2024-11-14T13:55:17-06:00 2023-12-31 135565207 KPMG LLP 515 BROADWAY 4TH FLOOR ALBANY NY 122072974 990 2023-01-01 161540394 O'CONNOR HOSPITAL OCON 6077460326 460 ANDES ROAD DELHI NY 13753 STACI THOMPSON CEO 6077460326 2024-11-15 1 0 GENEVA FURLANO P01877392 5184274600 2023 2024-10-15 13:58:12Z STACI THOMPSON 460 ANDES ROAD DELHI NY 13753 22201131 0 X WWW.OCONNORHOSP.ORG X 1997 NY IMPROVING THE HEALTH OF OUR PATIENTS AND WELL-BEING OF OUR COMMUNITIES. 13 11 175 11 533220 0 593241 555419 22554481 21254586 6388 0 348063 391126 23502173 22201131 0 0 0 0 9593580 10086382 0 0 37422 13411374 10845833 23004954 20932215 497219 1268916 39449351 41031766 3441241 3129802 36008110 37901964 IMPROVING THE HEALTH OF OUR PATIENTS AND WELL-BEING OF OUR COMMUNITIES. 0 0 16199741 21254586 INPATIENT AND OUTPATIENT SERVICES PROVIDED TO OUR PATIENTS RESULTED IN:HOSPITALIZATIONS: 452PATIENT DAYS: 3,156CLINIC VISITS: 8,849 61292 COMMUNITY INVOLVEMENT HAS BEEN LINKED TO O'CONNOR HOSPITAL'S MISSION AND VALUES SINCE IT FIRST OPENED. WE ARE WORKING WITH OUR COMMUNITY TO IMPROVE THE QUALITY OF LIFE FOR THE PEOPLE OF OUR REGION. OUR COMMUNITY SERVICES PROGRAMS PROVIDE FREE SERVICES TO PERSONS WHO CANNOT AFFORD TO PAY, WHO DO NOT QUALIFY FOR MEDICAID, AND WHO FALL WITHIN THE ESTABLISHED INCOME GUIDELINES. IN 2023, WE PROVIDED $61,292 IN FREE CARE. OUR DOORS ARE OPEN 24 HOURS A DAY, 7 DAYS A WEEK, 365 DAYS A YEAR. WE ARE PROUD TO PROVIDE THIS CARE TO OUR COMMUNITIES. NOT ONLY DID WE PROVIDE $61,292 IN CHARITY CARE, $892,263 IN PATIENT ACCOUNTS WERE RECORDED AS BAD DEBT IN 2023. 16261033 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 38 0 1 175 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 13 11 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 0 0 NY X CRAIG FAERBER 6077460326 31 BEAVER STREET COOPERSTOWN NY 13326 PETER HAMILTON CHAIRMAN 4.00 0.00 X X 0 0 0 BRUCE MCKEEGAN VICE CHAIRMAN 1.00 0.00 X X 0 0 0 JOHN JACK LYNCH TREASURER 1.00 0.00 X X 0 0 0 JOYCE BARBER SECRETARY 1.00 0.00 X X 0 0 0 JACKIE WILLIAMS ASSISTANT BOARD SECRETARY 1.00 0.00 X X 92271 0 3995 SUSAN OAKES-FERRUCCI PRESIDENT/CEO 40.00 0.00 X X 0 257286 20056 POLLY DELLACROSSE TRUSTEE 1.00 0.00 X 0 0 0 CHARLOTTE HILL TRUSTEE 1.00 0.00 X 0 0 0 DR PETER SOSNOW TRUSTEE 1.00 40.00 X 0 70027 0 DONALD HARRIS PHD TRUSTEE 1.00 0.00 X 0 0 0 ERICA PELLEGRINO TRUSTEE 1.00 0.00 X 0 0 0 PAMELA VOGT TRUSTEE 1.00 0.00 X 0 0 0 DR FRANK SILAGY TRUSTEE 1.00 0.00 X 0 0 0 JIM VIELKIND VP OF FINANCE 40.00 X 0 232159 13013 DR TIMOTHY WHITAKER MEDICAL DIRECTOR 1.00 0.00 X 554370 0 35867 ANDREA BARCOMB PHARMACIST 40.00 0.00 X 167386 0 8611 EMILEE GUEVARRA SUPERVISOR LAB SERVICES 40.00 0.00 X 134525 0 7868 DANIEL ENDRESS DIR OF OPS/NURSING 40.00 0.00 X 141006 0 10270 ERIN KINGSBURY PHARMACIST 40.00 0.00 X 174425 0 19339 KONSTANTIN VLAHOS SUPERVISING PHARMACIST 40.00 0.00 X 142698 0 10911 ERIC STEIN FORMER PRESIDENT 0.00 40.00 X 0 162020 0 1406681 721492 129930 24 1 1 0 MEDEFIS PO BOX 5068 NEW YORK NY 10087 AGENCY 393409 CROTHALL FACILITIES MANAGEMENT 1500 LIBERTY RIDGE DRIVE WAYNE PA 19087 FACILITY SERVICES 364258 AYA HEALTHCARE 5930 CORNERSTONE COURT W 300 SAN DIEGO CA 92121 AGENCY 357339 MORRISON MANAGEMENT SPECIALISTS 5801 PACHTREE DUNWOODY ROAD ATLANTA GA 30342 FOOD SERVICES 271470 MAYO MEDICAL LABORATORIES 3050 SUPERIOR DR NW