2013-11-12T11:47:06-06:00 2012-12-31 KPMG LLP 515 BROADWAY 4TH FL ALBANY NY 12207 990 2012-01-01 135596796 MARY IMOGENE BASSETT HOSPITAL DBA BASSETT MEDICAL CENTER MARY 6075473635 ONE ATWELL ROAD COOPERSTOWN NY 13326 NICHOLAS J NICOLETTA 6075473635 2013-11-15 true MARY-EVELYN ANTONETTI 5184274600 2013-11-12 2012 2016-03-07 17:11:31Z BASSETT MEDICAL CENTER NICHOLAS J NICOLETTA ONE ATWELL ROAD COOPERSTOWN NY 13326 454579097 false X WWW.BASSETT.ORG X 1921 NY 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. 20 18 3926 155 24333 7712078 15144838 399868572 413231887 4865736 1833345 40575 -523561 412486961 429686509 50825 0 237833788 243007003 0 1066287 177222598 184364624 415056386 427422452 -2569425 2264057 343191925 357225149 122504389 124215669 220687536 233009480 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 344458318 50825 413231887 INPATIENT AND OUTPATIENT SERVICES PROVIDED TO OUR PATIENTS RESULTED IN: 12,708 HOSPITALIZATIONS (INCLUSIVE OF OPEN HEART SURGERIES) 50,711 PATIENT DAYS 699,970 CLINIC VISITS 24,144 RENAL TREATMENTS 9,410 SURGICAL CASES 5433926 SEE SCHEDULE O COMMUNITY INVOLVEMENT HAS BEEN LINKED TO BASSETT'S MISSION, VISION, AND VALUES SINCE WE 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 FOR 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 2012, WE PROVIDED 5,433,926 IN FREE CARE. BASSETT'S COMMUNITY HEALTH EDUCATION PROGRAMS INCLUDE LECTURES, PRESENTATIONS, HEALTH FAIRS, AND OTHER GROUP PROGRAMS APART FROM 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. NOT ONLY DID WE PROVIDE 5.4M IN CHARITY CARE, BAD DEBT EXPENSE WAS 15M, MEDICAID PAYMENTS BELOW COST TO PROVIDE SERVICES WERE 27.2M. 349892244 true true false true false false false false false true true true false false false 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 244 0 true 3926 true true true false false false false false false false false false X 20 18 true false false false false false false true true false false false true true true true true true true true false NY X NICHOLAS J NICOLETTA 6075473635 ONE ATWELL ROAD COOPERSTOWN NY 13326 THOMAS Q MORRIS MD 1.00 3.25 X X 0 0 0 KEVIN S MOORE 3.00 2.50 X X 0 0 0 TIMOTHY A PEDLEY MD 1.00 1.00 X X 0 0 0 WILLIAM T BURDICK 8.00 3.00 X X 0 0 0 JOHN D BULLIS 1.00 2.50 X 0 0 0 JANE FORBES CLARK 1.00 0.00 X 0 0 0 BARBARA DICOCCO 1.00 1.50 X 0 0 0 TERRY FULMER PHD 1.00 0.00 X 0 0 0 MICHAEL S GOLD MD 1.00 0.20 X 0 0 0 PETER J HAMILTON 1.00 2.50 X 0 0 0 NANCY KLENIEWSKI 1.00 0.00 X 0 0 0 RALPH H MEYER 1.00 1.00 X 0 0 0 J MICHAEL MOFFAT 1.00 0.00 X 0 0 0 KATHERINE D NICKERSON 1.00 1.00 X 0 0 0 DONALD O QUEST MD 1.00 0.00 X 0 0 0 VANNESS D ROBINSON 1.00 0.00 X 0 0 0 RENEE SCIALDO SHEVAT 1.00 0.00 X 0 0 0 EDWARD W STACK 1.00 2.20 X 0 0 0 CLIFTON WHARTON JR PHD 1.00 0.00 X 0 0 0 DOUGLAS B WILLIES 1.00 0.50 X 0 0 0 WILLIAM F STRECK MD 40.00 2.20 X 786435 0 27775 BERTINE MCKENNA PHD 40.00 1.50 X 489159 0 22919 NICHOLAS J NICOLETTA 40.00 13.50 X 483575 0 26532 RICHARD C VANISON 4.00 2.50 X 0 0 0 GLENN A PERRONE 2.00 2.50 X 0 0 0 PASCALE G RAYMOND MD 40.00 0.00 X 585972 0 18096 STEVEN