MILLCREEK COMMUNITY HOSPITAL: Form 990, tax year 2010
View the entire original 990 at ProPublica ↗
- Organization
- MILLCREEK COMMUNITY HOSPITAL (EIN 25-1002937)
- Tax period
- 2010-07-01 to 2011-06-30
- Filed
- 2012-05-14
- IRS object ID
- 201241359349304024
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule H
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-05-14T13:48:45-05:00 | Timestamp |
| Tax Period End Date | 2011-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SCHAFFNER KNIGHT MINNAUGH & CO PC | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1001 STATE STREET SUITE 1300 | AddressLine1 |
| City | ERIE | City |
| State | PA | State |
| ZIP Code | 16501 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2010-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 251002937 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MILLCREEK COMMUNITY HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | MILL | NameControl |
| Phone | 8148644031 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 5515 PEACH STREET | AddressLine1 |
| City | ERIE | City |
| State | PA | State |
| ZIP Code | 16509 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | RICHARD P OLINGER | Name |
| Title | TREASURER | Title |
| Phone | 8148644031 | Phone |
| Date Signed | 2012-05-11 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | MATTHEW J MINNAUGH CPA | Name |
| Phone | 8144541997 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2010 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | MARY L ECKERT | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 5515 PEACH STREET | AddressLine1 |
| City | ERIE | City |
| State | PA | State |
| ZIP Code | 16509 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 58742679 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.MILLCREEKCOMMUNITYHOSPITAL.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1948 | YearFormation |
| State Legal Domicile | PA | StateLegalDomicile |
| Activity Or Mission Description | THE ORGANIZATION PROVIDES THE COMMUNITY WITH HEALTHCARE SERVICES AND EDUCATION. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 12 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 7 | NbrIndependentVotingMembers |
| Total Nbr Employees | 641 | TotalNbrEmployees |
| Total Nbr Volunteers | 13 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 351844 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 404184 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 40370256 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 41406725 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 1396554 | InvestmentIncomePriorYear |
| Investment Income Current Year | 1621145 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 1762233 | OtherRevenuePriorYear |
| Other Revenue Current Year | 1742647 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 43880887 | TotalRevenuePriorYear |
| Total Revenue Current Year | 45174701 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 19593218 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 21097744 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 19327350 | OtherExpensePriorYear |
| Other Expenses Current Year | 19133771 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 38920568 | TotalExpensesPriorYear |
| Total Expenses Current Year | 40231515 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 4960319 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 4943186 | RevenuesLessExpensesCY |
| Total Assets BOY | 76728883 | TotalAssetsBOY |
| Total Assets EOY | 82175161 | TotalAssetsEOY |
| Total Liabilities BOY | 7740058 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 6905612 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 68988825 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 75269549 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | MILLCREEK COMMUNITY HOSPITAL PROVIDES QUALITY HEALTHCARE REGARDLESS OF RACE, CREED, SEX, NATIONALITY, ORIGIN, HANDICAPS, AGE OR ABILITY TO PAY. THE ORGANIZATION'S MISSION IS TO SERVE THE COMMUNITY BY PROVIDING HEALTHCARE SERVICES AND EDUCATION. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 11711187 | Expense |
| Revenue | 13395687 | Revenue |
| Description | ACUTE INPATIENT CARE: MILLCREEK COMMUNITY HOSPITAL (THE HOSPITAL) IS A COMMUNITY BASED HOSPITAL PROVIDING QUALITY HEALTH CARE FOR PATIENTS WITH ILLNESSES, PROMOTING HEALING, AND IMPROVING THE QUALITY OF LIFE AT AFFORDABLE COST. THE HOSPITAL INPATIENT SERVICES INCLUDE, BUT ARE NOT LIMITED TO, SURGERY, RADIOLOGY, INTENSIVE CARE, PHYSICAL THERAPY, ENDOSCOPY, AND A CATH LAB. THE FACILITY HAS 80 BEDS ACCOMODATING THE WELLNESS OF THE COMMUNITY. FOR FISCAL YEAR ENDED JUNE 30, 2011, 10,032 PATIENT DAYS WERE PROVIDED. REFER TO SCHEDULE O FOR ADDITIONAL INFORMATION REGARDING ACUTE INPATIENT CARE.THE HOSPITAL DEMONSTRATES FISCAL RESPONSIBILITY BY PURSUING COST REIMBURSEMENT FOR THOSE PATIENTS WHO HAVE THE MEANS AND ABILITY TO PAY WHILE PROVIDING CARE FOR THOSE WHO LACK THE FINANCIAL RESOURCES TO PAY FOR SOME OR ALL OF THE COST. FOR THE FISCAL YEAR ENDED JUNE 30, 2011, 164 DAYS OF CHARITY CARE WERE PROVIDED AMOUNTING TO $821,649 OF FORGONE REVENUE AT A COST OF $278,081 TO THE HOSPITAL. BAD DEBT CHARGES INCLUDED IN ACUTE CARE - MEDICAL SURGICAL WERE $1,779,817 AT A COST OF $602,290 TO THE HOSPITAL. THE HOSPITAL ACTIVELY COMMITS TO ITS UNINSURED/UNDERINSURED AND CHARITY DISCOUNT POLICIES, AND IT DOES NOT DISCRIMINATE AGAINST THOSE INDIVIUDALS WHO ARE IN NEED OF FINANCIAL ASSISTANCE FROM THE FACILITY OR THOSE IN NEED OF GOVERNMENT ASSISTANCE.THE HOSPITAL'S COMMUNITY ACTIVITIES INCLUDED SEVERAL BLOOD PRESSURE SCREENING EVENTS HELD AT SENIOR DAY, THE ANNUAL CONSUMER FAIR, AND NATIONAL SENIOR HEALTH & FITNESS DAY. A BLOOD DRIVE IS CONDUCTED TWICE A YEAR TO ASSIST IN THE COMMUNITY NEED FOR BLOOD. THE HOSPITAL PARTICIPATES IN PREVENTIVE HEALTH EDUCATION CLASSES AND PROVIDES LITERATURE FOR HEALTHY LIVING. IN ADDITION, THE HOSPITAL PLAYS A PROACTIVE ROLE IN THE DISASTER/BIOTERRORISM PREPAREDNESS PROGRAM.FOR INDIVIDUALS NEEDING FINANCIAL ASSISTANCE, TRANSPORTATION IS PROVIDED TO THE HOSPITAL'S FACILITIES FOR PHYSICIAN VISITS EITHER BY THE HOSPITAL VAN, BUS TOKENS, OR A CAB. PRESCRIPTIONS AND CLOTHING ARE ALSO PROVIDED TO THOSE IN NEED. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 7353878 | Expense |
| Revenue | 8425725 | Revenue |
| Description | BEHAVIORAL UNIT CARE: IN 2001, A LARGE LOCAL BEHAVIORAL HEALTH INPATIENT PROVIDER ANNOUNCED THAT IS WAS DISCONTINUING ITS LINE OF SERVICE. A COMMUNITY TASK FORCE WAS FORMED TO ADDRESS THE VOID AND, AT THIS GROUP'S REQUEST, MILLCREEK COMMUNITY HOSPITAL FILLED A CRITICAL NEED FOR MENTAL HEALTH CARE FACILITIES IN THE AREA. TODAY, THE HOSPITAL'S BEHAVIORAL HEALTH OFFERINGS INCLUDE A 10 BED DETOXIFICATION UNIT, 62 BEDS OF LICENSED ACUTE PSYCHIATRIC CARE, AND AN ACUTE ADULT PARTIAL HOSPITALIZATION PROGRAM. THE HOSPITAL'S CHILD/ADOLESCENT UNIT IS THE REGION'S ONLY SUCH BEHAVIORAL HEALTH ACUTE CARE FACILITY. REFER TO SCHEULDE O FOR ADDITIONAL INFORMATION REGARDING BEHAVIORAL CARE.FOR THE FISCAL YEAR ENDED JUNE 30, 2011, 1,970 DISCHARGES TOTALING 11,771 PATIENT DAYS WERE PROVIDED.THE HOSPITAL PURSUES COLLABORATION WITH THE ERIE HEALTH CARE AND HUMAN SERVICES COMMUNITY. THE HOSPITAL IS REPRESENTED ON MANY COUNTY-SPONSORED AND OTHER PLANNING COMMITTEES, AND IS PART OF INITIATIVES TO IMPROVE OUTCOMES FOR MUTUAL CLIENTS. THE HOSPITAL IS ALSO REPRESENTED AT COMMUNITY CLINICAL FORUMS TO PROVIDE EXPERT INFORMATION AND INPUT ON DIFFICULT SITUATIONS AND CASES. THE HOSPITAL HOSTS MEETINGS AT THE FACILITY IN ORDER TO IMPROVE CONTINUITY OF CARE; THESE MEETINGS ARE ATTENDED BY REPRESENTATIVES FROM MORE THAN TWENTY LOCAL SCHOOLS, SCHOOL DISTRICTS, AND SERVICE PROVIDERS. THE HOSPITAL ALSO WELCOMES REPRESENTATIVES FROM JUVENILE JUSTICE, THE OFFICE OF CHILDREN AND YOUTH, AND OTHER GOVERNMENTAL ORGANIZATIONS IN THE INTEREST OF IMPROVING THE LIVES OF ITS PATIENTS. WORKING AGREEMENTS ARE DEVELOPED WITH LOCAL SERVICE AGENCIES TO ALLOW BOTH PATIENTS AND RECEIVING PROVIDERS TO BE LINKED WITH EACH OTHER WHILE THE PATIENT IS AT THE HOSPITAL RECEIVING CARE. | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 4241592 | Expense |
| Revenue | 3280589 | Revenue |
| Description | RESIDENT TRAINING:IN AN EFFORT TO ADDRESS THE CRITICAL SHORTAGE OF PHYSICIANS, MILLCREEK COMMUNITY HOSPITAL ACTS AS A TEACHING HOSPITAL AND OFFERS MORE PHYSICIAN RESIDENCY PROGRAMS THAN ANY OTHER HOSPITAL IN NORTHWESTERN PENNSYLVANIA. FOR THE FISCAL YEAR ENDED JUNE 30, 2011, THE HOSPTIAL UTILIZED 65 INTERNS ACROSS A WIDE RANGE OF MEDICAL CARE SPECIALTIES INCLUDING FAMILY PRACTICE, EAR/NOSE/THROAT, INTERNAL MEDICINE, OPHTHALMOLOGY, ORTHOPEDICS, PSYCHIATRY, GASTROINTESTINAL, PODIATRY, SPORTS MEDICINE, AND NEUROMUSCULOSKETAL MEDICINE. | Description |
Activity Other ActivityOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 12725509 | Expense |
| Revenue | 16304724 | Revenue |
| Description | OTHER PROGRAM ACTIVITIES:OTHER PROGRAM ACTIVITIES INCLUDED 27,599 OUTPATIENT VISITS INCLUDING 1,230 OUTPATIENT SURGERIES, 15,027 EMERGENCY ROOM VISITS, 304 ADMISSIONS FOR 4,095 DAYS TO THE TRANSITIONAL CARE UNIT, 455 OBSTETRICAL DAYS, AND 711 ADMISSIONS FOR 2,765 DAYS TO THE DETOX UNIT. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Other Program Service Exp | 12725509 | TotalOfOtherProgramServiceExp |
| Total Of Other Program Service Rev | 16304724 | TotalOfOtherProgramServiceRev |
| Total Program Service Expense | 36032166 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 1 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 1 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 1 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 85 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 641 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 12 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 7 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 1 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | PA | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RICHARD P OLINGER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 8148644031 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 5515 PEACH STREET | AddressLine1 |
| City | ERIE | City |
| State | PA | State |
| ZIP Code | 16509 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (19 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|
| MARY L ECKERT | ||||||||
| PRESIDENT/CEO | 72.00 | X | X | 427418 | 3859 | 29123 | ||
| RICHARD P OLINGER | ||||||||
| CFO/TREASURER | 31.00 | X | X | 205666 | 190435 | 35179 | ||
| JOHN M FERRETTI DO | ||||||||
| CHAIRMAN | 10.00 | X | X | 0 | 501737 | 29168 | ||
| SILVIA M FERRETTI DO | ||||||||
| TRUSTEE | 2.00 | X | 0 | 658129 | 29168 | |||
| MARIO EJ LANNI DSC | ||||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |||
| NANCY Z O'NEILL | ||||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |||
| MARK R RENDULIC | ||||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |||
| JAMES A SCHAFFNER | ||||||||
| SECRETARY | 1.00 | X | X | 0 | 0 | 0 | ||
| DALE P SPARBER | ||||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |||
| WILLIAM F MCCARTHY | ||||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |||
| RICHARD B SEAGER | ||||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |||
| JOHN J KALATA DO | ||||||||
| TRUSTEE/CHIEF OF STAFF | 7.00 | X | 35000 | 0 | 0 | |||
| PAUL A KOHUT DO | ||||||||
| DIRECTOR OF EMERGENCY ROOM | 40.00 | 229611 | 0 | 29850 | X | |||
| RONALD BRADLEY DO | ||||||||
| CHIEF OF PSYCHIATRIC SERVICES | 40.00 | 169499 | 0 | 6116 | X | |||
| THOMAS ZIEGLER MD | ||||||||
| CLINICAL LAB PHYSICIAN | 40.00 | 238793 | 0 | 23995 | X | |||
| ELISEO ROQUIZ MD | ||||||||
| ANETHESIOLOGIST | 40.00 | 350212 | 0 | 34432 | X | |||
| MARVIN WIELAND DO | ||||||||
| RADIOLOGY ANESTHESIOLOGIST | 40.00 | 325262 | 0 | 25089 | X | |||
| MICHELLE MACKENZIE | ||||||||
| CRNA | 40.00 | 135261 | 0 | 6952 | X | |||
| TIMOTHY ZURN | ||||||||
| PHARMACY MANAGER | 40.00 | 120004 | 0 | 23913 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 2236726 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 1354160 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 272985 | TotalOtherCompensation |
| Number Individuals GT100 K | 10 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| BUILDING CONTROLS AND SERVICES | |||||
| 4 PEUQUET PARKWAY | TONAWANDA | NY | 14150 | CONSTRUCTION | 2060153 |
| AMERISOURCE BERGEN | |||||
| PO BOX 959 | VALLEY FORGE | PA | 19482 | PROFESSIONAL PHARMACEUTICAL SERVICES | 832134 |
| CLINICAL PATHOLOGY INSTITUTE | |||||
| 1526 PEACH STREET | ERIE | PA | 16501 | PROFESSIONAL PATHOLOGY SERVICES | 817763 |
| CHURCH & MURDOCK ELECTRIC COMPANY | |||||
| PO BOX 10908 | ERIE | PA | 16514 | CONSTRUCTION | 803723 |
| PRESQUE ISLE PSYCHIATRIC | |||||
| 2808 STATE STREET | ERIE | PA | 16508 | PSYCHIATRIC AND BEHAVIORAL HEALTH SERVIC | 518634 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 26 | NumberOfContractorsGT100K |
| Related Organizations | 155600 | RelatedOrganizations |
| Government Grants | 239192 | GovernmentGrants |
| All Other Contributions | 9392 | AllOtherContributions |
| Total Contributions | 404184 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| NET PATIENT REVENUE | 900099 | 39444169 | 39444169 |
| RESIDENT CONTRACT REV | 900099 | 1962556 | 1962556 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 41406725 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1118029 | TotalRevenueColumn |
| Exclusion | $1,118,029 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 890892 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 83608 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 807284 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 807284 | TotalRevenueColumn |
| Exclusion | $807,284 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 13984857 | Securities |
| Other | 2629 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 13484370 | Securities |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 500487 | Securities |
| Other | 2629 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 503116 | TotalRevenueColumn |
| Exclusion | $503,116 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount |
|---|---|---|---|
| CAFETERIA REVENUE | 900099 | 326790 | $326,790 |
| MISCELLANEOUS REVENUE | 900099 | 258692 | $258,692 |
| SNACKBAR/ VEND MACH RE | 900099 | 190835 | $190,835 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 159046 | TotalRevenueColumn |
| Exclusion | $159,046 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 935363 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 45174701 | TotalRevenueColumn |
| Related Or Exempt Function Income | 41406725 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $3,363,792 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1158870 | Total |
| Program Services | 965926 | ProgramServices |
| Management And General | 192944 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 16201066 | Total |
| Program Services | 14465407 | ProgramServices |
| Management And General | 1735659 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 368715 | Total |
| Program Services | 321396 | ProgramServices |
| Management And General | 47319 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2033513 | Total |
| Program Services | 1775773 | ProgramServices |
| Management And General | 257740 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1335580 | Total |
| Program Services | 1175655 | ProgramServices |
| Management And General | 159925 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 62662 | Total |
| Program Services | 55957 | ProgramServices |
| Management And General | 6705 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9116 | Total |
| Management And General | 9116 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 86146 | Total |
| Management And General | 86146 | ManagementAndGeneral |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 183040 | Total |
| Management And General | 183040 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4681948 | Total |
| Program Services | 4180980 | ProgramServices |
| Management And General | 500968 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 49161 | Total |
| Program Services | 43901 | ProgramServices |
| Management And General | 5260 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3895803 | Total |
| Program Services | 3478952 | ProgramServices |
| Management And General | 416851 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 504427 | Total |
| Program Services | 450453 | ProgramServices |
| Management And General | 53974 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 685318 | Total |
| Program Services | 611989 | ProgramServices |
| Management And General | 73329 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 51105 | Total |
| Program Services | 45637 | ProgramServices |
| Management And General | 5468 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2120919 | Total |
| Program Services | 1893981 | ProgramServices |
| Management And General | 226938 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 841576 | Total |
| Program Services | 748331 | ProgramServices |
| Management And General | 93245 | ManagementAndGeneral |
Other Expenses OtherExpenses (5 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| PROVISION FOR BAD DEBT | 3796430 | 3796430 | |
| REPAIRS AND MAINTENANCE | 841313 | 751293 | 90020 |
| PHARMACY DRUGS | 669010 | 669010 | |
| MISCELLANEOUS | 278394 | 248606 | 29788 |
| MRI EXPENSE | 180000 | 180000 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 197403 | Total |
| Program Services | 172489 | ProgramServices |
| Management And General | 24914 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 40231515 | Total |
| Program Services | 36032166 | ProgramServices |
| Management And General | 4199349 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2928743 | BOY |
| EOY | 1922884 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5312728 | BOY |
| EOY | 6229488 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4409323 | BOY |
| EOY | 4333748 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 731802 | BOY |
| EOY | 641882 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 630043 | BOY |
| EOY | 630108 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 61429595 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 23070485 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 35623057 | BOY |
| EOY | 38359110 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 16378309 | BOY |
| EOY | 18708918 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 917581 | BOY |
| EOY | 917581 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9797297 | BOY |
| EOY | 10431442 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 76728883 | BOY |
| EOY | 82175161 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3262971 | BOY |
| EOY | 3108034 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 42259 | BOY |
| EOY | 42922 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4434828 | BOY |
| EOY | 3754656 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7740058 | BOY |
| EOY | 6905612 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 68978825 | BOY |
| EOY | 75247914 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10000 | BOY |
| EOY | 21635 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 68988825 | BOY |
| EOY | 75269549 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 76728883 | BOY |
| EOY | 82175161 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 4943186 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 1337538 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Separate | X | FinancialStatementSeparate |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 8990321 | OtherCostOrOtherBasis |
| Book Value | 8990321 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 35603648 | OtherCostOrOtherBasis |
| Depreciation | 11153607 | Depreciation |
| Book Value | 24450041 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 15375850 | OtherCostOrOtherBasis |
| Depreciation | 11666967 | Depreciation |
| Book Value | 3708883 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1459776 | OtherCostOrOtherBasis |
| Depreciation | 249911 | Depreciation |
| Book Value | 1209865 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 38359110 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (3 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| IRREVOCABLE SELF-INSURED TRUST FUND | 8916502 |
| OTHER RECEIVABLES | 994126 |
| DUE FROM AFFILIATES | 520814 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 10431442 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities (2 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| ACCRUED MEDICAL MALPRACTICE | $3,708,679 |
| DUE TO THIRD PARTY PAYERS | $45,977 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 3754656 | TotalOfAmounts |
| Total Revenue | 45174701 | TotalRevenue |
| Total Expenses | 40231515 | TotalExpenses |
| Excess Or Deficit For Year | 4943186 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | 1825903 | NetUnrealizedGLOnInvestments |
| Other | -$488,365 | OtherAmount |
| Total Adjustments | 1337538 | TotalAdjustments |
| Excess Or Deficit Per FS | 6280724 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 46901172 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | 1825903 | NetUnrealizedGainsInvestments |
| Revenue Not Rptd F990 | 1825903 | RevenueNotRptdF990 |
| Revenue Subtotal | 45075269 | RevenueSubtotal |
| Other Revenues Not Included | 99432 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 99432 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 45174701 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 40132083 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 83608 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 83608 | ExpensesNotRptdF990 |
| Expenses Subtotal | 40048475 | ExpensesSubtotal |
| Other Expenses Not Included | 183040 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 183040 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 40231515 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (5 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | PART X: | THE HOSPITAL IS A NOT-FOR-PROFIT CORPORATION AND IS EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. ACCORDINGLY, NO PROVISION FOR INCOME TAXES HAS BEEN PROVIDED. THE HOSPITAL ADOPTED THE STANDARD FOR ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN A COMPANY'S FINANCIAL STATEMENTS THAT PRESCRIBES 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 HAS NOT BEEN MET. THE STANDARD ALSO PROVIDES GUIDANCE ON DERECOGNITION, CLASSIFICATION, INTEREST AND PENALTIES, ACCOUNTING FOR INTERIM PERIODS, AND DISCLOSURE. MANAGEMENT HAS DETERMINED THAT ADOPTION OF THE STANDARD DID NOT HAVE A MATERIAL EFFECT ON THE FINANCIAL STATEMENTS. THE HOSPITAL'S INCOME TAX RETURNS FOR THE YEARS ENDED 2010, 2009, AND 2008 REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE AND STATE AGENCIES. |
| PART XI, LINE 8 - OTHER ADJUSTMENTS: | EQUITY TRANSFER TO AFFILIATE -500,000. INCREASE IN TEMPORARILY RESTRICTED NET ASSETS 11,635. | |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | INVESTMENT MANAGEMENT FEES NETTED AGAINST DIVIDEND INCOME 183,040. DEPRECIATION EXPENSE RELATED TO RENTAL INCOME -83,608. | |
| PART XIII, LINE 2D - OTHER ADJUSTMENTS: | DEPRECIATION EXPENSE REFLECTED ON STMT OF REVENUE 83,608. | |
| PART XIII, LINE 4B - OTHER ADJUSTMENTS: | INVESTMENT MANAGEMENT FEES NETTED AGAINST DIVIDEND INCOME 183,040. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
Other Percentage OtherPercentage
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Free Other Percentage | 140.000000000000 | FreeOtherPercentage |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent200 D | X | Pcent200D |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 0 | AmountsBudgetedForCharityCare |
| Annual Community Benefit Report | 0 | AnnualCommunityBenefitReport |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 14 | NumberOfActivitiesOrPrograms |
| Persons Served | 457 | PersonsServed |
| Total Community Benefit Expense | 278081 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 278081 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00760 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 14 | NumberOfActivitiesOrPrograms |
| Persons Served | 1710 | PersonsServed |
| Total Community Benefit Expense | 9451093 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 9445082 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 6011 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00020 | PercentOfTotalExpense |
Unreimbursed Costs UnreimbursedCosts
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 0 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 28 | NumberOfActivitiesOrPrograms |
| Persons Served | 2167 | PersonsServed |
| Total Community Benefit Expense | 9729174 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 9445082 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 284092 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00780 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 0 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 10 | NumberOfActivitiesOrPrograms |
| Persons Served | 65 | PersonsServed |
| Total Community Benefit Expense | 4241592 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3280589 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 961003 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02640 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 3 | NumberOfActivitiesOrPrograms |
| Persons Served | 496 | PersonsServed |
| Total Community Benefit Expense | 3685519 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2199299 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1486220 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04080 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 13 | NumberOfActivitiesOrPrograms |
| Persons Served | 561 | PersonsServed |
| Total Community Benefit Expense | 7927111 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 5479888 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2447223 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.06720 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 41 | NumberOfActivitiesOrPrograms |
| Persons Served | 2728 | PersonsServed |
| Total Community Benefit Expense | 17656285 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 14924970 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2731315 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.07500 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $1,284,875 | BadDebtExpenseAmount |
| Amount Attributable To | 642438 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 10198390 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 9125902 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 1072488 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MILLCREEK COMMUNITY HOSPITAL | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 5515 PEACH STREET | AddressLine1 |
| City | ERIE | City |
| State | PA | State |
| ZIP Code | 16509 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Teaching Hospital | X | TeachingHospital |
| Er24 Hours | X | Er24Hours |
| Other | SKILLED NURS BEHAV UNIT; HOSPITALZ PROG | Other |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MILLCREEK COMMUNITY HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 140.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 200.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Medical Indigency | X | MedicalIndigency |
| Insurance Status | X | InsuranceStatus |
| Uninsured Discount | X | UninsuredDiscount |
| Medicaid Medicare | X | MedicaidMedicare |
| State Regulation | X | StateRegulation |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Attached To Invoices | X | AttachedToInvoices |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Provided On Admission | X | ProvidedOnAdmission |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Permit Report To Credit Agency | X | PermitReportToCreditAgency |
| Collection Activities | 1 | CollectionActivities |
| Report To Credit Agency | X | ReportToCreditAgency |
| Notify Upon Admission | X | NotifyUponAdmission |
| Notified All Patients | X | NotifiedAllPatients |
| Documented Determination | X | DocumentedDetermination |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 1 | GrossCharges |
Form990 Schedule H Part VI Form990ScheduleHPartVI (13 entries)
| ExplanationExplanation | IdentifierIdentifier |
|---|---|
| PART I, LINE 7: LINE 7A CHARITY CARE - RATIO OF PATIENT CARE COSTS TO CHARGESLINE 7B MEDICAID - RATIO OF PATIENT CARE COSTS TO CHARGESLINE 7F HEALTH PROFESSIONAL EDUCATION - A COMBINATION OF ACTUAL COST AND COST TO CHARGES IS USED. ACTUAL IS USED FOR DIRECT EXPENSE AND COST TO CHARGES FOR COMMON EXPENSE FROM THE MEDICARE COST REPORT.LINE 7G SUBSIDIZED HEALTH SERVICES - THE COSTING METHODOLOGY WAS DETERMINED BASED ON THE PARTICULAR ACTIVITY/PROGRAM AND THE TYPE OF EXPENSE. ACTUAL COST WAS USED WHERE DIRECT EXPENSES WERE IDENTIFIABLE. A RATIO OF PATIENT CARE COST TO CHARGES WAS USED IN THE CASE OF INDIRECT EXPENSES. | |
| PART I, LINE 7G: EXPENSE INCLUDES $521,477 FOR MEDICAL ASSISTANCE CLINICS | |
| PART I, L7 COL(F): BAD DEBT OF $3,796,430 IS EXCLUDED FROM THE DENOMINATOR FOR PURPOSES OF PART 1, LINE 7, COLUMN F - "PERCENT OF TOTAL EXPENSE" | |
| PART III, LINE 4: ACCOUNTS RECEIVABLE ARE STATED AT THE AMOUNT THE HOSPITAL EXPECTS TO COLLECT. THE HOSPITAL PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS EQUAL TO THE ESTIMATED UNCOLLECTIBLE AMOUNTS. THE HOSPITAL'S ESTIMATE IS BASED ON HISTORICAL COLLECTION EXPERIENCE AND REVIEW OF THE CURRENTS STATUS OF PATIENT ACCOUNTS RECEIVABLE. IT IS REASONABLY POSSIBLE THAT THE HOSPITAL'S ESTIMATE OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS WILL CHANGE. PATIENT ACCOUNTS RECEIVABLE ARE PRESENTED NET OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS OF $1,119,025 AND $911,317 AS OF JUNE 2011 AND 2010, RESPECTIVELY.THE METHODOLOGY FOR DETERMINING THE COST OF BAD DEBT FOR LINE 2 IS THE RATIO OF PATIENT CARE COSTS TO CHARGES TIMES THE GROSS CHARGES ATTRIBUTABLE TO THE BAD DEBT PATIENT ACCOUNTS. OFFERED DISCOUNTS RELATING TO CHARITY CARE EXPENSES ARE RECORDED AS PART OF THE CONTRACTUAL ALLOWANCE OFFSET AGAINST GROSS CHARGES. ACCORDINGLY, A DISCOUNT IN NOT INCLUDED AS PART OF BAD DEBT EXPENSE. BAD DEBT EXPENSE AT COST ATTRIBUTABLE TO PATIENTS ELIGIBLE FOR CHARITY CARE IS BASED ON ESTIMATES. | |
| PART III, LINE 8: EXPENSE RELATED TO ACUTE SERVICES WAS BASED ON THE RATIO OF ACUTE MEDICARE CHARGES TO TOTAL PAYOR CHARGES. COST FOR OTHER SERVICES WAS BASED ON A COMBINATION OF ACTUAL DIRECT CHARGES TIMES THE RATIO OF MEDICARE DAYS TO TOTAL DAYS, INDIRECT COSTS BASED ON A COST TO CHARGE RATIO, AND OVERHEAD COSTS BASED ON ALLOCATED COSTS FROM THE MEDICARE REPORT. | |
| PART III, LINE 9B: CHARITY CARE IS NOT CONSIDERED A SUBSTITUTE FOR PERSONAL RESPONSIBILITY. PATIENTS ARE EXPECTED TO FOLLOW THE HOSPITAL'S BILLING PROCEDURES AND PAY HIS/HER SHARE BASED ON FINANCIAL ABILITY. MILLCREEK COMMUNITY HOSPITAL'S COLLECTION PRACTICES TAKE INTO ACCOUNT THE EXTENT TO WHICH THE PATIENT QUALIFIES FOR CHARITY, A PATIENT'S GOOD FAITH EFFORT TO APPLY FOR A GOVERNMENTAL PROGRAM OR FOR CHARITY FROM MILLCREEK COMMUNITY HOSPITAL, AND A PATIENT'S GOOD FAITH EFFORT TO COMPLY WITH HIS OR HER PAYMENT AGREEMENTS WITH MILLCREEK COMMUNITY HOSPITAL. FOR PATIENTS WHO QUALIFY FOR CHARITY AND WHO ARE COOPERATING IN GOOD FAITH TO RESOLVE THEIR HOSPITAL BILLS, MILLCREEK COMMUNITY HOSPITAL MAY OFFER EXTENDED PAYMENT PLANS TO ELIGIBLE PATIENTS, WILL NOT IMPOSE WAGE GARNISHMENTS OR LIENS ON PRIMARY RESIDENCES, WILL NOT SEND UNPAID BILLS TO OUTSIDE COLLECTION AGENCIES, AND WILL CEASE ALL COLLECTION EFFORTS. | |
| PART V, SECTION B, LINE 19D: AN AMOUNT THAT EQUALS OR NEARS MEDICAID RATES | MILLCREEK COMMUNITY HOSPITAL |
| PART V, SECTION B, LINE 21: GROSS CHARGES ARE BILLED ON SERVICES TO PATIENTS NOT QUALIFYING FOR FINANCIAL ASSISTANCE AND WHO ARE NOT ACTIVELY COOPERATING WITH THE PROCESSES AND PROCEDURES OF THE HOSPITAL TO SATISFY THEIR OBLIGATION FOR PAYMANT. | MILLCREEK COMMUNITY HOSPITAL |
| PART VI, LINE 2: THE HOSPITAL IS CURRENTLY WORKING WITH OTHER HOSPITALS AND INSTITUTIONS WITH SPECIAL KNOWLEDGE REGARDING PUBLIC HEALTH IN ERIE COUNTY TO DEVELOP A FORMAL COMMUNITY HEALTH NEEDS ASSESSMENT AND WILL HAVE THE REPORT IN PLACE DURING FISCAL YEAR-END JUNE 2013. | |
| PART VI, LINE 3: THE HOSPITAL UTILIZES THE FOLLOWING PROCEDURES TO INFORM AND EDUCATE ITS PATIENTS AND PERSONS, WHO MAY BE BILLED FOR PATIENT CARE, ABOUT THEIR ELIGIBLITY FOR ASSISTANCE:- A HOSPITAL EMPLOYEE WITH KNOWLEDGE OF GOVERNMENT PROGRAMS PERSONALLY VISITS APPLICABLE INPATIENTS AND EXPLAINS THE MEDICAL ASSISTANCE ALTERNATIVES AVAILABLE TO THE INPATIENT- PATIENT BILLING STATEMENTS INCLUDE A NOTATION REGARDING THE FACT DISCOUNTS OR SPECIAL PAYMENT ARRANGEMENTS ARE AVAILABLE TO QUALIFYING INDIVIDUALS- A CHARITY CARE CONTACT PHONE NUMBER IS PHYSICALLY POSTED IN THE HOSPITAL'S EMERGENCY ROOM AND PRINTED ON THE PATIENT'S BILLING STATEMENT. THE APPROPRIATE HOSPITAL EMPLOYEES ASSIST PATIENTS IN THE COMPLETION OF THE REQUIRED FORMS. | |
| PART VI, LINE 4: THE HOSPITAL SERVES ERIE COUNTY, PENNSYLVANIA AND PERIPHERAL AREAS SURROUNDING THE COUNTY. BASED ON 2010 INFORMATION PUBLISHED ON ERIEVITALSIGNS.ORG, 17% OF ERIE COUNTY RESIDENTS WERE BELOW THE POVERTY LEVEL DURING THE STUDIED TIME FRAME. POVERTY RATES FOR THE SAME TIME PERIOD EXCEEDED 25% IN THE CITY OF ERIE. MEDIAN HOUSEHOLD INCOME IN ERIE COUNTY WAS $42,519, WHICH WAS 12.8% BELOW MEDIAN HOUSEHOLD INCOME IN PENNSYLVANIA AND 9.6% BELOW THE NATIONAL AVERAGE.ACCORDING TO A FORECASTED CENSUS STUDY, THE POPULATION OF ERIE COUNTY IS 282,224 AND IS EXPECTED TO DECREASE BY 2.1% BY 2015 WHILE THE POPULATION GROUP AGED 65 AND OVER IS EXPECTED TO INCREASE BY 7.6%. ACCORDINGLY, THE HOSPITAL WILL LIKELY SEE ITS MEDICARE PERCENTAGE OF NET PATIENT REVENUE INCREASE FROM ITS CURRENT PERCENTAGE OF 40.16%.THE HOSPITAL SERVICES A DISPROPORTIONATE SHARE OF LOW INCOME HOUSEHOLDS. MEDICAL ASSISTANCE COMPRISED APPROXIMATELY 19.6% OF THE HOSPITAL'S NET PATIENT REVENUE. THE HOSPITAL'S UNCOMPENSATED CARE IS APPROXIMATELY 4.58%. | |
| PART VI, LINE 6: THE FILING ORGANIZATION IS THE ONLY HOSPITAL IN ITS SERVICE AREA THAT OPERATES UNDER THE PRINCIPLES OF OSTEOPATHIC HEALTH CARE. OSTEOPHATHIC MEDICINE'S ROOTS CENTER ON THE BELIEF OF THE BODY BEING ABLE TO HEAL ITSELF. THIS HOLISTIC APPROACH TO MEDICINE WAS BROUGHT TO ERIE, PENNSYLVANIA IN THE FORM OF A COMMUNITY HOSPITAL OVER 50 YEARS AGO THROUGH THE VISION AND EFFORTS OF SIX OSTEOPATHIC PHYSICIANS. THE FOUNDING PHYSICIANS BELIEVED IT WAS NOT UP TO THE PUBLIC TO GIVE THEM A PLACE TO WORK. THEY WANTED TO SUPPLY THE COMMUNITY WITH A PLACE. IN 1950, THE PREDECESSOR TO MILLCREEK COMMUNITY HOSPITAL, ERIE OSTEOPATHIC HOSPITAL, WAS OPENED.THE HOSPITAL EXPERIENCED RAPID GROWTH AND MOVED TO A LARGER FACILITY IN 1958 TO BETTER ACCOMODATE THE NEEDS OF THE COMMUNITY. IN 1981, MILLCREEK COMMUNITY HOSPITAL BECAME A REALITY AFTER 31 YEARS OF COMMUNITY SERVICES AS ERIE OSTEOPATHIC HOSPITAL. THE HOSPITAL PRIDES ITSELF IN ITS COMMITMENT TO PROVIDE THE BEST PERSONAL CARE POSSIBLE FOR ITS PATIENTS.IN RECENT YEARS, THE HOSPITAL HAS CONTINUED TO EXPAND THEREBY IMPROVING THE SERVICES IT PROVIDES TO THE COMMUNITY. SMALLER EXPANSION PROJECTS IN THE AREAS OF PARTIAL HOSPITALIZATION, THE DIETARY DEPARTMENT AND NURSING ADMINISTRATION/SOCIAL SERVICES HAVE ALL BEEN COMPLETED. THE HOSPITAL HAS ALSO UNDERGONE SEVERAL MAJOR EXPANSION PROJECTS IN RECENT YEARS:- A THREE-STORY ADDITION TO THE SOUTHEAST SIDE OF THE HOSPITAL, WHICH INCLUDES A TRANSITIONAL CARE UNIT TO SERVE PATIENTS WHO NO LONGER NEED ACUTE CARE, BUT WHO ARE NOT WELL ENOUGH TO RETURN HOME; A MEDICAL LIBARY; ADDITIONAL CONFERENCE ROOMS AND OFFICES. - AN EMERGENCY ROOM EXPANSION TO BETTER HANDLE ACUTE MEDICAL AND PSYCHIATRIC EMERGENCIES. - A FIFTH-FLOOR ADDITION TO THE MAIN HOSPITAL TOWER FOR A 12-BED GERIATRIC BEHAVIORAL HEALTH CARE UNIT AND AN 18-BED CHILD/ADOLESCENT PSYCHIATRIC UNIT, WHICH WILL SERVE AS THE ONLY CHILD/ADOLESCENT UNIT OF ITS KIND IN NORTHWESTERN PA. THE HOSPITAL'S 4TH FLOOR SERVES AS A 32 BED GENERAL PSYCHIATRIC UNIT. MILLCREEK COMMUNITY HOSPITAL PROVIDES QUALITY HEALTHCARE REGARDLESS OF RACE, CREED, SEX, NATIONALITY, ORIGIN, HANDICAPS, AGE OR ABILITY TO PAY. IT DOES NOT DISCRIMINATE AGAINST THOSE INDIVIUDALS WHO ARE IN NEED OF FINANCIAL ASSISTANCE FROM THE FACILITY OR THOSE IN NEED OF GOVERNMENT ASSISTANCE. FOR INDIVIDUALS NEEDING FINANCIAL ASSISTANCE, TRANSPORTATION IS PROVIDED TO THE HOSPITAL'S FACILITIES FOR PHYSICIAN VISITS EITHER BY THE HOSPITAL VAN, BUS TOKENS, OR A CAB. PRESCRIPTIONS AND CLOTHING ARE ALSO PROVIDED TO THOSE IN NEED.IN AN EFFORT TO ADDRESS THE CRITICAL SHORTAGE OF PHYSICIANS, MILLCREEK COMMUNITY HOSPITAL ACTS AS A TEACHING HOSPITAL AND WORKS CLOSELY WITH ITS AFFILIATE, LAKE ERIE COLLEGE OF OSTEOPATHIC MEDICINE. FOR THE FISCAL YEAR ENDED JUNE 30, 2011, THE HOSPITAL UTILIZED 65 INTERNS ACROSS A WIDE RANGE OF MEDICAL CARE SPECIALTIES INCLUDING FAMILY PRACTICE, EAR/NOSE/THROAT, INTERNAL MEDICINE, OPHTHALMOLOGY, ORTHOPEDICS, PSYCHIATRY, GASTROINTESTINAL, PODIATRY, SPORTS MEDICINE, AND NEUROMUSCULOSKETAL MEDICINE. IN ADDITION, THE HOSPITAL HAS A SHORT TERM SKILLED TRANSITIONAL CARE UNIT, AND IT WORKS IN CONJUNCTION WITH ITS AFFILIATE, MILLCREEK MANOR, TO PROVIDE LONG TERM RESIDENTIAL NURSING HOME CARE.MILLCREEK COMMUNITY HOSPITAL EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN AN EFFORT TO ENSURE HIGH QUALITY CARE IS ACCESSIBLE IN A VARIETY OF PRIMARY AND SPECIALTY CARE AREAS.THE HOSPITAL'S COMMUNITY ACTIVITIES INCLUDED SEVERAL BLOOD PRESSURE SCREENING EVENTS HELD AT SENIOR DAY, THE ANNUAL CONSUMER FAIR, NATIONAL SENIOR HEALTH & FITNESS DAY, AND THE SALVATION ARMY'S ANGEL TREE GIFT PROGRAM. A BLOOD DRIVE IS CONDUCTED TWICE A YEAR TO ASSIST IN THE COMMUNITY NEED FOR BLOOD. THE HOSPITAL HOSTS EVENTS, SUCH AS SMOKE CESSATION CLASSES SPONSORED BY THE AMERICAN LUNG ASSOCIATION AND THE CHIEF RESIDENT WORKSHOP, WHICH IS A TRAINING SESSION FOR CHIEF RESIDENTS FROM VARIOUS HOSPITALS. IN ADDITION, THE HOSPTIAL PARTICIPATES IN PREVENTIVE HEALTH EDUCATION CLASSES, PROVIDES LITERATURE FOR HEALTHY LIVING, AND PLAYS A PROACTIVE ROLE IN THE DISASTER/BIOTERRORISM PREPAREDNESS PROGRAM.THE HOSPITAL IS ACTIVE IN THE BEHAVIORAL HEALTH FIELD AS IT IS REPRESENTED ON MANY COUNTY-SPONSORED AND OTHER PLANNING COMMITTEES. THE HOSPITAL IS ALSO REPRESENTED AT COMMUNITY CLINICAL FORUMS TO PROVIDE EXPERT INFORMATION AND INPUT ON DIFFICULT SITUATIONS AND CASES. | |
| PART VI, LINE 7: MEDICAL ASSOCIATES OF ERIE (MAE), AN AFFILIATE OF THE HOSPITAL, SERVES OVER 23,000 PATIENTS ANNUALLY. THE PATIENTS TREATED ARE PREDOMINANTLY LOW INCOME AND RESIDE IN THREE UNDERSERVED AREAS OF ERIE COUNTY. FOR 57% OF MAE'S PATIENTS, THEIR MEDICAL CHARGES ARE EITHER COVERED BY MEDICAL ASSISTANCE OR THE PATIENTS QUALIFY FOR CHARITY CARE. U.S. CENSUS STUDIES INDICATE HOUSEHOLD INCOME IN SOME OF MAE'S PRACTICE AREAS IS ONLY 2/3 OF THE NATIONAL AVERAGE, AND THE THE PERCENTAGE OF THE POPULATION UNDER THE FEDERAL POVERTY GUIDELINES IS 150% OF THE NATIONAL AVERAGE. MAE PATIENTS ALSO INCLUDE A LARGE NUMBER OF REFUGEES FROM AFRICA, THE MIDDLE EAST, AND NAPAL.DESPITE THE RIGORS OF THEIR TRAINING TO BECOME PHYSICIANS AND PHARMACISTS, STUDENTS ATTENDING THE LAKE ERIE COLLEGE OF OSTEOPATHIC MEDICINE (LECOM), AN AFFILIATE OF MILLCREEK COMMUNITY HOSPITAL, PROVIDE MORE THAN 30,000 HOURS ANNUALLY FOR COMMUNITY SERVICE. THE PRESIDENT'S HIGHER EDUCATION COMMUNITY SERVICE HONOR ROLL HAS RECOGNIZED THE VOLUNTEER EFFORTS BY LECOM STUDENTS. STUDENTS WORK WITH LOCAL SCHOOL CHILDREN DELIVERING HEALTH CARE EDUCATION THROUGH POISON PREVENTION, TOBACCO CESSATION, MINI-MEDICAL SCHOOL AND FIT-FOR-LIFE EXERCISE AND NUTRITION TRAINING.LECOM PARTICIPATES IN BRIDGING THE GAPS, A SUMMER INTERNSHIP PROGRAM THAT PLACES MEDICAL STUDENTS WITH SOCIAL SERVICE AND HEALTHCARE AGENCIES WHO DEAL DIRECTLY WITH UNDERSERVED POPULATIONS. STUDENTS DELIVER HEALTH EDUCATION TO ADULTS AND CHILDREN SERVED BY THESE AGENCIES.THE COLLEGE HAS UNDERWRITTEN A SIX-HOUR BLOCK OF HEALTH, NUTRITION AND FITNESS PROGRAMMING AIRED DAILY BY WQLN-TV IN ERIE AS PART OF THE PUBLIC BROADCASTING CREATE NETWORK. IN ADDITION, LECOM PHYSICIANS HOST TWO MONTHLY, HALF-HOUR HEALTH EDUCATION PROGRAMS CALLED MEET THE DOCTORS, ON WQLN-TV.LECOM FURTHER DEMONSTRATED ITS COMMITMENT TO THE COMMUNITY WHEN IT CONSTRUCTED AND OPENED AN 82,000 SQUARE FOOT STATE-OF-THE-ART MEDICALLY INTEGRATED FITNESS AND WELLNESS CENTER IN MARCH 2009. THE FACILITY FEATURES CARDIOVASCULAR EQUIPMENT, CIRCUIT/FREE WEIGHT TRAINING AREAS, FOUR GROUP EXERCISE STUDIOS, THREE SWIMMING POOLS: A LAP POOL, EXERCISE POOL, AND THERAPY POOL, A THREE LANE WALKING/RUNNING TRACK, A FULL-SIZED BASKETBALL GYMNASIUM, RACQUETBALL COURTS, AND INDOOR GOLF SIMULATOR. THE FACILITY IS STAFFED BY HEALTH PROMOTION EXPERTS, AND EACH TRAINER IN THE FACILITY POSSESSES AT LEAST A BACHELOR DEGREE IN A FIELD RELATED TO THE MISSION OF THE WELLNESS CENTER. THE WELLNESS CENTER ALSO OFFERS SPA AND MASSAGE THERAPY SERVICES, A HEALTHY CAFE WITH A COOKING DEMONSTRATION KITCHEN, A CONFERENCE/EDUCATION CENTER, AND A SAFE ENVIRONMENT FOR CHILDREN TO PLAY WHILE THEIR RESPONSIBLE ADULTS UTILIZE THE FACILITY. THE FACILITY ALSO HOUSES A DESIGNATED PHYSICAL THERAPY AREA OPERATED BY THE HOSPITAL, AND PHYSICAN OFFICES STAFFED BY DOCTORS EMPLOYED BY THE HOSPITAL'S AFFILIATE, MEDICAL ASSOCIATES OF ERIE.LECOM ANNOUNCED PLANS TO OPEN A SCHOOL OF DENTAL MEDICINE AND INVEST $52 MILLION AT THE BRADENTON CAMPUS SO THAT THE DENTAL SCHOOL CAN OPEN IN JULY 2012. THE SCHOOL OF DENTAL MEDICINE WILL HAVE A COMMUNITY BASED CURRICULLUM WHERE STUDENTS WILL HAVE CLINICAL EXPERIENCES IN OFF-CAMPUS DENTAL CLINICS SERVING POPULATIONS LACKING ADEQUATE DENTAL CARE.LECOM INTRODUCED ITS SECOND THREE-YEAR MEDICAL DEGREE PROGRAM. THE ACCELERATED PHYSICIAN ASSISTANT PATHWAY WILL ALLOW CERTIFIED PHYSICIAN ASSISTANTS (PA-C) TO EARN THE DOCTOR OF OSTEOPATHIC MEDICINE DEGREE IN THREE YEARS TAKING INTO ACCOUNT THE PA-C CLINICAL EXPERIENCE PRIOR TO ENTERING MEDICAL SCHOOL.THE LECOM COLLEGE OF OSTEOPATHIC MEDICINE, THE SCHOOL OF PHARMACY AND THE NEW SCHOOL OF DENTAL MEDICINE ALL RECEIVED ACCREDITATION DURING THE 2010-2011 ACADEMIC YEAR. THE AMERICAN OSTEOPATHIC ASSOCIATION COMMISSION ON COLLEGE ACCREDITATION, THE AMERICAN DENTAL ASSOCIATION COMMISSION ON DENTAL ACCREDITATION AND THE ACCREDITATION COUNCIL FOR PHARMACY EDUCATION GAVE THEIR APPROVAL FOR THE EDUCATIONAL PROGRAMS OFFERED BY LECOM.US NEWS AND WORLD REPORT BEST MEDICAL SCHOOLS RANKED LECOM #63 IN THE NATION FOR PRIMARY CARE. THE MAGAZINE LISTED LECOM AS #3 IN THE COUNTRY FOR THE PERCENTAGE OF GRADUATES WHO GO INTO PRIMARY CARE.FOR MORE INFORMATION REGARDING THE ACTIVITIES OF THE HOSPITAL AND ITS AFFILIATES, PLEASE VIST THE MILLCREEK COMMUNITY HOSPITAL WEBSITE AT WWW.MILLCREEKCOMMUNITYHOSPITAL.COM. WEBSITE LINKS TO THE HOSPITAL'S AFFILIATES ARE AVAILABLE ON THE HOSPITAL'S WEBSITE. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Form990 Of Other Organizations | X | Form990OfOtherOrganizations |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (9 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MARY L ECKERT | |||||||||||||
| 405978 | 0 | 0 | 0 | 21440 | 3859 | 19600 | 0 | 5227 | 4296 | 452245 | 8155 | 0 | 0 |
| RICHARD P OLINGER | |||||||||||||
| 205666 | 161300 | 0 | 0 | 0 | 29135 | 16453 | 0 | 14430 | 4296 | 236549 | 194731 | 0 | 0 |
| JOHN M FERRETTI DO | |||||||||||||
| 0 | 481621 | 0 | 0 | 0 | 20116 | 0 | 19600 | 0 | 9568 | 0 | 530905 | 0 | 0 |
| SILVIA M FERRETTI DO | |||||||||||||
| 0 | 639273 | 0 | 0 | 0 | 18856 | 0 | 19600 | 0 | 9568 | 0 | 687297 | 0 | 0 |
| PAUL A KOHUT DO | |||||||||||||
| 229611 | 0 | 0 | 0 | 0 | 0 | 15328 | 0 | 14522 | 0 | 259461 | 0 | 0 | 0 |
| RONALD BRADLEY DO | |||||||||||||
| 169499 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 6116 | 0 | 175615 | 0 | 0 | 0 |
| THOMAS ZIEGLER MD | |||||||||||||
| 238793 | 0 | 0 | 0 | 0 | 0 | 18628 | 0 | 5367 | 0 | 262788 | 0 | 0 | 0 |
| ELISEO ROQUIZ MD | |||||||||||||
| 350212 | 0 | 0 | 0 | 0 | 0 | 19600 | 0 | 14832 | 0 | 384644 | 0 | 0 | 0 |
| MARVIN WIELAND DO | |||||||||||||
| 325262 | 0 | 0 | 0 | 0 | 0 | 19600 | 0 | 5489 | 0 | 350351 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | SUPPLEMENTAL INFORMATION | Identifier |
| Return Reference | PART III | ReturnReference |
| Explanation | SCHEDULE J, PART II, COLUMN F: IN ACCORDANCE WITH THE SCHEDULE J INSTRUCTIONS, COLUMN F REPRESENTS ANY PAYMENT REPORTED IN THE CURRENT YEAR'S COLUMN (B) TO THE EXTENT SUCH PAYMENT WAS ALREADY REPORTED AS COMPENSATION TO THE LISTED PERSON ON A PRIOR FORM 990. | Explanation |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV
Name Of Interested Person NameOfInterestedPerson
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | VANTAGE | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship | INDEPENDENT CONTRACTOR - SHARES ONE COMMON TRUSTEE WITH THE FILING ORG. | Relationship |
| Amount Of Transaction | 477335 | AmountOfTransaction |
| Description Of Transaction | INDEPENDENT CONTRACTOR - SELLS MEDICAL SUPPLIES AND SERVICES TO MILLCREEK COMMUNITY HOSPITAL. | DescriptionOfTransaction |
| Sharing Of Revenues | 0 | SharingOfRevenues |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (12 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 2 | DR. JOHN M. FERRETTI, D.O. AND DR. SILVIA M. FERRETTI, D.O. - FAMILY RELATIONSHIP | |
| FORM 990, PART VI, SECTION A, LINE 6 | MILLCREEK HEALTH SYSTEM, THE FILING ORGANIZATION'S PARENT CORPORATION, IS THE SOLE MEMBER OF THE FILING ORGANIZATION. | |
| FORM 990, PART VI, SECTION A, LINE 7B | MILLCREEK HEALTH SYSTEM IS THE PARENT ORGANIZATION OF MILLCREEK COMMUNITY HOSPITAL. IN ACCORDANCE WITH MILLCREEK HEALTH SYSTEM'S BY-LAWS, ITS BOARD OF TRUSTEES HAS THE RIGHT TO APPROVE ANY AND ALL TRANSACTIONS THAT CHANGE, OR HAVE THE EFFECT OF CHANGING, THE OWNERSHIP AND/OR CONTROL OF THE ORGANIZATION. | |
| FORM 990, PART VI, SECTION B, LINE 11 | PRIOR TO FILING ITS FORM 990, THE ORGANIZATION PROVIDED ITS BOARD MEMBERS WITH ACCESS TO AN ELECTRONIC COPY OF THE TAX RETURN AND INVITED COMMENTS AND QUESTIONS FROM THE BOARD MEMBERS. PRIOR TO FILING FORM 990, MEMBERS OF THE ORGANIZATION'S FINANCIAL MANAGEMENT CONDUCTED A DETAILED REVIEW OF THE TAX FILING. THROUGHOUT THE REVIEW PROCESS, THERE WAS ONGOING DISCUSSION BETWEEN THE ORGANIZATION'S FINANCIAL MANAGEMENT AND THE TAX PREPARER. | |
| EACH MEMBER OF THE BOARD OF TRUSTEES IS REQUIRED TO COMPLETE A STANDARDIZED CONFLICT OF INTEREST FORM ON AN ANNUAL BASIS. ANY POTENTIAL CONFLICTS OF INTEREST ARE ADDRESSED BY AN APPOINTED COMMITTEE WHOSE MEMBERS ARE INDEPENDENT WITH REGARD TO THE MATTER BEING EXAMINED. IF A POTENTIAL CONFLICT OF INTEREST ARISES, IT IS REVIEWED AND DOCUMENTED BY THE APPOINTED COMMITTEE, AND THEN THE APPOINTED COMMITTEE REPORTS THE RESULTS OF ITS REVIEW TO THE BOARD OF TRUSTEES. | FORM 990, PART VI, SECTION B, LINE 12C | |
| THE ORGANIZATION'S BUDGET/FINANCE COMMITTEE, WHICH ALSO FUNCTIONS AS THE COMPENSATION COMMITTEE, REVIEWED A STUDY PERFORMED BY AN INDEPENDENT COMPENSATION CONSULTANT IN MARCH 2007. IN ADDITION, THE COMMITTEE ALSO REVIEWED VARIOUS FORM 990 FILINGS BY COMPARATIVE ORGANIZATIONS IN ORDER TO MAKE EXECUTIVE PAY COMPARISONS. FOR FISCAL YEARS ENDED JUNE 30, 2008, 2009, 2010 AND 2011, THE COMMITTEE REVIEWED THE SAME FORM 990 COMPARISONS. | FORM 990, PART VI, SECTION B, LINE 15 | |
| THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. | FORM 990, PART VI, SECTION C, LINE 19 | |
| CHANGES IN NET ASSETS OR FUND BALANCES: | NET UNREALIZED GAINS ON INVESTMENTS: 1,825,903. EQUITY TRANSFER TO AFFILIATE -500,000. INCREASE IN TEMPORARILY RESTRICTED NET ASSETS 11,635. TOTAL TO FORM 990, PART XI, LINE 5: 1,337,538. | FORM 990, PART XI, LINE 5: |
| THE FINANCE COMMITTEE ASSUMES RESPONSIBILITY FOR THE OVERSIGHT OF THE ORGANIZATION'S INDEPENDENT FINANCIAL STATEMENT AUDIT. THE PROCESS ASSOCIATED WITH THE OVERSIGHT OF THE INDEPENDENT FINANCIAL STATEMENT AUDIT REMAINS CONSISTENT WITH THE PRIOR FISCAL YEAR. | FORM 990, PART XI, LINE 2C: | |
| ESTIMATE OF AVERAGE HOURS DEVOTED TO RELATED ORGANIZATIONS | DR. JOHN M. FERRETTI, D.O.: MEDICAL ASSOCIATES OF ERIE - 5 HOURS PER WEEK MILLCREEK HEALTH SYSTEM MEDICAL PROFESSIONAL LIABILITY SELF-INSURANCE TRUST - 1 HOUR PER WEEK MILLCREEK MANOR - 5 HOURS PER WEEK MILLCREEK HEALTH SYSTEM - 1 HOUR PER WEEK LAKE ERIE COLLEGE OF OSTEOPATHIC MEDICINE - 58 HOURS PER WEEK DR. SILVIA M. FERRETTI, D.O.: MEDICAL ASSOCIATES OF ERIE - 1 HOUR PER WEEK MILLCREEK MANOR - 1 HOUR PER WEEK MILLCREEK HEALTH SYSTEM - 1 HOUR PER WEEK LAKE ERIE COLLEGE OF OSTEOPATHIC MEDICINE - 75 HOURS PER WEEK MARY L. ECKERT: MEDICAL ASSOCIATES OF ERIE - 1 HOUR PER WEEK MILLCREEK HEALTH SYSTEM MEDICAL PROFESSIONAL LIABILITY SELF-INSURANCE TRUST - 1 HOUR PER WEEK MILLCREEK MANOR - 1 HOUR PER WEEK MILLCREEK HEALTH SYSTEM - 1 HOUR PER WEEK LAKE ERIE COLLEGE OF OSTEOPATHIC MEDICINE - 4 HOURS PER WEEK RICHARD P. OLINGER: MEDICAL ASSOCIATES OF ERIE - 1 HOUR PER WEEK MILLCREEK HEALTH SYSTEM MEDICAL PROFESSIONAL LIABILITY SELF-INSURANCE TRUST - 1 HOUR PER WEEK MILLCREEK MANOR - 1 HOUR PER WEEK MILLCREEK HEALTH SYSTEM - 1 HOUR PER WEEK LAKE ERIE COLLEGE OF OSTEOPATHIC MEDICINE -30 HOURS PER WEEK | FORM 990, PART VII, SECTION A: |
| SUPPLEMENTAL DISCLOSURE REGARDING BUSINESS TRANSACTIONS | CERTAIN PERSONS LISTED ON FORM 990, PART VII, SECTION A ARE EMPLOYED OR HAVE AN OWNERSHIP INTEREST IN ORGANIZATIONS WITH WHOM MILLCREEK COMMUNITY HOSPITAL (THE HOSPITAL) TRANSACTS BUSINESS. BASED ON THE REPORTING THRESHOLDS STATED IN THE FILING INSTRUCTIONS, THESE BUSINESS TRANSACTIONS ARE NOT REQUIRED TO BE REPORTED ON SCHEDULE L, PART IV. THE HOSPITAL'S BOARD OF TRUSTEES VOLUNTARILY DISCLOSES THE FOLLOWING BUSINESS RELATIONSHIPS: JAMES A. SCHAFFNER, CPA/ABV, CFF, CVA: MR. SCHAFFNER'S EMPLOYER, SCHAFFNER KNIGHT MINNAUGH & CO, P.C., WAS ENGAGED TO PREPARE THE HOSPITAL'S TAX RETURNS AS WELL THE TAX FILINGS FOR RELATED ORGANIZATIONS. MR. SCHAFFNER'S FIRM IS ALSO ENGAGED FOR CONSULTING SERVICES AS NEEDED. THE HOSPITAL PAID ACCOUNTING FEES TOTALING $18,725 TO SCHAFFNER KNIGHT MINNAUGH & COMPANY, P.C. DURING THE FISCAL YEAR ENDED JUNE 30, 2011. AT JUNE 30, 2011, MR. SCHAFFNER'S OWNERSHIP INTEREST IN SCHAFFNER KNIGHT MINNAUGH AND COMPANY, P.C. EXCEEDED 5%. DR. JOHN M. FERRETTI, D.O.: THE HOSPITAL ENGAGED OSTEOPATHIC INTERNAL MEDICINE ASSOCIATES (OIMA) TO PERFORM SPECIFIED MEDICAL SERVICES DURING THE FISCAL YEAR ENDED JUNE 30, 2011. THE HOSPITAL PAID OIMA $52,000 FOR THOSE SERVICES. OIMA IS A PROFESSIONAL CORPORATION IN WHICH DR. FERRETTI HOLDS A 100% OWNERSHIP INTEREST. NANCY Z. O'NEILL: THE HOSPITAL ENGAGED ENGEL & O'NEILL TO PERFORM ADVERTISING SERVICES DURING THE FISCAL YEAR ENDED JUNE 30, 2011. THE HOSPITAL PAID ENGEL & O'NEILL $27,000 FOR THOSE SERVICES. NANCY O'NEILL OWNS 50% OF ENGEL & O'NEILL. | FORM 990, PART IV, LINE 28C: |
| SUPPLEMENTAL BALANCE SHEET DISCLOSURE: | THE ASSETS OF A RELATED ORGANIZATION, MILLCREEK HEALTH SYSTEM MEDICAL PROFESSIONAL LIABILITY SELF-INSURANCE TRUST (EIN 57-6204119), ARE INCLUDED ON THE BALANCE SHEET OF THE FILING ORGANIZATION. | FORM 990, PART X: |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (5 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|---|---|---|---|
| LAKE ERIE COLLEGE OF OSTEOPATHIC MEDICINE | |||||||||||
| 5515 PEACH STREET | ERIE | PA | 16509 | 251698677 | MEDICAL SCHOOL AND SCHOOL OF PHARMACY | PA | 501(C)(3) | LINE 2 | MILLCREEK HEALTH SYSTEM | 0 | |
| MILLCREEK HEALTH SYSTEM | |||||||||||
| 5515 PEACH STREET | ERIE | PA | 16509 | 251766164 | PARENT CORPORATION | PA | 501(C)(3) | LINE 11C, III-FI | 0 | N/A | |
| MILLCREEK MANOR | |||||||||||
| 5515 PEACH STREET | ERIE | PA | 16509 | 251619204 | LONG TERM CARE NURSING FACILITY | PA | 501(C)(3) | LINE 3 | MILLCREEK HEALTH SYSTEM | 0 | |
| MILLCREEK HEALTH SYSTEM MEDICAL PROF LIABILITY SELF-INS TRUST | |||||||||||
| 5515 PEACH STREET | ERIE | PA | 16509 | 576204119 | PROVIDES MANDATORY PROFESSIONAL LIABILITY COVERAGE TO AFFILIATE ORGS | PA | 501(C)(3) | LINE 11D, III-O | 0 | N/A | |
| MEDICAL ASSOCIATES OF ERIE | |||||||||||
| ONE LECOM PLACE | ERIE | PA | 16505 | 113716896 | PHYSICIAN PRACTICE CORPORATION | PA | 501(C)(3) | LINE 9 | MILLCREEK HEALTH SYSTEM | 0 | |
Form990 Schedule R Part IV Form990ScheduleRPartIV
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MCH CORPORATION | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 5515 PEACH STREET | AddressLine1 |
| City | ERIE | City |
| State | PA | State |
| ZIP Code | 16509 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 251549695 | EIN |
| Primary Activity | LESSOR OF REAL ESTATE | PrimaryActivity |
| Legal Domicile State | PA | LegalDomicileState |
| Direct Controlling Entity NA | N/A | DirectControllingEntityNA |
| Type Of Entity | C | TypeOfEntity |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 1 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 1 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 1 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 1 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 1 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (14 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| LAKE ERIE COLLEGE OF OSTEOPATHIC MEDICINE | ||
| B | 6500 | ACTUAL AMOUNT CONTRIBUTED |
| LAKE ERIE COLLEGE OF OSTEOPATHIC MEDICINE | ||
| I | 518892 | ACTUAL AMOUNT PAID BASED ON USAGE |
| MEDICAL ASSOCIATES OF ERIE | ||
| I | 60000 | ACTUAL AMOUNT PAID BASED ON USAGE |
| MILLCREEK MANOR | ||
| K | 357498 | ACTUAL COST OF SERVICES |
| LAKE ERIE COLLEGE OF OSTEOPATHIC MEDICINE | ||
| O | 63031 | ACTUAL EXPENSES REIMBURSED |
| LAKE ERIE COLLEGE OF OSTEOPATHIC MEDICINE | ||
| P | 1012659 | ACTUAL EXPENSES REIMBURSED |
| MILLCREEK MANOR | ||
| P | 397820 | ACTUAL EXPENSES REIMBURSED |
| MCH CORPORATION | ||
| P | 31890 | ACTUAL EXPENSES REIMBURSED |
| MILLCREEK HEALTH SYSTEM | ||
| Q | 500000 | ACTUAL AMOUNT TRANSFERRED |
| MILLCREEK HEALTH SYSTEM MEDICAL PROF LIAB SELF-INS TRUST | ||
| Q | 68000 | ACTUAL AMOUNT TRANSFERRED |
| LAKE ERIE COLLEGE OF OSTEOPATHIC MEDICINE | ||
| J | 95760 | ACTUAL AMOUNT PAID BASED ON USAGE |
| MILLCREEK MANOR | ||
| O | 30184 | ACTUAL EXPENSES REIMBURSED |
| LAKE ERIE COLLEGE OF OSTEOPATHIC MEDICINE | ||
| C | 155600 | ACTUAL AMOUNT CONTRIBUTED |
| MEDICAL ASSOCIATES OF ERIE | ||
| O | 161220 | ACTUAL EXPENSES REIMBURSED |