2019-11-15T15:34:31-06:00 2018-12-31 KPMG LLP 515 Broadway 4th Floor Albany NY 122072974 990 2018-01-01 141772971 Bassett Hospital of Schoharie Cty % Eric H Stein BASS 5182543456 178 Grandview Drive Cobleskill NY 12043 ERIC H STEIN President & CEO 5182543456 2019-11-15 true TODD P TERESCO P00247720 5184274600 2019-11-14 167.68.102.5 14012520193195000017 2019-11-15 P 7B5190DACD7950FB62E11B317DAE60956DD6A6E7 7B5190DACD7950FB62E11B317DAE60956DD6A6E7 2018 2020-04-17 16:48:07Z Cobleskill Regional Hospital Eric Stein 178 Grandview Drive Cobleskill NY 12043 29348958 false X www.cobleskillhospital.org X 1994 NY Provision of health care services to residents of Schoharie County and the surrounding region. 14 12 280 33 0 0 403813 396793 27740060 28452630 51119 20170 475464 478030 28670456 29347623 0 0 0 0 12361895 12273552 0 0 0 18101028 17620529 30462923 29894081 -1792467 -546458 24553660 23640184 6013102 5681078 18540558 17959106 Provision of health care services to residents of Schoharie County and the surrounding region. false false 20396219 28452630 Provision of hospital care to residents of Schoharie County and the surrounding region. Inpatient and Outpatient Services provided to our patients resulted in: Hospitalizations: 1,111 Patient Days: 4,822 Clinic Visits: 21,681 ER Visits: 10,083 Surgical Cases: 583 20396219 true true false true false false false false false true true false false false true true true false false false false false false false false false true true false false true false false false false false false false false false false false false false true false false false true 38 0 true 280 true false false false false false false false false false false false false X 14 12 false false false false true true true true true false false false true true true true true true false false NY X Eric H Stein 5182543456 178 Grandview Drive Cobleskill NY 12043 Michael Tengeres Trustee (until 4/2018) 2.0 40.0 X 0 147341 6965 Joseph Sellers Trustee 0.5 40.0 X 0 353519 27274 Barbara DiCocco Chairman (until 8/2018) 1.0 2.5 X X 0 0 0 Anne C Myers Vice Chairman (until 8/2018) 1.0 0.0 X X 0 0 0 Glenn A Perrone Secretary 1.0 0.0 X X 0 0 0 George P Konta Treasurer 1.0 0.0 X X 0 0 0 Nancy Bellinger Trustee (until 8/2018) 1.0 0.0 X 0 0 0 Paul Brady Trustee (until 8/2018) 1.0 0.0 X 0 0 0 Michael Breen Trustee 0.5 0.0 X 0 0 0 Edwin Kintz Trustee (Until 8/2018) 0.5 0.0 X 0 0 0 Steven Kroll Vice Chairman and Trustee 0.5 0.0 X 0 0 0 Henry Lamont Trustee (Until 8/2018) 0.5 0.0 X 0 0 0 Peter Lopez Trustee (until 8/2018) 0.5 0.0 X 0 0 0 Carl Mummenthey Chairman and Trustee 0.5 0.0 X 0 0 0 Garth Roberts Trustee 0.5 0.0 X 0 0 0 Renee Scialdo Shevat PhD Trustee (Until 8/2018) 0.5 0.0 X 0 0 0 Daniel M Ayres Trustee 0.5 0.0 X 0 0 0 Antonio Cogliandro Trustee 0.5 0.0 X 0 0 0 Deborah Funk-Valois MD Trustee 0.5 40.0 X 0 389807 24219 Amy E Gildemeister PhD Trustee 0.5 0.0 X 0 0 0 Jennifer Saunders Trustee 0.5 0.0 X 0 0 0 Sue Ellen Wagner Trustee 0.5 0.0 X 0 0 0 Patricia O'Connor PhD Trustee 0.0 0.0 X 0 0 0 Eric Stein President & CEO 38.0 0.0 X 0 204049 22525 Susan Oakes Ferrucci VP, Clinical Operations & CNO 38.0 0.0 X 158845 0 16630 David DeSando Director of Pharmacy 38.0 0.0 X 150230 0 6699 Christine Pirri VP, Non Cl Op & Compliance 38.0 0.0 X 145845 0 5620 Christopher Manley Staff Pharmacist 38.0 0.0 X 107752 0 