2019-05-14T13:38:39-05:00 2018-06-30 520783935 SMITH ELLIOTT KEARNS & COMPANY LLC 19 BROOKWOOD AVE STE 101 CARLISLE PA 17015 990 2017-07-01 230465970 THE CHAMBERSBURG HOSPITAL CHAM 7172673000 112 N SEVENTH STREET CHAMBERSBURG PA 172014232 KIMBERLY M RZOMP TREASURER/VP & CFO 7172673000 2019-05-14 true GREGORY P HALL CPA P00156653 7172439104 2019-05-14 50.192.7.141 2019-05-14 13:38:39 CD P 6CBB79C053B248571C9CF37C921E5AD012119690 F292BA449C1BF8BBA7F8F0BF46EB3EDD96736C0F 2017 2019-02-21 02:37:17Z KIMBERLY M RZOMP 112 NORTH SEVENTH STREET CHAMBERSBURG PA 17201 368601545 false X WWW.SUMMITHEALTH.ORG X 1904 PA THE CHAMBERSBURG HOSPITAL IS A REGIONAL NONPROFIT HEALTH CARE ORGANIZATION COMMITTED TO THE IMPROVEMENT OF THE HEALTH AND WELL-BEING OF THE PEOPLE IN SOUTH-CENTRAL PENNSYLVANIA. 14 10 2396 442 3633981 407913 458257 340184627 346841987 21499191 4869129 5709276 6000979 367801007 358170352 2392959 2316680 0 170752338 173189699 0 0 128403101 132939202 301548398 308445581 66252609 49724771 513333407 504783786 246915813 215445267 266417594 289338519 THE CHAMBERSBURG HOSPITAL IS A REGIONAL NONPROFIT HEALTH CARE ORGANIZATION COMMITTED TO THE IMPROVEMENT OF THE HEALTH AND WELL-BEING OF THE PEOPLE IN SOUTH-CENTRAL PENNSYLVANIA. false false 225571382 346841987 THE CHAMBERSBURG HOSPITAL PROVIDES NEEDED MEDICAL CARE TO THE COMMUNITY REGARDLESS OF ANY PATIENT'S ABILITY TO PAY. HEALTH CARE SERVICES INCLUDE INPATIENT ROUTINE, INPATIENT ANCILLARY AND OUTPATIENT CARE. ALL MANAGEMENT AND GENERAL EXPENSES ARE CONSIDERED PROGRAM RELATED. 2316680 2316680 GRANTS TO VARIOUS NON-PROFIT ORGANIZATIONS IN THE COMMUNITY TO DEVELOP OR EXPAND HEALTH CARE PROGRAMS TO EDUCATE THE COMMUNITY ABOUT HEALTH CARE ISSUES. CHAMBERSBURG HOSPITAL PARTNERS WITH COMMUNITY ORGANIZATIONS TO ENHANCE, PROMOTE, AND OFFER COMMUNITY PROGRAMS FOR THE HEALTH AND WELL BEING OF RESIDENTS IN SOUTH CENTRAL PENNSYLVANIA. 227888062 true true false false false false false false false true true true false false true true true true false false false false false false false false true true true false true true false false false false false false false false false false false false false false false true false false false true 172 0 true 2396 true true true false false false false false false false false false X 14 10 false false false false true true true true true false false false true true true true true true true true true PA X X KIMBERLY M RZOMP VPCFO 7172677107 112 NORTH SEVENTH STREET CHAMBERSBURG PA 17201 CHERYL PLUMMER CHAIR 0.14 0.91 X X 0 0 0 SUZANNE MILLER TRINH VICE CHAIR 0.09 0.25 X X 0 0 0 DENISE B BARROWS CPA SECRETARY 0.06 0.06 X X 0 0 0 KIMBERLY M RZOMP TREASURER/VP 26.00 15.04 X X 315520 169896 71976 PATRICK W O'DONNELL PRESIDENT 24.14 18.56 X X 517565 345043 271314 DR CHRISTINE MALLOY DIRECTOR 0.11 40.00 X 0 400368 26175 DR ROBERT PYATT DIRECTOR 0.11 0.20 X 0 0 0 JEFF REEDER DIRECTOR 0.06 0.05 X 0 0 0 L MICHAEL ROSS DIRECTOR 0.11 0.30 X 0 0 0 MICHAEL STARR DIRECTOR 0.12 X 0 0 0 JOHN VANHORN DIRECTOR 0.14 X 0 0 0 JOANNE COCHRAN DIRECTOR 0.14 X 0 0 0 DR W DAVID KENT DIRECTOR 0.14 0.13 X 0 0 0 DR JOSHUA DUNKLEBARGER DIRECTOR 0.12 40.00 X 0 874560 27204 THOMAS ANDERSON MD VP MEDICAL A 32.00 8.00 X 396242 99061 58426 JOHN MASSIMILLA VP ADMIN/COO 40.00 X 346794 0 75627 BARBARA ROSSINI VP COMMUNITY 30.00 10.00 X 205877 68626 49743 SHERRI STAHL SR VP HOSPIT 32.00 8.00 X 350024 87506 67190 MICHELE ZEIGLER VP INFORMATI 28.00 12.00 X 229501 98358 57331 CATHY PUHL VP HUMAN RES 40.00 X 234660 0 46188 CAROLYN GEORGE VP CORPORATE 40.00 X 183464 0 41637 DAVID K GRANT VP PATIENT S 40.00 X 184780 0 49153 ELYSE FISLER VP PATIENT S 40.00 X 185174 0 43370 NIKOLA KOUNEV PHARMACIST 40.00 X 179693 0 20427 3329294 2143418 905761 163 false true false CUMBERLAND VALLEY ER ASSOC 112 NORTH SEVENTH STREET CHAMBERSBURG PA 17201 PROF MED SERV 7632521 FASTAFF INC PO BOX 911452 DENVER CO 80291 TEMP EMP SERV 4915162 MELILLO CONSULTING INC 285 DAVIDSON AVENUE SOMERSET NJ 08873 SOFTWARE SUPPOR 2951763 GE HEALTHCARE IITS USA CORP 40 IDX DRIVE SOUTH BURLINGTON VT 05403 SERV/LIC FEES 2454016 KEYSTONE HEALTH CENTER 22 ST PAUL DRIVE SUITE 200 CHAMBERSBURG PA 17201 PROF MED SERV 1768375 73 458257 458257 PROGRAM SERVICE REVENUE 621990 346841987 346841987 346841987 6330905 6330905 588064 683193 -95129 -95129 -95129 8276341 9883 9748000 -1471659 9883 -1461776 -1461776 UNRELATED BUSINESS INCOME 621990 1839904 1839904 COURIER AND LAB SERVICES 621990 1547942 1547942 PURCHASE DISCOUNTS/RECYCLING 621500 1082926 1082926 1625336 875055 246135 504146 6096108 358170352 348799968 3633981 5278146 2316680 2316680 2910368 2910368 125367775 95866337 29501438 9327434 7265854 2061580 26746094 20142791 6603303 8838028 6629405 2208623 1674084 1674084 86112 86112 20169804 7770268 12399536 1066652 433184 633468 6536148 3476676 3059472 4475592 1049926 3425666 230398 87210 143188 177111 46075 131036 6542388 4474993 2067395 14700594 10055205 4645389 2076544 1420356 656188 SUPPLIES 45476845 41568600 3908245 PHYSICIAN CONTRACTUAL PAY 25016802 25016802 MISCELLANEOUS EXPENSE 4419594 195287 4224307 DUES 289012 72413 216599 1522 1522 308445581 227888062 80557519 0 6345 6745 25190088 16129643 29866843 32229431 3914004 4725367 2796343 2609614 5289629 6050556 387211969 260120688 134780611 127091281 73405025 80905160 205912047 209185241 959319 903843 31213153 24946905 513333407 504783786 27285967 31706521 115676426 114125369 13935001 13268146 90018419 56345231 246915813 215445267 X 256211926 278635676 186255 251146 10019413 10451697 266417594 289338519 513333407 504783786 49724771 1418401 -28222247 X false true X true false X 2110603 28100 210972 -15152 -24725 2309798 1885357 40038 247551 -41918 -20425 2110603 1875978 16186 -34780 -20110 -18751 1885357 1875978 54280 43996 -14532 -14532 1942811 1564587 125693 218390 -17048 -15644 1875978 0.62420 0.37580 false false 6299096 6299096 11807653 181808682 95686921 97929414 1966737 1522273 444464 185329801 162911494 22418307 127091281 FIXED INCOME SECURITIES 126039220 F REAL ASSETS 67479868 F CASH AND MONEY FUNDS 15588752 F UNCONDITIONAL PROMISES TO GIVE 77000 C OTHER INVESTMENTS 401 F 209185241 ACCRUED PENSION OBLIGATION 20349347 INTEREST RATE SWAP AGREEMENTS 16947850 ADVANCES FROM THIRD-PARTY PAYORS 6978424 PAYABLE UNDER THIRD-PARTY AGREEMENTS 6342787 DEFERRED COMPENSATION 3576601 ACCRUED WORKERS' COMP 1227830 ACCRUED LIABILITY INSURANCE 922392 56345231 X 352729715 24918 24918 352704797 5465555 5465555 358170352 305889031 305889031 2556550 2556550 308445581 SCHEDULE D, PAGE 2, PART V, LINE 4 ENDOWMENT FUNDS ARE TO BE USED FOR THE DEVELOPMENT OR EXPANSION OF COMMUNITY HEALTHCARE INITIATIVE AND PROGRAMS. FUNDS ARE ALSO USED TO EDUCATE THE COMMUNITY ABOUT HEALTHCARE ISSUES. SCHEDULE D, PAGE 3, PART X WHEN TAX RETURNS ARE FILED, IT IS HIGHLY CERTAIN THAT SOME POSITIONS TAKEN WOULD BE SUSTAINED UPON EXAMINATION BY THE TAXING AUTHORITIES, WHILE OTHERS ARE SUBJECT TO UNCERTAINTY ABOUT THE MERITS OF THE POSITION TAKEN OR THE AMOUNT OF THE POSITION THAT WOULD BE ULTIMATELY SUSTAINED. THE BENEFIT OF A TAX POSITION IS RECOGNIZED IN THE FINANCIAL STATEMENTS IN THE PERIOD DURING WHICH, BASED ON ALL AVAILABLE EVIDENCE, MANAGEMENT BELIEVES IT IS MORE LIKELY THAN NOT THAT THE POSITION WILL BE SUSTAINED UPON EXAMINATION, INCLUDING THE RESOLUTION OF APPEALS OR LITIGATION PROCESSES, IF ANY. TAX POSITIONS TAKEN ARE NOT OFFSET OR AGGREGATED WITH OTHER POSITIONS. TAX POSITIONS THAT MEET THE MORE-LIKELY-THAN-NOT RECOGNITION THRESHOLD ARE MEASURED AS THE LARGEST AMOUNT OF TAX BENEFIT THAT IS MORE THAN 50 PERCENT LIKELY OF BEING REALIZED UPON SETTLEMENT WITH THE APPLICABLE TAXING AUTHORITY. THE PORTION OF THE BENEFITS ASSOCIATED WITH TAX POSITIONS TAKEN THAT EXCEEDS THE AMOUNT MEASURED AS DESCRIBED ABOVE WOULD BE REFLECTED AS A LIABILITY FOR UNRECOGNIZED TAX BENEFITS IN THE ACCOMPANYING BALANCE SHEETS ALONG WITH ANY ASSOCAITED INTEREST AND PENALTIES THAT WOULD BE PAYABLE TO THE TAXING AUTHORITIES UPON EXAMINATION. INTEREST AND PENALTIES ASSOCIATED WITH UNRECOGNIZED TAX BENEFITS WOULD BE CLASSIFIED AS EXPENSES AGAINST OTHER OPERATING REVENUE IN THE STATEMENTS OF OPERATIONS. AT JUNE 30, 2018 AND 2017, THERE WAS NO LIABILITY FOR UNRECOGNIZED TAX BENEFITS. SCHEDULE D, PAGE 4, PART XI, LINE 2D REVENUE RELEASED FROM RESTRICTIONS 24,918 SCHEDULE D, PAGE 4, PART XI, LINE 4B RECLASSIFICATION OF EXPENSES 246,214 INVESTMENT INCOME 6,330,905 RENTAL LOSS -95,129 REALIZED LOSS ON SECURITIES -1,471,659 GAIN ON SALE OF ASSETS 9,883 CONTRIBUTIONS 445,341 SCHEDULE D, PAGE 4, PART XII, LINE 4B RECLASSIFICATION OF EXPENSE 246,214 GRANT EXPENSES 2,310,336 true true X true X true X false true false true true 3100851 3100851 0.01010 19407679 19407679 0.06340 22508530 22508530 0.07350 37 16346 272836 29099 243737 0.00080 4 1125 185259 185259 0.00060 3 20 2717122 200 2716922 0.00890 1 150263 150263 0.00050 6 60 2834087 2834087 0.00930 51 17551 6159567 29299 6130268 0.02010 51 17551 28668097 29299 28638798 0.09360 1 5684 5684 1 32 2 32 5684 5684 false 16940943 56314521 79649364 -23334843 X true true 1 1 THE CHAMBERSBURG HOSPITAL 112 NORTH SEVENTH STREET CHAMBERSBURG PA 17201 X X X THE CHAMBERSBURG HOSPITAL 1 false false true X X X X X X X X X X 15 true true true true X WWW.SUMMITHEALTH.ORG X WWW.HEALTHYFRANKLINCOUNTY.COM X X true 16 true WWW.SUMMITHEALTH.ORG false false true X 200.000000000000 300.000000000000 X true true X X X X true X WWW.SUMMITHEALTH.ORG X WWW.SUMMITHEALTH.ORG X WWW.SUMMITHEALTH.ORG X X X X X X X true X false X X X X X true X false false FACILITY 1, THE CHAMBERSBURG HOSPITAL - PART V, LINE 5 THE ORGANIZATION FORMED AN ADVISORY GROUP WHICH IS COMPOSED OF A CORE GROUP OF AGENCIES AND COMMUNITY LEADERS IN FRANKLIN COUNTY. THE ORGANIZATION ALSO CONTRACTED THE PENN STATE HARRISBURG'S INSTITUTE OF STATE AND REGIONAL AFFAIRS. PENN STATE OBTAINED DATA THROUGH THE USE OF FOCUS GROUPS, A COMMUNITY HEALTH SURVEY, AND RESEARCHING SECONDARY DEMOGRAPHIC AND HEALTH DATA. FACILITY 1, THE CHAMBERSBURG HOSPITAL - PART V, LINE 6A WAYNESBORO HOSPITAL FACILITY 1, THE CHAMBERSBURG HOSPITAL - PART V, LINE 6B HEALTHY FRANKLIN COUNTY FACILITY 1, THE CHAMBERSBURG HOSPITAL - PART V, LINE 7D ON JUNE 9, 2016, SUMMIT HEALTH AND HEALTHY FRANKLIN COUNTY FACILITATED A COMMUNITY HEALTH SUMMIT ON THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT. 121 INDIVIDUALS ATTENDED THE HEALTH SUMMIT, REPRESENTING HEALTHCARE ORGANIZATIONS, COMMUNITY ORGANIZATIONS, EDUCATION INSTITUTIONS, LOCAL GOVERNMENT AND COMMUNITY REPRESENTATIVES. FACILITY 1, THE CHAMBERSBURG HOSPITAL - PART V, LINE 11 A COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP) WAS DEVELOPED. FACILITY 1, THE CHAMBERSBURG HOSPITAL - PART V, LINE 16J INFORMATION AND APPLICATION CAN BE FOUND ON THE BACK OF A PATIENT BILLING STATEMENT. FACILITY 1, THE CHAMBERSBURG HOSPITAL - PART V, LINE 20E FINANCIAL COUNSELORS CALL AND SEND LETTERS TO SELF PAY PATIENTS WITH HIGH DEDUCTIBLE PLANS THAT RECEIVE EMERGENCY DEPARTMENT, SURGICAL OR IN-PATIENT SERVICES. PART I, LINE 3C - OTHER INCOME BASED CRITERIA FOR FREE OR DISCOUNTED CARE IF A FAMILY HAS LIQUID ASSETS AVAILABLE, THEY ARE EXPECTED TO CONTRIBUTE TO THE COST OF THEIR CARE USING THOSE FUNDS. HOWEVER, THEY ARE NOT REQUIRED TO SPEND DOWN ALL OF THEIR LIQUID ASSETS IN ORDER TO BE ELIGIBLE FOR A DISCOUNT. PATIENTS MAY RETAIN SIX MONTHS OF LIVING EXPENSES FROM THEIR LIQUID ASSETS. SIX MONTHS OF LIVING EXPENSES IS ESTIMATED TO BE ONE HALF OF 300% OF FPG. AT THAT POINT, THEY RECEIVE A DISCOUNT ON THEIR MEDICAL BILL. PART I, LINE 7 - COSTING METHODOLOGY EXPLANATION THE INFORMATION WAS OBTAINED USING THE COST METHODS USED IN PREPARING THE MEDICARE COST REPORTS. PART II - COMMUNITY BUILDING ACTIVITIES CHAMBERSBURG HOSPITAL WORKS TO STRENGTHEN OUR COMMUNITY THROUGH HEALTH EDUCATION EFFORTS FOR CHILDREN AND ADULTS, HEALTH FAIRS PROVIDING HEALTH SCREENINGS, EDUCATING COMMUNITY GROUPS ON SPECIFIC HEALTH TOPICS, FUNDING HEALTH PROGRAMS BY LOCAL NONPROFIT ORGANIZATIONS THROUGH THE SUMMIT ENDOWMENT PROGRAM, PROVIDING CAPACITY-BUILDING WORKSHOPS AND ASSISTANCE THROUGH SUMMIT ENDOWMENT, PARTICIPATING IN MANY LOCAL CIVIC ORGANIZATIONS, SPONSORING EVENTS HELD BY LOCAL CHARITABLE ORGANIZATIONS, AND SUPPORTING WORKFORCE DEVELOPMENT INITIATIVES THROUGH SUMMIT HEALTH'S SCHOOL LIASON PROGRAMS. PART III, LINE 2 - BAD DEBT EXPENSE METHODOLOGY FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT SOME PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. THE COST TO CHARGE RATIO WAS USED TO CALCULATE THE COST OF BAD DEBT EXPENSE. THIS RATIO IS CALCULATED AS FOLLOWS: (NET PATIENT REVENUE DIVIDED BY THE TOTAL OPERATING REVENUE MULTIPLIED BY THE TOTAL OPERATING EXPENSE) DIVIDED BY THE GROSS PATIENT REVENUE. BAD DEBT EXPENSE FOOTNOTE TO FINANCIAL STATEMENTS THE HOSPITAL PROVIDES CREDIT IN THE NORMAL COURSE OF ITS BUSINESS TO PATIENTS. PATIENT RECEIVABLES ARE BASED ON THE OUTSTANDING PATIENT BALANCE AFTER ANY CONTRACTUAL REIMBURSEMENTS ARE APPLIED AND ARE GENERALLY DUE 30 DAYS AFTER BILLED. ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD- PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT SOME PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. PART III, LINE 8 - MEDICARE EXPLANATION THE SHORTFALL FOR MEDICARE IS NOT INCLUDED IN THE CHAMBERSBURG HOSPITAL'S COMMUNITY BENEFIT REPORTING. A COST TO CHARGE RATIO WAS USED TO CALCULATE THE MEDICARE ALLOWABLE COST. PART III, LINE 9B - COLLECTION PRACTICES EXPLANATION ALL PATIENTS ARE SUBJECT TO THE DEBT COLLECTION POLICY REGARDLESS OF THEIR ABILITY TO PAY. PART VI, LINE 2 - NEEDS ASSESSMENT HEALTH NEEDS OF FRANKLIN COUNTY RESIDENTS AND SURROUNDING COMMUNITIES ARE ASSESSED THROUGH NUMEROUS RESEARCH METHODS INCLUDING CONDUCTING A COMMUNITY HEALTH NEEDS ASSESSMENT(TELEPHONE SURVEY FORMAT) IN 2012. THE NEEDS WERE IDENTIFIED BY KEY LEADERS AND NONPROFITS WITHIN THE COMMUNITY. FOUR PRIORITIES WERE DETERMINED; ACCESS TO HEALTHCARE, NUTRITION, EDUCATION AND MENTAL HEALTH. THE COMMUNITY HEALTH NEEDS ASSESSMENT CAN BE FOUND ON OUR WEBSITE AT WWW.SUMMITHEALTH.ORG/ABOUTUS. PART VI, LINE 3 - PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE PATIENTS ARE MADE AWARE OF THE CHARITY PROGRAM AND OTHER BILLING ASSISTANCE SERVICES AT REGISTRATION, DURING EMERGENCY ROOM VISITS, AND NOTICES PLACED IN SERVICE AREAS. BILLING STATEMENTS ALSO INFORM PATIENTS OF CHARITY CARE AND OTHER BILLING ASSISTANCE PROGRAMS. AVAILABILITY OF CHARITY PROGRAMS IS ALSO LISTED ON OUR WEBSITE. PART VI, LINE 4 - COMMUNITY INFORMATION CHAMBERSBURG HOSPITAL PRIMARILY SERVES COMMUNITY MEMBERS FROM FRANKLIN COUNTY,PA, AND NEARBY COMMUNITIES IN FULTON COUNTY, PA, CUMBERLAND COUNTY, PA, AND WASHINGTON COUNTY, MD. ACCORDING TO U.S. CENSUS DATA, FRANKLIN COUNTY RESIDENTS HAVE A SLIGHTLY LOWER INCOME AND ARE SLIGHTLY OLDER THAN THE STATE AVERAGE. FOR A HEALTH SYSTEM, THIS TYPICALLY RESULTS IN AN INCREASED NEED FOR HEALTHCARE SERVICES. PART VI, LINE 5 - PROMOTION OF COMMUNITY HEALTH CHAMBERSBURG HOSPITAL PROVIDES FINANCIAL AND MANAGERIAL SUPPORT TO KEYSTONE HEALTH, A RURAL HEALTH CENTER THAT SERVICES THE UNDERPRIVILEGED COMMUNITY. IN ADDITION, THE HOSPITAL SUPPORTS LOCAL NONPROFIT ORGANIZATIONS WITH FINANCIAL GRANTS FROM THE SUMMIT ENDOWMENT. WE ENGAGE AND PARTNER WITH OTHER NONPROFITS IN THE COMMUNITY TO ENHANCE AND SUPPORT PROGRAMS AND INITIATIVES THAT ENCOURAGE HEALTHY BEHAVIORS AND LIFESTYLES THROUGH EDUCATION, AWARENESS, AND ACCESS TO SERVICES. PART VI, LINE 6 - AFFILIATED HEALTH CARE SYSTEM THE HOSPITAL IS PART OF SUMMIT HEALTH, A REGIONAL NETWORK OF TWO HOSPITALS, OUTPATIENT DIAGNOSTIC AND ANCILLARY SERVICES OFFICES, AND HEALTHCARE PROVIDERS. CHAMBERSBURG HOSPITAL AND THESE SUMMIT ENTITIES ARE SERVED BY THE ORGANIZATION'S COMMUNITY HEALTH DEPARTMENT. THIS DEPARTMENT'S MISSION IS TO IMPROVE THE HEALTH OF THE COMMUNITY THROUGH EDUCATION, EARLY DETECTION AND PREVENTION PROGRAMS INCLUDING HEALTH FAIRS, SCREENINGS, AND SEMINARS. MANY OF THE DEPARTMENT'S PROGRAMS ARE PLANNED AND PROVIDED THROUGH COLLABORATION WITH OTHER COMMUNITY ORGANIZATIONS INCLUDING THE PA DEPARTMENT OF HEALTH. true CHAMBERSBURG MEMORIAL YMCA 570 E MCKINLEY STREET CHAMBERSBURG PA 17201 231476339 3 8549 HEALTHY LIFESTYLE MAINSTREET WAYNESBORO INC 13 W MAIN STREET WAYNESBORO PA 17268 232868740 3 7085 NURSE PROGRAM NOAH'S HOUSE RECOVERY HOMES 635 S 4TH STREET CHAMBERSBURG PA 17201 812810826 3 8000 EMOTIONAL SUPPORT SOUTH CENTRAL COMMUNITY ACTION PROG 533 S MAIN STREET CHAMBERSBURG PA 17201 232020123 3 27698 HEALTHY EATING EDU SUMMIT PHYSICIAN SERVICES 785 5TH AVENUE CHAMBERSBURG PA 17201 251716306 3 102960 HOME MONITORING WAYNESBORO YMCA 810 E MAIN STREET WAYNESBORO PA 17268 231352601 3 8549 WELLNESS PROGRAM WAYNESBORO YMCA 810 E MAIN STREET WAYNESBORO PA 17268 231352601 3 7755 FOOD DONATIONS GREENCASTLE - ANTRIM ENDOWMENT SCHO 500 EAST LEITERSBURG STREET GREENCASTLE PA 17225 GOV 20000 VARIOUS 2121984 SCHEDULE I, PAGE 1, PART I, LINE 2 ALL FUNDING DECISIONS ARE MADE BY THE SUMMIT ENDOWMENT COMMITTEE, A COMMITTEE OF THE SUMMIT HEALTH BOARD. THE ENDOWMENT MANAGER PROCESSES GRANT APPLICATIONS, ASSISTS GRANTEES IN DEVELOPING SOUND PROGRAM EVALUATION METHODOLOGIES, RECEIVES AND SUMMARIZES PERIODIC REPORTS, AND VISITS PROGRAM SITES, REPORTING ALL ACTIVITIES TO THE SUMMIT ENDOWMENT COMMITTEE. AS WELL, ENDWOMENT COMMITTEE MEETING MINUTES ARE SHARED WITH WAYNESBORO HOSPITAL'S, CHAMBERSBURG HOSPITAL'S, AND SUMMIT HEALTH'S BOARD OF DIRECTORS. X X true true X X X X false true false false false false false true false KIMBERLY M RZOMP TREASURER/VP & CFO 244719 131772 52939 28506 17862 9618 34450 18550 12334 6642 362304 195088 PATRICK W O'DONNELL PRESIDENT 373813 249208 118080 78720 25672 17115 134639 89760 28149 18766 680353 453569 DR CHRISTINE MALLOY DIRECTOR 330894 62203 7271 8100 18075 426543 DR JOSHUA DUNKLEBARGER DIRECTOR 750257 96125 28178 8100 19104 901764 THOMAS ANDERSON MD VP MEDICAL AFFAIRS 305696 76424 64583 16146 25963 6491 31357 7839 15384 3846 442983 110746 JOHN MASSIMILLA VP ADMIN/COO 259133 56902 30759 55384 20243 422421 BARBARA ROSSINI VP COMMUNITY RELATIO 155674 51891 34367 11456 15836 5279 19451 6484 17856 5952 243184 81062 SHERRI STAHL SR VP HOSPITAL SERVI 270639 67660 58433 14608 20952 5238 37557 9389 16195 4049 403776 100944 MICHELE ZEIGLER VP INFORMATION SERVI 172626 73983 36726 15740 20149 8635 33440 14332 6691 2868 269632 115558 CATHY PUHL VP HUMAN RESOURCES 177371 33238 24051 27984 18204 280848 CAROLYN GEORGE VP CORPORATE FINANCE 162014 20183 1267 22988 18649 225101 DAVID K GRANT VP PATIENT SERVICES 159235 25235 310 33865 15288 233933 ELYSE FISLER VP PATIENT SERVICES 163963 20911 300 21370 22000 228544 NIKOLA KOUNEV PHARMACIST 179693 11901 8526 200120 SCHEDULE J, PAGE 1, PART I, LINE 1A THE ORGANIZATION REIMBURSES THE COO FOR DUES ASSOCIATED WITH A SOCIAL CLUB. THE OFFICER RECEIVES AN ALLOWANCE THAT CAN BE CONSIDERED A DISCRETIONARY SPENDING ACCOUNT. THE MONIES ARE IN LIEU OF AN AUTOMOBILE ALLOWANCE, TO PURCHASE ADDITIONAL LIFE INSURANCE, ETC. THESE MONIES ARE INCLUDED IN COMPENSATION AS REPORTED IN THE COMPENSATION OF OFFICERS TABLE. A RESULTS FITNESS CLUB MEMBERSHIP IS AVAILABLE FREE OF CHARGE FOR ANY OFFICER AND ACTIVE BOARD MEMBER. SCHEDULE J, PAGE 1, PART I, LINE 4 KIMBERLY M. RZOMP 0 11,700 0 PATRICK W. O'DONNELL 0 10,800 0 THOMAS ANDERSON, MD 0 14,400 0 JOHN MASSIMILLA 0 16,026 0 BARBARA ROSSINI 0 9,701 0 SHERRI STAHL 0 14,400 0 MICHELE ZEIGLER 0 10,543 0 CATHY PUHL 0 10,930 0 SCHEDULE J, PAGE 1, PART I, LINE 7 INCENTIVE COMPENSATION IS BASED ON PRE-DETERMINED, MEASURABLE GOALS APPROVED BY THE BOARD OF DIRECTORS EXECUTIVE COMMITTEE. THE MEASURABLE GOALS ARE BASED ON QUALITY, COMMUNITY ACCESS TO CARE, PATIENT SAFETY AND LEADERSHIP. A FCIDA REVENUE BONDS SERIES 2010 230458500 353273AR6 2010-07-28 685000 NEW BUILDING AND REFINANCE 1998 BONDS false false false B FCIDA REVENUE BONDS SERIES 2010 230458500 353273BA2 2010-07-28 1000000 NEW BUILDING AND REFINANCE 1998 BONDS false false false C FCIDA REVENUE BONDS SERIES 2010 230458500 353273AS4 2010-07-28 1760000 NEW BUILDING AND REFINANCE 1998 BONDS false false false D FCIDA REVENUE BONDS SERIES 2010 230458500 353273AT2 2010-07-28 1835000 NEW BUILDING AND REFINANCE 1998 BONDS false false false A 685000 59951 83811 6050 527505 false true true true B 1000000 87520 112352 8832 770080 false true true true C 1760000 154035 215339 15544 1355340 false true true true D 1835000 160599 224515 16207 1413096 false true true true A false false true true true true false false false B false false true true true true false false false C false false true true true true false false false D false false true true true true false false false A false false false false false false false false false B false false false false false false false false false C false false false false false false false false false D false false false false false false false false false A false B false C false D false FORM 990, PAGE 6, PART VI, LINE 6 SUMMIT HEALTH, A 501(C)(3) ENTITY, IS A MEMBER OF THIS ORGANIZATION. FORM 990, PAGE 6, PART VI, LINE 7A SUMMIT HEALTH, A 501(C)(3) ENTITY, ELECTS THE GOVERNING BODY OF THIS ORGANIZATION. FORM 990, PAGE 6, PART VI, LINE 7B SUMMIT HEALTH, A 501(C)(3) ENTITY, HAS CERTAIN RESERVE POWERS OVER THIS ORGANIZATION. FORM 990, PAGE 6, PART VI, LINE 11B PRIOR TO FILING, THE FORM 990 IS REVIEWED BY THE AUDIT COMMITTEE AND PRESENTED TO THE FULL BOARD OF DIRECTORS FOR APPROVAL. FORM 990, PAGE 6, PART VI, LINE 12C MEMBERS ARE ASKED TO ANNUALLY DISCLOSE ANY CONFLICTS OF INTEREST THEY MAY HAVE. FORM 990, PAGE 6, PART VI, LINE 15A THE COMPENSATION IS DISCUSSED WITH AN INDEPENEDENT COMPENSATION COMMITTEE. THIS IS PERFORMED IN CONCERT WITH A COMPENSATION CONSULTANT WHO ASSISTS THE COMMITTEE IN SETTING THE COMPENSATION FOR THESE INDIVIDUALS. FORM 990, PAGE 6, PART VI, LINE 15B THE COMPENSATION IS DISCUSSED WITH AN INDEPENEDENT COMPENSATION COMMITTEE. THIS IS PERFORMED IN CONCERT WITH A COMPENSATION CONSULTANT WHO ASSISTS THE COMMITTEE IN SETTING THE COMPENSATION FOR THESE INDIVIDUALS. FORM 990, PAGE 6, PART VI, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. THESE DOCUMENTS ARE HELD IN THE FINANCE DEPARTMENT OF THE CHAMBERSBURG HOSPITAL. HOSPITAL BYLAWS AND ALL POLICIES AND PROCEDURES ARE FOUND ON THE CHAMBERSBURG HOSPITAL INTRANET. FORM 990, PART XI, LINE 9 CHANGE IN VALUE OF DERIVATIVES 9,344,461 TRANSFERS TO AFFILIATES -36,446,160 PENSION LIABILITY ADJUSTMENT -1,120,548 TOTAL -28,222,247 SUMMIT HEALTH 112 NORTH SEVENTH STREET CHAMBERSBURG PA 17201 251515371 HEALTHCARE PA 501C3 7 SUMMIT HEA false WAYNESBORO HOSPITAL 501 EAST MAIN STREET WAYNESBORO PA 17268 231360854 HEALTHCARE PA 501C3 3 SUMMIT HEA false CHAMBERSBURG HEALTH SERVICES 785 5TH AVENUE SUITE 5 CHAMBERSBURG PA 17201 251515376 HEALTHCARE PA 501C3 12A SUMMIT HEA false SUMMIT PHYSICIAN SERVICES 785 5TH AVENUE SUITE 3 CHAMBERSBURG PA 17201 251716306 HEALTHCARE PA 501C3 3 SUMMIT HEA false SUMMIT SURGERY CENTER LP 785 5TH AVENUE SUITE 3 CHAMBERSBURG PA 17201 251845303 PHYSICIAN PA NA 11244 32450 false false 0.00650 SURGERY CENTER ASSOCIATES LLC 785 5TH AVENUE SUITE 3 CHAMBERSBURG PA 17201 251845304 PHYSICIAN PA NA 225 484 false true 0.01000 false false true false false false false false false true true true true false false true true true true SUMMIT HEALTH R CASH SUMMIT PHYSICIAN SERVICES R CASH SUMMIT HEALTH C CASH WAYNESBORO HOSPITAL Q CASH CHAMBERSBURG HEALTH SERVICES Q CASH SUMMIT PHYSICIAN SERVICES Q CASH SUMMIT PHYSICIAN SERVICES P CASH WAYNESBORO HOSPITAL Q CASH SUMMIT PHYSICIAN SERVICES J CASH CHAMBERSBURG HEALTH SERVICES K CASH CHAMBERSBURG HEALTH SERVICES Q CASH SUMMIT SURGERY CENTER C CASH SURGERY CENTER ASSOCIATES C