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200 HOSPITAL - MYMC INC: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
200 HOSPITAL - MYMC INC (EIN 25-1002946)
Tax period
2012-07-01 to 2013-06-30
Filed
2014-02-10
IRS object ID
201420419349301062
Schema version
2012v2.1
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)
Timestamp2014-02-10T15:37:43-06:00Timestamp
Tax Period End Date2013-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN250988255EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1CARBIS WALKER LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line15700 CORPORATE DRIVE STE 650AddressLine1
CityPITTSBURGHCity
StatePAState
ZIP Code15237ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN251002946EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1MEYERSDALE COMMUNITY HOSPITALBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlMEYENameControl
Phone8146345911Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1200 HOSPITAL DRIVEAddressLine1
CityMEYERSDALECity
StatePAState
ZIP Code15552ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameEDWARD DEPASQUALEName
TitleCHIEF FINANCIAL OFFICERTitle
Phone8144108271Phone
Date Signed2014-01-30DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameJEFFREY J PETRELL CPAName
PTINP00138808PTIN
Phone4126356270Phone
Date Prepared2014-01-30DatePrepared
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2015-11-30 17:44:51ZBuildTS

Form 990 IRS990

Doing Business As DoingBusinessAs

FieldValueIRS element (for citing)
Business Name Line1MEYERSDALE MEDICAL CENTERBusinessNameLine1
FieldValueIRS element (for citing)
Name Of Principal Officer PersonSCOTT BECKERNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11086 FRANKLIN STREETAddressLine1
CityJOHNSTOWNCity
StatePAState
ZIP Code15905ZIPCode
FieldValueIRS element (for citing)
Gross Receipts13023917GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.CONEMAUGH.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1952YearFormation
State Legal DomicilePAStateLegalDomicile
Activity Or Mission DescriptionGENERAL ACUTE CARE CRITICAL ACCESS HOSPITAL PROVIDING INPATIENT, SWING BED, OUTPATIENT, AND CLINIC SERVICES TO THE SOUTHERN SOMERSET COUNTY POPULATION.ActivityOrMissionDescription
Nbr Voting Members Governing Body14NbrVotingMembersGoverningBody
Nbr Independent Voting Members8NbrIndependentVotingMembers
Total Nbr Employees147TotalNbrEmployees
Total Nbr Volunteers23TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year98602ContributionsGrantsPriorYear
Contributions Grants Current Year104424ContributionsGrantsCurrentYear
Program Service Revenue Prior Year11782292ProgramServiceRevenuePriorYear
Program Service Revenue CY12778686ProgramServiceRevenueCY
Investment Income Prior Year59509InvestmentIncomePriorYear
Investment Income Current Year37981InvestmentIncomeCurrentYear
Other Revenue Prior Year114148OtherRevenuePriorYear
Other Revenue Current Year46760OtherRevenueCurrentYear
Total Revenue Prior Year12054551TotalRevenuePriorYear
Total Revenue Current Year12967851TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY7000GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year5414947SalariesEtcPriorYear
Salaries Etc Current Year5630814SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year6332739OtherExpensePriorYear
Other Expenses Current Year6447029OtherExpensesCurrentYear
Total Expenses Prior Year11747686TotalExpensesPriorYear
Total Expenses Current Year12084843TotalExpensesCurrentYear
Revenues Less Expenses Prior Year306865RevenuesLessExpensesPriorYear
Revenues Less Expenses CY883008RevenuesLessExpensesCY
Total Assets BOY8892745TotalAssetsBOY
Total Assets EOY9728169TotalAssetsEOY
Total Liabilities BOY3885968TotalLiabilitiesBOY
Total Liabilities EOY3770679TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY5006777NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY5957490NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionGENERAL ACUTE CARE CRITICAL ACCESS HOSPITAL PROVIDING INPATIENT, SWING BED, OUTPATIENT, AND CLINIC SERVICES TO THE SOUTHERN SOMERSET COUNTY POPULATION.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense9983579Expense
Grants7000Grants
Revenue12809839Revenue
DescriptionLOCATED IN SOUTHERN SOMERSET COUNTY, MEYERSDALE COMMUNITY HOSPITAL (MYMC) IS A STATE DESIGNATED CRITICAL CARE ACCESS HOSPITAL DEEMED A NECESSARY HEALTH CARE PROVIDER BY THE COMMONWEALTH OF PENNSYLVANIA. SPECIALIZING IN FAMILY AND PRIMARY CARE, MYMC OFFERS 20 BEDS FOR INPATIENT AND OUTPATIENT CARE; 24/7 EMERGENCY DEPARTMENT; OR FOR SHORT OR MINOR PROCEDURES; RADIOLOGY SERVICES, INCLUDING MOBILE MRI, AND CT SCANS; PATHOLOGY SERVICES; PHYSICAL THERAPY; RESPIRATORY THERAPY; ULTRASOUND; WOUND HEALING; OB/GYN OUTPATIENT CARE; STEP-DOWN SWING UNIT; AND MEDSTAR MEDICAL HELICOPTER TRANSPORTATION. DURING FISCAL YEAR 2013, THE HOSPITAL TREATED 249 ACUTE PATIENTS FOR A TOTAL OF 854 DAYS AND 97 SWING BED PATIENTS FOR A TOTAL OF 901 DAYS. ALSO, 40,742 OUTPATIENTS WERE TREATED THROUGHOUT THE FACILITY'S CLINICAL DEPARTMENTS AND RURAL HEALTH CLINICS.Description
Total Program Service Expense9983579TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets1ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote0ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Financial Stmt Attached1FinancialStmtAttached
Grants To Organizations1GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member1BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109629NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees147NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members14NbrVotingGoverningBodyMembers
Number Independent Voting Members8NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledPAStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1HEATHER SMITHBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number8146345911TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1200 HOSPITAL DRIVEAddressLine1
CityMEYERSDALECity
StatePAState
ZIP Code15552ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (18 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekAverage Hours Per Week RelatedAverageHoursPerWeekRelatedIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
FRANK QUITONI
CHAIRMAN1.002.00XX000
SAMUEL MCCLURE
VICE-CHAIRMAN1.002.00XX000
PATTI STEFANICK DO
SECRETARY1.004.00XX0250000
ALAN STANKIEWICZ DO
ASSISTANT SECRETARY1.002.00XX000
WILLIAM DURYEA
TREASURER1.002.00XX000
ELMER LASLO
TRUSTEE1.002.00X000
THOMAS MARINO
TRUSTEE1.002.00X000
KEVIN MILLER
TRUSTEE1.002.00X000
WILLIAM POLACEK
TRUSTEE1.002.00X000
NATHAN THOMAS MD
TRUSTEE2.0042.00X016814430924
JAMES TRETTER DO
TRUSTEE1.0073.00X059916538064
SHIBAN WARIKOO MD
TRUSTEE1.0042.00X031345422390
STEVEN TUCKER
TRUSTEE, CHIEF OPERATING OFFICER3.0050.50XX044415532796
SCOTT BECKER
TRUSTEE, CHIEF EXECUTIVE OFFICER1.0069.00XX087472635496
EDWARD DEPASQUALE
CHIEF FINANCIAL OFFICER1.0049.00X044137331177
DAVID CARLSON DO
CHIEF MEDICAL OFFICER2.0048.50X053934828020
JOSEPH DADO
CHIEF INFORMATION OFFICER2.0051.00X035291815945
MARY LIBENGOOD
PRESIDENT50.00X166047020054
FieldValueIRS element (for citing)
Total Reportable Comp From Org166047TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs3758283TotalReportableCompFrmRltdOrgs
Total Other Compensation254866TotalOtherCompensation
Number Individuals GT100 K1NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
CONEMAUGH HEALTH INITIATIVES
1086 FRANKLIN STREETJOHNSTOWNPA15905ER PHYSICIAN, OFFICE STAFF1211272
MEMORIAL MEDICAL CENTER
1086 FRANKLIN STREETJOHNSTOWNPA15905FINANCIAL, IT, PHARMACY SVCS1075681
WILHELM MERIWETHER
9213 PEGASUS COURTPOTOMACMD20854ER PHYSICIAN233328
CDL
6400 BROOKTREE COURTWEXFORDPA15090NUCLEAR MEDICINE189395
ALLIANCE IMAGING
PO BOX 96485CHICAGOIL60693MRI165538
FieldValueIRS element (for citing)
Number Of Contractors GT100 K7NumberOfContractorsGT100K
Government Grants20893GovernmentGrants
All Other Contributions83531AllOtherContributions
Total Contributions104424TotalContributions

Program Service Revenue ProgramServiceRevenue (4 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
NET PATIENT SERVICE REVENUE9000991252852512528525
340B REVENUE900099199165199165
BLOOD SCREENING9000995078050780
MEDICAL RECORDS & VERISMA900099216216
FieldValueIRS element (for citing)
Total Program Service Revenue12778686TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column37981TotalRevenueColumn
Exclusion$37,981ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real27226Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real51598Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real-24372Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column-24372TotalRevenueColumn
Exclusion-$24,372ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events12345GrossIncomeFundraisingEvents
Fundraising Direct Expenses4468FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column7877TotalRevenueColumn
Exclusion$7,877ExclusionAmount

Other Revenue Misc OtherRevenueMisc (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
MEANINGFUL USE9000992125021250
CAFETERIA AND VENDING SALES90009999039903

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column32102TotalRevenueColumn
Exclusion$32,102ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue63255TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column12967851TotalRevenueColumn
Related Or Exempt Function Income12809839RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$53,588ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total7000Total
Program Services7000ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total189454Total
Program Services37891ProgramServices
Management And General151563ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total4233399Total
Program Services3582754ProgramServices
Management And General650645ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total163818Total
Program Services134331ProgramServices
Management And General29487ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total717448Total
Program Services588307ProgramServices
Management And General129141ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total326695Total
Program Services276921ProgramServices
Management And General49774ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total191256Total
Management And General191256ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total5540Total
Management And General5540ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total600Total
Management And General600ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total998591Total
Program Services998591ProgramServices

Advertising Advertising

FieldValueIRS element (for citing)
Total62148Total
Management And General62148ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total72419Total
Program Services36428ProgramServices
Management And General35991ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total326192Total
Program Services244964ProgramServices
Management And General81228ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total34158Total
Program Services615ProgramServices
Management And General33543ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total12647Total
Program Services10425ProgramServices
Management And General2222ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total95953Total
Program Services95953ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total463402Total
Program Services370722ProgramServices
Management And General92680ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total105873Total
Program Services84698ProgramServices
Management And General21175ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
PURCHASED SERVICES24743331987009487324
PATIENT SUPPLIES AND FO102849810196748824
REPAIRS AND MAINTENANCE41240838955622852
BAD DEBT EXPENSE9387993879

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total69132Total
Program Services23861ProgramServices
Management And General45271ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total12084843Total
Program Services9983579ProgramServices
Management And General2101264ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY2832097BOY
EOY12642EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY344083BOY
EOY4329472EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY1585286BOY
EOY1330630EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY17931BOY
EOY27880EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis9669637LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec6708738LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY3098598BOY
EOY2960899EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY1014750BOY
EOY1066646EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY8892745BOY
EOY9728169EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY794000BOY
EOY715538EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY49189BOY
EOY54370EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY1484646BOY
EOY1486543EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

FieldValueIRS element (for citing)
BOY150952BOY
EOY51884EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY1407181BOY
EOY1462344EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY3885968BOY
EOY3770679EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY4077321BOY
EOY4974128EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY211860BOY
EOY237373EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY717596BOY
EOY745989EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY5006777BOY
EOY5957490EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY8892745BOY
EOY9728169EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses883008ReconcilationRevenueExpenses
Reconcilation Other Changes67705ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement ConsolidatedXFinancialStatementConsolidated
FieldValueIRS element (for citing)
Audit Committee1AuditCommittee
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0Volunteers
Paid Staff Or Management0PaidStaffOrManagement
Media Advertisements0MediaAdvertisements
Mailings Members0MailingsMembers
Publications Or Broadcast0PublicationsOrBroadcast
Grants Other Organizations0GrantsOtherOrganizations
Direct Contact Legislators0DirectContactLegislators
Rallies Demonstrations0RalliesDemonstrations
Other Activities1OtherActivities
Other Activities$600OtherActivitiesAmount
Total Lobbying Expenditures IIB600TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierEXPLANATION OF LOBBYING ACTIVITIES:Identifier
Return ReferencePART II-B, LINE 1:ReturnReference
ExplanationMEMBERSHIP DUES PAID TO THE HOSPITAL COUNCIL OF WESTERN PENNSYLVANIA INDICATED THAT A SPECIFIC PERCENTAGE OF THE DUES WOULD BE RELATED TO LOBBYING ACTIVITIES.Explanation

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis136049OtherCostOrOtherBasis
Book Value136049BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis5641511OtherCostOrOtherBasis
Depreciation3592382Depreciation
Book Value2049129BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis3750169OtherCostOrOtherBasis
Depreciation3105845Depreciation
Book Value644324BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis141908OtherCostOrOtherBasis
Depreciation10511Depreciation
Book Value131397BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings2960899TotalOfBookValueLandBuildings

Other Assets OtherAssets (7 entries)

DescriptionDescriptionBook ValueBookValue
ACCRUED INTEREST RECEIVABLE77
MISCELLANEOUS ACCOUNTS RECEIVABLE16137
INTEREST IN INCOME TRUSTS745989
RESTRICTED CASH FOUNDATION173934
RESTRICTED CASH FOUNDATION - CITIZENS NATIONAL BANK63439
DEFERRED FINANCING EXPENSE29195
ASSETS HELD BY TRUSTEE37875
FieldValueIRS element (for citing)
Total Book Value Other Assets1066646TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (5 entries)

DescriptionDescriptionAmountAmount
ASSET RETIREMENT OBLIGATION$75,233
DUE TO MEMORIAL MEDICAL CENTER$791,899
DUE TO CONEMAUGH HEALTH INITIATIVES, INC.$104,453
DUE TO MEDICARE$459,603
DUE TO CONEMAUGH HEALTH SYSTEM, INC.$31,156
FieldValueIRS element (for citing)
Total Of Amounts1462344TotalOfAmounts

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
Policy Applied To All HospitalsXPolicyAppliedToAllHospitals
FPG Reference Free Care1FPGReferenceFreeCare
Pcent200XPcent200
FPG Reference Discounted Care0FPGReferenceDiscountedCare
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget0ExpensesExceededBudget
Annual Community Benefit Report1AnnualCommunityBenefitReport
Report Publically Available1ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense776404TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense776404NetCommunityBenefitExpense
Percent Of Total Expense0.06470PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense766954TotalCommunityBenefitExpense
Direct Offsetting Revenue1280169DirectOffsettingRevenue
Net Community Benefit Expense-513215NetCommunityBenefitExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Unreimbursed Costs UnreimbursedCosts

FieldValueIRS element (for citing)
Total Community Benefit Expense14185TotalCommunityBenefitExpense
Direct Offsetting Revenue13456DirectOffsettingRevenue
Net Community Benefit Expense729NetCommunityBenefitExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
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Direct Offsetting Revenue1293625DirectOffsettingRevenue
Net Community Benefit Expense263918NetCommunityBenefitExpense
Percent Of Total Expense0.06480PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense36836TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense36836NetCommunityBenefitExpense
Percent Of Total Expense0.00310PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
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Net Community Benefit Expense36836NetCommunityBenefitExpense
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Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
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Direct Offsetting Revenue1293625DirectOffsettingRevenue
Net Community Benefit Expense300754NetCommunityBenefitExpense
Percent Of Total Expense0.06790PercentOfTotalExpense

Community Support CommunitySupport

FieldValueIRS element (for citing)
Total Community Building Expense7000TotalCommunityBuildingExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Building Expense7000NetCommunityBuildingExpense
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Total Total

FieldValueIRS element (for citing)
Total Community Building Expense7000TotalCommunityBuildingExpense
Net Community Building Expense7000NetCommunityBuildingExpense
Percent Of Total Expense0.00060PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported0BadDebtExpenseReported
Bad Debt Expense$44,779BadDebtExpenseAmount
Amount Attributable To0AmountAttributableTo
Amount Reimbursed By Medicare3502166AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare3095970CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall406196MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost Accounting SystemXCostAccountingSystem
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care1ProvisionForCharityCare
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1MEYERSDALE COMMUNITY HOSPITALBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line1200 HOSPITAL DRIVEAddressLine1
CityMEYERSDALECity
StatePAState
ZIP Code15552ZIPCode
FieldValueIRS element (for citing)
Website AddressWWW.CONEMAUGH.ORGWebsiteAddress
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Critical Access HospitalXCriticalAccessHospital
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1MEYERSDALE COMMUNITY HOSPITALBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
CHNA Conducted1CHNAConducted
Community DefinitionXCommunityDefinition
Community DemographicsXCommunityDemographics
Existing ResourcesXExistingResources
How Data ObtainedXHowDataObtained
Community Health NeedsXCommunityHealthNeeds
Other Health IssuesXOtherHealthIssues
Identifying ProcessXIdentifyingProcess
Consulting ProcessXConsultingProcess
Needs Assessment Conducted12NeedsAssessmentConducted
Take Into Account1TakeIntoAccount
Other Facilities1OtherFacilities
CHNA Widely Available1CHNAWidelyAvailable
Own WebsiteXOwnWebsite
On RequestXOnRequest
Other MethodXOtherMethod
Adopt Implement StrategyXAdoptImplementStrategy
Execute Implement StrategyXExecuteImplementStrategy
Include Operational PlansXIncludeOperationalPlans
Prioritize Health NeedsXPrioritizeHealthNeeds
Prioritize ServicesXPrioritizeServices
Other Needs AddressedXOtherNeedsAddressed
All Needs Addressed0AllNeedsAddressed
Organization Incur Excise Tax0OrganizationIncurExciseTax
Eligibility Criteria Explained1EligibilityCriteriaExplained
Uses FPG Free1UsesFPGFree
FPG Free Percent200.000000000000FPGFreePercent
Uses FPG Discounted0UsesFPGDiscounted
Explains Basis1ExplainsBasis
Insurance StatusXInsuranceStatus
Uninsured DiscountXUninsuredDiscount
Explains Application Method1ExplainsApplicationMethod
Includes Publicity Measures1IncludesPublicityMeasures
Posted On WebsiteXPostedOnWebsite
Available On RequestXAvailableOnRequest
Other PublicityXOtherPublicity
Actions On Nonpayment1ActionsOnNonpayment
Collection Activities0CollectionActivities
Nondiscrim Emergency Care Policy1NondiscrimEmergencyCarePolicy
Average Negotiated RatesXAverageNegotiatedRates
Amounts Generally Billed0AmountsGenerallyBilled
Gross Charges0GrossCharges

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities2NumberOfOtherFacilities

Other Facilities OtherFacilities (2 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeFacility TypeFacilityType
FAMILY HEALTHCARE RHC MEYERSDALE
202 BEACHLEY STREETMEYERSDALEPA15552RURAL HEALTH CLINIC
FAMILY HEALTHCARE RHC SALISBURY
231 ORD STREETSALISBURYPA15558RURAL HEALTH CLINIC

Form990 Schedule H Part VI Form990ScheduleHPartVI (20 entries)

ExplanationExplanationIdentifierIdentifier
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 7B: A GAIN WAS EXPERIENCED WITHIN THE MEDICAID PROGRAMS THIS YEAR DUE TO THE TIMING OF THE COST SETTLEMENTS RECEIVED.
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 $ 93879.
PART II: MEYERSDALE MEDICAL CENTER'S COMMUNITY BUILDING INITIATIVES CONSIST OF A DONATION MADE TO A LOCAL ORGANIZATION THAT PROMOTES THE SUCCESS OF HIGH SCHOOL STUDENTS IN MANY AREAS, INCLUDING COMMUNITY SERVICE.
PART III, LINE 4: PART III, LINE 2: THE METHODOLOGY UTILIZED TO DETERMINE THE AMOUNT REPORTED AS BAD DEBT IS BASED ON THE DESCRIPTIONS CONTAINED IN THE FOOTNOTES DETAILED UNDER PART III, LINE 4. THESE PROCESSES ARE FOLLOWED TO SUPPORT THE AMOUNT OF BAD DEBT REPORTED ON THE FINANCIAL STATEMENTS, WHICH IS REPORTED AT CHARGES. THE ORGANIZATION'S COST TO CHARGE RATIO IS THEN USED TO CALCULATE THE AMOUNT OF BAD DEBT AT COST, SHOWN ON LINE 2. PART III, LINE 3: THE AMOUNT REPORTED ON LINE 3 IS ZERO AS THERE IS NO PORTION OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY. CHS HAS IMPLEMENTED A SCORING SYSTEM BASED ON FEDERAL POVERTY GUIDELINES THAT SEGREGATES PATIENT BALANCES THAT ARE WRITTEN OFF TO PRESUMPTIVE CHARITY CARE, RATHER THAN BEING SENT TO COLLECTION. THIS HAS RESULTED IN MOVING PATIENTS OUT OF BAD DEBT STATUS THAT WOULD OTHERWISE BE PRESUMED TO BE ELIGIBLE UNDER THE CHS FINANCIAL ASSITANCE POLICY.PART III, LINE 4: PATIENT ACCOUNTS RECEIVABLE FOOTNOTE - ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, CHS ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYER SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYER SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, CHS ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE WHERE THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL, CHS RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE DISCOUNTED RATES PROVIDED BY POLICY AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. CHS' ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR SELF-PAY PATIENTS 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.
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.MEYERSDALE COMMUNITY 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).MEYERSDALE COMMUNITY 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.MEYERSDALE COMMUNITY 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=11782MEYERSDALE COMMUNITY HOSPITAL
PART V, SECTION B, LINE 7: THE CHNA IDENTIFIED A TOTAL OF EIGHT PRIORITY HEALTH NEEDS. PLANS TO ADDRESS ALL EIGHT HAVE BEEN INITIATED AND INCLUDE MULTIPLE STEPS. HOWEVER, 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.MEYERSDALE COMMUNITY 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.MEYERSDALE COMMUNITY 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.MEYERSDALE COMMUNITY HOSPITAL
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 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: LOCATED IN SOUTHERN SOMERSET COUNTY, MEYERSDALE MEDICAL CENTER (MYMC) IS A STATE DESIGNATED CRITICAL CARE ACCESS HOSPITAL DEEMED A NECESSARY HEALTH CARE PROVIDER BY THE COMMONWEALTH OF PENNSYLVANIA. SPECIALIZING IN FAMILY AND PRIMARY CARE, MYMC OFFERS 20 BEDS FOR INPATIENT AND OUTPATIENT CARE; 24/7 EMERGENCY DEPARTMENT; OR FOR SHORT OR MINOR PROCEDURES; RADIOLOGY SERVICES, INCLUDING MOBILE MRI, AND CT SCANS; PATHOLOGY SERVICES; PHYSICAL THERAPY; RESPIRATORY THERAPY; ULTRASOUND; WOUND HEALING; OB/GYN OUTPATIENT CARE; STEP-DOWN SWING UNIT; AND MEDSTAR MEDICAL HELICOPTER TRANSPORTATION. THROUGH ITS PARTNERSHIP WITH MEMORIAL MEDICAL CENTER (MMC), MYMC PROVIDES PATIENTS WITH ACCESS TO SPECIALISTS AND NEW TECHNOLOGIES. SPECIALTY SERVICES ARE AVAILABLE ONSITE SEVERAL TIMES A WEEK. THESE SPECIALTIES INCLUDE CARDIOLOGY, OPHTHALMOLOGY, GASTROENTEROLOGY, AND PODIATRY.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 MEYERSDALE MEDICAL CENTER (MYMC), 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 MYMC AND ALL CHS HOSPITALS BY AN ELECTRONIC MEDICAL RECORD SYSTEM. MYMC 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. DIGITAL MAMMOGRAPHY EQUIPMENT WAS FULLY IMPLEMENTED AT MYMC AND COMMUNITY EDUCATION AND SCREENINGS CONTINUE TO ENCOURAGE WOMEN TO TAKE ADVANTAGE OF THIS IMPORTANT SCREENING. PROMOTION OF PROGRAMS FOR THE UNINSURED AND UNDERINSURED HAS RESULTED IN MORE WOMEN SEEKING SCREENINGS THROUGH A MAMMOGRAPHY VOUCHER PROGRAM. EACH YEAR MYMC ALSO HOLDS A LARGE COMMUNITY HEALTH FAIR AT THE HOSPITAL WHICH DRAWS APPROXIMATELY 500 PEOPLE FOR HEALTH INFORMATION, MEDICAL SCREENINGS, AND EDUCATION.MYMC EMPLOYEES ARE GENEROUS WITH THEIR TIME AND TALENT. SPECIFIC EXAMPLES INCLUDE: COLLABORATION WITH THE SALVATION ARMY AND THE SALISBURY AREA FAMILY CENTER FOR THE "ANGEL TREE" PROJECT DESIGNED TO HELP UNDERPRIVILEGED FAMILIES HAVE A BRIGHTER HOLIDAY; PARTNERSHIP WITH EDWARD LIFESCIENCES AND THE MEYERSDALE AREA SCHOOL DISTRICT TO PROVIDE STUDENTS AND FAMILIES WITH A CARDIAC/DIABETES PREVENTION PROGRAM; THE MYMC RELAY FOR LIFE TEAM HOSTED "NIGHT AT THE MOVIES" WITH PROCEEDS BENEFITTING LOCAL CANCER PATIENTS; AND MYMC PRESIDENT MARY LIBENGOOD SERVES AS PRESIDENT OF THE PENNSYLVANIA RURAL HEALTH ASSOCIATION, AN ADVOCACY GROUP WITH THE GOAL OF IMPROVING AND MAINTAINING THE HEALTH OF RESIDENTS IN RURAL PENNSYLVANIA.MYMC ALSO DONATES SPACE IN ITS DINING ROOM AND CONFERENCE ROOM EACH WEEK FOR ALCOHOLIC ANONYMOUS MEETINGS. THE FACILITY IS ALSO USED FOR A MONTHLY WELL BABY CLINIC.MEYERSDALE COMMUNITY HOSPITAL FACILITY HIGHLIGHTS:LICENSED BEDS - 20BEDS IN SERVICE - 20PATIENT DAYS OF SERVICE - 1,755INPATIENT DAILY CENSUS - 4.81ADMISSIONS - 346AVERAGE LENGTH OF STAY - 5.1FULL TIME EQUIVALENT EMPLOYEES - 110VOLUNTEERS - 23PHYSICIANS:ACTIVE - 6SERVICES:EMERGENCY VISITS - 4,173SAME DAY/AMBULATORY SURGERY - 131PHYSICAL THERAPY TREATMENTS - 4,852LABORATORY TESTS -69,789RADIOLOGY DIAGNOSTIC/MAMMOGRAPHY - 6,293ULTRASOUND PROCEDURES - 1,001CT SCANS - 2,358MRI PROCEDURES - 416CARDIO/RESPIRATORY PROCEDURES - 13,538
PART VI, LINE 6: MEYERSDALE 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.

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Recipient Table RecipientTable

Recipient Name Business RecipientNameBusiness

FieldValueIRS element (for citing)
Business Name Line1THE CHALLENGE PROGRAM INCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11910 MINNO DRIVE SUITE 100AddressLine1
CityJOHNSTOWNCity
StatePAState
ZIP Code15905ZIPCode
FieldValueIRS element (for citing)
EIN Of Recipient201644028EINOfRecipient
IRC Section501(C)(3)IRCSection
Amount Of Cash Grant7000AmountOfCashGrant
Purpose Of GrantGENERAL SUPPORTPurposeOfGrant
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants1TotalNbrOf501C3AndGovtGrants

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierPROCEDURE FOR MONITORING GRANTS IN THE U.S.:Identifier
Return ReferencePART I, LINE 2:ReturnReference
ExplanationSCHEDULE I, PART I, LINE 2: THE CONEMAUGH HEALTH SYSTEM, WHICH INCLUDES MEYERSDALE COMMUNITY HOSPITAL, ANALYZES REQUESTS FOR CHARITABLE CONTRIBUTIONS AND ASSISTANCE TO OTHER ORGANIZATIONS ON AN ONGOING BASIS IN ACCORDANCE WITH INTERNAL POLICY. THE GOALS OF THE HEALTH SYSTEM ARE TO SUPPORT ORGANIZATIONS AND PROGRAMS THAT FOCUS ON COMMUNITY HEALTH AND WELLNESS, ENHANCE THE DEVELOPMENT OF AREA YOUTH, ENRICH THE LIVES AND ENHANCE THE CULTURE OF ITS REGION, AND CONTRIBUTE TO THE OVERALL GOOD OF THE COMMUNITIES IT SERVES. AMOUNTS ARE AWARDED TO THOSE THAT MEET THESE GOALS, DEMONSTRATE A CHARITABLE PURPOSE, AND PROVIDE COMMUNITY BENEFIT SERVICES.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org1CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs1CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (9 entries)

TitleTitleBase Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
NATHAN THOMAS MD
TRUSTEE014750301379019262014542016382019906800
JAMES TRETTER DO
TRUSTEE057776705687015711022224015840063722900
SHIBAN WARIKOO MD
TRUSTEE03041900009264011215011175033584400
STEVEN TUCKER
TRUSTEE, CHIEF OPERATING OFFICER0345487074409024259020551012245047695100
SCOTT BECKER
TRUSTEE, CHIEF EXECUTIVE OFFICER06259990200000048727016605018891091022200
EDWARD DEPASQUALE
CHIEF FINANCIAL OFFICER0347620072561021192019888011289047255000
DAVID CARLSON DO
CHIEF MEDICAL OFFICER0424629092101022618013386014634056736800
JOSEPH DADO
CHIEF INFORMATION OFFICER027467305871701952801390002045036886300
MARY LIBENGOOD
PRESIDENT14170702250701833096440104100186101000

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
Return ReferencePART I, LINE 6ReturnReference
ExplanationMARY LIBENGOOD RECEIVED A BONUS FROM MEYERSDALE COMMUNITY 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.Explanation

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV

Name Of Interested Person NameOfInterestedPerson

FieldValueIRS element (for citing)
Name PersonKAREN MILLERNamePerson
FieldValueIRS element (for citing)
RelationshipFAMILY MEMBER OF MARY LIBENGOOD (OFFICER)Relationship
Amount Of Transaction25698AmountOfTransaction
Description Of TransactionEMPLOYMENTDescriptionOfTransaction
Sharing Of Revenues0SharingOfRevenues

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (10 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
FORM 990, PART VI, SECTION A, LINE 6THE MEMBERS OF MEYERSDALE COMMUNITY HOSPITAL CONSIST OF THREE CLASSES: PERPETUAL MEMBERS, LIFE MEMBERS, AND CONEMAUGH HEALTH SYSTEM, INC. (THE CORPORATE MEMBER).
FORM 990, PART VI, SECTION A, LINE 7ATHE CORPORATE MEMBER OF MEYERSDALE COMMUNITY HOSPITAL, 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 7BALL DECISIONS OF THE GOVERNING BODY OF MEYERSDALE COMMUNITY HOSPITAL ARE SUBJECT TO APPROVAL BY ITS CORPORATE MEMBER, CONEMAUGH HEALTH SYSTEM, INC.
FORM 990, PART VI, SECTION B, LINE 11THE 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 12CTHE 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 15THE ORGANIZATION'S PARENT, A HEALTH SYSTEM, MANAGES THE DETERMINATION OF COMPENSATION AND THE PROCESS IS OUTLINED IN ITS BY-LAWS. 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 19THE ORGANIZATION IS PART OF A HEALTH SYSTEM AND ALL REQUESTS FOR THIS INFORMATION ARE HANDLED BY THE SYSTEM'S MARKETING/PUBLIC RELATIONS DEPARTMENT.
FORM 990, PART VI, SECTION B, LINES 12A, 13, AND 14: ALL APPLICABLE POLICY QUESTIONS HAVE BEEN ANSWERED YES SINCE THE ORGANIZATION IS A SUBSIDIARY OF A LARGER HEALTH SYSTEM AND IS GOVERNED BY THE SYSTEM'S POLICIES. ALL POLICIES HAVE BEEN APPROVED BY THE HEALTH SYSTEM'S BOARD.
FORM 990, PART XI, LINE 9:CHANGE IN CHF FAS 136 RECEIVABLE 25,512. CHANGE IN INCOME TRUSTS 28,393. MEDICAL DIRECTOR REIMBURSEMENT FROM CHS 13,800.CHANGES IN NET ASSETS OR FUND BALANCES:
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 RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT AND THE SELECTION OF THE INDEPENDENT ACCOUNTANT.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (4 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusDirect Controlling Entity NADirectControllingEntityNAControlled OrgControlledOrgBusiness Name Line1DirectControllingEntityName/BusinessNameLine1
CONEMAUGH HEALTH SYSTEM
1086 FRANKLIN STREETJOHNSTOWNPA15905232801799SUPPORT MEMBER HOSPITALSPA501(C)(3)11AN/A0
CONEMAUGH HEALTH FOUNDATION
1086 FRANKLIN STREETJOHNSTOWNPA15905251719695SUPPORTS CONEMAUGH HEALTH SYSTEMPA501(C)(3)11B0CONEMAUGH HEALTH SYSTEM
CONEMAUGH VALLEY MEMORIAL HOSPITAL DBA MEMORIAL MEDICAL CENTER
1086 FRANKLIN STREETJOHNSTOWNPA15905250965307HEALTHCARE SERVICESPA501(C)(3)30CONEMAUGH HEALTH SYSTEM
MINERS HOSPITAL DBA MINERS MEDICAL CENTER
290 HAIDA AVENUEHASTINGSPA16646250977902HEALTHCARE SERVICESPA501(C)(3)30CONEMAUGH HEALTH SYSTEM

Form990 Schedule R Part III Form990ScheduleRPartIII (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateDirect Controlling Entity NADirectControllingEntityNA
LAUREL HIGHLANDS ADVANCED IMAGING
1450 SCALP AVENUEJOHNSTOWNPA15904251864587DIAGNOSTIC SERVICESPAN/A
GREATER JOHNSTOWN TECH PARK
1086 FRANKLIN STREETJOHNSTOWNPA15905260389121OPERATES MULTI TENANT COMMERCE OFFICE PARKPAN/A

Form990 Schedule R Part IV Form990ScheduleRPartIV (3 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateDirect Controlling Entity NADirectControllingEntityNAType Of EntityTypeOfEntityControlled OrgControlledOrg
CONEMAUGH HEALTH INITIATIVES INC
1086 FRANKLIN STREETJOHNSTOWNPA15905251658283PHYSICIAN SERVICESPAN/AC0
1086 REAL ESTATE
1086 FRANKLIN STREETJOHNSTOWNPA15905251489704REAL ESTATEPAN/AC0
CONEMAUGH ENTERPRISES INC
1086 FRANKLIN STREETJOHNSTOWNPA15905202998473ECONOMIC DEVELOPMENTPAN/AC0
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Dividends Related Organization0DividendsRelatedOrganization
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs1PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg