2022-11-15T15:27:45-06:00 2021-12-31 135565207 KPMG LLP 515 BROADWAY 4TH FLOOR ALBANY NY 122072974 990 2021-01-01 141772971 BASSETT HOSPITAL OF SCHOHARIE COUNTY BASS 5182543456 178 GRANDVIEW DRIVE COBLESKILL NY 12043 ERIC STEIN PRESIDENT 5182543456 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 COBLESKILL REGIONAL HOSPITAL ERIC STEIN 178 GRANDVIEW DRIVE COBLESKILL NY 12043 38476078 0 X COBLESKILLHOSPITAL.ORG X 1994 NY PROVISION OF HEALTH CARE SERVICES TO RESIDENTS OF SCHOHARIE COUNTY AND THE SURROUNDING REGION. 12 10 260 42 0 0 7428584 981260 28877655 36705922 -15685 3899 994138 783658 37284692 38474739 0 0 0 0 13954161 15105081 0 0 0 17290225 15252519 31244386 30357600 6040306 8117139 38686098 50070763 10269061 13536587 28417037 36534176 X PROVISION OF HEALTH CARE SERVICES TO RESIDENTS OF SCHOHARIE COUNTY AND THE SURROUNDING REGION. 0 0 24271465 0 36705922 PROVISION OF HOSPITAL CARE TO RESIDENTS OF SCHOHARIE COUNTY AND THE SURROUNDING REGION. INPATIENT AND OUTPATIENT SERVICES PROVIDED TO OUR PATIENTS RESULTED IN:HOSPITALIZATIONS: 913PATIENT DAYS: 4,845CLINIC VISITS: 21,585ER VISITS: 10,721SURGICAL CASES: 501 24271465 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 34 0 1 260 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 10 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 0 0 NY X ERIC STEIN 5182543456 178 GRANDVIEW DRIVE COBLESKILL NY 12043 STEVEN A KROLL TRUSTEE AND CHAIR 0.50 0.00 X X 0 0 0 PATRICIA A O'CONNOR PHD TRUSTEE AND VICE CHAIR 0.50 0.00 X X 0 0 0 ANTONINO COGLIANDRO TRUSTEE AND TREASURER 0.50 0.00 X X 0 0 0 JENNIFER SAUNDERS TRUSTEE AND SECRETARY 0.50 0.00 X X 0 0 0 DANIEL M AYRES TRUSTEE 0.50 0.00 X 0 0 0 DEBORAH FUNK VALOIS MD TRUSTEE 0.50 40.00 X 0 433471 28484 AMY E GILDEMEISTER PHD TRUSTEE 0.50 0.00 X 0 0 0 RYAN T MCALLISTER TRUSTEE 0.50 0.00 X 0 0 0 CARL MUMMENTHEY TRUSTEE 0.50 0.00 X 0 0 0 JOSEPH R SELLERS MD TRUSTEE 0.50 40.00 X 0 558747 28600 SUE ELLEN WAGNER TRUSTEE 0.50 0.00 X 0 0 0 JOHN ZACHAREK TRUSTEE 0.50 0.00 X 0 0 0 ERIC STEIN PRESIDENT & CEO 40.00 0.00 X 0 249537 37287 SUSAN OAKES FERRUCCI VP, CLINICAL OPERATIONS & CNO 40.00 0.00 X 209122 0 16457 CHRISTINE PIRRI VP, NON CLINICAL OPS 40.00 0.00 X 287295 0 12277 MARCIA WHITBECK PHARMACIST 40.00 0.00 X 177479 0 6638 KIMBERLY ZIELINSKI REGISTERED NURSE 40.00 0.00 X 151434 0 5885 REYNALDO SANARES INPATIENT RN 40.00 0.00 X 191581 0 0 1016911 1241755 135628 16 0 1 0 MAYO MEDICAL LABORATORIES 200 FIRST ST SW PO BOX 4100 ROCHESTER MN 55903 LAB SERVICES 534608 TRUSTED NURSE STAFFING 500 SENECA STREET SUITE 501 BUFFALO NY 14204 AGENCY 491173 ALLIANCE HEALTHCARE SERVICES 1900 S STATE COLLEGE BLVD SUITE 60 SUNRISE FL 33323 RADIOLOGY SERVICES 259312 AMN HEALTHCARE INC 12400 HIGH BLUFF DRIVE SAN DIEGO CA 92130 AGENCY 117975 DAVIN HEALTHCARE WORKFORCE SOLUTIONS 18 DIVISION STREET SUITE 311 SARATOGA SPRINGS NY 12866 AGENCY 107387 6 124099 829707 27454 981260 NET PATIENT SERVICE REVENUE 900099 36705922 36705922 36705922 5238 5238 1339 -1339 -1339 -1339 OTHER OPERATING REVENUE 900099 595226 595226 AFFILIATE REVENUE 900099 178349 0 178349 RENTAL REVENUE 900099 10083 0 10083 783658 38474739 36705922 0 787557 X 472276 472276 11625631 7910370 3715261 296306 193743 102563 1669069 1091342 577727 1041799 681193 360606 5887 5887 38230 38230 10549 10549 5935647 5935647 34318 34318 105953 69279 36674 583754 381695 202059 14137 14137 81973 53599 28374 1428149 933813 494336 120162 78569 41593 OTHER DIRECT EXPENSES 5011372 5011372 BAD DEBT 1319760 1319760 UTILITIES 464214 464214 CHARITY CARE 98414 98414 30357600 24271465 6086135 0 23448910 38168919 0 0 415101 336402 2213932 2461958 0 0 0 0 0 0 287056 400688 372763 143158 29246323 20992950 8938300 8253373 0 0 0 0 0 0 0 0 3010036 306265 38686098 50070763 2014048 1429774 0 0 0 0 0 0 0 0 0 0 2114627 1704601 0 0 6140386 10402212 10269061 13536587 X 28036057 36109482 380980 424694 28417037 36534176 38686098 50070763 8117139 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 10549 10549 0 PART II-B, LINE 1: SCHEDULE C, PART II-B, LINE 1 IROQUOIS HEALTHCARE ALLIANCE DUES ALLOCATE 57% TOWARDS GENERAL LOBBYING ACTIVITIES. TOTAL DUES PAID IN 2021 WERE $8,791. AMERICAN HOSPITAL ASSOCIAITON DUES ALLOCATE 26.47% TOWARDS GENERAL LOBBYING ACTIVITIES. TOTAL DUES PAID IN 2021 WERE $17,079. THE HEALTHCARE ASSOCIATION OF NYS (HANYS) DUES ALLOCATE 14.13% TOWARDS GENERAL LOBBYING ACTIVITIES. TOTAL DUES PAID IN 2021 WERE $7,203. 0 306098 167 306265 305552 546 306098 304698 854 305552 304203 495 304698 304059 144 304203 1.00000 0 0 33584 33584 17131079 11228226 5902853 11028940 8902867 2126073 1052720 861857 190863 8253373 ASSET RETIREMENT OBLIGATIONS 10402212 10402212 X PART V, LINE 4: INTENDED USES FOR ENDOWMENT FUNDS ENDOWMENT FUNDS OF $260,008 HELD WITH INTEREST EARNED ARE UNRESTRICTED FOR GENERAL HOSPITAL EXPENDITURES. ENDOWMENT FUNDS OF $46,257 WITH INTEREST EARNED ARE RESTRICTED TO NURSING SCHOLARSHIPS. PART X, LINE 2: SCHEDULE D, PART X FIN 48 FOOTNOTE BASSETT HOSPITAL OF SCHOHARIE CTY 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 162018 56642 105377 0.00360 5025733 3218110 1807623 0.06250 5187751 3274752 1913000 0.06610 9540 0 9540 0.00030 9540 9540 0.00030 5197291 3274752 1922540 0.06640 1 9483916 6687816 2796100 X 1 1 1 1 BASSETT HOSPITAL OF SCHOHARIE COUNTY 178 GRANDVIEW DRIVE COBLESKILL NY 12043 COBLESKILLHOSPITAL.ORG 4720700C X X X X BASSETT HOSPITAL OF SCHOHARIE CTY 1 0 0 1 X X X X X X X X X 19 1 0 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 BASSETT HOSPITAL OF SCHOHARIE CTY PART V, SECTION B, LINE 5: THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS AUTHORED BY THE PUBLIC HEALTH DIRECTOR OF SCHOHARIE COUNTY AND THE BHSC DIRECTOR OF QUALITY SERVICES WITH ASSISTANCE FROM THE BASSETT RESEARCH INSTITUTE. A COMMUNITY STAKEHOLDER SURVEY WAS DISTRIBUTED IN THE FALL OF 2019 TO ELICIT OPINIONS ON THE TOP COMMUNITY HEALTH NEEDS IN SCHOHARIE COUNTY. THIS SURVEY WAS COMPLETED BY 108 PARTICIPANTS REPRESENTING AGING AND OLDER ADULT SERVICES, BUSINESS, EDUCATION, HEALTH CARE, HUMAN SERVICES, LAW ENFORCEMENT, SOCIAL SERVICES, HOUSING, AND PUBLIC HEALTH. THIS COMMUNITY HEALTH NEEDS ASSESSMENT HAS TAKEN INTO ACCOUNT INPUT FROM THIS DIVERSE GROUP WHO REPRESENT THE BROAD INTEREST OF THE COMMUNITY SERVED BY BASSETT HOSPITAL OF SCHOHARIE COUNTY (BHSC).THE STAKEHOLDERS WERE ALSO ASKED TO REVIEW AND COMMENT ON THE PREVIOUS COMMUNITY HEALTH NEEDS ASSESSMENT AND THE COMMUNITY HEALTH IMPROVEMENT PLAN TO GAIN INSIGHT ON CONTINUING PUBLIC HEALTH EFFORTS.IN ADDITION TO THE PROCESS AND COMMUNITY PARTICIPATION SPECIFICALLY USED IN DEVELOPING THIS COMMUNITY HEALTH ASSESSMENT, SIGNIFICANT PROCESSES AND COMMUNITY PARTICIPATION WERE INVOLVED IN COMPILING THE BHSC COMMUNITY SERVICE PLAN AND THE SCHOHARIE COUNTY HEALTH ASSESSMENT. EACH OF THESE EFFORTS INCLUDED THEIR OWN PROCESS AND METHODS OF IDENTIFYING COMMUNITY HEALTH NEEDS. THE COMMUNITY STAKEHOLDER SURVEY ALSO COLLECTED COMMENTS FROM THE PARTICIPANTS WHICH PROVIDED MORE DETAILED INFORMATION ON THE PARTICIPANTS AREA OF EXPERTISE WHICH HELPED INFLUENCE THE SELECTION OF PRIORITY HEALTH NEEDS.THE 2019-2021 COMMUNITY SERVICES PLAN (CSP) FOR BHSC WAS DEVELOPED AS PART OF A MULTI-HOSPITAL PLANNING PROCESS AMONG SIX HOSPITALS IN THE BASSETT HEALTHCARE NETWORK. THE DEVELOPMENT OF THE SCHOHARIE COUNTY COMMUNITY HEALTH