2015-05-14T14:26:29-05:00 2014-06-30 390859910 BAKER TILLY VIRCHOW KRAUSE LLP 1000 COMMERCE PARK DRIVE SUITE 430 WILLIAMSPORT PA 17701 990 2013-07-01 231352159 JC BLAIR MEMORIAL HOSPITAL JCBL 8146432290 1225 WARM SPRINGS AVENUE HUNTINGDON PA 16652 DEBORAH SHUGHART CFO 8146432290 2015-05-14 1 JULIUS C GREEN CPA JD P00350393 5703236023 2013 2016-03-07 17:11:31Z JASON HAWKINS 1225 WARM SPRINGS AVENUE HUNTINGDON PA 16652 46468060 0 X WWW.JCBLAIR.ORG X 1909 PA HEALTHCARE PROVIDER - NOT-FOR-PROFIT ACUTE CARE HOSPITAL 16 15 489 70 1240803 -457215 335492 107370 38043469 37397461 1513414 1956235 2872436 4588211 42764811 44049277 167973 171787 0 0 23933071 24357432 0 0 0 16247210 18128210 40348254 42657429 2416557 1391848 40701660 43277609 15721820 16616697 24979840 26660912 X MISSION: J.C. BLAIR MEMORIAL HOSPITAL IS COMMITTED TO BEING THE PREMIER HEALTH RESOURCE FOR THE RESIDENTS OF HUNTINGDON COUNTY AND NEARBY COMMUNITIES AND STRIVES TO DELIVER THE BEST OUTCOME FOR EVERY PATIENT. VISION: TO BE A MODEL OF EXCELLENCE FOR THE PROVISION OF A COMPREHENSIVE RANGE OF HEALTHCARE AND WELLNESS SERVICES DESIGNED TO CONTINUALLY IMPROVE THE HEALTH STATUS AND QUALITY OF LIFE FOR THE RESIDENTS OF HUNTINGDON COUNTY AND NEARBY COMMUNITIES. 0 0 32796268 171787 40012593 J.C. BLAIR MEMORIAL HOSPITAL PROVIDES INPATIENT, OUTPATIENT, AND EMERGENCY CARE SERVICES TO FURTHER THE HEALTH AND WELLNESS OF HUNTINGDON, PENNSYLVANIA AND SURROUNDING COMMUNITIES IN HUNTINGDON COUNTY, PENNSYLVANIA. IN FISCAL YEAR 2014, J.C. BLAIR MEMORIAL HOSPITAL PROVIDED THE COMMUNITY WITH CHARITY SERVICES AMOUNTING TO APPROXIMATELY $709,000. PATIENTS RECEIVE MEDICALLY NECESSARY SERVICES REGARDLESS OF ABILITY TO PAY. IN ADDITION, THE REIMBURSEMENT SHORTFALL FROM THE MEDICAID PROGRAM WAS OVER $1,251,000. THE HOSPITAL CONTRIBUTED OVER $1 MILLION IN COMMUNITY BENEFIT PROGRAMS THAT INCLUDED THOUSANDS OF HOURS OF VOLUNTEER SERVICE PROVIDING FREE EDUCATION AND SCREENING PROGRAMS, MENTORING FUTURE HEALTH CARE PROFESSIONALS, PROVIDING LEADERSHIP SERVICE TO COMMUNITY ORGANIZATIONS, AND CONTRIBUTING FINANCIAL AND IN-KIND SUPPORT TO A NUMBER OF LOCAL INITIATIVES. THESE PROGRAMS INCLUDED: FREE DIABETES SELF-MANAGEMENT CLASSES, SPONSORSHIP OF BLOODMOBILE DRIVES THROUGHOUT THE YEAR, FREE BREAST FEEDING EDUCATION AND CONSULTING FOR NEW MOTHERS, FREE NEWBORN SAFETY KITS, FREE YEAR-ROUND EDUCATIONAL PROGRAMS ON NUTRITION, HEART HEALTH, BREAST HEALTH, ETC., FREE OSTEOPOROSIS SCREENINGS, SPONSORSHIP OF FAMILY FITNESS EVENTS, PARTICIPATION IN NUMEROUS HEALTH FAIRS THROUGOUT THE COUNTY, AND WELLNESS CHECK COMPREHENSIVE BLOOD SCREENING AND HEALTH FAIRS. 32796268 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 42 0 1 489 1 1 1 0 0 0 0 0 0 0 0 0 X 16 15 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 PA X DEBORAH SHUGHART CFO 8146438445 1225 WARM SPRINGS AVENUE HUNTINGDON PA 16652 FRANCES V VAUGHN CHAIR 1.00 2.00 X X 0 0 0 FRED E PRICE VICE CHAIR 1.00 3.00 X X 0 0 0 GARRY L POTE TREASURER 1.00 3.00 X X 0 0 0 JOSEPH A MASCIANGELO SECRETARY 1.00 2.00 X X 0 0 0 ELLEN F SLOAN ASSISTANT SECRETARY 1.00 2.00 X X 0 0 0 JOHN D COURSEN DIRECTOR 1.00 1.00 X 0 0 0 JAMES J LAKSO PHD DIRECTOR 1.00 2.00 X 0 0 0 FRANK X DEMAR DIRECTOR 1.00 1.00 X 0 0 0 ARTHUR J DECAMP DIRECTOR 1.00 2.00 X 0 0 0 A KEITH BLACK DIRECTOR 1.00 1.00 X 0 0 0 CHARLES R CRUIKSHANK DIRECTOR 1.00 1.00 X 0 0 0 JAMES E SCHALL MD VICE MEDICAL DIRECTOR 1.00 2.00 X 0 0 0 MARIA T PETTINGER MD DIRECTOR 1.00 4.00 X 0 0 0 ROBERT S RITCHEY DIRECTOR 1.00 2.00 X 0 0 0 JOHN P THOMPSON DIRECTOR 1.00 1.00 X 0 0 0 MELANIE MACDONALD DIRECTOR 1.00 1.00 X 0 0 0 MOLLY M ETTINGER DIRECTOR/CHIEF OF STAFF 1.00 40.00 X 0 116259 19915 LISA M MALLON CEO 41.00 4.00 X 214847 0 16619 EDWARD M QUINN CFO 41.00 4.00 X 165001 0 21579 JENNIFER E HOLT PHYSICIAN 40.00 X 333987 0 18515 BREET L ACKER PHYSICIAN 40.00 X 288110 0 29395 JOHN D ROTH PHYSICIAN 40.00 X 265426 0 30536 ALFRED K SUTTON MD PHYSICIAN 20.00 20.00 X 219909 0 28821 FRANK J HAMLETT PSYCHIATRIST 40.00 X 219632 0 0 1706912 116259 165380 13 0 1 0 AMERISOURCE BERGEN PO BOX 29808 NEW YORK NY 100879808 PHARMACY SERVICES 1445584 US FOODS INC PO BOX 641303 PITTSBURGH PA 152641303 DIETARY SERVICES 598155 BENCHMARK THERAPIES PO BOX 870 HUNTINGDON PA 16652 THERAPY SERVICES 504152 PYRAMID CONSTRUCTION 840 NORTH FRONT STREET WORMLEYSBURG PA 17043 CONSTRUCTION 443429 MICHAEL D CESARE DO 7370 LOVELAND DRIVE HUNTINGDON PA 16652 ER DEPARTMENT SERVICES 134187 5 69502 32224 5644 107370 NET PATIENT REV 621110 37397461 37397461 37397461 279320 279320 291113 136251 154862 154862 154862 3958847 600 2274238 8294 1684609 -7694 1676915 1676915 MEANINGFUL USE REVENUE 900099 1326060 1326060 CRNA SERVICES 623000 1126183 1126183 DIETARY SVCS REVENUE 812900 973063 973063 1008043 162889 267740 577414 4433349 44049277 40012593 1240803 2688511 171787 171787 594864 594864 18440463 13607171 4833292 853465 610057 243408 3124740 2233564 891176 1343900 949211 394689 218243 218243 95170 95170 4680 4680 93089 93089 2920849 2007358 913491 103472 601 102871 2053393 1512858 540535 222598 222598 1854714 1854714 107501 26960 80541 125803 125803 1232146 1232146 629791 629791 MED SUPPLIES & PHARMACY 3301041 3301041 BAD DEBT 2476996 2476996 REPAIRS & MAINTENANCE 1327695 927102 400593 FOOD 671360 646897 24463 689669 482211 207458 42657429 32796268 9861161 0 2400 2500 2299645 2733179 3265399 3588674 10000 724676 619524 338852 368486 57709212 49333079 9063044 8376133 15184557 14522891 9823087 13056222 40701660 43277609 4377839 5616723 4447628 3947628 6896353 7052346 15721820 16616697 X 22507024 23897371 749277 917791 1723539 1845750 24979840 26660912 40701660 43277609 X 1391848 219816 331460 -262052 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 4680 4680 0 PART II-B, LINE 1: THE HOSPITAL IS A MEMBER OF THE HOSPITAL ASSOCIATION OF PENNSYLVANIA, HOSPITAL COUNCIL OF WESTERN PA AND THE AMERICAN HOSPITAL ASSOCIATION. AS SUCH, A PERCENTAGE OF DUES IS EXPENDED BY THOSE ORGANIZATIONS ON LOBBYING ACTIVITIES. IT IS ESTIMATED THAT $4,680 OF THE DUES PAID WAS USED BY THOSE ORGANIZATIONS FOR LOBBYING ACTIVITIES. 1707837 137913 1845750 1652503 55334 1707837 1662208 -9705 1652503 1534994 127214 1662208 1486749 48245 1534994 0.00000 1.00000 0.00000 0 1 1 518428 518428 23024756 19293652 3731104 32701987 29213265 3488722 1464041 826162 637879 8376133 DUE FROM AFFILIATES 8116370 BENEFICIAL INTEREST IN PERPETUAL TRUSTS 1731799 INSURANCE RECOVERIES RECEIVABLE 1099043 ASSETS RECEIVED UNDER REVOCABLE TRUST 111972 DEFERRED FINANCING COSTS, NET 184306 INTEREST IN NET ASSETS OF AFFILIATE 708135 ACCRUED INTEREST AND OTHER RECEIVABLES 1104597 13056222 ESTIMATED MEDICAL MALPRACTICE CLAIMS LIABILITY 1478600 ACCRUED PENSION COST 4617423 REFUNDABLE ADVANCE 111972 OBLIGATIONS UNDER CAPITAL LEASE 395764 THIRD-PARTY PAYOR SETTLEMENTS 448587 7052346 X 41502345 219816 -2910693 -2690877 44193222 -143945 -143945 44049277 40152733 -27700 -27700 40180433 2476996 2476996 42657429 PART V, LINE 4: J.C. BLAIR MEMORIAL HOSPITAL HAS RECORDED ON ITS BALANCE SHEET ITS INTEREST IN THE NET ASSETS OF THE J.C. BLAIR MEMORIAL HOSPITAL FOUNDATION. THAT AMOUNT IS REPORTED ABOVE AND CATEGORIZED AS A TERM ENDOWMENT. THE FOUNDATION TRANSFERS FUNDS RAISED TO THE HOSPITAL FOR THE PURCHASE OF EQUIPMENT AND BUILDING IMPROVEMENTS. FUNDS RAISED AND NOT YET TRANSFERRED ARE REPORTED AS INTEREST IN NET ASSETS OF THE FOUNDATION. PART X, LINE 2: THE HOSPITAL 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 HAS BEEN MET. MANAGEMENT HAS DETERMINED THAT THERE WERE NO TAX UNCERTAINTIES THAT MET THE RECOGNITION THRESHOLD IN 2014 AND 2013. THE HOSPITAL'S FEDERAL EXEMPT ORGANIZATION BUSINESS INCOME TAX RETURNS FOR THE YEARS ENDED PRIOR TO JUNE 30, 2011 NO LONGER REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. THE HOSPITAL'S POLICY IS TO RECOGNIZE INTEREST RELATED TO UNRECOGNIZED TAX BENEFITS IN INTEREST EXPENSE AND PENALTIES IN OPERATING EXPENSES. PART XI, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN PERMANENTLY RESTRICTED NET ASSETS 122,211. MINIMUM PENSION LIABILITY ADJUSTMENT -778,928. BAD DEBT EXPENSE NETTED ON FINANCIALS -2,476,996. CHANGE IN NET ASSETS OF FOUNDATION 223,020. PART XI, LINE 4B - OTHER ADJUSTMENTS: RENTAL EXPENSE -136,251. LOSS ON SALE OF PPE REPORTED AS EXPENSE ON FINANCIALS -7,694. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSE 136,251. LOSS ON SALE OF PPE REPORTED AS EXPENSE ON FINANCIALS 7,694. FORGIVENESS OF DUE TO AFFILIATE NETTED AGAINST TRANSFERS ON FINANCIALS -171,645. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE NETTED ON FINANCIALS 2,476,996. 1 1 X 1 X 1 X 1 1 1 0 1 1 709701 31067 678634 0.01690 5665718 4414164 1251554 0.03110 6375419 4445231 1930188 0.04800 63075 63075 0.00160 602588 602588 0.01500 117932 117932 0.00290 783595 783595 0.01950 7159014 4445231 2713783 0.06750 38988 38988 0.00100 2500 2500 0.00010 2500 2500 0.00010 43988 43988 0.00120 1 865930 432965 10602860 12427168 -1824308 X 1 1 1 1 JC BLAIR MEMORIAL HOSPITAL 1225 WARM SPRINGS AVENUE HUNTINGDON PA 16652 WWW.JCBLAIR.ORG 101101 X X X INPATIENT PSYCHIATRIC UNIT JC BLAIR MEMORIAL HOSPITAL 1 1 X X X X X X X X 12 1 0 1 X WWW.JCBLAIR.ORG/COMMUNITY X X X X X X 0 0 1 1 200.000000000000 1 200.000000000000 1 X X X 1 1 X X X X X 1 0 X X X 1 X 0 0 J.C. BLAIR MEMORIAL HOSPITAL PART V, SECTION B, LINE 3: A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) WAS CONDUCTED BY J.C. BLAIR MEMORIAL HOSPITAL WITH SUPPORT FROM THE HUNTINGDON COUNTY HEALTHY COMMUNITIES PARTNERSHIP AND ITS STEERING COMMITTEE. THE STEERING COMMITTEE WAS COMPRISED OF REPRESENTATIVES FROM VARIOUS HUNTINGDON COUNTY HEALTH AND HUMAN SERVICE ORGANIZATIONS AND INCLUDED:UNITED WAYJUNIATA COLLEGE COMMUNITY OUTREACH COORDINATORJUNIATA COLLEGE HEALTH MARKETING INTERNJUNIATA COLLEGE HEALTH COMMUNICATIONS INTERNJUNIATA COLLEGE HEALTH COMMUNICATIONS ADVISORJ.C. BLAIR COMMUNITY RELATIONS COORDINATOR AND HUNTINGDON COUNTY SAFE KIDS COORDINATORJ.C. BLAIR DIRECTOR OF COMMUNITY RELATIONSTRI-COUNTY DRUG & ALCOHOL COMMISSIONCENTER FOR COMMUNITY ACTIONHUNTINGDON COUNTY CHILD AND ADULT DEVELOPMENT CORPORATIONJUNIATA COLLEGE INSTITUTIONAL RESEARCHJ.C. BLAIR BEHAVIORAL HEALTH SERVICESHUNTINGDON COUNTY DEPARTMENT OF HEALTH OFFICEJ.C. BLAIR COMMUNITY RELATIONS COORDINATORDIRECTOR OF HUNTINGDON COUNTY PLANNING & DEVELOPMENT OFFICEMAIN STREAM COUNSELINGCENTER FOR COMMUNITY ACTION J.C. BLAIR MEMORIAL HOSPITAL PART V, SECTION B, LINE 7: AS NOTED EARLIER IN THIS REPORT, J.C. BLAIR HAS SELECTED INITIATIVES AND STRATEGIES FOR THIS IMPLEMENTATION PLAN BASED ON THE HEALTH SYSTEM'S CAPACITY AND THE LIKELIHOOD OF SUCCESS. ANOTHER CONSIDERATION WAS WHETHER OR NOT OTHER AGENCIES IN THE COMMUNITY WERE BETTER SUITED AND ALREADY FOCUSED ON ADDRESSING IDENTIFIED ISSUES OR NEEDS.J.C. BLAIR WILL NOT DIRECTLY ADDRESS THE SOCIO-ECONOMIC NEEDS FOR JOBS, HIGHER INCOME, POST SECONDARY EDUCATION, OR TRANSPORTATION; HOWEVER, THESE NEEDS WILL BE AND ARE ALREADY THE FOCUS OF OTHER ORGANIZATIONS SUCH AS HUNTINGDON COUNTY BUSINESS AND INDUSTRY, HUNTINGDON COUNTY CHAMBER OF COMMERCE, HUNTINGDON CAREERLINK, AND OTHERS. J.C. BLAIR LEADERSHIP PARTICIPATES IN COMMUNITY BUILDING INITIATIVES WITH THESE ORGANIZATIONS AS BOARD AND COMMITTEE MEMBERS, AND THE HOSPITAL'S EDUCATION CENTER SERVES AS A HOST SITE FOR MANY EVENTS AND MEETINGS ADDRESSING THESE NEEDS. DENTAL HEALTH IS ANOTHER NEED IDENTIFIED THAT J.C. BLAIR WILL NOT DIRECTLY ADDRESS DUE TO THE HEALTH SYSTEM'S LIMITED CAPACITY TO ADDRESS THIS ISSUE. J.C. BLAIR WILL, HOWEVER, PARTICIPATE IN ANY COLLABORATIVE EFFORTS TO ADDRESS THIS NEED. J.C. BLAIR MEMORIAL HOSPITAL PART V, SECTION B, LINE 14G: FINANCIAL COUNSELORS DISCUSS THE AVAILABILITY OF DISCOUNTED AND CHARITY CARE INDIVIDUALLY WITH PATIENTS. J.C. BLAIR MEMORIAL HOSPITAL PART V, SECTION B, LINE 20D: INDIVIDUALS ELIGIBLE UNDER THE FINANCIAL ASSISTANCE POLICY RECEIVE DISCOUNTED OR FREE CARE BASED UPON THE INDIVIDUAL'S CIRCUMSTANCES. PART I, LINE 3C: THE ORGANIZATION OFFERS A 20% DISCOUNT FOR PROMPT PAYMENT REGARDLESS OF INCOME. PART I, LINE 6A: J.C. BLAIR HEALTH SYSTEMS, INC., PARENT OF J.C. BLAIR MEMORIAL HOSPITAL, PRODUCES AN ANNUAL REPORT WHICH INCLUDES A REPORT OF COMMUNITY BENEFIT. THE REPORT HIGHLIGHTS THE COST OF CHARITY CARE AND THE SHORTFALL BETWEEN MEDICAL ASSISTANCE PAYMENTS AND THE COST OF CARE, AND THE VALUE OF THE COMMUNITY BENEFIT PROGRAMS CATEGORIZED AS REQUIRED IN THE 990 TAX RETURN. IT ALSO PROVIDES A NARRATIVE SECTION LISTING EXAMPLES OF THE EVENTS HOSPITAL LEADERSHIP, BOARD MEMBERS, MEDICAL STAFF AND EMPLOYEES PARTICIPATE IN OR SPONSOR. THE ANNUAL REPORT IS DISTRIBUTED AT AN ANNUAL PUBLIC MEETING, THROUGH THE MAIL, THROUGH THE HOSPITAL WEBSITE AND THROUGHOUT THE ORGANIZATION. PART I, LINE 7: THE HOSPITAL USES THE COST TO CHARGE RATIO TO DETERMINE COSTS. 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 $2,476,996. PART II, COMMUNITY BUILDING ACTIVITIES: MUCH OF THE BENEFIT TO THE COMMUNITY COMES FROM PARTICIPATION IN COLLABORATIVE EFFORTS THAT HELP TO ASSESS COMMUNITY NEED AND TO ADDRESS HEALTH ISSUES IN HUNTINGDON COUNTY. SOME OF THE DIRECT SERVICE ACTIVITIES INCLUDE FREE BREAST HEALTH AND HEART HEALTH SCREENINGS FOR WOMEN, SUPPORTED BY TWO GRANTS, FREE DIABETES SELF-MANAGEMENT CLASSES, EDUCATIONAL PROGRAMS, MENTORING FUTURE HEALTH CARE PROFESSIONALS THROUGH INTERNSHIPS AND STUDENT PRACTICUMS, PARTICIPATION IN HEALTH FAIRS, PATIENT ADVOCACY AND PROMOTION OF HEALTHY LIFESTYLES. INDIRECT SUPPORT OF THESE ACTIVITIES INCLUDE HOSPITAL STAFF AND MEDICAL STAFF MEMBERS SERVING IN LEADERSHIP AND WORKING ROLES ON BOARDS AND COMMITTEES THAT IMPACT THE HEALTH STATUS AND WELL-BEING OF COMMUNITY MEMBERS. PART III, LINE 2: THE AMOUNT OF BAD DEBT EXPENSE AT COST IS TAKEN FROM THE COST REPORT S-10 LINE 29. PART III, LINE 3: THE HOSPITAL ESTIMATES THAT APPROXIMATELY 50% OF THEIR BAD DEBT EXPENSE IS ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY FINANCIAL ASSISTANCE POLICY. THE HOSPITAL FEELS THIS SHOULD BE CONSIDERED COMMUNITY BENEFIT AS THEY ARE PROVIDING CARE TO PATIENTS 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. THE ALLOWANCE FOR DOUBTFUL COLLECTIONS IS ESTIMATED BASED UPON A PERIODIC REVIEW OF THE ACCOUNTS RECEIVABLE AGING, PAYOR CLASSIFICATIONS, AND APPLICATION OF HISTORICAL WRITE-OFF PERCENTAGES.COST TO CHARGE RATIO FROM THE COST REPORT WAS USED TO ESTIMATE COSTS. DISCOUNTS AND PAYMENTS ON PATIENTS ACCOUNTS ARE NOT INCLUDED IN BAD DEBT EXPENSE. PAYMENTS MADE AFTER AN ACCOUNT HAS BEEN WRITTEN OFF TO BAD DEBT ARE TREATED AS RECOVERIES OF BAD DEBT AND ARE NETTED AGAINST BAD DEBTS. PART III, LINE 8: LINE 6 INCLUDES ALLOWABLE COSTS REPORTED ON THE COST REPORT FOR BOTH, PART A AND PART B. LINE 5 REVENUES REPORTED INCLUDE ALL NET REVENUES FOR MEDICARE, INCLUDING PART A AND PART B, AS REPORTED ON THE 2014 COST REPORT.THE HOSPITAL CENTER IS RECEIVING LESS THAN THE COST OF PROVIDING CARE TO PATIENTS THROUGH THE PROSPECTIVE PAYMENT SYSTEM. IN SPITE OF THIS, THE HOSPITAL IS STILL COMMITTED TO MEETING THE MEDICAL NEEDS OF THE COMMUNITY. THEREFORE, MEDICARE SHORTFALL SHOULD BE CONSIDERED COMMUNITY BENEFIT. PART VI, LINE 2: A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) WAS CONDUCTED BY J.C. BLAIR MEMORIAL HOSPITAL WITH SUPPORT FROM THE HUNTINGDON COUNTY HEALTHY COMMUNITIES PARTNERSHIP AND ITS STEERING COMMITTEE. THE STEERING COMMITTEE WAS COMPRISED OF REPRESENTATIVES FROM VARIOUS HUNTINGDON COUNTY HEALTH AND HUMAN SERVICE ORGANIZATIONS AND INCLUDED:KATHY ARMILLEI, UNITED WAYABBEY BAIRD, JUNIATA COLLEGE COMMUNITY OUTREACH COORDINATORTARA BLACK, JUNIATA COLLEGE HEALTH MARKETING INTERNSHELBY CASSELL, JUNIATA COLLEGE HEALTH COMMUNICATIONS INTERNGRACE FALA, JUNIATA COLLEGE HEALTH COMMUNICATIONS ADVISORSTACEY FREITAG, J.C. BLAIR COMMUNITY RELATIONS COORDINATOR AND HUNTINGDON COUNTY SAFE KIDS COORDINATORCHRIS GILDEA, J.C. BLAIR DIRECTOR OF COMMUNITY RELATIONSMARTHA LEISTER, TRI-COUNTY DRUG & ALCOHOL COMMISSIONWENDY MELIUS, CENTER FOR COMMUNITY ACTIONDANA PODRASKY, HUNTINGDON COUNTY CHILD AND ADULT DEVELOPMENT CORPORATIONCARLEE RANALLI, JUNIATA COLLEGE INSTITUTIONAL RESEARCHSHELLY RIVELLO, J.C. BLAIR BEHAVIORAL HEALTH SERVICESTAMMY SCHNARRS, HUNTINGDON COUNTY DEPARTMENT OF HEALTH OFFICEHOLLI SMITH, J.C. BLAIR COMMUNITY RELATIONS COORDINATORRICHARD STAHL, DIRECTOR OF HUNTINGDON COUNTY PLANNING & DEVELOPMENT OFFICEKELLY STATES, MAIN STREAM COUNSELINGCHRISTIE STEIDLE, MAIN STREAM COUNSELINGSTACEY TICE, CENTER FOR COMMUNITY ACTIONSEE ALSO SCHEDULE H PART V RESPONSES PART VI, LINE 3: IN ORDER TO BE ELIGIBLE FOR CHARITY CARE, A PATIENT WHO DOES NOT HAVE HEALTH INSURANCE MUST COMPLETE AN APPLICATION FOR MEDICAL ASSISTANCE AND BE DENIED COVERAGE. SUCH PATIENTS, DESIGNATED AS SELF-PAY, ARE OFFERED ASSISTANCE BY OUR SELF-PAY FINANCIAL COUNSELORS IN COMPLETING APPLICATIONS FOR MEDICAL ASSISTANCE. COUNSELORS FOLLOW UP WITH PATIENTS IF APPLICATIONS ARE NOT COMPLETED OR INFORMATION IS NOT RETURNED. THE HOSPITAL ALSO HAS ACCESS TO LIMITED FUNDS (THE INCOME FROM A TRUST WHICH HAS BEEN DESIGNATED TO BE USED FOR CHARITY CARE). APPLICANTS FOR CHARITY CARE ARE SCREENED FOR ELIGIBILITY FOR THIS PROGRAM. IN ADDITION, A RESTRICTED DONATION FROM A COMMUNITY MEMBER HAS PROVIDED FOR PAYMENT FOR HEALTH CARE SERVICES WHICH ARE NOT ELIGIBLE FOR ANY OTHER PROGRAMS OR INSURANCE COVERAGES. WHILE THE AMOUNT OF THAT GRANT WAS ONLY $10,000, IT HAS ALREADY PROVIDED COVERAGE FOR COSTS OF CARE FOR SEVERAL PATIENTS FOR NEEDED SERVICES. PATIENT BROCHURES ARE PROVIDED TO EXPLAIN THE AVAILABILITY OF ASSISTANCE AND CHARITY CARE PROGRAMS.THE FEDERAL POVERTY LEVEL GUIDELINES WITH OUR 200% MULTIPLIER ARE POSTED IN LOCATIONS FREQUENTED BY PATIENTS, SUCH AS THE EMERGENCY DEPARTMENT AND REGISTRATION AREAS. IF A PATIENT IS SELF PAY AT THE TIME OF REGISTRATION, THE REGISTRATION CLERK NOTIFIES A PATIENT FINANCIAL COUNSELOR AND PROVIDES THE PATIENT WITH A FINANCIAL ASSISTANCE PROGRAM LETTER. THE PROGRAM LETTER OFFERS A 20% SELF PAY DISCOUNT PROGRAM AND CHARITY CARE PROGRAM OUTLINE. PATIENT COUNSELORS ADVISE AND ASSIST WITH APPLICATION PROCESS. TO APPLY FOR CHARITY CARE, THE PATIENT MUST FIRST APPLY FOR MEDICAL ASSISTANCE. THIS PROCESS CAN TAKE UP TO 30 DAYS FOR MEDICAL ASSISTANCE APPROVAL OR DENIAL. IF MEDICAL ASSISTANCE COVERAGE IS DENIED, THE PATIENT IS ASKED TO CONTACT THE PATIENT COUNSELOR FOR ASSISTANCE WITH COMPLETING THE CHARITY CARE APPLICATION, OR TO HAVE THE APPLICATION MAILED OUT TO THE PATIENT. ONCE THE PATIENT IS DETERMINED TO BE ELIGIBLE, THE PATIENT IS ISSUED AN IDENTIFICATION CARD, WHICH THEY MAY PRESENT AT FUTURE VISITS TO VALIDATE THEY HAVE BEEN DETERMINED TO BE ELIGIBLE FOR CHARITY CARE. ELIGIBILITY MUST BE RENEWED EVERY SIX MONTHS. THE HOSPITAL IS CURRENTLY DEVELOPING A NEW BROCHURE WHICH DESCRIBES THE CHARITY PROGRAM ALONG WITH OTHER FINANCIAL POLICIES, SUCH AS PROMPT PAYMENT DISCOUNTS AND ELIGIBILITY FOR PAYMENT PLANS AND GRANT FUNDED CARE. PART VI, LINE 4: THE HOSPITAL SERVES THE RESIDENTS OF HUNTINGDON COUNTY AND IS THE ONLY HOSPITAL IN THE COUNTY. THE POPULATION IN THE COUNTY IS APPROXIMATELY 45,875, SPREAD ACROSS MANY SMALL BOROUGHS AND VILLAGES. THERE ARE A NUMBER OF AMISH AND MENNONITE SETTLEMENTS IN THE REGION. THE COMMUNITIES IN THE PRIMARY SERVICE AREA ARE HUNTINGDON, SMITHFIELD, MOUNT UNION, ALEXANDRIA, ORBISONIA, PETERSBURG, THREE SPRINGS, MAPLETON DEPOT, JAMES CREEK, MILL CREEK. A NUMBER OF SMALL COMMUNITIES MAKE UP THE SECONDARY SERVICE AREA. THE AREA IS RURAL. HUNTINGDON COUNTY IS IN THE 'RIDGE AND VALLEY' SECTION OF PENNSYLVANIA, WHICH MAKES FOR SMALL COMMUNITIES CONNECTED BY WINDING AND HILLY SECONDARY ROADS. DAIRY AND OTHER FARMING IS ALSO PREVALENT IN THE VALLEYS. ABOUT 12% OF THE POPULATION LIVES BELOW THE FEDERAL POVERTY LEVEL. AVERAGE PER CAPITA INCOME IS APPROXIMATELY $20,574 AND MEDIAN HOUSEHOLD INCOME IS ABOUT $43,026. 12.1% OF THE POPULATION IS UNINSURED. A FEW OF THE COMMUNITIES SERVED BY THE HOSPITAL ARE DESIGNATED AS MEDICALLY UNDERSERVED OR HEALTH PROFESSIONAL SERVICE AREAS, BUT THE BOROUGH OF HUNTINGDON, WHERE THE HOSPITAL IS LOCATED, IS NOT. PART VI, LINE 5: THE GOVERNING BODY IS REPRESENTATIVE OF THE COMMUNITIES IN THE PRIMARY AND SECONDARY SERVICE AREAS OF THE HOSPITAL. THE CHIEF AND VICE CHIEF OF THE MEDICAL STAFF ARE VOTING MEMBERS OF THE BOARD. EMPLOYEES ARE GENERALLY NOT ALLOWED TO SERVE AS VOTING MEMBERS OF THE BOARD, HOWEVER, ONE EMPLOYED PHYSICIAN SERVES AS VICE CHIEF OF THE MEDICAL STAFF AND IS A VOTING MEMBER BY VIRTUE OF THAT POSITION. MEMBERS OF THE MEDICAL STAFF WHO SERVE ON THE BOARD MAY HAVE CONTRACTUAL RELATIONSHIPS WITH THE HOSPITAL OR ITS AFFILIATES, WHICH THEY ARE REQUIRED TO DISCLOSE IN CONFLICT OF INTEREST STATEMENTS. ANY CONFLICTS THAT MEET THE REPORTING THRESHOLDS OF THE 990 ARE DULY REPORTED. MEDICAL STAFF PRIVILEGES ARE GRANTED THROUGH AN APPLICATION AND CREDENTIALING PROCESS AND ARE GRANTED IN ACCORDANCE WITH BYLAWS AND RULES AND REGULATIONS OF THE MEDICAL STAFF AND BOARD OF DIRECTORS. J.C. BLAIR MEMORIAL HOSPITAL IS A SMALL, RURAL HOSPITAL THAT IS NOT ENGAGED IN RESEARCH, BUT IT DOES ALLOCATE FUNDS ANNUALLY FOR THE UPGRADE OF PATIENT CARE EQUIPMENT AND FOR EXPENDITURES IN TECHNOLOGY OR FACILITES TO IMPROVE THE SAFETY AND CARE OF PATIENTS. RECENT EXAMPLES OF PURCHASES AND UPGRADES ARE A NEW DIGITAL MAMMOGRAPHY SYSTEM, ORTHOPEDIC SURGERY EQUIPMENT, STEREOTACTIC SPECIMEN IMAGING SYSTEM, AND A DIETARY TRAYLINE SYSTEM. RECENT TECHNOLOGY INVESTMENTS INCLUDE NURSING DOCUMENTATION, ELECTRONIC MEDICATION ADMINISTRATION RECORD AND BEDSIDE MEDICATION VERIFICATION. PART VI, LINE 6: J.C. BLAIR MEMORIAL HOSITAL IS PART OF J.C. BLAIR HEALTH SYSTEM, INC. THE HEALTH SYSTEM ALSO INCLUDES A FOUNDATION, WHICH RAISES FUNDS THROUGH DONATIONS AND GRANTS TO HELP THE HOSPITAL ACQUIRE NEEDED EQUIPMENT AND PROVIDE HEALTH AND PREVENTION PROGRAMMING, J.C BLAIR REHABILITATIVE SERVICES, INC. WHICH PARTICIPATES IN A JOINT VENTURE TO PROVIDE OUTPATIENT PHYSICAL AND OCCUPATIONAL THERAPY, AND J.C. BLAIR MEDICAL SERVICES, INC. WHICH HAS GROWN QUICKLY OVER THE PAST FEW YEARS OPERATING PHYSICIAN PRACTICES, ALLOWING FOR A TURN KEY SET UP THAT ENHANCES RECRUITMENT OF NEW PROVIDERS. THE COMPANIES WORK TOGETHER UNDER THE PARENT COMPANY UMBRELLA TO DELIVER HEALTH CARE SERVICES AND ACCOMPLISH THE VISION OF THE HEALTH SYSTEM: TO BE A MODEL OF EXCELLENCE FOR THE PROVISION OF A COMPREHENSIVE RANGE OF HEALTHCARE AND WELLNESS SERVICES DESIGNED TO CONTINUALLY IMPROVE THE HEALTH STATUS AND QUALITY OF LIFE FOR THE RESIDENTS OF HUNTINGDON COUNTY AND NEARBY COMMUNITIES.THE SYSTEM ENTERED INTO AN AFFILIATION WITH PINNACLE HEALTH SYSTEM ("PINNACLE") THROUGH A MEMBERSHIP INTEREST PURCHASE AGREEMENT (THE "AGREEMENT"), ON MAY 1, 2014. UNDER THE TERMS OF THE AGREEMENT, THIS AFFILIATION WILL, AMONG OTHER THINGS, (A) PROVIDE THE SYSTEM WITH ACCESS TO PINNACLE'S CLINICAL AND OPERATING CAPABILITIES, INCLUDING ACCESS TO MANAGEMENT AND LEADERSHIP, CONTRACTS FOR PROCUREMENT OF PHARMACEUTICAL SUPPLIES AND OTHER CORPORATE SUPPORT SERVICES; (B) ENSURE THE AVAILABILITY OF ADEQUATE PHYSICIAN AND OTHER HEALTH CARE PROFESSIONALS; (C) IMPLEMENT CLINICAL INTEGRATION INITIATIVES; AND (D) SUPPORT PROGRAMS TO HELP THE SYSTEM ACHIEVE FINANCIAL SUSTAINABLITIY. PART VI, LINE 7, REPORTS FILED WITH STATES PA 1 JC BLAIR MEMORIAL HOSPITAL FOUNDATION INC 935 14TH STREET HUNTINGDON PA 16652 251881377 501(C)(3) 171787 CASH N/A PROVIDE FINANCIAL SUPPORT FOR AFFILIATES 1 0 PART I, LINE 2: FUNDS ARE TRANSFERRED TO AN AFFILIATED ORGANIZATION WITH CONSISTENT MANAGEMENT AND USED TO FINANCIALLY SUPPORT THE FURTHERING OF THEIR EXEMPT PURPOSE. X X X 0 0 0 0 0 0 0 0 0 LISA M MALLON CEO 214847 0 0 0 0 0 10750 0 5869 0 231466 0 0 0 EDWARD M QUINN CFO 165001 0 0 0 0 0 8250 0 13329 0 186580 0 0 0 JENNIFER E HOLT PHYSICIAN 333987 0 0 0 0 0 12646 0 5869 0 352502 0 0 0 BREET L ACKER PHYSICIAN 288110 0 0 0 0 0 13346 0 16049 0 317505 0 0 0 JOHN D ROTH PHYSICIAN 265426 0 0 0 0 0 14487 0 16049 0 295962 0 0 0 ALFRED K SUTTON MD PHYSICIAN 219909 0 0 0 0 0 12772 0 16049 0 248730 0 0 0 FRANK J HAMLETT PSYCHIATRIST 219632 0 0 0 0 0 0 0 0 0 219632 0 0 0 FRED PRICE BOARD OF DIRECTORS 32042 SEE PART V 0 SCH L, PART IV, BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS: (A) NAME OF PERSON: FRED PRICE(D) DESCRIPTION OF TRANSACTION: MR. PRICE'S SISTER-IN-LAW IS EMPLOYED BY J.C. BLAIR MEDICAL SERVICES, A RELATED ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 2 JOHN COURSEN AND FRANCES VAUGHN ARE EMPLOYED BY THE SAME EMPLOYER, MUTUAL BENEFIT GROUP INSURANCE. FORM 990, PART VI, SECTION B, LINE 11 THE 990 WAS REVIEWED IN DETAIL BY THE ACCOUNTING DEPARTMENT AND CFO. THE CFO ALSO PRESENTED THE 990 TO THE FINANCE COMMITTEE OF THE BOARD FOR THEIR REVIEW PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD MEMBERS COMPLETE A CONFLICT OF INTEREST STATEMENT ANNUALLY AND RETURN TO THE EXECUTIVE ASSISTANT WHO REVIEWS AND MONITORS COMPLIANCE WITH THE POLICY. BOARD MEMBERS ARE REQUIRED TO ABSTAIN FROM VOTING ON MATTERS THAT INVOLVE CONFLICTS. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION FOR THE CEO AND CFO WAS DETERMINED BY THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS BASED ON SALARY MARKET DATA. IF THE EXECUTIVE IS ELIGIBLE FOR A PERFORMANCE BONUS, THE CRITERIA FOR DETERMINATION OF THE BONUS IS DEVELOPED BY ESTABLISHING OBJECTIVES AND MEASUREMENTS THAT WILL INDICATE THE DEGREE TO WHICH OBJECTIVES HAVE BEEN ACCOMPLISHED. APPROVAL IS DOCUMENTED VIA COMMITTEE 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 XI, LINE 9: MINIMUM PENSION LIABILITY ADJUSTMENT -778,928. CHANGE IN PERMANENTLY RESTRICTED NET ASSETS 122,211. CHANGE IN NET ASSETS OF FOUNDATION 223,020. FORGIVENESS OF DUE TO AFFILIATE 171,645. JC BLAIR HEALTH SYSTEMS INC 1225 WARM SPRINGS AVENUE HUNTINGDON PA 16652 251881383 PROVIDE SUPPORT TO RELATED ORGANIZATIONS PA 501(C)(3) 11 TYPE 1 N/A 0 JC BLAIR MEDICAL SERVICES INC 1225 WARM SPRINGS AVENUE HUNTINGDON PA 16652 251881378 PROVIDER OF HOSPITALIST SERVICES AND OPERATIONS OF PHYSICAN PRACTICES PA 501(C)(3) 3 JC BLAIR HEALTH SYSTEMS INC 0 JC BLAIR MEMORIAL HOSPITAL FOUNDATION 935 14TH STREET HUNTINGDON PA 16652 231352159 TO SUPPORT HEALTH CARE PROGRAMS OF THE HOSPTIAL PA 501(C)(3) 11 TYPE 1 JC BLAIR HEALTH SYSTEMS INC 0 JC BLAIR REAL ESTATE HOLDINGS 1226 WARM SPRINGS AVENUE HUNTINGDON PA 16652 251881380 REAL ESTATE HOLDING PA N/A C 0 JC BLAIR REHABILITATION SERVICES INC 1226 WARM SPRINGS AVENUE HUNTINGDON PA 16652 251881385 REHABILITATION SERVICES PA N/A C 0 0 1 1 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 0