2011-02-12T08:06:26-06:00 2010-06-30 PARENTEBEARD LLC 400 MARKET STREET WILLIAMSPORT PA 17701 990 2009-07-01 240795411 EVANGELICAL COMMUNITY HOSPITAL EVAN 5705222741 ONE HOSPITAL DRIVE LEWISBURG PA 17837 JAMES STOPPER CPA CFO 5705222741 2011-02-10 1 5703236023 2009 2016-02-24 21:20:13Z MICHAEL O'KEEFE ONE HOSPITAL DRIVE LEWISBURG PA 17837 142644800 0 X WWW.EVANHOSPITAL.COM X 1926 PA Provide health care services to the public and to be the community's health care provider of choice. 22 20 1374 614 2661072 741637 1307743 2786638 112483659 114538362 -3586368 2591073 3095626 3000785 113300660 122916858 47580 22000 0 59591819 56875722 0 585356 51253688 52750551 110893087 109648273 2407573 13268585 162652471 177099609 55675897 58486321 106976574 118613288 Evangelical Community Hospital, a non-profit health care provider, serves Union, Snyder and Northumberland Counties as well as surrounding communities. The Hospital provides a broad range of health care services that are consistently high quality, compassionate, accessible and cost-effective. In partnership with a strong and diverse medical staff, the Hospital promotes a healthy lifestyle and provides advanced medical care in an atmosphere that is caring and compassionate. This is accomplished by maintaining a challenging, energized work environment for our valued employees who exemplify our Core Values: Quality Service, Compassion, Respect, Professionalism, Integrity, Cooperation and Creativity. 0 1 93246911 113261962 Meeting the healthcare needs of the community is at the heart of Evangelical Community Hospital's mission as a not-for-profit charitable organization. The Hospital's resources provide for long-term initiatives such as recruitment and retention of outstanding medical professionals, enhanced technologies and new facilities and services.The Hospital is licensed to accommodate 127 overnight patients, 12 Acute Rehabilitation Unit patients and 18 newborn babies. It is a not-for-profit community hospital offering a full continuum of care. Services range from comprehensive diagnostic tests to delicate microsurgery and from specific treatment programs to numerous outpatient services.In addition to providing hospital-based medical services, Evangelical provides a number of community-based services designed to improve the health of area residents. Many of the employees and medical staff lead health education and screenings as well as support groups for individuals in the community living with serious or chronic health conditions. Whether through charitable care, subsidized hospital programs and services, or community health education, Evangelical strives to respond to the Valley's most pressing health needs. 93246911 1 1 0 0 0 0 0 0 1 1 0 1 0 0 0 0 0 0 1 0 1 1 1 1 1 0 0 0 0 0 0 0 1 0 1 1 0 0 0 0 1 1 0 0 1 71 0 1 1374 1 1 1 0 0 0 0 1 1 0 0 0 22 20 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 0 PA X EVANGELICAL COMMUNITY HOSPITAL 5705222000 ONE HOSPITAL DRIVE LEWISBURG PA 17837 James Apple 1.00 X 0 0 0 Martha Barrick 1.00 X 0 0 0 Carol Graybeal 1.00 X 0 0 0 JOHN Griffith 1.00 X 0 0 0 ROBERT GRONLUND 1.00 X 0 0 0 Roger Haddon Jr 1.00 X 0 0 0 James Morgan Jr MD 1.00 X 0 0 0 Fredrik Paulsen Jr 1.00 X 0 0 0 W GALE REISH MD 1.00 X 0 0 0 SUSAN FORGETT RHEAM CPA 1.00 X 0 0 0 Norman Rich 1.00 X 0 0 0 DOUGLAS SPOTTS MD 1.00 X 0 0 0 Michael Wimer 1.00 X 0 0 0 MARK VAN BLARGAN ESQ 1.00 X 0 0 0 SARA KIRKLAND 1.00 X 0 0 0 Henry A Truslow IV 1.00 X 0 0 0 JOHN MATHIAS 1.00 X 0 0 0 Julie Barna DMD 1.00 X 0 0 0 tim apple 1.00 X 0 0 0 brooks gronlund 1.00 X 0 0 0 john meckley esq 1.00 X 0 0 0 julia redcay DO 1.00 X 0 0 0 john e rice md 1.00 X 0 0 0 russell stankiiewicz md 1.00 X 0 0 0 jeanette williams 1.00 X 0 0 0 MICHAEL N O'KEEFE 40.00 X 259789 0 78976 CHRISTINE M MARTIN 40.00 X 175600 0 53382 james a stopper 40.00 X 94604 0 28760 J LAWRENCE GINSBURG 40.00 X 329001 0 100016 Richard E Smith Jr 40.00 X 156165 0 47474 kendra A aucker 40.00 X 158532 0 48194 MARK K KRAMMES 47.00 X 237441 0 72182 LORI K GOODLING 47.00 X 221665 0 67386 RAYMOND J TOMASZEWSKI 46.00 X 205363 0 62430 BRADLEY P BOWER 44.00 X 202589 0 61587 sandra s walker 48.00 X 229115 0 69651 MICHAEL P PIERCE 40.00 X 68512 0 0 SCOTT W PETERSON 40.00 X 267711 0 0 2537575 0 690038 21 1 1 0 the quandel group inc 3033 north front st suite 201 harrisburg PA 17110 construction 1663766 BURT HILL PO BOX 360248M PITTSBURGH PA 15251 ARCHITECT 1242034 CHART SERVICES PO BOX 6305 BRATTLEBORO VT 053026305 MANAGEMENT SERVICES 917211 zartman construction 3000 point township dr northumberland PA 17857 construction 659969 Coresource Inc PO Box 34707 Newark NJ 071894707 MANAGEMENT SERVICES 451914 118 10500 118111 64931 2593096 89261 2786638 NET PATIENT SERVICE RE 621400 112997907 112997907 LABORATORY SERVICES 621500 1540455 1540455 114538362 1995659 1995659 1982200 2200324 -218124 -218124 -218124 17971433 82459 17261378 197100 710055 -114641 595414 595414 53973 118111 65804 -11831 -11831 1925 3336 -1411 -1411 BILLING AND CODING FEE 541900 554801 554801 ADMINISTRATIVE FEE INC 541900 543333 543333 CAFETERIA AND VENDING 722210 529014 529014 1605003 643490 22483 939030 3232151 122916858 113641397 2661072 3827751 22000 22000 1533154 429618 1103536 42285193 35878807 6189899 216487 1307099 1089011 211577 6511 8607420 7370150 1192603 44667 3142856 2618473 508727 15656 1082433 1082433 292641 292641 171199 54515 116684 280945 7650 273295 4259968 2782503 1327149 150316 446354 29509 403636 13209 24906007 22528456 2343717 33834 2259677 2259677 159800 143328 12646 3826 135777 92756 35439 7582 1391024 1391024 6390037 6390037 1059268 1059268 BAD DEBT 4949924 4949924 LiCENSES & fees 3372561 2350607 1021854 100 federal & state taxes 271150 271150 contRAST MEDIA 241251 241251 EMPLOYEE & PHYSICIAN RE 212764 382 212382 867771 475532 299071 93168 109648273 93246911 15816006 585356 1465 1465 33331421 22663582 137224 1026948 10656452 9961572 1766403 1744377 2578134 2540533 1551902 1456765 146180407 72453515 72628026 73726892 32615713 57366549 2921881 1939694 4463850 4671232 162652471 177099609 11949777 12872502 35075000 33945000 8651120 11668819 55675897 58486321 X 102912714 113040176 349508 1401450 3714352 4171662 106976574 118613288 162652471 177099609 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2701406 123011 102387 2000 66203 4949 2853652 