2013-05-13T10:42:35-05:00 2012-06-30 232932984 PARENTEBEARD LLC 400 MARKET STREET WILLIAMSPORT PA 17701 990 2011-07-01 240795682 MOUNT NITTANY MEDICAL CENTER MOUN 8142317000 1800 EAST PARK AVENUE STATE COLLEGE PA 16803 RICHARD J WISNIEWSKI 8142317000 2013-05-10 1 JULIUS C GREEN CPA JD P00350393 5703236023 2013-05-10 2011 2016-02-24 21:20:13Z STEVEN E BROWN 1800 EAST PARK AVENUE STATE COLLEGE PA 16803 367628014 0 X WWW.MOUNTNITTANY.ORG X 1905 PA PROVIDE INPATIENT, OUTPATIENT & EMERGENCY CARE SERVICES TO RESIDENTS OF THE CENTRE COUNTY REGION. 15 10 1755 795 2580906 1076318 5090097 2899939 234689060 256401835 2719156 2561259 726422 3428458 243224735 265291491 36599650 16099602 0 0 98235970 109118779 0 0 0 108286852 124353711 243122472 249572092 102263 15719399 332089625 353140117 208941116 238688534 123148509 114451583 X MOUNT NITTANY MEDICAL CENTER WILL PROVIDE EVERY PATIENT WITH THE FINEST, PATIENT-CENTERED CARE IN A SAFE AND COMFORTABLE ENVIRONMENT, CONTINUALLY IMPROVING ACCESS TO CARE, AND STRIVING TO ENHANCE THE QUALITY OF HUMAN LIFE FOR EVERYONE WE SERVE.MOUNT NITTANY MEDICAL CENTER WILL ENHANCE ITS POSITION AS THE PREFERRED REGIONAL HEALTHCARE DESTINATION FOR BOTH PATIENTS AND MEDICAL PROFESSIONALS - PROVIDING VITAL CLINICAL CENTERS OF EXCELLENCE AND SUPERIOR ACCESS TO CARE - SUPPORTED BY A COMMITMENT TO MEDICAL EDUCATION AND BACKED BY A CULTURE OF ADVANCEMENT AND ACCOUNTABILITY - MOVING LIFE FORWARD. 0 0 209409419 16099602 256401835 MOUNT NITTANY MEDICAL CENTER IS COMMITTED TO PROVIDING QUALITY MEDICAL CARE IN AN ATMOSPHERE THAT REFLECTS HIGH STANDARDS OF SOCIAL, ETHICAL, AND FINANCIAL RESPONSIBILITY AND WILL ASSURE THAT THOSE SAME STANDARDS ARE MET IN ALL CONTRACTUAL RELATIONSHIPS. THE BOARD OF TRUSTEES HAS ESTABLISHED THIS STATEMENT OF ORGANIZATIONAL VALUES TO ASSURE THAT MEMBERS OF THE BOARD, THE MEDICAL CENTER STAFF, AND THE MEDICAL STAFF HONOR THE FOLLOWING PRINCIPLES THROUGH OUR BEHAVIORS:ALLIANCES WITH PATIENTS:- WE WILL TREAT ALL PATIENTS WITH DIGNITY AND RESPECT, AND WILL ACCOMMODATE INDIVIDUAL RESPONSES TO THE STRESS OF ILLNESS.- WE FULLY SUPPORT THE PRINCIPLES OUTLINED IN THE STATEMENT OF PATIENT'S RIGHTS AND RESPONSIBILITIES DOCUMENT.- WE COMMIT TO A SERVICE EXCELLENCE PHILOSOPHY THAT STRIVES TO MEET OR EXCEED PATIENT EXPECTATIONS.- ALL PATIENTS RECEIVE A UNIFORM STANDARD OF CARE THROUGHOUT THE FACILITY, REGARDLESS OF SOCIAL, CULTURAL, FINANCIAL, RELIGIOUS, RACIAL, GENDER, OR SEXUAL ORIENTATION FACTORS.- THE MEDICAL CENTER AND MEDICAL STAFF WORK JOINTLY TO ASSURE THAT ONLY APPROPRIATE AND EFFECTIVE TESTS, PROCEDURES, AND TREATMENTS ARE PROVIDED TO PATIENTS.COMMUNITY RELATIONS- WE WILL FAIRLY AND ACCURATELY REPRESENT OURSELVES AND OUR CAPABILITIES TO THE PUBLIC.- WE ARE COMMITTED TO CONSTANT PREPARATION FOR THE LONG-TERM FINANCIAL VIABILITY OF THE MEDICAL CENTER THROUGH RESPONSIBLE UTILIZATION OF RESOURCES AND IN SUPPORT OF OUR COMMITMENT TO MEET THE HEALTHCARE NEEDS OF THE COMMUNITY.- MEDICAL CENTER LEADERSHIP (EXECUTIVES, BOARD OF TRUSTEES, MEDICAL STAFF) WILL DISCLOSE AND AVOID POTENTIAL CONFLICTS OF INTEREST. ALL OTHER HOSPITAL STAFF WILL AVOID SIMILAR CONFLICTS OF INTEREST.- WE WILL MAINTAIN AN OPEN ADMISSIONS POLICY: NO PATIENT WILL BE REFUSED EVALUATION AND SERVICE BASED UPON SEX, AGE, RACE, CREED, NATIONAL ORIGIN, SEXUAL ORIENTATION, INFECTION STATUS, OR THE ABILITY TO PAY. TRANSFERS TO OTHER FACILITIES WILL OCCUR ONLY WHEN WE ARE UNABLE TO PROVIDE NEEDED SERVICES AND ONLY TO FACILITIES THAT PROVIDE AN APPROPRIATE LEVEL OF CARE, BASED ON OUR ASSESSMENT OF THE PATIENTS' NEEDS. PATIENTS MAY ALSO REQUEST ELECTIVE TRANSFER AND AN INFORMED CONSENT PROCESS WILL BE FOLLOWED.GENERAL PROGRAM SERVICE INFORMATIONOPERATIONS & PATIENTSMOUNT NITTANY MEDICAL CENTER, LOCATED IN STATE COLLEGE, PENNSYLVANIA, IS A 260-BED ACUTE-CARE, NOT-FOR-PROFIT FACILITY OFFERING GENERAL MEDICAL AND SURGICAL SERVICES THAT ARE FOCUSED ON HELPING PATIENTS REACH THEIR HEALTH POTENTIAL. FOR THE FISCAL YEAR ENDED JUNE 30, 2012, MOUNT NITTANY MEDICAL CENTER PROVIDED CARE TO THE FOLLOWING NUMBER OF PATIENTS:TOTAL NUMBER OF: INPATIENTS 13,282, OUTPATIENTS 191,041 AND ER VISITS 41,196 NUMBER WITH PRIVATE INSURANCE: INPATIENTS 5,545, OUTPATIENTS 111,643 AND ER VISITS 20,363 NUMBER WITH MEDICARE: INPATIENTS 3,540, OUTPATIENTS 29,844 AND ER VISITS 4,713 NUMBER WITH MEDICARE HMO: INPATIENTS 2,441, OUTPATIENTS 24,499 AND ER VISITS 2,498 NUMBER WITH MEDICAID INPATIENTS 1,089, OUTPATIENTS 14,712 ER VISITS 6,836 NUMBER WITH MEDICAID HMO INPATIENTS 123, OUTPATIENTS 251 ER VISITS 197 NUMBER WITH OTHER INSURANCE INPATIENTS 114, OUTPATIENTS 3,052 AND ER VISITS 1,399 NUMBER WITHOUT INSURANCE/SELF PAY: INPATIENTS 430, OUTPATIENTS 7,040, AND ER VISITS 5,190MOUNT NITTANY MEDICAL CENTER DID NOT DENY MEDICAL SERVICES TO ANY INDIVIDUALS INCLUDING THOSE THAT HAD PRIVATE INSURANCE, MEDICARE, MEDICAID, PUBLIC HEALTH INSURANCE, OR NO INSURANCE.EMERGENCY DEPARTMENTMOUNT NITTANY MEDICAL CENTER OPERATES AN EMERGENCY ROOM 24 HOURS A DAY, 365 DAYS A YEAR PROVIDING SERVICES TO ALL MEMBERS OF THE COMMUNITY REGARDLESS OF THEIR ABILITY TO PAY AND DENIED ZERO PATIENTS REQUESTING SUCH SERVICES. THE EMERGENCY ROOM DOES NOT HAVE A TRAUMA CENTER CERTIFICATION.MEDICAL STAFF PRIVILEGESALL QUALIFIED PHYSICIANS IN THE COMMUNITY ARE ELIGIBLE FOR MEDICAL STAFF PRIVILEGES AT MOUNT NITTANY MEDICAL CENTER AND ALL QUALIFIED PHYSICIAN APPLICATIONS HAVE BEEN ACCEPTED FOR MEDICAL STAFF PRIVILEGES. MORE THAN 300 NON-EMPLOYED PHYSICIANS IN 42 SPECIALTIES AND SUBSPECIALTIES ARE CREDENTIALED AT MOUNT NITTANY MEDICAL CENTER.PROFESSIONAL MEDICAL EDUCATION AND TRAININGMOUNT NITTANY MEDICAL CENTER CONDUCTS PROFESSIONAL MEDICAL EDUCATION AND TRAINING PROGRAMS FOR THE BENEFIT OF THE COMMUNITY WITH A RESULTING FINANCIAL LOSS TO THE MEDICAL CENTER. 209409419 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 83 0 1755 1 1 1 0 0 0 0 0 0 0 0 0 X 15 10 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 PA X RICHARD WISNIEWSKI SR VP OF FINANC 8142346148 1800 EAST PARK AVENUE STATE COLLEGE PA 168036797 X RICHARD D ALLATT MD 2.00 X 18074 0 0 CARL A ANDERSON 2.00 X X 0 0 0 PATRICIA BEST DED 2.00 X 0 0 0 S DIANE BRANNON PHD 2.00 X 0 0 0 STEVEN E BROWN 32.00 X X 583710 0 56192 JONATHON DRANOV MD 2.00 X 0 442681 43259 THOMAS J HARRIS 2.00 X X 0 0 0 EUGENE KEPHART DED 2.00 X 0 0 0 PHILIP I PARK 2.00 X 0 0 0 WAYNE SEBASTIANELLI MD 2.00 X 28138 0 0 KAREN P SHUTE 2.00 X 0 0 0 JAMES B THOMAS PHD 2.00 X X 0 0 0 CHARLES WITMER 2.00 X 0 0 0 PAUL SHUEY DO 2.00 X 0 0 0 THOMAS F BROWN 2.00 X X 0 0 0 RICHARD WISNIEWSKI 34.00 X 312377 0 50530 JEFFREY RATNER MD 40.00 X 325074 0 55909 JANET SCHACHTNER 38.00 X 258107 0 48053 THOMAS STOESSEL 40.00 X 225770 0 50629 GERALD DITTMANN 40.00 X 174146 0 44814 GAIL MILLER 40.00 X 151840 0 37745 ROBERT WUNAR 0.00 X 0 122204 10887 DAVID PETERSON 0.00 X 134349 0 8570 LANCE ROSE 0.00 X 14721 0 1126 2226306 564885 407714 36 1 1 0 ALEXANDER BUILDING CONSTRUCTION LLC 315 VAUGHN STREET HARRISBURG PA 17110 CONSTRUCTION 31910449 STICKLER CONSTRUCTION LLC 210 W HAMILTON AVE 294 STATE COLLEGE PA 16801 CONSTRUCTION 7110853 PENN STATE MILTON S HERSHEY MEDICAL CEN 210 W HAMILTON AVE 294 STATE COLLEGE PA 16801 CONTRACTED PHYSICIAN SERVICES 3449818 PULMOREHAB LLC 2718 CENTERVILLE ROAD TALLAHASSEE FL 32308 CONTRACTED MANAGEMENT & EMPLOYEE SERVICE 1239313 X-PERT COMMUNICATIONS INC 2490 COMMERCIAL BOULEVARD SUITE 1 STATE COLLEGE PA 16801 CONSTRUCTION 1040292 46 2073672 781067 45200 2899939 NET PATIENT SERVICE RE 621110 240664473 240664473 OTHER OPERATING REV 900099 15737362 15737362 256401835 2896804 2896804 113581 64750 48831 48831 48831 101855933 80295 102262031 9742 -406098 70553 -335545 -335545 OUTPATIENT LAB SERVICE 621500 2555080 2555080 CAFETERIA SALES 722210 773507 773507 VENDING MACHINES 722210 25214 25214 25826 25826 3379627 265291491 256401835 2580906 3408811 16099602 16099602 83039595 72103140 10936455 5478157 5478157 14895705 12966164 1929541 5705322 4994919 710403 773627 773627 90007 90007 32323 32323 2949 2949 11408969 7918264 3490705 597347 28 597319 72877100 57859647 15017453 3341524 780670 2560854 23368 15372 7996 125509 86213 39296 5821603 5821603 12732436 12732436 712228 692300 19928 UBIT TAXES 454093 454093 BAD DEBT EXPENSE 8155138 8155138 COMMUNICATIONS 2944916 2944916 PATHOLOGY LAB 1514911 1514911 2745663 1704439 1041224 249572092 209409419 40162673 0 3576 3848 16796489 25257138 27718614 27893048 5681662 6133968 3273893 1833564 296338614 139012073 119081389 157326541 145457257 117826438 658804 750288 13417941 16115284 332089625 353140117 60484406 92661151 327363 470147 140322681 138850170 1926112 2173917 5880554 4533149 208941116 238688534 X 122934398 114237472 35617 35617 178494 178494 123148509 114451583 332089625 353140117 X 15719399 -24416325 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 0 0 0 1 32323 32323 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: CONTINUED TO WORK WITH OSBORNE CONSULTING, INC., A FEDERAL LOBBYING GROUP, TO REQUEST FEDERAL APPROPRIATIONS - TOTAL COST $18,000. A PORTION OF THE DUES PAID TO THE HOSPITAL & HEALTHSYSTEM ASSOCIATION OF PENNSYLVANIA ($7,535) AND THE AMERICAN HOSPITAL ASSOCIATION ($6,788) WAS DETERMINED TO BE FOR LOBBYING PURPOSES - TOTAL COST $14,323. 305935 306824 2750 615509 279801 3991 22143 305935 275745 4056 279801 281903 1505 -7663 275745 0 1 1 9 9 153310435 59064312 94246123 1246316 436479 809837 107721385 77266180 30455205 34060469 2245102 31815367 157326541 DEFERRED COMPENSATION 189513 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 3267051 ACCRUED INTEREST 1076585 4533149 265291491 249572092 15719399 -1700796 -22715529 -24416325 -8696926 238863295 -1700796 -22715529 -24416325 263279620 2949 2008922 2011871 265291491 247560221 64750 64750 247495471 2949 2073672 2076621 249572092 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: PERMANENT ENDOWMENT FUNDS ARE HELD BY THE FOUNDATION FOR MOUNT NITTANY MEDICAL CENTER, INC. AND EARNINGS ARE DESIGNATED TO FUND FUTURE EXPENDITURES AND CAPITAL ACQUISITONS FOR MOUNT NITTANY MEDICAL CENTER. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE CORPORATION ACCOUNTS FOR UNCERTAINTY IN INCOME TAXES USING A RECOGNITION THRESHOLD OF MORE-LIKELY-THAN NOT TO BE SUSTAINED UPON EXAMINATION BY THE APPROPRIATE TAXING AUTHORITY. MEASUREMENT OF THE TAX UNCERTAINTY OCCURS IF THE RECOGNITION THRESHOLD IS MET. MANAGEMENT DETERMINED THERE WERE NO TAX UNCERTAINTIES THAT MET THE RECOGNITION THRESHOLD IN 2011 AND 2010. ALL REQUIRED FEDERAL EXEMPT ORGANIZATION BUSINESS INCOME TAX RETURNS FOR THE ORGANIZATION HAVE BEEN FILED UP TO, AND INCLUDING, THE TAX YEAR ENDED JUNE 30, 2011. THE ORGANIZATION'S FEDERAL INCOME TAX RETURNS FOR 2008, 2009, AND 2010 REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE ("IRS"). PART XI, LINE 8 - OTHER ADJUSTMENTS: CHANGE IN INTEREST IN THE FOUNDATION FOR MOUNT NITTANY MEDICAL CENTER, INC. -1,005,853. PENSION LIABILITY ADJUSTMENT -22,705,356. CHANGE IN FAIR VALUE OF DERIVATIVE 995,680. TOTAL TO SCHEDULE D, PART XI, LINE 8: -22,715,529. PART XII, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN INTEREST IN THE FOUNDATION FOR MOUNT NITTANY MEDICAL CENTER, INC. -1,005,853. PENSION LIABILITY ADJUSTMENT -22,705,356. CHANGE IN FAIR VALUE OF DERVATIVE INSTRUMENTS 995,680. PART XII, LINE 4B - OTHER ADJUSTMENTS: TRANSFERS FROM RELATED ORGANIZATIONS (NETTED ON FINANCIAL STATEMENTS) 2,073,672. RENTAL EXPENSES -64,750. PART XIII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 64,750. PART XIII, LINE 4B - OTHER ADJUSTMENTS: TRANSFERS FROM RELATED ORGANIZATIONS (NETTED ON FINANCIAL STATEMENTS) 2,073,672. 1 1 1 X 250.000000000000 0 1 1 0 1 1 1578088 1578088 0.00650 15049634 7056165 7993469 0.03310 16627722 7056165 9571557 0.03960 314327 109 314218 0.00130 615124 114975 500149 0.00210 3817498 2781970 1035528 0.00430 250588 250588 0.00100 4997537 2897054 2100483 0.00870 21625259 9953219 11672040 0.04830 7109 7109 0.00000 11184 11184 0.00000 29686 29686 0.00010 891 891 0.00000 7858 7858 0.00000 56728 56728 0.00010 1 2722185 38148464 50920463 -12771999 X 1 1 1 ADG HOSPITAL DRIVE ASSOCIATES LEASING REAL PROPERTY FOR MEDICAL OFFICE AND SURGICAL CENTER 0.24260 1 1 MOUNT NITTANY MEDICAL CENTER

1800 EAST PARK AVENUE STATE COLLEGE PA 16803

X X X MOUNT NITTANY MEDICAL CENTER 1 1 1 250.000000000000 0 1 X 1 1 X X X X X 1 X 1 X X X X X 1 X 0 0 PART I, LINE 7: COST TO CHARGE RATIO WAS COMPUTED USING WORKSHEET 2 IN THE IRS INSTRUCTIONS TO FORM 990 FOR LINES 7A, 7B, AND 7G. COST ACCOUNTING SYSTEM WAS USED FOR SUBSIDIZED HEALTH SERVICES. FOR ALL OTHERS, COSTS INCLUDED THE VALUE OF STAFF DONATED HOURS (WITH ESTIMATED BENEFITS), MONETARY CONTRIBUTIONS, ESTIMATED VALUE OF MATERIALS USED IN DELIVERING PROGRAMS, AND ESTIMATED SPACE COSTS. THE INDIRECT COST ALLOCATION APPLIES THE INDIRECT-TO-DIRECT COST RATIO FROM THE MEDICAL CENTER'S MOST RECENT MEDICARE COST REPORT (APPROX. 31%). PART I, L7 COL(F): AMOUNT OF BAD DEBT EXPENSE FROM PART IX SUBTRACTED IN ORDER TO CALCULATE PERCENT OF TOTAL EXPENSE IN DEMONINATOR FOR PART I LINE 7 COLUMN F WAS $8,155,138 PART II: THE MEDICAL CENTER AND ITS STAFF INVEST IN WORKFORCE DEVELOPMENT BY OFFERING TRAINING OPPORTUNITIES, SUCH AS RESOURCE-INTENSIVE INTERNSHIPS FOR NURSING STUDENTS IN THE REGION, AS WELL AS CONTRIBUTING TIME AND RESOURCES TO REGIONAL PLANNING EFFORTS AND LEADERSHIP DEVELOPMENT. FOR THE INTERNSHIPS AND RELATED PROGRAMS, CONSIDERABLE STAFF TIME IS REQUIRED TO ORGANIZE THESE PROGRAMS AND PROVIDE "PRECEPTOR" OR INSTRUCTOR SERVICES WHILE CONTINUING TO PROVIDE DIRECT CARE FOR PATIENTS WITH NORMAL JOB RESPONSIBILITIES. PART III, LINE 4: BAD DEBT (AT COST) IS CALCULATED BY APPLYING THE PATIENT CARE COST-TO-CHARGE RATIO FROM WORKSHEET 2 TO THE MEDICAL CENTER'S PROVISION FOR DOUBTFUL COLLECTIONS AS OF JUNE 30, 2012. THE MEDICAL CENTER'S ACCOUNTING DEPARTMENT RECORDS PAYMENTS, WHILE PATIENT ACCOUNTING STAFF MAKES APPROPRIATE ADJUSTMENTS TO PATIENT ACCOUNTS FOR BAD DEBT, DISCOUNTS, OR FREE CARE WRITE-OFFS. THE MEDICAL CENTER IS UNABLE TO ESTIMATE THE AMOUNT OF BAD DEBT THAT COULD BE ATTRIBUTABLE TO PATIENTS WHO LIKELY WOULD QUALIFY FOR FINANCIAL ASSISTANCE UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. PATIENTS DO NOT PROVIDE INCOME INFORMATION PRIOR TO RECEIVING CARE. THE REGISTRATION DEPARTMENT GIVES EVERY PATIENT A COPY OF OUR FINANCIAL ASSISTANCE PROGRAM TO ENSURE EVERY PATIENT HAS THE OPPORTUNITY AS APPROPRIATE TO QUALIFY FOR OUR ASSISTANCE PROGRAM. THE MEDICAL CENTER OFFERS DETAILED INFORMATION ABOUT THE CHARITY CARE PROGRAM WHEN PATIENTS OFFER INFORMATION THAT IS NEEDED TO DETERMINE ELIGIBILITY. SEE RESPONSE TO PART VI, LINE 3 HEREIN. BAD DEBT IS PUBLISHED IN THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS ON THE STATEMENT OF OPERATIONS ON THE LINE ENTITLED, "PROVISION FOR DOUBTFUL COLLECTIONS."MOUNT NITTANY MEDICAL CENTER PROVIDES SERVICES TO ALL PATIENTS REGARDLESS OF ABILITY TO PAY AS PART OF THE HOSPITAL'S MISSION. A PORTION OF THE MOUNT NITTANY MEDICAL CENTER'S BAD DEBT WOULD RELATE TO PATIENTS THAT COULD QUALIFY FOR CHARITY CARE BUT WERE UNWILLING OR UNABLE TO PROVIDE THE APPROPRIATE DOCUMENTATION TO ALLOW THAT CLASSIFICATION. AS SUCH A PORTION OF THE HOSPITAL'S BAD DEBT SHOULD BE CONSIDERED COMMUNITY BENEFIT. PART III, LINE 8: THE MEDICAL CENTER CONTINUES TO PROVIDE CARE TO ALL PRESENTING AND ADMITTED PATIENTS, REGARDLESS OF ABILITY TO PAY. THROUGH DILIGENT COST CONTROL PROCESSES, THE MEDICAL CENTER SEEKS WAYS TO KEEP COSTS OF PROVIDING CARE TO A MINIMUM, WHILE STILL PROVIDING THE SAFETY MEASURES, TECHNOLOGICAL CAPABILITIES, AND APPROPRIATE STAFFING LEVELS TO ENSURE THE BEST POSSIBLE OUTCOMES. NOTWITHSTANDING THE COSTS TO PROVIDE CARE, RECEIVING "LESS" THAN WHAT IT COSTS TO PROVIDE ADEQUATE CARE TO MEDICARE COVERED LIVES DOES THE MEDICAL CENTER A DISSERVICE. THIS SHORTFALL SHOULD COUNT AS A COMMUNITY BENEFIT AS THE MEDICAL CENTER STRIVES TO PROVIDE THE BEST CARE POSSIBLE TO ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. THE MEDICAL CENTER USES A STEP-DOWN COST ALLOCATION METHOD AND THEN APPLIES A COST-TO-CHARGE RATIO. PART III, LINE 9B: IF PATIENTS ARE FOUND TO QUALIFY, THE MEDICAL CENTER IMMEDIATELY CEASES COLLECTIONS AND ADJUSTS CHARGES OFF AS CHARITY CARE. MOUNT NITTANY MEDICAL CENTER PART V, SECTION B, LINE 10: THE MEDICAL CENTER DOES NOT HAVE A DISCOUNTED CARE POLICY. MOUNT NITTANY MEDICAL CENTER PART V, SECTION B, LINE 19D: PATIENTS WHOSE FAMILY INCOME IS AT OR BELOW 250% OF THE FEDERAL POVERTY GUIDELINES ARE ELIGIBLE TO RECEIVE A 100% DISCOUNT FOR FREE CHARITY/FREE CARE. PATIENTS WHOSE FAMILY INCOME EXCEEDS 250% OF THE FEDERAL POVERTY GUIDELINES MAY BE ELIGIBLE TO RECEIVE DISCOUNTED RATES ON A CASE-BY-CASE BASIS BASED ON THEIR SPECIFIC CIRCUMSTANCES, SUCH AS CATASTROPHIC ILLNESS OR MEDICAL INDIGENCE, AT THE DISCRETION OF THE MEDICAL CENTER. PART VI, LINE 2: MOUNT NITTANY HEALTH SYSTEM ("MNHS") HAS HISTORICALLY USED INFORMAL COMMUNITY FEEDBACK MECHANISMS SUCH AS PATIENT AND STAFF INTERACTIONS, AS WELL AS MORE FORMAL MEANS SUCH AS CONSULTANT-LED MARKET RESEARCH AND SOLICITING FEEDBACK FROM DONORS, NON-EMPLOYED PHYSICIANS, AND COMMUNITY LEADERS TO UNDERSTAND THE NEEDS OF REGIONAL POPULATIONS. IN ADDITION, MNHS CONTINUES TO HOLD ONGOING AND MEANINGFUL DISCUSSIONS WITH MAJOR COMMUNITY STAKEHOLDERS, INCLUDING, BUT NOT LIMITED TO, THE PENNSYLVANIA STATE UNIVERSITY AND MILTON S. HERSHEY MEDICAL CENTER, TO DEVELOP RESPONSIVE PROGRAMS AND SOLUTIONS TO THE HEALTH CARE NEEDS OF PROMINENT SEGMENTS OF THE LOCAL POPULATION IN CENTRE COUNTY. PART VI, LINE 3: MOUNT NITTANY MEDICAL CENTER IS DEDICATED TO IMPROVING THE HEALTH AND WELL-BEING OF ALL ITS CONSTITUENTS. THROUGH THE FINANCIAL ASSISTANCE PROGRAM, MEDICAL CARE IS PROVIDED REGARDLESS OF A PATIENT'S ABILITY TO PAY, INSUFFICIENT HEALTH INSURANCE OR WHETHER A GOVERNMENT-SPONSORED PROGRAM COVERS THE FULL COST OF SERVICES. AND AS THE COUNTRY'S ECONOMIC FUTURE REMAINS UNCERTAIN, MOUNT NITTANY MEDICAL CENTER WILL CONTINUE TO PROVIDE CARE FOR THOSE WHO NEED IT. MOUNT NITTANY MEDICAL CENTER WILL PROVIDE SERVICES AT NO CHARGE OR REDUCED CHARGES TO THOSE WHO ARE FINANCIALLY UNABLE TO PAY FOR THOSE SERVICES. MOUNT NITTANY MEDICAL CENTER WILL NOT ARBITRARILY RESTRICT THE PROVISIONS OF HEALTH SERVICES TO CERTAIN INDIVIDUALS OR GROUPS.MOUNT NITTANY MEDICAL CENTER'S REGISTRATION DEPARTMENT REPRESENTATIVES WILL GIVE A COPY OF OUR FINANCIAL ASSISTANCE PROGRAM TO EVERY PATIENT ALONG WITH OTHER IMPORTANT BILLING INFORMATION. OUR FINANCIAL COUNSELOR WILL DISCUSS THE AVAILABILITY OF VARIOUS GOVERNMENT BENEFITS SUCH AS MEDICAID OR STATE PROGRAMS TO ASSIST THE PATIENT WITH QUALIFICATIONS FOR THESE PROGRAMS. THE FINANCIAL COUNSELOR WILL ALSO ASSIST THE PATIENT IN COMPLETING THE PROPER PAPERWORK FOR ASSISTANCE. IN ADDITION, OUR VENDOR DEBIASE & LEVINE REPRESENTATIVE, WHO IS WORKING ON BEHALF OF MOUNT NITTANY MEDICAL CENTER, WILL ALSO ASSIST PATIENTS WITH THE MEDICAL ASSISTANCE PROCESS. OUR THIRD PARTY VENDOR WORKS ON BEHALF OF THE ORGANIZATION TO FOLLOW THE HOSPITAL'S POLICIES REGARDING PATIENT NOTIFICATION AND THE AVAILABILITY OF FINANCIAL ASSISTANCE. MOUNT NITTANY MEDICAL CENTER'S FINANCIAL ASSISTANCE POLICY IS POSTED ON OUR WEBSITE ALONG WITH AN APPLICATION FOR PATIENTS TO COMPLETE FOR FINANCIAL ASSISTANCE. THE FINANCIAL COUNSELORS AND CASE MANAGEMENT STAFF WILL ALSO WORK CLOSELY TO IDENTIFY AND ASSIST ELIGIBLE PATIENTS.MOUNT NITTANY MEDICAL CENTER WILL MAKE AVAILABLE A WRITTEN NOTICE TO EACH PATIENT OR THEIR REPRESENTATIVE OF THE EXISTENCE, CRITERIA AND MECHANISM FOR RECEIVING FINANCIAL ASSISTANCE. THE HOSPITAL WILL CREATE AND MAINTAIN RECORDS AND DOCUMENT THAT AN APPLICATION WAS SENT TO THE PATIENT DEMONSTRATING THAT THE REQUIRED CRITERIA AND MECHANISM ARE ESTABLISHED (MOUNT NITTANY MEDICAL CENTER WILL RECORD ANY AND ALL REQUESTS FOR FINANCIAL ASSISTANCE, THE DISPOSITION AND THE DOLLAR AMOUNT OF MOUNT NITTANY MEDICAL CENTER'S FINANCIAL ASSISTANCE PROGRAM PROVIDED). THE HOSPITAL SCANS ALL COMPLETED APPLICATIONS GIVEN TO THE PATIENT ACCOUNTS DEPARTMENT SHOWING WHETHER THE APPLICATION WAS APPROVED OR DENIED. IN ALL INSTANCES, PATIENT CONFIDENTIALITY WILL BE PROTECTED.ELIGIBILITY WILL BE DETERMINED BY COMPARING HOUSEHOLD FAMILY INCOME AGAINST THE INCOME POVERTY GUIDELINES. INCOME IS DEFINED AS THE TOTAL ANNUAL CASH RECEIPTS BEFORE TAXES FROM ALL SOURCES.A NOTICE OF AVAILABILITY OF MOUNT NITTANY MEDICAL CENTER'S FINANCIAL ASSISTANCE PROGRAM WILL BE GIVEN TO EACH PATIENT OR THEIR REPRESENTATIVE PRIOR TO SERVICES BEING RENDERED, WITH THE EXCEPTION OF EMERGENCY SERVICES. THESE NOTICES SHALL BE DISPLAYED AND MADE AVAILABLE IN ALL REGISTRATION AREAS OF THE HOSPITAL AND SHALL INCLUDE THE MOST CURRENT AVAILABLE "HOUSEHOLD INCOME GUIDELINES" AS PUBLISHED IN THE FEDERAL REGISTER. MOUNT NITTANY MEDICAL CENTER'S CURRENT FINANCIAL ASSISTANCE PROGRAM ELIGIBILITY IS BASED ON 2.5 TIMES THE "HOUSEHOLD INCOME GUIDELINES".THE PATIENT ACCOUNTS DIRECTOR OR HIS/HER DESIGNEE SHALL REVIEW ALL APPLICATIONS FOR THE MOUNT NITTANY MEDICAL CENTER FINANCIAL ASSISTANCE PROGRAM. IT IS THE APPLICANT'S RESPONSIBILITY TO PROVIDE PROOF OF INCOME. PART VI, LINE 4: THE MEDICAL CENTER'S PRIMARY SERVICE AREA INCLUDES CENTRE COUNTY AND PARTS OF THE SURROUNDING COUNTIES. CENTRE COUNTY'S POPULATION IS APPROXIMATELY 154,000. APPROXIMATELY 13% OF THE POPULATION IS AGED 0-14, 76% AGED 15-64, AND 11% IS 65 OR OLDER. THE ESTIMATE FOR THE POPULATION LIVING BELOW THE POVERTY LINE IS 18%. THE MEDIAN AGE IN CENTRE COUNTY IS 26.6 (39.9 FOR ALL OF PA). 40% OF THOSE AGED 25 OR OLDER HAVE AT LEAST A BACHELOR'S DEGREE VS. 26.4% FOR ALL OF PA. THE MEDIAN HOUSEHOLD INCOME IS $47,016, WHILE THE PA MEDIAN IS $53,098. 40,000+ COLLEGE STUDENTS LIVE IN STATE COLLEGE. MOUNT NITTANY MEDICAL CENTER IS THE SOLE GENERAL ACUTE CARE HOSPITAL IN CENTRE COUNTY. THE NEAREST LEVEL II TRAUMA CENTER IS APPROX. 43 MILES AWAY. PART OF CENTRE COUNTY IS A DESIGNATED MEDICALLY UNDERSERVED AREA. PART VI, LINE 5: THE MEDICAL CENTER'S BOARD OF TRUSTEES AND ITS VARIOUS COMMITTEES INCLUDE COMMUNITY MEMBERS AS WELL AS MEDICAL STAFF. THE COMMUNITY MEMBERS ARE NOT DIRECTLY INVOLVED IN THE MEDICAL CENTER'S OPERATIONS. THE MEDICAL CENTER'S MEDICAL STAFF EXCEEDS 300 PHYSICIANS AND CONTINUES TO INVEST IN STRONG AND BENEFICIAL RELATIONSHIPS WITH ALL PHYSICIANS WHO HAVE AN INTEREST IN WORKING WITH THE MEDICAL CENTER. ALL REVENUES IN EXCESS OF EXPENSES ARE RE-INVESTED IN THE COMMUNITY, INCLUDING SIGNIFICANT DONATIONS TO THE COUNTY'S ONLY FREE MEDICAL AND DENTAL CLINIC, AS WELL AS INTERNAL IMPROVEMENTS TO TECHNOLOGY SO THAT THE COMMUNITIES WE SERVE HAVE IMMEDIATE ACCESS TO THE BEST AND MOST APPROPRIATE DIAGNOSTIC AND TREATMENT OPTIONS AVAILABLE. PART VI, LINE 6: AS OF JUNE 30, 2012, MOUNT NITTANY HEALTH SYSTEMS HAS TWO CONTROLLED CORPORATIONS, WHICH ARE THE MOUNT NITTANY MEDICAL CENTER (INPATIENT AND OUTPATIENT SERVICES) AND MOUNT NITTANY MEDICAL CENTER HEALTH SERVICES, INC. (A PHYSICIAN PRACTICE D/B/A MOUNT NITTANY PHYSICAN GROUP). THE FOUNDATION FOR MOUNT NITTANY MEDICAL CENTER, INC. (FUNDRAISING) AND THE MOUNT NITTANY SURGICAL CENTER, INC. (OUTPATIENT SURGICAL CENTER) ARE CONTROLLED BY MOUNT NITTANY MEDICAL CENTER. REPORTS FILED WITH STATES PART VI, LINE 7 PA 0 MOUNT NITTANY MEDICAL CENTER HEALTH SERVICES INC 1800 EAST PARK AVENUE STATE COLLEGE PA 16803 510426500 501(C)(3) 15701027 CASH N/A PROVIDE FINANCIAL SUPPORT TO AFFILIATE THE FOUNDATION FOR MOUNT NITTANY MEDICAL CENTER 1800 EAST PARK AVENUE STATE COLLEGE PA 16803 571138956 501(C)(3) 266212 CASH N/A PROVIDE FINANCIAL SUPPORT TO AFFILIATE MOUNT NITTANY HEALTH SYSTEM 1800 EAST PARK AVENUE STATE COLLEGE PA 16803 800663092 501(C)(3) 132363 CASH N/A PROVIDE FINANCIAL SUPPORT TO AFFILIATE 3 0 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: ASSISTANCE IS PROVIDED TO RELATED ENTITIES FOR FINANCIAL SUPPORT. MANAGEMENT OF THE HEALTH SYSTEM OVERSEES THE USE OF FUNDS AT THE AFFILIATED ENTITIES. X X X X X 1 1 0 0 0 1 0 0 0 STEVEN E BROWN 454205 0 129505 0 0 0 19624 0 36568 0 639902 0 0 0 JONATHON DRANOV MD 0 432681 0 10000 0 0 0 16500 0 26759 0 485940 0 0 RICHARD WISNIEWSKI 252202 0 60175 0 0 0 19625 0 30905 0 362907 0 0 0 JEFFREY RATNER MD 302368 0 22706 0 0 0 19625 0 36284 0 380983 0 0 0 JANET SCHACHTNER 212002 0 46105 0 0 0 19625 0 28428 0 306160 0 0 0 THOMAS STOESSEL 191164 0 34606 0 0 0 18321 0 32308 0 276399 0 0 0 GERALD DITTMANN 152014 0 22132 0 0 0 13992 0 30822 0 218960 0 0 0 GAIL MILLER 129192 0 22648 0 0 0 12176 0 25569 0 189585 0 0 0 ROBERT WUNAR 0 77204 0 45000 0 0 0 0 0 10887 0 133091 0 0 DAVID PETERSON 0 0 0 0 134349 0 0 0 8570 0 142919 0 0 0 LANCE ROSE 0 0 0 0 14721 0 0 0 1126 0 15847 0 0 0 PART I, LINES 4A-B LANCE ROSE RECEIVED NONQUALIFIED PENSION PAYMENTS OF $14,721. DAVID PETERSON RECEIVED A PARTIAL SEVERANCE PAYMENT FOR 2011. PART I, LINE 6 THE EXECUTIVE TEAM MEMBERS OF MOUNT NITTANY MEDICAL CENTER RECEIVED A PORTION OF THEIR ANNUAL VARIABLE-PAY BASED UPON THE NET EARNINGS OF MOUNT NITTANY MEDICAL CENTER AND OTHER CORPORATE GOALS. THE CORPORATE GOALS FOCUSED ON FINANCE, GROWTH, HUMAN RESOURCES, CLINICAL QUALITY, AND PATIENT SAFETY. CENTRE COUNTY HOSPITAL AUTHORITY 203197497 156273CE2 2009-03-26 69748005 FUND EAST WING EXPANSION & OTHER CAPITAL EXPENDITURES 0 1 0 CENTRE COUNTY HOSPITAL AUTHORITY 203197497 156273CU6 2011-05-05 70552972 FUND EMERG. DEPT. EXPANSION & OTHER CAPITAL EXPENDITURES 0 1 0 69748005 24 3721113 53727339 5003579 2012 0 0 0 1 70552972 13872894 1033856 50203269 3764174 2013 0 0 0 1 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 0 0 0 0 0 0 0 0 SCHEDULE K, PART III, LINE 3: THERE ARE NO MANAGEMENT OR SERVICE CONTRACTS OR RESEARCH AGREEMENTS RELATING TO THE FINANCED PROPERTIES FOR THE 2009 OR 2011 BONDS. EDWARD BELL FAMILY MEMBER OF A BOARD TRUSTEE, KAREN SHUTE 123036 SALARY COMPENSATION AS A MNMC EMPLOYEE. 0 FORM 990, PART VI, SECTION B, LINE 11 THE 990 WAS REVIEWED BY THE BOARD OF TRUSTEES AND BY THE MOUNT NITTANY HEALTH SYSTEM AUDIT COMMITTEE BEFORE BEING FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY, THE CONFLICT OF INTEREST POLICY IS DISTIBUTED TO KEY MEMBERS OF THE ORGANIZATION INCLUDING BOARD MEMBERS, OFFICERS, AND KEY EMPLOYEES. EACH PERSON MUST REPORT ANY POTENTIAL CONFLICT OF INTERESTS, WHICH IS THEN REVIEWED BY THE CORPORATE COMPLIANCE OFFICER AND THEN REPORTED AND REVIEWED BY THE HEALTH SYSTEM'S AUDIT COMMITTEE. FORM 990, PART VI, SECTION B, LINE 15 EXECUTIVE COMPENSATION COMMITTEE FROM BOARD OF TRUSTEES REVIEWS COMPENSATION PAID TO EXECUTIVE MANAGEMENT TEAM IN CONJUNCTION WITH AN INDEPENDENT THIRD PARTY CONSULTING FIRM TO ENSURE COMPENSATION IS REASONABLE AND APPROPRIATE FOR DUTIES AND RESPONSIBILITES ASSIGNED. REVIEW AND APPROVAL OF COMPENSATION IS DOCUMENTED VIA MINUTES OF COMMITTEE MEETINGS. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VII, SECTION A: AVERAGE HOURS PER WEEK FOR DIRECTORS FOR MOUNT NITTANY MEDICAL CENTER AND ALL RELATED ORGANIZATIONS ARE AS FOLLOWS: CARL ANDERSON - 8 THOMAS BROWN - 10 THOMAS HARRIS - 6 JONATHON DRANOV, MD - 40 STEVEN BROWN - 40 RICHARD WISNIEWSKI - 40 CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -1,700,796. CHANGE IN INTEREST IN THE FOUNDATION FOR MOUNT NITTANY MEDICAL CENTER, INC. -1,005,853. PENSION LIABILITY ADJUSTMENT -22,705,356. CHANGE IN FAIR VALUE OF DERIVATIVE 995,680. TOTAL TO FORM 990, PART XI, LINE 5: -24,416,325. THE FOUNDATION FOR MOUNT NITTANY MEDICAL CENTER INC 1800 EAST PARK AVENUE STATE COLLEGE PA 168036796 571138956 FUNDRAISING AND SUPPORT FOR MOUNT NITTANY MEDICAL CENTER PA 501(C)(3) 11A MOUNT NITTANY MEDICAL CENTER 1 MOUNT NITTANY MEDICAL CENTER WORKMEN'S COMPENSATION SELF INSURANCE TRUST 1800 EAST PARK AVENUE STATE COLLEGE PA 168036796 256440788 PROVIDE WORKMEN'S COMPENSATION BENEFITS TO EMPLOYEES OF MNMC PA 501(C)(3) 11A N/A 0 MOUNT NITTANY MEDICAL CENTER HEALTH SERVICES INC 1800 EAST PARK AVENUE STATE COLLEGE PA 168036796 510426500 PROFESSIONAL SERVICES TO SUPPORT MNMC PA 501(C)(3) 11A MOUNT NITTANY HEALTH SYSTEM 0 MOUNT NITTANY SURGICAL CENTER INC 1850 EAST PARK AVENUE STATE COLLEGE PA 168036796 251712099 HEALTHCARE PA 501(C)(3) 11A MOUNT NITTANY MEDICAL CENTER 1 MOUNT NITTANY HEALTH SYSTEM 1800 EAST PARK AVENUE STATE COLLEGE PA 168036796 800663092 PROVIDE MANAGEMENT AND ADMINISTRATIVE SUPPORT TO MNMC & SUBSIDIARIES PA 501(C)(3) 11A N/A 0 0 1 1 0 0 0 0 0 0 0 1 1 1 1 0 0 1 1 FOUNDATION FOR MOUNT NITTANY MEDICAL CENTER C 2073672 CASH FOUNDATION FOR MOUNT NITTANY MEDICAL CENTER K 1751 COST OF SERVICES PERFORMED FOUNDATION FOR MOUNT NITTANY MEDICAL CENTER N 295841 COST OF SHARING PAID EMPLOYEES MOUNT NITTANY SURGICAL CENTER N 2687616 COST OF SHARING PAID EMPLOYEES MOUNT NITTANY SURGICAL CENTER K 449122 COST OF SERVICES PERFORMED FOUNDATION FOR MOUNT NITTANY MEDICAL CENTER B 266212 CASH MOUNT NITTANY MEDICAL CENTER HEALTH SERVICES INC B 15701027 CASH