2011-05-16T09:03:59-05:00 2010-06-30 PARENTEBEARD LLC 400 MARKET STREET WILLIAMSPORT PA 17701 990 2009-07-01 240795682 MOUNT NITTANY MEDICAL CENTER MOUN 8142317000 1800 EAST PARK AVENUE STATE COLLEGE PA 16803 RICHARD J WISNIEWSKI 8142317000 2011-05-13 1 JAIME KUNTZ 5703236023 2011-05-13 2009 2016-02-24 21:20:13Z STEVEN E BROWN 1800 EAST PARK AVENUE STATE COLLEGE PA 16803 224250285 0 X WWW.MOUNTNITTANY.ORG X 1905 PA PROVIDE INPATIENT, OUTPATIENT AND EMERGENCY CARE SERVICES TO RESIDENTS OF STATE COLLEGE, PA. 15 13 1526 780 2135214 945744 4051 481209 180965733 195179149 -34933 367930 656267 690499 181591118 196718787 4566613 0 85155470 91112845 59083 30268 33093 80069460 85264723 165284013 180974449 16307105 15744338 227974291 248215124 141413822 140838734 86560469 107376390 Mount Nittany Medical Center will provide every patient with the finest, patient-centered care in a safe and comfortable environment, continually improving access to care, and striving to enhance the quality of human life for everyone we serve.Mount Nittany Medical Center will enhance its position as the preferred regional healthcare destination for both patients and medical professionals - providing vital clinical centers of excellence and superior access to care - supported by a commitment to medical education and backed by a culture of advancement and accountability - moving life forward. 0 0 158621790 4566613 193052567 Mount Nittany Medical Center is committed to providing quality medical care in an atmosphere that reflects high standards of social, ethical and financial responsibility and will assure that those same standards are met in all contractual relationships. The Board of Trustees has established this statement of organizational values to assure that members of the Board, the Medical Center staff and the Medical Staff honor the following principles through our behaviors:Alliances with Patients:- We will treat all patients with dignity and respect, and will accommodate individual responses to the stress of illness.- We fully support the principles outlined in the Statement of Patient's Rights and Responsibilities document.- We commit to a service excellence philosophy that strives to meet or exceed patient expectations.- All patients receive a uniform standard of care throughout the facility, regardless of social, cultural, financial, religious, racial, gender or sexual orientation factors.- The Medical Center and Medical Staff work jointly to assure that only appropriate and effective tests, procedures and treatments are provided to patients.Community Relations- We will fairly and accurately represent ourselves and our capabilities to the public.- We are committed to constant preparation for the long-term financial viability of the Medical Center through responsible utilization of resources and in support of our commitment to meet the healthcare needs of the community.- Medical Center leadership (executives, Board of Trustees, Medical Staff) will disclose and avoid potential conflicts of interest. All other hospital staff will avoid similar conflicts of interest.- We will maintain an open admissions policy: no patient will be refused evaluation and service based upon sex, age, race, creed, national origin, sexual orientation, infection status or the ability to pay. Transfers to other facilities will occur only when we are unable to provide needed services and only to facilities that provide an appropriate level of care, based on our assessment of the patients' needs. Patients may also request elective transfer and an informed consent process will be followed.GENERAL PROGRAM SERVICE INFORMATIONOperations & PatientsMount Nittany Medical Center, located in State College, Pennsylvania, is a 207-bed acute-care, not-for-profit facility offering general medical and surgical services that are focused on helping patients reach their health potential. For the fiscal year ended June 30, 2010, Mount Nittany Medical Center provided care to the following number of patients:TOTAL NUMBER OF:INPTNTS-12,876, OUTPTNTS-196,986, ER VISITS-42,986NUMBER WITH PRIVATE INSURANCE:INPTNTS-5,489, OUTPTNTS-118,193, ER VISITS-22,043NUMBER WITH MEDICARE:INPTNTS-3,453, OUTPTNTS-28,961, ER VISITS-4,457NUMBER WITH MEDICARE HMO:INPTNTS-2,185, OUTPTNTS-22,711, ER VISITS-2,197NUMBER WITH MEDICAID:INPTNTS-1,193, OUTPTNTS-15,373, ER VISITS-6,595NUMBER WITH MEDICAID HMO:INPTNTS-83, OUTPTNTS-237, ER VISITS-119NUMBER WITH OTHER INSURANCE:INPTNTS-95, OUTPTNTS-3,148, ER VISITS-1,666NUMBER WITH NO INSURANCE/SELF-PAY:INPTNTS-378, OUTPTNTS-8,363, ER VISITS-5,909Mount Nittany Medical Center did not deny medical services to any individuals including those that had private insurance, Medicare, Medicaid, public health insurance, or no insurance.Emergency DepartmentMount Nittany Medical Center operates an emergency room 24 hours a day, 365 days a year providing services to all members of the community regardless of their ability to pay and denied zero patients requesting such services. The emergency room does not have a trauma center certification.Medical Staff PrivilegesAll qualified physicians in the community are eligible for medical staff privileges at Mount Nittany Medical Center and all qualified physician applications have been accepted for medical staff privileges. More than 240 non-employed physicians in 42 specialties and subspecialties are credentialed at Mount Nittany Medical Center.Professional Medical Education and TrainingMount Nittany Medical Center conducts professional medical education and training programs for the benefit of the community with a resulting financial loss to the Medical Center. 158621790 1 1 0 1 0 0 0 0 1 1 0 1 0 0 0 0 0 1 0 0 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 744 0 1 1526 1 1 1 0 0 0 0 0 0 0 0 15 13 0 0 0 0 1 0 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 PA X Richard Wisniewski Sr VP of finance and CFO 8142346148 1800 EAST PARK AVENUE STATE COLLEGE PA 16803 RICHARD WISNIEWSKI 40.00 X X 317709 0 41369 CARL RAUP 2.00 X X 0 0 0 GARY WEBER PHD 2.00 X X 0 0 0 THOMAS BROWN 2.00 X X 0 0 0 THOMAS HARRIS 2.00 X X 0 0 0 CARL ANDERSON 2.00 X 0 0 0 DIANNE BRANNON PHD 2.00 X 0 0 0 Wayne SeBASTIANELLI MD 2.00 X 10757 0 0 JONATHON DRANOV MD 2.00 X 0 0 0 KarEN SHUTE 2.00 X 0 0 0 ThEODORE ZIFF MD 2.00 X 0 0 0 EUGENE KEPHART DED 2.00 X 0 0 0 richard d allatt md 2.00 X 0 0 0 Phil Park 2.00 X 0 0 0 JAMES THOMAS PhD 2.00 X 0 0 0 steve brown hired by mnmc 31510 2.00 X X 0 0 0 DAVID PETERSON 40.00 X 239528 0 40839 neal holter 40.00 X 180470 0 29176 SADY RIBEIRO MD 30.00 X 372475 0 36805 DR DALE DANNEKER 40.00 X 287715 0 45492 DR WILLIAM HYLBERT 40.00 X 189808 0 29726 Janet Schachtner 40.00 X 186016 0 36028 LANCE H ROSE X 14721 0 1126 THOMAS J MURRAY X 565216 0 45768 2364415 0 306329 8 1 1 0 ALEXANDER BUILDING CONSTRUCTION LLC 315 VAUGHN STREET HARRISBURG PA 17110 CONSTRUCTION 22123704 Stickler Construction LLC 210 W Hamilton Ave 294 State College PA 16801 CoNSTRUCTION 3066036 state college anesthesia associates pc Box 1230 state College PA 16803 anesthsiology 1472654 PAVONE 1006 MARKET STREET HARRISBURG PA 17101 ADVERTISING & CREATIVE SERVICES 1346538 allied mechanical & electrical 2141 sandy drive state College PA 16803 cONSTRUCTION 1314626 28 363157 118052 481209 NET PATIENT SERVICE RE 621110 190518582 190518582 OTHER OPERATING REV 900099 2533985 2533985 OUTPATIENT LAB SERVICE 621500 2126582 2126582 195179149 1241781 1241781 111457 56114 55343 55343 55343 26584273 17260 27458874 16510 -874601 750 -873851 -873851 CAFETERIA SALES 722210 601608 601608 VENDING MACHINES 722210 24916 24916 OUTSIDE CATERING 722320 8432 8432 200 200 635156 196718787 193052567 2135214 1049797 4566613 4566613 1075203 935909 136469 2825 69394939 61539449 7855490 4747321 4145692 601629 11132605 9708817 1423788 4762777 4126897 635880 1048238 1837 1046401 80092 80092 30268 30268 18872 18872 9321022 6367901 2953121 517391 22758 494633 45232878 41827653 3405225 3018099 663751 2354348 11895 9175 2720 194789 145848 48941 2494597 2494597 10007598 10007598 1642497 1626855 15642 UNRELATED BUSINESS INCO 235564 235564 Bad Debt Expense 6451954 6451954 Pathology Lab 1593821 1593821 LiCENSES 1121019 1067972 53047 MisCELLANEOUS 605901 490661 115240 1668496 590468 1078028 180974449 158621790 22319566 33093 3796 3796 14110025 18934255 21359885 23225833 3943667 4480939 1839052 2746062 214510105 116567289 72357952 97942816 103090635 87538790 512879 579809 10756400 12762824 227974291 248215124 60276572 63511372 806690 754730 69750969 69761131 3115104 2453535 7464487 4357966 141413822 140838734 X 86346358 107162279 35617 35617 178494 178494 86560469 107376390 227974291 248215124 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 1 24000 1 1386 0 1 14037 39423 0 Part IV, Supplemental Information: MR. WISNIEWSKI AND MS. KIM NEELY MET WITH REPRESENTATIVE GT THOMPSON AND SENATOR CASEY'S STAFF TO REQUEST FEDERAL APPROPRIATIONS - TOTAL COST $1,386. CONTINUED TO WORK WITH OSBORNE CONSULTING, INC., A FEDERAL LOBBYING GROUP, TO REQUEST FEDERAL APPROPRIATIONS - TOTAL COST $24,000. A PORTION OF THE DUES PAID TO THE HOSPITAL & HEALTHSYSTEM ASSOCIATION OF PENNSYLVANIA ($7,316) AND THE AMERICAN HOSPITAL ASSOCIATION ($6,721) WAS DETERMINED TO BE FOR LOBBYING PURPOSES - TOTAL COST $14,037. 275745 4056 279801 281903 1505 -7663 275745 1.00000 0 1 1 8 8 83731368 49073839 34657529 1203076 268915 934161 91107206 65381333 25725873 38468447 1843202 36625245 97942816 INTEREST IN NET ASSETS OF THE FOUNDATION FOR MOUNT NITTANY MEDICAL CTR, INC. 8695583 OTHER ASSETS 539948 Deferred Financing CostS 3527293 12762824 DEFERRED COMPENSATION 287232 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 3089261 Derivative Liability 508973 Accrued Interest 472500 4357966 201464455 3118588 18872 180648534 18872 Part V, Line 4: Description of Intended Use of Endowment Funds: Permanent endowment funds are held by the Foundation for Mount Nittany Medical Center, Inc. and earnings are designated to fund future expenditures and capital acquisitons for Mount Nittany Medical Center. Part X: Description of Uncertain Tax Positions Under FIN 48: The Corporation 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 determined there were no tax uncertainties that met the recognition threshold in 2010 and 2009. X X 1 jeffrey Byrne & Associates Inc Committment to Distinction 0 0 0 30268 30268 PA 1 1 1 X 250.000000000000 0 1 1 1 0 1 0 1236749 1236749 0.00710 12671000 5996446 6674554 0.03820 13907749 5996446 7911303 0.04530 225233 2000 223233 0.00130 278327 9378 268949 0.00150 3170340 1955924 1214416 0.00700 466851 466851 0.00270 4140751 1967302 2173449 0.01250 18048500 7963748 10084752 0.05780 834 834 0.00000 2287 2287 0.00000 5959 5959 0.00000 205786 205786 0.00120 214866 214866 0.00120 1 2173663 33860938 42853489 -8992551 X 1 1 ADG-HOSPITAL DRIVE ASSOCIATES LEASING REAL PROPERTY FOR A SURGICAL CENTER AND MEDICAL OFFICE 0.24260 Mount Nittany Medical Center

1800 East Park Avenue State College PA 16803

X X X Part I, Line 7: Cost to charge ratio was computed using Worksheet 2 in the IRS instructions to Form 990 for lines 7a, 7b, and 7g. Cost accounting system was used for Subsidized Health Services. For all others, costs included the value of staff donated hours (with estimated benefits), monetary contributions, estimated value of materials used in delivering programs, and estimated space costs. The indirect cost allocation applies the indirect-to-direct cost ratio from the Medical Center's most recent Medicare Cost Report (approx. 31%). Part I, Line 7f: Amount of bad debt expense from Part IX subtracted in order to calculate percent of total expense in Part I Line 7 column f was $6,451,954. Part III, Line 4: Bad debt (at cost) is calculated by applying the patient care cost-to-charge ratio from Worksheet 2 to the Medical Center's provision for doubtful collections as of June 30, 2010. The Medical Center's Accounting Department records payments, while Patient Accounting staff makes appropriate adjustments to patient accounts for bad debt, discounts, or free care write-offs. The Medical Center is unable to estimate the amount of bad debt that could be attributable to patients who likely would qualify for financial assistance under the hospital's charity care policy. Patients do not provide income information prior to receiving care. Patients voluntarily contact the Medical Center to inquire about financial assistance. The Medical Center offers detailed information about the charity care program if and when patients offer information that is needed to determine eligibility. See response to Part VI, Line 2 herein. Bad debt is published in the consolidated audited financial statements on the Statement of Operations on the line entitled, "Provision for doubtful collections." Part III, Line 8: The Medical Center continues to provide care to all presenting and admitted patients, regardless of ability or pay. Notwithstanding the costs to provide care, receiving "less" than what it costs to provide adequate care to Medicare covered lives does the Medical Center a disservice. This shortfall should count as a community benefit. The Medical Center uses a step-down cost allocation method and then applies a cost-to-charge ratio. Part III, Line 9b: If patients are found to qualify, the Medical Center immediately ceases collections and adjusts charges off as charity care. Part VI, Line 2: The Medical Center uses, when appropriate, a combination of consultants, consultant reports, focus groups, and strong "grassroots" networking with community members and medical staff to determine needs, trends, preferences, and "best practices" for planning the delivery of care in the communities served by the Medical Center. Part VI, Line 3: The Medical Center posts financial assistance information in patient registration areas and provides literature to patients about financial assistance options. Part VI, Line 4: The Medical Center's primary service area includes Centre County and parts of the surrounding counties. Centre County's population is approximately 150,000. Approximately 13% of the population is aged 0-14, 76% aged 15-64, and 11% is 65 or older. The estimate for the population living below the poverty line is 14.8%. The median age in Centre County is 27.4 (39.9 for all of PA). 40.4% of those aged 25 or older have at least a bachelor's degree vs. 26.4% for all of PA. The median household income is $48,960, while the PA median is $49,520. 40,000+ college students live in State College. Mount Nittany Medical Center is the sole general acute care hospital in Centre County. The nearest Level II Trauma Center is approx. 43 miles away. Part of Centre County is a designated medically underserved area. Part VI, Line 5: The Medical Center and its staff invest in workforce development by offering training opportunities, such as resource-intensive internships for nursing students in the region, as well as contributing time and resources to regional planning efforts and leadership development. For the internships and related programs, considerable staff time is required to organize these programs and provide "preceptor" or instructor services while continuing to provide direct care for patients with normal job responsibilities. Part VI, Line 6: The Medical Center's Board of Trustees and its various committees include community members who are not directly involved in the Medical Center's operations, as well as medical staff. The Medical Center's medical staff exceeds 270 physicians and continues to invest in strong and beneficial relationships with all physicians who have an interest in working with the Medical Center. All revenues in excess of expenses are re-invested in the community, including significant donations to the county's only free medical and dental clinic, as well as internal improvements to technology so that the communities we serve have immediate access to the best and most appropriate diagnostic and treatment options available. Part VI, Line 7: As of June 30, 2010, the Medical Center (inpatient and outpatient services) had three controlled corporations, including the Foundation for Mount Nittany Medical Center, Inc. (fundraising), Mount Nittany Surgical Center, Inc.(outpatient surgical center), and Mount Nittany Medical Center Health Services, Inc. (physician group practice). 0 Mount Nittany Medical Center Health Services Inc 1800 East Park Avenue State College PA 16803 510426500 501(C)(3) 4566613 0 CASH N/A PROVIDE FINANCIAL SUPPORT TO AFFILIATE Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: ASSISTANCE IS PROVIDED TO RELATED ENTITIES FOR FINANCIAL SUPPORT. MANAGEMENT OF THE HEALTH SYSTEM OVERSEES THE USE OF FUNDS AT THE AFFILIATED ENTITIES. X 1 1 X X X X X 1 1 0 0 0 1 0 1 0 RICHARD WISNIEWSKI 290440 0 27269 0 0 0 0 0 41369 0 359078 0 0 0 DAVID PETERSON 210962 0 28566 0 0 0 0 0 40839 0 280367 0 0 0 neal holter 180470 0 0 0 0 0 0 0 2976 0 183446 0 0 0 SADY RIBEIRO MD 372475 0 0 0 0 0 0 0 36805 0 409280 0 0 0 DR DALE DANNEKER 287715 0 0 0 0 0 0 0 45492 0 333207 0 0 0 DR WILLIAM HYLBERT 189808 0 0 0 0 0 0 0 29726 0 219534 0 0 0 Janet Schachtner 164990 0 21026 0 0 0 0 0 36028 0 222044 0 0 0 LANCE H ROSE 14721 0 0 0 0 0 0 0 1126 0 15847 0 0 0 THOMAS J MURRAY 474421 0 28824 0 61971 0 0 0 45768 0 610984 0 0 0 Part I, Line 1a Steve Brown received a housing allowance for personal use when he was hired on 3/15/10. This housing allowance will be included in his taxable income for 2010. Steve Brown did not receive any compensation from Mount Nittany Medical Center during the calendar year 2009 to report on Schedule J or Part VII of the 990. Part I, Line 4a Former President and CEO - Thomas Murray was given a severance package during 5/09, which paid him for eighteen months. His last pay was 11/16/2010. Former President and CEO Lance Rose received nonqualified pension payments. Part I, Line 6 The executive team members received a portion of their annual variable-pay based upon net earnings of Mount Nittany Medical Center. Part I, Line 7 The executive team members received a portion of their annual variable-pay based upon the net earnings of Mount Nittany Medical Center and other corporate goals. The corporate goals for 2010 focused on finance, growth, human resources, clinical quality and patient safety. Centre County Hospital Authority 203197497 156273CE2 2009-03-26 69748005 To fund east wing expansion and other capital expenditures 0 1 70000000 15743428 8191010 3721113 39459562 2013 0 0 0 1 0 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 0 0 0 0 Form 990, Part VI, Section A, line 6 At one point in time, physicians on staff at the Hospital paid for a membership in the organization. The members currently have reserve powers to vote on the sale or closing of the Hospital. Form 990, Part VI, Section A, line 7b The members currently have reserve powers to vote on the sale or closing of the Hospital. Form 990, Part VI, Section B, line 11 the 990 was reviewed by the Mount Nittany Medical Center Audit Committee before it was filed with the IRS. Form 990, Part VI, Section B, line 12c ANNUALLY PHYSICIANS, KEY STAFF MEMBERS, BOARD OF TRUSTEE MEMBERS ARE REQUESTED TO COMPLETE A CONFLICT OF INTEREST DOCUMENT, WHICH IS REVIEWED BY THE CORPORATE COMPLIANCE OFFICER. THE CORPORATE COMPLIANCE OFFICER REPORTS ANY POTENTIAL ISSUES TO THE AUDIT COMMITTEE FOR THEIR REVIEW AND FINAL APPROVAL. Form 990, Part VI, Section B, line 15 Executive compensation committee from Board of Trustees reviews compensation paid to Executive Management team in conjunction with a third party organization to ensure compensation is reasonable and appropriate for duties and responsibilites assigned. Form 990, Part VI, Section C, line 19 Governing documents, conflict of interest policy and financial statements are made available to the public upon request. FORM 990, SCHEDULE K, LINE 3 THERE ARE NO MANAGEMENT OR SERVICE CONTRACTS OR RESEARCH AGREEMENTS RELATING TO THE FINANCED PROPERTIES FOR THE 2009 BONDS. THE FOUNDATION FOR MOUNT NITTANY MEDICAL CENTER INC 1800 EAST PARK AVENUE STATE COLLEGE PA 168036796 571138956 FUNDRAISING AND SUPPORT FOR MOUNT NITTANY MEDICAL CENTER PA 501(C)(3) 11A N/A MOUNT NITTANY MEDICAL CENTER WORKMEN'S COMPENSATION SELF INSURANCE TRUST 1800 EAST PARK AVENUE STATE COLLEGE PA 168036796 256440788 PROVIDE WORKMEN'S COMPENSATION BENEFITS TO EMPLOYEES OF MNMC PA 501(C)(3) 11A N/A MOUNT NITTANY MEDICAL CENTER HEALTH SERVICES INC 1800 EAST PARK AVENUE STATE COLLEGE PA 168036796 510426500 PROFESSIONAL SERVICES TO SUPPORT MNMC PA 501(C)(3) 11A N/A MOUNT NITTANY SURGICAL CENTER INC 1850 EAST PARK AVENUE STATE COLLEGE PA 168036796 251712099 HEALTHCARE PA 501(C)(3) 11A N/A 0 1 1 0 0 0 0 0 0 0 1 1 0 1 0 0 1 1 FOUNDATION FOR MOUNT NITTANY MEDICAL CENTER C 263157 FOUNDATION FOR MOUNT NITTANY MEDICAL CENTER K 370000 FOUNDATION FOR MOUNT NITTANY MEDICAL CENTER N 210284 mOUNT NITTANY MEDICAL CENTER HEALTH SERVICES INC B 4566613 MOUNT NITTANY MEDICAL CENTER HEALTH SERVICES INC K 845000 MOUNT NITTANY SURGICAL CENTER C 100000 MOUNT NITTANY SURGICAL CENTER K 798000