2023-05-12T13:13:44-05:00 2022-06-30 134008324 PRICEWATERHOUSECOOPERS LLP 655 NEW YORK AVENUE NW - SUITE 1100 WASHINGTON DC 20001 990 2021-07-01 230465970 CHAMBERSBURG HOSPITAL CHAM 7178513055 PO BOX 2767 YORK PA 174052767 LAURA BUCZKOWSKI EXECUTIVE VP & CFO 7178513055 2023-05-12 1 LAURA BUCZKOWSKI 999009999 TRAVIS L PATTON P00369623 2024141000 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z ROXANNA GAPSTUR PO BOX 2767 YORK PA 174052767 595452955 0 X WWW.WELLSPAN.ORG X 1904 PA THE CHAMBERSBURG HOSPITAL IS A REGIONAL NONPROFIT HEALTH CARE ORGANIZATION COMMITTED TO THE IMPROVEMENT OF THE HEALTH AND WELL-BEING OF THE PEOPLE IN SOUTHCENTRAL PENNSYLVANIA. 16 8 2274 488 474465 5692 18624515 9102202 391666213 454253407 4491796 20364068 742529 916789 415525053 484636466 24500000 2090863 0 0 167209223 168504110 189419 0 0 192508809 256511452 384407451 427106425 31117602 57530041 562981898 490281910 246506351 193737619 316475547 296544291 X THE CHAMBERSBURG HOSPITAL IS A REGIONAL NON-PROFIT HEALTH CARE ORGANIZATION COMMITTED TO THE IMPROVEMENT OF THE HEALTH AND WELL-BEING OF THE PEOPLE IN SOUTHCENTRAL PENNSYLVANIA. 0 0 380109045 2090863 453778942 ESTABLISHED IN 1895, WELLSPAN CHAMBERSBURG HOSPITAL CONTINUES TO GROW TO BETTER SERVE FRANKLIN COUNTY AND SURROUNDING COMMUNITIES.THE CHAMBERSBURG HOSPITAL PROVIDES NEEDED MEDICAL CARE TO THE COMMUNITY REGARDLESS OF ANY PATIENT'S ABILITY TO PAY. HEALTH CARE SERVICES INCLUDE INPATIENT ROUTINE, INPATIENT ANCILLARY AND OUTPATIENT CARE. AT THE HOSPITAL, WE OFFER A FULL RANGE OF MEDICAL SERVICES, AS WELL AS AWARD-WINNING HEART AND STROKE CARE. OUR FACILITY OFFERS PRIVATE PATIENT ROOMS, CARDIOVASCULAR SUITES, FAMILY BIRTHING UNIT, STATE-OF-THE-ART EQUIPMENT, SURGICAL ROOMS, INPATIENT REHAB UNIT AND WOUND CARE CENTER WITH HYPERBARIC OXYGEN THERAPY.SEE WELLSPAN HEALTH - 2022 COMMUNITY BENEFIT REPORT LOCATED AT HTTPS://WWW.WELLSPAN.ORG/ABOUT/WELLSPAN-IN-THE-COMMUNITY/2022-COMMUNITY-BENEFIT-REPORT/ 380109045 1 1 0 1 0 0 0 0 0 1 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 2274 1 1 1 0 0 0 0 0 0 0 0 0 1 0 X 16 8 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 1 1 1 PA X DAVID RIZZUTO 7178513055 3350 WHITEFORD ROAD YORK PA 17402 ROXANNA GAPSTUR PRESIDENT & CEO - WELLSPAN HEALTH 1.00 40.00 X X 0 2170321 83138 JULIANNE CRAIG DIRECTOR 1.00 0.00 X 0 0 0 JOHN MASSIMILLA VP & PRESIDENT - CHAMBERSBURG HOSPITAL 40.00 0.00 X X 450750 0 74403 HORACE MARTIN MD DIRECTOR 1.00 0.00 X 0 0 0 JULIE RAMSEY DIRECTOR 1.00 0.00 X 0 0 0 STEVE HOLOVIAK DIRECTOR 1.00 0.00 X 0 0 0 KEVIN LORENTSEN MD DIRECTOR - MEDICAL ONCOLOGIST 1.00 40.00 X 0 469707 58425 CHERYL PLUMMER CHAIR 1.00 0.00 X 0 0 0 DENIS ONEIAL VICE CHAIR 1.00 0.00 X 0 0 0 DAVID DOUD DO DIRECTOR - DOCTOR 1.00 40.00 X 0 425721 64693 EDITH JARDINE DIRECTOR 1.00 0.00 X 0 0 0 EDWARD MACKLE MD DIRECTOR - DOCTOR 1.00 40.00 X 0 583611 84947 MIKE SEIM DIRECTOR - SVP CHIEF QUALITY CONTROL 1.00 40.00 X X 0 928980 68596 SHERRI STAHL DIRECTOR - SVP EASTERN REGION 40.00 0.00 X X 700986 0 57921 PATRICIA GREEN-RODGERS DIRECTOR 1.00 0.00 X 0 0 0 FARAAZ YOUSUF EXECUTIVE VP & COO - WELLSPAN HEALTH 1.00 40.00 X X 0 0 0 LAURA BUCZKOWSKI EXECUTIVE VP & CFO - WELLSPAN HEALTH 1.00 40.00 X X 0 840750 68808 DAVID LOVETT DIRECTOR 1.00 0.00 X X 0 0 0 NANCY MYERS CHAIR (DEPARTED 12/21) 1.00 0.00 X 0 0 0 JANE HYDE SR VICE PRESIDENT 40.00 0.00 X 1210709 0 56488 ELYSE FISHER CHIEF NURSING OFFICER 40.00 0.00 X 256613 0 67144 ANTHONY BRUNO CHIEF MEDICAL OFFICER 40.00 0.00 X 229668 0 2177 THOMAS ANDERSON VP MEDICAL AFFAIRS 40.00 0.00 X 411820 0 35525 GINGER EVERHART SR DIR CLINICAL OPERATIONS 40.00 0.00 X 195110 0 57066 MELISSA GROSS REGIONAL MGR PHARMACY 40.00 1.00 X 226686 0 67667 JAMES PRYOR VP PATIENT CARE SVCS 40.00 1.00 X 202328 0 52663 LARRY PENTZ MGR PHARMACY OPERATIONS 40.00 1.00 X 192898 0 53732 PATRICIA MCCULLOH SR DIR OPERATIONS 40.00 1.00 X 184292 0 57734 TANYA RUDOLPH MGR PHARMACY OPERATIONS 40.00 1.00 X 179991 0 52840 MICHAEL O'CONNOR FORMER DIRECTOR 0.00 0.00 X 0 833772 27389 4441851 6252862 1091356 291 1 1 0 HEALTHTRUST WORKFORCE SOLUTION 6565 N MACARTHUR BLVD STE 325 IRVING TX 75039 STAFFING SERVICES 4650675 CUMBERLAND VALLEY ER ASSOC 112 N 7TH ST CHAMBERSBURG PA 17201 MEDICAL 4631157 QUEST DIAGNOSTICS PO BOX 912512 PASADENA CA 91110 LAB SERVICES 2017641 CUMBERLAND VALLEY MOBILE PO BOX T 323 MAIN STREET CONYNGHAM PA 18219 MOBILE MRI 1540286 NUWEST GROUP HOLDINGS LLC 325 118TH AVE SE 300 BELLEVUE WA 98005 STAFFING SERVICES 1242392 26 1342953 7555635 203614 9102202 PATIENT SERVICES 621500 454193268 453718803 474465 MEDICAL EDUCATION 624100 60139 60139 454253407 2811952 2811952 584254 787738 -203484 -203484 -203484 127556525 24342 110028751 0 17527774 24342 17552116 17552116 CAFETERIA SALES 722514 408579 408579 OTHER SERVICES 900099 280986 280986 SALARY REIMBURSEMENTS 900099 267050 267050 163658 163658 1120273 484636466 453778942 474465 21280857 X 2090863 2090863 2539183 2539183 123864239 116076186 7788053 1778370 1718616 59754 30971182 28696273 2274909 9351136 8607178 743958 30213736 30213736 380599 380599 57257 57257 15017 15017 105877902 105032787 845115 192 192 1027379 755851 271528 470873 431434 39439 4343448 3216076 1127372 89253 62192 27061 14481 9591 4890 4130381 4130381 12901644 12773661 127983 3046036 3046036 MEDICAL SUPPLIES 59165607 59165607 BAD DEBT 22429502 22429502 TAXES & LICENSES 6981055 6938112 42943 REPAIRS & MAINTENANCE 4644476 4375638 268838 722614 552869 169745 427106425 380109045 46997380 0 5765 5815 25321867 612894 77000 51305841 49616687 6650849 13925881 4520383 3875858 5832305 4833980 294463401 185142126 116181538 109321275 294029640 259939711 53909294 32858060 4065578 13271337 344348 2020412 737490 0 562981898 490281910 55096135 49217502 12146816 122451730 118150218 546694 68958486 13676389 246506351 193737619 X 315935109 295355203 540438 1189088 316475547 296544291 562981898 490281910 X 57530041 -63416045 -14045252 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 15017 15017 0 PART II-B, LINE 1: A PORTION OF THE DUES PAID TO THE HOSPITAL ASSOCIATION OF PENNSYLVANIA AND THE AMERICAN HOSPITAL ASSOCIATION INCLUDE LOBBYING ($2,332 AND $12,685). 540438 711220 62570 1189088 211362 331064 1988 540438 3255758 385810 -30306 3399900 211362 2309798 710805 307112 41545 30412 3255758 2110603 28100 210972 15152 24725 2309798 0.00000 0.00000 1.00000 1 1 1 6350063 6350063 197508152 116380160 81127992 8084930 6004257 2080673 80558392 62757709 17800683 1961864 1961864 109321275 PRIVATE EQUITY LTD PARTNERSHIPS 20155863 F ABSOLUTE RETURN, LIMITED PARTNERSHIPS 825980 F REAL ESTATE, LTD PARTNERS 11876217 F 32858060 DERIVATIVE VALUATION 11703322 LEASE PAYABLE 1973067 13676389 X 421713443 -63416045 405715 -63010330 484723773 -87307 -87307 484636466 403167022 787738 787738 402379284 24727141 24727141 427106425 PART V, LINE 4: THE FUNDS WERE USED TO IMPROVE THE HEALTH AND WELFARE OF THE RESIDENTS OF FRANKLIN COUNTY IN PENNSYLVANIA. PART X, LINE 2: IN JUNE 2006, THE FINANCIAL ACCOUNTING STANDARDS BOARD (FASB) ISSUED INTERPRETATION NO. 48, ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES-AN INTERPRETATION OF FASB STATEMENT NO. 109, ACCOUNTING FOR INCOME TAXES (FIN 48), WHICH CREATES A SINGLE MODEL TO ADDRESS UNCERTAINTY IN TAX POSITIONS AND CLARIFIES THE ACCOUNTING FOR INCOME TAXES BY PRESCRIBING THE MINIMUM RECOGNITION THRESHOLD A TAX POSITION IS REQUIRED TO MEET BEFORE BEING RECOGNIZED IN THE FINANCIAL STATEMENTS. UNDER THE REQUIREMENTS OF FIN 48, TAX-EXEMPT ORGANIZATIONS COULD NOW BE REQUIRED TO RECORD AN OBLIGATION AS THE RESULT OF A TAX POSITION THEY HAVE HISTORICALLY TAKEN OR VARIOUS TAX EXPOSURE ITEMS. PRIOR TO FIN 48, THE DETERMINATION OF WHEN TO RECORD A LIABILITY FOR TAX EXPOSURE WAS BASED ON WHETHER A LIABILITY WAS CONSIDERED PROBABLE AND REASONABLY ESTIMABLE IN ACCORDANCE WITH SFAS NO.5, ACCOUNTING FOR CONTINGENCIES. ON JULY 1, 2007, THE PARENT COMPANY, WELLSPAN HEALTH, ADOPTED FIN 48. WELLSPAN HEALTH DETERMINED THAT IT DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS THROUGH JUNE 30, 2022. PART XI, LINE 2D - OTHER ADJUSTMENTS: MANAGEMENT FEES -206,776. GRANTS -2,090,863. CHANGE IN FV DERIVATIVE 13,576,278. BAD DEBT -22,429,502. GAIN ON PENSION PLAN 11,556,578. PART XI, LINE 4B - OTHER ADJUSTMENTS: NET ASSET ACTIVITY 700,431. RENTAL EXPENSE -787,738. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES NETTED WITH REVENUE 787,738. PART XII, LINE 4B - OTHER ADJUSTMENTS: GRANTS 2,090,863. MANAGEMENT FEES 206,776. BAD DEBT 22,429,502. 1 1 1 X 300.000000000000 1 X 1 1 0 1 1 3857924 0 3857924 0.00950 1 55846 65771526 30642838 35128688 0.08680 1 55846 69629450 30642838 38986612 0.09630 8 62273 112955 0 112955 0.00030 2 179 1336 0 1336 0.00000 2 0 3743240 0 3743240 0.00920 1 0 168505 0 168505 0.00040 5 0 18 62452 4026036 4026036 0.00990 19 118298 73655486 30642838 43012648 0.10620 1 105 436844 0 436844 0.00110 1 105 436844 436844 0.00110 1 6932136 109528 150930835 181387276 -30456441 X 1 1 1 1 CHAMBERSBURG HOSPITAL 112 NORTH SEVENTH STREET CHAMBERSBURG PA 17201 WWW.WELLSPAN.ORG 036001 X X X CHAMBERSBURG HOSPITAL 1 0 0 1 X X X X X X X X X 21 1 1 1 1 X WWW.WELLSPAN.ORG X VARIOUS COALITION WEBSITES - PART VI, LINE 5 EXPLANATION X X 1 21 1 WWW.WELLSPAN.ORG 0 1 X 300.000000000000 350.000000000000 X X X X X X X 1 1 X X X X 1 X WWW.WELLSPAN.ORG X WWW.WELLSPAN.ORG X WWW.WELLSPAN.ORG X X X X X X X 1 X 0 X X X X 1 X 0 0 CHAMBERSBURG HOSPITAL PART V, SECTION B, LINE 5: COMMUNITY STAKEHOLDER ENGAGEMENT HAS BEEN VITAL TO THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) PROCESS SINCE IT BEGAN IN YORK COUNTY IN 1994. COUNTY HEALTH COALITIONS ACROSS THE REGION, INCLUDING HEALTHY ADAMS COUNTY, HEALTHY FRANKLIN COUNTY, HEALTHY YORK, HEALTHY COMMUNITY NETWORK, NORTHERN LANCASTER COUNTY HUB, AND THE COMMUNITY HEALTH COUNCIL OF LEBANON COUNTY HAVE BEEN INSTRUMENTAL IN THE COMPLETION OF WELLSPAN'S COMMUNITY HEALTH NEEDS ASSESSMENT. THE COALITION LEADERS HAVE BEEN ACTIVELY ENGAGED THROUGHOUT THE PROCESS AND HAVE PROVIDED EXPERTISE AND GUIDANCE WHILE ALSO ENSURING THEIR LEADERSHIP AND COMMUNITY PARTNERS ARE HEARD AND ENGAGED IN THE NEEDS ASSESSMENT PROCESS. ADDITIONALLY, A DIVERSE GROUP OF STAKEHOLDERS INCLUDING COMMUNITY NOT-FOR-PROFIT AGENCIES, ELECTED OFFICIALS, FEDERALLY QUALIFIED HEALTH CENTERS, AND PUBLIC HEALTH EXPERTS, WERE ACTIVELY ENGAGED IN THE PROCESS. CHAMBERSBURG HOSPITAL PART V, SECTION B, LINE 6A: WELLSPAN'S COMMUNITY HEALTH NEEDS ASSESSMENT IS PREPARED BY THE PARENT ORGANIZATION, WELLSPAN HEALTH, AND INCLUDES COLLECTIVE EFFORTS OF ALL ENTITIES UNDER THE PARENT ORGANIZATION. HOSPITALS:1. YORK HOSPITAL2. GETTYSBURG HOSPITAL3. CHAMBERSBURG HOSPITAL4. WAYNESBORO HOSPITAL5. EPHRATA COMMUNITY HOSPITAL6. THE GOOD SAMARITAN HOSPITAL OF LEBANON, PENNSYLVANIA7. WELLSPAN SURGERY & REHABILITATION HOSPITAL8. PHILHAVENFOUNDATIONS:1. YORK HEALTH FOUNDATION2. SUMMIT HEALTH FOUNDATION3. GETTYSBURG HOSPITAL FOUNDATION4. EPHRATA COMMUNITY HEALTH FOUNDATION5. GOOD SAMARITAN HEALTH SERVICES FOUNDATIONMEDICAL SERVICES:1. APPLE HILL SURGICAL CENTER, INC.2. CHAMBERSBURG HEALTH SERVICES3. SUMMIT PHYSICIAN SERVICES4. VNA HOME HEALTH SERVICES5. WELLSPAN HEALTH CARE SERVICES6. WELLSPAN MEDICAL GROUP7. WELLSPAN SUMMIT HEALTH8. GOOD SAMARITAN PHYSICIAN SERVICES9. HEALTHY COMMUNITY PHARMACY10. VNA COMMUNITY SERVICES CHAMBERSBURG HOSPITAL PART V, SECTION B, LINE 6B: COUNTY HEALTH COALITIONS ACROSS THE REGION, INCLUDING HEALTHY ADAMS COUNTY, HEALTHY FRANKLIN COUNTY, HEALTHY YORK, THE NORTHERN LANCASTER COUNTY HUB, AND THE COMMUNITY HEALTH COUNCIL OF LEBANON COUNTY HAVE BEEN INSTRUMENTAL IN THE COMPLETION OF WELLSPAN'S COMMUNITY HEALTH NEEDS ASSESSMENT. THE COALITION LEADERS HAVE BEEN ACTIVELY ENGAGED THROUGHOUT THE PROCESS AND HAVE PROVIDED EXPERTISE AND GUIDANCE WHILE ALSO ENSURING THEIR LEADERSHIP AND COMMUNITY PARTNERS ARE HEARD AND ENGAGED IN THE NEEDS ASSESSMENT PROCESS. FEDERALLY QUALIFIED HEALTH CENTERS ACROSS WELLSPAN'S REGION WERE ALSO CONTRIBUTING PARTNERS, INCLUDING FAMILY FIRST HEALTH, KEYSTONE HEALTH, AND UNION COMMUNITY CARE. CHAMBERSBURG HOSPITAL PART V, SECTION B, LINE 7D: WITH EACH ITERATION OF THE CHNA PROCESS, WELLSPAN AND ITS COMMUNITY PARTNERS CONTINUE TO REFINE AND ENHANCE THE SYSTEM BY WHICH IT OBTAINS DATA, SHARED IT WITH KEY COMMUNITY, HOSPITAL ENTITIES, AND SYSTEM LEADERS, AND INTEGRATED IT INTO THE SYSTEM-WIDE AND ENTITY-LEVEL PLANNING PROCESSES. THE CHNA RESULTS AND RELATED PRIORITIES IDENTIFIED WERE SHARED WITH WELLSPAN HEALTH'S REGIONAL BOARDS OF DIRECTORS AND THE SYSTEM-WIDE LEADERSHIP TEAMS. THIS STAKEHOLDER GROUP IS COMPRISED OF COMMUNITY MEMBERS AND LEADERS THAT REPRESENT EACH OF WELLSPAN'S PRIMARY ENTITIES AND SERVICE AREAS, IN ADDITION TO EXECUTIVE LEADERSHIP. COLLECTIVE INPUT WAS USED TO ESTABLISH SYSTEM-WIDE PRIORITIES. THE ESTABLISHED COMMUNITY-DRIVEN COUNTY HEALTH COALITIONS AND WELLSPAN SPECIFIC PRIORITIES AND ASSOCIATED DATA WERE PRESENTED TO THE WELLSPAN HEALTH BOARD FOR THEIR ADOPTION. EACH COUNTY HEALTH COALITION HOSTED A PUBLIC FORUM IN SUMMER/ FALL 2022 TO COMMUNICATE THE CHNA RESULTS AND IDENTIFY PRIORITIES TO HUNDREDS OF COMMUNITY MEMBERS ACROSS THE REGION. DURING THE FORUMS, COMMUNITY MEMBERS DISCUSSED THE OPPORTUNITIES AND RISKS ASSOCIATED WITH EACH PRIORITY, AS WELL AS HOW THE ORGANIZATION WHICH THEY REPRESENT CAN HAVE AN IMPACT ON EACH PRIORITY. IN ADDITION TO THESE VENUES, CHNA RESULTS ARE AVAILABLE ON EACH COALITION'S WEBSITE, AS WELL AS WELLSPAN HEALTH'S WEBSITE AND MAY ALSO BE OBTAINED UPON REQUEST. THE CORRESPONDING WELLSPAN COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP) IS ALSO AVAILABLE ON THE WELLSPAN HEALTH WEBSITE. CHAMBERSBURG HOSPITAL PART V, SECTION B, LINE 11: WELLSPAN'S THREE-YEAR COMMUNITY HEALTH IMPROVEMENT PLAN PROVIDES A FRAMEWORK FOR THE ORGANIZATION'S PROGRAMS AND ACTIVITIES THAT PROMOTE HEALTH AND WELLNESS IN RESPONSE TO THE NEEDS IDENTIFIED IN THE CHNA REPORTS. THESE AREAS OF FOCUS MEET AT LEAST ONE, AND OFTEN SEVERAL, OF THE COMMUNITY BENEFIT GUIDELINES OF A NONPROFIT HEALTH SYSTEM, AS OUTLINED BY THE CATHOLIC HEALTH ASSOCIATION: IMPROVING ACCESS TO HEALTHCARE SERVICES; ENHANCING THE HEALTH OF THE COMMUNITY; ADVANCING MEDICAL OR HEALTHCARE KNOWLEDGE OR RELIEVING OR REDUCING THE BURDEN OF GOVERNMENT OR OTHER COMMUNITY EFFORTS. SPECIFIC PRIORITIES ARE THEN INCORPORATED INTO WELLSPAN'S ANNUAL OPERATING PLAN AND BUDGET.WHILE THIS PLAN INCLUDES AN ARRAY OF GOALS AND OBJECTIVES FOR BROAD PRIORITY AREAS, IT DOES NOT ADDRESS ALL HEALTH-RELATED ISSUES IDENTIFIED THROUGH THE COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS. WELLSPAN USES THE FOLLOWING CRITERIA TO DETERMINE WHEN NOT TO ADDRESS AN IDENTIFIED NEED IN OUR FORMAL COMMUNITY HEALTH IMPROVEMENT PLAN:1. EFFORTS SPECIFIC TO AN ISSUE ARE ALREADY UNDERWAY AND WILL CONTINUE, THEREFORE A CALL-OUT IN THE COMMUNITY HEALTH IMPROVEMENT PLAN IS UNNECESSARY.2. ISSUE APPEARS TO BE EMERGING AND WARRANTS MONITORING, BUT NOT AFFECTING THE COMMUNITY IN A MANNER THAT REQUIRES IMMEDIATE ACTION.3. A COMMUNITY-WIDE OR PARTNER SPECIFIC APPROACH WOULD BE MORE EFFECTIVE IN ADDRESSING THE NEED.SEE THE WELLSPAN HEALTH COMMUNITY HEALTH IMPROVEMENT PLAN AVAILABLE ONLINE AT: HTTPS://WWW.WELLSPAN.ORG/ABOUT/WELLSPAN-IN-THE-COMMUNITY/. CHAMBERSBURG HOSPITAL PART V, SECTION B, LINE 13H: WELLSPAN HEALTH IS COMMITTED TO CARING FOR ALL THE MEMBERS OF ITS COMMUNITIES, REGARDLESS OF THEIR ABILITY TO PAY. IN RECENT YEARS, OVERALL CHARITY CARE HAS DECREASED SLIGHTLY AS MORE PEOPLE HAVE OBTAINED HEALTH INSURANCE COVERAGE THROUGH THE AFFORDABLE CARE ACT AND THE EXPANSION OF PENNSYLVANIA'S MEDICAL ASSISTANCE (MEDICAID) PROGRAM. WELLSPAN IS PROUD TO BE A LEADING PARTNER IN THE HEALTHY COMMUNITY NETWORK, WHICH WORKS TO ADDRESS THE NEEDS OF UNINSURED AND UNDERINSURED INDIVIDUALS IN OUR COMMUNITY. IN ADDITION, THE HEALTH SYSTEM RECENTLY ENHANCED ITS FINANCIAL ASSISTANCE POLICY AND THE DISCOUNTS THAT IT PROVIDES ON SERVICES. FOR MORE INFORMATION ON WELLSPAN'S FINANCIAL ASSISTANCE PROGRAM, VISIT HTTPS://WWW.WELLSPAN.ORG/PATIENTS-VISITORS/PATIENT-GUIDE/BILLING-INSURANCE/FINANCIAL-ASSISTANCE/. CHAMBERSBURG HOSPITAL PART V, SECTION B, LINE 16J: IN AN EFFORT TO MAKE PATIENTS, FAMILIES AND OTHERS IN OUR COMMUNITIES AWARE OF THE NEWLY EXPANDED FINANCIAL ASSISTANCE POLICY (FAP), WELLSPAN BROADLY PUBLICIZED ITS POLICY VIA PROMOTIONAL SIGNAGE AND THE DISTRIBUTION OF EASY-TO-READ INFORMATIONAL MATERIALS AT REGISTRATION SITES THROUGHOUT OUR COMMUNITIES. WELLSPAN PROVIDED INFORMATION ON THE FAP ON ITS BILLING STATEMENTS AND INCLUDED INFORMATION IN PATIENT DISCHARGE MATERIALS. IN ADDITION, THE MATERIALS AND INFORMATION ARE EASILY ACCESSIBLE VIA WELLSPAN'S WEBSITE AT WWW.WELLSPAN.ORG. THE SITE REFLECTS WELLSPAN'S NEWLY ENHANCED POLICY, AS WELL AS INFORMATIONAL AND APPLICATION MATERIALS. IT WAS ALSO PUBLICIZED VIA WELLSPAN'S ON-HOLD PHONE MESSAGING SYSTEM AND IN ITS DIRECT-TO-CONSUMER COMMUNITY NEWSLETTER/MAGAZINE, WHICH IS DISTRIBUTED BY MAIL, EMAIL AND ON-LINE. IN ADDITION, WELLSPAN PLACED POSTERS AND SIGNAGE AT ITS VARIOUS SITES OF CARE TO PUBLICIZE THE FAP. PRINTED COPIES OF WELLSPAN HEALTH'S POLICY AND THE PLAIN LANGUAGE SUMMARY OF THE POLICY, BOTH OF WHICH ARE AVAILABLE IN ENGLISH AND SPANISH, MAY BE OBTAINED AT NO COST BY VISITING OR CALLING ONE OF THE WELLSPAN PATIENT FINANCIAL SERVICES OFFICES.THE FINANCIAL ASSISTANCE POLICY, FINANCIAL ASSISTANCE APPLICATION, AND THE FINANCIAL ASSISTANCE POLICY PLAIN LANGUAGE SUMMARY ARE ALL AVAILABLE IN ENGLISH AND SPANISH. 11 1 - WELLSPAN CHAMBERSBURG HOSPITAL 176 SOUTH COLDBROOK AVENUE CHAMBERSBURG PA 172012714 PSYCHIATRIC UNIT 2 - WELLSPAN CHAMBERSBURG HOSPITAL 12 ST PAUL DRIVE CHAMBERSBURG PA 172011035 DIAGNOSTIC SERVICES 3 - WELLSPAN CHAMBERSBURG HOSPITAL MERCERSBU 2 KEEFER DRIVE MERCERSBURG PA 172361732 LABORATORY SERVICES 4 - WELLSPAN CHAMBERSBURG HOSPITAL 22 ST PAUL DRIVE CHAMBERSBURG PA 172011036 CARDIOLOGY TESTING 5 - WELLSPAN CHAMBERSBURG HOSPITAL MRI & SLE 97 PROGRESS BOULEVARD SHIPPENSBURG PA 172579053 SLEEP LAB FACILITY 6 - WELLSPAN CHAMBERSBURG HOSPITAL FIFTH AV 761 5TH AVENUE CHAMBERSBURG PA 172014210 LABORATORY SERVICES 7 - WELLSPAN CHAMBERSBURG HOSPITAL RESULTS T 1600 ORCHARD DRIVE CHAMBERSBURG PA 172019206 REHABILITATION SERVICES 8 - WELLSPAN CHAMBERSBURG HOSPITAL SHIPPENSB 46 WALNUT BOTTOM ROAD SHIPPENSBURG PA 172578219 LABORATORY SERVICES 9 - WELLSPAN CHAMBERSBURG HOSPITAL GREENCAST 50 EASTERN AVENUE GREENCASTLE PA 172251178 LABORATORY SERVICES 10 - WELLSPAN CHAMBERSBURG HOSPITAL CENTER FO 59 NORTH 7TH STREET CHAMBERSBURG PA 172011717 REHABILITATION SERVICES 11 - WELLSPAN CHAMBERSBURG HOSPITAL GREENCAST 24 ANTRIM COMMONS DRIVE GREENCASTLE PA 172251623 REHABILITATION SERVICES PART I, LINE 3C: PATIENTS/GUARANTORS WHO COMPLETE AN APPLICATION FOR FINANCIAL ASSISTANCE, WHOSE GROSS INCOME FALLS BETWEEN 351-400% OF THE FEDERAL POVERTY LEVEL (FPL), AND MEET ALL OTHER FINANCIAL ASSISTANCE QUALIFICATIONS, WILL BE ELIGIBLE FOR A 40% DISCOUNT ON SELF-PAY BALANCES. PATIENTS WHO HAVE GROSS INCOME IN EXCESS OF 400% OF FPL DO NOT QUALIFY FOR FINANCIAL ASSISTANCE. PART I, LINE 6A: COMMUNITY BENEFIT INFORMATION IS INCLUDED IN THE COMMUNITY BENEFIT REPORT FOR WELLSPAN HEALTH. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 22,429,502. PART III, LINE 2: THE NUMBER WAS CALCULATED USING THE COST TO CHARGE RATIO FACTOR APPLIED AGAINST ACTUAL PATIENT BAD DEBT WRITE-OFFS. THESE NUMBERS ARE INCLUDED AFTER ALL EFFORTS HAVE BEEN EXHAUSTED TO DETERMINE IF THE PATIENT MEETS OUR CHARITY CARE WRITE-OFF POLICY BASED ON FEDERAL POVERTY LEVELS. PART III, LINE 3: THE ESTIMATE OF BAD DEBT ATTRIBUTABLE TO CHARITY CARE POLICY WAS CALCULATED BY DIVIDING THE BAD DEBT AMOUNT THAT WAS ORIGINALLY CODED BAD DEBT BUT LATER FOUND TO QUALIFY AS CHARITY CARE BY THE AMOUNT CODED TO THE CHARITY CARE WRITE-OFF CODES. THIS RATIO IS APPLIED TO THE BAD DEBT COST FACTOR EXPENSE. PART III, LINE 4: CHAMBERSBURG HOSPITAL PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR ESTIMATED LOSSES RESULTING FROM THE UNWILLINGNESS OR INABILITY OF PATIENTS TO MAKE PAYMENTS FOR SERVICES. THE ALLOWANCE IS DETERMINED BY ANALYZING SPECIFIC AMOUNTS AND HISTORICAL DATA AND TRENDS. PATIENT ACCOUNTS RECEIVABLE ARE CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS WHEN MANAGEMENT DETERMINES THAT RECOVERY IS UNLIKELY AND THE COMPANY CEASES COLLECTION EFFORTS. LOSSES HAVE BEEN CONSISTENT WITH MANAGEMENT'S EXPECTATIONS IN ALL MATERIAL RESPECTS. PART III, LINE 8: CHAMBERSBURG HOSPITAL MAINTAINS RECORDS TO IDENTIFY AND MONITOR THE LEVEL OF CHARITY CARE AND COMMUNITY SERVICE IT PROVIDES. THESE RECORDS INCLUDE THE AMOUNT OF CHARGES FORGONE BASED ON ESTABLISHED RATES FOR SERVICES AND SUPPLIES FURNISHED UNDER ITS CHARITY CARE AND COMMUNITY SERVICE POLICIES AND THE ESTIMATED COST OF THOSE SERVICES. PAYMENTS FROM MEDICARE ARE GENERALLY LESS THAN CHAMBERSBURG HOSPITAL'S COSTS OF PROVIDING THE SERVICE. PART III, LINE 9B: GUIDELINES FOR SUGGESTED MINIMUM NUMBER OF PHONE ATTEMPTS AND LETTERS TO BE SENT BEFORE THE ACCOUNT IS TURNED OVER TO AN OUTSIDE COLLECTION AGENCY ARE INCLUDED IN THE PATIENT ADMINISTRATIVE SERVICES POLICY. UPON FINAL PARO (PAYMENT ASSISTANCE RANK ORDERING) SCORING, IF A PATIENT QUALIFIES FOR PRESUMPTIVE CHARITY, THEIR ACCOUNT WOULD NOT BE FORWARDED TO ANY THIRD PARTY COLLECTIONS. IT SHALL BE THE POLICY OF PATIENT ADMINISTRATIVE SERVICES TO RECOMMEND ACCOUNTS TO BAD DEBT ON A TIMELY BASIS. INPATIENT/OUTPATIENT ACCOUNTS WILL GO TO BAD DEBT AUTOMATICALLY AFTER THE ACCOUNT HAS BEEN IN THE FINANCIAL CLASS PENDING BAD DEBT FOR 30 DAYS. ALL ACCOUNTS MUST FOLLOW THE APPROVED LIMITS FOR REFUNDS AND WRITE OFFS, AS ESTABLISHED IN POLICY PF-102, BEFORE BEING TRANSFERRED. THE PRIMARY AGENCIES WILL WORK THE ACCOUNTS FOR 6 MONTHS OR UNTIL THEY FEEL IT IS UNCOLLECTABLE AND RETURN THE ACCOUNT. THE ACCOUNTS ARE FORWARDED TO SECONDARY AGENCIES FROM THE PRIMARY AGENCIES CLOSED AND RETURN REPORTS. THE FINANCIAL CLASS IS CHANGED TO BAD DEBT OTHER AFTER THE CLOSED AND RETURN REPORTS ARE RECEIVED FROM THE SECONDARY AGENCY. THE AGENCIES MUST GET WRITTEN APPROVAL FROM THE MANAGER IN THE RELATIVELY RARE INSTANCE OF LEGAL ACTION BEING TAKEN TO COLLECT THE DEBT. PART VI, LINE 2: THE 2022 WELLSPAN COMMUNITY HEALTH NEEDS ASSESSMENT PROVIDES A REPRESENTATIVE ANALYSIS OF PERTINENT COMMUNITY HEALTH ISSUES IN THE SOUTH CENTRAL PENNSYLVANIA. THE ASSESSMENT INCLUDES THE ENTIRETY OF FRANKLIN, ADAMS, YORK AND LEBANON COUNTIES AS WELL AS SPECIFIC GEOGRAPHIC AREAS WITHIN LANCASTER COUNTY. THIS GEOGRAPHIC FOCUS ENCOMPASSES THE WELLSPAN SERVICE AREA AND THE PATIENTS, COVERED LIVES, AND COMMUNITIES WITHIN THE FIVE-COUNTY REACH OF OUR ORGANIZATION. A LOCAL EMPHASIS PERMITS WELLSPAN'S SEVEN ACUTE CARE HOSPITALS AND ONE BEHAVIORAL HEALTH HOSPITAL TO ACT ON UNIQUE COUNTY ATTRIBUTES WHILE MAINTAINING A REGIONAL PERSPECTIVE OF COMMUNITY HEALTH ISSUES CHALLENGING OUR PATIENTS, NEIGHBORS AND COMMUNITIES. WELLSPAN'S 2022 COMMUNITY HEALTH NEEDS ASSESSMENT LEVERAGED DATA FROM MULTIPLE DATA SOURCES, INCLUDING: 1. WELLSPAN HEALTH PATIENT DATA. 2. WELLSPAN HEALTH'S PROVIDER SURVEY. 3. LOCAL, STATE AND NATIONAL DATA SOURCES. 4. REPRESENTATIVE AND SPECIAL POPULATIONS COMMUNITY SURVEY. 5. SPECIAL POPULATIONS DATA COLLECTION. IN ADDITION TO OUR ROUTINE DATA COLLECTION METHODS, WHICH PROVIDE A COMMUNITY-WIDE PERSPECTIVE OF STRENGTHS AND CHALLENGES, A PLAIN COMMUNITY SURVEY, FOCUS GROUPS AND KEY INFORMANT INTERVIEWS, AND OFF-CYCLE EXPLORATORY DATA COLLECTION HAVE PERMITTED AN OPPORTUNITY TO LEARN ABOUT GROUPS WITHIN OUR COMMUNITY WHO HAVE BEEN MARGINALIZED AND UNDERREPRESENTED IN SIMILAR ASSESSMENTS. MANY COMMUNITY MEMBERS ARE DISPROPORTIONATELY AT RISK OF POOR HEALTH OUTCOMES BECAUSE OF HEALTH INEQUITIES. OUR COMMUNITY HEALTH NEEDS ASSESSMENT STRATEGY ALIGNS WITH WELLSPAN'S ORGANIZATIONAL APPROACHES TO ADDRESS DIVERSITY AND INCLUSION AND HEALTH EQUITY. FOR EXAMPLE, EACH INDICATOR WAS CONSIDERED WITH A GEOGRAPHIC, AGE, RACE, LANGUAGE, GENDER AND INCOME/ POVERTY LENS TO IDENTIFY DISPARITIES AMONG SEGMENTS OF OUR COMMUNITY. THE COMMUNITY HEALTH NEEDS ASSESSMENT ALSO GATHERED DATA ABOUT SUBGROUPS WITHIN OUR COMMUNITY WHO HAVE TRADITIONALLY BEEN UNDERSERVED THROUGH HEALTHCARE INCLUDING (BUT NOT LIMITED TO) HISPANIC/LATINO, BLACK/AFRICAN AMERICAN, PLAIN COMMUNITY, INDIVIDUALS LIVING IN POVERTY, SENIORS, AND CHILDREN. THE DATA COLLECTION METHODS OF THE 2022 COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) BUILT ON FOUNDATIONAL WORK FROM PREVIOUS WELLSPAN COMMUNITY HEALTH NEEDS ASSESSMENT PROCESSES AND WERE EXPANDED TO BE MORE INCLUSIVE AND INNOVATIVE. DATA COLLECTION WAS FACILITATED BY THE CENTER FOR OPINION RESEARCH AT FRANKLIN AND MARSHALL COLLEGE, LED BY BERWOOD YOST, DIRECTOR OF THE CENTER AND PROJECT CONSULTANT FOR THE 2022 COMMUNITY HEALTH NEEDS ASSESSMENT. A DIVERSE GROUP OF STAKEHOLDERS THROUGHOUT THE REGION WERE ACTIVELY ENGAGED IN THE NEEDS ASSESSMENT PROCESS, INCLUDING LOCAL HEALTH COALITIONS, COMMUNITY NOT-FOR-PROFIT AGENCIES, ELECTED OFFICIALS, FEDERALLY QUALIFIED HEALTH CENTERS, PUBLIC HEALTH EXPERTS, ETC. BASED ON THE COMMUNITY HEALTH NEEDS ASSESSMENT RESULTS, WELLSPAN'S THREE-YEAR STRATEGIES AND PRIORITIES WITHIN ITS COMMUNITY HEALTH IMPROVEMENT PLAN WILL INCLUDE: - CARE FOR ALL: ENSURE ACCESS AND QUALITY OF CARE FOR PATIENTS BY IDENTIFYING AND REDUCING DISPARITIES AND BARRIERS TO CARE. - MENTAL WELL-BEING: SUPPORT PERSONAL WELL-BEING AND WHOLE PERSON HEALTH BY MAKING IT EASIER FOR PEOPLE TO RECOGNIZE AND GET SUPPORT FOR MENTAL HEALTH AND ADDICTION ISSUES. - SOCIAL DETERMINANTS OF HEALTH: DEVELOP AND IMPLEMENT NEW APPROACHES FOR COLLABORATING WITH COMMUNITY-BASED ORGANIZATIONS TO IMPACT THE MOST PRESSING SOCIAL DETERMINANTS OF HEALTH (SDOH) IMPACTING OUR PATIENTS AND THE COMMUNITY. - HEALTHY COMMUNITIES: CREATE HEALTHY, SAFE COMMUNITIES AND ENSURE OUR YOUNGEST COMMUNITY MEMBERS AND NEXT GENERATION CAN THRIVE AND GROW. WELLSPAN HAS EVOLVED ITS COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS OVER TIME AND REMAINS COMMITTED TO ENSURING DATA INTEGRITY AND A SOUND SCIENTIFIC APPROACH. NEVERTHELESS, THERE ARE LIMITATIONS TO OUR PROCESS. WE HAVE MINIMIZED THE RISK OF INCOMPLETE OR INACCURATE DATA WHENEVER POSSIBLE BUT REMAIN COGNIZANT OF THE FOLLOWING LIMITATIONS: 1. LAGGING DATA: UTILIZING SECONDARY DATA SOURCES MEANS EMBRACING THE LIMITATIONS OF THOSE SOURCES. 2. INTERNAL PATIENT DATA: UTILIZING WELLSPAN PATIENT DATA MAY HAVE AN INHERENT BIAS OF NOT INCLUDING THOSE WHO CANNOT AFFORD CARE AND ARE THEREFORE NOT CAPTURED IN OUR RECORDS. 3. SURVEY SAMPLE SIZES: FOR A VARIETY OF REASONS, WE ARE NOT ABLE TO SURVEY EVERY MEMBER OF OUR COMMUNITY. OUR HEALTH SYSTEM AND COMMUNITY EXPERIENCED GREAT HARDSHIPS OVER THE PAST COUPLE YEARS DUE TO THE PANDEMIC. THE ENORMITY OF THE COVID-19 IMPACT WARRANTS A REALISTIC APPROACH TO ADDRESSING COMMUNITY NEEDS IN AN OUTCOMES-FOCUSED MANNER. THIS IS AN UNPRECEDENTED TIME, AND OUR COMMUNITIES HAVE NOT YET RECOVERED FROM THE INTENSITY OF THE PANDEMIC'S INFLUENCES. THE WELLSPAN BOARD OF DIRECTORS APPROVED THE 2022 COMMUNITY HEALTH NEEDS ASSESSMENT, WHICH IS MADE AVAILABLE TO THE PUBLIC ON OUR WEBSITE AT: HTTPS://WWW.WELLSPAN.ORG/ABOUT/WELLSPAN-IN-THE-COMMUNITY/. IN ADDITION TO THE PLACEMENT OF THE CHNA ON THE WEBSITE, THERE WERE COMMUNITY LEVEL FORUMS IN THE COUNTY OF EACH WELLSPAN FACILITY WHICH PUBLICLY RELEASED THE DATA, SUMMARIZED THE FINDINGS, AND ARTICULATED WELLSPAN'S INTENTION TO ADDRESS THE IDENTIFIED NEEDS. PART VI, LINE 3: IN ACCORDANCE WITH THE WELLSPAN HEALTH FINANCIAL ASSISTANCE POLICY (FAP), PATIENTS/RESPONSIBLE PARTIES WILL BE NOTIFIED OF THE AVAILABLE OPTIONS FOR FINANCIAL ASSISTANCE PER IRS REGULATION 501(R). METHODS OF NOTIFICATION INCLUDE, BUT ARE NOT LIMITED TO: 1. POSTING OF LEGIBLE SIGNAGE2. DEVELOPMENT OF A PLAIN LANGUAGE SUMMARY3. DISTRIBUTING INFORMATIONAL BROCHURES AT HOSPITAL AND OFFICE REGISTRATION AREAS4. DISTRIBUTING INFORMATIONAL BROCHURES THROUGHOUT ITS COMMUNITIES5. A COPY OF THE FINANCIAL ASSISTANCE POLICY PLAIN LANGUAGE SUMMARY OFFERED DURING THE REGISTRATION/DISCHARGE PROCESS6. CONSPICUOUS NOTICE REGARDING THE FINANCIAL ASSISTANCE POLICY PRINTED ON ALL ACCOUNT STATEMENTS7. COPY OF THE FINANCIAL ASSISTANCE POLICY PLAIN LANGUAGE SUMMARY PROVIDED WITH LAST BILLING STATEMENT THE WELLSPAN FAP CAN BE FOUND ONLINE AT:HTTPS://WWW.WELLSPAN.ORG/MEDIA/2783971/118-WSH-FINANCIAL-ASSISTANCE-POLICY-71322.PDF PART VI, LINE 4: EVERY THREE YEARS, WE PARTNER WITH LIKE-MINDED COMMUNITY PARTNERS AND LOCAL COALITIONS TO CONDUCT COMMUNITY HEALTH NEEDS ASSESSMENTS (CHNA) FOR WHICH WE SURVEY COMMUNITY MEMBERS ABOUT THEIR HEALTH, LIFESTYLE BEHAVIORS, FINANCES, ACCESS TO HEALTH SERVICES AND OTHER RELATED TOPICS. WE USE THESE CHNA REPORTS TO IDENTIFY SPECIFIC COMMUNITY NEEDS AND DEVELOP STRATEGIES TO ADDRESS THEM.THE 2022 COMMUNITY HEALTH NEEDS ASSESSMENT PROVIDES INSIGHT ON THE HEALTH OF OUR COMMUNITIES, FROM BIRTH THROUGH ADVANCED AGE, ACROSS THE WELLSPAN HEALTH FIVE COUNTY REGION, INCLUDING ADAMS, FRANKLIN, LEBANON, YORK, AS WELL AS GEOGRAPHIC REGIONS WITHIN LANCASTER COUNTY.DIFFERENCES AMONG OUR GEOGRAPHIC COMMUNITIES OFTEN DO NOT DEMONSTRATE AS SIGNIFICANT A DIFFERENCE AS OBSERVED IN ATTRIBUTES SUCH AS RACE/ETHNICITY, GENDER, AGE, INCOME AND THE EXPERIENCE OF DEPRESSION, TRAUMA, OR DISCRIMINATION. IN SOME CIRCUMSTANCES HOWEVER, UNIQUE ATTRIBUTES IDENTIFIED FROM OUR COMMUNITY HEALTH NEEDS ASSESSMENT DATA SPECIFIC TO EACH COUNTY POINT TO OBVIOUS AREAS FOR IMPROVEMENT. THIS INFORMATION IS IMPORTANT AS WELLSPAN ANTICIPATES THE IMPLEMENTATION OF THE 2023-2025 COMMUNITY HEALTH IMPROVEMENT PLAN.A COUNTY-BY-COUNTY DEMOGRAPHIC ASSESSMENT IS CONTAINED WITHIN THE 2022 COMMUNITY HEALTH NEEDS ASSESSMENT REPORT, AVAILABLE ON OUR WEBSITE AT:HTTPS://WWW.WELLSPAN.ORG/ABOUT/WELLSPAN-IN-THE-COMMUNITY/ PART VI, LINE 5: AS A CHARITABLE, COMMUNITY-BASED HEALTHCARE ORGANIZATION, OUR COMMITMENT TO IMPROVING THE LIVES AND WELL-BEING OF ALL PEOPLE AND COMMUNITIES WE SERVE IS EVIDENT IN OUR MISSION STATEMENT: "WORKING AS ONE TO IMPROVE HEALTH THROUGH EXCEPTIONAL CARE FOR ALL, LIFELONG WELLNESS, AND HEALTHIER COMMUNITIES." EMPLOYEES LIVE OUT THIS MISSION STATEMENT EVERY DAY BY ENGAGING IN COMMUNITY BENEFIT ACTIVITIES THAT ADDRESS COMMUNITY NEEDS, ESPECIALLY THE HEALTH PRIORITIES IDENTIFIED IN THE MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT. MANY OF WELLSPAN'S EFFORTS TO ADVANCE COMMUNITY HEALTH PRIORITIES ARE OUTLINED IN OUR COMMUNITY BENEFIT REPORT, PUBLISHED ONLINE AT HTTPS://WWW.WELLSPAN.ORG/ABOUT/WELLSPAN-IN-THE-COMMUNITY/. BELOW ARE SOME EXAMPLES OF OUR EFFORTS ACROSS WELLSPAN'S FIVE-COUNTY SERVICE AREA IN THE LAST YEAR: - THE MOBILE MAMMOGRAPHY COACH, OUR STATE-OF-THE-ART BREAST IMAGING SERVICE MADE POSSIBLE THROUGH OUR COLLABORATIVE PARTNERSHIP WITH CAPITAL BLUE CROSS, CRISSCROSSED OUR SERVICE AREA PROVIDING PRIVATE AND DISCREET ONSITE SCREENINGS AT 70 COMMUNITY EVENTS AT NO COST FOR ALL UNINSURED PATIENTS. OF THE 595 PATIENTS SCREENED, SIX INDIVIDUALS WERE DIAGNOSED WITH CANCER THAT MIGHT OTHERWISE HAVE ESCAPED DETECTION. ADDITIONALLY, OUR MOBILE MAMMOGRAPHY PROGRAM HAS SUCCESSFULLY BUILT PARTNERSHIPS WITH SEVERAL COMMUNITY-BASED ORGANIZATIONS THAT HAVE SIGNIFICANTLY CONTRIBUTED TO OUR ABILITY TO REACH OUR DIVERSE AND UNDERSERVED PATIENTS.- WELLSPAN, IN PARTNERSHIP WITH ORGANIZATIONS INCLUDING THE NATIONAL ASSOCIATION FOR THE ADVANCEMENT OF COLORED PEOPLE (NAACP) YORK CHAPTER, CREATED THE OPPORTUNITY TO LEARN ABOUT THESE BARRIERS DIRECTLY FROM THE MEMBERS OF OUR COMMUNITY BY HOSTING A SERIES OF LISTENING SESSIONS ON COLORECTAL AND BREAST CANCER SCREENINGS. THESE INFORMATIVE AND ENGAGING SESSIONS ALLOWED WELLSPAN AND OUR PARTNERS TO HEAR ABOUT REAL CHALLENGES, BETTER IDENTIFY BARRIERS AND FIND MORE EFFECTIVE WAYS TO REACH OUT TO ALL.WELLSPAN IS AN HONORED COMMUNITY PARTNER WITH THE FOLLOWING HEALTH COALITIONS:- HEALTHY ADAMS COUNTY - WWW.HEALTHYADAMSCOUNTY.ORG- HEALTHY FRANKLIN COUNTY - WWW.HEALTHYFRANKLINCOUNTY.ORG- HEALTHY YORK COALITION - WWW.HEALTHYYORK.ORG- HEALTHY COMMUNITY NETWORK - WWW.HEALTHYCOMMUNITYNETWORK.ORG- NORTHERN LANCASTER COUNTY HUB - WWW.NORTHERNLANCASTERHUB.ORG- COMMUNITY HEALTH COUNCIL OF LEBANON COUNTY - WWW.COMMUNITYHEALTHCOUNCIL.COMTHESE COALITIONS PLAY AN IMPORTANT ROLE IN WELLSPAN'S COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) PROCESS. THIS YEAR, WELLSPAN COLLABORATED WITH OUR COALITIONS AND OTHER PARTNERS TO COMPLETE THE 2022 CHNA. THIS DATA WAS USED TO DESIGN WELLSPAN'S 2023-2025 COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP).THROUGH OUR COLLABORATION WITH THE COALITIONS AND OTHERS, WE IDENTIFIED CORE THEMES AND AREAS FOR IMPROVEMENT INCLUDING HEALTH EQUITY, SOCIAL DETERMINANTS OF HEALTH AND LIFELONG WELLNESS. EACH COUNTY COALITION HOSTED ITS OWN PUBLIC HEALTH FORUM EVENT, TO REVIEW THE IDENTIFIED NEEDS AND STRATEGIC PRIORITY AREAS FOR THE COMING YEARS AND ENGAGE NEW PARTNERS AND VOLUNTEERS TO HELP ADVANCE THE HEALTHCARE AGENDA FOR OUR COMMUNITIES.- WELLSPAN CONDUCTED MORE THAN 350,000 SCREENINGS TO IDENTIFY MORE THAN 21,000 PATIENTS WITH FOOD INSECURITY. WITHIN THE PAST THREE YEARS, WE INVESTED NEARLY $575,000 TO SUPPORT OUR COMMUNITY PARTNERS IN ADDRESSING HUNGER FOR OUR PATIENTS AND OTHERS WHO NEED HELP. - OUR VITAL LOCAL PARTNERSHIPS WITH FEDERALLY QUALIFIED HEALTH CENTERS CREATE A STRONG SAFETY NET OF HEALTH CARE SERVICES TO HELP MEET THE HEALTH NEEDS OF SO MANY OF OUR UNDERSERVED POPULATIONS. TOGETHER, WE PROVIDED MORE THAN 330,000 MEDICAL AND DENTAL VISITS ACROSS ADAMS, FRANKLIN, LANCASTER, LEBANON, AND YORK COUNTIES.- AS THE LEAD PARTNER IN HEALTHY COMMUNITY NETWORK, WELLSPAN HELPS TO PROVIDE THOUSANDS OF UNINSURED AND UNDERINSURED COMMUNITY MEMBERS WITH ACCESS TO CARE. OVER THE PAST YEAR, THE NETWORK ASSISTED 2,517 MEMBERS IN NEED OF CARE ACROSS THE REGION.- THROUGH THE PRESCRIPTION FOR CARING PROGRAM, HEALTHY COMMUNITY NETWORK PROVIDED FINANCIAL ASSISTANCE FOR NEARLY 16,562 PRESCRIPTIONS, SO THAT INDIVIDUALS LACKING SUFFICIENT HEALTH INSURANCE OR FINANCIAL MEANS COULD ACCESS THE MEDICATIONS THEY NEED.- PARTICIPATION BY 75,000 NEIGHBORS IN WELLSPAN HEALTH EDUCATION PROGRAMS IN THE LAST THREE YEARS, WITH MORE THAN 16,000 ENGAGED IN FISCAL YEAR 2022. THIS INCLUDED THE EXPANSION OF THE GET OUTDOORS (GO) PROGRAM TO ALL OF LANCASTER COUNTY AND ADDITION OF CUMBERLAND COUNTY, REACHING THOUSANDS OF FAMILIES IN SIX COUNTIES. PILOTED THE PROGRAM TO ADULTS IN CUMBERLAND AND YORK COUNTIES. - EXPANDED SUPPORT FOR THOSE WITH SUBSTANCE USE DISORDER, AND INTRODUCTION OF OPIOID PAIN MANAGEMENT OPTIONS. EFFORTS INCLUDED EXPANSION OF THE CCBH MODEL TO SUPPORT INCARCERATED INDIVIDUALS AS THEY RETURN TO OUR COMMUNITY; ESTABLISHING WARM LINE CALL CENTER FOR INDIVIDUALS SEEKING ADDICTION RESOURCES AND TREATMENT; AND BUILDING FOUNDATIONS PREGNANCY SUPPORT PROGRAM, WITH 97% ABSTINENCE RATE FOR MORE THAN SIX MONTHS.- THROUGH THE WELLSPAN COMMUNITY HEALTH FUND AND SUMMIT ENDOWMENT, WELLSPAN PARTNERED WITH 57 NONPROFIT COMMUNITY ORGANIZATIONS AND PROVIDED $1.4 MILLION IN COMMUNITY GRANTS TO DRIVE ACHIEVEMENT OF OUR COMMUNITY HEALTH IMPROVEMENT PLAN BY INCREASING ACCESS TO CARE AND CREATING INNOVATIVE APPROACHES TO IMPACT SOCIAL DETERMINANTS OF HEALTH. PART VI, LINE 6: WELLSPAN HEALTH IS AN INTEGRATED HEALTH SYSTEM SERVING THE COMMUNITIES OF SOUTHCENTRAL PENNSYLVANIA AND NORTHERN MARYLAND. AS A COMMUNITY-BASED, NOT-FOR-PROFIT ORGANIZATION, WELLSPAN IS DEDICATED TO IMPROVING THE HEALTH AND WELL-BEING OF THE PEOPLE IT SERVES. WELLSPAN WILL ASSUME A LEADERSHIP ROLE AND DEVELOP PARTNERSHIPS WITH OTHER ORGANIZATIONS TO IMPROVE ACCESS TO COORDINATED, HIGH-QUALITY, COST-EFFECTIVE HEALTH CARE SERVICES, EDUCATE THE HEALTH CARE PROVIDERS OF TOMORROW, PROMOTE HEALTHY LIFESTYLES AND LIFELONG WELLNESS, AND MAKE ITS LOCAL COMMUNITIES HEALTHIER, MORE DESIRABLE PLACES TO LIVE, WORK, AND PLAY. EACH OF OUR HOSPITALS WORK WITH OTHER PARTS OF THE SYSTEM TO PROVIDE A COMPREHENSIVE APPROACH TO MEETING COMMUNITY NEEDS.WELLSPAN HEALTH INCLUDES: HOSPITALS:1. YORK HOSPITAL2. GETTYSBURG HOSPITAL3. CHAMBERSBURG HOSPITAL4. WAYNESBORO HOSPITAL5. EPHRATA COMMUNITY HOSPITAL6. THE GOOD SAMARITAN HOSPITAL OF LEBANON, PENNSYLVANIA7. WELLSPAN SURGERY & REHABILITATION HOSPITAL8. PHILHAVENFOUNDATIONS:1. YORK HEALTH FOUNDATION2. SUMMIT HEALTH FOUNDATION3. GETTYSBURG HOSPITAL FOUNDATION4. EPHRATA COMMUNITY HEALTH FOUNDATION5. GOOD SAMARITAN HEALTH SERVICES FOUNDATIONMEDICAL SERVICES:1. APPLE HILL SURGICAL CENTER, INC.2. CHAMBERSBURG HEALTH SERVICES3. SUMMIT PHYSICIAN SERVICES4. VNA HOME HEALTH SERVICES5. WELLSPAN HEALTH CARE SERVICES6. WELLSPAN MEDICAL GROUP7. WELLSPAN SUMMIT HEALTH8. GOOD SAMARITAN PHYSICIAN SERVICES9. HEALTHY COMMUNITY PHARMACY10. VNA COMMUNITY SERVICESWELLSPAN'S COMMUNITY BENEFIT REPORT IS PREPARED BY THE PARENT ORGANIZATION, WELLSPAN HEALTH, AND INCLUDES COLLECTIVE EFFORTS OF ALL ENTITIES UNDER THE PARENT ORGANIZATION. SEE WELLSPAN HEALTH'S CURRENT COMMUNITY BENEFIT REPORT, COMMUNITY HEALTH NEEDS ASSESSMENT, AND COMMUNITY HEALTH IMPROVEMENT PLAN AT HTTPS://WWW.WELLSPAN.ORG/ABOUT/WELLSPAN-IN-THE-COMMUNITY/. PART VI, LINE 7, REPORTS FILED WITH STATES PA 1 WAYNESBORO AREA BUSINESS EDUCATION AND COMMUNITY FOUNDATION PO BOX 545 WAYNESBORO PA 17268 232678530 501(C)(3) 106953 0 GENERAL SUPPORT UNITED WAY OF FRANKLIN COUNTY 182 S SECOND ST PO BOX 47 CHAMBERSBURG PA 17201 251730590 501(C)(3) 30000 0 GENERAL SUPPORT KEYSTONE HEALTH CENTER 111 CHAMBERS HILL DRIVE SUITE 200 CHAMBERSBURG PA 17201 251546810 501(C)(3) 1505397 0 GENERAL SUPPORT PENN STATE 103 SHIELDS BUILDING UNIVERSITY PARK PA 16802 246000376 501(C)(3) 175333 0 GENERAL SUPPORT FIRST START PARTNERSHIP 871 STANLEY AVE CHAMBERSBURG PA 17201 231152007 501(C)(3) 131895 0 GENERAL SUPPORT WELLSPAN MEDICAL GROUP PO BOX 2767 YORK PA 17405 232730785 501(C)(3) 62455 0 GENERAL SUPPORT 6 0 PART I, LINE 2: ALL WELLSPAN ENTITIES FOLLOW WELLSPAN POLICIES AND PROCEDURES REGARDING GRANT PROJECTS (MAP 107) TO ENSURE THAT THE USE OF GRANT FUNDS ARE CONSISTENT WITH WELLSPAN'S MISSION OF WORKING AS ONE TO IMPROVE HEALTH THROUGH EXCEPTIONAL CARE FOR ALL, LIFELONG WELLNESS AND HEALTHY COMMUNITIES. COMMUNITY SUPPORT IS PROVIDED IN THE FORM OF GRANTS, WHICH SERVE HEALTH-RELATED PURPOSES AND ARE IN ALIGNMENT WITH THE WELLSPAN MISSION. ALL GRANTS ARE MADE TO ELIGIBLE 501(C)(3) ORGANIZATIONS AND INCLUDE CHURCHES, PUBLIC SCHOOLS, PUBLIC CHARITIES, PUBLIC CLINICS AND HOSPITALS, LEGAL AID SOCIETIES, VOLUNTEER SERVICES ORGANIZATIONS, AND SOME GOVERNMENTAL AGENCIES. WE MAINTAIN ADEQUATE RECORDS TO SUBSTANTIATE AMOUNTS, ELIGIBILITY, AND SELECTION CRITERIA USED FOR ALL GRANTS. X X 1 1 X X X X 0 1 0 0 0 0 0 0 0 ROXANNA GAPSTUR PRESIDENT & CEO - WELLSPAN HEALTH 0 1345021 0 825300 0 0 0 12765 0 70373 0 2253459 0 0 JANE HYDE SR VICE PRESIDENT 391128 0 171738 0 647843 0 15615 0 40873 0 1267197 0 647708 0 MIKE SEIM DIRECTOR - SVP CHIEF QUALITY CONTROL 0 640895 0 288000 0 85 0 14254 0 54342 0 997576 0 0 LAURA BUCZKOWSKI EXECUTIVE VP & CFO - WELLSPAN HEALTH 0 653090 0 187650 0 10 0 15722 0 53086 0 909558 0 0 MICHAEL O'CONNOR FORMER DIRECTOR 0 94517 0 400546 0 338709 0 3492 0 23897 0 861161 0 256622 SHERRI STAHL DIRECTOR - SVP EASTERN REGION 441050 0 200856 0 59080 0 25637 0 32284 0 758907 0 0 0 EDWARD MACKLE MD DIRECTOR - DOCTOR 0 513071 0 61500 0 9040 0 34998 0 49949 0 668558 0 0 KEVIN LORENTSEN MD DIRECTOR - MEDICAL ONCOLOGIST 0 361592 0 108115 0 0 0 18602 0 39823 0 528132 0 0 JOHN MASSIMILLA VP & PRESIDENT - CHAMBERSBURG HOSPIT 315081 0 86060 0 49609 0 27107 0 47296 0 525153 0 0 0 DAVID DOUD DO DIRECTOR - DOCTOR 0 345252 0 80469 0 0 0 18134 0 46559 0 490414 0 0 THOMAS ANDERSON VP MEDICAL AFFAIRS 308287 0 93599 0 9934 0 11150 0 24375 0 447345 0 0 0 ELYSE FISHER CHIEF NURSING OFFICER 195923 0 60676 0 14 0 19500 0 47644 0 323757 0 0 0 MELISSA GROSS REGIONAL MGR PHARMACY 200982 0 18706 0 6998 0 9522 0 58145 0 294353 0 0 0 JAMES PRYOR VP PATIENT CARE SVCS 153075 0 42159 0 7094 0 12157 0 40506 0 254991 0 0 0 GINGER EVERHART SR DIR CLINICAL OPERATIONS 157374 0 16457 0 21279 0 5400 0 51666 0 252176 0 0 0 LARRY PENTZ MGR PHARMACY OPERATIONS 178279 0 9997 0 4622 0 3420 0 50312 0 246630 0 0 0 PATRICIA MCCULLOH SR DIR OPERATIONS 151495 0 12606 0 20191 0 21605 0 36129 0 242026 0 0 0 TANYA RUDOLPH MGR PHARMACY OPERATIONS 167454 0 5163 0 7374 0 7192 0 45648 0 232831 0 0 0 ANTHONY BRUNO CHIEF MEDICAL OFFICER 229668 0 0 0 0 0 0 0 2177 0 231845 0 0 0 PART I, LINE 4B THE WELLSPAN HEALTH SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) WAS ADOPTED AND MADE EFFECTIVE ON DECEMBER 19TH, 2008. THE OBJECTIVE OF THE EXECUTIVE BENEFITS PROGRAM IS TO PROVIDE AN EXECUTIVE BENEFITS PROGRAM THAT IS COMPETITIVE WITH NATIONAL NORMS IN THE HEALTHCARE INDUSTRY FOR SIMILARLY SIZED ORGANIZATIONS ENABLING WELLSPAN HEALTH TO RECRUIT AND RETAIN TOP EXECUTIVE TALENT. TIER I EXECUTIVES ARE ELIGIBLE TO PARTICIPATE IN THE PLAN. A DESCRIPTION OF THE TARGETED BENEFIT OF THE PLAN IS AS FOLLOWS: 1) PROVIDE AN EMPLOYER SPONSORED RETIREMENT BENEFIT THAT REPLACES 60% OF AVERAGE PRE-RETIREMENT (5 YEARS) BASE COMPENSATION THROUGH A COMBINED APPROACH UTILIZING WELLSPAN'S RETIREMENT PLAN, 50% OF SOCIAL SECURITY, SPLIT-DOLLAR LIFE INSURANCE BENEFIT, AND SUPPLEMENTAL EXECUTIVE RETIREMENT BENEFIT. 2) PROVIDES A MINIMUM BENEFIT AFTER 10 YEARS OF SERVICE. 3) PROVIDES THE FULL TARGETED BENEFIT AFTER 25 YEARS OF SERVICE. 4) BENEFIT IS VESTED WHEN ELIGIBLE EXECUTIVE REACHES AGE 65. THE BENEFIT IS ALSO VESTED UPON DEATH, DISABILITY, JOB ELIMINATION AND "TERMINATION FOR GOOD REASON". 5) CREDITED SERVICE GRANTED ON A 1:2 BASIS FOR PREVIOUS SERVICE IN AN ELIGIBLE TIER II POSITION. 6) TARGETED BENEFIT IS TO BE CALCULATED USING A 15 YEAR CERTAIN PAYOUT. 7) PAYOUT WILL BE IN A LUMP SUM. 8) PAYOUT WILL BE TAXABLE WHEN VESTED. DURING THE CALENDAR YEAR 2021, THERE WERE NO DISTRIBUTIONS FROM THE SERP. THE WELLSPAN HEALTH DEFINED CONTRIBUTION DEFERRED COMPENSATION PLAN WAS ADOPTED AND MADE EFFECTIVE AS OF JULY 1, 2017. THIS PLAN WILL REPLACE THE SERP. AS PART OF THE TRANSITION, EACH PARTICIPANT IN THE SERP WAS GIVEN A ONE-TIME CHOICE TO BE GRANDFATHERED IN THE SERP OR TRANSFER TO THE NEW WELLSPAN HEALTH DEFINED CONTRIBUTION DEFERRED COMPENSATION PLAN. THE OBJECTIVE OF THE WELLSPAN HEALTH DEFINED CONTRIBUTION DEFERRED COMPENSATION PLAN IS TO ATTRACT AND RETAIN EXECUTIVE AND UPPER-LEVEL MANAGEMENT EMPLOYEES OF OUTSTANDING ABILITY. TIERS I, II, III AND A SELECT GROUP OF TIER IV EMPLOYEES ARE ELIGIBLE TO PARTICIPATE IN THE PLAN. A DESCRIPTION OF THE TARGETED BENEFIT OF THE PLAN IS AS FOLLOWS: 1)PROVIDE AN UNFUNDED DEFERRED COMPENSATION BENEFIT TO A SELECT GROUP OF MANAGEMENT AND HIGHLY COMPENSATED EMPLOYEES. 2)PLAN ACCOUNT CONTRIBUTIONS ARE CREDITED EACH YEAR TO A SUBACCOUNT, BASED UPON VARIOUS TIER LEVELS; TIER I, 22%, TIER II, 17%, TIER III, 12%, AND TIER IV, 8%. 3)PARTICIPANT ACCOUNTS ARE CREDITED INTEREST EACH YEAR BY APPLICATION OF THE 30-YEAR U.S. TREASURY RATE ON JUNE 30 OF THE PLAN YEAR THEN ENDING, PLUS ONE PERCENT (1%). 4)PARTICIPANT VESTING OCCURS ON THE EARLIER OF: A)JUNE 30TH OF THE FOURTH PLAN YEAR: 25% PER YEAR B)PARTICIPANT REACHES AGE 65. C)UPON DEATH, DISABILITY, JOB ELIMINATION AND "TERMINATION FOR GOOD REASON". 5)NON-ELECTIVE EMPLOYER CONTRIBUTIONS ARE ALSO PERMITTED. 6)PLAN DISTRIBUTIONS TO BE ADMINISTERED PER THE PLAN DOCUMENT. ADDITIONALLY, ANY VESTED PORTION OF CONTRIBUTIONS MADE TO THE PLAN WHICH ARE NO LONGER SUBJECT TO THE RISK OF FORFEITURE, ARE REFLECTED IN SCHEDULE J, PART II, COLUMN B(III). A FRANKLIN COUNTY INDUSTRIAL DEVELOPMENT AUTHORITY 230465850 2014-04-30 15887319 REFUND ECH BONDS 0 0 0 B GENERAL AUTHORITY OF SOUTHCENTRAL PENNSYLVANIA 277334160 2019-04-03 114109210 REFUND BONDS & EXPANSION 0 0 0 A 5466189 15887319 237083 3759598 11890638 2016 1 0 1 1 B 5714705 114109210 184162 762210 105786342 7376496 2019 1 1 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 1 0 0 0 0 1 B 0 0 0 0 1 0 0 0 1 A 1 B 1 SCHEDULE K, PART III, LINE 4 & 5 - PRIVATE BUSINESS USE THE ENTITY, IN CONJUNCTION WITH BOND COUNSEL, MONITORS ACTIVITIES THAT MAY RESULT IN PRIVATE BUSINESS USE. THERE WERE NONE FOUND. FORM 990, PART VI, SECTION A, LINE 6 WELLSPAN SUMMIT HEALTH, A NOT-FOR-PROFIT CORPORATION, IS THE SOLE MEMBER OF THE HOSPITAL. WELLSPAN HEALTH, A NOT-FOR-PROFIT CORPORATION, IS THE SOLE MEMBER OF WELLSPAN SUMMIT HEALTH. FORM 990, PART VI, SECTION A, LINE 7A THE PRIMARY PURPOSE OF THE GOVERNANCE COMMITTEE, AS ASSIGNED BY THE WELLSPAN HEALTH BOARD OF DIRECTORS, IS TO DEVELOP AND SUPPORT THE CULTURE OF HIGH-FUNCTIONING GOVERNANCE WITHIN THE WELLSPAN SYSTEM, INCLUDING THROUGH POLICIES, NOMINATIONS, COMPETENCIES OF DIRECTORS, EDUCATION, AND SELF-EVALUATIONS. THE GOVERNANCE COMMITTEE SHALL CONSIST OF NOT LESS THAN FIVE (5) NOR MORE THAN SEVEN (7) MEMBERS. NEITHER THE CHAIR OF THE WELLSPAN HEALTH BOARD OF DIRECTORS NOR PERSONS WHO ARE NOT MEMBERS OF THE WELLSPAN HEALTH BOARD OF DIRECTORS, MAY BE APPOINTED TO THE COMMITTEE. EACH GOVERNANCE COMMITTEE MEMBER SHALL BE NOMINATED BY THE GOVERNANCE COMMITTEE, AND APPOINTED BY THE WELLSPAN HEALTH BOARD OF DIRECTORS, FOR A TERM OF ONE (1) YEAR. REAPPOINTMENT OF A GOVERNANCE COMMITTEE MEMBER FOR MORE THAN ONE (1) TERM IS NOT AUTOMATIC OR PRESUMED AND SHALL BE BASED ON AN INDIVIDUAL PERFORMANCE EVALUATION OF THE GOVERNANCE COMMITTEE MEMBER (AS PERFORMED OR OVERSEEN BY THE GOVERNANCE COMMITTEE). FORM 990, PART VI, SECTION A, LINE 7B THE FOLLOWING RESPONSIBILITIES ARE SET FORTH AS A GUIDE FOR FULFILLING THE GOVERNANCE COMMITTEE'S PURPOSES IN SUCH MANNER AS THE COMMITTEE DETERMINES IS APPROPRIATE: 1. OVERSEE THE PROCESS OF SELECTING AND NOMINATING DIRECTORS AND OFFICERS FOR EACH OF THE GOVERNING BOARDS WITHIN THE WELLSPAN SYSTEM, INCLUDING ENSURING THAT DIRECTOR NOMINEES MEET THE QUALIFICATIONS REQUIRED BY THE RELEVANT BOARD COMPOSITION AND COMPETENCY GRID AND CHARACTERISTICS, BYLAWS, AND BOARD-APPROVED POLICIES AND GUIDELINES, AS APPLICABLE, AND ESTABLISH OTHER CRITERIA THAT ARE DESIRABLE FOR DIRECTORS; 2. IDENTIFY, EVALUATE AND SCREEN DIRECTOR CANDIDATES FOR EACH OF THE GOVERNING BOARDS WITHIN THE WELLSPAN SYSTEM (INCLUDING INCUMBENT DIRECTORS FOR POTENTIAL RE-NOMINATION), AND NOMINATE QUALIFIED INDIVIDUALS TO THE WELLSPAN HEALTH BOARD OF DIRECTORS FOR: (A) APPOINTMENT OR REAPPOINTMENT TO REGULAR TERMS, OR (B) APPOINTMENT TO FILL THE REMAINING TERM OF ANY GOVERNING BOARD VACANCIES; 3. REVIEW ANNUALLY THE SIZE, COMPOSITION AND LEADERSHIP OF EACH OF THE GOVERNING BOARDS WITHIN THE WELLSPAN SYSTEM, INCLUDING THE WELLSPAN HEALTH BOARD OF DIRECTORS AS A WHOLE, ITS COMMITTEES, AND ANY ADVISORY BODIES, MAKE A DETERMINATION OF WHETHER THE BOARD, ITS COMMITTEES AND ANY ADVISORY BODIES REFLECT THE APPROPRIATE BALANCE OF INDEPENDENCE, SOUND JUDGMENT, BUSINESS SPECIALIZATION, TECHNICAL SKILLS, DIVERSITY, FUNDRAISING AND DEVELOPMENT ABILITY, GEOGRAPHIC AND DEMOGRAPHIC REPRESENTATION, AND OTHER DESIRED QUALITIES, AND RECOMMEND ANY APPROPRIATE CHANGES TO THE WELLSPAN HEALTH BOARD OF DIRECTORS; 4. COORDINATE AND OVERSEE A PERIODIC SELF-EVALUATION OF THE ROLE AND PERFORMANCE OF EACH OF THE GOVERNING BOARDS WITHIN THE WELLSPAN SYSTEM, INCLUDING THE WELLSPAN HEALTH BOARD OF DIRECTORS, ITS COMMITTEES, AND ANY ADVISORY BODIES, AND EACH OF THEIR DIRECTORS AND OFFICERS; 5. DEVELOP AND RECOMMEND FOR APPROVAL BY THE WELLSPAN HEALTH BOARD OF DIRECTORS, REVIEW THE EFFECTIVENESS OF, AND RECOMMEND MODIFICATIONS AS APPROPRIATE TO, THE ORGANIZATION'S COMMITTEE STRUCTURE AND ORGANIZATIONAL DOCUMENTS, INCLUDING THE ARTICLES OF INCORPORATION, BYLAWS, BOARD-APPROVED POLICIES AND GUIDELINES, AND COMMITTEE CHARTERS; 6. THE GOVERNANCE COMMITTEE SHALL UNDERTAKE THE RESPONSIBILITY FOR BOARD EDUCATION AND BOARD RETREAT PLANNING. IN ADDITION, THE GOVERNANCE COMMITTEE SHALL COORDINATE WITH MANAGEMENT TO DEVELOP AND IMPLEMENT AN EFFECTIVE ORIENTATION PROGRAM FOR NEW DIRECTORS, INCLUDING ASSIGNMENT OF EXPERIENCED DIRECTORS AS APPROPRIATE MENTORS OF NEW DIRECTORS. 7. REVIEW EMERGING CORPORATE GOVERNANCE ISSUES AND BEST GOVERNANCE PRACTICES AND MAKE APPROPRIATE RECOMMENDATIONS TO THE WELLSPAN HEALTH BOARD OF DIRECTORS; 8. CONDUCT A PERIODIC SELF-EVALUATION OF THE PERFORMANCE OF THE COMMITTEE, INCLUDING ITS EFFECTIVENESS AND COMPLIANCE WITH THIS CHARTER, AND RECOMMEND TO THE WELLSPAN HEALTH BOARD OF DIRECTORS MODIFICATIONS AS APPROPRIATE; 9. THE GOVERNANCE COMMITTEE SHALL MAINTAIN MINUTES OF GOVERNANCE COMMITTEE MEETINGS AND RECORDS OF ITS ACTIVITIES AND SHALL REPORT PROMPTLY TO THE WELLSPAN HEALTH BOARD OF DIRECTORS ANY ACTION TAKEN BY THE GOVERNANCE COMMITTEE, ANY RECOMMENDATIONS OF THE GOVERNANCE COMMITTEE, AND ANY OTHER MATTERS THE GOVERNANCE COMMITTEE DEEMS APPROPRIATE OR THE WELLSPAN HEALTH BOARD OF DIRECTORS REQUESTS. 10. THE GOVERNANCE COMMITTEE SHALL UNDERTAKE SUCH OTHER RESPONSIBILITIES AS THE WELLSPAN HEALTH BOARD OF DIRECTORS MAY DELEGATE OR ASSIGN TO THE GOVERNANCE COMMITTEE FROM TIME TO TIME. THE GOVERNANCE COMMITTEE SHALL BE RESPONSIBLE TO, AND SUBJECT TO THE DIRECTION AND CONTROL OF, THE WELLSPAN HEALTH BOARD OF DIRECTORS. THE WELLSPAN HEALTH BOARD OF DIRECTORS SHALL BE SOLELY RESPONSIBLE FOR DELINEATING THE RESPONSIBILITIES OF THE GOVERNANCE COMMITTEE. THE GOVERNANCE COMMITTEE SHALL PERFORM ONLY SUCH FUNCTIONS AND DUTIES AS SHALL FROM TIME TO TIME BE SPECIFICALLY DELEGATED TO THE GOVERNANCE COMMITTEE BY THE WELLSPAN HEALTH BOARD OF DIRECTORS. THE GOVERNANCE COMMITTEE DOES NOT HAVE DELEGATED AUTHORITY TO TAKE FINAL AND BINDING ACTIONS ON BEHALF OF WELLSPAN HEALTH, AND THEREFORE ANY ACTIONS AND RECOMMENDATIONS OF THE COMMITTEE MUST BE APPROVED BY THE WELLSPAN HEALTH BOARD OF DIRECTORS BEFORE THEY ARE FINAL AND BINDING. IN DISCHARGING ITS ROLE, THE GOVERNANCE COMMITTEE IS EMPOWERED TO INQUIRE INTO ANY MATTER IT CONSIDERS APPROPRIATE TO CARRY OUT ITS RESPONSIBILITIES, WITH ACCESS TO ALL BOOKS, RECORDS, FACILITIES, AND PERSONNEL OF THE WELLSPAN SYSTEM. FORM 990, PART VI, SECTION B, LINE 11B MANAGEMENT PROVIDES AN ELECTRONIC COPY OF THE FORM 990 TO EACH VOTING MEMBER OF THE ORGANIZATION'S GOVERNING BODY, PRIOR TO ITS FILING WITH THE IRS. THE ORGANIZATION'S FINANCE MANAGEMENT TEAM PROVIDES A PRESENTATION TO THE AUDIT COMMITTEE ON THE ORGANIZATION'S 990 RETURN. FORM 990, PART VI, SECTION B, LINE 12C OFFICERS, DIRECTORS, AND KEY EMPLOYEES ARE REQUIRED TO COMPLETE A WELLSPAN HEALTH "CONFLICT OF INTEREST DISCLOSURE STATEMENT" QUESTIONNAIRE ANNUALLY. THE INTERNAL AUDIT DEPARTMENT OF WELLSPAN HEALTH ADMINISTERS THE QUESTIONNAIRES. THERE SHALL BE FULL DISCLOSURE BY A DIRECTOR HAVING A BUSINESS OR PERSONAL INTEREST OR RELATIONSHIP WHICH MAY BE IN CONFLICT WITH THE INTERESTS OF THE CORPORATION. AFTER SUCH DISCLOSURE, THE DIRECTOR SHALL ABIDE BY THE DETERMINATION OF THE BOARD OF DIRECTORS AS TO WHETHER A CONFLICT EXISTS, THE EXTENT TO WHICH, IF AT ALL, THE DIRECTOR WILL BE PERMITTED TO BE PRESENT DURING THE BOARD OF DIRECTORS' DISCUSSION OF THE MATTER IN WHICH THE DIRECTOR MAY BE INTERESTED, AND WHETHER THE DIRECTOR WILL BE PERMITTED TO PARTICIPATE IN SUCH DISCUSSION AND CAST A VOTE IN SUCH MATTER. ADDITIONALLY, ALL BOARD MEMBERS, EMPLOYEES, STUDENTS, AND VOLUNTEERS OF WELLSPAN HEALTH AND ITS RELATED ORGANIZATIONS MUST COMPLETE A "CODE OF CONDUCT" FORM TO ACKNOWLEDGE THAT HE OR SHE UNDERSTANDS THAT WE ALL HAVE AN OBLIGATION TO ACT IN WAYS THAT WILL MERIT THE TRUST, CONFIDENCE, AND RESPECT OF THE COMMUNITY WE SERVE, OTHER HEALTH CARE PROVIDERS, AND ALL OF THOSE WITH WHOM WE INTERACT. FORM 990, PART VI, SECTION B, LINE 15B THE PRIMARY PURPOSE OF WELLSPAN HEALTH COMPENSATION COMMITTEE, AS ASSIGNED BY THE WELLSPAN HEALTH BOARD OF DIRECTORS, IS TO REVIEW COMPENSATION PACKAGES OFFERED AND/OR PAID TO SENIOR SYSTEM EXECUTIVES AND PRACTICING PHYSICIANS EMPLOYED WITHIN THE SYSTEM. THE COMPENSATION COMMITTEE SHALL MONITOR AND EVALUATE THE PERFORMANCE OF THE PRESIDENT AND CEO OF WELLSPAN HEALTH AND SHALL, AT LEAST ANNUALLY, COORDINATE THE IN-PERSON PERFORMANCE REVIEW OF THE PRESIDENT AND CEO BY THE WELLSPAN HEALTH BOARD OF DIRECTORS. THE COMPENSATION COMMITTEE SHALL CONSIST OF 5-10 MEMBERS OF THE WELLSPAN HEALTH BOARD OF DIRECTORS, INCLUDING THE CHAIR AND THE VICE CHAIR. EACH COMPENSATION COMMITTEE MEMBER SHALL BE NOMINATED BY THE GOVERNANCE COMMITTEE, AND APPOINTED BY THE WELLSPAN HEALTH BOARD OF DIRECTORS, FOR A TERM OF ONE (1) YEAR. REAPPOINTMENT OF A COMPENSATION COMMITTEE MEMBER FOR MORE THAN ONE (1) TERM IS NOT AUTOMATIC OR PRESUMED AND SHALL BE BASED ON AN INDIVIDUAL PERFORMANCE EVALUATION OF THE COMPENSATION COMMITTEE MEMBER (AS PERFORMED OR OVERSEEN BY THE GOVERNANCE COMMITTEE). THE COMPENSATION COMMITTEE SHALL BE RESPONSIBLE TO, AND SUBJECT TO THE DIRECTION AND CONTROL OF, THE WELLSPAN HEALTH BOARD OF DIRECTORS. THE WELLSPAN HEALTH BOARD OF DIRECTORS SHALL BE SOLELY RESPONSIBLE FOR DELINEATING THE RESPONSIBILITIES OF THE COMPENSATION COMMITTEE. THE COMPENSATION COMMITTEE SHALL PERFORM ONLY SUCH FUNCTIONS AND DUTIES AS SHALL FROM TIME TO TIME BE SPECIFICALLY DELEGATED TO THE COMPENSATION COMMITTEE BY THE WELLSPAN HEALTH BOARD OF DIRECTORS. THE COMPENSATION COMMITTEE DOES NOT HAVE DELEGATED AUTHORITY, AND THEREFORE ANY ACTIONS AND RECOMMENDATIONS OF THE COMMITTEE MUST BE APPROVED BY THE WELLSPAN HEALTH BOARD OF DIRECTORS BEFORE THEY ARE FINAL AND BINDING. IN DISCHARGING ITS ROLE, THE COMPENSATION COMMITTEE IS EMPOWERED TO INQUIRE INTO ANY MATTER IT CONSIDERS APPROPRIATE TO CARRY OUT ITS RESPONSIBILITIES, WITH ACCESS TO ALL BOOKS, RECORDS, FACILITIES, AND PERSONNEL OF THE WELLSPAN SYSTEM. THE FOLLOWING RESPONSIBILITIES ARE SET FORTH AS A GUIDE FOR FULFILLING THE COMPENSATION COMMITTEE'S PURPOSES IN SUCH MANNER AS THE COMMITTEE DETERMINES IS APPROPRIATE: 1. SET, PERIODICALLY REVIEW AND ENSURE COMPLIANCE WITH THE EXECUTIVE COMPENSATION PHILOSOPHY FOR WELLSPAN, IN AN EFFORT TO ATTRACT AND RETAIN HIGH QUALITY EXECUTIVES, WHILE CONSIDERING COMPENSATION OFFERED TO THOSE IN COMPARABLE POSITIONS IN SIMILAR EMPLOYMENT MARKETS AS WELL AS THE SYSTEM'S NEEDS AND FINANCIAL RESOURCES. 2. RECOMMEND APPROVAL OF EXECUTIVE COMPENSATION PROGRAM ELEMENTS (INCENTIVES, SUPPLEMENTAL BENEFITS, ETC.). 3. IN CONJUNCTION WITH THE WELLSPAN HEALTH BOARD OF DIRECTORS, EVALUATE PERFORMANCE AND ESTABLISH COMPENSATION FOR THE PRESIDENT & CEO OF WELLSPAN HEALTH. 4. EVALUATE EXECUTIVE TEAM PERFORMANCE AND ESTABLISH AWARDS. 5. RECOMMEND APPROVAL OF SENIOR EXECUTIVE BASE SALARY RANGES. 6. ALIGN EXECUTIVE COMPENSATION WITH EXECUTIVE TALENT MANAGEMENT AND SUCCESSION. 7. OVERSEE EMPLOYED PHYSICIAN COMPENSATION PROGRAM. 8. THE COMPENSATION COMMITTEE SHALL MAINTAIN MINUTES OF COMPENSATION COMMITTEE MEETINGS AND RECORDS OF ITS ACTIVITIES, AND SHALL REPORT PROMPTLY TO THE WELLSPAN HEALTH BOARD OF DIRECTORS ANY ACTION TAKEN BY THE COMPENSATION COMMITTEE, ANY RECOMMENDATIONS OF THE COMPENSATION COMMITTEE, AND ANY OTHER MATTERS THE COMPENSATION COMMITTEE DEEMS APPROPRIATE TO THE WELLSPAN HEALTH BOARD OF DIRECTORS REQUESTS. 9. THE COMPENSATION COMMITTEE SHALL UNDERTAKE SUCH OTHER RESPONSIBILITIES AS THE WELLSPAN HEALTH BOARD OF DIRECTORS MAY DELEGATE OR ASSIGN TO THE COMPENSATION COMMITTEE FROM TIME TO TIME. THE COMPENSATION COMMITTEE ALSO UTILIZES THE SERVICES OF SULLIVANCOTTER, AN INDEPENDENT, THIRD-PARTY HEALTH CARE COMPENSATION CONSULTANT, TO ALIGN AND STRUCTURE WORKFORCE COMPENSATION AND BENEFIT STRATEGIES THAT SUPPORT ENTERPRISE-WIDE TRANSFORMATION AND BUSINESS PERFORMANCE. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, POLICIES, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART IX, LINE 11G OUTSIDE SERVICES: PROGRAM SERVICE EXPENSES 6,124,693. MANAGEMENT AND GENERAL EXPENSES 697,944. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,822,637. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 12,833,876. MANAGEMENT AND GENERAL EXPENSES 147,171. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 12,981,047. SPECIALIST CONTRACT: PROGRAM SERVICE EXPENSES 54,745,623. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 54,745,623. TEMPORARY PROFESSIONAL STAFF: PROGRAM SERVICE EXPENSES 31,328,595. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 31,328,595. FORM 990, PART XI, LINE 9: CHANGE IN FV DERIVATIVE 13,576,278. CHANGE IN RETIREMENT -5,678,108. GAIN ON PENSION PLAN 11,556,578. TRANSFER TO WELLSPAN HEALTH -19,000,000. TRANSFER TO WELLSPAN MEDICAL GROUP -14,500,000. APPLE HILL SURGICAL CENTER INC PO BOX 2767 YORK PA 174052767 222842253 SOLE GP IN LP. 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0 0 CUMBERLAND VALLEY MOBILE SERVICES 5 S MAIN ST SUGARLOAF PA 18249 200884014 MOBILE HEALTH SERVICES PA CHAMBERSBURG HEALTH SERVICES 0 0 LITTLESTOWN HEALTH CARE PARTNERS 300 WEST KING STREET LITTLESTOWN PA 17340 232880464 LEASE FACILITY PA WELLSPAN HEALTH CARE SERVICES 0 0 SUMMIT SURGERY CENTER PO BOX 2767 YORK PA 174052767 251845303 PHYSICIAN SERVICES PA CHAMBERSBURG HEALTH SERVICES 0 0 SURGERY CENTER ASSOCIATES LLC PO BOX 2767 YORK PA 174052767 251845304 PHYSICIAN SERVICES PA CHAMBERSBURG HEALTH SERVICES 0 0 THE REHAB CENTER 855 SPRINGDALE DRIVE SUITE 20 EXTON PA 19341 251687903 PHYSICAL THERAPY REHABILITATION PA EPHRATA HOSPITAL 0 0 APPLE HILL CONDOMINIUM ASSOCIATION PO BOX 2767 YORK PA 174052767 232504543 CONDOMINIUM ASSOCIATION PA WELLSPAN HEALTH CARE SERVICES C 0 EPHRATA HEALTH PAVILION CONDOMINIUM ASSOCIATION PO BOX 2767 YORK PA 174052767 475367279 CONDOMINIUM ASSOCIATION PA EPHRATA HOSPITAL C 0 GOOD SAMARITAN PHYSICIAN HOSPITAL ORGANIZATION OF LEBANON PA PO BOX 2767 YORK PA 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