2022-11-15T15:53:08-06:00 2021-12-31 135565207 KPMG LLP 515 BROADWAY 4TH FLOOR ALBANY NY 122072974 990 2021-01-01 150533578 LITTLE FALLS HOSPITAL LITT 3158231000 140 BURWELL STREET LITTLE FALLS NY 13365 ERIC STEIN PRESIDENT 3158231000 2022-11-14 1 ERIC STEIN XXX-XX-XXXX GENEVA FURLANO P01877392 5184274600 2022-11-11 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z ERIC STEIN 140 BURWELL STREET LITTLE FALLS NY 13365 41909970 0 X WWW.BASSETT.ORG X 1893 NY CRITICAL ACCESS HOSPITAL PROVIDING ACCESS TO HEALTH CARE SERVICES 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 SERVICES ARE PROVIDED FOR A VARIETY OF PROCEDURE SPECIALTIES. PERFORMANCE IMPROVEMENT AND HIGH QUALITY OF CARE IS DEMONSTRATED WITHIN THE HOSPITAL CONSUMER ASSESSMENT OF HEALTHCARE PROVIDERS AND SYSTEMS (HCAHPS) AS REPORTED ON MEDICARE.GOV HOSPITAL COMPARE. 11 10 353 18 0 0 8464504 1304794 32582919 39866823 310963 654328 0 0 41358386 41825945 0 0 0 0 15306004 15264808 0 0 38265 25233817 22479232 40539821 37744040 818565 4081905 40044586 49578750 15265197 19467046 24779389 30111704 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 8546679 7716574 INPATIENT SERVICES64% OCCUPANCY FOR AN AVERAGE DAILY INPATIENT DAILY CENSUS OF 16 PATIENTS. AS A CRITICAL ACCESS HOSPITAL (CAH) PROVIDER, OUR INPATIENT DAILY SERVICES INCLUDE; OBSERVATION CARE, EXTENDED SWINGBED REHAB SERVICES, AND ACUTE CARE SERVICES. THIS DIVERSITY OF PATIENT CARE ALLOWS FOR OUR RESIDENTS TO REMAIN LOCAL FOR MEDICALLY APPROPRIATE SERVICES. IN 2021, ACUTE CARE LENGTH OF STAY WAS 4.2 DAYS COMPARED WITH 3.3 IN 2020. 12465983 11663086 LITTLE FALLS HOSPITAL OPERATES AN EMERGENCY DEPARTMENT WITH TWENTY FOUR HOURS OF PHYSICIAN COVERAGE, SEVEN DAYS PER WEEK. THE EMERGENCY DEPARTMENT PROVIDED ACCESS TO CARE FOR APPROXIMATELY 13,832 PATIENTS IN 2021. LITTLE FALLS HOSPITAL EXPANDED THE EMERGENCY DEPARTMENT PARTICIPATED IN A NYS MEDICAID ACCELERATED EXCHANGE (MAX) PROGRAM TO REDUCE AVOIDABLE VISITS TO AN EMERGENCY DEPARTMENT. IN ADDITION A PARTNERSHIP WITH SALVATION ARMY AND THEIR COMMUNITY "PATHWAY TO HOPE" PROGRAM WAS FORMALIZED TO ASSIST IN PATIENT CARE MANAGMENT ACTIVITIES. THESE SERVCIES EMBEDDED IN OUR EMERGENCY ROOM PROVIDES ASSITANCE FOR PATIENTS TO MAKE MEDICAL APPOINTMENTS, OBTAIN INSURANCE COVERAGE, OR APPLY FOR COMMUNITY ASSISTANCE PROGRAMS. 11275768 20487163 TOTAL AMBULATORY OUTPATIENT SERVICE VISITS WERE APPROXIMATELY 29,848 IN 2021. OUR AMBULATORY SERVICES INCLUDE REHAB / WELLNESS PROGRAM, AMBULATORY SURGERY / GI SERVICES, WOMENS IMAGING SERVICE, DIAGNOSTIC IMAGING SERVICES, RURAL HEALTH CLINIC RIMARY CARE SERVICES. 32288430 1 1 0 1 0 0 0 0 0 1 1 0 0 0 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 0 0 0 1 32 0 1 353 1 0 0 0 0 0 0 0 0 0 0 0 0 X 11 10 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X JAMES G VIELKIND 3158235281 140 BURWELL STREET LITTLE FALLS NY 13365 TIMOTHY DALY CHAIRMAN 2.00 X X 0 0 0 ANTHONY DELUCA FIRST VICE CHAIRMAN 2.00 X X 0 0 0 JUSTIN HUMMEL SECOND VICE CHAIRMAN 2.00 X X 0 0 0 CHRISTINE REYNOLDS THIRD VICE CHAIRMAN 2.00 X X 0 0 0 GERARD SNYDER SECRETARY 2.00 X X 0 0 0 DAVID CASULLO TRUSTEE 2.00 X 0 0 0 LAURA POWERS TRUSTEE 2.00 0.00 X 0 0 0 PHYLLIS SPINNER TRUSTEE 2.00 X 0 0 0 KATHLEEN SELLERS MD TRUSTEE 2.00 X 0 0 0 CARLTON RULE MD MEDICAL DIRECTOR 2.00 40.00 X 0 385987 25730 AMY GRACE MD PRESIDENT OF MEDICAL STAFF 2.00 40.00 X 0 274014 26349 LISA BETRUS LEFT 32021 TRUSTEE 2.00 40.00 X 0 314645 20545 KATE READ LAVALLA LEFT 32021 TRUSTEE 2.00 X 0 0 0 WILLIAM LECATES MD PRESIDENT 10.00 30.00 X 0 585656 37114 JAMES G VIELKIND CHIEF FINANCIAL OFFICER 30.00 10.00 X 0 219342 12157 MICHAEL OGDEN LEFT 72021 FORMER PRESIDENT & CEO 40.00 X 0 147807 9999 DIANE DICOB NURSE 40.00 0.00 X 177240 0 4591 HEIDI CAMARDELLO CHIEF NURSING OFFICER 40.00 X 163012 0 5721 LOREEN SHEPARDSON DIRECTOR OF PHARMACY 40.00 X 152071 0 5143 JAMIE CARMARDELLO PHARMACIST 40.00 X 142553 0 2851 JODI POLLITT NIGHT SUPERVISOR 40.00 X 127751 0 5601 762627 1927451 155801 19 0 1 0 MAYO COLLABORATIVE SERVICES 200 FIRST STREET SOUTHWEST ROCHESTER MN 55905 REFERENCE LAB 125312 WESTWAYS STAFFING SERVICES INC 500 CITY PARKWAY WEST SUITE 130 ORANGE CA 92868 AGENCY STAFF 104164 0 76420 1228374 1304794 HOSPITAL - OUTPATIENT 623000 25265009 25265009 HOSPITAL - INPATIENT 621930 11848668 11848668 OTHER OPERATING REVENUE 900099 2205934 2205934 PROGRAM SERVICE LEASE 532000 442185 442185 HOSPITAL CAFETERIA 900099 105027 105027 39866823 641353 641353 97000 84025 12975 12975 12975 41825945 39866823 0 654328 12544794 10698169 1827761 18864 160541 136909 23391 241 1432661 1221769 208738 2154 1126812 959631 165644 1537 1861 1861 11052 11052 20154 20154 5782117 4930975 851142 1715566 1463030 252536 896203 764280 131923 11348 9678 1670 7859 6702 1157 79174 67519 11655 2278986 1943514 335472 242292 206626 35666 PURCHASED SERVICES 9524978 7951832 1557677 15469 BAD DEBT 1659099 1659099 NYS ASSESSMENT 143929 143929 CHARITY CARE 104614 104614 37744040 32288430 5417345 38265 11028994 21159958 2089576 54710 284877 621025 3167412 3779714 0 0 0 0 0 0 678934 575329 622870 197139 47278684 32400315 15689964 14878369 3128206 7881825 1981753 0 0 0 0 0 1372000 430681 40044586 49578750 4383596 3115030 0 0 0 0 0 0 0 0 0 0 1451495 234930 1847880 1216555 7582226 14900531 15265197 19467046 X 19070096 23728529 5709293 6383175 24779389 30111704 40044586 49578750 X 4081905 -90863 1341273 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 11052 11052 0 PART II-B, LINE 1: AMOUNTS FOR GENERAL LOBBYING ACTIVITIES ARE $11,052 COMPRISED FROM THE HEALTHCARE ASSOCIATION MEMBERSHIPS AS FOLLOWS: HEALTHCARE ASSOCIATION OF NEW YORK STATE 14.13% OF DUES PAID OF $7,203. AMERICAN HOSPITAL ASSOCIATION 26.47% OF DUES PAID OF $17,325. IROQUOIS HEALTHCARE ALLIANCE 57% OF DUES PAID OF $9,559. 5709293 16952 204782 -4000 5935027 5742017 75000 -117041 -84317 75000 5709293 5913759 482000 87791 3771 737762 5742017 4914943 487332 512484 1000 5913759 4609617 305326 4914943 0.21620 0.78380 0 1 1 402942 402942 32174669 21635570 10539099 13628707 10764745 2863962 1072366 1072366 14878369 CMS CARES ACT 2397757 DUE TO RELATED PARTIES 9573437 3RD PARTY PAYABLES 3641206 ACCRUED PENSION OBLIGATION -711869 14900531 X PART V, LINE 4: ENDOWMENT FUNDS DISTRIBUTE INCOME FOR PURPOSES OF CAPITAL INVESTMENT. TEMPORARY ENDOWMENTS ARE USED BASED ON THE INTENT OF THE DONATION, WHICH IS TYPICALLY FOR CAPITAL INVESTMENTS. PART X, LINE 2: FIN 48 FOOTNOTE LITTLE FALLS HOSPITAL IS INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF BASSETT HEALTHCARE NETWORK (THE NETWORK). THE TEXT OF THE FIN 48 FOOTNOTE FROM THE CONSOLIDATED FINANCIAL STATEMENTS IS AS FOLLOWS: THE NETWORK'S VARIOUS SUBSIDIARIES GENERALLY CONSIST OF NOT-FOR-PROFIT CORPORATIONS ORGANIZED IN ACCORDANCE WITH SECTION 501(C)(3) OF THE IRC AND THEREFORE ARE EXEMPT FROM FEDERAL INCOME TAXES PURSUANT TO SECTION 501(A) OF THE IRC. THE NETWORK RECOGNIZES INCOME TAX POSITIONS WHEN IT IS MORE-LIKELY THAN-NOT THAT THE POSITION WILL BE SUSTAINABLE BASED ON THE MERITS OF THE POSITION. MANAGEMENT HAS CONCLUDED THAT THERE ARE NO MATERIAL TAX LIABILITIES OR UNCERTAIN TAX POSITIONS THAT NEED TO BE RECORDED. FOR TAXABLE SUBSIDIARIES OR INVESTMENTS, INCLUDING CCE, DEFERRED TAX ASSETS AND LIABILITIES ARE RECOGNIZED FOR THE FUTURE TAX CONSEQUENCES OF TEMPORARY DIFFERENCES BY APPLYING ENACTED STATUTORY TAX RATES APPLICABLE TO FUTURE YEARS FOR THE DIFFERENCES BETWEEN THE CONSOLIDATED FINANCIAL STATEMENTS AND TAX BASIS OF EXISTING ASSETS AND LIABILITIES. SUCH DEFERRED TAX ASSETS AND LIABILITIES WERE NOT MATERIAL AS OF DECEMBER 31, 2021 AND 2020. 1 1 1 X 300.000000000000 0 1 1 0 1 1 142 182514 5987 176527 0.00470 14748 7909026 4832953 3076073 0.08160 14890 8091540 4838940 3252600 0.08630 18563 18563 0.00050 7 4479 4479 0.00010 0 7 23042 23042 0.00060 14897 8114582 4838940 3275642 0.08690 50448 50448 0.00130 50448 50448 0.00130 1 8614924 8629141 -14217 X 1 1 1 1 LITTLE FALLS HOSPITAL 140 BURWELL STREET LITTLE FALLS NY 13365 WWW.BASSETT.ORG/LOCATIONS/LITTLE-FALLS 2129700H X X X INCLUDES 25 INPATIENT BEDS LITTLE FALLS HOSPITAL 1 0 0 1 X X X X X X X X X 19 1 1 1 1 X SEE SECTION C X SEE SECTION C X 1 19 1 WWW.BASSETT.ORG 0 1 X 300.000000000000 1 1 X X X X 1 X SEE SECTION C X SEE SECTION C X SEE SECTION C X X X X X 1 X 0 X X X X X 1 X 0 0 LITTLE FALLS HOSPITAL PART V, SECTION B, LINE 5: LITTLE FALLS HOSPITAL COLLABORATED WITH BASSETT RESEARCH INSTITUTE'S MOHAWK VALLEY POPULATION HEALTH IMPROVEMENT PROGRAM AND HERKIMER COUNTY PUBLIC HEALTH TO IDENTIFY STAKEHOLDERS FOR COMPLETING THE 2019 COMMUNITY HEALTH NEEDS ASSESSMENT. THE COMMUNITY HEALTH NEEDS ASSESSMENT PROVIDES THE HOSPITAL, LOCAL COUNTY HEALTH DEPARTMENT, AND KEY INFORMANTS WITH DATA AND RESPONSES SO THAT THEY MAY IDENTIFY, PRIORITIZE, AND ADDRESS HEALTH CARE CHALLENGES FACING THEIR COMMUNITIES. MVPHIP COLLABORATED WITH HERKIMER COUNTY PUBLIC HEALTH, HERKIMER COUNTY OFFICE FOR THE AGING, AND LITTLE FALLS HOSPITAL TO COMPILE A LIST OF KEY INFORMANTS IN THE SERVICE REGION. THOSE KEY INFORMANTS REPRESENT A BROAD RANGE OF SECTORS, COMMUNITY INTERESTS, AND INCLUDED ORGANIZATIONS THAT REPRESENT THE MEDICALLY UNDERSERVED, LOW-INCOME, AND MINORITY POPULATIONS. LITTLE FALLS HOSPITAL, HERKIMER COUNTY OFFICE FOR THE AGING, AND HERKIMER COUNTY PUBLIC HEALTH INVITED KEY INFORMANTS TO ATTEND A HERKIMER COUNTY DATA PRESENTATION AND TO GIVE FEEDBACK ON THEIR PRIORITY FOCUS AREAS BASED ON THE 2019-2024 NEW YORK STATE PREVENTION AGENDA ACTION PLANS. THOSE KEY INFORMANTS WHO WERE UNABLE TO ATTEND IN PERSON WERE SENT THE INFORMATION ELECTRONICALLY AND ASKED TO FILL OUT A SHORT SURVEY.HERKIMER COUNTY OFFICE OF THE AGINGHERKIMER COUNTY OFA'S ADVISORY COUNCILHERKIMER COUNT LEGISLATORSHERKIMER COUNTY ADMINISTRATORBRIAN MILLER, NYS ASSEMBLYLITTLE FALLS COMMUNITY OUTREACHHERKIMER COUNTY WORKFORCE DEVELOPMENTCENTRAL ASSOCIATIONS OF THE BLINDHERKIMER COUNTY HOUSING AUTHORITYHOSPICE OF HERKIMER & ONEIDA COUNTIESCOMMUNITY FOUNDATION OF HERKIMER & ONEIDA COUNTIESTOWN OF HERKIMERHERKIMER COUNTY CLERKCHRIS REYNOLDS, PRESIDENT HEALTHNETVALLEY HEALTH SERVICESMOHAWK VALLEY COMMUNITY ACTION AGENCYARC HERKIMERHERKIMER COUNTY PUBLIC HEALTHLITTLE FALLS HOSPITAL 15-0533578REGIONAL PRIMARY CARE NETWORKCORNELL COOPERATIVE EXTENSION OF HERKIMER COUNTYRCIL (LIFE@RCIL)JOHN SCARANO COMMUNITY MEMBERSHERKIMER COUNTY BOCESBRIDGES TO PREVENT TOBACCOHERKIMER COUNTY DSS COMMISSIONERLITTLE FALLS HOSPITALHERKIMER COUNTY MENTAL HEALTH SERVICESCATHOLIC CHARITIES OF HERKIMER COUNTY LITTLE FALLS HOSPITAL PART V, SECTION B, LINE 6A: THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS DEVELOPED AS PART OF A MULTI-HOSPITAL PLANNING PROCESS IN COORDINATION WITH BASSETT HEALTHCARE RESEARCH, BASSETT HEALTHCARE NETWORK, AND BASSETT MEDICAL CENTER AND LITTLE FALLS HOSPITAL. LEAD COMMUNITY AGENCY WAS HERKIMER COUNTY PUBLIC HEALTH. LITTLE FALLS HOSPITAL PART V, SECTION B, LINE 6B: THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) INLCUDED COMMUNITY ORGANIZATIONS SUCH AS: HERKIMER COUNTY PUBLIC HEALTH, HERKIMER HEALTHNET, HERKIMER COUNTY MENTAL HEALTH, BASSETT MEDICAL CENTER, LEATHERSTOCKING COLLABORATIVE HEALTH PARTNERS, MOHAWK VALLEY POPULATION HEALTH IMPROVEMENT PROGRAM, AND CANCER CENTER SERVICES OF ONEIDA, MADISON, AND HERKIMER COUNTY. LITTLE FALLS HOSPITAL PART V, SECTION B, LINE 11: THE LITTLE FALLS HOSPITAL COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) WORKING WITH COMMUNITY STAKEHOLDERS WILL CONTINUE TO FOCUS ON PREVENTING CHRONIC DISEASE, WELL BEING FOR LIMITING MENTAL HEALTH EPISODIC EVENTS, AND IMPROVING A HEALTH SAFETY LIFESTYLE.THE CHRONIC CARE DISEASE MANAGEMENT WILL USE MORE METHODS TO COMMUNICATE WITH RESIDENTS AND PROVIDERS FOR TRACKING PREVENTATIVE HEALTH SCREENINGS FOR PREVENTATIVE WOMEN'S HEALTH CARE. THE WELL BEING INITIATIVES WILL UNITE EFFORTS TO BUILD TRUSTWORTHY RELATIONSHIPS FOR PATIENTS REQUIRING SUPPORTS LEVELS FOR MENTAL HEALTH SERVICES. OUR INITIATIVE TO HAVE A HEALTHIER AND SAFER LIVING ENVIRONMENT EXTENDS TO MANY OPPORTUNITIES OF HEALTH CARE INTERACTIONS. WE WILL FOCUS ON EDUCATION OF AGE COHORTS TO HAVE A HEALTHIER AND SAFER HOME, AND LIFESTYLE. THESE THREE INITIATIVES ARE SUPPORTED BY THE COLLECTIVE COMMUNITY ASSETS OF COMMUNITY-BASED ORGANIZATIONS WHO HAVE ADOPTED AND PARTNERED WITH LITTLE FALLS HOSPITAL AND HERKIMER COUNTY HEALTH DEPARTMENT.THE ESTABLISHED WORKPLAN WILL BE THE GUIDELINES FOR MONITORING PROGRESS AND ALIGNMENT OF SERVICES TO MEET THESE OBJECTIVES. THE COMMUNITY HEALTH NEEDS ASSESSMENT BUILDS UPON THE PRIOR PLAN OF 2016 - 2018. THESE INITIATIVES INCLUDED PROMOTING MENTAL, EMOTIONAL AND BEHAVIORAL HEALTH, PREVENTING SUBSTANCE ABUSE, REDUCING OBESITY IN ADULTS AND CHILDREN, PREVENTING DIABETES, AND PREVENTING HEART DISEASE. THE PROGRESS TO DATE REFLECTS THE STRONG COMMITMENT OF SUPPORT FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT ACROSS MANY STAKEHOLDERS. LITTLE FALLS HOSPITAL, BASSETT MEDICAL CENTER, AND OTHER LOCAL HEALTH PROVIDERS HAVE INCREASED USE OF MEDIA TO IMPROVE PUBLIC AWARENESS OF ACCESS FOR SCREENING SERVICES, USE OF CLINICAL EDUCATORS ON THE BENEFITS OF HEALTH SCREENINGS, AND PARTNERING WITH PROVIDERS TO IMPROVE THEIR USE OF SCREENINGS FOR CHRONIC CARE ILLNESS.LITTLE FALLS HOSPITAL WILL PARTNER WITH HERKIMER COUNTY PUBLIC HEALTH ON STRENGTHENING RESOURCES AVAILABLE FOR MENTAL HEALTH BEHAVIORAL PATIENTS. MENTAL HEALTH SERVICES ARE CURRENTLY UNDERSTAFFED WITH CLINICAL PROVIDERS IN OUR SERVICE AREA. WORKING WITH THE LEATHERSTOCKING COLLABORATIVE HEALTH PARTNERS, PRIMARY CARE PROVIDERS ARE PERFORMING MENTAL HEALTH SCREENINGS AND TRACKING INFORMATION IN THE ELECTRONIC HEALTH RECORD. THIS ALLOWS FOR PRIMARY CARE AND MENTAL HEALTH PROVIDERS TO COLLABORATE ON MEDICAL AND MENTAL HEALTH CARE PLANS. LITTLE FALLS HOSPITAL, BASSETT MEDICAL CENTER, AND HERKIMER COUNTY PUBLIC HEALTH ARE COORDINATING RECRUITMENT OF ADDITIONAL MENTAL HEALTH PROVIDERS.LITTLE FALLS HOSPITAL IS A PARTNER IN THE LEATHERSTOCKING COLLABORATIVE HEALTH PARTNERS (LHCP), LLC. THIS ORGANIZATION REPRESENTS A REGIONAL ORGANIZATION, ESTABLISHED IN PARTNERSHIP WITH NYS DEPARTMENT OF HEALTH, UNDER A CMS REFERENCED DELIVERY SYSTEM REFORM INCENTIVE PAYMENT (DSRIP) PROGRAM. WHILE THIS PROGRAM ENDED IN 2019, BASSETT HEALTHCARE NETWORK CONTINUES TO SUPPORT THE HERKIMER COUNTY HUB FOR PLANNING AND ORGANIZING HEALTH IMPROVEMENT RESOURCES. SOME CURRENT ON-GOING INITIATIVES ARE AS FOLLOWS:1.) COORDINATED ADMINISTRATION OF VACCINES IN OUR FIVE RURAL HEALTH CLINICS. ALSO PERFORMED LABORATORY COVID TESTING AND RESULTS REPORTING FOR PURPOSES OF MITIGATION OF THE SPREAD OF COVID. IN LITTLE FALLS HOSPITAL IN COORDINATION WITH BASSETT HEALTHCARE NETWORK COORDINATEED COMMUNITY EDUCATION ON CONTROLLING SPREAD OF COVID. 2 .) CONTINUED THE NYS MEDICAID ACCELERATED EXCHANGE (MAX) PROCESS TO USE PATIENT CENTERED PROCESSES TO REDUCE USE OF EMERGENCY DEPARTMENT BY CHRONIC CARE PATIENTS. LITTLE FALLS HEALTH CENTERS IN DOLGEVILLE AND NEWPORT PARTICIPATED IN THIS PROJECT AND IMPROVED THEIR CARE MANAGEMENT PLANS TO REDUCE EMERGENCY DEPARTMENT VISITS.3 .) THE SALVATION ARMY, LEATHERSTOCKING COLLABORATIVE HEALTH PARTNERS, AND LITTLE FALLS HOSPITAL DEVELOPED A CARE NAVIGATION PROGRAM TO ASSIST PATIENTS AND FAMILIES WITH HEALTH CARE DECISIONS.LIMITATIONS ON PROGRESSWE HAVE IDENTIFIED THE DIFFICULTY IN RECRUITING PRIMARY CARE AND UNDERSTAFFED MENTAL HEALTH PROVIDERS IN OUR REGION AS A BARRIER TO MEETING OUR CHNA GOALS. THIS SHORTAGE OF PROVIDERS IS BEING ADDRESSED IN RECRUITMENT PLANS IN COORDINATION WITH BASSETT MEDICAL CENTER, HERKIMER COUNTY PUBLIC HEALTH, AND LITTLE FALLS HOSPITAL. DUE TO THE COVID-19 PANDEMIC, THE HOSPITAL CANCELED ALL ELECTIVE PROCEDURES AND NON URGENT AMBULATORY VISITS WHICH RESULTED IN A SIGNIFICANT REDUCTION IN PATIENT VOLUMES. IN ADDITION TO THE LOST REVENUE THAT ACCOMPANIED THE LOWER PATIENT VOLUMES THE HOSPITAL EXPERIENCED A SIGNIFICANT INCREASE IN OPERATING EXPENSES ASSOCIATED WITH THE PURCHASE OF PERSONAL PROTECTIVE EQUIPMENT, CERTAIN PHARMACEUTICALS, COVID 19 TESTING SUPPLIES, AND OTHER OVERHEAD AND PATIENT SPECIFIC COSTS. ADMISSIONS FELL 11% FROM 2019 TO 2020 WHILE ER VISITS DECREASED 2% FROM 2019 TO 2020. THE IMPACT FROM THE COVID PANDEMIC CONTINUED IN 2021 CAUSING COST INCREASES TO RETAIN AND RECRUIT LABOR AND CONTINUED LOWER PATIENT VOLUMES COMPARED TO PRE-PANDEMIC LEVELS. TOTAL FUNDING FROM PANDEMIC FUNDING WAS $371,685. LITTLE FALLS HOSPITAL PART V, SECTION B, LINE 20E: LITTLE FALLS HOSPITAL PROVIDED MAILING INFORMATION TO UNINSURED PATIENTS FOR ENROLLING IN AN AFFORDABLE CARE ACT INSURANCE PRODUCT SPONSORED BY THE NYS HEALTH MARKETPLACE. LITTLE FALLS HOSPITAL ALSO ASSISTED PATIENTS WITH THE COMPLETION OF APPLICATIONS FOR ENROLLMENT INTO NYS MARKETPLACE PLANS. IN 2021, 127 PATIENTS WERE ENROLLED BY A LITTLE FALLS HOSPITAL EMPLOYED FACILITATOR INTO A NYS MARKETPLACE PLAN. PART V, LINE 7A AND 10A LITTLE FALLS HOSPITAL:THE HOSPITAL'S COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION STRATEGY ARE MADE AVAILABLE ON THE HOSPITAL'S WEBSITE:HTTPS://WWW.BASSETT.ORG/LOCATIONS/LITTLE-FALLS-HOSPITAL PART V, LINE 16A, 16B, AND 16C LITTLE FALLS HOSPITAL:THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY, APPLICATION, AND PLAIN LANGUAGE SUMMARY ARE MADE AVAILABLE ON THE HOSPITAL'S WEBSITE:HTTPS://WWW.BASSETT.ORG/PATIENTS-VISITORS/BILLING-INSURANCE/FINANCIAL-ASSISTANCE LITTLE FALLS HOSPITAL PART VBILLING AND COLLECTIONSBEGINNING IN 2021, BASSETT HEALTHCARE NETWORK, THE PARENT ORGANIZATION OF LITTLE FALLS HOSPITAL, ENTERED INTO A SERVICE AGREEMENT WITH OPTUM INSIGHT. THIS AGREEMENT RESULTED IN VARIOUS INFORMATION TECHNOLOGY, REVENUE CYCLE, AND BUSINESS ANALYTIC SERVICES ONCE PERFORMED BY BASSETT HEALTHCARE NETWORK BEING TRANSITIONED TO OPTUM INSIGHT, ALONG WITH THE FORMER BASSETT EMPLOYEES WHO PROVIDED THEM. THE TRANSITION INCLUDED PORTIONS OF THE BILLING AND COLLECTION ACTIVITIES FOR THE HOSPITALS IN THE NETWORK. HOWEVER, DESPITE THE CHANGE IN SERVICE PROVIDER, THE BILLING AND COLLECTION POLICIES OF THE HOSPITAL HAVE NOT CHANGED AS A RESULT OF THE TRANSITION. 6 1 - DOLGEVILLE HEALTH CENTER 36 SLAWSON STREET DOLGEVILLE NY 13329 CLINIC 2 - NEWPORT HEALTH CENTER BRIDGE STREET NEWPORT NY 13416 CLINIC 3 - LITTLE FALLS HEALTH CENTER 170 BURWELL STREET LITTLE FALLS NY 13365 CLINIC 4 - RICHFIELD SPRINGS HEALTH CENTER 8550 STATE HIGHWAY 28 RICHFIELD SPRINGS NY 13439 CLINIC 5 - WEST WINFIELD HEALTH CENTER 544 E MAIN STREET WEST WINFIELD NY 13491 CLINIC 6 - ST JOHNSVILLE HEALTH CENTER 8 PARK PLACE ST JOHNSVILLE NY 13452 CLINIC PART I, LINE 3C: LITTLE FALLS HOSPITAL PROVIDES SERVICES TO ALL PATIENTS, REGARDLESS OF THEIR ABILITY TO PAY. THE COMMUNITY SERVICE PROGRAM (CSP) IS AVAILABLE FOR PATIENTS WITHOUT INSURANCE COVERAGE FOR INCOMES UP TO 300% OF THE FEDERAL POVERTY INCOME GUIDELINES. OUR CSP COORDINATOR IS AN AUTHORIZED ENROLLMENT FACILITATOR FOR MEDICAID AND NEW YORK STATE INSURANCE EXCHANGE INSURANCE COVERAGES. PART I, LINE 6A: AS A MEMBER OF THE BASSETT HEALTHCARE NETWORK, LITTLE FALLS HOSPITAL JOINES IN THE BASSETT HEALTHCARE NETWORK ANNUAL COMMUNITY REPORT, WHICH IS AVAILABLE WWW.BASSETT.ORG/ABOUT-BASSETT-HEALTHCARE-NETWORK/ANNUAL-REPORTS. IT DOES NOT PREPARE A SEPARATE COMMUNITY BENEFIT REPORT. 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 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. FOR SUBSIDIZED HEALTH SERVICES, THE LOSS DOES NOT INCLUDE GOVERNMENT PAYERS LOSS INFORMATION IS REPORTED IN AGGREGATE AMOUNTS. PART I, LINE 7, COLUMN F LITTLE FALLS HOSPITAL EXCLUDED $1,659,099 OF BAD DEBT EXPENSE TO CALCULATE COST OF PATIENT CARE. BAD DEBT IS REPORTED AS A FUNCTIONAL PROGRAM EXPENSE. PART II, COMMUNITY BUILDING ACTIVITIES: COMMUNITY BUILDING ACTIVITIES ARE ASSOCIATED WITH LITTLE FALLS HOSPITAL WORKING WITH COMMUNITY BUSINESSES THROUGH OUR MEMBERSHIP WITH LOCAL AGENCIES, SUCH AS HERKIMER COUNTY HEALTHNET, AMERICAN HEART ASSOCIATION, HOSPICE AND PALLIATIVE CARE INC. . THESE ACTIVITIES ALLOW FOR DIALOG ON CURRENT HEALTHCARE TOPICS, INSURANCE PROGRAMS, AND RECRUITMENT OF FUTURE EMPLOYEES. LITTLE FALLS HOSPITAL COLLABORATES WITH BASSETT MEDICAL CENTER ON RECRUITMENT INITIATIVES FOCUSING ON PRIMARY CARE. HERKIMER COUNTY HAS ONE OF THE LOWEST RATIOS OF PRIMARY CARE PROVIDERS TO RESIDENTS IN NEW YORK STATE. IN 2021, LITTLE FALLS HOSPITAL WAS A LICENSED PRACTICAL NURSES (LPN)PRECEPTOR TRAINING LOCATION SPONSORED WITH THE MOHAWK VALLEY BOARDS OF COOPERATIVE EDUCATIONAL SERVICES (BOCES). THIS TRAINING PROGRAM ENABLES FOR THE DEVELOPMENT OF FRONT-LINE HEALTH CARE WORKERS. IN 2021 THIS PROGRAM SUPPORTED THE CLINICAL DEVELOPMENT OF 6 LPN'S. PART III, LINE 2: BAD DEBT EXPENSEDUE TO THE ADOPTION OF ASU NO. 2014-09, REVENUE FROM CONTRACTS WITH CUSTOMERS (TOPIC 606), BAD DEBT EXPENSE IS NO LONGER REPORTED ON THE AUDITED FINANCIAL STATEMENTS. RATHER IT IS TREATED AS A PRICE CONCESSION. THE BAD DEBT EXPENSE FOR 2021 WAS $1,659,099. PART III, LINE 3: CHARITY CAREFOOTNOTE (3) FROM THE CONSOLIDATED FINANCIALSTHE COST OF CHARITY CARE PROVIDED IS DETERMINED BASED ON THE APPLICATION OF A COST TO GROSS CHARGE RATIO TO THE TOTAL CHARITY CARE CHARGES FOREGONE. INCLUDED IN NET PATIENT SERVICE REVENUE ARE AMOUNTS PAID INTO AND RECEIVED FROM STATEWIDE UNCOMPENSATED CARE POOLS. THESE UNCOMPENSATED CARE POOLS ARE DESIGNED TO HELP OFFSET THE COST OF CHARITY CARE AND UNREIMBURSED MEDICAID SERVICES.BAD DEBT EXPENSEDUE TO THE ADOPTION OF ASU NO. 2014-09 REVENUE FROM CONTRACTS WITH CUSTOMERS (TOPIC 606) BAD DEBT EXPENSE IS NO LONGER REPORTED ON THE AUDITED FINANCIAL STATEMENT. RATHER IT IS TREATED AS A PRICE CONCESSION. PART III, LINE 8: IN 2021 OUR OPERATING INCOME WAS UNFAVORABLE, WITH MEDICARE PART A AND B PROGRAMS, RECOGNIZING ($14,217) . MEDICARE REPRESENTS APPROXIMATELY 31% OF TOTAL PATIENT SERVICE REVENUES. LITTLE FALLS HOSPITAL IS A CRITICAL ACCESS HOSPITAL (CAH) WHICH IS PAID BY MEDICARE BASED ON COST OF CARE. OUR SAFETY NET HOSPITAL STATUS INDICATES WE ARE A NYS RURAL PROVIDER WITH A GREATER THAN 30% THRESHOLD FOR MEDICAID SERVICES. THE SHORTFALL IS TREATED AS A COMMUNITY BENEFIT AS THE SERVICES SUPPORT SIGNIFICANT HEALTH NEEDS FROM THE COMMUNITY. PART III, LINE 9B: OUR COLLECTION AND CHARITY CARE POLICY SPECIFIES THAT ACCOUNTS WITH ACTIVE CHARITY CARE APPLICATIONS WILL NOT GO TO COLLECTION AGENCIES WHILE APPLICATIONS ARE IN REVIEW. WHILE A REQUEST FOR CHARITY CARE ASSISTANCE IS IN PROCESS, THESE ACCOUNTS ARE PLACED ON HOLD IN OUR BILLING SYSTEM. WE COMMUNICATE INFORMATION ON REQUIREMENTS FOR ASSISTANCE AND WILL COUNSEL PATIENTS ON PROVIDING THE INCOME INFORMATION TO DETERMINE IF THEY QUALIFY FOR CHARITY CARE USING 300% OF THE FEDERAL POVERTY INCOME GUIDELINES. (NOTE: OUR CHARITY CARE PROGRAM IS FOR THE UNINSURED PATIENT.) PART VI, LINE 2: IN ADDITION TO THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA), A VARIETY OF DATA ARE USED REGULARLY TO ASSESS THE HEALTHCARE NEEDS OF THE COMMUNITYSERVED BY LITTLE FALLS HOSPITAL, INCLUDING DATA FROM PATIENT SATISFACTION SURVEYS, THE NYS DEPARTMENT OF HEALTH, THE HERKIMER COUNTY COMMUNITY HEALTH ASSESSMENT, AND THE NYS PREVENTION AGENDA, WHICH IDENTIFIED PRIORITY HEALTH INDICATORS TO BE USED BY NYS HOSPITALS, PROVIDERS, AND COUNTY HEALTH DEPARTMENTS IN ASSESSING AND SETTINGLOCAL/REGIONAL PRIORITIES. LITTLE FALLS HOSPITAL USES AN HEALTHCARE INDUSTRY SPECIALITY EXPERT IN PATIENT DATA ANALYTICS, PRESS GANEY TO OBTAIN BENCHMARKING DATA ON PATIENT SATISFACTION IN ORDER TO ASSESS HOW THE HOSPITAL IS PERCEIVED TO BE MEETING PATIENT NEEDS. DATA FROM ONGOING MAIL SURVEYS CARRIED OUT AMONG A STATISTICALLY SIGNIFICANT RANDOM SAMPLE OF INPATIENTS AND OUTPATIENTS IS USED TO IMPROVE PATIENT CARE AND INFORM OFFICIAL QUALITY IMPROVEMENT ACTIVITIES. DATA COLLECTED FROM THIS INSTRUMENT INCLUDE A COMPREHENSIVE OVERVIEW OF KEY, EVIDENCE-BASED QUALITY INDICATORS -- FROM TIMELINESS OF CARE TO COMMUNICATIONS, PATIENT SAFETY, DISCHARGE INSTRUCTION, MEDICATION ISSUES, AND MORE. THE HOSPITAL RECEIVES REPORTS QUARTERLY. THE HOSPITAL ALSO UTILIZES INFORMATION FROM THE STANDARDIZED, PUBLICLY REPORTED HCAHPS (HOSPITAL CONSUMER ASSESSMENT OF HEALTHCARE PROVIDERS AND SYSTEMS) SURVEY OF PATIENTS' PERSPECTIVES OF HOSPITAL CARE. THE HCAHPS REPORTING AND SURVEY ARE REQUIRED BY THE CENTER FOR MEDICARE SERVICES (CMS) TO ALLOW STANDARD, OBJECTIVE, VALID COMPARISONS TO BE MADE ACROSS HOSPITALS NATIONALLY, REGIONALLY, AND LOCALLY REPORTS ARE RECEIVE QUARTERLY AND SINCE 2008 HAVE BEEN PUBLISHED NATIONALLY ON THE CMS AND NYS DEPARTMENT OF HEALTH WEBSITES. THE SURVEY METHODOLOGY AND RESULTS ARE IN THE PUBLIC DOMAIN. (WWW.HCAHPSONLINE.ORG).ADDITIONALLY, THE HOSPITAL'S NEEDS ASSESSMENT ACTIVITIES ARE INFORMED BY INITIATIVES AND STUDIES CARRIED OUT BY THE BASSETT HEALTHCARE NETWORK RESEARCH INSTITUTE, INCLUDING THE UPSTATE HEALTH AND WELLNESS STUDY 2009. THIS PROJECT ASSESSED HEALTH INDICATORS, IDENTIFIED RURAL-URBAN HEALTH DISPARITIES, AND PROVIDED BASELINE DATA TO ASSIST COMMUNITY HEALTHCARE PLANNING IN THE RURAL REGION SERVED BY BASSETT, INCLUDING SCHOHARIE COUNTY. IT IS A COLLABORATIVE EFFORT BETWEEN THE RESEARCH INSTITUTE, COUNTY HEALTH DEPARTMENTS, AND REGIONAL COMMUNITY SERVICES ORGANIZATIONS. IN COORNDATION WITH BASSETT RESEARCH INSTITUTE'S MOHAWK VALLEY POPULATION HEALTH IMPROVEMENT PROGRAM (MVPHIP), A GRANT FUNDED PROGRAM FROM NEW YORK STATE DEPARTMENT OF HEALTH, WHO COORDINATES ASSESSMENT ON BEHALF OF BASSETT HEALTHCARE NETWORK'S LITTLE FALLS HOSPITAL AND THE HERKIMER COUNTY PUBLIC HEALTH. PART VI, LINE 3: LITTLE FALLS HOSPITAL PROVIDES ACCESS AND EDUCATION ON THE COMMUNITY SERVICE PROGRAM WITH CONTACT INFORMATION FOR PATIENTS TO CALL AND MAKE APPOINTMENTS FOR COMPLETING APPLICATIONS FOR FINANCIAL ASSISTANCE. AT ALL PATIENT ACCESS LOCATIONS, APPLICATIONS FOR CHARITY CARE ASSISTANCE ARE AVAILABLE. THE WWW.BASSETT.ORG WEBSITE INCLUDES A LINK ON INFORMATION FOR COMPLETING AN APPLICATION AND OTHER RESOURCES CALLED "FINANCIAL ASSISTANCE RESOURCE GUIDE". OUR FINANCIAL ASSISTANCE COORDINATOR PROVIDES INSURANCE COVERAGE NAVIGATION SERVICES TO ASSIST RESIDENTS WITH ENROLLMENT IN GOVERNMENT SPONSORED HEALTH CARE COVERAGE PROGRAMS. A COMMUNITY NAVIGATOR IS ALSO PRESENT IN THE EMERGENCY DEPARTMENT TO ASSIST WITH APPLICATIONS FOR GOVERNMENT SPONSORED HEALTH CARE COVERAGE PROGRAMS OR TO COMPLETE APPLICATIONS FOR OUR FINANCIAL ASSISTANCE PROGRAM. OUR APPLICATION ALSO SPECIFIES ON-SITE PROVIDERS WHO DO NOT PARTICIPATE IN LITTLE FALLS HOSPITAL FINANCIAL ASSISTANCE PROGRAM. PART VI, LINE 4: LITTLE FALLS HOSPITAL SERVES AN ESTIMATED POPULATION OF OVER 62,000 PEOPLE IN 17 COMMUNITIES THROUGHOUT HERKIMER COUNTY, AND SECTIONS OF FULTON AND MONTGOMERY COUNTIES. THE SERVICE AREA POPULATION IS COMPRISED OF INDIVIDUALS AND FAMILIES FROM ALL SOCIO-ECONOMIC AND EDUCATIONAL LEVELS. THE POPULATION IS 96 PERCENT WHITE, 51 PERCENT FEMALE AND 49 PERCENT MALE. THE AGE DISTRIBUTION OF THE POPULATION IS SIMILAR TO OTHER UPSTATE NEW YORK AREAS WITH 5.4 PERCENT OF THE POPULATION UNDER 5 YEARS OF AGE, 24 PERCENT UNDER THE AGE OF 18, AND 22.2 PERCENT AGED 65 AND OLDER. NEARLY 89 PERCENT OF THE POPULATION OVER AGE OF 25 HAS GRADUATED FROM HIGH SCHOOL. MEDIAN HOUSEHOLD INCOME OF $54,794 IS BELOW THE STATE MEDIAN OF $71,855. IT'S ESTIMATED THAT 10 PERCENT OF THE POPULATION IS BELOW THE FEDERAL POVERTY LEVEL. APPROXIMATELY 93% OF RESIDENTS HAVE HEALTH COVERAGE, AN IMPROVEMENT OF 6% SINCE 2013. PART VI, LINE 5: LITTLE FALLS HOSPITAL IMPLEMENTS COORDINATED HEALTH CARE RESOURCES WITH BASSETT HEALTHCARE NETWORK. THIS COLLABORATION INCLUDED PLANNING AND IMPLEMENTING INITIATIVES UNDER A NEW YORK STATE DELIVERY SYSTEM REFORM INCENTIVE PAYMENT (DSRIP) PROJECT. DSRIP ACTIVITIES ARE COORDINATED WITH COMMUNITY BASED ORGANIZATIONS TO DEVELOP CARE IMPROVEMENT PROGRAMS IN A COORDINATED MANNER. THE HERKIMER COUNTY HUB WAS ORGANIZED SO COMMUNITY AGENCIES COULD DEVELOP INITIATIVES FOR IMPROVING COMMUNICATIONS FOR REFERRALS TO PROGRAMS FOR HIGH NEED PATIENTS. WITH THESE COMMUNITY AGENCIES ENGAGED A HIGHER DEGREE OF PATIENT INTERACTION IS POSSIBLE TO ACHIEVE POSITIVE IMPACTS ON IMPROVING THEIR HEALTH CARE. LITTLE FALLS HOSPITAL PARTNERED WITH SALVATION ARMY FOR THEIR ASSISTANCE IN PROVIDING PATIENT NAVIGATION SERVICES. THESE NAVIGATION SERVICES PROVIDE PATIENTS AND FAMILY SUPPORT FOR MEDICAL AND SOCIAL ASSISTANCE TO IMPROVE A HEALTHIER LIFESTYLE. PART VI, LINE 6: LITTLE FALLS HOSPITAL COLLABORATES WITH BASSETT HEALTHCARE NETWORK AND BASSETT MEDICAL CENTER TO COORDNATE THE EFFICIENT DELIVERY OF HEALTHCARE IN OUR SERVICE AREA. THIS RELATIONSHIP HAS DEVELOPED OVER A PERIOD OF FIFTEEN YEARS AND CONTINUES TO PROVIDE RESIDENTS ACCESS TO A HIGH-QUALITY HEALTHCARE SYSTEM. OUR INTEGRATED ELECTRONIC HEALTH RECORD HAS ENABLED OUR PATIENTS TO RECEIVE IMPROVED COORDINATED CARE AND ACCESS TO THEIR HEALTH INFORMATION NOT ROUTINELY SEEN IN RURAL HEALTH NETWORKS. OUR COLLABORATIVE PLANNING ON PROJECTS SUCH AS THE NYS DELIVERY SYSTEM REFORM INCENTIVE PAYMENT SYSTEM (DSRIP) AND RELATED MOHAWK VALLEY POPULATION HEALTH IMPROVEMENT PROGRAM ARE EXAMPLES OF OUR COLLABORATION TO IMPROVE THE HEALTHCARE SYSTEMS IN OUR SERVICE AREA.LITTLE FALLS HOSPITAL AS A LEADER WITH BASSETT HEALTHCARE NETWORK IN COORDINATION OF PATIENT ADVOCATE GROUPS IS MAKING A DIFFERENCE FOR IMPROVING HEALTHCARE. THESE INITIATIVES WITHIN THE DSRIP PROGRAM CONTINUE TO IMPROVE IN PATIENT INTERACTIONS TO SUPPORT ACCESS TO CARE, AND PREVENTATIVE CARE PLANS. THIS IS A NEW AREA OF EMPHASIS WITH CARE INNOVATION MODELS WHICH CREATE LEARNING PARTNERSHIPS WITH PATIENTS AND PROVIDERS. PART VI, LINE 7 STATE FILING OF COMMUNITY BENEFIT REPORTNEW YORK X X X X 0 0 0 0 0 0 0 0 0 WILLIAM LECATES MD PRESIDENT 0 582406 0 3250 0 0 0 26188 0 10926 0 622770 0 0 CARLTON RULE MD MEDICAL DIRECTOR 0 382987 0 3000 0 0 0 20388 0 5342 0 411717 0 0 LISA BETRUS LEFT 32021 TRUSTEE 0 314645 0 0 0 0 0 14490 0 6055 0 335190 0 0 AMY GRACE MD PRESIDENT OF MEDICAL STAFF 0 271014 0 3000 0 0 0 18063 0 8286 0 300363 0 0 JAMES G VIELKIND CHIEF FINANCIAL OFFICER 0 216342 0 3000 0 0 0 11243 0 914 0 231499 0 0 DIANE DICOB NURSE 177240 0 0 0 0 0 3545 0 1046 0 181831 0 0 0 HEIDI CAMARDELLO CHIEF NURSING OFFICER 163012 0 0 0 0 0 3260 0 2461 0 168733 0 0 0 MICHAEL OGDEN LEFT 72021 FORMER PRESIDENT & CEO 0 147807 0 0 0 0 0 8753 0 1246 0 157806 0 0 LOREEN SHEPARDSON DIRECTOR OF PHARMACY 152071 0 0 0 0 0 3041 0 2102 0 157214 0 0 0 PART I, LINE 3 THE COMPENSATION PROCESS FOR TOP OFFICIAL THE CHIEF EXECUTIVE OFFICER'S SALARY IS PAID BY A RELATED ORGANIZATION UNDER A MANAGEMENT SERVICES AGREEMENT. THE LITTLE FALLS HOSPITAL BOARD OF TRUSTEES REVIEWS THE FORMAL PROCESS THAT IS USED TO DETERMINE THE BASE COMPENSATION OF THE CEO. THE CEO'S WORK PLAN AND ACCOMPLISHMENTS FOR THE YEAR ARE REVIEWED. SALARY CHANGES ARE BASED ON MARKET, WORKPLAN, AND ACCOMPLISHMENTS. THE CEO'S SALARY IS SUBMITTED AS PART OF THE MANAGEMENT SERVICES AGREEMENT WHICH IS APPROVED BY THE BOARD. FORM 990, PART VI, SECTION A, LINE 6 BASSETT HEALTHCARE NETWORK IS THE PARENT AND SOLE MEMBER TO EACH OF THE FOLLOWING RELATED PARTIES. FRIENDS OF BASSETT, AO FOX MEMORIAL HOSPITAL, BASSETT HOSPITAL OF SCHOHARIE COUNTY, LITTLE FALLS HOSPITAL, O'CONNOR HOSPITAL, TEMPLETON FOUNDATION, VALLEY HEALTH SERVICES, VALLEY RESIDENTIAL SERVICES, TRI-TOWN REGIONAL HOSPITAL, AND MARY IMOGENE BASSETT HOSPITAL. AS PARENT AND SOLE MEMBER, BASSETT HEALTHCARE NETWORK HAS THE RIGHT TO APPOINT AND REMOVE MEMBERS OF THE GOVERNING BOARDS OF ITS SUBSIDIARIES AND APPROVE SIGNIFICANT DECISIONS OF THE GOVERNING BOARDS, INCLUDING, BUT NOT LIMITED TO, APPROVAL OF OPERATING AND CAPITAL BUDGETS, CERTAIN CAPITAL EXPENDITURES, INDEBTEDNESS NOT CONTAINED IN THE APPROVED BUDGETS, SUBSTANTIVE CHANGES IN CLINICAL PROGRAMS, MERGERS, CONSOLIDATIONS, LIQUIDATIONS AND DISSOLUTIONS INVOLVING ITS SUBSIDIARIES AND CERTIFICATE OF NEED APPLICATIONS. FORM 990, PART VI, SECTION A, LINE 7A SEE DISCLOSURE FOR PART VI, SECTION A, LINE 6 FORM 990, PART VI, SECTION A, LINE 7B SEE DISCLOSURE FOR PART VI, SECTION A, LINE 6 FORM 990, PART VI, SECTION B, LINE 11B LITTLE FALLS 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 PROVIDED TO EACH MEMBER OF THE BOARD BEFORE ITS FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST STATEMENTS ARE MADE ANNUALLY. NEW BOARD MEMBERS ARE REQUIRED TO DISCLOSE ON THEIR RESUME ALL AFFILIATED ORGANIZATIONS. FORM 990, PART VI, SECTION B, LINE 15 THE CHIEF EXECUTIVE OFFICER'S SALARY IS PAID BY A RELATED ORGANIZATION UNDER A MANAGEMENT SERVICES AGREEMENT. THE LITTLE FALLS HOSPITAL BOARD OF TRUSTEES REVIEWS THE FORMAL PROCESS THAT IS USED TO DETERMINE THE BASE COMPENSATION OF THE CEO. THE CEO'S WORK PLAN AND ACCOMPLISHMENTS FOR THE YEAR ARE REVIEWED. SALARY CHANGES ARE BASED ON MARKET, WORKPLAN, AND ACCOMPLISHMENTS. THE CEO'S SALARY IS SUBMITTED AS PART OF THE MANAGEMENT SERVICES AGREEMENT WHICH IS APPROVED BY THE BOARD. 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 AND CORPORATE VALUES IN PUBLIC AREAS OF THE FACILITY. FORM 990, PART XI, LINE 9: CHANGE IN PENSION OBLIGATIONS 1,341,273. BASSETT HEALTHCARE NETWORK ONE ATWELL ROAD COOPERSTOWN NY 13326 133218680 SUPPORT NY 501C3 12C NONE 0 FRIENDS OF BASSETT ONE ATWELL ROAD COOPERSTOWN NY 13326 237041610 FUNDRAISER NY 501C3 7 BHN 0 O'CONNOR HOSPITAL 460 ANDES ROAD DELHI NY 13753 161540394 HEALTHCARE NY 501C3 3 BHN 0 MARY IMOGENE BASSETT HOSPITAL ONE ATWELL ROAD COOPERSTOWN NY 13326 135596796 HEALTHCARE NY 501C3 3 BHN 0 TEMPLETON FOUNDATION ONE ATWELL ROAD COOPERSTOWN NY 13326 133317084 LANDLORD NY 501C3 10 BHN 0 VALLEY HEALTH SERVICES 690 WEST GERMAN STREET HERKIMER NY 13350 222511614 ELDER CARE NY 501C3 3 BHN 0 BASSETT PPS LLC 6181 STATE HIGHWAY 7 ONEONTA NY 13820 811749905 HEALTHCARE NY 501C3 12A MIBH 0 TRI TOWN REGIONAL HEALTHCARE 43 PEARL STREET SIDNEY NY 13838 260169584 HEALTHCARE NY 501C3 3 BHN 0 VALLEY RESIDENTIAL SERVICES 690 WEST GERMAN STREET HERKIMER NY 13350 463703838 ELDER CARE NY 501C3 10 BHN 0 AT HOME CARE PARTNERS 25 ELM STREET ONEONTA NY 13820 562397098 HEALTHCARE NY 501C3 10 AHC INC 0 AT HOME CARE INC 25 ELM STREET ONEONTA NY 13820 161287069 HEALTHCARE NY 501C3 10 BHN 0 BASSETT HOSPITAL SCHOHARIE COUNTY 178 GRANDVIEW DRIVE COBLESKILL NY 12043 141772971 HEALTHCARE NY 501C3 3 BHN 0 AO FOX FOUNDATION 1 NORTON AVE ONEONTA NY 13820 222871993 FUNDRAISER NY 501C3 9 AO FOX MEMORIAL HOSPITAL 0 AO FOX MEMORIAL HOSPITAL ONE NORTON AVENUE ONEONTA NY 13820 150539039 HEALTHCARE NY 501C3 3 BHN 0 STAMFORD PROFESSIONAL ASSOCIATES 1 NORTON AVE ONEONTA NY 13820 161322304 RENTAL NY N/A 0 0 FIRST COMMUNITY CARE OF BASSETT 60 NORTHPOINTE PARKWAY AMHERST NY 14228 161504464 HEALTHCARE NY N/A 0 0 CATSKILL CARE ENTERPRISES 1 NORTON AVE ONEONTA NY 13820 161236590 RETAIL PHARMACY & FITNESS CENTER NY N/A C 0 LEATHERSTOCKING PHYSICIANS PC ONE ATWELL ROAD COOPERSTOWN NY 13326 364864562 HEALTHCARE SERVICES NY N/A C 0 0 0 1 0 0 0 0 0 0 1 0 1 1 0 1 0 1 0 0