2023-11-14T14:07:56-06:00 2022-12-31 161226221 FUSTCHARLES LLP 220 S WARREN STREET SYRACUSE NY 13202 990 2022-01-01 150548010 COMMUNITY MEMORIAL HOSPITAL INC COMM 3158246550 150 BROAD STREET HAMILTON NY 13346 JASON LIEBEL VP OF FINANCE 3158246550 2023-11-02 1 JASON LIEBEL 999009999 0 THOMAS J GIUFRE P00841958 3154463600 2023-11-02 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z JASON LIEBEL 150 BROAD STREET HAMILTON NY 13346 63920787 0 X COMMUNITYMEMORIAL.ORG X 1949 NY COMMUNITY MEMORIAL HOSPITAL'S PRIMARY EXEMPT PURPOSE IS TO PROVIDE EMERGENCY AND INPATIENT CARE TO THE GENERAL POPULATION WITHOUT REGARD TO ABILITY TO PAY. 15 14 503 13 0 0 10121370 8346504 47485071 53684078 -68736 -47574 1612971 1841836 59150676 63824844 0 0 0 0 25294265 28502843 0 0 0 26509581 29273980 51803846 57776823 7346830 6048021 42387238 37308811 30493816 15807779 11893422 21501032 X COMMUNITY MEMORIAL HOSPITAL'S PRIMARY EXEMPT PURPOSE IS TO PROVIDE EMERGENCY AND INPATIENT CARE TO THE GENERAL POPULATION WITHOUT REGARD TO ABILITY TO PAY. 0 0 19972199 15780109 OPERATION OF A CRITICAL ACCESS HOSPITALBEDS 25PATIENT DAYS OF CARE 7,070ADMISSIONS 1,792COMMUNITY MEMORIAL HOSPITAL HAS RECEIVED MANY AWARDS FOR OUTSTANDING CARE TO INCLUDE: 1) A LEADER IN UPSTATE NEW YORK IN PATIENT SATISFACTION.2) JUDGED OUTSTANDING IN PATIENT CARE AND PATIENT SAFETY BY BOTH STATE AND FEDERAL SURVEYORS. IT IS A 4-STAR RATED HOSPITAL FOR CMS PATIENT SATISFACTION RATING SYSTEM.3) HEALTHGRADES MULTI-YEAR 5 STAR RATING IN ORTHOPEDIC SURGERY FOR KNEE REPLACEMENTS. 4) EXCELLUS AWARD FOR COMBINED CLINICAL PROCESS AND SURGICAL CARE IMPROVEMENT.5) JOINT COMMISSION RECOGNITION AS TOP PERFORMER IN QUALITY MEASURES.COMMUNITY MEMORIAL HOSPITAL STRIVES TO IMPROVE THE HEALTH OF THE COMMUNITY BY:1) PARTICIPATING IN LOCAL HEALTH FAIRS.2) IMPROVING ACCESS TO PRIMARY CARE.3) IMPROVING THE CARE OF CHRONIC ILLNESSES SUCH AS DIABETES.4) IMPROVING MENTAL HEALTH SERVICES THROUGH THE INTEGRATION OF BEHAVIORAL HEALTH IN CLINIC.5) INCREASING ACCESS TO SPECIALTY SERVICES.6) FREE COUNSELING ON THERAPEUTIC DIETS AND WEIGHT RELATED ISSUES.7) OFFERING A PRE-DIABETIC COACHING COURSE ON DIET, EXERCISE AND OTHER WAYS TO ELIMINATE CHANCES OF BECOMING A FULL-BLOWN DIABETIC. COMMUNITY MEMORIAL HOSPITAL HAS A CHARITY CARE PROGRAM FOR PATIENTS WHO CANNOT AFFORD TO PAY HOSPITAL BILLS AND FALL WITHIN THE NATIONAL POVERTY GUIDELINES, UP TO 375% OF THE POVERTY GUIDELINES. IN 2022 COMMUNITY MEMORIAL HOSPITAL PROVIDED CHARITY CARE IN THE AMOUNT OF $364,214 TO APPROXIMATELY 896 PATIENTS.) 