TY 2011 Form 990

(A) Name and Title	(B) Average hours per week (describe hours for related organizations in Schedule O)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)
(1) Thomas Q Morris MD Chairman	1.0	X	X
(2) Kevin S Moore Vice Chairman	3.0	X	X
(3) William T Burdick Secretary	8.0	X	X
(4) Jane Forbes Clark Trustee	1.0	X
(5) Edward W Stack Trustee	1.0	X
(6) Vanness D Robinson Trustee	1.0	X
(7) Barbara Dicocco Trustee	1.0	X
(8) Ralph H Meyer Trustee	1.0	X
(9) Donald O Pollock MD Trustee	1.0	X
(10) Donald O Quest MD Trustee	1.0	X
(11) Peter J Hamilton Trustee	1.0	X
(12) Douglas B Willies Trustee	1.0	X
(13) Terry Fulmer PHD RN Trustee	1.0	X
(14) J Michael Moffat Trustee	1.0	X
(15) Katherine D Nickerson Trustee	1.0	X
(16) Timothy A Pedley MD Vice Chairman	1.0	X	X
(17) Clifton R WhartonJRPHD Trustee	1.0	X

(A) Name and Title	(B) Average hours per week (describe hours for related organizations in Schedule O)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)
(18) John D Bullis Trustee	1.0	X			0	0
(19) Michael Getman Trustee	1.0	X			0	0
(20) Charles B Kieler Trustee	1.0	X			0	0
(21) Michael S Gold MD Trustee	1.0	X			0	0
(22) William F Streck MD President & CEO	40.0		X		656,951	17,949
(23) Bertine Colombo Mckenna PHD Executive VP & COO	40.0		X		369,024	12,712
(24) Nicholas J Nicoletta Corporate VP & CFO	40.0		X		368,286	15,739
(25) Richard C Vanison Treasurer	4.0		X		0	0
(26) Glenn A Perrone Assistant Secretary	2.0		X		0	0
(27) Steven J Heneghan MD Attending Physician	40.0			X	579,331	17,506
(28) Joseph Schmer MD Attending Physician	40.0			X	528,631	11,876
(29) James C Peters MD Attending Physician	40.0			X	508,989	24,832
(30) Jonathan Richman Md Attending Physician	40.0			X	527,196	18,275
(31) ROBERT LANCEY MD ATTENDING PHYSICIAN	40.0			X	520,879	21,396

(A) Name and business address	(B) Description of services	(C) Compensation
MCCARTHY 1341 North Rock Hill Road ST LOUIS,MO63124	CONSTRUCTION	5,978,297
NURSEFINDERS PO BOX 910738 DALLAS,TX75391	AGENCY SERVICES	3,014,979
MEDQUIST TRANSCRIPTION 1000 BISHOPS GATE BLVD S MT LAUREL,NJ08054	TRANSCRIPTION	2,513,882
STAFF CARE INC 5001 STATESMAN DRIVE IRVING,TX75063	AGENCY SERVICES	1,740,863
VITALIZE CONSULTING 248 MAIN STREET STE 101 BALTIMORE,MD21279	CONSULTING	1,562,330
2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 19

Do not include amounts reported on lines 6b, 7b, 8b, 9b, and 10b of Part VIII.	(A) Total expenses	(B) Program service expenses	(C) Management and general expenses	(D) Fundraising expenses
1	Grants and other assistance to governments and organizations in the United States. See Part IV, line 21	0
2	Grants and other assistance to individuals in the United States. See Part IV, line 22	0
3	Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16	0
4	Benefits paid to or for members	0
5	Compensation of current officers, directors, trustees, and key employees ....	1,440,661	0	1,440,661	0
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....	0
7	Other salaries and wages	207,487,525	157,964,427	49,026,337	496,761
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	4,811,485	3,663,601	1,138,344	9,540
9	Other employee benefits .......	11,415,100	8,631,917	2,756,038	27,145
10	Payroll taxes ...........	12,679,017	9,584,576	3,060,208	34,233
11	Fees for services (non-employees):
a	Management ......	0
b	Legal .........	0
c	Accounting ...........	0
d	Lobbying ...........	53,278		53,278
e	Professional fundraising. See Part IV, line 17..	0
f	Investment management fees ......	0
g	Other ..........	33,231,501	27,396,460	5,608,483	226,558
12	Advertising and promotion ....	0
13	Office expenses .......	2,123,226	1,577,118	503,549	42,559
14	Information technology ......	0
15	Royalties ..	0
16	Occupancy ...........	13,254,620	10,030,529	3,202,594	21,497
17	Travel ............	0
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......	0
19	Conferences, conventions, and meetings ....	0
20	Interest ...........	1,673,956	1,265,819	404,156	3,981
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization .....	19,401,620	14,705,044	4,695,094	1,482
23	Insurance ..............	3,373,543	2,551,020	814,501	8,022
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24f. If line 24f amount exceeds 10% of line 25, column (A) amount, list line 24f expenses on Schedule O.)
a	PATIENT CARE SUPPLIES	32,481,040	32,481,040
b	DRUGS AND REAGENTS	30,249,399	30,249,399
c	BAD DEBT	14,513,947	14,513,947
d	RENTAL EQUIPMENT & SPACE	8,872,818	6,724,549	2,147,045	1,224
e
f	All other expenses	17,993,650	15,581,263	2,285,961	126,426
25	Total functional expenses. Add lines 1 through 24f	415,056,386	336,920,709	77,136,249	999,428
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

Part X Balance Sheet
	1	Cashnon-interest-bearing ..........	14,917,654	1	7,155,225
2	Savings and temporary cash investments .......	0	2	0
3	Pledges and grants receivable, net .........	10,834,542	3	9,860,464
4	Accounts receivable, net .........	44,601,331	4	51,797,404
5	Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
	Schedule L ..........	0	5	0
6	Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
	Schedule L ..........	0	6	0
7	Notes and loans receivable, net .............	0	7	0
8	Inventories for sale or use ..............	3,083,021	8	3,305,577
9	Prepaid expenses and deferred charges ............	3,053,540	9	2,457,985
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	358,055,061
b	Less: accumulated depreciation. .....	10b	216,610,596	141,174,956	10c	141,444,465
11	Investments—publicly traded securities ..........	68,045,275	11	85,442,703
12	Investments—other securities. See Part IV, line 11 ......	30,936,393	12	33,634,077
13	Investments—program-related. See Part IV, line 11 ..	0	13	0
14	Intangible assets .........	0	14	0
15	Other assets. See Part IV, line 11 ...........	6,971,341	15	8,094,025
16	Total assets. Add lines 1 through 15 (must equal line 34)...	323,618,053	16	343,191,925
	17	Accounts payable and accrued expenses .	38,862,456	17	38,850,570
18	Grants payable ..........	0	18	0
19	Deferred revenue ..........	0	19	0
20	Tax-exempt bond liabilities ..........	33,385,000	20	56,570,000
21	Escrow or custodial account liability. Complete Part IV of Schedule D..	0	21	0
22	Payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........	0	22	0
23	Secured mortgages and notes payable to unrelated third parties ..	23,693,591	23	27,083,819
24	Unsecured notes and loans payable to unrelated third parties ....	0	24	0
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D.....	0	25	0
26	Total liabilities. Add lines 17 through 25.....	95,941,047	26	122,504,389
		Organizations that follow SFAS 117, check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets .....	169,040,821	27	163,124,202
28	Temporarily restricted net assets .....	44,847,111	28	43,733,963
29	Permanently restricted net assets .....	13,789,074	29	13,829,371
	Organizations that do not follow SFAS 117, check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....		30
31	Paid-in or capital surplus, or land, building or equipment fund .....		31
32	Retained earnings, endowment, accumulated income, or other funds		32
33	Total net assets or fund balances .....	227,677,006	33	220,687,536
34	Total liabilities and net assets/fund balances .....	323,618,053	34	343,191,925

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.

Attach to Form 990 or Form 990-EZ. right arrow

See separate instructions.

OMB No. 1545-0047

2011

Open to Public
Inspection

Name of the organization

The Mary Imogene Bassett Hospital

Employer identification number

13-5596796

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions

The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)

A church, convention of churches, or association of churches. section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E.)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in

section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in

section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross

receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of

its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses

acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. Seesection 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box that describes the type of supporting organization and complete lines 11e through 11h.

Type I

Type II

Type III - Functionally integrated

Type III - Other

By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).

If the organization received a written determination from the IRS that it is a Type I, Type II or Type III supporting organization, check this box ..................................................

Since August 17, 2006, has the organization accepted any gift or contribution from any of the
following persons?

(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)

Yes

and (iii) below, the governing body of the the supported organization? ................

11g(i)

(ii) a family member of a person described in (i) above? ......................

11g(ii)

(iii) a 35% controlled entity of a person described in (i) or (ii) above? ................

11g(iii)

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(iv) Is the organization in col. (i) listed in your governing document?		(v) Did you notify the organization in col. (i) of your support?		(vi) Is the organization in col. (i) organized in the U.S.?		(vii) Amount of support?
(i) Name of supported organization	(ii) EIN	Yes	No	Yes	No	Yes	No	(vii) Amount of support?


Total

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2011

Page 2

Part II

Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year(or fiscal year beginning in)		(a) 2007	(b) 2008	(c) 2009	(d) 2010	(e) 2011	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3..
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public Support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year(or fiscal year beginning in)		(a) 2007	(b) 2008	(c) 2009	(d) 2010	(e) 2011	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..
11	Total support (Add lines 7 through 10).

Gross receipts from related activities, etc. (See instructions.) ..................

First Five Years If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.......................................... right arrow

Section C. Computation of Public Support Percentage

Public Support Percentage for 2010 (line 6 column (f) divided by line 11 column (f)) .........

Public Support Percentage for 2009 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2011. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ...................... right arrow

33 1/3% support test—2010. If the organization did not check the box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2011. If the organization did not check a box on line 13, 16a, or 16b and line 14
is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported
organization .................................................. right arrow

10%-facts-and-circumstances test—2010. If the organization did not check a box on line 13, 16a, 16b, or 17a and line
15 is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly
supported organization .............................................. right arrow

Private Foundation If the organization did not check a box on line 13, 16a, 16b, 17a or 17b, check this box and see
instructions ................................................... right arrow

Schedule A (Form 990 or 990-EZ) 2011

Page 3

Part III

Support Schedule for Organizations Described in IRC 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year(or fiscal year beginning in)		(a) 2007	(b) 2008	(c) 2009	(d) 2010	(e) 2011	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3	Gross receipts from activities that are not an unrelated trade or business under section 513..
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge..
6	Total. Add lines 1 through 5.
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons...
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public Support (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2007	(b) 2008	(c) 2009	(d) 2010	(e) 2011	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
13	Total support (Add lines 9, 10c, 11 and 12.).

Section C. Computation of Public Support Percentage

Public Support Percentage for 2011 (line 8 column (f) divided by line 13 column (f)) .........

Public support percentage from 2010 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2011 (line 10c column (f) divided by line 13 column (f)) ......

Investment income percentage from 2010 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests—2011. If the organization did not check the box on line 14, and line 15 is more than 33 1/3% and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .......... right arrow

33 1/3% support tests—2010. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private Foundation If the organization did not check a box on line 14, 19a or 19b, check this box and see instructions ..... right arrow

Schedule A (Form 990 or 990-EZ) 2011

Page 4

Part IV

Supplemental Information. Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Explanation

Schedule A (Form 990 or 990-EZ) 2011

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

OMB No. 1545-0047

2011

Name of organization

The Mary Imogene Bassett Hospital

Employer identification number

13-5596796

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, $5,000 or more (in money or
property) from any one contributor. Complete Parts I and II.

Special Rules

For a section 501(c)(3) organization filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), and received from any one contributor, during the year, a contribution of the
greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For a section 501(c)(7), (8), or (10) organization filing Form 990, or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 for use exclusively for religious, charitable,
scientific, literary, or educational purposes, or the prevention of cruelty to children or animals. Complete Parts I, II, and
III.

For a section 501(c)(7), (8), or (10) organization filing Form 990, or 990-EZ that received from any one contributor,
during the year, contributions for use exclusively for religious, charitable, etc., purposes, but these contributions did
not total to more than $1,000. If this box is checked, enter here the total contributions that were received during
the year for an exclusively religious, charitable, etc., purpose. Do not complete any of the parts unless the General Rule
applies to this organization because it received nonexclusively religious, charitable, etc., contributions of $5,000 or more
during the year. ......................... Arrow Bullet

Caution. An Organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on Part I, line 2, of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 2

Name of organization The Mary Imogene Bassett Hospital
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Part I	Contributors (see Instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	RESTRICTED RESTRICTED RESTRICTED RESTRICTED, RESTRICTED RESTRICTED	$RESTRICTED	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 3

Name of organization The Mary Imogene Bassett Hospital
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Part II	Noncash Property (see Instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 4

Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Name of organization
The Mary Imogene Bassett Hospital

Employer identification number

13-5596796

Part III

Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
that total more than $1,000 for the year. Complete columns (a) through (e) and the following line entry.
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet

$
Use duplicate copies of Part III if additional space is needed

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet

Complete if the organization is described below.
SchCMd Bullet

Attach to Form 990 or Form 990-EZ. SchCMd Bullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public
Inspection

If the organization answered “Yes” to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered “Yes” to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)) Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered “Yes” to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, line 35c (Proxy Tax), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

The Mary Imogene Bassett Hospital

Employer identification number

13-5596796

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV.

Political expenditures .................................... SchCMd Bullet

Volunteer hours ........................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ......... SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ...... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............

Yes No

Was a correction made? .........................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c) except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ................................... SchCMd Bullet

Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b.. SchCMd Bullet

Did the filing organization file Form 1120-POL for this year? ..........................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.

For Privacy Act and Paperwork Reduction Act Notice, see the instructions for Form 990.

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2011

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......
b	Total lobbying expenditures to influence a legislative body (direct lobbying) .......
c	Total lobbying expenditures (add lines 1a and 1b) ...................
d	Other exempt purpose expenditures ........................
e	Total exempt purpose expenditures (add lines 1c and 1d) ...............
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) .................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ......................................	Yes No

4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2008	(b) 2009	(c) 2010	(d) 2011	(e) Total

2a	Lobbying non-taxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2011

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each “Yes” response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? .........................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....

Media advertisements? ....................................

Mailings to members, legislators, or the public? .........................

Publications, or published or broadcast statements? .......................

Grants to other organizations for lobbying purposes? .......................

Direct contact with legislators, their staffs, government officials, or a legislative body? ........

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......

Other activities? ..........................

Yes

53,278

Total. Add lines 1c through 1i ...............................

53,278

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 .................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ................

Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2 are answered “No” OR (b) Part III-A, line 3 is answered “Yes”.

Dues, assessments and similar amounts from members .....................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).

Current year .........................................

Carryover from last year ....................................

Total ...........................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................

Taxable amount of lobbying and political expenditures (see instructions) ..............

Part IV

Supplemental Information

Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, Part II-A; line 5; and Part ll-B, line 1.
Also, complete this part for any additional information.

Identifier	Return Reference	Explanation
Part II-B - Description of Lobbying Activity		AMERICAN HOSPITAL ASSOCIATION ALLOCATES 24.6% OF DUES TOWARDS GENERAL LOBBYING ACTIVITIES. TOTAL DUES PAID IN 2011 = $39,909 IROQUOIS HEALTHCARE ALLIANCE DUES ALLOCATES 45% OF DUES TOWARDS GENERAL LOBBYING ACTIVITIES. TOTAL DUES PAID IN 2011 : $31,469 HANYS ALLOCATES 30.3% OF DUES TOWARDS GENERAL LOBBYING ACTIVITIES. TOTAL DUES PAID IN 2011 : $96,697 THE CLARK ESTATES CONDUCTS LOBBYING ACTIVITIES ON BEHALF OF THE MARY IMOGENE BASSETT HOSPITAL. LOBBYING ACTIVITIES ARE LIMITED TO OFFICER DISCUSSIONS WITH CONSULTANTS AND LEGISLATORS TO OBTAIN FUNDING FOR CHARITABLE MISSIONS. NO FUNDS WERE EXPENDED.

Schedule C (Form 990 or 990EZ) 2011

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet

Attach to Form 990. SchDMd Bullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

The Mary Imogene Bassett Hospital

Employer identification number

13-5596796

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .......
2	Aggregate contributions to (during year) ...
3	Aggregate grants from (during year) ...
4	Aggregate value at end of year .......

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements .......................	2a
b	Total acreage restricted by conservation easements ..................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register ....................	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................

Yes No

Staff and volunteer hours devoted to monitoring, inspecting and enforcing conservation easements during the year SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section
170(h)(4)(B)(i) and 170(h)(4)(B)(ii)? ....................................

Yes No

In Part XIV, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.

If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of
art, historical treasures, or other similar assets held for public exhibition, education or research in furtherance of public service,
provide, in Part XIV, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art,
historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service,
provide the following amounts relating to these items:

(i)

Revenues included in Form 990, Part VIII, line 1 ........................ SchDMd Bullet

(ii)

Assets included in Form 990, Part X .............................. SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958), relating to these items:

Revenues included in Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990

Cat. No. 52283D

Schedule D (Form 990) 2011

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s accession and other records, check any of the following that are a significant use of its collection
items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIV.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No

If "Yes," explain the arrangement in Part XIV and complete the following table:


c	Beginning balance .................................	1c
d	Additions during the year ..............................	1d
e	Distributions during the year .............................	1e
f	Ending balance ...................................	1f

Did the organization include an amount on Form 990, Part X, line 21? .....................

Yes No

If “Yes,” explain the arrangement in Part XIV.

Part V

Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.

		(a)Current Year	(b)Prior Year	(c)Two Years Back	(d)Three Years Back
1a	Beginning of year balance ....	13,789,074	16,734,461	13,825,685	13,511,047
b	Contributions ........	40,297	54,613	2,908,776	314,638
c	Net investment earnings, gains, and losses ...		199,921	189,138	445,038
d	Grants or scholarships .....
e	Other expenditures for facilities and programs ........		3,000,000
f	Administrative expenses ....		199,921	189,138	445,038
g	End of year balance ......	13,829,371	13,789,074	16,734,461	13,825,685

Provide the estimated percentage of the year end balance (line 1g) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

100.000 %

Temporarily restricted endowment SchDMd Bullet

The percentages in lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) unrelated organizations ........................

3a(i)

Yes

(ii) related organizations ........................

3a(ii)

If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIV the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment. See Form 990, Part X, line 10.

Description of property		(b)Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value
1a	Land .................	233,974		233,974
b	Buildings ................	184,709,902	94,226,662	90,483,240
c	Leasehold improvements ............
d	Equipment ................	159,276,890	122,383,934	36,892,956
e	Other .................	13,834,295		13,834,295
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......				141,444,465

Schedule D (Form 990) 2011

Page 3

Part VII

InvestmentsOther Securities. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)	(b)Book value	(c) Method of valuation: Cost or end-of-year market value
(1)Financial derivatives
(2)Closely-held equity interests
(3)Other (A) LIMITED PARTNERSHIPS	32,662,519	C
(B) LIMITED PARTNERSHIPS	971,558	C







Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)	33,634,077

Part VIII

InvestmentsProgram Related. See Form 990, Part X, line 13.

(a) Description of investment type		(b) Book value	(c) Method of valuation: Cost or end-of-year market value









Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets. See Form 990, Part X, line 15.

(a) Description				(b) Book value









Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

Part X

Other Liabilities. See Form 990, Part X, line 25.

1.(a) Description of Liability		(b) Book value
Federal Income Taxes









Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)
2. Fin 48 (ASC 740) Footnote. In Part XIV, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC740).

Schedule D (Form 990) 2011

Page 4

Part XI Reconciliation of Change in Net Assets from Form 990 to Financial Statements
1	Total revenue (Form 990, Part VIII, column (A), line 12) ....................	1	412,486,961
2	Total expenses (Form 990, Part IX, column (A), line 25) .....................	2	415,056,386
3	Excess or (deficit) for the year. Subtract line 2 from line 1 .............	3	-2,569,425
4	Net unrealized gains (losses) on investments ..........................	4	-3,296,601
5	Donated services and use of facilities .............................	5
6	Investment expenses ...................................	6
7	Prior period adjustments ..................................	7
8	Other (Describe in Part XIV.) .................................	8	-1,123,444
9	Total adjustments (net). Add lines 4 through 8 .........................	9	-4,420,045
10	Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 .........	10	-6,989,470

Part XII Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1	Total revenue, gains, and other support per audited financial statements .......			1	387,853,882
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains on investments ..........	2a	-3,296,601
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIV.) ............	2d	-21,336,478
e	Add lines 2a through 2d .....................			2e	-24,633,079
3	Subtract line 2e from line 1.....................			3	412,486,961
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIV.) ...........	4b
c	Add lines 4a and 4b.......................			4c
5	Total Revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......			5	412,486,961

Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1	Total expenses and losses per audited financial statements .............			1	394,843,352
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities ..........	2a
b	Prior year adjustments ..............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIV.) ............	2d
e	Add lines 2a through 2d......................			2e
3	Subtract line 2e from line 1.....................			3	394,843,352
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIV.) ............	4b	20,213,034
c	Add lines 4a and 4b.......................			4c	20,213,034
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......			5	415,056,386

Part XIV

Supplemental Information

Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X; Part XI, line 8; Part XII, lines 2d and 4b; and Part XIII, lines 2d and 4b. Also complete this part to provide any additional information.

Identifier	Return Reference	Explanation
Part V, Line 4		Permanently restricted endowment funds are held in perpetuity with restrictions on income for health services, medical research, medical education, and indigent care.
Part XI, Line 8	OTHER CHANGES IN NET ASSETS OR FUND BALANCES	POST RETIREMENT BENEIFT RELATED CHANGES -698,689 PROJECT ABANDONMENT (PATIENT KEEPER) -424,755 --------- TOTAL -1,123,444
Part XII, Line 2d	OTHER REVENUE INCLUDED IN F/S BUT NOT INCLUDED ON FORM 990	BAD DEBT -14,513,947 CHARITY CARE -5,699,087 POST RETIREMENT BENEIFT RELATED CHANGES -698,689 PROJECT ABANDONMENT (PATIENT KEEPER) -424,755 --------- TOTAL -21,336,478
Part XIII, Line 4b	Other Expenses Included on Form 990 but not included in F/S	BAD DEBT 14,513,947 CHARITY CARE 5,699,087 ---------- Total 20,213,034

Schedule D (Form 990) 2011

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H (Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990. MediumBullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

The Mary Imogene Bassett Hospital

Employer identification number

13-5596796

Part I

Charity Care and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a....

