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200 HOSPITAL - MYMC INC: Form 990, tax year 2009

View the entire original 990 at ProPublica ↗

Organization
200 HOSPITAL - MYMC INC (EIN 25-1002946)
Tax period
2009-07-01 to 2010-06-30
Filed
2011-02-10
IRS object ID
201140419349300324
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)
EIN251002946EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1MEYERSDALE COMMUNITY HOSPITALBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlMEYENameControl
Phone8146345911Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1200 HOSPITAL DRIVEAddressLine1
CityMEYERSDALECity
StatePAState
ZIP Code15552ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameEDWARD DEPASQUALEName
TitleCHIEF FINANCIAL OFFICERTitle
Phone8144108271Phone
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 Line1MEYERSDALE 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 Receipts11855127GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501cXOrganization501c
Web SiteWWW.CONEMAUGH.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1952YearFormation
State Legal DomicilePAStateLegalDomicile
Activity Or Mission DescriptionGENERAL ACUTE CARE CRITICAL ACCESS HOSPITAL PROVIDING INPATIENT, SWING BED, OUTPATIENT, AND CLINIC SERVICES TO THE SOUTHERN SOMERSET COUNTY POPULATION.ActivityOrMissionDescription
Nbr Voting Members Governing Body16NbrVotingMembersGoverningBody
Nbr Independent Voting Members15NbrIndependentVotingMembers
Total Nbr Employees153TotalNbrEmployees
Total Nbr Volunteers40TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year134831ContributionsGrantsPriorYear
Contributions Grants Current Year214339ContributionsGrantsCurrentYear
Program Service Revenue Prior Year11021095ProgramServiceRevenuePriorYear
Program Service Revenue CY11557120ProgramServiceRevenueCY
Investment Income Prior Year30553InvestmentIncomePriorYear
Investment Income Current Year33906InvestmentIncomeCurrentYear
Other Revenue Prior Year-6224OtherRevenuePriorYear
Other Revenue Current Year-20082OtherRevenueCurrentYear
Total Revenue Prior Year11180255TotalRevenuePriorYear
Total Revenue Current Year11785283TotalRevenueCurrentYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year4970027SalariesEtcPriorYear
Salaries Etc Current Year4892117SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year6314397OtherExpensePriorYear
Other Expenses Current Year6581558OtherExpensesCurrentYear
Total Expenses Prior Year11284424TotalExpensesPriorYear
Total Expenses Current Year11473675TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-104169RevenuesLessExpensesPriorYear
Revenues Less Expenses CY311608RevenuesLessExpensesCY
Total Assets BOY7225356TotalAssetsBOY
Total Assets EOY7127524TotalAssetsEOY
Total Liabilities BOY4030458TotalLiabilitiesBOY
Total Liabilities EOY3558392TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY3194898NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY3569132NetAssetsOrFundBalancesEOY
Mission DescriptionGENERAL ACUTE CARE CRITICAL ACCESS HOSPITAL PROVIDING INPATIENT, SWING BED, OUTPATIENT, AND CLINIC SERVICES TO THE SOUTHERN SOMERSET COUNTY POPULATION.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense9756808Expense
Revenue11557120Revenue
DescriptionMEYERSDALE COMMUNITY HOSPITAL SERVES A RURAL AREA IN SOUTHWESTERN PENNSYLVANIA'S HISTORIC SOMERSET COUNTY. SPECIALIZING IN FAMILY AND PRIMARY CARE, IT IS A STATE-DESIGNATED CRITICAL CARE ACCESS HOSPITAL AND HAS BEEN DEEMED A NECESSARY HEALTH CARE PROVIDER BY THE COMMONWEALTH OF PENNSYLVANIA. MEYERSDALE COMMUNITY HOSPITAL OFFERS 24/7 EMERGENCY CARE, OPERATING ROOMS FOR MINOR PROCEDURES, RADIOLOGY AND PATHOLOGY SERVICES, PHYSICAL AND RESPIRATORY THERAPY, CARDIAC REHABILITATION, AND OB/GYN OUTPATIENT CARE. IN ADDITION A STEPDOWN SWING UNIT IS AVAILABLE FOR PATIENTS.DURING FISCAL YEAR 2010, THE HOSPITAL TREATED 266 ACUTE PATIENTS FOR A TOTAL OF 950 DAYS AND 85 SWING BED PATIENTS FOR A TOTAL OF 773 DAYS. ALSO, 41,764 OUTPATIENTS WERE TREATED THROUGHOUT THE FACILITY'S CLINICAL DEPARTMENTS AND RURAL HEALTH CLINICS.Description
Total Program Service Expense9756808TotalProgramServiceExpense
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 Member0BsnssRltnshpThruFamilyMember
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 With109618NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees153NumberOfEmployees
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 Members16NbrVotingGoverningBodyMembers
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 Line1HEATHER SMITHBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number8146345911TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1200 HOSPITAL DRIVEAddressLine1
CityMEYERSDALECity
StatePAState
ZIP Code15552ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (22 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
M RAY LECKEMBY
CHAIRMAN1.00XX000
CLIFFORD MAUST
1ST VICE-CHAIRMAN1.00XX000
DOUGLAS MCCALL BELL
2ND VICE-CHAIRMAN1.00XX000
M SUSAN DOM
SECRETARY1.00XX000
SAMUEL P MCCLURE
TREASURER1.00XX000
REBECCA BOWER
TRUSTEE1.00X000
MARK FOLK
TRUSTEE1.00X000
DAVID LAUVER
TRUSTEE1.00X000
KEVIN MILLER
TRUSTEE1.00X000
LEROY NEWELL
TRUSTEE1.00X000
HAROLD NICHOLSON
TRUSTEE1.00X000
DANIEL ROUGH
TRUSTEE1.00X000
NATHAN O THOMAS MD
TRUSTEE1.00X017744633525
JOHN SMAILA
TRUSTEE1.00X000
ROGER WAHL
TRUSTEE1.00X000
ROBERT YEDNOCK
TRUSTEE1.00X000
MARY L LIBENGOOD
PRESIDENT50.00X13874209118
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
STEVEN TUCKER
CHIEF OPERATING OFFICER5.00X036125274034
FieldValueIRS element (for citing)
Total Reportable Comp From Org138742TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs2378282TotalReportableCompFrmRltdOrgs
Total Other Compensation452217TotalOtherCompensation
Number Individuals GT100 K1NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
MEMORIAL MEDICAL CENTER
1086 FRANKLIN STREETJOHNSTOWNPA15905FINANCIAL, IT, REFERENCE LAB, PHARMACY S737384
CONEMAUGH HEALTH INITIATIVES
1086 FRANKLIN STREETJOHNSTOWNPA15905ER PHYSICIAN, OFFICE STAFF730156
CDL
6400 BROOKTREE COURTWEXFORDPA15090NUCLEAR MEDICINE363838
ALLIANCE IMAGING
PO BOX 96485CHICAGOIL60693MRI179844
CAMCO
1454 SCALP AVENUEJOHNSTOWNPA15904PHYSICAL & OCCUPATIONAL THERAPY157129
FieldValueIRS element (for citing)
Number Of Contractors GT100 K8NumberOfContractorsGT100K
Government Grants32256GovernmentGrants
All Other Contributions182083AllOtherContributions
Total Contributions214339TotalContributions

Program Service Revenue ProgramServiceRevenue (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
NET PATIENT SERVICE RE9000991151206711512067
BLOOD SCREENING9000994460244602
MEDICAL RECORDS & VERI900099451451
FieldValueIRS element (for citing)
Total Program Service Revenue11557120TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column33906TotalRevenueColumn
Exclusion$33,906ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real9627Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real65677Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real-56050Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column-56050TotalRevenueColumn
Exclusion-$56,050ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events11132GrossIncomeFundraisingEvents
Fundraising Direct Expenses4167FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column6965TotalRevenueColumn
Exclusion$6,965ExclusionAmount

Other Revenue Misc OtherRevenueMisc

FieldValueIRS element (for citing)
DescriptionMISCELLANEOUSDescription
Business Code900099BusinessCode
Total Revenue Column29003TotalRevenueColumn
Exclusion$29,003ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue29003TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column11785283TotalRevenueColumn
Related Or Exempt Function Income11557120RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$13,824ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total135938Total
Program Services27188ProgramServices
Management And General108750ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total3907253Total
Program Services3210813ProgramServices
Management And General696440ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total2360Total
Program Services2047ProgramServices
Management And General313ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total547945Total
Program Services437882ProgramServices
Management And General110063ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total298621Total
Program Services247958ProgramServices
Management And General50663ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total126993Total
Management And General126993ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total843236Total
Program Services773352ProgramServices
Management And General69884ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total65848Total
Management And General65848ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total69415Total
Program Services55532ProgramServices
Management And General13883ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total193280Total
Program Services154624ProgramServices
Management And General38656ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total18454Total
Program Services14763ProgramServices
Management And General3691ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total141679Total
Management And General141679ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total424493Total
Program Services339594ProgramServices
Management And General84899ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total143439Total
Management And General143439ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
PURCHASED SERVICES24774232477423
PATIENT SUPPLIES AND FO966691966691
BAD DEBT EXPENSE660746660746
REPAIRS AND MAINTENANCE26457621166152915
LEASE & RENTAL141531141531

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total43754Total
Program Services35003ProgramServices
Management And General8751ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total11473675Total
Program Services9756808ProgramServices
Management And General1716867ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY1151552BOY
EOY1609331EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY247148BOY
EOY287388EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY1367445BOY
EOY1025227EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY24584BOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY25560BOY
EOY19211EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis9125089LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec5851643LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY3401265BOY
EOY3273446EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY1007802BOY
EOY912921EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY7225356BOY
EOY7127524EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY909232BOY
EOY648820EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY245813BOY
EOY104498EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY2402419BOY
EOY2245259EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

FieldValueIRS element (for citing)
BOY413850BOY
EOY331589EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY59144BOY
EOY228226EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY4030458BOY
EOY3558392EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY2394041BOY
EOY2719450EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY170960BOY
EOY184326EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY629897BOY
EOY665356EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY3194898BOY
EOY3569132EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY7225356BOY
EOY7127524EOY
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$400OtherActivitiesAmount
Total Lobbying Expenditures IIB400TotalLobbyingExpendituresIIB
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
ExplanationMEMBERSHIP DUES PAID TO THE HOSPITAL COUNCIL OF WESTERN PENNSYLVANIA INDICATED THAT A SPECIFIC PERCENTAGE OF THE DUES WOULD BE RELATED TO LOBBYING ACTIVITIES.Explanation

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis136049OtherCostOrOtherBasis
Book Value136049BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis5434075OtherCostOrOtherBasis
Depreciation3104675Depreciation
Book Value2329400BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis3518747OtherCostOrOtherBasis
Depreciation2740281Depreciation
Book Value778466BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis36218OtherCostOrOtherBasis
Depreciation6687Depreciation
Book Value29531BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings3273446TotalOfBookValueLandBuildings

Other Assets OtherAssets (6 entries)

DescriptionDescriptionBook ValueBookValue
ACCRUED INTEREST RECEIVABLE100
MISCELLANEOUS ACCOUNTS RECEIVABLE (BI ANNUAL TRUST INCOME)11961
INTEREST IN INCOME TRUSTS665356
RESTRICTED CASH FOUNDATION126223
RESTRICTED CASH FOUNDATION - CITIZENS NATIONAL BANK58104
DEFERRED FINANCING EXPENSE51177
FieldValueIRS element (for citing)
Total Book Value Other Assets912921TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (4 entries)

DescriptionDescriptionAmountAmount
ASSET RETIREMENT OBLIGATION$62,811
DUE TO MEMORIAL MEDICAL CENTER$121,311
DUE TO CONEMAUGH HEALTH INITIATIVES, INC.$33,521
DUE TO CONEMAUGH HEALTH SYSTEM, INC.$10,583
FieldValueIRS element (for citing)
Total Of Amounts228226TotalOfAmounts

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 Budget0ExpensesExceededBudget
Annual Community Benefit Report0AnnualCommunityBenefitReport

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense317513TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense317513NetCommunityBenefitExpense
Percent Of Total Expense0.02940PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense1020719TotalCommunityBenefitExpense
Direct Offsetting Revenue544046DirectOffsettingRevenue
Net Community Benefit Expense476673NetCommunityBenefitExpense
Percent Of Total Expense0.04410PercentOfTotalExpense

Unreimbursed Costs UnreimbursedCosts

FieldValueIRS element (for citing)
Total Community Benefit Expense5745TotalCommunityBenefitExpense
Direct Offsetting Revenue4263DirectOffsettingRevenue
Net Community Benefit Expense1482NetCommunityBenefitExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense1343977TotalCommunityBenefitExpense
Direct Offsetting Revenue548309DirectOffsettingRevenue
Net Community Benefit Expense795668NetCommunityBenefitExpense
Percent Of Total Expense0.07360PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense40162TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense40162NetCommunityBenefitExpense
Percent Of Total Expense0.00370PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense40162TotalCommunityBenefitExpense
Net Community Benefit Expense40162NetCommunityBenefitExpense
Percent Of Total Expense0.00370PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense1384139TotalCommunityBenefitExpense
Direct Offsetting Revenue548309DirectOffsettingRevenue
Net Community Benefit Expense835830NetCommunityBenefitExpense
Percent Of Total Expense0.07730PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported0BadDebtExpenseReported
Bad Debt Expense$351,583BadDebtExpenseAmount
Amount Attributable To291181AmountAttributableTo
Amount Reimbursed By Medicare2943453AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare2868480CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall74973MedicareSurplusOrShortfall

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 (3 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeLicensed HospitalLicensedHospitalGeneral Medical And SurgicalGeneralMedicalAndSurgicalCritical Access HospitalCriticalAccessHospitalEr24 HoursEr24HoursOtherOther
MEYERSDALE COMMUNITY HOSPITAL
200 HOSPITAL DRIVEMEYERSDALEPA15552XXXX
FAMILY HEALTHCARE RHC MEYERSDALE
202 BEACHLEY STREETMEYERSDALEPA15552RURAL HEALTH CLINIC
FAMILY HEALTHCARE RHC SALISBURY
231 ORD STREETSALISBURYPA15558RURAL HEALTH CLINIC

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 COUNTY). 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 IMPACT OF PROGRAMMING IN PRIORITY AREAS AND REALLOCATE RESOURCES TO DRIVE RESULTS. THE SOUTHERN SOMERSET COUNTY REGION, SERVED BY CONEMAUGH MEYERSDALE MEDICAL CENTER, 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: MEYERSDALE COMMUNITY HOSPITAL SERVES A RURAL AREA IN SOUTHWESTERN PENNSYLVANIA'S HISTORIC SOMERSET COUNTY. SPECIALIZING IN FAMILY AND PRIMARY CARE, IT IS A STATE-DESIGNATED CRITICAL CARE ACCESS HOSPITAL AND HAS BEEN DEEMED A NECESSARY HEALTH CARE PROVIDER BY THE COMMONWEALTH OF PENNSYLVANIA. MEYERSDALE OFFERS 24/7 EMERGENCY CARE, OPERATING ROOMS FOR MINOR PROCEDURES, RADIOLOGY AND PATHOLOGY SERVICES, PHYSICAL AND RESPIRATORY THERAPY, CARDIAC REHABILITATION AND OB/GYN OUTPATIENT CARE. IN ADDITION A STEPDOWN SWING UNIT IS AVAILABLE FOR PATIENTS WHO ARE NO LONGER IN NEED OF HOSPITALIZATION BUT NEED A LITTLE EXTRA CARE BEFORE HEADING HOME. PHYSICIAN SPECIALISTS MAKE VISITS TO MEYERSDALE ON A REGULAR BASIS TO HELP IMPROVE ACCESS FOR PATIENTS IN THIS RURAL COMMUNITY. WEEKLY CLINIC SERVICES INCLUDE CARDIOLOGY, OBSTETRICS/GYNECOLOGY, OPHTHALMOLOGY, GASTROENTEROLOGY, NEPHROLOGY, WELL BABY CLINIC, WOUND CARE CENTER, HEARING AIDE CENTER, AND PODIATRY. AERO MEDICAL HELICOPTER TRANSPORTATION IS AVAILABLE TO PATIENTS IN THE MEYERSDALE AREA TO TRANSPORT THEM TO MEMORIAL MEDICAL CENTER OR OTHER FACILITIES IF NEEDED. MEYERSDALE HAS TWENTY LICENSED BEDS WITH AN AVERAGE INPATIENT CENSUS OF 6. THERE ARE 4 ACTIVE PHYSICIANS ON THE MEDICAL STAFF. 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: MEYERSDALE COMMUNITY HOSPITAL IS COMMITTED TO PROVIDING EDUCATIONAL INFORMATION AND SCREENINGS TO THE COMMUNITY. NEARLY 50 MEYERSDALE EMPLOYEES PARTICIPATED IN "WELLNESS" ACTIVITIES FOR THE COMMUNITY INCLUDING SCREENINGS FOR BLOOD SUGARS, PFTS, EKGS, VASCULAR SCREENS, VISION SCREENING, CHOLESTEROL, BONE DENSITY AND BODY FAT ANALYSIS. MEYERSDALE DONATES SPACE IN ITS DINING ROOM AND CONFERENCE ROOM EACH WEEK FOR ALCOHOLICS ANONYMOUS MEETINGS. MEYERSDALE COMMUNITY HOSPITAL FACILITY HIGHLIGHTS:LICENSED BEDS - 20BEDS IN SERVICE - 20PATIENT DAYS OF SERVICE - 1,723INPATIENT DAILY CENSUS - 6ADMISSIONS - 351AVERAGE LENGTH OF STAY - 4.9FULL TIME EQUIVALENT EMPLOYEES - 108.3VOLUNTEERS - 40PHYSICIANS:ACTIVE - 4SERVICES:EMERGENCY VISITS - 4,262SAME DAY/AMBULATORY SURGERY - 168PHYSICAL THERAPY TREATMENTS - 4,582LABORATORY TESTS - 68,605RADIOLOGY DIAGNOSTIC/MAMMOGRAPHY - 6,235ULTRASOUND PROCEDURES - 987CT SCANS - 2,252MRI PROCEDURES - 505CARDIO/RESPIRATORY PROCEDURES - 14,714OtherInformation

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 (6 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
NATHAN O THOMAS MD
0155000012312010134015307018218021097100
SCOTT BECKER
054340301624780239930106507014552085093300
EDWARD DEPASQUALE
0280659058583021407060840011214043270300
DAVID CARLSON DO
037683507611108744069053014984054572700
JOSEPH DADO
02362680475180358504868009710034576100
STEVEN TUCKER
0291113058583011556061468012566043528600

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; AND STEVEN TUCKER $44,214
Part I, Line 6MARY LIBENGOOD RECEIVED A BONUS FROM MEYERSDALE COMMUNITY 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 INCENTIVE CRITERIA, GOVERNED BY THE EXECUTIVE COMPENSATION COMMITTEE OF THE BOARD OF CONEMAUGH HEALTH SYSTEM.

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (8 entries)

IdentifierIdentifierExplanationExplanation
Form 990, Part VI, Section A, line 6THE MEMBERS OF MEYERSDALE COMMUNITY HOSPITAL CONSIST OF THREE CLASSES: PERPETUAL MEMBERS, LIFE MEMBERS, AND CONEMAUGH HEALTH SYSTEM, INC. (THE CORPORATE MEMBER).
Form 990, Part VI, Section A, line 7aTHE CORPORATE MEMBER OF MEYERSDALE COMMUNITY HOSPITAL, 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 MEYERSDALE COMMUNITY HOSPITAL ARE SUBJECT TO APPROVAL BY ITS CORPORATE MEMBER, 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 BY-LAWS. 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 (6 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 HEALTH FOUNDATION
1086 FRANKLIN STREETJOHNSTOWNPA15905251719695SUPPORTS CONEMAUGH HEALTH SYSTEMPA501(C)(3)11BCONEMAUGH HEALTH SYSTEM
CONEMAUGH VALLEY MEMORIAL HOSPITAL DBA MEMORIAL MEDICAL CENTER
1086 FRANKLIN STREETJOHNSTOWNPA15905250965307HEALTHCARE SERVICESPA501(C)(3)3CONEMAUGH HEALTH SYSTEM
MINERS HOSPITAL DBA MINERS MEDICAL CENTER
290 HAIDA AVENUEHASTINGSPA16646250977902HEALTHCARE SERVICESPA501(C)(3)3CONEMAUGH HEALTH SYSTEM
GOOD SAMARITAN MEDICAL CENTER
1020 FRANKLIN STREETJOHNSTOWNPA15905250965428HEALTHCARE SERVICESPA501(C)(3)3CONEMAUGH HEALTH SYSTEM
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 Org0GiftGrantOrCapContrFrOtherOrg
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 Orgs0PerformOfServicesForOtherOrgs
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