2011-05-11T13:08:03-05:00 2010-06-30 SMITH ELLIOTT KEARNS & COMPANY LLC 19 Brookwood Avenue Suite 101 Carlisle PA 17201 990 2009-07-01 231360854 Waynesboro Hospital WAYN 7177654000 501 East Main Street Waynesboro PA 17268 Patrick W O'Donnell 7172677106 2011-05-10 1 Gregory P Hall CPA 7172633910 2009 2016-02-24 21:20:13Z PATRICK W O'DONNELL 501 East Main Street Waynesboro PA 17268 65811871 0 X N/A X 1922 PA The Waynesboro Hospital is a regional nonprofit health care organization committed to the improvement of the health and well-being of the people in South-Central Pennsylvania. 11 10 611 0 762487 0 238484 188242 63044849 63676380 125804 626406 1260202 1244672 64669339 65735700 0 0 36465868 35636211 0 0 20566223 21557712 57032091 57193923 7637248 8541777 65839957 70887279 8340701 8108774 57499256 62778505 THE WAYNESBORO HOSPITAL IS A REGIONAL NON-PROFIT HEALTH CARE ORGANIZATION COMMITTED TO THE IMPROVEMENT OF THE HEALTH AND WELL-BEING OF THE PEOPLE IN SOUTH CENTRAL PENNSYLVANIA. 0 0 45350548 64053592 The Waynesboro Hospital provides needed medical care to the community regardless of any patient's ability to pay. Health care services include inpatient routine, inpatient ancillary and outpatient care. All management and general expenses are considered program related. 45350548 1 1 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 36 0 1 611 1 1 1 1 NT 0 0 0 0 0 0 0 11 10 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 PA X X PATRICK W O'DONNELL CFO 7172673000 112 NORTH SEVENTH STREET CHAMBERSBURG PA 17201 Rodger W Savage 0.40 X X 0 0 0 Norman B Epstein 9.00 X X 176780 1001751 90981 Richard Marks 0.20 X X 0 0 0 DENNIS SHOCKEY 0.20 X X 0 0 0 MARIE BECK 0.80 X X 0 0 0 Lynn Y MacBride 0.10 X 0 0 0 JOHN BLUBAUGH 0.10 X 0 0 0 fRANK ERVIN 0.10 X 0 0 0 ALLISON KOHLER 0.60 X 0 0 0 JEAN LESSARD MD 0.30 X 0 0 0 KATHRYN A REIHARD MD 0.20 X 0 0 0 Patrick O'Donnell 6.00 X 45007 405068 85759 Kenneth L Shur 50.00 X 221861 0 32996 JEFF CARTY 50.00 X 164087 0 29618 Thomas Anderson 10.00 X 79510 318041 35550 SHERRI STAHL 11.00 X 50740 202956 40837 PATRICIA BABAROWICZ 5.00 X 25030 225263 52828 MICHELE ZEIGLER 12.00 X 51242 204968 45578 NORBERT P MATHIAS 40.00 X 407508 0 27104 DB FOSTER 40.00 X 309233 0 26855 VICKI ELLIS 40.00 X 235673 0 24939 MERRIL MCKENZIE 40.00 X 232335 0 20393 ELIZABETH COOK 40.00 X 251048 0 27685 JILL KELLER 45.00 X 128817 0 26135 MELISSA DUBROW 45.00 X 126708 0 18473 2250054 2358047 541123 17 0 1 0 CHAMBERSBURG HOSPITAL 112 N SEVENTH STREET CHAMBERSBURG PA 17201 PHYSICAL THERAPY, X-RAY, AND LABORATORY 807845 ROBINWOOD ORTHOPEDIC SPECIALISTS 1110 MEDICAL CAMPUS ROAD SUITE 205 HAGERSTOWN MD 21742 SURGERY ON CALL 395000 WAYNESBORO CONTRUCTION 215 WEST FIFTH STREET WAYNESBORO PA 17268 BUILDING CONSTRUCTION 389073 SUMMIT PHYSICIAN SERVICES 785 FIFTH AVENUE SUITE 3 CHAMBERSBURG PA 17201 PHYSICIAN SERVICES 260620 QUEST DIAGNOSTICS 12436 COLLECTIONS CENTER DRIVE CHICAGO IL 60693 LAB TESTING SERVICES 202054 7 40504 147738 188242 PATIENT REVENUE 621990 63676380 63676380 63676380 568429 568429 178819 73846 104973 104973 104973 60302 2325 60302 -2325 57977 57977 COURIER AND LAB SERVIC 621500 762487 762487 CAFETERIA 900099 244572 244572 VHA INCENTIVE 900099 65598 