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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>2011-11-09</DateSigned>
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      <Description>74 bed general medical surgical hospital providing inpatient and outpatient services including the following service statistics for 2010: 15,377 inpatient days, 984 newborn days, 3,693 adult &amp; pediatric adminssions, 425 newborn admissions, 22,861 emergency room visits, 90,584 outpatient visits, and 4,960 day surgery visits. Included are 1,394 patients approved for financial assistance at a cost to the hospital of $594,000.</Description>
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        <Description>The Nathan Littauer Primary/Specialty Care Centers provide care for the whole family. Our eight conveniently located Centers offer a range of services and specialties with direct access to the specialists and state-of-the-art technology at Nathan Littauer Hospital. Several Centers are located in remote rural parts of our service area. The Centers employ 30 physicians and over 25 other healthcare providers such as nurse practioners, physician assistants and mid-wives. During 2010 the Centers collectively incurred 104,840 visits.</Description>
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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 over 155,000 area residents with more than 6,500 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 528 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 2010 more than 1,400 children, 59 pregnant women and more than 783 families were enrolled in health insurance programs through our agency. These enrollments included Medicaid and participating HMOs. (2242 Individuals and families)</Description>
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          <AddressUS>
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            <State>NY</State>
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        <Description>Asset Retirement Obligation</Description>
        <Amount>514158</Amount>
      </OtherLiabilities>
      <OtherLiabilities>
        <Description>Accrued Long-Term Pension Obligation</Description>
        <Amount>4554855</Amount>
      </OtherLiabilities>
      <OtherLiabilities>
        <Description>Section 457 Plans</Description>
        <Amount>1009106</Amount>
      </OtherLiabilities>
      <OtherLiabilities>
        <Description>Due to 1199</Description>
        <Amount>101966</Amount>
      </OtherLiabilities>
      <TotalOfAmounts>6753685</TotalOfAmounts>
      <TotalRevenue>84303223</TotalRevenue>
      <TotalExpenses>81757195</TotalExpenses>
      <ExcessOrDeficitForYear>2546028</ExcessOrDeficitForYear>
      <NetUnrealizedGLOnInvestments>0</NetUnrealizedGLOnInvestments>
      <DonatedServicesAndFacilities>0</DonatedServicesAndFacilities>
      <InvestmentExpenses>0</InvestmentExpenses>
      <PriorPeriodAdjustments>0</PriorPeriodAdjustments>
      <OtherAmount>0</OtherAmount>
      <TotalAdjustments>0</TotalAdjustments>
      <ExcessOrDeficitPerFS>2546028</ExcessOrDeficitPerFS>
      <TotRevenueEtcAuditedFinclStmt>89581442</TotRevenueEtcAuditedFinclStmt>
      <NetUnrealizedGainsInvestments>0</NetUnrealizedGainsInvestments>
      <DonatedSrvcAndUseOfFacilities>0</DonatedSrvcAndUseOfFacilities>
      <RecoveriesOfPriorYearGrants>0</RecoveriesOfPriorYearGrants>
      <OtherRevenues>5278219</OtherRevenues>
      <RevenueNotRptdF990>5278219</RevenueNotRptdF990>
      <RevenueSubtotal>84303223</RevenueSubtotal>
      <InvestmentExpensesNotIncluded>0</InvestmentExpensesNotIncluded>
      <OtherRevenuesNotIncluded>0</OtherRevenuesNotIncluded>
      <RevenueNotRptdOnFinStmt>0</RevenueNotRptdOnFinStmt>
      <TotalRevenuePerForm990>84303223</TotalRevenuePerForm990>
      <TotExpensesEtcAuditedFinclStmt>87035414</TotExpensesEtcAuditedFinclStmt>
      <DonatedServicesUseOfFacilities>0</DonatedServicesUseOfFacilities>
      <PriorYearAdjustments>0</PriorYearAdjustments>
      <LossesReported>0</LossesReported>
      <OtherExpensesIncluded>5278219</OtherExpensesIncluded>
      <ExpensesNotRptdF990>5278219</ExpensesNotRptdF990>
      <ExpensesSubtotal>81757195</ExpensesSubtotal>
      <InvestmentExpensesNotIncluded2>0</InvestmentExpensesNotIncluded2>
      <OtherExpensesNotIncluded>0</OtherExpensesNotIncluded>
      <ExpensesNotRptdOnFinStmt>0</ExpensesNotRptdOnFinStmt>
