2022-11-15T12:17:46-06:00 2021-12-31 135565207 KPMG LLP 515 BROADWAY 4TH FLOOR ALBANY NY 122072974 990 2021-01-01 135596796 THE MARY IMOGENE BASSETT HOSPITAL MARY 6075473635 ONE ATWELL ROAD COOPERSTOWN NY 13326 PAUL SWINKO CFO 6075473635 2022-11-15 1 PAUL SWINKO XXX-XX-XXXX GENEVA FURLANO P01877392 5184274600 2022-11-15 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z BASSETT MEDICAL CENTER PAUL SWINKO ONE ATWELL ROAD COOPERSTOWN NY 13326 666150828 0 X WWW.BASSETT.ORG X 1921 NY MARY IMOGENE BASSETT HOSPITAL IS A RURAL ACADEMIC MEDICAL CENTER COMMITTED TO PROVIDING EXCELLENCE IN HEALTH CARE SERVICES, EDUCATING PHYSICIANS AND OTHER HEALTH CARE PROFESSIONALS, AND PURSUING HEALTH RESEARCH. 19 17 4445 100 110258 14360 114108769 50230787 498555343 602425387 437741 1080374 -2235481 0 610866372 653736548 0 0 0 0 361525628 375628664 0 0 461944 254712118 273447638 616237746 649076302 -5371374 4660246 479173275 473816345 215776734 189143916 263396541 284672429 X MARY IMOGENE BASSETT HOSPITAL IS A RURAL ACADEMIC MEDICAL CENTER COMMITTED TO PROVIDING EXCELLENCE IN HEALTH CARE SERVICES, EDUCATING PHYSICIANS AND OTHER HEALTH CARE PROFESSIONALS, AND PURSUING HEALTH RESEARCH. 0 0 598135740 602425387 INPATIENT AND OUTPATIENT SERVICES PROVIDED TO OUR PATIENTS RESULTED IN:11,040 HOSPITALIZATIONS (INCLUSIVE OF OPEN HEART SURGERIES)54,166 PATIENT DAYS591,170 CLINIC VISITS13,509 EMERGENCY VISITS8,018 SURGICAL CASES 2251964 COMMUNITY INVOLVEMENT HAS BEEN LINKED TO BASSETT'S MISSION AND VALUES SINCE IT 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 OF 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 2021 WE PROVIDED $2,251,964 IN FREE CARE. BASSETT'S COMMUNITY HEALTH EDUCATION PROGRAMS INCLUDE LECTURES, PRESENTATIONS, HEALTH FAIRS, AND OTHER GROUP PROGRAMS IN ADDITION TO 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. 600387704 1 1 0 1 0 0 0 0 0 1 1 1 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 1 1 1 0 0 0 1 257 0 1 4445 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 19 17 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 0 NY X PAUL SWINKO 6075473635 ONE ATWELL ROAD COOPERSTOWN NY 13326 TERRY FULMER BOARD CHAIRMAN & TRUSTEE 1.00 0.50 X 0 0 0 MAUREEN KILLACKEY VICE CHAIRMAN & TRUSTEE 1.00 1.00 X 0 0 0 WALTER A FRANCK VICE CHAIRMAN & TRUSTEE 1.00 0.00 X 0 0 0 RICHARD VANISON TREASURER 1.00 3.50 X X 0 0 0 GLEN PERRONE SECRETARY 1.00 0.00 X X 0 0 0 JOHN BULLIS TRUSTEE 1.00 1.00 X 0 0 0 JANE FORBES CLARK TRUSTEE 1.00 1.00 X 0 0 0 PETER HAMILTON TRUSTEE 1.00 2.00 X 0 0 0 J MICHAEL MOFFAT TRUSTEE 1.00 1.50 X 0 0 0 KATHERINE NICKERSON TRUSTEE 1.00 0.00 X 0 0 0 DONALD QUEST TRUSTEE 1.00 0.00 X 0 0 0 EDWARD STACK TRUSTEE 1.00 0.00 X 0 0 0 DOUGLAS WILLIES TRUSTEE 1.00 0.00 X 0 0 0 DONALD R BORDLEY TRUSTEE 1.00 0.00 X 0 0 0 ROBERT S HANFT TRUSTEE 1.00 0.00 X 0 0 0 JAMES K PATRICK TRUSTEE 1.00 1.00 X 0 0 0 RICHARD A POLIN TRUSTEE 1.00 0.00 X 0 0 0 JASON TABOR TRUSTEE 1.00 0.00 X 0 0 0 BRUCE C VLADECK TRUSTEE 1.00 1.50 X 0 0 0 TOMMY IBRAHIM MD PRESIDENT & CEO BHN 40.00 0.00 X 0 854487 30536 PAUL G SWINKO CFO 40.00 0.00 X 492536 0 20500 RONETTE M WILEY EXEC VP & COO (THRU 5/21) 40.00 0.00 X 349612 0 11860 WILLIAM W LECATES EX-OFFICIO 40.00 0.00 X 585656 0 37114 WT HUNTSMAN ATTENDING PHYSICIAN 40.00 0.00 X 728054 0 31434 MUN HONG ATTENDING PHYSICIAN 40.00 0.00 X 809190 0 25208 DHANANJAI MENZIES ATTENDING PHYSICIAN 40.00 0.00 X 910506 0 31384 PETER LEROUX ATTENDING PHYSICIAN 40.00 0.00 X 713991 0 19365 JEREL ZOLTICK ATTENDING PHYSICIAN 40.00 0.00 X 783521 0 28963 STEVEN HENEGHAN FORMER CHIEF CLIN OFFICER 0.00 0.00 X 184756 0 0 5557822 854487 236364 816 1 1 0 OPTUM INSIGHT 11000 OPTUM CIRCLE EDEN PRARIE MN 55344 REVENUE CYCLE & IT 24372461 MCCARTHY 1341 NORTH ROCK HILL ROAD ST LOUIS MO 63124 ENGINEER 5202153 MAYO MEDICAL LABS 200 FIRST STREET SW ROCHESTER MN 55901 LAB SERVICES 4589643 SODEXO 9801 WASHINGTON BLVD GAITHERSBURG MD 20878 DIETARY SERVICES 2887497 EPIC SYSTEMS 1979 MILY WAY VERONA VA 53593 IT SERVICES 2756618 247 3823051 44119424 2288312 50230787 DIRECT PATIENT SERVICES 900099 558445129 558445129 OTHER PATIENT SERVICE REVENUE 900099 43980258 43980258 602425387 866006 110258 755748 11120629 1508019 11156637 1257643 -36008 250376 214368 214368 653736548 602425387 110258 970116 2434410 2434410 525624 525624 324296150 291941441 32039927 314782 14272343 12880606 1391737 14485076 13072594 1412482 19615061 17675108 1909779 30174 56302 56302 45432378 41834919 3493246 104213 1486473 1338207 143689 4577 15670472 14151020 1519452 2855745 2575688 277310 2747 27427705 24766568 2659286 1851 3742401 3375391 363410 3600 DRUGS AND REAGENTS 67003844 67003844 PATIENT SUPPLIES 50335978 50335978 BAD DEBT 11396731 11396731 CHARITY CARE 2251964 2251964 45787645 45787645 649076302 600387704 48226654 461944 20439115 14618231 2713132 11597623 23007491 9003819 52726929 53114013 0 0 0 0 0 1539318 9033171 6533135 5459983 4619974 494608082 334972380 165665201 159635702 27532656 64278335 91005709 63994547 0 0 0 0 81589888 84881648 479173275 473816345 134072236 109103453 0 0 0 0 68337470 71098223 0 0 0 0 3474497 5010000 0 0 9892531 3932240 215776734 189143916 X 180438188 207076916 82958353 77595513 263396541 284672429 479173275 473816345 X 4660246 13899208 2716434 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 56302 56302 0 SCHEDULE C, PART II-B, LINE 1 AMERICAN HOSPITAL ASSOCIATION ALLOCATES 26.47% OF DUES TOWARDS GENERAL LOBBYING ACTIVITIES. TOTAL DUES PAID FOR THE YEAR WERE $48,275. HANYS ALLOCATES 14.13% OF DUES TOWARDS GENERAL LOBBYING ACTIVITIES. TOTAL DUES PAID FOR THE YEAR WERE $ 108,039. IROQUOIS HEALTHCARE ALLICANCE ALLOCATES 57% OF DUES TOWARDS GENERAL LOBBYING ACTIVITIES. TOTAL PAID FOR THE YEAR WERE $ 49,574. THE CLARK ESTATES CONDUCTS LOBBYING ACTIVITIES ON BEHALF OF THE MARY IMOGENE BASSETT HOSPITAL. LOBBYING ACTIVITIES ARE LIMITED TO OFFICER DISCUSSIONS WITH CONSULTANTS AND LEGISLATORS TO OBTAIN FUNDING FOR CHARITABLE MISSIONS. NO FUNDS WERE EXPENDED. 14671115 19072 14690187 14658877 12238 14671115 14623624 35253 14658877 14455785 167839 14623624 14404447 51338 14455785 1.00000 1 0 1089856 1089856 245997986 156439129 89558857 211606673 178533251 33073422 35913567 35913567 159635702 US GOV'T BONDS AND SECURITIES 63994547 C 63994547 DUE FROM RELATED PARTIES 84881648 84881648 INTEREST RATE SWAPS 3932240 3932240 X PART X, LINE 2: THE MARY IMOGENE BASSETT 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. SCHEDULE D, PART V, LINE 4 INTENDED USES FOR ENDOWMENT FUNDS PERMANENTLY RESTRICTED ENDOWMENT FUNDS ARE HELD IN PERPETUITY WITH RESTRICTIONS ON INCOME FOR HEALTH SERVICES, MEDICAL RESEARCH, MEDICAL EDUCATION, AND INDIGENT CARE. 1 1 1 X 300.000000000000 0 1 1 0 1 1 3408472 271746 3136726 0.00500 88623638 71743597 16880041 0.02660 92032110 72015343 20016767 0.03160 81071 0 81071 0.00010 35653415 6522712 29130703 0.04600 10444145 9362125 1082020 0.00170 13744088 9071810 4672278 0.00740 27826 0 27826 0.00000 59950545 24956647 34993898 0.05520 151982655 96971990 55010665 0.08680 1 125453285 146671063 -21217778 X 1 1 1 AT HOME CARE INC HOME HEALTH AGENCY 0.50000 1 1 MARY IMOGENE BASSETT HOSPITAL ONE ATWELL ROAD COOPERSTOWN NY 13326 WWW.BASSETT.ORG 3824000H X X X X X OUTPATIENT PRIMARY & SPECIALTY MARY IMOGENE BASSETT HOSPITAL 1 0 0 1 X X X X X X X X X 19 1 1 1 1 X SEE SECTION C X 1 19 1 SEE SECTION C 0 1 X 300.000000000000 0.000000000000 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 1 X 0 0 MARY IMOGENE BASSETT HOSPITAL PART V, SECTION B, LINE 5: THIS COMMUNITY HEALTH NEEDS ASSESSMENT HAS TAKEN INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE BROAD RANGE OF SECTORS AND INTERESTS OF THE COMMUNITY INCLUDING ORGANIZATIONS THAT REPRESENT THE MEDICALLY UNDERSERVED, LOW-INCOME, AND MINORITY POPULATIONS SERVED BY BASSETT MEDICAL CENTER. ALL ORGANIZATIONS PROVIDING INPUT INTO THIS ASSESSMENT, INCLUDING THE NAME AND TITLE OF THOSE INDIVIDUALS REPRESENTATIVE OF THE ORGANIZATION, IS PROVIDED BELOW. THIS INCLUDED INPUT FROM INDIVIDUALS WITH EXPERTISE IN PUBLIC HEALTH, SPECIFICALLY, HEIDI BOND, DIRECTOR OF THE OTSEGO COUNTY HEALTH DEPARTMENT.A) HEIDI BOND, DIRECTOR AT OTSEGO COUNTY HEALTH DEPARTMENTB) PATRICIA KNUTH, EXECUTIVE DIRECTOR AT THE ARC OTSEGOC) AMEEN ASWAD, EXECUTIVE DIRECTOR OF JAIL MINISTRY OF OTSEGO COUNTYD) TREENA HALSTEAD, BUILDING HEALTHY FAMILIES PROGRAM MANAGER AT OPPORTUNITIES FOR OTSEGOE) MARGARET AVRITT, ONEONTA COMMUNITY HEALTH CENTERF) TOM HOHENSEE, CREATING HEALTHY SCHOOLS AND COMMUNITIES SCHOOL COORDINATOR BASSETT RESEARCH INSTITUTE AT BASSETT MEDICAL CENTERG) SARAH BUTTICE, DIRECTOR OF EDUCATION/EMPLOYEE WELLNESS AT A.O. FOX HOSPITALH) CALI RIESE, PUBLIC EDUCATION & COMMUNITY OUTREACH SPECIALIST CANCER SERVICES PROGRAM OF THE CENTRAL REGION AT BASSETT HEALTHCARE NETWORKI) TAMIE MACDONALD, DIRECTOR AT OTSEGO COUNTY OFFICE FOR THE AGINGJ) CHERILYN LACY, COORDINATOR OF THE PUBLIC HEALTH PROGRAM AT HARTWICK COLLEGEK) VERA SOSNOWSKI, BOARD MEMBER AT THE TOWN OF MILFORDL) CHRISTY HOUCK, CATHOLIC CHARITIES DELAWARE, OTSEGO & SCHOHARIE M) LYNAE WYCKOFF, LIVING WELL PROGRAM MANAGER BASSETT RESEARCH INSTITUTE AT BASSETT