ROCHESTER MN 55905 LAB TESTING SERVICES 229739 5 370928 184491 555419 DIRECT PATIENT SERVICES 621990 20716778 20716778 OUTPATIENT PHARMACY 456110 533220 533220 OTHER PROGRAM SERVICES 621990 4588 4588 21254586 391126 0 391126 391126 391126 22201131 20721366 533220 391126 X 686503 686503 7739155 6391141 1311830 36184 284845 219201 65644 736550 736550 639329 638178 1151 1015690 1015690 16244 16244 12500 12500 19245 19245 4761218 4384096 377122 39892 30274 9583 35 73855 56049 17806 462554 351032 111522 18318 13902 4416 10353 10353 1143969 868158 275759 52 334343 253733 80610 DRUGS AND REAGENTS 1184937 1184937 BAD DEBT 892263 892263 PATIENT CARE SUPPLIES 799160 799160 CHARITY CARE 61292 61292 20932215 16261033 4633760 37422 13108786 13781999 19352772 565074 2824849 2455599 271404 319419 92942 94957 23208672 16186199 7681488 7022473 275798 288519 250000 250000 1162085 10682953 39449351 41031766 917095 828763 342070 147683 2182076 2153356 3441241 3129802 X 34959793 36228709 1048317 1673255 36008110 37901964 39449351 41031766 1268916 624938 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 19245 19245 0 PART II-B, LINE 1: SCHEDULE C, PART II-B, LINE 1 - AMERICAN HOSPITAL ASSOCIATION MEMBERSHIP DUES ALLOCATE 32% TOWARDS LOBBYING ACTIVITIES. IROQUOIS MEMBERSHIP DUES ALLOCATE 54% TOWARDS GENERAL LOBBY ACTIVITIES. THE TOTAL DUES PAID BY BOTH ORGANIZATIONS ATTRIBUTABLE TO LOBBYING ACTIVITIES DURING 2023 WERE $19,245. 275798 250000 525798 251917 23881 275798 251917 251917 1.00000 0 0 203138 203138 15277393 9993579 5283814 942181 597910 344271 6761875 5594710 1167165 24085 24085 7022473 DUE FROM RELATED PARTIES 9978822 OPERATING LEASE RIGHT-USE 704131 10682953 OPERATING LEASE RIGHT OF USE 688641 THIRD PARTY PAYABLES 1464715 2153356 X PART V, LINE 4: INTENDED USES FOR ENDOWMENT FUNDS PERMANENTLY RESTRICTED ENDOWMENT FUNDS ARE HELD IN PERPETUITY WITH RESTRICTIONS ON INCOME FOR O'CONNOR NURSING EDUCATION AND ADVANCEMENT. PRIOR YEAR ADJUSTMENT THE AMOUNT REPORTED ON LINE 2 OF THE CURRENT YEAR REPRESENTS A PRIOR PERIOD ADJUSTMENT TO AMOUNTS CONTRIBUTED TO THE ENDOWMENT FUND. PART X, LINE 2: O'CONNOR HOSPITAL IS AN AFFILIATE 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, 2023 AND 2022. 1 1 1 X 300.000000000000 0 1 1 1 0 1 1 60399 31056 29343 0.00140 950534 950534 110131 48770 61361 0.00290 1121064 1030360 90704 0.00430 414668 192374 222294 0.01060 414668 192374 222294 0.01060 1535732 1222734 312998 0.01490 1 6228461 6018716 209745 X 1 1 1 1 O'CONNOR HOSPITAL 460 ANDES ROAD DELHI NY 13753 WWW.OCONNORHOSP.ORG 1254700C X X X X OUTPATIENT PRIMARY & SPECIALITY O'CONNOR HOSPITAL 1 0 0 1 X X X X X X X X X X 22 1 1 1 1 X SEE SECTION C 1 22 1 SEE SECTION C 0 1 X 300.000000000000 0.000000000000 0 1 X X X X 1 X SEE SECTION C X SEE SECTION C X SEE SECTION C X X X X 1 X 0 X X X 1 X 0 0 O'CONNOR HOSPITAL PART V, SECTION B, LINE 3J: BASSETT HEALTHCARE NETWORK, O'CONNOR HOSPITAL, IN COLLABORATION WITH DELAWARE COUNTY PUBLIC HEALTH, MARGARETVILLE MEMORIAL HOSPITAL, AND UHS DELAWARE VALLEY HOSPITAL, DEVELOPED A COMMUNITY SERVICE PLAN TO ADDRESS THE HEALTH INEQUITIES DEFINED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT FOR DELAWARE COUNTY, NY, ALSO A COLLABORATIVE EFFORT. O'CONNOR HOSPITAL PART V, SECTION B, LINE 5: THE COMMUNITY SERVICE PLAN IS A COMPREHENSIVE 3-YEAR PLAN TO