2021-11-15T17:20:20-06:00 2020-12-31 135565207 KPMG LLP 515 BROADWAY 4TH FLOOR ALBANY NY 122072974 990 2020-01-01 150539039 AURELIA OSBORN FOX MEMORIAL HOSPITAL AURE 6074315900 1 NORTON AVE ONEONTA NY 13820 CHRISTOPHER GRAHAM CHIEF FINANCIAL OFFICER 6074315900 2021-11-12 1 CHRISTOPHER GRAHAM XXX-XX-XXXX GENEVA FURLANO P01877392 5184274600 2021-11-15 0 AAL1 IAL1 2020 2022-09-23 18:48:47Z AO FOX MEMORIAL HOSPITAL CHRISTOPHER GRAHAM 1 NORTON AVE ONEONTA NY 13820 88170458 0 X WWW.AOFOXHOSPITAL.COM X 1900 NY HEALTH CARE DELIVERY: INCLUDES: UNCOMPENSATED CARE, PAYMENTS INTO BAD DEBT AND CHARITY CARE POOLS, NYS HEALTH FACILITIES ASSESSMENT, COMMUNITY EDUCATION, MATERNAL CARE PROGRAM, COST OF PROVIDING SERVICES TO GOVERNMENT PAYORS. HEALTH/WELLNESS AND EDUCATIONAL SERVICES TO THE GENERAL PUBLIC. 13 13 945 83 0 0 3591542 10847865 78078716 75543780 236577 210507 1287987 376350 83194822 86978502 0 0 0 0 41459908 41760863 0 0 0 44994484 45066338 86454392 86827201 -3259570 151301 59990112 58781143 27720154 25015265 32269958 33765878 X HEALTH CARE DELIVERY: INCLUDES: UNCOMPENSATED CARE, PAYMENTS INTO BAD DEBT AND CHARITY CARE POOLS, NYS HEALTH FACILITIES ASSESSMENT, COMMUNITY EDUCATION, MATERNAL CARE PROGRAM, COST OF PROVIDING SERVICES TO GOVERNMENT PAYORS. HEALTH/WELLNESS AND EDUCATIONAL SERVICES TO THE GENERAL PUBLIC. 0 0 68211854 63800932 HEALTH CARE DELIVERY: INCLUDES: UNCOMPENSATED CARE, PAYMENTS INTO BAD DEBT AND CHARITY POOLS, NYS HEALTH FACILITIES ASSESSMENT, COMMUNITY EDUCATION, MATERNAL CARE PROGRAM, COST OF PROVIDING SERVICES TO GOVERNMENT PAYORS. HEALTH/WELLNESS AND EDUCATIONAL SERVICES TO THE GENERAL PUBLIC. IN 2020 THE HOSPITAL HAD 7,364 PATIENT DAYS 18,728 EMERGENCY ROOM VISITS AND 116,517 OUTPATIENT VISITS.IN JANUARY 2020, THE SECRETARY OF THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES (HHS) DECLARED A NATIONAL PUBLIC HEALTH EMERGENCY DUE TO A NOVEL STRAIN OF CORONAVIRUS (COVID 19) AND IN MARCH 2020 THE WORLD HEALTH ORGANIZATION DECLARED THE SPREAD OF THE VIRUS TO BE A PANDEMIC. IN COORDINATION WITH STATE HEALTH AUTHORITIES, AO FOX HOSPITAL INITIATED EMERGENCY MEASURES TO PREVENT AVOIDABLE TRANSMISSION OF THE ILLNESS, INCLUDING CANCELING NON URGENT ELECTIVE PROCEDURES AND CLINIC VISITS. 12357623 11742848 NURSING HOME CARE - NURSING HOME FACILITY- SKILLED NURSING, HEALTH AND RESPITE CARE. IN 2020 THE NURSING HOME HAD 45,766 PATIENT DAYS. 80569477 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 0 0 1 61 0 1 945 1 0 0 0 0 0 0 0 0 0 0 0 0 X 13 13 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 1 0 NY X CHRISTOPHER GRAHAM 6074315900 1 NORTON AVENUE ONEONTA NY 13820 DAVID DUGAN DIRECTOR 0.50 0.00 X 0 0 0 CHRISTY COE DIRECTOR 0.50 0.00 X 0 0 0 THOMAS BRINDLEY DIRECTOR 0.50 0.00 X 0 0 0 CHERYL ROBINSON DIRECTOR 0.50 0.00 X 0 0 0 GENNARO FALCO MD DIRECTOR 0.50 0.00 X 0 0 0 LORRAINE ZIMNIEWICZ CHAIRMAN 0.50 0.00 X X 0 0 0 NOEL GOODSPEED TREASURER 0.50 0.00 X X 0 0 0 JEFFREY LORD VICE CHAIRMAN 0.50 0.00 X X 0 0 0 SCOTT MCLEAN DIRECTOR 0.50 0.00 X 0 0 0 LUIGIA MONTANTI SECRETARY 0.50 0.00 X X 0 0 0 ERIC JERVIS DIRECTOR 0.50 0.00 X 0 0 0 JOHN RYLAND DIRECTOR 0.50 0.00 X 0 0 0 LYNN GLUECKERT DIRECTOR 0.50 0.00 X 0 0 0 JEFF JOYNER PRESIDENT (UNTIL 12/2020) 40.00 0.00 X 0 373627 26012 CHRISTOPHER GRAHAM CFO 20.00 20.00 X 0 159999 12428 JOAN MACDONALD VP NURSING 40.00 0.00 X 144389 0 7772 REGINALD KNIGHT VP MEDICAL AFFAIRS 24.00 16.00 X 371225 0 31159 GARY SMITH VP OPERATIONS 40.00 0.00 X 154561 0 31065 ERIC STEIN PRESIDENT (START 12/2020) 20.00 20.00 X 0 227201 26664 KAREN MOWERS DIRECTOR NURSING SVCS 40.00 0.00 X 154315 0 29406 JEFFREY EMHOFF DIRECTOR NURSING HOME 40.00 0.00 X 140244 0 27211 MAIA DECKER DIRECTOR PHARMACY 40.00 0.00 X 137834 0 31055 MARGARET WIKOFF MANAGER NURSING CARE 40.00 0.00 X 121488 0 22178 ROBERT PAVELKA PHARMACIST 40.00 0.00 X 119277 0 14603 1343333 760827 259553 20 0 1 0 GATEWOOD NY EMERGENCY PHYSICIAN SERVICES 7082 COLL CTR DR CHICAGO NY 60698 EMERGENCY PHYSICIANS 2795064 STAT STAFF PROFESSIONALS INC 18 DIVISION ST SUITE 311 SARATOGA SPRINGS NY 12866 LOCUM EMPLOYEES 929691 CHANGE HEALTHCARE LLC CHANGE HEALTHCARE TECHNOLOGIES LLC ALPHARETTA GA 30005 IT SERVICE CONTRACT 145319 