2014-05-12T08:15:44-05:00 2013-06-30 232932984 PARENTEBEARD LLC 1650 MARKET STREET SUITE 4500 PHILADELPHIA PA 19103 990 2012-07-01 231352187 GEISINGER - LEWISTOWN HOSPITAL GEIS 7172427650 400 HIGHLAND AVENUE LEWISTOWN PA 17044 DAVID J FELICIO ESQUIRE 7172427650 2014-05-01 1 JULIUS C GREEN CPA JD P00350393 2159720701 2012 2015-11-30 17:44:51Z KAY HAMILTON 400 HIGHLAND AVENUE LEWISTOWN PA 17044 101697516 0 X WWW.LEWISTOWNHOSPITAL.ORG X 1905 PA TO PROVIDE PERSONAL, HIGH-QUALITY, ECONOMICAL HEALTHCARE FOR OUR COMMUNITIES. 15 13 1008 125 1754349 654448 236886 236422 91947243 93679205 1590713 1529552 3616344 6108526 97391186 101553705 3999633 4058008 0 0 48090262 51144169 0 0 551742 45500819 47277246 97590714 102479423 -199528 -925718 85016763 82611335 67816564 56826533 17200199 25784802 TO PROVIDE PERSONAL, HIGH-QUALITY, ECONOMICAL HEALTHCARE FOR OUR COMMUNITIES. 0 0 96432312 4058008 94971104 PROVIDED INPATIENT, OUTPATIENT, WELLNESS, AND COMMUNITY SERVICES TO RESIDENTS OF LEWISTOWN, PA AND SURROUNDING COMMUNITIES. PROVIDED 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 WERE APPROXIMATELY $4,472,000. 96432312 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 1 1 0 0 0 0 0 0 1 0 1 1 1 1 1 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 1 0 0 0 1 88 0 1 1008 1 1 1 0 0 0 0 1 1 0 0 0 0 X 15 13 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 PA X RANDY TEWKSBURY CFO 7172427650 400 HIGHLAND AVENUE LEWISTOWN PA 17044 KAY A HAMILTON 36.00 4.00 X X 288306 0 48590 WILLIAM F HERKERT 0.80 0.30 X X 0 0 0 DIANE SPOKUS PHD MCHES 0.80 0.30 X X 0 0 0 DONALD CHAPMAN SR 0.80 0.30 X X 0 0 0 DANA L PATTERSON 0.80 0.30 X X 0 0 0 JEFFREY W ANDERSON 0.80 0.30 X 0 0 0 GURPREET S BHALLA MD 0.80 0.30 X 0 0 0 RANDY SHEAFFER 0.80 0.30 X 0 0 0 JOHN W GEHMAN MD 0.80 0.30 X 0 0 0 SHASHPAL K MALHOTRA MD 0.80 0.30 X 0 0 0 JAMES L SHILLING JR 0.80 0.30 X 0 0 0 CATHERINE M STOUT 0.80 0.30 X 0 0 0 JON ZIMMERMAN 0.80 0.30 X 0 0 0 OKSANA DEARMENT 0.80 0.30 X 0 0 0 KETANKUMAR R SHETH MD 0.80 0.30 X 0 0 0 RANDY TEWKSBURY 37.00 3.00 X 192971 0 50706 KIRK E THOMAS 39.00 1.00 X 144869 0 46911 NANCY S REINKE 35.00 5.00 X 120903 0 44454 RONALD M COWAN 39.00 1.00 X 121352 0 34290 CHRISTINE W MATHEWS 40.00 X 142118 0 27965 NALIN G PATEL 40.00 X 407869 0 20478 RICHARD F STOMACKIN 40.00 X 153290 0 29756 LEWIS D ALLSHOUSE III 40.00 X 127783 0 32987 DESHAUN RICHARDS 40.00 X 121144 0 38121 KEITH S GRAHAM 40.00 X 115088 0 41796 1935693 0 416054 12 0 1 0 CERNER CORPORATION 43 KENSICO DRIVE MT KISCO NY 105491009 MAINTENANCE/REMOTE HOSTING FOR CLINICAL 1648473 EPA 307 SOUTH EVERGREEN AVE WOODBURY NJ 08096 EMERGENCY DEPT. PHYSICIANS 992744 GEISINGER HEALTH SYSTEM 100 NORTH ACADEMY AVENUE DANVILLE PA 17822 HOSPITALIST/E-ICU/PEDIATRIC LOCUMS/ENDOS 976183 QUEST DIAGNOSTICS NICHOLS INSTITUTE 12436 COLLECTIONS CENTER DRIVE CHICAGO IL 606932436 DIAGNOSTIC LABORATORY TESTING SERVICES 882811 KAUFMAN HALL 5202 OLD ORCHARD ROAD SUITE N700 SKOKIE IL 60077 CONSULTING SERVICES - POTENTIAL MERGER 630253 22 72763 34445 129214 236422 NET PATIENT SERVICE REV 621400 93679205 93679205 93679205 1408114 1408114 107925 54720 0 41207 107925 13513 121438 121438 20820 72763 33738 -12918 -12918 9882 1926 7956 7956 117773 66940 50833 50833 MEANINGFUL USE REVENUE 900099 2345768 2345768 LAB SERVICE REVENUE 621500 1728681 1728681 SCHOOL OF NURSING 611600 614730 614730 1373476 555731 25668 792077 6062655 101553705 94971104 1754349 4591830 4046008 4046008 12000 12000 1272699 1272699 35770462 34892523 697629 180310 3683066 3613029 51366 18671 7666084 7342638 285502 37944 2751858 2618072 120019 13767 429216 429216 84795 84795 14951 14951 3718 3718 9568213 7746905 1742679 78629 173420 11566 11272 150582 461918 366526 34662 60730 153740 153390 350 1952070 1785513 166557 78325 59802 15449 3074 96495 88514 6974 1007 1123781 1104760 19021 5497006 5467204 29802 697664 682732 14932 FEDERAL INCOME TAXES 219462 219462 MEDICAL SUPPLIES 13530182 13530182 BAD DEBT EXPENSE 5779966 5779966 REPAIRS AND MAINTENANCE 5095887 5093813 2074 2316437 2037169 272590 6678 102479423 96432312 5495369 551742 1870 1870 7172423 6459028 9293225 9937965 1428160 1390545 2334342 2463555 2549714 2437627 108001830 82596968 29528378 25404862 29839151 30907607 1347607 2137833 1521893 1470443 85016763 82611335 39819482 31041583 20580000 19915000 1411497 947467 6005585 4922483 67816564 56826533 X 16393000 25016718 265173 229158 542026 538926 17200199 25784802 85016763 82611335 X -925718 1308317 8202004 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 14951 14951 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: A PORTION (26.27%) OF OUR ANNUAL DUES PAID TO THE HOSPITAL AND HEALTHSYSTEM ASSOCIATION OF PENNSYLVANIA (HAP) IS ATTRIBUTABLE TO LOBBYING EXPENSES. A PORTION (23.98%) OF OUR ANNUAL DUES PAID TO THE AMERICAN HOSPITAL ASSOCIATION (AHA) IS ATTRIBUTABLE TO LOBBYING EXPENSES. 177960 2103 1341 1000 512 179892 174187 2846 2329 1000 402 177960 80371 91939 3266 1000 389 174187 69171 4750 7758 1000 308 80371 63766 4495 2070 1000 160 69171 1.00000 0 0 224653 224653 47131015 32734379 14396636 58826311 48442245 10384066 1819851 1420344 399507 25404862 OBLIGATIONS UNDER CAPITAL LEASE 1458741 DUE TO AFFILIATES 113631 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 1896533 BLUE CROSS CURRENT FINANCING ADVANCE 381800 ESTIMATED MEDICAL MALPRACTICE CLAIMS 1071778 4922483 X 105386664 1308317 2422038 3730355 101656309 -102604 -102604 101553705 96802061 102604 102604 96699457 5779966 5779966 102479423 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THE EARNINGS ON THE FRIENDS LEGACY ENDOWMENT FUND WILL BE USED SOLELY FOR THE PURPOSES OF CAPITAL AND BUILDING EXPENDITURES. NO EXPENDITURES CAN BE MADE UNTIL THE FUND REACHES $1,000,000 AND THEN ONLY THE EARNINGS FROM THE INVESTMENT CAN BE USED FOR THOSE PURPOSES. THE EARNINGS ON THE SCHOOL OF NURSING SCHOLARSHIP FUNDS ARE USED FOR SCHOLARSHIPS FOR LEWISTON HOSPITAL SCHOOL OF NURSING STUDENTS SELECTED BY THE SCHOLARSHIP COMMITTEE BASED ON ESTABLISHED CRITERIA. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: 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 2013 AND 2012. THE HOSPITAL'S FEDERAL EXEMPT ORGANIZATION BUSINESS INCOME TAX RETURNS FOR THE YEARS ENDED PRIOR TO JUNE 30, 2010 NO LONGER REMAIN SUBJECT TO EXAMINATION BY THE IRS. PART XI, LINE 2D - OTHER ADJUSTMENTS: VALUATION GAIN -3,100. PENSION LIABILITY ADJUSTMENT 8,205,104. BAD DEBT EXPENSE NETTED ON FINANCIAL STATEMENTS -5,779,966. PART XI, LINE 4B - OTHER ADJUSTMENTS: SPECIAL EVENT EXPENSES -33,738. COST OF GOODS SOLD -66,940. GAMING EXPENSES -1,926. PART XII, LINE 2D - OTHER ADJUSTMENTS: SPECIAL EVENT EXPENSES 33,738. COST OF GOODS SOLD 66,940. GAMING EXPENSES 1,926. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE NETTED ON FINANCIAL STATEMENTS 5,779,966. GOLF TOURNAMENT 48398 28052 20346 9511 5072 11641 456 PA PINK ZONE 25112 25112 528 523 616 2839 10 20073 19599 474 359 325 545 1323 93583 72763 20820 10398 5920 12257 545 4618 33738 -12918 1 1 1 X 0 1 1 0 1 1 1649039 1649039 0.01710 4680594 164799 4515795 0.04670 6329633 164799 6164834 0.06380 10289 10289 0.00010 176 176 0.00000 303 303 0.00000 10768 10768 0.00010 6340401 164799 6175602 0.06390 1630 1630 0.00000 51002 51002 0.00050 4914 4914 0.00010 2585 2585 0.00000 60131 60131 0.00060 1 5779966 2131530 24481174 26622859 -2141685 X 1 1 1 1 LEWISTOWN HOSPITAL

400 HIGHLAND AVENUE LEWISTOWN PA 17044

WWW.LEWISTOWNHOSPITAL.ORG X X X LEWISTOWN HOSPITAL 1 1 X X X X X X X X X 12 1 0 1 X X X X X X X X X X 0 0 1 1 200.000000000000 0 0 1 1 X X 1 0 X X X 1 X 0 1 PART I, LINE 3C: ELIGIBILITY FOR FREE CARE IS BASED ON FEDERAL POVERTY GUIDELINES. DISCOUNTS ARE AVAILABLE FOR PROMPT PAYMENT AND SELF PAY OVER CERTAIN DOLLAR LEVELS, REGARDLESS OF INCOME. PART I, LINE 7: COST-TO-CHARGE RATIOS WERE USED TO DETERMINE THE COST OF THESE PROGRAMS. PART I, L7 COL(F): BAD DEBT EXPENSE OF $5,779,966 WAS INCLUDED ON FORM 990, PART IX, LINE 25, BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN PART I LINE 7 COLUMN F. PART II: COMMUNITY BUILDING ACTIVITIES:MIFFLIN COUNTY INDUSTRIAL DEVELOPMENT CORPORATION - KAY HAMILTON, CEO, BOARD MEMBER THE MISSION OF THE MIFFLIN COUNTY INDUSTRIAL DEVELOPMENT CORPORATION IS TO PROMOTE THE GROWTH OF EMPLOYMENT AND INCOME IN MIFFLIN COUNTY BY USING TECHNICAL AND FINANCIAL RESOURCES FROM MCIDC AND FEDERAL, STATE, AND LOCAL AGENCIES AND INDIVIDUALS TO ENCOURAGE AND ASSIST BUSINESS AND INDUSTRIAL FORMATION, RETENTION, AND EXPANSION. MIFFLIN JUNIATA CAREER TECH CENTER ADVISORY COMMITTEE - KAY HAMILTON, CEO, BOARD MEMBERTHE MIFFLIN JUNIATA CAREER AND TECHNOLOGY CENTER OFFERS VOCATIONAL-TECHNICAL EDUCATIONAL PROGRAMS FOR BOTH MIFFLIN AND JUNIATA COUNTY STUDENTS IN GRADES 10 - 12. PROGRAMS INCLUDE: HEALTH PROFESSIONS, ALLIED HEALTH SCIENCE, AGRICULTURE, CONSTRUCTION, CRIMINAL JUSTICE, ETC. MIFFLIN-JUNIATA PARTNERS ADVANCING TOMORROW'S HEALTH (MJ PATH) - KIRK THOMAS, VP OPERATIONS, BOARD MEMBERTHE MISSION OF THE MJ PATH GROUP IS TO PROMOTE THE HEALTH AND WELLNESS OF INDIVIDUALS AND THE COMMUNITIES OF MIFFLIN AND JUNIATA COUNTIES. THIS IS ACCOMPLISHED BY ENGAGING A BROAD SPECTRUM OF LOCAL COMMUNITY INDIVIDUALS AND ORGANIZATIONS WITH INTERESTS AND INFLUENCE ON LOCAL HEALTH STATUS BY WORKING TOGETHER TO PROMOTE EFFECTIVE HEALTH IMPROVEMENT STRATEGIES, INCLUDING PLANNING AND COORDINATION OF LOCAL RESOURCES. MEETINGS ARE HELD BI-MONTHLY. MIFFLIN-JUNIATA HEALTH CENTER - KIRK THOMAS, VP OPERATIONS, BOARD CHAIR THE MISSION OF THE MIFFLIN-JUNIATA HEALTH CENTER IS TO PROVIDE ACCESS TO PRIMARY AND PREVENTIVE HEALTH CARE SERVICES TO RESIDENTS OF ALL INCOME LEVELS WITHIN OUR SERVICE AREA, WITH SPECIAL EMPHASIS ON THE INDIGENT, THE UNINSURED, AND THE UNDERSERVED. THE HEALTH CENTER IS COLLABORATING WITH PRIMARY HEALTH NETWORK, A FEDERALLY QUALIFIED HEALTH CENTER, TO ESTABLISH AFFILIATE CLINICS IN MIFFLIN AND JUNIATA COUNTIES. AMISH HEALTH COUNCIL LIAISON - KIRK THOMAS, VP OPERATIONSAN INITIATIVE HAS BEEN IMPLEMENTED TO MEET THE HEALTH CARE NEEDS OF THE AMISH POPULATION IN MIFFLIN AND JUNIATA COUNTIES. TO ENCOURAGE ACCESS TO CARE, A DISCOUNT PAYMENT SCHEDULE HAS BEEN DEVELOPED. MIFFLIN-JUNIATA UNITED WAY - PHYLLIS MITCHELL, VP MARKETING & COMMUNITY AFFAIRS, BOARD MEMBERTHE MISSION OF THE MJ UNITED WAY IS TO IMPROVE PEOPLE'S LIVES BY MOBILIZING THE CARING POWER OF THE COMMUNITY. THE UNITED WAY SUPPORTS VARIOUS AGENCIES THROUGH FUNDING. THE COMMUNITY IMPACT FOCUS AREAS INCLUDE: BASIC NEEDS AND SELF SUFFICIENCY, COMMUNITY LIFE AND HEALTH, EDUCATION, AND SUCCESSFUL CHILDREN AND YOUTH. LEWISTOWN HOSPITAL EMPLOYEES AND MEDICAL-DENTAL STAFF CONTRIBUTE TO THE UNITED WAY FUND EACH YEAR TO SUPPORT THESE LOCAL COMMUNITY ORGANIZATIONS. JUNIATA VALLEY CHAMBER OF COMMERCE - PHYLLIS MITCHELL, BOARD MEMBERTHE JUNIATA VALLEY CHAMBER OF COMMERCE HELPS PROMOTE AND SUPPORT LOCAL BUSINESSES IN MIFFLIN AND JUNIATA COUNTIES. THE CHAMBER IS A RESPECTED SOURCE FOR INFORMATION ABOUT COMMUNITY BUSINESSES AND EVENTS IN THE AREA. MIFFLINTOWN ROTARY - KIRK THOMAS, VP OPERATIONS, MEMBER LEWISTOWN ROTARY - RANDY TEWKSBURY, CFO, IS A BOARD MEMBER; PHYLLIS MITCHELL, VP MARKETING AND COMMUNITY AFFAIRS, IS A MEMBERBELLEVILLE CIVIC CLUB - CHRIS MATHEWS, VP NURSING SERVICES, MEMBER & VICE PRESIDENTTHE ABUSE NETWORK - CHRIS MATHEWS, VP NURSING SERVICES, BOARD MEMBER & PAST PRESIDENTNUVISIONS - PHYLLIS MITCHELL, BOARD MEMBERTHE MISSION OF NUVISIONS IS TO IMPROVE THE LIVES OF PEOPLE WITH VISION, PHYSICAL, OR MENTAL IMPAIRMENTS THROUGH COMMUNITY EDUCATIN, CLIENT SERVICES AND EMPLOYMENT OPPORTUNITIES. NUMEROUS HOSPITAL DEPARTMENTS PROVIDE HEALTH EDUCATION TO NUVISIONS CLIENTS. JUNIATA VALLEY CHAMBER OF COMMERCE - PHYLLIS MITCHELL, BOARD MEMBERTHE JUNIATA VALLEY CHAMBER OF COMMERCE HELPS PROMOTE AND SUPPORT LOCAL BUSINESSES IN MIFFLIN AND JUNIATA COUNTIS. THE CHAMBER IS A RESPECTED SOURCE FOR INFORMATION ABOUT COMMUNITY BUSINESSES AND EVENTS IN THE AREA.EMERGENCY PREPAREDNESS COMMITTEE - COMMUNITY PLANNING INITIATIVETHE EMERGENCY PREPAREDNESS COMMITTEE IS ACTUALLY A SUB-COMMITTEE OF THE RISK MANAGEMENT & SAFETY COMMITTEE. THE PRIMARY FUNCTION WOULD BE TO ASSURE THE HOSPITAL IS PREPARED AS BEST AS POSSIBLE FOR ANY EMERGENCY SITUATION. WE WORK CLOSELY WITH BOTH THE MIFFLIN AND JUNIATA COUNTY EMERGENCY MANAGEMENT AGENCIES (EMA'S), AND EACH OF THEIR RESPECTIVE DIRECTORS SITS ON THE COMMITTEE IN AN EX-OFFICIO CAPACITY. THIS HELPS US IN DEVELOPING OUR PLANS AND DRILLS/EXERCISES SO WE ADDRESS CONCERNS OF EACH COUNTY AS IT RELATES TO THEIR HVA'S (HAZARDS VULNERABILITY ANALYSIS).IN ADDITION, WE COORDINATE AND WORK CLOSELY WITH THE SOUTH CENTRAL MOUNTAINS REGIONAL TASK FORCE (SCMRTF). THE REGION IS COMPRISED OF THE FOLLOWING COUNTIES: MIFFLIN, JUNIATA, SNYDER, HUNTINGDON, BLAIR, BEDFORD, FULTON, AND CENTRE. BY MEETING, PLANNING, AND EXERCISING WITH THE HEALTH CARE PARTNERS, PRIMARILY HOSPITALS IN THIS AREA, WE ARE ABLE TO DEVELOP PLANS AND CONTINGENCIES IN THE EVENT OF LOCAL, REGIONAL, STATE AND/OR NATIONAL INCIDENTS. BY KNOWING WHAT EACH OTHERS CAPABILITIES AND RESOURCES ARE IN ADVANCE, WE HOPE TO BE ABLE TO MAINTAIN OR RESTORE HEALTHCARE SERVICES AS QUICKLY AS POSSIBLE TO OUR AREAS. THIS IS ONE COMPONENT OF OUR COMMUNITY INTERACTION AND PLANNING FOR INCIDENTS WHICH COULD ADVERSELY AFFECT HEALTHCARE FOR OUR RESIDENTS, VISITORS, AND PATIENTS. WE ALSO PLAN AT LEAST 2 EXTERNAL EXERCISES (DRILLS) WITHIN MIFFLIN AND/OR JUNIATA COUNTIES EACH YEAR. THIS INVOLVES NOT ONLY HOSPITAL ASSETS, BUT INCLUDES PERSONNEL AND EQUIPMENT FROM EMS, FIRE, LAW ENFORCEMENT, EMERGENCY MANAGEMENT, AND SEVEN MOUNTAINS EMS REGION TO PRACTICE WHAT COULD OCCUR IN A VARIETY OF DIFFERENT SITUATIONS SUCH AS MAJOR FIRES, BUILDING COLLAPSES, BUS ACCIDENTS, OR TERRORIST TYPES ATTACKS.THE COMMITTEE IS COMPRISED OF: HOSPITAL RISK MANAGER (CHAIR), PCD'S FROM THE ED AND ICCU, VP OF NURSING, VP OF COMMUNITY RELATIONS, MANAGER OF EMPLOYEE HEALTH, STAFF MEMBERS FROM THE ED, SECURITY, AND THE LAB, DIRECTOR OF QUALITY IMPROVEMENT, COMMUNICATIONS SUPERVISOR, SENIOR FINANCIAL ACCOUNTANT, AND OTHERS. WE MEET MONTHLY AND REVIEW ANY & ALL ITEMS RELATED TO EMERGENCY PREPAREDNESS AND CONTINUITY OF OPERATIONS DURING AN EMERGENCY INCIDENT. WE ALSO REVIEW INCIDENTS WHICH MAY HAVE OCCURRED, EVALUATE INTERNAL/EXTERNAL COMMUNICATIONS AS NECESSARY, DISCUSS DISSEMINATION OF PUBLIC INFORMATION DURING INCIDENTS, AND APPROVE EXPENDITURES OF THE ASPR/OPHP (ASSISTANT SECRETARY OF PREPAREDNESS RESPONSE/OFFICE OF PUBLIC HEALTH PREPAREDNESS) ANNUAL GRANTS.INTERNSHIP PROGRAMS FOR VARIOUS DEPARTMENTSTHE HOSPITAL WORKS WITH MANY DIFFERENT ORGANIZATIONS SUCH AS SECONDARY EDUCATION INSTITUTIONS, AND MEDICAL SCHOOLS, TO PROVIDE JOB SHADOWING AND TRAINING INTERNSHIPS FOR PARTICIPANTS. MANY DIFFERENT DEPARTMENTS WORK WITH INTERNS TO PROVIDE A VALUABLE WORK EXPERIENCE. IN FY2013, WE HELD THREE DAYS OF JOB SHADOWING WITH PARTICIPATION FROM APPROXIMATELY 15 DIFFERENT DEPARTMENTS ACROSS THE ORGANIZATION SHADOWING APPROXIMATELY 55 INDIVIDUALS INTERESTED IN CAREERS IN THE HEALTH CARE FIELD. THIS IS A VALUABLE SERVICE TO THE EDUCATIONAL INSTITUTIONS OF THE COMMUNITY AS THE STUDENTS ARE ABLE TO EXPERIENCE FIRSTHAND WHAT THESE TYPES OF CAREERS HAVE TO OFFER, SOMETHING THAT A CLASSROOM SETTING COULD NOT PROVIDE. THIS PROGRAM IS OF NO COST TO THE EDUCATIONAL INSTITUTIONS AND IT IS AN EXCELLENT WAY FOR STUDENTS TO MAKE INFORMED CAREER CHOICES ULTIMATELY RESULTING IN A STRONGER WORKFORCE FOR THE COMMUNITY.EXPERIENCE WORKS PROGRAM SPONSOR.EXPERIENCE WORKS IS A FEDERAL EMPLOYMENT PROGRAM THAT IS FOCUSED ON MEETING THE TRAINING AND EMPLOYMENT NEEDS OF A RAPIDLY GROWING OLDER POPULATION. LEWISTOWN HOSPITAL IS A TRAINING AGENCY FOR EXPERIENCE WORKS INDIVIDUALS. CURRENTLY ONE EXPERIENCED WORKS PARTICIPANT IS WORKING AT THE HOSPITALLEWISTOWN HOSPITAL SCHOOL OF NURSINGMANY RURAL AREAS FACE SEVERE SHORTAGES OF NURSES. NO MEDICAL CENTER CAN WORK PROPERLY WITHOUT ENOUGH GOOD NURSES, AND LEWISTOWN HOSPITAL IS NO EXCEPTION. THE HOSPITAL HAD DIFFICULTY HIRING AND KEEPING RNS FOR YEARS. SO DID OTHER FACILITIES IN THE REGION, SUCH AS NURSING HOMES AND DOCTORS' OFFICES . IN RESPONSE TO THIS SHORTAGE OF NURSES, LEWISTOWN HOSPITAL APPEALED TO THE STATE BOARD OF NURSING TO OPEN ITS CURRENT SCHOOL OF NURSING. IN MAY 2005, THE PENNSYLVANIA STATE BOARD OF NURSING GRANTED INITIAL APPROVAL TO THE LEWISTOWN HOSPITAL TO ADMIT TWENTY-FIVE STUDENTS TO EACH OF TWO CLASSES. THE PENNSYLVANIA STATE BOARD EDUCATION ADVISORS REVIEWED THE PROGRAM IN OCTOBER 2007 AFTER THE FIRST CLASS GRADUATED, AND FULL APPROVAL WAS GRANTED TO THE PROGRAM IN DECEMBER 2007. THE SCHOOL HAS RECEIVED FULL ACCREDITATION FROM THE NATIONAL LEAGUE FOR NURSING ACCREDITING COMMISSION (NLNAC) IN FEBRUARY 2010, EFFECTIVE FALL 2009 THROUGH FALL 2014. 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.THE COST-TO CHARGE RATIO WAS CALCULATED USING TOTAL COSTS AND TOTAL PATIENT CHARGES. THE MEDICARE STEPDOWN METHODOLOGY WAS USED BUT INCLUDED ALL EXPENSES, NET OF RELATED OTHER INCOME. THE TOTAL EXPENSES TIED TO THE AUDITED FINANCIAL STATEMENTS. PART III, LINE 8: THE HOSPITAL CONTINUES TO PROVIDE CARE TO ALL PRESENTING AND ADMITTED PATIENTS, REGARDLESS OF ABILITY TO PAY. NOTWITHSTANDING THE COSTS TO PROVIDE CARE, RECEIVING "LESS" THAN WHAT IT COSTS TO PROVIDE ADEQUATE CARE TO MEDICARE COVERED LIVES DOES THE HOSPITAL A DISSERVICE. THIS SHORTFALL SHOULD COUNT AS A COMMUNITY BENEFIT. OUR SERVICE AREA INCLUDES MANY MEDICARE RECIPIENTS THAT ARE ALSO DUALLY ELIGIBLE FOR MEDICAL ASSISTANCE, WHICH DENOTES SOME TYPE OF FINANCIAL NEED.MEDICARE COST-TO-CHARGE RATIOS FROM THE MEDICARE COST REPORT ARE USED TO DETERMINE THE COST OF THE PROGRAMS. PART III, LINE 9B: PER OUR CURRENT POLICIES, THE ONLY WAY WE ARE GUARANTEED TO KNOW IF SOMEONE IS INDIGENT IS IF THEY COMPLETE A CHARITY CARE APPLICATION. THERE IS A PROVISION IN THE COMMUNITY CARE POLICY (OUR CHARITY CARE POLICY) - THAT ONCE COMPLETED, A CHARITY CARE APPLICATION IS VALID FOR 6 MONTHS PRIOR TO AND 6 MONTHS FOLLOWING THE DATE OF APPROVAL OF THE CHARITY CARE APPLICATION. THEREFORE IF ANOTHER DEBT IS INCURRED DURING THAT WINDOW, WE KNOW THEY MEET THE REQUIREMENTS AND WE EXTEND THE TERMS OF FINANCIAL ASSISTANCE/CHARITY CARE TO THAT PATIENT. WE WOULD ALSO RETROSPECTIVELY APPLY THE FINANCIAL ASSISTANCE/CHARITY CARE POLICY TO ANY CHARGES 6 MONTHS PRIOR TO THE APPLICATION APPROVAL. LEWISTOWN HOSPITAL PART V, SECTION B, LINE 3: THE NEEDS ASSESSMENT STEERING COMMITTEE AND SEVERAL COMMUNITY PARTNERS MET TO DISCUSS THE KEY ISSUES IDENTIFIED IN THE NEEDS ASSESSMENT. A TOTAL OF 16 INDIVIDUALS ATTENDED THE STRATEGIC PLANNING SESSION, INCLUDING EXPERTS IN PUBLIC HEALTH, REPRESENTATIVES OF UNDERSERVED POPULATIONS, HEALTH AND SOCIAL SERVICE AGENCIES, AND OTHER COMMUNITY STAKEHOLDERS. * LINDA ALLEN, DIRECTOR, PA DOH - JUNIATA COUNTY STATE HEALTH CENTER * MARIE MULVIHILL, DIRECTOR, UNITED WAY OF MIFFLIN JUNIATA * WALT WHITMER, SR. EXTENSION ASSOCIATE, PENN STATE COOPERATIVE EXTENSION * CRYSTAL PAIGE, DIRECTOR, THE ABUSE NETWORK * MOLLY KINNEY, DIRECTOR, MIFFLIN COUNTY LIBRARY * PAULA LEACH, HEALTH & NUTRITION COORDINATOR, SUM CHILD DEVELOPMENT, * ALETA KAMMERER, EARLY HEAD START COORDINATOR, SUM CHILD DEVELOPMENT, * BOB HENRY, MENTAL HEALTH ADULT PROGRAM SPECIALIST, JUNIATA VALLEY BEHAVIORAL & DEVELOPMENTAL SERVICES * NANCY RECORDS, DIRECTOR, COMMUNITIES THAT CARE * JOHN MCCULLOUGH, DIRECTOR, JUNIATA VALLEY YMCA * BETH ZONG, DIRECTOR, MIFFLIN JUNIATA SPECIAL NEEDS CENTER * GAYLE LANDIS, QUALITY ASSURANCE/RISK MANAGEMENT, MIFFLIN JUNIATA REGIONAL SERVICES * RANDY TEWKSBURY, CFO, LEWISTOWN HOSPITAL * PHYLLIS MITCHELL, VP MARKETING & COMMUNITY AFFAIRS, LEWISTOWN HOSPITAL * KERIA MEALS, COMMUNICATIONS COORDINATOR, LEWISTOWN HOSPITAL * CINDY HOUSER, COMMUNICATIONS COORDINATOR, AMERICORPS - LEWISTOWN HOSPITAL LEWISTOWN HOSPITAL PART V, SECTION B, LINE 7: TWO AREAS WHERE WE HAVE A SIGNIFICANT NEED IN THE COMMUNITY WOULD BE DENTAL CARE AND MENTAL HEALTH CARE. THESE WOULD BE AREAS THAT OUR COMMUNITY PARTNERS WOULD ADDRESS AND WE WOULD HELP SUPPORT, SUCH AS THE MIFFLIN JUNIATA DENTAL CLINIC AND MH/MR OF JUNIATA VALLEY. LEWISTOWN HOSPITAL PART V, SECTION B, LINE 11: ALL PATIENTS IDENTIFIED AS SELF PAY ARE ELIGIBLE FOR DISCOUNTED CARE. LEWISTOWN HOSPITAL PART V, SECTION B, LINE 20D: THE HOSPITAL HAS A SELF-PAY DISCOUNT POLICY WHICH DISCOUNTS "OUT OF POCKET" BALANCES BY AS MUCH AS 50%. THIS DISCOUNT IS GENERALLY MORE GENEROUS THAN ANY NEGOTIATED COMMERCIAL INSURANCE RATE. LEWISTOWN HOSPITAL PART V, SECTION B, LINE 22: BY REGULATION WE APPLY THE SAME GROSS CHARGE TO ALL PATIENTS REGARDLESS OF PAYER CODE, HOWEVER, WHEN THE PATIENT IS IDENTIFIED AS SELF PAY THE DISCOUNT IS APPLIED THAT OFFERS A PAYMENT THAT IS LOWER THAN THAT PAID BY NEGOTIATED COMMERCIAL PAYERS OR FREE CARE IS OFFERED BASED ON INCOME GUIDELINES. PART VI, LINE 2: WE ASSESS THE NEEDS OF THE COMMUNITIES WE SERVE IN THE FOLLOWING WAYS:QUARTERLY ADVISORY GROUPS:THE PATIENT SATISFACTION ADVISORY GROUP PURPOSE IS TO PROVIDE FEEDBACK REGARDING THE HOSPITAL'S PATIENT SATISFACTION EFFORTS. THE COMMITTEE IS COMPOSED OF FORMER AND CURRENT PATIENTS, AS WELL AS COMMUNITY MEMBERS. MEMBERS GIVE INSIGHT INTO WHAT THE COMMUNITY IS SAYING ABOUT THE HOSPITAL AND SUGGESTIONS FOR CHANGES TO MAKE THE HOSPITAL EXPERIENCE MORE PATIENT-FOCUSED.THE MARKETING ADVISORY COMMITTEE'S PURPOSE IS TO PROVIDE GUIDANCE FOR THE HOSPITAL'S MARKETING AND OUTREACH EFFORTS. MEDICAL STAFF SURVEYS:THE PRIMARY OBJECTIVE OF THE MEDICAL STAFF ASSESSMENT PROCESS WAS TO CREATE A MEDICAL STAFF DEVELOPMENT PLAN FOR LEWISTOWN HOSPITAL THAT PROJECTS THE NEEDS FOR PHYSICIANS OVER THE NEXT SEVERAL YEARS, BY SPECIALTY, IN THE HOSPITAL'S PRIMARY AND SECONDARY SERVICE AREAS. IN ADDITION, THE SURVEY WAS USED TO CREATE A PHYSICIAN RECRUITMENT STRATEGY FOR THE HOSPITAL AND MEMBERS OF THE MEDICAL STAFF.UTILIZATION STATISTICS AND ANALYSIS:DECISION SUPPORT SOFTWARE WITHIN THE HOSPITAL'S FINANCE DEPARTMENT PROVIDES HISTORICAL AND CURRENT DATA ON THE UTILIZATION OF INPATIENT AND OUTPATIENT SERVICES. STATE HEALTH IMPROVEMENT PLAN PARTNERSHIP (SHIP) DATA:LEWISTOWN HOSPITAL IS A KEY MEMBER OF THE LOCAL SHIP (MIFFLIN -JUNIATA PARTNERS ADVANCING TOMORROW'S HEALTH). THE PURPOSE OF THIS GROUP IS TO SUPPORT THE HEALTH PLANNING INITIATIVES FROM THE PENNSYLVANIA DEPARTMENT OF HEALTH. THIS IS ACCOMPLISHED BY ENGAGING A BROAD SPECTRUM OF LOCAL COMMUNITY INDIVIDUALS AND ORGANIZATIONS WITH INTERESTS AND INFLUENCE ON LOCAL HEALTH STATUS BY WORKING TOGETHER TO PROMOTE EFFECTIVE HEALTH IMPROVEMENT STRATEGIES, INCLUDING PLANNING AND COORDINATION OF LOCAL RESOURCES. MEETINGS ARE HELD BI-MONTHLY. PA DEPARTMENT OF HEALTH STATISTICS:THE PA DEPARTMENT OF HEALTH WEBSITE PROVIDES A WEALTH OF HEALTH STATISTICS AND DATA FOR EACH COUNTY. THIS INCLUDES THE FOLLOWING: * RATES FOR BIRTH, DEATH, CANCER, AND OTHER VITAL STATISTICS * BEHAVIORAL RISK AND INJURY STATISTICS * COMMUNICABLE DISEASES * HEALTH FACILITIES * SCHOOL HEALTH PA DEPARTMENT OF HEALTH BEHAVIORAL RISK FACTOR SURVEY:THE BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (BRFSS) IS AN ANNUAL TELEPHONE SURVEY IMPLEMENTED NATIONWIDE UNDER A GRANT FROM THE CENTERS FOR DISEASE CONTROL AND PREVENTION. SINCE 1989, THE PENNSYLVANIA DEPARTMENT OF HEALTH HAS RELEASED ANNUAL REPORTS USING BRFSS DATA ON VARIOUS HEALTH RISK BEHAVIORS, SUCH AS SMOKING, DRINKING, SEAT BELT USAGE AND HEALTH STATUS.HOW IS ALL OF THE ABOVE INFORMATION PULLED TOGETHER AND UTILIZED?VARIOUS HOSPITAL STAFF MEMBERS ASSIST WITH THE DATA COLLECTION. PRIMARY AND SECONDARY DATA IS ORGANIZED INTO COMPUTER FILES TO MAKE THE INFORMATION EASIER TO USE AND ANALYZE. ONCE THE HOSPITAL HAS THE PRIMARY AND SECONDARY DATA COLLECTED AND IN HAND, THE SENIOR TEAM SPENDS TIME ANALYZING THE DATA TO DISCERN PATTERNS AND THEMES. ASSESSMENT DATA FINDINGS ARE SHARED WITH A VARIETY OF GROUPS INTERNALLY AND EXTERNALLY (MANAGEMENT STAFF, MEDICAL-DENTAL STAFF, BOARD OF TRUSTEES, COMMUNITY ORGANIZATIONS).SINCE SUFFICIENT RESOURCES ARE NOT AVAILABLE TO ADDRESS ALL THE HEALTH CONCERNS IDENTIFIED IN THE ASSESSMENTS, CHOICES MUST BE MADE ABOUT WHICH ISSUES ARE DESIGNATED AS PRIORITIES FOR ACTION IN THE SHORT TO INTERMEDIATE TERM (ONE TO THREE YEARS). IN GENERAL, THE HOSPITAL AIMS FOR THREE TO FOUR PRIORITIES.THE HOSPITAL COLLABORATES WITH OTHER COMMUNITY STAKEHOLDERS TO GAIN A GREATER COMMITMENT TO ACTION. A CONSENSUS IS REACHED WITH INPUT FROM HOSPITAL STAFF, MEDICAL STAFF, THE BOARD OF TRUSTEES, AND COMMUNITY MEMBERS. CRITERIA THAT ARE USED TO IDENTIFY THE MOST SIGNIFICANT HEALTH ISSUES INCLUDE: * THE MAGNITUDE OF THE PROBLEM * THE SEVERITY OF THE PROBLEM * A HIGH NEED AMONG VULNERABLE POPULATIONSCRITERIA THAT ARE USED TO EVALUATE WHICH HEALTH ISSUES THE HOSPITAL SHOULD PRIORITIZE INCLUDE: * THE HOSPITAL'S CAPACITY TO ACT ON THE ISSUE, INCLUDING ECONOMIC, SOCIAL, AND CULTURAL CONSIDERATIONS. * THE FEASIBILITY OF HAVING A MEASURABLE IMPACT ON THE ISSUE * COMMUNITY RESOURCES ALREADY FOCUSED ON THE ISSUE * WHETHER THE ISSUE IS A ROOT CAUSE OF OTHER PROBLEMS (THEREBY POSSIBLY AFFECTING MULTIPLE ISSUES)WHEN THE ISSUES HAVE BEEN PRIORITIZED, THE SENIOR TEAM AND BOARD OF TRUSTEES DISCUSS THE PRIORITIZED LIST AND ASK FOR ADDITIONAL INPUT AND VALIDATION. WHEN A FINAL DECISION IS MADE, A PLAN IS PUT INTO PLACE TO ADDRESS THE PRIORITIES AND IMPROVE COMMUNITY HEALTH. SPECIFIC GOALS HELP FOCUS THE SPECIFIC INTERVENTIONS AND PROVIDE A METHOD FOR VALUING EACH OPTION. PART VI, LINE 3: LEWISTOWN HOSPITAL PRODUCES DAILY REPORTS FOR HIGH TICKET SERVICES THAT IDENTIFY PATIENTS THAT ARE POTENTIALLY UNINSURED. WE CONTRACT WITH A THIRD PARTY THAT EMPLOYS A REPRESENTATIVE ON SITE AT THE HOSPITAL THAT WILL TAKE THE REPORT OF UNINSURED PATIENTS. THE REPRESENTATIVE WILL ATTEMPT TO PERSONALLY VISIT EACH PATIENT WHILE THEY ARE STILL AT THE HOSPITAL TO OUTLINE POSSIBLE OPTIONS. THE PRIMARY OPTION IS USUALLY MAKING AN APPLICATION FOR MEDICAL ASSISTANCE. THE REPRESENTATIVE IS HIGHLY EXPERIENCED IN THE MEDICAL ASSISTANCE APPLICATION PROCESS AND WILL ASSIST THE PATIENT IN COMPLETING THE APPLICATION PROCESS. THIS INCLUDES COMPLETING THE PAPERWORK, COPYING DOCUMENTS, AND EVEN REPRESENTING THE PATIENT AT THE FACE TO FACE INTERVIEW AT THE COUNTY OFFICE IF NECESSARY. POST DISCHARGE, ALL PATIENTS INDICATING THAT THEY ARE UNINSURED WILL RECEIVE A LETTER OFFERING A PROMPT PAY DISCOUNT. THERE ARE CONTACT PHONE NUMBERS ON THE LETTER SHOULD THE PATIENT HAVE ANY QUESTIONS CONCERNING OUR DISCOUNT PROGRAM. TELEPHONE CALLS ARE MADE TO PATIENTS IN AN ATTEMPT TO EXPLAIN OUR DISCOUNT POLICY, THE FACT THAT WE ACCEPT INTEREST FREE TIME PAYMENTS, WE ENCOURAGE PATIENTS TO MAKE APPLICATION FOR MEDICAL ASSISTANCE AND BLUECHIP, AND IF WE DETERMINE THAT THERE TRULY IS AN INDIGENT SITUATION WHERE THERE ARE NO OTHER ALTERNATIVES, WE DO OFFER A CHARITY PROGRAM WHEREBY PATIENTS MAY QUALIFY FOR FREE CARE.IN OUR PATIENT INFORMATION GUIDE, THERE IS WORDING THAT TELLS PATIENTS ABOUT FINANCIAL ASSISTANCE, OUR WEBSITE OFFERS INFORMATION REGARDING FINANCIAL ASSISTANCE, AND WE ALSO MAKE CHARITY CARE APPLICATIONS AVAILABLE AT REGISTRATION POINTS. WE ALSO HAVE TRANSLATORS AVAILABLE IF THE NEED ARISES.THERE ARE SIGNS WITH INFORMATION ABOUT THE FINANCIAL ASSISTANCE POLICY IN THE EMERGENCY DEPARTMENT AND CENTRAL REGISTRATION AREA. BOTH OF THESE AREAS HAVE SIGNS IN ENGLISH AND SPANISH. PART VI, LINE 4: OUR SERVICE AREA IS COMPRISED OF MIFFLIN COUNTY, JUNIATA COUNTY, AND PARTS OF HUNTINGDON AND SNYDER COUNTIES. THIS RURAL AREA CONTAINS SOME 145,000 PEOPLE SPREAD OVER MORE THAN 2,500 SQUARE MILES OF RUGGED TERRAIN LOCATED IN THE HEART OF THE APPALACHIAN MOUNTAINS IN CENTRAL PENNSYLVANIA. THE AVERAGE POPULATION DENSITY IS APPROXIMATELY 60 PERSONS PER SQUARE MILE. THE JUNIATA RIVER RUNS ALONG THE VERDANT VALLEYS AND SLICES THROUGH NARROW MOUNTAIN PASSES TO CONNECT OUR RESIDENTS TOGETHER, WHICH IS WHY OUR AREA IS CALLED THE JUNIATA VALLEY.TRANSPORTATION BARRIERS PLAY A MAJOR ROLE IN ACCESS TO HEALTH CARE IN OUR REGION. THESE NATURAL BARRIERS INCLUDE NARROW ROADS THAT EITHER MEANDER ALONG STREAMS AND CREEKS OR CROSSOVER THE MOUNTAIN RANGES THAT TRAVERSE OUR APPALACHIAN RIDGE REGION. THESE BARRIERS ARE EVEN MORE DAUNTING GIVEN HAZARDOUS WINTER DRIVING CONDITIONS CAUSED BY SNOW OR ICE COVERED ROADS. LOW-INCOME AND SENIOR CITIZENS ALSO FACE TRANSPORTATION ISSUES, AS THERE IS NO PUBLIC TRANSPORTATION IN OUR SERVICE AREA. SENIOR CITIZENS AND MEDICAID-ELIGIBLE PERSONS CAN USE THE "CARS" VAN SYSTEM FOR TRANSPORTATION TO REGULARLY SCHEDULED APPOINTMENTS WITH A WEEKS' NOTICE BUT NOT FOR URGENT OR EMERGENCY CARE. LOW INCOME CITIZENS HAVE NO ACCESS TO ANY PUBLIC TRANSPORTATION AT ALL IN OUR COMMUNITY. IF A TRIP TO A SPECIALIST IS REQUIRED THE MAJOR SUPPORT HOSPITALS ARE OVER ONE AND HALF HOURS DRIVE AWAY (IN THE SUMMER).THE POPULATION OF OUR TOTAL SERVICE AREA IS JUST ABOUT 145,000 PERSONS BASED ON 2010 US CENSUS DATA. MIFFLIN COUNTY HAS A RELATIVELY FLAT GROWTH RATE WITH A POPULATION CHANGE OF 0.4% FROM 2000 TO 2010. JUNIATA COUNTY, ON THE OTHER HAND, HAS SEEN SIGNIFICANT GROWTH WITH A 10.6% INCREASE IN POPULATION FROM 2000 TO 2010. IT IS BELIEVED THAT THIS GROWTH IS MOSTLY COMING FROM PEOPLE WHO WORK IN THE NEARBY HARRISBURG AREA WHO ARE LOOKING FOR A LOWER COST OF LIVING. WITH THE RECENT COMPLETION OF A NEW FOUR-LANE HIGHWAY NORTH OF HARRISBURG, THE COMMUTE TO HARRISBURG HAS BECOME MORE CONVENIENT RESULTING IN AN INCREASE IN JUNIATA COUNTY'S POPULATION AS PEOPLE MOVE FURTHER AWAY FROM THE URBAN AREAS TO LIVE IN THE COUNTRY. HIGHER GROWTH IN FULTON COUNTY IS EXPLAINED BY MIGRATION FROM MARYLAND AS PEOPLE TRY TO MOVE AWAY FROM HIGHER HOUSING COSTS IN MARYLAND. HUNTINGDON COUNTY'S GROWTH IS MOSTLY OCCURRING IN THE NORTHERN PORTION OF THE COUNTY THAT IS CLOSE ENOUGH TO STATE COLLEGE TO ALLOW RESIDENTS TO COMMUTE TO PENN STATE UNIVERSITY. THESE GROWTH RATES ARE STILL VERY LOW WHEN COMPARED TO A NATIONAL GROWTH RATE OF OVER 13%.OTHER IMPORTANT DEMOGRAPHIC STATISTICS ARE OUTLINED IN THE CHART BELOW.STATISTICS: MIFFLIN COUNTY(MC), JUNIATA COUNTY(JC), PENNSYLVANIA(PA)POPULATION: 46,682(MC), 24,636(JC), 12,702,379(PA)POPULATION LESS THAN 18 YEARS OF AGE: 23.1%(MC), 24%(JC), 22%(PA)AGE 65 AND UP: 18.5%(MC), 16.8%(JC), 15.4%(PA)PERCENTAGE OF POPULATION BELOW THE POVERTY LEVEL (2010): 16.6%(MC), 11.1%(JC), 13.4% (PA)POVERTY RATE FOR CHILDREN UNDER AGE 18 (2010): 28.1%(MC), 18.0%(JC), 18.9%(PA)MEDIAN HOUSEHOLD INCOME: $37,163(MC), $45,810(JC), $49,245(PA)UNINSURED ADULTS (2010): 19.1%(MC), 18.7%(JC), 14.5%(PA)UNEMPLOYMENT RATE (2010): 9.5%(MC), 7.7%(JC), 8.4%(PA)MIFFLIN COUNTY'S 65 AND OVER AGE GROUP IS 18.5 PERCENT (2010), WHILE JUNIATA COUNTY'S IS 16.8%, HUNTINGDON COUNTY'S, 16.2% AND FULTON COUNTY'S 17.1%. THE PENNSYLVANIA AVERAGE FOR THIS STATISTIC IS 15.4%. BOTH MIFFLIN AND JUNIATA COUNTIES HAVE HIGHER PERCENTAGES OF PERSONS LESS THAN 18 YEARS OF AGE, 23.1% AND 24.0% RESPECTIVELY, THAN THE PA AVERAGE OF 22.0%. BOTH OF THESE GROUPS REQUIRE MORE HEALTH CARE RESOURCES THAN OTHER AGE GROUPS IN OUR COMMUNITY. MIFFLIN COUNTY HAS 16.6% OF THE POPULATION WITH INCOME BELOW THE POVERTY LINE AND 28.1% OF CHILDREN UNDER 18 LIVING IN POVERTY. JUNIATA COUNTY HAS 11.1% OF THE POPULATION WITH INCOME BELOW THE POVERTY LINE, WHILE HUNTINGDON AND SNYDER COUNTIES ARE 13% AND 14% RESPECTIVELY. PER CAPITA PERSONAL INCOME (2009) FOR THE FOUR MAIN COUNTIES IN OUR SERVICE AREA ARE AS FOLLOWS: MIFFLIN $28.3K, JUNIATA $30.3K, HUNTINGDON $27.6K, AND SNYDER $30.8K. THE PERCENTAGES OF THE POPULATIONS WHO ARE UNINSURED (IN THE 18-64 AGE RANGE) FOR THOSE COUNTIES ARE AS FOLLOWS: MIFFLIN 19%, JUNIATA 19%, HUNTINGDON 19%, AND SNYDER 16%. DURING THE FISCAL YEAR 2013, APPROXIMATELY 14.1% OF OUR PATIENT POPULATION WAS MEDICAL ASSISTANCE, WHILE ANOTHER 3.8% WERE SELF PAY.THERE IS ONE OTHER HOSPITAL LOCATED WITHIN THE SERVICE AREA DESCRIBED ABOVE, JC BLAIR MEMORIAL HOSPITAL IN HUNTINGDON, PA. THERE ARE ALSO SEVERAL OTHER HOSPITALS LOCATED IN AREAS SURROUNDING OUR SERVICE AREA. THESE INCLUDE MT. NITTANY MEDICAL CENTER IN STATE COLLEGE, PA; GEISINGER MEDICAL CENTER IN DANVILLE, PA; HOLY SPIRIT HOSPITAL IN CAMP HILL, PA; THE PENN STATE MILTON S. HERSHEY MEDICAL CENTER IN HERSHEY, PA; AND SEVERAL CAMPUSES OF PINNACLE HEALTH IN THE HARRISBURG, PA AREA.THERE ARE ALSO SEVERAL FEDERALLY-DESIGNATED MEDICALLY UNDERSERVED AREAS WITHIN OUR SERVICE AREA. THERE ARE TWO LOCATED IN MIFFLIN COUNTY, ONE IN JUNIATA COUNTY, AND FOUR IN HUNTINGDON COUNTY.THE ADULT BEHAVIORAL HEALTH RISK FACTORS SURVEY (2008-2010) SHOWS THE FOLLOWING STATISTICS FOR THE POPULATION LIVING IN MIFFLIN AND JUNIATA COUNTIES:RISK FACTORS : PERCENTFAIR OR POOR GENERAL HEALTH: 16%OBESE: 31%OVERWEIGHT (INCLUDES OBESE): 66%EVER TOLD THEY HAD DIABETES: 11%CURRENTLY HAS ASTHMA: 10%CURRENT SMOKER: 19%FOR MIFFLIN AND JUNIATA COUNTIES, THE HEALTH PROFILE 2013 FROM THE PA DEPARTMENT OF HEALTH SHOWS THE MAJOR CAUSES OF DEATH ARE DISEASES OF THE HEART, CANCER, STROKE, AND CHRONIC LOWER RESPIRATORY DISEASES. PROSTATE CANCER RANKS AS NUMBER ONE FOR THE HIGHEST INCIDENCE OF CANCER, FOLLOWED BY FEMALE BREAST CANCER. RANKING THIRD AND FOURTH ON THE LIST ARE LUNG CANCER AND COLON CANCER, RESPECTIVELY. PART VI, LINE 5: ALL OF THE ORGANIZATION'S BOARD MEMBERS RESIDE WITHIN THE ORGANIZATION'S PRIMARY SERVICE AREA. KAY HAMILTON, THE PRESIDENT, IS THE ONLY EMPLOYEE ON THE BOARD AND NONE OF THE BOARD MEMBERS ARE FAMILY MEMBERS OF EMPLOYEES WITHIN THE ORGANIZATION.THE ORGANIZATION EXTENDS STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE AREA.ANNUALLY DURING THE BUDGET PROCESS, A CASH FORECAST IS PREPARED TO DETERMINE THE AMOUNT OF CASH AVAILABLE FOR CAPITAL PURCHASES. CAPITAL REQUESTS ARE MADE BY MANAGEMENT OF THE ORGANIZATION DURING THE BUDGET PROCESS AS WELL. REQUESTS ARE REVIEWED AND APPROVED BY THE MEDICAL EXECUTIVE COMMITTEE ONCE ALL OF THE REQUESTS ARE COMPLETE. THE AMOUNT DETERMINED TO BE AVAILABLE AND APPROVED IS SET ASIDE INTO A FUNDED DEPRECIATION ACCOUNT IN WEEKLY INSTALLMENTS OVER THE COURSE OF THE FISCAL YEAR. LEWISTOWN HOSPITAL IS WHOLLY DEDICATED TO THE LIVES, HEALTH AND WELL-BEING OF THE INDIVIDUALS IN OUR COMMUNITY. ENSURING THAT ADEQUATE CAPITAL EQUIPMENT IS AVAILABLE TO PROVIDE THE BEST TREATMENT POSSIBLE FOR OUR PATIENTS IS AN EXAMPLE OF THAT DEDICATION. PART VI, LINE 6: WHILE NOT PART OF A HEALTH SYSTEM PER SE, LEWISTOWN HOSPITAL IS A PART OF THE LEWISTOWN HEALTHCARE FOUNDATION NETWORK OF RELATED ORGANIZATIONS. THE ROLE OF THE HOSPITAL AND ITS AFFILIATED ORGANIZATIONS ARE AS FOLLOWS:LEWISTOWN HOSPITAL:LEWISTOWN HOSPITAL IS A 123-BED ACUTE CARE COMMUNITY HOSPITAL SERVING THE RESIDENTS OF MIFFLIN AND JUNIATA COUNTIES AND MEMBERS OF THE SURROUNDING COUNTIES OF SNYDER, AND HUNTINGDON. ESTABLISHED IN 1905, THE HOSPITAL PROVIDES INPATIENT, OUTPATIENT, WELLNESS AND COMMUNITY SERVICES WHILE EMPLOYING OVER 1,000 FULL-TIME AND PART-TIME EMPLOYEES AND PROVIDING A MEDICAL STAFF CONSISTING OF 128 PHYSICIANS AND ALLIED HEALTH PRACTITIONERS REPRESENTING SPECIALTIES RANGING FROM FAMILY MEDICINE, INTERNAL MEDICINE, AND CARDIOLOGY TO INFECTIOUS DISEASE AND GENERAL/CARDIOVASCULAR SURGERY.THE MISSION OF LEWISTOWN HOSPITAL IS TO PROVIDE PERSONAL, HIGH-QUALITY ECONOMICAL HEALTHCARE FOR OUR COMMUNITIES.85% OF COMMUNITY BENEFIT ACTIVITIES ARE CONTRIBUTED THROUGH LEWISTOWN HOSPITAL. FAMILY HEALTH ASSOCIATES OF LEWISTOWN HOSPITAL (FHA):FHA, A PENNSYLVANIA NON-PROFIT CORPORATION, IS A MULTI-SPECIALTY PHYSICIAN/PRACTITIONER GROUP LOCATED IN CENTRAL PENNSYLVANIA. OUR PHYSICIANS ARE BOARD-CERTIFIED OR BOARD ELIGIBLE IN PRIMARY CARE AS WELL AS MANY SPECIALTY AREAS INCLUDING GENERAL SURGERY, PULMONARY MEDICINE, SLEEP MEDICINE, AND WEIGHT LOSS AND NUTRITION. WE ARE DEDICATED TO OUR MISSION OF PROVIDING PERSONAL, HIGH QUALITY, ECONOMICAL HEALTH CARE THAT MEETS THE NEEDS OF OUR COMMUNITIES. FHA STAFF PARTICIPATES IN COMMUNITY HEALTH FAIRS AND SCREENINGS. SEVERAL PHYSICIANS ALSO PARTICIPATE IN MENTORSHIP PROGRAMS FOR INTERNS AND RESIDENTS. 10% OF COMMUNITY BENEFIT ACTIVITIES ARE CONTRIBUTED THROUGH FHA. LEWISTOWN AMBULATORY CARE CORPORATION (LACC):LACC IS A PENNSYLVANIA NON-PROFIT ORGANIZATION THAT IS MAINLY A REAL ESTATE HOLDING COMPANY THAT OWNS AND/OR MANAGES THE NON-HOSPITAL REAL ESTATE ASSETS INCLUDING A MEDICAL OFFICE BUILDING THAT IS ATTACHED TO THE HOSPITAL. HEALTH ENTERPRISES, INC. (HEI):HEI, A PENNSYLVANIA FOR-PROFIT ENTITY, THE ONLY ONE WITHIN THE LEWISTOWN HEALTHCARE FOUNDATION. THE MAIN PURPOSE OF HEI IS THE OPERATION OF OUR FOUR TOTAL LIFE CARE PHARMACIES (TLC PHARMACY). WE HAVE TAKEN THE ROAD LESS TRAVELED, LITERALLY, IN DETERMINING OUR SERVICE SITES. NOTICE THAT THEY ARE LOCATED IN THE MORE RURAL AREAS THROUGHOUT THE JUNIATA VALLEY TO PROVIDE CONVENIENCE AND CLOSE PROXIMITY TO OUR PHYSICIAN PRACTICES IN FAMILY HEALTH ASSOCIATES. 5% OF COMMUNITY BENEFIT ACTIVITIES ARE CONTRIBUTED THROUGH HEI. LEWISTOWN HEALTHCARE FOUNDATION (LHF):LHF, IS A PENNSYLVANIA NON-PROFIT MEMBERSHIP CORPORATION. LEWISTOWN HOSPITAL IMPLEMENTED A CORPORATE REORGANIZATION PLAN IN 1985, ESTABLISHING LHF AS THE PARENT COMPANY OF WHICH LEWISTOWN HOSPITAL IS ONE OF ITS SUBSIDIARIES. REPORTS FILED WITH STATES PART VI, LINE 7 PA 1 LEWISTOWN HEALTHCARE FOUNDATION 400 HIGHLAND AVENUE LEWISTOWN PA 17044 232344363 501(C)(3) 4046008 CASH N/A NET ASSET TRANSFER TO FUND OPERATIONS OF RELATED ENTITIES - FAMILY HEALTH ASSOCIATES OF LEWISTOWN HOSPITAL & LEWISTOWN AMBULATORY CARE CORP. 1 0 EDUCATIONAL SCHOLARSHIPS 10 12000 CASH N/A PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: FUNDS WERE PROVIDED TO A RELATED ORGANIZATION UNDER COMMON MANAGEMENT TO SUPPORT OPERATIONS. THE PARTNERS IN EDUCATION SCHOLARSHIP IS A SCHOLARSHIP PROGRAM FOR EMPLOYEES OF LEWISTOWN HOSPITAL OR AN AFFILIATE WHO IS PURSUING A DIPLOMA, ASSOCIATES, BACHELORS, OR MASTERS DEGREE IN A HEALTH CARE RELATED FIELD. THE FUNDING FOR THIS IS MADE POSSIBLE THROUGH NET PROCEEDS FROM THE HOSPITAL GIFT SHOP. APPLICANTS MUST MEET CERTAIN CRITERIA AND WRITE A MINIMUM TWO-PAGE ESSAY. THE APPLICATIONS AND ESSAYS ARE REVIEWED BY THE SCHOLARSHIP COMMITTEE WHICH IS COMPRISED OF 3 DIRECTOR LEVEL EMPLOYEES OF THE HOSPITAL. FINALISTS ARE AWARDED $1,000 EACH BY JUNE 1 OF EACH YEAR. THE SOPHIE SNOOK SCHOLARSHIP PROGRAM IS A SCHOLARSHIP PROGRAM IN MEMORY OF SOPHIE SNOOK, THE FIRST GRADUATE OF LEWISTOWN HOSPITAL SCHOOL OF NURSING. APPLICANTS MUST BE EITHER A FULL, PART-TIME, OR RELIEF EMPLOYEE FROM ANY DEPARTMENT OF THE HOSPITAL WHO IS PURSUING A SECONDARY DIPLOMA, CERTIFICATE OR DEGREE RELATING TO PATIENT CARE, OR A STUDENT WHO HAS BEEN ACCEPTED INTO THE LEWISTOWN HOSPITAL SCHOOL OF NURSING. APPLICANTS MUST MEET CERTAIN OTHER CRITERIA AND WRITE A MINIMUM TWO-PAGE ESSAY. THE APPLICATIONS AND ESSAYS ARE REVIEWED BY THE SCHOLARSHIP COMMITTEE WHICH IS COMPRISED OF MEMBERS OF THE FRIENDS OF LEWISTOWN HOSPITAL, FORMERLY THE LEWISTOWN HOSPITAL AUXILIARY. THE RECIPIENTS BY JULY 1 OF EACH YEAR. PROCEEDS TO FUND THE PROGRAM COME FROM THE FUNDRAISING ACTIVITIES OF THE FRIENDS OF LEWISTOWN HOSPITAL. X X X X X 0 0 0 0 0 0 0 0 0 KAY A HAMILTON 287716 0 0 0 590 0 38250 0 10340 0 336896 0 0 0 RANDY TEWKSBURY 192405 0 0 0 566 0 30199 0 20507 0 243677 0 0 0 KIRK E THOMAS 144694 0 0 0 175 0 22825 0 24086 0 191780 0 0 0 NANCY S REINKE 120430 0 0 0 473 0 19342 0 25112 0 165357 0 0 0 RONALD M COWAN 121085 0 0 0 267 0 18950 0 15340 0 155642 0 0 0 CHRISTINE W MATHEWS 141434 0 0 0 684 0 21744 0 6221 0 170083 0 0 0 NALIN G PATEL 324711 0 0 0 83158 0 0 0 20478 0 428347 0 0 0 RICHARD F STOMACKIN 152019 0 0 0 1271 0 23453 0 6303 0 183046 0 0 0 LEWIS D ALLSHOUSE III 127120 0 0 0 663 0 20215 0 12772 0 160770 0 0 0 DESHAUN RICHARDS 121028 0 0 0 116 0 19056 0 19065 0 159265 0 0 0 KEITH S GRAHAM 115009 0 0 0 79 0 18230 0 23566 0 156884 0 0 0 A MIFFLIN COUNTY HOSPITAL AUTHORITY 231352187 598520CE2 2007-06-13 21723377 REFUNDING ON AN ADVANCE BASIS A PORTION ($19,775,000) OF SERIES 2000 BONDS 0 0 0 A 21723377 1722381 434648 19561939 4589 0 1 1 1 A 0 0 0 1 0 0 0 0 0 A 0 SCHEDULE K PART IV, ARBITRAGE, LINE 2C DATE REBATE COMPUTATION PERFORMED ISSUER NAME: MIFFLIN COUNTY HOSPITAL AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 06/13/2013 GAYLE COWAN DIRECTOR/MANAGER OF THE EDUCATION DEPARTMENT, WIFE OF RONALD COWAN, CIO 85483 WAGES AND BENEFITS PAID TO GAYLE COWAN 0 GURPREET S BHALLA MD BOARD MEMBER/PROPRIETOR OF PENN ANESTHESIA 320000 CONTRACTUAL AGREEMENT WITH LH TO PROVIDE ANESTHESIA SERVICES TO THE HOSPITAL. THE BOARD MEMBERSHIP OF GURPREET S. BHALLA, MD CEASED ON NOVEMBER 1, 2013 WITH THE ACQUISITION OF THE ORGANIZATION BY GEISINGER HEALTH SYSTEM FOUNDATION. 0 FORM 990, PART VI, SECTION A, LINE 2 DIANE SPOKUS, VICE CHAIR OF THE BOARD, EMPLOYED BY PENN STATE UNIVERSITY AS A PROFESSOR OF HPA AND CATHERINE STOUT, BOARD MEMBER, EMPLOYED BY PENN STATE UNIVERSITY AS AN ASSISTANT DONALD CHAPMAN, SR., SECRETARY OF THE BOARD, IS MIFFLIN COUNTY INDUSTRIAL DEVELOPMENT CORPORATION (MCIDC) FIRST PRESIDENT, WHILE KAY HAMILTON, PRESIDENT OF THE BOARD AND JON ZIMMERMAN, BOARD MEMBER, ARE ALSO BOTH BOARD MEMBERS OF MCIDC. JAMES SHILLING, JR., BOARD MEMBER AND OKSANA DEARMENT, EX-OFFICIO BOARD MEMBER, ARE BOTH EMPLOYED BY KISH BANK. JAMES IS AN EXECUTIVE VP WHILE OKSANA IS AN AVP IN THE ADMIN. SERVICES GROUP. FORM 990, PART VI, SECTION B, LINE 11 A FINAL DRAFT REVIEWED BY THREE LEVELS OF FINANCE STAFF WAS PRESENTED TO THE BOARD FOR REVIEW PRIOR TO BEING FILED. THE BOARD REVIEWED PRIOR TO MEETING AT A REGULARLY SCHEDULED MEETING AND DEVELOPED QUESTIONS TO BE ASKED AT THE MEETING. ANY QUESTIONS SUBMITTED BY THE BOARD WERE RESEARCHED WITH THE PREPARER AND FINAL RESOLUTION WAS COMMUNICATED BACK TO THE BOARD BY THE FINANCE STAFF. FORM 990, PART VI, SECTION B, LINE 12C THE CHAIR OF THE LHF BOARD IS RESPONSIBLE FOR BEING FAMILIAR WITH ALL DISCLOSURE STATEMENTS IN ORDER TO GUIDE CONDUCT SHOULD CONFLICT ARISE. ALL MEMBERS AND KEY EMPLOYEES ARE ALSO RESPONSIBLE FOR UNDERSTANDING WHAT POTENTIAL CONFLICTS ARE AND SUBMITTING AN UPDATED DISCLOSURE STATEMENT IF CONFLICTING SITUATIONS ARISE. PER POLICY, PERIODIC REVIEWS ARE CONDUCTED BY LHF BOARD TO DETERMINE WHETHER COMPENSATION ARRANGEMENTS AND BENEFITS ARE REASONABLE; ACQUISITIONS OR OTHER ARRANGEMENTS WITH PROVIDERS DON'T RESULT IN ANY CONFLICTS; PARTNERSHIP AND JOINT VENTURE ARRANGEMENTS AND ANY ARRANGEMENTS WITH OTHER ORGANIZATIONS CONFORM TO WRITTEN POLICIES; AND ANY AGREEMENTS TO PROVIDE HEALTH CARE ENTERED INTO DO NOT RESULT IN INUREMENT OR IMPREMISSIBLE PRIVATE BENEFIT. ON AN ANNUAL BASIS, A CONFLICT OF INTEREST DISCLOSURE STATEMENT MUST BE SUBMITTED IN WRITING TO THE CEO. THE CEO, BOARD CHAIR AND CORPORATE COMPLIANCE OFFICER REVIEW AND MAINTAIN THE DISCLOSURE STATEMENTS. MEMBERS ARE REQUIRED TO ABSTAIN FROM VOTING ON MATTERS INVOLVING POTENTIAL CONFLICTS. FAILURE TO COMPLY WITH THE POLICY SHALL CONSTITUTE GROUNDS FOR REMOVAL FROM THE BOARD OR TERMINATION OF EMPLOYMENT. FORM 990, PART VI, SECTION B, LINE 15 THE SENIOR EXECUTIVE STAFF INCLUDES THE CEO AND OTHER KEY EMPLOYEES. THE SENIOR EXECUTIVE STAFF HAS THEIR SALARIES, RESPONSIBILITIES ANALYZED BY AN OUTSIDE CONSULTANT SPECIALIZING IN THE EXECUTIVE COMPENSATION AREA. RECOMMENDATIONS BASED ON THE ANALYSIS ARE THEN BROUGHT TO THE BOARD. THE BOARD DETERMINES ACTUAL INCREASES BASED ON THE RECOMMENDATIONS AND FINANCES OF THE HOSPITAL. THIS ANNUAL REVIEW AND APPROVAL PROCESS IS DOCUMENTED IN THE BOARD MINUTES. FORM 990, PART VI, SECTION C, LINE 19 AN ANNUAL REPORT IS AVAILABLE TO THE PUBLIC VIA THE ORGANIZATION'S WEBSITE. THIS REPORT SHOWS THE ANNUAL CONSOLIDATED STATEMENT OF OPERATIONS AND A CONSOLIDATED BALANCE SHEET. IT ALSO SHOWS ANNUAL OPERATING STATISTICS AND LISTS THE NAMES OF BOARD MEMBERS, SENIOR EXECUTIVE STAFF, AND THE MEMBERS OF THE MEDICAL EXECUTIVE COMMITTEE. CURRENTLY, THE GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT MADE AVAILABLE TO THE PUBLIC. THIS INFORMATION IS CONSIDERED PROPRIETARY AND IS NOT LEGALLY REQUIRED TO BE MADE AVAILABLE TO THE GENERAL PUBLIC. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: VALUATION LOSS -3,100. PENSION LIABILITY ADJUSTMENT 8,205,104. LEWISTOWN AMBULATORY CARE CORPORATION 400 HIGHLAND AVENUE LEWISTOWN PA 17044 232344362 TO DEVELOP AND RENT REAL ESTATE TO ITS AFFILIATES PA 501(C)(3) 11B LEWISTOWN HEALTHCARE FOUNDATION 0 LEWISTOWN HEALTHCARE FOUNDATION 400 HIGHLAND AVENUE LEWISTOWN PA 17044 232344363 TO CONDUCT FUNDRAISING AND GRANT-MAKING ACTIVITIES TO BENEFIT RELATED ORGS. PA 501(C)(3) 11B N/A 0 FAMILY HEALTH ASSOCIATES OF GEISINGER - LEWISTOWN HOSPITAL 400 HIGHLAND AVENUE LEWISTOWN PA 17044 251651582 TO EMPLOY PRIMARY CARE PHYSICIANS AND PROVIDE HEALTHCARE SERVICES PA 501(C)(3) 11B LEWISTOWN HEALTHCARE FOUNDATION 0 HEALTH ENTERPRISES INC 400 HIGHLAND AVENUE LEWISTOWN PA 17044 232353212 HEALTHCARE PA N/A C 0 0 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 1 1 1