Yes

If "Yes," was it a written policy? .......................

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) to determine eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other 300 %

Did the organization use FPG to determine eligibility for providing discounted care? If "Yes," indicate which of the

following was the family income limit for eligibility for discounted care: ............

200% 250% 300% 350% 400% Other

If the organization did not use FPG to determine eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, to determine eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? ..............

Yes

Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year? ............................

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount?......

Yes

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care?...............

Did the organization prepare a community benefit report during the tax year?...........

Yes

If "Yes," did the organization make it available to the public? ...............

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

	(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a Financial Assistance at cost (from Worksheet 1) ..	3,563,479	269,165	3,294,314	0.790 %
b Medicaid (from Worksheet 3, column a) .....	48,341,819	33,350,141	14,991,678	3.610 %
c Costs of other means-tested government programs (from Worksheet 3, column b) .
dTotal Financial Assistance and Means-Tested Government Programs .....	51,905,298	33,619,306	18,285,992	4.400 %
Other Benefits e Community health improvement services and community benefit operations (from (Worksheet 4) ....	50,666		50,666	0.010 %
f Health professions education (from Worksheet 5) ..	15,207,172	4,351,640	10,855,532	2.620 %
g Subsidized health services (from Worksheet 6) ..
h Research (from Worksheet 7)	8,154,970	317,280	7,837,690	1.890 %
i Cash and in-kind contributions for community benefit (from Worksheet 8) ....	494,136		494,136	0.120 %
jTotal Other Benefits ...	23,906,944	4,668,920	19,238,024	4.640 %
kTotal. Add lines 7d and 7j. ..	75,812,242	38,288,226	37,524,016	9.040 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2011

Schedule H (Form 990) 2011

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................

Yes

Enter the amount of the organization's bad debt expense........

6,468,132

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy .....

996,503

Provide in Part VI the text of the footnote to the organization's financial statements that describes bad debt expense. In addition, describe the costing methodology used in determining the amounts reported on lines 2 and 3, and rationale for including a portion of bad debt amounts as community benefit.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

96,155,735

Enter Medicare allowable costs of care relating to payments on line 5.....

85,668,387

Subtract line 6 from line 5. This is the surplus or (shortfall)........

10,487,348

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

Yes

Part IV

Management Companies and Joint Ventures

(see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership%	(e) Physicians' profit % or stock ownership %
1At home care inc	Home healthcare agency	50.000 %	0 %	0 %
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2011

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest) How many hospital facilities did the organization operate during the tax year?1 Name and address		Other (Describe)
1	Mary Imogene Bassett Hospital one atwell road cooperstown,NY13326	X	X	X	X	X	Outpatient primary & Specialty Clinics

Schedule H (Form 990) 2011

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Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)

Mary Imogene Bassett Hospital

Name of Hospital Facility:

Line Number of Hospital Facility (from Schedule H, Part V, Section A):1

				Yes	No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1	During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. .....................		1		No
	If “Yes,” indicate what the Needs Assessment describes (check all that apply):
	a	A definition of the community served by the hospital facility
	b	Demographics of the community
	c	Existing health care facilities and resources within the community that are available to respond to the health needs of the community
	d	How data was obtained
	e	The health needs of the community
	f	Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
	g	The process for identifying and prioritizing community health needs and services to meet the community health needs
	h	The process for consulting with persons representing the community’s interests
	i	Information gaps that limit the hospital facility’s ability to assess the community’s health needs
	j	Other (describe in Part VI)
2	Indicate the tax year the hospital facility last conducted a Needs Assessment: 20
3	In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted.		3
4	Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................		4
5	Did the hospital facility make its Needs Assessment widely available to the public? ...........		5
	If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
	a	Hospital facility’s website
	b	Available upon request from the hospital facility
	c	Other (describe in Part VI)
6	If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
	a	Adoption of an implementation strategy to address the health needs of the hospital facility’s community
	b	Execution of the implementation strategy
	c	Participation in the development of a community-wide community benefit plan
	d	Participation in the execution of a community-wide community benefit plan
	e	Inclusion of a community benefit section in operational plans
	f	Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
	g	Prioritization of health needs in the community
	h	Prioritization of services that the hospital facility will undertake to meet health needs in its community
	i	Other (describe in Part VI)
7	Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. ....		7
Financial Assistance Policy
	Did the hospital facility have in place during the tax year a written financial assistance policy that:
8	Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care?		8	Yes
9	Used federal poverty guidelines (FPG) to determine eligibility for providing free care?...........		9	Yes
	If "Yes," indicate the FPG family income limit for eligibility for free care: 300.% If "No," explain in Part VI the criteria the hospital facility used.

Schedule H (Form 990) 2011

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Part VFacility Information (continued)

				Yes	No
10	Used FPG to determine eligibility for providing discounted care?.................		10		No
	If “Yes,” indicate the FPG family income limit for eligibility for discounted care: % If "No," explain in Part VI the criteria the hospital facility used.
11	Explained the basis for calculating amounts charged to patients?.................		11		No
	If “Yes,” indicate the factors used in determining such amounts (check all that apply):
	a	Income level
	b	Asset level
	c	Medical indigency
	d	Insurance status
	e	Uninsured discount
	f	Medicaid/Medicare
	g	State regulation
	h	Other (describe in Part VI)
12	Explained the method for applying for financial assistance?...................		12	Yes
13	Included measures to publicize the policy within the community served by the hospital facility?.......		13	Yes
	If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
	a	The policy was posted on the hospital facility’s web site
	b	The policy was attached to all billing invoices
	c	The policy was posted in the hospital facility’s emergency rooms or waiting rooms
	d	The policy was posted in the hospital facility’s admissions offices
	e	The policy was provided, in writing, to patients upon admission to the hospital facility
	f	The policy was available upon request
	g	Other (describe in Part VI)
Billing and Collections
14	Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?.......		14	Yes
15	Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
	a	Reporting to credit agency
	b	Lawsuits
	c	Liens on residences
	d	Body attachments
	e	Other similar actions (describe in Part VI)
16	Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?..........		16	Yes
	If “Yes,” check all actions in which the hospital facility or a third party engaged:
	a	Reporting to credit agency
	b	Lawsuits
	c	Liens on residences
	d	Body attachments
	e	Other similar actions (describe in Part VI)
17	Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
	a	Notified patients of the financial assistance policy upon admission
	b	Notified patients of the financial assistance policy prior to discharge
	c	Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
	d	Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
	e	Other (describe in Part VI)

Schedule H (Form 990) 2011

Page

Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
				Yes	No
18	Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..........		18	Yes
	If “No,” indicate why:
	a	The hospital facility did not provide care for any emergency medical conditions
	b	The hospital facility’s policy was not in writing
	c	The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
	d	Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19	Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
	a	The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
	b	The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
	c	The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
	d	Other (describe in Part VI)
20	Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?.........		20		No
	If “Yes,” explain in Part VI.
21	Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?...............................		21	Yes
	If “Yes,” explain in Part VI.

Schedule H (Form 990) 2011

Page

Part VFacility Information (continued)

