2016-11-15T12:00:34-06:00 2015-12-31 161226221 FUST CHARLES CHAMBERS LLP 5784 WIDEWATERS PARKWAY SYRACUSE NY 13214 990 2015-01-01 150539039 AURELIA OSBORN FOX MEMORIAL HOSPITAL AURE 6074315900 1 NORTON AVE ONEONTA NY 13820 MARK J WRIGHT CFO 6074315900 2016-11-11 1 JOSEPH J SCHLEGEL P00301329 3154463600 2015 2017-02-10 21:41:12Z AO FOX MEMORIAL HOSPITAL MARK J WRIGHT 1 NORTON AVE ONEONTA NY 13820 77401367 0 X WWW.AOFOXHOSPITAL.COM X 1900 NY HEALTH CARE DELIVERY: INCLUDES: UNCOMPENSATED CARE, PAYMENTS INTO BAD DEBT AND CHARITY CARE POOLS, NYS HEALTH FACILITIES ASSESSMENT, COMMUNITY EDUCATION, MATERNAL CARE PROGRAM, COST OF PROVIDING SERVICES TO GOVERNMENT PAYORS. HEALTH/WELLNESS AND EDUCATIONAL SERVICES TO THE GENERAL PUBLIC. 15 13 1017 107 0 0 4143888 6080776 69790497 68965208 383479 61159 722490 864256 75040354 75971399 0 0 0 0 42649152 43604105 0 0 0 39831312 37900562 82480464 81504667 -7440110 -5533268 64024694 60032892 34090142 35625146 29934552 24407746 X HEALTH CARE DELIVERY: INCLUDES: UNCOMPENSATED CARE, PAYMENTS INTO BAD DEBT AND CHARITY POOLS, NYS HEALTH FACILITIES ASSESMENT, COMMUNITY EDUCATION, MATERNAL CARE PROGRAM, COST OF PROVIDING SERVICES TO GOVERNMENT PAYORS. HEALTH/WELLNESS AND EDUCATIONAL SERVICES TO THE GENERAL PUBLIC. 0 0 61954502 58874309 HEALTH CARE DELIVERY: INCLUDES: UNCOMPENSATED CARE, PAYMENTS INTO BAD DEBT AND CHARITY POOLS, NYS HEALTH FACILITIES ASSESSMENT, COMMUNITY EDUCATION, MATERNAL CARE PROGRAM, COST OF PROVIDING SERVICES TO GOVERNMENT PAYORS. HEALTH/WELLNESS AND EDUCATIONAL SERVICES TO THE GENERAL PUBLIC. IN 2015 THE HOSPITAL HAD 12129 PATIENT DAYS 14225 EMERGENCY ROOM VISITS AND 172787 OUTPATIENT VISITS. 9935373 9472871 NURSING HOME CARE - NURSING HOME FACILITY- SKILLED NURSING, HEALTH AND RESPITE CARE. IN 2015 THE NURSING HOME HAD 46501 PATIENT DAYS 71889875 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 82 0 1 1017 1 0 0 0 0 0 0 0 0 0 0 X 15 13 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 1 0 NY X MARK WRIGHT AURELIA OSBORN FOX MEMORIAL HOSPITAL 6074315900 1 NORTON AVE ONEONTA NY 13820 TODD BITTERMAN DIRECTOR 0.50 X 0 0 0 BRIAN D BURNS DIRECTOR 0.50 X 0 0 0 MAUREEN HULBERT DIRECTOR 0.50 X 0 0 0 NANCY KLENIEWSKI DIRECTOR 0.50 X 0 0 0 WILLIAM MIRABITO DIRECTOR 0.50 X 0 0 0 SARAH PATTERSON CHAIRMAN 0.50 X X 0 0 0 SETH HAIGHT TREASURER 0.50 X X 0 0 0 JEANNE HAVENER SECRETARY 0.50 X X 0 0 0 KEVIN KURKOWSKI LEFT 06012015 DIRECTOR 0.50 X 0 0 0 V DANIEL ROBINSON VICE CHAIR 0.50 X X 0 0 0 GENNARO FALCO MD 40.00 X 163677 0 15205 LORRAINE ZIMNIEWICZ DIRECTOR 0.50 X 0 0 0 JOSEPH FORGIANO DIRECTOR 0.50 X 0 0 0 GERALD GROFF DIRECTOR 0.50 40.00 X 0 386206 21785 MICHAEL TENGERES DIRECTOR 0.50 45.00 X 0 316107 1538 MARY ELLEN HOFFMAN DIRECTOR 0.50 X 0 0 0 JOHN REMILLARD LEFT 12312015 PRESIDENT 40.00 X 0 349000 11858 MARK WRIGHT CFO 40.00 X 169492 0 28389 BENJAMIN FRIEDELL VP MEDICAL AFFAIRS 40.00 X 255166 0 25726 PATRICK GERMAIN MD 40.00 X 420383 0 28236 SARBJIT VILKHU MD 40.00 X 320172 0 24776 MARIO VILLARINI MD 40.00 X 324284 0 28165 BLAINE JONES MD 40.00 X 326356 0 33285 GODWIN NJOKU MD 40.00 X 337485 0 27453 2317015 1051313 246416 38 0 1 0 PEGASUS MEDICINE GROUP 1007 E MAIN STREET SUITE 300 BOZEMAN MT 59715 CONTRACTED MEDICAL SERVICES 1273694 FUST CHARLES CHAMBERS 5784 WIDEWATERS PARKWAY SYRACUSE NY 13214 AUDITING, TAX AND CONSULTING SERVICES 145501 FUSION MEDICAL STAFFING LLC 11506 NICHOLAS STREET OMAHA NE 68154 MEDICAL LOCUM SERVICES 