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GEISINGER JERSEY SHORE HOSPITAL: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
GEISINGER JERSEY SHORE HOSPITAL (EIN 24-0792115)
Tax period
2010-07-01 to 2011-06-30
Filed
2012-05-14
IRS object ID
201231359349300843
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)
Timestamp2012-05-14T08:23:16-05:00Timestamp
Tax Period End Date2011-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1PARENTEBEARD LLCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1400 MARKET STREETAddressLine1
CityWILLIAMSPORTCity
StatePAState
ZIP Code17701ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN240792115EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1JERSEY SHORE HOSPITALBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlJERSNameControl
Phone5703980100Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line11020 THOMPSON STREETAddressLine1
CityJERSEY SHORECity
StatePAState
ZIP Code17740ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameCAREY W PLUMMERName
TitlePRESIDENT & CEOTitle
Phone5703980100Phone
Date Signed2012-05-11DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameJULIUS C GREEN CPA JDName
Phone5703236023Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonCAREY W PLUMMERNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11020 THOMPSON STREETAddressLine1
CityJERSEY SHORECity
StatePAState
ZIP Code17740ZIPCode
FieldValueIRS element (for citing)
Gross Receipts30580900GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.JSH.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1922YearFormation
State Legal DomicilePAStateLegalDomicile
Activity Or Mission DescriptionPROVIDE INPATIENT, OUTPATIENT, AND EMERGENCY CARE SERVICES FOR RESIDENTS OF JERSEY SHORE AREA.ActivityOrMissionDescription
Nbr Voting Members Governing Body14NbrVotingMembersGoverningBody
Nbr Independent Voting Members11NbrIndependentVotingMembers
Total Nbr Employees344TotalNbrEmployees
Total Nbr Volunteers8TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year448563ContributionsGrantsPriorYear
Contributions Grants Current Year130721ContributionsGrantsCurrentYear
Program Service Revenue Prior Year28901185ProgramServiceRevenuePriorYear
Program Service Revenue CY30076603ProgramServiceRevenueCY
Investment Income Prior Year21130InvestmentIncomePriorYear
Investment Income Current Year-6695InvestmentIncomeCurrentYear
Other Revenue Prior Year255384OtherRevenuePriorYear
Other Revenue Current Year316625OtherRevenueCurrentYear
Total Revenue Prior Year29626262TotalRevenuePriorYear
Total Revenue Current Year30517254TotalRevenueCurrentYear
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 Year11801828SalariesEtcPriorYear
Salaries Etc Current Year12260092SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year272140TotalFundrsngExpCurrentYear
Other Expense Prior Year15481101OtherExpensePriorYear
Other Expenses Current Year17463238OtherExpensesCurrentYear
Total Expenses Prior Year27282929TotalExpensesPriorYear
Total Expenses Current Year29723330TotalExpensesCurrentYear
Revenues Less Expenses Prior Year2343333RevenuesLessExpensesPriorYear
Revenues Less Expenses CY793924RevenuesLessExpensesCY
Total Assets BOY29001096TotalAssetsBOY
Total Assets EOY30259484TotalAssetsEOY
Total Liabilities BOY22153378TotalLiabilitiesBOY
Total Liabilities EOY20267058TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY6847718NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY9992426NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionJERSEY SHORE HOSPITAL IS A RURAL HEALTHCARE FACILITY COMMITTED TO PROVIDING QUALITY HEALTH SERVICES WITH AN EFFICIENT BALANCE OF OUTPATIENT CARE, ACUTE AND SUB-ACUTE INPATIENT CARE AND OUTREACH SERVICES. THE HOSPITAL MAXIMIZES THE EFFECTIVENESS OF ITS PROGRAM THROUGH INTEGRATION WITH OTHER HEALTHCARE PROVIDERS TO ASSURE THE COMMUNITY ACCESS TO A BROAD ARRAY OF HEALTH CARE SERVICES.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense25727048Expense
Revenue30076603Revenue
DescriptionAS A RURAL HEALTHCARE FACILITY AND DEDICATED COMMUNITY HOSPITAL WITH A COMMITMENT TO PROVIDING A HIGH QUALITY CIRCLE OF CARE, JERSEY SHORE HOSPITAL HAS DEVELOPED DELIVERY SYSTEMS THAT PROVIDE AN EFFICIENT BALANCE OF OUTPATIENT CARE, ACUTE AND SUB-ACUTE INPATIENT CARE, PRIMARY CARE, AND OUTREACH SERVICES. THE HOSPITAL MAXIMIZES THE EFFECTIVENESS OF ITS PROGRAMS FOR QUALITY, EFFICIENCY, AND ACCESSIBILITY BY INTEGRATING WITH OTHER PROVIDERS AND ALTERNATIVE CARE ORGANIZATIONS IN THE SERVICE COMMUNITY TO ASSURE THE COMMUNITY ACCESS TO A BROAD ARRAY OF SERVICE OPTIONS.THE HOSPITAL PROVIDES AN ENVIRONMENT OF CARE THAT IS COMPASSIONATE, HIGHLY PERSONALIZED, AND FOCUSED ON THE PHYSICAL, PSYCHO-SOCIAL, AND SPIRITUAL NEEDS OF ITS PATIENTS THROUGH THE USE OF SKILLED NURSES, PHYSICIANS, TECHNICAL AND SUPPORT STAFF, MANAGEMENT, AND COMMUNITY LEADERS. THE HOSPITAL ALSO PROVIDES HEALTH EDUCATION, PROGRAMS IN PREVENTION, AND RELATED SUPPORT SERVICES TO THE COMMUNITY WITH THE GOAL OF IMPROVING THE OVERALL WELLNESS OF ITS RESIDENTS. THE HOSPITAL ENSURES THAT THE NECESSARY RESOURCES ARE AVAILABLE TO PROVIDE FOR COMPREHENSIVE, MANAGED HEALTH PROGRAMS IN THE MOST COST EFFECTIVE MANNER WHILE MAINTAINING A SAFE, PLEASANT, AND MEANINGFUL WORK AND PATIENT CARE ENVIRONMENT.THE HOSPITAL PROVIDES CHARITY CARE TO PATIENTS WHO MEET CERTAIN CRITERIA WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. CHARGES FORGONE FOR SERVICES RENDERED AND SUPPLIES FURNISHED UNDER THE CHARITY CARE POLICY AMOUNTED TO APPROXIMATELY $605,000 DURING THE YEAR ENDED JUNE 30, 2011.Description
Total Program Service Expense25727048TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets1ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities1FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Financial Stmt Attached1FinancialStmtAttached
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
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 With1096110NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees344NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions1QuidProQuoContributions
Quid Pro Quo Disclosure1QuidProQuoDisclosure
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members14NbrVotingGoverningBodyMembers
Number Independent Voting Members11NumberIndependentVotingMembers
Family Or Business Relationship1FamilyOrBusinessRelationship
Delegation Of Management Duties1DelegationOfManagementDuties
Changes To Organizing Docs1ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body0Form990ProvidedToGoverningBody
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
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1CAREY W PLUMMER - PRESIDENTCEOBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number5703983101TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11020 THOMPSON STREETAddressLine1
CityJERSEY SHORECity
StatePAState
ZIP Code17740ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (22 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployee
CAREY PLUMMER
PRESIDENT & CEO39.50XX212422074457
LEROY KEILER III
CHAIRMAN1.00XX000
WILLIAM CAMERER III
TREASURER1.00XX000
CARMEN SPINNEY MD
SECRETARY1.00XX015967726801
JAMES REESER
MEMBER1.00X000
RICHARD BEATTY DMD
VICE CHAIRPERSON1.00XX000
PAUL DEMPSEY
MEMBER1.00X000
WALTER EISENHAUER
MEMBER1.00X000
JAMES ELY
MEMBER1.00X000
STEVEN KATZ MD
MEMBER (MEDICAL DIRECTOR)1.00X600041194140052
JOHN HUNTER DDS
MEMBER1.00X1500000
SEAN SIMCOX
MEMBER1.00X000
ROB GLUNK
MEMBER1.00X000
DOROTHY CHAPPEL PHD
MEMBER1.00X000
JACK DINGESS
MEMBER1.00X000
MARK RICE
CONTROLLER (STARTED 1/5/11)39.00X000
KEN CORNISH
ACTING CFO39.50X72000024000
AARON KOLB MD
PHYSICIAN40.00246328037307X
THOMAS FORKER MD
PHYSICIAN40.00169186029893X
THOMAS BURGE
CRNA40.00177110022806X
RONALD EISTER
PHYSICIAN40.00205791034119X
OWEN O'HEIR
CRNA40.00203206016096X
FieldValueIRS element (for citing)
Total Reportable Comp From Org1307043TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs571618TotalReportableCompFrmRltdOrgs
Total Other Compensation305531TotalOtherCompensation
Number Individuals GT100 K7NumberIndividualsGT100K
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
QUORUM HEALTH SYSTEM
105 CONTINENTAL PLACEBRENTWOODTN370275014MANAGEMENT FEES642005
SUSQUEHANNA HEALTH SYSTEM
1205 GRAMPIAN BOULEVARDWILLIAMSPORTPA17701IT SUPPORT/LAB TEST INTERPRETATION638650
STAFF CARE
PO BOX 281923ATLANTAGA303841923ER PHYSICIAN LOCUMS423910
MEDICAL STAFFING NETWORK CO
2300 VALLEY LANEIRVINGTX75062ER PHYSICIAN LOCUMS266123
QUEST DIAGNOSTICS
315 BOULEVARD NE STE 240ATLANTAGA30312LAB SERVICES248459
FieldValueIRS element (for citing)
Number Of Contractors GT100 K7NumberOfContractorsGT100K
Fundraising Events25140FundraisingEvents
Government Grants25322GovernmentGrants
All Other Contributions80259AllOtherContributions
Total Contributions130721TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionPATIENT SERVICE REVDescription
Business Code621110BusinessCode
Total Revenue Column30076603TotalRevenueColumn
Related Or Exempt Function Income30076603RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue30076603TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column14936TotalRevenueColumn
Exclusion$14,936ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real100549Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real22837Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real77712Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column77712TotalRevenueColumn
Exclusion$77,712ExclusionAmount

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other21631Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other-21631Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-21631TotalRevenueColumn
Exclusion-$21,631ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events12414GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events25140CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses19178FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column-6764TotalRevenueColumn
Exclusion-$6,764ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmount
CAFETERIA/VENDING REV722210111315$111,315
REBATES/REFUNDS90009954701$54,701
SALES TAX REFUND90009925168$25,168

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column54493TotalRevenueColumn
Exclusion$54,493ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue245677TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column30517254TotalRevenueColumn
Related Or Exempt Function Income30076603RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$309,930ExclusionAmount

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total9701764Total
Program Services8033988ProgramServices
Management And General1594910ManagementAndGeneral
Fundraising72866Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total438978Total
Program Services363516ProgramServices
Management And General72165ManagementAndGeneral
Fundraising3297Fundraising

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total1289885Total
Program Services1068148ProgramServices
Management And General212049ManagementAndGeneral
Fundraising9688Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total829465Total
Program Services686876ProgramServices
Management And General136359ManagementAndGeneral
Fundraising6230Fundraising

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total642005Total
Program Services642005ProgramServices

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total108604Total
Management And General108604ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total50810Total
Management And General50810ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total2684Total
Program Services2684ProgramServices

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total5531378Total
Program Services4633980ProgramServices
Management And General882663ManagementAndGeneral
Fundraising14735Fundraising

Advertising Advertising

FieldValueIRS element (for citing)
Total141700Total
Program Services9054ProgramServices
Fundraising132646Fundraising

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total4232766Total
Program Services3554479ProgramServices
Management And General666582ManagementAndGeneral
Fundraising11705Fundraising

Occupancy Occupancy

FieldValueIRS element (for citing)
Total629118Total
Program Services629118ProgramServices

Travel Travel

FieldValueIRS element (for citing)
Total35973Total
Program Services33012ProgramServices
Fundraising2961Fundraising

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total76287Total
Program Services61263ProgramServices
Fundraising15024Fundraising

Interest Interest

FieldValueIRS element (for citing)
Total879222Total
Program Services879222ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total2025358Total
Program Services2025358ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total495056Total
Program Services495056ProgramServices

Other Expenses OtherExpenses (3 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesFundraisingFundraising
BAD DEBT EXPENSE23368812336881
EMPLOYEE RECOGNITION9810398103
DUES & BOOKS89309873651944

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total87984Total
Program Services86940ProgramServices
Fundraising1044Fundraising

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total29723330Total
Program Services25727048ProgramServices
Management And General3724142ManagementAndGeneral
Fundraising272140Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY1425BOY
EOY1427EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY3423909BOY
EOY3340805EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY217292BOY
EOY94823EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY2858519BOY
EOY3132916EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY314915BOY
EOY309635EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY349860BOY
EOY515880EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis35609105LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec18410474LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY17868809BOY
EOY17198631EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY3966367BOY
EOY5665367EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY29001096BOY
EOY30259484EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY2182949BOY
EOY2691694EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY14838199BOY
EOY14656196EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY5132230BOY
EOY2919168EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY22153378BOY
EOY20267058EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY6079759BOY
EOY9469982EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY767959BOY
EOY522444EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY6847718BOY
EOY9992426EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY29001096BOY
EOY30259484EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses793924ReconcilationRevenueExpenses
Reconcilation Other Changes2350784ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
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 C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0Volunteers
Paid Staff Or Management0PaidStaffOrManagement
Media Advertisements0MediaAdvertisements
Mailings Members0MailingsMembers
Publications Or Broadcast0PublicationsOrBroadcast
Grants Other Organizations0GrantsOtherOrganizations
Direct Contact Legislators0DirectContactLegislators
Rallies Demonstrations0RalliesDemonstrations
Other Activities1OtherActivities
Other Activities$2,684OtherActivitiesAmount
Total Lobbying Expenditures IIB2684TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierEXPLANATION OF OTHER LOBBYING ACTIVITIES:Identifier
Return ReferencePART II-B, LINE 1I:ReturnReference
ExplanationTHE HOSPITAL PAYS DUES TO THE AMERICAN HOSPITAL ASSOCIATION (AHA) AND THE HOSPITAL ASSOCIATION OF PENNSYLVANIA (HAP). A PORTION OF THE DUES PAID TO THESE TWO ORGANIZATIONS ($2,684 DURING THE YEAR ENDED JUNE 30, 2011) WAS USED FOR LOBBYING PURPOSES.Explanation

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis154956OtherCostOrOtherBasis
Book Value154956BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis17824782OtherCostOrOtherBasis
Depreciation4266931Depreciation
Book Value13557851BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis16757521OtherCostOrOtherBasis
Depreciation13958965Depreciation
Book Value2798556BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis871846OtherCostOrOtherBasis
Depreciation184578Depreciation
Book Value687268BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings17198631TotalOfBookValueLandBuildings

Other Assets OtherAssets (4 entries)

DescriptionDescriptionBook ValueBookValue
ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS266169
DEFERRED FINANCING COSTS, NET121992
DUE FROM AFFILIATES2971067
FUNDED DEPRECIATION2306139
FieldValueIRS element (for citing)
Total Book Value Other Assets5665367TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (6 entries)

DescriptionDescriptionAmountAmount
OBLIGATIONS UNDER CAPITAL LEASES$1,067,548
PATIENT REFUNDS PAYABLE$49,474
BLUE CROSS CURRENT FINANCING ADVANCE$158,704
ESTIMATED MEDICAL MALPRACTICE CLAIMS LIABILITY$125,000
FAIR VALUE OF DERIVATIVE INSTRUMENT$417,953
ACCRUED PENSION COST$1,100,489
FieldValueIRS element (for citing)
Total Of Amounts2919168TotalOfAmounts
Total Revenue30517254TotalRevenue
Total Expenses29723330TotalExpenses
Excess Or Deficit For Year793924ExcessOrDeficitForYear
Other$2,350,784OtherAmount
Total Adjustments2350784TotalAdjustments
Excess Or Deficit Per FS3144708ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt32117827TotRevenueEtcAuditedFinclStmt
Other Revenues1577736OtherRevenues
Revenue Not Rptd F9901577736RevenueNotRptdF990
Revenue Subtotal30540091RevenueSubtotal
Other Revenues Not Included-22837OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt-22837RevenueNotRptdOnFinStmt
Total Revenue Per Form99030517254TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt30280068TotExpensesEtcAuditedFinclStmt
Other Expenses Included556738OtherExpensesIncluded
Expenses Not Rptd F990556738ExpensesNotRptdF990
Expenses Subtotal29723330ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form99029723330TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (5 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:PART X:THE CORPORATION ACCOUNTS FOR UNCERTAINTY IN INCOME TAXES USING A RECOGNITION THRESHOLD OF MORE-LIKELY-THAN-NOT TO BE SUSTAINED UPON EXAMINATION BY THE APPROPRIATE TAXING AUTHORITY. MEASUREMENT OF THE TAX UNCERTAINTY OCCURS IF THE RECOGNITION THRESHOLD IS MET. MANAGEMENT DETERMINED THERE WERE NO TAX UNCERTAINTIES THAT MET THE RECOGNITION THRESHOLD IN 2011 AND 2010. THE CORPORATION'S FEDERAL RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX, EXEMPT ORGANIZATION BUSINESS TAX RETURN, AND CORPORATE INCOME TAX RETURNS FOR THE YEARS ENDED JUNE 2011, 2010, AND 2009 REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE.
PART XI, LINE 8 - OTHER ADJUSTMENTS:PENSION LIABILITY ADJUSTMENT 1,071,805. CHANGE IN FAIR VALUE OF DERIVATIVE INSTRUMENT -44,054. TRANSFER FROM AFFILIATES PER CORPORATE RESTRUCTURING 1,323,033.
PART XII, LINE 2D - OTHER ADJUSTMENTS:CHANGE IN FAIR VALUE OF DERIVATIVE INSTRUMENT -44,054. PENSION LIABILITY ADJUSTMENT 1,071,805. REVENUE OF AFFILIATES CONSOLIDATED ON FINANCIAL STATEMENTS 549,985.
PART XII, LINE 4B - OTHER ADJUSTMENTS:RENTAL EXPENSE -22,837.
PART XIII, LINE 2D - OTHER ADJUSTMENTS:RENTAL EXPENSES 22,837. EXPENSES OF AFFILIATES CONSOLIDATED ON FINANCIAL STATEMENTS 533,901.

Schedule G IRS990ScheduleG

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1GOLF TOURNAMENTNameOfEvent1
Gross Receipts Event126853GrossReceiptsEvent1
Charitable Contributions Event119037CharitableContributionsEvent1
Gross Revenue Event17816GrossRevenueEvent1
Non Cash Prizes Event11200NonCashPrizesEvent1
Food And Beverage Event11857FoodAndBeverageEvent1
Other Direct Expenses Event18465OtherDirectExpensesEvent1
Name Of Event2CRAB FESTNameOfEvent2
Gross Receipts Event210701GrossReceiptsEvent2
Charitable Contributions Event26103CharitableContributionsEvent2
Gross Revenue Event24598GrossRevenueEvent2
Food And Beverage Event24598FoodAndBeverageEvent2
Other Direct Expenses Event23058OtherDirectExpensesEvent2
Gross Receipts Total37554GrossReceiptsTotal
Charitable Contributions Total25140CharitableContributionsTotal
Gross Revenue Total Events12414GrossRevenueTotalEvents
Non Cash Prizes Total Events1200NonCashPrizesTotalEvents
Food And Beverage Total Events6455FoodAndBeverageTotalEvents
Other Direct Expenses Total Events11523OtherDirectExpensesTotalEvents
Direct Expense Summary Events19178DirectExpenseSummaryEvents
Net Income Summary-6764NetIncomeSummary

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
FPG Reference Free Care1FPGReferenceFreeCare
Pcent200XPcent200
FPG Reference Discounted Care1FPGReferenceDiscountedCare
Pcent250XPcent250
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care0AmountsBudgetedForCharityCare
Annual Community Benefit Report0AnnualCommunityBenefitReport

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense249539TotalCommunityBenefitExpense
Net Community Benefit Expense249539NetCommunityBenefitExpense
Percent Of Total Expense0.00910PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense2548258TotalCommunityBenefitExpense
Direct Offsetting Revenue1998280DirectOffsettingRevenue
Net Community Benefit Expense549978NetCommunityBenefitExpense
Percent Of Total Expense0.02010PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense2797797TotalCommunityBenefitExpense
Direct Offsetting Revenue1998280DirectOffsettingRevenue
Net Community Benefit Expense799517NetCommunityBenefitExpense
Percent Of Total Expense0.02920PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense247173TotalCommunityBenefitExpense
Direct Offsetting Revenue18931DirectOffsettingRevenue
Net Community Benefit Expense228242NetCommunityBenefitExpense
Percent Of Total Expense0.00830PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense11076TotalCommunityBenefitExpense
Net Community Benefit Expense11076NetCommunityBenefitExpense
Percent Of Total Expense0.00040PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense258249TotalCommunityBenefitExpense
Direct Offsetting Revenue18931DirectOffsettingRevenue
Net Community Benefit Expense239318NetCommunityBenefitExpense
Percent Of Total Expense0.00870PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense3056046TotalCommunityBenefitExpense
Direct Offsetting Revenue2017211DirectOffsettingRevenue
Net Community Benefit Expense1038835NetCommunityBenefitExpense
Percent Of Total Expense0.03790PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported1BadDebtExpenseReported
Bad Debt Expense$958,121BadDebtExpenseAmount
Amount Reimbursed By Medicare6858059AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare4867764CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall1990295MedicareSurplusOrShortfall

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 Line1JERSEY SHORE HOSPITALBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line11020 THOMPSON STREETAddressLine1
CityJERSEY SHORECity
StatePAState
ZIP Code17740ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Critical Access HospitalXCriticalAccessHospital
Er24 HoursXEr24Hours

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 7: THE HOSPITAL USED THE COST TO CHARGE RATIO.
PART I, L7 COL(F): AMOUNT OF BAD DEBT EXPENSE FROM PART IX SUBTRACTED IN ORDER TO CALCULATE PERCENT OF TOTAL EXPENSE IN PART I LINE 7 COLUMN F WAS $2,336,881.
PART III, LINE 4: ACCOUNTS RECEIVABLE, PATIENTS ARE REPORTED AT NET REALIZABLE VALUE. ACCOUNTS ARE WRITTEN OFF WHEN THEY ARE DETERMINED TO BE UNCOLLECTIBLE BASED UPON MANAGEMENT'S ASSESSMENT OF INDIVIDUAL ACCOUNTS. THE ALLOWANCE FOR DOUBTFUL COLLECTIONS IS ESTIMATED BASED UPON A PERIODIC REVIEW OF THE ACCOUNTS RECEIVABLE AGING, PAYOR CLASSIFICATIONS, AND APPLICATION OF HISTORICAL WRITE-OFF PERCENTAGES.BAD DEBT EXPENSE IS BASED ON A PERCENTAGE OF REVENUE DURING THE YEAR. THE ALLOWANCE IS EVALUATED AT THE END OF THE YEAR AND ANY ADJUSTMENTS ARE MADE TO BAD DEBT EXPENSE.PATIENT DISCOUNTS ARE NOT INCLUDED IN BAD DEBT - THEY ARE INCLUDED IN CONTRACTUAL ADJUSTMENTS. PAYMENTS ON PATIENT ACCOUNTS ARE INCLUDED IN THE ALLOWANCE FOR BAD DEBTS.THE HOSPITAL IS DILIGENT IN THE CLASSIFICATION OF AMOUNTS AS CHARITY CARE OR BAD DEBT. WE BELIEVE NONE OF THE AMOUNTS IN BAD DEBT WOULD BE RECLASSIFIED TO CHARITY CARE GIVEN ADDITIONAL INFORMATION.
PART III, LINE 8: THERE IS NO MEDICARE SHORTFALL - AS A CRITICAL ACCESS HOSPITAL, WE ARE REIMBURSED AT 101% OF COST FROM MEDICARE.ALLOWABLE COSTS WERE DETERMINED USING THE COST-TO-CHARGE RATIO FROM MEDICARE COST REPORT.
PART III, LINE 9B: COLLECTIONS ARE PURSUED UP TO THE POINT THAT A PATIENT COMPLETES AND IS APPROVED FOR CHARITY CARE. ONCE CHARITY CARE IS APPROVED, NO FURTHER COLLECTION EFFORTS ARE MADE.
PART VI, LINE 2: SEVERAL GROUPS REQUEST HEALTH FAIRS. THE BOARD AND MANAGEMENT CONSIDERED THE HEALTH NEEDS OF THE COMMUNITY. COMMUNITY MEMBERS HAVE REQUESTED THE PROGRAM.
PART VI, LINE 3: PATIENTS ARE COUNSELED ON AN INDIVIDUAL BASIS IN PERSON OR PHONE CONVERSATION AS TO THE AVAILABILITY OF STATE OR CORPORATE PROGRAMS. AT THE TIME OF REGISTRATION, SELF-PAY PATIENTS ARE INFORMED OF ASSISTANCE AVAILABLE. PATIENT STATEMENTS INDICATE ASSISTANCE THAT IS AVAILABLE.THERE IS ALSO SIGNAGE INDICATING THAT ASSISTANCE PROGRAMS ARE AVAILABLE AND PATIENTS ARE PROVIDED A PAMPHLET AT REGISTRATION WITH THIS INFORMATION.
PART VI, LINE 4: JERSEY SHORE HOSPITAL'S PRIMARY SERVICE AREA COVERS MUCH OF CLINTON COUNTY AND LYCOMING COUNTY - AN AREA WITH A POPULATION OF APPROXIMATELY 40,000. JERSEY SHORE HOSPITAL IS CONSIDERED TO BE IN A MEDICALLY UNDERSERVED AREA (MUA). JERSEY SHORE AND JERSEY SHORE HOSPITAL IS LOCATED IN LYCOMING COUNTY, WHICH HAS AN AREA OF 1,237 SQUARE MILES. IT IS THE LARGEST COUNTY IN PENNSYLVANIA AND OCCUPIES A HILLY AND HEAVILY FORESTED PART OF THE STATE. THE WEST BRANCH OF THE SUSQUEHANNA RIVER FLOWS THROUGH THE SOUTHERN PART OF THE COUNTY. JERSEY SHORE IS APPROXIMATELY 45 MILES NORTHEAST OF STATE COLLEGE PENNSYLVANIA AND APPROXIMATELY 15 MILES WEST OF WILLIAMSPORT, PENNSYLVANIA.SEVENTY-NINE POINT FOUR PERCENT (79.4%) OF JERSEY SHORE HOSPITAL INPATIENTS LIVE IN THE PRIMARY SERVICE AREA (PSA) WHICH IS IN LYCOMING COUNTY AND CLINTON COUNTY, PENNSYLVANIA. THE PRIMARY SERVICE AREA (PSA) FOR JERSEY SHORE HOSPITAL CONSISTS OF FOUR ZIP CODES: 17720 - JERSEY SHORE, 17745 - LOCK HAVEN, 17779 - WOOLRICH AND 17751 - MILL HALL.JERSEY SHORE HOSPITAL RELIES UPON A RELATIVELY SMALL GEOGRAPHIC AREA TO SUPPORT THE HOSPITAL.THE SSA (SECONDARY SERVICE AREA) CONSISTS OF 9 ADDITIONAL ZIP CODES WHICH ARE IMPORTANT TO THE HOSPITAL AND FROM WHICH 17% OF HOSPITALIZED PATIENTS ORIGINATE. THESE ZIP CODES ARE TO THE WEST AND NORTHEAST OF THE PSA.WITHIN A 50 MILE RADIUS OF JSH, TOTAL POPULATION IS EXPECTED TO DECREASE BY 1/4% BY 2015.A MAJOR DEMOGRAPHIC ISSUE AFFECTING JSH IS THE AGING POPULATION. THE NUMBER OF INDIVIDUALS LIVING IN THIS AREA OVER THE AGE OF 65 IS EXPECTED TO INCREASE 7.4% BY 2015. THE NUMBER OF INDIVIDUALS AGES 15 THROUGH 44 IS EXPECTED TO DECREASE BY 7.3% BY 2015.THIS GROWING ELDERLY SEGMENT SHOULD GENERATE A FUTURE DEMAND FOR HEALTH CARE SERVICES, SINCE INDIVIDUALS OVER AGE 65 USE HEALTHCARE AND HOSPITAL SERVICES AT 2.7 TIMES THE RATE OF THE UNDER AGE 65 POPULATION.THE TOTAL SERVICE AREA FOR JERSEY SHORE HOSPITAL HAS A POPULATION OF 103,102 AND IS EXPECTED TO DECREASE IN POPULATION BY 1.2% BY 2012 TO 101,890.A DEMOGRAPHIC REALITY IS THE LOW INCOME LEVEL OF AREA HOUSEHOLDS. CURRENTLY, THE MEDIAN HOUSEHOLD INCOME IN THE SERVICE AREA IS $35,956, COMPARED TO PA ($45,038) AND THE U.S. ($48,250). BY 2012 THE PSA IS ANTICIPATED TO HAVE A MEDIAN HOUSEHOLD INCOME OF $41,006. THIS IS 82% OF THE PENNSYLVANIA STATE AVERAGE HOUSEHOLD INCOME AND CONSIDERABLY BELOW THE NATIONAL AVERAGE.THE SERVICE AREA IS NOT RACIALLY DIVERSIFIED TO A SIGNIFICANT DEGREE, WITH 98.6% OF THE POPULATION CONSIDERED WHITE.THE EDUCATIONAL PROFILE OF THE SERVICE AREA DEMONSTRATES THAT 44% OF THE POPULATION HAS A HIGH SCHOOL EDUCATION AND 7.1% OF THE POPULATION HAS AN ASSOCIATE DEGREE. THE PERCENTAGE ACHIEVING A BACHELOR OR PROFESSIONAL DEGREE IS LESS THAN PENNSYLVANIA OR THE U.S. AS A WHOLE. A HIGHER PERCENTAGE OF THE LABOR FORCE IN THE AREA IS ENGAGED IN MANUFACTURING / CONSTRUCTION WHEN COMPARED TO THE STATE AND US AS A WHOLE.IN TERMS OF PATIENTS SERVED, COMBINED INPATIENT AND OUTPATIENT PAYER MIX IN 2011 REMAINED CONSISTENT WITH PRIOR YEARS. MEDICARE AND MEDICARE ADVANTAGE MAKE UP ABOUT 40% OF OUR PAYORS IN TERMS OF GROSS CHARGES. MEDICAL ASSISTANCE BUSINESS CONTINUED TO HAVE A SIGNIFICANT IMPACT ON JSH AS A CRITICAL ACCESS HOSPITAL. MEDICAL ASSISTANCE PAYMENTS MAKE UP 9.48% OF OUR PAYERS, WHICH IS UP SLIGHTLY FROM 2010.
PART VI, LINE 6: ALL OF THE PERSONS SERVING ON OUR BOARD LIVE IN THE PRIMARY COMMUNITIES BEING SERVED BY THE HOSPITAL. THE BOARD CONSISTS OF SOME PHYSICIANS WHO ARE EMPLOYEES OF A RELATED ENTITY, A FEW CONTRACTORS, AND SEVERAL OTHER COMMUNITY MEMBERS.THE HOSPITAL EXTENDS STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE AREA. AS APPLICABLE, THE HOSPITAL APPLIES SURPLUS FUNDS TO IMPROVEMENTS IN PATIENT CARE THROUGH NEW AND UPDATED EQUIPMENT PURCHASES, MAJOR FACILITY IMPROVEMENTS, AND COMMUNITY HEALTH PROGRAMS.THE HOSPITAL PARTICIPATES IN MEDICARE, MEDICAID, CHAMPUS, AND TRICARE.
PART VI, LINE 7: THE HOSPITAL IS PART OF JERSEY SHORE HOSPITAL FOUNDATION, INC. THIS AFFILIATION INCLUDES A NON-PROFIT PHYSICIAN PRACTICE WITH FAMILY PRACTICE PHYSICIANS AND SURGEONS, AS WELL AS AN URGENT CARE CENTER.PART VI, LINE 7: N/A

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
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 Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (8 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
CAREY PLUMMER
2124220000000744570286879000
CARMEN SPINNEY MD
0159677000000026801018647800
STEVEN KATZ MD
6000411941000000040052600045199300
AARON KOLB MD
2463280000000373070283635000
THOMAS FORKER MD
1691860000000298930199079000
THOMAS BURGE
1771100000000228060199916000
RONALD EISTER
2057910000000341190239910000
OWEN O'HEIR
2032060000000160960219302000

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (9 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
FORM 990, PART VI, SECTION A, LINE 2LEROY KEILER, III, CHAIRPERSON, AND ROB GLUNK,MEMBER, HAVE A BUSINESS RELATIONSHIP.
FORM 990, PART VI, SECTION A, LINE 3THE HOSPITAL UTILIZES THE MANAGEMENT SERVICES OF QUORUM HEALTH SYSTEM.
FORM 990, PART VI, SECTION A, LINE 4JERSEY SHORE HOSPITAL MERGED WITH SHORE PROPERTIES CORP. AND JERSEY SHORE HEALTH SERVICES, INC.
FORM 990, PART VI, SECTION B, LINE 11THE FORM 990 WAS REVIEWED IN DETAIL BY MANAGEMENT BEFORE FILING WITH THE IRS. A COPY OF THE 990 WAS PROVIDED TO ALL BOARD MEMBERS AFTER FILING WITH THE IRS.
ALL BOARD MEMBERS AND EMPLOYEES ARE REQUIRED TO ANNUALLY COMPLETE A CONFLICT OF INTEREST STATEMENT. THESE ARE REVIEWED BY MANAGEMENT. BOARD MEMBERS ARE REQUIRED TO RECUSE THEMSELVES FROM VOTING ON MATTERS THAT ARE RELATED TO ANY POTENTIAL CONFLICTS. THERE HAS NEVER BEEN AN ISSUE INVOLVING CONFLICTS OF INTEREST.FORM 990, PART VI, SECTION B, LINE 12C
ON AN ANNUAL BASIS, THE PERSONNEL SALARY COMMITTEE AND QUORUM (MANAGEMENT COMPANY) REVIEWS AN EXECUTIVE COMPENSATION STUDY PERFORMED BY YAFFEE, AN INDEPENDENT THIRD PARTY WHO IS EMPLOYED BY HAP TO CONDUCT A COMPENSATION STUDY. HR ALSO PROVIDES A COMPENSATION STUDY FROM ACRS WHICH IS BASED ON THE APPALACHIAN REGION. THESE TWO STUDIES ARE USED TO DETERMINE FMV. THE RECOMMENDATIONS FOR COMPENSATION LEVELS ARE PASSED ON TO THE BOARD FOR THEIR APPROVAL. APPROVAL IS DOCUMENTED IN THE MINUTES. THE ACTUAL AMOUNT OF COMPENSATION IS NOT INCLUDED IN THE MINUTES FOR PRIVACY PURPOSES.FORM 990, PART VI, SECTION B, LINE 15
GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST.FORM 990, PART VI, SECTION C, LINE 19
AVERAGE HOURS SPENT PER WEEK FOR JERSEY SHORE HOSPITAL AND ALL RELATED ENTITIES WERE AS FOLLOWS: CAREY PLUMMER - 40 HOURS MARK RICE - 40 HOURS KEN CORNISH - 40 HOURS CARMEN SPINNEY - 40 HOURSFORM 990, PART VII, SECTION A:
CHANGES IN NET ASSETS OR FUND BALANCES:PENSION LIABILITY ADJUSTMENT 1,071,805. CHANGE IN FAIR VALUE OF DERIVATIVE INSTRUMENT -44,054. TRANSFER FROM AFFILIATES PER CORPORATE RESTRUCTURING 1,323,033. TOTAL TO FORM 990, PART XI, LINE 5: 2,350,784.FORM 990, PART XI, LINE 5:

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusDirect Controlling Entity NADirectControllingEntityNAControlled OrgControlledOrgBusiness Name Line1DirectControllingEntityName/BusinessNameLine1
JERSEY SHORE HOSPITAL FOUNDATION INC
1020 THOMPSON STREETJERSEY SHOREPA17740232480603HEALTHCAREPA501(C)(3)3N/A0
SHORE PROPERTIES CORPORATION
1020 THOMPSON STREETJERSEY SHOREPA17740231280605RENTAL INCOMEPA501(C)(3)11A0JERSEY SHORE HOSPITAL FOUNDATION INC

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1JERSEY SHORE AREA HEALTH SERVICES CORPORATIONBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11020 THOMPSON STREETAddressLine1
CityJERSEY SHORECity
StatePAState
ZIP Code17740ZIPCode
FieldValueIRS element (for citing)
EIN232192826EIN
Primary ActivityLABORATORY SERVICESPrimaryActivity
Legal Domicile StatePALegalDomicileState

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1JERSEY SHORE HOSPITAL FOUNDATION INCBusinessNameLine1
FieldValueIRS element (for citing)
Type Of EntityCTypeOfEntity
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 Org1LoansOrGuaranteesToOtherOrg
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 Orgs1RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities1SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org1ReimbursementPaidByOtherOrg
Other Transfer To Other Org1OtherTransferToOtherOrg
Other Transfer From Other Org1OtherTransferFromOtherOrg