2012-11-14T14:57:36-06:00 2011-12-31 161226221 FUST CHARLES CHAMBERS LLP 5784 WIDEWATERS PARKWAY SYRACUSE NY 13214 990 2011-01-01 150533578 LITTLE FALLS HOSPITAL LITT 3158231000 140 BURWELL STREET LITTLE FALLS NY 13365 JAMES VIELKIND 3158231000 2012-11-14 1 JOSEPH J SCHLEGEL P00301329 3154463600 2011 2016-02-24 21:20:13Z JAMES VIELKIND 140 BURWELL STREET LITTLE FALLS NY 13365 28768863 0 X LFHNY.ORG X 1893 NY LITTLE FALLS HOSPITAL IS A CRITICAL ACCESS HOSPITAL PROVIDING ACCESS TO HEALTH CARE SERVCIES TO RESIDENTS OF HERKIMER COUNTY, AND WESTERN PORTIONS OF MONTGOMERY AND FULTON COUNTIES. LITTLE FALLS HOSPITAL EMERGENCY DEPARTMENT IS STAFFED WITH PHYSICIANS ON A 24/7 BASIS. TWENTY FIVE BEDS ARE USED FOR INPATIENT AND SKILLED NURSING CARE. AMBULATORY SURGERY SERVCIES ARE PROVIDED FOR A VARIETY OF SPECIALTIES, PERFORMANCE IMPROVEMENT AND HIGH QUALITY OF CARE IS DEMOSTRATED WITHIN THE HOSPITAL CONSUMER ASSESSMENT OF HEALTHCARE PROVIDERS AND SYSTEMS (HCAHPS) AS REPORTED IN HOSPITAL COMPARE. 16 13 337 18 0 0 5752533 856607 25897565 26972536 87394 196800 0 0 31737492 28025943 0 0 0 0 12649682 13528783 0 9250 43646 13563673 13425422 26213355 26963455 5524137 1062488 29965668 30895128 11102428 13134431 18863240 17760697 X LITTLE FALLS HOSPITAL IS A VOLUNTARY, NOT-FOR-PROFIT COMMUNITY HEALTHCARE SYSTEM WHOSE MISSION IS TO OFFER QUALITY CARE WITH COMPASSION, TO ALL WHO NEED OUR SERVICES. 0 0 7822849 7231919 INPATIENT SERVICESLITTLE FALLS HOSPITAL SERVICES FOR SWING BED WERE BROADENED BY THE TRAINING OF NURSES TO HANDLE SWING BED PATIENTS WITH WOUND CARE AILMENTS. THE NEED FOR WOUND CARE HAS RISEN WITH PATIENTS WITH CHRONIC LONG TERM AILMENTS WITH LIMITED ABILITY TO AMBULATE. LITTLE FALLS HOSPITAL NURSING UNIT WAS AWARDED THE NICHE (NURSES IMPROVING CARE FOR HEALTHSYSTEM ELDERS) DESIGNATION FOR PROVIDING PATIENT CENTERED CARE FOR OUR ELDERLY PATIENTS. 6717513 6005183 LITTLE FALLS HOSPITAL OPERATES AN EMERGENCY DEPARTMENT WITH TWENTY FOUR HOURS OF PHYSICIAN COVERAGE SEVEN DAYS PER WEEK. THE EMERGENCY DEPARTMENT PROVIDES ACCESS TO CARE FOR APPROXIMATELY 15,000 PATIENTS IN 2011. THE NUMBER OF PATIENTS REQUIRING INPATIENT HOSPITAL CARE AS RESULT OF THE VISIT TO THE EMERGENCY DEPARTMENT WAS APPROXIMATELY 1,800. THESE SERVCIES ARE PROVIDED TO ALL PATIENTS REGARDLESS OF ABILITY TO PAY. IN 2011 THE EMERGENCY ROOM TRIAGE SYSTEM WAS IMPROVED TO INCLUDE ENTRY OF INFORMATION INTO AN ELECTRONIC HEALTH RECORD. THIS IS THE FIRST PHASE OF A LARGER FULLY ELECTRONIC MEDICAL RECORD TO BE IMPLEMENTED ON A WIDER SCALE IN 2012 - 2013. 7874974 9258077 TOTAL AMBULATORY OUTPATIENT VISITS WERE APPROXIMATELY 34,000 VISITS IN 2011. OUTPATIENT ANCILLARY DEPARTMENTS BEGAN TO RECEIVE ELECTRONIC ORDERS FOR OUTPATIENT SERVICES FROM BASSETT MEDICAL CENTER PHYSICIANS AS PART OF THE IMPLEMENTATION OF THE ELECTRONIC HEALTH RECORD. EXPANDED USE OF PROCESSING ORDERS ELECTRONICALLY WILL BE IMPLEMENTED IN 2012 - 2013. 