2025-11-13T13:49:01+00:00 2024-12-31 135565207 KPMG LLP 515 Broadway 4th Floor Albany NY 12207 990 2024-01-01 141772971 Bassett Hospital of Schoharie County BASS 5182543456 178 GRANDVIEW DRIVE COBLESKILL NY 12043 STACI THOMPSON CEO 2025-11-13 true GENEVA FURLANO P01877392 5184274600 2025-11-13 2024 2025-03-06 01:10:19Z COBLESKILL REGIONAL HOSPITAL STACI THOMPSON 178 GRANDVIEW DRIVE COBLESKILL NY 12043 54725804 false X COBLESKILLHOSPITAL.ORG X 1994 NY SEE SCHEDULE O 12 10 218 11 0 2381131 1591925 44626394 52867036 111675 251105 14750 15738 47133950 54725804 0 0 14690026 17670441 0 64499 24235998 23423166 38926024 41093607 8207926 13632197 60021391 249437337 5616412 181332695 54404979 68104642 SEE SCHEDULE O false false 34116769 52867036 PROVISION OF HOSPITAL CARE TO RESIDENTS OF SCHOHARIE COUNTY AND THE SURROUNDING REGION. INPATIENT AND OUTPATIENT SERVICES PROVIDED TO OUR PATIENTS RESULTED IN OVER 800 HOSPITALIZATIONS, 4,800 PATIENT DAYS, 27,000 CLINIC VISITS, AND 11,000 EMERGENCY VISITS. 34116769 true true false true false false false false false true true false false true true true false true 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 false false true false false false false true 57 0 true 218 true false false false false false false false false false false false false X 12 10 false false false false true true true true true false false false true true true true true true true false false false NY X CRAIG FAERBER 6075473635 ONE ATWELL ROAD COOPERSTOWN NY 13326 Jennifer Saunders Treasurer 2.0 0 X X 0 0 0 Patricia O'Connor PhD Vice Chair 2.0 0 X X 0 0 0 Steven Kroll Chair 2.0 0 X X 0 0 0 Amy Gildemeister PhD Board Member 2.0 0 X 0 0 0 Antonio Cogliandro Board Member (Thru 6/24) 2.0 0 X 0 0 0 Daniel Ayres Secretary 2.0 0 X 0 0 0 Deborah Funk-Valois MD Board Member 2.0 40.0 X 0 333556 29773 Gloria Kupferman Board Member 2.0 0 X 0 0 0 John J Zacharek Board Member 2.0 0 X 0 0 0 Joseph Sellers MD Board Member (THRU 3/24) 2.0 42.0 X 0 43536 746 Matthew Sickles Board Member 2.0 0 X 0 0 0 Olayemi Racheal Jafojo MD Board Member (As of 10/24) 2.0 40.0 X 0 313133 14428 Steven Palmer Board Member 2.0 0 X 0 0 0 Sue Ellen Wagner Board Member 2.0 0 X 0 0 0 Craig Faerber Interim Network CFO 2.0 56.0 X 0 524460 0 Staci Thompson BHN President and CEO 2.0 52.0 X 0 866810 12117 Susan Oakes-Ferrucci President 40.0 4.0 X 294938 0 18014 Christopher Manley Supervising Pharmacist 40.0 0 X 162180 0 13594 Cindy Palmer Dir Ambulatory Nursing (Thru 10/24) 40.0 0 X 182789 0 2118 Ghazala Nathu Clinical Director Lab 40.0 0 X 181911 0 9787 Marcia Whitbeck Pharmacist II 40.0 0 X 181413 0 8017 Susan Franko Director of Operations 40.0 0 X 147963 0 7950 Christine Pirri FORMER VP NON-CLINICAL OPS 0.0 40.0 X 0 424892 8105 Tommy Ibrahim MD Former President 0.0 0.0 X 0 411723 12888 1151194 2918110 137537 43 true true false DAVIN HEALTHCARE WORKFORCE SOLUTIONS INC 18 DIVISION STREET SUITE 311 SARATOGA SPRINGS NY 12866 AGENCY 722705 TRUSTED NURSE STAFFING LLC 500 SENECA ST 501 BUFFALO NY 14204 AGENCY 636285 ALLIANCE HEALTHCARE SERVICES PO BOX 19532 IRVINE CA 92623 MRI SERVICES 584364 MAYO MEDICAL LABORATORIES 3050 SUPERIOR DR NW ROCHESTER MN 55905 LAB TESTING SERVICES 507263 MORRISON MANAGEMENT SPECIALISTS 5801 PEACHTREE DUNWOODY RD ATLANTA GA 30342 FOOD SERVICES 361304 8 98517 1271522 221886 1591925 NET PATIENT SERVICE REVENUE 900099 52867036 52867036 0 0 0 0 52867036 249233 0 249233 15738 0 15738 0 15738 15738 1872 0 1872 1872 1872 0 0 0 0 0 0 54725804 52867036 0 266843 294938 294938 14308052 12446502 1808530 53020 343420 294631 48789 1768241 1507117 258024 3100 955790 820004 135786 11834315 8121390 3712925 0 0 15945 0 15945 10011 10011 3497284 3488905 0 8379 1586 1586 76086 60664 15422 817063 681133 135930 31527 31527 13870 13870 24983 24983 1067103 703065 364038 458660 348245 110415 REAGENTS & PHARMACEUTICALS 2508480 2508480 SUPPLIES 1418075 1418075 BAD DEBT EXPENSE 1062421 1062421 CHARITY CARE 300551 300551 285206 285206 0 0 41093607 34116769 6912339 64499 3291684 5136688 3723360 1078072 0 509676 726194 5528460 0 0 0 0 353356 557207 127502 152174 30761410 23873609 7550632 6887801 0 0 44248663 229587259 60021391 249437337 1729485 1975163 363284 0 0 2978041 0 908886 178994248 5616412 181332695 53274295 66851807 1130684 1252835 54404979 68104642 60021391 249437337 13632197 67466 0 X false true true true true X 0 0 0 0 0 0 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 10011 10011 false Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY LOBBYING ACTIVITIES: IROQUOIS HEALTHCARE ALLIANCE DUES ALLOCATE 50% TOWARDS GENERAL LOBBYING ACTIVITIES. TOTAL DUES PAID IN 2024 WERE $6,996. AMERICAN HOSPITAL ASSOCIATION DUES ALLOCATE 39% TOWARDS GENERAL LOBBYING ACTIVITIES. TOTAL DUES PAID IN 2024 WERE $16,700. 987135 90937 1078072 307182 679953 987135 306265 917 307182 306098 167 306265 305552 546 306098 1.0 false false 33584 33584 18874151 13185696 5688455 1061249 972318 88931 10614859 9715595 899264 177567 177567 6887801 DUE FROM RELATED PARTIES 229070093 RIGHT TO USE ASSETS 517166 OTHER ASSETS 229587259 Federal Income Taxes OPERATING LEASES 505464 DUE TO RELATED PARTIES 171502114 ESTIMATED THIRD PARTY PAYABLES 6986670 178994248 X 0 0 0 0 0 0 0 0 0 0 0 0 Schedule D, Part V, Line 4 Intended uses of endowment funds INTENDED USES FOR ENDOWMENT FUNDS ENDOWMENT FUNDS HELD WITH INTEREST EARNED ARE UNRESTRICTED FOR GENERAL HOSPITAL EXPENDITURES. Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote 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, 2024 AND 2023. true true true X true X 314550 29417 285133 0.00694 5988866 3770132 2218734 0.05399 0 0.0 0 0 6303416 3799549 2503867 0.06093 329018 42805 286213 0.00696 0 0.0 0 0.0 0 0.0 0 0.0 0 0 329018 42805 286213 0.00696 0 0 6632434 3842354 2790080 0.06790 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0 0 0 0 0.0 true 11211776 10999351 212425 X true true 1 1 BASSETT HOSPITAL OF SCHOHARIE COUNTY 178 GRANDVIEW DRIVE COBLESKILL NY 12043 COBLESKILLHOSPITAL.ORG 4720700C X X X X BASSETT HOSPITAL OF SCHOHARIE COUNTY 1 false false true X X X X X X X X X 22 true false true true X http://www.bassett.org/locations/cobleskill-regional-hospital X true 22 true http://www.bassett.org/locations/cobleskill-regional-hospital false true X 200.0 400.0 X X X true true X X X X true X https://www.bassett.org/patients-visitors/billing-insurance/financial-assistance X https://www.bassett.org/patients-visitors/billing-insurance/financial-assistance X https://www.bassett.org/patients-visitors/billing-insurance/financial-assistance X X X X X X true X false X X X X true X false false Schedule H, Part V, Section B, Line 5 Facility , 1 Facility , 1 - BASSETT HOSPITAL OF SCHOHARIE COUNTY. THE BASSETT HEALTHCARE NETWORK (BHN) COLLABORATED WITH SCHOHARIE COUNTY PUBLIC HEALTH (SCPH) AND COBLESKILL REGIONAL HOSPITAL TO DEVELOP THE COMMUNITY HEALTH NEEDS ASSESSMENT/ COMMUNITY HEALTH ASSESSMENT IN ADDITION TO THE COMMUNITY SERVICE PLAN/COMMUNITY HEALTH IMPROVEMENT PLAN. THIS DOCUMENT IS A COLLECTION OF DATA FROM VARIOUS SOURCES, INCLUDING FEDERAL AND STATE DATABASES AND SURVEYS COLLECTED FROM COMMUNITY MEMBERS AND COMMUNITY SERVICE ORGANIZATIONS. THE SURVEYS, COMMUNITY ENGAGEMENT AND STAKEHOLDER ENGAGEMENT WERE OFFERED ELECTRONICALLY DURING THE DATES OF JUNE 29, 2022, TO AUGUST 6, 2022. INFORMATION COLLECTED REFLECTS THE CURRENT COUNTY STATUS AND PROBLEMS RELATED TO SIGNIFICANT HEALTH NEEDS OR SOCIAL DETERMINANTS OF HEALTH (SDOH). AFTER THE COLLECTION OF DATA WAS COMPLETE, THE COLLABORATION OF PARTNERS HELD A STAKEHOLDER FOCUS GROUP TO DISCUSS POTENTIAL INTERVENTIONS AND DECIDE WHAT AREAS SHOULD BE ADDRESSED IN THIS NYS PREVENTION AGENDA CYCLE 2022-2024. THE STAKEHOLDER FOCUS GROUP WAS HELD THROUGH ZOOM ON SEPTEMBER 12, 2022. Schedule H, Part V, Section B, Line 6b Facility , 1 Facility , 1 - BASSETT HOSPITAL OF SCHOHARIE COUNTY. SCHOHARIE COUNTY PUBLIC HEALTH (SCPH) AND BASSETT HEALTHCARE NETWORK (BHN) Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - BASSETT HOSPITAL OF SCHOHARIE COUNTY. 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 THE HOSPITAL'S CHNA AND IMPLEMENTATION STRATEGY ARE MADE AVAILABLE ON ITS WEBSITE: HTTPS://WWW.BASSETT.ORG/SITES/DEFAULT/FILES/2023-03/SCHOHARIE_COUNTY_COM MUNITY_HEALTH_NEEDS_ASSESSMENT_AND_COMMUNITY_SERVICE_PLAN_2022-2024.PDF BASSETT HOSPITAL OF SCHOHARIE COUNTY Schedule H, Part V, Section B, Line 16 Facility , 1 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/PATIENTS-VISITORS/BILLING-INSURANCE/FINANCIAL-ASSISTANCE BASSETT HOSPITAL OF SCHOHARIE COUNTY 0 Schedule H, Part I, Line 7f 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 $1,062,421 WAS SUBTRACTED FROM THE TOTAL EXPENSE VALUE USED TO CALCULATE THE PERCENTAGES IN PART 1, LINE 7, COLUMN F. Schedule H, Part I, Line 7b THE MEDICAID SHORTFALL IS INCLUDED IN THIS LINE IN THE AMOUNT OF $2,218,734. DURING 2024, THE HOSPITAL'S UNREIMBURSED MEDICAID WAS PARTIALLY OFFSET BY DIRECTED PAYMENT TEMPLATE (DPT) FUNDS RECEIVED THROUGH NEW YORK STATE'S HOSPITAL VITAL ACCESS PROVIDER ASSURANCE PROGRAM. THOSE FUNDS ARE INCLUDED IN THE DIRECT OFFSETTING REVENUE TOTAL REPORTED ON PART I LINE 7B COLUMN. Schedule H, Part I, Line 3c Underinsured is defined by NYS for FPL purposes as anyone who has insurance and is between 0-400% FPL. Underinsured individuals are required to show they have spent 10% of their annual income on eligible medical expenses. Uninsured patients automatically qualify if they are between 0-400% FPL. Patients are eligible for financial assistance through the hospital's program for emergency services for residents of New York State, and for all other services, if they reside within the hospital's primary service area. Schedule H, Part I, Line 6a Community benefit report prepared by related organization BASSETT HEALTHCARE NETWORK Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance FOR SECTIONS (A) CHARITY CARE AT COST, (B) UNREIMBURSED MEDICAID, AND (E) COMMUNITY HEALTH IMPROVEMENT SERVICES AND COMMUNITY BENEFIT OPERATIONS, THE COSTING METHODOLOGY APPLIED IS A COST-TO-CHARGE RATIO CALCULATION, AS USED ON FILED STATE AND FEDERAL COST REPORTS. Schedule H, Part II Community Building Activities 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. Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount 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 NON-VOLUNTARY PRICE CONCESSION. Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote CHARITY CARE FOOTNOTE (3) FROM THE CONSOLIDATED FINANCIALS THE 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 EXPENSE 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. Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs BASSETT HOSPITAL OF SCHOHARIE COUNTY USED MEDICARE-APPROVED COSTS FROM THE 2017 MEDICARE COST REPORT, WHICH EMPLOY A COST-TO-CHARGE RATIO METHODOLOGY. Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance 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 V, Section B, Line 16a FAP website - BASSETT HOSPITAL OF SCHOHARIE COUNTY: Line 16a URL: https://www.bassett.org/patients-visitors/billing-insurance/financial-assistance; Schedule H, Part V, Section B, Line 16b FAP Application website - BASSETT HOSPITAL OF SCHOHARIE COUNTY: Line 16b URL: https://www.bassett.org/patients-visitors/billing-insurance/financial-assistance; Schedule H, Part V, Section B, Line 16c FAP plain language summary website - BASSETT HOSPITAL OF SCHOHARIE COUNTY: Line 16c URL: https://www.bassett.org/patients-visitors/billing-insurance/financial-assistance; 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 Patient education of eligibility for assistance 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 COMMUNITY INFORMATION BASSETT HOSPITAL OF SCHOHARIE COUNTY'S PRIMARY SERVICE AREA ENCOMPASSES ALL OF SCHOHARIE COUNTY, WITH A POPULATION OF 29,714 (U.S. CENSUS BUREAU, DECENNIAL CENSUS 2020), 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 2020). ACCORDING TO THE US CENSUS DATA (2020), SCHOHARIE COUNTY HAS A WIDE DISTRIBUTION OF AGE RANGES WITH A MEDIAN AGE OF 46.3. NINETY-TWO PERCENT OF THE POPULATION IS WHITE, WITH ASIANS MAKING UP .96 PERCENT OF THE POPULATION AND BLACKS 1.3 PERCENT (U.S. CENSUS 2020). AMERICAN INDIAN AND NATIVE PACIFIC PERSONS TOGETHER REPRESENT .22 PERCENT OF THE POPULATION, AND 1.95 PERCENT OF TWO OR MORE RACES (U.S. CENSUS 2020). SPECIAL POPULATIONS IN SCHOHARIE COUNTY DO EXIST. FOR INSTANCE, THERE IS AN AMISH SETTLEMENT IN COBLESKILL, NY. ACCORDING TO THE ELIZABETHTOWN COLLEGE, YOUNG CENTER FOR ANABAPTIST AND PIETIST STUDIES, THE AMISH POPULATION IN SCHOHARIE COUNTY (2020) TOTALED 80 INDIVIDUALS, WHICH CONSISTS OF 0.27% OF THE COUNTY POPULATION (ELIZABETHTOWN COLLEGE, 2020). EDUCATIONAL LEVELS, UNEMPLOYMENT, AND POVERTY ARE IDENTIFIED BARRIERS TO THE HEALTH OF WITH AN UNEMPLOYMENT RATE OF 3 PERCENT (US DEPARTMENT OF LABOR BUREAU OF LABOR STATISTICS}, THE MEDIAN HOUSEHOLD INCOME IN SCHOHARIE COUNTY IS $58,926 (2015 2019 ACS)), WHICH IS $12,191 LESS THAN THE NEW YORK STATE MEDIAN. THE PERCENTAGE OF RESIDENTS WITH INCOMES BELOW THE FEDERAL POVERTY GUIDELINES IS 11.6 PERCENT (ACS 2020). ACCESS TO HEALTH INSURANCE HAS A SIGNIFICANT INFLUENCE ON THE ACCESS TO THE HEALTHCARE DOMAIN OF SDOH. LACKING HEALTH INSURANCE CAN PREVENT INDIVIDUALS FROM SEEKING CARE, PARTICIPATING IN PREVENTATIVE MEDICINE, AND ACCESSING PRIMARY CARE PROVIDERS. THE 2016 2020 ACS REPORTS THE RATE OF UNINSURED INDIVIDUALS IN SCHOHARIE COUNTY IS 4.17% WHICH IS LOWER THAN NEW YORK STATE (5.38%) AND THE UNITED STATES (8.73%). REGARDING PATIENT DEMOGRAPHICS, THOSE MOST LIKELY TO BE UNDERINSURED IN SCHOHARIE COUNTY ARE THOSE THAT ARE BETWEEN THE AGE OF 1864. "THE ADJUSTED COHORT GRADUATION RATE (ACGR) IS A GRADUATION METRIC THAT FOLLOWS A "COHORT" OF FIRST-TIME 9TH GRADERS IN A PARTICULAR SCHOOL YEAR, AND ADJUST THIS NUMBER BY ADDING ANY STUDENTS WHO TRANSFER INTO THE COHORT AFTER 9TH GRADE AND SUBTRACTING ANY STUDENTS WHO TRANSFER OUT, EMIGRATE TO ANOTHER COUNTRY, OR PASS AWAY. THE ACGR IS THE PERCENTAGE OF THE STUDENTS IN THIS COHORT WHO GRADUATE WITHIN FOUR YEARS" (NCES, 2017). IN THE SCHOHARIE COUNTY REPORT AREA, THE ADJUSTED COHORT GRADUATION RATE WAS 86.1% DURING THE MOST RECENTLY REPORTED SCHOOL YEAR; THE AVERAGE ACGR IS GREATER THAN NEW YORK STATE'S (86.8%). 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. THE ORGANIZATION EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS WHO ARE EMPLOYED BY BASSETT MEDICAL CENTER. 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. THE HOSPITAL OPERATES AN EMERGENCY ROOM WHICH IS OPEN TO ALL, REGARDLESS OF ABILITY TO PAY. 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: PREVENT CHRONIC DISEASES - EXPLORE OPPORTUNITIES AND FUNDING TO EXTEND SIDEWALKS TO PROVIDE SAFE ACCESS BY WALKING, BIKING AND WHEELING TO THE HOSPITAL - EXPLORE FUNDING FOR AN OUTDOOR TRAIL ON HOSPITAL GROUNDS - UTILIZES EARNED MEDIA TO PROMOTE ANY UPGRADES TO THE PHYSICAL ENVIRONMENT CONVENE PLANNING GROUP QUARTERLY FOR PROGRESS AND ACTION PLANNING PROMOTE WELL-BEING AND PREVENT MENTAL AND SUBSTANCE USE DISORDERS - EXPLORE PROVIDING EMERGENCY DEPARTMENT OVERDOSE DATA TO THE COUNTY FOR SURVEILLANCE - ATTEND COLLABORATION MEETINGS - CONTACT SCCASA TO PERFORM IN "ROOM" CONNECTION WITH THE PATIENT - FORWARD PATIENT INFORMATION TO SCCASA IF IMMEDIATE CONNECTION IS NOT DESIRED OR POSSIBLE - TRACK PATIENT REFERRALS - PROMOTE HEALTHY WOMEN, INFANTS AND CHILDREN NEW REFERRAL WORKFLOW FOR BASSETT HEALTHCARE NETWORK OB, PEDIATRIC, AND PRIMARY CARE CLINICS; IF GIVEN PERMISSION BY THE PATIENT, IDENTIFIED BHN FACILITIES WILL SEND THE NAME, DELIVERY DATE, AND PHONE NUMBER OF PREGNANT MOTHERS TO SCHOHARIE PUBLIC HEALTH (SPH). SPH WILL CONTACT THE PATIENT TO OFFER A NUMBER OF AVAILABLE RESOURCES TO THE MOTHER FOR THEIR EXPECTED CHILD (EX: CAR SEATS, HEALTH EDUCATION, ETC.). Schedule H, Part VI, Line 6 Affiliated health care system 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 BASSETT HEALTHCARE NETWORK HAS FOUR AREA COMMUNITY HOSPITALS, INCLUDING BASSETT MEDICAL CENTER AND A.O. FOX HOSPITAL IN OTSEGO COUNTY, O'CONNOR HOSPITAL IN DELAWARE COUNTY, COBLESKILL REGIONAL HOSPITAL IN SCHOHARIE COUNTY, AND LITTLE FALLS HOSPITAL IN HERKIMER COUNTY. ANOTHER HOSPITAL, A.O. FOX HOSPITAL - TRI-TOWN CAMPUS IN DELAWARE COUNTY, PROVIDES A 24/7 EMERGENCY CARE FACILITY IN SIDNEY. THE NETWORK ALSO SUPPORTS OVER 30 COMMUNITY-BASED OUTPATIENT HEALTH CENTERS, 16 SCHOOL-BASED HEALTH CENTERS; TWO AMBULATORY SURGERY CENTERS; VALLEY HEALTH SERVICES, A RESIDENTIAL HEALTH CARE, AND REHABILITATION FACILITY; AT HOME CARE, A CERTIFIED HOME CARE AGENCY; AND FIRST COMMUNITY CARE OF BASSETT, A MEDICAL SUPPLY COMPANY. 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. A.O. FOX HOSPITAL -- ACUTE CARE FACILITY IN ONEONTA, OTSEGO COUNTY F. VALLEY HEALTH SERVICES - RESIDENTIAL HEALTH CARE AND REHABILITATION FACILITY G. AT HOME CARE - CERTIFIED HOME CARE AGENCY H. AT HOME CARE PARTNERS - CERTIFIED HOME CARE AGENCY I. 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 K. TO THIS EIGHT-COUNTY REGION IN CENTRAL NEW YORK. Schedule H, Part VI, Line 7 State filing of community benefit report NY X X X true false false false false false false false false Deborah Funk-Valois MD Board Member 0 333556 0 0 0 0 0 25804 0 3969 0 363329 0 0 Olayemi Racheal Jafojo MD Board Member (As of 10/24) 0 268073 0 45060 0 0 0 12049 0 2379 0 327561 0 0 Tommy Ibrahim MD Former President 0 0 0 0 0 411723 0 12888 0 0 0 424611 0 0 Staci Thompson BHN President and CEO 0 826810 0 40000 0 0 0 0 0 12117 0 878927 0 0 Susan Oakes-Ferrucci President 294938 0 0 0 0 0 9048 0 8966 0 312952 0 0 0 Craig Faerber Interim Network CFO 0 524460 0 0 0 0 0 0 0 0 0 524460 0 0 Christine Pirri FORMER VP NON-CLINICAL OPS 0 111017 0 33592 0 280283 0 6732 0 1373 0 432997 0 0 Ghazala Nathu Clinical Director Lab 181911 0 0 0 0 0 5522 0 4265 0 191698 0 0 0 Marcia Whitbeck Pharmacist II 181413 0 0 0 0 0 5475 0 2542 0 189430 0 0 0 Cindy Palmer Dir Ambulatory Nursing (Thru 10/24) 134904 0 0 0 47885 0 0 0 2118 0 184907 0 0 0 Christopher Manley Supervising Pharmacist 162180 0 0 0 0 0 5114 0 8480 0 175774 0 0 0 Susan Franko Director of Operations 147963 0 0 0 0 0 4493 0 3457 0 155913 0 0 0 Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation 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. Schedule J, Part I, Line 4a Severance or change-of-control payment TOMMY IBRAHIM, MD RECEIVED A SEVERANCE PAYMENT IN THE AMOUNT OF $166,325 AND PTO PAYOUT IN THE AMOUNT OF $245,398. CHRISTINE PIRRI RECEIVED A SEVERANCE PAYMENT IN THE AMOUNT OF $223,947 AND PTO PAYOUT IN THE AMOUNT OF $56,336. CINDY PALMER RECEIVED A SEVERANCE PAYMENT IN THE AMOUNT OF $39,510 AND PTO PAYOUT IN THE AMOUNT OF $8,375. THESE AMOUNTS ARE INCLUDED IN THE TOTAL REPORTED IN COLUMN B(III). Form 990, Part I, Line 1 DESCRIPTION OF ORGANIZATION MISSION: PROVISION OF HEALTH CARE SERVICES TO RESIDENTS OF SCHOHARIE COUNTY AND THE SURROUNDING REGION. Form 990, Part III, Line 1 DESCRIPTION OF ORGANIZATION MISSION: PROVISION OF HEALTH CARE SERVICES TO RESIDENTS OF SCHOHARIE COUNTY AND THE SURROUNDING REGION. Form 990, Part VI, Line 6 Classes of members or stockholders BASSETT HEALTHCARE NETWORK IS THE PARENT AND SOLE MEMBER TO EACH OF THE FOLLOWING RELATED PARTIES. FRIENDS OF BASSETT, AO FOX MEMORIAL HOSPITAL, BASSETT HOSPITAL OF SCHOHARIE COUNTY, LITTLE FALLS HOSPITAL, O'CONNOR HOSPITAL, TEMPLETON FOUNDATION, VALLEY HEALTH SERVICES, VALLEY RESIDENTIAL SERVICES, AND MARY IMOGENE BASSETT HOSPITAL. AS PARENT AND SOLE MEMBER, BASSETT HEALTHCARE NETWORK HAS THE RIGHT TO APPOINT AND REMOVE MEMBERS OF THE GOVERNING BOARDS OF ITS SUBSIDIARIES AND APPROVE SIGNIFICANT DECISIONS OF THE GOVERNING BOARDS, INCLUDING, BUT NOT LIMITED TO, APPROVAL OF OPERATING AND CAPITAL BUDGETS, CERTAIN CAPITAL EXPENDITURES, INDEBTEDNESS NOT CONTAINED IN THE APPROVED BUDGETS, SUBSTANTIVE CHANGES IN CLINICAL PROGRAMS, MERGERS, CONSOLIDATIONS, LIQUIDATIONS AND DISSOLUTIONS INVOLVING ITS SUBSIDIARIES AND CERTIFICATE OF NEED APPLICATIONS. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body SEE DISCLOSURE FOR PART VI, SECTION A, LINE 6 Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders SEE DISCLOSURE FOR PART VI, SECTION A, LINE 6 Form 990, Part VI, Line 11b Review of form 990 by governing body ORGANIZATION'S PROCESS TO REVIEW FORM 990 THE 990S ARE PROVIDED TO THE BOARD BEFORE FILING. IF THERE ARE ANY QUESTIONS OR CONCERNS, THEY CAN RAISE IT WITH THE BOARD, CEO AND/OR CFO. Form 990, Part VI, Line 12c Conflict of interest policy 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 Process to establish compensation of top management official COMPENSATION PROCESS FOR TOP OFFICIAL THE PRESIDENT'S SALARY IS PAID BY A RELATED ORGANIZATION UNDER A MANAGEMENT SERVICES AGREEMENT. THE PRESIDENT'S WORKPLAN AND ACCOMPLISHMENTS FOR THE YEAR ARE OVERSEEN BY THE NETWORK LEADERSHIP AND REVIEWABLE BY THE BOARD. THE PRESIDENT'S SALARY IS SUBMITTED AS PART OF THE MANAGEMENT SERVICES AGREEMENT. Form 990, Part VI, Line 19 Required documents available to the public 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. BASSETT HEALTHCARE NETWORK ONE ATWELL ROAD COOPERSTOWN NY 13326 133218680 SUPPORT NY 501(c)(3) Type III-FI NONE false FRIENDS OF BASSETT ONE ATWELL ROAD COOPERSTOWN NY 13326 237041610 FUNDRAISER NY 501(c)(3) 7 BHN false AO FOX MEMORIAL HOSPITAL ONE NORTON AVENUE ONEONTA NY 13820 150539039 HEALTHCARE NY 501(c)(3) 3 BHN false LITTLE FALLS HOSPITAL 140 BURWELL STREET LITTLE FALLS NY 13365 150533578 HEALTHCARE NY 501(c)(3) 3 BHN false MARY IMOGENE BASSETT HOSPITAL ONE ATWELL ROAD COOPERSTOWN NY 13326 135596796 HEALTHCARE NY 501(c)(3) 3 BHN false O'CONNOR HOSPTIAL 460 ANDES ROAD DELHI NY 13753 161540394 HEALTHCARE NY 501(c)(3) 3 BHN false TEMPLETON FOUNDATION ONE ATWELL ROAD COOPERSTOWN NY 13326 133317084 LANDLORD NY 501(c)(3) 10 BHN false VALLEY HEALTH SERVICES 690 WEST GERMAN STREET HERKIMER NY 13350 222511614 ELDER CARE NY 501(c)(3) Type I BHN false VALLEY RESIDENTIAL SERVICES 690 WEST GERMAN STREET HERKIMER NY 13350 463703838 ELDER CARE NY 501(c)(3) 10 BHN false AT HOME CARE PARTNERS INC 25 ELM STREET ONEONTA NY 13820 562398098 HEALTHCARE NY 501(c)(3) 10 AHC INC false AT HOME CARE INC 25 ELM STREET ONEONTA NY 13820 161287069 HEALTHCARE NY 501(c)(3) 10 BHN false BASSETT PPS LLC 618 STATE HIGHWAY 7 ONEONTA NY 13820 811749905 HEALTHCARE NY 501(c)(3) Type I BHN false STANFORD PROFESSIONAL ASSOCIATES 1 NORTON AVENUE ONEONTA NY 13820 161322304 RENTAL NY NA N/A false false FIRST COMMUNITY CARE OF BASSETT 161504464 HEALTHCARE NY NA N/A false false CATSKILL CARE ENTERPRISES 1 NORTON AVENUE ONEONTA NY 13820 161236590 RETAIL PHARMACY NY AO Fox C Corporation false LEATHERSTOCKING PHYSICIANS PC ONE ATWELL ROAD COOPERSTOWN NY 13326 364864562 HEALTHCARE NY NA C Corporation false false false false false false false false true false true true true true true true true true true true