2013-05-07T15:42:57-05:00 2012-06-30 135381590 BDO USA LLP 7101 WISCONSIN AVENUE BETHESDA MD 20814 990 2011-07-01 231360851 HANOVER HOSPITAL INC HANO 7176373711 300 HIGHLAND AVENUE HANOVER PA 173312214 MICHAEL GASKINS 7176373711 2013-05-07 1 MICHAEL SORRELLS CPA P00001737 3016544900 2011 2016-02-25 16:41:14Z JAMES WISSLER 300 HIGHLAND AVENUE HANOVER PA 173312214 145218820 0 X WWW.HANOVERHOSPITAL.ORG X 1924 PA NON-PROFIT COMMUNITY HOSPITAL DEDICATED TO PROMOTING WELLNESS WITHIN THE GREATER HANOVER AREA. 14 10 1387 220 3104599 1032915 3414259 1374791 138948622 140774903 321105 366645 976821 1273989 143660807 143790328 49823 62654 0 0 68386092 68192961 0 0 215977 63800181 68487625 132236096 136743240 11424711 7047088 151071138 156016413 70585825 73868322 80485313 82148091 X WE ARE A NOT-FOR-PROFIT COMMUNITY HOSPITAL WHICH IS DEDICATED TO THE PROMOTION OF WELLNESS, PRESERVATION OF HEALTH, AND THE PROVISION OF DIAGNOSTIC AND THERAPEUTIC SERVICES TO THE PEOPLE OF THE GREATER HANOVER AREA.WE WILL BE THE PROVIDER OF CHOICE FOR HOSPITAL SUPPORTED ACUTE CARE, DIAGNOSTIC, THERAPEUTIC, REHABILITATIVE, AND WELLNESS SERVICES REQUIRED TO SUPPORT OUR NETWORK OF CARE. 0 0 93103719 62654 137779363 HANOVER HOSPITAL, INC ("HH") OPERATES A NOT-FOR-PROFIT HOSPITAL WITH SERVICES INCLUDING OBSTETRICS, EMERGENCY, CARDIAC CARE, CRITICAL CARE, REHABILITATION, OCCUPATIONAL HEALTH, SURGICAL SERVICES, AND A WIDE RANGE OF THERAPEUTIC AND DIAGNOSTIC SUPPORT SERVICES. (SEE SCHEDULE O FOR CONTINUATION.) 93103719 1 1 0 1 0 0 0 0 1 1 1 0 0 0 1 1 1 1 0 0 0 0 0 0 1 0 1 1 1 0 1 1 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 1 0 0 0 0 1 91 0 1 1387 1 1 1 0 0 0 0 1 1 0 0 0 0 X 14 10 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 PA X DONNA MULLER 7176332032 310 STOCK STREET SUITE 7 HANOVER PA 17331 PAUL F DENDE 1.00 X 0 300161 14228 WILLIAM E HEISER 1.00 X 0 0 0 THOMAS K HOWARD MD 1.00 X 0 0 0 LAVERNE L LEESE 1.00 X 0 0 0 G STEVEN MCKONLY ESQUIRE 1.00 X 3427 0 0 STEVEN R SHEPPARD DO 1.00 X 0 0 0 MARCOS A UGARTE MD 1.00 X 0 0 0 C DANIEL WEBER 1.00 X 0 0 0 JILL R ROHRBAUGH 1.00 X X 0 0 0 ALAN J STOCK 1.00 X X 0 0 0 GEORGE M KYRIACOU 40.00 X X 324504 0 16300 PAUL F SPEARS MD 1.00 X X 0 0 0 JOHN R SCHNITZER CPA 1.00 X X 0 0 0 JAMES WISSLER 40.00 X X 0 0 0 MICHAEL W GASKINS 40.00 X 156728 0 2463 DAVID C CAPONE 40.00 X 170020 0 0 MICHAEL H ADER 1.00 X 0 238885 7873 MARY P SAUNDERS 40.00 X 158299 0 8667 WARREN C DANIELS 40.00 X 173758 0 9626 MICHAEL A HOCKENBERRY 40.00 X 147509 0 9776 REBECCA E GOODERMUTH 40.00 X 147145 0 9677 JENNIFER L SHIMKONIS 40.00 X 153820 0 6801 KELLY A BESACK 40.00 X 144934 0 2597 1580144 539046 88008 24 0 1 0 HUNTZINGER MANAGEMENT GROUP 670 N RIVER STREET STE 401 PLAINS PA 18705 CONSULTING - IT 2538079 GE MEDICAL SYSTEMS PO BOX 640944 PITTSBURGH PA 15264 EQUIPMENT MAINTENANCE 1277896 HANOVER ANESTHESIA & PAIN MEDICINE INC 250 FAME AVE STE 102 HANOVER PA 17331 