200 HOSPITAL - MYMC INC: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- 200 HOSPITAL - MYMC INC (EIN 25-1002946)
- Tax period
- 2011-07-01 to 2012-06-30
- Filed
- 2013-02-06
- IRS object ID
- 201340379349300609
- Schema version
- 2011v1.2
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-02-06T07:35:12-06:00 | Timestamp |
| Tax Period End Date | 2012-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 250988255 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CARBIS WALKER LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 5700 CORPORATE DRIVE STE 650 | AddressLine1 |
| City | PITTSBURGH | City |
| State | PA | State |
| ZIP Code | 15237 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 251002946 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MEYERSDALE COMMUNITY HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | MEYE | NameControl |
| Phone | 8146345911 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 HOSPITAL DRIVE | AddressLine1 |
| City | MEYERSDALE | City |
| State | PA | State |
| ZIP Code | 15552 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | EDWARD DEPASQUALE | Name |
| Title | CHIEF FINANCIAL OFFICER | Title |
| Phone | 8144108271 | Phone |
| Date Signed | 2013-01-28 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JEFFREY J PETRELL CPA | Name |
| PTIN | P00138808 | PTIN |
| Phone | 4126356270 | Phone |
| Date Prepared | 2013-01-28 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-25 16:41:14Z | BuildTS |
Form 990 IRS990
Doing Business As DoingBusinessAs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MEYERSDALE MEDICAL CENTER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | SCOTT BECKER | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1086 FRANKLIN STREET | AddressLine1 |
| City | JOHNSTOWN | City |
| State | PA | State |
| ZIP Code | 15905 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 12100148 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.CONEMAUGH.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1952 | YearFormation |
| State Legal Domicile | PA | StateLegalDomicile |
| Activity Or Mission Description | GENERAL ACUTE CARE CRITICAL ACCESS HOSPITAL PROVIDING INPATIENT, SWING BED, OUTPATIENT, AND CLINIC SERVICES TO THE SOUTHERN SOMERSET COUNTY POPULATION. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 14 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 9 | NbrIndependentVotingMembers |
| Total Nbr Employees | 143 | TotalNbrEmployees |
| Total Nbr Volunteers | 39 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 293413 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 98602 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 12050144 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 11782292 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 43877 | InvestmentIncomePriorYear |
| Investment Income Current Year | 59509 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 32561 | OtherRevenuePriorYear |
| Other Revenue Current Year | 114148 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 12419995 | TotalRevenuePriorYear |
| Total Revenue Current Year | 12054551 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 5072276 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 5414947 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 6622387 | OtherExpensePriorYear |
| Other Expenses Current Year | 6332739 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 11694663 | TotalExpensesPriorYear |
| Total Expenses Current Year | 11747686 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 725332 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 306865 | RevenuesLessExpensesCY |
| Total Assets BOY | 8268640 | TotalAssetsBOY |
| Total Assets EOY | 8892745 | TotalAssetsEOY |
| Total Liabilities BOY | 3908920 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 3885968 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 4359720 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 5006777 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | GENERAL ACUTE CARE CRITICAL ACCESS HOSPITAL PROVIDING INPATIENT, SWING BED, OUTPATIENT, AND CLINIC SERVICES TO THE SOUTHERN SOMERSET COUNTY POPULATION. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 9787308 | Expense |
| Revenue | 11906830 | Revenue |
| Description | MEYERSDALE COMMUNITY HOSPITAL 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. MEYERSDALE COMMUNITY HOSPITAL PROVIDES 20 BEDS FOR INPATIENT AND OUTPATIENT CARE, OFFERS 24/7 EMERGENCY CARE, OPERATING ROOMS FOR MINOR PROCEDURES, RADIOLOGY AND PATHOLOGY SERVICES, PHYSICAL AND RESPIRATORY THERAPY, CARDIAC REHABILITATION, AND OB/GYN OUTPATIENT CARE. IN ADDITION A STEPDOWN SWING UNIT IS AVAILABLE FOR PATIENTS.DURING FISCAL YEAR 2012, THE HOSPITAL TREATED 260 ACUTE PATIENTS FOR A TOTAL OF 846 DAYS AND 115 SWING BED PATIENTS FOR A TOTAL OF 984 DAYS. ALSO, 41,409 OUTPATIENTS WERE TREATED THROUGHOUT THE FACILITY'S CLINICAL DEPARTMENTS AND RURAL HEALTH CLINICS. | Description |
| Total Program Service Expense | 9787308 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 1 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 0 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 1 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 23 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 143 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 14 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 9 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 1 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | PA | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HEATHER SMITH | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 8146345911 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 HOSPITAL DRIVE | AddressLine1 |
| City | MEYERSDALE | City |
| State | PA | State |
| ZIP Code | 15552 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (18 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation |
|---|---|---|---|---|---|---|
| FRANK QUITONI | ||||||
| CHAIRMAN | 1.00 | X | X | 0 | 0 | 0 |
| SAMUEL MCCLURE | ||||||
| VICE-CHAIRMAN | 1.00 | X | X | 0 | 0 | 0 |
| PATTI STEFANICK DO | ||||||
| SECRETARY | 1.00 | X | X | 0 | 25000 | 0 |
| ALAN STANKIEWICZ DO | ||||||
| ASSISTANT SECRETARY | 1.00 | X | X | 0 | 0 | 0 |
| WILLIAM DURYEA | ||||||
| TREASURER | 1.00 | X | X | 0 | 0 | 0 |
| ELMER LASLO | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| THOMAS MARINO | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| KEVIN MILLER | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| HAROLD NICHOLSON | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| WILLIAM POLACEK | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| JAMES TRETTER DO | ||||||
| TRUSTEE | 1.00 | X | 0 | 657843 | 36294 | |
| SHIBAN WARIKOO MD | ||||||
| TRUSTEE | 1.00 | X | 0 | 494384 | 31962 | |
| STEVEN TUCKER | ||||||
| TRUSTEE, CHIEF OPERATING OFFICER | 3.00 | X | X | 0 | 464031 | 31715 |
| SCOTT BECKER | ||||||
| TRUSTEE, CHIEF EXECUTIVE OFFICER | 1.00 | X | X | 0 | 1087604 | 34890 |
| EDWARD DEPASQUALE | ||||||
| CHIEF FINANCIAL OFFICER | 1.00 | X | 0 | 461804 | 30569 | |
| DAVID CARLSON DO | ||||||
| CHIEF MEDICAL OFFICER | 4.00 | X | 0 | 562770 | 26848 | |
| JOSEPH DADO | ||||||
| CHIEF INFORMATION OFFICER | 4.00 | X | 0 | 364292 | 16140 | |
| MARY LIBENGOOD | ||||||
| PRESIDENT | 50.00 | X | 158334 | 0 | 15877 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 158334 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 4117728 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 224295 | TotalOtherCompensation |
| Number Individuals GT100 K | 1 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| MEMORIAL MEDICAL CENTER | |||||
| 1086 FRANKLIN STREET | JOHNSTOWN | PA | 15905 | FINANCIAL, IT, PHARMACY SVCS | 1045916 |
| CONEMAUGH HEALTH INITIATIVES | |||||
| 1086 FRANKLIN STREET | JOHNSTOWN | PA | 15905 | ER PHYSICIAN, OFFICE STAFF | 889711 |
| CDL | |||||
| 6400 BROOKTREE COURT | WEXFORD | PA | 15090 | NUCLEAR MEDICINE | 226668 |
| WILHELM MERIWETHER | |||||
| 9213 PEGASUS COURT | POTOMAC | MD | 20854 | ER PHYSICIAN | 220400 |
| ALLIANCE IMAGING | |||||
| PO BOX 96485 | CHICAGO | IL | 60693 | MRI | 173565 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 8 | NumberOfContractorsGT100K |
| Government Grants | 7892 | GovernmentGrants |
| All Other Contributions | 90710 | AllOtherContributions |
| Total Contributions | 98602 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| NET PATIENT SERVICE RE | 900099 | 11735999 | 11735999 |
| BLOOD SCREENING | 900099 | 46030 | 46030 |
| MEDICAL RECORDS & VERI | 900099 | 263 | 263 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 11782292 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 59509 | TotalRevenueColumn |
| Exclusion | $59,509 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 27701 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 41418 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | -13717 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -13717 | TotalRevenueColumn |
| Exclusion | -$13,717 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 12172 | GrossIncomeFundraisingEvents |
| Fundraising Direct Expenses | 4179 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 7993 | TotalRevenueColumn |