639102 801851 BASSETT MEDICAL CENTER HAD ITS FIRST FULL YEAR OF PROVIDING DIALYSIS TREATMENTS TO RESIDENTS OF HERKIMER COUNTY AT A FACILITY LOCATED ON THE CAMPUS OF LITTLE FALLS HOSPITAL. PLANNING IN 2011 WILL RESULT IN A NEW PRIMARY CARE FACILITY TO BE LOCATED ON THE CAMPUS OF LITTLE FALLS HOSPITAL AND OPERATED BY BASSETT MEDICAL CENTER. 639102 801851 23054438 1 1 0 0 0 0 0 0 0 1 1 1 1 0 1 1 1 0 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 0 0 0 0 1 41 0 1 337 1 0 0 0 0 0 0 0 0 X 16 13 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 NY X JAMES G VIELKIND 3158235281 140 BURWELL STREET LITTLE FALLS NY 13365 JOHN BULLIS 2.00 X 0 0 0 JOAN S CONBOY 2.00 X 0 0 0 TIMOTHY DALY 2.00 X 0 0 0 ANTHONY DELUCA 2.00 X X 0 0 0 STAN DICKSON 2.00 X X 0 0 0 JOY MALONE 2.00 X 0 0 0 MARSHA MASON 2.00 X 0 0 0 GERALD J SNYDER 2.00 X X 0 0 0 JENNIFER VANWAGONER 2.00 X 0 0 0 RANBIR SODHI MD 2.00 X 0 0 0 AUGUST LEINHART MD 2.00 X 0 408359 12909 NICHOLAS J NICOLETTA 2.00 X X 0 368286 15739 JEFFREY WOEPPEL 2.00 X X 0 208073 13168 KEVIN CROSLEY 2.00 X 0 0 0 JUSTIN HUMMEL 2.00 X 0 0 0 DALE ADAMSON MD 2.00 X 0 168671 7531 MICHAEL OGDEN 40.00 X 0 149581 462 JAMES G VIELKIND 40.00 X 128368 0 4045 RICHARD NOCELLA 40.00 X 160765 0 15453 289133 1302970 69307 2 0 1 0 BIVENS & ASSOCIATES ARCHITECTS 528 PLUM STREET SUITE 200 SYRACUSE NY 132041473 ARCHITECT SERVICES 901953 MEDSPAR LLC PO BOX 830 BINGHAMTON NY 139020830 BILLING SERVICES 149836 FUST CHARLES CHAMBERS 5784 WIDEWATER PARKWAY SYRACUSE NY 13214 AUDITING SERVICES 123288 DM CONSULTING PO BOX 4715 UTICA NY 13504 INFORMATION TECHNOLOGY 110610 4 117708 303899 435000 856607 OUTPATIENT SERVICES 623000 17777160 17777160 INPATIENT HOSPITAL 621930 8583389 8583389 PROGRAM SERVICE LEASE 532000 432986 432986 HOSPITAL CAFETERIA 900099 139867 139867 OTHER OPERATING REVENU 900099 39134 39134 26972536 95733 95733 843987 742920 101067 101067 101067 28025943 26972536 0 196800 308632 176218 132414 10502652 9040139 1439245 23268 580005 497170 81567 1268 1342489 1142344 197215 2930 795005 677503 115783 1719 88910 88910 17730 4096 13634 87189 87189 9250 9250 441172 239790 201382 29722 29722 2428336 2350545 76516 1275 727034 556408 170626 738434 625930 111901 603 21403 14537 6469 397 26144 19970 6174 152048 132447 19582 19 1474325 1284271 189872 182 246312 231433 14879 PURCHASED MEDICAL SERVI 3505495 3505495 PROVISION FOR BAD DEBT 2184712 2184712 ADMINISTRATIVE SERVICES 677779 677779 NEW YORK STATE ASSESSME 80962 80962 497715 260746 234234 2735 26963455 23054438 3865371 43646 598947 348968 1061327 1039532 5258493 5437347 2860833 3484074 369023 382900 166266 1215888 25874137 16911156 8757597 8962981 1539459 1915088 5482641 5478882 2472438 2455626 1398644 173842 29965668 30895128 2968638 3217283 20668 39912 4117756 3937377 3995366 5939859 11102428 13134431 X 6706244 5007384 11408912 12028938 748084 724375 18863240 17760697 29965668 30895128 X 1062488 -2165031 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 12156996 623347 -27030 12753313 5547082 5230555 1782439 403080 12156996 2664349 174329 3874661 1166257 5547082 4951188 327877 -202282 2412434 2664349 0.05680 0.94320 1 0 356392 356392 15882128 9643608 6238520 9635617 7267548 2368069 8962981 MARY LEARY CHARITABLE REMAINDER TR 2007963 F ELSA O'BRIEN CHARITABLE REMAINER TR 3470919 F 5478882 DIRECT FINANCE LEASE 2455626 C 2455626 ACCRUED PENSION LIABILITY 5014244 ACCRUED SALARIES, PAYROLL TAXES AND FRINGE BENEFITS 809115 OTHER LIABILITIES 116500 5939859 28025943 26963455 1062488 -245363 -1919668 -2165031 -1102543 25860912 -245363 -1919668 -2165031 28025943 0 28025943 26963455 0 26963455 0 26963455 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: ENDOWMENT FUNDS DISTRIBUTE INCOME FOR PURPOSES OF CAPITAL INVESTMENT. TEMPORARY ENDOWMENTS ARE USED BASED ON THE INTENT OF THE DONATION. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE HOSPITAL QUALIFIES AS AN ORGANIZATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL INCOME TAXES PURSUANT TO SECTION 501(A) OF THE INTERNAL REVENUE CODE. THE STANDARDS FOR ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES ESTABLISH A RECOGNITION THRESHOLD AND MEASUREMENT FOR INCOME TAX POSITIONS RECOGNIZED IN A HOSPITAL'S FINANCIAL STATEMENTS. THESE STANDARDS HAD NO IMPACT ON THE ACCOMPANYING FINANCIAL STATEMENTS. THE TAX YEARS OPEN TO EXAMINATION BY FEDERAL AND NEW YORK STATE TAXING AUTHORITIES ARE 2007 THROUGH 2011. PART XI, LINE 8 - OTHER ADJUSTMENTS: PENSION RELATED CHANGES OTHER THAN NET PERIODIC BENEFIT COST -1,915,909. CHANGES IN VALUE OF BENEFICIAL INTEREST IN CHARITABLE REMAINDER TRUST -3,759. TOTAL TO SCHEDULE D, PART XI, LINE 8: -1,919,668. PART XII, LINE 2D - OTHER ADJUSTMENTS: PENSION RELATED CHANGES OTHER THAN NET PERIODIC BEBEFIT COST -1,915,909. CHANGES IN VALUE OF BENEFICIAL REMAINDER TRUST -3,759. BUILDINGS INCLUDES CONSTRUCTION IN PROGRESS OF $1,115,093 AS OF 12/31/2011 X X X X 1 JAMES BOYLE PO BOX 27 140 MOODY HEIGHTS MOODY ME 040540027 FEASABILITY STUDY 0 0 9250 -9250 9250 -9250 NY EXPLANATION OF FUNDRAISING PAYMENTS SCHEDULE G, PART I, LINE 2B, COLUMN (V) IN 2011 JAMES BOYLE WAS RETAINED TO COMPLETE A FEASABILITY STUDY AS PART OF AN EFFORT TO IDENTIFY POTENTIAL FUND RAISING AMOUNTS FOR A SPECIAL CAPITAL CAMPAIGN. 1 1 1 X 300.000000000000 0 1 1 0 1 1 165 116746 77281 39465 0.00150 2084 1271058 1157760 113298 0.00420 9945 3601404 2157228 1444176 0.05360 12194 4989208 3392269 1596939 0.05930 67751 3416 64335 0.00240 67751 3416 64335 0.00240 12194 5056959 3395685 1661274 0.06170 1 874397 76613 8581184 8496212 84972 X 1 1 1 1 LITTLE FALLS HOSPITAL