130749 3 33652 5491738 555386 6080776 HOSPITAL 621990 58683917 58683917 NURSING HOME 623990 9472871 9472871 808420 808420 68965208 78282 78282 704714 261857 442857 442857 442857 809585 512 827220 0 -17635 512 -17123 -17123 531283 340891 190392 190392 EXPENSE REIMBURSEMENT 621910 214225 214225 CONVENIENCE SERVICES 621910 16782 16782 231007 75971399 68347180 0 1543443 X 966856 412349 554507 32219830 27327966 4891864 1824869 1547803 277066 6229258 5283484 945774 2363292 2004479 358813 360858 360858 209067 209067 217019 217019 16069 16069 13285928 13285928 55743 47280 8463 3714030 3150137 563893 1556658 1320314 236344 179373 152139 27234 794960 674263 120697 5252427 4126285 1126142 967662 967662 SUPPLIES 8252032 8252032 BAD DEBT 2631831 2631831 MISC EXPENSE 279837 279837 DUES & SUBSCRIPTIONS 127068 127068 81504667 71889875 9614792 0 1349759 1361438 2469298 2679944 8530631 8437822 1278260 1207301 624122 885493 146470164 113348965 36867485 33121199 2772972 2134147 10132167 10205548 64024694 60032892 14479545 14151453 16606330 14884017 3004267 6589676 34090142 35625146 X 25244564 19818336 1072361 969863 3617627 3619547 29934552 24407746 64024694 60032892 X -5533268 -170508 176970 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 16069 16069 0 PART II-B, LINE 1: A PERCENTAGE OF MEMBERSHIP DUES PAID TO HEALTHCARE ASSOCIATION OF NEW YORK STATE (28.03), IROQUOIS HEALTHCARE ALLIANCE (36.30) AND AMERICAN HOSPITAL ASSOCIATION (22.12) ARE USED SPECIFICALLY FOR LOBBYING PURPOSES 5228943 1070638 24349 1620387 4654824 10582609 1106618 325088 6785372 5228943 11422949 12698274 203520 13742134 10582609 10767313 2686662 837450 2868476 11422949 11139059 2001098 -182685 2190159 10767313 0.01410 0.77760 0.20830 0 1 1 4285231 4285231 52479445 33004495 19474950 89189034 80344470 8844564 516454 516454 33121199 DUE FROM AFFILIATES 3559906 BENEFICIAL INTEREST IN NET ASSETS OF A.O. FOX FOUNDATION 2948976 BENEFICIAL INTEREST IN NET ASSETS OF AT HOME CARE INC. 1588227 OTHER ASSETS 109285 DEFFERRED FINANCING COSTS, NET OF ACC. DEPRECIATION 382316 SETTLEMENT AMOUNTS DUE FORM 3RD PARTY PAYORS , NET 1091838 GRANTS AND OTHER RECEIVABLES 525000 10205548 LONG TERM (HUM) 404246 LPN PENSION PAYABLE 1304313 WORKERS COMP AMD MLMIC (HUM) LIABILITY 184817 INSURANCE LIABILITY CLAIMS 525000 COMPESATED ABSENCES 464525 MLMIC LT CASE - SOHL 10 YEARS 210000 DEFERRED REVENUE 213037 DUE TO AFFLIATES 3283738 6589676 X PART X, LINE 2: THE HOSPITAL AND FOUNDATION ARE NOT-FOR-PROFIT CORPORATIONS AND HAVE BEEN RECOGNIZED AS TAX EXEMPT ORGANIZATIONS PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. AS OF DECEMBER 31,2015 AND 2014, THE HOSPITAL AND FOUNDATION 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 2012 THROUGH 2015 PART V QUESTION 4 PERMANENT ENDOWMENTS: THE INTENDED USE OF THE INCOME FROM THESE FUNDS IS TO SUPPORT OPERATIONS, FUND THE ANNUAL PHYSICIANS LECTURES AND DINNERS. BOARD DESIGNATED OR QUASI ENDOWMENTS: THE INTENDED USE OF INCOME FROM THESE FUNDS IS TO SUPPORT OPERATIONS OR FOR THE FUTURE CAPITAL NEEDS. TERM ENDOWMENTS: THE INTENDED USE OF THESE FUNDS IS DETERMINED BY THE VARIOUS DONORS, AND TO PROVIDE FOR THE NEEDS OF NURSING HOME PATIENTS. 