2019-05-14T13:40:44-05:00 2018-06-30 520783935 SMITH ELLIOTT KEARNS & COMPANY LLC 19 BROOKWOOD AVE STE 101 CARLISLE PA 17015 990 2017-07-01 231360854 WAYNESBORO HOSPITAL WAYN 7177654000 501 E MAIN ST WAYNESBORO PA 17268 KIMBERLY M RZOMP TREASURER/VP & CFO 7177654000 2019-05-14 GREGORY P HALL CPA P00156653 7172439104 2019-05-14 50.192.7.141 2019-05-14 13:40:44 CD P 6CBB79C053B248571C9CF37C921E5AD012119690 F292BA449C1BF8BBA7F8F0BF46EB3EDD96736C0F 2017 2019-02-21 02:37:17Z PATRICK W O'DONNELL 112 N SEVENTH STREET CHAMBERSBURG PA 17201 81281046 false X WWW.SUMMITHEALTH.ORG X 1922 PA THE WAYNESBORO HOSPITAL IS A REGIONAL NONPROFIT HEALTH CARE ORGANIZATION COMMITTED TO THE IMPROVEMENT OF THE HEALTH AND WELL-BEING OF THE PEOPLE IN SOUTH-CENTRAL PENNSYLVANIA. 14 11 623 217 135081 -49888 140223 104254 66620015 73341536 3504146 3176155 735259 882195 70999643 77504140 0 0 37451511 37915391 0 0 22382319 25044410 59833830 62959801 11165813 14544339 139191250 144309278 27789720 26237684 111401530 118071594 THE WAYNESBORO HOSPITAL IS A REGIONAL NONPROFIT HEALTH CARE ORGANIZATION COMMITTED TO THE IMPROVEMENT OF THE HEALTH AND WELL-BEING OF THE PEOPLE IN SOUTH-CENTRAL PENNSYLVANIA. false false 46993218 73341536 THE WAYNESBORO 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. ALL MANAGEMENT AND GENERAL EXPENSES ARE CONSIDERED PROGRAM RELATED. 46993218 true true false false false false false false false true true true false false true true true true false false false false false false false false true true false false true false false false false false false false false false false false false false true false false false true 51 0 true 623 true true true false false false false false false false false false X 14 11 false false false false true true true true true false false true true true true true true true true false PA X KIMBERLY M RZOMP VPCFO 7172677107 112 NORTH SEVENTH STREET CHAMBERSBURG PA 17201 PAUL SCHEMEL CHAIR 0.14 0.45 X X 0 0 0 DR JOSEPH STEWART VICE-CHAIR 0.07 0.27 X X 0 0 0 PATRICK W O'DONNELL PRESIDENT 6.12 36.58 X X 129391 733217 271314 KIMBERLY M RZOMP TREASURER/VP 4.00 37.04 X X 48542 436875 71976 DR LISA HIGGINBOTHAM DIRECTOR 0.12 40.00 X 0 196750 14618 DR FRANCIS ACHAMPONG DIRECTOR 0.05 0.09 X 0 0 0 JOHN BLUBAUGH DIRECTOR 0.10 0.27 X 0 0 0 FRANK ERVIN DIRECTOR 0.02 0.24 X 0 0 0 STEVE HOLOVIAK DIRECTOR 0.12 0.40 X 0 0 0 GREG DUFFEY DIRECTOR 0.09 X 0 0 0 DR ROBERT PYATT DIRECTOR 0.09 0.22 X 0 0 0 JAMES ROCK DIRECTOR 0.14 0.03 X 0 0 0 DENNIS SHOCKEY DIRECTOR 0.14 0.19 X 0 0 0 BONNIE ZEHLER DIRECTOR 0.04 X 0 0 0 THOMAS ANDERSON VP MEDICAL A 8.00 32.00 X 99061 396242 