      <TotalExpensesPerForm990>81757195</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 can be used in the daily operations of the Hospital.</Explanation>
      </Form990ScheduleDPartXIV>
      <Form990ScheduleDPartXIV>
        <Identifier>SchD_P12_S00_L02d</Identifier>
        <ReturnReference>Schedule D, Part XII, Line 2d</ReturnReference>
        <Explanation>Provision for Bad Debts</Explanation>
      </Form990ScheduleDPartXIV>
      <Form990ScheduleDPartXIV>
        <Identifier>SchD_P13_S00_L02d</Identifier>
        <ReturnReference>Schedule D, Part XIII, Line 2d</ReturnReference>
        <Explanation>Provision for Bad Debts</Explanation>
      </Form990ScheduleDPartXIV>
    </IRS990ScheduleD>
    <IRS990ScheduleH documentId="R000005" softwareId="10000077" 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>1</NumberOfActivitiesOrPrograms>
        <PersonsServed>2642</PersonsServed>
        <TotalCommunityBenefitExpense>687013</TotalCommunityBenefitExpense>
        <DirectOffsettingRevenue>132275</DirectOffsettingRevenue>
        <NetCommunityBenefitExpense>554738</NetCommunityBenefitExpense>
        <PercentOfTotalExpense>0.0068</PercentOfTotalExpense>
      </CharityCareAtCost>
      <UnreimbursedMedicaid>
        <PersonsServed>54287</PersonsServed>
        <TotalCommunityBenefitExpense>17090143</TotalCommunityBenefitExpense>
        <DirectOffsettingRevenue>12409759</DirectOffsettingRevenue>
        <NetCommunityBenefitExpense>4680384</NetCommunityBenefitExpense>
        <PercentOfTotalExpense>0.0572</PercentOfTotalExpense>
      </UnreimbursedMedicaid>
      <TotalCharityCare>
        <NumberOfActivitiesOrPrograms>1</NumberOfActivitiesOrPrograms>
        <PersonsServed>56929</PersonsServed>
        <TotalCommunityBenefitExpense>17777156</TotalCommunityBenefitExpense>
        <DirectOffsettingRevenue>12542034</DirectOffsettingRevenue>
        <NetCommunityBenefitExpense>5235122</NetCommunityBenefitExpense>
        <PercentOfTotalExpense>0.0640</PercentOfTotalExpense>
      </TotalCharityCare>
      <CommunityHealthServices>
        <NumberOfActivitiesOrPrograms>19</NumberOfActivitiesOrPrograms>
        <PersonsServed>6501</PersonsServed>
        <TotalCommunityBenefitExpense>658601</TotalCommunityBenefitExpense>
        <DirectOffsettingRevenue>456609</DirectOffsettingRevenue>
        <NetCommunityBenefitExpense>201992</NetCommunityBenefitExpense>
        <PercentOfTotalExpense>0.0025</PercentOfTotalExpense>
      </CommunityHealthServices>
      <HealthProfessionsEducation>
        <NumberOfActivitiesOrPrograms>1</NumberOfActivitiesOrPrograms>
        <PersonsServed>24</PersonsServed>
        <TotalCommunityBenefitExpense>90629</TotalCommunityBenefitExpense>
        <DirectOffsettingRevenue>0</DirectOffsettingRevenue>
        <NetCommunityBenefitExpense>90629</NetCommunityBenefitExpense>
        <PercentOfTotalExpense>0.0011</PercentOfTotalExpense>
      </HealthProfessionsEducation>
      <SubsidizedHealthServices>
        <NumberOfActivitiesOrPrograms>1</NumberOfActivitiesOrPrograms>
        <PersonsServed>0</PersonsServed>
        <TotalCommunityBenefitExpense>11510751</TotalCommunityBenefitExpense>
        <DirectOffsettingRevenue>9037981</DirectOffsettingRevenue>
        <NetCommunityBenefitExpense>2472770</NetCommunityBenefitExpense>
        <PercentOfTotalExpense>0.0302</PercentOfTotalExpense>
      </SubsidizedHealthServices>
      <CashAndInKindContributions>
        <NumberOfActivitiesOrPrograms>2</NumberOfActivitiesOrPrograms>
        <PersonsServed>100</PersonsServed>
        <TotalCommunityBenefitExpense>14853</TotalCommunityBenefitExpense>
        <DirectOffsettingRevenue>0</DirectOffsettingRevenue>
        <NetCommunityBenefitExpense>14583</NetCommunityBenefitExpense>
        <PercentOfTotalExpense>0.0002</PercentOfTotalExpense>
      </CashAndInKindContributions>
      <TotalOtherBenefits>
        <NumberOfActivitiesOrPrograms>23</NumberOfActivitiesOrPrograms>
        <PersonsServed>6625</PersonsServed>
        <TotalCommunityBenefitExpense>12274834</TotalCommunityBenefitExpense>
        <DirectOffsettingRevenue>9494590</DirectOffsettingRevenue>
        <NetCommunityBenefitExpense>2779974</NetCommunityBenefitExpense>
        <PercentOfTotalExpense>0.0340</PercentOfTotalExpense>
      </TotalOtherBenefits>
      <TotalCommunityBenefits>
        <NumberOfActivitiesOrPrograms>24</NumberOfActivitiesOrPrograms>
