2018-11-15T13:33:55-06:00 2017-12-31 KPMG LLP 515 Broadway 4th Floor Albany NY 122072974 990 2017-01-01 161540394 O'Connor Hospital % O'CONNOR HOSPITAL OCON 6077460326 460 Andes Road Delhi NY 13753 SUE E ANDREWS TREASURER 6077460326 2018-11-13 true TODD P TERESCO P00247720 5184274600 2018-11-09 167.68.102.5 14012520183195000017 2018-11-15 P 7B5190DACD7950FB62E11B317DAE60956DD6A6E7 7B5190DACD7950FB62E11B317DAE60956DD6A6E7 2017 2019-02-21 02:37:17Z SCOTT BONDEROFF 460 Andes Road Delhi NY 13753 22455458 false X www.oconnorhosp.org X 1997 NY O'Connor Hospital is a 23 bed critical access hospital which serves the community in need of medical services without regard to their ability to pay for such services. 13 10 204 11 2292592 -461060 555952 575025 23623308 21447436 89579 153829 271540 279168 24540379 22455458 0 0 0 0 9796341 10126434 0 0 96698 12154786 11489294 21951127 21615728 2589252 839730 28220421 29819865 3016785 3825853 25203636 25994012 O'Connor Hospital is a 23 bed critical access hospital which serves the community in need of medical services without regard to their ability to pay for such services. false false 15546022 21447436 Inpatient and outpatient services provided to our patients resulted in: Hospitalizations: 485 Patient days: 2591 Clinic visits: 13,686 Surgical cases: 23 66978 Community involvement has been linked to O'Connor Hospital's mission and values since it first opened. We are working with our community to improve the quality of life for the people of our region. Our community services programs provide 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 $66,978 in free care. Our doors are open 24 hours a day, 7 days a week, 365 days a year. We are proud to provide this care to our communities. Not only did we provide $66,978 in charity care, $ 561,121 in patient accounts were recorded as bad debt in 2017. 15613000 true true false true false false false false false false true false false false false true true false false false false false false false false false true true false false true false false false false false false false false false false false false false true false false false true 29 0 true 204 true true true false false false false false false false false false X 13 10 false false false false false false false true true false false false true true true true true true false false NY X O'CONNOR HOSPITAL 6077460326 460 ANDES ROAD DELHI NY 13753 JAMES C PETERS DIRECTOR 1.0 40.0 X 0 585837 32240 MICHAEL TENGERES DIRECTOR 1.0 46.5 X 0 479062 10976 SUE E ANDREWS TREASURER 5.0 55.0 X X 0 288461 23664 PETER HAMILTON CHAIRMAN 1.0 3.5 X X 0 0 0 BRUCE MCKEEGAN VICE CHAIRMAN 1.0 0.0 X X 0 0 0 CONNIE PELLGRINO SECRETARY 1.0 0.0 X X 0 0 0 DONALD HARRIS PHD DIRECTOR 1.0 0.0 X 0 0 0 CHARLOTTE HILL DIRECTOR 1.0 0.0 X 0 0 0 DENNIS N MARSH DIRECTOR 1.0 0.0 X 0 0 0 JOHN NADER DIRECTOR 1.0 0.0 X 0 0 0 POLLY DELLACROSSE DIRECTOR 1.0 0.0 X 0 0 0 CAROL SPINELLI DIRECTOR 1.0 0.0 X 0 0 0 MICHAEL STEIN DIRECTOR 1.0 0.0 X 0 0 0 CARLTON RULE MD CEO (until 2/28/17) 24.0 16.0 X 0 40699 1035 PAMELA VOGT ASSISTANT SECRETARY 40.0 0.0 X 0 0 0 SCOTT J BONDEROFF CEO (beginning 3/2017) 24.0 16.0 X 0 218123 15652 ERIN KINGSBURY PHARMACIST 40.0 0.0 X 144136 0 12924 MICHAEL VIAFORE RADIOLOGY 40.0 0.0 X 125597 0 6614 BENJAMIN WOOD PHARMACIST 40.0 0.0 X 125300 0 11525 CONNIE FINKLE REGISTERED NURSE 40.0 0.0 X 114103 0 7058 DEBRA J NEALE DIRECTOR OF NURSING 40.0 0.0 X 116023 0 9679 625159 1612182 131367 6 false true false Alliance Healcare Service 1900 S State College Blvd Suite 60 Anaheim CA 92806 PET / CT Services 192420 Mayo Medical Laboratories 200 First Street SW Rochester MN 55903 Lab Services 116684 2 278412 191878 104735 575025 Direct patient services 18267413 18267413 Other program service revenue 887431 887431 Outpatient pharmacy 446110 2292592 2292592 21447436 153829 153829 0 0 279168 279168 0 279168 279168 0 0 0 0 0 0 0 0 0 0 0 22455458 19154844 2292592 432997 0 0 0 0 45965 45965 0 7452771 5400918 2018923 32930 325880 234422 87630 3828 1751357 1274813 476544 550461 399156 149211 2094 2882887 830391 2017496 35000 0 0 4701 4701 0 0 755368 549832 205536 51858 25808 9648 16402 69406 50494 18875 37 0 0 300692 218874 81818 45819 33286 12443 90 0 0 48884 35583 13301 0 1225669 892104 333482 83 81079 59017 22062 Drugs and reagents 3294623 3294623 Bad debt 561121 561121 Patient care supplies 521525 521525 Charity care 66978 66978 1578684 1164055 408395 6234 21615728 15613000 5906030 96698 19909 16920 7560843 8434184 741922 637941 2317334 2020194 0 0 0 0 0 0 558365 576483 105576 70097 24429926 14674316 10692659 9755610 6160244 8249052 0 0 63569 59384 0 0 0 0 28220421 29819865 918366 1407297 0 0 0 0 0 0 0 0 0 0 1626971 1393400 471448 1025156 0 0 3016785 3825853 X 25045455 25665764 158181 328248 0 0 25203636 25994012 28220421 29819865 X 839730 -45169 -4185 X false true X true false X false false false false false false false false true 4701 4701 false SCHEDULE C, PART II-B, LINE 1 American Hospital Association membership dues allocate 22.98 % towards lobbying activities. Total dues paid in 2017 = $2,727.27. HANY's membership dues allocate 21.90 % towards general lobbying activities. Total dues paid in 2017 = $0. Iroquois Healthcare Alliance membership dues allocate 34.9 % towards general lobbying activities. Total dues paid in 2017 = $1,973.60. 99400 99400 14706040 6868275 7837765 9382169 7806041 1576128 242317 242317 9755610 0 0 X 21778005 -45169 -632284 -677453 22455458 22455458 20987629 20987629 628099 628099 21615728 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 as of December 31, 2017 and 2016. SCHEDULE D, PART XI, LINE 2D BAD DEBT $(561,121) CHARITY CARE $ (66,978) UNDISTRIBUTED INTEREST IN FRIENDS OF BASSETT $ (4,185) --------------- TOTAL $(632,284) SCHEDULE D, PART XII, LINE 4B BAD DEBT $ 561,121 CHARITY CARE $ 66,978 --------------- TOTAL $ 628,009 true true true X 300. false true true true false true true 1 19 112770 41281 71490 0.00340 2094769 1436226 658545 0.03140 277823 167005 110818 0.00530 1 19 2485362 1644512 840853 0.04010 1 116153 116153 0.00550 1 4336516 3805586 530930 0.02530 170862 170862 0.00810 19 18948 18948 0.00090 21 4642479 3805586 836893 0.03980 22 19 7127841 5450098 1677746 0.07990 true 561121 1364 6811545 6744104 67441 X true true 1 1 O'CONNOR HOSPITAL 460 ANDES ROAD DELHI NY 13753 WWW.OCONNORHOSP.ORG 1254700C X X X X OUTPATIENT PRIMARY & SPECIALITY O'CONNOR HOSPITAL 1 false false true X X X X X X X X X X 16 true true false true X WWW.OCONNORHOSP.ORG X WWW.BASSETT.ORG true 16 true WWW.OCONNORHOSP.ORG false true X 300. 0. false true X X X X true X WWW.OCONNORHOSP.ORG X WWW.OCONNORHOSP.ORG X WWW.OCONNORHOSP.ORG X X X X true X true X X X X X true X false false SCHEDULE H, PART V, LINE 3J, FACILITY 1, OCONNOR HOSPITAL Continuing prior CHNA work on preventing chronic diseases, promoting mental health, and preventing substance abuse. SCHEDULE H, PART V, LINE 5, FACILITY 1, OCONNOR HOSPITAL This Community Health Needs Assessment has taken into account input from persons who represent the broad interests of the community served by O'Connor Hospital. All organizations providing input into this assessment, including the name and title of those individuals representative of the organization, is provided below. A) Amy Beveridge, Director of Operational Support B) Debra Neale, CNO at O'Connor Hospital C) Pamela Vogt, Administrative Manager at O'Connor Hospital D) Marcy Miles, Director of Lab Services at Tri-Town Regional E) Alisha Rule, Director of Quality at O'Connor & Tri-Town Regional Hospitals F) Amanda Walsh, Epidemiologist at Delaware County Public Health G) Regina Krzyston, Quality Consultant at O'Connor & Tri-Town Hospitals H) Karen Huxtable-Hooker, Director Public & Media at Bassett Medical Center Relations I) Dotti Kruppo, Community Relations Director at UHS Hospital J) Laurie Mozian, Community Health Coordinator at Margaretville Hospital K) Mark Pohar, Executive Director at Margaretville Hospital The Community Service Plan (also referred to as the Implementation Strategy) has taken into account input from persons who represent the broad interests of the community served by O'Connor Hospital. The primary proactive means for receiving community input was through the Regional Assessment conducted by the Southern Tier Population Health Improvement Program (PHIP). In the Southern Tier, PHIP covers five counties including Delaware County. In order to inform the direction of the Southern Tier PHIP, also known as HealthlinkNY Community Network, the team conducted a regional health assessment utilizing stakeholder interviews and consumer focus groups. The information from this assessment that specifically refers to Delaware County was utilized to direct the selection of the public health priorities for OConnor Hospital. From June 2015 through January 2016, a total of 43 one-on-one structured interviews in Delaware County were conducted with professionals working in diverse fields such as health care, education, transportation, economic development, mental health, law enforcement, public office, among others. The interview questions, 10 key questions and 5 secondary questions, centered on health disparities, key barriers to addressing them, and gaps in service provision. Consumers input was sought through focus groups which were conducted from January through March of 2016. Population Health Coordinators met with pre-existing groups including support groups, service clubs, parent groups, and senior meal sites. HealthlinkNY Community Network conducted five focus groups with 37 participants in Delaware County; they were asked about their experiences with health and health care delivery. Responses from the focus groups were collected by note-takers and summarized qualitatively by the Population Health Coordinators. In addition, OConnor Hospital is an active participant in Delaware Countys Community Health Improvement Plan process. This process included input and suggestions from Delaware County Public Health, Delaware Valley Hospital, Margaretville Hospital, Tri-Town Regional Hospital, and HealthlinkNY Community Network. SCHEDULE H, PART V, LINE 6A, FACILITY 1, OCONNOR HOSPITAL Bassett Medical Center, Tri Town Regional Hospital, Cobleskill Regional Hospital, Little Falls Hospital, AO Fox Memorial Hospital SCHEDULE H, PART V, LINE 11, FACILITY 1, OCONNOR 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 identified 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. 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 O'Connor Hospital's CSP/free care program. SCHEDULE H, PART I, LINE 6A RELATED ORGANIZATION INFORMATION O'Connor Hospital's comprehensive Community Service Plan is summarized in an annual report and posted on the O'Connor Hospital website, www.oconnorhosp.org. Printed copies are available to the public in patient waiting rooms or upon request. SCHEDULE H, PART I, LINE 7, COLUMN (F) EXCLUSIONS FROM PERCENT OF TOTAL EXPENSE The percent of total expense in Part 1, Line 7, column (f) is calculated by dividing column (e), net community benefit expense, by total expense. The bad debt expense of $561,121 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 Worksheet 2 was used to develop a cost-to-charge ratio. It was used for patient care services. For non- patient care services, charges were reduced to cost for those services to non-patients where a mark-up is readily identifiable. SCHEDULE H, PART II COMMUNITY BUILDING ACTIVITIES All O'Connor Community Building Activities are included in Part I and described above. SCHEDULE H, PART III, LINE 2 BAD DEBTS EXPENSE METHODOLOGY The ratio of approved applications for financial assistance to total applications was applied to arrive at charges presumed eligible for financial assistance. The cost-to-charge ratio was then applied to charges to arrive at cost. 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 4 BAD DEBT EXPENSE FOOTNOTE TO FINANCIAL STATEMENTS Financial statements, page 8, footnote (i), Provision for Uncollectible Patient Accounts Receivable: 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 account. 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 net collections, business and economic conditions, trends in federal and state governmental healthcare coverage, and other collection indicators. Financial statements, page 8, footnote (k), Charity Care: The Hospital has adopted a formal charity care policy whereby patients in need of medical services, who meet certain criteria under the policy, are treated without regard to their ability to pay for such services. 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. The Hospital's charity care policy was revised effective January 1, 2016 to be compliant with Internal Revenue Code (IRC) Section 501(r). SCHEDULE H, PART III, LINE 8 MEDICARE EXPLANATION O'Connor is a critical access hospital, so cost is calculated on the settlement sheets of the cost report. It was compared to Medicare reimbursement, which is also calculated on the cost 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 OConnor Hospital. OConnor Hospital 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 OConnor Hospital. 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, Delaware Co. Behavioral Risk Factor Surveillance System. Delaware County Public Health Nursing Services Community Health Assessment and other sources were used to assess priorities, including the rising percentage of adults with diabetes and rising obesity rate. Based on the priority items, the following strategies were identified: 1. Access to Quality Healthcare and Preventive Care Services a.) Recruitment of primary care providers for community based health centers by Bassett Medical Center in areas of the county where access to primary care is an issue. b.) O'Connor Hospital, Tri-Town Regional Hospital (TRH) and Bassett Medical Center will continue to identify grant opportunities to assist in attracting physicians to Delaware Co. c.) O'Connor Hospital and TRH will continue to evaluate the need for specialty services and expand or develop specialty clinics as needed to increase access. d.) O'Connor Hospital and Tri-Town Wellness Network will continue to offer and expand worksite wellness and occupational health services. e.) O'Connor Hospital will increase access through the provision of physician coverage at Countryside Care center nursing home. f.) O'Connor Hospital and TRH will work with Bassett's Cancer Services Program and community partners to increase access to preventive cancer screening services throughout the county. g.) Bassett Medical Center and O'Connor Hospital will work to increase access to dental health care by recruiting a dentist/oral surgeon for the Bassett Medical Center's Delhi Dental Clinic. h.) O'Connor Hospital and TRH will continue to provide and expand smoking cessation classes to area residents as well as to offer support to individuals who have recently become non-tobacco users. 2. Physical Activity and Nutrition a.) O'Connor Hospital, TRH and the Tri-Town Wellness Network will promote adoption of healthy lifestyle behaviors through group sessions to improve understanding of nutrition, diabetes medications and issues important to diabetics and those at risk of becoming diabetic. b.) O'Connor Hospital and TRH will collaborate with the Delaware Co. Public Health Nursing Services to encourage area residents to increase their personal physical activity via information about available programs in the region and encouragement to participate in these programs. c.) O'Connor Hospital will continue to collaborate with the Delaware Co. Rural Health Alliance to develop and implement community wellness and preventive programs. 3. Overall Goals a.) Increase access to preventive health care by recruiting primary care providers, expanding workplace and community-based wellness programs, and providing cancer screening services in underserved areas of the county b.) Improve community worksite access to smoking cessation programs through additional class offerings and follow-up sessions c.) Establish formal diabetes support and educational sessions on prevention and wellness topics of particular interest to diabetics and those who care for and about them d.) Promote physical activity by raising awareness of existing opportunities in the area and by offering additional activities and rewards programs for participation. O'Connor Hospital will continue to offer free educational programming, health screenings and events to increase knowledge about chronic diseases, women's health, aging, occupational health and other topics/prevention priorities. These include lectures, presentations, support groups and participation in community wellness events. SCHEDULE H, PART VI, LINE 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE A major component of the O'Connor Hospital 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 O'Connor 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. Patient referral to the Delaware County Medicaid Examiner is facilitated by the Finance Director at the O'Connor Hospital. 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 According to the 2017 United States census estimate, Delaware County, New York, has a population of 45,001 and is approximately the size of the state of Rhode Island. The county has four hospitals covering an area of 1,442.44 square miles with 33.3 people per square mile. O'Connor's service area includes the Delhi community, as well as, surrounding communities stretching from Grand Gorge, through Stamford, South Kortright, Bovina, Andes, Bloomville, Hamden and Franklin to Treadwell, and covering many hamlets in between. This large service area represents the eastern branch and areas of the northeastern part of Delaware County. SCHEDULE H, PART VI, LINE 5 PROMOTION OF COMMUNITY HEALTH O'Connor Hospital is a critical access hospital in Delhi, New York providing a full range of acute and preventative health care services, including acute inpatient care, restorative/rehabilitative (swing bed) care, an emergency services department where practitioners have the ability to interface with board-certified neurologists in Cooperstown through telemedicine connections, same-day surgery, a state-of-the-art medical imaging suite, laboratory services, an outpatient pharmacy, physical and occupational therapy, dietary consultations, an Eye Wear Center, a dental clinic and a wide range of specialty services. O'Connor has served the Delhi Community since 1922 and has been affiliated with The Mary Imogene Bassett Hospital (dba Bassett Medical Center) since 1988. O'Connor is an entity of the Bassett Healthcare Network. It is governed by a 13 member Board of Trustees consisting of community volunteers. O'Connor Hospital programs address chronic disease management and prevention, women's health, aging, tobacco and unintentional injury. They include: 1.) Cancer Services Program of Delaware, Otsego and Schoharie Counties 2.) Bassett Cancer Institute medical screening coach equipped with digital technology for mammography and other cancer screenings for men and women. 3.) O'Connor Dental Clinic operating since 2005 through a partnership with Bassett Medical Center 4.) Occupational Health - through a partnership with HealthWorks, a part of Bassett's New York Center for Agricultural Medicine & Health, O'Connor provides post-hire screenings to area employers and offers health screenings for firefighters and EMS personnel 5.) O'Connor Hospital provides space for diabetes, Alzheimer's, mental health and Parkinson's support groups on a monthly basis. 6.) O'Connor Hospital webinars are offered twice a month on healthy eating and other topics 7.) O'Connor offers a six-week facilitated group smoking cessation program 8.) O'Connor offers spring and fall flu shot clinics 9.) O'Connor provides free community assessments, screenings and educational events including health fairs, blood pressure screenings, free eye screenings for children (ages 1 - 5), balance assessment, fitness assessment tests for strength, and free lunch and learn workshops throughout the year. 10.) A program for expectant parents is offered in the O'Connor Specialty Clinic 11.) Rehabilitation Services department at O'Connor provides a fall prevention program and a wheelchair clinic O'Connor Hospital is continually engaging in quality improvement activities to ensure high quality health care and programs are available in Delaware County. O'Connor has a community board who are actively engaged in the hospital both supporting the growth and the investment in programs that bring health and wellness benefits to the community. O'Connor continually invests in programs, equipment and people to ensure high quality service is available in the community they serve. SCHEDULE H, PART VI, LINE 6 AFFILIATED HEALTH CARE SYSTEM O'Connor Hospital is part of the Bassett Healthcare Network that provides health services in more than 20 communities spanning 5,600 square miles and seven counties. The network focuses its community services programs in the counties where the six affiliated hospitals and greatest patient populations are located. Otsego County - population 60,094; Delaware County - population 45,001; Herkimer County - population 62,240; Schoharie County - population 31,420 (according to the 2017 U.S. Census estimates). a) O'Connor Hospital, a critical access hospital in Delhi, Delaware County b) The Mary Imogene Bassett Hospital - an acute care inpatient teaching facility, an outpatient primary and specialty care center, a regional network of 26 community based outpatient health centers, 20 school based health centers, two ambulatory surgery centers, and a fully salaried medical staff in Cooperstown, Otsego County c) Cobleskill Regional Hospital, an acute care facility in Cobleskill, Schoharie County d) Little Falls Hospital, a critical access hospital in Little Falls, Herkimer County e) Tri-Town Regional Hospital, a 24/7 emergency care facility in Sidney, Delaware County f) A.O. Fox Memorial Hospital, an acute care facility in Oneonta, Otsego County g) Valley Health Services, a residential health care and rehabilitation facility h) At Home Care, a certified home care agency i) First Community Care of Bassett, a medical supply company All of the above 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 false false false false false false false false JAMES C PETERS DIRECTOR 0 565837 0 20000 0 0 0 24612 0 7628 0 618077 0 0 MICHAEL TENGERES DIRECTOR 0 412662 0 66400 0 0 0 8912 0 2064 0 490038 0 0 SUE E ANDREWS TREASURER 0 268936 0 19525 0 0 0 17600 0 6064 0 312125 0 0 ERIN KINGSBURY PHARMACIST 144136 0 0 0 0 0 7717 0 5207 0 157060 0 0 0 SCOTT J BONDEROFF CEO (beginning 3/2017) 0 218123 0 0 0 0 0 13016 0 2636 0 233775 0 0 SCHEDULE J, PART I, LINE 3 RELATED ORG METHODS USED FOR COMPENSATION EXPLANATION The Mary Imogene Bassett Hospital (dba Bassett Medical Center) provides the compensation for the Presidents of O'Connor Hospital, A.O. Fox Memorial Hospital, Cobleskill Regional Hospital, and Little Falls Hospital. Bassett Medical Center uses the following methods to establish compensation for said individuals: A) compensation committee, B) independent compensation consultant, C) written employment contract, D) compensation survey or study and, E) approval by the board or compensation committee. FORM 990, PART VI, LINE 11B ORGANIZATIONS PROCESS TO REVIEW FORM 990 The Treasurer of the Board presents the draft 990 to the Executive and Finance Committee of the Board prior to any filing. Any member of the Board who wishes to attend this presentation may attend. Any questions raised are answered and 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 it's filing 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 Directors, board members, and key persons such as the Chief Executive Officer. Each board member, officer, or key person of the hospital shall complete a conflict of interest questionnaire annually. All completed questionnaires are reviewed and all disclosures of potential conflicts will be brought to the Chief Executive Officer. The CEO or his/her designee will take action to eliminate the potential conflict of interest. All disclosures of potential conflicts of interest in the completed questionnaires shall be compiled and reported by the Assistant Treasurer to the Executive and Finance Committee of the board to determine if the reported disclosure and resolution is satisfactory. If the actions taken are not satisfactory, the Executive and Finance Committee shall determine further action as it deems appropriate. FORM 990, PART VI, LINE 15A COMPENSATION PROCESS FOR TOP OFFICIAL The Chief Executive Officer's salary is paid by a related organization under a management services agreement. O'Connor Hospital reviews the formal process that is used to determine the base compensation of the CEO. The CEO workplan and accomplishments for the year are reviewed. The CEO's salary is submitted as part of the management services agreement, which is approved by the board. FORM 990, PART VI, LINE 19 GOVERNING DOCUMENTS DISCLOSURE EXPLANATION O'Connor Hospital makes its governing documents, conflict 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 O'Connor Hospital or by sending a self-addressed stamped envelope and payment for copying of the requested material to O'Connor Hospital Administrative offices. The cost of copying shall be equal to the costs imposed by the IRS for copying public documents. FORM 990, PART XI, LINE 9 OTHER CHANGES IN NET ASSETS UNDISTRIBUTED INTEREST IN FRIENDS OF BASSETT $(4,185) 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 Mary Imogene Bassett Hospital One Atwell Road Cooperstown NY 13326 135596796 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 6181 State Highway 7 Oneonta NY 13820 811749905 Healthcare NY 501c3 12a MIBH false false false true false false false false false false true false true true false false false true false false