1 1 1 X 300.000000000000 1 X 1 1 0 1 1 594385 127167 467218 0.00590 19959482 14047146 5912336 0.07500 219497 147815 71682 0.00090 20773364 14322128 6451236 0.08180 39957 39957 0.00050 39957 39957 0.00050 20813321 14322128 6491193 0.08230 1 2631830 16906698 20382393 -3475695 X 1 1 1 AT HOME CARE REGIONAL HOME HEALTH AGENCY 0.50000 0.00000 0.00000 1 1 AURELIA OSBORN FOX MEMORIAL HOSPITAL 1 NORTON AVE ONEONTA NY 13820 X X X AURELIA OSBORN FOX MEMORIAL HOSPITAL 1 0 0 1 X X X X X X X X 13 1 1 0 1 X WWW.BASSETT.ORG/AO-FOX-HOSPITAL.ORG X 1 13 1 HTTP://WWW.BASSETT.ORG/GEDOWNLOAD!/FOX%20-%202014%20CSP%20SUMMARY%20TABLE%2 0 0 1 X 300.000000000000 300.000000000000 X X X 1 1 1 X WWW.BASSETT.ORG X WWW.BASSETT.ORG X WWW.BASSETT.ORG X X X X 1 X 0 X X X 1 X 0 0 AURELIA OSBORN FOX MEMORIAL HOSPITAL PART V, SECTION B, LINE 5: THIS COMMUNITY HEALTH NEEDS ASSESSMENT HAS TAKEN INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVED BY A.O. FOX MEMORIAL HOSPITAL. 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 THERESA OELLRICH FROM THE OTSEGO COUNTY HEALTH DEPARTMENT. JOHN REMILLARD, PRESIDENT AURELIA OSBORN FOX MEMORIAL HOSPITAL FELECIA EMILIO, DIRECTOR MANDATORY EDUCATION & DIABETES EDUCATOR ROBERT LANCEY MD, NETWORK MEDICAL DIRECTOR BASSETT MEDICAL CENTER WILLIAM STAMP, EXECUTIVE DIRECTORMARKETING BASSETT MEDICAL CENTER PAUL G. FITZPATRICK PRESIDENT RURAL HEALTH DEVELOPMENT SARAH PATTERSON, VICE-CHAIR AURELIA OSBORN HOSPITAL BOARD BECKY DRAKE RD, CHAIRPERSON GET FIT OTSEGO SUSAN KURKOWSKI, YMCA AND ONEONTA SCHOOL BOARD MEMBER FRANK RUSSO, DIRECTOR YMCA BARBARA SPERLING, ONEONTA COMMUNITY HEALTH CENTER THERESA OELLRICH, DIRECTOR OTSEGO CO. HEALTH DEPARTMENT JULIE DOSTAL, EXECUTIVE DIRECTOR LEAF COUNCILIN ADDITION TO COMMUNITY COMMENTS AND INPUT GATHERED IN RESPONSE TO POSTING OF THE COMMUNITY HEALTH NEEDS ASSESSMENT OF BOTH THE HOSPITAL'S AND BASSETT HEALTHCARE NETWORK'S WEBSITES, THE PRIMARY PROACTIVE MEANS FOR RECEIVING COMMUNITY INPUT WAS THROUGH A COMMUNITY-WIDE STAKEHOLDER MEETING HOSTED BY A.O. FOX MEMORIAL HOSPITAL ON OCTOBER 31, 2012. THE PURPOSE OF THE STAKEHOLDER MEETING WAS THREEFOLD: 1) TO ELICIT GENERAL COMMENTS ON THE DRAFT CHNA; 2) TO SEEK COMMUNITY INPUT ON THE PRIORITY HEALTH NEEDS IDENTIFIED BY THE CHNA; AND 3) TO SEEK COMMUNITY INPUT ON POTENTIAL IMPLEMENTATION STRATEGIES. A SUMMARY OF THE STAKEHOLDER SESSION IS PROVIDED IN APPENDIX 2. THIRTEEN INDIVIDUALS REPRESENTING 9 AREA HEALTH PROVIDERS AND COMMUNITY SERVICES ORGANIZATIONS ATTENDED THE SESSION.IN ADDITION TO THE PROCESS AND COMMUNITY PARTICIPATION SPECIFICALLY USED IN DEVELOPING THIS COMMUNITY HEALTH NEEDS ASSESSMENT, SIGNIFICANT PROCESSES AND COMMUNITY PARTICIPATION WERE INVOLVED IN COMPILING THE 2010-2012 A.O. FOX MEMORIAL HOSPITAL COMMUNITY SERVICES PLAN AND THE 2010-2013 OTSEGO AND DELAWARE COUNTIES' HEALTH ASSESSMENTS. EACH OF THESE EFFORTS INCLUDED THEIR OWN PROCESS AND METHODS FOR IDENTIFYING COMMUNITY HEALTH NEEDS. EACH ALSO PROVIDED NUMEROUS OPPORTUNITIES FOR COMMUNITY INPUT AND PARTICIPATION IN REVIEWING AND INFLUENCING THE SELECTION OF PRIORITY HEALTH NEEDS.THE 2010- 2012 COMMUNITY SERVICE PLAN FOR A.O. FOX HOSPITAL AND THE 2010-2013 COMMUNITY HEALTH ASSESSMENT FOR OTSEGO COUNTY WERE DEVELOPED IN TANDEM. THE DEVELOPMENT PROCESS INVOLVED A RANGE OF COMMUNITY PARTNERS INCLUDING COUNTY DEPARTMENTS (HEALTH, SOCIAL SERVICES, AND EMERGENCY SERVICES), AS WELL AS COUNTY, TOWN AND CITY REPRESENTATIVES; OPPORTUNITIES FOR OTSEGO; NEW YORK CONNECTS OF OTSEGO COUNTY; PLANNED PARENTHOOD; SAFE KIDS; TWO CENTRAL SCHOOLS; CORNELL COOPERATIVE EXTENSION; RURAL THREE FOR TOBACCO FREE; CATSKILL AREA HOSPICE; SPRINGBROOK; THE ARC OTSEGO; UNITED WAY; AT HOME CARE, INC.; BASSETT MEDICAL CENTER; AND AO FOX HOSPITAL. A DETAILED DESCRIPTION OF THE PROCESS AND LEVEL OF COMMUNITY PARTICIPATION IN THEDEVELOPMENT OF THE COMMUNITY SERVICES PLAN IS PROVIDED IN APPENDIX 3.THE 2010-2013 DELAWARE COUNTY COMMUNITY HEALTH ASSESSMENT WAS PREPARED BY THE DELAWARE COUNTY PUBLIC HEALTH SERVICE (DCPH). DCPH CONDUCTED A COUNTYWIDE INFORMATION GATHERING INITIATIVE WITH THE GOAL OF UNDERSTANDING PUBLIC HEALTH PRIORITIES. THIS INVOLVED COLLABORATIVE EFFORTS AMONG DELAWARE COUNTY PUBLIC HEALTH NURSING SERVICES (DCPH), HOSPITALS, HEALTHCARE PROVIDERS, OTHER COMMUNITY-BASED ORGANIZATIONS, AND CONSUMERS. A DETAILED DESCRIPTION OF THE PROCESS AND LEVEL OF COMMUNITY PARTICIPATION IN THE DEVELOPMENT OF THE COUNTY COMMUNITY HEALTH ASSESSMENT IS PROVIDED IN APPENDIX 3. AURELIA OSBORN FOX MEMORIAL HOSPITAL PART V, SECTION B, LINE 6A: MARY IMOGENE BASSETT HOSPITALO'CONNER HOSPITALCOBLESKILL REGIONAL HOSPITALLITTLE FALLS HOSPITALTRI TOWN REGIONAL HEALTHCARE AURELIA OSBORN FOX MEMORIAL HOSPITAL PART V, SECTION B, LINE 11: A.O. FOX HAS BEEN CONTINUOUSLY WORKING TO BETTER MANAGE CHRONIC DISEASE AND INCREASE ACCESS TO HIGH QUALITY CHRONIC DISEASE MANAGEMENT/SELF-MANAGEMENT EDUCATION THROUGH OFFERING DIABETIC MANAGEMENT PROGRAM TO ALL PATIENTS WITH A HEMAGLOBIN A1C >9. A.O. FOX HAS BEEN TRACKING REFERRALS TO THE PROGRAM AND PROVIDING MONTHLY FEEDBACK AND EDUCATION ABOUT THE PROGRAM TO PRIMARY CARE PROVIDERS TO INCREASE REFERRALS TO THE PROGRAM. A.O. FOX CONTINUES TO HOLD NQCA RECOGNITION FOR SEVERAL PRIMARY CARE SITES FOR THE DIABETIC RECOGNITION PROGRAM. A.O. FOX HAS ALSO IMPLEMENTED PHYTEL POPULATION HEALTH TECHNOLOGY TO HELP IMPROVE SCREENING RATES FOR SEVERAL CONDITIONS INCLUDING BREAST CANCER, COLORECTAL CANCER, AND CERVICAL CANCER AMONG ALL PATIENTS OF THE ORGANIZATION. A.O. FOX IS A MEMBER OF THE DSRIP PCMH PROGRAM AND CURRENTLY WORKING TO TRANSFORM ALL PRIMARY CARE PRACTICES TO PCMH 2014 LEVEL 3 STANDARDS BY DEC 2017. IN AN EFFORT TO DECREASE CHILDHOOD OBESITY, A.O. FOX CONTINUES TO PARTICIPATE IN THE 5-2-1-0 EVERYDAY PROGRAM WITH GET FIT OTSEGO. A.O. FOX HAS ALSO INITIATED THE BREAST FEEDING FRIENDLY PRACTICE INITIATIVE WITH THE NYSDOH TO INCREASE BREASTFEEDING AND DECREASE CHILDHOOD OBESITY AND PROMOTE HEALTHY WOMEN AND CHILDREN. THE ORGANIZATION HAS BEGUN WORK ON TRAINING STAFF, TRANSFORMING THE PEDIATRIC AND WOMEN'S HEALTH PRACTICES, AND DEVELOPING COLLABORATIVE EFFORTS AND PROGRAMS SUCH AS A BREASTFEEDING CAFE.PART V, LINE 11:RESULTS OF 2015 COMMUNITY HEALTH NEEDS ASSESSMENT IMPLEMENTATION PLANIN 2015, A.O. FOX HOSPITAL'S COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) AND CORRESPONDING COMMUNITY SERVICE PLAN (CSP) IDENTIFIED THREE COMMUNITY HEALTH IMPROVEMENT GOALS: PREVENTING CHRONIC DISEASE, PROMOTING MATERNAL AND INFANT HEALTH AS WELL AS PROMOTING CHILD HEALTH. FOX HOSPITAL WAS SUCCESSFUL IN IMPLEMENTING THE FOLLOWING INTERVENTIONS:1. ACTION PLAN 1: PREVENTING CHRONIC DISEASE A. THE HOSPITAL HAS COMPLETED PRIORITY 1.4.2; INCREASE THE PERCENTAGE OF EMPLOYERS WITH SUPPORT FOR BREASTFEEDING AT THE WORKSITE BY 10%. THANKS TO THE WORK OF THE BREAST FEEDING TASK FORCE AT FOX, A PRIVATE SPACE FOR BREASTFEEDING EMPLOYEES AND PATIENTS IS NOW AVAILABLE AT THE FOXCARE CENTER AND IN THE WOMEN'S HEALTH PRACTICE. B. IN FEBRUARY OF 2015, THE HOSPITAL IMPLEMENTED PHYTEL POPULATION HEALTH TECHNOLOGY TO HELP IMPROVE SCREENING RATES FOR SEVERAL CONDITIONS INCLUDING BREAST CANCER, COLORECTAL AND CERVICAL CANCER AMONG ALL PATIENTS OF THE ORGANIZATION. SINCE 2015, OUR DATA SHOWS: 841 PATIENTS HAVE BEEN SCREENED FOR CERVICAL CANCER, 1,642 PATIENTS HAVE BEEN SCREENED FOR BREAST CANCER AND 296 PATIENTS HAVE BEEN SCREENED FOR COLORECTAL CANCER. 2. ACTION PLAN 2: PROMOTE HEALTH IN WOMEN, INFANTS AND CHILDREN: MATERNAL AND INFANT HEALTHA. THE HOSPITAL HAS COMPLETED NECESSARY REQUIREMENTS OF FOCUS AREA ONE; INCREASE THE PROPORTION OF NYS BABIES WHO ARE BREASTFED. OUT OF 331 PATIENTS SEEN AT FOX; 0-6 MONTHS OF AGE, 295 PATIENTS HAVE BEEN DOCUMENTED AS BREASTFED. THIS IS AN INCREASE OF 28% OF BREASTFED PATIENTS IN 2015. B. OUTPATIENT PRACTICES AT THE HOSPITAL NOW ADHERE TO THE TEN STEPS TO SUCCESSFUL BREASTFEEDING AND SUMMITED THE APPLICATION FOR DESIGNATION IN SEPTEMBER OF 2016. FOX ANTICIPATES RECEIVING THE BREASTFEEDING FRIENDLY PRACTICE DESIGNATION BY EARLY 2017. 3. ACTION PLAN 3: PROMOTE HEALTH WOMEN, INFANTS AND CHILDREN: CHILD HEALTHA. GOAL FOUR; INCREASE THE PERCENTAGE OF NYS POPULATION RECEIVING FLUORIDATED WATER BY 10%. TO HELP ACHIEVE THIS GOAL, THE HOSPITAL JOINED THE OTSEGO COUNTY ORAL HEALTH COALITION TO LOOK FOR OPPORTUNITIES TO PARTNER ON THE PASSIVE AND EFFECTIVE INTERVENTIONS AIMED AT REDUCING DENTAL CARIES IN CHILDREN. THANKS TO THE WORK OF THIS COMMITTEE THE COMMON COUNCIL VOTED TO CONTINUE ONEONTA'S CURRENT POLICY OF MUNICIPAL WATER FLUORIDATION. 2016-2018 COMMUNITY HEALTH NEEDS ASSESSMENT ACTION PLANBASSETT RESEARCH INSTITUTE'S MOHAWK VALLEY POPULATION HEALTH IMPROVEMENT PROGRAM (MVPHIP), A GRANT FUNDED PROGRAM FROM NEW YORK STATE DEPARTMENT OF HEALTH, CONDUCTED AN ASSESSMENT ON BEHALF OF THE MARY IMOGENE BASSETT HOSPITAL (DBA: BASSETT MEDICAL CENTER), A.O. FOX MEMORIAL HOSPITAL AND OTSEGO COUNTY HEALTH DEPARTMENT. UTILIZING THE NEW YORK STATE'S PREVENTION AGENDA 2013-2018; THE HOSPITALS, LOCAL COUNTY HEALTH DEPARTMENT AND STAKEHOLDERS HAVE SELECTED INTERVENTIONS THAT ADDRESS HEALTH CARE CHALLENGES IN THE LOCAL COMMUNITY. A.O. FOX HOSPITAL WILL TRANSITION TO WORK ON THE FOLLOWING INITIATIVES IN 2017:1. FOCUS AREA 2: REDUCE ILLNESS, DISABILITY AND DEATH RELATED TO TOBACCO USE AND SECONDHAND SMOKE EXPOSURE. A. THE HOSPITAL WILL OFFER A FREE SMOKING CESSATION COURSE TO ALL EMPLOYEES IN 2017, WITH A GOAL OF REDUCING THE AMOUNT OF ADULT SMOKERS BY 25.6%. BY PARTNERING WITH, "THE BUTT STOPS HERE," THE HOSPITAL WILL PROVIDE SEVEN, ONE-HOUR EDUCATIONAL COURSES, AS WELL AS PATCHES AND GUM TO ASSIST IN SMOKING CESSATION.B. IN JUNE OF 2017, THE PROGRAM WILL BE OFFERED TO THE COMMUNITY AND WILL BE MANAGED BY A SMOKING CESSATION COORDINATOR AT THE HOSPITAL. C. THE HOSPITAL WILL USE HEALTH COMMUNICATIONS TO INCREASE THE IMPACT AND UTILIZATION OF THE NYS SMOKER'S QUITLINE, PARTICULARLY AMONG DISPARATE POPULATIONS.2. FOCUS AREA 3: INCREASE ACCESS TO HIGH-QUALITY CHRONIC DISEASE PREVENTIVE CARE AND MANAGEMENT IN CLINICAL AND COMMUNITY SETTINGS A. THE HOSPITAL WILL FOCUS ON REDUCING THE ASTHMA EMERGENCY DEPARTMENT VISIT RATE BY DECEMBER 2018. ASTHMA EDUCATION AND MANAGEMENT WILL BE OFFERED TO CHILDREN AND ADULT PATIENTS. PARTICIPANTS WILL BE INFORMED ABOUT ASTHMA TRIGGERS, MEDICATIONS, PEAK FLOW METER MONITORING AND WARNING SIGNS ASSOCIATED WITH ASTHMA.B. THE EXCHANGE OF ASTHMA INFORMATION WILL BE DOCUMENTED IN EPIC IN THE EMERGENCY DEPARTMENT AND PRIMARY CARE PRACTICES, TO HELP PROMOTE THE INCLUSION OF DECISION SUPPORT TOOLS AND REMINDERS.C. THE HOSPITAL WILL EXPLORE WAYS TO PARTNER WITH BASSETT HEALTHCARE NETWORK'S-SCHOOL BASED HEALTH PROGRAMS IN ONEONTA, TO BRING ASTHMA EDUCATION TO HEALTHCARE PROVIDERS IN LOCAL SCHOOL DISTRICTS. AURELIA OSBORN FOX MEMORIAL HOSPITAL PART V, SECTION B, LINE 22D: IF PATIENTS MEET FINANCIAL ASSISTANCE CRITERIA, THEIR EMERGENCY AND MEDICALLY NECESSARY CARE ARE EITHER DISCOUNTED OR FREE OF CHARGE. 12 1 - AURELIA OSBORN FOX MEMORIAL HOSPITAL 1 NORTON AVE ONEONTA NY 13820 NURSING HOME 2 - NORTHERN CATSKILL UROLOGY 438 MAIN ST ONEONTA NY 13820 UROLOGY CLINIC 3 - CHILD AND ADOLESCENT HEALTHCARE 1 FOXCARE DRIVE SUITE 213 ONEONTA NY 13820 PEDIATRIC CLINIC 4 - ONEONTA FAMILY PRACTICE 1 FOXCARE DRIVE SUITE 308 ONEONTA NY 13820 FAMILY MEDICINE CLINIC 5 - FOXCARE WOMENS WELLNESS 1 FOXCARE DRIVE SUITE 303 ONEONTA NY 13820 OB/GYN CLINIC 6 - SUSQUEHANNA FAMILY PRACTICE 1 FOXCARE DRIVE SUITE 103 ONEONTA NY 13820 FAMILY MEDICINE CLINIC 7 - FOXCARE DENTAL 1 FOXCARE DRIVE SUITE 304 ONEONTA NY 13820 DENTAL CLINIC 8 - SIDNEY PRIMARY CARE CLINIC 59 RIVER ST SIDNEY NY 13838 FAMILY MEDICINE CLINIC 9 - FOXNOW 1 FOXCARE DRIVE SUITE 402 ONEONTA NY 13820 WALK-IN CLINIC 10 - FOX INTERNAL MEDICINE 1 FOXCARE DRIVE SUITE 302 ONEONTA NY 13820 INTERNAL MEDICINE CLINIC 11 - STAMFORD FAMILY PRACTICE 32-34 MAIN STREET STAMFORD NY 12167 FAMILY MEDICINE CLINIC 12 - SOUTHEASTERN HEALTH CENTER 4 DECATUR ST WORCESTER NY 12197 FAMILY MEDICINE CLINIC PART I, LINE 7: PART 1 LINE 7 THE COST METHODOLOGY USED FOR TABLE 7 IS THE RATIO OF COST TO CHARGES FROM 12/31/2015 MEDICARE FORM 2552. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 2,631,831. PART 1 LINE 6A WE COMPILE AND SUBMIT AN ANNUAL COMMUNITY SERVICE PLAN TO THE NEW YORK STATE DEPARTMENT OF HEALTH. PART III, LINE 4: PART III, LINE 4 PATIENT ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. THE HOSPITAL'S ALLOWANCE FOR DOUBTFUL ACCOUNTS WAS 11% AND 13% OF THE RELATED PATIENT ACCOUNTS RECEIVABLE, NET OF CONTRACTUAL ALLOWANCES AT DECEMBER 31, 2015 AND 2014, RESPECTIVELY. PART III, LINE 8: WHEN MEDICARE PATIENTS PRESENT WE ARE AWARE THAT THERE IS A PREDETERMINED REIMBURSEMENT THAT IS BELOW OUR HOSPITAL'S COST. THE PORTION THAT WE ARE NOT REIMBURSED THEREFORE WOULD BE CONSIDERED A COMMUNITY BENEFIT. PART III, LINE 9B: IF A PATIENT IS 100% CHARITY CARE, THEY ARE REMOVED FROM THE COLLECTION PROCESS. IF LESS THAN 100% CHARITY CARE THEY FOLLOW THE NORMAL COLLECTION PROCEDURES. PART VI, LINE 2: WE ASSESS THE COMMUNITIES HEALTHCARE NEEDS BASED UPON INPUT FROM THE COMMUNITY BOARD MEMBERS, MEDICAL STAFF AND BY HOSTING COMMUNITY FORUMS. IN ADDITION WE REVIEW TRENDS IN UTILIZATION OF OUR SERVICES PROVIDED. PART VI, LINE 3: WE INFORM PATIENTS THROUGH SIGNAGE, PAMPHLETS AND PROVIDE INFORMATIONAL PACKETS TO PATIENTS THAT INDICATE THEY HAVE NO INSURANCE COVERAGE. PART VI, LINE 4: WE SERVE RESIDENTS OF OTSEGO AND DELAWARE COUNTIES LOCATED IN RURAL UPSTATE NY. PART VI, LINE 5: WE HELP PROMOTE THE HEALTH OF THE COMMUNITY THROUGH MAINTAINING AN ACTIVE OPEN MEDICAL STAFF, SUPPORTING THE ANCILLARY NEEDS OF THE LOCAL FREE CLINIC AND HOSTING A CHILD BIRTH FAIR. WE ALSO PROVIDE MEETING SPACE FOR LOCAL COMMUNITY ORGANIZATIONS AT NO CHARGE. OUR BOARD IS COMPRISED OF LOCAL COMMUNITY MEMBERS WHO ADVOCATE FOR THE HEALTH INTEREST OF THE COMMUNITY. PART VI, LINE 6: AURELIA OSBORN FOX MEMORIAL HOSPITAL IS PART OF THE BASSETT HEALTHCARE NETWORK THAT PROVIDES HEALTHSERVICES IN MORE THAN 20 COMMUNITIES SPANNING 5,600 SQUARE MILES AND SEVENCOUNTIES. THE NETWORK FOCUSES ITS COMMUNITY SERVICES PROGRAMS IN THECOUNTIES WHERE THE SIX AFFILIATED HOSPITALS AND GREATEST PATIENTPOPULATIONS ARE LOCATED. OTSEGO COUNTY - POPULATION 61,709, DELAWARECOUNTY - POPULATION 47,276, HERKIMER COUNTY - POPULATION 64,508, SCHOHARIECOUNTY - POPULATION 32,099 (ACCORDING TO THE 2012 U.S. CENSUS ESTIMATES).A)BASSETT - AN ACUTE CARE INPATIENT TEACHING FACILITY, AN OUTPATIENTPRIMARY AND SPECIALTY CARE CENTER, A REGIONAL NETWORK OF 26 COMMUNITY BASEDOUTPATIENT HEALTH CENTERS, 19 SCHOOL BASED HEALTH CENTERS, TWO AMBULATORYSURGERY CENTERS AND A FULLY SALARIED MEDICAL STAFF IN COOPERSTOWN, OTSEGOCOUNTYB)O'CONNOR HOSPITAL - CRITICAL ACCESS HOSPITAL IN DELHI, DELAWARE COUNTYC)COBLESKILL REGIONAL HOSPITAL - ACUTE CARE FACILITY IN COBLESKILL,SCHOHARIE COUNTYD)LITTLE FALLS HOSPITAL - CRITICAL ACCESS HOSPITAL IN LITTLE FALLS,HERKIMER COUNTYE)TRI-TOWN REGIONAL HOSPITAL - 24/7 EMERGENCY CARE FACILITY IN SIDNEY,DELAWARE COUNTYF)A.O. FOX MEMORIAL HOSPITAL - ACUTE CARE FACILITY IN ONEONTA, OTSEGOCOUNTYG)VALLEY HEALTH SERVICES - RESIDENTIAL HEALTH CARE AND REHABILITATIONFACILITYH)AT HOME CARE - CERTIFIED HOME CARE AGENCYI)FIRST COMMUNITY CARE OF BASSETT - MEDICAL SUPPLY COMPANYALL THE ABOVE (A-I) MAKE UP THE BASSETT HEALTHCARE NETWORK AND PROVIDEHEALTH SERVICES TO THIS SEVEN COUNTY REGION IN CENTRAL NEW YORK. PART VI, LINE 7, REPORTS FILED WITH STATES NY X X X 0 0 0 0 0 0 0 0 0 GENNARO FALCO MD 163677 0 0 0 0 0 6300 0 8905 0 178882 0 0 0 GERALD GROFF DIRECTOR 0 386206 0 0 0 0 0 18550 0 3235 0 407991 0 0 MICHAEL TENGERES DIRECTOR 0 293607 0 22500 0 0 0 0 0 1538 0 317645 0 0 JOHN REMILLARD LEFT 12312015 PRESIDENT 0 347647 0 0 0 1353 0 10600 0 1258 0 360858 0 0 MARK WRIGHT CFO 169492 0 0 0 0 0 11811 0 16578 0 197881 0 0 0 BENJAMIN FRIEDELL VP MEDICAL AFFAIRS 255166 0 0 0 0 0 13230 0 12496 0 280892 0 0 0 PATRICK GERMAIN MD 420383 0 0 0 0 0 11712 0 16524 0 448619 0 0 0 SARBJIT VILKHU MD 320172 0 0 0 0 0 11828 0 12948 0 344948 0 0 0 MARIO VILLARINI MD 324284 0 0 0 0 0 11784 0 16381 0 352449 0 0 0 BLAINE JONES MD 326356 0 0 0 0 0 17029 0 16256 0 359641 0 0 0 GODWIN NJOKU MD 337485 0 0 0 0 0 11864 0 15589 0 364938 0 0 0 FORM 990, PART VI, SECTION A, LINE 6 THURSTON CORPORATION IS THE SOLE MEMBER OF A.O. FOX MEMORIAL HOSPITAL FORM 990, PART VI, SECTION A, LINE 7A ALL A.O. FOX MEMORIAL HOSPITAL BOARD MEMBERS ARE ELECTED BY THE SOLE MEMBER. FORM 990, PART VI, SECTION A, LINE 7B THE HOSPITALS SOLE MEMBER HAS POWER TO APPROVE BOARD NOMINATIONS AND BYLAW CHANGES. FORM 990, PART VI, SECTION B, LINE 11 AURELIA OSBORN FOX MEMORIAL HOSPITAL PRESENTS THE DRAFT 990 TO THE FINANCE/EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS PRIOR TO FILING. ANY QUESTIONS ARE RAISED AND ONCE APPROVED, THE 990 CAN BE FILED. A COMPLETE COPY OF THE ORGANIZATION'S FINAL FORM 990, INCLUDING ALL REQUIRED SCHEDULES, AS ULTIMATELY FILED WITH THE IRS, IS AVAILABLE TO EACH MEMBER OF THE BOARD BEFORE ITS FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C POTENTIAL CONFLICTS OF INTEREST ARE REVIEWED BY HOSPITAL ADMINISTRATION AND IF NECESSARY ARE REFERRED TO THE BOARD EXECUTIVE COMMITTEE TO BE HANDLED APPROPRIATELY. FORM 990, PART VI, SECTION B, LINE 15 PART VI SECTION B 15A THE BOARD EXECUTIVE COMMITTEE DETERMINES COMPENSATION FOR THE CEO BASED ON THE, "SURVEY OF THE INDUSTRIES C0MPENSATION DATA" SUPPLIED BY HANYS PART VI SECTION B 15B THE CEO TAKES RECOMMENDATIONS TO THE BOARD EXECUTIVE COMMITTEE BASED ON HANYS COMPENSATION SURVEY. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTATION, CONFLICTS OF INTEREST POLICIES, AND FINANCIAL STATEMENTS AVAILABLE UPON REQUEST. SOME INFORMATION IS ALSO AVAILABLE THROUGH THE DEPARTMENT OF HEALTH. THE DOH REQUIRES THE INFORMATION FOR PUBLIC AVAILABILITY. FORM 990, PART IX, LINE 11G TELEPHONE: PROGRAM SERVICE EXPENSES 253,589. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 253,589. POSTAGE: PROGRAM SERVICE EXPENSES 129,581. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 129,581. EQUIPMENT RENTAL MAINTENANCE: PROGRAM SERVICE EXPENSES 293,569. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 293,569. PRINTING: PROGRAM SERVICE EXPENSES 111,044. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 111,044. PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 1,086,704. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,086,704. PHYSICIAN RECRUITMENT: PROGRAM SERVICE EXPENSES 236,340. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 236,340. PROFESSIONAL SERVICES: PROGRAM SERVICE EXPENSES 203,101. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 203,101. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 10,972,000. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 10,972,000. FORM 990, PART XI, LINE 9: CHANGE ON BENEFICIAL INTEREST IN NET ASSETS OF A.O. FOX FOUNDATION -98,917. CHANGE IN BENEFICIAL INTEREST IN AT HOME CARE 1,493. PENSION RELATED CHANGES 274,394. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. THURSTON CORPORATION ONE ATWELL ROAD COOPERSTOWN NY 13326 133218680 SUPPORTING ORGANIZATION NY 501(C)3 11C NONE 0 BASSETT REGIONAL CORPORATION ONE ATWELL ROAD COOPERSTOWN NY 13326 133522783 PLANNING AND POLICY SERVICES NY 501(C)3 11B THURSTON CORPORATION 0 FRIENDS OF BASSETT ONE ATWELL ROAD COOPERSTOWN NY 13326 237041610 FUNDRAISING NY 501(C)3 7 THURSTON CORPORATION 0 MARY IMOGENE BASSETT HOSPITAL ONE ATWELL ROAD COOPERSTOWN NY 13326 135596796 HOSPITAL NY 501(C)3 3 THURSTON CORPORATION 0 BASSETT HOSPITAL OF SCHOHARIE CO 178 GRANDVIEW DRIVE COBLESKILL NY 12043 141772971 HOSPITAL NY 501(C)3 3 BASSETT REGIONAL CORP 0 LITTLE FALLS HOSPITAL 140 BURWELL STREET LITTLE FALLS NY 13365 150533578 HOSPITAL NY 501(C)3 3 BASSETT REGIONAL CORP 0 O'CONNOR HOSPITAL 460 ANDES ROAD DELHI NY 13753 161540394 HOSPITAL NY 501(C)3 3 BASSETT REGIONAL CORP 0 TEMPLETON FOUNDATION ONE ATWELL ROAD COOPERSTOWN NY 13326 133317084 OUTPATIENT SERVICES NY 501(C)3 9 THURSTON CORPORATION 0 TRI TOWN REGIONAL HEALTHCARE 43 PEARL STREET SIDNEY NY 13838 260169584 HOSPITAL NY 501(C)3 3 BASSETT REGIONAL CORP 0 VALLEY HEALTH SERVICES 690 W GERMAN STREET HERKIMER NY 13350 222511614 NOT-FOR-PROFIT SKILLED NURSING FACILITY NY 501(C)3 3 BASSETT REGIONAL CORP 0 AO FOX FOUNDATION 1 NORTON AVENUE ONEONTA NY 13820 222871993 SOLICITS CONTRIBUTIONS FOR AURELIA OSBORN FOX MEMORIAL HOSPITAL NY 501(C)3 9 AURELIA OSBORN FOX MEMORIAL HOSPITAL SOCIETY 0 AT HOME CARE 297 MAIN STREET ONEONTA NY 13820 161287069 HOME HEALTH CARE NY 501(C)3 9 0 CATSKILL CARE ENTERPRISES 1 NORTON AVE ONEONTA NY 13820 161236590 RETAIL PHARMACY AND FITNESS CENTER NY AURELIA OSBORN FOX MEMORIAL HOSPITAL SOCIETY C -288111 1116799 1.00000 0 0 0 1 1 0 0 0 0 0 1 0 0 0 0 0 1 1 0 0 CATSKILL CARE ENTERPRISES J 393592 CATSKILL CARE ENTERPRISES P 934032 CATSKILL CARE ENTERPRISES Q 182621 CATSKILL CARE ENTERPRISES D 510239