2019-05-13T12:05:46-05:00 2018-06-30 550486667 ARNETT CARBIS TOOTHMAN LLP 5700 CORPORATE DRIVE STE 650 PITTSBURGH PA 15237 990 2017-07-01 250965570 SOMERSET COMMUNITY HOSPITAL SOME 8144435221 225 SOUTH CENTER AVENUE SOMERSET PA 15501 ANDREW RUSH CEO 8144435221 2019-05-02 1 KELLY A BROCIOUS CPA P01254262 4126356270 2019-05-02 216.12.119.47 2019-05-02 14:24:17 ED P FA047645C58205390672F21DBD5C45410A20F442 4D960446B7F14F4AD26B7F75F1384555BBF7A246 2017 2019-02-21 02:37:17Z ANDREW RUSH 225 SOUTH CENTER AVENUE SOMERSET PA 15501 91631460 0 X WWW.SOMERSETHOSPITAL.COM X 1921 PA SOMERSET HOSPITAL IS A NOT-FOR-PROFIT COMMUNITY ASSET COMMITTED: TO PROVIDING CARE TO THE SICK AND INJURED, PRESERVING AND SUSTAINING LIFE, AND PROMOTING HEALTH AND WELL BEING; TO THE PROMOTION AND DEVELOPMENT OF COMPLEMENTARY PROGRAMS AND SERVICES, MANPOWER AND FACILITIES; TO THE CONTINUOUS IMPROVEMENT OF QUALITY, ACCESSIBILITY AND CONTINUITY OF PATIENT CARE; TO THE WELFARE AND LIVELIHOOD OF ITS EMPLOYEES; TO ENSURING THE HOSPITAL'S FINANCIAL VIABILITY NECESSARY TO MEET THE HEALTHCARE NEEDS OF THE COMMUNITY AND REGION TODAY AND IN THE FUTURE. 19 13 927 66 65427 33280 157720 1628148 66328109 69222531 640059 3242748 604775 410267 67730663 74503694 0 0 0 0 31407171 32970289 0 0 0 32895312 34996070 64302483 67966359 3428180 6537335 74548389 68415098 49212535 44017421 25335854 24397677 X OUR MISSION AS AN ORGANIZATION IS TO PRESERVE AND IMPROVE LIFE BY PROVIDING ACCESS TO QUALITY, CUSTOMER-FRIENDLY HEALTHCARE SERVICES. 0 0 56705605 69547070 SOMERSET HOSPITAL IS A NOT-FOR-PROFIT COMMUNITY ASSET COMMITTED: TO PROVIDING CARE TO THE SICK AND INJURED, PRESERVING AND SUSTAINING LIFE, AND PROMOTING HEALTH AND WELL BEING; TO THE PROMOTION AND DEVELOPMENT OF COMPLEMENTARY PROGRAMS AND SERVICES, MANPOWER AND FACILITIES; TO THE CONTINUOUS IMPROVEMENT OF QUALITY, ACCESSIBILITY AND CONTINUITY OF PATIENT CARE; TO THE WELFARE AND LIVELIHOOD OF ITS EMPLOYEES; TO ENSURING THE HOSPITAL'S FINANCIAL VIABILITY NECESSARY TO MEET THE HEALTHCARE NEEDS OF THE COMMUNITY AND REGION TODAY AND IN THE FUTURE.SOMERSET HOSPITAL IS A 111-BED, NOT-FOR-PROFIT COMMUNITY HOSPITAL SERVING THE SOMERSET AREA. THE HOSPITAL ALSO PROVIDES CARE FOR MANY PATIENTS NORTH OF SOMERSET TO ROUTE 30 AND SOUTH OF SOMERSET TO THE MARYLAND STATE LINE.SOMERSET HOSPITAL, ONE OF THE TOP FIVE EMPLOYERS IN SOMERSET COUNTY, PROVIDES QUALITY HEALTH CARE IN A COMPASSIONATE MANNER REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE OR THE PATIENT'S ABILITY TO PAY. ALTHOUGH REIMBURSEMENT FOR SERVICES RENDERED IS CRITICAL TO THE OPERATION AND STABILITY OF SOMERSET HOSPITAL, THE HOSPITAL, UNDER ITS WRITTEN CHARITY CARE POLICY, IS COMMITTED TO PROVIDING NECESSARY HEALTH CARE SERVICES AT NO CHARGE OR AT A REDUCED CHARGE TO PATIENTS.CHARITY CARE FY 2018FREE CARE $298,715PUBLIC POLICIESTHROUGH SIGNAGE POSTED IN THE HOSPITAL'S INFORMATION CENTER, ADMISSIONS DEPARTMENT, EMERGENCY ROOM AND CREDIT OFFICE, THE PUBLIC IS PROVIDED WITH THE ORGANIZATION'S POLICY OF PROVIDING CARE REGARDLESS OF ABILITY TO PAY. INFORMATION ABOUT THE FINANCIAL ASSISTANCE POLICY IS ALSO LOCATED ON THE SOMERSET HOSPITAL WEBSITE. SOMERSET HOSPITAL GENERALLY DESIGNATES SERVICES AS "CHARITY CARE" AFTER BILLING. BASED ON AN INDIVIDUAL'S ABILITY TO PAY, SOMERSET HOSPITAL OFFERS PAYMENT PLANS AND ASSISTS INDIVIDUALS IN APPLYING FOR THE STATE'S MEDICAL ASSISTANCE PROGRAM. SELF-PAY PATIENTS ARE REQUESTED TO PROVIDE PARTIAL PRE-PAYMENT FOR SERVICES RENDERED BY THE HOSPITAL. HOWEVER, SERVICES BY SOMERSET HOSPITAL ARE PROVIDED WITHOUT REGARD TO AN INDIVIDUAL'S ABILITY TO PAY.COMMUNITY SERVICE AND CONTRIBUTIONSDURING THE PAST YEAR, SOMERSET HOSPITAL HAS PROVIDED THE FOLLOWING SERVICES AND CONTRIBUTIONS TO THE COMMUNITY. THE SERVICES ARE PROVIDED FREE OF CHARGE OR AT A NOMINAL FEE AS INDICATED.COMMUNITY HEALTH EDUCATION (FREE OR MINIMAL FEES CHARGED TO COVER DIRECT COSTS)CPR 49/YEAR 40 HOURSBABYSITTING CLASS 17/YEAR 10 HOURSHIP AND KNEE PAIN SEMINARS 43/YEAR 6 HOURSSHOULDER SEMINAR 15/YEAR 1 HOURDIABETES PROGRAM 70/YEAR 10 HOURSBECOMING A WOMAN 8/YEAR 2 HOURSGROCERY STORE TOUR 11/YEAR 4 HOURSTOTAL 213/YEAR 73 HOURSSUPPORT GROUPS (NO CHARGE)HOSPICE BEREAVEMENT 49/YEAR 12 HOURSSLEEP APNEA 98/YEAR 10 HOURSPARKINSON'S 40/YEAR 12 HOURSTRANSPLANT SUPPORT 4/YEAR 2 HOURSDIABETES SUPPORT GROUP 25/YEAR 4 HOURSTOTAL 216/YEAR 40 HOURSCOMMUNITY EDUCATION INFORMATION REQUESTS (NO CHARGE)PHONE/MAIL REQUESTS 156/YEAR 10 HOURSSCHOOL PROGRAMS (NO CHARGE)SECOND GRADE TOURS 235 STUDENTS/YEAR 10 HOURSBOYS AND GIRLS CLUB TOUR 25/YEAR 1 HOURPOISON PREVENTION PROGRAMS 500/YEAR 8 HOURSSHADOW STUDENTS 42/YEAR 288 HOURS JUNIOR ACHIEVEMENT PROGRAMS 64/YEAR 46 HOURSSASD SCHOOL HEALTH FAIR 1200/YEAR 16 HOURSROCKWOOD STUDENT PRESENTATIONS 16/YEAR 4 HOURSCAREER EXPLORATION 25/YEAR 2 HOURSTOTAL 2,107/YEAR 375 HOURSHEALTH FAIRS OR COMMUNITY EDUCATION PROGRAMS (NO CHARGE TO THE COMMUNITY)HEALTH FAIRS/SCREENINGS 1,353/YEAR 26 HOURSHEART MONTH SEMINAR 30/YEAR 4 HOURSSTRESS MANAGEMENT 50/YEAR 12 HOURSSCHOOL HANDWASHING PROGRAMS 40/YEAR 2 HOURSSILVER SNEAKERS /YEAR 104 HOURSHEALTHWAYS /YEAR NO INSTRUCTION BY STAFFSILVER AND FIT /YEAR NO INSTRUCTION BY STAFFTOPS PROGRAM 80/YEAR 2 HOURSSENIOR CENTER PROGRAMS 185/YEAR 12 HOURSRUNNING PROGRAM 22/YEAR 2 HOURSTOTAL 1,760/YEAR 164 HOURSHOSPITAL STAFF CONTRIBUTIONS TO COMMUNITY ORGANIZATIONSSOMERSET ROTARY 8 HOURS/YEARSOMERSET COUNTY CHAMBER OF COMMERCE 24 HOURS/YEARSOMERSET EXCHANGE CLUB 47 HOURS/YEARREDEVELOPMENT AUTHORITY 14 HOURS/YEARDRUG-FREE COMMUNITIES 45 HOURS/YEARJUNIOR ACHIEVEMENT BOARD OF DIRECTORS 10 HOURS/YEARCHILD ADVOCACY INVESTIGATIVE COMMITTEE 9 HOURS/YEARSOMERSET MULTIDISCIPLINARY INVESTIGATIVE TEAM 9 HOURS/YEARSOMERSET COUNTY CHILD DEATH REVIEW BOARD 4 HOURS/YEAROTHER CONTRIBUTIONS"IN TOUCH" HOSPICETHROUGH THE HOSPITAL'S IN TOUCH HOSPICE CARE DEPARTMENT, TERMINALLY ILL PATIENTS AND THEIR FAMILIES ARE PROVIDED CLINICAL AND EMOTIONAL SUPPORT. THIS SERVICE IS SUPPORTED THROUGH COMMUNITY CONTRIBUTIONS: ANNUAL OPERATING BUDGET: $1,322,057 IN FISCAL YEAR 2018.SOCIAL WORK SERVICESSOMERSET HOSPITAL' SOCIAL WORK SERVICES DEPARTMENT, WITH AN OPERATING BUDGET IN EXCESS OF $142,705 IN FY 2018, IS RESPONSIBLE FOR MEETING BOTH INPATIENT AND OUTPATIENT SOCIAL NEEDS INCLUDING THE PLACEMENT OF PATIENTS IN AN APPROPRIATE COMMUNITY SETTING UPON DISCHARGE. THE STAFF PROVIDES EXPERTISE TO MANY COMMUNITY ORGANIZATIONS. 56705605 1 1 0 1 0 0 0 0 0 1 1 1 0 0 1 0 0 1 0 0 0 0 0 0 1 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 81 0 927 1 1 1 0 0 0 0 1 1 0 0 0 0 0 0 0 X 19 13 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 PA X CRAIG SPROCK 8144435221 225 SOUTH CENTER AVENUE SOMERSET PA 15501 KRISTA MATHIAS CHAIRMAN 2.00 2.00 X X 0 0 0 MARK BOWER 1ST VICE CHAIRMAN 2.00 X X 0 0 0 TOM SKELTON 2ND VICE CHAIRMAN 2.00 1.00 X X 0 0 0 CATHERINE POORBAUGH SECRETARY 2.00 2.00 X X 0 0 0 BRAD COBER TREASURER 1.00 2.00 X X 0 0 0 JOHN CUPPS ASST SECRETARY/TREASURER 2.00 2.00 X X 0 0 0 NATHANIEL A BARBERA DIRECTOR 1.00 1.00 X 0 0 0 AJAY P SINGH MD DIRECTOR 1.00 40.00 X 0 229725 16710 MICHELLE MOON DIRECTOR 1.00 1.00 X 0 0 0 SHARON CLAPPER DIRECTOR 1.00 1.00 X 0 0 0 V KRISHNAN NAIR MD DIRECTOR 1.00 41.00 X 0 322708 11046 FREDERIC ROSEMEYER DIRECTOR 1.00 1.00 X 0 0 0 LINDA FETTEROLF DIRECTOR 1.00 X 0 0 0 VINCE JACOB DIRECTOR 1.00 X 0 0 0 RON ALDOM DIRECTOR 1.00 X 0 0 0 SUZANNE STURNI DIRECTOR 1.00 X 0 0 0 BRUCE SHIPLEY DIRECTOR 1.00 X 0 0 0 JAYESH DESAI MD DIRECTOR 1.00 40.00 X 0 431660 19468 MARK YAROS MD DIRECTOR 1.00 40.00 X 0 250349 17575 MATTHEW KOCIOLA CFO 29.00 11.00 X 219080 0 4984 CRAIG SAYLOR CEO (UNTIL 12/18) 29.00 11.00 X 264920 0 23031 ANDREW RUSH CEO 29.00 11.00 X 250157 0 22488 RENEE YOUNG MD PHYSICIAN 40.00 X 407714 0 6158 MOKBEL MATTA MD PHYSICIAN 40.00 X 319650 0 4718 HAI C TSAO MD PHYSICIAN 40.00 X 313271 0 16455 NEELESH WELLING MD PHYSICIAN 40.00 X 288591 0 10887 NASREEN BAGWAN MD PHYSICIAN 40.00 X 273034 0 6743 2336417 1234442 160263 34 0 1 0 AHN EMERGENCY GRP OF SOMERSET COUNTY LT 4535 DRESSLER ROAD CANTON OH 44718 PHYSICIAN SERVICES 1425775 DIVERSIFIED CLINICAL SERVICES INC PO BOX 636981 CINCINNATI OH 45263 WOUND CLINIC SERVICES 611556 BUCHANAN INGERSOLL & ROONEY PC ONE OXFORD CENTER 301 GRANT STREET CHICAGO IL 606731285 LEGAL SERVICES 253277 ALLEGHENY SPECIALTY PRACTICE NETWORK 30 ISABELLA STREET PITTSBURGH PA 15212 PHYSICIAN SERVICES 148350 PONDER & CO 8498 SOLUTION CENTER CHICAGO IL 606678004 PHYSICIAN SERVICES 140517 5 20000 70000 1538148 1628148 NET PATIENT REVENUE 900099 68061184 68061184 PHARMACY SALES 900099 903886 894453 9433 MISC PATIENT REVENUE 900099 256583 245589 10994 MEDICAL RECORDS 900099 878 878 69222531 484188 484188 355434 356957 -1523 -1523 -1523 19486679 13627 16741746 0 2744933 13627 2758560 2758560 50887 20000 29063 21824 21824 OTHER OPERATING REVENUE 900099 212864 212864 GAIN ON INVESTMENTS IN EQUITY INV 900099 132102 132102 MANAGEMENT FEE 900099 45000 45000 389966 74503694 69547070 65427 3263049 X 26144148 20554910 5589238 4923090 3870605 1052485 1903051 1496206 406845 372868 372868 82407 82407 7845146 6167968 1677178 124595 97958 26637 530978 417463 113515 939531 738673 200858 100614 79104 21510 19659 15456 4203 593760 466823 126937 3679440 2892829 786611 462421 363562 98859 MEDICAL SUPPLIES 11986009 11986009 BAD DEBT 2908236 2908236 PHYSICIAN FEES 2073281 2073281 EQUIPMENT RENTAL & MAIN 1702926 1338865 364061 1574199 1237657 336542 67966359 56705605 11260754 0 3313876 1953846 750000 8840643 7380453 274888 252210 1434904 1568944 680242 1094643 110840725 79782287 31597617 31058438 26486615 22945654 1919604 1410910 74548389 68415098 11856044 9110006 21880821 20625782 396470 155115 15320555 13885163 49212535 44017421 X 23988769 23768229 1327085 609448 20000 20000 25335854 24397677 74548389 68415098 X 6537335 -1553058 -5922454 X X 0 1 X 1 0 X 0 0 0 0 0 0 1 35902 0 1 11525 47427 0 PART II-B, LINE 1: A PORTION OF SOMERSET COMMUNITY HOSPITAL'S DUES TO THE HOSPITAL & HEALTHSYSTEM ASSOCIATION OF PENNSYLVANIA (HAP), HEALTHCARE COUNCIL, AND OTHER HEALTHCARE ASSOCIATIONS ARE USED FOR LOBBYING. PART II-B, LINE 1(G), DIRECT CONTACT WITH LEGISLATORS, THEIR STAFFS, GOVERNMENT OFFICIALS, OR A LEGISLATIVE BODY: SOMERSET COMMUNITY HOSPITAL CONTACTS VARIOUS LEGISLATORS AND GOVERMENT OFFICIALS TO FURTHER HEALTH CARE INITIATIVES IN THE COMMUNITIES IT SERVES. 25465828 -3023957 22441871 22494129 2971699 25465828 22914977 -420848 22494129 22721873 193104 22914977 19783406 2938467 22721873 1.00000 1 0 3234957 3234957 58529575 36295179 22234396 48674050 43487108 5186942 402143 402143 31058438 MARKETABLE SECURITIES 22457597 F TRUST BOND INDENTURE 468057 F TRUST HELD BY OTHERS 20000 F 22945654 SELF INSURANCE 4194190 MINIMUM PENSION LIABILITY 9690973 13885163 PART V, LINE 4: THE BOARD DESIGNATED ENDOWMENT ARE ASSETS SET ASIDE BY THE BOARD OF DIRECTORS FOR DESIGNATED PURPOSES OVER WHICH THE BOARD RETAINS CONTROL AND MAY AT ITS DISCRETION SUBSEQUENTLY USE FOR OTHER PURPOSE. GOLF OUTING 70887 20000 50887 13354 13157 335 2217 70887 20000 50887 13354 13157 335 2217 29063 21824 1 1 X 1 X 1 X 1 1 1 0 1 1 129972 129972 0.00200 13374013 8633184 4740829 0.07290 13503985 8633184 4870801 0.07490 228067 228067 0.00350 1430439 709709 720730 0.01110 62167 62167 0.00100 1720673 709709 1010964 0.01560 15224658 9342893 5881765 0.09050 0 2908236 130262 14418163 14355813 62350 X 1 1 1 1 SOMERSET COMMUNITY HOSPITAL 225 SOUTH CENTER AVENUE SOMERSET PA 15501 X X X SOMERSET COMMUNITY HOSPITAL 1 0 0 1 X X X X X X X X X 15 1 0 0 1 X WWW.SOMERSETHOSPITAL.COM X 1 15 1 WWW.SOMERSETHOSPITAL.COM 0 1 X 200.000000000000 200.000000000000 X X X 1 1 X X X 1 X SOMERSETHOSPITAL.COM/PATIENT_INFORMATION/FINANCIAL_ASSISTANCE_POLICY.ASPX X SOMERSETHOSPITAL.COM/PATIENT_INFORMATION/FINANCIAL_ASSISTANCE_POLICY.ASPX X SOMERSETHOSPITAL.COM/PATIENT_INFORMATION/FINANCIAL_ASSISTANCE_POLICY.ASPX X X X X X X 1 X 0 1 X 0 0 SOMERSET COMMUNITY HOSPITAL PART V, SECTION B, LINE 5: IN CONDUCTING THE CHNA, INPUT FROM THE COMMUNITY WAS INCORPORATED IN A VARIETY OF WAYS. THE PROCESS WAS DIRECTED BY A STEERING COMMITTEE, WHICH INCLUDED INDIVIDUALS FROM WITHIN THE HOSPITAL, AS WELL AS THOSE WHO REPRESENT MEMBERS OF THE COMMUNITY. EXTERNAL REPRESENTATION INCLUDED: THE DIRECTOR OF THE SOMERSET CAMPUS OF PENNSYLVANIA HIGHLANDS COMMUNITY COLLEGE, VOLUNTEER WITH THE NEXT STEP CENTER (HOMELESS SHELTER), EDITOR OF DAILY AMERICAN (LOCAL NEWSPAPER), DIRECTOR OF CHILDREN AND YOUTH SERVICES, DIRECTOR OF SOMERSET TAPESTRY OF HEALTH (WIC OFFICE), DIRECTOR OF SINGLE COUNTY AUTHORITY (DRUG AND ALCOHOL), COMMUNITY HEALTH NURSE WITH THE PA DEPARTMENT OF HEALTH, CHIEF PROFESSIONAL OFFICER OF THE BOYS AND GIRLS CLUB SOMERSET COUNTY, SUPERINTENDENT OF THE SOMERSET AREA SCHOOL DISTRICT, RE-ENTRY SPECIALIST WITH STATE CORRECTIONAL INSTITUTE LAUREL HIGHLANDS, EXECUTIVE DIRECTOR OF THE SOMERSET CHAMBER OF COMMERCE, PROGRAM MANAGER OF BEHAVIORAL HEALTH SERVICES OF SOMERSET AND BEDFORD COUNTY AND THE GRANT WRITER WITH THE UNITED WAY. INTERNAL REPRESENTATION INCLUDED THE CHIEF EXECUTIVE OFFICER, CHIEF FINANCIAL OFFICER, CHIEF NURSING OFFICER, CHIEF OPERATING OFFICER, DIRECTOR OF REGULATORY AND INFECTION CONTROL, DIRECTOR OF TWIN LAKES CENTER (DRUG AND ALCOHOL REHABILITATION), DIRECTOR OF EMERGENCY ROOM, DIRECTOR OF QUALITY, DIRECTOR OF CORPORATE COMMUNICATIONS, PUBLIC RELATIONS COORDINATOR, CLINICAL NUTRITION MANAGER AND DIABETES EDUCATOR. A COMMUNITY SURVEY WAS UTILIZED TO OBTAIN INPUT FROM A LARGE SAMPLE OF OUR COMMUNITIES. THE STEERING COMMITTEE MET TO DEVELOP THE SURVEY TOOL. THIS TOOL WAS THEN INPUTTED INTO SURVEY MONKEY, WHICH IS A SITE THAT ALLOWS INDIVIDUALS TO ANONYMOUSLY SUBMIT THEIR RESULTS. ONCE THE SURVEY WAS COMPLETE ON SURVEY MONKEY, THE STEERING COMMITTEE WAS ASKED TO REVIEW PRIOR TO THE SURVEY GOING LIVE. THE SURVEY WAS ALSO MADE AVAILABLE IN HARD COPY SO THAT INDIVIDUALS, WHO WERE UNABLE TO ACCESS A COMPUTER, WERE ABLE TO PARTICIPATE IN THE SURVEY. THE SURVEY WENT LIVE IN JANUARY 2016. THE LINK TO THE SURVEY WAS PLACED ON SOMERSET HOSPITAL'S WEBSITE, FACEBOOK PAGE, EMAILED OUT TO ALL STEERING COMMITTEE MEMBERS AND EMAILED TO ALL HOSPITAL EMPLOYEES. ADDITIONALLY, AN INVITATION TO PARTICIPATE IN THE SURVEY WAS MAILED OUT TO APPROXIMATELY 6,000 HOUSEHOLDS IN OUR PRIMARY SERVICE AREA. A TOTAL OF 1,203 INDIVIDUALS COMPLETED THE SURVEY. DATA RECEIVED FROM THE SURVEY WAS ANALYZED BY SURVEY MONKEY. THE SURVEY INCLUDED QUESTIONS ABOUT PERSONAL HEALTH, AS WELL AS THE PERCEPTION OF HEALTH IN THE COMMUNITY.FIVE KEY INFORMANT INTERVIEWS WERE CONDUCTED. THE INTERVIEWEES WERE SELECTED BASED ON THEIR ROLE IN WORKING WITH SOMERSET HOSPITAL'S PRIORITY POPULATIONS. THIS INCLUDES THE AGING COMMUNITY (DIRECTOR OF THE SOMERSET/BOSWELL SENIOR CENTER THROUGH THE AREA AGENCY ON AGING), THOSE WITH PHYSICAL AND MENTAL DISABILITIES (LEAD COORDINATOR OF PA LINK TO AGING AND DISABILITY SERVICES), ECONOMICALLY DISADVANTAGED (HOMELESS ASSISTANCE CASE MANAGER WITH COMMUNITY ACTION PARTNERSHIP), WOMEN AND CHILDREN (DIRECTOR OF THE SOMERSET TAPESTRY OF HEALTH) AND THOSE WITHOUT HEALTH INSURANCE (COMMUNITY HEALTH NURSE WITH THE PA DEPARTMENT OF HEALTH).ONE FOCUS GROUP WAS CONDUCTED WITH A GROUP OF 6 INDIVIDUALS, WHO WERE ENROLLED IN THE HOUSING PROGRAM WITH THE COMMUNITY ACTION PARTNERSHIP. SOMERSET COMMUNITY HOSPITAL PART V, SECTION B, LINE 11: THROUGH THE CHNA PROCESS, THE AREAS IDENTIFIED FOR ACTION ARE AS FOLLOWS: HEART DISEASE, DIABETES, TOBACCO USE, CANCER, STROKE, MENTAL HEALTH DISORDERS/ACCESS TO MENTAL HEALTH CAREGIVERS, OVERWEIGHT/OBESITY AND ILLEGAL DRUG USE/PRESCRIPTION DRUG ABUSE. HEART DISEASE IS BEING ADDRESSED BY OFFERING COMMUNITY EDUCATION, OFFERING CPR TO THE COMMUNITY AND BUSINESSES, PROMOTE THE AVAILABILITY AND SERVICES OF THE CARDIAC CATHETERIZATION LAB AND OFFER CARDIAC REHABILITATION TO THOSE PATIENTS WITH A CARDIAC DIAGNOSIS. TO ADDRESS DIABETES, COMMUNITY EDUCATION SEMINARS ARE BEING OFFERED, AS WELL AS THE PROMOTION OF DIABETES SELF-MANAGEMENT EDUCATION. TO ADDRESS TOBACCO USE, SOMERSET HOSPITAL OFFERS FREE TOBACCO CESSATION CLASSES, THE PA QUITLINE IS PROMOTED TO ANY PATIENT WHO USES TOBACCO, PROVIDERS TRAINED IN FAX TO QUIT, TRAINING FOR RESPIRATORY THERAPISTS AND PARTICIPATION IN COMMUNITY OUTREACH. CANCER IS BEING ADDRESSED BY OFFERING COMMUNITY EDUCATION FOR THE PREVENTION OF CANCER/EARLY DETECTION AND THE PROMOTION OF SCREENING SUCH AS MAMMOGRAPHY AND COLORECTAL IN THE EARLY DETECTION OF CANCER. STROKE CARE IS BEING ENHANCED THROUGH COMMUNITY EDUCATION ON THE SIGNS AND SYMPTOMS OF STROKE AND THE DEVELOPMENT OF A PRIMARY STROKE CENTER AT SOMERSET HOSPITAL. THROUGH THE EXPANSION OF MENTAL HEALTH SERVICES, SPECIFICALLY THE GERIATRIC POPULATION, SOMERSET HOSPITAL IS PROMOTING THE AVAILABILITY OF MENTAL HEALTH CARE AT THE HOSPITAL AND ALSO PROMOTING THE AVAILABILITY OF MENTAL HEALTH SUPPORT GROUPS IN THE COUNTY. TO INCREASE AWARENESS AND EDUCATION ABOUT OBESITY, SOMERSET HOSPITAL WILL PROMOTE THE AVAILABILITY OF THE REHABILITATION AND WELLNESS CENTER, PROMOTE THE AVAILABILITY OF OUTPATIENT MEDICAL NUTRITION THERAPY, ORGANIZE ANNUAL HEALTH FAIR AND PROVIDE COMMUNITY EDUCATION SEMINARS REGARDING OBESITY. TO REDUCE DRUG USE IN SOMERSET COUNTY, SOMERSET HOSPITAL IS ADDRESSING THE ISSUE BY PROMOTING THE AVAILABILITY OF A PAIN MANAGEMENT SPECIALIST, INCREASING PATIENT EDUCATION ON MEDICATIONS THROUGH OCCUPATIONAL THERAPY AND PHARMACY, PROMOTE SAFE DISPOSAL OF MEDICATION AND PROMOTE TWIN LAKES CENTER, WHICH OFFERS RESIDENTIAL AND OUTPATIENT DRUG AND ALCOHOL REHABILITATION SERVICES.THE AREAS THAT WERE NOT ADDRESSED IN THE CHNA ACTION PLAN INCLUDE ACCESS TO PRIMARY CARE PROVIDERS, ACCESS TO AFFORDABLE HEALTH INSURANCE/CO-PAYS/DEDUCTIBLES, ACCESS TO PRENATAL CARE, ASTHMA, MEDICAL TRANSPORTATION, ACCESS TO DENTAL CARE, SEXUALLY TRANSMITTED INFECTIONS, MOTOR VEHICLE ACCIDENT/DEATHS/SEATBELT USAGE, UNEMPLOYMENT RATES/POVERTY, CRIME/DELINQUENCY/VIOLENCE, AND ENVIRONMENTAL HEALTH. MANY OF THESE AREAS WILL STILL BE ADDRESSED WITHIN THE HOSPITAL, BUT THE RANKING OF SIGNIFICANCE IN OUR COMMUNITY WERE NOT AS HIGH AS THE RANKINGS OF THE OTHER HEALTH ISSUES IDENTIFIED IN THIS ASSESSMENT. THEREFORE, THEY WILL NOT BE A PRIORITY FOCUS. THE HOSPITAL DOES LACK RESOURCES TO DIRECTLY ADDRESS ISSUES SUCH AS UNEMPLOYMENT RATES, POVERTY AND CRIME AND DELINQUENCY. SOMERSET COMMUNITY HOSPITAL PART V, SECTION B, LINE 16J: UNINSURED PATIENTS ARE PROVIDED A PLAIN LANGUAGE SUMMARY AND FAP APPLICATION FORM. BILLING STATEMENTS INCLUDE A NOTICE ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE AND HOW TO OBTAIN INFORMATION. PART V, SECTION B, LINE 2 PART V, SECTION B, LINE 2: THE CHNA WAS LAST CONDUCTED DURING THE ORGANIZATION'S 2015 TAX YEAR, WHICH IS EQUVIALENT TO ITS FISCAL YEAR ENDED JUNE 30, 2016. THE IMPLEMENTATION STRATEGY WAS ALSO ADOPTED DURING THAT SAME FISCAL YEAR. 3 1 - THE WHEELER CENTER 126 EAST CHURCH STREET SOMERSET PA 15501 OUTPATIENT REHABILITATION 2 - SOMERSET HOSPICE 1474 NORTH CENTER AVENUE SOMERSET PA 15501 INPATIENT HOSPICE 3 - BERLIN MEDICAL CENTER 426 MAIN STREET BERLIN PA 15530 OUTPATIENT PHYSICAL THERAPY PART I, LINE 7: A COST-TO-CHARGE RATIO CALCULATED FROM WORKSHEET 2, RATIO OF PATIENT CARE COSTS-TO-CHARGES IS THE COSTING METHODOLOGY USED TO DETERMINE THE AMOUNTS REPORTED ON PART I, LINE 7. PART I, LINE 7G: SUBSIDIZED HEALTH SERVICES INCLUDED IN FISCAL YEAR 2018 WERE OUTPATIENT BEHAVIORAL HEALTH, COUMADIN CLINIC, AND INPATIENT HOSPICE. PART I, LN 7 COL(F): THE BAD DEBT EXPENSE OF 2,908,236 INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN A WAS SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE OF TOTAL EXPENSES. PART III, LINE 4: THE PROVISION FOR BAD DEBTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTH CARE COVERAGE, AND OTHER COLLECTION INDICATORS. PERIODICALLY THROUGHOUT THE YEAR, MANAGEMENT ASSESSES THE ADEQUACY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED UPON HISTORICAL WRITE-OFF EXPERIENCE BY PAYOR. THE RESULTS OF THIS REVIEW ARE THEN USED TO MAKE MODIFICATIONS TO THE PROVISION FOR BAD DEBTS TO ESTABLISH AN APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. PART III, LINE 9B: SOMERSET HOSPITAL GENERALLY DESIGNATES SERVICES AS "CHARITY CARE" BASED ON AN INDIVIDUAL'S ABILITY TO PAY. SOMERSET HOSPITAL OFFERS PAYMENT PLANS AND ASSISTS INDIVIDUALS IN APPLYING FOR THE STATE'S MEDICAL ASSISTANCE PROGRAM. PART VI, LINE 2: DURING FISCAL YEAR 2017, SOMERSET COMMUNITY HOSPITAL CONDUCTED A COUNTY-WIDE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). THE STUDY WAS CONDUCTED TO IDENTIFY THE MOST IMPORTANT HEALTH ISSUES WHICH NEED TO BE ADDRESSED. THE CHNA LOOKS AT HEALTH STATUS, BARRIERS TO CARE, AND OTHER DEMOGRAPHIC AND SOCIAL ISSUES AFFECTING PEOPLE AND ORGANIZATIONS THROUGHOUT SOMERSET COUNTY. THE REPORT IS AIMED AT ASSISTING SOMERSET HOSPITAL IN MAKING DECISIONS ABOUT THE FUTURE OF HEALTHCARE AND PREVENTION. PART VI, LINE 3: THE PLAIN LANGUAGE SUMMARY OF THE FAP AND FAP APPLICATION ARE AVAILABLE ON SOMERSET HOSPITAL'S WEBSITE. PAPER COPIES OF THE FAP, PLAIN LANGUAGE SUMMARY OF THE FAP, AND FAP APPLICATION ARE AVAILABLE ON SOMERSET HOSPITAL'S WEBSITE, UPON REQUEST AND COPIES ARE IN THE EMERGENCY ROOM AND ADMISSIONS AREA. THE HOSPITAL HAS SIGNS THAT NOTIFY THE PATIENTS ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE IN THE EMERGENCY ROOM AND ADMISSIONS AREA. UNINSURED PATIENTS ARE PROVIDED A PLAIN LANGUAGE SUMMARY AND FAP APPLICATION FORM. BILLING STATEMENTS INCLUDE A NOTICE ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE AND HOW TO OBTAIN INFORMATION. PART VI, LINE 4: SOMERSET HOSPITAL SERVES RESIDENTS IN SOMERSET COUNTY, PENNSYLVANIA. SOMERSET COUNTY IS A RURAL AREA WITH A POPULATION OF APPROXIMATELY 76,000 AND LAND AREA OF 1075 SQUARE MILES. THE COST OF LIVING IS BELOW THE NATIONAL AVERAGE AND THE ESTIMATED MEDIAN HOUSEHOLD INCOME IS $44,255 WHICH IS ALSO BELOW THE PENNSYLVANIA AVERAGE. APPROXIMATELY 14% OF SOMERSET RESIDENTS LIVE IN POVERTY. PART VI, LINE 5: SOMERSET HOSPITAL IS A NOT-FOR-PROFIT COMMUNITY ASSET COMMITTED: TO PROVIDING CARE TO THE SICK AND INJURED, PRESERVING AND SUSTAINING LIFE, AND PROMOTING HEALTH AND WELL BEING; TO THE PROMOTION AND DEVELOPMENT OF COMPLEMENTARY PROGRAMS AND SERVICES, MANPOWER AND FACILITIES; TO THE CONTINUOUS IMPROVEMENT OF QUALITY, ACCESSIBILITY AND CONTINUITY OF PATIENT CARE; TO THE WELFARE AND LIVELIHOOD OF ITS EMPLOYEES; TO ENSURING THE HOSPITAL'S FINANCIAL VIABILITY NECESSARY TO MEET THE HEALTHCARE NEEDS OF THE COMMUNITY AND REGION TODAY AND IN THE FUTURE. SOMERSET HOSPITAL PROVIDES QUALITY HEALTH CARE IN A COMPASSIONATE MANNER REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE OR THE PATIENT'S ABILITY TO PAY. ALTHOUGH REIMBURSEMENT FOR SERVICES RENDERED IS CRITICAL TO THE OPERATION AND STABILITY OF SOMERSET HOSPITAL, THE HOSPITAL, UNDER ITS WRITTEN CHARITY CARE POLICY, IS COMMITTED TO PROVIDING NECESSARY HEALTH CARE SERVICES AT NO CHARGE OR AT A REDUCED CHARGE TO PATIENTS. THE HOSPITAL USES ANY EXCESS IN REVENUES OVER EXPENSES TO FUND IMPROVEMENTS IN PATIENT CARE IN ORDER TO PROVIDE THE COMMUNITY WITH STATE OF THE ART EQUIPMENT AND FACILITIES. THE HOSPITAL RECRUITS THE BEST AND THE BRIGHTEST TO PROVIDE SERVICES TO THE COMMUNITY WHERE THERE IS A NEED AND A SHORTAGE OF PHYSICIANS. THE HOSPITAL EXTENDS MEDICAL PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY. THE GOVERNING BODY IS COMPRISED OF LOCAL RESIDENTS WHO HAVE THE BEST INTEREST OF THE COMMUNITY. A MAJORITY OF THE GOVERNING BODY CONSISTS OF INDIVIDUALS WHO ARE NEITHER EMPLOYEES OF THE ORGANIZATION NOR CONTRACTORS OF THE ORGANIZATION. X X X 0 0 0 0 0 0 0 0 0 AJAY P SINGH MD DIRECTOR 0 229725 0 0 0 0 0 0 0 16710 0 246435 0 0 V KRISHNAN NAIR MD DIRECTOR 0 322708 0 0 0 0 0 0 0 11046 0 333754 0 0 JAYESH DESAI MD DIRECTOR 0 431660 0 0 0 0 0 0 0 19468 0 451128 0 0 MARK YAROS MD DIRECTOR 0 250349 0 0 0 0 0 0 0 17575 0 267924 0 0 MATTHEW KOCIOLA CFO 219080 0 0 0 0 0 3709 0 1275 0 224064 0 0 0 CRAIG SAYLOR CEO (UNTIL 12/18) 264920 0 0 0 0 0 5385 0 17646 0 287951 0 0 0 ANDREW RUSH CEO 250157 0 0 0 0 0 5187 0 17301 0 272645 0 0 0 RENEE YOUNG MD PHYSICIAN 407714 0 0 0 0 0 0 0 6158 0 413872 0 0 0 MOKBEL MATTA MD PHYSICIAN 319650 0 0 0 0 0 0 0 4718 0 324368 0 0 0 HAI C TSAO MD PHYSICIAN 313271 0 0 0 0 0 0 0 16455 0 329726 0 0 0 NEELESH WELLING MD PHYSICIAN 288591 0 0 0 0 0 0 0 10887 0 299478 0 0 0 NASREEN BAGWAN MD PHYSICIAN 273034 0 0 0 0 0 0 0 6743 0 279777 0 0 0 A SOMERSET COUNTY HOSPITAL AUTHORITY 256001040 2009-04-27 3590000 REPAYMENT OF NOTE 0 0 0 B SOMERSET COUNTY HOSPITAL AUTHORITY 256001040 2015-12-15 18000000 REFUND SERIES 2010 NOTE, PROVIDE FUNDING OF PAST & FUTURE CAPITAL PURCHASES 0 0 0 C SOMERSET COUNTY HOSPITAL AUTHORITY 256001040 2015-12-15 3000000 PROVIDE OPERATING FUNDS AND TO TERMINATE INTEREST RATE SWAP AGREEMENT 0 0 0 A 1964218 3590000 66780 0 1 1 1 B 18000000 180151 882233 0 1 0 1 C 2000000 3000000 2365427 212350 0 0 0 1 A 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 C 0 0 0 0 0 0 0 A 1 0 0 0 0 0 B 1 1 1 KEY BANK 9.000000000000 0 0 0 0 0 C 0 0 0 0 1 0 0 0 0 A 0 B 0 C 0 ANN COBER BRAD COBER, DIRECTOR - FAMILY MEMBER 110944 EMPLOYEE OF SOMERSET COMMUNITY HOSPITAL 0 MIKE PETROSKY MICHELLE MOON, DIRECTOR - FAMILY MEMBER 87367 EMPLOYEE OF SOMERSET COMMUNITY HOSPITAL 0 FORM 990, PART VI, SECTION A, LINE 6 MEMBERS ARE SELECTED BY THE BOARD OF DIRECTORS. ANY NATURAL PERSON OVER EIGHTEEN YEARS OF AGE WHO HAVE CONTRIBUTED TO SOMERSET COMMUNITY HOSPITAL IN THE YEAR PRECEDING THE SELECTION AN AMOUNT DETERMINED BY THE BOARD, OR PROPERTY OF EQUIVALENT VALUE SHALL BE ELIGIBLE TO BE SELECTED AS A MEMBER OF SOMERSET COMMUNITY HOSPITAL. FORM 990, PART VI, SECTION A, LINE 7A THE BOARD MEMBERS OF SOMERSET COMMUNITY HOSPITAL MUST BE APPROVED BY SOMERSET COMMUNITY HOSPITAL FOUNDATION. FORM 990, PART VI, SECTION B, LINE 11B SOMERSET COMMUNITY HOSPITAL HAS A CPA FIRM PREPARE ITS FORM 990. THE RETURN IS COMPLETED IN DRAFT FORM AND REVIEWED BY MANAGEMENT OF THE ORGANIZATION. THE RETURN IS THEN FINALIZED AND THE BOARD IS PROVIDED A COPY OF THE FORM 990 BEFORE IT IS FILED. FORM 990, PART VI, SECTION B, LINE 12C SOMERSET COMMUNITY HOSPITAL ANNUALLY REQUIRES ITS BOARD MEMBERS, OFFICERS AND KEY EMPLOYEES TO FILL OUT A CONFLICTS OF INTEREST FORM. DURING BOARD MEETINGS, IF AN INTERESTED PARTY HAS A CONFLICT, HE OR SHE RECUSES THEMSELVES FROM VOTING. FORM 990, PART VI, SECTION B, LINE 15 THE EXECUTIVE COMMITTEE, WHICH IS A SUBCOMMITTEE OF THE BOARD OF DIRECTORS, ANNUALLY REVIEWS AND APPROVES THE COMPENSATION OF THEIR ORGANIZATION'S TOP MANAGEMENT. FORM 990, PART VI, SECTION C, LINE 18 SOMEREST COMMUNITY HOSPITAL MAKES ITS FORM 990 AND CONSOLIDATED FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. FORM 990, PART VI, SECTION C, LINE 19 AT THIS TIME, SOMERSET COMMUNITY HOSPITAL DOES NOT MAKE ITS GOVERNING DOCUMENTS AND CONFLICTS OF INTEREST POLICY AVAILABLE TO THE GENERAL PUBLIC. FORM 990, PART IX, LINE 11G OTHER FEES: PROGRAM SERVICE EXPENSES 6,167,968. MANAGEMENT AND GENERAL EXPENSES 1,677,178. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 7,845,146. FORM 990, PART XI, LINE 9: CHANGE IN FAIR VALUE OF INTEREST RATE SWAP 250,957. CHANGE IN DEFINED BENEFIT PENSION COSTS 1,295,712. TRANSFERS TO AFFILIATES -6,745,218. CHANGE IN INTEREST OF TEMP RESTRICTED NET ASSETS OF FOUNDATION -723,905. FORM 990, PART XII, LINE 2C: SOMERSET COMMUNITY HOSPITAL HAS A FINANCE COMMITTEE THAT IS RESPONSIBLE FOR THE OVERSIGHT OF THE AUDIT AND SELECTION OF THE INDEPENDENT AUDITORS. THE PROCESS IS CONSISTENT WITH PRIOR YEARS AND HAS NOT CHANGED. FORM 990, PART I SOMERSET HOSPITAL MERGED WITH UPMC ON FEBRUARY 1, 2019 AND BECAME UPMC SOMERSET. TWIN LAKES CENTER INC 225 SOUTH CENTER AVENUE SOMERSET PA 15501 232910318 HEALTH CARE PA 501(C)(3) 509(A)(1) SOMERSET COMMUNITY HOSPITAL 1 SOMERSET COMMUNITY HOSPITAL FOUNDATION 225 SOUTH CENTER AVENUE SOMERSET PA 15501 251441863 HEALTH CARE PA 501(C)(3) 509(A)(3) 0 SOMERSET HEALTH SERVICESINC 225 SOUTH CENTER AVENUE SOMERSET PA 15501 251441920 HEALTH CARE PA 501(C)(3) 509(A)(1) SOMERSET COMMUN HOSP FOUNDATION 0 SOMERSET MANAGEMENT SERVICES INC 225 SOUTH CENTER AVENUE SOMERSET PA 15501 251512960 REAL ESTATE HOLDING PA SOMERSET HEALTH SERVICES INC C 0 SOMERSET ANESTHESIA INC 225 SOUTH CENTER AVENUE SOMERSET PA 15501 455135437 ANESTHESIA SERVICES PA SOMERSET COMMUNITY HOSPITAL C -1544936 247893 1.00000 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 SOMERSET ANESTHESIA INC R 1544936 TWIN LAKES CENTER INC S 25000