2018-05-15T10:55:29-05:00 2017-06-30 550486667 ARNETT CARBIS TOOTHMAN LLP 5700 CORPORATE DRIVE STE 650 PITTSBURGH PA 15237 990 2016-07-01 250461835 ELLWOOD CITY HOSPITAL ELLW 7247526819 724 PERSHING STREET ELLWOOD CITY PA 16117 WILLIAM MATTHEWS ACTING CEO/CFO 7247526819 2018-05-14 1 JEFFREY J PETRELL CPA P00138808 4126356270 2018-05-14 2016 2022-09-23 18:48:47Z WILLIAM MATTHEWS 724 PERSHING STREET ELLWOOD CITY PA 16117 30645846 0 X WWW.THEELLWOODCITYHOSPITAL.ORG X 1913 PA THE ELLWOOD CITY HOSPITAL IS AN ACUTE CARE GENERAL HOSPITAL CONSISTING OF 52 ACUTE CARE AND SWING BEDS AND 10 BEHAVIORAL HEALTH BEDS. THE HOSPITAL PROVIDES INPATIENT, PATIENT, HOME HEALTH CARE AND EMERGENCY ROOM SERVICES TO THE TRI-COUNTY AREA OF LAWRENCE, BUTLER, AND BEAVER COUNTIES. THE OBJECTIVES OF THIS CORPORATION SHALL BE TO MAINTAIN, SUPPORT, AND MANAGE, WITHIN A 100 MILE RADIUS OF THE BORO OF ELLWOOD CITY, PA, A GENERAL HOSPITAL, HOME HEALTH SERVICES, PHARMACY SERVICES, PHYSICAL THERAPY SERVICES AND WELLNESS SERVICES, FOR DIAGNOSTIC AND TREATMENT SERVICES TO ALL PATIENTS THROUGHOUT THE RANGE FROM PREVENTIVE SERVICES THROUGH REHABILITATION WITHOUT REGARD TO RAVE, ANCESTRY, RELIGION, OR ABILITY TO PAY. 12 11 408 66 0 0 4546780 8815930 24449190 20843671 34581 10536 1030789 437737 30061340 30107874 0 0 0 0 17783333 17449431 0 0 0 11785677 12125218 29569010 29574649 492330 533225 43909862 37258551 21377091 19594373 22532771 17664178 X THE OBJECTIVES OF THIS CORPORATION SHALL BE TO MAINTAIN, SUPPORT, AND MANAGE, WITHIN A 100-MILE RADIUS OF THE BOROUGH OF ELLWOOD CITY, PA, A GENERAL HOSPITAL, EMERGENCY SERVICES, HOME HEALTH SERVICES, PHARMACY SERVICES, PHYSICAL THERAPY SERVICES AND WELLNESS SERVICES, FOR DIAGNOSTIC AND TREATMENT SERVICES TO ALL PATIENTS THROUGH OUT THE RANGE FROM PREVENTIVE SERVICES THROUGH REHABILITATION WITHOUT REGARD TO RACE, ANCESTRY, RELIGION OR ABILITY TO PAY. 0 0 21754547 21559757 FROM JULY 1, 2016 TO JUNE 30, 2017, THE HOSPITAL PROVIDED INPATIENT SERVICES TO 1,323 PATIENTS ACCUMULATING 8,332 DAYS OF PATIENT CARE. IN ADDITION TO INPATIENT AND SWING BED CARE, THE HOSPITAL PROVIDES 24-HOUR EMERGENCY ROOM SERVICES. DURING THE FISCAL YEAR, THE HOSPITAL HAD EMERGENCY VISITS OF 11,889. THE ELLWOOD CITY HOME HEALTH AGENCY PROGRAM HAD VISITS OF 19,160. DURING THE FISCAL YEAR, SERVICES ARE PROVIDED TO ALL PATIENTS WITHOUT REGARD TO RAVE, COLOR, NATIONAL ORIGIN, ANCESTRY, AGE, RELIGIOUS CREED, OR HANDICAP. THE HOSPITAL MAINTAINS RECORDS TO IDENTIFY AND MONITOR THE LEVEL OF CHARITY CARE IT PROVIDES. THESE RECORDS INCLUDE THE AMOUNT OF CHAGRES FOR-GONE FOR SERVICES AND SUPPLIES FURNISHED UNDER ITS CHARITY CARE POLICY. DURING THE FISCAL YEAR, THE HOSPITAL PROVIDED UNCOMPENSATED AND CHARITY CARE IN THE AMOUNT OF $1,242,000. IN ADDITION TO CHARITY AND UNCOMPENSATED CARE, SERVICES ARE PROVIDED UNDER THE MEDICAID PROGRAM TO FINANCIALLY NEEDY PATIENTS. THE HOSPITAL ALSO CO-SPONSORS THE ELLWOOD CITY MEALS ON WHEELS PROGRAM BY PROVIDING THE PREPARATION OF FOODS FOR ALL MEALS SERVED. THE ELLWOOD CITY HOSPITAL AND THE ELLWOOD CITY HOSPITAL AUXILIARY ALSO PROVIDE A TECH ALERT SYSTEM FOR THE ELDERLY, YEARLY (AS WELL AS THROUGHOUT THE YEAR) INFORMATIONAL FAIRS, SUCH AS PRENATAL CLASSES, SIBLING CLASSES, BABYSITTING CLASSES, NATIONAL SAFETY BELT/SAFETY WEEK, BREAST CANCER AWARENESS WEEK, PROSTATE SCREENINGS, AND GENERAL HEALTH SCREENINGS TO NAME A FEW. THE HOSPITAL AND AUXILIARY ALSO PARTICIPATE WITH VARIOUS LOCAL, CIVIC, AND SCHOOL GROUPS TO PROVIDE OUTREACH SERVICES TO THE TRI-COUNTY AREA. SUCH PROGRAMS INCLUDE KINDERGARTEN TOURS OF THE HOSPITAL, A VOLUNTEER PROGRAM, AND USE OF THE HOSPITAL AS A CLINICAL SITE FOR AREA NURSING STUDENTS. THE HOSPITAL ALSO ENCOURAGES ITS EMPLOYEES TO BECOME INVOLVED WITH VOLUNTEER SERVICES SUCH AS THE UNITED WAY, THE RED CROSS ANNUAL BLOOD DRIVE, AND VARIOUS COMMUNITY PROJECTS. THE ELLWOOD CITY HOSPITAL, IN CORPORATION WITH HIGHMARK BLUE CROSS BLUE SHIELD, OFFERS A LOW COST COVERAGE PROGRAM CALLED SPECIAL CARE AND THE CARING PROGRAM SPECIAL CARE IS DESIGNED FOR INDIVIDUALS AND FAMILIES WITH LOW INCOMES WHO ARE INELIGIBLE FOR GOVERNMENT ASSISTANCE AND THE CARING PROGRAM IS FOR CHILDREN OF LOW INCOME FAMILIES. 21754547 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 108 0 408 1 0 0 0 0 0 0 0 0 X 12 11 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 PA X WILLIAM MATTHEWS 7247526819 724 PERSHING STREET ELLWOOD CITY PA 16117 CAROLYN IZZO PRESIDENT/CEO (7/1/16-5/6/17) 56.00 4.00 X X 223280 0 16884 CHRISTY SPOA CHAIRMAN 2.00 1.00 X X 0 0 0 GUS FORNATARO TREASURER 2.00 0.50 X X 0 0 0 ALAN DAMBACH SECRETARY 2.00 0.50 X X 0 0 0 BEVERLY ANNARUMO PRESIDENT/CEO (5/7/17-6/30/17) 56.00 4.00 X X 79976 0 1261 CLYDE BARTLEY MEMBER 2.00 0.50 X 0 0 0 GERALD CROWLEY MEMBER 2.00 0.50 X 0 0 0 SHARIEE DECOOMAN MEMBER 2.00 0.50 X 0 0 0 MARY ANN DIBIAGIO MEMBER 2.00 0.50 X 0 0 0 PETRA NOUR MEMBER 2.00 0.50 X 0 0 0 MARK SCHNURER MEMBER 2.00 0.50 X 0 0 0 ARTHUR SMILEK MEMBER 2.00 1.00 X 0 0 0 MARK TOMASZEWSKI MEMBER 2.00 0.50 X 0 0 0 CHRISTOPHER M LITTLE CFO 44.00 6.00 X 214056 0 20275 KRISTI B GARMA DIRECTOR OF REHAB SVCS/BUS 25.00 25.00 X 104520 0 3083 621832 0 41503 3 0 1 0 HORIZON HEALTH PO BOX 840839 DALLAS TX 75284 BEHAVIORAL HEALTH MANAGEMENT 687500 PHARMACY SYSTEMS INC 5050 BRADENTON AVE DUBLIN OH 43017 MEDICAL SERVICES 533445 DIVERSIFIED CLINICAL SERVICES 28525 NETWORK PLACE CHICAGO IL 60673 WOUND CARE SERVICES 254608 ALLEGHENY HEALTH NETWORK EMERGENCY GROUP PO BOX 19011 BELFAST ME 04915 EMERGENCY ROOM PHYSICIAN 250000 LABCORP OF AMERICA 231 MAPLE AVE BURLINGTON NC 27216 LABORATORY TESTING 152119 9 1340 1245 8784500 18903 9942 8815930 MEDICAL SERVICES 900099 20843671 20843671 20843671 18124 18124 166356 495096 -328740 -328740 -328740 7588 -7588 -7588 -7588 19700 1245 8420 11280 11280 48657 26868 21789 21789 MISCELLANEOUS 900099 541430 541430 MEALS ON WHEELS/CAFETERIA 900099 191978 191978 733408 30107874 21598868 0 -306924 555732 555732 14020638 11261772 2758866 324663 251499 73164 1529973 1214950 315023 1018425 788919 229506 1336290 1336290 56690 56690 21406 908 20498 2361907 2361274 633 664424 1949 662475 90598 53950 36648 3020 249 2771 157013 9484 147529 1106417 1106417 437184 437184 CONTRACTED SERVICE HOSP 4591100 4591100 REPAIRS & MAINTENANCE 948448 948448 BLOOD BANK/OUTSIDE TEST 269677 269677 OTHER 74651 368 74283 6393 6393 29574649 21754547 7820102 0 603611 641383 2521009 2601869 75237 563903 495615 2721084 2879551 38969238 32353127 7656008 6616111 351136 29417874 24024022 43909862 37258551 4299306 4661330 4657805 4311823 12419980 10621220 21377091 19594373 X 21284668 16339927 13156 0 1234947 1324251 22532771 17664178 43909862 37258551 X 533225 94497 -5496315 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 2076 2076 0 PART II-B, LINE 1: THE ELLWOOD CITY HOSPITAL HOLDS MEMBERSHIP IN THE HOSPITAL & HEALTH SYSTEM ASSOCIATION OF PENNSYLVANIA (HAP) AND THE HOSPITAL COUNCIL OF WESTERN PENNSYLVANIA (HCWP) WHICH ENGAGE IN LOBBYING AS PART OF THEIR MISSION TO REPRESENT THE INTEREST OF HOSPITALS AT BOTH THE FEDERAL AND STATE LEVELS. 54546 54546 12068925 9111998 2956927 25934858 22825462 3109396 910909 415667 495242 6616111 INTEREST IN FOUNDATION ASSETS 23255644 DUE FROM SUBSIDIARIES AND FOUNDATION 18938 MALPRACTICE INSURANCE RECOVERY 272931 INVESTMENT IN ELLWOOD CITY HEALTH ORG., INC. 201437 INVESTMENT IN CHART 71000 INVESTMENT IN VANTAGE 204072 24024022 MINIMUM PENSION LIABILITY 10175887 MALPRACTICE INSURANCE CLAIMS 272931 TOSHIBA CAPITAL LEASE 172402 10621220 X 30592983 495096 495096 30097887 9987 9987 30107874 30062754 495096 495096 29567658 6991 6991 29574649 PART X, LINE 2: THE ORGANIZATION HAS ADOPTED THE STANDARD FOR ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES. THE STANDARD CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES BY PRESCRIBING THE RECOGNITION THRESHOLD A TAX POSITION IS REQUIRED TO MEET BEFORE BEING RECOGNIZED IN THE FINANCIAL STATEMENTS. IT ALSO PROVIDES GUIDANCE ON DERECOGNITION, CLASSIFICATION, INTEREST AND PENALTIES, ACCOUNTING IN INTERIM PERIODS, DISCLOSURE, AND TRANSITION. PART XI, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES NETTED WITH REVENUE 495,096. PART XI, LINE 4B - OTHER ADJUSTMENTS: AUXILIARY INCOME 9,987. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES NETTED WITH REVENUE 495,096. PART XII, LINE 4B - OTHER ADJUSTMENTS: AUXILIARY INCOME 6,991. GOLF OUTING 20945 1245 19700 5400 2520 500 20945 1245 19700 5400 2520 500 8420 11280 TEST 1 1 1 X 300.000000000000 1 X 1 1 0 0 169165 169165 0.00570 3890772 1953164 1937608 0.06550 4059937 1953164 2106773 0.07120 443713 69624 374089 0.01260 443713 69624 374089 0.01260 4503650 2022788 2480862 0.08380 0 1241842 4549447 4549447 X 1 1 1 1 ELLWOOD CITY HOSPITAL 724 PERSHING STREET ELLWOOD CITY PA 16117 HTTP://WWW.THEELLWOODCITYHOSPITAL.ORG X X X ELLWOOD CITY HOSPITAL 0 0 1 X X X X X X X X X 15 1 0 0 1 X WWW.THEELLWOODCITYHOSPITAL.ORG X 1 15 1 WWW.THEELLWOODCITYHOSPITAL.ORG 0 1 X 300.000000000000 350.000000000000 X X X 1 1 X X X X 1 X WWW.THEELLWOODCITYHOSPITAL.ORG X WWW.THEELLWOODCITYHOSPITAL.ORG X X X X 1 X 0 1 0 0 ELLWOOD CITY HOSPITAL PART V, SECTION B, LINE 5: THE PRIMARY INTERVIEW DATA INCLUDED OPINIONS FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVED BY THE HOSPITAL AND INCLUDED THOSE WITH SPECIAL KNOWLEDGE AND EXPERTISE OF PUBLIC HEALTH ISSUES. ARNETT CARBIS TOOTHMAN, AN INDEPENDENT ACCOUNTING FIRM, WORKED TOGETHER WITH THE ELLWOOD CITY HOSPITAL COMMUNITY HEALTH NEEDS ASSESSMENT STEERING COMMITTE TO DEVELOP A BROAD LIST OF COMMUNITY LEADERS TO INTERVIEW. THESE COMMUNITY MEMBERS WERE SELECTED BASED ON THEIR INVOLVEMENT WITHIN THE COMMUNITY AND BECAUSE THEY PROVIDED DISTINCTIVE BACKGROUNDS AND A VARIETY OF PERSPECTIVES ON THE STATE OF THE COMMUNITY AND HEALTH CARE. INTERVIEWS WERE CONDUCTED WITH A NUMBER OF DIRECTORS AND STAFF MEMBERS FROM COMMUNITY HEALTH CENTERS, MEMBERS FROM SOCIAL SERVICES ORGANIZATIONS, EDUCATIONAL LEADERS, RELIGIOUS GROUPS, AND ELECTED OFFICIALS. THE SELECTED PARTICIPANTS GIVE AN OVERARCHING VIEWPOINT OF THE COMMUNITY AND THROUGH THESE INTERVIEWS THE HEALTH NEEDS FROM THE PERSPECTIVE OF THE COMMUNITY WERE IDENTIFIED. ELLWOOD CITY HOSPITAL PART V, SECTION B, LINE 11: THE ELLWOOD CITY HOSPITAL IS ADDRESSING THE SIGNIFICANT NEEDS IDENTIFIED IN ITS MOST RECENTLY CONDUCTED CHNA BY THE ADOPTION AND EXECUTION OF AN IMPLEMENTATION STRATEGY THAT ADDRESSES EACH COMMUNITY HEALTH NEED. THE HOSPITAL PARTICIPATED IN THE DEVELOPMENT OF A COMMUNITY-WIDE PLAN AND IMPLEMENTED THE STRATEGY BY PRIORITIZING THE COMMUNITY HEALTH NEEDS AND THE SERVICES THAT THE HOSPITAL WILL UNDERTAKE TO MEET THE HEALTH NEEDS. IN ADDITION, A BUDGET WAS ADOPTED FOR THE SERVICES THAT WOULD BE PROVIDED BY THE HOSPITAL TO ADDRESS THE IDENTIFIED COMMUNITY HEALTH NEEDS. A NEED THAT IS NOT BEING ADDRESSED IS DRUG AND ALCOHOL ABUSE. THE HOSPITAL DOES NOT HAVE A DRUG AND ALCOHOL INPATIENT UNIT AND DOES NOT HAVE THE RESOURCES THAT WOULD BE REQUIRED TO EFFECT THE CHANGES THAT ARE NEEDED TO ADEQUATELY ADDRESS THE LACK OF DRUG AND ALCOHOL ABUSE CARE IN ITS SERVICE ARE. HOWEVER, THIS NEED IS BEING ADDRESSED BY NUMEROUS PROGRAMS AND INITIATIVES OPERATED BY OTHER COMMUNITY PARTNERS WITHIN LAWRENCE COUNTY AND SURROUNDING AREAS. THE HOSPITAL SUPPORTED BRINGING IN A NEW SUBOXONE DRUG ADDICTION TREATMENT CENTER TO THE COMMUNITY. THE HOSPITAL WILL CONTINUE TO EVALUATE AND INTENDS TO ADDRESS IN A FUTURE PLAN. 3 1 - ELLWOOD CITY HOSPITAL BEHAVIORAL HEALTH 724 PERSHING STREET ELLWOOD CITY PA 16117 AN INPATIENT GERIATRIC BEHAVIORAL HEALTH UNIT THAT OPERATES AS A COST CENTER 2 - ELLWOOD CITY HOSPITAL HOME HEALTH AGENCY 402 BEATTY STREET ELLWOOD CITY PA 16117 A HOME HEALTH AGENCY THAT OPERATES AS A COST CENTER WITHIN THE HOSPITAL 3 - ZELIENOPLE DIAGNOSTIC CENTER 241 NORTH PERRY HIGHWAY UNIT 1 HARMONY PA 16037 AN OUTPATIENT DIAGNOSTIC CENTER THAT OPERATES AS A COST CENTER PART I, LINE 7: THE AMOUNTS DERIVED FOR CHARITY CARE AND CERTAIN OTHER COMMUNITY BENEFITS AT COST WERE CALCULATED USING THE HOSPITAL'S OWN INTERNAL REPORTING SYSTEM IN ACCESSING TOTAL CHARGES FOR EACH CATEGORY WHERE APPLICABLE. THE SYSTEM ADDRESSES ALL PATIENT SEGMENTS. COSTS FOR EACH OF THE AREAS WERE DERIVED USING WORKSHEET 2 FROM SCHEDULE H INSTRUCTIONS, "RATIO OF PATIENT CARE COST-TO-CHARGES." PART III, LINE 4: THE BAD DEBT EXPENSE AT COST WAS DETERMINED BASED ON THE HOSPITAL'S REPORTED BAD DEBT EXPENSE AT GROSS AND MULTIPLIED BY THE "RATIO OF PATIENT CARE COST-TO-CHARGES" FROM WORKSHEET 2 FROM SCHEDULE H INSTRUCTIONS. THE HOSPITAL'S FINANCIAL STATEMENTS STATE THAT MANAGEMENT ALSO PROVIDED FOR BAD DEBTS, WHICH PRIMARILY RELATE TO PATIENT RECEIVABLES FROM INDIVIDUALS, WHICH IT DETERMINES ARE UNCOLLECTABLE. THE HOSPITAL'S FINANCIAL STATEMENTS DO NOT INCLUDE A FOOTNOTE THAT FURTHER DESCRIBES BAD DEBT EXPENSE. BAD DEBT EXPENSE IS ACCOUNTED FOR BY ESTIMATING ON A MONTHLY BASIS THE AMOUNT OF BAD DEBT EXPENSE BASED ON HISTORICAL REIMBURSEMENT FOR OUTSTANDING ACCOUNTS RECEIVABLE BALANCES BY PAYOR AND TAKING INTO ACCOUNT THE AGING OF SUCH RECEIVABLES ALONG WITH ACTUAL ACCOUNTS WRITTEN OFF. PART III, LINE 8: MEDICARE ALLOWABLE COSTS OF CARE WERE DERIVED FROM THE MEDICARE COST REPORT WITH REIMBURSEMENT BASED ON THE PROSPECTIVE PAYMENT SYSTEM. OVERHEAD COSTS WERE ALLOCATED BASED ON STATISTICAL ALLOCATIONS TO THE HOSPITAL'S ANCILLARY DEPARTMENTS AFTER DEPARTMENTAL RECLASSES AND ADJUSTMENTS. PART III, LINE 9B: THE HOSPITAL'S COLLECTION POLICY DOES CONTAIN PROVISIONS ON THE COLLECTIONS PRACTICES TO BE FOLLOWED FOR PATIENTS WHO ARE KNOWN TO QUALIFY FOR CHARITY CARE OR FINANCIAL ASSISTANCE. PATIENTS WHO ARE KNOWN TO QUALIFY FOR CHARITY CARE WILL REMAIN A QUALIFYING PATIENT FOR SIX MONTHS FOLLOWING INITIAL QUALIFICATION. THESE PATIENTS ARE TRACKED AND EVALUATED ON ANY SUBSEQUENT STAY THAT MAY OR MAY NOT OCCUR IN THE FOLLOWING SIX MONTHS. THE COLLECTION POLICY ALSO COVERS THOSE PATIENTS WHO ARE UNINSURED AND THE PROCESS IN WHICH THEY CAN RECEIVE FINANCIAL ASSISTANCE IN THE FORM OF DISCOUNTS AND/OR PAYMENT ARRANGEMENTS. IF ACCOUNTS ARE NOT PAID IN FULL OR PAYMENT ARRANGEMENTS ARE NOT FOLLOWED, THEN FOLLOW-UP LETTERS ARE INITIATED AS A FRIENDLY REMINDER. IF THE ACCOUNT BECOMES DELINQUENT, THE ACCOUNT IS CONSIDERED FOR REFERRAL TO BAD DEBT. PART VI, LINE 2: THE ORGANIZATION ASSESSED THE HEALTH CARE NEEDS FOR THE COMMUNITIES IT SERVES BY PERFORMING A COMPREHENSIVE PROCESS THAT INCLUDED A COMBINATION OF COMMUNITY FEEDBACK, HOSPITAL STAFF REPRESENTATION, CONTRIBUTING SOCIAL AGENCY LEADERS AND GOVERNMENTAL OFFICIALS, AND SELECTED PRIMARY AND SECONDARY SOURCES OF DATA TO DISTINGUISH AREAS FOR IMPROVEMENT. THE PRIMARY INTERVIEW DATA INCLUDED OPINIONS FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVED BY THE HOSPITAL AND INCLUDED THOSE WITH SPECIAL KNOWLEDGE AND EXPERTISE OF PUBLIC HEALTH ISSUES. CONVENTIONAL HEALTH GUIDES AS WELL AS DEMOGRAPHIC, ECONOMIC, SOCIAL, AND ENVIRONMENTAL FACTORS WERE EVALUATED, THE DATA WAS UTILIZED TO ADDRESS THE IDENTIFIED HEALTH NEEDS OF THE SERVICE AREA, TO HELP PRIORITIES, AND TO PROVIDE RECOMMENDATIONS TO THE HOSPITAL ON THE WAYS TO MEET THE COMMUNITY HEALTH NEEDS. PART VI, LINE 3: THROUGH THE COMBINATION OF THE HOSPITAL'S PATIENT CREDIT AND COLLECTION POLICY AND THE COMMUNITY CARE GUIDELINES POLICY, GUARANTORS ARE INFORMED AND EDUCATED ABOUT THEIR AVAILABILITY FOR ASSISTANCE PROGRAMS OR CHARITY CARE. THERE ARE PHYSICAL POSTINGS IN THE HOSPITAL FOR PATIENTS TO READ. ALSO WRITTEN ON PATIENT STATEMENTS ARE INSTRUCTIONS REGARDING HOW TO APPLY FOR ASSISTANCE OR CHARITY CARE. ALSO, THE HOSPITAL FINANCIAL ASSISTANCE FORMS ARE ON ITS WEBSITE. THE UNINSURED ARE INFORMED OF THE AVAILABILITY OF A MEDICAL ASSISTANCE APPLICATION AND A CHARITY CARE APPLICATION IF THEY ARE NOT EXPECTING TO QUALIFY FOR MEDICAL ASSISTANCE. PART VI, LINE 4: ELLWOOD CITY HOSPITAL IS LOCATED IN RURAL WESTERN PENNSYLVANIA SERVING PRIMARILY LAWRENCE, BUTLER, AND BEAVER COUNTIES. THE LOCAL COMMUNITY USED TO BE A THRIVING STEEL INDUSTRY AREA AND NOW CONSISTS OF AN AGING POPULATION. APPROXIMATELY 56% OF THE HOSPITAL'S PATIENTS ARE MEDICARE RECIPIENTS AND 11% ARE UNINSURED OR MEDICAID RECIPIENTS. PART VI, LINE 5: THE HOSPITAL'S BOARD OF DIRECTORS IS COMPRISED OF BUSINESS PEOPLE WHO RESIDE IN THE PRIMARY SERVICE AREA WITH AN INTEREST IN THE CONTINUATION OF THE HOSPITAL IN PROVIDING MEDICAL SERVICES TO THE POPULATION. THE HOSPITAL EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY FOR ALL DEPARTMENTS. THE HOSPITAL IS ALSO PURSUING ARRANGEMENTS WITH OTHER HOSPITALS FOR ADDITIONAL PHYSICIAN STAFF TO PROVIDE HEALTH SERVICES. RESERVE CAPITAL FUNDS ALONG WITH CONTINUING OPERATIONS ARE BEING USED TO IMPROVE PATIENT CARE THROUGH THE PURCHASE OF UPDATED MEDICAL EQUIPMENT. SERVICES ARE PROVIDED TO ALL PATIENTS WITHOUT REGARD TO RACE, COLOR, NATIONAL ORIGIN, ANCESTRY, AGE, RELIGIOUS CREED, OR HANDICAP. SERVICES ARE PROVIDED UNDER THE MEDICAID PROGRAM TO FINANCIALLY NEEDY PATIENTS. THE HOSPITAL ALSO CO-SPONSORS THE ELLWOOD CITY MEALS ON WHEELS PROGRAM BY PROVIDING THE PREPARATION OF FOODS FOR ALL MEALS SERVED. THE ELLWOOD CITY HOSPITAL AND ELLWOOD CITY HOSPITAL AUXILIARY ALSO PROVIDE A TECH ALERT SYSTEM FOR THE ELDERLY, YEARLY (AS WELL AS THROUGHOUT THE YEAR) INFORMATIONAL FAIRS, SUCH AS NATIONAL SAFETY BELT/SAFETY WEEK, BREAST CANCER AWARENESS WEEK, PROSTATE SCREENINGS, AND GENERAL HEALTH SCREENINGS TO NAME A FEW. THE HOSPITAL AND AUXILIARY ALSO PARTICIPATE WITH VARIOUS LOCAL, CIVIC, AND SCHOOL GROUPS TO PROVIDE OUTREACH SERVICES TO THE TRI-COUNTY AREA. SUCH PROGRAMS INCLUDED KINDERGARTEN TOURS OF THE HOSPITAL, A VOLUNTEER PROGRAM, AND THE USE OF THE HOSPITAL AS A CLINICAL SITE FOR AREA NURSING STUDENTS. THE HOSPITAL ALSO ENCOURAGES ITS EMPLOYEES TO BECOME INVOLVED WITH VOLUNTEER SERVICES SUCH AS THE UNITED WAY, THE RED CROSS ANNUAL BLOOD DRIVE AND VARIOUS COMMUNITY PROJECTS. THE ELLWOOD CITY HOSPITAL, IN COOPERATION WITH HIGHMARK BLUE CROSS BLUE SHIELD, OFFERS A LOW COST COVERAGE PROGRAM CALLED SPECIAL CARE AND THE CARING PROGRAM. SPECIAL CARE IS DESIGNATED FOR INDIVIDUALS AND FAMILIES WITH LOW INCOMES WHO ARE INELIGIBLE FOR GOVERNMENT ASSISTANCE AND THE CARING PROGRAM IS FOR CHILDREN OF LOW-INCOME FAMILIES. X X X X 0 0 0 0 0 0 0 0 0 CAROLYN IZZO PRESIDENT/CEO (7/1/16-5/6/17) 215837 0 7443 0 0 0 2558 0 14326 0 240164 0 0 0 CHRISTOPHER M LITTLE CFO 210825 0 3231 0 0 0 5406 0 14869 0 234331 0 0 0 FORM 990, PART VI, SECTION A, LINE 6 THE ELLWOOD CITY HOSPITAL FOUNDATION IS THE SOLE MEMBER OF THE HOSPITAL. FORM 990, PART VI, SECTION A, LINE 7A THE ELLWOOD CITY HOSPITAL FOUNDATION'S BYLAWS STATE THAT THE FOUNDATION AS SOLE MEMBER OF THE HOSPITAL SHALL ELECT ALL OF THE HOSPITAL BOARD MEMBERS. FORM 990, PART VI, SECTION A, LINE 7B THE HOSPITAL'S BOARD OF TRUSTEES WILL ALWAYS BE COMPRISED OF AT LEAST ONE MEMBER FROM THE ELLWOOD CITY HOSPITAL FOUNDATION'S BOARD OF TRUSTEES. AS A RESULT, THE HOSPITAL BOARD MAY NOT TAKE CERTAIN ACTIONS WITHOUT APPROVAL OF THE FOUNDATION SUCH AS: APPROVAL OF THE HOSPITAL'S BUDGET, MAKING STRATEGIC PLANNING DECISIONS, AUTHORIZING OR ENGAGING IN MARKETING OR COMMUNITY EDUCATION PROGRAMS, AND RESOURCE ALLOCATION. IN ADDITION, THE FOUNDATION WILL ENGAGE IN ALL FUNDRAISING ACTIVITIES ON BEHALF OF THE HOSPITAL AND HOLD, SUBJECT TO BOARD OR DONOR RESTRICTIONS, THE HOSPITAL'S INVESTMENT AND ENDOWMENT FUNDS AND MAKE INVESTMENT DECISIONS REGARDING THESE FUNDS. THEREFORE, THE FOUNDATION WILL EXERCISE A SUBSTANTIAL DEGREE OF DIRECTION OVER THE POLICIES, PROGRAMS AND ACTIVITIES OF THE HOSPITAL FORM 990, PART VI, SECTION B, LINE 11B THE ELLWOOD CITY HOSPITAL PREPARES ITS FORM 990 IN DRAFT FORM. IT IS REVIEWED BY MANAGEMENT OF THE ORGANIZATION FOR FINAL APPROVAL. MANAGEMENT THEN DISTRIBUTES THE COMPLETED FORM 990 AND ACCOMPANYING SCHEDULES TO ALL MEMBERS OF THE BOARD FOR REVIEW PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE ELLWOOD CITY HOSPITAL ANNUALLY REQUIRES ITS BOARD MEMBERS, OFFICERS, AND KEY EMPLOYEES TO FILL OUT A CONFLICT OF INTEREST FORM DURING BOARD MEETINGS. IF AN INTERESTED PARTY HAS A CONFLICT, HE OR SHE RECUSES THEMSELVES FROM VOTING. FORM 990, PART VI, SECTION B, LINE 15 THE ELLWOOD CITY HOSPITAL'S BOARD OF DIRECTORS REVIEWS AND APPROVES THE COMPENSATION OF THEIR ORGANIZATION'S TOP MANAGEMENT. FORM 990, PART VI, SECTION C, LINE 19 AT THE TIME, THE ELLWOOD CITY HOSPITAL DOES NOT MAKE ITS GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY AVAILABLE TO THE GENERAL PUBLIC SINCE IT IS NOT REQUIRED TO DO SO UNDER CURRENT LAWS. FORM 990, PART XI, LINE 9: LIABILITY FOR PENSION BENEFITS 1,691,025. PERMANENTLY RESTRICTED CHANGE IN NET REALIZED GAIN/LOSS -5,195. LOSS FROM SUBSIDIARY OPERATIONS -1,488,467. CHANGE IN FOUNDATION VALUE -5,693,678. ELLWOOD CITY HOSPITAL GIFT SHOP 724 PERSHING STREET ELLWOOD CITY PA 16117 251010071 GIFT SHOP AND FUNDRAISING PA 46185 16150 ELLWOOD CITY HOSPITAL ELLWOOD CITY HOSPITAL FOUNDATION 724 PERSHING STREET ELLWOOD CITY PA 16117 274160006 FOUNDATION PA 501(C)(3) LINE 12C, III-FI N/A 0 ELLWOOD CITY HEALTH ORGANIZATION INC 724 PERSHING STREET ELLWOOD CITY PA 16117 251801004 HEALTHCARE PA ELLWOOD CITY HOSPITAL C -1442297 364296 1.00000 1 APPLE OCCUPATIONAL HEALTH SERVICES INC 724 PERSHING STREET ELLWOOD CITY PA 16117 251801003 HEALTHCARE PA ELLWOOD CITY HEALTH ORGANIZATION INC C 0 OUTREACH CARE GROUP INC 724 PERSHING STREET ELLWOOD CITY PA 16117 251801005 HEALTHCARE PA ELLWOOD CITY HEALTH ORGANIZATION INC C 0 0 1 1 0 0 0 0 0 0 1 0 1 1 0 1 0 1 0 0 ELLWOOD CITY HEALTH ORGANIZATION INC C 40000 ELLWOOD CITY HEALTH ORGANIZATION INC B 1539689