2020-08-17T11:07:08-05:00 2019-09-30 161226221 FUST CHARLES CHAMBERS LLP 5784 WIDEWATERS PARKWAY SYRACUSE NY 13214 990 2018-10-01 141338471 CHAMPLAIN VALLEY PHYSICIANS HOSPITAL MEDICAL CENTER CHAM 5185612000 75 BEEKMAN STREET PLATTSBURGH NY 12901 CHRISTOPHER HICKEY VICE PRESIDENT OF FINANCE 5185612000 2020-08-17 1 THOMAS J GIUFRE P00841958 3154463600 2020-08-17 45.47.55.42 2020-08-17 06:43:39 ED P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 6C6D92B252C939303AFEF40D396F39D1F437D1B1 2018 2020-09-23 17:36:50Z CHRISTOPHER HICKEY 75 BEEKMAN STREET PLATTSBURGH NY 12901 370724124 0 X WWW.CVPH.ORG X 1903 NY CVPH MEDICAL CENTER'S MISSION IS TO PROVIDE QUALITY HEALTH CARE FOR THE NORTH COUNTRY REGION IN UPSTATE NEW YORK. 13 13 2749 334 0 0 1970499 3689903 345657501 359656410 1817087 61023 6518782 6688906 355963869 370096242 0 0 0 0 218518693 230681100 0 0 0 143345874 142912956 361864567 373594056 -5900698 -3497814 217442781 225721877 158364583 189423030 59078198 36298847 X CVPH MEDICAL CENTER'S MISSION IS TO PROVIDE QUALITY HEALTHCARE FOR THE NORTH COUNTRY REGION IN UPSTATE NEW YORK. 0 0 275598144 366435550 CHAMPLAIN VALLEY PHYSICIANS HOSPITAL MEDICAL CENTER (CVPH)IS A 300 BED ACUTE CARE HOSPITAL AND 54 BED SKILLED NURSING FACILITY. CVPH PROVIDES COMPREHENSIVE MEDICAL AND SURGICAL SERVICES TO THE NORTHERN NEW YORK STATE REGION, REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE OR ABILITY TO PAY. DURING 2019, CVPH PROVIDED 66,350 PATIENT DAYS OF CARE TO ITS 9,631 ADMISSIONS, AND 44,807 EMERGENCY CARE CENTER VISITS. DURING THE YEAR, 18,134 SURGICAL PROCEDURES WERE PERFORMED. 753 BIRTHS OCCURRED IN CVPH FACILITIES. CVPH EMPLOYS MORE THAN 2,700 INDIVIDUALS. IN ADDITION, THE HOSPITAL HAS 179 MEMBERS OF ITS MEDICAL STAFF, 94% OF WHICH ARE BOARD CERTIFIED. THE HOSPITAL IS JOINT COMMISSION ACCREDITED AND LICENSED BY THE NEW YORK STATE DEPARTMENT OF HEALTH. IN ADDITION TO ITS MAIN CAMPUS, CVPH OPERATES SEVERAL OUTPATIENT FACILITIES WHERE SERVICES ARE PROVIDED TO ITS PATIENTS INCLUDING: AMBULATORY SURGERY, PHYSICAL AND OCCUPATIONAL THERAPY, REHABILITATION, RENAL DIALYSIS, AND DIAGNOSTIC IMAGING. CVPH ALSO OPERATES HEALTH CLINICS LOCATED IN OUTLYING GEOGRAPHIC AREAS, TO BETTER SERVE THE HEALTH NEEDS OF CVPH'S RURAL COMMUNITY SERVICE AREA. THROUGH ITS VARIOUS LOCATIONS, OUTREACH ACTIVITIES, AND SUPPORT GROUPS, CVPH IS ACTIVE IN THE COMMUNITY IN PROMOTING HEALTH AND WELLNESS OF THE BODY, MIND, AND SPIRIT. CVPH PROVIDES ONGOING MEDICAL EDUCATION TO ITS MEDICAL STAFF, IN ADDITION TO OFFERING AN X-RAY TECHNOLOGY PROGRAM FOR ENROLLED STUDENTS. CVPH MAINTAINS A COMPREHENSIVE MEDICAL LIBRARY AND HAVE MADE AVAILABLE WEB-BASED LINKS FOR THE COMMUNITY TO EASILY ACCESS HEALTH AND WELLNESS INFORMATION AND EDUCATIONAL MATERIALS. CVPH ACCEPTS NUMEROUS INSURANCE PLANS, AND IS MEDICARE AND MEDICAID APPROVED. ADDITIONALLY, CVPH HAS A CHARITY CARE POLICY TO ACCOMMODATE PATIENTS WHOSE FINANCIAL MEANS ARE WITHIN SPECIFIED GUIDELINES. 275598144 1 1 0 0 0 0 0 0 0 1 1 0 0 0 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 1 0 0 0 1 135 0 1 2749 1 0 0 0 0 0 0 0 0 0 0 0 0 X 13 13 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X CHRISTOPHER HICKEY VICE PRESIDENT 5185612000 75 BEEKMAN STREET PLATTSBURGH NY 12901 ROBERT BENAK MD EX-OFFICIO 1.00 X 0 0 0 JOHN BERNARDI CHAIR 1.00 X X 0 0 0 ALEXANDER EDWARDS TREASURER 1.00 X X 0 0 0 BETSY VINCENCIO VICE CHAIR 1.00 X X 0 0 0 DAVID ANDERSON MD BOARD MEMBER 1.00 X 0 0 0 JOANN GLEESON-KREIG PHD BOARD MEMBER 1.00 X 0 0 0 JOSEPH DONNERY DPM BOARD MEMBER 1.00 X 0 0 0 VICTORIA ZINSER DULEY SECRETARY 1.00 X X 0 0 0 PAOLO FEDI MD BOARD MEMBER 1.00 X 0 0 0 NEIL FESSETTE BOARD MEMBER 1.00 X 0 0 0 PAUL GRASSO BOARD MEMBER 1.00 X 0 0 0 VICKI MARKING BOARD MEMBER 1.00 X 0 0 0 THOMAS RECNY BOARD MEMBER 1.00 X 0 0 0 AMY SENECAL BOARD MEMBER 1.00 X 0 0 0 WOUTER RIETSEMAMD CHIEF QUALITY AND INFOR. 48.00 2.00 X 638918 0 45472 KENT HALL CHIEF MEDICAL OFFICER 48.00 2.00 X 698861 0 33361 MICHELLE LEBEAU PRESIDENT/COO 48.00 2.00 X 758620 0 39374 SCOTT ST GEORGE FORMER VICE PRESIDENT OF FINANCE 30.00 20.00 X 339582 0 11421 CHRISTOPHER HICKEY VICE PRESIDENT OF FINANCE 30.00 20.00 X 0 0 0 STEPHANE MULLIGAN ORTHOPEDIC SURGEON 45.00 X 124950 0 8893 CHARLES VOLK ORTHOPEDIC SURGEON 45.00 X 153652 0 7308 FRANKLIN BERTUCH ANESTHESIOLOGIST 40.00 X 331800 0 26872 VIVIAN MEJIAS ANESTHESIOLOGIST 40.00 X 260745 0 10708 LOIUS-PHILIPPE CHARETTE PHYSICIAN 40.00 X 253541 0 6375 STEPHENS MUNDY FORMER PRESIDENT/CEO 30.00 20.00 X 2254418 0 43625 5815087 0 233409 251 1 1 0 MAYO COLLABORATIVE SERVICES 200 FIRST STREET SOUTHWEST ROCHESTER MN 55905 LABORATORY 1110971 E4H - ENVIRONMENTS FOR HEALTH 185 TOLCOTT RD WILLISTON VT 05495 ARCHITECTURAL SERVICES 440094 HUDSON HEADWATERS HEALTH NETWORK 9 CAREY RD QUEENSBURY NY 12804 THIRD PARTY ADMINISTRATOR 369177 NIXON PEABODY LLP PO BOX 28012 NEW YORK NY 100878012 LEGAL 296866 SUNY PLATTSBURGH SPEECH AND HEARING 101 BROAD STREET PLATTSBURGH NY 12901 SPEECH PATHOLOGY 210414 21 200000 3489903 3689903 NET PATIENT SERVICE REVENUE 621990 347556182 347556182 340B REVENUE 611430 10467400 10467400 LABORATORY DIAGNOSTIC & CLINICAL 621500 797506 797506 BLOOD BANK 621500 566728 566728 DIALYSIS 621500 268594 268594 359656410 40296 40296 44374 134608 -90234 -90234 -90234 514001 493274 20727 20727 20727 CAFETERIA SALES 900099 1760998 1760998 WELLNESS CENTER 900099 889250 889250 MED SURG SUPPLIES 900099 173211 173211 3955681 3955681 