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BASSETT HOSPITAL OF SCHOHARIE COUNTY: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
BASSETT HOSPITAL OF SCHOHARIE COUNTY (EIN 14-1772971)
Tax period
2012-01-01 to 2012-12-31
Filed
2013-11-12
IRS object ID
201333169349304278
Schema version
2012v2.1
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2013-11-12T13:01:46-06:00Timestamp
Tax Period End Date2012-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1KPMG LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1515 Broadway 4th FloorAddressLine1
CityAlbanyCity
StateNYState
ZIP Code122072974ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN141772971EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Bassett Hospital of Schoharie CountyBusinessNameLine1
FieldValueIRS element (for citing)
In Care Of Name% LEANNA JENSEN VP FINANCE/CFInCareOfName
Name ControlBASSNameControl
Phone5182543456Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1178 Grandview DriveAddressLine1
Address Line2SuiteAddressLine2
CityCobleskillCity
StateNYState
ZIP Code120435144ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameEric SteinName
TitleCEOTitle
Phone5182543233Phone
Date Signed2013-11-11DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
Phone5184274600Phone
Date Prepared2013-11-08DatePrepared
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2016-03-07 17:11:31ZBuildTS

Form 990 IRS990

Doing Business As DoingBusinessAs

FieldValueIRS element (for citing)
Business Name Line1Cobleskill Regional HospitalBusinessNameLine1
FieldValueIRS element (for citing)
Name Of Principal Officer PersonEric h stein presidentceoNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1178 Grandview DriveAddressLine1
CityCobleskillCity
StateNYState
ZIP Code12043ZIPCode
FieldValueIRS element (for citing)
Gross Receipts27182844GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web Sitecobleskillhospital.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1994YearFormation
State Legal DomicileNYStateLegalDomicile
Activity Or Mission DescriptionPROVISION OF HEALTH CARE SERVICES TO RESIDENTS OF SCHOHARIE COUNTY AND THE SURROUNDING REGION.ActivityOrMissionDescription
Nbr Voting Members Governing Body16NbrVotingMembersGoverningBody
Nbr Independent Voting Members12NbrIndependentVotingMembers
Total Nbr Employees306TotalNbrEmployees
Total Nbr Volunteers55TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Contributions Grants Prior Year780348ContributionsGrantsPriorYear
Contributions Grants Current Year408922ContributionsGrantsCurrentYear
Program Service Revenue Prior Year25216492ProgramServiceRevenuePriorYear
Program Service Revenue CY26272938ProgramServiceRevenueCY
Investment Income Prior Year21487InvestmentIncomePriorYear
Investment Income Current Year-139819InvestmentIncomeCurrentYear
Other Revenue Prior Year267037OtherRevenuePriorYear
Other Revenue Current Year443874OtherRevenueCurrentYear
Total Revenue Prior Year26285364TotalRevenuePriorYear
Total Revenue Current Year26985915TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year12054484SalariesEtcPriorYear
Salaries Etc Current Year11924961SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year16500TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year13437979OtherExpensePriorYear
Other Expenses Current Year13941004OtherExpensesCurrentYear
Total Expenses Prior Year25508963TotalExpensesPriorYear
Total Expenses Current Year25865965TotalExpensesCurrentYear
Revenues Less Expenses Prior Year776401RevenuesLessExpensesPriorYear
Revenues Less Expenses CY1119950RevenuesLessExpensesCY
Total Assets BOY18768245TotalAssetsBOY
Total Assets EOY20713005TotalAssetsEOY
Total Liabilities BOY5178620TotalLiabilitiesBOY
Total Liabilities EOY5977167TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY13589625NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY14735838NetAssetsOrFundBalancesEOY
Mission DescriptionPROVISION OF HEALTH CARE SERVICES TO RESIDENTS OF SCHOHARIE COUNTY AND THE SURROUNDING REGION.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense18822742Expense
Revenue26272938Revenue
DescriptionPROVISION OF HOSPITAL CARE TO RESIDENTS OF SCHOHARIE COUNTY AND THE SURROUNDING AREA. IN 2012, THE NUMBER OF INPATIENTS CARED FOR WAS 748 AND THE NUMBER OF OUTPATIENTS CARED FOR WAS 66,763.Description
Total Program Service Expense18822742TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiestrueLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentstrueTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotetrueReportFin48Footnote
Independent Audit Financial StmttrueIndependentAuditFinancialStmt
Consolidated Audit Financial StmtfalseConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitaltrueHospital
Financial Stmt AttachedtrueFinancialStmtAttached
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With109670NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees306NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members16NbrVotingGoverningBodyMembers
Number Independent Voting Members12NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholdersfalseMembersOrStockholders
Election Of Board MembersfalseElectionOfBoardMembers
Decisions Subject To ApprovalfalseDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodyfalseForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OtherfalseCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
States Where Copy Of Return Is FiledNYStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonLEANNA JENSEN VP FINANCECFNamePerson
Telephone Number5182543456TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1178 GRANDVIEW DRIVEAddressLine1
CityCOBLESKILLCity
StateNYState
ZIP Code120435144ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (24 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationAverage Hours Per Week RelatedAverageHoursPerWeekRelatedOfficerOfficerHighest Compensated EmployeeHighestCompensatedEmployeeFormerFormer
Nancy S Bellinger
Trustee1.0X000
STEVEN C COLE
TRUSTEE1.0X0
MACDONALD J HOLMES DVM
TRUSTEE EMERITUS1.0X0
STEVEN KROLL
TRUSTEE1.0X0
HENRY LAMONT PE
TRUSTEE1.0X0
PETER D LOPEZ
TRUSTEE1.0X0
SUSAN K MCGIVER
TRUSTEE EMERITA1.0X0
RENEE SCIALDO SHEVAT PHD
TRUSTEE1.0X01.0
RANDY L CRAPSER
TRUSTEE1.0X0
ANNE CALDWELL MYERS PHD
2ND VICE CHAIR1.0X0X
NICHOLAS J NICOLETTA
TREASURER2.0X4835752653251.5X
JEFFREY J WOEPPEL
VICE CHAIR2.0X1976002207748.0X
JOSEPH R SELLERS MD
TRUSTEE1.0X2060091918740.0
EDWIN KINTZ
Trustee1.0X0
GEORGE KONTA CPA
Trustee1.0X0
ROBERT A LANCEY MD MBA
TRUSTEE1.0X5240743265840.0
ERIC H STEIN
PRESIDENT/CEO1644101408940.0X
BARBARA E DICOCCO
CHAIR1.002.5X
GLENN A PERRONE
SECRETARY1.003.5X
LEANNA I JENSEN
TRUSTEE38.01253988083X
JOAN MILLER
SENIOR DIRECTOR QUALITY RES38.01115426960X
SUSAN OAKES-FERRUCCI
VICE PRESIDENT PATIENT SVC/CNO38.0131736120354.0X
DAVID DE SANDO
DIRECTOR OF PHARMACY38.01424206967X
GERALD D GROFF MD
TRUSTEE3762992527542.0X
FieldValueIRS element (for citing)
Total Reportable Comp From Org511096TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs1951967TotalReportableCompFrmRltdOrgs
Total Other Compensation173863TotalOtherCompensation
Number Individuals GT100 K4NumberIndividualsGT100K
Formers ListedtrueFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (3 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
BENNETT CONTRACTING
693 PEARL STREETALBANYNY12202CONSTRUCTION210880
MEDICAL STAFFING NETWORK
901 Yamato Rd Suite 110BOCO RATONFL33431STAFF NURSE SERVICES127774
ATLAS HEALTHCARE LINEN
414 WEST TAYLOR STREETSYRACUSENY132023441LAUNDRY SERVICE115788
FieldValueIRS element (for citing)
Number Of Contractors GT100 K3NumberOfContractorsGT100K
Related Organizations215381RelatedOrganizations
Government Grants189586GovernmentGrants
All Other Contributions3955AllOtherContributions
Total Contributions408922TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionNET PATIENT SERVICE REVENUEDescription
Business Code900099BusinessCode
Total Revenue Column26272938TotalRevenueColumn
Related Or Exempt Function Income26272938RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue26272938TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column30460TotalRevenueColumn
Exclusion$30,460ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real0Real
Personal0Personal

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Other26650Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other196929Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other-170279Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-170279TotalRevenueColumn
Exclusion-$170,279ExclusionAmount

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmount
OTHER OPERATING REVENUE900099214143$214,143
COFFEE SHOP REVENUE90009968542$68,542
LIFELINE REVENUE900099110472$110,472

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column50717TotalRevenueColumn
Exclusion$50,717ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue443874TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column26985915TotalRevenueColumn
Related Or Exempt Function Income26272938RelatedOrExemptFunctionIncome
Exclusion$304,055ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total0Total

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total0Total

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total0Total

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total9770855Total
Program Services6851943ProgramServices
Management And General2918912ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total66152Total
Program Services50329ProgramServices
Management And General15823ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total1370652Total
Program Services930076ProgramServices
Management And General440576ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total717302Total
Program Services504281ProgramServices
Management And General213021ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total446685Total
Program Services23500ProgramServices
Management And General423185ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total51614Total
Management And General51614ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total100500Total
Management And General100500ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total7830Total
Management And General7830ManagementAndGeneral

