TY 2014 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) WILLIAM STRECK MD JAN - JUN........................................................................ PRESIDENT &	40.00 .......................2.20	X	X	2,049,112	24,912
(2) VANCE M BROWN MD JUN - DEC........................................................................ PRESIDENT, C	40.00 .......................2.20	X	X	430,475	1,343
(3) THOMAS Q MORRIS MD........................................................................ CHAIRMAN	1.00 .......................3.25	X	X	0	0
(4) KEVIN S MOORE........................................................................ VICE CHAIRMA	3.00 .......................2.50	X	X	0	0
(5) TIMOTHY A PEDLEY MD........................................................................ VICE CHAIRMA	1.00 .......................1.00	X	X	0	0
(6) WILLIAM T BURDICK........................................................................ SECRETARY	8.00 .......................3.00	X	X	0	0
(7) JOHN D BULLIS........................................................................ TRUSTEE	1.00 .......................2.50	X		0	0
(8) JANE FORBES CLARK........................................................................ TRUSTEE	1.00 .......................	X		0	0
(9) BARBARA DICOCCO........................................................................ TRUSTEE	1.00 .......................1.50	X		0	0
(10) TERRY FULMER PHD........................................................................ TRUSTEE	1.00 .......................	X		0	0
(11) MICHAEL S GOLD MD........................................................................ TRUSTEE	1.00 .......................0.20	X		0	0
(12) PETER J HAMILTON........................................................................ TRUSTEE	1.00 .......................2.50	X		0	0
(13) NANCY KLENIEWSKI........................................................................ TRUSTEE	1.00 .......................	X		0	0
(14) RALPH H MEYER........................................................................ TRUSTEE	1.00 .......................1.00	X		0	0
(15) J MICHAEL MOFFAT........................................................................ TRUSTEE	1.00 .......................	X		0	0
(16) KATHERINE D NICKERSON........................................................................ TRUSTEE	1.00 .......................1.00	X		0	0
(17) DONALD O QUEST MD........................................................................ TRUSTEE	1.00 .......................	X		0	0

(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) VANNESS D ROBINSON........................................................................ TRUSTEE	1.00 .......................	X			0	0
(19) RENEE SCIALDO SHEVAT........................................................................ TRUSTEE	1.00 .......................	X			0	0
(20) EDWARD W STACK........................................................................ TRUSTEE	1.00 .......................2.20	X			0	0
(21) DOUGLAS B WILLIES........................................................................ TRUSTEE	1.00 .......................0.50	X			0	0
(22) STEVEN HENEGHAN MD........................................................................ CCO	40.00 .......................		X		613,446	30,790
(23) NICHOLAS J NICOLETTA........................................................................ CORPORATE VP	40.00 .......................13.50		X		476,485	29,490
(24) BERTINE MCKENNA PHD........................................................................ EXECUTIVE VP	40.00 .......................1.50		X		463,302	27,042
(25) SUE E ANDREWS........................................................................ VP FINANCE &	40.00 .......................20.00		X		212,075	21,557
(26) RICHARD C VANISON........................................................................ TREASURER	4.00 .......................2.50		X		0	0
(27) GLENN A PERRONE........................................................................ ASSISTANT SE	2.00 .......................2.50		X		0	0
(28) KIRAN R NAKKALA MD........................................................................ ATTENDING PH	40.00 .......................			X	679,642	13,987
(29) DHANANJAI MENZIES MD........................................................................ ATTENDING PH	40.00 .......................			X	616,227	23,410
(30) WT HUNTSMAN MD........................................................................ ATTENDING PH	40.00 .......................			X	545,125	27,690
(31) JAMES C PETERS MD........................................................................ ATTENDING PH	40.00 .......................1.00			X	520,098	29,522
(32) JOHN A LEON MD........................................................................ ATTENDING PH	40.00 .......................			X	483,860	30,370

(A) Name and business address	(B) Description of services	(C) Compensation
STAT STAFF 258 USHERS ROAD SUITE 10 CLIFTON PARK,NY12065	AGENCY	2,686,862
WELLIVER MCGUIRE INC 250 N GENESEE ST MONTOUR FALLS,NY14865	CONSTRUCTION	1,579,383
SODEXO OPERATIONS 9801 WASHINGTON BLVD GAITHERSBURG,MD20760	FOOD SERVICES	1,539,473
MAYO MEDICAL LABORATORIES 144117762 200 FIRST STREET SW ROCHESTER,MN55903	LAB SERVICES	1,441,178
WEATHERBY LOCUMS PO BOX 972633 DALLAS,TX75397	AGENCY	1,370,747
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 20

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 domestic organizations and domestic governments. See Part IV, line 21 ....	33,708	33,708
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ....
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16 ............
4	Benefits paid to or for members ....
5	Compensation of current officers, directors, trustees, and key employees ....	4,380,028		4,380,028
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....	87,787		87,787
7	Other salaries and wages ....	233,922,854	178,098,268	55,376,861	447,725
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	12,202,982	9,293,548	2,889,683	19,751
9	Other employee benefits .......	10,218,520	7,780,189	2,419,128	19,203
10	Payroll taxes ...........	14,828,652	11,287,905	3,509,797	30,950
11	Fees for services (non-employees):
a	Management ......
b	Legal .........
c	Accounting ...........
d	Lobbying ...........	45,986		45,986
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) ....	37,449,602	28,354,772	8,813,829	281,001
12	Advertising and promotion ....
13	Office expenses .......	2,055,908	1,557,061	484,144	14,703
14	Information technology ......
15	Royalties ..
16	Occupancy ...........	15,006,164	11,443,176	3,558,076	4,912
17	Travel ............
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......
19	Conferences, conventions, and meetings ....
20	Interest ...........	1,395,935	1,062,839	330,473	2,623
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization .....	18,160,621	13,851,752	4,306,985	1,884
23	Insurance ..............	4,224,895	3,216,756	1,000,200	7,939
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	34,651,449	34,651,449
b	PATIENT CARE SUPPLIES	33,639,331	33,639,331
c	BAD DEBT	13,417,776	13,417,776
d	CHARITY CARE	4,338,634	4,338,634
e	All other expenses	28,023,726	22,751,731	5,143,726	128,269
25	Total functional expenses. Add lines 1 through 24e	468,084,558	374,778,895	92,346,703	958,960
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 or note to any line in this Part X ..............
	1	Cash–non-interest-bearing .............	17,119,485	1	13,034,358
2	Savings and temporary cash investments .........		2
3	Pledges and grants receivable, net ...........	15,038,626	3	13,170,733
4	Accounts receivable, net .............	45,505,475	4	46,500,672
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 ..............	3,691,605	8	3,505,567
9	Prepaid expenses and deferred charges ..........	2,691,819	9	3,037,657
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	431,197,284
b	Less: accumulated depreciation .....	10b	268,762,097	154,577,061	10c	162,435,187
11	Investments—publicly traded securities ..........	83,073,005	11	80,810,427
12	Investments—other securities. See Part IV, line 11 .....	51,538,571	12	58,055,351
13	Investments—program-related. See Part IV, line 11 .....		13
14	Intangible assets ...............		14
15	Other assets. See Part IV, line 11 ...........	8,515,825	15	8,091,200
16	Total assets. Add lines 1 through 15 (must equal line 34)......	381,751,472	16	388,641,152
	17	Accounts payable and accrued expenses .........	42,674,294	17	50,143,147
18	Grants payable .................		18
19	Deferred revenue ................		19
20	Tax-exempt bond liabilities .............	52,525,000	20	49,160,000
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 ..	19,774,825	23	28,651,725
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....................	3,534,159	25
26	Total liabilities. Add lines 17 through 25.........	118,508,278	26	127,954,872
		Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............	183,528,504	27	184,415,074
28	Temporarily restricted net assets ...........	65,833,180	28	61,908,167
29	Permanently restricted net assets ...........	13,881,510	29	14,363,039
	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 ...........	263,243,194	33	260,686,280
34	Total liabilities and net assets/fund balances ........	381,751,472	34	388,641,152

- 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.
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Attach to Form 990 or Form 990-EZ.
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Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public
Inspection

Name of the organization

MARY IMOGENE BASSETT HOSPITAL

Employer identification number

13-5596796

Part I

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

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

A church, convention of churches, or association of churches 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 in lines 11a through 11d that describes the type of supporting organization and complete lines 11e, 11f, and 11g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations .............................

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

(i)Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i)Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

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

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2014

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) 2010	(b) 2011	(c) 2012	(d) 2013	(e) 2014	(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) 2010	(b) 2011	(c) 2012	(d) 2013	(e) 2014	(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 VI.)..
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 section 501(c)(3) organization, check this box and stop here........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2014 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2013 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2014. 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—2013. 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—2014. 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 VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2013. 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 VI 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) 2014

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) 2010	(b) 2011	(c) 2012	(d) 2013	(e) 2014	(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) 2010	(b) 2011	(c) 2012	(d) 2013	(e) 2014	(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 VI.) ..
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 section 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2014 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2013 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2014 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2013 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests—2014. 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—2013. 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) 2014

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 11 of Part I. If you checked 11a of Part I, complete Sections A and B. If you checked 11b of Part I, complete Sections A and C. If you checked 11c of Part I, complete Sections A, D, and E. If you checked 11d of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 11a or 11b in Part I, answer (b) and (c) below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations....

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed, (ii) the reasons for each such action, (iii) the authority under the organization's organizing document authorizing such action, and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (a) its supported organizations; (b) individuals that are part of the charitable class benefited by one or more of its supported organizations; or (c) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in IRC 4958(c)(3)(C)), a family member of a substantial contributor, or a 35-percent controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part II of Schedule L (Form 990).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined in line 9(a)) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined in line 9(a)) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of IRC 4943 because of IRC 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?

11a

A family member of a person described in (a) above?

11b

A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.

11c

Schedule A (Form 990 or 990-EZ) 2014

Page 5

Part IV

Supporting Organizations (continued)

Section B. Type I Supporting Organizations

Yes

Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (1) a written notice describing the type and amount of support provided during the prior tax year, (2) a copy of the Form 990 that was most recently filed as of the date of notification, and (3) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer (a) and (b) below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer (a) and (b) below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI the role played by the organization in this regard.

Schedule A (Form 990 or 990-EZ) 2014

Page 6

Part V – Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

1. Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970. See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1
2	Recoveries of prior-year distributions	2
3	Other gross income (see instructions)	3
4	Add lines 1 through 3	4
5	Depreciation and depletion	5
6	Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions)	6
7	Other expenses (see instructions)	7
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a
b	Average monthly cash balances	1b
c	Fair market value of other non-exempt-use assets	1c
d	Total (add lines 1a, 1b, and 1c)	1d
e	Discount claimed for blockage or other factors (explain in detail in Part VI):
2	Acquisition indebtedness applicable to non-exempt use assets	2
3	Subtract line 2 from line 1d	3
4	Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions).	4
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5
6	Multiply line 5 by .035	6
7	Recoveries of prior-year distributions	7
8	Minimum Asset Amount (add line 7 to line 6)	8

	Section C - Distributable Amount		Current Year
1	Adjusted net income for prior year (from Section A, line 8, Column A)	1
2	Enter 85% of line 1	2
3	Minimum asset amount for prior year (from Section B, line 8, Column A)	3
4	Enter greater of line 2 or line 3	4
5	Income tax imposed in prior year	5
6	Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions)	6
7	Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990 or 990-EZ) 2014

Page 7

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity
3 Administrative expenses paid to accomplish exempt purposes of supported organizations
4 Amounts paid to acquire exempt-use assets
5 Qualified set-aside amounts (prior IRS approval required)
6 Other distributions (describe in Part VI). See instructions
7Total annual distributions. Add lines 1 through 6.
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions
9 Distributable amount for 2014 from Section C, line 6
10 Line 8 amount divided by Line 9 amount

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2014	(iii) Distributable Amount for 2014
1 Distributable amount for 2014 from Section C, line 6
2 Underdistributions, if any, for years prior to 2014 (reasonable cause required--see instructions)
3 Excess distributions carryover, if any, to 2014:
a From 2009.......X
b From 2010.......X
c From 2011.......X
d From 2012.......X
e From 2013.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2014 distributable amount
i Carryover from 2009 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2014 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2014 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2014, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions)
6 Remaining underdistributions for 2014. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions)
7 Excess distributions carryover to 2015. Add lines 3j and 4c.
8 Breakdown of line 7:
a From 2010.......X
b From 2011.......X
c From 2012.......X
d From 2013.......
e From 2014.......

Schedule A (Form 990 or 990-EZ) (2014)

Schedule A (Form 990 or 990-EZ) 2014

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990 or 990-EZ) 2014

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.

Information about Schedule B (Form 990, 990-EZ, or 990-PF) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Name of the organization

MARY IMOGENE BASSETT HOSPITAL

Employer identification number

13-5596796

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

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

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

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

501(c)(3) taxable private foundation

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

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or
property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) 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), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions 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 an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled 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 totaling $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 its Form 990PF, Part I, line 2, 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) (2014)

Schedule B (Form 990, 990-EZ, or 990-PF) (2014)

Page 2

Name of organization MARY IMOGENE BASSETT HOSPITAL

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	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2014)

Schedule B (Form 990, 990-EZ, or 990-PF) (2014)

Page 3

Name of organization MARY IMOGENE BASSETT HOSPITAL

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) (2014)

Schedule B (Form 990, 990-EZ, or 990-PF) (2014)

Page 4

Name of organization
MARY IMOGENE BASSETT HOSPITAL

Employer identification number

13-5596796

Part III

Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10)
that total more than $1,000 for the year from any one contributor. 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) (2014)

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

Information about Schedule C (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

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) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet

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

Name of the organization

MARY IMOGENE BASSETT HOSPITAL

Employer identification number

13-5596796

Part I-A

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

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

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

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

Part I-B

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

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

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

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

Yes No

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

Yes No

If "Yes," describe in Part IV.

Part I-C

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

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

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

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

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

Yes No

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

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

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

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2014

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 separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2011	(b) 2012	(c) 2013	(d) 2014	(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) 2014

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

45,986

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

45,986

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

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, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
SCHEDULE C, PART II-B, LINE 1	AMERICAN HOSPITAL ASSOCIATION ALLOCATES 22.80% OF DUES TOWARDS GENERAL LOBBYING ACTIVITIES. TOTAL DUES PAID IN 2014 WERE 42,351 HANYS ALLOCATES 24.60% OF DUES TOWARDS GENERAL LOBBYING ACTIVITIES. TOTAL DUES PAID IN 2014 WERE 85,498 IROQUOIS HEALTHCARE ALLIANCE ALLOCATES 38.80% OF DUES TOWARDS GENERAL LOBBYING ACTIVITES. TOTAL DUES PAID IN 2014 WERE 39,427 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.

Return Reference

Explanation

SCHEDULE C, PART II-B, LINE 1

AMERICAN HOSPITAL ASSOCIATION ALLOCATES 22.80% OF DUES TOWARDS GENERAL LOBBYING ACTIVITIES. TOTAL DUES PAID IN 2014 WERE 42,351 HANYS ALLOCATES 24.60% OF DUES TOWARDS GENERAL LOBBYING ACTIVITIES. TOTAL DUES PAID IN 2014 WERE 85,498 IROQUOIS HEALTHCARE ALLIANCE ALLOCATES 38.80% OF DUES TOWARDS GENERAL LOBBYING ACTIVITES. TOTAL DUES PAID IN 2014 WERE 39,427 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) 2014

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.
Information about Schedule D (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public Inspection

Name of the organization

MARY IMOGENE BASSETT HOSPITAL

Employer identification number

13-5596796

Part I

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

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

Revenue 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:

Revenue 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) 2014

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, for escrow or custodial account liability?

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 ....	13,881,510	13,849,731	13,829,371	13,789,074	16,734,461
b	Contributions ........	481,529	31,779	20,360	40,297	54,613
c	Net investment earnings, gains, and losses					199,921
d	Grants or scholarships .....
e	Other expenditures for facilities and programs ........					3,000,000
f	Administrative expenses ....					199,921
g	End of year balance ......	14,363,039	13,881,510	13,849,731	13,829,371	13,789,074

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. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(b)Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value
1a	Land .................	1,089,856		1,089,856
b	Buildings ................	209,543,795	114,288,438	95,255,357
c	Leasehold improvements ............
d	Equipment ................	198,462,362	154,473,659	43,988,703
e	Other .................	22,101,271		22,101,271
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......				162,435,187

Schedule D (Form 990) 2014

Page 3

Part VII

InvestmentsOther Securities. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11b. 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	53,237,252	C
(B) LIMITED PARTNERSHIP	4,818,099	C







Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)	58,055,351

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment		(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. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11d. 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. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability		(b) Book value
Federal income taxes
LINE OF CREDIT








Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)
2. Liability for uncertain tax positions. 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) 2014

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......			1	447,771,234
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a	-19,802,820
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d	-18,635,675
e	Add lines 2a through 2d .....................			2e	-38,438,495
3	Subtract line 2e from line 1.....................			3	486,209,729
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	486,209,729

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........			1	450,328,148
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	450,328,148
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	17,756,410
c	Add lines 4a and 4b.......................			4c	17,756,410
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......			5	468,084,558

Part XIII

Supplemental Information

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.

Return Reference	Explanation
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.
SCHEDULE D, PAGE 3, PART X	FOOTNOTE 2(N) FROM AUDITED FINANCIAL STATEMENTS THE HOSPITAL IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501 (C)(3) OF THE INTERNAL REVENUE CODE (IRC) AND IS EXEMPT FROM FEDERAL INCOME TAXES PURSUANT TO SECTION 501(A) OF THE IRC. THE HOSPITAL RECOGNIZES INCOME TAX POSITIONS WHEN IT IS MORE-LIKELY-THAN-NOT THAT THE POSITION WILL BE SUSTAINABLE BASED ON THE MERITS OF THE POSITION. MANAGEMENT HAS CONCLUDED THAT THERE ARE NO MATERIAL TAX LIABILITIES OR UNCERTAIN TAX POSITIONS THAT NEED TO BE RECORDED.
SCHEDULE D, PAGE 4, PART XI, LINE 2D	POST RETIREMENT BENEFIT CHANGE -1,528,952 CHANGE IN INTEREST AT FRIENDS OF BASSETT 649,687 BAD DEBT -13,417,776 CHARITY CARE -4,338,634
SCHEDULE D, PAGE 4, PART XII, LINE 4B	BAD DEBT 13,417,776 CHARITY CARE 4,338,634

Schedule D (Form 990) 2014

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H (Form 990)

Department of the TreasuryInternal Revenue Service

Hospitals

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

Attach to Form 990.
MediumBullet

Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public Inspection

Name of the organization

MARY IMOGENE BASSETT HOSPITAL

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 300.0000000000 %

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 criteria used 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? ......

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) ..	3,486,714	315,017	3,171,697	0.700 %
b	Medicaid (from Worksheet 3, column a) ....	55,238,894	41,668,515	13,570,379	3.010 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) .
d	Total Financial Assistance and Means-Tested Government Programs .	58,725,608	41,983,532	16,742,076	3.710 %
Other Benefits		50,854		50,854	0.010 %
e	Community health improvement services and community benefit operations (from Worksheet 4) ..	50,854		50,854	0.010 %
f	Health professions education (from Worksheet 5) ..	17,021,300	5,191,610	11,829,690	2.620 %
g	Subsidized health services (from Worksheet 6) ..
h	Research (from Worksheet 7)	8,724,205	464,499	8,259,706	1.830 %
i	Cash and in-kind contributions for community benefit (from Worksheet 8)	705,129		705,129	0.150 %
j	Total. Other Benefits ..	26,501,488	5,656,109	20,845,379	4.610 %
k	Total. Add lines 7d and 7j .	85,227,096	47,639,641	37,587,455	8.320 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2014

Schedule H (Form 990) 2014

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. ......

13,417,775

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. ......

677,614

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).....

103,082,102

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

105,486,410

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

-2,404,308

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) 2014

Page

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, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)							Other (describe)
1	MARY IMOGENE BASSETT HOSPITAL ONE ATWELL ROAD COOPERSTOWN,NY13326 WWW.BASSETT.ORG 3824000H	X	X	X	X	X	OUTPATIENT PRIMARY & SPECIALTY

Schedule H (Form 990) 2014

Page

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 letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a State as a hospital facility in the current tax year or the immediately preceding tax year?.......................

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C..........

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 12....................

Yes

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 significant 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 Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 13

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

Yes

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C................................

Yes

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

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

Yes

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

Hospital facility’s website (list url): WWW.BASSETT.ORG

Other website (list url):

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. .............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 13

Is the hospital facility's most recently adopted implementation strategy posted on a website? ........

If "Yes" (list url):

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Yes

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

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)? ...........................

12a

If "Yes" to line 12a, did the organization file Form 4720 to report the section 4959 excise tax? ......

12b

If "Yes" to line 12b, 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) 2014

Page

Part VFacility Information (continued)

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

Yes

Financial Assistance Policy (FAP)

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 included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 300.000000000000%
and FPG family income limit for eligibility for discounted care of %

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application.

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application.

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process.

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications.

Other (describe in Section C)

Included measures to publicize the policy within the community served by the hospital facility?.......

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

The FAP application form was widely available on a website (list url):

A plain language summary of the FAP was widely available on a website (list url):

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Notice of availability of the FAP was conspicuously displayed throughout the hospital facility

Notified members of the community who are most likely to require financial assistance about availability of the FAP

Other (describe in Section C)

Billing and Collections

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 all of the actions the hospital facility or other authorized party may take upon non-payment?..................................

Yes

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 individual’s eligibility under the facility’s FAP:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Schedule H (Form 990) 2014

Page

Part VFacility Information (continued)

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

Yes

Did the hospital facility or other authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?.........

Yes

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 18. (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 individuals regarding the individuals’ bills

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

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required 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 Section C)

Other (describe in Section C)

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 Section C)

During the tax year, did the hospital facility charge any FAP-eligible individual 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 Section C.

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

If "Yes," explain in Section C.

Schedule H (Form 990) 2014

Page

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16i, 18d, 19d, 20e, 21c, 21d, 22d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
FACILITY 1, MARY IMOGENE BASSETT HOSPITAL - PART V, LINE 5	THIS COMMUNITY HEALTH NEEDS ASSESSMENT HAS TAKEN INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVED BY BASSETT MEDICAL CENTER. ALL ORGANIZATIONS PROVIDING INPUT INTO THIS ASSESSMENT, INCLUDING THE NAME AND TITLE OF THOSE INDIVIDUALS REPRESENTATIVE OF THE ORGANIZATION, IS PROVIDED BELOW. THIS INCLUDED INPUT FROM INDIVIDUALS WITH EXPERTISE IN PUBLIC HEALTH, SPECIFICALLY HEIDI BOND, DIRECTOR OF THE OTSEGO COUNTY HEALTH DEPARTMENT. A) HEIDI BOND, DIRECTOR AT OTSEGO COUNTY PUBLIC HEALTH B) GILES RUSSELL, CONSUMER AND COMMUNITY MEMBER C) BETTY HORRIGAN, DIRECTOR AT FIRST COMMUNITY CARE D) FRANCES WRIGHT, DIRECTOR AT OTSEGO COUNTY OFFICE FOR AGING E) JUDY SWEET, COMMUNITY LIAISON WITH AT HOME CARE, INC. F) MEG DONAHUE FROM OTSEGO COUNTY PUBLIC HEALTH G) TANYA SHALER, DIRECTOR AT OPPORTUNITIES FOR OTSEGO H) C.J. HERBERT, SUPERINTENDENT AT COOPERSTOWN SCHOOL DISTRICT I) CHRIS KJOLHEDE MD, DIRECTOR AT BASSETT SCHOOL-BASED HEALTH J) WILLIAM LECATES MD, MEDICAL DIRECTOR AT BASSETT MEDICAL CENTER K) MARYANNE KEHOE FROM HARTWICK COLLEGE L) JOHN MAY MD, DIRECTOR AT BASSETT RESEARCH INSTITUTE M) DAVID STROGATZ PHD, DIRECTOR AT BASSETT CENTER FOR RURAL COMMUNITY HEALTH N) WILLIAM STAMP, VP MARKETING AND STRATEGIC PLANNING, CORPORATE COMMUNICATINS AT BASSETT MEDICAL CENTER O) KAREN HUXTABLE-HOOKER, DIRECTOR PUBLIC & MEDIA RELATIONS AT BASSETT MEDICAL CENTER P) PAUL G. FITZPATRICK, PRESIDENT AT RURAL HEALTH DEVELOPMENT IN ADDITION TO COMMUNITY COMMENTS AND INPUT GATHERED IN RESPONSE TO POSTING OF THE COMMUNITY HEALTH NEEDS ASSESSMENT OF BOTH THE HOSPITAL'S AND BASSETT HEALTHCARE NETWORK'S WEBSITES, THE PRIMARY PROACTIVE MEANS FOR RECEIVING COMMUNITY INPUT WAS THROUGH A COMMUNITY-WIDE STAKEHOLDER MEETING HOSTED BY BASSETT MEDICAL CENTER ON DECEMBER 7, 2012. THE PURPOSE OF THE STAKEHOLDER MEETING WAS THREEFOLD: 1) TO ELICIT GENERAL COMMENTS ON THE DRAFT CHNA; 2) TO SEEK COMMUNITY INPUT ON THE PRIORITY HEALTH NEEDS IDENTIFIED BY THE CHNA; AND 3) TO SEEK COMMUNITY INPUT ON POTENTIAL IMPLEMENTATION STRATEGIES. A SUMMARY OF THE STAKEHOLDER SESSION IS PROVIDED IN APPENDIX 2. SIXTEEN INDIVIDUALS REPRESENTING 10 AREA HEALTH PROVIDERS AND COMMUNITY SERVICES ORGANIZATIONS ATTENDED THE SESSION. IN ADDITION TO THE PROCESS AND COMMUNITY PARTICIPATION SPECIFICALLY USED IN DEVELOPING THIS COMMUNITY HEALTH NEEDS ASSESSMENT, SIGNIFICANT PROCESSES AND COMMUNITY PARTICIPATION WERE INVOLVED IN COMPILING THE BASSETT MEDICAL CENTER COMMUNITY SERVICE PLAN AND IN DEVELOPMENT OF THE SEVEN COUNTIES' COMMUNITY HEALTH ASSESSMENTS FOR 2010-2013 WITHIN BASSETTS SERVICE AREA. EACH OF THESE EFFORTS INCLUDED THEIR OWN PROCESS AND METHODS FOR IDENTIFYING COMMUNITY HEALTH NEEDS. EACH ALSO PROVIDED NUMEROUS OPPORTUNITIES FOR COMMUNITY INPUT AND PARTICIPATION IN REVIEWING AND INFLUENCING THE SELECTION OF PRIORITY HEALTH NEEDS. THE COMMUNITY SERVICES PLAN FOR BASSETT MEDICAL CENTER WAS DEVELOPED AS PART OF A MULTIHOSPITAL PLANNING PROCESS AMONG THE SIX HOSPITALS IN THE BASSETT HEALTHCARE NETWORK. THE PROCESS WAS GUIDED BY A STEERING COMMITTEE THAT INCLUDED REPRESENTATION FROM EACH OF THE FOUR COUNTIES IN WHICH BASSETT AFFILIATED HOSPITALS ARE LOCATED. THE STEERING COMMITTEE INCLUDED REPRESENTATION FROM ALL MAJOR HEALTH PROVIDERS, PUBLIC HEALTH SERVICES, COLLEGES AND OTHERS IN EACH COUNTY. IN ADDITION, THE CSP FOR BASSETT MEDICAL CENTER INCLUDED PARTICIPATION OF THE OTSEGO COUNTY CONNECTING COMMUNITIES ADVISORY GROUP. THIS ADVISORY GROUP INCLUDED REPRESENTATIVES OF: BASSETT MEDICAL CENTER, OTSEGO COUNTY DEPARTMENT OF HEALTH, ONEONTA PRIMARY CARE GROUP, ONEONTA SPECIALTY SERVICES, COMMUNITY BASED ORGANIZATIONS, COUNTY HUMAN SERVICES, YOUTH AND AGING AGENCIES, SUNY ONEONTA AND HARTWICK COLLEGE. PARTICIPATION IN THE DEVELOPMENT OF THE CSP WAS ALSO SOLICITED THROUGH LETTERS AND EMAILS TO SCHOOLS, HUMAN SERVICE AGENCIES AND ORGANIZATIONS, COUNTY GOVERNMENT AND ELECTED OFFICIALS. A MAJOR STEP IN THE DEVELOPMENT OF THE PLAN WAS CONDUCTING A COMMUNITY HEALTH ASSESSMENT FOCUS GROUP. THE FOCUS GROUP SESSION WAS ATTENDED BY A WIDE RANGE OF COMMUNITY BASED HEALTH CARE PROVIDERS AND SERVICES ORGANIZATIONS, INCLUDING: OTSEGO COUNTY DEPARTMENT OF HEALTH, OTSEGO COUNTY DEPARTMENT OF SOCIAL SERVICES, OTSEGO COUNTY EMERGENCY SERVICES, OPPPORTUNITIES FOR OTSEGO, INC., PLANNED PARENTHOOD, BASSETT RESEARCH INSTITUTE, SAFE KIDS OF OTSEGO COUNTY, TOWN OF PITTSFIELD, AT HOME CARE, INC., SPRINGBROOK, CITY OF ONEONTA, BASSETT HEALTHCARE NETWORK, HEAD START, CATSKILL AREA, HOSPICE & PALLIATIVE CARE, OTSEGO COUNTY BOARD OF SUPERVISORS, NY CONNECTS OF OTSEGO COUNTY, UNITED WAY, SCHENEVUS CENTRAL SCHOOL, THE ARC OTSEGO, RURAL THREE FOR TOBACCO FREE COMMUNITIES, CORNELL COOPERATIVE EXTENSION, CHERRY VALLEY SPRINGFIELD CENTRAL SCHOOL, A.O. FOX HOSPITAL AND TOWN OF RICHFIELD SPRINGS. THE FOCUS GROUP SESSION INVOLVED PROVIDING PARTICIPANTS WITH AN OVERVIEW OF THE NYS PREVENTION AGENDA AND OF OTSEGO COUNTY HEALTH AND RELATED DATA. PARTICIPANTS WERE THEN ASKED FOR INPUT ON THE HEALTH STATUS AND HEALTH NEEDS OF OTSEGO COUNTY RESIDENTS. FOLLOWING THIS DISCUSSION, PARTICIPANTS BROKE INTO GROUPS TO DISCUSS AND RANK THE NYS PREVENTION AGENDA PRIORITIES. EACH GROUP PRESENTED ITS RANKING TO THE FULL GROUP. THESE RESULTS WERE THEN COMPLIED INTO A FINAL FOCUS GROUP SESSION RANKING. AS A RESULT, IMPROVING ACCESS TO QUALITY HEALTHCARE AND IMPROVING MENTAL HEALTH & SUBSTANCE ABUSE SERVICES WERE IDENTIFIED AS TOP PRIORITIES AND INCREASING PHYSICAL ACTIVITY & GOOD NUTRITION HABITS WAS RANKED THIRD. USING THESE RESULTS, TWO STRATEGIC PLANNING SESSIONS WERE CONDUCTED AMONG INTERESTED AREA PROVIDERS TO IDENTIFY AND DISCUSS STRATEGIES FOR EACH OF THE SELECTED PRIORITY AREAS. REPRESENTATIVES OF COMMUNITY ORGANIZATIONS PROVIDING DENTAL HEALTH, MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES WERE INVITED. PARTICIPANTS INCLUDED: OTSEGO COUNTY DEPARTMENT OF HEALTH, BASSETT HEALTHCARE NETWORK, BASSETT RESEARCH INSTITUTE, A.O. FOX HOSPITAL, FOX DENTAL CLINIC, AMERICAN MOBILE DENTAL CORPORATION, BASSETT SCHOOL BASED HEALTH CENTERS AND LEATHERSTOCKING EDUCATION ON ALCOHOLISM/ADDICTIONS FOUNDATIONS INC. THE PROCESS OF DEVELOPING THE CHENANGO COUNTY COMMUNITY HEALTH ASSESSMENT FOR 2010-2013 INVOLVED BROAD COMMUNITY PARTICIPATION. THE CHENANGO COUNTY PUBLIC HEALTH DEPARTMENT MAINTAINS ON-GOING COLLABORATIONS AND DIALOGUES WITH AREA HOSPITALS, HEALTH CARE PROVIDERS, COMMUNITY-BASED ORGANIZATIONS AND SCHOOLS WHICH SERVE CHENANGO COUNTY. THE CHENANGO COUNTY PUBLIC HEALTH DEPARTMENT ALSO INTERACTS WITH COMMUNITY RESIDENTS AND CONSUMERS TO GATHER INFORMATION AND FEEDBACK. THE PROCESS OF DEVELOPING THE COMMUNITY HEALTH ASSESSMENT INVOLVED FACE-TO-FACE MEETINGS BETWEEN THE CHENANGO COUNTY PUBLIC HEALTH DEPARTMENT, CHENANGO MEMORIAL HOSPITAL AND MEMBERS OF THE CHENANGO HEALTH NETWORK BOARD OF DIRECTORS. PRIORITIES WERE DETERMINED THROUGH COLLABORATIVE DISCUSSIONS OF THE HEALTH CARE STATUS AND NEEDS OF CHENANGO COUNTY RESIDENTS. SELECTED PRIORITIES WERE SUPPORTED BY COMPELLING DATA, AS WELL AS THE KNOWLEDGE OF THE ABILITY OF ALL AREA ENTITIES TO MEET THOSE NEEDS. SPECIFICALLY, PRIORITIES WERE IDENTIFIED BASED ON THE COMPLETION OF A SERIES OF STEPS, INCLUDING: 1) A REVIEW OF CURRENT NEW YORK STATE AND CHENANGO COUNTY HEALTH INDICATORS; 2) EVALUATION OF CLINICAL EXPERIENCES OF COUNTY PUBLIC HEALTH STAFF; 3) KNOWLEDGE GAINED FROM REGULAR DIALOGUES AND PARTICIPATION WITH CHENANGO HEALTH NETWORK BOARD OF DIRECTORS AND STAFF; 4) PROVISION OF STAFF SUPPORT FOR THE ACTION PLANS OF SEVERAL AREA HEALTH PLANNING COMMITTEES WHICH FOCUSED ON IMPROVING LIVING SITUATIONS OF COUNTY RESIDENTS; 5) REVIEW OF OTHER CURRENT LOCAL NEEDS ASSESSMENTS INCLUDING THE COMMUNITY SERVICE PLAN OF CHENANGO MEMORIAL HOSPITAL; AND 6) INFORMATION AND DATA ACQUIRED FROM ASSESSMENTS AND FOCUS GROUPS HELD THROUGHOUT CHENANGO COUNTY AS A PART OF THE TWO YEAR LOCAL HEALTH PLANNING ACTIVITIES FACILITATED BY THE CHENANGO HEALTH NETWORK. THE DELAWARE COUNTY COMMUNITY HEALTH ASSESSMENT 2010-2013 WAS PREPARED BY THE DELAWARE COUNTY PUBLIC HEALTH SERVICE (DCPH). DCPH CONDUCTED A COUNTYWIDE INFORMATION GATHERING INITIATIVE WITH THE GOAL OF UNDERSTANDING PUBLIC HEALTH PRIORITIES. THROUGH COLLABORATIVE EFFORTS AMONG DELAWARE COUNTY PUBLIC HEALTH NURSING SERVICES (DCPH), HOSPITALS, HEALTH CARE PROVIDERS, OTHER COMMUNITY-BASED ORGANIZATIONS, AND CONSUMERS, DATA WAS GATHERED REGARDING CURRENT NEEDS OF THE DELAWARE COUNTY COMMUNITY. THE OUTREACH EFFORT ESTABLISHED A FRAMEWORK FOR IDENTIFYING THE NYSS PREVENTION AGENDA PRIORITIES IN THE CONTEXT OF LOCAL NEED. AN EXTENSIVE EFFORT WAS MADE TO MAXIMIZE COMMUNITY AND PROVIDER PARTICIPATION IN THE DEVELOPMENT OF THE DELAWARE COUNTY COMMUNITY HEALTH ASSESSMENT FOR 2010-2013 (DCCHA). IT INCLUDED A MULTI-LEVEL PLANNING PROCESS UNDERTAKEN TO ENGAGE A WIDE RANGE OF COMMUNITY PARTICIPATION. LOCAL OUTREACH INCLUDED A CALL-FOR-PARTICIPATION PUBLICITY CAMPAIGN, TELEPHONE QUESTIONNAIRES, SURVEYS AND THE FORMATION OF DISCUSSION PANELS. A CONSUME
FACILITY 1, MARY IMOGENE BASSETT HOSPITAL - PART V, LINE 6A	O'CONNOR HOSPITAL, AO FOX MEMORIAL HOSPITAL, COBLESKILL REGIONAL HOSPITAL, LITTEL FALLS HOSPITAL, TRI TOWN REGIONAL HEALTHCARE
FACILITY 1, MARY IMOGENE BASSETT HOSPITAL - PART V, LINE 11	ALL OF THE COMMUNITY HEALTH ASSESSMENT NEEDS ARE LONG TERM GOALS AND ARE ACTIVELY BEING WORKED ON.
FACILITY 1, MARY IMOGENE BASSETT HOSPITAL - PART V, LINE 22D	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) 2014

Page

Part VFacility Information (continued)

Section D. 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) 2014

Page

Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs 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.

Form and Line Reference	Explanation
PART I, LINE 3C - OTHER INCOME BASED CRITERIA FOR FREE OR DISCOUNTED CARE	THE CSP (COMMUNITY SERVICES PROGRAM) APPLICATION SPECIFIES FAMILY INCOME LIMITS AND OTHER REQUIREMENTS FOR SERVICES TO BE ELIGIBLE FOR BASSETT MEDICAL CENTER'S CSP/FREE CARE PROGRAM.
PART I, LINE 6A - RELATED ORGANIZATION INFORMATION	THE MARY IMOGENE BASSETT HOSPITAL'S, (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, WWW.BASSETT.ORG.
PART I, LINE 7, COLUMN (F) - EXCLUSIONS FROM PERCENT OF TOTAL EXPENSE	THE PERCENT OF TOTAL EXPENSE IS CALCULATED BY DIVIDING COLUMN (E), NET COMMUNITY BENEFIT EXPENSE, BY TOTAL EXPENSE. THE BAD DEBT EXPENSE OF 13,417,776 WAS SUBTRACTED FROM THE TOTAL EXPENSE VALUE USED TO CALCULATE THE PERCENTAGES IN PART 1, LINE 7, COLUMN F.
PART I, LINE 7 - COSTING METHODOLOGY EXPLANATION	SECTIONS (A) CHARITY CARE AT COST, (B) UNREIMBURSED MEDICAID, (F) HEALTH PROFESSIONS EDUCATION, THE COSTING METHODOLOGY USED IS A COST-TO-CHARGE RATIO CALCULATION UTILIZED ON FILED STATE AND FEDERAL COST REPORTS AS THE SOURCE. INDIRECT COSTS WERE APPLIED TO SECTIONS (E) COMMUNITY HEALTH IMPROVEMENT, PORTIONS OF (F) HEALTH PROFESSIONS EDUCATION, (H) RESEARCH, AND (I) CASH AND IN-KIND CONTRIBUTIONS TO COMMUNITY GROUPS ARE COMPRISED OF THE DIRECT SALARY COSTS FOR HOSPITAL STAFF WHOSE TIME WAS COMPENSATED BY THE HOSPITAL FOR TIME SPENT PARTICIPATING IN ACTIVITIES THAT QUALIFY AS COMMUNITY BENEFITS PLUS THE CURRENT FISCAL YEAR FRINGE BENEFIT RATE. INDIRECT COSTS WERE ONLY APPLIED TO SELECT SALARIES AND SERVICES UNDER COMMUNITY HEALTH IMPROVEMENT AND RESEARCH AND NOT BROADLY ACROSS ALL COMMUNITY BENEFIT ACTIVITY ENTRIES
PART II - COMMUNITY BUILDING ACTIVITIES	ALL BASSETT COMMUNITY BUILDING ACTIVITIES COULD BE CLASSIFIED UNDER ITEM 1 AND HIGHLIGHTED IN NUMBER 1 ABOVE.
PART III, LINE 2 - BAD DEBT EXPENSE METHODOLOGY	WORKSHEET 2, COST TO CHARGE RATIO, WAS USED TO DETERMINE THE AMOUNT REPORTED IN PART III, LINES 2 AND 3. PART III, LINE 4 - PROVISION FOR UNCOLLECTIBLE PATIENT ACCOUNTS RECEIVABLE FINANCIAL STATEMENTS NOTE 2(I), "THE HOSPITAL GRANTS CREDIT WITHOUT COLLATERAL TOPATIENTS, 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 FORESTIMATED UNCOLLECTIBLE ACCOUNTS. ADDITIONS TO THE ALLOWANCE FOR ESTIMATEDUNCOLLECTIBLE ACCOUNTS ARE MADE BY MEANS OF THE PROVISION FOR UNCOLLECTIBLEACCOUNTS. ACCOUNTS WRITTEN OFF AS UNCOLLECTIBLE ARE DEDUCTED FROM THEALLOWANCE AND SUBSEQUENT RECOVERIES ARE ADDED. THE AMOUNT OF THE PROVISIONFOR UNCOLLECTIBLE ACCOUNTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL EXPECTED COLLECTIONS, BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN FEDERAL AND STATE HEALTHCARE COVERAGE, AND OTHER COLLECTION INDICATORS." DURING 2014 AND 2013, THE TOTAL CHARGES FORGONE FOR BAD DEBT WERE APPROXIMATELY 13,417,776 AND 17,167,068 RESPECTIVELY. PROVISION FOR CHARITY AND UNCOMPENSATED CARE FROM THE FINANCIAL STATEMENT FOOTNOTES (J), "THE HOSPITAL'S GENERAL POLICY STATEMENT ON CHARITY CARE REQUIRES THAT MEDICAL CARE BE RENDERED TO ALL PERSONS IN NEED OF SUCH CARE REGARDLESS OF THEIR ABILITY TO PAY. BECAUSE THE HOSPITAL DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, THEY ARE NOT REPORTED AS REVENUE. THE HOSPITAL MAINTAINS RECORDS TO IDENTIFY AND MONITOR THE LEVEL OF CHARITY CARE IT PROVIDES. THESE RECORDS INCLUDE THE AMOUNT OF CHARGES FORGONE FOR SERVICES FURNISHED UNDER ITS CHARITY CARER POLICY. THE HOSPITAL'S CHARITY CARE POLICY HAS NOT CHANGED DURING FISCAL YEARS 2013 OR 2014."
PART III, LINE 3 BAD DEBT EXPENSE, PATIENTS ELIGIBLE FOR ASSISTANCE	THE COST-TO-CHARGE RATIO WAS USED TO REDUCE BAD DEBT CHARGES TO COST. THE RATIO OF APPROVED APPLICATIONS TO TOTAL APPLICATIONS FOR FINANCIAL ASSISTANCE WAS APPLIED TO THE BAD DEBT COST TO ESTIMATE AMOUNT PRESUMED ELIGIBLE, HAD PATIENTS COMPLETED THE APPLICATION PROCESS.
PART III, LINE 8 - MEDICARE EXPLANATION	AMOUNTS WERE DERIVED AS FOLLOWS: CHARGE TIMES COST TO CHARGE RATIO VERSUS REIMBURSEMENT ON THE MEDICARE PS&R REPORT. THE HOSPITAL BELIEVES THE AMOUNT SHOULD BE CONSIDERED A COMMUNITY BENEFIT EXPENSE SINCE THE GOVERNMENT SUBSIDY IS NOT SUFFICIENT TO COVER THE COST OF CARING FOR ELDERLY PATIENTS. THE PROVISION OF MEDICAL CARE TO THE ELDERLY IS A COMMUNITY NEED.
PART III, LINE 9B - COLLECTION PRACTICES EXPLANATION	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 SELF-PAY ACCOUNTS RECEIVABLE AS WELL PRESERVE THE PATIENT-PROVIDER RELATIONSHIP AND KEEP THE NECESSITY OF REFERRING ACCOUNTS TO THIRD PARTY BAD DEBT COLLECTION AGENCIES OR LAW FIRMS TO A MINIMUM. IT IS EXPECTED THAT ANY THIRD PARTY COLLECTION AGENCY OR LAW FIRM RETAINED BY BASSETT WILL REFRAIN FROM ANY CONDUCT THAT VIOLATES THE FAIR DEBT COLLECTION PRACTICES ACT, 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 DEBTOR'S PRINCIPAL RESIDENCE WILL NEVER BE CONSIDERED APPROPRIATE PURSUIT OF AN OPEN BALANCE IN THE NAME OF BASSETT MEDICAL CENTER. LIENS OR GARNISHMENTS UPON THE PERSONAL ASSETS OF A JUDGEMENT DEBTOR WILL BE PURSUED ONLY AFTER INDIVIDUAL CASE REVIEW BY COUNSEL TO ENSURE THAT SUCH ACTION IS NOT ONLY CONSISTENT WITH BASSETT'S INTERESTS, BUT ALSO THE ONLY FEASIBLE RECOVERY MECHANISM FROM A JUDGEMENT DEBTOR CAPABLE OF RESPONDING TO HIS OR HER OBLIGATIONS, BUT OTHERWISE UNWILLING TO DO SO.
PART VI, LINE 2 - NEEDS ASSESSMENT	IN ADDITION TO PUBLIC AND AGENCY INPUT, A VARIETY OF DATA FROM THE NYS DEPARTMENT OF HEALTH, OTSEGO COUNTY BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM, OTSEGO CO. DEPARTMENT OF HEALTH COMMUNITY ASSESSMENT AND OTHER SOURCES WERE USED TO ASSESS PRIORITIES, INCLUDING: A)PERCENTAGE OF OTSEGO CO. ADULTS WHO VISITED A DENTIST IN THE PAST YEARS B)PREVALENCE OF TOOTH DECAY IN THIRD-GRADE CHILDREN C)PERCENTAGE OF ADULTS REPORTING BINGE DRINKING D)HEAVY DRINKING E)PERCENTAGE OF OVERWEIGHT ADULTS IN OTSEGO CO. BASED ON THE OUTCOMES OF THE FOCUS GROUPS AND STRATEGIC PLANNING SESSIONS PREVENTION AGENDA PRIORITIES THROUGHOUT THE COUNTY WERE IDENTIFIED. ACCESS TO QUALITY HEALTHCARE AND MENTAL HEALTH & SUBSTANCE ABUSE WERE IDENTIFIED AS THE TOP PRIORITIES. PHYSICAL ACTIVITY AND NUTRITION WAS RANKED THIRD. SUBSEQUENT STRATEGIC PLANNING SESSIONS RELATED TO THE TWO TOP PRIORITIES WERE HELD TO IDENTIFY SERVICE BARRIERS AND GAPS AS WELL AS BRAINSTORM FOR COLLABORATIVE EFFORTS TO ADDRESS THESE PRIORITIES. STRATEGIES FOR THE SELECTED PRIORITIES: 1)ACCESS TO DENTAL HEALTH CARE A.BASSETT WILL SUPPORT OTSEGO CO. DEPT. OF HEALTH EFFORTS TO RE-ESTABLISH THE OTSEGO CO. ORAL HEALTH COALITION AS A MECHANISM FOR BRINGING COMMUNITY PARTNERS TOGETHER ON ADVOCACY EFFORTS AIMED AT ATTRACTING MORE DENTISTS TO OUR RURAL AREA, AND FOR TRACKING PROGRESS IN IMPROVING ACCESS TO DENTAL SERVICES B.BASSETT WILL WORK TO EXPAND COMPREHENSIVE PREVENTIVE DENTAL HEALTH SERVICES TO ALL SCHOOL-BASED HEALTH CENTERS IN THE COUNTY AND TO PROVIDE SEALANT SERVICES TO NON-SBHC SCHOOLS. BASSETT WILL WORK WITH THE OTSEGO CO. DEPT. OF HEALTH AND RHENDOMS TO MAKE MORE SCHOOLS AWARE OF RHENDOMS SERVICES TO INCREASE PARTICIPATION C.BASSETT WILL WORK WITH THE OTSEGO CO. DEPT. OF HEALTH AND A.O. FOX HOSPITAL TO EDUCATE PRIMARY CARE AND SBHC PROVIDERS ABOUT DENTAL PRACTICES AVAILABLE FOR REFERRAL. THE OTSEGO CO. DEPT. OF HEALTH WILL EDUCATE DENTAL PROVIDERS ABOUT MEDICAID REIMBURSEMENTS D.BASSETT WILL WORK WITH THE HEALTH DEPARTMENT AND OTHER COMMUNITY PARTNERS TO EDUCATE THE PUBLIC ABOUT DENTAL HEALTH IN FAIRS AND OTHER COMMUNITY EVENTS. 2)MENTAL HEALTH AND SUBSTANCE ABUSE A.IN A NEW INITITATIVE, BASSETT WILL WORK WITH A.O. FOX HOSPITAL AND LEATHERSTOCKING EDUCATION ON ALCOHOLISM/ADDICTIONS FOUNDATIONS, INC. (LEAF) TO PROVIDE CONTINUING MEDICAL EDUCATION TRAINING ON SUBSTANCE ABUSE SCREENING AND REFERRAL TO PRIMARY CARE PROVIDERS AND SURGEONS IN THE COUNTY B.BASSETT WILL WORK WITH THE HEALTH DEPARTMENT AND LEAF TO COMPLETE AND DISTRIBUTE AN UPDATED LIST OF MENTAL HEALTH AND SUBSTANCE ABUSE RESOURCES TO PRIMARY CARE PROVIDERS C.BASSETT WILL COLLABORATE WITH LEAF AND THE HEALTH DEPARTMENT ON PUBLIC HEALTH CAMPAIGN ABOUT THE RISK FACTORS ASSOCIATED WITH BINGE DRINKING AND PRESCRIPTION DRUG ABUSE 3)PHYSICAL ACTIVITY AND NUTRITION A.BASSETT WILL CONTINUE TO COLLABORATE WITH THE HEALTH DEPARTMENT AND OTHER COMMUNITY PARTNERS ON EFFORTS TO PROVIDE EARLY EDUCATION ABOUT THE IMPORTANCE OF PHYSICAL ACTIVITY AND NUTRITION THROUGHOUT LIFE, INCLUDING DURING PREGNANCY AND TO PREVENT CHRONIC DISEASE B.BASSETT WILL WORK WITH THE HEALTH DEPARTMENT, SCHOOLS, AND OTHER COMMUNITY PARTNERS TO IMPROVE CONTINUITY OF CARE BETWEEN FAMILIES, SCHOOLS, AND PRIMARY CARE PROVIDERS FOR THE TREATMENT OF CHILDHOOD OBESITY OVERALL GOALS WILL BE TO INCREASE THE PERCENTAGE OF OTSEGO COUNTY ADULTS WHO HAVE SEEN A DENTIST IN THE PAST YEAR, WORK TOWARD A 2013 PREVENTION AGENDA OBJECTIVE OF 83%, REDUCING THE RATE OF ALCOHOL ABUSE IN OTSEGO COUNTY AND REDUCING THE RATE OF OBESITY IN OTSEGO COUNTY.
PART VI, LINE 3 - PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE	A MAJOR COMPONENT OF BASSETT'S COMMUNITY SERVICES PROGRAM IS TO ACTIVELY IDENTIFY PATIENTS WHO MAY BE ELIGIBLE FOR CHARITY CARE. THE PROCESS BEGINS WITH AN ORGANIZATIONAL POLICY AND PROCEDURE THAT DEFINES THE PROGRAM AND SERVES AS AN EDUCATION TOOL FOR ALL BASSETT EMPLOYEES. THE POLICY IS UPDATED ANNUALLY, DISTRIBUTED TO KEY PERSONNEL AND POSTED IN THE ONLINE POLICY AND PROCEDURE MANUAL THAT IS ACCESSIBLE TO ALL EMPLOYEES. THE PROGRAM IS SUPPORTED BY A FOUR PAGE PLAIN LANGUAGE BROCHURE THAT INCLUDES AN APPLICATION. BROCHURES ARE PROMINENTLY DISPLAYED AND AVAILABLE AT ALL FACILITIES AND ALL CLINIC LOCATIONS. CLINICAL AND SUPPORT STAFF ARE MADE AWARE OF THE PROGRAM AND ABLE TO DIRECT PATIENTS TO SPECIALISTS WHO CAN ASSIST IN THE APPLICATION PROCESS. ALL PATIENTS WHO ARE REGISTERED AS 'SELF PAY' ARE PROVIDED A BROCHURE EITHER IN PERSON OR BY MAIL. PATIENTS WHO ARE IN THE HOSPITAL RECEIVE INFORMATION AS PART OF A PERSONAL VISIT GEARED TO HELP THE PATIENT NAVIGATE FINANCIAL ASSISTANCE INCLUDING, BUT NOT LIMITED TO, THE COMMUNITY SERVICES PROGRAM. GOVERNMENT PROGRAM OPPORTUNITIES ARE ALSO REFERENCED AND A DIRECTORY OF LOCAL SOCIAL SERVICES AGENCIES IS PROVIDED BASED ON THE PATIENT'S COUNTY OF RESIDENCE. REFERRAL TO AN ONSITE OTSEGO COUNTY MEDICAID EXAMINER IS AVAILABLE AT THE COOPERSTOWN CAMPUS. A LISTING OF ALL SELF-PAY ACCOUNTS IS PRODUCED AND REVIEWED DAILY TO INSURE THAT A COMMUNITY SERVICES BROCHURE HAS BEEN PROVIDED. THE SELF-PAY BILLING OFFICE IDENTIFIES PATIENTS DURING THE BILLING AND COLLECTIONS PROCESS THAT MAY REQUIRE ADDITIONAL HELP UNDERSTANDING THE PROGRAM. SELF-PAY ACCOUNTS FOR PATIENTS WHO HAVE BEEN APPROVED FOR COMMUNITY SERVICES WITHIN THE PRIOR 120 DAYS ARE AUTOMATICALLY INCLUDED WITH THE PRIOR APPROVAL.
PART VI, LINE 4 - COMMUNITY INFORMATION	THE SERVICE AREA OF BASSETT ENCOMPASSES 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 37,000 AND 40,000. 12-14 % OF THE COMMUNITY RESIDENTS HAVE INCOMES BELOW THE FEDERAL POVERTY GUIDELINES. THE FOLLOWING AREAS HAVE BEEN FEDERALLY DESIGNATED AS BEING MEDICALLY UNDERSERVED: A) 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
PART VI, LINE 5 - PROMOTION OF COMMUNITY HEALTH	BASSETT'S 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 SCHOOL-BASED HEALTH CENTERS; TWO AMBULATORY SURGERY CENTERS AND IS A LEVEL II TRAUMA CENTER AS DESIGNATED BY NEW YORK STATE. IN ADDITION, THE RESEARCH PROGRAMS AT BASSETT INCLUDE THE NEW YORK CENTER FOR AGRICULTURAL MEDICINE AND HEALTH. COMMUNITY BASED PARTNERSHIPS AS PART OF THE NORTHEAST CENTER FOR AGRICULTURAL HEALTH ARE ADDRESSING IMPORTANT HEALTH AND SAFETY ISSUES IN DIVERSE AGRICULTURAL POPULATIONS AT SEVERAL SITES ACROSS NEW YORK STATE. HEALTH WORKS OCCUPATIONAL HEALTH SERVICES PROGRAM CONTINUES TO MEET THE HEALTH, SAFETY AND WELLNESS NEEDS OF THE BUSINESS COMMUNITY. PROVIDING NEEDED OCCUPATIONAL HEALTH SERVICES BENEFITS AND IMPROVING EMPLOYEE HEALTH THROUGHOUT THE BASSETT HEALTHCARE NETWORK SEVEN COUNTY REGION. BASSETT IS WORKING TO RE-ESTABLISH THE OTSEGO COUNTY ORAL HEALTH COALITION AS A MECHANISM FOR BRINGING COMMUNITY PARTNERS TOGETHER AROUND A SHARED VISION IN AN EFFORT TO ATTRACT MORE DENTISTS TO OUR RURAL AREA. THE SIZE AND DEPTH OF BASSETT WITH ITS MORE THAN TWO DOZEN COMMUNITY HEALTH CENTERS AND 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 AND/OR TO PROMOTE HEALTH AND HEALING AS A RESPONSE TO IDENTIFIED COMMUNITY NEEDS. COMMUNITY HEALTH IMPROVEMENT INITIATIVES HAVE TARGETED THE NEW YORK STATE DEPARTMENT OF HEALTH NEW PUBLIC HEALTH PREVENTION AGENDA. IN ADDITION TO HOSPITAL PUBLIC HEALTH PROGRAMS RELATED TO THE THREE PRIORITY PREVENTION AGENDA ITEMS, PROGRAMS ADDRESSING CHRONIC DISEASE MANAGEMENT AND PREVENTION AND UNINTENTIONAL INJURY WERE CONSIDERED. BASSETT PUBLIC HEALTH PROGRAMS THAT ADDRESS THESE AREAS INCLUDE: A.SCHOOL-BASED HEALTH CENTER DENTAL SEALANT PROGRAM - A REGISTERED DENTAL HYGIENIST PROVIDES PREVENTIVE CARE, INCLUDING EDUCATION, CLEANINGS, FLUORIDE TREATMENT, SEALANT AND REFERRALS IN THIS GRANT FUNDED PROGRAM B.RHENDOMS (RURAL HEALTH EDUCATION NETWORK OF DELAWARE, OTSEGO, MONTGOMERY AND SCHOHARIE COUNTIES) - DENTAL HEALTH EDUCATION IS OFFERED TO ELEMENTARY SCHOOL STUDENTS, AND PARENTS OF NEWBORNS ARE EDUCATED ABOUT BABY-BOTTLE TOOTH DECAY C.BASSETT PSYCHIATRIC CRISIS CENTER - THE COOPERSTOWN CENTER OPENED IN FEBRUARY 2008, FILLING A VOID CREATED BY THE TERMINATION OF PSYCHIATRIC SERVICES AT A.O. FOX HOSPITAL IN ONEONTA MONTHS EARLIER. IN ITS FIRST YEAR, BASSETT'S PSYCHIATRIC CRISIS CENTER HELPED MORE THAN 1,200 PATIENTS. OF THOSE, 52 WERE CHILDREN 12 OR YOUNGER AND 154 WERE ADOLESCENTS D.PARENT HANY BOOK - THIS FAMILY RESOURCE WAS CREATED BY THE OTSEGO CO. COMMITTEE ON CHILD ABUSE AND NEGLECT AND UNDERWRITTEN BY BASSETT AND A.O. FOX HOSPITAL. IT'S GOAL IS TO GIVE PARENTS AND PROFESSIONALS A PLACE TO TURN FOR HELP IN DEALING WITH THE STRESSES OF FAMILY LIFE E.KICKSTART - A PROGRAM DESIGNED TO HELP COMBAT CHILDHOOD OBESITY THROUGH COLLABORATIVE PARTNERSHIPS WITH BASSETT HEALTH CENTERS AND LOCAL RECREATIONAL AND FITNESS GROUPS F.BASSETT CANCER INSTITUTE MEDICAL SCREENING COACH - A NEW, CUSTOM-BUILT MEDICAL COACH EQUIPPED WITH DIGITAL TECHNOLOGY FOR MAMMOGRAPHY AND OTHER CANCER SCREENINGS FOR MEN AND WOMEN. THE COACH WAS PLACED IN SERVICE IN 2008 WITH THE GOAL OF REDUCING THE NUMBER OF CANCER DEATHS BY INCREASING ACCESS TO SCREENING SERVICES IN RURAL AREAS G.CANCER SERVICES PROGRAM OF DELAWARE, OTSEGO AND SCHOHARIE COUNTIES - A NEW YORK STATE DEPARTMENT OF HEALTH PARTNERSHIP ADMINISTERED THROUGH BASSETT OFFERING FREE BREAST, CERVICAL AND COLORECTAL SCREENINGS TO PEOPLE WHO QUALIFY H.HEALTHY START BREAKFAST - A PARTNERSHIP BETWEEN COMMUNITY SERVICE ORGANIZATIONS AND BASSETT FOR DIABETES DETECTION, EDUCATION, AND PREVENTION I.SAFE KIDS COALITION OF OTSEGO COUNTY - AN ORGANIZATION WHOSE MISSION IS TO PREVENT UNINTENTIONAL INJURIES TO CHILDREN THROUGH EDUCATION. PROGRAMS AND SERVICES INCLUDE SAFETY SEAT EVENTS, EDUCATIONAL RESOURCES ON BICYCLING, IN-LINE SKATE AND SKATEBOARD SAFETY, HOME SAFETY, FIRE AND BURN PREVENTION, ROAD SAFETY AND PEDESTRIAN SAFETY THE REGIONAL PRIMARY AND SPECIALTY CARE CLINICS AND THE SCHOOL-BASED HEALTH CENTERS WERE ESTABLISHED IN RESPONSE TO COMMUNITY NEED. BASSETT IS CONTINUALLY ENGAGING IN QUALITY IMPROVEMENT INITIATIVES TO ENSURE THAT QUALITY HEALTH CARE AND PROGRAMS ARE BROUGHT TO CENTRAL NEW YORK. A CORE PART OF BASSETT IS RESEARCH AND EDUCATION. BASSETT'S VALUE TO THE COMMUNITIES IT SERVES IS COMPOUNDED BY PROVIDING PHYSICIANS THE ABILITY TO PRACTICE QUALITY MEDICINE IN A COLLEGIAL ENVIRONMENT IN A RURAL SETTING. THERE IS A TREMENDOUS COLLABORATION BETWEEN PHYSICIANS WITHIN BASSETT TO ENSURE A BETTER OUTCOME FOR THE PATIENT. BASSETT CONTINUALLY INVESTS IN PROGRAMS, EQUIPMENT AND PEOPLE TO ENSURE QUALITY SERVICE TO THE COMMUNITIES IN WHICH WE SERVE.
PART VI, LINE 6 - AFFILIATED HEALTH CARE SYSTEM	BASSETT IS PART OF THE BASSETT HEALTHCARE NETWORK THAT PROVIDES HEALTH SERVICES IN MORE THAN 20 COMMUNITIES SPANNING 5,600 SQUARE MILES AND SEVEN COUNTIES. THE NETWORK FOCUSES ITS COMMUNITY SERVICES PROGRAMS IN THE COUNTIES WHERE THE SIX AFFILIATED HOSPITALS AND GREATEST PATIENT POPULATIONS ARE LOCATED. OTSEGO COUNTY - POPULATION 61,709, DELAWARE COUNTY - POPULATION 47,276, HERKIMER COUNTY - POPULATION 64,508, SCHOHARIE COUNTY - POPULATION 32,099 (ACCORDING TO THE 2012 U.S. CENSUS ESTIMATES). A)BASSETT - AN ACUTE CARE INPATIENT TEACHING FACILITY, AN OUTPATIENT PRIMARY AND SPECIALTY CARE CENTER, A REGIONAL NETWORK OF 26 COMMUNITY BASED OUTPATIENT HEALTH CENTERS, 19 SCHOOL BASED HEALTH CENTERS, TWO AMBULATORY SURGERY CENTERS AND A FULLY SALARIED MEDICAL STAFF IN COOPERSTOWN, OTSEGO COUNTY B)O'CONNOR HOSPITAL - CRITICAL ACCESS HOSPITAL IN DELHI, DELAWARE COUNTY C)COBLESKILL REGIONAL HOSPITAL - ACUTE CARE FACILITY IN COBLESKILL, SCHOHARIE COUNTY D)LITTLE FALLS HOSPITAL - CRITICAL ACCESS HOSPITAL IN LITTLE FALLS, HERKIMER COUNTY E)TRI-TOWN REGIONAL HOSPITAL - 24/7 EMERGENCY CARE FACILITY IN SIDNEY, DELAWARE COUNTY F)A.O. FOX MEMORIAL HOSPITAL - ACUTE CARE FACILITY IN ONEONTA, OTSEGO COUNTY G)VALLEY HEALTH SERVICES - RESIDENTIAL HEALTH CARE AND REHABILITATION FACILITY H)AT HOME CARE - CERTIFIED HOME CARE AGENCY I)FIRST COMMUNITY CARE OF BASSETT - MEDICAL SUPPLY COMPANY ALL THE ABOVE (A-I) MAKE UP THE BASSETT HEALTHCARE NETWORK AND PROVIDE HEALTH SERVICES TO THIS SEVEN COUNTY REGION IN CENTRAL NEW YORK.
PART VI, LINE 7 - STATE FILING OF COMMUNITY BENEFIT REPORT	NEW YORK

Schedule H (Form 990) 2014

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.
lBullet

Information about Schedule I (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public
Inspection

Name of the organization
MARY IMOGENE BASSETT HOSPITAL

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 Domestic Organizations and Domestic Governments. 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 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

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) 2014

Page 2

Part III

Grants and Other Assistance to Domestic Individuals. 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. Provide the information required in Part I, line 2, Part III, column (b), and any other additional information.

Return Reference	Explanation

Schedule I (Form 990) 2014

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, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Information about Schedule J (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public Inspection

Name of the organization

MARY IMOGENE BASSETT HOSPITAL

Employer identification number

13-5596796

Part I

Questions Regarding Compensation

Yes

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

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

Travel for companions Payments for business use of personal residence

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

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

If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all 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
directors, trustees, officers, including 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? .........

Yes

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), 501(c)(4), and 501(c)(29) organizations 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) 2014

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 in column(B) 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)
1WILLIAM STRECK MD JAN - JUNPRESIDENT & CEO	(i) (ii)	995,346 ...............................	52,689 ...............................	1,001,077 ...............................	22,490 ...............................	2,422 ...............................	2,074,024 ...............................	...............................
2VANCE M BROWN MD JUN - DECPRESIDENT, CEO	(i) (ii)	379,167 ...............................	50,000 ...............................	1,308 ...............................	...............................	1,343 ...............................	431,818 ...............................	...............................
3STEVEN HENEGHAN MDCCO	(i) (ii)	608,550 ...............................	...............................	4,896 ...............................	23,920 ...............................	6,870 ...............................	644,236 ...............................	...............................
4NICHOLAS J NICOLETTACORPORATE VP & CFO	(i) (ii)	471,310 ...............................	5,175 ...............................	...............................	23,920 ...............................	5,570 ...............................	505,975 ...............................	...............................
5BERTINE MCKENNA PHDEXECUTIVE VP & CFO	(i) (ii)	463,000 ...............................	...............................	302 ...............................	21,320 ...............................	5,722 ...............................	490,344 ...............................	...............................
6SUE E ANDREWSVP FINANCE & CFO	(i) (ii)	212,075 ...............................	...............................	...............................	17,452 ...............................	4,105 ...............................	233,632 ...............................	...............................
7KIRAN R NAKKALA MDATTENDING PHYSICIAN	(i) (ii)	671,283 ...............................	2,810 ...............................	5,549 ...............................	13,987 ...............................	...............................	693,629 ...............................	...............................
8DHANANJAI MENZIES MDATTENDING PHYSICIAN	(i) (ii)	616,077 ...............................	150 ...............................	...............................	18,720 ...............................	4,690 ...............................	639,637 ...............................	...............................
9WT HUNTSMAN MDATTENDING PHYSICIAN	(i) (ii)	532,565 ...............................	12,560 ...............................	...............................	23,920 ...............................	3,770 ...............................	572,815 ...............................	...............................
10JAMES C PETERS MDATTENDING PHYSICIAN	(i) (ii)	508,500 ...............................	10,000 ...............................	1,598 ...............................	23,920 ...............................	5,602 ...............................	549,620 ...............................	...............................
11JOHN A LEON MDATTENDING PHYSICIAN	(i) (ii)	483,650 ...............................	210 ...............................	...............................	23,920 ...............................	6,450 ...............................	514,230 ...............................	...............................

Schedule J (Form 990) 2014

Page 3

Part III

Supplemental Information

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.

Return Reference	Explanation
SCHEDULE J, PAGE 1, PART I, LINE 4	W.T. HUNTSMAN, MD 0 103,005 0 JAMES C PETERS, MD 0 21,553 0 JOHN A LEON, MD 0 104,238 0
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
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 : 152,886

Schedule J (Form 990) 2014

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

Information about Schedule K (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public
Inspection

Name of the organization
MARY IMOGENE BASSETT HOSPITAL

Employer identification number
13-5596796

Part I

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	OTSEGO 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 . . . . . . . . . . . . . .	1,330,000		2,580,000
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 . . . . . . . . . . . .	2011		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) 2014

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? . . . . . . . . . . . . .
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, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? . .		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 "Yes" to 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 the hedge terminated? . . . . . .

Schedule K (Form 990) 2014

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
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?

Part VI

Supplemental Information. Provide additional information for responses to questions on Schedule K (see instructions).

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

Schedule K (Form 990) 2014

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

Information about Schedule L (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public Inspection

Name of the organization

MARY IMOGENE BASSETT HOSPITAL

Employer identification number

13-5596796

Part I

Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and 501(c)(29) 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 Benefiting 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) 2014

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	643,198	INVESTMENT MGMT FEES		No
(2) JANE HAMILTON	PART V	87,787	WAGES		No

Part V

Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).

Return Reference	Explanation
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) 2014

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 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public
Inspection

Name of the organization

MARY IMOGENE BASSETT HOSPITAL

Employer identification number

13-5596796

Return Reference	Explanation
FORM 990, PAGE 2, PART III, LINE 4B	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.
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
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.
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.
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.
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 BOARD TO THE DISCRETION OF THE OFFICERS.
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.
FORM 990, PART XI, LINE 9	POST RETIREMENT BENEFIT CHANGE -1,528,952 CHANGE IN INTEREST AT FRIENDS OF BASSETT 649,687 BAD DEBT -13,417,776 CHARITY CARE -4,338,634 BAD DEBT 13,417,776 CHARITY CARE 4,338,634

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2014

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" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

Information about Schedule R (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public Inspection

Name of the organization

MARY IMOGENE BASSETT HOSPITAL

Employer identification number

13-5596796

Part I

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

(a) Name, address, and EIN (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" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled 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) 2014

Page 2

Part III

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

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

Part IV

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(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) 2014

Page 3

Part V

Transactions With Related Organizations Complete if the organization answered "Yes" on 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 related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved

Schedule R (Form 990) 2014

Page 4

Part VI

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

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

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

Schedule R (Form 990) 2014

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R (see instructions).

Return Reference	Explanation

Schedule R (Form 990) 2014

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	21
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	19
5	Total number of individuals employed in calendar year 2014 (Part V, line 2a) ......	5	4,192
6	Total number of volunteers (estimate if necessary) .............	6	180
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	103,473
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b	9,063

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	7,552,591	9,582,444
9	Program service revenue (Part VIII, line 2g) .........	434,777,316	457,667,852
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	6,321,582	4,079,368
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	2,542,241	14,880,065
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	451,193,730	486,209,729
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	40,169	33,708
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)	254,984,578	275,640,823
16a	Professional fundraising fees (Part IX, column (A), line 11e).....		0
b	Total fundraising expenses (Part IX, column (D), line 25) 958,960
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	188,964,243	192,410,027
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	443,988,990	468,084,558
19	Revenue less expenses. Subtract line 18 from line 12.......	7,204,740	18,125,171
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	381,751,472	388,641,152
21	Total liabilities (Part X, line 26).............	118,508,278	127,954,872
22	Net assets or fund balances. Subtract line 21 from line 20.....	263,243,194	260,686,280

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 370,440,261 including grants of $ 33,708 ) (Revenue $ 457,667,852 )
	INPATIENT AND OUTPATIENT SERVICES PROVIDED TO OUR PATIENTS RESULTED IN: 12,585 HOSPITALIZATIONS (INCLUSIVE OF OPEN HEART SURGERIES) 52,191 PATIENT DAYS 718,327 CLINIC VISITS 25,357 RENAL TREATMENTS 9,623 SURGICAL CASES

4b	(Code: ) (Expenses $ 4,338,634 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 2014, WE PROVIDED 4,338,634 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.

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












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses374,778,895

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	7,089,847	260,113

				(A) Total revenue	(B) Related or exempt function revenue	(C) Unrelated business revenue	(D) Revenue excluded from tax under sections 512-514
1a	Federated campaigns..1a
b	Membership dues....1b
c	Fundraising events....1c
d	Related organizations...1d		2,657,183
e	Government grants (contributions)1e		6,429,888

f	All other contributions, gifts, grants, and similar amounts not included above1f		495,373

g	Noncash contributions included in lines 1a-1f:$
h	Total. Add lines 1a-1f.......			9,582,444
			Business Code
2a	DIRECT PATIENT SERVICES		900099	413,732,282	413,732,282
b	OTHER PROGRAM SERVICE REVENUE		900099	43,935,570	43,935,570
c
d
e
f	All other program service revenue .
g	Total. Add lines 2a–2f........			457,667,852
3	Investment income (including dividends, interest, and other similar amounts).......			1,113,556			1,113,556
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	9,912,492	2,032,524
b	Less: cost or other basis and sales expenses	6,961,403	2,017,801
c	Gain or (loss)	2,951,089	14,723
d	Net gain or (loss)..........			2,965,812		87,014	2,878,798
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	PARTNERSHIP INCOME			14,896,725			14,896,725
b	PARTNERSHIP INCOME		621500	16,459		16,459
c	INVESTMENT IN JOINT VENTURE		621610	-33,119			-33,119
d	All other revenue ....
e	Total. Add lines 11a–11d ......			14,880,065
12	Total revenue. See Instructions......			486,209,729	457,667,852	103,473	18,855,960


				(A) Beginning of year		(B) End of year
1	Cash–non-interest-bearing .............			17,119,485	1	13,034,358
2	Savings and temporary cash investments .........				2
3	Pledges and grants receivable, net ...........			15,038,626	3	13,170,733
4	Accounts receivable, net .............			45,505,475	4	46,500,672
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 ..............			3,691,605	8	3,505,567
9	Prepaid expenses and deferred charges ..........			2,691,819	9	3,037,657
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	431,197,284
b	Less: accumulated depreciation .....	10b	268,762,097	154,577,061	10c	162,435,187
11	Investments—publicly traded securities ..........			83,073,005	11	80,810,427
12	Investments—other securities. See Part IV, line 11 .....			51,538,571	12	58,055,351
13	Investments—program-related. See Part IV, line 11 .....				13
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........			8,515,825	15	8,091,200
16	Total assets. Add lines 1 through 15 (must equal line 34)......			381,751,472	16	388,641,152
17	Accounts payable and accrued expenses .........			42,674,294	17	50,143,147
18	Grants payable .................				18
19	Deferred revenue ................				19
20	Tax-exempt bond liabilities .............			52,525,000	20	49,160,000
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 ..			19,774,825	23	28,651,725
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....................			3,534,159	25
26	Total liabilities. Add lines 17 through 25.........			118,508,278	26	127,954,872
	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............			183,528,504	27	184,415,074
28	Temporarily restricted net assets ...........			65,833,180	28	61,908,167
29	Permanently restricted net assets ...........			13,881,510	29	14,363,039
	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 ...........			263,243,194	33	260,686,280
34	Total liabilities and net assets/fund balances ........			381,751,472	34	388,641,152