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WAYNESBORO HOSPITAL: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
WAYNESBORO HOSPITAL (EIN 23-1360854)
Tax period
2010-07-01 to 2011-06-30
Filed
2012-05-14
IRS object ID
201211359349301346
Schema version
2010v3.4
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2012-05-14T09:47:49-05:00Timestamp
Tax Period End Date2011-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1SMITH ELLIOTT KEARNS & COMPANY LLCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1804 WAYNE AVENUEAddressLine1
CityCHAMBERSBURGCity
StatePAState
ZIP Code17201ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN231360854EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1WAYNESBORO HOSPITALBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlWAYNNameControl
Phone7177654000Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1501 EAST MAIN STREETAddressLine1
CityWAYNESBOROCity
StatePAState
ZIP Code17268ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NamePATRICK W O'DONNELLName
TitleCHIEF FINANCIAL OFFICERTitle
Phone7172677106Phone
Date Signed2012-05-10DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameGREGORY P HALL CPAName
Phone7172633910Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonPATRICK W O'DONNELLNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1501 EAST MAIN STREETAddressLine1
CityWAYNESBOROCity
StatePAState
ZIP Code17268ZIPCode
FieldValueIRS element (for citing)
Gross Receipts68382011GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteN/AWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1922YearFormation
State Legal DomicilePAStateLegalDomicile
Activity Or Mission DescriptionTHE WAYNESBORO HOSPITAL IS A REGIONAL NONPROFIT HEALTH CARE ORGANIZATION COMMITTED TO THE IMPROVEMENT OF THE HEALTH AND WELL-BEING OF THE PEOPLE IN SOUTH-CENTRAL PENNSYLVANIA.ActivityOrMissionDescription
Nbr Voting Members Governing Body12NbrVotingMembersGoverningBody
Nbr Independent Voting Members11NbrIndependentVotingMembers
Total Nbr Employees597TotalNbrEmployees
Total Nbr Volunteers123TotalNbrVolunteers
Total Gross UBI712575TotalGrossUBI
Net Unrelated Business Txbl Income-2735NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year188242ContributionsGrantsPriorYear
Contributions Grants Current Year263467ContributionsGrantsCurrentYear
Program Service Revenue Prior Year63676380ProgramServiceRevenuePriorYear
Program Service Revenue CY65074572ProgramServiceRevenueCY
Investment Income Prior Year626406InvestmentIncomePriorYear
Investment Income Current Year1744409InvestmentIncomeCurrentYear
Other Revenue Prior Year1244672OtherRevenuePriorYear
Other Revenue Current Year1225716OtherRevenueCurrentYear
Total Revenue Prior Year65735700TotalRevenuePriorYear
Total Revenue Current Year68308164TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year35636211SalariesEtcPriorYear
Salaries Etc Current Year35818935SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year21557712OtherExpensePriorYear
Other Expenses Current Year21294283OtherExpensesCurrentYear
Total Expenses Prior Year57193923TotalExpensesPriorYear
Total Expenses Current Year57113218TotalExpensesCurrentYear
Revenues Less Expenses Prior Year8541777RevenuesLessExpensesPriorYear
Revenues Less Expenses CY11194946RevenuesLessExpensesCY
Total Assets BOY70887279TotalAssetsBOY
Total Assets EOY79456933TotalAssetsEOY
Total Liabilities BOY8108774TotalLiabilitiesBOY
Total Liabilities EOY8665865TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY62778505NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY70791068NetAssetsOrFundBalancesEOY
Mission DescriptionTHE WAYNESBORO HOSPITAL IS A REGIONAL NONPROFIT HEALTH CARE ORGANIZATION COMMITTED TO THE IMPROVEMENT OF THE HEALTH AND WELL-BEING OF THE PEOPLE IN SOUTH-CENTRAL PENNSYLVANIA.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense46692130Expense
Revenue65471330Revenue
DescriptionTHE WAYNESBORO HOSPITAL PROVIDES NEEDED MEDICAL CARE TO THE COMMUNITY REGARDLESS OF ANY PATIENT'S ABILITY TO PAY. HEALTH CARE SERVICES INCLUDE INPATIENT ROUTINE, INPATIENT ANCILLARY AND OUTPATIENT CARE. ALL MANAGEMENT AND GENERAL EXPENSES ARE CONSIDERED PROGRAM RELATED.Description
Total Program Service Expense46692130TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities1ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities1ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Financial Stmt Attached1FinancialStmtAttached
Grants To Organizations0GrantsToOrganizations
Grants To Individuals1GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109631NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees597NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income1UnrelatedBusinessIncome
Form990-T Filed1Form990-TFiled
Foreign Financial Account1ForeignFinancialAccount
Name Of Foreign CountryCJNameOfForeignCountry
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members12NbrVotingGoverningBodyMembers
Number Independent Voting Members11NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledPAStatesWhereCopyOfReturnIsFiled
Other WebsiteXOtherWebsite
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1PATRICK W O'DONNELL CFOBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number7172673000TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1112 NORTH SEVENTH STREETAddressLine1
CityCHAMBERSBURGCity
StatePAState
ZIP Code17201ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (25 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
RICHARD MARKS
CHAIR0.40XX000
PAUL GUNDER
VICE CHAIR0.40XX000
JOHN BLUBAUGH
TREASURER0.30XX000
DENNIS SHOCKEY
SECRETARY0.20XX000
NORMAN B EPSTEIN
PRESIDENT6.00XX14304181056694455
FRANK ERVIN
DIRECTOR0.30X000
JEAN LESSARD MD
DIRECTOR0.20X000
KATHRYN A REIHARD MD
DIRECTOR0.20X000
JAMES ROCK
DIRECTOR0.20X000
PAUL SCHEMEL
DIRECTOR0.20X000
LISA WARD
DIRECTOR0.10X000
BONNIE ZEHLER
DIRECTOR0.30X000
PATRICK W O'DONNELL
VICE PRESIDENT FINANCE4.00X4508940580487205
KENNETH L SHUR
VICE PRESIDENT OF OPERATIONS40.00X226736035489
JEFF CARTY
V.P. OF FINANCE - WAYNESBORO HOSP.40.00X168707031556
THOMAS E ANDERSON MD
V.P. FOR MEDICAL AFFAIRS8.007748230992935290X
SHERRI STAHL
V.P. FOR PATIENT SERVICES8.004814319257240055X
MICHELE ZEIGLER
V.P. FOR INFORMATION SERVICES8.004951119804444942X
PATRICIA BARBAROWICZ
V.P. FOR PLANNING & MARKETING4.002437021932852683X
JILL KELLER
V.P. NURSING SVCS/QUALITY/RISK MGMT40.00154574030078X
ELIZABETH COOK
EMERGENCY SERVICES40.00237673028744X
VICKI ELLIS
EMERGENCY SERVICES40.00251399028743X
BRUCE FOSTER
EMERGENCY SERVICES40.00311169028155X
NORBERT MATHAIS
EMERGENCY SERVICES40.00417468028034X
MERRILL MCKENZIE
EMERGENCY SERVICES40.00240620021477X
FieldValueIRS element (for citing)
Total Reportable Comp From Org2395982TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs2136243TotalReportableCompFrmRltdOrgs
Total Other Compensation586906TotalOtherCompensation
Number Individuals GT100 K18NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
CHAMBERSBURG HOSPITAL
112 N SEVENTH STREETCHAMBERSBURGPA17201PHYSICAL THERAPY, X-RAY, SECURITY, LABOR1006490
ROBINWOOD ORTHOPEDIC SPECIALISTS
11110 MEDICAL CAMPUS ROAD SUITE 20HAGERSTOWNMD21742SURGERY ON CALL392375
SUMMIT PHYSICIAN SERVICES
785 FIFTH AVENUE SUITE 3CHAMBERSBURGPA17201PHYSICIAN SERVICES326729
QUEST DIAGNOSTICS
12436 COLLECTIONS CENTER DRIVECHICAGOIL60693LAB TESTING SERVICES190467
E-PHARMPRO
3605 EDGEMONT AVE BACK BLDG STEBROOKHAVENPA19015PHARMACY SERVICES150400
FieldValueIRS element (for citing)
Number Of Contractors GT100 K5NumberOfContractorsGT100K
Government Grants32398GovernmentGrants
All Other Contributions231069AllOtherContributions
Total Contributions263467TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionPATIENT REVENUEDescription
Business Code621990BusinessCode
Total Revenue Column65074572TotalRevenueColumn
Related Or Exempt Function Income65074572RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue65074572TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column763976TotalRevenueColumn
Exclusion$763,976ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real190230Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real73847Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real116383Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column116383TotalRevenueColumn
Exclusion$116,383ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities978033Securities
Other2400Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities978033Securities
Other2400Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column980433TotalRevenueColumn
Exclusion$980,433ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnUnrelated Business RevenueUnrelatedBusinessRevenueRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
COURIER AND LAB SERVIC621500712575712575
CAFETERIA900099241133241133
VHA INCENTIVE9000996681766817

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column88808TotalRevenueColumn
Related Or Exempt Function Income88808RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Other Revenue1109333TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column68308164TotalRevenueColumn
Related Or Exempt Function Income65471330RelatedOrExemptFunctionIncome
Unrelated Business Revenue712575UnrelatedBusinessRevenue
Exclusion$1,860,792ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total1103042Total
Management And General1103042ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total26047819Total
Program Services22137368ProgramServices
Management And General3910451ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total1128533Total
Program Services983407ProgramServices
Management And General145126ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total5668097Total
Program Services4715552ProgramServices
Management And General952545ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total1871444Total
Program Services1534550ProgramServices
Management And General336894ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total24350Total
Management And General24350ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total2569051Total
Program Services2077170ProgramServices
Management And General491881ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total64880Total
Program Services51841ProgramServices
Management And General13039ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total171558Total
Program Services137079ProgramServices
Management And General34479ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total740667Total
Program Services591813ProgramServices
Management And General148854ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total69624Total
Program Services55631ProgramServices
Management And General13993ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total27880Total
Program Services22277ProgramServices
Management And General5603ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total21688Total
Program Services11902ProgramServices
Management And General9786ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total2779772Total
Program Services1470960ProgramServices
Management And General1308812ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total583112Total
Program Services465922ProgramServices
Management And General117190ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
SUPPLIES630659250391371267455
BAD DEBT EXPENSE52601815260181
PHYSICIAN CONTRACTUAL P13230221057130265892
EQUIPMENT RENTAL AND RE1068606853845214761
MISCELLANEOUS EXPENSE1023148175220562

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total180986Total
Program Services144613ProgramServices
Management And General36373ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total57113218Total
Program Services46692130ProgramServices
Management And General10421088ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY1420BOY
EOY1420EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY8851861BOY
EOY3752922EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
EOY22550EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY5603530BOY
EOY6035617EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY362136BOY
EOY335832EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY672868BOY
EOY776335EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis58973124LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec40813402LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY19268897BOY
EOY18159722EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
EOY11199169EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY33496561BOY
EOY36249589EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY2630006BOY
EOY2923777EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY70887279BOY
EOY79456933EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY5169500BOY
EOY6053109EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY1165000BOY
EOY595000EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY1774274BOY
EOY2017756EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY8108774BOY
EOY8665865EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY60613797BOY
EOY68271652EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY2164708BOY
EOY2519416EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY62778505BOY
EOY70791068EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY70887279BOY
EOY79456933EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses11194946ReconcilationRevenueExpenses
Reconcilation Other Changes-3182383ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement BothXFinancialStatementBoth
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

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

Schedule D IRS990ScheduleD

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance6096545BeginningOfYearBalance
Contributions77791Contributions
Investment Earnings Or Losses756758InvestmentEarningsOrLosses
Other Expenditures450000OtherExpenditures
End Of Year Balance6481094EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance5498442BeginningOfYearBalance
Contributions98262Contributions
Investment Earnings Or Losses499841InvestmentEarningsOrLosses
End Of Year Balance6096545EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance6290104BeginningOfYearBalance
Contributions80824Contributions
Investment Earnings Or Losses-872486InvestmentEarningsOrLosses
End Of Year Balance5498442EndOfYearBalance
FieldValueIRS element (for citing)
Board Designated EOY Balance0.96000BoardDesignatedEOYBalance
Permanent Endowment EOY Balance0.04000PermanentEndowmentEOYBalance
Endowments Held By Unrelated Orgs0EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs0EndowmentsHeldByRelatedOrgs

Land Land

FieldValueIRS element (for citing)
Investment Cost Or Other Basis313743InvestmentCostOrOtherBasis
Other Cost Or Other Basis2184775OtherCostOrOtherBasis
Book Value2498518BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Investment Cost Or Other Basis2302539InvestmentCostOrOtherBasis
Other Cost Or Other Basis15194458OtherCostOrOtherBasis
Depreciation9343976Depreciation
Book Value8153021BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis37796113OtherCostOrOtherBasis
Depreciation30876365Depreciation
Book Value6919748BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis1181496OtherCostOrOtherBasis
Depreciation593061Depreciation
Book Value588435BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings18159722TotalOfBookValueLandBuildings

Other Securities OtherSecurities (3 entries)

DescriptionDescriptionBook ValueBookValueMethod Of ValuationMethodOfValuation
CASH AND MONEY FUNDS7171849F
FIXED INCOME22090187F
REAL ASSETS6987553F
FieldValueIRS element (for citing)
Total Of Book Value Securities36249589TotalOfBookValueSecurities

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescriptionAmountAmount
ADVANCES FROM THIRD PARTY PAYORS$252,800
PAYABLE UNDER THIRD PARTY CONTRACTUAL AGREEMENT$1,764,956
FieldValueIRS element (for citing)
Total Of Amounts2017756TotalOfAmounts
Total Revenue68308164TotalRevenue
Total Expenses57113218TotalExpenses
Excess Or Deficit For Year11194946ExcessOrDeficitForYear
Net Unrealized GL On Investments1187051NetUnrealizedGLOnInvestments
Other-$4,369,434OtherAmount
Total Adjustments-3182383TotalAdjustments
Excess Or Deficit Per FS8012563ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt69810781TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments1187051NetUnrealizedGainsInvestments
Other Revenues315566OtherRevenues
Revenue Not Rptd F9901502617RevenueNotRptdF990
Revenue Subtotal68308164RevenueSubtotal
Revenue Not Rptd On Fin Stmt0RevenueNotRptdOnFinStmt
Total Revenue Per Form99068308164TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt57113218TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal57113218ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form99057113218TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (4 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS:PART V, LINE 4:ENDOWMENT FUNDS ARE TO BE USED FOR THE DEVELOPMENT OR EXPANSION OF COMMUNITY HEALTHCARE INITIATIVES AND PROGRAMS. FUNDS ARE ALSO USED TO EDUCATE THE COMMUNITY ABOUT HEALTH CARE ISSUES.
DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:PART X:WHEN TAX RETURNS ARE FILED, IT IS HIGHLY CERTAIN THAT SOME POSITIONS TAKEN WOULD BE SUSTAINED UPON EXAMINATION BY THE TAXING AUTHORITIES, WHILE OTHERS ARE SUBJECT TO UNCERTAINTY ABOUT THE MERITS OF THE POSITION TAKEN OR THE AMOUNT OF THE POSITION THAT WOULD BE ULTIMATELY SUSTAINED. THE BENEFIT OF A TAX POSITION IS RECOGNIZED IN THE FINANCIAL STATEMENTS IN THE PERIOD DURING WHICH, BASED ON ALL AVAILABLE EVIDENCE, MANAGEMENT BELIEVES IT IS MORE LIKELY THAN NOT THAT THE POSITION WILL BE SUSTAINED UPON EXAMINATION, INCLUDING THE RESOLUTION OF APPEALS OR LITIGATION PROCESSES, IF ANY. TAX POSITIONS TAKEN ARE NOT OFFSET OR AGGREGATED WITH OTHER POSITIONS. TAX POSITIONS THAT MEET THE MORE-LIKELY-THAN-NOT RECOGNITION THRESHOLD ARE MEASURED AS THE LARGEST AMOUNT OF TAX BENEFIT THAT IS MORE THAN 50 PERCENT LIKELY OF BEING REALIZED UPON SETTLEMENT WITH THE APPLICABLE TAXING AUTHORITY. THE PORTION OF THE BENEFITS ASSOCIATED WITH TAX POSITIONS TAKEN THAT EXCEEDS THE AMOUNT MEASURED AS DESCRIBED ABOVE WOULD BE REFLECTED AS A LIABILITY FOR UNRECOGNIZED TAX BENEFITS IN THE ACCOMPANYING BALANCE SHEET ALONG WITH ANY ASSOCIATED INTEREST AND PENALTIES THAT WOULD BE PAYABLE TO THE TAXING AUTHORITIES UPON EXAMINATION. INTEREST AND PENALTIES ASSOCIATED WITH UNRECOGNIZED TAX BENEFITS WOULD BE CLASSIFIED AS EXPENSES AGAINST OTHER OPERATING REVENUE IN THE STATEMENT OF OPERATIONS. AT JUNE 30, 2011 THERE WAS NO LIABILITY FOR UNRECOGNIZED TAX BENEFITS.
PART XI, LINE 8 - OTHER ADJUSTMENTS:INCREASE IN PERPETUAL TRUSTS HELD BY THIRD PARTIES 315,566. TRANSFER TO AFFILIATE ORG. - SUMMIT PHYSICIAN SERVICES -4,685,000.
PART XII, LINE 2D - OTHER ADJUSTMENTS:INCREASE IN PERPETUAL TRUSTS HELD BY THIRD PARTIES 315,566.

Schedule F IRS990ScheduleF

Accts Actvs Out US Table AcctsActvsOutUSTable

FieldValueIRS element (for citing)
RegionCENTRAL AMERICAN AND CARRIBBEANRegion
Number Of Offices0NumberOfOffices
Number Of Employees0NumberOfEmployees
Type Of Activities ConductedINVESTMENT IN ALTERNATIVE INVESTMENT VEHICLETypeOfActivitiesConducted
Total Expenditures711000TotalExpenditures
FieldValueIRS element (for citing)
Subtotal Number Of Offices0SubtotalNumberOfOffices
Subtotal Number Of Employees0SubtotalNumberOfEmployees
Cont Number Of Offices0ContNumberOfOffices
Cont Number Of Employees0ContNumberOfEmployees
Total Number Of Offices0TotalNumberOfOffices
Total Number Of Employees0TotalNumberOfEmployees
Subtotal Amount Spent711000SubtotalAmountSpent
Cont Amount Spent0ContAmountSpent
Total Amount Spent711000TotalAmountSpent
Transfer To Foreign Corp0TransferToForeignCorp
Interest In Foreign Trust0InterestInForeignTrust
Own Foreign Corp1OwnForeignCorp
Passive Foreign Invest Co0PassiveForeignInvestCo
Foreign Partnership0ForeignPartnership
Boycott Countries0BoycottCountries

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
Policy Applied To All HospitalsXPolicyAppliedToAllHospitals
FPG Reference Free Care1FPGReferenceFreeCare

Other Percentage OtherPercentage

FieldValueIRS element (for citing)
OtherXOther
Free Other Percentage125.000000000000FreeOtherPercentage
FieldValueIRS element (for citing)
FPG Reference Discounted Care1FPGReferenceDiscountedCare
Pcent250XPcent250
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget1ExpensesExceededBudget
Unable To Provide Care0UnableToProvideCare
Annual Community Benefit Report1AnnualCommunityBenefitReport
Report Publically Available1ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense970182TotalCommunityBenefitExpense
Net Community Benefit Expense970182NetCommunityBenefitExpense
Percent Of Total Expense0.01700PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense6514924TotalCommunityBenefitExpense
Direct Offsetting Revenue3125009DirectOffsettingRevenue
Net Community Benefit Expense3389915NetCommunityBenefitExpense
Percent Of Total Expense0.05940PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense7485106TotalCommunityBenefitExpense
Direct Offsetting Revenue3125009DirectOffsettingRevenue
Net Community Benefit Expense4360097NetCommunityBenefitExpense
Percent Of Total Expense0.07640PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Number Of Activities Or Programs7NumberOfActivitiesOrPrograms
Persons Served1726PersonsServed
Total Community Benefit Expense101252TotalCommunityBenefitExpense
Net Community Benefit Expense101252NetCommunityBenefitExpense
Percent Of Total Expense0.00180PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Number Of Activities Or Programs2NumberOfActivitiesOrPrograms
Persons Served269PersonsServed
Total Community Benefit Expense46275TotalCommunityBenefitExpense
Net Community Benefit Expense46275NetCommunityBenefitExpense
Percent Of Total Expense0.00080PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Number Of Activities Or Programs3NumberOfActivitiesOrPrograms
Persons Served290PersonsServed
Total Community Benefit Expense15072TotalCommunityBenefitExpense
Net Community Benefit Expense15072NetCommunityBenefitExpense
Percent Of Total Expense0.00030PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Total Community Benefit Expense51082TotalCommunityBenefitExpense
Net Community Benefit Expense51082NetCommunityBenefitExpense
Percent Of Total Expense0.00090PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs13NumberOfActivitiesOrPrograms
Persons Served2285PersonsServed
Total Community Benefit Expense213681TotalCommunityBenefitExpense
Net Community Benefit Expense213681NetCommunityBenefitExpense
Percent Of Total Expense0.00380PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs13NumberOfActivitiesOrPrograms
Persons Served2285PersonsServed
Total Community Benefit Expense7698787TotalCommunityBenefitExpense
Direct Offsetting Revenue3125009DirectOffsettingRevenue
Net Community Benefit Expense4573778NetCommunityBenefitExpense
Percent Of Total Expense0.08020PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported0BadDebtExpenseReported
Bad Debt Expense$2,161,934BadDebtExpenseAmount
Amount Attributable To102339AmountAttributableTo
Amount Reimbursed By Medicare12550761AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare17675672CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-5124911MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

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

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1WAYNESBORO HOSPITALBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line1501 EAST MAIN STREETAddressLine1
CityWAYNESBOROCity
StatePAState
ZIP Code17268ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1NOT REQUIREDBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber

Form990 Schedule H Part VI Form990ScheduleHPartVI (10 entries)

ExplanationExplanation
PART I, LINE 3C: THE ORGANIZATION USES FEDERAL POVERTY GUIDELINES (FPG) TO DETERMINE CHARITY CARE.
PART I, LINE 7: NOTE 1. TO THE FINANCIAL STATEMENTS: PATIENT RECEIVABLESTHE HOSPITAL PROVIDES CREDIT IN THE NORMAL COURSE OF ITS BUSINESS TO PATIENTS. PATIENT RECEIVABLES ARE BASED ON THE OUTSTANDING PATIENT BALANCE AFTER ANY CONTRACTUAL REIMBURSEMENTS ARE APPLIED AND ARE GENERALLY DUE 30 DAYS AFTER BILLED. AN ALLOWANCE FOR DOUBTFUL ACCOUNTS IS CARRIED FOR PATIENT ACCOUNTS THAT MAY BECOME UNCOLLECTIBLE IN FUTURE PERIODS BASED ON A SLIDING SCALE OF ESTIMATED UNCOLLECTIBLE PERCENTAGES COMPARED TO VARIOUS AGING SELF-PAY BALANCE CATEGORIES. THE ESTIMATED ALLOCATIONS ARE BASED ON MANAGEMENT'S JUDGMENT OF UNCOLLECTIBLE ACCOUNTS, HISTORICAL TRENDS OF CHARGE-OFFS, AND OTHER INFORMATION. PATIENT RECEIVABLES ARE CHARGED AGAINST THE ALLOWANCE WHEN, IN THE JUDGMENT OF MANAGEMENT, IT IS UNLIKELY THEY WILL BE COLLECTED. THE SHORTFALL FOR MEDICARE IS NOT INCLUDED IN OUR COMMUNITY BENEFIT REPORTING. A COST TO CHARGE RATIO WAS USED TO CALCULATE THE MEDICARE ALLOWABLE COST. RCC=((NET PATIENT REVENUE/(TOTAL OPERATING REV+(OTHER OPR REV -+ DERIVATIVE GAIN/LOSS))*TOTAL OPERATING EXPENSE)/GROSS PT REVALL PATIENTS ARE SUBJECT TO THE DEBT COLLECTION POLICY REGARDLESS OF THEIR ABILITY TO PAY.
PART II: WAYNESBORO HOSPITAL WORKS TO STRENGTHEN OUR COMMUNITY THROUGH HEALTH EDUCATION EFFORTS FOR CHILDREN AND ADULTS, HEALTH FAIRS PROVIDING DIAGNOSTIC TESTING, EDUCATING COMMUNITY GROUPS ON SPECIFIC HEALTH TOPICS, FUNDING LOCAL COMMUNITY ORGANIZATIONS THROUGH THE SUMMIT ENDOWMENT PROGRAM, PROVIDING RESOURCES FOR THE "HEALTHY COMMUNITIES PARTNERSHIP" PROGRAM, PARTICIPATING IN LOCAL CIVIC ORGANZIATIONS, SPONSORING EVENTS HELD BY LOCAL CHARTIABLE ORGANIZATIONS, AND SUPPORTING WORKFORCE DEVELOPMENT INITIATIVES THROUGH SUMMIT HEALTH'S SCHOOL LIAISON DEPARTMENT.
PART III, LINE 4: THE HOSPITAL PROVIDES CREDIT IN THE NORMAL COURSE OF ITS BUSINESS TO PATIENTS. PATIENT RECEIVABLES ARE BASED ON THE OUTSTANDING PATIENT BALANCE AFTER ANY CONTRACTUAL REIMBURSEMENTS ARE APPLIED AND ARE GENERALLY DUE 30 DAYS AFTER BILLED. AN ALLOWANCE FOR DOUBTFUL ACCOUNTS IS CARRIED FOR PATIENT ACCOUNTS THAT MAY BECOME UNCOLLECTIBLE IN FUTURE PERIODS BASED ON A SLIDING SCALE OF ESTIMATED UNCOLLECTIBLE PERCENTAGES COMPARED TO VARIOUS AGING SELF-PAY BALANCE CATEGORIES. THE ESTIMATED ALLOCATIONS ARE BASED ON MANAGEMENT'S JUDGMENT OF UNCOLLECTIBLE ACCOUNTS, HISTORICAL TRENDS OF CHARGE-OFFS, AND OTHER INFORMATION. PATIENT RECEIVABLES ARE CHARGED AGAINST THE ALLOWANCE WHEN, IN THE JUDGMENT OF MANAGEMENT, IT IS UNLIKELY THEY WILL BE COLLECTED. THE COST TO CHARGE RATIO WAS USE TO CALCULATE THE COST OF BAD DEBT EXPENSE. THIS RATIO IS CALCULATED AS FOLLOWS: [NET PATIENT REVENUE DIVIDED BY THE TOTAL OPERATING REVENUE MULTIPLIED BY THE TOTAL OPERATING EXPENSE] DIVIDED BY THE GROSS PATIENT REVENUE.
PART III, LINE 8: THE INFORMATION WAS OBTAINED USING THE COST METHODS USED IN PREPARING THE MEDICARE COST REPORTS. THE SHORTFALL ABOVE RELATES TO OUR MISSION OF PROVIDING SERVICES TO MEMBERS OF OUR COMMUNITY.
PART VI, LINE 2: HEALTH NEEDS OF FRANKLIN COUNTY RESIDENTS AND SURROUNDING COMMUNITIES ARE ASSESSED THROUGH NUMEROUS RESEARCH METHODS INCLUDING CONDUCTING COMMUNITY HEALTH NEEDS ASSESSMENT (SURVEY FORMAT) IN SPRING 2009, A REVIEW OF REGIONAL HEALTH DATA AND INTERVIEWS WITH KEY COMMUNITY ORGANIZATIONS INCLUDING SCHOOLS, AREA AGENCY ON AGING, PA DEPARTMENT OF HEALTH, FRANKLIN COUNTY HUMAN SERVICES AND THE HEALTHY COMMUNITIES PARTNERSHIP.
PART VI, LINE 3: PATIENTS ARE MADE AWARE OF THE CHARITY PROGRAM AND OTHER BILLING ASSISTANCE SERVICES AT REGISTRATION, DURING EMERGENCY ROOM VISITS, AND NOTICES PLACED IN SERVICE AREAS. BILLING STATEMENTS ALSO INFORM PATIENTS OF CHARITY CARE AND OTHER BILLING ASSISTANCE PROGRAMS.
PART VI, LINE 4: WAYNESBORO HOSPITAL PRIMARILY SERVES COMMUNITY MEMBERS FROM FRANKLIN AND FULTON COUNTY, PA, AND NEARBY COMMUNITIES IN WASHINGTON COUNTY, MD. ACCORDING TO U.S. CENSUS DATA, FRANKLIN COUNTY RESIDENTS HAVE A SLIGHTLY LOWER INCOME AND ARE SLIGHTLY OLDER THAN THE STATE AVERAGE. FOR A HEALTH SYSTEM, THIS TYPICALLY RESULTS IN AN INCREASED NEED FOR HEALTHCARE SERVICES.
PART VI, LINE 6: WAYNESBORO HOSPITAL SUPPORTS LOCAL NON-PROFIT ORGANIZATIONS WITH FINANCIAL GRANTS FROM THE SUMMIT ENDOWMENT.
PART VI, LINE 7: THE HOSPITAL IS PART OF SUMMIT HEALTH, A REGIONAL NETWORK OF HOSPITALS AND HEALTHCARE PROVIDERS THAT ARE SERVED BY THE ORGANIZATION'S COMMUNITY HEALTH DEPARTMENT. THIS DEPARTMENT'S MISSION IS TO IMPROVE THE HEALTH OF THE COMMUNITY THROUGH EDUCATION, DETECTION AND PREVENTION PROGRAMS INCLUDING HEALTH FAIRS, SCREENINGS, AND SEMINARS. THIS MISSION IS COMPLETED ON BEHALF OF WAYNESBORO HOSPITAL AND ALL OTHER SUMMIT HEATLH AFFILIATES. PART OF THIS MISSION IS COMPLETED THROUGH COLLABORATION WITH OTHER COMMUNITY ORGANIZATIONS INCLUDING THE PA DEPARTMENT OF HEALTH.

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Form990 Schedule I Part III Form990ScheduleIPartIII

FieldValueIRS element (for citing)
Type Of GrantFLU VACCINATIONSTypeOfGrant
Number Of Recipients233NumberOfRecipients
Amount Of Non Cash Assistance5688AmountOfNonCashAssistance
Method Of ValuationCOSTMethodOfValuation

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierPROCEDURE FOR MONITORING GRANTS IN THE U.S.:Identifier
Return ReferencePART I, LINE 2:ReturnReference
ExplanationSCHEDULE I, PART I, LINE 2: ALL FUNDING DECISIONS ARE MADE BY THE SUMMIT ENDOWMENT COMMITTEE, A COMMITTEE OF THE SUMMIT HEALTH BOARD. THE ENDOWMENT MANAGER PROCESSES GRANT APPLICATIONS, ASSISTS GRANTEES IN DEVELOPING SOUND PROGRAM EVALUATION METHODOLOGIES, RECEIVES AND SUMMARIZES PERIODIC REPORTS, AND VISITS PROGRAM SITES, REPORTING ALL ACTIVITIES TO THE SUMMIT ENDOWMENT COMMITTEE. AS WELL, ENDOWMENT COMMITTEE MEETING MINUTES ARE SHARED WITH WAYNESBORO HOSPITAL, CHAMBERSBURG HOSPITAL AND SUMMIT HEALTH BOARDS.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Discretionary Spending AccountXDiscretionarySpendingAccount
Club Dues Or FeesXClubDuesOrFees
Written Policy Re T And E Expenses1WrittenPolicyReTAndEExpenses
Substantiation Required1SubstantiationRequired
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan1SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments1AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (14 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
NORMAN B EPSTEIN
10720460749029400166600643736476108736161632951867115720989085300
PATRICK W O'DONNELL
322252900289232830843632326927217649481504135365381048428800
KENNETH L SHUR
1693310394520179530125480229410262225000
JEFF CARTY
141661013967013079098130217430200263000
THOMAS E ANDERSON MD
6126424505711280451204938197524494179702565102618454133816000
SHERRI STAHL
378961515877413296512834113345446217832565102615615422461600
MICHELE ZEIGLER
395551582216976279032980119206423256932565102615849923399800
PATRICIA BARBAROWICZ
1899817098137583382116141452645874129068161252963826674300
JILL KELLER
13330407750013520089350211430184652000
ELIZABETH COOK
22840100092720143690143750266417000
VICKI ELLIS
24212500092740143680143750280142000
BRUCE FOSTER
30739800037710147000134550339324000
NORBERT MATHAIS
404497000129710147000133340445502000
MERRILL MCKENZIE
239706000914014466070110262097000

Form990 Schedule J Part III Form990ScheduleJPartIII (3 entries)

Return ReferenceReturnReferenceExplanationExplanation
PART I, LINE 1ATHE ORGANIZATION REIMBURSES THE COO FOR DUES ASSOCIATED WITH A SOCIAL CLUB. THE OFFICER RECEIVES AN ALLOWANCE THAT CAN BE CONSIDERED A DISCRETIONARY SPENDING ACCOUNT. THE MONIES ARE IN LIEU OF AN AUTOMOBILE ALLOWANCE, TO PURCHASE ADDITIONAL LIFE INSURANCE, ETC. THESE MONIES ARE INCLUDED IN COMPENSATION AS REPORTED IN THE COMPENSATION OF OFFICERS TABLE. RESULTS FITNESS CLUB MEMBERSHIP IS AVAILABLE FREE OF CHARGE FOR ANY OFFICER AND ACTIVE BOARD MEMBER.
PART I, LINE 4BNORMAN EPSTEIN - NO PAYMENT PATRICK W. O'DONNELL - NO PAYMENT THOMAS ANDERSON - NO PAYMENT PAT BARBAROWICZ - NO PAYMENT KENNETH L. SHUR - $ 41,873
PART I, LINE 7INCENTIVE COMPENSATION IS BASED ON PRE-DETERMINED, MEASURABLE GOALS APPROVED BY THE BOARD OF DIRECTORS' EXECUTIVE COMPENSATION COMMITTEE. THE MEASURABLE GOALS ARE BASED ON QUALITY, COMMUNITY ACCESS TO CARE, PATIENT SAFETY AND LEADERSHIP.

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (8 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
FORM 990, PART VI, SECTION A, LINE 6SUMMIT HEALTH, A 501(C)(3) ENTITY, IS A MEMBER OF THIS ORGANIZATION.
FORM 990, PART VI, SECTION A, LINE 7ASUMMIT HEALTH, A 501(C)(3) ENTITY, ELECTS THE GOVERNING BODY OF THIS ORGANIZATION.
FORM 990, PART VI, SECTION A, LINE 7BSUMMIT HEALTH, A 501(C)(3) ENTITY, HAS CERTAIN RESERVE POWERS OF THIS ORGANIZATION
FORM 990, PART VI, SECTION B, LINE 11THE ORGANIZATION'S 990 IS REVIEWED BY THE AUDIT COMMITEE AND UPON APPROVAL RECOMMENDED TO THE FULL BOARD OF DIRECTORS FOR SUBMISSION TO THE IRS.
MEMBERS ARE ASKED TO ANNUALLY DISCLOSE ANY CONFLICTS OF INTEREST THEY MAY HAVE.FORM 990, PART VI, SECTION B, LINE 12C
COMPENSATION IS DISCUSSED WITH AN INDEPENDENT COMPENSATION COMMITTEE. THIS IS PERFORMED IN CONCERT WITH A COMPENSATION CONSULTANT WHO ASSISTS THIS COMMITTEE IN SETTING THE COMPENSATION FOR THESE INDIVIDUALS.FORM 990, PART VI, SECTION B, LINE 15
GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. THESE DOCUMENTS ARE HELD IN THE FINANCE DEPARTMENT OF THE WAYNESBORO HOSPITAL. HOSPITAL BYLAWS AND ALL POLICIES AND PROCEDURES ARE FOUND ON THE WAYNESBORO HOSPITAL INTRANET.FORM 990, PART VI, SECTION C, LINE 19
CHANGES IN NET ASSETS OR FUND BALANCES:NET UNREALIZED GAINS ON INVESTMENTS: 1,187,051. INCREASE IN PERPETUAL TRUSTS HELD BY THIRD PARTIES: 315,566. TRANSFER TO AFFILIATE ORG. - SUMMIT PHYSICIAN SERVICES: -4,685,000. TOTAL TO FORM 990, PART XI, LINE 5: -3,182,383.FORM 990, PART XI, LINE 5:

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (4 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrg
SUMMIT HEALTH
112 NORTH SEVENTH STREETCHAMBERSBURGPA17201251515371MANAGE AND ADMINISTER THE LOCAL AND REGIONAL NETWORK OF HEALTHCARE PROVIDERSPA501(C)(3)7SUMMIT HEALTH0
THE CHAMBERSBURG HOSPITAL
112 NORTH SEVENTH STREETCHAMBERSBURGPA17201230465970SERVE THE HEALTH CARE NEEDS OF FRANKLIN COUNTY PA AND THE SURROUNDING COMMUNPA501(C)(3)3SUMMIT HEALTH0
CHAMBERSBURG HEALTH SERVICES
260 NORTH SEVENTH STREETCHAMBERSBURGPA17201251515376SERVE THE HEALTH CARE NEEDS OF FRANKLIN COUNTY PA AND THE SURROUNDING COMMUNPA501(C)(3)11A - TYPE 1SUMMIT HEALTH0
SUMMIT PHYSICIAN SERVICES
601 NORLAND AVENUECHAMBERSBURGPA17201251716306PROVIDES APPROPRIATE PHYSICIAN MANPOWER FOR VARIOUS FAMILY PRACTICES SERVINGPA501(C)(3)11A - TYPE 1SUMMIT HEALTH0
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs1RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs1PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org1OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg