2015-05-15T08:31:34-05:00 2014-06-30 390859910 BAKER TILLY VIRCHOW KRAUSE LLP 1650 MARKET STREET SUITE 4500 PHILADELPHIA PA 19103 990 2013-07-01 231265004 MEMORIAL HOSPITAL MEMO 7178438623 325 SOUTH BELMONT STREET YORK PA 17403 SALLY J DIXON PRESIDENT/CEO 7178438623 2015-05-14 1 JULIUS C GREEN CPA JD P00350393 2159720701 2013 2016-04-25 22:37:26Z JACK KAY 325 SOUTH BELMONT STREET YORK PA 17403 108568 0 X WWW.MHYORK.ORG X 1945 PA MEDICAL SERVICES: INPATIENT, OUTPATIENT (EMERGENCY, CLINIC, AND OCCUPATIONAL MED), HOME HEALTH. 6 6 0 6 0 0 0 0 0 0 926145 0 0 108568 926145 108568 0 0 0 0 0 0 0 0 0 72561 0 72561 0 853584 108568 19046416 16748017 225205 116636 18821211 16631381 MEMORIAL HOSPITAL IS COMMITTED TO PROMOTING, IMPROVING, AND ENHANCING THE HEALTH AND WELL-BEING OF THE COMMUNITY WE SERVE. 0 0 MEMORIAL HEALTH SYSTEMS CORPORATION, PARENT COMPANY OF MEMORIAL HOSPITAL, ENTERED INTO AN ASSET PURCHASE AGREEMENT DATED JANUARY 24, 2012 WITH COMMUNITY HEALTH SYSTEMS, INC. TO SELL SUBSTANTIALLY ALL OF THE ASSETS OF THE SYSTEM. THE SALE CLOSED ON JULY 1, 2012. THE HOSPITAL TERMINATED ITS BUSINESS ACTIVITIES ON THAT DATE AND IS IN THE PROCESS OF DISSOLVING THE ENTITY. UPON DISSOLUTION, ANY ASSETS REMAINING WILL BE TRANSFERRED TO THE MEMORIAL HEALTH SYSTEMS CORPORATION ("MHSC"). MHSC WILL REMAIN ACTIVE IN THE YORK COMMUNITY PROVIDING FUNDS TO SUPPORT THE HEALTHCARE NEEDS OF THE COMMUNITY. 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 6 6 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 0 0 0 PA X SALLY J DIXON 7178438623 325 SOUTH BELMONT STREET YORK PA 17403 X JACK KAY CHAIRMAN 0.50 2.00 X X 0 0 0 RICHARD D POOLE VICE CHAIRMAN 0.50 2.00 X X 0 0 0 CHLOE R EICHELBERGER TREASURER 0.50 2.00 X X 0 0 0 TERRY N YORK DO DIRECTOR 0.50 2.00 X 0 0 0 SALLY J DIXON PRESIDENT/CEO 0.50 2.00 X X 0 0 0 RANDALL GROSS DIRECTOR 0.50 X 0 0 0 0 0 0 0 0 0 0 0 COST REPORT SETTLEMENT 900099 108568 108568 108568 108568 0 0 108568 0 0 0 0 16696820 16696820 2318596 20197 31000 31000 19046416 16748017 225205 116636 225205 116636 X 18231858 16392736 161822 161822 427531 76823 18821211 16631381 19046416 16748017 X 108568 -2298398 X 0 0 0 X 0 DEFERRED COMPENSATION 20197 ESTIMATED THIRD PARTY PAYOR SETTLEMENTS 96439 116636 FORM 990, PART VI, SECTION B, LINE 11 THE ACCOUNTING DEPARTMENT PROVIDES INFORMATION TO THE INDEPENDENT ACCOUNTANT FOR PREPARATION OF THE FORM 990. THE DRAFT IS REVIEWED BY THE CEO. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION USES AN ANNUAL QUESTIONNAIRE TO DETERMINE IF THE MEMBERS OF THE BOARD ARE INDEPENDENT. ANNUAL QUESTIONNAIRES FOR THE BOARD/SENIOR MANAGEMENT ARE COLLECTED BY THE CEO AND ARE REVIEWED BY THE CEO AND THE BOARD CHAIRPERSON. AT THE BOARD LEVEL, ANY POTENTIAL CONFLICT IS MONITORED BY THE CEO AND CHAIR, AND BOARD MEMBERS WILL REFRAIN FROM VOTING ON CONFLICT/RELATED ISSUES. IN ADDITION TO THE REPORTING REQUIRED, KEY EMPLOYEES AND SENIOR MANAGEMENT ARE MONITORED BY THE CEO THROUGH THE PURCHASING AND CASH DISTRIBUTIONS CONTROLS IN PLACE. 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 XI, LINE 9: TRANSFER OF PERMANENTLY RESTRICTED NET ASSETS TO AFFILIATE -350,708. TRANSFER OF INVESTMENTS TO AFFILIATE -1,947,690. SURGICAL CENTER OF YORK 1750 FIFTH AVENUE YORK PA 17403 232507740 OUT PATIENT SURGERY CENTER PA 501(C)3 3 MEMORIAL HEALTH SYSTEMS CORPORATION 0 MEMORIAL HEALTH SYSTEMS CORPORATION 1708 FIFTH AVENUE YORK PA 17403 222546051 SUPPORT AND DEVELOPMENT OF PROGRAMS FOR THE BENEFIT OF RELATED PARTIES PA 501(C)3 11 TYPE I N/A 0 MHS TITLE HOLDING CORP 325 SOUTH BELMONT STREET YORK PA 17403 222546052 REAL PROPERTY MANAGEMENT FOR RELATED ENTITIES PA 501(C)3 11 TYPE I MEMORIAL HEALTH SYSTEMS CORPORATION 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0