MEDICAL CENTERN) DAN MASKIN, EXECUTIVE DIRECTOR AT OPPORTUNITIES FOR OTSEGOO) LUCINDA LEVENE, ENGAGEMENT MANAGER AT LEATHERSTOCKING COLLABORATIVE HEALTH PARTNERSP) DEBRA MARCUS, EXECUTIVE DIRECTOR AT FAMILY PLANNING OF SOUTH CENTRAL NEW YORKQ) SUSAN MATT, DIRECTOR AT OTSEGO COUNTY COMMUNITY SERVICESR) DAVE RICHARDS, SUPERINTENDENT OF SCHOOLS AT UNATEGO CENTRAL SCHOOL DISTRICTS) ARLANA YOUNG, BOARD OF DIRECTORS MEMBER AT ONEONTA COMMUNITY HEALTH CENTERT) STEPHEN CLARK, ADMINISTRATIVE DIRECTOR BASSETT RESEARCH INSTITUTE AT BASSETT MEDICAL CENTERU) MATHEW JOHNSON, HEALTH EDUCATOR AT OTSEGO COUNTY HEALTH DEPARTMENTV) LAURA BRYANT, RABIES COORDINATOR AT OTSEGO COUNTY HEALTH DEPARTMENTW) KIM SCHLOSSER, ASSISTANT DIRECTOR AT OTSEGO COUNTY HEALTH DEPARTMENTX) MARION MANLIUS, BOARD MEMBER AT THE TOWN OF MILFORDY) MAUREEN BLANCHARD, CREATING HEALTHY SCHOOLS AND COMMUNITIES COMMUNITY COORDINATOR RESEARCH FOUNDATION AT SUNY COBLESKILLZ) MARION MOSSMAN, PROJECT DIRECTOR AT OTSEGO COUNTY SYSTEM OF CAREAA) JULIE SORENSEN, DIRECTOR AT THE NEW YORK CENTER OF AGRICULTURAL MEDICINE AND HEALTH/ NORTHEAST CENTER FOR OCCUPATIONAL HEALTH AND SAFETYBB) ANNE GADOMSKI, ATTENDING PEDIATRIC PHYSICIAN AND DIRECTOR OF THE BASSETT RESEARCH INSTITUTE AT BASSETT MEDICAL CENTERCC) LYNN GLUECKERT, EXECUTIVE DIRECTOR AT CATHOLIC CHARITIES DELAWARE, OTSEGO & SCHOHARIEDD) TERESA SEARS, CLERK AT THE TOWN OF OTEGOEE) GARY FURMAN, SUPERINTENDENT OF SCHOOLS AT EDMESTON CENTRAL SCHOOL DISTRICTFF) JULIE DOSTAL, EXECUTIVE DIRECTOR AT LEATHERSTOCKING EDUCATION ON ALCOHOLISM/ADDICTIONS FOUNDATIONFOLLOWING A REVIEW OF DATA FROM BASSETT MEDICAL CENTER'S, A.O. FOX MEMORIAL HOSPITAL'S AND OTSEGO COUNTY HEALTH DEPARTMENT'S 2019 JOINT COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) AND INPUT FROM KEY INFORMANTS, BASSETT MEDICAL CENTER, A.O. FOX MEMORIAL HOSPITAL AND OTSEGO COUNTY HEALTH DEPARTMENT WILL COLLABORATE ON THE NEW YORK STATE PREVENTION AGENDA PRIORITIES OF PROMOTE WELL-BEING AND PREVENT MENTAL AND SUBSTANCE USE DISORDERS' FOCUS AREA OF 'PREVENT MENTAL AND SUBSTANCE USE DISORDERS' WITH THE GOALS TO PREVENT OPIOID AND OTHER SUBSTANCE MISUSE AND DEATH, AND PREVENT CHRONIC DISEASES' FOCUS AREA OF 'TOBACCO PREVENTION' WITH THE GOAL TO PREVENT INITIATION OF TOBACCO USE.BASSETT MEDICAL CENTER, A.O. FOX MEMORIAL HOSPITAL, AND OTSEGO COUNTY HEALTH DEPARTMENT ENGAGED STAKEHOLDERS TO WORK WITH THEM ON THEIR 2013 AND 2016 PRIORITIES AND STAKEHOLDERS WERE ENGAGED FOR THE 2019 PRIORITIES. THESE STAKEHOLDERS, ALONG WITH INDIVIDUALS AND ORGANIZATIONS FOCUSED ON THE HEALTH OF THE COMMUNITY, HAD AN OPPORTUNITY TO INDICATE THEIR PRIORITIES DURING A COMMUNITY DATA PRESENTATION AND THOSE INDIVIDUALS UNABLE TO ATTEND HAD THE OPPORTUNITY TO COMPLETE A SURVEY INDICATING THEIR PRIORITIES.IN ORDER TO ADDRESS THE COMBINED FOCUS AREA OF 'PREVENT MENTAL AND SUBSTANCE USE DISORDERS' BASSETT MEDICAL CENTER, A.O. FOX MEMORIAL HOSPITAL, AND OTSEGO COUNTY HEALTH DEPARTMENT WILL INCREASE THE AVAILABILITY OF/ACCESS AND LINKAGES TO MEDICATION-ASSISTED TREATMENT (MAT) INCLUDING BUPRENORPHINE; PROMOTE AND ENCOURAGE PRESCRIBER EDUCATION AND FAMILIARITY WITH OPIOID PRESCRIBING GUIDELINES, AND LIMITS AS IMPOSED BY NEW YORK STATE STATUTES AND REGULATION; AND BUILD SUPPORT SYSTEMS TO CARE FOR OPIOID USERS WHO ARE AT RISK OF AN OVERDOSE. FOR 'TOBACCO PREVENTION' BASSETT MEDICAL CENTER, A.O. FOX MEMORIAL HOSPITAL, AND OTSEGO COUNTY HEALTH DEPARTMENT WILL USE MEDIA AND HEALTH COMMUNICATIONS TO HIGHLIGHT THE DANGERS OF TOBACCO/VAPING IN THE PEDIATRIC CLINICS, SCHOOL BASED HEALTH CENTERS AND COMMUNITY.BASSETT MEDICAL CENTER, A.O. FOX MEMORIAL HOSPITAL, AND OTSEGO COUNTY HEALTH DEPARTMENT WILL UTILIZE THE RECOMMENDED PROCESS MEASURES LISTED IN THE NEW YORK STATE PREVENTION AGENDA ACTION PLAN TO TRACK PROGRESS OF ALL PRIORITIES AND FOCUS AREAS. YEARLY PROGRESS TOWARDS THOSE MEASURES WILL BE DISSEMINATED TO THE NEW YORK STATE DEPARTMENT OF HEALTH AND WILL BE INCLUDED ON THE BASSETT HEALTHCARE NETWORKS AND OTSEGO COUNTY HEALTH DEPARTMENT'S WEBSITES. MARY IMOGENE BASSETT HOSPITAL PART V, SECTION B, LINE 6A: AO FOX MEMORIAL HOSPITAL MARY IMOGENE BASSETT HOSPITAL PART V, SECTION B, LINE 6B: OTSEGO COUNTY HEALTH DEPARTMENT MARY IMOGENE BASSETT HOSPITAL PART V, SECTION B, LINE 11: THE ORGANIZATION ADDRESSED SIGNIFICANT, PRIORITIZED HEALTH NEEDS IDENTIFIED IN ITS MOST RECENTLY CONDUCTED CHNA BY ADOPTION OF A BUDGET FOR PROVISION OF SERVICES THAT ADDRESS THE NEEDS IDENTIFICATION IN THE CHNA, PRIORITIZATION OF HEALTH NEEDS IN ITS COMMUNITY, AND PRIORITIZATION OF SERVICES THAT THE HOSPITAL FACILITY WILL UNDERTAKE TO MEET HEALTH NEEDS IN ITS COMMUNITY. FOR NEEDS NOT ADDRESSED AS A COLLABORATIVE, WE ADDRESS SOME AS AN INDIVIDUAL ORGANIZATION, AND ALSO CONTINUE TO REPRIORITIZE HIGHEST DEMAND OF NEEDS.DUE TO THE COVID-19 PANDEMIC, BASSETT MEDICAL CENTER ENCOUNTERED DECREASED VOLUMES DUE TO THE CANCELLATION OF NON EMERGENT SERVICES. BMC EXPERIENCED A DECREASE IN VARIOUS STATISTICS. CLINIC VISITS DECREASED BY 9.5% FROM 2019 TO 2020 WHILE ADMISSIONS FELL 9% FROM 2019 TO 2020 DUE TO THE PANDEMIC. PERSONAL PROTECTIVE EQUIPMENT WAS PURCHASED AND A COVID SURGE CENTER WAS SET UP AS DIRECTED BY NYS DOH. DURING 2021 THE MEDICAL CENTER CONTINUED TO CARE FOR PATIENTS WITH COVID. VOLUMES HAVE NOT RECOVERED TO PRE-PANDEMIC LEVELS. MARY IMOGENE BASSETT HOSPITAL: SCHEDULE H, PART V, LINE 7A AND 10ATHE HOSPITAL'S COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION STRATEGY ARE MADE AVAILABLE ON THE HOSPITAL'S WEBSITE:WWW.BASSETT.ORG/LOCATIONS/BASSETT-MEDICAL-CENTER MARY IMOGENE BASSETT HOSPITAL: SCHEDULE H, PART V, LINE 16A, 16B, 16CTHE HOSPITAL'S FINANCIAL ASSISTANCE POLICY, APPLICATION, AND PLAIN LANGUAGE SUMMARY ARE MADE AVAILABLE ON THE HOSPITAL'S WEBSITE:WWW.BASSETT.ORG/PATIENTS-VISITORS/BILLING-INSURANCE/FINANCIAL-ASSISTANCE/FINANCIAL-ASSISTANCE-PLAIN-LANGUAGE THE MARY IMOGENE BASSETT HOSPITAL PART VBILLING AND COLLECTIONSBEGINNING IN 2021, BASSETT HEALTHCARE NETWORK, THE PARENT ORGANIZATION OF THE MARY IMOGENE BASSETT 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. 56 1 - BASSETT HEALTHCARE PHYSICAL THERAPY 124 COUNTY ROAD 52 COOPERSTOWN NY 13326 OUTPATIENT PHYSICAL THERAPY SERVICES 2 - BASSETT HEALTHCARE HAMILTON SURGICAL 10 EATON STREET HAMILTON NY 13346 OUTPATIENT SPECIALTY CARE 3 - BASSETT HEALTHCARE HERKIMER CARDIAC 690 WEST GERMAN STREET HERKIMER NY 13350 OUTPATIENT REHAB SERVICES 4 - BASSETT HEALTHCARE CLINTON 34 CHENANGO AVENUE CLINTON NY 13323 OUTPATIENT PRIMARY CARE 5 - BASSETT HEALTHCARE CANAJOHARIE 56 MONTGOMERY STREET CANAJOHARIE NY 13317 OUTPATIENT PRIMARY CARE 6 - BASSETT HEALTHCARE COBLESKILL 121 LEGION DRIVE COBLESKILL NY 12043 OUTPATIENT PRIMARY CARE 7 - BASSETT HEALTHCARE DELANSON 1 COOLEY HEIGHTS DELANSON NY 12053 OUTPATIENT PRIMARY CARE 8 - BASSETT HEALTHCARE DELHI 460 ANDES ROAD DELHI NY 13753 OUTPATIENT PRIMARY CARE AND DENTAL 9 - BASSETT HEALTHCARE EDMESTON ROUTE 80 PO BOX 15 EDMESTON NY 13335 OUTPATIENT PRIMARY CARE 10 - BASSETT HEALTHCARE HAMILTON 160 BROAD STREET HAMILTON NY 13346 OUTPATIENT PRIMARY CARE AND DENTAL 11 - BASSETT HEALTHCARE HERKIMER 321 EAST ALBANY STREET HERKIMER NY 13350 OUTPATIENT PRIME, SPECIALTY, URGENT CARE 12 - BASSETT HEALTHCARE MIDDLEBURGH 109 BAKER AVENUE MIDDLEBURGH NY 12122 OUTPATIENT PRIMARY CARE 13 - BASSETT HEALTHCARE MORRIS 93 MAIN STREET MORRIS NY 13808 OUTPATIENT SPECIALTY CARE 14 - BASSETT HEALTHCARE ONEONTA SURGICAL 449 MAIN STREET ONEONTA NY 13820 OUTPATIENT SPECIALTY CARE 15 - BASSETT HEALTHCARE NORWICH 55 CALVARY DRIVE NORWICH NY 13815 OUTPATIENT PRIMARY CARE 16 - BASSETT HEALTHCARE ONEONTA 125 MAIN STREET ONEONTA NY 13820 OUTPATIENT PRIMARY CARE 17 - BASSETT HEALTHCARE ONEONTA SPECIALTY ONE ASSOCIATE DRIVE ONEONTA NY 13820 OUTPATIENT PRIME, SPECIALTY, URGENT CARE 18 - BASSETT HEALTHCARE RICHFIELD SPRINGS 8550 STATE HIGHWAY 28 RICHFIELD SPRINGS NY 13439 OUTPATIENT PRIMARY CARE 19 - BASSETT HEALTHCARE SCHOHARIE 111 BARTON HILL ROAD SCHOHARIE NY 12157 OUTPATIENT PRIMARY CARE 20 - BASSETT HEALTHCARE SHARON SPRINGS ROUTE 20 PO BOX 275 SHARON SPRINGS NY 13459 OUTPATIENT PRIMARY CARE 21 - BASSETT HEALTHCARE SHERBURNE 20 CHAPEL STREET SHERBURNE NY 13460 OUTPATIENT PRIMARY CARE 22 - BASSETT HEALTHCARE SIDNEY 39 PEARL STREET SIDNEY NY 13838 OUTPATIENT PRIMARY CARE 23 - BASSETT HEALTHCARE ST JOHNSVILLE 8 PARK PLACE ST JOHNSVILLE NY 13452 OUTPATIENT PRIMARY CARE 24 - BASSETT HEALTHCARE STAMFORD 28650 STATE HIGHWAY 23 STAMFORD NY 12167 OUTPATIENT PRIMARY CARE 25 - BASSETT HEALTHCARE WALTON 130 NORTH STREET WALTON NY 13856 OUTPATIENT PRIMARY CARE 26 - BASSETT HEALTHCARE WEST WINFIELD 544 EAST MAIN STREET WEST WINFIELD NY 13491 OUTPATIENT PRIMARY CARE 27 - BASSETT HEALTHCARE AT FOXCARE 1 FOXCARE DRIVE ONEONTA NY 13820 OUTPATIENT PRIMARY CARE 28 - BASSETT HEALTHCARE AT LITTLE FALLS 170 BURWELL STREET LITTLE FALLS NY 13365 OUTPATIENT PRIMARY CARE AND SPECIALTY CARE 29 - BASSETT HEALTHCARE UNADILLA 16 CLIFTON STREET UNADILLA NY 13849 OUTPATIENT PRIMARY CARE 30 - BASSETT REGIONAL CANCER CENTER 7 ASSOCIATE DRIVE ONEONTA NY 13820 OUTPATIENT SPECIALTY CARE 31 - HARTWICK SEMINARY SPECIALTY SERVICES 4580 ROUTE 28 MILFORD NY 13807 OUTPATIENT PRIMARY AND SPECIALTY CARE 32 - BASSETT HEALTHCARE ANDES 245 LOWER MAIN ST ANDES NY 13731 OUTPATIENT PRIMARY CARE 33 - BASSETT HEALTHCARE GREENE 29 N CHENANGO ST STE A GREENE NY 13778 OUTPATIENT PRIMARY CARE 34 - BASSETT FAMILY MEDICINE ONEONTA 739 NYS RTE 28 STE 9 ONEONTA NY 13820 OUTPATIENT PRIMARY CARE 35 - SBHC - COOPERSTOWN ELEMENTARY 21 WALNUT STREET COOPERSTOWN NY 13326 OUTPATIENT PRIMARY CARE 36 - SBHC - COOPERSTOWN MIDDLE AND HIGH 39 LINDEN AVENUE COOPERSTOWN NY 13326 OUTPATIENT PRIMARY CARE 37 - SBHC - DELHI ELEMENTARY 2 SHELDON DRIVE DELHI NY 13753 OUTPATIENT PRIMARY CARE 38 - SBHC - DELHI MIDDLE AND HIGH 2 SHELDON DRIVE DELHI NY 13753 OUTPATIENT PRIMARY CARE 39 - SBHC - EDMESTON CENTRAL SCHOOL 11 NORTH STREET EDMESTON NY 13335 OUTPATIENT PRIMARY CARE 40 - SBHC - LAURENS CENTRAL SCHOOL 55 MAIN STREET LAURENS NY 13796 OUTPATIENT PRIMARY CARE 41 - SBHC - MIDDLEBURGH ELEMENTARY 245-I MAIN STREET MIDDLEBURGH NY 12122 OUTPATIENT PRIMARY CARE 42 - SBHC - MIDDLEBURGH MIDDLE AND HIGH 291 MAIN STREET MIDDLEBURGH NY 12122 OUTPATIENT PRIMARY CARE 43 - SBHC - MILFORD CENTRAL SCHOOL 42 WEST MAIN STREET MILFORD NY 13807 OUTPATIENT PRIMARY CARE 44 - SBHC - MORRIS CENTRAL SCHOOL 65 MAIN STREET MORRIS NY 13808 OUTPATIENT PRIMARY CARE 45 - SBHC - ORAL HEALTH MOBILE PROGRAM ONE ATWELL ROAD COOPERSTOWN NY 13326 OUTPATIENT PRIMARY CARE 46 - SBHC - SCHENEVUS CENTRAL SCHOOL 159 MAIN STREET SCHENEVUS NY 12155 OUTPATIENT PRIMARY CARE 47 - SBHC - SHERBURNEEARLVILLE ELEMENTARY 13 SCHOOL STREET SHERBURNE NY 13460 OUTPATIENT PRIMARY CARE 48 - SBHC - SHERBURNEEARLVILLE MDLE & HIGH 13 SCHOOL STREET SHERBURNE NY 13460 OUTPATIENT PRIMARY CARE 49 - SBHC - SIDNEY CENTRAL SCHOOL 95 WEST MAIN STREET SIDNEY NY 13838 OUTPATIENT PRIMARY CARE 50 - SBHC - SOUTH KORTRIGHT CENTRAL PO BOX 113 SOUTH KORTRIGHT NY 13842 OUTPATIENT PRIMARY CARE 51 - SBHC - STAMFORD CENTRAL SCHOOL ONE RIVER STREET STAMFORD NY 12167 OUTPATIENT PRIMARY CARE 52 - SBHC - UNADILLA VALLEY CENTRAL PO BOX F 4238 STATE HIGHWAY 8 NEW BERLIN NY 13411 OUTPATIENT PRIMARY CARE 53 - SBHC - WORCESTER CENTRAL SCHOOL 195 MAIN STREET WORCESTER NY 12197 OUTPATIENT PRIMARY CARE 54 - SBHC - RICHFIELD SPRINGS CENTRAL 93 MAIN STREET RICHFIELD SPRINGS NY 13439 OUTPATIENT PRIMARY CARE 55 - SBHC - SPRINGBROOK 105 CAMPUS DRIVE ONEONTA NY 13820 OUTPATIENT PRIMARY CARE 56 - BASSETT HEALTHCARE ONEIDA 2031 DREAMCATCHER PLAZA RTE 5 ONEIDA NY 13421 OUTPATIENT PRIMARY CARE PART I, LINE 7: COSTING METHODOLOGY EXPLANATIONSECTIONS (A) CHARITY CARE AT COST, (B) UNREIMBURSED MEDICAID, (F) HEALTH PROFESSIONS EDUCATION, THE COSTING METHODOLOGY USED IS A COST-TO-CHARGE 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 IN-KIND 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. SCHEDULE H, PART I, LINE 3C OTHER INCOME BASED CRITERIA FOR FREE OR DISCOUNTED CARE THE CSP (COMMUNITY SERVICES PROGRAM) APPLICATION SPECIFIES FAMILY INCOME LIMITS AND OTHER REQUIREMENTS FOR SERVICES TO BE ELIGIBLE FOR BASSETT MEDICAL CENTER'S CSP/FREE CARE PROGRAM. SCHEDULE H, PART I, LINE 6A RELATED ORGANIZATION INFORMATION THE MARY IMOGENE BASSETT HOSPITAL'S, (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, WWW.BASSETT.ORG SCHEDULE H, PART I, LINE 7, COLUMN (F) EXCLUSIONS FROM PERCENT OF TOTAL EXPENSETHE PERCENT OF TOTAL EXPENSE IS CALCULATED BY DIVIDING COLUMN (E), NET COMMUNITY BENEFIT EXPENSE, BY TOTAL EXPENSE. THE BAD DEBT EXPENSE OF $11,396,731 WAS SUBTRACTED FROM THE TOTAL EXPENSE VALUE USED TO CALCULATE THE PERCENTAGES IN PART 1, LINE 7, COLUMN F. PART II, COMMUNITY BUILDING ACTIVITIES: COMMUNITY BUILDING ACTIVITIES ALL BASSETT COMMUNITY BUILDING ACTIVITIES COULD BE CLASSIFIED UNDER ITEM 1 AND HIGHLIGHTED IN NUMBER 1 ABOVE. 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 STATEMENT. RATHER IT IS TREATED AS A PRICE CONCESSION.THE BAD DEBT EXPENSE FOR 2021 WAS $11,396,731. 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: MEDICARE EXPLANATIONAMOUNTS WERE DERIVED AS FOLLOWS: CHARGE TIMES COST TO CHARGE RATIO VERSUS REIMBURSEMENT ON THE MEDICARE PS&R REPORT. THE SHORTFALL IS TREATED AS A COMMUNITY BENEFIT BECAUSE THE SERVICES SUPPORT SIGNIFICANT NEED FROM THE COMMUNITY. PART III, LINE 9B: COLLECTION PRACTICES EXPLANATIONFOR PATIENTS WHO DO QUALIFY FOR FINANCIAL ASSISTANCE ARE CONTACTED BY THE FINANCIAL COUNSELING TEAM THAT SENDS A LETTER OF APPROVAL AND TIME-FRAME FOR WHICH THE PATIENT IS APPROVED. PART VI, LINE 2: NEEDS ASSESSMENTIN 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: A) PERCENTAGE OF OTSEGO CO. ADULTS WHO VISITED A DENTIST IN THE PAST YEARSB) PREVALENCE OF TOOTH DECAY IN THIRD-GRADE CHILDRENC) PERCENTAGE OF ADULTS REPORTING BINGE DRINKINGD) HEAVY DRINKINGE) PERCENTAGE 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:1) ACCESS TO DENTAL HEALTH CAREA. BASSETT WILL SUPPORT OTSEGO CO. DEPT. OF HEALTH EFFORTS TO RE-ESTABLISH 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 INIMPROVING ACCESS TO DENTAL SERVICESB. BASSETT WILL WORK TO EXPAND COMPREHENSIVE PREVENTIVE DENTAL HEALTH SERVICES TO ALL SCHOOL-BASED HEALTH CENTERS IN THE COUNTY AND TO PROVIDE SEALANT SERVICES TO NON-SBHC SCHOOLS. BASSETT WILL WORK WITH THE OTSEGO CO. DEPT. OF HEALTH AND RURAL HEALTH EDUCATION NETWORK OF DELAWARE, OTSEGO, MONTGOMERY (RHENDOMS) TO MAKE MORE SCHOOLS AWARE OF RHENDOMSSERVICES TO INCREASE PARTICIPATIONC. BASSETT WILL WORK WITH THE OTSEGO CO. DEPT. OF HEALTH AND A.O. 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 REIMBURSEMENTSD. BASSETT WILL WORK WITH THE HEALTH DEPARTMENT AND OTHER COMMUNITY PARTNERS TO EDUCATE THE PUBLIC ABOUT DENTAL HEALTH IN FAIRS AND OTHER COMMUNITY EVENTS.2) MENTAL HEALTH AND SUBSTANCE ABUSEA. IN A NEW INITIATIVE, BASSETT WILL WORK WITH A.O. FOX HOSPITAL AND LEATHERSTOCKING EDUCATION ON ALCOHOLISM/ADDICTIONS FOUNDATIONS, INC. (LEAF) TO PROVIDE CONTINUING MEDICAL EDUCATION TRAINING ON SUBSTANCE ABUSE SCREENING AND REFERRAL TO PRIMARY CARE PROVIDERS AND SURGEONS INTHE COUNTY.B. BASSETT 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 PROVIDERSC. BASSETT WILL COLLABORATE WITH LEAF AND THE HEALTH DEPARTMENT ON PUBLIC HEALTH CAMPAIGN ABOUT THE RISK FACTORS ASSOCIATED WITH BINGE DRINKING AND PRESCRIPTION DRUG ABUSE3) PHYSICAL ACTIVITY AND NUTRITIONA. BASSETT 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 DISEASEB. BASSETT 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. PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCEA MAJOR COMPONENT OF BASSETT'S 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 PATIENT'S COUNTY OF RESIDENCE. REFERRAL TO AN ONSITE OTSEGO COUNTY MEDICAID EXAMINER IS AVAILABLE AT THE COOPERSTOWN CAMPUS.A LISTING OF ALL SELF-PAY ACCOUNTS IS PRODUCED AND REVIEWED DAILY TO INSURE THAT A COMMUNITY SERVICES BROCHURE HAS BEEN PROVIDED. THE SELF-PAY BILLING OFFICE IDENTIFIES PATIENTS DURING THE BILLING AND COLLECTIONS PROCESS THAT MAY REQUIRE ADDITIONAL HELP UNDERSTANDING THE PROGRAM.SELF-PAY ACCOUNTS FOR PATIENTS WHO HAVE BEEN APPROVED FOR COMMUNITY SERVICES WITHIN THE PRIOR 120 DAYS ARE AUTOMATICALLY INCLUDED WITH THE PRIOR APPROVAL. PART VI, LINE 4: COMMUNITY INFORMATIONTHE SERVICE AREA OF BASSETT ENCOMPASSES A 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 $43,000 AND $48,000. 13-18 % OF THE COMMUNITY RESIDENTS HAVE INCOMES BELOW THE FEDERAL POVERTY GUIDELINES. THE FOLLOWING AREAS HAVE BEEN FEDERALLY DESIGNATED AS BEING MEDICALLY UNDERSERVED:A) HERKIMER COUNTYB) FULTON COUNTY, TOWN OF OPPENHEIMC) MONTGOMERY COUNTY, CITY OF AMSTERDAMD) OTSEGO COUNTY, NORTH OTSEGO SERVICE AREA, TOWN OF PLAINFIELD, TOWN OF DECATURE) DELAWARE COUNTY, TOWNS OF DEPOSIT, COLCHESTER, MIDDLETOWN PART VI, LINE 5: PROMOTION OF COMMUNITY HEALTHBASSETT'S SOLE MEMBER IS 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 WIDERANGE 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 34 COMMUNITY BASED OUTPATIENT HEALTH CENTERS, 20 SCHOOL-BASED 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. PROVIDINGNEEDED OCCUPATIONAL HEALTH SERVICES BENEFITS AND IMPROVING EMPLOYEE HEALTH THROUGHOUT THE BASSETT HEALTHCARE NETWORK SEVEN COUNTY REGION.BASSETT IS WORKING TO RE-ESTABLISH 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 20 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 AND/OR TO PROMOTE HEALTH AND HEALING AS A RESPONSE TO IDENTIFIED COMMUNITY NEEDS. COMMUNITY HEALTHIMPROVEMENT 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:A. SCHOOL-BASED HEALTH CENTER DENTAL SEALANT PROGRAM - A REGISTERED DENTAL HYGIENIST PROVIDES PREVENTIVE CARE, INCLUDING EDUCATION, CLEANINGS, FLUORIDE TREATMENT, SEALANT AND REFERRALS IN THIS GRANT FUNDED PROGRAMB. RHENDOMS (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 BABY-BOTTLE TOOTH DECAYC. PARENT HANY BOOK - THIS FAMILY RESOURCE WAS CREATED BY THE OTSEGO CO. COMMITTEE ON CHILD ABUSE AND NEGLECT AND UNDERWRITTEN BY BASSETT AND A.O. FOX HOSPITAL. ITS GOAL IS TO GIVE PARENTS AND PROFESSIONALS A PLACE TO TURN FOR HELP IN DEALING WITH THE STRESSES OF FAMILY LIFED. KICKSTART - A PROGRAM DESIGNED TO HELP COMBAT CHILDHOOD OBESITY THROUGH COLLABORATIVE PARTNERSHIPS WITH BASSETT HEALTH CENTERS