COMMUNITY MEMORIAL HOSPITAL INC: Form 990, tax year 2017
View the entire original 990 at ProPublica ↗
- Organization
- COMMUNITY MEMORIAL HOSPITAL INC (EIN 15-0548010)
- Tax period
- 2017-01-01 to 2017-12-31
- Filed
- 2018-11-14
- IRS object ID
- 201843189349312049
- Schema version
- 2017v2.3
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2018-11-14T17:48:49-06:00 | ReturnTs |
| Tax Period End | 2017-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 161226221 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FUST CHARLES CHAMBERS LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 5784 WIDEWATERS PARKWAY | AddressLine1Txt |
| City | SYRACUSE | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 13214 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2017-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 150548010 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY MEMORIAL HOSPITAL INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | COMM | BusinessNameControlTxt |
| Phone | 3158246081 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 150 BROAD STREET | AddressLine1Txt |
| City | HAMILTON | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 13346 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | CHRISTOPHER W GRAHAM | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 3158246081 | PhoneNum |
| Signature | 2018-10-23 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | THOMAS J GIUFRE | PreparerPersonNm |
| PTIN | P00841958 | PTIN |
| Phone | 3154463600 | PhoneNum |
| Preparation | 2018-10-23 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 24.39.85.114 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2018-10-23 | IPDt |
| IP Tm | 13:35:15 | IPTm |
| IP Timezone | ED | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | 7E9C33F7C5CD1DA8693DD78F29AF2560BCFF7C5D | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 2B26D0CF862F5C09AB62214FFDF324E4AA0177DB | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2017 | TaxYr |
| Build TS | 2019-02-21 02:37:17Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | CHRISTOPHER W GRAHAM | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 150 BROAD STREET | AddressLine1Txt |
| City | HAMILTON | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 13346 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $43,520,042 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | COMMUNITYMEMORIAL.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1949 | FormationYr |
| Legal Domicile State | NY | LegalDomicileStateCd |
| Activity Or Mission | COMMUNITY MEMORIAL HOSPITAL'S PRIMARY EXEMPT PURPOSE IS TO PROVIDE EMERGENCY AND INPATIENT CARE TO THE GENERAL POPULATION WITHOUT REGARD TO ABILITY TO PAY. | ActivityOrMissionDesc |
| Voting Members Governing Body | 18 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 16 | VotingMembersIndependentCnt |
| Total Employee | 390 | TotalEmployeeCnt |
| Total Volunteers | 28 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $1,441,418 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,840,697 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $37,695,196 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $39,707,930 | CYProgramServiceRevenueAmt |
| PY Investment Income | -$21,059 | PYInvestmentIncomeAmt |
| CY Investment Income | -$31,146 | CYInvestmentIncomeAmt |
| PY Other Revenue | $1,659,194 | PYOtherRevenueAmt |
| CY Other Revenue | $1,878,471 | CYOtherRevenueAmt |
| PY Total Revenue | $40,774,749 | PYTotalRevenueAmt |
| CY Total Revenue | $43,395,952 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $21,967,116 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $22,956,618 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $21,244,258 | PYOtherExpensesAmt |
| CY Other Expenses | $22,280,013 | CYOtherExpensesAmt |
| PY Total Expenses | $43,211,374 | PYTotalExpensesAmt |
| CY Total Expenses | $45,236,631 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$2,436,625 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$1,840,679 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $22,341,566 | TotalAssetsBOYAmt |
| Total Assets EOY | $22,494,826 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $13,773,192 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $17,860,723 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $8,568,374 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $4,634,103 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | COMMUNITY MEMORIAL HOSPITAL'S PRIMARY EXEMPT PURPOSE IS TO PROVIDE EMERGENCY AND INPATIENT CARE TO THE GENERAL POPULATION WITHOUT REGARD TO ABILITY TO PAY. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $19,405,990 | ExpenseAmt |
| Revenue | $18,342,066 | RevenueAmt |
