TY 2020 Form 990

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W-2/1099-MISC)
(1) DIANNE SHUGRUE...................................................................... PRESIDENT & CEO	40.00 ................. 0.00	X	X	3,797,476	0	13,529
(2) STEVEN FRISCH MD...................................................................... BOARD MEMBER	1.00 ................. 57.00	X		0	1,217,996	118,555
(3) SEAN BAIN MD...................................................................... BOARD MEMBER	40.00 ................. 0.00	X		401,783	0	16,418
(4) GEOFFREY SERFILIPPI MD...................................................................... BOARD MEMBER	40.00 ................. 0.00	X		161,574	0	480
(5) MARK L BEHAN...................................................................... VICE CHAIR	1.00 ................. 0.00	X	X	0	0	0
(6) TENEE' CASACCIO...................................................................... BOARD MEMBER	1.00 ................. 0.00	X		0	0	0
(7) CARL CEDRONE...................................................................... BOARD MEMBER	1.00 ................. 0.00	X		0	0	0
(8) GREGORY CHAMPION...................................................................... BOARD MEMBER	1.00 ................. 0.00	X		0	0	0
(9) KATHIE L DUNCAN...................................................................... BOARD MEMBER	1.00 ................. 0.00	X		0	0	0
(10) GEORGE FERONE...................................................................... SECRETARY	1.00 ................. 0.00	X	X	0	0	0
(11) MARGARET GILLIS...................................................................... BOARD MEMBER	1.00 ................. 0.00	X		0	0	0
(12) THOMAS GUAY...................................................................... BOARD MEMBER	1.00 ................. 0.00	X		0	0	0
(13) WILLIAM HART...................................................................... BOARD MEMBER	1.00 ................. 0.00	X		0	0	0
(14) COURTNEY HASKINS...................................................................... BOARD MEMBER	1.00 ................. 0.00	X		0	0	0
(15) GARY R HICKS...................................................................... BOARD MEMBER	1.00 ................. 0.00	X		0	0	0
(16) WILLIAM G POWERS JR...................................................................... CHAIR	1.00 ................. 0.00	X	X	0	0	0
(17) KATE HERLIHY SCHWENKER...................................................................... BOARD MEMBER	1.00 ................. 0.00	X		0	0	0

(A) Name and business address	(B) Description of services	(C) Compensation
HUDSON HEADWATERS HEALTH NETWORK 9 CAREY RD QUEENSBURY,NY12804	MEDICAL SERVICES	6,058,229
KAUFMAN HALL & ASSOCIATES 8610 SOLUTION CENTER CHICAGO,IL60677	CONSULTANTS	2,326,439
MEDICAL ANESTHESIA SPECIALISTS OF NY PC PO BOX 744883 ATLANTA,GA30374	ANESTHESIA SERVICES	1,847,614
COMPHEALTH PO BOX 972651 DALLAS,TX75397	CONTRACT LABOR	1,568,237
REVMD PARTNERS 1111 PASQINELLI DR SUITE 400 WESTMONT,IL60559	COLLECTION SERVICES	1,088,502
2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 40

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
right arrow

Attach to Form 990 or Form 990-EZ.
right arrow

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2020

Open to Public
Inspection

Name of the organization

GLENS FALLS HOSPITAL

Employer identification number

14-1338413

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is: (For lines 1 through 12, check only one box.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990 or 990-EZ).)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box in lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ...............................

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i) Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2020

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization failed to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2016	(b) 2017	(c) 2018	(d) 2019	(e) 2020	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2016	(b) 2017	(c) 2018	(d) 2019	(e) 2020	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..
11	Total support. Add lines 7 through 10

Gross receipts from related activities, etc. (see instructions) ..................

First 5 years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2020 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2019 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2020. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2019. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2020. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2019. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow

Schedule A (Form 990 or 990-EZ) 2020

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2016	(b) 2017	(c) 2018	(d) 2019	(e) 2020	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose
3	Gross receipts from activities that are not an unrelated trade or business under section 513 .....
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge
6	Total. Add lines 1 through 5
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support. (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2016	(b) 2017	(c) 2018	(d) 2019	(e) 2020	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

First 5 years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2020 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2019 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2020 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2019 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2020. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2019. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990 or 990-EZ) 2020

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked box 12a, of Part I, complete Sections A and B. If you checked box 12b, of Part I, complete Sections A and C. If you checked box 12c, of Part I, complete Sections A, D, and E. If you checked box12d, of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer lines 3b and 3c below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked box 12a or 12b in Part I, answer lines 4b and 4c below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer lines 5b and 5c below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons, as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990 or 990-EZ) 2020

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described in lines 11b and 11c below, the governing body of a supported organization?

11a

A family member of a person described in 11a above?

11b

A 35% controlled entity of a person described in line 11a or 11b above? If “Yes” to 11a, 11b, or 11c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the officers, directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in line 2 above, did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer lines 2a and 2b below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described in line 2a, above constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer lines 3a and 3b below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations?If "Yes" or "No", provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990 or 990-EZ) 2020

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970 (explain in Part VI). See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1
2	Recoveries of prior-year distributions	2
3	Other gross income (see instructions)	3
4	Add lines 1 through 3	4
5	Depreciation and depletion	5
6	Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions)	6
7	Other expenses (see instructions)	7
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a
b	Average monthly cash balances	1b
c	Fair market value of other non-exempt-use assets	1c
d	Total (add lines 1a, 1b, and 1c)	1d
e	Discount claimed for blockage or other factors (explain in detail in Part VI):
2	Acquisition indebtedness applicable to non-exempt use assets	2
3	Subtract line 2 from line 1d	3
4	Cash deemed held for exempt use. Enter 0.015 of line 3 (for greater amount, see instructions).	4
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5
6	Multiply line 5 by 0.035	6
7	Recoveries of prior-year distributions	7
8	Minimum Asset Amount (add line 7 to line 6)	8

	Section C - Distributable Amount		Current Year
1	Adjusted net income for prior year (from Section A, line 8, Column A)	1
2	Enter 85% of line 1	2
3	Minimum asset amount for prior year (from Section B, line 8, Column A)	3
4	Enter greater of line 2 or line 3	4
5	Income tax imposed in prior year	5
6	Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions)	6

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990 or 990-EZ) 2020

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations(continued)

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes	1
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity	2
3 Administrative expenses paid to accomplish exempt purposes of supported organizations	3
4 Amounts paid to acquire exempt-use assets	4
5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI)	5
6 Other distributions (describe in Part VI). See instructions	6
7Total annual distributions. Add lines 1 through 6.	7
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions	8
9 Distributable amount for 2020 from Section C, line 6	9
10 Line 8 amount divided by Line 9 amount	10

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2020	(iii) Distributable Amount for 2020
1 Distributable amount for 2020 from Section C, line 6
2 Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2020:
a From 2015.......
b From 2016.......
c From 2017.......
d From 2018.......
e From 2019.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2020 distributable amount
i Carryover from 2015 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from line 3f.
4Distributions for 2020 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2020 distributable amount
c Remainder. Subtract lines 4a and 4b from line 4.
5 Remaining underdistributions for years prior to 2020, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions.
6 Remaining underdistributions for 2020. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions.
7 Excess distributions carryover to 2021. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2016.....
b Excess from 2017.....
c Excess from 2018.....
d Excess from 2019.....
e Excess from 2020.....

Schedule A (Form 990 or 990-EZ) (2020)

Schedule A (Form 990 or 990-EZ) 2020

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990 or 990-EZ) 2020

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2020

Name of the organization

GLENS FALLS HOSPITAL

Employer identification number

14-1338413

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note: Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Don't complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... Arrow Bullet

Caution: An organization that isn't covered by the General Rule and/or the Special Rules doesn't file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its Form 990-EZ
or on its Form 990PF, Part I, line 2, to certify that it doesn't meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2020)

Schedule B (Form 990, 990-EZ, or 990-PF) (2020) Page 2

Name of organization GLENS FALLS HOSPITAL

Part I Contributors	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	,	$ RESTRICTED	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2020)

Schedule B (Form 990, 990-EZ, or 990-PF) (2020)

Page 3

Name of organization GLENS FALLS HOSPITAL		Employer identification number 14-1338413

Part II	Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2020)

Schedule B (Form 990, 990-EZ, or 990-PF) (2020)

Page 4


Name of organization GLENS FALLS HOSPITAL			Employer identification number 14-1338413
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2020)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527

SchCMd Bullet

Complete if the organization is described below. SchCMd Bullet

Attach to Form 990 or Form 990-EZ.
SchCMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2020

Open to Public
Inspection

If the organization answered "Yes" on Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" on Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

GLENS FALLS HOSPITAL

Employer identification number

14-1338413

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV (see instructions for definition of “political campaign activities")

Political campaign activity expenditures (see instructions) .................................................................... SchCMd Bullet

Volunteer hours for political campaign activities (see instructions) ..................................................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ................................ SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ....................... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................

Yes No

Was a correction made? ......................................................................................................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................ SchCMd Bullet

Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b........... SchCMd Bullet

Did the filing organization file Form 1120-POL for this year? ...................................................................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.
1
2
3
4
5
6

For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2020

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check SchCMd Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......................
b	Total lobbying expenditures to influence a legislative body (direct lobbying) ........................
c	Total lobbying expenditures (add lines 1a and 1b) ............................................................
d	Other exempt purpose expenditures ...............................................................................
e	Total exempt purpose expenditures (add lines 1c and 1d) ..................................................
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) .................................................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................................................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................................................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ...................................................................................................................	Yes No

4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2017	(b) 2018	(c) 2019	(d) 2020	(e) Total

2a	Lobbying nontaxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2020

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each "Yes" response on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes|No

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? ...........................................................................................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........

Media advertisements? ...................................................................................................

Mailings to members, legislators, or the public? .............................................................................

Publications, or published or broadcast statements? ...........................................................

Grants to other organizations for lobbying purposes? ..........................................................

Direct contact with legislators, their staffs, government officials, or a legislative body? .......................

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................

Other activities? ...................................................................................................................

Yes

33,493

Total. Add lines 1c through 1i ....................................................................................................

33,493

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 ...........................................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? ........................

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ...............................................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................

Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."

Dues, assessments and similar amounts from members ......................................................................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).

Current year .............................................................................................................................

Carryover from last year ............................................................................................................

Total ...........................................................................................................................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ......................................................................................................................

Taxable amount of lobbying and political expenditures (see instructions) .........................................

Part IV

Supplemental Information

Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
PART II-B, LINE 1:	IN 2020, GLENS FALLS HOSPITAL PAID DUES TO THE AMERICAN HOSPITAL ASSOCIATION, THE HOSPITAL ASSOCIATION OF NEW YORK AND IROQUOIS HEALTHCARE ALLIANCE, A PORTION OF WHICH WENT TOWARDS LOBBYING EXPENSES AS DETERMINED BY THE ASSOCIATIONS AND ALLIANCE.

Schedule C (Form 990 or 990EZ) 2020

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet

Attach to Form 990.
SchDMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2020

Open to Public Inspection

Name of the organization

GLENS FALLS HOSPITAL

Employer identification number

14-1338413

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ........

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds are the organization’s property, subject to the organization’s exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

Conservation Easements.
Complete if the organization answered "Yes" on Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements ......................	2a
b	Total acreage restricted by conservation easements ....................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 7/25/06, and not on a historic structure listed in the National Register ...	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.

If the organization elected, as permitted under FASB ASC 958, not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under FASB ASC 958, to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:

(i)

Revenue included on Form 990, Part VIII, line 1 ......................... SchDMd Bullet

(ii)

Assets included in Form 990, Part X ............................... SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under FASB ASC 958 relating to these items:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 52283D

Schedule D (Form 990) 2020

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?...

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No


b	If "Yes," explain the arrangement in Part XIII and complete the following table:		Amount
c	Beginning balance .............................	1c
d	Additions during the year ............................	1d
e	Distributions during the year ..........................	1e
f	Ending balance ................................	1f

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ....

Part V

Endowment Funds.
Complete if the organization answered "Yes" on Form 990, Part IV, line 10.

		(a) Current year	(b) Prior year	(c) Two years back	(d) Three years back	(e) Four years back

1a	Beginning of year balance ....	1,506,672	1,506,672	1,506,672	1,506,672	1,506,672
b	Contributions ...
c	Net investment earnings, gains, and losses	53,846	423,632	218,087	154,101	393,967
d	Grants or scholarships ...	12,000	12,000	12,000	12,900	15,300
e	Other expenditures for facilities and programs ...
f	Administrative expenses ....	41,846	411,632	206,087	141,201	378,667
g	End of year balance ......	1,506,672	1,506,672	1,506,672	1,506,672	1,506,672

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

0 %

Permanent endowment SchDMd Bullet

100.000 %

Term endowment SchDMd Bullet

0 %

The percentages on lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) Unrelated organizations .......................

3a(i)

(ii) Related organizations .......................

3a(ii)

If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(a) Cost or other basis (investment)	(b) Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value

1a	Land .....	15,397,305		15,397,305
b	Buildings ....	226,053,843	128,099,422	97,954,421
c	Leasehold improvements	4,412,390	535,666	3,876,724
d	Equipment ....	175,470,397	140,609,472	34,860,925
e	Other .....
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				152,089,375

Schedule D (Form 990) 2020

Page 3

Part VII

Investments - Other Securities.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)	(b) Book value	(c) Method of valuation: Cost or end-of-year market value
(1) Financial derivatives.........
(2) Closely-held equity interests........
(3)Other
(B)
(C)
(D)
(E)
(F)
(G)
(H)
(I)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

Investments - Program Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment	(b) Book value	(c) Method of valuation: Cost or end-of-year market value

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value
(1)INVESTMENT IN ISNENY				-284,970
(2)INVESTMENT IN YANKEE ALLIANCE				828,093
(3)INVESTMENT IN YASCS				3,359,170
(4)PROF. LIABILITY REC.				460,000
(5)RIGHT OF USE ASSETS				10,848,841
(6)INTEREST IN NET ASSETS OF FDTN				5,464,828
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				20,675,962

Part X

Other Liabilities.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	37,673,183
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

Schedule D (Form 990) 2020

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......			1	391,235,144
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a	4,632,323
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d	40,167,450
e	Add lines 2a through 2d .....................			2e	44,799,773
3	Subtract line 2e from line 1..................			3	346,435,371
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b	16,299
c	Add lines 4a and 4b....................			4c	16,299
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......			5	346,451,670

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........			1	347,315,868
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities .........	2a
b	Prior year adjustments ............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d....................			2e	0
3	Subtract line 2e from line 1...................			3	347,315,868
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b	12,000
c	Add lines 4a and 4b.....................			4c	12,000
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......			5	347,327,868

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b; Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference	Explanation
PART V, LINE 4:	PERMANENTLY RESTRICTED NET ASSETS ARE INVESTMENTS TO BE HELD IN PERPETUITY, THE INCOME FROM WHICH IS EXPENDABLE TO SUPPORT THE FOLLOWING: DENTAL CARE - $1,053,285 INDIGENT CARE - $148,927 GENERAL OPERATING EXPENSES - $169,975 HEALTH EDUCATION - $134,485 TOTAL - $1,506,672
PART X, LINE 2:	GLENS FALLS HOSPITAL IS CLASSIFIED FOR TAX PURPOSES AS AN ORGANIZATION UNDER 501(C)(3) OF THE INTERNAL REVENUE CODE (THE CODE), AND AS SUCH ARE GENERALLY EXEMPT FROM INCOME TAXES UNDER THE PROVISIONS OF SECTION 501(A) OF THE CODE. GLENS FALLS HOSPITAL RECOGNIZES INCOME TAX POSITIONS WHEN IT IS MORE-LIKELY-THAN-NOT THAT THE POSITION WILL BE SUSTAINABLE BASED ON THE MERITS OF THE POSITION. MANAGEMENT HAS CONCLUDED THAT THERE ARE NO UNCERTAIN TAX POSITIONS THAT NEED TO BE RECORDED AS OF DECEMBER 31, 2020 AND 2019.
PART XI, LINE 2D - OTHER ADJUSTMENTS:	CHANGE IN INTEREST IN NET ASSETS OF GFH FOUNDATION 1,112,063. EFFECT OF BUSINESS COMBINATION 39,055,387.
PART XI, LINE 4B - OTHER ADJUSTMENTS:	RECEIPT OF FOUNDATION FUNDS TO BALANCE SHEET ACCOUNTS 4,299. OTHER GRANTS PAID 12,000.
PART XII, LINE 4B - OTHER ADJUSTMENTS:	OTHER GRANTS PAID 12,000.

Schedule D (Form 990) 2020

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990EZ for instructions and the latest information.

OMB No. 1545-0047

2020

Open to Public Inspection

Name of the organization

GLENS FALLS HOSPITAL

Employer identification number

14-1338413

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .

Yes

If "Yes," was it a written policy? ......................

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other 13000.0000000000 %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: . . . . . . . .

Yes

200% 250% 300% 350% 400% Other 33000.0000000000 %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

Yes

Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .

Yes

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .

Did the organization prepare a community benefit report during the tax year? . . . . . . . . .

Yes

If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .	4,395,382	4,557,342	0	0 %
b	Medicaid (from Worksheet 3, column a) . . . . .	50,147,028	38,432,469	11,714,559	3.370 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	54,542,410	42,989,811	11,714,559	3.370 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	2,332,503	383,943	1,948,560	0.560 %
f	Health professions education (from Worksheet 5) . . .	996,681	0	996,681	0.290 %
g	Subsidized health services (from Worksheet 6) . . . .	51,138,673	44,230,582	6,908,091	1.990 %
h	Research (from Worksheet 7) .	141,485	70,682	70,803	0.020 %
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	11,065	0	11,065	0 %
j	Total. Other Benefits . .	54,620,407	44,685,207	9,935,200	2.860 %
k	Total. Add lines 7d and 7j .	109,162,817	87,675,018	21,649,759	6.230 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2020

Schedule H (Form 990) 2020

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support	131,747	27,500	104,247	0.030 %
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development	75,653	0	75,653	0.020 %
9	Other
10	Total	207,400	27,500	179,900	0.050 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Healthcare Financial Management Association Statement No. 15? ..........................

Yes

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

60,418,569

Enter Medicare allowable costs of care relating to payments on line 5.....

101,868,166

Subtract line 6 from line 5. This is the surplus (or shortfall)........

-41,449,597

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
11 IMAGING SVCS OF NENY	DIAGNOSTIC RADIOLOGY	50.000 %	50.000 %	50.000 %
22 NORTH CTRY EYE	EYE CENTER	30.000 %	30.000 %	30.000 %
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2020

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions)How many hospital facilities did the organization operate during the tax year?1Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
1	GLENS FALLS HOSPITAL 100 PARK STREET GLENS FALLS,NY12801 GLENSFALLSHOSPITAL.ORG 5601000H	X	X	X

Schedule H (Form 990) 2020

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	GLENS FALLS HOSPITAL
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C...............

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12......................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 19

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Yes

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Yes

Did the hospital facility make its CHNA report widely available to the public?..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): SEE SECTION C

Other website (list url):

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 19

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): SEE SECTION C

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?...............................

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2020

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	GLENS FALLS HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 130.000000000000%
and FPG family income limit for eligibility for discounted care of 330.000000000000%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Was widely publicized within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

SEE SECTION C

The FAP application form was widely available on a website (list url):

SEE SECTION C

A plain language summary of the FAP was widely available on a website (list url):

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Individuals were notified about the FAP by being offered a paper copy of the plain language summary of the FAP, by
receiving a conspicuous written notice about the FAP on their billing statements, and via conspicuous public displays or
other measures reasonably calculated to attract patients' attention

Notified members of the community who are most likely to require financial assistance about availability of the FAP

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2020

Page 6

Part VFacility Information (continued)

Billing and Collections

	GLENS FALLS HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon nonpayment?..................................

Yes

Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs (if not, describe in Section C)

Made a reasonable effort to orally notify individuals about the FAP and FAP application process (if not, describe in
Section C)

Processed incomplete and complete FAP applications (if not, describe in Section C)

Made presumptive eligibility determinations (if not, describe in Section C)

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..................

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Schedule H (Form 990) 2020

Page 7

Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

	GLENS FALLS HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicaid, either alone or in combination with
Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month
period

The hospital facility used a prospective Medicare or Medicaid method

During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ...............................

