2016-05-16T10:51:11-05:00 2015-06-30 390859910 BAKER TILLY VIRCHOW KRAUSE LLP 1650 MARKET STREET SUITE 4500 PHILADELPHIA PA 19103 990 2014-07-01 230880420 SCHUYLKILL MEDICAL CTR - EAST NORWEGIAN STREET FKA GOOD SAM REGIONAL MED CTR SCHU 5706214000 700 EAST NORWEGIAN STREET POTTSVILLE PA 17901 JUDY PEEK-LEE INTERIM CFO 5706214000 2016-05-12 1 JULIUS C GREEN CPA JD P00350393 2159720701 2014 2016-08-17 19:52:53Z MARC H LORY 700 EAST NORWEGIAN STREET POTTSVILLE PA 17901 56875582 0 X WWW.SCHUYLKILLHEALTH.COM X 2008 PA TO MAKE A POSITIVE DIFFERENCE IN THE SCOPE AND QUALITY OF HEALTHCARE FOR THE SCHUYLKILL COMMUNITY. 17 16 762 75 277130 -308543 238715 510584 53181998 54313169 128481 75336 2427647 1846306 55976841 56745395 250 11484 0 0 33944505 32204134 0 0 0 26418560 27727072 60363315 59942690 -4386474 -3197295 33391107 31787865 16933108 18538853 16457999 13249012 X SCHUYLKILL MEDICAL CENTER - EAST NORWEGIAN STREET'S (EAST) MISSION IS TO MAKE A POSITIVE DIFFERENCE IN THE SCOPE AND QUALITY OF HEALTHCARE AVAILABLE FOR THE SCHUYLKILL COUNTY COMMUNITY. 0 0 45762886 11484 54699186 THE SCHUYLKILL MEDICAL CENTER - EAST NORWEGIAN STREET, THROUGH THE COMBINED EFFORTS OF ITS HIGHLY QUALIFIED MEDICAL STAFF, EMPLOYEES AND VOLUNTEERS, OFFERS A BROAD RANGE OF HEALTHCARE SERVICES TO THE RESIDENTS OF SCHUYLKILL COUNTY. INPATIENT HEALTHCARE SERVICES ARE PROVIDED IN MEDICINE, SURGERY, AND CRITICAL CARE MEDICINE. MORE THAN 20,000 VISITS BY RESIDENTS OF THE REGION WERE MADE TO RECEIVE EMERGENCY CARE AT THE SCHUYLKILL MEDICAL CENTER - EAST NORWEGIAN STREET'S EMERGENCY DEPARTMENT. A WIDE ARRAY OF DIAGNOSTIC AND TREATMENT PROGRAMS ARE ALSO OFFERED BY THE MEDICAL CENTER, INCLUDING, CT SCANNING, INPATIENT RENAL (KIDNEY) DIALYSIS, MEDICAL ONCOLOGY/CHEMOTHERAPY, DIAGNOSTIC, ULTRASOUND, BLOOD BANKING AND LABORATORY, PHYSICAL THERAPY, CARDIOVASCULAR SERVICE, AND AN OUTPATIENT CHEMICAL DEPENDENCY PROGRAM. THE INDUSTRA-MED PROGRAM OF THE MEDICAL CENTER PROVIDED OCCUPATIONAL AND INDUSTRIAL HEALTH SERVICES TO OVER 200 OF THE REGION'S EMPLOYERS. 45762886 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 1 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 34 0 1 762 1 1 1 0 0 0 0 0 0 0 0 0 X 17 16 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 PA X JUDY PEEK-LEE INTERIM CFO 5706215101 700 EAST NORWEGIAN STREET POTTSVILLE PA 17901 ANTHONY BARAN CHAIRMAN 1.00 3.00 X X 0 0 0 FRANKLIN K SCHOENEMAN VICE-CHAIRMAN 1.00 3.00 X X 0 0 0 E LORI SMITH TREASURER 1.00 4.00 X X 0 0 0 DEBRA C BLASCHAK SECRETARY 1.00 3.00 X X 0 0 0 RICHARD GONZALEZ TRUSTEE 1.00 4.00 X 0 0 0 REV HAROLD L HAND TRUSTEE 1.00 3.00 X 0 0 0 JEANNE BOYER PORTER TRUSTEE 1.00 3.00 X 0 0 0 WILLIAM L JONES III TRUSTEE 1.00 3.00 X 0 0 0 SARAH T CASEY TRUSTEE 1.00 3.00 X 0 0 0 WILLIAM E KIRWAN CPA ESQ TRUSTEE 1.00 3.00 X 0 0 0 STEVEN I FIELD TRUSTEE 1.00 3.00 X 0 0 0 AMRIT NARULA TRUSTEE 1.00 3.00 X 0 0 0 CYNTHIA PETCHULIS TRUSTEE 1.00 3.00 X 0 0 0 SYED SHAH MD TRUSTEE 1.00 3.00 X 0 0 0 TIMOTHY F TWARDZIK TRUSTEE 1.00 3.00 X 0 0 0 ROBERT M ZIMMERMAN JR DO TRUSTEE 1.00 3.00 X 0 0 0 JOHN E SIMODEJKA PRESIDENT/CEO (TO 8/14) 18.00 22.00 X X 0 1086774 27120 MARC LORY INTERIM PRESIDENT/CEO 18.00 22.00 X X 0 0 0 JUDY PEEK-LEE INTERIM CFO 18.00 22.00 X 0 0 0 DIANE BORIS VP FINANCE 18.00 22.00 X 147917 0 18042 DARNELL FURER VP NURSING/CNO (TO 6/15) 18.00 22.00 X 181695 0 23673 DR THOMAS CURRY VP MEDICAL AFFAIRS (TO 10/14) 18.00 22.00 X 0 203183 17784 SUE CURRY VP NURSING/CNO 18.00 22.00 X 100527 0 26081 SAJJAD MALIK PATHOLOGIST 40.00 X 299399 0 23231 JOHN RUSSO PATHOLOGIST 40.00 X 276175 0 26298 EARL WATERS JR DENTIST 40.00 X 153170 0 27585 ROBERT KARESTSKY DIRECTOR - PHARMACY 20.00 20.00 X 124064 0 12159 BRIAN PAUL PHARMACIST 20.00 20.00 X 123703 0 24518 1406650 1289957 226491 13 0 1 0 SODEXO INC & AFFILIATES PO BOX 360710 PITTSBURGH PA 152516922 DIETARY & HOUSEKEEPING SERVICES 693583 REHAB CARE GROUP INC PO BOX 502096 ST LOUIS MO 631502096 MGMT FIRM-INPAT-REHAB UNIT 546192 POTTSVILLE HOSPITALISTS PO BOX 1125 POTTSVILLE PA 17901 PHYSICIAN SERVICES 434000 DIAGNOSTIC IMAGING INC 25983 NETWORK PLACE CHICAGO IL 60673 INTERVENTIONAL RADIOLOGIST SERVICES 339000 ACCELECARE WOUND CENTERS INC PO BOX 671242 DALLAS TX 75267 WOUND CARE SERVICES 299196 15 164948 345636 510584 NET PATIENT SERVICE REV 621400 54313169 54313169 54313169 75588 75588 400415 129683 270732 270732 270732 252 504 -252 -252 -252 MEANINGFUL USE 561439 496238 496238 ALCOHOL & DRUG REV 561439 386017 386017 CAFETERIA/VENDING REV 561439 293254 293254 400065 277130 122935 1575574 