2014-05-12T08:15:44-05:00 2013-06-30 232932984 PARENTEBEARD LLC 400 MARKET STREET WILLIAMSPORT PA 17701 990 2012-07-01 240795682 MOUNT NITTANY MEDICAL CENTER MOUN 8142317000 1800 EAST PARK AVENUE STATE COLLEGE PA 16803 RICHARD J WISNIEWSKI 8142317000 2014-05-08 1 JULIUS C GREEN CPA JD P00350393 5703236023 2014-05-08 2012 2015-11-30 17:44:51Z STEVEN E BROWN 1800 EAST PARK AVENUE STATE COLLEGE PA 16803 432871942 0 X WWW.MOUNTNITTANY.ORG X 1905 PA PROVIDE INPATIENT, OUTPATIENT & EMERGENCY CARE SERVICES TO RESIDENTS OF THE CENTRE COUNTY REGION. 15 8 1860 804 2755738 1144115 2899939 3188138 256401835 278528821 2561259 4073823 3428458 3585815 265291491 289376597 16099602 13850795 0 0 109118779 124390204 0 0 0 124353711 149235483 249572092 287476482 15719399 1900115 353140117 414344237 238688534 276212432 114451583 138131805 X MOUNT NITTANY HEALTH'S MISSION: WE ARE HERE TO MAKE PEOPLE HEALTHIER. 0 0 259822076 13850795 278528821 MOUNT NITTANY MEDICAL CENTER IS COMMITTED TO PROVIDING QUALITY MEDICAL CARE IN AN ATMOSPHERE THAT REFLECTS HIGH STANDARDS OF SOCIAL, ETHICAL, AND FINANCIAL RESPONSIBILITY AND WILL ASSURE THAT THOSE SAME STANDARDS ARE MET IN ALL CONTRACTUAL RELATIONSHIPS. THE BOARD OF TRUSTEES HAS ESTABLISHED THIS STATEMENT OF ORGANIZATIONAL VALUES TO ASSURE THAT MEMBERS OF THE BOARD, THE MEDICAL CENTER STAFF, AND THE MEDICAL STAFF HONOR THE FOLLOWING PRINCIPLES THROUGH OUR BEHAVIORS:ALLIANCES WITH PATIENTS:- WE WILL TREAT ALL PATIENTS WITH DIGNITY AND RESPECT, AND WILL ACCOMMODATE INDIVIDUAL RESPONSES TO THE STRESS OF ILLNESS.- WE FULLY SUPPORT THE PRINCIPLES OUTLINED IN THE STATEMENT OF PATIENT'S RIGHTS AND RESPONSIBILITIES DOCUMENT.- WE COMMIT TO A SERVICE EXCELLENCE PHILOSOPHY THAT STRIVES TO MEET OR EXCEED PATIENT EXPECTATIONS.- ALL PATIENTS RECEIVE A UNIFORM STANDARD OF CARE THROUGHOUT THE FACILITY, REGARDLESS OF SOCIAL, CULTURAL, FINANCIAL, RELIGIOUS, RACIAL, GENDER, OR SEXUAL ORIENTATION FACTORS.- THE MEDICAL CENTER AND MEDICAL STAFF WORK JOINTLY TO ASSURE THAT ONLY APPROPRIATE AND EFFECTIVE TESTS, PROCEDURES, AND TREATMENTS ARE PROVIDED TO PATIENTS.COMMUNITY RELATIONS- WE WILL FAIRLY AND ACCURATELY REPRESENT OURSELVES AND OUR CAPABILITIES TO THE PUBLIC.- WE ARE COMMITTED TO CONSTANT PREPARATION FOR THE LONG-TERM FINANCIAL VIABILITY OF THE MEDICAL CENTER THROUGH RESPONSIBLE UTILIZATION OF RESOURCES AND IN SUPPORT OF OUR COMMITMENT TO MEET THE HEALTHCARE NEEDS OF THE COMMUNITY.- MEDICAL CENTER LEADERSHIP (EXECUTIVES, BOARD OF TRUSTEES, MEDICAL STAFF) WILL DISCLOSE AND AVOID POTENTIAL CONFLICTS OF INTEREST. ALL OTHER HOSPITAL STAFF WILL AVOID SIMILAR CONFLICTS OF INTEREST.- WE WILL MAINTAIN AN OPEN ADMISSIONS POLICY: NO PATIENT WILL BE REFUSED EVALUATION AND SERVICE BASED UPON SEX, AGE, RACE, CREED, NATIONAL ORIGIN, SEXUAL ORIENTATION, INFECTION STATUS, OR THE ABILITY TO PAY. TRANSFERS TO OTHER FACILITIES WILL OCCUR ONLY WHEN WE ARE UNABLE TO PROVIDE NEEDED SERVICES AND ONLY TO FACILITIES THAT PROVIDE AN APPROPRIATE LEVEL OF CARE, BASED ON OUR ASSESSMENT OF THE PATIENTS' NEEDS. PATIENTS MAY ALSO REQUEST ELECTIVE TRANSFER AND AN INFORMED CONSENT PROCESS WILL BE FOLLOWED.GENERAL PROGRAM SERVICE INFORMATIONOPERATIONS & PATIENTSMOUNT NITTANY MEDICAL CENTER, LOCATED IN STATE COLLEGE, PENNSYLVANIA, IS A 260-BED ACUTE-CARE, NOT-FOR-PROFIT FACILITY OFFERING GENERAL MEDICAL AND SURGICAL SERVICES THAT ARE FOCUSED ON HELPING PATIENTS REACH THEIR HEALTH POTENTIAL. FOR THE FISCAL YEAR ENDED JUNE 30, 2013, MOUNT NITTANY MEDICAL CENTER PROVIDED CARE TO THE FOLLOWING NUMBER OF PATIENTS:TOTAL NUMBER OF: INPATIENTS 12,681, OUTPATIENTS 220,211 AND ER VISITS 39,748 NUMBER WITH PRIVATE INSURANCE: INPATIENTS 5,299, OUTPATIENTS 127,214 AND ER VISITS 19,184NUMBER WITH MEDICARE: INPATIENTS 3,519, OUTPATIENTS 35,236 AND ER VISITS 4,558 NUMBER WITH MEDICARE HMO: INPATIENTS 2,486, OUTPATIENTS 31,936 AND ER VISITS 2,554 NUMBER WITH MEDICAID INPATIENTS 623, OUTPATIENTS 10,518 ER VISITS 4,321NUMBER WITH MEDICAID HMO INPATIENTS 480, OUTPATIENTS 5,151 ER VISITS 2,597NUMBER WITH OTHER INSURANCE INPATIENTS 113, OUTPATIENTS 2,357 AND ER VISITS 1,035 NUMBER WITHOUT INSURANCE/SELF PAY: INPATIENTS 161, OUTPATIENTS 7,799, AND ER VISITS 5,499MOUNT NITTANY MEDICAL CENTER DID NOT DENY MEDICAL SERVICES TO ANY INDIVIDUALS INCLUDING THOSE THAT HAD PRIVATE INSURANCE, MEDICARE, MEDICAID, PUBLIC HEALTH INSURANCE, OR NO INSURANCE.EMERGENCY DEPARTMENTMOUNT NITTANY MEDICAL CENTER OPERATES AN EMERGENCY ROOM 24 HOURS A DAY, 365 DAYS A YEAR PROVIDING SERVICES TO ALL MEMBERS OF THE COMMUNITY REGARDLESS OF THEIR ABILITY TO PAY AND DENIED ZERO PATIENTS REQUESTING SUCH SERVICES. THE EMERGENCY ROOM DOES NOT HAVE A TRAUMA CENTER CERTIFICATION.MEDICAL STAFF PRIVILEGESALL QUALIFIED PHYSICIANS IN THE COMMUNITY ARE ELIGIBLE FOR MEDICAL STAFF PRIVILEGES AT MOUNT NITTANY MEDICAL CENTER AND ALL QUALIFIED PHYSICIAN APPLICATIONS HAVE BEEN ACCEPTED FOR MEDICAL STAFF PRIVILEGES. MORE THAN 300 NON-EMPLOYED PHYSICIANS IN 42 SPECIALTIES AND SUBSPECIALTIES ARE CREDENTIALED AT MOUNT NITTANY MEDICAL CENTER.PROFESSIONAL MEDICAL EDUCATION AND TRAININGMOUNT NITTANY MEDICAL CENTER CONDUCTS PROFESSIONAL MEDICAL EDUCATION AND TRAINING PROGRAMS FOR THE BENEFIT OF THE COMMUNITY WITH A RESULTING FINANCIAL LOSS TO THE MEDICAL CENTER. 259822076 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 1 1 1 0 0 1 74 0 1 1860 1 1 1 0 0 0 0 0 0 0 0 0 X 15 8 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 PA X RICHARD WISNIEWSKI SR VP FINANCE 8142346148 1800 EAST PARK AVENUE STATE COLLEGE PA 168036797 RICHARD D ALLATT MD 2.00 X 16440 0 0 CARL A ANDERSON 2.00 4.00 X X 0 0 0 PATRICIA BEST DED 2.00 2.00 X 0 0 0 S DIANE BRANNON PHD 2.00 X 0 0 0 STEVEN E BROWN 32.00 8.00 X X 602851 0 58200 JONATHON DRANOV MD 2.00 4.00 X 0 494880 55124 THOMAS J HARRIS 2.00 4.00 X X 0 0 0 EUGENE KEPHART DED 2.00 X 0 0 0 PHILIP I PARK 2.00 X 0 0 0 WAYNE SEBASTIANELLI MD 2.00 2.00 X 28021 0 0 KAREN P SHUTE 2.00 X 0 0 0 JAMES B THOMAS PHD 2.00 4.00 X X 0 0 0 CHARLES WITMER 2.00 X 0 0 0 PAUL SHUEY DO 2.00 X 0 0 0 THOMAS F BROWN 2.00 8.00 X X 0 0 0 RICHARD WISNIEWSKI 36.00 4.00 X 326704 0 53230 JEFFREY RATNER MD 40.00 X 337087 0 58690 WAYNE THOMPSON 40.00 X 260034 0 50233 HAROLD BRUNGARD III 40.00 X 156401 0 25874 JANET SCHACHTNER 38.00 2.00 X 273883 0 50970 GERALD DITTMANN 40.00 X 177705 0 49567 GAIL MILLER 40.00 X 161216 0 41190 THOMAS STOESSEL 40.00 X 192175 0 43040 STEPHEN TINGLEY MD 40.00 X 251308 0 56113 JOHN ROSSI PHD 40.00 X 157430 0 25484 PATRICIA WATSON 40.00 X 140293 0 39947 NEAL HOLTER 40.00 X 188309 0 35834 LANCE ROSE 0.00 X 14721 0 1126 3284578 494880 644622 46 1 1 0 ALEXANDER BUILDING CONSTRUCTION LLC 315 VAUGHN STREET HARRISBURG PA 17110 CONSTRUCTION 20637813 PENN STATE MILTON S HERSHEY MEDICAL CEN 210 W HAMILTON AVE 294 STATE COLLEGE PA 16801 CONTRACTED PHYSICIAN SERVICES 7272669 VERONESI BUILDING & R 1111 WEST COLLEGE AVE STATE COLLEGE PA 16801 CONSTRUCTION 1779067 POOLE ANDERSON CONSTRUCTION 2121 GATESBURG ROAD STATE COLLEGE PA 16803 CONSTRUCTION 1295657 HF LENZ CO 1407 SCALP AVENUE JOHNSTOWN PA 15904 CONSTRUCTION 1295657 51 2882879 304683 576 3188138 NET PATIENT SERVICE REV 621110 264166838 264166838 OTHER OPERATING REV 900099 14361983 14361983 278528821 4214800 4214800 394189 832936 -438747 -438747 -438747 142521432 142455059 207350 66373 -207350 -140977 -140977 OUTPATIENT LAB SERVICES 621500 2712755 2712755 CAFETERIA SALES 722210 817142 817142 SNACK BAR REVENUE 722210 266602 266602 228063 42983 185080 4024562 289376597 278528821 2755738 4903900 13850795 13850795 95773424 83630237 12143187 6323136 6323136 15756942 13488841 2268101 6536702 5712174 824528 822674 822674 95663 95663 14541 14541 23755 23755 13424258 9901298 3522960 534223 4566 529657 3973170 280120 3693050 488030 488030 2774712 1122704 1652008 25440 17742 7698 177974 83002 94972 7726545 7726545 13740213 13740213 755019 755019 UBIT TAXES 345000 345000 MEDICAL SUPPLIES 74279980 74279980 LOSS ON REFINANCING 11515213 11515213 BAD DEBT EXPENSE 9347595 9347595 9171478 7683355 1488123 287476482 259822076 27654406 0 3848 3847 25257138 12482677 27893048 28403753 6133968 6460349 1833564 3051376 338154242 151768057 157326541 186386185 117826438 163086729 750288 855196 16115284 13614125 353140117 414344237 92661151 85120354 470147 476134 140320170 183678884 703917 589985 4533149 6347075 238688534 276212432 X 114237472 137917694 35617 35617 178494 178494 114451583 138131805 353140117 414344237 X 1900115 6236906 15543201 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 14541 14541 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: A PORTION OF THE DUES PAID TO THE HOSPITAL & HEALTHSYSTEM ASSOCIATION OF PENNSYLVANIA ($7,549) AND THE AMERICAN HOSPITAL ASSOCIATION ($6,992) WAS DETERMINED TO BE FOR LOBBYING PURPOSES - TOTAL COST $14,541. 615509 97914 7328 720750 305935 306824 2750 615509 279801 3991 22143 305935 275745 4056 279801 281903 1505 -7663 275745 1.00000 0 1 1 9 9 189996473 64663653 125332820 1246316 521053 725263 117507288 83950790 33556498 29404156 2632561 26771595 186386185 DEFERRED COMPENSATION 133104 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 4710419 ACCRUED INTEREST 1503552 6347075 X 309083006 6236906 15543201 21780107 287302899 23755 2049943 2073698 289376597 285402784 -2049943 -2049943 287452727 23755 23755 287476482 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: PERMANENT ENDOWMENT FUNDS ARE HELD BY THE FOUNDATION FOR MOUNT NITTANY MEDICAL CENTER, INC. AND EARNINGS ARE DESIGNATED TO FUND FUTURE EXPENDITURES AND CAPITAL ACQUISITONS FOR MOUNT NITTANY MEDICAL CENTER. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: 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 2013 AND 2012. ALL REQUIRED FEDERAL EXEMPT ORGANIZATION BUSINESS INCOME TAX RETURNS FOR THE ORGANIZATION HAVE BEEN FILED UP TO, AND INCLUDING, THE TAX YEAR ENDED JUNE 30, 2012. THE ORGANIZATION'S FEDERAL INCOME TAX RETURNS ARE NO LONGER SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE ("IRS") FOR THE YEARS ENDED BEFORE JUNE 30, 2010. PART XI, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN INTEREST IN THE FOUNDATION FOR MOUNT NITTANY MEDICAL CENTER, INC. -791,045. PENSION LIABILITY ADJUSTMENT 16,913,353. CHANGE IN FAIR VALUE OF DERVATIVE INSTRUMENTS -579,107. PART XI, LINE 4B - OTHER ADJUSTMENTS: TRANSFERS FROM RELATED ORGANIZATIONS (NETTED ON FINANCIAL STATEMENTS) 2,882,879. RENTAL EXPENSES -832,936. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 832,936. TRANSFERS FROM RELATED ORGANIZATIONS (NETTED ON FINANCIAL STATEMENTS) -2,882,879. 1 1 1 X 250.000000000000 0 1 1 1 0 1 1 1822862 1822862 0.00660 14769694 8975436 5794258 0.02080 16592556 8975436 7617120 0.02740 584832 280 584552 0.00210 321686 44940 276746 0.00100 4673825 2645791 2028034 0.00730 6083 6083 0.00000 284638 284638 0.00100 5871064 2691011 3180053 0.01140 22463620 11666447 10797173 0.03880 3603 3603 0.00000 4173 4173 0.00000 559 559 0.00000 3663 3663 0.00000 279 279 0.00000 12277 12277 1 2978144 43501608 60543847 -17042239 X 1 1 1 ADG HOSPITAL DRIVE ASSOCIATES LEASING REAL PROPERTY FOR MEDICAL OFFICE AND SURGICAL CENTER 0.24260 1 1 MOUNT NITTANY MEDICAL CENTER

1800 EAST PARK AVENUE STATE COLLEGE PA 16803

X X X MOUNT NITTANY MEDICAL CENTER 1 1 X X X X X X X X X 12 1 0 1 X X X X X X X 1 0 1 1 250.000000000000 0 1 X 1 1 X X X X X 1 X 0 X X X X 1 X 0 0 PART I, LINE 3C: A DISCOUNT OF 50% OFF OF CHARGES IS OFFERED TO UNINSURED PATIENTS ON HOSPITAL ACCOUNT BALANCES. THE FOLLOWING ARE EXAMPLES THAT QUALIFY PATIENTS AS UNINSURED: TERMINATED COVERAGE EITHER DUE TO JOB TERMINATION OR UNINSURED PERIODS DURING INSURANCE TRANSITION, EMPLOYED PATIENTS WHO MAY BE IN A "WAITING/GRACE" PERIOD FOR INSURANCE, OR INSURED PATIENTS WHERE COVERAGE HAS EXHAUSTED. PART I, LINE 7: COST TO CHARGE RATIO WAS COMPUTED USING WORKSHEET 2 IN THE IRS INSTRUCTIONS TO FORM 990 FOR LINES 7A, 7B, AND 7G. COST ACCOUNTING SYSTEM WAS USED FOR SUBSIDIZED HEALTH SERVICES. FOR ALL OTHERS, COSTS INCLUDED THE VALUE OF STAFF DONATED HOURS (WITH ESTIMATED BENEFITS), MONETARY CONTRIBUTIONS, ESTIMATED VALUE OF MATERIALS USED IN DELIVERING PROGRAMS, AND ESTIMATED SPACE COSTS. THE INDIRECT COST ALLOCATION APPLIES THE INDIRECT-TO-DIRECT COST RATIO FROM THE MEDICAL CENTER'S MOST RECENT MEDICARE COST REPORT ( AS OF 6/30/2013 APPROX. 31%). PART I, LINE 7, COLUMN (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 $ 9347595. PART II: OUR ENTRIES FOR COALITION BUILDING INCLUDE STAFF TIME FOR PARTICIPATION ON LOCAL COMMUNITY BOARDS OR STEERING COMMITTEES THAT FOCUS ON COMMUNITY HEALTH, FOR EXAMPLE, THE ADMINISTRATIVE DIRECTOR OF THE CANCER PROGRAM SERVES ON THE PA OATIENT NAVIGATOR INTERWORK STEERING COMMITTEE, MNMC'S DIRECTOR OF EDUCATION SERVED ON THE BOARD FOR CENTRE COUNTY PARTNERSHIP FOR COMMUNITY HEALTH, OUR INFECTION CONTROL NURSE SERVES ON THE INFECTION CONTROL COMMITTEE AT HEALTHSOUTH, AND OUR CFO SERVES ON THE BOARD FOR CENTRE VOLUNTEERS IN MEDICINE. THESE ARE JUST A FEW EXAMPLES. PART III, LINE 4: BAD DEBT (AT COST) IS CALCULATED BY APPLYING THE PATIENT CARE COST-TO-CHARGE RATIO FROM WORKSHEET 2 TO THE MEDICAL CENTER'S PROVISION FOR DOUBTFUL COLLECTIONS AS OF JUNE 30, 2013. THE MEDICAL CENTER'S ACCOUNTING DEPARTMENT RECORDS PAYMENTS, WHILE PATIENT ACCOUNTING STAFF MAKES APPROPRIATE ADJUSTMENTS TO PATIENT ACCOUNTS FOR BAD DEBT, DISCOUNTS, OR FREE CARE WRITE-OFFS. THE MEDICAL CENTER IS UNABLE TO ESTIMATE THE AMOUNT OF BAD DEBT THAT COULD BE ATTRIBUTABLE TO PATIENTS WHO LIKELY WOULD QUALIFY FOR FINANCIAL ASSISTANCE UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. PATIENTS DO NOT PROVIDE INCOME INFORMATION PRIOR TO RECEIVING CARE. THE REGISTRATION DEPARTMENT GIVES EVERY PATIENT A COPY OF OUR FINANCIAL ASSISTANCE PROGRAM TO ENSURE EVERY PATIENT HAS THE OPPORTUNITY AS APPROPRIATE TO QUALIFY FOR OUR ASSISTANCE PROGRAM. THE MEDICAL CENTER OFFERS DETAILED INFORMATION ABOUT THE CHARITY CARE PROGRAM WHEN PATIENTS OFFER INFORMATION THAT IS NEEDED TO DETERMINE ELIGIBILITY. SEE RESPONSE TO PART VI, LINE 3 HEREIN. BAD DEBT IS PUBLISHED IN THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS ON THE STATEMENT OF OPERATIONS ON THE LINE ENTITLED, "PROVISION FOR BAD DEBTS."MOUNT NITTANY MEDICAL CENTER PROVIDES SERVICES TO ALL PATIENTS REGARDLESS OF ABILITY TO PAY AS PART OF THE HOSPITAL'S MISSION. A PORTION OF THE MOUNT NITTANY MEDICAL CENTER'S BAD DEBT WOULD RELATE TO PATIENTS THAT COULD QUALIFY FOR CHARITY CARE BUT WERE UNWILLING OR UNABLE TO PROVIDE THE APPROPRIATE DOCUMENTATION TO ALLOW THAT CLASSIFICATION. AS SUCH A PORTION OF THE HOSPITAL'S BAD DEBT SHOULD BE CONSIDERED COMMUNITY BENEFIT. PART III, LINE 8: THE MEDICAL CENTER CONTINUES TO PROVIDE CARE TO ALL PRESENTING AND ADMITTED PATIENTS, REGARDLESS OF ABILITY TO PAY. THROUGH DILIGENT COST CONTROL PROCESSES, THE MEDICAL CENTER SEEKS WAYS TO KEEP COSTS OF PROVIDING CARE TO A MINIMUM, WHILE STILL PROVIDING THE SAFETY MEASURES, TECHNOLOGICAL CAPABILITIES, AND APPROPRIATE STAFFING LEVELS TO ENSURE THE BEST POSSIBLE OUTCOMES. NOTWITHSTANDING THE COSTS TO PROVIDE CARE, RECEIVING "LESS" THAN WHAT IT COSTS TO PROVIDE ADEQUATE CARE TO MEDICARE COVERED LIVES DOES THE MEDICAL CENTER A DISSERVICE. THIS SHORTFALL SHOULD COUNT AS A COMMUNITY BENEFIT AS THE MEDICAL CENTER STRIVES TO PROVIDE THE BEST CARE POSSIBLE TO ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. THE MEDICAL CENTER USES A STEP-DOWN COST ALLOCATION METHOD AND THEN APPLIES A COST-TO-CHARGE RATIO. PART III, LINE 9B: IF PATIENTS ARE FOUND TO QUALIFY, THE MEDICAL CENTER IMMEDIATELY CEASES COLLECTIONS AND ADJUSTS CHARGES OFF AS CHARITY CARE. MOUNT NITTANY MEDICAL CENTER PART V, SECTION B, LINE 3: DURING THE RECENT COMMUNITY NEEDS ASSESSMENT, MNMC PERSONNEL MET WITH COMMUNITY REPERSENTATIVES DURING THE HEALTH SUMMIT, AS WELL AS DURING KEY STAKEHOLDER INTERVIEWS. A TOTAL OF 36 INDIVIDUAL INTERVIEWS WERE CONDUCTED DURING THE FALL AND WINTER OF 2012/13. INTERVIEWEES INCLUDED THE DIRECTORS OF A VARIETY OF MAJOR HEALTH AND HUMAN SERVICE ORGANIZATIONS IN AND AROUND CENTRE COUNTY, HEALTH-RELATED FACULTY AND LEADERS FROM THE PENNSYLVANIA STATE UNIVERSITY, STUDENT HEALTH SERVICES STAFF, PUBLIC SAFETY OFFICIALS, SCHOOL DISTRICT ADMINISTRATORS, PHYSICIANS, AND TRANSPORTATION MANAGERS. MOUNT NITTANY MEDICAL CENTER PART V, SECTION B, LINE 11: A DISCOUNT OF 50% OFF OF CHARGES IS OFFERED TO UNINSURED PATIENTS ON HOSPITAL ACCOUNT BALANCES. THE FOLLOWING ARE EXAMPLES THAT QUALIFY PATIENTS AS UNINSURED: TERMINATED COVERAGE EITHER DUE TO JOB TERMINATION OR UNINSURED PERIODS DURING INSURANCE TRANSITION, EMPLOYED PATIENTS WHO MAY BE IN A "WAITING/GRACE" PERIOD FOR INSURANCE, OR INSURED PATIENTS WHERE COVERAGE HAS EXHAUSTED. MOUNT NITTANY MEDICAL CENTER PART V, SECTION B, LINE 20D: PATIENTS WHOSE FAMILY INCOME IS AT OR BELOW 250% OF THE FEDERAL POVERTY GUIDELINES ARE ELIGIBLE TO RECEIVE A 100% DISCOUNT FOR FREE CHARITY/FREE CARE. PATIENTS WHOSE FAMILY INCOME EXCEEDS 250% OF THE FEDERAL POVERTY GUIDELINES MAY BE ELIGIBLE TO RECEIVE DISCOUNTED RATES ON A CASE-BY-CASE BASIS BASED ON THEIR SPECIFIC CIRCUMSTANCES, SUCH AS CATASTROPHIC ILLNESS OR MEDICAL INDIGENCE, AT THE DISCRETION OF THE MEDICAL CENTER. PART VI, LINE 2: MOUNT NITTANY HEALTH SYSTEM ("MNHS") HAS HISTORICALLY USED INFORMAL COMMUNITY FEEDBACK MECHANISMS SUCH AS PATIENT AND STAFF INTERACTIONS, AS WELL AS MORE FORMAL MEANS SUCH AS CONSULTANT-LED MARKET RESEARCH AND SOLICITING FEEDBACK FROM DONORS, NON-EMPLOYED PHYSICIANS, AND COMMUNITY LEADERS TO UNDERSTAND THE NEEDS OF REGIONAL POPULATIONS. IN ADDITION, MNHS CONTINUES TO HOLD ONGOING AND MEANINGFUL DISCUSSIONS WITH MAJOR COMMUNITY STAKEHOLDERS, INCLUDING, BUT NOT LIMITED TO, THE PENNSYLVANIA STATE UNIVERSITY AND MILTON S. HERSHEY MEDICAL CENTER, TO DEVELOP RESPONSIVE PROGRAMS AND SOLUTIONS TO THE HEALTH CARE NEEDS OF PROMINENT SEGMENTS OF THE LOCAL POPULATION IN CENTRE COUNTY.DURING FISCAL YEAR 2013, MOUNT NITTANY MEDICAL CENTER CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). THE CHNA EFFORT CONSISTED OF THE COLLECTION, ANALYSIS, AND SYNTHESIS OF DATA FROM A WIDE VARIETY OR PRIMARY AND SECONDARY SOURCES IN ORDER TO CHARACTERIZE THE POPULATION AND PRIORITY HEALTH NEEDS OF CENTRE COUNTY AND THE SURROUNDING REGION. MNMC BEGAN ITS COMPREHENSIVE CHNA IN THE SUMMER OF 2012. PRELIMINARY MEETINGS WERE HELD WITH COMMUNITY LEADERS TO EXPLORE THE COMMUNITY'S PERCEPTION OF THE SCOPE OF MOUNT NITTANY MEDICAL CENTER'S EFFORTS, RESOURCES AVAILABLE FOR COLLABORATION, AND LEVEL OF INTEREST IN COMMUNITY-BASED AND COMMUNITY-OWNED SOLUTIONS. THESE DISCUSSIONS LED TO A FIVE PART APPROACH WHEREBY WE CONDUCTED:1. KEY STAKEHOLDER INTERVIEWS - A TOTAL OF 36 INDIVIDUAL INTERVIEWS WERE CONDUCTED DURING THE FALL AND WINTER OF 2012/13. INTERVIEWEES INCLUDED THE DIRECTORS OF A VARIETY OF MAJOR HEALTH AND HUMAN SERVICE ORGANIZATIONS IN AND AROUND CENTRE COUNTY, HEALTH-RELATED FACULTY AND LEADERS FROM THE PENNSYLVANIA STATE UNIVERSITY, STUDENT HEALTH SERVICES STAFF, PUBLIC SAFETY OFFICIALS, SCHOOL DISTRICT ADMINISTRATORS, PHYSICIANS, AND TRANSPORTATION MANAGERS. 2. HEALTH NEEDS SURVEY - AN ONLINE AND PAPER-BASED SURVEY WAS WIDELY DISTRIBUTED TO THE COMMUNITY AND WITHIN MOUNT NITTANY MEDICAL CENTER'S FACILITIES. BY THE END OF MARCH 2013, 1,133 COMPLETED SURVEYS WERE RECEIVED. RESULTS ARE INCLUDED IN THIS REPORT. 3. INTERNAL ADVISORY TEAM - BEGINNING IN LATE FALL 2012, AN INTERNAL TEAM OF EXPERIENCED MOUNT NITTANY MEDICAL CENTER CLINICAL AND CASE MANAGEMENT STAFF MET FOR A SERIES OF DISCUSSIONS TO DOCUMENT HEALTH NEEDS AS UNDERSTOOD BY THE PROVIDER COMMUNITY. 4. SECONDARY DATA - MOUNT NITTANY MEDICAL CENTER PARTNERED WITH THE PENNSYLVANIA STATE UNIVERSITY FACULTY AND STUDENTS IN THE DEPARTMENT OF HEALTH POLICY AND ADMINISTRATION TO IDENTIFY, REVIEW, AND SYNTHESIZE SECONDARY DATA ABOUT THE HEALTH OF CENTRAL PENNSYLVANIANS. 5. HEALTH NEEDS SUMMIT - MOUNT NITTANY MEDICAL CENTER IDENTIFIED CENTRE COUNTY'S SOLE STATE HEALTH IMPROVEMENT PLAN (SHIP) PARTNERSHIP AS A LOGICAL COLLABORATOR TO HELP BRING COMMUNITY LEADERS TOGETHER TO ENSURE COMPREHENSIVE INPUT INTO LOCAL AND REGIONAL POCKETS OF NEED. THE SHIP PARTNERSHIP, CENTRE COUNTY PARTNERSHIP FOR COMMUNITY HEALTH (CCPCH), HOSTED THIS EVENT ON FEBRUARY 25, 2013. THIS SUMMIT WAS THE FIRST IN A SERIES OF ONGOING MEETINGS ORGANIZED AND HOSTED BY CCPCH WITH SUPPORT FROM MOUNT NITTANY MEDICAL CENTER. THESE ONGOING EVENTS PROVIDE INCLUSIVE FORUMS TO MONITOR NEEDS, ADJUST IMPLEMENTATION TACTICS, AND CONDUCT ONGOING NEEDS ASSESSMENTS MORE EFFICIENTLY OVER TIME.SEE ALSO SCHEDULE H PART V. PART VI, LINE 3: MOUNT NITTANY MEDICAL CENTER IS DEDICATED TO IMPROVING THE HEALTH AND WELL-BEING OF ALL ITS CONSTITUENTS. AS MENTIONED PREVIOUSLY, MNMC CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT DURING FISCAL YEAR 2013. THIS ASSESSMENT RESULTED IN SIX MAJOR COMMUNITY HEALTH NEEDS AND GAPS WHICH INCLUDE ACCESS TO CARE, HEALTHY AGING, MENTAL HEALTH, OBESITY/DIABETES, ORAL HEALTH AND SUBSTANCE ABUSE. REFER TO THE CHNA FOR ANALYSIS AND RESPONSE TO THESE AREAS. THROUGH THE FINANCIAL ASSISTANCE PROGRAM, MOUNT NITTANY MEDICAL CENTER PROVIDES MEDICAL CARE REGARDLESS OF A PATIENT'S ABILITY TO PAY, INSUFFICIENT HEALTH INSURANCE OR WHETHER A GOVERNMENT-SPONSORED PROGRAM COVERS THE FULL COST OF SERVICES. AND AS THE COUNTRY'S ECONOMIC FUTURE REMAINS UNCERTAIN, MOUNT NITTANY MEDICAL CENTER WILL CONTINUE TO PROVIDE CARE FOR THOSE WHO NEED IT. MOUNT NITTANY MEDICAL CENTER WILL PROVIDE SERVICES AT NO CHARGE OR REDUCED CHARGES TO THOSE WHO ARE FINANCIALLY UNABLE TO PAY FOR THOSE SERVICES. MOUNT NITTANY MEDICAL CENTER WILL NOT ARBITRARILY RESTRICT THE PROVISIONS OF HEALTH SERVICES TO CERTAIN INDIVIDUALS OR GROUPS.MOUNT NITTANY MEDICAL CENTER'S REGISTRATION DEPARTMENT REPRESENTATIVES WILL GIVE A COPY OF OUR FINANCIAL ASSISTANCE PROGRAM TO EVERY PATIENT ALONG WITH OTHER IMPORTANT BILLING INFORMATION. OUR FINANCIAL COUNSELOR WILL DISCUSS THE AVAILABILITY OF VARIOUS GOVERNMENT BENEFITS SUCH AS MEDICAID OR STATE PROGRAMS TO ASSIST THE PATIENT WITH QUALIFICATIONS FOR THESE PROGRAMS. THE FINANCIAL COUNSELOR WILL ALSO ASSIST THE PATIENT IN COMPLETING THE PROPER PAPERWORK FOR ASSISTANCE. IN ADDITION, OUR VENDOR DEBIASE & LEVINE REPRESENTATIVE, WHO IS WORKING ON BEHALF OF MOUNT NITTANY MEDICAL CENTER, WILL ALSO ASSIST PATIENTS WITH THE MEDICAL ASSISTANCE PROCESS. OUR THIRD PARTY VENDOR WORKS ON BEHALF OF THE ORGANIZATION TO FOLLOW THE HOSPITAL'S POLICIES REGARDING PATIENT NOTIFICATION AND THE AVAILABILITY OF FINANCIAL ASSISTANCE. MOUNT NITTANY MEDICAL CENTER'S FINANCIAL ASSISTANCE POLICY IS POSTED ON OUR WEBSITE ALONG WITH AN APPLICATION FOR PATIENTS TO COMPLETE FOR FINANCIAL ASSISTANCE. THE FINANCIAL COUNSELORS AND CASE MANAGEMENT STAFF WILL ALSO WORK CLOSELY TO IDENTIFY AND ASSIST ELIGIBLE PATIENTS.MOUNT NITTANY MEDICAL CENTER WILL MAKE AVAILABLE A WRITTEN NOTICE TO EACH PATIENT OR THEIR REPRESENTATIVE OF THE EXISTENCE, CRITERIA AND MECHANISM FOR RECEIVING FINANCIAL ASSISTANCE. THE HOSPITAL WILL CREATE AND MAINTAIN RECORDS AND DOCUMENT THAT AN APPLICATION WAS SENT TO THE PATIENT DEMONSTRATING THAT THE REQUIRED CRITERIA AND MECHANISM ARE ESTABLISHED (MOUNT NITTANY MEDICAL CENTER WILL RECORD ANY AND ALL REQUESTS FOR FINANCIAL ASSISTANCE, THE DISPOSITION AND THE DOLLAR AMOUNT OF MOUNT NITTANY MEDICAL CENTER'S FINANCIAL ASSISTANCE PROGRAM PROVIDED). THE COMPLETED APPLICATIONS ARE GIVEN TO THE PATIENT ACCOUNTS DEPARTMENT SHOWING WHETHER THE APPLICATION WAS APPROVED OR DENIED. IN ALL INSTANCES, PATIENT CONFIDENTIALITY WILL BE PROTECTED.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.A NOTICE OF AVAILABILITY OF MOUNT NITTANY MEDICAL CENTER'S FINANCIAL ASSISTANCE PROGRAM WILL BE GIVEN TO EACH PATIENT OR THEIR REPRESENTATIVE PRIOR TO SERVICES BEING RENDERED, WITH THE EXCEPTION OF EMERGENCY SERVICES WHEREBY THE PATIENT IS TRIAGED PRIOR TO COMPLETING THE REGISTRATION PROCESS. THESE PATIENTS WOULD RECEIVE THE NOTICE REGARDING THE FINANCIAL ASSISTANCE PROGRAM AT SOME POINT DURING THAT VISIT. THESE NOTICES ARE DISPLAYED AND MADE AVAILABLE IN ALL REGISTRATION AREAS OF THE HOSPITAL AND INCLUDES THE MOST CURRENT AVAILABLE "HOUSEHOLD INCOME GUIDELINES" AS PUBLISHED IN THE FEDERAL REGISTER. MOUNT NITTANY MEDICAL CENTER'S CURRENT FINANCIAL ASSISTANCE PROGRAM ELIGIBILITY IS BASED ON 2.5 TIMES THE "HOUSEHOLD INCOME GUIDELINES".THE PATIENT ACCOUNTS DIRECTOR OR HIS/HER DESIGNEE SHALL REVIEW ALL APPLICATIONS FOR THE MOUNT NITTANY MEDICAL CENTER FINANCIAL ASSISTANCE PROGRAM. IT IS THE APPLICANT'S RESPONSIBILITY TO PROVIDE PROOF OF INCOME. PART VI, LINE 4: THE MEDICAL CENTER'S PRIMARY SERVICE AREA INCLUDES CENTRE COUNTY AND PARTS OF THE SURROUNDING COUNTIES. CENTRE COUNTY'S POPULATION IS APPROXIMATELY 155,000. APPROXIMATELY 16% OF THE POPULATION IS AGED 0-14, 72% AGED 15-64, AND 12% IS 65 OR OLDER. THE ESTIMATE FOR THE POPULATION LIVING BELOW THE POVERTY LINE IS 19%. THE MEDIAN AGE IN CENTRE COUNTY IS 26.6 (39.9 FOR ALL OF PA). 40% OF THOSE AGED 25 OR OLDER HAVE AT LEAST A BACHELOR'S DEGREE VS. 26.4% FOR ALL OF PA. THE MEDIAN HOUSEHOLD INCOME IS $48,262, WHILE THE PA MEDIAN IS $51,651. 40,000+ COLLEGE STUDENTS LIVE IN STATE COLLEGE. MOUNT NITTANY MEDICAL CENTER IS THE SOLE GENERAL ACUTE CARE HOSPITAL IN CENTRE COUNTY. THE NEAREST LEVEL II TRAUMA CENTER IS APPROX. 43 MILES AWAY. PART OF CENTRE COUNTY IS A DESIGNATED MEDICALLY UNDERSERVED AREA. PART VI, LINE 5: THE MEDICAL CENTER'S BOARD OF TRUSTEES AND ITS VARIOUS COMMITTEES INCLUDE COMMUNITY MEMBERS AS WELL AS MEDICAL STAFF. THE COMMUNITY MEMBERS ARE NOT DIRECTLY INVOLVED IN THE MEDICAL CENTER'S OPERATIONS. THE MEDICAL CENTER'S MEDICAL STAFF EXCEEDS 300 PHYSICIANS. THE MEDICAL CENTER CONTINUES TO INVEST IN STRONG AND BENEFICIAL RELATIONSHIPS WITH ALL PHYSICIANS WHO HAVE AN INTEREST IN WORKING WITH THE MEDICAL CENTER. ALL REVENUES IN EXCESS OF EXPENSES ARE RE-INVESTED IN THE COMMUNITY, INCLUDING SIGNIFICANT DONATIONS TO THE COUNTY'S ONLY FREE MEDICAL AND DENTAL CLINIC, AS WELL AS INTERNAL IMPROVEMENTS TO TECHNOLOGY SO THAT THE PEOPLE AND COMMUNITIES WE SERVE HAVE IMMEDIATE ACCESS TO THE BEST AND MOST APPROPRIATE DIAGNOSTIC AND TREATMENT OPTIONS AVAILABLE. PART VI, LINE 6: AS OF JUNE 30, 2013, MOUNT NITTANY HEALTH SYSTEMS HAS TWO CONTROLLED CORPORATIONS, WHICH ARE THE MOUNT NITTANY MEDICAL CENTER (INPATIENT AND OUTPATIENT SERVICES) AND MOUNT NITTANY MEDICAL CENTER HEALTH SERVICES, INC. (A PHYSICIAN PRACTICE D/B/A MOUNT NITTANY PHYSICAN GROUP). THE FOUNDATION FOR MOUNT NITTANY MEDICAL CENTER, INC. (FUNDRAISING) AND THE MOUNT NITTANY SURGICAL CENTER, INC. (OUTPATIENT SURGICAL CENTER) ARE CONTROLLED BY MOUNT NITTANY MEDICAL CENTER.COMMUNITY BENEFIT SERVICES OFFERED BY MOUNT NITTANY MEDICAL CENTER ARE AFFORDED TO THE BROAD COMMUNITY WITH THE INTENT OF IMPROVING COMMUNITY HEALTH. PROGRAMS AND SERVICES ARE DESIGNED TO RESPOND TO IDENTIFIED COMMUNITY NEEDS. COMMUNITY BENEFIT ACTIVITIES FALL INTO THESE MAJOR CATEGORIES: COMMUNITY HEALTH IMPROVEMENT SERVICES - INCLUDES ACTIVITIES THAT ARE CARRIED OUT TO IMPROVE COMMUNITY HEALTH. MOUNT NITTANY MEDICAL CENTER PROVIDES COMMUNITY HEALTH EDUCATION, HEALTH SCREENINGS, SUPPORT GROUPS, AND TRANSPORTATION ASSISTANCE. THIS PAST YEAR OFFERED NUMEROUS SCREENINGS AND EDUCATION EVENTS FOR MEMBERS OF OUR COMMUNITY. HEALTH PROFESSIONS EDUCATION - MOUNT NITTANY MEDICAL CENTER IS ADVANCING HEALTHCARE BY ADVANCING ACCESS TO EDUCATION AND TRAINING. IN 2013, MOUNT NITTANY AWARDED CONTINUING EDUCATION CREDITS FOR NURSES AND PHYSICIANS, AS WELL AS TRAININGS IN THE AMERICAN HEART ASSOCIATION TRAINING CENTER. CASH AND IN-KIND DONATIONS - MOUNT NITTANY MEDICAL CENTER REPORTED ITS SUPPORT OF MORE THAN FORTY LOCAL ORGANIZATIONS THROUGH IN-KIND AND CASH DONATIONS. THE LEAD BENEFICIARY OF MOUNT NITTANY'S SUPPORT IS CENTRE VOLUNTEERS IN MEDICINE. OTHER NON-PROFIT GROUPS INCLUDE AMERICAN HEART ASSOCIATION, PEOPLE CENTRE'D ON DIABETES, YMCA OF CENTRE COUNTY, AND MORE. COMMUNITY-BUILDING ACTIVITIES - MOUNT NITTANY IS A LEAD FACILITATOR IN LOCAL AND REGIONAL PREPAREDNESS ACTIVITIES, ENSURING THAT CENTRE COUNTY IS PREPARED SHOULD A DISASTER STRIKE. IN ADDITION, MOUNT NITTANY PROVIDES ACCESS TO CARE IN RURAL AREAS TO ENSURE THAT EVERY COMMUNITY HAS ACCESS TO CARE, SUCH AS PROVIDING DIABETES EDUCATION AT RURAL DOCTORS' OFFICES. SUBSIDIZED HEALTH SERVICES - MOUNT NITTANY MEDICAL CENTER PROVIDES THE COMMUNITY MENTAL HEALTH SERVICES AT ITS INPATIENT UNIT, ONCOLOGY PATIENT NAVIGATOR PROGRAM, TRANSPORTATION SERVICES FOR PATIENTS WITH CANCER, PEDIATRIC MEDICAL HOME PROGRAM FOR AT-RISK CHILDREN AND SEVERAL FREE SUPPORT GROUPS.THE MOUNT NITTANY PHYSICIAN GROUP OFFERS A COMMUNITY BENEFIT BY SEEING CENTRE VOLUNTEERS IN MEDICINE (CVIM) PATIENTS FOR SPECIALTY SERVICES AT NO COST TO THE PATIENT OR TO CVIM. THIS GROUP ALSO PROVIDES VARIOUS INTERNSHIPS, PRESENTATIONS AND NEWSLETTERS TO THE COMMUNITY INCLUDING TOPICS LIKE HEART HEALTH AND PEDIATRICS. REPORTS FILED WITH STATES PART VI, LINE 7 PA 1 MOUNT NITTANY MEDICAL CENTER HEALTH SERVICES INC 1800 EAST PARK AVENUE STATE COLLEGE PA 16803 510426500 501(C)(3) 13850795 0 CASH N/A PROVIDE FINANCIAL SUPPORT TO AFFILIATE 1 0 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: ASSISTANCE IS PROVIDED TO RELATED ENTITIES FOR FINANCIAL SUPPORT. MANAGEMENT OF THE ORGANIZATION OVERSEES THE USE OF FUNDS AT THE AFFILIATED ENTITIES. X X X X X 1 1 0 0 0 1 1 0 0 STEVEN E BROWN 477851 0 125000 0 0 0 19625 0 38575 0 661051 0 0 0 JONATHON DRANOV MD 0 494880 0 0 0 0 0 25301 0 29823 0 550004 0 0 RICHARD WISNIEWSKI 274143 0 52561 0 0 0 19625 0 33605 0 379934 0 0 0 JEFFREY RATNER MD 313859 0 23228 0 0 0 19625 0 39065 0 395777 0 0 0 WAYNE THOMPSON 226366 0 33668 0 0 0 19625 0 30608 0 310267 0 0 0 HAROLD BRUNGARD III 138731 0 17670 0 0 0 13654 0 12220 0 182275 0 0 0 JANET SCHACHTNER 226072 0 47811 0 0 0 19625 0 31345 0 324853 0 0 0 GERALD DITTMANN 159944 0 17761 0 0 0 15754 0 33813 0 227272 0 0 0 GAIL MILLER 134592 0 26624 0 0 0 13234 0 27956 0 202406 0 0 0 THOMAS STOESSEL 160799 0 31376 0 0 0 16022 0 27018 0 235215 0 0 0 STEPHEN TINGLEY MD 251308 0 0 0 0 0 19625 0 36488 0 307421 0 0 0 JOHN ROSSI PHD 157430 0 0 0 0 0 15428 0 10056 0 182914 0 0 0 PATRICIA WATSON 123749 0 16544 0 0 0 12424 0 27523 0 180240 0 0 0 NEAL HOLTER 188309 0 0 0 0 0 18573 0 17261 0 224143 0 0 0 LANCE ROSE 14721 0 0 0 0 0 0 0 1126 0 15847 0 0 0 PART I, LINES 4A-B KENNETH BIXEL RECEIVED SEVERANCE PAYMENTS. LANCE ROSE RECEIVED NONQUALIFIED PLAN PAYMENTS. PART I, LINE 6 THE EXECUTIVE TEAM MEMBERS OF MOUNT NITTANY MEDICAL CENTER RECEIVED A PORTION OF THEIR ANNUAL VARIABLE-PAY BASED UPON THE CONSOLIDATED OPERATING MARGIN, MOUNT NITTANY MEDICAL CENTER HEALTH SERVICES (D/B/A MOUNT NITTANY PHYSICIAN GROUP) OPERATING MARGIN, AND CONSOLIDATED NET EARNINGS OF MOUNT NITTANY HEALTH AND OTHER CORPORATE GOALS. THE CORPORATE GOALS FOCUSED ON FINANCE, QUALITY, PATIENT SAFETY, STRATEGY, AND GROWTH. A CENTRE COUNTY HOSPITAL AUTHORITY 203197497 156273CU6 2011-05-05 70552972 FUND EMERG. DEPT. EXPANSION & OTHER CAPITAL EXPENDITURES 0 1 0 B CENTRE COUNTY HOSPITAL AUTHORITY 203197497 156273ED2 2012-10-15 69404972 REFUNDING OF THE SERIES 2009 BONDS & PAY ISSUANCE COSTS 0 1 0 C CENTRE COUNTY HOSPITAL AUTHORITY 203197497 156273DK7 2012-10-15 44591375 FUND PERIOPERATIVE EXPANSION & OTHER CAPITAL EXPENDITURES 0 1 0 A 690000 70552972 1033856 69519116 2013 0 0 1 1 B 69404972 19 811090 68593863 2013 0 1 0 1 C 44591375 3000747 534964 18058146 22997518 2014 0 0 0 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 C 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 1 0 0 0 0 0 0 1 B 0 1 0 0 0 0 0 0 1 C 0 1 0 0 0 0 0 0 1 A 1 B 1 C 1 SCHEDULE K, PART III, LINE 3: THERE ARE NO MANAGEMENT OR SERVICE CONTRACTS OR RESEARCH AGREEMENTS RELATING TO THE FINANCED PROPERTIES FOR THE 2011 OR 2012 BONDS. EDWARD BELL FAMILY MEMBER OF A BOARD TRUSTEE, KAREN SHUTE 126729 SALARY COMPENSATION AS A MNMC EMPLOYEE. 0 APRIL HARRIS FAMILY MEMBER OF A BOARD TRUSTEE, THOMAS HARRIS 26676 SALARY COMPENSATION 0 BLUE COURSE MEDICAL REALITY PAUL SHUEY, DO (BOARD TRUSTEE) HAS OWNERSHIP INTEREST IN BLUE COURSE 112067 RENTAL INCOME TO COMPANY 0 FORM 990, PART VI, SECTION B, LINE 11 THE 990 WAS PROVIDED TO THE BOARD OF TRUSTEES AND TO THE MOUNT NITTANY HEALTH SYSTEM AUDIT COMMITTEE BEFORE BEING FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY, THE CONFLICT OF INTEREST POLICY IS DISTIBUTED TO KEY MEMBERS OF THE ORGANIZATION INCLUDING BOARD MEMBERS, OFFICERS, AND KEY EMPLOYEES. EACH PERSON MUST REPORT ANY POTENTIAL CONFLICT OF INTERESTS, WHICH IS THEN REVIEWED BY THE CORPORATE COMPLIANCE OFFICER AND THEN REPORTED AND REVIEWED BY THE HEALTH SYSTEM'S AUDIT COMMITTEE. FORM 990, PART VI, SECTION B, LINE 15 EXECUTIVE COMPENSATION COMMITTEE FROM BOARD OF TRUSTEES REVIEWS COMPENSATION PAID TO EXECUTIVE MANAGEMENT TEAM IN CONJUNCTION WITH AN INDEPENDENT THIRD PARTY CONSULTING FIRM TO ENSURE COMPENSATION IS REASONABLE AND APPROPRIATE FOR DUTIES AND RESPONSIBILITES ASSIGNED. REVIEW AND APPROVAL OF COMPENSATION IS DOCUMENTED VIA MINUTES OF COMMITTEE MEETINGS. 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: CHANGE IN INTEREST IN THE FOUNDATION FOR MOUNT NITTANY MEDICAL CENTER, INC. -791,045. PENSION LIABILITY ADJUSTMENT 16,913,353. CHANGE IN FAIR VALUE OF DERIVATIVE -579,107. THE FOUNDATION FOR MOUNT NITTANY MEDICAL CENTER INC 1800 EAST PARK AVENUE STATE COLLEGE PA 168036796 571138956 FUNDRAISING AND SUPPORT FOR MOUNT NITTANY MEDICAL CENTER PA 501(C)(3) 11A MOUNT NITTANY MEDICAL CENTER 1 MOUNT NITTANY MEDICAL CENTER WORKMEN'S COMPENSATION SELF INSURANCE TRUST 1800 EAST PARK AVENUE STATE COLLEGE PA 168036796 256440788 PROVIDE WORKMEN'S COMPENSATION BENEFITS TO EMPLOYEES OF MNMC PA 501(C)(3) 11A MOUNT NITTANY MEDICAL CENTER 1 MOUNT NITTANY MEDICAL CENTER HEALTH SERVICES INC 1800 EAST PARK AVENUE STATE COLLEGE PA 168036796 510426500 PROFESSIONAL SERVICES TO SUPPORT MNMC PA 501(C)(3) 11A MOUNT NITTANY HEALTH SYSTEM 0 MOUNT NITTANY SURGICAL CENTER INC 1850 EAST PARK AVENUE STATE COLLEGE PA 168036796 251712099 HEALTHCARE PA 501(C)(3) 11A MOUNT NITTANY MEDICAL CENTER 1 MOUNT NITTANY HEALTH SYSTEM 1800 EAST PARK AVENUE STATE COLLEGE PA 168036796 800663092 PROVIDE MANAGEMENT AND ADMINISTRATIVE SUPPORT TO MNMC & SUBSIDIARIES PA 501(C)(3) 11A N/A 0 0 1 1 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 1 FOUNDATION FOR MOUNT NITTANY MEDICAL CENTER C 2795379 CASH FOUNDATION FOR MOUNT NITTANY MEDICAL CENTER O 380582 COST OF SHARING PAID EMPLOYEES MOUNT NITTANY SURGICAL CENTER O 505799 COST OF SHARING PAID EMPLOYEES MOUNT NITTANY SURGICAL CENTER L 497922 COST OF SERVICES PERFORMED