ADDRESS THE HEALTH EQUITY DISPARITIES FOUND IN THE CHNA THROUGH COLLABORATIVE COMMUNITY HEALTH INITIATIVES. NEW YORK STATE PREVENTION AGENDA 2019-2024 ORGANIZATIONS CREATING THE CSP ARE PROVIDED THE NYS PREVENTION AGENDA 2019-2024, WHICH IS A BLUEPRINT FOR NEW YORK STATE'S HEALTH IMPROVEMENT PLAN FOR STATE AND LOCAL ACTION TO IMPROVE THE HEALTH AND WELL-BEING OF ALL NEW YORKERS AND PROMOTE HEALTH EQUITY ACROSS POPULATIONS WHO EXPERIENCE DISPARITIES. THE BLUEPRINT PROVIDES ACCEPTABLE PRIORITY AREAS TO FOCUS ON BASED ON THE EVIDENCE FOUND. THERE ARE FIVE MAIN PRIORITY AREAS IN THE NYSDOH PREVENTION AGENDA 2019-2024. - PREVENT CHRONIC DISEASE - PROMOTE A HEALTHY AND SAFE ENVIRONMENT - PROMOTE HEALTH FOR WOMEN, INFANTS, AND CHILDREN - PROMOTE WELL-BEING AND PREVENT MENTAL AND SUBSTANCE USE DISORDERS - PREVENT COMMUNICABLE DISEASE DATA MINING OF PRIMARY AND SECONDARY DATA SOURCES WAS CONDUCTED THROUGHOUT THE PROCESS AND PRESENTED TO THE CORE GROUP OF STAKEHOLDERS FOR DISCUSSION AND REVIEW. REPRESENTATIVES FROM DELAWARE COUNTY PUBLIC HEALTH, DELAWARE VALLEY HOSPITAL, MARGARETVILLE MEMORIAL HOSPITAL, AND O'CONNOR HOSPITAL HELD SEVERAL COUNTY, REGIONAL, AND STATE-LEVEL MEETINGS TO GATHER ADDITIONAL INPUT ON THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). THE LIST OF COALITIONS, WORK GROUPS, AND TASK FORCES IS PROVIDED IN THE CHNA.A CRUCIAL PART OF ASSESSING THE HEALTH OF OUR COMMUNITIES IS NOT ONLY COLLECTING OBJECTIVE DATA BUT ALSO SUBJECTIVE PERCEPTIONS OF THE COUNTY'S HEALTH STATUS (CHNA) FROM THE COMMUNITY MEMBER AND STAKEHOLDERS. THE DELAWARE COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT LEVERAGED ELECTRONIC SURVEYS TARGETED AT COMMUNITY MEMBERS AND STAKEHOLDERS. A WEB LINK WAS DISTRIBUTED THROUGH EMAIL AND SOCIAL MEDIA, INVITING PARTICIPANTS TO PARTICIPATE.ON MAY 17, 2022, THE COMMUNITY ENGAGEMENT SURVEY WAS POSTED ONLINE. THE SURVEY WAS CLOSED ON JUNE 23, 2022, AFTER RECEIVING 442 RESPONSES. RESPONDENT DEMOGRAPHICS: - LIVE IN DELAWARE COUNTY (99.77%) - PRIMARILY FEMALE (80.54%) - PRIMARILY WHITE (92.99%) AND NOT HISPANIC OR LATINO (90.93%) - HIGHEST AGE GROUP REPRESENTATION: 50-64 YRS OF AGE (38.32%), 35-49 (26.08%), AND OVER 65 (24.94%) THERE WERE A VERY LARGE NUMBER OF WRITTEN COMMENTS THAT INDICATED THE NEED FOR A COMMUNITY THAT COMES TOGETHER, THE IMPORTANCE OF MENTAL HEALTH SERVICES, A NEED FOR COMMUNITY PROGRAMS AND RECREATIONAL EVENTS, SOCIOECONOMIC STRUGGLES, ACCESS TO HEALTHCARE, AND LACK OF TRANSPORTATION. O'CONNOR HOSPITAL PART V, SECTION B, LINE 6A: UHS DELAWARE VALLEY HOSPITAL AND MARGARETVILLE MEMORIAL HOSPITAL O'CONNOR HOSPITAL PART V, SECTION B, LINE 6B: DELAWARE COUNTY PUBLIC HEALTH O'CONNOR HOSPITAL PART V, SECTION B, LINE 11: THE ORGANIZATION ADDRESSED SIGNIFICANT, PRIORITIZED HEALTH NEEDS IDENTIFIED IN ITS MOST RECENTLY CONDUCTED CHNA BY ADOPTION OF A BUDGET FOR PROVISION OF SERVICES THAT ADDRESS THE NEEDS 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 OF NEEDS.THE HOSPITAL'S COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION STRATEGY ARE MADE AVAILABLE ON THE HOSPITAL'S WEBSITE:HTTPS://WWW.BASSETT.ORG/SITES/DEFAULT/FILES/2023-03/DELAWARE_COUNTY_COMMUNITY_HEALTH_ASSESSMENT_2022-2024.PDF PART V, LINE 16A, 16B, & 16C, FACILITY 1, O'CONNOR HOSPITAL THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY, APPLICATION, AND