2013-09-12T13:58:40-05:00 2012-12-31 161226221 FUST CHARLES CHAMBERS LLP 5784 WIDEWATERS PARKWAY SYRACUSE NY 13214 990 2012-01-01 150548010 COMMUNITY MEMORIAL HOSPITAL INC COMM 3158246081 150 BROAD STREET HAMILTON NY 13346 RICHARD S KIRBY 3158246081 2013-09-05 1 ANGELA M FRANCO P00589741 3154463600 2012 2016-02-24 21:20:13Z RICHARD S KIRBY 150 BROAD STREET HAMILTON NY 13346 41400350 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. 16 14 417 25 0 0 531766 744789 40370075 40204010 32555 32047 302629 325442 41237025 41306288 0 0 0 0 22683919 21769730 0 0 0 20162988 19178114 42846907 40947844 -1609882 358444 20007959 19681324 12413722 11587385 7594237 8093939 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 22705655 21418628 OPERATION OF AN ACUTE CARE GENERAL HOSPITAL WITH AN ATTACHED SKILLED NURSING FACILITY. ACUTE CARE SNFBEDS 36 40PATIENT DAYS OF CARE 5317 14104ADMISSIONS 1680 58COMMUNITY 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) VHA AWARD FOR QUALITY OF CARE A) LOW RATE OF SURGICAL COMPLICATIONS B) LOW RATE OF HOSPITAL ACQUIRED INFECTIONS5) 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 HEALTH CARE LITERACY5) 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 2012 COMMUNITY MEMORIAL HOSPITAL PROVIDED CHARITY CARE IN THE AMOUNT OF $336199 TO APPROXIMATELY 251 PATIENTS. 4474021 5858497 OPERATION OF AN AMBULATORY SURGERY UNITTOTAL VISITS 1762 6711031 9183810 OPERATION OF EMERGENCY SERVICES AND OUTPATIENT REFERRED AMBULATORY TESTING EMERGENCY ROOM VISITS 9352REFERRED AMBULATORY VISITS 35866 3392799 3743075 OPERATION OF PRIMARY CARE CLINICS TOTAL VISITS 53818 3392799 3743075 37283506 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 13 0 1 417 1 0 0 0 0 0 0 0 0 0 0 X 16 14 0 0 1 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 NY X RICHARD S KIRBY 3158246081 150 BROAD STREET HAMILTON NY 13346 LAWRENCE BAKER 1.00 X 0 0 0 SUSAN BARRETT 1.00 X 0 0 0 PATRICIA CAPRIO 1.00 X 0 0 0 IVAN GOWAN 1.00 X 0 0 0 SUSIE GUSTAFSON 1.00 X 0 0 0 WILLIAM MAGEE 1.00 X 0 0 0 JANE PINCHIN 1.00 X 0 0 0 KERRI TAYLOR 40.00 X 170250 0 23588 BRADFORD WHELER 1.00 X 0 0 0 LAWRENCE TULLY 1.00 X X 0 0 0 WILLIAM GETMAN 1.00 X X 0 0 0 DAVID HALE 1.00 X X 0 0 0 JEFFREY RUBENSTEIN 1.00 X X 0 0 0 MATTHEW NORRIS 1.00 X 0 0 0 EVE ANN SCHWARTZ 1.00 X 0 0 0 SEAN FADALE 40.00 X X 101923 0 20904 DAVID FELTON 40.00 X 298772 0 31935 RICHARD KIRBY 40.00 X 206036 0 37990 RAYMOND CARLSON 40.00 X 364300 0 23588 ROBERT DELORME 40.00 X 258200 0 23588 CHERYL MATTERN 40.00 X 215579 0 23588 EDWARD MCDONALD 40.00 X 224810 0 23588 EUFROSINA YOUNG 40.00 X 295210 0 23588 2135080 0 232357 21 0 1 0 HAMILTON CRITICAL CARE & EMERGENCY PO BOX 605 DEWITT NY 13214 EMERGENCY ROOM SERVICES 120000 1 744789 744789 INPATIENT 622110 21418628 21418628 REFERRED AMBULATORY 621990 9183810 9183810 AMBULATORY SURGERY 621990 5858497 5858497 CLINIC 621110 3743075 3743075 40204010 14047 14047 189369 94062 95307 95307 95307 18000 0 18000 18000 18000 TOBACCO STLMT FNDS 900099 123480 123480 CAFETERIA SALES 900099 49595 49595 WELLNESS CTR DUES 900099 38606 38606 18454 18454 230135 41306288 40204010 0 357489 768571 193838 574733 15739312 14465413 1273899 979485 900147 79338 3142617 2888065 254552 1139745 1020411 119334 122827 122827 115241 115241 101198 101198 75361 75361 841286 721781 119505 139596 45347 94249 302495 75198 227297 328711 121305 207406 714316 710373 3943 46999 22432 24567 17429 17429 1406585 1356011 50574 451740 451740 SUPPLIES 9198054 9198054 PURCHASED SERVICES 3754383 3605322 149061 PROVISION FOR BAD DEBTS 825998 825998 735895 664642 71253 40947844 37283506 3664338 0 4342398 5323754 80417 178128 4158027 3613435 804115 695119 458701 776142 36981983 28809269 9208127 8172714 956174 922032 20007959 19681324 5579215 5237672 3768822 2844080 3065685 3505633 12413722 11587385 X 7513820 7942787 80417 151152 7594237 8093939 20007959 19681324 X 358444 141258 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 1 15361 0 0 1 0 0 1 60000 75361 0 EXPLANATION OF LOBBYING ACTIVITIES: 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 $12143 OF WHICH $5392 WAS FOR LOBBYING. HEALTHCARE ASSOCIATION OF NYS - MEMBERSHIP DUES $20694 OF WHICH $5918 WAS FOR LOBBYING. AHA-MEMBERSHIP DUES $16893 OF WHICH $4051 WAS FOR LOBBYING. LOBBYIST WILSON,ELSER,MARKOWITZ,ET AL RETAINED FOR $60000 FOR STATE LOBBYING REGARDING ENHANCEMENT OF ACUTE CARE MEDICAL RATES. 798751 430594 35937 187836 1077446 488980 557783 11988 260000 798751 638615 244911 5454 400000 488980 682787 250127 5701 300000 638615 150835 529522 2430 682787 0.00000 0.00000 1.00000 0 1 1 62115 62115 18408753 12638519 5770234 45346 29571 15775 17168800 15380013 1788787 1296969 761166 535803 8172714 ACCRUED RETIREMENT OBLIGATIONS, NET 2879772 OTHER LONG-TERM LIABILITIES 625861 3505633 X DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: ENDOWMENT FUNDS ARE USED TO FURTHUR THE HOSPITAL'S TAX EXEMPT PURPOSE, SUCH AS FOR THE PURCHASE OF CAPITAL ASSETS. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: THE HOSPITAL AND FOUNDATION QUALIFY AS TAX-EXEMPT, NOT-FOR-PROFIT ORGANIZATIONS UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. AS OF DECEMBER 31, 2012 AND 2011, THE HOSPITAL AND 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 2009 THROUGH 2012. THE HOSPITAL AND FOUNDATION DO NOT ANTICIPATE THAT THE TOTAL UNRECOGNIZED TAX BENEFITS WILL CHANGE IN THE NEXT TWELVE MONTHS. 1 1 1 X 1 X 0 1 0 1 1 329223 184026 145197 0.00360 4939405 4098041 841364 0.02100 5268628 4282067 986561 0.02460 112880 38606 74274 0.00180 112880 38606 74274 0.00180 5381508 4320673 1060835 0.02640 1 825998 605457 9332939 10165864 -832925 X 1 1 1 1 COMMUNITY MEMORIAL HOSPITAL INC

150 BROAD ST HAMILTON NY 13346

X X X COMMUNITY MEMORIAL HOSPITAL INC 1 1 1 150.000000000000 1 300.000000000000 1 X X 1 1 X X X X X X 1 0 1 X 0 0 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, L7 COL(F): BAD DEBT EXPENSE OF 825998 WAS SUBTRACTED FROM FORM 990, PART IX, LINE 25, COLUMN A PART III, LINE 4: THE FOOTNOTES TO THE FINANCIAL STATEMENTS STATE "AN ALLOWANCE FOR DOUBTFUL ACCOUNTS RECEIVABLE IS ESTIMATED BY MANAGEMENT BASED ON PERIODIC REVIEWS OF THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE CONSIDERING HISTORICAL EXPERIENCE 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 73.3% ON ALL PATIENTS WHO APPLIED FOR CHARITY CARE IN 2012 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 2012 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 $832925 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. 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. PART VI, LINE 2: COMMUNITY MEMORIAL HOSPITAL'S ANNUAL REVIEW OF IT'S STRATEGIC PLANNING PROCESS DRIVES OUR ASSESSMENT OF COMMUNITY HEALTH NEEDS. OUR COMMUNITY SERVICE PLAN WAS REVIEWED AND UPDATED UTILIZING THE FOLLOWING INFORMATION. COMMUNITY MEMORIAL CONTINUES TO BE AN ACTIVE PARTNER WITH THE MADISON COUNTY HEALTH DEPARTMENT, OTHER HEALTH AND HUMAN SERVICE AGENCIES, AND AREA COMMUNITY AND INDUSTRY LEADERS IN CONTINUOUSLY ASSESSING 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)SECONDARY- MADISON COUNTY DEPARTMENT OF HEALTH AND COMMUNITY NEEDS ASSESSMENT PLAN 2004, 2000 CENSUS OF POPULATION AND HOUSING, HEALTH CENSUS COMPARING 1999 AND 2009 BASSETT HEALTHCARE RESEARCH INSTITUTE PUBLISHED JULY 2011, MADISON COUNTY PRIORITIES COUNCIL, 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 REGARGING 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. REPORTS FILED WITH STATES PART VI, LINE 7 NY 1 X X X 0 0 0 0 0 0 0 0 0 KERRI TAYLOR 150000 0 20250 0 0 0 0 0 23588 0 193838 0 0 0 DAVID FELTON 298772 0 0 0 0 0 0 0 31935 0 330707 0 0 0 RICHARD KIRBY 206036 0 0 0 0 0 0 0 37990 0 244026 0 0 0 RAYMOND CARLSON 359500 0 4800 0 0 0 0 0 23588 0 387888 0 0 0 ROBERT DELORME 212846 0 45354 0 0 0 0 0 23588 0 281788 0 0 0 CHERYL MATTERN 215579 0 0 0 0 0 0 0 23588 0 239167 0 0 0 EDWARD MCDONALD 224810 0 0 0 0 0 0 0 23588 0 248398 0 0 0 EUFROSINA YOUNG 229200 0 66010 0 0 0 0 0 23588 0 318798 0 0 0 FORM 990, PART VI, SECTION A, LINE 4 THE BYLAWS WERE CHANGED IN 2012 TO NAME THE CEO AS A VOTING BOARD MEMBER. 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: RETIREMENT PLAN OBLIGATION CHANGES OTHER THAN NET PERIODIC BENEFIT COSTS 141,258. FORM 990, PART XII, LINE 2C COMMUNITY MEMORIAL HOSPITAL DID NOT CHANGE ITS OVERSIGHT PROCESS FOR THE AUDIT, REVIEW, OR COMPILATION OF ITS FINANCIAL STATEMENTS OR FOR ITS SELECTION PROCESS OF AN INDEPENDENT ACCOUNTANT. COMMUNITY MEMORIAL HOSPITAL FOUNDATION 150 BROAD ST HAMILTON NY 13346 161603283 FUNDRAISING NY 501 C 3 11- TYPE III N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0