2017-11-14T15:53:17-06:00 2016-12-31 160765486 LUMSDEN & MCCORMICK LLP 369 FRANKLIN STREET BUFFALO NY 14202 990 2016-01-01 141372647 MOSES-LUDINGTON HOSPITAL MOSE 5185853864 1019 WICKER STREET TICONDEROGA NY 12883 JOHN REMILLARD PRESIDENT 5185853864 2017-11-13 1 MICHAEL J GRIMALDI P01295846 7168563300 38.122.36.250 2017-11-13 15:40:30 ES P 87273CE15A7E4D536C246F8BF2CA388F6BFCF293 ECFD8073557412C3490EDC284AF2457AA53A359D 2016 2017-02-10 21:41:12Z JOHN REMILLARD 1019 WICKER STREET TICONDEROGA NY 12883 12732630 0 X WWW.INTERLAKESHEALTH.COM X 1908 NY A CARING, COMMUNITY RESPONSIVE HEALTHCARE PARTNER THAT PROMOTES WELLNESS, INDIVIDUAL DIGNITY, QUALITY, AND VALUE. 9 9 119 13 0 0 275379 273695 11384980 12123119 113405 112284 315043 223532 12088807 12732630 0 0 0 0 6203942 5506235 0 0 0 5623617 6117729 11827559 11623964 261248 1108666 8542770 9677557 13762361 13788482 -5219591 -4110925 A CARING, COMMUNITY RESPONSIVE HEALTHCARE PARTNER THAT PROMOTES WELLNESS, INDIVIDUAL DIGNITY, QUALITY AND VALUE. 0 0 9343375 12123119 MOSES-LUDINGTON HOSPITAL BEGAN PROVIDING HEALTH CARE SERVICES IN JUNE 1908. TODAY THE HOSPITAL IS A 15 BED CRITICAL ACCESS HOSPITAL WITH A 24-HOUR EMERGENCY ROOM AND HELICOPTER TRANSPORT CAPABILITY, OUTPATIENT CLINIC, PHYSICAL AND OCCUPATIONAL THERAPY CENTERS, CARDIAC REHABILITATION CENTER, OUTPATIENT SURGICAL SERVICES, AND EARLY PREVENTION CENTER. 9343375 1 1 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 16 0 1 119 1 0 0 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 1 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X JENNIFER OLCOTT 5185852831 1019 WICKER STREET TICONDEROGA NY 12883 X ROLAND ALLEN CHAIRPERSON 2.00 2.00 X X 0 0 0 ROBERT DEDRICK VICE-CHAIRPERSON 2.00 2.00 X X 0 0 0 ROSS KELLEY TREASURER 2.00 2.00 X X 0 0 0 CHATTIE VAN WERT SECRETARY 2.00 2.00 X X 0 0 0 DR GLEN CHAPMAN PRESIDENT MEDICAL STAFF 2.00 2.00 X 0 0 0 MICHAEL DISKIN TRUSTEE 2.00 2.00 X 0 0 0 WALTER LENDER TRUSTEE 2.00 2.00 X 0 0 0 DAVID SHELMIDINE TRUSTEE 2.00 2.00 X 0 0 0 DAWN STODDARD TRUSTEE 2.00 2.00 X 0 0 0 JOHN REMILLARD PRESIDENT 20.00 20.00 X 0 0 0 ALAN CHARDAVOYNE CHIEF FINANCIAL OFFICER 20.00 20.00 X 0 0 0 NANCY CAFFREY PHYSICIAN ASSISTANT 40.00 X 171186 0 17156 JAMES HOGAN PHYSICIAN ASSISTANT 40.00 X 156677 0 17156 JAMES L'EPISCOPO PHYSICIAN ASSISTANT 40.00 X 134930 0 5750 KRISTIN THOMPSON DIRECTOR OF CLINICAL OPERATIONS 40.00 X 119809 0 874 TODD JONES PHYSICIAN ASSISTANT 40.00 X 119182 0 310 701784 0 41246 5 0 1 0 UNIDINE CORPORATION 1000 WASHINGTON STREET SUITE 510 BOSTON MA 02118 DIETARY SERVICES 673804 CARDINAL HEALTH - PHARMACY MANAGEMENT 1330 ENCLAVE PARKWAY HOUSTON TX 77077 PHARMACY SERVICES 365906 COMMUNITY PROVIDERS 75 BEEKMAN STREET PLATTSBURGH NY 12901 MANAGEMENT SERVICES - CEO, CFO, CIO 222000 MORRISSWITZER ENVIRONMENTS 185 TALCOTT ROAD WILLISTON VT 05495 ARCHITECTURE SERVICES 216167 FUSION MEDICAL STAFFING LLC PO BOX 82674 LINCOLN NE 68501 LAB TECH SERVICES 141791 6 272455 1240 273695 PATIENT SERVICE REVENUE 621990 12123119 12123119 12123119 112284 112284 MEANINGFUL USE INCENTIVE PAYMENTS 621990 157112 157112 CAFETERIA 722210 48280 48280 REBATES AND REFUNDS 900099 13799 13799 4341 4341 223532 12732630 12123119 0 335816 X 4272041 3515890 756151 1234194 1015742 218452 94726 94726 75230 75230 1904398 1383520 520878 1340306 1169539 170767 669418 379774 289644 8269 4657 3612 10287 10287 377505 339755 37750 102840 18203 84637 PROVISION FOR BAD DEBTS 1154942 1154942 EQUIPMENT RENTAL & MAIN 729583 353106 376477 OTHER 28201 28201 PROFESSIONAL DEVELOPMEN 14019 8247 5772 -391995 -391995 11623964 9343375 2280589 0 232565 427666 1156679 636161 247149 224842 53796 27923 7002680 5188598 1549022 1814082 5303559 6546883 8542770 9677557 1835085 1660013 377045 219932 11429231 11377537 121000 531000 13762361 13788482 X -5551867 -4444779 3210 4788 329066 329066 -5219591 -4110925 8542770 9677557 1108666 0 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 332276 1578 333854 331432 844 332276 330674 758 331432 329823 851 330674 329231 592 329823 0.98570 0.01430 0 0 318586 177554 141032 6201621 5011044 1190577 482473 482473 1814082 INTER-COMPANY A/R 6116878 ASSETS LIMITED AS TO USE 333854 OTHER RECEIVABLES 96151 6546883 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 531000 531000 1 1 1 X 300.000000000000 1 X 300.000000000000 1 0 1 1 11863 11863 0.00110 2481457 110633 2370824 0.22650 11863 11863 0.00110 2505183 110633 2394550 0.22870 10053213 9010359 1042854 0.09960 10053213 9010359 1042854 0.09960 12558396 9120992 3437404 0.32830 0 663034 247447 3937408 3918289 19119 X 1 1 1 1 MOSES-LUDINGTON HOSPITAL 1019 WICKER STREET TICONDEROGA NY 12883 HTTP://WWW.INTERLAKESHEALTH.COM/ X MOSES-LUDINGTON HOSPITAL 1 0 0 1 X X X X X X X X X 16 1 1 1 1 X WWW.INTERLAKESHEALTH.COM X 1 16 0 1 0 1 X 300.000000000000 X X X X 1 1 X X X 1 X HTTP://WWW.INTERLAKESHEALTH.COM/ X 1 X X 0 1 0 0 MOSES-LUDINGTON HOSPITAL PART V, SECTION B, LINE 5: THE 81 QUESTION SURVEY WAS DEVELOPED THROUGH A COLLABORATIVE EFFORT BY A SEVEN-MEMBER SURVEY ARHN SUBCOMITTEE DURING THE SPRING OF 2016. THE SEVEN VOLUNTEER MEMBERS ARE REPRESENTATIVES OF THE COUNTY PUBLIC HEALTH DEPARTMENTS AND HOSPITALS IN THE REGION THAT ARE INVOLVED IN THE ADIRONDACK RURAL HEALTH NETWORK (ARHN). SUBCOMITTEE MEMBERS IDENTIFIED THE BROAD RESEARCH QUESTIONS TO BE ADDRESSED BY THE SURVEY, DRAFTED THE INDIVIDUAL SURVEY QUESTIONS, AND DEVELOPED THE LIST OF RELEVANT HEALTH CARE STAKEHOLDERS THAT RECEIVED THE SURVEY. A MORE DETAILED DESCRIPTION OF THE