2012-05-14T14:21:03-05:00 2011-06-30 KREISCHER MILLER 100 WITMER ROAD SUITE 350 HORSHAM PA 190442369 990 2010-07-01 231352193 MONTGOMERY HOSPITAL MONT 6102702070 1301 POWELL STREET NORRISTOWN PA 194040992 TIMOTHY M CASEY 6102702070 2012-05-11 1 KEVIN MCGINN 2154414600 2010 2016-02-24 21:20:13Z TIMOTHY M CASEY 1330 POWELL STREET NORRISTOWN PA 19044 113378050 0 X WWW.MONTGOMERYHOSPITAL.ORG X X 1889 PA SEE STATEMENT OF PRIMARY EXEMPT PURPOSE WITHIN PROGRAM SERVICE ACCOMPLISHMENTS 18 14 1139 66 0 0 76421 87461 111554671 111911963 1447546 570904 790093 755960 113868731 113326288 2500 0 0 0 50962922 52030277 0 0 0 59160383 71816053 110125805 123846330 3742926 -10520042 79739319 67093782 39209956 27422960 40529363 39670822 X SEE STATEMENT OF PRIMARY EXEMPT PURPOSE WITHIN PROGRAM SERVICE ACCOMPLISHMENTS 0 0 99308556 111911963 MONTGOMERY HOSPITAL ADMITS AND TREATS ALL INDIVIDUALS WHO REQUIRE SERVICES REGARDLESS OF THEIR ABILITY TO PAY FOR THOSE SERVICES. THESE INCLUDE ACUTE CARE ADMISSIONS, PSYCHIATRIC CARE ADMISSIONS, OUTPATIENT SERVICES, AND PATIENT SERVICE IN THE REGULAR EMERGENCY UNIT.ALTHOUGH REIMBURSEMENT FOR SERVICES RENDERED IS CRITICAL TO THE OPERATION AND STABILITY OF MONTGOMERY HOSPITAL, IT IS RECOGNIZED THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PURCHASE ESSENTIAL MEDICAL SERVICES. DESPITE THIS, THE HOSPITAL'S MISSION IS TO SERVE THE COMMUNITY WITH RESPECT TO PROVIDING HEALTHCARE SERVICES AND AN OVERALL COMMITMENT TO SERVICE ITS COMMUNITY. THESE SERVICES INCLUDE:FREE CARE AND/OR SUBSIDIZED CARE, CARE PROVIDED TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS AT BELOW COST, AND HEALTH ACTIVITIES AND PROGRAMS TO SUPPORT THE COMMUNITY AND ARE PROVIDED WHERE THE NEED AND/OR AN INDIVIDUAL'S INABILITY TO PAY COEXISTS. HEALTH ACTIVITIES AND PROGRAMS INCLUDE WELLNESS PROGRAMS, COMMUNITY EDUCATION PROGRAMS, SPECIAL PROGRAMS FOR THE ELDERLY, HANDICAPPED, MEDICALLY UNDERSERVED, AND A VARIETY OF BROAD COMMUNITY SUPPORT ACTIVITIES.UNCOMPENSATED CARE IS PROVIDED BY THE HOSPITAL IN CONNECTION WITH THESE COMMUNITY SERVICES. UNCOMPENSATED CARE INCLUDES CHARITY CARE AND BAD DEBTS FROM PROVIDING UNREIMBURSED SERVICES TO INDIVIDUALS. UNCOMPENSATED CARE ALSO INCLUDES SERVICES PROVIDED UNDER FEDERAL MEDICARE AND STATE MEDICAL ASSISTANCE PROGRAMS WHERE REIMBURSEMENT WAS LESS THAN THE COST OF SERVICES PROVIDED. 99308556 1 1 0 1 0 0 0 0 1 1 1 0 1 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 69 0 1 1139 1 0 0 0 0 0 0 0 0 0 0 X 18 14 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X THE ORGANIZATION 6102702070 1301 POWELL STREET NORRISTOWN PA 194040922 RICHARD BRAEMER 2.00 X 0 0 0 ANDREW B CANTOR ESQUIRE 2.00 X 0 0 0 GARY S DRIZIN MD 2.00 X 0 0 0 EDUARDO D GONZALEZ 2.00 X 0 0 0 JUDITH T Z LEVY 2.00 X 0 0 0 SCOTT A MELNICK MD 2.00 X 0 141194 10945 