2012-05-14T08:23:16-05:00 2011-06-30 PARENTEBEARD LLC 400 MARKET STREET WILLIAMSPORT PA 17701 990 2010-07-01 240792115 JERSEY SHORE HOSPITAL JERS 5703980100 1020 THOMPSON STREET JERSEY SHORE PA 17740 CAREY W PLUMMER 5703980100 2012-05-11 1 JULIUS C GREEN CPA JD 5703236023 2010 2016-02-24 21:20:13Z CAREY W PLUMMER 1020 THOMPSON STREET JERSEY SHORE PA 17740 30580900 0 X WWW.JSH.ORG X 1922 PA PROVIDE INPATIENT, OUTPATIENT, AND EMERGENCY CARE SERVICES FOR RESIDENTS OF JERSEY SHORE AREA. 14 11 344 8 0 0 448563 130721 28901185 30076603 21130 -6695 255384 316625 29626262 30517254 0 0 0 0 11801828 12260092 0 0 272140 15481101 17463238 27282929 29723330 2343333 793924 29001096 30259484 22153378 20267058 6847718 9992426 X JERSEY SHORE HOSPITAL IS A RURAL HEALTHCARE FACILITY COMMITTED TO PROVIDING QUALITY HEALTH SERVICES WITH AN EFFICIENT BALANCE OF OUTPATIENT CARE, ACUTE AND SUB-ACUTE INPATIENT CARE AND OUTREACH SERVICES. THE HOSPITAL MAXIMIZES THE EFFECTIVENESS OF ITS PROGRAM THROUGH INTEGRATION WITH OTHER HEALTHCARE PROVIDERS TO ASSURE THE COMMUNITY ACCESS TO A BROAD ARRAY OF HEALTH CARE SERVICES. 0 0 25727048 30076603 AS A RURAL HEALTHCARE FACILITY AND DEDICATED COMMUNITY HOSPITAL WITH A COMMITMENT TO PROVIDING A HIGH QUALITY CIRCLE OF CARE, JERSEY SHORE HOSPITAL HAS DEVELOPED DELIVERY SYSTEMS THAT PROVIDE AN EFFICIENT BALANCE OF OUTPATIENT CARE, ACUTE AND SUB-ACUTE INPATIENT CARE, PRIMARY CARE, AND OUTREACH SERVICES. THE HOSPITAL MAXIMIZES THE EFFECTIVENESS OF ITS PROGRAMS FOR QUALITY, EFFICIENCY, AND ACCESSIBILITY BY INTEGRATING WITH OTHER PROVIDERS AND ALTERNATIVE CARE ORGANIZATIONS IN THE SERVICE COMMUNITY TO ASSURE THE COMMUNITY ACCESS TO A BROAD ARRAY OF SERVICE OPTIONS.THE HOSPITAL PROVIDES AN ENVIRONMENT OF CARE THAT IS COMPASSIONATE, HIGHLY PERSONALIZED, AND FOCUSED ON THE PHYSICAL, PSYCHO-SOCIAL, AND SPIRITUAL NEEDS OF ITS PATIENTS THROUGH THE USE OF SKILLED NURSES, PHYSICIANS, TECHNICAL AND SUPPORT STAFF, MANAGEMENT, AND COMMUNITY LEADERS. THE HOSPITAL ALSO PROVIDES HEALTH EDUCATION, PROGRAMS IN PREVENTION, AND RELATED SUPPORT SERVICES TO THE COMMUNITY WITH THE GOAL OF IMPROVING THE OVERALL WELLNESS OF ITS RESIDENTS. THE HOSPITAL ENSURES THAT THE NECESSARY RESOURCES ARE AVAILABLE TO PROVIDE FOR COMPREHENSIVE, MANAGED HEALTH PROGRAMS IN THE MOST COST EFFECTIVE MANNER WHILE MAINTAINING A SAFE, PLEASANT, AND MEANINGFUL WORK AND PATIENT CARE ENVIRONMENT.THE HOSPITAL PROVIDES CHARITY CARE TO PATIENTS WHO MEET CERTAIN CRITERIA WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. CHARGES FORGONE FOR SERVICES RENDERED AND SUPPLIES FURNISHED UNDER THE CHARITY CARE POLICY AMOUNTED TO APPROXIMATELY $605,000 DURING THE YEAR ENDED JUNE 30, 2011. 25727048 1 1 0 1 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 110 0 1 344 1 0 0 0 0 0 1 1 0 0 0 0 X 14 11 1 1 1 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 PA X CAREY W PLUMMER - PRESIDENTCEO 5703983101 1020 THOMPSON STREET JERSEY SHORE PA 17740 X CAREY PLUMMER 39.50 X X 212422 0 74457 LEROY KEILER III 1.00 X X 0 0 0 WILLIAM CAMERER III 1.00 X X 0 0 0 CARMEN SPINNEY MD 1.00 X X 0 159677 26801 JAMES REESER 1.00 X 0 0 0 RICHARD BEATTY DMD 1.00 X X 0 0 0 PAUL DEMPSEY 1.00 X 0 0 0 WALTER EISENHAUER 1.00 X 0 0 0 JAMES ELY 1.00 X 0 0 0 STEVEN KATZ MD 1.00 X 6000 411941 40052 JOHN HUNTER DDS 1.00 X 15000 0 0 SEAN SIMCOX 1.00 X 0 0 0 ROB GLUNK 1.00 X 0 0 0 DOROTHY CHAPPEL PHD 1.00 X 0 0 0 JACK DINGESS 1.00 X 0 0 0 MARK RICE 39.00 X 0 0 0 KEN CORNISH 39.50 X 72000 0 24000 AARON KOLB MD 40.00 X 246328 0 37307 THOMAS FORKER MD 40.00 X 169186 0 29893 THOMAS BURGE 40.00 X 177110 0 22806 RONALD EISTER 40.00 X 205791 0 34119 OWEN O'HEIR 40.00 X 203206 0 16096 1307043 571618 305531 7 0 1 0 QUORUM HEALTH SYSTEM 105 CONTINENTAL PLACE BRENTWOOD TN 370275014 MANAGEMENT FEES 642005 SUSQUEHANNA HEALTH SYSTEM 1205 GRAMPIAN BOULEVARD WILLIAMSPORT PA 17701 IT SUPPORT/LAB TEST INTERPRETATION 638650 STAFF CARE PO BOX 281923 ATLANTA GA 303841923 ER PHYSICIAN LOCUMS 423910 MEDICAL STAFFING NETWORK CO 2300 VALLEY LANE IRVING TX 75062 ER PHYSICIAN LOCUMS 266123 QUEST DIAGNOSTICS 315 BOULEVARD NE STE 240 ATLANTA GA 30312 LAB SERVICES 248459 7 25140 25322 80259 130721 PATIENT SERVICE REV 621110 30076603 30076603 30076603 14936 14936 100549 22837 77712 77712 77712 21631 -21631 -21631 -21631 12414 25140 19178 -6764 -6764 CAFETERIA/VENDING REV 722210 111315 111315 REBATES/REFUNDS 900099 54701 54701 SALES TAX REFUND 900099 25168 25168 54493 54493 245677 30517254 30076603 0 309930 9701764 8033988 1594910 72866 438978 363516 72165 3297 1289885 1068148 212049 9688 829465 686876 136359 6230 642005 642005 108604 108604 50810 50810 2684 2684 5531378 4633980 882663 14735 141700 9054 132646 4232766 3554479 666582 11705 629118 629118 35973 33012 2961 76287 61263 15024 879222 879222 2025358 2025358 495056 495056 BAD DEBT EXPENSE 2336881 2336881 EMPLOYEE RECOGNITION 98103 98103 DUES & BOOKS 89309 87365 1944 87984 86940 1044 29723330 25727048 3724142 272140 1425 1427 3423909 3340805 217292 94823 2858519 3132916 314915 309635 349860 515880 35609105 18410474 17868809 17198631 3966367 5665367 29001096 30259484 2182949 2691694 14838199 14656196 5132230 2919168 22153378 20267058 X 6079759 9469982 767959 522444 6847718 9992426 29001096 30259484 X 793924 2350784 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 2684 2684 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: THE HOSPITAL PAYS DUES TO THE AMERICAN HOSPITAL ASSOCIATION (AHA) AND THE HOSPITAL ASSOCIATION OF PENNSYLVANIA (HAP). A PORTION OF THE DUES PAID TO THESE TWO ORGANIZATIONS ($2,684 DURING THE YEAR ENDED JUNE 30, 2011) WAS USED FOR LOBBYING PURPOSES. 154956 154956 17824782 4266931 13557851 16757521 13958965 2798556 871846 184578 687268 17198631 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 266169 DEFERRED FINANCING COSTS, NET 121992 DUE FROM AFFILIATES 2971067 FUNDED DEPRECIATION 2306139 5665367 OBLIGATIONS UNDER CAPITAL LEASES 1067548 PATIENT REFUNDS PAYABLE 49474 BLUE CROSS CURRENT FINANCING ADVANCE 158704 ESTIMATED MEDICAL MALPRACTICE CLAIMS LIABILITY 125000 FAIR VALUE OF DERIVATIVE INSTRUMENT 417953 ACCRUED PENSION COST 1100489 2919168 30517254 29723330 793924 2350784 2350784 3144708 32117827 1577736 1577736 30540091 -22837 -22837 30517254 30280068 556738 556738 29723330 0 29723330 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. THE CORPORATION'S FEDERAL RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX, EXEMPT ORGANIZATION BUSINESS TAX RETURN, AND CORPORATE INCOME TAX RETURNS FOR THE YEARS ENDED JUNE 2011, 2010, AND 2009 REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. PART XI, LINE 8 - OTHER ADJUSTMENTS: PENSION LIABILITY ADJUSTMENT 1,071,805. CHANGE IN FAIR VALUE OF DERIVATIVE INSTRUMENT -44,054. TRANSFER FROM AFFILIATES PER CORPORATE RESTRUCTURING 1,323,033. PART XII, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN FAIR VALUE OF DERIVATIVE INSTRUMENT -44,054. PENSION LIABILITY ADJUSTMENT 1,071,805. REVENUE OF AFFILIATES CONSOLIDATED ON FINANCIAL STATEMENTS 549,985. PART XII, LINE 4B - OTHER ADJUSTMENTS: RENTAL EXPENSE -22,837. PART XIII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 22,837. EXPENSES OF AFFILIATES CONSOLIDATED ON FINANCIAL STATEMENTS 533,901. GOLF TOURNAMENT 26853 19037 7816 1200 1857 8465 CRAB FEST 10701 6103 4598 4598 3058 37554 25140 12414 1200 6455 11523 19178 -6764 1 1 1 X 1 X 1 0 0 249539 249539 0.00910 2548258 1998280 549978 0.02010 2797797 1998280 799517 0.02920 247173 18931 228242 0.00830 11076 11076 0.00040 258249 18931 239318 0.00870 3056046 2017211 1038835 0.03790 1 958121 6858059 4867764 1990295 X 1 1 1 1 JERSEY SHORE HOSPITAL

1020 THOMPSON STREET JERSEY SHORE PA 17740

X X X X NOT REQUIRED 1 PART I, LINE 7: THE HOSPITAL USED THE COST TO CHARGE RATIO. PART I, L7 COL(F): AMOUNT OF BAD DEBT EXPENSE FROM PART IX SUBTRACTED IN ORDER TO CALCULATE PERCENT OF TOTAL EXPENSE IN PART I LINE 7 COLUMN F WAS $2,336,881. PART III, LINE 4: ACCOUNTS RECEIVABLE, PATIENTS ARE REPORTED AT NET REALIZABLE VALUE. ACCOUNTS ARE WRITTEN OFF WHEN THEY ARE DETERMINED TO BE UNCOLLECTIBLE BASED UPON MANAGEMENT'S ASSESSMENT OF INDIVIDUAL ACCOUNTS. THE ALLOWANCE FOR DOUBTFUL COLLECTIONS IS ESTIMATED BASED UPON A PERIODIC REVIEW OF THE ACCOUNTS RECEIVABLE AGING, PAYOR CLASSIFICATIONS, AND APPLICATION OF HISTORICAL WRITE-OFF PERCENTAGES.BAD DEBT EXPENSE IS BASED ON A PERCENTAGE OF REVENUE DURING THE YEAR. THE ALLOWANCE IS EVALUATED AT THE END OF THE YEAR AND ANY ADJUSTMENTS ARE MADE TO BAD DEBT EXPENSE.PATIENT DISCOUNTS ARE NOT INCLUDED IN BAD DEBT - THEY ARE INCLUDED IN CONTRACTUAL ADJUSTMENTS. PAYMENTS ON PATIENT ACCOUNTS ARE INCLUDED IN THE ALLOWANCE FOR BAD DEBTS.THE HOSPITAL IS DILIGENT IN THE CLASSIFICATION OF AMOUNTS AS CHARITY CARE OR BAD DEBT. WE BELIEVE NONE OF THE AMOUNTS IN BAD DEBT WOULD BE RECLASSIFIED TO CHARITY CARE GIVEN ADDITIONAL INFORMATION. PART III, LINE 8: THERE IS NO MEDICARE SHORTFALL - AS A CRITICAL ACCESS HOSPITAL, WE ARE REIMBURSED AT 101% OF COST FROM MEDICARE.ALLOWABLE COSTS WERE DETERMINED USING THE COST-TO-CHARGE RATIO FROM MEDICARE COST REPORT. PART III, LINE 9B: COLLECTIONS ARE PURSUED UP TO THE POINT THAT A PATIENT COMPLETES AND IS APPROVED FOR CHARITY CARE. ONCE CHARITY CARE IS APPROVED, NO FURTHER COLLECTION EFFORTS ARE MADE. PART VI, LINE 2: SEVERAL GROUPS REQUEST HEALTH FAIRS. THE BOARD AND MANAGEMENT CONSIDERED THE HEALTH NEEDS OF THE COMMUNITY. COMMUNITY MEMBERS HAVE REQUESTED THE PROGRAM. PART VI, LINE 3: PATIENTS ARE COUNSELED ON AN INDIVIDUAL BASIS IN PERSON OR PHONE CONVERSATION AS TO THE AVAILABILITY OF STATE OR CORPORATE PROGRAMS. AT THE TIME OF REGISTRATION, SELF-PAY PATIENTS ARE INFORMED OF ASSISTANCE AVAILABLE. PATIENT STATEMENTS INDICATE ASSISTANCE THAT IS AVAILABLE.THERE IS ALSO SIGNAGE INDICATING THAT ASSISTANCE PROGRAMS ARE AVAILABLE AND PATIENTS ARE PROVIDED A PAMPHLET AT REGISTRATION WITH THIS INFORMATION. PART VI, LINE 4: JERSEY SHORE HOSPITAL'S PRIMARY SERVICE AREA COVERS MUCH OF CLINTON COUNTY AND LYCOMING COUNTY - AN AREA WITH A POPULATION OF APPROXIMATELY 40,000. JERSEY SHORE HOSPITAL IS CONSIDERED TO BE IN A MEDICALLY UNDERSERVED AREA (MUA). JERSEY SHORE AND JERSEY SHORE HOSPITAL IS LOCATED IN LYCOMING COUNTY, WHICH HAS AN AREA OF 1,237 SQUARE MILES. IT IS THE LARGEST COUNTY IN PENNSYLVANIA AND OCCUPIES A HILLY AND HEAVILY FORESTED PART OF THE STATE. THE WEST BRANCH OF THE SUSQUEHANNA RIVER FLOWS THROUGH THE SOUTHERN PART OF THE COUNTY. JERSEY SHORE IS APPROXIMATELY 45 MILES NORTHEAST OF STATE COLLEGE PENNSYLVANIA AND APPROXIMATELY 15 MILES WEST OF WILLIAMSPORT, PENNSYLVANIA.SEVENTY-NINE POINT FOUR PERCENT (79.4%) OF JERSEY SHORE HOSPITAL INPATIENTS LIVE IN THE PRIMARY SERVICE AREA (PSA) WHICH IS IN LYCOMING COUNTY AND CLINTON COUNTY, PENNSYLVANIA. THE PRIMARY SERVICE AREA (PSA) FOR JERSEY SHORE HOSPITAL CONSISTS OF FOUR ZIP CODES: 17720 - JERSEY SHORE, 17745 - LOCK HAVEN, 17779 - WOOLRICH AND 17751 - MILL HALL.JERSEY SHORE HOSPITAL RELIES UPON A RELATIVELY SMALL GEOGRAPHIC AREA TO SUPPORT THE HOSPITAL.THE SSA (SECONDARY SERVICE AREA) CONSISTS OF 9 ADDITIONAL ZIP CODES WHICH ARE IMPORTANT TO THE HOSPITAL AND FROM WHICH 17% OF HOSPITALIZED PATIENTS ORIGINATE. THESE ZIP CODES ARE TO THE WEST AND NORTHEAST OF THE PSA.WITHIN A 50 MILE RADIUS OF JSH, TOTAL POPULATION IS EXPECTED TO DECREASE BY 1/4% BY 2015.A MAJOR DEMOGRAPHIC ISSUE AFFECTING JSH IS THE AGING POPULATION. THE NUMBER OF INDIVIDUALS LIVING IN THIS AREA OVER THE AGE OF 65 IS EXPECTED TO INCREASE 7.4% BY 2015. THE NUMBER OF INDIVIDUALS AGES 15 THROUGH 44 IS EXPECTED TO DECREASE BY 7.3% BY 2015.THIS GROWING ELDERLY SEGMENT SHOULD GENERATE A FUTURE DEMAND FOR HEALTH CARE SERVICES, SINCE INDIVIDUALS OVER AGE 65 USE HEALTHCARE AND HOSPITAL SERVICES AT 2.7 TIMES THE RATE OF THE UNDER AGE 65 POPULATION.THE TOTAL SERVICE AREA FOR JERSEY SHORE HOSPITAL HAS A POPULATION OF 103,102 AND IS EXPECTED TO DECREASE IN POPULATION BY 1.2% BY 2012 TO 101,890.A DEMOGRAPHIC REALITY IS THE LOW INCOME LEVEL OF AREA HOUSEHOLDS. CURRENTLY, THE MEDIAN HOUSEHOLD INCOME IN THE SERVICE AREA IS $35,956, COMPARED TO PA ($45,038) AND THE U.S. ($48,250). BY 2012 THE PSA IS ANTICIPATED TO HAVE A MEDIAN HOUSEHOLD INCOME OF $41,006. THIS IS 82% OF THE PENNSYLVANIA STATE AVERAGE HOUSEHOLD INCOME AND CONSIDERABLY BELOW THE NATIONAL AVERAGE.THE SERVICE AREA IS NOT RACIALLY DIVERSIFIED TO A SIGNIFICANT DEGREE, WITH 98.6% OF THE POPULATION CONSIDERED WHITE.THE EDUCATIONAL PROFILE OF THE SERVICE AREA DEMONSTRATES THAT 44% OF THE POPULATION HAS A HIGH SCHOOL EDUCATION AND 7.1% OF THE POPULATION HAS AN ASSOCIATE DEGREE. THE PERCENTAGE ACHIEVING A BACHELOR OR PROFESSIONAL DEGREE IS LESS THAN PENNSYLVANIA OR THE U.S. AS A WHOLE. A HIGHER PERCENTAGE OF THE LABOR FORCE IN THE AREA IS ENGAGED IN MANUFACTURING / CONSTRUCTION WHEN COMPARED TO THE STATE AND US AS A WHOLE.IN TERMS OF PATIENTS SERVED, COMBINED INPATIENT AND OUTPATIENT PAYER MIX IN 2011 REMAINED CONSISTENT WITH PRIOR YEARS. MEDICARE AND MEDICARE ADVANTAGE MAKE UP ABOUT 40% OF OUR PAYORS IN TERMS OF GROSS CHARGES. MEDICAL ASSISTANCE BUSINESS CONTINUED TO HAVE A SIGNIFICANT IMPACT ON JSH AS A CRITICAL ACCESS HOSPITAL. MEDICAL ASSISTANCE PAYMENTS MAKE UP 9.48% OF OUR PAYERS, WHICH IS UP SLIGHTLY FROM 2010. PART VI, LINE 6: ALL OF THE PERSONS SERVING ON OUR BOARD LIVE IN THE PRIMARY COMMUNITIES BEING SERVED BY THE HOSPITAL. THE BOARD CONSISTS OF SOME PHYSICIANS WHO ARE EMPLOYEES OF A RELATED ENTITY, A FEW CONTRACTORS, AND SEVERAL OTHER COMMUNITY MEMBERS.THE HOSPITAL EXTENDS STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE AREA. AS APPLICABLE, THE HOSPITAL APPLIES SURPLUS FUNDS TO IMPROVEMENTS IN PATIENT CARE THROUGH NEW AND UPDATED EQUIPMENT PURCHASES, MAJOR FACILITY IMPROVEMENTS, AND COMMUNITY HEALTH PROGRAMS.THE HOSPITAL PARTICIPATES IN MEDICARE, MEDICAID, CHAMPUS, AND TRICARE. PART VI, LINE 7: THE HOSPITAL IS PART OF JERSEY SHORE HOSPITAL FOUNDATION, INC. THIS AFFILIATION INCLUDES A NON-PROFIT PHYSICIAN PRACTICE WITH FAMILY PRACTICE PHYSICIANS AND SURGEONS, AS WELL AS AN URGENT CARE CENTER.PART VI, LINE 7: N/A X X X 0 0 0 0 0 0 0 0 0 CAREY PLUMMER 212422 0 0 0 0 0 0 0 74457 0 286879 0 0 0 CARMEN SPINNEY MD 0 159677 0 0 0 0 0 0 0 26801 0 186478 0 0 STEVEN KATZ MD 6000 411941 0 0 0 0 0 0 0 40052 6000 451993 0 0 AARON KOLB MD 246328 0 0 0 0 0 0 0 37307 0 283635 0 0 0 THOMAS FORKER MD 169186 0 0 0 0 0 0 0 29893 0 199079 0 0 0 THOMAS BURGE 177110 0 0 0 0 0 0 0 22806 0 199916 0 0 0 RONALD EISTER 205791 0 0 0 0 0 0 0 34119 0 239910 0 0 0 OWEN O'HEIR 203206 0 0 0 0 0 0 0 16096 0 219302 0 0 0 FORM 990, PART VI, SECTION A, LINE 2 LEROY KEILER, III, CHAIRPERSON, AND ROB GLUNK,MEMBER, HAVE A BUSINESS RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 3 THE HOSPITAL UTILIZES THE MANAGEMENT SERVICES OF QUORUM HEALTH SYSTEM. FORM 990, PART VI, SECTION A, LINE 4 JERSEY SHORE HOSPITAL MERGED WITH SHORE PROPERTIES CORP. AND JERSEY SHORE HEALTH SERVICES, INC. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 WAS REVIEWED IN DETAIL BY MANAGEMENT BEFORE FILING WITH THE IRS. A COPY OF THE 990 WAS PROVIDED TO ALL BOARD MEMBERS AFTER FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C ALL BOARD MEMBERS AND EMPLOYEES ARE REQUIRED TO ANNUALLY COMPLETE A CONFLICT OF INTEREST STATEMENT. THESE ARE REVIEWED BY MANAGEMENT. BOARD MEMBERS ARE REQUIRED TO RECUSE THEMSELVES FROM VOTING ON MATTERS THAT ARE RELATED TO ANY POTENTIAL CONFLICTS. THERE HAS NEVER BEEN AN ISSUE INVOLVING CONFLICTS OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15 ON AN ANNUAL BASIS, THE PERSONNEL SALARY COMMITTEE AND QUORUM (MANAGEMENT COMPANY) REVIEWS AN EXECUTIVE COMPENSATION STUDY PERFORMED BY YAFFEE, AN INDEPENDENT THIRD PARTY WHO IS EMPLOYED BY HAP TO CONDUCT A COMPENSATION STUDY. HR ALSO PROVIDES A COMPENSATION STUDY FROM ACRS WHICH IS BASED ON THE APPALACHIAN REGION. THESE TWO STUDIES ARE USED TO DETERMINE FMV. THE RECOMMENDATIONS FOR COMPENSATION LEVELS ARE PASSED ON TO THE BOARD FOR THEIR APPROVAL. APPROVAL IS DOCUMENTED IN THE MINUTES. THE ACTUAL AMOUNT OF COMPENSATION IS NOT INCLUDED IN THE MINUTES FOR PRIVACY PURPOSES. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VII, SECTION A: AVERAGE HOURS SPENT PER WEEK FOR JERSEY SHORE HOSPITAL AND ALL RELATED ENTITIES WERE AS FOLLOWS: CAREY PLUMMER - 40 HOURS MARK RICE - 40 HOURS KEN CORNISH - 40 HOURS CARMEN SPINNEY - 40 HOURS CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: PENSION LIABILITY ADJUSTMENT 1,071,805. CHANGE IN FAIR VALUE OF DERIVATIVE INSTRUMENT -44,054. TRANSFER FROM AFFILIATES PER CORPORATE RESTRUCTURING 1,323,033. TOTAL TO FORM 990, PART XI, LINE 5: 2,350,784. JERSEY SHORE HOSPITAL FOUNDATION INC 1020 THOMPSON STREET JERSEY SHORE PA 17740 232480603 HEALTHCARE PA 501(C)(3) 3 N/A 0 SHORE PROPERTIES CORPORATION 1020 THOMPSON STREET JERSEY SHORE PA 17740 231280605 RENTAL INCOME PA 501(C)(3) 11A JERSEY SHORE HOSPITAL FOUNDATION INC 0 JERSEY SHORE AREA HEALTH SERVICES CORPORATION 1020 THOMPSON STREET JERSEY SHORE PA 17740 232192826 LABORATORY SERVICES PA JERSEY SHORE HOSPITAL FOUNDATION INC C 0 0 0 1 0 0 0 0 1 1 0 0 1 1 1 1 1 1