PROCESS IS INCLUDED IN THE FULL REGIONAL REPORT.THE SURVEY WAS ADMINISTERED ELECTRONICALLY USING A WEB-BASED SURVEY PROGRAM AND DISTRIBUTED TO AN EMAIL CONTACT LIST OF 658. ULTIMATELY, 217 SURVEYS WERE COMPLETED DURING THE SIX-WEEK SURVEY PERIOD, A RESPONSE RATE OF 33.9%. OF ALL 217 RESPONSES, 79 INDICATED THAT ESSEX COUNTY WAS PART OF THEIR SERVICE AREA; HOWEVER IT SHOULD BE NOTED THAT MANY OF THE RESPONDING HEALTHCARE STAKEHOLDERS SERVICE MULTIPLE COUNTIES WITHIN THE LARGER ARHN REGION. MOSES-LUDINGTON HOSPITAL PART V, SECTION B, LINE 6A: OTHER HOSPITALS INCLUDE ELIZABETHTOWN COMMUNITY HOSPITAL AND ADIRONDACK MEDICAL CENTER.DATA WAS GATHERED AND ANALYZED BY ARHN - A REGIONAL MULTI-STAKEHOLDER COALITION THAT CONDUCTS COMMUNITY HEALTH PLANNING ACTIVITIES BY PROVIDING THE FORUM FOR LOCAL PUBLIC HEALTH SERVICES, COMMUNITY HEALTH CENTERS, HOSPITALS, COMMUNITY MENTAL HEALTH PROGRAMS, EMERGENCY MEDICAL SERVICES, AND OTHER COMMUNITY-BASED ORGANIZATIONS TO ASSESS REGIONAL NEEDS AND THE EFFECTIVENESS OF THE RURAL HEALTH CARE DELIVERY SYSTEM. MOSES-LUDINGTON HOSPITAL PART V, SECTION B, LINE 6B: ESSEX COUNTY HEALTH DEPARTMENT MOSES-LUDINGTON HOSPITAL PART V, SECTION B, LINE 11: OTHER HIGH RANKING ISSUES IDENTIFIED IN OUR COMMUNITY HEALTH NEEDS ASSESSMENT WHICH WE WILL NOT BE DIRECTLY ADDRESSING INCLUDE:- MATERNAL AND INFANT HEALTH: AS A SMALL, CRITICAL ACCESS HOSPITAL WITHOUT ONSITE SPECIALTY SERVICES, WE FEEL ILL-EQUIPPED TO ADDRESS THIS IDENTIFIED NEED.- BUILT ENVIRONMENT: WE FEEL THIS ISSUE BETTER ALIGNS WITH THE MISSION OF OTHER ORGANIZATIONS IN THE DEVELOPMENT OF COMMUNITY WALKING PATHS AND COMMUNAL GARDENS.- SUBSTANCE ABUSE AND MENTAL, EMOTIONAL AND BEHAVORIAL HEALTH: ESSEX COUNTY HAS VERY LIMITED MENTAL HEALTH RESOURCES TO HANDLE THE NEEDS OF THE POPULATION. ALTHOUGH IDENTIFIED AS A SIGNIFICANT NEED IN OUR COMMUNITY, MOSES-LUDINGTON CANNOT DEVELOP AND MAINTAIN INTERVENTIONS TO ADDRESS IT. SUBSTANCE ABUSE AND MENTAL HEALTH ARE NOT IN MLH'S CORE MISSION OR SKILL SET. MOSES-LUDINGTON HOSPITAL PART V, SECTION B, LINE 24: SELF-PAY PATIENTS ARE CHARGED GROSS CHARGES UNTIL THEY CONTACT THE HOSPITAL FOR A PROMPT PAYMENT DISCOUNT OR FINANCIAL ASSISTANCE. THE HOSPITAL DOES NOT ROUTINELY DISCOUNT SELF-PAY BILLS. PART I, LINE 7: IN CALCULATING LINE 7, COLUMN E, WE USED THE WORKSHEETS PROVIDED IN THE INSTRUCTIONS FOR THIS SCHEDULE. THE CHARGES AND COSTS THAT WE USED WERE FROM THE COST REPORT AND INCLUDED ALL SERVICES PROVIDED BY THE HOSPITAL. WHERE A COST TO CHARGE RATIO WAS NEEDED, WE USED THE COST TO CHARGE RATIO FROM WORKSHEET C ON THE FILED 2015 MEDICARE COST REPORT. 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 $ 1,154,942. PART III, LINE 4: ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, INTER-LAKES HEALTH 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, INTER-LAKES HEALTH 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 HAVE 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), INTER-LAKES HEALTH 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 8: SINCE MOSES-LUDINGTON IS A CRITICAL ACCESS HOSPITAL, WE TOOK THE MEDICARE ALLOWABLE COSTS CALCULATED ON THE COST REPORT AND REPORTED THEM ABOVE ON LINE 6. PART III, LINE 9B: PER THE MOSES-LUDINGTON FINANCIAL ASSISTANCE POLICY:1. WHEN A PATIENT HAS COMPLETED AND RETURNED AN APPLICATION FOR FINANCIAL ASSISTANCE, THE CLAIM WILL NOT BE FORWARDED TO A COLLECTION AGENCY, PENDING DETERMINATION OF ELIGIBILITY.2. THE HOSPITAL WILL NOT FORECLOSE, REQUIRE A FORCED SALE OR PLACE A LIEN ON THE APPLICANT'S PRIMARY RESIDENCE.3. PATIENTS WILL BE NOTIFIED AT LEAST 30 DAYS PRIOR TO FORWARDING AN ACCOUNT TO THE COLLECTION AGENCY.4. MOSES-LUDINGTON HOSPITAL WILL PROVIDE WRITTEN CONSENT TO A COLLECTION AGENCY PRIOR TO COMMENCING LEGAL ACTION ON AN ACCOUNT.5. COLLECTION AGENCIES CONTRACTED BY MOSES-LUDINGTON HOSPITAL WILL FOLLOW THE HOSPITAL'S FINANCIAL AID POLICIES AND PROCEDURES, INCLUDING THE MEANS OF APPLYING FOR AID.6. COLLECTIONS ARE PROHIBITED FROM PATIENTS ELIGIBLE FOR MEDICAID AT THE TIME OF SERVICE.7. A FAVORABLE DETERMINATION STILL ENABLES THE PATIENT TO MAKE INSTALLMENT PAYMENTS AT NO GREATER THAN 10% OF GROSS MONTHLY INCOME. THE PATIENT WILL BE REQUIRED TO SIGN A PAYMENT AGREEMENT IN THIS INSTANCE. PART VI, LINE 2: MOSES-LUDINGTON HOSPITAL (MLH) REGULARLY SOLICITS FEEDBACK AND INPUT FROM THE RESIDENTS OF OUR COMMUNITIES REGARDING THEIR HEALTH CARE NEEDS AND PREFERENCES. THIS ALLOWS MLH TO ENSURE THAT ESSENTIAL HEALTH CARE SERVICES ARE PRESERVED AND DEVELOPED AS NEEDED. TO THIS END, MLH SERVES ON THE ADIRONDACK RURAL HEALTH NETWORK (ARHN), COMMUNITY HEALTH PLANNING COMMITTEE (CHPC) AND COMMUNITY HEALTH ASSESSMENT (CHA) TASKFORCE.THE ARHN IS A COMMUNITY PARTNERSHIP OF PUBLIC, PRIVATE AND NON-PROFIT ORGANIZATIONS IN UPSTATE NEW YORK. THE ARHN FACILITATES A COLLABORATIVE PROCESS FOR DEVELOPING STRATEGIES AND FOR IMPLEMENTING, MONITORING AND EVALUATING THE REGIONAL HEALTH CARE SYSTEM. AS A LONG TIME MEMBER OF THE ARHN, MLH ACTIVELY SUPPORTS AND PARTICIPATES IN THIS GATHERING OF INFORMATION FROM A VARIETY OF STAKEHOLDERS. THIS PROCESS IS CONDUCTED REGIONALLY AND IS REPEATED EVERY THREE TO FIVE YEARS.MLH ALSO SOLICITS INDIVIDUAL PATIENT FEEDBACK REGULARLY THROUGH MULTIPLE PATIENT SATISFACTION SURVEYS. THESE SURVEYS ARE DEPARTMENT SPECIFIC AND ARE A VALUABLE METHOD OF MEASURING PUBLIC PERCEPTION OF PATIENT CARE. BOTH IN-PATIENT AND OUT-PATIENT DEPARTMENT DISCHARGES ARE SURVEYED, IN WRITTEN FORM AND BY TELEPHONE. PART VI, LINE 3: BY VIRTUE OF ITS EXEMPTION FROM FEDERAL AND STATE TAXES, AND AS PART OF THE HOSPITAL'S MISSION TO SERVE THE HEALTHCARE NEEDS OF THE COMMUNITY, MLH PROVIDES CHARITY CARE TO PATIENTS WITHOUT HEALTH INSURANCE OR THE FINANCIAL MEANS TO PAY FOR HOSPITAL SERVICES. CHARITY CARE IS PROVIDED TO ALL PATIENTS IN NEED IN FULL COMPLIANCE WITH TITLE VI OF THE CIVIL RIGHTS ACT, WITHOUT REGARD TO RACE, CREED, COLOR OR NATIONAL ORIGIN. CHARITY CARE SERVICES INCLUDE THOSE WHO ARE CLASSIFIED AS FINANCIALLY OR MEDICALLY INDIGENT ACCORDING TO THE HOSPITAL'S ELIGIBILITY SYSTEM.MLH PUBLISHES A FINANCIAL ASSISTANCE SUMMARY, UPDATED ANNUALLY, THAT ANSWERS ELIGIBILITY QUESTIONS AND DESCRIBES THE APPLICATION PROCESS. MLH EMPLOYS PATIENT ACCOUNTING REPRESENTATIVES FOR THIS PURPOSE. REGISTRATION STAFF IS TRAINED TO EDUCATE PATIENTS WHO NEED FINANCIAL ASSISTANCE WHEN THEY PRESENT FOR SERVICES. UNINSURED PATIENTS ARE PROVIDED A PACKET OF INFORMATIONAL MATERIAL, INCLUDING A FINANCIAL ASSISTANCE APPLICATION. SERVICES OF A TRANSLATOR ARE AVAILABLE FOR NON-ENGLISH SPEAKING OR HEARING IMPAIRED PATIENTS.IN THE EVENT THAT IT IS DETERMINED THAT A PATIENT DOES NOT QUALIFY FOR FREE OR LOW-COST INSURANCE, MLH'S FINANCIAL COUNSELOR OR PATIENT ACCOUNTING REPRESENTATIVE WILL ASSIST THEM IN APPLYING FOR A DISCOUNT. PART VI, LINE 4: MLH'S SERVICE AREA IS DEFINED BY ZIP CODE, AND IS COMPOSED PRIMARILY OF SIX ZIP CODES IN SOUTHEASTERN ESSEX COUNTY AND NORTHEASTERN WARREN AND WASHINGTON COUNTIES. HISTORICALLY, ABOUT 90% OF MLH'S PATIENTS RESIDE WITHIN THIS GEOGRAPHY, WITH THE REMAINING 10% BEING SEASONAL RESIDENTS. MLH SERVES AN INDEFINABLE TOURIST POPULATION AS WELL, SINCE THIS REGION IS A POPULAR NATIONAL VACATION SPOT. MLH IS LOCATED IN CONGRESSIONAL DISTRICT 23, 57 MILES FROM THE NEAREST ACUTE CARE NEW YORK STATE HOSPITAL, AND IS GEOGRAPHICALLY REMOTE FROM THREE COUNTY SEATS. THE TOWN OF TICONDEROGA IS LOCATED WITHIN THE 6 MILLION ACRE ADIRONDACK PARK. THE AREA'S SMALL VILLAGES AND HAMLETS ARE AT RISK FOR COMPLETE ISOLATION DURING ALL SEASONS BECAUSE OF THE SEVERE WEATHER CONDITIONS, FREQUENT POWER OUTAGES, ROAD IMPASSABILITY, AND MOUNTAINOUS TOPOGRAPHY. FOR THESE REASONS, AREA RESIDENTS TEND TO BE PLACE-BOUND AND ISOLATED. PUBLIC TRANSPORTATION IS VIRTUALLY NON-EXISTENT, AND THERE ARE FEW SECONDARY ROADS. MLH OPERATES A GRANT FUNDED BUS FOR PATIENT TRANSPORT TO AND FROM THE HOSPITAL AND PHYSICIAN'S OFFICES FOR THOSE WHO NEED TRANSPORTATION. THE TOWN OF TICONDEROGA ALSO OWNS AND OPERATES A SENIOR BUS AS LOW COST TRANSPORTATION FOR THE OTHERWISE HOME-BOUND ELDERLY.THE ECONOMY IS PRIMARILY GOVERNMENTAL OR SEASONAL, AND INCLUDES LAW ENFORCEMENT, PRISONS, EDUCATION, AND HEALTHCARE. MLH/ILH IS ONE OF THE TOP THREE EMPLOYERS IN THE TICONDEROGA AREA, FOLLOWED BY THE SCHOOL SYSTEM AND INTERNATIONAL PAPER'S TICONDEROGA MILL. MUCH OF THE AREA'S EMPLOYMENT OPPORTUNITIES FOCUS ON SEASONAL TOURISM, ALTHOUGH THIS HAS BEEN THINNING OVER THE YEARS. IT REACHED AN ALL-TIME LOW AFTER RISING GAS PRICES MET THE DWINDLING ECONOMIC CLIMATE NATIONWIDE. SEASONAL EMPLOYMENT USUALLY COMES WITHOUT HEALTHCARE BENEFITS, AND SO EXPANDS THE NUMBER OF WORKING COMMUNITY MEMBERS WITHOUT MEDICAL INSURANCE. LACKING SUBSTANTIAL EMPLOYMENT WITHOUT COMPREHENSIVE BENEFIT PLANS CONTRIBUTES TO THE POVERTY OF THE AREA'S RESIDENTS. IN THIS REGION, CHILDREN BETWEEN THE AGES OF 5 AND 17 LIVE IN POVERTY AT A RATE OF 16.1%.BASED ON THE U.S. CENSUS ESTIMATES, APPROXIMATELY 14,000 PEOPLE LIVE YEAR-ROUND WITHIN MLH'S SERVICE AREA, OF WHICH 50.4% ARE MALE AND 49.6% ARE FEMALE. OF THE TOTAL FEMALE POPULATION, APPROXIMATELY 38% ARE OF CHILDBEARING AGE. PEOPLE OVER THE AGE OF 65 CONSTITUTE 17.3% OF THE POPULATION. ETHNICALLY, NEARLY 100% OF THE POPULATION IS WHITE AND/OR NON-HISPANIC. THE GREATEST POPULATION GROWTH TREND IN OUR SERVICE AREA WILL BE FOR PEOPLE BETWEEN THE AGES 45 AND 75. PART VI, LINE 5: MOSES-LUDINGTON HOSPITAL (MLH) AND ITS PARENT INTER-LAKES HEALTH (ILH) ARE GOVERNED BY A VOLUNTEER BOARD MADE UP OF COMMUNITY MEMBERS. MANY MEMBERS OF OUR BOARD SERVE IN A PUBLIC CAPACITY, EITHER AS A MEMBER OR OFFICER ON ANOTHER NOT-FOR-PROFIT BOARD OR COMMITTEE, OR IN A POSITION WITHIN PUBLIC HEALTH, OR AS A MEMBER OF A NON-FOR-PROFIT SERVICE ORGANIZATION WITHIN THE SAME SERVICE AREA.MLH PARTICIPATES IN THE HRSA BIOTERRORISM GRANT PROGRAM, A FEDERAL PROGRAM ADMINISTERED THROUGH THE NYS DEPARTMENT OF HEALTH'S GRANT ADMINISTRATION OFFICES. THIS PROGRAM PROVIDES ONGOING INDIVIDUAL AND GROUP TRAINING IN MANY ASPECTS OF EMERGENCY PREPAREDNESS. MLH'S ENVIRONMENT OF CARE (EOC) MANAGER FACILITATES THE GRANT AND OVERSEES THE HOSPITAL SAFETY PROGRAM AND DECONTAMINATION TEAM. SHE PARTICIPATES IN REGULAR DRILLS IN COOPERATION WITH AREA ORGANIZATIONS, INCLUDING BUT NOT LIMITED TO LOCAL EMS SQUADS, THE VOLUNTEER FIRE DEPARTMENT, LOCAL POLICE AND COUNTY AUTHORITIES.A NUMBER OF NOT-FOR-PROFIT COMMUNITY-BASED ORGANIZATIONS USE SPACE AT MLH TO HOST COMMUNITY SERVICE-ORIENTED MEETINGS, FREE AND OPEN TO THE PUBLIC, INCLUDING BUT NOT LIMITED TO ALCOHOLICS ANONYMOUS AND CELEBRATE RECOVERY.MLH DONATES PRIVATE CONSULTATION SPACE ON CAMPUS FOR THE ESSEX COUNTY MENTAL HEALTH ASSOCIATION TO UTILIZE AS A CLINIC OFFICE TO COUNSEL PATIENTS FROM OUR SERVICE AREA THAT MAY NOT HAVE RELIABLE TRANSPORTATION TO TRAVEL THE 50-MILE TRIP TO THE ASSOCIATION'S ELIZABETHTOWN HEADQUARTERS. WE HOST AN ALZHEIMER SUPPORT GROUP, CONDUCT 4 BLOOD DRIVES PER YEAR, HOST AN ANNUAL HEALTH FAIR AND HELP SUPPORT OTHER CAUSES IN THE COMMUNITY. PART VI, LINE 6: IN JUNE OF 2010, INTER-LAKES HEALTH SIGNED AN AFFILIATION AGREEMENT WITH FLETCHER ALLEN HEALTH CARE (FAHC). THE INTENT BEHIND THIS AGREEMENT WAS TO "RAISE THE BAR" OF CLINICAL AND MANAGERIAL EXPERTISE AT MOSES-LUDINGTON HOSPITAL. THE AFFILIATION AGREEMENT WILL ENABLE BOTH ORGANIZATIONS TO WORK MORE CLOSELY TOGETHER TO MEET THE HEALTH CENTER NEEDS OF THE SOUTHERN ADIRONDACKS AND GREATER TICONDEROGA AREA. FAHC BRINGS A WEALTH OF RESOURCES TO THE TABLE WITH THEIR PARTNERS AT THE UNIVERSITY OF VERMONT COLLEGE OF MEDICINE AND THE COLLEGE OF NURSING AND HEALTH SCIENCES. A MANAGEMENT AGREEMENT IS IN PLACE BETWEEN THE TWO FACILITIES. FAHC HAS BEEN INSTRUMENTAL IN THE SEARCH AND ACQUISITION OF A PERMANENT CEO FOR MLH. THIS INDIVIDUAL SERVES AS PRESIDENT AND CEO OF ALL OF INTER-LAKES HEALTH, INC. PART VI, LINE 7, REPORTS FILED WITH STATES NY X X 0 0 0 0 0 0 0 0 0 NANCY CAFFREY PHYSICIAN ASSISTANT 171186 0 0 0 0 0 0 0 17156 0 188342 0 0 0 JAMES HOGAN PHYSICIAN ASSISTANT 156677 0 0 0 0 0 0 0 17156 0 173833 0 0 0 FORM 990, PART VI, SECTION A, LINE 6 INTER-LAKES HEALTH, INC. IS THE SOLE CORPORATE MEMBER OF MOSES-LUDINGTON HOSPITAL. FORM 990, PART VI, SECTION B, LINE 11B THE PRESIDENT AND INTERIM CFO REVIEW PRIOR TO THE FILING OF FORM 990. A FINAL COPY IS SHARED WITH THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 12C THE POLICY IS MONITORED AND ENFORCED THROUGH REGULAR EDUCATION AND INVOLVEMENT BY THE CORPORATE COMPLIANCE COMMITTEE. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION IS DETERMINED BY BOARD AND HUMAN RESOURCES REVIEW AS WELL AS SALARY SURVEYS. FORM 990, PART VI, SECTION C, LINE 19 THE POLICIES ARE MADE AVAILABLE VIA THE WEBSITE AND BY REQUEST. FORM 990, PART IX, LINE 11G OTHER FEES FOR SERVICES: PROGRAM SERVICE EXPENSES 1,383,520. MANAGEMENT AND GENERAL EXPENSES 520,878. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,904,398. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. INTER-LAKES HEALTH INC 1019 WICKER STREET TICONDEROGA NY 12883 141746088 SOLE CORPORATE MEMBER OF THE HOSPITAL, NURSING HOME, FOUNDATION, LORD HOWE NY 501(C)(3) LINE 12B, II N/A 0 MOSES-LUDINGTON NURSING HOME 1019 WICKER STREET TICONDEROGA NY 12883 237304957 PROVIDER OF LONG TERM HEALTH CARE SERVICES OF PATIENTS NY 501(C)(3) LINE 10 INTER-LAKES HEALTH INC 0 INTER-LAKES FOUNDATION INC 1019 WICKER STREET TICONDEROGA NY 12883 810566557 PROMOTE AND SUPPORT COMMUNITY HEALTHCARE SERVICES NY 501(C)(3) LINE 7 INTER-LAKES HEALTH INC 0 LORD HOWE ESTATES HOUSING DEVELOPMENT FUND CORPORATION 1019 WICKER STREET TICONDEROGA NY 12883 242434840 PROVIDING SUBSIDIZED HOUSING FOR THE ELDERLY AND HANDICAPPED NY 501(C)(3) LINE 10 INTER-LAKES HEALTH INC 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0