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total0Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total2242320Total
Program Services2105812ProgramServices
Management And General136508ManagementAndGeneral
Fundraising0Fundraising

Advertising Advertising

FieldValueIRS element (for citing)
Total53337Total
Management And General53337ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total2413518Total
Program Services2135173ProgramServices
Management And General278345ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total903518Total
Program Services306277ProgramServices
Management And General597241ManagementAndGeneral

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total0Total

Travel Travel

FieldValueIRS element (for citing)
Total36287Total
Program Services7158ProgramServices
Management And General29129ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total7650Total
Program Services2432ProgramServices
Management And General5218ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total79541Total
Management And General79541ManagementAndGeneral

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total1330629Total
Program Services626823ProgramServices
Management And General703806ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total135270Total
Management And General135270ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
PURCHASED SERVICES32214532649805571648
BAD DEBTS21837802183780
UTILITIES50431443057373741
OTHER DIRECT EXPENSES6632273865584

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total156436Total
Program Services14042ProgramServices
Management And General142394ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total25865965Total
Program Services18822742ProgramServices
Management And General7043223ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY6103758BOY
EOY9407974EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY122925BOY
EOY123670EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY68983BOY
EOY73155EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY3042254BOY
EOY2572908EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY158889BOY
EOY151843EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY146416BOY
EOY147352EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis18692606LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec10774848LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY8903136BOY
EOY7917758EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY221884BOY
EOY318345EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY18768245BOY
EOY20713005EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY1757128BOY
EOY1736366EOY

Grants Payable GrantsPayable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY1590000BOY
EOY1470000EOY

Escrow Account Liability EscrowAccountLiability

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Loans From Officers Directors LoansFromOfficersDirectors

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY162195BOY
EOY206131EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

FieldValueIRS element (for citing)
BOY1357569BOY
EOY2280714EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY311728BOY
EOY283956EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY5178620BOY
EOY5977167EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY13365019BOY
EOY14416279EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY45916BOY
EOY140869EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY178690BOY
EOY178690EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY13589625BOY
EOY14735838EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY18768245BOY
EOY20713005EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses1119950ReconcilationRevenueExpenses
Reconcilation Other Changes26263ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement SeparateXFinancialStatementSeparate
FieldValueIRS element (for citing)
Audit CommitteetrueAuditCommittee
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Total Grassroots LobbyingTotalGrassrootsLobbying
Total Direct LobbyingTotalDirectLobbying
Total Lobbying ExpendituresTotalLobbyingExpenditures
Other Exempt Purpose ExpendituresOtherExemptPurposeExpenditures
Total Exempt Purpose ExpendituresTotalExemptPurposeExpenditures
Lobbying NontaxableLobbyingNontaxableAmount
Grassroots NontaxableGrassrootsNontaxableAmount
Tot Lobbying Grassroot Minus Non TxTotLobbyingGrassrootMinusNonTx
Tot Lobby Expend Mns Lobbying NontxTotLobbyExpendMnsLobbyingNontx
VolunteersfalseVolunteers
Paid Staff Or ManagementfalsePaidStaffOrManagement
Media AdvertisementsfalseMediaAdvertisements
Mailings MembersfalseMailingsMembers
Publications Or BroadcastfalsePublicationsOrBroadcast
Grants Other OrganizationsfalseGrantsOtherOrganizations
Direct Contact LegislatorsfalseDirectContactLegislators
Rallies DemonstrationsfalseRalliesDemonstrations
Other ActivitiestrueOtherActivities
Other Activities$7,830OtherActivitiesAmount
Total Lobbying Expenditures IIB7830TotalLobbyingExpendituresIIB
Not Described In501c3falseNotDescribedIn501c3
Form4720 Filed4912 TaxfalseForm4720Filed4912Tax

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierSchedule C, Part II-B, LIne 11Identifier
ExplanationIroquois Healthcare Alliance dues allocate 44.4% towards general lobbying activities. Total dues paid in 2012 = $8,053. Healthcare Association of New York State dues allocate 28.6% towards general lobbying activities. Total dues paid in 2012 = $14,875.Explanation

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmtsArtPublicExhibitionAmts
Held Works Of Art AmtsHeldWorksOfArtAmts

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance301615BeginningOfYearBalance
Investment Earnings Or Losses745InvestmentEarningsOrLosses
End Of Year Balance302360EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance300787BeginningOfYearBalance
Investment Earnings Or Losses828InvestmentEarningsOrLosses
End Of Year Balance301615EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance299789BeginningOfYearBalance
Investment Earnings Or Losses998InvestmentEarningsOrLosses
End Of Year Balance300787EndOfYearBalance

