2013-02-06T07:35:12-06:00 2012-06-30 250988255 CARBIS WALKER LLP 5700 CORPORATE DRIVE STE 650 PITTSBURGH PA 15237 990 2011-07-01 232801799 CONEMAUGH HEALTH SYSTEM INC CONE 8144108271 1086 FRANKLIN STREET JOHNSTOWN PA 15905 EDWARD DEPASQUALE 8144105271 2013-01-28 1 JEFFREY J PETRELL CPA P00138808 4126356270 2013-01-28 2011 2016-03-07 17:11:31Z SCOTT BECKER 1086 FRANKLIN STREET JOHNSTOWN PA 15905 7838116 0 X WWW.CONEMAUGH.ORG X 1994 PA TO SUPPORT MEMBER HOSPITALS WITHIN THE CONEMAUGH HEALTH SYSTEM AND PROVIDE COMMUNITY BENEFIT 18 9 0 9 0 0 0 0 6629144 7837679 662 401 663 36 6630469 7838116 0 0 0 0 4773116 5078798 0 0 0 1857353 2759318 6630469 7838116 0 0 2770540 3417118 2578695 2395356 191845 1021762 X TO SUPPORT MEMBER HOSPITALS WITHIN THE CONEMAUGH HEALTH SYSTEM AND PROVIDE COMMUNITY BENEFIT SERVICES. 0 0 6511491 7837679 THE CONEMAUGH HEALTH SYSTEM (CHS) SERVES OVER A HALF-MILLION PATIENTS EACH YEAR THROUGH THE CONEMAUGH PHYSICIAN GROUP AND MEDICAL STAFF, THREE HOSPITALS, SPECIALTY CLINICS, AND OUTPATIENT FACILITIES. CHS IS THE LARGEST HEALTHCARE PROVIDER IN WEST CENTRAL PENNSYLVANIA WITH 4,500+ EMPLOYEES AND 350 PHYSICIANS. CHS, PHYSICIAN LED AND PROFESSIONALLY MANAGED, MAINTAINS A STEADFAST COMMITMENT TO QUALITY THAT MOTIVATES EVERY MEMBER OF ITS TEAM TO STRIVE FOR ITS VISION OF EXCELLENCE. EVERY PATIENT. EVERY TIME. HEALTH EDUCATION AND SCREENING EVENTS CONTINUE TO BE A BIG PART OF THE HEALTH SYSTEM'S YEARLY COMMUNITY OUTREACH. SCREENINGS THIS YEAR INCLUDED OSTEOPOROSIS, PROSTATE AND BREAST CANCER, DIABETES, AND HIGH BLOOD PRESSURE. IN ADDITION, CAR SEAT CLINICS WERE HELD TO HELP PARENTS IN THE REGION ENSURE THAT THEIR CHILDREN ARE SAFELY BUCKLED UP. THE CONEMAUGH HEALTH SYSTEM'S FLAGSHIP TEACHING HOSPITAL, 545-BED MEMORIAL MEDICAL CENTER, HAS BEEN REPEATEDLY RECOGNIZED AS A HEALTHGRADES DISTINGUISHED HOSPITAL WITH CLINICAL OUTCOMES IN THE TOP FIVE PERCENT IN THE NATION. CLINICAL QUALITY WITHIN CHS CONTINUES TO BE ENHANCED BY: CONEMAUGH PHYSICIAN GROUP, A MULTI-SPECIALTY GROUP WITH OVER 115 PHYSICIANS COMMITTED TO QUALITY AND EXCEPTIONAL PATIENT OUTCOMES; ONE TERTIARY MEDICAL CENTER, TWO COMMUNITY HOSPITALS, INPATIENT REHABILITATION, HOME HEALTH, AND HOSPICE SERVICES; A COMMITMENT TO EDUCATIONAL EXCELLENCE INCLUDING EIGHT MEDICAL RESIDENCY PROGRAMS, A PHARMD RESIDENCY, AN EMS FELLOWSHIP PROGRAM, SCHOOL OF NURSING, SCHOOLS OF ALLIED HEALTH, AND A MEDICAL SKILLS LEARNING CENTER WHICH IS ONE OF ONLY 58 ACCREDITED CENTERS WORLDWIDE; LEVEL 1 REGIONAL RESOURCE TRAUMA PROGRAM AND LEVEL 3 NEONATAL INTENSIVE CARE UNIT WITH AEROMEDICAL TRANSPORT SERVICE; NUMEROUS NATIONALLY RANKED CLINICAL PROGRAMS INCLUDING CARDIOLOGY, ORTHOPEDICS, WOMEN'S HEALTH, MATERNITY, PULMONARY CARE, GASTROINTESTINAL CARE, APPENDECTOMY, AND CRITICAL CARE; TECHNOLOGY ADVANCEMENTS CURRENTLY BEING IMPLEMENTED INCLUDE A PHARMACY ROBOT, ROBOT ASSISTED SURGERY TECHNOLOGY, AND PHYSICIAN ORDER ENTRY INFORMATION TECHNOLOGY SYSTEM; STATE OF THE ART CARDIAC CATHETERIZATION LABS, MINIMALLY INVASIVE OPERATING SUITES, VASCULAR ORS, INTERVENTIONAL RADIOLOGY LABS, AND IMAGING EQUIPMENT INCLUDING A 128-SLICE CT AND PET/CT ARE AVAILABLE WITHIN THE HEALTH SYSTEM AND RELATED ENTITIES; AN AGGRESSIVE STRATEGIC PLANNING PROCESS THAT HELPS SHAPE A SUCCESSFUL FUTURE FOR THE HEALTH SYSTEM AND THE REGION; AND RECOGNITION AS AN IMS TOP 100 INTEGRATED HEALTHCARE NETWORK FOR 2012 (WWW.IMSHEALTH.COM). IN ADDITION TO ITS MAIN CAMPUS, MEMORIAL MEDICAL CENTER'S LEE CAMPUS SERVES THE COMMUNITY IN DOWNTOWN JOHNSTOWN PROVIDING A WIDE VARIETY OF OUTPATIENT SERVICES INCLUDING LABORATORY, IMAGING, SAME DAY SURGERY, AND WOUND HEALING. IN ADDITION, THE LEE CAMPUS HOUSES THE CONEMAUGH DIABETES INSTITUTE, THE SLEEP DISORDERS CENTER, AND THE INPATIENT CRICHTON REHABILITATION CENTER AND TRANSITIONAL CARE UNIT, WHICH THIS YEAR WAS NAMED TO US NEWS AND WORLD REPORT'S BEST NURSING HOMES LIST. THE LEE CAMPUS PROVIDES A LARGE COMMUNITY ROOM FOR PUBLIC USE AS WELL AS A LOCATION FOR SPIRITUAL NEEDS. MEETING ROOMS AT THE LEE CAMPUS ARE ALSO USED FOR AREA NON-PROFITS AND COMMUNITY GROUPS INCLUDING ORGANIZATIONS THAT HELP PEOPLE WITH DRUG AND ALCOHOL PROBLEMS. MINERS MEDICAL CENTER IS A 30-BED FULLY RENOVATED COMMUNITY HOSPITAL SERVING RURAL NORTHERN CAMBRIA COUNTY AND SURROUNDING AREAS. IT IS THE REGION'S SOLE HOSPITAL AND SPECIALIZES IN FAMILY AND PRIMARY CARE. IT ALSO PROVIDES INPATIENT MEDICAL, SURGICAL, AND INTENSIVE CARE SERVICES; 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; OB/GYN OUTPATIENT CARE; AND NUMEROUS SPECIALTY SERVICES. MEYERSDALE MEDICAL CENTER SERVES A RURAL AREA IN SOUTHWESTERN PENNSYLVANIA'S HISTORIC SOMERSET COUNTY. SPECIALIZING IN FAMILY AND PRIMARY CARE, IT IS A STATE-DESIGNATED CRITICAL CARE ACCESS HOSPITAL AND HAS BEEN DEEMED A NECESSARY HEALTH CARE PROVIDER BY THE COMMONWEALTH OF PENNSYLVANIA. IT PROVIDES 20 BEDS FOR INPATIENT AND OUTPATIENT CARE; 24/7 EMERGENCY DEPARTMENT; OR FOR SHORT OR MINOR PROCEDURES; RADIOLOGY SERVICES, INCLUDING MOBILE MRI, CT SCANS, AND DIGITAL MAMMOGRAPHY; PATHOLOGY SERVICES; PHYSICAL THERAPY; RESPIRATORY THERAPY; ULTRASOUND; CARDIAC REHABILITATION; OB/GYN OUTPATIENT CARE; STEP-DOWN SWING UNIT; AND MEDSTAR MEDICAL HELICOPTER TRANSPORTATION. MANY PHYSICIAN SPECIALISTS ALSO PROVIDE SERVICES AT THIS LOCATION. CHS IS PROVIDED WITH DIVERSE AND DEDICATED LEADERSHIP FROM ITS BOARD OF TRUSTEES. THE BOARD IS COMPRISED OF A WIDE VARIETY OF VOLUNTEERS INCLUDING AREA BUSINESS LEADERS, EDUCATORS, PROFESSIONALS, AND PHYSICIANS, SOME AFFILIATED WITH THE CONEMAUGH HEALTH SYSTEM AND OTHERS INDEPENDENT. VALUABLE INPUT ALSO COMES FROM ITS PATIENT ADVISORY COMMITTEE. THIS GROUP MEETS REGULARLY WITH HEALTH SYSTEM OFFICIALS TO PROVIDE INPUT AND SUGGESTIONS ON A WIDE VARIETY OF TOPICS INCLUDING WAYFINDING, PATIENT CARE ISSUES, MARKETING, AND SERVICE EXCELLENCE. MEDICAL STAFF PRIVILEGES ARE EXTENDED TO CLOSE TO 400 PHYSICIANS THROUGHOUT A WIDE GEOGRAPHIC REGION IN BOTH PRIMARY CARE AND SPECIALTY FIELDS. IN FISCAL YEAR 2012, CHS ADDED A NUMBER OF NEW PROGRAMS AND TECHNOLOGY TO BENEFIT THE PEOPLE OF THE REGION. SOME OF THESE ADVANCEMENTS INCLUDED: THE IMPLEMENTATION OF $2.8 MILLION WORTH OF NEW DIGITAL MAMMOGRAPHY EQUIPMENT; A NEW DA VINCI SYSTEM FOR ROBOT-ASSISTED SURGERY; A NEW WOUND HEALING CENTER LOCATION AT MINERS MEDICAL CENTER; UPGRADES TO THE PULMONARY FUNCTION TESTING LAB AT MEYERSDALE MEDICAL CENTER; EQUIPMENT TO PERFORM A THIRD TYPE OF WEIGHT LOSS SURGERY - GASTRIC SLEEVE BYPASS; AND TWO NEW HUMAN PATIENT SIMULATORS FOR CLINICAL TRAINING PROGRAMS, ONE A TODDLER VERSION AND THE OTHER AN INFANT. IN ADDITION, A NEW ONLINE BILL PAYMENT SYSTEM WAS INTRODUCED FOR PATIENTS AND AN EMS FELLOWSHIP BEGAN. ALSO, WORK CONTINUED ON IMPLEMENTATION OF ELECTRONIC MEDICAL RECORDS FOR CONEMAUGH PHYSICIAN GROUP PRACTICES. CHS, AS THE REGION'S LARGEST EMPLOYER, CONTINUES TO BE AN AVID SUPPORTER OF COMMUNITY ORGANIZATIONS AND INITIATIVES. THROUGH THE CONEMAUGH CARING PROGRAM, CHS AND ITS EMPLOYEES PROVIDED A WIDE VARIETY OF BENEFITS TO THE COMMUNITY THROUGH THE DONATION OF TIME, TALENT, FUNDING, AND OTHER NEEDED ITEMS. MONTHLY DRIVES ARE HELD FOR LOCAL CHARITIES. EACH MONTH THE ORGANIZATION ASKS EMPLOYEES TO DONATE TO VARIOUS CAUSES, PLACING NEEDED ITEMS IN BOXES LOCATED IN EIGHT LOCATIONS THROUGHOUT THE HEALTH SYSTEM. ITEMS COLLECTED INCLUDE CANNED GOODS FOR FOOD PANTRIES, COATS AND HATS FOR DELIVERY BY THE SALVATION ARMY, TOYS FOR TOTS, ITEMS FOR ANIMALS AT THE HUMANE SOCIETY, AND BACK TO SCHOOL ITEMS FOR NEEDY CHILDREN. CHS EMPLOYEES ARE VERY GENEROUS IN THEIR GIVING TO THIS PROGRAM. ANOTHER PART OF THE PROGRAM REVOLVED AROUND COMMUNITY SERVICE. FOR THE PAST THREE YEARS DURING THE MONTH OF JUNE, CHS EMPLOYEES HAVE VOLUNTEERED AT VARIOUS ORGANIZATIONS THROUGHOUT THE COMMUNITY AS PART OF THE CONEMAUGH SPIRIT OF CARING DAYS. EMPLOYEES SIGN UP BASED UPON THEIR INTERESTS AND VOLUNTEER INDIVIDUALLY, AS A GROUP, OR AS A DEPARTMENT. VOLUNTEER OPPORTUNITIES VARY FROM PHYSICAL TO NON-PHYSICAL, INDOOR OR OUTDOOR, AND INCLUDE CLEANING, PAINTING, GARDENING, WORKING WITH CHILDREN, CLERICAL, AND MORE. OVER 25 ORGANIZATIONS THROUGHOUT THE COMMUNITY BENEFIT FROM THE VOLUNTEERING FROM OVER 300 EMPLOYEES. IN ADDITION TO THE VOLUNTEERING, THESE ORGANIZATIONS ARE ALSO INVITED TO A ONE-DAY EVENT IN THE ATRIUM OF MEMORIAL MEDICAL CENTER TO SHOWCASE THEIR ORGANIZATIONS AND PROVIDE INFORMATION TO CHS STAFF ON VOLUNTEER OPPORTUNITIES THAT ARE AVAILABLE THROUGHOUT THE YEAR. CHS CONTINUES TO BE A GENEROUS FINANCIAL CONTRIBUTOR TO VARIOUS NON-PROFIT PROGRAMS AND COMMUNITY EVENTS TAKING PLACE THROUGHOUT ITS REGION. IN FISCAL YEAR 2012, CHS MADE DONATIONS TOTALING MORE THAN $140-THOUSAND DOLLARS. MORE THAN 100 COMMUNITY ORGANIZATIONS AND EVENTS BENEFIT FROM THIS SUPPORT; SOME EXAMPLES INCLUDE YOUTH ATHLETIC TEAMS, AREA ARTISTIC VENUES, AND OTHER NON-PROFITS LIKE THE AMERICAN CANCER SOCIETY, MARCH OF DIMES, AND ALZHEIMER'S ASSOCIATION. IN ADDITION TO FINANCIAL DONATIONS, GIFTS ARE ALSO PROVIDED AND WHEN POSSIBLE, IN-KIND DONATIONS OF MARKETING SERVICES, ADVERTISING AND BILLBOARD SPACE, AND PRINTING ARE PROVIDED. 6511491 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 X 0 0 0 0 0 0 0 0 0 0 0 0 0 X 18 9 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 PA X EDWARD DEPASQUALE 8144108271 1086 FRANKLIN STREET JOHNSTOWN PA 15905 X JAMES HARGREAVES 2.00 X X 0 0 0 RON VICKROY 2.00 X X 0 0 0 JAMES CASCIO 2.00 X X 0 0 0 KIM CRAIG 2.00 X X 0 0 0 HAROLD ASHCRAFT MD 2.00 X 0 0 0 DOUGLAS BELL 2.00 X 0 0 0 KRISTIN BRANT MD 2.00 X 0 0 0 ROBERT A GLEASON JR 2.00 X 0 0 0 WILLIAM HAUGER MD 2.00 X 0 385025 37181 ADIB KHOUZAMI MD 2.00 X 0 1096838 32624 BRIAN LIEB DO 2.00 X 0 304885 35111 FRANK QUITONI 2.00 X 0 0 0 ROBERTA REAM 2.00 X 0 0 0 JOHN SARACENA 2.00 X 0 0 0 SALLY SARGENT 2.00 X 0 0 0 PATRICIA SEROTKIN 2.00 X 0 0 0 MICHAEL SMITH 2.00 X 0 0 0 SCOTT BECKER 49.50 X X 1087604 0 34890 EDWARD DEPASQUALE 22.00 X 461804 0 30569 DAVID CARLSON DO 20.00 X 562770 0 26848 JOSEPH DADO 18.00 X 364292 0 16140 JOHN MORYKEN 20.00 X 290094 0 28379 WESLEY SCHMIDT 22.00 X 187897 0 7495 DIANE PRINGLE 15.00 X 102560 0 7265 MARY YORK 0.00 X 110994 0 387 LOUIS SCIULLO 0.00 X 0 157291 13603 3168015 1944039 270492 8 1 1 0 BKD LLP PO BOX 1178 LOUISVILLE KY 40201 ACCOUNTING SERVICES 333750 BUCHANAN INGERSOLL ROONEY PC 301 GRANT STREET PITTSBURGH PA 15219 LEGAL SERVICES 307841 YAFFE & CO INC 49 WASHINGTON AVE SUITE 700 TOWSON MD 21204 CONSULTING SERVICES 173459 3 MANAGEMENT FEES 561000 7837679 7837679 7837679 401 401 INTEREST-OFFICER LOAN 900099 36 36 36 7838116 7837679 0 437 2860594 2746170 114424 1387541 616226 771315 43486 12681 30805 787177 576318 210859 543928 543928 416412 416412 505063 456483 48580 327706 327706 51650 48069 3581 93350 74000 19350 104892 54661 50231 43041 41926 1115 69184 56340 12844 261510 261283 227 DUES & SUBSCRIPTIONS 125096 69360 55736 PURCHASED SERVICES 47525 40348 7177 RELOCATION 4153 4153 165808 165427 381 7838116 6511491 1326625 0 200986 9181 116497 286916 2858 1206000 1206000 136571 92258 668663 328316 40633 340347 1066995 1482416 2770540 3417118 1139921 1615946 1438774 779410 2578695 2395356 X 191845 1021762 191845 1021762 2770540 3417118 X 0 829917 X X 0 1 1 X 0 X X X X 0 0 0 MEYERSDALE MEDICAL CENTER 251002946 3 0 1 1 13800 CONEMAUGH VALLEY MEMORIAL HOSPITAL 250965307 3 0 0 1 0 MINERS MEDICAL CENTER 250977902 3 0 0 1 0 GOOD SAMARITAN MEDICAL CENTER 250965428 3 0 0 1 0 CONEMAUGH HEALTH FOUNDATION 251719695 11 0 0 1 0 5 13800 668663 328316 340347 340347 INVESTMENT IN PHHP 7500 INVESTMENT IN RRG 1168280 NON COMPETE COVENANTS (NET) 306636 1482416 DUE TO MEMORIAL MEDICAL CENTER 779410 779410 X 0 1 X X X X X 1 1 0 0 0 1 1 0 0 WILLIAM HAUGER MD 0 298343 0 35796 0 50886 0 23820 0 13361 0 422206 0 0 ADIB KHOUZAMI MD 0 614000 0 440689 0 42149 0 21842 0 10782 0 1129462 0 0 BRIAN LIEB DO 0 213678 0 66349 0 24858 0 21978 0 13133 0 339996 0 0 SCOTT BECKER 599642 0 346114 0 141848 0 15971 0 18919 0 1122494 0 0 0 EDWARD DEPASQUALE 331734 0 109370 0 20700 0 19187 0 11382 0 492373 0 0 0 DAVID CARLSON DO 414185 0 128589 0 19996 0 12867 0 13981 0 589618 0 0 0 JOSEPH DADO 265102 0 87025 0 12165 0 13371 0 2769 0 380432 0 0 0 JOHN MORYKEN 214091 0 60892 0 15111 0 17009 0 11370 0 318473 0 0 0 WESLEY SCHMIDT 140412 0 29786 0 17699 0 0 0 7495 0 195392 0 0 0 MARY YORK 0 0 0 0 110994 0 387 0 0 0 111381 0 0 0 LOUIS SCIULLO 0 149113 0 5914 0 2264 0 12500 0 1103 0 170894 0 0 PART I, LINE 1A SOCIAL CLUB DUES ARE PAID FOR THE ORGANIZATION'S CEO. UNDER THE OVERSIGHT OF THE EXECUTIVE COMPENSATION COMMITTEE, IT HAS ALWAYS BEEN THE ORGANIZATION'S PRACTICE TO PAY THESE DUES FOR THE CEO AS THE SOCIAL CLUB IS PRIMARILY USED TO BENEFIT THE ORGANIZATION. PART I, LINES 4A-B MARY YORK RECEIVED SEVERANCE PAYMENTS OF $110,994. THE CONEMAUGH HEALTH SYSTEM'S 457(F) EXECUTIVE COMPENSATION PROGRAM WAS TERMINATED DECEMBER 10, 2010. PER IRS REGULATIONS, EACH PARTICIPANT'S ENTIRE ACCOUNT BALANCE WAS RECOGNIZED AS TAXABLE INCOME ON THAT DATE AND ALL APPLICABLE TAXES WERE REMITTED. HOWEVER, THESE NET ACCOUNT BALANCES WERE NOT PERMITTED TO BE DISTRIBUTED TO THE PARTICIPANTS UNTIL DECEMBER 11, 2011, OR 1 YEAR AND 1 DAY AFTER THE TERMINATION DATE. ON THAT DATE, EACH PARTICIPANT ALSO RECEIVED ANY ADDITIONAL AMOUNTS EARNED ON THE ACCOUNT BALANCES DURING THIS WAITING PERIOD. THESE EARNINGS, WHICH WERE RECOGNIZED AS TAXABLE INCOME AND ARE INCLUDED IN THE REPORTABLE COMPENSATION SHOWN, ARE AS FOLLOWS: SCOTT BECKER $7,682; DAVID CARLSON, DO $1,154; EDWARD DEPASQUALE $2,212; JOSEPH DADO $87; JOHN MORYKEN $424; AND LOUIS SCIULLO $449. PART I, LINE 6 SCOTT BECKER, DAVID CARLSON, DO, EDWARD DEPASQUALE, JOSEPH DADO, JOHN MORYKEN, AND WESLEY SCHMIDT RECEIVED A BONUS FROM THE CONEMAUGH HEALTH SYSTEM. LOUIS SCIULLO 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. PART I, LINE 6B: WILLIAM HAUGER, MD, ADIB KHOUZAMI, MD AND BRIAN LIEB, DO RECEIVED BONUSES 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 THEN DISTRIBUTED TO THE PHYSICIAN BASED ON A CONTRACTUAL PERCENTAGE AND CAP. TOTAL PHYSICIAN COMPENSATION IS ANNUALLY CHECKED FOR REASONABLENESS AGAINST IRS GUIDELINES. FORM 990, PART V, LINE 2A: CONEMAUGH HEALTH SYSTEM'S (CHS) EMPLOYEE WAGES ARE PROCESSED BY CONEMAUGH VALLEY MEMORIAL HOSPITAL D/B/A MEMORIAL MEDICAL CENTER (MMC), A RELATED 501(C)(3) ORGANIZATION. THE W2S ARE FILED BY MMC (EIN 25-0965307) ON BEHALF OF CHS. ALL CHS WAGES THAT ARE PROCESSED BY MMC ARE REFLECTED ON THE 990 AS REPORTABLE COMPENSATION FROM CHS. 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, 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 AND ALL SUBSIDIARIES ARE GOVERNED BY A 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 CHS 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 CHS 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 HAS DEVELOPED. FORM 990, PART VI, SECTION B, LINE 15 CHS MANAGES THE DETERMINATION OF COMPENSATION FOR ITS EXECUTIVES AS WELL AS THE EXECUTIVES OF ALL ITS SUBSIDIARIES. 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. CHS HAS ALSO ESTABLISHED AN EXECUTIVE COMPENSATION COMMITTEE TO REVIEW AND RECOMMEND THE COMPENSATION DECISIONS MADE. THIS COMMITTEE REPORTS DIRECTLY TO THE BOARD. FORM 990, PART VI, SECTION C, LINE 19 ALL REQUESTS FOR THIS INFORMATION ARE HANDLED BY THE CHS MARKETING/PUBLIC RELATIONS DEPARTMENT. FORM 990, PART VI, SECTION B, LINES 12A, 13, AND 14: ALL APPLICABLE POLICY QUESTIONS HAVE BEEN ANSWERED YES SINCE ALL POLICIES HAVE BEEN APPROVED BY THE HEALTH SYSTEM'S BOARD. FORM 990, PART VII, SECTION A, LINE 1A, COLUMN B: IN ADDITION TO THE HOURS DEVOTED TO THE FILING ORGANIZATION SHOWN IN PART VII, THE FOLLOWING OFFICERS AND TRUSTEES ALSO DEVOTED HOURS TO RELATED ORGANIZATIONS DURING THE YEAR. THE HOURS SHOWN REPRESENT THE AVERAGE NUMBER OF HOURS PER WEEK. SCOTT BECKER, CEO: CONEMAUGH HEALTH SYSTEM - 49.5 CONEMAUGH VALLEY MEMORIAL HOSPITAL - 4 MEYERSDALE COMMUNITY HOSPITAL - 1 MINERS HOSPITAL - 1 GOOD SAMARITAN MEDICAL CENTER - 0.3 CONEMAUGH HEALTH FOUNDATION - 4 CONEMAUGH HOUSING, INC. - 0.2 CONEMAUGH HEALTH INITIATIVES - 10 EDWARD DEPASQUALE, CFO: CONEMAUGH HEALTH SYSTEM - 22 CONEMAUGH VALLEY MEMORIAL HOSPITAL - 14 MEYERSDALE COMMUNITY HOSPITAL - 1 MINERS HOSPITAL - 1 GOOD SAMARITAN MEDICAL CENTER - 1 CONEMAUGH HEALTH FOUNDATION - 0.5 CONEMAUGH HOUSING, INC. - 0.5 CONEMAUGH HEALTH INITIATIVES - 10 DAVID CARLSON, DO, CMO: CONEMAUGH HEALTH SYSTEM - 20 CONEMAUGH VALLEY MEMORIAL HOSPITAL - 10 MEYERSDALE COMMUNITY HOSPITAL - 4 MINERS HOSPITAL - 4 GOOD SAMARITAN MEDICAL CENTER - 0.5 CONEMAUGH HEALTH FOUNDATION - 1 CONEMAUGH HOUSING, INC. - 1 CONEMAUGH HEALTH INITIATIVES - 10 JOSEPH DADO, CIO: CONEMAUGH HEALTH SYSTEM - 18 CONEMAUGH VALLEY MEMORIAL HOSPITAL - 10 MEYERSDALE COMMUNITY HOSPITAL - 4 MINERS HOSPITAL - 4 GOOD SAMARITAN MEDICAL CENTER - 1 CONEMAUGH HEALTH FOUNDATION - 1 CONEMAUGH HEALTH INITIATIVES - 12 JOHN MORYKEN, VP: CONEMAUGH HEALTH SYSTEM - 20 CONEMAUGH VALLEY MEMORIAL HOSPITAL - 10 MEYERSDALE COMMUNITY HOSPITAL - 1 MINERS HOSPITAL - 1 CONEMAUGH HEALTH INITIATIVES - 8 WESLEY SCHMIDT, VP: CONEMAUGH HEALTH SYSTEM - 22 CONEMAUGH VALLEY MEMORIAL HOSPITAL - 18 MEYERSDALE COMMUNITY HOSPITAL - 4 MINERS HOSPITAL - 4 CONEMAUGH HEALTH INITIATIVES - 4 DIANE PRINGLE: CONEMAUGH HEALTH SYSTEM - 15 CONEMAUGH VALLEY MEMORIAL HOSPITAL - 20 MEYERSDALE COMMUNITY HOSPITAL - 4 MINERS HOSPITAL - 4 CONEMAUGH HEALTH INITIATIVES - 5 WILLIAM HAUGER, MD: CONEMAUGH HEALTH SYSTEM - 2 CONEMAUGH VALLEY MEMORIAL HOSPITAL - 21 CONEMAUGH HEALTH INITIATIVES - 50 ADIB KHOUZAMI, MD: CONEMAUGH HEALTH SYSTEM - 2 CONEMAUGH VALLEY MEMORIAL HOSPITAL - 2 CONEMAUGH HEALTH INITIATIVES - 65 BRIAN LIEB, DO: CONEMAUGH HEALTH SYSTEM - 2 MEMORIAL MEDICAL CENTER - 1.5 MINERS HOSPITAL - 1 CONEMAUGH HEALTH INITIATIVES - 59 CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 843,717. SUPPORT TO MEYERSDALE MEDICAL CENTER -13,800. TOTAL TO FORM 990, PART XI, LINE 5: 829,917. FORM 990, PART XII, LINE 2: THE ORGANIZATION'S FINANCIAL STATEMENTS FOR THE FISCAL YEAR ENDING JUNE 30, 2012 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. GOOD SAMARITAN MEDICAL CENTER 1020 FRANKLIN STREET JOHNSTOWN PA 15905 250965428 HEALTHCARE SERVICES PA 501C(3) 3 CONEMAUGH HEALTH SYSTEM INC 1 CONEMAUGH VALLEY MEMORIAL HOSPITAL DBA MEMORIAL MEDICAL CTR 1086 FRANKLIN STREET JOHNSTOWN PA 15905 250965307 HEALTHCARE SERVICES PA 501C(3) 3 CONEMAUGH HEALTH SYSTEM INC 1 MINERS HOSPITAL DBA MINERS MEDICAL CENTER 290 HAIDA AVENUE HASTINGS PA 16646 250977902 HEALTHCARE SERVICES PA 501C(3) 3 CONEMAUGH HEALTH SYSTEM INC 1 MEYERSDALE COMMUNITY HOSPITAL DBA MEYERSDALE MEDICAL CENTER 200 HOSPITAL DRIVE MEYERSDALE PA 15552 251002946 HEALTHCARE SERVICES PA 501C(3) 3 CONEMAUGH HEALTH SYSTEM INC 1 CONEMAUGH HEALTH FOUNDATION 1086 FRANKLIN STREET JOHNSTOWN PA 15905 251719695 SUPPORTS CONEMAUGH HEALTH SYSTEM PA 501C(3) 11B CONEMAUGH HEALTH SYSTEM INC 1 CONEMAUGH HOUSING INC 1086 FRANKLIN STREET JOHNSTOWN PA 15905 251606936 PROVIDES SENIOR HOUSING FACILITIES PA 501C(3) 9 CONEMAUGH VALLEY MEMORIAL HOSPITAL 0 LAUREL HIGHLANDS ADVANCED IMAGING 1450 SCALP AVENUE JOHNSTOWN PA 15904 251864587 DIAGNOSTIC SERVICES PA CONEMAUGH VALLEY MEMORIAL HOSPITAL RELATED 0 0 GREATER JOHNSTOWN TECH PARK 1086 FRANKLIN STREET JOHNSTOWN PA 15905 260389121 OPERATES MULTI-TENANT COMMERCE OFFICE PARK PA CONEMAUGH ENTERPRISES INC UNRELATED 0 0 CONEMAUGH HEALTH INITIATIVES INC DBA CONEMAUGH PHYSICIAN GP 1086 FRANKLIN STREET JOHNSTOWN PA 15905 251658283 PHYSICIAN SERVICES PA CONEMAUGH HEALTH SYSTEM INC C -12526188 12373923 1.00000 CONEMAUGH ENTERPRISES INC 1086 FRANKLIN STREET JOHNSTOWN PA 15905 202998473 ECONOMIC DEVELOPMENT PA CONEMAUGH VALLEY MEMORIAL HOSPITAL C 1086 REAL ESTATE 1086 FRANKLIN STREET JOHNSTOWN PA 15905 251489704 REAL ESTATE PA CONEMAUGH HEALTH INITIATIVES C SINDO INC 1086 FRANKLIN STREET JOHNSTOWN PA 15905 251144116 COMMUNITY RENTALS PA CONEMAUGH HEALTH FOUNDATION C 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 CONEMAUGH HEALTH INITIATIVES P 1259291 FAIR MARKET VALUE CONEMAUGH VALLEY MEMORIAL HOSPITAL P 5533623 FAIR MARKET VALUE MINERS HOSPITAL P 276536 FAIR MARKET VALUE MEYERSDALE COMMUNITY HOSPITAL P 180728 FAIR MARKET VALUE CONEMAUGH VALLEY MEMORIAL HOSPITAL J 104892 FAIR MARKET VALUE