2018-11-15T13:35:36-06:00 2017-12-31 KPMG LLP 515 Broadway 4th Floor Albany NY 122072974 990 2017-01-01 135596796 Mary Imogene Bassett Hospital % Sue E Andrews MARY 6075473635 One Atwell Road Cooperstown NY 13326 SUE E ANDREWS VICE PRESIDENT, FINANCE & CFO 6075473635 2018-11-13 true TODD TERESCO P00247720 5184274600 2018-11-12 167.68.102.5 14012520183195000021 2018-11-15 P 297A0B6B5CFE2242045CEDF0E257C8659BD83048 7B5190DACD7950FB62E11B317DAE60956DD6A6E7 2017 2019-02-21 02:37:17Z Bassett Medical Center Sue Andrews One Atwell Road Cooperstown NY 13326 556322333 false X www.bassett.org X 1921 NY See Schedule O 18 17 4467 204 -2768 -3018 19218177 20648419 515521356 517460230 2582606 6390341 199553 2695075 537521692 547194065 35414 45486 0 0 303568537 313094486 0 0 757234 224082623 229947953 527686574 543087925 9835118 4106140 408471961 425576557 137490426 152362564 270981535 273213993 X Mary Imogene Bassett Hospital is a rural academic center committed to providing excellence in health care services, educating physicians and other health care professionals, and pursuing health research. false false 444437805 45486 517460230 Inpatient and outpatient services provided to our patients resulted in: 13,691 Hospitalizations(inclusive of open heart surgeries) 53,325 Patient days 745,805 Clinic visits 27,358 Renal treatments 9,756 Surgical cases 3699798 See Schedule O. 448137603 true true false true false false false false false true true true false false true true true false false false false false false false false false true true true false true true false false false false false false false false true true false false false false false true false false false true 319 0 true 4467 true true true false false false false false false false false false X 18 17 true false false false false false false true true false false false true true true true true true true true false NY X Sue E Andrews 6075473635 One Atwell Road Cooperstown NY 13326 Timothy Pedley Board Chairman 1.0 2.0 X X 0 0 0 Kevin Moore Vice Chairman 3.0 2.5 X X 0 0 0 Vance Brown President & CEO 40.0 2.0 X X 902752 0 21686 William Burdick Secretary 8.0 2.5 X X 0 0 0 John Bullis Trustee 1.0 0.5 X 0 0 0 Janes Forbes Clark Trustee 1.0 1.0 X 0 0 0 Barbara DiCocco Trustee 1.0 2.5 X 0 0 0 Terry Fulmer Trustee 1.0 0.0 X 0 0 0 Michael Gold Trustee 1.0 0.5 X 0 0 0 Peter Hamilton Trustee 1.0 3.5 X 0 0 0 Nancy Kleniewski Trustee 1.0 0.0 X 0 0 0 Ralph Meyer Trustee 1.0 1.0 X 0 0 0 J Michael Moffat Trustee 1.0 0.0 X 0 0 0 Maureen Murray Trustee 1.0 0.5 X 0 0 0 Katherine Nickerson Trustee 1.0 1.0 X 0 0 0 Donald Quest Trustee 1.0 1.0 X 0 0 0 Edward Stack Trustee 1.0 2.0 X 0 0 0 Douglas Willies Trustee 1.0 1.5 X 0 0 0 Andrew Manzer Executive VP & COO 40.0 10.0 X 387411 0 9521 Michael Tengeres Exec Vice President 40.0 7.5 X 479062 0 10976 Sue Andrews Finance VP & CFO 40.0 20.0 X 288461 0 23664 Steven Heneghan Chief Clinic Officer 40.0 1.0 X 660422 0 32239 Richard Vanison Treasurer 4.0 1.5 X 0 0 0 Mark Hornyak Attending Physician 40.0 0.0 X 649234 0 23639 WT Huntsman Attending Physician 40.0 0.0 X 628378 0 30663 Dhananjai Menzies Attending Physician 40.0 0.0 X 800714 0 28883 Nicholas Hellenthal Attending Physician 40.0 0.0 X 610881 0 25419 Larry Shannon II Attending Physician 40.0 0.0 X 626679 0 23639 6033994 0 230329 382 false true false Stat Staff 18 Division St Suite 311 Saratoga Springs NY 12866 Agency 7361638 Sodexo Operations 9801 Washington Blvd Gaithersburg MD 20760 Food Services/Housek 2505009 McCarthy 1341 North Rock Hill Road St Louis MO 63124 Engineer 2290768 Mayo Medical Laboratories 200 First Street SW Rochester MN 55903 Lab Services 1713498 AMN Healthcare Inc 12400 High Bluff Drive San Diego CA 92130 Agency 1519445 27 1374148 7412729 11861542 20648419 Direct Patient Services 900099 472659834 472659834 Other Program Service Revenue 900099 44800396 44800396 517460230 994431 994431 0 0 0 0 0 14457232 66946 9122744 5524 5334488 61422 5395910 34091 5361819 0 0 0 0 0 0 0 0 0 Partnership Income 2869874 -36859 2906733 Other nonoperating expense -174799 -174799 2695075 547194065 517460230 -2768 9088184 45486 45486 0 0 0 3197195 3197195 169828 169828 270572843 208561926 61469295 541622 11701024 9022212 2659109 19703 10524789 8112870 2391100 20819 16928807 13045671 3844941 38195 0 0 0 24902 19233 5669 0 0 44001204 33898279 9990813 112112 0 1744140 1340524 395092 8524 0 0 15717775 12136209 3576896 4670 0 0 1526999 1177064 346915 3020 0 0 23081096 17826350 5253946 800 3927545 3027487 892289 7769 Drugs and reagents 44018252 44018252 Patients Supplies 42575377 42575377 Bad Debt 13760199 13760199 Charity Care 3699798 3699798 35870666 35870666 543087925 448137603 94193088 757234 4597437 2989845 0 0 9732252 17472030 55656325 55858898 0 0 0 0 0 0 5197049 5743800 3891361 3276218 520825772 321929616 192442415 198896156 61449682 55848998 71567604 81751665 0 0 0 0 3937836 3738947 408471961 425576557 56539770 65305850 0 0 0 0 55934459 63785544 0 0 0 0 23983885 17761305 0 0 1032312 5509865 137490426 152362564 X 199848750 197888017 56728338 60870191 14404447 14455785 270981535 273213993 408471961 425576557 X 4106140 1696983 -3570665 X false true X true true true X false false false false false false false false true 24902 24902 false SCHEDULE C, PART II-B, LINE 1 American Hospital Association allocates 22.98% of dues towards general lobbying activities. Total dues paid for the year were $44,612. HANYS allocates 21.90% of dues towards general lobbying activities. Total dues paid for the year were $0. Iroquois Healthcare Alliance allocates 34.90% of dues towards general lobbying activities. Total dues paid for the year were $41,976. The Clark Estates conducts lobbying activities on behalf of the Mary Imogene Bassett Hospital. Lobbying activities are limited to officer discussions with consultants and legislators to obtain funding for charitable missions. No funds were expended. 14404447 51338 14455785 14398341 6106 14404447 14363039 35302 14398341 13881510 481529 14363039 13849731 31779 13881510 1.00000 true false 1089856 1089856 237563151 137137413 100425738 258024820 184792203 73232617 24147945 24147945 198896156 LP - CORPORATE BONDS & NOTES 2685246 C LP - LARGE CAP EQUITIES 7802460 C LP - DIVERSIFIED EQUITIES 59872788 C LP - OTHER LIMITED PARTNERSHIP 11391171 C 81751665 0 ADVANCED FUNDS FOR DSRIP 5509865 5509865 X 527860386 1696983 -21030662 -19333679 547194065 547194065 525627928 525627928 17459997 17459997 543087925 SCHEDULE D, PART V, LINE 4 INTENDED USES FOR ENDOWMENT FUNDS Permanently restricted endowment funds are held in perpetuity with restrictions on income for health services, medical research, medical education, and indigent care. SCHEDULE D, PART X FIN 48 FOOTNOTE The Hospital is a not-for-profit corporation as described in Section 501 (c)(3) of the Internal Revenue Code (the Code) and is exempt from federal income taxes pursuant to Section 501(a) of the Code. The Hospital recognizes income tax positions when it is more-likely-than-not that the position will be sustainable based on the merits of the position. Management has concluded that there are no material tax liabilities or uncertain tax positions that need to be recorded. SCHEDULE D, PART XI, LINE 2D POST-RETIREMENT BENEFIT CHANGE $ (3,594,756) CHANGE IN INTEREST AT FRIENDS OF BASSETT $ 24,091 BAD DEBT $(13,760,199) CHARITY CARE $ (3,699,798) ---------------- TOTAL $(21,030,662) SCHEDULE D, PART XII, LINE 4B BAD DEBT $ 13,760,199 CHARITY CARE $ 3,699,798 ---------------- TOTAL $ 17,459,997 true true true X 300. false true true false true true 3608946 359578 3249368 0.00610 73940904 59905388 14035516 0.02670 77549850 60264966 17284884 0.03280 48448 48448 0.00010 20564934 5894138 14670796 0.02790 11463192 9570843 1892349 0.00360 265584 265584 0.00050 32342158 15464981 16877177 0.03210 109892008 75729947 34162061 0.06490 true 13760199 667208 121275034 120539437 735597 X true true At Home Care Inc Home Health Agency 0.5 1 1 Mary Imogene Bassett Hospital One Atwell Road Cooperstown NY 13326 www.bassett.org 3824000H X X X X X Outpatient primary & specialty Mary Imogene Bassett Hospital 1 false false true X X X X X X X X X 16 true true false true X www.bassett.org X true 16 true www.bassett.org false true X 300. 0. false true X X X X true X www.bassett.org X www.bassett.org X www.bassett.org X X X X true X true X X X X X true X false false SCHEDULE H, PART V, LINE 5, FACILITY 1, MARY IMOGENE BASSETT HOSPITAL This Community Health Needs Assessment has taken into account input from persons who represent the broad interests of the community 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 Public Health b) Lorrie Arcuri, Workplace Wellness Consultant with Excellus BCBS c) Keith McCarty, Health & Ed Committee with Otsego Cty Representative d) Frances Wright, Director at Otsego County Office for Aging e) Laurie Neander, CEO with At Home Care, Inc. f) Jeanette Weldon, Director of Childcare with The Brookwood School g) Patricia Knuth, Executive Director at ARC Otsego h) Chris Kjolhede MD, Director at Bassett School-Based Health i) Andrew Marietta, Rep & businessman - Otsego Cty Representative j) Dana Plank, Nurse Educator with Hartwick College k) Matt Hazzard, Executive Director with Cooperstown Chamber of Commerce l) Patrick McNulty, Chief of Cardiology at Bassett Medical Center m) Patricia Kennedy, CEO at Springbrook n) Karen Huxtable-Hooker, Director Public & Media Relations at Bassett Medical Center o) Gerald Groff MD, Fox Trustee & Chief of Medical Insurance Following a review of data from A.O. Fox Memorial Hospital's, Bassett Medical Center's, and Otsego County Health Department's 2016 Community Health Needs Assessment (CHNA) and the key informant survey, A.O. Fox Memorial Hospital, Bassett Medical Center, and Otsego County Health Department will collaborate on the New York State Prevention Agenda priority of Prevent Chronic Diseases' focus area of "reduce illness, disability and death related to tobacco use and secondhand smoke exposure" will be the second priority and focus area and remains a priority area for A.O. Fox Memorial Hospital and Bassett Medical Center. This priority area replaces Otsego County Health Department's priority area of Promote Mental Health and Prevent Substance Abuse's "promote mental, emotional, and behavioral well-being in communities." A.O. Fox Memorial Hospital, Bassett Medical Center, and Otsego County Health Department engaged stakeholders to work with them on the 2013 priorities and stakeholders will be engaged for the 2016 priorities. These stakeholders, along with other individuals and organizations focused on the health of the community had an opportunity to participate in an online key informant survey for Bassett Medical Center's, A.O. Fox Memorial's and Otsego County Health Department's 2016 CHNA. As a result of the online key informant stakeholder survey, participants selected Promote Mental Health and Substance Abuse with a focus on "promoting MED and preventing substance abusePrevent Chronic Diseases with a focus on "obesity in adults and children, preventing diabetes and related risk factors and preventing heart disease" as their top priorities and focus areas. In order to address the combined focus area of "increase access to high quality chronic disease preventive care and management in both clinical and community settings", A.O. Fox Memorial Hospital, Bassett Medical Center, and Otsego County Health Department will promote evidence-based care to manage chronic diseases which addresses the community's concern about diabetes and heart disease. For the "reduce illness, disability and death related to tobacco use and secondhand smoke exposure" Otsego County Health Department, A.O. Fox Memorial Hospital and Bassett Medical Center will promote tobacco use cessation, especially among low socio-economic status populations and those with poor mental health, which coincides with Leatherstocking Collaborative Health Partners (LCHP), Domain 4 Population health priority of "Tobacco Cessation". Bassett Medical Center, A.O. Fox Memorial Hospital, and Otsego County Health Department will utilize the recommended process measures listed in the Prevention Agenda action plan to track progress of all priorities and focus areas. Yearly progress towards those measures will be included on the Bassett Healthcare Network's and Otsego County Health Department's websites. SCHEDULE H, PART V, LINE 6A, FACILITY 1, MARY IMOGENE BASSETT HOSPITAL O'Connor Hospital, AO Fox Memorial Hospital, Cobleskill Regional Hospital, Little Falls Hospital, Tri Town Regional Healthcare SCHEDULE H, PART V, LINE 11, FACILITY 1, MARY IMOGENE BASSETT HOSPITAL 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. 54 Bassett Healthcare Physical Therapy 124 County Road 52 Cooperstown NY 13326 Outpatient physical therapy services Bassett Healthcare Hamilton Surgical 10 Eaton Street Hamilton NY 13346 Outpatient specialty care Bassett Healthcare Herkimer Cardiac 690 West German Street Herkimer NY 13350 Outpatient rehab services Bassett Healthcare Clinton 34 Chenango Avenue Clinton NY 13323 Outpatient primary care Bassett Healthcare Canajoharie 56 Montgomery Street Canajoharie NY 13317 Outpatient primary care Bassett Healthcare Cobleskill 121 Legion Drive Cobleskill NY 12043 Outpatient primary care Bassett Healthcare Delanson 1 Cooley Heights Delanson NY 12053 Outpatient primary care Bassett Healthcare Delhi 460 Andes Road Delhi NY 13753 Outpatient primary care and dental Bassett Healthcare Edmeston Route 80 PO Box 15 Edmeston NY 13335 Outpatient primary care Bassett Healthcare Hamilton 160 Broad Street Hamilton NY 13346 Outpatient primary care and dental Bassett Healthcare Herkimer 321 East Albany Street Herkimer NY 13350 Outpatient prime, specialty, urgent care Bassett Healthcare Middleburgh 109 Baker Avenue Middleburgh NY 12122 Outpatient primary care Bassett Healthcare Morris 93 Main Street Morris NY 13808 Outpatient specialty care Bassett Healthcare Oneonta Surgical 449 Main Street Oneonta NY 13820 Outpatient specialty care Bassett Healthcare Norwich 55 Calvary Drive Norwich NY 13815 Outpatient primary care Bassett Healthcare Oneonta 125 Main Street Oneonta NY 13820 Outpatient primary care Bassett Healthcare Oneonta Specialty One Associate Drive Oneonta NY 13820 Outpatient prime, specialty, urgent care Bassett Healthcare Richfield Springs 8550 State Highway 28 Richfield Springs NY 13439 Outpatient primary care Bassett Healthcare Schoharie 111 Barton Hill Road Schoharie NY 12157 Outpatient primary care Bassett Healthcare Sharon Springs Route 20 PO Box 275 Sharon Springs NY 13459 Outpatient primary care Bassett Healthcare Sherburne 20 Chapel Street Sherburne NY 13460 Outpatient primary care Bassett Healthcare Sidney 39 Pearl Street Sidney NY 13838 Outpatient primary care Bassett Healthcare St Johnsville 8 Park Place St Johnsville NY 13452 Outpatient primary care Bassett Healthcare Stamford 28650 State Highway 23 Stamford NY 12167 Outpatient primary care Bassett Healthcare Walton 130 North Street Walton NY 13856 Outpatient primary care Bassett Healthcare West Winfield 544 East Main Street West Winfield NY 13491 Outpatient primary care Bassett Healthcare at FoxCare 1 Foxcare Drive Oneonta NY 13820 Outpatient specialty care Bassett Healthcare at Little Falls 170 Burwell Street Little Falls NY 13365 Outpatient primary care Bassett Healthcare Unadilla 16 Clifton Street Unadilla NY 13849 Outpatient primary care Bassett Regional Cancer Center 7 Associate Drive Oneonta NY 13820 Outpatient specialty care Hartwick Seminary Specialty Service 4580 Route 28 Milford NY 13807 Outpatient primary and specialty care Bassett Healthcare Andes 245 Lower Main St Andes NY 13731 Outpatient primary care Bassett Healthcare Greene 29 N Chenango St Ste A Greene NY 13778 Outpatient primary care Bassett Family Medicine Oneonta 739 NYS Rte 28 Ste 9 Oneonta NY 13820 Outpatient primary care SBHC - Cooperstown Elementary 21 Walnut Street Cooperstown NY 13326 Outpatient primary care SBHC - Cooperstown Middle and High 39 Linden Avenue Cooperstown NY 13326 Outpatient primary care SBHC - Delhi Elementary 2 Sheldon Drive Delhi NY 13753 Outpatient primary care SBHC - Delhi Middle and High 2 Sheldon Drive Delhi NY 13753 Outpatient primary care SBHC - Edmeston Central School 11 North Street Edmeston NY 13335 Outpatient primary care SBHC - Laurens Central School 55 Main Street Laurens NY 13796 Outpatient primary care SBHC - Middleburgh Elementary 245-I Main Street Middleburgh NY 12122 Outpatient primary care SBHC - Middleburgh Middle and High 291 Main Street Middleburgh NY 12122 Outpatient primary care SBHC - Milford Central School 42 West Main Street Milford NY 13807 Outpatient primary care SBHC - Morris Central School 65 Main Street Morris NY 13808 Outpatient primary care SBHC - Oral Health Mobile Program One Atwell Road Cooperstown NY 13326 Outpatient specialty care SBHC - Schenevus Central School 159 Main Street Schenevus NY 12155 Outpatient primary care SBHC - SherburneEarlville Elementary 13 School Street Sherburne NY 13460 Outpatient primary care SBHC - SherburneEarlville Mdle & High 13 School Street Sherburne NY 13460 Outpatient primary care SBHC - Sidney Central School 95 West Main Street Sidney NY 13838 Outpatient primary care SBHC - South Kortright Central PO Box 113 South Kortright NY 13842 Outpatient primary care SBHC - Stamford Central School One River Street Stamford NY 12167 Outpatient primary care SBHC - Unadilla Valley Central PO Box F 4238 State Highway 8 New Berlin NY 13411 Outpatient primary care SBHC - Worcester Central School 195 Main Street Worcester NY 12197 Outpatient primary care SBHC - Richfield Springs Central 93 Main Street Richfield Springs NY 13439 Outpatient primary care SCHEDULE H, PART I, LINE 3C OTHER INCOME BASED CRITERIA FOR FREE OR DISCOUNTED CARE The CSP (Community Services Program) application specifies family income limits and other requirements for services to be eligible for Bassett Medical Center's CSP/free care program. SCHEDULE H, PART I, LINE 6A RELATED ORGANIZATION INFORMATION The Mary Imogene Bassett Hospital's, (dba Bassett Medical Center (Bassett)), 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 SCHEDULE H, PART I, LINE 7, COLUMN (F) EXCLUSIONS FROM PERCENT OF TOTAL EXPENSE The percent of total expense is calculated by dividing column (e), net community benefit expense, by total expense. The bad debt expense of $13,760,199 was subtracted from the total expense value used to calculate the percentages in Part 1, Line 7, Column f. SCHEDULE H, PART I, LINE 7 COSTING METHODOLOGY EXPLANATION Sections (a) charity care at cost, (b) unreimbursed Medicaid, (f) health professions education, the costing methodology used is a cost-to-charge ratio calculation utilized on filed state and federal cost reports as the source. Indirect costs were applied to sections (e) community health improvement, portions of (f) health professions education, (h) research, and (i) cash and in-kind contributions to community groups are comprised of the direct salary costs for hospital staff whose time was compensated by the hospital for time spent participating in activities that qualify as community benefits plus the current fiscal year fringe benefit rate. Indirect costs were only applied to select salaries and services under community health improvement and research and not broadly across all community benefit activity entries. SCHEDULE H, PART II COMMUNITY BUILDING ACTIVITIES All Bassett Community Building Activities could be classified under item 1 and highlighted in number 1 above. SCHEDULE H, PART III, LINE 2 BAD DEBTS EXPENSE METHODOLOGY Worksheet 2, cost to charge ratio, was used to determine the amount reported in Part III, lines 2 and 3. SCHEDULE H, PART III, LINE 4 BAD DEBT EXPENSE FOOTNOTE TO FINANCIAL STATEMENTS Provision for Uncollectible Patient Accounts Receivable Financial statements note 2(i): The Hospital grants credit without collateral to patients, most of who are local residents and are insured under third party agreements. Services rendered to individuals when payment is expected and ultimately not received are written off to the allowance for estimated uncollectible accounts. Additions to the allowance for estimated uncollectible accounts are made by means of the provision for uncollectible accounts. Accounts written off as uncollectible are deducted from the allowance and subsequent recoveries are added. The amount of the provision for uncollectible accounts is based upon management's assessment of historical expected collections, business and economic conditions, trends in federal and state healthcare coverage, and other collection indicators. During 2017 and 2016 the total charges forgone for bad debt were approximately $13,760,199 and $12,781,378 respectively. Provision for Charity and Uncompensated Care from the financial statement footnotes (j): The Hospital's general policy statement on charity care requires that medical care be rendered to all persons in need of such care regardless of their ability to pay. Because the Hospital does not pursue collection of amounts determined to qualify as charity care, they are not reported as revenue. The Hospital maintains records to identify and monitor the level of charity care it provides. These records include the amount of charges forgone for services furnished under its charity care policy. The Hospital's charity care policy was revised effective January 1, 2016 to be in compliance with Internal Revenue Code (IRC) Section 501(r). SCHEDULE H, PART III, LINE 3 BAD DEBT EXPENSE, PATIENTS ELIGIBLE FOR ASSISTANCE The cost-to-charge ratio was used to reduce Bad Debt charges to cost. The ratio of approved applications to total applications for financial assistance was applied to the Bad Debt cost to estimate amount presumed eligible, had patients completed the application process. SCHEDULE H, PART III, LINE 8 MEDICARE EXPLANATION Amounts were derived as follows: charge times cost to charge ratio versus reimbursement on the medicare PS&R report. SCHEDULE H, PART III, LINE 9B COLLECTION PRACTICES EXPLANATION For patients or guarantors who do not qualify for financial assistance, Bassett must undertake to ensure an adequate understanding on the part of the patients and those responsible for their care of their financial obligations to Bassett. Bassett will, in compliance with all existing laws and regulations, take the necessary steps to recover self-pay accounts receivable as well preserve the patient-provider relationship and keep the necessity of referring accounts to third party bad debt collection agencies or law firms to a minimum. It is expected that any third party collection agency or law firm retained by Bassett will refrain from any conduct that violates the Fair Debt Collection Practices Act, as well as any applicable state law or regulations. The arrest or body attachment of a judgement debtor on contempt proceedings, or foreclosure of a judgement debtor's principal residence will never be considered appropriate pursuit of an open balance in the name of Bassett Medical Center. SCHEDULE H, PART VI, LINE 2 NEEDS ASSESSMENT In 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 years b) Prevalence of tooth decay in third-grade children c) Percentage of adults reporting binge drinking d) Heavy drinking e) 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 care a. Bassett 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 services b. Bassett 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 participation c. Bassett 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 reimbursements d. Bassett 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 Abuse a. In a new initiative, Bassett will work with A.O. Fox Hospital 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. Bassett 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 providers c. Bassett will collaborate with LEAF and the health department on public health campaign about the risk factors associated with binge drinking and prescription drug abuse 3) Physical Activity and Nutrition a. Bassett 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 disease b. Bassett 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. SCHEDULE H, PART VI, LINE 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE A major component of Bassett'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 Otsego County Medicaid Examiner is available at the Cooperstown campus. 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. SCHEDULE H, PART VI, LINE 4 COMMUNITY INFORMATION The service area of Bassett encompasses a seven county region in upstate New York. While the economy of Cooperstown is based on tourism and health care, the rest of the region is largely agricultural. There are a few larger employers in the region such as local school districts, community, state and private universities, the majority of employers are small businesses. 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 County B) Fulton County, town of Oppenheim C) Montgomery County, city of Amsterdam D) Otsego County, North Otsego service area, town of Plainfield, town of Decatur E) Delaware County, towns of Deposit, Colchester, Middletown SCHEDULE, H, PART VI, LINE 5 PROMOTION OF COMMUNITY HEALTH Bassett's sole member is Bassett Healthcare Network and is a 180 bed acute care inpatient teaching facility located in rural Cooperstown, New York. Bassett has a fully salaried medical staff and advanced practitioner staff providing a wide variety of services, including a wide range of specialty care. Bassett maintains a strong academic program through its affiliation with Columbia University College of Physicians and Surgeons, an affiliation highlighted by the establishment of a Columbia medical school campus at Bassett in 2009. Bassett has a network of 34 community based outpatient health centers, 20 school-based health centers; two ambulatory surgery centers and is a Level II Trauma Center as designated by New York State. In addition, the research programs at Bassett include the New York Center for Agricultural Medicine and Health Community based partnerships as part of the Northeast Center for Agricultural Health are addressing important health and safety issues in diverse agricultural populations at several sites across New York state. Health Works Occupational Health Services program continues to meet the health, safety and wellness needs of the business community. Providing needed occupational health services benefits and improving employee health throughout the Bassett Healthcare Network seven county region. Bassett is working to re-establish the Otsego County Oral Health Coalition as a mechanism for bringing community partners together around a shared vision in an effort to attract more dentists to our rural area. The size and depth of Bassett with its more than two dozen community health centers and 20 school based health centers makes it ideal for a new initiative to train primary care practitioners and surgeons in substance abuse screening and referral. The goal is to also train practitioners outside Bassett hospital, but Bassett provides the ideal platform from which to pilot this initiative. Bassett is also addressing the rate of obesity within its region reaching out to schools to provide resources, guidance and technical assistance in the areas of tobacco use, nutrition and physical activity. Bassett continues to combine health care with community service. Our program "Connecting Communities for Health & Wellness" is about collaborative efforts to provide treatment and/or to promote health and healing as a response to identified community needs. Community health improvement initiatives have targeted the New York State Department of Health new Public Health Prevention Agenda. In addition to hospital public health programs related to the three priority prevention agenda items, programs addressing chronic disease management and prevention and unintentional injury were considered. Bassett public health programs that address these areas include: A. School-Based Health center Dental sealant program - A registered dental hygienist provides preventive care, including education, cleanings, fluoride treatment, sealant and referrals in this grant funded program B. RHENDOMS (Rural Health Education Network of Delaware, Otsego, Montgomery and Schoharie Counties) - Dental health education is offered to elementary school students, and parents of newborns are educated about baby-bottle tooth decay C. Bassett Psychiatric Crisis Center - The Cooperstown center opened in February 2008, filling a void created by the termination of psychiatric services at A.O. Fox Hospital in Oneonta months earlier. In its first year, Bassett's psychiatric crisis center helped more than 1,200 patients. Of those, 52 were children 12 or younger and 154 were adolescents D. Parent HANY book - This family resource was created by the Otsego Co. Committee on Child Abuse and Neglect and underwritten by Bassett and A.O. Fox Hospital. Its goal is to give parents and professionals a place to turn for help in dealing with the stresses of family life E. KickStart - a program designed to help combat childhood obesity through collaborative partnerships with Bassett health centers and local recreational and fitness groups F. Bassett Cancer Institute Medical Screening Coach - a new, custom-built medical coach equipped with digital technology for mammography and other cancer screenings for men and women.The coach was placed in service in 2008 with the goal of reducing the number of cancer deaths by increasing access to screening services in rural areas G. Cancer Services Program of Delaware, Otsego and Schoharie Counties a New York State Department of Health partnership administered through Bassett offering free breast, cervical and colorectal screenings to people who qualify H. Healthy Start Breakfast - a partnership between community service organizations and Bassett for diabetes detection, education, and prevention I. Safe Kids Coalition of Otsego County - An organization whose mission is to prevent unintentional injuries to children through education. Programs and services include safety seat events, educational resources on bicycling, in-line skate and skateboard safety, home safety, fire and burn prevention, road safety and pedestrian safety The regional primary and specialty care clinics and the school-based health centers were established in response to community need. Bassett is continually engaging in quality improvement initiatives to ensure that quality health care and programs are brought to central New York. A core part of Bassett is research and education. Bassett's value to the communities it serves is compounded by providing physicians the ability to practice quality medicine in a collegial environment in a rural setting. There is a tremendous collaboration between physicians within Bassett to ensure a better outcome for the patient. Bassett continually invests in programs, equipment and people to ensure quality service to the communities in which we serve. SCHEDULE H, PART VI, LINE 6 AFFILIATED HEALTH CARE SYSTEM Bassett 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 County b) O'Connor Hospital - critical access hospital in Delhi, Delaware County c) Cobleskill Regional Hospital - acute care facility in Cobleskill, Schoharie County d) Little Falls Hospital - critical access hospital in Little Falls, Herkimer County e) Tri-Town Regional Hospital - 24/7 emergency care facility in Sidney, Delaware County f) A.O. Fox Memorial Hospital - acute care facility in Oneonta, Otsego County g) Valley Health Services - residential health care and rehabilitation facility h) At Home Care - certified home care agency i) 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 SCHEDULE H, PART VI, LINE 7 STATE FILING OF COMMUNITY BENEFIT REPORT New York false American Cancer Society 250 Williams St NW Atalanta GA 30303 131788491 501(c)(3) 10000 Cash Support 1 X X X X false false false false false false false true false Vance Brown President & CEO 735417 0 165165 0 2170 0 16512 0 5174 0 924438 0 0 0 Andrew Manzer Executive VP & COO 364276 0 23135 0 0 0 0 0 9521 0 396932 0 0 0 Michael Tengeres Exec Vice President 412662 0 66400 0 0 0 8912 0 2064 0 490038 0 0 0 Sue Andrews Finance VP & CFO 268936 0 19525 0 0 0 17600 0 6064 0 312125 0 0 0 Steven Heneghan Chief Clinic Officer 606742 0 53680 0 0 0 24612 0 7627 0 692661 0 0 0 Mark Hornyak Attending Physician 648711 0 523 0 0 0 16512 0 7127 0 672873 0 0 0 WT Huntsman Attending Physician 606341 0 22037 0 0 0 24612 0 6051 0 659041 0 0 0 Dhananjai Menzies Attending Physician 710272 0 90442 0 0 0 21912 0 6971 0 829597 0 0 0 Nicholas Hellenthal Attending Physician 590881 0 20000 0 0 0 19212 0 6207 0 636300 0 0 0 Larry Shannon II Attending Physician 626156 0 523 0 0 0 16512 0 7127 0 650318 0 0 0 SCHEDULE J, PART I, LINE 7 NON-FIXED PAYMENTS PROVIDED Non-fixed payments are made based on the success in meeting performance criteria that are prospectively agreed upon as goals for the officers and other employees. A 2011A Series Otsego County-CR Bond 263661593 2011-11-03 25000000 Construction false false false B 2011B Series Otsego County-CR Bond 263661593 2011-11-03 19200000 Refund 2007 Issue false false false C 2015A Series Otsego County-CRC Bond 263661593 2015-08-27 23600000 IT Proj& end 1998A&B false false false D 2015A Series Oneida County-LDC Bond 263661593 2015-09-01 17000000 Renovations false false false A 5605000 0 25000000 0 702000 0 500000 0 0 23798000 0 0 2011 false false false true B 5770000 0 19200000 0 0 0 75000 0 0 0 19125000 0 2009 true false true true C 5178563 0 23600000 0 0 0 472000 0 0 14020338 9107662 0 true false false true D 630000 0 17000000 0 0 0 327500 0 0 16672500 0 0 false false false true A false false true true false 0 false false false false B false false true true false 0 false false false false C false false true true false 0 false false false false D false false false false 0 false false false false A false true true false 0 false 0 false false B false true true false 0 false 0 false false C false true true false 0 false 0 false false D false true true false 0 false 0 false false A false B false C false D false 2011A Series Otsego County-CR Bond Part V The Mary Imogene Bassett Hospital does not have written procedures in place but management regularly reviews the obligations under tax-exempt bonds to ensure there is no violation of federal tax requirements. Our governing body is in the process of adopting written procedures. 2011A Series Otsego County-CR Bond Part I, LINE 1, Column F: building and resources 2011B Series Otsego County-CR Bond 2015A Series Otsego Country-CRC Bonds Part I, Line c, column F: Information systems project and defease 1998 Series A & B 2015A Series Oneida County-CDC Bonds Part I, Line D, Column F: renovation of off-campus data center THE CLARK ESTATES PART V 115217 INVESTMENT MGMT FEES false JANE HAMILTON PART V 99002 WAGES false LAUREN BROWN PART V 70826 WAGES false PART V ADDITIONAL INFORMATION Part IX, Line 1 More than 35% of The Clark Estates is owned by trustee Jane Forbes Clark Part IV, Line 2 Jane Hamilton is family member of trustee Peter Hamilton Part IV, Line 3 Lauren Brown is a family member of President & CEO - Vance Brown, M.D. FORM 990, PART I, LINE 1 ORGANIZATION'S MISSION Mary Imogene Bassett Hospital is a rural academic center committed to providing excellence in health care services, educating physicians and other health care professionals, and pursuing health research. FORM 990, PART III, LINE 4B Community involvement has been linked to Bassetts mission and values since it first opened in 1921. Whether it is strengthening our community relationships for health and wellness, communicating ideas for improving our services to our region, or providing a forum for Bassett to learn and listen, we are working with our community to improve the quality of life of the people of our region. Our community services program provides free services to persons who cannot afford to pay, who do not qualify for Medicaid, and who fall within the established income guidelines. In 2017 we provided $3,699,798 in free care. Bassetts community health education programs include lectures, presentations, health fairs, and other group programs in addition to the clinical and diagnostic services offered. Clinical services offered includes screenings, health tests and health risk appraisals including blood pressure, lipid profile, cholesterol screenings, cardiology risk factor screenings, and all cancer screenings. Our community building activities include philanthropic support for health initiatives and community health and welfare projects including promoting healthy lifestyles, disease prevention, and community awareness initiatives. Our doors are open 24 hours a day, 7 days a week, 365 days a year. We are proud to provide care to our communities. FORM 990, PART VI, LINE 2 RELATED PARTY INFORMATION AMONG OFFICERS Kevin S Moore & William T Burdick - BUSINESS Kevin S Moore & Jane Forbes Clark - BUSINESS Kevin S Moore & Richard C Vanison - BUSINESS William T Burdick & Jane Forbes Clark - BUSINESS William T Burdick & Richard C Vanison - BUSINESS Jane Forbes Clark & Richard C Vanison - BUSINESS FORM 990, PART VI, LINE 11B ORGANIZATIONS PROCESS TO REVIEW THE FORM 990 The Mary Imogene Bassett Hospital distributes the draft 990 to the Audit Committee of the Board of Trustees prior to filing. Any questions are raised and answered. The Audit Committee then presents its review findings to the full board of trustees. Once approved, the 990 can be electronically filed. A complete copy of the organization's final form 990, including all required schedules, as ultimately filed with the IRS is made available upon request to each member of the Board before its filed with the IRS. FORM 990, PART VI, LINE 12C ENFORCEMENT OF CONFLICTS POLICY The organization's conflict of interest policy applies to the board of trustees, including any committees of the board, individual members of the board, officers of the hospital (CEO, COO, CFO), Vice Presidents, and all directors serving as directors team members. Upon the commencement of an individual serving in the roles previously defined, and thereafter annually by January 1, a conflict of interest questionnaire which is prescribed by the Audit Committee of the Board of Trustees must be completed. All completed questionnaires are reviewed by the Compliance Officer of the organization. Any potential conflict of interest will be discussed with the individual and/or with legal counsel. The Compliance Officer will take action to eliminate the potential conflict of interest, if deemed appropriate. After investigation, if it is deemed that the individual has failed to comply with such policies and directives, appropriate corrective action will be taken. The Audit Committee of the Board of Trustees may determine whether the corrective action is satisfactory and, if not, shall require further action. FORM 990, PART VI, LINE 15A COMPENSATION PROCESS FOR TOP OFFICIAL The Mary Imogene Bassett Hospital has a formal process that is used to determine the base compensation of the CEO on an annual basis. This process includes a compensation committee of the board of trustees, an independent compensation consultant, compensation survey or study, and approval by the board of trustees or the compensation committee. MIBH pays non-fixed earnings based on the success in meeting performance criteria that are prospectively agreed upon as goals for the CEO. FORM 990, PART VI, LINE 15B COMPENSATION PROCESS FOR TOP OFFICIAL The same formal process noted above (Part VI, Section B, line 15a), is used to determine the base compensation of the other officers. Non-fixed earnings of other officers are based on the success in meeting performance criteria and comparative market data. For key employees, compensation is delegated by the board to the discretion of the officers. FORM 990, PART VI, LINE 19 GOVERNING DOCUMENTS DISCLOSURE EXPLANATION The Mary Imogene Bassett Hospital makes its governing documents, conflicts of interest policy, and financial statements available to the public upon written request. Parties desiring to obtain copies of such must present themselves at the administrative offices of the hospital or by sending a self-addressed stamped envelope along with payment for copying of the requested material to the administrative office of the hospital. The cost of copying shall be equal to the costs imposed by the IRS for copying of public documents. FORM 990, PART XI, LINE 9 OTHER CHANGES IN NET ASSETS POST-RETIREMENT BENEFIT CHANGE $ (3,594,756) CHANGE IN INTEREST AT FRIENDS OF BASSETT $ 24,091 ---------------- TOTAL $ (3,570,665) Bassett Healthcare Network One Atwell Road Cooperstown NY 13326 133218680 Support NY 501c3 12c NONE false Bassett Regional Corporation (BRC) One Atwell Road Cooperstown NY 13326 133522783 Support NY 501c3 N/A BHN false Friends of Bassett One Atwell Road Cooperstown NY 13326 237041610 Fundraiser NY 501c3 7 BHN false AO Fox Memorial Hospital One Norton Avenue Oneonta NY 13820 150539039 Healthcare NY 501c3 3 BHN false Bassett Hospital Schoharie County 178 Grandview Drive Cobleskill NY 12043 141772971 Healthcare NY 501c3 3 BHN false Little Falls Hospital 140 Burwell Street Little Falls NY 13365 150533578 Healthcare NY 501c3 3 BHN false O'Connor Hospital 460 Andes Road Delhi NY 13753 161540394 Healthcare NY 501c3 3 BHN false Templeton Foundation One Atwell Road Cooperstown NY 13326 133317084 Landlord NY 501c3 10 BHN false Tri Town Regional Healthcare 43 Pearl Street Sidney NY 13838 260169584 Healthcare NY 501c3 3 BHN false Valley Health Services 690 West German Street Herkimer NY 13350 222511614 Elder Care NY 501c3 3 BHN false Bassett PPS LLC 618 State Highway 7 Oneonta NY 13820 811749905 Healthcare NY 501c3 12a MIBH true false false true false false false false false true true true true true false false true true false false