J HENEGHAN MD 40.00 0.00 X 578884 0 29710 JONATHAN RICHMAN MD 40.00 0.00 X 524765 0 32663 ROBERT A LANCEY MD 40.00 0.00 X 524074 0 32658 TALLY E LASSITER MD 40.00 0.00 X 500127 0 12538 4472991 202891 8 false true true STAT STAFF 258 USHERS ROAD SUITE 10 CLIFTON PARK NY 12065 AGENCY 5924304 COMP HEALTH 6440 MILLROCK DRIVE SUITE 175 SALT LAKE CITY UT 84121 AGENCY 1721455 STAFF CARE INC 5001 STATESMAN DRIVE IRVING TX 75063 AGENCY 1675433 ANGELICA TEXTILE SERVICES 424 S WOODS MILL ROAD CHESTERFIELD MO 63017 LINEN SERVICE 1404413 MAYO MEDICAL LABORATORIES 200 FIRST STREET SW ROCHESTER MN 55903 LAB SERVICES 1380072 16 1477780 10731189 2935869 15144838 DIRECT PATIENT SERVICES 900099 385399702 385399702 OTHER PROGRAM SERVICE REVENUE 900099 27832185 27832185 413231887 720378 720378 25805046 200509 24276047 616541 1528999 -416032 1112967 1112967 INVESTMENT IN JOINT VENTURE 621610 70134 70134 PARTNERSHIP INCOME 621500 24333 24333 PARTNERSHIP INCOME -618028 -618028 -523561 429686509 413231887 24333 1285451 50825 50825 1836394 1836394 84335 84335 209127528 161636755 47020228 470545 8640033 6668020 1946770 25243 10430259 7991963 2415030 23266 12888454 9884044 2973002 31408 62494 62494 38009036 31709051 5987935 312050 1970959 1502800 454242 13917 14144531 10845370 3278166 20995 1689230 1294255 391207 3768 19571177 15027131 4542162 1884 3334332 2554701 772194 7437 DRUGS AND REAGENTS 31976982 31976982 PATIENT CARE SUPPLIES 30908915 30908915 BAD DEBT 14985208 14985208 CHARITY CARE 5433926 5433926 22277834 17422298 4699762 155774 427422452 349892244 76463921 1066287 7155225 15653880 9860464 14856350 51797404 44119304 3305577 3425444 2457985 2640600 380220889 233912362 141444465 146308527 85442703 84878064 33634077 36797740 8094025 8545240 343191925 357225149 38850570 39628165 56570000 54590000 27083819 29997504 122504389 124215669 X 163124202 163196856 43733963 55962893 13829371 13849731 220687536 233009480 343191925 357225149 2264057 9883165 174722 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 62494 62494 false SCHEDULE C, PART II-B, LINE 1 AMERICAN HOSPITAL ASSOCIATION ALLOCATES 23.98% OF DUES TOWARDS GENERAL LOBBYING ACTIVITIES. TOTAL DUES PAID IN 2012 = 51,536 HANYS ALLOCATES 28.60% OF DUES TOWARDS GENERAL LOBBYING ACTIVITIES. TOTAL DUES PAID IN 2012 = 121,790 IROQUOIS HEALTHCARE ALLIANCE ALLOCATES 44.40% OF DUES TOWARDS GENERAL LOBBYING ACTIVITES. TOTAL DUES PAID IN 2012 = 34,469 THE CLARK ESTATES CONDUCTS LOBBYING ACTIVITIES ON BEHALF OF THE MARY IMOGENE BASSETT HOSPITAL. LOBBYING ACTIVITES ARE LIMITED TO OFFICER DISCUSSIONS WITH CONSULTANTS AND LEGISLATORS TO OBTAIN FUNDING FOR CHARITABLE MISSIONS. NO FUNDS WERE EXPENDED. 13829371 20360 13849731 13789074 40297 13829371 16734461 54613 199921 3000000 199921 13789074 13825685 2908776 189138 189138 16734461 13511047 314638 445038 445038 13825685 1.00000 true false 207928 207928 187848195 100929403 86918792 172044677 132982959 39061718 20120089 20120089 146308527 LIMITED PARTNERSHIP 32584778 C LIMITED PARTNERSHIP 4212962 C 36797740 X 419325262 9883165 -20244412 -10361247 429686509 429686509 407003318 407003318 20419134 20419134 427422452 INTENDED USES FOR ENDOWMENT FUNDS SCHEDULE D, PAGE 2, PART V, LINE 4 PERMANENTLY RESTRICTED ENDOWMENT FUNDS ARE HELD IN PERPETUITY WITH RESTRICTIONS ON INCOME FOR HEALTH SERVICES, MEDICAL RESEARCH, MEDICAL EDUCATION, AND INDIGENT CARE. LIABILITY UNDER FIN 48 FOOTNOTE SCHEDULE D, PAGE 3, PART X PER AUDITED FINANCIAL STATEMENTS: "THE HOSPITAL IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE IRC. THE HOSPITAL RECOGNIZES 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." REVENUE AMOUNTS INCLUDED IN FINANCIALS - OTHER SCHEDULE D, PAGE 4, PART XI, LINE 2D POST RETIREMENT BENEFIT CHANGE 174,722 BAD DEBT -14,985,208 CHARITY CARE -5,433,926 EXPENSE AMOUNTS INCLUDED ON RETURN - OTHER SCHEDULE D, PAGE 4, PART XII, LINE 4B BAD DEBT 14,985,208 CHARITY CARE 5,433,926 true true true X 3.00000 false true true true false true true 3494935 291950 3202985 0.00750 52353300 38212851 14140449 0.03310 55848235 38504801 17343434 0.04060 48571 48571 0.00010 16222165 3952243 12269922 0.02870 7872642 358478 7514164 0.01760 703459 703459 0.00160 24846837 4310721 20536116 0.04800 80695072 42815522 37879550 0.08860 true 6527921 788659 97679871 82507115 15172756 X true true AT HOME CARE INC HOME HEALTHCARE AGENCY 0.50000 1 1 MARY IMOGENE BASSETT HOSPITAL

ONE ATWELL ROAD COOPERSTOWN NY 13326

WWWBASSETTORG X X X X X OUTPATIENT PRIMARY & SPECIALTY MARY IMOGENE BASSETT HOSPITAL 1 false true true 300.0 false false true true X X X X true X false X X X X true X false false 51 AC CLARK GYMNASIUM

124 COUNTY ROAD 52 COOPERSTOWN NY 13326

OUTPATIENT PHYSICAL THERAPY SERVICES BASSETT HEALTHCARE HAMILTON SURGICA

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 SPECIAL

ONE ASSOCIATE DRIVE ONEONTA NY 13820

OUTPATIENT PRIME, SPECIALTY, URGENT CARE BASSETT HEALTHCARE PHYSICAL THERAPY

21 RAILTOAD AVENUE COOPERSTOWN NY 13326

OUTPATIENT SPECIALTY CARE BASSETT HEALTHCARE RICHFIELD SPRING

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 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 ELEMEN

13 SCHOOL STREET SHERBURNE NY 13460

OUTPATIENT PRIMARY CARE SBHC - SHERBURNEEARLVILLE MID & HI

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 OTHER TESTING METHODS FOR FREE OR DISCOUNTED CARE PART I LINE 3C THE CSP COMMUNITY SERVICES PROGRAM APPLICATION SPECIFIES FAMILY INCOME LIMITS AND OTHER REQUIREMENTS FOR SERVICES TO BE ELIGIBLE FOR BASSETT MEDICAL CENTERS CSPFREE CARE PROGRAM RELATED ORGANIZATION INFORMATION PART I LINE 6A THE MARY IMOGENE BASSETT HOSPITALS 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 WWWBASSETTORG EXCLUSIONS FROM PERCENT OF TOTAL EXPENSE PART I LINE 7 COLUMN F THE PERCENT OF TOTAL EXPENSE IS CALCULATED BY DIVIDING COLUMN E NET COMMUNITY BENEFIT EXPENSE BY TOTAL EXPENSE THE BAD DEBT EXPENSE OF 14985208 WAS SUBTRACTED FROM THE TOTAL EXPENSE VALUE USED TO CALCULATE THE PERCENTAGES IN PART 1 LINE 7 COLUMN F COSTING METHODOLOGY EXPLANATION PART I LINE 7 SECTIONS A CHARITY CARE AT COST B UNREIMBURSED MEDICAID F HEALTH PROFESSIONS EDUCATION THE COSTING METHODOLOGY USED IS A