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GUTHRIE TOWANDA MEMORIAL HOSPITAL: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
GUTHRIE TOWANDA MEMORIAL HOSPITAL (EIN 24-0786657)
Tax period
2010-07-01 to 2011-06-30
Filed
2012-05-15
IRS object ID
201241369349301444
Schema version
2010v3.4
Source
Download XML · Original 990 at ProPublica

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

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2012-05-15T09:04:30-05:00Timestamp
Tax Period End Date2011-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1PARENTEBEARD LLCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

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

Filer Filer

FieldValueIRS element (for citing)
EIN240786657EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1THE MEMORIAL HOSPITAL INC OF TOWANDA PABusinessNameLine1
FieldValueIRS element (for citing)
Name ControlMEMONameControl
Phone5702652191Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line191 HOSPITAL DRIVEAddressLine1
CityTOWANDACity
StatePAState
ZIP Code188489703ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameGARY A BAKERName
TitlePRESIDENT/CEOTitle
Phone5702652191Phone
Date Signed2012-05-11DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

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

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonGARY A BAKERNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line191 HOSPITAL DRIVEAddressLine1
CityTOWANDACity
StatePAState
ZIP Code188489703ZIPCode
FieldValueIRS element (for citing)
Gross Receipts41408627GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.MEMORIALHOSPITAL.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1946YearFormation
State Legal DomicilePAStateLegalDomicile
Activity Or Mission DescriptionTO OPERATE AN ACUTE CARE HOSPITAL AND LONG TERM CARE FACILITY IN TOWANDA, PENNSYLVANIA.ActivityOrMissionDescription
Nbr Voting Members Governing Body28NbrVotingMembersGoverningBody
Nbr Independent Voting Members25NbrIndependentVotingMembers
Total Nbr Employees605TotalNbrEmployees
Total Nbr Volunteers22TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year228982ContributionsGrantsPriorYear
Contributions Grants Current Year277713ContributionsGrantsCurrentYear
Program Service Revenue Prior Year37820881ProgramServiceRevenuePriorYear
Program Service Revenue CY40025437ProgramServiceRevenueCY
Investment Income Prior Year40368InvestmentIncomePriorYear
Investment Income Current Year292127InvestmentIncomeCurrentYear
Other Revenue Prior Year222421OtherRevenuePriorYear
Other Revenue Current Year702016OtherRevenueCurrentYear
Total Revenue Prior Year38312652TotalRevenuePriorYear
Total Revenue Current Year41297293TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year22755173SalariesEtcPriorYear
Salaries Etc Current Year21459214SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year18211410OtherExpensePriorYear
Other Expenses Current Year18843904OtherExpensesCurrentYear
Total Expenses Prior Year40966583TotalExpensesPriorYear
Total Expenses Current Year40303118TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-2653931RevenuesLessExpensesPriorYear
Revenues Less Expenses CY994175RevenuesLessExpensesCY
Total Assets BOY42672765TotalAssetsBOY
Total Assets EOY46198397TotalAssetsEOY
Total Liabilities BOY21936324TotalLiabilitiesBOY
Total Liabilities EOY20936803TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY20736441NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY25261594NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionTHE MISSION OF MEMORIAL HOSPITAL, INC., A NONPROFIT ORGANIZATION, IS TO PROVIDE SUPERIOR QUALITY HEALTH CARE SERVICES IN A CARING, EFFICIENT AND FINANCIALLY RESPONSIBLE MANNER, THAT WILL IMPROVE THE QUALITY OF LIFE IN OUR COMMUNITY.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense37996112Expense
Revenue40025437Revenue
DescriptionMEMORIAL HOSPITAL, INC. OF TOWANDA, PA IS A NOT-FOR-PROFIT ACUTE CARE HOSPITAL AND LONG TERM CARE FACILITY LOCATED IN TOWANDA, PA. THE HOSPITAL PROVIDES INPATIENT, OUTPATIENT, EMERGENCY CARE, LONG-TERM CARE AND HOME HEALTH SERVICES TO RESIDENTS OF TOWANDA, PA AND SURROUNDING COMMUNITIES. OUR DOCTORS CONTINUOUSLY WORK WITH OUR OWN QUALIFIED SPECIALISTS AND MANY OTHERS WITHIN THE BRADFORD AND SULLIVAN COUNTY MEDICAL COMMUNITY AS WELL AS OUTSIDE OF THIS AREA TO PROVIDE ACCESS TO QUALITY SPECIALTY CARE.WE ROUTINELY WORK WITH SPECIALISTS IN SAYRE, PA; ELMIRA, NY; BINGHAMTON, NY; WILLIAMSPORT, PA; SCRANTON, PA; DANVILLE, PA; AND PHILADELPHIA, PA, TO MEET OUR PATIENTS' HEALTHCARE NEEDS.IN FEBRUARY 2008, COMMUNITY HEALTH ASSOCIATES, LLC, A SINGLE MEMBER LLC OWNED SOLELY BY MEMORIAL HOSPITAL, INC. WAS ESTABLISHED. THE PURPOSE OF COMMUNITY HEALTH ASSOCIATES, LLC IS TO EMPLOY PHYSICIANS TO ASSIST THE HOSPITAL WITH MEETING ITS MISSION AND TO IMPROVE THE RECRUITING AND RETENTION OF PHYSICIANS IN THE AREA.IN THE YEAR ENDING JUNE 30, 2011, THE HOSPITAL ADMITTED 1,886 PATIENTS AND HAD A TOTAL OF 53,151 PATIENT DAYS. TOTAL PATIENT DAYS WERE COMPRISED OF 5,352 ACUTE CARE; 473 NURSERY; 25,000 PERSONAL CARE HOME, AND 22,326 SKILLED NURSING. WE CONDUCTED 5,333 HOME HEALTH VISITS AND RECEIVED 55,356 OTHER OUTPATIENT VISITS. THE MATERNITY CENTER DELIVERED 200 NEWBORNS. THE ER SAW 11,521 VISITS DURING THE YEAR. DURING THE FISCAL YEAR JUNE 30, 2011, THE HOSPITAL PROVIDED $237,092 IN CHARITY CARE (COST BASIS) TO THE COMMUNITIES IT SERVES. MEMORIAL HOSPITAL IS DIRECTED BY A BOARD OF COMMUNITY LEADERS KNOWN AS TRUSTEES AND IS SUPPORTED BY THE SERVICE OF DOZENS OF VOLUNTEERS INCLUDING A VERY ACTIVE AUXILIARY.MANY OF MEMORIAL HOSPITAL'S ACTIVE MEDICAL STAFF PHYSICIANS ARE BOARD CERTIFIED IN THEIR RESPECTIVE