2011-05-10T11:33:32-05:00 2010-06-30 PARENTEBEARD LLC 400 MARKET STREET WILLIAMSPORT PA 17701 990 2009-07-01 231352187 LEWISTOWN HOSPITAL LEWI 7172427650 400 HIGHLAND AVENUE LEWISTOWN PA 17044 Randy Tewksbury 7172427650 2011-05-10 1 5703236023 2009 2016-02-24 21:20:13Z Kay Hamilton 400 Highland Avenue Lewistown PA 17044 92429604 0 X www.lewistownhospital.org X 1905 PA TO PROVIDE PERSONAL, HIGH-QUALITY, ECONOMICAL HEALTHCARE FOR OUR COMMUNITIES. 15 13 1167 140 1553498 596383 234771 1094863 86777591 87817917 944699 652451 1927529 1791897 89884590 91357128 4618728 3328297 0 46190347 45693639 0 485819 39561066 40550095 90370141 89572031 -485551 1785097 81075354 87901083 58023747 64859043 23051607 23042040 TO PROVIDE PERSONAL, HIGH-QUALITY, ECONOMICAL HEALTHCARE FOR OUR COMMUNITIES. 0 0 85501957 3328297 86274336 PROVIDED INPATIENT, OUTPATIENT, WELLNESS, AND COMMUNITY SERVICES TO RESIDENTS OF LEWISTOWN, PA AND SURROUNDING COMMUNITIES. PROVIDED CARE, TO PATIENTS WHO MEET CERTAIN CRITERIA, WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. CHARGES FORGONE FOR SERVICES RENDERED AND SUPPLIES FURNISHED WERE APPROXIMATELY $3,827,000. 85501957 1 1 0 1 0 0 0 0 1 1 1 1 0 0 0 0 0 0 1 0 1 1 1 1 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 1 0 0 0 1 47 0 1 1167 1 1 1 0 0 0 0 1 1 0 0 0 15 13 0 0 1 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 PA X RANDY TEWKSBURY CFO 7172427650 400 HIGHLAND AVENUE Lewistown PA 17044 Kay Hamilton 35.60 X X 282247 0 32433 PAUL D OLBRICH 1.00 X X 0 0 0 Brian D Schell 1.00 X X 0 0 0 Dan Patterson 1.00 X X 0 0 0 Francis Evanitsky 1.00 X X 0 0 0 Ricardo T Carter MD 1.00 X 0 0 0 Donald Chapman 1.00 X 0 0 0 JANICe L Darrow 1.00 X 0 0 0 Charles Everhart Jr MD 1.00 X 0 0 0 SHAShpal K Malhotra MD 1.00 X 0 0 0 Marsha A Soult PhD 1.00 X 0 0 0 Diane Spokus PHD CHES 1.00 X 0 0 0 Jon Zimmerman 1.00 X 0 0 0 Nancy Laub 1.00 X 0 0 0 Daniel Reifsnyder 1.00 X 0 0 0 Randy Tewksbury 34.00 X 162653 0 28935 kirk E THOMAS 38.80 X 136134 0 20244 NANCY S REINKE 40.00 X 113383 0 26503 RONALD M COWAN 40.00 X 109127 0 20237 CHRISTINE W MATHEWS 40.00 X 114389 0 17977 NITIN V SHETH MD 40.00 X 648630 0 16183 DAVID M NELSON 40.00 X 175116 0 30281 Richard F Stomackin 40.00 X 146590 0 21625 LEWIS ALLSHOUSE III 40.00 X 122595 0 19422 Robert A Montgomery 40.00 X 122141 0 27291 2133005 0 261131 14 0 1 0 The Quandel Group Inc 4755 Linglestown Road Harrisburg PA 17112 Construction Firm 1401773 Cerner Corporation 43 Kensico Drive Mt Kisco NY 105491009 Maintenance/remote hosting for clinical 1247471 Alliance Imaging Inc 1900 S State College Blvd Suite 6 Anaheim CA 92806 Contract Labor/ Imaging Technologists 839856 TEAM HEALTH EAST 307 SOUTH EVERGREEN AVENUE WOODBURY NJ 08096 763030 Quest Diagnostics Nichols Institute 12436 Collections Center Drive Chicago IL 606932436 Diagnostic Laboratory Testing Services 706262 22 79333 359775 565180 90575 1094863 NET PATIENT SERVICE RE 621400 86274336 86274336 LAB SERVICE REV 621500 1543581 1543581 87817917 571784 571784 44160 18904 25256 25256 25256 1000000 1530 920863 79137 1530 80667 80667 42178 79333 58023 -15845 -15845 3757 3757 3757 121327 74686 46641 46641 INTERCOMPANY REVENUE 900099 391249 391249 CAFETERIA REVENUE 722210 384023 384023 SCHOOL OF NURSING 611600 352296 352296 604520 200004 9917 394599 1732088 91357128 87243141 1553498 1465626 3321297 3321297 7000 7000 662645 662645 33166362 31803069 1206245 157048 3381518 3186695 178960 15863 6020700 5750732 241342 28626 2462414 2342008 109339 11067 120619 120619 88513 88513 14139 14139 7696883 7189630 342810 164443 121824 30198 17662 73964 14087065 14044718 35295 7052 66018 59983 5985 50 1688446 1561944 114208 12294 53789 43103 9646 1040 30203 24570 5235 398 1177017 1177017 6101406 6101406 641884 641884 Federal Income taxes 161627 161627 BAD DEBT EXPENSE 4389210 4389210 Repairs and Maintenance 3541880 3529834 12046 MEMBERSHIP FEES 153655 89288 63276 1091 Publications 127450 105867 8700 12883 288467 102504 185963 89572031 85501957 3584255 485819 1849 1849 6164769 11020406 8513994 8523804 1361227 1051551 2235928 2205958 1904531 2459475 101754795 68820992 31534481 32933803 28360443 28379832 148000 148000 850132 1176405 81075354 87901083 32392502 34764584 22385000 21815000 2281296 3246245 5998163 58023747 64859043 X 22276363 22260436 293036 272023 482208 509581 23051607 23042040 81075354 87901083 X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 14139 14139 0 Part II-B, Line 1i: Explanation of Other Lobbying Activities: A portion (25.82%) of our annual dues paid to the Hospital and Healthsystem Association of Pennsylvania (HAP) is attributable to lobbying expenses. A portion (23.76%) of our annual dues paid to the American Hospital Association (AHA) is attributable to lobbying expenses. 69171 4750 7758 1000 308 80371 63766 4495 2070 1000 160 69171 1.00000 0 0 224654 224654 45384692 28630799 16753893 54264209 38966596 15297613 1881240 1223597 657643 32933803 OBLIGATIONS UNDER CAPITAL LEASE 3725507 DUE TO AFFILIATES 97160 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 1335028 BLUE CROSS CURRENT FINANCING ADVANCE 381800 ESTIMATED MEDICAL MALPRACTICE CLAIMS 458668 5998163 91357128 89572031 1785097 1198533 -2993197 -1794664 -9567 89354302 1198533 -2993197 -1794664 91148966 208162 208162 91357128 89363869 -208162 -208162 89572031 0 89572031 Part V, Line 4: Description of Intended Use of Endowment Funds: The earnings on the Friends Legacy Endowment fund will be used solely for the purposes of capital and building expenditures. No expenditures can be made until the fund reaches $1,000,000 and then only the earnings from the investment can be used for those purposes. The earnings on the School of Nursing Scholarship funds are used for scholarships for Lewiston Hospital School of Nursing students selected by the scholarship committee based on established criteria. Part X: Description of Uncertain Tax Positions Under FIN 48: The Hospital accounts for uncertainty in income taxes using a recognition threshold of more-likely-than-not to be sustained upon examination by the appropriate taxing authority. Measurement of the tax uncertainty occurs if the recognition threshold has been met. Management has determined that there were no tax uncertainties that met the recognition threshold in 2010 and 2009. Part XI, Line 8 - Other Adjustments: VALUATION LOSS: 27373. Pension liability adjustment: -3020570. Part XII, Line 2d - Other Adjustments: VALUATION GAIN: 27373. Pension liability adjustment: -3020570. Part XII, Line 4b - Other Adjustments: Special Event EXPENSES: -58023. COST OF GOODS SOLD: -74686. RENTAL EXPENSES: -18904. TRANSFER TO AFFILIATE NETTED WITH EXPENSES ON FINANCIAL STATEMENTS: 359775. Part XIII, Line 2d - Other Adjustments: Special Event Expenses: 58023. COST OF GOODS SOLD: 74686. RENTAL EXPENSES: 18904. TRANSFER TO AFFILIATE NETTED WITH EXPENSES ON FINANCIAL STATEMENTS: -359775. MASQUERADE PARTY 48490 31990 16500 4797 9138 7554 Golf Tournament 59201 39273 19928 2400 6217 10662 10569 1 13820 8070 5750 1850 4531 305 121511 79333 42178 2400 12864 24331 18428 58023 -15845 1 1 1 X 0 1 1 1 0 1 1 1423378 1423378 0.01670 5688618 200004 5488614 0.06440 7111996 200004 6911992 0.08110 284888 284888 0.00330 12688 12688 0.00010 16805 16805 0.00020 314381 314381 0.00360 7426377 200004 7226373 0.08470 4014 4014 0.00000 59771 59771 0.00070 6696 6696 0.00010 649536 564063 85473 0.00100 720017 564063 155954 0.00180 1 1802736 0 24157541 24320627 -163086 X 1 0 Lewistown Hospital

400 Highland Avenue Lewistown PA 17044

X X X Part I, Line 3c: Eligibility for Free care is based on Federal Poverty Guidelines. Discounts are available for prompt payment and self pay over certain dollar levels, regardless of income. Part I, Line 7f: BAD DEBT EXPENSE OF $4,389,210 WAS INCLUDED ON FORM 990, PART IX, LINE 25, BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN PART I LINE 7 COLUMN F. Part III, Line 4: The cost-to charge ratio was calculated using total costs and total patient charges. The Medicare stepdown methodology was used but included all expenses, net of related other income. The total expenses tied to the audited financial statements. Part III, Line 8: This cost-to-charge is per the file Medicare Cost Report and reflects all reclasses and adjustments required by Medicare. Part VI, Line 2: Quarterly Advisory groups:The Patient Satisfaction Advisory Group purpose is to provide feedback regarding the hospital's patient satisfaction efforts. The committee is composed of former and current patients, as well as community members. Members give insight into what the community is saying about the hospital and suggestions for changes to make the hospital experience more patient-focused.The Marketing Advisory Committee's purpose is to provide guidance for the hospital's marketing and outreach efforts. Focus group interviews:The hospital engaged the Melior Group to conduct internal and external focus groups. The objectives of the research were to learn how Lewistown Hospital is perceived; what makes it a hospital of choice or not; what are experiences like with the Hospital; and what services and specialties it should focus on in the future. Medical Staff surveysThe primary objective of the medical staff assessment process was to create a medical staff development plan for Lewistown Hospital that projects the needs for physicians over the next several years, by specialty, in the Hospital's primary and secondary service areas. In addition, the survey was used to create a physician recruitment strategy for the Hospital and members of the medical staff.Utilization statistics and analysisDecision support software within the Hospital's Finance Department provides historical and current data on the utilization of inpatient and outpatient services. State Health Improvement Plan Partnership (SHIP) dataLewistown Hospital is a key member of the local SHIP (Mifflin -Juniata Partners Advancing Tomorrow's Health). The purpose of this group is to support the health planning initiatives from the Pennsylvania Department of Health. This is accomplished by engaging a broad spectrum of local community individuals and organizations with interests and influence on local health status by working together to promote effective health improvement strategies, including planning and coordination of local resources. Meetings are held bi-monthly. PA Department of Health StatisticsThe PA Department of Health website provides a wealth of health statistics and data for each county. This includes the following:- rates for birth, death, cancer, and other vital statistics- behavioral risk and injury statistics- communicable diseases- health facilities- school health PA Department of Health Behavioral Risk Factor surveyThe Behavioral Risk Factor Surveillance System (BRFSS) is an annual telephone survey implemented nationwide under a grant from the Centers for Disease Control and Prevention. Since 1989, the Pennsylvania Department of Health has released annual reports using BRFSS data on various health risk behaviors, such as smoking, drinking, seat belt usage and health status.Mifflin-Juniata Human Services Needs Assessment - from Mifflin County Commissioners Office:The Mifflin-Juniata County Human Needs Assessment project began in 2004 to identify critical areas where the assistance of the Human Services Department would be most beneficial for individuals, families and the community. The Human Services Department collaborated with Penn State University to conduct a needs assessment in both Juniata and Mifflin counties. The assessment was helpful in determining what the highest human service needs were for the two counties.Various hospital staff members assist with the data collection. Primary and secondary data is organized into computer files to make the information easier to use and analyze. Once the hospital has the primary and secondary data collected and in hand, the Senior Team spends time analyzing the data to discern patterns and themes. Assessment data findings are shared with a variety of groups internally and externally (management staff, medical-dental staff, Board of Trustees, community organizations).Since sufficient resources are not available to address all the health concerns identified in the assessments, choices must be made about which issues are designated as priorities for action in the short to intermediate term (one to three years). In general, the hospital aims for two to three priorities.The hospital collaborates with other community stakeholders to gain a greater commitment to action. A consensus is reached with input from hospital staff, medical staff, the board of trustees, and community members. Criteria that are used to identify the most significant health issues include:- The magnitude of the problem- The severity of the problem- A high need among vulnerable populationsCriteria that are used to evaluate which health issues the hospital should prioritize include:- The hospital's capacity to act on the issue, including economic, social, and cultural considerations.- The feasibility of having a measurable impact on the issue- Community resources already focused on the issue- Whether the issue is a root cause of other problems (thereby possibly affecting multiple issues)When the issues have been prioritized, the Senior Team and Board of Trustees discuss the prioritized list and ask for additional input and validation. When a final decision is made, a plan is put into place to address the priorities and improve community health. Specific goals help focus the specific interventions and provide a method for valuing each option. Part VI, Line 3: Lewistown Hospital produces daily reports for high ticket services that indentify patients that are potentially uninsured. We contract with a third party that employs a representative on site, at the hospital that will take the report of uninsured patients, the representative will attempt to personally visit each patient while they are still at the hospital to outline possible options. The options include oral communication and written materials that outline the availability of charity care in addition to assistance in making application for Medical Assistance. The representative is highly experienced in the Medical Assistance application process and will assist the patient in completing the application process. This includes completing the paperwork, copying documents and even will represent the patient at the face to face interview at the county office if necessary. If the patient is not available or declines communication while still hospitalized this service is also offered post discharge including visits to the patient home. The representative also assists with a charity care eligibility application in addition to the Medical Assistance application. Upon admission all patients receive a written Patient Information Guide that details contact information should they be uninsured or underinsured and have the need the seek charity care. Post discharge all patients indicating that they are uninsured will receive a letter offering a prompt pay discount. There are contact phone numbers on the letter should the patient have any questions concerning our discount program. Telephone calls are made to patients in an attempt to explain our discount policy, the fact that we accept interest free time payments, we encourage patients to make application for Medical Assistance and BlueChip and if we determine that there truly is an indigent situation where there are no other alternatives we do offer a charity program whereby patients may qualify for free care. Part VI, Line 4: Our service area is comprised of Mifflin County, Juniata County, Huntingdon County,and Fulton County along with some smaller municipalities located in western SnyderCounty and northern Blair County. This rural area contains some 145,000 people spread over more than 2,500 square miles of rugged terrain located in the heart of the Appalachian Mountains in central Pennsylvania. The average population density is approximately 60 persons per square mile. The Juniata River runs along the verdant valleys and slices through narrow mountain passes to connect our residents together, which is why our area is called the Juniata Valley.Transportation barriers play a major role in access to health care in our region. These natural barriers include narrow roads that either meander along streams and creeks or crossover the mountain ranges that traverse our Appalachian Ridge region. These barriers are even more daunting given hazardous winter driving conditions caused by snow or ice covered roads. Low-income and senior citizens also face transportation issues, as there is no public transportation in our service area. Senior citizens and Medicaid-eligible persons can use the CARS van system for transportation to regularly scheduled appointments with a week's notice but not for urgent or emergency care. Low income citizens have no access to any public transportation at all in our community. If a trip to a specialist is required the major support hospitals are over one and half hours drive away (in the summer).The population of our total service area is just about 145,000 persons based on 2000 US Census data. Mifflin County has a relatively flat growth rate and has not grown significantly in population since the 1950 census when overall population was about 46,000 people. Juniata County, on the other hand, has seen significant growth with a 10.6 % increase in population from 1990 to 2000. It is believed that this growth is mostly coming from people who work in the nearby Harrisburg area who are looking for a lower cost of living. With the recent completion of a new four-lane highway north of Harrisburg, the commute to Harrisburg has become more convenient resulting in an increase in Juniata County's population as people move further away from the urban areas to live in the country. Higher growth in Fulton County is explained by migration from Maryland as people try to move away from higher housing costs in Maryland. Huntingdon County's growth is mostly occurring in the northern portion of the county that is close enough to State College to allow residents to commute to Penn State University. These growth rates are still very low when compared to a national growth rate of over 13%.Mifflin County's 65 and over age group is 18.3 percent (2008), while Juniata County's is 17.2%, Huntingdon County's, 16% and Fulton County's 16.7%. The Pennsylvania average for this statistic is on 15.4%. Both Mifflin and Juniata Counties have higher percentages of persons less than 18 years of age, 23.1% and 23.3% respectively, than the PA average of 22%. Both of these groups require more health care resources than other age groups in our community. Mifflin County has 12.5 percent of the population with income below the poverty line and 19.8 percent of children under 18 living in poverty. The general poverty level compares to the state average poverty rate of 11 percent and the national average of 11.3 percent while the under 18 poverty level compares with the state average of 16.5 percent and the national average of 18.9 percent. Juniata County has 9.2% of the population with income below the poverty line, while Huntingdon and Fulton Counties are 12% and 10.3% respectively. Average household income for the four main counties in our service area are as follows: Mifflin $38.5K, Juniata $43K, Huntingdon $41.5K, and Fulton $43.3K. The percentages of the populations who are uninsured (in the 18-64 age range) for those counties are as follows: Mifflin 19%, Juniata 19%, Huntingdon 19%, and Fulton 13%. During the fiscal year 2010, approximately 14% of our patient population was Medical Assistance, while another 4.5% were Self Pay.There are two other hospitals located within the service area described above, and they are JC Blair Memorial Hospital in Huntingdon, PA and Fulton County Medical Center McConnellsburg, PA. There are also several other hospitals located in areas surrounding our service area. These include Mt. Nittany Medical Center in State College, PA; Geisinger Medical Center in Danville, PA; The Penn State Milton S. Hershey Medical Center in Hershey, PA; and several campuses of Pinnacle Health in the Harrisburg, PA area.There are also several federally-designated medically underserved areas within our service area. There are two located in Mifflin County, one in Juniata County, four in Huntingdon County, and one in Fulton County.The Adult Behavioral Health Risk Factors survey (2006-2008) shows the following statistics for the population living in Mifflin and Juniata counties:Risk Factors - PercentFair or Poor General Health - 20Obese - 29Overweight (includes obese) - 66Ever told they had diabetes - 12Currently has asthma - 10Current smoker - 26For Mifflin and Juniata counties, the Health Profile 2010 from the PA Department of Health show the major causes of death are diseases of the heart, cancer, stroke, and chronic lower respiratory diseases. Prostate cancer ranks as number one for the highest incidence of cancer, followed by female breast cancer. Ranking third and fourth on the list are lung cancer and colon cancer. Part VI, Line 5: Mifflin County Industrial Development Corporation: Kay Hamilton, CEO, Board member - The mission of the Mifflin County Industrial Development Corporation is to promote the growth of employment and income in Mifflin County by using technical and financial resources from MCIDC and federal, state, and local agencies and individuals to encourage and assist business and industrial formation, retention, and expansion. Mifflin County Planning Commission: Kay Hamilton, CEO, member of the Commission- The mission of the Mifflin County Planning Commission is to provide strategic, coordinated, and objective guidance and oversight to the growth, planning, and development activities of Mifflin County. In doing so, it is the goal of the Commission to ensure Mifflin County's future is characterized by a healthy environment, economy, and society achieved through proactive planning, citizen representation, effective communication, and the provision of professional services from the Mifflin County Planning and Development Department.Mifflin Juniata Career Tech Center Advisory Committee: Kay Hamilton, CEO, board member- The Mifflin Juniata Career and Technology Center offers vocational-technical educational programs for both Mifflin and Juniata County students in grades 10 - 12. Programs include: Health Professions, Allied Health Science, Agriculture, Construction, criminal justice, etc. Mifflin-Juniata Partners Advancing Tomorrow's Health (PA SHIP partnership): Kirk Thomas, VP Operations, Board Chair- The mission of the MJ PATH group is to promote the health and wellness of individuals and the communities of Mifflin and Juniata Counties. This is accomplished by engaging a broad spectrum of local community individuals and organizations with interests and influence on local health status by working together to promote effective health improvement strategies, including planning and coordination of local resources. Mifflin-Juniata Health Center: Kirk Thomas, VP Operations, Board Chair - The mission of the Mifflin-Juniata Health Center is to provide access to primary and preventive health care services to residents of all income levels within our service area, with special emphasis on the indigent, the uninsured, and the underserved. The Health Center is collaborating with Broad Top Medical Center, a federally-qualified health center, to establish affiliate clinics in Mifflin and Juniata counties. Amish Health Council Liaison: Kirk Thomas, VP Operations- An initiative has been implemented to meet the health care needs of the Amish population in Mifflin and Juniata counties. To encourage access to care, a discount payment schedule has been developed. Mifflin-Juniata United Way: Phyllis Mitchell, VP Marketing & Community Affairs, Board Member- The mission of the MJ United Way is to improve people's lives by mobilizing the caring power of the community. The United Way supports various agencies through funding. The community impact focus areas include: basic needs and self sufficiency, community life and health, education, and successful children and youth. Lewistown Hospital employees and medical-dental staff contribute to the United Way fund each year to support these local community organizations. Juniata Valley Chamber of Commerce: Phyllis Mitchell, Board Member- The Juniata Valley Chamber of Commerce helps promote and support local businesses in Mifflin and Juniata counties. The Chamber is a respected source for information about community businesses and events in the area. Disaster Preparedness Committee: community planning imitative- The Disaster Preparedness Committee is a multi-disciplinary group that includes first responders, EMS personnel, 911 personnel, and hospital staff. The purpose of the committee is to work collaboratively to respond to any community disaster situation that would require extensive health care services ( i.e., fires, etc.).Internship programs for various departments:- The hospital works with many different organizations such as secondary education institutions, and medical schools, to provide job shadowing and training internships for participants. Many different departments work with interns to provide a valuable work experience. Experience Works program sponsor:- Experience Works (formerly Green Thumb) is a federal employment program that is focused on meeting the training and employment needs of a rapidly growing older population. Lewistown Hospital is a training agency for Experience Works individuals. Currently two Experienced Works participants are working at the HospitalLewistown Hospital School of Nursing:- In response to the shortage of nurses, Lewistown Hospital appealed to the State Board of Nursing to open its current School of Nursing. In May 2005, the Pennsylvania State Board of Nursing granted initial approval to the Lewistown Hospital to admit twenty-five students to each of two classes. The Pennsylvania State Board Education Advisors reviewed the program in October 2007 after the first class graduated, and full approval was granted to the program in December 2007.- The School of Nursing has a full-time program, which takes two years to complete and is a total of 102 credit units. Students may also opt for part-time, and they can choose a three- or four-year option. In addition, the program offers an LPN to RN program, and it could take as little as four semesters (14 months) to complete. The mission of the Lewistown Hospital School of Nursing is to provide quality nursing education to a diverse group of students in a manner that enables the graduates to become leaders in providing competent and safe care in a variety of settings in order to meet the continually changing healthcare needs of the hospital's and school's community.Free Health education workshops and seminars- Through the Hospital's speaker bureau program, a wide variety of programs are offered to the community free of charge.Free Health Screenings- Various departments offer health screenings at local community events or during a sponsored business health fair. Screenings include: bone density, blood pressure, cholesterol, blood sugar, lung function, depression, and skin cancer. Free Child Safety Seat Inspections- The Family Place (maternity center) offers quarterly child safety seat inspections at the hospital. For families that do not have a safe car restraint for their children 0-8 years of age, the hospital provides a new and appropriate child safety seat. Quick ER Care Program- Quick ER Care, a new service introduced in December 2008, provides separate resources for non-emergency cases in the ER. These resources include three additional patient examination rooms and staff dedicated to handling these cases. These additional resources provide another path for patients to be treated.People who normally have to wait for long periods of time in the ER, are usually not the severe cases. Quick ER Care reduces the wait time for patients who come to the ER because they can't get an appointment or don't have an established physician relationship. Quick ER Care is available at Lewistown Hospital 7 days a week from 10:00am - 8:00pm. Quick ER Care has a full-time physician assistant and registered nurse who provide medical screening and treatment for patients who have less urgent conditions such as potential fractures, sprains, mild rashes and low grade fevers. Before being admitted to Quick ER Care, all patients will be triaged and assessed by a registered nurse to ensure that they are candidates for quick care. Telestroke Program- Lewistown Hospital, collaborating with Geisinger Health System, has expanded its stroke services to provide advanced care for patients in the Lewistown area. Through a new telemedicine program, the expertise of Geisinger's stroke specialists is now available to Lewistown Hospital Emergency Department physicians 24 hours a day, seven days a week. A secure video monitoring system (Polycom machine) provides a real-time link between Geisinger's stroke-trained neurologists and Lewistown's Emergency Department. Stroke patients now receive advanced treatment from Geisinger specialists in collaboration with Lewistown emergency physicians. Stroke is the third leading cause of death in the United States. As the population continues to age, strokes are likely to increase. The American Heart Association and the American College of Emergency Physicians say that aggressively treating stroke in its early stages significantly improves a person's chance for a full recovery.Geisinger specialists evaluate the patient, review brain scans and work with Lewistown Emergency Department physicians and staff to provide the best acute stroke care. Teleconferencing equipment is brought to the patient's bedside, allowing Geisinger staff to assess the patient, and speak directly to the Lewistown physician, patient and patient's family. Part VI, Line 6: All of the organization's board members reside within the organization's primary service area. Kay Hamilton, the President, is the only employee on the board and none of the board members are family members of employees within the organization. Dr. Charles Everhart, Jr, MD, board member owns Endoscopy Center of PA, which provides endoscopy services to Lewistown Hospital; Francis Evanitsky , Treasurer of the Board is former President of Juniata Valley Bank which does provide banking services for LH. The organization extends staff privileges to all qualified physisians in the area.Annually during the budget process, a cash forecast is prepared to determine the amount of cash available for capital purchases. Capital requests are made by management of the organization during the budget process as well. Requests are reviewed and approved by the Medical Executive Committee once all of the requests are complete. The amount determined to be available and approved is set aside into a Funded Depreciation account in weekly installments over the course of the fiscal year. Lewistown Hospital is wholly dedicated to the lives, health and well-being of the individuals in our community. Ensuring that adequate capital equipment is available to provide the best treatment possible for our patients is an example of that dedication. Part VI, Line 7: While not part of a Health System per se, Lewistown Hospital is a part of the Lewistown Healthcare Foundation network of related organizations. The role of the hospital and its affiliated organizations are as follows:Lewistown Hospital:- Lewistown Hospital is a 123-bed acute care community hospital serving the residents of Mifflin and Juniata counties and members of the surrounding counties of Snyder, and Huntingdon. - Established in 1905, the hospital provides inpatient, outpatient, wellness and community services while employing over 1,000 full-time and part-time employees and providing a Medical Staff consisting of 128 physicians and allied health practitioners representing specialties ranging from family medicine, internal medicine, and cardiology to infectious disease and general / cardiovascular surgery.- The mission of Lewistown Hospital is to provide personal, high-quality economical healthcare for our communities.85% of community benefit activities are contributed through Lewistown Hospital.Family Health Associates of Lewistown Hospital (FHA):- FHA, a Pennsylvania non-profit corporation, is a multi-specialty physician/practitioner group located in Central Pennsylvania. Our physicians are board-certified or board eligible in primary care as well as many specialty areas including general surgery, pulmonary medicine, sleep medicine, and weight loss and nutrition. We are dedicated to our mission of providing personal, high quality, economical health care that meets the needs of our communities.FHA staff participates in community health fairs and screenings. Several physicians also participate in mentorship programs for interns and residents. 8% of community benefit activities are contributed through FHA.Lewistown Ambulatory Care Corporation (LACC):- LACC is a Pennsylvania non-profit organization that is mainly a real estate holding company that owns and/or manages the non-Hospital real estate assets including a medical office building that is attached to the hospital. - LACC also manages the Medic 29 Advanced Life Support Services (ALS). The Medic 29 ALS Squads provide ALS service to the people in Mifflin and Juniata Counties, as well as to people in parts of Huntingdon, Snyder, and occasionally Perry counties. Emergency Medical Technicians - Paramedics, or Paramedics for short, staff these ALS squads twenty-four hours a day, seven days a week. ALS squads augment the staff of the existing Basic Life Support (BLS) ambulance teams that operate in our areas. During an emergency call, the ALS squad is dispatched, along with the BLS ambulance, and meets the BLS ambulance on scene or en route to the hospital. The paramedic takes his/her equipment and joins the BLS crew in their ambulance and provides ALS care to the patient while en route to the hospital. This ensures that you receive the best possible care as soon as possible. Medic 29 primarily transports patients to Lewistown Hospital, but will also transport to other hospitals based on the patient's needs and preferences. Medic 29 was originally placed in service in 1989 as the first ALS provider in the area and was responsible for providing ALS service to Mifflin and Juniata counties and parts of Huntingdon and Snyder counties. Over the years, the needs of the community have increased and Medic 29 has grown to meet these needs by providing faster access to ALS care. In 1992, Medic 29 increased staff to provide a second ALS squad based in Juniata County. The Juniata County paramedic squad brought much needed ALS care fifteen minutes closer to residents in Juniata County.The Director of Medic 29 volunteers many hours in service to several different community organizations including:- Juniata County Ambulance Association - 14 hours - Mifflin County Alert & Advisory Council - 12 hours- LEPC - 6 hours- EMS Association - 12 hours- PA Emergency Health Service Council - 10 hoursIn addition, the Director participates in several community health screenings.2% of community benefit activities are contributed through Medic 29.Health Enterprises, Inc. (HEI)- HEI, a Pennsylvania for-profit entity, the only one within the Lewistown Healthcare Foundation. The main purpose of HEI is the operation of our four Total Life Care Pharmacies (TLC Pharmacy). We have taken the road less traveled, literally, in determining our service sites. Notice that they are located in the more rural areas throughout the Juniata Valley to provide convenience and close proximity to our physician practices in Family Health Associates. Many of our sponsorships and contributions come from HEI. In 2010, at total of $12,800 was made to the following community organizations:- Lewistown Rotary- 4Step- United Way of Mifflin-Juniata- Mifflin Juniata Partnerships RC & D- Mifflin Juniata Arts Council- Juniata County Business & Professional Women- Experience Works of PA- Juniata River Valley Visitors Bureau- PA Association of Healthcare Auxiliaries- Mifflin County Youth Baseball League- Big Brothers Big Sisters- American Red Cross of Susquehanna Valley- American Cancer Society- Lewistown Country Club- Juniata River fest- Juniata Valley Council Boy Scouts Association- VNA - Centre Home Care5% of community benefit activities are contributed through HEI.Lewistown Healthcare Foundation (LHF):- LHF, is a Pennsylvania non-profit membership corporation. Lewistown Hospital implemented a corporate reorganization plan in 1985, establishing LHF as the parent company of which Lewistown Hospital is one of its subsidiaries. PA 1 LEWISTOWN HEALTHCARE FOUNDATION 400 HIGHLAND AVENUE LEWISTOWN PA 17044 232344363 501(c)(3) 3321297 0 CASH n/a Net asset transfer to fund operations of related entity - Family Health Associates of Lewistown Hospital 1 0 Educational Scholarships 7 7000 0 CASH N/A Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: FUNDS WERE PROVIDED TO A RELATED ORGANIZATION UNDER COMMON MANAGEMENT TO SUPPORT OPERATIONS. X 1 1 X X X X X 0 0 0 0 0 0 0 0 0 Kay Hamilton 268142 0 0 0 14105 0 25235 0 7198 0 314680 0 0 0 Randy Tewksbury 157421 0 0 0 5232 0 17010 0 11925 0 191588 0 0 0 kirk E THOMAS 135898 0 0 0 236 0 14022 0 6222 0 156378 0 0 0 NITIN V SHETH MD 385892 0 262738 0 0 0 0 0 16183 0 664813 0 0 0 DAVID M NELSON 174926 0 0 0 190 0 18263 0 12018 0 205397 0 0 0 Richard F Stomackin 145964 0 0 0 626 0 15099 0 6526 0 168215 0 0 0 Part I, Line 1a THE HOSPITAL PROVIDES KAY HAMILTON WITH A LEASED VEHICLE FOR HER PERSONAL USE, THE VALUE OF WHICH IS DETERMINED USING IRS LEASE TABLES AND INCLUDED IN HER W-2. THE AMOUNT OF THE LEASE IS GROSSED-UP FOR THE EMPLOYEE AND EMPLOYER SHARES OF FICA TAX THAT IS PAID ON THAT VALUE AS WELL. The total amount added to her 2009 W-2 related to the leased vehicle was $12,523. Mifflin County Hospital Authority 231352187 598520CE2 2007-06-13 21723377 Refunding on an advance basis a portion ($19,775,000) of Series 2000 Bonds 0 0 21723377 1722381 19561939 4589 434468 0 1 1 1 0 0 0 0 0 0 Gayle Cowan director/manager of the education department, wife of Ronald Cowan, CIO 79969 wages and benefits paid to Gayle Cowan 0 Charles Everhart Jr MD BOARD DIRECTOR 204591 Monthly endoscopy services provided to LH by the Endoscopy Center of PA. Charles Everhart Jr. has an 80% ownership interest in the Endoscopy Center. 0 Form 990, Part VI, Section A, line 4 Article III, Paragraph 3.10 now requires that the Board meet in executive session with only the presence of community members at least two times a year. Previously it was not required. Form 990, Part VI, Section B, line 11 A final draft reviewed by three levels of finance staff will be presented to the Board for review prior to being filed. The Board will review prior to meeting at a regularly scheduled meeting and develop questions to be asked at the meeting. Any questions submitted by the Board will be researched with the preparer and final resolution will be communicated back to the Board by the finance staff. Form 990, Part VI, Section B, line 12c THE CONFLICT OF INTEREST POLICY ASSURES THAT ALL MEMBERS OF THE BOARD AND THE MANAGEMENT TEAM DISCLOSE ALL FINANCIAL AND CONFLICTING INTERESTS. ON AN ANNUAL BASIS, A CONFLICT OF INTEREST DISCLOSURE STATEMENT MUST BE SUBMITTED IN WRITING TO THE CEO. THE CEO, BOARD CHAIR AND CORPORATE COMPLIANCE OFFICER REVIEW AND MAINTAIN THE DISCLOSURE STATEMENTS. MEMBERS ARE REQUIRED TO ABSTAIN FROM VOTING ON MATTERS INVOLVING POTENTIAL CONFLICTS. FAILURE TO COMPLY WITH THE POLICY SHALL CONSTITUTE GROUNDS FOR REMOVAL FROM THE BOARD OR TERMINATION OF EMPLOYMENT. Form 990, Part VI, Section B, line 15 The Senior Executive Staff includes the CEO and other key employees. The Senior Executive Staff has their salaries, responsibilities analyzed by an outside consultant specializing in the executive compensation area. Recommendations based on the analysis are then brought to the Board. The Board determines actual increases based on the recommendations and finances of the Hospital. Form 990, Part VI, Section C, line 19 An Annual Report is available to the public via the organization's website. This report shows the annual consolidated statement of operations and a consolidated balance sheet. It also shows annual operating statistics and lists the names of board members, senior executive staff, and the members of the Medical Executive Committee. Currently, the governing documents and conflict of interest policy are not made available to the public. This information is considered proprietary and is not legally required to be made available to the general public. Lewistown Ambulatory Care Corporation 400 Highland Avenue Lewistown PA 17044 232344362 To develop and rent real estate to its affiliates PA 501(c)(3) 11B N/A Lewistown Healthcare Foundation 400 Highland Avenue lewistown PA 17044 232344363 To conduct fundraising and grant-making activities to benefit related orgs. PA 501(c)(3) 11B N/A Family Health Associates of Lewistown Hospital 400 Highland Avenue lewistown PA 17044 251651582 To employ primary care physicians and provide healthcare services PA 501(c)(3) 11B N/A Health Enterprises Inc 400 Highland Avenue Lewistown PA 17044 232353212 HEALTHCARE PA N/A C 1 1 0 1 0 0 0 0 0 1 0 0 0 1 1 1 1 1