LITTLE FALLS HOSPITAL: Form 990, tax year 2019

View the entire original 990 at ProPublica ↗

Organization: LITTLE FALLS HOSPITAL (EIN 15-0533578)
Tax period: 2019-01-01 to 2019-12-31
Filed: 2020-11-14
IRS object ID: 202003199349301220
Schema version: 2019v5.1
Source: Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header
Form 990
Schedule A
Schedule B
Schedule C
Schedule D
Schedule H
Schedule J
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Return	2020-11-14T09:21:40-06:00	ReturnTs
Tax Period End	2019-12-31	TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Field	Value	IRS element (for citing)
Preparer Firm EIN	161226221	PreparerFirmEIN

Preparer Firm Name PreparerFirmName

Field	Value	IRS element (for citing)
Business Name Line1	FUST CHARLES CHAMBERS LLP	BusinessNameLine1Txt

Preparer US Address PreparerUSAddress

Field	Value	IRS element (for citing)
Address Line1	5784 WIDEWATERS PARKWAY	AddressLine1Txt
City	SYRACUSE	CityNm
State Abbreviation	NY	StateAbbreviationCd
ZIP	13214	ZIPCd

Field	Value	IRS element (for citing)
Return Type	990	ReturnTypeCd
Tax Period Begin	2019-01-01	TaxPeriodBeginDt

Filer Filer

Field	Value	IRS element (for citing)
EIN	150533578	EIN

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	LITTLE FALLS HOSPITAL	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Business Name Control	LITT	BusinessNameControlTxt
Phone	3158231000	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	140 BURWELL STREET	AddressLine1Txt
City	LITTLE FALLS	CityNm
State Abbreviation	NY	StateAbbreviationCd
ZIP	13365	ZIPCd

Business Officer BusinessOfficerGrp

Field	Value	IRS element (for citing)
Person	JAMES VIELKIND	PersonNm
Person Title	CFO	PersonTitleTxt
Phone	3158231000	PhoneNum
Signature	2020-11-12	SignatureDt
Discuss With Paid Preparer	Yes (1)	DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

Field	Value	IRS element (for citing)
Preparer Person	KELLY A REDMOND	PreparerPersonNm
PTIN	P00443718	PTIN
Phone	3154463600	PhoneNum
Preparation	2020-11-12	PreparationDt

Filing Security Information FilingSecurityInformation

IP Address IPAddress

Field	Value	IRS element (for citing)
I Pv4 Address	67.242.7.99	IPv4AddressTxt

Field	Value	IRS element (for citing)
IP	2020-11-12	IPDt
IP Tm	16:38:43	IPTm
IP Timezone	ES	IPTimezoneCd
Filing License Type	P	FilingLicenseTypeCd
At Submission Creation Device Id	DA39A3EE5E6B4B0D3255BFEF95601890AFD80709	AtSubmissionCreationDeviceId
At Submission Filing Device Id	D2E8F385EE88BD29EFAB248CF612B9DA1F974714	AtSubmissionFilingDeviceId

Field	Value	IRS element (for citing)
Tax	2019	TaxYr
Build TS	2021-01-29 14:40:06Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Principal Officer	JAMES VIELKIND	PrincipalOfficerNm

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	140 BURWELL STREET	AddressLine1Txt
City	LITTLE FALLS	CityNm
State Abbreviation	NY	StateAbbreviationCd
ZIP	13365	ZIPCd

Field	Value	IRS element (for citing)
Gross Receipts	$38,882,143	GrossReceiptsAmt
Group Return For Affiliates	0	GroupReturnForAffiliatesInd
Organization501c3	Yes (X)	Organization501c3Ind
Website Address	WWW.BASSETT.ORG	WebsiteAddressTxt
Type Of Organization Corp	Yes (X)	TypeOfOrganizationCorpInd
Formation	1893	FormationYr
Legal Domicile State	NY	LegalDomicileStateCd
Activity Or Mission	LITTLE FALLS HOSPITAL IS A CRITICAL ACCESS HOSPITAL PROVIDING ACCESS TO HEALTH CARE SERVICES TO RESIDENTS OF HERKIMER COUNTY, AND WESTERN PORTIONS OF MONTGOMERY AND FULTON COUNTIES. LITTLE FALLS HOSPITAL EMERGENCY DEPARTMENT IS STAFFED WITH PHYSICIANS ON A 24/7 BASIS. TWENTY FIVE BEDS ARE USED FOR INPATIENT AND SKILLED NURSING CARE. AMBULATORY SURGERY SERVICES ARE PROVIDED FOR A VARIETY OF PROCEDURE SPECIALTIES. PERFORMANCE IMPROVEMENT AND HIGH QUALITY OF CARE IS DEMONSTRATED WITHIN THE HOSPITAL CONSUMER ASSESSMENT OF HEALTHCARE PROVIDERS AND SYSTEMS (HCAHPS) AS REPORTED ON MEDICARE.GOV HOSPITAL COMPARE.	ActivityOrMissionDesc
Voting Members Governing Body	15	VotingMembersGoverningBodyCnt
Voting Members Independent	11	VotingMembersIndependentCnt
Total Employee	387	TotalEmployeeCnt
Total Volunteers	0	TotalVolunteersCnt
Total Gross UBI	$0	TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm	$0	NetUnrelatedBusTxblIncmAmt
PY Contributions Grants	$739,625	PYContributionsGrantsAmt
CY Contributions Grants	$1,265,539	CYContributionsGrantsAmt
PY Program Service Revenue	$32,939,635	PYProgramServiceRevenueAmt
CY Program Service Revenue	$33,439,501	CYProgramServiceRevenueAmt
PY Investment Income	$590,377	PYInvestmentIncomeAmt
CY Investment Income	$438,892	CYInvestmentIncomeAmt
PY Other Revenue	$0	PYOtherRevenueAmt
CY Other Revenue	$0	CYOtherRevenueAmt
PY Total Revenue	$34,269,637	PYTotalRevenueAmt
CY Total Revenue	$35,143,932	CYTotalRevenueAmt
PY Grants And Similar Paid	$0	PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid	$0	CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members	$0	PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members	$0	CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid	$15,786,356	PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid	$15,784,280	CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns	$0	PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns	$0	CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense	$118,637	CYTotalFundraisingExpenseAmt
PY Other Expenses	$18,937,262	PYOtherExpensesAmt
CY Other Expenses	$18,099,302	CYOtherExpensesAmt
PY Total Expenses	$34,723,618	PYTotalExpensesAmt
CY Total Expenses	$33,883,582	CYTotalExpensesAmt
PY Revenues Less Expenses	-$453,981	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	$1,260,350	CYRevenuesLessExpensesAmt
Total Assets BOY	$30,364,498	TotalAssetsBOYAmt
Total Assets EOY	$33,323,096	TotalAssetsEOYAmt
Total Liabilities BOY	$9,257,548	TotalLiabilitiesBOYAmt
Total Liabilities EOY	$9,825,312	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	$21,106,950	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	$23,497,784	NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part III	Yes (X)	InfoInScheduleOPartIIIInd
Mission	LITTLE FALLS HOSPITAL IS A VOLUNTARY, NOT-FOR-PROFIT COMMUNITY HEALTHCARE SYSTEM WHOSE MISSION IS TO OFFER QUALITY CARE WITH COMPASSION, TO ALL WHO NEED OUR SERVICES.	MissionDesc
Significant New Program Srvc	Yes (1)	SignificantNewProgramSrvcInd
Significant Change	0	SignificantChangeInd
Expense	$9,076,769	ExpenseAmt
Revenue	$7,635,287	RevenueAmt
Desc	INPATIENT SERVICESTHE INPATIENT OCCUPANCY RATE FOR INPATIENT AND OBSERVATION SERVICES WAS 59% FOR AN AVERAGE DAILY INPATIENT DAILY CENSUS OF 15 PATIENTS. AS A CRITICAL ACCESS HOSPITAL (CAH) PROVIDER, OUR INPATIENT DAILY SERVICES INCLUDE; OBSERVATION CARE, EXTENDED SWINGBED REHAB SERVICES, AND ACUTE CARE SERVICES. THIS DIVERSITY OF PATIENT CARE ALLOWS FOR OUR RESIDENTS TO REMAIN LOCAL FOR MEDICALLY APPROPRIATE SERVICES. IN 2019, ACUTE CARE LENGTH OF STAY WAS 3.4 DAYS COMPARED WITH 3.7 IN 2018. THIS LOWER LENGTH OF STAY HIGHLIGHTS THE QAULITY AND COORDINATION OF CARE FOR PATIENT AT LITTLE FALLS HOSPITAL.	Desc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

Field	Value	IRS element (for citing)
Expense	$9,084,739	ExpenseAmt
Revenue	$10,410,098	RevenueAmt
Desc	LITTLE FALLS HOSPITAL OPERATES AN EMERGENCY DEPARTMENT WITH TWENTY FOUR HOURS OF PHYSICIAN COVERAGE, SEVEN DAYS PER WEEK. THE EMERGENCY DEPARTMENT PROVIDED ACCESS TO CARE FOR APPROXIMATELY 15,000 PATIENTS IN 2019. LITTLE FALLS HOSPITAL EXPANDED THE EMERGENCY DEPARTMENT PARTICIPATED IN A NYS MEDICAID ACCELERATED EXCHANGE (MAX) PROGRAM TO REDUCE AVOIDABLE VISITS TO AN EMERGENCY DEPARTMENT. IN ADDITION A PARTNERSHIP WITH SALVATION ARMY AND THEIR COMMUNITY "PATHWAY TO HOPE" PROGRAM WAS FORMALIZED TO ASSIST IN PATIENT CARE MANAGMENT ACTIVITIES. THESE SERVCIES EMBEDDED IN OUR EMERGENCY ROOM PROVIDES ASSITANCE FOR PATIENTS TO MAKE MEDICAL APPOINTMENTS, OBTAIN INSURANCE COVERAGE, OR APPLY FOR COMMUNITY ASSISTANCE PROGRAMS.	Desc

Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp

Field	Value	IRS element (for citing)
Expense	$9,686,305	ExpenseAmt
Revenue	$14,278,569	RevenueAmt
Desc	TOTAL AMBULATORY OUTPATIENT SERVICE VISITS WERE APPROXIMATELY 33,500 IN 2019. OUR AMBULATORY SERVICES INCLUDE REHAB / WELLNESS PROGRAM, AMBULATORY SURGERY / GI SERVICES, WOMENS IMAGING SERVICE, DIAGNOSTIC IMAGING SERVICES, RURAL HEALTH CLINIC RIMARY CARE SERVICES. IN 2019, THE HOSPITAL COMPLETED A MRI CAPITAL REPALCEMENT PROJECT OF $1.6M TO UPDATE TECHNOLOGY AND SERVICES PROVIDED LOCALLY.	Desc

Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp

Field	Value	IRS element (for citing)
Expense	$1,437,182	ExpenseAmt
Revenue	$1,115,547	RevenueAmt
Desc	THE HOSPITAL CONTINUED EFFORTS WITH SUPPORTING OUR ROLE AS A NYS DEFINED SAFETY-NET PROVIDER. IN 2019 PALNNING WAS INITIATED TO EXPAND RURAL HEALTH CLINIC LOCATIONS. RURAL HEALTH CLINICS WILL ALLOW FOR ENHANCING SUPPORT FOR PRIMARY CARE SERVCIES AND ENSURING ACCESS TO PRIMARY CARE IN RURAL COMMUNITES.	Desc

Field	Value	IRS element (for citing)
Total Other Prog Srvc Expense	$1,437,182	TotalOtherProgSrvcExpenseAmt
Total Other Prog Srvc Revenue	$1,115,547	TotalOtherProgSrvcRevenueAmt
Total Program Service Expenses	$29,284,995	TotalProgramServiceExpensesAmt
Described In Section501c3	Yes (1)	DescribedInSection501c3Ind
Schedule B Required	Yes (1)	ScheduleBRequiredInd
Political Campaign Acty	0	PoliticalCampaignActyInd
Lobbying Activities	Yes (1)	LobbyingActivitiesInd
Subject To Proxy Tax	0	SubjectToProxyTaxInd
Donor Advised Fund	0	DonorAdvisedFundInd
Conservation Easements	0	ConservationEasementsInd
Collections Of Art	0	CollectionsOfArtInd
Credit Counseling	0	CreditCounselingInd
Donor Rstr Or Quasi Endowments	Yes (1)	DonorRstrOrQuasiEndowmentsInd
Report Land Building Equipment	Yes (1)	ReportLandBuildingEquipmentInd
Report Investments Other Sec	Yes (1)	ReportInvestmentsOtherSecInd
Report Program Related Invst	0	ReportProgramRelatedInvstInd
Report Other Assets	0	ReportOtherAssetsInd
Report Other Liabilities	Yes (1)	ReportOtherLiabilitiesInd
Include FIN48 Footnote	Yes (1)	IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt	Yes (1)	IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt	0	ConsolidatedAuditFinclStmtInd
School Operating	0	SchoolOperatingInd
Foreign Office	0	ForeignOfficeInd
Foreign Activities	0	ForeignActivitiesInd
More Than5000 K To Org	0	MoreThan5000KToOrgInd
More Than5000 K To Individuals	0	MoreThan5000KToIndividualsInd
Professional Fundraising	0	ProfessionalFundraisingInd
Fundraising Activities	0	FundraisingActivitiesInd
Gaming Activities	0	GamingActivitiesInd
Operate Hospital	Yes (1)	OperateHospitalInd
Audited Financial Stmt Att	Yes (1)	AuditedFinancialStmtAttInd
Grants To Organizations	0	GrantsToOrganizationsInd
Grants To Individuals	0	GrantsToIndividualsInd
Schedule J Required	Yes (1)	ScheduleJRequiredInd
Tax Exempt Bonds	0	TaxExemptBondsInd
Engaged In Excess Benefit Trans	0	EngagedInExcessBenefitTransInd
PY Excess Benefit Trans	0	PYExcessBenefitTransInd
Loan Outstanding	0	LoanOutstandingInd
Grant To Related Person	0	GrantToRelatedPersonInd
Business Rln With Org Mem	0	BusinessRlnWithOrgMemInd
Business Rln With Fam Mem	0	BusinessRlnWithFamMemInd
Business Rln With35 Ctrl Ent	0	BusinessRlnWith35CtrlEntInd
Deductible Non Cash Contri	0	DeductibleNonCashContriInd
Deductible Art Contribution	0	DeductibleArtContributionInd
Terminate Operations	0	TerminateOperationsInd
Partial Liquidation	0	PartialLiquidationInd
Disregarded Entity	0	DisregardedEntityInd
Related Entity	Yes (1)	RelatedEntityInd
Related Organization Ctrl Ent	0	RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org	0	TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp	0	ActivitiesConductedPrtshpInd
Schedule O Required	Yes (1)	ScheduleORequiredInd
IRP Document	66	IRPDocumentCnt
IRP Document W2 G	0	IRPDocumentW2GCnt
Employee	387	EmployeeCnt
Employment Tax Returns Filed	Yes (1)	EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit	0	UnrelatedBusIncmOverLimitInd
Foreign Financial Account	0	ForeignFinancialAccountInd
Prohibited Tax Shelter Trans	0	ProhibitedTaxShelterTransInd
Taxable Party Notification	0	TaxablePartyNotificationInd
Nondeductible Contributions	0	NondeductibleContributionsInd
Quid Pro Quo Contributions	0	QuidProQuoContributionsInd
Form8282 Property Disposed Of	0	Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct	0	RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct	0	PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services	0	IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt	0	SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc	0	SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VI	Yes (X)	InfoInScheduleOPartVIInd
Governing Body Voting Members	15	GoverningBodyVotingMembersCnt
Independent Voting Member	11	IndependentVotingMemberCnt
Family Or Business Rln	0	FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties	0	DelegationOfMgmtDutiesInd
Change To Org Documents	0	ChangeToOrgDocumentsInd
Material Diversion Or Misuse	0	MaterialDiversionOrMisuseInd
Members Or Stockholders	Yes (1)	MembersOrStockholdersInd
Election Of Board Members	Yes (1)	ElectionOfBoardMembersInd
Decisions Subject To Approva	0	DecisionsSubjectToApprovaInd
Minutes Of Governing Body	Yes (1)	MinutesOfGoverningBodyInd
Minutes Of Committees	Yes (1)	MinutesOfCommitteesInd
Officer Mailing Address	0	OfficerMailingAddressInd
Local Chapters	0	LocalChaptersInd
Form990 Provided To Gvrn Body	Yes (1)	Form990ProvidedToGvrnBodyInd
Conflict Of Interest Policy	Yes (1)	ConflictOfInterestPolicyInd
Annual Disclosure Covered Prsn	Yes (1)	AnnualDisclosureCoveredPrsnInd
Regular Monitoring Enfrc	Yes (1)	RegularMonitoringEnfrcInd
Whistleblower Policy	Yes (1)	WhistleblowerPolicyInd
Document Retention Policy	Yes (1)	DocumentRetentionPolicyInd
Compensation Process CEO	Yes (1)	CompensationProcessCEOInd
Compensation Process Other	Yes (1)	CompensationProcessOtherInd
Investment In Joint Venture	0	InvestmentInJointVentureInd
States Where Copy Of Return Is Fld	NY	StatesWhereCopyOfReturnIsFldCd
Upon Request	Yes (X)	UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Field	Value	IRS element (for citing)
Person	JAMES G VIELKIND	PersonNm
Phone	3158235281	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	140 BURWELL STREET	AddressLine1Txt
City	LITTLE FALLS	CityNm
State Abbreviation	NY	StateAbbreviationCd
ZIP	13365	ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (21 entries)

TitleTitleTxt	Average Hours Per WeekAverageHoursPerWeekRt	Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd	OfficerOfficerInd	Reportable Comp From OrgReportableCompFromOrgAmt	Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt	Other CompensationOtherCompensationAmt	Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt	Highest Compensated EmployeeHighestCompensatedEmployeeInd
CHRISTINE REYNOLDS
THIRD VICE CHAIRMAN	2.00	Yes (X)	Yes (X)	$0	$0	$0
PHYLLIS SPINNER
TRUSTEE	2.00	Yes (X)		$0	$0	$0
TIMOTHY DALY
CHAIRMAN	2.00	Yes (X)	Yes (X)	$0	$0	$0
ANTHONY DELUCA
FIRST VICE CHAIRMAN	2.00	Yes (X)	Yes (X)	$0	$0	$0
GERARD J SNYDER
SECRETARY	2.00	Yes (X)	Yes (X)	$0	$0	$0
KEVIN CROSLEY
TRUSTEE	2.00	Yes (X)		$0	$0	$0
JUSTIN R HUMMEL
SECOND VICE CHAIRMAN	2.00	Yes (X)	Yes (X)	$0	$0	$0
AMY GRACE MD
PRESIDENT OF MEDICAL STAFF	2.00	Yes (X)	Yes (X)	$0	$261,214	$17,750	40.00
ROBERT CASULLO
TRUSTEE	2.00	Yes (X)		$0	$0	$0
KATE READ LAVALLA
TRUSTEE	2.00	Yes (X)		$0	$0	$0
LISA BETRUS
TRUSTEE	2.00	Yes (X)	Yes (X)	$0	$230,556	$17,649	40.00
KATHLEEN SELLERS
TRUSTEE	2.00	Yes (X)		$0	$0	$0
CHRISTINA CAIN
TRUSTEE	2.00	Yes (X)		$0	$0	$0
DAVID CASULLO
TRUSTEE	2.00	Yes (X)		$0	$0	$0
MICHAEL OGDEN
PRESIDENT & CEO	40.00		Yes (X)	$0	$226,428	$0
JAMES G VIELKIND
CHIEF FINANCIAL OFFICER	40.00		Yes (X)	$30,320	$192,500	$976
HEIDI CAMARDELLO
DIRECTOR OF NURSING	40.00			$139,194	$0	$10,659		Yes (X)
LOREEN E SHEPARDSON
DIRECTOR OF PHARMACY	40.00			$142,497	$0	$3,377		Yes (X)
PAUL L TRZEPACZ
CLINICAL LAB COORDINATOR	40.00			$117,634	$0	$20,709		Yes (X)
LINDA BELDEN
ADVANCE CARE PRACTITIONER	40.00			$107,805	$0	$20,475		Yes (X)
JODI POLLITT
NURSE SUPERVISOR	40.00			$116,479	$0	$10,122		Yes (X)

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	$653,929	TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org	$910,698	TotReportableCompRltdOrgAmt
Total Other Compensation	$101,717	TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K	12	IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed	0	FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K	Yes (1)	TotalCompGreaterThan150KInd
Compensation From Other Srcs	0	CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (3 entries)

Address Line1ContractorAddress/USAddress/AddressLine1Txt	CityContractorAddress/USAddress/CityNm	State AbbreviationContractorAddress/USAddress/StateAbbreviationCd	ZIPContractorAddress/USAddress/ZIPCd	ServicesServicesDesc	CompensationCompensationAmt
E 4 H ENVIRONMENTS
185 TALCOTT RD	WILLISTON	VT	05495	ARCHITECT SERVICES	$118,251
DM CONSULTING
PO BOX 4715	UTICA	NY	13504	INFORMATION TECHNOLOGY	$117,832
FUST CHARLES CHAMBERS
5784 WIDEWATERS PKWY	SYRACUSE	NY	13214	ACCOUNTING SERVICES	$107,427

Field	Value	IRS element (for citing)
Cntrct Rcvd Greater Than100 K	3	CntrctRcvdGreaterThan100KCnt
Related Organizations	$594,581	RelatedOrganizationsAmt
Government Grants	$670,958	GovernmentGrantsAmt
Total Contributions	$1,265,539	TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (5 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
OUTPATIENT SERVICES	623000	$24,685,465	$24,685,465
INPATIENT HOSPITAL	621930	$7,635,287	$7,635,287
OTHER OPERATING REVENUE	900099	$508,793	$508,793
PROGRAM SERVICE LEASE	532000	$457,634	$457,634
HOSPITAL CAFETERIA	900099	$152,322	$152,322

Field	Value	IRS element (for citing)
Total Program Service Revenue	$33,439,501	TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$119,430	TotalRevenueColumnAmt
Exclusion	$119,430	ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

Field	Value	IRS element (for citing)
Securities	$4,057,673	SecuritiesAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

Field	Value	IRS element (for citing)
Securities	$3,738,211	SecuritiesAmt

Gain Or Loss GainOrLossGrp

Field	Value	IRS element (for citing)
Securities	$319,462	SecuritiesAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$319,462	TotalRevenueColumnAmt
Exclusion	$319,462	ExclusionAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$35,143,932	TotalRevenueColumnAmt
Related Or Exempt Func Income	$33,439,501	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$0	UnrelatedBusinessRevenueAmt
Exclusion	$438,892	ExclusionAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

Field	Value	IRS element (for citing)
Total	$31,296	TotalAmt
Management And General	$31,296	ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

Field	Value	IRS element (for citing)
Total	$12,620,296	TotalAmt
Program Services	$11,083,943	ProgramServicesAmt
Management And General	$1,486,149	ManagementAndGeneralAmt
Fundraising	$50,204	FundraisingAmt

Pension Plan Contributions PensionPlanContributionsGrp

Field	Value	IRS element (for citing)
Total	$666,285	TotalAmt
Program Services	$584,568	ProgramServicesAmt
Management And General	$79,069	ManagementAndGeneralAmt
Fundraising	$2,648	FundraisingAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

Field	Value	IRS element (for citing)
Total	$1,523,081	TotalAmt
Program Services	$1,334,517	ProgramServicesAmt
Management And General	$182,518	ManagementAndGeneralAmt
Fundraising	$6,046	FundraisingAmt

Payroll Taxes PayrollTaxesGrp

Field	Value	IRS element (for citing)
Total	$943,322	TotalAmt
Program Services	$826,499	ProgramServicesAmt
Management And General	$113,079	ManagementAndGeneralAmt
Fundraising	$3,744	FundraisingAmt

Fees For Services Legal FeesForServicesLegalGrp

Field	Value	IRS element (for citing)
Total	$61,249	TotalAmt
Management And General	$61,249	ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

Field	Value	IRS element (for citing)
Total	$57,017	TotalAmt
Management And General	$57,017	ManagementAndGeneralAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

Field	Value	IRS element (for citing)
Total	$8,769	TotalAmt
Management And General	$8,769	ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

Field	Value	IRS element (for citing)
Total	$879,492	TotalAmt
Program Services	$244,484	ProgramServicesAmt
Management And General	$635,008	ManagementAndGeneralAmt

Advertising AdvertisingGrp

Field	Value	IRS element (for citing)
Total	$29,822	TotalAmt
Program Services	$29,822	ProgramServicesAmt

Office Expenses OfficeExpensesGrp

Field	Value	IRS element (for citing)
Total	$3,285,584	TotalAmt
Program Services	$3,237,040	ProgramServicesAmt
Management And General	$48,544	ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

Field	Value	IRS element (for citing)
Total	$1,664,187	TotalAmt
Program Services	$1,546,355	ProgramServicesAmt
Management And General	$117,832	ManagementAndGeneralAmt

Occupancy OccupancyGrp

Field	Value	IRS element (for citing)
Total	$656,299	TotalAmt
Program Services	$571,485	ProgramServicesAmt
Management And General	$81,161	ManagementAndGeneralAmt
Fundraising	$3,653	FundraisingAmt

Travel TravelGrp

Field	Value	IRS element (for citing)
Total	$26,902	TotalAmt
Program Services	$15,769	ProgramServicesAmt
Management And General	$10,600	ManagementAndGeneralAmt
Fundraising	$533	FundraisingAmt

Conferences Meetings ConferencesMeetingsGrp

Field	Value	IRS element (for citing)
Total	$23,419	TotalAmt
Program Services	$15,834	ProgramServicesAmt
Management And General	$7,510	ManagementAndGeneralAmt
Fundraising	$75	FundraisingAmt

Interest InterestGrp

Field	Value	IRS element (for citing)
Total	$152,704	TotalAmt
Program Services	$23,382	ProgramServicesAmt
Management And General	$129,322	ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

Field	Value	IRS element (for citing)
Total	$2,178,189	TotalAmt
Program Services	$1,844,659	ProgramServicesAmt
Management And General	$333,530	ManagementAndGeneralAmt

Insurance InsuranceGrp

Field	Value	IRS element (for citing)
Total	$229,314	TotalAmt
Program Services	$219,077	ProgramServicesAmt
Management And General	$10,237	ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (3 entries)

DescDesc	TotalTotalAmt	Program ServicesProgramServicesAmt	Management And GeneralManagementAndGeneralAmt	FundraisingFundraisingAmt
PURCHASE SERVICES	$5,795,853	$4,983,866	$776,987	$35,000
PROVISION FOR BAD DEBT	$1,677,414	$1,677,414
NEW YORK STATE ASSESSME	$101,839	$101,839

All Other Expenses AllOtherExpensesGrp

Field	Value	IRS element (for citing)
Total	$1,271,249	TotalAmt
Program Services	$944,442	ProgramServicesAmt
Management And General	$310,073	ManagementAndGeneralAmt
Fundraising	$16,734	FundraisingAmt

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$33,883,582	TotalAmt
Program Services	$29,284,995	ProgramServicesAmt
Management And General	$4,479,950	ManagementAndGeneralAmt
Fundraising	$118,637	FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

Field	Value	IRS element (for citing)
BOY	$976,567	BOYAmt
EOY	$2,342,352	EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

Field	Value	IRS element (for citing)
BOY	$1,675,789	BOYAmt
EOY	$1,761,517	EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$974,357	BOYAmt
EOY	$936,170	EOYAmt

Accounts Receivable AccountsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$2,534,018	BOYAmt
EOY	$2,723,301	EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

Field	Value	IRS element (for citing)
BOY	$562,367	BOYAmt
EOY	$637,130	EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

Field	Value	IRS element (for citing)
BOY	$473,592	BOYAmt
EOY	$966,166	EOYAmt

Field	Value	IRS element (for citing)
Land Bldg Equip Cost Or Other Bss	$48,814,355	LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec	$31,230,165	LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

Field	Value	IRS element (for citing)
BOY	$15,198,828	BOYAmt
EOY	$17,584,190	EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

Field	Value	IRS element (for citing)
BOY	$3,648,642	BOYAmt
EOY	$2,875,766	EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

Field	Value	IRS element (for citing)
BOY	$1,596,915	BOYAmt
EOY	$1,789,027	EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

Field	Value	IRS element (for citing)
BOY	$1,397,951	BOYAmt
EOY	$940,883	EOYAmt

Other Assets Total OtherAssetsTotalGrp

Field	Value	IRS element (for citing)
BOY	$1,325,472	BOYAmt
EOY	$766,594	EOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$30,364,498	BOYAmt
EOY	$33,323,096	EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

Field	Value	IRS element (for citing)
BOY	$3,286,547	BOYAmt
EOY	$3,758,010	EOYAmt

Deferred Revenue DeferredRevenueGrp

Field	Value	IRS element (for citing)
BOY	$215,663	BOYAmt
EOY	$397,112	EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

Field	Value	IRS element (for citing)
BOY	$3,533,810	BOYAmt
EOY	$1,683,693	EOYAmt

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

Field	Value	IRS element (for citing)
EOY	$2,388,724	EOYAmt

Other Liabilities OtherLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$2,221,528	BOYAmt
EOY	$1,597,773	EOYAmt

Total Liabilities TotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$9,257,548	BOYAmt
EOY	$9,825,312	EOYAmt

Field	Value	IRS element (for citing)
Organization Follows FASB117	Yes (X)	OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$15,193,191	BOYAmt
EOY	$17,755,767	EOYAmt

Donor Restriction Net Assets DonorRestrictionNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$5,913,759	BOYAmt
EOY	$5,742,017	EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$21,106,950	BOYAmt
EOY	$23,497,784	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$30,364,498	BOYAmt
EOY	$33,323,096	EOYAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	Yes (X)	InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss	$1,260,350	ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst	$379,310	NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets	$751,174	OtherChangesInNetAssetsAmt
Info In Schedule O Part XII	Yes (X)	InfoInScheduleOPartXIIInd
Method Of Accounting Accrual	Yes (X)	MethodOfAccountingAccrualInd
Accountant Compile Or Review	0	AccountantCompileOrReviewInd
FS Audited	Yes (1)	FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

Field	Value	IRS element (for citing)
Separate Basis Fincl Stmt	Yes (X)	SeparateBasisFinclStmtInd

Field	Value	IRS element (for citing)
Audit Committee	Yes (1)	AuditCommitteeInd
Federal Grant Audit Required	0	FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Hospital	Yes (X)	HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

Field	Value	IRS element (for citing)
Contributor	RESTRICTED	ContributorNum

Contributor Business Name ContributorBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	RESTRICTED	BusinessNameLine1

Contributor US Address ContributorUSAddress

Field	Value	IRS element (for citing)
Address Line1	RESTRICTED	AddressLine1
Address Line2	RESTRICTED	AddressLine2
City	RESTRICTED	City
State	RESTRICTED	State
ZIP Code	RESTRICTED	ZIPCode

Field	Value	IRS element (for citing)
Total Contributions	RESTRICTED	TotalContributionsAmt

Schedule C IRS990ScheduleC

Field	Value	IRS element (for citing)
Volunteers	0	VolunteersInd
Paid Staff Or Management	0	PaidStaffOrManagementInd
Media Advertisements	0	MediaAdvertisementsInd
Mailings Members	0	MailingsMembersInd
Publications Or Broadcast	0	PublicationsOrBroadcastInd
Grants Other Organizations	0	GrantsOtherOrganizationsInd
Direct Contact Legislators	0	DirectContactLegislatorsInd
Rallies Demonstrations	0	RalliesDemonstrationsInd
Other Activities	Yes (1)	OtherActivitiesInd
Other Activities	$8,769	OtherActivitiesAmt
Total Lobbying Expenditures	$8,769	TotalLobbyingExpendituresAmt
Not Described Section501c3	0	NotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	PART II-B, LINE 1:	FormAndLineReferenceDesc
Explanation	AMOUNTS FOR GENERAL LOBBYING ACTIVITIES ARE $8,769 COMPRISED FROM THE HEALTHCARE ASSOCIAITON MEMBERSHIPS AS FOLLOWS: HEALTHCARE ASSOCIATION OF NEW YORK STATE 17.97% OF DUES PAID OF $6,582. AMERICAN HOSPITAL ASSOCIATION 23.32% OF DUES PAID OF $16,732. IROQUOIS HEALTHCARE ALLIANCE 39.7% OF DUES PAID OF $9,280	ExplanationTxt

Schedule D IRS990ScheduleD

CY Endwmt Fund CYEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$5,913,759	BeginningYearBalanceAmt
Contributions	$482,000	ContributionsAmt
Investment Earnings Or Losses	$87,791	InvestmentEarningsOrLossesAmt
Grants Or Scholarships	$3,771	GrantsOrScholarshipsAmt
Other Expenditures	$737,762	OtherExpendituresAmt
End Year Balance	$5,742,017	EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$4,914,943	BeginningYearBalanceAmt
Contributions	$487,332	ContributionsAmt
Investment Earnings Or Losses	$512,484	InvestmentEarningsOrLossesAmt
Grants Or Scholarships	-$1,000	GrantsOrScholarshipsAmt
End Year Balance	$5,913,759	EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$4,609,617	BeginningYearBalanceAmt
Investment Earnings Or Losses	$305,326	InvestmentEarningsOrLossesAmt
End Year Balance	$4,914,943	EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$4,460,686	BeginningYearBalanceAmt
Investment Earnings Or Losses	$148,931	InvestmentEarningsOrLossesAmt
End Year Balance	$4,609,617	EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$4,590,711	BeginningYearBalanceAmt
Contributions	$14,514	ContributionsAmt
Investment Earnings Or Losses	-$144,539	InvestmentEarningsOrLossesAmt
End Year Balance	$4,460,686	EndYearBalanceAmt

Field	Value	IRS element (for citing)
Prmnnt Endowment Balance EOY	0.18790	PrmnntEndowmentBalanceEOYPct
Term Endowment Balance EOY	0.81210	TermEndowmentBalanceEOYPct
Endowments Held Unrelated Org	0	EndowmentsHeldUnrelatedOrgInd
Endowments Held Related Org	Yes (1)	EndowmentsHeldRelatedOrgInd
Related Org List Sch R	Yes (1)	RelatedOrgListSchRInd

Land LandGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$402,942	OtherCostOrOtherBasisAmt
Book Value	$402,942	BookValueAmt

Buildings BuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$32,083,003	OtherCostOrOtherBasisAmt
Depreciation	$19,020,544	DepreciationAmt
Book Value	$13,062,459	BookValueAmt

Equipment EquipmentGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$16,328,410	OtherCostOrOtherBasisAmt
Depreciation	$12,209,621	DepreciationAmt
Book Value	$4,118,789	BookValueAmt

Field	Value	IRS element (for citing)
Total Book Value Land Buildings	$17,584,190	TotalBookValueLandBuildingsAmt

Other Securities OtherSecuritiesGrp

Field	Value	IRS element (for citing)
Desc	ELSA O'BRIEN CHARITABLE REMAINER TR	Desc
Book Value	$1,789,027	BookValueAmt
Method Valuation	F	MethodValuationCd

Field	Value	IRS element (for citing)
Total Book Value Securities	$1,789,027	TotalBookValueSecuritiesAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)

DescDesc	AmtAmt
ACCRUED PENSION LIABILITY	$1,075,422
OTHER LIABILITIES	$522,351

Field	Value	IRS element (for citing)
Total Liability	$1,597,773	TotalLiabilityAmt
Footnote Text	Yes (X)	FootnoteTextInd
Total Rev Etc Audited Fincl Stmt	$33,845,828	TotalRevEtcAuditedFinclStmtAmt
Net Unrealized Gains Invst	$379,310	NetUnrealizedGainsInvstAmt
Revenue Not Reported	$379,310	RevenueNotReportedAmt
Revenue Subtotal	$33,466,518	RevenueSubtotalAmt
Other Revenues Not Included	$1,677,414	OtherRevenuesNotIncludedAmt
Revenue Not Reported Fincl Stmt	$1,677,414	RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990	$35,143,932	TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt	$32,206,168	TotExpnsEtcAuditedFinclStmtAmt
Expenses Not Reported	$0	ExpensesNotReportedAmt
Expenses Subtotal	$32,206,168	ExpensesSubtotalAmt
Other Expenses Not Included	$1,677,414	OtherExpensesNotIncludedAmt
Expenses Not Rpt Fincl Stmt	$1,677,414	ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990	$33,883,582	TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (5 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
PART V, LINE 4:	ENDOWMENT FUNDS DISTRIBUTE INCOME FOR PURPOSES OF CAPITAL INVESTMENT. TEMPORARY ENDOWMENTS ARE USED BASED ON THE INTENT OF THE DONATION WHICH IS TYPICALLY FOR CAPITAL INVESTMENTS.
PART X, LINE 2:	THE HOSPITAL QUALIFIES AS AN ORGANIZATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL INCOME TAXES PURSUANT TO SECTION 501(A) OF THE INTERNAL REVENUE CODE. AS OF DECEMBER 31, 2019 AND 2018, THE HOSPITAL DID NOT HAVE ANY UNRECOGNIZED TAX BENEFITS OR ANY RELATED ACCRUED INTEREST OR PENALTIES. THE TAX YEARS OPEN TO EXAMINATION BY FEDERAL AND NEW YORK STATE TAXING AUTHORITIES ARE 2016 THROUGH 2019.
PART XI, LINE 4B - OTHER ADJUSTMENTS:	BAD DEBT 1,677,414.
PART XII, LINE 4B - OTHER ADJUSTMENTS:	BAD DEBT 1,677,414.
PART VI, LINE 1E	INCLUDED IN BUILDINGS AND EQUIPMENT IS $2,351,493 OF ASSETS NOT IN USE. THESE ASSETS ARE ASSOCIATED WITH THE DOLGEVILLE PRIMARY CARE FACILITY THATA WAS COMPLETED IN FEBRUARY 2020.

Schedule H IRS990ScheduleH

Field	Value	IRS element (for citing)
Financial Assistance Policy	Yes (1)	FinancialAssistancePolicyInd
Written Policy	Yes (1)	WrittenPolicyInd
FPG Reference Free Care	Yes (1)	FPGReferenceFreeCareInd

Free Care Oth Percentage FreeCareOthPercentageGrp

Field	Value	IRS element (for citing)
Other	Yes (X)	OtherInd
Free Care Other	300.000000000000	FreeCareOtherPct

Field	Value	IRS element (for citing)
FPG Reference Discounted Care	0	FPGReferenceDiscountedCareInd
Free Care Medically Indigent	Yes (1)	FreeCareMedicallyIndigentInd
Financial Assistance Budget	Yes (1)	FinancialAssistanceBudgetInd
Expenses Exceed Budget	0	ExpensesExceedBudgetInd
Annual Community Bnft Report	Yes (1)	AnnualCommunityBnftReportInd
Report Publically Available	Yes (1)	ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

Field	Value	IRS element (for citing)
Persons Served	94	PersonsServedCnt
Total Community Benefit Expns	$149,505	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$52,092	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$97,413	NetCommunityBenefitExpnsAmt
Total Expense	0.00300	TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

Field	Value	IRS element (for citing)
Persons Served	13565	PersonsServedCnt
Total Community Benefit Expns	$6,464,158	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$5,103,717	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$1,360,441	NetCommunityBenefitExpnsAmt
Total Expense	0.04220	TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

Field	Value	IRS element (for citing)
Persons Served	13659	PersonsServedCnt
Total Community Benefit Expns	$6,613,663	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$5,155,809	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$1,457,854	NetCommunityBenefitExpnsAmt
Total Expense	0.04520	TotalExpensePct

Community Health Services CommunityHealthServicesGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$43,356	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$1,415	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$41,941	NetCommunityBenefitExpnsAmt
Total Expense	0.00130	TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

Field	Value	IRS element (for citing)
Persons Served	22	PersonsServedCnt
Total Community Benefit Expns	$25,136	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$0	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$25,136	NetCommunityBenefitExpnsAmt
Total Expense	0.00080	TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

Field	Value	IRS element (for citing)
Persons Served	1754	PersonsServedCnt
Total Community Benefit Expns	$984,395	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$609,448	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$374,947	NetCommunityBenefitExpnsAmt
Total Expense	0.01160	TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

Field	Value	IRS element (for citing)
Persons Served	1776	PersonsServedCnt
Total Community Benefit Expns	$1,052,887	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$610,863	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$442,024	NetCommunityBenefitExpnsAmt
Total Expense	0.01370	TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

Field	Value	IRS element (for citing)
Persons Served	15435	PersonsServedCnt
Total Community Benefit Expns	$7,666,550	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$5,766,672	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$1,899,878	NetCommunityBenefitExpnsAmt
Total Expense	0.05890	TotalExpensePct

Economic Development EconomicDevelopmentGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$7,416	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$7,416	NetCommunityBenefitExpnsAmt
Total Expense	0.00020	TotalExpensePct

Workforce Development WorkforceDevelopmentGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$64,035	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$64,035	NetCommunityBenefitExpnsAmt
Total Expense	0.00200	TotalExpensePct

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$71,451	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$71,451	NetCommunityBenefitExpnsAmt
Total Expense	0.00220	TotalExpensePct

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	Yes (1)	BadDebtExpenseReportedInd
Bad Debt Expense	$1,677,414	BadDebtExpenseAmt
Bad Debt Expense Attributable	$28,340	BadDebtExpenseAttributableAmt
Reimbursed By Medicare	$8,035,571	ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr	$8,271,776	CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall	-$236,205	MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

Field	Value	IRS element (for citing)
Cost To Charge Ratio	Yes (X)	CostToChargeRatioInd

Field	Value	IRS element (for citing)
Written Debt Collection Policy	Yes (1)	WrittenDebtCollectionPolicyInd
Financial Assistance Prvsn	Yes (1)	FinancialAssistancePrvsnInd
Hospital Facilities	1	HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

Field	Value	IRS element (for citing)
Facility	1	FacilityNum

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	LITTLE FALLS HOSPITAL	BusinessNameLine1Txt

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	140 BURWELL STREET	AddressLine1Txt
City	LITTLE FALLS	CityNm
State Abbreviation	NY	StateAbbreviationCd
ZIP	13365	ZIPCd

Field	Value	IRS element (for citing)
Website Address	BASSETT.ORG	WebsiteAddressTxt
State License	2129700H	StateLicenseNum
Critical Access Hospital	Yes (X)	CriticalAccessHospitalInd
Emergency Room24 Hrs	Yes (X)	EmergencyRoom24HrsInd
Other	INCLUDES 25 INPATIENT BEDS,	OtherDesc

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

Field	Value	IRS element (for citing)
Business Name Line1	LITTLE FALLS HOSPITAL	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Facility	1	FacilityNum
First Licensed CY Or PY	0	FirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PY	0	TaxExemptHospitalCYOrPYInd
CHNA Conducted	Yes (1)	CHNAConductedInd
Community Definition	Yes (X)	CommunityDefinitionInd
Community Demographics	Yes (X)	CommunityDemographicsInd
Existing Resources	Yes (X)	ExistingResourcesInd
How Data Obtained	Yes (X)	HowDataObtainedInd
Community Health Needs	Yes (X)	CommunityHealthNeedsInd
Other Health Issues	Yes (X)	OtherHealthIssuesInd
Community Hlth Needs Id Process	Yes (X)	CommunityHlthNeedsIdProcessInd
Consulting Process	Yes (X)	ConsultingProcessInd
Prior CHNA Impact	Yes (X)	PriorCHNAImpactInd
CHNA Conducted	19	CHNAConductedYr
Take Into Account Others Input	Yes (1)	TakeIntoAccountOthersInputInd
CHNA Conducted With Other Fclts	Yes (1)	CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non Fclts	Yes (1)	CHNAConductedWithNonFcltsInd
CHNA Report Widely Available	Yes (1)	CHNAReportWidelyAvailableInd
Rpt Available On Own Website	Yes (X)	RptAvailableOnOwnWebsiteInd
Own Website URL	WWW.BASSETT.ORG	OwnWebsiteURLTxt
Other Website	Yes (X)	OtherWebsiteInd
Other Website URL	WWW.BASSETT.ORG	OtherWebsiteURLTxt
Paper Copy Public Inspection	Yes (X)	PaperCopyPublicInspectionInd
Implementation Strategy Adopt	Yes (1)	ImplementationStrategyAdoptInd
Implementation Strategy Adpt	19	ImplementationStrategyAdptYr
Strategy Posted Website	Yes (1)	StrategyPostedWebsiteInd
Strategy Website URL	WWW.BASSETT.ORG	StrategyWebsiteURLTxt
Organization Incur Excise Tax	0	OrganizationIncurExciseTaxInd
Elig Criteria Explained	Yes (1)	EligCriteriaExplainedInd
FPG Family Incm Lmt Free Dscnt	Yes (X)	FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care	300.000000000000	FPGFamilyIncmLmtFreeCarePct
Explained Basis	Yes (1)	ExplainedBasisInd
App Financial Asst Expln	Yes (1)	AppFinancialAsstExplnInd
Described Info	Yes (X)	DescribedInfoInd
Described Suprt Doc	Yes (X)	DescribedSuprtDocInd
Provided Hospital Contact	Yes (X)	ProvidedHospitalContactInd
Provided Nonprofit Contact	Yes (X)	ProvidedNonprofitContactInd
Includes Publicity Measures	Yes (1)	IncludesPublicityMeasuresInd
FAP Available On Website	Yes (X)	FAPAvailableOnWebsiteInd
FAP Available On Website URL	WWW.BASSETT.ORG	FAPAvailableOnWebsiteURLTxt
FAP App Available On Website	Yes (X)	FAPAppAvailableOnWebsiteInd
FAP App Available On Website URL	WWW.BASSETT.ORG	FAPAppAvailableOnWebsiteURLTxt
FAP Summary On Website	Yes (X)	FAPSummaryOnWebsiteInd
FAP Summary On Website URL	WWW.BASSETT.ORG	FAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No Charge	Yes (X)	FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No Chrg	Yes (X)	FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No Chrg	Yes (X)	FAPSumAvlblOnRequestNoChrgInd
Notified FAP Copy Bill Display	Yes (X)	NotifiedFAPCopyBillDisplayInd
Communtity Notified FAP	Yes (X)	CommuntityNotifiedFAPInd
FAP Actions On Nonpayment	Yes (1)	FAPActionsOnNonpaymentInd
Permit No Actions	Yes (X)	PermitNoActionsInd
Collection Activities	0	CollectionActivitiesInd
Made Effort Orally Notify	Yes (X)	MadeEffortOrallyNotifyInd
Processed FAP Application	Yes (X)	ProcessedFAPApplicationInd
Made Presumptive Elig Determ	Yes (X)	MadePresumptiveEligDetermInd
Other Actions Taken	Yes (X)	OtherActionsTakenInd
Nondis Emergency Care Policy	Yes (1)	NondisEmergencyCarePolicyInd
Look Back Medicare Private	Yes (X)	LookBackMedicarePrivateInd
Amounts Generally Billed	0	AmountsGenerallyBilledInd
Gross Charges	0	GrossChargesInd

Supplemental Information SupplementalInformationGrp (6 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
PART V, SECTION A:	LITTLE FALLS HOSPITAL HAS PRIMARY CARE HEALTH CENTERS IN DOLGEVILLE, NY (ZIP CODE 13329) AND NEWPORT, NY (ZIP CODE 13416). IN DECEMBER 2019 LITTLE FALLS HOSPITAL BECAME THE OPERATOR OF FOUR RURAL HEALTH CLINICS OPERATED IN THE COMMUNITES OF WEST WINFIELD (ZIP CODE 13491), RICHFIELD SPRINGS (ZIP CODE 13439), ST. JOHNSVILLE (ZIP CODE 13452), AND LITTLE FALLS (ZIP CODE 13365).
LITTLE FALLS HOSPITAL	PART V, SECTION B, LINE 5: LITTLE FALLS HOSPITAL COLLABORATED WITH BASSETT RESEARCH INSTITUTE'S MOHAWK VALLEY POPULATION HEALTH IMPROVEMENT PROGRAM AND HERKIMER COUNTY PUBLIC HEALTH TO IDENTIFY STAKEHOLDERS FOR COMPLETING THE 2019 COMMUNITY HEALTH NEEDS ASSESSMENT. THE COMMUNITY HEALTH NEEDS ASSESSMENT PROVIDES THE HOSPITAL, LOCAL COUNTY HEALTH DEPARTMENT, AND KEY INFORMANTS WITH DATA AND RESPONSES SO THAT THEY MAY IDENTIFY, PRIORITIZE, AND ADDRESS HEALTH CARE CHALLENGES FACING THEIR COMMUNITIES. MVPHIP COLLABORATED WITH HERKIMER COUNTY PUBLIC HEALTH, HERKIMER COUNTY OFFICE FOR THE AGING, AND LITTLE FALLS HOSPITAL TO COMPILE A LIST OF KEY INFORMANTS IN THE SERVICE REGION. THOSE KEY INFORMANTS REPRESENT A BROAD RANGE OF SECTORS, COMMUNITY INTERESTS, AND INCLUDED ORGANIZATIONS THAT REPRESENT THE MEDICALLY UNDERSERVED, LOW-INCOME, AND MINORITY POPULATIONS. LITTLE FALLS HOSPITAL, HERKIMER COUNTY OFFICE FOR THE AGING, AND HERKIMER COUNTY PUBLIC HEALTH INVITED KEY INFORMANTS TO ATTEND A HERKIMER COUNTY DATA PRESENTATION AND TO GIVE FEEDBACK ON THEIR PRIORITY FOCUS AREAS BASED ON THE 2019-2024 NEW YORK STATE PREVENTION AGENDA ACTION PLANS. THOSE KEY INFORMANTS WHO WERE UNABLE TO ATTEND IN PERSON WERE SENT THE INFORMATION ELECTRONICALLY AND ASKED TO FILL OUT A SHORT SURVEY.HERKIMER COUNTY OFFICE OF THE AGING HERKIMER COUNTY OFA'S ADVISORY COUNCILHERKIMER COUNT LEGISLATORSHERKIMER COUNTY ADMINISTRATOR BRIAN MILLER, NYS ASSEMBLYLITTLE FALLS COMMUNITY OUTREACHHERKIMER COUNTY WORKFORCE DEVELOPMENT CENTRAL ASSOCIATIONS OF THE BLINDHERKIMER COUNTY HOUSING AUTHORITYHOSPICE OF HERKIMER & ONEIDA COUNTIESCOMMUNITY FOUNDATION OF HERKIMER & ONEIDA COUNTIESTOWN OF HERKIMERHERKIMER COUNTY CLERKCHRIS REYNOLDS, PRESIDENT HEALTHNET VALLEY HEALTH SERVICESMOHAWK VALLEY COMMUNITY ACTION AGENCYARC HERKIMERHERKIMER COUNTY PUBLIC HEALTHREGIONAL PRIMARY CARE NETWORKCORNELL COOPERATIVE EXTENSION OF HERKIMER COUNTYRCIL (LIFE@RCIL)JOHN SCARANO COMMUNITY MEMBERSHERKIMER COUNTY BOCESBRIDGES TO PREVENT TOBACCOHERKIMER COUNTY DSS COMMISSIONERLITTLE FALLS HOSPITALHERKIMER COUNTY MENTAL HEALTH SERVICESCATHOLIC CHARITIES OF HERKIMER COUNTY
LITTLE FALLS HOSPITAL	PART V, SECTION B, LINE 6A: THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS DEVELOPED AS PART OF A MULTI-HOSPITAL PLANNING PROCESS IN COORDINATION WITH BASSETT HEALTHCARE RESEARCH, BASSETT HEALTHCARE NETWORK, AND BASSETT MEDICAL CENTER AND LITTLE FALLS HOSPITAL. LEAD COMMUNITY AGENCY WAS HERKIMER COUNTY PUBLIC HEALTH.
LITTLE FALLS HOSPITAL	PART V, SECTION B, LINE 6B: THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) INLCUDED COMMUNITY ORGANIZATIONS SUCH AS: HERKIMER COUNTY PUBLIC HEALTH, HERKIMER HEALTHNET, HERKIMER COUNTY MENTAL HEALTH, BASSETT MEDICAL CENTER, LEATHERSTOCKING COLLABORATIVE HEALTH PARTNERS, MOHAWK VALLEY POPULATION HEALTH IMPROVEMENT PROGRAM, AND CANCER CENTER SERVICES OF ONEIDA, MADISON, AND HERKIMER COUNTY.
LITTLE FALLS HOSPITAL	PART V, SECTION B, LINE 11: THE LITTLE FALLS HOSPITAL COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) WORKING WITH COMMUNITY STAKEHOLDERS WILL CONTINUE TO FOCUS ON PREVENTING CHRONIC DISEASE, WELL BEING FOR LIMITING MENTAL HEALTH EPISODIC EVENTS, AND IMPROVING A HEALTH SAFETY LIFE STYLE. THE CHRONIC CARE DISEASE MANAGEMENT WILL USE MORE METHODS TO COMMUNICATE WITH RESIDENTS AND PROVIDERS FOR TRACKING PREVENTATIVE HEALTH SCREENINGS FOR PREVENTATIVE WOMEN'S HEALTH CARE. THE WELL BEING INITIATIVES WILL UNITE EFFORTS TO BUILD TRUSTWORTHY RELATIONSHIPS FOR PATIENTS REQUIRING SUPPORTS LEVELS FOR MENTAL HEALTH SERVICES. OUR INITIATIVE TO HAVE A HEALTHIER AND SAFER LIVING ENVIRONMENT EXTENDS TO MANY OPPORTUNITIES OF HEALTH CARE INTERACTIONS. WE WILL FOCUS ON EDUCATION OF AGE COHORTS TO HAVE A HEALTHIER AND SAFER HOME, AND LIFE STYLE. THESE THREE INITIATIVES ARE SUPPORTED BY THE COLLECTIVE COMMUNITY ASSETS OF COMMUNITY-BASED ORGANIZATIONS WHO HAVE ADOPTED AND PARTNERED WITH LITTLE FALLS HOSPITAL AND HERKIMER COUNTY HEALTH DEPARTMENT. THE ESTABLISHED WORKPLAN WILL BE THE GUIDELINES FOR MONITORING PROGRESS AND ALIGNMENT OF SERVICES TO MEET THESE OBJECTIVES. THE COMMUNITY HEALTH NEEDS ASSESSMENT BUILDS UPON THE PRIOR PLAN OF 2016 - 2018. THESE INITIATIVES INCLUDED PROMOTING MENTAL, EMOTIONAL AND BEHAVIORAL HEALTH, PREVENTING SUBSTANCE ABUSE, REDUCING OBESITY IN ADULTS AND CHILDREN, PREVENTING DIABETES, AND PREVENTING HEART DISEASE. THE PROGRESS TO DATE REFLECTS THE STRONG COMMITMENT OF SUPPORT FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT ACROSS MANY STAKEHOLDERS. LITTLE FALLS HOSPITAL, BASSETT MEDICAL CENTER, AND OTHER LOCAL HEALTH PROVIDERS HAVE INCREASED USE OF MEDIA TO IMPROVE PUBLIC AWARENESS OF ACCESS FOR SCREENING SERVICES, USE OF CLINICAL EDUCATORS ON THE BENEFITS OF HEALTH SCREENINGS, AND PARTNERING WITH PROVIDERS TO IMPROVE THEIR USE OF SCREENINGS FOR CHRONIC CARE ILLNESS. LITTLE FALLS HOSPITAL WILL PARTNER WITH HERKIMER COUNTY PUBLIC HEALTH ON STRENGTHENING RESOURCES AVAILABLE FOR MENTAL HEALTH BEHAVIORAL PATIENTS. MENTAL HEALTH SERVICES ARE CURRENTLY UNDERSTAFFED WITH CLINICAL PROVIDERS IN OUR SERVICE AREA. WORKING WITH THE LEATHERSTOCKING COLLABORATIVE HEALTH PARTNERS, PRIMARY CARE PROVIDERS ARE PERFORMING MENTAL HEALTH SCREENINGS AND TRACKING INFORMATION IN THE ELECTRONIC HEALTH RECORD. THIS ALLOWS FOR PRIMARY CARE AND MENTAL HEALTH PROVIDERS TO COLLABORATE ON MEDICAL AND MENTAL HEALTH CARE PLANS. LITTLE FALLS HOSPITAL, BASSETT MEDICAL CENTER, AND HERKIMER COUNTY PUBLIC HEALTH ARE COORDINATING RECRUITMENT OF ADDITIONAL MENTAL HEALTH PROVIDERS. LITTLE FALLS HOSPITAL IS A PARTNER IN THE LEATHERSTOCKING COLLABORATIVE HEALTH PARTNERS (LHCP), LLC. THIS ORGANIZATION REPRESENTS A REGIONAL ORGANIZATION, ESTABLISHED IN PARTNERSHIP WITH NYS DEPARTMENT OF HEALTH, UNDER A CMS REFERENCED DELIVERY SYSTEM REFORM INCENTIVE PAYMENT (DSRIP) PROGRAM. WHILE THIS PROGRAM ENDED IN 2019, BASSETT HEALTHCARE NETWORK CONTINUES TO SUPPORT THE HERKIMER COUNTY HUB FOR PLANNING AND ORGANIZING HEALTH IMPROVEMENT RESOURCES. SOME CURRENT ON-GOING INITIATIVES ARE AS FOLLOWS:1.) EDUCATING HEALTH CENTER PROVIDERS ON USING ASTHMA TREATMENT PLANS TO SUPPORT PATIENTS. IMPROVE ACCESS TO ASTHMA SPECIALISTS WITH THE ELECTRONIC HEALTH RECORD FOR SHARING CARE PLANS WITH COMMUNITY AGENCIES WHEN APPROPRIATE. 2.) INTRODUCED THE NYS MEDICAID ACCELERATED EXCHANGE (MAX) PROCESS TO USE PATIENT CENTERED PROCESSES TO REDUCE USE OF EMERGENCY DEPARTMENT BY CHRONIC CARE PATIENTS. LITTLE FALLS HEALTH CENTERS IN DOLGEVILLE AND NEWPORT PARTICIPATED IN THIS PROJECT AND IMPROVED THEIR CARE MANAGEMENT PLANS TO REDUCE EMERGENCY DEPARTMENT VISITS. 3.) THE SALVATION ARMY, LEATHERSTOCKING COLLABORATIVE HEALTH PARTNERS, AND LITTLE FALLS HOSPITAL DEVELOPED A CARE NAVIGATION PROGRAM TO ASSIST PATIENTS AND FAMILIES WITH HEALTH CARE DECISIONS. THIS SUPPORT EXTENDED ONE ON ONE TRAINING FOR ENCOURAGEMENT ON HAVING A SAFER AND MORE WELL-BEING IN THEIR LIVES. WE HAVE IDENTIFIED THE DIFFICULTY IN RECRUITING PRIMARY CARE AND UNDERSTAFFED MENTAL HEALTH PROVIDERS IN OUR REGION AS A BARRIER TO MEETING OUR CHNA GOALS. THIS SHORTAGE OF PROVIDERS IS BEING ADDRESSED IN RECRUITMENT PLANS IN COORDINATION WITH BASSETT MEDICAL CENTER, HERKIMER COUNTY PUBLIC HEALTH, AND LITTLE FALLS HOSPITAL. IN 2019 LITTLE FALLS HOSPITAL BECAME THE OPERATOR OF FOUR RURAL HEALTH CLINICS TO SUPPORT A NETWORK OF RURAL PROVIDERS AND CONTINUE ACCESS TO COMMUNITIES WITH PRIMARY CARE SERVICES. IN 2019 LITTLE FALLS HOSPITAL BEGAN DEVELOPMENT OF A NEW PRIMARY CARE OFFICE LOCATED IN DOLGEVILLE NEW YORK. THIS FACILITY WILL ENABLE MORE ACCESS TO CARE PROMOTE PREVENTATIVE HEALTH EDUCATION AND SERVICES. IN COLLABORATION WITH COMMUNITY AGENCIES THIS NEW FACILITY WILL BE COMPLETED IN 2020. THERE WILL BE EXPANDED SERVICES TO CONTINUE THE MISSION OF IMPROVING THE HEALTH CARE OF OUR PATIENTS.
LITTLE FALLS HOSPITAL	PART V, SECTION B, LINE 20E: LITTLE FALLS HOSPITAL PROVIDED MAILING INFORMATION TO UNINSURED PATIENTS FOR ENROLLING IN AN AFFORDABLE CARE ACT INSURANCE PRODUCT SPONSORED BY THE NYS HEALTH MARKETPLACE. LITTLE FALLS HOSPITAL ALSO ASSISTED PATIENTS WITH THE COMPLETION OF APPLICATIONS FOR ENROLLMENT INTO NYS MARKETPLACE PLANS. IN 2019, 92 PATIENTS WERE ENROLLED BY A LITTLE FALLS HOSPITAL EMPLOYED FACILITATOR INTO A NYS MARKETPLACE PLAN.

Field	Value	IRS element (for citing)
Facility	6	FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (6 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	FacilityFacilityTxt
1 - DOLGEVILLE HEALTH CENTER
9 GIBSON STREET	DOLGEVILLE	NY	13329	CLINIC
2 - NEWPORT HEALTH CENTER
BRIDGE STREET	NEWPORT	NY	13416	CLINIC
3 - LITTLE FALLS HEALTH CENTER
170 BURWELL STREET	LITTLE FALLS	NY	13365	CLINIC
4 - RICHFIELD SPRINGS HEALTH CENTER
8550 STATE HIGHWAY 28	RICHFIELD SPRINGS	NY	13439	CLINIC
5 - WEST WINFIELD HEALTH CENTER
544 E MAIN STREET	WEST WINFIELD	NY	13491	CLINIC
6 - ST JOHNSVILLE HEALTH CENTER
8 PARK PLACE	ST JOHNSVILLE	NY	13452	CLINIC

Supplemental Information Detail SupplementalInformationDetail (17 entries)

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PART I, LINE 3C:	LITTLE FALLS HOSPITAL PROVIDES SERVICES TO ALL PATIENTS, REGARDLESS OF THEIR ABILITY TO PAY. THE COMMUNITY SERVICE PROGRAM (CSP) IS AVAILABLE FOR PATIENTS WITHOUT INSURANCE COVERAGE FOR INCOMES UP TO 300% OF THE FEDERAL POVERTY INCOME GUIDELINES. OUR CSP COORDINATOR IS AN AUTHORIZED ENROLLMENT FACILITATOR FOR MEDICAID AND NEW YORK STATE INSURANCE EXCHANGE INSURANCE COVERAGES.
PART I, LINE 6A:	LITTLE FALLS HOSPITAL HEALTH COMMUNITY HEALTH NEEDS ASSESSMENT FOR THE PERIOD OF 2019 - 2021 IS COORDINATED WITH BASSETT HEALTHCARE NETWORK. BASSETT'S RESEARCH INSITITUTE'S MOHAWK VALLEY POPULATION IMPROVEMENT PROGRAM (MVPHIP) RECEIVED A GRANT FROM NEW YORK STATE DEPARTMENT OF HEALTH TO CONDUCT THE ASSESSMENT ON BEHALF OF BASSETT HEALTHCARE NETWORK'S LITTLE FALLS HOSPITAL AND THE HERKIMER COUNTY PUBLIC HEALTH. MVPHIP COLLABORATED WITH AGENCIES SUCH AS HERKIMER COUNTY PUBLIC HEALTH, HERKIMER COUNTY OFFICE FOR THE AGING, AND LITTLE FALLS HOSPITAL. THIS COORDINATED GROUP OF INTERESTED PARTIES ALSO INVITED KEY STAKEHOLDERS INTO THE DEVELOPMENT PROCESS OF THE COMMUNITY NEEDS ASSESSMENT FOR 2019 - 2021.
PART I, LINE 7:	COST FOR CHARITY CARE PATIENTS WAS CALCULATED USING RATIO OF COST TO CHARGES. COST ASSOCIATED WITH MEDICAID AND MEDICAID HMO PROGRAMS REPRESENTS AGGREGATE ALLOWABLE COST AND TOTAL GROSS CHARGES USED TO CALCULATE A FACILITY LEVEL COST TO CHARGE RATIO. THIS FACILITY LEVEL COST TO CHARGE RATIO WAS APPLIED TO TOTAL MEDICAID AND MEDICAID HMO CHARGES TO ARRIVE AT TOTAL MEDICAID COST. FOR SUBSIDIZED HEALTH SERVICES, THE LOSS DOES NOT INCLUDE GOVERNEMENT PAYERS LOSS INFORMATION IS REPORTED IN AGGREGATE AMOUNTS.
PART I, LINE 7G:	LITTLE FALLS HOSPITAL OPERATES TWO PRIMARY CARE HEALTH CENTERS LOCATED IN DOLGEVILLE AND NEWPORT NEW YORK. IN DECEMBER 2019 THE HOSPITAL BECAME THE OWNER OF FOUR RURAL HEALTH CLINICS LOCATED WITHIN OUR PRIMARY AND SECONDARY MARKET. WHILE THE ACTIVITY OF THESE FOUR RURAL HEALTH CLINICS WAS LIMITED BASED ON A TWO - WEEK BUSINESS CYCLE FOR 2019 THEY WERE INLCUDED IN OUR ANALYSIS OF THE COST FOR PROVIDING ACCESS TO CARE IN RURAL REGIONS. IN 2019 THE SIX PRIMARY CARE LOCATIONS PROVIDED PRIMARY CARE SERVICES INCLUDING VACCINATIONS, WELL CARE VISITS, AND PRIMARY CARE FOLLOW-UP APPOINTMENTS. USING AN ELECTRONIC HEALTH RECORD ENABLES PATIENTS TO HAVE ACCESS TO THEIR PERSONAL HEALTH INFORMATION IN A TIMELY MANNER. THROUGH AN ELECTONIC HEALTH RECORD SYSTEM, PATIENTS CAN ELECT TO HAVE PORTAL ACCESS FOR PORTIONS OF THEIR PERSONAL HEALTH INFORMATION. THESE HEALTH CENTERS ACHIEVED THE STATUS TO BE RECOGNIZED AS PATIENT CENTERED MEDICAL HOME (PCMH) UNDER THE NATIONAL COMMITTEE OF QUALITY ASSURANCE (NCQA) STANDARDS. AS A PCMH CARE COORDINATION AND MANAGEMENT OF PATIENT SOCIAL DETERMINANTS IS PART OF CARE PLANS FOR PATIENTS. GOVERNMENT PAYERS ARE EXCLUDED IN MEASURING SUBSIDIZED HEALTH CARE SERVICES TO ELIMINATE ANY DUPLICATION THAT WOULD OCCUR WHEN LOOKING AT DEFICITS INCURRED FROM GOVERNEMENT PAYERS. THE METHODOLOGY REVIEWS THE NON GOVERNMENT PATIENT ENCOUNTERS AND MEASURES DIRECT REVENUE RECEIVED FOR SERVICES. EXPENSES ALLOCATIONS ARE APPORTIONED BASED ON PATIENT ENCOUNTERS FOR SUBSIDIZED PATIENTS COMPARED TO TOTAL PATIENTS. IN FUTURE PERIODS OUR NEW RURAL HEALTH CLINICS WILL RECEIVE INCREASED PAYMENTS IN RECOGNITION OF THE HIGH FIXED COST OF RURAL HEALTHCARE PRIMARY CARE OPERATIONS.
PART I, LN 7 COL(F):	LITTLE FALLS HOSPITAL EXCLUDED $1,677,414 OF BAD DEBT EXPENSE TO CALCULATE COST OF PATIENT CARE. BAD DEBT IS REPORTED AS A FUNCTIONAL PROGRAM EXPENSE.
PART II, COMMUNITY BUILDING ACTIVITIES:	COMMUNITY BUILDING ACTIVITIES ARE ASSOCIATED WITH LITTLE FALLS HOSPITAL WORKING WITH COMMUNITY BUSINESSES THROUGH OUR MEMBERSHIP WITH LOCAL AGENCIES, SUCH AS HERKIMER COUNTY HEALTHNET, AMERICAN HEART ASSOCIATION, HOSPICE AND PALLIATIVE CARE INC. AND THE AREA HEALTH EDUCATION CENTERS (AHEC). THESE ACTIVITIES ALLOW FOR DIALOG ON CURRENT HEALTHCARE TOPICS, INSURANCE PROGRAMS, AND RECRUITMENT OF FUTURE EMPLOYEES. LITTLE FALLS HOSPITAL COLLABORATES WITH BASSETT MEDICAL CENTER ON RECRUITMENT INITIATIVES FOCUSING ON PRIMARY CARE. HERKIMER COUNTY HAS ONE OF THE LOWEST RATIOS OF PRIMARY CARE PROVIDERS TO RESIDENTS IN NEW YORK STATE. IN 2019, LITTLE FALLS HOSPITAL WAS A LICENSED PRACTICAL NURSES (LPN)PRECEPTOR TRAINING LOCATION SPONSORED WITH THE MOHAWK VALLEY BOARDS OF COOPERATIVE EDUCATIONAL SERVICES (BOCES). THIS TRAINING PROGRAM ENABLES FOR THE DEVELOPMENT OF FRONT-LINE HEALTH CARE WORKERS. IN 2019 THIS PROGRAM SUPPORTED THE CLINICAL DEVELOPMENT OF 7 LPN'S.
PART III, LINE 2:	BAD DEBTS INLCUDE INSURED AND UNINSURED BALANCES REFERRED TO COLLECTION AGENCIES FOR ATTEMPT TO SATISFY THE AMOUNT OUTSTANDING AFTER COLLECTIONS ON REFERRED ACCOUNTS.
PART III, LINE 3:	AN ESTIMATE FOR POTENTIAL CHARITY CARE WAS BASED ON THE DENIED APPLICATIONS PROCESSED IN 2019 COMPARED WITH THOSE APPROVED APPLICATIONS. THIS AMOUNTED TO AN 17.7% DENIAL RATE FOR CHARITY CARE APPLICATIONS WHICH IF APPROVED WOULD HAVE INCREASED THE AMOUNT OF CHARITY CARE AT COSTED AMOUNTS BY $28,340.
PART III, LINE 4:	THE HOSPITAL FOOTNOTE DESCRIBING PATIENT ACCOUNTS RECEIVABLES IS IN THE ATTACHED AUDITED FINANCIAL STATEMENTS NOTE (1)(L) PAGES 12 - 17.
PART III, LINE 8:	IN 2019, OUR OPERATING DEFICIT, WITH THE MEDICARE PART A & B PROGRAMS, WAS $236,205. MEDICARE REPRESENTS APPROXIMATELY 33% OF OUR TOTAL PATIENT REVENUE. LITTLE FALLS HOSPITAL IS A CRITICAL ACCESS HOSPITAL (CAH) WHICH IS PAID BY MEDICARE BASED ON COST OF CARE. THIS SHORTFALL IS DIFFICULT TO FUND WHEN CONSIDERING OUR ADDITIONAL MEDICAID DEFICIT OF APPROXMIATELY $1.4. OUR SAFETY NET HOSPITAL STATUS INDICATES WE ARE A NYS RURAL PROVIDER WITH A GREATER THAN 30% THRESHOLD FOR MEDICAID UTILIZATION OF OUR SERVICES. OUR HIGH VOLUME OF MEDICAID IS REPRESENTED ON IRS FORM 990 SCHEDULE H LINE 7B.
PART III, LINE 9B:	OUR COLLECTION AND CHARITY CARE POLICY SPECIFIES THAT ACCOUNTS WITH ACTIVE CHARITY CARE APPLICATIONS WILL NOT GO TO COLLECTION AGENCIES WHILE APPLICATIONS ARE IN REVIEW. WHILE A REQUEST FOR CHARITY CARE ASSISTANCE IS IN PROCESS, THESE ACCOUNTS ARE PLACED ON HOLD IN OUR BILLING SYSTEM. WE COMMUNICATE INFORMATION ON REQUIREMENTS FOR ASSISTANCE AND WILL COUNSEL PATIENTS ON PROVIDING THE INCOME INFORMATION TO DETERMINE IF THEY QUALIFY FOR CHARITY CARE USING 300% OF THE FEDERAL POVERTY INCOME GUIDELINES. (NOTE: OUR CHARITY CARE PROGRAM IS FOR THE UNINSURED PATIENT.)
PART VI, LINE 2:	LITTLE FALLS HOSPITAL PARTNERED WITH BASSETT RESEARCH INSTITUTE'S MOHAWK VALLEY POPULATION HEALTH IMPROVEMENT PROGRAM (MVPHIP), A GRANT FUNDED PROGRAM FROM NEW YORK STATE DEPARTMENT OF HEALTH, WHO CONDUCTED AN ASSESSMENT ON BEHALF OF BASSETT HEALTHCARE NETWORK'S LITTLE FALLS HOSPITAL AND THE HERKIMER COUNTY PUBLIC HEALTH. THE COMMUNITY HEALTH NEEDS ASSESSMENT PROVIDES THE HOSPITAL, LOCAL COUNTY HEALTH DEPARTMENT AND STAKEHOLDERS WITH DATA AND KEY INFORMANT SURVEY RESPONSES SO THAT THEY MAY IDENTIFY, PRIORITIZE AND ADDRESS HEALTH CARE CHALLENGES FACING THEIR COMMUNITIES. UTILIZING THE NEW YORK STATE'S PREVENTION AGENDA. MVPHIP COLLABORATED WITH THE LOCAL HEALTH DEPARTMENT AND LITTLE FALLS HOSPITAL TO COMPILE A LIST OF KEY INFORMANTS IN THE SERVICE REGION. THOSE TWENTY NINE KEY INFORMANTS REPRESENT A BROAD RANGE OF SECTORS, COMMUNITY INTERESTS AND INCLUDED ORGANIZATIONS WHICH REPRESENT THE MEDICALLY UNDERSERVED, LOW-INCOME AND MINORITY POPULATIONS. THE KEY INFORMANTS PARTICIPATED AT A CONFERENCE ON JUNE 20, 2019 TO DEVELOP PRIORTIES FOR COMMUNITY HEALTH IMPROVEMENT PROGRAMS FOR 2019 2021.BASED ON THE KEY INFORMANT SURVEY RESULTS, PARTICIPANTS RANKED PROMOTION OF MENTAL HEALTH AND PREVENTION OF SUBSTANCE ABUSE NUMBER ONE AND PREVENTION OF CHRONIC DISEASE RANKED NUMBER TWO. AFTER SELECTING THE PRIORITIES, SURVEY PARTICIPANTS WERE ASKED TO RANKED THEIR TOP FIVE FOCUS AREAS FROM ALL OF THE PREVENTION AGENDA PRIORITIES.BASED ON THE SURVEY RESULTS, THE FOLLOWING TOP SIX FOCUS AREAS ARE TIED TO THE TOP TWO SELECTED PRIORITIES FOR LITTLE FALLS HOSPTIAL WERE APPROVED. PRIORITIES:1. PREVENT MENTAL HEALTH AND SUBSTANCE USE DISORDERS2. PROMOTE WELL BEING3. TOBACCO PREVENTION 4. CHILD AND ADOLSCENT HEALTH5. PREVENTITIVE CARE MANAGEMENT 6. INJURIES, VIOLENCE OCCUPATIONAL HEALTH COORDINTED ACTION PLANS WERE DEVELOPED WITH USE OF COMMUNITY RESOURCES TO ADDRESS THE SIX IDENTIFIFED AREAS FOR HEALTH IMPROVEMENT. LITTLE FALLS HOSPITAL IMPLEMENTED ACTION PLANS ADDRESSING PROMOTION OF WELL BEING, PREVENTAITIVE CARE AND MANAGEMENT, AND INJURIES, VIOLENCE & OCCUPATIONAL HEALTH. EACH ACTION PLAN INCLUDES, GOALS AND INTERVENTIONS, PROCES MEASURES, AND PARTNER ROLES AND RESOURCES. GOALS ARE MEASURED FROM THE 2019 COMMUNITY HEALTH NEEDS ASSESSMENT TO ADDRESS IDENITIFED DISPARATE POPULATIONS. ALONG WITH HEALTH INDICATORS TO MEASURE PROGRESS TOWARD ACHIEVING THE GOALS, INCLUDING REDUCING HEALTH DISPARITIES FOR INDIVIDUALS WITH LOW SOCIO-ECONOMIC STATUS, DISABILITIES, RACIAL AND ETHNIC GROUPS, AS WELL AS OTHER POPULATIONS WHO EXPERIENCE THEM.COMMUNITY ASSETS AND RESOURCES:A. NEW YORK STATE HEALTH CARE TRANSFORMATION INITIATIVES:NEW YORK STATE DEPARTMENT OF HEALTH PRIORITIZES THE SIGNNIFACNT HEALTH NEEDS OF ALL COMMUNITIES ACROSS THE STATE THROUGH THE PEVENTION AGENDA. THIS IS THE THIRD CYCLE FOR THIS STATEWIDE INITIAITIVE THAT WAS INITIATED IN 2008. NEW TO 2019 2024 CYCLE IS THE INCORPORATION OF A HEALTH ACROSS ALL POLICIES APPROACH, WHICH CALLS ON ALL STATE AGENCIES TO IDENTIFY AND STRENGEN THE WAYS THEIR POLICIES AND PROGRAMS CAN HAVE A POSITIVE IMPACT ON HEALTH. EACH OF SIX PRIORITIES HAVE CONTRIBUTES TO THE PURSUIT OF THESE NEW YORK STATE POLICY APPROACHES. DELIVERY SYSTEM REFORM INCENTIVE PAYMENT (DSRIP) PROGRAMSLITTLE FALLS HOSPITAL AND HERKIMER COUNTY PUBLIC HEALTH ARE PARTICIPATING PARTNERS IN BASSETT HEALTHCARE NETWORK'S LEATHERSTOCKING COLLABORATIVE HEALTH PARTNERS (LCHP) PPS. LCHP INCLUDES PROVIDERS AND COMMUNITY BASED ORGANIZATIONS FROM DELAWARE, HERKIMER, MADISON, OTSEGO AND SCHOHARIE COUNTIES. DSRIP'S PURPOSE IS TO USE COLLABORATIVE APPORACHES TO REDESIGN AND REINVESTIGN IN THE MEDICAID PROGRAM.POPULATION HEALTH IMPROVEMENT PROGRAMS (PHIP):THE PHIP SUPPORTS AND ADVANCES THE ONGOING ACTIVITIES OF NEW YORK STATE PREVENTION AGENDA AND THE STATE HEALTH INNOVATION PLAN, AS WELL AS, SERVES AS A RESOURCE FOR THE LOCAL PERFORMING PROVIDERS SYSTEMS.LITTLE FALLS HOSPITAL AND HERKIMER COUNTY PUBLIC HEALTH ARE ACTIVE MEMBERS OF THE MOHAWK VALLEY PHIP BOARD. THE BASSETT HEALTHCARE NETWORK'S BASSETT RESEARCH INSTITUTE IS THE CONTRACTOR FOR THE MOHAWK VALLEY PHIP WHICH COMPRISES FULTON, HERKIMER, MONTGOMERY, OTSEGO AND SCHOHARIE COUNTIES. COMMUUNITY HEALTH NEEDS ASSESSMENT PRIOR TOPICS 2016 2018MEASUREMENT FOR PRIOR TOPICS OF THE LITTLE FALLS HOSPITAL AND HERKIMER COUNTY PUBLIC HEALTH COMMUNITY HEALTH NEEDS ASSESSMENT CONTINUES AS BEING A PART OF THE NEW SIX NEW HEALTH PRIORITIES FOR 2019 2021. THESE CONTINUED ACTIVITIES ARE TO MEASURE PREVENTATIVE HEALTH SCREENINGS FOR BREAST AND CERVICAL CANCER, COLORECTAL TESTING SCREENINGS, AND BLLOD GLUCOSE MONITORING. THESE COORDIANTED HEALTH INTERVENTIONS ARE ALSO SUPPORTED WITH EDUCATION WITH MEDICAL PROVIDERS TO SUPPORT THEIR ROLE IN IDENTYING PATIENTS REQUIRING SERVICES TO SUPPORT HEALTHIER LIFE STLES. INCREASES IN USE OF MEDIA FOR POPULATION AWARENESS OF PROGRAMS WAS ALSO EXTENDED USING MORE ELECTRONIC MEDIA. DURING THE PERIOD OF 2016 2018 MANY OF THE HEALTH EDUCATION AND SCREENING ASSESSMENTS ACCOMPLISHED HIGHER RATES OF PARTICIAPTION. THESE INITIATIVES WILL CONTINUE TO SUPPORT OUR NEEDS ASSESSMENT FOR THE CURRENT PERIOD OF 2019 2021. THIS INFORMATION IS FROM LITTLE FALLS HOSPITAL 2019 COMMUNITY HEALTH NEEDS ASSESSMENT
PART VI, LINE 3:	LITTLE FALLS HOSPITAL PROVIDES ACCESS AND EDUCATION ON THE COMMUNITY SERVICE PROGRAM WITH CONTACT INFORMATION FOR PATIENTS TO CALL AND MAKE APPOINTMENTS FOR COMPLETING APPLICATIONS FOR FINANCIAL ASSISTANCE. AT ALL PATIENT ACCESS LOCATIONS, APPLICATIONS FOR CHARITY CARE ASSISTANCE ARE AVAILABLE. THE WWW.BASSETT.ORG WEBSITE INCLUDES A LINK ON INFORMATION FOR COMPLETING AN APPLICATION AND OTHER RESOURCES CALLED "FINANCIAL ASSISTANCE RESOURCE GUIDE". OUR FINANCIAL ASSISTANCE COORDINATOR PROVIDES INSURANCE COVERAGE NAVIGATION SERVICES TO ASSIST RESIDENTS WITH ENROLLMENT IN GOVERNMENT SPONSORED HEALTH CARE COVERAGE PROGRAMS. A COMMUNITY NAVIGATOR IS ALSO PRESENT IN THE EMERGENCY DEPARTMENT TO ASSIST WITH APPLICATIONS FOR GOVERNMENT SPONSORED HEALTH CARE COVERAGE PROGRAMS OR TO COMPLETE APPLICATIONS FOR OUR FINANCIAL ASSISTANCE PROGRAM. OUR APPLICATION ALSO SPECIFIES ON-SITE PROVIDERS WHO DO NOT PARTICIPATE IN LITTLE FALLS HOSPITAL FINANCIAL ASSISTANCE PROGRAM
PART VI, LINE 4:	LITTLE FALLS HOSPITAL SERVES AN ESTIMATED POPULATION OF OVER 62,000 PEOPLE IN 17 COMMUNITIES THROUGHOUT HERKIMER COUNTY, AND SECTIONS OF FULTON AND MONTGOMERY COUNTIES. THE SERVICE AREA POPULATION IS COMPRISED OF INDIVIDUALS AND FAMILIES FROM ALL SOCIO-ECONOMIC AND EDUCATIONAL LEVELS. THE POPULATION IS 96 PERCENT WHITE, 51 PERCENT FEMALE AND 49 PERCENT MALE. THE AGE DISTRIBUTION OF THE POPULATION IS SIMILAR TO OTHER UPSTATE NEW YORK AREAS WITH 5.4 PERCENT OF THE POPULATION UNDER 5 YEARS OF AGE, 24 PERCENT UNDER THE AGE OF 18, AND 22.2 PERCENT AGED 65 AND OLDER. NEARLY 89 PERCENT OF THE POPULATION OVER AGE OF 25 HAS GRADUATED FROM HIGH SCHOOL. MEDIAN HOUSEHOLD INCOME OF $54,794 IS BELOW THE STATE MEDIAN OF $71,855. IT'S ESTIMATED THAT 10 PERCENT OF THE POPULATION IS BELOW THE FEDERAL POVERTY LEVEL. APPROXIMATELY 93% OF RESIDENTS HAVE HEALTH COVERAGE, AN IMPROVEMENT OF 6% SINCE 2013.
PART VI, LINE 5:	LITTLE FALLS HOSPITAL IMPLEMENTS COORDINATED HEALTH CARE RESOURCES WITH BASSETT HEALTHCARE NETWORK. THIS COLLABORATION INCLUDED PLANNING AND IMPLEMENTING INITIATIVES UNDER A NEW YORK STATE DELIVERY SYSTEM REFORM INCENTIVE PAYMENT (DSRIP) PROJECT. DSRIP ACTIVITIES ARE COORDINATED WITH COMMUNITY BASED ORGANIZATIONS TO DEVELOP CARE IMPROVEMENT PROGRAMS IN A COORDINATED MANNER. THE HERKIMER COUNTY HUB WAS ORGANIZED SO COMMUNITY AGENCIES COULD DEVELOP INITIATIVES FOR IMPROVING COMMUNICATIONS FOR REFERRALS TO PROGRAMS FOR HIGH NEED PATIENTS. WITH THESE COMMUNITY AGENCIES ENGAGED A HIGHER DEGREE OF PATIENT INTERACTION IS POSSIBLE TO ACHIEVE POSITIVE IMPACTS ON IMPROVING THEIR HEALTH CARE. LITTLE FALLS HOSPITAL PARTNERED WITH SALVATION ARMY FOR THEIR ASSISTANCE IN PROVIDING PATIENT NAVIGATION SERVICES. THESE NAVIGATION SERVICES PROVIDE PATIENTS AND FAMILY SUPPORT FOR MEDICAL AND SOCIAL ASSISTANCE TO IMPROVE A HEALTHIER LIFE STYLE.
PART VI, LINE 6:	LITTLE FALLS HOSPITAL IS A SUBSIDIARY OF 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 FIVE 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.)THE MARY IMOGENE BASSETT HOSPITAL, AN ACUTE CARE INPATIENT TEACHING FACILITY IN COOPERSTOWN, NEW YORK. RELATED SERVCIES IS A REGIONAL NETWORK CONSITING OF 29 LOCATIONS FOR PRIMARY AND SPECIALTY CARE SERVICES, TWENTY SCHOOL BASED HEALTH CENTERS, AND TWO AMBULAORY SURGERY CENTERS.B.) O'CONNOR HOSPITAL, IS A CRITICAL ACCESS HOSPITAL IN DELHI, NEW YORK LOCATED IN DELAWARE COUNTY.C.) COBLESKILL REGIONAL HOSPITAL, IS A CRITICAL ACCESS HOSPITAL IN COBLESKILL, NEW YORK LOCATED IN SCHOHARIE COUNTY.D.) LITTLE FALLS HOSPITAL, IS A CRITICAL ACCESS HOSPITAL IN LITTLE FALLS, NEW YORK LOCATED IN HERKIMER COUNTY. LITTLE FALLS HOSPITAL INLCUDES FIVE RURAL HEALTH CLINICS AND ONE OUTPATIENT PRIMARY CARE CENTER. E.) TRI TOWN REGIONAL HOSPITAL A 24/7 EMERGENCY CARE FACILITY IN SIDNEY, DELAWARE COUNTY, OPERAITNG AS A DEPARTMENT OF AUREILA OSBORN FOX MEMORIAL HOSPITAL, AN ACUTE CARE FACILITY IN ONEONTA, OTSEGO COUNTY.F.) AURELIA OSBORN FOX HOSPITAL A SOLE COMMUNITY PROVIDER IN ONEONTA NEW YORK LOCATED IN OTSEGO COUNTY.G.) VALLEY HEALTH SERVICES A RESIDENTIAL HEALTH CARE AND REHABILITATION FACILITY LOCATED IN HERKIMER, NEW YORKOTHER COMPONENTS OF THE NETWORK, INCLUDES AT HOME CARE, A CERTIFIED HOME CARE AGENCY AND FIRST COMMUNITY CARE OF BASSETT, AND A MEDICAL SUPPLY COMPANY, ALL OF WHICH MAKE UP THE BASSETT HEALTHCARE NETWORK AND PROVIDE HEALTH SERVICES TO THIS NINE COUNTY REGION IN CENTRAL NEW YORK.LITTLE FALLS HOSPITAL COLLABORATES WITH BASSETT HEALTHCARE NETWORK AND BASSETT MEDICAL CENTER TO COORDIANTE THE EFFICIENT DELIVERY OF HEALTHCARE IN OUR SERVICE AREA. THIS RELATIONSHIP HAS DEVELOPED OVER A PERIOD OF FIFTEEN YEARS AND CONTINUES TO PROVIDE RESIDENTS ACCESS TO A HIGH QUALITY HEALTHCARE SYSTEM. OUR INTEGRATED ELECTRONIC HEALTH RECORD HAS ENABLED OUR PATIENTS TO RECEIVE IMPROVED COORDINDATED CARE AND ACCESS TO THEIR HEALTH INFORMATION NOT ROUTINELY SEEN IN RURAL HEALTH NETWORKS. OUR COLLABORTIVE PLANNING ON PROJECTS SUCH AS THE NYS DELIVERY SYSTEM REFORM INCENTIVE PAYMENT SYSTEM (DSRIP) AND RELATED MOHAWK VALLEY POPULATION HEALTH IMPROVEMENT PROGRAM ARE EXAMPLES OF OUR COLLABORATION TO IMPROVE THE HEALTHCARE SYSTEMS IN OUR SERVICE AREA. LITTLE FALLS HOSPITAL AS A LEADER WITH BASSETT HEALTHCARE NETWORK IN COORDINATION OF PATIENT ADVOCATE GROUPS IS MAKING A DIFFERENCE FOR IMPROVING HEALTHCARE. THESE INITIATIVES WITHIN THE DSRIP PROGRAM CONTINUE TO IMPROVE IN PATIENT INTERACTIONS TO SUPPORT ACCESS TO CARE, AND PREVENTATIVE CARE PLANS. THIS IS A NEW AREA OF EMPHASIS WITH CARE INNOVATION MODELS WHICH CREATE LEARNING PARTERSHIPS WITH PATIENTS AND PROVIDERS.
PART VI, LINE 7, REPORTS FILED WITH STATES	NY

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
First Class Or Charter Travel	Yes (X)	FirstClassOrCharterTravelInd
Written Policy Ref T And E Expnss	0	WrittenPolicyRefTAndEExpnssInd
Substantiation Required	0	SubstantiationRequiredInd
Compensation Committee	Yes (X)	CompensationCommitteeInd
Written Employment Contract	Yes (X)	WrittenEmploymentContractInd
Compensation Survey	Yes (X)	CompensationSurveyInd
Board Or Committee Approval	Yes (X)	BoardOrCommitteeApprovalInd
Severance Payment	0	SeverancePaymentInd
Supplemental Nonqual Rtr Plan	0	SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm	0	EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org	0	CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs	0	CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org	0	CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs	0	CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments	0	AnyNonFixedPaymentsInd
Initial Contract Exception	0	InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (4 entries)

TitleTitleTxt	Base Compensation Filing OrgBaseCompensationFilingOrgAmt	Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt	Bonus Filing OrganizationBonusFilingOrganizationAmount	Bonus Related OrganizationsBonusRelatedOrganizationsAmt	Other Compensation Filing OrgOtherCompensationFilingOrgAmt	Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt	Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt	Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt	Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt	Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt	Total Compensation Filing OrgTotalCompensationFilingOrgAmt	Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt	Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt	Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
AMY GRACE MD
PRESIDENT OF MEDICAL STAFF	$0	$237,517	$0	$23,697	$0	$0	$0	$10,254	$0	$7,496	$0	$278,964	$0	$0
LISA BETRUS
TRUSTEE	$0	$226,386	$0	$4,170	$0	$0	$0	$11,467	$0	$6,182	$0	$248,205	$0	$0
MICHAEL OGDEN
PRESIDENT & CEO	$0	$210,978	$0	$15,450	$0	$0	$0	$9,146	$0	$2,240	$0	$237,814	$0	$0
JAMES G VIELKIND
CHIEF FINANCIAL OFFICER	$30,320	$192,500	$0	$0	$0	$0	$910	$0	$66	$0	$31,296	$192,500	$0	$0

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	PART I, LINE 3	FormAndLineReferenceDesc
Explanation	THE COMPENSATION PROCESS FOR TOP OFFICIAL THE CHIEF EXECUTIVE OFFICER'S SALARY IS PAID BY A RELATED ORGANIZATION UNDER A MANAGEMENT SERVICES AGREEMENT. THE LITTLE FALLS HOSPITAL BOARD OF TRUSTEE'S REVIEWS THE FORMAL PROCESS THAT IS USED TO DETERMINE THE BASE COMPENSATION OF THE CEO. THE CEO WORK PLAN AND ACCOMPLISHMENTS FOR THE YEAR ARE REVIEWED. SALARY CHANGES ARE BASED ON MARKET, WORK PLAN, AND ACCOMPLISHMENTS. THE CEO'S SALARY IS SUBMITTED AS PART OF THE MANAGEMENT SERVICES AGREEMENT WHICH IS APPROVED BY THE BOARD OF TRUSTEES.	ExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (9 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
FORM 990, PART III, LINE 2	LITTLE FALLS HOSPITAL BECAME THE OPERATOR OF FOUR RURAL HEALTH CLINICS IN THE COMMUNITIES OF LITTLE FALLS, ST. JOHNSVILLE, WEST WINFIELD, AND RICHFIELD SPRINGS.
FORM 990, PART VI, SECTION A, LINE 6	THE SOLE MEMBER OF THE HOSPITAL IS BASSETT HEALTHCARE NETWORK.
FORM 990, PART VI, SECTION A, LINE 7A	BASSETT HEALTHCARE NETWORK, AS THE SOLE MEMBER, HAS THE POWER TO ELECT OR APPOINT ONE OR MORE MEMBERS OF THE GOVERNING BODY.
FORM 990, PART VI, SECTION B, LINE 11B	LITTLE FALLS HOSPITAL PRESENTS THE DRAFT 990 TO THE 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	CONFLICT OF INTEREST STATEMENTS ARE MADE ANNUALLY. NEW BOARD MEMBERS ARE REQUIRED TO DISCLOSE ON THEIR RESUME ALL AFFILIATED ORGANIZATIONS.
FORM 990, PART VI, SECTION B, LINE 15	THE CHIEF EXECUTIVE OFFICER'S SALARY IS PAID BY A RELATED ORGANIZATION UNDER A MANAGEMENT SERVICES AGREEMENT. THE LITTLE FALLS HOSPITAL BOARD OF TRUSTEES REVIEWS THE FORMAL PROCESS THAT IS USED TO DETERMINE THE BASE COMPENSATION OF THE CEO. THE CEO'S WORK PLAN AND ACCOMPLISHMENTS FOR THE YEAR ARE REVIEWED. SALARY CHANGES ARE BASED ON MARKET, WORKPLAN, AND ACCOMPLISHMENTS. THE CEO'S SALARY IS SUBMITTED AS PART OF THE MANAGEMENT SERVICES AGREEMENT WHICH IS APPROVED BY THE BOARD.
FORM 990, PART VI, SECTION C, LINE 19	LITTLE FALLS HOSPITAL MAKES AVAILABLE THE IRS FROM 990 UPON REQUEST ALONG WITH INFORMATION INCLUDED WITHIN THE 990 SUCH AS FINANCIAL REPORTS, CONFLICT OF INTEREST POLICY, AND CODE OF CONDUCT. THE HOSPITAL ALSO PROVIDES THE ANNUAL OPERATING PLAN AND CORPORATE VALUES IN PUBLIC AREAS OF THE FACILITY.
FORM 990, PART XI, LINE 9:	PENSION RELATED CHANGES OTHER THAN NET PERIODIC BENEFIT COST 837,473. CHANGE IN VALUE OF BENEFICIAL INTEREST IN CHARITABLE REMAINDER TRUST 260,427. CHANGE IN INTEREST FRIENDS OF BASSETT -342,955. RELEASE OF SCHOLARSHIPS -3,771.
FORM 990, PART XII, LINE 2C	THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (13 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Exempt Code SectionExemptCodeSectionTxt	Public Charity StatusPublicCharityStatusTxt	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt	Controlled OrganizationControlledOrganizationInd
BASSETT HEALTHCARE NETWORK
ONE ATWELL ROAD	COOPERSTOWN	NY	13326	133218680	SUPPORTING ORGANIZATION	NY	501 (C) 3	12 C	NONE	0
FRIENDS OF BASSETT
ONE ATWELL ROAD	COOPERSTOWN	NY	13326	237041610	FUND RAISING ORGANIZATION	NY	501 (C) 3	7	BASSETT HEALTHCARE NETWORK	0
MARY IMOGENE BASSETT HOSPITAL
ONE ATWELL ROAD	COOPERSTOWN	NY	13326	135596796	HEALTH CARE ORGANIZATION OFFERING INPATIENT AND OUTPATIENT SERVICES	NY	501 (C) 3	3	BASSETT HEALTHCARE NETWORK	0
AURELIA OSBORN FOX MEMORIAL HOSPITAL SOCIETY
ONE NORTON AVENUE	ONEONTA	NY	13820	150539039	HEALTH CARE ORGANIZATION OFFERING INPATIENT AND OUTPATIENT SERVICES	NY	501 (C) 3	3	BASSETT HEALTHCARE NETWORK	0
TEMPLETON FOUNDATION
ONE ATWELL ROAD	COOPERSTOWN	NY	13326	133317084	LANDLORD	NY	501 (C) 3	10	BASSETT HEALTHCARE NETWORK	0
COBLESKILL REGIONAL HOSPITAL
178 GRANDVIEW DRIVE	COBLESKILL	NY	12043	141772971	HEALTHCARE SERVICES OFFERING INPATEINT AND OUTPATIENT SERVICES	NY	501 (C) 3	3	BASSETT HEALTHCARE NETWORK	0
O'CONNOR HOSPITAL
460 ANDES ROAD	DELHI	NY	13753	161540394	HEALTH CARE ORGANIZATION OFFERING INPATIENT AND OUTPATIENT SERVICES	NY	501 (C) 3	3	BASSETT HEALTHCARE NETWORK	0
TRI TOWN REGIONAL HEALTHCARE
43 PEARL STREET	SYNDEY	NY	13838	260169584	HEALTHCARE SERVICES OFFERING OUTPATIENT SERVICES	NY	501 (C) 3	3	BASSETT HEALTHCARE NETWORK	0
VALLEY HEALTH SERVICES
690 GERMAN STREET	HERKIMER	NY	13350	222511614	NURSING HOME	NY	501 (C) 3	3	BASSETT HEALTHCARE NETWORK	0
BASSETT PPS LLC
6181 STATE HIGHWAY 7	ONEONTA	NY	13820	811749905	SUPPORTING ORGANIZATION	NY	501 (C) 3	12 A	MARY IMOGENE BASSETT HOSPITAL	0
AT HOME CARE INC
25 ELM STREET	ONEONTA	NY	13820	161287069	HOME CARE SERVICES	NY	501 (C) 3	10	BASSETT HEALTHCARE NETWORK	0
AT HOME CARE PARTNERS INC
25 ELM STREET	ONEONTA	NY	13820	562398098	HOME CARE SERVICES	NY	501 (C) 3	10	AT HOME CARE INC	0
VALLEY RESIDENTIAL SERVICES
690 GERMAN STREET	HERKIMER	NY	13350	463703838	ELDER CARE	NY	501 (C) 3	10	BASSETT HEALTHCARE NETWORK	0

Field	Value	IRS element (for citing)
Receipt Of Int Annts Rnts Rylts	0	ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org	0	GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org	Yes (1)	GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org	0	LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org	0	LoansOrGuaranteesFromOthOrgInd
Div Related Organization	0	DivRelatedOrganizationInd
Asset Sale To Other Org	0	AssetSaleToOtherOrgInd
Asset Purchase From Other Org	0	AssetPurchaseFromOtherOrgInd
Asset Exchange	0	AssetExchangeInd
Rental Of Facilities To Oth Org	Yes (1)	RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org	0	RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org	Yes (1)	PerformOfServicesForOthOrgInd
Perform Of Services By Other Org	Yes (1)	PerformOfServicesByOtherOrgInd
Sharing Of Facilities	0	SharingOfFacilitiesInd
Paid Employees Sharing	Yes (1)	PaidEmployeesSharingInd
Reimbursement Paid To Other Org	0	ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org	Yes (1)	ReimbursementPaidByOtherOrgInd
Transfer To Other Org	0	TransferToOtherOrgInd
Transfer From Other Org	0	TransferFromOtherOrgInd