL. THIS IS OFTEN IN THE FORM OF NEWSLETTERS AVAILABLE AND DISTRIBUTED TO THE COMMUNITY. PART I, LINE 7: THE 2020 COST REPORT PREPARED BY M.S. HALL & ASSOCIATES LLC WAS UTILIZED IN COMPLETION OF SCHEDULE H. THE COMMUNITY HEALTH NEEDS ASSESSMENT AND CARTHAGE AREA HOSPITAL'S COMMUNITY ACTION PLAN WAS ALSO USED TO COMPLETE SCHEDULE H. PART I, LINE 7G: CARTHAGE AREA HOSPITAL'S SUBSIDIZED HEALTH SERVICES INCLUDE ITS PRIMARY CARE CLINIC, REFERRED AMBULATORY SERVICE, EMERGENCY ROOM, AND OBSERVATION BEDS. PART II, COMMUNITY BUILDING ACTIVITIES: CARTHAGE AREA HOSPITAL HOSTS AND PARTICIPATES IN MANY COMMUNITY BUILDING ACTIVITIES. THERE ARE MANY ACTIVITIES HOSTED BY CARTHAGE WHICH ARE POINTED AT EDUCATING THE COMMUNITY ON THEIR HEALTH. EXAMPLES INCLUDE BREAST CANCER AWARENESS LUNCHEONS, HEALTH FAIRS AND COMMIT TO BE FIT PROGRAMS. INCREASING THE EDUCATION OF THE COMMUNITY IS BELIEVED TO AID IN PREVENTION OF AILMENTS AND THEREFORE ARE AN INTERVENTION METHOD. ADDITIONALLY CARTHAGE PARTICIPATES IN ACTIVITIES THAT BUILD THE GENERAL WELL BEING AND COHESIVENESS OF THE COMMUNITY. SUCH EVENTS INCLUDE UNITED WAY, COMMUNITY PARADES AND SPONSORSHIP OF COMMUNITY ACTIVITIES. PART III, LINE 2: BAD DEBT EXPENSE INFORMATION WAS OBTAINED FROM THE 2020 MEDICAID COST REPORT. THE COST REPORT IS COMPLETED BY INDEPENDENT CONSULTANTS UTILIZING PATIENT CHARGE DATA. PART III, LINE 3: THE AMOUNT OF BAD DEBT EXPENSE RELATED TO PATIENTS ELIGIBLE UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY WAS DETERMINED BY UTILIZING THE MEDICARE COST TO CHARGE RATIO APPLIED TO BAD DEBT EXPENSE. THIS INFORMATION WAS OBTAINED BY UTILIZING COST REPORTS PREPARED BY INDEPENDENT CONSULTANTS. PART III, LINE 4: THE HOSPITAL IS DESIGNATED AS A CRITICAL ACCESS HOSPITAL BY MEDICARE AND MEDICAID. AS A CRITICAL ACCESS HOSPITAL, MEDICARE AND TRICARE REIMBURSES THE HOSPITAL ON A COST BASIS, AND MEDICAID REIMBURSES THE HOSPITAL USING A TRENDED BASE YEAR COST PER DISCHARGE HELD TO 110% OF THE STATEWIDE AVERAGE OF ALL CRITICAL ACCESS HOSPITALS PLUS CAPITAL AND ON A PROSPECTIVE PAYMENT SYSTEM FOR OUTPATIENT VISISTS. THE COMPANY ALSO HAS AGREEMENTS WITH OTHER THIRD-PARTY PAYORS WITH PAYMENT ARRANGEMENTS WHICH INCLUDE PROSPECTIVELY DETERMINED RATES PER DISCHARGE OR VISIT, COST-BASED REIMBURSEMENT, DISCOUNTED CHARGES, PER DIEM PAYMENTS AND FEE-FOR-SERVICE PAYMENTS. THE COMPANY RECOGNIZES PATIENT AND RESIDENT SERVICE REVENUE ASSOCIATED WITH SERVICES OR HOUSING PROVIDED TO PATIENTS AND RESIDENTS WHO HAVE THIRD-PARTY COVERAGE ON THE BASIS OF CONTRACTUAL RATES FOR THE SERVICES OR HOUSING PROVIDED, INCLUDING ESTIMATED RETROACTIVE ADJUSTMENTS DUE TO FUTURE AUDITS, REVIEWS AND INVESTIGATIONS. RETROACTIVE ADJUSTMENTS ARE INCLUDED IN THE RECOGNITION OF PATIENT AND RESIDENT SERVICE 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.FOR UNINSURED PATIENTS AND RESIDENTS THAT DO NOT QUALIFY FOR CHARITY CARE, THE COMPANY RECOGNIZES REVENUE ON THE BASIS OF ITS STANDARD RATES FOR SERVICES OR HOUSING PROVIDED. HISTORICALLY, A SIGNIFICANT PORTION OF THE COMPANY'S UNINSURED PATIENTS AND RESIDENTS WILL BE UNABLE OR UNWILLING TO PAY FOR THE SERVICES OR HOUSING PROVIDED. THUS, THE COMPANY RECORDS A PROVISION FOR BAD DEBTS RELATED TO UNINSURED PATIENTS AND RESIDENTS IN THE PERIOD THE SERVICES OR HOUSING ARE PROVIDED. THE COMPANY ESTIMATES THE AMOUNT TO BE RECOGNIZED IN THE CONSOLIDATED FINANCIAL STATEMENTS FOR DOUBTFUL ACCOUNTS BY ANALYZING PATIENT AND RESIDENT ACCOUNTS FOR COLLECTABILITY, CONSIDERING PREVAILING ECONOMIC CONDITIONS, AND APPLYING HISTORICALLY ESTABLISHED PERCENTAGES FOR SELF-PAY AND VARIOUS THIRD-PARTY PAYORS TO THE AGING CATEGORIES IN THE ACCOUNTS RECEIVABLE AGING AND REVIEWING SPECIFIC OUTSTANDING BALANCES. ACCOUNTS FOR WHICH NO PAYMENTS HAVE BEEN RECEIVED FOR A SIGNIFICANT AMOUNT OF TIME ARE CONSIDERED DELINQUENT AND THE ACCOUNTS ARE WRITTEN-OFF WHEN CUSTOMARY COLLECTION EFFORTS ARE EXHAUSTED.THE COMPANY'S ACCOUNTING POLICY WITH RESPECT TO THE CONSOLIDATED FINANCIAL STATEMENTS IS TO REPORT THE CONSOLIDATED BAD DEBT EXPENSE AS A DEDUCTION FROM NET PATIENT SERVICE REVENUE. PART III, LINE 8: THE 2020 COST REPORT WAS UTILIZED WITHIN THE COMPLETION OF SCHEDULE H. CARTHAGE AREA HOSPITAL HAS A REMOTE LOCATION. THE HOSPITAL OFFERS A FULL RANGE OF SERVICES FROM LAB WORK, IMAGING, EMERGENCY ROOM AND PRIMARY CARE DESPITE LOW UTILIZATION AT TIMES. SURPLUSES AND SHORTFALLS OCCUR DUE TO THE WIDE SPREAD OF SERVICES OFFERED WITH A LIMITED AMOUNT OF PATIENTS WITHIN THE REMOTE AREA. HOWEVER, THESE SERVICES ARE CONTINUALLY OFFERED TO PATIENTS INCREASING THE AVAILABILITY TO HEALTHCARE SERVICES. THE HOSPITAL OFFERS SERVICES TO MANY LOW INCOME PATIENTS AS WELL, WHOM OFTEN WOULD CHOOSE NOT TO OBTAIN ANY HEALTH INTERVENTION IF THEY WERE REQURED TO SPEND FUNDS TO TRAVEL TO CARE. PART III, LINE 9B: THE COLLECTION POLICY REFERS TO CHARITY CARE. THE POLICY STATES "ANY PATIENT RECEIVING SERVICES FOR WHICH THERE IS NO INSURANCE COVERAGE WILL BE REGISTERED AS SELF PAY AND ALL BALANCES WILL BE DUE FROM THE PATIENT EXCEPT CHARIY CARE ADJUSTMENTS AS DETERMINED BY THE FINANCIAL COUNSELOR IN ACCORDANCE WITH CARTHAGE AREA HOSPITAL'S CHARITY CARE POLICY." CARTHAGE AREA HOSPITAL'S COLLECTION POLICY DOES STATE HOW TO APPLY FOR FINANCIAL ASSISTANCE. THERE ARE NO PROVISIONS WRITTEN INTO THE COLLECTION POLICY FOR THOSE ACCOUNTS WHICH ARE DEEMED ELIGIBLE FOR FINANCIAL ASSISTANCE. CARTHAGE HAS NOT WRITTEN THIS INTO THE POLICY AS THOSE WHO RECEIVE FINANCIAL ASSISTANCE TYPICALLY DO NOT HAVE A BALANCE TO SEND TO COLLECTION AFTER THE FINANCIAL ASSISTANCE IS APPLIED. PART VI, LINE 2: CARTHAGE AREA HOSPITAL UTILIZES OTHER DATA SOURCES AS NECESSARY INCLUDING PATIENT SATISFACTION SURVEYS, COMMUNITY WORKSHOP EVALUATIONS, AND COMMUNITY EVENT SURVEYS. PART VI, LINE 3: THE HOSPITAL POSTS ITS CHARITY CARE POLICY INCLUDING CONTACT INFORMATION FOR THE FINANCIAL COUNSELOR IN THE ADMISSION AREA. ADDITIONALLY THIS INFORMATION CAN BE FOUND ON THE HOSPITAL'S WEBSITE. IF A PATIENT DOES NOT MEET WITH A FINANCIAL COUNSELOR ANOTHER HOSPITAL EMPLOYEE INFORMS THE PATIENT OF OTHER STATE AND FEDERAL ASSISTANCE OPTIONS. PART VI, LINE 4: THE HOSPITAL'S SERVICE AREA CONSISTS OF SOCIO-ECONOMICALLY RURAL DEPRIVED POPULATION WITHIN A LARGE GEOGRAPHIC REGION. THE REGION IS SERVED BY THREE HOSPITALS. DUE TO THE PROXIMITY OF FORT DRUM, THE NEEDS OF THE POPULATION ARE UNIQUE. THIS AREA IS MORE ETHNICALLY DIVERSE COMPARED TO OTHER COUNTIES IN THE REGION. WHILE FERTILITY AND BIRTH RATES ARE ABOVE AVERAGE DUE TO THE PROXIMITY TO THE MILITARY BASE, THE POVERTY RATE IS HIGH AND HAS CAUSED A LOWER MEDIAN INCOME THAN THE NATIONAL AVERAGE. THE GROWTH OF FORT DRUM AND RAPID NEEDS OF SOLDIERS WHEN THEY REDEPLOY HEAVILY IMPACTS THE UTILIZATION EXPERIENCED AT THE HOSPITAL. THEREFORE OFTEN SERVICE NEEDS REVOLVE AROUND THE ACTIVITY OF THE BASE AND THE HOSPITAL MAY EXPERIENCE TIMES OF SLOW UTILIZATION DESPITE CONTINUED COMMUNITY NEED FOR THAT SERIVCE. THESE FACTORS HAVE CREATED A REGION WHERE THE POPULATION IS OFTEN MEDICALLY INDIGENT. PART VI, LINE 5: CARTHAGE AREA HOSPITAL PROMOTED THE IMPORTANCE OF GOOD COMMUNITY HEALTH DURING SEVERAL EVENTS. HEALTHCARE PROVIDERS, PHYSICAL THERAPISTS AND REGISTERED DIETITIANS MADE THEMSELVES AVAILABLE DURING COMMUNITY EVENTS, SPOKE AT LOCAL EVENTS AND OUTREACH EVENTS ON THE HOSPITAL CAMPUS. EVENTS INCLUDED MEDICAL IMAGING OPEN HOUSE EVENT, HOLIDAY PARADE, COOKING CLASSES FOR CHILDREN AND CARE SEAT SAFETY CHECKS.OTHER ORGANIZATIONS THE HOSPITAL SUPPORTED WERE THE AMERICAN HEART ASSOCIATION, TOYS FOR TOTS, UNITED WAY, AND MARCH OF DIMES. THE HOSPITAL PARTICIPATED IN WALKS, FOOD DRIVES AND OTHER EVENTS THROUGHOUT THE YEAR, AN EVEN HELPED TO RAISE MONEY FOR THE UNITED WAY OF NORTHERN NEW YORK, AMERICAN HEART ASSOCIATION AND MARCH OF DIMES. X X X X X 0 0 0 0 0 0 0 0 0 MICHAEL GORDON CHIEF MEDICAL OFFICER 1208953 0 0 0 0 0 9750 0 12450 0 1231153 0 0 0 NATA PARNES MEDICAL STAFF REPRESENTATI 900226 0 0 0 0 0 9750 0 12450 0 922426 0 0 0 RICCARDO TURRIN PHYSICIAN 711866 0 0 0 0 0 9750 0 9837 0 731453 0 0 0 FELIX OBEN CLINICAL PROVIDER 703581 0 10000 0 0 0 0 0 2924 0 716505 0 0 0 ROB BLOOM CHIEF FINANCIAL OFFICER 436466 0 50850 0 0 0 8100 0 10611 0 506027 0 0 0 REBECCA TAN ALBERTO MD-ANESTHESIA 475353 0 0 0 0 0 9750 0 12450 0 497553 0 0 0 KINGSLEY MALCOLM CRNA 459845 0 0 0 0 0 9750 0 10299 0 479894 0 0 0 BRYAN VENERUS PHYSICIAN 417758 0 0 0 0 0 0 0 8898 0 426656 0 0 0 NATALIE BURNHAM CHIEF OPERATING OFFICER 176795 0 13990 0 0 0 9569 0 10293 0 210647 0 0 0 PART I, LINE 3 CARTHAGE AREA HOSPITAL'S COMPENSATION COMMITTEE BENCHMARKS SALARIES BY USING FORM 990 FROM OTHER NOT-FOR-PROFIT ORGANIZATIONS AS WELL AS SALARY REPORTS PROVIDED BY REGIONAL HOSPITAL-SPECIFIC VENDORS. KRISTEN BLOOM FAMILY MEMBER OF ROB BLOOM, OFFICER 41260 EMPLOYEE COMPENSATION 0 FORM 990, PART VI, SECTION A, LINE 3 THE HOSPITAL ENTERED INTO A LEASED EMPLOYEE AGREEMENT WITH CLAXTON-HEPBURN MEDICAL CENTER FOR SHARED SERVICES OF THE CHIEF EXECUTIVE OFFICER. FORM 990, PART VI, SECTION B, LINE 11B A COPY OF THE COMPLETED FORM 990 IS PROVIDED TO THE BOARD OF DIRECTORS FOR REVIEW. THE FORM 990 IS REVIEWED AND APPROVDED BY BOTH THE BOARD OF DIRECTORS AND THE CHIEF FINANCIAL OFFICER PRIOR TO BEING SUBMITTED. IN ADDITION, AN EMAIL IS SENT TO EACH BOARD MEMBER INFORMING THEM THAT THE ADMINISTRATION WILL PROVIDE A COPY OF THE FORM 990 UPON REQUEST. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS COMPLETE AN ANNUAL CONFLICT OF INTEREST DISCLOSURE FORM. THE AUDIT AND FINANCE COMMITTEE OVERSEES THE ANNUAL COMPLETION OF THE CONFLICT OF INTEREST DISCLOSURES. THE EXECUTIVE SECRETARY IS RESPONSIBLE FOR OBTAINING THE SIGNED AND COMPLETED FORMS, THE CHIEF COMPLIANCE OFFICER REVIEWS ALL DISCLOSURE FORMS. DURING A BOARD VOTE, WHEN A MEMBER IS CONFLICTED, THEY ARE ASKED TO LEAVE THE ROOM DURING VOTING. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION OF THE CHIEF EXECUTIVE OFFICER, OFFICERS, AND KEY EMPLOYEES IS REVIEWED AND APPROVED ANNUALLY BY THE BOARD, COMPENSATION COMMITTEE, AS WELL AS THE FINANCE COMMITTEE. THE COMPENSATION COMMITTEE USES BENCH-MARKING DATA PROVIDED BY FORM 990 OF OTHER NOT-FOR-PROFIT ORGANIZATIONS IN ITS REVIEW OF OFFICER COMPENSATION. TO PROVIDE AN ADDITIONAL LEVEL OF COMPENSATION REVIEW, THE FINANCE COMMITTEE ALSO REVIEWS COMPENSATION OVER $115,000 ANNUALLY. FORM 990, PART VI, SECTION C, LINE 19 THE HOSPITAL'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE PROVIDED UPON REQUEST. FORM 990, PART XI, LINE 9: PENSION RELATED CHANGES OTHER THAN NET PERIODIC PENSION COST 419,314. CARTHAGE AREA HOSPITAL FOUNDATION INC 3 BRIDGE STREET CARTHAGE NY 13619 161467023 FUNDRAISING NY 501(C)(3) LINE 7 CARTHAGE AREA HOSPITAL INC 1 MEADOWBROOK TERRACE INC 21957 COLE ROAD CARTHAGE NY 13619 454102458 ASSISTED LIVING NY 501(C)(3) LINE 10 CARTHAGE AREA HOSPITAL INC 1 COMPREHENSIVE WOMEN'S HEALTH SERVICES PLLC 622 WASHINGTON STREET WATERTOWN NY 13601 562394825 OBSTETRICS AND GYNECOLOGY NY CARTHAGE AREA HOSPITAL INC RELATED -1 382587 0 0 1.00000 0 0 1 1 0 0 0 0 0 0 0 1 1 1 1 0 1 0 0 COMPREHENSIVE WOMEN'S HEALTH SERVICES PLLC L 80020 COMPREHENSIVE WOMEN'S HEALTH SERVICES PLLC D 109175 MEADOWBROOK TERRACE INC D 598139