Current Year Minus3 Years CurrentYearMinus3Years

FieldValueIRS element (for citing)
Beginning Of Year Balance298476BeginningOfYearBalance
Investment Earnings Or Losses1313InvestmentEarningsOrLosses
End Of Year Balance299789EndOfYearBalance

Current Year Minus4 Years CurrentYearMinus4Years

FieldValueIRS element (for citing)
Beginning Of Year Balance293947BeginningOfYearBalance
Investment Earnings Or Losses4529InvestmentEarningsOrLosses
End Of Year Balance298476EndOfYearBalance
FieldValueIRS element (for citing)
Term Endowment EOY Balance1.00000TermEndowmentEOYBalance
Endowments Held By Unrelated OrgsfalseEndowmentsHeldByUnrelatedOrgs
Endowments Held By Related OrgsfalseEndowmentsHeldByRelatedOrgs

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis10214OtherCostOrOtherBasis
Book Value10214BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis11148204OtherCostOrOtherBasis
Depreciation5593748Depreciation
Book Value5554456BookValue
FieldValueIRS element (for citing)
Leasehold ImprovementsLeaseholdImprovements

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis7534188OtherCostOrOtherBasis
Depreciation5181100Depreciation
Book Value2353088BookValue
FieldValueIRS element (for citing)
Other Land BuildingsOtherLandBuildings
Total Of Book Value Land Buildings7917758TotalOfBookValueLandBuildings
Federal Income Tax Liability0FederalIncomeTaxLiability

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescriptionAmountAmount
INTEREST RATE SWAP AGREEMENT$251,198
ASSET RETIREMENT OBLIGATIONS$32,758
FieldValueIRS element (for citing)
Total Of Amounts283956TotalOfAmounts
Footnote In Part XIIIXFootnoteInPartXIII
Tot Revenue Etc Audited Fincl Stmt24802135TotRevenueEtcAuditedFinclStmt
Other Revenues-2183780OtherRevenues
Revenue Not Rptd F990-2183780RevenueNotRptdF990
Revenue Subtotal26985915RevenueSubtotal
Total Revenue Per Form99026985915TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt23655922TotExpensesEtcAuditedFinclStmt
Other Expenses Included-26263OtherExpensesIncluded
Expenses Not Rptd F990-26263ExpensesNotRptdF990
Expenses Subtotal23682185ExpensesSubtotal
Other Expenses Not Included2183780OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt2183780ExpensesNotRptdOnFinStmt
Total Expenses Per Form99025865965TotalExpensesPerForm990

Form990 Schedule D Part XIII Form990ScheduleDPartXIII (5 entries)

IdentifierIdentifierExplanationExplanation
Part V, Line 4ENDOWMENT FUNDS OF $178,690 HELD WITH INTEREST EARNED UNRESTRICTED FOR GENERAL HOSPITAL EXPENDITURES. ENDOWMENT FUNDS OF $37,500 WITH INTEREST EARNED TO BE USED FOR NURSING SCHOLARSHIPS.
Part X, Line 2The hospital is a not-for-profit corporation as described in section 501(c)(3) of the Internal Revenue Code 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 that need to be recorded.
Part XI, Line 2dBAD DEBT $2,183,780
Part XII, line 2dINTEREST EXPENSE DUE TO POSITIVE ADJUSTMENT ON INTEREST RATE SWAP AGREEMENT OF ($27,772). CHANGE IN INTEREST IN NET ASSETS OF FRIENDS OF BASSETT, INC. OF $1,509.
Part XII, Line 4bBAD DEBT $2,183,780

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care PolicytrueCharityCarePolicy
Written PolicytrueWrittenPolicy
FPG Reference Free CaretrueFPGReferenceFreeCare