ANESTHESIA SERVICES 1236672 JOHNSON CONTROLS INC PO BOX 905240 CHARLOTTE NC 282905240 EQUIPMENT MAINTENANCE 562357 ECLINICAL WORKS LLC 110 TURNPIKE RD SUITE 300 WESTBORO MA 01581 CONSULTING - IT 534950 29 120655 1254136 155550 1374791 NET PATIENT SVC REV 621990 136597275 136597275 LAB SERVICE REV 621500 3671889 554818 3117071 EMERGENCY ROOM 621990 505739 505739 140774903 740756 740756 184325 58252 126073 126073 -26210 152283 952000 3190 1346034 -16733 -394034 19923 -374111 -374111 29968 120655 40939 -10971 -10971 FOOD SERVICES/CATERING 722210 530642 110 530532 PURCH REBATES/DISCNTS 900099 231752 231752 CHERRY TREE CANCER CTR 900099 93859 93859 302634 121531 13628 167475 1158887 143790328 137779363 3104599 1531575 62654 62654 854781 341912 512869 50983925 38912866 11940721 130338 1916081 1462426 448757 4898 10742214 8198865 2515887 27462 3695960 2823376 862735 9849 1174586 1174586 204194 204194 101129 101129 17941 17941 17919566 9024283 8874391 20892 739160 5177 734003 -20 1536828 794937 720472 21419 364649 68042 296607 3713786 814857 2898929 317123 170998 145788 337 2909284 2909284 9260986 3563632 5696552 802 1009895 1009895 SUPPLY EXPENSE 16930445 16451903 478542 BAD DEBT EXPENSE 7465766 7465766 LEASING EXPENSE 2767640 2652039 115601 UNRELATED BUS INC TAXES 287317 287317 1767330 2669 1764661 136743240 93103719 43423544 215977 58685 2674 6879240 9432227 1555387 1354904 10513132 14547154 2841914 3021029 3878380 2313883 177795606 90517710 87964895 87277896 33008794 31735982 1569108 1428967 2801603 4901697 151071138 156016413 11232294 14877533 52061203 50494052 4241634 5069693 3050694 3427044 70585825 73868322 X 77882309 78682664 2455527 3320765 147477 144662 80485313 82148091 151071138 156016413 X 7047088 -5384310 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 7025 7025 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: THE FOLLOWING PORTIONS OF THE DUES PAID TO VARIOUS ENTITIES WERE USED FOR LOBBYING PURPOSES: THE HOSPITAL ASSOCIATION OF PENNSYLVANIA - $6,761, YORK CHAMBER OF COMMERCE - $264. 1 17052 1543 15509 1 13681355 365692 -110985 1500 38894 13895668 10948733 386168 2405437 3000 55983 13681355 10655584 133632 1224661 1065145 10948732 12146275 76577 -1498956 68312 10655584 0.98960 0.01040 0.00000 0 0 2143865 2143865 120743144 55458577 65284567 1865873 852384 1013489 52461806 34206749 18255057 580918 580918 87277896 OBLIGATIONS UNDER CAPITAL LEASE 1467853 ADVANCES RECEIVED FROM THIRD-PARTY PAYORS 521201 DEFERRED COMPENSATION 487990 ESTIMATED 3RD PARTY PAYOR SETTLEMENTS 950000 3427044 143790328 136743240 7047088 -211366 -1965 -5170979 -5384310 1662778 143721041 -211366 -211366 143932407 -142079 -142079 143790328 137107340 364100 364100 136743240 0 136743240 PART IV, LINE 1B: PART IV, LINE 1B: JOSEPH & PATRICIA HUMBERT ORIGINALLY CONTRIBUTED $20,000 TO HANOVER HOSPITAL, INC. THE DONORS RECEIVE SEMI-ANNUAL DISTRIBUTIONS OF $535 AND HANOVER HOSPITAL, INC. RECEIVES INTEREST INCOME AND PAYS BANK FEES ON THE FUNDS. THE BALANCE OF THE FUND WHEN BOTH DONORS HAVE EXPIRED IS A CONTRIBUTION TO HANOVER HOSPITAL, INC. FOR TAX YEAR 2011, THERE WAS A CATCH-UP PAYMENT OF $490 TO THE DONORS FOR THE PRIOR YEAR. DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: BOARD DESIGNATED FUNDS ARE ASSETS SET ASIDE BY THE BOARD OF TRUSTEES FOR FUTURE CAPITAL IMPROVEMENTS, OVER WHICH THE BOARD RETAINS CONTROL AND MAY, AT ITS DISCRETION, SUBSEQUENTLY USE FOR OTHER PURPOSES. THE FOLLOWING ENDOWMENTS' INCOMES ARE USED FOR THE PURPOSE OF PROVIDING HANOVER HOSPITAL STAFF SCHOLARSHIPS FOR CONTINUING EDUCATION IN THE NOTED SPECIALTIES: BATHON-CRITICAL CARE, CARDIAC AND EMERGENCY SERVICES PATHOLOGISTS- LABORATORY KIRKPATRICK-MATERNITY/OBSTETRICS SHIPMAN-RADIOLOGY BONNIE HART-OPERATING ROOM STEVE LAWRENCE-EMERGENCY MEDICINE THE JACKIE LAWRENCE ENDOWMENT IS RESTRICTED FOR THE PURPOSE OF AWARDING A $500 SCHOLARSHIP TO A DELONE CATHOLIC HIGH SCHOOL SENIOR THAT IS PURSUING A BACHELOR OF SCIENCE- NURSING DEGREE. THE LEHMAN ENDOWMENT FUND IS TO SUPPORT A "WENDELL LEHMAN EDUCATION DAY" FOR THE HANOVER HOSPITAL CARDIAC SERVICES STAFF. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE HOSPITAL ACCOUNTS FOR UNCERTAINTY IN INCOME TAXES USING A RECOGNITION THRESHOLD OF MORE-LIKELY-THAN-NOT TO BE SUSTAINED UPON EXAMINATION BY THE APPROPRIATE TAXING AUTHORITY. MEASUREMENT OF THE TAX UNCERTAINTY OCCURS IF THE RECOGNITION THRESHOLD HAS BEEN MET. MANAGEMENT DETERMINED THAT THERE WERE NO TAX UNCERTAINTIES THAT MET THE RECOGNITION THRESHOLD IN 2012 OR 2011. THE TAX RETURNS FOR THE YEARS ENDED JUNE 30, 2009 THROUGH JUNE 30, 2012 REMAIN SUBJECT TO EXAMINATION BY MAJOR TAX JURISDICTIONS. PART XI, LINE 8 - OTHER ADJUSTMENTS: NET ASSET TRANSFER TO AFFILIATE -4,886,147. IMPAIRMENT LOSS -284,832. TOTAL TO SCHEDULE D, PART XI, LINE 8: -5,170,979. PART XII, LINE 4B - OTHER ADJUSTMENTS: RENTAL EXPENSES -58,252. GAIN (LOSS) ON SALE OF PROPERTY AND EQUIPMENT 19,923. FUNDRAISING EXPENSES -40,939. EXPENSES RELATED TO CONTRIBUTIONS -62,946. OTHER ADJUSTMENT TO REVENUE 135. PART XIII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 58,252. LOSS (GAIN) ON SALE OF ASSETS -19,923. IMPAIRMENT LOSS 284,832. FUNDRAISING EXPENSES 40,939. X X X X X X 0 GOLF BENEFIT 150623 120655 29968 13105 28063 -229 150623 120655 29968 13105 28063 -229 40939 -10971 1 1 1 X 1 X 1 1 1 0 1 1 4 2012 1008422 1008422 0.00740 1 15385 10096737 3899974 6196763 0.04530 5 17397 11105159 3899974 7205185 0.05270 26 18740 146924 475 146449 0.00110 4 447 3212 3212 0.00000 2 500 25118 25118 0.00020 32 19687 175254 475 174779 0.00130 37 37084 11280413 3900449 7379964 0.05400 3 1164 1302 1302 0.00000 3 323 5471 5471 0.00000 6 1487 6773 6773 1 3770213 28035 33837201 44637805 -10800604 X 1 1 1 CHERRY TREE CANCER CENTER LLP DIAGNOSTIC ONCOLOGY CENTER 0.50000 0.00000 0.00000 1 1 HANOVER HOSPITAL INC

300 HIGHLAND AVENUE HANOVER PA 17331

X X X HANOVER HOSPITAL 1 1 1 200.000000000000 1 350.000000000000 1 X X X X X X X 1 1 X X X X X X 1 0 1 X 0 0 12 HILLSIDE DIAGNOSTIC CENTER

250 FAME AVE STE 104 HANOVER PA 17331

LAB, MRI, X-RAY, CT SCAN, US SOUTH HANOVER

1404 BALTIMORE ST HANOVER PA 17331

LAB & X-RAY CHERRY TREE

785 CHERRY TREE CT HANOVER PA 17331

REHAB & PEDIATRICS REHAB SPRING GROVE

2030 THISTLE HILL DR SPRING GROVE PA 17362

LAB, REHAB, X-RAY LITTLESTOWN

300 W KING ST LITTLESTOWN PA 17340

LAB & REHAB NEW OXFORD

5615 YORK RD NEW OXFORD PA 17350

LAB & X-RAY EICHELBERGER LAB

195 STOCK ST HANOVER PA 17331

OUTPATIENT LAB YORK STREET

400 YORK ST HANOVER PA 17331

REHAB HILLSIDE CARDIAC DIAGNOSTIC

250 FAME AVE STE 207 HANOVER PA 17331

CARDIAC REHAB HILLSIDE LUNG & SLEEP CENTER

250 FAME AVE STE 200 HANOVER PA 17331

PULMONOLOGY & SLEEP CENTER HILLSIDE REHAB

250 FAME AVE STE 100 HANOVER PA 17331

REHAB HANOVER MEDICAL FITNESS CENTER

250 FAME AVE STE 100 HANOVER PA 17331

FITNESS CENTER PART I, LINE 7: CHARITY CARE, UNREIMBURSED MEDICAID AND SUBSIDIZED HEALTH SERVICES WERE CALCULATED USING WORKSHEET 2 (RATIO OF PATIENT CARE COST TO CHARGES) FROM THE INSTRUCTIONS FOR SCHEDULE H. PART I, LINE 7G: THE SUBSIDIZED HEALTH SERVICES WERE DETERMINED USING OUR COST ACCOUNTING SYSTEM, BEFORE MANUALLY REMOVING THE CHARITY CARE AND MEDICAID REVENUE. PART I, L7 COL(F): THE AMOUNT OF BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25 COLUMN (A) BUT SUBTRACTED OUT FOR PURPOSES OF CALCULATING THE PERCENTAGE ON SCH H, PART I, LINE 7, COLUMN (F) IS $7,465,766. PART II: HANOVER HOSPITAL OFFERS A WIDE VARIETY OF LECTURES, PRESENTATIONS AND OTHER PROGRAMS TO EDUCATE THE PUBLIC ABOUT HEALTH ISSUES, SUCH AS CHRONIC DISEASE PREVENTION, CANCER PREVENTION, MENTAL HEALTH AWARENESS, CARDIOVASCULAR DISEASE PREVENTION, AND HEALTHY BEHAVIORS. WE ALSO HAVE STRONG COMMUNITY COLLABORATIONS WITH HANOVER AREA YMCA, HANOVER CHAMBER OF COMMERCE, HANOVER YWCA, HEALTHY YORK COUNTY COALITION, HEALTHY ADAMS COUNTY, AND NUMEROUS OTHER ORGANIZATIONS. PART III, LINE 4: BAD DEBT EXPENSE IS THE UNCOLLECTIBLE PORTION OF CHARGES GENERATED BY PATIENT CARE. THIS SHOULD BE INCLUDED IN COMMUNITY BENEFIT TO SHOW HOW MUCH MONEY WAS DEEMED UNCOLLECTIBLE FROM PATIENTS.THE ALLOWABLE ADJUSTMENT IS TAKEN PRIOR TO THE REMAINING BALANCE IS WRITTEN OFF TO BAD DEBT EXPENSE. IF ANY PAYMENTS COME IN SUBSEQUENTLY, THE WRITE-OFF IS REVERSED AND THE BAD DEBT EXPENSE IS REDUCED.BAD DEBT EXPENSE WAS DETERMINED USING THE COST TO CHARGE RATIO. PART III, LINE 8: THE ORGANIZATION IS PROVIDING CARE TO COMMUNITY MEMBERS WHO ARE ENROLLED IN MEDICARE BUT THE ORGANIZATION CANNOT COLLECT ON THE SHORTFALL BECAUSE OF THE GOVERNMENT'S LIMITATIONS ON ALLOWABLE CHARGES. THE SAME LEVEL OF CARE IS PROVIDED TO ALL PATIENTS NO MATTER WHAT THE INSURANCE SITUATION, SO THE ORGANIZATION SHOULD BE ALLOWED TO CLAIM THE MEDICARE SHORTFALL AS COMMUNITY BENEFIT.MEDICARE ALLOWABLE COST OF CARE WAS OBTAINED FROM THE MEDICARE COST REPORT. PART III, LINE 9B: PATIENTS WHO QUALIFY FOR 100% CHARITY CARE HAVE THEIR ACCOUNT BALANCES WRITTEN OFF AS SOON AS ELIGIBILITY IS APPROVED. PATIENTS WHO QUALIFY FOR A LESSER AMOUNT ARE EXPECTED TO PAY THE REMAINING BALANCE AT THE TIME OF APPROVAL. IF NECESSARY, A PAYMENT PLAN IS SET UP FOR THE BALANCE. HANOVER HOSPITAL PART V, SECTION B, LINE 19D: SERVICES ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THIS POLICY WILL BE DISCOUNTED ON A SLIDING SCHEDULE, IN ACCORDANCE WITH FINANCIAL NEED, AS DETERMINED IN REFERENCE TO FEDERAL POVERTY LEVELS (FPL) IN EFFECT AT THE TIME OF DETERMINATION. THE BASIS FOR THE AMOUNTS HANOVER HOSPITAL WILL DISCOUNT IS AS FOLLOWS:1. PATIENTS WHOSE FAMILY INCOME IS AT OR BELOW 200% OF THE FPL ARE ELIGIBLE TO RECEIVE FREE CARE.2. PATIENTS WHOSE FAMILY INCOME IS AT OR ABOVE 201% BUT NOT MORE THAN 350% OF THE FPL ARE ELIGIBLE TO RECEIVE DISCOUNTS BASED ON THE FOLLOWING SLIDING FEE SCHEDULE:3. 201% - 250% - 75% DISCOUNT4. 251% - 300% - 50% DISCOUNT5. 301% - 350% - 25% DISCOUNT6. ABOVE 350% - CASE-BY-CASE7. PATIENTS WHOSE FAMILY INCOME IS ABOVE 350% OF THE FPL MAY BE ELIGIBLE TO RECEIVE ON A CASE-BY-CASE BASIS BASED ON THEIR SPECIFIC CIRCUMSTANCES AT THE DISCRETION OF HANOVER HOSPITAL. PART VI, LINE 2: A COMMUNITY HEALTH ASSESSMENT PROVIDES THE INFORMATION NEEDED TO CONSIDER WHEN DEVELOPING EFFECTIVE INTERVENTIONS SO THAT COMMUNITIES MAY IDENTIFY ISSUES OF GREATEST CONCERN AND DECIDE TO COMMIT RESOURCES TO THOSE AREAS, THEREBY MAKING THE GREATEST POSSIBLE IMPACT ON COMMUNITY HEALTH STATUS.SEVERAL COMMUNITY ORGANIZATIONS COME TOGETHER TO FORM A COMMITTEE WHOSE RESPONSIBILITY IS TO FORMULATE QUESTIONS TO BE ASKED OF COMMUNITY MEMBERS. A CONSULTANT THEN COLLECTS THE DATA AND ANALYZES IT ON OUR BEHALF. THE GREATEST NEEDS ARE THEN DETERMINED AND PROGRAMS ARE DESIGNED AROUND THOSE NEEDS. PART VI, LINE 3: NOTIFICATION OF THE FINANCIAL ASSISTANCE POLICY, WHICH SHALL INCLUDE A CONTACT NUMBER, WILL BE DISTRIBUTED BY VARIOUS MEANS INCLUDING, BUT NOT LIMITED TO, POSTING NOTICES IN PROMINENT PATIENT LOCATIONS AND PLACING INFORMATION ON PATIENT STATEMENTS. HANOVER HOSPITAL WILL ALSO PUBLICIZE A SUMMARY OF THE FINANCIAL ASSISTANCE POLICY ON THE FACILITY WEBSITE AND IN BROCHURES AVAILABLE IN PATIENT ACCESS AREAS. SUCH NOTICES AND SUMMARY INFORMATION WILL BE PROVIDED IN THE PRIMARY LANGUAGES SPOKEN BY THE POPULATION SERVED BY HANOVER HOSPITAL. PART VI, LINE 4: THE COMMUNITY DEFINED FOR THIS ASSESSMENT INCLUDES EACH OF THE PENNSYLVANIA ZIP CODES: 17316, 17301, 17350, 17364, 17362, 17344, 17331, 17329 & 17340. SECONDARY DATA IS COLLECTED AND REPRESENTATIVE OF THE ENTIRE COUNTIES OF YORK AND ADAMS. PART VI, LINE 5: HANOVER HOSPITAL FURTHERS ITS EXEMPT PURPOSE BY PROMOTING THE HEALTH OF ITS COMMUNITY THROUGH THE FOLLOWING. HANOVER HOSPITAL UTILIZES APPROXIMATELY 300 VOLUNTEERS OFFERING SUPPORT TO THE ORGANIZATION, FROM THE BOARD OF DIRECTORS TO THOSE WHO DELIVER FLOWERS AND TRANSPORT PATIENTS. THESE VOLUNTEERS ARE ALSO ACTIVE COMMUNITY MEMBERS LIVING IN THE HOSPITAL'S PRIMARY SERVICE AREA. THROUGH THEIR INVOLVEMENT AT THE HOSPITAL, THEY ARE ABLE TO COMMUNICATE ITS PROGRAMS AND SERVICES THAT BENEFIT THE WELFARE OF THE COMMUNITY. HANOVER HOSPITAL ALSO EMPLOYS APPROXIMATELY THIRTY PHYSICIANS. THESE PHYSICIANS SPECIALIZE IN FAMILY MEDICINE, INTERNAL MEDICINE, GENERAL SURGERY, GERIATRICS, LUNG AND SLEEP MEDICINE, ENDOCRINOLOGY, AND CARDIOLOGY. OUR PHYSICIANS WORK WITH THOUSANDS OF FAMILIES PROVIDING EXCEPTIONAL CARE. FINALLY, HANOVER HOSPITAL APPLIES ITS SURPLUS FUNDS BY REINVESTING IN THE ORGANIZATION. OVER THE PAST YEAR, THE HOSPITAL HAS PAID FOR THE EXPENSES TO ROLL OUT A COMMUNITY-WIDE ELECTRONIC MEDICAL RECORD (EMR). HANOVER IS ONE OF THE VERY FEW COMMUNITIES TO HAVE APPROXIMATELY EIGHTY PERCENT OF ITS EMPLOYED AND AFFILIATED PHYSICIAN PRACTICES JOIN THIS ROLL OUT. TOGETHER THE HOSPITAL AND ITS PHYSICIANS ARE COMMITTED TO PROVIDING A TIMELY, ACCURATE RECORD FOR PATIENTS TO REDUCE UNNECESSARY TESTING AND REDUCE COSTS. IN ADDITION TO THE EMR, THE HOSPITAL HAS INVESTED FUNDS TO IMPROVE TECHNOLOGY AND TO OPEN NEW CENTERS. MOST RECENTLY, THE HOSPITAL OPENED ITS THIRD EXPRESS CARE IN NEW OXFORD. THROUGH OUR MOST VALUABLE ASSETS, OUR VOLUNTEERS AND EMPLOYEES, ALONG WITH OUR ONGOING COMMITMENT TO OUR COMMUNITY HANOVER HOSPITAL HAS FURTHERED ITS EXEMPT PURPOSE. REPORTS FILED WITH STATES PART VI, LINE 7 PA 1 HANOVER AREA CHAMBER OF COMMERCE 146 CARLISLE STREET HANOVER PA 17331 232290798 501(C)(6) 7777 N/A N/A SPONSORSHIP OF VARIOUS PROGRAMS AND EVENTS AMERICAN HEART ASSOCIATION 5455 NORTH HIGH STREET COLUMBUS OH 43214 135613797 501(C)(3) 10000 N/A N/A ANNUAL SPONSORSHIP FOR GO RED LUNCHEON FRIENDS OF CODORUS STATE PARK 1600 BLOOMING GROVE ROAD HANOVER PA 17331 562675802 170(01)(2) 10000 N/A N/A CODORUS BLAST SPONSORSHIP SWEET CHARITIES-CANCER PATIENT FUND PMB 154 1150 CARLISLE ST HANOVER PA 17331 113662416 501(C)(3) 6900 N/A N/A GOLF TOURNAMENT, SPONSORSHIPS 2 2 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: DONATIONS ARE MADE TO 501(C)(3) PUBLIC CHARITIES FOR USE IN EXEMPT ACTIVITIES RELATED TO HEALTHCARE. ADDITIONAL DONATIONS ARE MADE TO LOCAL NON-CHARITABLE ORGANIZATIONS TO SUPPORT THE COMMUNITY. X X X X X X 0 1 0 0 0 0 0 0 0 PAUL F DENDE 0 140007 0 158962 0 1192 0 7000 0 7228 0 314389 0 0 GEORGE M KYRIACOU 266778 0 40292 0 17434 0 12250 0 4050 0 340804 0 0 0 MICHAEL W GASKINS 126157 0 30000 0 571 0 0 0 2463 0 159191 0 0 0 DAVID C CAPONE 170020 0 0 0 0 0 0 0 0 0 170020 0 0 0 MICHAEL H ADER 0 225014 0 12400 0 1471 0 3635 0 4238 0 246758 0 0 MARY P SAUNDERS 152100 0 0 0 6199 0 7605 0 1062 0 166966 0 0 0 WARREN C DANIELS 158298 0 0 0 15460 0 8500 0 1126 0 183384 0 0 0 MICHAEL A HOCKENBERRY 146457 0 0 0 1052 0 7267 0 2509 0 157285 0 0 0 REBECCA E GOODERMUTH 144272 0 0 0 2873 0 7213 0 2464 0 156822 0 0 0 JENNIFER L SHIMKONIS 152307 0 0 0 1513 0 5262 0 1539 0 160621 0 0 0 PART I, LINE 4B CEO GEORGE KYRIACOU TERMINATED 11/4/2011. HE PARTICIPATED IN A SERP AND RECEIVED $40,292 IN REPORTABLE COMPENSATION. GENERAL AUTHORITY OF SOUTHCENTRAL PENNSYLVANIA 232982233 84129NEB1 2005-10-12 32293464 RENOVATIONS, DEBT SERVICE FUND, AND COST TO INSURE & ISSUE BONDS 0 0 0 32293464 1784627 1854432 476117 989784 29042966 2008 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 ALAN STOCK BOARD MEMBER & PRESIDENT OF EICHOLTZ 111180 ALAN STOCK OWNS EICHOLTZ COMPANY. THE HOSPITAL PURCHASED OFFICE EQUIPMENT FROM EICHOLTZ COMPANY.THE BOARD MAINTAINS A CONFLICT OF INTEREST POLICY AND ALL TRANSACTIONS WITH EICHOLTZ COMPANY WERE CONDUCTED AT ARM'S LENGTH. 0 X 3 51877 FAIR MARKET VALUE X 1 103673 FAIR MARKET VALUE 0 1 1 THIRD PARTY USE: PART I, LINE 32B: HAVERFORD SELLS NON-CASH CONTRIBUTIONS OF SECURITIES. PROGRAM SERVICE ACCOMPLISHMENTS (CONTINUED): FORM 990, PART III, LINE 4A: HH PROVIDES ACUTE CARE SERVICES INCLUDING MEDICAL, SURGICAL, OBSTETRIC/GYNECOLOGICAL, PEDIATRIC, AND CRITICAL CARE. THE MEDICAL/SURGICAL UNITS ARE STAFFED ON TWO FLOORS, FOR A COMBINED TOTAL OF 58 BEDS. TOTAL PATIENTS DISCHARGED BY THESE UNITS DURING THE YEAR ENDED JUNE 30, 2012 WERE 3,749. OBSTETRICS/GYNECOLOGY STAFFS A TOTAL OF 18 BEDS AND DISCHARGED 726 PATIENTS. THE PEDIATRIC UNIT IS EQUIPPED WITH 5 BEDS AND HAD 149 DISCHARGES. THERE ARE 10 BEDS IN OUR CRITICAL CARE UNIT AND 312 PATIENTS WERE DISCHARGED. THE CENTER FOR ACUTE REHABILITATIVE MEDICINE HAS 15 BEDS, AND DISCHARGED 259 PATIENTS THIS YEAR. THERE WERE 590 DISCHARGES FROM THE NURSERY DURING THE YEAR AS WELL. HH PROVIDES A WIDE RANGE OF DIAGNOSTIC AND SUPPORT SERVICES FOR BOTH INPATIENTS AND OUTPATIENTS. THESE SERVICES INCLUDE, BUT ARE NOT LIMITED TO, LABORATORY, IMAGING SERVICES, CARDIAC SERVICES, AND REHAB FACILITIES. IMAGING SERVICES INCLUDES RADIOLOGY, NUCLEAR MEDICINE, MRI, ULTRASOUND, AND CT SCAN. CARDIAC SERVICES ARE COMPRISED OF REHAB, DIAGNOSTIC, AND A CARDIAC CATHETERIZATION LAB. HH PROVIDES MULTIPLE OUTPATIENT FACILITIES FOR PHYSICAL, OCCUPATIONAL, AND SPEECH THERAPY. HH ALSO PROVIDED CARE TO PATIENTS WHO MET CERTAIN CRITERIA WITHOUT CHARGE OR AT AMOUNTS LESS THAN ESTABLISHED RATES. CHARGES FOREGONE FOR SERVICES RENDERED AND SUPPLIES FURNISHED UNDER THE CHARITY CARE POLICY AMOUNTED TO APPROXIMATELY $1,997,000 DURING THE YEAR ENDED JUNE 30, 2012. FORM 990, PART VI, SECTION B, LINE 11 REVIEW OF THE DRAFT OF THE FORM 990 IS PERFORMED BY MANAGEMENT WITH THE OUTSIDE ACCOUNTING FIRM. ALL MEMBERS OF THE BOARD OF DIRECTORS ARE GIVEN A FINAL COPY OF THE FORM 990 PRIOR TO FILING WITH THE IRS. THE FINAL SUBMISSION IS REVIEWED BY THE FINANCE COMMITTTEE SO THAT THEIR QUESTIONS AND CONCERNS MAY BE ADDRESSED. FORM 990, PART VI, SECTION B, LINE 12C HH'S CODE OF CONDUCT CONTAINS PRINCIPLES OUTLINING THE POLICY OF HH AND STANDARDS THAT ARE INTENDED TO PROVIDE GUIDANCE TO ALL INDIVIDUALS PARTICIPATING IN HH'S OPERATIONS. THE PRINCIPLES AND STANDARDS SHALL BE DISTRIBUTED AT LEAST ANNUALLY TO ALL DIRECTORS, OFFICERS, EMPLOYEES AND AGENTS OF HH. INDIVIDUALS ARE RESPONSIBLE TO ENSURE THAT THEIR BEHAVIOR AND ACTIVITY IS CONSISTENT WITH THE CODE OF CONDUCT. THE TERM "INDIVIDUALS" INCLUDES DIRECTORS, EMPLOYEES AND AGENTS OF HH AND INCLUDES ANY PERSON WHO FILLS SUCH A ROLE OR PROVIDES SERVICES ON BEHALF OF HH INCLUDING NON-EMPLOYED MEMBERS OF HH'S MEDICAL STAFF PROVIDING SERVICES IN HH, NON-PHYSICIAN PRACTITIONERS EXERCISING PRIVILEGES IN HH, INTERNS AND MEDICAL STUDENTS AND SHALL INCLUDE VOLUNTEERS IN HH. UPON HIRE AND ANNUALLY THEREAFTER, ALL EMPLOYEES MUST COMPLETE OUR COMPLIANCE TRAINING, INCLUDING REVIEW OF OUR CODE OF CONDUCT STATEMENT. A COPY OF THE CODE OF CONDUCT IS LOCATED IN HH'S ADMINISTRATIVE POLICY MANUAL. OUR CODE OF CONDUCT HAS STANDARDS AND POLICIES THAT ADDRESS CONFLICTS OF INTEREST. IT IS EACH EMPLOYEE'S RESPONSIBILITY TO REVIEW AND COMPLY WITH THE CODE OF CONDUCT OR DISCUSS ANY QUESTIONS OR REPORT ANY CONCERNS TO THE CORPORATE DIRECTOR OF COMPLIANCE. INDIVIDUALS ARE INSTRUCTED THAT THEY OWE UNDIVIDED AND UNQUALIFIED LOYALTY TO HH. INDIVIDUALS MAY NOT USE THEIR POSITIONS TO PROFIT PERSONALLY OR TO ASSIST OTHERS IN PROFITING IN ANY WAY AT THE EXPENSE OF HH. INDIVIDUALS ARE EXPECTED TO CONDUCT THEMSELVES SO AS TO AVOID ACTUAL IMPROPRIETY AND/OR APPEARANCE OF IMPROPRIETY IN DEALING WITH HH AND TO AVOID DISCLOSURE OR PRIVATE USE OF THE BUSINESS AFFAIRS OR PLANS OF HH. DETERMINATION OF WHETHER A CONFLICT OF INTEREST EXISTS OR NOT AND THE ASSIGNMENT OF ANY NECESSARY ACTION IS MADE BY THE HH'S AUDIT COMMITTEE, A SUBCOMMITTEE OF OUR BOARD OF DIRECTORS. PARTICIPATION ON BOARD OF DIRECTORS/TRUSTEES: - AN INDIVIDUAL MUST OBTAIN APPROVAL OF HH COMPLIANCE OFFICER PRIOR TO SERVING AS A MEMBER OF THE BOARD OF DIRECTORS/TRUSTEES OF ANY ORGANIZATION WHOSE INTERESTS MAY CONFLICT WITH THOSE OF HH. AN INDIVIDUAL WHO IS ASKED OR SEEKS TO SERVE ON THE BOARD OF DIRECTORS/TRUSTEES OF ANY ORGANIZATION WHOSE INTEREST WOULD NOT IMPACT HH (E.G., CIVIC, CHARITABLE, FRATERNAL, ETC.) WILL NOT BE REQUIRED TO OBTAIN APPROVAL. - INDIVIDUALS SHALL SEEK THE APPROVAL OF HH COMPLIANCE OFFICER PRIOR TO RETAINING ANY FEES OR COMPENSATION (OTHER THAN REIMBURSEMENT FOR EXPENSES) THAT ARE RECEIVED BY THE INDIVIDUAL FOR BOARD SERVICES WHICH MAY HAVE BEEN RENDERED DURING NORMAL PAID WORK TIME AS AN EMPLOYEE OF HH. FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION COMMITTEE, CONSISTING OF INDEPENDENT MEMBERS OF THE HANOVER HOSPITAL BOARD OF DIRECTORS, COMMISSIONED AN INDEPENDENT AGENCY TO ESTABLISH A SALARY RANGE UTILIZING FOUR INDEPENDENT COMPENSATION SURVEYS. THE COMPENSATION OF TOP MANAGEMENT OFFICIALS WAS SET BY THE COMMITTEE UTILIZING THIS DATA AND WAS SUBSEQUENTLY APPROVED BY THE BOARD OF DIRECTORS IN EXECUTIVE SESSION. FORM 990, PART VI, SECTION C, LINE 18 THE ORGANIZATION MAKES FORMS 1023, 990 AND 990-T AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -211,366. PRIOR PERIOD ADJUSTMENTS: -1,965. NET ASSET TRANSFER TO AFFILIATE -4,886,147. IMPAIRMENT LOSS -284,832. TOTAL TO FORM 990, PART XI, LINE 5: -5,384,310. OVERSIGHT OF AUDIT: FORM 990, PART XI, LINE 2C THERE HAVE BEEN NO CHANGES DURING THE YEAR IN THE PROCESS FOR OVERSIGHT OF THE AUDIT OF THE FINANCIAL STATEMENTS. FORM 990, SCHEDULE K, PART III, LINE 3 THERE ARE NO MANAGEMENT OR SERVICE CONTRACTS OR RESEARCH AGREEMENTS RELATING TO THE FINANCED PROPERTIES FOR THE 2005 BONDS. HANOVER HEALTHCARE PLUS INC 300 HIGHLAND AVENUE HANOVER PA 173312214 222658574 PARENT COMPANY OF NOT-FOR-PROFIT HEALTHCARE SERVICE ORGANIZATION PA 501(C)(3) 11A N/A 0 CHERRY TREE CANCER CENTER LLP PO BOX 2767 YORK PA 17405 232915628 OPERATES A THERAPEUTIC RADIATION TREATMENT FACILITY PA N/A RELATED 1318832 1753502 0 1 0.50000 HANOVER APOTHECARY INC 310 STOCK STREET SUITE 1 HANOVER PA 17331 030594256 PROVIDES PHARMACY SERVICES PA N/A C 6068121 1708193 1.00000 HANOVER HEALTH CORPORATION INC 300 HIGHLAND AVENUE HANOVER PA 17331 900498067 OPERATES SEVERAL OUTPATIENT MEDICAL CARE FACILITIES PA N/A C 15077788 5295278 1.00000 0 1 0 1 0 0 0 0 1 0 1 1 0 0 0 0 0 0 HANOVER HEALTH CORPORATION INC B 4886147 CASH HANOVER HEALTH CORPORATION INC D 607000 FAIR MARKET VALUE HANOVER HEALTH CORPORATION INC K 353000 FAIR MARKET VALUE HANOVER HEALTH CORPORATION INC L 823000 FAIR MARKET VALUE HANOVER APOTHECARY INC I 25410 FAIR MARKET VALUE HANOVER HEALTH CORPORATION INC I 59211 FAIR MARKET VALUE