140 BURWELL STREET LITTLE FALLS NY 13365

X X INCLUDES 25 INPATIENT BEDS, LITTLE FALLS HOSPITAL 1 1 1 300.000000000000 0 1 X 0 1 X X X X X X 1 X 1 X X X X X X X 1 X 0 1 PART I, LINE 3C: LITTLE FALLS HOSPITAL DID NOT PROVIDE CHARITY CARE OR DISCOUNTED CARE TO PATIENTS WITH INSURANCE BENEFITS. PART I, LINE 7: COST FOR CHARITY CARE PATIENTS WAS CALCULATED USING RATIO OF COST TO CHARGES. COST ASSOCIATED WITH MEDICAID AND MEDICAID HMO PROGRAMS REPRESENTS AGGREGATE ALLOWABLE COST AND TOTAL GROSS CHARGES USED TO CALCULATE A FACILITY LEVEL OF COST TO CHARGE RATIO. THIS FACILITY LEVEL COST TO CHARGE RATIO WAS APPLIED TO TOTAL MEDICAID AND MEDICAID HMO CHARGES TO ARRIVE AT TOTAL MEDICAID COST. COST OF OTHER MEANS TESTED PROGRAMS IS COMPRISED OF MEDICAID HMO AND NYS FAMILY HEALTH PLUS INSURANCE PROGRAMS. PART I, LINE 7G: LITTLE FALLS HOSPITAL DOES NOT PROVIDE DISCOUNTED CARE FOR PATIENTS WITH INSURANCE. HARDSHIP CASES ARE REVIEWED ON AN INDIVIDUAL BASIS. PART I, L7 COL(F): LITTLE FALLS HOSPITAL REMOVED $2,184,712 OF BAD DEBT EXPENSE TO CALCULATE COST OF PATIENT CARE. PART III, LINE 4: NOTE (1) (K) NET PATIENT SERVICE REVENUE AND RELATED RECEIVABLESTHE HOSPITAL IS DESIGNATED AS A CRITICAL ACCESS HOSPITAL BY MEDICARE AND MEDICAID. THESE THIRD-PARTY PAYORS REIMBURSE THE HOSPITAL ON A COST BASIS. THE HOSPITAL ALSO HAS AGREEMENTS WITH OTHER THIRD-PARTY PAYORS. PAYMENT ARRANGEMENTS INCLUDE PROSPECTIVELY DETERMINED RATES PER DISCHARGE, COST-BASED REIMBURSEMENT, DISCOUNTED CHARGES AND PER DIEM PAYMENTS. NET PATIENT SERVICE REVENUE AND THE RELATED PATIENT ACCOUNTS RECEIVABLE ARE REPORTED AT THE ESTIMATED NET REALIZABLE AMOUNTS FROM PATIENTS, THIRD-PARTY PAYORS AND OTHERS FOR SERVICES RENDERED, INCLUDING ESTIMATED RETROACTIVE ADJUSTMENTS DUE TO FUTURE AUDITS, REVIEWS AND INVESTIGATIONS. RETROACTIVE ADJUSTMENTS ARE CONSIDERED IN THE RECOGNITION OF REVENUE ON AN ESTIMATED BASIS IN THE PERIOD THE RELATED SERVICES ARE RENDERED AND ADJUSTED IN FUTURE PERIODS AS ADJUSTMENTS BECOME KNOWN OR AS YEARS ARE NO LONGER SUBJECT TO SUCH AUDITS, REVIEWS AND INVESTIGATIONS.AN ALLOWANCE FOR DOUBTFUL ACCOUNTS IS ESTIMATED BY MANAGEMENT BASED ON PERIODIC REVIEWS OF THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE CONSIDERING HISTORICAL EXPERIENCE AND PREVAILING ECONOMIC CONDITIONS.REVENUE FROM THE MEDICARE AND MEDICAID PROGRAMS, INCLUDING THE HMO PROGRAMS OFFERED BY THESE PAYORS, ACCOUNTED FOR APPROXIMATELY 59% AND 69% OF THE HOSPITALS NET PATIENT SERVICE REVENUE FOR THE YEARS 2011 AND 2010, RESPECTIVELY. LAWS AND REGULATIONS GOVERNING THE MEDICARE AND MEDICAID PROGRAMS ARE EXTREMELY COMPLEX AND SUBJECT TO INTERPRETATION.AS A RESULT, THERE IS AT LEAST A REASONABLE POSSIBILITY THAT RECORDED ESTIMATES WILL CHANGE BY A MATERIAL AMOUNT IN THE NEAR TERM. IN 2011 AND 2010, NET PATIENT SERVICE REVENUE INCREASED (DECREASED) BY APPROXIMATELY $(150,000) AND $137,000, RESPECTIVELY, RELATED TO EITHER SETTLEMENT OF PRIOR YEAR ISSUES OR CHANGES IN ESTIMATES ASSOCIATED WITH THIRD-PARTY ISSUES.THE HOSPITAL GRANTS UNSECURED CREDIT TO ITS PATIENTS, MOST OF WHOM ARE LOCAL RESIDENTS AND ARE INSURED UNDER THIRD-PARTY PAYOR AGREEMENTS. THE MIX OF RECEIVABLES FROM PATIENTS AND THIRD-PARTY PAYORS AT DECEMBER 31 WAS AS FOLLOWS: 2011 2010 MEDICARE 43% 39%MEDICAID 13% 16%PRIVATE PAYORS 11% 16%INSURANCE AND ALL OTHERS 33% 29% 100% 100%AS A RESULT OF THE IMPLEMENTATION OF NEWLY ISSUED ELECTRONIC BILLING SPECIFICATIONS, CERTAIN OF THE HOSPITALS GOVERNMENT-RELATED AND INSURANCE PAYORS WERE UNABLE TO PROPERLY ADJUDICATE HOSPITAL CLAIMS FOR SERVICES RENDERED UNTIL EARLY JANUARY 2012. THIS TECHNICAL OCCURRENCE CREATED GROWTH OF APPROXIMATELY $425,000 IN PATIENT ACCOUNTS RECEIVABLE AT DECEMBER 31, 2011 COMPARED WITH 2010 AS WELL AS AN INCREASE IN THE CONCENTRATION OF THE RELATED ACCOUNTS RECEIVABLE AT DECEMBER 31, 2011.COSTING RATIONALELITTLE FALLS HOSPITAL INCURRED BAD DEBT EXPENSE OF $2,184,712 IN 2011 CONSISTING OF SERVICES UNPAID BY UNINSURED AND UNDERINSURED PATIENTS, THE COSTING OF BAD DEBT REPRESENTS USING RCC PERCENTAGES BY PATIENT SERVICE TYPE AGAINST THE SAME SERVICE TYPES INCURRING BAD DEBTS. IN 2011 THE RCC PERCENTAGE USED WAS 40.02%. PART III, LINE 8: LITTLE FALLS HOSPITAL COSTING METHODOLOGY CONSIST OF INFORMATION FROM MEDICARE COST REPORT. AS A CRITICAL ACCESS HOSPITAL PAYMENT IS BASED ON 101 % OF MEDICARE ALLOWABLE COST. PART III, LINE 9B: COLLECTION AND CHARITY CARE POLICY SPECIFY ACCOUNTS WITH ACTIVE CARE APPLICATIONS WILL NOT GO TO COLLECTION AGENCIES WHILE IN REVIEW. LITTLE FALLS HOSPITAL PART V, SECTION B, LINE 11H: LITTLE FALLS HOSPITAL CHARGES FOR SERVICES BASED ON RELATIONSHIPS OF COST OF SERVICES, AND AGGREGATE MARGINS REQUIRED FOR HEALTHCARE SERVICES. LITTLE FALLS HOSPITAL PART V, SECTION B, LINE 13G: LITTLE FALLS HOSPITAL BILLING FORMS INCLUDE A STATEMENT TO INQUIRE ABOUT FINANCIAL ASSISTANCE WITH A PHONE NUMBER TO CALL. UNINSURED PATEINTS ARE MAILED AN APPLICATION FOR THEIR COMPLETION. LITTLE FALLS HOSPITAL PART V, SECTION B, LINE 15E: THE HOSPITAL REFERRED COLLECTION MATTERS TO A THIRD PARTY AGENCY. LITTLE FALLS HOSPITAL PART V, SECTION B, LINE 19D: LITTLE FALLS HOSPITAL CHARGES UNIFORM CHARGES TO ALL PAYERS REGARDLESS OF RESPONSIBLE PARTY FOR THE BILL. LITTLE FALLS HOSPITAL PART V, SECTION B, LINE 21: LITTLE FALLS HOSPITAL CHARGES UNIFORM CHARGES TO ALL PAYERS REGARDLESS OF RESPONSIBLE PARTY FOR THE BILL. PART VI, LINE 5: LITTLE FALLS HOSPITAL ACTIVELY PLANS AND IMPLEMENTS COORDINATED HEALTH CARE RESOURCES WITH BASSETT HEALTHCARE NETWORK. THIS SYNERGY ALLOWS FOR GREATER ACCESS, MINIMIZES DUPLICATION OF SERVICES, AND RESULTS WITH HIGH QUALITY CARE. LITTLE FALLS HOSPITAL SERVES ALL PATIENTS WITHOUT CONSIDERATION OF PAYMENT SOURCES. IN 2011 THE AGGREGATE OUTPATIENT GOVERMENT AND UNINSURED SPONSORED PAYMENT PERCENTAGE WAS 63.9%. THIS MEANS 63.9% OF PATIENTS ARE COVERED BY MEDICAID, MEDICARE, GOVERMENT SPONSORED HMO PROGRAMS OR ARE UNINSURED. TO MANAGE CARE MORE APPROPRATELY EMPHASIS HAS BEEN PREVALENT IN QUALITY OF CARE MEASUREMENTS. THIS HAS RESULTED IN IMPROVING FEWER PATIENTS REQUIRING RE-ADMISSION TO THE HOSPITAL AFTER 30 DAYS. IN ADDITION THE NUMBER OF PATIENTS CONNECTED WITH FOLLOW - UP COMMUNICATIONS HAS SHOWN IMPROVED SHORT AND LONG TERM HEALTH STATUS BENEFITS. CONTINUED EFFORTS TO EXPAND THE PRIMARY CARE PROVIDER BASE WILL FURTHER IMPROVE ACCESS TO PRIMARY CARE RESULTING IN A MORE PATIENT CENTERED DELIVERY OF CARE MODEL. IN 2012 THE IMPLEMENTATION OF THE "ELECTRONIC HEALTH RECORD" WILL RESULT IN A MORE SIGNIFICANT ADOPTION OF CARE DOCUMENTATION PROTOCOLS TO FURTHER IMPROVE THE HEALTH STATUS OF OUR PATIENTS. PART VI, LINE 6: LITTLE FALLS 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 NINE 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 61,917; DELAWARE COUNTY - POPULATION 47,559; HERKIMER COUNTY - POPULATION 64,160; SCHOHARIE COUNTY - POPULATION 32,578 (ACCORDING TO THE 2011 U.S. CENSUS ESTIMATES). THE MARY IMOGENE BASSETT HOSPITAL, AN ACUTE CARE INPATIENT TECHING 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 REGIOANL HOSPITAL A 24/7 EMERGENCY CARE FACILITY IN SIDNEY, DELAWARE COUNTY, AUREILA OSBORN FOX MEMORIAL HOSPITAL, AN ACUTE CARE FAILITY 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, 18 SCHOOL BASED HEALTH CENTERS, TWO AMBULATORY SURGERY CENTERS, VALLEY HEALTH SERVICES A RESIDUAL HEALTH CARE AND REHABBILATION 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. REPORTS FILED WITH STATES PART VI, LINE 7 NY X X X X 0 0 0 0 0 0 0 0 0 AUGUST LEINHART MD 0 330000 0 3947 0 74412 0 11339 0 1570 0 421268 0 0 NICHOLAS J NICOLETTA 0 368286 0 0 0 0 0 11339 0 4400 0 384025 0 0 JEFFREY WOEPPEL 0 208000 0 73 0 0 0 8864 0 4304 0 221241 0 0 DALE ADAMSON MD 0 167000 0 1671 0 0 0 4544 0 2987 0 176202 0 0 MICHAEL OGDEN 0 148000 0 1581 0 0 0 0 0 462 0 150043 0 0 RICHARD NOCELLA 160765 0 0 0 0 0 0 0 15453 0 176218 0 0 0 FORM 990, PART VI, SECTION B, LINE 11 LITTLE FALLS EXECUTIVE & FINANCE COMMITTEE OF THE BOARD OF TRUSTEES REVIEWS FORM 990 AND INVITES ALL BOARD OF TRUSTEE MEMEBERS TO ATTEND. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST STATEMENTS ARE MADE ANNUALLY. NEW BOARD MEMEBERS ARE REQUIRED TO DISCLOSE ON THEIR RESUME ALL AFFILIATED ORGANIZATIONS. FORM 990, PART VI, SECTION B, LINE 15A BOARD OF TRUSTEES COMPLETES A CEO EVALUATION ANNUALLY AND MAKES ADJUSTMENTS TO COMPENSATION ACCORDING TO PERFORMANCE AND INDUSTRY COMPENSATION LEVELS. FORM 990, PART VI, SECTION C, LINE 19 LITTLE FALLS HOSPITAL MAKES AVAILABLE THE IRS FROM 990 UPON REQUEST ALONG WITH INFORMATION INCLUDED WITHIN THE 990 SUCH AS FINANCIAL REPORTS, CONFLICT OF INTEREST POLICY,AND CODE OF CONDUCT. THE HOSPITAL ALSO PROVIDES THE ANNUAL OPERATING PLAN, CORPORATE VLAUES, IN PUBLIC AREAS OF THE FACILITY. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -245,363. PENSION RELATED CHANGES OTHER THAN NET PERIODIC BENEFIT COST -1,915,909. CHANGES IN VALUE OF BENEFICIAL INTEREST IN CHARITABLE REMAINDER TRUST -3,759. TOTAL TO FORM 990, PART XI, LINE 5: -2,165,031. PART XII, LINE 2C THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. THURSTON CORPORATION ONE ROCKEFELLER PLAZA 31ST FLOOR NEW YORK NY 10020 133218680 SUPPORTING ORGANIZATION NY 501 (C) 3 11 C N/A 0 FRIENDS OF BASSETT ONE ATWELL ROAD COOPERSTOWN NY 13326 237041610 FUND RAISING ORGANIZATION NY 501 (C) 3 7 THURSTON CORPORATION 0 MARY IMOGENE BASSETT HOSPITAL ONE ATWELL ROAD COOPERSTOWN NY 13326 135596796 HEALTH CARE ORGANIZATION OFFERING INPATIENT AND OUTPATIENT SERVICES NY 501 (C) 3 3 THURSTON CORPORATION 0 AURELIA OSBORN FOX MEMORIAL HOSPITAL SOCIETY ONE NORTON AVENUE ONEONTA NY 13820 150539039 HEALTH CARE ORGANIZATION OFFERING INPATIENT AND OUTPATIENT SERVICES NY 501 (C) 3 3 THURSTON CORPORATION 0 TEMPLETON FOUNDATION ONE ATWELL ROAD COOPERSTOWN NY 13326 133317084 FACILITIES / OFFICE SPACE NY 501 (C) 3 9 THURSTON CORPORATION 0 BASSETT REGIONAL CORPORATION ONE ATWELL ROAD COOPERSTOWN NY 13326 133522783 PROVIDES EXCELLENCE IN THE COORDINATION PLANNING AND POLICY DIRECTION FOR NY 501 (C) 3 11 (B) THURSTON CORPORATION 0 COBLESKILL REGIONAL HOSPITAL 178 GRANDVIEW DRIVE COBLESKILL NY 12043 141772971 HEALTHCARE SERVICES OFFERING INPATEINT AND OUTPATIENT SERVICES NY 501 (C) 3 3 BASSETT REGIONAL CORPORATION 0 O'CONNOR HOSPITAL 460 ANDES ROAD DELHI NY 13753 161540394 HEALTH CARE ORGANIZATION OFFERING INPATIENT AND OUTPATIENT SERVICES NY 501 (C) 3 3 BASSETT REGIONAL CORPORATION 0 TRI TOWN REGIONAL HEALTHCARE 43 PEARL STREET SYNDEY NY 13838 260169584 HEALTHCARE SERVICES OFFERING OUTPATIENT SERVICES NY 501 (C) 3 3 BASSETT REGIONAL CORPORATION 0 VALLEY HEALTH SERVICES 690 GERMAN STREET HERKIMER NY 13350 222511614 NURSING HOME NY 501 (C) 3 3 BASSETT REGIONAL CORPORATION 0 0 0 0 0 0 0 0 0 1 0 1 1 0 1 0 1 0 0