2012-03-09T13:45:51-06:00 2011-06-30 CARBIS WALKER LLP 5700 CORPORATE DRIVE STE 650 PITTSBURGH PA 15237 990 2010-07-01 250977902 MINERS HOSPITAL MINE 8142473100 290 HAIDA AVENUE HASTINGS PA 16646 EDWARD DEPASQUALE 8142473100 2012-03-01 1 JEFFREY J PETRELL CPA 4126356270 2012-03-01 2010 2016-02-24 21:20:13Z MINERS MEDICAL CENTER SCOTT BECKER 1086 FRANKLIN STREET JOHNSTOWN PA 15905 19400511 0 X WWW.CONEMAUGH.ORG X 1909 PA TO PROVIDE QUALITY HEALTH CARE TO ANY PERSON REGARDLESS OF RACE, COLOR, CREED, NATIONAL ORIGIN, AGE, SEX, HANDICAP AND/OR ABILITY TO PAY. 19 15 176 16 0 0 162069 332463 17993431 18955411 5255 5727 98984 101472 18259739 19395073 0 0 0 0 7963088 8555140 0 0 0 9718546 9927233 17681634 18482373 578105 912700 6066811 7132436 14009590 12156730 -7942779 -5024294 TO PROVIDE QUALITY HEALTH CARE TO ANY PERSON REGARDLESS OF RACE, COLOR, CREED, NATIONAL ORIGIN, AGE, SEX, HANDICAP AND/OR ABILITY TO PAY. 0 0 15181591 19053341 MINERS HOSPITAL IS A COMMUNITY HOSPITAL SERVING FAMILIES ACROSS RURAL NORTHERN CAMBRIA COUNTY IN SOUTHWESTERN PENNSYLVANIA. THE HOSPITAL SPECIALIZES IN FAMILY AND PRIMARY CARE, AND HAS 30 BEDS FOR MEDICAL/SURGICAL AND INTENSIVE CARE SERVICES.DURING THE FISCAL YEAR ENDING JUNE 30, 2011, THE HOSPITAL ADMITTED 876 PATIENTS; HAD 10,651 EMERGENCY VISITS; AND PERFORMED 2,121 SURGICAL PROCEDURES. ALSO, THE HOSPITAL PROVIDED CHARITY CARE AT COST IN THE AMOUNT OF $188,248. 15181591 1 1 0 1 0 0 0 0 0 0 1 0 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 1 0 0 0 0 0 0 1 0 0 0 0 1 45 0 176 1 0 0 0 0 0 0 0 0 0 0 X 19 15 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 PA X EDWARD DEPASQUALE 8144108271 1086 FRANKLIN STREET JOHNSTOWN PA 15905 X PATRICIA SEROTKIN 1.00 X X 0 0 0 WILLIAM DURYEA 1.00 X X 0 0 0 SALVATORE VALENTY 1.00 X X 0 0 0 TIMOTHY WHITED 1.00 X X 0 0 0 CHARLES ERTTER 1.00 X X 0 0 0 JOHN BEM 1.00 X 0 0 0 GLENN BOWMAN 1.00 X 0 0 0 ROBERT DATSKO 1.00 X 0 0 0 M VIRGINIA ECKENRODE 1.00 X 0 0 0 JULIANNA FRONTINO 1.00 X 0 0 0 R SCOTT MAGLEY MD 1.00 X 0 134325 27680 THOMAS MARINO 1.00 X 0 0 0 RAYMOND PONCHIONE 1.00 X 0 0 0 JOHN REZK 1.00 X 0 0 0 JOHN ROUSE 1.00 X 0 0 0 ALAN STANKIEWICZ DO 1.00 X 0 0 0 STEVEN TUCKER 3.00 X X 0 531509 35347 PEGGY WATKINS 1.00 X 0 0 0 GEORGE WEBER MD 1.00 X 0 112648 19235 JOSEPH SABO MD 40.00 X 177943 0 75331 SCOTT BECKER 1.00 X 0 1236437 42969 EDWARD DEPASQUALE 1.00 X 0 538638 35167 DAVID CARLSON DO 4.00 X 0 678102 30611 JOSEPH DADO 2.00 X 0 442586 16131 WILLIAM CROWE 50.00 X 243944 0 23401 MARY WYLAND 40.00 X 105180 0 33447 527067 3674245 339319 3 0 1 0 MEMORIAL MEDICAL CENTER 1086 FRANKLIN STREET JOHNSTOWN PA 15905 FINANCIAL, IT, LAB, CLINICAL DOC, CLINIC 1260889 CONEMAUGH HEALTH INITIATIVES 1086 FRANKLIN STREET JOHNSTOWN PA 15905 PHYSICIAN, OFFICE STAFF, COLLECTION 1101803 ALLIANCE HEALTHCARE SERVICES PO BOX 96485 CHICAGO IL 60693 MRI 266323 SAFARI CONTRACT CLEANERS 111 ROOSEVELT BOULEVARD JOHNSTOWN PA 15906 CLEANING 235870 MAYO COLLABORATIVE SERVICE PO BOX 9146 MINNEAPOLIS MN 55480 LAB 147211 6 21802 310661 332463 PATIENT SERVICES 900099 18934045 18934045 MEDICAL SVC RM REV 900099 20937 20937 RENTAL INCOME 900099 429 429 18955411 5727 5727 8980 5438 3542 3542 CAFETERIA SALES 900099 74673 74673 PHARMACY SALES 