Other Percentage OtherPercentage

FieldValueIRS element (for citing)
OtherXOther
Free Other Percentage300.FreeOtherPercentage
FieldValueIRS element (for citing)
FPG Reference Discounted CarefalseFPGReferenceDiscountedCare
Free Disc Care Medically IndigenttrueFreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity CaretrueAmountsBudgetedForCharityCare
Expenses Exceeded BudgetfalseExpensesExceededBudget
Annual Community Benefit ReporttrueAnnualCommunityBenefitReport
Report Publically AvailabletrueReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense187905TotalCommunityBenefitExpense
Direct Offsetting Revenue74089DirectOffsettingRevenue
Net Community Benefit Expense113816NetCommunityBenefitExpense
Percent Of Total Expense0.00480PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense3259974TotalCommunityBenefitExpense
Direct Offsetting Revenue892513DirectOffsettingRevenue
Net Community Benefit Expense2367461NetCommunityBenefitExpense
Percent Of Total Expense0.09990PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense3447879TotalCommunityBenefitExpense
Direct Offsetting Revenue966602DirectOffsettingRevenue
Net Community Benefit Expense2481277NetCommunityBenefitExpense
Percent Of Total Expense0.10470PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense10542TotalCommunityBenefitExpense
Net Community Benefit Expense10542NetCommunityBenefitExpense
Percent Of Total Expense0.00040PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Total Community Benefit Expense1179TotalCommunityBenefitExpense
Net Community Benefit Expense1179NetCommunityBenefitExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense5138638TotalCommunityBenefitExpense
Direct Offsetting Revenue4614019DirectOffsettingRevenue
Net Community Benefit Expense524619NetCommunityBenefitExpense
Percent Of Total Expense0.02220PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense8884TotalCommunityBenefitExpense
Net Community Benefit Expense8884NetCommunityBenefitExpense
Percent Of Total Expense0.00030PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense5159243TotalCommunityBenefitExpense
Direct Offsetting Revenue4614019DirectOffsettingRevenue
Net Community Benefit Expense545224NetCommunityBenefitExpense
Percent Of Total Expense0.02300PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense8607122TotalCommunityBenefitExpense
Direct Offsetting Revenue5580621DirectOffsettingRevenue
Net Community Benefit Expense3026501NetCommunityBenefitExpense
Percent Of Total Expense0.12770PercentOfTotalExpense

Community Support CommunitySupport

FieldValueIRS element (for citing)
Total Community Building Expense5949TotalCommunityBuildingExpense
Net Community Building Expense5949NetCommunityBuildingExpense
Percent Of Total Expense0.00020PercentOfTotalExpense

Total Total

FieldValueIRS element (for citing)
Total Community Building Expense5949TotalCommunityBuildingExpense
Net Community Building Expense5949NetCommunityBuildingExpense
Percent Of Total Expense0.00020PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense ReportedtrueBadDebtExpenseReported
Bad Debt Expense$985,938BadDebtExpenseAmount
Amount Attributable To51425AmountAttributableTo
Amount Reimbursed By Medicare5429006AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare6193059CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-764053MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection PolicytrueWrittenDebtCollectionPolicy
Provision For Charity CaretrueProvisionForCharityCare
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1BASSETT HOSPITAL OF SCHOHARIE COUNTYBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line1178 Grandview DriveAddressLine1
CityCobleskillCity
StateNYState
ZIP Code12043ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1BASSETT HOSPITAL OF SCHOHARIE COUNTYBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
CHNA ConductedfalseCHNAConducted
Eligibility Criteria ExplainedtrueEligibilityCriteriaExplained
Uses FPG FreetrueUsesFPGFree
FPG Free Percent300.FPGFreePercent
Uses FPG DiscountedfalseUsesFPGDiscounted
Explains BasisfalseExplainsBasis
Explains Application MethodtrueExplainsApplicationMethod
Includes Publicity MeasurestrueIncludesPublicityMeasures
Posted On WebsiteXPostedOnWebsite
Posted In Emergency RoomXPostedInEmergencyRoom
Posted In Admission OfficeXPostedInAdmissionOffice
Available On RequestXAvailableOnRequest
Actions On NonpaymenttrueActionsOnNonpayment
Permit Report To Credit AgencyXPermitReportToCreditAgency
Permit LawsuitXPermitLawsuit
Permit Lien On ResidenceXPermitLienOnResidence
Collection ActivitiesfalseCollectionActivities
Notify Upon AdmissionXNotifyUponAdmission
Notify Before DischargeXNotifyBeforeDischarge
Notified All PatientsXNotifiedAllPatients
Documented DeterminationXDocumentedDetermination
Nondiscrim Emergency Care PolicytrueNondiscrimEmergencyCarePolicy
Used Other MethodXUsedOtherMethod
Amounts Generally BilledfalseAmountsGenerallyBilled
Gross ChargesfalseGrossCharges

Form990 Schedule H Part VI Form990ScheduleHPartVI (14 entries)

IdentifierIdentifierExplanationExplanation
Part I, Line 3CBassett 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 is available. Under the hospital policy governing the Community Services Program, 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 (FPIG), 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 6aThe Bassett Hospital of Schoharie County community benefits report is contained in a report prepared by Bassett Healthcare Network.
Part I, Line 7For 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 subsidized health services, sections (e) community health improvement; portions of (f) health professions education, and (i) cash and in-kind contributions to community groups, which are comprised of the direct salary costs for hospital staff whose time was compensated by the hospital for time spent participating in activities that qualify as community benefits plus the current fiscal year FICA rate. Part 1, Line 7, column (f) is calculated by dividing column (e), net community benefit expense, by total expense. The bad debt expense of $2,183,780 was subtracted from the total expense value used to calculate the percentages in Part 1, Line 7, Column f.
Part IIThe hospital's community building activities 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. The hospital participated in a community partnership between Schoharie County Health Department, Cornell University Cooperative Extension, Schoharie County Community Action Program and BHSC was expanded and formalized to form the Healthier Lifestyles Coalition of Schoharie County. This group met regularly to establish and offer community improvement activities focused on improving nutrition and increasing physical activity. The hospital has also played a leadership role, together with the county health department, in the formation and implementation of a new collaborative coalition, called Healthy Families Schoharie, which involves community health efforts aimed at women, babies, and children. Among the services provided are education, links to community health resources, car seat safety checks, and an extended home visiting program to follow children from birth through age 5. The hospital also plays a leadership role in the Creating Healthy Places Partnership, which is an advisory board comprised of agencies throughout Schoharie County that direct the planning and implementation of a 5-year, $875,000 New York State Department of Health Creating Healthy Places Grant. The hospital receives no portion of these grant funds but provides representation on the advisory board. The mission of the grant is to make Schoharie County a healthier place to live, work, and play by implementing policy, systems, and environmental change that will promote increased access to fresh fruits and vegetables and support a more active lifestyle for all community members, which is in alignment with prevention and health priorities identified in the hospital's community health assessment. Also in line with the identified priorities in the assessment is hospital representation on the NY Connects coalition committee, which works to improve access to health services and resources for the elderly in our rural communities with a goal to promote independent living, access to quality healthcare, and the appropriate utilization of institution-based services.
Part III, Line 4Bassett Hospital of Schoharie County uses the ratio of cost-to-charges methodology from Worksheet 2, Ratio of Patient Care Cost-to-Charges. The description of how the organization accounts for discounts and for payments on patient accounts in determining bad debt expense is contained in the text of the following audited financial statement footnote; also included in this footnote is the description of the method the organization uses to determine the amount that reasonably could be attributable to patients who likely would qualify for financial assistance under the hospital's charity care policy, if sufficient information had been available to make a determination of their eligibility. Footnote text: 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, they are not reported as revenue. The Hospital maintains records to identify and monitor the level of charity care it provides. The level of charity care, measured on the basis of established costs, is approximately $101,000 and $113,000 for 2012 and 2011, respectively. The cost of charity care provided was determined based on the application of a ratio of overall Hospital costs to patient charges. Included in net patient service revenue for 2012 and 2011 is approximately $755,000 and $591,000, respectively, from uncompensated care pools and income from restricted endowments to offset a portion of the cost of charity care. The Hospital grants credit without collateral to patients, most of whom are local residents and are insured under third-party agreements. Services rendered to individuals when payment is expected and ultimately not received are written off to the allowance for estimated uncollectible accounts. Additions to the allowance for estimated uncollectible accounts are made by means of the provision for bad debts. Accounts written off as uncollectible are deducted from the allowance and subsequent recoveries are added. The amount of the provision for bad debts is based upon management's assessment of historical and expected net collections, business and economic conditions, trends in federal and state governmental health care coverage and other collection indicators. Accounts receivable are presented net of allowances for estimated uncollectible accounts of approximately $1,710,000.
Part III, Line 8Bassett Hospital of Schoharie County used Medicare-approved costs from the 2012 Medicare Cost Report, which employ a cost-to-charge ratio methodology. The hospital believes it is part of its charitable purpose to provide medical services to the elderly population even if the costs of the services are not fully covered by Medicare. Therefore, the hospital believes the shortfall on Part III, Line 7 should be considered as part of its community benefit.
Part III, Line 9bFor 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 structure 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.
Part V, Section B, Line 20dBassett Hospital of Schoharie County recognizes that services will be provided equally to all patients without regard to their ability to pay for such services. Charge schedules are, therefore, uniform. Billings to patients are based on these charge schedules.
