4A (Expenses $ 33891745 including grants of $ 0) (Revenue $ 37262522)
Inpatient Services: The hospital provided acute medical care and diagnostic services for 4,110 inpatient admissions who stayed a total of 21,379 days before discharge. Included in this total were medical and surgical, psychiatric, maternity, newborn and acute physical rehabilitation patients.

4B (Expenses $ 12378433 including grants of $ 0) (Revenue $ 13609557)
Outpatient services: There were 18,738 outpatient diagnostic visits during 2011. Included in these services were medical imaging testing, medical laboratory testing, rehabilitation services (provided in both an on and off campus setting) and two outpatient specialty services delivered in the hospital's wound care center and sleep center.

4C (Expenses $ 1992441 including grants of $ 0) (Revenue $ 2190604)
Emergency services: The hospital provided emergency care services to 12,195 patients in 2011. Emergency services were provided to all parties regardless of their ability to pay.

4D (Expenses $ 4616514 including grants of $ 0) (Revenue $ 5075660)
The hospital provided ambulatory surgery services to 2,067 patients in 2011. These services were delivered on an outpatient basis to patients who benefited from the proximity of a fully equipped acute care facility in the event of post-surgical complications. The hospital also had other revenue consisting of parking fees, leased employee reimbursement, cafeteria revenue and reimbursement from governmental agencies for indigent care and graduate medical education.

SchH_P01_S00_L03c Schedule H, Part I, Line 3c
Community General Hospital offered charity care and financial assistance for qualified patients who met eligibility requirements including annual gross income up to 300% of the Federal Poverty Level with a sliding discount that met (exceeded) the provision to discount so that qualified patients were not charged more than Medicare, Medicaid or the Hospital's highest non-government payor. CGH successfully increased the amount of charity care and financial assistance provided year after year. One of the challenges faced in providing charity care and financial assistance is raising awareness of the program's existence. This improved over recent years. Application information was made available at several key locations throughout the hospital, and the forms were also available on the hospital's website, http://cgh-home.org. The Hospital employed a full time Financial Caseworker to provide patients and their families' guidance throughout the application process. The Financial Caseworker also assisted them in applying for Medicaid. It should be noted that charity care and financial assistance was not dependent on whether or not they qualify for Medicaid, and the charity care and financial assistance application was independent from the Medicaid application. Community General Hospital followed the New York State Department of Health (NYS DOH) guidelines for charity care and financial assistance policies. Based on the guidelines, the hospital reduced the amount of documentation requested from the applicant. Copies of tax returns or a list of monthly expenses was not required from the applicant. Proof of income was requested, however, the Hospital made sure obtaining such proof was not overly burdensome on the applicant. Community General Hospital requested standard documentation such as recent paystubs, child support, and worker's compensation. This information was used to assess the applicant's financial situation. The hospital also requested asset information. According to the NYS DOH, charity care and financial assistance cannot be denied based on asset levels. Assets can only be used in upgrading the payment obligation of the patient but there is no clear guidance on how to adjust the payment obligation. The Hospital only takes into consideration assets in excess of three times the Federal Asset Level when determining the level of charity care and financial assistance offered. If an application is denied based on income levels or if there are extenuating circumstances and the applicant appeals, the case will be reviewed by an Appeals Committee made up of financial and clinical members within the hospital. The NYS DOH guidelines also require that charity care and financial assistance must be provided to residents, not just U.S. citizens. The Hospital's policy provided for charity care and financial assistance for all qualified NYS residents for emergent services, and for residents of the hospital's primary service area for non-emergent services. Community General Hospital's primary service area was Onondaga County and all contiguous counties. During 2010, the Hospital has implemented a program to further assist patients in obtaining health care coverage. A representative from a Medicaid Managed Care Payor was available on-site weekly to help patients apply for any Medicaid Managed Care, free or low-cost health insurance program. Forms were made available in the hospital for any patients who wanted to schedule an appointment to apply for coverage.

SchH_P01_S00_L06a Schedule H, Part I, Line 6a
Annually, Community General Hospital (CGH) prepared and made available the complete community benefit report on the CGH website, http://cgh-home.org. On July 7, 2011, with the approval of New York State, Community General Hospital sold substantially all of its assets to SUNY Upstate Medical University which is operating the hospital as a campus of its main facility. Therefore, no Community General Hospital community benefit report was available subsequent to the sale.

SchH_P01_S00_L07 Schedule H, Part I, Line 7
Community benefit expense calculations reported in Part I Lines 7 (a), (b), and (c) are calculated using the ratio of cost to charges as reported in the Institutional Cost Report. The costs reported for Part I Lines (e) and (f) are actual, incurred costs. The sources for charges, GME, IME and Health Assessments are the Institutional Cost Report, the GME Budget Report to NYS and Statistical Report, and payment history of Community General Hospital. For the calendar year ended December 31, 2011, during which Community General Hospital operated as an independent hospital for approximately 6 months (through July 7, 2011), the Hospital provided charity care and certain other community benefits, representing 4.66% of total expenses reported on Form 990, Part IX, Line 25, column (a).

SchH_P01_S00_L072f Schedule H, Part I, Line 7, Column f
Community benefit expense calculations reported in Part I Lines 7 (a), (b), and (c) are calculated using the ratio of cost to charges as reported in the Institutional Cost Report. The costs reported for Part I Lines (e) and (f) are actual, incurred costs. The sources for charges, GME, IME and Health Assessments are the Institutional Cost Report, the GME Budget Report to NYS and Statistical Report, and payment history of Community General Hospital. For the calendar year ended December 31, 2011, during which Community General Hospital operated as an independent hospital for approximately 6 months (through July 7, 2011), the Hospital provided charity care and certain other community benefits, representing 4.66% of total expenses reported on Form 990, Part IX, Line 25, column (a).

SchH_P03_S0A_L04 Schedule H, Part III, Section A, Line 4
Bad debt is calculated using the ratio of cost to charges. The source for both the ratio of cost to charges and charges is the Institutional Cost Report.

SchH_P03_S0B_L08 Schedule H, Part III, Section B, Line 8
"Since 1964, when Community Hospital merged with the 69-year-old Syracuse General Hospital, through July 6, 2011 when, as discussed previously, its operations ceased. Community General Hospital of Greater Syracuse served the populations of Onondaga and surrounding counties. ""The core purpose of Community General Hospital is to advance high quality, safe, compassionate and cost-effective health care for the Central New York community."" This commitment extended to all patients regardless of ability to pay or type of insurance. Historically approximately 43% of all inpatient stays and 24% of all outpatient visits were Medicare patients. The reimbursement from Medicare is less than 42% and 31% of inpatient and outpatient charges respectively. At this level of reimbursement the payments are not nearly adequate to cover the costs of the delivery of care. Community General Hospital did not discriminate with regard to a patient's ability to pay. Consequently, the hospital absorbed significant shortfalls in Medicare."

SchH_P03_S0C_L09b Schedule H, Part III, Section C, Line 9b
"Patients without the ability to meet their financial obligations were contacted and evaluated for charity care and financial assistance. Educational materials were readily available in the hospital and there was full time assistance available to help patients with the charity care and financial assistance program at Community General Hospital. As stated in the Community General Hospital Charity Care and Financial Assistance Policy, ""The hospital provides assistance to low-income, uninsured or under-insured individuals who cannot afford to pay in full or in part for the care they received. Community General Hospital will consider a patient's income, assets (excluding primary residence, primary vehicle, retirement or college savings programs) and health care needs. This policy is not intended to eliminate personal responsibility for meeting financial obligations, including amounts owed for health care services. All patients are expected to contribute to their hospital care based on their individual ability to pay."""

SchH_P06_S00_L02 Schedule H, Part VI, Line 2
"The following are excerpts from the 2009 and 2010 reports. The determination of community needs has been developed as part of a broader process conducted by the Onondaga County Department of Health to define the health care needs of the community. The outcome of the process was to identify the following areas of focus which Community General Hospital embraces in its mission to ""to advance high quality, safe, compassionate and cost-effective health care for the Central New York community."" The prevention agenda priorities identified in 2009 were: * Access to quality health care * Healthy mothers, healthy babies, healthy children * Tobacco use The prevention agenda priorities: * Community status improvement with an emphasis on school age children * Healthy mothers, healthy babies/access to care with an emphasis on refugee health * Tobacco use The health improvement goals identified are as follows: Community status improvement: * Promote preventive care * Provide incentives for doctors to focus in primary care * Decrease wait times in hospital emergency departments * Lower rates of chronic disease * Decrease number of unintended pregnancies * Establish a generally healthier, more active community Healthy mothers, healthy babies, healthy children: * Organize refugee health care, particularly for maternal and child health services * Improve the health of refugee children, mothers and babies Tobacco use: * Implement smoke-free campuses * Engage public policy system through development of targeted laws and regulation * Reduce chronic diseases associated with tobacco use and secondhand smoke exposure"

SchH_P06_S00_L03 Schedule H, Part VI, Line 3
Community General Hospital offered charity care and financial assistance for qualified patients who met eligibility requirements including annual gross income up to 300% of the Federal Poverty Level with a sliding discount that met (exceeded) the provision to discount so that qualified patients were not charged more than Medicare, Medicaid or the Hospital's highest non-government payor. CGH successfully increased the amount of charity care and financial assistance provided year after year. One of the challenges faced in providing charity care and financial assistance is raising awareness of the program's existence. This improved over recent years. Application information was made available at several key locations throughout the hospital, and the forms were also available on the hospital's website, http://cgh-home.org. The Hospital employed a full time Financial Caseworker to provide patients and their families' guidance throughout the application process. The Financial Caseworker also assisted them in applying for Medicaid. It should be noted that charity care and financial assistance was not dependent on whether or not they qualify for Medicaid, and the charity care and financial assistance application was independent from the Medicaid application. Community General Hospital followed the New York State Department of Health (NYS DOH) guidelines for charity care and financial assistance policies. Based on the guidelines, the hospital reduced the amount of documentation requested from the applicant. Copies of tax returns or a list of monthly expenses was not required from the applicant. Proof of income was requested, however, the Hospital made sure obtaining such proof was not overly burdensome on the applicant. Community General Hospital requested standard documentation such as recent paystubs, child support, and worker's compensation. This information was used to assess the applicant's financial situation. The hospital also requested asset information. According to the NYS DOH, charity care and financial assistance cannot be denied based on asset levels. Assets can only be used in upgrading the payment obligation of the patient but there is no clear guidance on how to adjust the payment obligation. The Hospital only takes into consideration assets in excess of three times the Federal Asset Level when determining the level of charity care and financial assistance offered. If an application is denied based on income levels or if there are extenuating circumstances and the applicant appeals, the case will be reviewed by an Appeals Committee made up of financial and clinical members within the hospital. The NYS DOH guidelines also require that charity care and financial assistance must be provided to residents, not just U.S. citizens. The Hospital's policy provided for charity care and financial assistance for all qualified NYS residents for emergent services, and for residents of the hospital's primary service area for non-emergent services. Community General Hospital's primary service area was Onondaga County and all contiguous counties. During 2010, the Hospital has implemented a program to further assist patients in obtaining health care coverage. A representative from a Medicaid Managed Care Payor was available on-site weekly to help patients apply for any Medicaid Managed Care, free or low-cost health insurance program. Forms were made available in the hospital for any patients who wanted to schedule an appointment to apply for coverage.

SchH_P06_S00_L04 Schedule H, Part VI, Line 4
On July 7, 2011 Community General sold substantially all of its assets and turned over the hospital operations to SUNY Upstate Medical University. The following information represents the most recent information regarding the Community General Service Area. Community General Hospital's primary service area (PSA) consisted of 22 zip codes representing approximately 70% of all 2008 inpatient discharges, excluding newborns. A minimum discharge contribution percentage of one percent, or approximately 150 discharges, was established for the five-county area. Zip codes in the five-county area that fell below the one percent discharge contribution threshold were classified as being part of the secondary service area (SSA). The SSA has a similar number of zip codes as the PSA and represents about 19% of total hospital discharges. Those hospital discharges from zip codes outside the five-county area, which all had a discharge contribution percent of less than one percent, were classified as the third tier. This methodology was developed for market and strategic planning purposes, and was useful in concentrating the hospital's focus on services that effectively meet community needs. Hospital Service Area The hospital's service area was categorized into three separate tiers. The primary service area included the following zip codes: * 13021 * 13027 * 13031 * 13203 * 13208 * 13205 * 13204 * 13202 * 13206 * 13207 * 13219 * 13078 * 13084 * 13090 * 13088 * 13108 * 13120 * 13212 * 13215 * 13152 * 13209 * 13210 The secondary service area included the following zip codes: * 13057 * 13104 * 13066 * 13159 * 13039 * 13060 * 13126 * 13069 * 13214 * 13037 * 13166 * 13224 * 13041 * 13080 * 13110 * 13036 * 13035 * 13032 * 13045 * 13029 * 13132 * 13135 * 13112 * 13077 * 13211 * 13164 * 13141 The third tier of the hospital's service area included the following zip codes: * 13033 * 13040 * 13030 * 13082 * 13063