11769125 22374225 OPERATION OF EMERGENCY SERVICES AND OUTPATIENT REFERRED AMBULATORY TESTINGEMERGENCY ROOM VISITS 12,071REFERRED AMBULATORY VISITS 39,476 10812586 8075508 OPERATION OF PRIMARY CARE CLINICSTOTAL VISITS 42,062 8297135 8923751 OPERATION OF AN AMBULATORY SURGERY UNITTOTAL VISITS 2,467 8297135 8923751 50851045 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 32 0 1 503 0 0 0 0 0 0 0 0 0 0 0 0 0 X 15 14 1 0 1 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X COMMUNITY MEMORIAL HOSPITAL 3158246550 150 BROAD STREET HAMILTON NY 13346 RICHARD RUSSELL TRUSTEE 1.00 X X 0 0 0 MARY BRUNDAGE TRUSTEE 1.00 X 0 0 0 RICHARD COHEN MD TRUSTEE 1.00 X 0 0 0 LAURA JACK TRUSTEE 1.00 X 0 0 0 WILLIAM GETMAN TRUSTEE 1.00 X 0 0 0 PAUL KRONENBERG MD TRUSTEE 1.00 X 0 0 0 SETH KRONENBERG MD TRUSTEE 1.00 X 0 0 0 DAVID ROGERS TRUSTEE 1.00 X 0 0 0 MARK CURTIS TRUSTEE 1.00 X 0 0 0 JANE PINCHIN TRUSTEE 1.00 X 0 0 0 ROBERT TYBURSKI TRUSTEE 1.00 X 0 0 0 SUNNY NELSON MD TRUSTEE 40.00 X 199861 0 29679 JEFFERY COAKLEY PRESIDENT 40.00 X X 400884 0 2200 RAYMOND MEEKS MD SECRETARY 1.00 X X 0 0 0 DAVE REBUCK TRUSTEE 1.00 X 0 0 0 ANNE CLAUSS TRUSTEE 1.00 X 0 0 0 ELLEN P KRALY TRUSTEE 1.00 X 0 0 0 BRADFORD WHELER TREASURER 1.00 X 0 0 0 MICHAEL LATREILLE TRUSTEE 1.00 X 0 0 0 EVE ANN SCHWARTZ CHAIRPERSON 1.00 X X 0 0 0 SAMANTHI MARTINEZ TRUSTEE 1.00 X 0 0 0 JOANN BORFITZ VICE CHAIRPERSON 1.00 X X 0 0 0 MICHAEL CALOGERO VP OF FINANCE - DEPARTED 7/17/22 1.00 X 81499 0 14827 JASON LIEBEL CONTROLLER/VP OF FINANCE - 5/23/22 40.00 X 79544 0 14692 MICHAEL WALSH PHYSICIAN 40.00 X 360910 0 33939 MARTIN ERNITS PHYSICIAN 40.00 X 291766 0 34137 KAREEM HAMAD PHYSICIAN 40.00 X 311406 0 10750 MATTHEW MCKAY PHYSICIAN 40.00 X 254998 0 0 AVNEET SINGH PHYSICIAN 40.00 X 513285 0 25437 2494153 0 165661 57 0 1 0 CROUSE HEALTH HOSPITAL INC 736 IRVING AVE SYRACUSE NY 13210 MGMT, CLINICAL, & IT 2651550 CENTREX CLINICAL LABS INC 28 CAMPION RD NEW HARTFORD NY 13413 LABORATORY SERVICES 2216148 THE HAYNER HOYT CORPORATION 625 ERIE BLVD WEST SYRACUSE NY 13204 CONSTRUCTION SERVICES 848211 PRACTICE RESOURCES LLC 100 W FAYETTE STR SUITE 400 SYRACUSE NY 13204 CLINICAL SERVICES 563282 AMERICAN ANESTHESIOLOGY PO BOX 936824 ATLANTA GA 31193 MEDICAL SERVICES 529721 11 8237075 109429 8346504 REFERRED AMBULATORY 621990 22374225 22374225 INPATIENT 622110 15780109 15780109 AMBULATORY SURGERY 621990 8923750 8923750 CLINIC 621110 6605994 6605994 53684078 21243 21243 94228 25323 68905 68905 68905 1803 70620 -68817 -68817 -68817 340B REVENUE 900099 1469514 1469514 CAFETERIA SALES 900099 34531 34531 268886 268886 1772931 63824844 55153592 0 324748 823186 229540 593646 22335216 20356875 1978341 918214 824682 93532 2751055 2507380 243675 1675172 1490932 184240 129702 129702 191201 191201 14608 14608 2370619 2117657 252962 337277 130454 206823 473565 140933 332632 1542581 660913 881668 633528 618654 14874 40566 18022 22544 92043 92043 2852536 2682601 169935 670678 670678 SUPPLIES 10386177 10386177 PURCHASED SERVICES 8331893 6822543 1509350 PROVISION FOR BAD DEBTS 890013 890013 316993 210948 106045 57776823 50851045 6925778 0 14210251 8820111 5020867 5543256 858720 629481 1208132 1263858 55170381 35247375 19654138 19923006 1435130 1129099 42387238 