4A (Expenses $ 32389633 including grants of $ 0) (Revenue $ 35503387)
ADIRONDACK MEDICAL CENTER IS A 95-BED ACUTE CARE FACILITY IN SARANAC LAKE. IT PROVIDES A FULL RANGE OF INPATIENT SERVICES(SURGICAL, MATERNITY AND PEDIATRIC) AS WELL AS MAINTAINS A 60 BED LONG-TERM CARE FACILITY.

4B (Expenses $ 88345628 including grants of $ 0) (Revenue $ 96838673)
REFERRED AMBULATORY, AMBULATORY SURGERY AND EMERGENCY SERVICES IN SARANAC LAKE, LAKE PLACID, TUPPER LAKE, ST. REGIS FALLS AND KEENE.

4D (Expenses $ 0 including grants of $ 0) (Revenue $ 1846547)
MISCELLANEOUS PROGRAM SERVICE REVENUE DERIVED FROM SUPPORT OF ADIRONDACK MEDICAL CENTER, INCLUDING: DIETARY REVENUE, REBATES AND REFUNDS, PURCHASE DISCOUNTS AND OTHER REVENUE.

PART V, SECTION B
FACILITY REPORTING GROUP A

FACILITY REPORTING GROUP A CONSISTS OF:
- FACILITY 1: ADIRONDACK MEDICAL CENTER, - FACILITY 2: ADIRONDACK MEDICAL CENTER-LAKE PLACID

GROUP A-FACILITY 1 -- ADIRONDACK MEDICAL CENTER PART V, SECTION B, LINE 5:
ADIRONDACK MEDICAL CENTER AND OUR COLLABORATING PARTNERS, COUNTY PUBLIC HEALTH DEPARTMENTS AND REGIONAL HOSPITALS, WORKED THROUGH THE ADIRONDACK RURAL HEALTH NETWORK (ARHN) TO CONDUCT A SURVEY THAT GAVE US INPUT FROM STAKEHOLDERS WHO REPRESENT THE BROAD INTEREST OF THE COMMUNITY WE SERVE. THE ADIRONDACK RURAL HEALTH NETWORK (ARHN) REGION INCLUDES CLINTON, ESSEX, FRANKLIN, FULTON, HAMILTON, WARREN AND WASHINGTON COUNTIES. THERE ARE HEALTH PROFESSIONAL SHORTAGE AREAS WITHIN THE COUNTY, RESULTING IN SIGNIFICANT DISPARITIES IN ACCESS TO CARE AND THE POPULATION WITH LOW-INCOME AND LOW ACCESS TO SUPERMARKETS IS SIGNIFICANTLY HIGHER THAN THE ARHN REGION AND UPSTATE NEW YORK. THE WELL-BEING OF THE COMMUNUNITY IS REFLECTED THROUGH A WIDE ARRAY OF FACTORS, INCLUDING ACCESS TO MEDICAL SERVICES, INDIVIDUAL BEHAVIORS, SOCIO-DEMOGRAPHIC CHARACTERSTICS AND THE ENVIRONMENT IN WHICH ONE LIVES. ARHN ENGAGED THE CENTER FOR HEALTH WORKFORCE STUDIES (CHWS) AT THE UNIVERSITY AT ALBANY SCHOOL OF PUBLIC HEALTH FOR QUANTITATIVE AND QUALITATIVE DATA COLLECTION.THE SURVEY IS CREATED WITH SUPPORT FROM NYS DOH AND HEALTH RESOURCES AND SERVICES ADMINISTRATION. THE SURVEY WAS ADMINISTERED ELECTRONICALLY USING A WEB-BASED SURVEY PROGRAM AND DISTRIBUTED TO A REGIONAL EMAIL CONTACT LIST OF 807 COMMUNITY STAKEHOLDERS. ULTIMATELY, 409 SURVEYS WERE COMPLETED DURING THE SIX-WEEK SURVEY PERIOD, A RESPONSE RATE OF 50 PERCENT. COMMUNITY STAKEHOLDERS WERE ASKED TO INDICATE ONE SECTOR THAT BEST DESCRIBED THEIR ORGANIZATION. OF THE 160 ORGANIZATIONS THAT RESPONDED, REPORTED PROVIDING A VARIETY OF SERVICES INCLUDING EDUCATION, HEALTH CARE, SOCIAL SERVICES, PUBLIC HEALTH, AND HEALTH BASED COMMUNITY BASED ORGANIZATIONS, AMONG MANY OTHERS. BELOW, TABLE A.1 SHOWS THE PRIMARY FUNCTIONS SELECTED BY RESPONDENTS. HEALTH CARE AND EDUCATIONAL AGENCIES ARE WELL REPRESENTED, AND THE MAJORITY PROVIDES SERVICES TO CHILDREN AND ADOLESCENTS, AS WELL AS PEOPLE LIVING AT OR NEAR THE POVERTY LEVEL.TABLE A.1. PRIMARY FUNCTIONS INDICATED BY SURVEY RESPONDENTS ORGANIZATION PRIMARY FUNCTION / PERCENT OF ALL APPLICANTSNOTE: RESPONDENTS COULD SELECT MORE THAN ONE PRIMARY FUNCTION. BUSINESS: 4CIVIC ASSOCIATION:3COLLEGE/UNIVERSITY:7DISABILITY SERVICES:10EARLY CHILDHOOD: 9ECONOMIC DEVELOPMENT:6EMPLOYMENT/JOB TRAINING:2FAITH-BASED:3FOOD/NUTRITION:10FOUNDATION/PHILANTHROPY:1HEALTHBASED CBO:30HEALTHCARE PROVIDE:53HEALTH INS. PLAN:1HOUSING:7LAW ENFORCEMENT:10LOCAL GOVERNMENT:29MEDIA:2MENTAL, EMOTIONAL, BEHAVIORAL HEALTH PROVIDER:22PUBLIC HEALTH:37RECREATION:3SCHOOL (K-12): 69SENIORS/ELDERS:28SOCIAL SERVICES:50TRANSPORTATION:2TRIBAL GOVERNMENT:1VETERANS:2

GROUP A-FACILITY 1 -- ADIRONDACK MEDICAL CENTER PART V, SECTION B, LINE 6A:
OUR COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED WITH OUR PARTNERS ESSEX COUNTY PUBLIC HEALTH, FRANKLIN COUNTY PUBLIC HEALTH, UVM HEALTH NETWORK-ALICE HYDE MEDICAL CENTER, ELIZABETHTOWN COMMUNITY HOSPITAL, AND ADIRONDACK RURAL HEALTH NETWORK.

GROUP A-FACILITY 1 -- ADIRONDACK MEDICAL CENTER PART V, SECTION B, LINE 6B:
SEE QUESTION 6A ABOVE

GROUP A-FACILITY 1 -- ADIRONDACK MEDICAL CENTER PART V, SECTION B, LINE 11:
ADIRONDACK HEALTH STRIVES TO MEET AS MANY OF THE HEALTH NEEDS OF OUR COMMUNITY MEMBERS AS POSSIBLE. IN MANY CASES, WE PARTNER WITH APPROPRIATE ORGANIZATIONS AND AGENCIES TO ADDRESS NEEDS THAT ADIRONDACK HEALTH DOES NOT. ON INITIATIVES THAT ARE NOT HOSPITAL-LED, ADIRONDACK HEALTH PARTNERS AND WORKS WITH THE LOCAL HEALTH DEPARTMENTS, SOCIAL SERVICES, BEHAVIORAL HEALTH PROVIDERS, SUBSTANCE ABUSE PREVENTION AND TREATMENT PROVIDERS, HOME CARE, AND MANY OTHERS TO ENSURE THAT THE NEEDS OF OUR COMMUNITY MEMBERS ARE MET.THE FOLLOWING ARE THE NYS PREVENTION AGENDA ITEMS THAT ADIRONDACK HEALTH DOES NOT DIRECTLY ADDRESS IN OUR IMPLEMENTATION STRATEGY:PROMOTE A HEALTHY AND SAFE ENVIRONMENTFOCUS AREA: INJURIES, VIOLENCE AND OCCUPATIONAL HEALTH THE RATE OF CRIME AND ASSAULT ARE LOW IN ADIRONDACK HEALTH'S SERVICE AREA. FALLS IN THE HOME AND OCCUPATIONAL HEALTH ARE ISSUES THAT COMMUNITY PARTNERS ARE BETTER POSITIONED TO ADDRESS.FOCUS AREA: OUTDOOR AIR AND WATER QUALITYTHE AIR AND WATER QUALITY INDICATORS ARE GOOD. DATA INDICATES THAT IT IS ONLY A FEW DAYS EACH YEAR THAT OUTDOOR AIR QUALITY IS POOR, AND THE LIKELY CAUSE OF THIS IS INDUSTRIAL POLLUTION FROM THE MID-WEST CARRIED HERE ON THE JET STREAM. ADIRONDACK HEALTH DOES NOT HAVE A STRATEGY TO DIRECTLY ADDRESS THIS AT THIS TIME, BUT NATIONAL GROUPS HAVE MADE PROGRESS AND ARE STILL WORKING TO IMPROVE OUTPUTS FROM THESE INDUSTRIAL AREAS.FOCUS AREA: BUILT ENVIRONMENT AND FOOD AND CONSUMER PRODUCTSIN OUR SERVICE AREA, MUCH OF THIS WORK IS BEING DONE BY COALITIONS TO WHICH ADIRONDACK HEALTH BELONGS. THE COALITIONS, LED BY PUBLIC HEALTH AND THE NORTH COUNTRY HEALTHY HEART NETWORK, ARE WORKING TOWARD PASSING COMPLETE STREETS POLICIES, IMPROVING PARKS AND OTHER RECREATIONAL AREAS, PASSING TOBACCO FREE GROUNDS POLICIES, IMPROVING ACCESS TO FRESH FRUITS AND VEGETABLES IN STORES AND RESTAURANTS, AND OTHER PROJECTS THAT IMPROVE ACCESS TO HEALTHY FOODS AND IMPROVE THE BUILT ENVIRONMENT SO COMMUNITY MEMBERS OF ALL LEVELS OF MOBILITY CAN FEEL SAFE AS PEDESTRIANS AND USING ALTERNATIVE FORMS OF TRANSPORTATION.PREVENT COMMUNICABLE DISEASESFOCUS AREA: HIV/STD'S, VACCINES-PREVENTABLE DISEASE, AND HEALTH CARE-ASSOCIATED INFECTIONS: THE IMMUNIZATION RATE FOR CHILDREN AGES 19 TO 35 MONTHS (66.6%) IS LOWER THAN THE PREVENTION AGENDA BENCHMARK (80.0%) AND THE PERCENTAGE OF FEMALES 13 TO 17 WITH THREE DOSE HPV VACCINE (31.1%) IS SIGNIFICANTLY LOWER THAN THE PREVENTION AGENDA BENCHMARK OF 50.0%. THE RATE OF PNEUMONIA/FLU HOSPITALIZATIONS FOR THOSE 65 YEARS OF AGE OR OLDER IS LOWER IN FRANKLIN COUNTY (84.1) THAN IN ARHN REGION (93.3), UPSTATE NEW YORK (93.7), AND THE STATE AS A WHOLE (87.3). THE RATE OF HIV IS EXTREMELY LOW IN ADIRONDACK HEALTH'S SERVICE AREA. ADIRONDACK HEALTH'S PROVIDERS CONTINUE TO WORK WITH PUBLIC HEALTH AND OTHER PROVIDERS TO DELIVER THE HIGHEST LEVEL OF CARE TO PATIENTS WITH HIV.THE FULL 340 PAGE 2019 COMMUNITY HEALTH ASSESSMENT DOCUMENT FOR ADIRONDACK HEALTH IS POSTED ON OUR WEBSITE. THE DOCUMENT INCLUDES OUR 2019-2021 COMMUNITY SERVICE PLAN. THAT DOCUMENT CAN BE FOUND AT: HTTPS://WWW.ADIRONDACKHEALTH.ORG/UPLOADS/COMMUNITY-HEALTH-NEEDS-ASSESSMENT

