2017-11-13T10:35:39-06:00 2016-12-31 GRANT THORNTON LLP 2001 MARKET ST SUITE 700 PHILADELPHIA PA 19103 990 2016-01-01 160743222 WESTFIELD MEMORIAL HOSPITAL INC % TINA GOWEN CPA WEST 4125446668 C/O HIGHMARK TAX DEPT SUITE 922 PITTSBURGH PA 15222 SCOTT A WHALEN PRESIDENT & CEO 4125446668 2017-11-15 true Frank Giardini P00532355 2155614200 38.69.39.117 36941220173175000003 2017-11-13 P EBDF4F6BE16B4FBB18BCB4302BFCA50C1EC55CD5 95F700AB41AF8210FE65E78AA0BE95D9785B9642 2016 2018-03-14 21:41:22Z MARTHA SMITH 232 WEST 25TH STREET ERIE PA 16544 9329536 false X WWW.AHN.ORG X 1944 NY WESTFIELD MEMORIAL HOSPITAL IS A TEAM OF OF CARE GIVERS COMMITTED TO IMPROVING HEALTH AND PROMOTING WELLNESS IN OUR COMMUNITIES. SEE FORM 990, PAGE 2, PART III, QUESTION 1 14 13 110 17 0 218135 227706 8076597 8140071 280689 98372 863765 851695 9439186 9317844 0 0 0 0 4913308 5059886 0 0 0 5722451 5857288 10635759 10917174 -1196573 -1599330 9204736 7929072 1282670 1620605 7922066 6308467 X WESTFIELD MEMORIAL HOSPITAL, INC. (WMH) IS A TEAM OF CARE GIVERS COMMITTED TO IMPROVING HEALTH AND PROMOTING WELLNESS IN OUR COMMUNITIES, ONE PERSON AT A TIME. IT PLEDGES TO CONSISTENTLY DELIVER SAFE, COMPASSIONATE QUALITY HEALTHCARE BY TREATING THE WHOLE PERSON - BODY, MIND AND SPIRIT. TO COMPLETE THIS MISSION, WESTFIELD MEMORIAL HOSPITAL PROVIDES SERVICES TO ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. false false 9246201 8984179 WESTFIELD MEMORIAL HOSPITAL, INC. IS A TEAM OF CARE GIVERS COMMITTED TO IMPROVING HEALTH AND PROMOTING WELLNESS IN OUR COMMUNITIES, ONE PERSON AT A TIME. IT PLEDGES TO CONSISTENTLY DELIVER SAFE, COMPASSIONATE QUALITY HEALTHCARE BY TREATING THE WHOLE PERSON - BODY, MIND AND SPIRIT. REFER TO SCHEDULE O FOR A COMPLETE NARRATIVE OF OUR PROGRAM SERVICE ACCOMPLISHMENTS. 9246201 true true false false false false false false false true true false 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 19 0 true 110 true false false false false false false false false false false X 14 13 false false false false true true true true true false false true true true true true true true true false NY X TINA GOWEN CPA 8144525055 232 WEST 25TH STREET ERIE PA 16544 HELEN BARAN CHAIR 1.0 0.0 X X 0 0 0 JOHN HAMELS PHD VICE CHAIR 1.0 0.0 X X 0 0 0 SANDRA BROWN SECRETARY 1.0 0.0 X X 0 0 0 MARTHA SMITH TREASURER 1.0 0.0 X X 0 0 0 TOM BERKHOUSE DIRECTOR 1.0 0.0 X 0 0 0 TRACY BENNETT DIRECTOR 1.0 0.0 X 0 0 0 MAUREEN CHADWICK DIRECTOR 1.0 39.0 X 0 252070 46762 NORMA CUMMINGS DIRECTOR 1.0 0.0 X 0 0 0 ROBERT CRANE DIRECTOR 1.0 0.0 X 0 0 0 DAVID HAZELTON DIRECTOR 1.0 0.0 X 0 0 0 ROBERTA PATTERSON DIRECTOR 1.0 0.0 X 0 0 0 JILLIAN ROCHE DIRECTOR 1.0 0.0 X 0 0 0 THOMAS TARPLEY DIRECTOR 1.0 0.0 X 0 0 0 MARK HAGEN MD DIRECTOR 1.0 0.0 X 0 0 0 DIANA HOLT EX-OFFICIO, Foundation 1.0 0.0 X 0 0 0 ALEX SELIOUTSKI MD Member of the Board-Nonvoting 1.0 0.0 X 0 0 0 SCOTT WHALEN EX-OFFICIO, President/CEO 1.0 39.0 X X 0 729072 170696 RUSSELL ELWELL MEDICAL DIRECTOR 1.0 0.0 X 0 0 0 PETER PASCALE ADMINISTRATOR 20.0 20.0 X 0 149981 6019 PATRICIA BALLMAN ADMINISTRATOR (THRU 4/16/2016) 20.0 20.0 X 0 165331 6515 PRAGNA SUTARIA MD PHYSICIAN 40.0 0.0 X 194654 0 10750 RONALD FILIPPI MD PHYSICIAN 40.0 0.0 X 268718 0 4086 BRADFORD BUEGE DO PHYSICIAN 40.0 0.0 X 277013 0 16769 740385 1296454 261597 4 false true false AHN EMERGENCY GROUP OF ERIE COUNTY 4535 DRESSLER ROAD NW CANTON OH 44718 PHYSICIAN SERVICES 419790 CPS PAYMENT SERVICES LLC 501 CONGRESSIONAL BLVD SUITE 250 CARMEL IN 46032 PAYMENT SERVICES 317038 CARDINAL HEALTH 2675 SOUTH MILFORD ROAD - UNIT B HIGHLAND MI 48357 PHARMACY SERVICES 273440 TRI-STATE ANESTHESIA SERVICE 312 WEST 25TH STREET ERIE PA 16502 CRNA SERVICES 234418 Family health medical services PO Box 168 MAYVILLE NY 14757 hospitalist services 143250 9 7635 198480 21591 227706 NET PATIENT FEES 621110 8140071 8140071 8140071 100380 100380 0 0 13433 5846 7587 0 7587 7587 3688 150 5846 -2158 150 -2008 -2008 0 0 0 0 0 0 0 0 0 ELECTRONIC HEALTH RECORDS 621110 679702 679702 REIMBURSEMENT FOR FOUNDATION SALARIES 621110 71725 71725 PHYSICAL THERAPY 621110 25904 25904 66777 66777 844108 9317844 8984179 105959 0 0 0 0 94264 94264 0 4147239 3662758 484481 92335 81548 10787 442294 384433 57861 283754 244120 39634 0 28825 28825 15615 15615 0 0 0 1794054 1473877 320177 54487 54487 241081 74751 166330 46791 46791 0 0 21944 11808 10136 0 0 0 0 892980 690516 202464 150765 130044 20721 MEDICAL SUPPLIES 1134319 1085108 49211 BAD DEBTS 961176 961176 MAINTENANCE CONTRACTS 388925 377345 11580 FREIGHT 18196 18196 108130 3730 104400 10917174 9246201 1670973 0 100 100 396018 396231 0 0 783840 896886 0 0 0 0 0 0 271519 267566 0 80096 8616547 3097920 6221427 5518627 1531832 769566 0 0 0 0 0 0 0 0 9204736 7929072 1138513 1476448 0 0 0 0 0 0 0 0 0 0 0 0 0 0 144157 144157 1282670 1620605 X 7796948 6167603 28756 44502 96362 96362 7922066 6308467 9204736 7929072 X -1599330 8365 -22634 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 125118 227706 855 212815 140864 120320 218135 -5866 207471 125118 96362 515637 6372 498051 120320 60155 36207 96362 55433 4722 60155 0.50000 0.50000 true false 190000 0 4599442 1079566 3519876 0 3457605 1953880 1503725 0 369500 64474 495026 5518627 0 ESTIMATED THIRD PARTY PAYOR 144157 144157 X 8017015 -988819 -988819 9005834 312010 312010 9317844 9966563 -956457 -956457 10923020 -5846 -5846 10917174 Schedule D, Part V, Line 4 ENDOWNMENT FUNDS THE INTENDED USE OF THE WESTFIELD MEMORIAL HOSPITAL PERMANENT ENDOWMENTS ARE FOR, BUT NOT EXCLUSIVE TO: CAPITAL IMPROVEMENTS, RESEARCH, EDUCATION, DEPARTMENTAL NEEDS, OPERATING EFFICIENCIES, AND OVERALL PATIENT CARE. THE EARNINGS OFF OF THE PERMANENT AMOUNT ARE EXPENDABLE, BASED ON THE SPECIFIC USE OF THE FUND. SCHEDULE D, PART X, LINE 2 ASC 740 Footnote Highmark Health records uncertain tax positions in accordance with FASB accounting standards codification (ASC) 740, income taxes. ASC 740 clarifies the accounting for uncertainty in income taxes by defining criteria that a tax positon on an individual matter must meet before that position is recognized. ASC 740 also provides guidance on measurement, classification, interest and penalties, disclosure and accounting in interim periods. Based on an analysis prepared by Highmark Health, it was determined that the application of FASB ASC 740 had no material effect on the recorded assets and liabilities of HH on a standalone basis. The following is the footnote to the audited consolidated financial statements of Highmark Health for FASB ASC 740: At December 31, 2016 and 2015, gross unrecognized tax benefits (excluding the federal benefit received from state positions) were $158,491 and $151,436, respectively, and, if recognized, would have impacted the effective tax rate. The Corporation does not anticipate that any significant increase or decrease to unrecognized tax benefits will be recorded in 2017. SCHEDULE D, PART XI, LINE 2d Bad Debt -957,452 A/R Adjustment -38,150 Other 6,783 Total -988,819 Schedule D, Part XI, Line 4b Contribution Revenue 227,706 Investment Income not on AFS 89,295 Other Additions to net assets 855 Rental Expense -5,846 Total 312,010 Schedule D, Part XII, Line 2d Bad Debt -957,452 Other 955 Total -956,497 Schedule D, Part XII, Line 4b Rental Expense -5,846 Total -5,846 true true X true X 250. false true true false true true 241910 241910 0.00000 1748383 1080098 668285 0.06710 1990293 1322008 668285 0.06710 1862 1862 0.00020 43534 43534 0.00440 2676 2676 0.00030 48072 48072 0.00490 2038365 1322008 716357 0.07200 3 8044 8044 0.00080 3 8044 8044 0.00080 false 961176 2299735 2656386 -356651 X true true 1 1 WESTFIELD MEMORIAL HOSPITAL INC 189 EAST MAIN STREET WESTFIELD NY 14787 www.ahn.org 0632000H X X X 1 WESTFIELD MEMORIAL HOSPITAL INC 1 false false true X X X X X X X X X 15 true true false true X WWW.AHN.ORG X true 15 false true false true X 250. 0. true true X X X X true X www.ahn.org X www.ahn.org X www.ahn.org X X X X true X false X X X true X false false Schedule H, PART V, SECTION B, LINE 5 The Community Health Needs Assessment, which was conducted and implemented in 2015, was overseen by a Steering Committee of key health system representatives and an Advisory Committee made up of individual hospital leaders and community stakeholders who represent individuals who are medically underserved, low income, minorities or other special populations within the Allegheny Health Network service area. Taken together, the Steering and Advisory Committees drove the Community Health Needs Assessment process. In addition to the internal employed personnel engaged in the Community Health Needs Assessment process, the following individuals participated in the Community Health Needs Assessment planning and oversight process as part of the Allegheny Health Network Community Health Needs Assessment Steering and Advisory Committees: Honorable Robert Brooks, Mayor, Municipality of Monroeville; Aggie Brose, Deputy Executive Director, Bloomfield Garfield Corporation; Leslie Grenfell, Executive Director, SWPA Area Agency on Aging; Karen Hacker, MD, Director, Allegheny County Health Department; AJ Harper, President, Hospital Counsel of Western PA; Jack Krah, President, Allegheny County Medical Society; Sharon Wolf, Executive Director, North Hills Community Outreach Doris Carson Williams, President and CEO, African American Chamber of Commerce and Board Member; David Blandino, MD, Board Member; Basil Cox, Board Member; Joseph Macerelli, Esq., Board Member Qualitative research was conducted with key community stakeholders and others representing the broad interests of the community, including experts in public health, members of medically underserved, low-income, and minority populations, and other representatives of special populations within the communities. Qualitative research methodology used to solicit feedback from community stakeholders included: Key Informant Survey of 107 community representatives to solicit feedback on community health priorities, underserved populations and partnership; Six focus groups were conducted with target populations including pregnant and postpartum mothers, seniors, behavioral health consumers, EMS providers, and care coordinators to inform implementation strategies. In addition to the CHNA above, Hospital management and staff utilize multiple strategies to continually monitor and assess the health care needs of the communities it serves. This includes outreach to community members in an effort to receive input related to current health needs and trends. The hospital acts on specific requests received for health related matters such as screenings, programs and related events. Hospital participates in area groups and partnerships in an effort to understand the community and obtain a sense of specific issues. The hospital also acts on survey results received from patients and the patient families as well as being connected to world-wide, national and local health trends and needs and acting accordingly to ensure our patients have the best care available to them. Schedule H, PART V, SECTION B, LINE 6A The following hospital facilities conducted a joint community health needs assessment: -Allegheny General Hospital -Alle-Kiski Medical Center -Canonsburg General Hospital -Forbes Regional Hospital -Highlands Hospital -Jefferson Regional Medical Center -Saint Vincent Health Center -Westfield Memorial Hospital -Western Pennsylvania Hospital Schedule H, PART V, SECTION B, LINE 7 & 8 Our joint Community Health Needs Assessment can be found here: https://www.ahn.org/community-health-needs-assessments Schedule H, Part V, Line 11 The Allegheny Health Network developed a Community Health Improvement Plan (CHIP) to guide community benefit and population health improvement activities across the Allegheny Health Network service area in accordance with needs identified through the Community Health Needs Assessment process. The CHIP aligns with the Allegheny County Health Departments plan for a Healthy Allegheny and Erie County Health Departments Community Health Improvement Plan to ensure ongoing collaboration with public health and other community partners to address the regions most pressing community health needs. The following details the health priority, goal, objectives and the target population associated with the Allegheny Health Network CHIP: Health Priority: Behavioral Health Goal: Reduce mortality and morbidity related to mental and substance use disorders. Objectives: -Increase utilization of outpatient behavioral health services, particularly for the most vulnerable populations; -Increase knowledge and skills of first responders and community members around behavioral health; -Increase the number of healthcare providers integrating behavioral health and physical health. Target Populations: Minority Groups, Low Income and Senior Populations. Health Priority: Cancer Goal: Reduce the number of cancer cases, as well as the illness, disability, and death caused by cancer. Objectives: -Increase the percentage of adults who receive timely age-appropriate cancer screenings based on the most recent guidelines; -Reduce the incidence rate for the top four most commonly diagnosed cancers: prostate (male), lung and bronchus, colon and rectum and breast (female) and the overall mortality rate by promoting healthy lifestyle behaviors related to tobacco use and diet and exercise; -Provide health screenings and education to high-risk populations. Target Populations: Minority Groups, Low Income and Senior Populations. Health Priority: Chronic Disease Goal: Decrease preventable chronic disease by ensuring access to resources, knowledge, and opportunities for residents to adopt healthy behaviors. Objectives: -Increase primary care provider (PCP) recommendations for preventive screenings per risk and age guidelines. -Provide health screenings and education to high-risk populations; -Partner with community organizations to promote healthy lifestyles. Goal: Improve management and outcomes for patients diagnosed with a chronic disease. Objectives: -Reduce hospital 30-day readmission rates for chronic disease; -Manage high risk populations through care coordination and partnership with social service partners; -Partner with community organizations to promote healthy lifestyles. Target Populations: Ethnic minority groups, individuals with behavior health or substance abuse comorbidity, low income individuals and families and senior populations. Health Priority: Maternal and Child Health Goal: Reduce morbidity and mortality by improving the health and quality of life of woman, infants, children, caretakers and their families, especially in vulnerable communities. Objectives: -Reduce the proportion of preterm and low birth weights and reduce the disparity between White, Black and Hispanic populations; -Reduce the disparity between White, Black and Hispanic mothers who receive prenatal care within the first trimester; -Reduce occurrence of Neonatal Abstinence Syndrome (NAS); -Increase the proportion of mothers who breastfeed for the first six months after birth and reduce the disparity between White, Black and Hispanic populations; -Reduce the disparity between White, Black and Hispanic births resulting in infant mortality; -Partner with community organizations to improve prenatal indicators (including not smoking during pregnancy, not drinking during pregnancy and prenatal care in the first trimester). Target Populations: Minority racial groups (especially Black and Hispanic women), low income families, single mothers and women with behavioral health or substance abuse conditions. Plain language summary available in foreign languages Part V, Section B, Line 16I The hospital currently does not have the financial assistance policies and summaries available in foreign languages. However, this entity has an action plan in place with the target date of 12/31/16. Presently, they have foreign language interpreters available on-site to assist patients on a real-time basis. CHARGES EQUAL TO GROSS CHARGES FOR PATIENT SERVICES Schedule H, PART V, LINE 22D THE WESTFIELD MEMORIAL HOSPITAL BOARD OF DIRECTORS APPROVED A FINANCIAL ASSISTANCE POLICY IN THE FOURTH QUARTER OF 2015. THIS POLICY WAS ADOPTED BY WMH. THE POLICY DOES NOT ALLOW ANY FACILITY TO REPORT TO A CREDIT AGENCY BEFORE MAKING A REASONABLE EFFORT TO DETERMINE IF THE PATIENT QUALIFIES FOR ASSISTANCE UNDER THE FINANCIAL ASSISTANCE POLICY.THE HOSPITAL OFFERS A 100% OR 75% DISCOUNT TO ALL UNINSURED PATIENTS BASED ON FEDERAL POVERTY QUIDELINES. Financial assistance and community care benefits Schedule H, Part I, Line 3c WESTFIELD MEMORIAL HOSPITAL (WMH) PROVIDES MEDICALLY NECESSARY SERVICES TO ALL PATIENTS, REGARDLESS OF RACE, COLOR, CREED, GENDER OR COUNTRY OF NATIONAL ORIGIN AND WITHOUT REGARD TO THE PATIENT'S ABILITY TO PAY. THE AMOUNT OF CARE PROVIDED UNDER THE POLICY IS DETERMINED BY NEED AND IS NOT LIMITED OR RATIONED BY BUDGETED AMOUNTS UNDER THE POLICY. Related Organization Report Schedule H, Part I, Line 6a SAINT VINCENT HEALTH SYSTEM, THE SOLE CORPORATE MEMBER OF WMH, PREPARES THE COMMUNITY BENEFIT REPORT OF WMH. Costing Methodology Schedule H, Part I, Line 7 The costs entered for Financial Assistance at Cost and Medicaid are calculated using the Hospital's cost to charge ratio derived from Worksheet 2. All Other Benefits are the actual expenses incurred by the Hospital. Community Building Activities Schedule H, Part II The community building activities are the Hospital's direct support of the local community organizations via its membership in these organizations. Westfield/Mayville Rotary Club, Chautauqua County Chamber of Commerce and the HealthCare Association of New York. BAD DEBT EXPENSE FINANCIAL STATEMENT FOOTNOTE AND COSTING METHODOLOGY Schedule H, Part III, Line 3 and 4 WMH DOES NOT ISSUE SEPARATE AUDITED FINANCIAL STATEMENTS AND THEREFORE A FOOTNOTE DOES NOT EXIST. PATIENTS WHO ARE UNINSURED ARE SCREENED AS CLOSE TO TIME OF SERVICE AS POSSIBLE BY FINANCIAL COUNSELORS. UNINSURED IN-PATIENTS ARE USUALLY CONTACTED WITHIN A DAY OF ADMISSION (OR THEIR FAMILIES DEPENDING ON THE MEDICAL CIRCUMSTANCES) AS MANY UNINSURED EMERGENCY DEPARTMENT PATIENTS AS POSSIBLE ARE SEEN FOLLOWING MEDICAL SCREEN BY PHYSICIANS. DIAGNOSTIC OUT-PATIENTS AND THOSE WITH SCHEDULED PROCEDURES THAT ARE WITHOUT COVERAGE ARE OFTEN PRE-ADMITTED AND PART OF THE CALL INCLUDES CONVERSATION REGARDING PAYMENT EXPECTATIONS. IN ALL CASES, SCREENING INCLUDES SEARCHING FOR PAYMENT OPTIONS THROUGH INSURANCE CARRIERS OR IN LIABILITY SITUATIONS. FOR THOSE WHO REMAIN UNCOVERED, WE ATTEMPT TO ESTABLISH POTENTIAL QUALIFICATION FOR STATE MEDICAID COVERAGE. FAILING THAT, PATIENTS ARE GIVEN INFORMATION REGARDING OUR CHARITY CARE PROGRAM AND ARE GIVEN THE OPTION TO APPLY. ALL PATIENTS, WHETHER UNINSURED OR WHO OWE BALANCES AFTER INSURANCE PAYMENTS ARE RECEIVED, ARE BILLED AT THE SAME INCREMENTAL TIMES. ACTIVITIES DURING THIS PERIOD INCLUDE OUR SENDING REGULAR STATEMENTS WHICH INCLUDE REFERENCES TO OUR CHARITY CARE AND DISCOUNT POLICIES. ADDITIONALLY, PHONE CONTACT IS ATTEMPTED BASED ON ACCOUNT AGE AND AMOUNT DUE. DISCOUNTS ARE OFFERED TO THE UNINSURED IN THE SPIRIT OF EQUITY WITH THOSE WHO ARE INSURED. WE OFFER 50 PERCENT OFF OF CHARGES TO THIS GROUP AND ALSO OFFER A 10 PERCENT PROMPT PAY DISCOUNT FOR FULL PAYMENT WITHIN A TEN DAY TIME FRAME FROM CONTACT. AFTER NOTICE OF FINAL BILLING, THEY ARE CLASSIFIED AS BAD DEBT BY VIRTUE OF THEIR BEING WRITTEN OFF OF THE ACTIVE ACCOUNTS RECEIVABLES AND TRANSFERRED TO A BAD DEBT FILE WHERE THEY RESIDE UNTIL SUCH TIME AS THEY ARE PAID OR REMAIN UNCOLLECTIBLE. ANY PAYMENTS RECEIVED ON ACCOUNT AS WELL AS ANY DISCOUNTS TAKEN OVER THE LIFE OF THE ACCOUNT, EXCLUDING THOSE IN THE BAD DEBT FILE, ARE RECORDED AS SUCH WHEN THEY OCCUR AND WOULD THEREFORE NOT BE INCLUDED IN THE FINAL AMOUNTS DETERMINED TO BE BAD DEBT. HOWEVER, PAYMENTS MADE SUBSEQUENT TO BAD DEBT REPORTING ARE POSTED AGAINST THE ACCOUNTS AND WOULD OFFSET THE BAD DEBT EXPENSE WITHIN THAT PARTICULAR MONTH AS REPORTED ON THE FINANCIAL STATEMENTS. AS PART OF OUR CHARITY CARE POLICY PROCESS, WE TRY TO DETERMINE IF PATIENTS WHO ARE NOT PAYING AND/OR ARE NOT RESPONDING TO ANY ATTEMPTS FOR COMMUNICATION, MIGHT REASONABLY BE CONSIDERED AS CHARITY. A SECTION OF THE POLICY IS LABELED PRESUMPTIVE FINANCIAL ASSISTANCE POLICY AND ALLOWS US TO SCREEN FOR CHARITY CARE EVEN WITHOUT THE PATIENT"S APPLICATION. DISCOUNTS PROVIDED OR PAYMENTS MADE TO A PARTICULAR PATIENT ACCOUNT ARE APPLIED TO THAT PATIENT ACCOUNT PRIOR TO ANY BAD DEBT WRITE-OFF AND ARE THUS, NOT INCLUDED IN BAD DEBT EXPENSE. Debt Collection Policy Schedule H, Part III, Line 9b IN AN UNCERTAIN ECONOMIC ENVIROMENT, WMH FINANCIAL COUNSELORS REMAIN COMMITTED TO ASSISTING THOSE IN OUR COMMUNITY WHO ARE UNABLE TO AFFORD THEIR MEDICAL EXPENSE, YET SEEK EXPERT CARE. THE FINANCIAL COUNSELORS WORK WITH PATIENTS AND THEIR FAMILIES TO HELP THEM QUALIFY FOR THE COMMUNITY CARE PROGRAMS, ANSWERING THEIR QUESTIONS AND HELPING THEM THROUGH THE ENROLLMENT PROCESS. COMMUNITY CARE INFORMATION IS AVAILABLE IN THE WMH COMMUNITY CARE BROCHURE OR VISIT THE WEBSITE AT WWW.AHN.ORG. FOR PATIENTS WHO RECEIVE BILLS IN THE MAIL FOLLOWING THEIR TREATMENT, THE COMMUNITY CARE PROGRAM IS INTRODUCED ON THE BOTTOM OF THEIR BILL WITH THE APPROPRIATE CONTACT INFORMATION. FINANCIAL ADVISORS ARE AVAILABLE WEEKDAYS AND ARE CONVIENTLY LOCATED NEXT TO PATIENT REGISTRATION. IT IS OUR POLICY NOT TO PURSUE COLLECTION PRACTICES AGAINST PATIENTS KNOWN TO QUALIFY FOR CHARITY CARE OR OTHER FINANCIAL ASSISTANCE. Community Health Needs Assessment Schedule H, Part VI, LINE 2 THE WESTFIELD MEMORIAL HOSPITAL (WMH) COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) PROCESS IS COMPLETED AS PART OF THE LARGER ALLEGHENY HEALTH NETWORK WHICH WESTFIELD'S SOLE CORPROATE SPONSER - SAINT VINCENT HEALTH SYSTEM IS A MEMBER. IN 2015, WMH, ALONG WITH THE 8 OTHER HOSPITALS IN THE ALLEGHENY HEALTH NETWORK, EMBARKED ON A COMPREHENSIVE COMMUNITY HEATLH NEEDS ASSESSMENT (CHNA) TO COLLECT HEALTH AND SOCIO-ECONOMIC DATA TO DETERMINE HEALTH NEEDS OF THE GREATER ERIE/WESTERN NEW YORK AREAS. THE CHNA SOUGHT TO TAKE A COMMUNITY WIDE APPROACH TO IDENTIFYING REGIONAL HEALTH TRENDS AND UNIQUE DISPARITIES WITHIN HOSPITAL SERVICE AREAS PATIENT EDUCATION FOR ELIGIBILITY FOR ASSISTANCE Schedule H, Part VI, Line 3 INFORMING THE PUBLIC THAT CHARITY CARE IS AVAILABLE IS AN IMPORTANT ELEMENT OF OUR CHARITY CARE PROGRAM AND WMH CONTINUOUSLY STRIVES TO IMPROVE ITS COMMUNICATIONS WITH PATIENTS ON THE AVAILABILITY OF CHARITY CARE INFORMATION ABOUT THE CHARITY CARE POLICY. A SUMMARY DESCRIPTION OF THE CHARITY CARE POLICY IS AVAILABLE IN PATIENT REGISTRATION AREAS AND FROM FINANCIAL COUNSELORS WHO ARE PRESENT ON-SITE TO ASSIST PATIENTS IN QUALIFYING FOR GOVERNMENTAL ASSISTANCE PROGRAMS AND CHARITY CARE. COMMUNITY SERVED INFORMATION Schedule H, Part VI, Line 4 WMH SERVES RESIDENTS LOCATED IN CHAUTAUQUA COUNTY NEW YORK. CHAUTAUQUA COUNTY IS A RURAL AREA OF APPROXIMATELY 1500 SQUARE MILES AND HAS A POPULATION OF 133,000. THE COST OF LIVING INDEX IS LESS THAN AVERAGE AND THE PERCENT OF RESIDENTS LIVING IN POVERTY WAS 18.9%. PROMOTION OF COMMUNITY HEALTH Schedule H, Part VI, Line 5 WMH GOVERNING BOARD IS MADE UP OF TWO MEMBERS FROM ITS SOLE MEMBER, SAINT VINCENT HEALTH SYSTEM, AND THE BALANCE FROM THE COMMUNITY AT LARGE WHO DIRECT AND GUIDE MANAGEMENT IN CARRYING OUT THE MISSION OF WMH DIRECTORS ARE SELECTED ON THE BASIS OF THEIR EXPERTISE AND EXPERIENCE IN A VARIETY OF AREAS BENEFICIAL TO WMH AND ARE NOT COMPENSATED FOR THEIR SERVICES. AFFILIATED HEALTH CARE SYSTEM Schedule H, Part VI, Line 6 WMH IS A HOSPITAL FACILITY WHICH IS PART OF THE SAINT VINCENT HEALTH SYSTEM, AN INTEGRATED HEALTH SYSTEM CONSISTING OF SAINT VINCENT HEALTH CENTER (SVHC), SAINT VINCENT FOUNDATION FOR HEALTH AND HUMAN SERVICES, PHYSICIAN PRACTICE SITES, VAROIUS ANCILLARY SERVICES, OVER ONE HUNDRED EMPLOYED PHYSICIANS AND A VARIETY OF OTHER HEALTH-RELATED PROVIDERS. SAINT VINCENT HEALTH SYSTEM IS ALSO A MEMBER OF THE INTEGRATED DELIVERY SYSTEM NAMED ALLEGHENY HEALTH NETWORK. THE ALLEGHENY HEALTH NETWORK IS MADE UP OF EIGHT HOSPITALS: ALLEGHENY GENERAL, ALLEGHENY VALLEY, CANONSBURG, FORBES, JEFFERSON, SAINT VINCENT, WESTFIELD MEMORIAL, AND WEST PENN AND MORE THAN 200 PRIMARY AND SPECIALTY- CARE PRACTICES. AHN EMPLOYS APPROXIMATELY 1,700 PHYSICIANS IN EVERY CLINICAL SPECIALTY, 17,000 STAFF MEMBERS AND 2,000 VOLUNTEERS. TOGETHER, THEY PROVIDE WORLD CLASS MEDICINE TO ALL PATIENTS IN THEIR COMMUNITIES. STATE FILING OF COMMUNITY BENEFIT REPORT Schedule H, Part VI, Line 7 SAINT VINCENT HEALTH CENTER FILES THE COMMUNITY BENEFIT REPORT WITH THE STATE OF NEW YORK AS PART OF OUR OBLIGATION TO FURNISH THE STATE OF NEW YORK WITH A COPY OF THE IRS FORM 990 AND RELATED SCHEDULES. X X X X false true false false false false false false false MAUREEN CHADWICK DIRECTOR 0 221226 0 0 0 30844 0 34879 0 13052 0 300001 0 21928 SCOTT WHALEN EX-OFFICIO, President/CEO 0 594962 0 0 0 134110 0 160165 0 13618 0 902855 0 120960 PETER PASCALE ADMINISTRATOR 0 149497 0 0 0 484 0 6019 0 1040 0 157040 0 0 PATRICIA BALLMAN ADMINISTRATOR (THRU 4/16/2016) 0 162658 0 0 0 2673 0 6515 0 4973 0 176819 0 0 PRAGNA SUTARIA MD PHYSICIAN 194654 0 0 0 0 0 7686 0 3064 0 205404 0 0 0 RONALD FILIPPI MD PHYSICIAN 237799 0 0 0 30919 0 0 0 5202 0 273920 0 0 0 BRADFORD BUEGE DO PHYSICIAN 276615 0 0 0 398 0 9652 0 8507 0 295172 0 0 0 Supplemental Nonqualified Retirement Plan Part I, Line 4b The following individuals participated in a nonqualified retirement plan. The amounts below were included under a 457(f) plan. Distributions from the plan are included in their box 5 of their IRS Forms W-2. SCOTT WHALEN: $121,110 OF WHICH $120,960 WAS REPORTED AS ACCRUED IN A PRIOR PERIOD, AND DISTRIBUTED AS OF 12/31/16. MAUREEN MELIA CHADWICK: $21,955 OF WHICH $21,928 WAS REPORTED AS ACCRUED IN A PRIOR PERIOD, AND DISTRIBUTED AS OF 12/31/16. The following individuals received employer contributions to nonqualified plans that are currently nonvested: Scott Whalen $131,365 Maureen Chadwick $7,799 STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS Introduction to Westfield Memorial Hospital (WMH) Westfield Memorial Hospital, Inc. (WMH) is a member of the Allegheny Health Network (AHN). The AHN is an integrated delivery network focused on preserving health care choice and providing affordable, high-quality care to the people in our communities. In addition to Westfield Memorial Hospital, the AHN consists of seven hospitals and numerous health and wellness entities dedicated to serving the community. You can visit the AHN at AHN.org. Westfield Memorial Hospital is a not-for-profit acute care hospital located in Westfield, New York. WMH provides limited inpatient (4 beds), outpatient and emergency care services for residents of the northern Chautauqua County, New York area. Westfield was founded in 1942 as a way to provide patient care and improve the effectiveness of the remaining physicians not serving in World War II. Since then, WMH has evolved through new technologies, services and partnerships, offering patients the most sophisticated medical advancements, while keeping the ease and familiarity of a community hospital. In January 1999, Westfield became affiliated with Saint Vincent Health System which provides the hospital with a mechanism to share medical services and resources otherwise unavailable to a small rural hospital. Saint Vincent is the sole corporate sponsor of Westfield Memorial Hospital. On July 1, 2013, Saint Vincent joined the Allegheny Health Network, a Pennsylvania not-for-profit corporation, designed to form an integrated delivery care system that focuses on preserving health care choice and providing affordable, high quality care. For the 12 months ending December 31, 2016, WMH served 27 inpatients, registered 23,264 outpatient visits (including outpatient emergency department visits), treated 7,348 patients in the emergency department, transferring 621 of those patients for further treatment at Saint Vincent and performed 1,165 surgeries. During the summer months of June, July and August, Westfield providers will staff a clinic at the Chautauqua Institution, a very popular resort community. This allows the hospital to provide immediate medical care to those individuals at the Institution versus having to travel to 10-15 miles away to receive medical attention. They had 559 clinic visits in 2016. Mission/Vision Statement Mission Highmark Health is an interdependent system designed to deliver high quality, accessible, understandable and affordable experiences, outcomes and solutions for our customers. Vision Highmark Healths dedicated and respected employees will be leaders in the health care industry, working to improve the total healthcare experience of our customers. Uncompensated Care To enhance the health status of the community in which it operates and consistent with its tax-exempt status, Westfield Memorial Hospital provides necessary health care services to individuals regardless of their ability to pay-for all or part of the services rendered. These services include both inpatient and outpatient services as well as an emergency room that remains available 24 hours a day. Consistent with the filing of Schedule H, the components of uncompensated care include charity care and unreimbursed Medicaid costs. Westfield Memorial Hospital had $1,990,293 of uncompensated care expenses which was offset by $1,322,008 of uncompensated care revenue. This resulted in unfavorable net benefits of $668,285. Community Health Improvement Services and Community Benefit Operations Community health improvement services and community benefit operations include activities intended to improve health and wellness. They extend beyond patient care activities and are subsidized by the hospital. There were a number of programs and activities that the hospital was involved in. The hospital promoted a number of Diabetes/Nutrition Education programs such as the community outreach 'Diabetes Prevention Program'. This is a program designed for at risk individuals referred by their physicians. The course consists of 22 hour long sessions. Additionally, during a community health fair the hospital presented an Educational program of healthy eating and the prevention of Type 2 diabetes. There were several smaller activities that the hospital was involved in including; the 'Stepping On' program to promote better balance, fall prevention and increased safety in the elderly population, as well as sponsoring a number of Community Health Fairs & Blood Pressure Screenings that were put on by the Hospitals auxiliary. Consistent with the filing of Schedule H, Westfield Memorial Hospital provided $1,862 of community health services during calendar year 2016. Health Professions Education Westfield Memorial Hospital provides aspiring health professionals with an opportunity to gain an understanding in the area of physical therapy. Consistent with the filing of Schedule H, Westfield Memorial Hospital provided these services at a cost of $43,534 in calendar year 2016. Subsidized Health Services Subsidized health services represent those programs provided to the community by Westfield Memorial Hospital despite the fact the organization incurs a financial loss to do so. Westfield Memorial Hospital recognizes the needs of its community and voluntarily subsidizes these programs in support of its charitable mission. In this regard, Westfield Memorial Hospital is unable to determine those subsidized service lines at this time. Consistent with the filing of Schedule H, Westfield Memorial Hospital provided subsidized health services at a cost of $0.00 in calendar year 2016. Cash and In-Kind Contributions This category includes monetary and in-kind services donated to individuals and the community at large. In-kind services include hours donated by staff to the community during hospital work hours, overhead expenses of meetings, other space donated to not-for-profit community groups, and donations of food, equipment and supplies. Consistent with the filing of Schedule H, Westfield Memorial Hospital provided financial contributions during calendar year 2016 totaling $591. Cash Donations Westfield Memorial Hospital supports the community through cash contributions made at the discretion of the Hospital and its directors, benefiting not only the non-profit recipient but ultimately the community as a whole. The organization did not make any direct cash contributions in 2016. In-Kind Donations Westfield Memorial Hospital also made in-kind donations of time and resources to help support various community functions. For Calendar year 2016, in-kind contributions amounted to $2,676 and consisted of the following: List of contributions: Donation of staff members time during business hours to serve on the board of the Westfield Rotary Club Donation of time by staff to direct employee charitable giving Volunteer hours donated to Westfield Summer Kids program Movie Night Volunteer hours towards collecting Christmas gifts for needy families as well as food stuffs Chautauqua County Health Network support of as well as contributed meeting space Community Building Activities Community Building Activities include activities specifically designated for the purpose of improving or protecting the health, future and well being of the community. Westfield Memorial Hospital is a supporting member of the Westfield/Mayville Rotary Club and actively participates in the clubs community events and activities. Additionally, Westfield Memorial Hospital is a member of the Healthcare Association of New York and a member of the Chautauqua County Chamber of Commerce. Westfield Memorial Hospital also donates the use of the Hospital meeting areas to a number of community groups. Consistent with the filing of Schedule H, Westfield Memorial Hospital provided these services at a cost of $8,044 in calendar 2016. Members Or Stockholders Form 990, Part VI, Section A, Line 6 WMH HAS A BOARD OF DIRECTORS THAT ARE RESPONSIBLE FOR THE OVERSIGHT OF THE COMMUNITY ASSET - WMH. THE BOARD MEMBERS WILL SELECT MEMBERS OF THE COMMUNITY TO SERVE ON THE BOARD. THESE MEMBERS WILL HAVE VOTING RIGHTS TO THE ELECT OTHER GOVERNING BODY MEMBERS AS WELL AS APPROVING SIGNIFICANT DECISIONS MADE BY THE BOARD OF DIRECTORS. BOARD MEMBERS WILL NOT RECEIVE ANY SHARE OF THE ORGANIZATION'S PROFITS, EXCESS DUES, OR NET ASSETS UPON LIQUIDATION. Members or Stockholders who may elect Form 990, Part VI, Section A, Line 7A THERE ARE TWO TYPES OF BOARD MEMEBERS THAT CAN SERVE ON THE WMH BOARD OF DIRECTORS - VOTING AND NON-VOTING. VOTING MEMBERS CAN CAST THEIR VOTES FOR THE ELECTION OF OTHER BOARD MEMBERS AS WELL AS ADMINITRATIVE DECISIONS MADE BY THE BOARD. NON-VOTING MEMBERS PROVIDE THE BOARD WITH THEIR EXPERTISE AND KNOWLEDGE BUT DO NOT HAVE THE ABILITY TO VOTE ON THE ELECTION OF OTHER BOARD MEMBERS AND/OR ADMINISTRATIVE DECISIONS TAKEN BY THE BOARD. Decisions Subject to Approval Form 990, Part VI, Section A, Line 7B SAINT VINCENT HEALTH SYSTEM AS THE SOLE CORPORATE SPONSOR OF WMH WHO HAS THE AUTHORITY TO REVIEW/APPROVE THE DECISIONS MADE BY THE BOARD OF DIRECTORS OF WMH. OPERATIONAL OVERSIGHT AND FORM 990 REVIEW PROCESS Form 990, Part VI, Section B, Line 11b Westfield memorial hospital IRS form 990 was prepared by its external advisors grant thronton, llp and reviewed by the highmark health tax department, senior management of the organization, and the audit and compliance committee. before filing the tax return with the internal revenue service, a final copy was provided to all members of the board of directors. Conflict of Interest Policy Monitoring & Enforcement Form 990, Part VI, Section B, Line 12C HIGHMARK HEALTH (HH), HAS A CORPORATE COMPLIANCE DEPARTMENT THAT MONITORS AND OVERSEES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY FOR ALL ENTITIES WITHIN THE FILING GROUP. THE FOLLOWING DESCRIBES THE MANNER IN WHICH THE CORPORATE COMPLIANCE DEPARTMENT MONITORS AND OVERSEES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY: CONFLICT OF INTEREST DISCLOSURE FORMS ARE COMPLETED ON AN ANNUAL BASIS BY ALL BOARD MEMBERS, OFFICERS, AND ANY PERSON WHO HAS AUTHORITY TO ACT ON BEHALF OF THE BOARD OF DIRECTORS, KEY EMPLOYEES, MANAGERS AND ABOVE, PERSONS WITH PURCHASING AUTHORITY INCLUDING PROCUREMENT DEPARTMENT EMPLOYEES AND COMMITTEE WHICH MAY INFLUENCE PURCHASING DECISIONS, AND ANY OTHER EMPLOYEES AS DESIGNATED BY THE COMPLIANCE DEPARTMENT. UPON COMPLETION OF THE ABOVE DISCLOSURE STATEMENT BY ALL APPLICABLE INDIVIDUALS, THE INTEGRITY AND COMPLIANCE DEPARTMENT REVIEWS ALL DISCLOSURES. THOSE THAT REQUIRE ADDITIONAL INFORMATION OR CLARIFICATION ARE CONTACTED BY THE INTEGRITY AND COMPLIANCE DEPARTMENT REQUESTING SUCH. ONCE RECEIVED, ALL INFORMATION IS EVALUATED IN CONSULTATION WITH THE LEGAL DEPARTMENT AND SENIOR MANAGEMENT AS APPLICABLE TO DETERMINE WHETHER A REAL OR POTENTIAL CONFLICT OF INTEREST EXISTS. THOSE CONFLICTS THAT REQUIRE A MITIGATION PLAN ARE DEVELOPED AND APPROVED IN COORDINATION WITH THE RESPECTIVE RESPONSIBLE SENIOR MANAGEMENT. THE SENIOR MANAGERS ARE RESPONSIBLE FOR DISCUSSING THE MITIGATION PLAN WITH THE INDIVIDUAL AS NEEDED AND MONITORING COMPLIANCE WITH THE MITIGATION PLAN. A FINAL REPORT OF ALL BOARD AND EXECUTIVE LEVEL MANAGEMENT DISCLOSURES IS SUBMITTED FOR REVIEW TO THE AUDIT AND COMPLIANCE SUBCOMMITTEE OF THE BOARD, AS WELL AS BY THE BOARD OF DIRECTORS PROCESS FOR DETERMINING EXECUTIVE COMPENSATION Form 990, Part VI, Section B, Line 15 THE AHN CORPORATE FOLLOWS A PROCESS FOR DETERMINING COMPENSATION FOR EXECUTIVE POSITIONS, (INCLUDING OFFICERS, KEY EMPLOYEES AND OTHER MANAGEMENT POSITIONS), AND ARE COVERED BY THE AHN EXECUTIVE COMPENSATION POLICY. THE POLICY WAS APPROVED BY THE HIGHMARK HEALTH BOARD OF DIRECTORS. IT IS THE POLICY OF AHN MANAGEMENT TO COMPENSATE ITS EXECUTIVES IN ACCORDANCE WITH THE MARKET AND IN RELATION TO THE EXPERIENCE, SERVICE AND ACCOMPLISHMENTS OF THE INDIVIDUAL BOTH PRIOR TO AND DURING THEIR SERVICE WITH AHN. THE PERSONNEL AND COMPENSATION COMMITTEE (PEC) APPROVES THE COMPENSATION FOR THE PRESIDENT AND CEO OF AHN AND ALL NON-HOSPITAL SENIOR EXECUTIVES WHO REPORT DIRECTLY TO THE PRESIDENT AND CEO OF AHN. THE PERSONNEL AND COMPENSATION COMMITTEE USES COMPARABILITY DATA PROVIDED BY AN INDEPENDENT COMPENSATION CONSULTANT. THE EXTERNAL CONSULTANT PROVIDES A LETTER OF REASONABILITY FOR ALL OFFERS MADE TO NEW EXECUTIVES THAT REPORT TO THE AHN CEO. EACH PEC COMMITTEE MEMBER VOTING ON A SENIOR EXECUTIVE'S COMPENSATION ARRANGEMENT ENSURES THAT HE OR SHE HAS NO CONFLICT OF INTEREST, INCLUDING THAT HE OR SHE (A) DOES NOT ECONOMICALLY BENEFIT FROM THE PROPOSED EMPLOYMENT; (B) DOES NOT RECEIVE COMPENSATION SUBJECT TO THE APPROVAL OF THE PROPOSED EMPLOYEE; AND (C) HAS NO MATERIAL FINANCIAL INTEREST AFFECTED BY THE TRANSACTION. THE EXECUTIVE COMPENSATION PROGRAM FOR THE HOSPITAL ENTITIES WITHIN THE GROUP IS ADMINISTERED BY THE CEO OF ALLEGHENY HEALTH NETWORK WITH RESPECT TO THE CEOS, COOS AND CFOS OF EACH HOSPITAL, PURSUANT TO OVERALL GUIDELINES ESTABLISHED BY THE PERSONNEL AND COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS OF HIGHMARK HEALTH. IT IS THE POLICY OF AHN TO COMPENSATE ITS EXECUTIVES IN ACCORDANCE WITH COMPETITIVE MARKET PRACTICES, TAKING INTO ACCOUNT ORGANIZATIONAL PERFORMANCE AND THE SKILLS, EXPERIENCE, QUALIFICATIONS AND PERFORMANCE OF EACH EXECUTIVE. AHN GENERALLY TARGETS THE MEDIAN OF THE RELEVANT MARKET WITH REASONABLE VARIATION BASED ON EACH EXECUTIVE'S SKILLS, EXPERIENCE, PERFORMANCE AND CURRENT POSITIONING RELATIVE TO MARKET. THE HUMAN RESOURCES DEPARTMENT OF ALLEGHENY HEALTH NETWORK OBTAINS APPROPRIATE MARKET COMPARABILITY DATA FOR EACH ENTITY, INCLUDING NATIONALLY PUBLISHED COMPENSATION SURVEYS AND/OR SPECIFIC ORGANIZATION PEER GROUPS, TO PREPARE COMPENSATION RECOMMENDATIONS FOR ALL KEY EXECUTIVES, INCLUDING OFFICERS, KEY EMPLOYEES, AND OTHER DISQUALIFIED PERSONS. RECOMMENDATIONS ARE REVIEWED AND APPROVED BY A COMMITTEE THAT IS INDEPENDENT WITH RESPECT TO THE COMPENSATION PROVIDED TO THE EXECUTIVES. COMPENSATION MAY INCLUDE SEVERAL FORMS OF CASH COMPENSATION, INCLUDING BASE SALARY, PERFORMANCE-BASED INCENTIVE COMPENSATION, AND A COMPETITIVE EMPLOYEE BENEFITS PROGRAM. BASE SALARY IS THE FIXED ELEMENT OF COMPENSATION INTENDED TO ALIGN WITH EACH EXECUTIVE'S ROLE, RESPONSIBILITIES, OVERALL PERFORMANCE AND OTHER CONTRIBUTIONS. INCENTIVE COMPENSATION IS USED TO PROVIDE VARIABLE, OR "AT RISK" COMPENSATION BASED ON THE PERFORMANCE OF BOTH THE EXECUTIVE AND THE ORGANIZATION. THE HOSPITAL EXECUTIVES CAN EARN INCENTIVE COMPENSATION ONLY IF THE ORGANIZATION ACHIEVES CERTAIN PRE-DETERMINED FINANCIAL GOALS. THE PLANS ARE INTENDED TO HOLD EXECUTIVES ACCOUNTABLE FOR ACHIEVING PERFORMANCE THAT IS CONSISTENT WITH THE LONG-TERM GOALS AND OBJECTIVES OF THE HOSPITAL. Westfield memorial hospital FOLLOWs THE REQUIREMENT IN THE REGULATIONS TO COMPLY WITH THE REBUTTABLE PRESUMPTION OF THE REASONABLENESS OF COMPENSATION. How Documents are Made Available to the Public Form 990, Part VI, Section C, Line 19 THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS AND CONFLICTS OF INTEREST POLICY AVAILABLE TO THE PUBLIC. FINANCIAL STATEMENTS ARE ON A CONSOLIDATED BASIS, AND ARE AVAILABLE UPON REQUEST AND APPROVAL BY THE CFO OF HIGHMARK HEALTH. OTHER CHANGES IN NET ASSETS AND FUND BALANCES Form 990, Part XI, Line 9 THE FOLLOWING IS A RECONCILIATION OF THE OTHER CHANGES IN NET ASSETS OF WMH FOR THE YEAR ENDED DECEMBER 31, 2016: Transfers to Affiliate Organizations ($22,634) FORM 990 PART IX LINE 11G DESCRIPTION:OTHER PURCHASED SERVICES TOTAL FEES:528077 FORM 990 PART IX LINE 11G DESCRIPTION:EQUIPMENT REPAIRS TOTAL FEES:15107 FORM 990 PART IX LINE 11G DESCRIPTION:PURCHASED LAB SERVICES TOTAL FEES:60696 FORM 990 PART IX LINE 11G DESCRIPTION:BANK FEES TOTAL FEES:28089 FORM 990 PART IX LINE 11G DESCRIPTION:DATA PROCESSING TOTAL FEES:51460 FORM 990 PART IX LINE 11G DESCRIPTION:PRO FEES TOTAL FEES:1110625 Canonsburg Hospital & Health Foundation 100 Medical Boulevard Canonsburg PA 15317 251818505 Inactive PA 501(c)(3) 12-Type I NA false Clinical Pathology Institute Cooperative 1526 Peach Street Erie PA 16501 251528055 Healthcare PA 501(c)(3) 3 SVHC false Community Blood Bank 232 West 25th Street Erie PA 16544 251181389 Healthcare PA 501(c)(3) 12-Type I SVHC false Energycare Inc 232 West 25th Street Erie PA 16544 251430922 Healthcare PA 501(c)(3) 10 SVHC false Greater Canonsburg Health System 100 Medical Boulevard Canonsburg PA 15317 251488089 Inactive PA 501(c)(3) 12-Type I NA false Regional Cancer Center 232 West 25th Street Erie PA 16544 251385705 Healthcare PA 501(c)(3) 3 SVHS false Regional Heart Network 232 West 25th Street Erie PA 16544 251856341 Healthcare PA 501(c)(3) 3 SVHC false Regional Home Health and Hospice 232 West 25th Street Erie PA 16544 830371265 Healthcare PA 501(c)(3) 10 SVHS false Suburban Health Foundation 100 South Jackson Ave Pittsburgh PA 15202 251472073 Fundraising PA 501(c)(3) 12-Type I WPAHS INC false Vantage Health Group 232 West 25th Street Erie PA 16544 251498145 Healthcare PA 501(c)(3) 3 SVHC false West Allegheny Hospital 100 Medical Boulevard Pittsburgh PA 15317 251054206 Inactive PA 501(c)(3) 3 NA false Gateway Health Foundation 444 Liberty Avenue Pittsburgh PA 15222 811343916 Fundraising PA 501(c)(3) 12-Type I Gateway LP false Highmark Health 120 Fifth Avenue Suite 922 Pittsburgh PA 15222 453674900 HEALTHCARE PA 501(c)(3) 12-Type I NA false 5148 Liberty Avenue Associates 5989 Centre Avenue Pittsburgh PA 15206 251689871 Property Rental PA WPAHS Inc Allegheny Health Network Home Infusion 312 West 25th Street Erie PA 16502 251736527 Medical Practice PA SVHS Allegheny Imaging of Mccandles 4800 Friendship Ave Pittsburgh PA 15224 300314897 Medical Practice PA NA Associated Clinical Lab LP 312 West 25th Street Erie PA 16502 251533746 Medical Practice PA NA Associated Clinical Lab of PA 312 West 25th Street Erie PA 16502 453688292 Medical Practice PA NA Erie Medical Complex LLC 312 West 25th Street Erie PA 16502 201017545 Medical Practice DE NA Gateway Health Plan LP 444 Liberty Avenue Suite 2100 Pittsburgh PA 15222 251691945 Health Plan PA NA Jefferson Medical Associates L 565 Coal Valley Rd Jefferson Hills PA 15236 251740456 Medical Practice PA NA Jenkins Empire Associates 120 Fifth Avenue Suite 922 Pittsburgh PA 15222 251524682 Property Mgmt PA NA JV Holdco LLC 30 Isabella St Pittsburgh PA 15212 472368587 Holding Company PA WPAHS Inc Mccandless Endoscopy Center 4800 Friendship Ave Pittsburgh PA 15224 261284448 Medical Practice PA NA North Shore Endoscopy Center 4800 Friendship Ave Pittsburgh PA 15224 251880238 Medical Practice PA NA Provider PPI LLC 120 Fifth Avenue Suite 922 Pittsburgh PA 15222 320429947 Facilities Suppor PA HMPG Saint Vincent Professional Bld 312 West 25th Street Erie PA 16502 251578290 Property Mgmt PA CSI Silver Rain LP 30 Isabella St Pittsburgh PA 15212 273035436 Property Mgmt PA HMPG North South Hills Surgery Center LL 6161 Clairton Rd West Mifflin PA 15122 274011352 Medical Practice PA NA Thryve Digital Health LLP 120 Fifth Avenue Suite 922 Pittsburgh PA 15222 981311003 Informational Tec NA Tri State Regional Assoc LLP 312 West 25th Street Erie PA 16502 232919277 Medical Practice PA NA UPMC VNA Home Health LP 565 Coal Valley Rd Jefferson Hills PA 15236 251844485 Medical Practice PA NA Upper Midwest Consol Services 565 Coal Valley Rd Jefferson Hills PA 15236 263112347 Medical Practice MN NA Vantage Capital Management Ltd 312 West 25th Street Erie PA 16502 233099689 Capital Mgmt PA NA Vantage Holding Company LLC 312 West 25th Street Erie PA 16502 030477182 Capital Mgmt PA CSI Waterfront Surgery Center LLC 565 Coal Valley Rd Jefferson Hills PA 15236 251898743 Medical Practice PA NA WSC Realty Partners LP 565 Coal Valley Rd Jefferson Hills PA 15236 251874990 Property Mgmt PA NA AHN Emergency Medicine Mgmt 30 Isabella St Pittsburgh PA 15212 465705484 Medical Practice PA NA Healthcare Supply Chain Innovations 30 Isabella St Pittsburgh PA 15212 472509307 Group Purch. 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