2016-04-28T09:19:55-05:00 2015-06-30 390859910 BAKER TILLY VIRCHOW KRAUSE LLP 1650 MARKET STREET SUITE 4500 PHILADELPHIA PA 19103 990 2014-07-01 240795411 EVANGELICAL COMMUNITY HOSPITAL EVAN 5705222741 ONE HOSPITAL DRIVE LEWISBURG PA 17837 JAMES STOPPER CFO 5705222741 2016-04-15 1 JULIUS C GREEN CPA JD P00350393 2159720701 2014 2016-08-17 19:52:53Z KENDRA AUCKER ONE HOSPITAL DRIVE LEWISBURG PA 17837 211189872 0 X WWW.EVANHOSPITAL.COM X 1926 PA PROVIDE HEALTH CARE SERVICES TO THE PUBLIC AND TO BE THE COMMUNITY'S HEALTH CARE PROVIDER OF CHOICE. 17 14 1619 476 5237349 654417 2477137 1974449 162075899 171481635 5125488 5791811 5765700 7134452 175444224 186382347 77100 76100 0 0 75745702 78596865 0 0 459514 77728313 78790035 153551115 157463000 21893109 28919347 261612869 272520113 81614982 81341569 179997887 191178544 X WE WILL PROVIDE EXCEPTIONAL HEALTHCARE, ACCESSIBLE TO ALL, IN THE SAFEST AND MOST COMPASSIONATE ATMOSPHERE POSSIBLE. OUR VISION: WE WILL BE OUR COMMUNITY'S HEALTHCARE PROVIDER OF CHOICE BY PATIENTS, PHYSICIANS AND EMPLOYEES. 0 0 128432817 76100 171743628 MEETING THE HEALTHCARE NEEDS OF THE COMMUNITY IS AT THE HEART OF EVANGELICAL COMMUNITY HOSPITAL'S MISSION AS A NOT-FOR-PROFIT CHARITABLE ORGANIZATION. THE HOSPITAL'S RESOURCES PROVIDE FOR LONG-TERM INITIATIVES SUCH AS RECRUITMENT AND RETENTION OF OUTSTANDING MEDICAL PROFESSIONALS, ENHANCED TECHNOLOGIES AND NEW FACILITIES AND SERVICES.THE HOSPITAL IS LICENSED TO ACCOMMODATE 132 OVERNIGHT PATIENTS, 12 ACUTE REHABILITATION UNIT PATIENTS AND 18 NEWBORN BABIES. IT IS A NOT-FOR-PROFIT COMMUNITY HOSPITAL OFFERING A FULL CONTINUUM OF CARE. SERVICES RANGE FROM COMPREHENSIVE DIAGNOSTIC TESTS TO DELICATE MICROSURGERY AND FROM SPECIFIC TREATMENT PROGRAMS TO NUMEROUS OUTPATIENT SERVICES.IN ADDITION TO PROVIDING HOSPITAL-BASED MEDICAL SERVICES, EVANGELICAL PROVIDES A NUMBER OF COMMUNITY-BASED SERVICES DESIGNED TO IMPROVE THE HEALTH OF AREA RESIDENTS. MANY OF THE EMPLOYEES AND MEDICAL STAFF LEAD HEALTH EDUCATION AND SCREENINGS AS WELL AS SUPPORT GROUPS FOR INDIVIDUALS IN THE COMMUNITY LIVING WITH SERIOUS OR CHRONIC HEALTH CONDITIONS. WHETHER THROUGH CHARITABLE CARE, SUBSIDIZED HOSPITAL PROGRAMS AND SERVICES, OR COMMUNITY HEALTH EDUCATION, EVANGELICAL STRIVES TO RESPOND TO THE VALLEY'S MOST PRESSING HEALTH NEEDS. 128432817 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 1 0 1 1 0 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 0 0 0 1 43 0 1 1619 1 1 1 0 0 0 0 1 1 0 0 0 0 X 17 14 1 1 1 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 PA X JAMES STOPPER CPA 5705222000 ONE HOSPITAL DRIVE LEWISBURG PA 17837 MICHAEL N O'KEEFE UNTIL 63015 PRESIDENT/CEO (NON-VOTING) 40.00 1.00 X X 403880 0 104717 JOHN D GRIFFITH DIRECTOR 1.00 0.10 X 0 0 0 TIM APPLE DIRECTOR 1.00 0.10 X 0 0 0 JULIE BARNA DMD VICE CHAIR 1.00 0.10 X X 0 0 0 BROOKS GRONLUND DIRECTOR 1.00 0.10 X 0 0 0 ROBERT L GRONLUND DIRECTOR 1.00 0.10 X 0 0 0 ROGER S HADDON JR CHAIR 1.00 0.10 X X 0 0 0 AMANDA KESSLER ESQ DIRECTOR 1.00 0.10 X 0 0 0 LINDA KORB PHD NCPSYA DIRECTOR 1.00 0.10 X 0 0 0 JOHN MECKLEY ESQ DIRECTOR 1.00 0.10 X 0 0 0 FREDRIK B PAULSEN JR DIRECTOR 1.00 0.10 X 0 0 0 JANICE OMLOR DO DIRECTOR 1.00 0.10 X 0 0 0 W GALE REISH MD DIRECTOR 1.00 0.10 X 0 0 0 J DONALD STEELE JR DIRECTOR 1.00 0.10 X 0 0 0 JOHN E RICE MD DIRECTOR/PHYSICIAN 1.00 39.10 X 233700 0 26317 DENNIS SWANK DIRECTOR 1.00 0.10 X 0 0 0 HENRY A TRUSLOW IV DIRECTOR 1.00 0.10 X 0 0 0 P RONALD ZUG MD DIRECTOR/PHYSICIAN 1.00 39.10 X 57223 0 5184 KENDRA A AUCKER PRESIDENT/CEO (NON-VOTING) 40.00 1.00 X 280987 0 61711 JAMES A STOPPER TREASURER/CFO 40.00 1.00 X 283017 0 45918 J LAWRENCE GINSBURG VP MEDICAL AFFAIRS 40.00 X 632212 0 81401 PAUL E TARVES VP OF NURSING 40.00 X 195088 0 46886 DALE E MOYER CHIEF INFORMATION OFFICER 40.00 X 178768 0 46674 MARK K KRAMMES DIR OF PERI-ANESTHESIA 40.00 X 240698 0 29900 SANDRA S WALKER NURSE ANESTHETIST 45.00 X 211405 0 8977 LORI K GOODLING NURSE ANESTHETIST 45.00 X 205426 0 8771 BRADLEY P BOWER NURSE ANESTHETIST 43.00 X 185378 0 28828 RAYMOND J TOMASZEWSKI NURSE ANESTHETIST 45.00 X 191278 0 29290 3299060 0 524574 120 0 1 0 QUANDEL CONSTRUCTION GROUP INC 3003 NORTH FRONT ST SUITE 2-1 HARRISBURG PA 171101224 CONSTRUCTION 1487232 HBCS 118 LUKENS DRIVE NEW CASTLE DE 197202727 MANAGEMENT SERVICES 1186364 INTERIOR CONSTRUCTION SPEC 339 E SOUTHERN AVE PO BOX 5128 SOUTH WILLIAMSPORT PA 17702 CONSTRUCTION 891481 PARIS COMPANIES PO BOX 1043 67 HOOVER AVE DUBOIS PA 158011043 LAUNDRY SERVICES 659856 RPI CONSULTANTS 101 N HAVEN STE 201 BALTIMORE MD 21224 CONSULTING SERVICES 641478 114 151105 314399 1508945 33836 1974449 ECH NET PATIENT SERVICE REV 621400 171052259 171052259 EASC NET PATIENT SERVICE REVENUE 621400 429376 429376 171481635 2516965 2516965 2222746 2401856 -179110 -179110 -179110 25545971 2250 22273278 97 3272693 2153 3274846 3274846 80600 151105 132294 -51694 -51694 LABORATORY SERVICES 621500 3427137 3427137 BILLING FEES FROM AFFILIATE 541900 1165988 1165988 CAFETERIA AND VENDING MACHINE SAL 722210 500509 500509 2271622 261993 644224 1365405 7365256 186382347 171743628 5237349 7426921 76100 76100 3379432 774786 2604646 59317044 49483685 9651715 181644 1381305 1355471 21446 4388 10176732 8415608 1727052 34072 4342352 3596721 733270 12361 325571 324958 613 144106 29443 114663 5653 5653 391403 11945 379458 9129661 3924709 5112293 92659 664991 18564 646427 7065849 4497906 2552017 15926 4938093 1005912 3905123 27058 2802843 2802843 140353 101112 36884 2357 219184 113927 100935 4322 2277868 2277868 11005146 11005146 748581 748581 FEDERAL TAXES 271207 271207 MEDICAL SUPPLIES 24051196 24007640 43556 BAD DEBT EXPENSE 10910528 10910528 MA MODERNIZATION 1296591 1296591 2401211 1977731 339366 84114 157463000 128432817 28570669 459514 2570 3803 24058903 26138729 449410 88068 14319684 15764986 1370070 5722 3525864 3649366 2613212 2882229 238304362 116724619 118731707 121579743 83686070 86180451 3205125 3670701 3175259 3175259 6474995 9381056 261612869 272520113 17369328 19826297 28492 38311 45894698 43973897 594424 515909 17728040 16987155 81614982 81341569 X 172260702 184476058 1863475 995670 5873710 5706816 179997887 191178544 261612869 272520113 X 28919347 -2890362 -14848328 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 5653 5653 0 PART II-B, LINE 1: A PERCENTAGE OF ANNUAL HAP DUES WAS USED FOR LOBBYING; THIS AMOUNTED TO $5,653 FOR THE FISCAL YEAR. 5428211 349586 177781 20915 84049 23662 5826952 4590433 322276 635909 19298 79509 21600 5428211 3717474 700530 280387 22640 67350 17968 4590433 3351677 114280 341323 15894 60316 13596 3717474 2853652 380340 207310 16598 67522 5505 3351677 0.64400 0.35600 0 0 7580048 7580048 114364658 36621923 77742735 2216506 742143 1474363 103660804 76650646 27010158 10482346 2709907 7772439 121579743 BLUE CROSS CURRENT FINANCING ADVANCE 1057190 ACCRUED POSTRETIREMENT BENEFIT COSTS 6770928 ESTIMATED MEDICAL MALPRACTICE CLAIMS LIABILITY 1088008 CHARITABLE GIFT ANNUITIES PAYABLE 248127 DEFERRED COMPENSATION 2048728 CAPITAL LEASE OBLIGATION 1530546 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 3121898 DUE TO AFFILIATES 1121730 16987155 X 159887821 -2890362 -25758856 -28649218 188537039 379458 -2534150 -2154692 186382347 148707164 2534150 2534150 146173014 379458 10910528 11289986 157463000 PART V, LINE 4: ENDOWMENT FUNDS WILL BE USED TO SUPPORT VARIOUS HOSPITAL PROGRAMS SUCH AS FUNDING HELPLINE SERVICES, COMMUNITY HEALTH EDUCATION, HOSPICE SERVICES, PRE-HOSPITAL SERVICES, FAMILY PLACE (OB SERVICES), PROVIDE NURSING SCHOLARSHIPS AND TO PROVIDE FOOD, SERVICE, OR CARE FOR PEOPLE WHO DO NOT HAVE THE MEANS TO PAY FOR THE SERVICE. PART X, LINE 2: THE CORPORATION 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 THAT THERE WERE NO TAX UNCERTAINTIES THAT MET THE RECOGNITION THRESHOLD IN 2015 OR 2014. THE HOSPITAL'S FEDERAL RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX (FORM 990) AND THE FEDERAL EXEMPT ORGANIZATION BUSINESS INCOME TAX RETURNS (FORM 990-T) FOR THE YEARS ENDING PRIOR TO JUNE 30, 2011 NO LONGER REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE ("IRS"). PART XI, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN VALUE OF SPLIT-INTEREST AGREEMENT -12,276. VALUATION LOSS -191,483. POSTRETIREMENT BENEFIT LIABILITY ADJUSTMENT -444,569. PROVISION FOR BAD DEBT (NETTED ON F/S) -10,910,528. EQUITY TRANSFER TO AFFILIATE -14,200,000. PART XI, LINE 4B - OTHER ADJUSTMENTS: RENTAL EXPENSES -2,401,856. SPECIAL EVENTS EXPENSE -132,294. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 2,401,856. SPECIAL EVENTS EXPENSE 132,294. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBT (NETTED ON F/S) 10,910,528. 2015 GALA 151627 92395 59232 60902 7490 14934 6500 11314 2014 GOLF TOURNAMENT 57745 41942 15803 2625 8415 5735 6278 1 22333 16768 5565 2895 1713 300 3193 231705 151105 80600 2625 63797 17618 20669 6800 20785 132294 -51694 1 1 1 X 1 X 1 1 0 1 1 339 127822 127822 0.00090 19336 12999835 5416885 7582950 0.05170 139 54754 54754 0.00040 19814 13182411 5416885 7765526 0.05300 72 24623 871531 97726 773805 0.00530 6 75 84506 30000 54506 0.00040 1 15935 15935 0.00010 79 24698 971972 127726 844246 0.00580 79 44512 14154383 5544611 8609772 0.05880 7 329 12679 12679 0.00010 2 1095 5794 5794 0.00000 8 635 21431 21431 0.00010 12 547 122566 15881 106685 0.00070 29 2606 162470 15881 146589 0.00090 1 4918095 28204627 41823056 -13618429 X 1 1 1 1 EVANGELICAL COMMUNITY HOSPITAL ONE HOSPITAL DRIVE LEWISBURG PA 17837 X X X INPATIENT REHABILITATION, HOSPICE EVANGELICAL COMMUNITY HOSPITAL 1 0 0 1 X X X X X X X X X 12 1 1 0 1 X WWW.EVANHOSPITAL.COM/HEALTH-AND-WELLNESS X 1 12 1 WWW.EVANHOSPITAL.COM/HEALTH-AND-WELLNESS 0 0 1 X 100.000000000000 200.000000000000 X X 1 1 X X X 1 X X X 1 0 X X X 1 X 0 0 EVANGELICAL COMMUNITY HOSPITAL PART V, SECTION B, LINE 5: IN 2012, EVANGELICAL COMMUNITY HOSPITAL PARTICIPATED IN A FIVE-COUNTY (SNYDER, UNION, MONTOUR, NORTHUMBERLAND AND COLUMBIA) COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) LED BY ACTION HEALTH. TRIPP UMBACH WAS SELECTED TO CONDUCT THE ASSESSMENT AND REPORT ON THE FINDINGS. THE ASSESSMENT CONSISTED OF INTERVIEWS WITH KEY COMMUNITY STAKEHOLDERS AND FOCUS GROUPS. FOCUS GROUP PARTICIPANTS FOR EVANGELICAL'S SERVICE AREAS CONSISTED OF HEALTHCARE PROVIDERS, RESIDENTS FROM THE LATINO COMMUNITY AND UN/UNDER-INSURED RESIDENTS. KEY COMMUNITY STAKEHOLDER INTERVIEWS CONSISTED OF LEADERS FROM ORGANIZATIONS SUCH AS AGENCY ON AGING, PA DEPARTMENT OF HEALTH, AMERICAN CANCER SOCIETY, FAITH-BASED ORGANIZATIONS, LOCAL SCHOOLS AND UNIVERSITIES, BUSINESSES AND NONPROFIT ORGANIZATIONS. EVANGELICAL COMMUNITY HOSPITAL PART V, SECTION B, LINE 6A: IN 2012, EVANGELICAL COMMUNITY HOSPITAL PARTICIPATED IN A FIVE-COUNTY (SNYDER, UNION, MONTOUR, NORTHUMBERLAND AND COLUMBIA) COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). THE ASSESSMENT PROCESS WAS LED BY ACTION HEALTH, AN ORGANIZATION THAT FOSTERS COLLABORATION BETWEEN HOSPITALS AND LOCAL EDUCATIONAL INSTITUTIONS FOR THE PURPOSE OF MEETING THE HEALTH NEEDS OF THE COMMUNITY. THE OTHER FACILITIES THAT WERE INVOLVED WERE GEISINGER, GEISINGER-SHAMOKIN AREA COMMUNITY HOSPITAL, BLOOMSBURG HOSPITAL AND BLOOMSBURG UNIVERSITY. EVANGELICAL COMMUNITY HOSPITAL PART V, SECTION B, LINE 11: IN 2012, EVANGELICAL COMMUNITY HOSPITAL PARTICIPATED IN A FIVE-COUNTY (SNYDER, UNION, MONTOUR, NORTHUMBERLAND AND COLUMBIA) COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). THE ASSESSMENT PROCESS WAS LED BY ACTION HEALTH, AN ORGANIZATION THAT FOSTERS COLLABORATION BETWEEN HOSPITALS AND LOCAL EDUCATIONAL INSTITUTIONS FOR THE PURPOSE OF MEETING THE HEALTH NEEDS OF THE COMMUNITY. DURING THIS REPORTING PERIOD, EVANGELICAL HAS CONTINUED TO OFFER FREE OR LOW COST HEALTH SCREENINGS AND EDUCATIONAL PROGRAMS THAT FOCUS ON IMPROVING ACCESS TO HEALTHCARE AND IMPROVING HEALTHY BEHAVIORS. NEW PROGRAMS AND HEALTH SCREENS HAVE BEEN DEVELOPED AS NEEDS ARISE. THE HOSPITAL HAS BEEN WORKING ON THE SAME ACTION PLAN THAT WAS APPROVED IN JUNE OF 2013. THIS PLAN PROVIDED A ROADMAP FOR OUR HOSPITAL TO MEET SPECIFIC NEEDS WITHIN OUR FOUR COUNTY SERVICE AREA. BELOW ARE THE THREE KEY IDENTIFIED NEEDS, THE HOSPITAL'S RESPONSE ACCORDING TO OUR IMPLEMENTATION PLAN AND OUR ACCOMPLISHMENTS AS WELL AS WHAT IS IN PROCESS.SEE CONTINUED BELOW. EVANGELICAL COMMUNITY HOSPITAL PART V, SECTION B, LINE 13H: MEDICAL ASSISTANCE DENIAL EVANGELICAL COMMUNITY HOSPITAL PART V, SECTION B, LINE 16I: POLICY IS PRESENTED TO PATIENTS BY HRSI WHEN WORKING WITH PATIENTS ON MEDICAL ASSISTANCE APPLICATIONS. HRSI IS A THIRD PARTY USED BY EVANGELICAL COMMUNITY HOSPITAL TO WORK WITH PATIENTS FOR OBTAINING FINANCIAL ASSISTANCE. EVANGELICAL COMMUNITY HOSPITAL PART V, SECTION B, LINE 22D: PATIENTS ARE CHARGED THE FULL AMOUNT AND THEN CHARITY CARE DISCOUNT IS APPLIED AS AN ADJUSTMENT. EVANGELICAL COMMUNITY HOSPITAL'S POLICY IS TO PROVIDE EMERGENCY CARE TO STABILIZE PATIENTS, REGARDLESS OF THEIR ABILITY TO PAY. AN INDIVIDUAL NOTICE OF AVAILABILITY OF EVANGELICAL COMMUNITY HOSPITAL CHARITY CARE PROGRAM WILL BE GIVEN TO EACH PATIENT OR THEIR REPRESENTATIVE PRIOR TO SERVICES BEING RENDERED, WITH THE EXCEPTION OF EMERGENCY SERVICES.EVANGELICAL COMMUNITY HOSPITAL WILL PROVIDE SERVICES AT NO CHARGE OR REDUCED CHARGES TO THOSE WHO ARE FINANCIALLY UNABLE TO PAY FOR THOSE SERVICES. ELIGIBILITY WILL BE DETERMINED BY COMPARING HOUSEHOLD FAMILY INCOME AGAINST THE INCOME POVERTY GUIDELINES. INCOME IS DEFINED AS THE TOTAL ANNUAL CASH RECEIPTS BEFORE TAXES FROM ALL SOURCES. PART V SECTION B LINE 11: 1. IMPROVING ACCESS TO HEALTHCARE FOR UN/UNDER INSURED RESIDENTS - NEED FOR INCREASED ACCESS TO AFFORDABLE HEALTH INSURANCE AND INCREASED NUMBER OF HEALTHCARE PROVIDERS IN GENERAL AND SPECIFICALLY, HEALTHCARE PROVIDERS THAT WILL ACCEPT STATE FUNDED MEDICAL INSURANCE.A)CONTINUE TO OFFER A VARIETY OF HEALTH SCREENING PROGRAMS FOR THE COMMUNITY AT MINIMAL OR NO COST. CURRENTLY THE HOSPITAL OFFERS SEVERAL HEALTH SCREENINGS THROUGHOUT OUR SERVICE AREA. WE FOCUS ON LOW OR NO COST AND TARGET THOSE THAT ARE UN OR UNDER INSURED. PROGRESS: COLLABORATIVE EFFORTS WITH THE DEPARTMENT OF HEALTH, AREA AGENCY ON AGING AND A COMMUNITY CLINIC, A FREE, HIGH QUALITY HEALTHCARE CLINIC FOR THE UNINSURED, HAVE PROVEN TO BE SUCCESSFUL AND IN HIGH DEMAND. WE CONTINUE TO OFFER MULTIPLE HEALTH SCREENS MONTHLY. MOST RECENTLY WE BROUGHT BACK THE "HUNTERS HEALTH SCREEN" THAT FOCUSES HEAVILY ON CARDIAC AND STROKE RISK FACTORS.B)COLLABORATE WITH THE HOSPITAL'S EMPLOYED PHYSICIAN NETWORK, THE EVANGELICAL MEDICAL SERVICE ORGANIZATION (EMSO), FAMILY PRACTICE CENTERS AND EVANGELICAL'S HOSPITALISTS TO DEVELOP AND DEPLOY THE "YOUR WELLNESS PRESCRIPTION PAD". PROGRESS: CONTINUOUS COMMUNICATION WITH COMMUNITY HEALTH AND WELLNESS AND EMSO PRIMARY CARE OFFICES TO RAISE AWARENESS OF EDUCATIONAL RESOURCES AND PROGRAMMING AVAILABLE, I.E. COMPREHENSIVE BLOOD SCREENS, WHY WEIGHT, SMOKING CESSATION ETC. C)DEVELOP A COMMUNITY HEALTH COALITION.PROGRESS: COALITION CONTINUES TO MEET AND INCREASE MEMBERSHIP. THE COALITION MEMBERS ASSISTED WITH THE 2015 CHNA AND PROVIDED INPUT FOR THE HOSPITAL'S ACTION PLAN.D)EXPAND THE OUTREACH OF THE HOSPITAL'S "FREE OR REDUCED-FEE MAMMOGRAPHY PROGRAM" TO REACH HIGH-RISK WOMEN (E.G., MINORITY POPULATIONS, AMISH AND MENNONITES, AND THOSE WITHOUT INSURANCE). PROGRESS: THIS PROGRAM CONTINUES TO EXPAND. WE CONTINUE TO PROVIDE FREE MAMMOGRAPHY SCREENING AND ARE ABLE TO OFFER ASSISTANCE FOR RECOMMENDED DIAGNOSTIC FOLLOW-UPS. E)DEVELOP AND EXPAND A NEW SURVIVORSHIP ASSISTANCE PROGRAM FOR CANCER SURVIVORS. PROGRESS: OUR SURVIVORSHIP PROGRAM CONTINUES TO ADD VIABLE PROGRAMMING TO MEET THE NEEDS OF OUR CANCER SURVIVORS. THIS YEAR WE ADDED A WOMEN'S SUPPORT GROUP, INCREASED OUR "SURVIVEWELL" SERIES FROM ONE TO TWO ANNUALLY, AND HAVE ADDED AN ANNUAL LECTURE/DAY CONFERENCE EVENT. IN 2015 EVANGELICAL OFFICIAL ADOPTED A CANCER SERVICE LINE.F)DEVELOP AND EXECUTE OUTREACH EFFORTS TO IMPROVE ACCESS TO CARE AT EVANGELICAL COMMUNITY HOSPITAL AND THE LARGER HEALTH SERVICES NETWORK:A. IMPLEMENTATION OF A CALL CENTER FOR PHYSICIAN AND SERVICE REFERRALSB. DEVELOP OUTREACH EFFORTS TO ENCOURAGE USE OF EMERGENCY DEPARTMENT'S NEW "ERGENT CARE" TO REDUCE THE WAITING TIME TO RECEIVE CARE FOR EMERGENT ILLNESSES AND INJURIES. PROGRESS: THE CALL CENTER HAS PROVEN TO BE A BENEFIT. WE AVERAGE APPROXIMATELY 85 CALLS A MONTH WITH APPROXIMATELY 75% WANTING REFERRALS FOR A PHYSICIAN. DURING THIS REPORTING YEAR TIMES OF OPERATION AND STAFFING HAD TO BE INCREASED DUE TO VOLUMES AND NEED.G)DEVELOP AN ACCESS TO CARE TEAM COMPRISED OF KEY PERSONNEL FROM HOSPITAL SERVICE AREAS WITH THE GOAL TO ENHANCE OUR ABILITY TO PROVIDE BETTER ACCESS TO CARE. THEY INCLUDE: MANAGED CARE, REGISTRATION, FINANCE, PATIENT ACCOUNTS, COMMUNITY HEALTH, EMSO, EMERGENCY DEPARTMENT, OUTPATIENT CASE MANAGEMENT COORDINATOR, NURSING, SOCIAL SERVICES, AND MARKETING & PUBLIC RELATIONS.2. IMPROVING HEALTHY BEHAVIORS: NEED FOR INCREASED AWARENESS AND EDUCATION, MOTIVATION AND/OR INCENTIVES FOR RESIDENTS WHO PRACTICE HEALTHY BEHAVIORS AND INCREASE ACCESS TO HEALTHY OPTIONS IN THE REGION.A)CONTINUE TO OFFER A VARIETY OF EDUCATIONAL PROGRAMMING FOR THE YOUTH IN THE COMMUNITY AT NO COST. EVANGELICAL COMMUNITY HOSPITAL OFFERS A WIDE VARIETY OF EDUCATIONAL PROGRAMS GEARED TOWARD HEALTHY EATING, HYGIENE, STAYING ACTIVE AND LIVING TOBACCO FREE. THESE PROGRAMS WILL BE OFFERED WITHIN OUR SERVICE AREA AND WILL SPECIFICALLY TARGET LOCAL SCHOOL DISTRICTS. ADDITIONAL PROGRAMMING WILL BE ADDED FOR SPECIFIC IDENTIFIED POPULATIONS, I.E. PRESCHOOLS, YMCA'S, AND OTHER FACILITIES AS REQUESTED. PROGRESS: WE CONTINUE TO INCREASE OUR VISIBILITY IN THE NUMEROUS SCHOOL DISTRICTS AND CHILDCARE FACILITIES IN OUR AREA. WE HAVE DEVELOPED TWO NEW EDUCATIONAL PROGRAMS FOR OUR YOUTH INITIATIVES, SUMMER SAFETY AND STRESS EDUCATION. WE HAVE ALSO BROUGHT BACK THE "SAFE SITTER" PROGRAMB)DEVELOP AND IMPLEMENT A WALKING PROGRAM FOR THE YOUTH. THE WALKING PROGRAM WILL PROMOTE TAKING HEALTHIER STEPS FOR STAYING ACTIVE. THIS PROGRAM WILL BE OFFERED TO LOCAL SCHOOL DISTRICTS AS A BEFORE SCHOOL PROGRAM. THROUGH THE WALKING PROGRAM WE WILL OFFER MATERIAL ON HEALTHY EATING AND LIVING TOBACCO FREE TO ALL SCHOOL DISTRICTS WITHIN THE HOSPITAL'S FOOTPRINT. PROGRESS: COMPLETED LAST REPORTING CYCLE. WE CONTINUE TO SUPPORT GIRLS ON THE RUN. THIS INTERNATIONAL PROGRAM FOCUSES ON SEVERAL ASPECTS THAT OUR WALKING PROGRAM PLANNED TO INCORPORATE.C)DEVELOP AND IMPLEMENT 10,000 STEPS PROGRAM INTO THE GREATER SUSQUEHANNA VALLEY. THIS PROGRAM WILL PROMOTE GOOD HEALTH AND HELP PARTICIPANTS DEVELOP A FITNESS REGIME BY ENCOURAGING THEM TO STRIVE FOR 10,000 STEPS A DAY (THE EQUIVALENT OF WALKING ROUGHLY FIVE MILES). A PERSON WHO WALKS AT LEAST 10,000 STEPS A DAY COULD BURN 2,000 TO 3,500 EXTRA CALORIES PER WEEK. PROGRESS: COMPLETED LAST REPORTING PERIOD. DURING THIS REPORTING YEAR WE IMPLEMENTED AND SENIOR STRONG PROGRAM. THIS PROGRAM WAS DEVELOPED TO MEET THE HEALTH AND WELLNESS NEEDS OF OUR SENIOR POPULATION. WE HOSTED A NATIONAL SENIOR HEALTH AND WELLNESS EVENT IN COLLABORATION WITH AND AREA NURSING AND LONG TERM CARE FACILITY. WE OFFER MONTHLY WELLNESS PROGRAMS STRICTLY FOR THIS DEMOGRAPHIC. D)DEVELOP AND IMPLEMENT A NEW EDUCATIONAL PROGRAM TO OFFER LOCAL YMCA'S AND SUMMER/DAY CAMPS TO EDUCATE STUDENTS ON THE IMPORTANCE OF HEALTHY EATING, BEING ACTIVE, AND LIVING TOBACCO FREE. PROGRESS: WE DEVELOPED AND PILOTED A 10 WEEK YOUTH WELLNESS PROGRAM TITLED EAT WELL, PLAY WELL, LIVE WELL. THE PROGRAM CONSISTED OF PRE AND POST SCREENING THAT INCLUDED EDUCATIONAL KNOWLEDGE ON LIFESTYLE TOPICS, PHYSICAL ACTIVITY ASSESSMENT, BLOOD PRESSURE, BODY COMPOSITION, RESTING HEART RATE AND BLOOD SUGAR TESTING. THE PROGRAM WAS OFFERED TO YOUTH AGES OF 12-14 ENROLLED IN A COUNSELOR IN TRAINING PROGRAM AT THE SUNBURY YMCA. WE HAD 22 PARTICIPANTS START THE PROGRAM WITH 14 ACTUALLY COMPLETING THE POST ASSESSMENTS. OVERALL WE NOTED IMPROVEMENTS IN ALL CATEGORIES THAT WERE ASSESSED. OVER A 70% IMPROVEMENT OF BLOOD PRESSURE, BLOOD SUGAR AND RESTING HEART RATE WAS ACHIEVED. E) PARTNER WITH CLINICAL OUTCOMES GROUP, INC. IN SUNBURY AND THE PA DEPARTMENT OF HEALTH TO PROMOTE YOUNG LUNGS AT PLAY, A PROGRAM DESIGNED TO PROVIDE AWARENESS OF THE EFFECTS OF SECOND-HAND SMOKE ON CHILDREN AND YOUTH. THE HOSPITAL WILL HELP BRING THIS PROGRAM INTO PARKS, RECREATIONAL FACILITIES, BOROUGHS, TOWNSHIP AND COUNTIES BY PRESENTING YOUNG LUNGS AT PLAY WHEN NEEDED. PROGRESS: WE CONTINUE TO ADVOCATE FOR AREA FACILITIES, BOROUGHS, TOWNSHIPS ETC. TO ADOPT THE YOUNG LUNGS AT PLAY. WE ALSO HAVE ADOPTED A NEW SMOKING CESSATION PROGRAM, FREEDOM FROM SMOKING. A COMMUNITY HEALTH AND WELLNESS RN EDUCATOR ATTENDED A DAY LONG TRAINING AND WE ARE CURRENTLY OFFERING THE PROGRAM TO OUR COMMUNITY. F) DEVELOP AN IMPROVING HEALTHY BEHAVIORS TEAM COMPRISED OF KEY PERSONNEL FROM HOSPITAL SERVICE AREAS WITH THE EXPECTATION TO ENHANCE OUR COMMUNITY'S EDUCATION, ACCESS AND AWARENESS OF HEALTHY BEHAVIORS. TEAM PARTICIPANTS WOULD INCLUDE PERSONNEL FROM: ADMINISTRATION, CENTER FOR BREAST HEALTH, NUTRITIONAL SERVICES, FINANCE, CARDIAC REHABILITATION, COMMUNITY HEALTH, OUTPATIENT CLINIC, PULMONARY SERVICES, FITNESS CENTER, CENTER FOR ORTHOPEDICS, DIABETIC EDUCATION, REHABILITATION SERVICES, WOMEN'S ADVISORY GROUP, AND MARKETING/PR PART V SECTION B LINE 11: 3. COMMUNITY DEVELOPMENT, SPECIFICALLY TRANSPORTATION- BECAUSE OF THE RURAL NATURE OF OUR REGION, THE LACK OF TRANSPORTATION AND LIMITED TRANSLATION SERVICES CREATE MAJOR BARRIERS FOR COMMUNITY MEMBERS TO ACCESS HEALTHCARE AND OTHER PRIMARY HEALTH RESOURCES IN OUR AREA.THE ISSUE OF ENSURING ADEQUATE PUBLIC TRANSPORTATION FOR VALLEY RESIDENTS IS A CONCERN FOR EVANGELICAL COMMUNITY HOSPITAL, ESPECIALLY AS THE LACK OF TRANSPORTATION CREATES SIGNIFICANT BARRIERS FOR SOME RESIDENTS WHEN ATTEMPTING TO ACCESS HEALTHCARE. RESIDENTS MAY HAVE THE ABILITY TO SCHEDULE APPOINTMENTS WITH HEALTHCARE PROVIDERS, BUT MAY NEED TO CANCEL THOSE SAME APPOINTMENTS DUE TO THEIR INABILITY TO FIND ADEQUATE TRANSPORTATION TO AND FROM AN APPOINTMENT. THIS PRACTICE DISCOURAGES HEALTHCARE PROVIDERS' (PHYSICIANS AND DENTISTS) ACCEPTANCE OF STATE-FUNDED HEALTH INSURANCES DUE TO THE INABILITY OF THE UN/UNDER-INSURED TO KEEP THEIR SCHEDULED APPOINTMENTS.IN RESPONSE TO THIS IDENTIFIED NEED, HOSPITAL ADMINISTRATION HAS PROVIDED TIME DURING BUSINESS HOURS FOR A MEMBER OF THE COMMUNITY HEALTH AND WELLNESS DEPARTMENT TO SERVE ON THE REGIONAL NORTH CENTRAL PA PUBLIC TRANSPORTATION TASK FORCE. THE REPRESENTATIVE HAS BEEN SERVING AS A MEMBER OF THIS COMMITTEE SINCE 2012. IN ADDITION, KEY PERSONNEL IN SOCIAL SERVICES, CASE MANAGEMENT AND THE EMERGENCY DEPARTMENT ARE WORKING TOGETHER TO ADDRESS TRANSPORTATION ISSUES AS THEY RELATE TO PATIENTS WHO COME TO THE HOSPITAL FOR EMERGENT OR SCHEDULED CARE, BUT ARE UNABLE TO RETURN HOME DUE TO THE LACK OF TRANSPORTATION. A SPECIAL FUND HAS BEEN ESTABLISHED FOR THIS PURPOSE MAKING TAXI-FARE AVAILABLE TO THESE PATIENTS WHEN NEEDED. IN ADDITION, THE REPRESENTATIVES OF THE HOSPITAL WILL CONTINUE TO ADVOCATE AND SUPPORT EFFORTS IN OUR COMMUNITY TO ADDRESS AND SOLVE THE MOST URGENT TRANSPORTATION NEEDS IN THE VALLEY, ESPECIALLY AS THEY RELATE TO THOSE WHO HAVE DIFFICULTY ACCESSING HEALTHCARE DUE TO LACK OF TRANSPORTATION. HOWEVER, A SPECIAL SUBCOMMITTEE OF THE COMMUNITY BENEFITS COMMITTEE, SUCH AS THOSE FOR IMPROVING ACCESS TO HEALTHCARE OR IMPROVING HEALTHY BEHAVIORS, WILL NOT BE DEVELOPED AND STAFFED FOR THE PURPOSE OF ADDRESSING TRANSPORTATION NEEDS.THIS THIRD AND FINAL MOST PRESSING NEED IDENTIFIED THROUGH THE 2012 CHNA WAS THE NEED FOR ADEQUATE PUBLIC TRANSPORTATION - THIS HAS NOT BEEN FULLY ADDRESSED BY THE HOSPITAL. 1 EVANGELICAL AMBULATORY SURGICAL CENTER 210 JPM ROAD SUITE 100 LEWISBURG PA 17837 OUTPATIENT SURGICAL CENTER PART I, LINE 6A: THE COMMUNITY BENEFIT REPORT IS AVAILABLE ON THE HOSPITAL'S WEBSITE OR UPON REQUEST. PART I, LINE 7: THE HOSPITAL USED THE COST-TO-CHARGE RATIO TO DETERMINE THE AMOUNTS INCLUDED IN LINE 7. PART I, LN 7 COL(F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $10,910,528. PART II, COMMUNITY BUILDING ACTIVITIES: AS A COMMUNITY AND HEALTH RESOURCE FOR MORE THAN 88 YEARS, EVANGELICAL COMMUNITY HOSPITAL HAS CONTINUALLY DEMONSTRATED ITS COMMITMENT TO THE CENTRAL SUSQUEHANNA VALLEY BY TAKING CARE OF PATIENTS NEEDING TREATMENT, AND BY ITS OUTREACH TO THE COMMUNITY. BEYOND THE DAILY CARE OF PATIENTS, THE HOSPITAL EXTENDS ITS REACH TO PROVIDE PREVENTION AND WELLNESS EDUCATION TO RESIDENTS OF THE VALLEY. OUTREACH INCLUDES CHARITY-CARE FOR THOSE WHO CANNOT AFFORD MEDICAL TREATMENT, HEALTH SCREENINGS TARGETING THE UN/UNDER-INSURED, HEALTH EDUCATION FOCUSING ON HEALTHY LIFESTYLE CHANGES, CHILD SAFETY SEAT INSPECTIONS, SCHOOL AGED HEALTH INITIATIVES, AND LECTURES ON HEALTH CONCERNS AND TOPICS. MANY OF THESE PROGRAMS ARE PROVIDED AT MINIMAL OR NO COST, AND ARE SUBSIDIZED USING HOSPITAL RESOURCES. PART III, LINE 2: THE COSTING METHODOLOGY USED IN DETERMINING BAD DEBT EXPENSE AT COST IS BAD DEBT EXPENSE TIMES THE COST TO CHARGE RATIO. IN DETERMINING BAD DEBT EXPENSE, PATIENT LIABILITIES ARE NET OF THIRD-PARTY PAYMENTS AND ANY PATIENT PAYMENTS. PART III, LINE 3: WE BELIEVE THAT A PORTION OF OUR BAD DEBTS RESULTS FROM SERVICES PROVIDED TO PATIENTS WHO MEET THE CHARITY CARE GUIDELINES BUT WERE UNABLE OR UNWILLING TO PROVIDE THE APPROPRIATE DOCUMENTATIONS TO ALLOW THAT CLASSIFICATION. THESE WOULD BE CLASSIFIED AS BAD DEBT EXPENSE TIMES THE COST TO CHARGE RATIO TO ARRIVE AT COST. EVANGELICAL COMMUNITY HOSPITAL PROVIDES CARE TO ALL PATIENTS WHO NEED IT, REGARDLESS OF THEIR ABILITY TO PAY. THIS IS PART OF THE HOSPITAL'S MISSION. PART III, LINE 4: ACCOUNTS RECEIVABLE- PATIENTS ARE REPORTED AT NET REALIZABLE VALUE. THE ORGANIZATION ACCOUNTS FOR DISCOUNTS AND PAYMENTS ON PATIENT ACCOUNTS AS A REDUCTION OF REVENUE/ACCOUNTS RECEIVABLE AND ARE NOT COMPONENTS OF BAD DEBT EXPENSE. ACCOUNTS ARE WRITTEN OFF WHEN THEY ARE DETERMINED TO BE UNCOLLECTIBLE BASED UPON MANAGEMENT'S ASSESSMENT OF INDIVIDUAL ACCOUNTS. THE ALLOWANCE FOR DOUBTFUL COLLECTIONS ARE ESTIMATED BASED UPON A PERIODIC REVIEW OF THE ACCOUNTS RECEIVABLE AGING, PAYOR CLASSIFICATIONS AND APPLICATION OF HISTORICAL WRITE-OFF PERCENTAGES. PART III, LINE 8: THE HOSPITAL CONTINUES TO PROVIDE CARE TO ALL PRESENTING AND ADMITTED PATIENTS, REGARDLESS OF ABILITY OR PAY. NOTWITHSTANDING THE COSTS TO PROVIDE CARE, RECEIVING "LESS" THAN WHAT IT COSTS TO PROVIDE ADEQUATE CARE TO MEDICARE COVERED LIVES DOES THE HOSPITAL A DISSERVICE. THIS SHORTFALL SHOULD COUNT AS A COMMUNITY BENEFIT. THE HOSPITAL USES THE COST-TO-CHARGE RATIO TO DETERMINE THE MEDICARE ALLOWABLE COSTS. PART III, LINE 9B: IN ACCORDANCE WITH THE COLLECTION POLICY, BAD DEBT ACCOUNTS WILL BE ELIGIBLE FOR A CHARITY CARE DISCOUNT IF THE PATIENT MEETS CHARITY CARE POLICY GUIDELINES. THE PATIENT WILL NEED TO SUPPLY INCOME INFORMATION IN ORDER TO DETERMINE ELIGIBILITY FOR CHARITY CARE PER POLICY. ALSO SEE RESPONSES TO PART III SECTION A ABOVE. PART VI, LINE 2: THE COMMUNITY BENEFIT COMMITTEE OF THE HOSPITAL CONTINUES TO FOCUS ON DEVELOPING NEW WAYS OF IDENTIFYING AND ADDRESSING HEALTH NEEDS IN OUR REGION. THE HOSPITAL UTILIZES AN INTERNAL DOCUMENTATION PROCESS DEVELOPED TO CAPTURE COMMUNITY BENEFIT OUTREACH DELIVERED BY THE MAJORITY OF ITS EMPLOYEES. THE COMMITTEE CONSISTS OF MEMBERS FROM THE HOSPITAL'S BOARD OF DIRECTORS, EXECUTIVE OPERATING TEAM, MANAGEMENT STAFF, AS WELL AS FRONT-LINE CLINICAL AND ADMINISTRATIVE EMPLOYEES. THE COMMUNITY BENEFIT COMMITTEE WORKS COOPERATIVELY WITH DEPARTMENTS OF THE HOSPITAL AND OTHER ORGANIZATIONS IN THE COMMUNITY TO ADDRESS UNMET NEEDS. CANCER AWARENESS AND EDUCATION IS EXTREMELY IMPORTANT. THE FOLLOWING PROGRAMS WERE OFFERED IN FY15; THE CORRESPONDING NUMBER BESIDE THE PROGRAM DOCUMENTS THE NUMBER OF PEOPLE SERVED.PROGRAM INDIVIDUALS SERVEDLOOK GOOD, FEEL BETTER 1- 2 PARTICIPANTS/SESSIONHOSPITAL'S EMPLOYEE HEALTH FAIR (EDUCATION ON BREAST CANCER AWARENESS, SMOKING CESSATION, EARLY DETECTION AND PREVENTATIVE HEALTH ACTIVITIES.) APPROXIMATELY 200 EMPLOYEES AND FAMILY MEMBERSCOUPLES RETREAT 5 COUPLES (10 PARTICIPANTS)I CAN COPE SURVIVOR PROGRAM 100 PARTICIPANTSCOPING WITH THE HOLIDAYS PROGRAM 14 PARTICIPANTSFREE SKIN CANCER SCREENINGS 47 PARTICIPANTSCOMMUNITY EVENT TO SUPPORT BREAST CANCER - LILLIE SHOCKNEY 85 PARTICIPANTSLIFE AFTER LOSS BEREAVEMENT SUPPORT GROUP 18 PARTICIPANTSOTHER HEALTH EDUCATION AND PREVENTION ACTIVITIES INCLUDE:PROGRAM INDIVIDUALS SERVEDMONTHLY SUPPORT GROUPS 748 PARTICIPANTSFREE HEART HEALTH SCREENINGS 93 PARTICIPANTSCOMPREHENSIVE BLOOD SCREENINGS 796 PARTICIPANTSMEN'S HEALTH SCREEN 41 PARTICIPANTSWOMEN'S HEALTH SCREEN 89 PARTICIPANTSHUNTER'S HEALTH SCREEN 49 PARTICIPANTSBLOOD DRAW SERVICES A COMMUNITY CLINIC 124 PARTICIPANTSCHILD SAFETY SEAT REPLACEMENT 50 FAULTY SEATSFREE CHILD PASSENGER SEAT INSPECTIONS 490 INSPECTIONSFREE T-DAP VACCINATION FOR NEW DADS AND GRANDPARENTS 186 VACCINATIONS GIVENYOUTH BIKE HELMET GIVEAWAY PROGRAM 172 HELMETS GIVENPROPER HAND WASHING IS ESSENTIAL FOR PEOPLE OF ALL AGES TO LIMIT AND PROHIBIT THE SPREAD OF DISEASE AND GERMS. EVANGELICAL COMMUNITY HOSPITAL'S GERM CITY/BUG LIGHT PROGRAM USES AN ENTERTAINING TECHNIQUE TO STRESS THE IMPORTANCE OF FREQUENT, EFFECTIVE HAND WASHING AND SEE IMMEDIATE RESULTS. IN FY15, MORE THAN 3927 STUDENTS IN THE LOCAL SCHOOLS PARTICIPATED IN THE GERM CITY/BUG LIGHT PROGRAM AND WERE EDUCATED ON PROPER HAND WASHING TECHNIQUES. ADDITIONAL PROGRAMS FOCUSING ON HEALTHY BEHAVIORS WERE PRESENTED TO LOCAL SCHOOL DISTRICTS. THESE PROGRAMS INCLUDE: HEARTPOWER, MYPLATE AND TOBACCOS EDUCATION. A TOTAL OF 3,691 STUDENTS WERE EDUCATED THROUGH THESE PROGRAMS. PART VI, LINE 3: AS A COMMUNITY HOSPITAL, EVANGELICAL IS DEDICATED TOIMPROVING THE HEALTH AND WELL-BEING OF ALL ITS CONSTITUENTS. THROUGH THEFINANCIAL ASSISTANCE PROGRAM, MEDICAL CARE IS PROVIDED REGARDLESS OF APATIENT'S ABILITY TO PAY, INSUFFICIENT HEALTH INSURANCE OR WHETHER AGOVERNMENT-SPONSORED PROGRAM COVERS THE FULL COST OF SERVICES. AND AS THECOUNTRY'S ECONOMIC FUTURE REMAINS UNCERTAIN, EVANGELICAL WILL CONTINUE TOPROVIDE CARE FOR THOSE WHO NEED IT.EVANGELICAL WILL PROVIDE SERVICES AT NO CHARGE OR REDUCED CHARGES TO THOSEWHO ARE FINANCIALLY UNABLE TO PAY FOR THOSE SERVICES.EVANGELICAL WILL NOT ARBITRARILY RESTRICT THE PROVISIONS OF HEALTHSERVICES TO CERTAIN INDIVIDUALS OR GROUPS.EVANGELICAL COMMUNITY HOSPITAL'S REGISTRATION DEPARTMENT REPRESENTATIVESINFORM OUR UNINSURED OR UNDER INSURED PATIENTS, OF OUR FINANCIALASSISTANCE PROGRAM. FINANCIAL ASSISTANCE APPLICATIONS ARE OFFERED TOTHESE PATIENTS AND IN ADDITION, THEY HAVE THE OPPORTUNITY TO CALL OURFINANCIAL COUNSELOR. THE FINANCIAL COUNSELOR DISCUSSES THE AVAILABILITY OFVARIOUS GOVERNMENT BENEFITS SUCH AS MEDICAID OR STATE PROGRAMS TO ASSISTTHE PATIENT WITH QUALIFICATIONS FOR THESE PROGRAMS. THE FINANCIALCOUNSELOR WILL ALSO ASSIST THE PATIENT IN COMPLETING THE PROPER PAPERWORKFOR ASSISTANCE.THE FINANCIAL COUNSELORS AND CASE MANAGEMENT STAFF WORK CLOSELY TOIDENTIFY AND ASSIST ELIGIBLE PATIENTS. OUR SELF-PAY VENDOR ALSO INFORMSTHE PATIENT THAT EVANGELICAL HAS A FINANCIAL ASSISTANCE PROGRAM AND AFINANCIAL COUNSELOR WHO WILL SEND THEM AN APPLICATION IF REQUESTED. OURTHIRD PARTY VENDOR WORKS ON BEHALF OF THE ORGANIZATION TO FOLLOW THEHOSPITAL'S POLICIES REGARDING PATIENT NOTIFICATION AND THE AVAILABILITYOF FINANCIAL ASSISTANCE. EVANGELICAL'S FINANCIAL ASSISTANCE POLICY ISPOSTED ON THE EVANGELICAL WEBSITE(HTTP://WWW.EVANHOSPITAL.COM/PATIENTS/INSURANCE/CHARITY-CARE)ALONG WITH AN APPLICATION FOR PATIENTS TO COMPLETE FOR FINANCIALASSISTANCE.EVANGELICAL COMMUNITY HOSPITAL WILL MAKE AVAILABLE A WRITTEN NOTICE TOEACH PATIENT OR THEIR REPRESENTATIVE OF THE EXISTENCE, CRITERIA ANDMECHANISM FOR RECEIVING FINANCIAL ASSISTANCE. THE HOSPITAL WILL CREATE ANDMAINTAIN RECORDS DEMONSTRATING THAT THE REQUIRED CRITERIA AND MECHANISMARE ESTABLISHED (HOSPITAL WILL RECORD ANY AND ALL REQUESTS FOR FINANCIALASSISTANCE, THE DISPOSITION AND THE DOLLAR AMOUNT OF EVANGELICAL'SFINANCIAL ASSISTANCE PROGRAM PROVIDED). IN ALL INSTANCES, PATIENTCONFIDENTIALITY WILL BE PROTECTED.ELIGIBILITY WILL BE DETERMINED BY COMPARING HOUSEHOLD FAMILY INCOMEAGAINST THE INCOME POVERTY GUIDELINES. INCOME IS DEFINED AS THE TOTAL ANNUAL CASH RECEIPTS BEFORE TAXES FROM ALL SOURCES.AN INDIVIDUAL NOTICE OF AVAILABILITY OF EVANGELICAL'S FINANCIAL ASSISTANCEPROGRAM WILL BE GIVEN TO EACH PATIENT OR THEIR REPRESENTATIVE PRIOR TOSERVICES BEING RENDERED, WITH THE EXCEPTION OF EMERGENCY SERVICES. THESENOTICES SHALL BE AVAILABLE IN ALL REGISTRATION AREAS OF THE HOSPITAL ANDSHALL INCLUDE THE MOST CURRENT AVAILABLE "HOUSEHOLD INCOME GUIDELINES" AS PUBLISHED IN THE FEDERAL REGISTER.THE PATIENT ACCOUNTS DIRECTOR OR HIS/HER DESIGNEE SHALL REVIEW ALLAPPLICATIONS FOR THE EVANGELICAL FINANCIAL ASSISTANCE PROGRAM. IT IS THEAPPLICANT'S RESPONSIBILITY TO PROVIDE PROOF OF INCOME.WHEN LANGUAGE IS A BARRIER, EVANGELICAL OFFERS A SPECIAL INTERPRETERCONFERENCING TELEPHONE SERVICE. INTERPRETATION SERVICES ARE AVAILABLE FORA MULTITUDE OF PATIENT/CAREGIVER INTERACTIONS. WHEN A NON-ENGLISH SPEAKINGPATIENT, NO MATTER HIS OR HER NATIVE TONGUE, CALLS IN TO THE HOSPITAL, HEOR SHE WILL BE ABLE TO BE UNDERSTOOD THROUGH A TELEPHONE INTERPRETER.THIS IS AVAILABLE FOR OUTBOUND CALLS TO THE PATIENT AS WELL. THE PROCESSCONTRIBUTES TO IMPROVED PATIENT CARE AND CLINICAL OUTCOMES AND MAKES AVITAL DIFFERENCE IN THE QUALITY OF SERVICE EVANGELICAL IS ABLE TO PROVIDETO NON-ENGLISH SPEAKING PATIENTS. PART VI, LINE 4: EVANGELICAL COMMUNITY HOSPITAL (ECH) IS LOCATED IN LEWISBURG, PA (UNION COUNTY), THE HEART OF CENTRAL PA. THE HOSPITAL IS CONVENIENTLY LOCATED OFF INTERSTATE 80 ON U.S. ROUTE 15. ECH SERVES THE RESIDENTS OF UNION, SNYDER & NORTHUMBERLAND COUNTIES AND SURROUNDING AREAS. ECH IS THE 3RD LARGEST EMPLOYER IN UNION COUNTY WITH MORE THAN 1,200 EMPLOYEES. ACCORDING TO THE HOSPITAL AND HEALTHSYSTEM ASSOCIATION OF PENNSYLVANIA, ECH'S TOTAL IMPACT ON THE REGIONAL ECONOMY TOPS MORE THAN $180 MILLION. ECH IS A 132 LICENSED-BED ACUTE CARE COMMUNITY HOSPITAL WITH OVER 1,200 EMPLOYEES AND NEARLY 200 MEDICAL STAFF MEMBERS. ECH HAS A BUSY EMERGENCY DEPARTMENT WITH OVER 33,558 VISITS IN 2015. THE PRIMARY SERVICE AREA OF RESIDENTS OF ECH INCLUDES: 17810, 17812, 17843, 17813, 17730, 17827, 17829, 17831, 17876, 17833, 17835, 17837, 17749, 17842, 17844, 17845, 17847, 17850, 17853, 17855, 17856, 17857, 17861, 17862, 17864, 17865, 17086, 17870, 17801, 17880, 17882, 17772, 17883, 17777, 17886, 17887, 17885, 17889. OUR SECONDARY SERVICE AREA IS FROM THE FOLLOWING ZIP CODES: 16820, 17866, 17014, 17017, 17821, 17823, 17830, 17737, 17834, 17836, 17045, 17840, 17747, 17832, 17049, 17841, 17062, 17752, 17851, 17756, 17860, 17080, 16872, 17867, 17868, 17872, 17877, 17881, 17884, 16882. THE REGION IS HOME TO SEVERAL COLLEGES, UNIVERSITIES AND TECHNICAL SCHOOLS AS WELL AS STRONG PUBLIC SCHOOL SYSTEMS. IT HAS A VERY DIVERSE HISTORY AND RURAL APPEAL, YET FEATURES BUSINESS AND HEALTHCARE FACILITIES USING THE LATEST ADVANCES IN SCIENCE AND TECHNOLOGY. ADDITIONAL HOSPITALS IN OUR REGION CONSIST OF GEISINGER MEDICAL CENTER, SUNBURY COMMUNITY HOSPITAL (FOR-PROFIT SYSTEM), SHAMOKIN AREA COMMUNITY HOSPITAL, SUSQUEHANNA HEALTH SYSTEM, AND BLOOMSBURG HOSPITAL. ACCORDING TO THE MOST RECENT DATA FROM THE NEEDS ASSESSMENT, THE REGION IS PRIMARILY RURAL IN NATURE. THIS DATA WAS REAFFIRMED DURING THE ASSESSMENT PROCESS THROUGH COMMUNITY LEADERS AND KEY STAKEOLDER INTERVIEWS AND FOCUS GROUP DISCUSSIONS. FURTHERMORE WITH THE RURAL NATURE OF OUR AREA AND THE LACK OF A COORDINATED AND INTEGRATED TRANSPORTATION SYSTEM LIMITS COMMUNITY MEMBERS TO ACCESSIBLE HEALTH CARE AND RECREATIONAL OPPORTUNITIES. WITH THE LIMITATIONS OF ACCESSIBILITY TO HEALTHCARE AND HEALTHY OPTIONS LEADS TO UNHEALTHY LIFESTYLES AND OVER USE OF OUR EMERGENCY DEPARTMENT SERVICES. CITY-DATA.COM FOR UNION COUNTY INDICATES THAT THE POPULATION CONSISTS OF: WHITE NON-HISPANIC (85.2%), BLACK (6.8%), HISPANIC (5.2%), TWO OR MORE RACES (1.2%), AND ASIAN (1.2%). THE MEDIAN RESIDENT AGE IS 38.0. ESTIMATED MEDIAN HOUSEHOLD INCOME IN 2013: $48,120; RESIDENTS WITH INCOME BELOW THE POVERTY LEVEL IN 2013: 14.2%; POPULATION WITHOUT HEALTH INSURANCE COVERAGE IN 2000: 11%; CHILDREN UNDER 18 WITHOUT HEALTH INSURANCE COVERAGE IN 2000: 9%; 89.6% OF RESIDENTS OF UNION COUNTY SPEAK ENGLISH AT HOME; 3.7% OF RESIDENTS SPEAK SPANISH AT HOME; 5.7% OF RESIDENTS SPEAK OTHER INDO-EUROPEAN LANGUAGE AT HOME; 0.8% OF RESIDENTS SPEAK ASIAN OR PACIFIC ISLAND LANGUAGE AT HOME; 0.2% OF RESIDENTS SPEAK OTHER LANGUAGES AT HOME.CITY-DATA.COM FOR SNYDER COUNTY INDICATES THE POPULATION CONSISTS OF: WHITE NON-HISPANIC (96.0%), HISPANIC (1.7%), BLACK (.9%), TWO OR MORE RACES (.7%), AND ASIAN (.5%). THE MEDIAN RESIDENT AGE IS 39. ESTIMATED MEDIAN HOUSEHOLD INCOME IN 2013: $47,035; RESIDENTS WITH INCOME BELOW THE POVERTY LEVEL IN 2013: 10.6%; POPULATION WITHOUT HEALTH INSURANCE COVERAGE IN 2000: 9%; CHILDREN UNDER 18 WITHOUT HEALTH INSURANCE COVERAGE IN 2000: 8%; 92.0% OF RESIDENTS OF SNYDER COUNTY SPEAK ENGLISH AT HOME; 1.5% OF RESIDENTS SPEAK SPANISH AT HOME; 6.3% OF RESIDENTS SPEAK OTHER INDO-EUROPEAN LANGUAGE AT HOME; 0.2% OF RESIDENTS SPEAK ASIAN OR PACIFIC ISLAND LANGUAGE AT HOME; 0.1% OF RESIDENTS SPEAK OTHER LANGUAGES AT HOME.CITY-DATA.COM FOR NORTHUMBERLAND COUNTY INDICATES THAT THE POPULATION CONSISTS OF: WHITE NON-HISPANIC (94.3), BLACK (1.9%), HISPANIC (2.4%), AND TWO OR MORE RACES (0.8%). ESTIMATED MEDIAN HOUSEHOLD INCOME IN 2013: $41,011; THE MEDIAN RESIDENT AGE IS 43. RESIDENTS WITH INCOME BELOW THE POVERTY LEVEL IN 2013: 14.1%; POPULATION WITHOUT HEALTH INSURANCE COVERAGE IN 2000: 10%; CHILDREN UNDER 18 WITHOUT HEALTH INSURANCE COVERAGE IN 2000: 8%; 95.6% OF RESIDENTS OF NORTHUMBERLAND COUNTY SPEAK ENGLISH AT HOME; 1.5% OF RESIDENTS SPEAK SPANISH AT HOME; 2.6% OF RESIDENTS SPEAK OTHER INDO-EUROPEAN LANGUAGE AT HOME; 0.3% OF RESIDENTS SPEAK ASIAN OR PACIFIC ISLAND LANGUAGE AT HOME; 0.1% OF RESIDENTS SPEAK OTHER LANGUAGES AT HOME.ECH OPERATES AN EMERGENCY DEPARTMENT THAT IS OPEN TO ALL PERSONS REGARDLESS OF THEIR ABILITY TO PAY FOR SERVICES. WE HAVE OPEN MEDICAL STAFF WITH PRIVILEGES AVAILABLE TO ALL QUALIFIED PHYSICIANS IN THE AREA. ECH HAS A BOARD OF DIRECTORS IN WHICH INDEPENDENT COMMUNITY PERSONS ARE REPRESENTED. ECH IS AFFILIATED WITH HEALTHCARE FACILITIES, SUCH AS GEISINGER MEDICAL CENTER, TO PROVIDE THE BEST MEDICAL CARE FOR OUR PATIENTS. ECH WORKS WITH THE FOLLOWING HIGHER EDUCATION INSTITUTIONS (I.E. COLLEGES, TECHNICAL SCHOOL AND INTERMEDIATE UNITS): PENN COLLEGE, CENTRAL SUSQUEHANNA INTERMEDIATE UNIT, BLOOMSBURG UNIVERSITY, AND SUN-AREA VO-TECH. WE WORK WITH THESE HIGHER EDUCATION INSTITUTIONS TO ENGAGE IN TRAINING AND EDUCATION OF HEALTH CARE PROFESSIONALS. ECH PROVIDES FINANCIAL AID TO SUPPORT STUDENTS CHOOSING THE HEALTHCARE PROFESSION THROUGH THE MAE KEEFER AND CRYSTAL D. SNYDER NURSING SCHOLARSHIP FUND AND THE JOHN FAMILY HEALTH CAREERS SCHOLARSHIP FUND FOR CLINICAL SERVICES.ECH PARTICIPATES WITH THE FOLLOWING MAJOR HEALTH PLANS: CAPITAL BLUE CROSS, GEISINGER HEALTH PLAN, HIGHMARK BLUESHIELD, AETNA/HEALTHAMERICA, KEYSTONE HEALTH PLAN CENTRAL, AND MEDICARE.THE SECONDARY DATA COLLECTION FINDINGS FROM THE MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT SUMMARIZES THE FOLLOWING WITH REGARD TO DEMOGRAPHICS AND THE NEEDS OF THE COMMUNITY. ECH'S SERVICE AREA SHOWS A SLIGHT DECLINE IN POPULATION OVER THE PAST FIVE YEARS WHILE PENNSYLVANIA, AS A STATE, SHOWS A SLIGHT INCREASE. KEY FINDINGS: ANNUAL AVERAGE INCOME IN OUR SERVICE AREA IS $53,064. NORTHUMBERLAND COUNTY HAS THE LOWEST AVERAGE INCOME AT $45,871 AND THE AVERAGE INCOME IN ALL OF PENNSYLVANIA IS $64,000.16.6% OF ECH'S SERVICE AREA IS REPORTED AS NOT HAVING A HIGH SCHOOL DIPLOMA. THIS IS FOUR POINTS HIGHER THAT THE STATE AVERAGE OF 12.6%. ACCORDING TO THE COUNTY HEALTH RANKINGS ECH SHOWS A POOR RANKING IN THE FOLLOWING CATEGORIES: EMPLOYMENT, EDUCATION, AND DIET/EXERCISE. WE KNOW THAT THESE THREE FACTORS ARE HIGHLY CORRELATED: I.E. POOR EMPLOYMENT CAN LEAD TO LOWER INCOME WHICH CAN THEN LEAD TO FEWER OPTIONS FOR GOOD EDUCATIONAL OPPORTUNITIES AND THEREFORE POORER HEALTH DECISIONS IN TERMS OF DIET AND EXERCISE. WHEN COMPARED TO THE REST OF THE STATE AND EVEN THE UNITED STATES AS A WHOLE, ECH SHOWS VERY LITTLE DIVERSITY WITH ONLY 5.1% OF THE POPULATION IDENTIFYING AS A RACE/ETHNICITY OTHER THAN WHITE NON-HISPANIC. PENNSYLVANIA IS AT 19.6% AND THE UNITED STATES IS AT 35%.SUNBURY AND ALLENWOOD SCORED THE HIGHEST IN THE COMMUNITY NEED INDEX, MEANING THEY HAVE THE MOST BARRIERS TO COMMUNITY HEALTH CARE ACCESS. SUNBURY SHOWED VERY HIGH RATES OF INDIVIDUALS LIVING IN POVERTY; 65 AND OLDER (11%), FAMILIES WITH MARRIED INDIVIDUALS WITH CHILDREN (17%), AND FAMILIES WITH SINGLE INDIVIDUALS WITH CHILDREN (50%). ALLENWOOD SHOWS THE HIGHEST UNEMPLOYMENT RATE AT 17%, BUT THIS COULD BE MISLEADING DUE TO A FEDERAL PRISON BEING LOCATED IN THAT TOWN. TURBOTVILLE SHOWS THE LOWEST UNEMPLOYMENT RATE (4%) AND THE LOWEST RATE OF INDIVIDUALS LIVING IN POVERTY; 65 AND OLDER (9%), MARRIED WITH CHILDREN LIVING IN POVERTY (5%) AND SINGLE LIVING WITH CHILDREN IN POVERTY (8%). ACCORDING TO THE COUNTY HEALTH RANKINGS (PENNSYLVANIA'S COUNTIES ARE RANKED 1 THROUGH 67. 1 BEING THE BEST SCORE AND 67 BEING THE WORST) UNION AND SNYDER COUNTIES RANKED IN THE TOP 5 FOR HEALTH OUTCOMES WHILE NORTHUMBERLAND COUNTY RANKED IN THE BOTTOM 15 FOR HEALTH OUTCOMES. UNION COUNTY WAS NAMED THE HEALTHIEST COUNTY AND RANKED NUMBER ONE IN QUALITY OF CARE ACCORDING TO THE 2011 COUNTY HEALTH RANKINGS. CONSEQUENTLY, UNION COUNTY RANKED IN THE BOTTOM FIVE FOR ITS BUILT ENVIRONMENT WHICH REFERS TO ACCESS TO RECREATIONAL FACILITIES, LIMITED ACCESS TO HEALTHY FOODS AND NUMBER OF FAST FOOD RESTAURANTS. TOBACCO USE IN ECH'S SERVICE AREA RANKED AS FOLLOWS; NORTHUMBERLAND COUNTY WAS 54 OUT OF 67 COUNTIES, UNION COUNTY WAS 38 OUT OF 67 AND SNYDER COUNTY CAME IN AT THE LOWEST WITH A RANKING OF 16 OUT OF 67. WITH REGARD TO ALCOHOL USE ECH'S SERVICE AREA RANKED AS FOLLOWS; NORTHUMBERLAND COUNTY, 38 OUT OF 67, UNION COUNTY, 19 OUT OF 67, AND SNYDER COUNTY RANKED NUMBER 1 OUT OF 67. PART VI, LINE 5: EVANGELICAL COMMUNITY HOSPITAL HAS A TOTAL OF 132 PATIENT BEDS AND 18 BASSINETS. THERE ARE NEARLY 200 PHYSICIANS ON STAFF, AND NEARLY 900 CLINICAL EMPLOYEES, INCLUDING LAB TECHNICIANS, NURSES, NURSING ASSISTANCES, PHYSICAL, OCCUPATIONAL AND SPEECH THERAPISTS, RADIOLOGY TECHNICIANS, PHLEBOTOMISTS, AND SUPPORT PERSONNEL. EACH OF THESE PROFESSIONALS IS HIGHLY TRAINED TO DELIVER QUALITY AND SAFE CARE TO INPATIENTS AND OUTPATIENTS. THE HOSPITAL HAS:1) AN OPEN MEDICAL STAFF WITH PRIVILEGES AVAILABLE TO ALL QUALIFIED PHYSICIANS IN THE SUSQUEHANNA VALLEY REGION;2) A BOARD OF DIRECTORS WHO GOVERN THE ORGANIZATION. THE BOARD IS COMPRISED OF COMMUNITY AND BUSINESS LEADERS, AND PHYSICIANS REPRESENTING THE GEOGRAPHIC AREA OF OUR REGION;3) AN EMERGENCY DEPARTMENT THAT IS OPEN TO ALL PERSONS IN NEED REGARDLESS OF THEIR ABILITY TO PAY FOR SERVICES;4) A HOSPICE PROGRAM THAT PROVIDES END-OF-LIFE CARE TO ALL PERSONS REGARDLESS OF THEIR ABILITY TO PAY FOR CARE;5) A BIOETHICS COMMITTEE COMPRISED OF VOLUNTEERS WHO ARE PHYSICIANS, NURSES, SOCIAL SERVICE WORKERS, PASTORAL CAREGIVERS, EDUCATORS, AND OTHER PROFESSIONALS. THEY DISCUSS AND ADDRESS ETHICAL ISSUES AND DILEMMAS THAT ARE PRESENTED FOR REVIEW;6) A HISTORY OF PROVIDING FINANCIAL SUPPORT TO OTHER NONPROFIT ORGANIZATIONS FOR THE PURPOSE OF HEALTH PROMOTION AND IN COLLABORATING TO MEET UNMET NEEDS IN THE COMMUNITY.7) A COMMUNITY HEALTH AND WELLNESS DEPARTMENT THAT IS FUNDED USING HOSPITAL RESOURCES. THE DEPARTMENT INITIATES AND ORGANIZES PREVENTION, WELLNESS AND HEALTH EDUCATION LECTURES, EVENTS AND ACTIVITIES DEVELOPED FOR THE SOLE PURPOSE OF IMPROVING THE HEALTH OF THOSE IN OUR REGION. THE COMMUNITY HEALTH AND WELLNESS TEAM OFFERS: HEALTH SCREENINGS, HEALTH FAIRS, LECTURES, SUPPORT GROUPS, FLU SHOTS, AND SAFETY INSPECTIONS. THE HOSPITAL IS SUPPORTIVE OF ITS EMPLOYEES TO BE INVOLVED IN THE COMMUNITY ORGANIZATIONS TO SUPPORT AND TO BE A PART OF ADDRESSING THE NEEDS OF THE COMMUNITY. SURPLUS FUNDS OF THE HOSPITAL ARE USED TO DEVELOP EMPLOYEES AND FURTHER EDUCATE STAFF TO KEEP UP WITH THE EVER CHANGING HEALTHCARE TECHNOLOGY AND NEW TREATMENT PLANS FOR DISEASES, AS WELL AS CAPITAL NEEDS OF THE ORGANIZATION TO KEEP THE NECESSARY NEW MEDICAL EQUIPMENT AVAILABLE TO BETTER TREAT THE PATIENTS OF THE COMMUNITY. PART VI, LINE 6: THE ORGANIZATION IS PART OF AN AFFILIATED HEALTH CARE SYSTEM DUE TO THE HOSPITAL HAVING COMMON GOVERNANCE AND CONTROL FOR EVANGELICAL MEDICAL SERVICES ORGANIZATION. EVANGELICAL MEDICAL SERVICES ORGANIZATION PROVIDE HEALTHCARE SERVICES IN THE FORM OF PRIMARY AND SPECIALTY CARE PHYSICIANS TO THE COMMUNITY. PART VI, LINE 7, REPORTS FILED WITH STATES PA 1 SCHOLARSHIPS 25 76100 CASH N/A PART I, LINE 2: APPLICANTS MUST APPLY FOR NURSING AND TRAINING DEPARTMENT SCHOLARSHIPS. APPLICATIONS ARE REVIEWED BY A COMMITTEE TO DETERMINE IF THE APPLICANTS MEET THE ELIGIBILITY REQUIREMENTS. APPLICANTS ARE REVIEWED BASED ON COMMUNITY SERVICE AND/OR EXTRA CURRICULAR ACTIVITIES, ACADEMIC STANDING, QUALITY OF ESSAY, FINANCIAL NEED, ETC. X X X X 0 1 0 0 0 0 0 1 0 MICHAEL N O'KEEFE UNTIL 63015 PRESIDENT/CEO (NON-VOTING) 377924 0 25000 0 956 0 90575 0 14142 0 508597 0 0 0 JOHN E RICE MD DIRECTOR/PHYSICIAN 233700 0 0 0 0 0 4792 0 21525 0 260017 0 0 0 KENDRA A AUCKER PRESIDENT/CEO (NON-VOTING) 238839 0 42148 0 0 0 39847 0 21864 0 342698 0 0 0 JAMES A STOPPER TREASURER/CFO 215136 0 32519 0 35362 0 32445 0 13473 0 328935 0 0 0 J LAWRENCE GINSBURG VP MEDICAL AFFAIRS 413172 0 31831 0 187209 0 66863 0 14538 0 713613 0 0 0 PAUL E TARVES VP OF NURSING 177155 0 17933 0 0 0 26949 0 19937 0 241974 0 0 0 DALE E MOYER CHIEF INFORMATION OFFICER 162309 0 16459 0 0 0 24989 0 21685 0 225442 0 0 0 MARK K KRAMMES DIR OF PERI-ANESTHESIA 240698 0 0 0 0 0 8375 0 21525 0 270598 0 0 0 SANDRA S WALKER NURSE ANESTHETIST 211405 0 0 0 0 0 8435 0 542 0 220382 0 0 0 LORI K GOODLING NURSE ANESTHETIST 205426 0 0 0 0 0 2073 0 6698 0 214197 0 0 0 BRADLEY P BOWER NURSE ANESTHETIST 185378 0 0 0 0 0 7303 0 21525 0 214206 0 0 0 RAYMOND J TOMASZEWSKI NURSE ANESTHETIST 191278 0 0 0 0 0 7765 0 21525 0 220568 0 0 0 PART I, LINE 4B THE FOLLOWING INDIVIDUALS RECEIVED A DISTRIBUTION FROM A SUPPLMENTAL NONQUALIFIED RETIREMENT PLAN: MICHAEL O'KEEFE - $956 J. LAWRENCE GINSBURG - $187,209 JAMES STOPPER - $35,362 THE FOLLOWING INDIVIDUALS PARTICIPATED IN A SUPPLMENTAL NONQUALIFIED RETIREMENT PLAN: MICHAEL O'KEEFE - $81,372 J. LAWRENCE GINSBURG - $53,086 KENDRA AUCKER - $30,064 PAUL TARVES - $19,599 ANGELA HUMMEL - $13,477 DALE MOYER - $18,184 JAMES STOPPER - $23,989 PART I, LINE 7 THE EXECUTIVE TEAM IS ELIGIBLE TO RECEIVE A BONUS (BASED ON A % OF SALARY) WHEN THEIR INDIVIDUAL GOALS ARE MET FOR THE YEAR. GOALS ARE SET FOR EACH INDIVIDUAL BASED ON FINANCIAL AND OPERATIONAL RESULTS. THESE GOALS ARE REVIEWED AND APPROVED BY THE EXECUTIVE COMPENSATION COMMITTEE. A UNION COUNTY HOSPITAL AUTHORITY 232739624 2013-10-24 19694697 CAPITAL IMPROVEMENTS, REFINANCE 2004 BONDS, ISSUANCE COSTS 0 0 0 B UNION COUNTY HOSPITAL AUTHORITY 232739624 906460DJ6 2011-03-03 30235000 SERIES OF 2011 BONDS - FUND CONSTRUCTION & REFUND OUTSTANDING 2009 BONDS 0 0 0 A 745800 19694697 207720 19486977 2013 0 1 1 1 B 5210000 29719008 2252124 377544 27089340 2012 1 0 1 1 A 0 0 0 0 0.00000 0.00320 0.00320 0 0 1 B 0 0 0 0 0.00000 0.00320 0.00320 0 0 1 A 0 0 1 0 0 0 0 0 1 B 0 0 1 0 0 0 0 0 1 A 1 B 1 SCHEDULE K, PART II, LINE 3: TOTAL PROCEEDS OF ISSUE FOR BOND B ARE LESS THAN THE ISSUE PRICE LISTED IN PART I DUE TO THE UNDERWRITER'S DISCOUNT OF $515,992. JOHN D GRIFFITH SEE PART V 458571 SEE PART V 0 SCH L, PART IV, BUSINESS TRANSACTIONS INVOLVING INTERESTE PERSONS (A) NAME OF PERSON: JOHN D. GRIFFITH(B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: SERVES AS A DIRECTOR ON THE BOARD OF DIRECTORS(D) JOHN D. GRIFFITH LEASES PROPERTY TO THE HOSPITAL AT AN ARM'S LENGTH TRANSACTION. X 1 1449 DONOR COST X ADVERTISING 2 9135 DONOR COST X EUROPEAN DRIVING TRIP 1 6500 DONOR COST X LANDSCAPING SERVICES 1 6000 DONOR COST X FLORAL ARRANGEMENTS 1 5060 DONOR COST X TWO TRIPS TO SAN MARCO ISLAND, FLORIDA 1 5000 DONOR COST X FOOTBALL TICKETS W/ PARKING PASS 1 692 DONOR COST 0 1 0 PART I, COLUMN (B): NUMBER OF CONTRIBUTIONS IN COLUMN B REPRESENTS THE NUMBER OF CONTRIBUTORS FOR THE TYPE OF PROPERTY LISTED. FORM 990, PART VI, SECTION A, LINE 2 ROBERT GRONLUND IS THE FATHER OF BROOKS GRONLUND AND BOTH SERVE ON THE BOARD. FORM 990, PART VI, SECTION A, LINE 3 MANAGEMENT SERVICES FOR THE WOUND AND HYBERBARIC OXYGEN THERAPY ("HBOT") DEPARTMENT WERE OUTSOURCED TO DIVERSIFIED CLINICAL SERVICES. FORM 990, PART VI, SECTION A, LINE 4 THE BY LAWS WERE AMENDED DURING THE YEAR (1) TO EXPAND THE EX-OFFICIO MEMBERS OF THE BOARD TO INCLUDE THE PRESIDENT-ELECT OF THE MEDICAL STAFF (EX-OFFICIO) AND (2) TO REPLACE THE CURRENT LIMITATION ON EMPLOYEES SERVING ON OUR BOARD CONTAINED IN SECTION 4.2 OF THE BYLAWS WITH A REQUIREMENT THAT A MAJORITY OF THE BOARD BE "INDEPENDENT" AS DEFINED BY THE APPROPRIATE IRS REGULATIONS. FORM 990, PART VI, SECTION B, LINE 11 FORM 990 WAS REVIEWED BY THE FINANCE DEPARTMENT AND THE AUDIT COMMITTEE OF THE BOARD AT AN AUDIT COMMITTEE MEETING PRIOR TO FILING. THEY HAVE THE OPPORTUNUITY TO ASK QUESTIONS AND CHANGES CAN BE MADE AS A RESULT IF NECESSARY BEFORE THE RETURN IS FILED. FORM 990, PART VI, SECTION B, LINE 12C A CONFLICT OF INTEREST STATEMENT IS REQUIRED TO BE SIGNED ANNUALLY BY ALL VOTING BOARD MEMBERS, UPPER MANAGEMENT, AND KEY EMPLOYEES. THE HUMAN RESOURCES DEPARTMENT MONITORS COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY BY VERIFYING ALL FORMS ARE COMPLETED AND SIGNED. HR MAINTAINS COPIES OF ALL COMPLETED CONFLICT OF INTEREST STATEMENTS. MEMBERS WITH CONFLICTS ARE REQUIRED TO ABSTAIN FROM VOTING OR BEING A PART OF ACTIVE DISCUSSIONS WHERE THEY ARE IN DIRECT CONFLICT. ANYONE IN VIOLATION OF THE CONFLICT OF INTEREST POLICY IS ASKED TO STEP DOWN FROM THE BOARD. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD'S EXECUTIVE COMPENSATION COMMITTEE, WHICH IS COMPOSED SOLELY OF INDEPENDENT MEMBERS OF THE BOARD, HAS ADOPTED AND FOLLOWS A PROCESS FOR REVIEWING AND DETERMINING THE COMPENSATION OF THE CEO AND THE EXECUTIVE MANAGEMENT TEAM. THE EXECUTIVE MANAGEMENT TEAM CONSISTS OF THE FOLLOWING POSITIONS: CHIEF OPERATING OFFICER, CHIEF FINANCIAL OFFICER, VICE PRESIDENT OF MEDICAL AFFAIRS, VICE PRESIDENT - NURSING, ASSOCIATED VICE PRESIDENT - DEVELOPMENT, VICE PRESIDENT - HUMAN RESOURCES, CHIEF INFORMATION OFFICER, ASSOCIATE VICE PRESIDENT - SUBSIDIARY OPERATIONS. THE COMMITTEE HAS ENGAGED AN INDEPENDENT COMPENSATION CONSULTANT TO PROVIDE INFORMATION AND ADVICE TO THE COMMITTEE, INCLUDING BUT NOT LIMITED TO, PROVIDING INDEPENDENT COMPENSATION COMPARABILITY DATA FOR FUNCTIONALLY COMPARABLE POSITIONS IN SIMILARLY SITUATED HOSPITALS. THE DATA IS PROVIDED ON AN ANNUAL BASIS AND IS REVIEWED BY THE COMMITTEE, ALONG WITH OTHER INFORMATION, PRIOR TO APPROVING ANY CHANGES TO COMPENSATION. THE INDEPENDENCE OF THE COMMITTEE'S MEMBERS IS REVIEWED AND VERIFIED PRIOR TO THE START OF THE ANNUAL COMPENSATION REVIEW PROCESS. SHOULD A CONFLICT PRESENT, THOSE INDIVIDUALS WITH ACTUAL OR PERCEIVED CONFLICTS ABSTAIN FROM VOTING UNTIL SUCH TIME AS THE CONFLICT CAN BE RESOLVED OR A REPLACEMENT MEMBER IS APPOINTED TO THE COMMITTEE. THE COMMITTEE'S DELIBERATIONS AND DECISIONS ARE GUIDED BY A WRITTEN COMPENSATION PHILOSOPHY AND DOCUMENTED THROUGH WRITTEN MINUTES TAKEN DURING EACH MEETING. THE MINUTES INCLUDE, AMONG OTHER THINGS, THE WRITTEN MATERIALS DISTRIBUTED OR PRESENTED DURING THE MEETING AND THE SPECIFIC DECISIONS TAKEN AT THE MEETING. THE LAST REVIEW TOOK PLACE IN 2015. 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 VI, LINE 1 THE EXECUTIVE COMMITTEE OF THE BOARD IS COMPRISED OF THE CHAIRPERSON, THE VICE-CHAIRPERSON OF THE BOARD, THE IMMEDIATE PAST CHAIRPERSON OF THE BOARD, THE CHAIR OF THE FINANCE COMMITTEE AND THE PRESIDENT OF THE MEDICAL STAFF. NO PERSON IS ELIGIBLE TO SERVE ON THE EXECUTIVE COMMITTEE IN MORE THAN ONE CAPACITY. IN THE EVENT THAT ANY PERSON IS ELIGIBLE TO SERVE ON THE EXECUTIVE COMMITTEE IN MORE THAN ONE CAPACITY, THE CHAIRPERSON SHALL NOMINATE ANOTHER BOARD MEMBER TO SERVE ON THE EXECUTIVE COMMITTEE. THE EXECUTIVE COMMITTEE SHALL INCLUDE AT LEAST ONE PHYSICIAN WHO IS A BOARD MEMBER. THE PRESIDENT SHALL SERVE AS AN EX-OFFICIO MEMBER OF THE EXECUTIVE COMMITTEE WITHOUT A VOTE. THE EXECUTIVE COMMITTEE IS EMPOWERED TO ACT FOR THE BOARD IN THE GOVERNANCE OF ECH BETWEEN REGULAR MEETINGS OF THE BOARD, WHEN SUCH ACTION IS REQUIRED FOR THE TIMELY CONDUCT OF ECH BUSINESS, EXCEPT THE FOLLOWING: 1) SUCH POWERS AS MAY BY LAW OR THESE BYLAWS BE REQUIRED TO BE EXERCISED BY THE BOARD: 2) SUCH POWERS AS THE BOARD MAY BY RESOLUTION EXPRESSLY RESERVE TO ITSELF: 3) THE PURCHASE OR SALE OF REAL PROPERTY; 4) HIRING OR TERMINATING THE EMPLOYMENT OF THE PRESIDENT; 5) AMENDING OR REVISING THE BOARD APPROVED BUDGET; 6) TAKING ANY ACTION WHICH IS A "FUNDAMENTAL CHANGE" WITHIN THE MEANING OF CHAPTER 59 OF THE NONPROFIT CORPORATION LAW OF 1988 (OR ANY SIMILAR SUCCESSOR STATUTE); 7) THE BORROWING OF MONEY; 8) COMMITMENTS OR EXPENDITURES GREATER THAN $500,000. FORM 990, PART XI, LINE 9: CHANGE IN VALUE OF SPLIT-INTEREST AGREEMENT -12,276. VALUATION LOSS -191,483. POSTRETIREMENT BENEFIT LIABILITY ADJUSTMENT -444,569. NET TRANSFERRS WITH AFFILIATES -14,200,000. EVANGELICAL AMBULATORY SURGICAL CENTER 210 JPM ROAD LEWISBURG PA 17837 233021240 HEALTHCARE - SURGERY PA 503450 746321 EVANGELICAL COMMUNITY HOSPITAL EVANGELICAL-GEISINGER HEALTH LLC 100 N ACADEMY AVENUE DANVILLE PA 178224031 460567687 HEALTHCARE PA N/A RELATED 166925 815690 0 0 0.50000 KEYSTONE ACCOUNTABLE CARE ORG LLC 100 N ACADEMY AVENUE DANVILLE PA 17822 455484165 HEALTHCARE PA N/A RELATED -322373 122313 0 0 0.30000 CENTRAL SUSQUEHANNA HEALTHCARE PROVIDERS INC ONE HOSPITAL DRIVE LEWISBURG PA 17837 232452170 MEDICAL SERVICES PA EVANGELICAL COMMUNITY HOSPITAL C 36660 196466 0.50000 0 EVANGELICAL MEDICAL SERVICE ORGANIZATION ONE HOSPITAL DRIVE LEWISBURG PA 17837 232809429 MEDICAL SERVICES PA EVANGELICAL COMMUNITY HOSPITAL C 33459654 23129622 1.00000 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 1 0 EVANGELICAL MEDICAL SERVICES ORGANIZATION R 14200000 CASH EVANGELICAL MEDICAL SERVICES ORGANIZATION P 952995 CASH EVANGELICAL MEDICAL SERVICES ORGANIZATION O 814064 HOURS SPENT WORKING FOR AFFILIATE EVANGELICAL MEDICAL SERVICES ORGANIZATION J 726975 CASH