2012-05-09T09:34:06-05:00 2011-06-30 CARBIS WALKER LLP 5700 CORPORATE DRIVE STE 650 PITTSBURGH PA 15237 990 2010-07-01 240795461 MOSES TAYLOR HOSPITAL MOSE 7179632299 700 QUINCY AVE SCRANTON PA 18510 KAREN M MURPHY RN PHD 7179632299 2012-05-02 1 JEFFREY J PETRELL CPA 4126356270 2012-05-02 2010 2016-02-24 21:20:13Z KAREN M MURPHY RN PHD 700 QUINCY AVE SCRANTON PA 18510 148193888 0 X HTTP://WWW.MTH.ORG X 1892 PA MOSES TAYLOR HOSPITAL IS A 226-BED COMMUNITY HOSPITAL LOCATED IN SCRANTON, PA. THE HOSPITAL OFFERS A BROAD RANGE OF SERVICES INCLUDING ACUTE MEDICAL AND SURGICAL SERVICES, A 22-BED SENIOR MEDICAL MENTAL HEALTH UNIT, A 14-BED INPATIENT REHABILITATION UNIT, A 26-BED OBSTETRICS UNIT, A 15-BED NEONATAL INTENSIVE CARE UNIT, AND A 31-BED INPATIENT SKILLED NURSING FACILITY. IN ADDITION, OUTPATIENT PROGRAMMING INCLUDES 24 HOUR EMERGENCY SERVICES, MEDICAL CLINICS, AND AMBULATORY SURGERY SERVICES. THE HOSPITAL ALSO OPERATES A DIABETIC TREATMENT CENTER. 10 6 1680 160 439614 -111525 3793490 98408 144238142 142846217 2782 556250 4867994 4667703 152902408 148168578 0 0 0 0 73351975 61968031 0 0 0 78348600 77749208 151700575 139717239 1201833 8451339 68249477 64633697 72353797 64005490 -4104320 628207 X MOSES TAYLOR HOSPITAL WILL PROVIDE CONTINUOUSLY IMPROVING QUALITY AND COST EFFECTIVE HEALTH CARE THAT IS CUSTOMER AND COMMUNITY FOCUSED. 0 0 115435092 143367306 MOSES TAYLOR HOSPITAL IS A 226-BED COMMUNITY HOSPITAL LOCATED IN SCRANTON, PA. THE HOSPITAL OFFERS A BROAD RANGE OF SERVICES INCLUDING ACUTE MEDICAL AND SURGICAL SERVICES, A 22-BED SENIOR MEDICAL MENTAL HEALTH UNIT, A 14-BED INPATIENT REHABILITATION UNIT, A 26-BED OBSTETRICS UNIT, A 15-BED NEONATAL INTENSIVE CARE UNIT, AND A 31-BED INPATIENT SKILLED NURSING FACILITY. IN ADDITION, OUTPATIENT PROGRAMMING INCLUDES 24 HOUR EMERGENCY SERVICES, MEDICAL CLINICS, AND AMBULATORY SURGERY SERVICES. THE HOSPITAL ALSO OPERATES A DIABETIC TREATMENT CENTER.ADULT, PEDIATRICS, OBSTETRICS/MEDICAL SURGICAL SERVICES 44,621 DAYSLABORATORY SERVICES 664,024 LAB TESTSRADIOLOGICAL DIAGNOSTICS 58,512 X-RAYS, C.T. SCANS & MRISEMERGENCY & OUTPATIENT CLINIC SERVICES 35,047 ER & CLINIC SERVICES 115435092 1 1 0 1 0 0 0 0 0 1 1 0 1 1 1 1 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 56 0 1 1680 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 10 6 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 0 1 1 0 PA X JAMES BRITTAIN 5703402991 700 QUINCY AVE SCRANTON PA 18510 KAREN M MURPHY RN PHD 30.00 X X 319728 0 22900 DOUGLAS G ALLEN 1.00 X X 0 0 0 ROBERT MAZZONI ESQ 1.00 X X 0 0 0 PETER F MOYLAN 1.00 X X 0 0 0 EDWARD J DZIELAK DO 1.00 X 40000 109277 24204 MICHAEL L SUNDAY MD 1.00 X 40000 0 0 FRANK KOLUCKI MD 1.00 X 59400 353494 23090 CRAIG W BEST 1.00 X 0 0 0 PATRICIA B LYNETT 1.00 X 0 0 0 MARIA MARSILI ESQ 1.00 X 0 0 0 JAMES G BRITTAIN 32.00 X 150064 0 28392 IRENE FOLEY 40.00 X 51031 0 20328 THOMAS KELLY 32.00 X 24203 0 2050 MARY SEWATSKY MD 40.00 X 291240 0 1810 ELIZABETH ESCALANTE MD 46.00 X 297715 0 6674 BARRY YOSS MD 44.00 X 291024 0 12580 LOUIS DELAFUENTE MD 42.00 X 287768 0 6674 ADRIAN DORMANS MD 40.00 X 277384 0 13447 EUL KIM MD 44.00 X 296896 0 6674 2426453 462771 168823 34 0 1 0 THE WRIGHT CENTER FOR GRADUATE MEDICAL E 746 JEFFERSON AVENUE SCRANTON PA 15810 PHYSICIANS RESIDENCY PROGRAM 1822530 INSIGHT 695 CENTRAL AVE SUITE 15010 STPETERSBURGH FL 33701 CONSULTANTS 961100 HORIZON HEALTH PO BOX 840839 DALLAS TX 75284 SENIOR MEDICAL MENTAL HEALTH 697653 NAVIX DIAGNOSTIX INC PO BOX 403837 ATLANTA GA 30384 RADIOLOGICAL SERVICES 566880 PHYSICIANS HEALTH ALLIANCE 1401 ADAMS AVENUE SUITE 202 SCRANTON PA 18510 OBSTETRICAL DELIVERY 360200 18 98408 98408 PROGRAM SERVICE REVENU 900099 142846217 142846217 142846217 17692 17692 348165 348165 348165 348165 563868 25310 -25310 563868 538558 538558 APOTHECARY INCOME 900099 1807546 438172 1369374 REHABILITATION INCOME 900099 810583 810583 CAFETERIA INCOME 900099 688797 688797 1012612 521089 1442 490081 4319538 148168578 143367306 439614 4263250 1416893 1128830 288063 45985607 38496013 7489594 560486 469201 91285 10467217 8762440 1704777 3537828 2999055 538773 638920 638920 124885 124885 17041638 12381351 4660287 311862 205274 106588 2263926 1531102 732824 62411 29289 33122 1928809 935665 993144 4964254 2408160 2556094 4554821 2209544 2345277 SUPPLIES 20122026 19382713 739313 PROVISION FOR BAD DEBT 14821689 14821689 EQUIPMENT RENTAL & MAIN 4679470 4375646 303824 PHYSICIANS FEES 3405650 3405650 RESIDENCY PROGRAM 1864110 1864110 964737 29360 935377 139717239 115435092 24282147 0 339543 2177849 19561265 15535055 2310565 3323077 385816 795607 94658451 68281921 29363762 26376530 9233138 9686264 7055388 6739315 68249477 64633697 22534553 22667115 29888720 27908348 8454137 5601847 11476387 7828180 72353797 64005490 X -7689874 -2834921 2497053 2374627 1088501 1088501 -4104320 628207 68249477 64633697 X 8451339 -3718812 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 20805 0 1 22454 43259 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: A PORTION OF THE HOSPITAL'S DUES TO THE HOSPITAL AND HEALTHSYSTEM ASSOCIATION OF PENNSYLVANIA (HAP) AND AMERICAN HOSPITAL ASSOCIATION ARE USED FOR LOBBYING. 1773941 1773941 66807799 50032652 16775147 24178353 17209450 6968903 1898358 1039819 858539 26376530 INVESTMENTS 9686264 F 9686264 INTEREST IN NET ASSETS OF MOSES TAYLOR FOUNDATION 5891145 DEFERRED COMPENSATION AND BENEFITS 196377 OTHER ASSETS 35000 DUE FROM RELATED PARTIES 616793 6739315 ACCRUED PENSION LIABILITY 6820271 DEFERRED COMPENSATION AND OTHER BENEFITS 1007909 7828180 148168578 139717239 8451339 -67169 -3651643 -3718812 4732527 148168578 0 148168578 0 148168578 139717239 0 139717239 0 139717239 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE HOSPITAL FOLLOWS THE GUIDANCE FOR ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN AN ENTITY'S FINANCIAL STATEMENTS THAT PRESCRIBES 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 HAS BEEN MET. THE GUIDANCE ALSO ADDRESSES DERECOGNITION, CLASSIFICATION, INTEREST AND PENALTIES, ACCOUNTING IN INTERIM PERIODS, AND DISCLOSURE. THE HOSPITAL'S POLICY IS TO RECOGNIZE INTEREST RELATED TO UNRECOGNIZED TAX BENEFITS IN INTEREST EXPENSE AND PENALTIES IN OTHER EXPENSES. THERE WERE NO INTEREST OR PENALTIES RECOGNIZED ON THE STATEMENTS OF OPERATIONS AS A RESULT OF THIS GUIDANCE. GENERALLY, TAX RETURNS FOR YEARS ENDED JUNE 30, 2008, AND THEREAFTER REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES. PART XI, LINE 8 - OTHER ADJUSTMENTS: EQUITY TRANSFER TO AFFILIATE -4,621,000. ACCUMULATED LIABILITY FOR PENSION BENEFITS 941,312. CHANGE IN UNRESTRICTED INTEREST IN MOSES TAYLOR FOUNDATION, INC 37,851. NET ASSETS RELEASED FROM RESTRICTIONS -74,157. TEMPORARILY RESTRICTED CONTRIBUTIONS 82,281. CHANGE IN RESTRICTED INTEREST IN MTF, INC. -17,930. 1 1 1 X 1 X 1 1 0 0 168535 168535 0.00130 18363336 16171744 2191592 0.01750 18531871 16171744 2360127 0.01880 1864110 774123 1089987 0.00870 1864110 774123 1089987 0.00870 20395981 16945867 3450114 0.02750 0 2819759 37254923 33259493 3995430 X 1 0 1 1 MOSES TAYLOR HOSPITAL

700 QUINCY AVE SCRANTON PA 18510

X X X X MOSES TAYLOR HOSPITAL 1 PART I, LINE 7: A COST-TO-CHARGE RATIO CALCULATED FROM WORKSHEET 2, RATIO OF PATIENT CARE COSTS-TO-CHARGES IS THE COSTING METHODOLOGY USED TO DETERMINE THE AMOUNTS REPORTED ON PART I, LINE 7. PART I, L7 COL(F): THE BAD DEBT EXPENSE OF 14,821,689 INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN A WAS SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE OF TOTAL EXPENSES. PART III, LINE 4: MOSES TAYLOR HOSPITAL'S FINANCIAL STATEMENTS DO NOT INCLUDE A BAD DEBT FOOTNOTE. THE BAD DEBT EXPENSE IS CALCULATED AS A PERCENTAGE OF MONTHLY REVENUE, BASED ON THE PERCENTAGE USED FOR THE BUDGET. THAT AMOUNT IS THEN ADJUSTED UP OR DOWN BASED UPON THE ACTUAL ACCOUNTS RECEIVABLE BALANCES, CASH COLLECTIONS, AND AMOUNTS WRITTEN OFF.A COST-TO-CHARGE RATIO CALCULATED FROM WORKSHEET 2, RATIO OF PATIENT CARE COSTS-TO-CHARGES IS THE COSTING METHODOLOGY USED TO DETERMINE THE AMOUNTS REPORTED ON LINES 2 AND 3 OF PART III. PART III, LINE 8: A COST-TO-CHARGE RATIO CALCULATED FROM WORKSHEET 2, RATIO OF PATIENT CARE COSTS-TO-CHARGES IS THE COSTING METHODOLOGY USED TO DETERMINE THE AMOUNTS REPORTED ON PART III, LINE 6. PART VI, LINE 2: MOSES TAYLOR HOSPITAL DOES NOT CURRENTLY HAVE A FORMALIZED METHOD TO ASSESS THE COMMUNITY FOR ITS HEALTH NEEDS. IN THE NEXT FEW YEARS, THE ORGANIZATION PLANS TO LAUNCH A MORE FORMALIZED PROCESS TO ASSESS OUR COMMUNITY NEEDS. PART VI, LINE 3: IN ACCORDANCE WITH THE FINANCIAL ASSISTANCE POLICY, WHEN INDIVIDUALS QUALIFY UNDER THIS POLICY, THE AMOUNT OF FREE OR DISCOUNTED SERVICE FOR WHICH THEY QUALIFY IS ADJUSTED OFF THE ACCOUNT AT THE TIME APPROVAL IS GRANTED. IF THEY QUALIFY FOR A DISCOUNT FROM ACTUAL CHARGES, THE ORGANIZATION WILL TRY TO SET THE PATIENT UP ON A MONTHLY PAYMENT PLAN. AS PART OF THE FINANCIAL ASSISTANCE POLICY, IF THEY HAVE BEEN APPROVED FOR FREE OR DISCOUNTED SERVICE IN THE PAST 6 MONTHS, THE APPROVAL WILL APPLY FOR THE CURRENT SERVICE AS WELL. FOR INDIVIDUALS THAT DO NOT QUALIFY UNDER THE FINANCIAL ASSISTANCE POLICY, THE NORMAL COLLECTION PRACTICES ARE FOLLOWED. PART VI, LINE 4: MOSES TAYLOR HOSPITAL IS LOCATED IN SCRANTON, PA. MOSES TAYLOR HOSPITAL SERVES THE RESIDENTS OF LACKAWANNA COUNTY, PENNSYLVANIA. LACKAWANNA COUNTY IS 459 SQUARE MILES AND HAS A POPULATION OF 208,801. THE 2009 ESTIMATED MEDIAN HOUSEHOLD INCOME WAS $44,481 WHICH IS BELOW THE PENNSYLVANIA ESTIMATED HOUSEHOLD INCOME OF $49,520. APPROXIMATELY 15% OF RESIDENTS LIVE IN POVERTY. PART VI, LINE 6: MOSES TAYLOR HOSPITAL IS A COMMUNITY-BASED HEALTH CARE NETWORK WITH A LONG TRADITION OF PROVIDING QUALITY, COST-EFFECTIVE AND CONVENIENT CARE TO RESIDENTS OF NORTHEASTERN PENNSYLVANIA FOR MORE THAN 118 YEARS. MOSES TAYLOR HOSPITAL IS A PATIENT-FOCUSED HEALTH CARE FACILITY UTILIZING THE LATEST TECHNOLOGIES AND SERVICES, WITH ONE GOAL IN MIND - KEEPING YOU AND YOUR FAMILY HEALTHY AND WELL. A MAJORITY OF ORGANIZATION'S GOVERNING BODY IS COMPRISED OF PERSONS RESIDING IN PRIMARY SERVICE AREA AND ARE NOT EMPLOYEES OR CONTRACTORS OF THE ORGANIZATION OR FAMILY MEMBERS. THE ORGANIZATION USES SURPLUS FUNDS TO PROVIDE THE LATEST IN TECHNOLOGY TO IMPROVE PATIENT CARE. X 0 0 X 0 0 0 0 0 0 0 0 0 KAREN M MURPHY RN PHD 319728 0 0 0 0 0 15864 0 7036 0 342628 0 0 0 EDWARD J DZIELAK DO 40000 109277 0 0 0 0 0 22000 0 2204 40000 133481 0 0 FRANK KOLUCKI MD 59400 353494 0 0 0 0 0 4126 0 18964 59400 376584 0 0 JAMES G BRITTAIN 150064 0 0 0 0 0 15364 0 13028 0 178456 0 0 0 MARY SEWATSKY MD 291240 0 0 0 0 0 0 0 1810 0 293050 0 0 0 ELIZABETH ESCALANTE MD 297715 0 0 0 0 0 0 0 6674 0 304389 0 0 0 BARRY YOSS MD 291024 0 0 0 0 0 0 0 12580 0 303604 0 0 0 LOUIS DELAFUENTE MD 287768 0 0 0 0 0 0 0 6674 0 294442 0 0 0 ADRIAN DORMANS MD 277384 0 0 0 0 0 0 0 13447 0 290831 0 0 0 EUL KIM MD 296896 0 0 0 0 0 0 0 6674 0 303570 0 0 0 PART I, LINE 1B MOSES TAYLOR HOSPITAL DOES NOT CURRENTLY HAVE A WRITTEN POLICY REGARDING PAYMENT OR REIMBURSEMENT OF SOCIAL CLUB DUES BUT IS IN THE PROCESS OF IMPLEMENTING A POLICY. MOSES TAYLOR HOSPITAL PAYS THE SOCIAL CLUB DUES DIRECTLY. FORM 990, PART VI, SECTION A, LINE 6 THE MEMBERS OF THE CORPORATION SHALL BE INDIVIDUALS. THE CORPORATION SHALL HAVE NO LESS THAN FIVE OR MORE THAN NINE MEMBERS, AT LEAST THREE-FOURTHS OF WHOM SHALL BE RESIDENTS OF LACKAWANNA COUNTY. ANY NATURAL PERSON WHO IS LESS THAN SEVENTY YEARS OF AGE MAY SERVE AS A MEMBER OF THE CORPORATION. MEMBERS SHALL BE ELECTED ANNUALLY BY MAJORITY VOTE OF THE MEMBERS AT THE ANNUAL MEETING OF THE MEMBERS. FORM 990, PART VI, SECTION A, LINE 7A THE MEMBERS OF THE CORPORATION ELECT THE BOARD MEMBERS. FORM 990, PART VI, SECTION A, LINE 7B THE CORPORATION SHALL NOT TAKE ANY OF THE FOLLOWING ACTIONS WITHOUT FIRST OBTAINING THE APPROVAL OF A MAJORITY OF THE MEMBERS: (A) AMENDMENT OF THE BYLAWS OR THE ARTICLES OF INCORPORATION OF THE CORPORATION (B) MERGER, CONSOLIDATION, OR DIVISION OF THE CORPORATION (C) DISSOLUTION OR LIQUIDATION OF THE CORPORATION OR A SALE OF SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION FORM 990, PART VI, SECTION B, LINE 11 MOSES TAYLOR HOSPITAL HAS A CPA FIRM PREPARE ITS FORM 990. THE RETURN IS COMPLETED IN DRAFT FORM AND REVIEWED BY MANAGEMENT OF THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 12C MOSES TAYLOR HOSPITAL ANNUALLY REQUIRES ITS BOARD MEMBERS, OFFICERS AND KEY EMPLOYEES TO FILL OUT A CONFLICTS OF INTEREST FORM. DURING BOARD MEETINGS, IF AN INTERESTED PARTY HAS A CONFLICT, HE OR SHE RECUSES THEMSELVES FROM VOTING. FORM 990, PART VI, SECTION B, LINE 15 MOSES TAYLOR HOSPITAL'S BOARD OF DIRECTORS ANNUALLY REVIEWS AND APPROVES THE COMPENSATION OF THEIR ORGANIZATION'S TOP MANAGEMENT. FORM 990, PART VI, SECTION C, LINE 18 MOSES TAYLOR HOSPITAL MAKES ITS FORM 990, FORM 990-T AND FORM 1023 AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VI, SECTION C, LINE 19 AT THIS TIME, MOSES TAYLOR HOSPITAL DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE GENERAL PUBLIC. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -67,169. EQUITY TRANSFER TO AFFILIATE -4,621,000. ACCUMULATED LIABILITY FOR PENSION BENEFITS 941,312. CHANGE IN UNRESTRICTED INTEREST IN MOSES TAYLOR FOUNDATION, INC 37,851. NET ASSETS RELEASED FROM RESTRICTIONS -74,157. TEMPORARILY RESTRICTED CONTRIBUTIONS 82,281. CHANGE IN RESTRICTED INTEREST IN MTF, INC. -17,930. TOTAL TO FORM 990, PART XI, LINE 5: -3,718,812. FORM 990, PART XII, LINE 2C: THE ORGANIZATION'S BOARD OF DIRECTORS ASSUME RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT. THE PROCESS IS CONSISTENT WITH PRIOR YEARS AND HAS NOT CHANGED. FORM 990, PART VII, COLUMN B THE OFFICER KAREN M. MURPHY, RN, PHD, PRESIDENT & CEO SPLITS THE HOURS WORKED PER WEEK BETWEEN EACH OF THE MOSES TAYLOR ENTITIES IN THE FOLLOWING MANNER: MOSES TAYLOR HOSPITAL - 30 HOURS MID VALLEY HOSPITAL ASSOCIATION - 4 HOURS MOSES TAYLOR FOUNDATION, INC - 1 HOUR MTH RESOURCES, INC. - 1 HOUR PHYSICIANS HEALTH ALLIANCE, INC. - 4 HOURS THE OFFICER JAMES G. BRITTAIN, ACTING CFO SPLITS THE HOURS WORKED PER WEEK BETWEEN EACH OF THE MOSES TAYLOR ENTITIES IN THE FOLLOWING MANNER: MOSES TAYLOR HOSPITAL - 32 HOURS MID VALLEY HOSPITAL ASSOCIATION - 4 HOURS MOSES TAYLOR FOUNDATION, INC - 1 HOUR MTH RESOURCES, INC. - 1 HOUR PHYSICIANS HEALTH ALLIANCE, INC. - 2 HOURS THE OFFICER THOMAS KELLY, CFO SPLITS THE HOURS WORKED PER WEEK BETWEEN EACH OF THE MOSES TAYLOR ENTITIES IN THE FOLLOWING MANNER: MOSES TAYLOR HOSPITAL - 32 HOURS MID VALLEY HOSPITAL ASSOCIATION - 4 HOURS MOSES TAYLOR FOUNDATION, INC - 1 HOUR MTH RESOURCES, INC. - 1 HOUR PHYSICIANS HEALTH ALLIANCE, INC. - 2 HOURS MOSES TAYLOR FOUNDATION INC PO BOX 992 SCRANTON PA 18501 232281586 HEALTH CARE PA 501(C)(3) LINE 7 0 MTH RESOURCES INC PO BOX 1428 SCRANTON PA 18501 232281585 HEALTH CARE PA 501(C)(3) LINE 11A, I MOSES TAYLOR FOUNDATION INC 0 MID VALLEY HOSPITAL ASSOCIATION 1400 S MAIN STREET PECKVILLE PA 18452 240795458 HEALTH CARE PA 501(C)(3) LINE 3 MOSES TAYLOR FOUNDATION INC 0 PHYSICIANS HEALTH ALLIANCE INC 1401 ELECTRIC STREET DUNMORE PA 18509 232824685 HEALTH CARE PA MTH RESOURCES INC C 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 1 1 0