2015-05-14T09:34:34-05:00 2014-06-30 250988255 CARBIS WALKER LLP 5700 CORPORATE DRIVE STE 650 PITTSBURGH PA 15237 990 2013-07-01 250977902 MINERS HOSPITAL MINE 8142473100 290 HAIDA AVENUE HASTINGS PA 16646 SCOTT BECKER CHIEF EXECUTIVE OFFICER 8142473100 2015-05-11 1 JEFFREY J PETRELL CPA P00138808 4126356270 2015-05-11 2013 2016-02-25 16:41:14Z MINERS MEDICAL CENTER SCOTT BECKER 1086 FRANKLIN STREET JOHNSTOWN PA 15905 17707790 0 X WWW.CONEMAUGH.ORG X 1905 PA TO PROVIDE QUALITY HEALTH CARE TO ANY PERSON REGARDLESS OF RACE, COLOR, CREED, NATIONAL ORIGIN, AGE, SEX, HANDICAP AND/OR ABILITY TO PAY. 13 7 164 12 0 0 40873 50261 16606201 16118687 3011 2660 109147 1536182 16759232 17707790 0 4000 0 0 7855621 7266760 0 0 0 8991390 9606269 16847011 16877029 -87779 830761 6216685 5811178 10437050 10740626 -4220365 -4929448 X TO PROVIDE QUALITY HEALTH CARE TO ANY PERSON REGARDLESS OF RACE, COLOR, CREED, NATIONAL ORIGIN, AGE, SEX, HANDICAP AND/OR ABILITY TO PAY. 0 0 13299492 4000 17654869 MINERS HOSPITAL IS A COMMUNITY HOSPITAL SERVING RURAL NORTHERN CAMBRIA COUNTY AND SURROUNDING AREAS. THE HOSPITAL SPECIALIZES IN FAMILY AND PRIMARY CARE AND HAS 30 BEDS FOR INPATIENT MEDICAL/SURGICAL AND INTENSIVE CARE SERVICES. OTHER SERVICES INCLUDE: COMPREHENSIVE OUTPATIENT SERVICES; 24/7 EMERGENCY DEPARTMENT; 24/7 LABORATORY; ONSITE PHARMACY; OPERATING SUITE FOR SHORT OR MINOR PROCEDURES; ONSITE GENERAL AND ORTHOPEDIC SURGEONS; RADIOLOGY SERVICES, INCLUDING MOBILE MRI AND CT SCANS, DIGITAL MAMMOGRAPHY, AND ULTRASOUND; PATHOLOGY SERVICES; PHYSICAL THERAPY; RESPIRATORY THERAPY; AND OB/GYN OUTPATIENT CARE. DURING THE FISCAL YEAR ENDING JUNE 30, 2014, THE HOSPITAL ADMITTED 426 PATIENTS; HAD 9,748 EMERGENCY VISITS; AND PERFORMED 1,782 SURGICAL PROCEDURES. 13299492 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 24 0 1 164 1 0 0 0 0 0 0 0 0 0 0 X 13 7 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 PA X LINDA FANALE 8144108287 1086 FRANKLIN STREET JOHNSTOWN PA 15905 FRANK QUITONI CHAIRMAN 1.00 2.00 X X 0 0 0 SAMUEL MCCLURE VICE-CHAIRMAN 1.00 2.00 X X 0 0 0 PATTI STEFANICK DO SECRETARY 1.00 4.00 X X 0 25595 0 ALAN STANKIEWICZ DO ASSISTANT SECRETARY 1.00 2.00 X X 0 0 0 ELMER LASLO TREASURER 1.00 2.00 X X 0 0 0 TOM MARINO TRUSTEE 1.00 2.00 X 0 0 0 KEVIN MILLER TRUSTEE 1.00 2.00 X 0 0 0 ROBIN QUILLON TRUSTEE 1.00 2.00 X 0 0 0 NATHAN THOMAS MD TRUSTEE 1.00 72.00 X 0 168175 25317 JAMES TRETTER DO TRUSTEE 1.00 68.00 X 0 600633 38499 SHIBAN WARIKOO MD TRUSTEE 1.00 42.00 X 0 270858 30877 STEVEN TUCKER TRUSTEE, CHIEF OPERATING O 5.00 57.00 X X 0 454973 29568 SCOTT BECKER TRUSTEE, CHIEF EXECUTIVE O 1.00 69.00 X X 0 961721 30306 EDWARD DEPASQUALE CHIEF FINANCIAL OFFICER 1.00 49.00 X 0 456339 26649 DAVID CARLSON DO CHIEF MEDICAL OFFICER (TERM MAR14) 4.00 46.50 X 0 552617 24012 WILLIAM CARNEY MD CHIEF MEDICAL OFFICER (EFF MAR14) 0.00 62.00 X 0 470484 37189 JOSEPH DADO CHIEF INFORMATION OFFICER 1.00 49.50 X 0 360270 17102 BRENT MALLEK CHIEF HUMAN RESOURCES OFFICER 8.00 38.00 X 0 93720 3872 WILLIAM CROWE PRESIDENT 50.00 0.00 X 191621 0 28946 JOHN KARDUCK MD PHYSICIAN 27.00 12.00 X 124048 57155 9219 315669 4472540 301556 2 0 1 0 MEMORIAL MEDICAL CENTER 1086 FRANKLIN STREET JOHNSTOWN PA 15905 FINANCIAL, IT, LAB, CLINICAL/SUPPORT DEP 1703456 CONEMAUGH HEALTH INITIATIVES 1086 FRANKLIN STREET JOHNSTOWN PA 15905 PHYSICIANS 759761 WESTERN HEALTHCARE PO BOX 203152 DALLAS TX 75320 ER PHYSICIANS 261853 SAFARI CONTRACT CLEANERS 111 ROOSEVELT BOULEVARD JOHNSTOWN PA 15906 CLEANING 216447 SIEMENS INDUSTRY PO BOX 2134 CAROL STREAM IL 60132 FACILITY UPGRADES, MAINTENANCE 207830 8 42091 8170 50261 PATIENT SERVICES 900099 16092531 16092531 MEDICAL SERVICE ROOM REVENUE 900099 22724 22724 RENTAL INCOME 900099 3432 3432 16118687 2660 2660 MEANINGFUL USE 900099 2832089 2832089 CAFETERIA SALES 900099 77361 77361 LOSS ON IMPAIRMENT OF LONG-LIVED 900099 -1412167 -1412167 38899 38899 1536182 17707790 17654869 0 2660 4000 4000 223395 223395 5163855 4653430 510425 566453 496666 69787 917808 804734 113074 395249 346554 48695 282476 282476 1967 1967 900 900 5838 5838 1523431 1483514 39917 7587 7587 65782 47313 18469 166486 166486 505062 411734 93328 22513 19868 2645 18158 9585 8573 121816 121816 416898 343566 73332 298228 260860 37368 PURCHASED SERVICES 2777088 1375546 1401542 PATIENT CARE SUPPLIES 1512401 1512401 MAINTENANCE 732680 628770 103910 BAD DEBT 398883 398883 748075 380252 367823 16877029 13299492 3577537 0 987 884 1071613 829409 1711125 2696579 473315 526260 69462 156749 1469806 2760947 1469806 129236 131491 6216685 5811178 5800708 7358695 95161 88158 3191545 2940776 1349636 352997 10437050 10740626 X -4321245 -5035263 100880 105815 -4220365 -4929448 6216685 5811178 X 830761 -1539844 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 900 900 0 PART II-B, LINE 1: THE HOSPITAL PAID ANNUAL DUES TO THE HOSPITAL COUNCIL OF WESTERN PA (HCWP), A 501(C)(6) CORPORATION. ACCORDING TO HCWP, FIFTEEN PERCENT OF DUES WERE UTILIZED FOR LOBBYING AND PUBLIC POLICY DEVELOPMENT. 9706 9706 643920 643920 681303 681303 134877 134877 1469806 DUE TO CONEMAUGH HEALTH SYSTEM 37133 DUE TO MEMORIAL MEDICAL CENTER 233398 DUE TO CONEMAUGH HEALTH INITIATIVES, INC. 82466 352997 1 1 X 1 X 0 1 1 0 1 1 552015 552015 0.03350 1842766 1280590 562176 0.03410 23845 14249 9596 0.00060 2418626 1294839 1123787 0.06820 3226 3226 0.00020 3226 3226 0.00020 2421852 1294839 1127013 0.06840 4000 4000 0.00020 4000 4000 0.00020 0 136737 0 3484456 4399996 -915540 X 1 1 1 1 MINERS HOSPITAL 290 HAIDA AVENUE HASTINGS PA 16646 WWW.CONEMAUGH.ORG X X X MINERS HOSPITAL 1 1 X X X X X X X X 12 1 1 1 X HTTP://WWW.CONEMAUGH.ORG/TEMPLATE_ARTICLE X X X X X X X X 0 0 1 1 200.000000000000 0 1 X X 1 1 X X X 1 0 X X X 1 X 0 0 MINERS HOSPITAL PART V, SECTION B, LINE 3: THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) PROCESS INCLUDED INTERVIEWS TO GATHER INPUT FROM A BROAD RANGE OF COMMUNITY MEMBERS INCLUDING THOSE WITH PUBLIC HEALTH KNOWLEDGE AND EXPERTISE. KEY INDIVIDUALS WERE IDENTIFIED AND 26 OPEN-ENDED INTERVIEWS WERE COMPLETED WITH PARTICIPANTS FROM THE FOLLOWING PROFESSIONS: CHILD SERVICES, EDUCATION, CLERGY, ELECTED GOVERNMENT OFFICIALS, GOVERNMENT AGENCIES, HEALTH CARE, HUMAN SERVICE AGENCIES, JUDICIAL, LAW, NURSES, PHYSICIANS, SENIOR SERVICES, AND PUBLIC SAFETY. EACH PROFESSIONAL WAS ASKED WHAT HE OR SHE PERCEIVED TO BE THE MOST PRESSING ISSUES IN THE COMMUNITY.IN ADDITION, PAPER AND/OR ELECTRONIC SURVEYS WERE ADMINISTERED TO ASSURE THAT COMMUNITY MEMBERS, INCLUDING UNDER-REPRESENTED RESIDENTS, WERE INCLUDED IN THE NEEDS ASSESSMENT PLANNING PROCESS. A TOTAL OF 3,491 SURVEYS WERE DISTRIBUTED AND 446 WERE RETURNED; A PARTICIPATION RATE OF 12.7%. THE CHNA PROCESS ALSO INCLUDED FOCUS GROUPS AT TWO PUBLIC HOUSING FACILITIES TO ENSURE THAT POTENTIALLY UNDER-REPRESENTED RESIDENTS WERE INCLUDED. MINERS HOSPITAL PART V, SECTION B, LINE 4: THE CHNA WAS CONDUCTED FOR ALL HOSPITALS WITHIN THE CONEMAUGH HEALTH SYSTEM: MEMORIAL MEDICAL CENTER (MMC), MINERS MEDICAL CENTER (MIMC), AND MEYERSDALE MEDICAL CENTER (MYMC). MINERS HOSPITAL PART V, SECTION B, LINE 5D: THE CHNA WAS PUT ON THE CONEMAUGH HEALTH SYSTEM (CHS) WEBSITE WHICH AVERAGES ABOUT 150,000 HITS PER MONTH. THE CHNA WAS ALSO MENTIONED IN MULTIPLE NEWS RELEASES, REVIEWED AT VARIOUS COMMUNITY BOARD MEETINGS AND GATHERINGS, AND SHARED WITH APPROXIMATELY 5,000 CHS EMPLOYEES THROUGH VARIOUS FORMATS INCLUDING THE WEEKLY HUDDLE, CARENOTES NEWSLETTER, AND PHYSICIAN NEWSLETTER. THE CHNA WAS ALSO HIGHLIGHTED IN THE CHS PRIME MAGAZINE WHICH IS MAILED TO APPROXIMATELY 28,000 CONSUMERS AND EMAILED TO ANOTHER 6,000 ON AVERAGE. THE CHNA WAS PRESENTED TO THE CHS BOARD AND TO THE HOSPITAL DIVISION BOARD GOVERNING MEMORIAL MEDICAL CENTER, MEYERSDALE MEDICAL CENTER, AND MINERS MEDICAL CENTER. MINERS HOSPITAL PART V, SECTION B, LINE 6I: THE ORGANIZATION HAS DEVELOPED AND ADOPTED AN IMPLEMENTATION STRATEGY TO ADDRESS THE NEEDS IDENTIFIED WITHIN THE CHNA. THIS DOCUMENT IS AVAILABLE ON THE ORGANIZATION'S WEBSITE USING THIS SPECIFIC LINK: HTTP://WWW.CONEMAUGH.ORG/TEMPLATE_ARTICLE.ASPX?ID=11782 MINERS HOSPITAL PART V, SECTION B, LINE 7: THE CHNA IDENTIFIED A TOTAL OF EIGHT PRIORITY HEALTH NEEDS. PLANS TO ADDRESS SEVEN OF THESE NEEDS HAVE BEEN INITIATED AND INCLUDE MULTIPLE STEPS. THE ONLY NEED NOT BEING ADDRESSED BY MINERS MEDICAL CENTER (MIMC) IS THE NEED FOR PRIMARY CARE PHYSICIANS IN SOMERSET COUNTY. MIMC IS UNABLE TO IMPACT THIS NEED AS SOMERSET COUNTY IS NOT INCLUDED IN ITS PRIMARY SERVICE AREA. IN ADDITION, THE ORGANIZATION DOES HAVE CONCERNS ABOUT THE SUCCESS OF SIGNIFICANTLY IMPACTING OBESITY AND DRUG ADDICTION, AS THESE ARE DEEP SEATED ISSUES IN OUR COMMUNITY AND THE ORGANIZATION HAS LIMITED FINANCIAL RESOURCES TO ADDRESS THESE ISSUES. MINERS HOSPITAL PART V, SECTION B, LINE 11: FEDERAL POVERTY GUIDELINES ARE NOT USED IN THE DETERMINATION OF DISCOUNTED CARE. ALL SELF-PAY, UNINSURED PATIENTS ARE OFFERED A 60% DISCOUNT OFF OF CHARGES. MINERS HOSPITAL PART V, SECTION B, LINE 14G: THE ORGANIZATION IS GOVERNED BY THE CONEMAUGH HEALTH SYSTEM'S FINANCIAL ASSISTANCE POLICY. A SUMMARY OF THIS POLICY IS MADE AVAILABLE VIA BROCHURES LOCATED AT ALL REGISTRATION SITES, AND IS INCLUDED IN THE ADMISSIONS PACKET. IN ADDITION, BILLING STATEMENTS INDICATE THAT "FINANCIAL ASSISTANCE PROGRAM APPLICATIONS ARE AVAILABLE ON REQUEST, OR VISIT OUR WEBSITE AT WWW.CONEMAUGH.ORG". THE POLICY IS ALSO ADVERTISED PERIODICALLY IN THE LOCAL NEWSPAPERS. MINERS HOSPITAL PART V, SECTION B, LINE 18E: ALL REGISTRATION LOCATIONS HAVE THE HEALTH SYSTEM'S FINANCIAL ASSISTANCE POLICY INFORMATION ON HAND. THE INFORMATION IS ALSO AVAILABLE BY VISITING THE HEALTH SYSTEM'S WEBSITE AT WWW.CONEMAUGH.ORG. PART V, SECTION B, LINE 2: THE CHNA WAS LAST CONDUCTED DURING THE ORGANIZATION'S 2012 TAX YEAR, WHICH IS EQUVIALENT TO ITS FISCAL YEAR ENDED JUNE 30, 2013. THE IMPLEMENTATION STRATEGY WAS ALSO ADOPTED DURING THAT SAME FISCAL YEAR. PART I, LINE 3C: FEDERAL POVERTY GUIDELINES (FPG) ARE USED TO DETERMINE ELIGIBILITY FOR FREE CARE. HOWEVER, FPG ARE NOT USED WHEN MAKING A DETERMINATION FOR DISCOUNTED CARE. IN THESE CASES, ALL SELF-PAY, UNINSURED PATIENTS ARE OFFERED A 60% DISCOUNT OFF OF CHARGES. PART I, LINE 7: THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS REPORTED ON PART I, LINES 7A, 7B, AND 7C WAS BASED ON THE CONEMAUGH HEALTH SYSTEM'S COST ACCOUNTING SYSTEM AND ADDRESSES ALL PATIENT SEGMENTS. FOR FURTHER DETAILS OF THIS SYSTEM, SEE THE DESCRIPTION FOR PART III, LINE 8. THE METHODOLOGY USED TO CALCULATE THE AMOUNTS REPORTED ON PART I, LINES 7E THROUGH 7I AS APPLICABLE, WAS BASED ON ACTUAL REVENUES AND EXPENSES INCURRED. PART I, LN 7 COL(F): PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $398,883. PART II, COMMUNITY BUILDING ACTIVITIES: MINERS HOSPITAL'S COMMUNITY BUILDING INITIATIVES CONSIST OF A DONATION MADE TO A LOCAL ORGANIZATION THAT PROMOTES THE SUCCESS OF HIGH SCHOOL STUDENTS IN MANY AREAS, INCLUDING COMMUNITY SERVICE. PART III, LINE 4: PART III, LINE 2: THE METHODOLOGY UTILIZED TO DETERMINE THE AMOUNT REPORTED AS BAD DEBT IS BASED ON THE DESCRIPTIONS CONTAINED IN THE FOOTNOTES DETAILED UNDER PART III, LINE 4. THESE PROCESSES ARE FOLLOWED TO SUPPORT THE AMOUNT OF BAD DEBT REPORTED ON THE FINANCIAL STATEMENTS, WHICH IS REPORTED AT CHARGES. THE ORGANIZATION'S COST TO CHARGE RATIO IS THEN USED TO CALCULATE THE AMOUNT OF BAD DEBT AT COST, SHOWN ON LINE 2. PART III, LINE 3: THE AMOUNT REPORTED ON LINE 3 IS ZERO AS THERE IS NO PORTION OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY. CHS HAS IMPLEMENTED A SCORING SYSTEM BASED ON FEDERAL POVERTY GUIDELINES THAT SEGREGATES PATIENT BALANCES THAT ARE WRITTEN OFF TO PRESUMPTIVE CHARITY CARE, RATHER THAN BEING SENT TO COLLECTION. THIS HAS RESULTED IN MOVING PATIENTS OUT OF BAD DEBT STATUS THAT WOULD OTHERWISE BE PRESUMED TO BE ELIGIBLE UNDER THE CHS FINANCIAL ASSITANCE POLICY.PART III, LINE 4: PATIENT ACCOUNTS RECEIVABLE FOOTNOTE - ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, CHS ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYER SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYER SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, CHS ANALYZES CONTRACTUALLY DUE AMOUNTS 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 PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE WHERE THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL, CHS 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 DISCOUNTED RATES PROVIDED BY POLICY AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. CHS' ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR SELF-PAY PATIENTS REMAINED RELATIVELY CONSTANT FROM 85 PERCENT OF SELF-PAY ACCOUNTS RECEIVABLE AT JUNE 30, 2013 TO 84 PERCENT OF SELF-PAY ACCOUNTS RECEIVABLE AT JUNE 30, 2014. IN ADDITION, CHS' WRITE-OFFS OF APPROXIMATELY $5,794,000 AND $5,802,000 WERE CONSISTENT FOR THE YEARS ENDED JUNE 30, 2014 AND 2013, RESPECTIVELY. PART III, LINE 8: CONEMAUGH HEALTH SYSTEM UTILIZES MCKESSON'S HORIZON PERFORMANCE MANAGER (HPM) FOR COST ACCOUNTING. HPM PROVIDES THE ABILITY TO ALLOCATE ALL DEPARTMENTAL EXPENSES AT THE INDIVIDUAL CHARGE FOR EACH CHARGING DEPARTMENT, AS WELL AS ALLOCATE OVERHEAD EXPENSES IN A CONSISTENT MANNER. THE ENCOUNTER COSTING FUNCTIONALITY OF HPM PROVIDES THE ABILITY TO THEN DETERMINE AN ACCURATE ESTIMATE OF COST AT THE PATIENT LEVEL BASED ON THE CHARGE UNIT COSTS. THE SYSTEM THEN PROVIDES THE ABILITY TO SUMMARIZE THE PATIENT VOLUME, CHARGES, AND COSTS IN ANY NUMBER OF WAYS, INCLUDING PAYER SPECIFIC COST ALLOCATION. PART III, LINE 9B: PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE ARE NOT PURSUED USING ANY DEBT COLLECTION PRACTICES. PART VI, LINE 2: THERE ARE VARIOUS WAYS THAT THE ORGANIZATION ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES, IN ADDITION TO THE NEEDS ASSESSMENT REPORTED IN PART V, SECTION B. THE CONEMAUGH HEALTH SYSTEM (CHS) PROVIDES A WAY FOR PEOPLE WITHIN THE COMMUNITIES OF ALL MEMBER HOSPITALS TO ASK QUESTIONS THROUGH ITS WEBSITE. THROUGH EMAILUS@CONEMAUGH.ORG, THE HEALTH SYSTEM RECEIVES NUMEROUS QUESTIONS AND SUGGESTIONS, ALL OF WHICH ARE FILED BY ITS MARKETING DEPARTMENT AND THEN GIVEN TO THE APPROPRIATE PERSON OR DEPARTMENT FOR A QUICK AND ACCURATE RESPONSE. THESE EMAILS RANGE FROM SUGGESTIONS TO HEALTH QUESTIONS AND HELP FINDING AN APPROPRIATE PROVIDER OR SERVICE. IN ADDITION, NUMEROUS HEALTH FAIRS ARE HELD AT VARIOUS LOCATIONS THROUGHOUT CHS EACH YEAR TO ALLOW PEOPLE TO LEARN MORE ABOUT SPECIFIC HELP TOPICS. PEOPLE ARE ENCOURAGED TO SPEAK DIRECTLY TO CAREGIVERS AND HAVE THEIR SPECIFIC QUESTIONS ANSWERED WHEN APPROPRIATE. CHS PROVIDES A 1-800 NUMBER FOR PEOPLE TO CALL TO SEEK HELP FINDING A PHYSICIAN. CALLS COME IN DAILY WITH A VARIETY OF QUESTIONS RANGING FROM HELP FINDING A PHYSICIAN TO SPECIFIC MEDICAL QUESTIONS TO REQUESTS FOR SUPPORT GROUP INFORMATION. THE PHONE NUMBER IS INCLUDED IN MOST CHS ADVERTISING MATERIALS AS A WAY TO HELP PEOPLE FIND ADDITIONAL INFORMATION OR TO ASK QUESTIONS. THE CHS FACEBOOK PAGE PROVIDES ANOTHER OPPORTUNITY FOR PEOPLE TO PROVIDE FEEDBACK AND TO INQUIRE ABOUT HEALTH RELATED TOPICS AND SERVICES. IN ADDITION TO PROVIDING HEALTH INFORMATION AND WELLNESS TIPS, PEOPLE ARE ENCOURAGED TO PROVIDE TOPICS THEY WOULD LIKE TO LEARN MORE ABOUT. CHS USES THE VOICE OF THE CUSTOMER (VOC) TO HELP DETERMINE APPROPRIATE ADVERTISING MESSAGES AND TO PLAN PROGRAMMING. ONE WAY THE VOICE OF THE CUSTOMER IS ACQUIRED IS THROUGH A PATIENT ADVISORY COMMITTEE WHICH PROVIDES CONSTRUCTIVE CRITICISM AND FEEDBACK REGARDING VARIOUS ASPECTS OF CARE DELIVERY. VOC IS ALSO USED WITHIN LEAN SIX SIGMA PROJECTS TAKING PLACE THROUGHOUT THE HEALTH SYSTEM AS A WAY TO IMPROVE PROCESSES AND THE PATIENT EXPERIENCE. IN ADDITION, THE MARKETING DEPARTMENT REGULARLY RECEIVES FEEDBACK ON ISSUES AND HEALTH TRENDS FROM PHYSICIANS AND OTHER CLINICAL CAREGIVERS. THESE TRENDS ARE THEN ADDRESSED THROUGH MARKETING, SOCIAL MEDIA, OR MEDIA RELEASES. PART VI, LINE 3: CONEMAUGH HEALTH SYSTEM (CHS) COMMUNICATES TO PATIENTS THE AVAILABILITY OF FINANCIAL ASSISTANCE UNDER FEDERAL, STATE AND LOCAL PROGRAMS, AS WELL AS THE CHARITY CARE PROGRAM, ON ITS WEBSITE, WHICH INCLUDES A DOWNLOADABLE CHARITY CARE APPLICATION AND INSTRUCTIONS. TABLE TOP BROCHURES ARE PROVIDED AT ALL POINTS OF REGISTRATION, AND BROCHURES ARE INCLUDED IN PATIENT ADMISSION PACKETS. INFORMATION ON THE AVAILABILITY OF FINANCIAL ASSISTANCE IS ALSO INCLUDED ON PATIENT STATEMENTS. ASSISTANCE IS PROVIDED TO PATIENTS TO APPLY FOR MEDICAL ASSISTANCE THROUGH A THIRD-PARTY VENDOR. A ROBUST FINANCIAL COUNSELING AND CUSTOMER SERVICE DEPARTMENT IS AVAILABLE TO HANDLE SPECIFIC PATIENT NEEDS. PART VI, LINE 4: MINERS MEDICAL CENTER (MIMC) IS THE SOLE HOSPITAL SERVING RURAL NORTHERN CAMBRIA COUNTY AND SURROUNDING AREAS, SPECIALIZING IN FAMILY AND PRIMARY CARE. PHYSICIAN SPECIALISTS FROM CONEMAUGH PHYSICIAN GROUP VISIT MIMC ON A REGULAR BASIS TO PROVIDE CARE FOR PATIENTS. SPECIALTY SERVICES, WHICH ARE AVAILABLE SEVERAL TIMES A MONTH, INCLUDE CARDIOLOGY, UROLOGY, OPHTHALMOLOGY, GASTROENTEROLOGY, NEPHROLOGY, NEUROLOGY, PHYSICAL MEDICINE AND REHABILITATION, PULMONOLOGY, WOUND HEALING, AND OBSTETRICS/GYNECOLOGY.MIMC HAS 30 BEDS FOR INPATIENT MEDICAL, SURGICAL AND INTENSIVE CARE SERVICES. OUTPATIENT SERVICES INCLUDE 24/7 EMERGENCY DEPARTMENT, MOST OFTEN TREATING ACCIDENTS, CARDIAC ARREST OR TRAUMA; 24/7 LABORATORY; ONSITE PHARMACY; OPERATING SUITE FOR SHORT OR MINOR PROCEDURES; RADIOLOGY SERVICES, INCLUDING MOBILE MRI AND CT SCANS, MAMMOGRAPHY, AND ULTRASOUND; PATHOLOGY SERVICES; PHYSICAL THERAPY; RESPIRATORY THERAPY; AND OB/GYN OUTPATIENT CARE.WITH GENERALLY OLDER POPULATIONS, CAMBRIA AND SOMERSET COUNTIES HAVE LOWER BIRTH RATES THAN DEATH RATES WHICH WILL FURTHER REDUCE HOUSEHOLD SIZE AND RESULT IN A FURTHER INCREASE OF MEDIAN AGE OF THE POPULATION OVER TIME. MEDIAN HOUSEHOLD INCOME IN 2009 WAS $38,205 IN CAMBRIA COUNTY AND $38,712 IN SOMERSET COUNTY, WHICH ARE SIGNIFICANTLY LOWER THAN BOTH STATE AND NATIONAL AVERAGES OF $49,501 AND $50,221 RESPECTIVELY.THE CONEMAUGH HEALTH SYSTEM'S COVERAGE REGION ALSO PRESENTS SOME GEOGRAPHIC CHALLENGES DUE TO ITS MOUNTAINOUS TOPOGRAPHY AND HIGHWAY INFRASTRUCTURE. MINDFUL OF THESE CHALLENGES, THE HEALTH SYSTEM CONTINUES TO PRESENT EDUCATIONAL AND SCREENING OPPORTUNITIES TO COMMUNITIES OUTSIDE OF ITS IMMEDIATE REGION. PART VI, LINE 5: THE CONEMAUGH HEALTH SYSTEM (CHS), WHICH INCLUDES MINERS MEDICAL CENTER (MIMC), IS COMPRISED OF A MEDICAL STAFF OF ABOUT 350 PHYSICIANS REPRESENTING NUMEROUS SPECIALTIES THROUGHOUT A WIDE GEOGRAPHIC REGION. IN ADDITION, THE CONEMAUGH PHYSICIAN GROUP WITHIN CHS IS A MULTI-SPECIALTY GROUP OF MORE THAN 120 PHYSICIANS PARTICIPATING AT SITES CONVENIENTLY LOCATED ACROSS 5 COUNTIES. ALL PRIMARY CARE PHYSICIAN OFFICES ARE CONNECTED TO MIMC AND ALL CHS HOSPITALS BY AN ELECTRONIC MEDICAL RECORD SYSTEM. MIMC IS FORTUNATE TO HAVE NOT ONLY STRONG PHYSICIAN LEADERSHIP, BUT STRONG BOARD LEADERSHIP. THE BOARD IS COMPRISED OF A WIDE VARIETY OF DEDICATED LEADERS REPRESENTING DIVERSE FIELDS WHICH INCLUDES AREA BUSINESS LEADERS, EDUCATORS, AND PHYSICIANS, BOTH FROM CONEMAUGH PHYSICIAN GROUP AS WELL AS INDEPENDENT PHYSICIANS. AN ACTIVE PATIENT ADVISORY COMMITTEE CONTRIBUTES REGULAR CONSTRUCTIVE CRITICISM AND FEEDBACK REGARDING VARIOUS ASPECTS OF CARE DELIVERY INCLUDING WAY FINDING, MARKETING, AND SERVICE EXCELLENCE. IN FISCAL YEAR 2014, THE CONEMAUGH HEALTH SYSTEM ADDED A NUMBER OF NEW PROGRAMS AND TECHNOLOGY TO BENEFIT THE PEOPLE OF THE REGION INCLUDING: THE OPENING OF A PRIMARY CARE RESOURCE CENTER (PCRC) TO HELP PATIENTS AT HIGH RISK FOR READMISSIONS TRANSITION SAFELY FROM THE HOSPITAL TO HOME; THE ADDITION OF DATSCAN IMAGING TECHNOLOGY TO HELP CLINICALLY EVALUATE PARKINSON'S DISEASE; NEW XOFIGO PROSTATE THERAPY SYSTEM FOR MEN WITH ADVANCED STAGE METASTATIC PROSTATE CANCER; A NEW CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) PROGRAM TO HELP PATIENTS BETTER MANAGE THEIR CONDITION; AND THE ADDITION OF THE FOLLOWMYHEALTH PATIENT PORTAL TO ALLOW PATIENTS TO ACCESS THEIR MEDICAL RECORDS ONLINE AND TRACK THEIR TEST AND LAB RESULTS, UPDATE ALLERGY AND MEDICATION INFORMATION AND REQUEST PRESCRIPTION REFILLS AND APPOINTMENTS. IN THE WOMEN/CHILD SERVICE LINE, A NEW SECURITY SYSTEM WAS IMPLEMENTED. AN ADDITIONAL NEWBORN SCREENING FOR CRITICAL CONGENITAL HEART DISEASE (CCHD) WAS ALSO ADDED.MIMC STAFF PROVIDED HEALTH AND WELLNESS INFORMATION, FREE BLOOD PRESSURE SCREENINGS AND PULSE OX SCREENINGS AT THE CAMBRIA COUNTY FAIRGROUND. SIMILAR SCREENING AND EDUCATIONAL INFORMATION WAS SHARED BY EMPLOYEES AT THE HASTINGS FIREMAN'S CONVENTION AND COMMUNITY CELEBRATION. MAMMOGRAPHY SCREENING EVENTS ARE HELD AT MIMC EACH YEAR TO ATTRACT WOMEN IN NEED OF MAMMOGRAMS SPECIFICALLY TARGETING WOMEN WITHOUT INSURANCE. PHYSICIANS AND STAFF ONCE AGAIN PARTICIPATED IN THE KIDSKINS PROGRAM, A COMMUNITY INITIATIVE THAT PROVIDES FREE PHYSICALS FOR STUDENTS IN THE REGION PLAYING FOOTBALL.MINERS HOSPITAL FACILITY HIGHLIGHTS:LICENSED PATIENT BEDS - 30PATIENT DAYS OF SERVICE - 1,944INPATIENT DAILY CENSUS - 5ADJUSTED PATIENT DAYS - 16,422ADMISSIONS - 426AVERAGE LENGTH OF STAY - 4.56FULL TIME EQUIVALENT EMPLOYEES - 115VOLUNTEERS - 12PHYSICIANS:ACTIVE - 9COURTESY - 32CONSULTING - 18ALLIED HEALTH - 4 SERVICES:EMERGENCY VISITS - 9,748INPATIENT SURGERIES - 74SAME DAY/AMBULATORY SURGERIES - 1,708OUTPATIENT VISITS - 51,111LABORATORY TESTS - 178,570RADIOLOGY EXAMS - 9,474ULTRASOUND PROCEDURES - 4,317CT SCANS - 3,045MRI PROCEDURES - 584NUCLEAR MEDICINE EXAMS - 793RESPIRATORY THERAPY PROCEDURES - 27,558EKG'S, EEG'S, HOLTERS - 2,794SHORT PROCEDURE UNIT VISITS - 2,259 PART VI, LINE 6: MINERS MEDICAL CENTER IS A SUBSIDIARY OF A LARGER HEALTH SYSTEM, CONEMAUGH HEALTH SYSTEM, INC. THE CONEMAUGH HEALTH SYSTEM AND ITS AFFILIATES WORK TOGETHER TO PROMOTE THE HEALTH OF THE COMMUNITIES THEY SERVE. 0 0 0 0 0 1 1 0 0 NATHAN THOMAS MD TRUSTEE 0 149773 0 150 0 18252 0 12031 0 13286 0 193492 0 0 JAMES TRETTER DO TRUSTEE 0 502750 0 51787 0 46096 0 22589 0 15910 0 639132 0 0 SHIBAN WARIKOO MD TRUSTEE 0 263144 0 150 0 7564 0 19318 0 11559 0 301735 0 0 STEVEN TUCKER TRUSTEE, CHIEF OPERATING O 0 362496 0 63233 0 29244 0 17008 0 12560 0 484541 0 0 SCOTT BECKER TRUSTEE, CHIEF EXECUTIVE O 0 656723 0 250000 0 54998 0 10927 0 19379 0 992027 0 0 EDWARD DEPASQUALE CHIEF FINANCIAL OFFICER 0 364815 0 67275 0 24249 0 15209 0 11440 0 482988 0 0 DAVID CARLSON DO CHIEF MEDICAL OFFICER (TERM MAR14) 0 445491 0 82785 0 24341 0 9007 0 15005 0 576629 0 0 WILLIAM CARNEY MD CHIEF MEDICAL OFFICER (EFF MAR14) 0 367194 0 56319 0 46971 0 22589 0 14600 0 507673 0 0 JOSEPH DADO CHIEF INFORMATION OFFICER 0 288176 0 49591 0 22503 0 15398 0 1704 0 377372 0 0 WILLIAM CROWE PRESIDENT 165941 0 22431 0 3249 0 14656 0 14290 0 220567 0 0 0 JOHN KARDUCK MD PHYSICIAN 121962 0 75 0 2011 57155 0 0 9219 0 133267 57155 0 0 PART I, LINE 3 THE CEO'S COMPENSATION IS PAID BY CONEMAUGH HEALTH SYSTEM WHICH USES THE FOLLOWING METHODS TO ESTABLISH THE COMPENSATION OF THE CEO: COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, COMPENSATION STUDY OR SURVEY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. PART I, LINE 6 WILLIAM CROWE RECEIVED A BONUS FROM MINERS HOSPITAL. SCOTT BECKER, EDWARD DEPASQUALE, DAVID CARLSON, DO, AND JOSEPH DADO RECEIVED A BONUS FROM THE CONEMAUGH HEALTH SYSTEM, A RELATED ORGANIZATION. STEVEN TUCKER RECEIVED A BONUS FROM MEMORIAL MEDICAL CENTER, A RELATED ORGANIZATION. EXECUTIVE BONUSES ARE CALCULATED AS A PERCENTAGE OF BASE SALARY. THE PERCENTAGE IS CONTINGENT ON VARIOUS FINANCIAL AND NON-FINANCIAL INCENTIVE CRITERIA, GOVERNED BY THE EXECUTIVE COMPENSATION COMMITTEE OF THE BOARD OF CONEMAUGH HEALTH SYSTEM. JAMES TRETTER, DO AND WILLIAM CARNEY, MD RECEIVED A BONUS FROM CONEMAUGH HEALTH INITIATIVES, A RELATED ORGANIZATION. PHYSICIAN BONUSES ARE CALCULATED ON A CASH BASIS; TAKING TOTAL CASH COLLECTIONS LESS ALL OFFICE OPERATING, PHYSICIAN AND OVERHEAD EXPENSES. ANY REMAINING AMOUNT IS DISTRIBUTED TO THE PHYSICIAN BASED ON A CONTRACTUAL PERCENTAGE, A PRACTICE REINVESTMENT CONTRIBUTION AND/OR A CAP. TOTAL PHYSICIAN COMPENSATION IS REVIEWED ANNUALLY FOR REASONABLENESS USING INDUSTRY STANDARDS AND APPLICABLE IRS GUIDELINES. FORM 990, PAGE 1 DURING SEPTEMBER 2014, MINERS HOSPITAL WAS ACQUIRED BY DUKE LIFEPOINT HEALTHCARE. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF MINERS HOSPITAL IS THE CONEMAUGH HEALTH SYSTEM, INC. FORM 990, PART VI, SECTION A, LINE 7A THE CONEMAUGH HEALTH SYSTEM, INC. HAS THE POWER TO APPROVE OR DISAPPROVE THE ELECTION OF OR REMOVAL OF MEMBERS OF THE GOVERNING BODY. FORM 990, PART VI, SECTION A, LINE 7B ALL DECISIONS OF THE GOVERNING BODY OF MINERS HOSPITAL ARE SUBJECT TO APPROVAL BY THE CONEMAUGH HEALTH SYSTEM, INC. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS PROVIDED TO THE ORGANIZATION'S BOARD OF DIRECTORS BEFORE IT IS FILED. ONCE THE FORM IS COMPLETE, BOARD MEMBERS ARE GIVEN THE OPPORTUNITY TO REVIEW THE CONTENTS OF THE FORM AND SUBMIT ANY COMMENTS OR QUESTIONS. IN ADDITION, SINCE THE ORGANIZATION IS A SUBSIDIARY WITHIN A LARGER HEALTH SYSTEM, THE FORM IS REVIEWED BY THE HEALTH SYSTEM'S FINANCIAL OPERATIONS LEADERSHIP. AN EXTERNAL CPA FIRM IS ENGAGED TO REVIEW AND ELECTRONICALLY FILE THE RETURN. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION IS A SUBSIDIARY OF A LARGER HEALTH SYSTEM AND IS GOVERNED BY THE SYSTEM'S CONFLICT OF INTEREST POLICY, WHICH HAS BEEN APPROVED BY THE HEALTH SYSTEM'S BOARD. UNDER THIS POLICY, EVERY BOARD MEMBER IS GIVEN A COPY OF THE POLICY AS WELL AS A FORM THAT MUST BE COMPLETED ON AN ANNUAL BASIS. NO BOARD MEMBER IS APPROVED OR RE-APPOINTED UNTIL HE OR SHE HAS COMPLETED AND SIGNED THE CONFLICT OF INTEREST FORM. ONCE THE FORM IS RETURNED, IT IS REVIEWED BY THE SYSTEM'S COMPLIANCE OFFICER AND CEO. IF ANY CONFLICTS ARE DISCLOSED, THE DETAILS ARE FORWARDED TO THE BOARD CHAIR TO BE ADDRESSED. DEPENDING ON THE CONFLICT, THE BOARD MEMBER COULD BE GIVEN CERTAIN RESTRICTIONS, SUCH AS BEING PROHIBITED FROM PARTICIPATING IN CERTAIN BOARD DECISIONS. THE HEALTH SYSTEM'S AUDIT AND COMPLIANCE COMMITTEE HAS THE FINAL DECISION-MAKING REGARDING ALL CONFLICTS OF INTEREST. THROUGHOUT THE FISCAL YEAR, BOARD MEMBERS MUST NOTIFY THE BOARD CHAIR, COMPLIANCE OFFICER, AND/OR CEO IF A NEW CONFLICT OF INTEREST HAS DEVELOPED. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION'S PARENT, A HEALTH SYSTEM, MANAGES THE DETERMINATION OF COMPENSATION AND THE PROCESS IS OUTLINED IN ITS BYLAWS. AN OUTSIDE CONSULTING FIRM IS UTILIZED TO ENSURE THAT EXECUTIVE COMPENSATION PACKAGES ARE FAIR AND COMPARABLE WITH SIMILAR ORGANIZATIONS. THE HEALTH SYSTEM HAS ALSO ESTABLISHED AN EXECUTIVE COMPENSATION COMMITTEE TO REVIEW AND RECOMMEND THE COMPENSATION DECISIONS MADE. THIS COMMITTEE REPORTS DIRECTLY TO THE HEALTH SYSTEM'S BOARD. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION IS PART OF A HEALTH SYSTEM AND ALL REQUESTS FOR THIS INFORMATION ARE HANDLED BY THE SYSTEM'S MARKETING/PUBLIC RELATIONS DEPARTMENT. FORM 990, PART VI, SECTION B, LINES 12A, 13 AND 14: ALL APPLICABLE POLICY QUESTIONS HAVE BEEN ANSWERED YES SINCE THE ORGANIZATION IS A SUBSIDIARY OF A LARGER HEALTH SYSTEM AND IS GOVERNED BY THE SYSTEM'S POLICIES. ALL POLICIES HAVE BEEN APPROVED BY THE HEALTH SYSTEM'S BOARD. FORM 990, PART XI, LINE 9: PENSION ADJUSTMENT -1,547,854. OTHER ADJUSTMENTS 8,010. FORM 990, PART XII, LINE 2: FORM 990, PART XII, LINE 2: THE ORGANIZATION'S FINANCIAL STATEMENTS FOR THE FISCAL YEAR ENDING JUNE 30, 2014 WERE AUDITED AS PART OF THE AUDIT OF THE CONSOLIDATED FINANCIAL STATEMENTS OF THE CONEMAUGH HEALTH SYSTEM, INC. AND SUBSIDIARIES. THE HEALTH SYSTEM'S AUDIT AND COMPLIANCE COMMITTEE ASSUMES RESPONSIBLITY FOR THE OVERSIGHT OF THE AUDIT AND THE SELECTION OF THE INDEPENDENT ACCOUNTANT. CONEMAUGH HEALTH SYSTEM 1086 FRANKLIN STREET JOHNSTOWN PA 15905 232801799 SUPPORT MEMBER HOSPITALS PA 501(C)(3) 11A N/A 0 CONEMAUGH VALLEY MEMORIAL HOSPITAL DBA MEMORIAL MEDICAL CTR 1086 FRANKLIN STREET JOHNSTOWN PA 15905 250965307 HEALTHCARE SERVICES PA 501(C)(3) 3 CONEMAUGH HEALTH SYSTEM 0 MEYERSDALE COMMUNITY HOSPITAL DBA MEYERSDALE MEDICAL CENTER 200 HOSPITAL DRIVE MEYERSDALE PA 15552 251002946 HEALTHCARE SERVICES PA 501(C)(3) 3 CONEMAUGH HEALTH SYSTEM 0 CONEMAUGH HEALTH FOUNDATION 1086 FRANKLIN STREET JOHNSTOWN PA 15905 251719695 SUPPORTS CONEMAUGH HEALTH SYSTEM PA 501(C)(3) 11B CONEMAUGH HEALTH SYSTEM 0 LAUREL HIGHLANDS ADVANCED IMAGING 1450 SCALP AVENUE JOHNSTOWN PA 15904 251864587 DIAGNOSTIC SERVICES PA N/A GREATER JOHNSTOWN TECH PARK 1086 FRANKLIN STREET JOHNSTOWN PA 15905 260389121 OPERATES MULTI-TENANT COMMERCE OFFICE PARK PA N/A CONEMAUGH HEALTH INITIATIVES INC DBA CONEMAUGH PHYSICIAN GP 1086 FRANKLIN STREET JOHNSTOWN PA 15905 251658283 PHYSICIAN SERVICES PA N/A C 0 1086 REAL ESTATE 1086 FRANKLIN STREET JOHNSTOWN PA 15905 251489704 REAL ESTATE PA N/A C 0 CONEMAUGH ENTERPRISES INC 1086 FRANKLIN STREET JOHNSTOWN PA 15905 202998473 ECONOMIC DEVELOPMENT PA N/A C 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 1 1 1 0 0