2014-02-10T15:37:25-06:00 2013-06-30 250988255 CARBIS WALKER LLP 5700 CORPORATE DRIVE STE 650 PITTSBURGH PA 15237 990 2012-07-01 250977902 MINERS HOSPITAL MINE 8142473100 290 HAIDA AVENUE HASTINGS PA 16646 EDWARD DEPASQUALE 8142473100 2014-01-30 1 JEFFREY J PETRELL CPA P00138808 4126356270 2014-01-30 2012 2015-11-30 17:44:51Z MINERS MEDICAL CENTER SCOTT BECKER 1086 FRANKLIN STREET JOHNSTOWN PA 15905 16759232 0 X WWW.CONEMAUGH.ORG X 1905 PA TO PROVIDE QUALITY HEALTH CARE TO ANY PERSON REGARDLESS OF RACE, COLOR, CREED, NATIONAL ORIGIN, AGE, SEX, HANDICAP AND/OR ABILITY TO PAY. 14 8 176 9 0 0 43068 40873 18579880 16606201 4371 3011 281748 109147 18909067 16759232 0 0 0 0 8104011 7855621 0 0 0 9403592 8991390 17507603 16847011 1401464 -87779 7296886 6216685 13397728 10437050 -6100842 -4220365 X TO PROVIDE QUALITY HEALTH CARE TO ANY PERSON REGARDLESS OF RACE, COLOR, CREED, NATIONAL ORIGIN, AGE, SEX, HANDICAP AND/OR ABILITY TO PAY. 0 0 13291969 16715348 MINERS HOSPITAL IS A COMMUNITY HOSPITAL SERVING FAMILIES ACROSS RURAL NORTHERN CAMBRIA COUNTY IN SOUTHWESTERN PENNSYLVANIA. THE HOSPITAL SPECIALIZES IN FAMILY AND PRIMARY CARE AND HAS 30 BEDS FOR MEDICAL/SURGICAL AND INTENSIVE CARE SERVICES. OTHER SERVICES INCLUDE: COMPREHENSIVE OUTPATIENT SERVICES; 24/7 EMERGENCY DEPARTMENT; 24/7 LABORATORY; ONSITE PHARMACY; OPERATING SUITE FOR SHORT OR MINOR PROCEDURES; RADIOLOGY SERVICES, INCLUDING MOBILE MRI AND CT SCANS, DIGITAL MAMMOGRAPHY, AND ULTRASOUND; PATHOLOGY SERVICES; PHYSICAL THERAPY; RESPIRATORY THERAPY; AND OB/GYN OUTPATIENT CARE. DURING THE FISCAL YEAR ENDING JUNE 30, 2013, THE HOSPITAL ADMITTED 533 PATIENTS; HAD 10,283 EMERGENCY VISITS; AND PERFORMED 2,026 SURGICAL PROCEDURES. 13291969 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 37 0 1 176 1 0 0 0 0 0 0 0 0 0 0 X 14 8 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 PA X EDWARD DEPASQUALE 8144108271 1086 FRANKLIN STREET JOHNSTOWN PA 15905 FRANK QUITONI 1.00 2.00 X X 0 0 0 SAMUEL MCCLURE 1.00 2.00 X X 0 0 0 PATTI STEFANICK DO 1.00 4.00 X X 0 25000 0 ALAN STANKIEWICZ DO 1.00 2.00 X X 0 0 0 WILLIAM DURYEA 1.00 2.00 X X 0 0 0 ELMER LASLO 1.00 2.00 X 0 0 0 THOMAS MARINO 1.00 2.00 X 0 0 0 KEVIN MILLER 1.00 2.00 X 0 0 0 WILLIAM POLACEK 1.00 2.00 X 0 0 0 NATHAN THOMAS MD 1.00 43.00 X 0 168144 30924 JAMES TRETTER DO 1.00 73.00 X 0 599165 38064 SHIBAN WARIKOO MD 1.00 42.00 X 0 313454 22390 STEVEN TUCKER 3.00 50.50 X X 0 444155 32796 SCOTT BECKER 1.00 69.00 X X 0 874726 35496 EDWARD DEPASQUALE 1.00 49.00 X 0 441373 31177 DAVID CARLSON DO 4.00 46.50 X 0 539348 28020 JOSEPH DADO 2.00 51.00 X 0 352918 15945 WILLIAM CROWE 50.00 X 187852 0 25790 187852 3758283 260602 1 0 1 0 MEMORIAL MEDICAL CENTER 1086 FRANKLIN STREET JOHNSTOWN PA 15905 FINANCIAL, IT, LAB, CLINICAL/SUPPORT DEP 1583251 CONEMAUGH HEALTH INITIATIVES 1086 FRANKLIN STREET JOHNSTOWN PA 15905 PHYSICIANS, OFFICE STAFF, COLLECTION 665780 WESTERN HEALTHCARE PO BOX 203152 DALLAS TX 75320 ER PHYSICIANS 303671 SAFARI CONTRACT CLEANERS 111 ROOSEVELT BOULEVARD JOHNSTOWN PA 15906 CLEANING 252794 ALLIANCE HEALTHCARE SERVICES PO BOX 96485 CHICAGO IL 60693 MRI 213260 8 33295 7578 40873 PATIENT SERVICES 900099 16582621 16582621 MEDICAL SERVICE ROOM REVENUE 900099 19862 19862 RENTAL INCOME 900099 3718 3718 16606201 3011 3011 CAFETERIA SALES 900099 82828 82828 PHARMACY SALES 900099 13121 13121 P-CARD REBATES 900099 7538 7538 5660 5660 109147 16759232 16715348 0 3011 217014 217014 5410918 4730272 680646 887631 775967 111664 933749 816283 117466 406309 355195 51114 301008 301008 6215 6215 900 900 6283 6283 1303184 1268452 34732 6005 -38 6043 69035 50099 18936 19668 19668 530779 444206 86573 19477 17692 1785 10034 5987 4047 138095 138095 433021 356766 76255 340444 297616 42828 PURCHASED SERVICES 2646739 1365362 1281377 PATIENT CARE SUPPLIES 1548041 1541708 6333 MAINTENANCE 657545 533511 124034 BAD DEBT 231583 231583 723334 363213 360121 16847011 13291969 3555042 0 1456 987 1455111 1071613 2189676 1711125 484660 473315 59533 69462 17487188 14726241 2918490 2760947 187960 129236 7296886 6216685 7762501 5800708 125803 95161 3494453 3191545 2014971 1349636 13397728 10437050 X -6190647 -4321245 89805 100880 -6100842 -4220365 7296886 6216685 X -87779 1611 1966645 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 900 900 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: THE HOSPITAL PAID ANNUAL DUES TO THE HOSPITAL COUNCIL OF WESTERN PA (HCWP), A 501(C)(6) CORPORATION. ACCORDING TO HCWP, FIFTEEN PERCENT OF DUES WERE UTILIZED FOR LOBBYING AND PUBLIC POLICY DEVELOPMENT. 102879 102879 7885346 6561383 1323963 8271994 7123526 1148468 1226969 1041332 185637 2760947 DUE TO CONEMAUGH HEALTH SYSTEM 66415 DUE TO MEDICARE 231239 DUE TO MEMORIAL MEDICAL CENTER 979824 DUE TO CONEMAUGH HEALTH INITIATIVES, INC. 72158 1349636 1 1 X 1 X 0 1 1 1 0 1 1 603271 603271 0.03630 1692902 1311102 381800 0.02300 19707 10039 9668 0.00060 2315880 1321141 994739 0.05990 1397 1397 0.00010 3113 3113 0.00020 4510 4510 0.00030 2320390 1321141 999249 0.06020 0 74076 0 4247069 4760610 -513541 X 1 1 1 1 MINERS HOSPITAL

290 HAIDA AVENUE HASTINGS PA 16646

WWW.CONEMAUGH.ORG X X X MINERS HOSPITAL 1 1 X X X X X X X X 12 1 1 1 X X X X X X X X X 0 0 1 1 200.000000000000 0 1 X X 1 1 X X X 1 0 1 X 0 0 PART I, LINE 3C: FEDERAL POVERTY GUIDELINES (FPG) ARE USED TO DETERMINE ELIGIBILITY FOR FREE CARE. HOWEVER, FPG ARE NOT USED WHEN MAKING A DETERMINATION FOR DISCOUNTED CARE. IN THESE CASES, ALL SELF-PAY, UNINSURED PATIENTS ARE OFFERED A 60% DISCOUNT OFF OF CHARGES. PART I, LINE 7: THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS REPORTED ON PART I, LINES 7A, 7B, AND 7C WAS BASED ON THE CONEMAUGH HEALTH SYSTEM'S COST ACCOUNTING SYSTEM AND ADDRESSES ALL PATIENT SEGMENTS. FOR FURTHER DETAILS OF THIS SYSTEM, SEE THE DESCRIPTION FOR PART III, LINE 8. THE METHODOLOGY USED TO CALCULATE THE AMOUNTS REPORTED ON PART I, LINES 7E THROUGH 7I AS APPLICABLE, WAS BASED ON ACTUAL REVENUES AND EXPENSES INCURRED. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 231583. PART III, LINE 4: PART III, LINE 2: THE METHODOLOGY UTILIZED TO DETERMINE THE AMOUNT REPORTED AS BAD DEBT IS BASED ON THE DESCRIPTIONS CONTAINED IN THE FOOTNOTES DETAILED UNDER PART III, LINE 4. THESE PROCESSES ARE FOLLOWED TO SUPPORT THE AMOUNT OF BAD DEBT REPORTED ON THE FINANCIAL STATEMENTS, WHICH IS REPORTED AT CHARGES. THE ORGANIZATION'S COST TO CHARGE RATIO IS THEN USED TO CALCULATE THE AMOUNT OF BAD DEBT AT COST, SHOWN ON LINE 2. PART III, LINE 3: THE AMOUNT REPORTED ON LINE 3 IS ZERO AS THERE IS NO PORTION OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY. CHS HAS IMPLEMENTED A SCORING SYSTEM BASED ON FEDERAL POVERTY GUIDELINES THAT SEGREGATES PATIENT BALANCES THAT ARE WRITTEN OFF TO PRESUMPTIVE CHARITY CARE, RATHER THAN BEING SENT TO COLLECTION. THIS HAS RESULTED IN MOVING PATIENTS OUT OF BAD DEBT STATUS THAT WOULD OTHERWISE BE PRESUMED TO BE ELIGIBLE UNDER THE CHS FINANCIAL ASSITANCE POLICY.PART III, LINE 4: PATIENT ACCOUNTS RECEIVABLE FOOTNOTE - ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, CHS ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYER SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYER SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, CHS ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE WHERE THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL, CHS RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE DISCOUNTED RATES PROVIDED BY POLICY AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. CHS' ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR SELF-PAY PATIENTS DECREASED FROM 86 PERCENT OF SELF-PAY ACCOUNTS RECEIVABLE AT JUNE 30, 2012 TO 85 PERCENT OF SELF-PAY ACCOUNTS RECEIVABLE AT JUNE 30, 2013. IN ADDITION, CHS' WRITE-OFFS DECREASED APPROXIMATELY $5,514,000 FROM APPROXIMATELY $11,316,000 FOR THE YEAR ENDED JUNE 30, 2012, TO APPROXIMATELY $5,802,000 FOR THE YEAR ENDED JUNE 30, 2013. BOTH DECREASES WERE THE RESULT OF CHANGES IN SELF-PAY DISCOUNTING POLICIES EFFECTIVE JULY 1, 2011 THAT RESULTED IN DISCOUNTS ON SELF-PAY ACCOUNTS RECORDED IN NET PATIENT SERVICE REVENUE BEFORE THE PROVISION FOR BAD DEBTS. PART III, LINE 8: CONEMAUGH HEALTH SYSTEM UTILIZES MCKESSON'S HORIZON PERFORMANCE MANAGER (HPM) FOR COST ACCOUNTING. HPM PROVIDES THE ABILITY TO ALLOCATE ALL DEPARTMENTAL EXPENSES AT THE INDIVIDUAL CHARGE FOR EACH CHARGING DEPARTMENT, AS WELL AS ALLOCATE OVERHEAD EXPENSES IN A CONSISTENT MANNER. THE ENCOUNTER COSTING FUNCTIONALITY OF HPM PROVIDES THE ABILITY TO THEN DETERMINE AN ACCURATE ESTIMATE OF COST AT THE PATIENT LEVEL BASED ON THE CHARGE UNIT COSTS. THE SYSTEM THEN PROVIDES THE ABILITY TO SUMMARIZE THE PATIENT VOLUME, CHARGES, AND COSTS IN ANY NUMBER OF WAYS, INCLUDING PAYER SPECIFIC COST ALLOCATION. PART III, LINE 9B: PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE ARE NOT PURSUED USING ANY DEBT COLLECTION PRACTICES. MINERS HOSPITAL PART V, SECTION B, LINE 3: THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) PROCESS INCLUDED INTERVIEWS TO GATHER INPUT FROM A BROAD RANGE OF COMMUNITY MEMBERS INCLUDING THOSE WITH PUBLIC HEALTH KNOWLEDGE AND EXPERTISE. KEY INDIVIDUALS WERE IDENTIFIED AND 26 OPEN-ENDED INTERVIEWS WERE COMPLETED WITH PARTICIPANTS FROM THE FOLLOWING PROFESSIONS: CHILD SERVICES, EDUCATION, CLERGY, ELECTED GOVERNMENT OFFICIALS, GOVERNMENT AGENCIES, HEALTH CARE, HUMAN SERVICE AGENCIES, JUDICIAL, LAW, NURSES, PHYSICIANS, SENIOR SERVICES, AND PUBLIC SAFETY. EACH PROFESSIONAL WAS ASKED WHAT HE OR SHE PERCEIVED TO BE THE MOST PRESSING ISSUES IN THE COMMUNITY.IN ADDITION, PAPER AND/OR ELECTRONIC SURVEYS WERE ADMINISTERED TO ASSURE THAT COMMUNITY MEMBERS, INCLUDING UNDER-REPRESENTED RESIDENTS, WERE INCLUDED IN THE NEEDS ASSESSMENT PLANNING PROCESS. A TOTAL OF 3,491 SURVEYS WERE DISTRIBUTED AND 446 WERE RETURNED; A PARTICIPATION RATE OF 12.7%. THE CHNA PROCESS ALSO INCLUDED FOCUS GROUPS AT TWO PUBLIC HOUSING FACILITIES TO ENSURE THAT POTENTIALLY UNDER-REPRESENTED RESIDENTS WERE INCLUDED. MINERS HOSPITAL PART V, SECTION B, LINE 4: THE CHNA WAS CONDUCTED FOR ALL HOSPITALS WITHIN THE CONEMAUGH HEALTH SYSTEM: MEMORIAL MEDICAL CENTER (MMC), MINERS MEDICAL CENTER (MIMC), AND MEYERSDALE MEDICAL CENTER (MYMC). MINERS HOSPITAL PART V, SECTION B, LINE 5C: THE CHNA WAS PUT ON THE CONEMAUGH HEALTH SYSTEM (CHS) WEBSITE WHICH AVERAGES ABOUT 150,000 HITS PER MONTH. THE CHNA WAS ALSO MENTIONED IN MULTIPLE NEWS RELEASES, REVIEWED AT VARIOUS COMMUNITY BOARD MEETINGS AND GATHERINGS, AND SHARED WITH APPROXIMATELY 5,000 CHS EMPLOYEES THROUGH VARIOUS FORMATS INCLUDING THE WEEKLY HUDDLE, CARENOTES NEWSLETTER, AND PHYSICIAN NEWSLETTER. THE CHNA WAS ALSO HIGHLIGHTED IN THE CHS PRIME MAGAZINE WHICH IS MAILED TO APPROXIMATELY 28,000 CONSUMERS AND EMAILED TO ANOTHER 6,000 ON AVERAGE. THE CHNA WAS PRESENTED TO THE CHS BOARD AND TO THE HOSPITAL DIVISION BOARD GOVERNING MEMORIAL MEDICAL CENTER, MEYERSDALE MEDICAL CENTER, AND MINERS MEDICAL CENTER. MINERS HOSPITAL PART V, SECTION B, LINE 6I: THE ORGANIZATION HAS DEVELOPED AND ADOPTED AN IMPLEMENTATION STRATEGY TO ADDRESS THE NEEDS IDENTIFIED WITHIN THE CHNA. THIS DOCUMENT IS AVAILABLE ON THE ORGANIZATION'S WEBSITE USING THIS SPECIFIC LINK: HTTP://WWW.CONEMAUGH.ORG/TEMPLATE_ARTICLE.ASPX?ID=11782 MINERS HOSPITAL PART V, SECTION B, LINE 7: THE CHNA IDENTIFIED A TOTAL OF EIGHT PRIORITY HEALTH NEEDS. PLANS TO ADDRESS SEVEN OF THESE NEEDS HAVE BEEN INITIATED AND INCLUDE MULTIPLE STEPS. THE ONLY NEED NOT BEING ADDRESSED BY MINERS MEDICAL CENTER (MIMC) IS THE NEED FOR PRIMARY CARE PHYSICIANS IN SOMERSET COUNTY. MIMC IS UNABLE TO IMPACT THIS NEED AS SOMERSET COUNTY IS NOT INCLUDED IN ITS PRIMARY SERVICE AREA. IN ADDITION, THE ORGANIZATION DOES HAVE CONCERNS ABOUT THE SUCCESS OF SIGNIFICANTLY IMPACTING OBESITY AND DRUG ADDICTION, AS THESE ARE DEEP SEATED ISSUES IN OUR COMMUNITY AND THE ORGANIZATION HAS LIMITED FINANCIAL RESOURCES TO ADDRESS THESE ISSUES. MINERS HOSPITAL PART V, SECTION B, LINE 11: FEDERAL POVERTY GUIDELINES ARE NOT USED IN THE DETERMINATION OF DISCOUNTED CARE. ALL SELF-PAY, UNINSURED PATIENTS ARE OFFERED A 60% DISCOUNT OFF OF CHARGES. MINERS HOSPITAL PART V, SECTION B, LINE 14G: THE ORGANIZATION IS GOVERNED BY THE CONEMAUGH HEALTH SYSTEM'S FINANCIAL ASSISTANCE POLICY. A SUMMARY OF THIS POLICY IS MADE AVAILABLE VIA BROCHURES LOCATED AT ALL REGISTRATION SITES, AND IS INCLUDED IN THE ADMISSIONS PACKET. IN ADDITION, BILLING STATEMENTS INDICATE THAT "FINANCIAL ASSISTANCE PROGRAM APPLICATIONS ARE AVAILABLE ON REQUEST, OR VISIT OUR WEBSITE AT WWW.CONEMAUGH.ORG". THE POLICY IS ALSO ADVERTISED PERIODICALLY IN THE LOCAL NEWSPAPERS. PART V, SECTION B, LINE 2: THE CHNA WAS LAST CONDUCTED DURING THE ORGANIZATION'S 2012 TAX YEAR, WHICH IS EQUVIALENT TO ITS FISCAL YEAR ENDED JUNE 30, 2013. THE IMPLEMENTATION STRATEGY WAS ALSO ADOPTED DURING THAT SAME FISCAL YEAR. PART VI, LINE 2: THERE ARE VARIOUS WAYS THAT THE ORGANIZATION ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES, IN ADDITION TO THE NEEDS ASSESSMENT REPORTED IN PART V, SECTION B. THE CONEMAUGH HEALTH SYSTEM (CHS) PROVIDES A WAY FOR PEOPLE WITHIN THE COMMUNITIES OF ALL MEMBER HOSPITALS TO ASK QUESTIONS THROUGH ITS WEBSITE. THROUGH EMAILUS@CONEMAUGH.ORG, THE HEALTH SYSTEM RECEIVES NUMEROUS QUESTIONS AND SUGGESTIONS, ALL OF WHICH ARE FILED BY ITS MARKETING DEPARTMENT AND THEN GIVEN TO THE APPROPRIATE PERSON OR DEPARTMENT FOR A QUICK AND ACCURATE RESPONSE. THESE EMAILS RANGE FROM SUGGESTIONS TO HEALTH QUESTIONS AND HELP FINDING AN APPROPRIATE PROVIDER OR SERVICE. IN ADDITION, NUMEROUS HEALTH FAIRS ARE HELD AT VARIOUS LOCATIONS THROUGHOUT CHS EACH YEAR TO ALLOW PEOPLE TO LEARN MORE ABOUT SPECIFIC HELP TOPICS. PEOPLE ARE ENCOURAGED TO SPEAK DIRECTLY TO CAREGIVERS AND HAVE THEIR SPECIFIC QUESTIONS ANSWERED WHEN APPROPRIATE. CHS PROVIDES A 1-800 NUMBER FOR PEOPLE TO CALL TO SEEK HELP FINDING A PHYSICIAN. CALLS COME IN DAILY WITH A VARIETY OF QUESTIONS RANGING FROM HELP FINDING A PHYSICIAN TO SPECIFIC MEDICAL QUESTIONS TO REQUESTS FOR SUPPORT GROUP INFORMATION. THE PHONE NUMBER IS INCLUDED IN MOST CHS ADVERTISING MATERIALS AS A WAY TO HELP PEOPLE FIND ADDITIONAL INFORMATION OR TO ASK QUESTIONS. THE CHS FACEBOOK PAGE PROVIDES ANOTHER OPPORTUNITY FOR PEOPLE TO PROVIDE FEEDBACK AND TO INQUIRE ABOUT HEALTH RELATED TOPICS AND SERVICES. IN ADDITION TO PROVIDING HEALTH INFORMATION AND WELLNESS TIPS, PEOPLE ARE ENCOURAGED TO PROVIDE TOPICS THEY WOULD LIKE TO LEARN MORE ABOUT. CHS USES THE VOICE OF THE CUSTOMER (VOC) TO HELP DETERMINE APPROPRIATE ADVERTISING MESSAGES AND TO PLAN PROGRAMMING. A RECENT EXAMPLE OF THIS IS A SURVEY THAT WAS CONDUCTED OF PATIENTS ASKING THEM "WHAT MAKES THE IDEAL PATIENT EXPERIENCE?" RESPONSES WERE RECEIVED FROM APPROXIMATELY 75 PATIENTS, HELPING CHS AND ITS MEMBER HOSPITALS TO CREATE IDEAL PATIENT EXPERIENCE TRAINING WHICH IS NOW UNDERWAY FOR EVERY EMPLOYEE OF CHS. VOC IS ALSO USED WITHIN LEAN SIX SIGMA PROJECTS TAKING PLACE THROUGHOUT THE HEALTH SYSTEM AS A WAY TO IMPROVE PROCESSES AND THE PATIENT EXPERIENCE. THE MARKETING DEPARTMENT ALSO REGULARLY RECEIVES FEEDBACK ON ISSUES AND HEALTH TRENDS FROM PHYSICIANS AND OTHER CLINICAL CAREGIVERS. THESE TRENDS ARE THEN ADDRESSED THROUGH MARKETING, SOCIAL MEDIA, OR MEDIA RELEASES. PART VI, LINE 3: CONEMAUGH HEALTH SYSTEM (CHS) COMMUNICATES TO PATIENTS THE AVAILABILITY OF FINANCIAL ASSISTANCE UNDER FEDERAL, STATE AND LOCAL PROGRAMS, AS WELL AS THE CHARITY CARE PROGRAM, ON ITS WEBSITE, WHICH INCLUDES A DOWNLOADABLE CHARITY CARE APPLICATION AND INSTRUCTIONS. TABLE TOP BROCHURES ARE PROVIDED AT ALL POINTS OF REGISTRATION, AND BROCHURES ARE INCLUDED IN PATIENT ADMISSION PACKETS. INFORMATION ON THE AVAILABILITY OF FINANCIAL ASSISTANCE IS ALSO INCLUDED ON PATIENT STATEMENTS. ASSISTANCE IS PROVIDED TO PATIENTS TO APPLY FOR MEDICAL ASSISTANCE THROUGH A THIRD-PARTY VENDOR. A ROBUST FINANCIAL COUNSELING AND CUSTOMER SERVICE DEPARTMENT IS AVAILABLE TO HANDLE SPECIFIC PATIENT NEEDS. PART VI, LINE 4: SERVING RURAL NORTHERN CAMBRIA COUNTY AND SURROUNDING AREAS, MINERS MEDICAL CENTER (MIMC) IS THE REGION'S SOLE HOSPITAL AND SPECIALIZES IN FAMILY AND PRIMARY CARE. PHYSICIAN SPECIALISTS FROM CONEMAUGH PHYSICIAN GROUP VISIT MIMC ON A REGULAR BASIS TO PROVIDE CARE FOR PATIENTS. SPECIALTY SERVICES, WHICH ARE AVAILABLE SEVERAL TIMES A MONTH, INCLUDE CARDIOLOGY, UROLOGY, OPHTHALMOLOGY, GASTROENTEROLOGY, NEPHROLOGY, NEUROLOGY, PHYSICAL MEDICINE AND REHABILITATION, PULMONOLOGY, WOUND HEALING, AND OBSTETRICS/GYNECOLOGY.MIMC HAS 30 BEDS FOR INPATIENT MEDICAL, SURGICAL AND INTENSIVE CARE SERVICES. OUTPATIENT SERVICES INCLUDE 24/7 EMERGENCY DEPARTMENT, MOST OFTEN TREATING ACCIDENTS, CARDIAC ARREST OR TRAUMA; 24/7 LABORATORY; ONSITE PHARMACY; OPERATING SUITE FOR SHORT OR MINOR PROCEDURES; RADIOLOGY SERVICES, INCLUDING MOBILE MRI AND CT SCANS, MAMMOGRAPHY, AND ULTRASOUND; PATHOLOGY SERVICES; PHYSICAL THERAPY; RESPIRATORY THERAPY; AND OB/GYN OUTPATIENT CARE.WITH GENERALLY OLDER POPULATIONS, CAMBRIA AND SOMERSET COUNTIES HAVE LOWER BIRTH RATES THAN DEATH RATES WHICH WILL FURTHER REDUCE HOUSEHOLD SIZE AND RESULT IN A FURTHER INCREASE OF MEDIAN AGE OF THE POPULATION OVER TIME. MEDIAN HOUSEHOLD INCOME IN 2009 WAS $38,205 IN CAMBRIA COUNTY AND $38,712 IN SOMERSET COUNTY, WHICH ARE SIGNIFICANTLY LOWER THAN BOTH STATE AND NATIONAL AVERAGES OF $49,501 AND $50,221 RESPECTIVELY.THE CONEMAUGH HEALTH SYSTEM'S COVERAGE REGION ALSO PRESENTS SOME GEOGRAPHIC CHALLENGES DUE TO ITS MOUNTAINOUS TOPOGRAPHY AND HIGHWAY INFRASTRUCTURE. MINDFUL OF THESE CHALLENGES, THE HEALTH SYSTEM CONTINUES TO PRESENT EDUCATIONAL AND SCREENING OPPORTUNITIES TO COMMUNITIES OUTSIDE OF ITS IMMEDIATE REGION. PART VI, LINE 5: THE CONEMAUGH HEALTH SYSTEM (CHS), WHICH INCLUDES MINERS MEDICAL CENTER (MIMC), IS COMPRISED OF A MEDICAL STAFF OF ABOUT 350 PHYSICIANS REPRESENTING NUMEROUS SPECIALTIES THROUGHOUT A WIDE GEOGRAPHIC REGION. IN ADDITION, THE CONEMAUGH PHYSICIAN GROUP WITHIN CHS IS A MULTI-SPECIALTY GROUP OF MORE THAN 115 PHYSICIANS PARTICIPATING AT SITES CONVENIENTLY LOCATED ACROSS 5 COUNTIES. ALL PRIMARY CARE PHYSICIAN OFFICES ARE CONNECTED TO MIMC AND ALL CHS HOSPITALS BY AN ELECTRONIC MEDICAL RECORD SYSTEM. MIMC IS FORTUNATE TO HAVE NOT ONLY STRONG PHYSICIAN LEADERSHIP, BUT STRONG BOARD LEADERSHIP. THE BOARD IS COMPRISED OF A WIDE VARIETY OF DEDICATED LEADERS REPRESENTING DIVERSE FIELDS WHICH INCLUDES AREA BUSINESS LEADERS, EDUCATORS, AND PHYSICIANS, BOTH FROM CONEMAUGH PHYSICIAN GROUP AS WELL AS INDEPENDENT PHYSICIANS. AN ACTIVE PATIENT ADVISORY COMMITTEE CONTRIBUTES REGULAR CONSTRUCTIVE CRITICISM AND FEEDBACK REGARDING VARIOUS ASPECTS OF CARE DELIVERY INCLUDING WAY FINDING, MARKETING, AND SERVICE EXCELLENCE. IN FISCAL YEAR 2013, CHS ADDED A NUMBER OF NEW PROGRAMS AND TECHNOLOGY TO BENEFIT THE PEOPLE OF THE REGION. SOME OF THESE ADVANCEMENTS INCLUDED: STATE-OF-THE-ART COMPUTED TOMOGRAPHY (CT) SCANNER WHICH OFFERS PATIENTS FASTER, SAFER, AND MORE RELIABLE CT SCANS THAN EVER BEFORE; DA VINCI ROBOTIC ASSISTED SURGERY SYSTEM FOR GENERAL, GYNECOLOGICAL, THORACIC, AND WEIGHT LOSS SURGERY; DIGITAL MAMMOGRAPHY AT SIX CONVENIENT SITES PROVIDES EXCELLENT IMAGE QUALITY WHILE MINIMIZING THE PATIENT'S RADIATION DOSE AND EXPOSURE TIME; STATE-OF-THE-ART ELECTROPHYSIOLOGY LABORATORY OFFERING PATIENTS LOCAL DIAGNOSIS AND TREATMENT OF ABNORMAL HEART RHYTHM CONDITIONS; THE ONLY FETAL ECHOCARDIOGRAPHY LABORATORY BETWEEN PITTSBURGH AND HARRISBURG ACCREDITED BY THE INTERSOCIETAL COMMISSION FOR THE ACCREDITATION OF ECHOCARDIOGRAPHY LABORATORIES; INTERVENTIONAL RADIOLOGY CAPABILITIES NOW INCLUDE ADVANCED "C" ARMS THAT ALLOW SPECIALISTS TO VIEW IMAGES FROM TWO PLANES WHICH QUICKLY GENERATES MORE PRECISE IMAGES WITH FEWER EXPOSURES, REDUCING PATIENTS' RADIATION EXPOSURE AND SHORTENING PROCEDURE TIMES; 4G MRI CAPABILITIES OF THE NEW 48-CHANNEL MAGNETOMAERO 1.5 TESLA MRI UNIT SIGNIFICANTLY REDUCE THE TIME TO COMPLETE AN MRI PROCEDURE, WHILE PROVIDING SHARPER IMAGES THROUGH THE SOPHISTICATED TECHNOLOGY; ROBOT RX-3000HP PHARMACY SYSTEM USES BARCODE SCANNING TECHNOLOGY TO AUTOMATE THE STORAGE, PICKING, RETURNING, RESTOCKING, AND CREDITING OF MORE THAN 90% OF DAILY UNIT DOSE MEDICATIONS, PROVIDING A PATIENT SPECIFIC MEDICATION ENVELOPE WHICH PREVENTS PICKING ERRORS AND MANAGES UNIT-DOSE INVENTORY. MAMMOGRAPHY SCREENING EVENTS ARE HELD AT MIMC EACH YEAR TO ATTRACT WOMEN IN NEED OF MAMMOGRAMS SPECIFICALLY TARGETING WOMEN WITHOUT INSURANCE. IN FY13, MIMC PHYSICIANS AND STAFF PARTICIPATED IN THE KIDSKINS PROGRAM, A COMMUNITY INITIATIVE THAT PROVIDES FREE PHYSICALS FOR STUDENTS IN THE REGION PLAYING FOOTBALL. IN ADDITION, PHYSICAL THERAPY AND RESPIRATORY THERAPY EMPLOYEES AT MIMC VOLUNTEER THEIR TIME FOR A STUDENT JOB SHADOWING PROGRAM TO HELP PROVIDE SOME HANDS ON EXPERIENCE FOR AREA YOUTH CONSIDERING PURSUING A CAREER IN THOSE THERAPY FIELDS.MINERS HOSPITAL FACILITY HIGHLIGHTS:LICENSED PATIENT BEDS - 30PATIENT DAYS OF SERVICE - 2,382INPATIENT DAILY CENSUS - 6.5ADJUSTED PATIENT DAYS - 16,087ADMISSIONS - 533AVERAGE LENGTH OF STAY - 4FULL TIME EQUIVALENT EMPLOYEES - 121VOLUNTEERS - 9PHYSICIANS:ACTIVE - 11COURTESY - 28CONSULTING - 23ALLIED HEALTH - 4 SERVICES:EMERGENCY VISITS - 10,283INPATIENT SURGERIES - 139SAME DAY/AMBULATORY SURGERIES - 1,887OUTPATIENT VISITS - 52,986LABORATORY TESTS - 192,437RADIOLOGY EXAMS - 9,974ULTRASOUND PROCEDURES - 4,600CT SCANS - 3,340MRI PROCEDURES - 492NUCLEAR MEDICINE EXAMS - 958RESPIRATORY THERAPY PROCEDURES - 30,222EKG'S, EEG'S, HOLTERS - 3,116SHORT PROCEDURE UNIT VISITS - 2,430 PART VI, LINE 6: MINERS MEDICAL CENTER IS A SUBSIDIARY OF A LARGER HEALTH SYSTEM, CONEMAUGH HEALTH SYSTEM, INC. THE CONEMAUGH HEALTH SYSTEM AND ITS AFFILIATES WORK TOGETHER TO PROMOTE THE HEALTH OF THE COMMUNITIES THEY SERVE. X X X X 0 0 0 0 0 1 1 0 0 NATHAN THOMAS MD 0 147503 0 1379 0 19262 0 14542 0 16382 0 199068 0 0 JAMES TRETTER DO 0 577767 0 5687 0 15711 0 22224 0 15840 0 637229 0 0 SHIBAN WARIKOO MD 0 304190 0 0 0 9264 0 11215 0 11175 0 335844 0 0 STEVEN TUCKER 0 345487 0 74409 0 24259 0 20551 0 12245 0 476951 0 0 SCOTT BECKER 0 625999 0 200000 0 48727 0 16605 0 18891 0 910222 0 0 EDWARD DEPASQUALE 0 347620 0 72561 0 21192 0 19888 0 11289 0 472550 0 0 DAVID CARLSON DO 0 424629 0 92101 0 22618 0 13386 0 14634 0 567368 0 0 JOSEPH DADO 0 274673 0 58717 0 19528 0 13900 0 2045 0 368863 0 0 WILLIAM CROWE 159248 0 25529 0 3075 0 12959 0 12831 0 213642 0 0 0 PART I, LINE 6 WILLIAM CROWE RECEIVED A BONUS FROM MINERS HOSPITAL. SCOTT BECKER, EDWARD DEPASQUALE, DAVID CARLSON, DO, AND JOSEPH DADO RECEIVED A BONUS FROM THE CONEMAUGH HEALTH SYSTEM, A RELATED ORGANIZATION. STEVEN TUCKER RECEIVED A BONUS FROM MEMORIAL MEDICAL CENTER, A RELATED ORGANIZATION. EXECUTIVE BONUSES ARE CALCULATED AS A PERCENTAGE OF BASE SALARY. THE PERCENTAGE IS CONTINGENT ON VARIOUS FINANCIAL AND NON-FINANCIAL INCENTIVE CRITERIA, GOVERNED BY THE EXECUTIVE COMPENSATION COMMITTEE OF THE BOARD OF CONEMAUGH HEALTH SYSTEM. JAMES TRETTER, DO RECEIVED A BONUS FROM CONEMAUGH HEALTH INITIATIVES, A RELATED ORGANIZATION. PHYSICIAN BONUSES ARE CALCULATED ON A CASH BASIS; TAKING TOTAL CASH COLLECTIONS LESS ALL OFFICE OPERATING, PHYSICIAN AND OVERHEAD EXPENSES. ANY REMAINING AMOUNT IS DISTRIBUTED TO THE PHYSICIAN BASED ON A CONTRACTUAL PERCENTAGE, A PRACTICE REINVESTMENT CONTRIBUTION AND/OR A CAP. TOTAL PHYSICIAN COMPENSATION IS REVIEWED ANNUALLY FOR REASONABLENESS USING INDUSTRY STANDARDS AND APPLICABLE IRS GUIDELINES. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBERS OF MINERS HOSPITAL ARE THE NORTHERN CAMBRIA HEALTHCARE FOUNDATION AND THE CONEMAUGH HEALTH SYSTEM, INC. FORM 990, PART VI, SECTION A, LINE 7A THE CONEMAUGH HEALTH SYSTEM, INC. HAS THE POWER TO APPROVE OR DISAPPROVE THE ELECTION OF OR REMOVAL OF MEMBERS OF THE GOVERNING BODY. FORM 990, PART VI, SECTION A, LINE 7B ALL DECISIONS OF THE GOVERNING BODY OF MINERS HOSPITAL ARE SUBJECT TO APPROVAL BY THE CONEMAUGH HEALTH SYSTEM, INC. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS PROVIDED TO THE ORGANIZATION'S BOARD OF DIRECTORS BEFORE IT IS FILED. ONCE THE FORM IS COMPLETE, BOARD MEMBERS ARE GIVEN THE OPPORTUNITY TO REVIEW THE CONTENTS OF THE FORM AND SUBMIT ANY COMMENTS OR QUESTIONS. IN ADDITION, SINCE THE ORGANIZATION IS A SUBSIDIARY WITHIN A LARGER HEALTH SYSTEM, THE FORM IS REVIEWED BY THE HEALTH SYSTEM'S MANAGER, TAX & COMPLIANCE; DIRECTOR, FINANCIAL OPERATIONS; VICE PRESIDENT, FINANCIAL OPERATIONS; CHIEF FINANCIAL OFFICER; AND THE AUDIT AND COMPLIANCE COMMITTEE. AN EXTERNAL CPA FIRM IS ENGAGED TO REVIEW AND ELECTRONICALLY FILE THE RETURN. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION IS A SUBSIDIARY OF A LARGER HEALTH SYSTEM AND IS GOVERNED BY THE SYSTEM'S CONFLICT OF INTEREST POLICY, WHICH HAS BEEN APPROVED BY THE HEALTH SYSTEM'S BOARD. UNDER THIS POLICY, EVERY BOARD MEMBER IS GIVEN A COPY OF THE POLICY AS WELL AS A FORM THAT MUST BE COMPLETED ON AN ANNUAL BASIS. NO BOARD MEMBER IS APPROVED OR RE-APPOINTED UNTIL HE OR SHE HAS COMPLETED AND SIGNED THE CONFLICT OF INTEREST FORM. ONCE THE FORM IS RETURNED, IT IS REVIEWED BY THE SYSTEM'S COMPLIANCE OFFICER AND CEO. IF ANY CONFLICTS ARE DISCLOSED, THE DETAILS ARE FORWARDED TO THE BOARD CHAIR TO BE ADDRESSED. DEPENDING ON THE CONFLICT, THE BOARD MEMBER COULD BE GIVEN CERTAIN RESTRICTIONS, SUCH AS BEING PROHIBITED FROM PARTICIPATING IN CERTAIN BOARD DECISIONS. THE HEALTH SYSTEM'S AUDIT AND COMPLIANCE COMMITTEE HAS THE FINAL DECISION-MAKING REGARDING ALL CONFLICTS OF INTEREST. THROUGHOUT THE FISCAL YEAR, BOARD MEMBERS MUST NOTIFY THE BOARD CHAIR, COMPLIANCE OFFICER, AND/OR CEO IF A NEW CONFLICT OF INTEREST HAS DEVELOPED. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION'S PARENT, A HEALTH SYSTEM, MANAGES THE DETERMINATION OF COMPENSATION AND THE PROCESS IS OUTLINED IN ITS BYLAWS. AN OUTSIDE CONSULTING FIRM IS UTILIZED TO ENSURE THAT EXECUTIVE COMPENSATION PACKAGES ARE FAIR AND COMPARABLE WITH SIMILAR ORGANIZATIONS. THE HEALTH SYSTEM HAS ALSO ESTABLISHED AN EXECUTIVE COMPENSATION COMMITTEE TO REVIEW AND RECOMMEND THE COMPENSATION DECISIONS MADE. THIS COMMITTEE REPORTS DIRECTLY TO THE HEALTH SYSTEM'S BOARD. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION IS PART OF A HEALTH SYSTEM AND ALL REQUESTS FOR THIS INFORMATION ARE HANDLED BY THE SYSTEM'S MARKETING/PUBLIC RELATIONS DEPARTMENT. FORM 990, PART VI, SECTION B, LINES 12A, 13 AND 14: ALL APPLICABLE POLICY QUESTIONS HAVE BEEN ANSWERED YES SINCE THE ORGANIZATION IS A SUBSIDIARY OF A LARGER HEALTH SYSTEM AND IS GOVERNED BY THE SYSTEM'S POLICIES. ALL POLICIES HAVE BEEN APPROVED BY THE HEALTH SYSTEM'S BOARD. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: PENSION ADJUSTMENT 1,936,639. OTHER ADJUSTMENTS 30,006. FORM 990, PART XII, LINE 2: THE ORGANIZATION'S FINANCIAL STATEMENTS FOR THE FISCAL YEAR ENDING JUNE 30, 2013 WERE AUDITED AS PART OF THE AUDIT OF THE CONSOLIDATED FINANCIAL STATEMENTS OF THE CONEMAUGH HEALTH SYSTEM, INC. AND SUBSIDIARIES. THE HEALTH SYSTEM'S AUDIT AND COMPLIANCE COMMITTEE ASSUMES RESPONSIBLITY FOR THE OVERSIGHT OF THE AUDIT AND THE SELECTION OF THE INDEPENDENT ACCOUNTANT. CONEMAUGH HEALTH SYSTEM 1086 FRANKLIN STREET JOHNSTOWN PA 15905 232801799 SUPPORT MEMBER HOSPITALS PA 501(C)(3) 11A N/A 0 CONEMAUGH VALLEY MEMORIAL HOSPITAL DBA MEMORIAL MEDICAL CTR 1086 FRANKLIN STREET JOHNSTOWN PA 15905 250965307 HEALTHCARE SERVICES PA 501(C)(3) 3 CONEMAUGH HEALTH SYSTEM 0 MEYERSDALE COMMUNITY HOSPITAL DBA MEYERSDALE MEDICAL CENTER 200 HOSPITAL DRIVE MEYERSDALE PA 15552 251002946 HEALTHCARE SERVICES PA 501(C)(3) 3 CONEMAUGH HEALTH SYSTEM 0 CONEMAUGH HEALTH FOUNDATION 1086 FRANKLIN STREET JOHNSTOWN PA 15905 251719695 SUPPORTS CONEMAUGH HEALTH SYSTEM PA 501(C)(3) 11B CONEMAUGH HEALTH SYSTEM 0 LAUREL HIGHLANDS ADVANCED IMAGING 1450 SCALP AVENUE JOHNSTOWN PA 15904 251864587 DIAGNOSTIC SERVICES PA N/A GREATER JOHNSTOWN TECH PARK 1086 FRANKLIN STREET JOHNSTOWN PA 15905 260389121 OPERATES MULTI-TENANT COMMERCE OFFICE PARK PA N/A CONEMAUGH HEALTH INITIATIVES INC DBA CONEMAUGH PHYSICIAN GP 1086 FRANKLIN STREET JOHNSTOWN PA 15905 251658283 PHYSICIAN SERVICES PA N/A C 0 1086 REAL ESTATE 1086 FRANKLIN STREET JOHNSTOWN PA 15905 251489704 REAL ESTATE PA N/A C 0 CONEMAUGH ENTERPRISES INC 1086 FRANKLIN STREET JOHNSTOWN PA 15905 202998473 ECONOMIC DEVELOPMENT PA N/A C 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 1 1 1 0 1