2014-11-12T10:13:20-06:00 2013-12-31 161226221 FUST CHARLES CHAMBERS LLP 5784 WIDEWATERS PARKWAY SYRACUSE NY 13214 990 2013-01-01 150548010 COMMUNITY MEMORIAL HOSPITAL INC COMM 3158246081 150 BROAD STREET HAMILTON NY 13346 CHRISTOPHER W GRAHAM CFO 3158246081 2014-11-10 1 ANGELA M FRANCO P00589741 3154463600 2013 2015-11-30 17:44:51Z CHRISTOPHER W GRAHAM 150 BROAD STREET HAMILTON NY 13346 43339504 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 16 432 25 0 0 744789 3525478 40204010 39395336 32047 98546 325442 223893 41306288 43243253 0 0 0 0 21769730 21879986 0 0 0 19178114 20119228 40947844 41999214 358444 1244039 19681324 22932498 11587385 10890716 8093939 12041782 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 22495708 19436556 OPERATION OF AN ACUTE CARE GENERAL HOSPITAL WITH AN ATTACHED SKILLED NURSING FACILITY. ACUTE CARE SNFBEDS 36 40PATIENT DAYS OF CARE 4412 13979ADMISSIONS 1540 83COMMUNITY MEMORIAL HOSPITAL HAS RECEIVED MANY AWARDS FOR OUTSTANDING CARE TO INCLUDE: 1) A LEADER IN UPSTATE NEW YORK IN PATIENT SATISFACTION2) JUDGED OUTSTANDING IN PATIENT CARE AND PATIENT SAFETY BY BOTH STATE AND FEDERAL SURVEYORS3) HEALTHGRADES MULTI-YEAR 5 STAR RATING IN ORTHOPEDIC SURGERY INCLUDING HIP AND KNEE REPLACEMENTS. 4) EXCELLUS AWARD FOR QUALITY OF CARE A) LOW RATE OF SURGICAL COMPLICATIONS B) PATIENT SATISFACTION SCORES5) JOINT COMMISSION RECOGNITION AS TOP PERFORMER IN QUALITY MEASURES6) LEAPFROG GROUP A RATING ON PATIENT SAFETYCOMMUNITY MEMORIAL HOSPITAL STRIVES TO IMPROVE THE HEALTH OF THE COMMUNITY BY:1) PARTICIPATING IN LOCAL HEALTH FAIRS2) IMPROVING ACCESS TO PRIMARY CARE3) IMPROVING THE CARE OF CHRONIC ILLNESSES SUCH AS DIABETES4) IMPROVING MENTAL HEALTH SERVICES WORKING WITH LOCAL SCHOOL DISTRICTS5) HEALTH CAREER SUMMER PROGRAM FOR AREA CHILDREN6) INCREASING ACCESS TO SPECIALTY SERVICESCOMMUNITY 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 2013 COMMUNITY MEMORIAL HOSPITAL PROVIDED CHARITY CARE IN THE AMOUNT OF $361665 TO APPROXIMATELY 268 PATIENTS. 4721795 6588803 OPERATION OF AN AMBULATORY SURGERY UNITTOTAL VISITS 2294 6833168 9627545 OPERATION OF EMERGENCY SERVICES AND OUTPATIENT REFERRED AMBULATORY TESTING EMERGENCY ROOM VISITS 8681REFERRED AMBULATORY VISITS 35449 4337910 3742432 OPERATION OF PRIMARY CARE CLINICS TOTAL VISITS 35776 4337910 3742432 38388581 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 0 0 0 0 0 0 0 1 0 0 0 1 20 0 1 432 1 0 0 0 0 0 0 0 0 0 0 X 18 16 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 NY X CHRISTOPHER W GRAHAM 3158246081 150 BROAD STREET HAMILTON NY 13346 LAWRENCE BAKER TRUSTEE 1.00 X 0 0 0 PATRICIA CAPRIO TRUSTEE 