PLAIN LANGUAGE SUMMARY ARE MADE AVAIALBLE ON THE HOSPITAL'S WEBSITE:HTTPS://WWW.BASSETT.ORG/PATIENTS-VISITORS/BILLING-INSURANCE/FINANCIAL-ASSISTANCE PART V BILLING AND COLLECTIONSBEGINNING IN JULY 2021, BASSETT HEALTHCARE NETWORK, THE PARENT ORGANIZATION OF O'CONNOR HOSPITAL, ENTERED INTO A SERVICE AGREEMENT WITH OPTUM INSIGHT. THIS AGREEMENT RESULTED IN VARIOUS INFORMATION TECHNOLOGY, REVENUE CYCLE, AND BUSINESS ANALYTIC SERVICES ONCE PERFORMED BY BASSETT HEALTHCARE NETWORK BEING TRANSITIONED TO OPTUM INSIGHT, ALONG WITH THE FORMER BASSETT EMPLOYEES WHO PROVIDED THEM. THE TRANSITION INCLUDED PORTIONS OF THE BILLING AND COLLECTION ACTIVITIES FOR THE HOSPITALS IN THE NETWORK. HOWEVER, DESPITE THE CHANGE IN SERVICE PROVIDER, THE BILLING AND COLLECTION POLICIES OF THE HOSPITAL DID NOT CHANGE AS A RESULT OF THE TRANSITION. PART I, LINE 3C: OTHER INCOME BASED CRITERIA FOR FREE OR DISCOUNTED CARETHE CSP (COMMUNITY SERVICES PROGRAM) APPLICATION SPECIFIES FAMILY INCOME LIMITS AND OTHER REQUIREMENTS FOR SERVICES TO BE ELIGIBLE FOR O'CONNOR HOSPITAL'S CSP/FREE CARE PROGRAM. PART I, LINE 6A: RELATED ORGANIZATION INFORMATIONO'CONNOR HOSPITAL'S COMPREHENSIVE COMMUNITY SERVICE PLAN IS SUMMARIZED IN AN ANNUAL REPORT AND POSTED ON THE O'CONNOR HOSPITAL WEBSITE, WWW.BASSETT.ORG/LOCATIONS/OCONNOR-HOSPITAL. PRINTED COPIES ARE AVAILABLE TO THE PUBLIC UPON REQUEST. PART I, LINE 7: COSTING METHODOLOGY EXPLANATIONWORKSHEET 2 WAS USED TO DEVELOP A COST-TO-CHARGE RATIO. IT WAS USED FOR PATIENT CARE SERVICES. FOR NON- PATIENT CARE SERVICES, CHARGES WERE REDUCED TO COST FOR THOSE SERVICES TO NON-PATIENTS WHERE A MARK-UP IS READILY IDENTIFIABLE.LINE 7B UNREIMBURSED MEDICAIDDURING 2023, THE HOSPITAL'S UNREIMBURSED MEDICAID WAS WHOLLY OFFSET BY DIRECTED PAYMENT TEMPLATE (DPT) FUNDS RECEIVED THROUGH NEW YORK STATE'S HOSPITAL VITAL ACCESS PROVIDER ASSURANCE PROGRAM.PART I, LINE 7, COLUMN (F)EXCLUSIONS FROM PERCENT OF TOTAL EXPENSE THE PERCENT OF TOTAL EXPENSE IN PART 1, LINE 7, COLUMN (F) IS CALCULATED BY DIVIDING COLUMN (E), NET COMMUNITY BENEFIT EXPENSE, BY TOTAL EXPENSE. THE BAD DEBT EXPENSE OF $892,263 WAS SUBTRACTED FROM THE TOTAL VALUE USED TO CALCULATE THE PERCENTAGES IN PART 1, LINE 7, COLUMN F. PART II, COMMUNITY BUILDING ACTIVITIES: COMMUNITY BUILDING ACTIVITIESALL O'CONNOR COMMUNITY BUILDING ACTIVITIES ARE INCLUDED IN PART I AND DESCRIBED ABOVE. PART III, LINE 2: BAD DEBT EXPENSEDUE TO THE ADOPTION OF ASU NO. 2014-09 - REVENUE FROM CONTRACTS WITH CUSTOMERS (TOPIC 606) BAD DEBT EXPENSE IS NO LONGER REPORTED ON THE AUDITED FINANCIAL STATEMENT. RATHER IT IS TREATED AS A NON-VOLUNTARY PRICE CONCESSION. PART III, LINE 4: FOOTNOTE (3) FROM THE AUDITED FINANCIAL STATEMENTSCHARITY CARE: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. PART III, LINE 8: MEDICARE EXPLANATIONO'CONNOR IS A CRITICAL ACCESS HOSPITAL, SO COST IS CALCULATED ON THE SETTLEMENT SHEETS OF THE COST REPORT. IT WAS COMPARED TO MEDICARE REIMBURSEMENT, WHICH IS ALSO CALCULATED ON THE COST REPORT. PART III, LINE 9B: COLLECTION PRACTICES EXPLANATIONPATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE ARE CONTACTED BY THE FINANCIAL COUNSELING TEAM THAT SENDS A LETTER OF APPROVAL AND TIME-FRAME FOR WHICH THE PATIENT IS APPROVED. PART VI, LINE 2: BASSETT HEALTHCARE NETWORK, O'CONNOR HOSPITAL, IN