FUST CHARLES CHAMBERS LLP 5784 WIDEWATERS PARKWAY SYRACUSE NY 13214 AUDIT/ACCOUNTING 118339 4 591903 9368787 887175 130000 10847865 HOSPITAL 621990 63692079 63692079 NURSING HOME 623990 11742808 11742808 OTHER 621400 108893 108893 75543780 7419 7419 832127 455777 376350 376350 376350 795387 143880 736179 0 59208 143880 203088 203088 86978502 75543780 0 586857 X 740170 740170 30668126 27614469 3053657 1757212 1584009 173203 6385005 5753467 631538 2210350 1992483 217867 572066 572066 227306 227306 87625 87625 11883 11883 22659623 22659623 48818 48818 4054107 3527073 527034 1439760 1252591 187169 24752 24752 91070 79231 11839 3438443 3438443 1609214 1609214 SUPPLIES 4038636 4038636 0 OTHER EXPENSES 3334336 3334336 BAD DEBT 2992361 2992361 0 CHARITY CARE 341975 341975 0 94363 94363 86827201 80569477 6257724 0 1506730 8525803 0 0 2206880 2182635 8945684 8667764 0 0 0 0 0 0 1685464 1268845 546842 470508 127740100 98368928 31306422 29371172 4169067 4068397 0 0 0 0 0 0 9623023 4226019 59990112 58781143 10259055 12837142 0 0 0 0 0 0 0 0 0 0 603885 587921 0 0 16857214 11590202 27720154 25015265 X 26618819 27730964 5651139 6034914 32269958 33765878 59990112 58781143 X 151301 471245 873374 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 11883 11883 0 PART II-B, LINE 1: A PERCENTAGE OF MEMBERSHIP DUES PAID TO HEALTHCARE ASSOCIATION OF NEW YORK STATE (20.44%), IROQUOIS HEALTHCARE ALLIANCE (59.00%) AND AMERICAN HOSPITAL ASSOCIATION (25.56%) ARE USED SPECIFICALLY FOR LOBBYING PURPOSES. 6481701 451384 377261 432088 6878258 6930166 1473157 468717 2390339 6481701 7141540 1699636 -11630 1899380 6930166 6971037 1021527 357468 1208492 7141540 4654824 3186220 226472 1096479 6971037 0.12260 0.52680 0.35060 0 1 1 4504269 4504269 55811620 38847450 16964170 67105410 59521478 7583932 318801 318801 29371172 DUE FROM RELATED PARTIES 1686441 ESTIMATED THIRD PARTY RECEIVABLE 1529479 OTHER ASSETS 1010099 4226019 ACCRUED THIRD PARTY PAYABLES 9215344 ACCRUED PENSION LIBILITY 2374858 11590202 X PART V, LINE 4: PERMANENT ENDOWMENTS: THE INTENDED USE OF THE INCOME FROM THESE FUNDS IS TO SUPPORT OPERATIONS AND TO FUND THE ANNUAL PHYSICIANS LECTURES AND DINNERS. BOARD DESIGNATED OR QUASI ENDOWMENTS: THE INTENDED USE OF INCOME FROM THESE FUNDS IS TO SUPPORT OPERATIONS OR FOR FUTURE CAPITAL NEEDS. TERM ENDOWMENTS: THE INTENDED USE OF THESE FUNDS IS DETERMINED BY THE VARIOUS DONORS, AND TO PROVIDE FOR THE NEEDS OF NURSING HOME PATIENTS. PART X, LINE 2: FIN 48 FOOTNOTE AURELIA OSBORN FOX MEMORIAL HOSPITAL IS INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF BASSETT HEALTHCARE NETWORK (THE NETWORK). THE TEXT OF THE FIN 48 FOOTNOTE FROM THE CONSOLIDATED FINANCIAL STATEMENTS IS AS FOLLOWS: THE NETWORK'S VARIOUS SUBSIDIARIES GENERALLY CONSIST OF NOT-FOR-PROFIT CORPORATIONS ORGANIZED IN ACCORDANCE WITH SECTION 501(C)(3) OF THE IRC AND THEREFORE ARE EXEMPT FROM FEDERAL INCOME TAXES PURSUANT TO SECTION 501(A) OF THE IRC. THE NETWORK RECOGNIZES INCOME TAX POSITIONS WHEN IT IS MORE-LIKELY THAN-NOT THAT THE POSITION WILL BE SUSTAINABLE BASED ON THE MERITS OF THE POSITION. MANAGEMENT HAS CONCLUDED THAT THERE ARE NO MATERIAL TAX LIABILITIES OR UNCERTAIN TAX POSITIONS THAT NEED TO BE RECORDED. FOR TAXABLE SUBSIDIARIES OR INVESTMENTS, INCLUDING CCE, DEFERRED TAX ASSETS AND LIABILITIES ARE RECOGNIZED FOR THE FUTURE TAX CONSEQUENCES OF TEMPORARY DIFFERENCES BY APPLYING ENACTED STATUTORY TAX RATES APPLICABLE TO FUTURE YEARS FOR THE DIFFERENCES BETWEEN THE CONSOLIDATED FINANCIAL STATEMENTS AND TAX BASIS OF EXISTING ASSETS AND LIABILITIES. SUCH DEFERRED TAX ASSETS AND LIABILITIES WERE NOT MATERIAL AS OF DECEMBER 31, 2020. 1 1 1 X 300.000000000000 1 X 1 1 0 1 1 341975 184029 241982 0.00280 22389342 13773124 8616217 0.09920 751583 388147 363436 0.00420 23482900 14345300 9221635 0.10620 14755 14755 0.00020 14755 14755 0.00020 23497655 14345300 9236390 0.10640 1 17349386 19173733 -1824347 X 0 1 AT HOME CARE REGIONAL HOME HEALTH AGENCY 0.50000 0.00000 0.00000 1 1 AURELIA OSBORN FOX MEMORIAL HOSPITAL 1 NORTON AVENUE ONEONTA NY 13820 X X X AURELIA OSBORN FOX MEMORIAL HOSPITAL 1 0 0 1 X X X X X X X X X 19 1 1 1 1 X SEE SECTION C SEE SECTION C X 1 19 1 SEE SECTION C 0 1 X 300.000000000000 300.000000000000 X X X 1 1 X X X X 1 X SEE SECTION C X SEE SECTION C X SEE SECTION C X X X X X X 1 X 0 X 1 X 0 0 AURELIA OSBORN FOX MEMORIAL HOSPITAL PART V, SECTION B, LINE 5: AURELIA OSBORN FOX MEMORIAL HOSPITAL:THIS COMMUNITY HEALTH NEEDS ASSESSMENT HAS TAKEN INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE BROAD RANGE OF SECTORS AND INTERESTS OF THE COMMUNITY INCLUDING ORGANIZATIONS THAT REPRESENT THE MEDICALLY UNDERSERVED, LOW-INCOME, AND MINORITY POPULATIONS SERVED BY BASSETT MEDICAL CENTER. ALL ORGANIZATIONS PROVIDING INPUT INTO THIS ASSESSMENT, INCLUDING THE NAME AND TITLE OF THOSE INDIVIDUALS REPRESENTATIVE OF THE ORGANIZATION, IS PROVIDED BELOW. THIS INCLUDED INPUT FROM INDIVIDUALS WITH EXPERTISE IN PUBLIC HEALTH, SPECIFICALLY, HEIDI BOND, DIRECTOR OF THE OTSEGO COUNTY HEALTH DEPARTMENT.A) HEIDI BOND, DIRECTOR AT OTSEGO COUNTY HEALTH DEPARTMENTB) PATRICIA KNUTH, EXECUTIVE DIRECTOR AT THE ARC OTSEGOC) AMEEN ASWAD, EXECUTIVE DIRECTOR OF JAIL MINISTRY OF OTSEGO COUNTYD) TREENA HALSTEAD, BUILDING HEALTHY FAMILIES PROGRAM MANAGER AT OPPORTUNITIES FOR OTSEGOE) MARGARET AVRITT, ONEONTA COMMUNITY HEALTH CENTERF) TOM HOHENSEE, CREATING HEALTHY SCHOOLS AND COMMUNITIES SCHOOLCOORDINATOR BASSETT RESEARCH INSTITUTE AT BASSETT MEDICAL CENTERAURELIA OSBORN FOX MEMORIAL HOSPITAL 15-0539039G) SARAH BUTTICE, DIRECTOR OF EDUCATION/EMPLOYEE WELLNESS AT A.O. FOX HOSPITALH) CALI RIESE, PUBLIC EDUCATION & COMMUNITY OUTREACH SPECIALIST CANCER SERVICES PROGRAM OF THE CENTRAL REGION AT BASSETT HEALTHCARE NETWORKI) TAMIE MACDONALD, DIRECTOR AT OTSEGO COUNTY OFFICE FOR THE AGINGJ) CHERILYN LACY, COORDINATOR OF THE PUBLIC HEALTH PROGRAM AT HARTWICK COLLEGEK) VERA SOSNOWSKI, BOARD MEMBER AT THE TOWN OF MILFORDL) CHRISTY HOUCK, CATHOLIC CHARITIES DELAWARE, OTSEGO & SCHOHARIEM) LYNAE WYCKOFF, LIVING WELL PROGRAM MANAGER BASSETT RESEARCH INSTITUTE AT BASSETT MEDICAL CENTERN) DAN MASKIN, EXECUTIVE DIRECTOR AT OPPORTUNITIES FOR OTSEGOO) LUCINDA LEVENE, ENGAGEMENT MANAGER AT LEATHERSTOCKING COLLABORATIVE HEALTH PARTNERSP) DEBRA MARCUS, EXECUTIVE DIRECTOR AT FAMILY PLANNING OF SOUTH CENTRAL NEW YORKQ) SUSAN MATT, DIRECTOR AT OTSEGO COUNTY COMMUNITY SERVICESR) DAVE RICHARDS, SUPERINTENDENT OF SCHOOLS AT UNATEGO CENTRAL SCHOOL DISTRICTS) ARLANA YOUNG, BOARD OF DIRECTORS MEMBER AT ONEONTA COMMUNITY HEALTH CENTERT) STEPHEN CLARK, ADMINISTRATIVE DIRECTOR BASSETT RESEARCH INSTITUTE AT BASSETT MEDICAL CENTERU) MATHEW JOHNSON, HEALTH EDUCATOR AT OTSEGO COUNTY HEALTH DEPARTMENTV) LAURA BRYANT, RABIES COORDINATOR AT OTSEGO COUNTY HEALTH DEPARTMENTW) KIM SCHLOSSER, ASSISTANT DIRECTOR AT OTSEGO COUNTY HEALTH DEPARTMENTX) MARION MANLIUS, BOARD MEMBER AT THE TOWN OF MILFORDY) MAUREEN BLANCHARD, CREATING HEALTHY SCHOOLS AND COMMUNITIES COMMUNITY COORDINATOR RESEARCH FOUNDATION AT SUNY COBLESKILLZ) MARION MOSSMAN, PROJECT DIRECTOR AT OTSEGO COUNTY SYSTEM OF CARE AA) JULIE SORENSEN, DIRECTOR AT THE NEW YORK CENTER OF AGRICULTURAL MEDICINE AND HEALTH/NORTHEAST CENTER FOR OCCUPATIONAL HEALTH AND SAFETYBB) ANNE GADOMSKI, ATTENDING PEDIATRIC PHYSICIAN AND DIRECTOR OF THE BASSETT RESEARCH INSTITUTE AT BASSETT MEDICAL CENTERCC) LYNN GLUECKERT, EXECUTIVE DIRECTOR AT CATHOLIC CHARITIES DELAWARE, OTSEGO & SCHOHARIEDD) TERESA SEARS, CLERK AT THE TOWN OF OTEGOEE) GARY FURMAN, SUPERINTENDENT OF SCHOOLS AT EDMESTON CENTRAL SCHOOL DISTRICTFF) JULIE DOSTAL, EXECUTIVE DIRECTOR AT LEATHERSTOCKING EDUCATION ON ALCOHOLISM/ADDICTIONS FOUNDATIONFOLLOWING A REVIEW OF DATA FROM BASSETT MEDICAL CENTER'S, A.O. FOX MEMORIAL HOSPITAL'S AND OTSEGO COUNTY HEALTH DEPARTMENT'S 2019 JOINT COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) AND INPUT FROM KEY INFORMANTS, BASSETT MEDICAL CENTER, A.O. FOX MEMORIAL HOSPITAL AND OTSEGO COUNTY HEALTH DEPARTMENT WILL COLLABORATE ON THE NEW YORK STATE PREVENTION AGENDA PRIORITIES OF PROMOTE WELL-BEING AND PREVENT MENTAL AND SUBSTANCE USE DISORDERS' FOCUS AREA OF 'PREVENT MENTAL AND SUBSTANCE USE DISORDERS' WITH THE GOALS TO PREVENT OPIOID AND OTHER SUBSTANCE MISUSE AND DEATH, AND PREVENT CHRONIC DISEASES' FOCUS AREA OF 'TOBACCO PREVENTION' WITH THE GOAL TO PREVENT INITIATION OF TOBACCO USE. BASSETT MEDICAL CENTER, A.O. FOX MEMORIAL HOSPITAL, AND OTSEGO COUNTY HEALTH DEPARTMENT ENGAGED STAKEHOLDERS TO WORK WITH THEM ON THEIR 2013 AND 2016 PRIORITIES AND STAKEHOLDERS WERE ENGAGED FOR THE 2019 PRIORITIES. THESE STAKEHOLDERS, ALONG WITH INDIVIDUALS AND ORGANIZATIONS FOCUSED ON THE HEALTH OF THE COMMUNITY, HAD AN OPPORTUNITY TO INDICATE THEIR PRIORITIES DURING A COMMUNITY DATA PRESENTATION AND THOSE INDIVIDUALS UNABLE TO ATTEND HAD THE OPPORTUNITY TO COMPLETE A SURVEY INDICATING THEIR PRIORITIES.IN ORDER TO ADDRESS THE COMBINED FOCUS AREA OF 'PREVENT MENTAL AND SUBSTANCE USE DISORDERS' BASSETT MEDICAL CENTER, A.O. FOX MEMORIAL HOSPITAL, AND OTSEGO COUNTY HEALTH DEPARTMENT WILL INCREASE THE AVAILABILITY OF/ACCESS AND LINKAGES TO MEDICATION-ASSISTED TREATMENT (MAT) INCLUDING BUPRENORPHINE; PROMOTE AND ENCOURAGE PRESCRIBER EDUCATION AND FAMILIARITY WITH OPIOID PRESCRIBING GUIDELINES, AND LIMITS AS IMPOSED BY NEW YORK STATE STATUTES AND REGULATION; AND BUILD SUPPORT SYSTEMS TO CARE FOR OPIOID USERS WHO ARE AT RISK OF AN OVERDOSE.FOR 'TOBACCO PREVENTION' BASSETT MEDICAL CENTER, A.O. FOX MEMORIAL HOSPITAL, AND OTSEGO COUNTY HEALTH DEPARTMENT WILL USE MEDIA AND HEALTH COMMUNICATIONS TO HIGHLIGHT THE DANGERS OF TOBACCO/VAPING IN THE PEDIATRIC CLINICS, SCHOOL BASED HEALTH CENTERS AND COMMUNITY. BASSETT MEDICAL CENTER, A.O. FOX MEMORIAL HOSPITAL, AND OTSEGO COUNTY HEALTH DEPARTMENT WILL UTILIZE THE RECOMMENDED PROCESS MEASURES LISTED IN THE NEW YORK STATE PREVENTION AGENDA ACTION PLAN TO TRACK PROGRESS OF ALL PRIORITIES AND FOCUS AREAS. YEARLY PROGRESS TOWARDS THOSE MEASURES WILL BE DISSEMINATED TO THE NEW YORK STATE DEPARTMENT OF HEALTH AND WILL BE INCLUDED ON THE BASSETT HEALTHCARE NETWORKS AND OTSEGO COUNTY HEALTH DEPARTMENTS WEBSITE. AURELIA OSBORN FOX MEMORIAL HOSPITAL PART V, SECTION B, LINE 6A: MARY IMOGENE BASSETT HOSPITAL AURELIA OSBORN FOX MEMORIAL HOSPITAL PART V, SECTION B, LINE 6B: OTSEGO COUNTY DEPARTMENT OF HEALTH AURELIA OSBORN FOX MEMORIAL HOSPITAL PART V, SECTION B, LINE 11: THE ORGANIZATION ADDRESSED SIGNIFICANT, PRIORITIZED HEALTH NEEDS IDENTIFIED IN ITS MOST RECENTLY CONDUCTED CHNA BY ADOPTION OF A BUDGET FOR PROVISION OF SERVICES THAT ADDRESS THE NEEDS IDENTIFICATION IN THE CHNA, PRIORITIZATION OF HEALTH NEEDS IN ITS COMMUNITY, AND PRIORITIZATION OF SERVICES THAT THE HOSPITAL FACILITY WILL UNDERTAKE TO MEET HEALTH NEEDS IN ITS COMMUNITY. FOR NEEDS NOT ADDRESSED AS A COLLABORATIVE, WE ADDRESS SOME AS AN INDIVIDUAL ORGANIZATION, AND ALSO CONTINUE TO REPRIORITIZE HIGHEST DEMAND OF NEEDS.DUE TO THE COVID-19 PANDEMIC, THE HOSPITAL CANCELED ALL ELECTIVE PROCEDURES AND NON-URGENT AMBULATORY VISITS WHICH RESULTED IN A SIGNIFICANT REDUCTION IN PATIENT VOLUMES. IN ADDITION TO THE LOST REVENUE THAT ACCOMPANIED THE LOWER PATIENT VOLUMES THE HOSPITAL EXPERIENCED A SIGNIFICANT INCREASE IN OPERATING EXPENSES ASSOCIATED WITH THE PURCHASE OF PERSONAL PROTECTIVE EQUIPMENT, CERTAIN PHARMACEUTICALS, COVID 19 TESTING SUPPLIES, AND OTHER OVERHEAD AND PATIENT SPECIFIC COSTS. ADMISSIONS FELL 22% FROM 2019 TO 2020 WHILE OUTPATIENT CLINIC AND ER VISITS DECREASED 21% FROM 2019 TO 2020. PART V, LINE 7A AND 10A AURELIA OSBORN FOX MEMORIAL HOSPITAL:THE HOSPITAL'S COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION STRATEGY ARE MADE AVAILABLE ON THE HOSPITAL'S WEBSITE:HTTPS://WWW.BASSETT.ORG/LOCATIONS/AO-FOX-HOSPITAL PART V, LINE 16A, 16B, AND 16C AURELIA OSBORN FOX MEMORIAL HOSPITAL:THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY, APPLICATION, AND PLAIN LANGUAGE SUMMARY ARE MADE AVAILABLE ON THE HOSPITAL'S WEBSITE:HTTPS://WWW.BASSETT.ORG/PATIENTS-VISITORS/BILLING-INSURANCE/FINANCIAL-ASSISTANCE 10 1 - AURELIA OSBORN FOX MEMORIAL HOSPITAL 1 NORTON AVENUE ONEONTA NY 13820 NURSING HOME 2 - CHILD AND ADOLESCENT HEALTHCARE 1 FOXCARE DRIVE SUITE 213 ONEONTA NY 13820 PEDIATRIC CLINIC 3 - ONEONTA FAMILY PRACTICE 1 FOXCARE DRIVE SUITE 308 ONEONTA NY 13820 FAMILY MEDICINE CLINIC 4 - FOXCARE WOMENS WELLNESS 1 FOXCARE DRIVE SUITE 303 ONEONTA NY 13820 OB/GYN CLINIC 5 - SUSQUEHANNA FAMILY PRACTICE 1 FOXCARE DRIVE SUITE 103 ONEONTA NY 13820 FAMILY MEDICINE CLINIC 6 - FOX INTERNAL MEDICINE 1 FOXCARE DRIVE SUITE 103 ONEONTA NY 13820 INTERNAL MEDICINE CLINIC 7 - FOXCARE DENTAL 1 FOXCARE DRIVE SUITE 304 ONEONTA NY 13820 DENTAL CLINIC 8 - SIDNEY PRIMARY CARE CLINIC 59 RIVER STREET SIDNEY NY 13838 FAMILY MEDICINE CLINIC 9 - STAMFORD FAMILY PRACTICE 32-34 MAIN STREET STAMFORD NY 12167 FAMILY MEDICINE CLINIC 10 - FOX TRI TOWN CAMPUS 43 PEARL STREET WEST SIDNEY NY 13838 OUTPATIENT SERVICES PART I, LINE 7: COSTING METHODOLOGY EXPLANATIONTHE COST METHODOLOGY USED FOR TABLE 7 IS THE RATIO OF COST TO CHARGES FROM 12/31/2020 MEDICARE FORM 2552. SCHEDULE H, PART I, LINE 6A AURELIA OSBORN FOX MEMORIAL HOSPITAL'S COMPREHENSIVE THREE YEAR COMMUNITY SERVICE PLAN WAS SUMMARIZED IN AN ANNUAL COMMUNITY REPORT. PRINTED COPIES WERE AVAILABLE TO THE PUBLIC IN PATIENT WAITING ROOMS AND AT INFORMATION KIOSKS. THE REPORT IS ALSO POSTED ON THE BASSETT WEBSITE, WWW.BASSETT.ORG/LOCATIONS/AO-FOX-HOSPITAL. SCHEDULE H, PART I, LINE 7, COLUMN (D) DIRECT OFFSETTING REVENUEDURING 2020, THE HOSPITAL RECEIVED PROVIDER RELIEF FUNDS THAT MAY BE USED AS REIMBURSEMENT FOR COMMUNITY BENEFIT EXPENSES THE HOSPITAL INCURRED AS A RESULT OF THE COVID-19 PANDEMIC. SUCH EXPENSES ARE CURRENTLY REPORTED IN PART I, LINE 7, COLUMN (C) BUT THE HOSPITAL HAS NOT INCLUDED THE PROVIDER RELIEF FUNDS AS DIRECT OFFSETTING REVENUE IN COLUMN (D) PENDING FURTHER GUIDANCE FROM THE IRS AS TO WHETHER PROVIDER RELIEF GRANTS ARE CONSIDERED RESTRICTED GRANTS FOR THE PURPOSES OF LINE 7. PART II, COMMUNITY BUILDING ACTIVITIES: WE HELP PROMOTE THE HEALTH OF THE COMMUNITY THROUGH MAINTAINING AN ACTIVE OPEN MEDICAL STAFF, SUPPORTING THE ANCILLARY NEEDS OF THE LOCAL FREE CLINIC AND HOSTING A CHILD BIRTH FAIR. WE ALSO PROVIDE MEETING SPACE FOR LOCAL COMMUNITY ORGANIZATIONS AT NO CHARGE. OUR BOARD IS COMPRISED OF LOCAL COMMUNITY MEMBERS WHO ADVOCATE FOR THE HEALTH INTEREST OF THE COMMUNITY. PART III, LINE 2: 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. THE BAD DEBT EXPENSE FOR 2020 WAS $2,992,361. PART III, LINE 4: CHARITY CAREFOOTNOTE (3) FROM THE CONSOLIDATED FINANCIALSTHE COST OF CHARITY CARE PROVIDED IS DETERMINED BASED ON THE APPLICATION OF A COST TO GROSS CHARGE RATIO TO THE TOTAL CHARITY CARE CHARGES FOREGONE. INCLUDED IN NET PATIENT SERVICE REVENUE ARE AMOUNTS PAID INTO AND RECEIVED FROM STATEWIDE UNCOMPENSATED CARE POOLS. THESE UNCOMPENSATED CARE POOLS ARE DESIGNED TO HELP OFFSET THE COST OF CHARITY CARE AND REIMBURSED MEDICAID SERVICES.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. THE BAD DEBT EXPENSE FOR 2020 WAS $2,992,361. PART III, LINE 8: WHEN MEDICARE PATIENTS PRESENT WE ARE AWARE THAT THERE IS A PREDETERMINED REIMBURSEMENT THAT IS BELOW OUR HOSPITAL'S COST. THE PORTION THAT WE ARE NOT REIMBURSED THEREFORE WOULD BE CONSIDERED A COMMUNITY BENEFIT. PART III, LINE 9B: IT IS A.O. FOX MEMORIAL HOSPITAL'S POLICY TO DELAY FINAL COLLECTION EFFORTS WHILE AN APPLICATION IS IN PROCESS UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. COLLECTION EFFORTS ARE NOT INITIATED UNTIL THE FINAL DETERMINATION OF ELIGIBILITY UNDER THE FINANCIAL ASSISTANCE POLICY. PART VI, LINE 2: NEEDS ASSESSMENTIN ADDITION TO PUBLIC AND AGENCY INPUT, A VARIETY OF DATA FROM THE NYS DEPARTMENT OF HEALTH, OTSEGO COUNTY BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM, OTSEGO CO. DEPARTMENT OF HEALTH COMMUNITY ASSESSMENT AND OTHER SOURCES WERE USED TO ASSESS PRIORITIES, INCLUDING: A) PERCENTAGE OF OTSEGO CO. ADULTS WHO VISITED A DENTIST IN THE PAST YEARSB) PREVALENCE OF TOOTH DECAY IN THIRD-GRADE CHILDRENC) PERCENTAGE OF ADULTS REPORTING BINGE DRINKINGD) HEAVY DRINKINGE) PERCENTAGE OF OVERWEIGHT ADULTS IN OTSEGO CO. BASED ON THE OUTCOMES OF THE FOCUS GROUPS AND STRATEGIC PLANNING SESSIONS PREVENTION AGENDA PRIORITIES THROUGHOUT THE COUNTY WERE IDENTIFIED. ACCESS TO QUALITY HEALTHCARE AND MENTAL HEALTH & SUBSTANCE ABUSE WERE IDENTIFIED AS THE TOP PRIORITIES. PHYSICAL ACTIVITY AND NUTRITION WAS RANKED THIRD.SUBSEQUENT STRATEGIC PLANNING SESSIONS RELATED TO THE TWO TOP PRIORITIES WERE HELD TO IDENTIFY SERVICE BARRIERS AND GAPS AS WELL AS BRAINSTORM FOR COLLABORATIVE EFFORTS TO ADDRESS THESE PRIORITIES. STRATEGIES FOR THE SELECTED PRIORITIES:1) ACCESS TO DENTAL HEALTH CAREA. AURELIA OSBORN FOX MEMORIAL HOSPITAL (A.O. FOX) WILL SUPPORT OTSEGO CO. DEPT. OF HEALTH EFFORTS TO RE-ESTABLISH THE OTSEGO CO. ORAL HEALTH COALITION AS A MECHANISM FOR BRINGING COMMUNITY PARTNERS TOGETHER ON ADVOCACY EFFORTS AIMED AT ATTRACTING MORE DENTISTS TO OUR RURAL AREA, AND FOR TRACKING PROGRESS IN IMPROVING ACCESS TO DENTAL SERVICESB. A.O. FOX WILL WORK TO EXPAND COMPREHENSIVE PREVENTIVE DENTAL HEALTH SERVICES TO ALL SCHOOL-BASED HEALTH CENTERS IN THE COUNTY AND TO PROVIDE SEALANT SERVICES TO NON-SBHC SCHOOLS. BASSETT WILL WORK WITH THE OTSEGO CO. DEPT. OF HEALTH AND RURAL HEALTH EDUCATION NETWORK OF DELAWARE, OTSEGO, MONTGOMERY (RHENDOMS) TO MAKE MORE SCHOOLS AWARE OF RHENDOMS SERVICES TO INCREASE PARTICIPATIONC. A.O. FOX WILL WORK WITH THE OTSEGO CO. DEPT. OF HEALTH AND A.O. FOX HOSPITAL TO EDUCATE PRIMARY CARE AND SBHC PROVIDERS ABOUT DENTAL PRACTICES AVAILABLE FOR REFERRAL. THE OTSEGO CO. DEPT. OF HEALTH WILL EDUCATE DENTAL PROVIDERS ABOUT MEDICAID REIMBURSEMENTSD. A.O. FOX WILL WORK WITH THE HEALTH DEPARTMENT AND OTHER COMMUNITY PARTNERS TO EDUCATE THE PUBLIC ABOUT DENTAL HEALTH IN FAIRS AND OTHER COMMUNITY EVENTS.2) MENTAL HEALTH AND SUBSTANCE ABUSEA. IN A NEW INITIATIVE, A.O. FOX WILL WORK WITH BASSETT MEDICAL CENTER AND LEATHERSTOCKING EDUCATION ON ALCOHOLISM/ADDICTIONS FOUNDATIONS, INC. (LEAF) TO PROVIDE CONTINUING MEDICAL EDUCATION TRAINING ON SUBSTANCE ABUSE SCREENING AND REFERRAL TO PRIMARY CARE PROVIDERS AND SURGEONS IN THE COUNTY.B. A.O. FOX WILL WORK WITH THE HEALTH DEPARTMENT AND LEAF TO COMPLETE AND DISTRIBUTE AN UPDATED LIST OF MENTAL HEALTH AND SUBSTANCE ABUSE RESOURCES TO PRIMARY CARE PROVIDERSC. A.O. FOX WILL COLLABORATE WITH LEAF AND THE HEALTH DEPARTMENT ON PUBLIC HEALTH CAMPAIGN ABOUT THE RISK FACTORS ASSOCIATED WITH BINGE DRINKING AND PRESCRIPTION DRUG ABUSE3) PHYSICAL ACTIVITY AND NUTRITIONA. A.O. FOX WILL CONTINUE TO COLLABORATE WITH THE HEALTH DEPARTMENT AND OTHER COMMUNITY PARTNERS ON EFFORTS TO PROVIDE EARLY EDUCATION ABOUT THE IMPORTANCE OF PHYSICAL ACTIVITY AND NUTRITION THROUGHOUT LIFE, INCLUDING DURING PREGNANCY AND TO PREVENT CHRONIC DISEASEB. A.O. FOX WILL WORK WITH THE HEALTH DEPARTMENT, SCHOOLS, AND OTHER COMMUNITY PARTNERS TO IMPROVE CONTINUITY OF CARE BETWEEN FAMILIES, SCHOOLS, AND PRIMARY CARE PROVIDERS FOR THE TREATMENT OF CHILDHOOD OBESITY OVERALL GOALS WILL BE TO INCREASE THE PERCENTAGE OF OTSEGO COUNTY ADULTS WHO HAVE SEEN A DENTIST IN THE PAST YEAR, WORK TOWARD A 2013 PREVENTION AGENDA OBJECTIVE OF 83%, REDUCING THE RATE OF ALCOHOL ABUSE IN OTSEGO COUNTY AND REDUCING THE RATE OF OBESITY IN OTSEGO COUNTY. PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCEA MAJOR COMPONENT OF AURELIA OSBORN FOX MEMORIAL HOSPITAL'S COMMUNITY SERVICES PROGRAM IS TO ACTIVELY IDENTIFY PATIENTS WHO MAY BE ELIGIBLE FOR CHARITY CARE. THE PROCESS BEGINS WITH AN ORGANIZATIONAL POLICY AND PROCEDURE THAT DEFINES THE PROGRAM AND SERVES AS AN EDUCATION TOOL FOR ALL BASSETT EMPLOYEES. THE POLICY IS UPDATED ANNUALLY, DISTRIBUTED TO KEY PERSONNEL AND POSTED IN THE ONLINE POLICY AND PROCEDURE MANUAL THAT IS ACCESSIBLE TO ALL EMPLOYEES. THE PROGRAM IS SUPPORTED BY A FOUR PAGE PLAIN LANGUAGE BROCHURE THAT INCLUDES AN APPLICATION. BROCHURES ARE PROMINENTLY DISPLAYED AND AVAILABLE AT ALL FACILITIES AND ALL CLINIC LOCATIONS. CLINICAL AND SUPPORT STAFF ARE MADE AWARE OF THE PROGRAM AND ABLE TO DIRECT PATIENTS TO SPECIALISTS WHO CAN ASSIST IN THE APPLICATION PROCESS.ALL PATIENTS WHO ARE REGISTERED AS SELF-PAY ARE PROVIDED A BROCHURE EITHER IN PERSON OR BY MAIL. PATIENTS WHO ARE IN THE HOSPITAL RECEIVE INFORMATION AS PART OF A PERSONAL VISIT GEARED TO HELP THE PATIENT NAVIGATE FINANCIAL ASSISTANCE INCLUDING, BUT NOT LIMITED TO, THE COMMUNITY SERVICES PROGRAM. GOVERNMENT PROGRAM OPPORTUNITIES ARE ALSO REFERENCED AND A DIRECTORY OF LOCAL SOCIAL SERVICES AGENCIES IS PROVIDED BASED ON THE PATIENT'S COUNTY OF RESIDENCE. REFERRAL TO AN ONSITE MEDICAID EXAMINER IS AVAILABLE.A LISTING OF ALL SELF-PAY ACCOUNTS IS PRODUCED AND REVIEWED DAILY TO INSURE THAT A COMMUNITY SERVICES BROCHURE HAS BEEN PROVIDED. THE SELF-PAY BILLING OFFICE IDENTIFIES PATIENTS DURING THE BILLING AND COLLECTIONS PROCESS THAT MAY REQUIRE ADDITIONAL HELP UNDERSTANDING THE PROGRAM.SELF-PAY ACCOUNTS FOR PATIENTS WHO HAVE BEEN APPROVED FOR COMMUNITY SERVICES WITHIN THE PRIOR 120 DAYS ARE AUTOMATICALLY INCLUDED WITH THE PRIOR APPROVAL. PART VI, LINE 4: COMMUNITY INFORMATIONAURELIA OSBORN FOX MEMORIAL HOSPITAL IS PART OF THE BASSETT HEALTHCARE NETWORK THAT PROVIDES HEALTH SERVICES IN MORE THAN 20 COMMUNITIES SPANNING 5,600 SQUARE MILES AND SEVEN COUNTIES. THE NETWORK FOCUSES ITS COMMUNITY SERVICES PROGRAMS IN THE COUNTIES WHERE THE SIX AFFILIATED HOSPITALS AND GREATEST PATIENT POPULATIONS ARE LOCATED. IN THE SEVEN COUNTY REGIONS, THE MEDIAN HOUSEHOLD INCOME RANGES BETWEEN $43,000 AND $48,000. 13-18 % OF THE COMMUNITY RESIDENTS HAVE INCOMES BELOW THE FEDERAL POVERTY GUIDELINES. THE FOLLOWING AREAS HAVE BEEN FEDERALLY DESIGNATED AS BEING MEDICALLY UNDERSERVED:A) HERKIMER COUNTYB) FULTON COUNTY, TOWN OF OPPENHEIMC) MONTGOMERY COUNTY, CITY OF AMSTERDAMD) OTSEGO COUNTY, NORTH OTSEGO SERVICE AREA, TOWN OF PLAINFIELD, TOWN OF DECATURE) DELAWARE COUNTY, TOWNS OF DEPOSIT, COLCHESTER, MIDDLETOWN PART VI, LINE 6: AURELIA OSBORN FOX MEMORIAL HOSPITAL IS PART OF THE BASSETT HEALTHCARE NETWORK THAT PROVIDES HEALTH SERVICES IN MORE THAN 20 COMMUNITIES SPANNING 5,600 SQUARE MILES AND SEVEN COUNTIES. THE NETWORK FOCUSES ITS COMMUNITY SERVICES PROGRAMS IN THE COUNTIES WHERE THE SIX AFFILIATED HOSPITALS AND GREATEST PATIENT POPULATIONS ARE LOCATED. OTSEGO COUNTY POPULATION 60,094, DELAWARE COUNTY - POPULATION 45,001, HERKIMER COUNTY POPULATION 62,240, SCHOHARIE COUNTY - POPULATION 31,420 (ACCORDING TO THE 2017 U.S. CENSUS ESTIMATES).A) BASSETT - AN ACUTE CARE INPATIENT TEACHING FACILITY, AN OUTPATIENT PRIMARY AND SPECIALTY CARE CENTER, A REGIONAL NETWORK OF 29 COMMUNITY BASED OUTPATIENT HEALTH CENTERS, 20 SCHOOL BASED HEALTH CENTERS, TWO AMBULATORY SURGERY CENTERS AND A FULLY SALARIED MEDICAL STAFF IN COOPERSTOWN, OTSEGO COUNTYB) O'CONNOR HOSPITAL - CRITICAL ACCESS HOSPITAL IN DELHI, DELAWARE COUNTYC) COBLESKILL REGIONAL HOSPITAL - ACUTE CARE FACILITY IN COBLESKILL, SCHOHARIE COUNTYD) LITTLE FALLS HOSPITAL - CRITICAL ACCESS HOSPITAL IN LITTLE FALLS, HERKIMER COUNTYE) FOX TRI-TOWN CAMPUS- 24/7 EMERGENCY CARE FACILITY IN SIDNEY, DELAWARE COUNTYF) A.O. FOX MEMORIAL HOSPITAL - ACUTE CARE FACILITY IN ONEONTA, OTSEGO COUNTYG) VALLEY HEALTH SERVICES - RESIDENTIAL HEALTH CARE AND REHABILITATION FACILITYH) AT HOME CARE - CERTIFIED HOME CARE AGENCYI) FIRST COMMUNITY CARE OF BASSETT - MEDICAL SUPPLY COMPANY ALL THE ABOVE (A-I) MAKE UP THE BASSETT HEALTHCARE NETWORK AND PROVIDE HEALTH SERVICES TO THIS SEVEN COUNTY REGION IN CENTRAL NEW YORK. PART VI, LINE 7 STATE FILING OF COMMUNITY BENEFIT REPORTNEW YORK X X X 0 0 0 0 0 0 0 0 0 REGINALD KNIGHT VP MEDICAL AFFAIRS 371225 0 0 0 0 0 14250 0 16909 0 402384 0 0 0 JEFF JOYNER PRESIDENT (UNTIL 12/2020) 0 373627 0 0 0 0 0 26012 0 0 0 399639 0 0 ERIC STEIN PRESIDENT (START 12/2020) 0 217097 0 10104 0 0 0 18042 0 8622 0 253865 0 0 GARY SMITH VP OPERATIONS 154561 0 0 0 0 0 11856 0 19209 0 185626 0 0 0 KAREN MOWERS DIRECTOR NURSING SVCS 154315 0 0 0 0 0 11113 0 18293 0 183721 0 0 0 CHRISTOPHER GRAHAM CFO 0 159999 0 0 0 0 0 12428 0 0 0 172427 0 0 MAIA DECKER DIRECTOR PHARMACY 137834 0 0 0 0 0 10664 0 20391 0 168889 0 0 0 JEFFREY EMHOFF DIRECTOR NURSING HOME 140244 0 0 0 0 0 7251 0 19960 0 167455 0 0 0 JOAN MACDONALD VP NURSING 144389 0 0 0 0 0 7204 0 568 0 152161 0 0 0 X 1 130000 FMV 0 0 0 0 FORM 990, PART VI, SECTION A, LINE 6 BASSETT HEALTHCARE NETWORK IS THE SOLE MEMBER OF A.O. FOX MEMORIAL HOSPITAL. FORM 990, PART VI, SECTION A, LINE 7A BASSETT HEALTHCARE NETWORK IS THE PARENT AND SOLE MEMBER TO EACH OF THE FOLLOWING RELATED PARTIES: FRIENDS OF BASSETT, AURELIA OSBORN FOX MEMORIAL HOSPITAL, BASSETT HOSPITAL OF SCHOHARIE COUNTY, LITTLE FALLS HOSPITAL, O'CONNER HOSPITAL, TEMPLETON FOUNDATION, VALLEY HEALTH SERVICES, TRI-TOWN REGIONAL HOSPITAL, AND THE MARY IMOGENE BASSETT HOSPITAL. AS PARENT AND SOLE MEMBER, BASSETT HEATHCARE NETWORK HAS THE RIGHT TO APPONT AND REMOVE MEMBERS OF THE GOVERNING BOARDS, INCLUDING, BUT NOT LIMITED TO, APPROVAL OF OPERATING AND CAPITAL BUDGETS, CERTAIN CAPITAL EXPENDITURES, INDEBTEDNESS NOT CONTAINED IN THE APPROVED BUDGETS, SUBSTANTIVE CHANGES IN CLINICAL PROGRAMS, MERGERS, CONSOLIDATIONS, LIQUIDATIONS AND DISSOLUTIONS INVOLVING ITS SUBSIDIARIES AND CERTIFICATE OF NEED APPLICATIONS. FORM 990, PART VI, SECTION A, LINE 7B SEE DISCLOSURE FOR PART VI, SECTION A, LINE 6. FORM 990, PART VI, SECTION B, LINE 11B AURELIA OSBORN FOX MEMORIAL HOSPITAL PRESENTS THE DRAFT 990 TO THE FINANCE/EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS PRIOR TO FILING. ANY QUESTIONS ARE RAISED AND ONCE APPROVED, THE 990 CAN BE FILED. A COMPLETE COPY OF THE ORGANIZATION'S FINAL FORM 990, INCLUDING ALL REQUIRED SCHEDULES, AS ULTIMATELY FILED WITH THE IRS, IS AVAILABLE TO EACH MEMBER OF THE BOARD BEFORE ITS FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C POTENTIAL CONFLICTS OF INTEREST ARE REVIEWED BY HOSPITAL ADMINISTRATION AND IF NECESSARY ARE REFERRED TO THE BOARD EXECUTIVE COMMITTEE TO BE HANDLED APPROPRIATELY. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD EXECUTIVE COMMITTEE DETERMINES COMPENSATION FOR THE CEO BASED ON THE, "SURVEY OF THE INDUSTRIES C0MPENSATION DATA" SUPPLIED BY HANYS. THE CEO TAKES RECOMMENDATIONS TO THE BOARD EXECUTIVE COMMITTEE BASED ON HANYS COMPENSATION SURVEY. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTATION, CONFLICTS OF INTEREST POLICIES, AND FINANCIAL STATEMENTS AVAILABLE UPON REQUEST. SOME INFORMATION IS ALSO AVAILABLE THROUGH THE DEPARTMENT OF HEALTH. THE DOH REQUIRES THE INFORMATION FOR PUBLIC AVAILABILITY. FORM 990, PART IX, LINE 11G AGENCY: PROGRAM SERVICE EXPENSES 749,870. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 749,870. SERVICE CONTRACTS: PROGRAM SERVICE EXPENSES 9,066,459. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,066,459. CONSULTING: PROGRAM SERVICE EXPENSES 338,370. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 338,370. NETWORK SHARED SVCS: PROGRAM SERVICE EXPENSES 12,257,079. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 12,257,079. TAXES: PROGRAM SERVICE EXPENSES 247,845. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 247,845. FORM 990, PART XI, LINE 9: CHANGE IN POST RETIREMENT VALUATION 411,961. OTHER CHANGES TO BEGINNING OF YEAR NET ASSETS 461,413. BASSETT HEALTHCARE NETWORK ONE ATWELL ROAD COOPERSTOWN NY 13326 133218680 SUPPORT NY 501C3 12C NONE 0 FRIENDS OF BASSETT ONE ATWELL ROAD COOPERSTOWN NY 13326 237041610 FUNDRAISER NY 501C3 7 BHN 0 O'CONNOR HOSPITAL 460 ANDES ROAD DELHI NY 13753 161540394 HEALTHCARE NY 501C3 3 BHN 0 LITTLE FALLS HOSPITAL 140 BURWELL STREET LITTLE FALLS NY 13365 150533578 HEALTHCARE NY 501C3 3 BHN 0 MARY IMOGENE BASSETT HOSPITAL ONE ATWELL ROAD COOPERSTOWN NY 13326 135596796 HEALTHCARE NY 501C3 3 BHN 0 TEMPLETON FOUNDATION ONE ATWELL ROAD COOPERSTOWN NY 13326 133317084 LANDLORD NY 501C3 10 BHN 0 VALLEY HEALTH SERVICES 690 WEST GERMAN STREET HERKIMER NY 13350 222511614 ELDER CARE NY 501C3 3 BHN 0 BASSETT PPS LLC 6181 STATE HIGHWAY 7 ONEONTA NY 13820 811749905 HEALTHCARE NY 501C3 12A MIBH 0 TRI TOWN REGIONAL HEALTHCARE 43 PEARL STREET SIDNEY NY 13838 260169584 HEALTHCARE NY 501C3 3 BHN 0 VALLEY RESIDENTIAL SERVICES 690 WEST GERMAN STREET HERKIMER NY 13350 463703838 ELDER CARE NY 501C3 10 BHN 0 AT HOME CARE PARTNERS 25 ELM STREET ONEONTA NY 13820 562397098 HEALTHCARE NY 501C3 10 AHC INC 0 AT HOME CARE INC 25 ELM STREET ONEONTA NY 13820 161287069 HEALTHCARE NY 501C3 10 BHN 0 BASSETT HOSPITAL SCHOHARIE COUNTY 178 GRANDVIEW DRIVE COBLESKILL NY 12043 141772971 HEALTHCARE NY 501C3 3 BHN 0 AO FOX FOUNDATION 1 NORTON AVE ONEONTA NY 13820 222871993 FUNDRAISER NY 501C3 9 AO FOX MEMORIAL HOSPITAL 1 STAMFORD PROFESSIONAL ASSOCIATES 1 NORTON AVE ONEONTA NY 13820 161322304 RENTAL NY N/A 0 0 FIRST COMMUNITY CARE OF BASSETT 60 NORTHPOINTE PARKWAY AMHERST NY 14228 161504464 HEALTHCARE NY N/A 0 0 CATSKILL CARE ENTERPRISES 1 NORTON AVE ONEONTA NY 13820 161236590 RETAIL PHARMACY & FITNESS CENTER NY AO FOX C 299480 503726 1.00000 1 LEATHERSTOCKING PHYSICIANS PC ONE ATWELL ROAD COOPERSTOWN NY 13326 364864562 HEALTHCARE SERVICES NY N/A C 0 1 0 1 1 0 0 0 0 0 1 0 0 0 0 0 1 1 0 0 CATSKILL CARE ENTERPRISES J 360481 FMV CATSKILL CARE ENTERPRISES P 258715 FMV CATSKILL CARE ENTERPRISES Q 93096 FMV CATSKILL CARE ENTERPRISES D 50000 FMV AO FOX FOUNDATION C 220735 FMV