2020-11-06T13:00:30-06:00 2019-12-31 161226221 FUST CHARLES CHAMBERS LLP 5784 WIDEWATERS PARKWAY SYRACUSE NY 13214 990 2019-01-01 150548010 COMMUNITY MEMORIAL HOSPITAL INC COMM 3158247088 150 BROAD STREET HAMILTON NY 13346 JEFF COAKLEY CEO 3158247088 2020-11-06 1 DEBORAH STUCK P01281391 3154463600 2020-11-06 67.242.16.154 2020-11-06 08:24:32 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 6C9B1A35775087DBDB8A6D25ECA509C7F6C27838 2019 2021-01-29 14:40:06Z JEFF COAKLEY 150 BROAD STREET HAMILTON NY 13346 47584088 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. 18 17 420 30 0 0 1722758 4823607 37460419 40497830 -12469 -2787 4109315 2199752 43280023 47518402 0 0 0 0 22205943 23224232 0 0 0 21008794 21931030 43214737 45155262 65286 2363140 22368071 23358956 18009746 19056523 4358325 4302433 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 17431038 15166209 OPERATION OF A CRITICAL ACCESS HOSPITALBEDS 25PATIENT DAYS OF CARE 4,710ADMISSIONS 1,393COMMUNITY 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) SPIRIT OF WOMEN PROGRAM FOCUSING ON WOMEN AND FAMILY HEALTH.7) FREE COUNSELING ON THERAPEUTIC DIETS AND WEIGHT RELATED ISSUES.8) HOSTING A SUMMER "MASH CAMP" FOR AREA STUDENTS WHICH EXPOSES THEM TO A VARIETY OF FACETS IN THE HEALTHCARE FIELD.9) 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 300% OF THE POVERTY GUIDELINES. IN 2019 COMMUNITY MEMORIAL HOSPITAL PROVIDED CHARITY CARE IN THE AMOUNT OF $781,793 TO APPROXIMATELY 1,229 PATIENTS.) 9235448 16779010 OPERATION OF EMERGENCY SERVICES AND OUTPATIENT REFERRED AMBULATORY TESTINGEMERGENCY ROOM VISITS 9,919REFERRED AMBULATORY VISITS 35,798 9213596 6660670 OPERATION OF PRIMARY CARE CLINICSTOTAL VISITS 45,390 3279771 3904591 OPERATION OF AN AMBULATORY SURGERY UNITTOTAL VISITS 1,849 3279771 3904591 39159853 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 21 0 1 420 1 0 0 0 0 0 0 0 0 0 0 0 0 X 18 17 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X COMMUNITY MEMORIAL HOSPITAL 3158247088 150 BROAD STREET HAMILTON NY 13346 MARY BRUNDAGE 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 MATTHEW NORRIS TRUSTEE 1.00 X 0 0 0 DAVID ROGERS TRUSTEE 1.00 X 0 0 0 RICHARD RUSSELL SECRETARY 1.00 X X 0 0 0 LAWRENCE TULLY 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 JANE PINCHIN TRUSTEE 1.00 X 0 0 0 RAYMOND MEEKS MD TRUSTEE 1.00 X 0 0 0 EVE ANN SCHWARTZ VICE CHAIRPERSON 1.00 X X 0 0 0 WILLIAM GETMAN TRUSTEE 1.00 X 0 0 0 MARK CURTIS CHAIRMAN 1.00 X X 0 0 0 ROBERT TYBURSKI TRUSTEE 1.00 X 0 0 0 BRADFORD WHELER TREASURER 1.00 X X 0 0 0 JEFFREY RUBENSTEIN TRUSTEE 1.00 X 0 0 0 SEAN FADALE PRESIDENT/CEO 40.00 X X 289398 0 97745 THOMAS GREEN MD TRUSTEE 1.00 X 0 0 0 JENNIFER MEYERS MD TRUSTEE 40.00 X 235635 0 27023 JOANNE BORFITZ TRUSTEE 1.00 X 0 0 0 CHRISTOPHER GRAHAM CFO 40.00 X 178195 0 27965 MICHAEL WALSH MD PHYSICIAN 40.00 X 319979 0 31711 RAYMOND CARLSON PHYSICIAN 40.00 X 405196 0 31523 MARTIN ERNITS PHYSICIAN 40.00 X 316282 0 10280 HAO LAM PHYSICIAN 40.00 X 272817 0 12175 JOCELYN MORIN PHYSICIAN 40.00 X 260360 0 22408 2277862 0 260830 26 0 1 0 CROUSE HEALTH HOSPITAL INC 736 IRVING AVE SYRACUSE NY 13210 MGMT, CLINICAL, & IT 2819107 THE HAYNER HOYT CORPORATION 625 ERIE BLVD WEST SYRACUSE NY 13204 CONSTRUCTION SERVICES 1832156 CENTREX CLINICAL LABS INC 28 CAMPION RD NEW HARTFORD NY 13413 LABORATORY SERVICES 1280171 DWYER ARCHITECTURAL 120 EAST WASHINGTON ST SUITE 822 SYRACUSE NY 13202 ARCHITECTURAL SERVICES 534131 CENTRAL NEW YORK SURGICAL PC 2202 GENESEE ST UTICA NY 13502 SURGICAL SERVICES & PROGRAM DEVELOPMENT 520750 5 1919963 2903644 4823607 REFERRED AMBULATORY 621990 16779010 16779010 INPATIENT 