2623000 229877 -101037 11900 34346 4188 2701406 0.67000 0.33000 0 0 3225844 3225844 69539159 23738669 45800490 3607878 2121441 1486437 63391998 46593405 16798593 6415528 6415528 73726892 BLUE CROSS CURRENT FINANCING ADVANCE 1057200 ACCRUED POSTRETIREMENT BENEFIT COSTS 5192589 ESTIMATED MEDICAL MALPRACTICE CLAIMS LIABILITY 582512 CHARITABLE GIFT ANNUITIES PAYABLE 765608 DEFERRED COMPENSATION 1664598 Estimated third-party payor settlements 1032995 capital lease obligation 1373317 11668819 122916858 109648273 13268585 1661303 -3293174 -1631871 11636714 126026156 1661303 -821469 839834 125186322 -2269464 -2269464 122916858 114389442 5014464 5014464 109374978 273295 273295 109648273 Part V, Line 4: Description of Intended Use of Endowment Funds: ENDOWMENT FUNDS WILL BE USED TO SUPPORT VARIOUS HOSPITAL PROGRAMS SUCH AS FUNDING HELPLINE SERVICES, COMMUNITY HEALTH EDUCATION, HOSPICE SERVICES, PRE-HOSPITAL SERVICES, FAMILY PLACE (OB SERVICES), PROVIDE NURSING SCHOLARSHIPS AND TO PROVIDE FOOD, SERVICE, OR CARE FOR PEOPLE WHO DO NOT HAVE THE MEANS TO PAY FOR THE SERVICE. 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 has been met. Management has determined that there were no tax uncertainties that met the recognition threshold in 2010. Part XI, Line 8 - Other Adjustments: CHANGE IN VALUE OF SPLIT-INTEREST AGREEMENT: 12004. VALUATION GAIN: 324394. POSTRETIREMENT BENEFIT LIABILITY ADJUSTMENT: -884572. EQUITY TRANSFER TO AFFILIATE: -2745000. Part XII, Line 2d - Other Adjustments: Changes in Value of Split Interest Agreement: 12004. VALUATION GAIN: 324394. Investment Fees: -273295. POSTRETIREMENT BENEFIT LIABILITY ADJUSTMENT: -884572. Part XII, Line 4b - Other Adjustments: RENTAL EXPENSES: -2200324. Special Events Expense: -69140. Part XIII, Line 2d - Other Adjustments: RENTAL EXPENSES: 2200324. Special Events Expense: 69140. EQUITY TRANSFER TO AFFILIATE: 2745000. Golf Tournament 72097 39416 32681 755 10937 Evan Gala 81666 60374 21292 54112 1 18321 18321 172084 118111 53973 755 65049 65804 -11831 1 1 1 X 1 X 0 1 1 0 1 1 1930 329492 7282 322210 0.00310 20218 8920999 3593612 5327387 0.05090 796 90430 90430 0.00090 22944 9340921 3600894 5740027 0.05490 47 10773 111214 14730 96484 0.00090 16 243 266326 22000 244326 0.00230 1 100 1327 1327 0.00000 2 35 5730 5730 0.00010 66 11151 384597 36730 347867 0.00330 66 34095 9725518 3637624 6087894 0.05820 6 11 7570 2708 4862 0.00000 1 2197 2197 0.00000 19 2200 16677 16677 0.00020 23 970 861657 225598 636059 0.00610 49 3181 888101 228306 659795 0.00630 1 2439020 657668 39831809 49296673 -9464864 X 1 1 EVANGELICAL COMMUNITY HOSPITAL

ONE HOSPITAL DRIVE LEWISBURG PA 17837

X X X Inpatient Rehabilitation, Home Health, Hospice Part I, Line 3c: Part III, Line 4: Accounts receivable are reported at net realizable value. Accounts are written off when they are determined to be uncollectible based upon management's assessment of individual accounts. The allowance for doubtful collections are estimated based upon a periodic review of the accounts receivable aging, payor classifications and application of historical write-off percentages. The costing methodology used in determining bad debts expense at cost and estimated amount of the organization's bad debt expense attributed to patients eligible under the Organization's charity care policy is bad debt expense times the cost to charge ratio. In determining bad debt expense, patient liabilities are net of third-party payments and any patient payments. The method the organization uses to determine the amount that reasonably could be attributed to patients who likely would qualify for financial assistance under the Hospital's charity care policy, but did not adequately complete the charity care paperwork. We believe that a portion of our bad debts results from services provided to patients who meet the charity care guidelines but were unable or unwilling to provide the appropriate documentations to allow that classification. These would be classified as bad debt expense times the cost to charge ratio to arrive at cost. The organization accounts for discounts and payments on patient accounts as a reduction of revenue/accounts receivable and are not components of bad debt expense. Evangelical Community Hospital provides care to all patients who need it, regardless of their ability to pay. This is part of the hospital's mission. Part VI, Line 2: Evangelical Community Hospital participated in a five county (Snyder, Union, Montour, Northumberland, Columbia) community health needs assessment conducted by ACTION Health (represented by five area community hospitals, including Evangelical Community Hospital, and two universities). In February of 2009, ACTION Health formed a Needs Assessment Committee. In May of 2009, the committee selected Geisinger Center for Health Research to conduct the assessment. The assessment consisted of focus groups, community interviews, and a clustered randomized sample of county residents. 3,300 surveys were returned, with a response rate of 36%. Focus group and community interviews consisted of Hospital Stakeholders, and leaders within each county from the following organizations: government, non-profit organizations, faith based organizations, schools, universities, and private businesses. The Community Needs Assessment is made available to the community on the ACTION health website http://actionhealthpa.org/blog/community-health-needs-assessment).Focus group findings varied somewhat from county to county and community to community. However, a number of findings were consistent across the region:1. Medical care and specialty care: residents have difficulty navigating the health care system. This includes finding appropriate health care, particularly specialty care. Moreover, participants noted that there is limited care available for those who are uninsured or who are under insured. 2. Dental care for area residents is limited. Particularly problematic for low-income residents and for those who do not have dental insurance. There are few area dentists who accept state-assistance (Medicaid/CHIPS) as a form of payment for dental care and there is no dental care for low-income adults. Children with state-funded insurance must often receive their dental care outside of the region, necessitating travel which may be a problem for families with no dependable transportation. 3. Mental health and substance abuse treatment is limited. There is limited availability of specialty services for substance abuse particularly. Inpatient mental health services are limited and residents often do not know how to navigate the mental health care system. 4. There is a general agreement that area residents do not know where to go to obtain information about availability of all kinds of social and support services. Moreover, there is only limited coordination of information and services between agencies and organizations. 5. Limited access to homeless shelters and transitional housing support. 6. Need for health and consumer education and promotion of consumer literacy, health and wellness education, parenting, and prevention programs. 7. Need for expanded public transportation. While focus group participants acknowledged the tremendous work of the Union-Snyder Transportation Authority (USTA) and other similar transportation systems, there were general agreement that there remains a need for expanded public transportation. 8. Limited food resources. Participants noted that food pantries are difficult to locate and may be limited in their ability to meet the increasing demands for additional food support in the community. 9. Need for affordable child care and child care for all work shifts. There was significant concern at some focus group locations regarding the lack of 24-hour child care due to shift work required in some employment settings. 10. Services and education designed for special groups including seniors, adolescents, grandparents raising grand children, non-English-speaking seniors. Participants noted that these demographic groups have unique needs that may not be met by "one-size fits all" approaches currently in place. The development of special programs for unique groups that reach out to these individuals may improve access.11. Rising unemployment was noted as the economic downturn reached this area. The central concern for focus group members was the increasing population without health insurance and a middle class that was not schooled in accessing assistance, such as food pantry and utility assistance. 12. Increase in domestic violence. Again, in the current economic environment members expressed concerns about the increased reporting of domestic violence. There was an expressed need for education strategies to promote stress management and other strategies for reducing interpersonal violence. 13. Reduction in tobacco use, but continued need for affordable tobacco cessation programs. Members suggested that tobacco cessation programs should be available in workplaces such as food sales environment and programs should be developed to target particular demographic groups. 14. Computer access was viewed as potentially increasing disparity. Many use the computer to access health information, social services and other resources. Addressing computer access may include providing training for the use of the computer to navigate health and human services. Evangelical Community Hospital has been a very active member of ACTION Health and now participates actively in ACTION Health Community Health Needs Assessment Committee. This committee is a coalition of leaders that assist in making necessary program changes to promote a healthier community and address identified needs of the community. Evangelical Community Hospital's Community Benefit Committee works cooperatively with others in the community to address the specific health needs identified in the health assessment. The committee consists of hospital employees with diverse expertise from social services to fundraising, direct patient care to community health education. The Community Benefit Committee has developed a strategic plan to address the needs as identified in the assessment and has prioritized the hospital's community programs to address these needs. The Committee is leading the way for Evangelical's future in outreach, aid and support. Hospital personnel were informed of the community needs and prioritized programs conducted in the hospital and the community to assist with addressing these needs. The ACTION Health organization will be conducting the next needs assessment in 2012. Part VI, Line 3: As a community hospital, Evangelical is dedicated to improving the health and well-being of all its constituents. Through the financial assistance program, medical care is provided regardless of a patient's ability to pay, insufficient health insurance or whether a government-sponsored program covers the full cost of services. And as the country's economic future remains uncertain, Evangelical will continue to provide care for those who need it. Evangelical will provide services at no charge or reduced charges to those who are financially unable to pay for those services.Evangelical will not arbitrarily restrict the provisions of health services to certain individuals or groups.Evangelical Community Hospital's Registration Department representatives inform our uninsured or under insured patients, of our financial assistance program. Financial assistance applications are offered to these patient and in addition, they have the opportunity to call our financial counselor. The financial counselor discusses the availability of various government benefits such as Medicaid or state programs to assist the patient with qualifications for these programs. The financial counselor will also assist the patient in completing the proper paperwork for assistance. The financial counselors and case management staff work closely to identify and assist eligible patients. Our self-pay vendor also informs the patient that Evangelical has a financial assistance program and a financial counselor who will send them an application if requested. Our third party vendor works on behalf of the organization to follow the hospital's policies regarding patient notification and the availability of financial assistance. Evangelical's financial assistance policy is posted on the Evangelical Website (http://www.evanhospital.com/services/community_resources/charity_care) along with an application for patients to complete for financial assistance. Evangelical Community Hospital will make available a written notice to each patient or their representative of the existence, criteria and mechanism for receiving Financial Assistance. The Hospital will create and maintain records demonstrating that the required criteria and mechanism are established (Hospital will record any and all requests for Financial Assistance, the disposition and the dollar amount of Evangelical's Financial Assistance Program provided). In all instances, patient confidentiality will be protected.Eligibility will be determined by comparing household family income against the income poverty guidelines. Income is defined as the total annual cash receipts before taxes from all sources.An individual notice of availability of Evangelical's Financial Assistance Program will be given to each patient or their representative prior to services being rendered, with the exception of emergency services. These notices shall be available in all registration areas of the Hospital and shall include the most current available "Household Income Guidelines" as published in the Federal Register.The Patient Accounts Director or his/her designee shall review all applications for the Evangelical Financial Assistance Program. It is the applicant's responsibility to provide proof of income. When language is a barrier, Evangelical offers a special interpreter conferencing telephone service. Interpretation services are available for a multitude of patient/caregiver interactions. When a non-English speaking patient, no matter his or her native tongue, calls in to the Hospital, he or she will be able to be understood through a telephone interpreter. This is available for outbound calls to the patient as well. The process contributes to improved patient care and clinical outcomes and makes a vital difference in the quality of service Evangelical is able to provide to non-English speaking patients. Part VI, Line 4: Evangelical Community Hospital (ECH) is located in Lewisburg, Pa (Union County), the heart of Central PA. The Hospital is conveniently located off Interstate 80 on U.S. Route 15. ECH serves the residents of Union, Snyder & Northumberland counties and surrounding areas. ECH is the 3rd largest employer in Union County with more than 1,200 employees. According to the Hospital and Healthsystem Association of Pennsylvania, ECH's total impact on the regional economy tops more than $180 million. ECH is a 127 licensed-bed acute care community hospital with over 1,200 employees and nearly 200 medical staff members. ECH has a busy emergency department with over 31,500 visits in 2010. ECH has earned the Patient Safety Excellence Award four of the past five years from HealthGrades (a leading national independent healthcare ratings organization) which puts ECH in the top 5% of all hospitals in the country for patient safety, sharing this distinction with only 242 others. The primary service area of residents of ECH includes: 17810, 17812, 17843, 17813, 17730, 17827, 17829, 17831, 17876, 17833, 17835, 17837, 17749, 17842, 17844, 17845, 17847, 17850, 17853, 17855, 17856, 17857, 17861, 17862, 17864, 17865, 17086, 17870, 17801, 17880, 17882, 17772, 17883, 17777, 17886, 17887, 17885, 17889.Our secondary service area is from the following zip codes: 16820, 17866, 17014, 17017, 17821, 17823, 17830, 17737, 17834, 17836, 17045, 17840, 17747, 17832, 17049, 17841, 17062, 17752, 17851, 17756, 17860, 17080, 16872, 17867, 17868, 17872, 17877, 17881, 17884, 16882.The region is home to several colleges, universities and technical schools as well as strong public school systems. It has a very diverse history and rural appeal, yet features business and healthcare facilities using the latest advances in science and technology. Additional hospitals in our region consist of Geisinger Medical Center, Sunbury Community Hospital (for-profit system), Shamokin Area Community Hospital, Susquehanna Health System, and Bloomsburg Hospital. According to most national data collection efforts the region is primarily a rural region. This is confirmed in respondent reports from the needs assessment. About 61% of respondents in the region described their place of residence as rural.Many participants responding to the community needs assessment reported significant barriers to accessing health care in their communities. These were primarily related to lack of health care coverage, lack of understanding about how to navigate the healthcare system and where to go for help, transportation, low income and locating health care providers and paying for services-particularly dental care. City-Data.com for Union County indicates that the population consists of: White Non-Hispanic (87.6%), Black (6.9%), Hispanic (3.9%), Two or more races (1.4%) The median resident age is 35.8. Estimated median household income in 2009: $49,803 Residents with income below the poverty level in 2009: 8.8%Persons enrolled in hospital insurance and/or supplemental medical insurance (Medicare) in July 1, 2003: 6,234 (5,612 aged, 622 disabled); Population without health insurance coverage in 2000: 11%; Children under 18 without health insurance coverage in 2000: 9%89.6% of residents of Union County speak English at home; 3.7% of residents speak Spanish at home; 5.7% of residents speak other Indo-European language at home; 0.8% of residents speak Asian or Pacific Island language at home; 0.2% of residents speak other language at home City-Data.com for Snyder County indicates the population consists of: White Non-Hispanic (97.4%), Hispanic (1.0%), Black (0.8%) The median resident age is 36.7. Estimated median household income in 2009: $44,426 Residents with income below the poverty level in 2009: 9.9%Persons enrolled in hospital insurance and/or supplemental medical insurance (Medicare) in July 1, 2003: 6,148 (5,230 aged, 918 disabled); Population without health insurance coverage in 2000: 9%; Children under 18 without health insurance coverage in 2000: 8%92.0% of residents of Snyder County speak English at home; 1.5% of residents speak Spanish at home; 6.3% of residents speak other Indo-European language at home; 0.2% of residents speak Asian or Pacific Island language at home; 0.1% of residents speak other language at homeCity-Data.com for Northumberland County indicates that the population consists of: White Non-Hispanic (96.6%), Black (1.5%), Hispanic (1.1%), Two or more races (0.6%) Estimated median household income in 2009: $37,602; Residents with income below the poverty level in 2009: 11.9%; Persons enrolled in hospital insurance and/or supplemental medical insurance (Medicare) in July 1, 2003: 19,762 (16,930 aged, 2,832 disabled)Population without health insurance coverage in 2000: 10%; Children under 18 without health insurance coverage in 2000: 8%; 95.6% of residents of Northumberland County speak English at home; 1.5% of residents speak Spanish at home; 2.6% of residents speak other Indo-European language at home; 0.3% of residents speak Asian or Pacific Island language at home; 0.1% of residents speak other language at home ECH operates an Emergency Department that is open to all persons regardless of their ability to pay for services. We have open medical staff with privileges available to all qualified physicians in the area. ECH has a Board of Directors in which independent community persons are represented. ECH is affiliated with healthcare facilities, such as Geisinger Medical Center, to provide the best medical care for our patients. ECH works with the following colleges: Penn College, Central Susquehanna Intermediate Unit, Bloomsburg University, and Thomas Jefferson University to engage in training and education of health care professionals. ECH provides financial aid to support students choosing the nursing profession through the Mae Keefer and Crystal Snyder Nursing Scholarship Fund.ECH participates with the following major health plans: Capital Blue Cross, Geisinger Health Plan, Highmark BlueShield, HealthAmerica/Health Assurance, Keystone Health Plan Central, and Medicare.The Community Needs Assessment summarized the following regarding the demographics and needs of our community: Nearly 39% of respondents were senior citizens; More than half of responses represent households with income of $40,000 per year or less; About one-third of area residents report that their financial circumstances are somewhat or much worse off compared to two years ago; While the educational levels of area residents are generally quite high due to the presence of occupations that require higher levels of education, about 1 out of 9 adults in the region do not have a high school diploma. Those without a high school diploma have a significantly increased risk for unemployment, low income, and housing issues. Most residents have lived in the area for ten or more years. About 8.2% have moved two or more times in the past two years. About two-thirds of households in the region have a computer in their home. Among those with a computer, 74.0% use the computer daily. Senior households are the least likely to report having a computer or using a computer regularly. Community Cohesion - 91% of area residents indicated that they feel safe or very safe at home. Senior residents are somewhat less likely to feel safe in their neighborhoods. Residents who do not feel safe in their neighborhood are less likely to ask for assistance such as a ride to an appointment. Tobacco and Alcohol Use - About 16% of area adults use tobacco products. Two-thirds of these individuals have attempted to stop using tobacco. Most adults in the region have used alcohol at some time in their lives. About 6% of adults reported alcohol use consistent with binge drinking during the past thirty days. One third of those who reported drinking five or more drinks the last time alcohol was consumed had problems associated with drinking such as family or legal problems. Nearly 60% of these individuals believed that they had a drinking problem and nearly half of those who drank five or more drinks the last time they drank were unable to get help when sought during the past year. Prevention and Healthy Lifestyles - Generally, there is a need for increased compliance with prevention and healthy lifestyle practices. It appears that individuals with a chronic health condition are likely to have had many of the screening and prevention procedures that are indicated. However, among those without a diagnosed health condition, and among those who are under age 65 years, there is a much lower rate of compliance with recommended evaluations and prevention activities. SEE SCHEDULE O FOR CONTINUATION Part VI, Line 5: As a fixture in the community for more than eight decades, Evangelical Community Hospital has proven its commitment to the Central Susquehanna Valley. Beyond the daily care and healing of patients, the Hospital extends its reach outside its walls to provide prevention and wellness education to the wider community. Outreach includes charity care, health education, subsidized programs and other benefits that support community partnerships. The Community Benefit Committee was formed in 2010 to track the ways the Hospital gives back and to seek out new and interesting ways to extend its reach. Members with diverse expertise, from social services to fundraising, direct patient care to community health education, the Committee is leading the way for Evangelical's future in outreach, aid and support. Some of the programs included but are not limited to the following:H1N1 prevention, education and immunizations for the business and school community;Community Recycling Event;Opportunity for future healthcare leaders to complete internship programs;Reminder phone calls to community women to schedule their mammograms and programs for those under and uninsured women;In 2010, our Child Safety Seat program replaced 58 faulty seats at no cost to our patients;our Men's and Women's Health Screenings served over 200 men and women who completed a yearly physical exam for minimal fee; scholarships were awarded to those who could not afford the fee; and 250 bike helmets were distributed in the community at no charge. Grant was given to Evangelical for Emergency Preparedness in the amount of $45,196. This will be used for disaster planning and medical equipment and supplies for Disaster Preparedness at Evangelical. The grant will be used to train staff in disaster preparedness. An ample supply of tamiflu was purchased in 2010 to combat the H1N1 influenza. Additionally monies were used to renovate the Haz-Mat Room in the Emergency Department. The Center for Breast Health received $25,000 in grant monies to contact women in the Lycoming County area and encourage them to schedule their mammogram. The grant was funded by the Williamsport Lycoming Community Foundation. This money will also help to provide free mammograms to uninsured or underinsured women in Lycoming County. Additionally, The Center received the Susan G. Komen Grant, in the amount of $20,000 to help meet the needs of the underinsured women in our community that qualified for a mammogram or diagnostic breast studies. More than 200 women participated in this program. The American Cancer Society provided the hospital with $1000 grant for the I Can Cope for the Breast Cancer Survivor. The Hospital's Cancer Committee identified lack of area resources for "cancer survivors". The I Can Cope program provided the twenty women with a 4-week program in educating them on community resources and living with breast cancer. In 2010, Evangelical Community Hospital has kicked off a multi-million-dollar construction project that will expand and renovate its current operating rooms to accommodate some of the most up-to-date and advanced surgical technologies. The expansion also will include an addition to the Hospital's cardiovascular services and support to introduce interventional cardiac procedures at Evangelical Community Hospital. Grants to support this project included the following: The Stabler Foundation $200,000; Charles Foundation $25,000; Ralph and Josephine Smith Fund at the First Community Foundation; $25,000. The new surgical suite will be built bringing the total number of operating rooms from six to eight. Each of the eight rooms will be 63 percent larger than the current ORs. Space currently occupied by the existing operating rooms will be renovated and will provide for much-needed support services such as locker rooms, physician consultation areas, and storage.In 2009, the Hospital introduced some new surgical procedures including an ear, nose, and throat (ENT) procedure called balloon sinuplasty for sinusitis sufferers, total laparoscopic hysterectomies for gynecological patients, and gastric banding surgery for severely overweight patients. Within the next few months we will begin performing radiation seed implant surgery for prostate cancer patients. In total our surgeons performed 5,574 procedures in 2009. The Central Susquehanna Valley United Way and Lou Harris Funds granted the hospital $6,000, towards hospice patient care and funds for families who were unable to pay for their care. The Sixth Annual Tell-A-Friend Mammathon, a joint effort between Evangelical Community Hospital's Thyra M. Humphreys Center for Breast Health and the American Cancer Society, placed over 6,400 calls. During the event, 197 women made appointments at the Center for Breast Health for their annual mammogram, and nearly 2,000 made a commitment to schedule their exams either at the Center or at another facility. Roche Pharmaceuticals provided $2,000 to assist with the program costs. State Farm and Evangelical work together each year to educate families and inspect child safety seats through their Child Seat Safety Program Day held at our local shopping mall. $1,800 was given to Evangelical to replace more than eighteen outdated and unsafe seats to families as well as provide them with educational materials.Evangelical Community Hospital was pleased to be the first hospital in the nation, and the first organization in Pennsylvania, to offer Germ City. "Germ City: Clean Hands, Healthy People" uses an entertaining technique to help children, parents and teachers look differently at an invisible problem: germs. The hands-on experience lets everyone examine the effects of improper hand washing in a new light. The focal point of the Germ City program is a large, walk-through tunnel equipped with black lights. Participants apply black-light-sensitive lotion and enter the tunnel, seeing pretend germs on their hands. After initial observation, participants wash their hands normally, re-visit Germ City, and assess the effectiveness. Sometimes they are pleased with their hand washing; other times they are not. It's a "hands-on" experience. Everyone has an opportunity to learn about the importance of frequent, effective hand washing and see immediate results. More than 4,000 students in the local schools were educated on proper hand washing and traveled through Germ City.$25,000 was given to the hospital from The Degenstein Foundation. The monies were use for hospital medical equipment-glide scope, stretcher, bladder scanner, and reference materials for health care professional education.PPL Electric Company gave the Hospital a $24,000 grant for improvements in the hospital security system and to purchase the C-Cure 9000 Security Management System. This technology will be used to restrict access to certain areas of the hospital. Part VI, Line 6: Evangelical has a total of 127 patient beds and 18 bassinets. There are nearly 200 physicians on the Medical Staff, and nearly 900 clinical employees, including lab technicians, nurses and nursing assistants, physical, occupational and speech therapists, radiology technicians, phlebotomist, and countless other personnel, highly trained and expertly skilled to give you the best possible care, both on an inpatient and outpatient basis. The hospital:1. Has an open medical staff with privileges available to all qualified physicians in the area. Evangelical has nearly 200 employed and non-employed physicians on its medical staff. 2. Has a governing body in which independent persons representative of the community 3. Operates an Emergency Department that is open to all persons regardless of their ability to pay for services.4. Is affiliated with health care facilities, such as Geisinger Medical Center, to provide the best medical care for our patients.5. Has a Board of Directors made up of people who reside within the community they serve and volunteer their time because of their concern for the hospital and the community7. Created a Bio ethics Committee which is composed of volunteer members of the medical field, nursing, social service, pastoral care staffs and other health care professionals within the Hospital, as well as volunteers from the community at large8. Supports the hospital plant by using surplus funds through the operational and capital budget process to enhance/maintain the facility to meet current governmental required safety codes.9. Fundraises through the hospital's development department. The fundraising provides programming such as the Child Safety Seat program along with the major renovations such as Surgical and Cardiac expansion project. 10. "Speakers Bureau" is to provide the community with an opportunity to become better acquainted with our physicians and staff members and to become better educated in health-oriented topics. Members of Evangelical's "Speakers Bureau" are available to provide a wide range of interesting programs regarding health information, health care advances, or health education and career opportunities for any group, large or small, service club, church group or business organization. Our speakers include physicians, nurses, social workers, therapists and other Hospital staff members. 11. Evangelical Community Hospital participates with five area community hospitals, including Evangelical Community Hospital, and two universities to identify community needs and addresses the community concerns. 11. "Community Health Education" at Evangelical Community Hospital is devoted to prevention, early intervention and health education--the forerunners of health care today. "Community Health Education" provides an array of health screenings, health fairs, lectures and support groups. We offer programs for people of all ages including children, parents, parents-to-be and grandparents. Evangelical is committed to "taking care of our community" and believes that by enhancing awareness and creating an environment that supports good health practices, we can make a difference in many lives today and in the future. Among our many activities in a year, "Community Health Education" provided more than 2,500 flu vaccinations. 1,400 children and their families attended the Annual Children's Health Fair. These are only a few of the activities held each year to not only make community members' lives healthier and fuller but also to help save them. Through our programs we are able to identify persons at risk for a stroke, heart attack, diabetes, prostate cancer and breast cancer, as well as other health risks or injuries.12. The Thyra M. Humphreys Center for Breast Health at Evangelical Community Hospital is a comprehensive, multi disciplinary breast care program, offering a full spectrum of clinical and support services, from screening and diagnosis to treatment and counseling. The Center provides innovative, integrated, high quality care delivered in an atmosphere that has been designed with women in mind. Part VI, Line 7: The organization is part of an affiliated health care system due to the Hospital having common governance and control for Evangelical Medical Services Organization and Evangelical Community Hospital Pharmacy & Homecare Products. Evangelical Medical Services Organization provide healthcare services in the form of Primary and Specialty Care physician's to the community. Homecare Pharmacy provided an outpatient pharmacy service to the community until it's closure in October 2009. Homecare Products provide durable medical equipment and oxygen to the support the community needs. PA 1 X NURSING SCHOLARSHIPS 11 20500 FMV N/A X X X X 1 1 0 0 0 0 0 0 0 MICHAEL N O'KEEFE 259789 0 0 0 0 0 38272 0 40704 0 338765 0 0 0 CHRISTINE M MARTIN 175600 0 0 0 0 0 23768 0 29614 0 228982 0 0 0 J LAWRENCE GINSBURG 329001 0 0 0 0 0 44622 0 55394 0 429017 0 0 0 Richard E Smith Jr 156165 0 0 0 0 0 20698 0 26776 0 203639 0 0 0 kendra A aucker 158532 0 0 0 0 0 8386 0 39808 0 206726 0 0 0 MARK K KRAMMES 237441 0 0 0 0 0 0 0 72182 0 309623 0 0 0 LORI K GOODLING 221665 0 0 0 0 0 0 0 67386 0 289051 0 0 0 RAYMOND J TOMASZEWSKI 205363 0 0 0 0 0 0 0 62430 0 267793 0 0 0 BRADLEY P BOWER 202589 0 0 0 0 0 0 0 61587 0 264176 0 0 0 sandra s walker 229115 0 0 0 0 0 0 0 69651 0 298766 0 0 0 SCOTT W PETERSON 267711 0 0 0 0 0 0 0 0 0 267711 0 0 0 Part I, Line 4a Scott W. Peterson received $77,303 of severence payments. Michael P. Pierce received $ 53,568 of payment from a supplemental nonqualified retirement plan. Scott W. Peterson received $135,716 of payment from a supplemental nonqualified retirement plan. union county hospital authority 232739624 906460CU2 2009-05-01 12795000 SERIES OF 2009 BONDS - FUND CONSTRUCTION & RENOVATIONS PROJECTS 0 0 union county hospital authority 232739624 906460CT5 2004-08-01 23660000 SERIES OF 2004 BONDS - FUND CONSTRUCTION & RENOVATIONS PROJECTS 0 0 12795000 12795000 2001 1 0 1 1 23660000 1753500 6868000 15038500 2004 1 1 1 1 0 0 0 0 0 0.00000 0.00320 0.00320 1 0 0 0 0 0 0.00000 0.00320 0.00320 1 0 1 0 0 0 0 0 0 0 0 0 0 JOHN D GRIFFITH DIRECTOR OF THE BOARD 420530 JOHN D. GRIFFITH LEASES PROPERTY TO THE HOSPITAL AT AN ARM'S LENGTH TRANSACTION. 0 JAMES W MORGAN JR MD DIRECTOR OF THE BOARD 245975 PAYMENT OF COMPENSATION 0 MARK VAN BLARGAN ESQ SOLICITOR 235000 MARK VAN BLARGAN WORKS AT MCNEES, WALLACE AND NURICK WHO PROVIDE LEGAL SERVICES TO THE HOSPITAL. THESE TRANSACTIONS ARE PROVIDED ON AN ARM'S LENGTH BASIS. 0 0 X 1 5000 FMV X Advertisement Space 2 15313 FMV X flowers 2 12500 FMV X Accomodations 1 8400 fmv X Fundraising prizes 176 48048 fmV 0 0 0 0 Form 990, Part III, line 3 Changes in Program Services Home Health ceased operations in November 2009. Form 990, Part VI, Section A, line 2 James Apple is the father of Tim Apple and both serve on the board. Robert Gronlund is the father of Brooks Gronlund and both serve on the board. Form 990, Part VI, Section B, line 11 Form 990 was reviewed by the Finance Department with the Audit Committee at an Audit Committee meeting prior to filing. Form 990, Part VI, Section B, line 12c A CONFLICT OF INTEREST STATEMENT IS REQUIRED TO BE SIGNED ANNUALLY BY ALL VOTING BOARD MEMBERS, UPPER MANAGMENT, AND KEY EMPLOYEES. THE HUMAN RESOURCES DEPARTMENT MONITORS COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY BY VERIFYING ALL FORMS ARE COMPLETED AND SIGNED. HR MAINTAINS COPIES OF ALL COMPLETED CONFLICT OF INTEREST STATEMENTS. MEMBERS WITH CONFLICTS ARE REQUIRED TO ABSTAIN FROM VOTING A BEING A PART OF ACTIVE DISCUSSIONS WHERE THEY ARE IN DIRECT CONFLICT. ANYONE IN VIOLATION OF THE CONFLICT OF INTEREST POLICY IS ASKED TO STEP DOWN FROM THE BOARD. Form 990, Part VI, Section B, line 15 The Board's Executive Compensation Committee, which is composed solely of independent members of the Board, has adopted and follows a process for reviewing and determining the compensation of the CEO and the executive management team. The executive management team consists of the following positions: Chief Operating Officer, Chief Financial Officer, Vice President of Medical Affairs, Vice President, Nursing, Vice President, Development, Vice President, Human Resources, Chief Information Officer, Vice President, Subsidiary Operations. The Committee has engaged an independent compensation consultant to provide information and advice to the Committee, including but not limited to, providing independent compensation comparability data for functionally comparable positions in similarly situated hospitals. The data is provided on an annual basis and is reviewed by the Committee, along with other information, prior to approving any changes to compensation. The independence of the Committee's members is reviewed and verified prior to the start of the annual compensation review process. Should a conflict present, those individuals with actual or perceived conflicts abstain from voting until such time as the conflict can be resolved or a replacement member is appointed to the Committee. The Committee's deliberations and decisions are guided by a written compensation philosophy and documented through written minutes taken during each meeting. The minutes include, among other things, the written materials distributed or presented during the meeting and the specific decisions taken at the meeting. 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 H, PART VI, LINE 4 Additionally, those who have no health insurance are less likely to have these prevention and screening procedures: * Influenza vaccines were more likely among seniors and those with insurance. * Less than two-thirds of adults who do not have hypertension (high blood pressure) reported a blood pressure check in the past year. * Most young adults did not plan to get the H1N1 vaccine during the height of the influenza outbreak. * About 37% of area adults do not exercise regularly each week. An additional one-third exercise one to three days each week. While the remaining 31% exercise four or more days each week. * Most residents report walking as their usual exercise. Thus, promoting healthy walkable communities should be an important public health agenda item for the region. * Household income was associated with the ability to afford a healthy diet. Nearly 7% of low income families are often or very often unable to afford a healthy diet. Households with children were more likely to report that they could not afford fresh fruits and vegetables. Health Status The most prevalent chronic health conditions reported by adults included: High blood pressure Arthritis Diabetes Anxiety and depression Heart disease High blood pressure is most prevalent among adults over the age of 44 years, while anxiety and depression is most prevalent among 18-44 year olds. About 13% of respondents met criteria for serious psychological distress. These individuals may have need for treatment for conditions such as depression or anxiety. Access to Health Care and Health Information About 90% of area residents have a usual source of health care. However, among those residents who do not have health insurance, nearly 41% reported that they did not have a usual source of care. More than 5% of area residents are unable to afford prescribed medicines often or very often. Uninsurance status reduces the likelihood that a resident of the area will have seen a health care provider in the past two years. Most area residents obtain health information from their health care provider. However, more than 40% obtain some health information from the internet. Community Problems The most significant community problems noted by area residents included: Unemployment Domestic violence Child abuse Drug abuse Underage drinking Affordable childcare Personal and Household Needs during the past year Among the services or assistance that area residents were reported having difficulty accessing was: * Paying for prescription medication, mental health services, dental care, and medical care. * Finding mental health care, substance abuse treatment, dental care, medical care and childcare. * Locating or applying for social services, food pantry and other food assistance, heating assistance, legal assistance, and adult Access. Conclusion Themes across the focus groups, interviews and surveys were similar. There is considerable work to be done by area agencies and organization. There is a significant need for health and wellness education and support and promotion of wellness education and physical activity. A very clear need is present in helping area residents navigate the health care and social service system. There is no clear road map for area residents in locating services. For example, there is not a listing in the phone book or on the internet for food banks. The greatest needs appear to be in obtaining health and dental care for low income and uninsured residents. The problem is a multi-level problem that begins with locating providers and is closely followed by negotiating payment strategies for services. It is unlikely that these problems can be resolved by one organization but may offer opportunities for partnership across many organizations. Prevention and education for substance use disorders and tobacco use is one of many issues that will require the development of strategies for reaching many different constituencies. A frequently noted concern in the focus groups was that a minority population was not reached by existing services. These populations included seniors, teens, immigrant populations, and others. Education for consumer issues as well as health issues cannot be assumed to be "one size fits all" and must be tailored to populations of need. Evangelical is collaborating with area hospitals-through "ACTION Health" along with several community organizations to use this data to develop partnerships for meeting the needs of area residents. Our strategic plan calls for expanding programs and services to address Community needs and growing outreach efforts to under served communities. 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