GROUP A-FACILITY 1 -- ADIRONDACK MEDICAL CENTER PART V, SECTION B, LINE 16J:
AN INTERPRETER IS AVAILABLE TO ASSIST LEP POPULATIONS AND STAFF IS AVAILABLE TO HELP PATIENTS FILL OUT DOCUMENTATION AND ANSWER ANY QUESTIONS.

GROUP A-FACILITY 1 -- ADIRONDACK MEDICAL CENTER PART V, SECTION B, LINE 20A:
FINANCIAL ASSISTANCE IS NOT OFFERED AT THE SNF FACILITY AND ECAS ARE NOT PERFORMED AT THE HOSPITAL.

GROUP A-FACILITY 2 -- ADIRONDACK MEDICAL CENTER - LAKE PLACID PART V, SECTION B, LINE 5:
ADIRONDACK MEDICAL CENTER AND OUR COLLABORATING PARTNERS, COUNTY PUBLIC HEALTH DEPARTMENTS AND REGIONAL HOSPITALS, WORKED THROUGH THE ADIRONDACK RURAL HEALTH NETWORK (ARHN) TO CONDUCT A SURVEY THAT GAVE US INPUT FROM STAKEHOLDERS WHO REPRESENT THE BROAD INTEREST OF THE COMMUNITY WE SERVE. THE ADIRONDACK RURAL HEALTH NETWORK (ARHN) REGION INCLUDES CLINTON, ESSEX, FRANKLIN, FULTON, HAMILTON, WARREN AND WASHINGTON COUNTIES. THERE ARE HEALTH PROFESSIONAL SHORTAGE AREAS WITHIN THE COUNTY, RESULTING IN SIGNIFICANT DISPARITIES IN ACCESS TO CARE AND THE POPULATION WITH LOW-INCOME AND LOW ACCESS TO SUPERMARKETS IS SIGNIFICANTLY HIGHER THAN THE ARHN REGION AND UPSTATE NEW YORK. THE WELL-BEING OF THE COMMUNUNITY IS REFLECTED THROUGH A WIDE ARRAY OF FACTORS, INCLUDING ACCESS TO MEDICAL SERVICES, INDIVIDUAL BEHAVIORS, SOCIO-DEMOGRAPHIC CHARACTERSTICS AND THE ENVIRONMENT IN WHICH ONE LIVES. ARHN ENGAGED THE CENTER FOR HEALTH WORKFORCE STUDIES (CHWS) AT THE UNIVERSITY AT ALBANY SCHOOL OF PUBLIC HEALTH FOR QUANTITATIVE AND QUALITATIVE DATA COLLECTION.THE SURVEY IS CREATED WITH SUPPORT FROM NYS DOH AND HEALTH RESOURCES AND SERVICES ADMINISTRATION. THE SURVEY WAS ADMINISTERED ELECTRONICALLY USING A WEB-BASED SURVEY PROGRAM AND DISTRIBUTED TO A REGIONAL EMAIL CONTACT LIST OF 807 COMMUNITY STAKEHOLDERS. ULTIMATELY, 409 SURVEYS WERE COMPLETED DURING THE SIX-WEEK SURVEY PERIOD, A RESPONSE RATE OF 50 PERCENT. COMMUNITY STAKEHOLDERS WERE ASKED TO INDICATE ONE SECTOR THAT BEST DESCRIBED THEIR ORGANIZATION. OF THE 160 ORGANIZATIONS THAT RESPONDED, REPORTED PROVIDING A VARIETY OF SERVICES INCLUDING EDUCATION, HEALTH CARE, SOCIAL SERVICES, PUBLIC HEALTH, AND HEALTH BASED COMMUNITY BASED ORGANIZATIONS, AMONG MANY OTHERS. SURVEY PARTICIPANTS REPRESENTED A DIVERSE ARRAY OF DIFFERENT AGENCIES, POPULATION GROUPS, AND SERVICE-AREAS WITHIN THE OVERALL SEVEN-COUNTY ARHN REGION. BELOW, TABLE A.1 SHOWS THE PRIMARY FUNCTIONS SELECTED BY RESPONDENTS. HEALTH CARE AND EDUCATIONAL AGENCIES ARE WELL REPRESENTED, AND THE MAJORITY PROVIDES SERVICES TO CHILDREN AND ADOLESCENTS, AS WELL AS PEOPLE LIVING AT OR NEAR THE POVERTY LEVEL.TABLE A.1. PRIMARY FUNCTIONS INDICATED BY SURVEY RESPONDENTS ORGANIZATION PRIMARY FUNCTION / PERCENT OF ALL APPLICANTSNOTE: RESPONDENTS COULD SELECT MORE THAN ONE PRIMARY FUNCTION.BUSINESS: 4CIVIC ASSOCIATION:3COLLEGE/UNIVERSITY:7DISABILITY SERVICES:10EARLY CHILDHOOD: 9ECONOMIC DEVELOPMENT:6EMPLOYMENT/JOB TRAINING:2FAITH-BASED:3FOOD/NUTRITION:10FOUNDATION/PHILANTHROPY:1HEALTHBASED CBO:30HEALTHCARE PROVIDE:53HEALTH INS. PLAN:1HOUSING:7LAW ENFORCEMENT:10LOCAL GOVERNMENT:29MEDIA:2MENTAL, EMOTIONAL, BEHAVIORAL HEALTH PROVIDER:22PUBLIC HEALTH:37RECREATION:3SCHOOL (K-12): 69SENIORS/ELDERS:28SOCIAL SERVICES:50TRANSPORTATION:2TRIBAL GOVERNMENT:1VETERANS:2

GROUP A-FACILITY 2 -- ADIRONDACK MEDICAL CENTER - LAKE PLACID PART V, SECTION B, LINE 6A:
OUR COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED WITH OUR PARTNERS ESSEX COUNTY PUBLIC HEALTH, FRANKLIN COUNTY PUBLIC HEALTH, UVM HEALTH NETWORK-ALICE HYDE MEDICAL CENTER, ELIZABETHTOWN COMMUNITY HOSPITAL, AND ADIRONDACK RURAL HEALTH NETWORK.

GROUP A-FACILITY 2 -- ADIRONDACK MEDICAL CENTER - LAKE PLACID PART V, SECTION B, LINE 6B:
SEE QUESTION 6A ABOVE

GROUP A-FACILITY 2 -- ADIRONDACK MEDICAL CENTER - LAKE PLACID PART V, SECTION B, LINE 11:
ADIRONDACK HEALTH STRIVES TO MEET AS MANY OF THE HEALTH NEEDS OF OUR COMMUNITY MEMBERS AS POSSIBLE. IN MANY CASES, WE PARTNER WITH APPROPRIATE ORGANIZATIONS AND AGENCIES TO ADDRESS NEEDS THAT ADIRONDACK HEALTH DOES NOT. ON INITIATIVES THAT ARE NOT HOSPITAL-LED, ADIRONDACK HEALTH PARTNERS AND WORKS WITH THE LOCAL HEALTH DEPARTMENTS, SOCIAL SERVICES, BEHAVIORAL HEALTH PROVIDERS, SUBSTANCE ABUSE PREVENTION AND TREATMENT PROVIDERS, HOME CARE, AND MANY OTHERS TO ENSURE THAT THE NEEDS OF OUR COMMUNITY MEMBERS ARE MET.THE FOLLOWING ARE THE NYS PREVENTION AGENDA ITEMS THAT ADIRONDACK HEALTH DOES NOT DIRECTLY ADDRESS IN OUR IMPLEMENTATION STRATEGY:PROMOTE A HEALTHY AND SAFE ENVIRONMENTFOCUS AREA: INJURIES, VIOLENCE AND OCCUPATIONAL HEALTH THE RATE OF CRIME AND ASSAULT ARE LOW IN ADIRONDACK HEALTH'S SERVICE AREA. FALLS IN THE HOME AND OCCUPATIONAL HEALTH ARE ISSUES THAT COMMUNITY PARTNERS ARE BETTER POSITIONED TO ADDRESS.FOCUS AREA: OUTDOOR AIR AND WATER QUALITYTHE AIR AND WATER QUALITY INDICATORS ARE GOOD. DATA INDICATES THAT IT IS ONLY A FEW DAYS EACH YEAR THAT OUTDOOR AIR QUALITY IS POOR, AND THE LIKELY CAUSE OF THIS IS INDUSTRIAL POLLUTION FROM THE MID-WEST CARRIED HERE ON THE JET STREAM. ADIRONDACK HEALTH DOES NOT HAVE A STRATEGY TO DIRECTLY ADDRESS THIS AT THIS TIME, BUT NATIONAL GROUPS HAVE MADE PROGRESS AND ARE STILL WORKING TO IMPROVE OUTPUTS FROM THESE INDUSTRIAL AREAS.FOCUS AREA: BUILT ENVIRONMENT AND FOOD AND CONSUMER PRODUCTSIN OUR SERVICE AREA, MUCH OF THIS WORK IS BEING DONE BY COALITIONS TO WHICH ADIRONDACK HEALTH BELONGS. THE COALITIONS, LED BY PUBLIC HEALTH AND THE NORTH COUNTRY HEALTHY HEART NETWORK, ARE WORKING TOWARD PASSING COMPLETE STREETS POLICIES, IMPROVING PARKS AND OTHER RECREATIONAL AREAS, PASSING TOBACCO FREE GROUNDS POLICIES, IMPROVING ACCESS TO FRESH FRUITS AND VEGETABLES IN STORES AND RESTAURANTS, AND OTHER PROJECTS THAT IMPROVE ACCESS TO HEALTHY FOODS AND IMPROVE THE BUILT ENVIRONMENT SO COMMUNITY MEMBERS OF ALL LEVELS OF MOBILITY CAN FEEL SAFE AS PEDESTRIANS AND USING ALTERNATIVE FORMS OF TRANSPORTATION.PREVENT HIV/STDS, VACCINE-PREVENTABLE DISEASE AND HEALTHCARE ASSOCIATED INFECTIONSFOCUS AREA: PREVENT HIV AND STDS THE RATE OF HIV IS EXTREMELY LOW IN ADIRONDACK HEALTH'S SERVICE AREA. ADIRONDACK HEALTH'S PROVIDERS CONTINUE TO WORK WITH PUBLIC HEALTH AND OTHER PROVIDERS TO DELIVER THE HIGHEST LEVEL OF CARE TO PATIENTS WITH HIV.PREVENT COMMUNICABLE DISEASESFOCUS AREA: HIV/STD'S, VACCINES-PREVENTABLE DISEASE, AND HEALTH CARE-ASSOCIATED INFECTIONS: THE IMMUNIZATION RATE FOR CHILDREN AGES 19 TO 35 MONTHS (73.0%) IS LOWER THAN THE PREVENTION AGENDA BENCHMARK (80.0%) AND THE PERCENTAGE OF FEMALES 13 TO 17 WITH THREE DOSE HPV VACCINE (34.2%) IS SIGNIFICANTLY LOWER THAN THE PREVENTION AGENDA BENCHMARK OF 50.0%. THE RATE OF PNEUMONIA/FLU HOSPITALIZATIONS FOR THOSE 65 YEARS OF AGE OR OLDER IS ALSO HIGHER IN ESSEX COUNTY (98.4) THAN IN ARHN REGION (93.3), UPSTATE NEW YORK (93.7), AND THE STATE AS A WHOLE (87.3). THE RATE OF HIV IS EXTREMELY LOW IN ADIRONDACK HEALTH'S SERVICE AREA. ADIRONDACK HEALTH'S PROVIDERS CONTINUE TO WORK WITH PUBLIC HEALTH AND OTHER PROVIDERS TO DELIVER THE HIGHEST LEVEL OF CARE TO PATIENTS WITH HIV.THE FULL 340 PAGE 2019 COMMUNITY HEALTH ASSESSMENT DOCUMENT FOR ADIRONDACK HEALTH IS POSTED ON OUR WEBSITE. THE DOCUMENT INCLUDES OUR 2019-2021 COMMUNITY SERVICE PLAN. THAT DOCUMENT CAN BE FOUND AT: HTTPS://WWW.ADIRONDACKHEALTH.ORG/UPLOADS/COMMUNITY-HEALTH-NEEDS-ASSESSMENT

GROUP A-FACILITY 2 -- ADIRONDACK MEDICAL CENTER - LAKE PLACID PART V, SECTION B, LINE 16J:
AN INTERPRETER IS AVAILABLE TO ASSIST LEP POPULATIONS AND STAFF IS AVAILABLE TO HELP PATIENTS FILL OUT DOCUMENTATION AND ANSWER ANY QUESTIONS.

PART V, SECTION B, LINE 20A:
FINANCIAL ASSISTANCE IS NOT OFFERED AT THE SNF FACILITY AND ECAS ARE NOT PERFORMED AT THE HOSPITAL.

PART I, LINE 7:
AMOUNTS CALCULATED USING COST-TO-CHARGE RATIO FROM WORKSHEET 2 (TOTAL OPERATING EXPENSE MINUS MEDICAID/PROVIDER TAXES, TOTAL COMMUNITY BENEFIT EXPENSE, AND TOTAL COMMUNITY BUILDING EXPENSE DIVIDED BY GROSS PATIENT CHARGES), AND ADDRESSES ALL PATIENT SEGMENTS.

PART I, LINE 7, COLUMN (F):
THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 6,763,854.

PART II, COMMUNITY BUILDING ACTIVITIES:
THE CEO ATTENDED ADIRONDACK HEALTH INSTITUTE MEETINGS. AHI IS A REGIONAL ORGANIZATION THAT INCLUDES THE TRI-LAKES, PLATTSBURGH, AND GLENS FALLS COMMUNITIES WHOSE PURPOSE IS TO IMPROVE THE OVERALL HEALTH OF THESE ADIRONDACK COMMUNITIES BY WORKING TOGETHER ON A REGIONAL BASIS. THE INFECTION PREVENTIONIST PREPARED AND CONDUCTED A BLOOD BORN PATHOGENS PROGRAM FOR THE GABRIELS FIRE DEPARTMENT, AND ALSO SERVES AS A COMMUNITY MEMBER FOR THE TRUDEAU INSTITUTE BIOSAFETY COMMITTEE.

PART III, LINE 2:
THE ORGANIZATION'S BAD DEBT EXPENSE OF $2,978,949 IS CALCULATED USING THE COST-TO-CHARGE RATIO FROM WORKSHEET 2 AND BAD DEBT EXPENSE.

PART III, LINE 3:
THE ORGANIZATION'S BAD DEBT EXPENSE IS CALCULATED USING A PERCENTAGE OF BAD DEBT THAT CONTAINS POSSIBLE CHARITY CARE CASES AND APPLYING IT TO LINE 2. RATIONALE FOR WHAT PORTION OF BAD DEBT SHOULD CONSTITUTE COMMUNITY BENEFIT: THE PROVISION OF HEALTH CARE IS DIFFERENT FROM PROVIDING OTHER SERVICES, IN THAT HOSPITALS, ALTHOUGH THEY MAY ATTEMPT TO OBTAIN FINANCIAL INFORMATION BEFORE SERVICE IS PROVIDED, FOCUS ON PROVIDING THE PATIENT WITH NEEDED HEALTH CARE AND LATER TRY TO OBTAIN PAYMENT. IN OTHER INDUSTRIES, THE SERVICE PROVIDER CAN CHECK THE CUSTOMER'S CREDIT RATING, ASK FOR PAYMENT IN ADVANCE, ETC AND IS USUALLY ASKING THIS INFORMATION WHEN THE CONSUMER IS NOT IN A HEALTH CRISIS AND UNDER GREAT STRESS AND WORRY. AT A LATER TIME, WHEN THE PROVIDER ATTEMPTS TO COLLECT PAYMENT AND FINDS THE PATIENT UNWILLING TO PAY, THEIR OPTIONS ARE AGAIN LIMITED GIVEN THE NATURE OF THE SERVICE PROVIDED AND THE INABILITY TO REPOSSESS THESERVICE.

PART III, LINE 4:
IN EVALUATING THE COLLECTIBILITY OF PATIENT ACCOUNTS RECEIVABLE, ADIRONDACK HEALTH ANALYZES PAST PAYMENT HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND PROVISION FOR BAD DEBTS. FOR RECEIVABLES ASSOCIATED WITH PATIENTS WHO HAVE THIRD-PARTY COVERAGE, ADIRONDACK HEALTH ANALYZES CONTRACTUALY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), ADIRONDACK HEALTH RECORDS A PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNT RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS.

PART III, LINE 8:
CALCULATED USING COST-TO-CHARGE RATIO FROM WORKSHEET 2 AND APPLYING IT TO GROSS MEDICARE CHARGES. SHORTFALL SHOULD BE TREATED AS A COMMUNITY BENEFIT BECAUSE MEDICARE PATIENT SERVICES ARE PROVIDED AT A COST THAT IS GREATER THAN REIMBURSEMENT.

PART III, LINE 9B:
ACCORDING TO OUR CHARITY CARE POLICY, THE LARGEST NUMBER OF OUR FAP-ELIGIBLE PATIENTS ARE WRITTEN-OFF AT 100% SO NO COLLECTION EFFORTS ARE NECESSARY.

PART VI, LINE 2:
ADIRONDACK MEDICAL CENTER USES A NUMBER OF ASSESSMENT METHODS TO DETERMINE HOW WELL WE ARE MEETING COMMUNITY NEEDS AND WHAT ADDITIONAL SERVICES WE CAN OFFER OUR COMMUNITY MEMBERS.AMC USES THE PRESS-GANEY PATIENT SATISFACTION SURVEY FOR CONTINUAL PATIENT FEEDBACK. THE SURVEYS ARE MAILED TO RANDOMLY SELECTED PATIENTS BY PRESS-GANEY, A NATIONALLY RECOGNIZED PATIENT SURVEY FIRM, AND PRESS-GANEY PROCESSES THE RESULTS. THEY GIVE AMC THE RESULTS BENCHMARKED AGAINST OTHER HOSPITALS TO HELP US UNDERSTAND HOW WELL WE ARE SERVING OUR COMMUNITY.THE MAJORITY OF AMC'S STRATEGIC INITIATIVES ARE DRIVEN BY A THREE-YEAR STRATEGIC PLAN, WHICH IS DEVELOPED THROUGH THE COLLABORATION OF THE BOARD, MEDICAL STAFF, AMC STAFF AND COMMUNITY MEMBERS. THE GOALS THAT ARE SET FORTH EVERY THREE YEARS IN THE STRATEGIC PLAN ARE INCORPORATED INTO AMC'S MANAGEMENT ACTION PLAN (MAP), WHICH IS REVIEWED AND REVISED EACH YEAR. AT THE BEGINNING OF EACH YEAR EVERY DEPARTMENT CREATES A MAP THAT OUTLINES THE CONCRETE STEPS THAT THE DEPARTMENT WILL ACCOMPLISH IN MOVING THE HOSPITAL CLOSER TO COMPLETING THE STRATEGIC PLAN GOALS. THE SUCCESS OF AMC, EACH DEPARTMENT, AND EACH EMPLOYEE IS MEASURED BY THE MAP AND THE PROGRESS MADE TOWARD ACCOMPLISHING THE GOALS SET OUT IN THE STRATEGIC PLAN.FOR NEW SERVICES, AMC STAFF DEVELOPS A NEEDS ASSESSMENT USING A VARIETY OF DATA INCLUDING REGIONAL DEMAND FOR THE SPECIFIC SERVICE, DEMOGRAPHICS, AND FINANCIAL ANALYSIS. THE BOARD OF TRUSTEES CAREFULLY REVIEWS THE ANALYSIS AND EITHER SUPPORTS THE RECOMMENDATION OR ASKS FOR FURTHER INFORMATION.

PART VI, LINE 3:
ANY PATIENT THAT CONTACTS SCHEDULING OR PRESENTS TO ANY AMC DEPARTMENT (INCLUDING ADMITTING, EMERGENCY ROOM, ETC.) THAT DOES NOT IDENTIFY AN INSURANCE COMPANY OR IDENTIFIES THEMSELVES AS SELF-PAY ARE INFORMED OF OUR SELF-PAY PROCESS. THIS PROCESS INCLUDES INFORMATION ABOUT AMC'S CHARITY CARE POLICY AND THE BENEFITS OF VISITING WITH A CERTIFIED FACILITATED ENROLLER WHO CAN CHECK THE PATIENT'S ELIGIBILITY FOR STATE AND FEDERAL HEALTH INSURANCE PROGRAMS.

PART VI, LINE 6:
THE ORGANIZATION IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM.

