2011-05-16T16:08:36-05:00 2010-06-30 PARENTEBEARD LLC 400 MARKET STREET WILLIAMSPORT PA 17701 990 2009-07-01 235562316 THE PALMERTON HOSPITAL PALM 6103777003 135 Lafayette Avenue Palmerton PA 18071 ANDREW E HARRIS 6103777003 2011-05-16 0 5703236023 2009 2016-02-24 21:20:13Z Andrew E Harris 135 Lafayette Avenue Palmerton PA 18071 29086122 0 X WWW.BLMTN.ORG X 1913 PA OPERATES A 111 BED ACUTE CARE HOSP, A 91 BED SKILLED NURSING FACILITY & A HOME HEALTH CARE AGENCY. 18 17 399 108 0 0 1643353 1836838 24959112 26221667 1886259 73188 689533 109377 29178257 28241070 0 0 14317734 13816769 0 0 15573437 13884622 29891171 27701391 -712914 539679 16626828 15703302 12726422 11225461 3900406 4477841 PROMOTE, MAINTAIN AND RESTORE THE GOOD HEALTH OF ALL THE PEOPLE IN THE COMMUNITIES WE SERVE THROUGH PARTNERSHIPS FOR EXCELLENCE IN HEALTHCARE SERVICE DELIVERY. 0 0 24746741 26270706 PALMERTON HOSPITAL IS AN ACUTE CARE NOT-FOR-PROFIT HOSPITAL, ORGANIZED FOR CHARITABLE AND EDUCATIONAL PURPOSES WITHIN THE MEANING OF IRC SECTION 501(c)(3). THE ORGANIZATION'S PURPOSE IS TO PROMOTE THE HEALTH AND WELFARE OF ALL PERSONS WITHIN ITS SERVICE AREA. THE ENTITY OPERATES ACUTE INPATIENT AND GEROPSYCH BEDS AND PROVIDES OUTPATIENT EMERGENCY AND ADULT DAY CARE SERVICES TO PATIENTS IN PALMERTON, PENNSYLVANIA AND THE SURROUDING AREAS. 24746741 1 1 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 24 0 1 399 1 0 0 0 0 0 0 0 0 0 18 17 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 PA X Andrea L Andrae 6103774317 180 North 12th Street Lehighton PA 18235 barbara green 3.00 X 0 0 0 Conrad Biege 3.00 X 0 0 0 jaime mendes 3.00 X 0 0 0 William H Fegley Jr 3.00 X 0 0 0 Patrick Hanley DO 3.00 X X 0 0 0 Michael Harleman 3.00 X X 0 0 0 mark sverchek 3.00 X 0 0 0 William Mason 3.00 X 0 0 0 william markson MD 3.00 X 0 0 0 Thomas Munshower DO 3.00 X 0 0 0 Shelba Scheffner 3.00 X X 0 0 0 Reverend H Wilson Scott 3.00 X 0 0 0 Steven Serfass 3.00 X 0 0 0 Elizabeth Smith 3.00 X 0 0 0 Louis Sportelli DC 3.00 X 0 0 0 Andrew Wakstein DO 3.00 X 0 0 0 Patrick Reilly 3.00 X X 0 0 0 Andrew E Harris 20.00 X X 0 315480 45900 Ruthann Brennan 40.00 X 122400 0 18360 Theresa Long 40.00 X 111200 0 16680 Lori Frey 50.00 X 106248 0 15937 David Plaviak 40.00 X 101492 0 0 441340 315480 96877 4 1 1 0 Sodexo 1900 Selwyn Avenue Charlotte NC 28207 Food Service 1081600 Pinnacle Anesthesia 13601 Preston Road Dallas TX 75240 Anesthesia Services 330833 lab corporation of america 231 maple ave burlington NC 27216 lab services 283927 ISS Solutions PO Box 13700-1066 Philadelphia PA 19191 Biomed Services 181191 Incare PC 1402 Treeline Drive Bloomsburg PA 17815 Hospitalist Services 124998 13 1683038 86336 67464 1836838 NET PATIENT SVC REV 621990 26221667 26221667 26221667 48153 48153 230280 229400 880 880 880 640687 615652 25035 25035 25035 MEALS ON WHEELS 624200 42284 42284 REBATES 900099 10862 10862 cafe meals 900099 7065 7065 48286 6755 41531 108497 28241070 26270706 0 133526 10754332 9441299 1313033 7255 6369 886 2160284 1896528 263756 894898 785637 109261 6372 6372 47995 47995 3231140 2724570 506570 137919 137919 3313005 3187572 125433 515854 184236 331618 711308 711308 20381 6454 13927 5002 3153 1849 299642 299642 1262219 1262219 644228 644228 BAD DEBT EXPENSE 2192158 2192158 DRUGS 748641 748641 REPAIRS & MAINTENANCE 219836 211920 7916 BLOOD PROCESSING 205531 205531 LAUNDRY & LINEN 118265 118265 205126 117011 88115 27701391 24746741 2954650 0 1682484 596188 2655583 3146044 689676 778558 246526 195838 35771915 27572682 7954739 8199233 2906180 2336471 414411 393578 77229 57392 16626828 15703302 3037754 3317627 5145000 4540000 575604 1177334 3968064 2190500 12726422 11225461 X 3451213 4217683 125658 0 323535 260158 3900406 4477841 16626828 15703302 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 449193 36601 -63377 162259 260158 541318 -53148 38977 449193 1.00000 0 0 198324 198324 11489718 6204257 5285461 344891 278823 66068 23166413 20533523 2632890 572569 556079 16490 8199233 BLUE CROSS WORKING CAPITAL ADVANCE 171128 ESTIMATED MEDICAL MALPRACTICE CLAIMS LIABILITY 340647 Due to Gnaden Huetten Memorial Hospital 1450173 Estimated Third-Party PAYOR Settlements 40000 OBLIGATIONS UNDER CAPITAL LEASES 188552 2190500 28241070 27701391 539679 101133 -63377 37756 577435 28508226 101133 -63377 37756 28470470 -229400 -229400 28241070 27930791 229400 229400 27701391 0 27701391 Part V, Line 4: Description of Intended Use of Endowment Funds: TERM ENDOWMENT FUNDS ARE USED FOR THE PURCHASE OF PLANT AND EQUIPMENT TO FURTHER THE MISSION OF THE ORGANIZATION. 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 there were no tax uncertainties that met the recognition threshold. Part XI, Line 8 - Other Adjustments: VALUATION LOSS: -63377. Part XII, Line 2d - Other Adjustments: VALUATION LOSS: -63377. Part XII, Line 4b - Other Adjustments: RENTAL EXPENSES: -229400. Part XIII, Line 2d - Other Adjustments: RENTAL EXPENSES: 229400. 1 1 X 1 X 1 X 1 0 0 0 47215 13009 34206 0.00130 947151 354532 592619 0.02320 488981 176746 312235 0.01220 1483347 544287 939060 0.03670 45382 45382 0.00180 8800 8800 0.00030 434567 284037 150530 0.00590 65085 42284 22801 0.00090 553834 326321 227513 0.00890 2037181 870608 1166573 0.04560 0 816274 81627 12874771 9612696 3262075 X 1 0 Palmerton Hospital

135 Lafayette Avenue Palmerton PA 18071

X X X Geripsych Unit Part I, Line 7g: Subsidized health services included under Schedule H for the Palmerton Hospital are the Adult Day Services Program. Adult Day Services of the Blue Mountain Health System offers an alternative to nursing care while providing respite for those caring for someone at home. The program offers a warm, friendly atmosphere and the opportunity for seniors to develop friendships while participating in activities they enjoy. Our experienced staff includes registered nurses, licensed practical nurses, certified therapeutic recreation specialists and certified nurse aides. The Palmerton Hospital provided subsidies of approximately $150,000 to the Adult Day Services Center during FY2010.Subsidized health services included under Schedule H for the Gnaden Huetten Memorial Hospital are the Family Planning Clinic. The National Family Planning Program, also know as Title X (ten) of the Public Health Service Act, was established in 1970 to ensure that no American woman would be denied access to family planning assistance because of her economic condition. For more than three decades, Title X has been an integral component of our nation's public health care system, providing high quality family planning services and other preventive health care to low-income or uninsured individuals who may otherwise lack access to health care. Maternal and Family Health Services administers the program through a network of direct and contract service providers. In addition to direct sites, the network system includes hospitals, Planned Parenthood affiliates, community health centers and physician groups. The Gnaden Huetten Memorial Hospital provided subsidies of approximately $30,000 to our Family Planning Clinic during FY2010. Part I, Line 7f: The amount of bad debt expense included on Form 990, Part IX, Line 25 column (A) but subtracted out for purposes of calculating the percentage on Sch H, Part I, Line 7, Column (f) is $2,192,158. Part VI, Line 2: The hospitals of the Blue Mountain Health System assess the community health needs through review of emergency room statistics as well as inquiry during regular Pennsylvania Department of Health surveys to identify far-reaching health needs faced by people in the communities served by the hospitals. Those results are evaluated over time and serve as the basis to develop new or expanded plans to address services in response to need. The Blue Mountain Health System develops programs and services to address community health needs and makes investments in initiatives that align with the Health System's core mission.Beyond that focus are programs and services that benefit every resident and support the far reaching goal of a healthier community. The Health System relies on the engagement and support of key stakeholders, including the medical staff of the hospitals of the Blue Mountain Health System, as well as the vital Carbon County Partners for Progress and numerous other community organizations. Together, we work toward developing a network of care and support that provides quality medical care for our community members. The Health System continues to use data from the Partners for Progress Community Assessment 2009 as a guide in developing programs and services and making community benefit investments in 2010.Adult Priority NeedsPrimary-Affordability of health care-Accessibility of medical care-Access to affordable mental and behavioral health careSecondary-Access to affordable prescription medications-Substance abuse prevention and treatmentOther-Smoking prevention and cessation-Nutrition-Weight management and exerciseYouth and Teen NeedsAccess and affordability of care-Dental-Health care-Suicide prevention-Mental and behavioral health-Family planning services Part VI, Line 3: In accordance with Pennsylvania State reporting requirements, the Blue Mountain Health System's charity care expense is reported based upon costs versus charges. Charity Care includes the Health System's traditional inpatient and emergency services, as well as the care provided as part of external educational programs and services such as through our Family Planning program.More people were served through the Hospital's charitable care and financial assistance programs in virtually all categories, as follows:-Gnaden Huetten Memorial Hospital Charitable Care - 310 patients-Palmerton Hospital Charitable Care - 140 patients-Blue Mountain Health System's "Healthy Smiles, Happy Kids" Dental Van - 1,109 served in 2010Signage will be visible in all Blue Mountain Health System points of registration in order to create awareness of the financial assistance program. At a minimum, signage will be posted in all patient intake areas, including, but not limited to, the emergency department, and the admission/patient registration area. In recent years, the Health System has expanded the number of financial counselors available to assist patients. A key goal is to identify community members in need sooner. Counselors proactively seek out patients prior to treatment in an effort to connect them with public insurance programs as appropriate or to encourage them to complete an assistance application. The result is more charity care and less reported as bad debt; most importantly, community members are provided with the support to access the medical care they need. Part VI, Line 4: The median income of households in Carbon County was $47,283. Seventy-four percent of the households received earnings and 25 percent received retirement income other than Social Security. Thirty-nine percent of the households received Social Security. The average income from Social Security was $15,428.In 2005-2009, 10 percent of people of Carbon County were in poverty. Sixteen percent of related children under 18 were below the poverty level, compared with 7 percent of people 65 years old and over. Seven percent of all families and 27 percent of families with a female householder and no husband present had incomes below the poverty level.Two percent of the people living in Carbon County in 2005-2009 were foreign born. Ninety-eight percent was native, including 80 percent who were born in Pennsylvania. Among people at least five years old living in Carbon County in 2005-2009, 4 percent spoke a language other than English at home. Of those speaking a language other than English at home, 32 percent spoke Spanish and 68 percent spoke some other language; 22 percent reported that they did not speak English "very well." Part VI, Line 5: In 2010, the hospitals, programs and services of the Blue Mountain Health System provided many community health improvement services. Included in this category are the community outreach programs and services offered by the Health System's Community Education program that includes health and wellness education, life-saving CPR and emergency support and information, and specific programming to help people make healthier lifestyle choices. Also included are the myriad of support group activities that help patients and their families manage chronic health conditions.In the fall of 2010, the Blue Mountain Health System collaborated with the Carbon County Emergency Management Agency on the largest service project in recent years - an emergency preparedness drive-thru influenza vaccination program in which more than 2,100 free seasonal influenza vaccinations were distributed to area residents. This program was found to be an invaluable arrangement in the event of a mass inoculation would be needed. Local fire, police, and ambulance personnel as well as the local school districts and college and university students were involved in the planning of the event. Approximately 50 staff persons from the Health System donated their time and effort to ensure the project was a successful one. The Health System's "Healthy Smiles, Happy Kids" Dental Van provides under-insured or non-insured children in Carbon and Schuylkill Counties with preventative and restorative dental care. In 2010, the Dental Van team, consisting of a board-certified dentist, a dental hygienist and a dental assistant/driver, cared for 1,109 children. The van has become the "dental home" for more than 2,000 children since its inception.Free screening mammograms and breast ultrasound procedures are provided to women, and men, who are uninsured or who have no insurance as part of the Health System's Women's Health Services program. During 2010, nearly 200 persons took advantage of the Blue Mountain Health System's breast cancer voucher screening program. The Health System's Ladies Night Out event served approximately 220 with breast cancer awareness and education. Support groups - Adult Day Services Caregiver Support group, Women's Breast Cancer Support Group, Bariatric & Weight Loss support groupsHealth Fairs - children's health fair and the national senior health and fitness dayWorkforce Wellness programHealth Images television program/Community newsletterGeneral screenings provided at other organization's events - blood pressure, cholesterol, body fat analysis, stroke risk, depression. Family Planning ClinicHaving highly trained medical personnel benefits everyone in the community. Beyond on-going education for physicians, nurses, emergency medical technicians, and other clinicians, the Blue Mountain Health System supported numerous initiatives in 2010 to further the capabilities of area medical personnel, investing $17,600 in Health Professions Education (Gnaden - $8,800 and Palmerton - $8,800).The Health System provided clinical rotations to medical students of Pennsylvania State University and Pennsylvania College of Osteopathic Medicine through the East Central Area Health Education Center. Living accommodations are provided during the time of each student's rotation. Through the Health System's Staff Development department, numerous persons were trained in CPR, ALS, PALS, and Rhythm monitoring. The Health System also provided a clinical setting for undergraduate nursing students enrolled in various local colleges and universities, namely, Lehigh Carbon Community College, Northampton Area Community College, Cedar Crest College, Wilkes University and Johnson College of Technology. Having highly trained medical personnel benefits everyone in the community. Beyond on-going education for physicians, nurses, emergency medical technicians, and other clinicians, the Blue Mountain Health System supported numerous initiatives in 2010 to further the capabilities of area medical personnel. Part VI, Line 6: The medical staff of the Blue Mountain Health System is an open medical staff allowing submissions for privileges and credentialing from any interested physician or surgeon. The board of directors is comprised of 18 individuals from various community organizations such as financial institutions, telecommunication, recreation, and representation from the medical staff. Of the 18 members of the board of directors, 13 reside immediately within the primary service area of the health system. All of the board members are independent, with the exception of the President and Chief Executive Officer, who is employed directly by the health system. Part VI, Line 7: During difficult economic times when more people are unemployed or are struggling to make ends meet, community members rely upon the hospitals of the Blue Mountain Health System's long standing tradition to provide needed medical care regardless of insurance coverage or financial ability to pay for services.For the Blue Mountain Health System, fiscal year 2010 was one of the most challenging financial years in its history. Decreasing government reimbursement, lower than anticipated patient volume and greater numbers of people needing financial assistance combined to create nearly the perfect storm, wreaking havoc with our financial expectations early on in the year. Yet, the Health System never wavered from either its not-for-profit mission or its attention to quality care and patient safety. In fact, any surplus funds are used for two main items, capital equipment purchases or for staff compensation. The Blue Mountain Health System provided over $5,500,000 in programs and services to meet the health needs of the residents of our communities. That number, however, reflects only a small piece of the organization's mission-driven story of this past year. (Gnaden Huetten Memorial Hospital $4,300,000; Palmerton Hospital $1,200,000)Attentive to the needs of our community's lower income and most vulnerable populations, the Health System served 450 patients through its financial assistance programs. Overall, approximately $5,177,000 was provided in free and subsidized patient care. (Gnaden - $4,087,000 and 12,502 patient visits; Palmerton - $1,090,000 and 5,102 patient visits), which addresses identified community health needs of access and affordability of medical care.In the area of Community Health Services, there was an increase in both the investment and numbers served through community health and wellness education as well as screenings and fairs.The Blue Mountain Health System invested approximately $95,000 (Gnaden - $49,450 and Palmerton - $45,382) and provided health and wellness education for hundreds of community members last year. One area where the Health System's investment increased dramatically was in emergency preparedness and response - working with the Carbon County Emergency Management Agency - with more than 50 staff persons volunteering to provide more than 2,100 free influenza vaccines to area residents as well as assist local schools with administering more than 1500 H1N1 influenza vaccinations during the potential pandemic timeframe. X 0 0 X X X X 1 0 0 0 0 0 0 0 0 Andrew E Harris 0 306000 0 0 0 9480 0 0 0 45900 0 361380 0 0 David Plaviak 101492 0 0 0 0 0 0 0 0 0 101492 0 0 0 Part I, Line 1a THE ORGANIZATION INCLUDED $2,530 FOR CLUB DUES IN PRESIDENT/CEO ANDREW HARRIS' REPORTABLE INCOME FOR THE FISCAL YEAR ENDED JUNE 30, 2010. THIS AMOUNT WAS INCLUDED AS TAXABLE INCOME FOR MR. HARRIS. Part I, Line 4a Part I, Line 4a: DAVID PLAVIAK - SEVERANCE PAYMENT - $101,492 FOR PERIOD FROM 1/2/2009 TO 7/3/2009. CARBON COUNTY HOSPITAL AUTHORITY 232280834 140868dx5 2003-10-01 3891707 Refund 1997 bond issue & pay issue costs 0 0 3891707 91834 2003 1 0 1 1 0 0 0 0 0 0 Form 990, Part VI, Section B, line 11 The BMHS staff communicated to the Finance Committee of the Board that the Forms 990 were prepared by ParenteBeard LLC, as well as communicating the general types of information contained in the filing and how to access the specific report. Form 990, Part VI, Section B, line 12c The conflict policy must be signed off on an annual basis by all governing body members, officers, and key employees. THIS PROCESS IS MONITORED BY THE ADMINISTRATIVE ASSISTANT TO THE PRESIDENT/CEO. ANY CONFLICTS NOTED WOULD BE COMMUNICATED TO THE COMPLIANCE COMMITTEE. THERE HAVE BEEN NO OCCURENCES OF ANY CONFLICTS NOT BEING DISCLOSED. Form 990, Part VI, Section B, line 15 Senior Management salaries are determined by the market. Human Resources participate in various salary surveys to determine the correct salary range. The Appalachian Hospital Human Resource Society conducts an annual salary survey for all positions. In addition, the Pennsylvanian Hospital Association conducts an annual survey with Yaffe Associates for senior management employees. The market data is analyzed and the goal is to pay at the 50 percentile. Salaries are recommended by Human Resources and approved by the President and CEO. The executive committee of the board serves as the Compensation Committee and approves recommendations for salary increases. The executive committee approves increases for the CEO. Senior Management has received the same general increases as the staff employees received. Form 990, Part VI, Section C, line 19 Form 990, Part VI, Section C, Line 19: UPON REQUEST, THE ORGANIZATION MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND/OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. BLUE MOUNTAIN HEALTH SYSTEM INC 211 NORTH 12TH STREET Lehighton PA 182351195 201311316 MAINTAINS AN INTEGRATED HEALTH CARE SYSTEM PA 501(c)(3) 11a N/A CMS MEDICAL CARE CORPORATION 211 NORTH 12TH STREET Lehighton PA 182351195 232473899 OWNS AND OPERATES AMBULATORY CARE CENTERS IN VARIOUS COMMUNITIES PA 501(c)(3) 3 N/A GNADEN HUETTEN MEMORIAL HOSPITAL INC 211 NORTH 12TH STREET Lehighton PA 182351195 240795436 OPERATES AN ACUTE CARE HOSP, A NURSING FACILITY & A HOME HEALTH CARE AGENCY PA 501(c)(3) 3 N/A 0 0 1 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0