37308811 10285367 7654455 3584701 0 3589901 1645446 13033847 6507878 30493816 15807779 X 11143422 20751032 750000 750000 11893422 21501032 42387238 37308811 X 6048021 -11824 3571413 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 1 11888 0 0 1 0 0 11888 0 PART II-B, LINE 1: COMMUNITY MEMORIAL HOSPITAL HAS LIMITED LOBBYING ACTIVITIES. SEVERAL ACTIVITIES ARE CONDUCTED ON BEHALF OF THE ORGANIZATION THROUGH MEMBERSHIP IN THE IROQUOIS HEALTHCARE ALLIANCE AND HEALTHCARE ASSOCIATION OF NYS. THESE ACTIVITIES INCLUDE ADVERTISEMENTS AND CONTACT WITH THE LEGISLATORS ON VARIOUS HEALTHCARE ISSUES. IROQUOIS HEALTHCARE ALLIANCE - MEMBERSHIP DUES $7,724 OF WHICH $4,016 WAS FOR LOBBYING. HEALTHCARE ASSOCIATION OF NYS - MEMBERSHIP DUES $21,311 OF WHICH $2,570 WAS FOR LOBBYING. AHA-MEMBERSHIP DUES $20,031 OF WHICH $5,302 WAS FOR LOBBYING. 3063566 479697 -310239 725 66047 3166252 1380696 1534889 178761 593 30187 3063566 654422 739279 100604 65769 47840 1380696 2084312 371164 168817 1919963 49908 654422 2029066 300177 -78109 83183 83639 2084312 0.17300 0.82700 0 1 1 62115 62115 32031791 18158870 13872921 28584 28584 0 20013437 15841774 4171663 3034454 1218147 1816307 19923006 ACCRUED RETIREMENT OBLIGATIONS, NET 4122356 OTHER LONG-TERM LIABILITIES 906462 ESTIMATED 3RD PARTY PAYABLE, NET 1479060 6507878 X PART V, LINE 4: ENDOWMENT FUNDS ARE USED TO FURTHUR THE HOSPITAL'S TAX EXEMPT PURPOSE, SUCH AS FOR THE PURCHASE OF CAPITAL ASSETS. PART X, LINE 2: THE HOSPITAL IS A NOT-FOR-PROFIT CORPORATION AND HAS BEEN RECOGNIZED AS TAX-EXEMPT PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. AS OF DECEMBER 31, 2022 AND 2021, THE HOSPITAL DID NOT HAVE ANY UNRECOGNIZED TAX BENEFITS OR ANY RELATED ACCRUED INTEREST OR PENALTIES. THE TAX YEARS OPEN TO EXAMINATION BY FEDERAL AND STATE TAXING AUTHORITIES ARE 2019 THROUGH 2022. THE HOSPITAL DOES NOT ANTICIPATE THAT THE TOTAL UNRECOGNIZED TAX BENEFITS WILL CHANGE IN THE NEXT TWELVE MONTHS. 1 1 1 X 1 X 0 1 1 0 1 1 303899 185598 118301 0.00210 8031855 5035353 2996502 0.05270 8335754 5220951 3114803 0.05480 116087 89383 26704 0.00050 116087 89383 26704 0.00050 8451841 5310334 3141507 0.05530 1 890013 751577 9930256 12549943 -2619687 X 1 1 1 1 COMMUNITY MEMORIAL HOSPITAL INC 150 BROAD ST HAMILTON NY 13346 WWW.COMMUNITYMEMORIAL.ORG X X X X COMMUNITY MEMORIAL HOSPITAL INC 1 0 0 1 X X X X X X X X 22 1 1 1 1 X WWW.COMMUNITYMEMORIAL.ORG X WWW.HEALTHYMADISONCOUNTY.ORG X 1 22 1 WWW.COMMUNITYMEMORIAL.ORG 0 1 X 150.000000000000 400.000000000000 X X X X 1 1 X X X 1 X WWW.COMMUNITYMEMORIAL.ORG X WWW.COMMUNITYMEMORIAL.ORG X WWW.COMMUNITYMEMORIAL.ORG X X X X X X X 1 X 0 X X X X 1 X 0 0 COMMUNITY MEMORIAL HOSPITAL, INC PART V, SECTION B, LINE 5: COMMUNITY MEMORIAL HOSPITAL PARTNERED WITH MADISON COUNTY DEPARTMENT OF HEALTH (MCDOH), ONEIDA HEALTH, AND THE MADISON COUNTY RURAL HEALTH COUNCIL, INC. TO COMPLETE THE COMMUNITY HEALTH ASSESSMENT AND IMPROVEMENT PLAN PROCESS. REPRESENTATIVES FROM THE FOUR AGENCIES COMPRISED THE 2022-2024 STEERING COMMITTEE. THE COMMUNITY HEALTH ASSESSMENT AND IMPROVEMENT PLAN OUTLINES THE CURRENT HEALTH STATUS OF RESIDENTS AND IDENTIFIES A COMPREHENSIVE PLAN FOR ADDRESSING HEALTH CHALLENGES. THE PROCESS WAS UNDERTAKEN IN ALIGNMENT WITH THE 2019-2024 NEW YORK STATE PREVENTION AGENDA1, WHICH IDENTIFIES FIVE PRIORITY AREAS FOR HEALTH IMPROVEMENT: PREVENT CHRONIC DISEASES PROMOTE WELL-BEING AND PREVENT MENTAL AND SUBSTANCE USE DISORDERS PROMOTE A HEALTHY AND SAFE ENVIRONMENT PROMOTE HEALTHY WOMEN, INFANTS, AND CHILDREN PREVENT COMMUNICABLE DISEASES COMMUNITY MEMORIAL HOSPITAL, INC PART V, SECTION B, LINE 6A: THE OTHER HOSPITAL THAT PARTICIPATED WAS ONEIDA HEALTHCARE. COMMUNITY MEMORIAL HOSPITAL, INC PART V, SECTION B, LINE 6B: PLEASE SEE LINE 5 EXPLANATION. COMMUNITY MEMORIAL HOSPITAL, INC PART V, SECTION B, LINE 11: THE 2022 CHA INTEGRATED RESULTS FROM THE PREVIOUS ASSESSMENTS WITH AN UPDATED COMMUNITY HEALTH STATUS ASSESSMENT. RESULTS OF THE REVISED CHA WERE PRESENTED TO THE STEERING COMMITTEE MEMBERS IN APRIL 2022 FOR THE SELECTION OF PRIORITY AREAS. A FACILITATED DISCUSSION LED TO THE DECISION TO FOCUS ON THE FOLLOWING PRIORITY AREAS: 1. PREVENT CHRONIC DISEASES 2. PROMOTE WELL-BEING AND PREVENT MENTAL AND SUBSTANCE USE DISORDERS TO PROMOTE ACTIVE COLLABORATION WITH COMMUNITY ORGANIZATIONS, THE STEERING COMMITTEE CONVENED PRIORITY AREA WORKGROUPS WITH REPRESENTATIVES FROM LOCAL ORGANIZATIONS. WORKGROUPS SELECTED GOALS, OBJECTIVES, AND EVIDENCE-BASED STRATEGIES TO ADDRESS PRIORITY AREAS. COMMUNITY MEMORIAL HOSPITAL WORKED CLOSELY WITH THE MADISON COUNTY PUBLIC HEALTH DEPARTMENT, AND ONEIDA HEALTHCARE. WE SELECTED PRIORITIES THAT COULD REACH THE MOST PEOPLE AND COULD HAVE THE MOST IMPACT, IDENTIFYING TWO PRIORITIES: PROMOTE WELL-BEING AND PREVENT MENTAL AND SUBSTANCE USE DISORDERS AND PREVENTION OF CHRONIC DISEASETHE IDENTIFIED GOALS RELATED TO SUBSTANCE ABUSE INCLUDE 1) ESTABLISH COLLABORATIVE CARE MODEL IN PRIMARY CARE SETTINGS COMMUNITY MEMORIAL HOSPITAL IS DEVELOPING AND IMPLEMENTING A NETWORK OF LOCAL HEALTHCARE PROVIDERS, PUBLIC HEALTH ENTITIES, AND COMMUNITY NONPROFIT ORGANIZATIONS TO ENHANCE AND SUSTAIN THE DELIVERY OF COMMUNITY-BASED, BEHAVIORAL HEALTH CARE SERVICES TO RURAL AND UNDERSERVED POPULATIONS IN CENTRAL NEW YORK. PARTNER AGENCIES: MADISON COUNTY MENTAL HEALTH DEPARTMENT, FAMILY COUNSELING SERVICES OF CORTLAND COUNTY AND THE MADISON COUNTY COUNCIL ON ALCOHOLISM AND SUBSTANCE ABUSE, INC. (BRIDGES). 2) EXPAND COMMUNITY ACCESS TO NALOXONE COMMUNITY MEMORIAL HOSPITAL IS PARTNERING WITH BRIDGES TO ENSURE THAT WE HAVE NALOXONE TO PROVIDE TO PATIENTS PRESCRIBED NARCOTICS IN PRIMARY CARE, THOSE DISCHARGED FROM THE HOSPITAL, AND THOSE PATIENTS WHO VISIT THE EMERGENCY DEPARTMENT. IDENTIFIED GOALS RELATED TO PREVENTION OF CHRONIC DISEASE INCLUDE 1) IMPROVING ACCESS TO CARE COMMUNITY MEMORIAL HOSPITAL IS ACTIVELY RECRUITING FAMILY PRACTICE PROVIDERS TO INCREASE ACCESS TO CARE. COMMUNITY MEMORIAL HOSPITAL, INC PART V, SECTION B, LINE 16J: A MESSAGE IS PRINTED ON PATIENTS' BILLS THAT STATES "COMMUNITY MEMORIAL HOSPITAL OFFERS A FINANCIAL ASSISTANCE PROGRAM. FOR MORE INFO PLEASE CALL 315-824-6552 OR 315-824-6553 OR GO TO WWW.COMMUNITYMEMORIAL.ORG" COMMUNITY MEMORIAL HOSPITAL, INC PART V, SECTION B, LINE 20E: PATIENTS THAT ARE SELFPAY ON ADMISSION ARE SEEN BY THE FINANCIAL COUNSELING DEPARTMENT AND THE FINANCIAL ASSISTANCE PROGRAM IS DISCUSSED AND AN APPLICATION IS GIVEN. SELF PAY PATIENTS RECEIVING OUTPATIENT SERVICES ARE CALLED TO ADVISE THEM OF OUR POLICY BEFORE SERVICE IS SCHEDULED OR AFTER SERVICE IS RENDERED. 5 1 - COMMUNITY MEMORIAL HOSPITAL FHC 164 BROAD ST HAMILTON NY 13346 PRIMARY CARE PHYSICIAN OFFICE 2 - COMMUNITY MEMORIAL HOSPITAL FHC 3460 SOUTH ST MORRISVILLE NY 13408 PRIMARY CARE PHYSICIAN OFFICE 3 - COMMUNITY MEMORIAL HOSPITAL FHC 117 WEST MAIN ST WATERVILLE NY 13480 PRIMARY CARE PHYSICIAN OFFICE 4 - COMMUNITY MEMORIAL HOSPITAL FHC 4180 SOUTH MAIN ST MUNNSVILLE NY 13409 PRIMARY CARE PHYSICIAN OFFICE 5 - COMMUNITY MEMORIAL HOSPITAL FHC 3045 JOHN TRUSH BLVD CAZENOVIA NY 13035 PRIMARY CARE PHYSICIAN OFFICE PART I, LINE 7: LINE 7A - A COST-TO-CHARGE RATIO WAS USED, DERIVED FROM WORKSHEET 2LINE 7B - A COST-TO-CHARGE RATIO WAS USED, DERIVED FROM WORKSHEET 2.LINE 7E - WE USED OUR ACTUAL EXPENSES AND ACTUAL REVENUE FROM OUR WELLNESS CENTER AND HEALTHY LIVING PROGRAM, EXPENSES ASSOCIATED WITH NURSING TIME SPENT FOR CERTAIN PROGRAMS, AND EXPENSES FOR DIETARY COUNSELING. PART I, LN 7 COL(F): BAD DEBT EXPENSE OF $890,013 WAS SUBTRACTED FROM FORM 990, PART IX, LINE 25, COLUMN A. PART III, LINE 2: LINE 2 METHODOLOGY- THE HOSPITAL ESTIMATES BAD DEBT EXPENSE BASED ON HISTORICAL EXPERIENCE EXPRESSED AS A PERCENTAGE OF CURRENT YEAR GROSS REVENUE. PART III, LINE 3: LINE 3 METHODOLOGY- THE APPROVAL PERCENTAGE OF 81.26% ON ALL PATIENTS WHO APPLIED FOR CHARITY CARE IN 2022 WAS MULTIPLIED BY THE AMOUNT ON LINE 2. THE RATIONAL BEING THAT THAT % WOULD HOLD ACROSS ALL OF OUR BAD DEBTS EXPENSE IF THOSE PATIENTS HAD APPLIED FOR CHARITY CARE. WE DID NOT INCLUDE BAD DEBT AMOUNTS IN COMMUNITY BENEFITS. BAD DEBTS EXPENSE IS NET OF DISCOUNTS AND PAYMENTS. PART III, LINE 4: SEE PAGE 12 OF ATTACHED FINANCIAL STATEMENTS. PART III, LINE 8: FOR LINE 6 - THE HOSPITAL DETERMINED MEDICARE ALLOWABLE COSTS BY MULTIPLYING THE RATIO OF PATIENT CARE COST TO CHARGES DERIVED FROM WORKSHEET 2 BY THE TOTAL MEDICARE CHARGES REPORTED IN THE 2022 MEDICARE COST REPORT.THE SHORTFALL OF $2,619,687 ON LINE 7 REPRESENTS UNRECOGNIZED COMMUNITY BENEFIT INHERENT IN PROVIDING MEDICAL CARE TO THE COMMUNITY. OUR UNREIMBURSED COSTS FROM MEDICARE ARE INCURRED BY PROVIDING SERVICES TO OUR RURAL COMMUNITIES THAT HAVE A HIGHER THAN AVERAGE MEDICARE POPULATION, MANY OF WHOM ARE INDIGENT. PART III, LINE 9B: LINE 9B -IN THE COLLECTION POLICY FOR COMMUNITY MEMORIAL HOSPITAL IT STATES THAT APPROVED APPLICATIONS WILL BE HONORED FOR A PERIOD OF TIME IF THE PATIENT RETURNS NEEDING MEDICAL SERVICES AND THE PATIENTS FINANCIAL STATUS HAS NOT CHANGED. PATIENTS WITHOUT INSURANCE ARE APPROVED FOR 3 MONTH COVERAGE PERIOD (MAY REAPPLY FOR COVERAGE IF ADDITIONAL MEDICAL SERVICES) AND PATIENTS WITH INSURANCE ARE APPROVED FOR ONE YEAR. PATIENTS WITH AN APPROVED APPLICATION ON FILE WILL BE IDENTIFIED UPON ADMISSION OR REGISTRATION IN THE HOSPITAL'S PATIENT ACCOUNTING SYSTEM BY PATIENT ACCESS STAFF. PATIENTS MAY ALSO CONTACT FINANCIAL COUNSELING TO NOTIFY THEM THAT AN APPROVED APPLICATION IS ON FILE IF THE APPROPRIATE DISCOUNT IS NOT TAKEN. ADDITIONAL DOCUMENTATION MAY BE REQUIRED TO DETERMINE IF INCOME LEVELS HAVE CHANGED. A NEW APPLICATION WILL BE REQUIRED AT THE END OF EACH COVERED PERIOD. PART VI, LINE 2: COMMUNITY MEMORIAL WAS AN ACTIVE PARTNER WITH THE MADISON COUNTY HEALTH DEPARTMENT, OTHER HEALTH AND HUMAN SERVICE AGENCIES, AND AREA COMMUNITY AND INDUSTRY LEADERS IN PERFORMING AN EXTENSIVE ASSESSMENT OF THE HEALTH NEEDS OF OUR AREA. THE SHARED INFORMATION COLLECTED HAS BEEN USEFUL IN OUR EFFORTS TO PLAN FOR THE CHANGING NEEDS AND DEMOGRAPHICS OF OUR SERVICE AREA POPULATIONS. INFORMATION USED IN OUR PLANNING AND ASSESSMENT IS DERIVED FROM THE FOLLOWING SOURCES: 1) PRIMARY - PATIENT SATISFACTION SURVEYS, BOARD OF DIRECTORS, AUXILIARY MEMBERSHIP, MEDICAL STAFF, AND EMPLOYEES 2)PRIMARY - MADISON COUNTY DEPARTMENT OF HEALTH AND COMMUNITY NEEDS ASSESSMENT PLAN, SECONDARY - CHENANGO COUNTY COMMUNITY NEEDS ASSESSMENT, SPARCS, NYSDOH REPORTS AND DATA SOURCES, PHYSICIAN AND HEALTH SERVICES USAGE DATA BASES, MARKET SHARE AND DEMOGRAPHICS DATA BASES, HEALTHCARE ASSOCIATION OF NYS, AMERICAN HOSPITAL ASSOCIATION, IROQUOIS HEALTH ASSOCIATION, AND VOLUNTARY HOSPITALS OF AMERICA STATISTICAL REPORTS. PART VI, LINE 3: LINE 3 - SIGNS ARE POSTED IN OUR ADMITTING/REGISTRATION AREAS REGARDING OUR POLICY OF PROVIDING SERVICES AT A REDUCED CHARGE OR NO CHARGE TO PATIENTS WHO HAVE FAMILY INCOME BELOW CERTAIN FEDERAL STANDARDS, INCLUDING A PHONE NUMBER TO CALL IN OUR FINANCIAL COUNSELING DEPARTMENT. A SUMMARY OF OUR FINANCIAL ASSISTANCE PROGRAM IS AVAILABLE FOR THEM TO TAKE. PATIENTS THAT ARE SELF PAY ON ADMISSION ARE SEEN BY THE FINANCIAL COUNSELING DEPARTMENT PERSONNEL AND THE FINANCIAL ASSISTANCE PROGRAM IS DISCUSSED AND AN APPLICATION IS GIVEN. PATIENTS THAT RECEIVE OUTPATIENT SERVICES ARE CALLED TO ADVISE THEM OF OUR POLICY BEFORE SERVICE IS SCHEDULED, OR AFTER SERVICE IS RENDERED. A MESSAGE IS AUTOMATICALLY PRINTED ON ALL PATIENT STATEMENTS THAT FINANCIAL ASSISTANCE IS AVAILABLE FOR THOSE WHO QUALIFY, WITH THE PHONE NUMBER TO CALL. OUR FINANCIAL ASSISTANCE PROGRAM POLICY, SUMMARY AND APPLICATION ARE AVAILABLE ON OUR HOSPITAL WEBSITE. PATIENTS ARE MADE AWARE THAT THEY MAY APPLY TO THE COUNTY IN WHICH THEY RESIDE FOR MEDICAID ASSISTANCE. PART VI, LINE 4: COMMUNITY MEMORIAL HOSPITAL IN HAMILTON, NY, SERVES 45,000 PEOPLE IN 27 CENTRAL NEW YORK COMMUNITIES. THE REGION IS NOTED FOR ITS RICH AGRICULTURAL HISTORY AND A STRONG TRADITION OF HIGHER EDUCATION. TODAY, IN ADDITION TO THE DAIRY INDUSTRY, THERE ARE HORSE FARMS, GRASS FED BEEF AND HOMESTEADS PRODUCING ORGANIC FRUITS AND VEGETABLES. COLGATE UNIVERSITY, MORRISVILLE STATE COLLEGE, AND CAZENOVIA COLLEGE OFFER CURRICULUMS THAT ARE RENOWNED NATIONWIDE. THE COMMUNITIES WE SERVE ALSO HAVE A SIGNIFICANT NUMBER OF FRAIL AND POOR ELDERLY, MEDICAID OF ALL AGES AND WORKING POOR. COMMUNITY MEMORIAL HOSPITAL PROVIDES CARE TO ALL OF THESE GROUPS REGARDLESS OF ABILITY TO PAY. THIS APPLIES TO ALL HOSPITAL AND OUTPATIENT SERVICES. COMMUNITY MEMORIAL HOSPITAL HAS A FINANCIAL ASSISTANCE PROGRAM FOR THOSE WHO CANNOT AFFORD TO PAY FOR THEIR HOSPITAL BILLS. PART VI, LINE 5: A MAJORITY OF COMMUNITY MEMORIAL HOSPITAL'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE HOSPITAL'S PRIMARY SERVICE AREA WHO ARE NEITHER EMPLOYEES NOR CONTRACTORS OF THE HOSPITAL, NOR FAMILY MEMBERS. COMMUNITY MEMORIAL EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY. THE HOSPITAL USES SURPLUS FUNDS TO BUY STATE-OF-THE-ART CAPITAL EQUIPMENT, I.E. CARDIAC MONITOR FOR SPECIAL CARE UNIT, PHARMACY COMPUTER SYSTEM, SURGICAL EQUIPMENT, AND ADDITIONAL COMPUTERS/SERVERS.IN 1989, COMMUNITY MEMORIAL HOSPITAL EXPANDED ITS MISSION TO PROVIDE PRIMARY CARE IN THE RURAL COMMUNITIES OF ITS SERVICE AREA. SEVERAL PHYSICIANS HAD RETIRED OR WERE ABOUT TO CLOSE THEIR PRACTICES AND MANY SMALL TOWNS AND VILLAGES WERE LEFT WITHOUT ANY COVERAGE. THE HOSPITAL HAS A NETWORK OF FIVE FAMILY HEALTH CENTERS (IN HAMILTON, CAZENOVIA, MORRISVILLE, MUNNSVILLE AND WATERVILLE). THE HOSPITAL EMPLOYS FOUR FAMILY PRACTICE SPECIALISTS, ONE PEDIATRICIAN, ONE CARDIOLOGIST, ONE GENERAL SURGEON AND NURSE PRACTITIONERS/PHYSICIAN ASSISTANTS. WE ARE ACTIVELY RECRUITING PRIMARY CARE PROVIDERS AND APPROPRIATE SPECIALISTS. ALL PATIENTS WHO COME TO THE FAMILY HEALTH CENTERS ARE SERVED WITHOUT REGARD TO THEIR ABILITY TO PAY. THE HOSPITAL HAS DEVELOPED A SAFETY NET FOR LOW INCOME, UNINSURED AND/OR UNDERINSURED PATIENTS WHILE ENSURING PRIMARY CARE WILL REMAIN AVAILABLE IN RURAL CENTRAL NEW YORK.THE HOSPITAL PROMOTED CAREERS IN THE HEALTH CARE FIELD BY ATTENDING CAREER DAYS AT LOCAL HIGH SCHOOLS AND COLLEGES. THE HOSPITAL OFFERS A PRE-DIABETIC COACHING COURSE ON DIET, EXERCISE AND OTHER WAYS TO ELIMINATE THE CHANCES OF BECOMING A FULL-BLOWN DIABETIC. IN ADDITION, THE HOSPITAL DIETITIAN PROVIDES FREE COUNSELING TO THE COMMUNITY ON THERAPEUTIC DIETS AND WEIGHT RELATED ISSUES. PART VI, LINE 6: COMMUNITY MEMORIAL HOSPITAL'S PASSIVE PARENT AFFILIATE IS CROUSE