2018-05-14T15:14:12-05:00 2017-06-30 550486667 ARNETT CARBIS TOOTHMAN LLP 5700 CORPORATE DRIVE STE 650 PITTSBURGH PA 15237 990 2016-07-01 250987222 CORRY MEMORIAL HOSPITAL ASSOCIATION CORR 8146644641 965 SHAMROCK LANE CORRY PA 16407 MICHAEL HELLER CFO 8146644641 2018-05-10 1 JEFFREY J PETRELL CPA P00138808 4126356270 2018-05-03 2016 2022-09-23 18:48:47Z LECOM HEALTH CORRY MEMORIAL HOSPITAL BARBARA NICHOLS 965 SHAMROCK LANE CORRY PA 16407 20458726 0 X WWW.CORRYHOSPITAL.COM X 1894 PA INPATIENT AND OUTPATIENT MEDICAL CARE 7 3 213 73 0 0 115589 11996 21459085 22882036 128660 8476 490368 -2448133 22193702 20454375 0 0 0 0 10131820 11261734 0 0 0 13940188 13535174 24072008 24796908 -1878306 -4342533 48667687 46402673 40344857 37574584 8322830 8828089 CORRY MEMORIAL HOSPITAL - A COMMUNITY OF CAREGIVERS COMMITTED TO EXCELLENCE 0 0 19725442 22882036 CORRY MEMORIAL HOSPITAL ASSOCIATION IS A NOT FOR PROFIT CRITICAL ACCESS HOSPITAL LOCATED IN CORRY, PENNSYLVANIA. THE ASSOCIATION OPERATES A 20-BED ACUTE CARE FACILITY WHICH PROVIDES INPATIENT, OUTPATIENT, AND EMERGENCY CARE SERVICES FOR RESIDENTS IN NORTHWESTERN PENNSYLVANIA AND SOUTHWESTERN NEW YORK. THE ASSOCIATION MAINTAINS RECORDS TO IDENTIFY AND MONITOR THE LEVEL OF CHARITY CARE IT PROVIDES. 19725442 1 1 0 1 0 0 0 0 0 1 1 1 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 12 0 213 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 7 3 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 0 PA X MICHAEL HELLER 8146644641 965 SHAMROCK LANE CORRY PA 16407 BARBARA NICHOLS CEO 37.00 3.00 X X 245401 0 504 JOHN M FERRETTI DO CHAIR, LECOM CEO 1.00 79.00 X X 0 869345 31852 RICHARD P OLINGER SECRETARY/TREASURER 1.00 64.00 X X 0 671478 40826 DAVID HERR TRUSTEE 1.00 2.00 X 0 0 0 JOHN J KALATA DO TRUSTEE 1.00 2.00 X 0 50000 0 JOHN WILSON TRUSTEE 1.00 2.00 X 0 0 0 MARY L ECKERT TRUSTEE, MILLCREEK HOSPITAL 1.00 79.00 X 0 807860 31753 ROBERT JOY TRUSTEE 1.00 2.00 X 867 0 0 MICHAEL HELLER CFO 37.00 3.00 X 116246 0 13592 MARION MACALUSO CRNA 40.00 X 278195 0 2375 MICHAEL ANTOON DO ER MEDICAL DIRECTOR 40.00 X 150025 0 60 KAREN KELLY CRNA 40.00 X 146025 0 1861 WILLIAM MCANULTY CRNA 40.00 X 139430 0 14798 MOHAMMAD ELMUSA MD FAMILY PRACTICE PHYSICIAN 40.00 X 117012 0 5791 1193201 2398683 143412 8 0 1 0 MEDICAL ASSOCIATES OF ERIE ONE LECOM PLACE ERIE PA 16505 PHYSICIAN STAFFING 1680538 CLINICAL PATHOLOGY INSTITUTE 1526 PEACH STREET ERIE PA 16501 LAB EMPLOYEES 695044 ASSOCIATED CLINICAL LABS 350 E BAYFRONT PKWY ERIE PA 16507 LAB SERVICES 335130 VANTAGE MOBILE SERVICES 1305 SOUTH MAIN ST MEADVILLE PA 16335 MOBILE MRI 259839 EMCARE PHYSICIAN SERVICES 7032 COLLECTION CENTER DRIVE CHICAGO IL 60693 ER PHYSICIANS 176417 9 11996 11996 PATIENT SERVICE REVENUE 900099 22882036 22882036 22882036 8476 8476 27488 4351 23137 23137 23137 OTHER REVENUE 900099 668453 668453 LOSS ON IMPAIRMENT OF PROPERTY 900099 -1553213 -1553213 JOINT VENTURE LOSS 900099 -1586510 -1586510 -2471270 20454375 22882036 0 -2439657 375743 375743 8842323 8069981 772342 195741 195741 1326762 13063 1313699 521165 456285 64880 44729 44729 2351454 2010685 340769 25114 13301 11813 623790 543761 80029 273616 216474 57142 620186 595507 24679 12457 7084 5373 1443346 1443346 2990822 2990822 416841 26803 390038 MEDICAL SUPPLIES 2505360 2505360 BAD DEBT EXPENSE 1368878 1368878 REPAIRS & MAINTENANCE 604419 591598 12821 MISCELLANEOUS 254162 120099 134063 24796908 19725442 5071466 0 2230 2230 368381 498641 1255193 2012521 223414 248337 276467 295984 36621974 14430407 25067043 22191567 1701087 5354180 6575179 5957269 1553213 11645480 9841944 48667687 46402673 2452795 5306077 34309331 31718614 3582731 549893 40344857 37574584 X 6222918 6597091 129366 19315 1970546 2211683 8322830 8828089 48667687 46402673 X -4342533 17354 4830438 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 3535 3535 0 PART II-B, LINE 1: A PORTION OF THE ORGANIZATION'S DUES TO HOSPITAL COUNCIL AND THE HOSPITAL & HEALTHSYTEM ASSOCIATION OF PENNSYLVANIA (HAP) ARE USED FOR LOBBYING. 1970546 26403 235744 21011 2211683 2089131 -5947 91970 20668 1970546 2134557 64221 87995 21652 2089131 1914203 324314 83055 20905 2134557 1794669 217561 79959 18068 1914203 1.00000 1 0 147000 147000 24705541 7998663 16706878 8652106 5664374 2987732 3117327 767370 2349957 22191567 CLINICAL PATHOLOGY INSTITUTE 18000 C COMMUNITY HOSPITAL ALTERNATIVE FOR RISK TRANSFER 50000 C CORRY AMBULANCE SERVICE, INC 53054 C INTEREST IN ASSETS HELD BY CORRY COMMUNITY FOUNDATION 5636338 F VANTAGE HOLDING COMPANY 199877 C 5957269 ADVANCE DEPOSITS 26100 DUE FROM AFFILIATES 9680434 PREPAID PENSION PLAN COST 135410 9841944 ESTIMATED MEDICAL MALPRACTICE CLAIM 65921 ESTIMATED THIRD PARTY PAYOR SETTLEMENTS 483972 549893 X PART V, LINE 4: THE ENDOWMENTS ARE USED PRIMARY FOR HOSPITAL PROGRAMS AND NEW EQUIPMENT TO PROVIDE THE LATEST TECHNOLOGY IN PATIENT CARE. PART X, LINE 2: THE ASSOCIATION IS A NOT-FOR-PROFIT CORPORATION AND IS EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. ACCORDINGLY, NO PROVISION FOR INCOME TAXES HAS BEEN PROVIDED. THE ASSOCIATION ADOPTED THE STANDARD FOR ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN AN ENTITY'S FINANCIAL STATEMENTS THAT PRESCRIBES A RECOGNITION THRESHOLD OF MORE-LIKELY-THAN-NOT TO BE SUSTAINED UPON EXAMINATION BY THE APPROPRIATE TAXING AUTHORITY. MEASUREMENT OF THE TAX UNCERTAINTY OCCURS IF THE RECOGNITION THRESHOLD HAS NOT BEEN MET. THE STANDARD ALSO PROVIDES GUIDANCE ON DERECOGNITION, CLASSIFICATION, INTEREST AND PENALTIES, ACCOUNTING FOR INTERIM PERIODS, AND DISCLOSURE. MANAGEMENT HAS DETERMINED THAT THE ADOPTION OF THE STANDARD DID NOT HAVE A MATERIAL EFFECT ON THE CONSOLIDATED FINANCIAL STATEMENTS. GENERALLY, TAX RETURNS FOR YEARS ENDED JUNE 30, 2014, AND THEREAFTER REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES. 1 1 1 X 1 X 1 1 1 0 1 1 27213 27213 0.00120 2347585 1887378 460207 0.01960 2374798 1887378 487420 0.02080 27727 27727 0.00120 27727 27727 0.00120 2402525 1887378 515147 0.02200 0 636204 7448732 7489524 -40792 X 1 1 1 1 CORRY MEMORIAL HOSPITAL ASSOCATION 965 SHAMROCK LANE CORRY PA 16407 X X X X CORRY MEMORIAL HOSPITAL ASSOCIATION 1 0 0 1 X X X X X X X X 15 1 1 1 1 X WWW.CORRYHOSPITAL.COM/ABOUT X 1 15 1 WWW.CORRYHOSPITAL.COM/ABOUT 0 1 X 150.000000000000 300.000000000000 X X X X X X 1 1 X X X X 1 X WWW.CORRYHOSPITAL.COM/ABOUT/ X WWW.CORRYHOSPITAL.COM/ABOUT/ X WWW.CORRYHOSPITAL.COM/ABOUT/ X X X X X 1 X 0 X X X X 1 X 0 0 CORRY MEMORIAL HOSPITAL ASSOCIATION PART V, SECTION B, LINE 5: A STEERING COMMITTEE WAS FORMED WITH REPRESENTATIVES FROM THE ERIE COUNTY DEPARTMENT OF HEALTH (ECDH), COMMUNITY HEALTH NET (A FEDERALLY QUALIFIED HEALTH CENTER), THE ERIE COMMUNITY FOUNDATION, HIGHMARK BLUE CROSS BLUE SHIELD, THE NORTHWEST PENNSYLVANIA AREA HEALTH EDUCATION CENTER, ERIE COUNTY DEPARTMENT OF HUMAN SERVICES, ERIE COUNTY OFFICE OF DRUG & ALCOHOL ABUSE, ERIE COUNTY OFFICE OF MENTAL HEALTH AND INTELLECTUAL DISABILITIES, UNITED WAY OF ERIE COUNTY AND THE FOUR ERIE COUNTY NONPROFIT HOSPITALS OF CORRY MEMORIAL HOSPITAL, MILLCREEK COMMUNITY HOSPITAL, SAINT VINCENT HEALTH SYSTEM, AND UPMC HAMOT. ERIE COUNTY DEPARTMENT OF HEALTH (ECDH) WAS IDENTIFIED AS THE LEAD AGENCY. QUANTITATIVE DATA SOURCES INCLUDED LOCAL HEALTH STATISTICS CALCULATED AND REPORTED BY ECDH EPIDEMIOLOGISTS AND AVAILABLE ON THE ECDH WEBSITE, STATE HEALTH STATISTICS AND HEALTH CARE REPORTS FROM THE PENNSYLVANIA DEPARTMENT OF HEALTH, NATIONAL HEALTH STATISTICS AVAILABLE ON THE CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC) WEBSITE, DEMOGRAPHIC DATA FROM THE U.S. CENSUS BUREAU, HOSPITAL-RELATED INFORMATION FROM THE HOSPITAL AND HEALTHSYSTEM ASSOCIATION OF PENNSYLVANIA, AND RELATED DATA AND INFORMATION FROM VARIOUS LOCAL, STATE, AND NATIONAL ORGANIZATIONS.QUALITATIVE DATA WAS GATHERED VIA FOCUS GROUPS WHICH WERE CONDUCTED TO PROVIDE RESIDENT PERCEPTIONS OF HEALTH ISSUES WITHIN THE COUNTY. GROUPS WERE FACILITATED BY THE NORTHWEST PENNSYLVANIA AREA HEALTH EDUCATION CENTER. CORRY MEMORIAL HOSPITAL ASSOCIATION PART V, SECTION B, LINE 6A: THE CHNA WAS COMPLETED IN COLLABORATION WITH OTHER ERIE COUNTY HOSPITALS WHICH INCLUDED MILLCREEK COMMUNITY HOSPITAL, SAINT VINCENT HEALTH SYSTEM, AND UPMC HAMOT. CORRY MEMORIAL HOSPITAL ASSOCIATION PART V, SECTION B, LINE 6B: THE CHNA WAS CONDUCTED WITH THE FOLLOWING ORGANIZATIONS: ERIE COUNTY DEPARTMENT OF HEALTH (ECDH), COMMUNITY HEALTH NET (A FEDERALLY QUALIFIED HEALTH CENTER), THE ERIE COMMUNITY FOUNDATION, HIGHMARK BLUE CROSS BLUE SHIELD, AND THE NORTHWEST PENNSYLVANIA AREA HEALTH EDUCATION CENTER. CORRY MEMORIAL HOSPITAL ASSOCIATION PART V, SECTION B, LINE 11: CORRY MEMORIAL HOSPITAL DEVELOPED AN IMPLEMENTATION PLAN TO ADDRESS THE SIGNIFICANT NEEDS IDENTIFIED THROUGH ITS CHNA. AS WITH MOST HEATH CARE FACILITIES, CORRY MEMORIAL HOSPITAL HAS LIMITED FINANCIAL RESOURCES TO ADDRESS ALL ISSUES IDENTIFIED IN THE CHNA. CORRY MEMORIAL HOSPITAL ASSOCIATION PART V, SECTION B, LINE 16J: THE FINANCIAL ASSISTANCE POLICY IS ALSO POSTED IN LOCAL PHYSICIAN OFFICES. 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, LN 7 COL(F): THE BAD DEBT EXPENSE OF 1,368,878 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: CORRY MEMORIAL HOSPITAL ASSOCIATION'S FINANCIAL STATEMENTS DO NOT INCLUDE A BAD DEBT FOOTNOTE. THE BAD DEBT EXPENSE CONSISTS OF BALANCES THAT ARE SENT TO COLLECTIONS AS WELL AN ADDITIONAL AMOUNT ASSESSED BY MANAGEMENT. EVERY MONTH MANAGEMENT REVIEWS THE ACCOUNTS RECEIVABLE BALANCE AND WRITES OFF ADDITIONAL AMOUNTS BASED ON MANAGEMENT'S ASSESSMENT OF HISTORICAL COLLECTIONS AND ECONOMIC CONDITIONS.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 LINES 2 AND 3. PART III, LINE 8: CORRY MEMORIAL HOSPITAL IS A CRITICAL ACCESS HOSPITAL. IF CORRY MEMORIAL HOSPITAL CEASED TO EXIST PATIENTS WOULD HAVE TO TRAVEL A MINIMUM OF 26 MILES TO NEAREST HOSPITAL WHICH WOULD CREATE A HARDSHIP FOR MANY. 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 III, LINE 6. PART III, LINE 9B: THE HOSPITAL DOES NOT ENGAGE IN EXTRAORDINARY COLLECTION ACTIONS BEFORE MAKING REASONABLE EFFORTS TO DETERMINE WHETHER THE INDIVIDUAL IS ELIGIBLE FOR FINANCIAL ASSISTANCE. PART VI, LINE 2: DURING FISCAL YEAR 2016, CORRY MEMORIAL HOSPITAL ASSOCATION CONDUCTED A COUNTY-WIDE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). THIS STUDY WAS CONDUCTED TO: (1) PROVIDE A COMPREHENSIVE OVERVIEW OF THE HEALTH STATUS OF ERIE COUNTY, (2) IDENTIFY PRIORITY HEALTH NEEDS WITHIN THE COUNTY, (3) ORGANIZE THESE PRIORITIES INTO STRATEGIC ISSUES, AND (4) SHARE THIS INFORMATION WITH THE COMMUNITY AT LARGE, INCLUDING STAKEHOLDERS. PART VI, LINE 3: IF A PERSON IS ADMITTED WITH NO INSURANCE THEY ARE VISITED BY A FINANCIAL AID COUNSELOR AND MADE AWARE OF ASSISTANCE OPTIONS. ALL SELF-PAY PATIENTS ARE MAILED A LETTER THAT DESCRIBES THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM AND HOW TO APPLY. PART VI, LINE 4: CORRY MEMORIAL HOSPITAL IS A CRITICAL ACCESS HOSPITAL LOCATED IN CORRY PENNSYLVANIA. THE HOSPITAL SERVES THE RESIDENTS OF NORTHWESTERN PENNSYLVANIA AND SOUTHWESTERN NEW YORK. CORRY PENNSYLVANIA IS A RURAL TOWN WITH A POPULATION OF APPROXIMATELY 6,300. THE ESTIMATED MEDIAN HOUSEHOLD INCOME IS $30,474 WHICH IS WELL BELOW THE PENNSYLVANIA AVERAGE OF $49,520. APPROXIMATELY 25% OF RESIDENTS IN CORRY PENNSYLVANIA LIVE IN POVERTY. PART VI, LINE 5: CORRY MEMORIAL HOSPITAL IS A NOT-FOR-PROFIT CRITICAL ACCESS HOSPITAL THAT PROVIDES INPATIENT, OUTPATIENT, AND EMERGENCY CARE SERVICES. FROM DIABETES EDUCATION TO OCCUPATIONAL HEALTH SERVICES AND MORE, WE WANT TO ENSURE THAT EACH AND EVERY MEMBER OF OUR COMMUNITY RECEIVES THE BEST CARE AVAILABLE NOT FOR THE MONEY, NOT FOR THE ACCOLADES, BUT FOR THE HEALTH AND WELL-BEING OF OUR NEIGHBORS, OUR FRIENDS AND OUR FAMILIES. CORRY MEMORIAL HOSPITAL HAS BEEN ABLE TO PROVIDE "STATE OF THE ART" MEDICAL FACILITIES FOR THE PAST ONE HUNDRED YEARS BECAUSE OF THE EFFORTS OF THE BOARD OF TRUSTEES, THE DOCTORS, NURSES AND EMPLOYEES. THE BOARD OF TRUSTEES IS MADE UP OF INDIVIDUALS WHO LIVE AND WORK IN THE COMMUNITY WHO VOLUNTEER THEIR TIME AND SERVICES TO ASSIST IN THE GOVERNANCE OF THE ORGANIZATION. CORRY MEMORIAL HOSPITAL EXTENDS MEDICAL PRIVILEGES TO QUALIFIED PHYSICIANS SUBJECT TO THE NORMAL APPLICATION PROCESS WHICH MUST BE APPROVED BY THE CREDENTIALS COMMITTEE, THE MEDICAL EXECUTIVE COMMITTEE AND THE BOARD OF TRUSTEES. THE ORGANIZATION USES SURPLUS FUNDS TO PROVIDE THE LATEST IN TECHNOLOGY TO IMPROVE PATIENT CARE. X X X 0 0 0 0 0 0 0 1 0 BARBARA NICHOLS CEO 239801 0 0 0 5600 0 0 0 504 0 245905 0 0 0 JOHN M FERRETTI DO CHAIR, LECOM CEO 0 844322 0 0 0 25023 0 21200 0 10652 0 901197 0 0 RICHARD P OLINGER SECRETARY/TREASURER 0 638951 0 0 0 32527 0 21200 0 19626 0 712304 0 0 MARY L ECKERT TRUSTEE, MILLCREEK HOSPITAL 0 777159 0 0 0 30701 0 21200 0 10553 0 839613 0 0 MARION MACALUSO CRNA 278195 0 0 0 0 0 0 0 2375 0 280570 0 0 0 MICHAEL ANTOON DO ER MEDICAL DIRECTOR 150025 0 0 0 0 0 0 0 60 0 150085 0 0 0 WILLIAM MCANULTY CRNA 139430 0 0 0 0 0 0 0 14798 0 154228 0 0 0 PART I, LINE 7 THE CEO RECEIVED A DISCRETIONARY BONUS, THE AMOUNT OF WHICH WAS DETERMINED BY THE HUMAN RESOURCES COMMITTEE AND APPROVED BY THE BOARD OF TRUSTEES. A ERIE COUNTY HOSPITAL AUTHORITY 232302072 2011-01-06 1218000 CONSTRUCTION OF NEW HOSPITAL 0 0 0 A 117500 1218000 66846 2748 24360 1121878 2168 2013 0 0 0 1 A 0 0 0 0 0 0 0 A 0 0 0 1 1 0 0 0 0 A 0 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: ERIE COUNTY HOSPITAL AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 12/21/2017 FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF CORRY MEMORIAL HOSPITAL IS MILLCREEK HEALTH SYSTEM D/B/A LECOM HEALTH SYSTEM, A PENNSYLVANIA NONPROFIT CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A THE SOLE MEMBER, MILLCREEK HEALTH SYSTEM HAS THE RIGHT TO APPOINT OR REMOVE BOARD MEMBERS. THE BOARD SHALL CONSIST OF SEVEN (7) MEMBERS. THREE BOARD MEMBERS SHALL BE NAMED BY THE MEMBER AND FOUR BY THE PRIOR BOARD OF CORRY. FORM 990, PART VI, SECTION A, LINE 7B THE FOLLOWING POWERS, RIGHTS, AND PRIVILEGES ARE EXPRESSLY RESERVED BY THE MEMBER: (1) THE RIGHT TO ALTER, AMEND OR REPEAL THE ARTICLES OF INCORPORATION OF CORRY; (2) THE RIGHT TO APPROVE ANY AND ALL TRANSACTIONS THAT CHANGE, OR HAVE THE EFFECT OF CHANGING, THE OWNERSHIP AND/OR CONTROL OF CORRY. SUCH A TRANSACTION SHALL INCLUDE, BUT NOT BE LIMITED TO, ANY PROPOSED ATTEMPT TO MERGE, ACQUIRE OR COMBINE CORRY WITH ANY OTHER FACILITY, SYSTEM, AFFILIATE, ENTITY OR PERSON, WHETHER SUCH TRANSACTION IS BY CONTRACT, SALE OF ALL OR SUBSTANTIALLY ALL OF ITS ASSETS OR BY OPERATION OF LAW; (3) THE RIGHT TO APPOINT OR REMOVE BOARD MEMBERS OF CORRY; (4) THE RIGHT TO APPROVE THE BUDGET AND ALL PROPOSED CAPITAL EXPENDITURES OF CORRY. FORM 990, PART VI, SECTION B, LINE 11B CORRY MEMORIAL HOSPITAL ASSOCIATION HAS A CPA FIRM PREPARE ITS FORM 990. THE RETURN IS COMPLETED IN DRAFT FORM AND REVIEWED BY MANAGEMENT OF THE ORGANIZATION. A COPY OF THE 990 IS PROVIDED TO THE BOARD OF TRUSTEES BEFORE IT IS FILED. FORM 990, PART VI, SECTION B, LINE 12C EACH OFFICER, TRUSTEE AND KEY EMPLOYEE IS REQUIRED TO FILL OUT AN ANNUAL CONFLICT OF INTEREST FORM. THE FORMS ARE REVIEWED INITIALLY BY THE CEO. ANY CONFLICTS ARE REVIEWED BY BOARD MEMBERS. A PERSON WITH A CONFLICT IS RESTRICTED FROM VOTING ON RELATED MATTERS. FORM 990, PART VI, SECTION B, LINE 15 CORRY MEMORIAL HOSPITAL ASSOCIATION'S EXECUTIVE COMMITTEE APPROVES COMPENSATION FOR ALL OFFICERS AND KEY EMPLOYEES. MEMBERS OF MANAGEMENT MAKE RECOMMENDATIONS TO THE HR COMMITTEE. THE HR COMMITTEE THEN MAKES RECOMMENDATIONS TO THE EXECUTIVE COMMITTEE, WHICH HAS FINAL APPROVAL. PERIODIC REVIEW OF REGIONAL COMPARABLE SALARIES IS TAKEN INTO CONSIDERATION. FORM 990, PART VI, SECTION C, LINE 18 CORRY MEMORIAL HOSPITAL ASSOCIATION MAKES ITS FORM 990 AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VI, SECTION C, LINE 19 CORRY MEMORIAL HOSPITAL ASSOCIATION MAKES ITS GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: CHANGE IN INTEREST IN ASSETS HELD BY CORRY COMMUNITY FOUNDATION 620,882. MINIMUM PENSION LIABILITY ADJUSTMENT 309,556. NET ASSET TRANSFER FROM AFFILIATE 4,000,000. NET ASSET TRANSFER TO AFFILIATE -100,000. FORM 990, PART XII, LINE 2C: THE ORGANIZATION'S BOARD OF TRUSTEES ASSUME RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT. THE PROCESS IS CONSISTENT WITH PRIOR YEARS AND HAS NOT CHANGED. FORM 990, PART VI, LINE 13 THE ORGANIZATION'S EMPLOYEE HANDBOOK STATES EMPLOYEES SHALL BE ALLOWED TO VOICE AN UNJUST SITUATION WITHOUT FEAR OF RECRIMINATION. FORM 990, PART VI, LINE 16B WHEN CORRY MEMORIAL HOSPITAL ASSOCIATION CONTEMPLATES ENTERING INTO A JOINT VENTURE WITH FOR PROFIT ORGANIZATIONS, IT ENGAGES LEGAL COUNSEL AND TAX COUNSEL TO ENSURE THAT THE TAX EXEMPT STATUS OF THE HEALTH CENTER IS SAFEGUARDED. CORRY MEDICAL SERVICES 965 SHAMROCK LANE CORRY PA 16407 251425220 HEALTH CARE PA 501(C)(3) LINE 12A, I CORRY MEMORIAL HOSPITAL ASSOCIATION 1 CORRY MEMORIAL HOSPITAL FOUNDATION 965 SHAMROCK LANE CORRY PA 16407 208285800 FUNDRAISING PA 501(C)(3) LINE 12A, I CORRY MEMORIAL HOSPITAL ASSOCIATION 1 MILLCREEK HEALTH SYSTEM (MHS) 5515 PEACH STREET ERIE PA 16509 251766164 PARENT CORPORATION PA 501(C)(3) LINE 12C, III-FI 0 MILLCREEK COMMUNITY HOSPITAL 5515 PEACH STREET ERIE PA 16509 251002937 HOSPITAL PA 501(C)(3) LINE 3 MILLCREEK HEALTH SYSTEM 0 MILLCREEK MANOR 5515 PEACH STREET ERIE PA 16509 251619204 LONG TERM CARE PA 501(C)(3) LINE 3 MILLCREEK HEALTH SYSTEM 0 MILLCREEK HEALTH SYSTEM MEDICAL PRO 5515 PEACH STREET ERIE PA 16507 576204119 LIABILITY INSURANCE PA 501(C)(3) LINE 12C, III-FI 0 MEDICAL ASSOCIATES OF ERIE ONE LECOM PLACE ERIE PA 16509 113716896 PHYSICIAN MANAGEMENT PA 501(C)(3) LINE 10 MILLCREEK HEALTH SYSTEM 0 ERIE CENTER ON HEALTH AND AGING 406 PEACH STREET ERIE PA 16509 251361363 SENIOR HEALTH PA 501(C)(3) LINE 7 MILLCREEK HEALTH SYSTEM 0 LAKE ERIE COLLEGE OF OSTEOPATHIC MEDICINE 1858 W GRANDVIEW BLVD ERIE PA 16509 251698677 MEDICAL SCHOOL PA 501(C)(3) LINE 2 MILLCREEK HEALTH SYSTEM 0 LECOM AT PRESQUE ISLE INC 4114 SCHAPER AVE ERIE PA 16508 475049201 LONG TERM CARE PA 501(C)(3) LINE 10 MILLCREEK HEALTH SYSTEM 0 VISITING NURSE ASSOCIATION OF ERIE COUNTY 2253 WEST GRANDVIEW BOULEVARD ERIE PA 16506 250969488 HOME HEALTH PA 501(C)(3) LINE 7 MILLCREEK HEALTH SYSTEM (MHS) 0 CORRY HEALTH SERVICES INC 965 SHAMROCK LANE CORRY PA 16407 251488214 HEALTH CARE PA CORRY MEMORIAL HOSPITAL ASSOCIATION C 65804 843986 1.00000 1 MCH CORPORATION 5515 PEACH STREET ERIE PA 16509 251549695 REAL ESTATE PA C 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 CORRY HEALTH SERVICES INC R 85000 CORRY MEDICAL SERVICES S 570000