PART VI, LINE 7, REPORTS FILED WITH STATES
NY

PART VI, LINE 4:
AMC, LOCATED IN THE HEART OF THE ADIRONDACK PARK IN RURAL, UPSTATE NEW YORK. THE ADIRONDACK PARK IS A UNIQUE, SIX-(6)-MILLION-ACRE PATCHWORK OF PUBLIC AND PRIVATE LANDS. THE ADIRONDACK PARK CREATES A UNIQUE SETTING WHERE SMALL POPULATION CENTERS ARE SURROUNDED BY SUBSTANTIAL AREAS OF STATE-OWNED WILDERNESS AREAS. IT IS BEST KNOWN FOR ITS MOUNTAINS, THE HIGHEST IN NEW YORK STATE, AND ITS LAKES. THERE ARE EXPANSIVE AREAS OF BACKCOUNTRY INTERSPERSED WITH VILLAGES, PRIVATE HOMES, AND FARMS. AMC'S SERVICE AREA IS MAINLY COMPRISED OF TOWNS IN SOUTHERN FRANKLIN AND NORTHERN ESSEX COUNTIES, BUT ALSO INCLUDES PORTIONS OF SOUTHWESTERN CLINTON, NORTHERN HAMILTON, AND SOUTHEASTERN ST. LAWRENCE COUNTIES. THIS SERVICE AREA COVERS OVER 1,200 SQUARE MILES WITH AN AVERAGE OF JUST OVER 30 PEOPLE PER SQUARE MILE. AMC IS THE PRINCIPAL PROVIDER OF ACUTE CARE FOR 70.7% OF THE 22,595 RESIDENTS IN THE PRIMARY SERVICE AREA AND CARES FOR APPROXIMATELY 25.1% OF THE 12,455 RESIDENTS IN THE SECONDARY SERVICE AREA. FRANKLIN COUNTY'S POPULATION IS 51,054. SIMILAR TO THE REST OF UPSTATE NEW YORK, FRANKLIN COUNTY'S POPULATION IS VERY LIMITED IN ITS DIVERSITY, OVER 82% ARE WHITE/NON-HISPANICS, FOLLOWED BY 5.9% BLACK/AFRICAN AMERICAN, NON-HISPANICS AND 3.4% HISPANIC/LATINOS. OVER 15% OF THE POPULATION IS 65 YEARS OF AGE AND OLDER, WHICH IS SLIGHTLY LOWER THAN THE ARHN REGION (18.0%) AND UPSTATE NEW YORK (16.37%). ESSEX COUNTY'S POPULATION IS 38,233, MAKING IT THE SECOND LEAST POPULATED COUNTY IN THE ARHN REGION. SIMILAR TO THE REST OF UPSTATE NEW YORK, ESSEX COUNTY'S POPULATION IS VERY LIMITED IN ITS DIVERSITY, OVER 92% ARE WHITE/NON-HISPANICS, FOLLOWED BY 3.2% BLACK/AFRICAN AMERICAN, NON-HISPANICS AND 3.2% HISPANIC/LATINOS. OVER 21% OF THE POPULATION IS 65 YEARS OF AGE AND OLDER, WHICH IS SLIGHTLY HIGHER THAN THE ARHN REGION (18.0%) AND HIGHER THAN UPSTATE NEW YORK (16.37%). WHILE THERE ARE NO SIGNIFICANT HEALTH DISPARITIES BASED ON RACE AND ETHNICITY IN FRANKLIN COUNTY, THERE ARE SIGNIFICANT ACCESS TO CARE ISSUES. THE PERCENTAGE OF ADULTS WITH HEALTH INSURANCE IN FRANKLIN COUNTY IS AT 92.3%, WITH 81.1% OF THE POPULATION HAVING A REGULAR HEALTH CARE PROVIDER. THE RATE OF AGE-ADJUSTED PREVENTABLE HOSPITALIZATIONS PER 10,000 POPULATION AMONG THOSE 18 YEARS OF AGE AND OLDER (111.5) IS LOWER THAN THE RATE FOR UPSTATE NEW YORK (116.8), AND THE PREVENTION AGENDA BENCHMARK (122.0) RATE. THE RATE OF ED VISITS PER 10,000 POPULATION IN FRANKLIN COUNTY (4,694.2) IS LOWER THAN THE ARHN REGION (4,866.3) AND HIGHER THAN UPSTATE NEW YORK (3,865.6). LASTLY, THE PERCENTAGE OF ADULTS 18 YEARS OF AGE AND OLDER IN FRANKLIN COUNTY WITH DISABILITY (24.5%) IS LOWER THAN THE ARHN REGION (25.6%), BUT HIGHER THAN UPSTATE NEW YORK (22.8%), AND THE STATE AS A WHOLE (22.9%).SPECIFICALLY, IN OUR REGION WE SEE THAT WE ARE: -OLDER: 18% OF THE REGION'S RESIDENTS ARE OVER THE AGE OF 65 (VERSUS 16% NYS). -POORER: 23% RECEIVE MEDICAID AND THE AVERAGE HOUSEHOLD INCOME IS $66,618 (NYS AVERAGE IS $93,443) -MEDIAN HOUSEHOLD INCOME IN EVERY COUNTY OF THE REGION IS BELOW THE STATE MEDIAN OF $59,269 -UNEMPLOYMENT RATES ARE HIGHER THAN IN THE STATE AS A WHOLE, AS ARE CHILD POVERTY AND HOUSINGVACANCY RATES. LEGACY MANUFACTURING AND MINING INDUSTRIES IN THE REGION HAVE DECLINED OVERRECENT DECADES. HOWEVER, JOB GROWTH IN OTHER SECTORS E.G., ACCOMMODATIONS, FOOD SERVICESAND HEALTH CARE SERVICES HELPED MITIGATE UNEMPLOYMENT AFTER THE RECENT RECESSION. -HAVE POOR PREVENTIVE CARE: IMMUNIZATION RATES FOR CHILDREN ARE LOWER THAN THE PREVENTION AGENDA BENCHMARK -AT RISK: -MOTOR VEHICLE SPEED RELATED ACCIDENTS ARE HIGHER IN OUR REGION THAN IN NYS -ALCOHOL-RELATED CRASHES, INJURIES AND DEATHS IN THE REGION ARE SIGNIFICANTLY HIGHER THAN STATE RATES (38 VERSUS 19) -EXPERIENCE BEHAVIORAL HEALTH CHALLENGES: -SUICIDE RATES FOR ADOLESCENTS (15-19) HIGHER THAN THE STATE AVERAGE (11 V. 6) -RATE OF INDIVIDUALS 17 AND YOUNGER SERVED IN A MENTAL HEALTH OUTPATIENT SETTING IS TWICE THAT OF THE STATE AVERAGE -FOOD INSECURE/OVERWEIGHT AND OBESE: -PROPORTION OF THE POPULATION WITH LOW INCOME AND LOW ACCESS TO SUPERMARKETS OR LARGE GROCERY STORES IN MUCH HIGHER IN THE REGION THAT IN UPSTATE NEW YORK OR THE SAT AS A WHOLE -OBESITY IN ELEMENTARY SCHOOL STUDENTS IN THE REGION IN HIGHER THAN THE UPSTATE AND STATEWIDE AVERAGE -DEATHS AND HOSPITALIZATIONS DUE TO DIABETES IS HIGHER THAN THE UPSTATE AND NYS AVERAGE -SMOKERS: -SMOKING RELATED DISEASE ARE A CHALLENGE IN THE AREAS WITH CHRONIC LOWER RESPIRATORY DEATHS HOSPITALIZATIONS SIGNIFICANTLY HIGHER THAN IN UPSTATE NY AND THE STATE -PERCENT OF ADULTS WITH ASTHMA HIGHER -RATES OF LUNG AND BRONCHUS CANCER CASES ARE HIGHER -PERCENT OF BIRTHS WITHIN 24 MONTHS HIGHER THAN PREVENTION AGENDA BENCHMARK -PERCENT OF UNINTENDED PREGNANCIES HIGHER

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"AMC IS A SOLE COMMUNITY HOSPITAL AND ALTHOUGH NOT AFFILIATED WITH A LARGER MEDICAL NETWORK, IS PART OF THE ADIRONDACK ACCOUNTABLE CARE ORGANIZATION, WHICH IS COMPRISED OF 450 PRIMARY AND SPECIALTY CLINICIANS THROUGH NEW YORK AND VERMONT. AMC IS A PARTNER IN THE ADIRONDACK HEALTH INSTITUTE PPS FOR DSRIP AND COLLABORATES CLOSELY WITH MANY COMMUNITY-BASED ORGANIZATIONS IN THE REGION, INCLUDING PUBLIC HEALTH AGENCIES IN BOTH FRANKLIN AND ESSEX COUNTIES AND BEHAVIORAL HEALTH AGENCIES TO FURTHER THE GOALS OF THE COMMUNITY SERVICE PLAN. EFFORTS INCLUDE: -COLLABORATION WITH THE HEART HEALTHY NETWORK TO PROVIDE CHRONIC DISEASE COACHING THAT FOCUSES ON COACHING PATIENTS WHO HAVE CHRONIC DISEASES OR ARE AT RISK FOR THEM LIKE COPD, HYPERTENSION, HEART DISEASE AND DIABETES. -ENGAGED IN QUALITY IMPROVEMENT INITIATIVES AIMED AT REDUCING HOSPITAL READMISSIONS FOR PATIENTS WITH HEART FAILURE BY INITIATING A GUIDELINE BASED INPATIENT HEART FAILURE EDUCATION PROGRAM CALLED ""HEART FAILURE ZONES."" THIS PROGRAM EDUCATES THE PATIENT AND CAREGIVERS ALONG WITH CONTINUOUS FOLLOW UP POST DISCHARGE TO DETERMINE PATIENT'S PROGRESS. -CREATED CHRONIC DISEASE WELLNESS COACHES WHO WORK IN THE PRIMARY CARE SETTING TO CONNECT WITH AT-RISK, LOW-RISK INDIVIDUALS OF PRE-DIABETES, DIABETES AND OTHER CHRONIC ILLNESSSES TO MAKE LIFESTYLE CHANGES THAT IMPROVE HEALTH OUTCOMES. -OFFERED FREE ADVANCED CARE PLANNING TO ALL MEMBERS OF THE COMMUNITY TO DECREASE IN-HOSPITAL DEATHS, INCREASE THE USE OF HOPSICE CARE AND DECREASE UNNECESSARY MEDICAL TREATMENTS. -CREATED PEER NAVIGATORS IN THE ED TO ACT AS A GATEKEEPER FOR PATIENTS BEING EVALUATED FOR ADMISSIONS/OBSERVATION INTO THE HOSPITAL SETTING BY WORKING WITH PATIENTS TO ACT AS AN ADVOCATE AND LIAISON BETWEEN THE PATIENT, FAMILY/CAREGIVER, THEIR CLINICAL TEAM AND PROVIDERS, AND THIRD-PAYORS. -NEW YORK STATE PREVENTION AGENDA PRIORITY OF PROMOTING HEALTHY WOMEN, INFANT AND CHILDREN WITH A PERINATAL QUALITY COLLABORATIVE SAFE SLEEP PROJECT TO REDUCE SUDDEN INFANT DEATH SYNDROME AND INCREASE BREASTFEEDING IN OUR REGION. -SPONSOR OF ADIRONDACK HEALTH PROGRAMS AND EMPLOYEE WELLNESS PROGRAMS WHICH INCLUDED FREE PHYSICAL ACTIVITY EVENTS FOR THE COMMUNITY WITH CHAIR YOGA, 5K EVENTS/HALF MARATHON EVENTS, CHAIR MASSAGE, CROSS COUNTRY SKIING, FAMILY SWIM PROGRAMS AND SNOWSHOE CLASSES. -PARTICIPATION IN DSRIP (DELIVERY SYSTEM REFORM INCENTIVE PAYMENT) WITH SEVEN PROJECTS ALL OF WHICH ARE PART OF A COMPREHENSIVE MEDICAID REFORM PROGRAM TO REDUCE AVOIDABLE HOSPITAL ADMISSIONS AND EMERGENCY DEPARTMENT ADMISSIONS BY 25% OVER 5 YEARS. THESE PROJECTS INCLUDE HOME TELEMONITORING EQUIPMENT, FACILITATOR TRAINING WITH RESPECTING CHOICES (A PALLIATIVE CARE INITIATIVE), CHRONIC DISEASE PREVENTION, INTEGRATING BEHAVIORAL HEALTH INTO PRIMARY CARE, HEALTH CENTER CERTIFICATION UNDER NCQA AND MANY OTHER POPULATION HEALTH EFFORTS."