2013-01-28T13:47:23-06:00 2012-06-30 410746749 CLIFTONLARSONALLEN LLP 610 WEST GERMANTOWN PIKE SUITE 400 PLYMOUTH MEETING PA 19462 990 2011-07-01 510069243 NANTICOKE MEMORIAL HOSPITAL INC NANT 3026296611 801 MIDDLEFORD ROAD SEAFORD DE 19973 DEAN SWINGLE 3026296611 2013-01-07 1 MICHAEL SIEGEL P01587323 2156433900 2013-01-07 2011 2016-02-25 16:41:14Z STEVEN ROSE 801 MIDDLEFORD ROAD SEAFORD DE 19973 142952145 0 X WWW.NANTICOKE.ORG X 1945 DE PROVIDE HEALTH CARE SERVICES TO THE COMMUNITY, REGARDLESS OF THE ABILITY TO PAY. 17 14 1005 384 0 0 0 14362401 110222611 122486253 622793 892624 1895372 4535420 112740776 142276698 38899 7033346 0 0 56204048 60470129 0 0 0 54207757 59695077 110450704 127198552 2290072 15078146 91535165 116971831 60977575 76585778 30557590 40386053 X NANTICOKE MEMORIAL HOSPITAL OPERATES IN A MANNER CONSISTENT WITH THE REQUIREMENTS OF REVENUE RULING 69-545, THROUGH ITS PROVISION OF HEALTH CARE SERVICES TO THE COMMUNITY, REGARDLESS OF THE ABILITY TO PAY. 0 0 116953391 7025296 122486253 NANTICOKE MEMORIAL HOSPITAL PROVIDES QUALITY MEDICAL CARE REGARDLESS OF THE RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE, OR ABILITY TO PAY. ALTHOUGH REIMBURSEMENT FOR SERVICES RENDERED IS CRITICAL TO THE OPERATIONS AND STABILITY OF MID-SUSSEX MEDICAL CENTER, IT IS RECOGNIZED THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PURCHASE ESSENTIAL MEDICAL SERVICES. THEREFORE, IN KEEPING WITH THE MEDICAL CENTER'S COMMITMENT TO SERVE ALL MEMBERS OF THE COMMUNITY, HEALTH ACTIVITIES AND PROGRAMS NEEDED TO SUPPORT THE COMMUNITY WILL BE CONSIDERED WHERE THE NEED AND/OR THE INDIVIDUAL'S INABILITY TO PAY CO-EXISTS. THESE ACTIVITIES INCLUDE WELLNESS PROGRAMS, COMMUNITY EDUCATION PROGRAMS, SPECIAL PROGRAMS FOR THE UNDER SERVED, SCREENING AND A WIDE VARIETY OF BROAD COMMUNITY SUPPORT ACTIVITIES.PATIENTS SEEN.INPATIENTS 5,298; BIRTHS 864; ER VISITS 37,017; OP VISITS 80,666;DAYS OF INPATIENT CARE:ADULTS AND PEDIATRICS 19,278; NEWBORN 1,733;OTHER FACTS:AVERAGE PATIENT STAY 3.6; OPERATIONS 3,619;NANTICOKE MEMORIAL HOSPITAL PROVIDES CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS AT OR BELOW COST. RECOGNIZING ITS MISSION TO THE COMMUNITY, SERVICES ARE PROVIDED TO BOTH MEDICARE AND MEDICAID PATIENTS. SERVICES PROVIDED TO THOSE UNABLE TO PAY $17,184,707. DISCOUNTS TO MEDICARE, MEDICAID, AND OTHERS $129,993,910. 116953391 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 1 176 0 1 1005 1 0 0 0 0 0 0 0 0 0 0 X 17 14 1 0 0 0 1 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 0 DE X X ACCOUNTING DEPT 3026296611 801 MIDDLEFORD ROAD SEAFORD DE 19973 STEVEN ROSE 40.00 X X 482898 0 152131 JOHN ALLEN 1.00 X 0 0 0 JOAQUIN CABRERA 40.00 X 28750 339635 14660 DAVID CROUSE 1.00 X 0 0 0 FERNANDO GUAJARDO 1.00 X 0 0 0 DONALD HOLLENBECK 1.00 X 0 0 0 GREG JOHNSON 1.00 X 0 0 0 TRINA JOYNER 1.00 X 0 0 0 JOSEPH KIM 40.00 X 15000 164617 49187 HARRY LEHMAN 1.00 X 0 0 0 LYNDA MESSICK 1.00 X 0 0 0 PATRICIA OLEKSZYK 1.00 X 0 0 0 TAMMY PAXTON 1.00 X 0 0 0 KENT PETERSON 1.00 X 0 0 0 MICHELE PROCINO-WELLS 1.00 X 0 0 0 JACK RIDDLE 1.00 X 0 0 0 REP DANNY SHORT 1.00 X 0 0 0 DARR HALL 40.00 X 243347 0 69347 PENNY SHORT 40.00 X 164379 0 53528 THOMAS BROWN 40.00 X 205673 0 56763 DON TRICARICO 40.00 X 150288 0 56831 MEREDITH ARTHUR 40.00 X 173283 0 5282 ROBER FERBER 40.00 X 226371 0 49920 ANJU BHARDWAJ 40.00 X 205080 0 21832 LI ZHANG 40.00 X 215304 0 21774 IMRAN JANJUA 40.00 X 203097 0 39478 2313470 504252 590733 26 0 1 0 CERNER CORPORATION 2800 ROCKCREEK PARKWAY KANSAS CITY MO 64141 TECHNOLOGY 3957661 ANESTHESIA SERVICES 2 READS WAY NEW CASTLE DE 19720 ANESTHESIA 1449996 DELPHI HEALTHCARE 170 SOUTHPORT DRIVE MORRISVILLE NC 27560 ORTHOPEDICS 1420433 ARAMARK 25271 NETWORK PLACE CHICAGO IL 60673 FOOD SERVICE 1092159 ARAMARK MASTERPLAN 12483 COLLECTIONS CENTER DRIVE CHICAGO IL 60673 BIO-MEDICAL 742285 24 14362401 14362401 PATIENT REVENUE 623000 122486253 122486253 122486253 166207 166207 469041 932823 0 675447 469041 257376 726417 726417 MISCELLANEOUS 623000 3896192 3896192 CAFETERIA 623000 525627 525627 GIFT SHOP 623000 113601 113601 4535420 142276698 122486253 0 5428044 7033346 7033346 2247034 2044801 202233 44561607 40551062 4010545 10764844 9796008 968836 2896644 2635946 260698 1165738 1060822 104916 137967 137967 123785 123785 13538006 12319585 1218421 1929689 1756017 173672 249133 226711 22422 77523 70546 6977 5529408 5031761 497647 226067 205721 20346 2975927 2975927 6008814 6008814 117114 106574 10540 SUPPLIES 12669962 11529665 1140297 BAD DEBT EXPENSE 10930949 9947164 983785 DRUGS 3943134 3588252 354882 MISCELLANEOUS 64842 58282 6560 7019 6387 632 127198552 116953391 10245161 0 130836 11635762 11341985 10775290 4775584 1624950 1560415 907311 1690653 116094397 66272092 37624919 49822305 28775634 31871491 6353946 9615915 91535165 116971831 9342958 19065541 39752910 52320114 6284685 3033521 5597022 2166602 60977575 76585778 X 30557590 40386053 30557590 40386053 91535165 116971831 X 15078146 -5249683 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 1 11630 1 0 0 11630 0 PART IV, SUPPLEMENTAL INFORMATION: SCHEDULE C, PART II-B, LINE 1I NANTICOKE MEMORIAL HOSPITAL PAYS DUES TO AHA AND DEHA: THE AMERICAN HOSPITAL ASSOCIATION AND THE DELAWARE HEALTHCARE ASSOCIATION. NANTICOKE MEMORIAL HOSPITAL'S MANAGEMENT ALSO CORRESPONDS WITH OUR STATE AND FEDERAL LEGISLATORS REGARDING CURRENT LEGISLATION AND REGULATIONS THAT MAY AFFECT THE FINANCIAL VIABILITY OF THE HOSPITAL AND ITS ABILITY TO CONTINUE TO PROVIDE QUALITY HEALTHCARE TO THE COMMUNITY. 2039510 2039510 59946588 24904129 35042459 631472 486940 144532 53476827 40881023 12595804 49822305 OTHER TRUSTEE FUNDS 429162 INTERCOMPANY RECEIVABLES 7098305 OTHER ASSETS 2088448 9615915 ESTIMATED THIRD PARTY PAYOR SETTLEMENTS 950000 OTHER LIABILITIES 1216602 2166602 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE ORGANIZATION FOLLOWS THE STANDARD OF ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN AN ENTITY'S FINANCIAL STATEMENTS. THE STANDARD PRESCRIBES RECOGNITION AND MEASUREMENT OF TAX PROVISIONS TAKEN OR EXPECTED TO BE TAKEN ON A TAX RETURN THAT ARE NOT CERTAIN TO BE REALIZED. THE APPLICATION OF THE STANDARD HAD NO IMPACT ON THE ORGANIZATION'S CONSOLIDATED FINANCIAL STATEMENTS. THE ORGANIZATION'S TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL AND STATE AUTHORITIES. THE TAX RETURNS FOR THE YEARS 2009 TO 2011 ARE OPEN TO EXAMINATION BY FEDERAL AND STATE AUTHORITIES. 1 1 1 X 175.000000000000 1 X 1 1 1 0 1 1 2411 2634772 2634772 0.02070 37360 26525784 19007416 7518368 0.05910 39771 29160556 19007416 10153140 0.07980 269 33410 968690 0 968690 0.00760 275 2390 86686 0 86686 0.00070 544 35800 1055376 1055376 0.00830 544 75571 30215932 19007416 11208516 0.08810 100 100 292835 292835 0.00230 100 100 292835 292835 0.00230 1 10930949 0 44751252 49191046 -4439794 X 1 1 1 1 NANTICOKE MEMORIAL HOSPITAL

801 MIDDLEFORD ROAD SEAFORD DE 19973

X X X NANTICOKE MEMORIAL HOSPITAL 1 1 1 175.000000000000 1 300.000000000000 1 X X 1 1 X X X X X 1 0 1 X 0 0 PART I, LINE 7: THE COSTING METHOD USED TO CALCULATE THE AMOUNTS REPORTED WAS THE MEDICARE OPERATING COST-TO-CHARGE RATIO FOR BOTH OUTPATIENT AND INPATIENT SERVICES. PART I, LINE 7G: THE HOSPITAL DID NOT INCLUDE SUBSIDIZED HEALTH SERVICE ATTRIBUTABLE TO PHYSICIAN CLINICS. PART I, L7 COL(F): THE HOSPITAL DID NOT INCLUDE ANY AMOUNT OF BAD DEBT EXPENSE IN THE NUMERATOR IN COMPUTING THE PERCENTAGE IN COLUMN (F). PART III, LINE 4: THE ORGANIZATION PROVIDES CARE WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY. BECAUSE THE ORGANIZATION DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, THOSE AMOUNTS ARE NOT REPORTED AS REVENUES. FOR THOSE PATIENTS WHO DID NOT MEET THE CHARITY CARE POLICY, THE ORGANIZATION MUST EVALUATE THEIR ABILITY TO COLLECT AMOUNTS DUE FROM PATIENTS THAT ARE PAST DUE. A PROVISION FOR BAD DEBTS IS RECORDED FOR AMOUNTS NOT YET WRITTEN OFF WHICH ARE EXPECTED TO BECOME UNCOLLECTIBLE. THE HOSPITAL'S POLICY IS TO HAVE A MINIMUM OF 2-3 STATEMENTS AND A FINAL NOTICE BEFORE SENDING PATIENT ACCOUNTS TO COLLECTIONS. ADDITIONALLY, ACCOUNTS GREATER THAN $500 ARE ATTEMPTED TO BE REACHED BY TELEPHONE. PART III, LINE 8: THE COSTING METHOD USED TO DETERMINE ALLOWABLE COSTS ARE THE COSTS IN ACCORDANCE WITH MEDICARE REQUIREMENTS AND REGULATIONS. ONLY COSTS THAT ARE CONSISTENT WITH EFFICIENT, COST-EFFECTIVE MANAGEMENT AND OPERATIONS ARE ALLOWED. ONLY OPERATING COSTS THAT ARE DIRECTLY RELATED TO THE DELIVERY OF HEALTH CARE SERVICES TO MEDICARE AND MEDICAID PATIENTS WERE ALLOWED. PART III, LINE 9B: THE COLLECTION POLICY PERTAINS TO ALL PATIENTS WITH A SELF PAY BALANCE. IF A PATIENT APPLIES FOR EITHER CHARITY CARE OR ANY OTHER ASSISTANCE PROGRAM SUCH AS MEDICARE AND MEDICAID, ALL COLLECTION ACTIVITY IS PUT ON HOLD UNTIL A DETERMINATION OF ELIGIBILITY IS MADE. NANTICOKE MEMORIAL HOSPITAL PART V, SECTION B, LINE 5C: AVAILABLE VIA WEBSITE AT WWW.NANTICOKE.ORG/PDF-FILES/HEALTH-ASSESSMENT-2010_SMALLER.ASPX NANTICOKE MEMORIAL HOSPITAL PART V, SECTION B, LINE 7: BECAUSE OF THE METHOD OF COLLECTION, MORE NEEDS WERE IDENTIFIED THAN WE ARE ABLE TO ADDRESS INDIVIDUALLY. FOR EXAMPLE, MENTAL HEALTH WAS IDENTIFIED AS A TOP NEED FOR THE COUNTY. THIS NEED IS NOT BEING DIRECTLY ADDRESSED BY NANTICOKE SINCE, AS A RURAL COMMUNITY HOSPITAL, WE ARE UNABLE TO FINANCIALLY SUSTAIN A SOLUTION ON OUR OWN. THIS NEED IS BEING ADDRESSED THROUGH ADVOCACY ONLY ALONG WITH CONTINUED DISCUSSIONS WITH OTHER STATE-WIDE RESOURCES. MENTAL HEALTH IS A GREAT NEED THROUGHOUT THE STATE OF DELAWARE. TO ADDRESS THE BROADER NEED, NANTICOKE ALONG WITH THE OTHER TWO HOSPITALS WITHIN SUSSEX COUNTY HAVE COME TOGETHER TO FORM HEALTHIER SUSSEX COUNTY. THIS GROUP IS CURRENTLY WORKING TO PRODUCE A COMBINED CHNA AND STRATEGY FOR ADDRESSING COMMUNITY NEEDS ON A COUNTY-WIDE SCALE. NANTICOKE MEMORIAL HOSPITAL PART V, SECTION B, LINE 19D: NANTICOKE MEMORIAL HOSPITAL CHARGES PATIENTS WHO ARE UNINSURED AND WHOSE FAMILY INCOME IS LESS THAN 500% OF THE FEDERAL POVERTY LEVEL, AN AMOUNT NO GREATER THAN 115% OF THE APPLICABLE PAYMENT RATE UNDER THE FEDERAL MEDICARE PROGRAM ESTABLISHED PURSUANT TO PUB. L.89-87 (42 U.S.C.S.1395 ET SEQ.) THE AMOUNT IS IN ACCORDANCE WITH THE SLIDING SCALE BASED ON INCOME DEVELOPED BY THE DEPARTMENT OF HEALTH & SENIOR SERVICES PURSUANT TO THIS ACT. PART VI, LINE 2: NEEDS ASSESSMENT-NANTICOKE HEALTH SERVICES CURRENTLY USES AVAILABLE STATE DATA ON COMMUNITY HEALTH NEEDS. THE STATE OF DELAWARE CURRENTLY CONDUCTS STATEWIDE REPORTS ON HEALTH DISPARITIES FOR THOSE WITHOUT INSURANCE. THIS REPORT IS PRODUCED ABOUT EVERY FIVE YEARS. ADDITIONALLY, THE STATE OF DELAWARE PUBLISHED "RACIAL AND ETHNIC DISPARITIES HEALTH STATUS REPORT CARD" IN 2008. THIS REPORT INCLUDES COUNTY LEVEL DETAIL. THE STATE OF DELAWARE ALSO PRODUCES HEALTH NEED DATA ON DIABETES, CANCER, WOMEN'S AND CHILDREN'S HEALTH AND PROVIDER ACCESS. IN ADDITION TO STATE DATA, HOSPITAL DATA IS USED. NANTICOKE MEMORIAL HOSPITAL TREATS A LARGE NUMBER OF MEDICAID PATIENTS. IN ADDITION, IN OCTOBER 2010, NANTICOKE CONDUCTED A COMMUNITY NEEDS ASSESSMENT SURVEY. SURVEYS WERE COLLECTED FROM PHYSICIANS, HIGH SCHOOL WELLNESS PROGRAM COORDINATORS, CLERGY AND THE COMMUNITY AT LARGE. RESULTS WERE COMBINED WITH THE ABOVE MENTIONED STATE DATA FOR THE PURPOSES OF PLANNING FOR COMMUNITY HEALTH OUTREACH NEEDS. COMMUNITY SURVEYS ARE CONDUCTED ON AN ON-GOING BASIS. PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE-NANTICOKE MEMORIAL HOSPITAL PROVIDES INFORMATION IN THEIR PATIENT INFORMATION AND VISITORS GUIDE UNDER THE "FINANCIAL ARRANGEMENT/INSURANCE" SECTION CONCERNING THE AVAILABILITY OF FINANCIAL COUNSELORS TO DISCUSS PAYMENT ARRANGEMENTS. AT THIS TIME, PATIENTS ARE INFORMED ABOUT ALL THE PROGRAMS AVAILABLE TO THEM, BOTH VERBALLY AND IN WRITTEN FORMAT. IN POSSIBLE ELIGIBILITY FOR DELAWARE MEDICAID ASSISTANCE. THE FOLLOWING DEPARTMENTS OFFER THIS TYPE OF ASSISTANCE TO OUR PATIENTS: BUSINESS OFFICE, REGISTRATION, CASE MANAGEMENT, CHAPS COORDINATOR, CANCER CARE COORDINATOR, CANCER NURSE NAVIGATOR (SCREENING APPROACH), AND PERSCRIPTION ASSISTANCE PROGRAM. PART VI, LINE 4: USING THE INFORMATION PROVIDED THROUGH NANTICOKE'S 2010 CHNA, NANTICOKE'S COMMUNITY BENEFIT COMMITTEE (CBC) OF THE BOARD CONTINUED TO FOCUS OUTREACH EFFORTS AND BUILD STRUCTURE AROUND THE COMMUNITY BENEFIT PROCESS. DURING CALENDAR YEAR 2011, THE FIRST STRATEGIC PLAN FOR COMMUNITY BENEFIT WAS DEVELOPED AND APPROVED BY THE NHS BOARD OF DIRECTORS IN JUNE 2011. THIS ESTABLISHED A PROCESS TO DO AN INITIAL ASSESSMENT ON THE CURRENT IDENTIFIED OUTREACH INITIATIVES. THESE INITIATIVES INCLUDE GROUPS WORKING ON: CANCER, STROKE, DIABETES, OBESITY, SCHOOL WELLNESS AND GENERAL OUTREACH. AFTER COMPLETING AN INITIAL ASSESSMENT, EACH GROUP DEVELOPED MEASURABLE GOALS. THESE INITIATIVES WORK ON A FISCAL YEAR THAT RUNS JULY 1 THROUGH JUNE 30. A ONE YEAR ASSESSMENT WAS REQUESTED FROM EACH GROUP AT THE CONCLUSION OF FISCAL YEAR 2012 (JUNE), RESULTS TO BE PRESENTED TO THE CBC IN DECEMBER 2012. RESULTS WILL BE USED TO DETERMINE IF PROGRESS IS BEING MADE IN IMPROVING HEALTH OR ACCESS TO CARE IN THESE AREAS.IN ADDITION TO IDENTIFYING HEALTH NEEDS, THE 2010 CHNA ALSO IDENTIFIED BOTH THE GROWING HISPANIC POPULATION OF SUSSEX COUNTY AS WELL AS THE AFRICAN AMERICAN POPULATION AS GROUPS WITH INCREASED COMMUNITY HEALTH NEEDS. IN THE 2010 CHNA, NANTICOKE REFERENCED THE "HISPANIC HEALTH IN DELAWARE: BARRIERS TO CARE FOR THE HISPANIC POPULATION". IN 2011 AND CONTINUING INTO 2012, NANTICOKE IS EXPANDING INITIATIVES WITH BOTH LA RED AND LA ESPERANZA, ORGANIZATIONS THAT PROVIDE HEALTH AND SOCIAL SERVICES FOR THE GROWING HISPANIC POPULATION WITHIN THE COUNTY. HISPANIC REPRESENTATION ON BOTH THE NHS BOARD OF DIRECTORS AND THE COMMUNITY BENEFIT COMMITTEE HAS BEEN INCREASED. THE CEO OF NANTICOKE HEALTH SERVICES ALSO SERVES ON AND PROVIDES LEADERSHIP FOR THE GOVERNOR'S COMMISSION ON HISPANIC AFFAIRS. IN ADDITION IN 2012, NANTICOKE IS SPECIFICALLY TARGETING INCREASED PARTNERSHIPS TO ADDRESS THE NEEDS OF THE AFRICAN AMERICAN POPULATION AS WELL. THIS BEGAN WITH A COMMUNITY MEETING WITH CLERGY AND OTHER AFRICAN AMERICAN COMMUNITY REPRESENTATIVES TO OPENLY DISCUSS PRESSING NEEDS FOR THIS POPULATION. THE AFRICAN AMERICAN POPULATION IS A TARGET AREA FOR OUTREACH RELATED TO INCREASING MAMMOGRAPHY SCREENINGS SINCE THIS POPULATION IS AT HIGHER RISK TO DISCOVER THE CANCER IN LATER STAGES, WHICH INCREASES THE RISK OF DEATH FROM THE DISEASE.BY THE END OF CALENDAR YEAR 2011, THE CEO'S FROM THE THREE SUSSEX COUNTY HOSPITALS HAD MET AND APPROVED THE FORMATION OF HEALTHIER SUSSEX COUNTY. HEALTHIER SUSSEX COUNTY BRINGS TOGETHER THE THREE HOSPITALS AND OTHER HEALTH PROVIDERS AND RESOURCES TO TARGET HEALTH ISSUES THAT IMPACT NOT JUST INDIVIDUAL HOSPITAL SERVICE AREA POPULATIONS, BUT RESIDENTS THROUGHOUT THE COUNTY. BEGINNING IN 2012, HEALTHIER SUSSEX COUNTY HAS TASK FORCES WORKING ON (1) A COUNTY WIDE CHNA; (2) A DIABETES TASK FORCE WORKING TOWARD INCREASING COMPLIANCE AND FOLLOW UP FOR DIAGNOSED DIABETICS; AND (3) A MAMMOGRAPHY TASK FORCE WORKING TO INCREASE THE NUMBER OF WOMEN COMPLETING HAVE THEIR ANNUAL MAMMOGRAM, PARTICULARLY THOSE FROM MINORITY POPULATIONS AND/OR THOSE WITHOUT INSURANCE. THESE INITIATIVES COMBINE THE RESOURCES OF ALL THREE HOSPITALS AS WELL AS OTHER HEALTH PROVIDERS IN THE AREA INCLUDING LA RED, DELAWARE BREAST CANCER COALITION, SUSAN G. KOMEN, AMERICAN DIABETES ASSOCIATION REPRESENTATIVES, COMMUNITY CLINICIANS, INSURERS, AND STATE HEALTH RESOURCES. PART VI, LINE 5: FOR THE 2010 CHNA, STATE DATA FROM DELAWARE HEALTH AND SOCIAL SERVICES. THIS INCLUDED COUNTY LEVEL DATA AND WAS THE PRIMARY SOURCE OF INFORMATION RELATED TO TRENDS AND SERVICE AREA HEALTH NEEDS. NO INDIVIDUAL AT DHSS WAS INTERVIEWED. IN ADDITION TO THE ABOVE, NANTICOKE REFERENCED THE "HISPANIC HEALTH IN DELAWARE: BARRIERS TO CARE FOR THE HISPANIC POPULATION" PRODUCED BY THE GOVERNORS COMMISSION ON HISPANIC AFFAIRS.TO BETTER UNDERSTAND LOCAL NEEDS OF SEAFORD, DELAWARE AND THE SURROUNDING AREAS NANTICOKE CONDUCTED THREE SURVEYS WITHIN OUR PRIMARY SERVICE AREA. FIRST WE SURVEYED THE COMMUNITY AT LARGE DURING A NUMBER OF COMMUNITY HEALTH EVENT AND RECEIVED 235 RESPONSES TO THE COMMUNITY SURVEY. VIA A MAILED SURVEY, WE CONTACTED MEMBERS OF THE LOCAL CLERGY. FAITH-BASED GROUPS REPRESENT A LARGE NUMBER OF OUR SERVICE AREA POPULATION. WE RECEIVED 26 RESPONSES TO THIS SURVEY. LASTLY, VIA A MAILED SURVEY, WE SURVEYED THE ACTIVE AND COMMUNITY AFFILIATE PHYSICIANS FROM NANTICOKE MEMORIAL HOSPITAL. WE RECEIVED 62 RESPONSES FROM THIS GROUP. A COPY OF NANTICOKES CURRENT CHNA CAN BE FOUND AT WWW.NANTICOKE.ORG.FOR THE NEXT CHNA, NANTICOKE IS WORKING WITH TWO OTHER HOSPITALS THROUGH THE HEALTHIER SUSSEX COUNTY INITIATIVE TO JOINTLY ASSESS THE NEEDS OF SUSSEX COUNTY, DELAWARE. THIS WILL ALSO BE SHARED WITH HEALTHIER SUSSEX COUNTY, A COUNTY WIDE INITIATIVE TO ADDRESS THE HEALTH NEEDS OF RESIDENTS THROUGHOUT THE COUNTY THROUGH PARTNERSHIPS THAT ALLOW FOR MORE EFFICIENT AND EFFECTIVE INITIATIVES AND BETTER OUTCOMES. MORE INFORMATION ABOUT HEALTHIER SUSSEX COUNTY CAN BE ACCESSED THROUGH WWW.HEALTHIERSUSSEXCOUNTY.COM. PART VI, LINE 6: THE HOSPITAL IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. 0 AMERICAN HEART ASSOCIATION 1109 MATTLIND WAY MILFORD DE 19963 135613797 501(C)(3) 8000 CANCER RESEARCH MID-SUSSEX MEDICAL CENTER INC 801 MIDDLEFORD ROAD SEAFORD DE 19973 510224470 501(C)(3) 4874999 TO PROVIDE FUNDS FOR NANTICOKE MEMORIAL HOSPITAL NANTICOKE ALTERNATIVE CARE INC 801 MIDDLEFORD ROAD SEAFORD DE 19973 510328654 501(C)(3) 770000 TO PROVIDE FUNDS FOR NANTICOKE MEMORIAL HOSPITAL NANTICOKE ALTERNATIVE CARE INC 801 MIDDLEFORD ROAD SEAFORD DE 19973 510328654 501(C)(3) 1348347 TO PROVIDE FUNDS FOR NANTICOKE MEMORIAL HOSPITAL AMERICAN CANCER SOCIETY PO BOX 163 SALISBURY MD 21803 580659875 501(C)(3) 7000 CANCER RESEARCH DELAWARE TECHNICAL AND COMMUNITY COLLEGE PO BOX 610 GEORGETOWN DE 19947 516000279 501(C)(3) 25000 0 DIAGNOSTIC MEDICAL SONOGRAPHY TECHNOLOGY PROGRAM 6 0 X 1 1 X X X X X 1 1 0 0 0 0 0 0 0 STEVEN ROSE 437000 0 45898 0 0 0 42500 0 109631 0 635029 0 0 0 JOAQUIN CABRERA 0 285000 0 0 28750 54635 0 0 0 14660 28750 354295 0 0 JOSEPH KIM 0 161057 0 0 15000 3560 0 0 0 49187 15000 213804 0 0 DARR HALL 223857 0 19490 0 0 0 16500 0 52847 0 312694 0 0 0 PENNY SHORT 152379 0 12000 0 0 0 6005 0 47523 0 217907 0 0 0 THOMAS BROWN 192330 0 13343 0 0 0 16500 0 40263 0 262436 0 0 0 DON TRICARICO 140088 0 10200 0 0 0 5604 0 51227 0 207119 0 0 0 MEREDITH ARTHUR 173283 0 0 0 0 0 0 0 5282 0 178565 0 0 0 ROBER FERBER 226371 0 0 0 0 0 0 0 49920 0 276291 0 0 0 ANJU BHARDWAJ 205080 0 0 0 0 0 0 0 21832 0 226912 0 0 0 LI ZHANG 215304 0 0 0 0 0 0 0 21774 0 237078 0 0 0 IMRAN JANJUA 203097 0 0 0 0 0 0 0 39478 0 242575 0 0 0 PART I, LINE 1A STEVE ROSE- HEALTH OR SOCIAL CLUB DUES FOR $2,800 PART I, LINES 4A-B TERRI DRYE- SEVERANCE FOR $72,450 ED HANCOCK-SERP PLAN FOR $43,723 DAVID CROUSE BOARD MEMBER OF NANTICOKE MEMORIAL HOSPITAL AND IS EMPLOYED BY PNC BANK. 104969 NANTICOKE HAS SEVERAL ACCOUNTS WITH PNC BANK. IN ORDER TO ELIMINATE ANY BIASES, DAVID CROUSE ABSTAINS FROM VOTING WHEN A TOPIC RELATED TO BANKING AND INVESTMENTS ARE DISCUSSED DURING BOARD MEETINGS. 0 FORM 990, PART VI, SECTION A, LINE 2 DANNY SHORT (DIRECTOR) HAS A FAMILY RELATIONSHIP WITH PENNY SHORT (COO/CNO). FORM 990, PART VI, SECTION A, LINE 6 NANTICOKE HEALTH SERVICES, INC IS THE SOLE MEMBER. FORM 990, PART VI, SECTION B, LINE 11 A COPY OF THE FORM 990 IS PROVIDED TO EACH MEMBER OF THE BOARD BEFORE BEING FILED. FORM 990, PART VI, SECTION B, LINE 12C THIS POLICY IS APPLICABLE TO THE BOARD OF DIRECTORS, INCLUDING COMMUNITY AND PHYSICIAN MEMBERS OF BOARD COMMITTEES, AND ADMINISTRATION (COLLECTIVELY REFERRED TO AS "BOARD, COMMITTEE MEMBERS, AND ADMINISTRATION") OF NANTICOKE HEALTH SERVICES, NANTICOKE MEMORIAL HOSPITAL, NANTICOKE ALTERNATIVE CARE (D/B/A LIFECARE AT LOFLAND PARK), MID-SUSSEX MEDICAL CENTER, AND DUAL DEVELOPMENT CORPORATION, ALL OF WHICH ARE TAX-EXEMPT CHARITABLE ORGANIZATIONS (REFERRED TO HEREIN AS "NHS"). POLICY:THE POLICY OF NHS IS TO REQUIRE THAT EACH INDIVIDUAL SUBJECT TO THIS POLICY STATEMENT PROMPTLY AND FULLY DISCLOSE (IN THE MANNER PROVIDED HEREIN) ANY ACTUAL, APPARENT, OR POTENTIAL CONFLICT OF INTEREST, AND THAT NHS WILL NOT ENGAGE IN ANY CONTRACT, TRANSACTION, OR ARRANGEMENT INVOLVING A CONFLICT OF INTEREST UNLESS THE DISINTERESTED MEMBERS OF THE BOARD OF DIRECTORS (ACTING AT A DULY CONSTITUTED MEETING THEREOF) (WITH THE ADVICE OF LEGAL COUNSEL) DETERMINE BY A MAJORITY VOTE THAT APPROPRIATE SAFEGUARDS TO PROTECT THE CHARITABLE MISSION OF NHS HAVE BEEN IMPLEMENTED. VIOLATIONS OF THE CONFLICTS OF INTEREST POLICY: IF THE BOARD OF DIRECTORS OR A COMMITTEE HAS REASON TO BELIEVE THAT AN INTERESTED PERSON HAS FAILED TO COMPLY WITH THE DISCLOSURE OBLIGATION OF THIS POLICY, THE BOARD OF DIRECTORS SHALL INFORM THAT PERSON OF THE BASIS FOR ITS BELIEF AND PROVIDE THAT PERSON AN OPPORTUNITY TO ADDRESS THE ALLEGED FAILURE TO DISCLOSE. AFTER HEARING THE RESPONSE OF SUCH PERSON AND CONDUCTING SUCH FURTHER INVESTIGATION AS MAY BE WARRANTED UNDER THE CIRCUMSTANCES, THE BOARD OF DIRECTORS SHALL DETERMINE WHETHER SUCH PERSON HAS, IN FACT, VIOLATED THE DISCLOSURE REQUIREMENTS OF THIS CONFLICT OF INTEREST POLICY. IF THE BOARD DETERMINES THAT THERE HAS BEEN A VIOLATION, THE BOARD SHALL TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION, WHICH MAY INCLUDE REMOVAL (IF THE INTERESTED PERSON IS A BOARD OR COMMITTEE MEMBER) OR TERMINATION (IF THE INTERESTED PERSON IS AN EMPLOYEE). INTENTIONALLY OR REPEATEDLY FAILING TO ADHERE TO THIS POLICY IS GROUNDS FOR REMOVAL FROM THE BOARD. FORM 990, PART VI, SECTION B, LINE 15 ON AN ANNUAL BASIS, THE BOARD OF DIRECTORS' CHAIRMAN AND CHAIRMAN-ELECT REVIEW THE EXECUTIVE COMPENSATION OF THE CEO, SENIOR VP'S AND VP'S. AS PART OF THAT PROCESS, THE FACILITY'S OPERATIONS AND PERFORMANCE ARE TAKEN INTO CONSIDERATION, WHICH INCLUDE REVIEW OF HOSPITAL QUALITY INDICATORS, FINANCIAL PERFORMANCE, EMPLOYEE SATISFACTION SCORES AND PHYSICIAN SATISFACTION SCORES. THE PROCESS INCLUDES A REVIEW OF ACCOMPLISHMENTS OF EACH OF THE EXECUTIVES AND THEIR IMPORTANCE TO THE OVERALL ORGANIZATION. IN DETERMINING THE REASONABLENESS OF COMPENSATION, OTHER AREA HOSPITAL FORM 990'S ARE REVIEWED FOR THEIR EXECUTIVE COMPENSATION, AS WELL AS PUBLISHED NATIONAL SALARY SURVEY DATA. AFTER THE REVIEW AND RECOMMENDATION OF THE CHAIRMAN AND VICE CHAIRMAN, IT IS THEN PRESENTED TO THE FULL BOARD OF DIRECTORS, WHO REVIEW THE ANNUAL COMPENSATION REQUESTS AND EITHER APPROVE OR RECOMMEND APPROPRIATE CHANGES FOR IMPLEMENTATION. THE SAME PROCESS GOES FOR OTHER KEY EMPLOYEES AND OFFICERS. THIS WAS LAST COMPLETED IN 2012. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS FINANCIAL STATEMENTS AND GOVERNING DOCUMENTS AVAILABLE TO THE PUBLIC VIA ANOTHER'S WEBSITE OR UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -309,345. PENSION AND POSTRETIREMENT ADJUSTMENT -4,940,352. ROUNDING 14. TOTAL TO FORM 990, PART XI, LINE 5: -5,249,683. FORM 990, PART XII, LINE 2C THE ORGANZIATION HAS NOT CHANGED ITS PROCESS. ABOUT NANTICOKE NANTICOKE MEMORIAL HOSPITAL, ORIGINALLY INCORPORATED IN 1945, IS ORGANIZED UNDER THE CORPORATE TITLE OF NANTICOKE HEALTH SERVICES. WHAT STARTED AS A 32-BED HOSPITAL IN 1952 HAS GROWN TO INPATIENT SERVICES, OUTPATIENT SERVICES, MEDICAL CENTERS ACROSS SUSSEX COUNTY DELAWARE, BUSINESS SERVICES AND A HOST OF PREVENTATIVE MEDICINE AND HEALTH EDUCATION PROGRAMS. EACH PART OF NANTICOKE HEALTH SERVICES WORKS TOGETHER TO FOCUS ON FULFILLING OUR MISSION STATEMENT: WE EXIST TO POSITIVELY IMPACT OUR COMMUNITIES QUALITY OF LIFE THROUGH SUPERIOR HEALTH SERVICES. TODAY, PATIENTS AND BUSINESSES ARE CONTINUALLY SEEKING SUPERIOR HEALTH CARE AT AN AFFORDABLE PRICE. NANTICOKE HEALTH SERVICES STANDS COMMITTED TO PROVIDING THAT CARE. AS A PARTICIPANT IN THE CMS AND JOINT COMMISSION CORE MEASURE PROJECTS, NANTICOKE MEMORIAL HOSPITAL HAS ACHIEVED THE TOP SCORES IN THE STATE OF DELAWARE FOR CARDIAC CARE, AND HAS BEEN RECOGNIZED AS AMONG THE TOP 10% OF HOSPITALS PARTICIPATING NATIONALLY. FEEDBACK FROM OUR PATIENTS OVERWHELMINGLY COMPLIMENTS US ON THE CARE AND FRIENDLINESS OF OUR STAFF IN ALL OF OUR ENTITIES. OUR DEDICATION TO SERVING OUR PATIENTS IS EVIDENCED THROUGH A COORDINATED SYSTEM OF CARE. OUR ORGANIZATION IS ABLE TO TREAT YOU AND YOUR FAMILY ACROSS THE COMPLETE SPECTRUM OF HEALTHCARE NEEDS. OUR GROWTH IS EVIDENCED NOT ONLY THROUGH THE CONTINUED ADDITION TO MEDICAL PROGRAMS, BUT ALSO THROUGH SUCCESSFUL PHYSICIAN RECRUITMENT OVER 60 PHYSICANS IN THE LAST 15 YEARS. AS OUR COMMUNITIES HEALTHCARE NEEDS CHANGE, NANTICOKE HEALTH SERVICES CONTINUES TO CHANGE AND EXPAND SERVICES TO MEET COMMUNITY NEEDS. RECOGNIZED NATIONALLY FOR OUR ACCOMPLISHMENTS BY ORGANIZATIONS SUCH AS THE AMERICAN HOSPITAL ASSOCIATION AND THE CENTER FOR CASE MANAGEMENT, OUR STAFF WELCOMES THE OPPORTUNITY TO MEET YOUR HEALTHCARE NEEDS. COMMUNITY OUTREACH NANTICOKE HEALTH SERVICES' TRAINED STAFF GOES INTO THE COMMUNITY TO PRESENT HEALTH EDUCATION SEMINARS AND HEALTH SCREENINGS. WE HAVE WORKED WITH AREA SCHOOLS, SENIOR CENTERS AND CIVIC ORGANIZATIONS IN OUR EFFORTS TO EDUCATE OUR COMMUNITY ON PREVENTION AND WELLNESS. PHYSICIANS, NURSES, ANCILLARY STAFF AND ADMINISTRATIVE PERSONNEL HAVE ALL RESPONDED TO REQUESTS TO MEET WITH THESE VARIOUS ORGANIZATIONS. THERE ARE MANY SUPPORT GROUPS AND EDUCATIONAL MEETINGS WHICH ARE HELD IN THE HOSPITAL AS WELL.OUR MATERNITY EDUCATION PROGRAM IS VERY STRONG, AND INCLUDES CHILDBIRTH PREPARATION, SIBLING PREPARATION, AND BREAST-FEEDING SUPPORT. WE ALSO HOST DIABETES EDUCATION CLASSES, STROKE SUPPORT GROUPS AND OTHERS. WE CONDUCT REGULAR CHOLESTEROL SCREENINGS, DIABETES AND GLUCOSE SCREENINGS, BLOOD PRESSURE AND PROSTATE SCREENINGS AND ADULT AND INFANT / CHILD CPR INSTRUCTION ON A REGULAR BASIS. IN 2010 NANTICOKE COMPLETED A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) WHICH IDENTIFIED A NEED FOR A NUMBER OF OUTREACH PROGRAMS, INCLUDING PROGRAMS AROUND HEALTH AND WELLNESS, OBESITY AND DIABETES. THESE PROGRAMS HAVE BEEN ESTABLISHED AND ARE MEASURED ON AN ANNUAL BASIS BEGINNING IN JUNE 2011. NANTICOKE ALSO DEVELOPED A LATINO OUTREACH TEAM TO ADDRESS ACCESS TO CARE AND HAS EXPANDED PARTNERSHIPS WITH HEALTH AND SOCIAL SERVICE PROVIDERS FOR THE HISPANIC POPULATION. OTHER PARTNERSHIPS ALSO CONTINUE AS NANTICOKE CONTINUES CONNECTIONS WITH COMMUNITY PARTNERS ON HEALTH NEEDS SUCH AS PARTNERING WITH THE SUSSEX CHILD HEALTH PROMOTION COALITION IN THE DEVELOPMENT OF THE PRESCRIPTION FOR HEALTH PROGRAM AND PARTNERING WITH THE DELAWARE BREAST CANCER COALITION TO PROVIDE ACCESS TO MAMMOGRAMS FOR UNDERSERVED POPULATIONS. ADDITIONALLY, IN 2011 NANTICOKE ALONG WITH THE TWO OTHER HOSPITALS IN SUSSEX COUNTY PARTNERED TO ESTABLISH HEALTHIER SUSSEX COUNTY (WWW.HEALTHERSUSSEXCOUNTY.COM) WITH THE GOAL OF ADDRESSING HEALTH NEEDS THAT IMPACT ALL PARTS OF THE COUNTY. INCREASING MAMMOGRAMS IN MINORITY POPULATIONS, ESPECIALLY THE AFRICAN AMERICAN POPULATIONS, AND INCREASING COMPLAINCE OF SELF-MANAGEMENT AMONG DIAGNOSED DIABETICS WERE IDENTIFIED. PROGRAMS HAVE BEEN ESTABLISHED AND WERE CONTINUED INTO 2012. IN 2012 HEALTHIER SUSSEX COUNTY IS COMBINING EFFORTS TO DEVELOP A COUNTY WIDE HEALTH NEEDS ASSESSMENT TO BE PUBLISHED IN 2013. HEALTHIER SUSSEX COUNTY HAS EXPANDED TO INCLUDE NOT JUST THE HOSPITALS BUT OTHER COUNTY-WIDE HEALTH AND SOCIAL SERVICE ORGANIZATIONS. PATIENT EDUCATION PATIENT AND FAMILY EDUCATION HAS BECOME AN INTEGRAL PART OF THE CLINICAL PATHWAY PROCESS UTILIZED THROUGHOUT NANTICOKE HEALTH SERVICES. THROUGH THE PATIENT EDUCATION CENTER, OUR PATIENT CARE STAFF HAS BEEN TRAINED TO TEACH OUR PATIENTS AND THEIR FAMILIES ABOUT THEIR ILLNESSES AND TREATMENTS. UTILIZING AN ASSORTMENT OF PRINTED MATERIALS AND CLOSED CIRCUIT TELEVISION, WE ARE ABLE TO EFFECTIVELY TRANSFER CRITICAL INFORMATION DURING ALL PHASES OF CARE. NANTICOKE HEALTH SERVICES 801 MIDDLEFORD ROAD SEAFORD DE 19973 510293888 HEALTH SERVICES DE 501(C)(3) LINE 11B, II N/A 0 NANTICOKE ALTERNATIVE CARE 801 MIDDLEFORD ROAD SEAFORD DE 19973 510328654 HEALTH SERVICES DE 501(C)(3) LINE 9 NHS 0 MID-SUSSEX MEDICAL CENTER 801 MIDDLEFORD ROAD SEAFORD DE 19973 510224470 HEALTH SERVICES DE 501(C)(3) LINE 9 NHS 0 DUAL DEVELOPMENT CORP 801 MIDDLEFORD ROAD SEAFORD DE 19973 510293892 PROPERTY DE 501(C)(3) LINE 11B, II NHS 0 NANTICOKE INSURANCE CO PO BOX 1109 GT GEORGETOWN CAYMAN ISLANDS CJ 980446259 INSURANCE CJ 501(C)(15) N/A NHS 0 PROPRIETARY ENTERPRISES 801 MIDDLEFORD ROAD SEAFORD DE 19973 510293887 INACTIVE DE N/A C 0 0 0 0 0 0 0 0 1 0 1 1 1 1 1 1 0 0