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GEISINGER JERSEY SHORE HOSPITAL: Form 990, tax year 2013

View the entire original 990 at ProPublica ↗

Organization
GEISINGER JERSEY SHORE HOSPITAL (EIN 24-0792115)
Tax period
2013-07-01 to 2014-06-30
Filed
2015-05-14
IRS object ID
201531349349300318
Schema version
2013v4.0
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2015-05-14T07:06:05-05:00ReturnTs
Tax Period End2014-06-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN390859910PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1BAKER TILLY VIRCHOW KRAUSE LLPBusinessNameLine1

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line11650 MARKET STREET SUITE 4500AddressLine1
CityPHILADELPHIACity
StatePAState
ZIP Code19103ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2013-07-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN240792115EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1JERSEY SHORE HOSPITALBusinessNameLine1
FieldValueIRS element (for citing)
Business Name ControlJERSBusinessNameControlTxt
Phone5703980100PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11020 THOMPSON STREETAddressLine1
CityJERSEY SHORECity
StatePAState
ZIP Code17740ZIPCode

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonDAVID A SHANNONPersonNm
Person TitlePRESIDENT & CEOPersonTitleTxt
Phone5703980100PhoneNum
Signature2015-05-13SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonJULIUS C GREEN CPA JDPreparerPersonNm
PTINP00350393PTIN
Phone2159720701PhoneNum
FieldValueIRS element (for citing)
Tax2013TaxYr
Build TS2016-02-25 16:41:14ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerDAVID A SHANNONPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line11020 THOMPSON STAddressLine1
CityJERSEY SHORECity
StatePAState
ZIP Code17740ZIPCode
FieldValueIRS element (for citing)
Gross Receipts$28,315,541GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.JSH.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1922FormationYr
Legal Domicile StatePALegalDomicileStateCd
Activity Or MissionPROVIDE INPATIENT, OUTPATIENT, AND EMERGENCY CARE SERVICES FOR RESIDENTS OF JERSEY SHORE AREA.ActivityOrMissionDesc
Voting Members Governing Body11VotingMembersGoverningBodyCnt
Voting Members Independent8VotingMembersIndependentCnt
Total Employee324TotalEmployeeCnt
Total Volunteers8TotalVolunteersCnt
Total Gross UBI$602,147TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$241,789PYContributionsGrantsAmt
CY Contributions Grants$226,863CYContributionsGrantsAmt
PY Program Service Revenue$30,018,665PYProgramServiceRevenueAmt
CY Program Service Revenue$27,263,577CYProgramServiceRevenueAmt
PY Investment Income$5,589PYInvestmentIncomeAmt
CY Investment Income$43,060CYInvestmentIncomeAmt
PY Other Revenue$1,803,734PYOtherRevenueAmt
CY Other Revenue$737,350CYOtherRevenueAmt
PY Total Revenue$32,069,777PYTotalRevenueAmt
CY Total Revenue$28,270,850CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$14,878,300PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$14,017,818CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$16,251,815PYOtherExpensesAmt
CY Other Expenses$16,359,582CYOtherExpensesAmt
PY Total Expenses$31,130,115PYTotalExpensesAmt
CY Total Expenses$30,377,400CYTotalExpensesAmt
PY Revenues Less Expenses$939,662PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$2,106,550CYRevenuesLessExpensesAmt
Total Assets BOY$28,890,899TotalAssetsBOYAmt
Total Assets EOY$25,663,302TotalAssetsEOYAmt
Total Liabilities BOY$22,690,697TotalLiabilitiesBOYAmt
Total Liabilities EOY$21,359,776TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$6,200,202NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$4,303,526NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionJERSEY SHORE HOSPITAL IS A RURAL HEALTHCARE FACILITY COMMITTED TO PROVIDING QUALITY HEALTH SERVICES WITH AN EFFICIENT BALANCE OF OUTPATIENT CARE, ACUTE AND SUB-ACUTE INPATIENT CARE AND OUTREACH SERVICES. THE HOSPITAL MAXIMIZES THE EFFECTIVENESS OF ITS PROGRAM THROUGH INTEGRATION WITH OTHER HEALTHCARE PROVIDERS TO ASSURE THE COMMUNITY ACCESS TO A BROAD ARRAY OF HEALTH CARE SERVICES.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$26,324,687ExpenseAmt
Revenue$27,499,242RevenueAmt
DescAS A RURAL HEALTHCARE FACILITY AND DEDICATED COMMUNITY HOSPITAL WITH A COMMITMENT TO PROVIDING A HIGH QUALITY CIRCLE OF CARE, JERSEY SHORE HOSPITAL HAS DEVELOPED DELIVERY SYSTEMS THAT PROVIDE AN EFFICIENT BALANCE OF OUTPATIENT CARE, ACUTE AND SUB-ACUTE INPATIENT CARE, PRIMARY CARE, AND OUTREACH SERVICES. THE HOSPITAL MAXIMIZES THE EFFECTIVENESS OF ITS PROGRAMS FOR QUALITY, EFFICIENCY, AND ACCESSIBILITY BY INTEGRATING WITH OTHER PROVIDERS AND ALTERNATIVE CARE ORGANIZATIONS IN THE SERVICE COMMUNITY TO ASSURE THE COMMUNITY ACCESS TO A BROAD ARRAY OF SERVICE OPTIONS.THE HOSPITAL PROVIDES AN ENVIRONMENT OF CARE THAT IS COMPASSIONATE, HIGHLY PERSONALIZED, AND FOCUSED ON THE PHYSICAL, PSYCHO-SOCIAL, AND SPIRITUAL NEEDS OF ITS PATIENTS THROUGH THE USE OF SKILLED NURSES, PHYSICIANS, TECHNICAL AND SUPPORT STAFF, MANAGEMENT, AND COMMUNITY LEADERS. THE HOSPITAL ALSO PROVIDES HEALTH EDUCATION, PROGRAMS IN PREVENTION, AND RELATED SUPPORT SERVICES TO THE COMMUNITY WITH THE GOAL OF IMPROVING THE OVERALL WELLNESS OF ITS RESIDENTS. THE HOSPITAL ENSURES THAT THE NECESSARY RESOURCES ARE AVAILABLE TO PROVIDE FOR COMPREHENSIVE, MANAGED HEALTH PROGRAMS IN THE MOST COST EFFECTIVE MANNER WHILE MAINTAINING A SAFE, PLEASANT, AND MEANINGFUL WORK AND PATIENT CARE ENVIRONMENT.THE HOSPITAL PROVIDES CHARITY CARE TO PATIENTS WHO MEET CERTAIN CRITERIA WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. CHARGES FORGONE FOR SERVICES RENDERED AND SUPPLIES FURNISHED UNDER THE CHARITY CARE POLICY AMOUNTED TO APPROXIMATELY $609,740 DURING THE YEAR ENDED JUNE 30, 2014.Desc
Total Program Service Expenses$26,324,687TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying ActivitiesYes (1)LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Temp Or Permanent Endowments0TempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other AssetsYes (1)ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (1)IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (1)ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising ActivitiesYes (1)FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate HospitalYes (1)OperateHospitalInd
Audited Financial Stmt AttYes (1)AuditedFinancialStmtAttInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam MemYes (1)BusinessRlnWithFamMemInd
Business Rln With Officer EntYes (1)BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document36IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee324EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitYes (1)UnrelatedBusIncmOverLimitInd
Form990 T FiledYes (1)Form990TFiledInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo ContributionsYes (1)QuidProQuoContributionsInd
Quid Pro Quo Contri DisclYes (1)QuidProQuoContriDisclInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members11GoverningBodyVotingMembersCnt
Independent Voting Member8IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesYes (1)DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or Stockholders0MembersOrStockholdersInd
Election Of Board Members0ElectionOfBoardMembersInd
Decisions Subject To Approva0DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEOYes (1)CompensationProcessCEOInd
Compensation Process OtherYes (1)CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
States Where Copy Of Return Is FldPAStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1MARK RICE CFOBusinessNameLine1
FieldValueIRS element (for citing)
Phone5703983101PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11020 THOMPSON STREETAddressLine1
CityJERSEY SHORECity
StatePAState
ZIP Code17740ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIYes (X)InfoInScheduleOPartVIIInd