Part VI, Question 2Needs Assessment: 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 Health Stream Research to obtain benchmarking data on patient satisfaction in order to assess how the hospital is perceived to be meeting patient needs. Data from written 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 quarterly reports. Health Stream Research is a national leader in providing customized patient satisfaction data to more than 1000 hospitals in the United States. (www.healthstreamresearch.com). The hospital also utilizes information from the standardized, publicly reported HCAHPS (Hospital Care Quality Information from the Consumer Perspective) 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, Question 3Patient 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 CRH-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 insure 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 (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. Additionally, a representative from FidelisCare was available one day per week on-site at the hospital throughout 2012. 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, Question 4Community Information: Bassett Hospital of Schoharie County's primary service area encompasses all of Schoharie County, with a population of 32,099 (U.S. Census 2012 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 17.5 percent of the population, while the New York State average is 14.1 percent (U.S. Census 2012). Ninety-six percent of the population is white, with Hispanics making up 2.9 percent of the population and Blacks 1.3 percent (U.S. Census 2012). 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 2012). Educational levels, unemployment, and poverty are identified barriers to the health of residents of Schoharie County (Schoharie County Health Assessment 2010-13, 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 $50,795 (US Census 2007-2011), which is nearly $6,156 less than the New York State median. The percentage of residents with incomes below the federal poverty guidelines is 10.7 percent (US Census State 2007-2011). Seventeen percent of Schoharie County residents lack health insurance (Schoharie County Community Health Assessment 2010 - 2013). Of the hospital's patients, 14% were Medicaid patients in 2012. 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: 87.2 percent for Schoharie County compared to 84.6 percent for the state. However, the percentage of the population with a college degree or higher is 12 percent lower than the New York State average: 20.5 percent for Schoharie County compared to 32.5 percent for the state (U.S. Census 2007-2011). 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, Question 5Promotion of Community Health: A majority of the Basset 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. Currently there are a total of 16 members on the Basset Hospital of Schoharie County Board of Trustees, of whom 11 are community volunteer board members who live in the service area. Four board members are executive-level employees of the Bassett Healthcare Network (BHN). One board member, who is trust advisor of The Clark Estates, Inc., holds a place on the various boards of BHN entities. 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. In 2012, these projects totaled approximately $226,000. For example, in 2012, work continued on a 10-year project (2004 - 2014) that will enhance building systems and meet standards set by the Joint Commission, which is the accreditation entity for hospitals nationwide. The project involved extension of sprinklers, heating and cooling improvements, and asbestos abatement, all targeted to enhance patient safety. Similarly, other investments were made to replace aging, increasingly unreliable equipment and to secure medical technology and equipment advances that will insure that the only hospital in the county continues to offer its patients safe, quality patient care that meets accepted standards of care. This included the 2012 implementation of the Electronic Medical Record. The new system means a BHSC patient's information will be readily and accurately available to the appropriate healthcare providers throughout the Bassett network. Moreover, electronic medical record systems nationally are expected to lead to significant improvements in patient safety and quality of care, along with improvements in efficiency and coordination of care among multiple providers. Other examples of equipment/technology improvements made to improve health care in 2012 include new ultrasound equipment with 3D and 4D imaging to help doctors to diagnose and treat a variety of conditions, with a pricetag of $150,000. This equipment will help enable the hospital to continue to deliver appropriate, high-quality, safe emergency, preventitive, inpatient, and outpatient healthcare to our patients and to our rural, aging community (portions of the county are a federally designated rural area). Additionally, renovations in the hospital inpatient area will ensure ADA compliance and further the goals of the hospital's NICHE designation, which was attained in 2011 (Nurses Improving Care for Health System Elders). 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 the following: Diabetes community education and evidence-based support program; Senior Lunch and Learn education series; 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 spent coordinating events not sponsored by the hospital, such as blood drives and Marathon for a Better Life for the benefit of cancer patients/survivors in the community; 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; Provision of a program specifically requested by the Middleburgh Central School District to acclimate kindergarten students to the emergency room, medical imaging, and other hospital services which they may encounter. The hospital also provides community benefits services not easily counted or portrayed quantitatively. In 2012, these included regular educational displays in public areas of the hospital on a variety of health/wellness; a community newsletter dedicated in large part to educational messages intended to improve health knowledge, attitudes, skills/behaviors related to prevention priorities; private, individual staff donations to specific patients in need; and hundreds of hours of staff volunteer time in a wide-range of activities that promote the health of the community.
Part VI, Question 6Affiliated 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 seven counties. The network focuses its community services programs in the counties where the six affiliated hospitals and greatest patient populations are located. Otsego County - population 61,917; Delaware County - population 47,559; Herkimer County - population 64,160 (according to the 2011 U.S. Census estimates); and Schoharie County - population 32,578 (U.S. Census 2011 estimate), a. Bassett - an acute care inpatient teaching facility, an outpatient primary and specialty care center, a regional network of 26 community-based outpatient health centers, 19 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 - 24/7 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-i) make up Bassett Healthcare Network and provide health services to this seven-county region in central New York.
Part VI, Question 7State Filing of Community Benefit Report: New York State