1.00 X 0 0 0 WILLIAM GETMAN TRUSTEE 1.00 X 0 0 0 IVAN GOWAN TRUSTEE 1.00 X 0 0 0 JS HOPE TRUSTEE 1.00 X 0 0 0 PAUL KRONENBERG TRUSTEE 1.00 X 0 0 0 GLORIA LENHART TRUSTEE 1.00 X 0 0 0 WILLIAM MAGEE TRUSTEE 1.00 X 0 0 0 MATTHEW NORRIS TRUSTEE 1.00 X 0 0 0 RICHARD RUSSELL TRUSTEE 1.00 X 0 0 0 EVE ANN SCHWARTZ TRUSTEE 1.00 X 0 0 0 KERRI TAYLOR TRUSTEE 40.00 X 177546 0 26658 ROBERT TYBURSKI TRUSTEE 1.00 X 0 0 0 LAWRENCE TULLY CHAIRMAN 1.00 X X 0 0 0 SUSIE GUSTAFSON VICE CHAIRMAN 1.00 X X 0 0 0 BRAD WHELER TREASURER 1.00 X X 0 0 0 JEFFREY RUBENSTEIN SECRETARY 1.00 X X 0 0 0 SEAN FADALE PRESIDENT/CEO 40.00 X X 250885 0 54052 RICHARD KIRBY EXEC VP/COO/CFO 40.00 X 206132 0 31247 RAYMOND CARLSON PHYSICIAN 40.00 X 364300 0 26658 ROBERT DELORME PHYSICIAN 40.00 X 259238 0 26658 MARTIN ERNITS PHYSICIAN 40.00 X 271988 0 1697 JENNIFER MEYERS PHYSICIAN 40.00 X 164699 0 26658 EUFROSINA YOUNG PHYSICIAN 40.00 X 263463 0 26658 1958251 0 220286 19 0 1 0 HAMILTON CRITICAL CARE & EMERGENCY PO BOX 605 DEWITT NY 13214 EMERGENCY ROOM SERVICES 117896 FUST CHARLES CHAMBERS LLP 5784 WIDEWATERS PARKWAY SYRACUSE NY 13214 AUDIT SERVICES 105916 2 3340478 185000 3525478 INPATIENT 622110 19436556 19436556 REFERRED AMBULATORY 621990 9627545 9627545 AMBULATORY SURGERY 621990 6588803 6588803 CLINIC 621110 3742432 3742432 39395336 98546 98546 192660 96251 96409 96409 96409 CAFETERIA SALES 900099 51534 51534 WELLNESS CTR DUES 900099 40231 40231 CCC-SERVICES 900009 24000 24000 11719 11719 127484 43243253 39395336 0 322439 746520 204204 542316 15887509 14436007 1451502 1153828 1048413 105415 2946182 2677016 269166 1145947 1022966 122981 28068 28068 117507 117507 75509 75509 1245963 1154838 91125 154403 77344 77059 261067 64260 196807 402541 144767 257774 760182 756715 3467 35665 22978 12687 4141 4141 1318556 1260431 58125 409361 409361 SUPPLIES 8624666 8624666 PURCHASED SERVICES 5000858 4865360 135498 PROVISION FOR BAD DEBTS 850934 850934 829807 764180 65627 41999214 38388581 3610633 0 5323754 7073285 178128 214417 3613435 3870295 695119 755608 776142 768792 38710106 30195384 8172714 8514722 922032 1735379 19681324 22932498 5237672 5935223 2844080 2223853 3505633 2731640 11587385 10890716 X 7942787 12041782 151152 0 8093939 12041782 19681324 22932498 X 1244039 2703804 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 1 15509 0 0 1 0 1 60000 75509 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 $12946 OF WHICH $5541 WAS FOR LOBBYING. HEALTHCARE ASSOCIATION OF NYS - MEMBERSHIP DUES $21046 OF WHICH $5893 WAS FOR LOBBYING. AHA-MEMBERSHIP DUES $17231 OF WHICH $4075 WAS FOR LOBBYING. LOBBYIST WILSON,ELSER,MARKOWITZ,ET AL RETAINED FOR $60000 FOR STATE LOBBYING REGARDING ENHANCEMENT OF ACUTE CARE MEDICAL RATES. 1077446 469906 43085 -185000 -154800 1250637 798751 430594 35937 187836 1077446 488980 557783 11988 260000 798751 638615 244911 5454 400000 488980 682787 250127 5701 300000 638615 1.00000 0 1 1 62115 62115 18825531 13285644 5539887 47146 35732 11414 18488092 16052516 2435576 1287222 821492 465730 8514722 HAMILTON CRITICAL CARE 54771 PROFESSIONAL LIABILITY RESERVE 1680608 1735379 ACCRUED RETIREMENT OBLIGATIONS, NET 1245101 OTHER LONG-TERM LIABILITIES 1486539 2731640 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 AND FOUNDATION ARE NOT-FOR-PROFIT CORPORATIONS AND HAVE BEEN RECOGNIZED AS TAX-EXEMPT PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. AS OF DECEMBER 31, 2013 AND 2012, THE HOSPITAL AND THE FOUNDATION DID NOT HAVE ANY UNRECOGNIZED TAX BENEFITS OR ANY RELATED ACCRUED INTEREST OR PENALTIES. THE TAX YEARS OPEN TO EXAMINATION BY FEDERAL AND NEW YORK STATE TAXING AUTHORITIES ARE 2010 THROUGH 2013. 1 1 1 X 1 X 0 1 0 1 1 403980 166891 237089 0.00580 5945541 5064495 881046 0.02140 6349521 5231386 1118135 0.02720 106352 40231 66121 0.00160 106352 40231 66121 0.00160 6455873 5271617 1184256 0.02880 1 850934 707126 8391357 9365796 -974439 X 1 1 1 1 COMMUNITY MEMORIAL HOSPITAL INC 150 BROAD ST HAMILTON NY 13346 X X X COMMUNITY MEMORIAL HOSPITAL INC 1 1 X X X X X X X X 13 1 1 1 X WWW.COMMUNITYMEMORIAL.ORG X X X X 0 0 1 1 150.000000000000 1 300.000000000000 1 X 1 1 X X X X X X 1 0 1 X 0 0 COMMUNITY MEMORIAL HOSPITAL, INC PART V, SECTION B, LINE 3: COMMUNITY MEMORIAL HOSPITAL PARTICIPATED IN AN EXTENSIVE COMMUNITY HEALTH ASSESSMENT AND WAS CO-CHAIRMAN OF THE STEERING COMMITTEE WITH MADISON COUNTY PUBLIC HEALTH FOR THE EFFORT. THERE WAS WIDE-SPREAD REPRESENTATION FROM THE COMMUNITY ON THE STEERING COMMITTEE INCLUDING: REACH NY; EXCELLUS BLUE CROSS BLUE SHIELD; ONEIDA HEALTHCARE; COMMUNITY ACTION PLAN FOR MADISON COUNTY; MADISON COUNTY YOUTH BUREAU; MADISON COUNTY BOARD OF HEALTH; HCR HOMECARE; HEALTH FOUNDATION FOR WESTERN AND CENTRAL NEW YORK; CHILD CARE COUNCIL OF CORNELL COOPERATIVE EXTENSION; MADISON COUNTY DEPARTMENT OF SOCIAL SERVICES; MADISON CORTLAND ARC; HEALTHECONNECTIONS HEALTH PLANNING; MADISON COUNTY PLANNING DEPARTMENT; BRIDGES, HAMILTON COLLEGE; MADISON COUNTY MENTAL HEALTH; AND MADISON COUNTY OFFICE FOR THE AGING. THE STEERING COMMITTEE DEVELOPED FOCUS GROUPS TO ANALYZE AND DISCUSS INFORMATION GATHERED AND PRESENTED BY A REPRESENTATIVE FROM HEALTHECONNECTS AS WELL AS SET PRIORITIES AND SUGGEST INTERVENTIONS. IN ADDITION TO THE STEERING COMMITTEE MEMBERS THE FOLLOWING ORGANIZATIONS PARTICIPATED IN THE FOCUS GROUPS: MID YORK CCC/DAY CARE; ARISE; MADISON-ONEIDA BOCES; CABVI; HAZEL L. CARPENTER HOME, INC.; LORETTO LIFELINE; WIC; CNY AHEC; CORNELL COOPERATIVE EXTENSION; LONG-TERM CARE CONSULTANT; HERITAGE FARMS; MORRISVILLE COLLEGE; BROOKFIELD TOWN SUPERVISOR; HEAD START, CANASTOTA PSYCHOLOGIST; AND LIBERTY RESOURCES. COMMUNITY MEMORIAL HOSPITAL, INC PART V, SECTION B, LINE 4: THE OTHER HOSPITAL THAT PARTICIPATED WAS ONEIDA HEALTHCARE. COMMUNITY MEMORIAL HOSPITAL, INC PART V, SECTION B, LINE 7: COMMUNITY MEMORIAL HOSPITAL IS UNABLE TO ADDRESS ALL OF THE NEEDS IDENTIFIED IN THE COMMUNITY NEEDS ASSESSMENT FOR MANY REASONS. FIRST OF ALL THE NEEDS IDENTIFIED ARE TOO NUMEROUS AND WIDE-SPREAD FOR ANY FACILITY TO ADDRESS. SOME OF THE NEEDS WERE RELATED TO SERVICES THAT COMMUNITY MEMORIAL DOES NOT PROVIDE SUCH AS PRENATAL CARE AND TRANSPORTATION. COMMUNITY MEMORIAL HOSPITAL, INC PART V, SECTION B, LINE 14G: A MESSAGE IS PRINTED ON PATIENTS' BILLS THAT STATES "COMMUNITY MEMORIAL HOSPITAL OFFERS FINANCIAL ASSISTANCE TO QUALIFYING PATIENTS. PLEASE CALL 315-824-6553." COMMUNITY MEMORIAL HOSPITAL, INC PART V, SECTION B, LINE 20D: WE USED THE NEGOTIATED COMMERCIAL INSURANCE RATE OF OUR HIGHEST VOLUME COMMERCIAL PAYOR. 5 COMMUNITY MEMORIAL HOSPITAL SNF 150 BROAD ST HAMILTON NY 13346 ATTACHED SKILLED NURSING FACILITY COMMUNITY MEMORIAL HOSPITAL FHC 164 BROAD ST HAMILTON NY 13346 PRIMARY CARE PHYSICIAN OFFICE COMMUNITY MEMORIAL HOSPITAL FHC 3460 SOUTH ST MORRISVILLE NY 13408 PRIMARY CARE PHYSICIAN OFFICE COMMUNITY MEMORIAL HOSPITAL FHC 117 WEST MAIN ST WATERVILLE NY 13480 PRIMARY CARE PHYSICIAN OFFICE COMMUNITY MEMORIAL HOSPITAL FHC 4180 SOUTH MAIN ST MUNNSVILLE NY 13409 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. PART I, LN 7 COL(F): BAD DEBT EXPENSE OF 850934 WAS SUBTRACTED FROM FORM 990, PART IX, LINE 25, COLUMN A 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."LINE 2 METHODOLOGY- THE HOSPITAL ESTIMATES BAD DEBT EXPENSE BASED ON HISTORICAL EXPERIENCE EXPRESSED AS A PERCENTAGE OF CURRENT YEAR GROSS REVENUE..LINE 3 METHODOLOGY- WE TOOK THE APPROVAL PERCENTAGE OF 83.1% ON ALL PATIENTS WHO APPLIED FOR CHARITY CARE IN 2013 AND MULTIPLIED IT 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 8: FOR LINE 6 - THE HOSPITAL USED THE 2013 MEDICARE COST REPORT IN DETERMINING MEDICARE COSTS. THE MEDICARE COST REPORT CALCULATES A COST-TO-CHARGE RATIO FOR EACH COST CENTER USING HOSPITAL TOTAL ALLOWABLE CHARGES AND TOTAL ALLOWABLE COSTS; THESE RATIOS ARE THEN APPLIED AGAINST MEDICARE CHARGES IN EACH COST CENTER RESULTING IN MEDICARE COSTS.THE SHORTFALL OF $974439 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 WHEN A SELF-PAY STATEMENT GENERATES FOR A PATIENT KNOWN TO HAVE RECEIVED UNCOMPENSATED SERVICE AID FROM COMMUNITY MEMORIAL WITHIN THE LAST YEAR, THE STATEMENT IS PULLED AND AN UNCOMPENSATED SERVICE APPROVAL LETTER IS MAILED TO THE PATIENT. 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 2013, 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 CREDIT DEPARTMENT. A SUMMARY OF OUR UNCOMPENSATED CARE PROGRAM IS AVAILABLE FOR THEM TO TAKE. PATIENTS THAT ARE SELF PAY ON ADMISSION ARE SEEN BY THE CREDIT DEPARTMENT PERSONNEL AND THE UNCOMPENSATED SERVICE PROGRAM IS DISCUSSED AND AN APPLICATION IS GIVEN. PATIENTS THAT RECEIVE OUTPATIENT SERVICES ARE CALLED TO ADVISE THEM OF OUR POLICY WHEN THE FIRST ITEMIZED STATEMENT PRINTS AND WHEN SUBSEQUENT COLLECTION PHONE CALLS ARE MADE. A MESSAGE IS AUTOMATICALLY PRINTED ON ALL PATIENT STATEMENTS THAT FINANCIAL ASSISTANCE IS AVAILABLE FOR THOSE WHO QUALIFY, WITH THE PHONE NUMBER TO CALL. 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 RENOWN 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 CHARITY CARE 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 FOUR FAMILY HEALTH CENTERS( IN HAMILTON, MORRISVILLE, MUNNSVILLE AND WATERVILLE). THE HOSPITAL EMPLOYS FIVE FAMILY PRACTICE SPECIALISTS, ONE PEDIATRICIAN, ONE CARDIOLOGIST, ONE NEUROLOGIST, AND NURSE PRACTIONERS/PHYSICIAN ASSISTANTS. 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. PART VI, LINE 7, REPORTS FILED WITH STATES NY 1 X X 0 0 0 0 0 0 0 0 0 KERRI TAYLOR TRUSTEE 155208 0 22338 0 0 0 0 0 26658 0 204204 0 0 0 SEAN FADALE PRESIDENT/CEO 250885 0 0 0 0 0 0 0 54052 0 304937 0 0 0 RICHARD KIRBY EXEC VP/COO/CFO 206132 0 0 0 0 0 0 0 31247 0 237379 0 0 0 RAYMOND CARLSON PHYSICIAN 359500 0 4800 0 0 0 0 0 26658 0 390958 0 0 0 ROBERT DELORME PHYSICIAN 234000 0 25238 0 0 0 0 0 26658 0 285896 0 0 0 MARTIN ERNITS PHYSICIAN 271988 0 0 0 0 0 0 0 1697 0 273685 0 0 0 JENNIFER MEYERS PHYSICIAN 155077 0 9622 0 0 0 0 0 26658 0 191357 0 0 0 EUFROSINA YOUNG PHYSICIAN 239239 0 24224 0 0 0 0 0 26658 0 290121 0 0 0 FORM 990, PART VI, SECTION B, LINE 11 THE CEO AND THE CFO PRESENT THE 990 TO THE FINANCE COMMITTEE OF THE BOARD OF DIRECTORS PRIOR TO SUBMISSION TO THE IRS. THE FINANCE COMMITTEE ADVISES THE FULL BOARD OF IT'S REVIEW. 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 INDEPENDANT CONSULTANTS GAFFE & ASSOCIATES.THE BOARD EMPLOYS THE SERVICES OF OUTSIDE CONSULTANT, HARBRIDGE CONSULTING.THE BOARD REVIEWS SALARIES FOR SIMILAR POSTIONS 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 2,703,804. 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 0 0 0