TY 2012 Form 990

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(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	1.00 .......................3.25	X	X
(2) KEVIN S MOORE........................................................................ VICE CHAIRMA	3.00 .......................2.50	X	X
(3) TIMOTHY A PEDLEY MD........................................................................ VICE CHAIRMA	1.00 .......................1.00	X	X
(4) WILLIAM T BURDICK........................................................................ SECRETARY	8.00 .......................3.00	X	X
(5) JOHN D BULLIS........................................................................ TRUSTEE	1.00 .......................2.50	X
(6) JANE FORBES CLARK........................................................................ TRUSTEE	1.00 .......................0.00	X
(7) BARBARA DICOCCO........................................................................ TRUSTEE	1.00 .......................1.50	X
(8) TERRY FULMER PHD........................................................................ TRUSTEE	1.00 .......................0.00	X
(9) MICHAEL S GOLD MD........................................................................ TRUSTEE	1.00 ........................20	X
(10) PETER J HAMILTON........................................................................ TRUSTEE	1.00 .......................2.50	X
(11) NANCY KLENIEWSKI........................................................................ TRUSTEE	1.00 .......................0.00	X
(12) RALPH H MEYER........................................................................ TRUSTEE	1.00 .......................1.00	X
(13) J MICHAEL MOFFAT........................................................................ TRUSTEE	1.00 .......................0.00	X
(14) KATHERINE D NICKERSON........................................................................ TRUSTEE	1.00 .......................1.00	X
(15) DONALD O QUEST MD........................................................................ TRUSTEE	1.00 .......................0.00	X
(16) VANNESS D ROBINSON........................................................................ TRUSTEE	1.00 .......................0.00	X
(17) RENEE SCIALDO SHEVAT........................................................................ TRUSTEE	1.00 .......................0.00	X

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(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) EDWARD W STACK........................................................................ TRUSTEE	1.00 .......................2.20	X			0	0
(19) CLIFTON WHARTON JR PHD........................................................................ TRUSTEE	1.00 .......................0.00	X			0	0
(20) DOUGLAS B WILLIES........................................................................ TRUSTEE	1.00 ........................50	X			0	0
(21) WILLIAM F STRECK MD........................................................................ PRESIDENT, C	40.00 .......................2.20		X		786,435	27,775
(22) BERTINE MCKENNA PHD........................................................................ EXECUTIVE VP	40.00 .......................1.50		X		489,159	22,919
(23) NICHOLAS J NICOLETTA........................................................................ CORPORATE VP	40.00 .......................13.50		X		483,575	26,532
(24) RICHARD C VANISON........................................................................ TREASURER	4.00 .......................2.50		X		0	0
(25) GLENN A PERRONE........................................................................ ASSISTANT SE	2.00 .......................2.50		X		0	0
(26) PASCALE G RAYMOND MD........................................................................ ATTENDING PH	40.00 .......................0.00			X	585,972	18,096
(27) STEVEN J HENEGHAN MD........................................................................ ATTENDING PH	40.00 .......................0.00			X	578,884	29,710
(28) JONATHAN RICHMAN MD........................................................................ ATTENDING PH	40.00 .......................0.00			X	524,765	32,663
(29) ROBERT A LANCEY MD........................................................................ ATTENDING PH	40.00 .......................0.00			X	524,074	32,658
(30) TALLY E LASSITER MD........................................................................ ATTENDING PH	40.00 .......................0.00			X	500,127	12,538

(A) Name and business address	(B) Description of services	(C) Compensation
STAT STAFF258 USHERS ROADSUITE 10CLIFTON PARKNY12065	AGENCY	5,924,304
COMP HEALTH6440 MILLROCK DRIVESUITE 175SALT LAKE CITYUT84121	AGENCY	1,721,455
STAFF CARE INC5001 STATESMAN DRIVEIRVINGTX75063	AGENCY	1,675,433
ANGELICA TEXTILE SERVICES424 S WOODS MILL ROADCHESTERFIELDMO63017	LINEN SERVICE	1,404,413
MAYO MEDICAL LABORATORIES200 FIRST STREET SWROCHESTERMN55903	LAB SERVICES	1,380,072
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 16

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	50,825	50,825
2	Grants and other assistance to individuals in the United States. See Part IV, line 22
3	Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16
4	Benefits paid to or for members
5	Compensation of current officers, directors, trustees, and key employees ....	1,836,394		1,836,394
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....	84,335		84,335
7	Other salaries and wages	209,127,528	161,636,755	47,020,228	470,545
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	8,640,033	6,668,020	1,946,770	25,243
9	Other employee benefits .......	10,430,259	7,991,963	2,415,030	23,266
10	Payroll taxes ...........	12,888,454	9,884,044	2,973,002	31,408
11	Fees for services (non-employees):
a	Management ......
b	Legal .........
c	Accounting ...........
d	Lobbying ...........	62,494		62,494
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ........	38,009,036	31,709,051	5,987,935	312,050
12	Advertising and promotion ....
13	Office expenses .......	1,970,959	1,502,800	454,242	13,917
14	Information technology ......
15	Royalties ..
16	Occupancy ...........	14,144,531	10,845,370	3,278,166	20,995
17	Travel ............
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......
19	Conferences, conventions, and meetings ....
20	Interest ...........	1,689,230	1,294,255	391,207	3,768
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization .....	19,571,177	15,027,131	4,542,162	1,884
23	Insurance ..............	3,334,332	2,554,701	772,194	7,437
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	DRUGS AND REAGENTS	31,976,982	31,976,982
b	PATIENT CARE SUPPLIES	30,908,915	30,908,915
c	BAD DEBT	14,985,208	14,985,208
d	CHARITY CARE	5,433,926	5,433,926
e	All other expenses	22,277,834	17,422,298	4,699,762	155,774
25	Total functional expenses. Add lines 1 through 24e	427,422,452	349,892,244	76,463,921	1,066,287
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 Check if Schedule O contains a response to any question in this Part X ...............
	1	Cashnon-interest-bearing .............	7,155,225	1	15,653,880
2	Savings and temporary cash investments .........		2
3	Pledges and grants receivable, net ...........	9,860,464	3	14,856,350
4	Accounts receivable, net .............	51,797,404	4	44,119,304
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L ..................
			5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
			6
7	Notes and loans receivable, net .............		7
8	Inventories for sale or use ..............	3,305,577	8	3,425,444
9	Prepaid expenses and deferred charges ..........	2,457,985	9	2,640,600
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	380,220,889
b	Less: accumulated depreciation .....	10b	233,912,362	141,444,465	10c	146,308,527
11	Investments—publicly traded securities ..........	85,442,703	11	84,878,064
12	Investments—other securities. See Part IV, line 11 .....	33,634,077	12	36,797,740
13	Investments—program-related. See Part IV, line 11 .....		13
14	Intangible assets ...............		14
15	Other assets. See Part IV, line 11 ...........	8,094,025	15	8,545,240
16	Total assets. Add lines 1 through 15 (must equal line 34)......	343,191,925	16	357,225,149
	17	Accounts payable and accrued expenses .........	38,850,570	17	39,628,165
18	Grants payable .................		18
19	Deferred revenue ................		19
20	Tax-exempt bond liabilities .............	56,570,000	20	54,590,000
21	Escrow or custodial account liability. Complete Part IV of Schedule D..		21
22	Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........		22
23	Secured mortgages and notes payable to unrelated third parties ..	27,083,819	23	29,997,504
24	Unsecured notes and loans payable to unrelated third parties ....		24
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....................		25
26	Total liabilities. Add lines 17 through 25.........	122,504,389	26	124,215,669
		Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............	163,124,202	27	163,196,856
28	Temporarily restricted net assets ...........	43,733,963	28	55,962,893
29	Permanently restricted net assets ...........	13,829,371	29	13,849,731
	Organizations that do not follow SFAS 117 (ASC 958), 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 ...........	220,687,536	33	233,009,480
34	Total liabilities and net assets/fund balances ........	343,191,925	34	357,225,149

