2012-05-14T13:25:17-05:00 2011-06-30 PARENTEBEARD LLC 400 MARKET STREET WILLIAMSPORT PA 17701 990 2010-07-01 230880420 SCHUYLKILL MEDICAL CTR - EAST NORWEGIAN STREET F/K/A GOOD SAM REGIONAL MED CTR SCHU 5706214000 700 EAST NORWEGIAN STREET POTTSVILLE PA 17901 JOHN E SIMODEJKA 5706214000 2012-05-14 1 JULIUS C GREEN CPA JD 5703236023 2012-05-14 2010 2016-02-24 21:20:13Z JOHN E SIMODEJKA 700 EAST NORWEGIAN STREET POTTSVILLE PA 17901 62004029 0 X WWW.SCHUYLKILLHEALTH.COM X 2008 PA TO MAKE A POSITIVE DIFFERENCE IN THE SCOPE AND QUALITY OF HEALTHCARE FOR THE SCHUYLKILL COMMUNITY. 14 14 817 119 446836 -184371 1211405 1085383 55418265 57317303 71573 74129 1203481 3422875 57904724 61899690 0 8983 0 0 34298357 34339966 0 0 0 26836090 28819288 61134447 63168237 -3229723 -1268547 35758717 36774117 16068389 14301868 19690328 22472249 X SCHUYLKILL MEDICAL CENTER - EAST NORWEGIAN STREET'S MISSION IS TO MAKE A POSITIVE DIFFERENCE IN THE SCOPE AND QUALITY OF HEALTHCARE AVAILABLE FOR THE SCHUYLKILL COUNTY COMMUNITY. 0 1 51192861 8983 57731795 THE SCHUYLKILL MEDICAL CENTER - EAST NORWEGIAN STREET, THROUGH THE COMBINED EFFORTS OF ITS HIGHLY QUALIFIED MEDICAL STAFF, EMPLOYEES AND VOLUNTEERS, OFFERS A BROAD RANGE OF HEALTHCARE SERVICES TO THE RESIDENTS OF SCHUYLKILL COUNTY. INPATIENT HEALTHCARE SERVICES ARE PROVIDED IN MEDICINE, SURGERY, AND CRITICAL CARE MEDICINE. THE HOSPITAL OPERATES A HIGHLY SOPHISTICATED SURGICAL SUITE WITH A MAJOR EMPHASIS ON AMBULATORY SURGERY. MORE THAN 22,000 VISITS BY RESIDENTS OF THE REGION WERE MADE TO RECEIVE EMERGENCY CARE AT THE SCHUYLKILL MEDICAL CENTER - EAST NORWEGIAN STREET'S EMERGENCY DEPARTMENT. A WIDE ARRAY OF DIAGNOSTIC AND TREATMENT PROGRAMS ARE ALSO OFFERED BY THE MEDICAL CENTER, INCLUDING MAGNETIC RESONANCE IMAGE, CT SCANNING, INPATIENT RENAL (KIDNEY) DIALYSIS, MEDICAL ONCOLOGY/CHEMOTHERAPY, DIAGNOSTIC, ULTRASOUND, BLOOD BANKING AND LABORATORY, PHYSICAL THERAPY, CARDIOVASCULAR SERVICE, AND AN OUTPATIENT CHEMICAL DEPENDENCY PROGRAM. THE INDUSTRA-MED PROGRAM OF THE MEDICAL CENTER PROVIDED OCCUPATIONAL AND INDUSTRIAL HEALTH SERVICES TO OVER 200 OF THE REGION'S EMPLOYERS. 51192861 1 1 0 1 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 22 0 1 817 1 1 1 0 0 0 0 0 0 0 0 0 X 14 14 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 PA X DIANE BORIS DIRECTOR OF FINANCE 5706214142 700 EAST NORWEGIAN STREET POTTSVILLE PA 17901 X JUDGE JOSEPH MCCLOSKEY 1.00 X X 0 0 0 JUDGE WILLIAM BALDWIN 1.00 X X 0 0 0 JAY LINARD 1.00 X X 0 0 0 WILLIAM KIRWAN CPA ESQ 1.00 X X 0 0 0 JESSE ACHENBACH 1.00 X 0 0 0 ANTHONY BARAN 1.00 X 0 0 0 DEBRA BLASCHAK 1.00 X 0 0 0 SARAH CASEY 1.00 X 0 0 0 JAMES GALLAGHER ED D 1.00 X 0 0 0 ROBERT ZIMMERMAN JR DO 1.00 X 0 0 0 WILLIAM JONES III 1.00 X 0 0 0 ALLEN KEIFER 1.00 X 0 0 0 FRANKLIN SHOENEMAN 1.00 X 0 0 0 SYED SHAH MD 1.00 X 0 0 0 JOHN SIMODEJKA 14.00 X 0 401645 15152 DIANE BORIS 14.00 X 107241 0 19293 DANIEL KOCHIE 20.00 X 169330 0 17206 DARNELL FURER 19.80 X 170991 0 5777 JOHN RUSSO 40.00 X 273298 0 19979 EARL WATERS JR 40.00 X 144667 0 20553 LESLIE DUBOWITZ 40.00 X 131830 0 16675 NICOLE KNARR 40.00 X 121098 0 16023 ROBERT KARETSKY 40.00 X 116942 0 13194 1235397 401645 143852 13 0 1 0 SODEXHO INC & AFFILIATES PO BOX 360170 PITTSBURGH PA 152516922 MGMT FIRM - DIETARY 860155 REHAB CARE GROUP INC PO BOX 502096 ST LOUIS MO 631502096 MGMT FIRM-INPAT-REHAB UNIT 812050 PH ANESTHESIA ASSOCIATES 4210 SOUTH JACKSON STREET POTTSVILLE PA 17901 ANESTHESIOLOGIST GROUP 474500 TRIMEX HEALTHCARE EQUIP SERVICES PO BOX 636129 CINCINNATI OH 452636129 HEALTH CARE EQPT MAINT/REPAIR 375426 POTTSVILLE HOSPITALIST ASSOCIATES PO BOX 1125 POTTSVILLE PA 17901 HOUSE PHYSICIAN GROUP 284000 10 465000 396862 223521 1085383 NET PATIENT SERVICE RE 621400 57317303 57317303 57317303 67831 67831 260322 72323 187999 187999 187999 38314 32016 6298 6298 6298 371 371 371 MEANINGFUL USE 561439 1985243 1985243 LAB AND BILLING SERVIC 621400 446836 446836 ALCOHOL & DRUG REV 561439 414492 414492 387934 387934 3234505 61899690 57731795 446836 2635676 6100 6100 2883 2883 738792 738792 26850420 21024539 5825881 528288 413662 114626 4198501 3287530 910971 2023965 1599230 424735 75066 75066 83317 83317 58945 58945 6294386 4460610 1833776 67722 67722 8249893 7610588 639305 1315842 1273937 41905 26218 16920 9298 20165 8391 11774 282862 282862 4079295 4079295 862224 862224 BAD DEBT EXPENSE 3231672 3231672 DRUGS 2374418 2374418 COLLECTION FEES 600980 600980 FOOD 536205 533244 2961 DATA PROCESSING 453272 30271 423001 206806 35540 171266 63168237 51192861 11975376 0 38670 1236 878555 418382 8583129 9995247 1407010 1303170 371810 475278 79683783 61381385 21677590 18302398 3697266 549067 1441912 2252886 1139228 35758717 36774117 7751495 6871367 663217 722636 3450971 3097125 4202706 3610740 16068389 14301868 X 19671479 21537489 18849 762025 172735 19690328 22472249 35758717 36774117 X -1268547 4050468 X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 58945 58945 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: THE SCHUYLKILL MEDICAL CENTER - EAST NORWEGIAN STREET IS A MEMBER OF THE HOSPITAL & HEALTH SYSTEM ASSOCIATION OF PENNSYLVANIA. A PERCENTAGE OF THE DUES PAID TO THE HOSPITAL & HEALTH SYSTEM ASSOCIATION GOES TOWARDS LOBBYING EFFORTS. THEIR MISSION IS TO ADVANCE THE HEALTH FOR INDIVIDUALS AND COMMUNITIES TO LEAD, REPRESENT, AND SERVE HEALTH CARE PROVIDER ORGANIZATIONS THAT ARE ACCOUNTABLE TO THE COMMUNITY, AND COMMITTED TO HEALTH IMPROVEMENT. 559398 559398 50825190 40051152 10774038 28141211 21197427 6943784 157984 132806 25178 18302398 PENSION LIABILITY 491268 BLUE CROSS CURRENT FINANCING ADVANCE 419600 CAPITAL LEASE OBLIGATION 1979872 ESTIMATED MALPRACTICE LIABILITY 720000 3610740 61899690 63168237 -1268547 4050468 4050468 2781921 61972013 0 61972013 -72323 -72323 61899690 63240560 72323 72323 63168237 0 63168237 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE CORPORATION PRESCRIBES A RECOGNITION THRESHOLD OF MORE-LIKELY-THAN-NOT TO BE SUSTAINED UPON EXAMINATION BY THE APPROPRIATE TAXING AUTHORITY IN RECORDING TAX LIABILITIES IN THE FINANCIAL STATEMENTS. MEASUREMENT AND RECOGNITION OF THE TAX UNCERTAINTY OCCURS IF THE RECOGNITION THRESHOLD HAS BEEN MET. FEDERAL EXEMPT ORGANIZATION BUSINESS INCOME TAX RETURNS FOR THE MEDICAL CENTERS, THE FOUNDATION, SMG, AND THE CENTERS FOR 2010, 2009, AND 2008 REMAIN SUBJECT TO EXAMINATION BY THE IRS. PART XI, LINE 8 - OTHER ADJUSTMENTS: TRANSFER OF ASSETS FROM THE FOUNDATION UPON DISSOLUTION 4,050,468. PART XII, LINE 4B - OTHER ADJUSTMENTS: RENTAL EXPENSES -72,323. PART XIII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 72,323. 1 1 1 X 250.000000000000 1 X 1 1 0 0 291898 291898 0.00490 4351752 2368878 1982874 0.03310 4643650 2368878 2274772 0.03800 49029 49029 0.00080 111905 111905 0.00190 1010498 628492 382006 0.00640 1171432 628492 542940 0.00910 5815082 2997370 2817712 0.04710 1 3231672 1441031 27796040 28477531 -681491 X 1 1 1 1 SCHUYLKILL MEDICAL CENTER - EAST NORWEGI

700 EAST NORWEGIAN STREET POTTSVILLE PA 17901

X X X NOT REQUIRED 1 PART I, LINE 7: SCHUYLKILL MEDICAL CENTER - EAST COMPUTED A COST TO CHARGE RATIO USING INFORMATION FROM THE MOST RECENTLY FILED MEDICARE COST REPORT (FYE 6/30/11) FOR THE CALCULATION OF COSTS FOR CHARITY CARE AND MEDICAID. DIRECT COSTS ARE OBTAINED FROM THE HOSPITAL COMPUTER SYSTEM FOR EACH COST CENTER FOR ALL OTHER BENEFITS. INDIRECT COSTS ARE COMPUTED UTILIZING THE MOST RECENTLY FILED MEDICARE COST REPORT (FYE 6/30/11). PART I, LINE 7G: THERE ARE NO PHYSICIAN CLINICAL SERVICES INCLUDED. PART I, L7 COL(F): THE AMOUNT OF BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25 COLUMN (A) BUT SUBTRACTED OUT FOR PURPOSES OF CALCULATING THE PERCENTAGE ON SCH H, PART I, LINE 7, COLUMN (F) IS $3,231,672. PART III, LINE 4: ACCOUNTS RECEIVABLE, OTHER 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 INDIVIDUAL ACCOUNTS.ALL APPROPRIATE DISCOUNTS AND PAYMENTS ARE REFLECTED ON EACH PATIENTS' ACCOUNT. ONCE A PATIENT IS IDENTIFIED AS BAD DEBT, THE BALANCE THAT IS BAD DEBT WOULD BE CHARGES NET OF ANY PAYMENTS OR ADJUSTMENTS. THE COST OF BAD DEBT EXPENSE IS CALCULATED BY USING THE COST TO CHARGE RATIO FROM THE MOST RECENTLY FILE MEDICARE COST REPORT AND APPLYING THAT TO THE CHARGE.WE BELIEVE THAT A PORTION OF OUR BAD DEBTS RESULTS FROM SERVICES PROVIDED TO PATIENTS WHO MEET THE CHARITY CARE GUIDELINES BUT WERE UNABLE OR UNWILLING TO PROVIDE THE APPROPRIATE DOCUMENTATION TO ALLOW THAT CLASSIFICATION. THESE WOULD BE CLASSIFIED AS BAD DEBT EXPENSE TIMES THE COST TO CHARGE RATIO TO ARRIVE AT THE COST. PART III, LINE 9B: THE ORGANIZATION DOES HAVE A WRITTEN DEBT COLLECTION POLICY. ALL STAFF INVOLVED IN DEBT COLLECTION (EMPLOYEES OF THE MEDICAL CENTER AND ANY THIRD PARTY AGENCIES) ARE TRAINED ON THE POLICY AS WELL AS THE CHARITY CARE POLICY. IN DEALING WITH PATIENTS IN DEBT COLLECTION, STAFF WILL INFORM PATIENTS OF THE CHARITY CARE POLICY THAT IS AVAILABLE AND ALSO ANY OTHER FINANCIAL ASSISTANCE POLICIES OF THE MEDICAL CENTER THAT MAY BE APPLICABLE TO THE PATIENT. THE STAFF WILL INSTRUCT PATIENTS ON APPROPRIATE PAPERWORK THAT NEEDS TO BE COMPLETED IN REGARDS TO CHARITY CARE OR FINANCIAL ASSISTANCE. PART VI, LINE 2: SCHUYLKILL MEDICAL CENTER - EAST NORWEGIAN STREET (SMS-ENS) WORKS WITH SCHUYLKILL MEDICAL CENTER - SOUTH JACKSON STREET (SMS-SJS) IN ASSESSING THE HEALTH NEEDS OF THE COMMUNITY IT IS LOCATED IN AND SERVES; SCHUYLKILL COUNTY IN PENNSYLVANIA. BOTH MEDICAL CENTERS ALSO WORK WITH VARIOUS CITY, COUNTY AND STATE AGENCIES TO SPECIFICALLY IDENTIFY THE HEALTH NEEDS OF THE RESIDENTS OF SCHUYLKILL COUNTY.SMC-ENS IS LOCATED IN POTTSVILLE, WHICH IS THE COUNTY SEAT FOR SCHUYLKILL COUNTY. SCHUYLKILL COUNTY IS A RURAL COUNTY. THE COUNTY HAS AN UNEMPLOYMENT RATE OF OVER 11%, 19% OF THE RESIDENTS ARE COVERED BY MEDICAID, AND 18% OF THE RESIDENTS ARE OVER THE AGE OF 65.SMC-ENS IS A 126 BED ACUTE CARE FACILITY THAT PROVIDES ACUTE MEDICAL SURGICAL CARE, ACUTE REHAB SERVICES AND SENIOR BEHAVIORAL HEALTH SERVICES TO THE COMMUNITY.SMC-ENS WORKS WITH THE SOCIAL SERVICE AGENCIES, LOCAL DEPARTMENT OF HEALTH, THE CHAMBER OF COMMERCE, UNITED WAY, AMERICAN CANCER SOCIETY, LOCAL SCHOOLS, LOCAL SUPPORT GROUPS, PHYSICIAN OFFICES AND OTHER HEALTHCARE ORGANIZATIONS IN IDENTIFYING THE HEALTHCARE NEEDS OF THE LOCAL COMMUNITIES AND THE SERVICES THAT ARE NEEDED. AFTER A NEED HAS BEEN IDENTIFIED, THE MEDICAL CENTER WORKS WITH THESE ORGANIZATIONS TO HELP PROVIDE THE SERVICE TO RESIDENTS.THE MEDICAL CENTER ALSO WORKS WITH HEALTHCARE ORGANIZATIONS OUTSIDE SCHUYLKILL COUNTY TO HELP BRING HEALTHCARE SERVICES TO THE COUNTY. THIS ALLOWS COUNTY RESIDENTS TO OBTAIN NECESSARY SERVICES CONVENIENTLY WITHIN THE COUNTY.THE MEDICAL CENTER ALSO REVIEWS INTERNAL DATA ON ADMISSIONS, EMERGENCY ROOM VISITS, CLINIC VISITS AND DIAGNOSIS TO HELP IDENTIFY COMMUNITY NEEDS. THIS INFORMATION IS REVIEWED ANNUALLY AS PART OF THE BUDGET AND STRATEGIC PLANNING PROCESS.THE BOARD OF THE MEDICAL CENTER IS COMPRISED OF INDIVIDUALS FROM THE COMMUNITY REPRESENTING SOCIAL SERVICE AGENCIES, EDUCATION, ASSISTED LIVING/LONG TERM CARE, PHYSICIANS, MATERNAL/CHILD HEALTH AND LOCAL BUSINESSES. THESE INDIVIDUALS ALSO PROVIDE INPUT ON THE NEEDS OF THE COMMUNITY IN MEETING HEALTHCARE NEEDS. PART VI, LINE 3: EACH PATIENT IS REGISTERED INTO THE HOSPITAL COMPUTER SYSTEM WHEN THEY ARRIVE FOR SERVICES. AS PART OF THE REGISTRATION, INFORMATION IS OBTAINED ON ANY HEALTH INSURANCE THEY HAVE. INDIVIDUALS WITHOUT HEALTH INSURANCE ARE INFORMED AT THAT TIME OF THE MEDICAL CENTER'S CHARITY CARE POLICY. PATIENTS ARE GIVEN INFORMATION ON CONTACTING STAFF WITHIN THE HOSPITAL PATIENT ACCOUNTING DEPARTMENT TO DISCUSS APPLYING FOR THE HOSPITAL CHARITY CARE PROGRAM. SPECIFIC STAFF HAS BEEN TRAINED AND ARE RESPONSIBLE FOR ADMINISTERING THE CHARITY CARE PROGRAM FOR THE HOSPITAL. HOSPITAL STAFF CONTACT PATIENTS WITHOUT INSURANCE AND EXPLAIN THE POLICY AND THE INFORMATION NEEDED TO APPLY. HOSPITAL STAFF WILL ALSO ASSIST PATIENTS IN APPLYING FOR MEDICAL ASSISTANCE. THEY WILL ALSO ASSIST PATIENTS IN COMPLETING THE APPLICATION AND GATHERING THE NECESSARY FINANCIAL DOCUMENTS.THE MEDICAL CENTER ALSO POSTS INFORMATION WITHIN THE ADMISSION AND EMERGENCY ROOM AREAS INFORMING PATIENTS THAT THERE IS A CHARITY CARE POLICY AVAILABLE. ALL REGISTRATION PERSONNEL ARE TRAINED ON THE POLICY SO THAT THEY ARE ABLE TO INFORM PATIENTS WHEN THEY ARE REGISTERED.OTHER HOSPITAL STAFF MEMBERS THAT MAY COME IN CONTACT WITH PATIENTS ARE ALSO EDUCATED REGARDING THE CHARITY CARE POLICY. THIS WOULD INCLUDE SOCIAL WORKERS, CARE MANAGERS, NURSING STAFF AND ALL DEPARTMENT DIRECTORS. THE CHARITY CARE POLICY IS AVAILABLE ON THE HOSPITAL INTRANET WHICH IS ACCESSIBLE BY ALL EMPLOYEES. THE HOSPITAL IS ALSO IN THE PROCESS OF PLACING THE POLICY ON THE HOSPITAL WEBSITE.ALL PATIENT ACCOUNTING, CASHIERING AND COLLECTION STAFF ARE ALSO EDUCATED ON THE CHARITY CARE POLICY AND CAN ASSIST PATIENTS IN APPLYING FOR CHARITY CARE. ALSO ALL THIRD PARTY ORGANIZATIONS THAT WORK ON BEHALF OF THE MEDICAL CENTER IN PERFORMING COLLECTIONS HAVE ALSO BEEN EDUCATED ON THE CHARITY CARE POLICY AND CAN ALSO ADVISE PATIENTS ON APPLYING FOR THIS BENEFIT. PART VI, LINE 4: SMC-ENS IS LOCATED IN POTTSVILLE, PENNSYLVANIA. THE MEDICAL CENTER SERVES ALL OF SCHUYLKILL COUNTY. SCHUYLKILL COUNTY IS A RURAL COUNTY IN PENNSYLVANIA. POTTSVILLE IS THE LARGEST POPULATION CENTER OF SCHUYLKILL COUNTY AND IS ALSO THE COUNTY SEAT. THE COUNTY IS COMPRISED OF SMALL TOWNS, BOROUGHS AND TOWNSHIPS.THE POPULATION OF THE COUNTY IS APPROXIMATELY 147,000. APPROXIMATELY 25% OF THE POPULATION IS UNDER THE AGE OF 18 AND 18% IS OVER THE AGE OF 65. THE POPULATION IS 49% FEMALE AND 96% WHITE. APPROXIMATELY 11% OF THE POPULATION HAS A BACHELOR'S DEGREE OR HIGHER. 12.4% OF THE POPULATION IS BELOW THE POVERTY LEVEL. THE UNEMPLOYMENT RATE IS 11.2%.19% OF THE POPULATION IS INSURED BY MEDICAID. 42% OF THAT NUMBER ARE UNDER THE AGE OF 18, 13% ARE OVER THE AGE OF 65 AND 18 % ARE DISABLED. MORE THAN 50% OF THE BIRTHS ARE COVERED BY THE MEDICAID PROGRAM.IN A RECENT REPORT RELEASED BY THE ROBERT WOOD JOHNSON FOUNDATION AND THE UNIVERSITY OF WISCONSIN'S POPULATION HEALTH INSTITUTE, SCHUYLKILL COUNTY WAS RANKED THE 57TH HEALTHIEST OF THE 67 COUNTIES IN PENNSYLVANIA. SCHUYLKILL COUNTY HAD HIGHER THAN THE STATE AND NATIONAL RATES FOR SMOKING, OBESITY, EXCESSIVE DRINKING AND MOTOR VEHICLE CRASH DEATH RATES. THIS REPORT ALSO SHOWED THAT THE COUNTY HAD ACCESS TO FEWER PRIMARY CARE PHYSICIANS.THE DEMOGRAPHICS OF THE PATIENTS ADMITTED TO SMC-ENS WERE 74 % MEDICARE, 7% MEDICAID AND 1% SELF PAY. EMERGENCY PATIENTS AT SMC-ENS ARE 22% MEDICARE, 20% MEDICAID AND 10% SELF PAY.SCHUYLKILL COUNTY HAS FOUR HOSPITALS SERVING THE COUNTY. SMC-ENS AND SCHUYLKILL MEDICAL CENTER - SOUTH JACKSON STREET ARE BOTH LOCATED IN POTTSVILLE AND SERVE THE MAJORITY OF THE COUNTY RESIDENTS. SAINT CATHERINE MEDICAL CENTER IS LOCATED IN ASHLAND IN NORTHERN SCHUYLKILL COUNTY AND ST. LUKE'S MINERS MEMORIAL HOSPITAL IS LOCATED IN COALDALE NEAR THE CARBON COUNTY BORDER. PART VI, LINE 6: THE BOARD OF SMC - ENS IS COMPRISED OF TWELVE INDIVIDUALS FROM THE SCHUYLKILL COUNTY COMMUNITY. THESE INDIVIDUALS ARE NOT EMPLOYED BY THE MEDICAL CENTER. THEY ARE INVOLVED IN EDUCATION, SOCIAL SERVICES, GERIATRIC SERVICES, MATERNAL/CHILD SERVICES, PRIMARY MEDICAL CARE, CRIMINAL JUSTICE, SMALL BUSINESS AND MANUFACTURING. ALL PHYSICIANS ARE ENCOURAGED TO APPLY FOR MEDICAL STAFF PRIVILEGES FOR THE MEDICAL CENTER.SMC-ENS ALSO WORKS WITH VARIOUS COMMUNITY ORGANIZATIONS TO HELP IDENTIFY COMMUNITY NEEDS AND WORK TOGETHER TO MEET THOSE NEEDS. THE MEDICAL CENTER OPENED A WOUND CARE DEPARTMENT TO HELP IN DEALING WITH THE HIGH INCIDENT OF DIABETES WITHIN THE COUNTY POPULATION. THE MEDICAL CENTER ALSO HAS A CERTIFIED DIABETES EDUCATOR AVAILABLE TO CONSULT WITH PATIENTS AND ALSO WITH PHYSICIANS WHEN THEY HAVE A PATIENT THAT IS NEWLY DIAGNOSED WITH DIABETES. THE MEDICAL CENTER HAS AN OUTPATIENT DENTAL CLINIC AVAILABLE FOR THOSE PATIENTS WITH MEDICAID OR NO INSURANCE. THIS CLINIC HAD BEEN OPENED BASED ON THE NEED FOR DENTAL CARE FOR PATIENTS WITH MEDICAID OR LACK OF INSURANCE. THE MEDICAL CENTER ALSO WORKS WITH THE COUNTY SOCIAL SERVICE AGENCIES AND CRIMINAL JUSTICE DEPARTMENT ON OUTPATIENT DRUG AND ALCOHOL ISSUES. THE COUNSELING SERVICES OF THE MEDICAL CENTER PROVIDE OUTPATIENT DRUG AND ALCOHOL COUNSELING SERVICES IN BOTH INDIVIDUAL AND GROUP SETTINGS. THE COUNSELING SERVICES DEPARTMENT ALSO PROVIDES NICOTINE CESSATION COUNSELING AS WELL AS PARTICIPATING IN A GRANT PROGRAM WITH THE SOUTHEASTERN PENNSYLVANIA REGIONAL TOBACCO PROJECT.THE EMERGENCY DEPARTMENT OF SMC-ENS IS A 24 HOUR EMERGENCY ROOM AVAILABLE TO ALL REGARDLESS OF THEIR ABILITY TO PAY. THE MEDICAL CENTER PARTICIPATES IN MANY INSURANCE PROGRAMS SUCH AS MEDICARE, MEDICAID, CHAMPUS AND VA. THE MEDICAL CENTER ALSO HAS A CHARITY CARE POLICY THAT PROVIDES ASSISTANCE TO ELIGIBLE INDIVIDUALS IN PROVIDING FREE OR DISCOUNTED CARE BASED ON THEIR ABILITY TO PAY AND THE FEDERAL POVERTY GUIDELINES.SMC-ENS ALSO PROVIDES OPPORTUNITIES TO STUDENTS IN HEALTHCARE FIELDS TO GAIN EXPERIENCE WORKING IN THE HEALTH CARE ENVIRONMENT SUCH AS NURSING STUDENTS (RN AND LPN), PHARMACY STUDENTS, PHYSICIAN ASSISTANT STUDENTS, PHYSICAL THERAPY STUDENTS, RADIOLOGY TECHNICIANS AND MEDICAL ASSISTANTS. THE MEDICAL CENTER ALSO PROVIDES A VOLUNTEER PROGRAM FOR JUNIOR HIGH AND HIGH SCHOOL STUDENTS TO BECOME FAMILIAR WITH THE MEDICAL SERVICES OFFERED AND THE EDUCATIONAL OPPORTUNITIES AVAILABLE WITHIN THE HEALTHCARE ENVIRONMENT.THE MEDICAL CENTER ALSO SPONSORS AND PARTICIPATES IN HEALTH FAIRS AT COMMUNITY EVENTS SUCH AS THE COUNTY FAIR, EVENTS AT THE LOCAL MALL, HEALTH SCREENINGS, BLOOD PRESSURE SCREENINGS, VETERAN'S BREAKFAST EVENT, MEALS ON WHEELS, SKIN CANCER SCREENINGS, MAMMOGRAPHY SCREENINGS, BLOOD PRESSURE CLINICS, SUPPORT GROUPS AND LOCAL AMERICAN CANCER SOCIETY RELAY FOR LIFE.ANY EXCESS FUNDS THAT ARE GENERATED FROM OPERATIONS ARE INVESTED BACK INTO THE MEDICAL CENTER BY PURCHASING NECESSARY CAPITAL EQUIPMENT, FUNDING CAPITAL IMPROVEMENT PROJECTS, FUNDING NEW SERVICES, IMPROVING AND EXPANDING EXISTING SERVICES AND ANY OTHER GENERAL IMPROVEMENTS TO PATIENT CARE. PART VI, LINE 7: ON AUGUST 1, 2008, SMC-ENS AND SMC-SJS AFFILIATED UNDER THE CONTROL OF SCHUYLKILL HEALTH SYSTEM. THE PRIMARY SERVICE AREA IS POTTSVILLE AND THE SURROUNDING COMMUNITIES IN SCHUYLKILL COUNTY. THE PURPOSE OF BOTH MEDICAL CENTERS IS TO ENGAGE IN ACTIVITIES RELATED TO THE PROMOTION OF HEALTH OF THE PEOPLE IN THE SERVICE AREA, WORK CHARITABLY TO PROMOTE COMMUNITY HEALTH EDUCATION, PREVENTION OF ILLNESS AND INJURY AND PROVISION OF MEDICAL SERVICES TO THE DIVERSE POPULATION OF THE SERVICE AREA AND ENGAGE IN ANY AND ALL ACTIVITIES CONSISTENT WITH OR IN FURTHERANCE OF THESE PURPOSES.EACH MEDICAL CENTER OPERATES INDEPENDENTLY OF EACH OTHER BUT WORKS IN SYNC WITH EACH OTHER IN PROVIDING HEALTHCARE SERVICES TO THE RESIDENTS OF SCHUYLKILL COUNTY. BOTH MEDICAL CENTERS HAVE WORKED TO PROVIDE A CONTINUUM OF CARE SO THAT HEALTHCARE IS AVAILABLE WITHIN THE COUNTY AND RESIDENTS DO NOT HAVE TO TRAVEL OUTSIDE OF THE COUNTY FOR CARE. THE FOLLOWING SERVICES ARE AVAILABLE AT EITHER SMC-ENS OR SMC-SJS: - ACUTE CARE /MEDICAL SURGICAL SERVICES- INTENSIVE CARE SERVICES- MATERNITY SERVICES- NEWBORN SERVICES- PEDIATRICS SERVICES- ADOLESCENT, ADULT AND GERIATRIC BEHAVIORAL SERVICES- ACUTE REHAB AND TRANSITIONAL REHAB SERVICES- INPATIENT AND OUTPATIENT PHYSICAL THERAPY- INPATIENT AND OUTPATIENT DIAGNOSTIC SERVICES- HOME HEALTH SERVICES- OUTPATIENT DRUG AND ALCOHOL SERVICES- OUTPATIENT BEHAVIORAL HEALTH SERVICES- 24 HOUR EMERGENCY ROOM SERVICES- OUTPATIENT DENTAL CLINIC- INPATIENT AND OUTPATIENT SURGICAL SERVICES- COMMUNITY BENEFIT/CHARITY CARE SERVICES- ADVANCED WOUND CENTER- OUTPATIENT SURGERY CENTERPART VI, LINE 7: N/A 0 X X X X X 0 0 0 0 0 0 0 0 0 JOHN SIMODEJKA 0 401645 0 0 0 0 0 0 0 15152 0 416797 0 0 DANIEL KOCHIE 131830 0 0 0 37500 0 0 0 17206 0 186536 0 0 0 DARNELL FURER 170991 0 0 0 0 0 3427 0 2350 0 176768 0 0 0 JOHN RUSSO 273298 0 0 0 0 0 4900 0 15079 0 293277 0 0 0 EARL WATERS JR 144667 0 0 0 0 0 2940 0 17613 0 165220 0 0 0 CHANGES IN PROGRAM SERVICES FORM 990, PART III, LINE 3 SMC - EAST CEASED OPERATING A SLEEP CLINIC AND A TRANSITIONAL LIVING COUNSELING CLINIC. THE SLEEP CLINIC AT SMC - EAST WAS COMBINED WITH THE SLEEP LAB AT SMC - SOUTH. THE TRANSITIONAL LIVING CLINIC WAS RUN THROUGH OUR COUNSELING CENTER AND RECEIVED FUNDING FROM SCHUYLKILL COUNTY. WHEN FUNDING FROM THE COUNTY ENDED THE PROGRAM WAS CLOSED DOWN. FORM 990, PART VI, SECTION A, LINE 3 THE HOSPITAL HAS DELEGATED MANAGEMENT DUTIES OVER ITS DIETARY SERVICES TO SODEXHO INC. AND AFFILIATES AND MANAGEMENT DUTIES OVER ITS REHABILITATION SERVICES TO REHAB CARE GROUP, INC. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS REVIEWED BY MANAGEMENT PRIOR TO ITS FILING WITH THE INTERNAL REVENUE SERVICE. SELECTED MEMBERS OF THE BOARD REVIEWED THE 990 WITH THE TAX RETURN PREPARER AND MANAGEMENT ON BEHALF OF THE BOARD. FORM 990, PART VI, SECTION B, LINE 12C EACH OFFICER, KEY EMPLOYEE, DIRECTOR OR TRUSTEE WITH BOARD DELEGATED AUTHORITY IS REQUIRED TO ANNUALLY SIGN A CONFLICT OF INTEREST DISCLOSURE STATEMENT. THESE STATEMENTS ARE REVIEWED BY THE PRESIDENT/CEO'S ADMINISTRTIVE ASSISTANT AND ANY CONFLICTS ARE REPORTED TO THE PRESIDENT/CEO. THE STATEMENTS ARE KEPT ON FILE IN THE PRESIDENT/CEO'S OFFICE AFTER REVIEW. BOARD MEMBERS ARE EXPECTED TO EXCUSE THEMSELVES FROM TAKING ANY ACTION OR EVEN DISCUSSING ISSUES OF RELATED PARTIES. IF THEY VIOLATE THESE RULES THEY ARE REMOVED FROM THE BOARD. FORM 990, PART VI, SECTION B, LINE 15 ANNUALLY, THE HOSPITAL CONTRACTS WITH JAFFE AND COMPANY, AN INDEPENDENT CONSULTANT, TO MAKE RECOMMENDATIONS TO THE COMPENSATION COMMITTEE, A SUB-COMMITTEE OF THE BOARD, BASED ON MARKET AND INDUSTRY DATA. THIS PROCESS IS USED FOR THE FOLLOWING POSITIONS: PRESIDENT/CEO, VICE PRESIDENT OF OPERATION/COO, VICE PRESIDENT OF NURSING/CNO, AND THE VICE PRESIDENT OF FINANCE/CFO. REVIEW AND APPROVAL IS DOCUMENTED IN BOARD AND COMMITTEE MEETING MINUTES. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VII, SECTION A: THE FOLLOWING INDIVIDUALS WORK AN AVERAGE OF 40 HOURS PER WEEK FOR ALL SCHUYLKILL RELATED ENTITIES: DARNELL FURER DANIEL KOCHIE JOHN SIMODEJKA DIANE BORIS CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: TRANSFER OF ASSETS FROM THE FOUNDATION UPON DISSOLUTION 4,050,468. TOTAL TO FORM 990, PART XI, LINE 5: 4,050,468. STATEMENT PURSUANT TO SECTION 1.351-3(A): STATEMENT PURSUANT TO SECTION 1.351-3(A) BY SCHUYLKILL MEDICAL CENTER - EAST NORWEGIAN STREET 23-0880420 (1) NAME AND EMPLOYER IDENTIFICATION NUMBER OF THE TRANSFEREE CORPORATION: NAME: SCHUYLKILL MEDICAL CENTER - EAST NORWEGIAN STREET EIN: 23-0880420 (2) DATE(S) OF TRANSFER(S) OF ASSETS: TRANSFER DATE(S): 10/08/2010 (3) AGGREGATE FAIR MARKET VALUE AND BASIS OF PROPERTY TRANSFERRED: FAIR MARKET VALUE: $16,000 BASIS: $16,000 (4) DATE AND CONTROL NUMBER OF PRIVATE LETTER RULING(S) ISSUED BY THE IRS IN CONNECTION WITH THE EXCHANGE: DATE(S) AND CONTROL NUMBER(S): NONE SCHUYLKILL COMMUNITY HEALTH SERVICES INC 420 SOUTH JACKSON STREET POTTSVILLE PA 17901 232410904 INACTIVE PA 501(C)(3) SCHUYLKILL HEALTH SYSTEM 0 SCHUYLKILL HEALTH SYSTEM 420 SOUTH JACKSON STREET POTTSVILLE PA 17901 262990543 TO SUPPORT, PROMOTE, ADVANCE & ENHANCE QUALITY OF LIFE OF SCHUYLKILL CNTY PA 501(C)(3) 11B N/A 0 SCHUYLKILL HEALTH SYSTEM MEDICAL GROUP INC 700 EAST NORWEGIAN STREET POTTSVILLE PA 17901 232866006 TO SUPPORT AND PROMOTE THE PURPOSES OF AFFILIATED ENTITIES PA 501(C)(3) 9 SCHUYLKILL HEALTH SYSTEM 0 SCHUYLKILL MEDICAL CENTER - SOUTH JACKSON STREET MAUCH CHUNK JACKSON STREETS POTTSVILLE PA 17901 231352202 OPERATES A HOSPITAL PROVIDING INPATIENT, OUTPATIENT & EMERGENCY SVCS PA 501(C)(3) 3 SCHUYLKILL HEALTH SYSTEM 0 SCHUYLKILL REHABILITATION CENTER INC 420 SOUTH JACKSON STREET POTTSVILLE PA 17901 232440891 OPERATES A COMPREHENSIVE REHABILITATION FACILITY PA 501(C)(3) 3 SCHUYLKILL HEALTH SYSTEM 0 SCHUYLKILL HEALTH SYSTEM FOUNDATION EAST NORWEGIAN TREMONT STREETS POTTSVILLE PA 17901 222793805 SOLICIT, RECEIVE, MAINTAIN AND INVEST MONEY FOR CHARITABLE PURPOSES PA 501(C)(3) 7 SCHUYLKILL HEALTH SYSTEM 0 SCHUYLKILL HEALTH SYSTEM MEDICAL MALL LP EAST NORWEGIAN TREMONT ST POTTSVILLE PA 17901 232514813 RENTAL PA N/A INVESTMENT 79365 222620 0 0 0.30910 SCHUYLKILL HEALTH SYSTEM DEVELOPMENT CORPORATION 700 EAST NORWEGIAN STREET POTTSVILLE PA 17901 232432417 PURSUES, IMPLEMENTS & FURTHERS THE ACTVTIES & PURPOSES OF THE SYS PA SCHUYLKILL MEDICAL CENTER - EAST NORWEGIAN STREET C 33072 219560 1.00000 SCHUYLKILL MEDICAL PLAZA - CONDOMINIUM ASSOCIATION 420 SOUTH JACKSON STREET POTTSVILLE PA 17901 232931821 CONDOMINIUM ASSOCIATION PA N/A C 0 0 1 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0