2024-11-15T14:32:05-06:00 2023-12-31 161131146 BONADIO & CO LLP 432 NORTH FRANKLIN STREET SYRACUSE NY 13204 990 2023-01-01 150622079 CARTHAGE AREA HOSPITAL CART 3154931000 1001 WEST STREET CARTHAGE NY 13619 RICHARD DUVALL CHIEF EXECUTIVE OFFICER 3154931000 2024-11-15 1 0 TIMOTHY HAMMOND P01224809 3154227109 2024-11-15 2023 2024-10-15 13:58:12Z RICHARD DUVALL 1001 WEST STREET CARTHAGE NY 13619 90472994 0 X HTTP://WWW.CARTHAGEHOSPITAL.COM/ X 1921 NY PROVIDE QUALITY, COMPREHENSIVE HEALTHCARE SERVICES, IN A COMMUNITY SETTING. 10 9 663 50 0 0 6665263 1896016 69887769 86824007 -277123 278823 2332443 157367 78608352 89156213 0 0 0 0 45415126 47398827 0 0 21431 34034541 42656513 79449667 90055340 -841315 -899127 48059004 52546552 40552345 45699895 7506659 6846657 CARTHAGE AREA HOSPITAL PROVIDES QUALITY COMPREHENSIVE HEALTHCARE SERVICES, PRIMARILY IN JEFFERSON COUNTY, PERSONALIZING QUALITY HEALTHCARE IN PARTNERSHIP WITH VARIOUS COMMUNITIES THROUGHOUT THE AREA. 0 0 81961165 86927515 CARTHAGE AREA HOSPITAL IS A NOT-FOR-PROFIT, CRITICAL ACCESS HOSPITAL, LOCATED IN CARTHAGE, NEW YORK. THE HOSPITAL PROVIDES QUALITY INPATIENT AND OUTPATIENT HEALTHCARE SERVICES. THE HOSPITAL HAS 25 CERTIFIED BEDS, COMPRISED OF 10 MEDICAL/SURGICAL, 4 INTENSIVE CARE, 3 PEDIATRIC, AND 8 MATERNITY. THE HOSPITAL PROVIDES OUTPATIENT ANCILLARY SERVICES SUCH AS GENERAL AND ORTHOPEDIC SURGERIES, LAB TESTS, MEDICAL IMAGING, EMERGENCY ROOM SERVICES, AND RESPIRATORY SERVICES. THE HOSPITAL HAD 162,104 OUTPATIENT VISITS AND 6,760 PATIENT DAYS OF CARE IN 2023. THE HOSPITAL ALSO HAS AN EXTENSIVE NETWOK OF PRIMARY CARE, SPECIALTY CARE, AND SCHOOL-BASED CLINICS AND HOME HEALTH SERVICES LOCATED PRIMARILY IN JEFFERSON COUNTY. 81961165 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 1 0 0 1 40 0 1 663 1 0 0 0 0 0 0 0 0 0 0 0 0 X 10 9 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 1 0 NY X EMILY GAZDA 3154931000 40 FRANKLIN STREET CARTHAGE NY 13619 GARY ROWE PRESIDENT 1.00 3.00 X X 0 0 0 DALE KLOCK VICE PRESIDENT 1.00 3.00 X X 0 0 0 TIM STURICK TREASURER 1.00 3.00 X X 0 0 0 LAWRENCE HASSELER SECRETARY 1.00 3.00 X X 0 0 0 DR MIRZA ASHRAF DIRECTOR 1.00 X 373910 0 4368 DR KENNETH FISH DIRECTOR 1.00 X 0 0 0 ADAM FULLER DIRECTOR 1.00 3.00 X 0 0 0 ANNE ROHR DIRECTOR 1.00 X 0 0 0 PATTIE EARL DIRECTOR 1.00 1.00 X 0 0 0 JENNIFER PREMO DIRECTOR 1.00 X 0 0 0 RICHARD DUVALL CHIEF EXECUTIVE OFFICER 20.00 22.00 X 0 649370 37353 MICHAEL GORDON CHIEF MEDICAL OFFICER 40.00 X 1196014 0 23777 ERIC BURCH CHIEF OPERATING OFFICER 40.00 X 257476 0 2308 MORGAN PIERCE DIRECTOR OF FINANCE 40.00 X 203819 0 0 HARDIK PATEL MEDICAL STAFF PRESIDENT 40.00 X 352900 0 23777 NATA PARNES PHYSICIAN 40.00 X 1394489 0 23777 PETER VANEENENAAM PHYSICIAN 40.00 X 812225 0 24892 STEVEN FISH PHYSICIAN 40.00 X 801661 0 23777 BRUCE BAIRD PHYSICIAN 40.00 X 814295 0 23777 HOWARD HUANG PHYSICIAN 40.00 X 737528 0 20416 ROB BLOOM FORMER CHIEF FINANCIAL OFFICER 