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2020

Page 8

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
GLENS FALLS HOSPITAL	PART V, SECTION B, LINE 5: GFH CONDUCTED THE CHNA TO IDENTIFY AND PRIORITIZE THE COMMUNITY HEALTH NEEDS OF THE PATIENTS AND COMMUNITIES WITHIN THE GFH SERVICE AREA. THE FINDINGS IN THIS CHNA RESULT FROM A YEAR-LONG PROCESS OF COLLECTING AND ANALYZING DATA AND CONSULTING WITH STAKEHOLDERS THROUGHOUT THE COMMUNITY AND REGION. THE CHNA CAN BE USED AS A ROADMAP TO GUIDE SERVICE PROVIDERS, ESPECIALLY PUBLIC HEALTH, IN THEIR EFFORTS TO DEVELOP PROGRAMS AND SERVICES TARGETED TO IMPROVE THE OVERALL HEALTH AND WELL-BEING OF PEOPLE AND COMMUNITIES IN THE REGION.WORKING WITHIN THE FRAMEWORK PROVIDED BY NYS' PREVENTION AGENDA, GFH AND WARREN, WASHINGTON AND SARATOGA COUNTY PUBLIC HEALTH DEPTS. COLLABORATED IN THE DEVELOPMENT OF THE CHNA. ADDITIONALLY, GFH COORDINATED WITH FULTON, ESSEX, HAMILTON, FRANKLIN, AND CLINTON COUNTY PUBLIC HEALTH, AS WELL AS WITH SEVERAL OTHER HOSPITALS IN THE REGION, THROUGH THE REGIONAL HEALTH ASSESSMENT AND PLANNING EFFORTS COORDINATED BY THE ADIRONDACK RURAL HEALTH NETWORK (ARHN). SINCE 2002, ARHN HAS BEEN RECOGNIZED AS THE LEADING SPONSOR OF FORMAL COMMUNITY HEALTH PLANNING IN THE REGION. THE COMMUNITY HEALTH ASSESSMENT (CHA) COMMITTEE, FACILITATED BY ARHN, IS MADE UP OF HOSPITALS AND COUNTY HEALTH DEPARTMENTS WORKING TOGETHER TO UTILIZE A SYSTEMATIC APPROACH TO COMMUNITY HEALTH PLANNING AND ASSESSMENT.A VARIETY OF DATA SOURCES WERE USED TO INFORM THE COUNTY AND HOSPITAL ASSESSMENTS. THE TWO MOST SIGNIFICANT RESOURCES USED WERE DEVELOPED AND PROVIDED BY ARHN COLLABORATION: 1) PUBLICLY AVAILABLE COUNTY HEALTH INDICATOR DATA AND 2) DATA COLLECTED FROM A REGIONAL COMMUNITY STAKEHOLDER SURVEY. EACH COUNTY PUBLIC HEALTH DEPARTMENT, AS WELL AS GFH, USED ADDITIONAL DATA SOURCES TO SUPPLEMENT THIS INFORMATION AND INFORM THE PROCESS BASED ON THEIR NEEDS. ADDITIONAL DATA SOURCES USED BY GFH INCLUDE THE NYS PREVENTION AGENDA DASHBOARD, COUNTY HEALTH RANKINGS, THE NYS CANCER REGISTRY, THE GOVERNOR'S CANCER RESEARCH INITIATIVE WARREN COUNTY CANCER INCIDENCE REPORT, AND AN ATTITUDINAL TOBACCO ASSESSMENT CONDUCTED IN WARREN, WASHINGTON AND SARATOGA COUNTIES.
GLENS FALLS HOSPITAL	PART V, SECTION B, LINE 6A: HOSPITALS: ADIRONDACK HEALTH, NATHAN LITTAUER HOSPITAL, UVM HEALTH NETWORK-ALICE HYDE MEDICAL CENTER, UVM HEALTH NETWORK-CHAMPLAIN VALLEY PHYSICIANS HOSPITAL, AND UVM HEALTH NETWORK-ELIZABETHTOWN COMMUNITY HOSPITAL.
GLENS FALLS HOSPITAL	PART V, SECTION B, LINE 6B: OTHER ORGS: PUBLIC HEALTH DEPTS. OF CLINTON, ESSEX, FRANKLIN, FULTON, HAMILTON, WARREN, WASHINGTON AND AHRN
GLENS FALLS HOSPITAL	PART V, SECTION B, LINE 11: AFTER CAREFUL CONSIDERATION AND EXTENSIVE INTERNAL AND EXTERNAL DISCUSSIONS, GFH DETERMINED THAT THE MOST EFFECTIVE STRATEGY WOULD BE TWOFOLD: 1) ENSURE THE HOSPITAL COORDINATED WITH AND/OR PARTICIPATED IN EACH OF THE PUBLIC HEALTH DEPARTMENT'S ASSESSMENT PROCESSES AND 2) UTILIZE THE RESULTS OF EACH OF THE COUNTIES ASSESSMENTS TO INFORM A COORDINATED AND COMPLEMENTARY REGIONAL CHNA FOR THE GFH SERVICE AREA.IN ADDITION TO EVALUATING THE PRIORITIES AND COUNTY LEVEL DATA INDICATORS FOR OUR LOCAL COUNTY HEALTH DEPARTMENTS, GFH CONSIDERED OUR EXPERTISE CAPACITY, FUNDING, AND POTENTIAL IMPACT. THE FOLLOWING HAVE BEEN IDENTIFIED AS THE MOST SIGNIFICANT HEALTH NEEDS FOR THE POPULATION SERVED BY GFH. THESE NEEDS WILL BE THE MAJOR FOCUS OF GFH'S COMMUNITY HEALTH STRATEGIES FOR 2019-2021.PRIORITY AREA: PREVENT CHRONIC DISEASEFOCUS AREA 1 - HEALTHY EATING AND FOOD SECURITYFOCUS AREA 2 - PHYSICAL ACTIVITYFOCUS AREA 3 - TOBACCO PREVENTIONFOCUS AREA 4 - CHRONIC DISEASE PREVENTIVE CARE AND MANAGEMENT.GFH IS EXPANDING THE SCOPE OF WORK TO INCLUDE AN ADDITIONAL PRIORITY AREA.PRIORITY AREA: PREVENT COMMUNICABLE DISEASESFOCUS AREA 5 - ANTIBIOTIC RESISTANCE AND HEALTHCARE-ASSOCIATED INFECTIONSIN REGARDS TO REGIONAL PRIORITIES, AND IN ADDITION TO GFH CHOOSING THE FOUR FOCUS AREAS UNDER THE PREVENT CHRONIC DISEASES PRIORITY AREA, AS PART OF THE COMMUNITY HEALTH PLANNING AND ASSESSMENT PROCESS, THE CHA COMMITTEE IDENTIFIED AND SELECTED PREVENT CHRONIC DISEASES AS ONE OF THE REGIONAL PRIORITIES IN SUPPORT OF THE NYS PREVENTION AGENDA 2019-2024. THE CHA COMMITTEE ALSO SELECTED AN ADDITIONAL PRIORITY, PROMOTE WELL-BEING AND PREVENT MENTAL AND SUBSTANCE USE DISORDERS.ADDITIONAL ANALYSIS REVEALED AN INCREASING DEMAND AND NEED FOR MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES THROUGHOUT THE THREE-COUNTY REGION. GFH RECOGNIZES THIS TREND AND THE NEED FOR QUALITY SERVICES AND PROGRAM, HOWEVER, HAS NOT HISTORICALLY FORMALIZED STRATEGIES INTO THE PLAN DUE TO LACK OF RESOURCES AND CAPACITY. CURRENTLY, GLENS FALLS HOSPITAL IS THE CONTRACTED BEHAVIORAL HEALTH PROVIDER FOR WARREN AND WASHINGTON COUNTIES. THE NEED WILL ONLY INCREASE, AND WE ARE WORKING TO PROACTIVELY ENSURE PATIENTS HAVE ACCESS TO THE CARE THEY NEED. MOST RECENTLY, GLENS FALLS HOSPITAL IS WORKING WITH WARREN AND WASHINGTON COUNTIES TO CONDUCT A THOUGHTFUL AND DELIBERATE PARTNERSHIP EXPLORATION PROCESS FOR OUTPATIENT BEHAVIORAL HEALTH AND SUBSTANCE USE SERVICES. BEHAVIORAL HEALTH SERVICES NORTH HAS STEPPED IN TO TAKE OVER THE OUTPATIENT BEHAVIORAL HEALTH SERVICE TO HELP US BETTER SERVE PATIENTS, WITH A GOAL TO EXPAND ACCESS TO MUCH NEEDED SPECIALIZED BEHAVIORAL HEALTH SERVICES IN OUR COMMUNITY. SIMULTANEOUSLY, GFH WILL CONTINUE TO WORK THROUGH INITIATIVES SUCH AS HEALTH HOME AND DSRIP TO WORK WITH ALL PROVIDERS ON INTEGRATED CARE MODELS AND POPULATION HEALTH STRATEGIES. ADDITIONAL COMMUNITY HEALTH NEEDS, SUCH AS HOUSING, TRANSPORTATION, AND OTHER SOCIAL DETERMINANTS OF HEALTH, ARE NOT ADDRESSED IN THE ACTION PLAN DUE TO LACK OF RESOURCES, EXPERTISE AND/OR QUANTITATIVE DATA TO SUPPORT A PROPER ASSESSMENT AND PLAN.
PART V, LINE 7A AND 10A	THE HOSPITAL'S CHNA AND IMPLEMENTATION STRATEGY IS POSTED ON ITS WEBSITE: WWW.GLENSFALLSHOSPITAL.ORG/SERVICES/COMMUNITY-SERVICES/HEALTH-PROMOTION-CENTERPART V, LINE 16A & 16B: THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY AND APPLICATION FORM IS POSTED ON ITS WEBSITE: WWW.GLENSFALLSHOSPITAL.ORG/PATIENTS-AND-VISITORS/PATIENTS/PATIENT-FINANCIAL-ASSISTANCE
PART V, LINE 20D	IN 2020, THE HOSPITAL DID NOT HAVE A PRESUMTIVE ELIGIBILITY TOOL IN PLACE. WE HAVE SELECTED A VENDOR TO PROVIDE THE SOFTWARE TOOL AND WILL HAVE IT IMPLEMENTED IN THE 3RD QUARTER OF 2021

Schedule H (Form 990) 2020

Page 9

Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?19
Name and address		Type of Facility (describe)
1	1 - ADIRONDACK CARDIOLOGY 6 HEARTS WAY QUEENSBURY,NY12804	HOSPITAL EXTENSION CLINIC - CARDIOLOGY AND CARDIAC REHABILITATION
2	2 - SURGICAL SPECIALISTS OF GLENS FALLS 14 HUDSON AVE GLENS FALLS,NY12801	HOSPITAL EXTENSION CLINIC - SURGICAL SERVICES, UROLOGY, THORACIC, ORTHOPEDIC
3	3 - THE REHAB CENTER & HEARING CENTER 2 COUNTRY CLUB RD QUEENSBURY,NY12804	HOSPITAL EXTENSION CLINIC - OUTPATIENT PT, OT, SPEECH, AUDIOLOGY
4	4 - GLENS FALLS BROAD ST MEDICAL CENTER 2 BROAD ST GLENS FALLS,NY12801	HOSPITAL EXTENSION CLINIC - PRIMARY MEDICAL CARE, ENT
5	5 - CAMBRIDGE MEDICAL CENTER AND URGENT CARE 35 GILBERT ST CAMBRIDGE,NY12816	HOSPITAL EXTENSION CLINIC - PRIMARY MEDICAL CARE, O/P RADIOLOGY, PT
6	6 - GREENWICH MEDICAL CENTER 1134 COUNTY RT 29 GREENWICH,NY12834	HOSPITAL EXTENSION CLINIC - PRIMARY MEDICAL CARE, O/P RADIOLOGY, PT
7	7 - THE REHAB CENTER & HEARING CENTER 4 IRONGATE CTR GLENS FALLS,NY12801	HOSPITAL EXTENSION CLINIC - O/P PT, OT, SPEECH, AUDIOLOGY
8	8 - GRANVILLE MEDICAL CENTER 79 NORTH ST GRANVILLE,NY12832	HOSPITAL EXTENSION CLINIC - PRIMARY MEDICAL CARE, O/P RADIOLOGY, LAB, REHAB
9	9 - PHYSICAL THERAPY AT MAIN ST 17 MAIN ST GLENS FALLS,NY12801	HOSPITAL EXTENSION CLINIC - O/P PHYSICAL THERAPY
10	10 - MEDICAL IMAGING AND LAB 1299 RT 9 GANSEVOORT,NY12831	HOSPITAL EXTENSION CLINIC - MEDICAL IMAGING AND LAB
11	11 - CENTER FOR RECOVERY 101 RIDGE ST GLENS FALLS,NY12801	HOSPITAL EXTENSION CLINIC - CHEMICAL DEPENDENCE, O/P REHAB
12	12 - BEHAVIORAL HEALTH SERVICESRIDGE COMMONS 1 LAWRENCE ST LAWRENCE ST,NY12801	HOSPITAL EXTENSION CLINIC - O/P MENTAL HEALTH SERVICES
13	13 - HUDSON FALLS MEDICAL CENTER 325 MAIN ST HUDSON FALLS,NY12839	HOSPITAL EXTENSION CLINIC - PRIMARY MEDICAL CARE
14	14 - EVERGREEN MEDICAL CENTER 13 PALMER AVE CORINTH,NY12822	HOSPITAL EXTENSION CLINIC - PRIMARY MEDICAL CARE, O/P RADIOLOGY, PT, MENTAL
15	15 - THE CENTER FOR RECOVERY 340 MAIN ST HUDSON FALLS,NY12839	HOSPITAL EXTENSION CLINIC - CHEMICAL DEPENDENCE, O/P REHAB
16	16 - ADVANCED IMAGING AT BAYBROOK 22 WILLOWBROOK RD QUEENSBURY,NY12804	HOSPITAL EXTENSION CLINIC - DIAGNOSTIC OP RADILOGY, CT SCANNER
17	17 - WHITEHALL MEDICAL CENTER 65 POULTNEY ST WHITEHALL,NY12887	HOSPITAL EXTENSION CLINIC - PRIMARY MEDICAL CARE, O/P RADIOLOGY, LAB
18	18 - SALEM MEDICAL CENTER 213 MAIN ST SALEM,NY12865	HOSPITAL EXTENSION CLINIC - PRIMARY MEDICAL CARE, O/P PT
19	19 - WILTON MEDICAL CENTER 135 NORTH RD GANSEVOORT,NY12831	HOSPITAL EXTENSION CLINIC - PRIMARY MEDICAL CARE, O/P RADIOLOGY, PT

Schedule H (Form 990) 2020

Page 10

Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Form and Line Reference	Explanation
PART I, LINE 6A:	GLENS FALLS HOSPITAL DEVELOPS AND PRODUCES THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) AND IMPLEMENTATION STRATEGY (IS) PER IRS GUIDELINES AND PUBLISHES THE REPORT ON THE WEBSITE. IN ADDITION, A COMMUNITY SERVICE PLAN IS PRODUCED PER NYS DEPT OF HEALTH GUIDELINES, AND ALSO MADE AVAILABLE ON THE WEBSITE. THESE REPORTS ALSO INCLUDE THE AMERICAN COLLEGE OF SURGEONS COMM. ON CANCER REQUIREMENTS FOR THE CR WOOD CANCER CENTER. PAPER COPIES ARE AVAILABLE FOR PICK UP IN PERSON OR BY MAIL BY REQUEST. IN ADDITION, GLENS FALLS HOSPITAL PRODUCES AN ANNUAL REPORT, WHICH IS MAILED TO APPROXIMATELY 60,000 HOUSEHOLDS, AND AVAILABLE AT MULTIPLE LOCATIONS THROUGHOUT THE HOSPITAL. A COMMUNITY NEWSLETTER IS ALSO DISTRIBUTED MULTIPLE TIMES PER YEAR.
PART I, LINE 7:	THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS REPORTED IN THE TABLE WAS A COST-TO-CHARGE RATIO AS DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO CHARGES.
PART II, COMMUNITY BUILDING ACTIVITIES:	GLENS FALLS HOSPITAL REGULARLY ASSESSES THE MAKEUP OF THE REGION'S PHYSICIAN POPULATION, PAYING PARTICULAR ATTENTION TO PHYSICIANS WHO MAY BE APPROACHING RETIREMENT AGE AND SPECIALTIES THAT MAY HAVE A PHYSICIAN SHORTAGE DUE TO RETIREMENT OR RELOCATION. THE HOSPITAL EMPLOYS A FULL-TIME PHYSICIAN RECRUITER WHO FOCUSES ON THE RECRUITMENT AND RETENTION OF HIGH QUALITY PROVIDERS. THE POSITION ACTIVELY RECRUITS FOR VACANCIES AND SHORTAGES AMONG HOSPITAL EMPLOYED PHYSICIANS, AND PARTNERS WITH INDEPENDENT PRACTICES TO HELP THEM KEEP A FULL COMPLEMENT OF PHYSICIANS ACROSS SPECIALTIES.THE HOSPITAL ALSO MONITORS AND ACTIVELY ENGAGES IN PREVENTING THE SPREAD OF INFECTIOUS DISEASE THROUGH SCHOOL BASED HEALTH AND THE HOSPITAL'S INFECTION CONTROL PROGRAM. THIS INCLUDES VACCINATIONS FOR CHILDREN, AND ACCESS TO FLU VACCINES FOR THE RESIDENTS OF OUR SERVICE AREA, (FREE OR AT A SIGNIFICANTLY REDUCED COST), INCLUDING AN ANNUAL HPODS DRILL.THE HOSPITAL MEETS REGULARLY WITH COMMUNITY GROUPS IN PLANNING FOR EMERGENCY PREPAREDNESS. COORDINATING WITH POLICE DEPARTMENTS, FIRE DEPARTMENTS, EMS AND COUNTY OFFICIALS. EMERGENCY DRILLS ARE CARRIED OUT FOR SUCH THINGS AS NATURAL DISASTERS, TERRORISM, ACCIDENTS WITH MASS CASUALTIES AND BIO HAZARDS. COMMUNITY MEMBERS PLAY AN ACTIVE ROLL IN THESE DRILLS.THROUGHOUT THE CORONAVIRUS (COVID-19) PANDEMIC, GFH HAS DEMONSTRATED THE ESSENTIAL NATURE OF OUR SERVICES FOR THE REGION AND HIS CONTINUED TO BE THE SAFETY NET HOSPITAL FOR OUR SURROUNDING COMMUNITIES. THE COVID-19 PANDEMIC HAD A DEVASTATING AND MULTI-FACETED IMPACT ON THE UPSTATE NEW YORK AREA. THREE SIGNIFICANT CHALLENGES, PARTICULARLY AT THE ONSET OF THE PANDEMIC, INCLUDED: 1) COVID-19 INFECTIONS AND ASSOCIATED COST OF CARE, 2) PLANNING FOR UNKNOWN HEALTH CARE SYSTEM SURGE CAPACITY AS DIRECTED BY THE GOVERNOR OF NY, AND 3) EXTREME AND CATASTROPHIC REVENUE LOSS DUE TO SOCIAL DISTANCING AND NYS MANDATED DELAY OF ROUTINE AND ELECTIVE CARE/PROCEDURES. WITHIN THE COST OF CARE FOR COVID-19 INCLUDED THE ADDITIONAL EXPENSE AND COMPLEXITY OF RESOURCES REQUIRED FOR MASS TESTING AND VACCINATION EFFORTS, FOR BOTH EMPLOYEES AND THE COMMUNITY AT LARGE, AS WELL AS INTERNAL CONTACT TRACING FOR EXPOSURE OF OUR EMPLOYEE WORKFORCE AND PATIENTS. ALL FACTORS WERE HEIGHTENED BY THE UNKNOWNS REGARDING WHAT, IF ANY, FUNDING ASSISTANCE WAS GOING TO BE AVAILABLE TO HEALTHCARE PROVIDERS IN ADDITION TO THE EVER CHANGING LANDSCAPE OF REGULATORY REQUIREMENTS, EXECUTIVE ORDERS AND NYS MANDATES ON HOSPITALS.AT THE BEGINNING OF THE COVID-19 PANDEMIC IN MARCH 2020, PREDICTIVE MODELING INDICATED POTENTIAL CATASTROPHIC VOLUMES OF COVID-19 CASES AND HOSPITALIZATIONS IN NYS, NATIONALLY, AND GLOBALLY. IN THE FIRST WEEKS AND MONTHS OF COVID-19 EMERGENCE IN NYS, THERE WAS EXTREME UNCERTAINTY REGARDING GEOGRAPHICAL COVID-19 CLUSTERS/SURGES AND THE IMPACT ON THE HEALTHCARE (AND SUPPLY CHAIN) SYSTEMS. PROJECTIONS INDICATED THAT VOLUMES OF COVID-19 HOSPITALIZATIONS WOULD EXCEED HEALTHCARE SYSTEM BED AND WORKFORCE CAPACITY. CONSEQUENTLY, NYS HEAVILY CONTROLLED AND MANAGED THE COVID-19 RESPONSE. PER NYS GOVERNOR'S EXECUTIVE ORDERS, OFFICIALLY EFFECTIVE MARCH 22, 2020, ELECTIVE SURGERIES AND PROCEDURES WERE CANCELLED TO ENSURE THAT NYS WOULD BE PREPARED FOR THE PREDICTED SURGE LEVELS REGARDING BED CAPACITY, SUPPLIES AND LABOR. AS A RESULT, THE HOSPITAL INCURRED SIGNIFICANT DECLINES IN NET PATIENT SERVICE REVENUE, WHILE INCURRING COSTS TO SECURE A LABOR FORCE, PERSONAL PROTECTIVE EQUIPMENT (PPE), AND CAPITAL TO BE IN A STATE OF READINESS FOR A SURGE AND THE ACUITY OF PATIENTS SEEN IN THE PANDEMIC. AS RESTRICTIONS HAVE LOOSENED, MANY PATIENTS WHO HAVE DELAYED THEIR CARE OR HAD THEIR CARE RESTRICTED DURING THE PANDEMIC, ARE ONCE AGAIN SEEKING TREATMENT. THESE EXTREMELY VOLATILE DAILY VOLUMES AND CENSUS CONTINUE TO CREATE MAJOR CHALLENGES FOR WORKFORCE AND FINANCIAL PLANNING.
PART III, LINE 3:	PART III, SECTION A, LINE 2 AND 3 BAD DEBT EXPENSEDUE TO THE ADOPTION OF ASU NO 2014-09 REVENUE FROM CONTRACTS WITH CUSTOMERS (TOPIC 606) BAD DEBT EXPENSE IS NO LONGER REPORTED ON THE AUDITED FINANCIAL STATEMENTS. RATHER IT IS TREATED AS A PRICE CONCESSION. PLEASE SEE THE FOLLOWING WHICH DESCRIBES THE PRONOUNCEMENT: UPON ADOPTION THE MAJORITY OF WHAT IS CURRENTLY CLASSIFIED AS PROVISION FOR UNCOLLECTIBLE ACCOUNTS IS PRESENTED AS A REDUCTION TO NET PATIENT SERVICE REVENUE ON THE CONSOLIDATED STATEMENTS OF OPERATIONS AND CHANGES IN NET ASSET IS TREATED AS A PRICE CONCESSION THAT REDUCES THE TRANSACTION PRICE, WHICH IS REPORTED AS NET PATIENT SERVICE REVENUE. DURING 2020 AND 2019, THE HOSPITAL INCURRED ($315,066) AND $564,057 IN PROVISIONS FOR UNCOLLECTIBLE ACCOUNTS, RESPECTIVELY.
PART III, LINE 4:	FOOTNOTE 1G OF THE AUDITED FINANCIALS "CONSISTENT WITH THE HOSPITAL'S MISSION, CARE IS PROVIDED TO PATIENTS REGARDLESS OF THEIR ABILITY TO PAY AND WHO QUALIFY FOR CHARITY CARE UNDER ITS PATIENT FINANCIAL ASSISTANCE PROGRAM. CHARITY CARE IS DEFINED AS SERVICES FOR WHICH PATIENTS HAVE THE OBLIGATION AND WILLINGNESS TO PAY BUT DO NOT HAVE THE ABILITY TO DO SO. THE SYSTEM DOES NOT REPORT CHARITY CARE AS NET PATIENT SERVICE REVENUE. THE COST OF CHARITY CARE WAS ~1.892M AND $1.855M FOR 2020 AND 2019, RESPECTIVELY, AS DETERMINED BASED ON THE APPLICATION OF A RATIO OF OVERALL HOSPITAL COSTS TO PATIENT CHARGES. INCLUDED IN PATIENT SERVICE REVENUES FOR 2020 AND 2019 IS APPROXIMATELY $3.498M AND $2.709M, RESPECTIVELY, FROM UNCOMPENSATED CARE POOLS AND INCOME FROM RESTRICTED ENDOWMENTS. THE HOSPITAL ANNUALLY CONDUCTS A COMPREHENSIVE ASSESSMENT OF THE COMMUNITY BENEFITS IT PROVIDES. THE MOST RECENT ASSESSMENT WAS COMPLETED IN THE FALL OF 2020 AND CULMINATED WITH THE ISSUANCE OF THE GLENS FALLS HOSPITAL COMMUNITY SERVICE PLAN, A COPY OF WHICH IS AVAILABLE FROM MANAGEMENT UPON REQUEST.
PART III, LINE 8:	THE COSTING METHODOLOGY USED TO DETERMINE THE MEDICARE ALLOWABLE COSTS REPORTED IN THE ORGANIZATION'S MEDICARE COST REPORT, AS REFLECTED ON LINE 6, IS THE METHODOLOGY PRESCRIBED BY MEDICARE IN THE COMPLETION FOR FORM CMS-2552-96 AND CONFORMS TO THE REQUIREMENTS AND PRINCIPALS SET FORTH IN 42 CFR, PART 412, 42 CFR, PART 413 AND IN THE PROVIDER REIMBURSEMENT MANUAL, PART 1. GLENS FALLS HOSPITAL CONSIDERS 100% OF THE AMOUNT REPORTED IN PART III, LINE 7 A COMMUNITY BENEFIT. GFH IS THE ONLY COMPREHENSIVE ACUTE-CARE HOSPITAL SERVING A PREDOMINANTLY RURAL, 6,000 SQ. MILE AREA OF UPSTATE NEW YORK THAT ENCOMPASSES WARREN, WASHINGTON, HAMILTON, ESSEX, AND NORTHERN SARATOGA COUNTIES. IN A VERY REAL SENSE, IT IS THE SAFETY NET HOSPITAL FOR THE MEDICARE PATIENTS IN THESE COMMUNITIES. DESPITE THE FACT THAT THE PAYMENTS RECEIVED FROM MEDICARE FOR THE SERVICES PROVIDED ARE GENERALLY BELOW THE RATES THAT THE HOSPITAL RECEIVES FROM MANAGED CARE PAYERS AND PRIVATE INSURERS THE HOSPITAL REMAINS COMMITTED TO SERVING ELDERLY PATIENTS AND IMPROVING THE HEALTH STATUS OF THE ELDERLY.
PART III, LINE 9B:	IT IS GFH POLICY TO DELAY FINAL COLLECTION EFFORTS WHILE A PATIENT FINANCIAL ASSISTANCE APPLICATION IS IN PROCESS. A FINAL DETERMINATION IS REQUIRED BEFORE OUTSIDE COLLECTION EFFORTS ARE INITIATED.
PART III, SECTION B, LINES 5-7	IN ADDITION TO THE AMOUNT INCLUDED IN THE MEDICARE COST REPORT AND REPORTED ON LINES 5, 6, & 7, THE HOSPITAL INCURRED LOSSES ON SERVICES PROVIDED TO MEDICARE PATIENTS AND PAID FOR UNDER THE PART B FEE SCHEDULE AND NOT REPORTABLE ON THE MEDICARE COST REPORT.
PART VI, LINE 2:	IN ADDITION TO COMPLETING A CHNA, HOSPITALS IN NYS ARE REQUIRED TO WORK TOGETHER WITH COUNTY PUBLIC HEALTH DEPARTMENTS TO COMPLETE A COMMUNITY SERVICE PLAN (CSP) THAT MIRRORS THE CHNA AND IMPLEMENTATION STRATEGY (IS) PER THE ACA. FURTHERMORE, ALL AMERICAN COLLEGE OF SURGEONS (ACOS) COMMISSION ON CANCER (COC) PROGRAMS ARE REQUIRED TO COMPLETE A COMMUNITY NEEDS ASSESSMENT AS WELL. TO ENSURE THE MOST EFFICIENT USE OF HOSPITAL RESOURCES AND SUPPORT A COMPREHENSIVE APPROACH TO COMMUNITY HEALTH AND POPULATION HEALTH MANAGEMENT IN THE REGION, GFH CHOSE TO ALIGN AND COMBINE THE REQUIREMENTS OF THE THREE ENTITIES. WORKING WITHIN THE FRAMEWORK PROVIDED BY THE NYS PREVENTION AGENDA, GFH AND WARREN, WASHINGTON, AND SARATOGA COUNTY PUBLIC HEALTH COLLABORATED IN THE DEVELOPMENT OF THE CHNA IN A WAY THAT CAN MEET THE REQUIREMENTS FOR THE THREE ENTITIES. ADDITIONALLY, GFH COORDINATED WITH FULTON, ESSEX, HAMILTON, FRANKLIN AND CLINTON COUNTY PUBLIC HEALTH IN ADDITION TO SEVERAL OTHER HOSPITALS IN THE REGION, THROUGH THE REGIONAL HEALTH ASSESSMENT AND PLANNING EFFORTS COORDINATED BY ARHN.
PART VI, LINE 3:	PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE BROCHURES ARE GIVEN AT THE POINT OF SERVICE. ALL PATIENT'S STATEMENTS ADVERTISE CHARITY CARE PROGRAMS. CUSTOMER SERVICE REPS ARE TRAINED TO OUTLINE AND ENCOURAGE PARTICIPATION IN THE PROGRAM. VENDOR MEDICAID ELIGIBILITY PROCESS INCLUDES CHARITY CARE SCREENING STEP FOR ALL INPATIENT AND OUTPATIENT. WEBSITE CONTAINS INFORMATION ON CHARITY CARE PROGRAMS AND WEB PORTAL HAS AN APPLICATION FORM ONLINE THAT CAN BE PRINTED AND FILLED OUT.
PART VI, LINE 4:	THE GFH HEALTHCARE SYSTEM SERVICES A LARGE AREA OF UPSTATE NY THAT INCLUDES ALL OR PORTIONS OF THE FOLLOWING COUNTIES: WARREN, WASHINGTON, HAMILTON, ESSEX AND NORTHERN SARATOGA. THE SERVICE AREA COVERS APPROXIMATELY 350K PEOPLE. THE POPULATION IS LARGELY WHITE, NON-HISPANIC (95.9%). PEOPLE OVER THE AGE OF 65 CONSTITUTE 17.4% OF THE POPULATION; CHILDREN UNDER THE AGE OF 17 MAKE UP 20.2% OF THE POPULATION. THE AVERAGE HOUSEHOLD INCOME IS $79,547, LOWER THAN THE NYS AVERAGE OF $93,443. JUST OVER 1/4 OF THE POPULATION HAS OBTAINED A BACHELOR'S DEGREE OR HIGHER LEVEL OF EDUCATION (29.8%). THE AGE GROUP THAT WILL SEE THE GREATEST GROWTH ARE PEOPLE AGED 65 AND OLDER.
PART VI, LINE 5	PROMOTION OF COMMUNITY HEALTHTHE GOVERNANCE OF GFH IS VESTED IN THE BOARD OF GOVERNORS (THE BOARD), WHICH IS COMPRISED OF DULY ELECTED COMMUNITY MEMBERS AND PHYSICIANS. THE BOARD CONSISTS OF NOT LESS THAN TWELVE AND NOT MORE THAN EIGHTEEN MEMBERS. ANY AND ALL PHYSICIANS LIVING IN THE SERVICE ARE WHO ARE QUALIFIED, AND WHO MEET REQUIREMENTS AS DOCUMENTED IN THE MEDICAL STAFF BYLAWS, ARE EXTENDED PRIVILEGES. FUNDS IN EXCESS OF EXPENSES ARE ALLOCATED FOR CAPITAL PROJECTS, MEDICAL RESEARCH AND CLINICAL TRIALS, PATIENT CARE IMPROVEMENTS AND SYSTEM IMPROVEMENTS. CAPITAL PROJECTS ARE PRIORITIZED BY AN INTERDISCIPLINARY COMMITTEE.
PART VI, LINE 7	GFH FILES A COMMUNITY BENEFIT REPORT IN NEW YORK STATE.

Schedule H (Form 990) 2020

Additional Data

Software ID:
Software Version:

- TIN:

Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," on Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990.
lBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2020

Open to Public
Inspection

Name of the organization
GLENS FALLS HOSPITAL

Employer identification number
14-1338413

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient

that received more than $5,000. Part II can be duplicated if additional space is needed.

(a) Name and address of organization or government	(b) EIN	(c) IRC section (if applicable)	(d) Amount of cash grant	(e) Amount of non-cash assistance	(f) Method of valuation (book, FMV, appraisal, other)	(g) Description of noncash assistance	(h) Purpose of grant or assistance
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
(12)

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image

Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50055P

Schedule I (Form 990) 2020

Page 2

Part III

Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.

(a) Type of grant or assistance	(b) Number of recipients	(c) Amount of cash grant
(1) NURSING SCHOLARSHIPS	3	12,000
(1)
(2)
(3)
(4)
(5)
(6)
(7)

Part IV

Supplemental Information. Provide the information required in Part I, line 2; Part III, column (b); and any other additional information.

Return Reference	Explanation
PART I, LINE 2:	EVERY GRANT THAT IS APPLIED FOR AND RECEIVED IS OVERSEEN BY A MANAGER OR DIRECTOR WITHIN THE ORGANIZATION. THESE INDIVIDUALS WORK CLOSELY WITH THE ACCOUNTING FUNCTION TO ENSURE ALL EXPENSES RELATED TO GRANTS ARE USED APPROPRIATELY AND TRACKED CORRECTLY. FINANCE MAINTAINS A TRACKING LOG OF GRANT FUNDS RECEIVED.

Schedule I (Form 990) 2020

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
Graphic Arrow

Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
Graphic Arrow

Attach to Form 990.
Graphic Arrow

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2020

Open to Public Inspection

Name of the organization

GLENS FALLS HOSPITAL

Employer identification number

14-1338413

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes on Line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .....

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked on Line 1a? ....

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed on Form 990, Part VII, Section A, line 1a, with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? .............

Yes

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? .........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ....................

Any related organization? .......................

If "Yes," on line 5a or 5b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ..................

Any related organization? ......................

If "Yes," on line 6a or 6b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Yes

Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III ..........................

If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2020

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported on Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.

(A) Name and Title		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation in column (B) reported as deferred on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1DIANNE SHUGRUE PRESIDENT & CEO	(i) (ii)	616,329 ------------- 0	0 ------------- 0	3,181,147 ------------- 0	7,692 ------------- 0	5,837 ------------- 0	3,811,005 ------------- 0	0 ------------- 0
2STEVEN FRISCH MD BOARD MEMBER	(i) (ii)	0 ------------- 824,345	0 ------------- 279,144	0 ------------- 114,507	0 ------------- 95,504	0 ------------- 23,051	0 ------------- 1,336,551	0 ------------- 65,476
3ADAM BROD MD ORTHOPEDIC PHYSICIAN	(i) (ii)	412,525 ------------- 0	303,125 ------------- 0	16,916 ------------- 0	11,400 ------------- 0	7,870 ------------- 0	751,836 ------------- 0	0 ------------- 0
4JOHN STOUTENBURG MD ONCOLOGY PHYSICIAN	(i) (ii)	528,543 ------------- 0	90,213 ------------- 0	630 ------------- 0	11,400 ------------- 0	7,870 ------------- 0	638,656 ------------- 0	0 ------------- 0
5MATTHEW DICKSON ENT PHYSICIAN	(i) (ii)	480,756 ------------- 0	128,275 ------------- 0	630 ------------- 0	11,400 ------------- 0	5,597 ------------- 0	626,658 ------------- 0	0 ------------- 0
6ANDRE JOHNSON MD ORTHOPEDIC PHYSICIAN	(i) (ii)	412,787 ------------- 0	194,258 ------------- 0	420 ------------- 0	11,400 ------------- 0	5,597 ------------- 0	624,462 ------------- 0	0 ------------- 0
7MICHAEL LIEBERTH MD SURGICAL PHYSICIAN	(i) (ii)	327,740 ------------- 0	265,737 ------------- 0	966 ------------- 0	11,400 ------------- 0	7,870 ------------- 0	613,713 ------------- 0	0 ------------- 0
8SEAN BAIN MD BOARD MEMBER	(i) (ii)	280,173 ------------- 0	120,644 ------------- 0	966 ------------- 0	11,400 ------------- 0	5,018 ------------- 0	418,201 ------------- 0	0 ------------- 0
9PAUL SCIMECA COO	(i) (ii)	360,480 ------------- 0	0 ------------- 0	22,196 ------------- 0	11,400 ------------- 0	5,837 ------------- 0	399,913 ------------- 0	0 ------------- 0
10MITCH AMADO CFO	(i) (ii)	349,974 ------------- 0	0 ------------- 0	20,866 ------------- 0	11,069 ------------- 0	5,837 ------------- 0	387,746 ------------- 0	0 ------------- 0
11HOWARD FRITZ MD CMO	(i) (ii)	351,610 ------------- 0	0 ------------- 0	19,500 ------------- 0	11,400 ------------- 0	720 ------------- 0	383,230 ------------- 0	0 ------------- 0
12PATTI HAMMOND VP PHYSICIAN PRACTICES	(i) (ii)	274,873 ------------- 0	0 ------------- 0	16,144 ------------- 0	11,074 ------------- 0	5,289 ------------- 0	307,380 ------------- 0	0 ------------- 0
13DONNA KIRKER CNO	(i) (ii)	264,579 ------------- 0	0 ------------- 0	13,879 ------------- 0	10,635 ------------- 0	780 ------------- 0	289,873 ------------- 0	0 ------------- 0
14GEOFFREY SERFILIPPI MD BOARD MEMBER	(i) (ii)	143,802 ------------- 0	15,000 ------------- 0	2,772 ------------- 0	0 ------------- 0	480 ------------- 0	162,054 ------------- 0	0 ------------- 0

Schedule J (Form 990) 2020

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.

Return Reference

Explanation

PART I, LINES 4A-B

PART 1, LINE 4A ON SEPTEMBER 23, 2020, MS. SHUGRUE TENDERED RESIGNATION FOR "GOOD REASON" UNDER TERMS OF HER EMPLOYMENT AGREEMENT, DATED 6/18/13, TRIGGERING SEVERANCE OF $956,250 AND A PRO RATA OF HER SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) OF $920,541, PER SCHEDULE A OF HER SERP AGREEMENT, DATED JANUARY 1, 2016. PART 1, LINE 4B EFFECTIVE JANUARY 1, 2016, A SERP WAS ESTABLISHED BETWEEN GLENS FALLS HOSPITAL AND DIANNE SHUGRUE. IN ACCORDANCE WITH SCHEDULE A OF MS. SHUGRUE'S SERP, SHE MET THE FOLLOWING VESTING REQUIREMENT IN 2020: "THE PARTICIPANT SHALL BE ENTITLED TO A FIXED BENEFIT EQUAL TO $1,300,000 IF THE PARTICIPANT REMAINS IN CONTINUOUS EMPLOYMENT AND HAS NOT INCURRED A SEPARATION FROM SERVICE, WITH THE EMPLOYER THROUGH THE DATE THE PARTICIPANT ATTAINS AGE 62, AT WHICH TIME THIS BENEFIT SHALL BECOME VESTED."

PART I, LINE 7

PHYSICIANS ARE ELIGIBLE AND DID RECEIVE ADDITIONAL COMPENSATION THROUGH PARTICIPATION IN AN INCENTIVE PROGRAM THAT ADDRESSED QUALITY, PATIENT SATISFACTION AND THEIR PERSONAL PRODUCTIVITY.

Schedule J (Form 990) 2020

Additional Data

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Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax-Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part Ⅵ, line 24a. Provide descriptions,
explanations, and any additional information in Part Ⅵ.
SchKMediumBullet

Attach to Form 990.
SchKMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2020

Open to Public
Inspection

Name of the organization
GLENS FALLS HOSPITAL

Employer identification number
14-1338413

Part Ⅰ

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	GLENS FALLS CIVIC DEVELOPMENT CORP-SERIES 2015	45-1673501	NONEAVAIL	09-21-2015	67,000,000	REFUND 2003 BONDS, FINANCE CAPITAL PROJECTS		X		X		X

Part Ⅱ

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................	20,100,000
2 Amount of bonds legally defeased ..............
3 Total proceeds of issue ..................	67,000,000
4 Gross proceeds in reserve funds .............
5 Capitalized interest from proceeds .............
6 Proceeds in refunding escrows ...............
7 Issuance costs from proceeds ...............	360,205
8 Credit enhancement from proceeds .............
9 Working capital expenditures from proceeds .............
10 Capital expenditures from proceeds .............	17,520,856
11 Other spent proceeds .............	49,118,939
12 Other unspent proceeds .............
13 Year of substantial completion .............	2015
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue of tax-exempt bonds (or, if issued prior to 2019, a current refunding issue)? ........	X
15 Were the bonds issued as part of an advance refunding issue of taxable bonds (or, if issued prior to 2019, an advance refunding issue)? ........		X
16 Has the final allocation of proceeds been made? ..........	X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50193E

Schedule K (Form 990) 2020

Page 2

Part Ⅲ

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? .............		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............	X
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............	X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?	X
c Are there any research agreements that may result in private business use of bond-financed property? .............		X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....	1.700 %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government .........	0 %
6 Total of lines 4 and 5 .............	1.700 %
7 Does the bond issue meet the private security or payment test? ...		X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............		X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2? ........	X

Part Ⅳ

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...		X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......		X
b Exception to rebate? ........		X
c No rebate due? .........	X
If "Yes" to line 2c, provide in Part Ⅵ the date the rebate computation was performed ......
3 Is the bond issue a variable rate issue? .....		X

Schedule K (Form 990) 2020

Page 3

Part Ⅳ

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X
b Name of provider ..........
c Term of hedge .........
d Was the hedge superintegrated? ......
e Was the hedge terminated? ........
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?		X
b Name of provider ..........
c Term of GIC .........
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........
6 Were any gross proceeds invested beyond an available temporary period?		X
7 Has the organization established written procedures to monitor the requirements of section 148? ...		X

Part Ⅴ

Procedures To Undertake Corrective Action

---------------------------------------------------------------------------------------------------------------	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations?	X

Part Ⅵ

Supplemental Information. Provide additional information for responses to questions on Schedule K. (See instructions).

Return Reference	Explanation
PART IV, LINE 2 C:	A THIRD-PARTY WAS USED TO PERFORM AN ARBITRAGE CALCULATION WHICH WAS COMPLETED ON NOVEMBER 20, 2020. IT WAS DETERMINED THAT THERE IS NO POSITIVE ARBITRAGE ASSOCIATED WITH THE ABOVE REFERENCED BOND ISSUE.

Schedule K (Form 990) 2020

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Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

Complete if the organization answered "Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c, or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet

Attach to Form 990 or Form 990-EZ.
MediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2020

Open to Public Inspection

Name of the organization

GLENS FALLS HOSPITAL

Employer identification number

14-1338413

Part I

Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and section 501(c)(29) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.

1(a) Name of disqualified person	(c) Description of transaction	(d) Corrected?
1(a) Name of disqualified person	(c) Description of transaction	Yes	No

Enter the amount of tax incurred by the organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image

Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ........ Bullet Image

Part II

Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22

(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	(d) Loan to or from the organization?		(e) Original principal amount	(f) Balance due	(g) In default?		(h) Approved by board or committee?		(i) Written agreement?
(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	To	From	(e) Original principal amount	(f) Balance due	Yes	No	Yes	No	Yes	No






Total ............... $

Part III

Grants or Assistance Benefiting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of assistance	(d) Type of assistance	(e) Purpose of assistance

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2020

Page 2

Part IV

Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) DAVID WESTFALL MD	DIRECTOR	22,500	JV		No

Part V

Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).

Return Reference

Explanation

SCHEDULE L, PART IV

DR. WESTFALL IS A DIRECTOR OF THE GLENS FALLS HOSPITAL BOARD, AND IS ALSO A MEMBER IN AN ENTITY INVOLVED IN A JOINT VENTURE WITH GFH FOR A PORTION OF 2020. GFH'S INVESTMENT IN THIS JOINT VENTURE, NEW YORK EYE SURGERY CENTER, LLC, EXCEEDS $10,000. IN 2020, GFH SOLD ITS INTEREST IN THE JOINT VENTURE TO NEW YORK EYE SURGERY CENTER, LLC.ALL OF GFH'S BOARD MEMBERS ARE REQUIRED TO SIGN A CONFLICT OF INTEREST POLICY TO ENSURE THAT THE HOSPITAL OPERATES IN A MANNER CONSISTENT WITH ITS CHARITABLE PURPOSES. ACTIVITIES, ARRANGEMENTS AND SERVICES ARE THE RESULT OF ARM'S LENGTH BARGAINING REFLECTING REASONABLE PAYMENTS FOR GOODS AND SERVICES. BOARD BYLAWS STIPULATE THAT BOARD MEMBERS RECUSE THEMSELVES REGARDING ANY SUBJECT THAT PERTAINS TO A POTENTIAL CONFLICT OF INTEREST.

Schedule L (Form 990 or 990-EZ) 2020

Additional Data

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SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2020

Open to Public
Inspection

Name of the organization

GLENS FALLS HOSPITAL

Employer identification number

14-1338413

Return Reference	Explanation
FORM 990, PART III, LINE 3	ON JUNE 11, 2020, BEHAVIORAL HEALTH SERVICES NORTH (BHSN) RECEIVED ENDORSEMENT FROM GLENS FALLS HOSPITAL (GFH) AND WARREN/WASHINGTON COMMUNITY SERVICE BOARD TO MOVE FORWARD WITH BECOMING THE PROVIDER FOR OUTPAIENT SUBSTANCE ABUSE, MENTAL HEALTH TREATMENT AND CHILD AND FAMILY SERVICES FOR THE GLENS FALLS REGION. THESE SERVICES TRANSITIONED FROM GFH TO BHSN IN NOVEMBER 2020.
PART I, LINE 1 & PART III, LINE 1	THE MISSION OF GFH IS TO IMPROVE THE HEALTH OF PEOPLE IN OUR REGION BY PROVIDING ACCESS TO EXCEPTIONAL, AFFORDABLE, AND PATIENT-CENTERED CARE IN EVERY SETTING. OUR CORE VALUES ARE CENTERED ON COLLABORATION, ACCOUNTABILITY, RESPECT, EXCELLENCE, AND SAFETY. GFH MAINTAINS A SERVICE AREA THAT SPANS 6,000 SQ. MILES ACROSS 5 COUNTIES. WE ALSO OPERATE 20 REGIONAL HEALTHCARE FACILITIES THROUGHOUT OUR SERVICE AREA. GFH HAS OVER 550 MEDICAL STAFF, INCLUDING OVER 170 EMPLOYED PHYSICIANS, PAS, AND NPS.
FORM 990, PART VI, SECTION A, LINE 4	ON JULY 1, 2020 GLENS FALLS HOSPITAL BECAME AN AFFILIATE OF THE ALBANY MED HEALTH SYSTEM. AS PART OF THE AFFILIATION, THE GLENS FALLS HOSPITAL BY-LAWS WERE UPDATED TO INCLUDE ALBANY MED HEALTH SYSTEM AS ITS SOLE CORPORATE MEMBER.
FORM 990, PART VI, SECTION B, LINE 11B	AN OVERVIEW OF THE FORM 990 WAS PRESENTED TO THE FULL BOARD IN OCTOBER 2021. AN ELECTRONIC COPY OF THE 990 WAS POSTED ON THE BOARD PORTAL PRIOR TO FILING, THAT CAN BE ACCESSED BY THE BOARD FOR THEM TO REVIEW AND COMMENT ON. IN ADDITION, THE 990 WAS REVIEWED BY THE CFO, CONTROLLER, SR. DIRECTOR OF FINANCE, AND OUR INDEPENDENT ACCOUNTANT, KPMG, TO MAKE SURE IT WAS FILLED OUT COMPLETELY AND ACCURATELY.
FORM 990, PART VI, SECTION B, LINE 12C	EACH DIRECTOR, PRINCIPAL OFFICER AND MEMBER OF A COMMITTEE WITH BOARD DELEGATED POWERS SHALL ANNUALLY SIGN A STATEMENT WHICH AFFIRMS THAT SUCH PERSON, A) HAS RECEIVED A COPY OF THE CONFLICTS OF INTEREST POLICY, B) HAS READ AND UNDERSTANDS THE POLICY, C) HAS AGREED TO COMPLY WITH THE POLICY, AND D) UNDERSTANDS THAT THE CORPORATION IS A CHARITABLE ORGANIZATION AND THAT IN ORDER TO MAINTAIN ITS FEDERAL EXEMPTION IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX EXEMPT PURPOSES. TO ENSURE THAT THE CORPORATION OPERATES IN A MANNER CONSISTENT WITH ITS CHARITABLE PURPOSES AND THAT IT DOES NOT ENGAGE IN ACTIVITIES THAT COULD JEOPARDIZE ITS STATUS AS AN ORGANIZATION EXEMPT FROM FEDERAL INCOME TAX, PERIODIC REVIEWS SHALL BE CONDUCTED. REVIEWS SHALL INCLUDE THE FOLLOWING SUBJECTS: A) WHETHER COMPENSATION ARRANGEMENTS AND BENEFITS ARE REASONABLE AND ARE THE RESULT OF ARM'S LENGTH BARGAINING, B) WHETHER ACQUISITIONS OF PHYSICIAN PRACTICES AND OTHER PROVIDER SERVICES RESULT IN INUREMENT OR IMPERMISSIBLE PRIVATE BENEFIT, AND C) WHETHER PARTNERSHIP AND JOINT VENTURE ARRANGEMENTS AND ARRANGEMENTS WITH MANAGEMENT SERVICE ORGANIZATIONS AND PHYSICIAN HOSPITAL ORGANIZATIONS CONFORM TO WRITTEN POLICIES, ARE PROPERLY RECORDED, REFLECT REASONABLE PAYMENTS FOR GOODS AND SERVICES, FURTHER THE CORPORATION'S CHARITABLE PURPOSES AND DO NOT RESULT IN THE INUREMENT OR IMPERMISSIBLE PRIVATE BENEFIT. IN CONDUCTING REVIEWS, THE CORPORATION MAY USE OUTSIDE ADVISORS.
FORM 990, PART VI, SECTION B, LINE 15	GFH IS COMMITTED TO DEVELOPING AND MAINTAINING A TOTAL COMPENSATION PROGRAM THAT IS COMPETITIVE WITH PROGRAMS OFFERED BY OTHER HEALTH CARE ORGANIZATIONS THAT ARE COMPARABLE TO GFH IN REVENUE, STRUCTURE, MISSION AND SCOPE OF SERVICES. THE COMPENSATION PHILOSOPHY INCLUDES: BASE SALARY RANGES POSITIONED IN THE 50TH PERCENTILE OF A NATIONAL AND REGIONAL PEER GROUP, ANNUAL INCENTIVE OPPORTUNITIES TIED TO PERFORMANCE GOALS ESTABLISHED BY THE BOARD, BENEFITS DELIVERED IN THE 50TH PERCENTILE OF A NATIONAL PEER GROUP AND TOTAL COMPENSATION POSITIONED AT APPROXIMATELY THE 50TH PERCENTILE FOR EXPECTED PERFORMANCE, AND SOMEWHAT ABOVE THAT FOR EXCEPTIONAL PERFORMANCE. EXECUTIVE PAY IS REVIEWED ANNUALLY BY A THIRD PARTY CONSULTANT. THIS REVIEW INCLUDES A COMPARISON OF GFH EXECUTIVE PAY PRACTICES WITH NATIONAL AND REGIONAL BENCHMARK STUDIES AS APPROPRIATE. THE CONSULTANT IS ENGAGED DIRECTLY BY THE GFH BOARD OF GOVERNORS AND REPORTS THEIR FINDINGS TO BOARD PERSONNEL COMMITTEE FOR REVIEW AND ACTION.
FORM 990, PART VI, SECTION C, LINE 19	THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART IX, LINE 11G	PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 5,343,431. MANAGEMENT AND GENERAL EXPENSES 68,305. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,411,736. P/S STAFFING: PROGRAM SERVICE EXPENSES 8,556,681. MANAGEMENT AND GENERAL EXPENSES 4,823,446. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 13,380,127. P/S REPAIRS AND MAINTENANCE: PROGRAM SERVICE EXPENSES 2,546,322. MANAGEMENT AND GENERAL EXPENSES 5,582,926. FUNDRAISING EXPENSES 573. TOTAL EXPENSES 8,129,821. P/S COLLECTION FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 1,448,392. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,448,392. P/S TRANSCRIPTION AND MICROFILMING: PROGRAM SERVICE EXPENSES 159,098. MANAGEMENT AND GENERAL EXPENSES 85,596. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 244,694. MISC PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 6,136,483. MANAGEMENT AND GENERAL EXPENSES 2,474,312. FUNDRAISING EXPENSES 50,881. TOTAL EXPENSES 8,661,676. INFECTIOUS OUTBREAK MISC: PROGRAM SERVICE EXPENSES 4,299,238. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,299,238.
FORM 990, PART XI, LINE 9:	CHANGE IN INTEREST IN NET ASSETS OF GFH FOUNDATION 1,112,063. FOUNDATION TRANSFER TO BALANCE SHEET ACCOUNTS -4,299. EFFECT OF BUSINESS COMBINATION 39,055,387.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2020

Additional Data

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SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2020

Open to Public Inspection

Name of the organization

GLENS FALLS HOSPITAL

Employer identification number

14-1338413

Part I

Identification of Disregarded Entities. Complete if the organization answered "Yes" on Form 990, Part IV, line 33.

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

Identification of Related Tax-Exempt Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)GLENS FALLS HOSPITAL FOUNDATION 100 PARK ST GLENS FALLS,NY12801 14-1790805	SUPPORT	NY	501(C)(3)	LINE 10	N/A		No
(2)ADIRONDACK HEALTH SERVICES 100 PARK ST GLENS FALLS,NY12801 14-1667492	PARENT	NY	501(C)(3)	LINE 12B, II	N/A		No
(3)GLENS FALLS MEDICAL PLLC 100 PARK ST GLENS FALLS,NY12801 82-3943636	PHYSICIANS	NY	501(C)(3)	LINE 10	N/A	Yes
(4)ALBANY MEDICAL CENTER FOUNDATION 47 NEW SCOTLAND AVE ALBANY,NY12208 14-6023119	FUNDRAISING	NY	501(C)(3)	LINE 7	N/A		No
(5)ALBANY MEDICAL CENTER HOSPITAL 43 NEW SCOTLAND AVE ALBANY,NY12208 14-1338307	HOSPITAL SERVICES	NY	501(C)(3)	LINE 3	N/A		No
(6)ALBANY MEDICAL CENTER KIDSKELLER 47 NEW SCOTLAND AVE ALBANY,NY12208 22-2635792	EDUCATION DAY PROGRAM	NY	501(C)(3)	LINE 2	ALBANY MED HEALTH SYSTEM	Yes
(7)ALBANY MEDICAL COLLEGE 47 NEW SCOTLAND AVE ALBANY,NY12208 14-1338310	MEDICAL DEGREE PROGRAMS	NY	501(C)(3)	LINE 2	N/A		No
(8)BETTER HEALTH FOR NORTHEAST NY 47 NEW SCOTLAND AVE ALBANY,NY12208 81-1861104	DSRIP	NY	501(C)(6)		AMC HOSPITAL	Yes
(9)CENTER FOR DONATION AND TRANSPLANT 218 GREAT OAKS BLVD ALBANY,NY12203 14-1820447	ORGAN AND TISSUE BANK	NY	501(C)(3)	LINE 12A, I	ALBANY MEDICAL COLLEGE		No
(10)COLUMBIA MEMORIAL HEALTH FOUNDATION 71 PROSPECT AVE HUDSON,NY12534 14-1761112	FUNDRAISING	NY	501(C)(3)	LINE 10	COLUMBIA MEMORIAL HOSPITAL	Yes
(11)COLUMBIA MEMORIAL HOSPITAL 71 PROSPECT AVE HUDSON,NY12534 14-1338373	HOSPITAL SERVICES	NY	501(C)(3)	LINE 3	N/A		No
(12)HEALTHCARE PARTNERS OF SARATOGA LTD 211 CHURCH STREET SARATOGA SPRINGS,NY12886 56-3303309	EMERGENT CARE	NY	501(C)(3)	LINE 3	N/A		No
(13)KAATERSKILL COMMONC INC 163 JEFFERSON HEIGHTS CATSKILL,NY12414 20-5700964	HOUSING	NY	501(C)(3)	LINE 7	COLUMBIA MEMORIAL HOSPITAL	Yes
(14)SARATOGA HOSPITAL 211 CHURCH STREET SARATOGA SPRINGS,NY12886 14-1338547	HOSPITAL SERVICES	NY	501(C)(3)	LINE 3	N/A		No
(15)SARATOGA CARE INC 211 CHURCH STREET SARATOGA SPRINGS,NY12886 14-1775218	PROMOTING HEALTH	NY	501(C)(3)	LINE 12B, II	SARATOGA HOSPITAL		No
(16)SARATOGA REGIONAL MED PC 211 CHURCH STREET SARATOGA SPRINGS,NY12886 47-2468259	HEALTHCARE SERVICES	NY	501(C)(3)	LINE 3	SARATOGA HOSPITAL	Yes

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2020

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, because it had one or more related organizations treated as a partnership during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Predominant income(related, unrelated, excluded from tax under sections 512-514)	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity		(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No	(k) Percentage ownership
(1) IMAG SVC OF NENY 100 PARK STREET GLENS FALLS,NY12801 14-1820955	DIAG. RADIOLOGY	NY	N/A	RELATED	347,871	62,901		No			No	50.000 %
(2) NORTH COUNTRY EYE CENTER LLC 465B MAPLE AVE SARATOGA,NY12866 45-3715451	EYE CENTER	NY	N/A	RELATED				No			No	30.000 %

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	Yes	No

Schedule R (Form 990) 2020

Page 3

Part V

Transactions With Related Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity .....................

b Gift, grant, or capital contribution to related organization(s) ............................

c Gift, grant, or capital contribution from related organization(s) ............................

d Loans or loan guarantees to or for related organization(s) ............................

e Loans or loan guarantees by related organization(s) ............................

f Dividends from related organization(s) ............................

g Sale of assets to related organization(s) ............................

Yes

h Purchase of assets from related organization(s) ............................

i Exchange of assets with related organization(s) ............................

j Lease of facilities, equipment, or other assets to related organization(s) .......................

k Lease of facilities, equipment, or other assets from related organization(s) ......................

l Performance of services or membership or fundraising solicitations for related organization(s) .....................

m Performance of services or membership or fundraising solicitations by related organization(s) .................

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................

o Sharing of paid employees with related organization(s) ............................

p Reimbursement paid to related organization(s) for expenses ............................

q Reimbursement paid by related organization(s) for expenses ............................

r Other transfer of cash or property to related organization(s) ............................

s Other transfer of cash or property from related organization(s) ............................

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) NORTH COUNTRY EYE CENTER LLC	G	225,000	CASH

Schedule R (Form 990) 2020

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 37.

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No	(k) Percentage ownership

Schedule R (Form 990) 2020

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R. See instructions.

Return Reference	Explanation
PART V, LINE 2	DURING 2020, GLENS FALLS HOSPITAL SOLD ITS INTEREST IN NORTH COUNTRY EYE CENTER LLC (FEIN 45-3715451) TO THE PRIMARY PARTNER FOR $225,000.

Schedule R (Form 990) 2020

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: SEE SCHEDULE O.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	18
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	14
5	Total number of individuals employed in calendar year 2020 (Part V, line 2a) ......	5	2,752
6	Total number of volunteers (estimate if necessary) .............	6	206
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	3,743,761
b	Net unrelated business taxable income from Form 990-T, line 39 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	9,875,463	32,681,969
9	Program service revenue (Part VIII, line 2g) .........	326,668,033	309,285,653
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	5,664,436	1,381,698
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	5,581,749	3,102,350
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	347,789,681	346,451,670
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	12,000	12,000
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	179,481,366	173,372,095
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 329,888
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	171,691,638	173,943,773
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	351,185,004	347,327,868
19	Revenue less expenses. Subtract line 18 from line 12.......	-3,395,323	-876,198
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	265,741,933	356,058,419
21	Total liabilities (Part X, line 26).............	159,704,948	206,102,158
22	Net assets or fund balances. Subtract line 21 from line 20.....	106,036,985	149,956,261

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 265,815,100 including grants of $ 12,000 ) (Revenue $ 310,547,977 )
	GLENS FALLS HOSPITAL PROVIDES A COMPREHENSIVE HEALTH CARE SYSTEM THAT STRETCHES ACROSS 6,000 SQUARE MILES ACROSS 5 DIVERSE COUNTIES. WE PROVIDE HIGH QUALITY CARE TO PEOPLE, REGARDLESS OF THEIR ABILITY TO PAY. WE ARE A 391 BED FACILITY WITH MORE THAN 380 CERTIFIED PHYSICIANS IN OVER 25 SPECIALTIES. OUR SERVICES INCLUDE, BUT ARE NOT LIMITED TO, EMERGENCY CARE, SURGICAL SERVICES, MENTAL HEALTH, CANCER CARE, PRIMARY CARE, AND PREVENTATIVE HEALTH EDUCATION. IN 2020, WE HAD 46,180 PATIENT DAYS AND 11,043 DISCHARGES. THE EMERGENCY CARE CENTER PROVIDED CARE TO 38,579 PATIENTS. OUR MENTAL HEALTH DEPARTMENT PROVIDED 39,846 OUTPATIENT TREATMENTS AND 6,617 INPATIENT DAYS. OUR SURGERY CENTER PERFORMED 9,149 PROCEDURES. SEE CONTINUATION ON SCHEDULE O. THROUGHOUT THE COVID-19 PANDEMIC, GLENS FALLS HOSPITAL HAS DEMONSTRATED THE ESSENTIAL NATURE OF OUR SERVICES FOR THE REGION AND HAS CONTINUED TO BE THE SAFETY NET HOSPITAL FOR OUR SURROUNDING COMMUNITIES. AT THE HOSPITAL, A COVID COMMAND CENTER WAS IMMEDIATELY ESTABLISHED AT THE ONSET OF THE PANDEMIC TO MANAGE COMMUNITY-BASED TESTING, SUPPLIES (ACQUISITION AND DEPLOYMENT), EQUIPMENT NEEDS, STAFFING, NEW DIRECTIVES AND LOCAL AND STATE-WIDE RESPONSES, INCLUDING DATA REQUESTS. IT WAS OPEN 7 DAYS PER WEEK FROM 7AM TO 7PM TO COVER ALL SHIFTS OF THE HOSPITAL UNTIL IT WAS SCALED BACK IN MAY 2020. IT WAS STAFFED BY AT LEAST TWO SENIOR LEADERS AT ALL TIMES, AS WELL AS A SUPPORT PERSON WHO ASSISTED WITH ANSWERING CALLS, SECURING SUPPLIES AND COORDINATING WITH OTHERS THROUGHOUT THE HOSPITAL. DESPITE SIGNIFICANT DECLINES IN VOLUMES AT THE ONSET OF THE PANDEMIC, THE HOSPITAL SECURED AND RETAINED AGENCY CONTRACTED LABOR AT PREMIUMS DURING THIS TIME TO MAINTAIN STAFF FOR THE NYS SURGE PLAN AND REQUIRED PREPAREDNESS MEASURES, AS WELL AS SECURED APPROPRIATE PHYSICIAN COVERAGE. THE HOSPITAL ALSO SET UP EMERGENCY TESTING TENT SITES IN OUR EMERGENCY DEPARTMENT PARKING LOT TO ADDRESS THE COMMUNITY TESTING NEED EARLY IN THE PANDEMIC. ADDITIONAL SIGNIFICANT COSTS WERE INCURRED TO: INCREASE PPE AVAILABILITY, SECURE CAPITAL NEEDED TO EXECUTE A SURGE PLAN, IMPLEMENT ADDITIONAL CLEANING PROCESSES AND PROCEDURES, IMPLEMENT TELEHEALTH, MAINTAIN OVERHEAD STRUCTURE, AND EXECUTE TESTING (AMONG OTHER ITEMS). EXAMPLES OF CAPITAL ITEMS PURCHASED INCLUDE IV PUMPS, A TELEMETRY SYSTEM, A UV MASK REPROCESSING ROOM, AIR PURIFYING EQUIPMENT, VACCINE FREEZERS, AND IPADS/EQUIPMENT FOR TELEHEALTH AND PATIENT/FAMILY COMMUNICATION. ADDITIONAL SUPPLY EXPENSES INCLUDE PATIENT SEPARATION BARRIERS FOR SOCIAL DISTANCING, N95 MASKS, HAND SANITIZER AND DISINFECTANTS, AND REFERENCE LAB COSTS RELATED TO THE PROCESSING OF COVID-19 TESTING RELATED TO IP, OBSERVATION, AND ED VISITS. FACILITY RELATED EXPENSES INCLUDE LEASED TENTS/TRAILERS SET UP OUTSIDE FOR COVID TESTING AND SCREENING. WE ALSO ADJUSTED OUR HVAC SYSTEMS TO CREATE NEGATIVE PRESSURE CARE ROOMS FOR COVID PATIENTS. THE HOSPITAL ALSO INVESTED MONEY IN ADVERTISING AND COMMUNITY EDUCATION TO PRODUCE COVID-RELATED EDUCATIONAL MATERIALS, BROCHURES, AND VIDEOS TO HELP THE COMMUNITY BETTER UNDERSTAND COVID AND THE SAFETY MEASURES IN PLACE AT GFH FOR THEMSELVES AND THEIR FAMILY MEMBERS. THE HOSPITAL ALSO RAPIDLY, EFFICIENTLY AND EFFECTIVELY SET UP A MASS VACCINATION CLINIC IN DECEMBER AS VACCINES BECAME AVAILABLE. THE HOSPITAL NOT ONLY SERVICED HOSPITAL-EMPLOYEES IN GETTING THEIR VACCINE ADMINISTRATION, BUT ALL ADMINISTERED TO COMMUNITY AGENCIES AND OTHER FIRST-RESPONDERS, THEREBY ENSURING THAT THESE GROUPS IN THE COMMUNITY WERE ABLE TO ALSO BE VACCINATED IN AN EFFICIENT MANNER.

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses265,815,100

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)				(D) Reportable compensation from the organization (W-2/1099-MISC)	(E) Reportable compensation from related organizations (W-2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and title
(18) DAVID WESTFALL MD........................................................................ BOARD MEMBER	1.00 .......................0.00	X				0	0	0
(19) PAUL SCIMECA........................................................................ COO	40.00 .......................1.00		X			382,676	0	17,237
(20) MITCH AMADO........................................................................ CFO	40.00 .......................1.00		X			370,840	0	16,906
(21) HOWARD FRITZ MD........................................................................ CMO	40.00 .......................1.00		X			371,110	0	12,120
(22) DONNA KIRKER........................................................................ CNO	40.00 .......................1.00		X			278,458	0	11,415
(23) ADAM BROD MD........................................................................ ORTHOPEDIC PHYSICIAN	40.00 .......................0.00			X		732,566	0	19,270
(24) JOHN STOUTENBURG MD........................................................................ ONCOLOGY PHYSICIAN	40.00 .......................1.00			X		619,386	0	19,270
(25) MATTHEW DICKSON........................................................................ ENT PHYSICIAN	40.00 .......................1.00			X		609,661	0	16,997
(26) ANDRE JOHNSON MD........................................................................ ORTHOPEDIC PHYSICIAN	40.00 .......................0.00			X		607,465	0	16,997
(27) MICHAEL LIEBERTH MD........................................................................ SURGICAL PHYSICIAN	40.00 .......................0.00			X		594,443	0	19,270
(28) PATTI HAMMOND........................................................................ VP PHYSICIAN PRACTICES	40.00 .......................0.00				X	291,017	0	16,363

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	9,218,455	1,217,996	314,827

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	1,131,813
e	Government grants (contributions)		1e	31,301,792

f	All other contributions, gifts, grants, and similar amounts not included above		1f	248,364

g	Noncash contributions included in lines 1a - 1f:$		1g

h Total. Add lines 1a-1f.......		32,681,969

		Business Code
2a	PATIENT SERVICE REVENUE	622110	297,854,308	297,854,308
b	OUTPATIENT PHARMACY	446110	4,855,420	4,855,420
c	HOSPITAL LAB SERVICES	621500	3,052,207		3,052,207
d	MEDICAL HOME PROJECT	621110	676,383	676,383
e	PHARMACY REBATES	900099	551,367	551,367
f	All other program service revenue.		2,295,968	2,072,695	223,273
g	Total. Add lines 2a–2f .....		309,285,653

3 Investment income (including dividends, interest, and othersimilar amounts) ......			1,336,087			1,336,087
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents			6a
b	Less: rental expenses			6b
c	Rental income or (loss)			6c
d	Net rental income or (loss).......
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	365,094	13,858,206	7a
b	Less: cost or other basis and sales expenses	466,060	13,711,629	7b
c	Gain or (loss)	-100,966	146,577	7c
d	Net gain or (loss).........			45,611			45,611
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a
b	Less: direct expenses ...		8b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a
b	Less: direct expenses ...		9b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
			10a
b	Less: cost of goods sold ..		10b
c	Net income or (loss) from sales of inventory..
Business Code			Miscellaneous Revenue
11a	INVESTMENT IN YANKEE ALLIANCE		900099	1,531,502	1,063,221	468,281
b	CAFETERIA VENDING REVENUE		900099	861,598			861,598
c	INVESTMENT IN NORTH COUNTRY EYE C		621990	199,103	199,103
d	All other revenue ....			510,147			510,147
e	Total. Add lines 11a–11d ......			3,102,350
12	Total revenue. See instructions.....			346,451,670	307,272,497	3,743,761	2,753,443

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........	12,000	12,000
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............
4	Benefits paid to or for members .......
5	Compensation of current officers, directors, trustees, and key employees ...........	5,852,022		5,852,022
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........	2,167	2,167
7	Other salaries and wages........	141,682,494	114,656,193	26,843,242	183,059
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	4,868,044	3,785,468	1,076,532	6,044
9	Other employee benefits .......	11,349,296	8,893,905	2,441,191	14,200
10	Payroll taxes ...........	9,618,072	7,479,166	2,126,965	11,941
11	Fees for services (non-employees):
a	Management ......	3,378,612	972,074	2,402,788	3,750
b	Legal .........	599,002		599,002
c	Accounting ...........	191,916		182,401	9,515
d	Lobbying ...........	33,493		33,493
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	41,575,684	27,041,253	14,482,977	51,454
12	Advertising and promotion ....	776,298	2,464	773,834
13	Office expenses .......	89,175,400	82,307,263	6,857,374	10,763
14	Information technology ......	7,877,604	133,379	7,744,225
15	Royalties ..
16	Occupancy ...........	3,671,574	991,033	2,680,541
17	Travel ............	118,616	56,555	62,061
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	176,600	148,214	28,116	270
20	Interest ...........	2,214,930	1,725,115	489,815
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	18,691,908	14,558,331	4,133,577
23	Insurance ...	3,237,918	2,466,837	771,081
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	ASSESSMENT	1,155,066		1,155,066
b	LICENSE AND TAXES	301,782	282,148	19,634
c	RERUITEMENT FEES	216,964		216,964
d	DONATED FUNDS EXPENSE	173,694	106,407	28,721	38,566
e	All other expenses	376,712	195,128	181,258	326
25	Total functional expenses. Add lines 1 through 24e	347,327,868	265,815,100	81,182,880	329,888
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			12,464,353	1	52,795,776
2	Savings and temporary cash investments .........			12,780,819	2	11,015,446
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			32,588,007	4	28,626,471
5	Loans and other receivables from any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
					5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
					6
7	Notes and loans receivable, net ...........			133,432	7	110,127
8	Inventories for sale or use ............			4,453,968	8	6,272,680
9	Prepaid expenses and deferred charges ......			3,921,101	9	2,807,816
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	421,333,935
b	Less: accumulated depreciation	10b	269,244,560	118,127,453	10c	152,089,375
11	Investments—publicly traded securities .			71,730,843	11	81,664,766
12	Investments—other securities. See Part IV, line 11 .....				12
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........			9,541,957	15	20,675,962
16	Total assets. Add lines 1 through 15 (must equal line 33)...			265,741,933	16	356,058,419

17	Accounts payable and accrued expenses .....	55,457,255	17	95,675,319
18	Grants payable ...		18
19	Deferred revenue .........		19
20	Tax-exempt bond liabilities .........	49,461,136	20	46,900,000
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
22	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
			22
23	Secured mortgages and notes payable to unrelated third parties ..	13,233,166	23	25,853,656
24	Unsecured notes and loans payable to unrelated third parties ..		24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17 - 24). Complete Part X of Schedule D	41,553,391	25	37,673,183
26	Total liabilities. Add lines 17 through 25..	159,704,948	26	206,102,158

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	98,206,366	27	140,572,385
28	Net assets with donor restrictions ...........	7,830,619	28	9,383,876
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds		31
32	Total net assets or fund balances ...........	106,036,985	32	149,956,261
33	Total liabilities and net assets/fund balances ........	265,741,933	33	356,058,419