2017-10-12T12:22:28-05:00 2016-12-31 221478099 COHNREZNICK LLP 4 BECKER FARM ROAD ROSELAND NJ 07068 990 2016-01-01 141628237 HUDSON HEADWATERS HEALTH NETWORK INC HUDS 5187610300 9 carey road queensbury NY 12804 Christopher Tournier CFO 5187610300 2017-10-10 1 LORI ROTHE YOKOBOSKY CPA P01273422 9732283500 2017-10-06 209.3.217.20 2017-10-10 10:52:34 ED P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 67CFAA63E2A691D60518C91E1992F03FF1BDEC35 2016 2021-01-29 14:40:06Z DR SLINGERLAND 9 carey road queensbury NY 12804 94723867 0 X WWW.HHHN.ORG X 1981 NY FQHC - OUR MISSION IS TO PROVIDE THE BEST HEALTH CARE AND ACCESS TO THAT CARE FOR EVERYONE IN OUR COMMUNITIES. 18 18 900 10 2403293 48135 10270592 10636423 73153627 58683298 -540842 31205 3455023 25352255 86338400 94703181 0 0 0 0 52367487 58060131 0 0 0 26009123 27617128 78376610 85677259 7961790 9025922 63307812 73659647 21367288 24893201 41940524 48766446 X WE ARE A COMMUNITY BASED HEALTH CLINIC WHICH SERVICED 79,471 patients in 2016. TO FURTHER THE PROVISION OF COMPREHENSIVE HEALTH CARE SERVICES TO THE GENERAL POPULATION OF WARREN, WASHINGTON, SARATOGA, HAMILTON AND ESSEX COUNTIES. TO PROMOTE, SPONSOR, FOSTER AND DELIVER PROGRAMS, ACTIVITIES AND SERVICES WHICH SHALL HAVE THE PURPOSE OF IMPROVING THE HEALTH AND WELL-BEING OF THE POPULATION SERVED BY THIS CORPORATION AND TO CONTINUALLY SEEK NEW AND INNOVATIVE METHODS OF IMPROVING HEALTH CARE DELIVERY AND ITS FINANCING TO THE COMMUNITY SERVED. TO CARRY OUT ANY EDUCATION AND TEACHING ACTIVITIES RELATED TO RENDERING HEALTH CARE OR TO THE PROMOTION OF HEALTH THAT IN THE OPINION OF THE BOARD OF DIRECTORS MAY BE JUSTIFIED BY THE FACILITIES, PERSONNEL, FUNDS OR OTHER RESOURCES THAT ARE FOR, OR CAN BE, MADE. 0 0 70652202 80851222 The center is a community based health center clinic with multiple locations. In 2016, we serviced 79,471 patients with 351,299 visits. 5200929 654741 340B pharmacy program - as a federally qualified health center we are able to acquire drugs at the lower prices mandated by the federal 340B drug purchasing program, this allows us to assist indigent patients with the sometime overwhelming costs of prescription medications. Facilitate the Hudson Headwaters Health Network patient assistance program which enables needy patients to receive medications free of charge from the drug manufacturers and generate revenue to support HHHN's overall operational viability. 75853131 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 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 66 0 1 900 1 1 1 0 0 0 0 0 0 0 0 0 X 18 18 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 NY X AMY GERSTEN 5187610300 9 Carey Road Queensbury NY 12804 Amy Langworthy Board Member 1.00 X 0 0 0 Barbara Sweet Board Chair 1.00 0.10 X X 0 0 0 Bruce Carr Board Member 1.00 X 0 0 0 bruce robbins Outgoing board member 1.00 X 0 0 0 Cathy Moses Secretary 1.00 X X 0 0 0 Celine Racine-Paquette Executive Committee Member at Large 1.00 X 0 0 0 Dana Hogan Board Member 1.00 X 0 0 0 Eileen Haynes Board Member 1.00 0.10 X 0 0 0 Eugene Arsenault Treasurer 1.00 0.10 X X 0 0 0 Graham greeley Outgoing secretary 1.00 0.10 X X 0 0 0 Harry Robinson Board Member 1.00 0.10 X 0 0 0 Ike Wolgin Vice-Chair 1.00 X X 0 0 0 jean cronin Outgoing member-at-large 1.00 1.10 X 0 0 0 Jim Morris Board Member 1.00 X 0 0 0 joseph kelly Outgoing board chair 1.00 0.10 X X 0 0 0 Kevin Porpora Board Member 1.00 X 0 0 0 Michael McCarthy Board Member 1.00 X 0 0 0 Mildred Anzalone Board Member 1.00 X 0 0 0 Patricia Allen Board Member 1.00 X 0 0 0 Patricia Hunt Board Member 1.00 0.10 X 0 0 0 Peter Reale Board Member 1.00 X 0 0 0 William O'Dwyer Board Member 1.00 1.00 X 0 0 0 Christopher Tournier CFO 40.00 1.10 X 227090 0 31114 David T Slingerland MD Deputy CEO 40.00 X 260516 0 31369 John Rugge MD CEO 40.00 1.10 X 434279 0 34228 Daniel Larson MD CMO 40.00 X 266174 0 31884 Edward Shannon CDO 40.00 X 188620 0 28881 George Purdue CAO 40.00 X 252172 0 20838 John Sawyer MD CMO 40.00 X 157569 0 29656 Paul Bachman MD CMO 40.00 X 257554 0 21752 Michael Fuller MD Physician 40.00 X 261071 0 35124 Thomas Portuese MD Physician 40.00 X 257837 0 38178 Willaim Borgos MD Vice President & Physician 40.00 X 242697 0 32070 William Cleaver Physician 40.00 X 242180 0 8193 William Parker MD Physician 40.00 X 257350 0 30804 3305109 0 374091 14 0 1 0 RICHARD E JONES ASSOCIATES 339 Aviation Rd queensbury NY 12804 ARCHiTECTURAL AND ENGINEERING SERVICES 644091 T&J ELECTRICAL ASSOCIATES LLC 5 Fairchild Square Clifton Park NY 12065 Electrical work 302474 COHNREZNICK LLP 1301 AVENUE OF THE AMERICAS NEW YORK NY 10019 accounting/tax services 252504 GARNET RIVER LLC 60 Railroad Pl 501 saratoga Springs NY 12866 management consulting 212217 ADIRONDACK APOTHECARY LLC 1081 Main St po box 458 Schroon Lake NY 12870 consulting services 117056 6 28091 7962363 2645969 10636423 Other Third-party payors 621400 22449743 22449743 medicare 621400 13639518 13639518 Medicaid Managed Care 621400 7699970 7699970 Self-Pay 621400 6357773 6357773 New York State Medicaid and Medic 621400 4258929 4258929 4277365 4277365 58683298 19391 19391 126297 0 126297 126297 126297 32500 20686 11814 11814 11814 PHARMACY 621400 20784021 20784021 340b consulting 541610 3058034 654741 2403293 Engagement revenue 621400 623000 623000 760903 760903 25225958 94703181 81505963 2403293 157502 2288754 2063231 225523 43361811 41072053 2289758 1710596 1542138 168458 7107247 6407334 699913 3591723 3238015 353708 204926 204926 224738 224738 5964938 3665538 2299400 346198 167107 179091 893654 561311 332343 1492164 621455 870709 2046222 1824996 221226 367633 274575 93058 127554 95266 32288 351651 351651 2247087 1715893 531194 333263 143130 190133 FEDERAL TAXES 91295 50567 40728 340 b supplies 5200929 5200929 PROVISION FOR BAD DEBT 2123962 2123962 pharmacy supplies 1695875 1695875 3905039 3038105 866934 85677259 75853131 9824128 0 464829 511313 13945812 13641604 109845 156552 8173433 10869391 350000 350000 624524 638768 55381189 12050753 35951753 43330436 1000000 1000000 270000 270000 2417616 2891583 63307812 73659647 9936063 12521098 109936 5542794 6298709 3500000 3092560 2388431 2870898 21367288 24893201 X 41940524 48766446 41940524 48766446 63307812 73659647 9025922 0 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 3277150 3277150 31504616 4438182 27066434 3565712 1955117 1610595 5734809 2201992 3532817 11298902 3455462 7843440 43330436 DEFERRED COMPENSATION PAYABLE 2870898 2870898 X 93107409 21948 -1617720 -1595772 94703181 0 94703181 86029119 21948 -1870088 -1848140 87877259 0 87877259 Part X, Line 2: The Companies have no unrecognized tax benefits at December 31, 2016. The Companies federal and state information returns prior to calendar year 2013 are closed and management continually evaluates expiring statutes of limitations, audits, proposed settlements, changes in tax law and new authoritative rulings. The Companies recognize interest and penalties associated with tax matters as operating expenses and include accrued interest and penalties with accrued expenses in the consolidated statement of financial position. Part XI, Line 2d - Other Adjustments: RELATED PARTies REVENUE 525,651. Intercompany eliminations -19,409. bad debt expense -2,123,962. Part XII, Line 2d - Other Adjustments: RELATED PARTies EXPENSES 273,283. INTERCOMPANY ELIMINATIONs -19,409. bad debt expense -2,123,962. X X X X 0 0 0 0 0 0 0 1 0 Christopher Tournier CFO 197326 0 27389 0 2375 0 13303 0 19600 0 259993 0 0 0 David T Slingerland MD Deputy CEO 212106 0 29469 0 18941 0 15591 0 17457 0 293564 0 0 0 John Rugge MD CEO 331513 0 68987 0 33779 0 15900 0 20747 0 470926 0 0 0 Daniel Larson MD CMO 222649 0 32756 0 10769 0 15246 0 18674 0 300094 0 0 0 Edward Shannon CDO 162226 0 24219 0 2175 0 11236 0 19515 0 219371 0 0 0 George Purdue CAO 213006 0 37359 0 1807 0 14754 0 7872 0 274798 0 0 0 John Sawyer MD CMO 147314 0 6630 0 3625 0 13212 0 17867 0 188648 0 0 0 Paul Bachman MD CMO 165912 0 69668 0 21974 0 15668 0 8138 0 281360 0 0 0 Michael Fuller MD Physician 152421 0 98588 0 10062 0 14346 0 22470 0 297887 0 0 0 Thomas Portuese MD Physician 149013 0 100363 0 8461 0 15900 0 23945 0 297682 0 0 0 Willaim