58426 BARBARA ROSSINI VP COMMUNITY 4.00 36.00 X 27453 247053 49742 MELISSA DUBROW VP & COO 40.00 X 258565 0 40344 SHERRI STAHL SR VP HOSPIT 8.00 32.00 X 87506 350024 67190 MICHELE ZEIGLER VP INFORMATI 8.00 32.00 X 65572 262288 57331 JEFF CARTY VP OF FINANC 40.00 X 222765 0 42918 JILL KELLER VP NURSING S 40.00 X 189689 0 35274 BRUCE FOSTER ED PHYSICIAN 40.00 X 132336 0 24156 SCOTT CARD ED PHYSICIAN 40.00 X 312542 0 35577 KEVIN SANDERS ED PHYSICIAN 40.00 X 166608 0 15425 CLARENCE MILLER PATHOLOGIST 40.00 X 219426 0 29508 JARETT LOGSDON PHARMACY MAN 40.00 X 131978 0 16027 2091434 2622449 829826 19 false true false FRANKLIN COUNTY EMER ASSO LLC 720 ORCHARD CT CHAMBERSBURG PA 17201 PROF MED SERV 3719533 PYRAMID CONSTRUCTION SVS INC 840 NORTH FRONT STREET WORMLEYSBURG PA 17043 GENERAL CONTRAC 2624326 GE HEALTHCARE IITS USA CORP 40 IDX DRIVE SOUTH BURLINGTON VT 05403 COMPUTER SERVIC 764241 MUSSER MECHANICAL INC 80 LANDIS DRIVE MERCERSBURG PA 17236 PROF. SERVICES 511740 FASTAFF LLC 5700 S QUEBEC STREET DENVER CO 80111 MEDICAL STAFFIN 345253 16 84957 19297 104254 PROGRAM SERVICE REVENUE 621990 73341536 73341536 73341536 2478556 2478556 1435780 1375502 60278 60278 60278 3099003 2385000 16404 714003 -16404 697599 697599 VHA INCENTIVE BONUS 621990 272429 272429 CAFETERIA REVENUE 621990 253454 253454 COURIER AND LAB SERVICES 621500 135081 135081 160953 160953 821917 77504140 73341536 135081 3923269 1368426 1368426 27531231 22375055 5156176 934119 813482 120637 6063389 4809457 1253932 2018226 1574115 444111 30375 17743 12632 4940357 2885762 2054595 133908 78218 55690 1371249 800974 570275 629395 367642 261753 56339 32909 23430 21769 12716 9053 3567616 1945778 1621838 479810 280267 199543 PHYSICIAN CONTRACTUAL PAY 7046035 7046035 SUPPLIES 6625214 3869920 2755294 MISCELLANEOUS EXPENSE 78429 45812 32617 DUES 63914 37333 26581 62959801 46993218 15966583 0 1125 1125 6350025 9344335 15671 22615 6614128 6194059 345257 359076 253261 278827 746746 876706 101720964 61122440 39401180 40598524 22195801 24539123 57054788 58325581 162023 142962 6051245 3626345 139191250 144309278 8033728 8096459 13612507 13039117 6143485 5102108 27789720 26237684 X 108118326 114732876 13471 22615 3269733 3316103 111401530 118071594 139191250 144309278 14544339 526019 -8400294 X false true X true false X 9507802 136108 597504 -8251 -4510 10228229 8591208 128985 800942 -8675 -4658 9507802 8609595 138437 -143310 -8509 -5005 8591208 8355696 191429 73178 -6513 -4195 8609595 7379981 127977 859000 -6878 -4388 8355696 0.95450 0.04550 false false 3009243 1083234 4092477 17216780 20619448 14293684 23542544 1247779 58544480 46828756 12963503 40598524 FIXED INCOME 34188325 F REAL ASSETS 21059900 F CASH AND MONEY FUNDS 2288985 F PARTNERSHIPS 670083 F FIXED INCOME MUTUAL FUNDS 118279 F OTHER SECURITIES 9 C 58325581 ESTIMATED PAYABLES TO THIRD PARTY 4849308 ADVANCES FROM THIRD PARTY PAYORS 252800 5102108 X 78030159 526019 526019 77504140 77504140 62959801 62959801 62959801 SCHEDULE D, PAGE 2, PART V, LINE 4 ENDOWMENT FUNDS ARE TO BE USED FOR THE DEVELOPMENT OR EXPANSIONS OF COMMUNITY HEALTHCARE INITIATIVES AND PROGRAMS. FUNDS ARE ALSO USED TO EDUCATE THE COMMUNITY ABOUT HEALTHCARE ISSUES. SCHEDULE D, PAGE 3, PART X WHEN TAX RETURNS ARE FILED, IT IS HIGHLY CERTAIN THAT SOME POSITIONS TAKEN WOULD BE SUSTAINED UPON EXAMINATION BY THE TAXING AUTHORITIES, WHILE OTHERS ARE SUBJECT TO UNCERTAINTY ABOUT THE MERITS OF THE POSITION TAKEN OR THE AMOUNT OF THE POSITION THAT WOULD BE ULTIMATELY SUSTAINED. THE BENEFIT OF A TAX POSITION IS RECOGNIZED IN THE FINANCIAL STATEMENTS IN THE PERIOD DURING WHICH , BASED ON ALL AVAILABLE EVIDENCE, MANAGEMENT BELIEVES IT IS MORE LIKELY THAN NOT THAT THE POSITION WILL BE SUSTAINED UPON EXAMINATION, INCLUDING THE RESOLUTION OF APPEALS OR LITIGATION PROCESSES, IF ANY. TAX POSITIONS TAKEN ARE NOT OFFSET OR AGGREGATED WITH OTHER POSITIONS. TAX POSITIONS THAT MEET THE MORE-LIKELY-THAN-NOT RECOGNITION THRESHOLD ARE MEASURED AS THE LARGEST AMOUNT OF TAX BENEFIT THAT IS MORE THAN 50 PERCENT LIKELY OF BEING REALIZED UPON SETTLEMENT WITH THE APPLICABLE TAXING AUTHORITY. THE PORITON OF THE BENEFITS ASSOCIATED WITH TAX POSITIONS TAKEN THAT EXCEEDS THE AMOUNT MEASURED AS DESCRIBED ABOVE WOULD BE REFLECTED AS A LIABILITY FOR UNRECOGNIZED TAX BENEFITS IN THE ACCOMPANYING BALANCE SHEETS ALONG WITH ANY ASSOCIATED INTEREST AND PENALTIES THAT WOULD BE PAYABLE TO THE TAXING AUTHORITIES UPON EXAMINATION. INTEREST AND PENALTIES ASSOCIATED WITH UNRECOGNIZED TAX BENEFITS WOULD BE CLASSIFIED AS EXPENSES AGAINST OTHER OPERATING REVENUE IN THE STATEMENTS OF OPERATIONS. AT JUNE 30, 2018 AND 2017, THERE WAS NO LIABILITY FOR UNRECOGNIZED TAX BENEFITS. SCHEDULE D, PAGE 4, PART XII, LINE 4B -746,473 BOOK / TAX DEPRECIATION DIFFERENCE 746,473 true true X true X true X false true false true true 778735 778735 0.01240 8948159 4100414 4847745 0.07700 9726894 4100414 5626480 0.08940 87866 87866 0.00140 46612 46612 0.00070 33303 33303 0.00050 18783 18783 0.00030 87515 87515 0.00140 274079 274079 0.00430 10000973 4100414 5900559 0.09370 false 5366444 9534536 10530051 -995515 X true true 1 1 WAYNESBORO HOSPITAL 501 EAST MAIN STREET WAYNESBORO PA 17268 X X X WAYNESBORO HOSPITAL 1 false false true X X X X X X X X X X 15 true true true true X WWW.SUMMITHEALTH.ORG X WWW.HEALTHYFRANKLINCOUNTY.ORG X X true 16 true WWW.SUMMITHEALTH.ORG false false true X 200.000000000000 300.000000000000 X true true X X X X true X WWW.SUMMITHEALTH.ORG X WWW.SUMMITHEALTH.ORG X WWW.SUMMITHEALTH.ORG X X X X X X X true X false X X X X X true X false false FACILITY 1, WAYNESBORO HOSPITAL - PART V, LINE 5 THE ORGANIZATION FORMED AN ADVISORY GROUP WHICH IS COMPOSED OF A CORE GROUP OF AGENCIES AND COMMUNITY LEADERS IN FRANKLIN COUNTY. THE ORGANIZATION ALSO CONTRACTED THE PENN STATE HARRISBURG'S INSTITUTE OF STATE AND REGIONAL AFFAIRS. PENN STATE OBTAINED DATA THROUGH THE USE OF FOCUS GROUPS, A COMMUNITY HEALTH SURVEY, AND RESEARCHING SECONDARY DEMOGRAPHIC AND HEALTH DATA. FACILITY 1, WAYNESBORO HOSPITAL - PART V, LINE 6A THE CHAMBERSBURG HOSPITAL FACILITY 1, WAYNESBORO HOSPITAL - PART V, LINE 6B HEALTHY FRANKLIN COUNTY FACILITY 1, WAYNESBORO HOSPITAL - PART V, LINE 7D ONE JUNE 9, 2016, SUMMIT HEALTH AND HEALTHY FRANKLIN COUNTY FACILITATED A COMMUNITY HEALTH SUMMIT ON THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT. THERE WERE 121 INDIVIDUALS WHO ATTENDED THE HEALTH SUMMIT, REPRESENTING HEALTHCARE ORGANIZATIONS, COMMUNITY ORGANIZATIONS, EDUCATION INSTITUTIONS, LOCAL GOVERNMENT, AND COMMUNITY. FACILITY 1, WAYNESBORO HOSPITAL - PART V, LINE 11 A COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP) WAS DEVELOPED. FACILITY 1, WAYNESBORO HOSPITAL - PART V, LINE 16J INFORMATION AND APPLICATION CAN BE FOUND ON THE BACK OF A PATIENT BILLING STATEMENT. FACILITY 1, WAYNESBORO HOSPITAL - PART V, LINE 20E FINANCIAL COUNSELORS CALL AND SEND LETTERS TO SELF PAY PATIENTS OR PATIENTS WITH HIGH DEDUCTIBLE PLANS THAT RECEIVE EMERGENCY DEPARTMENT, SURGICAL, OR I/P SERVICES. PART I, LINE 3C - OTHER INCOME BASED CRITERIA FOR FREE OR DISCOUNTED CARE IF A FAMILY HAS LIQUID ASSETS AVAILABLE, THEY ARE EXPECTED TO CONTRIBUTE TO THE COST OF THEIR CARE USING THOSE FUNDS. HOWEVER, THEY ARE NOT REQUIRED TO SPEND DOWN ALL OF THEIR LIQUID ASSETS IN ORDER TO BE ELIGIBLE FOR A DISCOUNT. PATIENTS MAY RETAIN SIX MONTHS OF LIVING EXPENSES FROM THEIR LIQUID ASSETS. SIX MONTHS OF LIVING EXPENSES IS ESTIMATED TO BE ONE HALF OF 300% OF FPG. AT THAT POINT, THEY RECEIVE A DISCOUNT ON THEIR MEDICAL BILL. PART I, LINE 7 - COSTING METHODOLOGY EXPLANATION THE INFORMATION WAS OBTAINED USING THE COST METHODS USED IN PREPARING THE MEDICARE COST REPORTS. PART II - COMMUNITY BUILDING ACTIVITIES WAYNESBORO HOSPITAL WORKS TO STRENGTHEN OUR COMMUNITY THROUGH HEALTH EDUCATION EFFORTS FOR CHILDREN AND ADULTS, HEALTH FAIRS PROVIDING DIAGNOSTIC TESTING, EDUCATING COMMUNITY GROUPS OF SPECIFIC HEALTH TOPICS, FUNDING LOCAL COMMUNITY ORGANIZATIONS THROUGH THE SUMMIT HEALTH ENDOWNMENT PROGRAM, PROVIDING RESOURCES FOR THE "HEALTHY COMMUNITIES PARTNERSHIP" PROGRAM, PARTICIPATING IN LOCAL CIVIC ORGANIZATIONS, SPONSORING EVENTS HELD BY LOCAL CHARITABLE ORGANIZATIONS, AND SUPPORTING WORKFORCE DEVELOPMENT INITIATIVES THROUGH SUMMIT HEALTH'S SCHOOL LIAISON DEPARTMENT. PART III, LINE 2 - BAD DEBT EXPENSE METHODOLOGY FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT SOME PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. THE COST TO CHARGE RATIO WAS USED TO CALCULATE THE COST OF BAD DEBT EXPENSE. THIS RATIO IS CALCULATED AS FOLLOWS: (NET PATIENT REVENUE DIVIDED BY THE TOTAL OPERATING REVENUE MULTIPLIED BY THE TOTAL OPERATING EXPENSE) DIVIDED BY THE GROSS PATIENT REVENUE. BAD DEBT EXPENSE FOOTNOTE TO FINANCIAL STATEMENTS THE HOSPITAL PROVIDES CREDIT IN THE NORMAL COURSE OF ITS BUSINESS TO PATIENTS. PATIENT RECEIVABLES ARE BASED ON THE OUTSTANDING PATIENT BALANCE AFTER ANY CONTRACTUAL REIMBURSEMENTS ARE APPLIED AND ARE GENERALLY DUE 30 DAYS AFTER BILLED. ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD- PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT SOME PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. PART III, LINE 8 - MEDICARE EXPLANATION THE INFORMATION WAS OBTAINED USING THE COST METHODS USED IN PREPARING THE MEDICARE COST REPORTS. THE SHORTFALL ABOVE RELATES TO OUR MISSION OF PROVIDING SERVICES TO MEMBERS OF OUR COMMUNITY. PART III, LINE 9B - COLLECTION PRACTICES EXPLANATION ALL PATIENTS ARE SUBJECT TO THE DEBT COLLECTION POLICY REGARDLESS OF THEIR ABILITY TO PAY. PART VI, LINE 2 - NEEDS ASSESSMENT HEALTH NEEDS OF FRANKLIN COUNTY RESIDENTS AND SURROUNDING COMMUNITIES ARE ASSESSED THROUGH NUMEROUS RESEARCH METHODS INCLUDING CONDUCTING COMMUNITY HEALTH NEEDS ASSESSMENT(TELEPHONE SURVEY FORMAT) IN 2012. THE NEEDS WERE IDENTIFIED BY KEY LEADERS AND NONPROFITS WITHIN THE COMMUNITY. FOUR PRIORITIES WERE DETERMINED: ACCESS TO HEALTHCARE, NUTRITION, EDUCATION AND MENTAL HEALTH. THE COMMUNITY NEEDS ASSESSMENT CAN BE FOUND ON OUR WEBSITE AT WWW.SUMMITHEALTH.ORG/ABOUTUS. PART VI, LINE 3 - PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE PATIENTS ARE MADE AWARE OF THE CHARITY PROGRAM AND OTHER BILLING ASSISTANCE SERVICES AT REGISTRATION, DURING EMERGENCY ROOM VISITS, AND NOTICES PLACED IN SERVICE AREAS. BILLING STATEMENTS ARE ALSO INFORM PATIENTS OF CHARITY CARE AND OTHER BILLING ASSISTANCE PROGRAMS. PART VI, LINE 4 - COMMUNITY INFORMATION WAYNESBORO HOSPITAL PRIMARILY SERVES COMMUNITY MEMBERS FROM FRANKLIN AND FULTON COUNTY, PA, AND NEARBY COMMUNITIES IN WASHINGTON COUNTY, MD. ACCORDING TO U.S. CENSUS DATA, FRANKLIN COUNTY RESIDENTS HAVE A SLIGHTLY LOWER INCOME AND ARE SLIGHTLY OLDER THAN THE STATE AVERAGE. FOR A HEALTH SYSTEM, THIS TYPICALLY RESULTS IN AN INCREASED NEED FOR HEALTHCARE SERVICES. PART VI, LINE 5 - PROMOTION OF COMMUNITY HEALTH WAYNESBORO HOSPITAL SUPPORTS LOCAL NON-PROFIT ORGANIZATIONS WITH FINANCIAL GRANTS FROM THE SUMMIT ENDOWMENT. PART VI, LINE 6 - AFFILIATED HEALTH CARE SYSTEM THE HOSPITAL IS PART OF SUMMIT HEALTH, A REGIONAL NETWORK OF HOSPITALS AND HEALTHCARE PROVIDERS THAT ARE SERVED BY THE ORGANIZATION'S COMMUNITY HEALTH DEPARTMENT. THIS DEPARTMENT'S MISSION IS TO IMPROVE THE HEALTH OF THE COMMUNITY THROUGH EDUCATION, DETECTION AND PREVENTION PROGRAMS INCLUDING HEALTH FAIRS, SCREENINGS, AND SEMINARS. THIS MISSION IS COMPLETED ON BEHALF OF WAYNESBORO HOSPITAL AND ALL OTHER SUMMIT AFFILIATES. PART OF THIS MISSION IS COMPLETED THROUGH COLLABORATION WITH OTHER COMMUNITY ORGANIZATIONS INCLUDING THE PA DEPARTMENT OF HEALTH. X X true true X X X X X false true false false false false false true false PATRICK W O'DONNELL PRESIDENT 93453 529568 29520 167280 6418 36369 33660 190739 7037 39878 170088 963834 KIMBERLY M RZOMP TREASURER/VP & CFO 37649 338842 8145 73301 2748 24732 5300 47700 1898 17078 55740 501653 DR LISA HIGGINBOTHAM DIRECTOR 182732 13788 230 5818 8800 211368 THOMAS ANDERSON VP MEDICAL AFFAIRS 76424 305696 16146 64583 6491 25963 7839 31357 3846 15384 110746 442983 BARBARA ROSSINI VP COMMUNITY RELATIO 20757 186809 4585 41241 2111 19003 2593 23341 2381 21427 32427 291821 MELISSA DUBROW VP & COO 187949 41011 29605 13787 26557 298909 SHERRI STAHL SR VP HOSPITAL SERVI 67660 270639 14608 58433 5238 20952 9389 37557 4049 16195 100944 403776 MICHELE ZEIGLER VP INFORMATION SERVI 49322 197287 10493 41973 5757 23028 9554 38218 1912 7647 77038 308153 JEFF CARTY VP OF FINANCE 181981 22645 18139 12917 30001 265683 JILL KELLER VP NURSING SERVICES/ 171127 9614 8948 11005 24269 224963 BRUCE FOSTER ED PHYSICIAN 127401 4935 8133 16023 156492 SCOTT CARD ED PHYSICIAN 301430 11112 16200 19377 348119 KEVIN SANDERS ED PHYSICIAN 166469 139 9996 5429 182033 CLARENCE MILLER PATHOLOGIST 215399 4027 13419 16089 248934 SCHEDULE J, PAGE 1, PART I, LINE 1A THE ORGANIZATION REIMBURSES THE COO FOR DUES ASSOCIATED WITH A SOCIAL CLUB. THE OFFICER RECEIVES AN ALLOWANCE THAT CAN BE CONSIDERED A DISCRETIONARY SPENDING ACCOUNT. THE MONIES ARE IN LIEU OF AN AUTOMOBILE ALLOWANCE, TO PURCHASE ADDITIONAL LIFE INSURANCE, ETC. THESE MONIES ARE INCLUDED IN COMPENSATION AS REPORTED IN THE COMPENSATION OF OFFICERS TABLE. A RESULTS FITNESS CLUB MEMBERSHIP IS AVAILABLE FREE OF CHARGE FOR ANY OFFICER AND ACTIVE BOARD MEMBER. SCHEDULE J, PAGE 1, PART I, LINE 4 PATRICK W. O'DONNELL 0 2,700 0 KIMBERLY M. RZOMP 0 1,800 0 THOMAS ANDERSON 0 3,600 0 BARBARA ROSSINI 0 1,293 0 MELISSA DUBROW 0 11,551 0 SHERRI STAHL 0 3,600 0 MICHELE ZEIGLER 0 3,012 0 SCHEDULE J, PAGE 1, PART I, LINE 7 INCENTIVE COMPENSATION IS BASED ON PRE-DETERMINED, MEASURABLE GOALS APPROVED BY THE BOARD OF DIRECTORS EXECUTIVE COMMITTEE. THE MEASUREABLE GOALS ARE BASED ON QUALITY, COMMUNITY ACCESS TO CARE, PATIENT SAFETY, AND LEADERSHIP. FORM 990, PAGE 6, PART VI, LINE 6 SUMMIT HEALTH, A 501(C)(3) ENTITY, IS A MEMBER OF THIS ORGANIZATION. FORM 990, PAGE 6, PART VI, LINE 7A SUMMIT HEALTH, A 501(C)(3) ENTITY, ELECTS THE MEMBERS OF THE GOVERNING BODY. FORM 990, PAGE 6, PART VI, LINE 7B SUMMIT HEALTH, A 501(C)(3) ENTITY, RETAINS CERTAIN RESERVE POWERS OVER THIS ORGANIZATION. FORM 990, PAGE 6, PART VI, LINE 11B THE ORGANIZATION'S 990 IS REVIEWED BY THE AUDIT COMMITEE AND UPON APPROVAL RECOMMENDED TO THE FULL BOARD OF DIRECTORS FOR SUBMISSION TO THE IRS. FORM 990, PAGE 6, PART VI, LINE 12C MEMBERS ARE ASKED TO ANNUALLY DISCLOSE ANY CONFLICTS OF INTEREST THEY MAY HAVE. FORM 990, PAGE 6, PART VI, LINE 15A COMPENSATION IS DISCUSSED WITH AN INDEPENDENT COMPENSATION COMMITTEE. THIS IS PERFORMED IN CONCERT WITH A COMPENSATION CONSULTANT WHO ASSISTS THIS COMMITTEE IN SETTING THE COMPENSATION FOR THESE INDIVIDUALS. FORM 990, PAGE 6, PART VI, LINE 15B COMPENSATION IS DISCUSSED WITH AN INDEPENDENT COMPENSATION COMMITTEE. THIS IS PERFORMED IN CONCERT WITH A COMPENSATION CONSULTANT WHO ASSISTS THIS COMMITTEE IN SETTING THE COMPENSATION FOR THESE INDIVIDUALS. FORM 990, PAGE 6, PART VI, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. THESE DOCUMENTS ARE HELD IN THE FINANCE DEPARTMENT OF THE WAYNESBORO HOSPITAL. HOSPITAL BYLAWS AND ALL POLICIES AND PROCEDURES ARE FOUND ON THE WAYNESBORO HOSPITAL INTRANET. FORM 990, PART XI, LINE 9 NET TRANSFERS TO AFFILIATES -8,400,294 SUMMIT PHYSICIAN SERVICES 785 5TH AVENUE SUITE 3 CHAMBERSBURG PA 17201 251716306 HEALTHCARE PA 501C3 3 SUMMIT HEA true CHAMBERSBURG HOSPITAL 112 NORTH SEVENTH STREET CHAMBERSBURG PA 17201 230465970 HEALTHCARE PA 501C3 3 SUMMIT HEA true CHAMBERSBURG HEALTH SERVICES 785 5TH AVENUE SUITE 5 CHAMBERSBURG PA 17201 251515376 HEALTHCARE PA 501C3 12A SUMMIT HEA true SUMMIT HEALTH 112 NORTH SEVENTH STREET CHAMBERSBURG PA 17201 251515371 HEALTHCARE PA 501C3 7 SUMMIT HEA true false false true false false false false false false true true true true false false true false true false