6779140 370096242 366435550 0 -29211 2565610 2047419 518191 173079997 136808901 36271096 12497533 10997829 1499704 31887441 30016771 1870670 10650519 10650519 12479250 12088377 390873 654539 654539 236110 236110 12545 12545 17409201 6131710 11277491 594799 88668 506131 602645 437129 165516 1944887 1186495 758392 1173345 654819 518526 2370067 2370067 15438138 15438138 3190930 3190930 SUPPLIES 58097657 56625341 1472316 BAD DEBTS 8599644 8599644 MAINTENANCE & REPAIRS 7570161 4536132 3034029 UTILITIES 2249694 265101 1984593 10289344 5113808 5175536 373594056 275598144 97995912 0 4867229 2540774 42888793 50304741 6245337 6864715 1736663 2892542 211720955 106607210 102821564 105113745 50267182 49842413 8616013 8162947 217442781 225721877 24246773 29165602 29470000 27975308 25393152 29892985 79254658 102389135 158364583 189423030 X 55815361 33105335 1918894 1849569 1343943 1343943 59078198 36298847 217442781 225721877 X -3497814 14120 -19295657 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 37078542 1095690 2237948 4084 35932200 34780589 2271004 33273 6324 37078542 33237051 3475138 1931600 34780589 30409963 2998228 108488 62652 33237051 30540658 722012 -760034 92673 30409963 0.91110 0.03740 0.05150 0 1 1 3280000 3280000 89293780 35021979 54271801 2933678 1019914 1913764 106801450 69039816 37761634 9412047 1525501 7886546 105113745 DEFERRED COMPENSATION PLAN 6017119 ACCRUED PENSION COSTS 54061290 DUE TO RELATED PARTIES 23837492 SWAP AGREEMENT LIABILITY 9567661 L-T COMPENSATION RELATED 5939156 ESTIMATED THIRD PARTY SETTLEMENTS 2792500 OTHER LIABILITIES 173917 102389135 X PART V, LINE 4: CERTAIN BOARD-DESIGNATED FUNDS HAVE BEEN ESTABLISHED TO MEET SPECIFIC CURRENT AND FUTURE NEEDS OF THE HOSPITAL OR TO ADEQUATELY DISCHARGE FUTURE LIABILITES. THESE FUNDS INCLUDE THE PLANT AND CAPITAL IMPROVEMENT FUNDS, WHICH ARE DESIGNATED FOR SPECIFIC PROJECTS SUCH AS THE SURGICAL CENTER CONSTRUCTION, AND DESIGNATED FUNDS FOR BOTH SELF-INSURANCE AND FOR CVPH'S VARIOUS EMPLOYEE BENEFIT PLANS. TEMPORARILY RESTRICTED NET ASSETS ARE INTENDED FOR THE PURCHASE OF PROPERTY AND EQUIPMENT. PERMANENTLY RESTRICTED NET ASSETS ARE TO BE HELD IN PERPETUITY, THE INCOME FROM WHICH IS EXPENDABLE TO SUPPORT HEALTH CARE SERVICES, INCLUDING MEDICAL SERVICES PROVIDED TO CHILDREN, AND PROVIDING FOR CHARITY CARE. PART X, LINE 2: THE SYSTEM IS INCORPORATED AND RECOGNIZED BY THE INTERNAL REVENUE SERVICE ("IRS") AS TAX-EXEMPT UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE "CODE"). ACCORDINGLY, THE IRS HAS DETERMINED THAT THE SYSTEM IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. AS OF SEPTEMBER 30, 2019 AND 2018, NO PROVISION FOR FEDERAL INCOME TAXES HAS BEEN RECORDED IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS FOR THE SYSTEM. THE SYSTEM ACCOUNTS FOR RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS IN ACCORDANCE WITH ACCOUNTING STANDARDS CODIFICATION (ASC) 740 INCOME TAXES, WHICH ADDRESSES HOW TO ACCOUNT FOR AND REPORT THE EFFECTS OF TAXES BASED ON INCOME. NO PROVISION FOR UNCERTAIN TAX POSITIONS IS RECORDED IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. THE TAX YEARS OPEN TO EXAMINATION BY FEDERAL AND STATE TAXING AUTHORITIES ARE 2016 THROUGH 2019. 1 1 1 X 1 X 1 1 0 1 1 1203965 0 1203965 0.00330 53350635 25247145 28103490 0.07700 54554600 25247145 29307455 0.08030 5033075 2952380 2080695 0.00570 2415442 0 2415442 0.00660 36302707 20157046 16145661 0.04420 43751224 23109426 20641798 0.05650 98305824 48356571 49949253 0.13680 1 3008155 1203262 98113771 117733631 -19619860 X 1 1 1 PET SCAN LLC IMAGING SERVICES 0.49000 0.00000 0.51000 1 1 CHAMPLAIN VALLEY PHYSICIANS HOSPITAL MED 75 BEEKMAN ST PLATTSBURGH NY 12901 X X X X CHAMPLAIN VALLEY PHYSICIANS HOSPITAL MED 1 0 0 1 X X X X X X X X X 18 1 1 1 1 X HTTPS://WWW.CVPH.ORG/DATA/FILES/CHNA%20FILES/CHA-COMPRESSED%2012%2030%2019. X HTTP://WWW.CLINTONHEALTH.ORG/PDF%20FILES/CHA.PDF X 1 18 1 HTTPS://WWW.CVPH.ORG/DATA/FILES/CHNA%20FILES/CSP-COMPRESSED%2012%2030%2019. 0 1 X 150.000000000000 400.000000000000 1 1 X X X X 1 X HTTP://WWW.CVPH.ORG X HTTP://WWW.CVPH.ORG X HTTP://WWW.CVPH.ORG X X X X X X 1 X 0 X X X X 1 X 0 0 CHAMPLAIN VALLEY PHYSICIANS HOSPITAL MED PART V, SECTION B, LINE 5: TO REACH THIS CONCLUSION, THE UNIVERSITY OF VERMONT HEALTH NETWORK- CHAMPLAIN VALLEY PHYSICIANS HOSPITAL (CVPH) AND CLINTON COUNTY HEALTH DEPARTMENT (CCHD), LEAD ENTITIES IN THE PROCESS, FACILITATED/ COMPLETED THE FOLLOWING ACTIVITIES WITH THE CLINTON COUNTY COMMUNITY: TWO COMMUNITY BASED, HEALTH FOCUSED SURVEYS; A REVIEW OF OVER 300 HEALTH INDICATORS AND A SECONDARY DATA ANALYSIS; A COMMUNITY HEALTH PRIORITY SETTING SESSION; A PRIORITY AND FOCUS AREA FINALIZATION PROCESS; AND CREATION OF SHARED ACTION PLANS.HEALTH INDICATORS FROM SCORES OF RESOURCES WERE CONSIDERED IN THE PROCESS, INCLUDING DATA FROM THE NYS PREVENTION AGENDA DASHBOARD, COMMUNITY HEALTH INDICATOR REPORTS, NYS OFFICE OF MENTAL HEALTH, DIVISION OF CRIMINAL JUSTICE SERVICES, NYS EXPANDED BEHAVIORAL RISK FACTOR SURVEY, USDA ECONOMIC RESEARCH SERVICE, AMERICAN COMMUNITY SURVEY, HEALTH RESOURCES AND SERVICES ADMINISTRATION, CENTER FOR HEALTH WORKFORCE STUDIES AND OTHERS. LOCALLY GENERATED AND/ OR COLLECTED DATA WERE ALSO CONSIDERED, WHEN AVAILABLE. PRIMARY DATA INCLUDED FEEDBACK FROM RESIDENT SURVEYS RELATED TO HEALTH, SOCIAL AND ENVIRONMENTAL CONCERNS AS WELL AS QUALITATIVE PROGRAM DATA FROM VARIOUS COMMUNITY BASED ORGANIZATIONS AND CCHD. PARTICIPATION IN HEALTH PRIORITY SELECTION REPRESENTED AT LEAST ELEVEN DISTINCT COMMUNITY SECTORS INCLUDING HEALTHCARE (CLINICAL, POPULATION AND PUBLIC HEALTH), BUSINESS, COMMUNITY BASED ORGANIZATION/SERVICE, HOUSING, HUMAN SERVICES, AND MENTAL/BEHAVIORAL HEALTH. THESE VERY PARTNERS CONTRIBUTE ACTIVITIES AND RESOURCES TO CREATE LOCAL ACTION PLANS. THE RESULTING ACTION PLANS FEATURE IN-PROGRESS AND PLANNED WORK RELATED TO THE SELECTED HEALTH PRIORITIES AND INTENDED TO ALTER HEALTH OUTCOMES FOR THE BETTER OF ALL RESIDENTS. FEATURED INTERVENTIONS REFLECT A RANGE OF ACTIVITIES AND APPROACHES THAT FALL ACROSS THE HEALTH IMPACT PYRAMID AND INCLUDE SERVICE INFRASTRUCTURE, PROGRAM DEVELOPMENT, EDUCATION AND CROSS-SECTOR COLLABORATIONS. CHAMPLAIN VALLEY PHYSICIANS HOSPITAL MED PART V, SECTION B, LINE 6A: CVPH IS PART OF THE ADIRONDACK RURAL HEALTH NETWORK. ADIRONDACK RURAL HEALTH NETWORK: THE ADIRONDACK RURAL HEALTH NETWORK (ARHN) IS A PROGRAM OF THE ADIRONDACK HEALTH INSTITUTE, INC. (AHI). AHI IS A JOINT VENTURE OF ADIRONDACK HEALTH (ADIRONDACK MEDICAL CENTER), UNIVERSITY OF VERMONT HEALTH NETWORK - CHAMPLAIN VALLEY PHYSICIANS HOSPITAL, GLENS FALLS HOSPITAL AND HUDSON HEADWATERS HEALTH NETWORK. THE MISSION OF AHI IS TO PROMOTE, SPONSOR, AND COORDINATE INITIATIVES AND PROGRAMS THAT IMPROVE HEALTHCARE QUALITY, ACCESS, AND SERVICE DELIVERY IN THE ADIRONDACK REGION.THE ADIRONDACK RURAL HEALTH NETWORK (ARHN) PROVIDES A FORUM FOR LOCAL PUBLIC HEALTH SERVICES, COMMUNITY HEALTH CENTERS, HOSPITALS, COMMUNITY MENTAL HEALTH PROGRAMS, EMERGENCY MEDICAL SERVICES, AND OTHER COMMUNITY-BASED ORGANIZATIONS TO ADDRESS RURAL HEALTHCARE DELIVERY BARRIERS, IDENTIFY REGIONAL HEALTH NEEDS AND SUPPORT THE NYS PREVENTION AGENDA TO IMPROVE HEALTH CARE IN THE REGION. THE ARHN REGION INCLUDES NEW YORK'S CLINTON, ESSEX, FRANKLIN, FULTON, HAMILTON, WARREN, AND WASHINGTON COUNTIES.SINCE 2002, ARHN HAS BEEN RECOGNIZED AS THE LEADING SPONSOR OF FORMAL COMMUNITY HEALTH PLANNING IN THE REGION WORKING WITH SEVERAL LOCAL HEALTH DEPARTMENTS. THE COMMUNITY HEALTH ASSESSMENT (CHA) COMMITTEE, FACILITATED BY ARHN, IS MADE UP OF HOSPITALS AND COUNTY HEALTH DEPARTMENTS WORKING TOGETHER UTILIZING A SYSTEMATIC APPROACH TO COMMUNITY HEALTH PLANNING. THE CHA COMMITTEE IS MADE UP OF MEMBERS FROM ADIRONDACK HEALTH, ALICE HYDE MEDICAL CENTER, ELIZABETHTOWN COMMUNITY HOSPITAL, ESSEX COUNTY PUBLIC HEALTH, FRANKLIN COUNTY PUBLIC HEALTH, FULTON COUNTY PUBLIC HEALTH, GLENS FALLS HOSPITAL, HAMILTON COUNTY PUBLIC HEALTH SERVICES, MOSES LUDINGTON HOSPITAL & INTER-LAKES HEALTH, NATHAN LITTAUER HOSPITAL, UVM HEALTH NETWORK - CVPH, WARREN COUNTY HEALTH SERVICES, AND WASHINGTON COUNTY PUBLIC HEALTH SERVICES. CHAMPLAIN VALLEY PHYSICIANS HOSPITAL MED PART V, SECTION B, LINE 6B: THE CHNA IS A JOINT EFFORT WITH THE CLINTON COUNTY HEALTH DEPARTMENT. IN ADDITION, CLINTON COUNTY ACTION FOR HEALTH CONSORTIUM IS A KEY PART OF THE PROCESS, AND THEIR PURPOSE IS DESCRIBED BELOW.CLINTON COUNTY ACTION FOR HEALTH CONSORTIUM: THE CLINTON COUNTY ACTION FOR HEALTH (AFH) CONSORTIUM IS A MULTI-SECTOR, MULTI-DISCIPLINARY COLLECTION OF LOCAL HEALTH SYSTEM PARTNERS WORKING TOWARDS COMMUNITY HEALTH IMPROVEMENT AND FACILITATED BY CCHD. THE PRIMARY WORK OF THE GROUP HAS BEEN BUILT AROUND DATA DRIVEN IDENTIFIED NEEDS (NYS PREVENTION AGENDA) AND AVAILABLE COMMUNITY RESOURCES. PARTNERS IN THE EFFORT INCLUDE: MUNICIPALITIES, BUSINESSES, GRASSROOTS COMMUNITY GROUPS, HEALTH CARE PROVIDERS, THE LOCAL HOSPITAL, CHAMBER OF COMMERCE, HUMAN SERVICE AGENCIES, SCHOOLS AND LOCAL NOT-FOR-PROFITS. THE GROUP HAS EXISTED FOR OVER A DECADE AND PRESENTLY HAS APPROXIMATELY FORTY MEMBERS THAT HAVE FORMALLY COMMITTED TO ITS PURPOSE BY SIGNING AFH PARTNERSHIP LETTERS. RECRUITMENT OF NEW MEMBERS IS ONGOING. THE AFH CONSORTIUM HAS INCREASED COMMUNITY OWNERSHIP AND COMMITMENT TO THE SHARED HEALTH IMPROVEMENT GOALS AND TO THE WORK CAPTURED IN THE CHIP. IN FACILITATING THESE EFFORTS, THE CCHD HAS STRENGTHENED ITS ABILITY TO LEVERAGE RESOURCES FROM PUBLIC HEALTH PARTNERS AND PRIVATE ENTITIES ALIKE. SIGNIFICANT PROGRESS ON THE COUNTY'S CHIP HAS BEEN MADE CAPITALIZING ON THIS SYSTEM OF PARTNERSHIP CREATED THROUGH THE CONSORTIUM. THE AFH CONSORTIUM MEETS PERIODICALLY FOR UPDATES, ISSUE DISCUSSION, AND INFORMATION SHARING. A MINIMUM OF SIX MEETING ARE SCHEDULED EACH YEAR, WITH ADDITIONAL GATHERINGS SCHEDULED AS NEEDED. SUBCOMMITTEES OF MEMBERS WITH EXPERTISE RELATED TO SELECTED PRIORITY AREAS MEET MORE FREQUENTLY AND KEEP THE GROUP APPRISED OF THEIR WORK. CCHD TRACKS PROGRESS ON THE CHIP CONTINUALLY AND PREPARES A YEAR-END REPORT WHICH INCLUDES UPDATES ON WORK RELATED TO THE TWO FEATURED PRIORITY AREAS AND A SUMMARY OF ACCOMPLISHMENTS BY LOCAL PARTNERS RELATED TO EACH OF THE NYSDOH PREVENTION PLAN PRIORITY AREAS. CAPTURED ACTIVITIES DEMONSTRATE WORK ON ALL TIERS OF THE PUBLIC HEALTH IMPACT PYRAMID. MORE INFORMATION ON THE PUBLIC HEALTH PYRAMID IS INCLUDED IN THE COMMUNITY HEALTH IMPROVEMENT PLAN.CVPH IS PART OF THE ADIRONDACK RURAL HEALTH NETWORK (ARHN). ARHN IS A PROGRAM OF THE ADIRONDACK HEALTH INSTITUTE, INC. (AHI). AHI IS A JOINT VENTURE OF ADIRONDACK MEDICAL CENTER, UVMHN-CVPH, GLENS FALLS HOSPITAL, AND HUDSON HEADWATERS HEALTH NETWORK. THE MISSION OF AHI IS TO PROMOTE, SPONSOR, AND COORDINATE INITIATIVES AND PROGRAMS THAT IMPROVE HEALTHCARE QUALITY, ACCESS, AND SERVICE DELIVERY IN THE ADIRONDACK REGION. ARHN PROVIDES A FORUM FOR LOCAL PUBLIC HEALTH SERVICES, COMMUNITY HEALTH CENTERS, COMMUNITY MENTAL HEALTH PROGRAMS, EMERGENCY MEDICAL SERVICES, AND OTHER COMMUNITY-BASED ORGANIZATIONS TO ADDRESS RURAL HEALTHCARE DELIVERY BARRIERS, IDENTIFY REGIONAL HEALTH NEEDS AND SUPPORT THE NYS PREVENTION AGENDA TO IMPROVE CARE IN THE REGION. THE ARHN REGION INCLUDES NEW YORK'S CLINTON, ESSEX, FRANKLIN, FULTON, HAMILTON, WARREN, AND WASHINGTON COUNTIES. CLINTON COUNTY HEALTH DEPARTMENT (ALONG WITH OTHER COUNTIES) PLAYS AN ACTIVE ROLE IN ARHN AS WELL. CHAMPLAIN VALLEY PHYSICIANS HOSPITAL MED PART V, SECTION B, LINE 11: THE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY WERE IDENTIFIED AS FOLLOWS, MODELED AFTER THE NEW YORK STATE PREVENTION AGENDA:1. PREVENT CHRONIC DISEASESA. FOCUS AREA 1: HEALTHY EATING AND FOOD SECURITYB. FOCUS AREA 3: TOBACCO PREVENTIONC. FOCUS AREA 4: CHRONIC DISEASE PREVENTIVE CARE AND MANAGEMENT2. PROMOTE WELL-BEING AND PREVENT MENTAL AND SUBSTANCE USE DISORDERSA. FOCUS AREA 1: WELL-BEINGB. FOCUS AREA 2: MENTAL AND SUBSTANCE USE DISORDERS AND PREVENTION3. DISPARITY TO FOCUS ON: LOW INCOME POPULATION 8 1 - CVPH AMBULATORY SURGERY CENTER 77 PLAZA BLVD PLATTSBURGH NY 12901 AMBULATORY SURGERY 3 - CVPH DIAGNOSTIC CENTER 89 PLAZA BLVD PLATTSBURGH NY 12901 LAB & IMAGING SERVICES 4 - CVPH REHABILITATION - DEGRANDPRE WAY 16 DEGRANDPRE WAY PLATTSBURGH NY 12901 PHYSICAL THERAPY 5 - CVPH REHABILITATION - TOM MILLER RD TOM MILLER RD PLATTSBURGH NY 12901 PHYSICAL THERAPY 6 - NORTH COUNTRY REGIONAL BLOOD DONOR CENTE 85 PLAZA BOULEVARD PLATTSBURGH NY 12901 BLOOD DONATION CENTER 7 - CVPH SPORTS MEDICAL AND REHABILITATION 295 NEW YORK RD PLATTSBURGH NY 12901 PHYSICAL AND OCCUPATIONAL THERAPY, EXERCISE AND WELLNESS 8 - FAMILY MEDICINE CENTER 159 MARGARET STREET SUITE 100 PLATTSBURGH NY 12901 PRIMARY CARE 9 - MOBILE HEALTH SCREENING VAN 75 BEEKMAN ST PLATTSBURGH NY 12901 LAB AND DIAGNOSTIC IMAGING PART I, LINE 7: IN ACCORDANCE WITH THE IRS INSTRUCTIONS, CVPH USED THE RATIO OF COST TO CHARGES TO CALCULATE COSTS. SPECIFICALLY, THE FACILITY'S TOTAL EXPENSES FROM PART IX LINE 25 OF $373,594,056 LESS COMMUNITY BENEFIT EXPENSES OF $5,033,075 WAS USED TO DETERMINE THE 2019 RCC PERCENTAGE. THE GROSS CHARITY CARE WRITE OFFS WAS OBTAINED FROM OUR REVENUE REPORTS AND TO WHICH THE CALCULATED RCC APPLIED. LINE 7(E): CLINTON COUNTY NY IS DESIGNATED AS A HEALTHCARE PROFESSIONAL SHORTAGE AREA (HPSA) FOR PRIMARY CARE. TO HELP ALLEVIATE THE LACK OF ACCESS TO PRIMARY CARE IN THE COUNTY AND SURROUNDING AREA, CVPH HAS BEEN OPERATING A HEALTH CENTER CLINIC TO PROVIDE MEDICAL TREATMENT FOR THIS AT RISK POPULATION. DURING 2019, THE CLINIC HAD IN EXCESS OF 20,000 PATIENT ENCOUNTERS WITH A PAYER MIX OF 81% MEDICAID AND MEDICARE, 16% COMMERCIAL, 1% SELF PAY AND 2% OTHER. PART 1 LINE 7, COLUMN F: AMOUNT OF BAD DEBT EXPENSE INCLUDED IN FORM 990 PART IX LINE 25 COLUMN (A), BUT REMOVED FROM THIS FIGURE FOR PURPOSES OF CALCULATING THE RCC PERCENTAGE WAS $8,599,644 AS REFLECTED ON PART IX LINE 24(B) PART I, LN 7 COL(F): AMOUNT OF BAD DEBT EXPENSE INCLUDED IN FORM 990 PART IX LINE 25 COLUMN (A), BUT REMOVED FROM THIS FIGURE FOR PURPOSES OF CALCULATING THE RCC PERCENTAGE WAS $3,008,155 AS REFLECTED ON PART IX LINE 24(E)PART III, LINE 3:IN ACCORDANCE WITH IRS 990 INSTRUCTIONS, CVPH APPLIED THE CALCULATED RATIO OF COST TO CHARGES TO THE FACILITY'S 2019 BAD DEBT EXPENSE OF $8,599,644 IN ORDER TO CALCULATE THE BAD DEBT EXPENSE (AT COST) AS REPORTED ON PART III LINE 2. THE RCC USED WAS 34.98%. THEREFORE, THE BAD DEBT EXPENSE (AT COST) FOR 2019 WAS $3,008,155. WE ATTRIBUTE APPROXIMATELY 40% OF THIS AMOUNT TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY, CAUSING THE PORTION OF BAD DEBT AS A COMMUNITY BENEFIT TO BE $1,203,262. PART III, LINE 4: THE BAD DEBT EXPENSE FOOTNOTE IS DISCLOSED IN ATTACHED AUDITED FINANCIAL STATEMENTS ON PAGE 14. PART III, LINE 8: USED MEDICARE ONLY TOTAL CHARGES FROM INSTITUTIONAL COST REPORT FOR 2019 AND APPLIED THE RATIO OF COST TO CHARGES FROM THE 2019 COST REPORT DATA. APPROXIMATELY 44% OF OUR REVENUE IS DERIVED FROM MEDICARE PATIENTS. WE FEEL THE SHORTFALL FROM THIS PROGRAM IS DIRECTLY A COMMUNITY BENEFIT IN THAT WE ARE A SOLE COMMUNITY HOSPITAL. PART III, LINE 9B: CVPH HAS A FORMAL CREDIT AND COLLECTION POLICY. ALL PATIENT ACCOUNTS WILL BE BILLED AND FOLLOWED UP ON IN A TIMELY FASHION. ALL DISCOUNTS WILL BE APPLIED AND OFFERED PER POLICY, UNIFORMLY AND WITHOUT PREJUDICE OR DISCRIMINATION. THE POLICY CONSISTS OF DOCUMENTED PROCEDURES FOR INSURANCE, CREDIT BALANCES, SELF PAY OUTPATIENT, AND SELF PAY INPATIENT (NO INSURANCE & AFTER INSURANCE). THERE ARE SPECIFIED PAYMENT ARRANGEMENTS THAT ARE OFFERED AND THE TIME FRAME ALLOTTED FOR REPAYMENT IS GRADUATED BASED ON THE AMOUNT OWED, RANGING FROM 30 DAYS TO 36 MONTHS. CUSTOMER SERVICE REPRESENTATIVES PLACE PHONE CALLS TO PATIENTS TO RESOLVE ACCOUNTS OR ESTABLISH PAYMENT ARRANGEMENTS. AFTER ACCOUNTS HAVE BEEN AT THE PRIMARY BAD DEBT AGENCY FOR A PERIOD OF 6 MONTHS WITHOUT PAYMENTS, THE ACCOUNTS ARE FORWARDED TO A SECOND PLACEMENT AGENCY FOR ATTEMPTED RECOVERY. PART VI, LINE 2: CVPH WORKS COLLABORATIVELY TO ASSESS HEALTH NEEDS AND THEN IMPLEMENT STRATEGIES TO ADDRESS THE HEALTH PRIORITIES OF THE COMMUNITY IT SERVES. CVPH HAS WORKED WITH OTHER HOSPITALS, HEALTH DEPARTMENTS, AND AGENCIES IN CLINTON, ESSEX, AND FRANKLIN COUNTIES THROUGH PARTICIPATION IN THE MAPPING OUR WAY TO A HEALTHIER COMMUNITY PROCESS WHICH IS COORDINATED BY THE NEW YORK STATE DEPARTMENT OF HEALTH. THE GOAL OF THIS GROUP IS TO ANALYZE DATA AND SEEK OPINIONS FROM THE PUBLIC TO DETERMINE THE MAJOR CHALLENGES, NEEDS AND BARRIERS TO PROVIDING SERVICES. BY BRINGING THE VARIOUS PROVIDERS TOGETHER FROM A THREE-COUNTY AREA, IT IS BELIEVED THAT THIS PROVIDES A BROADER, MORE REPRESENTATIVE DETERMINATION OF THE NEEDS THAT EXIST. A FOUR-STEP PROCESS IS USED TO ESTABLISH PRIORITIES AS PART OF THE FORMALIZED COMMUNITY HEALTH ASSESSMENT. DATA IS COMPILED AND ANALYZED, PRIORITIES ARE DETERMINED, FOCUS GROUPS SEEK CONSENSUS AND REPORT OUT, DATA IS FURTHER WEIGHTED AND A FINAL SELECTION OF PRIORITIES FOCUSING ON ACCESS TO CARE AND THE NEED TO DIRECT RESOURCES TO TREATMENT OF CHRONIC DISEASE WERE ADOPTED AS KEY NEEDS. TO THAT END, CVPH HAS DIRECTED RESOURCES TO SUPPORT OF THE ADIRONDACK REGION MEDICAL HOME, PHYSICIAN RECRUITMENT, ITS DIABETES EDUCATION CENTER AND COMMUNITY EFFORT RELATED TO THE IMPORTANCE OF PROPER NUTRITION AND EXERCISE. WORKING INDEPENDENTLY, CVPH ASSESSES NEEDS BY ENCOURAGING AN OPEN DIALOGUE WITH ITS VARIOUS COMMUNITY CONSTITUENCIES. THE MEDICAL CENTER HOSTS MEETINGS, VISITS CLUBS AND ORGANIZATIONS, SURVEYS ITS PATIENTS, ENCOURAGES FEEDBACK THROUGH ITS WEB SITE AND INVITES FORMER PATIENTS FOR LUNCH AND TO SHARE OBSERVATIONS ABOUT UNMET NEEDS AND WAYS TO IMPROVE SERVICES WITH EMPHASIS ON FILLING EXISTING GAPS IN SERVICE. AS PART OF ITS STRATEGIC PLANNING PROCESS A COORDINATED AND FORMALIZED APPROACH IS TAKEN TO ASSESS PERCEIVED NEEDS FROM THE COMMUNITY, MEDICAL STAFF, EMPLOYEES AND BOARD MEMBERS UTILIZING FULL AND HALF- DAY MEETING SESSIONS.CVPH IS A VOLUNTARY, NOT-FOR-PROFIT, ARTICLE 28 ORGANIZATION THAT IS GOVERNED BY A VOLUNTARY BOARD OF DIRECTORS AND IS LICENSED FOR 300 BEDS. CVPH IS LOCATED AT 75 BEEKMAN STREET IN PLATTSBURGH, NEW YORK WITH SATELLITE SERVICES AT A NUMBER OF OTHER AUTHORIZED LOCATIONS WITHIN THE PLATTSBURGH AREA. CVPH IS PART OF THE UNIVERSITY OF VERMONT HEALTH NETWORK, WHICH IS COMPRISED OF SIX HOSPITALS, A HOME HEALTH AND HOSPICE AGENCY, AND AN EMPLOYED MEDICAL GROUP. IT IS AFFILIATED WITH AN ACADEMIC MEDICAL CENTER IN BURLINGTON, VERMONT. CVPH OFFERS A VARIETY OF SERVICES INCLUDING CARDIOVASCULAR, ORTHOPEDICS, OBSTETRICS, PSYCHIATRY, LONG TERM CARE, AND PRIMARY CARE. IT HAS A FAMILY MEDICINE RESIDENCY PROGRAM TO HELP ADDRESS PRIMARY CARE SHORTAGES IN THE COMMUNITY. CVPH PROVIDES CANCER SERVICES THROUGH THE FITZPATRICK CANCER CENTER. IN ADDITION, CVPH HAS A ROBUST MEDICAL HOME AS WELL AS THE ADIRONDACK REGION ACO WHICH ARE KEY PARTNERS IN ADDRESSING COMMUNITY HEALTH NEEDS. PART VI, LINE 3: THE FOLLOWING INFORMATION IS LISTED ON EVERY PATIENT STATEMENT: "FINANCIAL AID MAY BE AVAILABLE TO QUALIFIED PATIENTS. PLEASE CALL OUR OFFICE AT 562-7074 TO SEE IF YOU QUALIFY." WE ALSO HAVE INFORMATIONAL FLYERS AT THE CASHIERS DESK AND SEVERAL OTHER AREAS IN THE HOSPITAL. AT TIME OF REGISTRATION FOR EVERY SELF PAY PATIENT, WE ASK PERMISSION TO HAVE THE PATIENT CONTACTED TO SEE IF THEY QUALIFY FOR MEDICAID. ALSO WHEN MAKING A CALL TO COLLECT ON PATIENT ACCOUNTS, THE PATIENT IS OFFERED TO TAKE PART IN CVPH'S CARES PROGRAM WHERE APPROPRIATE TO DO SO. PART VI, LINE 4: THE PRIMARY SERVICE AREA FOR CVPH IS DEFINED AS CLINTON COUNTY. CVPH'S SECONDARY SERVICE AREA FOR TERTIARY SERVICES NOT AVAILABLE IN THOSE COMMUNITIES ARE ESSEX, FRANKLIN, AND EASTERN ST. LAWRENCE COUNTIES. THE DEMOGRAPHIC CHARACTERISTICS AND HEALTH NEEDS OF THESE COUNTIES REFLECT THOSE IN CLINTON COUNTY. OUR PAYER MIX CONSINSTS OF APPROXIMATELY 53% MEDICARE AND MEDICAID PROGRAMS. CVPH IS THE ONLY HOSPITAL IN CLINTON COUNTY. CLINTON COUNTY'S POPULATION IS 81,224. SIMILAR TO THE REST OF UPSTATE NEW YORK, CLINTON COUNTY'S POPULATION IS LIMITED IN ITS ETHNIC AND RACIAL DIVERSITY; OVER 90% OF RESIDENTS ARE WHITE/NON-HISPANICS, FOLLOWED BY 4.2% BLACK/AFRICAN AMERICAN, NON-HISPANICS AND 2.8% HISPANIC/LATINOS. WHILE THERE ARE NO SIGNIFICANT HEALTH DISPARITIES BASED ON RACE AND ETHNICITY IN CLINTON COUNTY, THERE ARE ACCESS TO CARE ISSUES. IN FACT, IN A RECENT RESIDENT SURVEY, OVER HALF OF THE RESPONDENTS (50.3%) REPORTED EXPERIENCING AT LEAST ONE BARRIER TO MEDICAL CARE FOR THEMSELVES OR THEIR FAMILY IN THE PAST YEAR. THE MOST COMMONLY REPORTED BARRIERS, IDENTIFIED BY ALMOST 1 IN 3 RESPONDENTS, INCLUDED: NOT HAVING DENTAL OR VISION INSURANCE (32.8%), CO-PAYS OR DEDUCTIBLES THAT WERE TOO HIGH (31.9%), NO SPECIALIST WAS AVAILABLE LOCALLY (30.4%) AND COULD NOT AFFORD (29.9%). THE PERCENTAGE OF ADULTS WITH HEALTH INSURANCE IN CLINTON COUNTY IS AT 94.0%, WITH 88.5% OF THE POPULATION HAVING A REGULAR HEALTH CARE PROVIDER. THE RATE OF AGE-ADJUSTED PREVENTABLE HOSPITALIZATIONS PER 10,000 POPULATION AMONG THOSE 18 YEARS OF AGE AND OLDER (129.5) IS HIGHER THAN THE RATE FOR UPSTATE NEW YORK (116.8), AND THE PREVENTION AGENDA BENCHMARK (122.0) RATE. THE RATE OF ED VISITS PER 10,000 POPULATION IN CLINTON COUNTY (5164.5) IS HIGHER THAN THE ARHN REGION (4,866.3) AND SIGNIFICANTLY HIGHER THAN UPSTATE NEW YORK (3,865.6). OVER 16% OF THE POPULATION IS 65 YEARS OF AGE AND OLDER. THE PERCENTAGE OF ADULTS 18 YEARS OF AGE AND OLDER IN CLINTON COUNTY WITH A DISABILITY (25.7%) IS HIGHER THAN THE ARHN REGION (25.6%), UPSTATE NEW YORK (22.8%), AND THE STATE AS A WHOLE (22.9%).HOUSEHOLD INCOME ON AVERAGE IS $65,435, WITH PER CAPITA INCOME AT $25,833. THE PERCENTAGE OF INDIVIDUALS IN CLINTON COUNTY LIVING BELOW THE FEDERAL POVERTY LEVEL HAS REMAINED STABLE AT 15.2%. IN TOTAL, THERE ARE 30,624 HOUSEHOLDS IN CLINTON COUNTY. THE PERCENTAGE OF INDIVIDUALS ENROLLED IN MEDICAID IS 24.4%.OF THE TOTAL POPULATION IN CLINTON COUNTY, APPROXIMATELY 37% OF INDIVIDUALS 25 YEARS OF AGE AND OLDER HAVE A HIGH SCHOOL DIPLOMA OR EQUIVALENT. ANOTHER 30.8% HAVE AN ASSOCIATE'S OR BACHELOR'S DEGREE OR HIGHER. FIFTY SIX PERCENT OF THE POPULATION 16 YEARS AND OLDER IS IN THE WORKFORCE, WITH THE HIGHEST PERCENTAGE OF INDIVIDUALS IN THE FIELD OF EDUCATION (26.7%), FOLLOWED BY RETAIL TRADE (13.3%), MANUFACTURING (12.3%), AND ARTS, ENTERTAINMENT, RECREATION, HOTEL AND FOOD SERVICES (10.8%). PART VI, LINE 5: CVPH MEDICAL CENTER PLAYS AN IMPORTANT ROLE IN PROMOTING HEALTH IN THE COMMUNITY BY, FOR INSTANCE, HOSTING FREE COMMUNITY LECTURES, SUPPORT GROUPS, AND SCREENINGS. A FREE MONTHLY COMMUNITY LECTURE SERIES OFFERS A WIDE RANGE OF TOPICS FROM DIABETES AND CANCER TO RHEUMATOLOGY AND MACULAR DEGENERATION. CVPH SPONSORS A NUMBER OF FREE SUPPORT GROUPS INCLUDING PROGRAMS ON DIABETES, MULTIPLE CANCER GROUPS, AND BEREAVEMENT. AN ARRAY OF FOCUSED CLASSES ARE HELD FOR EXPECTANT MOTHERS AS PART OF AN OVERALL CHILDBIRTH EDUCATION INITIATIVE. REGULAR CAR-SEAT SAFETY CHECKS ARE HELD TO ENSURE THAT INFANTS AND TODDLERS ARE APPROPRIATELY SECURED IN THEIR VEHICLES. CVPH WORKS IN CONJUNTION WITH THE ADIRONDACK SAFE KIDS NETWORK FOR AN ANNUAL BIKE AND SKATEBOARD SAFETY FAIR THAT DISTRIBUTES HUNDREDS OF FREE SAFETY HELMETS. CVPH IS A REGULAR PARTICIPANT AT VARIOUS HEALTH FAIRS IN THE REGION DISPENSING EDUCATION INFORMATION AND PROVIDING FREE HEALTH SCREENINGS. CVPH ALSO WORKS WITH OTHER AGENCIES TO FACILITATE INSURANCE COVERAGE FOR ELIGIBLE INDIVIDUALS AND FAMILIES. CVPH MEDICAL CENTER OVERSEES THE NEW YORK STATE GRANT-FUNDED CANCER SERVICES PROGRAM (CSP) OF CLINTON COUNTY. THE PROGRAM PROVIDES CLINTON COUNTY RESIDENTS WHO HAVE NO INSURANCE OR WHO ARE UNDERINSURED WITH FREE SCREENINGS FOR BREAST, CERVICAL AND COLORECTAL CANCERS. THE SERVICES ARE PROVIDED VIA LOCAL PROVIDERS AND CLINICS. CVPH ALSO PARTICIPATES IN THE ACTION FOR HEALTH COALITION WHICH WAS CREATED AS PART OF THE MAPP/CHNA PROCESS. THIS GROUP HAS AN ACTIVE ROLE IN TRACKING PROGRESS MADE IN IMPLEMENTING CHANGES TO IMPACT THE HEALTH OF THE COMMUNITY AS WELL AS MAKING ADJUSTMENTS TO THE STRATEGIES IDENTIFIED TO ADDRESS THESE NEEDS. SOME OF THE ACCOMPLISHMENTS OF THE ACTION FOR HEALTH COALITION INCLUDE CVPH HOSTING NEW VISIONS PROGRAM FOR SELECTED COLLEGE BOUND HIGH SCHOOL SENIORS PLANNING TO MAJOR IN A HEALTH RELATED FIELD OF STUDY, MOVING TOBACCO PRODUCTS OUT OF SIGHT IN MANY RETAIL ESTABLISHMENTS, IMPROVING NUTRITION IN SCHOOLS, AND FOCUSING ON POSITIVELY IMPACTING CHRONIC DISEASE MANAGEMENT IN CLINTON COUNTY. PART VI, LINE 6: CVPH MEDICAL CENTER, IS A MEMBER OF THE UNIVERSITY OF VERMONT HEALTH NETWORK (FORMERLY FLETCHER ALLEN PARTNERS, INC.), ALSO COVERING THE BURLINGTON AND BERLIN, VERMONT AREAS.CVPH IS A VOLUNTARY, NOT-FOR-PROFIT, ARTICLE 28 ORGANIZATION THAT IS GOVERNED BY A VOLUNTARY BOARD OF DIRECTORS AND IS LICENSED FOR 300 BEDS. CVPH IS LOCATED AT 75 BEEKMAN STREET IN PLATTSBURGH, NEW YORK WITH SATELLITE SERVICES AT A NUMBER OF OTHER AUTHORIZED LOCATIONS WITHIN THE PLATTSBURGH AREA. CVPH IS PART OF THE UNIVERSITY OF VERMONT HEALTH NETWORK, WHICH IS COMPRISED OF SIX HOSPITALS, A HOME HEALTH AND HOSPICE AGENCY, AND AN EMPLOYED MEDICAL GROUP. IT IS AFFILIATED WITH AN ACADEMIC MEDICAL CENTER IN BURLINGTON, VERMONT. CVPH OFFERS A VARIETY OF SERVICES INCLUDING CARDIOVASCULAR, ORTHOPEDICS, OBSTETRICS, PSYCHIATRY, LONG TERM CARE, AND PRIMARY CARE. IT HAS A FAMILY MEDICINE RESIDENCY PROGRAM TO HELP ADDRESS PRIMARY CARE SHORTAGES IN THE COMMUNITY. CVPH PROVIDES CANCER SERVICES THROUGH THE FITZPATRICK CANCER CENTER. IN ADDITION, CVPH HAS A ROBUST MEDICAL HOME AS WELL AS THE ADIRONDACK REGION ACO WHICH ARE KEY PARTNERS IN ADDRESSING COMMUNITY HEALTH NEEDS. X 1 1 X X X X X 1 1 0 1 0 1 0 0 0 WOUTER RIETSEMAMD CHIEF QUALITY AND INFOR. 476532 0 144170 0 18216 0 0 0 45472 0 684390 0 0 0 KENT HALL CHIEF MEDICAL OFFICER 526394 0 153455 0 19012 0 0 0 33361 0 732222 0 0 0 MICHELLE LEBEAU PRESIDENT/COO 523830 0 193297 0 41493 0 0 0 39374 0 797994 0 0 0 SCOTT ST GEORGE FORMER VICE PRESIDENT OF FINANCE 292319 0 47263 0 0 0 0 0 11421 0 351003 0 0 0 CHARLES VOLK ORTHOPEDIC SURGEON 153652 0 0 0 0 0 0 0 7308 0 160960 0 0 0 FRANKLIN BERTUCH ANESTHESIOLOGIST 331800 0 0 0 0 0 0 0 26872 0 358672 0 0 0 VIVIAN MEJIAS ANESTHESIOLOGIST 260745 0 0 0 0 0 0 0 10708 0 271453 0 0 0 LOIUS-PHILIPPE CHARETTE PHYSICIAN 253541 0 0 0 0 0 0 0 6375 0 259916 0 0 0 STEPHENS MUNDY FORMER PRESIDENT/CEO 402105 0 283122 0 1569191 0 0 0 43625 0 2298043 0 706487 0 PART I, LINE 1A TRAVEL FOR COMPANIONS: TOTAL TRAVEL COSTS FOR COMPANION OF THE CEO OF LESS THAN $1,000 IS ALLOWED TO BE INCURRED AND REIMBURSED BY CVPH MEDICAL CENTER. NO OTHER BOARD MEMBER, OFFICER, DIRECTOR, OR KEY EMPLOYEE RECEIVES THIS BENEFIT. PART I, LINE 1B TRAVEL FOR COMPANIONS: TOTAL TRAVEL COSTS FOR COMPANION OF THE CEO OF LESS THAN $1,000 IS ALLOWED TO BE INCURRED AND REIMBURSED BY CVPH MEDICAL CENTER. NO OTHER BOARD MEMBER, OFFICER, DIRECTOR, OR KEY EMPLOYEE RECEIVES THIS BENEFIT. PART I, LINE 3 IN ADDITION TO THE TOOLS AND PROCESSES IDENTIFIED IN PART I, CHAMPLAIN VALLEY PHYSICIANS HOSPITAL RECEIVES GUIDANCE REGARDING ITS PRESIDENT'S COMPENSATION FROM THE COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES OF THE UNIVERSITY OF VERMONT HEALTH NETWORK, WHICH IS THE SOLE MEMBER OF THE HOSPITAL. THAT NETWORK COMPENSATION COMMITTEE UTILIZES THE FOLLOWING METHODS TO ESTABLISH THAT GUIDANCE: -COMPENSATION COMMITTEE -INDEPENDENT COMPENSATION CONSULTANT -COMPENSATION SURVEY OR STUDY -APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE PART I, LINES 4A-B STEPHENS MUNDY, PRESIDENT & CFO OF CHAMPLAIN VALLEY PHYSICIANS HOSPITAL MEDICAL CENTER, SEPARATED FROM SERVICE ON JULY 1, 2018. IN ACCORDANCE WITH THE SEPARATION AGREEMENT, HE IS ENTITLED TO 18 MONTHS CONTINUATION OF SALARY AND CONTINUATION OF CERTAIN BENEFITS. IN 2018 HE RECEIVED PAYMENTS IN LIEU OF BENEFIT CONTINUATION PLUS SALARY CONTINUATION PAYMENTS TOTALLING $409,487. DURING CALENDAR YEAR 2018, CHAMPLAIN VALLEY PHYSICIANS HOSPITAL, A SUBSIDIARY OF THE UVM HEALTH NETWORK, PAID OFFICER MUNDY FOR AMOUNTS VESTED IN 2018 UNDER A LONG TERM SUPPLEMENTAL RETIREMENT BENEFIT PLAN SRP) WHICH WAS ENTERED INTO DURING 2012. THE AMOUNT VESTED AND PAID FOR CALENDAR YEAR 2018 OF $988,459 IS REPORTED IN SCHEDULE J, PART II, COLUMN BIII. A DISTRIBUTION TO STEPHENS MUNDY, CEO,IN THE AMOUNT OF $1,569,191 WAS MADE FROM A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP). THE AMOUNT WAS INCLUDED IN MR. MUNDY'S TAXABLE COMPENSATION. A DISTRIBUTION TO WOUTER RIETSEMA IN THE AMOUNT OF $18,216 WAS MADE FROM A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP). THE AMOUNT WAS INCLUDED IN MR. RIETSEMA'S TAXABLE COMPENSATION. A DISTRIBUTION TO MICHELLE LEBEAU IN THE AMOUNT OF $41,494 WAS MADE FROM A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP). THE AMOUNT WAS INCLUDED IN MS. LEBEAU'S TAXABLE COMPENSATION. A DISTRIBUTION TO KENT HALL IN THE AMOUNT OF $19,012 WAS MADE FROM A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP). THE AMOUNT WAS INCLUDED IN MR. HALL'S TAXABLE COMPENSATION. PART I, LINE 6 DURING 2019, CHAMPLAIN VALLEY PHYSICIANS HOSPITAL MEDICAL CENTER CONTINUED A COMPENSATION INCENTIVE PLAN FOR MANAGEMENT OF THE ORGANIZATION. THE PLAN SETS FORTH NUMEROUS OBJECTIVES AND GOALS (16) TO BE MET IN ORDER TO EARN AN INCENTIVE AWARD. EACH OF THE GOALS ARE AIMED AT IMPROVING THE EXPANSE OF CVPH'S SERVICE OFFERINGS, QUALITY OF SERVICE AND OPERATION, AND MEETING COMMUNITY NEEDS. ONLY ONE OF THE 16 OBJECTIVES INCLUDED IN THE 2019 PLAN IS KEYED TO NET MARGIN OF THE ORGANIZATION. THIS MEASURE IS INTENDED TO MEET THE OVERALL GOAL OF MAINTAINING THE FINANCIAL HEALTH OF THE ORGANIZATION. OTHER GOALS IN THE PLAN ARE TO IMPROVE PATIENT & EMPLOYEE SATISFACTION. A COUNTY OF CLINTON INDUSTRIAL DEVELOPMENT AGENCY 146035154 187476AD8 2007-06-07 19565000 CONSTRUCTION OF SURGICAL SVC WING 0 0 0 B COUNTY OF CLINTON INDUSTRIAL DEVELOPMENT AGENCY 146035154 187476AB2 2006-12-19 12650000 REFINANCE SERIES 1997 BONDS 0 0 0 C COUNTY OF CLINTON INDUSTRIAL DEVELOPMENT AGENCY 146035154 187476AE6 2007-06-25 12505000 RENOVATION OF SURGICAL AREA 0 0 0 A 19565000 1172250 1340812 17051938 2009 0 0 1 1 B 12650000 12511605 138395 1998 0 1 1 1 C 12505000 727569 811805 10965626 2009 0 0 1 1 A 0 0 0 0 1 0 1 B 0 0 0 0 1 0 1 C 0 0 0 0 1 0 1 A 0 0 0 1 1 1 KEY BANK 35.000000000000 0 0 0 0 1 B 0 0 0 1 1 1 KEY BANK 11.000000000000 0 0 0 0 1 C 0 0 0 1 1 1 KEY BANK 35.000000000000 0 0 0 0 1 A 0 B 0 C 0 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: COUNTY OF CLINTON INDUSTRIAL DEVELOPMENT AGENCY DATE THE REBATE COMPUTATION WAS PERFORMED: 12/16/2010 ISSUER NAME: COUNTY OF CLINTON INDUSTRIAL DEVELOPMENT AGENCY DATE THE REBATE COMPUTATION WAS PERFORMED: 07/01/2011 ISSUER NAME: COUNTY OF CLINTON INDUSTRIAL DEVELOPMENT AGENCY DATE THE REBATE COMPUTATION WAS PERFORMED: 06/25/2012 FORM 990, PART VI, SECTION A, LINE 6 THE UNIVERSITY OF VERMONT HEALTH NETWORK, INC. (UVMHN) IS THE VOTING MEMBER OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A THE UNIVERSITY OF VERMONT HEALTH NETWORK SHALL ELECT THE DIRECTORS TO HOLD OFFICE ANNUALLY. EACH DIRECTOR SHALL HOLD OFFICE UNTIL THE EXPIRATION OF THE TERM AND UNTIL A SUCCESSOR HAS BEEN ELECTED AND SHALL HAVE QUALIFIED, OR UNTIL THE DIRECTOR'S PRIOR RESIGNATION OR REMOVAL. FORM 990, PART VI, SECTION B, LINE 11B CVPH PROVIDES AN ELECTRONIC COPY OF FORM 990 TO EACH BOARD MEMBER PRIOR TO THE FORM BEING FILED. FORM 990, PART VI, SECTION B, LINE 12C CVPH HAS A WRITTEN CONFLICT OF INTEREST POLICY AS A PART OF ITS GOVERNING DOCUMENTS. THE POLICY IS APPLICABLE TO MEMBERS OF THE GOVERNING BODY, OFFICERS AND KEY EMPLOYEES. THE ORGANIZATION REQUIRES THAT MEMBERS HAVING A CONFLICT OF INTEREST IN A TRANSACTION RECUSE THEMSELVES OF VOTING ON THE MATTER. PROPOSED AND ONGOING TRANSACTIONS ARE REVIEWED BY APPROPRIATE GROUPS OF INDIVIUALS (COMMITTEES AND/OR LEVELS OF REVIEW) TO ENSURE THE BEST INTEREST OF THE HOSPITAL. THE ORGANIZATION SOLICITS FROM EACH MEMBER OF THE GOVERNING BODY, OFFICERS, AND KEY EMPLOYEES AN ANNUAL SIGNED STATEMENT CERTIFYING COMPLIANCE WITH THE ORGANIZATION'S CONFLICT OF INTEREST POLICY AND SELF-DISCLOSURE OF CERTAIN INTEREST FOR EACH ANNUAL PERIOD. FORM 990, PART VI, SECTION B, LINE 15 CVPH HAS A FORMAL PROCESS THAT IS USED TO DETERMINE THE COMPENSATION OF THE CEO ON AN ANNUAL BASIS. THIS PROCESS INCLUDES A COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES, ENGAGING AN INDEPENDENT CONSULTANT, PERFORMANCE OF A COMPENSATION SURVEY OR STUDY, REVIEW OF OTHER ORGANIZATION'S 990 FORMS, AND APPROVAL BY THE BOARD OF COMPENSATION COMMITTEE. A WRITTEN EMPLOYMENT AGREEMENT IS ESTABLISHED SETTING FORTH THE COMPENSATION AND BENEFITS OF THE CEO. CVPH PAYS NON-FIXED EARNINGS BASED ON THE SUCCESS IN MEETING PERFORMANCE CRITERIA THAT ARE PROSPECTIVELY AGREED UPON AS GOALS FOR THE CEO. PART B: THE SAME FORMAL PROCESS NOTED IN QUESTION 15(A) ABOVE IS USED TO DETERMINE THE BASE COMPENSATION OF THE OTHER OFFICERS. NON-FIXED EARNINGS OF OTHER OFFICERS ARE BASED ON THE SUCCESS IN MEETING PERFORMANCE CRITERIA AND COMPARATIVE MARKET DATA. IN ADDITION TO THE TOOLS AND PROCESSES IDENTIFIED IN SCHEDULE J, PART I, CHAMPLAIN VALLEY PHYSICIANS HOSPITAL RECEIVES GUIDANCE REGARDING ITS PRESIDENT'S COMPENSATION FROM THE COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES OF THE UNIVERSITY OF VERMONT HEALTH NETWORK, WHICH IS THE SOLE MEMBER OF THE HOSPITAL. THAT NETWORK COMPENSATION COMMITTEE UTILIZES THE FOLLOWING METHODS TO ESTABLISH THAT GUIDANCE: -COMPENSATION COMMITTEE -INDEPENDENT COMPENSATION CONSULTANT -COMPENSATION SURVEY OR STUDY -APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE FORM 990, PART VI, SECTION C, LINE 19 CVPH MAKES ITS GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. PARTIES DESIRING COPIES OF SUCH DOCUMENTS MUST PRESENT THEMSELVES AT THE ADMINISTRATIVE OFFICES OF CVPH OR BY SENDING A REQUEST IN WRITING TO CVPH ADMINISTRATIVE OFFICES. THE ORGANIZATION HAS INSTRUCTIONS POSTED ON ITS WEBSITE FOR THOSE SEEKING COPIES OF DOCUMENTS. FORM 990, PART XI, LINE 9: CHANGE IN FAIR VALUE OF INTEREST RATE SWAP -3,447,434. PENSION RELATED CHANGES OTHER THAN NET PERIODIC PENSION COSTS -22,296,801. CHANGE IN NET INTEREST OF FOUNDATION -69,325. TRANSFERS FROM PARENT/RELATED PARTY 4,537,124. CHANGE IN INTEREST IN INVESTMENT POOL 1,980,779. FORM 990, PART XII, LINE 2C: THERE IS AN AUDIT COMMITTEE THAT ASSUMES RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT AND SELECTION OF THE INDEPENDENT ACCOUNTANT. THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. SCHEDULE H, PART V, SECTION B, LINE 11 EACH PRIORITY-SPECIFIC ACTION PLAN INCLUDES FOCUS AREAS, GOALS, OBJECTIVES, AND MEASURES FOR EVIDENCE-BASED INTERVENTIONS TO TRACK THEIR IMPACTS INCLUDING REDUCTIONS IN HEALTH DISPARITIES AMONG RACIAL, ETHNIC, AND SOCIOECONOMIC GROUPS, AGE GROUPS, AND PERSONS WITH DISABILITIES. CCHD AND CVPH USE THE PREVENTION AGENDA AS A FRAMEWORK FOR ASSESSING HEALTH, IDENTIFYING LOCAL HEALTH PRIORITIES AND PLANNING COLLABORATIVE HEALTH IMPROVEMENT EFFORTS WITHIN CLINTON COUNTY. CVPH AND CCHD UNDERSTAND THE KEY TO SUCCESSFULLY IMPACTING THE HEALTH OF CLINTON COUNTY IS PARTNERING WITH THE COMMUNITY AND ITS ORGANIZATIONS AND COMBINING RESOURCES. IT IS THE INTENT OF THE LEAD PARTNERS THAT ACTION PLANS CAPTURE THE PARTNERSHIP, CONTRIBUTIONS AND SUPPORT OF MANY COMMUNITY ORGANIZATIONS TO STRENGTHEN THE IMPACT OF THE PLANNED INTERVENTIONS AND ASSURE THE RESPONSIBLE USE OF LIMITED RESOURCES. CLINTON COUNTY IS FORTUNATE TO HAVE DEVELOPED A STRONG NETWORK OF PARTNERS REPRESENTING MANY DIFFERENT COMMUNITY SECTORS AND OFFERING A VARIETY OF ASSETS AND CAPACITIES FOR ACHIEVING ITS SHARED VISION FOR COMMUNITY HEALTH. LEAD STAFF FROM CCHD AND CVPH HAVE WORKED WITH PARTNERS TO COLLECT AND ORGANIZE ACTIVITIES AND INTERVENTIONS THAT WILL ADDRESS THE IDENTIFIED HEALTH PRIORITIES. THIS WAS DONE UTILIZING A VARIETY OF METHODS: REVIEW OF CURRENT CHIP/IS ACTIVITIES AND PROGRESS AS WELL AS THOSE OF OTHER SHARED WORK PLANS (IE. COMMUNITY SERVICES PLAN), INDIVIDUAL MEETINGS WITH KEY PARTNERS, EMAILS SOLICITING SUGGESTIONS AND CONTRIBUTIONS OF RELATED ACTIVITIES FROM AFH PARTICIPANTS, AND REVIEW OF INFORMATION COLLECTED FROM THE PRIORITY SETTING EVENT AND DIRECTLY FROM RESIDENTS THROUGH THE SURVEY PROCESS. INFORMATION WAS THEN ORGANIZED BY GOALS/ OBJECTIVES WITHIN EACH FOCUS AREA, RESULTING IN FIVE ACTION PLANS AND FORMATTED FOLLOWING NYSDOH GUIDANCE AND PROVIDED TOOLS. THESE ACTION PLANS BECOME CCHD'S CHIP AND CVPH'S IS FOR THE NEXT THREE YEARS. IT IS IMPOSSIBLE TO FEATURE ALL THE HEALTH IMPROVEMENT WORK THAT WILL OCCUR IN CLINTON COUNTY OVER THE NEXT THREE YEARS IN THE ACTION PLANS. MUCH THOUGHT IS GIVEN TO THE FEATURED INTERVENTIONS; OFTEN IT IS THE ITEMS THAT BEST DEMONSTRATE THE LOCAL COMMITMENT TO COLLECTIVE IMPACT WORK, INNOVATION, AND CROSS-SYSTEM COLLABORATION. THERE IS ALSO AN INTENTIONAL BLEND OF ACTIVITIES THAT WILL VARY IN DURATION. AS SUCH, THERE WILL BE PROGRESS TO ACKNOWLEDGE AND CELEBRATE PERPETUALLY. THIS ALSO ALLOWS NEW INTERVENTIONS TO BE CONSIDERED AND ADDED REGULARLY BASED ON EMERGING LOCAL NEEDS AND RESOURCES. TARGET PROGRAMS AND LOCATIONS FOR THE FEATURED INTERVENTIONS ARE DETERMINED BY A NUMBER OF FACTORS INCLUDING REVIEW OF HEALTH INDICATOR DATA, ESPECIALLY TO IDENTIFY HIGH NEEDS POPULATIONS AND AREAS WITHIN THE COUNTY, AND FEASIBILITY OF ACTIVITIES MEETING SUCCESS (EXISTENCE OF POTENTIAL SITES, ACCESSIBILITY, RECEPTIVENESS, ETC.). FEATURED INTERVENTIONS AND PROJECTED OUTCOMES ARE INFLUENCED BY PARTNER RESOURCES INCLUDING STAFF, FUNDING AND EXPERTISE. SOME INTERVENTIONS THAT THE HOSPITAL HAS A ROLE IN ARE AS FOLLOWS: - PROVIDING COMMUNITY EDUCATION ON HPV SCREENING - EXPANDING THE CVPH DIABETES PREVENTION PROGRAM (DPP) - COORDINATION OF REFERRALS TO DPP - OFFER TOBACCO CESSATION ASSISTANCE THROUGH CERTIFIED TOBACCO TREATMENT SPECIALISTS - EMBEDDING OUTPATIENT BEHAVIORAL HEALTH SERVICES INTO THE INPATIENT PSYCHIATRY UNITS TO ESTABLISH WARM HAND OFF OF CARE - ASSIST IN THE CREATION AND SUSTAINABILITY OF INCLUSIVE, HEALTHY PUBLIC SPACES (INDOOR WALKING TRAILS, RIVER SPUR TRAILS, ETC.) 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