- 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

2012

Open to Public
Inspection

Name of the organization

MARY IMOGENE BASSETT HOSPITAL
DBA BASSETT MEDICAL CENTER

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 described in 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. See section 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 - Non-functionally integrated

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 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 monetary support
(i) Name of supported organization	(ii) EIN	Yes	No	Yes	No	Yes	No	(vii) Amount of monetary support


Total

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

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2012

Page 2

Part II

Support Schedule for Organizations Described in Sections 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) 2008	(b) 2009	(c) 2010	(d) 2011	(e) 2012	(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) 2008	(b) 2009	(c) 2010	(d) 2011	(e) 2012	(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. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..
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 2012 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2011 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2012. 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—2011. If the organization did not check a 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—2012. 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—2011. 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) 2012

Page 3

Part III

Support Schedule for Organizations Described in Section 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) 2008	(b) 2009	(c) 2010	(d) 2011	(e) 2012	(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) 2008	(b) 2009	(c) 2010	(d) 2011	(e) 2012	(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.)..

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 2012 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2011 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2012 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2011 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests—2012. 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—2011. 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) 2012

Page 4

Part IV

Supplemental Information. Complete this part to provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and 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) 2012

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

2012

Name of the organization

MARY IMOGENE BASSETT HOSPITAL
DBA BASSETT MEDICAL CENTER

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) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Page 2

Name of organization MARY IMOGENE BASSETT HOSPITAL DBA BASSETT MEDICAL CENTER

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) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Page 3

Name of organization MARY IMOGENE BASSETT HOSPITAL DBA BASSETT MEDICAL CENTER

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) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Page 4

Name of organization
MARY IMOGENE BASSETT HOSPITAL
DBA BASSETT MEDICAL CENTER

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) (2012)

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

2012

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, Part V, line 35c (Proxy Tax), then
Round Bullet

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

Name of the organization

MARY IMOGENE BASSETT HOSPITAL
DBA BASSETT MEDICAL CENTER

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

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2012

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 SchCMd Bullet

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 SchCMd Bullet

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) 2009	(b) 2010	(c) 2011	(d) 2012	(e) Total

2a	Lobbying nontaxable 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) 2012

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

62,494

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

62,494

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, line 5; Part II-A (affiliated group list); Part II-A, line 2; and Part ll-B, line 1. Also, complete this part for any additional information.

Identifier	Return Reference	Explanation
	SCHEDULE C, PART II-B, LINE 1	AMERICAN HOSPITAL ASSOCIATION ALLOCATES 23.98% OF DUES TOWARDS GENERAL LOBBYING ACTIVITIES. TOTAL DUES PAID IN 2012 = 51,536 HANYS ALLOCATES 28.60% OF DUES TOWARDS GENERAL LOBBYING ACTIVITIES. TOTAL DUES PAID IN 2012 = 121,790 IROQUOIS HEALTHCARE ALLIANCE ALLOCATES 44.40% OF DUES TOWARDS GENERAL LOBBYING ACTIVITES. TOTAL DUES PAID IN 2012 = 34,469 THE CLARK ESTATES CONDUCTS LOBBYING ACTIVITIES ON BEHALF OF THE MARY IMOGENE BASSETT HOSPITAL. LOBBYING ACTIVITES 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) 2012

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

2012

Open to Public Inspection

Name of the organization

MARY IMOGENE BASSETT HOSPITAL
DBA BASSETT MEDICAL CENTER

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 section 170(h)(4)(B)(ii)? .......................................

Yes No

In Part XIII, 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 XIII, 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 Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 52283D

Schedule D (Form 990) 2012

Page 2

Part III

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

Using the organization’s acquisition, 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 XIII.

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 XIII 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 XIII. Check here if the explanation has been provided in Part XIII ........

Part V

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

		(a)Current year	(b)Prior year	b (c)Two years back	(d)Three years back	(e)Four years back
1a	Beginning of year balance ....	13,829,371	13,789,074	16,734,461	13,825,685	13,511,047
b	Contributions ........	20,360	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 ......	13,849,731	13,829,371	13,789,074	16,734,461	13,825,685

Provide the estimated percentage of the current year end balance (line 1g, column (a)) 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 XIII 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 .................	207,928		207,928
b	Buildings ................	187,848,195	100,929,403	86,918,792
c	Leasehold improvements ............
d	Equipment ................	172,044,677	132,982,959	39,061,718
e	Other .................	20,120,089		20,120,089
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......				146,308,527

Schedule D (Form 990) 2012

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 PARTNERSHIP	32,584,778	C
(B) LIMITED PARTNERSHIP	4,212,962	C







Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)	36,797,740

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 XIII, 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 (ASC 740). Check here if the text of the footnote has been provided in Part XIII .....................................................

Schedule D (Form 990) 2012

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1	Total revenue, gains, and other support per audited financial statements .......			1	419,325,262
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains on investments ..........	2a	9,883,165
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d	-20,244,412
e	Add lines 2a through 2d .....................			2e	-10,361,247
3	Subtract line 2e from line 1.....................			3	429,686,509
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 XIII.) ...........	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	429,686,509

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1	Total expenses and losses per audited financial statements ...........			1	407,003,318
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 XIII.) ............	2d
e	Add lines 2a through 2d......................			2e
3	Subtract line 2e from line 1.....................			3	407,003,318
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 XIII.) ............	4b	20,419,134
c	Add lines 4a and 4b.......................			4c	20,419,134
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......			5	427,422,452

Part XIII

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, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Identifier	Return Reference	Explanation
INTENDED USES FOR ENDOWMENT FUNDS	SCHEDULE D, PAGE 2, 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.
LIABILITY UNDER FIN 48 FOOTNOTE	SCHEDULE D, PAGE 3, PART X	PER AUDITED FINANCIAL STATEMENTS: "THE HOSPITAL IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE IRC. THE HOSPITAL RECOGNIZES TAX POSITIONS WHEN IT IS MORE-LIKELY-THAN-NOT THAT THE POSITION WILL BE SUSTAINABLE BASED ON THE MERITS OF THE POSITION. MANAGEMENT HAS CONCLUDED THAT THERE ARE NO MATERIAL TAX LIABILITIES OR UNCERTAIN TAX POSITIONS THAT NEED TO BE RECORDED."
REVENUE AMOUNTS INCLUDED IN FINANCIALS - OTHER	SCHEDULE D, PAGE 4, PART XI, LINE 2D	POST RETIREMENT BENEFIT CHANGE 174,722 BAD DEBT -14,985,208 CHARITY CARE -5,433,926
EXPENSE AMOUNTS INCLUDED ON RETURN - OTHER	SCHEDULE D, PAGE 4, PART XII, LINE 4B	BAD DEBT 14,985,208 CHARITY CARE 5,433,926

Schedule D (Form 990) 2012

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

2012

Open to Public Inspection

Name of the organization

MARY IMOGENE BASSETT HOSPITAL
DBA BASSETT MEDICAL CENTER

Employer identification number

13-5596796

Part I

Financial Assistance 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) as a factor in determining 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 300.000 %

Did the organization use FPG as a factor in determining 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 used factors other than FPG in determining 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, as a factor in determining 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

Financial Assistance and Means-Tested Government Programs		(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) ..	3,494,935	291,950	3,202,985	0.750 %
b	Medicaid (from Worksheet 3, column a) ....	52,353,300	38,212,851	14,140,449	3.310 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) .
d	Total Financial Assistance and Means-Tested Government Programs .	55,848,235	38,504,801	17,343,434	4.060 %
Other Benefits		48,571		48,571	0.010 %
e	Community health improvement services and community benefit operations (from Worksheet 4) ..	48,571		48,571	0.010 %
f	Health professions education (from Worksheet 5) ..	16,222,165	3,952,243	12,269,922	2.870 %
g	Subsidized health services (from Worksheet 6) ..
h	Research (from Worksheet 7)	7,872,642	358,478	7,514,164	1.760 %
i	Cash and in-kind contributions for community benefit (from Worksheet 8)	703,459		703,459	0.160 %
j	Total. Other Benefits ..	24,846,837	4,310,721	20,536,116	4.800 %
k	Total. Add lines 7d and 7j .	80,695,072	42,815,522	37,879,550	8.860 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2012

Schedule H (Form 990) 2012

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. Explain in Part VI the methodology used by the organization to estimate this amount. ......

6,527,921

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

788,659

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

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

97,679,871

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

82,507,115

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

15,172,756

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(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %
1AT HOME CARE INC	HOME HEALTHCARE AGENCY	50.000 %
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2012

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Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions) How many hospital facilities did the organization operate during the tax year?1 Name, address, and primary website address							Other (Describe)
1	MARY IMOGENE BASSETT HOSPITAL ONE ATWELL ROAD COOPERSTOWN,NY13326 WWWBASSETTORG	X	X	X	X	X	OUTPATIENT PRIMARY & SPECIALTY

Schedule H (Form 990) 2012

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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 or facility reporting groups listed in Part V, Section A)

	MARY IMOGENE BASSETT HOSPITAL
Name of hospital facility or facility reporting group

For single facility filers only: line Number of Hospital Facility (from Schedule H, Part V, Section A)

Yes

Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9....................

If “Yes,” indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

Information gaps that limit the hospital facility’s ability to assess the community’s health needs

Other (describe in Part VI)

Indicate the tax year the hospital facility last conducted a CHNA: 20

In conducting its most recent CHNA, did the hospital facility take into account input from representatives of the community served by the hospital facility, including those with special knowledge of or expertise in public health? 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 ....................

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI................................

Did the hospital facility make its CHNA report widely available to the public? .............

If “Yes,” indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website

Available upon request from the hospital facility

Other (describe in Part VI)

If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply to date):

Adoption of an implementation strategy that addresses each of the community health needs identified through the CHNA

Execution of the implementation strategy

Participation in the development of a community-wide plan

Participation in the execution of a community-wide plan

Inclusion of a community benefit section in operational plans

Adoption of a budget for provision of services that address the needs identified in the CHNA

Prioritization of health needs in its community

Prioritization of services that the hospital facility will undertake to meet health needs in its community

Other (describe in Part VI)

Did the hospital facility address all of the needs identified in its most recently conducted CHNA? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs ........

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ...........................

If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ......

If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2012

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Part VFacility Information (continued)

Financial Assistance Policy			Yes	No
9	Did the hospital facility have in place during the tax year a written financial assistance policy that:
	Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care?	9	Yes
10	Used federal poverty guidelines (FPG) to determine eligibility for providing free care?...........	10	Yes
	If "Yes," indicate the FPG family income limit for eligibility for free care: 300.0% If "No," explain in Part VI the criteria the hospital facility used.
11	Used FPG to determine eligibility for providing discounted care?.................	11		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.
12	Explained the basis for calculating amounts charged to patients?.................	12		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)
13	Explained the method for applying for financial assistance?...................	13	Yes
14	Included measures to publicize the policy within the community served by the hospital facility?.......	14	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 website
b	The policy was attached to 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 on admission to the hospital facility
f	The policy was available upon request
g	Other (describe in Part VI)
Billing and Collections
15	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?.......	15	Yes
16	Check all of the following 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)
17	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?..........	17		No
	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)

Schedule H (Form 990) 2012

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Part VFacility Information (continued)

Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

Notified individuals of the financial assistance policy in communications with the patients regarding the patients’ bills

Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy

Other (describe in Part VI)

Policy Relating to Emergency Medical Care

Yes

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?..........

Yes

If “No,” indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)

Other (describe in Part VI)

Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)

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.

The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged

The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged

The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged

Other (describe in Part VI)

During the tax year, did the hospital facility charge any FAP-eligible individuals 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? ............................

If “Yes,” explain in Part VI.

During the tax year, did the hospital facility charge any FAP-eligible individuals an amount equal to the gross charge for any service provided to that individual? .........................

If “Yes,” explain in Part VI.

Schedule H (Form 990) 2012

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?51
Name and address		Type of Facility (describe)
1	AC CLARK GYMNASIUM 124 COUNTY ROAD 52 COOPERSTOWN,NY13326	OUTPATIENT PHYSICAL THERAPY SERVICES
2	BASSETT HEALTHCARE HAMILTON SURGICA 10 EATON STREET HAMILTON,NY13346	OUTPATIENT SPECIALTY CARE
3	BASSETT HEALTHCARE HERKIMER CARDIAC 690 WEST GERMAN STREET HERKIMER,NY13350	OUTPATIENT REHAB SERVICES
4	BASSETT HEALTHCARE CLINTON 34 CHENANGO AVENUE CLINTON,NY13323	OUTPATIENT 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
8	BASSETT HEALTHCARE DELHI 460 ANDES ROAD DELHI,NY13753	OUTPATIENT PRIMARY CARE AND DENTAL
9	BASSETT HEALTHCARE EDMESTON ROUTE 80 PO BOX 15 EDMESTON,NY13335	OUTPATIENT PRIMARY CARE
10	BASSETT HEALTHCARE HAMILTON 160 BROAD STREET HAMILTON,NY13346	OUTPATIENT PRIMARY CARE AND DENTAL
11	BASSETT HEALTHCARE HERKIMER 321 EAST ALBANY STREET HERKIMER,NY13350	OUTPATIENT PRIME, SPECIALTY, 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 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 SPECIAL ONE ASSOCIATE DRIVE ONEONTA,NY13820	OUTPATIENT PRIME, SPECIALTY, URGENT CARE
18	BASSETT HEALTHCARE PHYSICAL THERAPY 21 RAILTOAD AVENUE COOPERSTOWN,NY13326	OUTPATIENT SPECIALTY CARE
19	BASSETT HEALTHCARE RICHFIELD SPRING 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 SHERBURNE 20 CHAPEL STREET SHERBURNE,NY13460	OUTPATIENT PRIMARY CARE
23	BASSETT HEALTHCARE SIDNEY 39 PEARL STREET 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 HEALTHCARE 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 FOXCARE 1 FOXCARE DRIVE ONEONTA,NY13820	OUTPATIENT SPECIALTY CARE
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 SERVICE 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 AND HIGH 39 LINDEN AVENUE COOPERSTOWN,NY13326	OUTPATIENT PRIMARY CARE
35	SBHC - DELHI ELEMENTARY 2 SHELDON DRIVE DELHI,NY13753	OUTPATIENT PRIMARY CARE
36	SBHC - DELHI MIDDLE AND HIGH 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 AND HIGH 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 PROGRAM ONE ATWELL ROAD COOPERSTOWN,NY13326	OUTPATIENT SPECIALTY CARE
44	SBHC - SCHENEVUS CENTRAL SCHOOL 159 MAIN STREET SCHENEVUS,NY12155	OUTPATIENT PRIMARY CARE
45	SBHC - SHERBURNEEARLVILLE ELEMEN 13 SCHOOL STREET SHERBURNE,NY13460	OUTPATIENT PRIMARY CARE
46	SBHC - SHERBURNEEARLVILLE MID & HI 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 PO BOX 113 SOUTH KORTRIGHT,NY13842	OUTPATIENT PRIMARY CARE
49	SBHC - STAMFORD CENTRAL SCHOOL ONE RIVER STREET STAMFORD,NY12167	OUTPATIENT PRIMARY CARE
50	SBHC - UNADILLA VALLEY CENTRAL PO BOX F 4238 STATE HIGHWAY 8 NEW BERLIN,NY13411	OUTPATIENT PRIMARY CARE
51	SBHC - WORCESTER CENTRAL SCHOOL 195 MAIN STREET WORCESTER,NY12197	OUTPATIENT PRIMARY CARE

Schedule H (Form 990) 2012

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; Part V, Section A; and Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 10, 11, 12h, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22.
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.
8	Facility reporting group(s). If applicable, for each hospital facility in a facility reporting group provide the descriptions required for Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 10, 11, 12h, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22.

Identifier	ReturnReference	Explanation
OTHER TESTING METHODS FOR FREE OR DISCOUNTED CARE	PART I LINE 3C	THE CSP COMMUNITY SERVICES PROGRAM APPLICATION SPECIFIES FAMILY INCOME LIMITS AND OTHER REQUIREMENTS FOR SERVICES TO BE ELIGIBLE FOR BASSETT MEDICAL CENTERS CSPFREE CARE PROGRAM
RELATED ORGANIZATION INFORMATION	PART I LINE 6A	THE MARY IMOGENE BASSETT HOSPITALS DBA 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 WWWBASSETTORG
EXCLUSIONS FROM PERCENT OF TOTAL EXPENSE	PART I LINE 7 COLUMN F	THE PERCENT OF TOTAL EXPENSE IS CALCULATED BY DIVIDING COLUMN E NET COMMUNITY BENEFIT EXPENSE BY TOTAL EXPENSE THE BAD DEBT EXPENSE OF 14985208 WAS SUBTRACTED FROM THE TOTAL EXPENSE VALUE USED TO CALCULATE THE PERCENTAGES IN PART 1 LINE 7 COLUMN F
COSTING METHODOLOGY EXPLANATION	PART I LINE 7	SECTIONS A CHARITY CARE AT COST B UNREIMBURSED MEDICAID F HEALTH PROFESSIONS EDUCATION THE COSTING METHODOLOGY USED IS A COSTTOCHARGE 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 INKIND 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
COMMUNITY BUILDING ACTIVITIES	PART II	ALL BASSETT COMMUNITY BUILDING ACTIVITIES COULD BE CLASSIFIED UNDER ITEM 1 AND HIGHLIGHTED IN NUMBER 1 ABOVE
BAD DEBT EXPENSE EXPLANATION	PART III LINE 4	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 FROM THE FINANCIAL STATEMENTS NOTES I 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 PROVISION 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 MANAGEMENTS 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 FROM THE FINANCIAL STATEMENT FOOTNOTES J THE HOSPITALS 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 CARER POLICY THE HOSPITALS CHARITY CARE POLICY HAS NOT CHANGED DURING FISCAL YEARS 2011 OR 2012 DURING 2012 AND 2011 THE TOTAL CHARGES FORGONE FOR BAD DEBT WERE APPROXIMATELY 14985208 AND 14513947 RESPECTIVELY
MEDICARE EXPLANATION	PART III LINE 8	AMOUNTS WERE DERIVED AS FOLLOWS CHARGE TIMES COST TO CHARGE RATIO VERSUS REIMBURSEMENT ON THE MEDICARE PSR REPORT
COLLECTION PRACTICES EXPLANATION	PART III LINE 9B	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 NECESSARY STEPS TO RECOVER SELFPAY ACCOUNTS RECEIVABLE AS WELL PRESERVE THE PATIENTPROVIDER 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 AS WELL AS ANY APPLICABLE STATE LAW OR REGULATIONS THE ARREST OR BODY ATTACHMENT OF A JUDGEMENT DEBTOR ON CONTEMPT PROCEEDINGS OR FORECLOSURE OF A JUDGEMENT DEBTORS 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 JUDGEMENT DEBTOR WILL BE PURSUED ONLY AFTER INDIVIDUAL CASE REVIEW BY COUNSEL TO ENSURE THAT SUCH ACTION IS NOT ONLY CONSISTENT WITH BASSETTS INTERESTS BUT ALSO THE ONLY FEASIBLE RECOVERY MECHANISM FROM A JUDGEMENT DEBTOR CAPABLE OF RESPONDING TO HIS OR HER OBLIGATIONS BUT OTHERWISE UNWILLING TO DO SO
NEEDS ASSESSMENT	PART VI	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 APERCENTAGE OF OTSEGO CO ADULTS WHO VISITED A DENTIST IN THE PAST YEARS BPREVALENCE OF TOOTH DECAY IN THIRDGRADE CHILDREN CPERCENTAGE OF ADULTS REPORTING BINGE DRINKING DHEAVY DRINKING EPERCENTAGE 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 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 1ACCESS TO DENTAL HEALTH CARE ABASSETT WILL SUPPORT OTSEGO CO DEPT OF HEALTH EFFORTS TO REESTABLISH 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 BBASSETT WILL WORK TO EXPAND COMPREHENSIVE PREVENTIVE DENTAL HEALTH SERVICES TO ALL SCHOOLBASED HEALTH CENTERS IN THE COUNTY AND TO PROVIDE SEALANT SERVICES TO NONSBHC SCHOOLS BASSETT WILL WORK WITH THE OTSEGO CO DEPT OF HEALTH AND RHENDOMS TO MAKE MORE SCHOOLS AWARE OF RHENDOMS SERVICES TO INCREASE PARTICIPATION CBASSETT WILL WORK WITH THE OTSEGO CO DEPT OF HEALTH AND AO 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 DBASSETT WILL WORK WITH THE HEALTH DEPARTMENT AND OTHER COMMUNITY PARTNERS TO EDUCATE THE PUBLIC ABOUT DENTAL HEALTH IN FAIRS AND OTHER COMMUNITY EVENTS 2MENTAL HEALTH AND SUBSTANCE ABUSE AIN A NEW INITITATIVE BASSETT WILL WORK WITH AO FOX HOSPITAL AND LEATHERSTOCKING EDUCATION ON ALCOHOLISMADDICTIONS FOUNDATIONS INC LEAF TO PROVIDE CONTINUING MEDICAL EDUCATION TRAINING ON SUBSTANCE ABUSE SCREENING AND REFERRAL TO PRIMARY CARE PROVIDERS AND SURGEONS IN THE COUNTY BBASSETT 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 CBASSETT WILL COLLABORATE WITH LEAF AND THE HEALTH DEPARTMENT ON PUBLIC HEALTH CAMPAIGN ABOUT THE RISK FACTORS ASSOCIATED WITH BINGE DRINKING AND PRESCRIPTION DRUG ABUSE 3PHYSICAL ACTIVITY AND NUTRITION ABASSETT 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 BBASSETT 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
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE	PART VI	A MAJOR COMPONENT OF BASSETTS 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 PATIENTS COUNTY OF RESIDENCE REFERRAL TO AN ONSITE OTSEGO COUNTY MEDICAID EXAMINER IS AVAILABLE AT THE COOPERSTOWN CAMPUS A LISTING OF ALL SELFPAY ACCOUNTS IS PRODUCED AND REVIEWED DAILY TO INSURE THAT A COMMUNITY SERVICES BROCHURE HAS BEEN PROVIDED THE SELFPAY BILLING OFFICE IDENTIFIES PATIENTS DURING THE BILLING AND COLLECTIONS PROCESS THAT MAY REQUIRE ADDITIONAL HELP UNDERSTANDING THE PROGRAM SELFPAY ACCOUNTS FOR PATIENTS WHO HAVE BEEN APPROVED FOR COMMUNITY SERVICES WITHIN THE PRIOR 120 DAYS ARE AUTOMATICALLY INCLUDED WITH THE PRIOR APPROVAL
COMMUNITY INFORMATION	PART VI	THE SERVICE AREA OF BASSETT ENCOMPASSES AN SEVEN 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 SEVEN COUNTY REGIONS THE MEDIAN HOUSEHOLD INCOME RANGES BETWEEN 37000 AND 40000 1214 OF THE COMMUNITY RESIDENTS HAVE INCOMES BELOW THE FEDERAL POVERTY GUIDELINES THE FOLLOWING AREAS HAVE BEEN FEDERALLY DESIGNATED AS BEING MEDICALLY UNDERSERVED A HERKIMER COUNTY B FULTON COUNTY TOWN OF OPPENHEIM C MONTGOMERY COUNTY CITY OF AMSTERDAM D OTSEGO COUNTY NORTH OTSEGO SERVICE AREA TOWN OF PLAINFIELD TOWN OF DECATUR E DELAWARE COUNTY TOWNS OF DEPOSIT COLCHESTER MIDDLETOWN
HEALTH OF COMMUNITY IN RELATION TO EXEMPT PURPOSE	PART VI	BASSETTS SOLE MEMBER IS THURSTON CORPORATION DBA BASSETT HEALTHCARE NETWORK AND IS A 180 BED ACUTE CARE INPATIENT TEACHING FACILITY LOCATED IN RURAL COOPERSTOWN NEW YORK BASSETT HAS A FULLY SALARIED MEDICAL STAFF AND ADVANCED PRACTITIONER STAFF PROVIDING A WIDE VARIETY OF SERVICES INCLUDING 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 19 SCHOOLBASED 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 SEVEN COUNTY REGION BASSETT IS WORKING TO REESTABLISH 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 19 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 ANDOR 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 ASCHOOLBASED 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 BRHENDOMS 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 BABYBOTTLE TOOTH DECAY CBASSETT PSYCHIATRIC CRISIS CENTER THE COOPERSTOWN CENTER OPENED IN FEBRUARY 2008 FILLING A VOID CREATED BY THE TERMINATION OF PSYCHIATRIC SERVICES AT AO FOX HOSPITAL IN ONEONTA MONTHS EARLIER IN ITS FIRST YEAR BASSETTS PSYCHIATRIC CRISIS CENTER HELPED MORE THAN 1200 PATIENTS OF THOSE 52 WERE CHILDREN 12 OR YOUNGER AND 154 WERE ADOLESCENTS DPARENT HANYBOOK THIS FAMILY RESOURCE WAS CREATED BY THE OTSEGO CO COMMITTEE ON CHILD ABUSE AND NEGLECT AND UNDERWRITTEN BY BASSETT AND AO FOX HOSPITAL ITS GOAL IS TO GIVE PARENTS AND PROFESSIONALS A PLACE TO TURN FOR HELP IN DEALING WITH THE STRESSES OF FAMILY LIFE EKICKSTART A PROGRAM DESIGNED TO HELP COMBAT CHILDHOOD OBESITY THROUGH COLLABORATIVE PARTNERSHIPS WITH BASSETT HEALTH CENTERS AND LOCAL RECREATIONAL AND FITNESS GROUPS FBASSETT CANCER INSTITUTE MEDICAL SCREENING COACH A NEW CUSTOMBUILT 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 GCANCER 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 HHEALTHY START BREAKFAST A PARTNERSHIP BETWEEN COMMUNITY SERVICE ORGANIZATIONS AND BASSETT FOR DIABETES DETECTION EDUCATION AND PREVENTION ISAFE 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 BICYCLING INLINE SKATE AND SKATEBOARD SAFETY HOME SAFETY FIRE AND BURN PREVENTION ROAD SAFETY AND PEDESTRIAN SAFETY THE REGIONAL PRIMARY AND SPECIALTY CARE CLINICS AND THE SCHOOLBASED 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 BASSETTS 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
AFFILIATED HEALTH CARE INFORMATION	PART VI	BASSETT IS PART OF THE BASSETT HEALTHCARE NETWORK THAT PROVIDES HEALTH SERVICES IN MORE THAN 20 COMMUNITIES SPANNING 5600 SQUARE MILES AND SEVEN COUNTIES THE NETWORK FOCUSES ITS COMMUNITY SERVICES PROGRAMS IN THE COUNTIES WHERE THE SIX AFFILIATED HOSPITALS AND GREATEST PATIENT POPULATIONS ARE LOCATED OTSEGO COUNTY POPULATION 61709 DELAWARE COUNTY POPULATION 47276 HERKIMER COUNTY POPULATION 64508 SCHOHARIE COUNTY POPULATION 32099 ACCORDING TO THE 2012 US CENSUS ESTIMATES ABASSETT AN ACUTE CARE INPATIENT TEACHING FACILITY AN OUTPATIENT PRIMARY AND SPECIALTY CARE CENTER A REGIONAL NETWORK OF 26 COMMUNITY BASED OUTPATIENT HEALTH CENTERS 19 SCHOOL BASED HEALTH CENTERS TWO AMBULATORY SURGERY CENTERS AND A FULLY SALARIED MEDICAL STAFF IN COOPERSTOWN OTSEGO COUNTY BOCONNOR HOSPITAL CRITICAL ACCESS HOSPITAL IN DELHI DELAWARE COUNTY CCOBLESKILL REGIONAL HOSPITAL ACUTE CARE FACILITY IN COBLESKILL SCHOHARIE COUNTY DLITTLE FALLS HOSPITAL CRITICAL ACCESS HOSPITAL IN LITTLE FALLS HERKIMER COUNTY ETRITOWN REGIONAL HOSPITAL 247 EMERGENCY CARE FACILITY IN SIDNEY DELAWARE COUNTY FAO FOX MEMORIAL HOSPITAL ACUTE CARE FACILITY IN ONEONTA OTSEGO COUNTY GVALLEY HEALTH SERVICES RESIDENTIAL HEALTH CARE AND REHABILITATION FACILITY HAT HOME CARE CERTIFIED HOME CARE AGENCY IFIRST COMMUNITY CARE OF BASSETT MEDICAL SUPPLY COMPANY ALL THE ABOVE AI MAKE UP THE BASSETT HEALTHCARE NETWORK AND PROVIDE HEALTH SERVICES TO THIS SEVEN COUNTY REGION IN CENTRAL NEW YORK
LIST OF STATES WHERE COMMUNITY BENEFIT REPORT IS FILED	PART VI	NEW YORK
ADDITIONAL INFORMATION	PART VI	PART V SECTION B LINE 11 BASSETT MEDICAL CENTER DOES NOT PROVIDE DISCOUNTED CARE
MARY IMOGENE BASSETT HOSPITAL LINE NUMBER 1 PART V LINE 16E	PART V LINE 16E	BASSETT ENGAGES WITH A THIRD PARTY TO PERFORM COLLECTION ACTIONS
MARY IMOGENE BASSETT HOSPITAL LINE NUMBER 1 PART V LINE 20D	PART V LINE 20D	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

Schedule H (Form 990) 2012

Additional Data

Software ID:
Software Version:

- TIN:

Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990

OMB No. 1545-0047

2012

Open to Public
Inspection

Name of the organization
MARY IMOGENE BASSETT HOSPITAL
DBA BASSETT MEDICAL CENTER

Employer identification number
13-5596796

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21, for any recipient that received more than $5,000. Part II can be duplicated if additional space is needed.