Form990 Part VII Section A Form990PartVIISectionAGrp (20 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtHighest Compensated EmployeeHighestCompensatedEmployeeInd
CAREY PLUMMER NONVOTING
PRESIDENT & CEO (END 5.1.14)39.001.00Yes (X)Yes (X)$0$0$0
LEROY H KEILER III
SECRETARY1.001.00Yes (X)Yes (X)$0$0$0
WILLIAM R CAMERER III
MEMBER1.00Yes (X)$0$0$0
CARMEN SPINNEY MD
MEMBER1.0039.00Yes (X)$0$101,796$11,371
JAMES REESER
MEMBER1.00Yes (X)$0$0$0
RICHARD BEATTY DMD
CHAIRPERSON1.001.00Yes (X)Yes (X)$0$0$0
WALTER EISENHAUER
MEMBER1.00Yes (X)$0$0$0
JAMES ELY
TREASURER1.001.00Yes (X)Yes (X)$0$0$0
SEAN SIMCOX
VICE CHAIRPERSON1.00Yes (X)Yes (X)$0$0$0
THOMAS C CONNOLLY MD
MEDICAL STAFF PRESIDENT1.0039.00Yes (X)$0$456,290$31,124
CRAIG HARRIS
MEMBER1.00Yes (X)$0$0$0
STEPHEN P NEUN PHD
MEMBER1.00Yes (X)$0$0$0
DAVID A SHANNON NONVOTING
PRESIDENT & CEO (BEGIN 5.1.14)39.001.00Yes (X)Yes (X)$0$0$0
LISA STRAWSER DO
MEMBER (END 12/2013)1.00Yes (X)$0$0$0
MARK RICE
CFO39.001.00Yes (X)$95,684$0$23,281
AARON KOLB MD
PHYSICIAN40.00$321,383$0$27,400Yes (X)
RONALD EISTER
PHYSICIAN40.00$242,303$0$23,110Yes (X)
SHAIRKO MISSOURI
ANESTHESIOLOGIST40.00$445,625$0$20,098Yes (X)
TAMAR BAITEL
PHYSICIAN40.00$300,353$0$6,903Yes (X)
RICHARD CORNISH
PHYSICIAN40.00$258,213$0$15,978Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$1,663,561TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$558,086TotReportableCompRltdOrgAmt
Total Other Compensation$159,265TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K7IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1CityContractorAddress/USAddress/CityStateContractorAddress/USAddress/StateZIP CodeContractorAddress/USAddress/ZIPCodeServicesServicesDescCompensationCompensationAmt
JERSEY SHORE RADIOLOGY
222 DEER TRAIL ROADSPRING GROVEPA17362RADIOLOGY TESTS INTREPRETATIONS$1,160,469
MEDICAL STAFFING NETWORK
PO BOX 202996DALLASTX753202996ER PHYSICIAN LOCUMS$655,570
QUORUM HEALTH RESOURCES
105 CONTINENTAL PLACEBRENTWOODTN370271018MANAGEMENT FEES$296,135
LOCUM-TENENSCOM
PO BOX 405547ATLANTAGA30384ER PHYSICIAN LOCUMS$237,529
SUSQUEHANNA HEALTH SYSTEM
1205 GRAMPIAN BOULEVARDWILLIAMSPORTPA17701IT SUPPORT/LAB TEST INTERPRETATION$174,354
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K8CntrctRcvdGreaterThan100KCnt
Fundraising$4,000FundraisingAmt
Government Grants$197,522GovernmentGrantsAmt
All Other Contributions$25,341AllOtherContributionsAmt
Total Contributions$226,863TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp

FieldValueIRS element (for citing)
DescPATIENT SERVICE REVDesc
Business621110BusinessCd
Total Revenue Column$27,263,577TotalRevenueColumnAmt
Related Or Exempt Func Income$26,661,430RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$602,147UnrelatedBusinessRevenueAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$27,263,577TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$43,060TotalRevenueColumnAmt
Exclusion$43,060ExclusionAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$84,256RealAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$35,654RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$48,602RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$48,602TotalRevenueColumnAmt
Exclusion$48,602ExclusionAmt
FieldValueIRS element (for citing)
Fundraising Gross Income$18,191FundraisingGrossIncomeAmt
Contri Rpt Fundraising Event$4,000ContriRptFundraisingEventAmt
Fundraising Direct Expenses$9,037FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column$9,154TotalRevenueColumnAmt
Exclusion$9,154ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmtExclusionExclusionAmt
LHU CLNIC REVENUE900099$279,369$279,369
MEANINGFUL USE622000$235,665$235,665
CAFETERIA/VENDING REV722210$106,440$106,440

Miscellaneous Revenue MiscellaneousRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$58,120TotalRevenueColumnAmt
Exclusion$58,120ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$679,594OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$28,270,850TotalRevenueColumnAmt
Related Or Exempt Func Income$27,176,464RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$602,147UnrelatedBusinessRevenueAmt
Exclusion$265,376ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$461,777TotalAmt
Program Services$401,297ProgramServicesAmt
Management And General$60,480ManagementAndGeneralAmt

Comp Disqual Persons CompDisqualPersonsGrp

FieldValueIRS element (for citing)
Total$31,200TotalAmt
Program Services$27,114ProgramServicesAmt
Management And General$4,086ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$10,591,831TotalAmt
Program Services$9,204,599ProgramServicesAmt
Management And General$1,387,232ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$491,528TotalAmt
Program Services$427,152ProgramServicesAmt
Management And General$64,376ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$1,570,182TotalAmt
Program Services$1,364,532ProgramServicesAmt
Management And General$205,650ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$871,300TotalAmt
Program Services$757,184ProgramServicesAmt
Management And General$114,116ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$596,040TotalAmt
Program Services$517,975ProgramServicesAmt
Management And General$78,065ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$83,508TotalAmt
Management And General$83,508ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$68,377TotalAmt
Management And General$68,377ManagementAndGeneralAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

FieldValueIRS element (for citing)
Total$2,970TotalAmt
Program Services$2,970ProgramServicesAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$4,957,792TotalAmt
Program Services$3,805,110ProgramServicesAmt
Management And General$1,152,682ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$46,916TotalAmt
Program Services$46,916ProgramServicesAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$470,962TotalAmt
Program Services$266,683ProgramServicesAmt
Management And General$204,279ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$544,470TotalAmt
Program Services$355,636ProgramServicesAmt
Management And General$188,834ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$568,969TotalAmt
Program Services$525,807ProgramServicesAmt
Management And General$43,162ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$64,254TotalAmt
Program Services$54,258ProgramServicesAmt
Management And General$9,996ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$24,757TotalAmt
Program Services$7,597ProgramServicesAmt
Management And General$17,160ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$827,755TotalAmt
Program Services$827,755ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$2,365,496TotalAmt
Program Services$2,365,496ProgramServicesAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$421,252TotalAmt
Program Services$421,252ProgramServicesAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
BAD DEBT EXPENSE$2,802,969$2,802,969
MEDICAL SUPPLIES$1,013,311$1,013,311
CHARGEABLE SUPPLIES$510,487$510,487
NONCHARGE SUPPLIES$463,965$453,393$10,572

