2016-10-31T15:22:42-05:00 2015-12-31 160765486 LUMSDEN & MCCORMICK LLP 369 FRANKLIN STREET BUFFALO NY 14202 990 2015-01-01 160772474 TLC HEALTH NETWORK TLCH 7169517000 845 ROUTES 5 20 IRVING NY 140819716 JOHN GALATI PRESIDENT & CHIEF EXECUTIVE OFFICER 7169517000 2016-10-27 1 MICHAEL J GRIMALDI P01295846 7168563300 2015 2017-02-10 21:41:12Z JOHN GALATI 845 ROUTES 5 20 IRVING NY 140819716 28211358 0 X WWW.TLCHEALTH.ORG X 2002 NY TLC HEALTH NETWORK (TLC) IS A HEALTH SYSTEM AND DESIGNATED SAFETY NET/VITAL ACCESS PROVIDER IN WESTERN NEW YORK THAT OFFERS A VARIETY OF CRITICAL HEALTH SERVICES TO UNDERSERVED, RURAL COMMUNITIES OF CHAUTAUQUA, CATTARAUGUS, AND SOUTHERN ERIE COUNTIES. TLC WAS FORMED AS A RESULT OF A MERGER BETWEEN THE FORMER TRI-COUNTY MEMORIAL HOSPITAL IN GOWANDA, NY AND LAKE SHORE HOSPITAL (NOW LAKE SHORE HEALTH CARE CENTER) IN IRVING, NY. TLC OPERATES FACILITIES IN CHAUTAUQUA, CATTARAUGUS, AND ERIE COUNTIES INCLUDING LAKE SHORE HEALTH CARE CENTER, GOWANDA URGENT CARE & MEDICAL CENTER, FORESTVILLE PRIMARY CARE CENTER, AND OUTPATIENT CHEMICAL DEPENDENCY CLINICS IN CASSADAGA AND DERBY. WE ALSO OPERATE A HOME HEALTH CARE AGENCY THAT OPERATES THROUGHOUT THE TRI-COUNTY AREA. 6 5 531 7 222848 -461060 4972448 2945348 24197449 23922117 119306 172048 240027 1171845 29529230 28211358 0 0 0 0 15983102 15244343 0 0 3347 16012945 13605830 31996047 28850173 -2466817 -638815 24147357 23906963 13796585 14385352 10350772 9521611 X TLC HEALTH NETWORK'S MISSION IS TO PROVIDE A DIVERSE RANGE OF QUALITY HEALTHCARE SERVICES THROUGHOUT WESTERN NEW YORK WHILE ADHERING TO THE VALUES UPON WHICH WE WERE FOUNDED:INTEGRITY - COMPASSION - ACCOUNTABILITY - RESPECT - EXCELLENCE 0 0 5609712 INPATIENT CARE: TLC HEALTH NETWORK PROVIDES INPATIENT ACUTE AND BEHAVIORAL HEALTH TO RESIDENTS OF IRVING, NY AND THE SURROUNDING AREA REGARDLESS OF ABILITY TO PAY. INPATIENT ADMISSIONS FOR 2015 TOTALED 1,194. 11040628 OUTPATIENT, SURGICAL & EMERGENCY CARE: TLC HEALTH NETWORK PROVIDES OUTPATIENT, SURGICAL AND EMERGENCY HOSPITAL CARE TO RESIDENTS OF IRVING, NY AND THE SURROUNDING AREA REGARDLESS OF ABILITY TO PAY. OUTPATIENT, SURGICAL AND EMERGENCY CARE VISITS FOR 2015 TOTALED 59,988. 3151272 SKILLED NURSING CARE: TLC HEALTH NETWORK PROVIDES SKILLED NURSING CARE TO RESIDENTS OF IRVING, NY AND THE SURROUNDING AREA REGARDLESS OF ABILITY TO PAY. PATIENT CARE DAYS FOR 2015 TOTALED 3,908. 2547837 HOME HEALTH CARE: TLC HEALTH NETWORK PROVIDES HOME HEALTH CARE TO RESIDENTS OF IRVING, NY AND THE SURROUNDING AREA REGARDLESS OF ABILITY TO PAY. HOME HEALTH CARE VISITS FOR 2015 TOTALED 24,541. 2547837 22349449 1 1 0 0 0 0 0 0 0 1 1 0 0 1 1 1 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 1 103 0 1 531 1 1 1 0 0 0 0 0 0 0 0 0 X 6 5 0 0 0 0 0 0 1 1 1 0 0 0 1 1 1 1 1 1 1 0 NY X X DAWN TURK 7169517000 12644 SENECA ROAD IRVING NY 14081 TIMOTHY COOPER CHAIR 5.00 X X 0 0 0 JAMES WILD MD SECRETARY 15.00 X 67958 0 0 THOMAS POSTLE MEMBER 2.00 X 0 0 0 VIRGINIA COOPER MEMBER 2.00 X 0 0 0 DANA ANDERSON MD MEMBER 2.00 X 8932 0 0 BRIAN FENZL MEMBER 2.00 X 0 0 0 JOHN GALATI PRESIDENT & CHIEF EXECUTIVE OFFICER 25.00 X 154398 0 10077 JOHN EICHNER DIRECTOR OF FINANCE 40.00 X 100749 0 12714 JOEL YOVIENE PHYSICIAN 40.00 X 132605 0 5175 ROBERT PIOTROWSKI PHYSICIAN ASSISTANT 40.00 X 144077 0 6520 AMY BLUM PHARMACIST 40.00 X 113281 0 9317 ELIZABETH LYBOULT PHARMACIST 40.00 X 112945 0 10117 CHARLES SPICOLA DIRECTOR OF PHARMACY 40.00 X 127075 0 4858 962020 0 58778 8 0 1 0 MENTER RUDIN & TRIVELPIECE PC 308 MALTBIE STREET SUITE 200 SYRACUSE NY 13204 LEGAL SERVICES 1487500 WILLCARE 346 DELAWARE AVENUE BUFFALO NY 14202 HOMECARE AID SERVICES 587755 JAMESTOWN PSYCHIATRIC PC 305 EAST FAIRMOUNT AVENUE LAKEWOOD NY 14750 PSYCHIATRIST 550000 LABORATORY CORPORATION OF AMERICA PO BOX 2240 BURLINGTON NC 27216 LABORATORY SERVICES 422459 BROOKS MEMORIAL HOSPITAL 529 CENTRAL AVENUE DUNKIRK NY 14048 VARIOUS SERVICES 375855 10 2938163 7185 2945348 NET PATIENT SERVICE REVENUE 621990 23916874 23694026 222848 NURSING SERVICE REVENUE 621990 5243 5243 23922117 120027 120027 4420 0 4420 4420 4420 52021 0 52021 52021 52021 INSURANCE RECOVERY, NET 900099 778340 778340 GAIN ON BANKRUPTCY SETTLEMENT 900099 117039 117039 CAFETERIA/VENDING 722210 77354 77354 194692 194692 1167425 28211358 23699269 222848 1343893 354827 76890 277937 12007632 9134264 2872458 910 240741 190553 50169 19 1737497 1303148 434220 129 903646 674542 229038 66 349514 349514 1410487 1065254 345233 97865 48633 49232 991334 793067 198267 155599 123821 31778 133667 106934 26733 2234945 1787956 446989 248265 198612 49653 PURCHASED SERVICES 3563082 3045535 517547 MEDICAL & NON-MEDICAL S 2830893 2704077 125946 870 MISCELLANEOUS 851905 522643 327909 1353 LEASES AND RENTALS 738274 573520 164754 28850173 22349449 6497377 3347 1535 1645 374670 1009151 4288576 3349120 605667 550890 571886 525863 54081157 40031614 15466869 14049543 2838154 4420751 24147357 23906963 9874766 10493563 600000 603305 365805 3318514 2925984 13796585 14385352 X 7544822 6906007 2805950 2615604 10350772 9521611 24147357 23906963 X -638815 -190346 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2805950 -190346 2615604 2861552 -55602 2805950 2731677 129875 2861552 2593589 138088 2731677 2782487 -188898 2593589 1.00000 1 0 697617 697617 23664579 14795755 8868824 1313838 1180684 133154 27903210 24055175 3848035 501913 501913 14049543 INTEREST IN PERPETUAL TRUST 1815604 INTERCOMPANY RECEIVABLE 294822 BANKRUPTCY ESCROW 1597347 INSURANCE PROCEEDS DESIGNATED FOR REPAIRS 579086 OTHER ASSETS 133892 4420751 ACCRUED PAYROLL AND RELATED LIABILITIES 1401470 ESTIMATED THIRD PARTY-PAYOR SETTLEMENTS 1524514 2925984 X PART V, LINE 4: FOR HOSPITAL SERVICES. PART X, LINE 2: TLC IS A 501(C)(3) ORGANIZATION EXEMPT FROM INCOME TAXES UNDER SECTION 501(A) OF THE INTERNAL REVENUE CODE. TLC BELIEVES IT IS NO LONGER SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAXING AUTHORITIES FOR YEARS ENDED PRIOR TO DECEMBER 31, 2012. 1 1 X 1 X 1 X 101.000000000000 1 0 1 1 722686 999962 -277276 0.00000 7314696 6553619 761077 0.02750 173748 0 173748 0.00630 8211130 7553581 657549 0.03380 16246985 11717963 4529022 0.16340 16246985 11717963 4529022 0.16340 24458115 19271544 5186571 0.19720 0 571790 231727 4692798 5062651 -369853 X 1 0 1 1 TLC HEALTH NETWORK - LAKESHORE HOSPITAL 845 ROUTES 5 20 IRVING NY 14081 X X IP MENTAL HEALTH, LONG TERM CARE, HOME HEALTH SERVICES, URGENT CARE, CLINICS TLC HEALTH NETWORK - LAKE SHORE HOSPITAL 1 0 0 1 X X X X X X X X X 13 1 1 1 1 X WWW.TLCHEALTH.ORG X WWW.CO.CHAUTAUQUA.NY.US X 1 14 1 WWW.TLCHEALTH.ORG 0 0 1 X 100.000000000000 300.000000000000 X 1 1 X X X X 1 X WWW.TLCHEALTH.ORG X X X 1 X 1 X X X X X 1 X 0 1 TLC HEALTH NETWORK - LAKE SHORE HOSPITAL PART V, SECTION B, LINE 5: FOR THE 2013 COMMUNITY HEALTH NEEDS ASSESSMENT, TLC HEALTH NETWORK WORKED WITH THE REST OF THE CHAUTAUQUA COUNTY COMMUNITY HEALTH PLANNING TEAM (CCCHPT) TO ASSESS THE HEALTH NEEDS OF THE GREATER CHAUTAUQUA COUNTY REGION. THE CCCHPT ADOPTED A THREE-PRONGED APPROACH IN CONDUCTING THE ASSESSMENT WHICH INVOLVED GATHERING INPUT FROM COMMUNITY MEMBERS, SECONDARY DATA FROM NYSDOH AND OTHER HEALTH RESOURCES, AND INPUT FROM LOCAL CONTENT AREA EXPERTS.COMMUNITY INPUT WAS GATHERED THROUGH A PRIMARILY WEB-BASED SURVEY AND THREE COMMUNITY CONVERSATIONS IN DIFFERENT GEOGRAPHIC SECTIONS OF THE COUNTY. FROM MARCH 28 TO JUNE 2, 2013, 1,170 SURVEY RESPONSES WERE COLLECTED. COMMUNITY MEMBERS' PERCEPTIONS OF HEALTH ISSUES WERE ALSO GATHERED AT THREE "COMMUNITY CONVERSATIONS" SPONSORED BY THE P2 COLLABORATIVE OF WNY AND THE CHAUTAUQUA COUNTY HEALTH NETWORK. THESE CONVERSATIONS SPANNED CHAUTAUQUA COUNTY'S GEOGRAPHIC AND CULTURAL SEPARATIONS, COVERING THE "NORTH COUNTY" IN DUNKIRK, THE "SOUTH COUNTY" IN JAMESTOWN, AND THE "WEST COUNTY" IN WESTFIELD. THESE DIVERSE LOCATIONS WERE ABLE TO CAPTURE BOTH THE COUNTY'S RURAL AND URBAN POPULATIONS. IN ADDITION TO THE DATA GLEANED FROM THE PUBLIC PARTICIPATION PROCESS, THE CCCHPT THOROUGHLY EXAMINED THE NYSDOH COMMUNITY HEALTH INDICATOR REPORTS AND TRACKING INDICATORS FOR PUBLIC HEALTH PRIORITY AREAS, COMPARING COUNTY NUMBERS AND RATES OF HEALTH CONDITIONS WITH THOSE OF NEW YORK STATE AND NEW YORK STATE EXCLUDING NEW YORK CITY. DEMOGRAPHIC DATA FOR CHAUTAUQUA COUNTY WAS GLEANED FROM THE UNITED STATES CENSUS BUREAU WEBSITE. LOCAL-LEVEL DATA THAT WAS NOT CAPTURED BY THE U.S. CENSUS BUREAU WAS REQUESTED FROM LOCAL AGENCIES. THE NEW YORK STATE EDUCATION DEPARTMENT SCHOOL REPORT CARDS WERE ACCESSED TO RETRIEVE SPECIFIC INFORMATION ABOUT THE SCHOOL DISTRICTS. THE NEW YORK STATE DEPARTMENT OF HEALTH'S COMMUNITY HEALTH INDICATOR REPORTS AND TRACKING INDICATORS FOR PUBLIC HEALTH PRIORITY AREAS WERE EXTENSIVELY USED TO IDENTIFY HEALTH ISSUES IN CHAUTAUQUA COUNTY. NYS VITAL STATISTICS DATA, EXPANDED BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM, AND THE STUDENT WEIGHT STATUS CATEGORY REPORTING SYSTEM WERE ALSO REFERRED TO THROUGHOUT THE PLANNING PROCESS. TLC HEALTH NETWORK - LAKE SHORE HOSPITAL PART V, SECTION B, LINE 6A: INPUT WAS ALSO PROVIDED FROM MANY OTHER LOCAL AREA CONTENT EXPERTS, INCLUDING THE REST OF THE CCHPT PARTNERS INCLUDING: CHAUTAUQUA COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES, CHAUTAUQUA COUNTY HEALTH NETWORK, CHAUTAUQUA COUNTY DEPARTMENT OF MENTAL HYGIENE, THE CHAUTAUQUA CENTER (FQHC), WCA HOSPITAL, WESTFIELD MEMORIAL HOSPITAL, BROOKS MEMORIAL HOSPITAL, AND TLC HEALTH NETWORK. TLC HEALTH NETWORK - LAKE SHORE HOSPITAL PART V, SECTION B, LINE 6B: OTHER EXPERTS CONSULTED ON THIS PROJECT INCLUDE:- CHAUTAUQUA ALCOHOL AND SUBSTANCE ABUSE COUNCIL - KATHLEEN COLBY- CHAUTAUQUA COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES - JULIE APPERSON, ANGELA SWARTZMAN, BREEANNE AGETT- CHAUTAUQUA COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES, CANCER SERVICES PROGRAM - DARLENE ROWE- CHAUTAUQUA COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES, EARLY INTERVENTION PROGRAM - DENISE NICHOLS- CHAUTAUQUA COUNTY DEPARTMENT OF MENTAL HYGIENE - BRIANA POST, PAT BRINKMAN- CHAUTAUQUA COUNTY HEALTH NETWORK - KERRI BROWN, ANN ABDELLA, JANET FORBES- CHAUTAUQUA LAKE CHILD CARE CENTER - BETH STARKS- CHAUTAUQUA OPPORTUNITIES INC. - TARRA JOHNSON, JEN IRWIN- DELPHI HEALTH CARE PARTNERS - MELISSA BOCK- EASTSIDE YMCA - MAX MARTIN- JAMESTOWN PSYCHIATRIC - SANDRA DOHL- JAMESTOWN TREATMENT COURT, 8TH JUDICIAL DISTRICT - CATHY NEWTON- LAKE ERIE REGIONAL HEALTH SYSTEM - SCOTT BUTLER, KIMBERLY MABEN- P2 OF WNY - MARISSA SLEVAR- THE CHAUTAUQUA CENTER - MIKE PEASE- WCA HOSPITAL - TONI DEANGELO, LINDA JOHNSON, ANDY O'BRIEN, MARY BOSEK- WESTFIELD MEMORIAL HOSPITAL - PATTY BALLMAN, KIM GREINER- YMCA OF JAMESTOWN - MEG PICKARD TLC HEALTH NETWORK - LAKE SHORE HOSPITAL PART V, SECTION B, LINE 22D: UP TO MAXIMUM OF THE GREATER AMOUNT THAT WOULD HAVE BEEN PAID FOR THE SAME SERVICE BY THE HIGHEST VOLUME PAYOR FOR SERVICES RENDERED. TLC HEALTH NETWORK - LAKE SHORE HOSPITAL PART V, SECTION B, LINE 24: BILL USUAL AND CUSTOMARY FEES. PART I, LINE 7: COST-TO-CHARGE RATIO 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 $ 1,140,842. PART III, LINE 4: FOOTNOTE TO AUDITED FS: PATIENT ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF PATIENT ACCOUNTS RECEIVABLE, TLC 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, TLC 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), TLC 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: N/A - NO MEDICARE SHORTFALL, COST TO CHARGE RATIO USED. PART VI, LINE 2: THE HOSPITAL PARTICIPATES WITH OTHER HEALTHCARE PROVIDERS AND INTERESTED PARTIES IN THE CHAUTAUQUA COUNTY COMMUNITY HEALTH PLANNING TEAM (CCCHPT) INCLUDING ALL HOSPITALS IN THE COUNTY TO ASSESS NEED REGIONALLY. TLC ALSO WORKS WITH THE HEALTH COMMUNITY ALLIANCE AND CATTARAUGUS COUNTY HEALTH DEPARTMENT TO ASSESS THE NEEDS OF THAT COUNTY ALSO.THE HOSPITAL ALSO UTILIZES PATIENT SATISFACTION SURVEY TOOLS AND LOCAL PUBLIC INFORMATION PERTAINING TO POPULATION CHARACTERISTICS AND HEALTH STATUS.AT MONTHLY PUBLIC PRESENTATIONS OF HEALTH TOPICS, PROGRAM EVALUATION FORMS REQUEST INPUT FROM THE ATTENDEES FOR NEEDED SERVICES AND TOPICS. PART VI, LINE 3: TLC HEALTH NETWORK PARTICIPATES WITH OTHER MANY OTHER HEALTHCARE PROVIDERS AND INTERESTED PARTIES IN REGULAR CHAUTAUQUA COUNTY COMMUNITY HEALTH PLANNING TEAM (CCCHPT) MEETINGS TO ASSESS AND DISCUSS THE EVER-CHANGING HEALTH NEEDS IN THE COMMUNITY. TLC ALSO WORKS WITH THE HEALTHY COMMUNITY ALLIANCE (THE RURAL HEALTH NETWORK FOR NEIGHBORING CATTARAUGUS COUNTY) AND CATTARAUGUS COUNTY HEALTH DEPARTMENT TO ASSESS THE HEALTH NEEDS OF THAT PORTION OF TLC'S SERVICE AREA AS WELL. TLC ALSO LEADS A COMMUNITY ADVISORY GROUP DISCUSSION A FEW TIMES A YEAR TO CAPTURE COMMUNITY FEEDBACK REGARDING HEALTH NEEDS IN THE NORTHERN CATTARAUGUS AREA. TLC ALSO UTILIZES PATIENT SATISFACTION SURVEY TOOLS AND LOCAL PUBLIC INFORMATION PERTAINING TO POPULATION CHARACTERISTICS AND HEALTH STATUS. FURTHERMORE, TLC IS A PARTICIPATING MEMBER OF THE WESTERN NEW YORK HEALTHCARE ALLIANCE THAT MEETS ON A REGULAR BASIS TO DISCUSS THE HEALTH NEEDS OF VARIOUS POPULATIONS WITHIN THE WESTERN NEW YORK REGION. PART VI, LINE 4: FOR THE PURPOSES OF COMMUNITY/LOCAL HEALTH PLANNING, AND BASED ON 2010 USAGE PATTERNS AND A CORRESPONDING ZIP CODE ANALYSIS OF DISCHARGE DATA, TLC HEALTH NETWORK'S PRIMARY SERVICE AREA (TOP 75% OF ALL PATIENTS) INCLUDES THE FOLLOWING ZIP CODES: ANGOLA (14006), GOWANDA (14070), SILVER CREEK (14136), IRVING (14081), FORESTVILLE (14062), DERBY (14047), DUNKIRK (14048), NORTH COLLINS (14111), SOUTH DAYTON (14138), CATTARAUGUS (14719), PERRYSBURG (14129), COLLINS (14034), FREDONIA (14063), EDEN (14057).CURRENTLY, TLC HEALTH NETWORK CONTINUES TO PROVIDE SERVICES TO A LARGELY RURAL POPULATION IN NORTHERN CHAUTAUQUA, WESTERN CATTARAUGUS, AND SOUTHERN ERIE COUNTIES. BESIDES THE GENERAL POPULATION, TLC HEALTH NETWORK SERVES MANY VULNERABLE POPULATIONS INCLUDING THE SENECA NATION OF INDIANS (CATTARAUGUS AND ALLEGHENY RESERVATIONS), A LARGE OLD-ORDER AMISH POPULATION, AND A HOST OF SEASONAL MIGRANT WORKERS. IN ADDITION, THE SHORES OF LAKE ERIE PROVIDE AN INFLUX OF SEASONAL BEACHFRONT RESIDENTS THAT OFTEN TURN TO TLC HEALTH NETWORK FOR HEALTHCARE SUPPORT. THE SERVICE AREA HAS ALSO BEEN OFFICIALLY DESIGNATED AS A PHYSICIAN SHORTAGE AREA (PSA), AND MANY ZIP CODES HAVE AN AVERAGE HOUSEHOLD INCOME THAT IS BELOW THE NATIONAL AVERAGE - MAKING ACCESS TO QUALITY HEALTHCARE A CONSTANT CHALLENGE. PART VI, LINE 5: THE BOARD OF TRUSTEES IS A COMMUNITY BOARD, MADE UP ENTIRELY OF CIVIC AND COMMUNITY LEADERS, WHO SERVE VOLUNTARILY. THE BOARD APPOINTS THE CEO, APPROVES BUDGETS, DEVELOPS STRATEGIC PLANS AND PROVIDES OVERSIGHT FOR THE HOSPITAL IN GENERAL. POTENTIAL CONFLICT OF INTEREST BETWEEN BOARD MEMBERS AND THE HOSPITAL ARE REVIEWED ANNUALLY.THE HOSPITAL'S MEDICAL STAFF IS COMPRISED OF QUALIFIED PHYSICIANS FROM WITHIN THE COMMUNITY. THE HOSPITAL CONTRACTS DIRECTLY FOR EMERGENCY ROOM PHYSICIANS AND A PATHOLOGIST AND EMPLOYS PRIMARY CARE PHYSICIANS.THE HOSPITAL OPERATES A FULL-TIME EMERGENCY ROOM OPEN TO ALL PATIENTS, REGARDLESS OF THEIR ABILITY TO PAY. PATIENTS COME TO THE EMERGENCY ROOM BY THEIR OWN TRANSPORTATION OR BY AMBULANCE FROM EITHER A LOCAL FIRE DEPARTMENT OR AN INDEPENDENT AMBULANCE BUSINESS THAT SERVES THE ENTIRE COUNTY. IN ORDER TO ENSURE 24 HOUR PHYSICIAN COVERAGE IN THE ER, THE HOSPITAL PROVIDES A SUBSIDY TO THE ER PHYSICIAN GROUP. NON EMERGENCY CARE IS PROVIDED BASED UPON PHYSICIAN ORDERS TO ALL PATIENTS, REGARDLESS OF THEIR ABILITY TO PAY.SURPLUS FUNDS ARE INVESTED IN MEDICAL EQUIPMENT UPGRADES AND NEW TECHNOLOGIES THROUGH A CAPITAL BUDGET PROCESS. THERE ARE NO "OWNERS OR STOCKHOLDERS SO NO SURPLUS FUNDS ARE PAID OUT TO OWNERS OR STOCKHOLDERS.TLC HEALTH NETWORK IS IN A MEDICALLY UNDERSERVED AREA. SIGNIFICANT ONGOING EFFORTS AT PHYSICIAN RECRUITMENT ARE EXPENDED. CURRENT PHYSICIAN SHORTAGES INCLUDE PRIMARY CARE, PEDIATRICS, OBSTETRICS, SURGERY, ORTHOPEDIC, UROLOGY, RADIATION ONCOLOGIST, NEUROLOGIST, MEDICAL ONCOLOGIST AND PULMONOLOGIST.THE HOSPITAL WORKS TO ENSURE AN ADEQUATE BLOOD SUPPLY IN THE COMMUNITY AND SURROUNDING AREAS BY HOSTING BI-MONTHLY BLOOD DRIVES IN COOPERATION WITH THE COMMUNITY BLOOD BANK.THE HOSPITAL STRIVES TO IMPROVE THE QUALITY OF PATIENT CARE BY A VARIETY OF ACCREDITATIONS, SURVEYS AND BENCHMARKS INCLUDING:- THE HOSPITAL IS ACCREDITED THROUGH DNV AND THE AMERICAN COLLEGE OF RADIOLOGY FOR MAMMOGRAPHY, CT SCAN, NUCLEAR MEDICINE AND ULTRASOUND.THE HOSPITAL TAKES A PROACTIVE APPROACH TO THE PREVENTION OF HOSPITAL-ACQUIRED INFECTIONS, INCLUDING:- INSTITUTION WIDE PROGRAM TO PROMOTE EFFECTIVE HAND WASHING.- INSTITUTION WIDE PROGRAM TO REDUCE URINARY TRACT INFECTIONS.- INSTITUTION WIDE PROGRAM TO REDUCE CENTRAL LINE INFECTIONS.- INSTITUTION WIDE PROGRAM TO REDUCE VENTILATOR-ASSOCIATED INFECTIONS.- THE HOSPITAL MONITORS NATIONAL AND STATE BENCHMARKS FOR THE USE OF ANTIBIOTICS RELATED TO SURGERY.- THE HOSPITAL MONITORS NATIONAL AND STATE BENCHMARKS FOR THE PREVENTION OF BLOOD CLOTS AFTER SURGERY.- THE HOSPITAL IMPLEMENTED BAR CODE MEDICATION ADMINISTRATION TO REDUCE/ELIMINATE MEDICATION ERRORS.- THE HOSPITAL USES PATIENT SURVEYS THROUGH BOTH PRESS GANEY AND HCAPHS. AREAS THAT MEASURED BELOW AVERAGE ARE REVIEWED WEEKLY AND BEING ADDRESSED THROUGH: - HOURLY ROUNDING- PRE-OPERATIVE JOINT EDUCATION CLASSES- POST DISCHARGE CALLS TO ASSURE PATIENTS UNDERSTAND THEIR MEDICATION INSTRUCTIONS.- CUSTOMER SERVICE TRAINING. PART VI, LINE 7, REPORTS FILED WITH STATES NY X X 0 0 0 0 0 0 0 0 0 JOHN GALATI PRESIDENT & CHIEF EXECUTIVE OFFICER 154398 0 0 0 0 0 10077 0 0 0 164475 0 0 0 ROBERT PIOTROWSKI PHYSICIAN ASSISTANT 144077 0 0 0 0 0 3258 0 3262 0 150597 0 0 0 FORM 990, PART VI, SECTION A, LINE 7B THE DECISIONS OF THE GOVERNING BODY ARE SUBJECT TO APPROVAL OF BOARD MEMBERS. FORM 990, PART VI, SECTION B, LINE 11 THE 990 IS PREPARED AND REVIEWED BY VARIOUS INDIVIDUALS WITHIN MANAGEMENT AND PROVIDED TO THE GOVERNING BODY PREVIOUS TO ITS FILING WHEN TIME ALLOWS OR AT ITS NEXT MEETING WHEN TIME DOES NOT PERMIT REVIEW PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C DEPARTMENT MANAGERS, ADMINISTRATORS, BOARD MEMBERS AND MATERIAL MANAGEMENT EMPLOYEES SIGN A CONFLICT OF INTEREST STATEMENT UPON HIRE DATE AND ANNUALLY THEREAFTER. FORM 990, PART VI, SECTION B, LINE 15 PER CORPORATE BYLAWS, THE BOARD SHALL AT LEAST ANNUALLY REVIEW THE CEO'S PERFORMANCE, COMPENSATION, AND BENEFITS. FORM 990, PART VI, SECTION C, LINE 19 THESE DOCUMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: DEPRECIATION OF FUNDS HELD IN TRUST -190,346. FORM 990, PART XII, LINE 2C THE AUDIT OVERSIGHT PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. LAKE SHORE NURSING HOME INC 845 ROUTES 5 20 IRVING NY 14081 160976895 SKILLED NURSING FACILITY NY 501(C)(1) LINE 3 N/A 0 LAKE SHORE CHILDCARE 845 ROUTES 5 20 IRVING NY 14081 161381646 CHILD DAYCARE SERVICES NY 501(C)(3) LINE 9 N/A 0 LSP CORPORATION 845 ROUTES 5 20 IRVING NY 14081 117239014 REAL ESTATE - MEDICAL AND ADMINISTRATIVE OFFICE FACILITY NY 501(C)(3) LINE 3 N/A 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0