11376 Cindy Palmer Director, ACC/Op Svcs 38.0 0.0 X 102375 0 3919 665047 1094716 125227 6 false true false Mgmt Health Systems Inc 1580 Sawgrass Pkwy Suite 200 Sunrise FL 33323 Agency 425141 AMN Healthcare Inc 12400 High Bluff Drive San Diego CA 92130 Agency 376444 Mayo Medical Laboratories 200 First St SW PO Box 4100 Rochester MN 55903 Lab Services 314904 Medical Staffing Network 6551 Park of Commerce Blvd Boca Raton FL 33487 Agency 301933 Alliance Healthcare Service 1900 S State College Blvd Suite 6 Anaheim CA 92806 PET / CT Service 285760 6 168617 228176 396793 Net Patient Revenue 900009 28452630 28452630 28452630 21325 21325 0 0 0 0 0 180 1335 -1155 -1155 -1155 0 0 0 0 0 0 0 0 0 Other Operating Revenue 333696 333696 Coffee Shop Revenue 60775 60775 Lifeline Revenue 47367 47367 36192 36192 478030 29347623 28452630 498200 0 0 0 0 0 0 9957107 6082338 3874769 249194 152221 96973 1345193 821716 523477 722058 441072 280986 0 103678 103678 96816 96816 9356 9356 0 0 1736069 677067 1059002 85967 52513 33454 489505 299016 190489 1825410 711910 1113500 0 0 47816 18648 29168 0 11200 5068 6132 139827 85414 54413 0 1673506 1020839 652667 175844 175844 Purchased Services 5909131 4727305 1181826 DRUGS AND REAGENTS 1882746 1882746 PATIENT CARE 1819378 1819378 BAD DEBT 838387 838387 775893 584737 191156 29894081 20396219 9497862 0 8824127 7758461 125404 125528 194730 351591 2916135 4327183 0 0 0 0 0 0 354058 355296 346780 281418 27739180 17487936 11603755 10251244 0 0 0 0 0 0 0 0 188671 189463 24553660 23640184 2013095 2316778 0 0 0 0 0 0 0 0 0 0 3527530 3043457 439719 288085 32758 32758 6013102 5681078 X 18297496 17749916 0 0 243062 209190 18540558 17959106 24553660 23640184 X -546458 -34994 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 9356 9356 false Schedule C, Part II-B, Line 1 IROQUOIS HEALTHCARE ALLIANCE DUES ALLOCATE 39.30% TOWARDS GENERAL LOBBYING ACTIVITIES. TOTAL DUES PAID IN 2018 WERE $8,535. AMERICAN HOSPITAL ASSOCIATION DUES ALLOCATE 22.73% TOWARDS GENERAL LOBBYING ACTIVITIES. TOTAL DUES PAID IN 2018 WERE $16,099. THE HEALTHCARE ASSOCIATION OF NEW YORK STATE (HANYS) DUES ALLOCATE 17.51% TOWARDS GENERAL LOBBYING ACTIVITIES. TOTAL DUES PAID IN 2018 WERE $13,378. 304203 495 304698 304059 144 304203 303712 347 304059 303365 347 303712 302994 371 303365 1.00000 false false 33584 33584 17728852 9571899 8156953 9976744 7916037 2060707 10251244 0 ASSET RETIREMENT OBLIGATIONS 32758 32758 X 28356234 -991389 -991389 29347623 29347623 28937686 28937686 956395 956395 29894081 SCHEDULE D, Part V, Line 4 Intended Uses for Endowment Funds ENDOWMENT FUNDS OF $261,709 HELD WITH INTEREST EARNED ARE UNRESTRICTED FOR GENERAL HOSPITAL EXPENDITURES. ENDOWMENT FUNDS OF $42,989 WITH INTEREST EARNED ARE RESTRICTED TO NURSING SCHOLARSHIPS. SCHEDULE D, Part X, LINE 2 FIN 48 Footnote THE HOSPITAL IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501 (C)(3) OF THE INTERNAL REVENUE CODE (IRC) AND IS EXEMPT FROM FEDERAL INCOME TAXES PURSUANT TO SECTION 501(A) OF THE IRC. THE HOSPITAL 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 AS OF DECEMBER 31, 2018 AND 2017. SCHEDULE D, PART XI, LINE 2D BAD DEBT $ (838,387) CHARITY CARE $ (118,008) CHANGE IN FRIENDS OF BASSETT INTEREST $ (34,994) --------------- TOTAL $ (991,389) SCHEDULE D, PART XII, LINE 4B BAD DEBT $ 838,387 CHARITY CARE $ 118,008 --------------- TOTAL $ 956,395 true true true X 300. false true true false true true 309508 64134 245374 0.00850 5500735 3503187 1997548 0.06900 5810243 3567321 2242922 0.07750 1150 1150 1150 1150 5811393 3567321 2244072 0.07750 true 7063876 8476142 -1412266 X true true 1 1 Bassett Hospital of Schoharie Cty 178 Grandview Drive Cobleskill NY 12043 4720001H X X X X Bassett Hospital of Schoharie Cty 1 false false true X X X X X X X X X 16 true true false true X See Section C X true 16 true See Section C false true X 300. 0. true true X X X X true X See Section C X See Section C X See Section C X X X X X true X false X X X X true X false false Facility 1, BASSETT HOSPITAL OF SCHOHARIE COUNTY - Part V, Line 5 THIS COMMUNITY HEALTH NEEDS ASSESSMENT HAS TAKEN INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE BROAD INTEREST OF THE COMMUNITY SERVED BY BASSETT HOSPITAL OF SCHOHARIE COUNTY (BHSC). THIS INCLUDES INPUT FROM INDIVIDUALS WITH EXPERTISE IN PUBLIC HEALTH, SPECIFICALLY, THE DIRECTOR OF THE SCHOHARIE COUNTY DEPARTMENT OF HEALTH. IN ADDITION TO COMMUNITY COMMENTS AND INPUT GATHERED IN RESPONSE TO POSTING OF THE COMMUNITY HEALTH NEEDS ASSESSMENT ON THE HOSPITAL'S WEBSITE, THE PRIMARY PROACTIVE MEANS FOR RECEIVING COMMUNITY INPUT WAS THROUGH A COMMUNITY-WIDE STAKEHOLDER MEETING HELD AND HOSTED BY BHSC ON MARCH 15, 2015. THE PURPOSE OF THE STAKEHOLDER MEETING WAS THREEFOLD: 1) TO ELICIT GENERAL COMMENTS ON THE DRAFT CHNA; 2) TO SEEK COMMUNITY INPUT ON THE PRIORITY HEALTH NEEDS IDENTIFIED BY THE CHNA; AND 3) TO SEEK COMMUNITY INPUT ON POTENTIAL IMPLEMENTATION STRATEGIES. TWENTY-SIX INDIVIDUALS REPRESENTING 17 AREA HEALTH PROVIDER AND COMMUNITY SERVICE ORGANIZATIONS ATTENDED THE SESSION. 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. EACH ALSO PROVIDED NUMEROUS OPPORTUNITIES FOR COMMUNITY INPUT AND PARTICIPATION IN REVIEWING AND INFLUENCING THE SELECTION OF PRIORITY HEALTH NEEDS. THE 2016-2018 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) 2016-2018 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. Facility 1, BASSETT HOSPITAL OF SCHOHARIE COUNTY - Part V, Line 6a BASSETT MEDICAL CENTER, TRI TOWN REGIONAL HOSPITAL, COBLESKILL REGIONAL HOSPITAL, O'CONNOR HOSPITAL, LITTLE FALLS HOSPITAL, AND AO FOX MEMORIAL HOSPITAL. Facility 1, BASSETT HOSPITAL OF SCHOHARIE COUNTY - Part V, Lines 7a & 10a The Hospital's CHNA and Implementation Strategy are made available on its website: www.bassett.org/medical/locations/hospitals/cobleskill-regional-hospital Facility 1, BASSETT HOSPITAL OF SCHOHARIE COUNTY - Part V, 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. Facility 1, BASSETT HOSPITAL OF SCHOHARIE COUNTY - Part V, Lines 16a-16c The Hospital's FAP, application form, and plain language summary are available on its website: www.bassett.org/medical/patients-visitors/billing-insurance/financial-assi stance SCHEDULE H, Part I, Line 3c Other Income Based Criteria for Free or Discounted Care 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. 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. SCHEDULE H, Part I, Line 6a Related Organization Information THE BASSETT HOSPITAL OF SCHOHARIE COUNTY COMMUNITY BENEFITS REPORT IS CONTAINED IN A REPORT PREPARED BY BASSETT HEALTHCARE NETWORK. SCHEDULE H, PART I, LINE 7, COLUMN (F) EXCLUSIONS FROM PERCENT OF TOTAL EXPENSE PART I, LINE 7, COLUMN (F) IS CALCULATED BY DIVIDING COLUMN (E), NET COMMUNITY BENEFIT EXPENSE, BY TOTAL EXPENSE. THE BAD DEBT EXPENSE OF $838,387 WAS SUBTRACTED FROM THE TOTAL EXPENSE VALUE USED TO CALCULATE THE PERCENTAGES IN PART 1, LINE 7, COLUMN F. SCHEDULE H, PART I, LINE 7 COSTING METHODOLOGY EXPLANATION FOR 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 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. SCHEDULE H, PART III, LINE 2 BAD DEBTS EXPENSE METHODOLOGY 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. PLEASE SEE THE FOLLOWING AUDITED FINANCIAL STATEMENT FOOTNOTE WHICH DESCRIBES THIS PRONOUNCEMENT. RECENT ACCOUNTING PRONOUNCEMENTS - FOOTNOTE 1(n)(i) from the Audited Financial Statements (ii) Revenue from contracts with customers Adoption of ASC 606 Upon adoption, the majority of what is currently classified as provision for uncollectible accounts and presented as a reduction to net patient service revenue on the statements of operations and changes in net assets is treated as a price concession that reduces the transaction price, which is reported as net patient service revenue. During 2018 and 2017, the Hospital incurred $838,387 and $2,131,218 in provisions for uncollectible accounts, respectively. SCHEDULE H, PART III, LINE 4 CHARITY CARE FOOTNOTE FOOTNOTE 1(j) from the Audited Financial Statements The Hospital has adopted a formal charity care policy whereby patients in need of medical services, who meet certain criteria under the policy, are treated without regard to their ability to pay for such services. Because the Hospital does not pursue collection of amounts determined to qualify as charity care, and therefore historical evidence demonstrates no payments are made by such patients, they are not reported as revenue. The Hospital maintains records to identify and monitor the level of charity care it provides. These records include the amount of charges forgone for services furnished under its charity care policy. The level of charity care, measured on the basis of established costs, is approximately $48,000 and $25,000 for 2018 and 2017, respectively. The cost of charity care provided was determined based on the application of a ratio of overall Hospital costs to patient charges. In addition, the cost of unreimbursed Medicaid services was approximately $1,185,000 in 2018 and $987,000 in 2017. The cost of unreimbursed Medicaid is determined based on the application of a cost to gross charge ratio to total Medicaid charges. Included in net patient service revenue for 2018 and 2017 is approximately $735,000 and $756,000, respectively, from statewide uncompensated care pools and income from restricted endowments to offset a portion of the cost of charity care. These uncompensated care pools are designed to help offset the cost of charity care and unreimbursed Medicaid services. SCHEDULE H, PART III, LINE 8 MEDICARE EXPLANATION BASSETT HOSPITAL OF SCHOHARIE COUNTY USED MEDICARE-APPROVED COSTS FROM THE 2017 MEDICARE COST REPORT, WHICH EMPLOY A COST-TO-CHARGE RATIO METHODOLOGY. THE HOSPITAL DID NOT DESIGNATE THE SHORTFALL REPORTED IN PART III, LINE 7 TOWARD COMMUNITY BENEFIT. SCHEDULE H, PART III, LINE 9B COLLECTION PRACTICES EXPLANATION FOR PATIENTS, OR GUARANTORS, WHO DO NOT QUALIFY FOR COMPLETE CHARITY CARE ASSISTANCE, THE HOSPITAL MUST UNDERTAKE TO ENSURE UNDERSTANDING OF OBLIGATIONS AND SATISFACTION OF OBLIGATIONS. THE HOSPITAL EMPLOYS A THIRD-PARTY SELF-PAY BILLING AGENCY, IN COMPLIANCE WITH EXISTING LAWS AND REGULATIONS, TO RECOVER SELF-PAY ACCOUNTS RECEIVABLE, PRESERVE THE PATIENT-PROVIDER RELATIONSHIP TO THE MAXIMUM EXTENT POSSIBLE, AND KEEP THE NECESSITY OF REFERRING ACCOUNTS TO THIRD PARTY BAD DEBT COLLECTION OR LAW FIRMS TO A MINIMUM. THIS AGENCY IS MEDICAL SELF-PAY ACCOUNTS RECEIVABLE SERVICES, LLC (MEDSPAR). AS A STRICTURE OF THE HOSPITAL'S UNIFIED CHARITY CARE, SELF-PAY BILLING & COLLECTION POLICY, BASSETT HOSPITAL OF SCHOHARIE COUNTY MUST ENSURE THAT BAD DEBT COLLECTION POLICIES OF ANY THIRD-PARTY AGENCY RETAINED FOR OUTSIDE DEBT COLLECTION REFLECT THE MISSION AND VALUES OF THE HOSPITAL, AS WELL AS REFRAIN FROM ANY CONDUCT THAT VIOLATES THE FAIR DEBT COLLECTION PRACTICES ACT, THE FAIR CREDIT REPORTING ACT, AS WELL AS ANY APPLICABLE STATE LAW OR REGULATIONS. UNDER THE MEDSPAR CREDIT AND COLLECTION POLICY (DOC. NO. 1), RESPONSIBLE PARTIES PLEADING INDIGENCE OR INABILITY TO ESTABLISH AN INSTALLMENT PLAN MUST COMPLETE AN APPLICATION FOR THE HOSPITAL'S CHARITY CARE OR COMMUNITY SERVICES PROGRAM. THE PATIENT WILL BE FORWARDED THE APPLICATION AND INFORMED THAT THEIR ACCOUNTS WILL BE TEMPORARILY SUSPENDED FROM FURTHER BILLING FOR 30 DAYS. THE RESPONSIBLE PARTY MAY MAKE INTEREST FREE MONTHLY INSTALLMENT PAYMENTS NOT TO EXCEED 10 PERCENT OF GROSS MONTHLY INCOME (WHICH MUST BE VERIFIED BY A COPY OF A CURRENT PAYSTUB OR EQUIVALENT PROOF OF INCOME), ACCORDING TO A SET SCHEDULE BASED ON ACCOUNT BALANCE AND MAXIMUM NUMBER OF MONTHS IN WHICH INSTALLMENTS MUST BE MADE. SCHEDULE H, PART VI, LINE 2 NEEDS ASSESSMENT 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. SCHEDULE H, 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. COMMUNITY SERVICE 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. SCHEDULE H, PART VI, LINE 4 COMMUNITY INFORMATION 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 RESIDENTS OF SCHOHARIE COUNTY (SCHOHARIE COUNTY HEALTH ASSESSMENT 2016- 18, SCHOHARIE COUNTY DEPT. OF HEALTH). 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 TO 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). SCHEDULE H, PART VI, LINE 5 PROMOTION OF COMMUNITY HEALTH 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 2017, THERE WERE A TOTAL OF 16 MEMBERS ON THE BASSETT HOSPITAL OF SCHOHARIE COUNTY BOARD OF TRUSTEES, OF WHOM 15 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 CONTINUE SERVING 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 ARE CHOSEN 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. SCHEDULE H, PART VI, LINE 6 AFFILIATED HEALTH CARE SYSTEM 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 HEALTH CENTERS, 2 AMBULATORY SURGERY CENTERS, AND A FULLY SALARIED MEDICAL STAFF IN COOPERSTOWN, OTSEGO COUNTY B. O'CONNOR HOSPITAL - CRITICAL ACCESS HOSPITAL IN DELHI, DELAWARE COUNTY C. BASSETT HOSPITAL OF SCHOHARIE COUNTY (DBA COBLESKILL REGIONAL HOSPITAL) - ACUTE CARE FACILITY IN COBLESKILL, SCHOHARIE COUNTY D. LITTLE FALLS HOSPITAL - CRITICAL ACCESS HOSPITAL IN LITTLE FALLS, HERKIMER COUNTY E. TRI-TOWN REGIONAL HOSPITAL - 2417 EMERGENCY CARE FACILITY IN SIDNEY, DELAWARE COUNTY F. A.O. FOX HOSPITAL -- ACUTE CARE FACILITY IN ONEONTA, OTSEGO COUNTY G. VALLEY HEALTH SERVICES - RESIDENTIAL HEALTH CARE AND REHABILITATION FACILITY H. AT HOME CARE - CERTIFIED HOME CARE AGENCY I. 