2014-05-14T08:36:05-05:00 2013-06-30 232932984 PARENTEBEARD LLC 1650 MARKET STREET SUITE 4500 PHILADELPHIA PA 19103 990 2012-07-01 230880420 SCHUYLKILL MEDICAL CTR - EAST NORWEGIAN STREET FKA GOOD SAM REGIONAL MED CTR SCHU 5706214000 700 EAST NORWEGIAN STREET POTTSVILLE PA 17901 JOHN E SIMODEJKA 5706214000 2014-05-13 1 JULIUS C GREEN CPA JD P00350393 2159720701 2012 2015-11-30 17:44:51Z JOHN E SIMODEJKA 700 EAST NORWEGIAN STREET POTTSVILLE PA 17901 61045010 0 X WWW.SCHUYLKILLHEALTH.COM X 2008 PA TO MAKE A POSITIVE DIFFERENCE IN THE SCOPE AND QUALITY OF HEALTHCARE FOR THE SCHUYLKILL COMMUNITY. 17 16 795 122 297951 -291391 193461 504784 58880243 57405215 118896 82264 1603507 2919176 60796107 60911439 8320 850 0 0 34484107 34689407 0 0 0 27061352 27067794 61553779 61758051 -757672 -846612 33523239 33260390 11856975 12433807 21666264 20826583 X SCHUYLKILL MEDICAL CENTER - EAST NORWEGIAN STREET'S (EAST) MISSION IS TO MAKE A POSITIVE DIFFERENCE IN THE SCOPE AND QUALITY OF HEALTHCARE AVAILABLE FOR THE SCHUYLKILL COUNTY COMMUNITY. 1 0 44099595 850 57757836 THE SCHUYLKILL MEDICAL CENTER - EAST NORWEGIAN STREET, THROUGH THE COMBINED EFFORTS OF ITS HIGHLY QUALIFIED MEDICAL STAFF, EMPLOYEES AND VOLUNTEERS, OFFERS A BROAD RANGE OF HEALTHCARE SERVICES TO THE RESIDENTS OF SCHUYLKILL COUNTY. INPATIENT HEALTHCARE SERVICES ARE PROVIDED IN MEDICINE, SURGERY, AND CRITICAL CARE MEDICINE. MORE THAN 22,000 VISITS BY RESIDENTS OF THE REGION WERE MADE TO RECEIVE EMERGENCY CARE AT THE SCHUYLKILL MEDICAL CENTER - EAST NORWEGIAN STREET'S EMERGENCY DEPARTMENT. A WIDE ARRAY OF DIAGNOSTIC AND TREATMENT PROGRAMS ARE ALSO OFFERED BY THE MEDICAL CENTER, INCLUDING, CT SCANNING, INPATIENT RENAL (KIDNEY) DIALYSIS, MEDICAL ONCOLOGY/CHEMOTHERAPY, DIAGNOSTIC, ULTRASOUND, BLOOD BANKING AND LABORATORY, PHYSICAL THERAPY, CARDIOVASCULAR SERVICE, AND AN OUTPATIENT CHEMICAL DEPENDENCY PROGRAM. THE INDUSTRA-MED PROGRAM OF THE MEDICAL CENTER PROVIDED OCCUPATIONAL AND INDUSTRIAL HEALTH SERVICES TO OVER 200 OF THE REGION'S EMPLOYERS. 44099595 1 1 0 1 0 0 0 0 0 0 1 1 0 1 1 1 0 1 0 0 1 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 24 0 1 795 1 1 1 0 0 0 0 0 0 0 0 0 X 17 16 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 PA X BERNIE KOSKULITZ DIRECTOR FINANCE 5706215142 700 EAST NORWEGIAN STREET POTTSVILLE PA 17901 JOHN SIMODEJKA 14.00 26.00 X X 0 465081 23868 TIMOTHY TWARDZIK 1.00 3.00 X 0 0 0 JAY LINARD 1.00 3.00 X X 0 0 0 WILLIAM KIRWAN CPA ESQ 1.00 3.00 X X 0 0 0 JESSE ACHENBACH 1.00 3.00 X 0 0 0 ANTHONY BARAN 1.00 3.00 X X 0 0 0 JEANNE BOYER PORTER 1.00 3.00 X 0 0 0 DEBRA BLASCHAK 1.00 3.00 X 0 0 0 STEVEN FIELD 1.00 3.00 X 0 0 0 SARAH CASEY 1.00 3.00 X 0 0 0 REV HAROLD L HAND 1.00 3.00 X 0 0 0 CYNTHIA PETCHULIS 1.00 3.00 X 0 0 0 ROBERT ZIMMERMAN JR DO 1.00 3.00 X 0 0 0 WILLIAM JONES III 1.00 3.00 X 0 0 0 E LORI SMITH 1.00 3.00 X 0 0 0 FRANKLIN SHOENEMAN 1.00 3.00 X X 0 0 0 SYED SHAH MD 1.00 3.00 X 0 0 0 DIANE BORIS 14.00 26.00 X 117112 0 22095 DARNELL FURER 19.80 20.20 X 175335 0 19859 DR THOMAS CURRY 14.00 26.00 X 0 134933 10388 JOHN RUSSO 40.00 X 276474 0 20446 EARL WATERS JR 40.00 X 148751 0 22981 LESLIE DUBOWITZ 40.00 X 126469 0 18478 BRIAN PAUL 20.00 20.00 X 139307 0 22194 ROBERT KARETSKY 20.00 20.00 X 119449 0 13527 1102897 600014 173836 13 0 1 0 SODEXHO INC & AFFILIATES PO BOX 360710 PITTSBURGH PA 152516922 DIETARY & HOUSEKEEPING SERVICES 972029 REHAB CARE GROUP INC PO BOX 502096 ST LOUIS MO 631502096 MGMT FIRM-INPAT-REHAB UNIT 913579 POTTSVILLE HOSPITALISTS PO BOX 1125 POTTSVILLE PA 17901 PHYSICIAN SERVICES 641750 PH ANESTHESIA ASSOCIATES 420 SOUTH JACKSON STREET POTTSVILLE PA 17901 ANESTHESIOLOGIST SERVICES 439003 DIAGNOSTIC IMAGING INC 25983 NETWORK PLACE CHICAGO IL 60673 INTERVENTIONAL RADIOLOGIST SERVICES 343300 16 301979 202805 504784 NET PATIENT SERVICE REV 621400 57405215 57405215 57405215 72972 72972 251658 133571 118087 118087 118087 9292 0 9292 9292 9292 2179 0 2179 2179 MEANINGFUL USE 561439 1713977 1713977 ALCOHOL & DRUG REV 561439 352621 352621 LAB AND BILLING SERVICE REVENUE 621400 297951 297951 434361 434361 2798910 60911439 57757836 297951 2350868 850 850 346379 346379 26519325 20824528 5694797 710333 710333 5151002 13307 5137695 1962368 1528575 433793 252668 252668 71752 71752 55879 55879 6032377 4160928 1871449 95621 95621 7296855 6366169 930686 1151654 38619 1113035 31297 16184 15113 16254 6993 9261 226785 226785 3654207 3654207 882777 882777 BAD DEBT EXPENSE 3911780 3911780 DRUGS 1845735 1845735 DATA PROCESSING 554890 84883 470007 FOOD 523447 522263 1184 463816 15012 448804 61758051 44099595 17658456 0 1234 1235 745115 684186 33665 33665 6857309 6893243 1035606 1094871 600277 522058 84645334 68410509 15440906 16234825 3743146 3764875 1533963 1685836 3532018 2345596 33523239 33260390 4589035 4227552 686686 730113 2727422 1841149 3853832 5634993 11856975 12433807 X 20733288 19883222 259584 263038 673392 680323 21666264 20826583 33523239 33260390 X -846612 6931 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 55879 55879 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: THE SCHUYLKILL MEDICAL CENTER - EAST NORWEGIAN STREET IS A MEMBER OF THE HOSPITAL & HEALTH SYSTEM ASSOCIATION OF PENNSYLVANIA. A PERCENTAGE OF THE DUES PAID TO THE HOSPITAL & HEALTH SYSTEM ASSOCIATION GOES TOWARDS LOBBYING EFFORTS. THEIR MISSION IS TO ADVANCE THE HEALTH OF INDIVIDUALS AND COMMUNITIES TO LEAD, REPRESENT, AND SERVE HEALTH CARE PROVIDER ORGANIZATIONS THAT ARE ACCOUNTABLE TO THE COMMUNITY, AND COMMITTED TO HEALTH IMPROVEMENT. 559398 559398 51156234 42854484 8301750 31683006 25420450 6262556 1246696 135575 1111121 16234825 LONG TERM INVESTMENTS 175002 F INVESTMENT IN PA COMMUNITY HOSPITAL ASSOCIATION 403754 F INVESTMENT IN SCHUYLKILL HEALTH SYSTEM MEDICAL MALL LP 224404 F CASH SURRENDER VALUE LIFE INSURANCE 152563 F DEFERRED COMP ACCOUNT 730113 F 1685836 DUE FROM AFFILIATES 980341 BENEFICIAL INTEREST IN PERPETUAL TRUSTS 170324 INSURANCE RECOVERIES RECEIVABLE 1194931 2345596 PENSION LIABILITY 717741 BLUE CROSS CURRENT FINANCING ADVANCE 419600 CAPITAL LEASE OBLIGATION 2677699 ESTIMATED MALPRACTICE LIABILITY 1819953 5634993 X 57137982 -3904849 -3904849 61042831 -131392 -131392 60911439 57977663 131392 131392 57846271 3911780 3911780 61758051 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: THE CORPORATION PRESCRIBES A RECOGNITION THRESHOLD OF MORE-LIKELY-THAN-NOT TO BE SUSTAINED UPON EXAMINATION BY THE APPROPRIATE TAXING AUTHORITY IN RECORDING TAX LIABILITIES IN THE FINANCIAL STATEMENTS. MEASUREMENT AND RECOGNITION OF THE TAX UNCERTAINTY OCCURS IF THE RECOGNITION THRESHOLD HAS BEEN MET. THE CORPORATION'S FEDERAL EXEMPT ORGANIZATION RETURNS OF INCOME TAX FOR THE YEARS ENDED PRIOR TO JUNE 30, 2010 NO LONGER REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. PART XI, LINE 2D - OTHER ADJUSTMENTS: VALUATION GAIN 6,931. PROVISION FOR BAD DEBTS, NETTED ON FINANCIAL STATEMENTS -3,911,780. PART XI, LINE 4B - OTHER ADJUSTMENTS: RENTAL EXPENSES -133,571. GROSS SALES OF INVENTORY, NETTED ON F/S 2,179. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 133,571. GROSS SALES OF INVENTORY, NETTED ON F/S -2,179. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS, NETTED ON FINANCIAL STATEMENTS 3,911,780. CENTRAL AMERICA AND THE CARIBBEAN INVESTMENT 403754 0 0 0 0 0 0 403754 0 403754 0 0 1 0 0 0 1 1 1 X 175.000000000000 1 X 1 1 0 1 1 262123 262123 0.00450 5240815 2856452 2384363 0.04120 5502938 2856452 2646486 0.04570 6 122 52143 52143 0.00090 2 19 86580 86580 0.00150 960954 505933 455021 0.00790 8 141 1099677 505933 593744 0.01030 8 141 6602615 3362385 3240230 0.05600 32162 32162 0.00060 32162 32162 0.00060 1 1619831 1619831 28400598 26530712 1869886 X 1 1 1 1 SCHUYLKILL MEDICAL CENTER - EAST NORWEGI

700 EAST NORWEGIAN STREET POTTSVILLE PA 17901

X X X SCHUYLKILL MEDICAL CENTER EAST NORWEGIAN 1 1 X X X X X X X X 12 1 1 1 X X X X X X X X X X 0 0 1 1 175.000000000000 1 250.000000000000 1 X X X X X X 1 1 X X 1 0 X 1 X 0 0 PART I, LINE 7: SCHUYLKILL MEDICAL CENTER - EAST COMPUTED A COST TO CHARGE RATIO USING INFORMATION FROM THE MOST RECENTLY FILED MEDICARE COST REPORT (FYE 6/30/13) FOR THE CALCULATION OF COSTS FOR CHARITY CARE AND MEDICAID. DIRECT COSTS ARE OBTAINED FROM THE HOSPITAL COMPUTER SYSTEM FOR EACH COST CENTER FOR ALL OTHER BENEFITS. INDIRECT COSTS ARE COMPUTED UTILIZING THE MOST RECENTLY FILED MEDICARE COST REPORT (FYE 6/30/13). PART I, LINE 7G: THERE ARE NO PHYSICIAN CLINICAL SERVICES INCLUDED. PART I, L7 COL(F): THE AMOUNT OF BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25 COLUMN (A) BUT SUBTRACTED OUT FOR PURPOSES OF CALCULATING THE PERCENTAGE ON SCH H, PART I, LINE 7, COLUMN (F) IS $3,911,780. PART III, LINE 4: ACCOUNTS RECEIVABLE, OTHER ARE REPORTED AT NET REALIZABLE VALUE. ACCOUNTS ARE WRITTEN OFF WHEN THEY ARE DETERMINED TO BE UNCOLLECTIBLE BASED UPON MANAGEMENT'S ASSESSMENT OF INDIVIDUAL ACCOUNTS. THE ALLOWANCE FOR DOUBTFUL COLLECTIONS IS ESTIMATED BASED UPON A PERIODIC REVIEW OF INDIVIDUAL ACCOUNTS.ALL APPROPRIATE DISCOUNTS AND PAYMENTS ARE REFLECTED ON EACH PATIENTS' ACCOUNT. ONCE A PATIENT IS IDENTIFIED AS BAD DEBT, THE BALANCE THAT IS BAD DEBT WOULD BE CHARGES NET OF ANY PAYMENTS OR ADJUSTMENTS. THE COST OF BAD DEBT EXPENSE IS CALCULATED BY USING THE COST TO CHARGE RATIO FROM THE MOST RECENTLY FILE MEDICARE COST REPORT AND APPLYING THAT TO THE CHARGE.WE BELIEVE THAT A PORTION OF OUR BAD DEBT RESULTS FROM SERVICES PROVIDED TO PATIENTS WHO MEET THE CHARITY CARE GUIDELINES BUT WERE UNABLE OR UNWILLING TO PROVIDE THE APPROPRIATE DOCUMENTATION TO ALLOW THAT CLASSIFICATION. THESE WOULD BE CLASSIFIED AS BAD DEBT EXPENSE TIMES THE COST TO CHARGE RATIO TO ARRIVE AT THE COST. PART III, LINE 8: THE HOSPITAL USES THE COST-TO-CHARGE RATIO TO DETERMINE THE MEDICARE ALLOWABLE COSTS. PART III, LINE 9B: THE ORGANIZATION DOES HAVE A WRITTEN DEBT COLLECTION POLICY. ALL STAFF INVOLVED IN DEBT COLLECTION (EMPLOYEES OF THE MEDICAL CENTER AND ANY THIRD PARTY AGENCIES) ARE TRAINED ON THE POLICY AS WELL AS THE CHARITY CARE POLICY. IN DEALING WITH PATIENTS IN DEBT COLLECTION, STAFF WILL INFORM PATIENTS OF THE CHARITY CARE POLICY THAT IS AVAILABLE AND ALSO ANY OTHER FINANCIAL ASSISTANCE POLICIES OF THE MEDICAL CENTER THAT MAY BE APPLICABLE TO THE PATIENT. THE STAFF WILL INSTRUCT PATIENTS ON APPROPRIATE PAPERWORK THAT NEEDS TO BE COMPLETED IN REGARDS TO CHARITY CARE OR FINANCIAL ASSISTANCE. SCHUYLKILL MEDICAL CENTER EAST NORWEGIAN PART V, SECTION B, LINE 3: SCHUYLKILL HEALTH PARTNERED WITH STRATEGY SOLUTIONS TO CONDUCT THE ASSESSMENT. WITH THEIR HELP, SCHUYLKILL HEALTH IDENTIFIED 11 COMMUNITY MEMBERS TO SERVE ON A STEERING COMMITTEE TO CONDUCT THIS ASSESSMENT. THE 11 COMMUNITY MEMBERS INCLUDED LEADERS IN EDUCATON, BUSINESS, PUBLIC SERVICES, HUMAN SERVICES, AND PUBLIC HEALTH OFFICIALS. SCHUYLKILL MEDICAL CENTER EAST NORWEGIAN PART V, SECTION B, LINE 4: SCHUYLKILL MEDICAL CENTER - SOUTH JACKSON STREET SCHUYLKILL MEDICAL CENTER EAST NORWEGIAN PART V, SECTION B, LINE 7: SCHUYLKILL HEALTH DID NOT ADDRESS ALL NEEDS IN THE ASSESSMENT. SCHUYLKILL HEALTH LEADERSHIP HAD A MEETING TO DISCUSS WHAT ITEMS WOULD BE BEST HANDLED BY EACH FACILITY. THE ITEMS THAT THEY DID NOT ADDRESS WERE THEN GIVEN TO THE APPROPRIATE COMMUNITY ORGANIZATIONS THAT WOULD BE ABLE TO BEST HANDLE THEM. SCHUYLKILL COUNTY VISION ADDRESSES 2 ISSUES THAT WERE IDENTIFIED: 1) PHYSICAL ACTIVITY, NUTRITION AND OBESITY AND 2) UNINTENTIONAL INJURIES FROM MOTOR VEHICLES. SCHUYLKILL COUNTY VISION TOOK THIS ISSUE ON BECAUSE THEY DEAL WITH A DIVERSE GROUP OF ORGANIZATIONS THAT WOULD BE ABLE TO IMPROVE THESE NEEDED BETTER THAN THE HEALTH SYSTEM. SCHUYLKILL COUNTY DRUG AND ALCOHOL PROGRAM ALSO HANDLED ONE OF THE RECOGNIZED NEEDS FROM THE ASSESSMENT. THEY HANDLED THE NEED TO IMPROVE MENTAL HEALTH AND CONTROL DRUG AND ALCOHOL ABUSE. THEY CHOSE TO ADDRESS THIS NEED BECAUSE THEY WORK WITH THESE ISSUES ALREADY AND ARE MORE PREPARED TO ADDRESS THIS NEED THAN THE HEALTH SYSTEM. SCHUYLKILL MEDICAL CENTER EAST NORWEGIAN PART V, SECTION B, LINE 12H: THE SIZE OF THE FAMILY - THE LARGER THE NUMBER OF PEOPLE IN THE PATIENT'S FAMILY COULD ADJUST HOW MUCH OF A BENEFIT THEY RECEIVE. SCHUYLKILL MEDICAL CENTER EAST NORWEGIAN PART V, SECTION B, LINE 18E: WHEN A PATIENT DOES NOT MAKE A PAYMENT A PATIENT IS EVALUATED TO DETERMINE IF THEY MEET THE GUIDELINES FOR FINANCIAL ASSISTANCE. IF THEY DO, THEY ARE THEN GIVEN THE PROPER INFORMATION. SCHUYLKILL MEDICAL CENTER EAST NORWEGIAN PART V, SECTION B, LINE 20D: THE SAME POLICY IS USED FOR EMERGENCY OR MEDICALLY NECESSARY CARE THAT IS USED FOR ANY OTHER TYPE OF CARE. THERE IS A STANDARD AMOUNT CHARGED FOR A PROCEDURE PER THE HOSPITAL'S CHARGE MASTER. PART VI, LINE 2: SCHUYLKILL MEDICAL CENTER - EAST NORWEGIAN STREET (SMS-ENS) WORKS WITH SCHUYLKILL MEDICAL CENTER - SOUTH JACKSON STREET (SMS-SJS) IN ASSESSING THE HEALTH NEEDS OF THE COMMUNITY IT IS LOCATED IN AND SERVES; SCHUYLKILL COUNTY IN PENNSYLVANIA. BOTH MEDICAL CENTERS ALSO WORK WITH VARIOUS CITY, COUNTY AND STATE AGENCIES TO SPECIFICALLY IDENTIFY THE HEALTH NEEDS OF THE RESIDENTS OF SCHUYLKILL COUNTY.SMC-ENS IS LOCATED IN POTTSVILLE, WHICH IS THE COUNTY SEAT FOR SCHUYLKILL COUNTY. SCHUYLKILL COUNTY IS A RURAL COUNTY. THE COUNTY HAS AN UNEMPLOYMENT RATE OF OVER 9%, 19% OF THE RESIDENTS ARE COVERED BY MEDICAID, AND 18% OF THE RESIDENTS ARE OVER THE AGE OF 65.SMC-ENS IS A 126 BED ACUTE CARE FACILITY THAT PROVIDES ACUTE MEDICAL SURGICAL CARE, ACUTE REHAB SERVICES AND SENIOR BEHAVIORAL HEALTH SERVICES TO THE COMMUNITY.THE INFORMATION FOR THE NEEDS ASSESSMENT WAS GATHERED IN 2 DIFFERENT WAYS. THE FIRST WAY WAS TO SET UP A COMMITTEE OF 11 DIFFERENT MEMBERS FOR VARIOUS DIFFERENT GROUPS IN THE COMMUNITY TO DISCUSS WHAT WAS NEEDED TO IMPROVE THE HEALTH OF THE COMMUNITY. QUALITATIVE AND QUANTITATIVE DATA COLLECTION WAS ALSO USED TO ANALYZE WHAT WAS NEEDED TO IMPROVE THE HEALTH OF COMMUNITY MEMBERS.SMC-ENS WORKS WITH THE SOCIAL SERVICE AGENCIES, LOCAL DEPARTMENT OF HEALTH, THE CHAMBER OF COMMERCE, UNITED WAY, AMERICAN CANCER SOCIETY, LOCAL SCHOOLS, LOCAL SUPPORT GROUPS, PHYSICIAN OFFICES AND OTHER HEALTHCARE ORGANIZATIONS IN IDENTIFYING THE HEALTHCARE NEEDS OF THE LOCAL COMMUNITIES AND THE SERVICES THAT ARE NEEDED. AFTER A NEED HAS BEEN IDENTIFIED, THE MEDICAL CENTER WORKS WITH THESE ORGANIZATIONS TO HELP PROVIDE THE SERVICE TO RESIDENTS.THE MEDICAL CENTER ALSO WORKS WITH HEALTHCARE ORGANIZATIONS OUTSIDE SCHUYLKILL COUNTY TO HELP BRING HEALTHCARE SERVICES TO THE COUNTY. THIS ALLOWS COUNTY RESIDENTS TO OBTAIN NECESSARY SERVICES CONVENIENTLY WITHIN THE COUNTY.THE MEDICAL CENTER ALSO REVIEWS INTERNAL DATA ON ADMISSIONS, EMERGENCY ROOM VISITS, CLINIC VISITS AND DIAGNOSIS TO HELP IDENTIFY COMMUNITY NEEDS. THIS INFORMATION IS REVIEWED ANNUALLY AS PART OF THE BUDGET AND STRATEGIC PLANNING PROCESS.THE BOARD OF THE MEDICAL CENTER IS COMPRISED OF INDIVIDUALS FROM THE COMMUNITY REPRESENTING SOCIAL SERVICE AGENCIES, EDUCATION, ASSISTED LIVING/LONG TERM CARE, PHYSICIANS, MATERNAL/CHILD HEALTH AND LOCAL BUSINESSES. THESE INDIVIDUALS ALSO PROVIDE INPUT ON THE NEEDS OF THE COMMUNITY IN MEETING HEALTHCARE NEEDS. PART VI, LINE 3: EACH PATIENT IS REGISTERED INTO THE HOSPITAL COMPUTER SYSTEM WHEN THEY ARRIVE FOR SERVICES. AS PART OF THE REGISTRATION, INFORMATION IS OBTAINED ON ANY HEALTH INSURANCE THEY HAVE. INDIVIDUALS WITHOUT HEALTH INSURANCE ARE INFORMED AT THAT TIME OF THE MEDICAL CENTER'S CHARITY CARE POLICY. PATIENTS ARE GIVEN INFORMATION ON CONTACTING STAFF WITHIN THE HOSPITAL PATIENT ACCOUNTING DEPARTMENT TO DISCUSS APPLYING FOR THE HOSPITAL CHARITY CARE PROGRAM. SPECIFIC STAFF HAS BEEN TRAINED AND ARE RESPONSIBLE FOR ADMINISTERING THE CHARITY CARE PROGRAM FOR THE HOSPITAL. HOSPITAL STAFF CONTACT PATIENTS WITHOUT INSURANCE AND EXPLAIN THE POLICY AND THE INFORMATION NEEDED TO APPLY. HOSPITAL STAFF WILL ALSO ASSIST PATIENTS IN APPLYING FOR MEDICAL ASSISTANCE. THEY WILL ALSO ASSIST PATIENTS IN COMPLETING THE APPLICATION AND GATHERING THE NECESSARY FINANCIAL DOCUMENTS.THE MEDICAL CENTER ALSO POSTS INFORMATION WITHIN THE ADMISSION AND EMERGENCY ROOM AREAS INFORMING PATIENTS THAT THERE IS A CHARITY CARE POLICY AVAILABLE. ALL REGISTRATION PERSONNEL ARE TRAINED ON THE POLICY SO THAT THEY ARE ABLE TO INFORM PATIENTS WHEN THEY ARE REGISTERED.OTHER HOSPITAL STAFF MEMBERS THAT MAY COME IN CONTACT WITH PATIENTS ARE ALSO EDUCATED REGARDING THE CHARITY CARE POLICY. THIS WOULD INCLUDE SOCIAL WORKERS, CARE MANAGERS, NURSING STAFF AND ALL DEPARTMENT DIRECTORS. THE CHARITY CARE POLICY IS AVAILABLE ON THE HOSPITAL INTRANET WHICH IS ACCESSIBLE BY ALL EMPLOYEES. THE HOSPITAL IS ALSO IN THE PROCESS OF PLACING THE POLICY ON THE HOSPITAL WEBSITE.ALL PATIENT ACCOUNTING, CASHIERING AND COLLECTION STAFF ARE ALSO EDUCATED ON THE CHARITY CARE POLICY AND CAN ASSIST PATIENTS IN APPLYING FOR CHARITY CARE. ALSO ALL THIRD PARTY ORGANIZATIONS THAT WORK ON BEHALF OF THE MEDICAL CENTER IN PERFORMING COLLECTIONS HAVE ALSO BEEN EDUCATED ON THE CHARITY CARE POLICY AND CAN ALSO ADVISE PATIENTS ON APPLYING FOR THIS BENEFIT. PART VI, LINE 4: SMC-ENS IS LOCATED IN POTTSVILLE, PENNSYLVANIA. THE MEDICAL CENTER SERVES ALL OF SCHUYLKILL COUNTY. SCHUYLKILL COUNTY IS A RURAL COUNTY IN PENNSYLVANIA. POTTSVILLE IS THE LARGEST POPULATION CENTER OF SCHUYLKILL COUNTY AND IS ALSO THE COUNTY SEAT. THE COUNTY IS COMPRISED OF ONE SMALL CITY AS WELL AS SEVERAL BOROUGHS AND TOWNSHIPS.THE POPULATION OF THE COUNTY IS APPROXIMATELY 147,000. APPROXIMATELY 20% OF THE POPULATION IS UNDER THE AGE OF 18 AND 18% IS OVER THE AGE OF 65. THE POPULATION IS 49% FEMALE AND 95% WHITE. APPROXIMATELY 14% OF THE POPULATION HAS A BACHELOR'S DEGREE OR HIGHER. 11.8% OF THE POPULATION IS BELOW THE POVERTY LEVEL. THE UNEMPLOYMENT RATE IS 9.3%.19% OF THE POPULATION IS INSURED BY MEDICAID. 42% OF THAT NUMBER ARE UNDER THE AGE OF 18, 13% ARE OVER THE AGE OF 65 AND 18 % ARE DISABLED. MORE THAN 50% OF THE BIRTHS ARE COVERED BY THE MEDICAID PROGRAM.IN A RECENT REPORT RELEASED BY THE ROBERT WOOD JOHNSON FOUNDATION AND THE UNIVERSITY OF WISCONSIN'S POPULATION HEALTH INSTITUTE, SCHUYLKILL COUNTY WAS RANKED THE 57TH HEALTHIEST OF THE 67 COUNTIES IN PENNSYLVANIA. SCHUYLKILL COUNTY HAD HIGHER THAN THE STATE AND NATIONAL RATES FOR SMOKING, OBESITY, EXCESSIVE DRINKING AND MOTOR VEHICLE CRASH DEATH RATES. THIS REPORT ALSO SHOWED THAT THE COUNTY HAD ACCESS TO FEWER PRIMARY CARE PHYSICIANS.THE DEMOGRAPHICS OF THE PATIENTS ADMITTED TO SMC-ENS WERE 74 % MEDICARE, 7% MEDICAID AND 1% SELF PAY. EMERGENCY PATIENTS AT SMC-ENS ARE 22% MEDICARE, 20% MEDICAID AND 10% SELF PAY.SCHUYLKILL COUNTY HAS THREE HOSPITALS SERVING THE COUNTY. SMC-ENS AND SCHUYLKILL MEDICAL CENTER - SOUTH JACKSON STREET ARE BOTH LOCATED IN POTTSVILLE AND SERVE THE MAJORITY OF THE COUNTY RESIDENTS. ST. LUKE'S MINERS MEMORIAL HOSPITAL IS LOCATED IN COALDALE NEAR THE CARBON COUNTY BORDER. PART VI, LINE 5: THE BOARD OF SMC - ENS IS COMPRISED OF SEVENTEEN INDIVIDUALS FROM THE SCHUYLKILL COUNTY COMMUNITY. THESE INDIVIDUALS ARE NOT EMPLOYED BY THE MEDICAL CENTER. THEY ARE INVOLVED IN EDUCATION, SOCIAL SERVICES, GERIATRIC SERVICES, MATERNAL/CHILD SERVICES, PRIMARY MEDICAL CARE, CRIMINAL JUSTICE, SMALL BUSINESS AND MANUFACTURING. ALL PHYSICIANS ARE ENCOURAGED TO APPLY FOR MEDICAL STAFF PRIVILEGES FOR THE MEDICAL CENTER.SMC-ENS ALSO WORKS WITH VARIOUS COMMUNITY ORGANIZATIONS TO HELP IDENTIFY COMMUNITY NEEDS AND WORK TOGETHER TO MEET THOSE NEEDS. THE MEDICAL CENTER OPENED A WOUND CARE DEPARTMENT TO HELP IN DEALING WITH THE HIGH INCIDENT OF DIABETES WITHIN THE COUNTY POPULATION. THE MEDICAL CENTER ALSO HAS A CERTIFIED DIABETES EDUCATOR AVAILABLE TO CONSULT WITH PATIENTS AND ALSO WITH PHYSICIANS WHEN THEY HAVE A PATIENT THAT IS NEWLY DIAGNOSED WITH DIABETES. THE MEDICAL CENTER HAS AN OUTPATIENT DENTAL CLINIC AVAILABLE FOR THOSE PATIENTS WITH MEDICAID OR NO INSURANCE. THIS CLINIC HAD BEEN OPENED BASED ON THE NEED FOR DENTAL CARE FOR PATIENTS WITH MEDICAID OR LACK OF INSURANCE. THE MEDICAL CENTER ALSO WORKS WITH THE COUNTY SOCIAL SERVICE AGENCIES AND CRIMINAL JUSTICE DEPARTMENT ON OUTPATIENT DRUG AND ALCOHOL ISSUES. THE COUNSELING SERVICES OF THE MEDICAL CENTER PROVIDE OUTPATIENT DRUG AND ALCOHOL COUNSELING SERVICES IN BOTH INDIVIDUAL AND GROUP SETTINGS. THE COUNSELING SERVICES DEPARTMENT ALSO PROVIDES NICOTINE CESSATION COUNSELING AS WELL AS PARTICIPATING IN A GRANT PROGRAM WITH THE SOUTHEASTERN PENNSYLVANIA REGIONAL TOBACCO PROJECT.THE EMERGENCY DEPARTMENT OF SMC-ENS IS A 24 HOUR EMERGENCY ROOM AVAILABLE TO ALL REGARDLESS OF THEIR ABILITY TO PAY. THE MEDICAL CENTER PARTICIPATES IN MANY INSURANCE PROGRAMS SUCH AS MEDICARE, MEDICAID, CHAMPUS AND VA. THE MEDICAL CENTER ALSO HAS A CHARITY CARE POLICY THAT PROVIDES ASSISTANCE TO ELIGIBLE INDIVIDUALS IN PROVIDING FREE OR DISCOUNTED CARE BASED ON THEIR ABILITY TO PAY AND THE FEDERAL POVERTY GUIDELINES.SMC-ENS ALSO PROVIDES OPPORTUNITIES TO STUDENTS IN HEALTHCARE FIELDS TO GAIN EXPERIENCE WORKING IN THE HEALTH CARE ENVIRONMENT SUCH AS NURSING STUDENTS (RN AND LPN), PHARMACY STUDENTS, PHYSICIAN ASSISTANT STUDENTS, PHYSICAL THERAPY STUDENTS, RADIOLOGY TECHNICIANS AND MEDICAL ASSISTANTS. THE MEDICAL CENTER ALSO PROVIDES A VOLUNTEER PROGRAM FOR JUNIOR HIGH AND HIGH SCHOOL STUDENTS TO BECOME FAMILIAR WITH THE MEDICAL SERVICES OFFERED AND THE EDUCATIONAL OPPORTUNITIES AVAILABLE WITHIN THE HEALTHCARE ENVIRONMENT.THE MEDICAL CENTER ALSO SPONSORS AND PARTICIPATES IN HEALTH FAIRS AT COMMUNITY EVENTS SUCH AS THE COUNTY FAIR, EVENTS AT THE LOCAL MALL, HEALTH SCREENINGS, BLOOD PRESSURE SCREENINGS, VETERAN'S BREAKFAST EVENT, MEALS ON WHEELS, SKIN CANCER SCREENINGS, MAMMOGRAPHY SCREENINGS, BLOOD PRESSURE CLINICS, SUPPORT GROUPS AND LOCAL AMERICAN CANCER SOCIETY RELAY FOR LIFE.ANY EXCESS FUNDS THAT ARE GENERATED FROM OPERATIONS ARE INVESTED BACK INTO THE MEDICAL CENTER BY PURCHASING NECESSARY CAPITAL EQUIPMENT, FUNDING CAPITAL IMPROVEMENT PROJECTS, FUNDING NEW SERVICES, IMPROVING AND EXPANDING EXISTING SERVICES AND ANY OTHER GENERAL IMPROVEMENTS TO PATIENT CARE. PART VI, LINE 6: ON AUGUST 1, 2008, SMC-ENS AND SMC-SJS AFFILIATED UNDER THE CONTROL OF SCHUYLKILL HEALTH SYSTEM. THE PRIMARY SERVICE AREA IS POTTSVILLE AND THE SURROUNDING COMMUNITIES IN SCHUYLKILL COUNTY. THE PURPOSE OF BOTH MEDICAL CENTERS IS TO ENGAGE IN ACTIVITIES RELATED TO THE PROMOTION OF HEALTH OF THE PEOPLE IN THE SERVICE AREA, WORK CHARITABLY TO PROMOTE COMMUNITY HEALTH EDUCATION, PREVENTION OF ILLNESS AND INJURY AND PROVISION OF MEDICAL SERVICES TO THE DIVERSE POPULATION OF THE SERVICE AREA AND ENGAGE IN ANY AND ALL ACTIVITIES CONSISTENT WITH OR IN FURTHERANCE OF THESE PURPOSES.EACH MEDICAL CENTER OPERATES INDEPENDENTLY OF EACH OTHER BUT WORKS IN SYNC WITH EACH OTHER IN PROVIDING HEALTHCARE SERVICES TO THE RESIDENTS OF SCHUYLKILL COUNTY. BOTH MEDICAL CENTERS HAVE WORKED TO PROVIDE A CONTINUUM OF CARE SO THAT HEALTHCARE IS AVAILABLE WITHIN THE COUNTY AND RESIDENTS DO NOT HAVE TO TRAVEL OUTSIDE OF THE COUNTY FOR CARE. THE FOLLOWING SERVICES ARE AVAILABLE AT EITHER SMC-ENS OR SMC-SJS: - ACUTE CARE /MEDICAL SURGICAL SERVICES- INTENSIVE CARE SERVICES- MATERNITY SERVICES- NEWBORN SERVICES- PEDIATRICS SERVICES- ADOLESCENT, ADULT AND GERIATRIC BEHAVIORAL SERVICES- ACUTE REHAB AND TRANSITIONAL REHAB SERVICES- INPATIENT AND OUTPATIENT PHYSICAL THERAPY- INPATIENT AND OUTPATIENT DIAGNOSTIC SERVICES- HOME HEALTH SERVICES- OUTPATIENT DRUG AND ALCOHOL SERVICES- OUTPATIENT BEHAVIORAL HEALTH SERVICES- 24 HOUR EMERGENCY ROOM SERVICES- OUTPATIENT DENTAL CLINIC- INPATIENT AND OUTPATIENT SURGICAL SERVICES- COMMUNITY BENEFIT/CHARITY CARE SERVICES- ADVANCED WOUND CENTER- OUTPATIENT SURGERY CENTERSCHUYLKILL MEDICAL GROUP IS AN ORGANIZATION FORMED IN WHICH PHYSICIANS WOULD BE ABLE TO OPEN THEIR OWN PRACTICE BUT NOT INCUR ALL THE EXPENSES THAT THEY WOULD HAD THEY OPENED A PRACTICE ON THEIR OWN. THIS WAS DONE SO THAT MORE PHYSICIANS WOULD BE AVAILABLE TO THE PUBLIC IN THIS AREA. WITHOUT THIS ORGANIZATION THESE PHYSICIANS MAY BE PRACTICING IN A DIFFERENT AREA.SCHUYLKILL HEALTH SYSTEM IS AN ORGANIZATION FORMED TO RAISE FUNDS TO PROVIDE TO BOTH SMC - EAST AND SMC - SOUTH. THE MONEY RAISED IN THIS ORGANIZATION IS USED TO BENEFIT THE COMMUNITY IN VARIOUS WAYS. MONEY FROM THIS ORGANIZATION IS USED TO PURCHASE EQUIPMENT TO MAKE THE PUBLIC SAFER. IT IS ALSO USED TO FUND PROJECTS THAT WILL MAKE HEALTH CARE ACCESS EASIER TO THE PUBLIC. SCHUYLKILL REHAB IS AN ORGANIZATION WHO OFFERS REHABILITATION SERVICES TO THE PUBLIC. ONE SERVICE THAT THEY OFFER THAT BENEFITS THE PUBLIC ARE SEVERAL DIFFERENT PROGRAMS EACH YEAR ON HEALTH CARE TOPICS. THESE PROGRAMS ARE OFFERED FREE TO THE PUBLIC.SCHUYLKILL MEDICAL MALL/DEVELOPMENT CORP IS AN ORGANIZATION WHO OWNS AND OPERATES A MEDICAL OFFICE BUILDING NEAR SMC - EAST. THIS BUILDING OFFERS AN AREA FOR PHYSICIANS TO BE ABLE TO RENT SPACE FOR THEIR PRACTICE INSTEAD OF HAVING TO PURCHASE THEIR OWN SPACE.PART VI, LINE 7: N/A X X X X X 0 0 0 0 0 0 0 0 0 JOHN SIMODEJKA 0 465081 0 0 0 0 0 6125 0 17743 0 488949 0 0 DARNELL FURER 175335 0 0 0 0 0 4509 0 15350 0 195194 0 0 0 JOHN RUSSO 276474 0 0 0 0 0 4900 0 15546 0 296920 0 0 0 EARL WATERS JR 148751 0 0 0 0 0 3725 0 19256 0 171732 0 0 0 BRIAN PAUL 139307 0 0 0 0 0 2975 0 19219 0 161501 0 0 0 NEW PROGRAM SERVICES FORM 990, PART III, LINE 2 PET SCANS HAD PREVIOUSLY BEEN PERFORMED ONLY AT SCHUYLKILL MEDICAL CENTER - SOUTH JACKSON STREET (SOUTH). HOWEVER, IN THE DECEMBER 2012-JANUARY 2013 TIMEFRAME, THE PET SCANNING SERVICE WAS TRANSITIONED FROM SOUTH TO EAST, AND THE SERVICE WAS DISCONTINUED AT SOUTH. FORM 990, PART VI, SECTION A, LINE 3 THE HOSPITAL HAS DELEGATED MANAGEMENT DUTIES OVER ITS DIETARY AND HOUSEKEEPING SERVICES TO SODEXHO INC. AND AFFILIATES. MANAGEMENT DUTIES OVER ITS REHABILITATION SERVICES HAVE BEEN DELEGATED TO REHAB CARE GROUP, INC. MANAGEMENT OF WOUND CARE SERVICES IS MANAGED BY ACCELECARE. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS REVIEWED BY MANAGEMENT PRIOR TO ITS FILING WITH THE INTERNAL REVENUE SERVICE. SELECTED MEMBERS OF THE BOARD REVIEWED THE 990 WITH THE TAX RETURN PREPARER AND MANAGEMENT ON BEHALF OF THE BOARD. FORM 990, PART VI, SECTION B, LINE 12C EACH OFFICER, KEY EMPLOYEE, DIRECTOR OR TRUSTEE WITH BOARD DELEGATED AUTHORITY IS REQUIRED TO ANNUALLY SIGN A CONFLICT OF INTEREST DISCLOSURE STATEMENT. THESE STATEMENTS ARE REVIEWED BY THE PRESIDENT/CEO'S ADMINISTRATIVE ASSISTANT AND ANY CONFLICTS ARE REPORTED TO THE PRESIDENT/CEO. THE STATEMENTS ARE KEPT ON FILE IN THE PRESIDENT/CEO'S OFFICE AFTER REVIEW. BOARD MEMBERS ARE EXPECTED TO EXCUSE THEMSELVES FROM TAKING ANY ACTION OR EVEN DISCUSSING ISSUES OF RELATED PARTIES. IF THEY VIOLATE THESE RULES THEY ARE REMOVED FROM THE BOARD. FORM 990, PART VI, SECTION B, LINE 15 ANNUALLY, THE HOSPITAL CONTRACTS WITH YAFFE AND COMPANY, AN INDEPENDENT CONSULTANT, TO MAKE RECOMMENDATIONS TO THE COMPENSATION COMMITTEE, A SUB-COMMITTEE OF THE BOARD, BASED ON MARKET AND INDUSTRY DATA TO ENSURE THAT COMPENSATION IS PAID AT NO MORE THAN FAIR MARKET VALUE. THIS PROCESS IS USED FOR THE FOLLOWING POSITIONS: PRESIDENT/CEO, VICE PRESIDENT OF OPERATION/COO, VICE PRESIDENT OF NURSING/CNO, AND THE VICE PRESIDENT OF FINANCE/CFO. REVIEW AND APPROVAL IS DOCUMENTED IN BOARD AND COMMITTEE MEETING MINUTES. 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: TRANSFER OF ASSETS TO AFFILIATE VALUATION GAIN 6,931. SCHUYLKILL HEALTH SYSTEM 420 SOUTH JACKSON STREET POTTSVILLE PA 17901 262990543 TO SUPPORT, PROMOTE, ADVANCE & ENHANCE QUALITY OF LIFE OF SCHUYLKILL CNTY PA 501(C)(3) 11B N/A 0 SCHUYLKILL HEALTH SYSTEM MEDICAL GROUP INC 700 EAST NORWEGIAN STREET POTTSVILLE PA 17901 232866006 TO SUPPORT AND PROMOTE THE PURPOSES OF AFFILIATED ENTITIES PA 501(C)(3) 9 SCHUYLKILL HEALTH SYSTEM 0 SCHUYLKILL MEDICAL CENTER - SOUTH JACKSON STREET MAUCH CHUNK JACKSON STREETS POTTSVILLE PA 17901 231352202 OPERATES A HOSPITAL PROVIDING INPATIENT, OUTPATIENT & EMERGENCY SVCS PA 501(C)(3) 3 SCHUYLKILL HEALTH SYSTEM 0 SCHUYLKILL REHABILITATION CENTER INC 420 SOUTH JACKSON STREET POTTSVILLE PA 17901 232440891 OPERATES A COMPREHENSIVE REHABILITATION FACILITY PA 501(C)(3) 3 SCHUYLKILL HEALTH SYSTEM 0 SCHUYLKILL HEALTH SYSTEM MEDICAL MALL LP EAST NORWEGIAN TREMONT ST POTTSVILLE PA 17901 232514813 RENTAL PA N/A INVESTMENT 139125 208610 0 0 0.30910 SCHUYLKILL HEALTH SYSTEM DEVELOPMENT CORPORATION 700 EAST NORWEGIAN STREET POTTSVILLE PA 17901 232432417 PURSUES, IMPLEMENTS & FURTHERS THE ACTVTIES & PURPOSES OF THE SYS PA SCHUYLKILL MEDICAL CENTER - EAST NORWEGIAN STREET C 48991 296407 1.00000 0 SCHUYLKILL MEDICAL PLAZA - CONDOMINIUM ASSOCIATION 420 SOUTH JACKSON STREET POTTSVILLE PA 17901 232931821 CONDOMINIUM ASSOCIATION PA N/A C 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0