        <PersonsServed>63554</PersonsServed>
        <TotalCommunityBenefitExpense>30051990</TotalCommunityBenefitExpense>
        <DirectOffsettingRevenue>22036624</DirectOffsettingRevenue>
        <NetCommunityBenefitExpense>8015096</NetCommunityBenefitExpense>
        <PercentOfTotalExpense>0.0980</PercentOfTotalExpense>
      </TotalCommunityBenefits>
      <BadDebtExpenseReported>1</BadDebtExpenseReported>
      <BadDebtExpenseAmount>2039796</BadDebtExpenseAmount>
      <AmountAttributableTo>0</AmountAttributableTo>
      <AmountReimbursedByMedicare>12480348</AmountReimbursedByMedicare>
      <CostOfCareReimbursedByMedicare>14782722</CostOfCareReimbursedByMedicare>
      <MedicareSurplusOrShortfall>-2302374</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>
        <PostedInEmergencyRoom>X</PostedInEmergencyRoom>
        <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>2</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 Centers</BusinessNameLine1>
          </Name>
          <Address>
            <AddressLine1>99 East State Street</AddressLine1>
            <City>Gloversville</City>
            <State>NY</State>
            <ZIPCode>12078</ZIPCode>
          </Address>
          <FacilityType>Primary/Specialty Care Centers (Clinics).</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>12010</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>Johnstown</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>Pediatric 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 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 Care Center (Clinic)</FacilityType>
        </OtherFacilities>
        <OtherFacilities>
          <Name>
            <BusinessNameLine1>Terrace Primary Care Center</BusinessNameLine1>
          </Name>
          <Address>
            <AddressLine1>2 Fonclair Terrace</AddressLine1>
            <City>Johnstown</City>
            <State>NY</State>
            <ZIPCode>12095</ZIPCode>
          </Address>
          <FacilityType>Primary 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 communty. Our State requires the filing of a community benefit report every 3 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 the 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 $81,757,195. Bad debt expense is not included 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 seven 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.</Explanation>
      </Form990ScheduleHPartVI>
      <Form990ScheduleHPartVI>
        <Identifier>SchH_P03_S0A_L02</Identifier>
        <ReturnReference>Schedule H, Part III, Section A, Line 2</ReturnReference>
        <Explanation>The ratio of patient care cost to charges is applied to the bad debt attributable to patient accounts to calculate the estimated cost of bad debt attributable to patient accounts that is reported on line 2. Discounts and payments on patient accounts are recorded as an adjustment to revenue, not bad debt expense.</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 paitents 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. The 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 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. The calculation method used to determine costs reported on Line 2 is the ratio of cost to charges.</Explanation>
      </Form990ScheduleHPartVI>
      <Form990ScheduleHPartVI>
        <Identifier>SchH_P03_S0B_L07</Identifier>
        <ReturnReference>Schedule H, Part III, Section B, Line 7</ReturnReference>
        <Explanation>The actual cost for Medicare patients when all costs to the organization are included is $15,770,848 which amounts to an actual $2,433,996 shortfall between payments and costs.</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. Community Benefit: 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 patients, including those covered by Medicare. We are relieving a government burden by providing care to Medicare patients even though costs exceed reimbursements by $2,302,374. 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 the patients forcing the hospital to use other funds to cover the deficit. Medicare Cost Reports that hospitals are required to file do not include all of the costs required to treat Medicare patients. Therefore the amount reflected on the Medicare Cost Report differs from actual losses. In 2010 the Hospital realized an additional shortfall of $1,499,627 resulting from Medicare Advantage and non PPS Medicare patients. The total shortfall for all types of Medicare patients was $3,802,001.