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlanfalseSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (6 entries)

TitleTitleComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Related OrgsBonusRelatedOrgsDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Related OrgsTotalCompensationRelatedOrgsOther Compensation Related OrgsOtherCompensationRelatedOrgs
NICHOLAS J NICOLETTA
TREASURER376575107000230963436510107
JEFFREY J WOEPPEL
VICE CHAIR197600175964481219677
GERALD D GROFF MD
TRUSTEE3726502309621794015743649
JOSEPH R SELLERS MD
TRUSTEE20550018201986225196509
ERIC H STEIN
PRESIDENT/CEO164410102663823178499
ROBERT A LANCEY MD MBA
TRUSTEE52155425201809614562556732

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
IdentifierPart I, Line 3Identifier
ExplanationThe 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.Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (6 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
PART VI - SECTION B - NUMBER 11AThe 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.
PART VI-SECTION B - NUMBER 12CMEMBERS OF THE BOARD OF TRUSTEES COMPLETE CONFLICT OF INTEREST QUESTIONNAIRE ANNUALLY. A SUMMARY OF RESULTS IS REPORTED EACH YEAR AT THE ANNUAL MEETING OF THE BOARD OF TRUSTEES.
PART VI-SECTION B - NUMBER 15AANNUAL 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 FINANACE COMMITTEE FOR REVIEW AND CONCLUSION.
PART VI-SECTION C - NUMBER 19GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC BY REQUEST OF THE ADMINISTRATIVE OFFICE.
PART XI - NUMBER 5$27,772 INTEREST RATE SWAP AGREEMENT (1,509) CHANGE IN INTEREST IN NET ASSETS OF FRIENDS OF BASSETT $26,263 TOTAL CHANGE IN NET ASSETS OR FUND BALANCECHANGES IN NET ASSETS OR FUND BALANCE
FORM 990, PART X - PREPAID EXPENSES AND DEFERRED CHARGESPREPAID EXPENSES 147,352

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (10 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrg
Thurston Corporation
One Atwell RoadCooperstownNY13326133218680supportingorgNY501(c)(3)11cNAfalse
FRIENDS OF BASSETT
ONE ATWELL ROADCOOPERSTOWNNY13326237041610SOLICITS CONTNY501(c)(3)7THURSTONfalse
MARY IMOGENE BASSETT HOSPITAL
ONE ATWELL ROADCOOPERSTOWNNY13326135596796HEALTH CARENY501(c)(3)3THURSTONfalse
AURELIA OSBORNE FOX MEMORIAL HOSPITAL SO
ONE NORTON AVENUEONEONTANY13820150539039HEALTH CARENY501(c)(3)3THURSTONfalse
TEMPLETON FOUNDATION
ONE ATWELL ROADCOOPERSTOWNNY13326133317084REAL ESTATENY501(c)(3)9THURSTONfalse
BASSETT REGIONAL CORPORATION
ONE ATWELL ROADCOOPERSTOWNNY13326133522783PLAN & POLICYNY501(c)(3)11BTHURSTONfalse
O'CONNOR HOSPITAL
460 ANDES ROADDELHINY13753161540394HEALTH CARENY501(c)(3)3BRCfalse
TRI TOWN REGIONAL HEALTHCARE
43 PEARL STREETSIDNEYNY13838260169584HEALTH CARENY501(c)(3)3BRCfalse
LITTLE FALLS HOSPITAL
140 BURWELL STREETLITTLE FALLSNY13365150533578HEALTH CARENY501(c)(3)3BRCfalse
VALLEY HEALTH SERVICES
690 WEST GERMAN STREETHERKIMERNY13350222511614HEALTH CARENY501(c)(3)3BRCfalse
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgfalseGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgtrueGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgstrueRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgsfalseRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgsfalsePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgstruePerformOfServicesByOtherOrgs
Sharing Of FacilitiesfalseSharingOfFacilities
Sharing Of Paid EmployeesfalseSharingOfPaidEmployees
Reimbursement Paid To Other OrgtrueReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgtrueReimbursementPaidByOtherOrg
Other Transfer To Other OrgfalseOtherTransferToOtherOrg
Other Transfer From Other OrgtrueOtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable

Name Of Other Organization NameOfOtherOrganization

FieldValueIRS element (for citing)
Business Name Line1BASSETT REGIONAL CORPORATIONBusinessNameLine1
FieldValueIRS element (for citing)
Transaction TypeCTransactionType
Amount Involved100000AmountInvolved
Method Of Amt DeterminationCASHMethodOfAmtDetermination