2011-02-10T11:22:32-06:00 2010-06-30 Carbis Walker LLP 5700 Corporate Drive Ste 650 Pittsburgh PA 15237 990 2009-07-01 250977902 MINERS HOSPITAL MINE 8142473100 290 HAIDA AVENUE HASTINGS PA 16646 EDWARD DEPASQUALE 8142473100 2011-02-08 1 Jeffrey J Petrell CPA 4126356270 2009 2016-02-24 21:20:13Z MINERS MEDICAL CENTER SCOTT BECKER 1086 FRANKLIN STREET JOHNSTOWN PA 15905 18264733 0 X WWW.MINERSMEDICALCENTER.ORG X 1909 PA TO PROVIDE QUALITY HEALTH CARE TO ANY PERSON REGARDLESS OF RACE, COLOR, CREED, NATIONAL ORIGIN, AGE, SEX, HANDICAP AND/OR ABILITY TO PAY. 19 15 174 16 0 0 56324 162069 16837023 17993431 7380 5255 167130 98984 17067857 18259739 0 0 7485324 7963088 0 0 9558498 9718546 17043822 17681634 24035 578105 5871764 6066811 12830556 14009590 -6958792 -7942779 TO PROVIDE QUALITY HEALTH CARE TO ANY PERSON REGARDLESS OF RACE, COLOR, CREED, NATIONAL ORIGIN, AGE, SEX, HANDICAP AND/OR ABILITY TO PAY. 0 0 14396314 18090064 MINERS HOSPITAL IS A COMMUNITY HOSPITAL SERVING FAMILIES ACROSS RURAL NORTHERN CAMBRIA COUNTY IN SOUTHWESTERN PENNSYLVANIA. THE HOSPITAL SPECIALIZES IN FAMILY AND PRIMARY CARE, AND HAS 30 BEDS FOR MEDICAL/SURGICAL AND INTENSIVE CARE SERVICES.DURING THE FISCAL YEAR ENDING JUNE 30, 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. 14396314 1 1 0 1 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 37 0 174 1 0 0 0 0 0 0 0 0 0 19 15 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 PA X EDWARD DEPASQUALE 8144108271 1086 FRANKLIN STREET JOHNSTOWN PA 15905 THOMAS MARINO 1.00 X X 0 0 0 GEORGE WEBER MD 1.00 X X 6770 150591 24974 SALVATORE VALENTY 1.00 X X 0 0 0 TIMOTHY WHITED 1.00 X X 0 0 0 CHARLES ERTTER 1.00 X X 0 0 0 JOHN BEM 1.00 X 0 0 0 GLENN BOWMAN 1.00 X 0 0 0 ROBERT DATSKO 1.00 X 0 0 0 WILLIAM DURYEA 1.00 X 0 0 0 M VIRGINIA ECKENRODE 1.00 X 0 0 0 JULIANNA FRONTINO 1.00 X 0 0 0 RAYMOND PONCHIONE 1.00 X 0 0 0 JOHN REZK 1.00 X 0 0 0 JOHN ROUSE 1.00 X 0 0 0 JOSEPH SABO MD 40.00 X 160902 0 43064 PATRICIA SEROTKIN 1.00 X 0 0 0 ALAN STANKIEWICZ DO 1.00 X 0 0 0 peGGY WATKINS 1.00 X 0 0 0 STEVEN TUCKER 5.00 X X 0 361252 74034 WILLIAM CROWE 50.00 X 170922 0 38184 SCOTT BECKER 1.00 X 0 729874 121059 EDWARD DEPASQUALE 1.00 X 0 360649 72054 DAVID CARLSON DO 1.00 X 0 461690 84037 JOSEPH DADO 1.00 X 0 287371 58390 338594 2351427 515796 2 0 1 0 CONEMAUGH HEALTH INITIATIVES 1086 FRANKLIN STREET JOHNSTOWN PA 15905 PHYSICIAN, OFFICE STAFF, COLLECTION 1797635 MEMORIAL MEDICAL CENTER 1086 FRANKLIN STREET JOHNSTOWN PA 15905 FINANCIAL, IT, CLINICAL DOC, SLEEP