RICHARD MERCIER MD 2.00 X 0 0 0 JAMES J O'BRIEN MD 2.00 X 0 0 0 RICHARD C SHEERR 2.00 X 0 0 0 MANUEL N STAMATAKIS 2.00 X 0 0 0 CHARLES J TORNETTA 2.00 X 0 0 0 JEFFREY WARDEN 2.00 X 0 0 0 RICHARD WOLFSON 2.00 X 0 0 0 MURRAY SWIM 40.00 X 171184 0 2098 ANN WITKOWSKI 40.00 X 201420 0 8039 PAT MODAFFERI 40.00 X 163788 0 3558 JOHN E F CORSON 4.00 X 0 0 0 ARTHUR L POWELL 2.00 X 0 0 0 TIMOTHY M CASEY 40.00 X 4034928 0 75778 EUGENE W BUCKLEY 2.00 X 0 0 0 PAUL N ANGSTADT JR MD 2.00 X 0 0 0 EDWARD LADELY 40.00 X 297884 0 17035 MICHAEL T KOST 40.00 X 163913 0 2163 ALICE SHIRAKAWA 40.00 X 153520 0 0 FRANCIS J CARR 40.00 X 126226 0 1652 EDWARD R HEMSCHOOT 40.00 X 125515 0 1582 DAVID V MIHALIC 40.00 X 117108 0 1504 5555486 141194 124354 19 0 1 0 BUCHANAN INGERSOLL & ROONEY PC 301 GRANT STREET PITTSBURGH PA 15219 LEGAL 497456 FRESENIUS MGT SERVICE INC 16343 COLLECTION CENTER DRIVE CHICAGO IL 60693 PATIENT DIALYSIS 348251 ALLIANCE HEALTHCARE SERVICES PO BOX 96485 CHICAGO IL 606936485 OUTSIDE PT TESTING 290304 QUEST DIAGNOSTICS 27027 TOURNEY ROAD VALENCIA CA 19355 OUTSIDE PT TESTING 259139 CAREFUSION 25565 NETWORK PLACE CHICAGO IL 606731255 QUALITY MGMT/ PHARMACY LEASING 232548 6 87461 87461 NET PATIENT SERVICE RE 621110 110261156 110261156 OTHER DEPT. REVENUE 621110 1650807 1650807 111911963 562916 562916 203208 203208 203208 203208 59750 51762 7988 7988 7988 FOOD SERVICES 722210 346304 346304 PARKING LOT 812930 143718 143718 PURCHASE DISCOUNTS 900099 60735 60735 1995 1995 552752 113326288 111974693 0 1264134 4332812 4332812 38850594 35650089 3200505 1367462 1367462 4549709 4549709 2929700 2545261 384439 508238 508238 105792 105792 489508 586 488922 158281 156238 2043 43661 39223 4438 128188 128188 15056745 14998651 58094 1532787 1515876 16911 SUPPLIES 15882973 15627675 255298 BAD DEBT 15874330 15874330 CONTRACTED SERVICES 9948391 4013802 5934589 PROFESSIONAL FEES 4951483 4334202 617281 NON-OPERATING EXPENSE 2754590 716798 2037792 4381086 3707637 673449 123846330 99308556 24537774 0 3545535 1431316 11780148 10297813 2124928 1958761 582520 463161 103382056 97043535 19534573 6338521 25870000 27936412 16301615 18667798 79739319 67093782 7485742 4479468 1950000 3838104 1946310 25936110 20997182 39209956 27422960 X 33981686 31909327 647387 716273 5900290 7045222 40529363 39670822 79739319 67093782 X -10520042 9661501 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 20837 0 0 0 20837 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: LOBBYING EXPENSES INCURRED WHEN DUES PAID TO HOSPITAL ASSOCIATION OF PENNSYLVANIA. A PERCENT OF LOBBYING EXPENSES INCURRED BY THE ASSOCIATION IS ALLOCATED TO EACH PARTICIPANT. 5897316 1144997 7042313 5385697 511619 5897316 6838593 -1452896 5385697 1 0 41722054 37579952 4142102 61579389 59382970 2196419 80613 80613 0 6338521 CASH & CASH EQUIVALENTS (HELD IN TRUST) 4055423 F MARKETABLE EQUITY SECURITIES (HELD IN TRUST) 17721827 F US GOVERNMENT OBLIGATIONS (HELD IN TRUST) 6159162 F 27936412 OTHER ASSETS 12466 DUE FROM AFFILIATES 6631754 INTEREST IN NET ASSETS OF FOUNDATION 12023578 18667798 ACCRUED PAYROLL & EMPLOYEE BENEFITS 3991566 RETIREMENT LIABILITY 7114000 ACCRUED PENSION 7258975 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 2100390 DUE TO AFFILIATES 532251 20997182 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: MONTGOMERY HOSPITAL IS THE PARTIAL OR 100% OWNER OF NINE ENDOWMENT FUNDS. EIGHT OF THE FUNDS HAVE UNRESTRICTED DISTRIBUTIONS TO MONTGOMERY HOSPITAL. ONE ENDOWMENT FUND DISTRIBUTES FUNDS TO THE GEORGE RALSTON RESTRICTED FUND. THE PURPOSE OF THIS FUND IS TO PAY FOR CONTINUED EDUCATION/SEMINARS FOR THE GRADUATES OF THE MONTGOMERY SCHOOL OF NURSING. 1 1 1 X 250.000000000000 1 X 1 1 1 0 0 875000 875000 0.00710 14802000 12174000 2628000 0.02120 15677000 12174000 3503000 0.02830 15 3500 136072 41729 94343 0.00080 2223000 1894000 329000 0.00270 201000 201000 0.00160 9175 9175 0.00010 15 3500 2569247 1935729 633518 0.00520 15 3500 18246247 14109729 4136518 0.03350 11 13200 13200 0.00010 11 13200 13200 0.00010 1 2334000 0 23522000 27321000 -3799000 X 1 1 1 1 MONTGOMERY HOSPITAL

1301 POWELL STREET NORRISTOWN PA 19404

X X X X NOT REQUIRED - IRS ANNOUNCEMENT 2011-37 1 PART I, LINE 7: COST WERE DETERMINED USING A RATIO OF COST TO CHARGES DERIVED FROM THE MEDICARE COST REPORT. PATIENT WOULD NOT HAVE HEALTHCARE SERVICES WITHOUT THE BENEFITS OF TREATING REGARDLESS OF FINANCIAL MEANS. PART I, LINE 7G: HOSPITAL SUBSIDIZES THE LOSS ON OPERATIONS OF THE SYSTEM PHYSICIAN OB CLINIC. OB CLINIC SERVICES ARE PROVIDED TO LOW INCOME WOMEN WHO DO NOT HAVE A PRIMARY CARE PHYSICIAN FOR OBSTETRICS SERVICES. PART II: AS A TRUE COMMUNITY PARTNER, MONTGOMERY HOSPITAL PROVIDED $13,200 TO OTHER CHARITABLE ORGANIZATIONS LAST YEAR. PARTNERSHIPS WITH THESE ORGANIZATIONS HAVE CONTINUED TO LEAD TO NEW OPPORTUNITIES TO IMPROVE THE HEALTH AND WELLBEING OF OUR COMMUNITY. FROM ASSISTING MOTHERS IN NEED OF PRENATAL CARE TO SUPPORT FOR SEXUALLY ABUSED CHILDREN TO BEING A HEALTHCARE RESOURCE THROUGH FREE SCREENINGS, MONTGOMERY HOSPITAL CONTINUES TO BUILD UPON EXISTING RELATIONSHIPS TO INCREASE THE OUTREACH OF THE HOSPITAL. PART III, LINE 4: MONTGOMERY HOSPITAL MAINTAINS RECORDS TO IDENTIFY AND MONITOR THE LEVEL OF CHARITY CARE PROVIDED. THESE RECORDS INCLUDE THE AMOUNT OF CHARGES FORGONE FOR SERVICES AND SUPPLIES FURNISHED. SUCH AMOUNTS HAVE BEEN EXCLUDED FROM NET PATIENT SERVICE REVENUE. MANAGEMENT ESTIMATES THAT THE COST OF UNREIMBURSED CHARITY CARE PROVIDED BY THE HOSPITAL APPROXIMATED $0.9 MILLION IN 2011. SUCH AMOUNTS HAVE BEEN EXCLUDED FROM NET PATIENT SERVICE REVENUE. THESE AMOUNTS DO NOT INCLUDE THE PROVISION FOR BAD DEBTS, AMOUNTING TO $2.3 MILLION FOR AMOUNTS DUE FROM PATIENTS BUT NOT COLLECTED FOR THE YEAR ENDED JUNE 30, 2011. PART III, LINE 8: COSTS ARE BASED ON THE 2011 FYE MEDICARE COST REPORT FILING. PART III, LINE 9B: 1) PATIENTS WHO RECEIVED SERVICES IN EMERGENCY DEPARTMENT THAT RESIDE IN SELECTED ZIP CODES ARE WRITTEN OFF TO CHARITY CARE BASED ON CENSUS DEPARTMENT INCOME INFORMATION.2) PATIENTS WHO DID NOT QUALIFY FOR MEDICAID AND APPEAR TO MET THE HOSPITAL'S CHARITY CARE GUIDELINES THE CHARGES ARE DISCOUNTED OR WRITTEN OFF IF APPROPRIATE.3) IF IN COLLECTION, PATIENTS ARE STILL GIVEN THE OPPORTUNITY TO APPLY FOR CHARITY CARE. PART V, LINE 19 BASED ON AN AVERAGE COMMERCIAL CASE RATE. PART V, LINE 21 UNINSURED INELIGIBLE, UNCOOPERATIVE PATIENTS WERE CHARGED GROSS CHARGES. PART VI, LINE 2: NEEDS ASSESSEMENT-MONTGOMERY HOSPITAL WORKS IN PARTNERSHIP WITH BOROUGH, COUNTY, REGIONAL AND STATE ORGANIZATIONS, ESPECIALLY MONTGOMERY COUNTY DEPARTMENT OF HEALTH AND THE DELAWARE VALLEY HEALTH COUNCIL TO ASSESS HEALTHCARE NEEDS IN THE IMMEDIATE REGION. WORKING TOGETHER, MONTGOMERY HOSPITAL AND ITS PARTNERS HAVE CONTINUED TO IDENTIFY HEALTHCARE TRENDS AND NEEDS WITHIN OUR COMMUNITY. TO BETTER MEET THESE NEEDS, MONTGOMERY HOSPITAL PROVIDES PRENATAL EDUCATION AND CARE, AN OB/GYN CLINIC FOR UNINSURED/UNDERINSURED WOMEN, ACCESS TO CASE MANAGEMENT AND SOCIAL WORKERS, PASTORAL CARE AND HOME CARE, HOSPICE AND PALLIATIVE CARE OPTIONS FOR THE UNDERSERVED. THE HOSPITAL HOSTS A VARIETY OF SUPPORT GROUPS, PARTICIPATION IN WHICH IS FREE. THROUGHOUT THE YEAR, THE HOSPITAL PROVIDES OUTREACH AND EDUCATION PROGRAMMING OPPORTUNITIES TO IMPROVE THE HEALTH OF THE COMMUNITY IT SERVES REGARDLESS OF RACE, RELIGION OR ABILITY TO PAY. PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE-MONTGOMERY HOSPITAL EDUCATES PATIENTS AND PERSONS WHO MAY BE BILLED FOR PATIENT CARE ABOUT THEIR ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL STATE, OR LOCAL GOVERNMENT PROGRAMS OR UNDER THE HOSPITAL'S CHARITY CARE POLICY IN THE FOLLOWING WAYS:1. THE HOSPITAL'S CHARITY CARE POLICY IS POSTED IN PATIENT REGISTRATION AND IS AVAILABLE IN WRITING UPON REQUEST.2. INFORMATION ABOUT THE HOSPITAL'S CHARITY CARE POLICY AND HOW TO RECEIVE HELP UNDERSTANDING HOSPITAL BILLS ARE INCLUDED IN THE MONTGOMERY HOSPITAL PATIENT GUIDE, GIVEN TO EVERY PATIENT UPON ADMISSION (AVAILABLE IN ENGLISH AND SPANISH. 3. THE HOSPITAL'S CHARITY CARE POLICY AND SELF-PAY FEE SCHEDULE ARE AVAILABLE FROM PATIENT REGISTRATION, EMERGENCY DEPARTMENT REGISTRATION AND THE HOSPITAL'S BILLING OFFICE.4. CHARITY CARE INFORMATION AND SELF-PAY FEE SCHEDULE ARE AVAILABLE ON THE HOSPITAL'S WEBSITE.5.TWO FINANCIAL COUSELORS ARE AVAILABLE TO EDUCATE PATIENTS ABOUT FINANCIAL OPTIONS AND ASSIST WITH COMPLETION AND FILING OF FORMS. PART VI, LINE 4: COMMUNITY INFORMATION - MONTGOMERY HOSPITAL SITS CLOSE TO THE CENTER OF NORRISTOWN, THE COUNTY SEAT OF MONTGOMERY COUNTY, PA. NORRISTOWN IS CLASSIFIED AS URBAN. PER THE 2010 US CENSUS, THE POPULATION OF NORRISTOWN IS 40.9% CAUCASIAN, 39.8% BLACK OR AFRICAN AMERICAN AND 23.5% OF HISPANIC OR LATINO DESCENT, ALMOST TRIPLE THE LATINO POPULATION REPORTED IN THE 2000 CENSUS. ALTHOUGH MONTGOMERY COUNTY IS THE THIRD MOST POPULOUS IN THE STATE AND THE MOST AFFLUENT, 17.2% OF NORRISTOWN RESIDENTS AND 13.5% OF FAMILIES IN THE BOROUGH LIVE BELOW THE POVERTY LINE COMPARED TO 2.4% OF PEOPLE IN MONTGOMERY COUNTY AND 11.9% FOR THE STATE. PROJECTIONS SHOW THAT ONE-THIRD OF THE BOROUGH'S RESIDENTS ARE UNINSURED WITH NO SOURCE OF PRIMARY CARE. IN ADDITION TO A LACK OF MEDICAL INSURANCE OR PRIMARY CARE, THE GROWING UNDOCUMENTED LATINO POPULATION IS FURTHER HAMPERED BY CULTURAL AND LANGUAGE BARRIERS WHICH PRODUCE AN OVERALL LACK OF HEALTHCARE KNOWLEDGE. LANGUAGE BARRIERS OFTEN DISSUADE ATTENDANCE AT FREE HEALTH SCREENINGS THROUGHOUT THE COUNTY BY MULTIPLE ORGANIZATIONS. ADDITIONALLY, UNDOCUMENTED INDIVIDUALS ARE OFTEN FEARFUL OF QUESTIONS BEING RAISED ABOUT CITIZENSHIP AND THEREFORE DO NOT SEEK PROPER HEALTHCARE UNTIL THE NEED IS CRITICAL. PROVIDING PROGRAMS, FAMILIARITY AND ACCESS TO MONTGOMERY HOSPITAL PROGRAMS, ESPECIALLY FOR PREVENTATIVE AND PRENATAL HEALTH NEEDS, IS IMPORTANT AT THIS TIME. IN ADDITION TO THE IMMEDIATE NORRISTOWN VICINTY, MONTGOMERY HOSPITAL'S REGIONAL REACH IS THE CENTRAL PORTION OF MONTGOMERY COUNTY, EXTENDING APPROXIMATELY 10 MILES TO THE NORTH AND WEST AND 5 MILES TO THE EAST (TOWARDS PHILADELPHIA). MONTGOMERY HOSPITAL GEOGRAPHICALLY FINDS ITSELF IN DIRECT COMPETITION WITH AT LEAST 10 OTHER SUBURBAN PHILADELPHIA HOSPITALS ALL OF WHOM ARE IN CONSTANT COMPETITION WITH HOSPITALS LOCATED DOWNTOWN, A TREND THAT FINDS ALMOST 60% OF THE POPULATION SEEKING HEALTHCARE OUTSIDE OF THE IMMEDIATE REGION. PART VI, LINE 6: PROMOTION OF COMMUNITY HEALTH-MONTGOMERY HOSPITAL MEDICAL CENTER IS COMMITTED TO IMPROVING THE HEALTH OF OUR COMMUNITY. THROUGH A VARIETY OF FORMS, MONTGOMERY HOSPITAL PROVIDES OUTREACH AND EDUCATION EACH YEAR, ENGAGING WITH A NUMBER OF COMMUNITY PARTNERS. PROGRAMS INCLUDE: 1. AS A PRIMARY SOURCE OF HEALTHCARE FOR NORRISTOWN AND CENTRAL MONTGOMERY COUNTY, MONTGOMERY HOSPITAL ENJOYS BEING THE HEALTHCARE RESOURCE FOR ITS NEIGHBORS. EACH YEAR, THE HOSPITAL PROVIDES EDUCATIONAL MATERIALS AND HEALTHCARE RELATED GIVEAWAYS TO NORRISTOWN AREA SCHOOL DISTRICT, CHURCHES WITHIN THE IMMEDIATE AREA, CIVIC ORGANIZATIONS SUCH AS BOY/GIRL SCOUTS OF AMERICA, LOCAL COMMUNITY CENTERS SUCH AS THE POLICE ATHLETIC LEAGUE AND AS WELL AS OUR BOROUGH AND BORDERING TOWNSHIPS. THE HOSPITAL ALSO SUPPORTS SEVERAL LOCAL "BLOCK" PARTIES EACH SUMMER BY SUPPLYING HEALTHCARE INFORMATION TO SURROUNDING NEIGHBORHOODS.2. FREE CANCER SUPPORT GROUPS FOR PATIENTS, FAMILIES AND SURVIVORS. TO INCREASE THE HOSPITAL'S OUTREACH, PARTICIPANTS DO NOT NEED TO HAVE BEEN TREATED AT THE HOSPITAL TO PARTICIPATE. SUPPORT GROUPS IN 2010-2011 INCLUDED BREAST CANCER SUPPORT, CPAP SUPPORT, LARYNGECTOMY SUPPORT, PROSTATE SUPPORT AND BEREAVEMENT SUPPORT. THE HOSPITAL'S CANCER PROGRAM ALSO PROVIDES A HEALING ARTS PROGRAM FOR PATIENTS FEATURING A FREE WIG PROGRAM FOR PATIENTS WHO HAVE LOST THEIR HAIR TO CHEMOTHERAPY. MASSAGE, MEDITATION AND OTHER RELAXATION OPPORTUNITIES ARE OFFERED THROUGHOUT THE YEAR. THE CANCER PROGRAM ALSO PARTNERS WTH THE AMERICAN CANCER SOCIETY TO PRESENT TRADEMARKED PROGRAMMING.3. EACH MAY, THE HOSPITAL HOSTS AN ANNUAL FUNDRAISER. WHILE THE "WALK THROUGH THE PARK" GENERATES ON AVERAGE $15,000 FOR CANCER PROGRAMS AT MONTGOMERY HOSPITAL, THE GREATER PURPOSE OF THE WALK IS TO BRING CANCER AWARENESS TO THE REGION WHILE SUPPORTING ALL OF THOSE WHO HAVE EVER BEEN DIAGNOSED WITH CANCER. THE WALK IS A TRUE COLLABORATION OF PHYSICIANS, PATIENTS, ORGANIZATIONS, LOCAL BUSINESSES AND INDIVIDUALS WHO WANT TO SHOW SUPPORT FOR THOSE WHO HAVE BEEN TOUCHED BY CANCER. THE WALK IS LED BY A COMMITTEE COMPRISED OF LOCAL BUSINESS LEADERS, COMMUNITY MEMBERS AND HOSPITAL PHYSICIANS AND STAFF.4. AS A TRUE COMMUNITY PARTNER, MONTGOMERY HOSPITAL PROVIDED $13,200 TO OTHER CHARITABLE ORGANIZATIONS LAST YEAR. PARTNERSHIPS WITH THESE ORGANIZATIONS HAVE CONTINUED TO LEAD TO NEW OPPORTUNITIES TO IMPROVE THE HEALTH AND WELLBEING OF OUR COMMUNITY. FROM ASSISTING MOTHERS IN NEED OF PRENATAL CARE TO SUPPORT FOR SEXUALLY ABUSED CHILDREN TO BEING A HEALTHCARE RESOURCE THROUGH FREE SCREENINGS, MONTGOMERY HOSPITAL CONTINUES TO BUILD UPON EXISTING RELATIONSHIPS TO INCREASE THE OUTREACH OF THE HOSPITAL. 5. MONTGOMERY HOSPITAL ENJOYS A CLOSE RELATIONSHIP WITH ITS NEIGHBOR HOSPITALS FROM MONTGOMERY AND BUCKS COUNTIES WITH A REGIONAL ZONE AGREEMENT, PART OF A COALITION DEVELOPED AFTER 9/11. THROUGH A MUTUAL AID AGREEMENT, HOSPITALS WITHIN THE ZONE HAVE PREDETERMINED METHODS IN PLACE TO ENCOURAGE INTER-HOSPITAL COOPERATION SHOULD A DISASTER ARISE. THE ZONE WORKS WITH AREA MUNICIPAL AND COUNTY AGENCIES, EMS, DELAWARE VALLEY HEALTH COUNCIL, AND THE STATE. IN ADDITION, THE HOSPITAL HOSTS A SAFETY/EMERGENCY PREPARATION MEETING EACH MONTH FOR STAFF MEMBERS TO RECEIVE CONTINUOUS TRAINING AND ASSESS ANY NEEDS WITHIN THE COMMUNITY. THE MUNICIPAL FIRE DEPARTMENT IS INVITED AS A PARTICIPANT AT LEAST ONCE EACH YEAR AS IS THE SAFETY OFFICER FROM THE EXCELON NUCLEAR POWER PLANT, LOCATED 20 MILES TO THE NORTHWEST OF THE HOSPITAL.6. WHEN A PUBLIC HEALTH CRISIS DEVELOPS, MONTGOMERY HOSPITAL IS A RESPONSIVE, COLLABORATIVE COMMUNITY PARTNER. THE HOSPITAL WORKS IN CONJUNCTION WITH LOCAL PUBIC HEALTH AGENCIES TO BRING AWARENESS TO THE COMMUNITY REGARDING HEALTH CARE OUTREACH. THIS YEAR THE HOSPITAL HAS WORKED WITH THESE AGENCIES, INCLUDING THE DEPARTMENT OF HEALTH, TO EDUCATE THE COMMUNITY ABOUT:THE IMPORTANCE OF FLU VACCINATIONS, PROPER HAND WASHING TECHNIQUES, SIGNS OF HEART TROUBLE, IMPORTANCE OF ADVANCED DIRECTIVES, THE NEEED FOR PROPER PRE-NATAL CARE AND THE DANGERS OF CO-SLEEPING WITH INFANTS. IN RESPONSE TO A DRAMATIC INCREASE IN INFANT MORTALITY WITHIN THE BOROUGH IN 2011, THE HOSPITAL ADOPTED A "NO LOOSE BLANKET" POLICY, OUTFITTING EACH NEWBORN DELIVERED WITH TWO WEARABLE AND SEASONALLY APPROPRIATE SLEEP SACKS TO HELP DECREASE THE RISK OF SIDS. X X X X X X 0 0 0 0 0 0 0 0 0 SCOTT A MELNICK MD 0 141194 0 0 0 0 0 0 0 10945 0 152139 0 0 MURRAY SWIM 156475 0 14709 0 0 0 0 0 2098 0 173282 0 0 0 ANN WITKOWSKI 181306 0 20114 0 0 0 0 0 8039 0 209459 0 0 0 PAT MODAFFERI 143209 0 20579 0 0 0 0 0 3558 0 167346 0 0 0 TIMOTHY M CASEY 665045 0 292229 0 3077654 0 0 0 75778 0 4110706 0 0 0 EDWARD LADELY 271442 0 26442 0 0 0 0 0 17035 0 314919 0 0 0 MICHAEL T KOST 163913 0 0 0 0 0 0 0 2163 0 166076 0 0 0 ALICE SHIRAKAWA 153520 0 0 0 0 0 0 0 0 0 153520 0 0 0 FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS MEMBERS. FORM 990, PART VI, SECTION A, LINE 7A BOARD MEMBERS AND OFFICERS ARE ELECTED BY THE MONTGOMERY HOSPITAL MEDICAL CENTER EXECUTIVE COMMITTEE (BOARD). FORM 990, PART VI, SECTION A, LINE 7B A MAJORITY OF ELECTED BOARD MEMBERS AT A MEETING CONSTITUTES A QUORUM. A BOARD VOTE AT A MEETING WITH A QUORUM CARRIES ANY ACTION. FORM 990, PART VI, SECTION B, LINE 11 FORM 990 IS FIRST REVIEWED BY THE DIRECTOR OF FINANCE. ALL DATA IS TIED BACK TO THE ORIGINAL SUPPORTING DOCUMENTS. DATA IS ALSO TIED BACK TO THE AUDITED FINANCIAL STATEMENTS. AFTER REVIEW BY THE DIRECTOR OF FINANCE, FORM 990 IS REVIEWED BY THE CEO. THE CEO THEN PRESENTS THE FORM 990 TO A SUB COMMITTEE OF THE BOARD FOR REVIEW. AFTER ALL REVIEWS, THE CEO SIGNS THE TAX RETURN AND IT IS FILED. FORM 990, PART VI, SECTION B, LINE 12C OFFICERS AND DIRECTORS ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST STATEMENT ON A YEARLY BASIS. FORM 990, PART VI, SECTION B, LINE 15 A COMPENSATION COMMITTEE IS USED TO APPROVE COMPENSATION FOR THE CEO AND OFFICERS. AN OUTSIDE COMPANY IS USED TO COMPLETE COMPARABILITY STUDIES. AN OUTSIDE REVIEW OF THE SURVEYS IS COMPLETED BY AN INDEPENDENT PERSON. THE COMPENSATION COMMITTEE REVIEWS THE DATA AND ULTIMATELY APPROVES OR DISAPPROVES OF ANY EXECUTIVE COMPENSATION. THERE ARE DOCUMENTED MINUTES OF THE COMPENSATION COMMITTEE MEETINGS. THESE MINUTES ARE KEPT CONFIDENTIAL AND ARE STORED IN THE EXECUTIVE OFFICE FILES. FORM 990, PART VI, SECTION C, LINE 19 FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: UNREALIZED GAIN/LOSS ON INVESTMENTS 3,242,000. RESTRICTED CONTRIBUTIONS 218,000. NET ASSETS RELEASED FROM RESTRICTIONS FOR PROPERTY & EQUIPMENT ACQUISITIONS 62,000. NET ASSETS RELEASED FROM RESTRICTIONS -149,000. MISCELLANEOUS/ROUNDING 501. INCREASE/DECREASE IN ASSETS HELD IN PERPETUITY BY TRUSTEES 1,145,000. CHANGE IN ADDITIONAL MINIMUM PENSION LIABILITY 5,143,000. TOTAL TO FORM 990, PART XI, LINE 5: 9,661,501. PROCESS FOR OVERSIGHT OF AUDIT OF FINANCIAL STATEMENTS FORM 990, PART XI, LINE 2C THE PROCESS FOR OVERSIGHT OF THE AUDIT OF THE ORGANIZATION'S FINANCIAL STATEMENTS AND THE SELECTION OF AN INDEPENDENT ACCOUNTANT HAS NOT CHANGED SINCE THE PRIOR YEAR. FORNANCE PHYSICIAN SERVICES 1330 POWELL STREET NORRISTOWN PA 19401 232275991 HEALTH CARE PA 501(C)(3) 11A AEHN 0 MONTGOMERY HEALTH FOUNDATION 1330 POWELL STREET SUITE 309 NORRISTOWN PA 19401 222456265 FINANCIAL SUPPORT OF MONTGOMERY HOSPITAL PA 501(C)(3) 11B AEHN 0 MONTGOMERY HOSPITAL WORKERS COMPENSATION 1301 POWELL STREET NORRISTOWN PA 19401 232351775 HEALTH CARE PA 501(C)(3) 11A AEHN 0 BROADLINE RISK RETENTION GROUP 100 BANK STREET BURLINGTON VT 05401 272583356 INSURANCE VT 501(C)(3) 11A AEHN 0 EINSTEIN PRACTICE PLAN 5501 OLD YORK ROAD PHILADELPHIA PA 19141 232664784 HEALTH CARE PA 501(C)(3) 11A AEHN 0 MONTGOMERY HOSPITAL SELF INSURED TRUST 1301 POWELL STREET NORRISTOWN PA 19401 556151681 INSURANCE PA 501(C)(3) 11A AEHN 0 ALBERT EINSTEIN HEALTHCARE NETWORK 5501 OLD YORK ROAD PHILADELPHIA PA 19141 232290323 HEALTH CARE PA 501(C)(3) 11B N/A 0 ALBERT EINSTEIN MEDICAL CENTER 5501 OLD YORK ROAD PHILADELPHIA PA 19141 231396794 HEALTH CARE PA 501(C)(3) 3 AEHN 0 EINSTEIN COMMUNITY HEALTH ASSOCIATES 5501 OLD YORK ROAD PHILADELPHIA PA 19141 232760086 HEALTH CARE PA 501(C)(3) 11A AEHN 0 BELMONT CTR FOR COMPREHENSIVE TREATMENT 4200 MONUMENT ROAD PHILADELPHIA PA 19131 231352200 HEALTH CARE PA 501(C)(3) 3 AEHN 0 GHMC MANAGEMENT INC 101 E OLNEY AVENUE PHILADELPHIA PA 19141 232225809 HEALTH CARE PA 501(C)(3) 11A AEHN 0 EINSTEIN MEDICAL CENTER MONTOMERY 5501 OLD YORK ROAD PHILADELPHIA PA 19141 204193243 HEALTH CARE PA 501(C)(3) 3 AEHN 0 FRIENDS OF MOSS REHAB 12TH STREETS TABOR ROAD PHILADELPHIA PA 19141 222483287 HEALTH CARE PA 501(C)(3) 11A AEHN 0 CMMC INC 15 W WOOD STREET NORRISTOWN PA 19401 232256479 REAL ESTATE MANAGEMENT PA N/A C EINSTEIN HEALTHCARE SYSTEMS INC 101 OLNEY AVENUE PHILADELPHIA PA 19120 232314938 HOLDING COMPANY PA N/A C REHAB VENTURES INC 1200 W TABOR ROAD PHILADELPHIA PA 19141 232619394 HOLDING COMPANY PA N/A C 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 1 1 NO TRANSACTIONS ARE WITH CONTROLLED ENTITIES OR NON-501(C)(3) ORGANIZATIONS I NO TRANSACTIONS ARE WITH CONTROLLED ENTITIES OR NON-501(C)(3) ORGANIZATIONS J NO TRANSACTIONS ARE WITH CONTROLLED ENTITIES OR NON-501(C)(3) ORGANIZATIONS Q NO TRANSACTIONS ARE WITH CONTROLLED ENTITIES OR NON-501(C)(3) ORGANIZATIONS R