2015-11-13T12:59:48-06:00 2014-12-31 161226221 FUST CHARLES CHAMBERS LLP 5784 WIDEWATERS PARKWAY SYRACUSE NY 13214 990 2014-01-01 150539039 AURELIA OSBORN FOX MEMORIAL HOSPITAL AURE 6074315900 1 NORTON AVE ONEONTA NY 13820 MARK J WRIGHT CFO 6074315900 2015-11-12 1 JOSEPH J SCHLEGEL P00301329 3154463600 2014 2016-02-25 16:41:14Z AO FOX MEMORIAL HOSPITAL MARK J WRIGHT 1 NORTON AVE ONEONTA NY 13820 79514323 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. 14 12 1037 112 0 0 13407601 4143888 75150303 69790497 650506 383479 949068 722490 90157478 75040354 0 0 0 0 48038468 42649152 0 0 0 38235818 39831312 86274286 82480464 3883192 -7440110 79782149 64024694 38577719 34090142 41204430 29934552 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 63711859 59112878 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 2014 THE HOSPITAL HAD 12401 PATIENT DAYS 13590 EMERGENCY ROOM VISITS AND 187012 OUTPATIENT VISITS. 9116060 9469369 NURSING HOME CARE - NURSING HOME FACILITY- SKILLED NURSING, HEALTH AND RESPITE CARE. IN 2014 THE NURSING HOME HAD 46354 PATIENT DAYS 72827919 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 99 0 1 1037 1 0 0 0 0 0 0 0 0 0 0 X 14 12 0 0 1 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 ROSEMARY HOLBROOKRESIGNED 04302014 DIRECTOR 0.50 X 0 0 0 MAUREEN HULBERT DIRECTOR 0.50 X 0 0 0 NANCY KLENIEWSKI CHAIRMAN 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 NICHOLAS J NICOLETTA LEFT 1231201 TREASURER 0.50 X 0 476485 29490 SETH HAIGHT TREASURER 0.50 X X 0 0 0 JEANNE HAVENER SECRETARY 0.50 X X 0 0 0 KEVIN KURKOWSKI DIRECTOR 0.50 X 0 0 0 V DANIEL ROBINSON VICE CHAIR 0.50 X X 0 0 0 JEFFREY WOEPPELRESIGNED 03312014 DIRECTOR 0.50 X 0 120196 19665 GENNARO FALCO MD 40.00 X 245838 0 24041 LORRAINE ZIMNIEWICZ DIRECTOR 0.50 X 0 0 0 JOSEPH FORGIANO DIRECTOR 0.50 X 0 0 0 JOHN REMILLARD PRESIDENT 40.00 X 0 303564 17352 MARK WRIGHT CFO 40.00 X 157038 0 25066 BENJAMIN FRIEDELL VP MEDICAL AFFAIRS 40.00 X 265639 0 22446 PATRICK GERMAIN MD 40.00 X 393433 0 24338 SARBJIT VILKHU MD 40.00 X 348616 0 22001 MARIO VILLARINI MD 40.00 X 329903 0 24128 BLAINE JONES MD 40.00 X 297957 0 28438 GODWIN NJOKU MD 40.00 X 273796 0 22671 2312220 900245 259636 36 0 1 0 LECHASE CONSTRUCTION SERVICES 205 INDIGO CREEK DRIVE ROCHESTER NY 14626 CONSTRUCTION COMPANY 3169959 PEGASUS MEDICINE GROUP 1007 E MAIN STREET SUITE 300 BOZEMAN MT 59715 CONTRACTED MEDICAL SERVICES 652418 DELL HEALTHCARE C/O DELL USA PITTSBURGH PA 152643561 IT HARDWARE & SOFTWARE 270804 FUSION MEDICAL STAFFING LLC 11506 NICHOLAS STREET OMAHA NE 68154 MEDICAL LOCUM SERVICES 202581 FUST CHARLES CHAMBERS 5784 WIDEWATERS PARKWAY SYRACUSE NY 13214 AUDITING, TAX AND CONSULTING SERVICES 169901 9 2002061 1594689 547138 4143888 HOSPITAL 621990 58937058 58937058 NURSING HOME 623990 9469369 9469369 1384070 1384070 69790497 110463 110463 672669 259524 413145 413145 413145 4111059 2381 3840424 0 270635 2381 273016 273016 549841 374021 175820 175820 EXPENSE REIMBURSEMENT 621910 119333 119333 CONVENIENCE SERVICES 621910 14192 14192 133525 75040354 68582247 0 2314219 X 1032986 504984 528002 32139013 27688200 4450813 1276807 1099987 176820 5772666 4973231 799435 2427680 2091480 336200 320915 320915 108178 108178 137411 137411 16575 16575 13757114 13757114 42095 36265 5830 2854634 2459306 395328 1525648 1314367 211281 198557 171060 27497 1124753 968990 155763 6002753 4163042 1839711 1006521 1006521 SUPPLIES 7618761 7618761 BAD DEBT 4409521 4409521 MISC EXPENSE 565090 565090 DUES & SUBSCRIPTIONS 142786 142786 82480464 72827919 9652545 0 728347 1349759 2717773 2469298 13711979 8530631 1258726 1278260 496326 624122 145815066 108947581 40739798 36867485 7320161 2772972 12809039 10132167 79782149 64024694 17272149 14479545 12057236 6561058 16606330 2687276 3004267 38577719 34090142 X 35637010 25244564 1951988 1072361 3615432 3617627 41204430 29934552 79782149 64024694 X -7440110 -782218 -3047550 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 16575 16575 0 PART II-B, LINE 1: A PERCENTAGE OF MEMBERSHIP DUES PAID TO HEALTHCARE ASSOCIATION OF NEW YORK STATE (24.6%), IROQUOIS HEALTHCARE ALLIANCE (38.8%) AND AMERICAN HOSPITAL ASSOCIATION (22.8%) ARE USED SPECIFICALLY FOR LOBBYING PURPOSES 10582609 1106618 325088 6785372 5228943 11422949 12698274 203520 13742134 10582609 10767313 2686662 837450 2868476 11422949 11139059 2001098 -182685 2190159 10767313 11610765 3686076 -251191 3906591 11139059 0.10310 0.69180 0.20510 0 1 1 4271421 4271421 52627441 31327079 21300362 87910892 77620502 10290390 1005312 1005312 36867485 DUE FROM AFFILIATES 2921412 BENEFICIAL INTEREST IN NET ASSETS OF A.O. FOX FOUNDATION 3047893 BENEFICIAL INTEREST IN NET ASSETS OF AT HOME CARE INC. 1586734 OTHER ASSETS 109285 DEFFERRED FINANCING COSTS, NET OF ACC. DEPRECIATION 402704 SETTLEMENT AMOUNTS DUE FORM 3RD PARTY PAYORS , NET 1456123 GRANTS AND OTHER RECEIVABLES 525000 INSURANCE RECEIVABLE 83016 10132167 LONG TERM (HUM) 501857 LPN PENSION PAYABLE 1471118 WORKERS COMP AMD MLMIC (HUM) LIABILITY 261292 INSURANCE LIABILITY CLAIMS 770000 3004267 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 31,2014 AND 2013, 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 2011 THROUGH 2014 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 646583 161195 485388 0.00590 19273464 14663510 4609954 0.05590 419380 266427 152953 0.00190 20339427 15091132 5248295 0.06370 44874 44874 0.00050 44874 44874 0.00050 20384301 15091132 5293169 0.06420 1 4409524 17396780 20794421 -3397641 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 X X 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 THECOMMUNITY 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 PRGARM 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 BEGAN WORK ON TRAINING STAFF, TRANSFORMING THE PEDIATRIC AND WOMEN'S HEALTH PRACTICES, AND DEVELOPING COLLABORATIVE EFFORTS AND PROGRAMS SUCH AS A BREASTFEEDING CAFE . 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. PART V, SECTION B, LINE 16 FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY AURELIA OSBORN FOX MEMORIAL HOSPITAL PART V, SECTION B, LINE 16A WEBSITE: WWW.BASSETT.ORG AURELIA OSBORN FOX MEMORIAL HOSPITAL PART V, SECTION B, LINE 16B WEBSITE: WWW.BASSETT.ORG AURELIA OSBORN FOX MEMORIAL HOSPITAL PART V, SECTION B, LINE 16C WEBSITE: WWW.BASSETT.ORG 12 AURELIA OSBORN FOX MEMORIAL HOSPITAL 1 NORTON AVE ONEONTA NY 13820 NURSING HOME NORTHERN CATSKILL UROLOGY 438 MAIN ST ONEONTA NY 13820 UROLOGY CLINIC CHILD AND ADOLESCENT HEALTHCARE 1 FOXCARE DRIVE SUITE 213 ONEONTA NY 13820 PEDIATRIC CLINIC ONEONTA FAMILY PRACTICE 1 FOXCARE DRIVE SUITE 308 ONEONTA NY 13820 FAMILY MEDICINE CLINIC FOXCARE WOMENS WELLNESS 1 FOXCARE DRIVE SUITE 303 ONEONTA NY 13820 OB/GYN CLINIC SUSQUEHANNA FAMILY PRACTICE 1 FOXCARE DRIVE SUITE 103 ONEONTA NY 13820 FAMILY MEDICINE CLINIC FOXCARE DENTAL 1 FOXCARE DRIVE SUITE 304 ONEONTA NY 13820 DENTAL CLINIC SIDNEY PRIMARY CARE CLINIC 59 RIVER ST SIDNEY NY 13838 FAMILY MEDICINE CLINIC FOXNOW 1 FOXCARE DRIVE SUITE 402 ONEONTA NY 13820 WALK-IN CLINIC FOX INTERNAL MEDICINE 1 FOXCARE DRIVE SUITE 302 ONEONTA NY 13820 INTERNAL MEDICINE CLINIC STAMFORD FAMILY PRACTICE 32-34 MAIN STREET STAMFORD NY 12167 FAMILY MEDICINE CLINIC 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 12/31/2014 MEDICARE FORM 2552. 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 13% AND 10% OF THE RELATED PATIENT ACCOUNTS RECEIVABLE, NET OF CONTRACTUAL ALLOWANCES AT DECEMBER 31, 2014 AND 2013, RESPECTIVELY. PART III, LINE 8: WE DO NOT CONSIDER ANY OF THE SHORTFALLS TO BE A COMMUNITY BENEFIT.THE SOURCE USED FOR THE MEDICARE ALLOWABLE COST IS FROM THE SETTLEMENT PAGES OF THE 12/31/2014 FILED MEDICARE FORM 2552. 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 A MEMBER OF THURSTON CORPORATION (DBA 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 HOSPTITALS AND GREATEST PATIENT POPULATIONS ARE LOCATED. OTSEGO COUNTY - POPULATION 61128; DELAWARE COUNTY - POPULATION 46581; HERKIMER COUNTY - POPULATION 63744; SCHOHARIE COUNTY - POPULATION 31566(ACCORDING TO THE 2014 U.S. CENSUS ESTIMATES). THE MARY IMOGENE BASSETT HOSPITAL, AN ACUTE CARE INPATIENT TEACHING FACILITY IN COOPERSTOWN, OTSEGO COUNTY, O'CONNOR HOSPITAL, A CRITICAL ACCESS HOSPITAL IN DELHI, DELAWARE COUNTY, COBLESKILL REGIONAL HOSPITAL, AN ACUTE CARE FACILITY IN COBLESKILL, SCHOHARIE COUNTY, LITTLE FALLS HOSPTAL, A CRITICAL ACCESS HOSPITAL IN LITTLE FALLS, HERKIMER COUNTY, TRI TOWN REGIONAL HOSPITAL A 24/7 EMERGENCY CARE FACILITY IN SIDNEY, DELAWARE COUNTY, AUREILA OSBORN FOX MEMORIAL HOSPITAL, AN ACUTE CARE FACILITY IN ONEONTA, OTSEGO COUNTY, THE BASSETT CLINIC, AN OUTPATIENT PRIMARY AND SPECIALTY CARE CENTER IN COOPERSTOWN, A REGIONAL NETWORK OF 26 COMMUNITY BASED HEALTH CENTERS, 19 SCHOOL BASED HEALTH CENTERS, TWO AMBULATORY SURGERY CENTERS, VALLEY HEALTH SERVICES A RESIDUAL HEALTH CARE AND REHABILITATION FACILITY, AT HOME CARE, A CERTIFIED HOME CARE AGENCY AND FIRST COMMUNITY CARE OF BASSETT A MEDICAL SUPPLY COMPANY, ALL OF WHICH MAKE UP THE BASSETT HEALTHCARE NETWORK AND PROVIDE HEALTH SERVICES TO THIS NINE COUNTY REGION IN CENTRAL NEW YORK. PART VI, LINE 7, REPORTS FILED WITH STATES NY X X X 0 0 0 0 0 0 0 0 0 NICHOLAS J NICOLETTA LEFT 1231201 TREASURER 0 471310 0 5175 0 0 0 23920 0 5570 0 505975 0 0 GENNARO FALCO MD 245838 0 0 0 0 0 7741 0 16300 0 269879 0 0 0 JOHN REMILLARD PRESIDENT 0 292243 0 10000 0 1321 0 16120 0 1232 0 320916 0 0 MARK WRIGHT CFO 157038 0 0 0 0 0 8665 0 16401 0 182104 0 0 0 BENJAMIN FRIEDELL VP MEDICAL AFFAIRS 265639 0 0 0 0 0 9692 0 12754 0 288085 0 0 0 PATRICK GERMAIN MD 393433 0 0 0 0 0 8038 0 16300 0 417771 0 0 0 SARBJIT VILKHU MD 348616 0 0 0 0 0 8817 0 13184 0 370617 0 0 0 MARIO VILLARINI MD 329903 0 0 0 0 0 7966 0 16162 0 354031 0 0 0 BLAINE JONES MD 297957 0 0 0 0 0 11790 0 16648 0 326395 0 0 0 GODWIN NJOKU MD 273796 0 0 0 0 0 6629 0 16042 0 296467 0 0 0 FORM 990, PART VI, SECTION A, LINE 4 CHANGES WERE MADE IN ACCORDANCE WITH THE NYS NON-PROFIT REVITALIZATION ACT. A SEPERATE AUDIT COMMITTEE WAS ADOPTED. 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 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 396,964. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 396,964. POSTAGE: PROGRAM SERVICE EXPENSES 121,563. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 121,563. EQUIPMENT RENTAL MAINTENANCE: PROGRAM SERVICE EXPENSES 335,332. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 335,332. PRINTING: PROGRAM SERVICE EXPENSES 99,543. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 99,543. PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 1,782,409. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,782,409. PHYSICIAN RECRUITMENT: PROGRAM SERVICE EXPENSES 167,499. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 167,499. PROFESSIONAL SERVICES: PROGRAM SERVICE EXPENSES 322,437. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 322,437. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 10,531,367. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 10,531,367. FORM 990, PART XI, LINE 9: CHANGE ON BENEFICIAL INTEREST IN NET ASSETS OF A.O. FOX FOUNDATION -1,788,091. CHANGE IN BENEFICIAL INTEREST IN AT HOME CARE -37,449. PENSION RELATED CHANGES -742,458. LOSS ON EXTIGUISHMENT OF DEBT -479,552. 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 1495525 1007966 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 389213 CATSKILL CARE ENTERPRISES P 989524 CATSKILL CARE ENTERPRISES Q 642908 CATSKILL CARE ENTERPRISES D 128625