LAB/E 1083126 aLLIANCE HEALTHCARE SERVICES pO BOX 96485 cHICAGO IL 60693 mrI 309562 sAFARI CONTRACT CLEANERS 111 ROOSEVELT BOULEVARD jOHNSTOWN PA 15906 clEANING 216951 4 6938 155131 162069 PATIENT SERVICES 900099 17972163 17972163 MEDICAL SVC RM REV 900099 19833 19833 RENTAL INCOME 900099 1435 1435 17993431 5255 5255 7345 4994 2351 2351 CAFETERIA SALES 900099 65594 65594 PHARMACY SALES 900099 7644 7644 23395 23395 96633 18259739 18090064 0 7606 395729 182922 212807 5137313 4263226 874087 1014747 840306 174441 1021426 876491 144935 393873 326875 66998 219454 219454 37950 37950 600 600 3499 3499 2042179 1974690 67489 19149 947 18202 48670 34310 14360 16369 16369 506774 422538 84236 13016 8766 4250 23308 11270 12038 207855 207855 400426 316537 83889 310147 256740 53407 PURCHASED SERVICES 1806123 945673 860450 BAD DEBT 1332661 1332661 PATIENT CARE SUPPLIES 1131413 1131413 MAINTENANCE 374548 328614 45934 FOOD 127967 46593 81374 1096438 887887 208551 17681634 14396314 3285320 0 5900 14785 514448 1034148 1632478 1630320 358920 333787 113545 83754 19603161 16822991 3057599 2780170 12226 8576 176648 181271 5871764 6066811 8066895 8438518 116961 141769 4433285 4116842 213415 1312461 12830556 14009590 X -7037477 -8025609 78685 82830 -6958792 -7942779 5871764 6066811 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 600 600 0 Part II-B, Line 1i: Explanation of Other Lobbying Activities: THE 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. 102879 102879 7822380 6331268 1491112 10490080 9472917 1017163 1187822 1018806 169016 2780170 CAPITAL LEASES 6628 DUE TO CONEMAUGH HEALTH SYSTEM 142588 DUE TO MC 169961 DUE TO MEMORIAL MEDICAL CENTER 687021 DUE TO CONEMAUGH HEALTH INITIATIVES, INC. 306263 1312461 Part X: Description of Uncertain Tax Positions Under FIN 48: FASB 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. 1 1 X 1 X 1 X 1 1 1 0 0 210907 0 210907 0.01290 1937710 1258337 679373 0.04160 17858 13177 4681 0.00030 2166475 1271514 894961 0.05480 1606 0 1606 0.00010 3286 0 3286 0.00020 4892 4892 0.00030 2171367 1271514 899853 0.05510 0 467231 384625 5096018 5109759 -13741 X 1 0 MINERS HOSPITAL

290 HAIDA AVENUE HASTINGS PA 16646

X X X Part 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. Part III, Line 8: CONEMAUGH HEALTH SYSTEM UTILIZES MCKESSON'S HORIZON PERFORMANCE MANAGER (HPM) FOR COST ACCOUNTING. HPM PROVIDES THE ABILITY TO ALLOCATE ALL DEPARTMENTAL EXPENSES AT THE INDIVIDUAL CHARGE FOR EACH CHARGING DEPARTMENT, AS WELL AS ALLOCATE OVERHEAD EXPENSES IN A CONSISTENT MANNER. THE ENCOUNTER COSTING FUNCTIONALITY OF HPM PROVIDES THE ABILITY TO THEN DETERMINE AN ACCURATE ESTIMATE OF COST AT THE PATIENT LEVEL BASED ON THE CHARGE UNIT COSTS. THE SYSTEM THEN PROVIDES THE ABILITY TO SUMMARIZE THE PATIENT VOLUME, CHARGES, AND COSTS IN ANY NUMBER OF WAYS, INCLUDING PAYER SPECIFIC COST ALLOCATION. PART I, LINE 3B: SEE ATTACHED TABLE FOR SPECIFIC INCOME GUIDELINES RELATED TO PARTIAL CHARITY CARE (DISCOUNTED CARE). Part 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. Part VI, Line 3: CONEMAUGH HEALTH SYSTEM COMMUNICATES TO PATIENTS THE AVAILABILITY OF FINANCIAL ASSISTANCE UNDER FEDERAL, STATE AND LOCAL PROGRAMS, AS WELL AS THE CHARITY CARE PROGRAM, ON OUR WEBSITE, WHICH INCLUDES A DOWNLOADABLE CHARITY CARE APPLICATION AND INSTRUCTIONS. TABLE TOP BROCHURES ARE PROVIDED AT ALL POINTS OF REGISTRATION, AND BROCHURES ARE INCLUDED IN PATIENT ADMISSION PACKETS. INFORMATION ON THE AVAILABILITY OF FINANCIAL ASSISTANCE IS ALSO INCLUDED ON PATIENT STATEMENTS. ASSISTANCE IS PROVIDED TO PATIENTS TO APPLY FOR MEDICAL ASSISTANCE THROUGH A THIRD-PARTY VENDOR. A ROBUST FINANCIAL COUNSELING AND CUSTOMER SERVICE DEPARTMENT IS AVAILABLE TO HANDLE SPECIFIC PATIENT NEEDS. Part VI, Line 4: MINERS HOSPITAL (MINERS) IS A 30 BED, STATE-OF-THE-ART COMMUNITY HOSPITAL SERVING FAMILIES ACROSS RURAL NORTHERN CAMBRIA COUNTY. IT IS THE REGION'S SOLE HOSPITAL AND SPECIALIZES IN FAMILY AND PRIMARY CARE. ITS PARTNERSHIP WITH THE CONEMAUGH VALLEY MEMORIAL HOSPITAL MEANS THAT ITS SMALL SIZE IS NO BARRIER TO PROVIDING PATIENTS WITH ACCESS TO SPECIALISTS OR NEW TECHNOLOGIES. IN FACT, SPECIALTY SERVICES ARE AVAILABLE ONSITE SEVERAL TIMES PER WEEK.MINERS PROVIDES 24/7 EMERGENCY CARE AND HAS GENERAL AND ORTHOPEDIC SURGEONS ON SITE. LABORATORY SERVICES ARE PERFORMED AROUND THE CLOCK AND THERE IS AN ONSITE PHARMACY ENHANCING PATIENT CARE. 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. Part 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 - 1,983 X X X X X 0 1 0 0 0 1 1 0 0 GEORGE WEBER MD 0 146461 0 624 6770 3506 0 11502 0 13472 6770 175565 0 0 JOSEPH SABO MD 158853 0 0 0 2049 0 33054 0 10010 0 203966 0 0 0 STEVEN TUCKER 0 291113 0 58583 0 11556 0 61468 0 12566 0 435286 0 0 WILLIAM CROWE 147080 0 22364 0 1478 0 26713 0 11471 0 209106 0 0 0 SCOTT BECKER 0 543403 0 162478 0 23993 0 106507 0 14552 0 850933 0 0 EDWARD DEPASQUALE 0 280659 0 58583 0 21407 0 60840 0 11214 0 432703 0 0 DAVID CARLSON DO 0 376835 0 76111 0 8744 0 69053 0 14984 0 545727 0 0 JOSEPH DADO 0 236268 0 47518 0 3585 0 48680 0 9710 0 345761 0 0 Part I, Line 4a THE 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 6 WILLIAM CROWE RECEIVED A BONUS FROM MINERS HOSPITAL. SCOTT BECKER, EDWARD DEPASQUALE, DAVID CARLSON, DO, AND JOSEPH DADO RECEIVED A BONUS FROM THE CONEMAUGH HEALTH SYSTEM, A RELATED ORGANIZATION. STEVEN TUCKER RECEIVED A BONUS FROM MEMORIAL MEDICAL CENTER, A RELATED ORGANIZATION. EXECUTIVE BONUSES ARE CALCULATED AS A PERCENTAGE OF BASE SALARY. THE PERCENTAGE IS CONTINGENT ON VARIOUS FINANCIAL AND NON-FINANCIAL CRITERIA, GOVERNED BY THE EXECUTIVE COMPENSATION COMMITTEE OF THE BOARD OF CONEMAUGH HEALTH SYSTEM. DEBORAH WHITED FAMILY MEMBER OF TIMOTHY WHITED (TRUSTEE) 51758 EMPLOYMENT 0 Form 990, Part VI, Section A, line 6 THE SOLE MEMBERS OF MINERS HOSPITAL ARE THE NORTHERN CAMBRIA HEALTHCARE FOUNDATION AND THE CONEMAUGH HEALTH SYSTEM, INC. Form 990, Part VI, Section A, line 7a THE CONEMAUGH HEALTH SYSTEM, INC. HAS THE POWER TO APPROVE OR DISAPPROVE THE ELECTION OF OR REMOVAL OF MEMBERS OF THE GOVERNING BODY. Form 990, Part VI, Section A, line 7b ALL DECISIONS OF THE GOVERNING BODY OF MINERS HOSPITAL ARE SUBJECT TO APPROVAL BY THE CONEMAUGH HEALTH SYSTEM, INC. Form 990, Part VI, Section B, line 11 THE FORM 990 IS PROVIDED TO THE ORGANIZATION'S BOARD OF DIRECTORS BEFORE IT IS FILED. ONCE THE FORM IS COMPLETE, BOARD MEMBERS ARE GIVEN THE OPPORTUNITY TO REVIEW THE CONTENTS OF THE FORM AND SUBMIT ANY COMMENTS OR QUESTIONS. IN ADDITION, SINCE THE ORGANIZATION IS A SUBSIDIARY WITHIN A LARGER HEALTH SYSTEM, THE FORM IS REVIEWED BY THE HEALTH SYSTEM'S MANAGER, TAX & COMPLIANCE; DIRECTOR, FINANCIAL OPERATIONS; VICE PRESIDENT, FINANCIAL OPERATIONS; CHIEF FINANCIAL OFFICER; AND THE AUDIT AND COMPLIANCE COMMITTEE. AN EXTERNAL CPA FIRM IS ENGAGED TO REVIEW AND ELECTRONICALLY FILE THE RETURN. Form 990, Part VI, Section B, line 12c THE ORGANIZATION IS A SUBSIDIARY OF A LARGER HEALTH SYSTEM AND IS GOVERNED BY THE SYSTEM'S CONFLICT OF INTEREST POLICY. UNDER THIS POLICY, EVERY BOARD MEMBER IS GIVEN A COPY OF THE POLICY AS WELL AS A FORM THAT MUST BE COMPLETED ON AN ANNUAL BASIS. NO BOARD MEMBER IS APPROVED OR RE-APPOINTED UNTIL HE OR SHE HAS COMPLETED AND SIGNED THE CONFLICT OF INTEREST FORM. ONCE THE FORM IS RETURNED, IT IS REVIEWED BY THE SYSTEM'S COMPLIANCE OFFICER AND CEO. IF ANY CONFLICTS ARE DISCLOSED, THE DETAILS ARE FORWARDED TO THE BOARD CHAIR TO BE ADDRESSED. DEPENDING ON THE CONFLICT, THE BOARD MEMBER COULD BE GIVEN CERTAIN RESTRICTIONS, SUCH AS BEING PROHIBITED FROM PARTICIPATING IN CERTAIN BOARD DECISIONS. THE HEALTH SYSTEM'S AUDIT AND COMPLIANCE COMMITTEE HAS THE FINAL DECISION-MAKING REGARDING ALL CONFLICTS OF INTEREST. THROUGHOUT THE FISCAL YEAR, BOARD MEMBERS MUST NOTIFY THE BOARD CHAIR, COMPLIANCE OFFICER, AND/OR CEO IF A NEW CONFLICT OF INTEREST HAS DEVELOPED. Form 990, Part VI, Section B, line 15 THE ORGANIZATION'S PARENT, A HEALTH SYSTEM, MANAGES THE DETERMINATION OF COMPENSATION AND THE PROCESS IS OUTLINED IN ITS BYLAWS. 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 19 THE ORGANIZATION IS PART OF A HEALTH SYSTEM AND ALL REQUESTS FOR THIS INFORMATION ARE HANDLED BY THE SYSTEM'S MARKETING/PUBLIC RELATIONS DEPARTMENT. 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. CONEMAUGH HEALTH SYSTEM 1086 FRANKLIN STREET JOHNSTOWN PA 15905 232801799 SUPPORT MEMBER HOSPITALS PA 501(C)(3) 11A N/A CONEMAUGH VALLEY MEMORIAL HOSPITAL DBA MEMORIAL MEDICAL CENTER 1086 FRANKLIN STREET JOHNSTOWN PA 15905 250965307 HEALTHCARE SERVICES PA 501(C)(3) 3 CONEMAUGH HEALTH SYSTEM GOOD SAMARITAN MEDICAL CENTER 1020 FRANKLIN STREET JOHNSTOWN PA 15905 250965428 HEALTHCARE SERVICES PA 501(C)(3) 3 CONEMAUGH HEALTH SYSTEM MEYERSDALE COMMUNITY HOSPITAL DBA MEYERSDALE MEDICAL CENTER 200 HOSPITAL DRIVE MEYERSDALE PA 15552 251002946 HEALTHCARE SERVICES PA 501(C)(3) 3 CONEMAUGH HEALTH SYSTEM CONEMAUGH HEALTH FOUNDATION 1086 FRANKLIN STREET JOHNSTOWN PA 15905 251719695 SUPPORTS CONEMAUGH HEALTH SYSTEM PA 501(C)(3) 11B CONEMAUGH HEALTH SYSTEM NORTHERN CAMBRIA HEALTHCARE FOUNDATION PO BOX 732 NORTHERN CAMBRIA PA 15714 251537143 SUPPORTS MINERS HOSPITAL PA 501(C)(3) 7 N/A CONEMAUGH HOUSING INC 1086 FRANKLIN STREET JOHNSTOWN PA 15905 251606936 PROVIDES SENIOR HOUSING FACILITIES PA 501(C)(3) 9 CONEMAUGH VALLEY MEMORIAL HOSPITAL LAUREL HIGHLANDS ADVANCED IMAGING 1450 SCALP AVENUE JOHNSTOWN PA 15904 251864587 DIAGNOSTIC SERVICES PA N/A GREATER JOHNSTOWN TECH PARK 1086 FRANKLIN STREET JOHNSTOWN PA 15905 260389121 OPERATES MULTI-TENANT COMMERCE OFFICE PARK PA N/A CONEMAUGH HEALTH INITIATIVES INC 1086 FRANKLIN STREET JOHNSTOWN PA 15905 251658283 PHYSICIAN SERVICES PA N/A C 1086 REAL ESTATE 1086 FRANKLIN STREET JOHNSTOWN PA 15905 251489704 REAL ESTATE PA N/A C CONEMAUGH ENTERPRISES INC 1086 FRANKLIN STREET JOHNSTOWN PA 15905 202998473 ECONOMIC DEVELOPMENT PA N/A C SINDO INC 1086 FRANKLIN STREET JOHNSTOWN PA 15905 251144116 COMMUNITY RENTALS PA N/A C 0 0 1 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0