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$525,332TotalAmt
Program Services$165,194ProgramServicesAmt
Management And General$360,138ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$30,377,400TotalAmt
Program Services$26,324,687ProgramServicesAmt
Management And General$4,052,713ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$1,200BOYAmt
EOY$1,435EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$1,161,073BOYAmt
EOY$1,288,441EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$11,068BOYAmt
EOY$6,029EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$3,446,820BOYAmt
EOY$2,887,474EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
EOY$50,000EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$243,070BOYAmt
EOY$239,137EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$201,690BOYAmt
EOY$176,371EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$37,719,281LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$21,918,774LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$17,489,053BOYAmt
EOY$15,800,507EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$6,336,925BOYAmt
EOY$5,213,908EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$28,890,899BOYAmt
EOY$25,663,302EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$2,863,811BOYAmt
EOY$2,947,572EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$14,761,344BOYAmt
EOY$13,889,676EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$5,065,542BOYAmt
EOY$4,522,528EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$22,690,697BOYAmt
EOY$21,359,776EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$6,056,609BOYAmt
EOY$4,244,099EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$143,593BOYAmt
EOY$59,427EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$6,200,202BOYAmt
EOY$4,303,526EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$28,890,899BOYAmt
EOY$25,663,302EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss-$2,106,550ReconcilationRevenueExpnssAmt
Other Changes In Net Assets$209,874OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0VolunteersInd
Paid Staff Or Management0PaidStaffOrManagementInd
Media Advertisements0MediaAdvertisementsInd
Mailings Members0MailingsMembersInd
Publications Or Broadcast0PublicationsOrBroadcastInd
Grants Other Organizations0GrantsOtherOrganizationsInd
Direct Contact Legislators0DirectContactLegislatorsInd
Rallies Demonstrations0RalliesDemonstrationsInd
Other ActivitiesYes (1)OtherActivitiesInd
Other Activities$2,970OtherActivitiesAmt
Total Lobbying Expenditures$2,970TotalLobbyingExpendituresAmt
Not Described Section501c30NotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART II-B, LINE 1:FormAndLineReferenceDesc
ExplanationTHE HOSPITAL PAYS DUES TO THE AMERICAN HOSPITAL ASSOCIATION (AHA) AND THE HOSPITAL ASSOCIATION OF PENNSYLVANIA (HAP). A PORTION OF THE DUES PAID TO THESE TWO ORGANIZATIONS ($2,970 DURING THE YEAR ENDED JUNE 30, 2014) WAS USED FOR LOBBYING PURPOSES.ExplanationTxt

Schedule D IRS990ScheduleD

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$154,956OtherCostOrOtherBasisAmt
Book Value$154,956BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$18,170,788OtherCostOrOtherBasisAmt
Depreciation$7,159,633DepreciationAmt
Book Value$11,011,155BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$18,685,153OtherCostOrOtherBasisAmt
Depreciation$14,458,552DepreciationAmt
Book Value$4,226,601BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$708,384OtherCostOrOtherBasisAmt
Depreciation$300,589DepreciationAmt
Book Value$407,795BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$15,800,507TotalBookValueLandBuildingsAmt

Other Assets Org OtherAssetsOrgGrp (4 entries)

DescDescBook ValueBookValueAmt
DEFERRED FINANCING COSTS, NET$106,080
DUE FROM AFFILIATES$4,739,455
FUNDED DEPRECIATION$234,187
OTHER ASSET$134,186
FieldValueIRS element (for citing)
Total Book Value Other Assets$5,213,908TotalBookValueOtherAssetsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (5 entries)

DescDescAmtAmt
OBLIGATIONS UNDER CAPITAL LEASES$1,335,625
BLUE CROSS CURRENT FINANCING ADVANCE$79,353
ACCRUED PENSION COST$2,010,204
DEFERRED REVENUE$824,826
ESTIMATED THRID-PARTY PAYOR SETTLEMENTS$272,520
FieldValueIRS element (for citing)
Total Liability$4,522,528TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd
Total Rev Etc Audited Fincl Stmt$28,525,415TotalRevEtcAuditedFinclStmtAmt
Other Revenue$209,874OtherRevenueAmt
Revenue Not Reported$209,874RevenueNotReportedAmt
Revenue Subtotal$28,315,541RevenueSubtotalAmt
Other Revenues Not Included-$44,691OtherRevenuesNotIncludedAmt
Revenue Not Reported Fincl Stmt-$44,691RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$28,270,850TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$30,422,091TotExpnsEtcAuditedFinclStmtAmt
Other Expenses Included$44,691OtherExpensesIncludedAmt
Expenses Not Reported$44,691ExpensesNotReportedAmt
Expenses Subtotal$30,377,400ExpensesSubtotalAmt
Expenses Not Rpt Fincl Stmt$0ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$30,377,400TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (4 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
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 IS MET. MANAGEMENT DETERMINED THERE WERE NO TAX UNCERTAINTIES THAT MET THE RECOGNITION THRESHOLD IN 2014 AND 2013. THE HOSPITAL'S FEDERAL RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX AND EXEMPT ORGANIZATION BUSINESS TAX RETURN 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:CHANGE IN FAIR VALUE OF DERIVATIVE INSTRUMENT 179,803. PENSION LIABILITY ADJUSTMENT 30,071.
PART XI, LINE 4B - OTHER ADJUSTMENTS:RENTAL EXPENSE -35,654. FUNDRAISING EXPENSE -9,037.
PART XII, LINE 2D - OTHER ADJUSTMENTS:RENTAL EXPENSES 35,654. FUNDRAISING EXPENSE 9,037.

Schedule G IRS990ScheduleG

Fundraising Event Information FundraisingEventInformationGrp

FieldValueIRS element (for citing)
Name Of Event1GOLF TOURNAMENTNameOfEvent1Amt
Gross Receipts Event1$22,191GrossReceiptsEvent1Amt
Charitable Contri Event1$4,000CharitableContriEvent1Amt
Gross Revenue Event1$18,191GrossRevenueEvent1Amt
Cash Prizes Event1$320CashPrizesEvent1Amt
Non Cash Prizes Event1$1,200NonCashPrizesEvent1Amt
Rent Facility Costs Event1$4,990RentFacilityCostsEvent1Amt
Food And Beverage Event1$656FoodAndBeverageEvent1Amt
Other Direct Expenses Event1$1,871OtherDirectExpensesEvent1Amt
Gross Receipts Total$22,191GrossReceiptsTotalAmt
Charitable Contributions Tot$4,000CharitableContributionsTotAmt
Gross Revenue Total Events$18,191GrossRevenueTotalEventsAmt
Cash Prizes Total Events$320CashPrizesTotalEventsAmt
Non Cash Prizes Total Events$1,200NonCashPrizesTotalEventsAmt
Rent Fclty Costs Total Events$4,990RentFcltyCostsTotalEventsAmt
Food And Beverage Total Events$656FoodAndBeverageTotalEventsAmt
Oth Direct Expnss Total Events$1,871OthDirectExpnssTotalEventsAmt
Direct Expense Summary Events$9,037DirectExpenseSummaryEventsAmt
Net Income Summary$9,154NetIncomeSummaryAmt

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (1)FinancialAssistancePolicyInd
Written PolicyYes (1)WrittenPolicyInd
All Hospitals PolicyYes (X)AllHospitalsPolicyInd
FPG Reference Free CareYes (1)FPGReferenceFreeCareInd
Percent200Yes (X)Percent200Ind
FPG Reference Discounted CareYes (1)FPGReferenceDiscountedCareInd
Percent250Yes (X)Percent250Ind
Free Care Medically IndigentYes (1)FreeCareMedicallyIndigentInd
Financial Assistance Budget0FinancialAssistanceBudgetInd
Annual Community Bnft Report0AnnualCommunityBnftReportInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$234,422TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$234,422NetCommunityBenefitExpnsAmt
Total Expense0.00850TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$2,326,996TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$2,134,542DirectOffsettingRevenueAmt
Net Community Benefit Expns$192,454NetCommunityBenefitExpnsAmt
Total Expense0.00700TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$2,561,418TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$2,134,542DirectOffsettingRevenueAmt
Net Community Benefit Expns$426,876NetCommunityBenefitExpnsAmt
Total Expense0.01550TotalExpensePct

Community Health Services CommunityHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$253,476TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$20,196DirectOffsettingRevenueAmt
Net Community Benefit Expns$233,280NetCommunityBenefitExpnsAmt
Total Expense0.00850TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$2,800TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$2,800NetCommunityBenefitExpnsAmt
Total Expense0.00010TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$256,276TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$20,196DirectOffsettingRevenueAmt
Net Community Benefit Expns$236,080NetCommunityBenefitExpnsAmt
Total Expense0.00860TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$2,817,694TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$2,154,738DirectOffsettingRevenueAmt
Net Community Benefit Expns$662,956NetCommunityBenefitExpnsAmt
Total Expense0.02410TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense ReportedYes (1)BadDebtExpenseReportedInd
Bad Debt Expense$1,120,609BadDebtExpenseAmt
Bad Debt Expense Attributable$0BadDebtExpenseAttributableAmt
Reimbursed By Medicare$4,305,825ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$4,393,699CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall-$87,874MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

FieldValueIRS element (for citing)
OtherYes (X)OtherInd
FieldValueIRS element (for citing)
Written Debt Collection PolicyYes (1)WrittenDebtCollectionPolicyInd
Financial Assistance PrvsnYes (1)FinancialAssistancePrvsnInd
Hospital Facilities1HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1JERSEY SHORE HOSPITALBusinessNameLine1

US Address USAddress

FieldValueIRS element (for citing)
Address Line11020 THOMPSON STREETAddressLine1
CityJERSEY SHORECity
StatePAState
ZIP Code17740ZIPCode
FieldValueIRS element (for citing)
Website AddressHTTP://WWW.JSH.ORGWebsiteAddressTxt
State License101401StateLicenseNum
Licensed HospitalYes (X)LicensedHospitalInd
General Medical And SurgicalYes (X)GeneralMedicalAndSurgicalInd
Critical Access HospitalYes (X)CriticalAccessHospitalInd
Emergency Room24 HrsYes (X)EmergencyRoom24HrsInd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1JERSEY SHORE HOSPITALBusinessNameLine1
FieldValueIRS element (for citing)
Facility1FacilityNum
CHNA ConductedYes (1)CHNAConductedInd
Community DefinitionYes (X)CommunityDefinitionInd
Community DemographicsYes (X)CommunityDemographicsInd
Existing ResourcesYes (X)ExistingResourcesInd
How Data ObtainedYes (X)HowDataObtainedInd
Community Health NeedsYes (X)CommunityHealthNeedsInd
Other Health IssuesYes (X)OtherHealthIssuesInd
Community Hlth Needs Id ProcessYes (X)CommunityHlthNeedsIdProcessInd
Consulting ProcessYes (X)ConsultingProcessInd
CHNA Conducted12CHNAConductedYr
Take Into Account Others InputYes (1)TakeIntoAccountOthersInputInd
CHNA Conducted With Other Fclts0CHNAConductedWithOtherFcltsInd
CHNA Report Widely AvailableYes (1)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLHTTP://WWW.JSH.ORG/CHNA-JSH-2012.PDFOwnWebsiteURLTxt
Rpt Available Upon RequestYes (X)RptAvailableUponRequestInd
Prioritize Health NeedsYes (X)PrioritizeHealthNeedsInd
Prioritize ServicesYes (X)PrioritizeServicesInd
All Needs Addressed0AllNeedsAddressedInd
Organization Incur Excise Tax0OrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (1)EligCriteriaExplainedInd
FPG Used Deter Elig Free CareYes (1)FPGUsedDeterEligFreeCareInd
FPG Family Incm Lmt Free Care200.000000000000FPGFamilyIncmLmtFreeCarePct
FPG Used Determ Elig Dscnt CareYes (1)FPGUsedDetermEligDscntCareInd
FPG Family Incm Lmt Dscnt Care250.000000000000FPGFamilyIncmLmtDscntCarePct
Explained BasisYes (1)ExplainedBasisInd
Income LevelYes (X)IncomeLevelInd
Medical IndigencyYes (X)MedicalIndigencyInd
Medicaid MedicareYes (X)MedicaidMedicareInd
App Financial Asst ExplnYes (1)AppFinancialAsstExplnInd
Includes Publicity MeasuresYes (1)IncludesPublicityMeasuresInd
Posted In Emergency RoomYes (X)PostedInEmergencyRoomInd
Available On RequestYes (X)AvailableOnRequestInd
Other PublicityYes (X)OtherPublicityInd
FAP Actions On NonpaymentYes (1)FAPActionsOnNonpaymentInd
Collection Activities0CollectionActivitiesInd
FAP Notified Upon AdmissionYes (X)FAPNotifiedUponAdmissionInd
FAP Notified Before DischargeYes (X)FAPNotifiedBeforeDischargeInd
FAP Notified All PatientsYes (X)FAPNotifiedAllPatientsInd
Documented Elig DeterminationYes (X)DocumentedEligDeterminationInd
Nondis Emergency Care PolicyYes (1)NondisEmergencyCarePolicyInd
Other Method UsedYes (X)OtherMethodUsedInd
Amounts Generally Billed0AmountsGenerallyBilledInd
Gross Charges0GrossChargesInd

Supplemental Information SupplementalInformationGrp (4 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
JERSEY SHORE HOSPITALPART V, SECTION B, LINE 3: TWO FOCUS GROUPS WITH COMMUNITY LEADERS AND STAKEHOLDERS WERE HELD ON AUGUST 15, 2012 AT JERSEY SHORE HOSPITAL. THE PURPOSE OF THE FOCUS GROUPS WAS TO GATHER QUALITATIVE DATA FROM "KEY INFORMANTS" ON LOCAL HEALTH ISSUES. KEY INFORMANTS WERE DEFINED AS AREA HEALTH CARE PROFESSIONALS, SOCIAL SERVICE PROVIDERS, NON-PROFIT LEADERS, BUSINESS LEADERS, FAITH-BASED ORGANIZATIONS AND OTHER AREA AUTHORITIES. EACH SESSION LASTED APPROXIMATELY TWO HOURS. A DISCUSSION GUIDE WAS USED TO PROMPT DISCUSSION AND GUIDE THE FACILITATION. THE GUIDE FOCUSED ON GATHERING QUALITATIVE FEEDBACK REGARDING PERCEPTIONS OF COMMUNITY NEEDS ACCROSS THREE KEY DOMAINS: HEALTH CARE ACCESS, KEY HEALTH ISSUES, AND COMMUNITY ASPIRATIONS & CAPACITY. IN TOTAL, 18 PEOPLE PARTICIPATED IN THE FOCUS GROUPS, REPRESENTING A VARIETY OF SECTORS INCLUDING PUBLIC HEALTH AND MEDICAL SERVICES, NON-PROFIT AND SOCIAL ORGANIZATIONS, CHILDREN AND YOUTH AGENCIES, AND THE BUSINESS COMMUNITY.
JERSEY SHORE HOSPITALPART V, SECTION B, LINE 7: THE COMMUNITY HEALTH NEEDS ASSESSMENT IDENTIFIED 8 OVERALL NEEDS WITHIN THE COMMUNITY. THESE NEEDS IDENTIFIED ARE AS FOLLOWS: ACCESS TO CARE, MENTAL/BEHAVOIRAL HEALTH/SUBSTANCE ABUSE, OVERWIEGHT & OBESITY, RESPIRATORY DISEASE/ASTHMA, DIABETES, HEART DISEASE, LYME DISEASE, AND MATERNAL/INFANT HEALTH. THE TOP FOUR PRIORITIES THAT ARE BEING ADDRESSED ARE: ACCESS TO CARE, MENTAL & BEHAVIORAL HEALTH, OVERWEIGHT & OBESITY, AND RESPIRATORY DISEASE/ASTHMA. BEING OVERWEIGHT OR OBESE HAS AN EFFECT ON DIABETES AND HEART DISEASE, THEREFORE, IT WAS DECIDED TO INCLUDE DIABETES AND HEART DISEASE AS SUBSETS OF THE OVERWEIGHT AND OBESITY PRIORITY. THEREFORE THE ONLY TWO NEEDS IDENTIFIED THAT ARE NOT CURRENTLY BEING ADDRESSED ARE LYME DISEASE AND MATERNAL/INFANT HEALTH. THESE NEEDS WILL BE CONSIDERED AS FUTURE PROJECTS.
JERSEY SHORE HOSPITALPART V, SECTION B, LINE 14G: POLICY WAS REFERENCED ON INVOICES AND VERBALLY DISCUSSED WITH PATIENTS.
JERSEY SHORE HOSPITALPART V, SECTION B, LINE 20D: AS SOON AS THE PATIENT IS DEEMED ELIGIBLE FOR FINANCIAL ASSISTANCE, THE HOSPITAL RECORDS THE DISCOUNT AND BILLS THE PAITENT THE AMOUNT THAT THEY ARE RESPONSIBLE FOR UNDER THEIR FAP POLICY. THE DISCOUNT CHARGED IS IN LINE WITH THE COMMERCIAL PAYOR RATE.

Supplemental Information Detail SupplementalInformationDetail (13 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, LINE 7:THE HOSPITAL USED THE COST TO CHARGE RATIO.
PART I, LN 7 COL(F):AMOUNT OF BAD DEBT EXPENSE FROM PART IX SUBTRACTED IN ORDER TO CALCULATE PERCENT OF TOTAL EXPENSE IN PART I LINE 7 COLUMN F WAS $2,802,969.
PART III, LINE 2:BAD DEBT EXPENSE IS CALCULATED BASED ON ACTUAL WRITE-OFFS THROUGHOUT THE YEAR AND IS ESTIMATED AT COST USING THE RATIO OF PATIENT CARE COST TO CHARGES.
PART III, LINE 4:PATIENT ACCOUNTS RECEIVABLE 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 COLLECTABILITY 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, 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, 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 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.BAD DEBT EXPENSE IS BASED ON THE NECESSARY ALLOWANCE AT THE END OF EACH MONTH.PATIENT DISCOUNTS ARE NOT INCLUDED IN BAD DEBT - THEY ARE INCLUDED IN CONTRACTUAL ADJUSTMENTS. PAYMENTS ON PATIENT ACCOUNTS ARE INCLUDED IN THE ALLOWANCE FOR BAD DEBTS.THE HOSPITAL IS DILIGENT IN THE CLASSIFICATION OF AMOUNTS AS CHARITY CARE OR BAD DEBT. WE BELIEVE NONE OF THE AMOUNTS IN BAD DEBT WOULD BE RECLASSIFIED TO CHARITY CARE GIVEN ADDITIONAL INFORMATION.
PART III, LINE 8:THE MEDICARE SHORTFALL NOTED IS NOT CONSIDERED A COMMUNITY BENEFIT BECAUSE IT IS DUE TO SEQUESTRATION.ALLOWABLE COSTS WERE DETERMINED USING THE COST-TO-CHARGE RATIO FROM MEDICARE COST REPORT.
PART III, LINE 9B:COLLECTIONS ARE PURSUED UP TO THE POINT THAT A PATIENT COMPLETES AND IS APPROVED FOR CHARITY CARE. ONCE CHARITY CARE IS APPROVED, NO FURTHER COLLECTION EFFORTS ARE MADE.
PART VI, LINE 2:JERSEY SHORE HOSPITAL (JSH) LED A COMPREHENSIVE COMMUNITY HEALTH NEEDS ASSESSMENT TO EVALUATE THE HEALTH NEEDS OF INDIVIDUALS LIVING IN THE JERSEY SHORE HOSPITAL SERVICE AREA IN NORTH CENTRAL, PENNSYLVANIA. THE PURPOSE OF THE ASSESSMENT WAS TO GATHER INFORMATION ABOUT LOCAL HEALTH NEEDS AND HEALTH BEHAVIORS. THE ASSESSMENT EXAMINED A VARIETY OF INDICATORS, INCLUDING SOCIAL DETERMINANTS OF HEALTH (POVERTY, HOUSING, EDUCATION), MORTALITY RATES, RISKY BEHAVIORS (ALCOHOL USE, TOBACCO USE) AND CHRONIC HEALTH CONDITIONS (DIABETES, HEART DISEASE). METHODOLOGYJSH DEFINED THEIR SERVICE AREA BASED ON ANALYSIS OF THE GEOGRAPHIC AREA WHERE INDIVIDUALS UTILIZING JSH HEALTH SERVICES RESIDE. BECAUSE JSH'S SERVICE AREA ENCOMPASSES RESIDENTS LIVING IN TWO COUNTIES IN NORTH CENTRAL PENNSYLVANIA, THE CHNA INCLUDES QUANTITATIVE AND QUALITATIVE RESEARCH DATA FOR BOTH CLINTON COUNTY AND LYCOMING COUNTY.THE CHNA WAS COMPRISED OF BOTH QUANTITATIVE AND QUALITATIVE RESEARCH COMPONENTS. THIS MULTI-FACETED APPROACH TOOK INTO ACCOUNT VARIOUS DATA SOURCES AND PERSPECTIVES. QUANTITATIVE DATA INCLUDED A SECONDARY DATA PROFILE DEPICTING POPULATION AND HOUSEHOLD STATISTICS, EDUCATION AND ECONOMIC MEASURES, MORBIDITY AND MORTALITY RATES, INCIDENCE RATES, AND OTHER HEALTH STATISTICS FOR CLINTON AND LYCOMING COUNTIES. QUALITATIVE DATA INCLUDED TWO FOCUS GROUPS HELD ON AUGUST 15, 2012 AT JERSEY SHORE HOSPITAL WITH KEY COMMUNITY LEADERS. JSH CONTRACTED WITH HOLLERAN, AN INDEPENDENT RESEARCH AND CONSULTING FIRM, TO CONDUCT RESEARCH IN SUPPORT OF THE CHNA. THE FIRM PROVIDED THE FOLLOWING ASSISTANCE: 1) COLLECTED AND INTERPRETED SECONDARY DATA, 2) CONDUCTED FOCUS GROUPS WITH COMMUNITY STAKEHOLDERS, AND 3) FACILITATED A PRIORITIZATION AND IMPLEMENTATING PLANNING SESSION. COMMUNITY ENGAGEMENT AND FEEDBACK WAS AN INTEGRAL PART OF THE CHNA PROCESS. JSH SOUGHT COMMUNITY INPUT THROUGH FOCUS GROUPS WITH COMMUNITY STAKEHOLDERS AND THROUGH INCLUSION OF COMMUNITY PARTNERS IN THE PRIORITIZATION AND IMPLEMENTATION PLANNING PROCESS. PUBLIC HEALTH AND HEALTHCARE PROFESSIONALS SHARED KNOWLEDGE AND EXPERTISE ABOUT HEALTH ISSUES, WHILE LEADERS AND REPRESENTATIVES OF NON-PROFIT AND COMMUNITY-BASED ORGANIZATIONS PROVIDED INSIGHT ON THE COMMUNITY SERVED BY JSH INCLUDING MEDICALLY UNDERSERVED, LOW INCOME, AND MINORITY POPULATIONS. JSH AND ITS PARTNERS USED THE RESULTS OF THE FOCUS GROUPS IN CONJUNCTION WITH SECONDARY STATISTICAL DATA TO PRIORITIZE PUBLIC HEALTH ISSUES AND DEVELOP A COMMUNITY HEALTH IMPLEMENTATION PLAN FOCUSED ON MEETING COMMUNITY NEEDS.
PART VI, LINE 3:PATIENTS ARE COUNSELED ON AN INDIVIDUAL BASIS IN PERSON OR PHONE CONVERSATION AS TO THE AVAILABILITY OF STATE OR CORPORATE PROGRAMS. AT THE TIME OF REGISTRATION, SELF-PAY PATIENTS ARE INFORMED OF ASSISTANCE AVAILABLE. PATIENT STATEMENTS INDICATE ASSISTANCE THAT IS AVAILABLE.THERE IS ALSO SIGNAGE INDICATING THAT ASSISTANCE PROGRAMS ARE AVAILABLE AND PATIENTS ARE PROVIDED A PAMPHLET AT REGISTRATION WITH THIS INFORMATION.PATIENTS ARE INFORMED OF WHAT CHARITY CARE IS AND THAT IT EXISTS. IF THE PATIENT IS INTERESTED THE PROCESS IS EXPLAINED.
PART VI, LINE 4:JERSEY SHORE HOSPITAL'S PRIMARY SERVICE AREA (PSA) COVERS EASTERN CLINTON COUNTY AND WESTERN LYCOMING COUNTY - AN AREA WITH A POPULATION OF APPROXIMATELY 42,000. THE PSA FOR JERSEY SHORE HOSPITAL CONSISTS OF FIVE ZIP CODES: 17721 - AVIS, 17740 - JERSEY SHORE, 17745 - LOCK HAVEN, 17779 - WOOLRICH AND 17751 MILL HALL. JERSEY SHORE HOSPITAL IS CONSIDERED TO BE IN A MEDICALLY UNDERSERVED AREA (MUA). JERSEY SHORE AND JERSEY SHORE HOSPITAL IS LOCATED IN LYCOMING COUNTY, WHICH HAS AN AREA OF 1,237 SQUARE MILES. IT IS THE LARGEST COUNTY IN PENNSYLVANIA AND OCCUPIES A HILLY AND HEAVILY FORESTED PART OF THE STATE. THE WEST BRANCH OF THE SUSQUEHANNA RIVER FLOWS THROUGH THE SOUTHERN PART OF THE COUNTY. JERSEY SHORE IS APPROXIMATELY 45 MILES NORTHEAST OF STATE COLLEGE, PENNSYLVANIA AND APPROXIMATELY 15 MILES WEST OF WILLIAMSPORT, PENNSYLVANIA. ABOUT SIXTEEN PERCENT (16%) OF INPATIENT STAYS IN THE PSA OCCUR AT JERSEY SHORE HOSPITAL. ABOUT FORTY PERCENT (40%) OF OUTPATIENT VISITS IN THE PSA OCCUR AT JERSEY SHORE HOSPITAL. JERSEY SHORE HOSPITAL RELIES UPON A RELATIVELY SMALL GEOGRAPHIC AREA TO SUPPORT THE HOSPITAL.THE SSA (SECONDARY SERVICE AREA) CONSISTS OF 9 ADDITIONAL ZIP CODES WHICH ARE IMPORTANT TO THE HOSPITAL. THESE ZIP CODES ARE PRIMARILY TO THE WEST AND NORTH OF THE PSA. ABOUT TWO PERCENT (2%) OF INPATIENT STAYS IN THE PSA OCCUR AT JERSEY SHORE HOSPITAL. ABOUT ELEVEN PERCENT (11%) OF OUTPATIENT VISITS IN THE PSA OCCUR AT JERSEY SHORE HOSPITAL.WITHIN THE PSA, THE TOTAL POPULATION IS EXPECTED TO INCREASE BY 1.0% BY 2019. A MAJOR DEMOGRAPHIC ISSUE AFFECTING JERSEY SHORE HOSPITAL IS THE AGING POPULATION. THE NUMBER OF INDIVIDUALS LIVING IN THE PSA OVER THE AGE OF 65 IS EXPECTED TO INCREASE 13.7% BY 2019. THIS AGE GROUP CURRENTLY MAKES UP OVER 16% OF THE POPULATION IN THE PSA COMPARED TO ABOUT 14% FOR THE U.S. THIS GROWING ELDERLY SEGMENT SHOULD GENERATE A FUTURE DEMAND FOR HEALTH CARE SERVICES, SINCE INDIVIDUALS OVER AGE 65 USE HEALTHCARE AND HOSPITAL SERVICES AT 2.7 TIMES THE RATE OF THE UNDER AGE 65 POPULATION.A DEMOGRAPHIC REALITY IS THE LOW INCOME LEVEL OF AREA HOUSEHOLDS. CURRENTLY, THE MEDIAN HOUSEHOLD INCOME IN THE PSA IS $47,113, COMPARED TO PA ($54,138) AND THE U.S. ($54,889). THE MEDIAN HOUSEHOLD INCOME IN THE SSA IS $41,085.THE SERVICE AREA IS NOT RACIALLY DIVERSIFIED TO A SIGNIFICANT DEGREE, WITH 98.6 % OF THE POPULATION CONSIDERED WHITE. THE EDUCATIONAL PROFILE OF THE SERVICE AREA DEMONSTRATES THAT 44% OF THE POPULATION HAS A HIGH SCHOOL EDUCATION AND 7.1% OF THE POPULATION HAS AN ASSOCIATE DEGREE. THE PERCENTAGE ACHIEVING A BACHELOR OR PROFESSIONAL DEGREE IS LESS THAN PENNSYLVANIA OR THE U.S. AS A WHOLE. A HIGHER PERCENTAGE OF THE LABOR FORCE IN THE AREA IS ENGAGED IN MANUFACTURING / CONSTRUCTION WHEN COMPARED TO THE STATE AND US AS A WHOLE.IN TERMS OF PATIENTS SERVED, COMBINED INPATIENT AND OUTPATIENT PAYER MIX IN 2013 REMAINED FAIRLY CONSISTENT. MEDICARE AND MEDICARE ADVANTAGE MAKE UP ABOUT 42% OF OUR PAYERS IN TERMS OF GROSS CHARGES. MEDICAL ASSISTANCE BUSINESS CONTINUED TO HAVE A SIGNIFICANT IMPACT ON JSH AS A CRITICAL ACCESS HOSPITAL. MEDICAL ASSISTANCE CHARGES ACCOUNT FOR ABOUT 10% OF OUR PAYERS. SELF-PAY CHARGES ACCOUNTED FOR ABOUT 5% OF OUR PAYERS.
PART VI, LINE 5:ALL OF THE PERSONS SERVING ON OUR BOARD LIVE IN THE PRIMARY COMMUNITIES BEING SERVED BY THE HOSPITAL. THE BOARD CONSISTS OF SOME PHYSICIANS WHO ARE EMPLOYEES OF A RELATED ENTITY, A FEW CONTRACTORS, AND SEVERAL OTHER COMMUNITY MEMBERS.THE HOSPITAL EXTENDS STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE AREA. AS APPLICABLE, THE HOSPITAL APPLIES SURPLUS FUNDS TO IMPROVEMENTS IN PATIENT CARE THROUGH NEW AND UPDATED EQUIPMENT PURCHASES, MAJOR FACILITY IMPROVEMENTS, AND COMMUNITY HEALTH PROGRAMS.THE HOSPITAL PARTICIPATES IN MEDICARE, MEDICAID, CHAMPUS, AND TRICARE.
PART VI, LINE 6:THE HOSPITAL IS PART OF JERSEY SHORE HOSPITAL FOUNDATION, INC. THIS AFFILIATION INCLUDES A NON-PROFIT PHYSICIAN PRACTICE WITH FAMILY PRACTICE PHYSICIANS AND SURGEONS, AS WELL AS AN URGENT CARE CENTER.
PART VI, LINE 7, REPORTS FILED WITH STATESPA
PART VIIN SUPPORT OF THE 2012 COMMUNITY HEALTH NEEDS ASSESSMENT, AND ONGOING COMMUNITY BENEFIT INITIATIVES, JERSEY SHORE HOSPITAL PLANS TO IMPLEMENT THE FOLLOWING STRATEGIES TO IMPACT AND MEASURE COMMUNITY HEALTH IMPROVEMENT.OVERWEIGHT /OBESITY (HEALTHY EATING/PHYSICAL ACTIVITY/CHRONIC CONDITIONS)JERSEY SHORE HOSPITAL STAFF RECOGNIZES THE CONNECTION BETWEEN OVERWEIGHT AND OBESITY TO HEART DISEASE, DIABETES AND OTHER CHRONIC ILLNESSES. THE HOSPITAL WILL SEEK TO REDUCE THE PERCENTAGE OF OUR CLIENTS IDENTIFIED AS BEING EITHER OVERWEIGHT OR OBESE BY FOCUSING EDUCATION AND AWARENESS ON PROMOTING HEALTHY WEIGHT THROUGH DIET AND EXERCISE.GOAL:REDUCE THE PERCENTAGE OF COMMUNITY MEMBERS CONSIDERED OVERWEIGHT OR OBESE THROUGH PROMOTION OF HEALTHY EATING AND PHYSICAL ACTIVITY.OBJECTIVES:1) PARTNER WITH SCHOOL DISTRICTS TO IMPROVE THE EDUCATION AND AWARENESS OF PROPER DIETARY HABITS.STRATEGIES:-PARTNER WITH JERSEY SHORE AND KEYSTONE CENTRAL SCHOOL DISTRICTS TO PROVIDE EDUCATION TO STAFF AND FACULTY ABOUT HEALTHY EATING AND PHYSICAL ACTIVITY.-SUPPORT RESEARCH GRANT FOR STRETCH AND GROW PROGRAM THROUGH AMERICAN HEART ASSOCIATION.2)RAISE AWARENESS TO THE BENEFITS OF AREA TOURISM ATTRACTIONS BUILT AROUND EXERCISE ACTIVITY TO LOCAL RESIDENTS.STRATEGIES:-ORGANIZE 5K WALK WITH NATURALIST.3)PROVIDE COMMUNITY-WIDE EDUCATION EVENTS ON HEALTHY NUTRITION. STRATEGIES:-CONTINUE WITH PORTION DISTORTION PROGRAM TO EDUCATE RESIDENTS ON HEALTHY EATING AND PROPER MEALS PROPORTION.-CONTINUE BI-ANNUAL HEALTH SCREENINGS EVENT TO IDENTIFY HIGH CHL/TRIGLICERIDES AND OTHER HEALTH INDICATORS.-RESEARCH GRANT OPPORTUNITIES FOR SUCH EXERCISE AND HEALTHY EATING PROGRAMS INCLUDING STRETCH N' GROW.ACCESS TO CARE:ACCESS TO CARE INCLUDES PRIMARY CARE PROVIDERS, BEHAVIORAL HEALTH PROVIDERS, AND LOCATION OF SERVICES AS MAY BE IMPACTED BY AVAILABILITY OF TRANSPORTATION.JERSEY SHORE HOSPITAL STAFF BELIEVES THAT IMPROVED HEALTH STATUS IS CONTINGENT ON ACCESS TO PRIMARY CARE SERVICES BY ALL. WE WILL DESIGNATE RESOURCES TO IMPROVING ACCESS TO CARE FOR ALL RESIDENTS AND TO CREATING A STRUCTURE OF PROVIDERS THAT SUPPORTS COORDINATION OF CARE. GOAL:1) INCREASE ACCESS TO QUALITY HEALTH CARE PROVIDERS WITH A FOCUS ON PRIMARY CARE AND BEHAVIORAL SCIENCES.STRATEGY: INCREASE PHYSICIAN/PATIENT RATIO THROUGH RECRUITMENT AND PARTNERSHIP EFFORTS.2)IMPROVE COMMUNITY AWARENESS AND UNDERSTANDING OF CHOOSING BETWEEN EMERGENCY DEPARTMENT, URGENT CARE CENTER AND FAMILY PHYSICIAN WHEN SEEKING NON-EMERGENT CARE.STRATEGIES: -CONDUCT AWARENESS CAMPAIGN TO INCLUDE PRINT MATERIALS, RADIO AND PRINT ADVERTISING, AND SERVICE-EDUCATE INSURANCE CARRIERS ABOUT AVAILABILITY AND COVERAGE OF ALTERNATIVE CARE DELIVERY OPTIONS.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Written Employment ContractYes (X)WrittenEmploymentContractInd
Compensation SurveyYes (X)CompensationSurveyInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr Plan0SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments0AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (6 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
THOMAS C CONNOLLY MD
MEDICAL STAFF PRESIDENT$0$456,290$0$0$0$0$0$12,000$0$19,124$0$487,414$0$0
AARON KOLB MD
PHYSICIAN$321,383$0$0$0$0$0$12,767$0$14,633$0$348,783$0$0$0
RONALD EISTER
PHYSICIAN$242,303$0$0$0$0$0$10,243$0$12,867$0$265,413$0$0$0
SHAIRKO MISSOURI
ANESTHESIOLOGIST$445,625$0$0$0$0$0$12,767$0$7,331$0$465,723$0$0$0
TAMAR BAITEL
PHYSICIAN$300,353$0$0$0$0$0$0$0$6,903$0$307,256$0$0$0
RICHARD CORNISH
PHYSICIAN$258,213$0$0$0$0$0$0$0$15,978$0$274,191$0$0$0

Schedule L IRS990ScheduleL

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (2 entries)

Relationship DescriptionRelationshipDescriptionTxtTransactionTransactionAmtTransactionTransactionDescSharing Of RevenuesSharingOfRevenuesInd
LISA STRAWSER
MEDICAL STAFF DIRECTOR AND BOARD MEMBER THROUGH DECEMBER 2013$1,160,469LISA STRAWSER IS A PART OWNER OF JERSEY SHORE RADIOLOGISTS. JERSEY SHORE RADIOLOGISTS HAS A CONTRACT WITH THE HOSPITAL TO PERFORM RADIOLOGY SERVICES FOR THE HOSPITAL. THE SERVICES ARE PROVIDED AT FMV. IN ACCORDANCE WITH THE CONFLICT OF INTEREST POLICY, LISA STRAWSER ABSTAINS FROM ANY DECISION MAKING AS IT RELATES TO THIS TRANSACTION.0
JAMES ELY
BOARD MEMBER AND BROTHER TO EMPLOYEE$31,200JAMES ELY IS A BOARD MEMBER AND IS ALSO THE BROTHER TO EMPLOYEE MARY HOLLICK.0

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (8 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 3THE HOSPITAL UTILIZES THE MANAGEMENT SERVICES OF QUORUM HEALTH RESOURCES.
FORM 990, PART VI, SECTION B, LINE 11THE FORM 990 WAS REVIEWED IN DETAIL BY MANAGEMENT BEFORE FILING WITH THE IRS. A COPY OF THE 990 WAS PROVIDED TO ALL BOARD MEMBERS PRIOR TO ISSUANCE.
FORM 990, PART VI, SECTION B, LINE 12CALL BOARD MEMBERS AND EMPLOYEES ARE REQUIRED TO ANNUALLY COMPLETE A CONFLICT OF INTEREST STATEMENT. THE CEOS OFFICE MONITORS THE PROCESS AND COMPLETION OF THE STATEMENTS. THE COMPLETED STATEMENTS ARE REVIEWED BY MANAGEMENT. BOARD MEMBERS ARE REQUIRED TO RECUSE THEMSELVES FROM VOTING ON MATTERS THAT ARE RELATED TO ANY POTENTIAL CONFLICTS. THERE HAS NEVER BEEN AN ISSUE INVOLVING CONFLICTS OF INTEREST.
FORM 990, PART VI, SECTION B, LINE 15ON AN ANNUAL BASIS, THE PERSONNEL SALARY COMMITTEE AND QUORUM (MANAGEMENT COMPANY) REVIEWS AN EXECUTIVE COMPENSATION STUDY PERFORMED BY YAFFE, AN INDEPENDENT THIRD PARTY WHO IS EMPLOYED BY HOSPITAL ASSOCIATION OF PENNSYLVANIA TO CONDUCT A COMPENSATION STUDY. HUMAN RESOURCES ALSO PROVIDES A COMPENSATION STUDY FROM ACRS WHICH IS BASED ON THE APPALACHIAN REGION. THESE TWO STUDIES ARE USED TO DETERMINE FMV. THE RECOMMENDATIONS FOR COMPENSATION LEVELS ARE PASSED ON TO THE BOARD FOR THEIR APPROVAL. APPROVAL IS DOCUMENTED IN THE MINUTES. THE ACTUAL AMOUNT OF COMPENSATION IS NOT INCLUDED IN THE MINUTES FOR PRIVACY PURPOSES.
FORM 990, PART VI, SECTION C, LINE 19GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART VII, SECTION A:THE PRESIDENT/CEO IS AN EMPLOYEE OF QUORUM (MANAGEMENT COMPANY). THE HOSPITAL PAYS QUORUM FOR THE PRESIDENT/CEO'S SALARY. FOR CALENDAR YEAR 2013 HIS COMPENSATION WAS $299,905.
FORM 990, PART IX, LINE 11GLAUNDRY: PROGRAM SERVICE EXPENSES 79,499. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 79,499. OTHER: PROGRAM SERVICE EXPENSES 13,367. MANAGEMENT AND GENERAL EXPENSES 528,279. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 541,646. CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 243,314. MANAGEMENT AND GENERAL EXPENSES 388,055. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 631,369. MEDICAL: PROGRAM SERVICE EXPENSES 193,652. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 193,652. MEDICAL LABS: PROGRAM SERVICE EXPENSES 235,030. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 235,030. TRANSPORTATION: PROGRAM SERVICE EXPENSES 2,819. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,819. MICROFILM: PROGRAM SERVICE EXPENSES 28,000. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 28,000. COLLECTIONS: PROGRAM SERVICE EXPENSES 50,889. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 50,889. CONSULTING: PROGRAM SERVICE EXPENSES 97,000. MANAGEMENT AND GENERAL EXPENSES 22,701. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 119,701. BIOHAZARDOUS MATERIALS: PROGRAM SERVICE EXPENSES 29,833. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 29,833. MAINTENANCE AND REPAIRS: PROGRAM SERVICE EXPENSES 628,972. MANAGEMENT AND GENERAL EXPENSES 213,647. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 842,619. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 2,202,735. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,202,735.
FORM 990, PART XI, LINE 9:PENSION LIABILITY ADJUSTMENT 30,071. CHANGE IN FAIR VALUE OF DERIVATIVE INSTRUMENT 179,803.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp

Disregarded Entity Name DisregardedEntityName

FieldValueIRS element (for citing)
Business Name Line1JERSEY SHORE HOSPITAL FOUNDATION INCBusinessNameLine1

US Address USAddress

FieldValueIRS element (for citing)
Address Line11020 THOMPSON STREETAddressLine1
CityJERSEY SHORECity
StatePAState
ZIP Code17740ZIPCode
FieldValueIRS element (for citing)
EIN232480603EIN
Primary ActivitiesHEALTHCAREPrimaryActivitiesTxt
Legal Domicile StatePALegalDomicileStateCd
Exempt Code Section501(C)(3)ExemptCodeSectionTxt
Public Charity Status3PublicCharityStatusTxt
Direct Controlling NAN/ADirectControllingNACd
Controlled Organization0ControlledOrganizationInd
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org0GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org0GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgYes (1)LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth OrgYes (1)RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgYes (1)PerformOfServicesForOthOrgInd
Perform Of Services By Other OrgYes (1)PerformOfServicesByOtherOrgInd
Sharing Of FacilitiesYes (1)SharingOfFacilitiesInd
Paid Employees SharingYes (1)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (1)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd