2013-04-11T16:16:41-05:00 2012-06-30 BKD LLP 910 E ST LOUIS 200 PO BOX 1190 SPRINGFIELD MO 658062523 990 2011-07-01 240802108 CHARLES COLE MEMORIAL HOSPITAL % RON RAPP CONTROLLER CHAR 8142749300 1001 EAST SECOND STREET COUDERSPORT PA 16915 EDWARD C PITCHFORD 2013-01-22 true Brian D Todd 4178658701 2011 2016-02-25 16:41:14Z EDWARD PITCHFORD 1001 EAST SECOND STREET COUDERSPORT PA 16915 82803029 false X http://www.charlescolehospital.com/ X 1967 PA CCMH PROVIDES EXCELLENT HEALTH CARE SERVICES BY PROVIDING INPATIENT, OUTPATIENT AND PRIMARY CARE SERVICES TO THE SURROUNDING COMMUNITY. SEE SCHEDULE O FOR MORE INFORMATION. 13 10 695 74 59861 58534 350224 702961 69567713 73182076 1031244 -24785 361647 200871 71310828 74061123 0 0 0 0 30837009 32066073 84000 48000 92843 38318324 41140996 69239333 73255069 2071495 806054 55302779 58973125 35146860 43577089 20155919 15396036 X THE PURPOSE OF CHARLES COLE MEMORIAL HOSPITAL IS TO PROVIDE EXCELLENT HEALTHCARE SERVICES, RESPONDING TO THE NEEDS OF THE COMMUNITIES WE SERVE. false false 17932993 38919673 CCMH OFFERS OUTPATIENT SERVICES, EXCEEDING 350,000 TESTS/TREATMENTS ANNUALLY THROUGHOUT THE HOSPITAL'S FOUR-COUNTY AREA AND INCLUDING IMAGING, LAB, AND REHABILITATION SERVICES. OUTPATIENT SURGERIES EXCEED 4,160 ANNUALLY. THE PATTERSON CANCER CARE CENTER OFFERS FULL SERVICE RADIATION AND MEDICAL ONCOLOGY SERVICES AND HOUSES AN AMERICAN CANCER SOCIETY PATIENT RESOURCE CENTER ONSITE. THE CANCER CENTER IS HOME TO A VARIETY OF SUPPORT GROUPS, AS WELL AS FREQUENT FREE CANCER SCREENINGS FOR THE PUBLIC. CCMH'S HOME HEALTH AND HOSPICE SERVICES ASSIST PATIENTS THROUGHOUT THE REGION, WITH A GROWING NUMBER OF REFERRALS AND LOWER INFECTION RATES AMONG STATE AND NATIONAL AVERAGES. 16653040 11486106 CHARLES COLE MEMORIAL HOSPITAL PROVIDES PRIMARY CARE TO ITS SURROUNDING COMMUNITIES. THE HOSPITAL PROVIDES PRIMARY CARE TO THE SURROUNDING COMMUNITIES IN FOUR COUNTIES AT RURAL HEALTH CENTERS (RHCS), LOCATED IN COUDERSPORT, GALETON, ULYSSES, WESTFIELD, SHINGLEHOUSE, PORT ALLEGANY, ELDRED, SMETHPORT, AND EMPORIUM. FOUR OF THOSE LOCATIONS ALSO INCLUDE WELLNESS AND REHABILITATION CENTERS, MAKING IT MORE CONVENIENT FOR PATIENTS TO RECEIVE THE CARE THEY NEED CLOSE TO HOME. ONE OUTLYING CENTER OFFERS IMAGING SERVICES, WHILE ALL RHCS PROVIDE LAB DRAWS SO PATIENTS DON'T HAVE TO DRIVE TO RECEIVE NECESSARY TESTING. SEE SCHEDULE O FOR FURTHER DETAIL. 12338161 19467936 CHARLES COLE MEMORIAL HOSPITAL OFFERS VARIOUS INPATIENT SERVICES. CCMH ADMITTED 2,770 PATIENTS LAST YEAR (5,260 ACUTE CARE DAYS) TO INPATIENT SERVICES INCLUDING MEDICAL/SURGICAL, INTENSIVE CARE AND OBSTETRICS UNITS. CCMH'S 24-HOUR EMERGENCY DEPARTMENT ADMITTED 865 PATIENTS LAST YEAR AND SAW 9,810 VISITS LAST YEAR. THE HOSPITAL'S MATERNITY UNIT WELCOMED 180 BABIES INTO THE WORLD LAST YEAR AND ALSO SUPPORTS MOTHERS-TO-BE WITH REGULAR LAMAZE AND BREASTFEEDING SUPPORT PROGRAMS AND THE HEALTHY BEGINNINGS PLUS PROGRAM FOR LOW INCOME MOTHERS. SEE SCHEDULE O FOR FURTHER DETAIL. 17147445 3308361 64071639 true true false true false false false false true true true false false true true false false true false false false false false true true false true true false false true false false false false false false true true false false false false false true true true false false true 44 0 true 695 true true true false false false false true true false false false false X 13 10 false false false false true true false true true false false true true true true true true true false false PA X RON RAPP CONTROLLER 8142745250 1001 EAST SECOND STREET COUDERSPORT PA 16915 X MICHAEL E CALLAHAN 40.0 X X 182397 0 16720 JASON TRONETTI 40.0 X 313542 0 23018 CHARLES UPDEGRAFF 1.0 X X 0 0 0 RON CASKEY 1.0 X X 0 0 0 REVEREND RANDALL HEADLEY 1.0 X X 0 0 0 KALLIOPI NESTOR 40.0 X 223861 0 21453 ROBERT SMITH 1.0 X 0 0 0 RUSSELL STREICH 1.0 X 0 0 0 DAVID BUCKLER 1.0 X 0 0 0 DAVID CRANDALL 1.0 X X 0 0 0 JEANNE MIGLICIO 1.0 X 0 0 0 THOMAS SHAFFER 1.0 X 0 0 0 CLIFFORD WOOD 1.0 X 0 0 0 PAUL PRITCHARD 1.0 X 0 0 0 EDWARD C PITCHFORD 40.0 X 283959 0 25719 CYNTHIA HARDESTY 40.0 X 164115 0 9762 BRADLEY F GIANNOTTI 40.0 X 871055 0 15142 TERRENCE L FOUST 40.0 X 724802 0 12056 SAKET PRASAD 40.0 X 574075 0 23971 CHRISTAN M CARAMIA 40.0 X 424927 0 24734 CELSO BACKES 40.0 X 382006 0 4775 4144739 0 177350 34 false true false JAMES BARKE MD PHYSICIAN 708963 FOOT ANKLE INNOV PHYSICIAN 447278 TAYLOR ARMSTRONG CONTRACTOR 203302 BKD LLP AUDIT/TAX/CONSULTING 104591 4 33246 35633 634082 702961 NET PATIENT SERVICE REVENUE 621990 69430673 69430673 OTHER REVENUE 621990 3751403 3751403 73182076 270083 270083 0 0 266341 268048 -1707 -1707 -1707 8104268 7666 8375507 31295 -271239 -23629 -294868 -294868 7680 33246 15067 -7387 -7387 0 77683 51989 25694 25694 GAIN ON INVESTMENT IN EQUITY INVESTEE 900099 145166 145166 INCOME FROM INVESTMENT IN SUBSIDIARIES 900099 39105 59861 -20756 184271 74061123 73182076 59861 116225 0 0 0 0 1340140 829771 510369 142608 142608 23442785 19973676 3469109 717086 604353 112733 4602668 3679928 922740 1820786 1513115 307671 387882 387882 83158 83158 112062 112062 0 48000 48000 67918 67918 15367945 14612649 755296 115420 3785 111635 4882150 3663225 1218925 0 0 2045529 1881409 164120 340802 300010 40792 0 244184 147149 97035 1124521 1006666 117855 0 2259226 2022450 236776 1050941 575038 475903 MEDICAL SUPPLIES & DRUGS 9491781 9491781 BAD DEBT 3149056 3149056 LICENSES, DUES, SUBSCRIPTIONS 373578 229696 143882 OTHER AUXILIARY EXPENSES 44843 44843 73255069 64071639 9090587 92843 2828824 805193 3942066 1582372 71851 188609 7510740 8269567 0 0 0 0 0 0 1081698 1173740 1785764 1718605 65084813 41730718 23013598 23354095 12716424 14266810 1532975 1696602 396598 385098 0 0 422241 5532434 55302779 58973125 12962644 20839387 0 0 0 0 19534724 18686837 14430 18092 0 0 1239449 2948230 0 0 1395613 1084543 35146860 43577089 X 15669621 11287807 205421 230847 4280877 3877382 20155919 15396036 55302779 58973125 X 806054 -5565937 X false true true X false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 10700 10700 false LOBBYING ACTIVITIES SCHEDULE C, PART II-B, LINE 1I THE ORGANIZATION IS A MEMBER OF HAP, AHA, AND HCWP. $10,700 OF DUES ARE ATTRIBUTABLE TO LOBBYING ACTIVITIES. false true 4280877 -106295 297200 3877382 3667800 942900 329823 4280877 3616355 437150 385705 3667800 4837234 -1006344 214535 3616355 1.00000 true false 1135847 1135847 36964876 20738910 16225966 24260927 19751659 4509268 2723163 1240149 1483014 23354095 DUE FROM AFFILIATES 38632 OTHER RECEIVABLES 5493802 5532434 0 DUE TO THIRD PARTY PAYERS 1084543 1084543 74061123 73255069 806054 -265931 -4979521 -5245452 -4439398 65836969 -265931 -8160237 -8426168 74263137 -202014 -202014 74061123 70276367 283115 283115 69993252 67918 3193899 3261817 73255069 ESCROW ACCOUNTS SCHEDULE D, PART IV, LINE 2B THE CORPORATION HAS AN ESCROW ACCOUNT FOR THEIR SKILLED NURSING FACILITY PATIENTS WHO REQUEST THE USE OF THE ACCOUNT. THIS AMOUNT IS REPORTED ON FORM 990, PART X, LINE 21. ENDOWMENT FUND SCHEDULE D, PART V, LINE 4 THE ENDOWMENT FUND WAS ESTABLISHED TO ALLOW THE HOSPITAL TO PROVIDE HEALTHCARE SERVICES TO POOR AND NEEDY PATIENTS. UNCERTAIN TAX POSITIONS SCHEDULE D, PART X, LINE 2 MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. OTHER CHANGES IN NET ASSETS SCHEDULE D, PART XI, LINE 8 DEFINED BENEFIT PENSION COSTS: AMORTIZATION OF NET LOSS $ 187,532 NET GAIN ARISING DURING YEAR ( 5,130,795) AUXILIARY NET INCOME 13,742 AUXILIARY TRANSFER TO CCMH ( 50,000) ------------- NET ADJUSTMENT ($4,979,521) OTHER REVENUE INCLUDED ON LINE 1, BUT NOT ON FORM 990, PART VIII, LINE 12 SCHEDULE D, PART XII, LINE 2D DEFINED BENEFIT PENSION COSTS: AMORTIZATION OF NET LOSS $ 187,532 NET GAIN ARISING DURING YEAR ( 5,130,795) BAD DEBT EXPENSE ( 3,149,056) INVESTMENT MANAGEMENT FEES ( 67,918) ------------- NET ADJUSTMENT ($8,160,237) OTHER REVENUE INCLUDED ON FORM 990, PART VIII, LINE 12, BUT NOT ON LINE 1 SCHEDULE D, PART XII, LINE 4B RENTAL EXPENSES ($ 268,048) AUXILIARY SPECIAL EVENTS 40,926 AUXILIARY SALES OF INVENTORY 77,683 AUXILIARY COST OF GOODS SOLD ( 51,989) AUXILIARY INTEREST INCOME 33 AUXILIARY OTHER INCOME 14,448 SPECIAL EVENTS EXPENSES ( 15,067) ------------- NET ADJUSTMENT ($ 202,014) OTHER EXPENSES INCLUDED ON LINE 1, BUT NOT ON FORM 990, PART IX, LINE 25 SCHEDULE D, PART XIII, LINE 2D RENTAL EXPENSES $ 268,048 SPECIAL EVENTS EXPENSES 15,067 ------------- NET ADJUSTMENT $ 283,115 OTHER EXPENSES INCLUDED ON FORM 990, PART IX, LINE 25, BUT NOT ON LINE 1 SCHEDULE D, PART XIII, LINE 4B OTHER AUXILIARY EXPENSES $ 44,843 BAD DEBT EXPENSE 3,149,056 ------------- NET ADJUSTMENT $3,193,899 X X true DELTA DEVELOPMENT GROUP INC GRANT WRITING false 48000 48000 PA GOLF TOURNAMENT 40926 33246 7680 2310 0 6394 4118 2245 0 0 40926 33246 7680 2310 0 6394 4118 2245 0 15067 -7387 FUNDRAISING ACTIVITIES SCHEDULE G, PART I, LINE 2B THE ORGANIZATION HIRED DELTA DEVELOPMENT GROUP, INC., FOR GRANT WRITING SERVICES. THE AGREEMENT PROVIDED FOR A MONTHLY FEE FOR PROFESSIONAL FUNDRAISING SERVICES AS WELL AS REIMBURSEMENT OF ADDITIONAL FUNDRAISING EXPENSES. true true X true X true X true true true false true true 716198 716198 0.01020 11445280 8238716 3206564 0.04570 0 0 0 0.00000 12161478 8238716 3922762 0.05590 82839 14908 67931 0.00100 333683 0 333683 0.00480 24469066 18261569 6207497 0.08850 0 0 0 0.00000 1430 0 1430 0.00000 24887018 18276477 6610541 0.09430 37048496 26515193 10533303 0.15020 0 0 0 0 0.00000 0 0 0 0 0.00000 4 129 171 0 171 0.00000 0 0 0 0 0.00000 12 228 5686 0 5686 0.00000 4 0 3956 0 3956 0.00010 20 460 4678 0 4678 0.00010 3 150 353 0 353 0.00000 0 0 0 0 0.00000 43 967 14844 0 14844 0.00020 true 3149056 494402 21408333 22119142 -710809 X true true 1 1 CHARLES COLE MEMORIAL HOSPITAL

1001 EAST 2ND STREET COUDERSPORT PA 16915

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SIZERVILLE ROAD EMPORIUM PA 15834

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30 RIVER STREET GALETON PA 16922

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222 CHURCH STREET WESTFIELD PA 16950

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111 WEST HONEOYE STREET SHINGLEHOUSE PA 16748

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511 ACADEMY STREET ULYSSES PA 16948

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46 ELK STREET COUDERSPORT PA 16915

RURAL HEALTH CENTER LAB SERVICES PERCENT OF TOTAL EXPENSE SCHEDULE H, PART I, LINE 7, COLUMN F TO ARRIVE AT THE PERCENT OF TOTAL EXPENSES, THE DENOMINATOR WHICH EQUALS TOTAL OPERATING EXPENSES PER PART IX, LINE 25, OF THE FORM 990 ($73,255,069) WAS REDUCED BY BAD DEBT EXPENSE ($3,149,056). SUBSIDIZED HEALTH SERVICES SCHEDULE H, PART I, LINE 7G SEVERAL RURAL HEALTH CLINICS WERE INCLUDED IN THE COMPUTATION OF SUBSIDIZED HEALTH SERVICES ON LINE 7G. CCMH PROVIDES PRIMARY CARE TO THE SURROUNDING COUNTIES AT THESE RURAL HEALTH CENTERS. THESE SERVICES ARE PROVIDED IN RURAL AREAS WHERE THERE WOULD BE A SHORTAGE OF QUALITY MEDICAL CARE WITHOUT THE SERVICES. CCMH CONTINUES TO PROVIDE THESE SERVICES AS A BENEFIT TO THE COMMUNITY DESPITE KNOWING THAT FINANCIAL SHORTFALLS WILL BE SUSTAINED. COSTING METHODOLOGY SCHEDULE H, PART I, LINE 7G THE COST TO CHARGE RATIO CALCULATED ON IRS WORKSHEET 2 WAS USED IN THE CALCULATION OF COST ON IRS WORKSHEETS 1 AND 3. OTHER IRS WORKSHEETS USED ACTUAL COST METHOD. BAD DEBT EXPENSE SCHEDULE H, PART III, SECTION A, LINE 4 THE AUDITED FINANCIAL STATEMENTS DO NOT CONTAIN A FOOTNOTE THAT DESCRIBES BAD DEBT EXPENSE. THEY DO, HOWEVER, CONTAIN A FOOTNOTE THAT DESCRIBES PATIENT ACCOUNTS RECEIVABLE: ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYER SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR UNCOLLECTIBLE ACCOUNTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYER SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR UNCOLLECTIBLE ACCOUNTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYER HAS NOT YET PAID, OR FOR PAYERS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR UNCOLLECTIBLE ACCOUNTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED OR PROVIDED BY POLICY) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. THE HOSPITAL'S ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR SELF-PAY PATIENTS INCREASED FROM 40% OF SELF-PAY ACCOUNTS RECEIVABLE AT JUNE 30, 2011, TO 47% OF SELF-PAY ACCOUNTS RECEIVABLE AT JUNE 30, 2012. THE HOSPITAL'S WRITE-OFFS DECREASED APPROXIMATELY $15,000 FROM APPROXIMATELY $3,028,000 FOR THE YEAR ENDED JUNE 30, 2011, TO APPROXIMATELY $3,013,000 FOR THE YEAR ENDED JUNE 30, 2012. OVERALL FOR THE YEAR ENDED JUNE 30, 2012, THE CHANGE IN WRITE-OFFS AND COLLECTION TRENDS REMAINED RELATIVELY CONSISTENT COMPARED TO THE PRIOR YEAR. LINE 2 REPORTS THE BAD DEBT ATTRIBUTABLE TO PATIENT ACCOUNTS FROM THE AUDITED FINANCIAL STATEMENTS. LINE 3 WAS DETERMINED BY MULTIPLYING THE BAD DEBT EXPENSE (LINE 2) BY THE PERCENT OF PERSONS BELOW THE POVERTY LEVEL BASED ON US CENSUS BUREAU DATA FOR 2006 - 2010. COMMUNITY BENEFIT SCHEDULE H, PART III, SECTION B, LINE 8 MEDICARE DATA COMPUTED USING THE MEDICARE COST REPORT FILED WITH CMS WAS UTILIZED FOR THE COMPUTATIONS IN PART III, SECTION B. MEDICARE SHORTFALL SHOULD BE TREATED AS A COMMUNITY BENEFIT, AS CCMH IS CLASSIFIED AS A CRITICAL ACCESS HOSPITAL. THIS CLASSIFICATION SHOWS THAT CCMH IS IN A MEDICALLY UNDERSERVED AREA AND AT A HEALTH PROFESSIONAL SHORTAGE AREA. THIS DEMONSTRATES THAT CCMH IS THE ONLY REASONABLE SOURCE OF HOSPITAL CARE AVAILABLE TO MEDICARE BENEFICIARIES IN OUR SERVICE AREA, AND LIKEWISE TREATS ALL BENEFICIARIES IN OUR SERVICE AREA THAT PRESENT THEMSELVES FOR CARE, DESPITE KNOWING WE WILL GENERALLY LOSE MONEY CARING FOR MEDICARE PATIENTS. ADDITIONALLY, SERVING PATIENTS WITH GOVERNMENT HEALTH BENEFITS, SUCH AS MEDICARE, IS A COMPONENT OF THE COMMUNITY BENEFIT STANDARD THAT TAX-EXEMPT HOSPITALS ARE HELD TO. THIS IMPLIES THAT SERVING MEDICARE PATIENTS IS A COMMUNITY BENEFIT AND THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. COLLECTION POLICY SCHEDULE H, PART III, SECTION C, LINE 9B EFFORTS ARE MADE TO IDENTIFY PATIENTS WHO MAY BE ELIGIBLE FOR CHARITY CARE IN ACCORDANCE WITH THE HOSPITAL'S CHARITY CARE POLICY OR THE PHYSICIAN NETWORK SLIDING FEE SCALE PRIOR TO THE STATEMENT PROCESS WHEN POSSIBLE. NEEDS ASSESSMENT SCHEDULE H, PART VI, LINE 2 COMPLETING A SERVICE AREA (4 COUNTIES) COMMUNITY HEALTH NEEDS ASSESSMENT WITH THE PROCESS BEGINNING IN JANUARY 2010 AND CONCLUDING IN MARCH 2010 WHEN CHARLES COLE MEMORIAL HOSPITAL RECEIVED OUTCOMES FROM THE SURVEY. SURVEYS WERE CONDUCTED BY TELEPHONE BY OKLAHOMA STATE UNIVERSITY. QUESTIONS WERE DETERMINED AT THE RECOMMENDATION OF OKLAHOMA STATE UNIVERSITY AND REVISED, AS DEEMED NECESSARY, BY CCMH. A TOTAL OF 200 PHONE SURVEYS WERE COMPLETED AND 48 ONLINE SURVEYS WERE SUBMITTED FROM ALL SERVICE AREA ZIP CODES. RESULTS WERE TALLIED AND ANALYZED BY OKLAHOMA STATE UNIVERSITY AND THEN PRESENTED TO CCMH AND A GROUP OF APPROXIMATELY 100 INDIVIDUALS FROM OUR COMMUNITY BENEFIT ADVISORY COMMITTEES (NOW KNOWN AS CORPORATE ADVISORS), CCMH PUBLIC RELATIONS COMMITTEE (A BOARD OF DIRECTOR'S SUB-COMMITTEE AND NOW KNOWN AS THE COMMUNITY RELATIONS COMMITTEE), CCMH LEADERSHIP AND CCMH BOARD OF DIRECTORS. IN ADDITION TO THE RECENT COMMUNITY HEALTH NEEDS ASSESSMENT, CCMH DETERMINES HEALTHCARE NEEDS OF THE COMMUNITIES WHICH WE SERVE THROUGH SURVEYS OF OUR COMMUNITY BENEFIT ADVISORY COMMITTEE MEMBERS, INDIVIDUAL RECOMMENDATIONS, BOARD OF DIRECTORS RECOMMENDATIONS, COMMUNITY EVENT SATISFACTION SURVEYS, AND LOCAL AND STATE HEALTHCARE TRENDS. PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE SCHEDULE H, PART VI, LINE 3 THE PATIENT FINANCIAL COUNSELOR CONTACTS SELF-PAY PATIENTS/GUARANTORS TO DISCUSS PAYMENT ARRANGEMENTS. IF THEY ARE UNABLE TO PAY - SHE EXPLAINS THE PROCESS OF APPLYING FOR CHARITY WHICH INCLUDES APPLYING FOR PA MEDICAL ASSISTANCE FIRST AND IF THEY ARE DENIED OR HAVE A PORTION TO PAY, THEN THEY CAN APPLY FOR CHARITY. THE CHARITY APPLICATION IS ON THE BACK OF OUR SELF-PAY STATEMENTS. ALSO, THE HOSPITAL OWNED PHYSICIAN PRACTICES ARE AWARE OF THIS PROGRAM AND REFER PATIENTS/GUARANTORS TO THE PATIENT FINANCIAL COUNSELOR. COMMUNITY INFORMATION SCHEDULE H, PART VI, LINE 4 CCMH SERVES PATIENTS MAINLY FROM POTTER, MCKEAN, TIOGA, CAMERON AND ELK COUNTIES IN NORTHCENTRAL PA. ALL OF THE COUNTIES THAT WE SERVE ARE CONSIDERED RURAL AND MOUNTAINOUS. CAMERON COUNTY CURRENTLY HAS THE HIGHEST UNEMPLOYMENT RATE IN THE STATE AND ALL OF THE COUNTIES SERVED ARE BATTLING THE EFFECTS OF THE ECONOMY AND JOB LOSS. OUR POPULATION IS ALSO AGING AS THE AREA OFFERS LITTLE FOR A YOUNGER DEMOGRAPHIC IN THE WAY OF EMPLOYMENT, EDUCATION AND CULTURE. PROMOTION OF COMMUNITY HEALTH SCHEDULE H, PART VI, LINE 5 THE MISSION OF CHARLES COLE MEMORIAL HOSPITAL INDICATES THAT THE HOSPITAL RESPONDS TO THE HEALTHCARE NEEDS OF THE COMMUNITIES IT SERVES AND IS LARGELY DEPENDENT ON PROVIDING SERVICES AND CARE TO THOSE INDIVIDUALS WHO MAY NOT HAVE THE RESOURCES TO BE AWARE OF, ABLE TO PAY FOR, OR HAVE THE EDUCATION/KNOWLEDGE ABOUT CARE, PROGRAMS AND SERVICES THAT ARE AVAILABLE TO THEM. THROUGH VARIOUS ACTIVITIES CHARLES COLE REACHES OUT TO OUR COMMUNITIES TO EDUCATE, IMPROVE HEALTH, PREVENT AND TREAT DISEASE AND SUPPORT INDIVIDUALS AND GROUPS. CHARLES COLE, IN COOPERATION WITH COMMUNITY BASED GROUPS SUCH AS ROTARY AND OSWAYO VALLEY MEMORIAL LIBRARY, PROVIDE FIVE COMPREHENSIVE BLOOD ANALYSIS ANNUALLY. COMPREHENSIVE BLOOD ANALYSIS SCREENINGS ARE PROVIDED IN FIVE RURAL COMMUNITIES: GALETON, SMETHPORT, PORT ALLEGANY, SHINGLEHOUSE AND COUDERSPORT. CBA'S SCREEN OVER 30 OF THE MOST COMMON BLOOD TESTS THAT DETECT HEALTH ISSUES SUCH AS CORONARY HEART DISEASE, LIVER DISEASE, KIDNEY DISEASE, CANCER, THYROID DISEASE, DIABETES, ANEMIA, BONE DISEASE AND RESPIRATORY DISEASE. THESE SCREENINGS ARE PROVIDED AT A FRACTION OF THE COST OF HAVING THESE TESTS PERFORMED THROUGH A FAMILY PHYSICIAN. ALL PARTICIPANTS AND THEIR PRIMARY MEDICAL PROVIDER ARE SENT THE RESULTS AND PROVIDERS FOLLOW-UP WITH INDIVIDUALS WHOSE SCREENING RESULTS INDICATE ABNORMALITIES. FOR MANY INDIVIDUALS WHO ARE UNINSURED OR UNDERINSURED AND LIKELY WOULD NOT SEEK MEDICAL CARE UNTIL IT WAS EMERGENT, THESE EVENTS PROVIDE AN AVENUE TO MONITOR THEIR HEALTH AND DETECT POTENTIAL ISSUES BEFORE THEY BECOME EMERGENT. IN ADDITION, THE LOCAL CO-SPONSORS RECEIVE A PORTION OF THE PROCEEDS FROM THESE EVENTS AND UTILIZE THE FUNDS TO PROVIDE SCHOLARSHIPS AND SUPPORT TO LOCAL STUDENTS AND PROJECTS TO BENEFIT THE COMMUNITY. ANNUALLY, CHARLES COLE PARTNERS WITH THE AREA AGENCY ON AGING AND THE PENNSYLVANIA DEPARTMENT OF HEALTH TO ADMINISTER SEASON INFLUENZA AND PNEUMOCCOCAL VACCINE TO POTTER COUNTY RESIDENTS WHO ARE OVER THE AGE OF 60 AT NO COST. HOWEVER, RESIDENTS WHO ARE UNDER THE AGE OF 60 WITH A CHRONIC DISEASE ARE ELIGIBLE AS WELL. FY2011 654 NO-COST INFLUENZA VACCINES AND 50 PNEUMOCOCCAL VACCINES WERE ADMINISTERED THROUGH 11 CLINICS IN 7 COMMUNITIES. IN MANY CASES THE UNDERSERVED POPULATIONS ARE MORE LIKELY TO BECOME ILL AND POTENTIALLY FACE EMERGENT HEALTH NEEDS FROM VACCINE-PREVENTABLE DISEASE. BY PROVIDING CLINICS AT COUNTY SENIOR CENTERS AND IN RURAL COMMUNITY SETTINGS MANY INDIVIDUALS WHO WOULD LIKELY NOT RECEIVE THESE COMMON VACCINES CAN BE IMMUNIZED AT NO COST AND IN CLOSE PROXIMITY TO THEIR HOMES. ALSO IN CONJUNCTION WITH THE AREA AGENCY ON AGING, CHARLES COLE PROVIDES NO-COST EDUCATION TO COUNTY SENIOR CENTERS. IN FY 2011, CCMH PROVIDED 7 HEALTH EDUCATION PROGRAMS, EACH PRESENTED AT 4 SENIOR CENTERS FOR A TOTAL OF 30+ SESSIONS. TOPICS INCLUDED IMMUNIZATIONS, QUESTION TO ASK YOUR HEALTHCARE PROVIDER, INJURY PREVENTION, THE DIABETIC FOOT & GOUT, REDUCE RISK OF CANCER/ SIGNS AND SYMPTOMS OF CANCER, AND QUESTIONS REGARDING YOUR MEDICATIONS. FINALLY, AS AN ON-GOING EFFORT TO PROVIDE FULL-SPECTRUM CANCER CARE TO INDIVIDUALS IN RURAL NORTH CENTRAL PENNSYLVANIA, THE PATTERSON CANCER CARE CENTER PHYSICIANS AND STAFF PROVIDED APPROXIMATELY 170 NO-COST CANCER SCREENINGS. SCREENINGS INCLUDED SCREENINGS FOR PROSTATE, COLORECTAL AND SKIN CANCER. SCREENINGS WERE PERFORMED BY ONCOLOGY PHYSICIANS WHO SPECIALIZE IN THE DETECTION, DIAGNOSIS AND TREATMENT OF CANCER. INDIVIDUALS PARTICIPATING IN THESE SCREENINGS WERE BOTH MALE AND FEMALE, ADULT AND SENIOR AND UNINSURED/UNDERINSURED. ALONG WITH MANY OTHER PROGRAMS SUCH AS SUPPORT GROUPS, SPEAKER'S BUREAU, 9 AGENCY WELLNESS COLLABORATIVE, WORKFORCE DEVELOPMENT, ECONOMIC SUPPORT, COMMUNITY LEADERSHIP, PARTNERSHIPS WITH LOCAL CIVIC, GOVERNMENT, SCHOOL DISTRICTS AND COMMUNITY GROUPS, CHARLES COLE MEMORIAL HOSPITAL CONTINUES EFFORTS TO ASSURE THAT HEALTHCARE, IN ALL FORMS, IS ACCESSIBLE AND AVAILABLE TO THOSE WHO MAY OTHERWISE GO WITHOUT. CCMH PROVIDES THE COMMUNITY WITH SPACE FOR EVENTS, MEETINGS AND PROGRAMS SUCH AS SUPPORT GROUPS, ANNUAL EVENTS, TRAINING SESSIONS AND YOUTH SPORTS. CCMH'S EMPLOYEE GIVING CLUB, HEART OF COLE, HAS A DESIGNATED GROUP THAT FOCUSES ON COMMUNITY CONNECTIONS. THE GROUP ANNUALLY UTILIZES APPROXIMATELY $10,000 ON COMMUNITY CONNECTIONS INCLUDING DONATIONS, IN FY11 SPECIFICALLY TO SERVE INDIVIDUALS AND FAMILIES THROUGH MONETARY AND NON-PERISHABLE FOOD DONATIONS TO LOCAL FOOD BANKS AND TO PURCHASE OF HEALTHCARE-RELATED ITEMS TO BE USED AS GIVE-AWAYS AT COMMUNITY EVENTS. CHARLES COLE STRIVES TO LIVE UP TO ITS NON-PROFIT MISSION EVERY DAY, PROVIDING EXCELLENT HEALTHCARE SERVICES TO OUR AREA AND LISTENING AND RESPONDING TO THE COMMUNITIES WE SERVE. IN AN EFFORT TO PLAN FOR THE UNIQUE NEEDS OF COMMUNITIES IN THE SERVICE AREA, FIVE COMMUNITY BENEFIT ADVISORY COMMITTEES WERE ESTABLISHED AS A MAJOR INITIATIVE TO DEEPEN AND STRENGTHEN ITS CONNECTION WITH THE COMMUNITY AND TO LINK COMMUNITY BENEFIT ACTIVITIES TO STRATEGIC AND OPERATIONAL PLANS. THE ROLE OF THE COMMITTEES IS TO IDENTIFY THE NEEDS AND CONCERNS OF THE COMMUNITY, ADVISE ABOUT THE BEST WAY TO PARTNER WITH THE COMMUNITY, AID IN THE DEVELOPMENT OF MEANINGFUL COMMUNITY PROGRAMS AND ACTIVITIES, AND PROMOTE IMPROVED COMMUNICATIONS BETWEEN THE HOSPITAL AND THE COMMUNITY. THE HOSPITAL PROVIDES DEDICATED ADMINISTRATIVE TIME TO PLANNING AND CONDUCTING FIVE CBAC MEETINGS IN THE COMMUNITIES WE SERVE THREE TIMES PER YEAR. LASTLY, CCMH OFTEN PARTNERS WITH FUNDING FOUNDATIONS TO PROVIDE HEALTH SPECIFIC IMPROVEMENT INITIATIVES IN THE COMMUNITIES WHICH WE SERVE. AS AN EXAMPLE, CCMH, WITH FUNDING FROM THE MAKING STRIDES AGAINST BREAST CANCER FOUNDATION, TO PROVIDE A NIGHT FOR WOMEN WHO HAVE OR HAD BREAST CANCER. AFFILIATED HEALTH CARE SYSTEM SCHEDULE H , PART VI, LINE 6 THE AFFILIATED HEALTH CARE SYSTEM INCLUDES CHARLES COLE MEMORIAL HOSPITAL, COLE CARE, INC, AND HENDORN, INC. CHARLES COLE MEMORIAL HOSPITAL (THE "HOSPITAL") PRIMARILY EARNS REVENUES BY PROVIDING INPATIENT, OUTPATIENT AND EMERGENCY CARE SERVICES TO PATIENTS IN COUDERSPORT, PENNSYLVANIA. THE HOSPITAL ALSO OPERATES A HOME HEALTH AGENCY AND A NUMBER OF PHYSICIAN CLINICS IN THE SAME GEOGRAPHIC AREA. COLE CARE, INC., A WHOLLY OWNED SUBSIDIARY OF THE HOSPITAL, OPERATES A DURABLE MEDICAL EQUIPMENT COMPANY FOR THE SALE AND RENTAL OF EQUIPMENT. HENDORN, INC., D/B/A COLE MANOR (COLE MANOR), OF WHICH THE HOSPITAL IS THE SOLE CORPORATE MEMBER, OWNS AND OPERATES A 30-BED PERSONAL CARE RESIDENTIAL FACILITY AND PROVIDES HOMEMAKER SERVICES. X X X X X false false false false false false false true false MICHAEL E CALLAHAN 181414 0 0 0 983 0 4378 0 12342 0 199117 0 0 0 JASON TRONETTI 213798 0 99563 0 181 0 6009 0 17009 0 336560 0 0 0 KALLIOPI NESTOR 219181 0 4370 0 310 0 5609 0 15844 0 245314 0 0 0 EDWARD C PITCHFORD 236567 0 18047 0 29345 0 6106 0 19613 0 309678 0 0 0 CYNTHIA HARDESTY 134098 0 10566 0 19451 0 4066 0 5696 0 173877 0 0 0 BRADLEY F GIANNOTTI 825418 0 29237 0 16400 0 4515 0 10627 0 886197 0 0 0 TERRENCE L FOUST 617142 0 107120 0 540 0 6070 0 5986 0 736858 0 0 0 SAKET PRASAD 466714 0 90012 0 17349 0 6067 0 17904 0 598046 0 0 0 CHRISTAN M CARAMIA 424541 0 0 0 386 0 6096 0 18638 0 449661 0 0 0 CELSO BACKES 374850 0 0 0 7156 0 4775 0 0 0 386781 0 0 0 BONUS SCHEDULE J, PART I, LINE 7 SOME OF THOSE LISTED IN FORM 990, PART VII RECEIVED PAYOUTS OF ACCRUED BONUSES AND ACCRUED ADDITIONAL BONUSES FOR PARTICIPATING IN THE EXECUTIVE TEAM INCENTIVE COMPENSATION PROGRAM. EACH PARTICIPANT HAD AN ESTABLISHED TARGET TOTAL COMPENSATION BASED ON INDUSTRY SURVEYS AND THE INCENTIVE PROGRAM COMPRISED APPROXIMATELY 10% OF THE TARGETED TOTAL COMPENSATION. THE BONUS WAS BASED ON OVERALL PERFORMANCE. COLE CARE COMMON BOARD MEMBERS 6854608 RENT, DIVIDENDS, SERVICES false EDMOND HARDESTY HUSBAND OF C HARDESTY 142608 EMPLOYEE OF HOSPITAL false ORGANIZATION'S MISSION FORM 990, PART I, LINE 1 CHARLES COLE MEMORIAL HOSPITAL IS A FULL SERVICE, COMPREHENSIVE HEALTH SYSTEM, SERVING POTTER, MCKEAN, CAMERON, AND TIOGA COUNTIES IN RURAL, NORTH CENTRAL PA AND PORTIONS OF NEW YORK STATE AND IS THE ONLY HOSPITAL IN POTTER COUNTY (COUDERSPORT, PA). CCMH IS A CRITICAL ACCESS HOSPITAL PROVIDING PRIMARY, EMERGENCY, AND SPECIALTY CARE, AS WELL AS REHABILITATION AND WELLNESS SERVICES TO PATIENTS WITHIN A 50-MILE RADIUS. CHARLES COLE STRIVES TO LIVE UP TO ITS NON-PROFIT MISSION EVERY DAY, PROVIDING EXCELLENT HEALTHCARE SERVICES TO OUR AREA AND LISTENING AND RESPONDING TO THE COMMUNITIES WE SERVE. IN AN EFFORT TO PLAN FOR THE UNIQUE NEEDS OF COMMUNITIES IN THE SERVICE AREA, FIVE COMMUNITY BENEFIT ADVISORY COMMITTEES WERE ESTABLISHED AS A MAJOR INITIATIVE TO DEEPEN AND STRENGTHEN OUR CONNECTION WITH THE COMMUNITY AND TO LINK COMMUNITY BENEFIT ACTIVITIES TO STRATEGIC AND OPERATIONAL PLANS. THE ROLE OF THE COMMITTEES ARE TO IDENTIFY THE NEEDS AND CONCERNS OF THE COMMUNITY, ADVISE ABOUT THE BEST WAY TO PARTNER WITH THE COMMUNITY, AID IN THE DEVELOPMENT OF MEANINGFUL COMMUNITY PROGRAMS AND ACTIVITIES, AND PROMOTE IMPROVED COMMUNICATIONS BETWEEN THE HOSPITAL AND THE COMMUNITY. THE HOSPITAL PROVIDES DEDICATED ADMINISTRATIVE TIME TO PLANNING AND CONDUCTING FIVE CBAC MEETINGS IN THE COMMUNITIES WE SERVE THREE TIMES PER YEAR. PROGRAM SERVICE ACCOMPLISHMENTS FORM 990, PART III, LINE 4 LINE 4B IN ADDITION TO THE FAMILY AND INTERNAL MEDICINE SERVICES AT RHCS, PHYSICIAN PRACTICES ALSO PROVIDE SPECIALTY CARE INCLUDING PEDIATRICS, GASTROENTEROLOGY, ORTHOPEDICS, PSYCHIATRY, SURGERY, PODIATRY, OBSTETRICS/GYNECOLOGY AND ONCOLOGY. COLLECTIVELY, PHYSICIAN PRACTICES REPORTED 93,600 PATIENT VISITS LAST YEAR. LINE 4C INPATIENT SATISFACTION RANKS IN THE TOP 6% IN OUR OB SERVICES AND TOP 16% IN OUR IP SERVICES ACROSS THE NATION. IN ADDITION TO THE HOSPITAL'S ACUTE CARE FLOORS, CHARLES COLE CARES FOR PATIENTS IN ITS 49-BED LONG TERM CARE UNIT WHICH REPORTED 16,060 DAYS LAST YEAR. A 10-BED INPATIENT GERIATRIC BEHAVIORAL HEALTH UNIT ADMITTED 170 PATIENTS LAST YEAR. LINE 4D THE ORGANIZATION ALSO OFFERS CARDIO-PULMONARY SERVICES, CLINICAL SERVICES, CLINICS, AND CORPORATE SERVICES. MEMBERS FORM 990, PART VI, SECTION A, LINES 6 & 7A THE MEMBERS OF THE CORPORATION, THE CHARLES COLE MEMORIAL HOSPITAL, SHALL BE KNOWN AS COMMUNITY BENEFIT ADVISORS ("ADVISORS"), WHOSE FUNCTIONS AND QUALIFICATIONS SHALL INCLUDE THE FOLLOWING: (A) PROMOTE THE PROGRAMS, GOALS AND OBJECTIVES OF CHARLES COLE MEMORIAL HOSPITAL; (B) EDUCATE THEIR PUBLIC CONTACTS, BOTH ON HEALTH CARE ISSUES AND ON SERVICES AND PROGRAMS AVAILABLE THROUGH CHARLES COLE MEMORIAL HOSPITAL, AND SEEK THEIR SERVICES WHEN NECESSARY AND APPROPRIATE; (C) PROVIDE AN IMPORTANT LINK BETWEEN CHARLES COLE MEMORIAL HOSPITAL, THE OTHER INSTITUTIONS AND BUSINESSES WHICH THEY REPRESENT, AND THE COMMUNITIES SERVED BY THE HOSPITAL; (D) ATTEND REGULAR MEETINGS, TO SHARE INFORMATION ON ACTIVITIES AND TAKE APPROPRIATE ACTION TO SUPPORT AND GUIDE CHARLES COLE MEMORIAL HOSPITAL; (E) PROVIDE SPECIAL ASSISTANCE ON PROJECTS AND ISSUES WHEN REQUESTED; (F) PARTICIPATE IN FUNDRAISING EFFORTS TO BENEFIT PATIENT CARE PROGRAMS FOR CHARLES COLE MEMORIAL HOSPITAL; AND (G) BE A CITIZEN IN GOOD STANDING, AS DETERMINED BY THE EXECUTIVE COMMITTEE OF THE BOARD, IN A COMMUNITY SERVED BY THE HOSPITAL. THE MEMBERS SHALL BE DIVIDED INTO TWO CLASSES: (A) ACTIVE ADVISORS (B) HONORARY ADVISORS THE ADVISORS SHALL ANNUALLY ELECT: (A) SUCCESSORS TO THE BOARD OF DIRECTORS WHOSE TERMS EXPIRE. (B) HONORARY DIRECTORS AND HONORARY ADVISORS. UPON NOMINATION BY THE EXECUTIVE COMMITTEE PER SECTION 5.2.2.(E) OF THESE BYLAWS, ALL ADVISORS SHALL BE ELECTED BY A TWO THIRDS VOTE OF THE MEMBERS PRESENT AND VOTING AT A DULY CALLED MEETING OF THE MEMBERS WHICH A QUORUM IS PRESENT. (A) AN ACTIVE ADVISOR OF CHARLES COLE MEMORIAL HOSPITAL SHALL BE A MEMBER FOR A TERM OF FIVE (5) YEARS AFTER HIS ELECTION, OR UNTIL HIS EARLIER RESIGNATION. THERE IS NO LIMIT ON THE NUMBER OF TERMS AN ADVISOR CAN SERVE. (B) AN HONORARY ADVISOR MAY BE ELECTED BY THE ACTIVE ADVISORS AND SHALL SERVE FOR LIFE, IN RECOGNITION OF MERITORIOUS OR FAITHFUL SERVICE TO CHARLES COLE MEMORIAL HOSPITAL OR IN RECOGNITION OF DISTINGUISHED ACHIEVEMENT. (C) EACH ADVISOR OWES A DUTY OF UNDIVIDED AND UNQUALIFIED LOYALTY TO THE ORGANIZATION. ADVISORS MAY NOT USE THEIR POSITIONS TO PROFIT PERSONALLY OR TO ASSIST OTHERS IN PROFITING IN ANY WAY AT THE EXPENSE OF THE ORGANIZATION. (D) ADVISORS SHALL AVOID ALL CONFLICTS OF INTEREST AND THE APPEARANCE OF ANY CONFLICT OF INTEREST. A CONFLICT OF INTEREST OCCURS IN ANY SITUATION IN WHICH ONE IS POTENTIALLY NOT ABLE TO REMAIN IMPARTIAL OR MAINTAIN OBJECTIVITY IN CHOOSING BETWEEN THE INTERESTS OF THE ORGANIZATION AND ONE'S PERSONAL INTERESTS OR THE INTERESTS OF THIRD PARTIES. TO AVOID THE APPEARANCE OF A CONFLICT OF INTEREST, AN ADVISOR SHALL NOT PARTICIPATE IN THE MAKING OF ANY DECISION OR RECOMMENDATION CONCERNING A MATTER WHICH MAY RESULT IN ANY BENEFIT OR FINANCIAL GAIN, EITHER DIRECTLY OR INDIRECTLY, TO THE ADVISOR OR A MEMBER OF HIS/HER IMMEDIATE FAMILY. IN ADDITION, FULL DISCLOSURE OF THE PERTINENT FACTS REGARDING THE POTENTIAL CONFLICT OF INTEREST SHOULD BE PROVIDED BY THE ADVISOR. (E) NO ADVISOR SHALL HAVE ANY VESTED RIGHT, INTEREST OR PRIVILEGE OF, IN, OR TO THE ASSETS, FUNCTIONS, AFFAIRS OR FRANCHISES OF THE CORPORATION OR ANY SUCH RIGHT, INTEREST OR PRIVILEGE WHICH MAY BE TRANSFERABLE OR INHERITABLE, OR WHICH SHALL CONTINUE IF HIS MEMBERSHIP CEASES. NO ADVISOR SHALL BE AN EMPLOYEE OF THE HOSPITAL OR ANY OF ITS AFFILIATES. (F) ADVISORS SHALL INCLUDE REPRESENTATIVES FROM VARIOUS ECONOMIC, SOCIAL AND OCCUPATIONAL GROUPS BROADLY REPRESENTATIVE OF THE DEMOGRAPHIC CHARACTERISTICS OF THE COMMUNITIES SERVED BY THE HOSPITAL, AND SHALL ALL HAVE AN INTEREST IN AND COMMITMENT TO FURTHER THE HEALTH AND WELL-BEING OF THE CITIZENS OF THE HOSPITAL'S SERVICE AREA. (G) THE SECRETARY OF THE BOARD SHALL ACT AS LIAISON TO THE COMMUNITY BENEFIT ADVISORS. THE NUMBER OF ADVISORS SHALL NOT BE LESS THAN FIFTY (50) NOR MORE THAN ONE HUNDRED (100), EXCLUSIVE OF HONORARY ADVISORS. EVERY ACTIVE ADVISOR SHALL BE ENTITLED TO ONE (1) VOTE AT ANY MEETING OF THE ADVISORS IN WHICH A VOTE IS TAKEN FOR ANY ELECTION OR ON ANY MATTER OR TRANSACTION. IN THE CASE OF VOTING FOR THE ELECTION OF DIRECTORS, EACH ADVISOR MUST CAST ONE (1) VOTE FOR EACH POSITION TO BE FILLED OR THE BALLOT WILL BE VOID AS IT PERTAINS TO THE ELECTION OF DIRECTORS. VOTING FOR DIRECTORS SHALL BE BY WRITTEN BALLOT BY FIRST CLASS MAIL, POSTMARKED NO LATER THAN TWENTY (20) DAYS PRIOR TO THE DATE SELECTED FOR THE ANNUAL MEETING. EVERY ADVISOR SHALL BE ENTITLED IN RETURNING HIS BALLOT FOR THE ANNUAL ELECTION OF DIRECTORS, TO DIRECT THAT HIS VOTE BE WITHHELD FROM ONE (1) OR MORE OF THE CANDIDATES SUBMITTED BY THE NOMINATING COMMITTEE AND ANY SUCH ADVISOR MAY, ON HIS BALLOT, MAY SET FORTH THE NAME OF ANY PERSON FOR WHOM HE WISHES TO RECORD HIS VOTE FOR A DIRECTOR OF THE CORPORATION. RESULTS OF THE ELECTION PROCESS WILL BE ANNOUNCED AT THE ANNUAL MEETING OF THE ADVISORS. HONORARY ADVISORS SHALL RECEIVE NOTICES OF AND MAY ATTEND ALL MEETINGS OF THE ADVISORS BUT SHALL NOT BE ENTITLED TO VOTE ON ANY MATTER. THE ELECTION PROCESS WILL BE ANNOUNCED AT THE ANNUAL MEETING OF THE ADVISORS. HONORARY ADVISORS SHALL RECEIVE NOTICES OF AND MAY ATTEND ALL MEETINGS OF THE ADVISORS BUT SHALL NOT BE ENTITLED TO VOTE ON ANY MATTER. FORM 990 REVIEW PROCESS FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM BASED ON THE AUDITED FINANCIAL STATEMENTS AND INFORMATION PROVIDED BY THE ACCOUNTING DEPARTMENT OF THE ORGANIZATION. THE 990 IS THEN REVIEWED BY THE ACCOUNTING DEPARTMENT AND THE CONTROLLER. IT IS THEN PRESENTED TO THE AUDIT / COMP COMMITTEE FOR REVIEW. AFTER THE AUDIT / COMP COMMITTEE HAS REVIEWED, A FULL COPY IS DISTRIBUTED TO THE BOARD OF DIRECTORS and THE COMMITTEE WILL REPORT THEIR REVIEW OF FORM 990 TO THE ENTIRE BOARD OF DIRECTORS PRIOR TO THE CEO'S FINAL SIGNATURE. MONITORING COMPLIANCE WITH CONFLICT OF INTEREST POLICY FORM 990, PART VI, SECTION B, LINE 12C MEMBERS OF THE BOARD OF DIRECTORS; BOARD COMMITTEES; MANAGEMENT EMPLOYEES; AND MEDICAL STAFF WITH ADMINISTRATIVE RESPONSIBILITIES ARE COVERED UNDER THE CONFLICT OF INTEREST POLICY. THE LEVELS AT WHICH ACTUAL CONFLICTS ARE REVIEWED ARE THE COMPLIANCE OFFICER AND AUDIT COMMITTEE OF THE BOARD OF DIRECTORS. RESTRICTIONS INCLUDE: A MEMBER OF THE BOARD/BOARD COMMITTEE MUST DISCLOSE THE EXISTENCE OF HIS/HER FINANCIAL INTEREST. A VOTING MEMBER OF ANY COMMITTEE WHOSE SCOPE OF RESPONSIBILITIES INCLUDES COMPENSATION MATTERS AND WHO RECEIVES COMPENSATION, DIRECTLY OR INDIRECTLY, FROM THE HOSPITAL FOR SERVICES IS PRECLUDED FROM VOTING ON MATTERS PERTAINING TO THAT MEMBER'S COMPENSATION. PHYSICIANS WHO RECEIVE COMPENSATION, DIRECTLY OR INDIRECTLY, FROM THE HOSPITAL, WHETHER AS EMPLOYEES OR INDEPENDENT CONTRACTORS, ARE PRECLUDED FROM MEMBERSHIP ON ANY COMMITTEE WHOSE PRIMARY SCOPE OF RESPONSIBILITIES INCLUDES COMPENSATION MATTERS. A MANAGEMENT EMPLOYEE, OR A MEDICAL STAFF MEMBER WITH ADMINISTRATIVE RESPONSIBILITIES MUST DISCLOSE TO THE SENIOR LEADER THE EXISTENCE OF THE FINANCIAL INTEREST AND ALL RELATED MATERIAL FACTS. COMPENSATION DETERMINATION FORM 990, PART VI, SECTION B, LINE 15A A REVIEW WAS CONDUCTED IN JUNE 2012 FOR PRESIDENT & CEO EDWARD PITCHFORD BY 3C COMPENSATION CONSULTING CONSORTIUM, LLC, LOCATED IN PITTSBURGH, PENNSYLVANIA. THE BOARD WOULD HAVE TO APPROVE ANY INCREASE RECOMMENDED BY THE AUDIT/COMPENSATION COMMITTEE. DOCUMENT AVAILABILITY FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S CONFLICT OF INTEREST POLICY AND GOVERNING DOCUMENTS CAN BE VIEWED ONSITE THROUGH A WRITTEN REQUEST TO THE ORGANIZATION'S CORPORATE COMPLIANCE OFFICER. REQUESTS FOR FINANCIAL STATEMENTS AND 990'S ARE FORWARDED TO THE FINANCE / ACCOUNTING DEPARTMENT AND ARE OPEN FOR PUBLIC INSPECTION. BOARD MEMBER COMPENSATION & HOURS WORKED FOR RELATED ORGANIZATIONS FORM 990, PART VII, SECTION A NO BOARD MEMBERS RECEIVE ANY COMPENSATION FOR THEIR DIRECTOR DUTIES. MICHAEL CALLAHAN IS COMPENSATED BY CHARLES COLE MEMORIAL HOSPITAL AS A PHYSICIAN. JASON TRONETTI IS COMPENSATED BY CHARLES COLE MEMORIAL HOSPITAL AS A PHYSICIAN. KALLIOPI NESTOR IS COMPENSATED BY CHARLES COLE MEMORIAL HOSPITAL AS A PHYSICIAN. EACH WORK APPROXIMATELY 40 HOURS PER WEEK IN THESE ROLES. EDWARD PITCHFORD SERVES AS THE PRESIDENT, CEO, AND ASSISTANT SECRETARY FOR CHARLES COLE MEMORIAL HOSPITAL, HENDORN, INC., AND COLE CARE, INC., AND SPLITS APPROXIMATELY 40 HOURS PER WEEK BETWEEN THESE ENTITIES. ALL BOARD MEMBERS SERVE FOR AN AVERAGE OF ONE HOUR PER WEEK ON THE BOARDS OF CHARLES COLE MEMORIAL HOSPITAL, HENDORN, INC., AND COLE CARE, INC. OTHER CHANGES IN NET ASSETS FORM 990, PART XI, LINE 5 DEFINED BENEFIT PENSION COSTS: AMORTIZATION OF NET LOSS $ 187,532 NET GAIN ARISING DURING YEAR ( 5,130,795) AUXILIARY TRANSFER TO CCMH ( 50,000) CHANGE IN ACCOUNTING PRINCIPLE ( 306,743) NET UNREALIZED LOSSES ( 265,931) ------------- NET ADJUSTMENT ($5,565,937) HENDORN INC DBA COLE MANOR 1001 EAST SECOND STREET COUDERSPORT PA 16915 231972659 RESIDENT CARE PA 501(C)(3) 11A I CCMH true HAMOTCOLE VENTURES INC 1001 EAST SECOND STREET COUDERSPORT PA 16915 273172100 REAL ESTATE PA 501(C)(3) 11A I NA false COLE CARE INC 1001 EAST 2ND STREET COUDERSPORT PA 16915 251497347 DURABLE MED EQUIP PA CCMH C CORPORATION 8278270 851707 1.00000 true false false false false false false false true true true true true true true true false false COLE CARE INC A/I 174399 FMV COLE CARE INC K 56692 FMV COLE CARE INC L 174348 FMV HENDORN INC K 314226 FMV HENDORN INC L 40824 FMV COLE CARE INC N 6449169 FMV