2011-05-16T16:23:24-05:00 2010-06-30 Kreischer Miller 100 Witmer Road Suite 350 Horsham PA 190442369 990 2009-07-01 231352193 Montgomery Hospital MONT 6102702070 1301 Powell Street Norristown PA 194040992 timothy M Casey 6102702070 2011-05-16 1 Kevin McGinn 2154414600 2009 2016-02-24 21:20:13Z timothy M Casey 1330 powell street norristown PA 19044 114214144 0 X www.montgomeryhospital.org X 1889 PA See Statement of Primary Exempt Purpose within Program Service Accomplishments 19 17 1177 95 0 0 98176 76421 105635001 111554671 643633 1447546 792842 790093 107169652 113868731 250 2500 0 52435806 50962922 0 0 51091304 59160383 103527360 110125805 3642292 3742926 77368035 79739319 38411267 39209956 38956768 40529363 SEE STATEMENT OF PRIMARY EXEMPT PURPOSE WITHIN PROGRAM SERVICE ACCOMPLISHMENTS 0 0 91685590 111554671 MONTGOMERY HOSPITAL ADMITS AND TREATS ALL INDIVIDUALS WHO REQUIRE SERVICES REGARDLESS OF THEIR ABILITY TO PAY FOR THOSE SERVICES. THESE INCLUDE ACUTE CARE ADMISSIONS, PSYCHIATRIC CARE ADMISSIONS, OUTPATIENT SERVICES, AND PATIENT SERVICE IN THE REGULAR EMERGENCY UNIT.ALTHOUGH REIMBURSEMENT FOR SERVICES RENDERED IS CRITICAL TO THE OPERATION AND STABILITY OF MONTGOMERY HOSPITAL, IT IS RECOGNIZED THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PURCHASE ESSENTIAL MEDICAL SERVICES. DESPITE THIS, THE HOSPITAL'S MISSION IS TO SERVE THE COMMUNITY WITH RESPECT TO PROVIDING HEALTHCARE SERVICES AND AN OVERALL COMMITMENT TO SERVICE ITS COMMUNITY. THESE SERVICES INCLUDE:FREE CARE AND/OR SUBSIDIZED CARE, CARE PROVIDED TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS AT BELOW COST, AND HEALTH ACTIVITIES AND PROGRAMS TO SUPPORT THE COMMUNITY AND ARE PROVIDED WHERE THE NEED AND/OR AN INDIVIDUAL'S INABILITY TO PAY COEXISTS. HEALTH ACTIVITIES AND PROGRAMS INCLUDE WELLNESS PROGRAMS, COMMUNITY EDUCATION PROGRAMS, SPECIAL PROGRAMS FOR THE ELDERLY, HANDICAPPED, MEDICALLY UNDERSERVED, AND A VARIETY OF BROAD COMMUNITY SUPPORT ACTIVITIES.UNCOMPENSATED CARE IS PROVIDED BY THE HOSPITAL IN CONNECTION WITH THESE COMMUNITY SERVICES. UNCOMPENSATED CARE INCLUDES CHARITY CARE AND BAD DEBTS FROM PROVIDING UNREIMBURSED SERVICES TO INDIVIDUALS. UNCOMPENSATED CARE ALSO INCLUDES SERVICES PROVIDED UNDER FEDERAL MEDICARE AND STATE MEDICAL ASSISTANCE PROGRAMS WHERE REIMBURSEMENT WAS LESS THAN THE COST OF SERVICES PROVIDED. 91685590 1 1 0 1 0 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 69 0 1177 1 0 0 0 0 0 0 0 0 0 19 17 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X the organization 6102702070 1301 Powell Street Norristown PA 194040922 RICHARD BRAEMER 2.00 X 0 0 0 ANDREW B CANTOR ESQ 2.00 X 0 0 0 GARY S DRIZIN MD 2.00 X 0 0 0 EDUARDO D GONZALEZ 2.00 X 0 0 0 JUDITH T Z LEVY 2.00 X 0 0 0 SCOTT A MELNICK MD 2.00 X 0 141629 7603 BRUCE J MENKOWITZ MD 2.00 X 0 0 0 JAMES J O'BRIEN MD 2.00 X 0 0 0 RICHARD C SHEERR 2.00 X 0 0 0 MANUEL N STAMATAKIS 2.00 X 0 0 0 CHARLES J TORNETTA 2.00 X 0 0 0 FRANK J TORNETTA MD 2.00 X 0 0 0 JEFFREY WARDEN 2.00 X 0 0 0 RICHARD WOLFSON 2.00 X 0 0 0 JOHN E F CORSON 4.00 X X 0 0 0 ARTHUR L POWELL 2.00 X X 0 0 0 EUGENE W BUCKLEY 2.00 X X 0 0 0 PAUL N ANGSTADT JR MD 2.00 X X 0 0 0 TIMOTHY M CASEY 40.00 X X 1106901 0 73131 ANN WITKOWSKI 40.00 X 168946 0 7676 Murray Swim 40.00 X X 143987 0 1308 PAT MODAFFERI 40.00 X X 134837 0 2382 MICHAEL T KOST 40.00 X 165764 0 2072 ALICE SHIRAKAWA 40.00 X 152861 0 0 GERILYN L OLIVIERI 40.00 X 131032 0 1567 EDWARD LADELY 40.00 X 255203 0 14645 2259531 141629 110384 21 1 1 0 RENAL CARE GROUP EAST 111 PRESIDENTIAL BOULEVARD SUITE 1 BALA CYNWYD PA 19004 PATIENT DIALYSIS 411846 BUCHANAN INGERSOLL & ROONEY PC 301 GRANT STREET Pittsburgh PA 15219 LEGAL 315136 BONZA LANDSCAPING 148 WEST 2ND AVENUE CONSHOHOCKEN PA 19428 LANDSCAPING 177392 SHIh-min lo phd 4477 commonwealth drive Emmaus PA 18049 PATIENT CARE 153391 JACOB TRACHTENBERG MD 117 DRAKES DRUM DRIVE BRYN MAWR PA 19010 PATIENT CARE 150000 5 76421 76421 NET Patient Service Re 621110 108250445 108250445 Other Dept. Revenue 621110 3304226 3304226 111554671 1488141 1488141 209344 209344 209344 209344 304818 345413 -40595 -40595 -40595 Food Services 722210 370941 370941 Parking Lot 812930 150615 150615 Purchase Discounts 900099 57328 57328 1865 1865 580749 113868731 111613864 0 2178446 2500 2500 1275847 1275847 40586609 33794473 6792136 445995 360046 85949 5636853 4550563 1086290 3017618 2601812 415806 323715 323715 108000 108000 285310 1621 283689 181972 179082 2890 63831 49715 14116 256158 256158 3849723 3737237 112486 2501308 2428804 72504 Supplies 15759469 15508616 250853 Bad Debt 15388869 15388869 Contracted Services 9829413 4092177 5737236 Professional Fees 4876581 4273520 603061 Equipment Rental & Main 1997974 1840411 157563 3738060 2619986 1118074 110125805 91685590 18440215 0 3385615 3545535 12239050 11780148 2166702 2124928 637759 582520 122394413 102859840 19159512 19534573 25131377 25870000 14648020 16301615 77368035 79739319 9558149 7485742 3780000 1950000 2727408 3838104 22345710 25936110 38411267 39209956 X 32823927 33981686 743860 647387 5388981 5900290 38956768 40529363 77368035 79739319 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 23299 0 0 0 23299 0 Part II-B, Line 1i: Explanation of Other Lobbying Activities: lobbying expenses incurred when dues paid to Hospital Association of Pennsylvania. A percent of lobbying expenses incurred by the Association is allocated to each participant. 5385697 511619 5897316 6838593 -1452896 5385697 1 0 1020968 1020968 48627542 39065595 9561947 71053649 62738330 8315319 1692254 1055915 636339 19534573 CASH & CASH EQUIVALENTS (HELD IN TRUST) 3417543 F MARKETABLE EQUITY SECURITIES (HELD IN TRUST) 14803314 F US GOVERNMENT OBLIGATIONS (LTD USE) 2013458 F US GOVERNMENT OBLIGATIONS (HELD IN TRUST) 5635685 F 25870000 Other assets 56814 Due from Affiliates 5745975 Interest in Net Assets of Foundation 10498826 16301615 Accrued Payroll & Employee Benefits 3907033 Retirement Liability 6824696 Accrued Pension 14064284 Estimated Third-Party Payor Settlements 680575 Due to Affiliates 459522 25936110 113868731 110125805 3742926 -2170331 -2170331 1572595 113911000 0 113911000 -42269 -42269 113868731 110128000 2195 2195 110125805 0 110125805 Part V, Line 4: Description of Intended Use of Endowment Funds: Montgomery Hospital is the partial or 100% owner of nine Endowment Funds. Eight of the Funds have unrestricted distributions to Montgomery Hospital. One Endowment Fund distributes funds to the George Ralston Restricted Fund. The purpose of this fund is to pay for continued education/seminars for the graduates of the Montgomery School of Nursing. Part XI, Line 8 - Other Adjustments: UNREALIZED GAIN/LOSS ON INVESTMENTS: 693000. RESTRICTED CONTRIBUTIONS: 125000. NET ASSETS RELEASED FROM RESTRICTIONS FOR PROPERTY & EQUIPMENT ACQUISITIONS: 148000. NET ASSETS RELEASED FROM RESTRICTIONS: -221000. MISCELLANEOUS/ROUNDING: -1276. increase/DECREASE IN ASSETS HELD IN PERPETUITY BY TRUSTEES: 511000. GAIN ON SALE OF PERPETUITIES: 41945. CHANGE IN ADDITIONAL MINIMUM PENSION LIABiLITY: -3467000. Part XII, Line 4b - Other Adjustments: ROUNDING: -324. LOSS ON SALE OF PERPETUITIES: -41945. Part XIII, Line 2d - Other Adjustments: rounding: 2195. 1 1 1 X 250.000000000000 1 X 1 1 1 0 0 262000 262000 0.00240 10029000 8963000 1066000 0.00970 10291000 8963000 1328000 0.01210 79408 41234 38174 0.00030 2159000 1579000 580000 0.00530 228000 228000 0.00210 18620 18620 0.00020 2485028 1620234 864794 0.00790 12776028 10583234 2192794 0.02000 1 2185000 0 22323000 21730000 593000 X 1 1 MONTGOMERY HOSPITAL

1301 POWELL STREET NORRISTOWN PA 19401

X X X X MONTGOMERY HOSPITAL - Psych Unit

1301 POWELL STREET NORRISTOWN PA 19401

Psychiatric Unit MONTGOMERY Hospital - HOME CARE

25 WEST FORNANCE STREET NORRISTOWN PA 19401

HOME CARE MonTGOMERY HOSPITAL - Hospice

25 WEST FORNANCE STREET nORRISTOWN PA 19401

Hospice Part I, Line 7 & Part III, Line 4 - Cost were determined using a ratio of Cost to Charges derived from the Medicare Cost Report. Patient would not have healthcare services without the benefits of treating regardless of financial means.Part I, Line 7g - Hospital subsidizes the loss on operations of the System physician OB clinic. OB Clinic services are provided to low income women who do not have a primary care physicia for obstetrics services.Part III Section B, Lines 5-7 are based on the FYE 2010 Medicare Cost Report Filing.Part III Section C, 9 b If "Yes" does the organization's collection policy contain provisions on the collection practices to be followed for patients who are known to qualify for charity care or financial assistance? Describe in Part VI.1) Patients who received services in Emergency Department that reside in selected zip codes are written off to charity care based on census department income information.2) Patients who did not qualify for Medicaid and appear to met the Hospital's Charity care guidelines the charges are discounted or written off if appropriate.Part IV #3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organizations charity care policy. 1) A Financial Counselor informs inpatient's of Meapplication. Information is also available on the Hospital's website.application. Information is also available on the Hospital's website. Line 2- Needs Assessement-Montgomery Hospital works in partnership with several county organizations, especially Montgomery County Department of Health and the Delaware Valley Health Council to assess healthcare needs in the immediate region. Working together, Montgomery Hospital and its partners have continued to identify healthcare trends and needs within the community. To better meet these needs, Montgomery Hospital provides prenatal education and care, an OB/GYN clinic for uninsured/underinsured women, smoking cessation classes, access to case management and social workers, pastoral care, and home care and hospice options for the underserved. Line 3-Patient Education of Eligibility for Assistance-Montgomery Hospital educates patients and persons who may be billed for patient care about their eligibility for assistance under federal state, or local government programs or under the hospitals charity care policy in the following ways: 1. The hospitals charity care policy is available is posted in Patient Registration.2. Information about the hospitals charity care policy and how to receive help understanding hospital bills are are included in the Montgomery Hospital Patient Guide, given to every patient upon registration (available in English and Spanish. 3. The hospitals charity care policy and self-pay fee schedule are available from Patient Registration and the hospitals billing office.4. Charity care information and self-pay fee schedule are available on the hospitals website.5.The hospital employs two full-time financial counselors available Monday-Friday. Financial counselors educate patients and families about available programs to assist with incurred medical costs. Counselors assist patients to complete and file forms. Line 4 - Community Information - Montgomery Hospital sits close to the center on Norristown, the county seat. Located in the heart of Montgomery County, Norristown is classified as urban. The general population of Norristown includes 49.4% Causaian, 34.8% African American and 9.7% Latino, as well as a rapidly growing undocumented Latino/Hispanic population facing both economic hardship and health difficulties. Norristowns poverty rate is disparate compared to the state;17.2% of Norristown residents and 13.5% of families in the Borough live below the poverty line compared to 11% and 5.1% respectively in Pennsylvania. Projections show that more than one-third of the Boroughs residents are uninsured with no source of primary care. Language is often a barrier receiving medical information and produces an overall lack of healthcare knowledge. This language barrier results in poor attendance at the free screenings provided throughout the county by multiple organizations. Additionally, undocumented individuals are often fearful of questions being raised about their citizenship and therefore do not participate until the need is critical. With US Census Bureau figures showing an 82% increase in Hispanic or Latino populations within Montgomery County between 2000-2010, providing programs, familiarity and access to Montgomery Hospital programs, especially for preventative healthcare, is a need at this time. Although Norristown is the urban center, Montgomery County itself is one of the most affluent within the state. Montgomery Hospitals regional reach is the central ssection of the county which includes almost 10-15 miles to the north and west of the hospital and about 5 miles to the east (towards Philadelphia). Like most Philadelphia suburban hospitals, Montgomery finds itself in constant competition with hospitals located downtown, a trend that finds 60% of the population seeking healthcare outside of the region. Line 5-Community Building Activities-Montgomery Hospital provides community support in a variety of forms: 1. The hospital hosts free support groups throughout the year for cancer patients, families and survivors. Members of the group do not have had to have received care at Montgomery to participate. Support groups in 2009-2010 included Breast Cancer Support, CPAP Support, Laryngectomy Support, Prostate Support, and Bereavement Support. Support group membership is free. The hospital's cancer program also provides a healing arts program featuring a free wig program available to patients who have lost their hair due to chemotherapy treatment, massage, and meditation.2. The hospitals cancer program continues to provide educational information and awareness activities with Area High School. Originally formed via a grant from Komen for the Cure, Montgomery Hospital and the high school have developed a collaborative partnership to help educate women in the region about breast cancer and promote early detection through mammography screenings. All materials and staff time allocated to activities are provided to the school free of cost.3. When a public health crisis develops, Montgomery Hospital is a responsive, collaborative community partner. With the H1N1 outbreak in Spring 2009, Montgomery (like most other hospitals) found itself in the position of limiting visitation hors, placing restrictions on visitors, and observing new hygiene protocols. Hand sanitizer stations were installed throughout the hospital, educational information from Health Department was made readily available, updates were posted on the hospital's website with a link to the CDC, and patients and visitors were kept informed. In October2009, in an effort to continue to educate the public about flu, Montgomery Hospital invited the medical director for the Montgomery County Department of Health to speak to 300 women at the hospitals annual Womens Conference. The County was also invited to provide materials about immunizations, clinics, and disaster preparation info. 4. Montgomery Hospital enjoys a close relationship with its neighbor hospitals from Montgomery and Bucks Counties with a Regional Zone agreement, part of a coalition developed after 9/11. Through a mutual aid agreement, hospitals within the Zone have predetermined methods in place to encourage inter-hospital cooperation should a disaster arise. The Zone works with area municipal and county agencies, EMS, Delaware Valley Health Council, and the state. In addition, the hospital hosts a Safety/Emergency Preparation meeting each month for staff members to receive continuous training and assess any needs within the community. The municipal fire department is invited as a participant at least once each year as is the safety officer from the Excelon Nuclear Power Plant, located 20 miles to the northwest of the hospital.5. As a primary source of healthcare for Norristown and central Montgomery County, Montgomery Hospital enjoys being the healthcare resources for its neighbors. Each year, the hospital provides educational materials, healthcare related information and giveaways to churches within the immediate area, Norristown Area School District, civic organizations such as Girl Scouts of America and Boy Scouts of America, local community centers such as the Police Athletic League, and others. The hospital also supports local block parties each summer by supplying healthcare outreach information to the neighborhoods.6. Each May, the hospital hosts an annual fundraiser. While the Walk Through the Park generates on average $15,000 each year for cancer programs at Montgomery Hospital, the greater purpose of the Walk is to bring cancer awareness to the region while supporting all of those who have ever been diagnosed with cancer. The Walk is a true collaboration of organizations and individuals who want to show support for all of those who have been touched by cancer. The Walk is run each year by a committee comprised of local business leaders, community members and personnel. Expenses for the 2009 Walk were $3,581.47 (not including staff hours) with a net profit of $13,502.53. X X X X X X 0 0 0 0 0 0 0 0 0 TIMOTHY M CASEY 595943 0 256904 0 254054 0 0 0 73131 0 1180032 0 0 0 ANN WITKOWSKI 168946 0 0 0 0 0 0 0 7676 0 176622 0 0 0 MICHAEL T KOST 165764 0 0 0 0 0 0 0 2072 0 167836 0 0 0 ALICE SHIRAKAWA 152861 0 0 0 0 0 0 0 0 0 152861 0 0 0 EDWARD LADELY 255203 0 0 0 0 0 0 0 14645 0 269848 0 0 0 Form 990, Part VI, Section A, line 2 Board Members Charles J. Tornetta and Frank J. Tornetta are brothers. Form 990, Part VI, Section A, line 6 The organization has members. Form 990, Part VI, Section A, line 7a Board members and officers are elected by the Montgomery Hospital Medical Center Executive Committee (Board). Form 990, Part VI, Section A, line 7b A majority of elected board members at a meeting constitutes a quorum. A board vote at a meeting with a quorum carries any action. Form 990, Part VI, Section B, line 11 Form 990 is first reviewed by the Director of Finance. All data is tied back to the original supporting documents. Data is also tied back to the audited financial statements. After review by the Director of Finance, Form 990 is reviewed by the CEO. The CEO then presents the Form 990 to a sub committee of the Board for review. After all reviews, the CEO signs the tax return and it is filed. Form 990, Part VI, Section B, line 12c Officers and Directors are required to complete a conflict of interest statement on a yearly basis. Form 990, Part VI, Section B, line 15 A compensation committee is used to approve compensation for the CEO and officers. An outside company is used to complete comparability studies. An outside review of the surveys is completed by an independent person. The Compensation Committee reviews the data and ultimately approves or disapproves of any executive compensation. There are documented minutes of the compensation committee meetings. These minutes are kept confidential and are stored in the executive office files. Form 990, Part VI, Section C, line 19 FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST FORM 990, PART XI, LINE 2C PROCESS FOR OVERSIGHT OF AUDIT OF FINANCIAL STATEMENTS The process for oversight of the audit of the organization's financial statements and the selection of an independent accountant has not changed since the prior year. FORNANCE PHYSICIAN SERVICES 1330 POWELL STREET NORRISTOWN PA 19401 232275991 HEALTH CARE PA 501(C)(3) 509(A)(2) N/A MONTGOMERY HEALTH FOUNDATION 1330 POWELL STREET SUITE 309 NORRISTOWN PA 19401 222456265 FINANCIAL SUPPORT OF MONTGOMERY HOSPITAL PA 501(C)(3) 509(A)(3) N/A CMMC INC 15 W WOOD STREET NORRISTOWN PA 19401 232256479 MEDICAL SERVICES PA N/A C 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 1 1 NO TRANSACTIONS ARE WITH CONTROLLED ENTITIES OR NON-501(c)(3) ORGANIZATIONS I NO TRANSACTIONS ARE WITH CONTROLLED ENTITIES OR NON-501(c)(3) ORGANIZATIONS J NO TRANSACTIONS ARE WITH CONTROLLED ENTITIES OR NON-501(c)(3) ORGANIZATIONS Q NO TRANSACTIONS ARE WITH CONTROLLED ENTITIES OR NON-501(c)(3) ORGANIZATIONS R