56745395 54699186 277130 1258495 X 11484 11484 508138 508138 25123840 19749345 5374495 679849 535108 144741 4040095 3165080 875015 1852212 1437970 414242 299459 299459 91805 91805 43156 43156 7620964 3833900 3787064 66064 66064 1472971 770197 702774 1157887 108756 1049131 53983 7175 46808 10561 9141 1420 152569 152569 3688952 3688952 491759 491759 MEDICAL SUPPLIES 4152142 4152142 BAD DEBT EXPENSE 3391241 3391241 DRUGS 2583716 2583716 MA ASSESSMENT FEES 1176088 1176088 1273755 498263 775492 59942690 45762886 14179804 0 1585 1580 453527 824945 33665 33665 7561832 5662219 954117 1008293 356716 396942 85591291 72054975 15565417 13536316 3554456 3572766 1471854 1463271 3437938 5287868 33391107 31787865 5609053 6675351 822315 796060 1000000 1000000 9501740 10067442 16933108 18538853 X 15716175 12517353 43611 45138 698213 686521 16457999 13249012 33391107 31787865 X -3197295 -11692 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 43156 43156 0 PART II-B, LINE 1: THE SCHUYLKILL MEDICAL CENTER - EAST NORWEGIAN STREET IS A MEMBER OF THE HOSPITAL & HEALTH SYSTEM ASSOCIATION OF PENNSYLVANIA. A PERCENTAGE OF THE DUES PAID TO THE HOSPITAL & HEALTH SYSTEM ASSOCIATION GOES TOWARDS LOBBYING EFFORTS. THEIR MISSION IS TO ADVANCE THE HEALTH OF INDIVIDUALS AND COMMUNITIES TO LEAD, REPRESENT, AND SERVE HEALTH CARE PROVIDER ORGANIZATIONS THAT ARE ACCOUNTABLE TO THE COMMUNITY, AND COMMITTED TO HEALTH IMPROVEMENT. 559398 559398 52850753 44624861 8225892 31910606 27291793 4618813 270534 138321 132213 13536316 DUE FROM AFFILIATES 4619542 BENEFICIAL INTEREST IN PERPETUAL TRUSTS 176522 INSURANCE RECOVERIES RECEIVABLE 491804 5287868 PENSION LIABILITY 691058 BLUE CROSS CURRENT FINANCING ADVANCE 419600 CAPITAL LEASE OBLIGATION 2268774 ESTIMATED MALPRACTICE LIABILITY 829500 DUE TO AFFILIATES 6054441 ESTIMATED THIRD PARTY PAYOR SETTLEMENT -195931 10067442 X 53472145 -3402933 -3402933 56875078 -129683 -129683 56745395 56681132 129683 129683 56551449 3391241 3391241 59942690 PART X, LINE 2: THE CORPORATION ACCOUNTS FOR UNCERTAINTY IN INCOME TAXES USING 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 IS MET. MANAGEMENT DETERMINED THERE WERE NO TAX UNCERTAINTIES THAT MET THE RECOGNITION THRESHOLD IN 2015 AND 2014. THE CORPORATION'S FEDERAL EXEMPT ORGANIZATION RETURNS OF INCOME TAX AND ITS BUSINESS INCOME TAX RETURNS FOR THE YEARS ENDED PRIOR TO JUNE 30, 2012 NO LONGER REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. PART XI, LINE 2D - OTHER ADJUSTMENTS: VALUATION GAIN -11,692. PROVISION FOR BAD DEBTS, NETTED ON FINANCIAL STATEMENTS -3,391,241. PART XI, LINE 4B - OTHER ADJUSTMENTS: RENTAL EXPENSES -129,683. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 129,683. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS, NETTED ON FINANCIAL STATEMENTS 3,391,241. CENTRAL AMERICA AND THE CARIBBEAN - ANTIGUA & BARBUDA, ARUBA, BAHAMAS, 0 0 INVESTMENT 403754 0 0 0 0 0 0 403754 0 403754 0 0 1 0 0 0 1 1 X 1 X 175.000000000000 1 X 1 1 0 1 1 251479 251479 0.00440 4842589 1058036 3784553 0.06690 5094068 1058036 4036032 0.07130 6 359 54035 54035 0.00100 1 9 21818 21818 0.00040 1132217 556461 575756 0.01020 1 9357 9357 0.00020 8 368 1217427 556461 660966 0.01180 8 368 6311495 1614497 4696998 0.08310 1 1330046 1330046 26491327 25835981 655346 X 1 1 1 1 SCHUYLKILL MEDICAL CENTER EAST NORWEGIAN 700 EAST NORWEGIAN STREET POTTSVILLE PA 17901 X X X SCHUYLKILL MEDICAL CENTER EAST NORWEGIAN 1 0 0 1 X X X X X X X X 12 1 1 0 1 X HTTP://WWW.SCHUYLKILLHEALTH.COM/ABOUT-SCHUYLKILL-HEALTH/COMMUNITY-BENEFIT X 1 12 1 HTTP://WWW.SCHUYLKILLHEALTH.COM/ABOUT-SCHUYLKILL-HEALTH/COMMUNITY-BENEFIT 0 0 1 X 175.000000000000 250.000000000000 X X X 1 1 X X X 1 X X X X 1 X 0 X 1 X 0 0 SCHUYLKILL MEDICAL CENTER EAST NORWEGIAN PART V, SECTION B, LINE 5: SCHUYLKILL HEALTH PARTNERED WITH STRATEGY SOLUTIONS TO CONDUCT THE ASSESSMENT. WITH THEIR HELP, SCHUYLKILL HEALTH IDENTIFIED 11 COMMUNITY MEMBERS TO SERVE ON A STEERING COMMITTEE TO CONDUCT THIS ASSESSMENT. THE 11 COMMUNITY MEMBERS INCLUDED LEADERS IN EDUCATION, BUSINESS, PUBLIC SERVICES, HUMAN SERVICES, AND PUBLIC HEALTH OFFICIALS.IN AN EFFORT TO EXAMINE THE HEALTH RELATED NEEDS OF THE RESIDENTS OF SCHUYLKILL COUNTY AND TO MEET ALL OF THE KNOWN GUIDELINES AND REQUIREMENTS OF THE IRS 990 STANDARDS THAT HAD BEEN PUBLISHED TO DATE, THE STEERING COMMITTEE AND CONSULTING TEAM EMPLOYED BOTH QUALITATIVE AND QUANTITATIVE DATA COLLECTION AND ANALYSIS METHODS. QUALITATIVE METHODS ASK QUESTIONS THAT ARE EXPLORATORY IN NATURE AND ARE TYPICALLY EMPLOYED IN INTERVIEWS AND FOCUS GROUPS. QUANTITATIVE DATA IS DATA THAT CAN BE DISPLAYED NUMERICALLY. IN ADDITION, BOTH PRIMARY AND SECONDARY DATA WERE COLLECTED. PRIMARY DATA IS DATA THAT WAS COLLECTED SPECIFICALLY FOR THIS STUDY BY THE CONSULTANT TEAM. SECONDARY DATA INCLUDES DATA AND INFORMATION THAT WAS PREVIOUSLY COLLECTED AND PUBLISHED BY SOME OTHER SOURCE. THE SCHUYLKILL HEALTH MANAGEMENT TEAM, THE STEERING COMMITTEE MEMBERS AND CONSULTING TEAM MADE SIGNIFICANT EFFORTS TO ENSURE THAT ALL AREAS OF THE COUNTY, ALL SOCIO-DEMOGRAPHIC GROUPS AND ALL UNDERREPRESENTED POPULATIONS WERE INCLUDED IN THE STUDY. THIS WAS ACCOMPLISHED BY IDENTIFYING FOCUS GROUPS AND KEY STAKEHOLDERS THAT REPRESENTED VARIOUS SUBGROUPS IN THE COMMUNITY. IN ADDITION, THE PROCESS INCLUDED PUBLIC HEALTH PARTICIPATION AND INPUT, BOTH THROUGH EXTENSIVE USE OF PA HEALTH DEPARTMENT AND CENTERS FOR DISEASE CONTROL DATA, AS WELL AS THROUGH THE PARTICIPATION OF A REGIONAL DEPARTMENT OF HEALTH REPRESENTATIVE ON THE STEERING COMMITTEE. A SCHUYLKILL COUNTY BEHAVIORAL RISK FACTOR SURVEILLANCE SURVEY FOLLOWING THE DATA COLLECTION PROTOCOLS AND QUESTIONS DESIGNED BY THE CENTERS FOR DISEASE CONTROL WITH A REPRESENTATIVE SAMPLE OF 400 SCHUYLKILL COUNTY RESIDENTS CONDUCTED BY STRATEGY SOLUTIONS, INC. AND MOORE RESEARCH SERVICES. SEVEN FOCUS GROUPS WERE CONDUCTED IN ORDER TO GAIN INSIGHTS FROM DIVERSE COMMUNITY GROUPS AND UNDERREPRESENTED POPULATIONS. THIRTEEN INDIVIDUAL INTERVIEWS WERE CONDUCTED WITH KEY STAKEHOLDERS IN THE COMMUNITY TO GATHER A PERSONAL PERSPECTIVE FROM THOSE WHO HAVE INSIGHT INTO THE HEALTH OF A COMMUNITY OR THE REGION. THESE INDIVIDUALS ALSO PROVIDED SUGGESTED ACTIVITIES FOR IMPROVING THE HEALTH OF THE REGION. FINALLY, AN INTERNET COMMUNITY NEEDS SURVEY WAS CONDUCTED WITH A TOTAL OF 373 RESPONDENTS (275 COMPLETE AND 98 PARTIAL). THE SURVEY WAS DESIGNED TO INCLUDE THE IDENTICAL QUESTIONS FROM THE FOCUS GROUPS; AND WAS ADDED TO THE DATA COLLECTION PROCESS AS PARTICIPATION IN THE FOCUS GROUPS WAS LOWER THAN ANTICIPATED. SCHUYLKILL MEDICAL CENTER EAST NORWEGIAN PART V, SECTION B, LINE 6A: SCHUYLKILL MEDICAL CENTER - SOUTH JACKSON STREET SCHUYLKILL MEDICAL CENTER EAST NORWEGIAN PART V, SECTION B, LINE 11: THE HOSPITAL IS ADDRESSING THE FOLLOWING NEEDS:ACCESS TO QUALITY HEALTH CARE/WOMEN'S HEALTH - DEVELOPED BROCHURES TO EXPLAIN THE NEED FOR MAMMOGRAMS FOR EARLY DETECTION OF BREAST CANCER. BROCHURES ARE AVAILABLE IN WAITING AREAS OF THE MEDICAL CENTER AS WELL AS DOCTORS OFFICES. A PROGRAM WAS SET UP TO OFFER LOW COST OR FREE MAMMOGRAMS TWICE A YEAR FOR PEOPLE WHO MEET CERTAIN CRITERIA. THE CHAT PRESENTATION PROGRAM IS ALSO USED TO GET INFORMATION OUT EXPLAINING THE NEED FOR EARLY DETECTION OF BREAST CANCER AND THE AVAILABILITY OF TESTING.HEALTHY MOTHERS, BABIES, CHILDREN/TOBACCO & ALCOHOL USE DURING PREGNANCY - DEVELOPED BROCHURES TO EXPLAIN THE RISK OF SMOKING AND ALCOHOL USE DURING PREGNANCY. BROCHURES ARE AVAILABLE IN WAITING AREAS OF THE MEDICAL CENTER AS WELL AS DOCTORS OFFICES. THE SMOKING CESSATION PROGRAM THAT WAS DEVELOPED IN THE EAST COUNSELING CENTER WAS EXPANDED TO BE INCLUDED DURING CHILD BIRTH CLASSES IN THE SOUTH MATERNITY AREA.PHYSICAL ACTIVITY AND NUTRITION, OBESITY - A PROGRAM TITLED "HEALTHY HAVEN" WAS PRESENTED TO BOTH SCHUYLKILL HAVEN MIDDLE SCHOOL AND ST AMBROSE STUDENTS. THE PROGRAM DISCUSSED WELLNESS PROGRAMS AS WELL AS NUTRITIONAL EXERCISE INTERVENTIONS. THE HOPE IS TO EXPAND THIS PROGRAM TO OTHER COMMUNITIES. UNINTENTIONAL INJURIES, MOTOR VEHICLES - THIS WAS ADDRESSED IN 2 DIFFERENT WAYS. AS PART OF MAKE A DIFFERENCE DAY THE MATERNITY/NURSERY DEPARTMENTS HELD A CHILD SEAT SAFETY CHECK. THE GOAL OF THE PROGRAM WAS TO ENSURE SEATS WERE INSTALLED PROPERLY. EDUCATION WAS ALSO PROVIDED FOR ANY RECALLS THAT MAY BE ISSUED. ANOTHER PROGRAM THAT WAS USED DURING HIGH SCHOOL FOOTBALL GAMES TO EDUCATE STUDENTS AND THE GENERAL PUBLIC ABOUT THE DANGERS OF TEXTING AND DRIVING AND OTHER TYPES OF DISTRATECTED DRIVING THAT MAY CAUSE ACCIDENTS THAT RESULT IN INJURIES.CHRONIC DISEASE: DIABETES - THERE ARE SEVERAL INITIATIVES THAT THE MEDICAL CENTER HAS TO GET EDUCATIONAL INFORMATION TO THE PUBLIC ABOUT DIABETES. THERE IS A TYPE 2 DIABETES SUPPORT GROUP THAT MEETS TO DISCUSS HOW TO DEAL WITH THE DISEASE. THE MEDICAL CENTER IS ALSO INVOLVED IN THE NATIONAL DIABETES EDUCATION PROGRAM TO HELP PREVENT OR DELAY THE ONSET OF DIABETES. THERE ARE ALSO SEVERAL CHAT PROGRAMS THAT ARE OFFERED TO DISCUSS DIABETES.SCHUYLKILL HEALTH DID NOT ADDRESS ALL NEEDS IN THE ASSESSMENT. SCHUYLKILL HEALTH LEADERSHIP HAD A MEETING TO DISCUSS WHAT ITEMS WOULD BE BEST HANDLED BY EACH FACILITY. THE ITEMS THAT THEY DID NOT ADDRESS WERE THEN GIVEN TO THE APPROPRIATE COMMUNITY ORGANIZATIONS THAT WOULD BE ABLE TO BEST HANDLE THEM. SCHUYLKILL COUNTY VISION ADDRESSES 2 ISSUES THAT WERE IDENTIFIED: 1) PHYSICAL ACTIVITY, NUTRITION AND OBESITY AND 2) UNINTENTIONAL INJURIES FROM MOTOR VEHICLES. SCHUYLKILL COUNTY VISION TOOK THIS ISSUE ON BECAUSE THEY DEAL WITH A DIVERSE GROUP OF ORGANIZATIONS THAT WOULD BE ABLE TO IMPROVE THESE NEEDS BETTER THAN THE HEALTH SYSTEM. SCHUYLKILL COUNTY DRUG AND ALCOHOL PROGRAM ALSO HANDLED ONE OF THE RECOGNIZED NEEDS FROM THE ASSESSMENT. THEY HANDLED THE NEED TO IMPROVE MENTAL HEALTH AND CONTROL DRUG AND ALCOHOL ABUSE. THEY CHOSE TO ADDRESS THIS NEED BECAUSE THEY WORK WITH THESE ISSUES ALREADY AND ARE MORE PREPARED TO ADDRESS THIS NEED THAN THE HEALTH SYSTEM. SCHUYLKILL MEDICAL CENTER EAST NORWEGIAN PART V, SECTION B, LINE 20E: WHEN A PATIENT DOES NOT MAKE A PAYMENT A PATIENT IS EVALUATED TO DETERMINE IF THEY MEET THE GUIDELINES FOR FINANCIAL ASSISTANCE. IF THEY DO, THEY ARE THEN GIVEN THE PROPER INFORMATION. SCHUYLKILL MEDICAL CENTER EAST NORWEGIAN PART V, SECTION B, LINE 22D: THE SAME POLICY IS USED FOR EMERGENCY OR MEDICALLY NECESSARY CARE THAT IS USED FOR ANY OTHER TYPE OF CARE. THERE IS A STANDARD AMOUNT THAT IS CHARGED FOR PROCEDURES PER THE HOSPITAL'S CHARGE MASTER. INCOME GUIDELINES ARE DEVELOPED TO SHOW OR PROVE A PATIENT'S OR GUARANTOR'S INABILITY TO PAY. THESE INCOME GUIDELINES WILL BE BASED UPON THE FEDERAL POVERTY INCOME GUIDELINES ESTABLISHED BY THE DEPARTMENT OF HEALTH AND HUMAN SERVICES AND WILL BE REVISED EACH YEAR.INCOME LEVELS WILL DETERMINE IF SERVICES WILL BE RENDERED WITHOUT CHARGE OR AT AMOUNTS LESS THAN ESTABLISHED RATES. THE PERCENTAGE OF TOTAL INCOME ABOVE THE FEDERAL POVERTY INCOME GUIDELINE WILL DETERMINE THE PERCENTAGE OF CHARITY CARE GRANTED. PART I, LINE 7: SCHUYLKILL MEDICAL CENTER - EAST COMPUTED A COST TO CHARGE RATIO USING INFORMATION FROM THE MOST RECENTLY FILED MEDICARE COST REPORT (FYE 6/30/15) FOR THE CALCULATION OF COSTS FOR CHARITY CARE AND MEDICAID. DIRECT COSTS ARE OBTAINED FROM THE HOSPITAL COMPUTER SYSTEM FOR EACH COST CENTER FOR ALL OTHER BENEFITS. INDIRECT COSTS ARE COMPUTED UTILIZING THE MOST RECENTLY FILED MEDICARE COST REPORT (FYE 6/30/15). PART I, LINE 7G: THERE ARE NO PHYSICIAN CLINICAL SERVICES INCLUDED. PART I, LN 7 COL(F): THE AMOUNT OF BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25 COLUMN (A) BUT SUBTRACTED OUT FOR PURPOSES OF CALCULATING THE PERCENTAGE ON SCH H, PART I, LINE 7, COLUMN (F) IS $3,391,241. PART III, LINE 2: ALL APPROPRIATE DISCOUNTS AND PAYMENTS ARE REFLECTED ON EACH PATIENTS' ACCOUNT. ONCE A PATIENT IS IDENTIFIED AS BAD DEBT, THE BALANCE THAT IS BAD DEBT WOULD BE CHARGES NET OF ANY PAYMENTS OR ADJUSTMENTS.THE COST OF BAD DEBT EXPENSE IS CALCULATED BY USING THE COST TO CHARGE RATIO FROM THE MOST RECENTLY FILED MEDICARE COST REPORT AND APPLYING THAT TO THE CHARGE. PART III, LINE 3: WE BELIEVE THAT A PORTION OF OUR BAD DEBTS RESULTS FROM SERVICES PROVIDED TO PATIENTS WHO MEET THE CHARITY CARE GUIDELINES BUT WERE UNABLE OR UNWILLING TO PROVIDE THE APPROPRIATE DOCUMENTATION TO ALLOW THAT CLASSIFICATION. THESE WOULD BE CLASSIFIED AS BAD DEBT EXPENSE TIMES THE COST TO CHARGE RATIO TO ARRIVE AT THE COST. THIS SHOULD BE CONSIDERED COMMUNITY BENEFIT AS THE HOSPITAL IS PROVIDING CARE TO PATIENTS IN NEED REGARDLESS OF THEIR ABILITY TO PAY. PART III, LINE 4: ACCOUNTS RECEIVABLE, PATIENTS ARE REPORTED AT NET REALIZABLE VALUE. ACCOUNTS ARE WRITTEN OFF WHEN THEY ARE DETERMINED TO BE UNCOLLECTIBLE BASED UPON MANAGEMENT'S ASSESSMENT OF INDIVIDUAL ACCOUNTS. IN EVALUATING THE COLLECTIBILITY OF PATIENT ACCOUNTS RECEIVABLE, THE CORPORATION ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE CORPORATION ANALYZES CONTRACTUAL AMOUNTS DUE AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND INSURED PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES), THE CORPORATION RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE BILLED RATES AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. PART III, LINE 8: THE HOSPITAL USES THE COST-TO-CHARGE RATIO TO DETERMINE THE MEDICARE ALLOWABLE COSTS. PART III, LINE 9B: THE ORGANIZATION DOES HAVE A WRITTEN DEBT COLLECTION POLICY. ALL STAFF INVOLVED IN DEBT COLLECTION (EMPLOYEES OF THE MEDICAL CENTER AND ANY THIRD PARTY AGENCIES) ARE TRAINED ON THE POLICY AS WELL AS THE CHARITY CARE POLICY. IN DEALING WITH PATIENTS IN DEBT COLLECTION, STAFF WILL INFORM PATIENTS OF THE CHARITY CARE POLICY THAT IS AVAILABLE AND ALSO ANY OTHER FINANCIAL ASSISTANCE POLICIES OF THE MEDICAL CENTER THAT MAY BE APPLICABLE TO THE PATIENT. THE STAFF WILL INSTRUCT PATIENTS ON APPROPRIATE PAPERWORK THAT NEEDS TO BE COMPLETED WITH REGARDS TO CHARITY CARE OR FINANCIAL ASSISTANCE. PART VI, LINE 2: SCHUYLKILL MEDICAL CENTER - EAST NORWEGIAN STREET (SMS-ENS) WORKS WITH SCHUYLKILL MEDICAL CENTER - SOUTH JACKSON STREET (SMS-SJS) IN ASSESSING THE HEALTH NEEDS OF THE COMMUNITY IN WHICH IT IS LOCATED AND SERVES; SCHUYLKILL COUNTY, PENNSYLVANIA. BOTH MEDICAL CENTERS ALSO WORK WITH VARIOUS CITY, COUNTY AND STATE AGENCIES TO SPECIFICALLY IDENTIFY THE HEALTH NEEDS OF THE RESIDENTS OF SCHUYLKILL COUNTY.SMC-ENS IS LOCATED IN POTTSVILLE, WHICH IS THE COUNTY SEAT FOR SCHUYLKILL COUNTY. SCHUYLKILL COUNTY IS A RURAL COUNTY. THE COUNTY HAS AN UNEMPLOYMENT RATE OF OVER 6%, 19% OF THE RESIDENTS ARE COVERED BY MEDICAID, AND 18% OF THE RESIDENTS ARE OVER THE AGE OF 65.SMC-ENS IS A 126 BED ACUTE CARE FACILITY THAT PROVIDES ACUTE MEDICAL SURGICAL CARE, ACUTE REHAB SERVICES AND SENIOR BEHAVIORAL HEALTH SERVICES TO THE COMMUNITY.THE INFORMATION FOR THE NEEDS ASSESSMENT WAS GATHERED IN 2 DIFFERENT WAYS. THE FIRST WAY WAS TO SET UP A COMMITTEE OF 11 DIFFERENT MEMBERS FOR VARIOUS DIFFERENT GROUPS IN THE COMMUNITY TO DISCUSS WHAT WAS NEEDED TO IMPROVE THE HEALTH OF THE COMMUNITY. QUALITATIVE AND QUANTITATIVE DATA COLLECTION WAS ALSO USED TO ANALYZE WHAT WAS NEEDED TO IMPROVE THE HEALTH OF COMMUNITY MEMBERS.SMC-ENS WORKS WITH THE SOCIAL SERVICE AGENCIES, LOCAL DEPARTMENT OF HEALTH, THE CHAMBER OF COMMERCE, UNITED WAY, AMERICAN CANCER SOCIETY, LOCAL SCHOOLS, LOCAL SUPPORT GROUPS, PHYSICIAN OFFICES AND OTHER HEALTHCARE ORGANIZATIONS IN IDENTIFYING THE HEALTHCARE NEEDS OF THE LOCAL COMMUNITIES AND THE SERVICES THAT ARE NEEDED. AFTER A NEED HAS BEEN IDENTIFIED, THE MEDICAL CENTER WORKS WITH THESE ORGANIZATIONS TO HELP PROVIDE THE SERVICE TO RESIDENTS.THE MEDICAL CENTER ALSO WORKS WITH HEALTHCARE ORGANIZATIONS OUTSIDE SCHUYLKILL COUNTY TO HELP BRING HEALTHCARE SERVICES TO THE COUNTY. THIS ALLOWS COUNTY RESIDENTS TO OBTAIN NECESSARY SERVICES CONVENIENTLY WITHIN THE COUNTY.THE MEDICAL CENTER ALSO REVIEWS INTERNAL DATA ON ADMISSIONS, EMERGENCY ROOM VISITS, CLINIC VISITS AND DIAGNOSIS TO HELP IDENTIFY COMMUNITY NEEDS. THIS INFORMATION IS REVIEWED ANNUALLY AS PART OF THE BUDGET AND STRATEGIC PLANNING PROCESS.THE BOARD OF THE MEDICAL CENTER IS COMPRISED OF INDIVIDUALS FROM THE COMMUNITY REPRESENTING SOCIAL SERVICE AGENCIES, EDUCATION, ASSISTED LIVING/LONG TERM CARE, PHYSICIANS, MATERNAL/CHILD HEALTH AND LOCAL BUSINESSES. THESE INDIVIDUALS ALSO PROVIDE INPUT ON THE NEEDS OF THE COMMUNITY IN MEETING HEALTHCARE NEEDS. PART VI, LINE 3: EACH PATIENT IS REGISTERED INTO THE HOSPITAL COMPUTER SYSTEM WHEN THEY ARRIVE FOR SERVICES. AS PART OF THE REGISTRATION, INFORMATION IS OBTAINED ON ANY HEALTH INSURANCE THEY HAVE. INDIVIDUALS WITHOUT HEALTH INSURANCE ARE INFORMED AT THAT TIME OF THE MEDICAL CENTER'S CHARITY CARE POLICY. PATIENTS ARE GIVEN INFORMATION ON CONTACTING STAFF WITHIN THE HOSPITAL PATIENT ACCOUNTING DEPARTMENT TO DISCUSS APPLYING FOR THE HOSPITAL CHARITY CARE PROGRAM. SPECIFIC STAFF HAVE BEEN TRAINED AND ARE RESPONSIBLE FOR ADMINISTERING THE CHARITY CARE PROGRAM FOR THE HOSPITAL. HOSPITAL STAFF CONTACT PATIENTS WITHOUT INSURANCE AND EXPLAIN THE POLICY AND THE INFORMATION NEEDED TO APPLY. HOSPITAL STAFF WILL ALSO ASSIST PATIENTS IN APPLYING FOR MEDICAL ASSISTANCE. THEY WILL ALSO ASSIST PATIENTS IN COMPLETING THE APPLICATION AND GATHERING THE NECESSARY FINANCIAL DOCUMENTS.THE MEDICAL CENTER ALSO POSTS INFORMATION WITHIN THE ADMISSION AND EMERGENCY ROOM AREAS INFORMING PATIENTS THAT THERE IS A CHARITY CARE POLICY AVAILABLE. ALL REGISTRATION PERSONNEL ARE TRAINED ON THE POLICY SO THAT THEY ARE ABLE TO INFORM PATIENTS WHEN THEY ARE REGISTERED.OTHER HOSPITAL STAFF MEMBERS THAT MAY COME IN CONTACT WITH PATIENTS ARE ALSO EDUCATED REGARDING THE CHARITY CARE POLICY. THIS WOULD INCLUDE SOCIAL WORKERS, CARE MANAGERS, NURSING STAFF AND ALL DEPARTMENT DIRECTORS. THE CHARITY CARE POLICY IS AVAILABLE ON THE HOSPITAL INTRANET WHICH IS ACCESSIBLE BY ALL EMPLOYEES. THE HOSPITAL IS ALSO IN THE PROCESS OF PLACING THE POLICY ON THE HOSPITAL WEBSITE.ALL PATIENT ACCOUNTING, CASHIERING AND COLLECTION STAFF ARE ALSO EDUCATED ON THE CHARITY CARE POLICY AND CAN ASSIST PATIENTS IN APPLYING FOR CHARITY CARE. ALSO ALL THIRD PARTY ORGANIZATIONS THAT WORK ON BEHALF OF THE MEDICAL CENTER IN PERFORMING COLLECTIONS HAVE ALSO BEEN EDUCATED ON THE CHARITY CARE POLICY AND CAN ALSO ADVISE PATIENTS ON APPLYING FOR THIS BENEFIT. PART VI, LINE 4: SMC-ENS IS LOCATED IN POTTSVILLE, PENNSYLVANIA. THE MEDICAL CENTER SERVES ALL OF SCHUYLKILL COUNTY. SCHUYLKILL COUNTY IS A RURAL COUNTY IN PENNSYLVANIA. POTTSVILLE IS THE LARGEST POPULATION CENTER OF SCHUYLKILL COUNTY AND IS ALSO THE COUNTY SEAT. THE COUNTY IS COMPRISED OF ONE SMALL CITY AS WELL AS SEVERAL BOROUGHS AND TOWNSHIPS.THE POPULATION OF THE COUNTY IS APPROXIMATELY 147,000. APPROXIMATELY 20% OF THE POPULATION IS UNDER THE AGE OF 18 AND 18% IS OVER THE AGE OF 65. THE POPULATION IS 49% FEMALE AND 95% WHITE. APPROXIMATELY 14% OF THE POPULATION HAS A BACHELOR'S DEGREE OR HIGHER. 11.8% OF THE POPULATION IS BELOW THE POVERTY LEVEL. THE UNEMPLOYMENT RATE IS 6.9%.19% OF THE POPULATION IS INSURED BY MEDICAID. 42% OF THAT NUMBER ARE UNDER THE AGE OF 18, 13% ARE OVER THE AGE OF 65 AND 18% ARE DISABLED. MORE THAN 50% OF THE BIRTHS ARE COVERED BY THE MEDICAID PROGRAM.IN A RECENT REPORT RELEASED BY THE ROBERT WOOD JOHNSON FOUNDATION AND THE UNIVERSITY OF WISCONSIN'S POPULATION HEALTH INSTITUTE, SCHUYLKILL COUNTY WAS RANKED THE 57TH HEALTHIEST OF THE 67 COUNTIES IN PENNSYLVANIA. SCHUYLKILL COUNTY HAD HIGHER THAN THE STATE AND NATIONAL RATES FOR SMOKING, OBESITY, EXCESSIVE DRINKING AND MOTOR VEHICLE CRASH DEATH RATES. THIS REPORT ALSO SHOWED THAT THE COUNTY HAD ACCESS TO FEWER PRIMARY CARE PHYSICIANS.THE DEMOGRAPHICS OF THE PATIENTS ADMITTED TO SMC-ENS WERE 74% MEDICARE, 7% MEDICAID AND 1% SELF PAY. EMERGENCY PATIENTS AT SMC-ENS ARE 22% MEDICARE, 20% MEDICAID AND 10% SELF PAY.SCHUYLKILL COUNTY HAS THREE HOSPITALS SERVING THE COUNTY. SMC-ENS AND SCHUYLKILL MEDICAL CENTER - SOUTH JACKSON STREET ARE BOTH LOCATED IN POTTSVILLE AND SERVE THE MAJORITY OF THE COUNTY RESIDENTS. ST. LUKE'S MINERS MEMORIAL HOSPITAL IS LOCATED IN COALDALE NEAR THE CARBON COUNTY BORDER. PART VI, LINE 5: THE BOARD OF SMC - ENS IS COMPRISED OF SIXTEEN INDIVIDUALS FROM THE SCHUYLKILL COUNTY COMMUNITY WHO ARE NOT EMPLOYED BY THE MEDICAL CENTER. THEY ARE INVOLVED IN EDUCATION, SOCIAL SERVICES, GERIATRIC SERVICES, MATERNAL/CHILD SERVICES, PRIMARY MEDICAL CARE, CRIMINAL JUSTICE, SMALL BUSINESS AND MANUFACTURING. ALL PHYSICIANS ARE ENCOURAGED TO APPLY FOR MEDICAL STAFF PRIVILEGES FOR THE MEDICAL CENTER.SMC-ENS ALSO WORKS WITH VARIOUS COMMUNITY ORGANIZATIONS TO HELP IDENTIFY COMMUNITY NEEDS AND WORK TOGETHER TO MEET THOSE NEEDS. THE MEDICAL CENTER OPENED A WOUND CARE DEPARTMENT TO HELP IN DEALING WITH THE HIGH INCIDENT OF DIABETES WITHIN THE COUNTY POPULATION. THE MEDICAL CENTER ALSO HAS A CERTIFIED DIABETES EDUCATOR AVAILABLE TO CONSULT WITH PATIENTS AND ALSO WITH PHYSICIANS WHEN THEY HAVE A PATIENT THAT IS NEWLY DIAGNOSED WITH DIABETES. THE MEDICAL CENTER HAS AN OUTPATIENT DENTAL CLINIC AVAILABLE FOR THOSE PATIENTS WITH MEDICAID OR NO INSURANCE. THIS CLINIC HAD BEEN OPENED BASED ON THE NEED FOR DENTAL CARE FOR PATIENTS WITH MEDICAID OR LACK OF INSURANCE. THE MEDICAL CENTER ALSO WORKS WITH THE COUNTY SOCIAL SERVICE AGENCIES AND CRIMINAL JUSTICE DEPARTMENT ON OUTPATIENT DRUG AND ALCOHOL ISSUES. THE COUNSELING SERVICES OF THE MEDICAL CENTER PROVIDE OUTPATIENT DRUG AND ALCOHOL COUNSELING SERVICES IN BOTH INDIVIDUAL AND GROUP SETTINGS. THE COUNSELING SERVICES DEPARTMENT ALSO PROVIDES NICOTINE CESSATION COUNSELING AS WELL AS PARTICIPATING IN A GRANT PROGRAM WITH THE SOUTHEASTERN PENNSYLVANIA REGIONAL TOBACCO PROJECT.THE EMERGENCY DEPARTMENT OF SMC-ENS IS A 24 HOUR EMERGENCY ROOM AVAILABLE TO ALL REGARDLESS OF THEIR ABILITY TO PAY. THE MEDICAL CENTER PARTICIPATES IN MANY INSURANCE PROGRAMS SUCH AS MEDICARE, MEDICAID, CHAMPUS AND VA. THE MEDICAL CENTER ALSO HAS A CHARITY CARE POLICY THAT PROVIDES ASSISTANCE TO ELIGIBLE INDIVIDUALS IN PROVIDING FREE OR DISCOUNTED CARE BASED ON THEIR ABILITY TO PAY AND THE FEDERAL POVERTY GUIDELINES.SMC-ENS ALSO PROVIDES OPPORTUNITIES TO STUDENTS IN HEALTHCARE FIELDS TO GAIN EXPERIENCE WORKING IN THE HEALTH CARE ENVIRONMENT SUCH AS NURSING STUDENTS (RN AND LPN), PHARMACY STUDENTS, PHYSICIAN ASSISTANT STUDENTS, PHYSICAL THERAPY STUDENTS, RADIOLOGY TECHNICIANS AND MEDICAL ASSISTANTS. THE MEDICAL CENTER ALSO PROVIDES A VOLUNTEER PROGRAM FOR JUNIOR HIGH AND HIGH SCHOOL STUDENTS TO BECOME FAMILIAR WITH THE MEDICAL SERVICES OFFERED AND THE EDUCATIONAL OPPORTUNITIES AVAILABLE WITHIN THE HEALTHCARE ENVIRONMENT.THE MEDICAL CENTER ALSO SPONSORS AND PARTICIPATES IN HEALTH FAIRS AT COMMUNITY EVENTS SUCH AS THE COUNTY FAIR, EVENTS AT THE LOCAL