2017-05-11T14:10:18-05:00 2016-06-30 390859910 BAKER TILLY VIRCHOW KRAUSE LLP 1650 MARKET STREET SUITE 4500 PHILADELPHIA PA 19103 990 2015-07-01 240795436 GNADEN HUETTEN MEMORIAL HOSPITAL GNAD 6103777003 211 NORTH 12TH STREET LEHIGHTON PA 182351195 ANDREA ANDRAE CHIEF FINANCIAL OFFICER 6103777003 2017-05-11 1 JULIUS C GREEN CPA P00350393 2159720701 2015 2021-01-29 14:40:06Z ANDREA L ANDRAE 211 NORTH 12TH STREET LEHIGHTON PA 182351195 63998307 0 X WWW.BLMTN.ORG X 1947 PA OPERATES A 90 BED ACUTE CARE HOSP, A 91 BED SKILLED NURSING FACILITY & A HOME HEALTH CARE AGENCY. 19 14 874 61 0 0 303390 1527152 61784089 60779425 120311 32120 909992 1521027 63117782 63859724 399747 0 0 0 31306513 32508600 0 0 0 29162254 29101653 60868514 61610253 2249268 2249471 40434679 41500306 43521294 53064100 -3086615 -11563794 X PROMOTE, MAINTAIN AND RESTORE THE GOOD HEALTH OF ALL THE PEOPLE IN THE COMMUNITIES WE SERVE THROUGH PARTNERSHIPS FOR EXCELLENCE IN HEALTHCARE SERVICE DELIVERY. 0 0 52155752 60874993 GNADEN HUETTEN MEMORIAL HOSPITAL (THE "HOSPITAL"), LOCATED IN LEHIGHTON, PENNSYLVANIA, IS A 90-BED, NOT-FOR-PROFIT GENERAL ACUTE CARE HOSPITAL SERVING THE RESIDENTS OF CARBON, SCHUYLKILL AND MONROE COUNTIES. THE HOSPITAL'S SERVICES PROVIDE BOTH INPATIENT AND OUTPATIENT CARE, INCLUDING HOME HEALTH CARE, MEDICAL/SURGICAL SERVICES, MENTAL HEALTH SERVICES AND ACUTE REHABILITATION SERVICES. THE HOSPITAL ALSO OFFERS A BROAD ARRAY OF ANCILLARY SERVICES SUCH AS RADIOLOGY, EMERGENCY, CARDIOLOGY AND REHABILITATION SERVICES.DURING THE PERIOD OF JULY 1, 2015 THROUGH JUNE 30, 2016, THE HOSPITAL HAD A TOTAL OF 3,143 ADMISSIONS AND 17,079 PATIENT DAYS. TOTAL OCCUPANCY FOR THE HOSPITAL WAS 50.86%. IN ADDITION, THERE WERE A TOTAL OF 17,414 EMERGENCY ROOM VISITS AND 24,097 HOME HEALTH CARE VISITS. IN ADDITION TO THE SERVICES PROVIDED AS INDICATED ABOVE, THE HOSPITAL ALSO PROVIDES LONG-TERM CARE SERVICES THROUGH AN ON-CAMPUS 91-BED SKILLED NURSING UNIT. DURING THE PERIOD OF JULY 1, 2015 THROUGH JUNE 30, 2016, THE SKILLED NURSING UNIT HAD 279 ADMISSIONS AND PATIENT DAYS OF 31,324. TOTAL OCCUPANCY FOR THE SKILLED NURSING UNIT WAS 94.31%. 52155752 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 38 0 1 874 1 0 0 0 0 0 0 0 0 0 0 X 19 14 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 PA X ANDREA L ANDRAE CFO 6103777003 211 NORTH 12TH STREET LEHIGHTON PA 18235 MICHAEL HARLEMAN CHAIRMAN 1.00 3.00 X X 0 0 0 LOUIS SPORTELLI DC VICE CHAIRMAN 1.00 3.00 X X 0 0 0 BARBARA GREEN BOARD FINANCE CHAIR 1.00 3.00 X X 0 0 0 PATRICK HANLEY DO SECRETARY/PHYSICIAN 1.00 3.00 X X 17450 0 0 ANDREW E HARRIS PRESIDENT & CEO 15.00 35.00 X X 545082 0 46485 JOHN DEMATTE IV DC DIRECTOR 1.00 3.00 X 0 0 0 WILLIAM MASON DIRECTOR 1.00 3.00 X 0 0 0 WILLIAM H FEGLEY JR DIRECTOR 1.00 3.00 X 0 0 0 REV ROBERT VONFRISCH DIRECTOR 1.00 3.00 X 0 0 0 PATRICK REILLY DIRECTOR 1.00 3.00 X 0 0 0 SHELBA SCHEFFNER DIRECTOR 1.00 3.00 X 0 0 0 WILLIAM MARKSON MD DIRECTOR 1.00 3.00 X 0 0 0 JAIME MENDES DIRECTOR 1.00 3.00 X 0 0 0 ROBERT GROB DO DIRECTOR/PHYSICIAN 1.00 3.00 X 85313 36562 0 HON STEVEN SERFASS DIRECTOR 1.00 3.00 X 0 0 0 WILLIAM KISSNER DIRECTOR 1.00 3.00 X 0 0 0 CONRAD BIEGE DIRECTOR 1.00 3.00 X 0 0 0 JAMES SHOBER III DIRECTOR 1.00 3.00 X 0 0 0 GARY WENTZ DIRECTOR 1.00 3.00 X 0 0 0 ANDREA L ANDRAE CHIEF FINANCIAL OFFICER 15.00 35.00 X 0 186972 30154 KATHLEEN R NOLL PHYSICIAN 40.00 X 326437 0 6109 HAMAYUN N AHMED PHYSICIAN 40.00 X 317115 0 15843 BRIAN A LEFROCK PHYSICIAN 40.00 X 259189 0 15837 DENNIS KONDASH VP OF MEDICAL AFFAIRS 40.00 X 216477 0 14542 VITALY SAWYNA PHYSICIAN 40.00 X 206078 0 4688 1973141 223534 133658 24 0 1 0 CARDIOLOGY ASSOCIATES 1241 BLAKESLEE BLVD LEHIGHTON PA 18235 ADMINISTER CARDIOLOGY PROGRAM 1195719 F J LESHER GENERAL CONTRACTOR 4195 FIRELINE ROAD PALMERTON PA 18071 CONTRACTING SERVICES 296110 MAHONING VALLEY ORTHOPEDICS 246 NORTH 6TH STREET LEHIGHTON PA 18235 ADMINISTER ORTHOPEDICS PROGRAM 170000 3 1241202 54827 231123 1527152 NET PATIENT SERVICE REV 621990 60779425 60779425 60779425 32120 32120 187616 138583 49033 49033 49033 MEANINGFUL USE 622000 612765 612765 CHART INCOME 900099 249821 249821 CAFETERIA MEALS 900099 204688 204688 404720 95568 309152 1471994 63859724 60874993 0 1457579 X 560271 496272 63999 24074783 21324732 2750051 304854 270031 34823 5054738 4477337 577401 2513954 2226786 287168 204898 204898 96218 96218 736 736 7424641 5436226 1988415 218403 4214 214189 2282649 1828781 453868 1732162 635594 1096568 998130 998130 139964 125587 14377 1612 1612 571312 571312 2502165 2502165 1311833 1311833 BAD DEBT EXPENSE 3936302 3936302 MEDICAL SUPPLIES 3859771 3859771 DRUGS 1536095 1536095 ACT 55 ASSESS. PAYMENTS 725287 725287 1559475 1185896 373579 61610253 52155752 9454501 0 1700 1700 157784 7318593 7382000 768970 747198 346061 433614 69110338 53762730 16516049 15347608 2392869 2945107 13090437 14485295 40434679 41500306 9583508 10411115 6041257 24892089 87790 11895 27808739 17749001 43521294 53064100 X -3136953 -11725023 125000 50338 36229 -3086615 -11563794 40434679 41500306 X 2249471 -10726650 X 1 X 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 736 736 0 PART II-B, LINE 1: A PORTION OF THE DUES PAID TO THE HOSPITAL & HEALTH SYSTEM ASSOCIATION OF PENNSYLVANIA ($736) WAS DETERMINED TO BE FOR LOBBYING PURPOSES. 50338 -14109 36229 62955 -12617 50338 66907 -3952 62955 73600 6693 66907 86624 13024 73600 0.00000 1.00000 0.00000 0 0 477770 477770 26573253 19148758 7424495 1169116 424368 744748 39149523 33271431 5878092 1740676 918173 822503 15347608 DUE FROM PALMERTON HOSPITAL 11488572 BENEFICIAL INTEREST IN PERPETUAL TRUST 36229 DEFERRED FINANCING COSTS, NET 369898 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 369368 INSURANCE RECOVERIES RECEIVABLE 1792904 DEFERRED COMPENSATION PLAN ASSET 280851 OTHER ASSETS 147473 14485295 OBLIGATIONS UNDER CAPITAL LEASES 1357047 BLUE CROSS WORKING CAPITAL ADVANCE 304227 PENSION LIABILITY 13745970 ESTIMATED MEDICAL MALPRACTICE CLAIMS LIABILITY 2185572 DEFERRED GIFT ANNUITIES PAYABLE 41559 OFFICE RENTAL DEPOSIT 114626 17749001 X 53271657 -10726650 -10726650 63998307 -138583 -138583 63859724 61748836 138583 138583 61610253 0 61610253 PART V, LINE 4: TERM ENDOWMENT FUNDS ARE USED FOR THE PURCHASE OF PLANT AND EQUIPMENT TO FURTHER THE MISSION OF THE ORGANIZATION. PART X, LINE 2: GNADEN HUETTEN MEMORIAL HOSPITAL IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL INCOME TAXES ON ITS EXEMPT INCOME UNDER SECTION 501(A) OF THE INTERNAL REVENUE CODE. THE HOSPITAL ACCOUNTS FOR UNCERTAINTY IN INCOME TAXES USING A RECOGNITION THRESHOLD OF MORE-LIKELY-THAN-NOT TO BE SUSTAINED UPON EXAMINATION BY THE APPROPRIATE TAXING AUTHORITY. MEASUREMENT OF THE TAX UNCERTAINTY OCCURS IF THE RECOGNITION THRESHOLD HAS BEEN MET. MANAGEMENT HAS DETERMINED THERE WERE NO TAX UNCERTAINTIES THAT MET THE RECOGNITION THRESHOLD. THE HOSPITAL'S FEDERAL EXEMPT ORGANIZATION BUSINESS INCOME TAX RETURNS FOR YEARS AFTER 2012 REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. PART XI, LINE 2D - OTHER ADJUSTMENTS: PENSION LIABILITY ADJUSTMENT -10,712,541. VALUATION LOSS -14,109. PART XI, LINE 4B - OTHER ADJUSTMENTS: RENTAL EXPENSES -138,583. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 138,583. 1 1 X 1 X 1 X 1 1 0 1 1 847636 117501 730135 0.01270 13183149 5800127 7383022 0.12800 14030785 5917628 8113157 0.14070 354455 72240 282215 0.00490 9904 9904 0.00020 6122091 4080841 2041250 0.03540 6486450 4153081 2333369 0.04050 20517235 10070709 10446526 0.18120 1 3936302 393630 18902945 19980141 -1077196 X 1 1 1 1 GNADEN HUETTEN MEMORIAL HOSPITAL 211 NORTH 12TH STREET LEHIGHTON PA 18235 X X X SKILLED NURSING FACILITY GNADEN HUETTEN MEMORIAL HOSPITAL INC 1 0 0 1 X X X X X X X X X 15 1 1 1 1 X WWW.BLMTN.ORG/WHY-BMHS/2016-COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ X 1 15 1 WWW.BLMTN.ORG/WHY-BMHS/2016-COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ 0 0 1 X 200.000000000000 400.000000000000 X 1 1 X X X 1 X WWW.BLMTN.ORG X WWW.BLMTN.ORG X X X 1 X 0 X X X X 1 X 0 0 GNADEN HUETTEN MEMORIAL HOSPITAL, INC. PART V, SECTION B, LINE 5: THE CHNA INCLUDED THREE SEPARATE DATA COLLECTION STRATEGIES: 1) AN ANALYSIS OF EXISTING SECONDARY DATA AND EXISTING COMMUNITY HEALTH MEASURES. AS PART OF THIS, IN-HOUSE AT BMHS, A COMMUNITY BENEFIT PLAN STEERING COMMITTEE WAS FORMED AND PROVIDED INPUT PRIOR TO THE NEEDS ASSESSMENT. THE COMMITTEE WAS COMPOSED OF SENIOR MANAGEMENT AND DEPARTMENT HEADS WITHIN THE HEALTH SYSTEM. 2) A FOCUS GROUP CONDUCTED ON MAY 11, 2016 DURING A REGULARLY SCHEDULED MEETING OF THE CARBON COUNTY INTERAGENCY COUNCIL. THE CARBON COUNTY INTERAGENCY COUNCIL IS COMPOSED OF LEADERSHIP FROM NUMEROUS AGENCIES AND ORGANIZATIONS, REPRESENTING MATERNAL AND CHILD HEALTH, ELDER CARE, BEHAVIORAL HEALTH, COUNTY INFRASTRUCTURE, HEALTHCARE PROVIDERS AND SOCIAL SERVICES. IN ATTENDANCE AT THE MEETING WERE REPRESENTATIVES FROM THE FOLLOWING ORGANIZATIONS: CARBON MONROE PIKE DRUG & ALCOHOL COMMISSION, CARBON MONROE PIKE MENTAL HEALTH/DEVELOPMENT SERVICES, DOMESTIC VIOLENCE SERVICE CENTER, PATHSTONE/HEAD START, VICTIMS RESOURCE CENTER, PANTHER VALLEY SCHOOL DISTRICT, TURN TO US, OPERATION CAREER WEAR, PA LINK TO AGING AND DISABILITIES, COUNTY COMMISSIONERS GERHARD AND NOTHSTEIN, AND STATE REPRESENTATIVE HEFFLEY. AND 3) KEY INFORMANT SURVEYS AND INTERVIEWS. KEY INFORMANTS FROM THE FOLLOWING PROFESSIONAL FIELDS/WORKPLACES WERE SURVEYED: FAMILY PRACTICE PHYSICIANS, CARBON CAREER & TECHNICAL INSTITUTE, THE ASSISTANT DIRECTOR OF WORKFORCE/COMMUNITY SERVICES AT A COMMUNITY COLLEGE, FAMILY PRACTICE NURSE PRACTITIONERS, AND STATE HEALTH NURSES WITH THE PA DEPARTMENT OF HEALTH. GNADEN HUETTEN MEMORIAL HOSPITAL, INC. PART V, SECTION B, LINE 6A: GNADEN HUETTEN MEMORIAL HOSPITAL COLLABORATED WITH THE PALMERTON HOSPITAL. GNADEN HUETTEN MEMORIAL HOSPITAL, INC. PART V, SECTION B, LINE 6B: EAST CENTRAL PENNSYLVANIA AREA HEALTH EDUCATION CENTER GNADEN HUETTEN MEMORIAL HOSPITAL, INC. PART V, SECTION B, LINE 11: THE COMMUNITY HEALTH NEEDS ASSESSMENT IDENTIFIED HEALTH PROBLEMS THE COMMUNITY FACES AND BARRIERS THAT KEEP RESIDENTS OF THE COMMUNITY FROM BEING HEALTHY. THE PRIORITY AREAS OF NEEDS WERE CLEARLY IDENTIFIED THROUGHOUT THE ASSESSMENT PROCESS TO BE: DRUG ADDICTION (HEROIN, OPIOIDS/NARCOTICS), DIABETES, OBESITY, MENTAL HEALTH, DENTAL HEALTH, AND OTHER CHRONIC ILLNESSES (HEART DISEASE, HYPERTENSION/STROKE, AND CANCER). THE BARRIERS TO GOOD HEALTH IDENTIFIED THROUGHOUT THE ASSESSMENT PROCESS WERE: COMPLEXITY OF CURRENT HEALTHCARE SYSTEM, NOTABLY HIGH DEDUCTIBLES, ACCESS TO COMMUNITY SERVICES, PARTICULARLY PROVIDERS WHO ACCEPT MA AND UNINSURED POPULATIONS EMPHASIZING MENTAL AND DENTAL HEALTH, LACK OF PREVENTION/EDUCATION/TREATMENT SERVICES, PARTICULARLY RELATED TO DRUG ADDICTION, TRANSPORATION, AND SEDENTARY LIFESTYLE AND POOR DIET CONTRIBUTING TO OBESITY PROBLEMS ACROSS ALL AGES. THE HOSPITAL CONTINUES TO WORK ACROSS MANY OF THE OTHER IDENTIFIED NEEDS. AS THE NEEDS THAT WERE IDENTIFIED ARE NOT MUTUALLY EXCLUSIVE FROM ONE ANOTHER, IT IS THE HOSPITAL'S HOPE THAT BY ADEQUATELY ADDRESSING THE ABOVE NEEDS AND BARRIERS, THE OTHER NEEDS AND BARRIERS WILL BE INDRECTLY IMPACTED AS WELL. THE NEEDS THAT WERE IDENTIFIED BUT ARE NOT CURRENTLY BEING ADDRESSED ARE: ALZHEIMERS, MS/FIBROMYALGIA, LYME DISEASE, AND STD/CHLAMYDIA. GNADEN HUETTEN MEMORIAL HOSPITAL, INC. PART V, SECTION B, LINE 22D: THE AMOUNTS CHARGED WERE IN ACCORDANCE WITH THE HOSPITAL'S OVERALL FINANCIAL ASSISTANCE POLICY. PART I, LINE 7: THE COST TO CHARGE METHOD WAS USED. PART I, LINE 7G: SUBSIDIZED HEALTH SERVICES INCLUDED UNDER SCHEDULE H FOR THE GNADEN HUETTEN MEMORIAL HOSPITAL ARE THE EMERGENCY DEPARTMENT. THE EMERGENCY DEPARTMENT LOCATED AT GNADEN HUETTEN MEMORIAL HOSPITAL PROVIDES AROUND-THE-CLOCK EMERGENCY SERVICES TO THE SURROUNDING COMMUNITIES WITHIN CARBON COUNTY. CARE IS PROVIDED TO ALL PATIENTS, REGARDLESS OF THEIR ABILITY TO PAY OR THEIR INSURANCE STATUS. DURING FY2016, THE GNADEN HUETTEN MEMORIAL HOSPITAL EMERGENCY DEPARTMENT SAW 17,414 PATIENTS WITH A SUBSIDIZED COST TO PROVIDE THESE SERVICES OF $2,847,409, OF WHICH $806,158 IS INCLUDED IN THE MEDICAID SHORTFALL.WHILE WE ARE AWARE THAT EACH HOSPITAL IS REQUIRED TO STAND ALONE WITH REGARD TO THEIR COMMUNITY BENEFIT REPORTING, THE TWO HOSPITALS OF BLUE MOUNTAIN FUNCTION IN TANDEM TO DRIVE COMMUNITY BENEFIT STRATEGY. SUBSIDIZED HEALTH SERVICES INCLUDED UNDER SCHEDULE H FOR THE PALMERTON HOSPITAL ARE THE ADULT DAY SERVICES PROGRAM AND THE EMERGENCY DEPARTMENT. ADULT DAY SERVICES OF THE BLUE MOUNTAIN HEALTH SYSTEM OFFERS AN ALTERNATIVE TO NURSING CARE WHILE PROVIDING RESPITE FOR THOSE CARING FOR SOMEONE AT HOME. THE PROGRAM OFFERS A WARM, FRIENDLY ATMOSPHERE AND THE OPPORTUNITY FOR SENIORS TO DEVELOP FRIENDSHIPS WHILE PARTICIPATING IN ACTIVITIES THEY ENJOY. OUR EXPERIENCED STAFF INCLUDES REGISTERED NURSES, LICENSED PRACTICAL NURSES, CERTIFIED THERAPEUTIC RECREATION SPECIALISTS AND CERTIFIED NURSE AIDES. THE PALMERTON HOSPITAL PROVIDED SUBSIDIES OF APPROXIMATELY $134,000 TO THE ADULT DAY SERVICES CENTER DURING FY2016.THE EMERGENCY DEPARTMENT LOCATED AT PALMERTON HOSPITAL PROVIDES AROUND-THE-CLOCK EMERGENCY SERVICES TO THE SURROUNDING COMMUNITIES WITHIN CARBON COUNTY. CARE IS PROVIDED TO ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY OR THEIR INSURANCE STATUS. DURING FY2016, THE PALMERTON EMERGENCY DEPARTMENT SAW 11,708 PATIENTS WITH A SUBSIDIZED COST TO PROVIDE THESE SERVICES OF $1,900,441, OF WHICH $662,403 IS INCLUDED IN THE MEDICAID SHORTFALL. PART I, LN 7 COL(F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25(A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $3,936,302. PART II, COMMUNITY BUILDING ACTIVITIES: COMMUNITY OUTREACH PROGRAMS-PROVIDES MORE THAN 1,000 INFLUENZA VACCINES TO COMMUNITY RESIDENTS IN PARTNERSHIP WITH THE PA DEPARTMENT OF HEALTH AND THE CARBON COUNTY EMERGENCY MANAGEMENT AGENCY.-PARTICIPATES IN MORE THAN 25 COMMUNITY HEALTH FAIRS PROVIDING A VARIETY OF SCREENINGS - EMS, L.B. MORRIS ELEMENTARY SCHOOL, THE VILLAGE AT PALMERTON, CARBON COUNTY FAIR, WEST END FAIR, PALMERTON COMMUNITY FESTIVAL, LEHIGHTON LIONESS AND LIONS CLUB, PALMERTON LIONS CLUB, PALMER ELEMENTARY SCHOOL, LEHIGHTON RECREATION SENIOR FAIR, REP. DOYLE HEFFLEY SENIOR FAIR, WEATHERLY SCHOOL DISTRICT WELLNESS FAIR, PLEASANT VALLEY ACADEMIC HEALTH FAIR, 27TH ANNUAL CHILDREN'S HEALTH FAIR, AND COMMUNITY SAFETY DAY.-HOSTS FIVE HEALTH SUPPORT GROUPS IN THE COMMUNITY: BREAST CANCER, WEIGHT LOSS/BARIATRIC SURGERY, ADULT DAY CAREGIVER, THE SUMMIT CAREGIVER, DIABETES, AND OTHER SPECIALTY SUPPORT PROGRAMMING, SUCH AS 6-WEEK BEREAVEMENT WORKSHOP.-OFFERS FREE DIAGNOSTIC MAMMOGRAMS AND ULTRASOUNDS TO WOMEN AND MEN WHO ARE UNDER- OR NON-INSURED.-BMHS ADULT DAY CARE PROVIDES AN ALTERNATIVE TO NURSING CARE WHILE PROVIDING RESPITE FOR THOSE CARING FOR SOMEONE IN THEIR HOME.-PROVIDES A PHYSICIAN MEDICAL DIRECTOR FOR THE LOCAL ALS/BLS SERVICES IN THE SURROUNDING COMMUNITIES.-PROVIDES THE HEALTHY SMILES, HAPPY KIDS DENTAL VAN, PROVIDES PREVENTATIVE AND RESTORATIVE DENTAL CARE TO UNDER- AND NON-INSURED CHILDREN WITHIN CARBON COUNTY AND THE SURROUNDING AREAS.-HOSTS "LADIES NIGHT OUT," AN EDUCATIONAL EVENT FOR MORE THAN 200 PARTICIPANTS IN REGARDS TO AWARENESS ABOUT FEMALE CANCERS, ESPECIALLY BREAST CANCER.-SUPPORTS LOCAL COMMUNITY GROUPS, E.G., AMERICAN CANCER SOCIETY TELETHON, RELAY FOR LIFE, LIGHT THE NIGHT, AMERICAN LUNG ASSOCIATION, AMERICAN HEART ASSOCIATION, AND ALZHEIMER'S ASSOCIATION.-VARIOUS STAFF MEMBERS PARTICIPATE IN LOCAL CIVIC ORGANIZATIONS SUCH AS CARBON COUNTY INTERAGENCY COUNCIL, CARBON COUNTY SAFE KIDS COALITION, AMERICAN CANCER SOCIETY, LEHIGHTON ROTARY, JIM THORPE ROTARY, LEHIGHTON LIONESS AND LIONS CLUBS, PALMERTON LIONS AND LIONESS CLUB, CARBON COUNTY CHAMBER OF COMMERCE, AND PALMERTON CHAMBER OF COMMERCE.-PROMOTES VARIOUS PHYSICAL EXERCISE AND WELLNESS EVENT THROUGHOUT THE YEAR, INCLUDING THE GREAT AMERICAN SMOKE OUT AND WEAR RED DAYS. HOSTS THE BMHS 5K RUN/WALK THAT DRAWS 500 PARTICIPANTS ANNUALLY. PART III, LINE 2: TOTAL ADJUSTED OPERATING EXPENSES WERE APPROXIMATELY $62,019,927 FOR FY2016. TOTAL ADJUSTED PATIENT CHARGES WAS CALCULATED AS FOLLOWS: GROSS PATIENT CHARGES LESS GROSS CHARGES FOR COMMUNITY BENEFIT PROGRAMS. TOTAL ADJUSTED PATIENT CHARGES WERE APPROXIMATELY $102,670,610 FOR FY2016. PART III, LINE 3: MANAGEMENT DETERMINED APPROXIMATELY 10% OF THE TOTAL BAD DEBT EXPENSE REPORTED ON LINE 2 WAS ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY.MANAGEMENT CONSIDERED THIS TO BE REASONABLE BASED ON HISTORICAL ANALYSIS OF BAD DEBT EXPENSE. 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. IN EVALUATING THE COLLECTIBILITY OF PATIENT 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 COLLECTIONS AND PROVISION FOR BAD DEBTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE (WHICH INCLUDES PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL ANALYZES CONTRACTUAL AMOUNTS DUE AND PROVIDES AN ALLOWANCE FOR DOUBTFUL COLLECTIONS 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 HOSPITAL 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 COLLECTIONS. PART III, LINE 8: NONE OF THE MEDICARE SHORTFALL REPORTED IN LINE 8 WAS TREATED AS A COMMUNITY BENEFIT. AMOUNTS REPORTED ON LINE 6 WERE OBTAINED FROM THE MEDICARE COST REPORT. SERVING PATIENTS WITH GOVERNMENT HEALTH BENEFITS, SUCH AS MEDICARE, IS A COMPONENT OF THE COMMUNITY BENEFIT STANDARD THAT TAX-EXEMPT HOSPITALS ARE HELD TO. THIS IMPLIES THAT SERVING MEDICARE PATIENTS IS A COMMUNITY BENEFIT IN THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. PART III, LINE 9B: COLLECTION ACTIVITY WILL BE SUSPENDED DURING THE CONSIDERATION OF A COMPLETED FINANCIAL ASSISTANCE APPLICATION OR AN APPLICATION FOR ANY OTHER HEALTHCARE BRACKET (I.E. MEDICARE, PA MEDICAL ASSISTANCE, ETC.). A NOTE WILL BE ENTERED INTO THE PATIENT'S ACCOUNT, ALONG WITH ADDING INSURANCE PLAN CODE L97, TO SUSPEND COLLECTION ACTIVITY UNTIL THE FINANCIAL ASSISTANCE PROCESS IS COMPLETE. IF THE ACCOUNT HAS BEEN WITH A COLLECTION AGENCY, THE AGENCY WILL BE NOTIFIED BY TELEPHONE OR EMAIL TO SUSPEND COLLECTION EFFORTS UNTIL A DETERMINATION IS MADE. THIS NOTIFICATION WILL BE DOCUMENTED IN THE ACCOUNT NOTES. THE PATIENT WILL ALSO BE NOTIFIED VERBALLY THAT THE COLLECTION ACTIVITY WILL BE SUSPENDED DURING CONSIDERATION. IF A FINANCIAL ASSISTANCE DETERMINATION ALLOWS FOR A PERCENT REDUCTION BUT LEAVES THE PATIENT WITH A SELF-PAY BALANCE, PAYMENT TERMS WILL BE ESTABLISHED ON THE BASIS OF DISPOSABLE INCOME. PART VI, LINE 2: THE HOSPITALS OF THE BLUE MOUNTAIN HEALTH SYSTEM CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT, 2013-2016 AND DEVELOPED AN IMPLEMENTATION PLAN WITH STRATEGIES TO ADDRESS IDENTIFIED COMMUNITY HEALTH NEEDS. THE PROCESS, CONDUCTED BY EASTCENTRAL PA AREA HEALTH EDUCATION CENTER (ECPA AHEC), USED PRIMARY AND SECONDARY SURVEY DATA, KEY INFORMANT SURVEYS AND INTERVIEWS, AND A FOCUS GROUP TO IDENTIFY AND PRIORITIZE HEALTH PROBLEMS AND RISK FACTORS IN THE CARBON COUNTY SERVICE AREA. AFTER ANALYZING THIS DATA AND MAPPING EXISTING INTERNAL AND COMMUNITY BASED RESOURCES, BMHS DEVELOPED AN IMPLEMENTATION PLAN WITH EVIDENCE BASED STRATEGIES. THE IMPLEMENTATION PLAN WAS REVIEWED AND APPROVED BY THE BOARD OF DIRECTORS ON AUGUST 3, 2016. THE FINAL APPROVED VERSION OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION PLAN IS AVAILABLE TO THE PUBLIC ON THE HEALTH SYSTEM'S WEBSITE. WITH THE COLLABORATION AFFORDED BY BMHS LEADERSHIP AND KEY COMMUNITY PARTNERS, THE GOALS, OBJECTIVES AND OUTCOME MEASURES DEFINED FOR THE IMPLEMENTATION PLAN WILL BE REVIEWED ON AN ANNUAL BASIS FOR THE IMPROVEMENT AND POSITIVE IMPACT OF THE IDENTIFIED/PERCEIVED HEALTH NEEDS OF THE COMMUNITY. POST-ASSESSMENT MEETINGS WERE HELD WITH BOTH THE BLUE MOUNTAIN HEALTH SYSTEM'S COMMUNITY BENEFIT PLAN STEERING COMMITTEE AND THE CARBON COUNTY INTERAGENCY COUNCIL TO REPORT THE FINDINGS AND GAIN FURTHER INPUT AND ASSISTANCE WITH THE PRIORITIZATION OF HEALTH NEEDS. PART VI, LINE 3: IN ACCORDANCE WITH PENNSYLVANIA STATE REPORTING REQUIREMENTS, THE BLUE MOUNTAIN HEALTH SYSTEM'S CHARITY CARE EXPENSE IS REPORTED BASED UPON COSTS VERSUS CHARGES. CHARITY CARE INCLUDES THE HEALTH SYSTEM'S TRADITIONAL INPATIENT AND EMERGENCY SERVICES, AS WELL AS THE CARE PROVIDED AS PART OF EXTERNAL EDUCATIONAL PROGRAMS AND SERVICES SUCH AS THROUGH OUR FAMILY PLANNING PROGRAM.MORE PEOPLE WERE SERVED THROUGH THE HOSPITAL'S CHARITABLE CARE AND FINANCIAL ASSISTANCE PROGRAMS IN VIRTUALLY ALL CATEGORIES, AS FOLLOWS:- GNADEN HUETTEN MEMORIAL HOSPITAL CHARITABLE CARE PATIENTS- PALMERTON HOSPITAL CHARITABLE CARE PATIENTS- BLUE MOUNTAIN HEALTH SYSTEM'S "HEALTHY SMILES, HAPPY KIDS" DENTAL VANSIGNAGE IS VISIBLE IN ALL BLUE MOUNTAIN HEALTH SYSTEM POINTS OF REGISTRATION IN ORDER TO CREATE AWARENESS OF THE FINANCIAL ASSISTANCE PROGRAM. AT A MINIMUM, SIGNAGE IS POSTED IN ALL PATIENT INTAKE AREAS, INCLUDING, BUT NOT LIMITED TO, EMERGENCY DEPARTMENT, AND THE ADMISSION/PATIENT REGISTRATION AREA.IN RECENT YEARS, THE HEALTH SYSTEM HAS EXPANDED THE NUMBER OF FINANCIAL COUNSELORS AVAILABLE TO ASSIST PATIENTS. A KEY GOAL IS TO IDENTIFY COMMUNITY MEMBERS IN NEED SOONER. COUNSELORS PROACTIVELY SEEK OUT PATIENTS PRIOR TO TREATMENT IN AN EFFORT TO CONNECT THEM WITH PUBLIC INSURANCE PROGRAMS AS APPROPRIATE OR TO ENCOURAGE THEM TO COMPLETE AN ASSISTANCE APPLICATION. THE RESULT IS MORE CHARITY CARE AND LESS REPORTED AS BAD DEBT; MOST IMPORTANTLY, COMMUNITY MEMBERS ARE PROVIDED WITH THE SUPPORT TO ACCESS THE MEDICAL CARE THEY NEED. PART VI, LINE 4: LOCATED IN NORTHEASTERN PENNSYLVANIA, APPROXIMATELY 90 MILES WEST OF NEW YORK CITY AND 90 MILES NORTHEAST OF PHILADELPHIA, CARBON COUNTY IS BORDERED ON THE NORTH BY LUZERNE COUNTY, ON THE EAST BY MONROE COUNTY, ON THE WEST BY SCHUYLKILL COUNTY AND ON THE SOUTH BY LEHIGH AND NORTHAMPTON COUNTIES. THE NORTHERN AND EASTERN PORTIONS OF THE COUNTY ARE PART OF THE POCONO MOUNTAINS REGION OF THE COMMONWEALTH. HALF OF THE COUNTY'S GEOGRAPHIC AREA IS CONSIDERED "RURAL" ALTHOUGH DUE TO ITS PROXIMITY TO LEHIGH COUNTY IS TYPICALLY NOT CONSIDERED UNDERSERVED. AT THE CURRENT TIME, THE COUNTY IS EXPERIENCING GROWTH IN POPULATION AND INDUSTRY PRIMARILY RELATED TO THE WESTWARD MOVEMENT OF THE EAST COAST METROPOLITAN AREA. COMPARED TO 16.7% ON THE STATEWIDE LEVEL, 19.6% OF THE POPULATION OF CARBON COUNTY IS OLDER ADULTS, AGE 65 OR OLDER. THIS TREND IS EXPECTED TO CONTINUE.ACCORDING TO 2010 CENSUS ESTIMATES, APPROXIMATELY 96% OF INDIVIDUALS IN CARBON COUNTY IDENTIFIED THEIR RACE AS "WHITE". THE U.S. CENSUS BUREAU'S 2014 ESIMATES REFLECT THE SAME APPROXIMATE PERCENTAGE (96.1%). THE COUNTY LAGS BEHIND THE STATE OF PA AS A WHOLE IN THE PROPORTION OF AFRICAN AMERICANS AND OTHER MINORITIES. NEIGHBORING LEHIGH AND NORTHAMPTON COUNTIES, HOWEVER, SHOW STATISTICS OF 20% AND 11% OF HISPANICS/LATINOS (COMPARED TO 6% STATEWIDE).ACCORDING TO THE CENTER FOR WORKFORCE INFORMATION & ANALYSIS, CARBON COUNTY'S UNEMPLOYMENT RATE HAS BEEN TRENDING DOWNWARD SINCE A HIGH OF 11% IN 2009-2010. IT CURRENTLY STANDS AT 5.8%, RELATIVELY CLOSE TO THE STATE RATE OF 5.3%PER CAPITA PERSONAL INCOME OF CARBON COUNTY RESIDENTS IS LOWER THAN THE STATE AVERAGE: $38,866 VS $47,679. MEDIAN HOUSEHOLD INCOME IS $49,913 VS THE STATE'S $53,115.OVERALL, CARBON COUNTY RANKS 58TH (OF 67 COUNTIES) IN HEALTH OUTCOMES RELATED TO MORTALITY, MORBIDITY, HEALTH BEHAVIORS, CLINICAL CARE, SOCIAL & ECONOMIC FACTORS AND PHYSICAL ENVIRONMENT. NOTE THAT THIS IS A DECREASE SINCE THE 2013 COMMUNITY HEALTH NEEDS ASSESSMENT, WHEN CARBON COUNTY WAS RANKED 49TH OF 67 COUNTIES.THE COUNTY IS RANKED 60TH IN LENGTH OF LIFE AND 46TH IN QUALITY OF LIFE, WHICH INCLUDES POOR OR FAIR HEALTH, POOR PHYSICAL HEALTH DAYS, POOR MENTAL HEALTH DAYS, AND LOW BIRTH WEIGHT.NATIONAL 2016 STATISTICS CITE THAT APPROXIMATELY 11% OF THE NATION'S POPULATION DID NOT HAVE ANY TYPE OF HEALTH INSURANCE AT SOME POINT DURING THE YEAR. IN CARBON COUNTY, ESTIMATES SUGGEST THAT ROUGHLY 12% OF ALL ADULTS BETWEEN THE AGES OF 18 AND 65 LACKED HEALTH INSURANCE.ANOTHER MEASURE OF ACCESS TO CARE RELATES TO THE PRIMARY CARE PROVIDER RATE, OR THE POPULATION TO PHYSICIAN RATIO. THE NATIONAL BENCHMARK FOR POPULATION TO PRIMARY PHYSICIAN RATIO IS 1,040:1. IN PENNSYLVANIA, THAT RATIO IS 1,220:1, AND IN CARBON COUNTY THE RATIO IS 2,090:1, WELL ABOVE BOTH NATIONAL AND STATE PERCENTAGES.IN THE ORAL HEALTH FIELD, THE NATIONAL BENCHMARK (FOR DENTISTS) IS 1,340:1. IN PENNSYLVANIA, THE RATIO IS 1,550:1 AND IN CARBON COUNTY 2,390:1.IN THE MENTAL HEALTH FIELD, THE NATIONAL BENCHMARK FOR MENTAL HEALTH PROVIDERS IS 370:1. IN PENNSYLVANIA, THE RATIO IS 580:1, AND IN CARBON COUNTY, 1,840:1. PART VI, LINE 5: THE MEDICAL STAFF OF THE BLUE MOUNTAIN HEALTH SYSTEM IS AN OPEN MEDICAL STAFF ALLOWING SUBMISSIONS FOR PRIVILEGES AND CREDENTIALING FROM ANY INTERESTED PHYSICIAN OR SURGEON. THE BOARD OF DIRECTORS IS COMPRISED OF 17 INDIVIDUALS FROM VARIOUS COMMUNITY ORGANIZATIONS SUCH AS FINANCIAL INSTITUTIONS, TELECOMMUNICATION, RECREATION, AND REPRESENTATION FROM THE MEDICAL STAFF. OF THE 19 MEMBERS OF THE BOARD OF DIRECTORS, 13 RESIDE IMMEDIATELY WITHIN THE PRIMARY SERVICE AREA OF THE HEALTH SYSTEM. ALL OF THE BOARD MEMBERS ARE INDEPENDENT, WITH THE EXCEPTION OF THE PRESIDENT/CHIEF EXECUTIVE OFFICER AND FOUR OTHER DIRECTORS.BLUE MOUNTAIN HEALTH EDUCATION PROGRAMMING-PROVIDES MORE THAN 30 EDUCATIONAL PROGRAMS AND SCREENINGS - NATIONAL CHOLESTEROL MONTH DINNER & LECTURE PROGRAM, WEIGHT LOSS SURGERY, AARP DRIVING CLASS, LUNG CANCER EDUCATION, DIABETES EDUCATION, STRESS/STROKE SCREENINGS, CARBON COUNTY DOMESTIC VIOLENCE, FAMILY CAREGIVER TRAINING NIGHT, CARBON COUNTY DRUG & ALCOHOL PROGRAM; LOOK GOOD...FEEL BETTER WITH AMERICAN CANCER SOCIETY, NEW TO MEDICARE CO-SPONSORED WITH CARBON COUNTY AREA AGENCY ON AGING, HEART HEALTH FAIR, AMERICAN HEART MONTH LUNCH 'N LEARN, LET'S TALK ABOUT WOUND CARE AND ADULT DAY SERVICE, CARBON COUNTY SAFE KIDS AND SENATOR YUDICHAK COMMUNITY SAFETY DAY, PANTHER VALLEY CAREER DAY, SAFE KIDS CAR SEAT CHECK, AND MENTAL HEALTH DEPRESSION OUTREACH ASSESSMENTS.-SERVES AS A MEDICAL TRAINING/CLINICAL EDUCATION SITE FOR AREA COLLEGES AND SCHOOLS SUCH AS CEDAR CREST COLLEGE, WILKES UNIVERSITY, KING'S COLLEGE, KUTZTOWN UNIVERSITY, DESALES UNIVERSITY, MARYWOOD UNIVERSITY, UNIVERSITY OF SCRANTON, LEHIGH CARBON COMMUNITY COLLEGE, LINCOLN TECHNICAL INSTITUTE, NORTHAMPTON AREA COMMUNITY COLLEGE, PENNSYLVANIA STATE UNIVERSITY, JOHNSON SCHOOL OF TECHNOLOGY, AND PENNSYLVANIA COLLEGE OF OSTEOPATHIC MEDICINE.-PROVIDE CPR/BLS/ACLS/PALS TRAINING TO COMMUNITY ORGANIZATIONS SUCH AS AMBULANCE/EMS, FIRE, POLICE, AND TEACHERS.-PROVIDES "HEALTH IMAGES," A HEALTH SYSTEM-HOSTED TELEVISION PROGRAM FEATURING A VARIETY OF HEALTH AND WELLNESS INFORMATION AND EDUCATION.-HOSTS NEW SEASONS, A PROGRAM FOR ADULTS AGE 65 AND OLDER THAT OFFERS EXERCISE AND WELLNESS PROGRAMS SUCH AS YOGA AND LOW-IMPACT AEROBICS, NEW SEASONS HEARING AID BATTERY BANK, AND THE NEW SEASONS ANNUAL HEALTH & INFORMATION FAIR. PART VI, LINE 6: THE HOSPITALS OF THE BLUE MOUNTAIN HEALTH SYSTEM ARE REGIONAL PROVIDERS OF HEALTH CARE SERVICES TO THE PEOPLE LIVING IN CARBON COUNTY AND PARTS OF MONROE, LEHIGH, NORTHAMPTON AND SCHUYLKILL COUNTIES. BLUE MOUNTAIN HEALTH SYSTEM INCLUDES PALMERTON HOSPITAL, A 70-BED COMMUNITY HOSPITAL LOCATED IN PALMERTON; GNADEN HUETTEN MEMORIAL HOSPITAL, A 90-BED COMMUNITY HOSPITAL; THE SUMMIT AT BLUE MOUNTAIN, A 91-BED NURSING AND REHABILITATION CENTER, BOTH LOCATED IN LEHIGHTON AND AN ADULT DAY SERVICE CENTER IN PALMERTON. COMBINED, THESE FACILITIES HAVE BEEN SERVING THE FAMILIES OF OUR AREA FOR MORE THAN 150 YEARS. THE HOSPITALS OF THE BLUE MOUNTAIN HEALTH SYSTEM ARE FULLY ACCREDITED BY THE JOINT COMMISSION. DIAGNOSTIC OUTPATIENT SERVICES, INCLUDING ACUTE REHABILIATION, MAMMOGRAPHY, ULTRASOUND, CARDIAC REHABILITATION AND THE CLINICAL LABORATORY ARE ALSO ACCREDITED BY THEIR RESPECTIVE NATIONAL PROFESSIONAL ORGANIZATIONS. PART VI, LINE 7, REPORTS FILED WITH STATES PA X 1 1 X X X X 0 1 0 0 0 0 0 1 0 ANDREW E HARRIS PRESIDENT & CEO 412571 0 120752 0 11759 0 40251 0 6234 0 591567 0 0 0 ANDREA L ANDRAE CHIEF FINANCIAL OFFICER 0 161728 0 25244 0 0 0 14311 0 15843 0 217126 0 0 KATHLEEN R NOLL PHYSICIAN 326437 0 0 0 0 0 0 0 6109 0 332546 0 0 0 HAMAYUN N AHMED PHYSICIAN 317115 0 0 0 0 0 0 0 15843 0 332958 0 0 0 BRIAN A LEFROCK PHYSICIAN 259189 0 0 0 0 0 0 0 15837 0 275026 0 0 0 DENNIS KONDASH VP OF MEDICAL AFFAIRS 187426 0 29051 0 0 0 0 0 14542 0 231019 0 0 0 VITALY SAWYNA PHYSICIAN 206078 0 0 0 0 0 0 0 4688 0 210766 0 0 0 PART I, LINE 1A THE ORGANIZATION INCLUDED $1,814 OF CLUB DUES IN PRESIDENT/CEO ANDREW HARRIS' REPORTABLE INCOME ON HIS 2015 W-2. THIS AMOUNT WAS INCLUDED AS TAXABLE INCOME FOR MR. HARRIS. PART I, LINE 4B THE FOLLOWING INDIVIDUALS PARTICIPATED IN THE ORGANIZATION'S 457(F) SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN. NO DISTRIBUTIONS WERE MADE IN CALENDAR YEAR 2015. ANDREW E. HARRIS - PRESIDENT & CEO ANDREA L. ANDRAE - CFO PART I, LINE 7 THE BONUS PROGRAM AT THE BLUE MOUNTAIN HEALTH SYSTEM IS BASED ON FIVE DEFINED PILLARS OF SUCCESS. THESE 5 PILLARS INCLUDE FINANCE, QUALITY, SERVICE, PEOPLE, AND GROWTH. ALL EMPLOYEES OF THE HEALTH SYSTEM PARTICIPATE IN THE BONUS PROGRAM. THE BONUS PAYMENT IS DETERMINED BASED ON SPECIFIED CRITERIA FOR EACH OF THE 5 PILLARS INDICATED ABOVE ON A FISCAL YEAR BASIS. THE CRITERIA ARE PREDETERMINED AND HAVE BEEN ESTABLISHED BY SENIOR MANAGEMENT AND APPROVED BY THE BOARD OF DIRECTORS OF THE BLUE MOUNTAIN HEALTH SYSTEM. CERTAIN EMPLOYEES RECEIVED BONUSES UNDER THE PLAN IN FISCAL YEAR 2016. THE BONUSES ARE REPORTED ON THE EMPLOYEES' 2015 W-2S. A CARBON COUNTY HOSPITAL AUTHORITY 232280834 140868EN6 2012-02-23 6306819 CURRENT REFUNDING OF THE 1999 REVENUE BONDS 0 0 0 B CARBON COUNTY HOSPITAL AUTHORITY 232280834 140868EE6 2015-12-31 20000000 TO FUND THE PENSION LIABILITY, & CAPITAL IMPROVEMENTS 0 0 0 A 1551819 6306819 2687802 126068 41940 6138811 2012 1 0 1 1 B 20000000 2164519 2015 0 0 1 1 B 0 0 1 1 0 0.00000 0.00000 0.00000 1 0 0 A 0 1 0 0 1 0 0 0 0 B 0 1 0 0 1 0 0 0 0 A 0 B 0 PART III, LINE 9; PART IV, LINE 7; AND PART V WHILE THE HOSPITAL DOES NOT HAVE FORMAL WRITTEN PROCEDURES, THEY WORK CONTINUOUSLY WITH A BOND CONSULTANT TO ENSURE THAT THEY ARE IN COMPLIANCE. THE HOSPITAL IS CONSIDERING ADOPTING WRITTEN PROCEDURES IN A FUTURE YEAR. FORM 990, PART VI, SECTION A, LINE 1 AN EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS HAS THE BROAD AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. THE COMMITTEE IS COMPOSED OF SEVEN MEMBERS OF THE BOARD OF DIRECTORS AND INCLUDES ALL FOUR OFFICERS OF THE BOARD. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF THE CORPORATION IS BLUE MOUNTAIN HEALTH SYSTEM, INC., AN AFFILIATED PENNSYLVANIA NONPROFIT, NONSTOCK CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A AS SOLE MEMBER, BLUE MOUNTAIN HEALTH SYSTEM, INC. HAS THE POWER TO APPOINT AND REMOVE BOARD MEMBERS OF THE HOSPITAL. FORM 990, PART VI, SECTION A, LINE 7B AS SOLE MEMBER, BLUE MOUNTAIN HEALTH SYSTEM, INC. HAS THE POWER TO EXERCISE EACH OF THE FOLLOWING POWERS WITH RESPECT TO THE HOSPITAL, AND IF ANY ACTION RELATED TO THE EXERCISE OF ANY SUCH POWER IS INITIATED BY THE HOSPITAL, SUCH ACTION WILL NOT BECOME EFFECTIVE UNLESS APPROVED BY THE SOLE MEMBER: 1) THE POWER TO REQUIRE ITS APPROVAL BEFORE THE HOSPITAL IS PERMITTED TO INCUR ADDITIONAL DEBT AND THE POWER TO REQUIRE THE HOSPITAL TO PARTICIPATE IN THE INCURRENCE OF DEBT BY THE SOLE MEMBER; 2) THE POWER TO ESTABLISH AND/OR APPROVE THE STRATEGIC AND BUSINESS PLANS OF THE HOSPITAL IN ACCORDANCE WITH THE SOLE MEMBER'S PRESCRIBED OBJECTIVES; 3) THE POWER TO APPOINT AND/OR REMOVE THE PRESIDENT/CEO OF THE HOSPITAL; 4) THE POWER TO REQUIRE THE HOSPITAL TO MAKE CAPITAL CONTRIBUTIONS TO THE SOLE MEMBER; 5) THE POWER TO ESTABLISH AND APPROVE ANNUAL CAPITAL EXPENDITURE AND OPERATING BUDGETS OF THE HOSPITAL; 6) THE POWER TO REVIEW FINANCIAL REPORTS, INTERVENE IN MANAGEMENT AND OPERATIONS AND TRANSFER ASSETS TO OR FROM THE HOSPITAL; 7) THE POWER TO APPROVE THE HOSPITAL'S PARTICIPATION IN ALLIANCES, JOINT VENTURES, AFFILIATIONS OR OTHER RELATIONSHIPS WITH ENTITIES NOT CONTROLLED, DIRECTLY OR INDIRECTLY, BY THE SOLE MEMBER AND THE POWER TO REQUIRE THE HOSPITAL TO PARTICIPATE IN SUCH RELATIONSHIPS; 8) THE POWER TO APPROVE OR DISAPPROVE OF THE HOSPITAL'S PARTICIPATION IN MANAGED CARE CONTRACTS AND/OR OTHER HEALTH CARE SERVICE CONTRACTING ARRANGEMENTS, THE POWER TO REQUIRE THE HOSPITAL TO PARTICIPATE IN SUCH CONTRACTS OR ARRANGEMENTS, AND THE POWER TO ACT AS THE PRINCIPAL REPRESENTATIVE AND NEGOTIATING AGENT FOR THE HOSPITAL WITH REGARD TO SUCH CONTRACTS AND ARRANGEMENTS; 9) THE POWER TO APPROVE OR DISAPPROVE OF ADDITIONS, REVISIONS OR DISCONTINUATIONS IN HEALTH CARE SERVICES AND THE POWER TO REQUIRE THE HOSPITAL TO ADD, REVISE, RELOCATE OR DISCONTINUE HEALTH CARE SERVICES; 10) THE POWER TO APPROVE THE TRANSFER OF ASSETS BY THE HOSPITAL OUTSIDE OF THE HEALTH CARE SYSTEM CONTROLLED BY THE SOLE MEMBER; 11) THE POWER TO APPROVE THE OCCURRENCE OF THE FOLLOWING EVENTS: SALE, LEASE, EXCHANGE OF SUBSTANTIALLY ALL ASSETS; MERGER; CONSOLIDATION; DIVISION; DISSOLUTION; OR LIQUIDATION OF THE HOSPITAL; OR AMENDMENT OF ITS ARTICLES OF INCORPORATION; 12) THE POWER TO ESTABLISH AND FROM TIME TO TIME MODIFY THE HOSPITAL'S STRATEGIC PLANS; 13) THE POWER TO ESTABLISH AND FROM TIME TO TIME MODIFY INVESTMENT GUIDELINES APPLICABLE TO THE HOSPITAL; 14) THE POWER TO APPROVE THE SELECTION, RETENTION OR TERMINATION OF THE HOSPITAL'S EXTERNAL AUDITORS; AND 15) THE POWER TO ESTABLISH, AMEND, TERMINATE, MERGE OR CONSOLIDATE ANY BENEFIT PLANS INCLUDING, WITHOUT LIMITATION, THE POWER TO REVISE EXISTING BENEFIT PLANS AS NECESSARY TO MEET THE COVERAGE AND NONDISCRIMINATION REQUIREMENTS OF THE CODE AND REGULATIONS THEREUNDER. FORM 990, PART VI, SECTION B, LINE 11 THE BLUE MOUNTAIN HEALTH SYSTEM (BMHS) STAFF COMMUNICATED TO THE FINANCE COMMITTEE OF THE BOARD THAT THE FORMS 990 WERE PREPARED BY BAKER TILLY VIRCHOW KRAUSE, LLP, AS WELL AS COMMUNICATING THE GENERAL TYPES OF INFORMATION CONTAINED IN THE FILING. THE FORM 990 IS REVIEWED BY THE CEO, THE CFO, AND THE VP OF FUND DEVELOPMENT PRIOR TO ISSUANCE AND THE BOARD IS PROVIDED THE DETAILS TO ACCESS THE 990 THROUGH A SECURED BOARD "PORTAL" PRIOR TO ISSUANCE. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT STATEMENT MUST BE SIGNED ON AN ANNUAL BASIS BY ALL GOVERNING BODY MEMBERS, OFFICERS, AND KEY EMPLOYEES. THIS PROCESS IS MONITORED BY THE ADMINISTRATIVE ASSISTANT TO THE PRESIDENT/CEO. A CONFLICT IS CONSIDERED TO BE ANY DIRECT OR INDIRECT FINANCIAL INTEREST, AND ANY CONFLICTS NOTED ARE COMMUNICATED TO THE COMPLIANCE COMMITTEE. THERE WERE NO CONFLICTS DISCLOSED FOR THIS YEAR. IF A CONFLICT WERE TO EXIST, THE INTERESTED PERSON MAY NOT BE PRESENT DURING THE DISCUSSION OF, AND THE VOTE ON, THE TRANSACTION OR ARRANGEMENT THAT RESULTS IN THE CONFLICT OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15 SENIOR MANAGEMENT SALARIES ARE DETERMINED BY THE EXECUTIVE COMMITTEE USING MARKET VALUES OBTAINED. HUMAN RESOURCES PARTICIPATES IN VARIOUS SALARY SURVEYS TO DETERMINE THE CORRECT SALARY RANGE. THE APPALACHIAN HOSPITAL HUMAN RESOURCE SOCIETY CONDUCTS AN ANNUAL SALARY SURVEY FOR ALL POSITIONS. IN ADDITION, THE HOSPITAL ASSOCIATION OF PENNSYLVANIA CONDUCTS AN ANNUAL SURVEY WITH YAFFE ASSOCIATES FOR SENIOR MANAGEMENT EMPLOYEES. THE MARKET DATA IS ANALYZED BY HUMAN RESOURCES AND THE GOAL IS TO PAY AT THE 50TH PERCENTILE. SALARIES OF OTHER EMPLOYEES ARE RECOMMENDED BY HUMAN RESOURCES AND APPROVED BY THE PRESIDENT AND CEO. THE EXECUTIVE COMMITTEE OF THE BOARD SERVES AS THE COMPENSATION COMMITTEE AND APPROVES RECOMMENDATIONS FOR SALARY INCREASES. THE EXECUTIVE COMMITTEE APPROVES INCREASES FOR THE CEO. THE REVIEW AND APPROVAL PROCESS FOR SALARY INCREASES IS DOCUMENTED IN THE COMMITEE MINUTES. SENIOR MANAGEMENT HAS RECEIVED THE SAME GENERAL INCREASES AS THE STAFF EMPLOYEES RECEIVED. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 886,909. MANAGEMENT AND GENERAL EXPENSES 564,469. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,451,378. OUTSIDE PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 742,135. MANAGEMENT AND GENERAL EXPENSES 1,407,716. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,149,851. CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 1,268,496. MANAGEMENT AND GENERAL EXPENSES 16,230. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,284,726. PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 174,072. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 174,072. ADVERTISING SERVICES: PROGRAM SERVICE EXPENSES 164,780. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 164,780. REPAIRS & MAINTENANCE SERVICES: PROGRAM SERVICE EXPENSES 392,729. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 392,729. LAUNDRY SERVICES: PROGRAM SERVICE EXPENSES 83,071. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 83,071. MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 391,388. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 391,388. SOFTWARE CONTRACTS: PROGRAM SERVICE EXPENSES 114,452. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 114,452. FOOD SERVICES: PROGRAM SERVICE EXPENSES 151,054. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 151,054. MEDICAL SUPPLIES: PROGRAM SERVICE EXPENSES 1,067,140. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,067,140. FORM 990, PART XI, LINE 9: PENSION LIABILITY ADJUSTMENT -10,712,541. VALUATION LOSS -14,109. BLUE MOUNTAIN HEALTH SYSTEM INC 211 NORTH 12TH STREET LEHIGHTON PA 182351195 201311316 MAINTAINS AN INTEGRATED HEALTH CARE SYSTEM. PA 501(C)(3) LINE 11A, I N/A 0 CMS MEDICAL CARE CORPORATION 211 NORTH 12TH STREET LEHIGHTON PA 182351195 232473899 OWNS AND OPERATES AMBULATORY CARE CENTERS IN VARIOUS COMMUNITIES PA 501(C)(3) LINE 3 GNADEN HUETTEN MEMORIAL HOSPITAL 1 THE PALMERTON HOSPITAL 135 LAFAYETTE AVENUE PALMERTON PA 18071 235562316 OPERATES AN ACUTE CARE HOSP, PROVIDNG INPATIENT, OUTPATIENT & EMERGENCY CARE PA 501(C)(3) LINE 3 BLUE MOUNTAIN HEALTH SYSTEM INC 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 CMS MEDICAL CARE CORPORATION O 3303051 CASH