</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 paitents 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 madeby means of the provision for bad debts. Accounts written off as uncollectible are deducted from the allowance and subsequent recoveries are added. The 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 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 building activities 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 and wellness and prevent disease. The most visible coalition program is our membership in the Adirondack Rural Health Network, a network of six counties that share similar geographic, demographic, and health care issues. ARHN is preparing the agenda and programming suggestions for our six counties in the battle to address physical activity and nutrition, voted as the number 1 health issue in our areas. 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 the number one local issue, childhood asthma. Over the next two years we will identify and implement strategies to further eradicate this health issue 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>The hospital's financial assistance policy is communicated in both English and Spanish in a variety of ways. Communications include: bilingual signage throughout the hospital, including the emergency department and outpatient registration areas; distribution of brochures describing the policy and how to apply for assistance; posting of the policy and application on the website, and a statement added to all publications indicating the availability of charity care. Interpretation services are available for patients needing information in languages other than English and Spanish.</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 Hamilton and Montgomery Counties. Both Fulton and Hamilton Counties are designated as Healthcare Professional Shortage Areas. A snapshot of our primary service area shows the 2010 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 41.4 years and 16% of the population is age 65 and older. The median household income in Fulton County is $44,175 (below the national median of $52,175) with 13.7% of families below the poverty level. 82.2% of the population has a high school degree or higher, 18% are high school drop outs. The leading industries are educational services, health care and social assistance employing 26% of the workforce followed by manufacturing employing 15%. Unemployment sits at nearly 10%. The major health issues inFulton 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 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 poverty level and major health issues will continue challenging Nathan Littauer to continue providing needed health 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 Excess funds help to support free and low cost education programs offered by Littauer to our community. Opened a new pediatric center and purchased and renovated an outpatient surgery center. Invested millions of dollars in computer resources to meet the Federal standards.</Explanation>
      </Form990ScheduleHPartVI>
      <Form990ScheduleHPartVI>
        <Identifier>SchH_P06_S00_L06</Identifier>
        <ReturnReference>Schedule H, Part VI, Line 6</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 renovated the aging maternity unit, expanded the emergency department and built a needed outpatient Primary Care Center in one of the fastest growing parts of our service area. Excess funds help to support free and low cost education programs offered by Littauer to our community.</Explanation>
      </Form990ScheduleHPartVI>
      <Form990ScheduleHPartVI>
        <Identifier>SchH_P06_S00_L07</Identifier>
        <ReturnReference>Schedule H, Part VI, Line 7</ReturnReference>
        <Explanation>Community benefit report is filed with New York State.</Explanation>
      </Form990ScheduleHPartVI>
    </IRS990ScheduleH>
    <IRS990ScheduleJ documentId="R000006" softwareId="10000077" softwareVersion="v1.00">
      <TravelForCompanions>X</TravelForCompanions>
      <WrittenPolicyReTAndEExpenses>1</WrittenPolicyReTAndEExpenses>
      <SubstantiationRequired>1</SubstantiationRequired>
      <CompensationCommittee>X</CompensationCommittee>
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      <Form990ScheduleJPartII>
        <NamePerson>Michael Martynik MD</NamePerson>
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        <TotalCompensationRelatedOrgs>0</TotalCompensationRelatedOrgs>
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        <CompReportPrior990RelatedOrgs>0</CompReportPrior990RelatedOrgs>
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      <Form990ScheduleJPartII>
        <NamePerson>Peter Dowling MD</NamePerson>
        <BaseCompensationFilingOrg>284231</BaseCompensationFilingOrg>
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        <NamePerson>Patricia Nguyen MD</NamePerson>
        <BaseCompensationFilingOrg>281231</BaseCompensationFilingOrg>
        <CompBasedOnRelatedOrgs>0</CompBasedOnRelatedOrgs>
        <BonusFilingOrg>0</BonusFilingOrg>
        <BonusRelatedOrgs>0</BonusRelatedOrgs>
        <OtherCompensationFilingOrg>690</OtherCompensationFilingOrg>
        <OtherCompensationRelatedOrgs>0</OtherCompensationRelatedOrgs>
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      <Form990ScheduleJPartIII>
        <Identifier>SchJ_P01_S00_L01a</Identifier>
        <ReturnReference>Schedule J, Part I, Line 1a</ReturnReference>
        <Explanation>The Chief Executive Officer's employment contract allows his spouse to accompany him to one conference per year. A 1099 tax form is filed for the associated travel expense as necessary.</Explanation>
      </Form990ScheduleJPartIII>
      <Form990ScheduleJPartIII>
        <Identifier>SchJ_P01_S00_L04</Identifier>
        <ReturnReference>Schedule J, Part I, Line 4</ReturnReference>
        <Explanation>Payments were made on behalf of the CEO and CFO to a 457(f) plan during 2010.</Explanation>
      </Form990ScheduleJPartIII>
    </IRS990ScheduleJ>
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      <RealEstateCommercial>
        <NonCashCheckbox>X</NonCashCheckbox>
        <NumberOfContributions>1</NumberOfContributions>
        <NoncashContribsRptdF990>0</NoncashContribsRptdF990>
        <MethodOfDeterminingRevenues>Apprasial</MethodOfDeterminingRevenues>
      </RealEstateCommercial>
      <NumberOf8283Received>0</NumberOf8283Received>
      <AnyPropertyThatMustBeHeld>0</AnyPropertyThatMustBeHeld>
      <ReviewProcessUnusualNCGifts>0</ReviewProcessUnusualNCGifts>
      <ThirdPartiesUsed>0</ThirdPartiesUsed>
      <Form990ScheduleMPartII>
        <Identifier>SchM_P01_S00_L33</Identifier>
        <ReturnReference>Schedule M, Part I, Line 33</ReturnReference>
        <Explanation>The commercial real estate donated increased the net assets of the hospital and was not recorded as income.</Explanation>
      </Form990ScheduleMPartII>
    </IRS990ScheduleM>
    <IRS990ScheduleO documentId="R000008" softwareId="10000077" softwareVersion="v1.00">
      <GeneralExplanation>
        <Identifier>F990_P01_S00_L06</Identifier>
        <ReturnReference>Form 990, Part I, Line 6</ReturnReference>
        <Explanation>Total volunteer hours for 2010 18,160 which includes 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 Nathan Littauer Hospital Association, must consent to any changes to the hospital's bylaws.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>F990_P06_S0B_L11a</Identifier>
        <ReturnReference>Form 990, Part VI, Section B, Line 11a</ReturnReference>
        <Explanation>The form 990 was presented at a regular meeting of the Board of Directors on October 24, 2011 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 materials." 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 participate 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 comparable 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 - $686,333 Change in Net Unrealized Gains and Losses - $206,945 Contribution of Capital Asset - $1,800,000 Restricted Gifts and Grants - $66,602 Distributions from NL Foundation - $640,000 Change in Interest in Net Assets of NL Foundation - $(754,813)</Explanation>
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        </NameOfDisregardedEntity>
        <AddressUS>
          <AddressLine1>99 East State Street</AddressLine1>
          <City>Gloversville</City>
          <State>NY</State>
          <ZIPCode>12078</ZIPCode>
        </AddressUS>
        <EIN>237065255</EIN>
        <PrimaryActivities>Leasing an 84 bed Skilled Nursing Facility to Hospital</PrimaryActivities>
        <LegalDomicileState>NY</LegalDomicileState>
        <ExemptCodeSection>501(c)3</ExemptCodeSection>
        <PublicCharityStatus>7</PublicCharityStatus>
        <DirectControllingEntityNA>N/A</DirectControllingEntityNA>
        <ControlledOrg>0</ControlledOrg>
      </Form990ScheduleRPartII>
      <Form990ScheduleRPartII>
        <NameOfDisregardedEntity>
          <BusinessNameLine1>NLH Realty Corp</BusinessNameLine1>
        </NameOfDisregardedEntity>
        <AddressUS>
          <AddressLine1>99 East State Street</AddressLine1>
          <City>Gloversville</City>
          <State>NY</State>
          <ZIPCode>12078</ZIPCode>
        </AddressUS>
        <EIN>141641020</EIN>
        <PrimaryActivities>Realty holding company</PrimaryActivities>
        <LegalDomicileState>NY</LegalDomicileState>
        <ExemptCodeSection>501(c)2</ExemptCodeSection>
        <DirectControllingEntityNA>N/A</DirectControllingEntityNA>
        <ControlledOrg>0</ControlledOrg>
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      <Form990ScheduleRPartII>
        <NameOfDisregardedEntity>
          <BusinessNameLine1>Nathan Littauer Foundation</BusinessNameLine1>
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        <AddressUS>
          <AddressLine1>99 East State Street</AddressLine1>
          <City>Gloversville</City>
          <State>NY</State>
          <ZIPCode>12078</ZIPCode>
        </AddressUS>
        <EIN>141638991</EIN>
        <PrimaryActivities>Support the Hospital &amp; promote healthcare programs in the community through donations.</PrimaryActivities>
        <LegalDomicileState>NY</LegalDomicileState>
        <ExemptCodeSection>501(c)3</ExemptCodeSection>
        <PublicCharityStatus>Type III</PublicCharityStatus>
        <DirectControllingEntityNA>N/A</DirectControllingEntityNA>
        <ControlledOrg>0</ControlledOrg>
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        <NameOfDisregardedEntity>
          <BusinessNameLine1>Nathan Littauer Hospital Auxiliary</BusinessNameLine1>
        </NameOfDisregardedEntity>
        <AddressUS>
          <AddressLine1>99 East State Street</AddressLine1>
          <City>Gloversville</City>
          <State>NY</State>
          <ZIPCode>12078</ZIPCode>
        </AddressUS>
        <EIN>146086641</EIN>
        <PrimaryActivities>Assisting Hospital in promoting health &amp; welfare of the community</PrimaryActivities>
        <LegalDomicileState>NY</LegalDomicileState>
        <ExemptCodeSection>501(c)3</ExemptCodeSection>
        <PublicCharityStatus>Type III</PublicCharityStatus>
        <DirectControllingEntityNA>N/A</DirectControllingEntityNA>
        <ControlledOrg>0</ControlledOrg>
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      <ReceiptOfIntAnnRentsRoyalties>0</ReceiptOfIntAnnRentsRoyalties>
      <GiftGrantOrCapContrToOtherOrg>0</GiftGrantOrCapContrToOtherOrg>
      <GiftGrantOrCapContrFrOtherOrg>1</GiftGrantOrCapContrFrOtherOrg>
      <LoansOrGuaranteesToOtherOrg>0</LoansOrGuaranteesToOtherOrg>
      <LoansOrGuaranteesFromOtherOrg>0</LoansOrGuaranteesFromOtherOrg>
      <SaleOfAssetsToOtherOrg>0</SaleOfAssetsToOtherOrg>
      <PurchaseOfAssetsFromOtherOrg>0</PurchaseOfAssetsFromOtherOrg>
      <ExchangeOfAssets>0</ExchangeOfAssets>
      <RentalOfFacilitiesToOtherOrgs>0</RentalOfFacilitiesToOtherOrgs>
      <RentalOfFacilitiesFrOtherOrgs>1</RentalOfFacilitiesFrOtherOrgs>
      <PerformOfServicesForOtherOrgs>0</PerformOfServicesForOtherOrgs>
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      <ReimbursementPaidByOtherOrg>0</ReimbursementPaidByOtherOrg>
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      <TransactionsRelatedOrgsTable>
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          <BusinessNameLine1>Nathan Littauer Foundation</BusinessNameLine1>
        </NameOfOtherOrganization>
        <TransactionType>c</TransactionType>
        <AmountInvolved>590000</AmountInvolved>
        <MethodOfAmtDetermination>Cash received.</MethodOfAmtDetermination>
      </TransactionsRelatedOrgsTable>
      <TransactionsRelatedOrgsTable>
        <NameOfOtherOrganization>
          <BusinessNameLine1>Gloversville Extended Care &amp; Nursing Home Co Inc</BusinessNameLine1>
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        <AmountInvolved>138953</AmountInvolved>
        <MethodOfAmtDetermination>Payments made for the lease.</MethodOfAmtDetermination>
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  </ReturnData>
</Return>