(a) Name and address of organization or government	(b) EIN	(c) IRC Code section if applicable	(d) Amount of cash grant	(f) Method of valuation (book, FMV, appraisal, other)	(h) Purpose of grant or assistance
(1) AMERICAN CANCER SOCIETY 250 WILLIAMS ST NW ATLANTA,GA30303	13-1788491	3	7,500	CASH	SUPPORT
(2) AMERICAN HEART ASSOCIATION 7272 GREENVILLE AVE DALLAS,TX75231	13-5613797	3	25,000	CASH	SUPPORT

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................ Bullet Image

Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image

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

Cat. No. 50055P

Schedule I (Form 990) 2012

Page 2

Part III

Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.

(a)Type of grant or assistance	(b)Number of recipients	(c)Amount of cash grant	(d)Amount of non-cash assistance	(e)Method of valuation (book, FMV, appraisal, other)	(f)Description of non-cash assistance

Part IV

Supplemental Information.

Complete this part to provide the information required in Part I, line 2, Part III, column (b), and any other additional information.

Identifier	Return Reference	Explanation

Schedule I (Form 990) 2012

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

2012

Open to Public Inspection

Name of the organization

MARY IMOGENE BASSETT HOSPITAL
DBA BASSETT MEDICAL CENTER

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 of 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 filing organization used 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 Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2012

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 (E) amounts for that individual.

(A) Name and Title		(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 and Title		(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 MDPRESIDENT CEO	(i) (ii)	773,975		12,460	23,096	4,679	814,210
(2)BERTINE MCKENNA PHDEXECUTIVE VP & CFO	(i) (ii)	380,437	107,000	1,722	18,096	4,823	512,078
(3)NICHOLAS J NICOLETTACORPORATE VP & CFO	(i) (ii)	376,575	107,000		23,096	3,436	510,107
(4)PASCALE G RAYMOND MDATTENDING PHYSICIAN	(i) (ii)	415,000	169,159	1,813	18,096		604,068
(5)STEVEN J HENEGHAN MDATTENDING PHYSICIAN	(i) (ii)	578,884			23,096	6,614	608,594
(6)JONATHAN RICHMAN MDATTENDING PHYSICIAN	(i) (ii)	521,565	3,200		23,096	9,567	557,428
(7)ROBERT A LANCEY MDATTENDING PHYSICIAN	(i) (ii)	521,554	2,520		18,096	14,562	556,732
(8)TALLY E LASSITER MDATTENDING PHYSICIAN	(i) (ii)	500,000		127	8,924	3,614	512,665

Schedule J (Form 990) 2012

Page 3

Part III

Supplemental Information

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

Identifier	Return Reference	Explanation
NON-FIXED PAYMENTS PROVIDED	SCHEDULE J, PAGE 1, 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. PHYSICIANS MAY RECEIVE NON FIXED PAYMENTS BASED ON PERFORMANCE CRITERIA THAT ARE PROSPECTIVELY AGREED UPON.
OTHER ADDITIONAL INFORMATION	SCHEDULE J, PART III	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 : 306,000

Schedule J (Form 990) 2012

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

2012

Open to Public
Inspection

Name of the organization
MARY IMOGENE BASSETT HOSPITAL
DBA BASSETT MEDICAL CENTER

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 COUNTY CAPITAL RESOURCES	26-3661593		11-03-2011	25,000,000	PART VI		X		X		X
B	OTSEGO COUNTY CAPITAL RESOURCES	26-3661593		11-03-2011	19,200,000	PART VI		X		X		X

Part II

Proceeds

	A		B		C		D
	1 Amount of bonds retired . . . . . . . . . . . . . .
2 Amount of bonds legally defeased . . . . . . . . . . .
3 Total proceeds of issue . . . . . . . . . . . . . .	25,000,000		19,200,000
4 Gross proceeds in reserve funds . . . . . . . . . . . .
5 Capitalized interest from proceeds . . . . . . . . . . .
6 Proceeds in refunding escrows . . . . . . . . . . . .	702,000
7 Issuance costs from proceeds . . . . . . . . . . . .	500,000		75,000
8 Credit enhancement from proceeds . . . . . . . . . . .
9 Working capital expenditures from proceeds . . . . . . . . .
10 Capital expenditures from proceeds . . . . . . . . . . .	23,798,000
11 Other spent proceeds . . . . . . . . . . . . . .	19,125,000		19,125,000
12 Other unspent proceeds . . . . . . . . . . . . . .
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 Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50193E

Schedule K (Form 990) 2012

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 . .	%		%		%		%
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
8a Has there been a sale or disposition of any of the bond financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?. . . . . . . . . . . . . . . . .		X		X
b If “Yes” to line 8a, enter the percentage of bond-financed property sold or disposed of.	%		%		%		%
c If “Yes” to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? . . . . . . . . . . . . .		X		X
9 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 the issuer filed Form 8038-T? . . . . .		X		X
2 If "No" to line 1, did the following apply? . . . .
a Rebate not due yet? . . . . . . . .		X		X
b Exception to rebate? . . . . . . . .		X		X
c No rebate due? . . . . . . . . . .		X		X
If you checked "No rebate due" in line 2c, provide in Part VI the date the rebate computation was performed
3 Is the bond issue a variable rate issue? . . . .	X		X
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X		X
b Name of provider . . . . . . . . .
c Term of hedge . . . . . . . . . .
d Was the hedge superintegrated? . . . . . .
e Was a hedge terminated? . . . . . . .

Schedule K (Form 990) 2012

Page 3

Part IV

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . . . . .		X		X
b Name of provider . . . . . . . . .
c Term of GIC . . . . . . . . . .
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? . . . . .
6 Were any gross proceeds invested beyond an available temporary period? . . . . . . . .		X		X
7 Has the organization established written procedures to monitor the requirements of section 148? . . .		X		X

Part V

Procedures To Undertake Corrective Action

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 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?		X

Part VI

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

Identifier	Return Reference	Explanation
ADDITIONAL INFORMATION	SCHEDULE K	OTSEGO COUNTY CAPITAL RESOURCES PART I LINE A COLUMN F BUILDING AND STRUCTURES OTSEGO COUNTY CAPITAL RESOURCES PART I LINE B COLUMN F REFUND OF PRIOR ISSUANCE

Schedule K (Form 990) 2012

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, line 38a or 40b.
MediumBullet

Attach to Form 990 or Form 990-EZ. MediumBullet

See separate instructions.

OMB No. 1545-0047

2012

Open to Public Inspection

Name of the organization

MARY IMOGENE BASSETT HOSPITAL
DBA BASSETT MEDICAL CENTER

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

Enter the amount of tax incurred by 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-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22

(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	(d) Loan to or from the organization?		(e)Original principal amount	(f)Balance due	(g) In default?		(h) Approved by board or committee?		(i)Written agreement?
(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	To	From	(e)Original principal amount	(f)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 assistance	(d) Type of assistance	(e) Purpose of assistance

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

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2012

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	449,096	INVESTMENT MGMT FEES		No
(2) JANE HAMILTON	PART V	84,335	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
ADDITIONAL INFORMATION	SCHEDULE L PART V	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) 2012

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

2012

Open to Public
Inspection

Name of the organization

MARY IMOGENE BASSETT HOSPITAL
DBA BASSETT MEDICAL CENTER

Employer identification number

13-5596796

Identifier	Return Reference	Explanation
SECOND ACCOMPLISHMENT DESCRIPTION	FORM 990, PAGE 2, PART III, LINE 4B	COMMUNITY INVOLVEMENT HAS BEEN LINKED TO BASSETT'S MISSION, VISION, AND VALUES SINCE WE FIRST OPENED IN 1921. 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 2012, WE PROVIDED 5,433,926 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 15M, MEDICAID PAYMENTS BELOW COST TO PROVIDE SERVICES WERE 27.2M.
RELATED PARTY INFORMATION AMONG OFFICERS	FORM 990, PAGE 6, PART VI, LINE 2	KEVIN S MOORE WILLIAM T BURDICK TRUSTEE TRUSTEE BUSINESS KEVIN S MOORE JANE FORBES CLARK TRUSTEE TRUSTEE BUSINESS KEVIN S MOORE RICHARD C VANISON TRUSTEE TREASURER BUSINESS KEVIN S MOORE GLENN A PERRONE TRUSTEE ASST. SEC. BUSINESS WILLIAM T BURDICK KEVIN S MOORE TRUSTEE TRUSTEE BUSINESS WILLIAM T BURDICK JANE FORBES CLARK TRUSTEE TRUSTEE BUSINESS WILLIAM T BURDICK RICHARD C VANISON TRUSTEE TREASURER BUSINESS WILLIAM T BURDICK GLENN A PERRONE TRUSTEE ASST. SEC. BUSINESS JANE FORBES CLARK KEVIN S MOORE TRUSTEE TRUSTEE BUSINESS JANE FORBES CLARK WILLIAM T BURDICK TRUSTEE TRUSTEE BUSINESS JANE FORBES CLARK RICHARD C VANISON TRUSTEE TREASURER BUSINESS JANE FORBES CLARK GLENN A PERRONE TRUSTEE ASST. SEC. BUSINESS RICHARD C VANISON KEVIN S MOORE TREASURER TRUSTEE BUSINESS RICHARD C VANISON WILLIAM T BURDICK TREASURER TRUSTEE BUSINESS RICHARD C VANISON JANE FORBES CLARK TREASURER TRUSTEE BUSINESS RICHARD C VANISON GLENN A PERRONE TREASURER ASST. SEC. BUSINESS GLENN A PERRONE KEVIN S MOORE ASST. SEC. TRUSTEE BUSINESS GLENN A PERRONE WILLIAM T BURDICK ASST. SEC. TRUSTEE BUSINESS GLENN A PERRONE JANE FORBES CLARK ASST. SEC. TRUSTEE BUSINESS GLENN A PERRONE RICHARD C VANISON ASST. SEC. TREASURER BUSINESS
ORGANIZATION'S PROCESS USED TO REVIEW FORM 990	FORM 990, PAGE 6, PART VI, LINE 11B	THE MARY IMOGENE BASSETT HOSPITAL 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. ONCE APPROVED, THE 990 CAN BE ELECTRONICALLY FILED. A COMPLETE COPY OF THE ORGANIZATION'S FINAL FORM 990, INCLUDING ALL REQUIRED SCHEDULES, AS ULTIMATELY FILED WITH THE IRS, IS AVAILABLE FOR EACH MEMBER OF THE BOARD BEFORE IT'S FILING WITH THE IRS.
ENFORCEMENT OF CONFLICTS POLICY	FORM 990, PAGE 6, PART VI, LINE 12C	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 PREVIOUSLY DEFINED, 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 OF 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.
COMPENSATION PROCESS FOR TOP OFFICIAL	FORM 990, PAGE 6, PART VI, LINE 15A	BASSETT MEDICAL CENTER 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, AND INDEPENDENT COMPENSATION CONSULTANT, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OF TRUSTEES OR THE COMPENSATION COMMITTEE. BASSETT MEDICAL CENTER PAYS NON-FIXED EARNINGS BASED ON THE SUCCESS IN MEETING PERFORMANCE CRITERIA THAT ARE PROSPECTIVELY AGREED UPON AS GOALS FOR THE CEO.
COMPENSATION PROCESS FOR OFFICERS	FORM 990, PAGE 6, PART VI, LINE 15B	THE SAME FORMAL PROCESS NOTED ABOVE (PART VI, SECTION B, LINE 15A), IS USED TO DETERMINE THE BASE COMPENSATION OF THE OTHER OFFICERS. NON FIXED EARNINGS OF OTHER OFFICERS ARE BASED ON THE SUCCESS IN MEETING PERFORMACE CRITERIA AND COMPARATIVE MARKET DATA. FOR KEY EMPLOYEES, COMPENSATION IS DELEGATED BY THE BAORD TO THE DISCRETION OF THE OFFICERS.
GOVERNING DOCUMENTS DISCLOSURE EXPLANATION	FORM 990, PAGE 6, PART VI, LINE 19	THE MARY IMOGENE BASSETT HOSPITAL 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 THE HOSPITAL OR BY SENDING A SELF-ADDRESSED STAMPLED ENVELOPE ALONG WITH PAYMENT FOR COPYING OF THE REQUESTED MATERIAL TO THE ADMINISTRATIVE OFFICE OF THE HOSPITAL. THE COST OF COPYING SHALL BE EQUAL TO THE COSTS IMPOSED BY THE IRS FOR COPYING OF PUBLIC DOCUMENTS.
RECONCILIATION OF CHANGES - OTHER	FORM 990, PART XI, LINE 9	POST RETIREMENT BENEFIT CHANGE 174,722 BAD DEBT -14,985,208 CHARITY CARE -5,433,926 BAD DEBT 14,985,208 CHARITY CARE 5,433,926

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2012

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

2012

Open to Public Inspection

Name of the organization

MARY IMOGENE BASSETT HOSPITAL
DBA BASSETT MEDICAL CENTER

Employer identification number

13-5596796

Part I

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

(a) Name, address, and EIN (if applicable) 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" to 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 entity?
(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	SUPPORT	NY	501C3	11C	NONE		No
(2) BASSETT REGIONAL CORPORATION (BRC) ONE ATWELL ROAD COOPERSTOWN,NY13326 13-3522783	SUPPORT	NY	501C3	11B	THURSTON		No
(3) TEMPLETON FOUNDATION ONE ATWELL ROAD COOPERSTOWN,NY13326 13-3317084	LANDLORD	NY	501C3	9	THURSTON		No
(4) FRIENDS OF BASSETT ONE ATWELL ROAD COOPERSTOWN,NY13326 23-7041610	FUNDRAISE	NY	501C3	7	THURSTON		No
(5) AO FOX MEMORIAL HOSPITAL ONE NORTON AVENUE ONEONTA,NY13820 15-0539039	HEALTHCARE	NY	501C3	3	THURSTON		No
(6) BASSETT HOSPITAL SCHOHARIE COUNTY 178 GRANDVIEW DRIVE COBLESKILL,NY12043 14-1772971	HEALTHCARE	NY	501C3	3	BRC		No
(7) LITTLE FALLS HOSPITAL 140 BURWELL STREET LITTLE FALLS,NY13365 15-0533578	HEALTHCARE	NY	501C3	3	BRC		No
(8) O'CONNOR HOSPITAL 460 ANDES ROAD DELHI,NY13753 16-1540394	HEALTHCARE	NY	501C3	3	BRC		No
(9) TRI TOWN REGIONAL HEALTHCARE 43 PEARL STREET SIDNEY,NY13838 26-0169584	HEALTHCARE	NY	501C3	3	BRC		No
(10) VALLEY HEALTH SERVICES 690 WEST GERMAN STREET HERKIMER,NY13350 22-2511614	ELDER CARE	NY	501C3	3	BRC		No

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

Cat. No. 50135Y

Schedule R (Form 990) 2012

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to 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" to 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	(i) Section 512(b)(13) controlled entity?
(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	Yes	No

Schedule R (Form 990) 2012

Page 3

Part V

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

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

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 or (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 Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

Yes

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

Yes

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

Yes

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

Yes

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

Yes

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

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

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

Yes

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

Yes

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

s 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-s)	(c) Amount involved	(d) Method of determining amount involved

Schedule R (Form 990) 2012

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to 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) 2012

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: MARY IMOGENE BASSETT HOSPITAL IS A RURAL ACADEMIC CENTER COMMITTED TO PROVIDING EXCELLENCE IN HEALTH CARE SERVICES, EDUCATING PHYSICIANS AND OTHER HEALTH CARE PROFESSIONALS, AND PURSUING HEALTH RESEARCH.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	20
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	18
5	Total number of individuals employed in calendar year 2011 (Part V, line 2a) ......	5	3,926
6	Total number of volunteers (estimate if necessary) .............	6	155
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	24,333
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) .........	7,712,078	15,144,838
9	Program service revenue (Part VIII, line 2g) .........	399,868,572	413,231,887
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	4,865,736	1,833,345
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	40,575	-523,561
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	412,486,961	429,686,509
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...		50,825
14	Benefits paid to or for members (Part IX, column (A), line 4).....		0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	237,833,788	243,007,003
16a	Professional fundraising fees (Part IX, column (A), line 11e).....		0
b	Total fundraising expenses (Part IX, column (D), line 25) 1,066,287
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	177,222,598	184,364,624
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	415,056,386	427,422,452
19	Revenue less expenses. Subtract line 18 from line 12.......	-2,569,425	2,264,057
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	343,191,925	357,225,149
21	Total liabilities (Part X, line 26).............	122,504,389	124,215,669
22	Net assets or fund balances. Subtract line 21 from line 20.....	220,687,536	233,009,480

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 344,458,318 including grants of $ 50,825 ) (Revenue $ 413,231,887 )
	INPATIENT AND OUTPATIENT SERVICES PROVIDED TO OUR PATIENTS RESULTED IN: 12,708 HOSPITALIZATIONS (INCLUSIVE OF OPEN HEART SURGERIES) 50,711 PATIENT DAYS 699,970 CLINIC VISITS 24,144 RENAL TREATMENTS 9,410 SURGICAL CASES

4b	(Code: ) (Expenses $ 5,433,926 including grants of $ ) (Revenue $ )
	SEE SCHEDULE O COMMUNITY INVOLVEMENT HAS BEEN LINKED TO BASSETT'S MISSION, VISION, AND VALUES SINCE WE FIRST OPENED IN 1921. 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 2012, WE PROVIDED 5,433,926 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 15M, MEDICAID PAYMENTS BELOW COST TO PROVIDE SERVICES WERE 27.2M.

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












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses349,892,244

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	4,472,991	202,891

				(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		1,477,780
e	Government grants (contributions)1e		10,731,189

f	All other contributions, gifts, grants, and similar amounts not included above1f		2,935,869

g	Noncash contributions included in lines 1a-1f:$
h	Total. Add lines 1a-1f.......			15,144,838
			Business Code
2a	DIRECT PATIENT SERVICES		900099	385,399,702	385,399,702
b	OTHER PROGRAM SERVICE REVENUE		900099	27,832,185	27,832,185
c
d
e
f	All other program service revenue .
g	Total. Add lines 2a–2f........			413,231,887
3	Investment income (including dividends, interest, and other similar amounts).......			720,378			720,378
4	Income from investment of tax-exempt bond proceeds..
5	Royalties...........
		(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	25,805,046	200,509
b	Less: cost or other basis and sales expenses	24,276,047	616,541
c	Gain or (loss)	1,528,999	-416,032
d	Net gain or (loss)..........			1,112,967			1,112,967
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..
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...
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..
Miscellaneous Revenue			Business Code
11a	INVESTMENT IN JOINT VENTURE		621610	70,134			70,134
b	PARTNERSHIP INCOME		621500	24,333		24,333
c	PARTNERSHIP INCOME			-618,028			-618,028
d	All other revenue ....
e	Total. Add lines 11a–11d ......			-523,561
12	Total revenue. See Instructions......			429,686,509	413,231,887	24,333	1,285,451


				(A) Beginning of year		(B) End of year
1	Cashnon-interest-bearing .............			7,155,225	1	15,653,880
2	Savings and temporary cash investments .........				2
3	Pledges and grants receivable, net ...........			9,860,464	3	14,856,350
4	Accounts receivable, net .............			51,797,404	4	44,119,304
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L ..................
					5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
					6
7	Notes and loans receivable, net .............				7
8	Inventories for sale or use ..............			3,305,577	8	3,425,444
9	Prepaid expenses and deferred charges ..........			2,457,985	9	2,640,600
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	380,220,889
b	Less: accumulated depreciation .....	10b	233,912,362	141,444,465	10c	146,308,527
11	Investments—publicly traded securities ..........			85,442,703	11	84,878,064
12	Investments—other securities. See Part IV, line 11 .....			33,634,077	12	36,797,740
13	Investments—program-related. See Part IV, line 11 .....				13
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........			8,094,025	15	8,545,240
16	Total assets. Add lines 1 through 15 (must equal line 34)......			343,191,925	16	357,225,149
17	Accounts payable and accrued expenses .........			38,850,570	17	39,628,165
18	Grants payable .................				18
19	Deferred revenue ................				19
20	Tax-exempt bond liabilities .............			56,570,000	20	54,590,000
21	Escrow or custodial account liability. Complete Part IV of Schedule D..				21
22	Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........				22
23	Secured mortgages and notes payable to unrelated third parties ..			27,083,819	23	29,997,504
24	Unsecured notes and loans payable to unrelated third parties ....				24
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....................				25
26	Total liabilities. Add lines 17 through 25.........			122,504,389	26	124,215,669
	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............			163,124,202	27	163,196,856
28	Temporarily restricted net assets ...........			43,733,963	28	55,962,893
29	Permanently restricted net assets ...........			13,829,371	29	13,849,731
	Organizations that do not follow SFAS 117 (ASC 958), 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 ...........			220,687,536	33	233,009,480
34	Total liabilities and net assets/fund balances ........			343,191,925	34	357,225,149