0.00 0.00 X 101370 0 150 7045687 649370 208372 91 1 1 0 DELPHI HOSPITALIST SERVICES 7785 N STATE STREET LOWVILLE NY 13367 STAFFING 4122308 DAVIN HEALTHCARE WORKFORCE SOLUTIONS 18 DIVISION ST SARATOGA SPRINGS NY 12866 STAFFING 3138510 SURGICALIST OF NEW YORK PC 1001 WEST STREET CARTHAGE NY 13619 STAFFING 3072108 BRIGHTON RADIOLOGY ASSOCIATES 3582 BRODHEAD ROAD SUITE 204 MONACA PA 15061 STAFFING 1022191 DIAGNOSTIC & INTERVENTIONAL RADIOLOGY 27 DOCKSIDE DRIVE MORRISTOWN NY 13661 STAFFING 500365 19 4800 1817137 74079 1896016 NET PATIENT SERVICE REVENUE 900099 86824007 86824007 86824007 267799 267799 1370640 1316781 53859 53859 53859 11024 0 11024 11024 11024 OTHER REVENUE 900099 103508 103508 103508 89156213 86927515 0 332682 X 1907760 1548914 358846 37113868 35631783 1460767 21318 1789482 1703532 85950 3876368 2672700 1203668 2711349 2580907 130442 277821 277821 810818 575 810243 10066661 9241243 825418 168433 7975 160458 11291904 11016540 275364 8183228 6877264 1305964 309975 200182 109793 133729 121830 11899 1069234 1052024 17210 1363133 864249 498884 MISCELLANEOUS EXPENSES 8191418 7752424 438881 113 DUES AND LICENSES 790159 689023 101136 90055340 81961165 8072744 21431 1881227 696276 7479105 5620644 5435322 13739937 1913740 1708299 1565927 1978533 51064566 39603398 11822592 11461168 358127 358127 17602964 16983568 48059004 52546552 16782805 24520861 4453707 3608681 19315833 17570353 40552345 45699895 X 7506659 6846657 7506659 6846657 48059004 52546552 X -899127 239125 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 0 1 2487 0 1 14644 17131 0 PART II-B, LINE 1: MEMBERS OF MANAGEMENT MET WITH VARIOUS STATE AND FEDERAL LEGISLATORS IN ORDER TO ADVOCATE FOR LEGISLATION FOR THE BENEFIT OF THE HEALTHCARE INDUSTRY. ADDITIONALLY, A PORTION OF MEMBERSHIP DUES PAID TO THE HEALTHCARE ASSOCIATION OF NEW YORK STATE, THE AMERICAN HOSPITAL ASSOCIATION, AND IROQUOIS HEALTHCARE ASSOCIATION ARE USED BY THOSE ASSOCIATIONS SPECIFICALLY FOR LOBBYING ACTIVITIES. 0 0 343688 343688 23820028 16698963 7121065 24596562 22904435 1692127 2304288 2304288 11461168 DUE FROM MEADOWBROOK TERRACE, INC. 2552149 INSURANCE CLAIMS ASSET 1799966 OTHER RECEIVABLES 3853568 OPERATING LEASE RIGHT-OF-USE ASSET 6566463 DUE FROM NORTH COUNTRY ORTHOPAEDIC AMBULATORY SURGERY CENTER, LLC 2211422 16983568 ESTIMATED AMOUNTS DUE TO THIRD PARTY PAYORS 8723850 ACCRUED PENSION LIABILITY 475279 INSURANCE CLAIMS LIABILITY 1799966 OPERATING LEASE LIABILITY 6570369 FUNDS HELD IN TRUST FOR OTHERS 889 17570353 1 1 X 1 X 1 X 1 1 1 0 1 1 429123 306011 123112 0.00140 18097431 18036768 60663 0.00070 18526554 18342779 183775 0.00210 48466894 46597635 1869259 0.02080 48466894 46597635 1869259 0.02080 66993448 64940414 2053034 0.02290 186742 186742 0.00210 30615 30615 0.00030 217357 217357 0.00240 1 2279923 1134307 11285444 11491985 -206541 X 1 1 1 1 CARTHAGE AREA HOSPITAL 1001 WEST STREET CARTHAGE NY 13619 HTTP://WWW.CARTHAGEHOSPITAL.COM/ 2238700C X X X X CARTHAGE AREA HOSPITAL 1 0 0 1 X X X X X X X 22 1 1 1 1 X HTTP://WWW.CARTHAGEHOSPITAL.COM/ABOUT/COMMUNITY-SERVICE-PLAN/ X 1 19 1 HTTP://WWW.CARTHAGEHOSPITAL.COM/ABOUT/COMMUNITY-SERVICE-PLAN/ 0 1 X 200.000000000000 300.000000000000 1 1 X X X X 1 X HTTP://WWW.CARTHAGEHOSPITAL.COM/PATIENTS-VISITORS/BILLING-INSURANCE/ X HTTP://WWW.CARTHAGEHOSPITAL.COM/PATIENTS-VISITORS/BILLING-INSURANCE/ X HTTP://WWW.CARTHAGEHOSPITAL.COM/PATIENTS-VISITORS/BILLING-INSURANCE/ X X X X X X 1 X 0 X X X 1 X 0 0 CARTHAGE AREA HOSPITAL PART V, SECTION B, LINE 5: CARTHAGE AREA HOSPITAL UTILIZES OTHER DATA SOURCES AS NECESSARY INCLUDING PATIENT SATISFACTION SURVEYS, COMMUNITY WORKSHOP EVALUATIONS, AND COMMUNITY EVENT SURVEYS. CARTHAGE AREA HOSPITAL PART V, SECTION B, LINE 6A: THE 2022-2024 JEFFERSON COUNTY COMMUNITY HEALTH ASSESSMENT WAS PERFORMED IN COOPERATION WITH RIVER HOSPITAL AND SAMARITAN MEDICAL CENTER. CARTHAGE AREA HOSPITAL PART V, SECTION B, LINE 6B: CARTHAGE AREA HOSPITAL'S SERVICE LOCATION IS WITHIN JEFFERSON COUNTY. THE 2022-2024 JEFFERSON COUNTY COMMUNITY HEALTH ASSESSMENT PREPARED BY FORT DRUM REGIONAL HEALTH PLANNING ORGANIZATION WAS PERFORMED IN COOPERATION WITH JEFFERSON COUNTY PUBLIC HEATH SERVICES AND NORTH COUNTRY HEALTH COMPASS PARTNERS. CARTHAGE AREA HOSPITAL PART V, SECTION B, LINE 11: CARTHAGE AREA HOSPITAL DEVELOPED AND IMPLEMENTED A COMMUNITY SERVICE PLAN WHICH ALIGNED WITH THE MOST RECENT CHNA. CARTHAGE AREA HOSPITAL FOCUSED ON TWO PRIORITIES ADDRESSING COMMUNITY NEEDS. 1) PREVENTING CHRONIC DISEASE; REDUCE OBESITY: OUR EMPLOYEES MADE REFERRALS TO NUTRITIONAL COUNSELING WITH A REGISTERED DIETITION FOR STUDENTS WHO WERE IDENTIFIED AS AT-RISK DURING THEIR ANNUAL PHYSICALS CONDUCTED THROUGH THE SCHOOL-BASED HEALTH CLINICS. THE HOSPITAL PARTNERED WITH A LOCAL FARMER TO USE LOCAL PRODUCE, AS AVAILABLE, IN THE HOSPITAL CAFETERIA AND ALSO OFFERED COOKING CLASSES ON HOW TO PREPARE HEALTHY FOODS AT HOME. THE HOSPITAL OFFERED COMMUNITY EDUCATION ON WEIGHT MANAGEMENT AND HEALTHY LIFESTYLES IN A "WEIGHT OF LIFE" EDUCATION SERIES. IN ADDITION TO THE COOKING CLASSES THE HOSPITAL INTRODUCED THE OPTION TO PURCHASE HEALTHY MEALS READY TO BE MADE IN SIMILAR STYLE OF "BLUE APRON AND "HELLO FRESH." OTHER PREVENTION AND WEIGHT MANAGEMENT PROGRAMS INCLUDED AN ANNUAL COMMUNITY HEALTH DAY AT A LOCAL PARK FOR ALL AGE GROUPS. 2) PROMOTE MENTAL HEALTH AND PREVENT SUBSTANCE ABUSE; STRENGTHEN INFRASTRUCTURE ACROSS SYSTEMS: THE HOSPITAL BEGAN TO INTEGRATE SCREENINGS FOR DEPRESSION DURING PRIMARY CARE VISITS AND REFERRING QUALIFYING HIGH RISK PATIENTS TO DEPRESSION CARE MANAGER. PROMOTE AWARENESS AND ACCESS TO MENTAL HEALTH TREATMENT AT COMMUNITY EVENTS AND CONTINUE TO RAISE AWARENESS REGARDING AVAILABLE SCHOOL-BASED MENTAL HEALTH PROGRAMS AS WELL AS BEHAVIORAL HEALTH CLINIC SERVICES. 18 1 - CAH FAMILY MEDICAL CENTER 117 NORTH MECHANIC STREET CARTHAGE NY 13619 PRIMARY CARE CLINIC 2 - WOMEN'S WAY TO WELLNESS 117 NORTH MECHANIC STREET CARTHAGE NY 13619 OB/GYNO OUTPATIENT CLINIC 3 - TRI-COUNTY ORTHOPEDIC CENTER 3 BRIDGE STREET CARTHAGE NY 13619 OUTPATIENT ORTHOPEDIC CENTER 4 - CAH SURGERY CENTER 3 BRIDGE STREET CARTHAGE NY 13619 OUTPATIENT SURGERY CLINIC 5 - CAH BEHAVIORAL HEALTH CENTER 3 BRIDGE STREET CARTHAGE NY 13619 OUTPATIENT BEHAVIORAL HEALTH CLINIC 6 - PHILADELPHIA PHYSICAL THERAPY US ROUTE 11 PHILADELPHIA NY 13673 REHABILITATION CLINIC 7 - CARTHAGE HIGH SCHOOL CLINIC 36500 ROUTE 26 CARTHAGE NY 13619 OUTPATIENT SCHOOL CLINIC 8 - CARTHAGE MIDDLE SCHOOL CLINIC 21986 COLE ROAD CARTHAGE NY 13619 OUTPATIENT SCHOOL CLINIC 9 - BEAVER RIVER SCHOOL CLINIC 9508 ARTZ ROAD BEAVER FALLS NY 13305 OUTPATIENT SCHOOL CLINIC 10 - CAH THERAPHY SERVICES 3 BRIDGE STREET CARTHAGE NY 13619 REHABILITATION CLINIC 11 - COMPREHENSIVE WOMEN'S HEALTH SERVICES 622 WASHINGTON STREET WATERTOWN NY 13601 OB/GYNO OUTPATIENT CLINIC 12 - PHILADELPHIA MEDICAL CENTER 32787 US ROUTE 11 PHILADELPHIA NY 13673 RURAL HEALTH CLINIC 13 - LAFARGEVILLE SCHOOL-BASED HEALTH CLINIC 20414 SUNRISE AVE LAFARGEVILLE NY 13656 SCHOOL-BASED HEALTH CLINIC 14 - MADRID HEALTH CENTER 2263 SH 310 MADRID NY 13660 RURAL HEALTH CLINIC 15 - CANTON HEALTH CENTER 39 WEST MAIN STREET CANTON NY 13617 RURAL HEALTH CLINIC 16 - WADDINGTON HEALTH CENTER 4 MONTGOMERY HEIGHTS WADDINGTON NY 13694 RURAL HEALTH CLINIC 17 - OGDENSBURG HEALTH CENTER 100 HORWOOD PLACE OGDENSBURG NY 13669 RURAL HEALTH CLINIC 18 - HEUVELTON HEALTH CENTER 103 RENSSELAER STREET HEUVELTON NY 13654 RURAL HEALTH CLINIC PART I, LINE 6A: CARTHAGE AREA HOSPITAL ROUTINELY PROVIDES THE COMMUNITY WITH INFORMATION ON THE COMMUNITY BENEFIT ACTIVITIES AND UTILIZATION OF CARTHAGE AREA HOSPITAL. THIS IS OFTEN IN THE FORM OF NEWSLETTERS AVAILABLE AND DISTRIBUTED TO THE COMMUNITY. PART I, LINE 7: THE 2023 COST REPORT PREPARED BY M.S. HALL & ASSOCIATES, INC. WAS UTILIZED IN COMPLETION OF SCHEDULE H. THE COMMUNITY HEALTH NEEDS ASSESSMENT AND CARTHAGE AREA HOSPITAL'S COMMUNITY ACTION PLAN WAS ALSO USED TO COMPLETE SCHEDULE H. PART I, LINE 7G: CARTHAGE AREA HOSPITAL'S SUBSIDIZED HEALTH SERVICES INCLUDE ITS PRIMARY CARE CLINIC, REFERRED AMBULATORY SERVICE, EMERGENCY ROOM, AND OBSERVATION BEDS. PART II, COMMUNITY BUILDING ACTIVITIES: CARTHAGE AREA HOSPITAL HOSTS AND PARTICIPATES IN MANY COMMUNITY BUILDING ACTIVITIES. THERE ARE MANY ACTIVITIES HOSTED BY CARTHAGE WHICH ARE POINTED AT EDUCATING THE COMMUNITY ON THEIR HEALTH. EXAMPLES INCLUDE BREAST CANCER AWARENESS LUNCHEONS, HEALTH FAIRS AND COMMIT TO BE FIT PROGRAMS. INCREASING THE EDUCATION OF THE COMMUNITY IS BELIEVED TO AID IN PREVENTION OF AILMENTS AND THEREFORE ARE AN INTERVENTION METHOD. ADDITIONALLY CARTHAGE PARTICIPATES IN ACTIVITIES THAT BUILD THE GENERAL WELL BEING AND COHESIVENESS OF THE COMMUNITY. SUCH EVENTS INCLUDE UNITED WAY, COMMUNITY PARADES AND SPONSORSHIP OF COMMUNITY ACTIVITIES. PART III, LINE 2: BAD DEBT EXPENSE INFORMATION WAS OBTAINED FROM THE 2022 MEDICAID COST REPORT. THE COST REPORT IS COMPLETED BY INDEPENDENT CONSULTANTS UTILIZING PATIENT CHARGE DATA. PART III, LINE 3: THE AMOUNT OF BAD DEBT EXPENSE RELATED TO PATIENTS ELIGIBLE UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY WAS DETERMINED BY UTILIZING THE MEDICARE COST TO CHARGE RATIO APPLIED TO BAD DEBT EXPENSE. THIS INFORMATION WAS OBTAINED BY UTILIZING COST REPORTS PREPARED BY INDEPENDENT CONSULTANTS. PART III, LINE 4: THE HOSPITAL IS DESIGNATED AS A CRITICAL ACCESS HOSPITAL BY MEDICARE AND MEDICAID. AS A CRITICAL ACCESS HOSPITAL, MEDICARE AND TRICARE REIMBURSES THE HOSPITAL ON A COST BASIS, AND MEDICAID REIMBURSES THE HOSPITAL USING A TRENDED BASE YEAR COST PER DISCHARGE HELD TO 110% OF THE STATEWIDE AVERAGE OF ALL CRITICAL ACCESS HOSPITALS PLUS CAPITAL AND ON A PROSPECTIVE PAYMENT SYSTEM FOR OUTPATIENT VISISTS. THE COMPANY ALSO HAS AGREEMENTS WITH OTHER THIRD-PARTY PAYORS WITH PAYMENT ARRANGEMENTS WHICH INCLUDE PROSPECTIVELY DETERMINED RATES PER DISCHARGE OR VISIT, COST-BASED REIMBURSEMENT, DISCOUNTED CHARGES, PER DIEM PAYMENTS AND FEE-FOR-SERVICE PAYMENTS. THE COMPANY RECOGNIZES PATIENT AND RESIDENT SERVICE REVENUE ASSOCIATED WITH SERVICES OR HOUSING PROVIDED TO PATIENTS AND RESIDENTS WHO HAVE THIRD-PARTY COVERAGE ON THE BASIS OF CONTRACTUAL RATES FOR THE SERVICES OR HOUSING PROVIDED, INCLUDING ESTIMATED RETROACTIVE ADJUSTMENTS DUE TO FUTURE AUDITS, REVIEWS AND INVESTIGATIONS. RETROACTIVE ADJUSTMENTS ARE INCLUDED IN THE RECOGNITION OF PATIENT AND RESIDENT SERVICE REVENUE ON AN ESTIMATED BASIS IN THE PERIOD THE RELATED SERVICES ARE RENDERED AND ADJUSTED IN FUTURE PERIODS AS ADJUSTMENTS BECOME KNOWN OR AS YEARS ARE NO LONGER SUBJECT TO SUCH AUDITS, REVIEWS AND INVESTIGATIONS.FOR UNINSURED PATIENTS AND RESIDENTS THAT DO NOT QUALIFY FOR CHARITY CARE, THE COMPANY RECOGNIZES REVENUE ON THE BASIS OF ITS STANDARD RATES FOR SERVICES OR HOUSING PROVIDED. HISTORICALLY, A SIGNIFICANT PORTION OF THE COMPANY'S UNINSURED PATIENTS AND RESIDENTS WILL BE UNABLE OR UNWILLING TO PAY FOR THE SERVICES OR HOUSING PROVIDED. THUS, THE COMPANY RECORDS A PROVISION FOR BAD DEBTS RELATED TO UNINSURED PATIENTS AND RESIDENTS IN THE PERIOD THE SERVICES OR HOUSING ARE PROVIDED. THE COMPANY ESTIMATES THE AMOUNT TO BE RECOGNIZED IN THE CONSOLIDATED FINANCIAL STATEMENTS FOR DOUBTFUL ACCOUNTS BY ANALYZING PATIENT AND RESIDENT ACCOUNTS FOR COLLECTABILITY, CONSIDERING PREVAILING ECONOMIC CONDITIONS, AND APPLYING HISTORICALLY ESTABLISHED PERCENTAGES FOR SELF-PAY AND VARIOUS THIRD-PARTY PAYORS TO THE AGING CATEGORIES IN THE ACCOUNTS RECEIVABLE AGING AND REVIEWING SPECIFIC OUTSTANDING BALANCES. ACCOUNTS FOR WHICH NO PAYMENTS HAVE BEEN RECEIVED FOR A SIGNIFICANT AMOUNT OF TIME ARE CONSIDERED DELINQUENT AND THE ACCOUNTS ARE WRITTEN-OFF WHEN CUSTOMARY COLLECTION EFFORTS ARE EXHAUSTED.THE COMPANY'S ACCOUNTING POLICY WITH RESPECT TO THE CONSOLIDATED FINANCIAL STATEMENTS IS TO TREAT BAD DEBT EXPENSE AS A PRICE CONCESSION WHICH IS DEDUCTED DIRECTLY FROM NET PATIENT SERVICE REVENUE. PART III, LINE 8: THE 2023 MEDICARE COST REPORT WAS UTILIZED TO COMPLETE SCHEDULE H. CARTHAGE AREA HOSPITAL HAS A REMOTE LOCATION AND IS A CRITICAL ACCESS HOSPITAL. THE HOSPITAL OFFERS A FULL RANGE OF SERVICES FROM LAB WORK, IMAGING, EMERGENCY ROOM AND PRIMARY CARE DESPITE LOW UTILIZATION AT TIMES. SURPLUSES AND SHORTFALLS OCCUR DUE TO THE WIDE SPREAD OF SERVICES OFFERED WITH A LIMITED AMOUNT OF PATIENTS WITHIN THE REMOTE AREA. HOWEVER, THESE SERVICES ARE CONTINUALLY OFFERED TO PATIENTS INCREASING THE AVAILABILITY TO HEALTHCARE SERVICES. THE HOSPITAL OFFERS SERVICES TO MANY LOW INCOME PATIENTS AS WELL, WHOM OFTEN WOULD CHOOSE NOT TO OBTAIN ANY HEALTH INTERVENTION IF THEY WERE REQURED TO SPEND FUNDS TO TRAVEL TO CARE. ANY AND ALL SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT. PART III, LINE 9B: THE COLLECTION POLICY REFERS TO CHARITY CARE. THE POLICY STATES "ANY PATIENT RECEIVING SERVICES FOR WHICH THERE IS NO INSURANCE COVERAGE WILL BE REGISTERED AS SELF PAY AND ALL BALANCES WILL BE DUE FROM THE PATIENT EXCEPT CHARIY CARE ADJUSTMENTS AS DETERMINED BY THE FINANCIAL COUNSELOR IN ACCORDANCE WITH CARTHAGE AREA HOSPITAL'S CHARITY CARE POLICY." CARTHAGE AREA HOSPITAL'S COLLECTION POLICY DOES STATE HOW TO APPLY FOR FINANCIAL ASSISTANCE. THERE ARE NO PROVISIONS WRITTEN INTO THE COLLECTION POLICY FOR THOSE ACCOUNTS WHICH ARE DEEMED ELIGIBLE FOR FINANCIAL ASSISTANCE. CARTHAGE HAS NOT WRITTEN THIS INTO THE POLICY AS THOSE WHO RECEIVE FINANCIAL ASSISTANCE TYPICALLY DO NOT HAVE A BALANCE TO SEND TO COLLECTION AFTER THE FINANCIAL ASSISTANCE IS APPLIED. PART VI, LINE 2: CARTHAGE AREA HOSPITAL UTILIZES OTHER DATA SOURCES AS NECESSARY INCLUDING PATIENT SATISFACTION SURVEYS, COMMUNITY WORKSHOP EVALUATIONS, AND COMMUNITY EVENT SURVEYS. PART VI, LINE 3: THE HOSPITAL POSTS ITS CHARITY CARE POLICY INCLUDING CONTACT INFORMATION FOR THE FINANCIAL COUNSELOR IN THE ADMISSION AREA. ADDITIONALLY THIS INFORMATION CAN BE FOUND ON THE HOSPITAL'S WEBSITE. IF A PATIENT DOES NOT MEET WITH A FINANCIAL COUNSELOR ANOTHER HOSPITAL EMPLOYEE INFORMS THE PATIENT OF OTHER STATE AND FEDERAL ASSISTANCE OPTIONS. PART VI, LINE 4: THE HOSPITAL'S SERVICE AREA CONSISTS OF SOCIO-ECONOMICALLY RURAL DEPRIVED POPULATION WITHIN A LARGE GEOGRAPHIC REGION. THE REGION IS SERVED BY THREE HOSPITALS. DUE TO THE PROXIMITY OF FORT DRUM, THE NEEDS OF THE POPULATION ARE UNIQUE. THIS AREA IS MORE ETHNICALLY DIVERSE COMPARED TO OTHER COUNTIES IN THE REGION. WHILE FERTILITY AND BIRTH RATES ARE ABOVE AVERAGE DUE TO THE PROXIMITY TO THE MILITARY BASE, THE POVERTY RATE IS HIGH AND HAS CAUSED A LOWER MEDIAN INCOME THAN THE NATIONAL AVERAGE. THE GROWTH OF FORT DRUM AND RAPID NEEDS OF SOLDIERS WHEN THEY REDEPLOY HEAVILY IMPACTS THE UTILIZATION EXPERIENCED AT THE HOSPITAL. THEREFORE OFTEN SERVICE NEEDS REVOLVE AROUND THE ACTIVITY OF THE BASE AND THE HOSPITAL MAY EXPERIENCE TIMES OF SLOW UTILIZATION DESPITE CONTINUED COMMUNITY NEED FOR THAT SERIVCE. THESE FACTORS HAVE CREATED A REGION WHERE THE POPULATION IS OFTEN MEDICALLY INDIGENT. PART VI, LINE 5: CARTHAGE AREA HOSPITAL PROMOTED THE IMPORTANCE OF GOOD COMMUNITY HEALTH DURING SEVERAL EVENTS. HEALTHCARE PROVIDERS, PHYSICAL THERAPISTS AND REGISTERED DIETITIANS MADE THEMSELVES AVAILABLE DURING COMMUNITY EVENTS, SPOKE AT LOCAL EVENTS AND OUTREACH EVENTS ON THE HOSPITAL CAMPUS. EVENTS INCLUDED MEDICAL IMAGING OPEN HOUSE EVENT, HOLIDAY PARADE, COOKING CLASSES FOR CHILDREN AND CARE SEAT SAFETY CHECKS.OTHER ORGANIZATIONS THE HOSPITAL SUPPORTED WERE THE AMERICAN HEART ASSOCIATION, TOYS FOR TOTS, UNITED WAY, AND MARCH OF DIMES. THE HOSPITAL PARTICIPATED IN WALKS, FOOD DRIVES AND OTHER EVENTS THROUGHOUT THE YEAR, AND EVEN HELPED TO RAISE MONEY FOR THE UNITED WAY OF NORTHERN NEW YORK, AMERICAN HEART ASSOCIATION AND MARCH OF DIMES. 0 0 0 0 0 0 0 0 0 NATA PARNES PHYSICIAN 1394489 0 0 0 0 0 11250 0 12527 0 1418266 0 0 0 MICHAEL GORDON CHIEF MEDICAL OFFICER 1196014 0 0 0 0 0 11250 0 12527 0 1219791 0 0 0 BRUCE BAIRD PHYSICIAN 814295 0 0 0 0 0 11250 0 12527 0 838072 0 0 0 PETER VANEENENAAM PHYSICIAN 812225 0 0 0 0 0 11250 0 13642 0 837117 0 0 0 STEVEN FISH PHYSICIAN 801661 0 0 0 0 0 11250 0 12527 0 825438 0 0 0 HOWARD HUANG PHYSICIAN 737528 0 0 0 0 0 11250 0 9166 0 757944 0 0 0 RICHARD DUVALL CHIEF EXECUTIVE OFFICER 0 649370 0 0 0 0 0 9900 0 27453 0 686723 0 0 DR MIRZA ASHRAF DIRECTOR 373910 0 0 0 0 0 4368 0 0 0 378278 0 0 0 HARDIK PATEL MEDICAL STAFF PRESIDENT 352900 0 0 0 0 0 11250 0 12527 0 376677 0 0 0 ERIC BURCH CHIEF OPERATING OFFICER 257476 0 0 0 0 0 2308 0 0 0 259784 0 0 0 MORGAN PIERCE DIRECTOR OF FINANCE 203819 0 0 0 0 0 0 0 0 0 203819 0 0 0 ROB BLOOM FORMER CHIEF FINANCIAL OFFICER 101370 0 0 0 0 0 150 0 0 0 101520 0 0 0 PART I, LINE 3 THE BOARD OF DIRECTORS OF CLAXTON-HEPBURN MEDICAL CENTER CONTRACTS WITH AN INDEPENDENT SALARY COMPENSATION SPECIALIST TO ADVISE ITS EXECUTIVE COMMITTEE ON SETTING COMPENSATION FOR THE CHIEF EXECUTIVE OFFICER. KRISTEN BLOOM FAMILY MEMBER OF ROB BLOOM, FORMER OFFICER 49234 EMPLOYEE COMPENSATION 0 FORM 990, PART VI, SECTION A, LINE 3 THE HOSPITAL ENTERED INTO A LEASED EMPLOYEE AGREEMENT WITH CLAXTON-HEPBURN MEDICAL CENTER FOR SHARED SERVICES OF THE CHIEF EXECUTIVE OFFICER. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PROVIDED TO THE BOARD OF DIRECTORS FOR REVIEW PRIOR TO FILING. THE FORM 990 IS REVIEWED AND APPROVDED BY BOTH THE BOARD OF DIRECTORS AND THE CHIEF FINANCIAL OFFICER PRIOR TO BEING SUBMITTED. IN ADDITION, AN EMAIL IS SENT TO EACH DIRECTOR STATING THAT THE ADMINISTRATION WILL PROVIDE A COPY OF THE FORM 990 UPON REQUEST. FORM 990, PART VI, SECTION B, LINE 12C DIRECTORS COMPLETE AN ANNUAL CONFLICT OF INTEREST DISCLOSURE FORM. THE AUDIT AND FINANCE COMMITTEE OVERSEES THE ANNUAL COMPLETION OF THE CONFLICT OF INTEREST DISCLOSURES. THE EXECUTIVE SECRETARY IS RESPONSIBLE FOR OBTAINING THE SIGNED AND COMPLETED FORMS, THE CHIEF COMPLIANCE OFFICER REVIEWS ALL DISCLOSURE FORMS. DURING A VOTE, WHEN ANY DIRECTORS ARE CONFLICTED, THEY ARE ASKED TO LEAVE THE ROOM DURING VOTING. FORM 990, PART VI, SECTION B, LINE 15B COMPENSATION OF OFFICERS AND KEY EMPLOYEES IS REVIEWED AND APPROVED ANNUALLY BY THE BOARD OF DIRECTORS, COMPENSATION COMMITTEE, AS WELL AS THE FINANCE COMMITTEE. THE COMPENSATION COMMITTEE USES BENCHMARKING DATA PROVIDED BY FORMS 990 OF OTHER COMPARABLE NOT-FOR-PROFIT ORGANIZATIONS IN ITS REVIEW OF OFFICER COMPENSATION. TO PROVIDE AN ADDITIONAL LEVEL OF COMPENSATION REVIEW, THE FINANCE COMMITTEE ALSO REVIEWS COMPENSATION FOR EACH EMPLOYEE OVER $115,000 ANNUALLY. FORM 990, PART VI, SECTION C, LINE 19 THE HOSPITAL'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE PROVIDED UPON REQUEST. FORM 990, PART IX, LINE 11G OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 9,241,243. MANAGEMENT AND GENERAL EXPENSES 825,418. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 10,066,661. FORM 990, PART XI, LINE 9: PENSION RELATED CHANGES OTHER THAN NET PERIODIC PENSION COST 239,125. COMPREHENSIVE WOMENS' HEALTH SERVICES PLLC 622 WASHINGTON STREET WATERTOWN NY 13601 562394825 OBSTETRICS AND GYNECOLOGY NY 852913 466158 CARTHAGE AREA HOSPITAL NORTH COUNTRY ORTHOPAEDIC GROUP PC 1571 WASHINGTON STREET WATERTOWN NY 13601 160982095 ORTHOPEDICS AND PAIN MANAGEMENT NY 7179925 1125971 CARTHAGE AREA HOSPITAL NORTH COUNTRY REALTY LLC 1571 WASHINGTON STREET SUITE 201 WATERTOWN NY 13601 161593029 LEASING PROPERTY NY 165424 5965028 CARTHAGE AREA HOSPITAL CARTHAGE AREA HOSPITAL FOUNDATION INC 3 BRIDGE STREET CARTHAGE NY 13619 161467023 FUNDRAISING NY 501(C)(3) LINE 7 CARTHAGE AREA HOSPITAL 1 MEADOWBROOK TERRACE INC 21957 COLE ROAD CARTHAGE NY 13619 454102458 ASSISTED LIVING NY 501(C)(3) LINE 10 CARTHAGE AREA HOSPITAL 1 NORTH STAR HEALTH ALLIANCE INC 214 KING STREET OGDENSBURG NY 13669 161449491 HOLDING COMPANY NY 501(C)(3) LINE 12B, II N/A 0 CLAXTON-HEPBURN MEDICAL CENTER FOUNDATION INC 503 MANSION AVENUE OGDENSBURG NY 13669 222488389 FUNDRAISING NY 501(C)(3) LINE 12B, II NORTH STAR HEALTH ALLIANCE INC 0 CLAXTON MEDICAL PC 214 KING STREET OGDENSBURG NY 13669 264009395 SPECIALTY HEALTHCARE SERVICES NY 501(C)(3) LINE 12B, II CLAXTON-HEPBURN MEDICAL CENTER 0 CLAXTON-HEPBURN MEDICAL CENTER 214 KING STREET OGDENSBURG NY 13669 150559686 HEALTHCARE SERVICES NY 501(C)(3) LINE 3 NORTH STAR HEALTH ALLIANCE INC 0 NORTH COUNTRY ORTHOPAEDIC AMBULATORY SURGERY CENTER LLC 1571 WASHINGTON STREET SUITE 201 WATERTOWN NY 13601 731653922 SURGICAL SERVICES NY CARTHAGE AREA HOSPITAL RELATED -55090 2914777 0 1 0.05000 0 0 1 1 0 0 0 0 0 0 0 1 1 1 1 0 1 0 0 MEADOWBROOK TERRACE INC D 2552149 BOOK VALUE NORTH COUNTRY ORTHOPAEDIC AMBULATORY SURGERY CENTER LLC D 2211422 BOOK VALUE