65598 67042 67042 1139699 65735700 64053592 762487 731379 861647 861647 26614599 22619995 3994604 1192394 1052749 139645 5041357 4221578 819779 1926214 1593902 332312 38637 38637 25425 25425 2783613 1942297 841316 47741 32213 15528 202041 136327 65714 746957 504007 242950 55813 37660 18153 23308 15727 7581 29128 15198 13930 2894991 1455039 1439952 666218 449529 216689 SUPPLIES 6154517 4152743 2001774 BAD DEBT EXPENSE 5528882 5528882 PHYSICIAN CONTRACTUAL P 1101851 743471 358380 EQUIPMENT RENTAL AND RE 1026794 692826 333968 MISCELLANEOUS EXPENSE 71206 48047 23159 160590 108358 52232 57193923 45350548 11843375 0 1420 1420 8457528 8851861 6523519 5603530 377957 362136 808022 672868 57480054 38211157 20243721 19268897 26908499 33496561 2519291 2630006 65839957 70887279 5559263 5169500 1710000 1165000 1071438 1774274 8340701 8108774 X 55557370 60613797 1941886 2164708 57499256 62778505 65839957 70887279 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 5498442 98262 499841 6096545 6290104 80824 -872486 5498442 0.97000 0.03000 0 0 313743 2184775 2498518 2302539 15194458 8863041 8633956 36212312 28851898 7360414 1272227 496218 776009 19268897 INVESTMENTS 33496561 F 33496561 Advances From Third Party Payors 252800 Payable Under Third Party Contratual Agreement 1519474 Pledges Payable 2000 1774274 65735700 57193923 8541777 -3262528 -3262528 5279249 65735700 0 65735700 0 65735700 57193924 0 57193924 0 57193924 Part X: Description of Uncertain Tax Positions Under FIN 48: When tax returns are filed, it is highly certain that some positions taken would be sustained upon examination by the taxing authorities, while others are subject to uncertainty about the merits of the position taken or the amount of the position that would be ultimately sustained. The benefit of a tax position is recognized in the financial statements in the period during which, based on all available evidence, management believes it is more likely than not that the position will be sustained upon examination, including the resolution of appeals or litigation processes, if any. Tax positions taken are not offset or aggregated with other positions. Tax positions that meet the more-likely-than-not recognition threshold are measured as the largest amount of tax benefit that is more than 50 percent likely of being realized upon settlement with the applicable taxing authority. The portion of the benefits associated with tax positions taken that exceeds the amount measured as described above would be reflected as a liability for unrecognized tax benefits in the accompanying balance sheet along with any associated interest and penalties that would be payable to the taxing authorities upon examination. Interest and penalties associated with unrecognized tax benefits would be classified as expenses against other operating revenue in the statement of operations. At June 30, 2010 there was no liability for unrecognized tax benefits. Part XI, Line 8 - Other Adjustments: Current Year Change In Unrealized Investment Gains: 12499. Current Year Change In Unrealized Investment gains: 948870. INCREASE In Perpetual Trusts Held By Third Parties: 209980. TRANSFER TO AFFILIATE ORGANIZATION - SUMMIT PHYSICIAN SERVICES: -4433877. 1 1 X 1 X 125.000000000000 1 X 1 1 0 1 1 845049 845067 0.01480 6321397 3026296 3295101 0.05760 76825 76825 0.00130 7243271 3026296 4216993 0.07370 3 1528 0 1 30 0 2 93 0 0 1 504 0 7 2155 7 2155 7243271 3026296 4216993 0.07370 0 5528882 12531497 -18245837 30777334 X 1 1 WAYNESBORO HOSPITAL

501 EAST MAIN STREET WAYNESBORO PA 17268

X Part I, Line 3c: THE ORGANIZATION USES FEDERAL POVERTY GUIDELINES (FPG) TO DETERMINE CHARITY CARE. Part I, Line 7: NOTE 1. TO THE FINANCIAL STATEMENTS: PATIENT RECEIVABLESTHE HOSPITAL PROVIDES CREDIT IN THE NORMAL COURSE OF ITS BUSINESS TO PATIENTS. PATIENT RECEIVABLES ARE GENERALLY DUE 60 DAYS AFTER BILLED. AN ALLOWANCE FOR DOUBTFUL ACCOUNTS IS CARRIED FOR PATIENT ACCOUNTS THAT MAY BECOME UNCOLLECTIBLE IN FUTURE PERIODS. THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IS BASED ON MANAGEMENT'S JUDGMENT OF UNCOLLECTIBLE ACCOUNTS, HISTORICAL TRENDS AND OTHER INFORMATION. PATIENT RECEIVABLES ARE CHARGED AGAINST THE ALLOWANCE WHEN, IN THE JUDGMENT OF MANAGEMENT, IT IS UNLIKELY THEY WILL BE COLLECTED. THE SHORTFALL FOR MEDICARE IS NOT INCLUDED IN OUR COMMUNITY BENEFIT REPORTING. A COST TO CHARGE RATIO WAS USED TO CALCULATE THE MEDICARE ALLOWABLE COST. RCC=((Net Patient Revenue/(Total operating rev+(other opr rev -+ derivative gain/loss))*Total Operating Expense)/Gross PT revALL PATIENTS ARE SUBJECT TO THE DEBT COLLECTION POLICY REGARDLESS OF THEIR ABILITY TO PAY. Part III, Line 4: The Hospital provides credit in the normal course of its business to patients. Patient receivables are generally due 60 days after billed. An allowance for doubtful accounts is carried for patient accounts that may become uncollectible in future periods. The allowance for doubtful accounts is based on management's judgment of uncollectible accounts, historical trends and other information. Patient receivables are charged against the allowance when, in the judgment of management, it is unlikely they will be collected.The Cost to charge ratio was used to calculate the cost of Bad Debt expense. This ratio is calculated as follows: [Net patient revenue divided by the total operating revenue multiplied by the total operating expense] Divided by the Gross patient revenue. Part III, Line 8: THE INFORMATION WAS OBTAINED USING THE COST METHODS USED IN PREPARING THE MEDICARE COST REPORTS. THE SHORTFALL ABOVE RELATES TO OUR MISSION OF PROVIDING SERVICES TO MEMBERS OF OUR COMMUNITY. Part VI, Line 2: HEALTH NEEDS OF FRANKLIN COUNTY RESIDENTS AND SURROUNDING COMMUNITIES ARE ASSESSED THROUGH NUMEROUS RESEARCH METHODS INCLUDING CONDUCTING COMMUNITY HEALTH NEEDS ASSESSMENT (SURVEY FORMAT) IN SPRING 2009, A REVIEW OF REGIONAL HEALTH DATA AND INTERVIEWS WITH KEY COMMUNITY ORGANIZATIONS INCLUDING SCHOOLS, AREA AGENCY ON AGING, PA DEPARTMENT OF HEALTH, FRANKLIN COUNTY HUMAN SERVICES AND THE HEALTHY COMMUNITIES PARTNERSHIP. Part VI, Line 3: PATIENTS ARE MADE AWARE OF THE CHARITY PROGRAM AND OTHER BILLING ASSISTANCE SERVICES AT REGISTRATION, DURING EMERGENCY ROOM VISITS, AND NOTICES PLACED IN SERVICE AREAS. BILLING STATEMENTS ALSO INFORM PATIENTS OF CHARITY CARE AND OTHER BILLING ASSISTANCE PROGRAMS. Part VI, Line 4: WAYNESBORO HOSPITAL PRIMARILY SERVES COMMUNITY MEMBERS FROM FRANKLIN AND FULTON COUNTY, PA, AND NEARBY COMMUNITIES IN WASHINGTON COUNTY, MD. ACCORDING TO U.S. CENSUS DATA, FRANKLIN COUNTY RESIDENTS HAVE A SLIGHTLY LOWER INCOME AND ARE SLIGHTLY OLDER THAN THE STATE AVERAGE. FOR A HEALTH SYSTEM, THIS TYPICALLY RESULTS IN AN INCREASED NEED FOR HEALTHCARE SERVICES. Part VI, Line 5: WAYNESBORO HOSPITAL WORKS TO STRENGTHEN OUR COMMUNITY THROUGH HEALTH EDUCATION EFFORTS FOR CHILDREN AND ADULTS, HEALTH FAIRS PROVIDING DIAGNOSTIC TESTING, EDUCATING COMMUNITY GROUPS ON SPECIFIC HEALTH TOPICS, FUNDING LOCAL COMMUNITY ORGANIZATIONS THROUGH THE SUMMIT ENDOWMENT PROGRAM, PROVIDING RESOURCES FOR THE "HEALTHY COMMUNITIES PARTNERSHIP" PROGRAM, PARTICIPATING IN LOCAL CIVIC ORGANZIATIONS, SPONSORING EVENTS HELD BY LOCAL CHARTIABLE ORGANIZATIONS, AND SUPPORTING WORKFORCE DEVELOPMENT INITIATIVES THROUGH SUMMIT HEALTH'S SCHOOL LIAISON DEPARTMENT. Part VI, Line 6: WAYNESBORO HOSPITAL SUPPORTS LOCAL NON-PROFIT ORGANIZATIONS WITH FINANCIAL GRANTS FROM THE SUMMIT ENDOWMENT. Part VI, Line 7: THE HOSPITAL IS PART OF SUMMIT HEALTH, A REGIONAL NETWORK OF HOSPITALS AND HEALTHCARE PROVIDERS THAT ARE SERVED BY THE ORGANIZATION'S COMMUNITY HEALTH DEPARTMENT. THIS DEPARTMENT'S MISSION IS TO IMPROVE THE HEALTH OF THE COMMUNITY THROUGH EDUCATION, DETECTION AND PREVENTION PROGRAMS INCLUDING HEALTH FAIRS, SCREENINGS, AND SEMINARS. THIS MISSION IS COMPLETED ON BEHALF OF WAYNESBORO HOSPITAL AND ALL OTHER SUMMIT HEATLH AFFILIATES. PART OF THIS MISSION IS COMPLETED THROUGH COLLABORATION WITH OTHER COMMUNITY ORGANIZATIONS INCLUDING THE PA DEPARTMENT OF HEALTH. 1 FLU VACCINATIONS 504 8495 COST Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: All funding decisions are made by the Summit Endowment Committee, a committee of the Summit Health Board. The Endowment Manager processes grant applications, assists grantees in developing sound program evaluation methodologies, receives and summarizes periodic reports, and visits program sites, reporting all activities to the Summit Endowment Committee. As well, Endowment Committee Meeting Minutes are shared with Waynesboro Hospital, Chambersburg Hospital and Summit Health Boards. X X 1 1 X X X X X 0 1 0 0 0 0 0 1 0 Norman B Epstein 101849 577142 30000 170000 44931 254609 10409 58986 3238 18348 190427 1079085 0 0 Patrick O'Donnell 31944 287499 9420 84780 3643 32789 7110 63989 1466 13194 53583 482251 0 0 Kenneth L Shur 166480 0 33854 0 21527 0 11928 0 21068 0 254857 0 0 0 JEFF CARTY 137457 0 13968 0 12662 0 9551 0 20067 0 193705 0 0 0 Thomas Anderson 62464 249856 12000 48000 5046 20185 4606 18424 2504 10016 86620 346481 0 0 SHERRI STAHL 40309 161235 7488 29950 2943 11771 5663 22654 2504 10016 58907 235626 0 0 PATRICIA BABAROWICZ 19578 176200 3796 34163 1656 14900 4587 41281 696 6264 30313 272808 0 0 MICHELE ZEIGLER 40281 161124 7838 31352 3123 12492 6612 26446 2504 10016 60358 241430 0 0 NORBERT P MATHIAS 394724 0 0 0 12784 0 14700 0 12404 0 434612 0 0 0 DB FOSTER 307483 0 0 0 1750 0 14700 0 12155 0 336088 0 0 0 VICKI ELLIS 226757 0 0 0 8916 0 12163 0 12776 0 260612 0 0 0 MERRIL MCKENZIE 231463 0 0 0 872 0 13969 0 6424 0 252728 0 0 0 ELIZABETH COOK 241997 0 0 0 9051 0 14700 0 12985 0 278733 0 0 0 Part I, Line 1a The organization reimburses the COO for dues associated with a social club. The officer receives an allowance that can be considered a discretionary spending account. The monies are in lieu of an automobile allowance, to purchase additional life insurance, etc. These monies are included in compensation as reported in the Compensation of Officers table. Results fitness club membership is available free of charge for any officer and active board member. Part I, Line 4a NORMAN EPSTEIN - $120,099 PATRICK W. O'DONNELL - NO PAYMENT THOMAS ANDERSON - NO PAYMENT PAT BARBAROWICZ - NO PAYMENT JOHN MCELWEE - NO PAYMENT Part I, Line 7 Incentive compensation is based on pre-determined, measurable goals approved by the Board of Directors' Executive Compensation Committee. The measurable goals are based on quality, community access to care, patient safety and leadership. Form 990, Part VI, Section A, line 6 SUMMIT HEALTH, A 501(C)(3) ENTITY, IS A MEMBER OF THIS ORGANIZATION. Form 990, Part VI, Section A, line 7a SUMMIT HEALTH, A 501(C)(3) ENTITY, ELECTS THE GOVERNING BODY OF THIS ORGANIZATION. Form 990, Part VI, Section A, line 7b SUMMIT HEALTH, A 501(C)(3) ENTITY, HAS CERTAIN RESERVE POWERS OF THIS ORGANIZATION. Form 990, Part VI, Section B, line 11 The organization's 990 is reviewed by the audit commitee and upon approval recommended to the full board of directors for submission to the IRS. Form 990, Part VI, Section B, line 12c MEMBERS ARE ASKED TO ANNUALLY DISCLOSE ANY CONFLICTS OF INTEREST THEY MAY HAVE. Form 990, Part VI, Section B, line 15 COMPENSATION IS DISCUSSED WITH AN INDEPENDENT COMPENSATION COMMITTEE. THIS IS PERFORMED IN CONCERT WITH A COMPENSATION CONSULTANT WHO ASSISTS THIS COMMITTEE IN SETTING THE COMPENSATION FOR THESE INDIVIDUALS. Form 990, Part VI, Section C, line 19 Governing documents, conflict of interest policy and financial statements are available upon request. These documents are held in the Finance department of the Waynesboro Hospital. Hospital bylaws and all Policies and Procedures are found on the Waynesboro Hospital intranet. SUMMIT HEALTH 112 north seventh street CHAMBERSBURG PA 17201 251515371 MANAGE AND ADMINISTER THE LOCAL AND REGIONAL NETWORK OF HEALTHCARE PROVIDERS PA 501(C)(3) 7 SUMMIT HEALTH THE CHAMBERSBURG HOSPITAL 112 NORTH SEVENTH STREET CHAMBERSBURG PA 17201 230465970 SERVE THE HEALTH CARE NEEDS OF FRANKLIN COUNTY PA AND THE SURROUNDING COMMUN PA 501(C)(3) 11A - TYPE 1 SUMMIT HEALTH CHAMBERSBURG HEALTH SERVICES 260 NORTH SEVENTH STREET CHAMBERSBURG PA 17201 251515376 SERVE THE HEALTH CARE NEEDS OF FRANKLIN COUNTY PA AND THE SURROUNDING COMMUN PA 501(C)(3) 11A - TYPE 1 SUMMIT HEALTH SUMMIT PHYSICIAN SERVICES 601 NORLAND AVENUE CHAMBERSBURG PA 17201 251716306 PROVIDES APPROPRIATE PHYSICIAN MANPOWER FOR VARIOUS FAMILY PRACTICES SERVING PA 501(C)(3) 3 SUMMIT HEALTH CUMBERLAND VALLEY SPECIALTY SERVICES 120 NORTH SEVENTH STREET CHAMBERSBURG PA 17201 201408985 MEDICAL SERVICES PROVIDED TO FRANKLIN COUNTY PENNSYLVANIA PA SUMMIT HEALTH C 0 1 0 0 0 0 0 0 1 0 0 1 0 0 1 0 1 0 THE CHAMBERSBURG HOSPITAL L 1651199 SUMMIT PHYSICIAN SERVICES I 67000 summit PHYSICIAN SERVICES O 147667 chambersburg health services I 12600 summit health B 147738