2011-05-16T10:00:49-05:00 2010-06-30 PARENTEBEARD LLC 400 MARKET STREET WILLIAMSPORT PA 17701 990 2009-07-01 231512747 HOLY SPIRIT HOSPITAL HOLY 7177632100 503 NORTH 21ST STREET CAMP HILL PA 170112204 SR ROMAINE NIEMEYER 7177632100 2011-05-11 1 5703236023 2009 2016-02-24 21:20:13Z SR ROMAINE NIEMEYER 503 NORTH 21ST STREET CAMP HILL PA 170112204 288830484 0 X www.hsh.org X 1963 PA TO PROVIDE HEALTH CARE TO THE COMMUNITY. 15 13 2682 425 3773004 801729 3796976 3627675 704246700 258349139 -2150986 2829630 7335725 6915780 713228415 271722224 3808716 5151206 0 117564856 123842975 0 393439 586072980 131364794 707446552 260358975 5781863 11363249 197877541 212401841 101505290 102545438 96372251 109856403 Holy Spirit Hospital is a community Catholic hospital sponsored by the Sisters of Christian Charity to carry out the healing ministry of Jesus Christ to all in need. We provide high quality, cost-effective health services to develop healthy communities in the greater Harrisburg area and South Central Pennsylvania. 0 0 71509219 87619260 Nursing Services:Nursing Services is driven by the hospital's Mission, Vision and Values. The provision of highly skilled, competent and compassionate nursing care is essential to fulfill our commitment to excellence in clinical practice, education and nursing research. Inpatient nursing units' expenses in fiscal year 2010 were $27,042,981; surgical nursing services' expenses were $30,757,781; and all other nursing expenses totaled $13,708,458. Those expenses totaled over $71.5 million.The Birthplace at Holy Spirit is equipped to meet the needs of women during and after the baby arrives. A variety of services are offered in a comfortable and warm environment. A team of specially trained nurses provides care to each mom and baby during labor, delivery, and recovery. The Neonatal Intensive Care Unit (NICU) is staffed by some of the area's most well-respected neonatologists, ready to assist physicians or midwives with babies' medical needs. The NICU offers Level III care onsite, which means today's most advanced medical technology is close at hand to deal with any special needs. In fiscal year 2010, the NICU staff cared for 108 babies in a family-friendly environment. Staff members have cared for babies as young as 24-weeks' gestation and other babies who need intensive care. Holy Spirit offers an online childbirth preparation course an alternative for couples who cannot attend a traditional prepared childbirth course due to bed rest and scheduling conflicts. The eLearning course is offered to pregnant women regardless of where they are planning to give birth. Holy Spirit participates in clinical research, a complex process involving cooperation among physicians, research administrators and other healthcare professionals. Clinical trials are overseen by the Institutional Review Board and the Research Review Committee. Many of these clinical trials have positively affected and extended many patients' lives. During fiscal year 2010, the Institutional Review Board approved 9 new protocols, continued reviewing 70 protocols and studied approximately 1,425 adverse event reports.Holy Spirit Hospital is committed to providing assistance to all faiths with their faith-based ministry of health. Free services offered to South Central Pennsylvania faith communities include an assessment of the congregation's needs, assistance in developing an individualized ministry of health, ongoing guidance, networking opportunities, a resource center and lending library, continuing educational programs and monthly lunch and learn programs.For individuals who are victims of sexual violence, having a positive experience in the hospital setting can contribute greatly to overall healing. To ensure dignity and compassion, our Emergency Center dedicated an examination room equipped with the latest forensic technology. A team of nurses who are trained Sexual Assault Nurse Examiners collect medical and legal evidence, while being sensitive to the patients needs.Registered nurses in Patient Care Services assisted the Education, Training, and Development Department with screenings at community activities and monthly screenings performed at the hospital. In addition, hospital nurses helped to administer free flu immunizations to the low income, uninsured population in a three-county area.Holy Spirit staff works collaboratively with Harrisburg Area Community College, Messiah College, York College, Eastern University, Widener University, Penn State University, Drexel University, South University, Southern Adventist University and Misericordia University to provide clinical learning opportunities for students. 19549225 31404142 Cardiovascular Services:The Ortenzio Heart Center at Holy Spirit is a four-story, 140,000-square-foot facility equipped with the latest technology and staffed with a skilled team of nurses and clinical specialists. Some of the region's most experienced cardiologists and cardiac surgeons practice in The Ortenzio Heart Center at Holy Spirit, offering open heart surgery, cardiac catheterization, vascular procedures, diagnostic cardiology, nuclear cardiology, cardiac rehabilitation, electrophysiology studies, tilt studies, and CRM device, pacemaker and other device implants.In fiscal year 2010, The Ortenzio Heart Center at Holy Spirit performed 2,249 diagnostic cardiac catheterizations and 866 interventional cardiac catheterizations. More than 1,500 patients had electrophysiology procedures performed and 310 patients had cardiothoracic surgeries. More than 32,668 EKGs were performed in fiscal year 2010. More than 7,500 cardiac rehabilitation sessions were provided to help patients recover from surgery or heart-related problems. The goal is to get the patients back to their normal activities and to educate and lead them to adopt a heart healthy lifestyle. Our cardiac team consistently beat the national quality goal for door-to-reperfusion (opening blocked coronary arteries and re-establishing blood flow to the heart) time for cardiac patients. Early restoration of blood flow, or reperfusion, to the heart can reduce the extent of myocardial damage. 16364142 57509908 Imaging Services:Holy Spirit Imaging Services assists healthcare providers in the diagnosis and treatment of a wide variety of diseases. From routine X-rays to the high-tech 4D imagery, Holy Spirit Imaging provides services at the hospital and through its outpatient imaging centers, located within the hospital and in surrounding communities. In August 2009, Holy Spirit opened a new center in Camp Hill. This center provides imaging services, including CT, digital mammography, general and vascular 4D ultrasound, and digital X-ray. In the fall, stereotactic breast biopsy and virtual colonoscopy services were added at this center.The Imaging Services staff participates in health fairs throughout the year. During this fiscal year, they attended 42 health fairs and Spirit of Women events and provided 2,227 free bone density screenings and 393 free carotid ultrasound screenings.Holy Spirit Imaging Centers offer free bone density screenings at convenient locations every month. In addition, women who are scheduled for mammograms are asked if they would like to have a free bone density test. This quick and easy heel scan helps to determine the thickness of the bone - the first step in checking for signs of osteoporosis. Through these offerings, Holy Spirit provided 4,040 free bone density screenings. 90630697 5151206 81815829 Laboratory ServicesHoly Spirit provides comprehensive laboratory services, including chemistry, urinalysis, toxicology, therapeutic drug monitoring, hematology, coagulation, microbiology, immunology, blood bank and transfusion services, cytology and histology. Laboratory services are provided at eight convenient locations.Laboratory collection and blood donor services relocated to a new facility, the Holy Spirit Camp Hill Center and were expanded.The Laboratory Services staff participated in 38 health fairs and screening events in order to provide a means to identify potential disease in patients who may not otherwise have access to testing for high cholesterol or glucose. A total of 1,899 glucose tests and 2,104 cholesterol tests were performed at no cost or at a reduced cost to patients. Emergency PreparednessHoly Spirit Hospital received a grant from the Office of Public Health Preparedness to fund supplies and equipment for mass casualty response efforts. Each month, the safety and emergency management coordinator attends four-hour regional counterterrorism task force meetings, and multiple regional workgroup meetings to further enhance regional response plans and capabilities.Clinical Information SystemOver the last five years Holy Spirit Hospital has implemented an advanced electronic medical record (EMR) that fewer than 20% of the nation's community hospitals can boast. The hospital board, the administration and staff have made a substantial time and monetary commitment which continues to demonstrate substantial improvements in patient safety while diminishing duplication, waste, and incomplete documentation. The information system has contributed to improvements in patient satisfaction scores and quality scores. The hospital is in excellent position to demonstrate meaningful use of its EMR, consistent with incentive funding authorized by the American Recovery and Reinvestment Act of 2009. The hospital stands to gain approximately $7 million over the next four years for its efforts.It has now been three years that Holy Spirit clinicians have used computerized provider order entry (CPOE). CPOE offers exceptional improvements in patient safety, reduced turn-around times, and reductions in wasteful duplicate testing. In addition, CPOE includes point-of-care clinical decision support to assist clinicians in selecting the safest orders.During the 2010 fiscal year Holy Spirit expanded use of bar-coded medication administration, another safety based technology. Starting with the first quarter of the next fiscal year we will embark on a major upgrade that will be the final step which will qualify us for meaningful use. Thereafter we will continue to add other patient safety and efficiency modules to our EMR. The most recent research suggests that only about 12% of hospitals similar to ours in size and structure have introduced the types of technologies that we already have. As we continue to introduce new and upgraded technologies we remain in the forefront of those institutions.Clinical Information SystemOver the last five years Holy Spirit Hospital has implemented an advanced electronic medical record (EMR) that fewer than 20% of the nation's community hospitals can boast. The hospital board, the administration and staff have made a substantial time and monetary commitment which continues to demonstrate substantial improvements in patient safety while diminishing duplication, waste, and incomplete documentation. The information system has contributed to improvements in patient satisfaction scores and quality scores. The hospital is in an excellent position to demonstrate meaningful use of its EMR, consistent with incentive funding authorized by the American Recovery and Reinvestment Act of 2009. The hospital stands to gain approximately $7 million over the next four years for its efforts.Health Education and Disease Prevention ProgramsHoly Spirit's Perinatal Education Services offers a continuum of appropriate population-based health initiatives for the community. Courses incorporate current research and are available for all expectant families. Educational offerings include Childbirth Preparation, Infant Feeding, Baby Boot Camp, and Sibling Preparation. Partnerships with clinicians from various service lines, including physicians and personnel from Behavioral Health have been established with an aim to increase health promotion and pregnancy wellness, a key strategy in current healthcare policy. The Behavioral Health staff offers a weekly support group for pregnant women and new mothers who are feeling alone, afraid, overwhelmed, sad or worried. Pregnant women and new mothers with babies less than one year of age are welcome. Educational family nights with childcare are offered periodically.Holy Spirit also offered free Healthy Living Lectures on the following topics this fiscal year: breast cancer, prostate cancer, heart disease, diabetes, minimally invasive surgery, Crohn's disease, ulcerative colitis and childhood depression.The Pastoral Care department offered several free bereavement support group/lecture series during the year for anyone grieving the death of a loved one and for those who care about friends who are grieving. Various aspects of the grieving process are discussed to help individuals understand how to cope with grief.In observance of National Diabetes Month, Holy Spirit Hospital's Diabetes Services offered a unique program to people with diabetes in November 2009. More than 200 people attended this free program to learn more about nutrition, exercise as medication, and diabetes.The Education, Training and Development office offers a babysitting certification class, called Safe Sitter, to children ages 11 to 13 in the community. During this fiscal year 89 children graduated from the program. Each participant pays $25 to cover the cost of materials for the two-day program.Health Fairs/Disease Prevention Programs/Health InformationDuring the year Holy Spirit Health System participated in 56 health fairs for businesses, clubs, organizations, and churches. Staff provided more than 3,200 health screenings, including glucose and cholesterol, blood pressure, body mass index, bone density and lung function testing, at the health fairs. More than 3,000 free blood pressure screenings were performed at weekly community screenings at area libraries and at the monthly screenings held at the hospital. The hospital also provided 22 speakers on various health-related topics to businesses, clubs, organizations, and churches. Staff also spoke at several high schools about healthcare careers, including nurses, physician's assistants, paramedics, and staff from the pharmacy and imaging.Community Non-Profit Projects or EventsThe hospital's auditorium is used for hospital-sponsored education and loaned free to community non-profit groups. Meeting space donation was valued at almost $7,600. Holy Spirit Hospital offers other innovative programs to schools to promote healthy living. The Holy Spirit Hospital Auxiliary and Volunteers teamed up to travel to area elementary schools throughout the year to present a program entitled "I'm in Charge of Me." The program uses soft-sculpture dolls, songs, and exercise to promote the values of good nutrition and safety, drug and alcohol avoidance, and the benefits of exercise among area third grade students. The "I'm in Charge of Me" program was presented free of charge to more than 1400 third-graders in 75 classrooms this fiscal year. Every student was given a coloring book and "I'm in Charge" sticker as a reminder of this important health message. Holy Spirit's Pastoral Care's Emergency Room (ER) Family Support Program helps patients and families in the ER, seven days a week, from 6 to 9 p.m. Through this program, specially trained volunteers provide information, to listen, to be a liaison between the family and the caregivers and to provide refreshments if needed. Holy Spirit Health System is a member of Spirit of Women. The Spirit of Women hospital network is a coalition of more than 80 hospitals and health care systems across the United States that ascribe to the highest standards of excellence in women's health, education, and community outreach programs. Consultation and Related ServicesHoly Spirit Hospital provides Crisis Intervention services to the community by telephone, walk-in visits, and, in their homes or other locations in the community. Crisis Intervention workers assist individuals and professional service agencies in Cumberland and Perry counties by assessing and stabilizing people in crisis situations, such as those with suicidal or homicidal thoughts, gestures and attempts; psychotic persons; and those showing signs of serious self-neglect. 90630697 5151206 81815829 198053283 1 1 0 1 0 0 0 0 1 1 1 1 0 0 0 0 0 0 1 0 1 1 1 1 0 0 0 1 0 1 0 1 0 0 0 0 0 1 0 0 0 1 77 0 1 2682 1 1 1 0 0 0 0 1 1 0 0 0 15 13 0 1 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 PA X OFFICERS 7177632100 503 NORTH 21ST STREET CAMP HILL PA 170112288 LEON FEINERMAN 1.00 X X 0 0 0 ROBERT DIETZ 1.00 X X 0 0 0 MICHAEL SERLUCO 1.00 X X 0 0 0 JAMES C BYERLY 1.00 X 0 0 0 JANAK M AMIN 1.00 X 0 0 0 SAMUEL COOPER III ESQUIRE 1.00 X 0 0 0 SISTER JOAN DANIEL HEALY SCC 1.00 X 0 0 0 timothy clark md 1.00 X 0 0 0 LAWRENCE M KLUGER 1.00 X 0 0 0 SISTER JOSITA MARKS SCC 1.00 X 0 0 0 SISTER ANNE THERESA PEACH SCC 1.00 X 0 0 0 RICHARD SCHREIBER MD 40.00 X 174429 0 9014 REV WILLIAM WALTERSHEID 1.00 X 0 0 0 SISTER ROMAINE NIEMEYER SCC 40.00 X X 0 0 0 steven wolf md 1.00 X 0 0 0 MANUEL J EVANS 40.00 X 337772 0 24853 RICHARD A SCHAFFNER JR 40.00 X 310051 0 22183 RICHARD LAVANTURE 40.00 X 279456 0 21016 DR JOSEPH A TORCHIA 40.00 X 346456 0 22285 William P Shartle 40.00 X 209567 0 8728 CHARLES CLADEL MD 40.00 X 211875 0 23653 DR MICHAEL J PASZEK 40.00 X 239569 0 22159 edith c dees 40.00 X 210797 0 13512 Lisa F Lewis 40.00 X 224304 0 13748 DR Robin K Miller 40.00 X 204594 0 14450 2748870 0 195601 144 0 1 0 West Shore Anesthesia PO Box 1050 Camp Hill PA 17001 Physician Contract 1127688 quantum imaging 629-D Lowther Road lewisbury PA 17339 Purchased Medical Services 1038491 center for wound healing 155 white plains road Suite 222 tarrytown NY 10591 management svcs - Hyperbaric 862032 Quest Diagnostics 12436 Collections Center Drive Chicago IL 60693 Purchased Medical Services 768665 HaRRISBURG MOBILE LITHOTRIPSEY 100 WEST THIRD AVE STE 350 CoLUMBUS OH 43201 Purchased Medical Services 757800 27 80997 652901 2203404 690373 3627675 PATIENT REV - ANCILLAR 621400 227091652 227091652 PATIENT REV - ROOM & B 621400 24850918 24850918 PATIENT REV - ANCILLAR 621400 3282545 3282545 PATIENT REV - ROOM & B 621400 3124024 3124024 258349139 1876278 1876278 703360 687755 15605 15605 15605 17318581 16309454 55775 1009127 -55775 953352 953352 98219 80997 55276 42943 42943 LABORATORY - NON PATIE 621500 2590778 2590778 INTENSIVE CASE MANAGEM 900099 687431 687431 LTACH - RENT & OTHER S 532000 658272 658272 2920751 1527387 523954 869410 6857232 271722224 260563957 3773004 3757588 4635445 4635445 515761 515761 1656447 1656447 99286842 75252417 23795542 238883 3500620 2615862 884741 17 11729067 8860797 2868213 57 7669999 5819267 1850704 28 4715998 4715998 388937 388937 126973 126973 140540 140540 18698895 14256740 4287784 154371 1823038 36978 1786060 57178265 52742117 4436146 2 5440518 214392 5226126 7068239 5038106 2030133 632482 382456 250026 23563 216 23347 4097493 3061879 1035594 20 14211091 9445372 4765664 55 1404894 872131 532757 6 UNRELATED BUSINESS INCO 203822 203822 BAD DEBT EXPENSE 14143276 14143276 DueS 473199 52834 420365 MedicAL LIBRARY/Physici 123071 123071 EmPLOYEE RECOGNITION 122835 122835 347665 107237 240428 260358975 198053283 61912253 393439 4170 4370 5684466 8834373 15930 33667126 32634073 710084 794485 740203 2255466 2089169 215154135 132373929 81813986 82780206 64775681 76989171 8866231 7620192 197877541 212401841 27296717 28887135 70125000 67975000 1174333 4083573 4508970 101505290 102545438 X 93824905 107509859 425414 119888 2121932 2226656 96372251 109856403 197877541 212401841 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 20083 20083 0 Part II-B, Line 1i: Explanation of Other Lobbying Activities: A PORTION OF THE HOSPITAL'S DUES PAID TO THE HOSPITAL ASSOCIATION OF PENNSYLVANIA ("HAP") AND THE AMERICAN HOSPITAL ASSOCIATION ("AHA") ARE USED FOR LOBBYING PURPOSES. IN FISCAL YEAR 2010, 25.82% OF DUES PAID TO HAP RELATED TO LOBBYING, 23.76% OF DUES PAID TO AHA RELATED TO LOBBYING AND 5.46% OF DUES PAID TO CHA RELATED TO LOBBYING. 2121932 9370 118956 23602 2226656 2526208 1218 -387499 17995 2121932 1.00000 1 0 2215369 2215369 61232926 31749195 29483731 3047945 2280679 767266 143044363 95321985 47722378 5613532 3022070 2591462 82780206 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 1395209 BLUE CROSS CURRENT FINANCING ADVANCE 1222600 ESTIMATED MEDICAL MALPRACTICE CLAIMS LIABILITY 1492000 DEFERRED COMPENSATION 287635 due to affiliates 111526 4508970 271722224 260358975 11363249 2144505 -23603 2120902 13484151 273702586 2144505 -23603 2120902 271581684 140540 140540 271722224 260218435 0 260218435 140540 140540 260358975 Part V, Line 4: Description of Intended Use of Endowment Funds: Interest earned is unrestricted and transferred to the operating fund. Part X: Description of Uncertain Tax Positions Under FIN 48: The System 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 has determined that there were no tax uncertainties that met the recognition threshold in 2010 or 2009. The System's federal Exempt Organization Business Income Tax Returns for 2009, 2008, and 2007 remain subject to examination by the IRS. Part XI, Line 8 - Other Adjustments: CHANGE IN SPLIT INTEREST AGREEMENTS: -1275. CHANGE IN POLICY CASH SURRENDER VALUE: -22328. Part XII, Line 2d - Other Adjustments: CHANGE IN SPLIT INTEREST AGREEMENTS: -1275. CHANGE IN POLICY CASH SURRENDER VALUE: -22328. Share the spirit gala 144732 71690 73042 3700 17757 2300 12084 spring fund raiser 17910 5405 12505 3585 8484 2 16574 3902 12672 350 5170 1846 179216 80997 98219 4050 26512 2300 22414 55276 42943 1 1 1 X 1 X 1 1 1 0 1 1 788826 788826 0.00320 16870224 10546566 6323658 0.02570 17659050 10546566 7112484 0.02890 702744 702744 0.00290 1027583 329672 697911 0.00280 17093209 11148941 5944268 0.02410 76823 76823 0.00030 17298 6695 10603 0.00000 18917657 11485308 7432349 0.03010 36576707 22031874 14544833 0.05900 1 4474152 887479 56384504 60951262 -4566758 X 1 1 HS CARDIAC MANAGEMENT LLC PARTNERSHIP AGREEMENT WITH CARDIOLOGISTS 0.30000 0.00000 0.70000 holy spirit hospital

503 North 21st Street Camp Hill PA 17011

X X X Part I, Line 7g: THERE ARE NO PHYSICIAN CLINICAL SERVICES INCLUDED. 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 $14,143,276. Part III, Line 4: HOLY SPIRIT HOSPITAL USES THE COST TO CHARGE RATIO IN COMPUTING THE AMOUNTS REPORTED ON PART III, LINES 2 & 3. The Hospital uses the allowance method to record bad debt expenses. Using this method the expenses are recorded each month based on the change in the Hospital's allowance for bad debts. The aging of accounts receivable and the probability of collections is used to estimate the credit needed for the Hospital's allowance for bad debts. Then accounts that are deemed to be uncollectible are written off to the allowance for bad debts and recoveries of past bad debt accounts are posted against the same allowance for bad debts.Holy Spirit Hospital uses the cost to charge ratio. Discounts applied to patient accounts are accounted for as "policy allowances", which are deducted from gross patient service revenues in arriving at net revenue. Patient payments on accounts in a bad debt classification are accounted for as reductions to the bad debt reserve. Patients with balances less than $1,500 who meet certain criteria (e.g. household income less than 200% of FPG) are deemed to be presumptively eligible for charity care. Other patients must complete a financial assistance application and, depending upon the amount owed, may also be asked for supporting documentation.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 documentations to allow that classification. These would be classified as bad debt expense times the cost to charge ratio to arrive at cost. The organization accounts for discounts and payments on patient accounts as a reduction of revenue/accounts receivable and are not components of bad debt expense. Hospital provides care to all patients who need it, regardless of their ability to pay. This is part of the hospital's mission. Part III, Line 8: The Adjusted Allowable Costs come directly from the Medicare Cost Report schedules. Amount only represents cost of claims paid at the time the Cost Report was submitted. Part III, Line 9b: The collections policy states "This policy does not apply to those patients who have demonstrated financial need and whose financial obligations to HSH, in whole or in part, are found to eligible for charity care allowance as defined in HSH's Financial Assistance Policy. However, in those instances where a patient has applied for financial assistance and only a portion of the account balance qualifies for charity care allowance, the remaining balance is subject to collection under the guidelines set forth herein." Part VI, Line 2: As part of its annual strategic planning process, Holy Spirit Hospital conducts an environmental impact analysis and assesses the health care needs of its community. Heart, cancer, and stroke have been identified as the leading causes of death, and Holy Spirit has committed resources to these service lines to address the health needs of its community, among other items driven by demographics and epidemiology. Holy Spirit Hospital has conducted physician needs assessments in 2008 and 2010 to identify medical and surgical specialties that are in short supply within its primary service area. Strong physician recruitment targets have been set to assure that the community has access to these physicians. Part VI, Line 3: The hospital informs patients about the possibility of assistance from government programs and/or the hospital's own charity care policy in a number of ways. Hospital-employed financial counselors and/or vendor agents assist uninsured patients in applying for and receiving Medicaid eligibility. In addition, the hospital uses signage at patient registration locations and includes language in patient brochures and on its billing statements to inform patients about the hospital's charity care program. Part VI, Line 4: Holy Spirit Hospital is located in suburban Cumberland County in Pennsylvania and is part of the larger Harrisburg-Carlisle metropolitan area. Holy Spirit Hospital's primary service area covers parts of the four counties of Cumberland, Dauphin, Perry, and York with a population of approximately 500,000, including pockets of urban, suburban, semi-rural, and rural populations. This same service area is served by four competing health systems - Holy Spirit Hospital, PinnacleHealth System, Penn State, and Health Management Associates. The Hospital's primary service area is rapidly aging (median age is 40.5), and the over 65 population is expected to grow by over 16% in the next five years. The median household income in the primary service area is $57,129. Part VI, Line 5: Holy Spirit has always had a tradition of supporting our community. One of the ways that we have been able to help is through our contributions to United Way. Holy Spirit employees donated more than $32,500 to United Way. Individuals were encouraged to take part in this system-wide fund-raiser. Without the organization's involvement, the majority of individuals most likely would not have contributed to this worthwhile community program. United Way of the Capital Region helps change lives locally by investing in children and youth, caring for families and seniors, overcoming disease and disabilities, providing emergency food and shelter, and building a stronger and safer community. Holy Spirit had 13 teams with a total of 164 walkers participate in the American Heart Association's Heart Walk in October and raised more than $11,000.Almost 60 Holy Spirit employees donated Christmas gifts to children whose mothers were clients of the Capital Region Maternal Assistance Program (MAP) and were successfully working toward their goals of overcoming drug, alcohol or tobacco addiction. Members of Holy Spirit Health System's leadership team are board members, members or participate with the following organizations: Ambulance Association of PA, American Ambulance Association, American College of Healthcare Executives, American Legion Auxiliary (Newport), Boy Scouts of America, Camp Hill Community Foundation, Carlisle Chamber of Commerce, Carlisle Welcome Jam, Catholic Health Association, Central Pennsylvania Energy Consortium, Central Pennsylvania HIMSS, Chambersburg Chamber of Commerce, Community Action Commission of the Tri-County Area, Dauphin County Department of Corrections' Program for Female Offenders, Dauphin County Health Improvement Partnership, Derry Township School District, Downtown Daily Bread, Emergency Health Services Federation, General Federation of Women's Club (Dillsburg), Goodwill, Greyhound Bus Station, Harrisburg Area Community College (Paramedic Program Advisory Board, Clinical Laboratory Technician Program Advisory Committee, Nursing Program, Shumaker Public Safety Center Advisory Board), Harrisburg Area Dental Society, Harrisburg Regional Chamber of Commerce, HELP Office, Junior Achievement of Central PA, Keystone Family Services, Leadership Cumberland, Leadership Harrisburg Area, Lions' Club (New Bloomfield), Lions' Community Theater, Lions' Foundation (Camp Hill), Lourdes House, Lower Swatara Volunteer Fire Department, Mechanicsburg Chamber of Commerce, Messiah College School of Nursing, National EMS Management Association, Pennsylvania Catholic Health Association, Pennsylvania Health Information Exchange, Pennsylvania Society for Respiratory Care, Perry Housing Partnership, Rotary Club, South Central PA Healthcare Partnership Pre-hospital Committee, South Central Task Force, St. Francis Soup Kitchen, Susquenita High School West Side Singers Organization, Technology Council of Central PA, United Way of the Capital Region, West Shore Chamber of Commerce, and the YWCA of the Harrisburg Area. This list does not include those community organizations in which the general employee population is involved.In the past year 425 volunteers contributed 43,766 hours of service to Holy Spirit Hospital. These hours represent 22.8 FTEs with an approximate value of $886,253.Holy Spirit's annual golf tournament was held August 2009. Almost 300 golfers participated in the outing which raised approximately $120,000. Proceeds were distributed to Holy Spirit's outreach programs. Part VI, Line 6: Holy Spirit Hospital is a community Catholic hospital sponsored and managed by the Sisters of Christian Charity to carry out the healing ministry of Jesus Christ to all in need. We provide high-quality, cost-effective health services to develop healthy communities in the greater Harrisburg area and South Central Pennsylvania. The hospital has more than 550 physicians on its medical staff and offers a comprehensive array of inpatient and outpatient services, including pre- and post-hospital care. The organization extends staff privileges to all qualified physicians in the area. We commit ourselves to the values of dignity, holism, service, stewardship, quality, and integrity. A majority of the organization's governing body is comprised of persons who reside in the organization's primary service area. They are neither contractors, nor family members of persons in the organization. There is only one person on the governing board who is an employee of the organization.Holy Spirit Hospital provided more than $58 million this year to directly benefit the communities we serve. This total includes uncompensated care, charity care and subsidies for Medicare and Medical Assistance as well as subsidies for behavioral health services. Holy Spirit is accessible beyond traditional healthcare settings, at local companies, libraries, senior centers, churches, schools, neighborhood events reaching those in need.Through free community health screenings, we provided more than 13,000 health screening such as blood pressure, glucose, cholesterol, carotid artery, peripheral artery disease, bone density, cardiovascular and stroke risk. We participated in 56 employer and community health fairs, talking with hundreds of people about diabetes, stress management and more. Our free Healthy Living Lectures helped educate the community, and thousands of people attended free health events sponsored by our Spirit of Women program. We even offer a pet therapy program for inpatients.On a broader scale, we devoted time and resources to assuring our preparedness in the event of a community-wide disaster. In clinical education, our staff spent more than 19,670 hours with some 1300 students at every level who are considering or working toward careers in healthcare. Our professional staff also spent many hours volunteering at health related community events, volunteering with emergency task forces, teaching continuing medical education courses and sharing their expertise with fellow practitioners. The physicians and staff at Holy Spirit Hospital cared for 15,447 inpatients during the fiscal year. Outpatient visits totaled 229,391. The Social Service/Case Management department handled 9,865 cases. Holy Spirit Health System and its affiliates establish and maintain all programs and services for sick, injured, or disabled persons without regard to race, creed, color, sex, national origin, handicap, age, or ability to pay.Missions: The hospital donates used medical equipment and supplies to both local and overseas missions. The value of donated supplies and services was approximately $1,875. Medical/surgical supplies and linens comprised most of this dollar amount. Uncompensated Care: The hospital provides care to patients who meet certain criteria without charge or at amounts less than its established rates. During the fiscal year ending June 30, 2010, $958,098 in care was delivered without reimbursement to the uninsured, the underinsured, and the indigent population of South Central Pennsylvania.Courtesy Transportation: A courtesy bus operates between the hospital's parking lot and its buildings as a community service for all patients and visitors. The hospital offers free valet parking service to all patients and visitors at the main entrance and at the emergency center entrance. Part VI, Line 7: Holy Spirit Hospital (the "Hospital") is a community Catholic hospital, providing high-quality, cost-effective health services to patients in the greater Harrisburg area and South Central Pennsylvania. The Hospital is licensed for 319 acute care beds and operates Outpatient Centers in Camp Hill, Colonial Park, Mechanicsburg, Dillsburg and Duncannon, a Gamma Knife at Oakwood Cancer Center in Mechanicsburg, a Cardiac Rehab program in Carlisle, and the Holy Spirit Sleep Center located in Lemoyne. Holy Spirit Corporation ("HSC") is a real estate holding corporation with properties in Camp Hill, Dillsburg, and Mechanicsburg, including the Medical Arts Building, American Office Center, and Kinder Care Center.Holy Spirit Ventures, Inc. ("HSV") is the corporate organization through which HSHS participates in the ownership and management of healthcare facilities jointly with other healthcare providers. In addition, HSV owns a retail pharmacy and the Senate House, a combined commercial office/residential apartment building.Comfort Care of Holy Spirit, Inc. ("CC") provides medical services under the direction of a patient's physician, in the comfort and privacy of the patient's own home. CC clinicians provide a variety of services, including skilled nursing, physical and occupational therapy, social services and personal care. Professionals also provide specialty programs in wound and ostomy care, intravenous therapy, mental health and telehealth.West Shore Advanced Life Support Services, Inc. ("WSALS") provides ambulance and medical transport services across Central Pennsylvania. Services include basic and advanced life support, as well as automated external defibrillation for quick response to heart attack and other cardiac emergencies. For non-emergency needs, WSALS provides wheelchair vans and coach services to transport invalid and bed-bound patients. WSALS also is involved in various administrative and consulting services.Spirit Physician Services, Inc. ("SPSI") provides convenient health care to the community through its six family health centers; an internal medicine practice, two women's health centers, a general surgery practice, a pediatrics practice, a cardiothoracic surgery practice, general internal medicine hospitalist services and neurological hospitalist services.PART VI, LINE 8: N/A 1 HOLY SPIRIT HEALTH SYSTEM 503 NORTH 21ST STREET CAMP HILL PA 17011 251865142 501(C)(3) 4635445 CASH N/A provide financial support for operations of affiliated organization 1 0 SCHOLARSHIPS AND GRANT/LOAN PROGRAMS FOR Nursing, Anesthesia, Respiratory Therapy, Lab, Employee Hlth, Community Hlth, Risk Mgmt, Education, Hlth Information Svcs, Behavorial Hlth, Dietary, Patient Registration, Administration, and Human Resources students. 101 515761 CASH N/A Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: The organization requires all applicants for the tuition and scholarship program(s) to complete an application prior to the start of each course that the employee is planning to take. This application requires an approval signature from the employees' direct manager/director before it is sent to Human Resources for processing. After the application(s) are received in Human Resources, the Benefits Specialist reviews the application to ensure that the employee is eligible to participate in the applicable program. Employees are required to submit proper documentation (proof of grades/payment) after completion of the course in order to receive reimbursement for the program. To ensure that all time commitments are fulfilled, a running spreadsheet is used to track the time the employee has committed to the organization. If an employee terminates before their time commitment is fulfilled, the employee would then be responsible for paying those monies back to the organization. X X X X 0 0 0 0 0 0 0 0 0 RICHARD SCHREIBER MD 174429 0 0 0 0 0 0 0 9014 0 183443 0 0 0 MANUEL J EVANS 270601 0 67171 0 0 0 0 0 24853 0 362625 0 0 0 RICHARD A SCHAFFNER JR 248437 0 61614 0 0 0 0 0 22183 0 332234 0 0 0 RICHARD LAVANTURE 223471 0 55985 0 0 0 0 0 21016 0 300472 0 0 0 DR JOSEPH A TORCHIA 279217 0 67239 0 0 0 0 0 22285 0 368741 0 0 0 William P Shartle 168078 0 41489 0 0 0 0 0 8728 0 218295 0 0 0 CHARLES CLADEL MD 211875 0 0 0 0 0 0 0 23653 0 235528 0 0 0 DR MICHAEL J PASZEK 239569 0 0 0 0 0 0 0 22159 0 261728 0 0 0 edith c dees 177723 0 33074 0 0 0 0 0 13512 0 224309 0 0 0 Lisa F Lewis 177769 0 46535 0 0 0 0 0 13748 0 238052 0 0 0 DR Robin K Miller 204594 0 0 0 0 0 0 0 14450 0 219044 0 0 0 MICHAEL SERLUCO MORTGAGE ON OFFICE SPACE X 1200000 1174333 0 1 1 1174333 RICHARD SCHRIEBER MD BOARD DIRECTOR 39350 DR. RICHARD SCHRIEBER WAS PAID AS INDEPENDENT CONTRACTOR TO BE THE PHYSICIAN ADVISOR FOR THE IT MEDICAL INFORMATICS DEPARTMENT OF HOLY SPIRIT HOSPITAL. IN APRIL 2009, HE BECAME AN EMPLOYEE OF THE HOSPIAL IN THE SAME CAPACITY AS PHYSICIAN ADVISOR FOR THE IT MEDICAL INFORMATICS DEPARTMENT. 0 Form 990, Part VI, Section A, line 3 The organization delegates control over food management services to Sodexho. Management services are also delegated to Comprehensive Pharmacy Services (aka McKesson) for management of the Pharmacy and to Center for Wound Healing, Inc. for Hyperbaric oxygen therapy and wound care. HS Cardiac Management LLC oversees the partnership agreement with cardiologists. Form 990, Part VI, Section A, line 4 In FY10, the Bylaws of Holy Spirit Hospital of the Sisters of Christian Charity were revised to reflect changes made as a result of the Governance Enhancement & Restructuring process. The revisions were approved by the Holy Spirit Board of Directors, Holy Spirit Health System Board of Directors & Sisters of Christian Charty Health Care Corp. Significant revisions:Included reducing the size of the Board of Directors to no fewer than eleven (11) or greater than fifteen (15) Directors, w/majority of voting members being Independent Directors, instituting term limits of Directors to three-year terms & of Officers to three consecutive one-year terms; & incorporating language of the Auditing Accountability & Responsibility Act(Sarbanes-Oxley) to adopt & enforce adopted code of conduct, to monitor & enforce the conflict of interest policy, the compliance program, the whistleblower program, and the document retention & destruction policy. Form 990, Part VI, Section A, line 6 The sole member of Holy Spirit Hospital is Holy Spirit Health System, a Pennsylvania non-profit corporation. Form 990, Part VI, Section A, line 7a The Chairperson of the Board of Trustees, Sisters of Christian Charity Health Care Corporation, has the power to appoint or remove the President and/or Chief Executive Officer of the Hospital. The Board of Directors of Holy Spirit Health System (sole corporate member of Holy Spirit Hospital) has the power to elect the Directors of Holy Spirit Hospital and to approve the nominees for elected officers of Holy Spirit Hospital. Form 990, Part VI, Section A, line 7b The governance structure of Holy Spirit Health System provides reserved powers in favor of Sisters of Christian Charity Health Care Corporation (Parent) and Holy Spirit Health System (the corporate member of all subsidiary corporations). The reserved powers pertain to (i) capital debt or modification of existing capital debt, (ii) sale or transfer of any land or building, (iii) acquisition or purchase of any land or building, (iv) leasing outside of the ordinary course of business, (v) approval of any guarantee of any debt, (vi) approval of any merger, consolidation, organization or reorganization, joint venture or any other modification of corporation structure or affiliation, (vii) dissolution or termination of any existing corporation, (viii) appointment of the external fiscal auditor and (ix) appointment of general counsel. Form 990, Part VI, Section B, line 11 In accordance with the Bylaws of Holy Spirit Health System (the Parent), the Form 990 was presented to the Health System's Finance and Audit Committee by the external tax preparers and management. Following review and approval by the Finance and Audit Committee, the Form 990 was distributed to the board of directors of each corporation via "BoardNet" before the Form 990 was filed. Form 990, Part VI, Section B, line 12c The Holy Spirit Hospital Bylaws have a conflict of interest provision, specifically Article XII. Article XII is applicable to "any Director, officer or Committee member (to include any member of his or her immediate family)" and describes the nature of a conflict of interest. In addition, there is a provision in Article XII (Section 12.2.1) which sets forth the methodology to determine whether a Director, officer or Committee member has a conflict of interest and the requirements pertaining to removal of the Director, officer or Committee member with the conflict of interest from the meeting, impact on the quorum and voting. Section 12.2 requires that if a Director, officer or Committee member is determined to have a conflict of interest that the individual cannot be present at the meeting when the matter was discussed or voted upon. Article XII also requires the Board of Directors of Holy Spirit Health System to adopt a conflict of interest policy requiring periodic statements (at least annually) from Directors, officers and Committee members to disclose existing and potential conflicts of interest. In addition, the Board is required to take corrective and disciplinary action with respect to transgressions of the conflict of interest policy. Each subsidiary corporation has a comparable provision in its current Bylaws. All Directors, officers and Committee members are required to complete an annual statement disclosing existing or potential conflicts of interest. This annual disclosure requirement has been in effect for all corporations for several years. The Health System Board of Directors adopted a separate Conflict of Interest Policy on March 23, 2010. That Conflict of Interest Policy is applicable to all Directors, officers, key employees and Committee members for Holy Spirit Health System and all subsidiary corporations. That Conflict of Interest Policy also has expanded the annual disclosure statement. In addition, the Corporate Compliance Program for Holy Spirit Health System provides a conflict of interest policy which is substantially the same as the one described above, except that policy is applicable to all employees of Holy Spirit Health System and all subsidiary corporations. It is not applicable to Directors, officers or Committee members of Holy Spirit Health System or any subsidiary corporation. Form 990, Part VI, Section B, line 15 An independent nationally recognized Compensation Consulting Firm annually reviews the executive compensation governance process, executive compensation philosophy, guidelines for management of compensation increases and recommends revisions. In addition, they collect competitive market data for development of salary ranges. A summary including analysis and recommendations is presented to the Compensation Committee to the Board of Directors for their review and approval. This process was implemented in March 2008 and repeated in 2009 and 2010. This review was done for the CEO, COO, all Senior VP's and VP's. Form 990, Part VI, Section C, line 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART I, LINES 9 AND 17: Contractual Allowances are reported in the current year as net of patient service revenue as is typically done with hospital organizations. Prior year presentation reflected Gross patient service revenue on the Statement of Revenues (line 9 of Part I) and contractual allowances on the Statement of Functional Expenses (line 17 of Part I). HOLY SPIRIT CORPORATION 503 NORTH 21ST STREET CAMP HILL PA 17011 232214540 REAL ESTATE PA 501(C)(2) N/A N/A HOLY SPIRIT HEALTH SYSTEM 503 NORTH 21ST STREET CAMP HILL PA 17011 251865142 HEALTHCARE PA 501(C)(3) 11B N/A COMFORT CARE OF HOLY SPIRIT INC 503 NORTH 21ST STREET CAMP HILL PA 17011 232465952 HEALTHCARE PA 501(C)(3) 9 N/A SISTERS OF CHRISTIAN CHARITY HEALTH CORP MALLINCKRODT CONVENT MENDHAM NJ 07945 232322926 HEALTHCARE NJ 501(C)(3) 1 N/A SPIRIT PHYSICIAN SERVICES INC 503 NORTH 21ST STREET CAMP HILL PA 17011 251766971 HEALTHCARE PA 501(C)(3) 9 N/A WEST SHORE ADVANCED LIFE SUPPORT SERVICES 503 NORTH 21ST STREET CAMP HILL PA 17011 232463002 HEALTHCARE PA 501(C)(3) 7 N/A HOLY SPIRIT VENTURES INC 503 NORTH 21ST STREET CAMP HILL PA 17011 232407709 MEDICAL SERVICES PA N/A C 0 1 0 0 0 0 0 0 1 1 0 0 0 0 0 0 1 0