SPECIALTIES, REFLECTING A DEDICATION AND COMMITMENT TO PROVIDE THE HIGHEST QUALITY OF CARE TO MEMORIAL HOSPITAL'S PATIENTS. ALL THREE LEADERSHIP GROUPS OF THE HOSPITAL - THE BOARD OF TRUSTEES, MEDICAL STAFF AND ADMINISTRATION - CONTINUOUSLY WORK TOGETHER TO IDENTIFY AND DIRECT THE PRIORITIES OF THE HOSPITAL THROUGH THE DEVELOPMENT AND IMPLEMENTATION OF STRATEGIC PLANS WITHIN THE SCOPE OF OUR MISSION. FROM EMERGENCY SERVICES TO OUR MATERNITY CENTER, FROM TOP-NOTCH RADIOLOGY DIAGNOSTICS TO LONG-TERM CARE, FROM HOME HEALTH TO OUTPATIENT THERAPIES, WE ARE HERE FOR FAMILIES AND INDIVIDUALS IN OUR COMMUNITIES. WE ARE COMMITTED TO MEETING THE HEALTH CARE NEEDS OF OUR RESIDENTS AND WILL DO OUR BEST TO MEET AND EXCEED THEIR EXPECTATIONS.MEMORIAL HOSPITAL, INC. PROVIDES HEALTH CARE TO RESIDENTS IN THE BRADFORD AND SULLIVAN COUNTY AREAS. THE HOSPITAL PROVIDES A WIDE RANGE OF SERVICES TO PATIENTS WITHOUT REGARD TO THE INDIVIDUAL'S ABILITY TO PAY. THE HOSPITAL'S EMERGENCY DEPARTMENT IS AVAILABLE ON A 7 DAY A WEEK, 24 HOUR A DAY BASIS FOR THE EMERGENT, AS WELL AS NON-EMERGENT, NEEDS OF THOSE THAT SEEK CARE. THE HOSPITAL HAS A HOSPITAL-BASED SKILLED NURSING FACILITY THAT CARES FOR A VERY HIGH PERCENTAGE OF MEDICAL ASSISTANCE RESIDENTS, AS WELL AS SOME MEDICARE RESIDENTS.Description
Total Program Service Expense37996112TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required0ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling1CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets1ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Financial Stmt Attached1FinancialStmtAttached
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP1LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity1DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity1RelatedOrgControlledEntity
Transaction Related Entity1TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109636NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees605NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members28NbrVotingGoverningBodyMembers
Number Independent Voting Members25NumberIndependentVotingMembers
Family Or Business Relationship1FamilyOrBusinessRelationship
Delegation Of Management Duties1DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledPAStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1WILLIAM ROHRBACHBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number5702682207TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line191 HOSPITAL DRIVEAddressLine1
CityTOWANDACity
StatePAState
ZIP Code18848ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (32 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerHighest Compensated EmployeeHighestCompensatedEmployee
DONALD ABREY
TRUSTEE5.00X000
RONALD BLACK MD
PRES. MEDICAL STAFF5.00X000
DONALD BRENNAN
TRUSTEE5.00X000
PETER BRODERICK
TRUSTEE5.00X000
BRIAN GROVE
TRUSTEE5.00X000
RAY DEPAOLA
TRUSTEE5.00X000
HANK DUNN
TRUSTEE5.00X000
BRIAN EMICK
TRUSTEE5.00X000
MARK GANNON
TRUSTEE5.00X000
LEWIS HOPE
TRUSTEE5.00X000
MARJORY KREISCHER
TRUSTEE5.00X000
LEO LAMBERT
TRUSTEE5.00X000
WILLIAM MCNETT
TRUSTEE5.00X000
JODY PLACE
TRUSTEE5.00X000
JAMES RODENHIZER
TRUSTEE5.00X000
GERALD E SHAFFER
TRUSTEE5.00X000
MARGUERITE SHANER
AUXILIARY PRESIDENT5.00X000
BARBARA YANAK OD
TRUSTEE5.00X000
JIM PARKS
CHAIRMAN5.00X000X
JOHN L SCHOONOVER III
VICE-CHAIRMAN5.00X000X
ROBERT FERRARIO
SECRETARY5.00X000X
DAVID PACKARD
TREASURER5.00X000X
GARY A BAKER
PRESIDENT/CEO40.00X222306052393X
WILLIAM ROHRBACH
CFO/ASST SECRETARY40.00X15058909483X
ALFREDO LLINAS
GENERAL SURGEON40.00X334357010841X
JOSEPH CAMA MD
TRUSTEE5.00X000
MARTIN MIKAYA
TRUSTEE5.00X000
TOM THOMPSON
TRUSTEE5.00X000
DAVID RUDA
CRNA40.00242320011025X
LARRY LINNELL
FAMILY PRACTITIONER40.0019643506484X
LISA CERAOLO
INTERNAL MEDICINE PHYSICIAN40.00191618010841X
GEETA KRISHNAN
ENT PHYSICIAN22.0017800000X
FieldValueIRS element (for citing)
Total Reportable Comp From Org1515625TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation101067TotalOtherCompensation
Number Individuals GT100 K15NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
TEAM CARE PC
2031 ORANGE HILL ROADATHENSPA18810EMERGENCY PHYSICIAN SERVICES1051920
GULFSTREAM ANESTHESIA CONSULTANTS
PO BOX 212110 ROYALPALM BEACHFL33421ANESTHESIA SERVICES504936
KINGS MEDICAL GROUP
PO BOX 72483CLEVELANDOH44192MRI SERVICES369160
MORRISON MANAGEMENT SPECIALIST
PO BOX 102289ATLANTAGA30368DIETARY MANAGEMENT SERVICES209942
ASSOCIATED RADIOLOGISTS
100 EAST FOURTEENTH STREETELMIRA HEIGHTSNY14903RADIOLOGY SERVICES204145
FieldValueIRS element (for citing)
Number Of Contractors GT100 K9NumberOfContractorsGT100K
Related Organizations3745RelatedOrganizations
All Other Contributions273968AllOtherContributions
Total Contributions277713TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
NET PATIENT SVC REV6219903997254539972545
THERAPIES & PROGRAMS6219905289252892
FieldValueIRS element (for citing)
Total Program Service Revenue40025437TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column306416TotalRevenueColumn
Exclusion$306,416ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real74694Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real60979Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real13715Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column13715TotalRevenueColumn
Exclusion$13,715ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Other26659Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other40948Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other-14289Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-14289TotalRevenueColumn
Exclusion-$14,289ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Gaming11871GrossIncomeGaming
Gaming Direct Expenses9407GamingDirectExpenses

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column2464TotalRevenueColumn
Exclusion$2,464ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeExclusionExclusionAmount
EHR INCENTIVE PAYMENT900099337782337782
CAFETERIA/VENDING722210105422$105,422
PURCHASE DISCOUNTS90009995459$95,459

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column147174TotalRevenueColumn
Exclusion$147,174ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue685837TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column41297293TotalRevenueColumn
Related Or Exempt Function Income40363219RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$656,361ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total374134Total
Management And General374134ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total15939108Total
Program Services15396607ProgramServices
Management And General542501ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total1019313Total
Program Services962038ProgramServices
Management And General57275ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total2967934Total
Program Services2801167ProgramServices
Management And General166767ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total1158725Total
Program Services1093617ProgramServices
Management And General65108ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total96797Total
Management And General96797ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total77550Total
Management And General77550ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total2756Total
Management And General2756ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total5107413Total
Program Services4675887ProgramServices
Management And General431526ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total67701Total
Program Services45280ProgramServices
Management And General22421ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total3805149Total
Program Services3566996ProgramServices
Management And General238153ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total989276Total
Program Services972356ProgramServices
Management And General16920ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total226924Total
Program Services224898ProgramServices
Management And General2026ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total53365Total
Program Services53365ProgramServices

Interest Interest

FieldValueIRS element (for citing)
Total528887Total
Program Services528887ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total2304628Total
Program Services2304628ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total806823Total
Program Services806823ProgramServices

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
BAD DEBT EXPENSE37562323756232
DIETARY EXPENSE46841144981718594
REPAIRS & MAINTENANCE256051256051
DUES & SUBSCRIPTIONS576731531742356
ADMIN ALLOCATION3773937739

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total200529Total
Program Services48407ProgramServices
Management And General152122ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total40303118Total
Program Services37996112ProgramServices
Management And General2307006ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY1350BOY
EOY1351EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY921038BOY
EOY2871330EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY5931655BOY
EOY5073889EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY592959BOY
EOY545393EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY468500BOY
EOY228509EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis44568281LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec22789528LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY22060246BOY
EOY21778753EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY110449BOY
EOY80167EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY65000BOY
EOY289586EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY12521568BOY
EOY15329419EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY42672765BOY
EOY46198397EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY2688437BOY
EOY2536021EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY11591805BOY
EOY11575250EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY7656082BOY
EOY6825532EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY21936324BOY
EOY20936803EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY20014980BOY
EOY24440400EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY656461BOY
EOY756194EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY65000BOY
EOY65000EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY20736441BOY
EOY25261594EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY42672765BOY
EOY46198397EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses994175ReconcilationRevenueExpenses
Reconcilation Other Changes3530978ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0Volunteers
Paid Staff Or Management0PaidStaffOrManagement
Media Advertisements0MediaAdvertisements
Mailings Members0MailingsMembers
Publications Or Broadcast0PublicationsOrBroadcast
Grants Other Organizations1GrantsOtherOrganizations
Grants Other Organizations$2,756GrantsOtherOrganizationsAmount
Direct Contact Legislators0DirectContactLegislators
Rallies Demonstrations0RalliesDemonstrations
Other Activities0OtherActivities
Total Lobbying Expenditures IIB2756TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierEXPLANATION OF OTHER LOBBYING ACTIVITIES:Identifier
Return ReferencePART II-B, LINE 1I:ReturnReference
ExplanationTHE MEMORIAL HOSPITAL, INC. OF TOWANDA, PA INCURS LOBBYING EXPENSES ONLY AS A PORTION OF THEIR HAP DUES APPLICABLE TO THE YEAR ENDED 6/30/11. THESE EXPENSES ARE APPROX. 21.26% OF DUES FOR THE YEAR.Explanation

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Agent Trustee Etc1AgentTrusteeEtc
Beginning Balance9412BeginningBalance
Additions During Year102406AdditionsDuringYear
Distributions During Year104674DistributionsDuringYear
Ending Balance7144EndingBalance
Included On FS0IncludedOnFS

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis247164OtherCostOrOtherBasis
Book Value247164BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis26034506OtherCostOrOtherBasis
Depreciation9019846Depreciation
Book Value17014660BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis18160421OtherCostOrOtherBasis
Depreciation13769682Depreciation
Book Value4390739BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis126190OtherCostOrOtherBasis
Book Value126190BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings21778753TotalOfBookValueLandBuildings

Other Assets OtherAssets (3 entries)

DescriptionDescriptionBook ValueBookValue
DEFERRED FINANCING COSTS, NET38486
BENEFICIAL INTEREST IN ASSETS HELD BY MEMORIAL HOSPITAL FDN14824299
OTHER CURRENT ASSETS466634
FieldValueIRS element (for citing)
Total Book Value Other Assets15329419TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (6 entries)

DescriptionDescriptionAmountAmount
ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS$901,371
AMTS W/H FROM EMPLOYEES FOR TAXES, ETC.$98,806
BLUE CROSS ADVANCE$184,441
PENSION LIABILITY$2,033,210
AMOUNTS DUE TO AFFILIATES$3,301,147
ESTIMATED MED MALPRACTICE CLAIMS LIAB$306,557
FieldValueIRS element (for citing)
Total Of Amounts6825532TotalOfAmounts
Total Revenue41297293TotalRevenue
Total Expenses40303118TotalExpenses
Excess Or Deficit For Year994175ExcessOrDeficitForYear
Net Unrealized GL On Investments11860NetUnrealizedGLOnInvestments
Other$3,519,118OtherAmount
Total Adjustments3530978TotalAdjustments
Excess Or Deficit Per FS4525153ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt44912946TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments11860NetUnrealizedGainsInvestments
Other Revenues3519118OtherRevenues
Revenue Not Rptd F9903530978RevenueNotRptdF990
Revenue Subtotal41381968RevenueSubtotal
Other Revenues Not Included-84675OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt-84675RevenueNotRptdOnFinStmt
Total Revenue Per Form99041297293TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt40387793TotExpensesEtcAuditedFinclStmt
Other Expenses Included84675OtherExpensesIncluded
Expenses Not Rptd F99084675ExpensesNotRptdF990
Expenses Subtotal40303118ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form99040303118TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (6 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
PART IV, LINE 1B:THE HOSPITAL MAINTAINS A SEPARATE ACCOUNT WITH SKILLED NURSING FACILITY RESIDENT FUNDS OF WHICH WE ARE THE REPRESENTATIVE PAYEE. FUNDS ARE USED TO PAY PATIENTS' BILLS AND PERSONAL EXPENSES.
PART X:THE ORGANIZATION ACCOUNTS FOR UNCERTAINTY IN INCOME TAXES USING A RECOGNITION THRESHOLD OF MORE-LIKELY-THAN NOT TO BE SUSTAINTED UPON EXAMINATION BY THE APPROPRIATE TAXING AUTHORITY. MEASUREMENT OF THE TAX UNCERTAINTY OCCURS IF THE RECOGNITION THRESHOLD IS MET. MANAGEMENT DETERMINED THAT THERE WERE NO TAX UNCERTAINTIES THAT MET THE RECOGNITION THRESHOLD IN 2011 & 2010. THE ORGANIZATION'S FEDERAL INCOME TAX RETURNS FOR JUNE 30, 2011, 2010, AND 2009 REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE.DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:
PENSION LIABILITY ADJUSTMENT 1,896,912. CHANGE IN INTEREST IN MEMORIAL HOSPITAL FOUNDATION 1,498,466. CHANGE IN TEMPORARILY RESTRICTED INTEREST IN MEMORIAL HOSPITAL FOUNDATION 100,701. NET ASSETS RELEASED FROM RESTRICTION FOR THE PURCHASES OF EQUIPMENT 23,039.PART XI, LINE 8 - OTHER ADJUSTMENTS:
CHANGE IN INTEREST IN MEMORIAL HOSPITAL FOUNDATION 1,498,466. PENSION LIABILITY ADJUSTMENT 1,896,912. CHANGE IN TEMPORARILY RESTRICTED INTEREST IN MEMORIAL HOSPITAL FOUNDATION 100,701. NET ASSETS RELEASED FROM RESTRICTION FOR THE PURCHASE OF EQUIPMENT 23,039.PART XII, LINE 2D - OTHER ADJUSTMENTS:
RENTAL EXPENSES -60,979. LOSS ON DISPOSAL OF EQUIPMENT -14,289. GAMING EXPENSES -9,407.PART XII, LINE 4B - OTHER ADJUSTMENTS:
LOSS ON DISPOSAL OF EQUIPMENT 14,289. RENTAL EXPENSES 60,979. GAMING EXPENSES 9,407.PART XIII, LINE 2D - OTHER ADJUSTMENTS:

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
FPG Reference Free Care1FPGReferenceFreeCare
Pcent200XPcent200
FPG Reference Discounted Care1FPGReferenceDiscountedCare
Pcent200 DXPcent200D
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget1ExpensesExceededBudget
Unable To Provide Care0UnableToProvideCare
Annual Community Benefit Report0AnnualCommunityBenefitReport

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense237092TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense237092NetCommunityBenefitExpense
Percent Of Total Expense0.00650PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense4203098TotalCommunityBenefitExpense
Direct Offsetting Revenue3625867DirectOffsettingRevenue
Net Community Benefit Expense577231NetCommunityBenefitExpense
Percent Of Total Expense0.01580PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense4440190TotalCommunityBenefitExpense
Direct Offsetting Revenue3625867DirectOffsettingRevenue
Net Community Benefit Expense814323NetCommunityBenefitExpense
Percent Of Total Expense0.02230PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Total Community Benefit Expense50921TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense50921NetCommunityBenefitExpense
Percent Of Total Expense0.00140PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense6496970TotalCommunityBenefitExpense
Direct Offsetting Revenue4633357DirectOffsettingRevenue
Net Community Benefit Expense1863613NetCommunityBenefitExpense
Percent Of Total Expense0.05100PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense6547891TotalCommunityBenefitExpense
Direct Offsetting Revenue4633357DirectOffsettingRevenue
Net Community Benefit Expense1914534NetCommunityBenefitExpense
Percent Of Total Expense0.05240PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense10988081TotalCommunityBenefitExpense
Direct Offsetting Revenue8259224DirectOffsettingRevenue
Net Community Benefit Expense2728857NetCommunityBenefitExpense
Percent Of Total Expense0.07470PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported1BadDebtExpenseReported
Bad Debt Expense$1,298,056BadDebtExpenseAmount
Amount Attributable To0AmountAttributableTo
Amount Reimbursed By Medicare7122791AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare6559754CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall563037MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care1ProvisionForCharityCare
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1THE MEMORIAL HOSP INC OF TOWANDA PABusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line1ONE HOSPITAL DRIVEAddressLine1
CityTOWANDACity
StatePAState
ZIP Code18848ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1THE MEMORIAL HOSPITAL INC OF TOWANDABusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber

Form990 Schedule H Part VI Form990ScheduleHPartVI (9 entries)

ExplanationExplanation
PART I, LINE 7: THE RATIO OF COST TO CHARGES WAS COMPUTED USING PATIENT CHARGES AND PATIENT COST EXCLUDING RELATED BAD DEBT COSTS COUNTED ELSEWHERE IN THE COMMUNITY BENEFIT NUMBERS. THE NUMBERS USED IN THE CALCULATION OF THE RATIO WERE OBTAINED FROM THE MEDICARE COST REPORT FOR THE RELATED PERIOD. THIS RATIO IS USED IN THE CALCULATION OF CHARITY CARE, MEDICAID, OTHER MEANS-TESTED GOVERNMENT PROGRAMS AND SUBSIDIZED HEALTH SERVICES. FOR THE REMAINING LINES, DIRECT EXPENSES WERE IDENTIFIED BY PROGRAM BASED ON PROGRAM RECORDS.
PART I, L7 COL(F): THE AMOUNT OF BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25 COLUMN (A) BUT SUBTRACTED OUT FOR PURPOSES OF CALCULATING THE PERCENTAGE ON SCH H, PART I, LINE 7, COLUMN (F) IS $3,756,232.
PART III, LINE 4: ACCOUNTS RECEIVABLE, PATIENTS ARE REPORTED AT NET REALIZABLE VALUE. ACCOUNTS ARE WRITTEN OFF WHEN THEY ARE DETERMINED TO BE UNCOLLECTIBLE BASED UPON THE ORGANIZATION'S APPROVED WRITE-OFF POLICY. THE ALLOWANCE FOR DOUBTFUL COLLECTIONS IS ESTIMATED BASED UPON A PERIODIC REVIEW OF THE ACCOUNTS RECEIVABLE AGING, PAYOR CLASSIFICATIONS, AND APPLICATION OF HISTORICAL WRITE-OFF PERCENTAGES.TOTAL RATIO OF COST TO CHARGES (BAD DEBT EXPENSE WAS BACKED OUT TO CALCULATE THE RATIO) WAS USED TO CALCULATE BAD DEBT EXPENSE.
PART III, LINE 9B: IF UPON REGISTRATION, PATIENT IS DETERMINED TO HAVE NO INSURANCE AND QUALIFIES FOR FINANCIAL ASSISTANCE THEY ARE ASKED TO PROVIDE COPIES OF A W-2, PAY STUB, OR INCOME TAX RETURN TO COMPLETE OUR CHARITY CARE APPLICATION. DETERMINATION IS MADE BASED ON INFORMATION RECEIVED AND FINANCIAL GUIDELINES.
PART VI, LINE 2: MEMORIAL HOSPITAL CONDUCTS ITS OWN HEALTH CARE ASSESSMENT ON AN ONGOING BASIS FOR THE HOSPITAL'S PRIMARY (ZIP CODES: 18837, 18854, 18815, 18853, 18814, 18848, 18832, 18833, 18614, 16947, 16926, 17743, 17724 AND 17735) AND SECONDARY (16914, 18817, 18840, 18831, 18850, 18851, 18829, 18845, 18818, 18828, 18839, 18801, 18843, 18846, 18616 AND 18632) SERVICE AREA. THE HOSPITAL USES ITS BOARD OF TRUSTEES, PHYSICIANS ON STAFF, EMPLOYEES AND COMMUNITY MEMBERS TO IDENTIFY NEEDS BASED ON INFORMATION OBTAINED BY THESE INDIVIDUALS OR GROUPS. BASED ON WHAT IS OBTAINED, THE HOSPITAL CAN THEN DETERMINE WHAT HEALTHCARE SERVICES SHOULD BE CONSIDERED TO BE OFFERED IN THE COMMUNITY.
PART VI, LINE 3: INFORMATION IS PROVIDED THROUGHOUT THE HOSPITAL REGARDING THE CHARITY CARE PROGRAM. TELEPHONE CALLS ARE MADE TO ALL SELF PAY PATIENTS AS WELL AS SEEING THEM PERSONALLY IF THEY HAPPEN TO BE AN INPATIENT OF THE HOSPITAL. EVERY INTAKE AREA OF THE HOSPITAL HAS INFORMATION REGARDING THE FINANCIAL ASSISTANCE THE HOSPITAL CAN PROVIDE AND THE CONTACT INFORMATION FOR THE HOSPITAL'S FINANCIAL COUNSELOR IS MADE AVAILABLE. ALL NEW HIRED EMPLOYEES IN INTAKE AREAS ARE TRAINED IN THE FINANCIAL ASSISTANCE POLICIES AS PART OF THEIR ORIENTATION PROCESS. A NOTICE FOR FINANCIAL AID IS POSTED ON THE HOSPITAL'S WEB SITE FOR THOSE SEEKING THE INFORMATION VIA THE WEB. IN THE EVENT AN INTERPRETER IS NEEDED TO ASSIST A PATIENT WHO DOES NOT SPEAK ENGLISH, ONE CAN BE PROVIDED.
PART VI, LINE 4: MEMORIAL HOSPITAL SERVES A RURAL PORTION OF BRADFORD AND SULLIVAN COUNTIES IN NORTHEAST PA. THE TOTAL POPULATION FOR BOTH COUNTIES IS APPROXIMATELY 67,000. THE HOSPITAL SERVES A HIGH PERCENTAGE OF MEDICAL ASSISTANCE PATIENTS AND IS ELIGIBLE FOR DSH REIMBURSEMENT AS A RESULT. ACCORDING TO THE PENNSYLVANIA HEALTH CARE COST CONTAINMENT COUNCIL (PHC4), MEMORIAL HOSPITAL HAD A 10.69% SHARE OF NET PATIENT REVENUE COMING FROM MEDICAL ASSISTANCE PATIENTS. THE AVERAGE FOR THE REGION MEMORIAL HOSPITAL IS LOCATED IN IS 7.75%. MEMORIAL HOSPITAL ALSO, HAD ACCORDING TO PHC4, AN UNCOMPENSATED CARE PERCENTAGE OF 5.17% WITH THE REGION AVERAGE BEING 3.07%. THE HOSPITAL'S 24 HOUR EMERGENCY ROOM CARES FOR MANY PATIENTS SEEKING PRIMARY CARE WHO DO NOT HAVE AN EXISTING PRIMARY CARE PHYSICIAN. WITHIN BRADFORD AND SULLIVAN COUNTIES THERE ARE AREAS DESIGNATED AS MEDICALLY UNDERSERVED, WITH THE HOSPITAL CARING FOR MANY PATIENTS WITHIN THOSE AREAS.
PART VI, LINE 6: MEMORIAL HOSPITAL IS GOVERNED BY A 30 MEMBER VOLUNTEER BOARD OF TRUSTEES WITH THE MAJORITY OF THOSE TRUSTEES RESIDING IN THE HOSPITAL'S PRIMARY SERVICE AREA. THE CEO AND THE CFO ARE MEMBERS OF THE BOARD OF TRUSTEES. THE REMAINING 28 MEMBERS ARE COMMUNITY MEMBERS OF THE AREAS THE HOSPITAL SERVES THAT ARE NEITHER EMPLOYEES, CONTRACTORS OF THE ORGANIZATION OR FAMILY MEMBERS THEREOF. THE HOSPITAL EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY WHO SEEK THOSE PRIVILEGES. ANY SURPLUS FUNDS GENERATED BY THE HOSPITAL ARE USED FOR FUNDING IMPROVEMENTS IN PATIENT CARE. THE HOSPITAL'S 24 HOUR EMERGENCY ROOM TREATS ALL PATIENTS WHO PRESENT REGARDLESS OF THEIR ABILITY TO PAY. THE HOSPITAL PARTICIPATES WITH ALL GOVERNMENT SPONSORED HEALTH CARE PROGRAMS AND OFFERS FINANCIAL ASSISTANCE TO PATIENTS WHO SEEK ASSISTANCE AND MEET THE GUIDELINES.
PART VI, LINE 7: MEMORIAL HOSPITAL IS SUPPORTED BY THE MEMORIAL HOSPITAL FOUNDATION, WHICH WAS ESTABLISHED IN 2003 TO FOSTER AND SUPPORT SPECIFIC PROJECTS AND PROGRAMS TO IMPROVE THE HOSPITAL'S SERVICES TO ITS PATIENTS. THE MISSION OF THE MEMORIAL HOSPITAL FOUNDATION IS TO GENERATE RESOURCES FOR THE SUSTAINABILITY AND ADVANCEMENT OF HEALTHCARE IN THE COMMUNITIES IT HAS THE PRIVILEGE OF SERVING.PART VI, LINE 7: AS PRESENT THE HOSPITAL DOES NOT FILE A COMMUNITY BENEFIT REPORT WITH ANY STATE.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Form990 Of Other OrganizationsXForm990OfOtherOrganizations
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (7 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
GARY A BAKER
185334036972000119480404450274699000
WILLIAM ROHRBACH
1325190180700002519069640160072000
ALFREDO LLINAS
3343570000000108410345198000
DAVID RUDA
2423200000000110250253345000
LARRY LINNELL
196435000000064840202919000
LISA CERAOLO
1916180000000108410202459000
GEETA KRISHNAN
178000000000000178000000

Schedule L IRS990ScheduleL

Loan Table LoanTable

FieldValueIRS element (for citing)
Name PersonLARRY LINNELL MDNamePerson
Purpose Of LoanRELOCATION EXPENSESPurposeOfLoan
Loan From OrganizationXLoanFromOrganization
Original Principal$30,000OriginalPrincipalAmount
Balance Due2828BalanceDue
Default0Default
Approved By Board1ApprovedByBoard
Written Agreement1WrittenAgreement
FieldValueIRS element (for citing)
Total Balance Due2828TotalBalanceDue

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (8 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
FORM 990, PART VI, SECTION A, LINE 2JIM PARKS (CHAIRMAN) IS THE BROTHER-IN-LAW OF ROBERT FERRARIO (SECRETARY).
FORM 990, PART VI, SECTION A, LINE 3MEMORIAL HOSPITAL HAS A MANAGEMENT CONTRACT WITH QUORUM HEALTH RESOURCES. GARY BAKER, PRESIDENT/CEO, IS EMPLOYED BY QUORUM HEALTH RESOURCES.
FORM 990, PART VI, SECTION B, LINE 11REVIEWED IN DETAIL BY MANAGEMENT WITH THE HELP OF PARENTEBEARD. A COPY OF THE RETURN WAS EMAILED TO THE MEMBERS OF THE FINANCE COMMITTEE OF THE BOARD OF TRUSTEES FOR THEIR REVIEW BEFORE FILING.
OUR TRUSTEES, MEDICAL STAFF AND MANAGEMENT STAFF ALL ARE REQUIRED TO DISCLOSE CONFLICTS OF INTEREST THROUGH A FORMAL PROCESS OF REVIEWING THE POLICY & DISCLOSING & SIGNING A STATEMENT. THEY ARE ENCOURAGED TO PARTICIPATE IN DISCUSSION, BUT WILL ABSTAIN DURING VOTES. FAILURE TO FULLY DISCLOSE ANY CONFLICTS OF INTEREST ARE REVIEWED BY MANAGEMENT. DISCIPLINARY ACTIONS RESULTING FROM INADEQUATE DISCLOSURE ARE DETERMINED ON A CASE BY CASE MANNER AND COULD RESULT IN TERMINATION OF EMPLOYMENT.FORM 990, PART VI, SECTION B, LINE 12C
THE COMPENSATION COMMITTEE REVIEWS AND APPROVES THE SALARIES OF THE CEO, CFO AND VP'S. MEMBERS OF THE BOARD, AS WELL AS THE VP OF THE MANAGEMENT COMPANY, ARE INVOLVED IN SETTING COMPENSATION. SURVEYS ARE USED TO COMPARE THE SALARIES TO MAINTAIN APPROPRIATENESS OF WAGES. REVIEW AND APPROVAL IS DOCUMENTED IN COMMITTEE MINUTES.FORM 990, PART VI, SECTION B, LINE 15
FORM 990, PART VI, SECTION C, LINE 19: THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND/OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.FORM 990, PART VI, SECTION C, LINE 19
AVERAGE HOURS PER WEEK FOR THE FOUNDATION AND RELATED ORGANIZATIONS ARE AS FOLLOWS: WILLIAM ROHRBACH - 42 HOURS GARY A. BAKER - 42 HOURSFORM 990, PART VII, SECTION A:
CHANGES IN NET ASSETS OR FUND BALANCES:NET UNREALIZED GAINS ON INVESTMENTS: 11,860. PENSION LIABILITY ADJUSTMENT 1,896,912. CHANGE IN INTEREST IN MEMORIAL HOSPITAL FOUNDATION 1,498,466. CHANGE IN TEMPORARILY RESTRICTED INTEREST IN MEMORIAL HOSPITAL FOUNDATION 100,701. NET ASSETS RELEASED FROM RESTRICTION FOR THE PURCHASES OF EQUIPMENT 23,039. TOTAL TO FORM 990, PART XI, LINE 5: 3,530,978.FORM 990, PART XI, LINE 5:

Schedule R IRS990ScheduleR

Form990 Schedule R Part I Form990ScheduleRPartI

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1COMMUNITY HEALTH ASSOCIATES LLCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line191 HOSPITAL DRIVEAddressLine1
CityTOWANDACity
StatePAState
ZIP Code18848ZIPCode
FieldValueIRS element (for citing)
EIN262096228EIN
Primary ActivitiesEMPLOYS PHYSICIANS FOR THE HOSPITALPrimaryActivities
Legal Domicile StatePALegalDomicileState
Total Income1855256TotalIncome
EOY Assets1005638EOYAssets

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1THE MEMORIAL HOSPITAL INC OF TOWANDABusinessNameLine1

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1THE MEMORIAL HOSPITAL FOUNDATIONBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line191 HOSPITAL DRIVEAddressLine1
CityTOWANDACity
StatePAState
ZIP Code188489703ZIPCode
FieldValueIRS element (for citing)
EIN651160811EIN
Primary ActivitiesSUPPORTS THE ACTIVITIES AND PURPOSES OF THE HOSPITALPrimaryActivities
Legal Domicile StatePALegalDomicileState
Exempt Code Section501(C)(3)ExemptCodeSection
Public Charity Status11APublicCharityStatus

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1THE MEMORIAL HOSPITAL INC OF TOWANDABusinessNameLine1
FieldValueIRS element (for citing)
Controlled Org1ControlledOrg
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org1GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org1LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities1SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable

Name Of Other Organization NameOfOtherOrganization

FieldValueIRS element (for citing)
Business Name Line1THE MEMORIAL HOSPITAL FOUNDATIONBusinessNameLine1
FieldValueIRS element (for citing)
Transaction TypeCTransactionType
Amount Involved3745AmountInvolved
Method Of Amt DeterminationFMVMethodOfAmtDetermination