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. SCHEDULE H, PART VI, LINE 7 NEW YORK X X false false false false false false false true false Michael Tengeres Trustee (until 4/2018) 0 147341 0 0 0 0 0 6245 0 720 0 154306 0 0 Joseph Sellers Trustee 0 328019 0 25500 0 0 0 25114 0 2160 0 380793 0 0 Eric Stein President & CEO 0 190777 0 13272 0 0 0 14533 0 7992 0 226574 0 0 Susan Oakes Ferrucci VP, Clinical Operations & CNO 158845 0 0 0 0 0 5111 0 11519 0 175475 0 0 0 David DeSando Director of Pharmacy 150230 0 0 0 0 0 4571 0 2128 0 156929 0 0 0 Christine Pirri VP, Non Cl Op & Compliance 145845 0 0 0 0 0 4412 0 1208 0 151465 0 0 0 Deborah Funk-Valois MD Trustee 0 387160 0 2647 0 0 0 16864 0 7355 0 414026 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, LINES 6, 7A, AND 7B 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, OConnor Hospital, Templeton Foundation, Valley Health Services, Tri-Town Regional 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, LINE 11B ORGANIZATIONS 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, 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, LINE 15A COMPENSATION PROCESS FOR TOP OFFICIAL ANNUAL REVIEW IS DONE BY THE ASSESSMENT OF PRESIDENT/CEO'S PERFORMANCE BY EACH MEMBER OF THE BOARD OF TRUSTEES, SENIOR MANAGEMENT, ADMINISTRATIVE AND CLINICAL LEADERSHIP, AND ACTIVE MEDICAL STAFF. THE ASSESSMENT TOOL ADDRESSES PERFORMANCE MEASURES THAT RELATE TO THE ORGANIZATION'S MISSION AND STRATEGY THAT IS IDENTIFIED IN THE INSTITUTION'S ANNUAL OPERATING PLAN AND BY SPECIFIC ITERATION BY THE BOARD OF TRUSTEES. INFORMATION RECEIVED IS SUMMARIZED AND PRESENTED TO THE EXECUTIVE AND FINANCE COMMITTEE FOR REVIEW AND CONCLUSION. FORM 990, PART VI, 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 XI, LINE 9 CHANGE IN FRIENDS OF BASSETT INTEREST $ (33,994) --------------- TOTAL $ (33,994) Bassett Healthcare Network One Atwell Road Cooperstown NY 13326 133218680 Support NY 501c3 12c NONE false Bassett Regional Corporation (BRC) One Atwell Road Cooperstown NY 13326 133522783 Support NY 501c3 N/A BHN false Friends of Bassett One Atwell Road Cooperstown NY 13326 237041610 Fundraise NY 501c3 7 BHN false AO Fox Memorial Hospital One Norton Avenue Oneonta NY 13820 150539039 Healthcare NY 501c3 3 BHN false Little Falls Hospital 140 Burwell Street Little Falls NY 13365 150533578 Healthcare NY 501c3 3 BHN false Mary Imogene Bassett Hospital One Atwell Road Cooperstown NY 13326 135596796 Healthcare NY 501c3 3 BHN false O'Connor Hospital 460 Andes Road Delhi NY 13753 161540394 Healthcare NY 501c3 3 BHN false Templeton Foundation One Atwell Road Cooperstown NY 13326 133317084 Landlord NY 501c3 10 BHN false Tri Town Regional Healthcare 43 Pearl Street Sidney NY 13838 260169584 Healthcare NY 501c3 3 BHN false Valley Health Services 690 West German Street Herkimer NY 13350 222511614 Elder care NY 501c3 3 BHN false Bassett PPS LLC 6181 State Highway 7 Oneonta NY 13820 811749905 Healthcare NY 501c3 12A MIBH false false false false false false false false true false true true true true true true true true true true Schedule R - Additional Information IN 2017 THURSTON CORPORATION COMPLETED A NAME CHANGE TO BASSETT HEALTHCARE NETWORK AND IS LISTED AS BHN FOR THE CONTROLLING ENTITY NAME DUE TO SPACE CONSTRAINTS.