900099 8019 8019 15238 15238 97930 19395073 19053341 0 9269 431072 181092 249980 5394922 4489646 905276 1212147 1007173 204974 1108786 921290 187496 408213 339184 69029 225847 225847 44807 44807 900 900 4800 4800 1591576 1528329 63247 10805 1851 8954 53962 35315 18647 17003 17003 569755 496378 73377 15218 11133 4085 11129 2760 8369 172376 172376 386435 326306 60129 346957 288460 58497 PURCHASED SERVICES 2380448 1539421 841027 PATIENT CARE SUPPLIES 1340416 1340416 BAD DEBT 1140929 1140929 MAINTENANCE 526156 473974 52182 FOOD 143370 51818 91552 944344 833740 110604 18482373 15181591 3300782 0 14785 563 1034148 1700775 1630320 1608551 333787 366023 83754 48701 20136128 17108824 2780170 3027304 8576 4926 181271 375593 6066811 7132436 8438518 7152022 141769 72057 4116842 3827034 1312461 1105617 14009590 12156730 X -8025609 -5111214 82830 86920 -7942779 -5024294 6066811 7132436 X 912700 2005785 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 900 900 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: THE HOSPITAL PAID ANNUAL DUES TO THE HOSPITAL COUNCIL OF WESTERN PA (HCWP), A 501(C)(6) CORPORATION. ACCORDING TO HCWP, FIFTEEN PERCENT OF DUES WERE UTILIZED FOR LOBBYING AND PUBLIC POLICY DEVELOPMENT. 102879 102879 7909855 6418310 1491545 10927947 9642635 1285312 1195447 1047879 147568 3027304 BOARD DESIGNATED INVESTMENTS 65349 MORTGAGE ISSUE COSTS 33714 CHF FAS 136 RECEIVABLE 86920 DUE FROM MA 189610 375593 DUE TO CONEMAUGH HEALTH SYSTEM 116496 DUE TO MC 368030 DUE TO MEMORIAL MEDICAL CENTER 567104 DUE TO CONEMAUGH HEALTH INITIATIVES, INC. 53987 1105617 1 1 X 1 X 1 X 0.0 1 1 0 0 188248 188248 0.01090 1861137 1359095 502042 0.02900 12102 5988 6114 0.00040 2061487 1365083 696404 0.04030 11050 315 10735 0.00060 2491 2491 0.00010 13541 315 13226 0.00070 2075028 1365398 709630 0.04100 0 399325 308798 5624425 5522808 101617 X 1 0 1 1 MINERS HOSPITAL

290 HAIDA AVENUE HASTINGS PA 16646

X X X NOT REQUIRED 1 PART I, LINE 7: THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS REPORTED ON PART I, LINES 7A, 7B, AND 7C WAS BASED ON THE CONEMAUGH HEALTH SYSTEM'S COST ACCOUNTING SYSTEM AND ADDRESSES ALL PATIENT SEGMENTS. FOR FURTHER DETAILS OF THIS SYSTEM, SEE THE DESCRIPTION FOR PART III, LINE 8. THE METHODOLOGY USED TO CALCULATE THE AMOUNTS REPORTED ON PART I, LINES 7E THROUGH 7I AS APPLICABLE, WAS BASED ON ACTUAL REVENUES AND EXPENSES INCURRED. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 1140929. PART III, LINE 4: PATIENT ACCOUNTS RECEIVABLE FOR SERVICES RENDERED ARE REPORTED AT NET REALIZABLE AMOUNTS FROM THIRD-PARTY PAYERS, PATIENTS AND OTHERS. CONEMAUGH HEALTH SYSTEM (CHS) PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED UPON A REVIEW OF OUTSTANDING RECEIVABLES, HISTORICAL COLLECTION INFORMATION AND EXISTING ECONOMIC CONDITIONS. AS A SERVICE TO THE PATIENT, CHS BILLS THIRD-PARTY PAYERS DIRECTLY AND BILLS THE PATIENT WHEN THE PATIENT'S LIABILITY IS DETERMINED. PATIENT ACCOUNTS RECEIVABLE ARE DUE IN FULL WHEN BILLED. ACCOUNTS ARE CONSIDERED DELINQUENT AND SUBSEQUENTLY WRITTEN OFF AS BAD DEBTS BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE ACCOUNT.THE METHODOLOGY UTILIZED TO DETERMINE THE AMOUNT REPORTED ON LINE 2 IS BASED ON THE ORGANIZATION'S COST TO CHARGE RATIO. THE METHODOLOGY FOR LINE 3 IS BASED ON A PREDICTIVE ANALYSIS SCORING SYSTEM DEVELOPED BY ACUMEN THAT HAS BEEN IMPLEMENTED AS PART OF THE HEALTH SYSTEM'S PRESUMPTIVE CHARITY CARE PROGRAM. THE SCORING PROGRAM CONSISTS OF A FOUR DIGIT SCORE; THE FIRST TWO DIGITS ARE BASED UPON THE FEDERAL POVERTY GUIDELINES AND THE LAST TWO DIGITS ARE THE PROBABILITY/PROPENSITY TO PAY SCORE. THE PERCENTAGES INCLUDED ON THE 990 HAVE BEEN DERIVED BY FOUR MONTHS OF ACTUAL EXPERIENCE (JULY-OCTOBER 2011) OF ACCOUNTS THAT HAVE GONE THROUGH THE NORMAL BILLING CYCLE OF 120 DAYS; BEING SCORED AND CONSIDERED FOR PRESUMPTIVE CHARITY CARE VS. SENDING TO COLLECTION AGENCY. THE ACCOUNTS THAT WERE SELECTED AND INCLUDED FOR PRESUMPTIVE CHARITY CONSIDERATION WERE BASED ON MEDIAN HOUSEHOLD INCOME AND AVERAGE HOUSEHOLD SIZE THAT FELL BELOW 150% OF THE FEDERAL POVERTY GUIDELINES. THAT SAME PERCENTAGE EXPERIENCE IS BEING APPLIED TO THE FISCAL YEAR 2011 BAD DEBT EXPENSE TO DERIVE AN AMOUNT THAT COULD POTENTIALLY QUALIFY FOR CHARITY CARE. PART III, LINE 8: CONEMAUGH HEALTH SYSTEM UTILIZES MCKESSON'S HORIZON PERFORMANCE MANAGER (HPM) FOR COST ACCOUNTING. HPM PROVIDES THE ABILITY TO ALLOCATE ALL DEPARTMENTAL EXPENSES AT THE INDIVIDUAL CHARGE FOR EACH CHARGING DEPARTMENT, AS WELL AS ALLOCATE OVERHEAD EXPENSES IN A CONSISTENT MANNER. THE ENCOUNTER COSTING FUNCTIONALITY OF HPM PROVIDES THE ABILITY TO THEN DETERMINE AN ACCURATE ESTIMATE OF COST AT THE PATIENT LEVEL BASED ON THE CHARGE UNIT COSTS. THE SYSTEM THEN PROVIDES THE ABILITY TO SUMMARIZE THE PATIENT VOLUME, CHARGES, AND COSTS IN ANY NUMBER OF WAYS, INCLUDING PAYER SPECIFIC COST ALLOCATION. PART I, LINE 3B: THE ORGANIZATION USES A SLIDING SCALE TO DETERMINE ELIGIBILITY FOR DISCOUNTED CARE. PART VI, LINE 2: CHS IS AN ACTIVE MEMBER OF THE COMMUNITY AND AN ADVOCATE FOR THE HEALTH, WELL BEING, AND ECONOMIC STRENGTH OF THE REGION. CHS ADMINISTRATORS HAVE TEAMED UP WITH THE UNITED WAY OF THE LAUREL HIGHLANDS OVER THE PAST FEW YEARS TO IDENTIFY COMMUNITY NEEDS. THIS YEAR, CHS INVESTED NEARLY 1,000 HOURS OF WORK INTO A COMMUNITY NEEDS ANALYSIS FOR CAMBRIA AND SOMERSET COUNTIES. THIS INCLUDED DOZENS OF INTERVIEWS OF AREA LEADERS, HEALTHCARE PROFESSIONALS, EDUCATORS, CLERGY, AND SOCIAL SERVICE PROFESSIONALS. THE FINDINGS HAVE BEEN SHARED WITH THE BOARDS OF CONEMAUGH HEALTH SYSTEM, THE UNTIED WAY OF THE LAUREL HIGHLANDS, AND OVER 20 HUMAN SERVICES AGENCIES. THE 70 PAGE FINAL REPORT WILL BE SHARED WITH COMMUNITY LEADERS AND A CONDENSED HIGHLIGHT VERSION WILL BE RELEASED TO THE MEDIA. THE UNITED WAY HAS BEGUN TO REDIRECT FUNDING TO KEY AREAS OF NEED INCLUDING: PROGRAMS TO HELP CHILDREN STAY IN SCHOOL TO INCREASE THEIR POTENTIAL TO BE SUCCESSFUL; DRUG AND ALCOHOL PROGRAMS; AND MENTAL HEALTH PROGRAMS. CONEMAUGH AND THE UNITED WAY WILL PERIODICALLY MEASURE COMMUNITY IMPACT.IN ADDITION TO PROVIDING THE COMMUNITY NEEDS REPORT, VARIOUS CHS LEADERS HAVE SERVED IN MANY ROLES FOR THE UNITED WAY INCLUDING CHAIRMAN OF THE BOARD, CHAIRMAN OF THE COMMUNITY IMPACT COMMITTEE, AND PARTICIPATION IN THE LOANED EXECUTIVE PROGRAM. SENIOR LEADERS AND DIRECTORS THROUGHOUT THE HEALTH SYSTEM ARE ALSO ENCOURAGED TO SERVE ON OTHER COMMUNITY BOARDS AND ORGANIZATIONS. SOME OF THOSE REPRESENTED INCLUDE THE AMERICAN RED CROSS, THE LEUKEMIA AND LYMPHOMA SOCIETY, THE JOHNSTOWN SYMPHONY, WOMEN'S HELP CENTER, JUNIOR ACHIEVEMENT, LAUREL HIGHLANDS FOOD PANTRY, AND THE GREATER JOHNSTOWN YMCA. PART VI, LINE 3: CONEMAUGH HEALTH SYSTEM COMMUNICATES TO PATIENTS THE AVAILABILITY OF FINANCIAL ASSISTANCE UNDER FEDERAL, STATE AND LOCAL PROGRAMS, AS WELL AS THE CHARITY CARE PROGRAM, ON OUR WEBSITE, WHICH INCLUDES A DOWNLOADABLE CHARITY CARE APPLICATION AND INSTRUCTIONS. TABLE TOP BROCHURES ARE PROVIDED AT ALL POINTS OF REGISTRATION, AND BROCHURES ARE INCLUDED IN PATIENT ADMISSION PACKETS. INFORMATION ON THE AVAILABILITY OF FINANCIAL ASSISTANCE IS ALSO INCLUDED ON PATIENT STATEMENTS. ASSISTANCE IS PROVIDED TO PATIENTS TO APPLY FOR MEDICAL ASSISTANCE THROUGH A THIRD-PARTY VENDOR. A ROBUST FINANCIAL COUNSELING AND CUSTOMER SERVICE DEPARTMENT IS AVAILABLE TO HANDLE SPECIFIC PATIENT NEEDS. PART VI, LINE 4: MINERS HOSPITAL (MINERS) IS A 30 BED, STATE-OF-THE-ART COMMUNITY HOSPITAL SERVING FAMILIES ACROSS RURAL NORTHERN CAMBRIA COUNTY. IT IS THE REGION'S SOLE HOSPITAL AND SPECIALIZES IN FAMILY AND PRIMARY CARE. ITS PARTNERSHIP WITH THE CONEMAUGH VALLEY MEMORIAL HOSPITAL MEANS THAT ITS SMALL SIZE IS NO BARRIER TO PROVIDING PATIENTS WITH ACCESS TO SPECIALISTS OR NEW TECHNOLOGIES. IN FACT, SPECIALTY SERVICES ARE AVAILABLE ONSITE SEVERAL TIMES PER WEEK.MINERS PROVIDES 24/7 EMERGENCY CARE AND HAS GENERAL AND ORTHOPEDIC SURGEONS ON SITE. LABORATORY SERVICES ARE PERFORMED AROUND THE CLOCK AND THERE IS AN ONSITE PHARMACY ENHANCING PATIENT CARE. ACCOMMODATIONS HAVE BEEN MADE TO IMPROVE ACCESS FOR PATIENTS NEEDING RADIOLOGY SERVICES BY OFFERING CT SCAN, ULTRASOUND, MAMMOGRAPHY, AND MOBILE MRI AS WELL AS ROUTINE RADIOLOGY STUDIES. PATHOLOGY, PHYSICAL THERAPY AND RESPIRATORY CARE ARE AVAILABLE AT MINERS AS WELL AS OB/GYN OUTPATIENT CARE.PHYSICIAN SPECIALISTS VISIT PATIENTS AT MINERS SEVERAL TIMES PER WEEK OR MONTH INCLUDING CARDIOLOGY, UROLOGY, OPHTHALMOLOGY, GASTROENTEROLOGY, NEPHROLOGY, NEUROLOGY AND PULMONOLOGY. THIS IS DONE FOR THE CONVENIENCE OF PATIENTS AND TO CUT DOWN ON TRAVEL TIME FOR PATIENTS.DEMOGRAPHICALLY, NEARLY 20 PERCENT OF RESIDENTS IN THE CONEMAUGH HEALTH SYSTEM SERVICE AREA ARE 65 OR OLDER, ONE OF THE HIGHEST PERCENTAGES IN THE STATE AND WELL ABOVE THE PENNSYLVANIA AVERAGE OF 15.3 PERCENT. THE PAYOR MIX FOR OUR REGION IS SKEWED HEAVILY TOWARD MEDICARE AND MEDICAID. AT 9.7 PERCENT, THE CONEMAUGH HEALTH SYSTEM'S SERVICE AREA HAS ONE OF THE STATE'S HIGHEST UNEMPLOYMENT RATES, AND MEDIAN HOUSEHOLD INCOMES OF $34,000 LAG 30 PERCENT BEHIND STATE AND NATIONAL AVERAGES. THE DEMOGRAPHIC MAKE UP OF THE REGION IS CONSIDERED WHEN PLANNING EDUCATION OPPORTUNITIES AND HEALTH INFORMATION PROGRAMS.THE CONEMAUGH HEALTH SYSTEM'S COVERAGE REGION ALSO PRESENTS SOME GEOGRAPHIC CHALLENGES. MOUNTAINOUS TOPOGRAPHY AND HIGHWAY INFRASTRUCTURE MAKE TIMELY TRAVEL A CONCERN FOR SOME PATIENTS. CHS CONTINUES TO LOOK FOR OPPORTUNITIES TO BRING PRIMARY CARE AND PHYSICIAN SPECIALISTS TO RURAL REGIONS OF THE MARKET. IN THE PAST YEAR, A CONCENTRATED EFFORT HAS BEEN MADE TO DEVELOP AND DELIVER HEALTH AND WELLNESS EDUCATION AND SCREENINGS TO CONSTITUENTS IN RURAL REGIONS. WHEN POSSIBLE, CHS TEAMS UP WITH OTHER COMMUNITY ORGANIZATIONS TO DELIVER THESE PROGRAMS AND SERVICES TO RURAL CONSTITUENTS. PART VI, LINE 6: THE CONEMAUGH HEALTH SYSTEM, WHICH INCLUDES MINERS HOSPITAL, IS THANKFUL FOR SUPPORT FROM THE LOCAL COMMUNITY IN THE FORM OF BOARD OF DIRECTOR PARTICIPATION. THE CHS BOARDS ARE MADE UP OF A WIDE VARIETY OF COMMUNITY LEADERS REPRESENTING A NUMBER OF INDUSTRIES INCLUDING BANKING, COMMUNICATION, INDUSTRIAL, EDUCATION, AND CUSTOMER SERVICE. PHYSICIAN LEADERS ARE ALSO INCLUDED ON THE BOARD, SOME WITH TIES TO THE CONEMAUGH HEALTH SYSTEM AND OTHERS WHO ARE INDEPENDENT. VALUABLE INPUT ALSO COMES FROM OUR PATIENT ADVISORY COMMITTEE; A VOLUNTEER BOARD OF PASSIONATE COMMUNITY MEMBERS WHO ARE DEDICATED TO PROVIDING SUGGESTIONS FOR INNOVATIVE SOLUTIONS TO IMPROVE THE PATIENT EXPERIENCE. MEDICAL STAFF PRIVILEGES ARE EXTENDED TO CLOSE TO 400 PHYSICIANS THROUGHOUT A WIDE GEOGRAPHIC REGION IN BOTH PRIMARY CARE AND SPECIALTY FIELDS. IN THE PAST YEAR, GREAT ENERGY, EFFORT, AND FINANCIAL SUPPORT HAVE BEEN DEDICATED TO A NUMBER OF KEY INITIATIVES DESIGNED TO IMPROVE PATIENT CARE. FOR EXAMPLE: $2.6 MILLION DOLLARS WAS USED TO BRING DIGITAL MAMMOGRAPHY EQUIPMENT TO PATIENTS IN OUR REGION WITH EIGHT NEW DIGITAL MAMMOGRAPHY UNITS INSTALLED IN SIX DIFFERENT HEALTH SYSTEM LOCATIONS; A WOUND HEALING CENTER WAS ADDED TO A THIRD LOCATION TO BETTER SERVE PATIENTS IN THE NORTHERN PORTION OF OUR COVERAGE AREA; CONEMAUGH REGIONAL HOSPICE ADDED A HELPING HEARTS PROGRAM TO ASSIST THOSE PATIENT SUFFERING FROM CONGESTIVE HEART FAILURE; A BRAND NEW WEBSITE WAS LAUNCHED PROVIDING MORE EDUCATIONAL RESOURCES AND SUPPORT GROUP INFORMATION FOR THE COMMUNITY; AND A NUMBER OF WELLNESS EVENTS AND SCREENINGS TOOK PLACE THROUGHOUT THE REGION TO RAISE AWARENESS AND PREVENTION FOR HEALTH ISSUES INCLUDING DIABETES, OBESITY, HEART DISEASE, AND PERIPHERAL VASCULAR DISEASE. MINERS HOSPITAL TAKES PART IN A NUMBER OF COMMUNITY ACTIVITIES EACH YEAR. THESE INCLUDE A KID SKINS SPORTS PHYSICAL PROGRAM, WHICH PROVIDES FREE PHYSICALS FOR APPROXIMATELY 150 YOUNGSTERS PARTICIPATING IN FALL SPORTS. PHYSICIANS AND OTHER CLINICAL STAFF VOLUNTEER THEIR TIME FOR THIS INITIATIVE.INTERNSHIPS AND EDUCATIONAL OPPORTUNITIES ARE OFFERED TO VARIOUS TYPES OF STUDENTS INCLUDING PHYSICIAN ASSISTANT, RN, LPN, PHARMACY, RADIOLOGY TECHNOLOGY, PHLEBOTOMY AND HEALTHCARE ADMINISTRATION THROUGH PARTNERSHIPS WITH VARIOUS EDUCATIONAL INSTITUTIONS INCLUDING THE LAKE ERIE COLLEGE OF OSTEOPATHIC MEDICINE, ST. FRANCIS UNIVERSITY, MOUNT ALOYSIUS COLLEGE AND THE PENNSYLVANIA HIGHLANDS COMMUNITY COLLEGE.SMOKING CESSATION, WEIGHT MANAGEMENT AND DIABETES EDUCATION CLASSES ARE ALL OFFERED AT MINERS HOSPITAL TO HELP PATIENTS IN THE NORTHERN CAMBRIA COUNTY REGION RECEIVE EDUCATION TO HELP THEM MAKE HEALTHY CHOICES. IN ADDITION, VARIOUS FREE SCREENINGS HAVE TAKEN PLACE AT MINERS; THIS INCLUDES BLOOD, RESPIRATORY AND VASCULAR SCREENINGS.MINERS HOSPITAL FACILITY HIGHLIGHTS:LICENSED PATIENT BEDS - 30PATIENT DAYS OF SERVICE - 3,747INPATIENT DAILY CENSUS - 10ADJUSTED PATIENT DAYS - 16,804ADMISSIONS - 876AVERAGE LENGTH OF STAY - 4FULL TIME EQUIVALENT EMPLOYEES - 131VOLUNTEERS - 16PHYSICIANS:ACTIVE - 12COURTESY - 33CONSULTING - 28ALLIED HEALTH - 19SERVICES:EMERGENCY VISITS - 10,651INPATIENT SURGERIES - 313SAME DAY/AMBULATORY SURGERIES - 1,808OUTPATIENT CLINIC VISITS - 50,699LABORATORY TESTS - 204,008RADIOLOGY EXAMS - 11,419ULTRASOUND PROCEDURES - 4,597CT SCANS - 4,007MRI PROCEDURES - 573NUCLEAR MEDICINE EXAMS - 840RESPIRATORY THERAPY PROCEDURES - 45,628EKG'S, EEG'S, HOLTERS - 3,259SHORT PROCEDURE UNIT VISITS - 2,072 X X X X X 0 1 0 0 0 1 1 0 0 R SCOTT MAGLEY MD 0 130965 0 0 0 3360 0 10187 0 17493 0 162005 0 0 STEVEN TUCKER 0 313307 0 66488 0 151714 0 19435 0 15912 0 566856 0 97025 JOSEPH SABO MD 175804 0 0 0 2139 0 66813 0 8518 0 253274 0 0 0 SCOTT BECKER 0 571461 0 210076 0 454900 0 13224 0 29745 0 1279406 0 204798 EDWARD DEPASQUALE 0 313637 0 66488 0 158513 0 18798 0 16369 0 573805 0 98604 DAVID CARLSON DO 0 400722 0 86056 0 191324 0 12606 0 18005 0 708713 0 103693 JOSEPH DADO 0 254066 0 53829 0 134691 0 13099 0 3032 0 458717 0 80488 WILLIAM CROWE 152045 0 24616 0 67283 0 11786 0 11615 0 267345 0 37989 0 PART I, LINE 4B THE CONEMAUGH HEALTH SYSTEM'S 457(F) EXECUTIVE COMPENSATION PROGRAM WAS TERMINATED DECEMBER 10, 2010 RESULTING IN A TAXABLE EVENT. ON THAT DATE, EACH PARTICIPANT'S ENTIRE ACCOUNT BALANCE WAS RECOGNIZED AS TAXABLE INCOME PER IRS REGULATIONS. THESE AMOUNTS, WHICH ARE INCLUDED ON THE 990 CORE FORM AND SCHEDULE J AS REPORTABLE COMPENSATION ARE AS FOLLOWS: $136,362 FOR STEVEN TUCKER; $65,058 FOR WILLIAM CROWE; $430,918 FOR SCOTT BECKER; $148,478 FOR EDWARD DEPASQUALE; $180,982 FOR DAVID CARLSON, DO; AND $130,649 FOR JOSEPH DADO. PLEASE NOTE THAT THESE AMOUNTS LESS ALL APPLICABLE TAXES, WHICH HAVE BEEN REMITTED UPON THE PLAN'S TERMINATION, WILL NOT BE DISTRIBUTED TO THE PARTICIPANTS UNTIL ONE YEAR AND ONE DAY AFTER THE TERMINATION DATE HAS PASSED. PART I, LINE 6 WILLIAM CROWE RECEIVED A BONUS FROM MINERS HOSPITAL. SCOTT BECKER, EDWARD DEPASQUALE, DAVID CARLSON, DO, AND JOSEPH DADO RECEIVED A BONUS FROM THE CONEMAUGH HEALTH SYSTEM, A RELATED ORGANIZATION. STEVEN TUCKER RECEIVED A BONUS FROM MEMORIAL MEDICAL CENTER, A RELATED ORGANIZATION. EXECUTIVE BONUSES ARE CALCULATED AS A PERCENTAGE OF BASE SALARY. THE PERCENTAGE IS CONTINGENT ON VARIOUS FINANCIAL AND NON-FINANCIAL CRITERIA, GOVERNED BY THE EXECUTIVE COMPENSATION COMMITTEE OF THE BOARD OF CONEMAUGH HEALTH SYSTEM. SUPPLEMENTAL INFORMATION PART III PART II, COLUMN F: PAST CONTRIBUTIONS MADE TO THE 457(F) PLAN ARE INCLUDED AS REPORTABLE COMPENSATION IN THE CURRENT YEAR DUE TO THE PLAN'S TERMINATION. AMOUNTS SHOWN REPRESENT CONTRIBUTIONS THAT WERE RECOGNIZED AS DEFERRED COMPENSATION ON PAST FORM 990S. DEBORAH WHITED FAMILY MEMBER OF TIMOTHY WHITED (TRUSTEE) 53500 EMPLOYMENT 0 FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBERS OF MINERS HOSPITAL ARE THE NORTHERN CAMBRIA HEALTHCARE FOUNDATION AND THE CONEMAUGH HEALTH SYSTEM, INC. FORM 990, PART VI, SECTION A, LINE 7A THE CONEMAUGH HEALTH SYSTEM, INC. HAS THE POWER TO APPROVE OR DISAPPROVE THE ELECTION OF OR REMOVAL OF MEMBERS OF THE GOVERNING BODY. FORM 990, PART VI, SECTION A, LINE 7B ALL DECISIONS OF THE GOVERNING BODY OF MINERS HOSPITAL ARE SUBJECT TO APPROVAL BY THE CONEMAUGH HEALTH SYSTEM, INC. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS PROVIDED TO THE ORGANIZATION'S BOARD OF DIRECTORS BEFORE IT IS FILED. ONCE THE FORM IS COMPLETE, BOARD MEMBERS ARE GIVEN THE OPPORTUNITY TO REVIEW THE CONTENTS OF THE FORM AND SUBMIT ANY COMMENTS OR QUESTIONS. IN ADDITION, SINCE THE ORGANIZATION IS A SUBSIDIARY WITHIN A LARGER HEALTH SYSTEM, THE FORM IS REVIEWED BY THE HEALTH SYSTEM'S MANAGER, TAX & COMPLIANCE; DIRECTOR, FINANCIAL OPERATIONS; VICE PRESIDENT, FINANCIAL OPERATIONS; CHIEF FINANCIAL OFFICER; AND THE AUDIT AND COMPLIANCE COMMITTEE. AN EXTERNAL CPA FIRM IS ENGAGED TO REVIEW AND ELECTRONICALLY FILE THE RETURN. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION IS A SUBSIDIARY OF A LARGER HEALTH SYSTEM AND IS GOVERNED BY THE SYSTEM'S CONFLICT OF INTEREST POLICY, WHICH HAS BEEN APPROVED BY THE HEALTH SYSTEM'S BOARD. UNDER THIS POLICY, EVERY BOARD MEMBER IS GIVEN A COPY OF THE POLICY AS WELL AS A FORM THAT MUST BE COMPLETED ON AN ANNUAL BASIS. NO BOARD MEMBER IS APPROVED OR RE-APPOINTED UNTIL HE OR SHE HAS COMPLETED AND SIGNED THE CONFLICT OF INTEREST FORM. ONCE THE FORM IS RETURNED, IT IS REVIEWED BY THE SYSTEM'S COMPLIANCE OFFICER AND CEO. IF ANY CONFLICTS ARE DISCLOSED, THE DETAILS ARE FORWARDED TO THE BOARD CHAIR TO BE ADDRESSED. DEPENDING ON THE CONFLICT, THE BOARD MEMBER COULD BE GIVEN CERTAIN RESTRICTIONS, SUCH AS BEING PROHIBITED FROM PARTICIPATING IN CERTAIN BOARD DECISIONS. THE HEALTH SYSTEM'S AUDIT AND COMPLIANCE COMMITTEE HAS THE FINAL DECISION-MAKING REGARDING ALL CONFLICTS OF INTEREST. THROUGHOUT THE FISCAL YEAR, BOARD MEMBERS MUST NOTIFY THE BOARD CHAIR, COMPLIANCE OFFICER, AND/OR CEO IF A NEW CONFLICT OF INTEREST HAS DEVELOPED. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION'S PARENT, A HEALTH SYSTEM, MANAGES THE DETERMINATION OF COMPENSATION AND THE PROCESS IS OUTLINED IN ITS BYLAWS. AN OUTSIDE CONSULTING FIRM IS UTILIZED TO ENSURE THAT EXECUTIVE COMPENSATION PACKAGES ARE FAIR AND COMPARABLE WITH SIMILAR ORGANIZATIONS. THE HEALTH SYSTEM HAS ALSO ESTABLISHED AN EXECUTIVE COMPENSATION COMMITTEE TO REVIEW AND RECOMMEND THE COMPENSATION DECISIONS MADE. THIS COMMITTEE REPORTS DIRECTLY TO THE HEALTH SYSTEM'S BOARD. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION IS PART OF A HEALTH SYSTEM AND ALL REQUESTS FOR THIS INFORMATION ARE HANDLED BY THE SYSTEM'S MARKETING/PUBLIC RELATIONS DEPARTMENT. FORM 990, PART VI, LINES 12A, 13, AND 14: ALL APPLICABLE POLICY QUESTIONS HAVE BEEN ANSWERED YES SINCE THE ORGANIZATION IS A SUBSIDIARY OF A LARGER HEALTH SYSTEM AND IS GOVERNED BY THE SYSTEM'S POLICIES. ALL POLICIES HAVE BEEN APPROVED BY THE HEALTH SYSTEM'S BOARD. FORM 990, PART VII, SECTION A, LINE 1A, COLUMN B: IN ADDITION TO THE HOURS DEVOTED TO THE FILING ORGANIZATION SHOWN IN PART VII, THE FOLLOWING OFFICERS AND TRUSTEES ALSO DEVOTED HOURS TO RELATED ORGANIZATIONS DURING THE YEAR. THE HOURS SHOWN REPRESENT THE AVERAGE NUMBER OF HOURS PER WEEK. SCOTT BECKER, CEO: CONEMAUGH HEALTH SYSTEM - 53 CONEMAUGH VALLEY MEMORIAL HOSPITAL - 4 MEYERSDALE COMMUNITY HOSPITAL - 1 GOOD SAMARITAN MEDICAL CENTER - 0.3 CONEMAUGH HEALTH FOUNDATION - 3.5 CONEMAUGH HOUSING, INC. - 0.2 CONEMAUGH HEALTH INITIATIVES - 7 EDWARD DEPASQUALE, CFO: CONEMAUGH HEALTH SYSTEM - 22 CONEMAUGH VALLEY MEMORIAL HOSPITAL - 14 MEYERSDALE COMMUNITY HOSPITAL - 1 GOOD SAMARITAN MEDICAL CENTER - 1 CONEMAUGH HEALTH FOUNDATION - 0.5 CONEMAUGH HOUSING, INC. - 0.5 CONEMAUGH HEALTH INITIATIVES - 10 DAVID CARLSON, DO, CMO: CONEMAUGH HEALTH SYSTEM - 20 CONEMAUGH VALLEY MEMORIAL HOSPITAL - 10 MEYERSDALE COMMUNITY HOSPITAL - 4 GOOD SAMARITAN MEDICAL CENTER - 0.5 CONEMAUGH HEALTH FOUNDATION - 0.5 CONEMAUGH HOUSING, INC. - 1 CONEMAUGH HEALTH INITIATIVES - 10 JOSEPH DADO, CIO: CONEMAUGH HEALTH SYSTEM - 20 CONEMAUGH VALLEY MEMORIAL HOSPITAL - 16 MEYERSDALE COMMUNITY HOSPITAL - 2 GOOD SAMARITAN MEDICAL CENTER - 1 CONEMAUGH HEALTH FOUNDATION - 1 CONEMAUGH HEALTH INITIATIVES - 8 STEVEN TUCKER, COO: CONEMAUGH HEALTH SYSTEM - 15 CONEMAUGH VALLEY MEMORIAL HOSPITAL - 25 MEYERSDALE COMMUNITY HOSPITAL - 3 GOOD SAMARITAN MEDICAL CENTER - 1 CONEMAUGH HEALTH FOUNDATION - 0.5 CONEMAUGH HOUSING, INC. - 1 CONEMAUGH HEALTH INITIATIVES - 1.5 R. SCOTT MAGLEY, MD: CONEMAUGH HEALTH INITIATIVES - 40 GEORGE WEBER, MD: CONEMAUGH HEALTH INITIATIVES - 40 CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 11,618. PENSION ADJUSTMENT 1,990,077. CHANGE IN CHF FAS 136 RECEIVABLE 4,090. TOTAL TO FORM 990, PART XI, LINE 5: 2,005,785. FORM 990, PART XI, LINE 2: THE ORGANIZATION'S FINANCIAL STATEMENTS FOR THE FISCAL YEAR ENDING JUNE 30, 2011 WERE AUDITED AS PART OF THE AUDIT OF THE CONSOLIDATED FINANCIAL STATEMENTS OF THE CONEMAUGH HEALTH SYSTEM, INC. AND SUBSIDIARIES. THE HEALTH SYSTEM'S AUDIT AND COMPLIANCE COMMITTEE ASSUMES RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT AND THE SELECTION OF THE INDEPENDENT ACCOUNTANT. CONEMAUGH HEALTH SYSTEM 1086 FRANKLIN STREET JOHNSTOWN PA 15905 232801799 SUPPORT MEMBER HOSPITALS PA 501(C)(3) 11A N/A 0 CONEMAUGH VALLEY MEMORIAL HOSPITAL DBA MEMORIAL MEDICAL CTR 1086 FRANKLIN STREET JOHNSTOWN PA 15905 250965307 HEALTHCARE SERVICES PA 501(C)(3) 3 CONEMAUGH HEALTH SYSTEM 0 GOOD SAMARITAN MEDICAL CENTER 1020 FRANKLIN STREET JOHNSTOWN PA 15905 250965428 HEALTHCARE SERVICES PA 501(C)(3) 3 CONEMAUGH HEALTH SYSTEM 0 MEYERSDALE COMMUNITY HOSPITAL DBA MEYERSDALE MEDICAL CENTER 200 HOSPITAL DRIVE MEYERSDALE PA 15552 251002946 HEALTHCARE SERVICES PA 501(C)(3) 3 CONEMAUGH HEALTH SYSTEM 0 CONEMAUGH HEALTH FOUNDATION 1086 FRANKLIN STREET JOHNSTOWN PA 15905 251719695 SUPPORTS CONEMAUGH HEALTH SYSTEM PA 501(C)(3) 11B CONEMAUGH HEALTH SYSTEM 0 NORTHERN CAMBRIA HEALTHCARE FOUNDATION PO BOX 732 NORTHERN CAMBRIA PA 15714 251537143 SUPPORTS MINERS HOSPITAL PA 501(C)(3) 7 N/A 0 CONEMAUGH HOUSING INC 1086 FRANKLIN STREET JOHNSTOWN PA 15905 251606936 PROVIDES SENIOR HOUSING FACILITIES PA 501(C)(3) 9 CONEMAUGH VALLEY MEMORIAL HOSPITAL 0 LAUREL HIGHLANDS ADVANCED IMAGING 1450 SCALP AVENUE JOHNSTOWN PA 15904 251864587 DIAGNOSTIC SERVICES PA N/A GREATER JOHNSTOWN TECH PARK 1086 FRANKLIN STREET JOHNSTOWN PA 15905 260389121 OPERATES MULTI-TENANT COMMERCE OFFICE PARK PA N/A CONEMAUGH HEALTH INITIATIVES INC DBA CONEMAUGH PHYSICIAN GP 1086 FRANKLIN STREET JOHNSTOWN PA 15905 251658283 PHYSICIAN SERVICES PA N/A C 1086 REAL ESTATE 1086 FRANKLIN STREET JOHNSTOWN PA 15905 251489704 REAL ESTATE PA N/A C CONEMAUGH ENTERPRISES INC 1086 FRANKLIN STREET JOHNSTOWN PA 15905 202998473 ECONOMIC DEVELOPMENT PA N/A C SINDO INC 1086 FRANKLIN STREET JOHNSTOWN PA 15905 251144116 COMMUNITY RENTALS PA N/A C 0 0 0 0 0 0 1 0 0 0 1 1 0 0 1 0 0 1