2019-05-15T13:21:50-05:00 2018-06-30 390859910 BAKER TILLY VIRCHOW KRAUSE LLP 1650 MARKET STREET SUITE 4500 PHILADELPHIA PA 191037341 990 2017-07-01 240795682 MOUNT NITTANY MEDICAL CENTER MOUN 8142317000 1800 EAST PARK AVENUE STATE COLLEGE PA 16803 DAMON D SORENSEN CPA FHFMA EVP FINANCE & ADMINISTRATIVE 8142317000 2019-05-15 1 JULIUS C GREEN CPA P00350393 2159720701 96.89.178.154 2019-05-15 10:02:15 ED P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 9D0D8DD59390B7764A3ECE0F40BBFE3618018605 2017 2019-02-21 02:37:17Z KATHLEEN RHINE 1800 EAST PARK AVENUE STATE COLLEGE PA 16803 750972406 0 X WWW.MOUNTNITTANY.ORG X 1905 PA INPATIENT, OUTPATIENT & EMERGENCY CARE SERVICES TO CENTRE COUNTY AND THE SURROUNDING AREAS. 8 3 2238 800 4307030 2389192 1101402 1920435 387215989 406433845 1067926 4131962 5639782 6345056 395025099 418831298 35403772 18038827 0 0 168778844 175959603 0 0 0 158805894 181501980 362988510 375500410 32036589 43330888 609325426 710754642 324717951 373381417 284607475 337373225 X MOUNT NITTANY'S MISSION: WE ARE HERE TO MAKE PEOPLE HEALTHIER.MOUNT NITTANY MEDICAL CENTER WILL PROVIDE EVERY PATIENT WITH THE FINEST, PATIENT-CENTERED CARE IN A SAFE AND COMFORTABLE ENVIRONMENT. CONTINUED ON SCHEDULE O.CARE WILL BE PROVIDED WHILE CONTINUALLY IMPROVING ACCESS TO CARE, AND STRIVING TO ENHANCE THE QUALITY OF HUMAN LIFE FOR EVERYONE WE SERVE. MOUNT NITTANY MEDICAL CENTER WILL ENHANCE ITS POSITION AS THE PREFERRED REGIONAL HEALTHCARE DESTINATION FOR BOTH PATIENTS AND MEDICAL PROFESSIONALS - PROVIDING VITAL CLINICAL CENTERS OF EXCELLENCE AND SUPERIOR ACCESS TO CARE - SUPPORTED BY A COMMITMENT TO MEDICAL EDUCATION AND BACKED BY A CULTURE OF ADVANCEMENT AND ACCOUNTABILITY - MOVING LIFE FORWARD. 0 0 329344145 18038827 406433845 MOUNT NITTANY MEDICAL CENTER IS AN ACUTE CARE HOSPITAL AND IS AN AFFILIATE OF MOUNT NITTANY HEALTH SYSTEM (HEALTH SYSTEM) WHICH INCLUDES MOUNT NITTANY MEDICAL CENTER, MOUNT NITTANY MEDICAL CENTER HEALTH SERVICES, CENTRE COUNTY CHILDREN'S ADVOCACY CENTER, AND THE FOUNDATION FOR MOUNT NITTANY MEDICAL CENTER. MOUNT NITTANY MEDICAL CENTER IS COMMITTED TO PROVIDING QUALITY MEDICAL CARE IN AN ATMOSPHERE THAT REFLECTS HIGH STANDARDS OF SOCIAL, ETHICAL, AND FINANCIAL RESPONSIBILITY AND WILL ASSURE THAT THOSE SAME STANDARDS ARE MET IN ALL CONTRACTUAL RELATIONSHIPS. CONTINUED ON SCHEDULE O.THE BOARD OF TRUSTEES HAS ESTABLISHED THIS STATEMENT OF ORGANIZATIONAL VALUES TO ASSURE THAT MEMBERS OF THE BOARD, THE MEDICAL CENTER STAFF, AND THE MEDICAL STAFF HONOR THE FOLLOWING PRINCIPLES THROUGH OUR BEHAVIORS:1) ALLIANCES WITH PATIENTS:- WE WILL TREAT ALL PATIENTS WITH DIGNITY AND RESPECT, AND WILL ACCOMMODATE INDIVIDUAL RESPONSES TO THE STRESS OF ILLNESS.- WE FULLY SUPPORT THE PRINCIPLES OUTLINED IN THE STATEMENT OF PATIENT'S RIGHTS AND RESPONSIBILITIES DOCUMENT.- WE COMMIT TO A SERVICE EXCELLENCE PHILOSOPHY THAT STRIVES TO MEET OR EXCEED PATIENT EXPECTATIONS.- ALL PATIENTS RECEIVE A UNIFORM STANDARD OF CARE THROUGHOUT THE FACILITY, REGARDLESS OF SOCIAL, CULTURAL, FINANCIAL, RELIGIOUS, RACIAL, GENDER, OR SEXUAL ORIENTATION FACTORS.- THE MEDICAL CENTER AND MEDICAL STAFF WORK JOINTLY TO ASSURE THAT ONLY APPROPRIATE AND EFFECTIVE TESTS, PROCEDURES, AND TREATMENTS ARE PROVIDED TO PATIENTS.2) COMMUNITY RELATIONS:- WE WILL FAIRLY AND ACCURATELY REPRESENT OURSELVES AND OUR CAPABILITIES TO THE PUBLIC.- WE ARE COMMITTED TO CONSTANT PREPARATION FOR THE LONG-TERM FINANCIAL VIABILITY OF THE MEDICAL CENTER THROUGH RESPONSIBLE UTILIZATION OF RESOURCES AND IN SUPPORT OF OUR COMMITMENT TO MEET THE HEALTHCARE NEEDS OF THE COMMUNITY.- MEDICAL CENTER LEADERSHIP (EXECUTIVES, BOARD OF TRUSTEES, MEDICAL STAFF) WILL DISCLOSE AND AVOID POTENTIAL CONFLICTS OF INTEREST. ALL OTHER HOSPITAL STAFF WILL AVOID SIMILAR CONFLICTS OF INTEREST.- WE WILL MAINTAIN AN OPEN ADMISSIONS POLICY: NO PATIENT WILL BE REFUSED EVALUATION AND SERVICE BASED UPON SEX, AGE, RACE, CREED, NATIONAL ORIGIN, SEXUAL ORIENTATION, INFECTION STATUS, OR THE ABILITY TO PAY. TRANSFERS TO OTHER FACILITIES WILL OCCUR ONLY WHEN WE ARE UNABLE TO PROVIDE NEEDED SERVICES AND ONLY TO FACILITIES THAT PROVIDE AN APPROPRIATE LEVEL OF CARE, BASED ON OUR ASSESSMENT OF THE PATIENTS' NEEDS. PATIENTS MAY ALSO REQUEST ELECTIVE TRANSFER AND AN INFORMED CONSENT PROCESS WILL BE FOLLOWED.GENERAL PROGRAM SERVICE INFORMATION:-1) OPERATIONS & PATIENTS:MOUNT NITTANY MEDICAL CENTER, LOCATED IN STATE COLLEGE, PENNSYLVANIA, IS A 260-BED ACUTE-CARE, NOT-FOR-PROFIT FACILITY OFFERING GENERAL MEDICAL AND SURGICAL SERVICES THAT ARE FOCUSED ON HELPING PATIENTS REACH THEIR HEALTH POTENTIAL. FOR THE FISCAL YEAR ENDED JUNE 30, 2018, MOUNT NITTANY MEDICAL CENTER PROVIDED CARE TO THE FOLLOWING NUMBER OF PATIENTS:TOTAL NUMBER OF: INPATIENTS 14,686, OUTPATIENTS 311,512 AND ER VISITS 56,367 TOTAL MEDICARE AND MEDICARE ADVANTAGE: INPATIENTS 7,488, OUTPATIENTS 130,268 AND ER VISITS 17,666 TOTAL MEDICAID AND MEDICAID HMO: INPATIENTS 1,540, OUTPATIENTS 26,215 AND ER VISITS 10,078TOTAL SELF PAY: INPATIENTS 178, OUTPATIENTS 3,897 AND ER VISITS 2,166MOUNT NITTANY MEDICAL CENTER DID NOT DENY MEDICAL SERVICES TO ANY INDIVIDUALS INCLUDING THOSE THAT HAD PRIVATE INSURANCE, MEDICARE, MEDICAID, PUBLIC HEALTH INSURANCE, OR NO INSURANCE.2) EMERGENCY DEPARTMENT:MOUNT NITTANY MEDICAL CENTER OPERATES AN EMERGENCY ROOM 24 HOURS A DAY, 365 DAYS A YEAR PROVIDING SERVICES TO ALL MEMBERS OF THE COMMUNITY REGARDLESS OF THEIR ABILITY TO PAY AND DENIED ZERO PATIENTS REQUESTING SUCH SERVICES. THE EMERGENCY ROOM DOES NOT HAVE A TRAUMA CENTER CERTIFICATION.3) MEDICAL STAFF PRIVILEGES:ALL QUALIFIED PHYSICIANS IN THE COMMUNITY ARE ELIGIBLE FOR MEDICAL STAFF PRIVILEGES AT MOUNT NITTANY MEDICAL CENTER AND ALL QUALIFIED PHYSICIAN APPLICATIONS HAVE BEEN ACCEPTED FOR MEDICAL STAFF PRIVILEGES. MORE THAN 300 PHYSICIANS IN 42 SPECIALTIES AND SUBSPECIALTIES ARE CREDENTIALED AT MOUNT NITTANY MEDICAL CENTER.4) PROFESSIONAL MEDICAL EDUCATION AND TRAINING:MOUNT NITTANY MEDICAL CENTER CONDUCTS PROFESSIONAL MEDICAL EDUCATION AND TRAINING PROGRAMS FOR THE BENEFIT OF THE COMMUNITY WITH A RESULTING FINANCIAL LOSS TO THE MEDICAL CENTER. 329344145 1 1 0 1 0 0 0 0 0 1 1 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 1 1 1 0 0 1 66 0 1 2238 1 1 1 0 0 0 0 0 0 0 0 0 X 8 3 0 0 0 0 0 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 PA X RANDY TEWKSBURY SR VP FINANCECFO 8142346148 1800 EAST PARK AVENUE STATE COLLEGE PA 16803 KRISTIE KAUFMAN MD CHAIR 2.00 2.00 X X 0 252075 28629 KATHLEEN RHINE SECRETARY/TREASURER/CEO 32.00 8.00 X X 698311 0 143269 DUSTIN CASE DO TRUSTEE 2.00 38.00 X 0 668566 38535 EUGENE M KEPHART DED TRUSTEE 2.00 2.00 X 0 0 0 KENNETH W PASCH TRUSTEE 2.00 X 0 0 0 JEFFREY PRO MD TRUSTEE 2.00 X 0 379316 38179 NANCY L SILVIS TRUSTEE 2.00 X 0 0 0 BARRY R STEIN DMD TRUSTEE 2.00 X 20790 0 0 RANDY TEWKSBURY SR VP FINANCE/CFO 32.00 8.00 X 366563 0 55686 UPENDRA THAKER MD ASSOCIATE CHIEF MEDICAL OFFICER 40.00 X 687855 0 66900 THOMAS CHARLES EXEC VP SYSTEM DVLMT 40.00 X 463484 0 62870 WAYNE THOMPSON EXEC VP CORPORATE SVCS 40.00 X 430528 0 62292 PATRICIA WATSON VP NURSING/CNO 40.00 X 333589 0 51874 ROGER YOST VP FINANCE 40.00 X 249049 0 44156 GERALD DITMANN VP HUMAN RESOURCES 40.00 X 234316 0 41445 HAROLD BRUNGARD III VP FACILITIES/PLANT OPS 40.00 X 215393 0 31952 MAUREEN KARSTETTER VP MKTG/COMM OUTREACH 40.00 X 175006 0 52301 GAIL MILLER UNTIL 1217 VP QUALITY/PATIENT SAFETY 40.00 X 160874 0 35994 ALLISON YINGLING MD PHYSICIAN 40.00 X 0 747899 20643 MICHAEL FRIEMAN MD PHYSICIAN 40.00 X 0 674223 38377 RICK PASQUARIELLO MD PHYSICIAN 40.00 X 0 607396 41487 ANTHONY CARDELL MD PHYSICIAN 40.00 X 0 597795 31848 JOHN SOLIC MD PHYSICIAN 40.00 X 0 591018 35996 LANCE ROSE FORMER CEO/OFFICER/DIRECTOR 0.00 X 14721 0 1126 4050479 4518288 923559 118 1 1 0 MILTON S HERSHEY MEDICAL CENTER 500 UNIVERSITY DRIVE HERSHEY PA 17033 PHYSICIAN SERVICES 6123517 ALEXANDER BUILDING CONSTRUCTION LLC 315 VAUGHN STREET HARRISBURG PA 17110 CONSTRUCTION SERVICES 4089370 HURON CONSULTING SERVICES LLC 550 W VAN BUREN STREET CHICAGO IL 60607 CONSULTING SERVICES 2425503 BALFURD CLEANERS 2467 PARK AVE PO BOX 109 TIPTON PA 16684 CLEANING SERVICES 1248756 COMPHEALTH ASSOCIATES PO BOX 972625 DALLAS TX 75397 PHYSICIAN SERVICES 1176438 153 360435 1560000 1560000 1920435 NET PATIENT SERVICE REVENUE 621110 404320308 404320308 OTHER OPERATING REVENUE 900099 2113537 2113537 406433845 1099058 1099058 341608 560820 -219212 -219212 -219212 334140997 349138 331317796 139435 2823201 209703 3032904 3032904 193102 123057 70045 70045 OUTPATIENT LAB SERVICES 621500 4302016 4302016 CAFETERIA SALES 722210 1129277 1129277 SERVICES SOLD TO RELATED ORGS. 900099 491403 491403 571527 5014 566513 6494223 418831298 406433845 4307030 6169988 18038827 18038827 130555569 109658000 20897569 13441026 11289568 2151458 22588648 18376196 4212452 9374360 7669152 1705208 1319747 1319747 145620 4620 141000 20472 20472 1665233 1665233 18261487 13056601 5204886 494912 494912 4139717 3082353 1057364 6294699 3310696 2984003 4720389 2086884 2633505 104474 82007 22467 72080 54724 17356 7570796 7570796 20770562 20770562 1879305 1879305 UBIT TAXES 736790 736790 MEDICAL SUPPLIES 62970470 62970470 LOSS ON REFINANCING 17902709 17902709 BAD DEBT EXPENSE 14542394 14542394 17890124 16261491 1628633 375500410 329344145 46156265 0 4186 4185 20706470 24158693 35926477 40421690 8620447 8498972 4007037 4432343 459023096 239839035 211003839 219184061 13590283 37435145 295885974 354571136 19580713 22048417 609325426 710754642 99252053 100261989 802506 889726 212098415 257976954 12564977 14252748 324717951 373381417 X 279867645 329972125 2717972 5396028 2021858 2005072 284607475 337373225 609325426 710754642 X 43330888 10330559 -895697 X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 20472 20472 0 PART II-B, LINE 1: A PORTION OF THE DUES PAID TO THE HOSPITAL & HEALTHSYSTEM ASSOCIATION OF PENNSYLVANIA ($13,230) AND THE AMERICAN HOSPITAL ASSOCIATION ($7,242) WAS DETERMINED TO BE FOR LOBBYING PURPOSES. 1946597 58475 2005072 1895434 43700 7463 1946597 1906340 45354 -8716 47544 1895434 773824 1134408 -1892 1906340 720750 51261 1813 773824 0.00000 1.00000 0.00000 0 1 1 1360009 1360009 243064839 100703684 142361155 16693572 6408975 10284597 172880137 127961735 44918402 25024539 4764641 20259898 219184061 INVESTMENT IN PARTNERSHIP - EQUITY METHOD 1616407 C ALTERNATIVE INVESTMENT 352954729 F 354571136 DEFERRED COMPENSATION 46923 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 11967690 CAPITAL LEASE OBLIGATIONS 431733 ACCRUED INTEREST 1806402 14252748 412742410 10330559 -17103324 -6772765 419515175 -683877 -683877 418831298 359976660 683877 683877 359292783 16207627 16207627 375500410 PART V, LINE 4: PERMANENT ENDOWMENT FUNDS ARE HELD BY THE FOUNDATION FOR MOUNT NITTANY MEDICAL CENTER, INC. AND EARNINGS ARE DESIGNATED TO FUND FUTURE EXPENDITURES AND CAPITAL ACQUISITIONS FOR MOUNT NITTANY MEDICAL CENTER. PART XI, LINE 2D - OTHER ADJUSTMENTS: INVESTMENT EXPENSES NETTED AGAINST REVENUE ON FINANCIALS -1,665,233. PENSION LIABILITY ADJUSTMENT -3,439,232. CHANGE IN BENEFICIAL INTEREST IN PERPETUAL TRUSTS -1,009. CHANGE IN INTEREST IN FOUNDATION 2,985,440. CHANGE IN INTEREST IN PARTNERSHIP -440,896. BAD DEBT EXPENSES NETTED AGAINST REVENUE ON FINANCIALS -14,542,394. PART XI, LINE 4B - OTHER ADJUSTMENTS: COST OF GOODS SOLD - GIFT SHOP -123,057. RENTAL EXPENSES -560,820. PART XII, LINE 2D - OTHER ADJUSTMENTS: COST OF GOODS SOLD - GIFT SHOP 123,057. RENTAL EXPENSES 560,820. PART XII, LINE 4B - OTHER ADJUSTMENTS: INVESTMENT EXPENSES NETTED AGAINST REVENUE ON FINANCIALS 1,665,233. BAD DEBT EXPENSE NETTED ON F/S 14,542,394. 1 1 1 X 250.000000000000 0 1 1 0 1 1 986360 986360 0.00270 28641743 11376473 17265270 0.04780 0 29628103 11376473 18251630 0.05050 257558 109500 148058 0.00040 85419 54528 30891 0.00010 5596299 3135940 2460359 0.00680 117832 117832 0.00030 376464 376464 0.00100 6433572 3299968 3133604 0.00860 36061675 14676441 21385234 0.05910 1156 1156 0.00000 1156 1156 0.00000 1 4057249 67758796 76759197 -9000401 X 1 1 1 1 MOUNT NITTANY MEDICAL CENTER 1800 EAST PARK AVENUE STATE COLLEGE PA 16803 WWW.MOUNTNITTANY.ORG 550301 X X X MOUNT NITTANY MEDICAL CENTER 1 0 0 1 X X X X X X X X X 16 1 0 1 1 X WWW.MOUNTNITTANY.ORG/HEALTHNEEDS X 1 16 1 WWW.MOUNTNITTANY.ORG/HEALTHNEEDS 0 1 X 250.000000000000 X 1 1 X X X 1 X MOUNTNITTANY.ORG/ASSETS/FILES/SETTINGLIST-48039/FILE-36936.PDF X MOUNTNITTANY.ORG/PHYSICIAN-GROUP/BILLING-AND-PAYMENT-OPTIONS X MOUNTNITTANY.ORG/PHYSICIAN-GROUP/BILLING-AND-PAYMENT-OPTIONS X X X X X X 1 X 0 X X 1 X 0 0 MOUNT NITTANY MEDICAL CENTER PART V, SECTION B, LINE 5: THESE ARE 3 METHODS OF RESEARCH CONDUCTED TO DETERMINE THE COMMUNITY HEALTH NEEDS: 1) A KEY INFORMANT SURVEY WITH 94 COMMUNITY REPRESENTATIVES TO SOLICIT FEEDBACK ON COMMUNITY HEALTH PRIORITIES, UNDERSERVED POPULATIONS, AND PARTNERSHIP OPPORTUNITIES. A LIST OF KEY INFORMANTS AND THEIR RESPECTIVE ORGANIZATION IS INCLUDED IN APPENDIX B OF THE 2016 CHNA. 2) THREE FOCUS GROUPS WITH 29 HEALTH CARE CONSUMERS, ADDRESSING MENTAL HEALTH, SUBSTANCE ABUSE, CHRONIC DISEASE, AND ACCESS TO CARE. 3) A PARTNER FORUM WITH 42 COMMUNITY REPRESENTATIVES TO IDENTIFY COMMUNITY HEALTH PRIORITIES AND FACILITATE POPULATION HEALTH STRATEGY COLLABORATION BASED ON INPUT REGARDING COMMUNITY ASSETS, GAPS IN SERVICES, AND PARTNERSHIP OPPORTUNITIES. A LIST OF PARTNERS IS INCLUDED IN APPENDIX C OF THE 2016 CHNA. MOUNT NITTANY MEDICAL CENTER PART V, SECTION B, LINE 6B: THE 2016 CHNA WAS CONDUCTED IN PARTNERSHIP WITH CENTRE FOUNDATION, CENTRE COUNTY UNITED WAY, AND CENTRE COUNTY PARTNERSHIP FOR COMMUNITY HEALTH. MOUNT NITTANY MEDICAL CENTER PART V, SECTION B, LINE 11: FROM THE 2016 CHNA, PRIORITIES WERE IDENTIFIED INCLUDING CHRONIC DISEASE, MENTAL HEALTH, AND SUBSTANCE ABUSE. THE PRIORITIES WERE ESTABLISHED WITH OUR PARTNERS IN THE PROCESS, CENTRE FOUNDATION, CENTRE COUNTY UNITED WAY, AND CENTRE COUNTY PARTNERSHIP FOR COMMUNITY HEALTH/CENTRE COUNTY GOVERNMENT USING A RESEARCH PROCESS THAT INCLUDED BOTH PRIMARY AND SECONDARY DATA SOURCES AND A COMMUNITY REVIEW AND APPROVAL OF THE PRIORITY AREAS, AS WELL AS REVIEW AND APPROVAL BY THE MEDICAL CENTER BOARD OF DIRECTORS. THE 2016-19 COMMUNITY HEALTH IMPLEMENTATION PLAN TO ADDRESS THE MOST PRESSING HEALTH PRIORITIES (CHRONIC DISEASE, SUBSTANCE ABUSE, AND MENTAL HEALTH) WAS REVIEWED BY THE BOARD OF DIRECTORS ON SEPTEMBER 19, 2016 AND WE ARE IN THE PROCESS OF EXECUTING THE GOALS, STRATEGIES AND TACTICS WITH SUPPORT FROM OUR COMMUNITY PARTNERS AS NOTED IN THE PLAN, WHICH IS PUBLICLY DISTRIBUTED ON THE MOUNTNITTANY.ORG/HEALTHNEEDS WEBSITE. WE ARE ADDRESSING THE IDENTIFIED PRIORITY HEALTH NEEDS THROUGH MOUNT NITTANY HEALTH-LED PROGRAMS, SUCH AS OUR CANCER PROGRAM, LUNG NODULE CLINIC AND SCREENING PROGRAM, THE STROKE PREVENTION PROGRAM AND OUR DIABETES PROGRAM. IN ADDITION, WE ARE SYSTEMATICALLY EXECUTING ON THE STRATEGIES IN THE IMPLEMENTATION PLAN TO DEVELOP CARE COORDINATION PROGRAMS IN OUR ED AND MEDICAL OFFICES AS WELL AS EXTENDING OUR REACH AS A HEALTH SYSTEM BY COLLABORATING WITH OUR COMMUNITY PARTNERS TO ADDRESS THE HEALTH CONCERNS OF THE COMMUNITY IN A COORDINATED EFFORT.AS PART OF THE CHNA, THE COMMUNITY ANECDOTALLY NOTED THAT ORAL HEALTH WAS AN ISSUE IN THE COMMUNITY, BUT DATA AND THE SCOPE AND SEVERITY OF THE ISSUE DID NOT RAISE IT TO THE TOP OF FINAL PRIORITIES LIST. THE MEDICAL CENTER WILL NOT ADDRESS THIS NEED; HOWEVER, OTHERS IN THE COMMUNITY, LIKE "CENTRE VOLUNTEERS IN MEDICINE", WHO HAVE ORAL HEALTH AND DENTAL CARE AS ONE OF THEIR CORE CARE SERVICES, DO PROVIDE THAT SERVICE TO PEOPLE. THE MEDICAL CENTER WILL CONTINUE TO SUPPORT THESE ORGANIZATIONS. MOUNT NITTANY MEDICAL CENTER PART V, SECTION B, LINE 13B: INCOME GUIDELINES FOR ELIGIBILITY ARE BASED ON THE SIZE OF A FAMILY: ONE MEMBER: $29,425, TWO MEMBERS: $39,825, FOR FAMILY UNITS WITH MORE THAN TWO MEMBERS, ADD $10,400 FOR EACH ADDITIONAL MEMBER. PART I, LINE 3C: IN ADDITION TO THE FINANCIAL ASSISTANCE (FREE CARE POLICY) BASED ON FPG, THE HOSPITAL ALSO OFFERS A DISCOUNT OF 55% OFF OF CHARGES TO UNINSURED PATIENTS ON HOSPITAL ACCOUNT BALANCES (THIS DISCOUNT IS FOR PATIENTS WHO DO NOT QUALIFY UNDER OUR 250% FPG FINANCIAL ASSISTANCE POLICY.) THE FOLLOWING ARE EXAMPLES THAT QUALIFY PATIENTS AS UNINSURED: TERMINATED COVERAGE EITHER DUE TO JOB TERMINATION OR UNINSURED PERIODS DURING TRANSITION, EMPLOYED PATIENTS WHO MAY BE IN A "WAITING/GRACE" PERIOD FOR INSURANCE, OR INSURED PATIENTS WHERE COVERAGE HAS EXHAUSTED. PART I, LINE 7: COST TO CHARGE RATIO WAS COMPUTED USING WORKSHEET 2 AS DESCRIBED IN THE IRS INSTRUCTIONS TO FORM 990 FOR LINES 7A, 7B, AND 7G. COST ACCOUNTING SYSTEM WAS USED FOR SUBSIDIZED HEALTH SERVICES. FOR ALL OTHERS, COSTS INCLUDED THE VALUE OF STAFF DONATED HOURS (WITH ESTIMATED BENFITS), MONETARY CONTRIBUTIONS, ESTIMATED VALUE OF MATERIALS USED IN DELIVERING PROGRAMS, AND ESTIMATED SPACE COSTS. THE INDIRECT COST ALLOCATION APPLIES THE INDIRECT-TO-DIRECT COST RATIO FROM THE MEDICAL CENTER'S MOST RECENT MEDICARE COST REPORT. PART I, LN 7 COL(F): THE AMOUNT OF BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25 AMOUNTS TO $14,542,394 FOR THE YEAR ENDED JUNE 30, 2018. PART II, COMMUNITY BUILDING ACTIVITIES: OUR ENTRIES FOR WORKFORCE DEVELOPMENT INCLUDE STAFF TIME TO PROVIDE EDUCATION TO LOCAL HIGH SCHOOL STUDENTS REGARDING STROKE CARE AT MNMC, INCLUDING PREVENTION, IN-HOSPITAL CARE, & POST-HOSPITAL CARE & THE PRESENTATION OF ROLES & RESPONSIBILITIES OF THE CLINICAL TRIALS OFFICE AT MNMC. PART III, LINE 2: BAD DEBT (AT COST) IS CALCULATED BY APPLYING THE PATIENT CARE COST-TO-CHARGE RATIO FROM WORKSHEET 2 TO THE MEDICAL CENTER'S PROVISION FOR DOUBTFUL COLLECTIONS AS OF JUNE 30, 2018. THE MEDICAL CENTER'S ACCOUNTING DEPARTMENT RECORDS PAYMENTS, WHILE PATIENT ACCOUNTING STAFF MAKES APPROPRIATE ADJUSTMENTS TO PATIENT ACCOUNTS FOR BAD DEBT, DISCOUNTS, OR FREE CARE WRITE-OFFS. PART III, LINE 3: THE MEDICAL CENTER IS UNABLE TO ESTIMATE THE AMOUNT OF BAD DEBT THAT COULD BE ATTRIBUTABLE TO PATIENTS WHO LIKELY WOULD QUALIFY FOR FINANCIAL ASSISTANCE UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. PATIENTS DO NOT PROVIDE INCOME INFORMATION PRIOR TO RECEIVING CARE. THE REGISTRATION DEPARTMENT GIVES EVERY PATIENT A COPY OF OUR FINANCIAL ASSISTANCE PROGRAM TO ENSURE EVERY PATIENT HAS THE OPPORTUNITY AS APPROPRIATE TO QUALIFY FOR OUR ASSISTANCE PROGRAM. THE MEDICAL CENTER OFFERS DETAILED INFORMATION ABOUT THE CHARITY CARE PROGRAM WHEN PATIENTS OFFER INFORMATION THAT IS NEEDED TO DETERMINE ELIGIBILITY. SEE RESPONSE TO PART VI, LINE 3.MOUNT NITTANY MEDICAL CENTER PROVIDES SERVICES TO ALL PATIENTS REGARDLESS OF ABILITY TO PAY AS PART OF THE HOSPITAL'S MISSION. A PORTION OF THE MOUNT NITTANY MEDICAL CENTER'S BAD DEBT WOULD RELATE TO PATIENTS THAT COULD QUALIFY FOR CHARITY CARE BUT WERE UNWILLING OR UNABLE TO PROVIDE THE APPROPRIATE DOCUMENTATION TO ALLOW THAT CLASSIFICATION. AS SUCH A PORTION OF THE HOSPITAL'S BAD DEBT SHOULD BE CONSIDERED COMMUNITY BENEFIT. PART III, LINE 4: ACCOUNTS RECEIVABLE, PATIENTS, ARE REPORTED AT NET REALIZABLE VALUE. ACCOUNTS ARE WRITTEN OFF WHEN THEY ARE DETERMINED TO BE UNCOLLECTIBLE BASED UPON MANAGEMENT'S ASSESSMENT OF INDIVIDUAL ACCOUNTS. THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IS ESTIMATED BASED ON A PERIODIC REVIEW OF THE ACCOUNTS RECEIVABLE AGING, PAYOR CLASSIFICATIONS, AND APPLICATION OF HISTORICAL WRITE-OFF PERCENTAGES. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE CORPORATION ANALYZES CONTRACTUAL AMOUNTS DUE AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND INSURED PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES, THE CORPORATION RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE BILLED RATES 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: THE MEDICAL CENTER CONTINUES TO PROVIDE CARE TO ALL PRESENTING AND ADMITTED PATIENTS, REGARDLESS OF ABILITY TO PAY. THROUGH DILIGENT COST CONTROL PROCESSES, THE MEDICAL CENTER SEEKS WAYS TO KEEP COSTS OF PROVIDING CARE TO A MINIMUM, WHILE STILL PROVIDING THE SAFETY MEASURES, TECHNOLOGICAL CAPABILITIES, AND APPROPRIATE STAFFING LEVELS TO ENSURE THE BEST POSSIBLE OUTCOMES. NOTWITHSTANDING THE COSTS TO PROVIDE CARE, RECEIVING "LESS" THAN WHAT IT COSTS TO PROVIDE ADEQUATE CARE TO MEDICARE COVERED LIVES DOES THE MEDICAL CENTER A DISSERVICE. THIS SHORTFALL SHOULD COUNT AS A COMMUNITY BENEFIT AS THE MEDICAL CENTER STRIVES TO PROVIDE THE BEST CARE POSSIBLE TO ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. THE MEDICAL CENTER USES A STEP-DOWN COST ALLOCATION METHOD AND THEN APPLIES A COST-TO-CHARGE RATIO. PART III, LINE 9B: IF PATIENTS ARE FOUND TO QUALIFY FOR FINANCIAL ASSISTANCE, THE MEDICAL CENTER IMMEDIATELY CEASES COLLECTIONS AND ADJUSTS CHARGES OFF AS CHARITY CARE. PART VI, LINE 2: MOUNT NITTANY HEALTH SYSTEM ("MNHS") HAS HISTORICALLY USED INFORMAL COMMUNITY FEEDBACK MECHANISMS SUCH AS PATIENT AND STAFF INTERACTIONS, AS WELL AS MORE FORMAL MEANS SUCH AS CONSULTANT-LED MARKET RESEARCH AND SOLICITING FEEDBACK FROM DONORS, NON-EMPLOYED PHYSICIANS, AND COMMUNITY LEADERS TO UNDERSTAND THE NEEDS OF REGIONAL POPULATIONS. IN ADDITION, MNHS CONTINUES TO HOLD ONGOING AND MEANINGFUL DISCUSSIONS WITH MAJOR COMMUNITY STAKEHOLDERS, INCLUDING, BUT NOT LIMITED TO, THE PENNSYLVANIA STATE UNIVERSITY AND MILTON S. HERSHEY MEDICAL CENTER, TO DEVELOP RESPONSIVE PROGRAMS AND SOLUTIONS TO THE HEALTH CARE NEEDS OF PROMINENT SEGMENTS OF THE LOCAL POPULATION IN CENTRE COUNTY.THE 2016 MOUNT NITTANY MEDICAL CENTER CHNA WAS CONDUCTED BETWEEN JULY 2015 AND JUNE 2016. QUANTITATIVE AND QUALITATIVE METHODS, REPRESENTING BOTH PRIMARY AND SECONDARY RESEARCH, WERE USED TO ILLUSTRATE AND COMPARE HEALTH TRENDS AND DISPARITIES ACROSS CENTRE COUNTY. PRIMARY RESEARCH METHODS SOUGHT TO SOLICIT INPUT FROM KEY COMMUNITY STAKEHOLDERS REPRESENTING THE BROAD INTERESTS OF THE COMMUNITY, INCLUDING EXPERTS IN PUBLIC HEALTH AND INDIVIDUALS REPRESENTING MEDICALLY UNDERSERVED, LOW INCOME, AND MINORITY POPULATIONS. SECONDARY RESEARCH METHODS SOUGHT TO IDENTIFY COMMUNITY HEALTH NEEDS AND TRENDS ACROSS GEOGRAPHIC AREAS AND POPULATIONS.THE FOLLOWING RESEARCH WAS CONDUCTED TO DETERMINE COMMUNITY HEALTH NEEDS:- A REVIEW OF PUBLIC HEALTH AND DEMOGRAPHIC DATA PORTRAYING THE HEALTH ANDSOCIOECONOMIC STATUS OF THE COMMUNITY.- AN ANALYSIS OF HOSPITAL DISCHARGE DATA TO DETERMINE HOW CONSUMERS AREACCESSING CARE AND WHERE GAPS IN SERVICE EXIST.- A KEY INFORMANT SURVEY WITH 94 COMMUNITY REPRESENTATIVES TO SOLICIT FEEDBACK ON COMMUNITY HEALTH PRIORITIES, UNDERSERVED POPULATIONS, AND PARTNERSHIP OPPORTUNITIES. - THREE FOCUS GROUPS WITH 29 HEALTH CARE CONSUMERS, ADDRESSING MENTAL HEALTH, SUBSTANCE ABUSE, CHRONIC DISEASE, AND ACCESS TO CARE.- A PARTNER FORUM WITH 42 COMMUNITY REPRESENTATIVES TO IDENTIFY COMMUNITY HEALTH PRIORITIES AND FACILITATE POPULATION HEALTH STRATEGY COLLABORATION BASED ON INPUT REGARDING COMMUNITY ASSETS, GAPS IN SERVICES, AND PARTNERSHIP OPPORTUNITIES. THE 2016 CHNA WAS CONDUCTED IN PARTNERSHIP WITH CENTRE FOUNDATION, CENTRE COUNTY UNITED WAY, AND CENTRE COUNTY PARTNERSHIP FOR COMMUNITY HEALTH. THE MISSION OF THESE ORGANIZATIONS ALIGNS WITH THE GOALS OF THE CHNA TO BUILD ENGAGED AND HEALTHY COMMUNITIES AND ENHANCE QUALITY OF LIFE THROUGH COLLABORATIVE RELATIONSHIPS. TO THAT END, THE CHNA PROCESS CONCENTRATED ON OPPORTUNITIES TO COLLECTIVELY ASSESS AND IMPACT THE HEALTH OF CENTRE COUNTY.SEE ALSO SCHEDULE H PART V. PART VI, LINE 3: MOUNT NITTANY MEDICAL CENTER IS DEDICATED TO IMPROVING THE HEALTH AND WELL-BEING OF ALL ITS CONSTITUENTS. AS MENTIONED PREVIOUSLY, MNMC CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT DURING THE FISCAL YEAR 2016. THIS ASSESSMENT RESULTED IN SIX MAJOR COMMUNITY HEALTH NEEDS AND GAPS WHICH INCLUDE ACCESS TO CARE, HEALTHY AGING, MENTAL HEALTH, OBESITY/DIABETES, ORAL HEALTH, AND SUBSTANCE ABUSE. REFER TO THE CHNA FOR ANALYSIS AND RESPONSE TO THESE AREAS. THROUGH THE FINANCIAL ASSISTANCE PROGRAM, MOUNT NITTANY MEDICAL CENTER PROVIDES MEDICAL CARE REGARDLESS OF A PATIENT'S ABILITY TO PAY, INSUFFICIENT HEALTH INSURANCE OR WHETHER A GOVERNMENT-SPONSORED PROGRAM COVERS THE FULL COST OF SERVICES. AND AS THE COUNTRY'S ECONOMIC FUTURE REMAINS UNCERTAIN, MOUNT NITTANY MEDICAL CENTER WILL CONTINUE TO PROVIDE CARE FOR THOSE WHO NEED IT. MOUNT NITTANY MEDICAL CENTER WILL PROVIDE SERVICES AT NO CHARGE OR REDUCED CHARGES TO THOSE WHO ARE FINANCIALLY UNABLE TO PAY FOR THOSE SERVICES. MOUNT NITTANY MEDICAL CENTER WILL NOT ARBITRARILY RESTRICT THE PROVISIONS OF HEALTH SERVICES TO CERTAIN INDIVIDUALS OR GROUPS.MOUNT NITTANY MEDICAL CENTER'S REGISTRATION DEPARTMENT REPRESENTATIVES WILL GIVE A COPY OF OUR FINANCIAL ASSISTANCE PROGRAM TO EVERY PATIENT ALONG WITH OTHER IMPORTANT BILLING INFORMATION. OUR FINANCIAL COUNSELOR WILL DISCUSS THE AVAILABILITY OF VARIOUS GOVERNMENT BENEFITS SUCH AS MEDICAID OR STATE PROGRAMS TO ASSIST THE PATIENT WITH QUALIFICATIONS FOR THESE PROGRAMS. THE FINANCIAL COUNSELOR WILL ALSO ASSIST THE PATIENT IN COMPLETING THE PROPER PAPERWORK FOR ASSISTANCE. IN ADDITION, OUR VENDOR DEBIASE & LEVINE, REPRESENTATIVE, WHO IS WORKING ON BEHALF OF MOUNT NITTANY MEDICAL CENTER, WILL ALSO ASSIST PATIENTS WITH THE MEDICAL ASSISTANCE PROCESS. OUR VENDOR WORKS ON BEHALF OF THE ORGANIZATION TO FOLLOW THE HOSPITAL'S POLICIES REGARDING PATIENT NOTIFICATION AND THE AVAILABILITY OF FINANCIAL ASSISTANCE. MOUNT NITTANY MEDICAL CENTER'S FINANCIAL ASSISTANCE POLICY IS POSTED ON OUR WEBSITE ALONG WITH AN APPLICATION FOR PATIENTS TO COMPLETE FOR FINANCIAL ASSISTANCE. THE FINANCIAL COUNSELORS AND CASE MANAGEMENT STAFF WILL ALSO WORK CLOSELY TO IDENTIFY AND ASSIST ELIGIBLE PATIENTS.MOUNT NITTANY MEDICAL CENTER WILL MAKE AVAILABLE A WRITTEN NOTICE TO EACH PATIENT OR THEIR REPRESENTATIVE OF THE EXISTENCE, CRITERIA AND MECHANISM FOR RECEIVING FINANCIAL ASSISTANCE. THE HOSPITAL WILL CREATE AND MAINTAIN RECORDS AND DOCUMENT THAT AN APPLICATION WAS SENT TO THE PATIENT DEMONSTRATING THAT THE REQUIRED CRITERIA AND MECHANISM ARE ESTABLISHED (MOUNT NITTANY MEDICAL CENTER WILL RECORD ANY AND ALL REQUESTS FOR FINANCIAL ASSISTANCE, THE DISPOSITION AND THE DOLLAR AMOUNT OF MOUNT NITTANY MEDICAL CENTER'S FINANCIAL ASSISTANCE PROGRAM PROVIDED). THE COMPLETED APPLICATIONS ARE GIVEN TO THE PATIENT ACCOUNTS DEPARTMENT SHOWING WHETHER THE APPLICATION WAS APPROVED OR DENIED. IN ALL INSTANCES, PATIENT CONFIDENTIALITY WILL BE PROTECTED.ELIGIBILITY WILL BE DETERMINED BY COMPARING HOUSEHOLD FAMILY INCOME TO THE INCOME POVERTY GUIDELINES. INCOME IS DEFINED AS THE TOTAL ANNUAL CASH RECEIPTS BEFORE TAXES FROM ALL SOURCES.A NOTICE OF AVAILABILITY OF MOUNT NITTANY MEDICAL CENTER'S FINANCIAL ASSISTANCE PROGRAM WILL BE GIVEN TO EACH PATIENT OR THEIR REPRESENTATIVE PRIOR TO SERVICES BEING RENDERED, WITH THE EXCEPTION OF EMERGENCY SERVICES WHEREBY THE PATIENT IS TRIAGED PRIOR TO COMPLETING THE REGISTRATION PROCESS. THESE PATIENTS WOULD RECEIVE THE NOTICE REGARDING THE FINANCIAL ASSISTANCE PROGRAM AT SOME POINT DURING THAT VISIT. THESE NOTICES ARE DISPLAYED AND MADE AVAILABLE IN ALL REGISTRATION AREAS OF THE HOSPITAL AND INCLUDES THE MOST CURRENTLY AVAILABLE "HOUSEHOLD INCOME GUIDELINES" AS PUBLISHED IN THE FEDERAL REGISTER. MOUNT NITTANY MEDICAL CENTER'S CURRENT FINANCIAL ASSISTANCE PROGRAM ELIGIBILITY IS BASED ON 2.5 TIMES THE "HOUSEHOLD INCOME GUIDELINES".THE PATIENT ACCOUNTS DIRECTOR OR HIS/HER DESIGNEE SHALL REVIEW ALL APPLICATIONS FOR THE MOUNT NITTANY MEDICAL CENTER FINANCIAL ASSISTANCE PROGRAM. IT IS THE APPLICANT'S RESPONSIBILITY TO PROVIDE PROOF OF INCOME. PART VI, LINE 4: THE MEDICAL CENTER'S PRIMARY SERVICE AREA INCLUDES CENTRE COUNTY AND PARTS OF THE SURROUNDING COUNTIES. CENTRE COUNTY'S POPULATION IS APPROXIMATELY 155,000. THE POPULATION INCREASED 14.2% FROM THE 2000 CENSUS. SEVERAL COMMUNITIES SERVED BY MOUNT NITTANY MEDICAL CENTER ARE DESIGNATED MEDICALLY UNDERSERVED AREAS, DETERMINED BY THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, HEALTH RESOURCES AND SERVICES ADMINISTRATION AS HAVING TOO FEW PRIMARY CARE PROVIDERS, HIGH INFANT MORTALITY, HIGH POVERTY, OR A HIGH ELDERLY POPULATION. IN ADDITION, THE FOLLOWING GEOGRAPHIES/POPULATIONS ARE DESIGNATED HEALTH PROFESSIONAL SHORTAGE AREAS (HPSA) FOR EITHER PRIMARY CARE OR DENTAL CARE:-LOW-INCOME RESIDENTS IN PHILIPSBURG (PRIMARY CARE)-SNOW SHOE (PRIMARY CARE)-LOW-INCOME RESIDENTS ACROSS CENTRE COUNTY (DENTAL CARE).THE CENTRE COUNTY POPULATION IS PRIMARILY WHITE WITH LESS THAN 11% OF RESIDENTS IDENTIFYING AS ANOTHER RACE AND LESS THAN 3% OF RESIDENTS IDENTIFYING AS HISPANIC OR LATINO. THE MEDIAN AGE OF CENTRE COUNTY (30) IS LOWER THAN THE STATE AND NATIONAL MEDIANS (40 AND 37 YEARS RESPECTIVELY), BUT INCREASED FROM THE 2013 CHNA (29). CENTRE COUNTY REPRESENTS A DIVERSE SOCIOECONOMIC ENVIRONMENT. THE OVERALL POVERTY LEVEL IN CENTRE COUNTY IS 21%. THE UNEMPLOYMENT RATE IS 7%. INDIVIDUALS WITH LESS THAN A HIGH SCHOOL DIPLOMA IS 7% OF CENTRE COUNTY'S POPULATION. POVERTY RATES IN CENTRE COUNTY MAY BE INFLUENCED BY STUDENTS ATTENDING THE PENNSYLVANIA STATE UNIVERSITY. POVERTY AND EDUCATION RATES MAY BE INFLUENCED BY AMISH POPULATIONS RESIDING IN CERTAIN ZIP CODES WITHIN CENTRE COUNTY. PART VI, LINE 5: THE MEDICAL CENTER'S BOARD OF TRUSTEES AND ITS VARIOUS COMMITTEES INCLUDE COMMUNITY MEMBERS AS WELL AS MEDICAL STAFF. THE COMMUNITY MEMBERS ARE NOT DIRECTLY INVOLVED IN THE MEDICAL CENTER'S OPERATIONS. THE MEDICAL CENTER'S MEDICAL STAFF EXCEEDS 300 PHYSICIANS. THE MEDICAL CENTER CONTINUES TO INVEST IN STRONG AND BENEFICIAL RELATIONSHIPS WITH ALL PHYSICIANS WHO HAVE AN INTEREST IN WORKING WITH THE MEDICAL CENTER. ALL REVENUES IN EXCESS OF EXPENSES ARE RE-INVESTED IN THE COMMUNITY, INCLUDING SIGNIFICANT DONATIONS TO THE COUNTY'S ONLY FREE MEDICAL AND DENTAL CLINIC, AS WELL AS INTERNAL IMPROVEMENTS TO TECHNOLOGY SO THAT THE PEOPLE AND COMMUNITIES WE SERVE HAVE IMMEDIATE ACCESS TO THE BEST AND MOST APPROPRIATE DIAGNOSTIC AND TREATMENT OPTIONS AVAILABLE. PART VI, LINE 6: AS OF JUNE 30, 2018, MOUNT NITTANY HEALTH SYSTEM HAS TWO CONTROLLED CORPORATIONS, WHICH ARE THE MOUNT NITTANY MEDICAL CENTER (INPATIENT AND OUTPATIENT SERVICES) AND MOUNT NITTANY MEDICAL CENTER HEALTH SERVICES, INC. (A PHYSICIAN PRACTICE D/B/A MOUNT NITTANY PHYSICAN GROUP). THE FOUNDATION FOR MOUNT NITTANY MEDICAL CENTER, INC. (FUNDRAISING) IS CONTROLLED BY THE MOUNT NITTANY MEDICAL CENTER.COMMUNITY BENEFIT SERVICES OFFERED BY MOUNT NITTANY MEDICAL CENTER ARE AFFORDED TO THE BROAD COMMUNITY WITH THE INTENT OF IMPROVING COMMUNITY HEALTH. PROGRAMS AND SERVICES ARE DESIGNED TO RESPOND TO IDENTIFIED COMMUNITY NEEDS. COMMUNITY BENEFIT ACTIVITIES FALL INTO THESE MAJOR CATEGORIES: COMMUNITY HEALTH IMPROVEMENT SERVICES - INCLUDES ACTIVITIES THAT ARE CARRIED OUT TO IMPROVE COMMUNITY HEALTH. MOUNT NITTANY MEDICAL CENTER PROVIDES COMMUNITY HEALTH EDUCATION, HEALTH SCREENINGS, SUPPORT GROUPS, AND TRANSPORTATION ASSISTANCE. THIS PAST YEAR MNMC OFFERED NUMEROUS SCREENING AND EDUCATION EVENTS FOR MEMBERS OF OUR COMMUNITY. HEALTH PROFESSIONS EDUCATION - MOUNT NITTANY MEDICAL CENTER IS ADVANCING HEALTHCARE BY ADVANCING ACCESS TO EDUCATION AND TRAINING. IN FISCAL YEAR 2017, MOUNT NITTANY AWARDED CONTINUING EDUCATION CREDITS FOR NURSES AND PHYSICIANS AS WELL AS TRAININGS IN THE AMERICAN HEART ASSOCIATION TRAINING CENTER. CASH AND IN-KIND DONATIONS - MOUNT NITTANY MEDICAL CENTER REPORTED ITS SUPPORT OF MORE THAN FORTY LOCAL ORGANIZATIONS THROUGH IN-KIND AND CASH DONATIONS. THE LEAD BENEFICIARY OF MOUNT NITTANY'S SUPPORT IS CENTRE VOLUNTEERS IN MEDICINE. OTHER NON-PROFIT GROUPS INCLUDE AMERICAN HEART ASSOCIATION, PEOPLE "CENTRE'D" ON DIABETES, YMCA OF CENTRE COUNTY AND MORE. COMMUNITY-BUILDING ACTIVITIES - MOUNT NITTANY IS A LEAD FACILITATOR IN LOCAL AND REGIONAL PREPAREDNESS ACTIVITIES, ENSURING THAT CENTRE COUNTY IS PREPARED SHOULD A DISASTER STRIKE. IN ADDITION, MOUNT NITTANY PROVIDES ACCESS TO CARE IN RURAL AREAS TO ENSURE THAT EVERY COMMUNITY HAS ACCESS TO CARE, SUCH AS PROVIDING DIABETES EDUCATION AT RURAL DOCTOR'S OFFICES. SUBSIDIZED HEALTH SERVICES - MOUNT NITTANY MEDICAL CENTER PROVIDES THE COMMUNITY MENTAL HEALTH SERVICES AT ITS INPATIENT UNIT, ONCOLOGY PATIENT NAVIGATOR PROGRAM, TRANSPORTATION SERVICES FOR THE PATIENTS WITH CANCER, PEDIATRIC MEDICAL HOME PROGRAM FOR AT-RISK CHILDREN AND SEVERAL FREE SUPPORT GROUPS. THE MOUNT NITTANY PHYSICIAN GROUP OFFERS A COMMUNITY BENEFIT BY SEEING CENTRE VOLUNTEERS IN MEDICINE (CVIM) PATIENTS FOR SPECIALTY SERVICES AT NO COST TO THE PATIENT OR TO CVIM. THIS GROUP ALSO PROVIDES VARIOUS INTERNSHIPS, PRESENTATIONS, AND NEWSLETTERS TO THE COMMUNITY INCLUDING TOPICS LIKE HEART HEALTH AND PEDIATRICS. PART VI, LINE 7, REPORTS FILED WITH STATES PA 1 MOUNT NITTANY MEDICAL CENTER HEALTH SERVICES INC 1800 EAST PARK AVENUE STATE COLLEGE PA 16803 510426500 501(C)(3) 17109561 0 CASH N/A PROVIDE FINANCIAL SUPPORT TO AFFILIATE MOUNT NITTANY HEALTH SYSTEM INC 1800 EAST PARK AVENUE STATE COLLEGE PA 16803 800663092 501(C)(3) 461268 0 CASH N/A PROVIDE FINANCIAL SUPPORT TO AFFILIATE CENTRE COUNTY CHILDREN'S ADVOCACY CENTER 1800 EAST PARK AVENUE STATE COLLEGE PA 16803 460871813 501(C)(3) 157612 0 CASH N/A PROVIDED FINANCIAL SUPPORT TO AFFILIATE THE FOUNDATION FOR MOUNT NITTANY MEDICAL CENTER 1800 EAST PARK AVENUE STATE COLLEGE PA 16803 571138956 501(C)(3) 310386 0 CASH N/A PROVIDED FINANCIAL SUPPORT TO AFFILIATE 4 0 PART I, LINE 2: ASSISTANCE IS PROVIDED TO RELATED ENTITIES FOR FINANCIAL SUPPORT. MANAGEMENT OF THE ORGANIZATION OVERSEES THE USE OF FUNDS AT THE AFFILIATED ENTITIES. X X X X X 0 1 0 0 0 0 0 1 0 KRISTIE KAUFMAN MD CHAIR 0 204270 0 33435 0 14370 0 0 0 28629 0 280704 0 0 KATHLEEN RHINE SECRETARY/TREASURER/CEO 541048 0 147893 0 9370 0 114308 0 28961 0 841580 0 0 0 DUSTIN CASE DO TRUSTEE 0 651873 0 15698 0 995 0 0 0 38535 0 707101 0 0 JEFFREY PRO MD TRUSTEE 0 335366 0 30612 0 13338 0 0 0 38179 0 417495 0 0 RANDY TEWKSBURY SR VP FINANCE/CFO 306900 0 58871 0 792 0 19625 0 36061 0 422249 0 0 0 UPENDRA THAKER MD ASSOCIATE CHIEF MEDICAL OFFICER 684931 0 0 0 2924 0 19625 0 47275 0 754755 0 0 0 THOMAS CHARLES EXEC VP SYSTEM DVLMT 342179 0 119515 0 1790 0 19625 0 43245 0 526354 0 0 0 WAYNE THOMPSON EXEC VP CORPORATE SVCS 313807 0 116721 0 0 0 19625 0 42667 0 492820 0 0 0 PATRICIA WATSON VP NURSING/CNO 309961 0 23628 0 0 0 19625 0 32249 0 385463 0 0 0 ROGER YOST VP FINANCE 219835 0 29214 0 0 0 19625 0 24531 0 293205 0 0 0 GERALD DITMANN VP HUMAN RESOURCES 207385 0 26931 0 0 0 19625 0 21820 0 275761 0 0 0 HAROLD BRUNGARD III VP FACILITIES/PLANT OPS 185983 0 29410 0 0 0 18072 0 13880 0 247345 0 0 0 MAUREEN KARSTETTER VP MKTG/COMM OUTREACH 154247 0 20759 0 0 0 15562 0 36739 0 227307 0 0 0 GAIL MILLER UNTIL 1217 VP QUALITY/PATIENT SAFETY 126987 0 33887 0 0 0 12467 0 23527 0 196868 0 0 0 ALLISON YINGLING MD PHYSICIAN 0 730316 0 1478 0 16105 0 20643 0 0 0 768542 0 0 MICHAEL FRIEMAN MD PHYSICIAN 0 493849 0 180374 0 0 0 0 0 38377 0 712600 0 0 RICK PASQUARIELLO MD PHYSICIAN 0 564929 0 27469 0 14998 0 0 0 41487 0 648883 0 0 ANTHONY CARDELL MD PHYSICIAN 0 513789 0 76523 0 7483 0 0 0 31848 0 629643 0 0 JOHN SOLIC MD PHYSICIAN 0 560944 0 19261 0 10813 0 0 0 35996 0 627014 0 0 LANCE ROSE FORMER CEO/OFFICER/DIRECTOR 0 0 0 0 14721 0 0 0 1126 0 15847 0 0 0 PART I, LINE 4B THE FORMER CEO, LANCE ROSE, RECEIVED A NONQUALIFIED RETIREMENT PLAN PAYMENT OF $14,721 DURING THE YEAR. PART I, LINE 7 THE EXECUTIVE TEAM MEMBERS OF MOUNT NITTANY MEDICAL CENTER AND THE MOUNT NITTANY MEDICAL CENTER HEALTH SERVICES' (D/B/A MOUNT NITTANY PHYSICIAN GROUP) EXECUTIVE DIRECTOR RECEIVED A PORTION OF THEIR ANNUAL VARIABLE-PAY BASED UPON THE CONSOLIDATED OPERATING MARGIN, MOUNT NITTANY MEDICAL CENTER HEALTH SERVICES' (D/B/A MOUNT NITTANY PHYSICIAN GROUP) OPERATING MARGIN, CONTRIBUTIONS, AND OTHER CORPORATE GOALS. THE CORPORATE GOALS FOCUSED ON (1) PROVIDING LOCALIZED CARE, INTEGRATED CARE, EFFICIENT CARE, AND ALIGNED CARE; (2) FINANCE; (3) QUALITY/PATIENT SAFETY; AND (4) THE WORK ENVIRONMENT. A CENTRE COUNTY HOSPITAL AUTHORITY 203197497 156273CU6 2011-05-05 70552972 SEE PART VI 0 0 0 B CENTRE COUNTY HOSPITAL AUTHORITY 203197497 156273ED2 2012-10-15 69404972 SEE PART VI 0 0 0 C CENTRE COUNTY HOSPITAL AUTHORITY 203197497 156273DK7 2012-10-15 44591375 SEE PART VI 0 0 0 D CENTRE COUNTY HOSPITAL AUTHORITY 203197497 156273FF6 2016-04-15 80895596 SEE PART VI 0 0 0 A 65695000 70552972 8281626 1033856 61237490 2013 0 0 1 1 B 18050000 69404972 811090 68593882 2012 0 1 1 1 C 9480000 44591375 3000747 534964 41055664 2014 0 0 1 1 D 620000 80895596 18878230 764512 61240000 2016 0 1 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 C 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 D 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 1 0 0 0 0 1 B 0 0 0 1 0 0 0 0 1 C 0 0 0 1 0 0 0 0 1 D 0 1 0 0 0 0 0 0 1 A 1 B 1 C 1 D 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: CENTRE COUNTY HOSPITAL AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 12/31/2015 ISSUER NAME: CENTRE COUNTY HOSPITAL AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 10/01/2017 ISSUER NAME: CENTRE COUNTY HOSPITAL AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 10/01/2017 SCHEDULE K, PART I, BOND ISSUES: BOND NUMBER 1 (A) ISSUER NAME: CENTRE COUNTY HOSPITAL AUTHORITY (F) DESCRIPTION OF PURPOSE: FUND EMERGENCY DEPARTMENT EXPANSION AND OTHER CAPITAL EXPENDITURES BOND NUMBER 2 (A) ISSUER NAME: CENTRE COUNTY HOSPITAL AUTHORITY (F) DESCRIPTION OF PURPOSE: REFUNDING OF THE SERIES 2009 BONDS AND ISSUANCE COSTS BOND NUMBER 3 (A) ISSUER NAME: CENTRE COUNTY HOSPITAL AUTHORITY (F) DESCRIPTION OF PURPOSE: FUND PERIOPERATIVE EXPANSION AND OTHER CAPITAL EXENDITURES BOND NUMBER 4 (A) ISSUER NAME: CENTRE COUNTY HOSPITAL AUTHORITY (F) DESCRIPTION OF PURPOSE: ADVANCE PARTIAL REFUNDING OF THE 2011 BONDS AND PAY 2016A BOND ISSUANCE COSTS BOND NUMBER 5 (A) ISSUER NAME: CENTRE COUNTY HOSPITAL AUTHORITY (F) DESCRIPTION OF PURPOSE: TO FUND 2016 CAPITAL PROJECTS AND PAY ISSUANCE COSTS FOR BOND SERIES 2016B BOND NUMBER 6 (A) ISSUER NAME: CENTRE COUNTY HOSPITAL AUTHORITY (F) DESCRIPTION OF PURPOSE: REFUNDING OF CALLABLE BONDS, FINANCING CAPITAL PROJECTS, AND COSTS OF ISSUANCE SCHEDULE K, PART III, LINE 3: THERE ARE NO MANAGEMENT OR SERVICE CONTRACTS OR RESEARCH AGREEMENTS THAT RESULT IN PRIVATE BUSINESS USE RELATING TO THE FINANCED PROPERTIES FOR THE 2011, 2012, 2016, OR 2018 BONDS. A CENTRE COUNTY HOSPITAL AUTHORITY 203197497 156273GE8 2016-04-15 20208892 SEE PART VI 0 0 0 B CENTRE COUNTY HOSPITAL AUTHORITY 203197497 156273HC1 2018-03-21 52073401 SEE PART VI 0 0 0 A 300000 20208892 199179 18135229 1872484 2017 0 0 0 1 B 52073401 350023 19572345 32151033 2020 0 0 0 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 1 0 0 0 0 0 0 1 B 0 1 0 0 0 0 0 0 1 A 1 B 1 EDWARD BELL SEE PART V 147137 SEE PART V 0 SCH L, PART IV, BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS: (A) NAME OF PERSON: EDWARD BELL(B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: EDWARD BELL IS RELATED TO KAREN SHUTE WHO IS A MEMBER OF THE BOARD OF TRUSTEES.(D) DESCRIPTION OF TRANSACTION: EDWARD BELL IS AN EMPLOYEE OF MOUNT NITTANY MEDICAL CENTER; THE AMOUNT SHOWN IS HIS SALARY FOR THE YEAR. X 1 1560000 ASSESSED VALUE 0 0 0 PART I, COLUMN (B): THE NUMBER IN COLUMN B REPRESENTS THE NUMBER OF CONTRIBUTORS. FORM 990, PART VI, SECTION A, LINE 7A AS THE PARENT ENTITY, MOUNT NITTANY HEALTH SYSTEM (MNHS) HAS THE POWER TO APPOINT AND REMOVE, OR APPROVE THE REMOVAL OF, ANY AND ALL TRUSTEES OF THE CORPORATION, WITH THE EXCEPTION OF EX-OFFICIO TRUSTEES. FORM 990, PART VI, SECTION A, LINE 7B MNHS HAS THE FOLLOWING POWERS: (A) TO APPOINT AND REMOVE, OR APPROVE THE REMOVAL OF, ANY AND ALL TRUSTEES OF THE CORPORATION, WITH THE EXCEPTION OF EX-OFFICIO TRUSTEES; (B) TO APPROVE THE ELECTION OF AND TO REMOVE ANY AND ALL OFFICERS OF THE CORPORATION; (C) TO DEVELOP AND APPROVE ALL ANNUAL OPERATING AND CAPITAL BUDGETS OF THE CORPORATION (INCLUDING ALL AMENDMENTS THERETO); (D) TO APPROVE THE INCURRENCE, RE-FINANCING, OR PREPAYMENT OF ANY INDEBTEDNESS OF THE CORPORATION; (E) TO APPROVE THE SECURING OF ANY MORTGAGE, DEED OF TRUST, PLEDGE, SECURITY INTEREST, OR OTHER ENCUMBRANCE OF THE CORPORATION; (F) EXCEPT AS MAY BE INVOLVED THEREAFTER IN ORDINARY REPAIRS, MAINTENANCE, AND REPLACEMENT, AND EXCEPT AS MAY HAVE ALREADY BEEN APPROVED AS PART OF THE CAPITAL BUDGET, TO APPROVE THE MAKING OF ANY CAPITAL EXPENDITURE OR CAPITAL ADDITION OR IMPROVEMENT; (G) TO APPROVE ALL UNBUDGETED EXPENDITURES IN EXCESS OF 1% OF EACH SUCH BUDGET; (H) TO APPROVE THE MOVEMENT OF FUNDS TO AND FROM THIS CORPORATION TO THE PARENT OR OTHER ENTITIES RELATED TO THE PARENT; (I) TO APPROVE ALL STRATEGIC PLANS OF THE CORPORATION; (J) TO SELECT THE INDEPENDENT AUDITORS AND LEGAL COUNSEL OF THE CORPORATION; (K) TO AMEND OR TO APPROVE AMENDMENTS, ALTERATIONS AND MODIFICATIONS TO OR REPEALS OF THE ARTICLES OF INCORPORATION AND BYLAWS OF THE CORPORATION IN ACCORDANCE WITH SECTION 12.1; (L) TO ENTER INTO, AMEND, OR TERMINATE ANY AGREEMENT WITH A MATERIAL THIRD PARTY PAYOR OF THE CORPORATION, AS DETERMINED BY THE PARENT IN ITS SOLE DISCRETION; (M) TO APPROVE ALL AMENDMENTS TO ARTICLES OF INCORPORATION, MERGERS, CONSOLIDATIONS, DIVISIONS, SALES OF SUBSTANTIALLY ALL ASSETS, LIQUIDATION OR DISSOLUTION OF THE CORPORATION, AND ALL OTHER FUNDAMENTAL CHANGE TRANSACTIONS, AS WELL AS ALL TRANSACTIONS OUTSIDE THE ORDINARY COURSE OF BUSINESS; (N) TO ESTABLISH, TERMINATE, OR WITHDRAW FROM ANY SUBSIDIARY, JOINT VENTURE, OR OTHER PARTNERSHIP OR SHARED GOVERNANCE AGREEMENT; TO ENTER INTO, AMEND, OR TERMINATE ANY AGREEMENT BETWEEN THE CORPORATION AND THE PARENT; (P) TO ENTER INTO, AMEND, OR TERMINATE AN AFFILIATION AGREEMENT WITH ANY HOSPITAL, PROVIDER, PAYOR, OR HEALTH CARE SYSTEM; (Q) TO APPROVE ANY MATERIAL CHANGE IN MISSION OR STRATEGIC DIRECTION OF THE CORPORATION; AND (R) TO TAKE ANY OTHER ACTION THAT IS RESERVED TO THE PARENT FROM TIME TO TIME BY THE CORPORATION'S BOARD OF TRUSTEES. FORM 990, PART VI, SECTION B, LINE 11B THE 990 WAS PROVIDED TO THE BOARD OF DIRECTORS AND TO THE MOUNT NITTANY HEALTH SYSTEM AUDIT COMMITTEE BEFORE BEING FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY, THE CONFLICT OF INTEREST POLICY IS DISTRIBUTED TO KEY MEMBERS OF THE ORGANIZATION INCLUDING BOARD MEMBERS, OFFICERS, AND KEY EMPLOYEES. EACH PERSON MUST REPORT ANY POTENTIAL CONFLICTS OF INTEREST. REPORTED CONFLICTS ARE THEN REVIEWED BY THE CORPORATE COMPLIANCE OFFICER AND THE HEALTH SYSTEM'S AUDIT COMMITTEE. THE CONFLICT OF INTEREST REPORT IS THEN SUBMITTED TO THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD OF DIRECTORS' EXECUTIVE & PHYSICIAN COMPENSATION COMMITTEE REVIEWS COMPENSATION PAID TO EXECUTIVE MANAGEMENT TEAM IN CONJUNCTION WITH AN INDEPENDENT THIRD PARTY CONSULTING FIRM TO ENSURE COMPENSATION IS REASONABLE AND APPROPRIATE FOR DUTIES AND RESPONSIBILITES ASSIGNED. THE PROCESS IS DESIGNED TO ENABLE THE HEALTH SYSTEM TO ATTRACT, MOTIVATE AND RETAIN THE HIGHLY SKILLED EXECUTIVE TALENT NEEDED TO CARRY OUT ITS MISSION AND STRATEGIC OBJECTIVES THROUGH THE ESTABLISHMENT OF SALARIES, BENEFITS, AND VARIABLE PAY OPPORTUNITIES THAT ARE REASONABLE, COMPARABLE WITH THOSE FOR SIMILAR POSITIONS IN SIMILARLY SITUATED NOT-FOR-PROFIT ORGANIZATIONS, AND REWARD ACHIEVEMENT OF ORGANIZATIONAL AND INDIVIDUAL OBJECTIVES. THE EXECUTIVE & PHYSICIAN COMPENSATION COMMITTEE ENSURES THAT THE BOARD FULLY UNDERSTANDS THE PROCESS BY WHICH THE ORGANIZATION'S OFFICERS/KEY EMPLOYEE COMPENSATION DECISIONS ARE MADE. THE COMMITTEE REVIEWS AND APPROVES EXECUTIVE COMPENSATION IN A MANNER THAT QUALIFIES FOR THE REBUTTABLE PRESUMPTION OF REASONABLENESS UNDER THE IRS INTERMEDIATE SANCTIONS RULES. THE COMMITTEE REPORTS ITS ACTIVITIES TO THE BOARD, INCLUDING THE SPECIFIC DETAILS OF COMPENSATION ACTIONS. THE BOARD HAS DELEGATED TO THE COMMITTEE THE AUTHORITY TO MAKE COMPENSATION DECISIONS. THE BOARD BEARS THE ULTIMATE RESPONSIBILITY FOR ENSURING SOUND DECISION-MAKING IN THIS AREA. REVIEW AND APPROVAL OF COMPENSATION IS DOCUMENTED VIA MINUTES OF COMMITTEE MEETINGS. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: PENSION LIABILITY ADJUSTMENT -3,439,232. CHANGE IN BENEFICIAL INTEREST IN PERPETUAL TRUSTS -1,009. CHANGE IN INTEREST IN THE FOUNDATION FOR MOUNT NITTANY 2,985,440. CHANGE IN INTEREST IN PARTNERSHIP -440,896. THE FOUNDATION FOR MOUNT NITTANY MEDICAL CENTER INC 1800 EAST PARK AVENUE STATE COLLEGE PA 168036796 571138956 FUNDRAISING AND SUPPORT FOR MOUNT NITTANY MEDICAL CENTER PA 501(C)(3) LINE 12A, I MOUNT NITTANY MEDICAL CENTER 1 MOUNT NITTANY MEDICAL CENTER WORKMEN'S COMPENSATION SELF INSURANCE TRUST 1800 EAST PARK AVENUE STATE COLLEGE PA 168036796 256440788 PROVIDE WORKMAN'S COMPENSATION BENEFITS TO EMPLOYEES OF MNMC PA 501(C)(3) LINE 12A, I MOUNT NITTANY MEDICAL CENTER 1 MOUNT NITTANY MEDICAL CENTER HEALTH SERVICES INC 1800 EAST PARK AVENUE STATE COLLEGE PA 168036796 510426500 PROFESSIONAL SERVICES TO SUPPORT MNMC PA 501(C)(3) LINE 10 MOUNT NITTANY HEALTH SYSTEM 0 MOUNT NITTANY HEALTH SYSTEM 1800 EAST PARK AVENUE STATE COLLEGE PA 168036796 800663092 PROVIDE MANAGEMENT AND ADMINISTRATIVE SUPPORT TO MNMC & SUBSIDIARIES PA 501(C)(3) LINE 12A, I N/A 0 CENTRE COUNTY CHILDREN'S ADVOCACY CENTER 1800 EAST PARK AVENUE STATE COLLEGE PA 16803 460871813 CHILD-FOCUSED APPROACH TO CHILD ABUSE CASES PA 501(C)(3) LINE 7 MOUNT NITTANY MEDICAL CENTER 1 0 1 1 0 0 0 0 0 0 1 1 0 1 1 1 0 1 1 1 FOUNDATION FOR MOUNT NITTANY MEDICAL CENTER B 310386 CASH FOUNDATION FOR MOUNT NITTANY MEDICAL CENTER O 429682 COST OF SHARING PAID EMPLOYEES CENTRE COUNTY CHILDREN'S ADVOCACY CENTER B 157612 CASH CENTRE COUNTY CHILDREN'S ADVOCACY CENTER O 240585 COST OF SHARING PAID EMPLOYEES