MALL, HEALTH SCREENINGS, BLOOD PRESSURE SCREENINGS, VETERAN'S BREAKFAST EVENT, MEALS ON WHEELS, SKIN CANCER SCREENINGS, MAMMOGRAPHY SCREENINGS, BLOOD PRESSURE CLINICS, SUPPORT GROUPS AND LOCAL AMERICAN CANCER SOCIETY RELAY FOR LIFE.ANY EXCESS FUNDS THAT ARE GENERATED FROM OPERATIONS ARE INVESTED BACK INTO THE MEDICAL CENTER BY PURCHASING NECESSARY CAPITAL EQUIPMENT, FUNDING CAPITAL IMPROVEMENT PROJECTS, FUNDING NEW SERVICES, IMPROVING AND EXPANDING EXISTING SERVICES AND ANY OTHER GENERAL IMPROVEMENTS TO PATIENT CARE. PART VI, LINE 6: ON AUGUST 1, 2008, SMC-ENS AND SMC-SJS AFFILIATED UNDER THE CONTROL OF SCHUYLKILL HEALTH SYSTEM. THE PRIMARY SERVICE AREA IS POTTSVILLE AND THE SURROUNDING COMMUNITIES IN SCHUYLKILL COUNTY. THE PURPOSE OF BOTH MEDICAL CENTERS IS TO ENGAGE IN ACTIVITIES RELATED TO THE PROMOTION OF HEALTH OF THE PEOPLE IN THE SERVICE AREA, WORK CHARITABLY TO PROMOTE COMMUNITY HEALTH EDUCATION, PREVENTION OF ILLNESS AND INJURY AND PROVISION OF MEDICAL SERVICES TO THE DIVERSE POPULATION OF THE SERVICE AREA AND ENGAGE IN ANY AND ALL ACTIVITIES CONSISTENT WITH OR IN FURTHERANCE OF THESE PURPOSES.EACH MEDICAL CENTER OPERATES INDEPENDENTLY OF EACH OTHER BUT WORKS IN SYNC WITH EACH OTHER IN PROVIDING HEALTHCARE SERVICES TO THE RESIDENTS OF SCHUYLKILL COUNTY. BOTH MEDICAL CENTERS HAVE WORKED TO PROVIDE A CONTINUUM OF CARE SO THAT HEALTHCARE IS AVAILABLE WITHIN THE COUNTY AND RESIDENTS DO NOT HAVE TO TRAVEL OUTSIDE OF THE COUNTY FOR CARE. THE FOLLOWING SERVICES ARE AVAILABLE AT EITHER SMC-ENS OR SMC-SJS: - ACUTE CARE /MEDICAL SURGICAL SERVICES- INTENSIVE CARE SERVICES- MATERNITY SERVICES- NEWBORN SERVICES- PEDIATRICS SERVICES- ADOLESCENT, ADULT AND GERIATRIC BEHAVIORAL SERVICES- ACUTE REHAB AND TRANSITIONAL REHAB SERVICES- INPATIENT AND OUTPATIENT PHYSICAL THERAPY- INPATIENT AND OUTPATIENT DIAGNOSTIC SERVICES- HOME HEALTH SERVICES- OUTPATIENT DRUG AND ALCOHOL SERVICES- OUTPATIENT BEHAVIORAL HEALTH SERVICES- 24 HOUR EMERGENCY ROOM SERVICES- OUTPATIENT DENTAL CLINIC- INPATIENT AND OUTPATIENT SURGICAL SERVICES- COMMUNITY BENEFIT/CHARITY CARE SERVICES- ADVANCED WOUND CENTER- OUTPATIENT SURGERY CENTERSCHUYLKILL MEDICAL GROUP IS AN ORGANIZATION FORMED IN WHICH PHYSICIANS WOULD BE ABLE TO OPEN THEIR OWN PRACTICE BUT NOT INCUR ALL THE EXPENSES THAT THEY WOULD HAD THEY OPENED A PRACTICE ON THEIR OWN. THIS WAS DONE SO THAT MORE PHYSICIANS WOULD BE AVAILABLE TO THE PUBLIC IN THIS AREA. WITHOUT THIS ORGANIZATION THESE PHYSICIANS MAY BE PRACTICING IN A DIFFERENT AREA.SCHUYLKILL HEALTH SYSTEM IS AN ORGANIZATION FORMED TO RAISE FUNDS TO PROVIDE TO BOTH SMC - EAST AND SMC - SOUTH. THE MONEY RAISED IN THIS ORGANIZATION IS USED TO BENEFIT THE COMMUNITY IN VARIOUS WAYS. MONEY FROM THIS ORGANIZATION IS USED TO PURCHASE EQUIPMENT TO MAKE THE PUBLIC SAFER. IT IS ALSO USED TO FUND PROJECTS THAT WILL MAKE HEALTH CARE ACCESS EASIER TO THE PUBLIC. SCHUYLKILL REHAB IS AN ORGANIZATION THAT OFFERS REHABILITATION SERVICES TO THE PUBLIC. ONE SERVICE THAT BENEFITS THE PUBLIC IS A SERIES OF DIFFERENT PROGRAMS EACH YEAR ON HEALTH CARE TOPICS. THESE PROGRAMS ARE OFFERED FREE TO THE PUBLIC.SCHUYLKILL MEDICAL MALL/DEVELOPMENT CORP IS AN ORGANIZATION THAT OWNS AND OPERATES A MEDICAL OFFICE BUILDING NEAR SMC - EAST. THIS BUILDING OFFERS AN AREA FOR PHYSICIANS TO BE ABLE TO RENT SPACE FOR THEIR PRACTICE INSTEAD OF HAVING TO PURCHASE THEIR OWN SPACE.PART VI, LINE 7: N/A 0 CITY OF POTTSVILLE 401 NORTH CENTRE STREET POTTSVILLE PA 179011330 236001906 11434 THE CITY OF POTTSVILLE USED THE MONEY TO PURCHASE A NEW POLICE VEHICLE. 1 0 0 1 0 0 0 0 0 0 0 JOHN E SIMODEJKA PRESIDENT/CEO (TO 8/14) 0 459212 0 62500 0 565062 0 7800 0 19320 0 1113894 0 565062 DIANE BORIS VP FINANCE 147917 0 0 0 0 0 4028 0 14014 0 165959 0 0 0 DARNELL FURER VP NURSING/CNO (TO 6/15) 181695 0 0 0 0 0 5384 0 18289 0 205368 0 0 0 DR THOMAS CURRY VP MEDICAL AFFAIRS (TO 10/14) 0 203183 0 0 0 0 0 6161 0 11623 0 220967 0 0 SAJJAD MALIK PATHOLOGIST 299399 0 0 0 0 0 0 0 23231 0 322630 0 0 0 JOHN RUSSO PATHOLOGIST 276175 0 0 0 0 0 7650 0 18648 0 302473 0 0 0 EARL WATERS JR DENTIST 153170 0 0 0 0 0 4590 0 22995 0 180755 0 0 0 PART I, LINE 3 A RELATED ORGANIZATION, SCHUYLKILL MEDICAL CENTER - SOUTH JACKSON STREET, USES THE FOLLOWING METHODS TO DETERMINE COMPENSATION FOR THE CEO: COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, WRITTEN EMPLOYMENT CONTRACT, COMPENSATION SURVEY OR STUDY AND APPROVAL BY THE BOARD. PART I, LINE 4B JOHN SIMODEJKA RECEIVED A DISTRIBUTION FROM A 457 SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN IN FY 2015 OF $565,062. PART II, COLUMN B (II) JOHN SIMODEJKA RECEIVED A BONUS OF $62,500 FOR THE YEAR ENDED JUNE 30, 2015. THIS BONUS WAS DETERMINED BY THE COMPENSATION COMMITTEE OF THE BOARD AND THE BOARD OF DIRECTORS BASED ON NONFINANCIAL PERFORMANCE GOALS SET BY THE COMMITTEE WHICH WERE ACHIEVED. FORM 990, PART VI, SECTION A, LINE 3 THE HOSPITAL HAS DELEGATED MANAGEMENT DUTIES OVER THE FOLLOWING SERVICES: * DIETARY SERVICES & HOUSEKEEPING TO SODEXHO INC. AND AFFILIATES, * REHABILITATION TO REHAB CARE GROUP, INC., * WOUND CARE TO ACCELECARE, * BEHAVIORAL HEALTH UNITS TO HORIZON HEALTH, AND * IT TO TRUBRIDEGE CIO IN ADDITION, THE INTERIM PRESIDENT AND CEO, MARC LORY, AND INTERIM CFO, JUDY PEEK-LEE ARE EMPLOYEES OF THE ADVISORY BOARD. PAYMENT FOR THEIR SERVICES IS PAID DIRECTLY TO THE ADVISORY BOARD. ADVISORY BOARD ALSO PROVIDED REVENUE CYCLE CONSULTING AND TURN AROUND TEAM CONSULTING SERVICES DURING THE YEAR. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS REVIEWED BY MANAGEMENT PRIOR TO ITS FILING WITH THE INTERNAL REVENUE SERVICE. SELECTED MEMBERS OF THE BOARD REVIEWED THE 990 WITH THE TAX RETURN PREPARER AND MANAGEMENT ON BEHALF OF THE BOARD. FORM 990, PART VI, SECTION B, LINE 12C EACH OFFICER, KEY EMPLOYEE, DIRECTOR OR TRUSTEE WITH BOARD DELEGATED AUTHORITY IS REQUIRED TO ANNUALLY SIGN A CONFLICT OF INTEREST DISCLOSURE STATEMENT. THESE STATEMENTS ARE REVIEWED BY THE PRESIDENT/CEO'S ADMINISTRATIVE ASSISTANT AND ANY CONFLICTS ARE REPORTED TO THE PRESIDENT/CEO. THE STATEMENTS ARE KEPT ON FILE IN THE PRESIDENT/CEO'S OFFICE AFTER REVIEW. BOARD MEMBERS ARE EXPECTED TO RECUSE THEMSELVES FROM TAKING ANY ACTION OR EVEN DISCUSSING ISSUES OF RELATED PARTIES. IF THEY VIOLATE THESE RULES THEY ARE REMOVED FROM THE BOARD. FORM 990, PART VI, SECTION B, LINE 15 ANNUALLY, THE HOSPITAL CONTRACTS WITH YAFFE AND COMPANY, AN INDEPENDENT CONSULTANT, TO MAKE RECOMMENDATIONS TO THE COMPENSATION COMMITTEE, A SUB-COMMITTEE OF THE BOARD, BASED ON MARKET AND INDUSTRY DATA TO ENSURE THAT COMPENSATION IS PAID AT NO MORE THAN FAIR MARKET VALUE. THIS PROCESS IS USED FOR THE FOLLOWING POSITIONS: PRESIDENT/CEO, VICE PRESIDENT OF OPERATION/COO, VICE PRESIDENT OF NURSING/CNO, VICE PRESIDENT OF POST ACUTE SERVICES, VICE PRESIDENT OF CLINICAL AND SUPPORT SERVICES, AND THE VICE PRESIDENT OF FINANCE/CFO. REVIEW AND APPROVAL IS DOCUMENTED IN BOARD AND COMMITTEE MEETING MINUTES. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 584,973. MANAGEMENT AND GENERAL EXPENSES 46,237. TOTAL EXPENSES 631,210. CONTRACT LABOR: PROGRAM SERVICE EXPENSES 1,272,709. MANAGEMENT AND GENERAL EXPENSES 729,863. TOTAL EXPENSES 2,002,572. REFERRED MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 248,334. TOTAL EXPENSES 248,334. PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 1,156,390. MANAGEMENT AND GENERAL EXPENSES 234,000. TOTAL EXPENSES 1,390,390. CONSULTING FEES: PROGRAM SERVICE EXPENSES 32,888. MANAGEMENT AND GENERAL EXPENSES 2,192,703. TOTAL EXPENSES 2,225,591. MAINTENANCE SERVICE CONTRACTS: PROGRAM SERVICE EXPENSES 538,606. MANAGEMENT AND GENERAL EXPENSES 584,261. TOTAL EXPENSES 1,122,867. FORM 990, PART XI, LINE 9: VALUATION GAIN -11,692. SCHUYLKILL HEALTH SYSTEM 420 SOUTH JACKSON STREET POTTSVILLE PA 17901 262990543 TO SUPPORT, PROMOTE, ADVANCE & ENHANCE QUALITY OF LIFE OF SCHUYLKILL CNTY PA 501(C)(3) 11B N/A 0 SCHUYLKILL HEALTH SYSTEM MEDICAL GROUP INC 700 EAST NORWEGIAN STREET POTTSVILLE PA 17901 232866006 TO SUPPORT AND PROMOTE THE PURPOSES OF AFFILIATED ENTITIES PA 501(C)(3) 9 SCHUYLKILL HEALTH SYSTEM 0 SCHUYLKILL MEDICAL CENTER - SOUTH JACKSON STREET MAUCH CHUNK JACKSON STREETS POTTSVILLE PA 17901 231352202 OPERATES A HOSPITAL PROVIDING INPATIENT, OUTPATIENT & EMERGENCY SVCS PA 501(C)(3) 3 SCHUYLKILL HEALTH SYSTEM 0 SCHUYLKILL REHABILITATION CENTER INC 420 SOUTH JACKSON STREET POTTSVILLE PA 17901 232440891 OPERATES A COMPREHENSIVE REHABILITATION FACILITY PA 501(C)(3) 3 SCHUYLKILL HEALTH SYSTEM 0 SCHUYLKILL HEALTH SYSTEM MEDICAL MALL LP EAST NORWEGIAN TREMONT ST POTTSVILLE PA 17901 232514813 RENTAL PA N/A INVESTMENT 61440 239970 0 0 0.30910 SCHUYLKILL HEALTH SYSTEM DEVELOPMENT CORPORATION 700 EAST NORWEGIAN STREET POTTSVILLE PA 17901 232432417 PURSUES, IMPLEMENTS & FURTHERS THE ACTVTIES & PURPOSES OF THE SYS PA SCHUYLKILL MEDICAL CENTER - EAST NORWEGIAN STREET C 39301 383314 1.00000 0 SCHUYLKILL MEDICAL PLAZA - CONDOMINIUM ASSOCIATION 420 SOUTH JACKSON STREET POTTSVILLE PA 17901 232931821 CONDOMINIUM ASSOCIATION PA N/A C 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0