FURP.ORG / PUBLIC DATA EXPLORER

BLUE MOUNTAIN HOSPITAL INC: Form 990, tax year 2009

View the entire original 990 at ProPublica ↗

Organization
BLUE MOUNTAIN HOSPITAL INC (EIN 24-0795436)
Tax period
2009-07-01 to 2010-06-30
Filed
2011-05-16
IRS object ID
201111369349306301
Schema version
2009v1.7
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2011-05-16T16:08:36-05:00Timestamp
Tax Period End Date2010-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1PARENTEBEARD LLCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1400 MARKET STREETAddressLine1
CityWILLIAMSPORTCity
StatePAState
ZIP Code17701ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2009-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN240795436EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1GNADEN HUETTEN MEMORIAL HOSPITAL INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlGNADNameControl
Phone6103777003Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1211 North 12th StreetAddressLine1
CityLehightonCity
StatePAState
ZIP Code182351195ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameANDREW E HARRISName
TitlePresident/CEOTitle
Phone6103777003Phone
Date Signed2011-05-16DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
Phone5703236023Phone
FieldValueIRS element (for citing)
Tax Year2009TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonAndrew E HarrisNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1211 North 12th StreetAddressLine1
CityLehightonCity
StatePAState
ZIP Code182351195ZIPCode
FieldValueIRS element (for citing)
Gross Receipts58080941GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501cXOrganization501c
Web Sitewww.blmtn.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1947YearFormation
State Legal DomicilePAStateLegalDomicile
Activity Or Mission DescriptionOPERATES A 111 BED ACUTE CARE HOSP, A 91 BED SKILLED NURSING FACILITY & A HOME HEALTH CARE AGENCY.ActivityOrMissionDescription
Nbr Voting Members Governing Body18NbrVotingMembersGoverningBody
Nbr Independent Voting Members17NbrIndependentVotingMembers
Total Nbr Employees800TotalNbrEmployees
Total Nbr Volunteers104TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year812486ContributionsGrantsPriorYear
Contributions Grants Current Year281756ContributionsGrantsCurrentYear
Program Service Revenue Prior Year55981447ProgramServiceRevenuePriorYear
Program Service Revenue CY57251697ProgramServiceRevenueCY
Investment Income Prior Year87315InvestmentIncomePriorYear
Investment Income Current Year57142InvestmentIncomeCurrentYear
Other Revenue Prior Year336571OtherRevenuePriorYear
Other Revenue Current Year394727OtherRevenueCurrentYear
Total Revenue Prior Year57217819TotalRevenuePriorYear
Total Revenue Current Year57985322TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year1422391GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY639038GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year28815380SalariesEtcPriorYear
Salaries Etc Current Year29445075SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year27482464OtherExpensePriorYear
Other Expenses Current Year28163441OtherExpensesCurrentYear
Total Expenses Prior Year57720235TotalExpensesPriorYear
Total Expenses Current Year58247554TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-502416RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-262232RevenuesLessExpensesCY
Total Assets BOY33745862TotalAssetsBOY
Total Assets EOY32158989TotalAssetsEOY
Total Liabilities BOY34563471TotalLiabilitiesBOY
Total Liabilities EOY37689284TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY-817609NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY-5530295NetAssetsOrFundBalancesEOY
Mission DescriptionPROMOTE, MAINTAIN AND RESTORE THE GOOD HEALTH OF ALL THE PEOPLE IN THE COMMUNITIES WE SERVE THROUGH PARTNERSHIPS FOR EXCELLENCE IN HEALTHCARE SERVICE DELIVERY.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense50827053Expense
Grants639038Grants
Revenue57251697Revenue
DescriptionGNADEN HUETTEN MEMORIAL HOSPITAL IS AN ACUTE CARE, NOT-FOR-PROFIT HOSPITAL, ORGANIZED FOR CHARITABLE AND EDUCATIONAL PURPOSES WITHIN THE MEANING OF IRC SEC. 501(c)(3). THE ORGANIZATION'S PURPOSE IS TO PROMOTE THE HEALTH AND WELFARE OF ALL PERSONS WITHIN ITS SERVICE AREA. THE ENTITY OPERATES ACUTE INPATIENT, REHABILITATION, ADULT PSYCH AND LONG-TERM CARE BEDS AND PROVIDES OUTPATIENT, EMERGENCY AND HOME HEALTH CARE SERVICES TO PATIENTS IN LEHIGHTON, PENNSYLVANIA AND THE SURROUNDING AREAS.Description
Total Program Service Expense50827053TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Balance Sheet Amounts Reported1BalanceSheetAmountsReported
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Grants To Organizations1GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity1RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109652NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees800NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums1FundsToPayPremiums
Premiums Paid1PremiumsPaid
Nbr Voting Governing Body Members18NbrVotingGoverningBodyMembers
Number Independent Voting Members17NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledPAStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1Andrea L AndraeBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number6103774317TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1180 NORTH 12TH STREETAddressLine1
CityLehightonCity
StatePAState
ZIP Code18235ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (24 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerHighest Compensated EmployeeHighestCompensatedEmployeeFormerFormer
barbara green
Director3.00X000
Conrad Biege
Director3.00X000
jaime mendes
Director3.00X000
William H Fegley Jr
Director3.00X000
PAtrick Hanley DO
board secretary3.00X000X
MICHAEL HARLEMAN
board treasurer3.00X000X
mark sverchek
Director3.00X000
William Mason
Director3.00X000
william markson md
Director3.00X000
THOMAS MUNSHOWER DO
Director3.00X000
SHELba Scheffner
board vice chairman3.00X000X
REVEREND H WILSON SCOTT
Director3.00X000
Steven Serfass
Director3.00X000
Elizabeth Smith
Director3.00X000
LOUIS SPORTELLI DC
Director3.00X000
ANDREW WAKSTein DO
Director3.00X000
PAtrick REILLY
CHAIRMAN3.00X000X
Andrew E Harris
President/CEO20.00X315480045900X
Clement McGinley
Chief Medical Officer20.00120472018071X
Terrence Purcell
VP Ambulatory Services40.00121992018299X
Ronald Freed
Dir-Information SERVICES40.00122401018360X
krista rimsky
dir. of pharmacy40.00112000016800X
william ravert
pharmacist40.00104769015715X
David Plaviak
FORMER (12/2008) CFO/VP40.0001014920X
FieldValueIRS element (for citing)
Total Reportable Comp From Org897114TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs101492TotalReportableCompFrmRltdOrgs
Total Other Compensation133145TotalOtherCompensation
Number Individuals GT100 K8NumberIndividualsGT100K
Formers Listed1FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
Sodexo
1900 Selwyn AvenueCharlotteNC28207Food Service1902807
Rehab Care Group
PO Box 502096St LouisMO63150Administer Acute Rehab Program1832075
Center for Wound Healing
155 White Plains RoadTarrytownNY10591Administer Wound Care Program931457
siemens medical solutions usa
po box 7777 w3580philadephiaPA19175it services669481
isschmc
po box 13700-1066philadephiaPA19191general contractor420286
FieldValueIRS element (for citing)
Number Of Contractors GT100 K23NumberOfContractorsGT100K
Related Organizations95000RelatedOrganizations
Government Grants41098GovernmentGrants
All Other Contributions145658AllOtherContributions
Total Contributions281756TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionNet patient svc revDescription
Business Code621990BusinessCode
Total Revenue Column57251697TotalRevenueColumn
Related Or Exempt Function Income57251697RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue57251697TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column46715TotalRevenueColumn
Exclusion$46,715ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real121440Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real60000Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real61440Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column61440TotalRevenueColumn
Exclusion$61,440ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities46046Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities35619Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities10427Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column10427TotalRevenueColumn
Exclusion$10,427ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
Maternal Health624100124130124130
Black Lung COALITION6241006435764357
Meals on Wheels6242005255352553

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column92247TotalRevenueColumn
Related Or Exempt Function Income1908RelatedOrExemptFunctionIncome
Exclusion$90,339ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue333287TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column57985322TotalRevenueColumn
Related Or Exempt Function Income57494645RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$208,921ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total639038Total
Program Services639038ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total361380Total
Management And General361380ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total21486613Total
Program Services18833611ProgramServices
Management And General2653002ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total1572343Total
Program Services1381413ProgramServices
Management And General190930ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total3860160Total
Program Services3391421ProgramServices
Management And General468739ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total2164579Total
Program Services1901734ProgramServices
Management And General262845ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total152549Total
Management And General152549ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total84218Total
Management And General84218ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total8257693Total
Program Services6513167ProgramServices
Management And General1744526ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total139689Total
Program Services1348ProgramServices
Management And General138341ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total5515638Total
Program Services5003421ProgramServices
Management And General512217ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total792168Total
Program Services366800ProgramServices
Management And General425368ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total1457464Total
Program Services1457464ProgramServices

Travel Travel

FieldValueIRS element (for citing)
Total132532Total
Program Services121974ProgramServices
Management And General10558ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total11142Total
Program Services6187ProgramServices
Management And General4955ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total721806Total
Program Services721806ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total2844104Total
Program Services2844104ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total1306966Total
Program Services1306966ProgramServices

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
BAD DEBT EXPENSE42872964287296
DRUGS12123191212319
REPAIRS & MAINTENANCE49829548350814787
LAUNDRY & LINENS223062223062
DUES & SUBSCRIPTIONS1257616868257079

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total400739Total
Program Services61732ProgramServices
Management And General339007ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total58247554Total
Program Services50827053ProgramServices
Management And General7420501ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY2220BOY
EOY2187EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY424741BOY
EOY1343762EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY6334489BOY
EOY5883845EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY734173BOY
EOY746891EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY457601BOY
EOY419595EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis60207549LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec42168998LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY20015707BOY
EOY18038551EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY2538342BOY
EOY2488763EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY3238589BOY
EOY3235395EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY33745862BOY
EOY32158989EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY7418106BOY
EOY6933093EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY11790000BOY
EOY10955000EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY283361BOY
EOY271385EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY15072004BOY
EOY19529806EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY34563471BOY
EOY37689284EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY-1453706BOY
EOY-5614606EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY551372BOY
EOY0EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY84725BOY
EOY84311EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY-817609BOY
EOY-5530295EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY33745862BOY
EOY32158989EOY
FieldValueIRS element (for citing)
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance636097BeginningOfYearBalance
Contributions41098Contributions
Investment Earnings Or Losses-414InvestmentEarningsOrLosses
Other Expenditures592470OtherExpenditures
End Of Year Balance84311EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance1022053BeginningOfYearBalance
Investment Earnings Or Losses-39694InvestmentEarningsOrLosses
Other Expenditures346262OtherExpenditures
End Of Year Balance636097EndOfYearBalance
FieldValueIRS element (for citing)
Permanent Endowment EOY Balance1.00000PermanentEndowmentEOYBalance
Endowments Held By Unrelated Orgs0EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs0EndowmentsHeldByRelatedOrgs

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis477770OtherCostOrOtherBasis
Book Value477770BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis25901084OtherCostOrOtherBasis
Depreciation15573457Depreciation
Book Value10327627BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis663068OtherCostOrOtherBasis
Depreciation432360Depreciation
Book Value230708BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis32186731OtherCostOrOtherBasis
Depreciation25393244Depreciation
Book Value6793487BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis978896OtherCostOrOtherBasis
Depreciation769937Depreciation
Book Value208959BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings18038551TotalOfBookValueLandBuildings

Other Assets OtherAssets (5 entries)

DescriptionDescriptionBook ValueBookValue
Due From Palmerton Hospital1263089
BENEFICIAL INTEREST IN PERPETUAL TRUST84311
DEFERRED FINANCING COSTS, Net163992
OTHER ASSETS745003
PHYSICIAN INCOME GUARANTEE979000
FieldValueIRS element (for citing)
Total Book Value Other Assets3235395TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (4 entries)

DescriptionDescriptionAmountAmount
OBLIGATIONS UNDER CAPITAL LEASES$1,647,915
Blue Cross working capital advance$304,227
PENSION LIABILITY$17,030,161
ESTIMATED MEDICAL MALPRACTICE CLAIMS LIABILITY$547,503
FieldValueIRS element (for citing)
Total Of Amounts19529806TotalOfAmounts
Total Revenue57985322TotalRevenue
Total Expenses58247554TotalExpenses
Excess Or Deficit For Year-262232ExcessOrDeficitForYear
Other-$4,450,454OtherAmount
Total Adjustments-4450454TotalAdjustments
Excess Or Deficit Per FS-4712686ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt57405870TotRevenueEtcAuditedFinclStmt
Other Revenues-639452OtherRevenues
Revenue Not Rptd F990-639452RevenueNotRptdF990
Revenue Subtotal58045322RevenueSubtotal
Other Revenues Not Included-60000OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt-60000RevenueNotRptdOnFinStmt
Total Revenue Per Form99057985322TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt62118556TotExpensesEtcAuditedFinclStmt
Other Expenses Included4510040OtherExpensesIncluded
Expenses Not Rptd F9904510040ExpensesNotRptdF990
Expenses Subtotal57608516ExpensesSubtotal
Other Expenses Not Included639038OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt639038ExpensesNotRptdOnFinStmt
Total Expenses Per Form99058247554TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (7 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Part V, Line 4:Description of Intended Use of Endowment Funds:Part V, line 4: TERM ENDOWMENT FUNDS ARE USED FOR THE PURCHASE OF PLANT AND EQUIPMENT TO FURTHER THE MISSION OF THE ORGANIZATION.
Part X:Description of Uncertain Tax Positions Under FIN 48:The Hospital accounts for uncertainty in income taxes recognized in a company's financial statements and prescribes 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 has been met. Management has determined there were no tax uncertainties that met the recognition threshold.
Part XI, Line 8 - Other Adjustments:PENSION LIABILITY ADJUSTMENT: -4450040. VALUATION LOSS, BENEFICIAL INTEREST IN PERPETUAL TRUST: -414.
Part XII, Line 2d - Other Adjustments:GLOBAL BUDGET SETTLEMENT: -639038. VALUATION LOSS, BENEFICIAL INTEREST IN PERPETUAL TRUST: -414.
Part XII, Line 4b - Other Adjustments:RENTAL EXPENSES: -60000.
Part XIII, Line 2d - Other Adjustments:RENTAL EXPENSES: 60000. pension liability adjustment: 4450040.
Part XIII, Line 4b - Other Adjustments:GLOBAL BUDGET SETTLEMENT: 639038.

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
Policy Applied To All HospitalsXPolicyAppliedToAllHospitals
FPG Reference Free Care1FPGReferenceFreeCare
Pcent200XPcent200
FPG Reference Discounted Care1FPGReferenceDiscountedCare
Pcent400XPcent400
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget0ExpensesExceededBudget
Annual Community Benefit Report0AnnualCommunityBenefitReport

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense68661TotalCommunityBenefitExpense
Direct Offsetting Revenue160628DirectOffsettingRevenue
Net Community Benefit Expense-91967NetCommunityBenefitExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense8125303TotalCommunityBenefitExpense
Direct Offsetting Revenue4430590DirectOffsettingRevenue
Net Community Benefit Expense3694713NetCommunityBenefitExpense
Percent Of Total Expense0.06850PercentOfTotalExpense

Unreimbursed Costs UnreimbursedCosts

FieldValueIRS element (for citing)
Total Community Benefit Expense1762996TotalCommunityBenefitExpense
Direct Offsetting Revenue1306802DirectOffsettingRevenue
Net Community Benefit Expense456194NetCommunityBenefitExpense
Percent Of Total Expense0.00850PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense9956960TotalCommunityBenefitExpense
Direct Offsetting Revenue5898020DirectOffsettingRevenue
Net Community Benefit Expense4058940NetCommunityBenefitExpense
Percent Of Total Expense0.07700PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense48374TotalCommunityBenefitExpense
Net Community Benefit Expense48374NetCommunityBenefitExpense
Percent Of Total Expense0.00090PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Total Community Benefit Expense8800TotalCommunityBenefitExpense
Net Community Benefit Expense8800NetCommunityBenefitExpense
Percent Of Total Expense0.00020PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense156380TotalCommunityBenefitExpense
Direct Offsetting Revenue127908DirectOffsettingRevenue
Net Community Benefit Expense28472NetCommunityBenefitExpense
Percent Of Total Expense0.00050PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense76035TotalCommunityBenefitExpense
Direct Offsetting Revenue52553DirectOffsettingRevenue
Net Community Benefit Expense23482NetCommunityBenefitExpense
Percent Of Total Expense0.00040PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense289589TotalCommunityBenefitExpense
Direct Offsetting Revenue180461DirectOffsettingRevenue
Net Community Benefit Expense109128NetCommunityBenefitExpense
Percent Of Total Expense0.00200PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense10246549TotalCommunityBenefitExpense
Direct Offsetting Revenue6078481DirectOffsettingRevenue
Net Community Benefit Expense4168068NetCommunityBenefitExpense
Percent Of Total Expense0.07900PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported0BadDebtExpenseReported
Bad Debt Expense$1,807,225BadDebtExpenseAmount
Amount Attributable To180726AmountAttributableTo
Amount Reimbursed By Medicare21071354AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare16002119CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall5069235MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care0ProvisionForCharityCare

Form990 Schedule H Part V Form990ScheduleHPartV

Name Name

FieldValueIRS element (for citing)
Business Name Line1Gnaden Huetten Memorial Hospital INCBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line1211 North 12th StreetAddressLine1
CityLehightonCity
StatePAState
ZIP Code18235ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Er24 HoursXEr24Hours
OtherSKILLED NURSING FACILITYOther

Form990 Schedule H Part VI Form990ScheduleHPartVI

FieldValueIRS element (for citing)
Subsidized Health Services ExplnPart I, Line 7g: Subsidized health services included under Schedule H for the Palmerton Hospital are the Adult Day Services Program. Adult Day Services of the Blue Mountain Health System offers an alternative to nursing care while providing respite for those caring for someone at home. The program offers a warm, friendly atmosphere and the opportunity for seniors to develop friendships while participating in activities they enjoy. Our experienced staff includes registered nurses, licensed practical nurses, certified therapeutic recreation specialists and certified nurse aides. The Palmerton Hospital provided subsidies of approximately $150,000 to the Adult Day Services Center during FY2010.Subsidized health services included under Schedule H for the Gnaden Huetten Memorial Hospital are the Family Planning Clinic. The National Family Planning Program, also know as Title X (ten) of the Public Health Service Act, was established in 1970 to ensure that no American woman would be denied access to family planning assistance because of her economic condition. For more than three decades, Title X has been an integral component of our nation's public health care system, providing high quality family planning services and other preventive health care to low-income or uninsured individuals who may otherwise lack access to health care. Maternal and Family Health Services administers the program through a network of direct and contract service providers. In addition to direct sites, the network system includes hospitals, Planned Parenthood affiliates, community health centers and physician groups. The Gnaden Huetten Memorial Hospital provided subsidies of approximately $30,000 to our Family Planning Clinic during FY2010.SubsidizedHealthServicesExpln
Percent Of Total Expense ExplnPart 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 $4,287,296.PercentOfTotalExpenseExpln
Needs AssessmentPart VI, Line 2: The hospitals of the Blue Mountain Health System assess the community health needs through review of emergency room statistics as well as inquiry during regular Pennsylvania Department of Health surveys to identify far-reaching health needs faced by people in the communities served by the hospitals. Those results are evaluated over time and serve as the basis to develop new or expanded plans to address services in response to need. The Blue Mountain Health System develops programs and services to address community health needs and makes investments in initiatives that align with the Health System's core mission.Beyond that focus are programs and services that benefit every resident and support the far reaching goal of a healthier community. The Health System relies on the engagement and support of key stakeholders, including the medical staff of the hospitals of the Blue Mountain Health System, as well as the vital Carbon County Partners for Progress and numerous other community organizations. Together, we work toward developing a network of care and support that provides quality medical care for our community members. The Health System continues to use data from the Partners for Progress Community Assessment 2009 as a guide in developing programs and services and making community benefit investments in 2010.Adult Priority NeedsPrimary-Affordability of health care-Accessibility of medical care-Access to affordable mental and behavioral health careSecondary-Access to affordable prescription medications-Substance abuse prevention and treatmentOther-Smoking prevention and cessation-Nutrition-Weight management and exerciseYouth and Teen NeedsAccess and affordability of care-Dental-Health care-Suicide prevention-Mental and behavioral health-Family planning servicesNeedsAssessment
Patient Education AssistancePart VI, Line 3: In accordance with Pennsylvania State reporting requirements, the Blue Mountain Health System's charity care expense is reported based upon costs versus charges. Charity Care includes the Health System's traditional inpatient and emergency services, as well as the care provided as part of external educational programs and services such as through our Family Planning program.More people were served through the Hospital's charitable care and financial assistance programs in virtually all categories, as follows:-Gnaden Huetten Memorial Hospital Charitable Care - 310 patients-Palmerton Hospital Charitable Care - 140 patients-Blue Mountain Health System's "Healthy Smiles, Happy Kids" Dental Van - 1,109 served in 2010Signage will be visible in all Blue Mountain Health System points of registration in order to create awareness of the financial assistance program. At a minimum, signage will be posted in all patient intake areas, including, but not limited to, the emergency department, and the admission/patient registration area. In recent years, the Health System has expanded the number of financial counselors available to assist patients. A key goal is to identify community members in need sooner. Counselors proactively seek out patients prior to treatment in an effort to connect them with public insurance programs as appropriate or to encourage them to complete an assistance application. The result is more charity care and less reported as bad debt; most importantly, community members are provided with the support to access the medical care they need.PatientEducationAssistance
Community InformationPart VI, Line 4: The median income of households in Carbon County was $47,283. Seventy-four percent of the households received earnings and 25 percent received retirement income other than Social Security. Thirty-nine percent of the households received Social Security. The average income from Social Security was $15,428.In 2005-2009, 10 percent of people of Carbon County were in poverty. Sixteen percent of related children under 18 were below the poverty level, compared with 7 percent of people 65 years old and over. Seven percent of all families and 27 percent of families with a female householder and no husband present had incomes below the poverty level.Two percent of the people living in Carbon County in 2005-2009 were foreign born. Ninety-eight percent was native, including 80 percent who were born in Pennsylvania. Among people at least five years old living in Carbon County in 2005-2009, 4 percent spoke a language other than English at home. Of those speaking a language other than English at home, 32 percent spoke Spanish and 68 percent spoke some other language; 22 percent reported that they did not speak English "very well."CommunityInformation
Community Building ActivitiesPart VI, Line 5: In 2010, the hospitals, programs and services of the Blue Mountain Health System provided many community health improvement services. Included in this category are the community outreach programs and services offered by the Health System's Community Education program that includes health and wellness education, life-saving CPR and emergency support and information, and specific programming to help people make healthier lifestyle choices. Also included are the myriad of support group activities that help patients and their families manage chronic health conditions.In the fall of 2010, the Blue Mountain Health System collaborated with the Carbon County Emergency Management Agency on the largest service project in recent years - an emergency preparedness drive-thru influenza vaccination program in which more than 2,100 free seasonal influenza vaccinations were distributed to area residents. This program was found to be an invaluable arrangement in the event of a mass inoculation would be needed. Local fire, police, and ambulance personnel as well as the local school districts and college and university students were involved in the planning of the event. Approximately 50 staff persons from the Health System donated their time and effort to ensure the project was a successful one. The Health System's "Healthy Smiles, Happy Kids" Dental Van provides under-insured or non-insured children in Carbon and Schuylkill Counties with preventative and restorative dental care. In 2010, the Dental Van team, consisting of a board-certified dentist, a dental hygienist and a dental assistant/driver, cared for 1,109 children. The van has become the "dental home" for more than 2,000 children since its inception.Free screening mammograms and breast ultrasound procedures are provided to women, and men, who are uninsured or who have no insurance as part of the Health System's Women's Health Services program. During 2010, nearly 200 persons took advantage of the Blue Mountain Health System's breast cancer voucher screening program. The Health System's Ladies Night Out event served approximately 220 with breast cancer awareness and education. Support groups - Adult Day Services Caregiver Support group, Women's Breast Cancer Support Group, Bariatric & Weight Loss support groupsHealth Fairs - children's health fair and the national senior health and fitness dayWorkforce Wellness programHealth Images television program/Community newsletterGeneral screenings provided at other organization's events - blood pressure, cholesterol, body fat analysis, stroke risk, depression. Family Planning ClinicHaving highly trained medical personnel benefits everyone in the community. Beyond on-going education for physicians, nurses, emergency medical technicians, and other clinicians, the Blue Mountain Health System supported numerous initiatives in 2010 to further the capabilities of area medical personnel, investing $17,600 in Health Professions Education (Gnaden - $8,800 and Palmerton - $8,800).The Health System provided clinical rotations to medical students of Pennsylvania State University and Pennsylvania College of Osteopathic Medicine through the East Central Area Health Education Center. Living accommodations are provided during the time of each student's rotation.Through the Health System's Staff Development department, numerous persons were trained in CPR, ALS, PALS, and Rhythm monitoring. The Health System also provided a clinical setting for undergraduate nursing students enrolled in various local colleges and universities, namely, Lehigh Carbon Community College, Northampton Area Community College, Cedar Crest College, Wilkes University and Johnson College of Technology. Having highly trained medical personnel benefits everyone in the community. Beyond on-going education for physicians, nurses, emergency medical technicians, and other clinicians, the Blue Mountain Health System supported numerous initiatives in 2010 to further the capabilities of area medical personnel.CommunityBuildingActivities
Other InformationPart VI, Line 6: The medical staff of the Blue Mountain Health System is an open medical staff allowing submissions for privileges and credentialing from any interested physician or surgeon. The board of directors is comprised of 18 individuals from various community organizations such as financial institutions, telecommunication, recreation, and representation from the medical staff. Of the 18 members of the board of directors, 13 reside immediately within the primary service area of the health system. All of the board members are independent, with the exception of the President and Chief Executive Officer, who is employed directly by the health system.OtherInformation
Affiliated Health Care SystemPart VI, Line 7: During difficult economic times when more people are unemployed or are struggling to make ends meet, community members rely upon the hospitals of the Blue Mountain Health System's long standing tradition to provide needed medical care regardless of insurance coverage or financial ability to pay for services.For the Blue Mountain Health System, fiscal year 2010 was one of the most challenging financial years in its history. Decreasing government reimbursement, lower than anticipated patient volume and greater numbers of people needing financial assistance combined to create nearly the perfect storm, wreaking havoc with our financial expectations early on in the year. Yet, the Health System never wavered from either its not-for-profit mission or its attention to quality care and patient safety. In fact, any surplus funds are used for two main items, capital equipment purchases or for staff compensation. The Blue Mountain Health System provided over $5,500,000 in programs and services to meet the health needs of the residents of our communities. That number, however, reflects only a small piece of the organization's mission-driven story of this past year. (Gnaden Huetten Memorial Hospital $4,300,000; Palmerton Hospital $1,200,000)Attentive to the needs of our community's lower income and most vulnerable populations, the Health System served 450 patients through its financial assistance programs. Overall, approximately $5,177,000 was provided in free and subsidized patient care. (Gnaden - $4,087,000 and 12,502 patient visits; Palmerton - $1,090,000 and 5,102 patient visits), which addresses identified community health needs of access and affordability of medical care.In the area of Community Health Services, there was an increase in both the investment and numbers served through community health and wellness education as well as screenings and fairs.The Blue Mountain Health System invested approximately $95,000 (Gnaden - $49,450 and Palmerton - $45,382) and provided health and wellness education for hundreds of community members last year. One area where the Health System's investment increased dramatically was in emergency preparedness and response - working with the Carbon County Emergency Management Agency - with more than 50 staff persons volunteering to provide more than 2,100 free influenza vaccines to area residents as well as assist local schools with administering more than 1500 H1N1 influenza vaccinations during the potential pandemic timeframe.AffiliatedHealthCareSystem

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained0RecordsMaintained

Recipient Table RecipientTable

Recipient Name Business RecipientNameBusiness

FieldValueIRS element (for citing)
Business Name Line1THE PALMERTON HOSPITALBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1135 LAFAYETTE AVENUEAddressLine1
CityPALMERTONCity
StatePAState
ZIP Code18071ZIPCode
FieldValueIRS element (for citing)
EIN Of Recipient135562316EINOfRecipient
IRC Section501(c)(3)IRCSection
Amount Of Cash Grant639038AmountOfCashGrant
Method Of ValuationN/AMethodOfValuation
Description Of Non Cash AssistanceN/ADescriptionOfNonCashAssistance
Purpose Of GrantTO Fund operations of THE palmerton hospitalPurposeOfGrant

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Club Dues Or FeesXClubDuesOrFees
Written Policy Re T And E Expenses1WrittenPolicyReTAndEExpenses
Substantiation Required1SubstantiationRequired
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Written Employment ContractXWrittenEmploymentContract
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment1SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (2 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
Andrew E Harris
3060000009480000459000361380000
David Plaviak
010149200000000010149200

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

Return ReferenceReturnReferenceExplanationExplanation
Part I, Line 1aTHE ORGANIZATION INCLUDED $2,530 FOR CLUB DUES IN PRESIDENT/CEO ANDREW HARRIS' REPORTABLE INCOME FOR THE FISCAL YEAR ENDED JUNE 30, 2010. THIS AMOUNT WAS INCLUDED AS TAXABLE INCOME FOR MR. HARRIS.
Part I, Line 4aDAVID PLAVIAK - SEVERANCE PAYMENT - $101,492 FOR PERIOD FROM 1/2/2009 TO 7/3/2009.

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (4 entries)

IdentifierIdentifierExplanationExplanation
Form 990, Part VI, Section B, line 11The BMHS staff communicated to the Finance Committee of the Board that the Forms 990 were prepared by ParenteBeard LLC, as well as communicating the general types of information contained in the filing and how to access the specific report.
Form 990, Part VI, Section B, line 12cThe conflict policy must be signed off on an annual basis by all governing body members, officers, and key employees. THIS PROCESS IS MONITORED BY THE ADMINISTRATIVE ASSISTANT TO THE PRESIDENT/CEO. ANY CONFLICTS NOTED WOULD BE COMMUNICATED TO THE COMPLIANCE COMMITTEE. THERE HAVE BEEN NO OCCURENCES OF ANY CONFLICTS NOT BEING DISCLOSED.
Form 990, Part VI, Section B, line 15Senior Management salaries are determined by the market. Human Resources participate in various salary surveys to determine the correct salary range. The Appalachian Hospital Human Resource Society conducts an annual salary survey for all positions. In addition, the Pennsylvanian Hospital Association conducts an annual survey with Yaffe Associates for senior management employees. The market data is analyzed and the goal is to pay at the 50 percentile. Salaries are recommended by Human Resources and approved by the President and CEO. The executive committee of the board serves as the Compensation Committee and approves recommendations for salary increases. The executive committee approves increases for the CEO. Senior Management has received the same general increases as the staff employees received.
Form 990, Part VI, Section C, line 19Form 990, Part VI, Section C, Line 19: UPON REQUEST, THE ORGANIZATION MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND/OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (3 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusDirect Controlling Entity NADirectControllingEntityNA
Blue Mountain Health System Inc
211 NORTH 12TH STREETLehightonPA182351195201311316MAINTAINS AN INTEGRATED HEALTH CARE SYSTEM.PA501(c)(3)11aN/A
CMS Medical Care Corporation
211 NORTH 12TH STREETLEhightonPA182351195232473899OWNS AND OPERATES AMBULATORY CARE CENTERS IN VARIOUS COMMUNITIESPA501(c)(3)3N/A
THE PALMERTON HOSPITAL
135 LAFAYETTE AVENUEPALMERTONPA18071235562316OPERATES AN ACUTE CARE HOSP, PROVIDNG INPATIENT, OUTPATIENT & EMERGENCY CAREPA501(c)(3)3N/A
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org1GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs1PerformOfServicesByOtherOrgs
Sharing Of Facilities1SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (2 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolved
CMS Medical Care Corporation
M51000
CMS Medical Care Corporation
N178500