HOSPITAL. THIS AFFILIATION PROVIDES ADDITIONAL SPECIALTY SERVICES TO THE COMMUNITY MEMORIAL HOSPITAL PATIENT POPULATION. PART VI, LINE 7, REPORTS FILED WITH STATES NY X X X 0 0 0 0 0 0 0 0 0 AVNEET SINGH PHYSICIAN 500101 0 13100 0 84 0 0 0 25437 0 538722 0 0 0 JEFFERY COAKLEY PRESIDENT 370608 0 30000 0 276 0 2200 0 0 0 403084 0 0 0 MICHAEL WALSH PHYSICIAN 321899 0 32120 0 6891 0 9312 0 24627 0 394849 0 0 0 MARTIN ERNITS PHYSICIAN 290099 0 600 0 1067 0 8700 0 25437 0 325903 0 0 0 KAREEM HAMAD PHYSICIAN 290729 0 20600 0 77 0 0 0 10750 0 322156 0 0 0 MATTHEW MCKAY PHYSICIAN 234269 0 20600 0 129 0 0 0 0 0 254998 0 0 0 SUNNY NELSON MD TRUSTEE 150965 0 42395 0 6501 0 4242 0 25437 0 229540 0 0 0 MICHAEL CALOGERO VP OF FINANCE - DEPARTED 7/17/22 81338 0 0 0 161 0 96 0 14731 0 96326 0 0 0 JASON LIEBEL CONTROLLER/VP OF FINANCE - 5/23/22 64495 0 15000 0 49 0 0 0 14692 0 94236 0 0 0 FORM 990, PART VI, SECTION A, LINE 2 PAUL KRONENBERG, MD AND SETH KRONENBERG, MD ARE FATHER AND SON. FORM 990, PART VI, SECTION A, LINE 4 COMMUNITY MEMORIAL HOSPITAL'S BYLAWS WERE AMENDED IN 2022 TO EFFECTUATE THE HOSPITAL'S DISAFFILIATION WITH CROUSE HEALTH SYSTEMS, INC. AND TO MODERNIZE AND UPDATE THE BYLAWS IN COMPLIANCE WITH THE NOT-FOR-PROFIT CORPORATION LAW. THE HOSPITAL SHALL NO LONGER HAVE CLASS A AND CLASS B MEMBERS AND ITS AFFAIRS SHALL BE GOVERNED BY ITS BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11B THE 990 IS PROVIDED TO THE BOARD OF DIRECTORS FOR REVIEW PRIOR TO SUBMISSION TO THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE CEO AND THE PRESIDENT OF THE BOARD OF DIRECTORS REVIEW THE CONFLICT OF INTEREST POLICIES ANNUALLY WITH THE FULL BOARD. ANY POSSIBLE CONFLICTS ARE REVIEWED AND APPROPRIATE ACTION TAKEN. FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION OF THE CEO AND THE VP OF FINANCE IS DETERMINED BY THE BOARD OF DIRECTORS. THE BOARD REVIEWS COMPARATIVE DATA PROVIDED BY HOSPITAL TRADE ORGANIZATIONS SUCH AS HANYS. THE BOARD USES SALARY SURVEYS COMPLETED BY INDEPENDENT CONSULTANTS YAFFE & COMPANY. THE BOARD ALSO REVIEWS SALARIES FOR SIMILAR POSITIONS AT OTHER COMPARABLE HOSPITALS. FORM 990, PART VI, SECTION C, LINE 19 FINANCIAL STATEMENTS ARE FILED WITH THE CHARITIES BUREAU AND ARE PART OF THE PUBLIC RECORD. IN ADDITION, THE ORGANIZATION PROVIDES ALL DOCUMENTS REQUIRED BY THE INTERNAL REVENUE CODE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: RETIREMENT PLAN OBLIGATION CHANGES OTHER THAN NET PERIODIC BENEFIT COSTS 4,042,747. PAYMENT ON BEHALF OF RELATED ORGANIZATION -159,426. OTHER COMPONENTS OF NET PERIODIC BENEFIT COST -311,908. FORM 990, PART XII, LINE 2C THERE WERE NO CHANGES TO THE OVERSIGHT PROCESS OR SELECTION PROCESS DURING THE CURRENT YEAR. COMMUNITY MEMORIAL HOSPITAL FOUNDATION 150 BROAD ST HAMILTON NY 13346 161603283 FUNDRAISING NY 501 C 3 11- TYPE I N/A 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 0 1 0 0