AND LOCAL RECREATIONAL AND FITNESS GROUPSE. BASSETT CANCER INSTITUTE MEDICAL SCREENING COACH - A NEW, CUSTOM-BUILT 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 AREASF. CANCER 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 QUALIFYG. HEALTHY START BREAKFAST - A PARTNERSHIP BETWEEN COMMUNITY SERVICE ORGANIZATIONS AND BASSETT FOR DIABETES DETECTION, EDUCATION, AND PREVENTIONH. SAFE 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, IN-LINE SKATE AND SKATEBOARD SAFETY, HOME SAFETY, FIRE AND BURN PREVENTION, ROAD SAFETY AND PEDESTRIAN SAFETYTHE REGIONAL PRIMARY AND SPECIALTY CARE CLINICS AND THE SCHOOL-BASED 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. BASSETT'S VALUE TO THECOMMUNITIES 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. PART VI, LINE 6: AFFILIATED HEALTH CARE SYSTEMBASSETT IS PART OF THE BASSETT HEALTHCARE NETWORK THAT PROVIDES HEALTH SERVICES IN MORE THAN 20 COMMUNITIES SPANNING 5,600 SQUARE MILES AND SEVEN COUNTIES. THE NETWORK FOCUSES ITS COMMUNITY SERVICES PROGRAMS IN THE COUNTIES WHERE THE SIX AFFILIATED HOSPITALS AND GREATEST PATIENT POPULATIONS ARE LOCATED. OTSEGO COUNTY - POPULATION 60,094, DELAWARE COUNTY - POPULATION 45,001, HERKIMER COUNTY - POPULATION 62,240, SCHOHARIE COUNTY - POPULATION 31,420 (ACCORDING TO THE 2017 U.S. CENSUS ESTIMATES).A) BASSETT - AN ACUTE CARE INPATIENT TEACHING FACILITY, AN OUTPATIENT PRIMARY AND SPECIALTY CARE CENTER, A REGIONAL NETWORK OF 29 COMMUNITY BASED OUTPATIENT HEALTH CENTERS, 20 SCHOOL BASED HEALTH CENTERS, TWO AMBULATORY SURGERY CENTERS AND A FULLY SALARIED MEDICAL STAFF INCOOPERSTOWN, OTSEGO COUNTYB) O'CONNOR HOSPITAL - CRITICAL ACCESS HOSPITAL IN DELHI, DELAWARE COUNTYC) COBLESKILL REGIONAL HOSPITAL - ACUTE CARE FACILITY IN COBLESKILL, SCHOHARIE COUNTYD) LITTLE FALLS HOSPITAL - CRITICAL ACCESS HOSPITAL IN LITTLE FALLS, HERKIMER COUNTYE) TRI-TOWN REGIONAL HOSPITAL - 24/7 EMERGENCY CARE FACILITY IN SIDNEY, DELAWARE COUNTYF) A.O. FOX MEMORIAL HOSPITAL - ACUTE CARE FACILITY IN ONEONTA, OTSEGO COUNTYG) VALLEY HEALTH SERVICES - RESIDENTIAL HEALTH CARE AND REHABILITATION FACILITYH) AT HOME CARE - CERTIFIED HOME CARE AGENCYI) FIRST COMMUNITY CARE OF BASSETT - MEDICAL SUPPLY COMPANYALL THE ABOVE (A-I) MAKE UP THE BASSETT HEALTHCARE NETWORK AND PROVIDE HEALTH SERVICES TO THIS SEVEN COUNTY REGION IN CENTRAL NEW YORK. SCHEDULE H, PART VI, LINE 7 STATE FILING OF COMMUNITY BENEFIT REPORTNEW YORK X X X X 1 0 0 0 0 0 0 1 0 DHANANJAI MENZIES ATTENDING PHYSICIAN 801810 0 108696 0 0 0 23288 0 8096 0 941890 0 0 0 TOMMY IBRAHIM MD PRESIDENT & CEO BHN 0 739487 0 115000 0 0 0 19500 0 11036 0 885023 0 0 MUN HONG ATTENDING PHYSICIAN 805940 0 3250 0 0 0 17488 0 7720 0 834398 0 0 0 JEREL ZOLTICK ATTENDING PHYSICIAN 572390 0 211131 0 0 0 23288 0 5675 0 812484 0 0 0 WT HUNTSMAN ATTENDING PHYSICIAN 671714 0 56340 0 0 0 26188 0 5246 0 759488 0 0 0 PETER LEROUX ATTENDING PHYSICIAN 650000 0 63991 0 0 0 11269 0 8096 0 733356 0 0 0 WILLIAM W LECATES EX-OFFICIO 582406 0 3250 0 0 0 26188 0 10926 0 622770 0 0 0 PAUL G SWINKO CFO 489536 0 3000 0 0 0 17488 0 3012 0 513036 0 0 0 RONETTE M WILEY EXEC VP & COO (THRU 5/21) 134654 0 0 0 214958 0 9351 0 2509 0 361472 0 0 0 STEVEN HENEGHAN FORMER CHIEF CLIN OFFICER 0 0 0 0 184756 0 0 0 0 0 184756 0 0 0 PART I, LINE 4A SEVERANCE PAYMENTS RONETTE WILEY, EXECUTIVE VP AND COO, RECEIVED SEVERANCE PAYMENTS IN THE AMOUNT OF $214,958 FROM THE ORGANIZATION DURING THE TAX YEAR. THESE PAYMENTS ARE INCLUDED IN THE TOTAL REPORTED ON SCHEDULE J, PART II, COLUMN B(III). STEVEN HENEGHAN, FORMER CHIEF CLINICAL OFFICER, RECEIVED SEVERANCE PAYMENTS IN THE AMOUNT OF $184,756 FROM THE ORGANIZATION DURING THE TAX YEAR. THESE PAYMENTS ARE INCLUDED IN THE TOTAL REPORTED ON SCHEDULE J, PART II, COLUMN B(III). PART I, LINE 7 NON-FIXED PAYMENTS PROVIDED NON-FIXED PAYMENTS ARE MADE BASED ON THE SUCCESS IN MEETING PERFORMANCE CRITERIA THAT ARE PROSPECTIVELY AGREED UPON AS GOALS FOR THE OFFICERS AND OTHER EMPLOYEES. A 2015A SERIES ONEIDA COUNTY-LDC BOND 263661593 2015-09-01 17000000 RENOVATIONS - SEE PART VI 0 0 0 B 2018A SERIES OTSEGO COUNTY CAPITAL RESOURCE CORP 263661593 2018-11-09 60550000 REFINANCE & REFUND - SEE PART VI 0 0 0 A 8700000 17000000 327500 16672500 2017 0 0 1 1 B 1680000 60550000 1145578 31525000 12585000 15294422 2019 1 0 1 1 A 0 0 0 0 0 0 0 B 0 0 1 1 0 0 0 0 A 0 0 1 0 1 0 0 0 B 0 1 0 0 1 1 M & T TRUST COMPANY 10.000000000000 0 0 0 0 A 0 B 0 PART I, LINE 1, COLUMN F 2015A SERIES ONEIDA COUNTY - LDC BONDS RENOVATION OF OFF-CAMPUS DATA CENTER 2018A SERIES OTSEGO COUNTY - CRC BONDS FUND CAPITAL EXPENDITURE PROJECTS REFINANCE LINE OF CREDIT FOR SERIES 2011A AND 2011B BONDS REFUND SERIES 2015A BOND. SEE BELOW FOR DATES OF ISSUANCE. 2011A SERIES OTSEGO COUNTY-CR BOND - DATE ISSUED 11/3/2011 2011B SERIES OTSEGO COUNTY-CR BOND - DATE ISSUED 11/3/2011 2015A SERIES OTSEGO COUNTY-CR BOND - DATE ISSUED 8/27/2015 PART III, LINE 1, PART IV, LINE 7, AND PART V THEY DO NOT MEET THE REQUIREMENTS UNDER THE REGULATIONS TO ANSWER YES TO THESE QUESTIONS. MANAGEMENT REGULARLY REVIEWS THE HOSPITAL'S TAX-EXEMPT BOND OBLIGATIONS TO ENSURE THERE ARE NO VIOLATIONS OF FEDERAL TAX REQUIREMENTS. THE CLARK ESTATES PART V 54398 INVESTMENT MGMT FEES 0 JANE HAMILTON PART V 110013 WAGES 0 LEE EDMONDS PART V 382752 WAGES 0 HANNAH KINZELMANN PART V 32869 WAGES 0 PART V - ADDITIONAL INFORMATION PART IX, LINE 1MORE THAN 35% OF THE CLARK ESTATES IS OWNED BY TRUSTEE JANE FORBES CLARKPART IV, LINE 2JANE HAMILTON IS FAMILY MEMBER OF TRUSTEE PETER HAMILTONPART IV, LINE 3LEE EDMONDS, MD IS A FAMILY MEMBER OF PRESIDENT & CEO WILLIAM LECATES.PART IV, LINE 4HANNAH KINZELMANN IS A FAMILY MEMBER OF EXECUTIVE VP & COO RONETTE WILEY. FORM 990, PART VI, SECTION A, LINE 2 RELATED PARTY INFORMATION AMONG OFFICERS JANE FORBES CLARK & RICHARD C VANISON - BUSINESS 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, TRI-TOWN REGIONAL HOSPITAL, 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 ORGANIZATION'S PROCESS TO REVIEW THE FORM 990 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 RECOMMENDS, TO THE EXECUTIVE AND FINANCE COMMITTEE, TO FILE. A COMPLETE COPY OF THE ORGANIZATION'S FINAL FORM 990, INCLUDING ALL REQUIRED SCHEDULES AS ULTIMATELY FILED WITH THE IRS, IS MADE AVAILABLE UPON REQUEST TO EACH MEMBER OF THE BOARD BEFORE IT'S FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C ENFORCEMENT OF CONFLICTS POLICY 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 (PRESIDENT, 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. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION PROCESS FOR TOP OFFICIAL THE MARY IMOGENE BASSETT HOSPITAL HAS A FORMAL PROCESS THAT IS USED TO DETERMINE THE BASE COMPENSATION OF THE PRESIDENT ON AN ANNUAL BASIS. THIS PROCESS INCLUDES A COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OF TRUSTEES OR THE COMPENSATION COMMITTEE. MIBH PAYS NON-FIXED EARNINGS BASED ON THE SUCCESS IN MEETING PERFORMANCE CRITERIA THAT ARE PROSPECTIVELY AGREED UPON AS GOALS FOR THE CEO. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS DISCLOSURE EXPLANATION THE MARY IMOGENE BASSETT HOSPITAL MAKES ITS 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 STAMPED 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. FORM 990, PART XI, LINE 9: CHANGE IN VALUE OF INTEREST RATE SWAPS 2,639,136. POST-RETIREMENT BENEFIT CHANGE 77,298. BASSETT ACCOUNTABLE CARE PARTNERS LLC ONE ATWELL ROAD COOPERSTOWN NY 13326 471390327 HLTHCARE QUAL NY MIBH 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 AO FOX MEMORIAL HOSPITAL ONE NORTON AVENUE ONEONTA NY 13820 150539039 HEALTHCARE NY 501C3 3 BHN 0 BASSETT HOSPITAL SCHOHARIE COUNTY 178 GRANDVIEW DRIVE COBLESKILL NY 12043 141772971 HEALTHCARE NY 501C3 3 BHN 0 LITTLE FALLS HOSPITAL 140 BURWELL STREET LITTLE FALLS NY 13365 150533578 HEALTHCARE NY 501C3 3 BHN 0 O'CONNOR HOSPITAL 460 ANDES ROAD DELHI NY 13753 161540394 HEALTHCARE NY 501C3 3 BHN 0 TEMPLETON FOUNDATION ONE ATWELL ROAD COOPERSTOWN NY 13326 133317084 LANDLORD NY 501C3 10 BHN 0 TRI TOWN REGIONAL HEALTHCARE 43 PEARL STREET SIDNEY NY 13838 260169584 HEALTHCARE NY 501C3 3 BHN 0 VALLEY HEALTH SERVICES 690 WEST GERMAN STREET HERKIMER NY 13350 222511614 ELDER CARE NY 501C3 3 BHN 0 BASSETT PPS LLC 618 STATE HIGHWAY 7 ONEONTA NY 13820 811749905 HEALTHCARE NY 501C3 12A MIBH 1 AT HOME CARE PARTNERS INC 25 ELM STREET ONEONTA NY 13820 562397098 HEALTHCARE NY 501C3 10 AHC INC 1 AT HOME CARE INC 25 ELM STREET ONEONTA NY 13820 161287069 HEALTHCARE NY 501C3 10 BHN 0 VALLEY RESIDENTIAL SERVICES 690 WEST GERMAN STREET HERKIMER NY 13350 463703838 ELDER CARE NY 501C3 10 BHN 0 AO FOX FOUNDATION 1 NORTON AVE ONEONTA NY 13820 222871993 FUNDRAISER NY 501C3 9 AO FOX 0 FIRST COMMUNITY CARE OF BASSETT 60 NORTHPOINT PARKWAY AMHERST NY 14228 161504464 HEALTHCARE NY N/A 0 0 STAMFORD PROFESSIONAL ASSOCIATES 1 NORTON AVE ONEONTA NY 13820 161322304 RENTAL NY N/A 0 0 LEATHERSTOCKING PHYSICIANS PC ONE ATWELL ROAD COOPERSTOWN NY 13326 364864562 HEALTHCARE SVCS NY N/A C 0 CATSKILL CARE ENTERPRISES 1 NORTON AVE ONEONTA NY 13820 161236590 RETAIL PHARMACY & FITNESS CENTER NY N/A C 0 0 0 1 0 0 0 0 0 1 1 1 1 1 0 0 1 1 0 0