2016-05-16T10:51:11-05:00 2015-06-30 390859910 BAKER TILLY VIRCHOW KRAUSE LLP 1650 MARKET STREET SUITE 4500 PHILADELPHIA PA 19103 990 2014-07-01 231352202 SCHUYLKILL MEDICAL CTR - SOUTH JACKSON ST F/K/A POTTSVILLE HOSP & WARNE CLINIC SCHU 5706215000 MAUCH CHUNK AND JACKSON STREETS POTTSVILLE PA 17901 JUDY PEEK-LEE INTERIM CFO 5706215000 2016-05-12 1 JULIUS C GREEN CPA JD P00350393 2159720701 2014 2016-08-17 19:52:53Z MARC H LORY MAUCH CHUNK AND JACKSON STREETS POTTSVILLE PA 17901 87281566 0 X WWW.SCHUYLKILLHEALTH.COM X 2008 PA TO MAKE A POSITIVE DIFFERENCE IN THE SCOPE AND QUALITY OF HEALTHCARE FOR THE SCHUYLKILL COMMUNITY. 17 16 985 22 0 0 594806 405804 93421166 85548751 57928 281012 1547342 972704 95621242 87208271 4925 2235 0 0 50947410 47852907 0 0 0 45527586 42939528 96479921 90794670 -858679 -3586399 59419421 56871043 74200974 80736498 -14781553 -23865455 X SCHUYLKILL MEDICAL CENTER - SOUTH JACKSON STREET'S MISSION IS TO MAKE A POSITIVE DIFFERENCE IN THE SCOPE AND QUALITY OF HEALTHCARE AVAILABLE FOR THE SCHUYLKILL COUNTY COMMUNITY. 0 0 73560832 2235 85548751 SCHUYLKILL MEDICAL CENTER - SOUTH JACKSON STREET THROUGH THE COMBINED EFFORTS OF ITS HIGHLY QUALIFIED MEDICAL STAFF, EMPLOYEES AND VOLUNTEERS, OFFERS A BROAD RANGE OF HEALTHCARE SERVICES TO THE RESIDENTS OF SCHUYLKILL COUNTY, PA. INPATIENT HEALTHCARE SERVICES ARE PROVIDED IN MEDICINE, SURGERY, CRITICAL CARE, MATERNITY, PEDIATRIC AND BEHAVIORAL HEALTH SERVICES. THERE WERE MORE THAN 30,000 EMERGENCY DEPARTMENT VISITS.SCHUYLKILL MEDICAL CENTER SOUTH JACKSON STREET PROVIDES A WIDE ARRAY OF DIAGNOSTIC AND TREATMENT PROGRAMS INCLUDING A HOSPITAL-BASED HOME HEALTH DEPARTMENT, PHYSICAL, OCCUPATIONAL AND SPEECH THERAPIES, OCCUPATIONAL MEDICINE AS WELL AS CT, MRI, MAMMOGRAPHY, ULTRASOUND, DEXA SCAN, NUCLEAR MEDICINE AND OTHER IMAGING TECHNOLOGIES.THE MEDICAL CENTER PROVIDES MANY COMMUNITY OUTREACH AND EDUCATIONAL PROGRAMS THROUGHOUT THE YEAR AS WELL AS SCREENINGS, EVENTS AND HEALTH FAIR PARTICIPATION. 73560832 1 1 0 1 0 0 0 0 0 0 1 1 0 1 1 1 0 1 0 0 1 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 0 0 0 1 49 0 1 985 1 0 0 0 0 0 0 0 0 0 0 X 17 16 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 PA X JUDY PEEK-LEE INTERIM CFO 5706215142 420 SOUTH JACKSON STREET POTTSVILLE PA 17901 ANTHONY BARAN CHAIRMAN 1.00 3.00 X X 0 0 0 FRANKLIN K SCHOENEMAN VICE-CHAIRMAN 1.00 3.00 X X 0 0 0 E LORI SMITH TREASURER 1.00 4.00 X X 0 0 0 DEBRA C BLASCHAK SECRETARY 1.00 3.00 X X 0 0 0 RICHARD GONZALEZ TRUSTEE 1.00 4.00 X 0 0 0 REV HAROLD L HAND TRUSTEE 1.00 3.00 X 0 0 0 JEANNE BOYER PORTER TRUSTEE 1.00 3.00 X 0 0 0 WILLIAM L JONES III TRUSTEE 1.00 3.00 X 0 0 0 SARAH T CASEY TRUSTEE 1.00 3.00 X 0 0 0 WILLIAM E KIRWAN CPA ESQ TRUSTEE 1.00 3.00 X 0 0 0 STEVEN I FIELD TRUSTEE 1.00 3.00 X 0 0 0 AMRIT NARULA TRUSTEE 1.00 3.00 X 0 0 0 CYNTHIA PETCHULIS TRUSTEE 1.00 3.00 X 0 0 0 SYED SHAH MD TRUSTEE 1.00 3.00 X 0 0 0 TIMOTHY F TWARDZIK TRUSTEE 1.00 3.00 X 0 0 0 ROBERT M ZIMMERMAN JR DO TRUSTEE 1.00 3.00 X 0 0 0 JOHN E SIMODEJKA PRESIDENT/CEO (TO 8/14) 18.00 22.00 X X 1086774 0 27120 MARC LORY INTERIM PRESIDENT/CEO 18.00 22.00 X X 0 0 0 JUDY PEEK-LEE INTERIM CFO 18.00 22.00 X 0 0 0 DIANE BORIS VP FINANCE 18.00 22.00 X 0 147917 18042 DARNELL FURER VP NURSING/CNO (TO 6/15) 18.00 22.00 X 0 181695 23673 DR THOMAS CURRY VP MEDICAL AFFAIRS (TO 10/14) 18.00 22.00 X 203183 0 17784 SUE CURRY VP NURSING/CNO 18.00 22.00 X 100527 0 26081 RICHARD BINDIE DIRECTOR OF PATHOLOGY 37.50 X 285207 0 25644 SHERRY L BURINSKY BOTTOR CRNA 37.50 X 234268 0 25856 JULIANNE M TIDMORE CRNA 37.50 X 220906 0 25455 LYNDA L JAKUBCO CRNA 37.50 X 220297 0 24083 MARY R TUNNESSEN CRNA 37.50 X 217467 0 23998 2568629 329612 237736 33 0 1 0 INSIGHT HEALTH CORP PO BOX 847689 DALLAS TX 75284 PET SCAN & MRI SERVICE 933745 SODEXHO INC & AFFILIATES PO BOX 360170 PITTSBURGH PA 15251 DIETARY 871617 GE HEALTHCARE PO BOX 96483 CHICAGO IL 606930944 EQUIPMENT MAINTENANCE 693158 ARAMARK CORPORATION 12483 COLLECTIONS CENTER DR CHICAGO IL 60693 BIOMED 682296 LABORATORY CORPORATION OF AMERICA HOLDIN PO BOX 12140 BURLINGTON NC 27216 REFERENCE LAB 495570 24 137000 268804 405804 NET PATIENT SERVICE REV 621400 84970461 84970461 SCHOOL OF NURSING 621400 578290 578290 85548751 251735 251735 55514 35175 20339 20339 20339 67397 38120 29277 29277 29277 MEANINGFUL USE 900099 467230 467230 CAFETERIA & VENDING 561439 312525 312525 PURCHASE DISCOUNTS 900099 74897 74897 97713 97713 952365 87208271 85548751 0 1253716 X 1210 1210 1025 1025 1127943 1127943 38055817 31051893 7003924 1297463 1062835 234628 4541598 3725005 816593 2830086 2327661 502425 246906 246906 59563 59563 9167 9167 11304647 6277756 5026891 77476 77476 1800908 934442 866466 1308637 1308637 161624 112239 49385 32323 28623 3700 2238248 2238248 4813440 4813440 896062 896062 MEDICAL SUPPLIES 11307899 11307899 BAD DEBT EXPENSE 5572322 5572322 MA ASSESSMENT FEES 1498236 1498236 FOOD 545925 543025 2900 1066145 40968 1025177 90794670 73560832 17233838 0 1793 2000 4027995 5804054 9626621 7775849 1378677 1101614 607213 418803 88253517 68194099 22799452 20059418 470404 477203 9551872 9081749 10955394 12150353 59419421 56871043 34795216 41578077 215775 209640 28998581 29079930 1500000 1500000 8691402 8368851 74200974 80736498 X -20097654 -29202113 78613 86019 5237488 5250639 -14781553 -23865455 59419421 56871043 X -3586399 -5497503 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 9167 9167 0 PART II-B, LINE 1: A PORTION OF THE HOSPITAL'S DUES PAID TO THE AMERICAN HOSPITAL ASSOCIATION (AHA) AND THE HOSPITAL ASSOCIATION OF PENNSYLVANIA (HAP) ARE USED FOR LOBBYING PURPOSES. 734233 734233 49933197 39018246 10914951 36882895 28922093 7960802 703192 253760 449432 20059418 FEDERAL AGENCY OBLIGATIONS 5653857 F INVESTMENT IN PENNSYLVANIA COMMUNITY HOSPITAL ASSOCIATION 3427892 C 9081749 BENEFICIAL INTEREST IN PERPETUAL TRUST 4858758 DEFERRED FINANCING COSTS, NET 480480 INSURANCE RECOVERIES RECEIVABLE 702505 DUE FROM AFFILIATES 6108610 12150353 OBLIGATION UNDER CAPITAL LEASE 6097964 BLUE CROSS CURRENT FINANCING ADVANCE 479000 ESTIMATED MEDICAL MALPRACTICE CLAIMS LIABILITY 1448298 ESTIMATED THIRD PARTY PAYOR SETTLEMENTS 343589 8368851 X 76173621 -11069825 -11069825 87243446 -35175 -35175 87208271 85257523 35175 35175 85222348 5572322 5572322 90794670 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 IS MET. MANAGEMENT DETERMINED THERE WERE NO TAX UNCERTAINTIES THAT MET THE RECOGNITION THRESHOLD IN 2015 AND 2014. THE CORPORATION'S FEDERAL EXEMPT ORGANIZATION RETURNS OF INCOME TAX AND ITS BUSINESS INCOME TAX RETURNS FOR THE YEARS ENDED PRIOR TO JUNE 30, 2012 NO LONGER REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. PART XI, LINE 2D - OTHER ADJUSTMENTS: PENSION LIABILITY ADJUSTMENT -5,371,558. POST RETIREMENT BENEFIT LIABILITY ADJUSTMENT -139,096. VALUATION GAIN 13,151. PROVISIONS FOR BAD DEBTS NETTED ON FINANCIAL STATEMENTS -5,572,322. PART XI, LINE 4B - OTHER ADJUSTMENTS: RENTAL EXPENSES -35,175. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 35,175. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISIONS FOR BAD DEBTS NETTED ON FINANCIAL STATEMENTS 5,572,322. CENTRAL AMERICA AND THE CARIBBEAN 0 0 INVESTMENT 3427892 0 0 0 0 0 0 3427892 0 3427892 0 0 1 0 0 0 1 1 X 1 X 175.000000000000 1 X 1 1 0 1 1 1504179 1504179 0.01770 7014969 1465982 5548987 0.06510 8519148 1465982 7053166 0.08280 23 5171 204630 1800 202830 0.00240 1 9 2261760 1267767 993993 0.01170 2918770 2083093 835677 0.00980 24 5180 5385160 3352660 2032500 0.02390 24 5180 13904308 4818642 9085666 0.10670 1 148 148 0.00000 1 176 940 940 0.00000 1 185 185 0.00000 3 176 1273 1273 1 2134762 2134762 25376408 27247094 -1870686 X 1 1 1 1 SCHUYLKILL MEDICAL CENTER SOUTH JACKSON 420 SOUTH JACKSON STREET POTTSVILLE PA 17901 X X X SCHUYLKILL MEDICAL CENTER SOUTH JACKSON 1 0 0 1 X X X X X X X X 12 1 1 0 1 X HTTP://WWW.SCHUYLKILLHEALTH.COM/ABOUT-SCHUYLKILL-HEALTH/COMMUNITY-BENEFIT X 1 12 1 HTTP://WWW.SCHUYLKILLHEALTH.COM/ABOUT-SCHUYLKILL-HEALTH/COMMUNITY-BENEFIT 0 0 1 X 175.000000000000 250.000000000000 X X X 1 1 X X X 1 X X X X 1 X 0 X X 1 X 0 0 SCHUYLKILL MEDICAL CENTER SOUTH JACKSON PART V, SECTION B, LINE 5: SCHUYLKILL HEALTH PARTNERED WITH STRATEGY SOLUTIONS TO CONDUCT THE ASSESSMENT. WITH THEIR HELP, SCHUYLKILL HEALTH IDENTIFIED 11 COMMUNITY MEMBERS TO SERVE ON A STEERING COMMITTEE TO CONDUCT THIS ASSESSMENT. THE 11 COMMUNITY MEMBERS INCLUDED LEADERS IN EDUCATION, BUSINESS, PUBLIC SERVICES, HUMAN SERVICES, AND PUBLIC HEALTH OFFICIALS.IN AN EFFORT TO EXAMINE THE HEALTH RELATED NEEDS OF THE RESIDENTS OF SCHUYLKILL COUNTY AND TO MEET ALL OF THE KNOWN GUIDELINES AND REQUIREMENTS OF THE IRS 990 STANDARDS THAT HAD BEEN PUBLISHED TO DATE, THE STEERING COMMITTEE AND CONSULTING TEAM EMPLOYED BOTH QUALITATIVE AND QUANTITATIVE DATA COLLECTION AND ANALYSIS METHODS. QUALITATIVE METHODS ASK QUESTIONS THAT ARE EXPLORATORY IN NATURE AND ARE TYPICALLY EMPLOYED IN INTERVIEWS AND FOCUS GROUPS. QUANTITATIVE DATA IS DATA THAT CAN BE DISPLAYED NUMERICALLY. IN ADDITION, BOTH PRIMARY AND SECONDARY DATA WERE COLLECTED. PRIMARY DATA IS DATA THAT WAS COLLECTED SPECIFICALLY FOR THIS STUDY BY THE CONSULTANT TEAM. SECONDARY DATA INCLUDES DATA AND INFORMATION THAT WAS PREVIOUSLY COLLECTED AND PUBLISHED BY SOME OTHER SOURCE. THE SCHUYLKILL HEALTH MANAGEMENT TEAM, THE STEERING COMMITTEE MEMBERS AND CONSULTING TEAM MADE SIGNIFICANT EFFORTS TO ENSURE THAT ALL AREAS OF THE COUNTY, ALL SOCIO-DEMOGRAPHIC GROUPS AND ALL UNDERREPRESENTED POPULATIONS WERE INCLUDED IN THE STUDY. THIS WAS ACCOMPLISHED BY IDENTIFYING FOCUS GROUPS AND KEY STAKEHOLDERS THAT REPRESENTED VARIOUS SUBGROUPS IN THE COMMUNITY. IN ADDITION, THE PROCESS INCLUDED PUBLIC HEALTH PARTICIPATION AND INPUT, BOTH THROUGH EXTENSIVE USE OF PA HEALTH DEPARTMENT AND CENTERS FOR DISEASE CONTROL DATA, AS WELL AS THROUGH THE PARTICIPATION OF A REGIONAL DEPARTMENT OF HEALTH REPRESENTATIVE ON THE STEERING COMMITTEE. A SCHUYLKILL COUNTY BEHAVIORAL RISK FACTOR SURVEILLANCE SURVEY FOLLOWING THE DATA COLLECTION PROTOCOLS AND QUESTIONS DESIGNED BY THE CENTERS FOR DISEASE CONTROL WITH A REPRESENTATIVE SAMPLE OF 400 SCHUYLKILL COUNTY RESIDENTS CONDUCTED BY STRATEGY SOLUTIONS, INC. AND MOORE RESEARCH SERVICES. SEVEN FOCUS GROUPS WERE CONDUCTED IN ORDER TO GAIN INSIGHTS FROM DIVERSE COMMUNITY GROUPS AND UNDERREPRESENTED POPULATIONS. THIRTEEN INDIVIDUAL INTERVIEWS WERE CONDUCTED WITH KEY STAKEHOLDERS IN THE COMMUNITY TO GATHER A PERSONAL PERSPECTIVE FROM THOSE WHO HAVE INSIGHT INTO THE HEALTH OF A COMMUNITY OR THE REGION. THESE INDIVIDUALS ALSO PROVIDED SUGGESTED ACTIVITIES FOR IMPROVING THE HEALTH OF THE REGION. FINALLY, AN INTERNET COMMUNITY NEEDS SURVEY WAS CONDUCTED WITH A TOTAL OF 373 RESPONDENTS (275 COMPLETE AND 98 PARTIAL). THE SURVEY WAS DESIGNED TO INCLUDE THE IDENTICAL QUESTIONS FROM THE FOCUS GROUPS; AND WAS ADDED TO THE DATA COLLECTION PROCESS AS PARTICIPATION IN THE FOCUS GROUPS WAS LOWER THAN ANTICIPATED. SCHUYLKILL MEDICAL CENTER SOUTH JACKSON PART V, SECTION B, LINE 6A: SCHUYLKILL MEDICAL CENTER - EAST NORWEGIAN STREET SCHUYLKILL MEDICAL CENTER SOUTH JACKSON PART V, SECTION B, LINE 11: THE HOSPITAL IS ADDRESSING THE FOLLOWING NEEDS:ACCESS TO QUALITY HEALTH CARE/WOMEN'S HEALTH - DEVELOPED BROCHURES TO EXPLAIN THE NEED FOR MAMMOGRAMS FOR EARLY DETECTION OF BREAST CANCER. BROCHURES ARE AVAILABLE IN WAITING AREAS OF THE MEDICAL CENTER AS WELL AS DOCTORS OFFICES. A PROGRAM WAS SET UP TO OFFER LOW COST OR FREE MAMMOGRAMS TWICE A YEAR FOR PEOPLE WHO MEET CERTAIN CRITERIA. THE CHAT PRESENTATION PROGRAM IS ALSO USED TO GET INFORMATION OUT EXPLAINING THE NEED FOR EARLY DETECTION OF BREAST CANCER AND THE AVAILABILITY OF TESTING.HEALTHY MOTHERS, BABIES, CHILDREN/TOBACCO & ALCOHOL USE DURING PREGNANCY - DEVELOPED BROCHURES TO EXPLAIN THE RISK OF SMOKING AND ALCOHOL USE DURING PREGNANCY. BROCHURES ARE AVAILABLE IN WAITING AREAS OF THE MEDICAL CENTER AS WELL AS DOCTORS OFFICES. THE SMOKING CESSATION PROGRAM THAT WAS DEVELOPED IN THE EAST COUNSELING CENTER WAS EXPANDED TO BE INCLUDED DURING CHILD BIRTH CLASSES IN THE SOUTH MATERNITY AREA.PHYSICAL ACTIVITY AND NUTRITION, OBESITY - A PROGRAM TITLED "HEALTHY HAVEN" WAS PRESENTED TO BOTH SCHUYLKILL HAVEN MIDDLE SCHOOL AND ST AMBROSE STUDENTS. THE PROGRAM DISCUSSED WELLNESS PROGRAMS AS WELL AS NUTRITIONAL EXERCISE INTERVENTIONS. THE HOPE IS TO EXPAND THIS PROGRAM TO OTHER COMMUNITIES. UNINTENTIONAL INJURIES, MOTOR VEHICLES - THIS WAS ADDRESSED IN 2 DIFFERENT WAYS. AS PART OF MAKE A DIFFERENCE DAY THE MATERNITY/NURSERY DEPARTMENTS HELD A CHILD SEAT SAFETY CHECK. THE GOAL OF THE PROGRAM WAS TO ENSURE SEATS WERE INSTALLED PROPERLY. EDUCATION WAS ALSO PROVIDED FOR ANY RECALLS THAT MAY BE ISSUED. ANOTHER PROGRAM THAT WAS USED DURING HIGH SCHOOL FOOTBALL GAMES TO EDUCATE STUDENTS AND THE GENERAL PUBLIC ABOUT THE DANGERS OF TEXTING AND DRIVING AND OTHER TYPES OF DISTRATECTED DRIVING THAT MAY CAUSE ACCIDENTS THAT RESULT IN INJURIES.CHRONIC DISEASE: DIABETES - THERE ARE SEVERAL INITIATIVES THAT THE MEDICAL CENTER HAS TO GET EDUCATIONAL INFORMATION TO THE PUBLIC ABOUT DIABETES. THERE IS A TYPE 2 DIABETES SUPPORT GROUP THAT MEETS TO DISCUSS HOW TO DEAL WITH THE DISEASE. THE MEDICAL CENTER IS ALSO INVOLVED IN THE NATIONAL DIABETES EDUCATION PROGRAM TO HELP PREVENT OR DELAY THE ONSET OF DIABETES. THERE ARE ALSO SEVERAL CHAT PROGRAMS THAT ARE OFFERED TO DISCUSS DIABETES.SCHUYLKILL HEALTH DID NOT ADDRESS ALL NEEDS IN THE ASSESSMENT. SCHUYLKILL HEALTH LEADERSHIP HAD A MEETING TO DISCUSS WHAT ITEMS WOULD BE BEST HANDLED BY EACH FACILITY. THE ITEMS THAT THEY DID NOT ADDRESS WERE THEN GIVEN TO THE APPROPRIATE COMMUNITY ORGANIZATIONS THAT WOULD BE ABLE TO BEST HANDLE THEM. SCHUYLKILL COUNTY VISION ADDRESSES 2 ISSUES THAT WERE IDENTIFIED: 1) PHYSICAL ACTIVITY, NUTRITION AND OBESITY AND 2) UNINTENTIONAL INJURIES FROM MOTOR VEHICLES. SCHUYLKILL COUNTY VISION TOOK THIS ISSUE ON BECAUSE THEY DEAL WITH A DIVERSE GROUP OF ORGANIZATIONS THAT WOULD BE ABLE TO IMPROVE THESE NEEDS BETTER THAN THE HEALTH SYSTEM. SCHUYLKILL COUNTY DRUG AND ALCOHOL PROGRAM ALSO HANDLED ONE OF THE RECOGNIZED NEEDS FROM THE ASSESSMENT. THEY HANDLED THE NEED TO IMPROVE MENTAL HEALTH AND CONTROL DRUG AND ALCOHOL ABUSE. THEY CHOSE TO ADDRESS THIS NEED BECAUSE THEY WORK WITH THESE ISSUES ALREADY AND ARE MORE PREPARED TO ADDRESS THIS NEED THAN THE HEALTH SYSTEM. SCHUYLKILL MEDICAL CENTER SOUTH JACKSON PART V, SECTION B, LINE 20E: WHEN A PATIENT DOES NOT MAKE A PAYMENT, A PATIENT IS EVALUATED TO DETERMINE IF THEY MEET THE GUIDELINES FOR FINANCIAL ASSISTANCE. IF THEY DO, THEY ARE THEN GIVEN THE PROPER INFORMATION. SCHUYLKILL MEDICAL CENTER SOUTH JACKSON PART V, SECTION B, LINE 22D: THE SAME POLICY IS USED FOR EMERGENCY OR MEDICALLY NECESSARY CARE THAT IS USED FOR ANY OTHER TYPE OF CARE. THERE IS A STANDARD AMOUNT THAT IS CHARGED FOR PROCEDURES PER THE HOSPITAL'S CHARGE MASTER. INCOME GUIDELINES ARE DEVELOPED TO SHOW OR PROVE A PATIENT'S OR GUARANTOR'S INABILITY TO PAY. THESE INCOME GUIDELINES WILL BE BASED UPON THE FEDERAL POVERTY INCOME GUIDELINES ESTABLISHED BY THE DEPARTMENT OF HEALTH AND HUMAN SERVICES AND WILL BE REVISED EACH YEAR.INCOME LEVELS WILL DETERMINE IF SERVICES WILL BE RENDERED WITHOUT CHARGE OR AT AMOUNTS LESS THAN ESTABLISHED RATES. THE PERCENTAGE OF TOTAL INCOME ABOVE THE FEDERAL POVERTY INCOME GUIDELINE WILL DETERMINE THE PERCENTAGE OF CHARITY CARE GRANTED. PART I, LINE 7: SCHUYLKILL MEDICAL CENTER - SOUTH COMPUTED A COST TO CHARGE RATIO USING INFORMATION FROM THE MOST RECENTLY FILED MEDICARE COST REPORT (FYE 6/30/15) FOR THE CALCULATION OF COSTS FOR CHARITY CARE AND MEDICAID. DIRECT COSTS ARE OBTAINED FROM THE HOSPITAL COMPUTER SYSTEM FOR EACH COST CENTER FOR ALL OTHER BENEFITS. INDIRECT COSTS ARE COMPUTED UTILIZING THE MOST RECENTLY FILED MEDICARE COST REPORT (FYE 6/30/15). PART I, LINE 7G: THERE ARE NO PHYSICIAN CLINICAL SERVICES INCLUDED. PART I, LN 7 COL(F): THE AMOUNT OF BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25 COLUMN (A) BUT SUBTRACTED OUT FOR PURPOSES OF CALCULATING THE PERCENTAGE ON SCH H, PART I, LINE 7, COLUMN (F) IS $5,572,322. PART II, COMMUNITY BUILDING ACTIVITIES: ECONOMIC DEVELOPMENT - SCHUYLKILL COUNTY CHILD DEVELOPMENT POLICY COUNCIL, CHILD DEVELOPMENT IS A DAY CARE PROGRAM IN SCHUYLKILL COUNTY THAT IS PROVIDED TO ANYONE BUT IS FOCUSED ON CHILDREN OF PARENTS WHO CANNOT AFFORD TO PAY THE FULL COST OF DAYCARE. IF THIS SERVICE WAS NOT AVAILABLE FOR THESE PARENTS, THEY WOULD NOT BE ABLE TO WORK BECAUSE THEY WOULD HAVE TO STAY HOME TO TAKE CARE OF THEIR CHILDREN. WE HAVE A CLINICAL RN CHARGE NURSE WHO ATTENDS THE MEETINGS AND IS A MEMBER OF THIS POLICY COUNCIL.COMMUNITY SUPPORT - BRIDGE HOUSE OF SCHUYLKILL COUNTY - THE BRIDGE HOUSING PROGRAM IS A TRANSITIONAL HOUSING SERVICE LOCATED ON THE GROUNDS OF THE POTTSVILLE HOUSING AUTHORITY AT LAUREL TERRACE, POTTSVILLE, PENNSYLVANIA. BRIDGE HOUSING PROVIDES COMPREHENSIVE SERVICES TO PERSONS FACING LONG-TERM HOMELESSNESS AND PROVIDES A SUPPORTIVE, SAFE ENVIRONMENT FOR ADULTS AND CHILDREN. STUDENTS FROM THE SCHOOL OF NURSING PROVIDE TALKS TO RESIDENTS ABOUT SEVERAL DIFFERENT HEALTH TOPICS INCLUDING PARENTING AND HEALTH PREVENTION.WORKFORCE DEVELOPMENT - SCHUYLKILL TRAINING AND TECHNOLOGY CENTER PROVIDES ASSISTANCE AND GUIDANCE TO THE LPN PROGRAM AT THE TRAINING & TECHNOLOGY CENTER AND ALSO KEEPS THE ADMINISTRATION AND LPN PROGRAM FACULTY UP TO DATE ON HEALTH CARE RELATED INFORMATION. THIS HELPS TO ENSURE THE LPN PROGRAM HAS A BACKGROUND THAT IS UP TO DATE TO PROVIDE THE STUDENTS TO ENTER THE WORKFORCE RIGHT AFTER GRADUATION. PART III, LINE 2: ALL APPROPRIATE DISCOUNTS AND PAYMENTS ARE REFLECTED ON EACH PATIENTS' ACCOUNT. ONCE A PATIENT IS IDENTIFIED AS BAD DEBT, THE BALANCE THAT IS BAD DEBT WOULD BE CHARGES NET OF ANY PAYMENTS OR ADJUSTMENTS.THE COST OF BAD DEBT EXPENSE IS CALCULATED BY USING THE COST TO CHARGE RATIO FROM THE MOST RECENTLY FILED MEDICARE COST REPORT AND APPLYING THAT TO THE CHARGE. 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 DOCUMENTATION TO ALLOW THAT CLASSIFICATION. THESE WOULD BE CLASSIFIED AS BAD DEBT EXPENSE TIMES THE COST TO CHARGE RATIO TO ARRIVE AT THE COST. THIS SHOULD BE CONSIDERED COMMUNITY BENEFIT AS THE HOSPITAL IS PROVIDING CARE TO PATIENTS IN NEED REGARDLESS OF THEIR ABILITY TO PAY. 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 CORPORATION ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE CORPORATION ANALYZES CONTRACTUAL AMOUNTS DUE AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND INSURED PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES), THE CORPORATION RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE BILLED RATES AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. PART III, LINE 8: THE HOSPITAL USES THE COST-TO-CHARGE RATIO TO DETERMINE THE MEDICARE ALLOWABLE COSTS.THE MEDICARE SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT AS THE HOSPITAL IS TREATING MEDICARE PATIENTS DESPITE THE RISE IN UNREIMBURSED COST. PART III, LINE 9B: THE ORGANIZATION DOES HAVE A WRITTEN DEBT COLLECTION POLICY. ALL STAFF INVOLVED IN DEBT COLLECTION (EMPLOYEES OF THE MEDICAL CENTER AND ANY THIRD PARTY AGENCIES) ARE TRAINED ON THE POLICY AS WELL AS THE CHARITY CARE POLICY. IN DEALING WITH PATIENTS IN DEBT COLLECTION, STAFF WILL INFORM PATIENTS OF THE CHARITY CARE POLICY THAT IS AVAILABLE AND ALSO ANY OTHER FINANCIAL ASSISTANCE POLICIES OF THE MEDICAL CENTER THAT MAY BE APPLICABLE TO THE PATIENT. THE STAFF WILL INSTRUCT PATIENTS ON APPROPRIATE PAPERWORK THAT NEEDS TO BE COMPLETED WITH REGARDS TO CHARITY CARE OR FINANCIAL ASSISTANCE. PART VI, LINE 2: SCHUYLKILL MEDICAL CENTER - SOUTH JACKSON STREET (SMS-SJS) WORKS WITH SCHUYLKILL MEDICAL CENTER - EAST NORWEGIAN STREET (SMS-ENS) IN ASSESSING THE HEALTH NEEDS OF THE COMMUNITY IN WHICH IT IS LOCATED AND SERVES; SCHUYLKILL COUNTY, PENNSYLVANIA. BOTH MEDICAL CENTERS ALSO WORK WITH VARIOUS CITY, COUNTY AND STATE AGENCIES TO SPECIFICALLY IDENTIFY THE HEALTH NEEDS OF THE RESIDENTS OF SCHUYLKILL COUNTY.SMC-SJS IS LOCATED IN POTTSVILLE, WHICH IS THE COUNTY SEAT FOR SCHUYLKILL COUNTY. SCHUYLKILL COUNTY IS A RURAL COUNTY. THE COUNTY HAS AN UNEMPLOYMENT RATE OF OVER 6%, 19% OF THE RESIDENTS ARE COVERED BY MEDICAID, AND 18% OF THE RESIDENTS ARE OVER THE AGE OF 65.SMC-SJS IS A 179 BED ACUTE CARE FACILITY THAT PROVIDES ACUTE MEDICAL SURGICAL CARE, ADOLESCENT AND ADULT BEHAVIORAL HEALTH SERVICES, AND TRANSITIONAL REHAB CARE AND NURSERY SERVICES TO THE COMMUNITY.THE INFORMATION FOR THE NEEDS ASSESSMENT WAS GATHERED IN 2 DIFFERENT WAYS. THE FIRST WAY WAS TO SET UP A COMMITTEE OF 11 DIFFERENT MEMBERS FOR VARIOUS DIFFERENT GROUPS IN THE COMMUNITY TO DISCUSS WHAT WAS NEEDED TO IMPROVE THE HEALTH OF THE COMMUNITY. QUALITATIVE AND QUANTITATIVE DATA COLLECTION WAS ALSO USED TO ANALYZE WHAT WAS NEEDED TO IMPROVE THE HEALTH OF COMMUNITY MEMBERS.SMC-SJS WORKS WITH THE SOCIAL SERVICE AGENCIES, LOCAL DEPARTMENT OF HEALTH, THE CHAMBER OF COMMERCE, UNITED WAY, AMERICAN CANCER SOCIETY, LOCAL SCHOOLS, LOCAL SUPPORT GROUPS, PHYSICIAN OFFICES AND OTHER HEALTHCARE ORGANIZATIONS IN IDENTIFYING THE HEALTHCARE NEEDS OF THE LOCAL COMMUNITIES AND THE SERVICES THAT ARE NEEDED. AFTER A NEED HAS BEEN IDENTIFIED, THE MEDICAL CENTER WORKS WITH THESE ORGANIZATIONS TO HELP PROVIDE THE SERVICE TO RESIDENTS.THE MEDICAL CENTER ALSO WORKS WITH HEALTHCARE ORGANIZATIONS OUTSIDE SCHUYLKILL COUNTY TO HELP BRING HEALTHCARE SERVICES TO THE COUNTY. THIS ALLOWS COUNTY RESIDENTS TO OBTAIN NECESSARY SERVICES CONVENIENTLY WITHIN THE COUNTY.THE MEDICAL CENTER ALSO REVIEWS INTERNAL DATA ON ADMISSIONS, EMERGENCY ROOM VISITS, CLINIC VISITS AND DIAGNOSIS TO HELP IDENTIFY COMMUNITY NEEDS. THIS INFORMATION IS REVIEWED ANNUALLY AS PART OF THE BUDGET AND STRATEGIC PLANNING PROCESS.THE BOARD OF THE MEDICAL CENTER IS COMPRISED OF INDIVIDUALS FROM THE COMMUNITY REPRESENTING SOCIAL SERVICE AGENCIES, EDUCATION, ASSISTED LIVING/LONG TERM CARE, PHYSICIANS, MATERNAL/CHILD HEALTH AND LOCAL BUSINESSES. THESE INDIVIDUALS ALSO PROVIDE INPUT ON THE NEEDS OF THE COMMUNITY IN MEETING HEALTHCARE NEEDS. PART VI, LINE 3: EACH PATIENT IS REGISTERED INTO THE HOSPITAL COMPUTER SYSTEM WHEN THEY ARRIVE FOR SERVICES. AS PART OF THE REGISTRATION, INFORMATION IS OBTAINED ON ANY HEALTH INSURANCE THEY HAVE. INDIVIDUALS WITHOUT HEALTH INSURANCE ARE INFORMED AT THAT TIME OF THE MEDICAL CENTER'S CHARITY CARE POLICY. PATIENTS ARE GIVEN INFORMATION ON CONTACTING STAFF WITHIN THE HOSPITAL PATIENT ACCOUNTING DEPARTMENT TO DISCUSS APPLYING FOR THE HOSPITAL CHARITY CARE PROGRAM. SPECIFIC STAFF HAVE BEEN TRAINED AND ARE RESPONSIBLE FOR ADMINISTERING THE CHARITY CARE PROGRAM FOR THE HOSPITAL. HOSPITAL STAFF CONTACT PATIENTS WITHOUT INSURANCE AND EXPLAIN THE POLICY AND THE INFORMATION NEEDED TO APPLY. HOSPITAL STAFF WILL ALSO ASSIST PATIENTS IN APPLYING FOR MEDICAL ASSISTANCE. THEY WILL ALSO ASSIST PATIENTS IN COMPLETING THE APPLICATION AND GATHERING THE NECESSARY FINANCIAL DOCUMENTS.THE MEDICAL CENTER ALSO POSTS INFORMATION WITHIN THE ADMISSION AND EMERGENCY ROOM AREAS INFORMING PATIENTS THAT THERE IS A CHARITY CARE POLICY AVAILABLE. ALL REGISTRATION PERSONNEL ARE TRAINED ON THE POLICY SO THAT THEY ARE ABLE TO INFORM PATIENTS WHEN THEY ARE REGISTERED.OTHER HOSPITAL STAFF MEMBERS THAT MAY COME IN CONTACT WITH PATIENTS ARE ALSO EDUCATED REGARDING THE CHARITY CARE POLICY. THIS WOULD INCLUDE SOCIAL WORKERS, CARE MANAGERS, NURSING STAFF AND ALL DEPARTMENT DIRECTORS. THE CHARITY CARE POLICY IS AVAILABLE ON THE HOSPITAL INTRANET WHICH IS ACCESSIBLE BY ALL EMPLOYEES. THE HOSPITAL IS ALSO IN THE PROCESS OF PLACING THE POLICY ON THE HOSPITAL WEBSITE.ALL PATIENT ACCOUNTING, CASHIERING AND COLLECTION STAFF ARE ALSO EDUCATED ON THE CHARITY CARE POLICY AND CAN ASSIST PATIENTS IN APPLYING FOR CHARITY CARE. ALSO ALL THIRD PARTY ORGANIZATIONS THAT WORK ON BEHALF OF THE MEDICAL CENTER IN PERFORMING COLLECTIONS HAVE ALSO BEEN EDUCATED ON THE CHARITY CARE POLICY AND CAN ALSO ADVISE PATIENTS ON APPLYING FOR THIS BENEFIT. PART VI, LINE 4: SMC-SJS IS LOCATED IN POTTSVILLE, PENNSYLVANIA. THE MEDICAL CENTER SERVES ALL OF SCHUYLKILL COUNTY. SCHUYLKILL COUNTY IS A RURAL COUNTY IN PENNSYLVANIA. POTTSVILLE IS THE LARGEST POPULATION CENTER OF SCHUYLKILL COUNTY AND IS ALSO THE COUNTY SEAT. THE COUNTY IS COMPRISED OF ONE SMALL CITY AS WELL AS SEVERAL BOROUGHS AND TOWNSHIPS.THE POPULATION OF THE COUNTY IS APPROXIMATELY 147,000. APPROXIMATELY 20% OF THE POPULATION IS UNDER THE AGE OF 18 AND 18% IS OVER THE AGE OF 65. THE POPULATION IS 49% FEMALE AND 95% WHITE. APPROXIMATELY 14% OF THE POPULATION HAS A BACHELOR'S DEGREE OR HIGHER. 11.8% OF THE POPULATION IS BELOW THE POVERTY LEVEL. THE UNEMPLOYMENT RATE IS 6.9%.19% OF THE POPULATION IS INSURED BY MEDICAID. 42% OF THAT NUMBER ARE UNDER THE AGE OF 18, 13% ARE OVER THE AGE OF 65 AND 18% ARE DISABLED. 50% OF THE BIRTHS ARE COVERED BY THE MEDICAID PROGRAM.IN A RECENT REPORT RELEASED BY THE ROBERT WOOD JOHNSON FOUNDATION AND THE UNIVERSITY OF WISCONSIN'S POPULATION HEALTH INSTITUTE, SCHUYLKILL COUNTY WAS RANKED THE 56TH HEALTHIEST OF THE 67 COUNTIES IN PENNSYLVANIA. SCHUYLKILL COUNTY HAD HIGHER THAN THE STATE AND NATIONAL RATES FOR SMOKING, OBESITY, EXCESSIVE DRINKING AND MOTOR VEHICLE CRASH DEATH RATES. THIS REPORT ALSO SHOWED THAT THE COUNTY HAD ACCESS TO FEWER PRIMARY CARE PHYSICIANS.THE DEMOGRAPHICS OF THE PATIENTS ADMITTED TO SMC-SJS ARE 41% MEDICARE, 24% MEDICAID AND 3% SELF PAY. EMERGENCY PATIENTS AT SMC-SJS ARE 14% MEDICARE, 25% MEDICAID AND 11% SELF PAY.SCHUYLKILL COUNTY HAS THREE HOSPITALS SERVING THE COUNTY. SMC-SJS AND SCHUYLKILL MEDICAL CENTER - EAST NORWEGIAN STREET ARE BOTH LOCATED IN POTTSVILLE AND SERVE THE MAJORITY OF THE COUNTY RESIDENTS. ST. LUKE'S MINERS MEMORIAL HOSPITAL ARE LOCATED IN COALDALE NEAR THE CARBON COUNTY BORDER. PART VI, LINE 5: THE BOARD OF SMC - SJS IS COMPRISED OF SIXTEEN INDIVIDUALS FROM THE SCHUYLKILL COUNTY COMMUNITY WHO ARE NOT EMPLOYED BY THE MEDICAL CENTER. THEY ARE INVOLVED IN EDUCATION, SOCIAL SERVICES, GERIATRIC SERVICES, MATERNAL/CHILD SERVICES, PRIMARY MEDICAL CARE, CRIMINAL JUSTICE, SMALL BUSINESS AND MANUFACTURING. ALL PHYSICIANS ARE ENCOURAGED TO APPLY FOR MEDICAL STAFF PRIVILEGES FOR THE MEDICAL CENTER.SMC-SJS ALSO WORKS WITH VARIOUS COMMUNITY ORGANIZATIONS TO HELP IDENTIFY COMMUNITY NEEDS AND WORK TOGETHER TO MEET THOSE NEEDS. THE MEDICAL CENTER HAS INPATIENT ADOLESCENT AND ADULT BEHAVIORAL HEALTH SERVICES AVAILABLE TO THE RESIDENTS OF SCHUYLKILL COUNTY. THIS ALLOWS COUNTY RESIDENTS TO OBTAIN NECESSARY INPATIENT CARE WITHIN THE COUNTY WITHOUT REQUIRING FAMILIES TO TRAVEL OUTSIDE OF THE COUNTY. THE MEDICAL CENTER ALSO HAS A CERTIFIED DIABETES EDUCATOR AVAILABLE TO CONSULT WITH PATIENTS AND ALSO WITH PHYSICIANS WHEN THEY HAVE A PATIENT THAT IS NEWLY DIAGNOSED WITH DIABETES. THE MEDICAL CENTER IS ALSO THE ONLY FACILITY IN THE COUNTY WITH A MATERNITY DEPARTMENT AND NEWBORN NURSERY. THIS ALLOWS COUNTY RESIDENTS TO REMAIN IN THE COUNTY FOR MATERNITY CARE. MORE THAN 50% OF THE BIRTHS EACH YEAR ARE MEDICAID.THE EMERGENCY DEPARTMENT OF SMC-SJS IS A 24 HOUR EMERGENCY ROOM AVAILABLE TO ALL REGARDLESS OF THEIR ABILITY TO PAY. THE MEDICAL CENTER PARTICIPATES IN MANY INSURANCE PROGRAMS SUCH AS MEDICARE, MEDICAID, CHAMPUS AND VA. THE MEDICAL CENTER ALSO HAS A CHARITY CARE POLICY THAT PROVIDES ASSISTANCE TO ELIGIBLE INDIVIDUALS IN PROVIDING FREE OR DISCOUNTED CARE BASED ON THEIR ABILITY TO PAY AND THE FEDERAL POVERTY GUIDELINES.SMC-ENS ALSO PROVIDES OPPORTUNITIES TO STUDENTS IN HEALTHCARE FIELDS TO GAIN EXPERIENCE WORKING IN THE HEALTH CARE ENVIRONMENT SUCH AS NURSING STUDENTS (RN AND LPN), PHARMACY STUDENTS, PHYSICIAN ASSISTANT STUDENTS, PHYSICAL THERAPY STUDENTS, RADIOLOGY TECHNICIANS AND MEDICAL ASSISTANTS. THE MEDICAL CENTER ALSO PROVIDES A VOLUNTEER PROGRAM FOR JUNIOR HIGH AND HIGH SCHOOL STUDENTS TO BECOME FAMILIAR WITH THE MEDICAL SERVICES OFFERED AND THE EDUCATIONAL OPPORTUNITIES AVAILABLE WITHIN THE HEALTHCARE ENVIRONMENT.THE MEDICAL CENTER ALSO SPONSORS AND PARTICIPATES IN HEALTH FAIRS AT COMMUNITY EVENTS SUCH AS THE COUNTY FAIR, EVENTS AT THE LOCAL MALL, HEALTH SCREENINGS, BLOOD PRESSURE SCREENINGS, VETERAN'S BREAKFAST EVENT, MEALS ON WHEELS, SKIN CANCER SCREENINGS, MAMMOGRAPHY SCREENINGS, BLOOD PRESSURE CLINICS, SUPPORT GROUPS AND LOCAL AMERICAN CANCER SOCIETY RELAY FOR LIFE.ANY EXCESS FUNDS THAT ARE GENERATED FROM OPERATIONS ARE INVESTED BACK INTO THE MEDICAL CENTER BY PURCHASING NECESSARY CAPITAL EQUIPMENT, FUNDING CAPITAL IMPROVEMENT PROJECTS, FUNDING NEW SERVICES, IMPROVING AND EXPANDING EXISTING SERVICES AND ANY OTHER GENERAL IMPROVEMENTS TO PATIENT CARE. PART VI, LINE 6: ON AUGUST 1, 2008, SMC-SJS AND SMC-ENS AFFILIATED UNDER THE CONTROL OF SCHUYLKILL HEALTH SYSTEM, THE PRIMARY SERVICE AREA IS POTTSVILLE AND THE SURROUNDING COMMUNITIES IN SCHUYLKILL COUNTY. THE PURPOSE OF BOTH MEDICAL CENTERS IS TO ENGAGE IN ACTIVITIES RELATED TO THE PROMOTION OF HEALTH OF THE PEOPLE IN THE SERVICE AREA, WORK CHARITABLY TO PROMOTE COMMUNITY HEALTH EDUCATION, PREVENTION OF ILLNESS AND INJURY AND PROVISION OF MEDICAL SERVICES TO THE DIVERSE POPULATION OF THE SERVICE AREA AND ENGAGE IN ANY AND ALL ACTIVITIES CONSISTENT WITH OR IN FURTHERANCE OF THESE PURPOSES.EACH MEDICAL CENTER OPERATES INDEPENDENTLY OF EACH OTHER BUT WORKS IN SYNC WITH EACH OTHER IN PROVIDING HEALTHCARE SERVICES TO THE RESIDENTS OF SCHUYLKILL COUNTY. BOTH MEDICAL CENTERS HAVE WORKED TO PROVIDE A CONTINUUM OF CARE SO THAT HEALTHCARE IS AVAILABLE WITHIN THE COUNTY AND RESIDENTS DO NOT HAVE TO TRAVEL OUTSIDE OF THE COUNTY FOR CARE. THE FOLLOWING SERVICES ARE AVAILABLE AT EITHER SMC-SJS OR SMC-ENS: - ACUTE CARE /MEDICAL SURGICAL SERVICES- INTENSIVE CARE SERVICES- MATERNITY SERVICES- NEWBORN SERVICES- PEDIATRICS SERVICES- ADOLESCENT, ADULT AND GERIATRIC BEHAVIORAL SERVICES- ACUTE REHAB AND TRANSITIONAL REHAB SERVICES- INPATIENT AND OUTPATIENT PHYSICAL THERAPY- INPATIENT AND OUTPATIENT DIAGNOSTIC SERVICES- HOME HEALTH SERVICES- OUTPATIENT DRUG AND ALCOHOL SERVICES- OUTPATIENT BEHAVIORAL HEALTH SERVICES- 24 HOUR EMERGENCY ROOM SERVICES- OUTPATIENT DENTAL CLINIC- INPATIENT AND OUTPATIENT SURGICAL SERVICES- COMMUNITY BENEFIT/CHARITY CARE SERVICES- ADVANCE WOUND CARE - OUTPATIENT SURGERY CENTERSCHUYLKILL MEDICAL GROUP IS AN ORGANIZATION FORMED IN WHICH PHYSICIANS WOULD BE ABLE TO OPEN THEIR OWN PRACTICE BUT NOT INCUR ALL THE EXPENSES THAT THEY WOULD HAD THEY OPENED A PRACTICE ON THEIR OWN. THIS WAS DONE SO THAT MORE PHYSICIANS WOULD BE AVAILABLE TO THE PUBLIC IN THIS AREA. WITHOUT THIS ORGANIZATION THESE PHYSICIANS MAY BE PRACTICING IN A DIFFERENT AREA.SCHUYLKILL HEALTH SYSTEM IS AN ORGANIZATION FORMED TO RAISE FUNDS TO PROVIDE TO BOTH SMC - EAST AND SMC - SOUTH. THE MONEY RAISED IN THIS ORGANIZATION IS USED TO BENEFIT THE COMMUNITY IN VARIOUS WAYS. MONEY FROM THIS ORGANIZATION IS USED TO PURCHASE EQUIPMENT TO MAKE THE PUBLIC SAFER. IT IS ALSO USED TO FUND PROJECTS THAT WILL MAKE HEALTH CARE ACCESS EASIER TO THE PUBLIC. SCHUYLKILL REHAB IS AN ORGANIZATION THAT OFFERS REHABILITATION SERVICES TO THE PUBLIC. ONE SERVICE THAT BENEFITS THE PUBLIC IS A SERIES OF DIFFERENT PROGRAMS EACH YEAR ON HEALTH CARE TOPICS. THESE PROGRAMS ARE OFFERED FREE TO THE PUBLIC.SCHUYLKILL MEDICAL MALL/DEVELOPMENT CORP IS AN ORGANIZATION THAT OWNS AND OPERATES A MEDICAL OFFICE BUILDING NEAR SMC - EAST. THIS BUILDING OFFERS AN AREA FOR PHYSICIANS TO BE ABLE TO RENT SPACE FOR THEIR PRACTICE INSTEAD OF HAVING TO PURCHASE THEIR OWN SPACE.PART VI, LINE 7: N/A X X X X 0 1 0 0 0 0 0 0 0 JOHN E SIMODEJKA PRESIDENT/CEO (TO 8/14) 459212 0 62500 0 565062 0 7800 0 19320 0 1113894 0 565062 0 DIANE BORIS VP FINANCE 0 147917 0 0 0 0 0 4028 0 14014 0 165959 0 0 DARNELL FURER VP NURSING/CNO (TO 6/15) 0 181695 0 0 0 0 0 5384 0 18289 0 205368 0 0 DR THOMAS CURRY VP MEDICAL AFFAIRS (TO 10/14) 203183 0 0 0 0 0 6161 0 11623 0 220967 0 0 0 RICHARD BINDIE DIRECTOR OF PATHOLOGY 285207 0 0 0 0 0 7800 0 17844 0 310851 0 0 0 SHERRY L BURINSKY BOTTOR CRNA 234268 0 0 0 0 0 7088 0 18768 0 260124 0 0 0 JULIANNE M TIDMORE CRNA 220906 0 0 0 0 0 6687 0 18768 0 246361 0 0 0 LYNDA L JAKUBCO CRNA 220297 0 0 0 0 0 6664 0 17419 0 244380 0 0 0 MARY R TUNNESSEN CRNA 217467 0 0 0 0 0 6579 0 17419 0 241465 0 0 0 PART I, LINE 4B JOHN SIMODEJKA RECEIVED A DISTRIBUTION FROM A 457 SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN IN FY 2015 OF $565,062. PART II, COLUMN B (II) JOHN SIMODEJKA RECEIVED A BONUS OF $62,500 FOR THE YEAR ENDED JUNE 30, 2015. THIS BONUS WAS DETERMINED BY THE COMPENSATION COMMITTEE OF THE BOARD AND THE BOARD OF DIRECTORS BASED ON NONFINANCIAL PERFORMANCE GOALS SET BY THE COMMITTEE WHICH WERE ACHIEVED. A CITY OF POTTSVILLE HOSPITAL AUTHORITY 232289554 738431AD7 2014-04-01 29282673 REFUNDING OF 1998 BONDS, REFUNDING OF USDA LOAN, CAPITAL PROJECTS. 0 0 0 A 29282673 2976552 585653 5018970 20701550 2013 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 1 0 1 0 0 0 1 A 1 FORM 990, PART VI, SECTION A, LINE 3 THE HOSPITAL HAS DELEGATED MANAGEMENT DUTIES OVER THE FOLLOWING SERVICES: * DIETARY AND HOUSEKEEPING TO SODEXHO INC. AND AFFILIATES, * BIOMED TO ARAMARK, * REHAB CARE TO SOUTH TRU, AND * IT TO TRUBRIDEGE CIO IN ADDITION, THE INTERIM PRESIDENT AND CEO, MARC LORY, AND INTERIM CFO, JUDY PEEK-LEE ARE EMPLOYEES OF THE ADVISORY BOARD. PAYMENT FOR THEIR SERVICES IS PAID DIRECTLY TO THE ADVISORY BOARD. ADVISORY BOARD ALSO PROVIDED REVENUE CYCLE CONSULTING AND TURN AROUND TEAM CONSULTING SERVICES DURING THE YEAR. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS REVIEWED BY MANAGEMENT PRIOR TO ITS FILING WITH THE INTERNAL REVENUE SERVICE. SELECTED MEMBERS OF THE BOARD REVIEWED THE 990 WITH THE TAX RETURN PREPARER AND MANAGEMENT ON BEHALF OF THE BOARD. FORM 990, PART VI, SECTION B, LINE 12C EACH OFFICER, KEY EMPLOYEE, DIRECTOR OR TRUSTEE WITH BOARD DELEGATED AUTHORITY IS REQUIRED TO ANNUALLY SIGN A CONFLICT OF INTEREST DISCLOSURE STATEMENT. THESE STATEMENTS ARE REVIEWED BY THE PRESIDENT/CEO'S ADMINISTRATIVE ASSISTANT AND ANY CONFLICTS ARE REPORTED TO THE PRESIDENT/CEO. THE STATEMENTS ARE KEPT ON FILE IN THE PRESIDENT/CEO'S OFFICE AFTER REVIEW. BOARD MEMBERS ARE EXPECTED TO RECUSE THEMSELVES FROM TAKING ANY ACTION OR EVEN DISCUSSING ISSUES OF RELATED PARTIES. IF THEY VIOLATE THESE RULES THEY ARE REMOVED FROM THE BOARD. FORM 990, PART VI, SECTION B, LINE 15 ANNUALLY, THE ORGANIZATION CONTRACTS WITH YAFFE AND COMPANY, AN INDEPENDENT CONSULTANT, TO MAKE RECOMMENDATIONS TO THE COMPENSATION COMMITTEE, A SUB COMMITTEE OF THE BOARD, BASED ON MARKET AND INDUSTRY DATA TO ENSURE COMPENSATION DOES NOT EXCEED FAIR MARKET VALUE. THIS PROCESS IS USED FOR THE FOLLOWING POSITIONS: PRESIDENT/CEO, VICE PRESIDENT OF OPERATIONS/COO, VICE PRESIDENT OF NURSING/CNO AND THE VICE PRESIDENT OF FINANCE/CFO. THIS REVIEW AND APPROVAL PROCESS IS DOCUMENTED VIA COMMITTEE MINUTES. 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 PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 2,112,313. MANAGEMENT AND GENERAL EXPENSES 339,048. TOTAL EXPENSES 2,451,361. CONSULTING FEE: PROGRAM SERVICE EXPENSES 122,274. MANAGEMENT AND GENERAL EXPENSES 2,295,852. TOTAL EXPENSES 2,418,126. CONTRACT LABOR: PROGRAM SERVICE EXPENSES 356,583. MANAGEMENT AND GENERAL EXPENSES 1,341,831. TOTAL EXPENSES 1,698,414. MAINTENANCE SERVICE CONTRACTS: PROGRAM SERVICE EXPENSES 1,273,935. MANAGEMENT AND GENERAL EXPENSES 932,012. TOTAL EXPENSES 2,205,947. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 1,752,888. MANAGEMENT AND GENERAL EXPENSES 118,148. TOTAL EXPENSES 1,871,036. REFERRED MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 659,763. TOTAL EXPENSES 659,763. FORM 990, PART XI, LINE 9: PENSION LIABILITY ADJUSTMENT -5,371,558. POSTRETIREMENT BENEFIT LIABILITY ADJUSTMENT -139,096. VALUATION GAIN 13,151. SCHUYLKILL REHABILITATION CENTER INC 420 SOUTH JACKSON STREET POTTSVILLE PA 17901 232440891 OPERATES A COMPREHENSIVE REHABILITATION FACILITY PA 501(C)(3) 3 SCHUYLKILL HEALTH SYSTEM 0 SCHUYLKILL MEDICAL CENTER - EAST NORWEGIAN STREET 700 EAST NORWEGIAN STREET POTTSVILLE PA 17901 230880420 OPERATES A HOSPITAL PROVIDING INPATIENT, OUTPATIENT & EMERGENCY SVCS PA 501(C)(3) 3 SCHUYLKILL HEALTH SYSTEM 0 SCHUYLKILL HEALTH SYSTEM MEDICAL GROUP INC 700 EAST NORWEGIAN STREET POTTSVILLE PA 17901 232866006 TO SUPPORT AND PROMOTE THE PURPOSES OF AFFILIATED ENTITIES PA 501(C)(3) 9 SCHUYLKILL HEALTH SYSTEM 0 SCHUYLKILL HEALTH SYSTEM 420 SOUTH JACKSON STREET POTTSVILLE PA 17901 262990543 TO SUPPORT, PROMOTE, ADVANCE & ENHANCE QUALITY OF LIFE OF SCHUYLKILL CNTY PA 501(C)(3) 11B N/A 0 SCHUYLKILL HEALTH SYSTEM MEDICAL MALL LP EAST NORWEGIAN TREMONT STREETS POTTSVILLE PA 17901 232514813 RENTAL PA N/A SCHUYLKILL HEALTH SYSTEM DEVELOPMENT CORPORATION 700 EAST NORWEGIAN STREET POTTSVILLE PA 17901 232432417 PURSUES, IMPLEMENTS & FURTHERS THE ACTVTIES & PURPOSES OF THE SYS PA N/A C 0 SCHUYLKILL MEDICAL PLAZA - CONDOMINIUM ASSOCIATION 420 SOUTH JACKSON STREET POTTSVILLE PA 17901 232931821 CONDOMINIUM ASSOCIATION PA N/A C 0 0 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 0 1 1