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        <BusinessNameLine1>NATHAN LITTAUER HOSPITAL ASSOCIATION</BusinessNameLine1>
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        <AddressLine1>99 East State Street</AddressLine1>
        <City>Gloversville</City>
        <State>NY</State>
        <ZIPCode>12078</ZIPCode>
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      <Name>Henry Legendziewicz</Name>
      <Title>Senior Vice-President &amp; CFO</Title>
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      <DateSigned>2014-11-14</DateSigned>
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        <Description>HealthLink is Nathan Littauer Hospital's Wellness Education Center located in Johnstown. HealthLink's role is to promote wellness by increasing community awareness and providing resources for those wishing to make positive, healthy lifestyle changes. Since its launch in 1989, HealthLink has served nearly 163,000 area residents with more than 6,890 free or low-cost education programs and health screenings. Our wide variety of programs are chosen based on the interests and needs of the community. Program categories include Health &amp; Wellness, Mind &amp; Body, Childbirth &amp; Parenting, Health Screenings, Support Groups, Special Events, and Vitality Plus (ViP)...especially for adults 50+. We also offer Worksite Wellness programs, including health screenings and wellness education programs, to promote health &amp; wellness on the job. Speakers are available for presentations to schools, churches, community groups, organizations, etc., on a variety of topics. HealthLink's growing library of books, videos/DVD's, magazines and brochures cover many health-related issues. Most are free or loaned at no charge. The Hospital also offers a Lifeline Program. Lifeline is a personal emergency response system which connects subscribers with the Hospitals emergency department through a telephone based communication system. A total of 550 subscribers are members of NLHs Lifeline Program. Other community services include community health fairs, speakers bureau, organ donation program, Camp Superstarrs and New Visions Program for high school students. Health Insurance Counseling: Nathan Littauer Hospital is the lead agency in the New York State Child and Family Health Plus grant funded facilitated enrollment insurance program for Fulton, Montgomery and Hamilton counties. Child and Family Health Plus is a facilitated insurance enrollment program for children and adults that do not have or cannot afford health insurance. In 2011 more than 1,340 children, 127 pregnant women and more than 862 families were enrolled in health insurance programs through our agency. These enrollments included Medicaid and participating HMOs. (2,329 Individuals and families)</Description>
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        <Description>Deferred Lease</Description>
        <BookValue>33154</BookValue>
      </OtherAssets>
      <OtherAssets>
        <Description>Other Deferred Asset</Description>
        <BookValue>1526497</BookValue>
      </OtherAssets>
      <TotalBookValueOtherAssets>5656141</TotalBookValueOtherAssets>
      <FederalIncomeTaxLiability>0</FederalIncomeTaxLiability>
      <OtherLiabilities>
        <Description>Due to Third Party Reimbursement Agencies</Description>
        <Amount>324600</Amount>
      </OtherLiabilities>
      <OtherLiabilities>
        <Description>Asset Retirement Obligation</Description>
        <Amount>401427</Amount>
      </OtherLiabilities>
      <OtherLiabilities>
        <Description>Accrued Long Term Pension Obligation</Description>
        <Amount>7986972</Amount>
      </OtherLiabilities>
      <OtherLiabilities>
        <Description>Section 457 Plan</Description>
        <Amount>1295257</Amount>
      </OtherLiabilities>
      <OtherLiabilities>
        <Description>Due to 1199</Description>
        <Amount>134241</Amount>
      </OtherLiabilities>
      <OtherLiabilities>
        <Description>Other</Description>
        <Amount>-922</Amount>
      </OtherLiabilities>
      <TotalOfAmounts>10141575</TotalOfAmounts>
      <TotalRevenue>87650717</TotalRevenue>
      <TotalExpenses>86212427</TotalExpenses>
      <ExcessOrDeficitForYear>1438290</ExcessOrDeficitForYear>
      <NetUnrealizedGLOnInvestments>0</NetUnrealizedGLOnInvestments>
      <DonatedServicesAndFacilities>0</DonatedServicesAndFacilities>
      <InvestmentExpenses>0</InvestmentExpenses>
      <PriorPeriodAdjustments>0</PriorPeriodAdjustments>
      <OtherAmount>0</OtherAmount>
      <TotalAdjustments>0</TotalAdjustments>
      <ExcessOrDeficitPerFS>1438290</ExcessOrDeficitPerFS>
      <TotRevenueEtcAuditedFinclStmt>93526292</TotRevenueEtcAuditedFinclStmt>
      <NetUnrealizedGainsInvestments>0</NetUnrealizedGainsInvestments>
      <DonatedSrvcAndUseOfFacilities>0</DonatedSrvcAndUseOfFacilities>
      <RecoveriesOfPriorYearGrants>0</RecoveriesOfPriorYearGrants>
      <OtherRevenues>5875575</OtherRevenues>
      <RevenueNotRptdF990>5875575</RevenueNotRptdF990>
      <RevenueSubtotal>87650717</RevenueSubtotal>
      <InvestmentExpensesNotIncluded>0</InvestmentExpensesNotIncluded>
      <OtherRevenuesNotIncluded>0</OtherRevenuesNotIncluded>
      <RevenueNotRptdOnFinStmt>0</RevenueNotRptdOnFinStmt>
      <TotalRevenuePerForm990>87650717</TotalRevenuePerForm990>
      <TotExpensesEtcAuditedFinclStmt>92088002</TotExpensesEtcAuditedFinclStmt>
      <DonatedServicesUseOfFacilities>0</DonatedServicesUseOfFacilities>
      <PriorYearAdjustments>0</PriorYearAdjustments>
      <LossesReported>0</LossesReported>
      <OtherExpensesIncluded>5875575</OtherExpensesIncluded>
      <ExpensesNotRptdF990>5875575</ExpensesNotRptdF990>
      <ExpensesSubtotal>86212427</ExpensesSubtotal>
      <InvestmentExpensesNotIncluded2>0</InvestmentExpensesNotIncluded2>
      <OtherExpensesNotIncluded>0</OtherExpensesNotIncluded>
      <ExpensesNotRptdOnFinStmt>0</ExpensesNotRptdOnFinStmt>
      <TotalExpensesPerForm990>86212427</TotalExpensesPerForm990>
      <Form990ScheduleDPartXIV>
        <Identifier>SchD_P05_S00_L04</Identifier>
        <ReturnReference>Schedule D, Part V, Line 4</ReturnReference>
        <Explanation>The principle donation is permanently restricted, income generated by the fund is used in the daily operations of the hospital.</Explanation>
      </Form990ScheduleDPartXIV>
      <Form990ScheduleDPartXIV>
        <Identifier>SchD_P10_S00_L02</Identifier>
        <ReturnReference>Schedule D, Part X, Line 2</ReturnReference>
        <Explanation>The Hospital is a not-for-profit organization, as described in Section 501(c)3 of the Internal Revenue Code (the Code) and is exempt from federal income taxes on related income pursuant to Section 501(a) of the Code. The Hospital recognizes income tax positions when it is more-likely than not that the position will be sustainable based on the merits of the position. Management has concluded that there are no material tax liabilities that need to be recorded.</Explanation>
      </Form990ScheduleDPartXIV>
      <Form990ScheduleDPartXIV>
        <Identifier>SchD_P12_S00_L02d</Identifier>
        <ReturnReference>Schedule D, Part XII, Line 2d</ReturnReference>
        <Explanation>Bad Debts</Explanation>
      </Form990ScheduleDPartXIV>
      <Form990ScheduleDPartXIV>
        <Identifier>SchD_P13_S00_L02d</Identifier>
        <ReturnReference>Schedule D, Part XIII, Line 2d</ReturnReference>
        <Explanation>Bad Debts</Explanation>
      </Form990ScheduleDPartXIV>
    </IRS990ScheduleD>
    <IRS990ScheduleH documentId="R000005" softwareId="11000129" softwareVersion="v1.00">
      <CharityCarePolicy>1</CharityCarePolicy>
      <WrittenPolicy>1</WrittenPolicy>
      <PolicyAppliedToAllHospitals>X</PolicyAppliedToAllHospitals>
      <FPGReferenceFreeCare>1</FPGReferenceFreeCare>
      <Pcent100>X</Pcent100>
      <FPGReferenceDiscountedCare>1</FPGReferenceDiscountedCare>
      <Pcent300>X</Pcent300>
      <FreeDiscCareMedicallyIndigent>1</FreeDiscCareMedicallyIndigent>
      <AmountsBudgetedForCharityCare>1</AmountsBudgetedForCharityCare>
      <ExpensesExceededBudget>1</ExpensesExceededBudget>
      <UnableToProvideCare>0</UnableToProvideCare>
      <AnnualCommunityBenefitReport>1</AnnualCommunityBenefitReport>
      <ReportPublicallyAvailable>1</ReportPublicallyAvailable>
      <CharityCareAtCost>
        <NumberOfActivitiesOrPrograms>0</NumberOfActivitiesOrPrograms>
        <PersonsServed>2309</PersonsServed>
        <TotalCommunityBenefitExpense>675686</TotalCommunityBenefitExpense>
        <DirectOffsettingRevenue>139725</DirectOffsettingRevenue>
        <NetCommunityBenefitExpense>535961</NetCommunityBenefitExpense>
        <PercentOfTotalExpense>0.0062</PercentOfTotalExpense>
      </CharityCareAtCost>
      <UnreimbursedMedicaid>
        <NumberOfActivitiesOrPrograms>0</NumberOfActivitiesOrPrograms>
        <PersonsServed>53801</PersonsServed>
        <TotalCommunityBenefitExpense>17219900</TotalCommunityBenefitExpense>
        <DirectOffsettingRevenue>13572880</DirectOffsettingRevenue>
        <NetCommunityBenefitExpense>3647020</NetCommunityBenefitExpense>
        <PercentOfTotalExpense>0.0423</PercentOfTotalExpense>
      </UnreimbursedMedicaid>
      <UnreimbursedCosts>
        <NumberOfActivitiesOrPrograms>0</NumberOfActivitiesOrPrograms>
        <PersonsServed>0</PersonsServed>
        <TotalCommunityBenefitExpense>0</TotalCommunityBenefitExpense>
        <DirectOffsettingRevenue>0</DirectOffsettingRevenue>
        <NetCommunityBenefitExpense>0</NetCommunityBenefitExpense>
        <PercentOfTotalExpense>0</PercentOfTotalExpense>
      </UnreimbursedCosts>
      <TotalCharityCare>
        <NumberOfActivitiesOrPrograms>0</NumberOfActivitiesOrPrograms>
        <PersonsServed>56110</PersonsServed>
        <TotalCommunityBenefitExpense>17895586</TotalCommunityBenefitExpense>
        <DirectOffsettingRevenue>13712605</DirectOffsettingRevenue>
        <NetCommunityBenefitExpense>4182981</NetCommunityBenefitExpense>
        <PercentOfTotalExpense>0.0485</PercentOfTotalExpense>
      </TotalCharityCare>
      <CommunityHealthServices>
        <NumberOfActivitiesOrPrograms>22</NumberOfActivitiesOrPrograms>
        <PersonsServed>7225</PersonsServed>
        <TotalCommunityBenefitExpense>743742</TotalCommunityBenefitExpense>
        <DirectOffsettingRevenue>288558</DirectOffsettingRevenue>
        <NetCommunityBenefitExpense>455184</NetCommunityBenefitExpense>
        <PercentOfTotalExpense>0.0053</PercentOfTotalExpense>
      </CommunityHealthServices>
      <HealthProfessionsEducation>
        <NumberOfActivitiesOrPrograms>1</NumberOfActivitiesOrPrograms>
        <PersonsServed>24</PersonsServed>
        <TotalCommunityBenefitExpense>107412</TotalCommunityBenefitExpense>
        <DirectOffsettingRevenue>0</DirectOffsettingRevenue>
        <NetCommunityBenefitExpense>107412</NetCommunityBenefitExpense>
        <PercentOfTotalExpense>0.0012</PercentOfTotalExpense>
      </HealthProfessionsEducation>
      <SubsidizedHealthServices>
        <NumberOfActivitiesOrPrograms>1</NumberOfActivitiesOrPrograms>
        <PersonsServed>0</PersonsServed>
        <TotalCommunityBenefitExpense>12297856</TotalCommunityBenefitExpense>
        <DirectOffsettingRevenue>10165421</DirectOffsettingRevenue>
        <NetCommunityBenefitExpense>2132435</NetCommunityBenefitExpense>
        <PercentOfTotalExpense>0.0247</PercentOfTotalExpense>
      </SubsidizedHealthServices>
      <Research>
        <NumberOfActivitiesOrPrograms>0</NumberOfActivitiesOrPrograms>
        <PersonsServed>0</PersonsServed>
        <TotalCommunityBenefitExpense>0</TotalCommunityBenefitExpense>
        <DirectOffsettingRevenue>0</DirectOffsettingRevenue>
        <NetCommunityBenefitExpense>0</NetCommunityBenefitExpense>
        <PercentOfTotalExpense>0</PercentOfTotalExpense>
      </Research>
      <CashAndInKindContributions>
        <NumberOfActivitiesOrPrograms>2</NumberOfActivitiesOrPrograms>
        <PersonsServed>100</PersonsServed>
        <TotalCommunityBenefitExpense>15239</TotalCommunityBenefitExpense>
        <DirectOffsettingRevenue>0</DirectOffsettingRevenue>
        <NetCommunityBenefitExpense>15239</NetCommunityBenefitExpense>
        <PercentOfTotalExpense>0.0002</PercentOfTotalExpense>
      </CashAndInKindContributions>
      <TotalOtherBenefits>
        <NumberOfActivitiesOrPrograms>26</NumberOfActivitiesOrPrograms>
        <PersonsServed>7349</PersonsServed>
        <TotalCommunityBenefitExpense>13164249</TotalCommunityBenefitExpense>
        <DirectOffsettingRevenue>10453979</DirectOffsettingRevenue>
        <NetCommunityBenefitExpense>2710270</NetCommunityBenefitExpense>
        <PercentOfTotalExpense>0.0314</PercentOfTotalExpense>
      </TotalOtherBenefits>
      <TotalCommunityBenefits>
        <NumberOfActivitiesOrPrograms>26</NumberOfActivitiesOrPrograms>
        <PersonsServed>63459</PersonsServed>
        <TotalCommunityBenefitExpense>31059835</TotalCommunityBenefitExpense>
        <DirectOffsettingRevenue>24166584</DirectOffsettingRevenue>
        <NetCommunityBenefitExpense>6893251</NetCommunityBenefitExpense>
        <PercentOfTotalExpense>0.0799</PercentOfTotalExpense>
      </TotalCommunityBenefits>
      <BadDebtExpenseReported>1</BadDebtExpenseReported>
      <BadDebtExpenseAmount>5854040</BadDebtExpenseAmount>
      <AmountAttributableTo>0</AmountAttributableTo>
      <AmountReimbursedByMedicare>12686984</AmountReimbursedByMedicare>
      <CostOfCareReimbursedByMedicare>16431005</CostOfCareReimbursedByMedicare>
      <MedicareSurplusOrShortfall>-3744021</MedicareSurplusOrShortfall>
      <CostingMethodologyUsed>
        <CostToChargeRatio>X</CostToChargeRatio>
      </CostingMethodologyUsed>
      <WrittenDebtCollectionPolicy>1</WrittenDebtCollectionPolicy>
      <ProvisionForCharityCare>1</ProvisionForCharityCare>
      <NumberOfHospitalFacilities>1</NumberOfHospitalFacilities>
      <Form990ScheduleHPartVSectionA>
        <FacilityNumber>1</FacilityNumber>
        <Name>
          <BusinessNameLine1>Nathan Littauer Hospital Association</BusinessNameLine1>
        </Name>
        <Address>
          <AddressLine1>99 East State Street</AddressLine1>
          <City>Gloversville</City>
          <State>NY</State>
          <ZIPCode>12078</ZIPCode>
        </Address>
        <LicensedHospital>X</LicensedHospital>
        <GeneralMedicalAndSurgical>X</GeneralMedicalAndSurgical>
        <Er24Hours>X</Er24Hours>
      </Form990ScheduleHPartVSectionA>
      <Form990ScheduleHPartVSectionB>
        <HospitalFacilityName>
          <BusinessNameLine1>Nathan Littauer Hospital Association</BusinessNameLine1>
        </HospitalFacilityName>
        <HospitalFacilityNumber>1</HospitalFacilityNumber>
        <EligibilityCriteriaExplained>1</EligibilityCriteriaExplained>
        <UsesFPGFree>1</UsesFPGFree>
        <FPGFreePercent>100</FPGFreePercent>
        <UsesFPGDiscounted>1</UsesFPGDiscounted>
        <FPGDiscountPercent>300</FPGDiscountPercent>
        <ExplainsBasis>1</ExplainsBasis>
        <IncomeLevel>X</IncomeLevel>
        <StateRegulation>X</StateRegulation>
        <ExplainsApplicationMethod>1</ExplainsApplicationMethod>
        <IncludesPublicityMeasures>1</IncludesPublicityMeasures>
        <AttachedToInvoices>X</AttachedToInvoices>
        <PostedInAdmissionOffice>X</PostedInAdmissionOffice>
        <ProvidedOnAdmission>X</ProvidedOnAdmission>
        <AvailableOnRequest>X</AvailableOnRequest>
        <ActionsOnNonpayment>1</ActionsOnNonpayment>
        <PermitLawsuit>X</PermitLawsuit>
        <PermitLienOnResidence>X</PermitLienOnResidence>
        <CollectionActivities>1</CollectionActivities>
        <Lawsuit>X</Lawsuit>
        <LienOnResidence>X</LienOnResidence>
        <NotifyUponAdmission>X</NotifyUponAdmission>
        <NotifyBeforeDischarge>X</NotifyBeforeDischarge>
        <NotifiedAllPatients>X</NotifiedAllPatients>
        <DocumentedDetermination>X</DocumentedDetermination>
        <NondiscrimEmergencyCarePolicy>1</NondiscrimEmergencyCarePolicy>
        <LowestNegotiatedRates>X</LowestNegotiatedRates>
        <AmountsGenerallyBilled>0</AmountsGenerallyBilled>
        <GrossCharges>0</GrossCharges>
      </Form990ScheduleHPartVSectionB>
      <Form990ScheduleHPartVSectionC>
        <NumberOfOtherFacilities>9</NumberOfOtherFacilities>
        <OtherFacilities>
          <Name>
            <BusinessNameLine1>Nathan Littauer Hospital Nursing Home</BusinessNameLine1>
          </Name>
          <Address>
            <AddressLine1>99 East State Street</AddressLine1>
            <City>Gloversville</City>
            <State>NY</State>
            <ZIPCode>12078</ZIPCode>
          </Address>
          <FacilityType>84 Bed Nursing Home.</FacilityType>
        </OtherFacilities>
        <OtherFacilities>
          <Name>
            <BusinessNameLine1>Nathan Littauer Hospital Primary Care Center</BusinessNameLine1>
          </Name>
          <Address>
            <AddressLine1>99 East State Street</AddressLine1>
            <City>Gloversville</City>
            <State>NY</State>
            <ZIPCode>12078</ZIPCode>
          </Address>
          <FacilityType>Primary/Specility Care Center (Clinic).</FacilityType>
        </OtherFacilities>
        <OtherFacilities>
          <Name>
            <BusinessNameLine1>Perth-Broadalbin Primary Care Center</BusinessNameLine1>
          </Name>
          <Address>
            <AddressLine1>4100 State Highway 30</AddressLine1>
            <City>Amsterdam</City>
            <State>NY</State>
            <ZIPCode>12078</ZIPCode>
          </Address>
          <FacilityType>Primary/Specialty Care Center (Clinic).</FacilityType>
        </OtherFacilities>
        <OtherFacilities>
          <Name>
            <BusinessNameLine1>Johnstown Primary Care Center</BusinessNameLine1>
          </Name>
          <Address>
            <AddressLine1>23 South Perry Street</AddressLine1>
            <City>Gloversville</City>
            <State>NY</State>
            <ZIPCode>12095</ZIPCode>
          </Address>
          <FacilityType>Primary/Specialty Care Center (Clinic).</FacilityType>
        </OtherFacilities>
        <OtherFacilities>
          <Name>
            <BusinessNameLine1>Mayfield Primary Care Center</BusinessNameLine1>
          </Name>
          <Address>
            <AddressLine1>2497 State Highway 30</AddressLine1>
            <City>Mayfield</City>
            <State>NY</State>
            <ZIPCode>12117</ZIPCode>
          </Address>
          <FacilityType>Primary/Specialty Care Center (Clinic).</FacilityType>
        </OtherFacilities>
        <OtherFacilities>
          <Name>
            <BusinessNameLine1>Steele Avenue Primary Care Center</BusinessNameLine1>
          </Name>
          <Address>
            <AddressLine1>182 Steele Avenue</AddressLine1>
            <City>Gloversville</City>
            <State>NY</State>
            <ZIPCode>12078</ZIPCode>
          </Address>
          <FacilityType>Primary/Specialty Care Center (Clinic).</FacilityType>
        </OtherFacilities>
        <OtherFacilities>
          <Name>
            <BusinessNameLine1>Caroga Lake Primary Care Center</BusinessNameLine1>
          </Name>
          <Address>
            <AddressLine1>1840 State Highway 10</AddressLine1>
            <City>Caroga Lake</City>
            <State>NY</State>
            <ZIPCode>12032</ZIPCode>
          </Address>
          <FacilityType>Primary/Specialty Care Center (Clinic).</FacilityType>
        </OtherFacilities>
        <OtherFacilities>
          <Name>
            <BusinessNameLine1>Speculator Primary Care Center</BusinessNameLine1>
          </Name>
          <Address>
            <AddressLine1>Route 8</AddressLine1>
            <City>Speculator</City>
            <State>NY</State>
            <ZIPCode>12164</ZIPCode>
          </Address>
          <FacilityType>Primary/Specialty Care Center (Clinic).</FacilityType>
        </OtherFacilities>
        <OtherFacilities>
          <Name>
            <BusinessNameLine1>Decker Drive Primary Care Center</BusinessNameLine1>
          </Name>
          <Address>
            <AddressLine1>110 Decker Drive</AddressLine1>
            <City>Johnstown</City>
            <State>NY</State>
            <ZIPCode>12095</ZIPCode>
          </Address>
          <FacilityType>Primary/Specialty Care Center (Clinic).</FacilityType>
        </OtherFacilities>
      </Form990ScheduleHPartVSectionC>
      <Form990ScheduleHPartVI>
        <Identifier>SchH_P01_S00_L06a</Identifier>
        <ReturnReference>Schedule H, Part I, Line 6a</ReturnReference>
        <Explanation>Our annual community benefit report is prepared by Nathan Littauer Hospital. The report can be found at www.nlh.org. We also mail the report to organizations in our community. Our State requires the filing of a community benefit report every three years, rather than on an annual basis. Our reporting is designed to conform to this standard.</Explanation>
      </Form990ScheduleHPartVI>
      <Form990ScheduleHPartVI>
        <Identifier>SchH_P01_S00_L07</Identifier>
        <ReturnReference>Schedule H, Part I, Line 7</ReturnReference>
        <Explanation>The costing methodology used to calculate the amounts reported in the Table for Line 7 is ratio of patient care cost to charges.</Explanation>
      </Form990ScheduleHPartVI>
      <Form990ScheduleHPartVI>
        <Identifier>SchH_P01_S00_L072f</Identifier>
        <ReturnReference>Schedule H, Part I, Line 7, Column f</ReturnReference>
        <Explanation>Our total expense from Form 990, Part IX, line 25 column (A) was $86,212,927. Bad debt expense is not inlcluded in this amount. It is reported as a deduction to net patient revenue and not included in column (f).</Explanation>
      </Form990ScheduleHPartVI>
      <Form990ScheduleHPartVI>
        <Identifier>SchH_P01_S00_L07g</Identifier>
        <ReturnReference>Schedule H, Part I, Line 7g</ReturnReference>
        <Explanation>Subsidized health services reported included details from the Primary Care Centers, licensed clinics. The Centers operated despite financial losses to the organization for at least the past eight years. The Hospital is committed to operate the Centers as a benefit to the community in order to address an identified community need and to improve access to healthcare, including our remote rural communities.</Explanation>
      </Form990ScheduleHPartVI>
      <Form990ScheduleHPartVI>
        <Identifier>SchH_P03_S0A_L04</Identifier>
        <ReturnReference>Schedule H, Part III, Section A, Line 4</ReturnReference>
        <Explanation>The Hospital provides care to patients who meet certain criteria under its charity care policy without charge or at amounts less than its established rates. Because the Hospital does not pursue collection of amounts determined to qualify as charity care, they are not reported as revenue. The Hospital maintains records to identify and monitor the level of charity care it provides. Those records include the amount of charges for services and supplies furnished to patients at no charge. The Hospital grants credit without collateral to patients, most of who are residents and are insured under third party agreements. Additions to allowance for estimated uncollectible accounts are made by means of the provision for bad debts. Accounts written off as uncollectible are deducted from the allowance and subsequent recoveries are added. Th amount of the provision for bad debts is based upon management's assessment of historical and expected net collections, local business and economic conditions, trends in federal and state governmental health care coverage and other collection indicators. Services rendered to individuals when payment is expected and ultimately not received are written off to the allowance for estimated uncollectible accounts.</Explanation>
      </Form990ScheduleHPartVI>
      <Form990ScheduleHPartVI>
        <Identifier>SchH_P03_S0B_L08</Identifier>
        <ReturnReference>Schedule H, Part III, Section B, Line 8</ReturnReference>
        <Explanation>Medicare allowable costs were calculated using a cost to charge ratio based upon the cost finding methodology in the Medicare 2552-10 Cost Report. Community Benefit rationale: The Medicare shortfall should be considered a community benefit because our mission is to promote health in the community and we do not limit the care available to any patient, including those covered by Medicare. We are relieving a government burden by providing care to Medicare patients even though costs exceed reimbursements by $3,744,021. Tax exempt hospitals are expected to participate in the Medicare program. For many of the medical services provided by the Hospital, Medicare does not provide sufficient reimbursement to cover the cost of providing care to our patients, forcing the Hospital to use other funds to cover the deficit. Medicare Cost Reports that hospitals are required to file do not include the costs required to treat all Medicare patients. Therefore the amount reflected on the Medicare Cost Report differs from actual losses. In 2011 the Hospital realized an additional shortfall of $2,434,851 resulting from Medicare Advantage and non-PPS Medicare patients. The total shortfall for all types of Medicare patients was $6,178,872.</Explanation>
      </Form990ScheduleHPartVI>
      <Form990ScheduleHPartVI>
        <Identifier>SchH_P03_S0C_L09b</Identifier>
        <ReturnReference>Schedule H, Part III, Section C, Line 9b</ReturnReference>
        <Explanation>The Hospital provides care to patients who meet certain criteria under its charity care policy without charge or at amounts less than its established rates. Because the Hospital does not pursue collection of amounts determined to qualify as charity care, they are not reported as revenue. The Hospital maintains records to identify and monitor the level of charity care it provides. Those records include the amount of charges for services and supplies furnished to patients at no charge. The Hospital grants credit without collateral to patients, most of who are residents and are insured under third party agreements. Additions to allowance for estimated uncollectible accounts are made by means of the provision for bad debts. Accounts written off as uncollectible are deducted from the allowance and subsequent recoveries are added. Th amount of the provision for bad debts is based upon management's assessment of historical and expected net collections, local business and economic conditions, trends in federal and state governmental health care coverage and other collection indicators. Services rendered to individuals when payment is expected and ultimately not received are written off to the allowance for estimated uncollectible accounts.</Explanation>
      </Form990ScheduleHPartVI>
      <Form990ScheduleHPartVI>
        <Identifier>SchH_P06_S00_L02</Identifier>
        <ReturnReference>Schedule H, Part VI, Line 2</ReturnReference>
        <Explanation>Nathan Littauer Hospital is involved in numerous community benefit acitivities which promote the health of the communities we serve. The concerns addressed include health improvement, education, poverty, workforce development, access to care and emergency services. We encourage our employees to serve on community collaboration boards and health advocacy programs to further demonstrate our commitment. And, we work with schools and work sites to promote wellness and prevent disease. The most visible coalition program is our membership in the Adirondack Rural Health Network (ARHN), a network of six counties that share similiar geographic, demographic and health care issues. ARHN prepared the 2010-2012 agenda and programming suggestions for our six counties in the battle to address physicial activity and nutrition, voted as the number one health issue in our area. In addition to the regional network, Littauer partners with Fulton County Public Health, schools, pediatric providers, New York State Department of Health and others to address issues on the local level, such as childhood asthma and nutrition and physical activity. In 2011-2012 we successfully launched a community garden and a bike/walk to school programs. Over the next few years we will identify and implement strategies to further eradicate these health issues plaguing our children. Not to be overlooked are our annual donations to organizations of used equipment and unused supplies.</Explanation>
      </Form990ScheduleHPartVI>
      <Form990ScheduleHPartVI>
        <Identifier>SchH_P06_S00_L03</Identifier>
        <ReturnReference>Schedule H, Part VI, Line 3</ReturnReference>
        <Explanation>Nathan Littauer Hospital &amp; Nursing Home educates our patient population for our Financial Assistance policy in the following ways: NLH has provided a "Frequently Asked Question" section on our website (www.nlh.org) to answer questions our patients may have. We have posted the complete Charity/Financial assistance policy on our website (www.NLH.org). NLH posts in their registration areas the availability of Financial Assistance and the appropriate contact information to obtain and complete the application process. NLH also provides pamphlets in all of our inpatient and outpatient registration areas literature providing information on insurances and, again, providing information on our Financial Assistance program and contact information. NLH has four facilitated enrollers available to assist patients with their application for Medicaid, Family Health Plus and Child Health Plus. They will also assist patients in completing our charity care application. Our staff has been trained in assisting our patients with obtaining application and providing direction and contact information for the completion of same. Our in-patient statements and our billing agency provides information advising patients to contact our offices to request the application and assistance in its completion.</Explanation>
      </Form990ScheduleHPartVI>
      <Form990ScheduleHPartVI>
        <Identifier>SchH_P06_S00_L04</Identifier>
        <ReturnReference>Schedule H, Part VI, Line 4</ReturnReference>
        <Explanation>Nathan Littauer Hospital and Nursing Home is located in a rural, upstate area of New York State. Our primary service area is Fulton County with additional service areas in neighboring Hamiliton and Montgomery Counties. Both Fulton and Hamilton counties are designated as Healthcare Professional Shortage Areas (HPSA). A snapshot of our primary service area shows the 2011 population is 55,053 and of those reporting one race, 95% are white. 51% of the population is female and 49% male. The median age is 41.8 years and 16% of the population is age 65 and older. The median household income in Fulton County is $43,240 (below the national median of $52,175) with 17.2% of families below the poverty level. 83.2% of the population has a high school degree or higher. The leading industries are educational services, health care and social asssistance employing 26% of the workforce followed by manufacturing employing 15%. Unemployment sits at nearly 11%. The major health issues in Fulton County include respiratory diseases/childhood asthma, cancers of the lung and colon, lack of physical fitness and nutrition, unintentional injuries, tobacco use and chronic diseases of lung and heart. The demographics and public health issues of our area clearly demonstrate why Nathan Littauer Hospital and Nursing Home and our eight outpatient centers are vital resources in the communities we serve. Specifically, aging population, high unemployment, households below the poverty level (Gloversville has the highest poverty rate in New York State) and major health issues will challenge Nathan Littauer to continue to provide the needed care in a safe, quality and accessible environment.</Explanation>
      </Form990ScheduleHPartVI>
      <Form990ScheduleHPartVI>
        <Identifier>SchH_P06_S00_L05</Identifier>
        <ReturnReference>Schedule H, Part VI, Line 5</ReturnReference>
        <Explanation>The Board of Directors of Nathan Littauer Hospital and Nursing Home is made up of medical and business professionals, all of whom reside in our primary service area. These volunteers give countless hours to the organization in their oversight role. They are involved in the community needs assessment process, in fundraising and in general stewardship. Littauer utilizes excess funds to reinvest in our technology, computerization and facilities to keep our organization safe, efficient and accessible as well as to ensure quality patient care. For example we recently used excess funds to support free and low cost education programs offered by Littauer to our community. Renovated and prepared an outpatient surgery center to be opened in 2012,invested millions of dollars in computer resources to meet Federal standards and is in the process of renovating the Health Information Management and Diagnostic Imaging departments.</Explanation>
      </Form990ScheduleHPartVI>
      <Form990ScheduleHPartVI>
        <Identifier>SchH_P06_S00_L07</Identifier>
        <ReturnReference>Schedule H, Part VI, Line 7</ReturnReference>
        <Explanation>New York</Explanation>
      </Form990ScheduleHPartVI>
    </IRS990ScheduleH>
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        <NamePerson>Peter Dowling MD</NamePerson>
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        <NamePerson>Patricia Nguyen MD</NamePerson>
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        <Identifier>SchJ_P01_S00_L04</Identifier>
        <ReturnReference>Schedule J, Part I, Line 4</ReturnReference>
        <Explanation>Schedule J, Part I, Line 4 - Payments were made on behalf of the CEO and CFO to a 457(f) plan during 2011.</Explanation>
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      <GeneralExplanation>
        <Identifier>F990_P01_S00_L06</Identifier>
        <ReturnReference>Form 990, Part I, Line 6</ReturnReference>
        <Explanation>Total volunteer hours for 2011 were 15,748 based upon the annual report of the Nathan Littauer Hospital Auxiliary. This included Auxilians, Candy Stripers and Jr. Volunteers.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>F990_P06_S0A_L06</Identifier>
        <ReturnReference>Form 990, Part VI, Section A, Line 6</ReturnReference>
        <Explanation>The sole member of the Nathan Littauer Hospital Association is Colonial Healthcare Corp. which shall be represented at all meetings of the Association by the President of the Board of Directors of Colonial Healthcare Corp. or such person designated by the President in writing.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>F990_P06_S0A_L07b</Identifier>
        <ReturnReference>Form 990, Part VI, Section A, Line 7b</ReturnReference>
        <Explanation>Colonial Healthcare Corp., the sole member of the Nathan Littauer Hospital Association, must consent to any changes to the hospital's bylaws.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>F990_P06_S0B_L11b</Identifier>
        <ReturnReference>Form 990, Part VI, Section B, Line 11b</ReturnReference>
        <Explanation>The form 990 was presented at a regular meeting of the Board of Directors on October 22, 2012 by Henry Legendziewicz, CFO and Laurence Kelly, CEO prior to the filing of the form. The Chairman and Vice-Chairman of the Board were presented with copies prior to the board meeting.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>F990_P06_S0B_L12c</Identifier>
        <ReturnReference>Form 990, Part VI, Section B, Line 12c</ReturnReference>
        <Explanation>The Hospital's Conflict of Interest policy requires the filing of an annual disclosure statement by covered persons. Covered persons are defined as "Any director, officer, member of a committee with governing board delegated powers, or any member of the Capital Acquisition Committee, Pharmacy &amp; Therapeutics Committee or Value Analysis Committee and Hospital employees who have a position which involves the acquisition of equipment and supplies or who authorize payments for such material." The Board or Committee is informed annually of any possible conflicts. The covered person has a duty to disclose the possible conflict when a matter is brought before the Board or Committee and the Board or Committee makes the determination if a conflict actually exists. The conflicted party will not particapate in the discussion of the matter at hand and will leave the meeting which a vote of the disinterested parties takes place. The Corporate Compliance Officer and the Chairman of the Board or Committee are responsible for compliance with policy.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>F990_P06_S0B_L15</Identifier>
        <ReturnReference>Form 990, Part VI, Section B, Line 15</ReturnReference>
        <Explanation>The Hospital's Compensation Committee is composed of the Chairman, Vice Chairman and immediate past Chairman of the Board of Directors. All members are independent directors. The Committee utilizes comparable compensation data in its deliberations. The compensation of the President (CEO) of the hospital is in the form of a recommendation to the full Board of Directors in an Executive Session of the meeting. Only independent directors are present at the meeting. The Compensation committee also advises and assists the President (CEO) in determining the compensation for senior management of the Hospital using comparative compensation data.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>F990_P06_S0C_L19</Identifier>
        <ReturnReference>Form 990, Part VI, Section C, Line 19</ReturnReference>
        <Explanation>The Hospital publishes an annual report distributed by mail and made available for distribution through a number of public outlets such as civic and social organizations. The report includes condensed financial statements and various statistical data relative to services provided to the community including free clinics, education programs, health fairs, etc. The Form 990 is available to the public upon request. The Hospital's governing documents, conflict of interest policy and internal financial statements are not available to the public.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>F990_P11_S00_L05</Identifier>
        <ReturnReference>Form 990, Part XI, Line 5</ReturnReference>
        <Explanation>Pension related changes - $ -3,449,809 Distributions from NL Foundation - $573,398 Change in net unrealized gains &amp; losses - $-94,062 Contribution of capital asset - $144,483 Change in interest in net assets of NL Foundation - $-306,849 Total - $-3,132,839</Explanation>
      </GeneralExplanation>
    </IRS990ScheduleO>
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        <AddressUS>
          <AddressLine1>99 East State Street</AddressLine1>
          <City>Gloversville</City>
          <State>NY</State>
          <ZIPCode>12078</ZIPCode>
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        <EIN>237065255</EIN>
        <PrimaryActivities>Leasing an 84 bed Skilled Nursing Facility to Hospital</PrimaryActivities>
        <LegalDomicileState>NY</LegalDomicileState>
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        <PrimaryActivities>Support the Hospital &amp; promote healthcare programs in the community through donations.</PrimaryActivities>
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