| Desc | OPERATION OF A CRITICAL ACCESS HOSPITALBEDS 25PATIENT DAYS OF CARE 5,656ADMISSIONS 1,690COMMUNITY 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.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 2017 COMMUNITY MEMORIAL HOSPITAL PROVIDED CHARITY CARE IN THE AMOUNT OF $340,971 TO APPROXIMATELY 356 PATIENTS. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $8,331,388 | ExpenseAmt |
| Revenue | $12,427,635 | RevenueAmt |
| Desc | OPERATION OF EMERGENCY SERVICES AND OUTPATIENT REFERRED AMBULATORY TESTINGEMERGENCY ROOM VISITS 9,698REFERRED AMBULATORY VISITS 33,443 | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $8,417,274 | ExpenseAmt |
| Revenue | $5,518,413 | RevenueAmt |
| Desc | OPERATION OF PRIMARY CARE CLINICSTOTAL VISITS 47,314 | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $4,535,373 | ExpenseAmt |
| Revenue | $5,100,710 | RevenueAmt |
| Desc | OPERATION OF AN AMBULATORY SURGERY UNITTOTAL VISITS 2,119 | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $4,535,373 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Revenue | $5,100,710 | TotalOtherProgSrvcRevenueAmt |
| Total Program Service Expenses | $40,690,025 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | Yes (1) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (1) | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 19 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 390 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 18 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 16 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (1) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | NY | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHRISTOPHER W GRAHAM | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 3158246081 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 150 BROAD STREET | AddressLine1Txt |
| City | HAMILTON | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 13346 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (25 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| JOSEPH S HOPE | |||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| PAUL KRONENBERG MD | |||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| SETH KRONENBERG MD | |||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| MATTHEW NORRIS | |||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| DAVID ROGERS | |||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| RICHARD RUSSELL | |||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| LAWRENCE TULLY | |||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| SUSAN GUSTAFSON | |||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| GLORIA LENHART | |||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| JANE PINCHIN | |||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| RAYMOND MEEKS MD | |||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| EVE ANN SCHWARTZ | |||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| WILLIAM GETMAN | |||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| MARK CURTIS | |||||||
| CHAIRMAN | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| ROBERT TYBURSKI | |||||||
| VICE CHAIRMAN | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| BRADFORD WHELER | |||||||
| TREASURER | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| JEFFREY RUBENSTEIN | |||||||
| SECRETARY | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| SEAN FADALE | |||||||
| PRESIDENT/CEO | 40.00 | Yes (X) | $278,702 | $0 | $97,287 | Yes (X) | |
| JENNIFER MEYERS MD | |||||||
| TRUSTEE | 40.00 | Yes (X) | $218,810 | $0 | $24,438 | ||
| CHRISTOPHER GRAHAM | |||||||
| CFO | 40.00 | $171,147 | $0 | $26,016 | Yes (X) | ||
| RAYMOND CARLSON MD | |||||||
| PHYSICIAN | 40.00 | $405,196 | $0 | $28,297 | Yes (X) | ||
| MARTIN ERNITS MD | |||||||
| PHYSICIAN | 40.00 | $275,886 | $0 | $4,049 | Yes (X) | ||
| ROBERT DELORME MD | |||||||
| PHYSICIAN | 40.00 | $259,367 | $0 | $24,741 | Yes (X) | ||
| KERRI TAYLOR MD | |||||||
| PHYSICIAN | 40.00 | $252,408 | $0 | $25,336 | Yes (X) | ||
| MICHAEL WALSH MD | |||||||
| PHYSICIAN | 40.00 | $319,637 | $0 | $29,083 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,181,153 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $259,247 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 22 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| CROUSE HEALTH HOSPITAL INC | |||||
| 736 IRVING AVE | SYRACUSE | NY | 13210 | MGMT, CLINICAL, & IT | $3,047,414 |
| CENTREX CLINICAL LABS INC | |||||
| 28 CAMPION RD | NEW HARTFORD | NY | 13413 | LABORATORY SERVICES | $893,650 |
| PARAFFIN INC | |||||
| PO BOX 479 | UTICA | NY | 13503 | LABORATORY SERVICES | $326,285 |
| TEITSCH-KENT-FAY ARCHITECTS PC | |||||
| 132 ALBANY ST SUITE M-1 | CAZENOVIA | NY | 13035 | ARCHITECT SERVICES | $119,355 |
| FUST CHARLES CHAMBERS LLP | |||||
| 5784 WIDEWATERS PARKWAY | SYRACUSE | NY | 13214 | AUDIT SERVICES | $107,708 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 5 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $12,933 | RelatedOrganizationsAmt |
| Government Grants | $1,821,911 | GovernmentGrantsAmt |
| All Other Contributions | $5,853 | AllOtherContributionsAmt |
| Total Contributions | $1,840,697 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| INPATIENT | 622110 | $18,342,066 | $18,342,066 |
| REFERRED AMBULATORY | 621990 | $12,427,635 | $12,427,635 |
| AMBULATORY SURGERY | 621990 | $5,100,710 | $5,100,710 |
| CLINIC | 621110 | $3,837,519 | $3,837,519 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $39,707,930 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $6,736 | TotalRevenueColumnAmt |
| Exclusion | $6,736 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $130,715 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $66,913 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $63,802 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $63,802 | TotalRevenueColumnAmt |
| Exclusion | $63,802 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $19,295 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $57,177 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$37,882 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$37,882 | TotalRevenueColumnAmt |
| Exclusion | -$37,882 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | ExclusionExclusionAmt |
|---|---|---|---|---|
| 340B REVENUE | 900099 | $1,680,894 | $1,680,894 | |
| CAFETERIA SALES | 900099 | $56,983 | $56,983 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $76,792 | TotalRevenueColumnAmt |
| Exclusion | $76,792 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $1,814,669 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $43,395,952 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $41,388,824 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $166,431 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $816,400 | TotalAmt |
| Program Services | $243,248 | ProgramServicesAmt |
| Management And General | $573,152 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $16,835,923 | TotalAmt |
| Program Services | $15,223,335 | ProgramServicesAmt |
| Management And General | $1,612,588 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,000,820 | TotalAmt |
| Program Services | $876,735 | ProgramServicesAmt |
| Management And General | $124,085 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,110,817 | TotalAmt |
| Program Services | $2,812,855 | ProgramServicesAmt |
| Management And General | $297,962 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,192,658 | TotalAmt |
| Program Services | $1,066,670 | ProgramServicesAmt |
| Management And General | $125,988 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $51,767 | TotalAmt |
| Management And General | $51,767 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $160,808 | TotalAmt |
| Management And General | $160,808 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $38,383 | TotalAmt |
| Management And General | $38,383 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,277,025 | TotalAmt |
| Program Services | $2,125,977 | ProgramServicesAmt |
| Management And General | $151,048 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $132,446 | TotalAmt |
| Program Services | $52,483 | ProgramServicesAmt |
| Management And General | $79,963 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $256,544 | TotalAmt |
| Program Services | $63,169 | ProgramServicesAmt |
| Management And General | $193,375 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,044,567 | TotalAmt |
| Program Services | $981,084 | ProgramServicesAmt |
| Management And General | $63,483 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $480,179 | TotalAmt |
| Program Services | $475,482 | ProgramServicesAmt |
| Management And General | $4,697 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $44,132 | TotalAmt |
| Program Services | $19,510 | ProgramServicesAmt |
| Management And General | $24,622 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $60,306 | TotalAmt |
| Program Services | $60,306 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,900,142 | TotalAmt |
| Program Services | $1,716,555 | ProgramServicesAmt |
| Management And General | $183,587 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $407,807 | TotalAmt |
| Program Services | $407,807 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (3 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| SUPPLIES | $9,584,854 | $9,584,854 | |
| PURCHASED SERVICES | $4,400,281 | $3,608,618 | $791,663 |
| PROVISION FOR BAD DEBTS | $1,065,117 | $1,065,117 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $375,655 | TotalAmt |
| Program Services | $306,220 | ProgramServicesAmt |
| Management And General | $69,435 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $45,236,631 | TotalAmt |
| Program Services | $40,690,025 | ProgramServicesAmt |
| Management And General | $4,546,606 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,398,477 | BOYAmt |
| EOY | $4,164,371 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,545 | BOYAmt |
| EOY | $313,650 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,934,046 | BOYAmt |
| EOY | $4,315,981 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $865,866 | BOYAmt |
| EOY | $805,785 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,304,163 | BOYAmt |
| EOY | $1,161,636 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $41,037,983 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $30,898,480 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,284,594 | BOYAmt |
| EOY | $10,139,503 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,533,875 | BOYAmt |
| EOY | $1,593,900 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $22,341,566 | BOYAmt |
| EOY | $22,494,826 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,645,591 | BOYAmt |
| EOY | $5,886,357 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,940,765 | BOYAmt |
| EOY | $4,661,553 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,186,836 | BOYAmt |
| EOY | $7,312,813 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,773,192 | BOYAmt |
| EOY | $17,860,723 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,128,471 | BOYAmt |
| EOY | $4,634,103 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $439,903 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,568,374 | BOYAmt |
| EOY | $4,634,103 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $22,341,566 | BOYAmt |
| EOY | $22,494,826 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$1,840,679 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | -$2,093,592 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | Yes (1) | MailingsMembersInd |
| Mailings Members | $13,184 | MailingsMembersAmt |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | Yes (1) | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $25,200 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $38,384 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | 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 $13,074 OF WHICH $4,563 WAS FOR LOBBYING. HEALTHCARE ASSOCIATION OF NYS - MEMBERSHIP DUES $21,503 OF WHICH $4,430 WAS FOR LOBBYING. AHA-MEMBERSHIP DUES $18,237 OF WHICH $4,191 WAS FOR LOBBYING. LOBBYIST SHENKER,RUSSO,& CLARK,LLP RETAINED FOR $25,200 FOR STATE LOBBYING REGARDING ENHANCEMENT OF ACUTE CARE MEDICAL RATES AND HELP GETTING ACCESS TO CAPITAL VIA DSRIP AND DASNY. | ExplanationTxt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,660,122 | BeginningYearBalanceAmt |
| Contributions | $227,374 | ContributionsAmt |
| Investment Earnings Or Losses | $148,935 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $12,933 | GrantsOrScholarshipsAmt |
| Other Expenditures | -$5,568 | OtherExpendituresAmt |
| End Year Balance | $2,029,066 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,318,462 | BeginningYearBalanceAmt |
| Contributions | $300,737 | ContributionsAmt |
| Investment Earnings Or Losses | $63,123 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | -$17,970 | GrantsOrScholarshipsAmt |
| Other Expenditures | -$4,230 | OtherExpendituresAmt |
| End Year Balance | $1,660,122 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,267,559 | BeginningYearBalanceAmt |
| Contributions | $72,215 | ContributionsAmt |
| Investment Earnings Or Losses | -$6,551 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | -$22,366 | GrantsOrScholarshipsAmt |
| Other Expenditures | $7,605 | OtherExpendituresAmt |
| End Year Balance | $1,318,462 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,250,637 | BeginningYearBalanceAmt |
| Contributions | $405,263 | ContributionsAmt |
| Investment Earnings Or Losses | $38,267 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $408,108 | GrantsOrScholarshipsAmt |
| Other Expenditures | $18,500 | OtherExpendituresAmt |
| End Year Balance | $1,267,559 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,077,446 | BeginningYearBalanceAmt |
| Contributions | $469,906 | ContributionsAmt |
| Investment Earnings Or Losses | $43,085 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | -$185,000 | GrantsOrScholarshipsAmt |
| Other Expenditures | -$154,800 | OtherExpendituresAmt |
| End Year Balance | $1,250,637 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prmnnt Endowment Balance EOY | 0.10300 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.89700 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | Yes (1) | EndowmentsHeldRelatedOrgInd |
| Related Org List Sch R | Yes (1) | RelatedOrgListSchRInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $62,115 | OtherCostOrOtherBasisAmt |
| Book Value | $62,115 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $18,914,831 | OtherCostOrOtherBasisAmt |
| Depreciation | $15,159,344 | DepreciationAmt |
| Book Value | $3,755,487 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $28,584 | OtherCostOrOtherBasisAmt |
| Depreciation | $28,404 | DepreciationAmt |
| Book Value | $180 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $20,321,882 | OtherCostOrOtherBasisAmt |
| Depreciation | $14,714,410 | DepreciationAmt |
| Book Value | $5,607,472 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,710,571 | OtherCostOrOtherBasisAmt |
| Depreciation | $996,322 | DepreciationAmt |
| Book Value | $714,249 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $10,139,503 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (2 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| PROFESSIONAL LIABILITY RESERVE | $1,390,623 |
| ESTIMATED 3RD PARTY RECEIVABLE & ADVANCE, NET | $203,277 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $1,593,900 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| ACCRUED RETIREMENT OBLIGATIONS, NET | $6,371,242 |
| OTHER LONG-TERM LIABILITIES | $737,232 |
| ESTIMATED 3RD PARTY PAYABLE, NET | $204,339 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $7,312,813 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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, 2017 AND 2016, 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 2014 THROUGH 2017. THE HOSPITAL DOES NOT ANTICIPATE THAT THE TOTAL UNRECOGNIZED TAX BENEFITS WILL CHANGE IN THE NEXT TWELVE MONTHS. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent150 | Yes (X) | Percent150Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent300 | Yes (X) | Percent300Ind |
| Free Care Medically Indigent | 0 | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $282,000 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $153,922 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $128,078 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00290 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,290,585 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,270,396 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,020,189 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06840 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,572,585 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,424,318 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,148,267 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07130 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $152,406 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $48,212 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $104,194 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00240 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $152,406 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $48,212 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $104,194 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00240 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,724,991 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,472,530 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,252,461 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07370 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,065,117 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $734,079 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $11,272,686 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $12,254,546 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$981,860 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY MEMORIAL HOSPITAL INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 150 BROAD ST | AddressLine1Txt |
| City | HAMILTON | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 13346 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.COMMUNITYMEMORIAL.ORG | WebsiteAddressTxt |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY MEMORIAL HOSPITAL INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| CHNA Conducted | 16 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (1) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | WWW.COMMUNITYMEMORIAL.ORG | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 16 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | WWW.COMMUNITYMEMORIAL.ORG | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 150.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 300.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | WWW.COMMUNITYMEMORIAL.ORG | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | WWW.COMMUNITYMEMORIAL.ORG | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | WWW.COMMUNITYMEMORIAL.ORG | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Other Actions Taken | Yes (X) | OtherActionsTakenInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| COMMUNITY MEMORIAL HOSPITAL, INC | PART V, SECTION B, LINE 5: COMMUNITY MEMORIAL HOSPITAL PARTICIPATED IN A COMMUNITY ASSESSMENT AND SERVICE PLAN WITH MADISON COUNTY DEPARTMENT OF HEALTH, ONEIDA HEALTHCARE, AND MADISON COUNTY RURAL HEALTH COUNCIL IN 2017 SERVING AS THE STEERING COMMITTEE. OTHER STAKEHOLDERS INCLUDED REPRESENTATIVES FROM SCHOOLS, INSURANCE COMPANIES, COMMUNITY BASED ORGANIZATIONS, CORNELL COOPERATIVE EXTENSION, HEALTH AND HUMAN SERVICE ORGANIZATIONS, THE AMERICAN CANCER SOCIETY, AND EMPLOYERS AND BUSINESSES. |
| 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, ONEIDA HEALTHCARE, AND MADISON COUNTY RURAL HEALTH COUNCIL AS THE STEERING COMMITTEE TO SELECT THE PRIORITIES FOR MADISON COUNTY. WE SELECTED PRIORITIES THAT COULD REACH THE MOST PEOPLE AND COULD HAVE THE MOST IMPACT, IDENTIFYING TWO PRIORITIES: REDUCTION OF OBESITY AND INCREASED ACCESS TO HIGH QUALITY CHRONIC DESEASE PREVENTION CARE. THE TWO IDENTIFIED GOALS RELATED TO THESE PRIORITIES INCLUDE 1) THE INCREASE IN COLORECTAL CANCER SREENING RATES FROM 65.4% TO 80% BY REACHING PUBLIC AND PRIVATE EMPLOYERS AND 2) EXPAND THE ROLE OF PUBLIC AND PRIVATE EMPLOYERS IN OBESITY PREVENTION TO DECREASE THE RATE OF OBESITY IN ADULTS BY 1%, FROM 31.5% O 30.5% THROUGH 2018. IT WAS DECIDED THAT THE ESTABLISHMENT OF A WORKSITE WELLNESS COALITION 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. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 5 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (5 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 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 |
Supplemental Information Detail SupplementalInformationDetail (13 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 $1,065,117 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 68.92% ON ALL PATIENTS WHO APPLIED FOR CHARITY CARE IN 2017 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 2017 MEDICARE COST REPORT.THE SHORTFALL OF $981,860 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 2016, 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, TWO PEDIATRICIANS, 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.DURING 2015 COMMUNITY MEMORIAL HOSPITAL BECAME 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 2017 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 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 |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (8 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| SEAN FADALE | ||||||||||||||
| PRESIDENT/CEO | $278,702 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $97,287 | $0 | $375,989 | $0 | $0 | $0 |
| JENNIFER MEYERS MD | ||||||||||||||
| TRUSTEE | $200,000 | $0 | $18,750 | $0 | $60 | $0 | $4,564 | $0 | $19,874 | $0 | $243,248 | $0 | $0 | $0 |
| CHRISTOPHER GRAHAM | ||||||||||||||
| CFO | $170,871 | $0 | $0 | $0 | $276 | $0 | $5,165 | $0 | $20,851 | $0 | $197,163 | $0 | $0 | $0 |
| RAYMOND CARLSON MD | ||||||||||||||
| PHYSICIAN | $400,000 | $0 | $4,800 | $0 | $396 | $0 | $8,423 | $0 | $19,874 | $0 | $433,493 | $0 | $0 | $0 |
| MARTIN ERNITS MD | ||||||||||||||
| PHYSICIAN | $275,490 | $0 | $0 | $0 | $396 | $0 | $2,775 | $0 | $1,274 | $0 | $279,935 | $0 | $0 | $0 |
| ROBERT DELORME MD | ||||||||||||||
| PHYSICIAN | $233,951 | $0 | $25,187 | $0 | $229 | $0 | $2,388 | $0 | $22,353 | $0 | $284,108 | $0 | $0 | $0 |
| KERRI TAYLOR MD | ||||||||||||||
| PHYSICIAN | $212,420 | $0 | $39,850 | $0 | $138 | $0 | $5,462 | $0 | $19,874 | $0 | $277,744 | $0 | $0 | $0 |
| MICHAEL WALSH MD | ||||||||||||||
| PHYSICIAN | $305,999 | $0 | $13,500 | $0 | $138 | $0 | $9,209 | $0 | $19,874 | $0 | $348,720 | $0 | $0 | $0 |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | STEPHANIE FADALE | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | SPOUSE OF CEO | RelationshipDescriptionTxt |
| Transaction | $28,372 | TransactionAmt |
| Transaction | CONSULTING SERVICES RELATING TO MARKETING, STRATEGIC PLANS DEVELOPMENT, AND COORDINATION OF SPIRIT OF WOMEN COMMUNITY OUTREACH PROJECT. | TransactionDesc |
| Sharing Of Revenues | 0 | SharingOfRevenuesInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 CEO AND THE CFO PRESENT THE 990 TO THE BOARD OF DIRECTORS 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 GAFFE & ASSOCIATES. THE BOARD EMPLOYS THE SERVICES OF AN OUTSIDE CONSULTANT, HARBRIDGE CONSULTING. THE BOARD REVIEWS SALARIES FOR SIMILAR POSITIONS AT OTHER COMPARABLE HOSPITALS. THE BOARD SETS BOTH QUALITY AND FINANCIAL GOALS AND REVIEWS PERFORMANCE ANNUALLY. |
| 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 -1,515,946. TEMPORARILY RESTRICTED NET ASSETS -439,903. PAYMENT ON BEHALF OF RELATED ORGANIZATION -137,743. |
| FORM 990, PART XII, LINE 2C: | THERE WERE NO CHANGES TO THE OVERSIGHT PROCESS OR SELECTION PROCESS DURING THE CURRENT YEAR. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY MEMORIAL HOSPITAL FOUNDATION | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 150 BROAD ST | AddressLine1Txt |
| City | HAMILTON | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 13346 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 161603283 | EIN |
| Primary Activities | FUNDRAISING | PrimaryActivitiesTxt |
| Legal Domicile State | NY | LegalDomicileStateCd |
| Exempt Code Section | 501 C 3 | ExemptCodeSectionTxt |
| Public Charity Status | 11- TYPE I | PublicCharityStatusTxt |
| Direct Controlling NA | N/A | DirectControllingNACd |
| Controlled Organization | 0 | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |