2011-05-16T11:17:15-05:00 2010-06-30 SCHAFFNER KNIGHT MINNAUGH & CO PC 1001 STATE STREET SUITE 1300 ERIE PA 16501 990 2009-07-01 251619204 MILLCREEK MANOR MILL 8148644031 5515 PEACH STREET ERIE PA 16509 RICHARD P OLINGER 8148644031 2011-05-13 1 DENNIS W GROW CPA 8144541997 2009 2016-02-24 21:20:13Z DR JOHN M FERRETTI DO 5515 PEACH STREET ERIE PA 16509 3684426 0 X WWW.MILLCREEKCOMMUNITYHOSPITAL.COM X 1989 PA TO PROVIDE LONG TERM MEDICAL CARE TO THE COMMUNITY. 10 4 74 12 0 0 550 3520701 3681914 13366 136 3091 1826 3537158 3684426 0 0 2113294 1974572 0 0 1176440 1259670 3289734 3234242 247424 450184 5297196 5748478 962523 963730 4334673 4784748 TO PROVIDE LONG TERM MEDICAL CARE TO THE COMMUNITY. 0 0 2941893 0 3681914 MILLCREEK MANOR PROVIDES QUALITY LONG-TERM MEDICAL CARE TO INDIVIDUALS REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAPS, AGE, OR ABILITY TO PAY. APPROXIMATELY 48 PERSONS A DAY BENEFITTED FROM THIS PROGRAM DURING THE FISCAL YEAR. 2941893 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 1 6 0 74 1 0 0 0 0 0 0 0 0 0 10 4 1 0 0 0 1 0 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X RICHARD P OLINGER CFO 8148687767 5515 PEACH STREET erie PA 16509 X DR JOHN M FERRETTI DO 5.00 X X 0 477930 29246 MARY L ECKERT 1.00 X X 0 436309 28905 RICHARD P OLINGER 1.00 X X 0 405696 34663 DR SILVIA M FERRETTI DO 1.00 X 0 675144 29246 DR VINCENT S FIERRO JR DO 1.00 X 0 4000 0 ESTHER J FUCCI 1.00 X 0 0 0 JOSEPH S KUJAWA 1.00 X 0 0 0 MICHAEL CLARK 40.00 X 0 60398 17381 JOYCE SAVOCCHIO 1.00 X 0 0 0 DR JAMES Y LIN DO 5.00 X 0 196669 31597 0 2256146 171038 0 0 1 0 CONCEPT REHAB INC 7150 GRANITE CIRCLE TOLEDO OH 436173113 THERAPY SERVICES 239274 1 550 550 NET PATIENT REVENUE 623000 3681914 3681914 3681914 136 136 OTHER REVENUE 900099 1826 1826 1826 3684426 3681914 0 1962 1531199 1330932 200267 3913 3401 512 326364 283676 42688 113096 98303 14793 16241 16241 603644 602105 1539 3356 3092 264 176852 167537 9315 33880 33880 1427 1427 135438 134116 1322 39579 39579 DIETARY/FOOD 111821 111821 PHARMACY DRUGS 96520 96520 REPAIRS AND MAINTENANCE 32311 32311 MEMBERSHIPS 3973 3973 EDUCATION AND TRAINING 2835 2835 1793 358 1435 3234242 2941893 292349 0 200 1741674 1294422 9274 359261 448136 9437 7258 48464 45802 4197928 1001594 3285412 3196334 300000 300000 5297196 5748478 962523 963730 962523 963730 X 4326104 4776289 8569 8459 4334673 4784748 5297196 5748478 X 0 0 0 X 3704827 771596 2933231 451759 219135 232624 41342 10863 30479 3196334 self-insured malpractice trust 300000 300000 X X X X X 0 0 0 0 0 0 0 0 0 DR JOHN M FERRETTI DO 0 435814 0 0 0 42116 0 19600 0 9646 0 507176 0 0 MARY L ECKERT 0 388998 0 0 0 47311 0 19600 0 9305 0 465214 0 0 RICHARD P OLINGER 0 355293 0 0 0 50403 0 16444 0 18219 0 440359 0 0 DR SILVIA M FERRETTI DO 0 634288 0 0 0 40856 0 19600 0 9646 0 704390 0 0 DR JAMES Y LIN DO 0 180019 0 0 0 16650 0 16650 0 14947 0 228266 0 0 Supplemental Information Part III SCHEDULE J, PART II, COLUMN F: IN ACCORDANCE WITH THE SCHEDULE J INSTRUCTIONS, COLUMN F REPRESENTS ANY PAYMENT REPORTED IN THE CURRENT YEAR'S COLUMN (B) TO THE EXTENT SUCH PAYMENT WAS ALREADY REPORTED AS COMPENSATION TO THE LISTED PERSON ON A PRIOR FORM 990. VANTAGE INDEPENDENT CONTRACTOR - SHARES ONE COMMON TRUSTEE WITH FILING ORGANIZATION 74214 INDEPENDENT CONTRACTOR - SELLS MEDICAL SUPPLIES AND SERVICES TO THE FILING ORGANIZATION 0 Form 990, Part VI, Section A, line 2 DR. SILVIA M. FERRETTI, D.O. AND DR. JOHN M. FERRETTI, D.O. - FAMILY RELATIONSHIP Form 990, Part VI, Section A, line 6 MILLCREEK HEALTH SYSTEM, THE FILING ORGANIZATION'S PARENT CORPORATION, IS THE SOLE MEMBER OF THE FILING ORGANIZATION. Form 990, Part VI, Section A, line 7b MILLCREEK HEALTH SYSTEM IS THE PARENT ORGANIZATION OF MILLCREEK MANOR. IN ACCORDANCE WITH MILLCREEK HEALTH SYSTEM'S BY-LAWS, ITS BOARD OF TRUSTEES HAS THE RIGHT TO APPROVE ANY AND ALL TRANSACTIONS THAT CHANGE, OR HAVE THE EFFECT OF CHANGING, THE OWNERSHIP AND/OR CONTROL OF THE CORPORATION. Form 990, Part VI, Section B, line 11 PRIOR TO FILING ITS FORM 990, THE ORGANIZATION PROVIDED ITS BOARD MEMBERS WITH ACCESS TO AN ELECTRONIC COPY OF THE TAX RETURN AND INVITED COMMENTS AND QUESTIONS FROM THE BOARD MEMBERS. PRIOR TO FILING FORM 990, MEMBERS OF THE ORGANIZATION'S FINANCIAL MANAGEMENT CONDUCTED A DETAILED REVIEW OF THE TAX FILING. THROUGHOUT THE REVIEW PROCESS, THERE WAS ONGOING DISCUSSION BETWEEN THE ORGANIZATION'S FINANCIAL MANAGEMENT AND THE TAX PREPARER. Form 990, Part VI, Section B, line 12c EACH MEMBER OF THE BOARD OF TRUSTEES IS REQUIRED TO COMPLETE A STANDARDIZED CONFLICT OF INTEREST FORM ON AN ANNUAL BASIS. ANY POTENTIAL CONFLICTS OF INTEREST ARE ADDRESSED BY AN APPOINTED COMMITTEE WHOSE MEMBERS ARE INDEPENDENT WITH REGARD TO THE MATTER BEING REVIEWED. IF A POTENTIAL CONFLICT OF INTEREST ARISES, IT IS REVIEWED AND DOCUMENTED BY THE APPOINTED COMMITTEE, AND THEN THE APPOINTED COMMITTEE REPORTS THE RESULTS OF ITS REVIEW TO THE BOARD OF TRUSTEES. Form 990, Part VI, Section B, line 15 THE SALARIES OF THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL AND CERTAIN MEMBERS OF ITS BOARD OF TRUSTEES ARE DETERMINED BY THE EMPLOYING ORGANIZATION'S BUDGET/FINANCE COMMITTEE, WHICH ALSO FUNCTIONS AS A COMPENSATION COMMITTEE. Form 990, Part VI, Section C, line 19 THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, BY-LAWS AND FINANCIAL STATEMENTS AVAILABLE TO THE GENERAL PUBLIC. FORM 990, PART VII, SECTION A ESTIMATE OF AVERAGE HOURS PER WEEK DEVOTED TO A RELATED ORGANIZATION DR. JOHN M. FERRETTI, D.O.: LAKE ERIE COLLEGE OF OSTEOPATHIC MEDICINE - 58 HOURS PER WEEK MILLCREEK COMMUNITY HOSPITAL - 10 HOURS PER WEEK MEDICAL ASSOCIATES OF ERIE - 5 HOURS PER WEEK MILLCREEK HEALTH SYSTEM - 1 HOUR PER WEEK MILLCREEK HEALTH SYSTEM MEDICAL PROFESSIONAL LIABILITY SELF-INSURANCE TRUST - 1 HOUR PER WEEK DR. SILVIA M. FERRETTI, D.O.: LAKE ERIE COLLEGE OF OSTEOPATHIC MEDICINE - 75 HOURS PER WEEK MILLCREEK COMMUNITY HOSPITAL - 2 HOURS PER WEEK MEDICAL ASSOCIATES OF ERIE - 1 HOUR PER WEEK MILLCREEK HEALTH SYSTEM - 1 HOUR PER WEEK MARY L. ECKERT: LAKE ERIE COLLEGE OF OSTEOPATHIC MEDICINE - 4 HOURS PER WEEK MILLCREEK COMMUNITY HOSPITAL - 72 HOURS PER WEEK MEDICAL ASSOCIATES OF ERIE - 1 HOUR PER WEEK MILLCREEK HEALTH SYSTEM - 1 HOUR PER WEEK MILLCREEK HEALTH SYSTEM MEDICAL PROFESSIONAL LIABILITY SELF-INSURANCE TRUST - 1 HOUR PER WEEK RICHARD P. OLINGER: LAKE ERIE COLLEGE OF OSTEOPATHIC MEDICINE - 30 HOURS PER WEEK MILLCREEK COMMUNITY HOSPITAL - 31 HOURS PER WEEK MEDICAL ASSOCIATES OF ERIE - 1 HOUR PER WEEK MILLCREEK HEALTH SYSTEM - 1 HOUR PER WEEK MILLCREEK HEALTH SYSTEM MEDICAL PROFESSIONAL LIABILITY SELF-INSURANCE TRUST - 1 HOUR PER WEEK DR. JAMES LIN, D.O.: MILLCREEK COMMUNITY HOSPITAL - 6 HOURS PER WEEK MEDICAL ASSOCIATES OF ERIE - 45 HOURS PER WEEK MILLCREEK HEALTH SYSTEM 5515 PEACH STREET ERIE PA 16509 251766164 PARENT CORPORATION PA 501(c)(3) Line 11c, III-FI N/A MILLCREEK COMMUNITY HOSPITAL 5515 PEACH STREET ERIE PA 16509 251002937 HOSPITAL PA 501(c)(3) Line 3 MILLCREEK HEALTH SYSTEM LAKE ERIE COLLEGE OF OSTEOPATHIC MEDICINE 5515 PEACH STREET ERIE PA 16509 251698677 MEDICAL SCHOOL AND SCHOOL OF PHARMACY PA 501(c)(3) Line 2 MILLCREEK HEALTH SYSTEM MILLCREEK HEALTH SYSTEM MEDICAL PROFESSIONAL SELF-INSURANCE TRUST 5515 PEACH STREET ERIE PA 16509 576204119 PROVIDE MANDATORY PROFESSIONAL LIABILITY COVERAGE TO AFFILIATED ORGS PA 501(c)(3) Line 11d, III-O N/A MEDICAL ASSOCIATES OF ERIE ONE LECOM PLACE ERIE PA 16505 113716896 PHYSICIAN PRACTICE CORPORATION PA 501(c)(3) Line 9 MILLCREEK HEALTH SYSTEM MCH CORPORATION 5515 PEACH STREET ERIE PA 16509 251549695 LESSOR OF REAL ESTATE PA N/A C 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 MILLCREEK COMMUNITY HOSPITAL L 376685 MILLCREEK COMMUNITY HOSPITAL O 436780 MILLCREEK COMMUNITY HOSPITAL P 39695