2014-05-15T11:22:16-05:00 2013-06-30 251249913 MALIN BERGQUIST & COMPANY LLP 2402 WEST 8TH STREET ERIE PA 165054428 990 2012-07-01 250965598 WARREN GENERAL HOSPITAL WARR 8147234973 TWO CRESCENT PARK WEST WARREN PA 16365 JULIE JACOBS 8147234973 2014-05-12 1 CRAIG C MOFFATT P00077574 8144544008 2012 2015-11-30 17:44:51Z JOHN P PAPALIA CEO TWO CRESCENT PARK WEST WARREN PA 16365 78101721 0 X WWW.WGH.ORG X 1898 PA TO PROVIDE HEALTHCARE SERVICES TO THE PUBLIC INCLUDING INPATIENT ACUTE CARE, PSYCHIATRIC CARE, 24-HR. EMERGENCY CARE, AND OTHER OUTPATIENT SERVICES TO WARREN AND SURROUNDING COUNTIES. WE PROVIDE HEALTH-RELATED CARE TO THE COMMUNITY, REGARDLESS OF THE ABILITY TO PAY. 11 9 724 171 0 0 2643369 257141 69748819 68763579 587675 1873695 1257907 1353094 74237770 72247509 0 0 0 0 32715353 35151068 0 0 175599 39690025 42599828 72405378 77750896 1832392 -5503387 60870418 55524241 27028923 22301245 33841495 33222996 X WARREN GENERAL HOSPITAL'S MISSION IS TO PROVIDE COMMUNITY HEALTHCARE WITH QUALITY AND COMPASSION. WE STRIVE TO IMPROVE THE COMMUNITY'S HEALTH, LEAD A VISION FOR THE HEALTHCARE FUTURE AND MAINTAIN FISCAL VIABILITY WHILE PROVIDING CORE HEALTHCARE SERVICES. 0 0 62169225 69253092 WARREN GENERAL HOSPITAL PROVIDES HEALTHCARE SERVICES TO THE PUBLIC. THESE HEALTHCARE SERVICES INCLUDE:INPATIENT ACUTE AND PSYCHIATRIC CARE, SKILLED NURSING, 24-HOUR EMERGENCY CARE, OUTPATIENT HOMECARE AND OTHER OUTPATIENT SERVICES FOR RESIDENTS OF WARREN COUNTY, PA AND THE SURROUNDING AREAS. THE HOSPITAL ALSO OPERATES TWO OUTPATIENT DENTAL CLINICS FOR THOSE UNDERINSURED/UNINSURED RESIDENTS IN NEED OF DENTAL SERVICES.AS PART OF ITS COMMITMENT TO THE COMMUNITY, THE HOSPITAL PROVIDES CARE TO INDIVIDUALS REGARDLESS OF THEIR ABILITY TO PAY. A CHARITY CARE PROGRAM IS UTILIZED FOR THOSE WHO HAVE NEED FOR HEALTHCARE SERVICES BUT LIMITED RESOURCES FOR PAYMENT. THIS PROGRAM PROVIDES RELIEF FROM PAYMENT UP TO 100% FOR THOSE WHO MEET THE QUALIFICATIONS, DESPITE COST. IN ADDITION, THE HOSPITAL PROVIDES CARE TO PATIENTS WHO QUALIFY FOR MEDICAID, EVEN THOUGH THE COST OF PROVIDING THOSE SERVICES EXCEED THE PROGRAM'S REIMBURSEMENTS.THE HOSPITAL ALSO PROVIDES FREE SCREENINGS (IN COLLABORATION WITH LOCAL SERVICE ORGANIZATIONS) FOR CANCER, DIABETES, HEART DISEASE, VASCULAR DISEASE, AND OSTEOPOROSIS. IN ADDITION, RURAL COMMUNITY HEALTH FAIRS ARE SPONSORED, PROVIDING DIAGNOSTIC TESTING AND HEALTHCARE EDUCATION TO PARTICIPANTS. VARIOUS COMMUNITY SERVICE ORGANIZATIONS UTILIZE THE HOSPITAL'S RESOURCES, BOTH SPACE AND STAFF, TO SEND A MESSAGE OR SUPPORT A PROGRAM THAT COINCIDES WITH THE HOSPITAL'S MISSION. 118193 119101 WARREN GENERAL HOSPITAL AUXILIARY PROVIDES SUPPORT TO THE HOSPITAL'S ACTIVITIES THROUGH VOLUNTEER AND FUNDRAISING ACTIVITIES. 62287418 1 1 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 0 0 0 0 0 0 1 0 1 1 0 0 1 0 0 0 1 0 1 1 1 0 0 0 0 0 1 1 1 0 0 1 45 0 1 724 1 0 0 0 0 0 0 0 0 0 0 X 11 9 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X JULIE JACOBS 8147233300 TWO CRESCENT PARK WEST WARREN PA 16365 TIMOTHY A HUBER 0.50 X 0 0 0 VAN W JOHNSON MD 0.50 X 0 0 0 JULIUS W BERTA MD 0.50 X 0 0 0 CHRISTOPHER DARLING 0.50 X 0 0 0 STEVE ROTHENBERG 0.50 X X 0 0 0 TIMOTHY R BEVEVINO ESQ 0.50 X X 0 0 0 CARMEN N FERRANTO 0.50 X X 0 0 0 CHARLES E MACKENZIE MD 0.50 X X 5800 0 0 JEFFREY F MORGAN MD 0.50 X 0 0 0 KIMBERLY ANGOVE 0.50 X 0 0 0 JOHN J SUTTON MD 0.50 X X 224828 0 49139 JOHN PAPALIA 40.00 X 492682 0 31688 MURRAY S MARSH JR 40.00 X 152616 0 30659 RANDY CALIFORNIA 40.00 X 212128 0 48144 LEROY J KORB JR MD 40.00 X 1042869 0 69891 DAVID J THOMAS MD 40.00 X 575543 0 36432 OSAMA AL-OMAR MD 40.00 X 544826 0 56432 TREVOR M OLSEN MD 40.00 X 564620 0 39291 ANNE RASSIGA MD 40.00 X 489635 0 25169 4305547 0 386845 33 0 1 0 GROUP MEDICAL SERVICES INC PO BOX 68 WARREN PA 16365 HEALTHCARE SERVICES 1056990 KINGS MEDICAL COMPANY PO BOX 72517 CLEVELAND OH 44192 IMAGING SERVICES - MRI 629416 ASSOCIATED CLINICAL LABS 1526 PEACH STREET ERIE PA 16501 LABORATORY SERVICES 359223 LABCORP PO BOX 12140 BURLINGTON NC 27216 LABORATORY SERVICES 324110 DEERFIELD BEHAVIORAL HEALTH 2808 STATE STREET ERIE PA 16508 PSYCHIATRIC SERVICES 320059 14 19731 100000 137410 257141 OUTPATIENT SERVICES 621400 47173527 47173527 INPATIENT SERVICES 623990 19375745 19375745 HOME HEALTH SERVICES 621610 1757320 1757320 HOSPITAL CAFETERIA 900099 227835 227835 229152 229152 68763579 374035 374035 226371 0 226371 226371 226371 7323465 3392 5758129 69068 1565336 -65676 1499660 1499660 58360 19731 27015 31345 31345 704 0 704 704 ONCOLOGY SUBWORK 900099 263142 263142 VANTAGE/DEERFIELD/CHART 900099 224726 224726 AUXILIARY/WINDOW BOX 900099 119101 119101 487705 487705 1094674 72247509 69372193 0 2618175 X 1134538 224116 910422 22928183 16101319 6760183 66681 3497836 2373119 1115024 9693 5479436 3717542 1746710 15184 2111075 1432266 672959 5850 291792 291792 97371 97371 16662997 15755643 907354 1051711 444833 538861 68017 3201859 2680548 521311 468798 189053 277715 2030 193256 193256 2717469 2717469 774010 774010 MEDICAL SUPPLIES 10992114 10992114 BAD DEBT EXPENSE 3866454 3866454 LICENSES AND FEES 775358 56057 719271 30 EQUIPMENT RENTALS AND L 382882 381695 1187 1123757 387924 727719 8114 77750896 62287418 15287879 175599 1992646 551316 1495758 689430 7978647 8016805 1380377 1441000 642749 618918 78106316 55200345 22234365 22905971 19563505 15981000 5582371 5319801 60870418 55524241 5191241 5189192 45749 26244 6153183 5393591 15638750 11692218 27028923 22301245 X 23893039 24116825 5476994 4364315 4471462 4741856 33841495 33222996 60870418 55524241 X -5503387 426162 4458725 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 9948456 99909 959373 1888832 12735 9106171 8391676 2342897 -195755 577004 13358 9948456 7583914 336153 1463868 979694 12565 8391676 6796279 533678 674527 410039 10531 7583914 7135823 979011 -273177 1035860 9518 6796279 0.52100 0.47900 1 0 503941 503941 21605888 13480900 8124988 3288171 1231687 2056484 50955170 40487758 10467412 1753146 1753146 22905971 DUE FROM AFFILIATE 11149 OTHER ASSETS 2996557 OTHER INVESTMENTS - PARTNERSHIPS AND OTHER ENTITIES VALUED BY EQUITY METHOD 2312095 5319801 DUE TO THIRD PARTY PAYOR 443691 ACCRUED POST RETIREMENT BENEFIT 233824 ACCRUED PENSION COSTS 10593286 CAPITAL LEASE OBLIGATIONS 421417 11692218 X 77529190 426162 4988116 5414278 72114912 132597 132597 72247509 78162094 529388 529388 77632706 118190 118190 77750896 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THE TEMPORARILY RESTRICTED FUNDS HELD IN ENDOWMENT ARE RESTRICTED FOR HEALTH CARE SERVICES, THE HOSPITAL'S BUILDING AND EQUIPMENT, AND CONSTRUCTION FOR THE CANCER CENTER BUILDING AND EQUIPMENT. THE PERMANENTLY RESTRICTED FUNDS HELD IN ENDOWMENT ARE RESTRICTED TO SUPPORT THE HOSPITAL'S HEALTH CARE SERVICES. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: THE HOSPITAL IS A NOT-FOR-PROFIT ORGANIZATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE HOSPITAL HAS EVALUATED ITS TAX POSITIONS AND ELECTIONS MADE FOR ALL OPEN TAX YEARS. ALL OPEN TAX YEARS ARE SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. HOWEVER, THE HOSPITAL IS NOT CURRENTLY UNDER AUDIT. THE HOSPITAL HAS NOT BEEN SUBJECT TO ANY INCOME TAX PENALTIES OR INTEREST FOR THE YEARS ENDED JUNE 30, 2013 AND 2012. BASED ON THE EVALUATION OF THE HOSPITAL'S TAX POSITIONS AND ELECTIONS, MANAGEMENT BELIEVES THAT ALL TAX POSITIONS TAKEN AND THE TAX-EXEMPT STATUS OF THE HOSPITAL WOULD BE UPHELD UNDER AN EXAMINATION. THEREFORE, NO PROVISION FOR THE EFFECTS OF UNCERTAIN TAX POSITIONS OR THE REVOCATION OF THE HOSPITAL'S TAX-EXEMPT STATUS HAS BEEN RECORDED AS OF JUNE 30, 2013. PART XI, LINE 2D - OTHER ADJUSTMENTS: PENSION RELATED CHANGES UNDER GAAP OTHER THAN NET PERIODIC COSTS 4,988,116. ROUNDING ADJUSTMENT BETWEEN FORM 990 AND AUDITED FINANCIAL STATEMENTS PART XI, LINE 4B - OTHER ADJUSTMENTS: AUXILLIARY/WINDOW BOX INCOME 132,597. PART XII, LINE 2D - OTHER ADJUSTMENTS: TRANSFERS TO AFFILIATE 402,987. POST RET. RELATED CHANGES UNDER GAAP OTHER THAN NET PERIODIC PENSION COSTS 126,401. PART XII, LINE 4B - OTHER ADJUSTMENTS: AUXILIARY/WINDOW BOX EXPENSES 118,190. HOSPITAL BALL 31001 19731 11270 6049 5182 3251 3725 GOLF OUTING 47090 47090 1242 6609 957 78091 19731 58360 1242 6049 11791 3251 4682 27015 31345 1 1 1 X 1 X 1 1 1 0 1 1 242871 242871 0.00310 2750536 2750536 0.03540 85238 85238 0.00110 3078645 3078645 0.03960 84506 84506 0.00110 21001 21001 0.00030 1117508 1117508 0.01440 19279 19279 0.00020 1242294 1242294 0.01600 4320939 4320939 0.05560 10000 10000 0.00010 299084 299084 0.00380 309084 309084 0.00390 1 1617336 161734 20023296 23691108 -3667812 X 1 1 1 PINEGROVE AMBULATORY SURGERY CENTER LLC OUTPATIENT AMBULATORY SURGERY CENTER 0.35000 0.11000 0.54000 2 MEDIPAR ASSOCIATES LP REAL ESTATE FOR MEDICAL OFFICE BUILDING 0.86000 0.00000 0.14000 3 SENIOR LIVING SERVICES OUTPATIENT REHABILITATION CLINIC 0.50000 0.00000 0.00000 1 1 WARREN GENERAL HOSPITAL

TWO CRESCENT PARK WEST WARREN PA 16365

X X X WARREN GENERAL HOSPITAL 1 1 X X X X X X X X X 13 1 0 1 X X X X X X X X X X X 1 0 1 1 200.000000000000 1 200.000000000000 1 X X X X X X 1 1 X X X X X 1 X 1 X X X X X X 1 X 0 0 PART I, L7 COL(F): THE HOSPITAL CALCULATED AN OVERALL COST TO CHARGE RATIO USING TOTAL GROSS CHARGES AND TOTAL OPERATING COSTS LESS BAD DEBT EXPENSE.THE HOSPITAL THEN REDUCED ITS BAD DEBT TO COST. SCHEDULE H, PART 1, LINE 6A THE HOSPITAL PROVIDES A DETAILED UNSPONSORED COMMUNITY BENEFITS FOOTNOTE IN ITS ANNUAL FINANCIAL STATEMENTS WHICH ARE AVAILABLE TO THE PUBLIC.THE NOTE DETAILS CHARITY CARE, UNPAID COST OF PUBLIC PROGRAMS, COMMUNITY HEALTH SERVICES, SUBSIDIZED HEALTH SERVICES AND COMMUNITY BUILDING ACTIVITIES. PART II: THE HOSPITAL SPENT APPROXIMATELY $299,000 JUST ON THE DIRECT EXPENSES OF RECRUITING PHYSICIANS INTO OUR RURAL MARKET IN FISCAL YEAR 2013.THE DIRECT HEALTH BENEFITS AND INDIRECT ECONOMIC BENEFITS OF OUR EMPLOYMENT AND SPENDING ARE SUBSTANTIAL. OUR TRADE ASSOCIATION ESTIMATES THAT THE ECONOMIC IMPACT (DIRECT SPENDING OF THE HOSPITAL PLUS INDIRECT BENEFITS ON OUR COMMUNITY) IS OVER $100 MILLION DOLLARS. PART III, LINE 4: PATIENT ACCOUNTS RECEIVABLE 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. THE ALLOWANCE FOR DOUBTFUL COLLECTIONS IS 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'S LARGEST GOVERNMENT PAYER IS THE FEDERAL MEDICARE PROGRAM. THE HOSPITAL'S COSTS ARE GREATER THAN PROGRAM REIMBURSEMENTS. IT IS CLEARLY A COMMUNITY BENEFIT FOR THE HOSPITAL TO PROVIDE RURAL ACCESS TO MEDICAID BENEFICIARIES IN TERMS OF TIME, DISTANCES, AND WEATHER CONDITION ISSUES.BY PROVIDING MEDICARE SERVICES WHEN PAYMENTS ARE LESS THAN COST IS OF GREAT COMMUNITY BENEFIT. PART III, LINE 9B: THE HOSPITAL EMPLOYS MANY METHODS TO IDENTIFY THOSE WHO QUALIFY FOR CHARITY CARE OR DISCOUNTED CARE. THE HOSPITAL ALSO EMPLOYS A FULL TIME COUNSELOR WHO ASSISTS FAMILIES WITH CHARITY CARE, MEDICAID APPLICANTS, AND ADVOCACY. WARREN GENERAL HOSPITAL PART V, SECTION B, LINE 3: DEMOGRAPHIC INFORMATION, SECONDARY DATA STATISTICS AND RESULTS OF A PHYSICIAN SURVEY WERE PROVIDED TO THE GROUP IN THE FORM OF A POWERPOINT PRESENTATION. THE GROUP WAS ASKED TO PROVIDE THEIR OPINION ON THE NUMBER CONCERN THE WARREN COUNTY POPULATION IS FACING PRE AND POST PRESENTATION. THE PERSONS THE HOSPITAL CONSULTED WITH ARE AS FOLLOWS:NUTRITION EDUCATION ADVISOR FROM PENN STATE NUTRITION LINK - CAROL WILCOXWGH ALCOHOL/DRUG COUNSELOR - JESSICA UBERSENIOR INCOME DEVELOPMENT REP FROM AMERICAN CANCER SOCIETY/WARREN COUNTY - MARIE COSTELLOEXECUTIVE DIRECTOR FROM WARREN COUNTY HOUSING AUTHORITY - TONYA MITCHELL-WESTONRNC FROM PA DEPT. OF HEALTH/WARREN COUNTY - BARBARA WHITEEXECUTIVE DIRECTOR OF EXPERIENCE INC./AREA AGENCY ON AGENCY - FARLEY WRIGHTWARREN COUNTY SHERIFF - WILLIAM GARDNERPOLICE LIEUTENANT FROM WARREN POLICE DEPARTMENT - JAMES JORDANWGH DIRECTOR OF MARKETING AND DEVELOPMENT - GEORGE LILJAPSYCHIATRIST FROM DEERFIELD BEHAVIORAL HEALTH - MARK BEUGER, MDVP OF PROGRAM EVALUATION FROM BEACON LIGHT BEHAVIORAL HEALTH - BECKY JENSENWGH DIABETES EDUCATOR - NANCY MAGUEADMINISTRATOR OF THE ROUSE HOME - CINDY WALTERSSUPERINTENDENT OF WARREN COUNTY SCHOOL DISTRICT - BRANDON HUFFNAGELOFFICE MANAGER AND PROGRAM DEVELOPMENT SPECIALIST AT DEERFIELD BEHAVIORAL HEALTH - SUSAN TECONCHUKWGH DIRECTOR OF PATIENT & PUBLIC RELATIONS - HOLLI SUMMERVILLECOO OF WARREN MEDICAL GROUP - KAREN COOMBSEXECUTIVE DIRECTOR OF THE WARREN COUNTY YMCA - THAD TURNER WARREN GENERAL HOSPITAL PART V, SECTION B, LINE 5C: INFORMATION ON HOW TO ACCESS THE CHNA WAS PUBLISHED IN THE WGH QUARTERLY NEWSLETTER. WARREN GENERAL HOSPITAL PART V, SECTION B, LINE 14G: THE HOSPITAL EMPLOYS A FINANCIAL COUNSELOR WHO SPEAKS WITH ELIGIBLE INDIVIDUALS REGARDING OUR FINANCIAL ASSISTANCE POLICY WARREN GENERAL HOSPITAL PART V, SECTION B, LINE 16E: THE HOSPITAL CONTRACTS WITH A RECEIVABLES MANAGEMENT COMPANY TO HANDLE OUR SELF-PAY ACCOUNTS RECEIVABLE FROM DAY 1 TO DAY 120. AFTER DAY 120 THE ACTIONS ARE SENT TO A COLLECTIONS AGENCY WHO AT THAT TIME REPORTS THE INDIVIDUAL(S) TO A CREDIT AGENCY. WARREN GENERAL HOSPITAL PART V, SECTION B, LINE 18E: THE HOSPITAL EMPLOYS A FINANCIAL COUNSELOR WHO SPEAKS WITH ELIGIBLE INDIVIDUALS REGARDING OUR FINANCIAL ASSISTANCE POLICY. SHE ASSISTS INDIVIDUALS IN APPLYING FOR OUR STATE MEDICAL ASSISTANCE PROGRAM. WARREN GENERAL HOSPITAL PART V, SECTION B, LINE 20D: SELF-PAY CHARGES ARE SET AT 50% OF GROSS CHARGES, WHICH REPRESENTS AN AVERAGE OF OUR COMMERCIAL INSURANCE REIMBURSEMENT. PART VI, LINE 2: THE HOSPITAL CONDUCTS ANNUAL STRATEGIC PLANNING WITH A FOCUS ON COMMUNITY HEALTH NEEDS. THE HOSPITAL USES METRICS SUCH AS "HEALTHY PEOPLE" AND PLANS SERVICES NEEDS ACCORDINGLY. THIS PROCESS IS INTERACTIVE AND HAS RESULTED IN EXPANSION OF PRIMARY DENTAL SERVICES IN 2010 AS ONE EXAMPLE.WE ALSO DRIVE OUR DOCTOR RECRUITING PLAN FROM THIS PROCESS. PART VI, LINE 3: THE HOSPITAL ADVERTISES ITS PROGRAMS IN LOCAL NEWSPAPERS. WE ALSO HAVE BROCHURES AVAILABLE AT OUR SERVICE LOCATIONS AND EMPLOYED DOCTORS' OFFICES.OUR INTAKE STAFF IS AWARE OF THESE PROGRAMS AND MAKE PATIENTS AWARE OF OUR COUNSELOR AS WELL. THIS FULL TIME EMPLOYEE HELPS IDENTIFY AND ASSIST PATIENTS WITH CHARITY CARE, DISCOUNTED CARE, MEDICAL ASSISTANCE APPLICATIONS AND ADVOCACY. PART VI, LINE 4: WARREN COUNTY HAS A POPULATION OF APPROXIMATELY 40,000. THE COUNTY IS A LARGE GEOGRAPHIC SIZE WITH MANY RURAL AND SMALL COMMUNITIES. WARREN COUNTY RANKS 13TH OF 67 COUNTIES IN PENNSYLVANIA IN TERMS OF OVERALL HEALTH OUTCOMES.WARREN COUNTY RANKS 48TH OF 67 COUNTIES IN PENNSYLVANIA IN TERMS OF HEALTH FACTORS17.5% OF THE POPULATION IS +65 - STATE AVERAGE 15.2%27% OF THE ADULT POPULATION SMOKES - STATE AVERAGE 23%28% OF THE ADULT POPULATION IS OBESE - STATE AVERAGE 28%16% OF THE POPULATION IS IN POOR HEALTH - STATE AVERAGE 14%12% OF THE ADULT POPULATION IS UNINSURED - STATE AVERAGE 12% PART VI, LINE 5: WE HAVE AN OPEN MEDICAL STAFF, A DIVERSE COMMUNITY BOARD AND ALL OF OUR SURPLUS IS USED TO SUSTAIN AND REINVEST IN OUR ASSOCIATES AND PLANT AND FUND BALANCE TO ASSURE LONG TERM VIABILITY AND ACCESS IN OUR COMMUNITY. PART VI, LINE 6: N/A X X 1 1 X X X X X 0 1 0 1 0 1 0 0 0 JOHN J SUTTON MD 206063 0 18765 0 0 0 32076 0 17063 0 273967 0 0 0 JOHN PAPALIA 388315 0 83897 0 20470 0 14625 0 17063 0 524370 0 0 0 MURRAY S MARSH JR 138209 0 2300 0 12107 0 19094 0 11565 0 183275 0 0 0 RANDY CALIFORNIA 203061 0 7727 0 1340 0 31081 0 17063 0 260272 0 0 0 LEROY J KORB JR MD 405573 0 617974 0 19322 0 52828 0 17063 0 1112760 0 0 0 DAVID J THOMAS MD 378776 0 161366 0 35401 0 19369 0 17063 0 611975 0 0 0 OSAMA AL-OMAR MD 544826 0 0 0 0 0 39369 0 17063 0 601258 0 0 0 TREVOR M OLSEN MD 547620 0 0 0 17000 0 22228 0 17063 0 603911 0 0 0 ANNE RASSIGA MD 349745 0 0 0 139890 0 19369 0 5800 0 514804 0 0 0 PART I, LINE 1A SPOUSAL TRAVEL AND SOCIAL CLUB DUES ARE PAID FOR THE CHIEF EXECUTIVE OFFICER. PART I, LINE 4B SIX EMPLOYEES LISTED ABOVE ARE PARTICIPANTS OF ACTIVE 457(F) PLANS: MURRAY MARSH: $7,273 RANDY CALIFORNIA: $14,546 LEROY KORB, JR, MD: $33,333 OSAMA AL-OMAR, MD: $20,000 JOHN SUTTON, MD: $15,000 TREVOR OLSEN, MD: $8,036 PART I, LINE 5 THE HOSPITAL HAS AN EMPLOYMENT CONTRACT WITH DR. KORB THAT PAYS A BASE SALARY AND ALSO AN INCENTIVE BASED ON COLLECTED REVENUES. IN ADDITION, DR. THOMAS, DR. MALJOVEC, DR. AHMED, DR. ENDRES AND DR. SUTTON RECEIVED AN INCENTIVE PAYMENT DURING THE CALENDAR YEAR ENDED DECEMBER 31, 2012 BASED UPON EXCEEDING THEIR SET RVU LEVELS. PART I, LINE 6 THE HOSPITAL USES A PAY FOR PERFORMANCE SYSTEM BALANCED SCORECARD FOR INCENTIVE COMPENSATION FOR SOME OF ITS MANAGERS. NET EARNINGS REPRESENTS ONLY ONE COMPONENT OF THE FORMULA WHICH ALSO HAS PATIENT SATISFACTION, CLINICAL QUALITY AND PATIENT SAFETY MEASURES. JOHN PAPALIA X 100000 11535 0 1 1 11535 TIM BEVEVINO BOARD PRESIDENT 117403 WIFE EMPLOYED BY WARREN GENERAL HOSPITAL 0 TIM BEVEVINO BOARD PRESIDENT 21052 LEGAL SERVICES PAID TO HIS FIRM 0 NORTHWEST SAVINGS BANK BOARD MEMBER AND EXECUTIVE VP OF BANK 172870 INTEREST EXPENSE PAID UPON LOANS THROUGH NORTHWEST SAVINGS BANK. 0 FORM 990, PART VI, SECTION A, LINE 6 CARE CORPORATION OF WARREN IS THE SOLE CORPORATE MEMBER OF WARREN GENERAL HOSPITAL. FORM 990, PART VI, SECTION A, LINE 7A CARE CORPORATION OF WARREN, THE PARENT COMPANY, APPOINTS THREE OF THE MEMBERS OF THE WARREN GENERAL HOSPITAL BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B SPECIFIC DECISIONS OF THE BOARD OF DIRECTORS ARE SUBJECT TO APPROVAL BY THE BOARD OF DIRECTORS OF CARE CORPORATION OF WARREN, THE PARENT COMPANY OF WARREN GENERAL HOSPITAL. FORM 990, PART VI, SECTION B, LINE 11 MANAGEMENT HAS INFORMED THE BOARD OF DIRECTORS THAT THE FORM 990 IS AVAILABLE IN THE ADMINISTRATIVE OFFICE FOR REVIEW BEFORE FILING. FORM 990, PART VI, SECTION B, LINE 12C EACH YEAR THE BOARD OF DIRECTORS ARE REQUIRED TO SIGN A CONFLICT OF INTEREST POLICY AND DISCLOSE ANY BUSINESS OR FAMILY RELATIONSHIPS WHICH MAY CREATE A CONFLICT. EACH BOARD OF DIRECTOR AGREES TO REFRAIN FROM VOTING ON ANY ITEM IN WHICH A CONFLICT MAY EXIST. ANNUALLY, THE CORPORATE COMPLIANCE OFFICER REVIEWS THE POLICY AND AUDITS THE SIGNATURES. FORM 990, PART VI, SECTION B, LINE 15 THE HOSPITAL PARTICIPATES IN THE YAFFE AND COMPANY HOSPITAL ASSOCIATION OF PENNSYLVANIA COUNCIL OF SMALL HOSPITALS EXECUTIVE COMPENSATION SURVEY. THIS INSTRUMENT SURVEYS HOSPITALS OF LIKE SIZE AND WITHIN OUR GEOGRAPHY. THE HOSPITAL BOARD CHOSE THIS INSTRUMENT DUE TO ITS RELEVANCY TO THE HOSPITALS MARKET. THE SURVEY DATA IS USED BY THE HOSPITAL BOARD OF DIRECTORS COMPENSATION COMMITTEE FOR COMPARISONS OF COMPENSATION AND BENEFITS FOR THE CEO AND OTHER TOP MANAGEMENT OFFICIALS. THE COMPENSATION COMMITTEE REPORTS ITS FINDINGS AND MAKES RECOMMENDATIONS TO THE FULL BOARD OF DIRECTORS FOR THEIR REVIEW, DELIBERATION AND APPROVAL OR MODIFICATION. THE HOSPITAL BOARD OF DIRECTORS ALSO APPOINTED A COMMITTEE CALLED THE MANAGEMENT TRANSACTION AND AUDIT COMMITTEE TO REVIEW ALL TRANSACTIONS BETWEEN THE HOSPITAL AND PHYSICIANS. THIS BODY REVIEWS SEVERAL PHYSICIAN COMPENSATION SURVEYS (SUCH AS THE MEDICAL GROUP MANAGEMENT ASSOCIATION SURVEY AND THE MERRITT HAWKINS SURVEY) TO ESTABLISH COMPARISONS FOR PHYSICIAN COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 EACH YEAR A COMBINED CORPORATE MEETING IS HELD IN WHICH THE PUBLIC IS WELCOME TO ATTEND. IN ADDITION, DOCUMENTS WILL BE MADE AVAILABLE TO THE PUBLIC IF THEY ARE REQUESTED IN PERSON OR IN WRITING. OTHER FEES FORM 990, PART IX, LINE 11G CONSULTING SERVICES: PROGRAM SERVICE EXPENSES 61,421. MANAGEMENT AND GENERAL EXPENSES 93,500. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 154,921. PURCHASED LINEN SERVICES: PROGRAM SERVICE EXPENSES 216,671. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 216,671. PURCHASED MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 3,212,694. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,212,694. COLLECTION AGENCY: PROGRAM SERVICE EXPENSES 239,393. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 239,393. OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 2,962,140. MANAGEMENT AND GENERAL EXPENSES 831,641. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,793,781. PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 9,063,324. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,063,324. INTER-ORG OFFSET: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES -17,787. FUNDRAISING EXPENSES 0. TOTAL EXPENSES -17,787. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: TRANSFERS TO AFFILIATE -402,987. PENSION RELATED CHANGES UNDER GAAP OTHER THAN NET PERIODIC PENSION COSTS 4,988,116. POSTRETIREMENT RELATED CHANGES UNDER GAAP OTHER THAN NET PERIODIC COSTS -126,401. ROUNDING ADJUSTMENT BETWEEN AUDITED FINANCIAL STATEMENTS AND FORM 990 -3. FINANCIAL STATEMENTS AND REPORTING FORM 990, PAGE 11, PART XI THE ORGANIZATION HAS A COMMITTEE THAT ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. WRITTEN POLICY OR PROCEDURES REGARDING PARTICIPATION IN JOINT VENTURE FORM 990, PART VI, SECTION B THE HOSPITAL BOARD OF DIRECTORS MUST ULTIMATELY APPROVE ANY INVESTMENTS IN ANY JOINT VENTURE OR SIMILAR ARRANGEMENT. AS AN ADDITIONAL STEP, THE HOSPITAL BOARD OF DIRECTORS APPOINTED A COMMITTEE CALLED THE MANAGEMENT TRANSACTION & AUDIT COMMITTEE THAT REVIEWS ALL TRANSACTIONS BETWEEN THE HOSPITAL AND PHYSICIANS. AS PART OF ITS GOVERNANCE AND OVERSIGHT ROLE, THE FULL HOSPITAL BOARD ALSO SUBJECTS ANY JOINT VENTURE ARRANGEMENTS TO LEGAL REVIEW PRIOR TO ANY INVESTMENT BY THE HOSPITAL CARE CORPORATION OF WARREN 2 CRESCENT PARK WEST WARREN PA 16365 251512016 PARENT CORP. PA 501(C)(3) 11 N/A 0 GENERAL CARE SERVICES INC 2 CRESCENT PARK WEST WARREN PA 16365 251512020 HOSPICE SERVICES PA 501(C)(3) 9 CARE CORPORATION OF WARREN 0 GROUP MEDICAL SERVICES CORP 2 CRESCENT PARK WEST WARREN PA 16365 232806359 HEALTH CARE SERVICES PA C 0 0 0 0 1 0 0 0 0 0 1 0 1 0 1 1 0 1 0 0 WGH LENT OPERATIONAL FUNDS TO GROUP MEDICAL SERVICES DEBT WAS FORGIVEN D 402987 ACTUAL CASH PAID WGH SHARES FACILITIES WITH RELATED ORGANIZATIONS NO RENT IS PAID N N/A WGH LEASES STAFF FROM GROUP MEDICAL SERVICES O 1056185 ACTUAL CASH PAID PERFORMANCE OF SERVICES FOR GENERAL CARE SERVICES L 92367 ACTUAL CASH PAID GENERAL CARE SERVICES INC Q 61945 ACTUAL CASH PAID GENERAL CARE SERVICES INC J 1 ACTUAL CASH PAID