ASSESSMENT (CCHA) 2019-2021 WAS COMPLETED IN CONJUNCTION WITH THE DEVELOPMENT OF THE COMMUNITY SERVICES PLAN BY BHSC. A WORK GROUP WAS FORMED WITH SEVERAL MEMBERS FROM BOTH THE HEALTH DEPARTMENT AND THE HOSPITAL, AS WELL AS COMMUNITY MEMBERS FORM OTHER AGENCIES, TO REVIEW DEMOGRAPHIC AND HEALTH STATUS INFORMATION, ASSESS COMMUNITY SERVICES AND ULTIMATELY SELECT PRIORITY AREAS FOR IMPROVING THE HEALTH STATUS OF SCHOHARIE COUNTY RESIDENTS. BASSETT HOSPITAL OF SCHOHARIE CTY PART V, SECTION B, LINE 6B: SCHOHARIE COUNTY DEPARTMENT OF HEALTH BASSETT HOSPITAL OF SCHOHARIE CTY 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 IDENTIFIED 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. BASSETT HOSPITAL OF SCHOHARIE COUNTY PART V, SECTION B, LINES 7A & 10ATHE HOSPITAL'S CHNA AND IMPLEMENTATION STRATEGY ARE MADE AVAILABLE ON ITS WEBSITE:WWW.BASSETT.ORG/MEDICAL/LOCATIONS/HOSPITALS/COBLESKILL-REGIONAL-HOSPITAL BASSETT HOSPITAL OF SCHOHARIE COUNTY PART V, SECTION B, LINES 16A - 16CTHE HOSPITAL'S FAP, APPLICATION FORM, AND PLAIN LANGUAGE SUMMARY ARE AVAILABLE ON ITS WEBSITE:WWW.BASSETT.ORG/MEDICAL/PATIENTS-VISITORS/BILLING-INSURANCE/FINANCIAL-ASSISTANCE BASSETT HOSPITAL OF SCHOHARIE COUNTY PART VBILLING AND COLLECTIONSBEGINNING IN JULY 2021, BASSETT HEALTHCARE NETWORK, THE PARENT ORGANIZATION OF BASSETT HOSPITAL OF SCHOHARIE COUNTY, 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. PART I, LINE 3C: OTHER INCOME BASED CRITERIA FOR FREE OR DISCOUNTED CAREBASSETT HOSPITAL OF SCHOHARIE COUNTY (BHSC) IS A NOT-FOR-PROFIT HEALTHCARE ORGANIZATION THAT RENDERS MEDICAL CARE TO ALL PERSONS IN NEED OF SUCH CARE, REGARDLESS OF THEIR ABILITY TO PAY. TO SUPPORT PATIENTS WHO MAY HAVE DIFFICULTY PAYING THEIR MEDICAL BILLS, THE COMMUNITY SERVICE PROGRAM (CSP) IS AVAILABLE. UNDER THE HOSPITAL POLICY GOVERNING THE CSP, BASSETT HOSPITAL OF SCHOHARIE COUNTY PROVIDES A LEVEL OF UNCOMPENSATED CARE EACH YEAR TO PERSONS UNABLE TO PAY THE TOTAL COST OF THE HOSPITAL SERVICES RENDERED. CSP ELIGIBILITY IS LIMITED TO SERVICES FOR THOSE PERSONS WHO ARE DETERMINED INELIGIBLE FOR MEDICAID WITHIN 60 DAYS PRIOR TO THE APPLICATION AND WHOSE ANNUAL FAMILY GROSS INCOME, AS DETERMINED BY AN APPLICATION FOR MEDICAID WITHIN THE SIX MONTHS PRIOR TO AN APPLICATION, DOES NOT EXCEED 300% OF THE FEDERAL POVERTY INCOME GUIDELINES, WHICH ARE UPDATED ANNUALLY. AN APPLICATION FOR THE CSP FREE CARE REQUIRES VERIFICATION OF INCOME FOR THE SIX MONTHS IMMEDIATELY PRECEDING THE APPLICATION AND, IF FAMILY INCOME IS BELOW THE MEDICAID GUIDELINES, A MEDICAID APPLICATION IS ALSO REQUIRED. PART I, LINE 6A: RELATED ORGANIZATION INFORMATIONTHE BASSETT HOSPITAL OF SCHOHARIE COUNTY COMMUNITY BENEFITS REPORT IS CONTAINED IN A REPORT PREPARED BY BASSETT HEALTHCARE NETWORK. PART I, LINE 7: COSTING METHODOLOGY EXPLANATIONFOR SECTIONS (A) CHARITY CARE AT COST, (B) UNREIMBURSED MEDICAID, (F) HEALTH PROFESSIONS EDUCATION, THE COSTING METHODOLOGY APPLIED IS A COST-TO-CHARGE RATIO CALCULATION, AS USED ON FILED STATE AND FEDERAL COST REPORTS. INDIRECT COSTS WERE APPLIED TO (G) SUBSIDEZED HEALTH SERVICES AND (I) CASH AND IN-KIND CONTRIBUTIONS TO COMMUNITY GROUPS, WHICH INCLUDE 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 FICA RATE. SCHEDULE H, PART I, LINE 7, COLUMN (F) EXCLUSIONS FROM PERCENT OF TOTAL EXPENSEPART I, LINE 7, COLUMN (F) IS CALCULATED BY DIVIDING COLUMN (E), NET COMMUNITY BENEFIT EXPENSE, BY TOTAL EXPENSE. THE BAD DEBT EXPENSE OF $1,319,760 WAS SUBTRACTED FROM THE TOTAL EXPENSE VALUE USED TO CALCULATE THE PERCENTAGES IN PART 1, LINE 7, COLUMN F. PART II, COMMUNITY BUILDING ACTIVITIES: ALL COMMUNITY BUILDING ACTIVITIES COULD BE CLASSIFIED UNDER PART I, LINE 7 AND ARE HIGHLIGHTED IN ITEM NUMBER 1 ABOVE. THE HOSPITAL HAS REPRESENTATION ON THE BOARD OF DIRECTORS FOR THE MOHAWK VALLEY POPULATION HEALTH IMPROVEMENT PROGRAM (PHIP) WHICH SERVES SCHOHARIE, FULTON, MONTGOMERY, HERKIMER, AND OTSEGO COUNTIES. THE MOHAWK VALLEY PHIP PROVIDES A FORUM IN WHICH STAKEHOLDERS INCLUDING COUNTY HEALTH DEPARTMENTS, HOSPITALS, INSURERS, AGENCIES AND A WIDE RANGE OF OTHER INTERESTED PARTIES CAN REVIEW THE REGION'S HEALTH STATUS AND DEFINE KEY PRIORITY AREAS. DECISIONS ARE BASED UPON INFORMATION RELATING TO THESE COUNTIES DERIVED FROM EXTENSIVE DATA GATHERING AND ANALYSES BY BASSETT HEALTHCARE NETWORK'S RESEARCH INSTITUTE. THE MOHAWK VALLEY PHIP PROMOTES THE TRIPLE AIM THROUGH REGIONAL EFFORTS THAT REFLECT LOCAL NEEDS, ASSETS AND CAPABILITIES. THE GOAL IS TO IMPROVE POPULATION HEALTH THROUGH STAKEHOLDER COLLABORATION, DATA-DRIVEN PRIORITIZATION, AND REGIONAL OR LOCAL STRATEGIES FOR ADDRESSING HEALTH DISPARITIES THAT ARE CONSISTENT WITH THE GOALS OF THE STATEWIDE PREVENTION AGENDA AND THE STATE HEALTH IMPROVEMENT PLAN. THE MOHAWK VALLEY PHIP STIMULATES AND SUPPORTS STRATEGIC PLANNING FOR IDENTIFYING, SHARING, DISSEMINATING AND HELPING TO IMPLEMENT BEST PRACTICES AND LOCAL STRATEGIES THAT PROMOTE POPULATION HEALTH AND REDUCE HEALTH CARE DISPARITIES IN THE FIVE COUNTY REGION.ADDITIONALLY, THE HOSPITAL HAS A PARTICIPATING ROLE WITH THE LEATHERSTOCKING COLLABORATIVE HEALTH PARTNERS, A NEW YORK STATE INITIATIVE TO BETTER THE HEALTH CARE DELIVERY, WHICH WAS FORMED BY PROVIDERS FROM SCHOHARIE, OTSEGO, MADISON, HERKIMER AND DELAWARE COUNTIES. THE MISSION IS TO BUILD A HIGH-PERFORMING INTEGRATED DELIVERY SYSTEM AND TRANSFORM HEALTH CARE DELIVERY IN THE REGION TO ACHIEVE DELIVERY SYSTEM REFORM INCENTIVE (DSRIP) PROGRAM GOALS. OF SPECIFIC FOCUS IS THE TOBACCO CESSATION PROJECT (PROJECT ID: 4.B .I) THAT PROMOTES TOBACCO USE CESSATION, ESPECIALLY AMONG LOW SES POPULATIONS AND THOSE WITH POOR MENTAL HEALTH (FOCUS AREA 2: GOAL 2.2). THE OBJECTIVE IS TO DECREASE THE PREVALENCE OF CIGARETTE SMOKING BY ADULTS 18 AND OLDER, AND INCREASE USE OF TOBACCO CESSATION SERVICES INCLUDING NYS SMOKERS' QUITLINE AND NICOTINE REPLACEMENT PRODUCTS. THE HOSPITAL'S COMMUNITY BUILDING ACTIVITIES ALSO FOCUSED ON REPRESENTATION TO COMMUNITY COALITIONS RELATED TO IDENTIFIED COMMUNITY HEALTH PRIORITIES; ON COSTS OF COALITION MEETINGS; AND ON PARTICIPATION WITH A SMALL BUSINESS/ECONOMIC DEVELOPMENT ORGANIZATION CALLED COBLESKILL PARTNERSHIP INC. (CPI), WHICH ADDRESSES THE HOSPITAL NEIGHBORHOOD IN DOWNTOWN COBLESKILL AND PARTICIPATION IN A NOT-FOR-PROFIT COUNTY-WIDE BUSINESS / ECONOMIC DEVELOPMENT ORGANIZATION CALLED SCHOHARIE ECONOMIC ENTERPRISE CORPORATION (SEEC), WHICH ADDRESSES THE BROADER HOSPITAL SERVICE AREA OF SCHOHARIE COUNTY. PART III, LINE 2: DUE 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 4: 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: BASSETT HOSPITAL OF SCHOHARIE COUNTY USED MEDICARE-APPROVED COSTS FROM THE 2017 MEDICARE COST REPORT, WHICH EMPLOY A COST-TO-CHARGE RATIO METHODOLOGY. 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: IN ADDITION TO THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA), A VARIETY OF DATA ARE USED REGULARLY TO ASSESS THE HEALTHCARE NEEDS OF THE COMMUNITY SERVED BY BASSETT HOSPITAL OF SCHOHARIE COUNTY, INCLUDING DATA FROM PATIENT SATISFACTION SURVEYS, THE NYS DEPARTMENT OF HEALTH, THE SCHOHARIE COUNTY BEHAVIORAL RISK FACTOR SURVEILLANCE SURVEY, THE SCHOHARIE 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 SETTING LOCAL/REGIONAL PRIORITIES. THE PREVENTION AGENDA ALSO IDENTIFIES A COMMON SET OF HEALTHCARE PRIORITIES FROM WHICH HOSPITALS AND COUNTY HEALTH DEPARTMENTS IN NEW YORK STATE ARE EXPECTED TO CHOOSE WHEN DEVELOPING IMPLEMENTATION STRATEGIES FOR ADDRESSING COMMUNITY HEALTHCARE NEEDS. COMMUNITY PARTNERS INVOLVED IN ASSESSING COMMUNITY HEALTH NEEDS IN SCHOHARIE COUNTY INCLUDED: SCHOHARIE COUNTY HEALTH DEPARTMENT; BASSETT PRIMARY CARE GROUP; COMMUNITY-BASED ORGANIZATIONS; AND COUNTY SOCIAL SERVICE, MENTAL HEALTH, YOUTH AND AGING AGENCIES. BASSETT HOSPITAL OF SCHOHARIE COUNTY CONTRACTS WITH 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 RECEIVED 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. PART VI, LINE 3: BASSETT HOSPITAL OF SCHOHARIE COUNTY (BHSC) IS A NOT-FOR-PROFIT HEALTHCARE ORGANIZATION THAT RENDERS MEDICAL CARE TO ALL PERSONS IN NEED OF SUCH CARE, REGARDLESS OF THEIR ABILITY TO PAY. AS REQUIRED BY NYS DEPARTMENT OF HEALTH, THE HOSPITAL PROMINENTLY POSTS NOTICES THROUGHOUT THE FACILITY STATING CLEARLY THAT EMERGENCY CARE IS TO BE PROVIDED REGARDLESS OF ABILITY TO PAY. THE LIST OF PATIENT RIGHTS IS ALSO POSTED THROUGHOUT THE HOSPITAL. INFORMATION ABOUT FEDERAL AND STATE GOVERNMENT HEALTH COVERAGE PLANS AND HOW TO ACCESS THEM IS ALSO POSTED AND IS READILY AVAILABLE AT KEY POINTS OF PATIENT CONTACT, INCLUDING , BUT NOT LIMITED TO, REGISTRATION STATIONS.BASSETT HOSPITAL OF SCHOHARIE COUNTY OFFERS A COMMUNITY SERVICE PLAN TO PATIENTS WHO NEED FINANCIAL ASSISTANCE. A MAJOR COMPONENT OF THE 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 BHSC EMPLOYEES. THE POLICY IS UPDATED ANNUALLY, DISTRIBUTED TO KEY PERSONNEL, AND IS POSTED IN THE ONLINE POLICY AND PROCEDURE MANUAL THAT IS ACCESSIBLE TO ALL EMPLOYEES.AS PART OF THE INTAKE PROCESS, PATIENTS RECEIVE A BHSC-SPECIFIC FINANCIAL AID BROCHURE DESCRIBING FINANCIAL ASSISTANCE OPTIONS. THE BROCHURE DESCRIBES FEDERAL AND STATE GOVERNMENT PROGRAMS, AS WELL AS THE HOSPITAL'S COMMUNITY SERVICE PLAN, AND IS WRITTEN IN PLAIN LANGUAGE THAT ADDRESSES LOW LITERACY LEVELS IN THE COUNTY (1 IN 5 COUNTY RESIDENTS READ AT THE 3RD GRADE LEVEL OR LOWER ACCORDING TO LITERACY VOLUNTEERS OF SCHOHARIE COUNTY). IT IS ALSO AVAILABLE AT KEY POINTS OF SERVICE, INCLUDING NURSE'S STATIONS, WAITING ROOMS, THE ER, AND OTHER HIGH-TRAFFIC PUBLIC AREAS.IN ADDITION TO POSTINGS CONTAINING CONTACT INFORMATION AND THE DISTRIBUTION OF THE BHSC-SPECIFIC FINANCIAL AID BROCHURE, PATIENT EDUCATION IS SUPPORTED BY A FOUR-PAGE, PLAIN-LANGUAGE BROCHURE THAT IS INCLUDED WITH THE COMMUNITY SERVICE PLAN APPLICATION ITSELF. COMMUNITYSERVICE PLAN BROCHURE/APPLICATIONS ARE READILY AVAILABLE AT ALL FACILITIES IN THE BASSETT HEALTHCARE NETWORK AND ALL CLINICS. CLINICAL AND SUPPORT STAFF ARE MADE AWARE OF THE PROGRAM AND ARE ABLE TO DIRECT PATIENTS TO SPECIALISTS WHO CAN ASSIST IN THE APPLICATION PROCESS. ALL PATIENTS WHO ARE REGISTERED AS "SELF PAY" ARE PROVIDED A COMMUNITY SERVICES PLAN BROCHURE/APPLICATION IN PERSON.A LISTING OF ALL SELF-PAY ACCOUNTS IS PRODUCED AND REVIEWED DAILY TO ENSURE THAT A COMMUNITY SERVICES PLAN BROCHURE/APPLICATION HAS BEEN PROVIDED. THE SELF-PAY BILLING OFFICE IDENTIFIES PATIENTS WHO MAY REQUIRE ADDITIONAL HELP UNDERSTANDING THE PROGRAM DURING THE BILLING AND COLLECTIONS PROCESS. CONTACT INFORMATION FOR THE COMMUNITY SERVICE PLAN IS INCLUDED IN PATIENT BILLS. SELF-PAY ACCOUNTS FOR PATIENTS WHO HAVE BEEN APPROVED FOR COMMUNITY SERVICES WITHIN THE PRIOR 120 DAYS ARE AUTOMATICALLY INCLUDED WITH PRIOR APPROVAL.IN SCHOHARIE COUNTY, FACILITATED ENROLLMENT IN GOVERNMENT HEALTH INSURANCE PROGRAMS IS HANDLED BY SEVERAL COMMUNITY AGENCIES/ORGANIZATIONS (SCHOHARIE COUNTY COMMUNITY ACTION PROGRAM (SCCAP), FIDELISCARE, AS WELL AS BASSETT MEDICAL CENTER. BHSC MAKES REFERRALS TO THEM BY MEANS OF A FORM THAT CAN BE SIGNED BY THE PATIENT AND FAXED. PATIENT REGISTRARS AND CUSTOMER SERVICE PROVIDERS FROM THE BUSINESS OFFICE ARE TRAINED TO UNDERSTAND THESE PROGRAMS AND THE PROCESS FOR HELPING PATIENTS ACCESS THEM. THEY PROVIDE ONE-ON-ONE ASSISTANCE WITH ACCESS, INFORMATION, AND APPOINTMENT SCHEDULING FOR FACILITATED ENROLLMENT. ADDITIONALLY, THE HOSPITAL'S BUSINESS SERVICES MANAGER PROVIDES ONE-ON-ONE COUNSELING TO PATIENTS WHO NEED HELP PAYING THEIR BILLS, INCLUDING REFERRAL TO FACILITATED ENROLLMENT FOR MEDICAID AND OTHER GOVERNMENT PROGRAMS. PART VI, LINE 4: BASSETT HOSPITAL OF SCHOHARIE COUNTY'S PRIMARY SERVICE AREA ENCOMPASSES ALL OF SCHOHARIE COUNTY, WITH A POPULATION OF 31,420 (U.S. CENSUS 2017 ESTIMATE), AND A PORTION OF NEIGHBORING SCHENECTADY COUNTY, INCLUDING THE TOWNS OF DELANSON AND DUANESBURG. LOCATED IN COBLESKILL, NY, BASSETT HOSPITAL OF SCHOHARIE COUNTY IS THE ONLY HOSPITAL IN SCHOHARIE COUNTY. SCHOHARIE COUNTY IS LOCATED AT THE FAR WESTERN EDGE OF NEW YORK STATE'S CAPITAL DISTRICT. A PRIMARILY RURAL AREA, SCHOHARIE COUNTY COVERS A LAND AREA OF APPROXIMATELY 622 SQUARE MILES, WITH A POPULATION DENSITY OF JUST 52.7 PERSONS PER SQUARE MILE (U.S. CENSUS 2010). SCHOHARIE COUNTY HAS A STRONG AGRICULTURAL HERITAGE, AND FARMING REMAINS A DOMINANT SECTOR OF ITS ECONOMY, WITH AGRICULTURAL SALES TOTALING $30 MILLION PER YEAR (SCHOHARIE COUNTY CHAMBER OF COMMERCE).PEOPLE AGE 65 AND OVER MAKE UP 21.1 PERCENT OF THE POPULATION, WHILE THE NEW YORK STATE AVERAGE IS 15 PERCENT (U.S. CENSUS 2017). NINETY-SIX PERCENT OF THE POPULATION IS WHITE, WITH HISPANICS MAKING UP 3.2 PERCENT OF THE POPULATION AND BLACKS 1.7 PERCENT (U.S. CENSUS 2017). AMERICAN INDIAN AND ASIAN PERSONS TOGETHER REPRESENT 1.1 PERCENT OF THE POPULATION, AT 0.3 PERCENT AND 0.8 PERCENT, RESPECTIVELY, AND PERSONS OF TWO OR MORE RACES MAKE UP 1.3 PERCENT (U.S. CENSUS 2017).EDUCATIONAL LEVELS, UNEMPLOYMENT, AND POVERTY ARE IDENTIFIED BARRIERS TO THE HEALTH OF WITH AN UNEMPLOYMENT RATE OF 9 PERCENT (APRIL 2013, U.S. BUREAU OF LABOR STATISTICS}, THE MEDIAN HOUSEHOLD INCOME IN SCHOHARIE COUNTY IS $51,195 (US CENSUS 2016 ESTIMATE), WHICH IS $8,074 LESS THAN THE NEW YORK STATE MEDIAN. THE PERCENTAGE OF RESIDENTS WITH INCOMES BELOW THE FEDERAL POVERTY GUIDELINES IS 13.2 PERCENT (US CENSUS 2016 ESTIMATE).SIX PERCENT OF SCHOHARIE COUNTY RESIDENTS LACK HEALTH INSURANCE (SCHOHARIE COUNTY COMMUNITY HEALTH ASSESSMENT 2016 - 2018). OF THE HOSPITAL'S PATIENTS, 14% WERE MEDICAID PATIENTS IN 2013. SCHOHARIE COUNTY IS A FEDERALLY DESIGNATED HEALTH PROFESSIONAL SHORTAGE AREA IN THE DISCIPLINES OF PRIMARY CARE, MENTAL HEALTH, AND DENTAL (HRSA.GOV).THE PERCENTAGE OF THE POPULATION WITH A HIGH SCHOOL DEGREE IS SLIGHTLY HIGHER THAN THE NEW YORK STATE AVERAGE: 87.7PERCENT FOR SCHOHARIE COUNTY COMPARED TO 84.9 PERCENT FOR THE STATE. HOWEVER, THE PERCENTAGE OF THE POPULATION WITH A COLLEGE DEGREE OR HIGHER IS 12.9 PERCENT LOWER THAN THE NEW YORK STATE AVERAGE: 19.9 PERCENT FOR SCHOHARIE COUNTY COMPARED TORESIDENTS OF SCHOHARIE COUNTY. 32.8 PERCENT FOR THE STATE (U.S. CENSUS 2013 ESTIMATE). ONE IN FIVE RESIDENTS IS ABLE TO READ ONLY AT A LEVEL THAT MAKES IT IMPOSSIBLE TO READ AND UNDERSTAND HEALTHCARE INSTRUCTIONS AND THE INFORMATION NEEDED TO FIND EMPLOYMENT (LITERACY VOLUNTEERS OF SCHOHARIE COUNTY). PART VI, LINE 5: A MAJORITY OF THE BASSETT HOSPITAL OF SCHOHARIE COUNTY BOARD OF TRUSTEES IS COMPRISED OF COMMUNITY VOLUNTEERS WHO RESIDE IN THE HOSPITAL'S PRIMARY SERVICE AREA AND WHO ARE NEITHER EMPLOYEES NOR CONTRACTORS OF THE ORGANIZATION, NOR FAMILY MEMBERS THEREOF. IN 2021, THERE WERE A TOTAL OF 12 MEMBERS ON THE BASSETT HOSPITAL OF SCHOHARIE COUNTY BOARD OF TRUSTEES, OF WHOM 10 WERE COMMUNITY VOLUNTEER BOARD MEMBERS. ONE BOARD MEMBER WAS AN EXECUTIVE-LEVEL EMPLOYEE OF THE BASSETT HEALTHCARE NETWORK (BHN). AS A NOT-FOR-PROFIT HOSPITAL, BASSETT HOSPITAL OF SCHOHARIE COUNTY REINVESTS SURPLUS FUNDS TOWARD EQUIPMENT/TECHNOLOGY IMPROVEMENTS IN PATIENT CARE AND PATIENT SAFETY, AS WELL AS INFRASTRUCTURE UPGRADES MANDATED BY JOINT COMMISSION AND GOVERNMENT/REGULATORY REQUIREMENTS AND DEEMED NECESSARY TO KEEP THE HOSPITAL ACCREDITED AND ABLE TO CONTINUESERVING THE HEALTH NEEDS.COMMUNITY HEALTH IMPROVEMENT AND EDUCATION ARE KEY STRATEGIES IN THE HOSPITAL'S PLAN OF RESPONSE TO THE COMMUNITY'S HEALTH PRIORITIES AND NEEDS. THE HOSPITAL'S INITIATIVES ARE LARGELY GUIDED BY THE NEW YORK STATE DEPARTMENT OF HEALTH PUBLIC HEALTH PREVENTION AGENDA. THEY ARECHOSEN AND COORDINATED IN CLOSE COLLABORATION WITH THE SCHOHARIE COUNTY DEPARTMENT OF HEALTH AND BASSETT HEALTHCARE NETWORK, IN PARTICULAR REFLECTING THE COUNTY'S HEALTH ASSESSMENT AND THE BASSETT HEALTH AND WELLNESS SURVEY. STRATEGIES FOCUS ON ACCESS, EDUCATION AND AWARENESS.HOSPITAL PROGRAMS AND EFFORTS THAT ADDRESS PREVENTION AGENDA-RELATED COMMUNITY HEALTH IMPROVEMENT AND EDUCATION PRIORITIES INCLUDE FOLLOWING:- DIABETES COMMUNITY EDUCATION AND EVIDENCE-BASED SUPPORT PROGRAM- LUNCH AND LEARN EDUCATIONAL PROGRAMS ON FIRE SAFETY, FOOD AND NUTRITION, SCHOHARIE FRESH (LOCALLY GROWN PRODUCE, DAIRY, MEATS, ETC.); FALL PREVENTION, NEW EMERGENCY DEP'T; AT HOME CARE; "DIABETES, ARE YOU AT RISK?; "5-2-1-0 CHILDHOOD OBESITY PREVENTION PROGRAM; SCHOHARIE COUNTY MENTAL HEALTH; WOMEN'S WELLNESS; AND SCHOHARIE COUNTY OFFICE FOR THE AGING"- STROKE SUPPORT GROUP- SPACE AND IN-KIND CONTRIBUTION OF PROFESSIONAL SERVICES FOR CANCER AND ALZHEIMER'S SUPPORT GROUPS; CONTRIBUTIONS TO NON-PROFIT COMMUNITY ORGANIZATIONS; IN-KIND SERVICES CONTRIBUTED BY STAFF TO NOT-FOR-PROFIT ORGANIZATIONS AND COMMUNITY GROUPS; STAFF TIME SPEND COORDINATING EVENTS NOT SPONSORED BY THE HOSPITAL, SUCH AS BLOOD DRIVES AND EMPLOYEE TIME SPENT ON COMMUNITY HEALTH RELATED BOARDS AND OTHER COMMUNITY INVOLVEMENT.- THE HOSPITAL HELPS TO PROTECT THE HEALTH ACCESS, SAFETY, AND INDEPENDENCE OF VULNERABLE POPULATIONS LIVING IN POVERTY THROUGH FINANCIALLY SUPPORTED PROVISION OF THE LIFELINE PERSONAL RESPONSE SYSTEM THE HOSPITAL ALSO PROVIDES COMMUNITY BENEFITS SERVICES NOT EASILY COUNTED OR PORTRAYED QUANTITATIVELY. IN 2015 A "HEALTHY DECISIONS" NEWSLETTER DEDICATED IN LARGE PART TO EDUCATIONAL MESSAGES INTENDED TO IMPROVE HEALTH KNOWLEDGE, ATTITUDES, SKILL/BEHAVIORS RELATED TO PREVENTION PRIORITIES; AND HUNDREDS OF HOURS OF STAFF VOLUNTEER TIME IN A WIDE-RANGE OF ACTIVITIES, INCLUDING BLOOD DRIVES, THAT PROMOTE THE HEALTH OF THE COMMUNITY. PART VI, LINE 6: BASSETT HOSPITAL OF SCHOHARIE COUNTY IS PART OF BASSETT HEALTHCARE NETWORK, WHICH PROVIDES SERVICES IN MORE THAN 20 COMMUNITIES SPANNING 5,600 SQUARE MILES AND EIGHT 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 (ACCORDING TO THE 2017 U.S. CENSUS ESTIMATES); AND SCHOHARIE COUNTY - POPULATION 31,420 (U.S. CENSUS 2017 ESTIMATE).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 HEALTHCENTERS, 2 AMBULATORY SURGERY CENTERS, AND A FULLY SALARIED MEDICAL STAFF IN COOPERSTOWN, OTSEGO COUNTY B. O'CONNOR HOSPITAL - CRITICAL ACCESS HOSPITAL IN DELHI, DELAWARE COUNTYC. BASSETT HOSPITAL OF SCHOHARIE COUNTY (DBA COBLESKILL REGIONAL HOSPITAL) - ACUTE CARE FACILITY IN COBLESKILL, SCHOHARIE COUNTYD. LITTLE FALLS HOSPITAL - CRITICAL ACCESS HOSPITAL IN LITTLE FALLS, HERKIMER COUNTYE. A.O. FOX HOSPITAL -- ACUTE CARE FACILITY IN ONEONTA, OTSEGO COUNTYF. VALLEY HEALTH SERVICES - RESIDENTIAL HEALTH CARE AND REHABILITATION FACILITYG. AT HOME CARE - CERTIFIED HOME CARE AGENCYH. AT HOME CARE PARTNERS - CERTIFIED HOME CARE AGENCYI. VALLEY RESIDENTIAL SERVICES -J. FIRST COMMUNITY CARE OF BASSETT - MEDICAL SUPPLY COMPANY ALL OF THE ABOVE (A-1) MAKE UP BASSETT HEALTHCARE NETWORK AND PROVIDE HEALTH SERVICES TO THIS EIGHT-COUNTY REGION IN CENTRAL NEW YORK. PART VI, LINE 7, REPORTS FILED WITH STATES NY X X 0 0 0 0 0 0 0 1 0 JOSEPH R SELLERS MD TRUSTEE 0 536334 0 22413 0 0 0 26188 0 2412 0 587347 0 0 DEBORAH FUNK VALOIS MD TRUSTEE 0 427221 0 6250 0 0 0 20388 0 8096 0 461955 0 0 CHRISTINE PIRRI VP, NON CLINICAL OPS 287295 0 0 0 0 0 8319 0 3958 0 299572 0 0 0 ERIC STEIN PRESIDENT & CEO 0 249537 0 0 0 0 0 20960 0 16327 0 286824 0 0 SUSAN OAKES FERRUCCI VP, CLINICAL OPERATIONS & CNO 209122 0 0 0 0 0 6274 0 10183 0 225579 0 0 0 REYNALDO SANARES INPATIENT RN 191581 0 0 0 0 0 1515 0 0 0 193096 0 0 0 MARCIA WHITBECK PHARMACIST 177479 0 0 0 0 0 5324 0 1314 0 184117 0 0 0 KIMBERLY ZIELINSKI REGISTERED NURSE 151434 0 0 0 0 0 4543 0 1342 0 157319 0 0 0 PART I, LINE 3 - RELATED ORG METHODS USED FOR COMPENSATION EXPLANATION THE CHIEF EXECUTIVE OFFICER'S SALARY IS PAID BY A RELATED ORGANIZATION UNDER A MANAGEMENT SERVICES AGREEMENT. THE BASSETT HOSPITAL OF SCHOHARIE COUNTY REVIEWS THE FORMAL PROCESS THAT IS USED TO DETERMINE THE BASE COMPENSATION OF THE CEO. THE CEO WORK PLAN AND ACCOMPLISHMENTS FOR THE YEAR ARE REVIEWED. SALARY CHANGES ARE BASED ON MARKET, WORK PLAN, AND ACCOMPLISHMENTS. THE CEO'S SALARY IS SUBMITTED AS PART OF THE MANAGEMENT SERVICES AGREEMENT WHICH IS APPROVED BY THE BOARD. 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. 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 FORM 990 THE 990 IS REVIEWED BY THE EXECUTIVE FINANCE COMMITTEE, WHICH HAS BEEN ASSIGNED THAT RESPONSIBILITY BY THE BOARD OF TRUSTEES. ALL TRUSTEES ARE MADE AWARE THAT THE 990 IS AVAILABLE FOR REVIEW IN THE ADMINISTRATIVE OFFICE UPON REQUEST. FORM 990, PART VI, SECTION B, LINE 12C ENFORCEMENT OF CONFLICTS POLICY MEMBERS OF THE BOARD COMPLETE A CONFLICT OF INTEREST QUESTIONNAIRE ANNUALLY. A SUMMARY OF RESULTS IS REPORTED EACH YEAR AT THE ANNUAL MEETING OF THE BOARD OF TRUSTEES. FORM 990, PART VI, SECTION B, LINE 15A COMPENSATION PROCESS FOR TOP OFFICIAL THE CHIEF EXECUTIVE OFFICER'S SALARY IS PAID BY A RELATED ORGANIZATION UNDER A MANAGEMENT SERVICES AGREEMENT. THE BASSETT HOSPITAL OF SCHOHARIE COUNTY REVIEWS THE FORMAL PROCESS THAT IS USED TO DETERMINE THE BASE COMPENSATION OF THE CEO. THE CEO WORK PLAN AND ACCOMPLISHMENTS FOR THE YEAR ARE REVIEWED. SALARY CHANGES ARE BASED ON MARKET, WORK PLAN, 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 GOVERNING DOCUMENTS DISCLOSURE EXPLANATION GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC BY REQUEST OF THE ADMINISTRATIVE OFFICE. FORM 990, PART IX, LINE 11G PHYSICIAN & CONTRACT FEES: PROGRAM SERVICE EXPENSES 1,063,889. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,063,889. CONSULTING: PROGRAM SERVICE EXPENSES 33,219. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 33,219. NETWORK SHARED SERVICES: PROGRAM SERVICE EXPENSES 4,838,539. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,838,539. 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 O'CONNOR HOSPITAL 460 ANDES ROAD DELHI NY 13753 161540394 HEALTHCARE NY 501C3 3 BHN 0 LITTLE FALLS HOSPITAL 140 BURWELL STREET LITTLE FALLS NY 13365 150533578 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 AO FOX FOUNDATION 1 NORTON AVE ONEONTA NY 13820 222871993 FUNDRAISER NY 501C3 9 AO FOX 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 0 0 0 0 0 1 0 1 1 1 1 1 1 1 1 1 1