COSTTOCHARGE 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 INKIND 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 COMMUNITY BUILDING ACTIVITIES PART II ALL BASSETT COMMUNITY BUILDING ACTIVITIES COULD BE CLASSIFIED UNDER ITEM 1 AND HIGHLIGHTED IN NUMBER 1 ABOVE BAD DEBT EXPENSE EXPLANATION PART III LINE 4 WORKSHEET 2 COST TO CHARGE RATIO WAS USED TO DETERMINE THE AMOUNT REPORTED IN PART III LINES 2 AND 3 PROVISION FOR UNCOLLECTIBLE PATIENT ACCOUNTS RECEIVABLE FROM THE FINANCIAL STATEMENTS NOTES 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 MANAGEMENTS ASSESSMENT OF HISTORICAL EXPECTED COLLECTIONS BUSINESS AND ECONOMIC CONDITIONS TRENDS IN FEDERAL AND STATE HEALTHCARE COVERAGE AND OTHER COLLECTION INDICATORS PROVISION FOR CHARITY AND UNCOMPENSATED CARE FROM THE FINANCIAL STATEMENT FOOTNOTES J THE HOSPITALS 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 CARER POLICY THE HOSPITALS CHARITY CARE POLICY HAS NOT CHANGED DURING FISCAL YEARS 2011 OR 2012 DURING 2012 AND 2011 THE TOTAL CHARGES FORGONE FOR BAD DEBT WERE APPROXIMATELY 14985208 AND 14513947 RESPECTIVELY MEDICARE EXPLANATION PART III LINE 8 AMOUNTS WERE DERIVED AS FOLLOWS CHARGE TIMES COST TO CHARGE RATIO VERSUS REIMBURSEMENT ON THE MEDICARE PSR REPORT COLLECTION PRACTICES EXPLANATION PART III LINE 9B 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 SELFPAY ACCOUNTS RECEIVABLE AS WELL PRESERVE THE PATIENTPROVIDER 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 DEBTORS PRINCIPAL RESIDENCE WILL NEVER BE CONSIDERED APPROPRIATE PURSUIT OF AN OPEN BALANCE IN THE NAME OF BASSETT MEDICAL CENTER LIENS OR GARNISHMENTS UPON THE PERSONAL ASSETS OF A JUDGEMENT DEBTOR WILL BE PURSUED ONLY AFTER INDIVIDUAL CASE REVIEW BY COUNSEL TO ENSURE THAT SUCH ACTION IS NOT ONLY CONSISTENT WITH BASSETTS INTERESTS BUT ALSO THE ONLY FEASIBLE RECOVERY MECHANISM FROM A JUDGEMENT DEBTOR CAPABLE OF RESPONDING TO HIS OR HER OBLIGATIONS BUT OTHERWISE UNWILLING TO DO SO NEEDS ASSESSMENT PART VI 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 APERCENTAGE OF OTSEGO CO ADULTS WHO VISITED A DENTIST IN THE PAST YEARS BPREVALENCE OF TOOTH DECAY IN THIRDGRADE CHILDREN CPERCENTAGE OF ADULTS REPORTING BINGE DRINKING DHEAVY DRINKING EPERCENTAGE 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 1ACCESS TO DENTAL HEALTH CARE ABASSETT WILL SUPPORT OTSEGO CO DEPT OF HEALTH EFFORTS TO REESTABLISH 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 BBASSETT WILL WORK TO EXPAND COMPREHENSIVE PREVENTIVE DENTAL HEALTH SERVICES TO ALL SCHOOLBASED HEALTH CENTERS IN THE COUNTY AND TO PROVIDE SEALANT SERVICES TO NONSBHC SCHOOLS BASSETT WILL WORK WITH THE OTSEGO CO DEPT OF HEALTH AND RHENDOMS TO MAKE MORE SCHOOLS AWARE OF RHENDOMS SERVICES TO INCREASE PARTICIPATION CBASSETT WILL WORK WITH THE OTSEGO CO DEPT OF HEALTH AND AO 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 DBASSETT WILL WORK WITH THE HEALTH DEPARTMENT AND OTHER COMMUNITY PARTNERS TO EDUCATE THE PUBLIC ABOUT DENTAL HEALTH IN FAIRS AND OTHER COMMUNITY EVENTS 2MENTAL HEALTH AND SUBSTANCE ABUSE AIN A NEW INITITATIVE BASSETT WILL WORK WITH AO FOX HOSPITAL AND LEATHERSTOCKING EDUCATION ON ALCOHOLISMADDICTIONS FOUNDATIONS INC LEAF TO PROVIDE CONTINUING MEDICAL EDUCATION TRAINING ON SUBSTANCE ABUSE SCREENING AND REFERRAL TO PRIMARY CARE PROVIDERS AND SURGEONS IN THE COUNTY BBASSETT 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 CBASSETT WILL COLLABORATE WITH LEAF AND THE HEALTH DEPARTMENT ON PUBLIC HEALTH CAMPAIGN ABOUT THE RISK FACTORS ASSOCIATED WITH BINGE DRINKING AND PRESCRIPTION DRUG ABUSE 3PHYSICAL ACTIVITY AND NUTRITION ABASSETT 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 BBASSETT 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 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE PART VI A MAJOR COMPONENT OF BASSETTS 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 PATIENTS COUNTY OF RESIDENCE REFERRAL TO AN ONSITE OTSEGO COUNTY MEDICAID EXAMINER IS AVAILABLE AT THE COOPERSTOWN CAMPUS A LISTING OF ALL SELFPAY ACCOUNTS IS PRODUCED AND REVIEWED DAILY TO INSURE THAT A COMMUNITY SERVICES BROCHURE HAS BEEN PROVIDED THE SELFPAY BILLING OFFICE IDENTIFIES PATIENTS DURING THE BILLING AND COLLECTIONS PROCESS THAT MAY REQUIRE ADDITIONAL HELP UNDERSTANDING THE PROGRAM SELFPAY ACCOUNTS FOR PATIENTS WHO HAVE BEEN APPROVED FOR COMMUNITY SERVICES WITHIN THE PRIOR 120 DAYS ARE AUTOMATICALLY INCLUDED WITH THE PRIOR APPROVAL COMMUNITY INFORMATION PART VI THE SERVICE AREA OF BASSETT ENCOMPASSES AN 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 37000 AND 40000 1214 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 HEALTH OF COMMUNITY IN RELATION TO EXEMPT PURPOSE PART VI BASSETTS SOLE MEMBER IS THURSTON CORPORATION DBA 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 29 COMMUNITY BASED OUTPATIENT HEALTH CENTERS 19 SCHOOLBASED 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 REESTABLISH 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 19 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 ANDOR 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 ASCHOOLBASED 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 BRHENDOMS 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 BABYBOTTLE TOOTH DECAY CBASSETT PSYCHIATRIC CRISIS CENTER THE COOPERSTOWN CENTER OPENED IN FEBRUARY 2008 FILLING A VOID CREATED BY THE TERMINATION OF PSYCHIATRIC SERVICES AT AO FOX HOSPITAL IN ONEONTA MONTHS EARLIER IN ITS FIRST YEAR BASSETTS PSYCHIATRIC CRISIS CENTER HELPED MORE THAN 1200 PATIENTS OF THOSE 52 WERE CHILDREN 12 OR YOUNGER AND 154 WERE ADOLESCENTS DPARENT HANYBOOK THIS FAMILY RESOURCE WAS CREATED BY THE OTSEGO CO COMMITTEE ON CHILD ABUSE AND NEGLECT AND UNDERWRITTEN BY BASSETT AND AO FOX HOSPITAL ITS GOAL IS TO GIVE PARENTS AND PROFESSIONALS A PLACE TO TURN FOR HELP IN DEALING WITH THE STRESSES OF FAMILY LIFE EKICKSTART A PROGRAM DESIGNED TO HELP COMBAT CHILDHOOD OBESITY THROUGH COLLABORATIVE PARTNERSHIPS WITH BASSETT HEALTH CENTERS AND LOCAL RECREATIONAL AND FITNESS GROUPS FBASSETT CANCER INSTITUTE MEDICAL SCREENING COACH A NEW CUSTOMBUILT 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 GCANCER 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 HHEALTHY START BREAKFAST A PARTNERSHIP BETWEEN COMMUNITY SERVICE ORGANIZATIONS AND BASSETT FOR DIABETES DETECTION EDUCATION AND PREVENTION ISAFE 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 INLINE SKATE AND SKATEBOARD SAFETY HOME SAFETY FIRE AND BURN PREVENTION ROAD SAFETY AND PEDESTRIAN SAFETY THE REGIONAL PRIMARY AND SPECIALTY CARE CLINICS AND THE SCHOOLBASED 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 BASSETTS 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 AFFILIATED HEALTH CARE INFORMATION PART VI BASSETT IS PART OF THE BASSETT HEALTHCARE NETWORK THAT PROVIDES HEALTH SERVICES IN MORE THAN 20 COMMUNITIES SPANNING 5600 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 61709 DELAWARE COUNTY POPULATION 47276 HERKIMER COUNTY POPULATION 64508 SCHOHARIE COUNTY POPULATION 32099 ACCORDING TO THE 2012 US CENSUS ESTIMATES ABASSETT AN ACUTE CARE INPATIENT TEACHING FACILITY AN OUTPATIENT PRIMARY AND SPECIALTY CARE CENTER A REGIONAL NETWORK OF 26 COMMUNITY BASED OUTPATIENT HEALTH CENTERS 19 SCHOOL BASED HEALTH CENTERS TWO AMBULATORY SURGERY CENTERS AND A FULLY SALARIED MEDICAL STAFF IN COOPERSTOWN OTSEGO COUNTY BOCONNOR HOSPITAL CRITICAL ACCESS HOSPITAL IN DELHI DELAWARE COUNTY CCOBLESKILL REGIONAL HOSPITAL ACUTE CARE FACILITY IN COBLESKILL SCHOHARIE COUNTY DLITTLE FALLS HOSPITAL CRITICAL ACCESS HOSPITAL IN LITTLE FALLS HERKIMER COUNTY ETRITOWN REGIONAL HOSPITAL 247 EMERGENCY CARE FACILITY IN SIDNEY DELAWARE COUNTY FAO FOX MEMORIAL HOSPITAL ACUTE CARE FACILITY IN ONEONTA OTSEGO COUNTY GVALLEY HEALTH SERVICES RESIDENTIAL HEALTH CARE AND REHABILITATION FACILITY HAT HOME CARE CERTIFIED HOME CARE AGENCY IFIRST COMMUNITY CARE OF BASSETT MEDICAL SUPPLY COMPANY ALL THE ABOVE AI MAKE UP THE BASSETT HEALTHCARE NETWORK AND PROVIDE HEALTH SERVICES TO THIS SEVEN COUNTY REGION IN CENTRAL NEW YORK LIST OF STATES WHERE COMMUNITY BENEFIT REPORT IS FILED PART VI NEW YORK ADDITIONAL INFORMATION PART VI PART V SECTION B LINE 11 BASSETT MEDICAL CENTER DOES NOT PROVIDE DISCOUNTED CARE MARY IMOGENE BASSETT HOSPITAL LINE NUMBER 1 PART V LINE 16E PART V LINE 16E BASSETT ENGAGES WITH A THIRD PARTY TO PERFORM COLLECTION ACTIONS MARY IMOGENE BASSETT HOSPITAL LINE NUMBER 1 PART V LINE 20D PART V LINE 20D BASSETT RECOGNIZES THAT SERVICES WILL BE PROVIDED EQUALLY TO ALL PATIENTS WITHOUT REGARD TO THEIR ABILITY TO PAY FOR SUCH SERVICES CHARGE SCHEDULES ARE THEREFORE UNIFORM BILLINGS TO PATIENTS ARE BASED ON THESE CHARGE SCHEDULES ALL CHARGES TO INDIVIDUALS THAT QUALIFY FOR CHARITY CARE ARE WRITTEN OFF COMPLETELY false AMERICAN CANCER SOCIETY 250 WILLIAMS ST NW ATLANTA GA 30303 131788491 3 7500 CASH SUPPORT AMERICAN HEART ASSOCIATION 7272 GREENVILLE AVE DALLAS TX 75231 135613797 3 25000 CASH SUPPORT 2 X X X X false false false false false false false true false WILLIAM F STRECK MD 773975 12460 23096 4679 814210 BERTINE MCKENNA PHD 380437 107000 1722 18096 4823 512078 NICHOLAS J NICOLETTA 376575 107000 23096 3436 510107 PASCALE G RAYMOND MD 415000 169159 1813 18096 604068 STEVEN J HENEGHAN MD 578884 23096 6614 608594 JONATHAN RICHMAN MD 521565 3200 23096 9567 557428 ROBERT A LANCEY MD 521554 2520 18096 14562 556732 TALLY E LASSITER MD 500000 127 8924 3614 512665 NON-FIXED PAYMENTS PROVIDED SCHEDULE J, PAGE 1, PART I, LINE 7 NON FIXED PAYMENTS ARE MADE BASED ON THE SUCCESS IN MEETING PERFORMANCE CRITERIA THAT ARE PROSPECTIVELY AGREED UPON AS GOALS FOR THE OFFICERS. PHYSICIANS MAY RECEIVE NON FIXED PAYMENTS BASED ON PERFORMANCE CRITERIA THAT ARE PROSPECTIVELY AGREED UPON. OTHER ADDITIONAL INFORMATION SCHEDULE J, PART III PART VII, LINE 5 COMPENSATION FROM UNRELATED ORGANIZATIONS NAME : WILLIAM F STRECK, MD NAME OF UNRELATED ORGANIZATION : COLUMBIA UNIVERSITY TYPE OF COMPENSATION : SALARY AMOUNT OF COMPENSATION : 306,000 A OTSEGO COUNTY CAPITAL RESOURCES 263661593 2011-11-03 25000000 PART VI false false false B OTSEGO COUNTY CAPITAL RESOURCES 263661593 2011-11-03 19200000 PART VI false false false A 25000000 702000 500000 23798000 false false false true B 19200000 75000 19125000 2009 true false true true A false false false false false false false true B false false false false false false false true A false false false false true false false false false B false false false false true false false false false A false ADDITIONAL INFORMATION SCHEDULE K OTSEGO COUNTY CAPITAL RESOURCES PART I LINE A COLUMN F BUILDING AND STRUCTURES OTSEGO COUNTY CAPITAL RESOURCES PART I LINE B COLUMN F REFUND OF PRIOR ISSUANCE THE CLARK ESTATES PART V 449096 INVESTMENT MGMT FEES false JANE HAMILTON PART V 84335 WAGES false ADDITIONAL INFORMATION SCHEDULE L PART V PART IV 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 SECOND ACCOMPLISHMENT DESCRIPTION FORM 990, PAGE 2, PART III, LINE 4B COMMUNITY INVOLVEMENT HAS BEEN LINKED TO BASSETT'S MISSION, VISION, AND VALUES SINCE WE 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 FOR 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 2012, WE PROVIDED 5,433,926 IN FREE CARE. BASSETT'S COMMUNITY HEALTH EDUCATION PROGRAMS INCLUDE LECTURES, PRESENTATIONS, HEALTH FAIRS, AND OTHER GROUP PROGRAMS APART FROM 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. NOT ONLY DID WE PROVIDE 5.4M IN CHARITY CARE, BAD DEBT EXPENSE WAS 15M, MEDICAID PAYMENTS BELOW COST TO PROVIDE SERVICES WERE 27.2M. RELATED PARTY INFORMATION AMONG OFFICERS FORM 990, PAGE 6, PART VI, LINE 2 KEVIN S MOORE WILLIAM T BURDICK TRUSTEE TRUSTEE BUSINESS KEVIN S MOORE JANE FORBES CLARK TRUSTEE TRUSTEE BUSINESS KEVIN S MOORE RICHARD C VANISON TRUSTEE TREASURER BUSINESS KEVIN S MOORE GLENN A PERRONE TRUSTEE ASST. SEC. BUSINESS WILLIAM T BURDICK KEVIN S MOORE TRUSTEE TRUSTEE BUSINESS WILLIAM T BURDICK JANE FORBES CLARK TRUSTEE TRUSTEE BUSINESS WILLIAM T BURDICK RICHARD C VANISON TRUSTEE TREASURER BUSINESS WILLIAM T BURDICK GLENN A PERRONE TRUSTEE ASST. SEC. BUSINESS JANE FORBES CLARK KEVIN S MOORE TRUSTEE TRUSTEE BUSINESS JANE FORBES CLARK WILLIAM T BURDICK TRUSTEE TRUSTEE BUSINESS JANE FORBES CLARK RICHARD C VANISON TRUSTEE TREASURER BUSINESS JANE FORBES CLARK GLENN A PERRONE TRUSTEE ASST. SEC. BUSINESS RICHARD C VANISON KEVIN S MOORE TREASURER TRUSTEE BUSINESS RICHARD C VANISON WILLIAM T BURDICK TREASURER TRUSTEE BUSINESS RICHARD C VANISON JANE FORBES CLARK TREASURER TRUSTEE BUSINESS RICHARD C VANISON GLENN A PERRONE TREASURER ASST. SEC. BUSINESS GLENN A PERRONE KEVIN S MOORE ASST. SEC. TRUSTEE BUSINESS GLENN A PERRONE WILLIAM T BURDICK ASST. SEC. TRUSTEE BUSINESS GLENN A PERRONE JANE FORBES CLARK ASST. SEC. TRUSTEE BUSINESS GLENN A PERRONE RICHARD C VANISON ASST. SEC. TREASURER BUSINESS ORGANIZATION'S PROCESS USED TO REVIEW FORM 990 FORM 990, PAGE 6, PART VI, LINE 11B 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 AVAILABLE FOR EACH MEMBER OF THE BOARD BEFORE IT'S FILING WITH THE IRS. ENFORCEMENT OF CONFLICTS POLICY FORM 990, PAGE 6, PART VI, LINE 12C 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. COMPENSATION PROCESS FOR TOP OFFICIAL FORM 990, PAGE 6, PART VI, LINE 15A BASSETT MEDICAL CENTER 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, AND INDEPENDENT COMPENSATION CONSULTANT, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OF TRUSTEES OR THE COMPENSATION COMMITTEE. BASSETT MEDICAL CENTER PAYS NON-FIXED EARNINGS BASED ON THE SUCCESS IN MEETING PERFORMANCE CRITERIA THAT ARE PROSPECTIVELY AGREED UPON AS GOALS FOR THE CEO. COMPENSATION PROCESS FOR OFFICERS FORM 990, PAGE 6, PART VI, LINE 15B 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 PERFORMACE CRITERIA AND COMPARATIVE MARKET DATA. FOR KEY EMPLOYEES, COMPENSATION IS DELEGATED BY THE BAORD TO THE DISCRETION OF THE OFFICERS. GOVERNING DOCUMENTS DISCLOSURE EXPLANATION FORM 990, PAGE 6, PART VI, LINE 19 THE MARY IMOGENE BASSETT HOSPITAL MAKES IT'S 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 STAMPLED 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. RECONCILIATION OF CHANGES - OTHER FORM 990, PART XI, LINE 9 POST RETIREMENT BENEFIT CHANGE 174,722 BAD DEBT -14,985,208 CHARITY CARE -5,433,926 BAD DEBT 14,985,208 CHARITY CARE 5,433,926 THURSTON CORPORATION ONE ATWELL ROAD COOPERSTOWN NY 13326 133218680 SUPPORT NY 501C3 11C NONE false BASSETT REGIONAL CORPORATION (BRC) ONE ATWELL ROAD COOPERSTOWN NY 13326 133522783 SUPPORT NY 501C3 11B THURSTON false TEMPLETON FOUNDATION ONE ATWELL ROAD COOPERSTOWN NY 13326 133317084 LANDLORD NY 501C3 9 THURSTON false FRIENDS OF BASSETT ONE ATWELL ROAD COOPERSTOWN NY 13326 237041610 FUNDRAISE NY 501C3 7 THURSTON false AO FOX MEMORIAL HOSPITAL ONE NORTON AVENUE ONEONTA NY 13820 150539039 HEALTHCARE NY 501C3 3 THURSTON false BASSETT HOSPITAL SCHOHARIE COUNTY 178 GRANDVIEW DRIVE COBLESKILL NY 12043 141772971 HEALTHCARE NY 501C3 3 BRC false LITTLE FALLS HOSPITAL 140 BURWELL STREET LITTLE FALLS NY 13365 150533578 HEALTHCARE NY 501C3 3 BRC false O'CONNOR HOSPITAL 460 ANDES ROAD DELHI NY 13753 161540394 HEALTHCARE NY 501C3 3 BRC false TRI TOWN REGIONAL HEALTHCARE 43 PEARL STREET SIDNEY NY 13838 260169584 HEALTHCARE NY 501C3 3 BRC false VALLEY HEALTH SERVICES 690 WEST GERMAN STREET HERKIMER NY 13350 222511614 ELDER CARE NY 501C3 3 BRC false false false true false false false false false true true true true true false false true true false false