622110 15166209 15166209 CLINIC 621110 4648020 4648020 AMBULATORY SURGERY 621990 3904591 3904591 40497830 1438 1438 107568 61461 46107 46107 46107 4225 -4225 -4225 -4225 340B REVENUE 900099 2012650 2012650 CAFETERIA SALES 900099 52541 52541 88454 88454 2153645 47518402 42510480 0 184315 855961 262658 593303 17335914 15826308 1509606 839894 752625 87269 2957803 2700238 257565 1234660 1109689 124971 92245 92245 146600 146600 13108 13108 2397146 2176222 220924 92571 31620 60951 330911 103217 227694 1182198 133606 1048592 550919 545776 5143 35925 10700 25225 10029 10029 1826860 1597356 229504 563319 563319 SUPPLIES 8212945 8212945 PURCHASED SERVICES 5300202 4014977 1285225 PROVISION FOR BAD DEBTS 833135 833135 342917 275433 67484 45155262 39159853 5995409 0 4806129 4240665 410501 3551780 3927325 912013 818580 1294658 1023600 44338525 33976242 8926659 10362283 2466331 2986503 22368071 23358956 5507607 6172506 3702923 2884177 8799216 9999840 18009746 19056523 X 4358325 4302433 4358325 4302433 22368071 23358956 X 2363140 9416 -2428448 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 1 13108 0 0 1 0 0 13108 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 $12,558 OF WHICH $4,986 WAS FOR LOBBYING. HEALTHCARE ASSOCIATION OF NYS - MEMBERSHIP DUES $20,334 OF WHICH $3,654 WAS FOR LOBBYING. AHA-MEMBERSHIP DUES $19,160 OF WHICH $4,468 WAS FOR LOBBYING. 2084312 371164 168817 1919963 49908 654422 2029066 300177 -78109 83183 83639 2084312 1660122 227374 148935 12933 -5568 2029066 1318462 300737 63123 -17970 -4230 1660122 1267559 72215 -6551 -22366 7605 1318462 0.83500 0.16500 0 1 1 62115 62115 21304256 16153044 5151212 28584 28584 0 20748200 16705866 4042334 2195370 1088748 1106622 10362283 PROFESSIONAL LIABILITY RESERVE 2075310 OTHER RECEIVABLE 391951 ESTIMATED THIRD PARTY RECEIVABLE, NET 519242 2986503 ACCRUED RETIREMENT OBLIGATIONS, NET 7720191 OTHER LONG-TERM LIABILITIES 2075310 ESTIMATED 3RD PARTY PAYABLE, NET 204339 9999840 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, 2019 AND 2018, 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 2016 THROUGH 2019. 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 332957 218299 114658 0.00260 5889884 4784659 1105225 0.02490 6222841 5002958 1219883 0.02750 156033 67230 88803 0.00200 156033 67230 88803 0.00200 6378874 5070188 1308686 0.02950 1 833135 627282 10850232 11882740 -1032508 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 19 1 1 1 1 X WWW.HEALTHYMADISONCOUNTY.ORG X 1 19 1 WWW.HEALTHYMADISONCOUNTY.ORG 0 1 X 150.000000000000 300.000000000000 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 X 1 X 0 0 COMMUNITY MEMORIAL HOSPITAL, INC PART V, SECTION B, LINE 5: COMMUNITY MEMORIAL HOSPITAL PARTICIPATED IN A COMMUNITY HEALTH IMPROVEMENT PLAN WITH MADISON COUNTY DEPARTMENT OF HEALTH AND ONEIDA HEALTHCARE. OTHER STAKEHOLDERS INCLUDED RESIDENTS, COMMUNITY ORGANIZATIONS, AND LOCAL LEADERS. 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: 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: SUBSTANCE ABUSE AND LUNG CANCER. THE IDENTIFIED GOALS RELATED TO SUBSTANCE ABUSE INCLUDE 1) ADDRESS SUBSTANCE USE AMONG YOUTH, 2) ADDRESS ALCOHOL-RELATED MOTOR VEHICLE INJURIES AND DEATH, 3) ADDRESS SUBSTANCE ABUSE AMONG ADULTS. THE IDENTIFIED GOALS RELATED TO LUNG CANCER INCLUDE 1) INCREASE LUNG CANCER SCREENING RATES, 2) REDUCE IMPACT OF RADON. IT WAS DECIDED THAT THE ESTABLISHMENT OF A COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP) WOULD BE A KEY STRATEGY TO THE SUCCESSFUL IMPLEMENTATION OF THE IDENTIFIED ACTION ITEMS.NOT ALL NEEDS CAN BE A PRIORITY FOR COMMUNITY MEMORIAL HOSPITAL DUE TO FACTORS SUCH AS LIMITED RESOURCES OR THE FACT THAT WE DO NOT PROVIDE SERVICES IN CERTAIN SPECIALTY AREAS. COMMUNITY MEMORIAL HOSPITAL WILL CONTINUE TO PROVIDE HIGH QUALITY HEALTHCARE IN MANY AREAS NOT IDENTIFIED AS PRIORITIES. 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 SPIRIT OF WOMEN 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 $833,135 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 75.29% ON ALL PATIENTS WHO APPLIED FOR CHARITY CARE IN 2019 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: THE FOOTNOTES TO THE FINANCIAL STATEMENTS STATE "THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IS EVALUATED ON A REGULAR BASIS BY MANAGEMENT AND IS BASED UPON MANAGEMENT'S PERIODIC REVIEW OF THE COLLECTIBILITY OF THE RECEIVABLES IN LIGHT OF HISTORICAL EXPERIENCE, THE NATURE AND VOLUME OF THE RECEIVABLES, OR ADVERSE SITUATION THAT MAY AFFECT THE PATIENT OR RESIDENT'S ABILITY TO REPAY AND PREVAILING ECONOMIC CONDITIONS." 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 2019 MEDICARE COST REPORT.THE SHORTFALL OF $1,032,508 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: IN THE COLLECTION POLICY FOR COMMUNITY MEMORIAL HOSPITAL IT STATES THAT APPROVED APPLICATIONS WILL BE HONORED FOR A PERIOD OF ONE YEAR IN THE EVENT A PATIENT RETURNS NEEDING MEDICAL SERVICES AND THE PATIENTS FINANCIAL STATUS HAS NOT CHANGED. 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 YEARLY. 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 2019, 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: SIGNS ARE POSTED IN OUR ADMITTING/REGISTRATION AREA 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 45000 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 PRACTIONERS/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.COMMUNITY MEMORIAL HOSPITAL IS A SPIRIT OF WOMEN PROVIDER FOR MADISON AND SURROUNDING COUNTIES. THIS IS AN OUTREACH PROGRAM DESIGNED TO BRING HEALTH EDUCATION CONCERNING WOMEN AND FAMILY SERVICES TO THE AREAS COMMUMITY MEMORIAL SERVES.IN 2019 COMMUNITY MEMORIAL HOSPITAL PROVIDED FREE BLOOD PRESSURE CHECKS AT A COMMUNITY FARMER'S MARKET. THE HOSPITAL PROMOTED CAREERS IN THE HEALTH CARE FIELD BY ATTENDING CAREER DAYS AT LOCAL HIGH SCHOOLS AND COLLEGES. THE HOSPITAL ALSO HOSTED A "MASH CAMP" DESIGNED TO EXPOSE AREA STUDENTS TO ALL FACETS OF THE HEALTHCARE FIELD. 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 CROUSE HOSPITAL IS A PARTNER IN COMMUNITY MEMORIAL HOSPITAL'S SPIRIT OF WOMEN PROGRAM. THIS AFFILIATION ALSO 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 SEAN FADALE PRESIDENT/CEO 289398 0 0 0 0 0 0 0 97745 0 387143 0 0 0 JENNIFER MEYERS MD TRUSTEE 200000 0 35575 0 60 0 4615 0 22408 0 262658 0 0 0 CHRISTOPHER GRAHAM CFO 177679 0 0 0 516 0 5331 0 22634 0 206160 0 0 0 MICHAEL WALSH MD PHYSICIAN 310091 0 0 0 9888 0 9303 0 22408 0 351690 0 0 0 RAYMOND CARLSON PHYSICIAN 400000 0 0 0 5196 0 9115 0 22408 0 436719 0 0 0 MARTIN ERNITS PHYSICIAN 295886 0 20000 0 396 0 8859 0 1421 0 326562 0 0 0 HAO LAM PHYSICIAN 247979 0 15000 0 9838 0 0 0 12175 0 284992 0 0 0 JOCELYN MORIN PHYSICIAN 235399 0 15000 0 9961 0 0 0 22408 0 282768 0 0 0 STEPHANIE FADALE SPOUSE OF CEO 17658 CONSULTING SERVICES RELATING TO MARKETING, STRATEGIC PLANS DEVELOPMENT, AND COORDINATION OF SPIRIT OF WOMEN COMMUNITY OUTREACH PROJECT. 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 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 CFO 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 -2,055,288. PAYMENT ON BEHALF OF RELATED ORGANIZATION -205,987. OTHER COMPONENTS OF NET PERIODIC BENEFIT COST -167,173. 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