Borgos MD Vice President & Physician 162932 0 70290 0 9475 0 14625 0 19162 0 276484 0 0 0 William Cleaver Physician 186577 0 48458 0 7145 0 2109 0 7415 0 251704 0 0 0 William Parker MD Physician 131248 0 123271 0 2831 0 15456 0 17014 0 289820 0 0 0 Part I, Line 7 The organization provided bonuses to various officers, and highest compensated employees. These amounts are included in SCHedule J, Part II, Column B(II). SCHEDULE J, PART II: AMOUNTS SHOWN ON PART II, COLUMN B(III) INCLUDE THE EMPLOYEE CONTRIBUTIONS TO THE 457(B) PLAN, as well as Group Term Life insurance. A counties of warren & washington civic development corporation 383853734 2014-12-16 6500000 land, facility & equipment for health center 0 0 0 B clinton county capital resource corporation 452521133 2015-12-18 6500000 land, facility & equipment for health center 0 0 0 A 251296 6500000 50000 5442789 1007211 2015 0 0 1 1 B 50005 50005 0 0 1 1 A 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 A 0 0 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 0 0 A 0 B 0 schedule k, Part I, line b: During 2015, the Network took out an additional loan for construction. The outstanding amount relates to the initial draws in order to secure the loan. The construction period draws began in December 2015 and the remaining draws are expected to primarily occur in 2017. Once the draw period ends, the outstanding amount will be converted to a note and paid back based on the amortization schedule. The loan bears interest at 2.85%. The maximum amount of draws on this loan is $6,500,000. The term of this loan, once converted to a note, is 7 years with a 20 year amortization period. In addition, the Network must meet certain financial covenants. Form 990, Part VI, Section B, line 11b An independent accountant prepares the 990. After preparation, a copy of the draft return is provided to the Board Members via email or at a Board meeting prior to submission with the IRS. Form 990, Part VI, Section B, line 12c The organization regularly and consistently monitors its' conflict of interest policy with an annual update of all interest that could potentially lead to a conflict of interest for all employees. If a conflict of interest potential is recognized the board shall determine whether a conflict exists and whether such director should abstain from voting. Form 990, Part VI, Section B, line 15a the board of directors sets compensation for the CEO. the ceo sets the compensation for members of senior management. the organization also uses a survey where possible, comparable positions within the region, compensation consultants and board review. Compensation is determined by a combination of senior management, finance and human resources to ensure fairness and consistency in setting pay rate and benefit levels. Form 990, Part VI, Section C, line 19 Documents are Available upon written request. They are made available at our administrative office at 9 Carey Road, Queensbury, NY. Form 990, Part XII, Line 2C: The selection and oversight Process did not change from the prior year. Form 990, Part IV, question 20a: The organization is licensed under article 28 of New York State Public Health Law. However, subsection 10 of article 28 excludes certain healthcare facilities from the definition of general hospital. Therefore, the organization is not including schedule H in the current year form 990 as they do not meet this definition. HUDSON HEADWATERS STRATEGIC SERVICES LLC 9 Carey Road Queensbury NY 12804 811084946 consulting NY Hudson Headwaters Health Network Hudson Headwaters Health Foundation 9 Carey Rd Queensbury NY 12804 651261242 Financial support to Hudson Headwaters Health Network NY 501(c)(3) Line 12a, I Hudson Headwaters Health Network 1 Compre Care Inc 9 Carey Rd Queensbury NY 12804 141692479 Idle Health center Operation NY 501(c)(3) Line 3 Hudson Headwaters Health Network 1 hudson headwaters health management po box 357 glen falls NY 12801 141467175 managment services NY Hudson Headwaters Health Network C 226 112892 1.00000 1 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0