FURP.ORG / PUBLIC DATA EXPLORER

COMMUNITY MEMORIAL HOSPITAL INC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
COMMUNITY MEMORIAL HOSPITAL INC (EIN 15-0548010)
Tax period
2011-01-01 to 2011-12-31
Filed
2012-11-13
IRS object ID
201213189349304871
Schema version
2011v1.2
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 ReturnHeader

FieldValueIRS element (for citing)
Timestamp2012-11-13T17:40:11-06:00Timestamp
Tax Period End Date2011-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN161226221EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1FUST CHARLES CHAMBERS LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line15784 WIDEWATERS PARKWAYAddressLine1
CitySYRACUSECity
StateNYState
ZIP Code13214ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN150548010EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1COMMUNITY MEMORIAL HOSPITAL INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlCOMMNameControl
Phone3158246081Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1150 BROAD STREETAddressLine1
CityHAMILTONCity
StateNYState
ZIP Code13346ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameRICHARD S KIRBYName
TitleEXEC VP/CFOTitle
Phone3158246081Phone
Date Signed2012-11-10DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameANGELA M FRANCOName
PTINP00589741PTIN
Phone3154463600Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonRICHARD S KIRBYNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1150 BROAD STREETAddressLine1
CityHAMILTONCity
StateNYState
ZIP Code13346ZIPCode
FieldValueIRS element (for citing)
Gross Receipts41347915GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteCOMMUNITYMEMORIAL.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1949YearFormation
State Legal DomicileNYStateLegalDomicile
Activity Or Mission DescriptionCOMMUNITY MEMORIAL HOSPITAL'S PRIMARY EXEMPT PURPOSE IS TO PROVIDE EMERGENCY AND INPATIENT CARE TO THE GENERAL POPULATION WITHOUT REGARD TO ABILITY TO PAY.ActivityOrMissionDescription
Nbr Voting Members Governing Body15NbrVotingMembersGoverningBody
Nbr Independent Voting Members15NbrIndependentVotingMembers
Total Nbr Employees409TotalNbrEmployees
Total Nbr Volunteers25TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year544768ContributionsGrantsPriorYear
Contributions Grants Current Year531766ContributionsGrantsCurrentYear
Program Service Revenue Prior Year40525947ProgramServiceRevenuePriorYear
Program Service Revenue CY40370075ProgramServiceRevenueCY
Investment Income Prior Year75074InvestmentIncomePriorYear
Investment Income Current Year32555InvestmentIncomeCurrentYear
Other Revenue Prior Year344661OtherRevenuePriorYear
Other Revenue Current Year302629OtherRevenueCurrentYear
Total Revenue Prior Year41490450TotalRevenuePriorYear
Total Revenue Current Year41237025TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year21832726SalariesEtcPriorYear
Salaries Etc Current Year22683919SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year21561843OtherExpensePriorYear
Other Expenses Current Year20162988OtherExpensesCurrentYear
Total Expenses Prior Year43394569TotalExpensesPriorYear
Total Expenses Current Year42846907TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-1904119RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-1609882RevenuesLessExpensesCY
Total Assets BOY19968508TotalAssetsBOY
Total Assets EOY20007959TotalAssetsEOY
Total Liabilities BOY11454273TotalLiabilitiesBOY
Total Liabilities EOY12413722TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY8514235NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY7594237NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionCOMMUNITY MEMORIAL HOSPITAL'S PRIMARY EXEMPT PURPOSE IS TO PROVIDE EMERGENCY AND INPATIENT CARE TO THE GENERAL POPULATION WITHOUT REGARD TO ABILITY TO PAY.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense23521151Expense
Revenue21748463Revenue
DescriptionOPERATION OF AN ACUTE CARE GENERAL HOSPITAL WITH AN ATTACHED SKILLED NURSING FACILITY. ACUTE CARE SNFBEDS 36 40PATIENT DAYS OF CARE 6150 13135ADMISSIONS 1721 104COMMUNITY 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) NYS HONOR ROLL, NIAGARA QUALITY GROUP - LOW RATES POST-OPERATIVELY OF PULMONARY EMBOLI AND DEEP VEIN THROMBOSIS6) LEAPFROG GROUP A RATINGCOMMUNITY 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 CHILDRENCOMMUNITY 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 2011 COMMUNITY MEMORIAL HOSPITAL PROVIDED CHARITY CARE IN THE AMOUNT OF $227739 TO APPROXIMATELY 211 PATIENTS.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense5096249Expense
Revenue6180400Revenue
DescriptionOPERATION OF AN AMBULATORY SURGERY UNITTOTAL VISITS 1780Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense7056345Expense
Revenue9114110Revenue
DescriptionOPERATION OF EMERGENCY SERVICES AND OUTPATIENT REFERRED AMBULATORY TESTING EMERGENCY ROOM VISITS 9812REFERRED AMBULATORY VISITS 38304Description

Activity Other ActivityOther

FieldValueIRS element (for citing)
Expense3528173Expense
Revenue3327102Revenue
DescriptionOPERATION OF PRIMARY CARE CLINICS TOTAL VISITS 42530Description
FieldValueIRS element (for citing)
Total Of Other Program Service Exp3528173TotalOfOtherProgramServiceExp
Total Of Other Program Service Rev3327102TotalOfOtherProgramServiceRev
Total Program Service Expense39201918TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Financial Stmt Attached1FinancialStmtAttached
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109614NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees409NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members15NbrVotingGoverningBodyMembers
Number Independent Voting Members15NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body0Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledNYStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1RICHARD S KIRBYBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number3158246081TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1150 BROAD STREETAddressLine1
CityHAMILTONCity
StateNYState
ZIP Code13346ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (22 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerHighest Compensated EmployeeHighestCompensatedEmployee
JOHN BRADLEY
TRUSTEE1.00X000
SUSIE GUSTAFSON
TRUSTEE1.00X000
DAVID REBUCK MD
TRUSTEE1.00X000
LAWRENCE BAKER
TRUSTEE1.00X000
JOHN MORRIS
TRUSTEE1.00X000
WILLIAM MAGEE
TRUSTEE1.00X000
SUSAN BARRETT
TRUSTEE1.00X000
JEFFREY RUBENSTEIN
TRUSTEE1.00X000
BARBARA WHELER
TRUSTEE1.00X000
PATRICIA CAPRIO
TRUSTEE1.00X000
JANE PINCHIN
TRUSTEE1.00X000
KERRI TAYLOR MD
TRUSTEE40.00X16671301661
LAWRENCE TULLY
CHAIRMAN1.00X000X
CYNTHIA HUMMEL
VICE CHAIRMAN1.00X000X
WILLIAM GETMAN
TREASURER1.00X000X
DAVID FELTON
PRESIDENT/CEO40.00285442036762X
RICHARD KIRBY
EXEC VP/COO/CFO40.00199588031656X
RAYMOND CARLSON
PHYSICIAN40.00379300022058X
ROBERT DELORME
VP PHYSICIAN SERVICES40.00256313022058X
EDWARD MCDONALD
PHYSICIAN40.00210654021945X
COLLEEN PARENT
PHYSICIAN40.00169775022058X
EUFROSINA YOUNG MD
PHYSICIAN40.00243834022058X
FieldValueIRS element (for citing)
Total Reportable Comp From Org1911619TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation180256TotalOtherCompensation
Number Individuals GT100 K19NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation

Name Of Contractor NameOfContractor

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1HAMILTON CRITICAL CARE & EMERGENCYBusinessNameLine1

Address Of Contractor AddressOfContractor

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1PO BOX 605AddressLine1
CityDEWITTCity
StateNYState
ZIP Code13214ZIPCode
FieldValueIRS element (for citing)
Description Of ServicesEMERGENCY ROOM SERVICESDescriptionOfServices
Compensation120000Compensation
FieldValueIRS element (for citing)
Number Of Contractors GT100 K1NumberOfContractorsGT100K
Government Grants531766GovernmentGrants
Total Contributions531766TotalContributions

Program Service Revenue ProgramServiceRevenue (4 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
INPATIENT6221102174846321748463
REFERRED AMBULATORY62199091141109114110
AMBULATORY SURGERY62199061804006180400
CLINIC62111033271023327102
FieldValueIRS element (for citing)
Total Program Service Revenue40370075TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column32555TotalRevenueColumn
Exclusion$32,555ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real188090Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real110890Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real77200Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column77200TotalRevenueColumn
Exclusion$77,200ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmount
TOBACCO STLMT FNDS900099126000$126,000
CAFETERIA SALES90009952840$52,840
WELLNESS CTR DUES90009938308$38,308

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column8281TotalRevenueColumn
Exclusion$8,281ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue225429TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column41237025TotalRevenueColumn
Related Or Exempt Function Income40370075RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$335,184ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total721822Total
Program Services168374ProgramServices
Management And General553448ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total15501391Total
Program Services14249594ProgramServices
Management And General1251797ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total1686276Total
Program Services1504158ProgramServices
Management And General182118ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total3646255Total
Program Services3252459ProgramServices
Management And General393796ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total1128175Total
Program Services1010326ProgramServices
Management And General117849ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total80271Total
Management And General80271ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total114662Total
Management And General114662ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total34586Total
Management And General34586ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total1123430Total
Program Services1025322ProgramServices
Management And General98108ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total116988Total
Program Services55594ProgramServices
Management And General61394ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total301821Total
Program Services67581ProgramServices
Management And General234240ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total349321Total
Program Services124035ProgramServices
Management And General225286ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total672703Total
Program Services668973ProgramServices
Management And General3730ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total55682Total
Program Services26826ProgramServices
Management And General28856ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total37456Total
Program Services37456ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total1632549Total
Program Services1582483ProgramServices
Management And General50066ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total455822Total
Program Services434325ProgramServices
Management And General21497ManagementAndGeneral

Other Expenses OtherExpenses (3 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
SUPPLIES96494059649405
PURCHASED SERVICES38589233737604121319
PROVISION FOR BAD DEBTS10036821003682

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total675687Total
Program Services603721ProgramServices
Management And General71966ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total42846907Total
Program Services39201918ProgramServices
Management And General3644989ManagementAndGeneral
Fundraising0Fundraising

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY4216045BOY
EOY4342398EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY147986BOY
EOY80417EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY3909354BOY
EOY4158027EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY930977BOY
EOY804115EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY273515BOY
EOY458701EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis36604179LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec27396052LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY10291431BOY
EOY9208127EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY199200BOY
EOY956174EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY19968508BOY
EOY20007959EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY5270429BOY
EOY5579215EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY4775951BOY
EOY3768822EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY1407893BOY
EOY3065685EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY11454273BOY
EOY12413722EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY8510599BOY
EOY7513820EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY3636BOY
EOY80417EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY8514235BOY
EOY7594237EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY19968508BOY
EOY20007959EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-1609882ReconcilationRevenueExpenses
Reconcilation Other Changes689884ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0Volunteers
Paid Staff Or Management0PaidStaffOrManagement
Media Advertisements0MediaAdvertisements
Mailings Members1MailingsMembers
Mailings Members$14,586MailingsMembersAmount
Publications Or Broadcast0PublicationsOrBroadcast
Grants Other Organizations0GrantsOtherOrganizations
Direct Contact Legislators1DirectContactLegislators
Direct Contact Legislators$0DirectContactLegislatorsAmount
Rallies Demonstrations0RalliesDemonstrations
Other Activities1OtherActivities
Other Activities$20,000OtherActivitiesAmount
Total Lobbying Expenditures IIB34586TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierEXPLANATION OF LOBBYING ACTIVITIES:Identifier
Return ReferencePART II-B, LINE 1:ReturnReference
ExplanationCOMMUNITY 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 $9143 OF WHICH $4114 WAS FOR LOBBYING. HEALTHCARE ASSOCIATION OF NYS - MEMBERSHIP DUES $21116 OF WHICH $6398 WAS FOR LOBBYING. AHA-MEMBERSHIP DUES $16562 OF WHICH $4074 WAS FOR LOBBYING. LOBBYIST WILSON,ELSNER,MARKOWITZ,ET AL RETAINED FOR $20000 FOR STATE LOBBYING REGARDING ENHANCEMENT OF ACUTE CARE MEDICAL RATES.Explanation

Schedule D IRS990ScheduleD

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance488980BeginningOfYearBalance
Contributions557783Contributions
Investment Earnings Or Losses11988InvestmentEarningsOrLosses
Other Expenditures260000OtherExpenditures
End Of Year Balance798751EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance638615BeginningOfYearBalance
Contributions244911Contributions
Investment Earnings Or Losses5454InvestmentEarningsOrLosses
Other Expenditures400000OtherExpenditures
End Of Year Balance488980EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance682787BeginningOfYearBalance
Contributions250127Contributions
Investment Earnings Or Losses5701InvestmentEarningsOrLosses
Other Expenditures300000OtherExpenditures
End Of Year Balance638615EndOfYearBalance

Current Year Minus3 Years CurrentYearMinus3Years

FieldValueIRS element (for citing)
Beginning Of Year Balance150835BeginningOfYearBalance
Contributions529522Contributions
Investment Earnings Or Losses2430InvestmentEarningsOrLosses
End Of Year Balance682787EndOfYearBalance
FieldValueIRS element (for citing)
Board Designated EOY Balance0.00000BoardDesignatedEOYBalance
Permanent Endowment EOY Balance0.00000PermanentEndowmentEOYBalance
Term Endowment EOY Balance1.00000TermEndowmentEOYBalance
Endowments Held By Unrelated Orgs0EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs1EndowmentsHeldByRelatedOrgs
Are Related Orgs Listed Schedule R1AreRelatedOrgsListedScheduleR

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis62115OtherCostOrOtherBasis
Book Value62115BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis18207458OtherCostOrOtherBasis
Depreciation11990733Depreciation
Book Value6216725BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis34006OtherCostOrOtherBasis
Depreciation24725Depreciation
Book Value9281BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis17037168OtherCostOrOtherBasis
Depreciation14692740Depreciation
Book Value2344428BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis1263432OtherCostOrOtherBasis
Depreciation687854Depreciation
Book Value575578BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings9208127TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescriptionAmountAmount
ACCRUED RETIREMENT OBLIGATIONS, NET$2,365,685
OTHER LONG-TERM LIABILITIES$700,000
FieldValueIRS element (for citing)
Total Of Amounts3065685TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierDESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:Identifier
Return ReferencePART X:ReturnReference
ExplanationTHE 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, 2011 AND 2010, 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 2008 THROUGH 2011. THE HOSPITAL AND FOUNDATION DO NOT ANTICIPATE THAT THE TOTAL UNRECOGNIZED TAX BENEFITS WILL CHANGE IN THE NEXT TWELVE MONTHS.Explanation

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
FPG Reference Free Care1FPGReferenceFreeCare
Pcent150XPcent150
FPG Reference Discounted Care1FPGReferenceDiscountedCare
Pcent300XPcent300
Free Disc Care Medically Indigent0FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget0ExpensesExceededBudget
Annual Community Benefit Report1AnnualCommunityBenefitReport
Report Publically Available1ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense186973TotalCommunityBenefitExpense
Direct Offsetting Revenue114309DirectOffsettingRevenue
Net Community Benefit Expense72664NetCommunityBenefitExpense
Percent Of Total Expense0.00170PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense4699881TotalCommunityBenefitExpense
Direct Offsetting Revenue4190966DirectOffsettingRevenue
Net Community Benefit Expense508915NetCommunityBenefitExpense
Percent Of Total Expense0.01220PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense4886854TotalCommunityBenefitExpense
Direct Offsetting Revenue4305275DirectOffsettingRevenue
Net Community Benefit Expense581579NetCommunityBenefitExpense
Percent Of Total Expense0.01390PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense109458TotalCommunityBenefitExpense
Direct Offsetting Revenue38308DirectOffsettingRevenue
Net Community Benefit Expense71150NetCommunityBenefitExpense
Percent Of Total Expense0.00170PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense109458TotalCommunityBenefitExpense
Direct Offsetting Revenue38308DirectOffsettingRevenue
Net Community Benefit Expense71150NetCommunityBenefitExpense
Percent Of Total Expense0.00170PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense4996312TotalCommunityBenefitExpense
Direct Offsetting Revenue4343583DirectOffsettingRevenue
Net Community Benefit Expense652729NetCommunityBenefitExpense
Percent Of Total Expense0.01560PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported1BadDebtExpenseReported
Bad Debt Expense$576,816BadDebtExpenseAmount
Amount Attributable To438380AmountAttributableTo
Amount Reimbursed By Medicare9877567AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare11287038CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-1409471MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care1ProvisionForCharityCare
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1COMMUNITY MEMORIAL HOSPITAL INCBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line1150 BROAD STAddressLine1
CityHAMILTONCity
StateNYState
ZIP Code13346ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1COMMUNITY MEMORIAL HOSPITAL INCBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
Eligibility Criteria Explained1EligibilityCriteriaExplained
Uses FPG Free1UsesFPGFree
FPG Free Percent150.000000000000FPGFreePercent
Uses FPG Discounted1UsesFPGDiscounted
FPG Discount Percent300.000000000000FPGDiscountPercent
Explains Basis1ExplainsBasis
Income LevelXIncomeLevel
State RegulationXStateRegulation
Explains Application Method1ExplainsApplicationMethod
Includes Publicity Measures1IncludesPublicityMeasures
Posted On WebsiteXPostedOnWebsite
Posted In Emergency RoomXPostedInEmergencyRoom
Posted In Admission OfficeXPostedInAdmissionOffice
Provided On AdmissionXProvidedOnAdmission
Available On RequestXAvailableOnRequest
Other PublicityXOtherPublicity
Actions On Nonpayment1ActionsOnNonpayment
Collection Activities0CollectionActivities
Nondiscrim Emergency Care Policy1NondiscrimEmergencyCarePolicy
Used Other MethodXUsedOtherMethod
Amounts Generally Billed0AmountsGenerallyBilled
Gross Charges0GrossCharges

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities6NumberOfOtherFacilities

Other Facilities OtherFacilities (6 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeFacility TypeFacilityType
COMMUNITY MEMORIAL HOSPITAL SNF
150 BROAD STHAMILTONNY13346ATTACHED SKILLED NURSING FACILITY
COMMUNITY MEMORIAL HOSPITAL FHC
164 BROAD STHAMILTONNY13346PRIMARY CARE PHYSICIAN OFFICE
COMMUNITY MEMORIAL HOSPITAL FHC
3460 SOUTH STMORRISVILLENY13408PRIMARY CARE PHYSICIAN OFFICE
COMMUNITY MEMORIAL HOSPITAL FHC
3045 RT 20CAZENOVIANY13035PRIMARY CARE PHYSICIAN OFFICE
COMMUNITY MEMORIAL HOSPITAL FHC
117 WEST MAIN STWATERVILLENY13480PRIMARY CARE PHYSICIAN OFFICE
COMMUNITY MEMORIAL HOSPITAL FHC
4180 SOUTH MAIN STMUNNSVILLENY13409PRIMARY CARE PHYSICIAN OFFICE

Form990 Schedule H Part VI Form990ScheduleHPartVI (12 entries)

ExplanationExplanationIdentifierIdentifierReturn ReferenceReturnReference
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 1,003,682 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- WE USED THE COST-TO-CHARGE RATIO FROM WORKSHEET 2, LINE 11 MULTIPLIED BY OUR TOTAL BAD DEBT EXPENSE.LINE 3 METHODOLOGY- WE TOOK THE APPROVAL PERCENTAGE OF 76.0% ON ALL PATIENTS WHO APPLIED FOR CHARITY CARE IN 2011 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 2011 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 $1,409,471 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 V, SECTION B, LINE 13G: 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 19D: WE USED THE NEGOTIATED COMMERCIAL INSURANCE RATE OF OUR HIGHEST VOLUME COMMERCIAL PAYOR.COMMUNITY MEMORIAL HOSPITAL, INC
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. CARDIOLOGY (EEG) MUSE SYSTEM, MAMMOGRAPHY IMAGER, PHACO VISION SYSTEM, RADIOLOGY PAC SYSTEM STORAGE, INTRAVENOUS DRUG THERAPY INFUSION PUMPS, PRIMARY CARE CLINICS ELECTRONIC MEDICAL RECORDS SYSTEM.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 FORMED A NETWORK OF FIVE FAMILY HEALTH CENTERS( IN CAZENOVIA, 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.
NYREPORTS FILED WITH STATESPART VI, LINE 7

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Substantiation Required1SubstantiationRequired
Independent ConsultantXIndependentConsultant
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (8 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
KERRI TAYLOR MD
1450000217130000016610168374000
DAVID FELTON
2854420000000367620322204000
RICHARD KIRBY
1995880000000316560231244000
RAYMOND CARLSON
35950001980000000220580401358000
ROBERT DELORME
20900004731300000220580278371000
EDWARD MCDONALD
2106540000000219450232599000
COLLEEN PARENT
15180001797500000220580191833000
EUFROSINA YOUNG MD
22915001468400000220580265892000

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (6 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
FORM 990, PART VI, SECTION B, LINE 11THE 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 REVIEWS.
FORM 990, PART VI, SECTION B, LINE 12CTHE 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 15THE 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 19FINANCIAL 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 5:RETIREMENT PLAN OBLIGATION CHANGES OTHER THAN NET PERIODIC BENEFIT COSTS 429,884. NET ASSETS RELEASED FOR OPERATIONS 260,000. TOTAL TO FORM 990, PART XI, LINE 5: 689,884.CHANGES IN NET ASSETS OR FUND BALANCES:
FORM 990, PART XII, LINE 2CCOMMUNITY 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.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1COMMUNITY MEMORIAL HOSPITAL FOUNDATIONBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1150 BROAD STAddressLine1
CityHAMILTONCity
StateNYState
ZIP Code13346ZIPCode
FieldValueIRS element (for citing)
EIN161603283EIN
Primary ActivitiesFUNDRAISINGPrimaryActivities
Legal Domicile StateNYLegalDomicileState
Exempt Code Section501 C 3ExemptCodeSection
Public Charity Status11- TYPE IIIPublicCharityStatus
Direct Controlling Entity NAN/ADirectControllingEntityNA
Controlled Org0ControlledOrg
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities1SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg