2019-11-13T12:26:25-06:00 2018-12-31 160765486 LUMSDEN & MCCORMICK LLP 369 FRANKLIN STREET BUFFALO NY 14202 990 2018-01-01 810600548 RIVER HOSPITAL INC RIVE 3157135350 4 FULLER STREET ALEXANDRIA BAY NY 13607 KELLEY TIERNAN CHIEF FINANCIAL OFFICER 3157135350 2019-11-11 1 JILL M JOHNSON CPA P01701478 7168563300 2019-11-07 38.122.36.250 2019-11-11 08:28:18 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 178EDCBBEFC1CD3328C1DD6E94D390C4A7F3C5E4 2018 2020-03-31 21:24:44Z KELLEY TIERNAN 4 FULLER STREET ALEXANDRIA BAY NY 13607 25539709 0 X RIVERHOSPITAL.ORG X 2003 NY IT IS THE MISSION OF RIVER HOSPITAL, INC. TO PROVIDE COMPASSIONATE, COST EFFECTIVE AND ACCESSIBLE PRIMARY HEALTH CARE TO THE YEAR ROUND AND SEASONAL RESIDENTS, AND VISITORS OF THE RIVER COMMUNITIES. THE HOSPITAL PRIDES ITSELF ON HIGH QUALITY OUTPATIENT, INPATIENT AND SPECIALTY SERVICES TO MEET INDIVIDUAL AND COMMUNITY NEEDS THROUGH PARTNERSHIPS WITH OUR PATIENTS AND COMMUNITIES WE SERVE. 16 16 280 80 0 0 3236158 1046892 18901211 19805303 119210 133645 3689779 4118029 25946358 25103869 0 0 0 0 13814317 13435009 0 0 0 7612017 8821236 21426334 22256245 4520024 2847624 17105750 18741662 3251060 2319784 13854690 16421878 X IT IS THE MISSION OF RIVER HOSPITAL, INC. TO PROVIDE COMPASSIONATE, COST EFFECTIVE AND ACCESSIBLE PRIMARY HEALTH CARE TO THE YEAR ROUND AND SEASONAL RESIDENTS, AND VISITORS OF THE RIVER COMMUNITIES. THE HOSPITAL PRIDES ITSELF ON HIGH QUALITY OUTPATIENT, INPATIENT AND SPECIALTY SERVICES TO MEET INDIVIDUAL AND COMMUNITY NEEDS THROUGH PARTNERSHIPS WITH OUR PATIENTS AND COMMUNITIES WE SERVE. 0 0 16491753 19805303 RIVER HOSPITAL, INC. PROVIDED GENERAL INPATIENT, OUTPATIENT, AND EMERGENCY SERVICES TO RESIDENTS IN THE NORTHERN NEW YORK AREA. DURING 2018, THE HOSPITAL PROVIDED 1,353 SWING BED DAYS AND 306 DAYS OF CRITICAL ACCESS CARE TO THE SICK AND INJURED. IN THE OUTPATIENT SERVICE AREA, RIVER HOSPITAL PROVIDED 7,426 EMERGENCY ROOM VISITS IN 2018. RIVER HOSPITAL STRIVES TO IDENTIFY AND UPDATE SERVICES BASED UPON THE COMMUNITY NEEDS. WE HAVE IMPLEMENTED ELECTRONIC HEALTH RECORDS AND ARE PARTICIPATING IN THE REGIONAL HEALTH INFORMATION EXCHANGE (RHIO). THE HOSPITAL SERVES A COMMUNITY PAYOR MIX OF 71% GOVERNMENT PAYORS, 27% COMMERCIAL PAYORS AND OTHER, AND 2% UNINSURED. 16491753 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 0 1 0 0 0 0 0 0 0 1 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 121 0 1 280 1 0 0 0 0 0 0 0 0 0 0 X 16 16 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 0 0 NY X KELLEY TIERNAN 3154822511 4 FULLER STREET ALEXANDRIA BAY NY 13607 JOSEPH RUSSELL CHAIRMAN 2.00 X X 0 0 0 NORM SNYDER VICE CHAIRMAN 2.00 X X 0 0 0 JEANNE SNOW TREASURER 2.00 X X 0 0 0 RICHARD MACSHERRY SECRETARY 2.00 X X 0 0 0 LYNN BROWN TRUSTEE 2.00 X 0 0 0 JAMES DONEGAN TRUSTEE 2.00 X 0 0 0 CRAIG GARLOCK TRUSTEE 2.00 X 0 0 0 KATHY MORRIS TRUSTEE 2.00 X 0 0 0 RON RANDALL TRUSTEE 2.00 X 0 0 0 SUE RAPANT TRUSTEE 2.00 X 0 0 0 STEPHEN SARFATY TRUSTEE 2.00 X 0 0 0 RAYMOND SMITH TRUSTEE 2.00 X 0 0 0 RONALD THOMPSON TRUSTEE 2.00 X 0 0 0 ROBERT TOOLE TRUSTEE 2.00 X 0 0 0 CHET TRUSKOWSKI TRUSTEE 2.00 X 0 0 0 KEN VANHATTEN TRUSTEE 2.00 X 0 0 0 BEN MOORE III CHIEF EXECUTIVE OFFICER 40.00 X 240000 0 12120 KELLEY TIERNAN CHIEF FINANCIAL OFFICER 9.00 31.00 X 55700 196345 44920 BRADELY FREY MEDICAL STAFF PRESIDENT 40.00 X 160015 0 10734 AMANDA RYDBERG CLINICS DIRECTOR 40.00 X 147369 0 13542 JOHN ELLIE PHYSICIAN 40.00 X 444481 0 28611 ROBERT WERBLIN ER MEDICAL DIRECTOR 40.00 X 257358 0 12421 ANDREW OGDEN MEDICAL DIRECTOR 40.00 X 204714 0 23903 DAVID WALLACE PHYSICIAN 40.00 X 175120 0 10996 1684757 196345 157247 7 0 1 0 BERNIER CARR & ASSOCIATES PC 327 MULLIN STREET WATERTOWN NY 13601 ARCHITECT AND ENGINEERS 785988 CLAXTON HEPBURN MEDICAL CENTER 214 KING STREET OGDENSBURG NY 13669 MEDICAL AND HEALTH CARE PAYMENTS AND MED 761103 DELPHI HEALTHCARE PLLC 1160 CHILI AVENUE ROCHESTER NY 14624 MEDICAL SERVICES 504597 DELPHI HOSPITALIST SERVICES LLC 1160 CHILI AVENUE ROCHESTER NY 14624 MEDICAL SERVICES 479960 PURCELL CONSTRUCTION CORP 566 COFFEEN STREET WATERTOWN NY 13601 CONSTRUCTION SERVICES 417748 10 15220 254082 777590 1046892 PATIENT SERVICE REVENUE 623000 19805303 19805303 19805303 91508 91508 16979 67848 -50869 -50869 -50869 322531 280394 42137 42137 42137 203118 15220 87598 115520 115520 MLMIC DISTRIBUTION 900099 1476608 1476608 NYS OPERATING SUBSIDIES 900099 1318991 1318991 340B PROGRAM 900099 555531 555531 702248 702248 4053378 25103869 19805303 0 4251674 400015 312012 88003 10856389 8467983 2388406 1399054 1091262 307792 779551 643432 136119 248995 248995 2142075 788919 1353156 98041 3024 95017 64683 50732 13951 58122 36272 21850 10056 9050 1006 944817 736957 207860 316033 246505 69528 SUPPLIES 1794315 1652948 141367 OUTSIDE SERVICES 1567385 912985 654400 PROVISION FOR BAD DEBTS 800928 800928 NYS ASSESSMENT 68829 68829 706957 669915 37042 22256245 16491753 5764492 0 2811834 2920485 1841667 1884938 2049619 1698311 495828 443081 148794 261042 18623116 12225921 5393329 6397195 4352679 5124610 12000 12000 17105750 18741662 2285934 1851765 44546 5000 116521 165487 804059 297532 3251060 2319784 X 10038383 12035483 3290585 3860673 525722 525722 13854690 16421878 17105750 18741662 2847624 -280436 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 573498 -32109 541389 572284 1214 573498 567628 4656 572284 544923 22705 567628 538493 6430 544923 0.97100 0.02900 0 0 18000 18000 4580813 2931923 1648890 11527178 9293998 2233180 2497125 2497125 6397195 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 297532 297532 24177951 -280436 -800928 -1081364 25259315 -155446 -155446 25103869 21610763 155446 155446 21455317 800928 800928 22256245 PART XI, LINE 2D - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS -800,928. PART XI, LINE 4B - OTHER ADJUSTMENTS: RENTAL EXPENSE -67,848. SPECIAL EVENT EXPENSE -87,598. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSE 67,848. SPECIAL EVENT EXPENSE 87,598. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS 800,928. PART V, LINE 4 PERMANENT ENDOWMENT FUNDS ARE TO BE HELD IN PERPETUITY WITH THE INCOME TO BE USED TO SUPPORT HEALTHCARE SERVICES. TEMPORARILY RESTRICTED ENDOWMENT FUNDS ARE TO BE USED TO PURCHASE CAPITAL EQUIPMENT FOR HEALTHCARE SERVICES, HOSPITAL OPERATIONS AND SCHOLARSHIPS. FESTIVE EVENING 113232 6100 107132 20400 200 8830 POLAR BEAR DIP 83617 83617 400 6145 2 21489 9120 12369 1972 1468 218338 15220 203118 22372 600 16443 39415 163703 1 1 1 X 1 X 1 1 1 0 1 1 362432 67926 294506 0.01320 3845797 1743842 2101955 0.09440 4208229 1811768 2396461 0.10760 4208229 1811768 2396461 0.10760 0 800928 117988 4598809 3830809 768000 X 1 1 1 1 RIVER HOSPITAL 4 FULLER STREET ALEXANDRIA BAY NY 13607 X X X X RIVER HOSPITAL INC 1 0 0 1 X X X X X X X X X 18 1 1 1 1 X WWW.RIVERHOSPITAL.ORG X WWW.NCNYHEALTHCOMPASS.ORG (SURVEY RESULTS) X 1 18 1 WWW.RIVERHOSPITAL.ORG 0 1 X 100.000000000000 300.000000000000 1 1 X X X X 1 X WWW.RIVERHOSPITAL.ORG X WWW.RIVERHOSPITAL.ORG X WWW.RIVERHOSPITAL.ORG X X X X X 1 X 1 X X X X 1 X 0 0 RIVER HOSPITAL, INC. PART V, SECTION B, LINE 5: RIVER HOSPITAL TOOK INTO ACCOUNT THE BROAD INTERESTS OF THE COMMUNITY AND THE TRI COUNTY REGION THROUGH COLLABORATIVE EFFORTS OF THE NORTH COUNTRY HEALTH COMPASS PARTNERSHIP, IN THE DEVELOPMENT OF THE 2018 COMMUNITY HEALTH ASSESSMENT AND THE 2016-2018 REGIONAL COMMUNITY HEALTH IMPROVEMENT PLAN. THE NORTH COUNTRY HEALTH COMPASS PARTNERSHIP IS COMPRISED OF REGIONAL REPRESENTATION FROM PUBLIC HEALTH AGENCIES, HOSPITALS AND COMMUNITY-BASED ORGANIZATIONS FROM JEFFERSON, LEWIS AND ST. LAWRENCE COUNTIES, WHO MEET ON A MONTHLY BASIS. THE REGIONAL PRIORITIES WERE SELECTED AFTER CAREFULLY EVALUATING COMMUNITY HEALTH NEEDS, POPULATION HEALTH DATA, REGIONAL ASSETS, AND REGIONAL BARRIERS. PREVENTION AGENDA PRIORITIES AND GOALS WERE RANKED USING AN ONLINE SURVEY TOOL WHICH DISPLAYED HEALTH INDICATORS RELATED TO EACH PRIORITY. RIVER HOSPITAL SELECTED PRIORITIES FOR THE COMMUNITY SERVICE PLAN WHICH ARE IN ALIGNMENT WITH THE PREVENTION AGENDA AND THE EFFORTS OF THE NORTH COUNTRY HEALTH COMPASS PARTNERSHIP AS WELL AS THE INDIVIDUAL HOSPITAL'S EFFORT. RIVER HOSPITAL, INC. PART V, SECTION B, LINE 6A: CARTHAGE AREA HOSPITAL, CLAXTON-HEPBURN MEDICAL CENTER, CLIFTON-FINE HOSPITAL, LEWIS COUNTY GENERAL HOSPITAL, MASSENA MEMORIAL HOSPITAL, RIVER HOSPITAL AND SAMARITAN MEDICAL CENTER. RIVER HOSPITAL, INC. PART V, SECTION B, LINE 6B: COMMUNITY PARTNERS IN JEFFERSON, LEWIS, AND ST. LAWRENCE COUNTIES WHO INTERFACE WITH LOW INCOME TARGET POPULATION. RIVER HOSPITAL, INC. PART V, SECTION B, LINE 11: THE NY STATE 2013-2018 PREVENTION AGENDA WAS THE BASIS TO DEVELOP THIS HEALTH IMPROVEMENT COMMUNITY HEALTH ASSESSMENT AND IMPROVEMENT PLAN. RIVER HOSPITAL AND JEFFERSON COUNTY PUBLIC HEALTH DEPARTMENT SELECTED DISPARITIES IN COLLABORATION WITH PARTNERING HEALTH CARE FACILITIES OF THE NORTH COUNTRY. THE 2018 EVIDENCE BASED INTERVENTIONS SELECTED WERE PREVENT CHRONIC DISEASE WITH EFFORTS TO REDUCE OBESITY, AS WELL AS PROMOTE MENTAL HEALTH AND PREVENT SUBSTANCE ABUSE THROUGH THE STRENGTHENING OF THE INFRASTRUCTURE ACROSS SYSTEMS.RIVER HOSPITAL'S 2016-2018 COMMUNITY SERVICE HAS CONTINUED TO FOCUS ON INITIATIVES TO IMPROVE OUTCOMES WITH CHRONIC DISEASE AND MENTAL HEALTH & SUBSTANCE ABUSE PREVENTION AGENDA PRIORITIES AND THE LOW SOCIOECONOMIC HEALTH DISPARITIES. RIVER HOSPITAL IS ENGAGING THE COMMUNITY AND PATIENT BASE IN THEIR OWN HEALTH CARE DECISIONS THROUGH PROVIDER-TO-PATIENT EDUCATION METHODS AS A PATIENT CENTERED MEDICAL HOME. IN ADDITION TO PATIENT ENGAGEMENT IN THE HEALTH CARE SETTING, RIVER HOSPITAL SEEKS OPPORTUNITIES TO EDUCATE THE COMMUNITY WHEN THERE ARE OPPORTUNITIES FOR COMMUNITY OUTREACH AND EMPLOYER-BASED HEALTH FAIR TYPE EVENTS. PART I, LINE 7: WORKSHEETS 1, 2 AND 3 WERE USED TO COMPLETE LINES 7A AND 7B. PART III, LINE 2: PATIENT ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF PATIENT ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS.FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). 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), THE HOSPITAL RECORDS A SIGNIFICANT 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 DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. PART III, LINE 3: THE METHODOLOGY USED TO CALCULATE THE PORTION OF BAD DEBT ATTRIBUTABLE TO THE PATIENTS ELIGIBLE UNDER THE FINANCIAL ASSISTANCE POLICY WAS TO SUM THE BAD DEBT WRITE OFFS FOR PATIENTS CURRENTLY RECEIVING THE CHARITY CARE DISCOUNTS FROM THE DETAILED BAD DEBT WRITE OFF REPORTS FROM THE BILLING SYSTEM. PART III, LINE 4: PATIENT ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF PATIENT ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS.FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). 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), THE HOSPITAL RECORDS A SIGNIFICANT 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 DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. PART III, LINE 9B: UNDER OUR CHARITY CARE PROGRAM, PATIENTS MAY APPLY FOR ASSISTANCE WITHIN 90 DAYS OF DISCHARGE OR DATE OF SERVICE. ONCE THE APPLICATION IS REQUESTED AND RECEIVED BY THE APPLICANT, THE APPLICATION MUST BE RETURNED TO RIVER HOSPITAL WITHIN 30 DAYS FROM THE DATE OF SERVICE. RIVER HOSPITAL DOES NOT PURSUE FURTHER COLLECTION ACTION WHILE THIS APPLICATION IS IN PROCESS PROVIDING THAT THE APPLICATION IS COMPLETED IN A TIMELY FASHION. RIVER HOSPITAL PROCESSES THIS APPLICATION WITHIN 30 DAYS OF RECEIPT. APPLICANTS ARE NOTIFIED IN WRITING OF OUR DECISION. AN INSTALLMENT AGREEMENT IS THEN SENT TO THE APPLICANT, AN INTEREST FREE AGREEMENT, TO BE SIGNED AND RETURNED. PART VI, LINE 2 RIVER HOSPITAL CONTINUES TO COLLABORATE WITH THE TRI-COUNTY "NORTH COUNTRY HEALTH COMPASS" PARTNERS. THE MISSION OF THE PARTNERSHIP IS TO DEVELOP, IMPLEMENT AND EVALUATE A REGIONAL HEALTH IMPROVEMENT INITIATIVE THROUGH RESEARCH, DATA ANALYSIS, COMMUNITY ENGAGEMENT AND COLLABORATION AMONG PUBLIC HEALTH DEPARTMENTS, HOSPITALS, COMMUNITY BASED ORGANIZATIONS, GENERAL PUBLIC AND HEALTHCARE PROVIDERS. THROUGH THE EFFORTS OF THIS PARTNERSHIP, IT WAS POSSIBLE TO DO A COMMUNITY HEALTH ASSESSMENT (CHA), IN ORDER TO AID THE DEVELOPMENT OF THE COMMUNITY HEALTH IMPROVEMENT PLAN AND THE HOSPITAL'S COMMUNITY SERVICE PLAN IN 2018.THE 2018 COMMUNITY HEALTH SURVEY IS THE THIRD ANNUAL SURVEY ON HEALTH AND HEALTH RELATED ISSUES CONDUCTED BY THE FORT DRUM REGIONAL HEALTH PLANNING ORGANIZATION IN JEFFERSON, LEWIS, AND ST. LAWRENCE COUNTIES.THE PURPOSE OF THIS SURVEY IS TO COLLECT INFORMATION ON LOCAL RESIDENTS' EXPERIENCES WITH HEALTHCARE, THEIR HEALTH STATUS, AND THEIR HEALTH-RELATED ACTIVITIES. THE RESULTS OF THE ANNUAL SURVEY ARE USED TO TRACK THE HEALTH STATUS OF PEOPLE IN THE REGION AND INFORM THE COMMUNITY HEALTH WORK OF HOSPITALS, COUNTY PUBLIC HEALTH DEPARTMENTS, AND THEIR PARTNERS. PART VI, LINE 3 PATIENTS ARE PROVIDED INFORMATION ABOUT OUR CHARITY CARE PROGRAM AND THE ELIGIBILITY GUIDELINES AT THE TIME OF SERVICE. WE ALSO HAVE THE INFORMATION AVAILABLE ON OUR WEBSITE. PART VI, LINE 4 RIVER HOSPITAL IS LOCATED WITHIN THE VILLAGE OF ALEXANDRIA BAY, NY, 'THE HEART OF THE THOUSAND ISLAND REGION', AND INCLUDES AREAS OF BOTH JEFFERSON AND ST. LAWRENCE COUNTIES. RIVER HOSPITAL IS SITUATED DIRECTLY ON THE SHORE OF THE ST. LAWRENCE SEAWAY, A VERY RURAL AREA, YET, ONE OF THE MAJOR COMMERCIAL WATERWAYS, CONNECTING THE GREAT LAKES TO THE WATER WAYS OF THE WORLD. RIVER HOSPITAL'S IMMEDIATE SERVICE AREA REACHES A RADIUS OF APPROXIMATELY 25 MILES. THE FACILITY PROVIDES HEALTH CARE SERVICES TO SEVERAL SURROUNDING COMMUNITIES. WITHIN THE RANGE OF THE RIVER HOSPITAL SERVICE AREA IS THE EXPANSIVE UNITED STATES ARMY'S 10TH MOUNTAIN LIGHT INFANTRY DIVISION AT FORT DRUM AND THE INFLUX OF FAMILY MEMBERS AND ASSOCIATED POPULATION. DIRECTLY TO THE NORTH, ON THE OPPOSITE SHORE OF THE ST. LAWRENCE RIVER IS THE PROVINCE OF ONTARIO, CANADA, CONFINING AVAILABILITY OF UNITED STATES HEALTH CARE SYSTEM TO 180 DEGREE RADIUS. THE LARGEST NEARBY UNITED STATES POPULATION CENTER IS SYRACUSE, NEW YORK, LOCATED 100 MILES TO THE SOUTH.IN ADDITION TO THE FULL TIME RESIDENTS OF THESE COMMUNITIES, RIVER HOSPITAL SERVES A LARGE POPULATION OF SEASONAL RESIDENTS AND VISITORS FROM THE UNITED STATES AND OTHER COUNTRIES OF THE WORLD, DUE IN PARTY TO THE SEASONAL TOURISM INDUSTRY. THIS ENTIRE REGION IS A MEDICALLY UNDERSERVED AREA (MUA) AND FEDERALLY DESIGNATED HEALTH PROVIDER SHORTAGE AREA (HPSA) WITH POVERTY AND UNEMPLOYMENT RATES THAT SIGNIFICANTLY EXCEED BOTH STATE AND NATIONAL AVERAGES. PART VI, LINE 5 RIVER HOSPITAL CONTINUES TO BE VERY INVOLVED WITH OTHER PARTNERS TO PROVIDE QUALITY HEALTHCARE SERVICES TO THIS REGION OF NORTHERN NEW YORK STATE, INCLUDING RELATIONSHIPS WITH JEFFERSON COUNTY PUBLIC HEALTH DEPARTMENT, OTHER NORTH COUNTY HOSPITALS AND AGENCIES/ORGANIZATIONS TO SHARE INFORMATION AND WORK TOGETHER TO EDUCATE THE PUBLIC ON THE AVAILABILITY OF SERVICES IN THIS REGION. RIVER HOSPITAL WORKS CLOSELY WITH FORT DRUM REGIONAL HEALTH PLANNING ORGANIZATION (FDRHPO), WHICH WAS ESTABLISHED TO LINK MILITARY FAMILIES ASSIGNED TO FORT DRUM MILITARY BASE TO QUALITY HEALTHCARE SERVICES AND RESOURCES IN THE REGION, AS THERE IS NO ON-BASE HOSPITAL.RIVER HOSPITAL PARTICIPATED IN HEALTH AND WELLNESS FAIRS WHERE HEALTH INFORMATION WAS DISTRIBUTED ALONG WITH INFORMATION ABOUT THE HOSPITAL. IN AUGUST, THE HOSPITAL PARTNERED WITH UNITED HEALTHCARE TO HOST A BACK TO SCHOOL VACCINATION EVENT. THE HOSPITAL ALSO CONTINUES TO WORK WITH OTHER AGENCIES SUCH AS CANCER SERVICES PROGRAM OF JEFFERSON AND LEWIS COUNTIES, FOR INDIVIDUALS WITHOUT ADEQUATE HEALTH INSURANCE WHO NEEDED MAMMOGRAMS. RIVER HOSPITAL WAS THE HEALTHCARE PROVIDER AT THE HOOD PLANT ANNUAL EMPLOYEE/FAMILY HEALTH FAIR AND OFFERED FLU VACCINES, PHYSICAL THERAPY TECHNIQUES, BLOOD PRESSURE CHECKS, PROPER NUTRITION GUIDELINES AS WELL AS INFORMATION TO IMPROVE/MAINTAIN GOOD HEALTH AND GENERAL RIVER HOSPITAL SERVICES INFORMATION.RIVER HOSPITAL ALSO HOSTED MASH CAMP STUDENTS, SPONSORED BY FORT DRUM REGIONAL HEALTH PLANNING ORGANIZATION, WHEREBY STUDENTS FROM AREA SCHOOLS EXPLORED CAREERS IN HEALTHCARE AT RIVER HOSPITAL. WELLS COLLEGE STUDENTS ALSO VISITED RIVER HOSPITAL TO LEARN MORE ABOUT RURAL HEALTHCARE AND THE COMMUNITIES WE SERVE.RIVER HOSPITAL CONTINUED TO WORK WITH OTHER REGIONAL HOSPITALS ON A COLLABORATION TO DEVELOP A STRATEGY TO ADDRESS THE DELIVERY OF AFFORDABLE HEALTH CARE SOLUTIONS TO RESIDENTS IN THE TRI-COUNTY AREA. THE REGIONAL NCI HOSPITAL COLLABORATION INCLUDES RIVER HOSPITAL, ALEXANDRIA BAY; CLAXTON-HEPBURN MEDICAL CENTER, OGDENSBURG; CLIFTON-FINE HOSPITAL, STAR LAKE; SAMARITAN MEDICAL CENTER, WATERTOWN AND CARTHAGE AREA HOSPITAL, CARTHAGE. RIVER HOSPITAL HAS A PASSIVE PARENT COLLABORATION WITH CLAXTON-HEPBURN MEDICAL CENTER; NORTH STAR HEALTH ALLIANCE. IN DECEMBER 2017 RIVER HOSPITAL ENTERED INTO A CLINICAL AFFILIATION WITH CROUSE HEALTH, CARTHAGE AREA HOSPITAL AND CLAXTON-HEBURN MEDICAL CENTER TO ENHANCE HEALTH CARE QUALITY AND ACCESS IN CENTRAL AND NORTHERN NEW YORK. THE AGREEMENT ALLOWS THE THREE NORTHERN NEW YORK HOSPITALS TO DEVELOP STRONG PROFESSIONAL AND CLINICAL RELATIONSHIPS BETWEEM ONE ANOTHER AND CROUSE HEALTH IN SYRACUSE. THE AFFILIATION DO NOT REPRESENT A MERGER OR ACQUISITION, BUT INSTEAD WILL ALLOW EACH INSTITUTION TO STRENGTHEN PATIENT SERVICES AND SHARE BEST PRACTICES AND EXPERTISE, YET EACH INSITUTION WILL CONTINUE TO OPERATE AS AN INDEPENDENT HOSPITAL. RIVER HOSPITAL ACTIVELY PARTICIPATES WITH THE NEW YORK STATE CRITICAL ACCESS HOSPITALS WHO WORK TOGETHER ON QUALITY IMPROVEMENT PROCESSES AND PATIENT SATISFACTION OUTCOMES. PART VI, LINE 7 NY X X X 0 0 0 0 0 0 0 0 0 BEN MOORE III CHIEF EXECUTIVE OFFICER 200000 0 40000 0 0 0 0 0 12120 0 252120 0 0 0 KELLEY TIERNAN CHIEF FINANCIAL OFFICER 55700 196345 0 0 0 0 0 0 44920 0 100620 196345 0 0 BRADELY FREY MEDICAL STAFF PRESIDENT 160015 0 0 0 0 0 0 0 10734 0 170749 0 0 0 AMANDA RYDBERG CLINICS DIRECTOR 147369 0 0 0 0 0 0 0 13542 0 160911 0 0 0 JOHN ELLIE PHYSICIAN 444481 0 0 0 0 0 0 0 28611 0 473092 0 0 0 ROBERT WERBLIN ER MEDICAL DIRECTOR 257358 0 0 0 0 0 0 0 12421 0 269779 0 0 0 ANDREW OGDEN MEDICAL DIRECTOR 204714 0 0 0 0 0 0 0 23903 0 228617 0 0 0 DAVID WALLACE PHYSICIAN 175120 0 0 0 0 0 0 0 10996 0 186116 0 0 0 FORM 990, PART VI, SECTION A, LINE 6 NORTH STAR HEALTH ALLIANCE, INC. A NOT-FOR-PROFIT HOLDING COMPANY, IS THE SOLE CORPORATE MEMBER OF THE HOSPITAL. FORM 990, PART VI, SECTION A, LINE 7A NORTH STAR HEALTH ALLIANCE, INC. ELECTS THE MEMBERS OF THE GOVERNING BODY. FORM 990, PART VI, SECTION A, LINE 7B DECISIONS OF THE GOVERNING BODY ARE SUBJECT TO THE APPROVAL OF NORTH STAR HEALTH ALLIANCE, INC. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS MADE AVAILABLE TO THE BOARD MEMBERS PRIOR TO ITS FILING. FORM 990, PART VI, SECTION B, LINE 12C EACH MEMBER OF THE BOARD IS REQUIRED TO COMPLETE AND SIGN A CONFLICT OF INTEREST POLICY ANNUALLY. IF A CONFLICT ARISES IN BETWEEN ANNUAL REVIEW OF THE POLICY, THE BOARD MEMBER IS REQUIRED TO AND RESPONSIBLE FOR REPORTING THE CONFLICT OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15A THE CHIEF EXECUTIVE OFFICER'S WAGES ARE REVIEWED AND APPROVED BY THE BOARD OF TRUSTEES AND COMPARABLE REGIONAL WAGE DATA PROVIDED BY PAYSCALE AND THE IROQUOIS HEALTHCARE ASSOCIATION SURVEY OF WAGE DATA ARE USED TO DETERMINE COMPETITIVE WAGES. THE CHIEF EXECUTIVE OFFICER IS MONITORED AND EVALUATED BY THE BOARD OF TRUSTEES ON AN ANNUAL BASIS. OTHER TOP MANAGEMENT OFFICERS ARE MONITORED AND REVIEWED ON AN ANNUAL BASIS BY THE CHIEF EXECUTIVE OFFICER. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS AND THE CONFLICT OF INTEREST POLICY ARE MADE AVAILABLE TO THE PUBLIC THROUGH THE HOSPITAL'S WEBSITE OR ARE AVAILABLE UPON REQUEST. THE FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC THROUGH THE PUBLIC CHARITY WEBSITE. NORTH STAR HEALTH ALLIANCE INC 214 KING STREET OGDENSBURG NY 13669 161449491 PARENT HOLDING COMPANY FOR CLAXTON-HEPBURN MEDICAL CENTER NY 501(C)(3) 509(A)(3) 0 CLAXTON-HEPBURN MEDICAL CENTER 214 KING STREET OGDENSBURG NY 13669 150559686 HOSPITAL NY 501(C)(3) 509(A)(3) NORTH STAR HEALTH ALLIANCE 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0