2011-02-10T11:22:32-06:00 2010-06-30 Carbis Walker LLP 5700 Corporate Drive Ste 650 Pittsburgh PA 15237 990 2009-07-01 232801799 CONEMAUGH HEALTH SYSTEM INC CONE 8144108271 1086 FRANKLIN STREET JOHNSTOWN PA 15905 EDWARD DEPASQUALE 8144105271 2011-02-08 1 Jeffrey J Petrell CPA 4126356270 2009 2016-02-24 21:20:13Z Scott Becker 1086 FRANKLIN STREET JOHNSTOWN PA 15905 6973114 0 X www.conemaugh.org X 1994 PA TO SUPPORT MEMBER HOSPITALS WITHIN THE CONEMAUGH HEALTH SYSTEM AND PROVIDE COMMUNITY BENEFIT 16 9 0 9 0 0 0 6743809 6971063 3431 602 589899 1449 7337139 6973114 0 0 5184477 5111026 0 0 2152662 1862088 7337139 6973114 0 0 4776566 5195610 2808118 3149851 1968448 2045759 TO SUPPORT MEMBER HOSPITALS WITHIN THE CONEMAUGH HEALTH SYSTEM AND PROVIDE COMMUNITY BENEFIT SERVICES. 0 0 5724693 6971063 Conemaugh Health System (CHS) serves a seven county region and supports five healthcare entities that provide medical care to protect the health and welfare of all patients. This includes providing opportunities to restore, reclaim or aid persons experiencing physical, cognitive, mental or emotional disabilities. CHS is committed to providing community health education and public awareness to the communities it serves. CHS sponsors free health screenings and free health education seminars. A monthly calendar is published in newspapers throughout the region inviting the community to attend free informational and support sessions catering to all age and demographic groups. CHS offers more than 15 support groups to provide education, networking and open forums on numerous topics including diabetes, epilepsy, stroke and suicide. Conemaugh Health System sponsored the following free screenings throughout fiscal year 2010: various healthy heart and weight management screenings as well as prostate and osteoporosis screenings. CHS also had community health fairs as follows: a heart month community health fair was held that included free screenings, speakers and health related information; a brain injury awareness health fair; a Cribs for Kids awareness program; and a free car seat check. In addition to these specific community events, contributions and event sponsorships for not for profit organizations and community groups occurred throughout the year.Memorial Medical Center, in Johnstown, Cambria County, is the flagship hospital of the Conemaugh Health System. Memorial is a regional referral hospital known for clinical excellence and offers the only Level One Regional Resource Trauma Center between Pittsburgh and Harrisburg. In addition, Memorial houses a Level III (highest level) neo-natal intensive care unit and nationally ranked programs in orthopedics, maternity, vascular, critical care, pulmonary care, neurosurgery and cardiac care. Memorial Medical Center's Lee Campus serves as a hub for outpatient care including the Lee Ambulatory Surgery Center, the Conemaugh Diabetes Institute, and numerous diagnostic and treatment options. Miners Medical Center is a 30-bed, state-of-the-art community hospital serving families across rural northern Cambria County. Meyersdale Medical Center, serving a rural area in Somerset County, is a state-designated Critical Care Access Hospital specializing in family and primary care. Good Samaritan Medical Center provides the region with a nursing care center. CHS also includes the 110+ physicians of Conemaugh Physician Group with practice office locations in Cambria, Somerset, Bedford, Indiana and Westmorland Counties.The Conemaugh Health System is an active member of the community and an advocate for the health, well being and economic strength of the region. CHS administrators have teamed up with the United Way of the Laurel Highlands over the past few years to work to identify and prioritize programs and services that can best impact the most significant needs of the community (Cambria and Somerset County). CHS and the United Way are now collecting data for a 2011 Community Needs analysis, which will be presented and distributed broadly. CHS and the United Way have also committed to monitoring the impact of programming in priority areas and reallocating resources to drive results. 5724693 1 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 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 16 9 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 PA X EDWARD DEPASQUALE 8144108271 1086 FRANKLIN STREET JOHNSTOWN PA 15905 Judge Norman Krumenacker 2.00 X X 0 0 0 James Hargreaves 2.00 X X 0 0 0 Samuel McClure 2.00 X X 0 0 0 Ron Vickroy 2.00 X X 0 0 0 Kristin Brant md 2.00 X 0 0 0 James Cascio 2.00 X 0 0 0 Kim Craig 2.00 X 0 0 0 Robert A Gleason JR 2.00 X 0 0 0 aDIB kHOUZAMI MD 2.00 X 0 1054875 33133 BRIAN LIEB DO 2.00 X 0 168170 28155 Tom Marino 2.00 X 0 0 0 Roberta Ream 2.00 X 0 0 0 Sally sargent 2.00 X 0 0 0 jOHN sARACENA cpa 2.00 X 0 0 0 mICHAEL sMITH 2.00 X 0 0 0 sCOTT bECKER 50.00 X X 729874 0 121059 dAVID CARLSON dO 50.00 X 461690 0 84037 EDWARD DEPASQUALE 50.00 X 360649 0 72054 JOSEPH DADO 50.00 X 287371 0 58390 maRY YORK 50.00 X 198954 0 34198 John Moryken 40.00 X 232208 0 47905 Louis Sciullo 40.00 X 150890 0 21335 2421636 1223045 500266 8 0 1 0 BKD LLP PO Box 1178 louisville KY 40201 Accounting Services 313820 Numerof & Associates Four City Place Drive Suite 430 st louis MO 63141 consulting services 146753 yaffe & co inc 49 washington ave suite 700 towson MD 21204 consulting services 116740 buck consultants dept ch4061 palatine IL 60053 consulting services 107000 4 Management Fees 561000 6971063 6971063 6971063 602 602 INTEREST-OFFICER LOAN 900099 1449 1449 1449 6973114 6971063 0 2051 2954277 2836106 118171 1133866 433687 700179 28975 11287 17688 993908 794886 199022 355394 355394 433037 433037 405204 349469 55735 196209 196209 63409 36594 26815 107488 55337 52151 34021 33435 586 59650 45996 13654 10707 6825 3882 Dues & Subscriptions 97157 40893 56264 Miscellaneous 58913 58643 270 Purchased Services 40899 36895 4004 6973114 5724693 1248421 0 5139 118448 1258400 1052489 23897 13771 214731 192740 181152 163121 28738 18031 3245661 3800131 4776566 5195610 1599860 1521895 503229 508623 705029 1119333 2808118 3149851 X 1968448 2045759 1968448 2045759 4776566 5195610 X 0 1 1 X 0 X X X X 0 0 0 Meyersdale Medical Center 251002946 3 0 1 1 13800 Conemaugh Valley Memorial Hospital 250965307 3 0 0 1 0 Miners Medical Center 250977902 3 0 0 1 0 Good Samaritan Medical Center 250965428 3 0 0 1 0 Conemaugh Health Foundation 251719695 11 0 0 1 0 5 13800 181152 163121 18031 18031 Henry M Jackson Post Polio Grant Account 508621 Investment in PHHP 7500 Investment in RRG 2164677 457(f) deferred compensation contribution 1119333 3800131 457(f) Deferred Compensation contribution 1119333 1119333 Part X: Description of Uncertain Tax Positions Under FIN 48: FASB issued ASC Topic 740 clarifies the accounting for uncertainty in income taxes recognized in an entity's financial statements and prescribes a recognition threshold and measurement attribute for the financial statement recognition and measurement of a tax position taken, or expected to be taken in a tax return. Topic 740 also provides guidance on description, classification, interest and penalties, accounting in interim periods, disclosure and transition. Conemaugh Health System does not have any uncertain tax positions recognized for 2010 OR 2009. X 0 1 X X X X X 1 1 0 0 0 1 1 0 0 aDIB kHOUZAMI MD 0 616808 0 401927 0 36140 0 21842 0 11291 0 1088008 0 0 BRIAN LIEB DO 0 166886 0 624 0 660 0 15232 0 12923 0 196325 0 0 sCOTT bECKER 543403 0 162478 0 23993 0 106507 0 14552 0 850933 0 0 0 dAVID CARLSON dO 376835 0 76111 0 8744 0 69053 0 14984 0 545727 0 0 0 EDWARD DEPASQUALE 280659 0 58583 0 21407 0 60840 0 11214 0 432703 0 0 0 JOSEPH DADO 236268 0 47518 0 3585 0 48680 0 9710 0 345761 0 0 0 maRY YORK 164715 0 32794 0 1445 0 24750 0 9448 0 233152 0 0 0 John Moryken 190740 0 28921 0 12547 0 36054 0 11851 0 280113 0 0 0 Louis Sciullo 135000 0 13416 0 2474 0 18972 0 2363 0 172225 0 0 0 Part I, Line 1a Social club dues are paid for the organization's CEO. Under the oversight of the executive compensation committee, it has always been the organization's practice to pay these dues for the CEO as the social club is primarily used to benefit the organization. Part I, Line 4a Part I, Line 4B: The following individuals participated in supplemental nonqualified retirement plans. Amounts related to these plans, which are included in the deferred compensation shown, are: Scott Becker $92,650; David Carlson, DO $57,443; Edward DePasquale $44,214; John Moryken $21,342; Joseph Dado $35,863; Mary York $24,750; Louis Sciullo $11,184; and Brian Lieb, DO $1,667. Part I, Line 6 Executive bonuses are calculated as a percentage of base salary. The percentage is contingent on various financial and non-financial incentive criteria governed by the executive compensation committee of the board. Part I, Line 6B: ADIB Khouzami, MD and BRIAN Lieb, DO received bonuses from Conemaugh Health Initiatives, a related organization. Physician bonuses are calculated on a cash basis; taking total cash collections less all office operating, physician and overhead expenses. Any remaining amount is then distributed to the physician based on a contractual percentage and cap. Total physician compensation is annually checked for reasonableness against IRS guidelines. David Carlson DO Housing loan X 31010 13771 0 1 1 13771 Form 990, Part VI, Section B, line 11 The Form 990 is provided to the organization's board of directors before it is filed. Once the form is complete, board members are given the opportunity to review the contents of the form and submit any comments or questions. In addition, the form is reviewed by the health system's manager, tax & compliance; director, financial operations; vice president, financial operations; chief financial officer; and the audit and compliance committee. An external CPA firm is engaged to review and electronically file the return. Form 990, Part VI, Section B, line 12c The organization and all subsidiaries is governed by a conflict of interest policy. Under this policy, every board member is given a copy of the policy as well as a form that must be completed on an annual basis. No board member is approved or re-appointed until he or she has completed and signed the conflict of interest form. Once the form is returned, it is reviewed by the CHS compliance officer and CEO. If any conflicts are disclosed, the details are forwarded to the board chair to be addressed. Depending on the conflict, the board member could be given certain restrictions, such as being prohibited from participating in certain board decisions. The CHS audit and compliance committee has the final decision-making regarding all conflicts of interest. Throughout the fiscal year, board members must notify the board chair, compliance officer, and/or ceo if a new conflict has developed. Form 990, Part VI, Section B, line 15 CHS manages the determination of compensation for its executives as well as the executives of all its subsidiares. The process is outlined in its by-laws. Two outside consulting firms are utilitized to ensure that executive compensation packages are fair and comparable with similar organizations. CHS has also established an executive compensation committee to review and recommend the compensation decisions made. This committee reports directly to the board. Form 990, Part VI, Section C, line 19 All requests for this information are handled by the CHS Marketing/Public Relations department. Part XI, Line 2: The organization's financial statements for the fiscal year ending June 30, 2010 were audited as part of the audit of the consolidated financial statements of the Conemaugh health System, Inc. and subsidiaries. The health system's audit and compliance committee assumes responsibility for the oversight of the audit and the selection of the independent accountant. Good Samaritan Medical Center 1020 Franklin Street Johnstown PA 15905 250965428 Health Care Services PA 501C(3) 3 N/A Conemaugh Valley Memorial Hospital DBA Memorial Medical Center 1086 FRANKLIN STREET JOHNSTOWN PA 15905 250965307 HEALTH CARe Services PA 501C(3) 3 N/A MINERS HOSPITAL DBA MINERS MEDICAL CENTER 290 HAIDA AVENUE HASTINGS PA 16646 250977902 Health Care Services PA 501C(3) 3 N/A meyersdale community hospital dba meyersdale medical center 200 hospital drive meyersdale PA 15552 251002946 health Care Services PA 501C(3) 3 N/A conemaugh health foundation 1086 franklin street johnstown PA 15905 251719695 supports conemaugh health system PA 501C(3) 11b N/A conemaugh housing inc 1086 FRANKLIN STREET johnstown PA 15905 251606936 provides senior housing facilities PA 501C(3) 9 conemaugh valley memorial hospital laurel highlands advanced imaging 1450 scalp avenue johnstown PA 15904 251864587 diagnostic services PA conemaugh valley memorial hospital related 0 0 greater johnstown tech park 1086 franklin street johnstown PA 15905 260389121 operates multi-tenant commerce office park PA conemaugh enterprises inc unrelated 0 0 conemaugh health initiatives 1086 franklin street johnstown PA 15905 251658283 physician services PA N/A C conemaugh enterprises inc 1086 franklin street johnstown PA 15905 202998473 economic development PA Conemaugh Valley Memorial Hospital C 1086 real estate 1086 franklin street johnstown PA 15905 251489704 real estate PA conemaugh health initiatives C sindo inc 1086 franklin street Johnstown PA 15905 251144116 COMMUNITY RENTALS PA CONEMAUGH HEALTH FOUNDATION C 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 CONEMAUGH HEALTH INITIATIVES P 807338