2012-11-13T17:40:11-06:00 2011-12-31 161226221 FUST CHARLES CHAMBERS LLP 5784 WIDEWATERS PARKWAY SYRACUSE NY 13214 990 2011-01-01 150548010 COMMUNITY MEMORIAL HOSPITAL INC COMM 3158246081 150 BROAD STREET HAMILTON NY 13346 RICHARD S KIRBY 3158246081 2012-11-10 1 ANGELA M FRANCO P00589741 3154463600 2011 2016-02-24 21:20:13Z RICHARD S KIRBY 150 BROAD STREET HAMILTON NY 13346 41347915 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. 15 15 409 25 0 0 544768 531766 40525947 40370075 75074 32555 344661 302629 41490450 41237025 0 0 0 0 21832726 22683919 0 0 0 21561843 20162988 43394569 42846907 -1904119 -1609882 19968508 20007959 11454273 12413722 8514235 7594237 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 23521151 21748463 OPERATION 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. 5096249 6180400 OPERATION OF AN AMBULATORY SURGERY UNITTOTAL VISITS 1780 7056345 9114110 OPERATION OF EMERGENCY SERVICES AND OUTPATIENT REFERRED AMBULATORY TESTING EMERGENCY ROOM VISITS 9812REFERRED AMBULATORY VISITS 38304 3528173 3327102 OPERATION OF PRIMARY CARE CLINICS TOTAL VISITS 42530 3528173 3327102 39201918 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 0 1 14 0 1 409 1 0 0 0 0 0 0 0 0 0 0 X 15 15 0 0 0 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 JOHN BRADLEY 1.00 X 0 0 0 SUSIE GUSTAFSON 1.00 X 0 0 0 DAVID REBUCK MD 1.00 X 0 0 0 LAWRENCE BAKER 1.00 X 0 0 0 JOHN MORRIS 1.00 X 0 0 0 WILLIAM MAGEE 1.00 X 0 0 0 SUSAN BARRETT 1.00 X 0 0 0 JEFFREY RUBENSTEIN 1.00 X 0 0 0 BARBARA WHELER 1.00 X 0 0 0 PATRICIA CAPRIO 1.00 X 0 0 0 JANE PINCHIN 1.00 X 0 0 0 KERRI TAYLOR MD 40.00 X 166713 0 1661 LAWRENCE TULLY 1.00 X X 0 0 0 CYNTHIA HUMMEL 1.00 X X 0 0 0 WILLIAM GETMAN 1.00 X X 0 0 0 DAVID FELTON 40.00 X 285442 0 36762 RICHARD KIRBY 40.00 X 199588 0 31656 RAYMOND CARLSON 40.00 X 379300 0 22058 ROBERT DELORME 40.00 X 256313 0 22058 EDWARD MCDONALD 40.00 X 210654 0 21945 COLLEEN PARENT 40.00 X 169775 0 22058 EUFROSINA YOUNG MD 40.00 X 243834 0 22058 1911619 0 180256 19 0 1 0 HAMILTON CRITICAL CARE & EMERGENCY PO BOX 605 DEWITT NY 13214 EMERGENCY ROOM SERVICES 120000 1 531766 531766 INPATIENT 622110 21748463 21748463 REFERRED AMBULATORY 621990 9114110 9114110 AMBULATORY SURGERY 621990 6180400 6180400 CLINIC 621110 3327102 3327102 40370075 32555 32555 188090 110890 77200 77200 77200 TOBACCO STLMT FNDS 900099 126000 126000 CAFETERIA SALES 900099 52840 52840 WELLNESS CTR DUES 900099 38308 38308 8281 8281 225429 41237025 40370075 0 335184 721822 168374 553448 15501391 14249594 1251797 1686276 1504158 182118 3646255 3252459 393796 1128175 1010326 117849 80271 80271 114662 114662 34586 34586 1123430 1025322 98108 116988 55594 61394 301821 67581 234240 349321 124035 225286 672703 668973 3730 55682 26826 28856 37456 37456 1632549 1582483 50066 455822 434325 21497 SUPPLIES 9649405 9649405 PURCHASED SERVICES 3858923 3737604 121319 PROVISION FOR BAD DEBTS 1003682 1003682 675687 603721 71966 42846907 39201918 3644989 0 4216045 4342398 147986 80417 3909354 4158027 930977 804115 273515 458701 36604179 27396052 10291431 9208127 199200 956174 19968508 20007959 5270429 5579215 4775951 3768822 1407893 3065685 11454273 12413722 X 8510599 7513820 3636 80417 8514235 7594237 19968508 20007959 X -1609882 689884 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 1 14586 0 0 1 0 0 1 20000 34586 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 $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. 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 18207458 11990733 6216725 34006 24725 9281 17037168 14692740 2344428 1263432 687854 575578 9208127 ACCRUED RETIREMENT OBLIGATIONS, NET 2365685 OTHER LONG-TERM LIABILITIES 700000 3065685 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: 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, 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. 1 1 1 X 1 X 0 1 0 1 1 186973 114309 72664 0.00170 4699881 4190966 508915 0.01220 4886854 4305275 581579 0.01390 109458 38308 71150 0.00170 109458 38308 71150 0.00170 4996312 4343583 652729 0.01560 1 576816 438380 9877567 11287038 -1409471 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 6 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

3045 RT 20 CAZENOVIA NY 13035

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 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. COMMUNITY MEMORIAL HOSPITAL, INC 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. 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. REPORTS FILED WITH STATES PART VI, LINE 7 NY 1 X X X 0 0 0 0 0 0 0 0 0 KERRI TAYLOR MD 145000 0 21713 0 0 0 0 0 1661 0 168374 0 0 0 DAVID FELTON 285442 0 0 0 0 0 0 0 36762 0 322204 0 0 0 RICHARD KIRBY 199588 0 0 0 0 0 0 0 31656 0 231244 0 0 0 RAYMOND CARLSON 359500 0 19800 0 0 0 0 0 22058 0 401358 0 0 0 ROBERT DELORME 209000 0 47313 0 0 0 0 0 22058 0 278371 0 0 0 EDWARD MCDONALD 210654 0 0 0 0 0 0 0 21945 0 232599 0 0 0 COLLEEN PARENT 151800 0 17975 0 0 0 0 0 22058 0 191833 0 0 0 EUFROSINA YOUNG MD 229150 0 14684 0 0 0 0 0 22058 0 265892 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 REVIEWS. 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 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. 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 1 1 0 0 0 0