Section C. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?50
Name and address		Type of Facility (describe)
1	AC CLARK GYMNASIUM SUSQUEHANA AVENUE COOPERSTOWN,NY13326	OUTPATIENT PHYSICAL THERAPY SERVICES
2	BASSETT HEALTHCARE HAMILTON SURGICAL SER 10 EATON STREET HAMILTON,NY13346	OUTPATIENT SPECIALTY CARE
3	BASSETT HEALTHCARE HERKIMER CARDIAC REHA 690 WEST GERMAN STREET HERKIMER,NY13350	OUTPATIENT REHAB SERVICES
4	BASSETT HEALTHCARE CLINTON 34 CHENANGO AVENUE CLINTON,NY13323	OUTPATIENT PRIMARY CARE PRIMARY CARE
5	BASSETT HEALTHCARE CANAJOHARIE 56 MONTGOMERY STREET CANAJOHARIE,NY13317	OUTPATIENT PRIMARY CARE
6	BASSETT HEALTHCARE COBLESKILL 121 LEGION DRIVE COBLESKILL,NY12043	OUTPATIENT PRIMARY CARE
7	BASSETT HEALTHCARE DELANSON 1 COOLEY HEIGHTS DELANSON,NY12053	OUTPATIENT PRIMARY CARE PRIMARY CARE
8	BASSETT HEALTHCARE DELHI 460 ANDES ROAD DELHI,NY13753	OUTPATIENT DENTAL AND PRIMARY
9	BASSETT HEALTHCARE EDMESTON ROUTE 80 PO BOX 15 EDMESTON,NY13335	OUTPATIENT PRIMARY CARE
10	BASSETT HEALTHCARE HAMILTON 160 BROAD STREET HAMILTON,NY13346	OUTPATIENT DENTAL AND PRIMARY CARE
11	BASSETT HEALTHCARE HERKIMER 321 EAST ALBANY STREET HERKIMER,NY13350	OUTPATIENT PRIMARY, SPECIALTY, SPECIALTY, AND URGENT CARE
12	BASSETT HEALTHCARE MIDDLEBURGH 109 BAKER AVENUE MIDDLEBURGH,NY12122	OUTPATIENT PRIMARY CARE
13	BASSETT HEALTHCARE MORRIS 93 MAIN STREET MORRIS,NY13808	OUTPATIENT SPECIALTY CARE
14	BASSETT HEALTHCARE ONEONTA SURGICAL ASSO 449 MAIN STREET ONEONTA,NY13820	OUTPATIENT SPECIALTY CARE
15	BASSETT HEALTHCARE NORWICH 55 CALVARY DRIVE NORWICH,NY13815	OUTPATIENT PRIMARY CARE
16	BASSETT HEALTHCARE ONEONTA 125 MAIN STREET ONEONTA,NY13820	OUTPATIENT PRIMARY CARE
17	BASSETT HEALTHCARE ONEONTA SPECIALTY SER ONE ASSOCIATE DRIVE ONEONTA,NY13820	OUTPATIENT PRIMARY, SPECIALTY, SPECIALTY, AND URGENT CARE
18	BASSETT HEALTHCARE PHYSICAL THERAPY 21 RAILROAD AVENUE COOPERSTOWN,NY13326	OUTPATIENT SPECIALTY CARE
19	BASSETT HEALTHCARE RICHFIELD SPRINGS 8550 STATE HIGHWAY 28 RICHFIELD SPRINGS,NY13439	OUTPATIENT PRIMARY CARE
20	BASSETT HEALTHCARE SCHOHARIE 111 BARTON HILL ROAD SCHOHARIE,NY12157	OUTPATIENT PRIMARY CARE
21	BASSETT HEALTHCARE SHARON SPRINGS ROUTE 20 PO BOX 275 SHARON SPRINGS,NY13459	OUTPATIENT PRIMARY CARE
22	BASSETT HEALTHCARE SHERBOURNE 20 CHAPEL STREET SHERBOURNE,NY13460	OUTPATIENT PRIMARY CARE
23	BASSETT HEALTHCARE SIDNEY 39 PEARL STREET WEST SIDNEY,NY13838	OUTPATIENT PRIMARY CARE
24	BASSETT HEALTHCARE ST JOHNSVILLE 8 PARK PLACE ST JOHNSVILLE,NY13452	OUTPATIENT PRIMARY CARE
25	BASSETT HEALTHCARE STAMFORD 28650 STATE HIGHWAY 23 STAMFORD,NY12167	OUTPATIENT PRIMARY CARE
26	BASSETT HEALTH WALTON 130 NORTH STREET WALTON,NY13856	OUTPATIENT PRIMARY CARE
27	BASSETT HEALTHCARE WEST WINFIELD 544 EAST MAIN STREET WEST WINFIELD,NY13491	OUTPATIENT PRIMARY CARE
28	BASSETT HEALTHCARE AT FOX CARE 1 FOX CARE DRIVE ONEONTA,NY13820	OUTPATIENT SPECIALTY SERVICES
29	BASSETT HEALTHCARE AT LITTLE FALLS 170 BURWELL STREET LITTLE FALLS,NY13365	OUTPATIENT PRIMARY CARE
30	BASSETT HEALTHCARE UNADILLA 16 CLIFTON STREET UNADILLA,NY13849	OUTPATIENT PRIMARY CARE
31	BASSETT REGIONAL CANCER CENTER 7 ASSOCIATE DRIVE ONEONTA,NY13820	OUTPATIENT SPECIALTY CARE
32	HARTWICK SEMINARY SPECIALTY SERVICES 4580 ROUTE 28 MILFORD,NY13807	OUTPATIENT PRIMARY AND specialty care
33	SBHC COOPERSTOWN ELEMENTARY 21 WALNUT STREET COOPERSTOWN,NY13326	OUTPATIENT PRIMARY CARE
34	SBHC COOPERSTOWN MIDDLE & HIGH SCHOOL 39 LINDEN AVENUE COOPERSTOWN,NY13326	OUTPATIENT PRIMARY CARE
35	SBHC DELHI ELEMENTARY 2 SHELDON DRIVE DELHI,NY13753	OUTPATIENT PRIMARY CARE
36	SBHC DELHI MIDDLE & HIGH SCHOOL 2 SHELDON DRIVE DELHI,NY13753	OUTPATIENT PRIMARY CARE
37	SBHC EDMESTON CENTRAL SCHOOL 11 NORTH STREET EDMESTON,NY13335	OUTPATIENT PRIMARY CARE
38	SBHC LAURENS CENTRAL SCHOOL 55 MAIN STREET LAURENS,NY13796	OUTPATIENT PRIMARY CARE
39	SBHC MIDDLEBURGH ELEMENTARY 245-I MAIN STREET MIDDLEBURGH,NY12122	OUTPATIENT PRIMARY CARE
40	SBHC MIDDLEBURGH MIDDLE & HIGH SCHOOL 291 MAIN STREET MIDDLEBURGH,NY12122	OUTPATIENT PRIMARY CARE
41	SBHC MILFORD CENTRAL SCHOOL 42 WEST MAIN STREET MILFORD,NY13807	OUTPATIENT PRIMARY CARE
42	SBHC MORRIS CENTRAL SCHOOL 65 MAIN STREET MORRIS,NY13808	OUTPATIENT PRIMARY CARE
43	SBHC ORAL HEALTH MOBILE EQUIPMENT PROGRA ONE ATWELL ROAD COOPERSTOWN,NY13326	OUTPATIENT SPECIALTY CARE
44	SBHC SCHENEVUS CENTRAL SCHOOL 159 MAIN STREET SCHENEVUS,NY12155	OUTPATIENT PRIMARY CARE
45	SBHC SHERBURNEEARLVILLE ELEMENTARY 13 SCHOOL STREET SHERBURNE,NY13460	OUTPATIENT PRIMARY CARE
46	SBHC SHERBURNEEARLVILLE MIDDLE & HIGH S 13 SCHOOL STREET SHERBURNE,NY13460	OUTPATIENT PRIMARY CARE
47	SBHC SIDNEY CENTRAL SCHOOL 95 WEST MAIN STREET SIDNEY,NY13838	OUTPATIENT PRIMARY CARE
48	SBHC SOUTH KORTRIGHT CENTRAL SCHOOL PO BOX 113 SOUTH KORTRIGHT,NY13842	OUTPATIENT PRIMARY CARE
49	SBHC STAMFORD CENTRAL SCHOOL ONE RIVER STREET STAMFORD,NY12167	OUTPATIENT PRIMARY CARE
50	SBHC WORCESTER CENTRAL SCHOOL 195 MAIN STREET WORCESTER,NY12197	OUTPATIENT PRIMARY CARE

Schedule H (Form 990) 2011

Page

Part VI

Supplemental Information

Complete this part to provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; and Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 9, 10, 11h, 13g, 15e, 16e, 17e, 18d, 19d, 20, and 21.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any needs assessments reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Identifier	ReturnReference	Explanation
Part I, Line 3c	Charity Care Eligibility Criteria (FPG is Not Used)	The CSP (community services program) application specifies family income limits and other requirements for services to be eligible for Bassett Medical Center's CSP/free care program.
Part I, Line 6a	Related Organization Community Benefit Report	THE MARY IMOGENE BASSETT HOSPITAL, D/B/A BASSETT MEDICAL CENTER (BASSETT), COMPREHENSIVE THREE-YEAR COMMUNITY SERVICE PLAN WAS SUMMARIZED IN AN ANNUAL COMMUNITY REPORT. PRINTED COPIES WERE AVAILABLE TO THE PUBLIC IN PATIENT WAITING ROOMS AND AT INFORMATION KIOSKS. THE REPORT IS ALSO POSTED ON THE BASSETT WEBSITE, WWW.BASSETT.ORG.
Part I, Line 7	Explanation of Costing Methodology	SECTIONS (A) CHARITY CARE AT COST, (B) UNREIMBURSED MEDICAID, (F) HEALTH PROFESSIONS EDUCATION, THE COSTING METHODOLOGY USED IS A COST-TO-CHARGE RATIO CALCULATION UTILIZED ON FILED STATE AND FEDERAL COST REPORTS AS THE SOURCE. INDIRECT COSTS WERE APPLIED TO SECTIONS (E) COMMUNITY HEALTH IMPROVEMENT, PORTIONS OF (F) HEALTH PROFESSIONS EDUCATION, (H) RESEARCH, AND (I) CASH AND IN-KIND CONTRIBUTIONS TO COMMUNITY GROUPS 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 FRINGE BENEFIT RATE. INDIRECT COSTS WERE ONLY APPLIED TO SELECT SALARIES AND SERVICES UNDER COMMUNITY HEALTH IMPROVEMENT AND RESEARCH AND NOT BROADLY ACROSS ALL COMMUNITY BENEFIT ACTIVITY ENTRIES.
Part I, Line 7, Column F	Explanation of Bad Debt Expense	THE PERCENT OF TOTAL EXPENSE IS CALCULATED BY DIVIDING COLUMN (E), NET COMMUNITY BENEFIT EXPENSE, BY TOTAL EXPENSE. THE BAD DEBT EXPENSE OF $14,513,947 WAS SUBTRACTED FROM THE TOTAL EXPENSE VALUE USED TO CALCULATE THE PERCENTAGES IN PART 1, LINE 7, COLUMN F.
Part III, Line 4	Bad Debt Expense	WORKSHEET 2 COST TO CHARGE RATIO WAS USED TO DETERMINE THE AMOUNT REPORTED IN PART III, LINES 2 AND 3. Provision for Uncollectible Patient Accounts Receivable text within Financial Statements Footnotes: "The Hospital grants credit without collateral to patients, most of who 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 provisions for uncollectible accounts. Accounts written off as uncollectible are deducted from the allowance and subsequent recoveries are added. The amount of the provision for uncollectible accounts is based upon management's assessment of historical expected collections, business and economic conditions, trends in federal and state healthcare coverage, and other collection indicators." Provision for Charity and Uncompensated Care text within Financial Statements Footnotes: "The Hospital's general policy statement on charity care requires that medical care be rendered to all persons in need of such care regardless of their ability to pay. 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. These records include the amount of charges forgone for services furnished under its charity care policy. The hospital's charity care policy has not changed during fiscal years 2010 or 2011." DURING 2011 AND 2010, THE TOTAL CHARGES FORGONE FOR Bad Debt WERE APPROXIMATELY $14,513,947 AND $15,329,504 RESPECTIVELY.
Part III, Line 9b	Provisions on Collection Practices for Qualified Patients	For patients or guarantors who do not qualify for financial assistance, Bassett must undertake to ensure an adequate understanding on the part of the patients and those responsible for their care of their financial obligations to Bassett. Bassett will in compliance with all existing laws and regulations take the steps necessary to recover self-pay accounts receivable as well as preserve the patient-provider relationship and keep the necessity of referring accounts to third party bad debt collection agencies or law firms to a minimum. It is expected that any third party collection agency or law firm retained by Bassett will 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. The arrest or body attachment of a judgment debtor on contempt proceedings, or foreclosure of a judgment debtor's principal residence will never be considered appropriate pursuit of an open balance in the name of Bassett Medical Center. Liens or garnishments upon the personal assets of a judgment debtor will be pursued only after individual case review by counsel to ensure that such action is not only consistent with Bassett's interests, but also the only feasible recovery mechanism from a judgment debtor capable of responding to his or her obligations, but otherwise unwilling to do so.
Part V, line 10	Discounted Care	Bassett Medical Center does not provide discounted care.
Part V, Line 15e	Other Collection Actions Against a Patient	Bassett engages with a third party to perform collection actions.
Part V, Line 16e	Other Collection Actions by Facility or Third Party Engaged	Other actions taken include claims on estates, claims on bankruptcies, and wage garnishments.
Part V, Line 19d	Other Billing Determination of Individuals Without Insurance	Bassett 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. All charges to individuals that qualify for charity care are written off completely.
Part V, Line 21	Charge Patients Amount Equal Gross Charge for Services	THE HOSPITAL'S CHARGE DESCRIPTION MASTER, WHICH INCLUDES A SEPARATE GROSS CHARGE FOR ALL SERVICES, IS WHAT IS USED TO BILL ALL PATIENTS WHEN A SERVICE IS RENDERED. All charges to individuals that qualify for charity care are written off completely.
Part VI, Line 2	Needs Assessment	In addition to public and agency input, a variety of data from the NYS Department of Health, Otsego County Behavioral Risk Factor Surveillance System, Otsego Co. Department of Health Community Assessment and other sources were used to assess priorities, including: A) Percentage of Otsego Co. adults who visited a dentist in the past years. B) Prevalence of tooth decay in third-grade children. C) Percentage of adults reporting binge drinking D) Heavy drinking E) Percentage of overweight adults in Otsego Co. Based on the outcomes of the focus groups and strategic planning sessions prevention agenda priorities throughout the county were identified. Access to quality healthcare and Mental Health and Substance Abuse were identified as the top priorities. Physical Activity and Nutrition was ranked third. Subsequent strategic planning sessions related to the two top priorities were held to identify service barriers and gaps as well as brainstorm for collaborative efforts to address these priorities. Strategies for the selected priorities: 1) Access to dental health care a) Bassett will support Otsego Co. Dept. of Health efforts to re-establish the Otsego Co. Oral Health Coalition as a mechanism for bringing community partners together on advocacy efforts aimed at attracting more dentists to our rural area, and for tracking progress in improving access to dental services b) Bassett will work to expand comprehensive preventive dental health services to all School-Based Health Centers in the county and to provide sealant services to non-SBHC schools. Bassett will work with the Otsego Co. Dept. of Health and RHENDOMS to make more schools aware of RHENDOMS services to increase participation. c) Bassett will work with the Otsego Co. Dept. of Health and A.O. Fox Hospital to educate primary care and SBHC providers about dental practices available for referral. The Otsego Co. Dept. of Health will educate dental providers about Medicaid reimbursements. d) Bassett will work with the health department and other community partners to educate the public about dental health in fairs and other community events. 2. Mental Health and Substance Abuse a) In a new initiative Bassett will work with A.O. Fox Hospital and Leatherstocking Education on Alcoholism/Addictions Foundations, Inc. (LEAF) to provide continuing medical education training on substance abuse screening and referral to primary care providers and surgeons in the county. b) Bassett will work with the health department and LEAF to complete and distribute an updated list of mental health and substance abuse resources to primary care providers. c) Bassett will collaborate with LEAF and the health department on public health campaign about the risk factors associated with binge drinking and prescription drug abuse. 3. Physical Activity and Nutrition a) Bassett will continue to collaborate with the health department and other community partners on efforts to provide early education about the importance of physical activity and nutrition throughout life, including during pregnancy and to prevent chronic disease. b) Bassett will work with the health department, schools and other community partners to improve continuity of care between families, schools and primary care providers for the treatment of childhood obesity. Overall goals will be to increase the percentage of Otsego County adults who have seen a dentist in the past year, work toward a 2013 prevention agenda objective of 83%, reducing the rate of alcohol abuse in Otsego County and reducing the rate of obesity in Otsego County.
Part VI, Line 3	Patient Education of Eligibility for Assistance	A MAJOR COMPONENT OF THE BASSETT MEDICAL CENTER 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 BASSETT EMPLOYEES. THE POLICY IS UPDATED ANNUALLY, DISTRIBUTED TO KEY PERSONNEL AND POSTED IN THE ONLINE POLICY AND PROCEDURE MANUAL THAT 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 AT ALL FACILITIES AND ALL CLINIC LOCATIONS. 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. REFERRAL TO AN ONSITE OTSEGO COUNTY MEDICAID EXAMINER IS AVAILABLE AT THE COOPERSTOWN CAMPUS. A LISTING OF ALL SELF-PAY ACCOUNTS IS PRODUCED AND REVIEWED DAILY TO INSURE 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 Information	THE SERVICE AREA OF BASSETT ENCOMPASSES A EIGHT COUNTY REGION IN UPSTATE NEW YORK. WHILE THE ECONOMY OF COOPERSTOWN IS BASED ON TOURISM AND HEALTH CARE, THE REST OF THE REGION IS LARGELY AGRICULTURAL. THERE ARE A FEW LARGER EMPLOYERS IN THE REGION SUCH AS LOCAL SCHOOL DISTRICTS, COMMUNITY, STATE AND PRIVATE UNIVERSITIES, THE MAJORITY OF EMPLOYERS ARE SMALL BUSINESSES. IN THE EIGHT COUNTY REGIONS, THE MEDIAN HOUSEHOLD INCOME RANGES BETWEEN $37,000 AND $40,000. 12-14 % OF THE COMMUNITY RESIDENTS HAVE INCOMES BELOW THE FEDERAL POVERTY GUIDELINES. THE FOLLOWING AREAS HAVE BEEN FEDERALLY DESIGNATED AS BEING MEDICALLY UNDERSERVED: A) IN HERKIMER COUNTY THE CITY OF HERKIMER. B) IN DELAWARE COUNTY THE TOWNS OF MIDDLETOWN, MARGARETVILLE, ANDES AND DEPOSIT.
Part VI, Line 5	Community Building Activities	BASSETT SERVES AS THE FOUNDATION FOR THE THURSTON CORPORATION (DBA BASSETT HEALTHCARE NETWORK) AND IS A 180-BED ACUTE CARE INPATIENT TEACHING FACILITY LOCATED IN COOPERSTOWN, NEW YORK. PROVIDING A WIDE RANGE OF SPECIALTY CARE, BASSETT MAINTAINS A STRONG ACADEMIC PROGRAM THROUGH ITS AFFILIATION WITH COLUMBIA UNIVERSITY COLLEGE OF PHYSICIANS AND SURGEONS, AN AFFILIATION HIGHLIGHTED BY THE ESTABLISHMENT OF A COLUMBIA MEDICAL SCHOOL CAMPUS AT BASSETT IN 2009. BASSETT HAS A NETWORK OF 29 COMMUNITY BASED OUTPATIENT HEALTH CENTERS, 18 SCHOOL-BASED HEALTH CENTERS, TWO AMBULATORY SURGERY CENTERS AND IS A LEVEL II TRAUMA CENTER AS DESIGNATED BY NEW YORK STATE. IN ADDITION, THE RESEARCH PROGRAMS AT BASSETT INCLUDE THE NEW YORK CENTER FOR AGRICULTURAL MEDICINE AND HEALTH. COMMUNITY BASED PARTNERSHIPS AS PART OF THE NORTHEAST CENTER FOR AGRICULTURAL HEALTH ARE ADDRESSING IMPORTANT HEALTH AND SAFETY ISSUES IN DIVERSE AGRICULTURAL POPULATIONS AT SEVERAL SITES ACROSS NEW YORK STATE. HEALTH WORKS OCCUPATIONAL HEALTH SERVICES PROGRAM CONTINUES TO MEET THE HEALTH, SAFETY AND WELLNESS NEEDS OF THE BUSINESS COMMUNITY. PROVIDING NEEDED OCCUPATIONAL HEALTH SERVICES BENEFITS AND IMPROVING EMPLOYEE HEALTH THROUGHOUT THE BASSETT HEALTHCARE NETWORK EIGHT-COUNTY REGION. BASSETT IS WORKING TO RE-ESTABLISH THE OTSEGO COUNTY ORAL HEALTH COALITION AS A MECHANISM FOR BRINGING COMMUNITY PARTNERS TOGETHER AROUND A SHARED VISION IN AN EFFORT TO ATTRACT MORE DENTISTS TO OUR RURAL AREA. THE SIZE AND DEPTH OF BASSETT WITH ITS MORE THAN TWO DOZEN COMMUNITY HEALTH CENTERS AND 18 SCHOOL BASED HEALTH CENTERS MAKES IT IDEAL FOR A NEW INITIATIVE TO TRAIN PRIMARY CARE PRACTITIONERS AND SURGEONS IN SUBSTANCE ABUSE SCREENING AND REFERRAL. THE GOAL IS TO ALSO TRAIN PRACTITIONERS OUTSIDE BASSETT HOSPITAL, BUT BASSETT PROVIDES THE IDEAL PLATFORM FROM WHICH TO PILOT THIS INITIATIVE. BASSETT IS ALSO ADDRESSING THE RATE OF OBESITY WITHIN ITS REGION REACHING OUT TO SCHOOLS TO PROVIDE RESOURCES, GUIDANCE AND TECHNICAL ASSISTANCE IN THE AREAS OF TOBACCO USE, NUTRITION AND PHYSICAL ACTIVITY. BASSETT CONTINUES TO COMBINE HEALTH CARE WITH COMMUNITY SERVICE. OUR PROGRAM "CONNECTING COMMUNITIES FOR HEALTH & WELLNESS" IS ABOUT COLLABORATIVE EFFORTS TO PROVIDE TREATMENT AND/OR TO PROMOTE HEALTH AND HEALING AS A RESPONSE TO IDENTIFIED COMMUNITY NEEDS. COMMUNITY HEALTH IMPROVEMENT INITIATIVES HAVE TARGETED THE NEW YORK STATE DEPARTMENT OF HEALTH NEW PUBLIC HEALTH PREVENTION AGENDA. IN ADDITION TO HOSPITAL PUBLIC HEALTH PROGRAMS RELATED TO THE THREE PRIORITY PREVENTION AGENDA ITEMS, PROGRAMS ADDRESSING CHRONIC DISEASE MANAGEMENT AND PREVENTION AND UNINTENTIONAL INJURY WERE CONSIDERED. BASSETT PUBLIC HEALTH PROGRAMS THAT ADDRESS THESE AREAS INCLUDE: A) SCHOOL-BASED HEALTH CENTER DENTAL SEALANT PROGRAM. A REGISTERED DENTAL HYGIENIST PROVIDES PREVENTIVE CARE, INCLUDING EDUCATION, CLEANINGS, FLUORIDE TREATMENT, SEALANT AND REFERRALS IN THIS GRANT FUNDED PROGRAM. B) RHENDOMS (RURAL HEALTH EDUCATION NETWORK OF DELAWARE, OTSEGO, MONTGOMERY AND SCHOHARIE COUNTIES) - DENTAL HEALTH EDUCATION IS OFFERED TO ELEMENTARY SCHOOL STUDENTS, AND PARENTS OF NEWBORNS ARE EDUCATED ABOUT BABY-BOTTLE TOOTH DECAY. C) BASSETT PSYCHIATRIC CRISIS CENTER - THE COOPERSTOWN CENTER OPENED IN FEBRUARY 2008, FILLING A VOID CREATED BY THE TERMINATION OF PSYCHIATRIC SERVICES AT A.O. FOX HOSPITAL IN ONEONTA MONTHS EARLIER. IN ITS FIRST YEAR, BASSETT'S PSYCHIATRIC CRISIS CENTER HELPED MORE THAN 1,200 PATIENTS. OF THOSE, 52 WERE CHILDREN 12 OR YOUNGER AND 154 WERE ADOLESCENTS. D) PARENT HANDBOOK - THIS FAMILY RESOURCE WAS CREATED BY THE OTSEGO CO. COMMITTEE ON CHILD ABUSE AND NEGLECT AND UNDERWRITTEN BY BASSETT HEALTHCARE AND A.O. FOX HOSPITAL. IT'S GOAL IS TO GIVE PARENTS AND PROFESSIONALS A PLACE TO TURN FOR HELP IN DEALING WITH THE STRESSES OF FAMILY LIFE. E) KICKSTART - A PROGRAM DESIGNED TO HELP COMBAT CHILDHOOD OBESITY THROUGH COLLABORATIVE PARTNERSHIPS WITH BASSETT HEALTH CENTERS AND LOCAL RECREATIONAL AND FITNESS GROUPS. F) BASSETT CANCER INSTITUTE MEDICAL SCREENING COACH - A NEW, CUSTOM-BUILT MEDICAL COACH EQUIPPED WITH DIGITAL TECHNOLOGY FOR MAMMOGRAPHY AND OTHER CANCER SCREENINGS FOR MEN AND WOMEN. THE COACH WAS PLACED IN SERVICE IN 2008 WITH THE GOAL OF REDUCING THE NUMBER OF CANCER DEATHS BY INCREASING ACCESS TO SCREENING SERVICES IN RURAL AREAS. G) CANCER SERVICES PROGRAM OF DELAWARE, OTSEGO AND SCHOHARIE COUNTIES A NEW YORK STATE DEPARTMENT OF HEALTH PARTNERSHIP ADMINISTERED THROUGH BASSETT OFFERING FREE BREAST, CERVICAL AND COLORECTAL SCREENINGS TO PEOPLE WHO QUALIFY. H) HEALTHY START BREAKFAST - A PARTNERSHIP BETWEEN COMMUNITY SERVICE ORGANIZATIONS AND BASSETT FOR DIABETES DETECTION, EDUCATION AND PREVENTION. I) SAFE KIDS COALITION OF OTSEGO COUNTY - AN ORGANIZATION WHOSE MISSION IS TO PREVENT UNINTENTIONAL INJURIES TO CHILDREN THROUGH EDUCATION. PROGRAMS AND SERVICES INCLUDE SAFETY SEAT EVENTS, EDUCATIONAL RESOURCES ON BICYCLE, IN-LINE SKATE AND SKATEBOARD SAFETY, HOME SAFETY, FIRE AND BURN PREVENTION, ROAD SAFETY AND PEDESTRIAN SAFETY. THE REGIONAL PRIMARY AND SPECIALTY CARE CLINICS AND THE SCHOOL-BASED HEALTH CENTERS WERE ESTABLISHED IN RESPONSE TO COMMUNITY NEED. BASSETT IS CONTINUALLY ENGAGING IN QUALITY IMPROVEMENT INITIATIVES TO ENSURE THAT QUALITY HEALTH CARE AND PROGRAMS ARE BROUGHT TO CENTRAL NEW YORK. A CORE PART OF BASSETT IS RESEARCH AND EDUCATION. BASSETT'S VALUE TO THE COMMUNITIES IT SERVES IS COMPOUNDED BY PROVIDING PHYSICIANS THE ABILITY TO PRACTICE QUALITY MEDICINE IN A COLLEGIAL ENVIRONMENT IN A RURAL SETTING. THERE IS A TREMENDOUS COLLABORATION BETWEEN PHYSICIANS WITHIN BASSETT TO ENSURE A BETTER OUTCOME FOR THE PATIENT. BASSETT CONTINUALLY INVESTS IN PROGRAMS, EQUIPMENT AND PEOPLE TO ENSURE QUALITY SERVICE TO THE COMMUNITIES IN WHICH WE SERVE.
Part VI, Line 6	Affilated Health Care System Roles and Promotion	BASSETT IS PART OF THE BASSETT HEALTHCARE NETWORK THAT PROVIDES HEALTH SERVICES IN MORE THAN 20 COMMUNITIES SPANNING 5,600 SQUARE MILES AND EIGHT COUNTIES. THE NETWORK FOCUSES ITS COMMUNITY SERVICES PROGRAMS IN THE COUNTIES WHERE THE SIX AFFILIATED HOSPITALS AND GREATEST PATIENT POPULATIONS ARE LOCATED. OTSEGO COUNTY - POPULATION 61,917; DELAWARE COUNTY - POPULATION 47,559; HERKIMER COUNTY - POPULATION 62,200; SCHOHARIE COUNTY - POPULATION 31,910 (ACCORDING TO THE 2008 U.S. CENSUS ESTIMATES). 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, 18 SCHOOL BASED HEALTH CENTERS, TWO AMBULATORY SURGERY CENTERS AND A FULLY SALARIED MEDICAL STAFF IN COOPERSTOWN, OTSEGO COUNTY B) O'CONNOR HOSPITAL - A CRITICAL ACCESS HOSPITAL IN DELHI, DELAWARE COUNTY C. COBLESKILL REGIONAL HOSPITAL - AN ACUTE CARE FACILITY IN COBLESKILL, SCHOHARIE COUNTY D) LITTLE FALLS HOSPITAL - A CRITICAL ACCESS HOSPITAL IN LITTLE FALLS, HERKIMER COUNTY E) TRI-TOWN REGIONAL HOSPITAL - A 24/7 EMERGENCY CARE FACILITY IN SIDNEY, DELAWARE COUNTY F) A.O. FOX MEMORIAL HOSPITAL - AN 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 THE ABOVE (A-I) MAKE UP THE BASSETT HEALTHCARE NETWORK AND PROVIDE HEALTH SERVICES TO THIS EIGHT COUNTY REGION IN CENTRAL NEW YORK.
Part VI, Line 7	States Where Community Benefit Report Filed	NY
Additional Information		Part II - All Bassett community building activities could be classified under item 1 and highlighted in Part I.
Part III, line 8	Explanation of Shortfall as community benefit	Amounts were derived as follows: charges times cost to charge ratio versus reimbursement on the Medicare PS&R report.

Schedule H (Form 990) 2011

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet

Attach to Form 990. SchJMediumBullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

The Mary Imogene Bassett Hospital

Employer identification number

13-5596796

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all the expenses described above? If "No," complete Part III to explain....

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
officers, directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? ....

Indicate which, if any, of the following the organization uses to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? ...............

Participate in, or receive payment from, a supplemental nonqualified retirement plan? ........

Participate in, or receive payment from, an equity-based compensation arrangement? ........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.

For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 5a or 5b, describe in Part III.

For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 6a or 6b, describe in Part III.

For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Yes

Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................

If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990

Cat. No. 50053T

Schedule J (Form 990) 2011

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.

Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and column (E) for that individual.

(A) Name		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation reported as deferred in prior Form 990
(A) Name		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation reported as deferred in prior Form 990
(1) William F Streck MD	(i) (ii)	651,668 0	0 0	5,283 0	11,339 0	6,610 0	674,900 0	0 0
(2) Bertine Colombo Mckenna PHD	(i) (ii)	369,024 0	0 0	0 0	8,709 0	4,003 0	381,736 0	0 0
(3) Nicholas J Nicoletta	(i) (ii)	368,286 0	0 0	0 0	11,339 0	4,400 0	384,025 0	0 0
(4) Steven J Heneghan MD	(i) (ii)	579,331 0	0 0	0 0	11,339 0	6,167 0	596,837 0	0 0
(5) Joseph Schmer MD	(i) (ii)	450,350 0	75,916 0	2,365 0	8,709 0	3,167 0	540,507 0	0 0
(6) James C Peters MD	(i) (ii)	484,616 0	24,373 0	0 0	10,114 0	14,718 0	533,821 0	0 0
(7) Jonathan Richman Md	(i) (ii)	527,196 0	0 0	0 0	11,339 0	6,936 0	545,471 0	0 0
(8) ROBERT LANCEY MD	(i) (ii)	520,879 0	0 0	0 0	8,709 0	12,687 0	542,275 0	0 0

Schedule J (Form 990) 2011

Page 3

Part III

Supplemental Information

Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4c, 5a, 5b, 6a, 6b, 7, and 8. Also complete this part for any additional information.

Identifier	Return Reference	Explanation
PART I, LINE 7		NON-FIXED PAYMENTS ARE MADE BASED ON THE SUCCESS IN MEETING PERFORMANCE CRITERIA THAT ARE PROSPECTIVELY AGREED UPON AS GOALS FOR THE OFFICERS. PHYSICIAN CHIEFS MAY RECEIVE NON-FIXED PAYMENTS BASED ON PERFORMANCE AND COMPARATIVE MARKET DATA
Part VII, Line 5	Compensation from Unrelated ORganizations	NAME : WILLIAM F STRECK, MD NAME OF UNRELATED ORGANIZATION : COLUMBIA UNIVERSITY TYPE OF COMPENSATION : SALARY AMOUNT OF COMPENSATION : $228,798

Schedule J (Form 990) 2011

Additional Data

Software ID:
Software Version:

- TIN:

Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
SchKMediumBullet

Attach to Form 990. SchKMediumBullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public
Inspection

Name of the organization
The Mary Imogene Bassett Hospital

Employer identification number
13-5596796

Part I

Bond Issues

(a) Issuer Name		(b) Issuer EIN	(c) CUSIP #	(d) Date Issued	(e) Issue Price	(f) Description of Purpose	(g) Defeased		(h) On Behalf of Issuer		(i) Pool financing
(a) Issuer Name		(b) Issuer EIN	(c) CUSIP #	(d) Date Issued	(e) Issue Price	(f) Description of Purpose	Yes	No	Yes	No	Yes	No
A	Otsego Cty Capital Resour	26-3661593		11-03-2011	25,000,000	Building & Structures		X		X		X
B	Otsego Cty Capital Resour	26-3661593		11-03-2011	19,200,000	Refund of prior issuance		X		X		X

Part II

Proceeds

	A		B		C		D
	1 Amount of bonds retired . . . . . . . . . . . . .	0		19,125,000
2 Amount of bonds legally defeased . . . . . . . . . .	0		0
3 Total proceeds of issue . . . . . . . . . . . . .	25,000,000		19,200,000
4 Gross proceeds in reserve funds . . . . . . . .	0		0
5 Capitalized interest from proceeds . . . . . . . . . .	0		0
6 Proceeds in refunding escrows . . . . . . . . . . .	702,000		0
7 Issuance costs from proceeds . . . . . . . . . . .	500,000		75,000
8 Credit enhancement from proceeds . . . . . . . . . .	0		0
9 Working capital expenditures from proceeds . . . . . . .	0		0
10 Capital expenditures from proceeds . . . . . . . . . .	23,798,000		0
11 Other spent proceeds . . . . . . . . . . .	0		0
12 Other unspent proceeds . . . . . . . . . . .	0		0
13 Year of substantial completion . . . . . . . . . . .	2009		2009
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue? . . . .		X	X
15 Were the bonds issued as part of an advance refunding issue? . . . .		X		X
16 Has the final allocation of proceeds been made? . . . . . .		X	X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . .	X		X

Part III

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . . . . . .		X		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . . . . .		X		X

For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50193E

Schedule K (Form 990) 2011

Page 2

Part III

Private Business Use (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
3a Are there any management or service contracts that may result in private business use of bond-financed property? . . . . . . . . .		X		X
b If ‘Yes’ to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property? . . . . .
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . .		X		X
d If ‘Yes’ to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property? .
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . .	0%		0%		%		%
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . . . . . . .	%		%		%		%
6 Total of lines 4 and 5 . . .. . . . . . . . .	%		%		%		%
7 Does the bond issue meet the private security or payment test? . . .	X		X
8 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2?	X		X

Part IV

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has a Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate, been filed with respect to the bond issue? . . .		X		X
2 Is the bond issue a variable rate issue?	X		X
3a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X		X
b Name of provider . . . . . . . .	0		0
c Term of hedge . . . . . . . .
d Was the hedge superintegrated? . . . .
e Was a hedge terminated? . . . . .
4a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . .		X		X
b Name of provider . . . . . .	0		0
c Term of GIC . . . . . . .
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? . . . . . .
5 Were any gross proceeds invested beyond an available temporary period? . . . . . .		X		X
6 Did the bond issue qualify for an exception to rebate? .		X		X
7 Has the organization established written procedures to monitor the requirements of section 148? . . .		X		X

Schedule K (Form 990) 2011

Page 3

Part V

Procedures To Undertake Corrective Action

Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations? . . . . . . . . . . . . . . YesNo

Part VI

Supplemental Information

Complete this part to provide additional information for responses to questions on Schedule K (see instructions).

Identifier	Return Reference	Explanation

Schedule K (Form 990) 2011

Additional Data

Software ID:
Software Version:

- TIN:

Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
SchKMediumBullet

Attach to Form 990. SchKMediumBullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public
Inspection

Name of the organization
The Mary Imogene Bassett Hospital

Employer identification number
13-5596796

Part I

Bond Issues

(a) Issuer Name		(b) Issuer EIN	(c) CUSIP #	(d) Date Issued	(e) Issue Price	(f) Description of Purpose	(g) Defeased		(h) On Behalf of Issuer		(i) Pool financing
(a) Issuer Name		(b) Issuer EIN	(c) CUSIP #	(d) Date Issued	(e) Issue Price	(f) Description of Purpose	Yes	No	Yes	No	Yes	No
A	Otsego Cty Capital Resour	26-3661593		11-03-2011	25,000,000	Building & Structures		X		X		X
B	Otsego Cty Capital Resour	26-3661593		11-03-2011	19,200,000	Refund of prior issuance		X		X		X

Part II

Proceeds

	A		B		C		D
	1 Amount of bonds retired . . . . . . . . . . . . .	0		19,125,000
2 Amount of bonds legally defeased . . . . . . . . . .	0		0
3 Total proceeds of issue . . . . . . . . . . . . .	25,000,000		19,200,000
4 Gross proceeds in reserve funds . . . . . . . .	0		0
5 Capitalized interest from proceeds . . . . . . . . . .	0		0
6 Proceeds in refunding escrows . . . . . . . . . . .	702,000		0
7 Issuance costs from proceeds . . . . . . . . . . .	500,000		75,000
8 Credit enhancement from proceeds . . . . . . . . . .	0		0
9 Working capital expenditures from proceeds . . . . . . .	0		0
10 Capital expenditures from proceeds . . . . . . . . . .	23,798,000		0
11 Other spent proceeds . . . . . . . . . . .	0		0
12 Other unspent proceeds . . . . . . . . . . .	0		0
13 Year of substantial completion . . . . . . . . . . .	2009		2009
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue? . . . .		X	X
15 Were the bonds issued as part of an advance refunding issue? . . . .		X		X
16 Has the final allocation of proceeds been made? . . . . . .		X	X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . .	X		X

Part III

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . . . . . .		X		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . . . . .		X		X

For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50193E

Schedule K (Form 990) 2011

Page 2

Part III

Private Business Use (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
3a Are there any management or service contracts that may result in private business use of bond-financed property? . . . . . . . . .		X		X
b If ‘Yes’ to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property? . . . . .
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . .		X		X
d If ‘Yes’ to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property? .
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . .	0%		0%		%		%
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . . . . . . .	%		%		%		%
6 Total of lines 4 and 5 . . .. . . . . . . . .	%		%		%		%
7 Does the bond issue meet the private security or payment test? . . .	X		X
8 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2?	X		X

Part IV

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has a Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate, been filed with respect to the bond issue? . . .		X		X
2 Is the bond issue a variable rate issue?	X		X
3a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X		X
b Name of provider . . . . . . . .	0		0
c Term of hedge . . . . . . . .
d Was the hedge superintegrated? . . . .
e Was a hedge terminated? . . . . .
4a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . .		X		X
b Name of provider . . . . . .	0		0
c Term of GIC . . . . . . .
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? . . . . . .
5 Were any gross proceeds invested beyond an available temporary period? . . . . . .		X		X
6 Did the bond issue qualify for an exception to rebate? .		X		X
7 Has the organization established written procedures to monitor the requirements of section 148? . . .		X		X

Schedule K (Form 990) 2011

Page 3

Part V

Procedures To Undertake Corrective Action

Part VI

Supplemental Information

Complete this part to provide additional information for responses to questions on Schedule K (see instructions).

Identifier	Return Reference	Explanation

Schedule K (Form 990) 2011

Additional Data

Software ID:
Software Version:

- TIN:

Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V lines 38a or 40b.
MediumBullet

Attach to Form 990 or Form 990-EZ. MediumBullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

The Mary Imogene Bassett Hospital

Employer identification number

13-5596796

Part I

Excess Benefit Transactions (section 501(c)(3) and section 501 (c)(4) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.

1(a) Name of disqualified person	(b) Description of transaction	(c) Corrected?
1(a) Name of disqualified person	(b) Description of transaction	Yes	No

Enter the amount of tax imposed on the organization managers or disqualified persons during the year under section 4958. ......................... Bullet Image

Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ....... Bullet Image

Part II

Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 26, or Form 990-EZ, Part V, line 38a.

(a) Name of interested person and purpose	(b) Loan to or from the organization?		(c)Original principal amount	(d)Balance due	(e) In default?		(f) Approved by board or committee?		(g)Written agreement?
(a) Name of interested person and purpose	To	From	(c)Original principal amount	(d)Balance due	Yes	No	Yes	No	Yes	No






Total ............... $

Part III

Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.

(a) Name of interested person	(b)Relationship between interested person and the organization	(c)Amount of grant or type of assistance

For Privacy Act and Paperwork Reduction Act Notice, see the
Instructions for Form 990 or 990-EZ.

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2011

Page 2

Part IV

Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) The Clark Estates	Part V	418,421	Investment mgmt fees		No
(2) Jane Hamilton	Part V	65,514	wages		No

Part V

Supplemental Information

Complete this part to provide additional information for responses to questions on Schedule L (see instructions).

Identifier	Return Reference	Explanation
Part IV, Line 1		More than 35% of The Clark Estates is owned by trustee Jane Forbes Clark
Part IV, Line 2		Jane Hamilton is family member of trustee Peter Hamilton

Schedule L (Form 990 or 990-EZ) 2011

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.

OMB No. 1545-0047

2011

Open to Public
Inspection

Name of the organization

The Mary Imogene Bassett Hospital

Employer identification number

13-5596796

Identifier	Return Reference	Explanation
Part I, Summary, Line 1		MIBH is a 180 bed acute care facility that serves Cooperstown and an 8 county region through its regional health center network. MIBH offers 24 hour emergency/trauma care, cancer and heart care, dialysis, and most medical and surgical specialties, and conducts research and education programs.
Part VI, Section A, Question 2		Trustees Kevin S Moore, William T Burdick, Jane Forbes clark, Richard C Vanison, and glenn a perrone have a business relationship.
Part VI, Section B, Line 11b	Form 990 Review Process	Bassett distributes the draft 990 to the audit committee of the board of trustees prior to filing. any questions are raised and answered. the audit committee then presents its review findings to the full board of trustees. Copies are distributed to all Bassett's other trustees at their request. once approved, the 990 can be electronically filed.
Part VI, Section B, Question 12c	Explanation of Monitoring and Enforcement of Conflicts	The organization's Conflict of interest Policy applies to the board of Trustees, including any committees of the Board, individual members of the Board, officers of the hospital (CEO,COO,CFO), Vice presidents, and all Directors serving as directors team members. Upon the commencement of an individual serving in the roles defined above, and thereafter annually by january 1, a conflict of interest questionnaire which is prescribed by the audit committee of the Board of trustees must be completed. All completed questionnaires are reviewed by the Compliance Officer for the organization. Any potential conflict of interest will be discussed with the individual and/or with legal counsel. The Compliance Officer will take action to eliminate the potential conflict of Interest, if deemed appropriate. After investigation if it is deemed that the individual has failed to comply with such policies and directives, appropriate corrective action will be taken. The audit committee of the board of Trustees may determine whether the corrective action is satisfactory and, if not, shall require further action.
Part VI, Section B, Question 15a	Compensation Review & Approval Process for CEO, Exec. Dir., or Top Mgtment	Bassett has a formal process that is used to determine the base compensation of the CEO on an annual basis. This process includes a compensation committee of the board of Trustees, an independent compensation consultant, compensation survey or study, and approval by the Board of trustees or the compensation committee. Bassett pays non-fixed earnings based on the success in meeting performance criteria that are prospectively agreed upon as goals for the CEO.
Part VI, Section B, Question 15b	Compensation Review & Approval Process for Officers & Key Employees	The same formal process noted in Question 15(a) above, is used to determine the base compensation of the other officers. Non fixed earnings of other officers are based on the success in meeting performance criteria and comparative market data.
Part VI, Section C, Question 19	Other Organization Documents Publicly Available	Bassett makes it's governing documents, conflicts 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 Bassett or by sending a self-addressed stamped envelope and payment for copying of the requested material to Bassett Administrative Offices. The cost of copying shall be equal to the costs imposed by the IRS for copying of public documents.
Part VII - Compensation Explanation		Thomas Q Morris, MD Hours worked for related organizations: Thurston Corporation - 1.25 Bassett Regional Corporation - 2.00 Total hours worked for related organizations = 3.25 Kevin S Moore Hours worked for related organizations: Thurston Corporation - 1.50 Templeton Foundation - .50 Bassett Regional Corporation - .50 Total hours worked for related organizations = 2.50 Timothy A Pedly, MD Hours worked for related organizations: Thurston Corporation - 1.00 William F Streck, MD Hours worked for related organizations: Thurston Corporation - 1.00 Templeton Foundation - .20 Bassett Regional Corporation - 1.00 Total hours worked for related organizations = 2.20 Bertine Colombo McKenna, PhD Hours worked for related organizations: Thurston Corporation - 1.00 Bassett Regional Corporation - .50 Total hours worked for related organizations = 1.50 Nicholas J Nicoletta Hours worked for related organizations: Thurston Corporation - 2.00 Templeton Foundation - 1.00 Bassett Regional Corporation - 2.00 O'Connor Hospital - 2.00 Tri Town Regional - 2.00 Bassett Hospital of Schoharie County - 2.00 AO Fox Memorial Hospital - .50 Little Falls Hospital - 2.00 Total hours worked for related organizations = 13.50 William T Burdick Hours worked for related organizations: Thurston Corporation - 1.50 Templeton Foundation - .50 Bassett Regional Corporation - 1.00 Total hours worked for related organizations = 3.00 Richard C Vanison Hours worked for related organizations: Thurston Corporation - 1.50 Friends of Bassett, Inc. - 1.00 Total hours worked for related organizations = 2.50 Glenn A Perrone Hours worked for related organizations: Templeton Foundation - .50 Bassett Regional Corporation - 1.00 Bassett Hospital of Schoharie County - 1.00 Total hours worked for related organizations = 2.50 John D Bullis Hours worked for related organizations: Bassett Regional Corporation - .50 Little Falls Hospital - 2.00 Total hours worked for related organizations = 2.50 Barbara DiCocco Hours worked for related corporation: Bassett Regional Corporation - .50 Bassett Hospital of Schoharie County - 1.00 Total hours worked at related organizations = 1.50 Michael Getman Hours worked at related organization: AO Fox Memorial Hospital - .50 Michael S Gold, MD Hours worked for related organizations: Friends of Bassett, Inc. - .20 Peter J Hamilton Hours worked for related organizations: Templeton Foundation - .50 Bassett Regional Corporation - .50 O'Connor Hospital - 1.00 Friends of Bassett, Inc - .50 Total hours worked for related organizations = 2.50 Charles B Kieler Hours worked for related organizations: Friends of Bassett, Inc - 3.00 Ralph H Meyer Hours worked for related organizations: Thurston Corporation - 1.00 Katherine D Nickerson Hours worked for related organizations: Thurston Corporation - 1.00 Edward W Stack Hours worked for related organizations: Thurston Corporation - 1.00 Templeton Foundation - .50 Bassett Regional Corporation - .50 Friends of Bassett, Inc - .20 Total hours worked for related organizations = 2.20 Douglas B Willies Hours worked for related organizations: Templeton Foundation - .50 James C Peters, MD Hours worked for related organizations: O'Connor Hospital - 1.00
Part XI, Line 5	Other Changes in Net Assets or Fund Balances	NET UNREALIZED GAINS OR LOSSES ON INVESTMENTS -3,296,601 POST RETIREMENT BENEIFT RELATED CHANGES. -698,689 PROJECT ABANDONMENT (PATIENT KEEPER) -424,755 ----------- TOTAL -4,420,045

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2011

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBullet

Attach to Form 990. MediumBullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

The Mary Imogene Bassett Hospital

Employer identification number

13-5596796

Part I

Identification of Disregarded Entities (Complete if the organization answered "Yes" on Form 990, Part IV, line 33.)

(a) Name, address, and EIN of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.)

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled organization
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1) Thurston Corporation one atwell road cooperstown,NY13326 13-3218680	supportingorg	NY	501(c)3	11c	NA		No
(2) Friends of Bassett one atwell road cooperstown,NY13326 23-7041610	solicits cont	NY	501(c)3	7	THURSTON		No
(3) Templeton Foundation one atwell road cooperstown,NY13326 13-3317084	Health care	NY	501(c)3	9	THURSTON		No
(4) Bassett Regional corporation ONE ATWELL ROAD COOPERSTOWN,NY13326 13-3522783	Plan & Policy	NY	501(c)3	11b	THURSTON		No
(5) Bassett Hospital of Schoharie Co 178 grandview drive cobleskill,NY12043 14-1772971	health care	NY	501(c)3	3	BRC		No
(6) O Connor Hospital 460 andes road delhi,NY13753 16-1540394	health care	NY	501(c)3	3	BRC		No
(7) Tri Town Regional Healthcare 43 pearl street sidney,NY13838 26-0169584	health care	NY	501(c)3	3	BRC		No
(8) Little falls hospital 140 Burwell Street little falls,NY13365 15-0533578	health care	NY	501(c)3	3	BRC		No
(9) Valley Health Services 690 W GERMAN street herkimer,NY13350 22-2511614	health care	NY	501(c)3	3	BRC		No
(10) Aurelia Osborn Fox Memorial Hospsociety 1 Norton avenue Oneonta,NY13820 15-0539039	Health care	NY	501(c)3	3	Thurston		No

For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2011

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership

Schedule R (Form 990) 2011

Page 3

Part V

Transactions With Related Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35, 35A, or 36.)

Note. Complete line 1 if any entity is listed in Parts II, III or IV.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest (ii) annuities (iii) royalties (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .

b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

f Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

g Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

h Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

i Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

j Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

k Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .

Yes

l Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .

Yes

m Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .

n Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

o Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

p Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

q Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

r Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of other organization	(b) Transaction type(a-r)	(c) Amount involved	(d) Method of determining amount involved
(1)
(2)
(3)
(4)
(5)
(6)

Schedule R (Form 990) 2011

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 37.)

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2011

Page 5

Part VII

Supplemental Information

Complete this part to provide additional information for responses to questions on Schedule R (see instructions).

Identifier	Return Reference	Explanation

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: See Schedule O.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a).....	3	21
4	Number of independent voting members of the governing body (Part VI, line 1b) ....	4	19
5	Total number of individuals employed in calendar year 2011 (Part V, line 2a) ...	5	3,835
6	Total number of volunteers (estimate if necessary) ....	6	145
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ..	7a	31,127
b	Net unrelated business taxable income from Form 990-T, line 34 ..	7b

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	6,857,245	7,712,078
9	Program service revenue (Part VIII, line 2g) .........	393,100,520	399,868,572
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	2,543,350	4,865,736
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	1,590,743	40,575
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	404,091,858	412,486,961
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	0	0
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	228,854,646	237,833,788
16a	Professional fundraising fees (Part IX, column (A), line 11e).....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 999,428
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f)....	174,044,275	177,222,598
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	402,898,921	415,056,386
19	Revenue less expenses. Subtract line 18 from line 12.......	1,192,937	-2,569,425
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	323,618,053	343,191,925
21	Total liabilities (Part X, line 26).............	95,941,047	122,504,389
22	Net assets or fund balances. Subtract line 21 from line 20.....	227,677,006	220,687,536

Sign Here

	Signature of officer	Date

	Type or print name and title.


4a	(Code: ) (Expenses $ 331,221,622 including grants of $ ) (Revenue $ 399,868,572 )
	INPATIENT AND OUTPATIENT SERVICES PROVIDED TO OUR PATIENTS RESULTED IN: 12,775 HOSPITALIZATIONS (INCLUSIVE OF OPEN HEART SURGERIES) 50,055 PATIENT DAYS 694,986 CLINIC VISITS 24,684 RENAL TREATMENTS 9,572 SURGICAL CASES

4b	(Code: ) (Expenses $ 5,699,087 including grants of $ ) (Revenue $ )
	Community involvement has been linked to Bassett's mission, vision, and values since we first opened in 1922. Whether it is strengthening our community relationships for health and wellness, communicating ideas for improving our services to our region, or providing a forum for Bassett to learn and listen, we are working with our community to improve the quality of life for the people of our region. Our community services program provides free services to persons who cannot afford to pay, who do not qualify for Medicaid, and who fall within the established income guidelines. In 2011, we provided $5,699,087 in free care. Bassett's community health education programs include lectures, presentations, health fairs, and other group programs apart from the clinical and diagnostic services offered. Clinical services offered includes screenings, health tests and health risk appraisals including blood pressure, lipid profile, cholesterol screenings, cardiology risk factor screenings, and all cancer screenings. Our community building activities include philanthropic support for health initiatives and community health and welfare projects including promoting healthy lifestyles, disease prevention, and community awareness initiatives. Our doors are open 24 hours a day, 7 days a week, 365 days a year. We are proud to provide care to our communities. Not only did we provide $5.4M in charity care, bad debt expense was $14.5M, Medicaid payments below cost to provide services were $33.3M.

4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses$ 336,920,709

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	4,059,287	0	140,285

				(A) Total revenue	(B) Related or exempt function revenue	(C) Unrelated business revenue	(D) Revenue excluded from tax under sections 512, 513, or 514
1a	Federated campaigns..1a
b	Membership dues....1b
c	Fundraising events....1c
d	Related organizations...1d		1,269,834
e	Government grants (contributions)1e		5,492,550

f	All other contributions, gifts, grants, and similar amounts not included above1f		949,694
g	Noncash contributions included in lines 1a-1f:$
h	Total. Add lines 1a-1f.......			7,712,078
			Business Code
2a	DIRECT PATIENT SERVICES		900,099	376,743,704	376,743,704
b	OTHER PROGRAM SERVICE REVENUE		900,099	23,124,868	23,124,868
c
d
e
f	All other program service revenue .
g	Total. Add lines 2a–2f........			399,868,572
3	Investment income (including dividends, interest
	and other similar amounts).....			924,390			924,390
4	Income from investment of tax-exempt bond proceeds..			0
5	Royalties............			0
		(i) Real	(ii) Personal
6a	Gross rents
b	Less: rental expenses
c	Rental income or (loss)
d	Net rental income or (loss).......
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory	28,882,695	57,958
b	Less: cost or other basis and sales expenses	24,925,485	73,822
c	Gain or (loss)	3,957,210	-15,864
d	Net gain or (loss)..........			3,941,346			3,941,346
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from fundraising events..			0
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from gaming activities...			0
10a	Gross sales of inventory, less returns and allowances .
	a
b	Less: cost of goods sold ..b
c	Net income or (loss) from sales of inventory..			0
Miscellaneous Revenue			Business Code
11a	PARTNERSHIP INCOME		621,500	226,575		31,127	195,448
b	INVESTMENT IN JOINT VENTURES		621,610	-186,000			-186,000
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......			40,575
12	Total revenue. See Instructions....			412,486,961	399,868,572	31,127	4,875,184


				(A) Beginning of year		(B) End of year
1	Cashnon-interest-bearing ..........			14,917,654	1	7,155,225
2	Savings and temporary cash investments .......			0	2	0
3	Pledges and grants receivable, net .........			10,834,542	3	9,860,464
4	Accounts receivable, net .........			44,601,331	4	51,797,404
5	Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
	Schedule L ..........			0	5	0
6	Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
	Schedule L ..........			0	6	0
7	Notes and loans receivable, net .............			0	7	0
8	Inventories for sale or use ..............			3,083,021	8	3,305,577
9	Prepaid expenses and deferred charges ............			3,053,540	9	2,457,985
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	358,055,061
b	Less: accumulated depreciation. .....	10b	216,610,596	141,174,956	10c	141,444,465
11	Investments—publicly traded securities ..........			68,045,275	11	85,442,703
12	Investments—other securities. See Part IV, line 11 ......			30,936,393	12	33,634,077
13	Investments—program-related. See Part IV, line 11 ..			0	13	0
14	Intangible assets .........			0	14	0
15	Other assets. See Part IV, line 11 ...........			6,971,341	15	8,094,025
16	Total assets. Add lines 1 through 15 (must equal line 34)...			323,618,053	16	343,191,925
17	Accounts payable and accrued expenses .			38,862,456	17	38,850,570
18	Grants payable ..........			0	18	0
19	Deferred revenue ..........			0	19	0
20	Tax-exempt bond liabilities ..........			33,385,000	20	56,570,000
21	Escrow or custodial account liability. Complete Part IV of Schedule D..			0	21	0
22	Payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........			0	22	0
23	Secured mortgages and notes payable to unrelated third parties ..			23,693,591	23	27,083,819
24	Unsecured notes and loans payable to unrelated third parties ....			0	24	0
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D.....			0	25	0
26	Total liabilities. Add lines 17 through 25.....			95,941,047	26	122,504,389
	Organizations that follow SFAS 117, check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets .....			169,040,821	27	163,124,202
28	Temporarily restricted net assets .....			44,847,111	28	43,733,963
29	Permanently restricted net assets .....			13,789,074	29	13,829,371
	Organizations that do not follow SFAS 117, check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....				30
31	Paid-in or capital surplus, or land, building or equipment fund .....				31
32	Retained earnings, endowment, accumulated income, or other funds				32
33	Total net assets or fund balances .....			227,677,006	33	220,687,536
34	Total liabilities and net assets/fund balances .....			323,618,053	34	343,191,925