2014-05-21T15:10:25-05:00 2013-06-30 232932984 PARENTEBEARD LLC SUITE 200 221 W PHILADELPHIA ST YORK PA 174012993 990 2012-07-01 231265004 MEMORIAL HOSPITAL MEMO 7178438623 325 SOUTH BELMONT STREET YORK PA 17403 SALLY J DIXON 7178438623 2014-05-21 1 JULIUS C GREEN CPA JD P00350393 7178467000 2012 2015-11-30 17:44:51Z SALLY J DIXON 325 SOUTH BELMONT STREET YORK PA 17403 26741796 0 X WWW.MHYORK.ORG X 1945 PA MEDICAL SERVICES: INPATIENT, OUTPATIENT (EMERGENCY, CLINIC, AND OCCUPATIONAL MED), HOME HEALTH. 13 10 1121 0 0 0 358044 0 99602117 0 106156 926145 1919851 0 101986168 926145 0 0 0 0 55982082 0 0 0 0 51889295 72561 107871377 72561 -5885209 853584 50094459 19046416 31903800 225205 18190659 18821211 X MEMORIAL HOSPITAL IS COMMITTED TO PROMOTING, IMPROVING, AND ENHANCING THE HEALTH AND WELL-BEING OF THE COMMUNITY WE SERVE. 0 1 MEMORIAL HEALTH SYSTEMS CORPORATION, PARENT COMPANY OF MEMORIAL HOSPITAL, ENTERED INTO AN ASSET PURCHASE AGREEMENT DATED JANUARY 24, 2012 WITH COMMUNITY HEALTH SYSTEMS, INC. TO SELL SUBSTANTIALLY ALL OF THE ASSETS OF THE SYSTEM. THE SALE CLOSED ON JULY 1, 2012. THE HOSPITAL TERMINATED ITS BUSINESS ACTIVITIES ON THAT DATE AND IS IN THE PROCESS OF DISSOLVING THE ENTITY. UPON DISSOLUTION, ANY ASSETS REMAINING WILL BE TRANSFERRED TO THE MEMORIAL HEALTH SYSTEMS CORPORATION ("MHSC"). MHSC WILL REMAIN ACTIVE IN THE YORK COMMUNITY PROVIDING FUNDS TO SUPPORT THE HEALTHCARE NEEDS OF THE COMMUNITY. HOSPICE SERVICES 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 1 X 26 0 1 1121 1 0 0 0 0 0 0 0 0 0 0 X 13 10 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 PA X SALLY J DIXON 7178438623 325 SOUTH BELMONT STREET YORK PA 17403 CHLOE R EICHELBERGER 3.00 2.00 X X 0 0 0 RANDALL A GROSS 3.00 1.00 X X 0 0 0 JACK KAY 3.00 5.00 X 0 0 0 RICHARD D POOLE 1.00 2.00 X 0 0 0 TERRY N YORK DO 1.00 1.00 X 0 0 0 LUTHER B SOWERS PHD 1.00 X 0 0 0 DELAINE TOERPER 1.00 X 0 0 0 MICHAEL NEWSOME 3.00 X X 0 0 0 MICHAEL W KING 1.00 X 0 0 0 CAROL ST GEORGE DO 1.00 X 0 0 0 JAMES A LEASE DO 40.00 X 183077 0 0 PATRICK BRUBAKER 1.00 X 0 0 0 SALLY J DIXON 31.00 9.00 X X 710616 0 1783 MANU S RAJACHANDRAN 40.00 X 376923 0 0 VAN D ADAMS 40.00 X 258028 0 0 RAYMOND S CUZZANITI 40.00 X 250619 0 0 HAOEH M JUNG 40.00 X 227845 0 0 RAVICHANDRAN SUPPIAH 40.00 X 230105 0 0 2237213 0 1783 18 0 1 0 0 309966 309966 66092 26365738 59596 25756055 6496 609683 616179 616179 926145 0 0 926145 14737 14737 57824 57824 72561 0 72561 0 31 11279466 16696820 2315747 1202540 0 20566788 3443128 2318596 31000 31000 11255759 0 50094459 19046416 9775370 17502769 4625661 225205 31903800 225205 X 17567172 18231858 195956 161822 427531 427531 18190659 18821211 50094459 19046416 853584 -93523 -129509 0 X X 0 0 0 X 427531 427531 427480 51 427531 426890 590 427480 426127 500 -263 426890 351269 75000 2 144 426127 1.00000 1 0 0 DEFERRED COMPENSATION 20197 ESTIMATED THIRD PARTY PAYOR SETTLEMENTS 205008 225205 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: INCOME EARNED FROM ENDOWMENTS IS AVAILABLE FOR THE GENERAL OPERATIONS OF THE HOSPITAL. X X X X X 0 1 0 0 0 0 0 0 0 JAMES A LEASE DO 183077 0 0 0 0 0 0 0 0 0 183077 0 0 0 SALLY J DIXON 225550 0 0 0 485066 0 1000 0 783 0 712399 0 485066 0 MANU S RAJACHANDRAN 376923 0 0 0 0 0 0 0 0 0 376923 0 0 0 VAN D ADAMS 258028 0 0 0 0 0 0 0 0 0 258028 0 0 0 RAYMOND S CUZZANITI 250619 0 0 0 0 0 0 0 0 0 250619 0 0 0 HAOEH M JUNG 227845 0 0 0 0 0 0 0 0 0 227845 0 0 0 RAVICHANDRAN SUPPIAH 230105 0 0 0 0 0 0 0 0 0 230105 0 0 0 PART I, LINE 4B SALLY J DIXON, PRESIDENT/CEO: SUPPLEMENTAL NON QUALIFIED RETIREMENT PLAN - RECEIVED $485,066 IN CALENDAR YEAR 2012. MILLER & DIPIETRO ASSOCIATES TERRY N. YORK D.O., DIRECTOR, IS PARTNER IN MILLER & DIPIETRO PARTNERSHIP 211296 MILLER & DIPIETRO ASSOCIATES, MILLER & DIPIETRO PARTNERSHIP, AND MEDICAL IMAGING SYSTEMS OF YORK PROVIDED MEDICAL SERVICES. TERRY N. YORK IS A PARTNER WITH MILLER & DIPIETRO ASSOCIATES WHICH IS AFFILIATED WITH MILLER & DIPIETRO PARTNERSHIP AND MEDICAL IMAGING SYSTEMS OF YORK. 0 CHANGES IN PROGRAM SERVICES FORM 990, PART III, LINE 3 MEMORIAL HEALTH SYSTEMS CORPORATION, PARENT COMPANY OF MEMORIAL HOSPITAL, ENTERED INTO AN ASSET PURCHASE AGREEMENT DATED JANUARY 24, 2012 WITH COMMUNITY HEALTH SYSTEMS, INC. TO SELL SUBSTANTIALLY ALL OF THE ASSETS OF THE SYSTEM. THE SALE CLOSED ON JULY 1, 2012. THE HOSPITAL TERMINATED ITS BUSINESS ACTIVITIES ON THAT DATE AND IS IN THE PROCESS OF DISSOLVING THE ENTITY. UPON DISSOLUTION, ANY ASSETS REMAINING WILL BE TRANSFERRED TO THE MEMORIAL HEALTH SYSTEMS CORPORATION ("MHSC"). MHSC WILL REMAIN ACTIVE IN THE YORK COMMUNITY PROVIDING FUNDS TO SUPPORT THE HEALTHCARE NEEDS OF THE COMMUNITY. FORM 990, PART V, LINE 2B: MEMORIAL HOSPITAL IS THE COMMON REPORTING AGENT FOR THE GROUP OF RELATED TAX-EXEMPT ORGANIZATIONS AND FILES ALL 1099 FORMS FOR THE FOLLOWING: MHS TITLE COPORATION, SURGICAL CENTER OF YORK INC., AND MEMORIAL HEALTH SYSTEMS CORPORATION. FORM 990, PART VI, SECTION B, LINE 11 THE ACCOUNTING DEPARTMENT PROVIDES INFORMATION TO THE INDEPENDENT ACCOUNTANT FOR PREPARATION OF THE FORM 990. THE DRAFT IS REVIEWED BY THE CEO. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION USES AN ANNUAL QUESTIONNAIRE TO DETERMINE IF ALL EMPLOYEES AND MEMBERS OF THE BOARD ARE INDEPENDENT. THE EMPLOYEE QUESTIONNAIRES ARE INITIALLY COMPLETED AS PART OF THE ORIENTATION PROGRAM UPON EMPLOYMENT, AND THEN AS PART OF THE ANNUAL REVIEW PROCESS. THESE FORMS ARE REVIEWED BY THE DIRECTOR OF HUMAN RESOURCES AND ANY POTENTIAL CONFLICT OF INTEREST IS REVIEWED WITH THE RELATED PARTY. ANNUAL QUESTIONNAIRES FOR THE BOARD/SENIOR MANAGEMENT ARE COLLECTED BY THE CEO AND ARE REVIEWED BY THE CEO AND THE BOARD CHAIRPERSON. AT THE BOARD LEVEL, ANY POTENTIAL CONFLICT IS MONITORED BY THE CEO AND CHAIR, AND BOARD MEMBERS WILL REFRAIN FROM VOTING ON CONFLICT/RELATED ISSUES. IN ADDITION TO THE REPORTING REQUIRED, KEY EMPLOYEES AND SENIOR MANAGEMENT ARE MONITORED BY THE CEO THROUGH THE PURCHASING AND CASH DISTRIBUTIONS CONTROLS IN PLACE. FORM 990, PART VI, SECTION B, LINE 15 THE DETERMINATION OF THE COMPENSATION OF THE TOP MANAGEMENT OFFICIAL AND OTHER OFFICERS OF THE ORGANIZATION INCLUDES A REVIEW AND APPROVAL BY THE COMPENSATION COMMITTEE OF MEMORIAL HOSPITAL. AN OUTSIDE CONSULTANT IS RETAINED BY THE COMPENSATION COMMITTEE. ON AN ANNUAL BASIS, THE CONSULTANT CONDUCTS A COMPENSATION SURVEY OF COMPARABLE EXECUTIVE POSITIONS AT COMPARABLE HOSPITALS WITHIN OUR GENERAL GEOGRAPHIC MARKETPLACE. THE CONSULTANT WILL ALSO ADVISE THE BOARD ON CURRENT TRENDS REGARDING COMPENSATION IN HEALTHCARE AND THE MARKETPLACE, INCLUDING THE REVIEW AND ESTABLISHMENT OF A VARIABLE PAY ("INCENTIVE") PROGRAM. THE COMMITTEE'S GENERAL GUIDELINES ARE TO MAINTAIN A BASE SALARY WITHIN THE 50TH-60TH PERCENTILE OF SIMILAR POSITIONS IN PEER INSTITUTIONS. ALONG WITH THE VARIABLE PAY OPPORTUNITY, TOTAL COMPENSATION IS GEARED TO THE 75TH PERCENTILE AND SHOULD NOT EXCEED THE 90TH PERCENTILE. IN UNIQUE AND SUPPORTABLE CIRCUMSTANCES, THE COMMITTEE MAY DEVIATE FROM THESE GUIDELINES. THE COMPENSATION IS REVIEWED BY THE EXECUTIVE COMMITTEE. THE DELIBERATION AND DECISION PROCESS IS CONTEMPORANEOUSLY DOCUMENTED. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XII, LINE 2C: THE FINANCE COMMITTEE IS RESPONSIBLE FOR THE OVERSIGHT OF THE AUDIT AND THE SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED IN THE LAST YEAR. SURGICAL CENTER OF YORK 1750 FIFTH AVENUE YORK PA 17403 232507740 OUT PATIENT SURGERY CENTER PA 501(C)3 3 MEMORIAL HEALTH SYSTEMS CORPORATION 0 MEMORIAL HEALTH SYSTEMS CORPORATION 1708 FIFTH AVENUE YORK PA 17403 222546051 SUPPORT AND DEVELOPMENT OF PROGRAMS FOR THE BENEFIT OF RELATED PARTIES PA 501(C)3 11 TYPE I N/A 0 MHS TITLE HOLDING CORP 325 SOUTH BELMONT STREET YORK PA 17403 222546052 REAL PROPERTY MANAGEMENT FOR RELATED ENTITIES PA 501(C)3 11 TYPE I MEMORIAL HEALTH SYSTEMS CORPORATION 0 MEMORIAL ENTERPRISES INC 325 SOUTH BELMONT STREET YORK PA 17403 232353226 MEDICAL CLINICS PA N/A C 0 0 0 0 1 1 0 0 0 0 0 0 1 1 1 1 1 1 1 1