| Exclusion | $7,993 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | ExclusionExclusionAmount |
|---|---|---|---|---|
| MEANINGFUL USE | 900099 | 113867 | 113867 | |
| CAFETERIA AND VENDING | 900099 | 10671 | 10671 | |
| LOSS ON EXTINGUISHMENT | 900099 | -29974 | -$29,974 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 25308 | TotalRevenueColumn |
| Exclusion | $25,308 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 119872 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 12054551 | TotalRevenueColumn |
| Related Or Exempt Function Income | 11906830 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $49,119 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 187732 | Total |
| Program Services | 37546 | ProgramServices |
| Management And General | 150186 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4143104 | Total |
| Program Services | 3525930 | ProgramServices |
| Management And General | 617174 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 182119 | Total |
| Program Services | 162688 | ProgramServices |
| Management And General | 19431 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 582263 | Total |
| Program Services | 483372 | ProgramServices |
| Management And General | 98891 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 319729 | Total |
| Program Services | 272515 | ProgramServices |
| Management And General | 47214 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 163776 | Total |
| Management And General | 163776 | ManagementAndGeneral |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 600 | Total |
| Management And General | 600 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 781743 | Total |
| Program Services | 781743 | ProgramServices |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 66738 | Total |
| Management And General | 66738 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 75381 | Total |
| Program Services | 29750 | ProgramServices |
| Management And General | 45631 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 324628 | Total |
| Program Services | 245671 | ProgramServices |
| Management And General | 78957 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 30138 | Total |
| Program Services | 24110 | ProgramServices |
| Management And General | 6028 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 16872 | Total |
| Program Services | 12677 | ProgramServices |
| Management And General | 4195 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 114493 | Total |
| Program Services | 114493 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 431701 | Total |
| Program Services | 345361 | ProgramServices |
| Management And General | 86340 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 137676 | Total |
| Program Services | 110141 | ProgramServices |
| Management And General | 27535 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| PURCHASED SERVICES | 2614114 | 2167592 | 446522 |
| PATIENT SUPPLIES AND FO | 1047802 | 1038714 | 9088 |
| REPAIRS AND MAINTENANCE | 328842 | 317861 | 10981 |
| BAD DEBT EXPENSE | 85337 | 85337 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 112898 | Total |
| Program Services | 31807 | ProgramServices |
| Management And General | 81091 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 11747686 | Total |
| Program Services | 9787308 | ProgramServices |
| Management And General | 1960378 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2670965 | BOY |
| EOY | 2832097 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 286360 | BOY |
| EOY | 344083 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1127045 | BOY |
| EOY | 1585286 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 17088 | BOY |
| EOY | 17931 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 10109763 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 7011165 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2975777 | BOY |
| EOY | 3098598 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1191405 | BOY |
| EOY | 1014750 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8268640 | BOY |
| EOY | 8892745 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 685400 | BOY |
| EOY | 794000 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 41387 | BOY |
| EOY | 49189 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2247954 | BOY |
| EOY | 1484646 | EOY |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 244067 | BOY |
| EOY | 150952 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 690112 | BOY |
| EOY | 1407181 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3908920 | BOY |
| EOY | 3885968 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3458583 | BOY |
| EOY | 4077321 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 211210 | BOY |
| EOY | 211860 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 689927 | BOY |
| EOY | 717596 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4359720 | BOY |
| EOY | 5006777 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8268640 | BOY |
| EOY | 8892745 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 306865 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 340192 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 0 | GrantsOtherOrganizations |
| Direct Contact Legislators | 0 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 1 | OtherActivities |
| Other Activities | $600 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 600 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | EXPLANATION OF LOBBYING ACTIVITIES: | Identifier |
| Return Reference | PART II-B, LINE 1: | ReturnReference |
| Explanation | MEMBERSHIP 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 136049 | OtherCostOrOtherBasis |
| Book Value | 136049 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 5619696 | OtherCostOrOtherBasis |
| Depreciation | 3436504 | Depreciation |
| Book Value | 2183192 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 4271783 | OtherCostOrOtherBasis |
| Depreciation | 3566365 | Depreciation |
| Book Value | 705418 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 82235 | OtherCostOrOtherBasis |
| Depreciation | 8296 | Depreciation |
| Book Value | 73939 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 3098598 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (7 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| ACCRUED INTEREST RECEIVABLE | 29 |
| MISCELLANEOUS ACCOUNTS RECEIVABLE | 16248 |
| INTEREST IN INCOME TRUSTS | 717596 |
| RESTRICTED CASH FOUNDATION | 150105 |
| RESTRICTED CASH FOUNDATION - CITIZENS NATIONAL BANK | 61756 |
| DEFERRED FINANCING EXPENSE | 31141 |
| ASSETS HELD BY TRUSTEE | 37875 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 1014750 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities (5 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| ASSET RETIREMENT OBLIGATION | $70,841 |
| DUE TO MEMORIAL MEDICAL CENTER | $851,907 |
| DUE TO CONEMAUGH HEALTH INITIATIVES, INC. | $78,450 |
| DUE TO MEDICARE | $380,000 |
| DUE TO CONEMAUGH HEALTH SYSTEM, INC. | $25,983 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 1407181 | TotalOfAmounts |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | 0 | FPGReferenceDiscountedCare |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 1 | ExpensesExceededBudget |
| Unable To Provide Care | 0 | UnableToProvideCare |
| Annual Community Benefit Report | 0 | AnnualCommunityBenefitReport |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 632550 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 632550 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05420 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 910541 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 560217 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 350324 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03000 | PercentOfTotalExpense |
Unreimbursed Costs UnreimbursedCosts
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 10171 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 6241 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3930 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00030 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1553262 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 566458 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 986804 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.08450 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 40271 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 40271 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00350 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 40271 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 40271 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00350 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1593533 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 566458 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1027075 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.08800 | PercentOfTotalExpense |
Community Support CommunitySupport
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 7000 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 7000 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00060 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 7000 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 7000 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00060 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $40,723 | BadDebtExpenseAmount |
| Amount Attributable To | 0 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 3545044 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 2971661 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 573383 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost Accounting System | X | CostAccountingSystem |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MEYERSDALE COMMUNITY HOSPITAL | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 HOSPITAL DRIVE | AddressLine1 |
| City | MEYERSDALE | City |
| State | PA | State |
| ZIP Code | 15552 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Critical Access Hospital | X | CriticalAccessHospital |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MEYERSDALE COMMUNITY HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | 0 | CHNAConducted |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 200.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 0 | UsesFPGDiscounted |
| Explains Basis | 1 | ExplainsBasis |
| Insurance Status | X | InsuranceStatus |
| Uninsured Discount | X | UninsuredDiscount |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Available On Request | X | AvailableOnRequest |
| Other Publicity | X | OtherPublicity |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Collection Activities | 0 | CollectionActivities |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Average Negotiated Rates | X | AverageNegotiatedRates |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 2 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (2 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| FAMILY HEALTHCARE RHC MEYERSDALE | ||||
| 202 BEACHLEY STREET | MEYERSDALE | PA | 15552 | RURAL HEALTH CLINIC |
| FAMILY HEALTHCARE RHC SALISBURY | ||||
| 231 ORD STREET | SALISBURY | PA | 15558 | RURAL HEALTH CLINIC |
Form990 Schedule H Part VI Form990ScheduleHPartVI (14 entries)
| ExplanationExplanation | IdentifierIdentifier |
|---|---|
| PART I, LINE 3C: FEDERAL POVERTY GUIDELINES (FPG) ARE USED TO DETERMINE ELIGIBILITY FOR FREE CARE. HOWEVER, FPG ARE NOT USED WHEN MAKING A DETERMINATION FOR DISCOUNTED CARE. IN THESE CASES, ALL SELF-PAY, UNINSURED PATIENTS ARE OFFERED A 60% DISCOUNT OFF OF CHARGES. | |
| PART I, LINE 7: THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS REPORTED ON PART I, LINES 7A, 7B, AND 7C WAS BASED ON THE CONEMAUGH HEALTH SYSTEM'S COST ACCOUNTING SYSTEM AND ADDRESSES ALL PATIENT SEGMENTS. FOR FURTHER DETAILS OF THIS SYSTEM, SEE THE DESCRIPTION FOR PART III, LINE 8. THE METHODOLOGY USED TO CALCULATE THE AMOUNTS REPORTED ON PART I, LINES 7E THROUGH 7I AS APPLICABLE, WAS BASED ON ACTUAL REVENUES AND EXPENSES INCURRED. | |
| PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 85337. | |
| 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: CHANGE IN ACCOUNTING PRINCIPLE FOOTNOTE - IN 2012, CONEMAUGH HEALTH SYSTEM (CHS) CHANGED ITS METHOD OF PRESENTATION AND DISCLOSURE OF PATIENT SERVICE REVENUE, PROVISION FOR BAD DEBTS, AND THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IN ACCORDANCE WITH ACCOUNTING STANDARDS UPDATE (ASU) 2011-07, "PRESENTATION AND DISCLOSURE OF PATIENT SERVICE REVENUE, PROVISION FOR BAD DEBTS, AND THE ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR CERTAIN HEALTH CARE ENTITIES." THE MAJOR CHANGES ASSOCIATED WITH ASU 2011-07 ARE TO RECLASSIFY THE PROVISION FOR UNCOLLECTIBLE ACCOUNTS RELATED TO PATIENT SERVICE REVENUE TO A DEDUCTION FROM PATIENT SERVICE REVENUE AND TO PROVIDE ENHANCED DISCLOSURES AROUND CHS' POLICIES RELATED TO UNCOLLECTIBLE ACCOUNTS. THE CHANGE HAD NO EFFECT ON PRIOR YEAR OPERATING INCOME OR CHANGE IN NET ASSETS. 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 FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL, CHS RECORDS A SIGNIFICANT PROVISION FOR UNCOLLECTIBLE ACCOUNTS 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 90 PERCENT OF SELF-PAY ACCOUNTS RECEIVABLE AT JUNE 30, 2011 TO 86 PERCENT OF SELF-PAY ACCOUNTS RECEIVABLE AT JUNE 30, 2012. IN ADDITION, CHS' WRITE-OFFS DECREASED APPROXIMATELY $3,066,000 FROM APPROXIMATELY $14,382,000 FOR THE YEAR ENDED JUNE 30 2011, TO APPROXIMATELY $11,316,000 FOR THE YEAR ENDED JUNE 30, 2012. 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.THE METHODOLOGY UTILIZED TO DETERMINE THE AMOUNT REPORTED ON LINE 2 IS BASED ON THE DESCRIPTIONS CONTAINED IN THE PRECEDING FOOTNOTES. 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. BEGINNING WITH FISCAL YEAR 2012, THE AMOUNT REPORTED ON LINE 3 IS ZERO. 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 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 10: 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 13G: 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 VI, LINE 2: THROUGH A COLLABORATIVE EFFORT WITH THE UNITED WAY OF THE LAUREL HIGHLANDS, CONEMAUGH HEALTH SYSTEM (CHS) HAS WORKED WITH VARIOUS COMMUNITY ORGANIZATIONS TO EDUCATE AND ACTIVATE THE COMMUNITY ABOUT IDENTIFIED COMMUNITY NEEDS. THIS ANALYSIS INCLUDES THE COMMUNITIES SERVED BY MEYERSDALE MEDICAL CENTER (MYMC). THE HEALTH NEEDS OF THE COMMUNITY WERE ASSESSED IN MANY WAYS, INCLUDING SURVEYS AND INTERVIEWS. THE MAJOR HEALTHCARE-RELATED NEEDS IDENTIFIED INCLUDE THE SUPPORT OF VULNERABLE AND AGING POPULATIONS AS WELL AS THE PROMOTION OF HEALTH AND WELLNESS PROGRAMS. OTHER METHODS TO ASSESS HEALTH NEEDS INCLUDED VARIOUS FORMS OF DATA ANALYSIS ALONG WITH THE EVALUATION OF DEMOGRAPHICS FOR THE COMMUNITIES SERVED. RESULTS FROM THESE ANALYSES RESULTED IN KEY FOCUS AREAS RELATED TO CARDIOVASCULAR RISK MANAGEMENT, ACCESS TO HEALTH SCREENINGS, AND DIABETIC EDUCATION.CHS IS CURRENTLY WORKING ON A COMMUNITY HEALTH NEEDS ASSESSMENT THAT WILL INCLUDE RESULTS RELATED SPECIFICALLY TO MYMC. THIS WILL BE FINALIZED DURING THE NEXT FISCAL YEAR AND A FORMAL IMPLEMENTATION PLAN WILL BE DEVELOPED. | |
| 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: MEYERSDALE MEDICAL CENTER (MYMC) 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. FACILITY HIGHLIGHTS INCLUDE: 20 BEDS FOR INPATIENT AND OUTPATIENT CARE; 24/7 EMERGENCY DEPARTMENT; OPERATING ROOMS FOR SHORT OR MINOR PROCEDURES; RADIOLOGY SERVICES, INCLUDING MOBILE MRI AND CT SCANS; PATHOLOGY SERVICES; PHYSICAL THERAPY; RESPIRATORY THERAPY; ULTRASOUND; CARDIAC REHABILITATION; OB/GYN OUTPATIENT CARE; STEP-DOWN SWING UNIT; AND MEDSTAR MEDICAL HELICOPTER TRANSPORTATION.ITS PARTNERSHIP WITH MEMORIAL MEDICAL CENTER (MMC) PROVIDES MYMC PATIENTS WITH ACCESS TO SPECIALISTS AND NEW TECHNOLOGIES. SPECIALTY SERVICES ARE AVAILABLE ONSITE SEVERAL TIMES A WEEK. THESE SPECIALTIES INCLUDE: CARDIOLOGY, UROLOGY, OPHTHALMOLOGY, GASTROENTEROLOGY, NEPHROLOGY, AND PODIATRY. DIGITAL MAMMOGRAPHY EQUIPMENT WAS FULLY IMPLEMENTED AT MEYERSDALE THIS YEAR ALONG WITH AN EDUCATIONAL CAMPAIGN TO ENCOURAGE WOMEN OVER THE AGE OF 40 TO MAKE MAMMOGRAPHY A PART OF THEIR YEARLY ROUTINE. MYMC PRESIDENT MARY LIBENGOOD SERVES AS PRESIDENT OF THE PENNSYLVANIA RURAL HEALTH ASSOCIATION. THE ORGANIZATION HAS MEMBERS FROM HOSPITALS, CLINICS, SOCIAL SERVICE AGENCIES, PHYSICIANS, AND DENTISTS. IT IS AN ADVOCACY GROUP WITH THE GOAL OF IMPROVING AND MAINTAINING THE HEALTH OF RESIDENTS IN RURAL PENNSYLVANIA.ACCORDING TO THE 2010 US CENSUS, THE AVERAGE HOUSEHOLD SIZE WAS 2.3 IN CAMBRIA COUNTY AND 2.4 IN SOMERSET COUNTY AS COMPARED TO THE NATIONAL AND STATE AVERAGES OF 2.6 AND 2.5 RESPECTIVELY. 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. SOME EFFECTS OF LOW HOUSEHOLD INCOMES INCLUDE LESS DISPOSABLE INCOME FOR FOOD, CLOTHING, PAYING ESSENTIAL BILLS AND SUPPORTING CHILDREN/FAMILY. CONTRIBUTING FACTORS TO DECREASED MEDIAN HOUSEHOLD INCOME IN CAMBRIA AND SOMERSET COUNTIES INCLUDE, BUT ARE NOT LIMITED TO, THE AVAILABILITY OF JOBS, THE DISTRIBUTION AND ECONOMIC VALUE OF JOBS, AND THE CONTINUED HIGH UNEMPLOYMENT RATE. THE CAMBRIA AND SOMERSET EMPLOYED POPULATION INCLUDES HIGHER PROPORTIONS OF THOSE WHO WORK IN HEALTH CARE, GOVERNMENT, RETAIL, TECHNOLOGICAL CORPORATIONS, AND EDUCATION (GREATER JOHNSTOWN CHAMBER OF COMMERCE, 2011).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 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; UPGRADES TO THE PULMONARY FUNCTION TESTING LAB AT MYMC; 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. EACH YEAR MYMC HOLDS A FREE COMMUNITY-WIDE HEALTH FAIR AT THE HOSPITAL. THE EVENT INCLUDES WELLNESS ACTIVITIES, 14 MEDICAL SCREENINGS, AND A VARIETY OF HEALTHCARE EDUCATIONAL INFORMATION. THIS YEAR, THE EVENT DREW OVER 500 PEOPLE. MYMC EMPLOYEES SUPPORT A NUMBER OF COMMUNITY-WIDE ORGANIZATIONS AND NON-PROFIT EVENTS INCLUDING HOSTING A HOSPITAL WIDE "RELAY FOR LIFE" TEAM, THE MIRACLE MAKERS, WHO CONDUCT A NUMBER OF FUNDRAISING ACTIVITIES INCLUDING HOSTING A CALENDAR PARTY AT THE MEYERSDALE FIRE HALL. ALL PROCEEDS FROM THE EVENT BENEFIT THE AMERICAN CANCER SOCIETY. MYMC ALSO DONATES SPACE IN ITS DINING ROOM AND CONFERENCE ROOM EACH WEEK FOR ALCOHOLIC ANONYMOUS MEETINGS.MEYERSDALE COMMUNITY HOSPITAL FACILITY HIGHLIGHTS:LICENSED BEDS - 20BEDS IN SERVICE - 20PATIENT DAYS OF SERVICE - 1,830INPATIENT DAILY CENSUS - 5ADMISSIONS - 375AVERAGE LENGTH OF STAY - 4.9FULL TIME EQUIVALENT EMPLOYEES - 110.10VOLUNTEERS - 39PHYSICIANS:ACTIVE - 4SERVICES:EMERGENCY VISITS - 4,334SAME DAY/AMBULATORY SURGERY - 178PHYSICAL THERAPY TREATMENTS - 4,707LABORATORY TESTS - 67,879RADIOLOGY DIAGNOSTIC/MAMMOGRAPHY - 6,176ULTRASOUND PROCEDURES - 1,055CT SCANS - 2,206MRI PROCEDURES - 425CARDIO/RESPIRATORY PROCEDURES - 12,910 | |
| 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 J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 1 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 1 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (8 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JAMES TRETTER DO | |||||||||||||
| 0 | 586621 | 0 | 56704 | 0 | 14518 | 0 | 21842 | 0 | 14452 | 0 | 694137 | 0 | 0 |
| SHIBAN WARIKOO MD | |||||||||||||
| 0 | 486420 | 0 | 0 | 0 | 7964 | 0 | 21448 | 0 | 10514 | 0 | 526346 | 0 | 0 |
| STEVEN TUCKER | |||||||||||||
| 0 | 331702 | 0 | 109738 | 0 | 22591 | 0 | 19837 | 0 | 11878 | 0 | 495746 | 0 | 0 |
| SCOTT BECKER | |||||||||||||
| 0 | 599642 | 0 | 346114 | 0 | 141848 | 0 | 15971 | 0 | 18919 | 0 | 1122494 | 0 | 0 |
| EDWARD DEPASQUALE | |||||||||||||
| 0 | 331734 | 0 | 109370 | 0 | 20700 | 0 | 19187 | 0 | 11382 | 0 | 492373 | 0 | 0 |
| DAVID CARLSON DO | |||||||||||||
| 0 | 414185 | 0 | 128589 | 0 | 19996 | 0 | 12867 | 0 | 13981 | 0 | 589618 | 0 | 0 |
| JOSEPH DADO | |||||||||||||
| 0 | 265102 | 0 | 87025 | 0 | 12165 | 0 | 13371 | 0 | 2769 | 0 | 380432 | 0 | 0 |
| MARY LIBENGOOD | |||||||||||||
| 136774 | 0 | 20666 | 0 | 894 | 0 | 6335 | 0 | 9542 | 0 | 174211 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| PART I, LINE 4B | 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: STEVEN TUCKER $40; SCOTT BECKER $7,682; EDWARD DEPASQUALE $2,212; DAVID CARLSON, DO $1,154; JOSEPH DADO $87; AND MARY LIBENGOOD $11. |
| PART I, LINE 6 | MARY 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 THEN DISTRIBUTED TO THE PHYSICIAN BASED ON A CONTRACTUAL PERCENTAGE AND CAP. TOTAL PHYSICIAN COMPENSATION IS ANNUALLY CHECKED FOR REASONABLENESS AGAINST IRS GUIDELINES. |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV
Name Of Interested Person NameOfInterestedPerson
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | KAREN MILLER | NamePerson |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship | FAMILY MEMBER OF MARY LIBENGOOD (OFFICER) | Relationship |
| Amount Of Transaction | 26696 | AmountOfTransaction |
| Description Of Transaction | EMPLOYMENT | DescriptionOfTransaction |
| Sharing Of Revenues | 0 | SharingOfRevenues |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (12 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 4 | THE BYLAWS OF MEYERSDALE COMMUNITY HOSPITAL WERE AMENDED FOR FISCAL YEAR 2012 WITH REGARD TO THE NUMBER AND COMPOSITION OF THE ORGANIZATION'S BOARD MEMBERS. | |
| FORM 990, PART VI, SECTION A, LINE 6 | THE 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 7A | THE 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 7B | ALL 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 11 | THE FORM 990 IS PROVIDED TO THE ORGANIZATION'S BOARD OF DIRECTORS BEFORE IT IS FILED. ONCE THE FORM IS COMPLETE, BOARD MEMBERS ARE GIVEN THE OPPORTUNITY TO REVIEW THE CONTENTS OF THE FORM AND SUBMIT ANY COMMENTS OR QUESTIONS. IN ADDITION, SINCE THE ORGANIZATION IS A SUBSIDIARY WITHIN A LARGER HEALTH SYSTEM, THE FORM IS REVIEWED BY THE HEALTH SYSTEM'S MANAGER, TAX & COMPLIANCE; DIRECTOR, FINANCIAL OPERATIONS; VICE-PRESIDENT, FINANCIAL OPERATIONS; CHIEF FINANCIAL OFFICER; AND THE AUDIT AND COMPLIANCE COMMITTEE. AN EXTERNAL CPA FIRM IS ENGAGED TO REVIEW AND ELECTRONICALLY FILE THE RETURN. | |
| FORM 990, PART VI, SECTION B, LINE 12C | THE ORGANIZATION IS A SUBSIDIARY OF A LARGER HEALTH SYSTEM AND IS GOVERNED BY THE SYSTEM'S CONFLICT OF INTEREST POLICY, WHICH HAS BEEN APPROVED BY THE HEALTH SYSTEM'S BOARD. UNDER THIS POLICY, EVERY BOARD MEMBER IS GIVEN A COPY OF THE POLICY AS WELL AS A FORM THAT MUST BE COMPLETED ON AN ANNUAL BASIS. NO BOARD MEMBER IS APPROVED OR RE-APPOINTED UNTIL HE OR SHE HAS COMPLETED AND SIGNED THE CONFLICT OF INTEREST FORM. ONCE THE FORM IS RETURNED, IT IS REVIEWED BY THE SYSTEM'S COMPLIANCE OFFICER AND CEO. IF ANY CONFLICTS ARE DISCLOSED, THE DETAILS ARE FORWARDED TO THE BOARD CHAIR TO BE ADDRESSED. DEPENDING ON THE CONFLICT, THE BOARD MEMBER COULD BE GIVEN CERTAIN RESTRICTIONS, SUCH AS BEING PROHIBITED FROM PARTICIPATING IN CERTAIN BOARD DECISIONS. THE HEALTH SYSTEM'S AUDIT AND COMPLIANCE COMMITTEE HAS THE FINAL DECISION-MAKING REGARDING ALL CONFLICTS OF INTEREST. THROUGHOUT THE FISCAL YEAR, BOARD MEMBERS MUST NOTIFY THE BOARD CHAIR, COMPLIANCE OFFICER, AND/OR CEO IF A NEW CONFLICT OF INTEREST HAS DEVELOPED. | |
| FORM 990, PART VI, SECTION B, LINE 15 | THE ORGANIZATION'S PARENT, A HEALTH SYSTEM, MANAGES THE DETERMINATION OF COMPENSATION AND THE PROCESS IS OUTLINED IN ITS 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 19 | THE ORGANIZATION IS PART OF A HEALTH SYSTEM AND ALL REQUESTS FOR THIS INFORMATION ARE HANDLED BY THE SYSTEM'S MARKETING/PUBLIC RELATIONS DEPARTMENT. | |
| FORM 990, PART VI, SECTION B, LINES 12A, 13, AND 14: ALL APPLICABLE POLICY QUESTIONS HAVE BEEN ANSWERED YES SINCE THE ORGANIZATION IS A SUBSIDIARY OF A LARGER HEALTH SYSTEM AND IS GOVERNED BY THE SYSTEM'S POLICIES. ALL POLICIES HAVE BEEN APPROVED BY THE HEALTH SYSTEM'S BOARD. | ||
| 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 STEVEN TUCKER, COO: CONEMAUGH HEALTH SYSTEM - 15 CONEMAUGH VALLEY MEMORIAL HOSPITAL - 26 MEYERSDALE COMMUNITY HOSPITAL - 3 MINERS HOSPITAL - 3 GOOD SAMARITAN MEDICAL CENTER - 0.5 CONEMAUGH HEALTH FOUNDATION - 0.5 CONEMAUGH HOUSING, INC. - 0.5 CONEMAUGH HEALTH INITIATIVES - 1.5 PATTI STEFANICK, DO: CONEMAUGH VALLEY MEMORIAL HOSPITAL - 8 MEYERSDALE COMMUNITY HOSPITAL - 1 MINERS HOSPITAL - 1 JAMES TRETTER, DO: CONEMAUGH VALLEY MEMORIAL HOSPITAL - 7 MEYERSDALE COMMUNITY HOSPITAL - 1 MINERS HOSPITAL - 1 CONEMAUGH HEALTH INITIATIVES - 65 SHIBAN WARIKOO, MD: CONEMAUGH VALLEY MEMORIAL HOSPITAL - 2 MEYERSDALE COMMUNITY HOSPITAL - 1 MINERS HOSPITAL - 1 CONEMAUGH HEALTH INITIATIVES - 40 | ||
| FORM 990, PART XI, LINE 5: | CHANGE IN CHF FAS 136 RECEIVABLE 651. CHANGE IN INCOME TRUSTS 27,669. MEDICAL DIRECTOR REIMBURSEMENT FROM CHS 13,800. MEANINGFUL USE ASSET TRANSFER 298,072. TOTAL TO FORM 990, PART XI, LINE 5: 340,192. | 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, 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. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (6 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Direct Controlling Entity NADirectControllingEntityNA | Controlled OrgControlledOrg | Business Name Line1DirectControllingEntityName/BusinessNameLine1 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| CONEMAUGH HEALTH SYSTEM | |||||||||||
| 1086 FRANKLIN STREET | JOHNSTOWN | PA | 15905 | 232801799 | SUPPORT MEMBER HOSPITALS | PA | 501(C)(3) | 11A | N/A | 0 | |
| CONEMAUGH HEALTH FOUNDATION | |||||||||||
| 1086 FRANKLIN STREET | JOHNSTOWN | PA | 15905 | 251719695 | SUPPORTS CONEMAUGH HEALTH SYSTEM | PA | 501(C)(3) | 11B | 0 | CONEMAUGH HEALTH SYSTEM | |
| CONEMAUGH VALLEY MEMORIAL HOSPITAL DBA MEMORIAL MEDICAL CENTER | |||||||||||
| 1086 FRANKLIN STREET | JOHNSTOWN | PA | 15905 | 250965307 | HEALTHCARE SERVICES | PA | 501(C)(3) | 3 | 0 | CONEMAUGH HEALTH SYSTEM | |
| MINERS HOSPITAL DBA MINERS MEDICAL CENTER | |||||||||||
| 290 HAIDA AVENUE | HASTINGS | PA | 16646 | 250977902 | HEALTHCARE SERVICES | PA | 501(C)(3) | 3 | 0 | CONEMAUGH HEALTH SYSTEM | |
| GOOD SAMARITAN MEDICAL CENTER | |||||||||||
| 1020 FRANKLIN STREET | JOHNSTOWN | PA | 15905 | 250965428 | HEALTHCARE SERVICES | PA | 501(C)(3) | 3 | 0 | CONEMAUGH HEALTH SYSTEM | |
| CONEMAUGH HOUSING INC | |||||||||||
| 1086 FRANKLIN STREET | JOHNSTOWN | PA | 15905 | 251606936 | PROVIDES SENIOR HOUSING FACILITIES | PA | 501(C)(3) | 9 | 0 | CONEMAUGH VALLEY MEMORIAL HOSPITAL | |
Form990 Schedule R Part III Form990ScheduleRPartIII (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|
| LAUREL HIGHLANDS ADVANCED IMAGING | |||||||
| 1450 SCALP AVENUE | JOHNSTOWN | PA | 15904 | 251864587 | DIAGNOSTIC SERVICES | PA | N/A |
| GREATER JOHNSTOWN TECH PARK | |||||||
| 1086 FRANKLIN STREET | JOHNSTOWN | PA | 15905 | 260389121 | OPERATES MULTI TENANT COMMERCE OFFICE PARK | PA | N/A |
Form990 Schedule R Part IV Form990ScheduleRPartIV (4 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Direct Controlling Entity NADirectControllingEntityNA | Type Of EntityTypeOfEntity |
|---|---|---|---|---|---|---|---|---|
| CONEMAUGH HEALTH INITIATIVES INC | ||||||||
| 1086 FRANKLIN STREET | JOHNSTOWN | PA | 15905 | 251658283 | PHYSICIAN SERVICES | PA | N/A | C |
| 1086 REAL ESTATE | ||||||||
| 1086 FRANKLIN STREET | JOHNSTOWN | PA | 15905 | 251489704 | REAL ESTATE | PA | N/A | C |
| CONEMAUGH ENTERPRISES INC | ||||||||
| 1086 FRANKLIN STREET | JOHNSTOWN | PA | 15905 | 202998473 | ECONOMIC DEVELOPMENT | PA | N/A | C |
| SINDO INC | ||||||||
| 1086 FRANKLIN STREET | JOHNSTOWN | PA | 15905 | 251144116 | COMMUNITY RENTALS | PA | N/A | C |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 1 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |