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290 HAIDA- MIMC INC: Form 990, tax year 2009

View the entire original 990 at ProPublica ↗

Organization
290 HAIDA- MIMC INC (EIN 25-0977902)
Tax period
2009-07-01 to 2010-06-30
Filed
2011-02-10
IRS object ID
201100419349300915
Schema version
2009v1.7
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)
Timestamp2011-02-10T11:22:32-06:00Timestamp
Tax Period End Date2010-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1Carbis Walker LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line15700 Corporate Drive Ste 650AddressLine1
CityPittsburghCity
StatePAState
ZIP Code15237ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2009-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN250977902EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1MINERS HOSPITALBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlMINENameControl
Phone8142473100Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1290 HAIDA AVENUEAddressLine1
CityHASTINGSCity
StatePAState
ZIP Code16646ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameEDWARD DEPASQUALEName
TitleCHIEF FINANCIAL OFFICERTitle
Phone8142473100Phone
Date Signed2011-02-08DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameJeffrey J Petrell CPAName
Phone4126356270Phone
FieldValueIRS element (for citing)
Tax Year2009TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

Doing Business As DoingBusinessAs

FieldValueIRS element (for citing)
Business Name Line1MINERS MEDICAL CENTERBusinessNameLine1
FieldValueIRS element (for citing)
Name Of Principal Officer PersonSCOTT BECKERNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11086 FRANKLIN STREETAddressLine1
CityJOHNSTOWNCity
StatePAState
ZIP Code15905ZIPCode
FieldValueIRS element (for citing)
Gross Receipts18264733GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501cXOrganization501c
Web SiteWWW.MINERSMEDICALCENTER.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1909YearFormation
State Legal DomicilePAStateLegalDomicile
Activity Or Mission DescriptionTO PROVIDE QUALITY HEALTH CARE TO ANY PERSON REGARDLESS OF RACE, COLOR, CREED, NATIONAL ORIGIN, AGE, SEX, HANDICAP AND/OR ABILITY TO PAY.ActivityOrMissionDescription
Nbr Voting Members Governing Body19NbrVotingMembersGoverningBody
Nbr Independent Voting Members15NbrIndependentVotingMembers
Total Nbr Employees174TotalNbrEmployees
Total Nbr Volunteers16TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year56324ContributionsGrantsPriorYear
Contributions Grants Current Year162069ContributionsGrantsCurrentYear
Program Service Revenue Prior Year16837023ProgramServiceRevenuePriorYear
Program Service Revenue CY17993431ProgramServiceRevenueCY
Investment Income Prior Year7380InvestmentIncomePriorYear
Investment Income Current Year5255InvestmentIncomeCurrentYear
Other Revenue Prior Year167130OtherRevenuePriorYear
Other Revenue Current Year98984OtherRevenueCurrentYear
Total Revenue Prior Year17067857TotalRevenuePriorYear
Total Revenue Current Year18259739TotalRevenueCurrentYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year7485324SalariesEtcPriorYear
Salaries Etc Current Year7963088SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year9558498OtherExpensePriorYear
Other Expenses Current Year9718546OtherExpensesCurrentYear
Total Expenses Prior Year17043822TotalExpensesPriorYear
Total Expenses Current Year17681634TotalExpensesCurrentYear
Revenues Less Expenses Prior Year24035RevenuesLessExpensesPriorYear
Revenues Less Expenses CY578105RevenuesLessExpensesCY
Total Assets BOY5871764TotalAssetsBOY
Total Assets EOY6066811TotalAssetsEOY
Total Liabilities BOY12830556TotalLiabilitiesBOY
Total Liabilities EOY14009590TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY-6958792NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY-7942779NetAssetsOrFundBalancesEOY
Mission DescriptionTO PROVIDE QUALITY HEALTH CARE TO ANY PERSON REGARDLESS OF RACE, COLOR, CREED, NATIONAL ORIGIN, AGE, SEX, HANDICAP AND/OR ABILITY TO PAY.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense14396314Expense
Revenue18090064Revenue
DescriptionMINERS HOSPITAL IS A COMMUNITY HOSPITAL SERVING FAMILIES ACROSS RURAL NORTHERN CAMBRIA COUNTY IN SOUTHWESTERN PENNSYLVANIA. THE HOSPITAL SPECIALIZES IN FAMILY AND PRIMARY CARE, AND HAS 30 BEDS FOR MEDICAL/SURGICAL AND INTENSIVE CARE SERVICES.DURING THE FISCAL YEAR ENDING JUNE 30, 2010, THE HOSPITAL ADMITTED 850 PATIENTS; HAD 10,698 EMERGENCY VISITS; AND PERFORMED 2,065 SURGICAL PROCEDURES. ALSO, THE HOSPITAL PROVIDED CHARITY CARE AT COST IN THE AMOUNT OF $210,907.Description
Total Program Service Expense14396314TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Balance Sheet Amounts Reported1BalanceSheetAmountsReported
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
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member1BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109637NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees174NumberOfEmployees
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
Nbr Voting Governing Body Members19NbrVotingGoverningBodyMembers
Number Independent Voting Members15NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
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 Line1EDWARD DEPASQUALEBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number8144108271TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11086 FRANKLIN STREETAddressLine1
CityJOHNSTOWNCity
StatePAState
ZIP Code15905ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (24 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
THOMAS MARINO
CHAIRPERSON1.00XX000
GEORGE WEBER MD
1ST VICE CHAIRPERSON1.00XX677015059124974
SALVATORE VALENTY
2ND VICE CHAIRPERSON1.00XX000
TIMOTHY WHITED
SECRETARY1.00XX000
CHARLES ERTTER
TREASURER1.00XX000
JOHN BEM
TRUSTEE1.00X000
GLENN BOWMAN
TRUSTEE1.00X000
ROBERT DATSKO
TRUSTEE1.00X000
WILLIAM DURYEA
TRUSTEE1.00X000
M VIRGINIA ECKENRODE
TRUSTEE1.00X000
JULIANNA FRONTINO
TRUSTEE1.00X000
RAYMOND PONCHIONE
TRUSTEE1.00X000
JOHN REZK
TRUSTEE1.00X000
JOHN ROUSE
TRUSTEE1.00X000
JOSEPH SABO MD
TRUSTEE40.00X160902043064
PATRICIA SEROTKIN
TRUSTEE1.00X000
ALAN STANKIEWICZ DO
TRUSTEE1.00X000
peGGY WATKINS
trustEE1.00X000
STEVEN TUCKER
CHIEF OPERATING OFFICER5.00XX036125274034
WILLIAM CROWE
PRESIDENT50.00X170922038184
SCOTT BECKER
CHIEF EXECUTIVE OFFICER1.00X0729874121059
EDWARD DEPASQUALE
CHIEF FINANCIAL OFFICER1.00X036064972054
DAVID CARLSON DO
CHIEF MEDICAL OFFICER1.00X046169084037
JOSEPH DADO
CHIEF INFORMATION OFFICE1.00X028737158390
FieldValueIRS element (for citing)
Total Reportable Comp From Org338594TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs2351427TotalReportableCompFrmRltdOrgs
Total Other Compensation515796TotalOtherCompensation
Number Individuals GT100 K2NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (4 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
CONEMAUGH HEALTH INITIATIVES
1086 FRANKLIN STREETJOHNSTOWNPA15905PHYSICIAN, OFFICE STAFF, COLLECTION1797635
MEMORIAL MEDICAL CENTER
1086 FRANKLIN STREETJOHNSTOWNPA15905FINANCIAL, IT, CLINICAL DOC, SLEEP LAB/E1083126
aLLIANCE HEALTHCARE SERVICES
pO BOX 96485cHICAGOIL60693mrI309562
sAFARI CONTRACT CLEANERS
111 ROOSEVELT BOULEVARDjOHNSTOWNPA15906clEANING216951
FieldValueIRS element (for citing)
Number Of Contractors GT100 K4NumberOfContractorsGT100K
Government Grants6938GovernmentGrants
All Other Contributions155131AllOtherContributions
Total Contributions162069TotalContributions

Program Service Revenue ProgramServiceRevenue (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
PATIENT SERVICES9000991797216317972163
MEDICAL SVC RM REV9000991983319833
RENTAL INCOME90009914351435
FieldValueIRS element (for citing)
Total Program Service Revenue17993431TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column5255TotalRevenueColumn
Exclusion$5,255ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events7345GrossIncomeFundraisingEvents
Fundraising Direct Expenses4994FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column2351TotalRevenueColumn
Exclusion$2,351ExclusionAmount

Other Revenue Misc OtherRevenueMisc (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
CAFETERIA SALES9000996559465594
PHARMACY SALES90009976447644

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column23395TotalRevenueColumn
Related Or Exempt Function Income23395RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Other Revenue96633TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column18259739TotalRevenueColumn
Related Or Exempt Function Income18090064RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$7,606ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total395729Total
Program Services182922ProgramServices
Management And General212807ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total5137313Total
Program Services4263226ProgramServices
Management And General874087ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total1014747Total
Program Services840306ProgramServices
Management And General174441ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total1021426Total
Program Services876491ProgramServices
Management And General144935ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total393873Total
Program Services326875ProgramServices
Management And General66998ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total219454Total
Management And General219454ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total37950Total
Management And General37950ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total600Total
Management And General600ManagementAndGeneral

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total3499Total
Management And General3499ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total2042179Total
Program Services1974690ProgramServices
Management And General67489ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total19149Total
Program Services947ProgramServices
Management And General18202ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total48670Total
Program Services34310ProgramServices
Management And General14360ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total16369Total
Management And General16369ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total506774Total
Program Services422538ProgramServices
Management And General84236ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total13016Total
Program Services8766ProgramServices
Management And General4250ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total23308Total
Program Services11270ProgramServices
Management And General12038ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total207855Total
Program Services207855ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total400426Total
Program Services316537ProgramServices
Management And General83889ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total310147Total
Program Services256740ProgramServices
Management And General53407ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
PURCHASED SERVICES1806123945673860450
BAD DEBT13326611332661
PATIENT CARE SUPPLIES11314131131413
MAINTENANCE37454832861445934
FOOD1279674659381374

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total1096438Total
Program Services887887ProgramServices
Management And General208551ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total17681634Total
Program Services14396314ProgramServices
Management And General3285320ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY5900BOY
EOY14785EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY514448BOY
EOY1034148EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY1632478BOY
EOY1630320EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY358920BOY
EOY333787EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY113545BOY
EOY83754EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis19603161LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec16822991LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY3057599BOY
EOY2780170EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY12226BOY
EOY8576EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY176648BOY
EOY181271EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY5871764BOY
EOY6066811EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY8066895BOY
EOY8438518EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY116961BOY
EOY141769EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY4433285BOY
EOY4116842EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY213415BOY
EOY1312461EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY12830556BOY
EOY14009590EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY-7037477BOY
EOY-8025609EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY78685BOY
EOY82830EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY-6958792BOY
EOY-7942779EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY5871764BOY
EOY6066811EOY
FieldValueIRS element (for citing)
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0Volunteers
Paid Staff Or Management0PaidStaffOrManagement
Media Advertisements0MediaAdvertisements
Mailings Members0MailingsMembers
Publications Or Broadcast0PublicationsOrBroadcast
Grants Other Organizations0GrantsOtherOrganizations
Direct Contact Legislators0DirectContactLegislators
Rallies Demonstrations0RalliesDemonstrations
Other Activities1OtherActivities
Other Activities$600OtherActivitiesAmount
Total Lobbying Expenditures IIB600TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierPart II-B, Line 1i:Identifier
Return ReferenceExplanation of Other Lobbying Activities:ReturnReference
ExplanationTHE HOSPITAL PAID ANNUAL DUES TO THE HOSPITAL COUNCIL OF WESTERN PA (HCWP), A 501(C)(6) CORPORATION. ACCORDING TO HCWP, TEN PERCENT OF DUES ARE UTILIZED FOR LOBBYING AND PUBLIC POLICY DEVELOPMENT.Explanation

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis102879OtherCostOrOtherBasis
Book Value102879BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis7822380OtherCostOrOtherBasis
Depreciation6331268Depreciation
Book Value1491112BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis10490080OtherCostOrOtherBasis
Depreciation9472917Depreciation
Book Value1017163BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis1187822OtherCostOrOtherBasis
Depreciation1018806Depreciation
Book Value169016BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings2780170TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (5 entries)

DescriptionDescriptionAmountAmount
CAPITAL LEASES$6,628
DUE TO CONEMAUGH HEALTH SYSTEM$142,588
DUE TO MC$169,961
DUE TO MEMORIAL MEDICAL CENTER$687,021
DUE TO CONEMAUGH HEALTH INITIATIVES, INC.$306,263
FieldValueIRS element (for citing)
Total Of Amounts1312461TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierPart X:Identifier
Return ReferenceDescription of Uncertain Tax Positions Under FIN 48:ReturnReference
ExplanationFASB ISSUED ASC TOPIC 740 CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN AN ENTITY'S FINANCIAL STATEMENTS AND PRESCRIBES A RECOGNITION THRESHOLD AND MEASUREMENT ATTRIBUTE FOR THE FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT OF A TAX POSITION TAKEN, OR EXPECTED TO BE TAKEN IN A TAX RETURN. TOPIC 740 ALSO PROVIDES GUIDANCE ON DESCRIPTION, CLASSIFICATION, INTEREST AND PENALTIES, ACCOUNTING IN INTERIM PERIODS, DISCLOSURE AND TRANSITION. CONEMAUGH HEALTH SYSTEM DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS RECOGNIZED FOR 2010 OR 2009.Explanation

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
Policy Applied To All HospitalsXPolicyAppliedToAllHospitals
FPG Reference Free Care1FPGReferenceFreeCare
Pcent200XPcent200
FPG Reference Discounted Care1FPGReferenceDiscountedCare

Discounted Other DiscountedOther

FieldValueIRS element (for citing)
OtherXOther
FieldValueIRS element (for citing)
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 Expense210907TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense210907NetCommunityBenefitExpense
Percent Of Total Expense0.01290PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense1937710TotalCommunityBenefitExpense
Direct Offsetting Revenue1258337DirectOffsettingRevenue
Net Community Benefit Expense679373NetCommunityBenefitExpense
Percent Of Total Expense0.04160PercentOfTotalExpense

Unreimbursed Costs UnreimbursedCosts

FieldValueIRS element (for citing)
Total Community Benefit Expense17858TotalCommunityBenefitExpense
Direct Offsetting Revenue13177DirectOffsettingRevenue
Net Community Benefit Expense4681NetCommunityBenefitExpense
Percent Of Total Expense0.00030PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense2166475TotalCommunityBenefitExpense
Direct Offsetting Revenue1271514DirectOffsettingRevenue
Net Community Benefit Expense894961NetCommunityBenefitExpense
Percent Of Total Expense0.05480PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense1606TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense1606NetCommunityBenefitExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense3286TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense3286NetCommunityBenefitExpense
Percent Of Total Expense0.00020PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense4892TotalCommunityBenefitExpense
Net Community Benefit Expense4892NetCommunityBenefitExpense
Percent Of Total Expense0.00030PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense2171367TotalCommunityBenefitExpense
Direct Offsetting Revenue1271514DirectOffsettingRevenue
Net Community Benefit Expense899853NetCommunityBenefitExpense
Percent Of Total Expense0.05510PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported0BadDebtExpenseReported
Bad Debt Expense$467,231BadDebtExpenseAmount
Amount Attributable To384625AmountAttributableTo
Amount Reimbursed By Medicare5096018AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare5109759CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-13741MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost Accounting SystemXCostAccountingSystem
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care0ProvisionForCharityCare

Form990 Schedule H Part V Form990ScheduleHPartV

Name Name

FieldValueIRS element (for citing)
Business Name Line1MINERS HOSPITALBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line1290 HAIDA AVENUEAddressLine1
CityHASTINGSCity
StatePAState
ZIP Code16646ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Er24 HoursXEr24Hours

Form990 Schedule H Part VI Form990ScheduleHPartVI

FieldValueIRS element (for citing)
Bad Debt FootnotePart III, Line 4: PATIENT ACCOUNTS RECEIVABLE FOR SERVICES RENDERED ARE REPORTED AT NET REALIZABLE AMOUNTS FROM THIRD-PARTY PAYORS, PATIENTS AND OTHERS. CONEMAUGH HEALTH SYSTEM (CHS) PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED UPON A REVIEW OF OUTSTANDING RECEIVABLES, HISTORICAL COLLECTION INFORMATION AND EXISTING ECONOMIC CONDITIONS. AS A SERVICE TO THE PATIENT, CHS BILLS THIRD-PARTY PAYORS DIRECTLY AND BILLS THE PATIENT WHEN THE PATIENT'S LIABILITY IS DETERMINED. PATIENT ACCOUNTS RECEIVABLE ARE DUE IN FULL WHEN BILLED. ACCOUNTS ARE CONSIDERED DELINQUENT AND SUBSEQUENTLY WRITTEN OFF AS BAD DEBTS BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE ACCOUNT.THE METHODOLOGY UTILIZED TO DETERMINE THE AMOUNT REPORTED ON LINE 2 IS BASED ON THE ORGANIZATION'S COST TO CHARGE RATIO. THE METHODOLOGY FOR LINE 3 IS BASED ON A PREDICTIVE ANALYSIS SCORING SYSTEM DEVELOPED BY ACUMEN THAT WAS APPLIED TO ALL OUTSTANDING SELF PAY ACCOUNTS IN FISCAL YEAR 2010. THIS SCORING PROGRAM CONSISTS OF A FOUR DIGIT SCORE; THE FIRST TWO DIGITS ARE BASED UPON THE FEDERAL POVERTY GUIDELINES AND THE LAST TWO DIGITS ARE THE PROBABILITY/PROPENSITY TO PAY SCORE. THE ACCOUNTS THAT WERE INCLUDED IN THE STUDY WERE SEGREGATED BASED ON MEDIAN HOUSEHOLD INCOME AND AVERAGE HOUSEHOLD SIZE ABOVE AND BELOW 150% OF THE FEDERAL POVERTY GUIDELINES. THE NUMBER OF ACCOUNTS THAT FELL BELOW THAT THRESHOLD WERE PRESUMED TO POTENTIALLY QUALIFY FOR CHARITY CARE. THE PERCENTAGES WERE THEN DERIVED FROM THE NUMBER OF ACCOUNTS FALLING BELOW THAT THRESHOLD BY THE TOTAL NUMBER OF OUTSTANDING ACCOUNTS.BadDebtFootnote
Shortfall As Community BenefitPart III, Line 8: CONEMAUGH HEALTH SYSTEM UTILIZES MCKESSON'S HORIZON PERFORMANCE MANAGER (HPM) FOR COST ACCOUNTING. HPM PROVIDES THE ABILITY TO ALLOCATE ALL DEPARTMENTAL EXPENSES AT THE INDIVIDUAL CHARGE FOR EACH CHARGING DEPARTMENT, AS WELL AS ALLOCATE OVERHEAD EXPENSES IN A CONSISTENT MANNER. THE ENCOUNTER COSTING FUNCTIONALITY OF HPM PROVIDES THE ABILITY TO THEN DETERMINE AN ACCURATE ESTIMATE OF COST AT THE PATIENT LEVEL BASED ON THE CHARGE UNIT COSTS. THE SYSTEM THEN PROVIDES THE ABILITY TO SUMMARIZE THE PATIENT VOLUME, CHARGES, AND COSTS IN ANY NUMBER OF WAYS, INCLUDING PAYER SPECIFIC COST ALLOCATION.ShortfallAsCommunityBenefit
General ExplanationPART I, LINE 3B: SEE ATTACHED TABLE FOR SPECIFIC INCOME GUIDELINES RELATED TO PARTIAL CHARITY CARE (DISCOUNTED CARE).GeneralExplanation
Needs AssessmentPart VI, Line 2: THE CONEMAUGH HEALTH SYSTEM IS AN ACTIVE MEMBER OF THE COMMUNITY AND AN ADVOCATE FOR THE HEALTH, WELL BEING AND ECONOMIC STRENGTH OF THE REGION. CHS ADMINISTRATORS HAVE TEAMED UP WITH THE UNITED WAY OF THE LAUREL HIGHLANDS OVER THE PAST FEW YEARS TO WORK TO IDENTIFY AND PRIORITIZE PROGRAMS AND SERVICES THAT CAN BEST IMPACT THE MOST SIGNIFICANT NEEDS OF THE COMMUNITY (CAMBRIA AND SOMERSET COUNTIES). CHS LEADERS HAVE SERVED IN MANY ROLES INCLUDING CHAIRMAN OF THE BOARD, CHAIRMAN OF THE COMMUNITY IMPACT COMMITTEE, AND PARTICIPATION IN THE LOANED EXECUTIVE PROGRAM. LEADERS HAVE ALSO SERVED IN MANY OF THE UNITED WAY MEMBERSHIP ORGANIZATIONS INCLUDING THE WOMEN'S HELP CENTER, SALVATION ARMY, NATIONAL ALLIANCE ON MENTAL ILLNESS AND THE UNITED WAY OF THE LAUREL HIGHLANDS FOOD PANTRY.CHS AND THE UNITED WAY ARE NOW COLLECTING DATA FOR A 2011 COMMUNITY NEEDS ANALYSIS, WHICH WILL BE PRESENTED AND DISTRIBUTED BROADLY. CHS AND THE UNITED WAY HAVE ALSO COMMITTED TO MONITOR THE IMPACT OF PROGRAMMING IN PRIORITY AREAS AND REALLOCATE RESOURCES TO DRIVE RESULTS. THE NORTHERN CAMBRIA REGION, SERVED BY MINERS HOSPITAL, WILL BE INCLUDED IN THIS REPORT.NeedsAssessment
Patient Education AssistancePart VI, Line 3: CONEMAUGH HEALTH SYSTEM COMMUNICATES TO PATIENTS THE AVAILABILITY OF FINANCIAL ASSISTANCE UNDER FEDERAL, STATE AND LOCAL PROGRAMS, AS WELL AS THE CHARITY CARE PROGRAM, ON OUR WEBSITE, WHICH INCLUDES A DOWNLOADABLE CHARITY CARE APPLICATION AND INSTRUCTIONS. TABLE TOP BROCHURES ARE PROVIDED AT ALL POINTS OF REGISTRATION, AND BROCHURES ARE INCLUDED IN PATIENT ADMISSION PACKETS. INFORMATION ON THE AVAILABILITY OF FINANCIAL ASSISTANCE IS ALSO INCLUDED ON PATIENT STATEMENTS. ASSISTANCE IS PROVIDED TO PATIENTS TO APPLY FOR MEDICAL ASSISTANCE THROUGH A THIRD-PARTY VENDOR. A ROBUST FINANCIAL COUNSELING AND CUSTOMER SERVICE DEPARTMENT IS AVAILABLE TO HANDLE SPECIFIC PATIENT NEEDS.PatientEducationAssistance
Community InformationPart VI, Line 4: MINERS HOSPITAL (MINERS) IS A 30 BED, STATE-OF-THE-ART COMMUNITY HOSPITAL SERVING FAMILIES ACROSS RURAL NORTHERN CAMBRIA COUNTY. IT IS THE REGION'S SOLE HOSPITAL AND SPECIALIZES IN FAMILY AND PRIMARY CARE. ITS PARTNERSHIP WITH THE CONEMAUGH VALLEY MEMORIAL HOSPITAL MEANS THAT ITS SMALL SIZE IS NO BARRIER TO PROVIDING PATIENTS WITH ACCESS TO SPECIALISTS OR NEW TECHNOLOGIES. IN FACT, SPECIALTY SERVICES ARE AVAILABLE ONSITE SEVERAL TIMES PER WEEK.MINERS PROVIDES 24/7 EMERGENCY CARE AND HAS GENERAL AND ORTHOPEDIC SURGEONS ON SITE. LABORATORY SERVICES ARE PERFORMED AROUND THE CLOCK AND THERE IS AN ONSITE PHARMACY ENHANCING PATIENT CARE. ACCOMODATIONS HAVE BEEN MADE TO IMPROVE ACCESS FOR PATIENTS NEEDING RADIOLOGY SERVICES BY OFFERING CT SCAN, ULTRASOUND, MAMMOGRAPHY, AND MOBILE MRI AS WELL AS ROUTINE RADIOLOGY STUDIES. PATHOLOGY, PHYSICAL THERAPY AND RESPIRATORY CARE ARE AVAILABLE AT MINERS AS WELL AS OB/GYN OUTPATIENT CARE.PHYSICIAN SPECIALISTS VISIT PATIENTS AT MINERS SEVERAL TIMES PER WEEK OR MONTH INCLUDING CARDIOLOGY, UROLOGY, OPHTHALMOLOGY, GASTROENTEROLOGY, NEPHROLOGY, NEUROLOGY AND PULMONOLOGY. THIS IS DONE FOR THE CONVENIENCE OF PATIENTS AND TO CUT DOWN ON TRAVEL TIME FOR PATIENTS.DEMOGRAPHICALLY, NEARLY 20 PERCENT OF RESIDENTS IN THE CONEMAUGH HEALTH SYSTEM SERVICE AREA ARE 65 OR OLDER, ONE OF THE HIGHEST PERCENTAGES IN THE STATE AND WELL ABOVE THE PENNSYLVANIA AVERAGE OF 15.3 PERCENT. THE PAYOR MIX FOR OUR REGION IS SKEWED HEAVILY TOWARD MEDICARE AND MEDICAID. AT 9.7 PERCENT, THE CONEMAUGH HEALTH SYSTEM'S SERVICE AREA HAS ONE OF THE STATE'S HIGHEST UNEMPLOYMENT RATES, AND MEDIAN HOUSEHOLD INCOMES OF $34,000 LAG 30 PERCENT BEHIND STATE AND NATIONAL AVERAGES. THE DEMOGRAPHIC MAKE UP OF THE REGION IS CONSIDERED WHEN PLANNING EDUCATION OPPORTUNITIES AND HEALTH INFORMATION PROGRAMS.THE CONEMAUGH HEALTH SYSTEM'S COVERAGE REGION ALSO PRESENTS SOME GEOGRAPHIC CHALLENGES. MOUNTAINOUS TOPOGRAPHY AND HIGHWAY INFRASTRUCTURE MAKE TIMELY TRAVEL A CONCERN FOR SOME PATIENTS. CHS CONTINUES TO LOOK FOR OPPORTUNITIES TO BRING PRIMARY CARE AND PHYSICIAN SPECIALISTS TO RURAL REGIONS OF THE MARKET. IN THE PAST YEAR, A CONCENTRATED EFFORT HAS BEEN MADE TO DEVELOP AND DELIVER HEALTH AND WELLNESS EDUCATION AND SCREENINGS TO CONSTITUENTS IN RURAL REGIONS. WHEN POSSIBLE, CHS TEAMS UP WITH OTHER COMMUNITY ORGANIZATIONS TO DELIVER THESE PROGRAMS AND SERVICES TO RURAL CONSTITUENTS.CommunityInformation
Other InformationPart VI, Line 6: MINERS HOSPITAL TAKES PART IN A NUMBER OF COMMUNITY ACTIVITIES EACH YEAR. THESE INCLUDE A KID SKINS SPORTS PHYSICAL PROGRAM, WHICH PROVIDES FREE PHYSICALS FOR APPROXIMATELY 150 YOUNGSTERS PARTICIPATING IN FALL SPORTS. PHYSICIANS AND OTHER CLINICAL STAFF VOLUNTEER THEIR TIME FOR THIS INITIATIVE.INTERNSHIPS AND EDUCATIONAL OPPORTUNITIES ARE OFFERED TO VARIOUS TYPES OF STUDENTS INCLUDING PHYSICIAN ASSISTANT, RN, LPN, RADIOLOGY TECHNOLOGY, PHLEBOTOMY AND HEALTHCARE ADMINISTRATION THROUGH PARTNERSHIPS WITH VARIOUS UNIVERSITIES INCLUDING ST. FRANCIS AND MOUNT ALOYSIUS, AS WELL AS THE PENNSYLVANIA HIGHLANDS COMMUNITY COLLEGE.SMOKING CESSATION, WEIGHT MANAGEMENT AND DIABETES EDUCATION CLASSES ARE ALL OFFERED AT MINERS HOSPITAL TO HELP PATIENTS IN THE NORTHERN CAMBRIA COUNTY REGION RECEIVE EDUCATION TO HELP THEM MAKE HEALTHY CHOICES. IN ADDITION, VARIOUS FREE SCREENINGS HAVE TAKEN PLACE AT MINERS INCLUDING RESPIRATORY SCREENINGS, SLEEP APNEA MASK FIT TESTING AND BLOOD SCREENINGS. A TEDDY BEAR CLINIC IS ALSO HELD EACH YEAR TO ENGAGE WITH CHILDREN IN THE AREA.MINERS HOSPITAL FACILITY HIGHLIGHTS:LICENSED PATIENT BEDS - 30PATIENT DAYS OF SERVICE - 3,714INPATIENT DAILY CENSUS - 10ADJUSTED PATIENT DAYS - 18,862ADMISSIONS - 850AVERAGE LENGTH OF STAY - 4FULL TIME EQUIVALENT EMPLOYEES - 126VOLUNTEERS - 16PHYSICIANS:ACTIVE - 16COURTESY - 33CONSULTING - 28ALLIED HEALTH - 19SERVICES:EMERGENCY VISITS - 10,698INPATIENT SURGERIES - 207SAME DAY/AMBULATORY SURGERIES - 1,858OUTPATIENT CLINIC VISITS - 52,668LABORATORY TESTS - 205,622RADIOLOGY EXAMS - 12,520ULTRASOUND PROCEDURES - 4,138CT SCANS - 4,929MRI PROCEDURES - 790NUCLEAR MEDICINE EXAMS - 931RESPIRATORY THERAPY PROCEDURES - 41,813EKG'S, EEG'S, HOLTERS - 3,131AMBULATORY SURGERY UNIT VISITS - 1,983OtherInformation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan1SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org1CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs1CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (8 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
GEORGE WEBER MD
0146461062467703506011502013472677017556500
JOSEPH SABO MD
15885300020490330540100100203966000
STEVEN TUCKER
0291113058583011556061468012566043528600
WILLIAM CROWE
147080022364014780267130114710209106000
SCOTT BECKER
054340301624780239930106507014552085093300
EDWARD DEPASQUALE
0280659058583021407060840011214043270300
DAVID CARLSON DO
037683507611108744069053014984054572700
JOSEPH DADO
02362680475180358504868009710034576100

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

Return ReferenceReturnReferenceExplanationExplanation
Part I, Line 4aTHE FOLLOWING INDIVIDUALS PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN. THE AMOUNTS RELATED TO THIS PLAN, WHICH ARE INCLUDED IN THE DEFERRED COMPENSATION SHOWN ARE: SCOTT BECKER $92,650; EDWARD DEPASQUALE $44,214; DAVID CARLSON, DO $57,443; JOSEPH DADO $35,863; STEVEN TUCKER $44,214; AND WILLIAM CROWE $16,503.
Part I, Line 6WILLIAM CROWE RECEIVED A BONUS FROM MINERS HOSPITAL. SCOTT BECKER, EDWARD DEPASQUALE, DAVID CARLSON, DO, AND JOSEPH DADO RECEIVED A BONUS FROM THE CONEMAUGH HEALTH SYSTEM, A RELATED ORGANIZATION. STEVEN TUCKER RECEIVED A BONUS FROM MEMORIAL MEDICAL CENTER, A RELATED ORGANIZATION. EXECUTIVE BONUSES ARE CALCULATED AS A PERCENTAGE OF BASE SALARY. THE PERCENTAGE IS CONTINGENT ON VARIOUS FINANCIAL AND NON-FINANCIAL CRITERIA, GOVERNED BY THE EXECUTIVE COMPENSATION COMMITTEE OF THE BOARD OF CONEMAUGH HEALTH SYSTEM.

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV

Name Of Interested Person NameOfInterestedPerson

FieldValueIRS element (for citing)
Name PersonDEBORAH WHITEDNamePerson
FieldValueIRS element (for citing)
RelationshipFAMILY MEMBER OF TIMOTHY WHITED (TRUSTEE)Relationship
Amount Of Transaction51758AmountOfTransaction
Description Of TransactionEMPLOYMENTDescriptionOfTransaction
Sharing Of Revenues0SharingOfRevenues

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (8 entries)

IdentifierIdentifierExplanationExplanation
Form 990, Part VI, Section A, line 6THE SOLE MEMBERS OF MINERS HOSPITAL ARE THE NORTHERN CAMBRIA HEALTHCARE FOUNDATION AND THE CONEMAUGH HEALTH SYSTEM, INC.
Form 990, Part VI, Section A, line 7aTHE CONEMAUGH HEALTH SYSTEM, INC. HAS THE POWER TO APPROVE OR DISAPPROVE THE ELECTION OF OR REMOVAL OF MEMBERS OF THE GOVERNING BODY.
Form 990, Part VI, Section A, line 7bALL DECISIONS OF THE GOVERNING BODY OF MINERS HOSPITAL ARE SUBJECT TO APPROVAL BY THE CONEMAUGH HEALTH SYSTEM, INC.
Form 990, Part VI, Section B, line 11THE FORM 990 IS PROVIDED TO THE ORGANIZATION'S BOARD OF DIRECTORS BEFORE IT IS FILED. ONCE THE FORM IS COMPLETE, BOARD MEMBERS ARE GIVEN THE OPPORTUNITY TO REVIEW THE CONTENTS OF THE FORM AND SUBMIT ANY COMMENTS OR QUESTIONS. IN ADDITION, SINCE THE ORGANIZATION IS A SUBSIDIARY WITHIN A LARGER HEALTH SYSTEM, THE FORM IS REVIEWED BY THE HEALTH SYSTEM'S MANAGER, TAX & COMPLIANCE; DIRECTOR, FINANCIAL OPERATIONS; VICE PRESIDENT, FINANCIAL OPERATIONS; CHIEF FINANCIAL OFFICER; AND THE AUDIT AND COMPLIANCE COMMITTEE. AN EXTERNAL CPA FIRM IS ENGAGED TO REVIEW AND ELECTRONICALLY FILE THE RETURN.
Form 990, Part VI, Section B, line 12cTHE ORGANIZATION IS A SUBSIDIARY OF A LARGER HEALTH SYSTEM AND IS GOVERNED BY THE SYSTEM'S CONFLICT OF INTEREST POLICY. UNDER THIS POLICY, EVERY BOARD MEMBER IS GIVEN A COPY OF THE POLICY AS WELL AS A FORM THAT MUST BE COMPLETED ON AN ANNUAL BASIS. NO BOARD MEMBER IS APPROVED OR RE-APPOINTED UNTIL HE OR SHE HAS COMPLETED AND SIGNED THE CONFLICT OF INTEREST FORM. ONCE THE FORM IS RETURNED, IT IS REVIEWED BY THE SYSTEM'S COMPLIANCE OFFICER AND CEO. IF ANY CONFLICTS ARE DISCLOSED, THE DETAILS ARE FORWARDED TO THE BOARD CHAIR TO BE ADDRESSED. DEPENDING ON THE CONFLICT, THE BOARD MEMBER COULD BE GIVEN CERTAIN RESTRICTIONS, SUCH AS BEING PROHIBITED FROM PARTICIPATING IN CERTAIN BOARD DECISIONS. THE HEALTH SYSTEM'S AUDIT AND COMPLIANCE COMMITTEE HAS THE FINAL DECISION-MAKING REGARDING ALL CONFLICTS OF INTEREST. THROUGHOUT THE FISCAL YEAR, BOARD MEMBERS MUST NOTIFY THE BOARD CHAIR, COMPLIANCE OFFICER, AND/OR CEO IF A NEW CONFLICT OF INTEREST HAS DEVELOPED.
Form 990, Part VI, Section B, line 15THE ORGANIZATION'S PARENT, A HEALTH SYSTEM, MANAGES THE DETERMINATION OF COMPENSATION AND THE PROCESS IS OUTLINED IN ITS BYLAWS. TWO OUTSIDE CONSULTING FIRMS ARE UTILIZED TO ENSURE THAT EXECUTIVE COMPENSATION PACKAGES ARE FAIR AND COMPARABLE WITH SIMILAR ORGANIZATIONS. THE HEALTH SYSTEM HAS ALSO ESTABLISHED AN EXECUTIVE COMPENSATION COMMITTEE TO REVIEW AND RECOMMEND THE COMPENSATION DECISIONS MADE. THIS COMMITTEE REPORTS DIRECTLY TO THE HEALTH SYSTEM'S BOARD.
Form 990, Part VI, Section C, line 19THE ORGANIZATION IS PART OF A HEALTH SYSTEM AND ALL REQUESTS FOR THIS INFORMATION ARE HANDLED BY THE SYSTEM'S MARKETING/PUBLIC RELATIONS DEPARTMENT.
PART XI, LINE 2: THE ORGANIZATION'S FINANCIAL STATEMENTS FOR THE FISCAL YEAR ENDING JUNE 30, 2010 WERE AUDITED AS PART OF THE AUDIT OF THE CONSOLIDATED FINANCIAL STATEMENTS OF THE CONEMAUGH HEALTH SYSTEM, INC. AND SUBSIDIARIES. THE HEALTH SYSTEM'S AUDIT AND COMPLIANCE COMMITTEE ASSUMES RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT AND THE SELECTION OF THE INDEPENDENT ACCOUNTANT.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (7 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusDirect Controlling Entity NADirectControllingEntityNABusiness Name Line1DirectControllingEntityName/BusinessNameLine1
CONEMAUGH HEALTH SYSTEM
1086 FRANKLIN STREETJOHNSTOWNPA15905232801799SUPPORT MEMBER HOSPITALSPA501(C)(3)11AN/A
CONEMAUGH VALLEY MEMORIAL HOSPITAL DBA MEMORIAL MEDICAL CENTER
1086 FRANKLIN STREETJOHNSTOWNPA15905250965307HEALTHCARE SERVICESPA501(C)(3)3CONEMAUGH HEALTH SYSTEM
GOOD SAMARITAN MEDICAL CENTER
1020 FRANKLIN STREETJOHNSTOWNPA15905250965428HEALTHCARE SERVICESPA501(C)(3)3CONEMAUGH HEALTH SYSTEM
MEYERSDALE COMMUNITY HOSPITAL DBA MEYERSDALE MEDICAL CENTER
200 HOSPITAL DRIVEMEYERSDALEPA15552251002946HEALTHCARE SERVICESPA501(C)(3)3CONEMAUGH HEALTH SYSTEM
CONEMAUGH HEALTH FOUNDATION
1086 FRANKLIN STREETJOHNSTOWNPA15905251719695SUPPORTS CONEMAUGH HEALTH SYSTEMPA501(C)(3)11BCONEMAUGH HEALTH SYSTEM
NORTHERN CAMBRIA HEALTHCARE FOUNDATION
PO BOX 732NORTHERN CAMBRIAPA15714251537143SUPPORTS MINERS HOSPITALPA501(C)(3)7N/A
CONEMAUGH HOUSING INC
1086 FRANKLIN STREETJOHNSTOWNPA15905251606936PROVIDES SENIOR HOUSING FACILITIESPA501(C)(3)9CONEMAUGH VALLEY MEMORIAL HOSPITAL

Form990 Schedule R Part III Form990ScheduleRPartIII (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateDirect Controlling Entity NADirectControllingEntityNA
LAUREL HIGHLANDS ADVANCED IMAGING
1450 SCALP AVENUEJOHNSTOWNPA15904251864587DIAGNOSTIC SERVICESPAN/A
GREATER JOHNSTOWN TECH PARK
1086 FRANKLIN STREETJOHNSTOWNPA15905260389121OPERATES MULTI-TENANT COMMERCE OFFICE PARKPAN/A

Form990 Schedule R Part IV Form990ScheduleRPartIV (4 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateDirect Controlling Entity NADirectControllingEntityNAType Of EntityTypeOfEntity
CONEMAUGH HEALTH INITIATIVES INC
1086 FRANKLIN STREETJOHNSTOWNPA15905251658283PHYSICIAN SERVICESPAN/AC
1086 REAL ESTATE
1086 FRANKLIN STREETJOHNSTOWNPA15905251489704REAL ESTATEPAN/AC
CONEMAUGH ENTERPRISES INC
1086 FRANKLIN STREETJOHNSTOWNPA15905202998473ECONOMIC DEVELOPMENTPAN/AC
SINDO INC
1086 FRANKLIN STREETJOHNSTOWNPA15905251144116COMMUNITY RENTALSPAN/AC
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 Org0LoansOrGuaranteesToOtherOrg
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 Orgs1PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs1PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg