2011-11-04T10:11:51-05:00 2010-12-31 FUST CHARLES CHAMBERS LLP 5784 WIDEWATERS PARKWAY SYRACUSE NY 13214 990 2010-01-01 150548010 COMMUNITY MEMORIAL HOSPITAL INC COMM 3158246081 150 BROAD STREET HAMILTON NY 13346 DAVID W FELTON 3158246080 2011-10-20 1 3154463600 2010 2016-03-07 17:11:31Z DAVID W FELTON 150 BROAD STREET HAMILTON NY 13346 41600884 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 15 446 25 0 0 795823 544768 42493326 40525947 121778 75074 384414 344661 43795341 41490450 0 0 0 0 22377760 21832726 0 0 0 21987443 21561843 44365203 43394569 -569862 -1904119 23588519 19968508 13058397 11454273 10530122 8514235 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 23745476 22786549 OPERATION OF AN ACUTE CARE GENERAL HOSPITAL WITH AN ATTACHED SKILLED NURSING FACILITY. ACUTE CARE SNFBEDS 36 40PATIENT DAYS OF CARE 7839 13728ADMISSIONS 2084 93COMMUNITY 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 THROMBOSISCOMMUNITY MEMORIAL HOSPITAL STRIVES TO IMPROVE THE HEALTH OF THE COMMUNITY BY:1) PARTICIPATING IN LOCAL HEALTH FAIRS2) PARTICIPATION IN COMMUNITY HEALTH EDUCATION3) COMMUNITY SMOKING CESSATION PROGRAMS4) 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 2010 COMMUNITY MEMORIAL HOSPITAL PROVIDED CHARITY CARE IN THE AMOUNT OF $263,925 TO APPROXIMATELY 253 PATIENTS. 5144853 6108101 OPERATION OF AN AMBULATORY SURGERY UNITTOTAL VISITS 1897 6727886 8588225 OPERATION OF EMERGENCY SERVICES AND OUTPATIENT REFERRED AMBULATORY TESTING EMERGENCY ROOM VISITS 10020REFERRED AMBULATORY VISITS 38372 3957579 3043072 OPERATION OF PRIMARY CARE CLINICS TOTAL VISITS 44206 3957579 3043072 39575794 1 1 0 1 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 17 17 1 446 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 RAY CROSS 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 X 193646 0 1061 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 JEFFREY RUBENSTEIN 1.00 X X 0 0 0 DAVID FELTON 40.00 X X 282490 0 35479 RICHARD KIRBY 40.00 X X 208867 0 30382 DENISE HUMMER 40.00 X 137570 0 26950 ROBERT DELORME 40.00 X X 260780 0 21352 JOHN HUBBARD 40.00 X 37086 0 11296 CARINA ALFARO-FRANCO MD 40.00 X 270254 0 12550 EURFROSINA YOUNG MD 40.00 X 247106 0 1889 JENNIFER MEYERS MD 40.00 X 170127 0 21352 BARBARA JEFFERS MD 40.00 X 165233 0 21352 1973159 0 183663 19 0 1 0 HAMILTON CRITICAL CARE & EMERGENCY PO BOX 605 DEWITT NY 13214 EMERGENCY ROOM SERVICES 120000 1 544768 544768 INPATIENT 622110 22786549 22786549 REFERRED AMBULATORY 621990 8588225 8588225 AMBULATORY SURGERY 621990 6108101 6108101 CLINIC 621110 3043072 3043072 40525947 75074 75074 202912 110434 92478 92478 92478 TOBACCO STLMT FNDS 900099 126000 126000 CAFETERIA SALES 900099 51309 51309 CCC-SERVICES 900099 30892 30892 43982 43982 252183 41490450 40525947 0 419735 1246959 476839 770120 15515681 14305499 1210182 668079 592586 75493 3227648 2862924 364724 1174359 1048890 125469 45546 45546 174571 174571 1797734 1579668 218066 113614 73373 40241 304943 64521 240422 354985 121006 233979 607009 596478 10531 70676 32381 38295 56385 56385 1832176 1755122 77054 436530 414603 21927 SUPPLIES 9875229 9875229 PURCHASED SERVICES 3950059 3872997 77062 PROVISION FOR BAD DEBTS 1191349 1191349 OTHER EXPENSES 751037 655944 95093 43394569 39575794 3818775 0 6098062 4216045 30371 147986 4323340 3909354 890716 930977 278875 273515 35988817 25697386 11449848 10291431 517307 199200 23588519 19968508 5651116 5270429 5778013 4775951 1629268 1407893 13058397 11454273 X 10363131 8510599 166991 3636 10530122 8514235 23588519 19968508 X -1904119 -111768 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 1 10502 0 0 1 0 0 0 10502 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: 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 $4250 WAS FOR LOBBYING. HEALTHCARE ASSOCIATION OF NYS - MEMBERSHIP DUES $20702 OF WHICH $6252 WAS FOR LOBBYING. 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 18108843 11333994 6774849 34006 21013 12993 16522836 13717946 2804890 1261017 624433 636584 10291431 ACCRUED RETIREMENT OBLIGATIONS, NET 1407893 1407893 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, 2010 AND 2009, 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 2007 THROUGH 2010. 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 202142 122691 79451 0.00190 4983451 4644463 338988 0.00800 5185593 4767154 418439 0.00990 106230 38778 67452 0.00160 106230 38778 67452 0.00160 5291823 4805932 485891 0.01150 1 659888 503495 10339022 11636078 -1297056 X 1 1 1 1 COMMUNITY MEMORIAL HOSPITAL INC

150 BROAD ST HAMILTON NY 13346

X X X COMMUNITY MEMORIAL HOSPITAL INC 1 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 MEDICAID COST-TO-CHARGE RATIO WAS USED, DERIVED BY USING THE COST-TO-CHARGE RATIOS FROM OUR 2010 MEDICARE COST REPORT, APPLIED AGAINST MEDICAID CHARGES, RESULTING IN MEDICAID COSTS, THEN GETTING MEDICAID COST-TO-CHARGE RATIO.LINE 7E - WE USED OUR ACTUAL EXPENSES AND ACTUAL REVENUE FROM OUR WELLNESS CENTER. PART I, L7 COL(F): BAD DEBT EXPENSE OF 1,191,349 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 76.3% ON ALL PATIENTS WHO APPLIED FOR CHARITY CARE IN 2010 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 2010 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 $1,297,056 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 HOSPITAL'S ANNUAL REVIEW OF IT'S STRATEGIC PLANNING PROCESS DRIVES OUR ASSESSMENT OF COMMUNITY HEALTH NEEDS. 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 6: 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 SEVEN FAMILY PRACTICE SPECIALISTS, A PEDIATRICIAN, AN INTERNIST, NURSE PRACTIONERS/PHYSICIAN ASSISTANTS, SUPPORT STAFF FOR THE CENTERS AND IN 2008 ADDED A HOSPITAL EMPLOYED CARDIOLOGIST. 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 48646 0 0 0 0 0 1061 0 194707 0 0 0 DAVID FELTON 282490 0 0 0 0 0 0 0 35479 0 317969 0 0 0 RICHARD KIRBY 208867 0 0 0 0 0 0 0 30382 0 239249 0 0 0 DENISE HUMMER 137570 0 0 0 0 0 0 0 26950 0 164520 0 0 0 ROBERT DELORME 209000 0 51780 0 0 0 0 0 21352 0 282132 0 0 0 CARINA ALFARO-FRANCO MD 267669 0 2585 0 0 0 0 0 12550 0 282804 0 0 0 EURFROSINA YOUNG MD 234500 0 12606 0 0 0 0 0 1889 0 248995 0 0 0 JENNIFER MEYERS MD 149500 0 20627 0 0 0 0 0 21352 0 191479 0 0 0 BARBARA JEFFERS MD 142000 0 23233 0 0 0 0 0 21352 0 186585 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 -511,768. NET ASSETS RELEASED FROM RESTRICTIONS 400,000. NET ASSETS RELEASED FOR OPERATIONS TOTAL TO FORM 990, PART XI, LINE 5: -111,768. 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