2014-05-14T14:15:28-05:00 2013-06-30 990 2012-07-01 251737079 Canonsburg General Hospital % MATTHEW PETERSON CANO 4125446668 C/O Tax Dept 120 Fifth Ave Suit Suite Pittsburgh PA 15222 Elizabeth Allen 4125446668 2014-05-09 2012 2016-02-25 16:41:14Z X Matthew Peterson 30 Isabella Street Pittsburgh PA 15212 53771361 false X www.wpahs.org X 1994 PA See Form 990, Page 2, Part III, Line 1 11 10 549 165 156396 -75651 108639 79385 47651284 49886120 -3944 1555 1575044 3748060 49331023 53715120 950 10464 0 0 23268857 25711457 0 0 101386 30346263 32590536 53616070 58312457 -4285047 -4597337 27946630 38492381 52826694 81207779 -24880064 -42715398 X Canonsburg General Hospital is a team of care givers committed to improving health and promoting wellness in our communities, one person at a time. We pledge to consistently deliver safe, compassionate quality healthcare by treating the whole person - body, mind and spirit. false false 16299834 15611433 Canonsburg General Hospital is a team of care givers committed to improving health and promoting wellness in our communities, one person at a time. We pledge to consistently deliver safe, compassionate quality healthcare by treating the whole person - body, mind and spirit. To complete this mission, Canonsburg General Hospital provides Medical services to all patients regardless of their ability to pay. 6677123 7046812 Canonsburg General Hospital is a team of care givers committed to improving health and promoting wellness in our communities, one person at a time. We pledge to consistently deliver safe, compassionate quality healthcare by treating the whole person - body, mind and spirit. To complete this mission, Canonsburg General Hospital provides Orthepedic services to all patients regardless of their ability to pay. 4742930 4718895 Canonsburg General Hospital is a team of care givers committed to improving health and promoting wellness in our communities, one person at a time. We pledge to consistently deliver safe, compassionate quality healthcare by treating the whole person - body, mind and spirit. To complete this mission, Canonsburg General Hospital provides Cardiovascular services to all patients regardless of their ability to pay. 25291112 10464 25779694 Other Medical Services Provided To Patients 25291112 10464 25779694 53010999 true true false false false false false false false true true false false false true true false true false false false false false false true true true true true false true true false false false false false false false false false false false false false false false true true true false false true 70 1 true 549 true true true false false false false true true false false false false X 11 10 false true true false false true true true true false false true true true true true true true true false PA X X MATTHEW PETERSON 4123306090 30 ISABELLA STREET Pittsburgh PA 15212 X Joseph Macerelli 1.0 X X William Burt 1.0 X Carol Pankas 1.0 X William Thomeier MD 1.0 X Charles LaBelle 1.0 X Michael Alterio 1.0 X David Celko MD 1.0 X David Burkey MD 1.0 X Joseph Cerenzia 1.0 X John Isherwood 1.0 X Theodore Neighbors 1.0 X Vincent Trapanotto DO 1.0 X Terry Wiltrout 1.0 39.0 X X 0 186183 0 Kimberly Sperring 1.0 39.0 X 0 195221 0 Jeffrey Gretz MD 1.0 39.0 X 0 316781 0 Deborah Olszewski 1.0 39.0 X 0 181014 0 Matthew Peterson 1.0 39.0 X 0 281808 0 Robert Brandfass 1.0 39.0 X 0 478242 0 Judy Zedreck 1.0 39.0 X 0 415075 0 Michael Sirott 1.0 39.0 X 0 193042 0 Teresa Gordon 40.0 X 208804 0 0 Denise Westwood 40.0 X 129516 Laurie Molinda MD 40.0 X 144354 Cathleen Allinder 40.0 X 151037 0 0 Barbara Gorby 40.0 X 167594 0 0 Christopher Olivia MD X 0 1261143 0 Diane Dismukes X 0 833367 0 Roy Santarella X 0 703046 0 David Kiehn X 0 619128 0 Eugene Trout 40.0 0.0 X 0 116708 0 801305 5780758 0 9 true true false Allegheny Chesapeake Physical The 3053 New Germany Road EBENSBURG PA 15931 Physical Therapy 1150856 Triangle Urological Group 1307 Federal St STE 300 PITTSBURGH PA 15212 Medical Prof Svcs 214152 Aramark Corp 24863 Network Pl CHICAGO IL 60673 Mgmt Services 106733 Clean Care 51st and AV R R PITTSBURGH PA 15201 Linen Services 220919 4 X 28724 10601 40060 79385 PATIENT SERVICE REVENUE 621500 49886120 49755482 130638 49886120 -725 -725 0 0 302104 302104 0 302104 16331 285773 2280 2280 2280 2280 48746 28724 27587 21159 21159 42672 28654 14018 14018 0 GRANT REVENUE 621110 465817 465817 SCHOOL DISTRICT NURSING SERVICES 621110 310515 310515 HIGHMARK QUALITY AWARD 621110 291000 291000 2343447 2334020 9427 3410779 53715120 53156834 156396 322505 10464 10464 0 0 0 0 0 21076574 18916226 2107657 52691 1364857 1228371 136486 1936472 1737984 193647 4841 1333554 1196865 133355 3334 357474 357474 0 0 0 0 79 79 2907404 2410238 494259 2907 5861 2861 3000 193896 174312 19390 194 0 0 1239068 1115161 123907 12717 11439 1272 6 0 5160 4644 516 1325394 1192855 132539 7136994 6423295 713699 3038464 2734618 303846 1171539 1054385 117154 PATIENT CARE COSTS 6439864 6439864 BAD DEBT 4227222 4227222 REPAIR AND MAINTENANCE 2155420 1939878 215542 PA ACT 49 - QUALITY CARE 770448 770448 1603532 1419869 149250 34413 58312457 53010999 5200072 101386 X 935 1292 5119356 3087918 168064 95145 4931181 5991968 0 0 0 0 0 0 819464 1245210 773924 427089 27398434 457955 15869489 26940479 208018 332773 13848 49468 0 0 0 0 42351 321039 27946630 38492381 3738262 3902611 0 0 3117042 2869907 26142473 25709643 0 0 0 0 0 0 0 0 19828917 48725618 52826694 81207779 X -25247734 -43137811 288498 343763 79172 78650 -24880064 -42715398 27946630 38492381 X -4597337 1097 -13239094 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 367670 134638 2781 82597 79 422413 364235 121900 936 119274 127 367670 776418 278567 12775 703464 61 364235 469207 460881 10255 163880 45 776418 290085 183331 -1398 2624 187 469207 0.19000 0.81000 true false 1730000 1730000 16777180 145482 16631698 42000 700 41300 8351380 168225 8183155 497875 143549 354326 26940479 0 ACCRUED PENSION COST 7684249 INSURANCE LIABILITIES 1000453 DUE TO AFFILIATED ORGANIZATION 40040916 48725618 X CGH Inclusion In The Consolidated Audit of WPAHS Form 990, Schedule D, Part X, Question 2, Part XIII Canonsburg General Hospital does not receive its own independent audit. It is a member of a regional healthcare system named West Penn Allegheny Health System. West Penn Allegheny Health System receives a consolidated audit that includes the operations of Canonsburg General Hospital. The following analysis represents the reconciliation between the Canonsburg General Hospital financial statement net income and the net income as reported on Form 990, Page 1, line 19: Net loss per financial statements $(4,654,075) Plus: Income and expense reclassified from restricted net assets on the financial statements to unrestricted income and expense on Form 990 56,738 ___________ Net loss per Form 990 $(4,597,337) The following is the footnote to the audited consolidated financial statements of the West Penn Allegheny Health System for FASB ASC 740: WPAHS adopted Financial Accounting Standards Board (FASB) Accounting Standards Codification (ASC) 740, Income Taxes, which clarifies the accounting for uncertainty in income taxes recognized in an enterprise's financial statements. FASB ASC 740 prescribes a more-likely than-not recognition threshold and measurement attribute for the financial statement recognition and measurement of a tax position taken or expected to be taken. Under FASB ASC 740, tax positions will be evaluated for recognition, derecognition, and measurement using consistent criteria and will provide more information about the uncertainty in income tax assets and liabilities. Based on an analysis prepared by WPAHS, it was determined that the application of FASB ASC 740 had no material effect on the recorded assets and liabilities of WPAHS. Intended Use of the Organization Endowment Fund Schedule D, Page 2, Part V, Line 4 The intended use of the Canonsburg General Hospital permanent and term endowments are for, but not exclusive to: capital improvements, research, education, departmental needs, operating efficiencies, and overall patient care. The earnings off of the permanent amount are expendable, based on the specific use of the fund. Golf Tournament 77470 28724 48746 26192 325 1070 0 77470 28724 48746 26192 325 1070 27587 21159 42672 12404 1420 14830 true 0.90000 42672 12404 1420 14830 28654 14018 PA true false false false 1.00000 Rebecca Bibble 100 Medical Boulevard Canonsburg PA 15317 false Rebecca Bibble 81408 oversight of gaming activity X false true true true X true X true true false true true 172194 172194 0.00320 3631934 1826223 1805711 0.03340 3804128 1826223 1977905 0.03660 151806 151806 0.00280 105453 105453 0.00190 289239 194105 95134 0.00180 47605 47605 0.00090 594103 194105 399998 0.00740 4398231 2020328 2377903 0.04400 73353 73353 0.00140 73353 73353 0.00140 true 1333689 320885 7234853 11344790 -4109937 X true true 1 1 Canonsburg General Hospital

100 NMedical Boulevard Canonsburg PA 15317

X X X Canonsburg General Hospital true X X X X X X X X 12 true true true X X X X X X X false false true true 200. true 400. true X X X X X X true true X X X X true false X X X X true X X false true 3 Peters Township Outpatient Care Center

160 Gallery Drive McMurray PA 15317

Outpatient Care Center Canonsburg Community Health Care

36 East Pike Street Canonsburg PA 15317

Community Health Care CGH - Physician Offices

Southpoint Plaza 1 Ste 235 Canonsburg PA 15317

Physician Offices Bad Debt Expense Financial Statement Footnote and Costing Methodology Schedule H, Part III, Question 4 Canonsburg General Hospital does not issue a separate audited financial statement and therefore a footnote does not exist. Bad debt is accounted for on a charge basis in our internal financial statements. A cost to charge ratio is applied to the internal figures to convert the charge to cost. It is the opinion of Canonsburg General Hospital management that because patients are often reluctant to complete the required charity care paperwork that an significant amount of charity care results in bad debt. Thus, it is our opinion that bad debt expense should be considered a justifiable component of charity care. Medicare Costing Methodology Schedule H, Part III, Question 8 Canonsburg General Hospital receives overall reimbursement from Medicare less than the cost of the services provided. As such, we consider the shortfall a community benefit. The source used to determine the amount reported on line 6 is the medicare cost report. Collection Practices For Patients Who Qualify For Financial Assistance Schedule H, Part III, Question 9b Patients that qualify for charity care or financial assistance are provided with an approval letter with the effective dates for the assistance. At any time the individual presents for services within a 90 day span of approval, they show the letter and will be registered as a charity care case. Charity care cases are designated in the internal computerized systems with unique plan codes that prevent billing to the patient. Reports are run to capture the patient accounts registered with the charity care plan codes so they can be written off to charity care. Charges For Medical Care Schedule H, Part V, Line 19 Canonsburg General Hospital offers uninsured patients a fifty percent (50%) discount on total gross charges to all hospital charges. The intent of the discount is to standardize charging practices for covered and non covered patients. The discount is offered during patient contact for elective/ urgent (non cosmetic) procedures during the financial counseling process, as well as during the patient statement cycle process for services provided (including Emergency services.) Patient statements are clearly marked with the uninsured discount, reducing the 'amount owed' of the gross charges. An uninsured discount of 50% is applied to the patient account either at the time of payment or prior to transferring the account to bad debt upon conclusion of the routine four statement cycle, for any unpaid balances. Charges Equal to Gross Charges for Patient Services Schedule H, Part V, Line 20 The hospital offers a variety of procedures. For elective/non medically emergent procedures not covered by health plans, individual fee schedules are published and communicated prior to services. Patients are contacted in advance of the procedure by financial counselors and are required to pay for services in full based on the fee schedule. The patient is required to pay the hospital fee schedule for the technical component and the physician for the professional services rendered. Health Needs Assessment Schedule H, Part VI, Line 2 Canonsburg General Hospital management and staff utilize multiple strategies to continually monitor and assess the health care needs of the communities it serves. One approach to assessing needs involves surveying community members about health needs related to national and state health goals. Canonsburg General Hospital also acts on expressed community needs by responding to direct community requests for health screenings, outreach events and other health-related activities and by maintaining longstanding programs that are well attended and positively evaluated by community participants. In addition, Canonsburg General Hospital gathers community input through participation in area rotaries, chambers of commerce, through partnerships with community organizations and other community engagement activities. Another means is through reviewing and taking appropriate actions on feedback gathered from the following sources: routine market assessments; patient and family satisfaction surveys; Press Ganey surveys; patient, patient family and staffs' suggestions for improving patient safety; medical staff input and physician surveys. Canonsburg General Hospital conducted a Community Health Needs Assessment (CHNA) during the year ended June 30, 2013 in accordance with IRC Section 501(r) and the guidance documented in the Internal Revenue Bulletin 2011-30, Notice 2011-52 and the proposed regulations issued April 5, 2013. The CHNA process began in August 2012 and concluded in May 2013. The Board of Directors that govern Canonsburg General Hospital approved an implementation strategy designed to address the community health needs identified in the CHNA on October 1, 2013. The CHNA process included input from persons representing the broad interests of the community including individuals with special knowledge of or expertise in public health, organizations with information relevant to the health needs of the community and representatives of medically underserved populations. The results of the CHNA identified multiple health needs in the communities we serve. The Hospital addressed the following health needs: diabetes, heart disease and breast cancer. The CHNA identified the following health needs the Hospital chose not to address: flu and pneumonia, bronchus and lung cancer and health literacy because existing hospital and/or community resources work to address these needs. Canonsburg General Hospital evaluated all top priority needs and put forth plans to address the needs we felt we were best positioned to make a positive impact for the betterment of the health of the communities we serve. The Hospital has made the CHNA widely available to the public. The community health needs assessment can be viewed at : www.wpahs.org. Patient Education For Eligibility For Assistance Schedule H, Part VI, Line 3 Canonsburg General Hospital displays signage in various patient Admission, Registration and Emergency Department areas that alerts that patient to Account Assistance program availability and contact information. During the preservice process, patients are evaluated to determine financial assistance options. Canonsburg General Hospital offers the "Account Assistance Program" which consists of application assistance for governmental eligibility, Charity Care application completion and submission support, as well as uninsured provisions. Account Assistance summaries are available on the West Penn Allegheny Health System website www.wpahs.org under the link titled, "Care for Uninsured" are available to the public. The Charity Care application, as well as, a Medical Assistance check list is available for patients who wish to self-apply. In addition to the documents, toll free telephone numbers regarding Account Assistance, charity and/or other financial inquiries are available. The website also contains a copy of the brochure that summarizes the Account Assistance program, as well as provides various governmental and internal numbers to patients seeking additional support. Canonsburg General Hospital also provides on-site support through Financial Counselor staff who are available to work with patient walk in's. Financial Counselors work directly with the patients as well as designated agency support regarding qualifying patients for Medical Assistance. Both week day and weekend coverage is available to the patients, as well as field support needed for post discharge follow up needed for application submission. The above support is available at no charge to the patient. Community Served Information Schedule H, Part VI, Line 4 Canonsburg General Hospital, located in Canonsburg Pennsylvania, provides health care services to residents of Allegheny and Washington Counties. Located approximately 20 miles outside of Pittsburgh, Canonsburg has approximately 9,000 residents. Allegheny County consists of approximately 1,227,000 residents living in a land area of approximately 730 square miles. The median housing value in Allegheny County is $118,700. Washington County consists of approximately 209,000 residents living in a land area of approximately 857 square miles. The median housing value in Washington County is $136,400. Promotion of Community Health Schedule H, Part VI, Line 5 The Canonsburg General Hospital Emergency Department cares for the community by operating 24 hours a day, 7 days a week with highly skilled and trained emergency medicine physicians and nurses. The Emergency Department is open to all individuals regardless of their ability to pay. The voting members of the Canonsburg General Hospital Board of Directors consist of a majority of independent community members without personal financial ties to the hospital. Affiliated Healthcare System Schedule H, Part VI, Line 6 West Penn Allegheny Health System (WPAHS) is comprised of some of the oldest and best-known names in health care in western Pennsylvania. From their inception, the system's hospitals have been in the vanguard of patient care, medical research and health sciences education. Comprised of two tertiary and three community hospitals, WPAHS includes Allegheny General Hospital and The Western Pennsylvania Hospital, both in Pittsburgh; Alle-Kiski Medical Center in Natrona Heights; Canonsburg General Hospital in Canonsburg; and Forbes Regional Campus in Monroeville. Offering a comprehensive range of medical and surgical services, the hospitals serve Pittsburgh and the surrounding five-state area, house approximately 1,600 beds and employ more than 11,000 people. Together, the WPAHS hospitals admit nearly 56,000 patients, log over 164,000 emergency visits and deliver more than 3,800 newborns each year. Combined, the hospitals are among the leaders in percentages of total surgeries, cardiac surgeries, neurosurgeries and cardiac catheterization procedures performed throughout the region. Through the West Penn Allegheny Health System, Canonsburg General Hospital (CGH) is able to ensure that area residents have access to a complete continuum of health care services. And through appropriate integration across the system, both clinically and operationally, the hospital is able to remain a high-quality, low-cost provider with linkages to the latest medical research and advanced technology. Canonsburg General Hospital provides a wide range of medical and surgical services, with advanced diagnostic and treatment services accessible on both an inpatient and outpatient basis. The Hospital has an active ambulatory care center available to serve the needs of the community. On April 29, 2013, WPAHS consummated an affiliation with Highmark Health, a 501(c)(3) tax exempt organization. This affiliation was one step toward the creation of an integrated delivery system named Allegheny Health Network. In addition to WPAHS, the Allegheny Health Network also includes Jefferson Regional Medical Center, Saint Vincent Health System and Saint Vincent Health Center. State Filing of Community Benefit Report Schedule H, Part VI, Line 7 Canonsburg General Hospital files the community benefit report with the state of Pennsylvania as part of our obligation to furnish the state of Pennsylvania with a copy of the IRS Form 990 and related schedules. true INCLUSION OF SCHEDULE I SCHEDULE I CANONSBURG GENERAL HOSPITAL REPORTED A TOTAL OF $10,464 OF GRANTS TO ORGANIZATIONS IN THE US ON PART IX, COLUMN A, LINE 1. SINCE THIS TOTAL IS GREATER THAN $5,000, PART V, LINE 21 ON THE FORM 990 WAS ANSWERED YES. A SCHEDULE I IS REQUIRED TO BE ATTACHED TO THE FORM 990. THERE WAS NO RECIPIENT THAT RECEIVED MORE THAN $5,000, THEREFORE, NOTHING IS REQUIRED TO BE DISCLOSED ON SCHEDULE I. PROCEDURES FOR MONITORING THE USE OF GRANT FUNDS SCHEDULE I CANONSBURG GENERAL HOSPITAL MANAGEMENT ANALYZES REQUESTS FOR DISBURSEMENT OF CONTRIBUTIONS AND GRANTS. REQUESTS ARE GRANTED TO THOSE ORGANIZATIONS THAT DEMONSTRATE A CHARITABLE PURPOSE AND A MISSION THAT WILL UTILIZE THE FUNDS TO THE BETTERMENT OF THE COMMUNITY THAT WE SERVE. X X X X true false false false false false false false false Christopher Olivia MD 0 0 0 0 0 1261143 0 625000 0 7325 0 1893468 0 1250000 Roy Santarella 0 0 0 0 0 703046 0 585817 0 183 0 1289046 0 703046 Deborah Olszewski 0 179977 0 0 0 1037 0 10858 0 1538 0 193410 0 0 Matthew Peterson 0 231605 0 50000 0 203 0 6250 0 9353 0 297411 0 0 Terry Wiltrout 0 186012 0 0 0 171 0 7667 0 8745 0 202595 0 0 Kimberly Sperring 0 194818 0 0 0 403 0 9974 0 8915 0 214110 0 0 Teresa Gordon 208804 0 0 0 0 0 8452 0 8245 0 225501 0 0 0 Cathleen Allinder 151037 0 0 0 0 0 7801 0 6781 0 165619 0 0 0 Barbara Gorby 167594 0 0 0 0 0 6941 0 8556 0 183091 0 0 0 Jeffrey Gretz MD 0 241788 0 74649 0 344 0 8125 0 9156 0 334062 0 0 David Kiehn 0 13033 0 100000 0 506095 0 0 0 725 0 619853 0 564419 Robert Brandfass 0 317358 0 150717 0 10167 0 0 0 10801 0 489043 0 0 Diane Dismukes 0 0 0 0 0 833367 0 0 0 183 0 833550 0 833367 Eugene Trout 0 37623 0 0 0 79085 0 0 0 2873 0 119581 0 66147 Judy Zedreck 0 379144 0 34000 0 1931 0 12500 0 13188 0 440763 0 0 Michael Sirott 0 192662 0 0 0 380 0 0 0 9370 0 202412 0 0 Additional Compensation Disclosure Form 990, Schedule J, Page 1, Part I, Question 4a The following represents additional disclosure for Schedule J, line 4a pertaining to officers and key employees listed in Form 990, Part VII, Section A, Line 1a receiving severance pay during the calendar year ending within the June 30, 2013 fiscal year end: Christopher Olivia, MD $1,250,000 Diane Dismukes $ 833,367 Roy Santarella $ 703,046 David Kiehn $ 464,419 Gene Trout $ 66,147 Deferred Compensation Schedule J, Part II, Column C Retirement and other deferred compensation reflect amounts accrued to the benefit of the applicable individuals related to qualified pension and severance plans. In this regard, the following individuals have amounts accrued related to future severance payments to be made: Christopher Olivia, MD Roy Santarella Bond Information Form 990, Schedule K, Part VI Canonsburg General Hospital is a member of the West Penn Allegheny Health System obligated group in regards to 2007 Allegheny County Hospital Development Authority Tax-exempt Bonds. Accordingly, Schedule K has been inserted into this form 990 for full disclosure purposes. The IRS form 990 filed for West Penn Allegheny Health System, Inc., EIN: 25-0969492 contains the full disclosure for Schedule K. IRS Form 990 - Organizational Comment IRS Form 990 On April 29, 2013, West Penn Allegheny Health System, Inc., the parent organization of the West Penn Allegheny Health System formalized an affiliation with Highmark Health, EIN: 45-3674900, a 501(c)(3) tax exempt organization to become a member of a newly created integrated delivery system named Allegheny Health Network (the "Network"). West Penn Allegheny Health System, Inc. is the sole member of Canonsburg General Hospital. In addition to West Penn Allegheny Health System, the Allegheny Health Network also consists of Jefferson Regional Medical Center, Saint Vincent Health Center and Saint Vincent Health System. In total, the Network consists of 22 different organizations exempt from federal income tax under IRS Section 501(c)(3). The parent organization of the Network is Allegheny Health Network, EIN: 45-3674924, a 501(c)(3) tax exempt organization. Together, these organizations have combined to create a cost-effective health system that raises quality, enhances outcomes and preserves consumer choice for everyone. Statement of Program Service Accomplishments Form 990, Page 2, Part III, Line 4a INTRODUCTION TO CANONSBURG GENERAL HOSPITAL Canonsburg General Hospital (CGH), founded in 1904, is a 104-bed community hospital located 25 miles southwest of Pittsburgh. The hospital's primary service areas are northern Washington and southern Allegheny counties. CGH is a member of the Allegheny Health Network by virtue of being affiliated with West Penn Allegheny Health System (WPAHS). Organized in 2000, WPAHS (www.wpahs.org) is comprised of West Penn Allegheny Health System, Inc. (WPAHS, Inc.), Alle-Kiski Medical Center (AKMC), Allegheny Medical Practice Network (AMPN), Allegheny Specialty Practice Network (ASPN) Allegheny-Singer Research Institute (ASRI), West Penn Allegheny Oncology Network (WPAON), West Penn Physician Practice Network (WPPPN), Canonsburg General Hospital Ambulance Service (CGH Ambulance), the Western Pennsylvania Hospital Foundation (WPHF), Forbes Health Foundation (FHF), Suburban Health Foundation (SHF) and the Alle-Kiski Medical Center Trust (AKMC Trust) as well as CGH. Through its affiliation with the West Penn Allegheny Health System, CGH area residents have access to a complete continuum of health care services. Through appropriate integration across the System both clinically and operationally, the Hospital is able to remain a high quality, low-cost provider with linkages to the latest medical research and advanced technology. The Hospital received various accreditations in Fiscal 2013 from sources that include the state Department of Health and the American College of Radiology. CGH has also maintained The Joint Commission's Gold Seal of Approval by demonstrating compliance with The Joint Commission's national standards for health care quality and safety. CGH participated in the Quality Blue program sponsored by Highmark that measured quality initiatives and indicators that included Emergency Department Throughput, Readmissions, Surgical Safety, and Venous Thromboembolism Care and Coordination. The Hospital achieved the maximum level of incentive for the Highmark Quality Blue initiative as a result of our infection prevention initiatives, and process changes to improve patient care and patient safety. CGH provides a wide range of medical and surgical services, with diagnostic and treatment services easily accessible on both an inpatient and outpatient basis. The hospital offers specialized services in acute inpatient rehabilitation, as well as having a strong focus on health education and preventive care programs that reflect its commitment to wellness and health improvement. CGH's ambulatory care center offers a full complement of outpatient services including same-day surgery, gastrointestinal (GI) procedures, computed tomography (CT) scans, pain management and sleep labs. Other specific departments and services available at CGH include medical imaging; laboratory testing and analysis, acute care and intensive care units, and rehabilitation services. The Outpatient Care Center - Peters Township offers medical services and physician offices, allowing cancer care, diagnostic testing, laboratory services, primary care physician offices, specialists, and same-day surgery. For the 12 months ended June 30, 2013, CGH served 3,260 inpatients, registered 70,991 outpatient visits, treated 20,603 patients in the emergency department (2,364 of which were admitted) and performed 2,143 surgeries. CGH employed a workforce of 459 employees and has 312 physicians on its medical staff during the year ended June 30, 2013. PURPOSE AND MISSION Canonsburg general Hospital is a team of care givers committed to improving health and promoting wellness in our communities, one person at a time. We pledge to consistently deliver safe, compassionate quality healthcare by treating the whole person - body, mind and spirit. UNCOMPENSATED CARE To enhance the health status of the community in which it operates and consistent with its tax-exempt status, CGH provides needed health care services to individuals regardless of their ability to pay for all or part of the services rendered. These services include both inpatient and outpatient services as well as an emergency room that is available 24 hours a day. Consistent with the filing of Schedule H, the components of uncompensated care include charity care and unreimbursed Medicaid costs. CGH provided uncompensated care at a cost of $1,977,905 in Fiscal 2013. COMMUNITY BENEFIT Community Health Improvement Services and Community Benefit Operations Community health improvement services and community benefit operations include activities carried out to improve community health. They extend beyond patient care to include activities subsidized by the Hospital. The activities range from community health clinics and screenings to health education programs designed to raise community awareness of various healthcare topics and issues. Consistent with the filing of Schedule H, CGH provided these services at a cost of $151,806 in Fiscal 2013. Flu Vaccinations - Flu vaccinations were provided free of charge at local community clinics. In addition, the Hospital provided free vaccinations to local fire, police and ambulance personnel of Canonsburg, Fort Cherry, North Strabane and Houston borough. Medivan Service - CGH provided a free transportation service to area residents who require testing or surgery at the hospital. The Hospital provides this program to enhance access to healthcare for those members of the community who cannot find adequate transportation. During Fiscal 2013, the medivan service made 2,799 trips. Health Fairs and Screenings - CGH sponsored various free health fairs throughout the year. Medical professionals provided cholesterol, glucose, body composition, bone density, lung capacity and blood pressure screenings. Festivals - CGH CGH participated in several local festivals throughout the year where first aid supplies were donated and CGH provided health care services, handed out health information and performed blood pressure screenings. Health & Education Classes - The community is provided with the opportunity to attend various programs and classes throughout the year, including CPR, First Aid, AED, Pediatric CPR as well as informational sessions on joint replacement and pain management. opportunity to attend various programs and classes throughout the year, including CPR, First Aid, AED, Pediatric CPR as well as informational sessions on joint replacement and pain management. Statement of Program Service Accomplishments (continued) Ask The Doctor Show - CGH, in collaboration with local cable television, produced a monthly health education program during which a CGH surgeon hosts the 30-minute live show. Physician guests answer questions regarding a variety of topics. Pastoral Care - CGH, in association with Canonsburg Ministerial Association, contracted with a Hospital Chaplain to provide spiritual guidance and healing to CGH patients and their respective families. Diabetes Awareness and Education - A registered pharmacist conducted quarterly presentations to the public on diabetes related topics such as oral and insulin medications and the side effects of those medications. In addition, CGH sponsored a four-week course designed to promote diabetes awareness and education three times a year. The courses provided education on diabetes, diet, eye care, insulin pumps, foot care and coping skills. Sessions are in conjunction with other local agencies. Bereavement Series - Three times during the year, the Hospital Chaplain lead a six-week series on the process of grief. A grief and loss support dinner was held monthly at the Hospital. Hospital Tours - 50 Children from local pre-schools and elementary schools were provided tours of the Hospital. The event promoted awareness and comfort by teaching children about the hospital and it allows the schools to learn about the services the hospital provides in the case of an emergency. Summer Camp Splash Program - This program educated children attending summer camp about basic first aid, summer safety tips, hazardous weather emergencies and water safety concerns. Poison Presentations - CGH staff gave two presentations during the year in an effort to educate young children about various types of poisons. The children were taught how to identify and avoid poisonous substances. Glo-Germ Presentations - Hospital personnel made eight presentations to pre-school and K-2 grades about how to properly wash hands. An educational lesson was given to the children in conjunction with a photosynthesized gel. Safe Sitter Classes - CGH held numerous classes during the year designed to teach boys and girls how to handle emergencies when caring for young children. Physician Speaking Engagements/Media Interviews - during the course of the year, our physicians and medical staff visited numerous church and community groups to continue to educate and raise awareness for different medical conditions. Health Professions Education CGH provided aspiring health professionals with many educational opportunities to further their career in healthcare. Consistent with the filing of Schedule H, CGH provided these services at a cost of $105,453 in Fiscal 2013. Physical Therapy - Physical therapy students received mentoring and training by CGH therapists. The training took place during regular clinical rotations. Phlebotomy Training - Twelve students received 120 hours of training and mentoring in phlebotomy at the hospital during the year. Subsidized Health Services Subsidized health services represent those programs provided to the community by CGH despite the fact the Hospital incurs a financial loss to do so. CGH recognizes the need of its community and voluntarily subsidizes these programs in support of its charitable mission. Among the subsidized health services provided by CGH are the treatment of drug and alcohol abuse and mental health treatment. Consistent with the filing of Schedule H, CGH provided subsidized health services at a cost of $95,134 in Fiscal 2013. In Kind Donations - Financial Contributions This category includes funds and in-kind services donated to individuals and the community at large. In-kind services include hours donated by staff to the community during hospital work hours, overhead expenses of meeting space donated to not-for-profit community groups and the free provision of food, equipment, supplies as well as monetary donations. Consistent with the filing of Schedule H, CGH provided these contributions at a cost of $47,605 in Fiscal 2013. Community Blood Drives - In conjunction with the Central Blood Bank, the Hospital provided large common areas for the community and employees, one at CGH and several at OCC, plus markets for these events. Cash Donations - CGH supported the community through cash contributions made at the discretion of the Hospital and its directors, benefiting not only the non-profit recipient but also ultimately the community as a whole. The Hospital made cash contributions totaling $10,464 during Fiscal 2013. In-kind Donations - In addition to the cash contributions, CGH also made in-kind donations of time and resources to help support various community functions. The Hospital donated space for community food drives, blood drives, girl scouts, boy scouts, clothing drives, ministerial associations, United Way, Rotary International, elderly functions, local EMS and Fire departments. In addition, the Hospital donated products and equipment to various local charitable organizations including Brother's Brother Foundation, the humane society and local youth sports teams. COMMUNITY BUILDING ACTIVITIES Community Building Activities include activities engaged in for the purpose of improving or protecting the health, future and well being of the community. Consistent with the filing of Schedule H, CGH provided these services at a cost of $ $73,353 in Fiscal 2013. Social Work Services - The services of a professionally trained medical social worker is available to all patients and families for crisis intervention, counseling and discharge planning. The social worker handles problems that may arise during hospitalization or at the time of discharge. The social worker also provides counseling, emotional support and information regarding community services and programs. Thanksgiving Essay Contest- The Hospital Children Services Department sponsored a Thanksgiving essay contest for elementary age students. The essays were intended to promote healthy themes to children. Each essay focused on a healthy topic and the reasons why the child is thankful. Each child completed an essay which was judged by the community. The winners received a U.S. Savings Bond. Halloween Trail - The Hospital sponsored the annual Halloween Trail to provide a fun and safe way for children to celebrate Halloween. Treats were provided free of charge and hospital employees dressed in costumes and passed out treats. Approximately 1,000 children attended the free event held at the hospital. 4th of July - Each year Canonsburg, PA has a large Fourth of July Celebration in which the hospital participates with employees walking in the parade, supporting the celebration with donations and making medical staff available. Operational Oversight By A Third Party Management Company Form 990, Page 6, Part VI, Line 3 Canonsburg General Hospital (CGH) is a member of the Allegheny Health Network by virtue of being affiliated with the West Penn Allegheny Health System (System). The System consists of thirteen operational IRC Section 501(c)(3) organizations. The parent organization for CGH and the other eleven operational IRC Section 501(c)(3) organizations is West Penn Allegheny Health System, Inc. (WPAHS, Inc.). The board of directors of WPAHS, Inc. is comprised of a majority of independent members. On November 7, 2011 (Effective Date), the board of directors of WPAHS, Inc. engaged Alvarez & Marsal Healthcare Industry Group, LLC (A&M) to assign an Interim Chief Executive Officer of the System, Interim Chief Operating Officer of the System and Interim Chief Financial Officer of the System. All individuals appointed to their respective positions are under the employment of A&M and have daily oversight of all matters pertinent to the operation of the System as a whole and all organizations on an independent basis. All interim management personnel under the employment of A&M are responsible to and report to the WPAHS, Inc. board of directors. The term of the engagement is to last one year from the effective date with the option to renew the engagement beyond the initial one year term. During the course of the engagement, the WPAHS, Inc. board of directors upon written notice may cause any individual employed by A&M to be removed from their respective position and replaced by another similarly qualified individual. CGH did not directly compensate A&M for their management services. WPAHS, Inc. compensates A&M directly for these services. The decision was made to allocate a portion of the expenditures of WPAHS, Inc. to CGH. Thus, the portion of management expense allocated from WPAHS, Inc. to CGH is reflected on Form 990, Page 10, Line 11a. On April 29, 2013, West Penn Allegheny Health System, Inc., the sole member of Canonsburg General Hospital consummated a formal affiliation to establish a regional integrated health care services delivery system. With the establishment of this formal affiliation, the management team from A&M were removed from their respective positions and ceased to provide management services. CHANGE TO THE ORGANZATIONAL GOVERNING DOCUMENTS FORM 990, PAGE 6, PART IV, SECTION A, QUESTION 4 The bylaws of Canonsburg General Hospital were amended effective May 17, 2013 to reflect an affiliation with Highmark Health, EIN: 45-3674900 and the creation of a regional integrated healthcare delivery system, the parent organization of which is Allegheny Health Network, EIN: 45-3674924. In accordance with the affiliation, Highmark Health assumed certain reserve powers over Canonsburg General Hospital. Among the reserve powers given to Highmark Health includes the right to approve the election, re-election and removal of all officers of the corporation; to amend, revise and restate the corporation's Articles of Incorporation and Bylaws; adopt or change the mission, purpose, philosophy or objective of the corporation; to change the general structure of the corporation; to dissolve or liquidate, consolidate or merge and sell or acquire assets in excess of certain thresholds; approve the capital, operating plan and budget of the corporation; approve the incurrence of debt by the corporation and the making of capital expenditures in excess of certain thresholds; to approve donations or other transfers in excess of certain thresholds; approve the strategic plan and mission statement; approve investment policies; approve the closure or relocation of a licensed healthcare facility; approve the creation of or dissolution of subsidiary corporations, partnerships or other joint ventures in excess of certain thresholds; manage the corporations program for compliance with all legal requirements; selection of auditors and the designation of the fiscal year of the corporation. Form 990 Review Process Form 990, Page 6, Part VI, Section B, Question 11a The IRS Form 990 of the Canonsburg General Hospital was prepared by the Highmark Health Tax Department. Prior to filing the final tax return with the Internal Revenue Service, members of senior management reviewed components of the tax return and the voting members of the governing body received a copy of the tax return. Monitoring and Enforcement of the Conflict of Interest Policy Form 990, Page 6, Part VI, Section B, Question 12c Canonsburg General Hospital (CGH) is a member of the Allegheny Health Network by virtue of being affiliiated with West Penn Allegheny Health System (WPAHS). WPAHS has a corporate compliance department that monitors and oversees compliance with the conflict of interest policy of all organizations in the health system. The following describes the manner in which the corporate compliance department monitors and oversees compliance with the conflict of interest policy for CGH as well as the other WPAHS affiliates: Conflict of Interest disclosure forms are completed on an annual basis by all board members, officers, employees who have a title of Manager and above, physicians in leadership roles, Pharmacy and Therapeutic Committee members, all employees of the System's Compliance and Internal Audit Departments as well as personnel involved with contracting in the Corporate Purchasing Department. Upon completion of the above disclosure statement by all applicable individuals, a report is generated listing all individuals that have reported a conflict. The System Compliance Officer and General Counsel review the conflicts disclosed. Those that require additional information or clarification receive a letter from the Compliance Officer requesting such. Once received, all additional information is added to the report and again reviewed by the Compliance Officer and General Counsel. Those conflicts that require a mitigation plan are sent to the respective organization's senior management for development of the mitigation plan. The organization's senior management is responsible to discuss the mitigation plan with the individual as needed and monitor compliance with the mitigation plan. Once mitigation is received, a final report is reviewed by System Executive Compliance Council with the Legal Department and the Allegheny Health Network(AHN)senior management and finally with the AHN Audit and Compliance Subcommittee of the Board. the mitigation plan. Once mitigation is received, a final report is reviewed by System Executive Compliance Council with the Legal Department and the Allegheny Health Network(AHN)senior management and finally with the AHN Audit and Compliance Subcommittee of the Board. Process Used To Determine Executive Compensation Form 990, Page 6, Part VI, Section B, Line 15b The West Penn Allegheny Health Systems (WPAHS) process for determining compensation for executive positions (including officers, key employees and other management positions) within Canonsburg General Hospital is covered by the WPAHS Executive Compensation Policy. This policy was approved by the West Penn Allegheny Health System, Inc. Board of Directors. It is the policy of WPAHS and its Board of Directors to compensate its executives in accordance with the market and in relation to the experience, service and accomplishments of the individual both prior to and during their service with WPAHS. The Compensation Committee of the West Penn Allegheny Health System, Inc. Board of Directors approves the compensation for WPAHS senior executives. The Compensation Committee approves the initial compensation for newly hired senior executives, which shall include all compensation components, including without limitation, base compensation, incentive compensation, deferred compensation, fringe and other benefits, as well as the total compensation. It shall also approve all base compensation adjustments and all incentive compensation awards, as well as material changes to deferred compensation, fringe, or other benefits. The Compensation Committee uses comparability data provided by the System Human Resources Department, which may include industry surveys, expert compensation studies, documented compensation of persons holding similar positions, or other comparable data in approving any executive compensation. The Compensation Committee shall periodically retain the services of an independent compensation consultant to provide an expert opinion report as to the reasonableness of total compensation of Canonsburg General Hospital officers and key employees. Each Compensation Committee member voting on a senior executive's compensation arrangement ensures that he or she has no conflict of interest, including that he or she (a) does not economically benefit from the proposed employment; (b) does not receive compensation subject to the approval of the proposed employee; and (c) has no material financial interest affected by the transaction. The Compensation Committee consists of five independent Board Members of West Penn Allegheny Health System, Inc. All decisions of the Compensation Committee regarding executive compensation matters are documented. Public Availability of Organizational Documents Form 990, Page 6, Part VI, Section C, Question 19 Canonsburg General Hospital (CGH) does not make its governing documents available to the public. CGH is a member of Allegheny Health Network by virtue of being affiliiated with West Penn Allegheny Health System (WPAHS). The WPAHS makes available their annual and quarterly financial statements through the use of a dissemination agent. These financial statements are on a consolidated basis with CGH being one of the consolidated entities. In addition, the WPAHS annual report and quarterly financial results are available on the WPAHS website. WPAHS has adopted a conflict of interest policy that is uniformly applied to all organizations of the health system, including CGH. A condensed version of this conflict of interest policy is available on the WPAHS website. Average Hours Per Week Reported for Officers, Directors and Key Employees Form 990, Page 7, Part VII, Column B Canonsburg General Hospital (CGH) is a member of the Allegheny Health Network by virtue of being affilated with West Penn Allegheny Health System ( WPAHS). WPAHS is part of an integrated healthcare delivery system. Individuals employed by one organization may be assigned to provide management for an affiliated organization. As such, many individuals play key roles or serve as officers or directors on multiple affiliated organizations. Each individual will be assigned forty hours to the organization of their actual employment. If the individual is employed by one organization and appointed as an officer, director or key employee of affiliated organizations the hour allocation on Form 990, Part VII, Page 7, Column (B) takes various factors into account when attempting to assign hours in a reasonable manner. Thus, it is possible for a single individual to have hours assigned in excess of forty hours per week if all affiliated organization IRS Forms 990 is taken into account. Directors who are not employed and volunteer their services are assigned one hour of service. The actual time served for all individuals disclosed in IRS Form 990 can vary based upon the need of the organization. Officers and Directors - Partial Year Terms Form 990, Page 7, Part VII, Column C The following list represents Officers, Directors or Key Employees of Canonsburg General Hospital listed on Form 990, Part VII who did not serve a full consecutive twelve month tenure for the year ended June 30, 2013 along with the dates served: William Burt 07-01-2012 - 02-28-2013 Joseph Cerenzia 07-01-2012 - 02-28-2013 Jefery Gretz 07-01-2012 - 02-28-2013 Terry Wiltrout 07-01-2012 - 02-28-2013 Vincent Trapanotto 02-28-2013 - 06-30-2013 Kim Sperring 02-28-2013 - 06-30-2013 Robert Brandfass 07-01-2012 - 11-16-2012 Mike Sirott 02-28-2013 - 06-30-2013 Judy Zedreck 02-28-2013 - 06-30-2013 Rental Expense Form 990, Page 9, Part VIII, Line 6b Canonsburg General Hospital does not account for rental expense in a manner that would allow for a direct offset of rental income on Form 990, Page 9, Line 6b(i). The components of rental expense are reflected on Form 990, Page 10, Statement of Functional Expense. Purpose of Tax Exempt Bond Issue Form 990, Page 11, Part X, Line 20 Canonsburg General Hospital is a member of the West Penn Allegheny Health System obligated group in regards to 2007 Allegheny County Hospital Development Authority tax-exempt bonds. Accordingly, Schedule K has been inserted into this Form 990 for full disclosure purposes. The purpose of the issue of the Allegheny County Hospital Development Authority (ACHDA) Hospital Revenue Bonds, Series 2007 A is to refund the outstanding ACHDA Series 2000A and B Bond Issues, refund the Dauphin County General Authority (DCGA) Series 1992A and B Hospital Bonds, the Pennsylvania Higher Education Facility Authority (PHEFA) Series 1991A Revenue Bonds, the Monroeville Hospital Authority (MHA) Series 1992 and 1995 Revenue Bonds, the funding of a project fund for certain prior and future capital expenditures and to pay the cost of issuing Series 2007A Debt. The amount of $25,709,643 reflected on Form 990, Page 11, Line 20 represents the internal allocation of debt to Canonsburg General Hospital by the parent organization, West Penn Allegheny Health System, Inc. The IRS Form 990 filed by West Penn Allegheny Health System, Inc., EIN: 25-0969492 has completed Schedule K in its entirety. Please refer to the Form 990 filed by West Penn Allegheny Health System, Inc., EIN: 25-0969492 to review Schedule K with regard to this bond issue. Other Changes In Net Assets Form 990, Page 12, Part XI, Line 9 The following is a reconciliation of Other Changes in Net Assets of Canonsburg General Hospital for the year ended June 30, 2013: Change in Minimum Pension Liability $ 754,903 Transfer to Balance Sheet Investment Account (3,091) Purchase Accounting Ajustment (13,990,906) __________ Other Changes in Net Assets ($13,239,094) West Penn Allegheny Health System Inc 4800 Friendship Avenue Pittsburgh PA 15224 250969492 Healthcare PA 3 NA false Alle-Kiski Medical Center 1301 Carlisle Street Natrona Heights PA 15065 251875178 Healthcare PA 3 NA false Allegheny Singer Research Institute 320 East North Avenue Pittsburgh PA 15212 251320493 Sci. Research PA 4 NA false Allegheny Medical Practice Network 4800 Friendship Avenue Pittsburgh PA 15224 251838457 Healthcare PA 3 NA false Allegheny Specialty Practice Network 320 East North Avenue Pittsburgh PA 15212 251838458 Healthcare PA 3 NA false West Penn Allegheny Oncology Network 4800 Friendship Avenue Pittsburgh PA 15224 113683376 Healthcare PA 11-III FL NA false West Penn Physician Practice Network 4800 Friendship Avenue Pittsburgh PA 15224 251494317 Healthcare PA 9 NA false CGH Ambulance Service Inc 100 Medical Boulevard Canonsburg PA 15317 232939715 Emer Response PA 9 NA false Alle-Kiski Medical Center Trust 1301 Carlisle Street Natrona Heights PA 15065 205855753 Fundraising PA 11-I NA false Forbes Health Foundation 2570 Haymaker Road Monroeville PA 15146 251798379 Fundraising PA 7 NA false Suburban Health Foundation 100 South Jackson Avenue Pittsburgh PA 15202 251472073 Fundraising PA 11-I NA false Western Pennsylvania Hospital Foundation 4800 Friendship Avenue Pittsburgh PA 15224 251470766 Fundraising PA 11-I NA false West Allegheny Hospital 100 Medical Boulevard Canonsburg PA 15317 251054206 Inactive PA 3 NA false Greater Canonsburg Health System 100 Medical Boulevard Canonsburg PA 15317 251488089 Inactive PA 11-I NA false Canonsburg HealthHospital Foundation 100 Medical Boulevard Canonsburg PA 15317 251818505 Inactive PA 11-I NA false Burn Care Associates 4800 Friendship Avenue Pittsburgh PA 15224 232899534 Healthcare PA NA C Corporation Medical Center Clinic 4800 Friendship Avenue Pittsburgh PA 15224 232894939 Healthcare PA NA C Corporation West Penn Corporate Medical Services Inc 4800 Friendship Avenue Pittsburgh PA 15224 251437405 Healthcare PA NA C Corporation West Penn Neurosurgery 4800 Friendship Avenue Pittsburgh PA 15224 251630719 Healthcare PA NA C Corporation Friendship Insurance Company Ltd 980116952 Insurance CJ NA C Corporation false false false false false false false false false false false false false false true true false false Canonsburg General Hospital Ambulance Servic 1p 268840