2011-05-16T16:13:00-05:00 2010-06-30 PARENTEBEARD LLC 400 MARKET STREET WILLIAMSPORT PA 17701 990 2009-07-01 230880420 SCHUYLKILL MEDICAL CTR - EAST NORWEGIAN STREET fka GOOD SAM REGIONAL MED CTR SCHU 5706214000 700 EAST NORWEGIAN STREET POTTSVILLE PA 17901 JOHN E SIMODEJKA 5706214000 2011-05-16 1 JULIUS GREEN 5703236023 2011-05-16 2009 2016-02-24 21:20:13Z JOHN E SIMODEJKA 700 EAST NORWEGIAN STREET POTTSVILLE PA 17901 58055963 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 14 789 119 24274 -212641 520021 1211405 60186458 55418265 -263858 71573 1412881 1203481 61855502 57904724 2425955 0 0 35879803 34298357 0 0 28482734 26836090 66788492 61134447 -4932990 -3229723 31854780 35758717 9029054 16068389 22825726 19690328 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. 1 0 57337990 55925120 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. 57337990 1 1 0 1 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 29 0 1 789 1 1 1 0 0 0 0 0 0 1 1 14 14 0 0 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 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 40.00 X 0 349022 12507 Craig Hunt 40.00 X 0 186490 13090 Daniel Kochie 40.00 X 197067 0 22667 Darnell Furer 40.00 X 167607 0 8190 LESLIE DUBOWITZ 40.00 X 152376 0 9555 JOHN RUSSO 40.00 X 137509 0 16363 NICOLE BRUNI 37.00 X 126799 0 9307 BRIAN PAUL 37.00 X 125844 0 18208 Earl Waters Jr 40.00 X 145876 0 19009 1053078 535512 128896 12 0 1 0 REHAB CARE GROUP INC PO BOX 502096 ST LOUIS MO 631502096 MGMT FIRM-INPAT-REHAB UNIT 720322 TRIMEX HEALTHCARE EQUIP SERVICES PO BOX 636129 CINCINNATI OH 452636129 HEALTH CARE EQPT MAINT/REPAIR 685740 SODEXHO INC & AFFILIATES PO BOX 536922 ATLANTA GA 303536922 MGMT FIRM - DIETARY 569715 GAP CONSULTING INC 6035 DEER RUN ROAD HUNTING VALLEY OH 44022 CONSULTING FIRM/IT Conversion 496635 PH Anesthesia Associates 4210 South Jackson Street Pottsville PA 17901 Anesthesiologist Group 437917 15 700220 412173 99012 1211405 NET PATIENT SERVICE RE 621400 55418265 55418265 55418265 73993 73993 273113 98233 174880 174880 174880 2420 -2420 -2420 -2420 84447 50586 33861 33861 ALCOHOL & DRUG REV 561439 426160 426160 CAFETERIA/VENDING REV 561439 377340 377340 TRANSITIONAL LIVING PR 561439 62562 62562 128678 18133 24274 86271 994740 57904724 55925120 24274 743925 460937 435080 25857 26892609 25384046 1508563 468336 376074 92262 4370748 4125845 244903 2105727 1987596 118131 121619 121619 83085 83085 6029131 5429718 599413 68875 68875 7600301 6765539 834762 1172923 1129271 43652 34295 20426 13869 26959 9519 17440 284347 284347 3489312 3489312 852695 852695 BAD DEBT EXPENSE 3308230 3308230 DRUGS 2743486 2743486 FOOD 589998 582970 7028 DATA PROCESSING 273109 273109 DUES AND REGISTRATIONS 104828 104828 52897 35899 16998 61134447 57337990 3796457 0 38670 1232057 878555 7352434 8583129 1042861 1245139 1407010 486614 371810 83478897 61801307 19485014 21677590 1010661 549067 0 2252886 31854780 35758717 6222608 7751495 663217 1089992 3450971 1716454 4202706 9029054 16068389 X 22742129 19671479 83597 18849 22825726 19690328 31854780 35758717 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 28146 28146 0 Part II-B, Line 1i: Explanation of Other Lobbying Activities: 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 50726682 38628436 12098246 32040802 23041503 8999299 152015 131368 20647 21677590 DUE FROM AFFILIATES 1281275 DEFERRED COMPENSATION 663217 ESTIMATED THIRD PARTY PAYOR SETTLEMENT 308394 2252886 Pension Liability 464912 BLUE CROSS CURRENT FINANCING ADVANCE 419600 CAPITAL LEASE OBLIGATION 2663694 ESTIMATED MALPRACTICE LIABILITY 654500 4202706 57904724 61134447 -3229723 94325 94325 -3135398 58147868 94325 94325 58053543 -148819 -148819 57904724 61283266 148819 148819 61134447 0 61134447 Part X: Description of Uncertain Tax Positions Under FIN 48: 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. Part XI, Line 8 - Other Adjustments: INCREASE IN INTEREST IN NET ASSETS OF AFFILIATE: 47767. OTHER CHANGES IN NET ASSETS: 46558. Part XII, Line 2d - Other Adjustments: INCREASE IN INTEREST IN NET ASSETS OF AFFILIATE: 47767. OTHER CHANGES IN NET ASSETS: 46558. Part XII, Line 4b - Other Adjustments: RENTAL EXPENSES: -98233. Cost of Goods Sold: -50586. Part XIII, Line 2d - Other Adjustments: COST OF GOODS SOLD: 50586. RENTAL EXPENSES: 98233. 1 1 1 X 250.000000000000 1 X 1 1 0 0 170157 170157 0.00290 4422452 1348810 3073642 0.05320 4592609 1348810 3243799 0.05610 50472 50472 0.00090 144099 144099 0.00250 9804675 7140527 2664148 0.04610 150 150 0.00000 9999396 7140527 2858869 0.04950 14592005 8489337 6102668 0.10560 1 3308231 1412426 32432426 29652836 2779590 X 1 1 Schuylkill Medical Center - East Norwegi

700 East Norwegian Street Pottsville PA 17901

X X X Part I, Line 7f: 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 $3,308,230. 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 9%, 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 have 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 9.6%.19% of the population are insured by Medicaid. 42% of that number are under the age of 18, 13% are over the age of 65 and 18% are disabled. 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 56th 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. In Pennsylvania, there is one primary care physician for 838 people. In Schuylkill County, it is one for every 1,989 people.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 5: SMC-ENS 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, support groups and local American Cancer Society relay for life. 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. 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; prevent illness and injury; provide 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 X X X X 0 0 0 0 0 0 0 0 0 John Simodejka 0 349022 0 0 0 0 0 0 0 12507 0 361529 0 0 Craig Hunt 0 186490 0 0 0 0 0 0 0 13090 0 199580 0 0 Daniel Kochie 197067 0 0 0 0 0 0 0 22667 0 219734 0 0 0 Darnell Furer 167607 0 0 0 0 0 0 0 8190 0 175797 0 0 0 LESLIE DUBOWITZ 152376 0 0 0 0 0 0 0 9555 0 161931 0 0 0 JOHN RUSSO 137509 0 0 0 0 0 0 0 16363 0 153872 0 0 0 Earl Waters Jr 145876 0 0 0 0 0 0 0 19009 0 164885 0 0 0 Form 990, Part III, line 2 New Program Services The Center for Wound Healing has reopened. This program was discountinued during FY 2008 when the management company left. A new management company came in and reopened service during FY 2010. 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, 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 REIVIEW. 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 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. SCHUYLKILL COMMUNITY HEALTH SERVICES INC 420 SOUTH JACKSON STREET POTTSVILLE PA 17901 232410904 INACTIVE PA 501(c)(3) N/A SCHUYLKILL HEALTH CARE SERVICES INC 420 SOUTH JACKSON STREET pOTTSVILLE PA 17901 232593486 TO SUPPORT, PROMOTE, ADVANCE & ENHANCE QUALITY OF LIFE OF SCHUYLKILL CNTY PA 501(c)(3) 7 N/A 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 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 N/A 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 N/A SCHUYLKILL REHABILITATION CENTER INC 420 SOUTH JACKSON STREET POTTSVILLE PA 17901 232440891 OPERATES A COMPREHENSIVE REHABILITATION FACILITY PA 501(c)(3) 3 N/A 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 N/A SCHUYLKILL HEALTH SYSTEM MEDICAL MALL LP EAST NORWEGIAN TREMONT ST POTTSVILLE PA 17901 232514813 RENTAL PA INVESTMENT 51720 113093 0 0 SCHUYLKILL HEALTH SYSTEM DEVELOPMENT CORPORATION 700 EAST NORWEGIAN STREET POTTSVILLE PA 17901 232432417 PURSUES, IMPLEMENTS & FURTHERS THE ACTVTIES & PURPOSES OF THE SYS PA C 38443 177218 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