COLLABORATION WITH DELAWARE COUNTY PUBLIC HEALTH, MARGARETVILLE MEMORIAL HOSPITAL, AND UHS DELAWARE VALLEY HOSPITAL, DEVELOPED A COMMUNITY SERVICE PLAN TO ADDRESS THE HEALTH INEQUITIES DEFINED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT FOR DELAWARE COUNTY, NY, ALSO A COLLABORATIVE EFFORT. PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCEA MAJOR COMPONENT OF THE O'CONNOR HOSPITAL COMMUNITY SERVICES PROGRAM IS TO ACTIVELY IDENTIFY PATIENTS WHO MAY BE ELIGIBLE FOR CHARITY CARE. THE PROCESS BEGINS WITH AN ORGANIZATIONAL POLICY AND PROCEDURE THAT DEFINES THE PROGRAM AND SERVES AS AN EDUCATION TOOL FOR ALL O'CONNOR EMPLOYEES. THE POLICY IS UPDATED ANNUALLY, DISTRIBUTED TO KEY PERSONNEL AND IS ACCESSIBLE TO ALL EMPLOYEES. THE PROGRAM IS SUPPORTED BY A FOUR PAGE PLAIN LANGUAGE BROCHURE THAT INCLUDES AN APPLICATION. BROCHURES ARE PROMINENTLY DISPLAYED AND AVAILABLE. CLINICAL AND SUPPORT STAFF ARE MADE AWARE OF THE PROGRAM AND ABLE TO DIRECT PATIENTS TO SPECIALISTS WHO CAN ASSIST IN THE APPLICATION PROCESS.ALL PATIENTS WHO ARE REGISTERED AS SELF-PAY ARE PROVIDED A BROCHURE EITHER IN PERSON OR BY MAIL. PATIENTS WHO ARE IN THE HOSPITAL RECEIVE INFORMATION AS PART OF A PERSONAL VISIT GEARED TO HELP THE PATIENT NAVIGATE FINANCIAL ASSISTANCE INCLUDING, BUT NOT LIMITED TO, THE COMMUNITY SERVICES PROGRAM. GOVERNMENT PROGRAM OPPORTUNITIES ARE ALSO REFERENCED AND A DIRECTORY OF LOCAL SOCIAL SERVICES AGENCIES IS PROVIDED BASED ON THE PATIENT'S COUNTY OF RESIDENCE. PATIENT REFERRAL TO THE DELAWARE COUNTY MEDICAID EXAMINER IS FACILITATED BY THE FINANCE DIRECTOR AT THE O'CONNOR HOSPITAL.A LISTING OF ALL SELF-PAY ACCOUNTS IS PRODUCED AND REVIEWED DAILY TO ENSURE THAT A COMMUNITY SERVICES BROCHURE HAS BEEN PROVIDED. THE SELF-PAY BILLING OFFICE IDENTIFIES PATIENTS DURING THE BILLING AND COLLECTIONS PROCESS THAT MAY REQUIRE ADDITIONAL HELP UNDERSTANDING THE PROGRAM. SELF-PAY ACCOUNTS FOR PATIENTS WHO HAVE BEEN APPROVED FOR COMMUNITY SERVICES WITHIN THE PRIOR 120 DAYS ARE AUTOMATICALLY INCLUDED WITH THE PRIOR APPROVAL. PART VI, LINE 4: COMMUNITY INFORMATIONO'CONNOR HOSPITAL'S SERVICE AREA INCLUDES MUCH OF DELAWARE COUNTY, NY. THE PRIMARY SERVICE AREA OF 11 ZIP CODES INCLUDES ANDES, BLOOMVILLE, BOVINA CENTER, DELANCEY, DELHI, HAMDEN, HOBART, MARGARETVILLE, SOUTH KORTRIGHT, STAMFORD, AND WALTON. THE SECONDARY SERVICE AREA IS REFLECTIVE OF 12 ZIP CODES AND INCLUDES DENVER, DOWNSVILLE, EAST BRANCH, EAST MEREDITH, FLEISHMANS, FRANKLIN, HANCOCK, HARPERSFIELD, LONG EDDY, MERIDALE, PRATTSVILLE, AND ROXBURY. PART VI, LINE 5: PROMOTION OF COMMUNITY HEALTHO'CONNOR HOSPITAL IS A CRITICAL ACCESS HOSPITAL IN DELHI, NEW YORK PROVIDING A FULL RANGE OF ACUTE AND PREVENTATIVE HEALTH CARE SERVICES, INCLUDING ACUTE INPATIENT CARE, RESTORATIVE/REHABILITATIVE (SWING BED) CARE, AN EMERGENCY SERVICES DEPARTMENT (WHERE PRACTITIONERS HAVE THE ABILITY TO INTERFACE WITH BOARD-CERTIFIED PRACTITIONERS IN COOPERSTOWN AND PRACTITIONERS IN ROCHESTER THROUGH TELEMEDICINE CONNECTIONS), A STATE-OF-THE-ART MEDICAL IMAGING SUITE, LABORATORY SERVICES, AN OUTPATIENT PHARMACY, PHYSICAL AND OCCUPATIONAL THERAPY, DIETARY CONSULTATIONS, A DENTAL CLINIC AND A WIDE RANGE OF SPECIALTY SERVICES.O'CONNOR HAS SERVED THE DELHI COMMUNITY SINCE 1922 AND HAS BEEN AFFILIATED WITH THE MARY IMOGENE BASSETT HOSPITAL (DBA BASSETT MEDICAL CENTER) SINCE 1988. O'CONNOR IS AN ENTITY OF THE BASSETT HEALTHCARE NETWORK. IT IS GOVERNED BY A 11 MEMBER BOARD OF TRUSTEES CONSISTING OF COMMUNITY VOLUNTEERS. O'CONNOR HOSPITAL COMMUNITY SERVICE PROGRAMS ADDRESS CHRONIC DISEASE MANAGEMENT, PROMOTE WELL-BEING AND MENTAL HEALTH, AND PREVENT SUBSTANCE ABUSE DISORDERS. THEY INCLUDE:1. O'CONNOR HOSPITAL PROVIDES SPACE FOR DIABETES, MENTAL HEALTH AND PARKINSON'S SUPPORT GROUPS ON A MONTHLY BASIS.2. O'CONNOR OFFERS FALL FLU SHOT CLINICS.3. PROMOTED PLACES FOR PHYSICAL ACTIVITY, HIKING, PADDLING AND BIKING.4. TRACKED TRAIL USE ON TWO LOCAL HIKING TRAILS.5. MAINTAINED GETOUTANDWALK.ORG WEBSITE.6. ENCOURAGED MUNICIPALITIES TO SIGN COMPLETE STREET POLICIES AND AGE-FRIENDLY STRUCTURAL IMPROVEMENTS.7. BUILT AND MAINTAINED O'CONNOR HOSPITAL .5 MILE FITNESS TRAIL COMPLETE WITH FIVE FITNESS STATIONS AND OPEN TO THE COMMUNITY.8. SUBMITTED DSRIP PROPOSAL TO FUND A PRESCRIBING MENTAL HEALTH PROVIDER TO WORK IN LOCAL HEALTH CENTER.9. SUBMITTED GRANT PROPOSAL TO FUND PRACTITIONER RECRUITMENT AND RETENTION EFFORTS IN THE O'CONNOR HOSPITAL SERVICE AREA.10. CONDUCTED PERFORMANCE IMPROVEMENT PROJECT TO REFER E.D. PATIENTS TO MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES AND COMMUNITY RESOURCES.11. COMPLETED PERFORMANCE IMPROVEMENT PROJECT TO INCREASE PATIENT REFERRALS TO CARE NAVIGATOR PROGRAM.12. PARTICIPATED IN PILOT DRUG TAKE BACK PROGRAM.13. PARTICIPATED IN LOCAL COMMUNITY COALITIONS AND COMMITTEES FORMED TO ADDRESS MENTAL HEALTH ISSUES IN THE COUNTY.14. PARTICIPATED IN SUICIDE PREVENTION COALITION.15. SUPPORTED TWO NURSES TO COMPLETE SEXUAL ASSAULT NURSE EXAMINER TRAINING COURSES.16. COMPLETED AND PARTICIPATED IN COUNTY AND REGIONAL EMERGENCY PREPAREDNESS PROGRAMS AND DRILLS.17. CONDUCTED PERFORMANCE IMPROVEMENT PROJECT ADDRESSING STANDARD PRECAUTIONS FOR MRSA/ VRE OF INPATIENTS.18. HOSTED FIRST GRADERS FOR AN EDUCATIONAL PROGRAM OF THE EMERGENCY DEPARTMENT.19. SPONSORED COMMUNITY WELLNESS EVENTS SUCH AS ROAD RACES, SUICIDE AWARENESS ACTIVITIES, AND EMS TEACHING EVENTS.O'CONNOR HAS A COMMUNITY BOARD WHO ARE ACTIVELY ENGAGED IN THE HOSPITAL BOTH SUPPORTING THE GROWTH AND THE INVESTMENT IN PROGRAMS THAT BRING HEALTH AND WELLNESS BENEFITS TO THE COMMUNITY. O'CONNOR CONTINUALLY INVESTS SURPLUS FUNDS IN PROGRAMS, EQUIPMENT AND PEOPLE TO ENSURE HIGH QUALITY SERVICE IS AVAILABLE IN THE COMMUNITY THEY SERVE. THE ORGANIZATION EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS WHO ARE EMPLOYED BY BASSETT MEDICAL CENTER. THE HOSPITAL OPERATES AN EMERGENCY ROOM WHICH IS OPEN TO ALL, REGARDLESS OF ABILITY TO PAY. PART VI, LINE 6: AFFILIATED HEALTH CARE SYSTEMO'CONNOR HOSPITAL IS PART OF THE BASSETT HEALTHCARE NETWORK THAT PROVIDES HEALTH SERVICES IN MORE THAN 20 COMMUNITIES SPANNING 5,600 SQUARE MILES AND SEVEN 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, 21 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) O'CONNOR HOSPITAL, A CRITICAL ACCESS HOSPITAL IN DELHI, DELAWARE COUNTYB) THE MARY IMOGENE BASSETT HOSPITAL - AN ACUTE CARE INPATIENT TEACHING FACILITY, AN OUTPATIENT PRIMARY AND SPECIALTY CARE CENTER, A REGIONAL NETWORK OF 34 COMMUNITY BASED OUTPATIENT HEALTH CENTERS, 22 SCHOOL BASED HEALTH CENTERS, TWO AMBULATORY SURGERY CENTERS, AND A FULLY SALARIED MEDICAL STAFF IN COOPERSTOWN, OTSEGO COUNTYC) COBLESKILL REGIONAL HOSPITAL, A CRITICAL ACCESS HOSPITAL IN COBLESKILL, SCHOHARIE COUNTYD) LITTLE FALLS HOSPITAL, A CRITICAL ACCESS HOSPITAL IN LITTLE FALLS, HERKIMER COUNTYE) A.O. FOX HOSPITAL TRI-TOWN CAMPUS, A 24/7 EMERGENCY CARE FACILITY IN SIDNEY, DELAWARE COUNTYF) A.O. FOX MEMORIAL HOSPITAL, AN ACUTE CARE FACILITY IN ONEONTA, OTSEGO COUNTYG) VALLEY HEALTH SERVICES, A RESIDENTIAL HEALTH CARE AND REHABILITATION FACILITYH) AT HOME CARE, A CERTIFIED HOME CARE AGENCYI) FIRST COMMUNITY CARE OF BASSETT, A MEDICAL SUPPLY COMPANY ALL OF THE ABOVE MAKE UP THE BASSETT HEALTHCARE NETWORK AND PROVIDE HEALTH SERVICES TO THIS SEVEN COUNTY REGION IN CENTRAL NEW YORK. PART VI, LINE 7, REPORTS FILED WITH STATES NY 0 0 0 0 0 0 0 1 0 DR TIMOTHY WHITAKER MEDICAL DIRECTOR 554370 0 0 0 0 0 29892 0 5975 0 590237 0 0 0 SUSAN OAKES-FERRUCCI PRESIDENT/CEO 0 257286 0 0 0 0 0 8078 0 11978 0 277342 0 0 JIM VIELKIND VP OF FINANCE 0 232159 0 0 0 0 0 12067 0 946 0 245172 0 0 ERIN KINGSBURY PHARMACIST 170348 0 4077 0 0 0 10047 0 9292 0 193764 0 0 0 ANDREA BARCOMB PHARMACIST 161113 0 6273 0 0 0 6273 0 2338 0 175997 0 0 0 ERIC STEIN FORMER PRESIDENT 0 162020 0 0 0 0 0 0 0 0 0 162020 0 0 KONSTANTIN VLAHOS SUPERVISING PHARMACIST 142698 0 0 0 0 0 5464 0 5447 0 153609 0 0 0 DANIEL ENDRESS DIR OF OPS/NURSING 141006 0 0 0 0 0 8239 0 2031 0 151276 0 0 0 PART I, LINE 7 NON-FIXED PAYMENTS PROVIDED NON-FIXED PAYMENTS ARE MADE BASED ON THE SUCCESS IN MEETING PERFORMANCE CRITERIA THAT ARE PROSPECTIVELY AGREED UPON AS GOALS FOR THE OFFICERS AND OTHER EMPLOYEES. FORM 990, SCHEDULE J, PART I, LINE 3 RELATED ORG METHODS USED FOR COMPENSATION EXPLANATION THE MARY IMOGENE BASSETT HOSPITAL (DBA BASSETT MEDICAL CENTER) PROVIDES THE COMPENSATION FOR THE PRESIDENTS OF O'CONNOR HOSPITAL, A.O. FOX MEMORIAL HOSPITAL, COBLESKILL REGIONAL HOSPITAL, AND LITTLE FALLS HOSPITAL. BASSETT MEDICAL CENTER USES THE FOLLOWING METHODS TO ESTABLISH COMPENSATION FOR SAID INDIVIDUALS: A) COMPENSATION COMMITTEE, B) INDEPENDENT COMPENSATION CONSULTANT, C) WRITTEN EMPLOYMENT CONTRACT, D) COMPENSATION SURVEY OR STUDY AND, E) APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. FORM 990, PART VI, SECTION A, LINE 6 BASSETT HEALTHCARE NETWORK IS THE PARENT AND SOLE MEMBER TO EACH OF THE FOLLOWING RELATED PARTIES. FRIENDS OF BASSETT, AO FOX MEMORIAL HOSPITAL, BASSETT HOSPITAL OF SCHOHARIE COUNTY, LITTLE FALLS HOSPITAL, O'CONNOR HOSPITAL, TEMPLETON FOUNDATION, VALLEY HEALTH SERVICES, 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 AFFILIATES 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 AFFILIATES AND CERTIFICATE OF NEED APPLICATIONS. FORM 990, PART VI, SECTION A, LINE 7A SEE FORM 990, PART VI, SECTION A, LINE 6 ABOVE. FORM 990, PART VI, SECTION A, LINE 7B SEE FORM 990, PART VI, SECTION A, LINE 6 ABOVE. FORM 990, PART VI, SECTION B, LINE 11B 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, SECTION B, LINE 12C ENFORCEMENT OF CONFLICTS POLICY THE ORGANIZATION'S CONFLICT OF INTEREST POLICY APPLIES TO THE BOARD OF DIRECTORS, BOARD MEMBERS, AND KEY PERSONS SUCH AS THE PRESIDENT. EACH BOARD MEMBER, OFFICER, OR KEY PERSON OF THE HOSPITAL SHALL COMPLETE A CONFLICT-OF-INTEREST QUESTIONNAIRE ANNUALLY. ALL COMPLETED QUESTIONNAIRES ARE REVIEWED AND ALL DISCLOSURES OF POTENTIAL CONFLICTS WILL BE BROUGHT TO THE PRESIDENT. THE PRESIDENT OR HIS/HER DESIGNEE WILL TAKE ACTION TO ELIMINATE THE POTENTIAL CONFLICT OF INTEREST. ALL DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST IN THE COMPLETED QUESTIONNAIRES SHALL BE COMPILED AND REPORTED BY THE ASSISTANT TREASURER TO THE EXECUTIVE AND FINANCE COMMITTEE OF THE BOARD TO DETERMINE IF THE REPORTED DISCLOSURE AND RESOLUTION IS SATISFACTORY. IF THE ACTIONS TAKEN ARE NOT SATISFACTORY, THE EXECUTIVE AND FINANCE COMMITTEE SHALL DETERMINE FURTHER ACTION AS IT DEEMS APPROPRIATE. FORM 990, PART VI, SECTION B, LINE 15A 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. THE PRESIDENT'S SALARY IS SUBMITTED AS PART OF THE MANAGEMENT SERVICES AGREEMENT. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS DISCLOSURE EXPLANATION O'CONNOR HOSPITAL MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON WRITTEN REQUEST. PARTIES DESIRING TO OBTAIN COPIES OF SUCH MUST PRESENT THEMSELVES AT THE ADMINISTRATIVE OFFICES OF O'CONNOR HOSPITAL OR BY SENDING A SELF-ADDRESSED STAMPED ENVELOPE AND PAYMENT FOR COPYING OF THE REQUESTED MATERIAL TO O'CONNOR HOSPITAL ADMINISTRATIVE OFFICES. THE COST OF COPYING SHALL BE EQUAL TO THE COSTS IMPOSED BY THE IRS FOR COPYING PUBLIC DOCUMENTS. FORM 990, PART IX, LINE 11G SUPPLIES/OTHER: PROGRAM SERVICE EXPENSES 172,209. MANAGEMENT AND GENERAL EXPENSES 54,710. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 226,919. CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 4,211,887. MANAGEMENT AND GENERAL EXPENSES 322,412. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,534,299. FORM 990, PART XII, LINE 2C THE CONSOLIDATED AUDIT REPORT IS REVIEWED AT A NETWORK LEVEL, BY THE BASSETT HEALTHCARE NETWORK AUDIT COMMITTEE. BASSETT HEALTHCARE NETWORK ONE ATWELL ROAD COOPERSTOWN NY 13326 133218680 SUPPORT NY 501C3 12C NONE 0 FRIENDS OF BASSETT ONE ATWELL ROAD COOPERSTOWN NY 13326 237041610 FUNDRAISER NY 501C3 7 BHN 0 AO FOX MEMORIAL HOSPITAL ONE NORTON AVENUE ONEONTA NY 13820 150539039 HEALTHCARE NY 501C3 3 BHN 0 BASSETT HOSPITAL SCHOHARIE COUNTY 178 GRANDVIEW DRIVE COBLESKILL NY 12043 141772971 HEALTHCARE NY 501C3 3 BHN 0 LITTLE FALLS HOSPITAL 140 BURWELL STREET LITTLE FALLS NY 13365 150533578 HEALTHCARE NY 501C3 3 BHN 0 MARY IMOGENE BASSETT HOSPITAL ONE ATWELL ROAD COOPERSTOWN NY 13326 135596796 HEALTHCARE NY 501C3 3 BHN 0 TEMPLETON FOUNDATION ONE ATWELL ROAD COOPERSTOWN NY 13326 133317084 LANDLORD NY 501C3 10 BHN 0 VALLEY HEALTH SERVICES 690 WEST GERMAN STREET HERKIMER NY 13350 222511614 ELDER CARE NY 501C3 3 BHN 0 BASSETT PPS LLC 6181 STATE HIGHWAY 7 ONEONTA NY 13820 811749905 HEALTHCARE NY 501C3 12A BHN 0 VALLEY RESIDENTIAL SERVICES 690 WEST GERMAN STREET HERKIMER NY 13350 463703838 ELDER CARE NY 501C3 3 BHN 0 AT HOME CARE PARTNERS 25 ELM STREET ONEONTA NY 13820 562397098 HEALTHCARE NY 501C3 3 AHC INC 0 AT HOME CARE INC 25 ELM STREET ONEONTA NY 13820 161287069 HEALTHCARE NY 501C3 3 BHN 0 STAMFORD PROFESSIONAL ASSOCIATES 1 NORTON AVENUE ONEONTA NY 13820 161322304 RENTAL NY N/A 0 0 FIRST COMMUNITY CARE OF BASSETT 60 NORTHPOINTE PARKWAY AMHERST MA 14228 161504464 HEALTHCARE NY N/A 0 0 CATSKILL CARE ENTERPRISES 1 NORTON AVENUE ONEONTA NY 13820 161236590 RETAIL PHARMACY NY N/A C 0 LEATHERSTOCKING PHYSICIANS PC ONE ATWELL ROAD COOPERSTOWN NY 13326 364864562 HEALTHCARE NY N/A C 0 0 0 1 0 0 0 0 0 0 1 0 1 1 0 0 0 1 0 0