2013-02-06T07:35:12-06:00 2012-06-30 250988255 CARBIS WALKER LLP 5700 CORPORATE DRIVE STE 650 PITTSBURGH PA 15237 990 2011-07-01 250977902 MINERS HOSPITAL MINE 8142473100 290 HAIDA AVENUE HASTINGS PA 16646 EDWARD DEPASQUALE 8142473100 2013-01-28 1 JEFFREY J PETRELL CPA P00138808 4126356270 2013-01-28 2011 2016-02-25 16:41:14Z MINERS MEDICAL CENTER SCOTT BECKER 1086 FRANKLIN STREET JOHNSTOWN PA 15905 18909067 0 X WWW.CONEMAUGH.ORG X 1905 PA TO PROVIDE QUALITY HEALTH CARE TO ANY PERSON REGARDLESS OF RACE, COLOR, CREED, NATIONAL ORIGIN, AGE, SEX, HANDICAP AND/OR ABILITY TO PAY. 14 9 175 10 0 0 332463 43068 18955411 18579880 5727 4371 101472 281748 19395073 18909067 0 0 0 0 8555140 8104011 0 0 0 9927233 9403592 18482373 17507603 912700 1401464 7132436 7296886 12156730 13397728 -5024294 -6100842 X TO PROVIDE QUALITY HEALTH CARE TO ANY PERSON REGARDLESS OF RACE, COLOR, CREED, NATIONAL ORIGIN, AGE, SEX, HANDICAP AND/OR ABILITY TO PAY. 0 0 14473482 18861628 MINERS HOSPITAL IS A COMMUNITY HOSPITAL SERVING FAMILIES ACROSS RURAL NORTHERN CAMBRIA COUNTY IN SOUTHWESTERN PENNSYLVANIA. THE HOSPITAL SPECIALIZES IN FAMILY AND PRIMARY CARE AND HAS 30 BEDS FOR MEDICAL/SURGICAL AND INTENSIVE CARE SERVICES. OTHER SERVICES INCLUDE: COMPREHENSIVE OUTPATIENT SERVICES; 24/7 EMERGENCY DEPARTMENT; 24/7 LABORATORY; ONSITE PHARMACY; OPERATING SUITE FOR SHORT OR MINOR PROCEDURES; RADIOLOGY SERVICES, INCLUDING MOBILE MRI AND CT SCANS, DIGITAL MAMMOGRAPHY, AND ULTRASOUND; PATHOLOGY SERVICES; PHYSICAL THERAPY; RESPIRATORY THERAPY; AND OB/GYN OUTPATIENT CARE. DURING THE FISCAL YEAR ENDING JUNE 30, 2012, THE HOSPITAL ADMITTED 772 PATIENTS; HAD 10,641 EMERGENCY VISITS; AND PERFORMED 2,020 SURGICAL PROCEDURES. 14473482 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 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 0 1 42 0 1 175 1 0 0 0 0 0 0 0 0 0 0 X 14 9 0 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 PA X EDWARD DEPASQUALE 8144108271 1086 FRANKLIN STREET JOHNSTOWN PA 15905 X FRANK QUITONI 1.00 X X 0 0 0 SAMUEL MCCLURE 1.00 X X 0 0 0 PATTI STEFANICK DO 1.00 X X 0 25000 0 ALAN STANKIEWICZ DO 1.00 X X 0 0 0 WILLIAM DURYEA 1.00 X X 0 0 0 ELMER LASLO 1.00 X 0 0 0 TOM MARINO 1.00 X 0 0 0 KEVIN MILLER 1.00 X 0 0 0 HAROLD NICHOLSON 1.00 X 0 0 0 WILLIAM POLACEK 1.00 X 0 0 0 JAMES TRETTER DO 1.00 X 0 657843 36294 SHIBAN WARIKOO MD 1.00 X 0 494384 31962 STEVEN TUCKER 3.00 X X 0 464031 31715 SCOTT BECKER 1.00 X X 0 1087604 34890 EDWARD DEPASQUALE 1.00 X 0 461804 30569 DAVID CARLSON DO 4.00 X 0 562770 26848 JOSEPH DADO 4.00 X 0 364292 16140 WILLIAM CROWE 50.00 X 182134 0 28091 JOSEPH SABO MD 40.00 X 165345 0 55844 MARY WYLAND 40.00 X 110168 2192 29413 457647 4119920 321766 3 0 1 0 MEMORIAL MEDICAL CENTER 1086 FRANKLIN STREET JOHNSTOWN PA 15905 FINANCIAL, IT, LAB, CLINICAL DOC, CLINIC 1523682 CONEMAUGH HEALTH INITIATIVES 1086 FRANKLIN STREET JOHNSTOWN PA 15905 PHYSICIANS, OFFICE STAFF, COLLECTION 849035 ALLIED AFFILIATED FUNDING PO BOX 676649 DALLAS TX 75267 ER PHYSICIANS 382111 SAFARI CONTRACT CLEANERS 111 ROOSEVELT BOULEVARD JOHNSTOWN PA 15906 CLEANING 224888 ALLIANCE HEALTHCARE SERVICES PO BOX 96485 CHICAGO IL 60693 MRI 195859 7 18154 24914 43068 PATIENT SERVICES 900099 18559192 18559192 MEDICAL SVC RM REV 900099 20402 20402 RENTAL INCOME 900099 286 286 18579880 4371 4371 MEANINGFUL USE 900099 189997 189997 CAFETERIA SALES 900099 81214 81214 PHARMACY SALES 900099 9989 9989 548 548 281748 18909067 18861628 0 4371 214511 214511 5613844 4789003 824841 698715 685020 13695 1159921 1137187 22734 417020 408846 8174 276536 276536 77979 77979 900 900 5698 5698 1532536 1476083 56453 13714 1390 12324 68841 46442 22399 19287 19287 547777 471149 76628 18488 16324 2164 15906 9537 6369 154001 154001 453139 377782 75357 333202 324972 8230 PURCHASED SERVICES 2422693 1459303 963390 PATIENT CARE SUPPLIES 1654842 1654842 MAINTENANCE 608738 554161 54577 BAD DEBT 558342 558342 640973 349098 291875 17507603 14473482 3034121 0 563 1456 1700775 1455111 1608551 2189676 366023 484660 48701 59533 20264500 17346010 3027304 2918490 4926 375593 187960 7132436 7296886 7152022 7762501 72057 125803 3827034 3494453 1105617 2014971 12156730 13397728 X -5111214 -6190647 86920 89805 -5024294 -6100842 7132436 7296886 X 1401464 -2478012 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 900 900 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: THE HOSPITAL PAID ANNUAL DUES TO THE HOSPITAL COUNCIL OF WESTERN PA (HCWP), A 501(C)(6) CORPORATION. ACCORDING TO HCWP, FIFTEEN PERCENT OF DUES WERE UTILIZED FOR LOBBYING AND PUBLIC POLICY DEVELOPMENT. 102879 102879 7913155 6511396 1401759 11005287 9837800 1167487 1243179 996814 246365 2918490 DUE TO CONEMAUGH HEALTH SYSTEM 56968 DUE TO MEDICARE 788000 DUE TO MEMORIAL MEDICAL CENTER 1128968 DUE TO CONEMAUGH HEALTH INITIATIVES, INC. 41035 2014971 1 1 X 1 X 0 1 1 1 0 0 505437 505437 0.02980 1835047 1451336 383711 0.02260 18518 11190 7328 0.00040 2359002 1462526 896476 0.05280 7348 7348 0.00040 1963 1963 0.00010 9311 9311 0.00050 2368313 1462526 905787 0.05330 3500 3500 0.00020 3500 3500 0.00020 0 179228 0 4910943 4766449 144494 X 1 1 1 1 MINERS HOSPITAL

290 HAIDA AVENUE HASTINGS PA 16646

X X X MINERS HOSPITAL 1 0 1 1 200.000000000000 0 1 X X 1 1 X X X 1 0 1 X 0 0 PART I, LINE 3C: FEDERAL POVERTY GUIDELINES (FPG) ARE USED TO DETERMINE ELIGIBILITY FOR FREE CARE. HOWEVER, FPG ARE NOT USED WHEN MAKING A DETERMINATION FOR DISCOUNTED CARE. IN THESE CASES, ALL SELF-PAY, UNINSURED PATIENTS ARE OFFERED A 60% DISCOUNT OFF OF CHARGES. PART I, LINE 7: THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS REPORTED ON PART I, LINES 7A, 7B, AND 7C WAS BASED ON THE CONEMAUGH HEALTH SYSTEM'S COST ACCOUNTING SYSTEM AND ADDRESSES ALL PATIENT SEGMENTS. FOR FURTHER DETAILS OF THIS SYSTEM, SEE THE DESCRIPTION FOR PART III, LINE 8. THE METHODOLOGY USED TO CALCULATE THE AMOUNTS REPORTED ON PART I, LINES 7E THROUGH 7I AS APPLICABLE, WAS BASED ON ACTUAL REVENUES AND EXPENSES INCURRED. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 558342. PART II: MINERS MEDICAL CENTER'S COMMUNITY BUILDING INITIATIVES CONSIST OF A DONATION MADE TO A LOCAL ORGANIZATION THAT PROMOTES THE SUCCESS OF HIGH SCHOOL STUDENTS IN MANY AREAS, INCLUDING COMMUNITY SERVICE. PART III, LINE 4: CHANGE IN ACCOUNTING PRINCIPLE FOOTNOTE - IN 2012, CONEMAUGH HEALTH SYSTEM (CHS) CHANGED ITS METHOD OF PRESENTATION AND DISCLOSURE OF PATIENT SERVICE REVENUE, PROVISION FOR BAD DEBTS, AND THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IN ACCORDANCE WITH ACCOUNTING STANDARDS UPDATE (ASU) 2011-07, "PRESENTATION AND DISCLOSURE OF PATIENT SERVICE REVENUE, PROVISION FOR BAD DEBTS, AND THE ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR CERTAIN HEALTH CARE ENTITIES." THE MAJOR CHANGES ASSOCIATED WITH ASU 2011-07 ARE TO RECLASSIFY THE PROVISION FOR UNCOLLECTIBLE ACCOUNTS RELATED TO PATIENT SERVICE REVENUE TO A DEDUCTION FROM PATIENT SERVICE REVENUE AND TO PROVIDE ENHANCED DISCLOSURES AROUND CHS' POLICIES RELATED TO UNCOLLECTIBLE ACCOUNTS. THE CHANGE HAD NO EFFECT ON PRIOR YEAR OPERATING INCOME OR CHANGE IN NET ASSETS. PATIENT ACCOUNTS RECEIVABLE FOOTNOTE - ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, CHS 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 BAD DEBTS. 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, CHS ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY. 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, CHS 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 DISCOUNTED RATES 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. CHS' ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR SELF-PAY PATIENTS DECREASED FROM 90 PERCENT OF SELF-PAY ACCOUNTS RECEIVABLE AT JUNE 30, 2011 TO 86 PERCENT OF SELF-PAY ACCOUNTS RECEIVABLE AT JUNE 30, 2012. IN ADDITION, CHS' WRITE-OFFS DECREASED APPROXIMATELY $3,066,000 FROM APPROXIMATELY $14,382,000 FOR THE YEAR ENDED JUNE 30 2011, TO APPROXIMATELY $11,316,000 FOR THE YEAR ENDED JUNE 30, 2012. BOTH DECREASES WERE THE RESULT OF CHANGES IN SELF-PAY DISCOUNTING POLICIES EFFECTIVE JULY 1, 2011 THAT RESULTED IN DISCOUNTS ON SELF-PAY ACCOUNTS RECORDED IN NET PATIENT SERVICE REVENUE BEFORE THE PROVISION FOR BAD DEBTS.THE METHODOLOGY UTILIZED TO DETERMINE THE AMOUNT REPORTED ON LINE 2 IS BASED ON THE DESCRIPTIONS CONTAINED IN THE PRECEDING FOOTNOTES. THESE PROCESSES ARE FOLLOWED TO SUPPORT THE AMOUNT OF BAD DEBT REPORTED ON THE FINANCIAL STATEMENTS, WHICH IS REPORTED AT CHARGES. THE ORGANIZATION'S COST TO CHARGE RATIO IS THEN USED TO CALCULATE THE AMOUNT OF BAD DEBT AT COST, SHOWN ON LINE 2. BEGINNING WITH FISCAL YEAR 2012, THE AMOUNT REPORTED ON LINE 3 IS ZERO. CHS HAS IMPLEMENTED A SCORING SYSTEM BASED ON FEDERAL POVERTY GUIDELINES THAT SEGREGATES PATIENT BALANCES THAT ARE WRITTEN OFF TO PRESUMPTIVE CHARITY CARE, RATHER THAN BEING SENT TO COLLECTION. THIS HAS RESULTED IN MOVING PATIENTS OUT OF BAD DEBT STATUS THAT WOULD OTHERWISE BE PRESUMED TO BE ELIGIBLE UNDER THE CHS FINANCIAL ASSITANCE POLICY. PART III, LINE 8: CONEMAUGH HEALTH SYSTEM UTILIZES MCKESSON'S HORIZON PERFORMANCE MANAGER (HPM) FOR COST ACCOUNTING. HPM PROVIDES THE ABILITY TO ALLOCATE ALL DEPARTMENTAL EXPENSES AT THE INDIVIDUAL CHARGE FOR EACH CHARGING DEPARTMENT, AS WELL AS ALLOCATE OVERHEAD EXPENSES IN A CONSISTENT MANNER. THE ENCOUNTER COSTING FUNCTIONALITY OF HPM PROVIDES THE ABILITY TO THEN DETERMINE AN ACCURATE ESTIMATE OF COST AT THE PATIENT LEVEL BASED ON THE CHARGE UNIT COSTS. THE SYSTEM THEN PROVIDES THE ABILITY TO SUMMARIZE THE PATIENT VOLUME, CHARGES, AND COSTS IN ANY NUMBER OF WAYS, INCLUDING PAYER SPECIFIC COST ALLOCATION. PART III, LINE 9B: PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE ARE NOT PURSUED USING ANY DEBT COLLECTION PRACTICES. MINERS HOSPITAL PART V, SECTION B, LINE 10: FEDERAL POVERTY GUIDELINES ARE NOT USED IN THE DETERMINATION OF DISCOUNTED CARE. ALL SELF-PAY, UNINSURED PATIENTS ARE OFFERED A 60% DISCOUNT OFF OF CHARGES. MINERS HOSPITAL PART V, SECTION B, LINE 13G: THE ORGANIZATION IS GOVERNED BY THE CONEMAUGH HEALTH SYSTEM'S FINANCIAL ASSISTANCE POLICY. A SUMMARY OF THIS POLICY IS MADE AVAILABLE VIA BROCHURES LOCATED AT ALL REGISTRATION SITES, AND IS INCLUDED IN THE ADMISSIONS PACKET. IN ADDITION, BILLING STATEMENTS INDICATE THAT "FINANCIAL ASSISTANCE PROGRAM APPLICATIONS ARE AVAILABLE ON REQUEST, OR VISIT OUR WEBSITE AT WWW.CONEMAUGH.ORG". THE POLICY IS ALSO ADVERTISED PERIODICALLY IN THE LOCAL NEWSPAPERS. PART VI, LINE 2: THROUGH A COLLABORATIVE EFFORT WITH THE UNITED WAY OF THE LAUREL HIGHLANDS, CONEMAUGH HEALTH SYSTEM (CHS) HAS WORKED WITH VARIOUS COMMUNITY ORGANIZATIONS TO EDUCATE AND ACTIVATE THE COMMUNITY ABOUT IDENTIFIED COMMUNITY NEEDS. THIS ANALYSIS INCLUDES THE COMMUNITIES SERVED BY MINERS MEDICAL CENTER (MIMC). THE HEALTH NEEDS OF THE COMMUNITY WERE ASSESSED IN MANY WAYS, INCLUDING SURVEYS AND INTERVIEWS. THE MAJOR HEALTHCARE-RELATED NEEDS IDENTIFIED INCLUDE THE SUPPORT OF VULNERABLE AND AGING POPULATIONS AS WELL AS THE PROMOTION OF HEALTH AND WELLNESS PROGRAMS. OTHER METHODS TO ASSESS HEALTH NEEDS INCLUDED VARIOUS FORMS OF DATA ANALYSIS ALONG WITH THE EVALUATION OF DEMOGRAPHICS FOR THE COMMUNITIES SERVED. RESULTS FROM THESE ANALYSES RESULTED IN KEY FOCUS AREAS RELATED TO CARDIOVASCULAR RISK MANAGEMENT, ACCESS TO HEALTH SCREENINGS, AND DIABETIC EDUCATION.CHS IS CURRENTLY WORKING ON A COMMUNITY HEALTH NEEDS ASSESSMENT THAT WILL INCLUDE RESULTS RELATED SPECIFICALLY TO MIMC. THIS WILL BE FINALIZED DURING THE NEXT FISCAL YEAR AND A FORMAL IMPLEMENTATION PLAN WILL BE DEVELOPED. PART VI, LINE 3: CONEMAUGH HEALTH SYSTEM COMMUNICATES TO PATIENTS THE AVAILABILITY OF FINANCIAL ASSISTANCE UNDER FEDERAL, STATE AND LOCAL PROGRAMS, AS WELL AS THE CHARITY CARE PROGRAM, ON ITS WEBSITE, WHICH INCLUDES A DOWNLOADABLE CHARITY CARE APPLICATION AND INSTRUCTIONS. TABLE TOP BROCHURES ARE PROVIDED AT ALL POINTS OF REGISTRATION, AND BROCHURES ARE INCLUDED IN PATIENT ADMISSION PACKETS. INFORMATION ON THE AVAILABILITY OF FINANCIAL ASSISTANCE IS ALSO INCLUDED ON PATIENT STATEMENTS. ASSISTANCE IS PROVIDED TO PATIENTS TO APPLY FOR MEDICAL ASSISTANCE THROUGH A THIRD-PARTY VENDOR. A ROBUST FINANCIAL COUNSELING AND CUSTOMER SERVICE DEPARTMENT IS AVAILABLE TO HANDLE SPECIFIC PATIENT NEEDS. PART VI, LINE 4: MINERS MEDICAL CENTER (MIMC) IS A 30-BED FULLY RENOVATED COMMUNITY HOSPITAL SERVING RURAL NORTHERN CAMBRIA COUNTY AND SURROUNDING AREAS. IT IS THE REGION'S SOLE HOSPITAL AND SPECIALIZES IN FAMILY AND PRIMARY CARE. FACILITY HIGHLIGHTS INCLUDE: 30 BEDS FOR INPATIENT MEDICAL, SURGICAL AND INTENSIVE CARE SERVICES; COMPREHENSIVE OUTPATIENT SERVICES; 24/7 EMERGENCY DEPARTMENT; 24/7 LABORATORY; ONSITE PHARMACY; OPERATING SUITE FOR SHORT OR MINOR PROCEDURES; RADIOLOGY SERVICES, INCLUDING MOBILE MRI AND CT SCANS, DIGITAL MAMMOGRAPHY, AND ULTRASOUND; PATHOLOGY SERVICES; PHYSICAL THERAPY; RESPIRATORY THERAPY; AND OB/GYN OUTPATIENT CARE. ITS PARTNERSHIP WITH MEMORIAL MEDICAL CENTER (MMC) PROVIDES A VARIETY OF PHYSICIAN SPECIALISTS WHO PROVIDE CARE TO PATIENTS AT MIMC SO THAT PATIENTS DO NOT HAVE TO TRAVEL TO JOHNSTOWN. SPECIALTY SERVICES, WHICH ARE AVAILABLE SEVERAL TIMES A MONTH, INCLUDE: CARDIOLOGY, UROLOGY, OPHTHALMOLOGY, GASTROENTEROLOGY, NEPHROLOGY, NEUROLOGY, PHYSICAL MEDICINE AND REHABILITATION, PULMONOLOGY, WOUND HEALING, AND OBSTETRICS/GYNECOLOGY. DIGITAL MAMMOGRAPHY EQUIPMENT WAS FULLY IMPLEMENTED AT MIMC TO ENHANCE THIS IMPORTANT SCREENING EXPERIENCE FOR WOMEN IN THE REGION. EDUCATIONAL MATERIALS HAVE BEEN DISTRIBUTED TO THE COMMUNITY AND FREE SCREENINGS WERE PERFORMED TO INCREASE AWARENESS. IN ADDITION, MEDSTAR MEDICAL HELICOPTER TRANSPORTATION IS AVAILABLE FOR PATIENTS NEEDED TO BE TRANSFERRED TO MMC OR ANOTHER FACILITY. ACCORDING TO THE 2010 US CENSUS, THE AVERAGE HOUSEHOLD SIZE WAS 2.3 IN CAMBRIA COUNTY AND 2.4 IN SOMERSET COUNTY AS COMPARED TO THE NATIONAL AND STATE AVERAGES OF 2.6 AND 2.5 RESPECTIVELY. WITH GENERALLY OLDER POPULATIONS, CAMBRIA AND SOMERSET COUNTIES HAVE LOWER BIRTH RATES THAN DEATH RATES WHICH WILL FURTHER REDUCE HOUSEHOLD SIZE AND RESULT IN A FURTHER INCREASE OF MEDIAN AGE OF THE POPULATION OVER TIME. MEDIAN HOUSEHOLD INCOME IN 2009 WAS $38,205 IN CAMBRIA COUNTY AND $38,712 IN SOMERSET COUNTY, WHICH ARE SIGNIFICANTLY LOWER THAN BOTH STATE AND NATIONAL AVERAGES OF $49,501 AND $50,221 RESPECTIVELY. SOME EFFECTS OF LOW HOUSEHOLD INCOMES INCLUDE LESS DISPOSABLE INCOME FOR FOOD, CLOTHING, PAYING ESSENTIAL BILLS AND SUPPORTING CHILDREN/FAMILY. CONTRIBUTING FACTORS TO DECREASED MEDIAN HOUSEHOLD INCOME IN CAMBRIA AND SOMERSET COUNTIES INCLUDE, BUT ARE NOT LIMITED TO, THE AVAILABILITY OF JOBS, THE DISTRIBUTION AND ECONOMIC VALUE OF JOBS, AND THE CONTINUED HIGH UNEMPLOYMENT RATE. THE CAMBRIA AND SOMERSET EMPLOYED POPULATION INCLUDES HIGHER PROPORTIONS OF THOSE WHO WORK IN HEALTH CARE, GOVERNMENT, RETAIL, TECHNOLOGICAL CORPORATIONS, AND EDUCATION (GREATER JOHNSTOWN CHAMBER OF COMMERCE, 2011).THE CONEMAUGH HEALTH SYSTEM'S COVERAGE REGION ALSO PRESENTS SOME GEOGRAPHIC CHALLENGES DUE TO ITS MOUNTAINOUS TOPOGRAPHY AND HIGHWAY INFRASTRUCTURE. MINDFUL OF THESE CHALLENGES, THE HEALTH SYSTEM CONTINUES TO PRESENT EDUCATIONAL AND SCREENING OPPORTUNITIES TO COMMUNITIES OUTSIDE OF ITS IMMEDIATE REGION. PART VI, LINE 5: THE CONEMAUGH HEALTH SYSTEM (CHS), WHICH INCLUDES MINERS MEDICAL CENTER (MIMC), IS PROVIDED WITH DIVERSE AND DEDICATED LEADERSHIP FROM ITS BOARD OF TRUSTEES. THE BOARD IS COMPRISED OF A WIDE VARIETY OF VOLUNTEERS INCLUDING AREA BUSINESS LEADERS, EDUCATORS, PROFESSIONALS AND PHYSICIANS, SOME AFFILIATED WITH THE CONEMAUGH HEALTH SYSTEM AND OTHERS INDEPENDENT. VALUABLE INPUT ALSO COMES FROM ITS PATIENT ADVISORY COMMITTEE. THIS GROUP MEETS REGULARLY WITH HEALTH SYSTEM OFFICIALS TO PROVIDE INPUT AND SUGGESTIONS ON A WIDE VARIETY OF TOPICS INCLUDING WAYFINDING, PATIENT CARE ISSUES, MARKETING AND SERVICE EXCELLENCE. MEDICAL STAFF PRIVILEGES ARE EXTENDED TO CLOSE TO 400 PHYSICIANS THROUGHOUT A WIDE GEOGRAPHIC REGION IN BOTH PRIMARY CARE AND SPECIALTY FIELDS. IN FISCAL YEAR 2012, CHS ADDED A NUMBER OF NEW PROGRAMS AND TECHNOLOGY TO BENEFIT THE PEOPLE OF THE REGION. SOME OF THESE ADVANCEMENTS INCLUDED: THE IMPLEMENTATION OF $2.8 MILLION WORTH OF NEW DIGITAL MAMMOGRAPHY EQUIPMENT; A NEW DA VINCI SYSTEM FOR ROBOT-ASSISTED SURGERY; A NEW WOUND HEALING CENTER LOCATION AT MIMC; EQUIPMENT TO PERFORM A THIRD TYPE OF WEIGHT LOSS SURGERY - GASTRIC SLEEVE BYPASS; AND TWO NEW HUMAN PATIENT SIMULATORS FOR CLINICAL TRAINING PROGRAMS, ONE A TODDLER VERSION AND THE OTHER AN INFANT. IN ADDITION, A NEW ONLINE BILL PAYMENT SYSTEM WAS INTRODUCED FOR PATIENTS AND AN EMS FELLOWSHIP BEGAN. MINERS HOSPITAL TAKES PART IN A NUMBER OF COMMUNITY ACTIVITIES EACH YEAR, INCLUDING A FREE COMMUNITY HEALTH SCREENING. IN ADDITION, INTERNSHIPS AND EDUCATIONAL OPPORTUNITIES ARE OFFERED TO VARIOUS TYPES OF STUDENTS, SUCH AS PHARMACY AND PHYSICAL THERAPY, THROUGH PARTNERSHIPS WITH VARIOUS EDUCATIONAL INSTITUTIONS INCLUDING THE LAKE ERIE COLLEGE OF OSTEOPATHIC MEDICINE, ST. FRANCIS UNIVERSITY AND MOUNT ALOYSIUS COLLEGE.MINERS HOSPITAL FACILITY HIGHLIGHTS:LICENSED PATIENT BEDS - 30PATIENT DAYS OF SERVICE - 3,280INPATIENT DAILY CENSUS - 9ADJUSTED PATIENT DAYS - 16,937ADMISSIONS - 772AVERAGE LENGTH OF STAY - 4FULL TIME EQUIVALENT EMPLOYEES - 127VOLUNTEERS - 10PHYSICIANS:ACTIVE - 11COURTESY - 30CONSULTING - 22ALLIED HEALTH - 4SERVICES:EMERGENCY VISITS - 10,641INPATIENT SURGERIES - 286SAME DAY/AMBULATORY SURGERIES - 1,773OUTPATIENT CLINIC VISITS - 55,215LABORATORY TESTS - 202,987RADIOLOGY EXAMS - 10,851ULTRASOUND PROCEDURES - 5,078CT SCANS - 3,572MRI PROCEDURES - 531NUCLEAR MEDICINE EXAMS - 904RESPIRATORY THERAPY PROCEDURES - 38,092EKG'S, EEG'S, HOLTERS - 3,409SHORT PROCEDURE UNIT VISITS - 2,099 PART VI, LINE 6: MINERS MEDICAL CENTER IS A SUBSIDIARY OF A LARGER HEALTH SYSTEM, CONEMAUGH HEALTH SYSTEM, INC. THE CONEMAUGH HEALTH SYSTEM AND ITS AFFILIATES WORK TOGETHER TO PROMOTE THE HEALTH OF THE COMMUNITIES THEY SERVE. X X X X X 0 1 0 0 0 1 1 0 0 JAMES TRETTER DO 0 586621 0 56704 0 14518 0 21842 0 14452 0 694137 0 0 SHIBAN WARIKOO MD 0 486420 0 0 0 7964 0 21448 0 10514 0 526346 0 0 STEVEN TUCKER 0 331702 0 109738 0 22591 0 19837 0 11878 0 495746 0 0 SCOTT BECKER 0 599642 0 346114 0 141848 0 15971 0 18919 0 1122494 0 0 EDWARD DEPASQUALE 0 331734 0 109370 0 20700 0 19187 0 11382 0 492373 0 0 DAVID CARLSON DO 0 414185 0 128589 0 19996 0 12867 0 13981 0 589618 0 0 JOSEPH DADO 0 265102 0 87025 0 12165 0 13371 0 2769 0 380432 0 0 WILLIAM CROWE 156355 0 22121 0 3658 0 16338 0 11753 0 210225 0 0 0 JOSEPH SABO MD 163206 0 0 0 2139 0 46756 0 9088 0 221189 0 0 0 PART I, LINE 4B THE CONEMAUGH HEALTH SYSTEM'S 457(F) EXECUTIVE COMPENSATION PROGRAM WAS TERMINATED DECEMBER 10, 2010. PER IRS REGULATIONS, EACH PARTICIPANT'S ENTIRE ACCOUNT BALANCE WAS RECOGNIZED AS TAXABLE INCOME ON THAT DATE AND ALL APPLICABLE TAXES WERE REMITTED. HOWEVER, THESE NET ACCOUNT BALANCES WERE NOT PERMITTED TO BE DISTRIBUTED TO THE PARTICIPANTS UNTIL DECEMBER 11, 2011, OR 1 YEAR AND 1 DAY AFTER THE TERMINATION DATE. ON THAT DATE, EACH PARTICIPANT ALSO RECEIVED ANY ADDITIONAL AMOUNTS EARNED ON ACCOUNT BALANCES DURING THIS WAITING PERIOD. THESE EARNINGS, WHICH WERE RECOGNIZED AS TAXABLE INCOME AND ARE INCLUDED IN THE REPORTABLE COMPENSATION SHOWN, ARE AS FOLLOWS: STEVEN TUCKER $40; SCOTT BECKER $7,682; EDWARD DEPASQUALE $2,212; DAVID CARLSON, DO $1,154; JOSEPH DADO $87; AND WILLIAM CROWE $694. PART I, LINE 6 WILLIAM CROWE RECEIVED A BONUS FROM MINERS HOSPITAL. SCOTT BECKER, EDWARD DEPASQUALE, DAVID CARLSON, DO, AND JOSEPH DADO RECEIVED A BONUS FROM THE CONEMAUGH HEALTH SYSTEM, A RELATED ORGANIZATION. STEVEN TUCKER RECEIVED A BONUS FROM MEMORIAL MEDICAL CENTER, A RELATED ORGANIZATION. EXECUTIVE BONUSES ARE CALCULATED AS A PERCENTAGE OF BASE SALARY. THE PERCENTAGE IS CONTINGENT ON VARIOUS FINANCIAL AND NON-FINANCIAL INCENTIVE CRITERIA, GOVERNED BY THE EXECUTIVE COMPENSATION COMMITTEE OF THE BOARD OF CONEMAUGH HEALTH SYSTEM. JAMES TRETTER, DO RECEIVED A BONUS FROM CONEMAUGH HEALTH INITIATIVES, A RELATED ORGANIZATION. PHYSICIAN BONUSES ARE CALCULATED ON A CASH BASIS; TAKING TOTAL CASH COLLECTIONS LESS ALL OFFICE OPERATING, PHYSICIAN AND OVERHEAD EXPENSES. ANY REMAINING AMOUNT IS THEN DISTRIBUTED TO THE PHYSICIAN BASED ON A CONTRACTUAL PERCENTAGE AND CAP. TOTAL PHYSICIAN COMPENSATION IS ANNUALLY CHECKED FOR REASONABLENESS AGAINST IRS GUIDELINES. FORM 990, PART VI, SECTION A, LINE 4 THE BYLAWS OF MINERS HOSPITAL WERE AMENDED FOR FISCAL YEAR 2012 WITH REGARD TO THE NUMBER AND COMPOSITION OF THE ORGANIZATION'S BOARD MEMBERS. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBERS OF MINERS HOSPITAL ARE THE NORTHERN CAMBRIA HEALTHCARE FOUNDATION AND THE CONEMAUGH HEALTH SYSTEM, INC. FORM 990, PART VI, SECTION A, LINE 7A THE CONEMAUGH HEALTH SYSTEM, INC. HAS THE POWER TO APPROVE OR DISAPPROVE THE ELECTION OF OR REMOVAL OF MEMBERS OF THE GOVERNING BODY. FORM 990, PART VI, SECTION A, LINE 7B ALL DECISIONS OF THE GOVERNING BODY OF MINERS HOSPITAL ARE SUBJECT TO APPROVAL BY THE CONEMAUGH HEALTH SYSTEM, INC. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS PROVIDED TO THE ORGANIZATION'S BOARD OF DIRECTORS BEFORE IT IS FILED. ONCE THE FORM IS COMPLETE, BOARD MEMBERS ARE GIVEN THE OPPORTUNITY TO REVIEW THE CONTENTS OF THE FORM AND SUBMIT ANY COMMENTS OR QUESTIONS. IN ADDITION, SINCE THE ORGANIZATION IS A SUBSIDIARY WITHIN A LARGER HEALTH SYSTEM, THE FORM IS REVIEWED BY THE HEALTH SYSTEM'S MANAGER, TAX & COMPLIANCE; DIRECTOR, FINANCIAL OPERATIONS; VICE PRESIDENT, FINANCIAL OPERATIONS; CHIEF FINANCIAL OFFICER; AND THE AUDIT AND COMPLIANCE COMMITTEE. AN EXTERNAL CPA FIRM IS ENGAGED TO REVIEW AND ELECTRONICALLY FILE THE RETURN. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION IS A SUBSIDIARY OF A LARGER HEALTH SYSTEM AND IS GOVERNED BY THE SYSTEM'S CONFLICT OF INTEREST POLICY, WHICH HAS BEEN APPROVED BY THE HEALTH SYSTEM'S BOARD. UNDER THIS POLICY, EVERY BOARD MEMBER IS GIVEN A COPY OF THE POLICY AS WELL AS A FORM THAT MUST BE COMPLETED ON AN ANNUAL BASIS. NO BOARD MEMBER IS APPROVED OR RE-APPOINTED UNTIL HE OR SHE HAS COMPLETED AND SIGNED THE CONFLICT OF INTEREST FORM. ONCE THE FORM IS RETURNED, IT IS REVIEWED BY THE SYSTEM'S COMPLIANCE OFFICER AND CEO. IF ANY CONFLICTS ARE DISCLOSED, THE DETAILS ARE FORWARDED TO THE BOARD CHAIR TO BE ADDRESSED. DEPENDING ON THE CONFLICT, THE BOARD MEMBER COULD BE GIVEN CERTAIN RESTRICTIONS, SUCH AS BEING PROHIBITED FROM PARTICIPATING IN CERTAIN BOARD DECISIONS. THE HEALTH SYSTEM'S AUDIT AND COMPLIANCE COMMITTEE HAS THE FINAL DECISION-MAKING REGARDING ALL CONFLICTS OF INTEREST. THROUGHOUT THE FISCAL YEAR, BOARD MEMBERS MUST NOTIFY THE BOARD CHAIR, COMPLIANCE OFFICER, AND/OR CEO IF A NEW CONFLICT OF INTEREST HAS DEVELOPED. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION'S PARENT, A HEALTH SYSTEM, MANAGES THE DETERMINATION OF COMPENSATION AND THE PROCESS IS OUTLINED IN ITS BYLAWS. AN OUTSIDE CONSULTING FIRM IS UTILIZED TO ENSURE THAT EXECUTIVE COMPENSATION PACKAGES ARE FAIR AND COMPARABLE WITH SIMILAR ORGANIZATIONS. THE HEALTH SYSTEM HAS ALSO ESTABLISHED AN EXECUTIVE COMPENSATION COMMITTEE TO REVIEW AND RECOMMEND THE COMPENSATION DECISIONS MADE. THIS COMMITTEE REPORTS DIRECTLY TO THE HEALTH SYSTEM'S BOARD. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION IS PART OF A HEALTH SYSTEM AND ALL REQUESTS FOR THIS INFORMATION ARE HANDLED BY THE SYSTEM'S MARKETING/PUBLIC RELATIONS DEPARTMENT. FORM 990, PART VI, SECTION B, LINES 12A, 13 AND 14: ALL APPLICABLE POLICY QUESTIONS HAVE BEEN ANSWERED YES SINCE THE ORGANIZATION IS A SUBSIDIARY OF A LARGER HEALTH SYSTEM AND IS GOVERNED BY THE SYSTEM'S POLICIES. ALL POLICIES HAVE BEEN APPROVED BY THE HEALTH SYSTEM'S BOARD. FORM 990, PART VII, SECTION A, LINE 1A, COLUMN B: IN ADDITION TO THE HOURS DEVOTED TO THE FILING ORGANIZATION SHOWN IN PART VII, THE FOLLOWING OFFICERS AND TRUSTEES ALSO DEVOTED HOURS TO RELATED ORGANIZATIONS DURING THE YEAR. THE HOURS SHOWN REPRESENT THE AVERAGE NUMBER OF HOURS PER WEEK. SCOTT BECKER, CEO: CONEMAUGH HEALTH SYSTEM - 49.5 CONEMAUGH VALLEY MEMORIAL HOSPITAL - 4 MEYERSDALE COMMUNITY HOSPITAL - 1 MINERS HOSPITAL - 1 GOOD SAMARITAN MEDICAL CENTER - 0.3 CONEMAUGH HEALTH FOUNDATION - 4 CONEMAUGH HOUSING, INC. - 0.2 CONEMAUGH HEALTH INITIATIVES - 10 EDWARD DEPASQUALE, CFO: CONEMAUGH HEALTH SYSTEM - 22 CONEMAUGH VALLEY MEMORIAL HOSPITAL - 14 MEYERSDALE COMMUNITY HOSPITAL - 1 MINERS HOSPITAL - 1 GOOD SAMARITAN MEDICAL CENTER - 1 CONEMAUGH HEALTH FOUNDATION - 0.5 CONEMAUGH HOUSING, INC. - 0.5 CONEMAUGH HEALTH INITIATIVES - 10 DAVID CARLSON, DO, CMO: CONEMAUGH HEALTH SYSTEM - 20 CONEMAUGH VALLEY MEMORIAL HOSPITAL - 10 MEYERSDALE COMMUNITY HOSPITAL - 4 MINERS HOSPITAL - 4 GOOD SAMARITAN MEDICAL CENTER - 0.5 CONEMAUGH HEALTH FOUNDATION - 1 CONEMAUGH HOUSING, INC. - 1 CONEMAUGH HEALTH INITIATIVES - 10 JOSEPH DADO, CIO: CONEMAUGH HEALTH SYSTEM - 18 CONEMAUGH VALLEY MEMORIAL HOSPITAL - 10 MEYERSDALE COMMUNITY HOSPITAL - 4 MINERS HOSPITAL - 4 GOOD SAMARITAN MEDICAL CENTER - 1 CONEMAUGH HEALTH FOUNDATION - 1 CONEMAUGH HEALTH INITIATIVES - 12 STEVEN TUCKER, COO: CONEMAUGH HEALTH SYSTEM - 15 CONEMAUGH VALLEY MEMORIAL HOSPITAL - 26 MEYERSDALE COMMUNITY HOSPITAL - 3 MINERS HOSPITAL - 3 GOOD SAMARITAN MEDICAL CENTER - 0.5 CONEMAUGH HEALTH FOUNDATION - 0.5 CONEMAUGH HOUSING, INC. - 0.5 CONEMAUGH HEALTH INITIATIVES - 1.5 PATTI STEFANICK, DO: CONEMAUGH VALLEY MEMORIAL HOSPITAL - 8 MEYERSDALE COMMUNITY HOSPITAL - 1 MINERS HOSPITAL - 1 JAMES TRETTER, DO: CONEMAUGH VALLEY MEMORIAL HOSPITAL - 7 MEYERSDALE COMMUNITY HOSPITAL - 1 MINERS HOSPITAL - 1 CONEMAUGH HEALTH INITIATIVES - 65 SHIBAN WARIKOO, MD: CONEMAUGH VALLEY MEMORIAL HOSPITAL - 2 MEYERSDALE COMMUNITY HOSPITAL - 1 MINERS HOSPITAL - 1 CONEMAUGH HEALTH INITIATIVES - 40 CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 1,769. PENSION ADJUSTMENT -2,482,666. CHANGE IN CHF FAS 136 RECEIVABLE 2,885. TOTAL TO FORM 990, PART XI, LINE 5: -2,478,012. FORM 990, PART XII, LINE 2: THE ORGANIZATION'S FINANCIAL STATEMENTS FOR THE FISCAL YEAR ENDING JUNE 30, 2012 WERE AUDITED AS PART OF THE AUDIT OF THE CONSOLIDATED FINANCIAL STATEMENTS OF THE CONEMAUGH HEALTH SYSTEM, INC. AND SUBSIDIARIES. THE HEALTH SYSTEM'S AUDIT AND COMPLIANCE COMMITTEE ASSUMES RESPONSIBLITY FOR THE OVERSIGHT OF THE AUDIT AND THE SELECTION OF THE INDEPENDENT ACCOUNTANT. CONEMAUGH HEALTH SYSTEM 1086 FRANKLIN STREET JOHNSTOWN PA 15905 232801799 SUPPORT MEMBER HOSPITALS PA 501(C)(3) 11A N/A 0 CONEMAUGH VALLEY MEMORIAL HOSPITAL DBA MEMORIAL MEDICAL CTR 1086 FRANKLIN STREET JOHNSTOWN PA 15905 250965307 HEALTHCARE SERVICES PA 501(C)(3) 3 CONEMAUGH HEALTH SYSTEM 0 GOOD SAMARITAN MEDICAL CENTER 1020 FRANKLIN STREET JOHNSTOWN PA 15905 250965428 HEALTHCARE SERVICES PA 501(C)(3) 3 CONEMAUGH HEALTH SYSTEM 0 MEYERSDALE COMMUNITY HOSPITAL DBA MEYERSDALE MEDICAL CENTER 200 HOSPITAL DRIVE MEYERSDALE PA 15552 251002946 HEALTHCARE SERVICES PA 501(C)(3) 3 CONEMAUGH HEALTH SYSTEM 0 CONEMAUGH HEALTH FOUNDATION 1086 FRANKLIN STREET JOHNSTOWN PA 15905 251719695 SUPPORTS CONEMAUGH HEALTH SYSTEM PA 501(C)(3) 11B CONEMAUGH HEALTH SYSTEM 0 NORTHERN CAMBRIA HEALTHCARE FOUNDATION PO BOX 732 NORTHERN CAMBRIA PA 15714 251537143 SUPPORTS MINERS HOSPITAL PA 501(C)(3) 7 N/A 0 CONEMAUGH HOUSING INC 1086 FRANKLIN STREET JOHNSTOWN PA 15905 251606936 PROVIDES SENIOR HOUSING FACILITIES PA 501(C)(3) 9 CONEMAUGH VALLEY MEMORIAL HOSPITAL 0 LAUREL HIGHLANDS ADVANCED IMAGING 1450 SCALP AVENUE JOHNSTOWN PA 15904 251864587 DIAGNOSTIC SERVICES PA N/A GREATER JOHNSTOWN TECH PARK 1086 FRANKLIN STREET JOHNSTOWN PA 15905 260389121 OPERATES MULTI-TENANT COMMERCE OFFICE PARK PA N/A CONEMAUGH HEALTH INITIATIVES INC DBA CONEMAUGH PHYSICIAN GP 1086 FRANKLIN STREET JOHNSTOWN PA 15905 251658283 PHYSICIAN SERVICES PA N/A C 1086 REAL ESTATE 1086 FRANKLIN STREET JOHNSTOWN PA 15905 251489704 REAL ESTATE PA N/A C CONEMAUGH ENTERPRISES INC 1086 FRANKLIN STREET JOHNSTOWN PA 15905 202998473 ECONOMIC DEVELOPMENT PA N/A C SINDO INC 1086 FRANKLIN STREET JOHNSTOWN PA 15905 251144116 COMMUNITY RENTALS PA N/A C 0 0 0 0 0 0 0 0 1 0 1 1 0 0 1 0 0 1