2013-11-14T15:32:04-06:00 2012-12-31 232932984 PARENTEBEARD LLC 1650 MARKET STREET SUITE 4500 PHILADELPHIA PA 19103 990 2012-01-01 232720289 ENDLESS MOUNTAINS HEALTH SYSTEMS INC ENDL 5702783801 25 GROW AVENUE MONTROSE PA 18801 REXFORD O CATLIN 5702783801 2013-11-14 1 JULIUS GREEN CPA P00350393 2159720701 2013-11-11 2012 2016-02-25 16:41:14Z REXFORD O CATLIN 25 GROW AVENUE MONTROSE PA 18801 18210205 0 X WWW.ENDLESSCARE.ORG X 1992 PA OPERATES A NOT-FOR-PROFIT ACUTE CARE HOSPITAL LOCATED IN MONTROSE, PENNSYLVANIA. 14 10 231 10 0 0 266065 2215426 15190108 15858833 11032 14651 53956 119292 15521161 18208202 0 0 0 0 6754901 7335488 0 0 0 8368488 8382561 15123389 15718049 397772 2490153 8215613 21825216 3705414 14824030 4510199 7001186 X THE ENDLESS MOUNTAINS HEALTH SYSTEMS ("EMHS") IS A NOT-FOR-PROFIT CORPORATION COMMITTED TO THE OPERATION AND DEVELOPMENT OF A HEALTH SYSTEM WHICH WILL PROVIDE OPTIMUM CARE WITHIN THE SCOPE OF ITS ABILITIES. THE KEY ELEMENTS IN THE EMHS PROCESS ARE QUALITY, SERVICE, SAFETY, COST, FLEXIBILITY, AND ACCESS. 0 0 14696338 15858833 OPERATED A NOT-FOR-PROFIT ACUTE CARE HOSPITAL WHICH PROVIDES INPATIENT, OUTPATIENT, AND EMERGENCY CARE SERVICES. DURING THE YEAR ENDED DECEMBER 31, 2012, PATIENT DAYS WERE 2,820, PRIMARY CARE VISITS WERE 38,385, AND EMERGENCY DEPARTMENT VISITS WERE 4,325.EMHS ALSO PROVIDED CHARITY CARE TO PATIENTS WHO MET CERTAIN CRITERIA. CHARGES FORGONE FOR SERVICES RENDERED AND SUPPLIES FURNISHED UNDER THE CHARITY CARE POLICY AMOUNTED TO APPROXIMATELY $33,000 IN 2012. 14696338 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 1 0 1 0 0 0 0 0 1 0 0 0 1 16 0 1 231 1 0 0 0 0 0 0 0 0 0 0 X 14 10 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 PA X LOREN STONE 5702783801 25 GROW AVENUE MONTROSE PA 18801 ROBERT COY 1.00 X 0 0 0 IHAB DANA 50.00 X 557919 0 0 MICHAEL GIANGRIECO 1.00 X 0 0 0 MARGARET MARGIE GREEN 1.00 X 0 0 0 ROBERT HOUSEL 1.00 X 0 0 0 PAUL A KELLY 1.00 X 0 0 0 ROGER DOOLITTLE 1.00 X 0 0 0 LARRY SOUDER 1.00 X 0 0 0 JOSEPH SPEICHER 1.00 X 286792 0 0 RAY WILMARTH JR 10.00 1.00 X X 0 0 0 ALLYN HINDS 1.00 X X 0 0 0 CHRIS CATERSON 10.00 X X 0 0 0 REXFORD CATLIN 49.00 1.00 X X 92679 0 12814 BARRY BERKOWITZ 1.00 1.00 X 0 0 0 LOREN STONE 49.00 1.00 X 84166 0 13519 1021556 0 26333 2 0 1 0 IHAB DANA MD 3 GROW AVENUE MONTROSE PA 18801 MEDICAL SERVICES 557919 JOSE ENRIQUE NAZAR MD 3 GROW AVENUE MONTROSE PA 18801 MEDICAL SERVICES 491500 HASSAN KHALIL MD 3 GROW AVENUE MONTROSE PA 18801 MEDICAL SERVICES 442792 LANG PAO SU MD 3 GROW AVENUE MONTROSE PA 18801 MEDICAL SERVICES 362554 SHASHANK BHATT MD 3 GROW AVENUE MONTROSE PA 18801 MEDICAL SERVICES 286998 7 250480 428795 1536151 2215426 NET PATIENT SVC REV 623000 15833310 15833310 PREMIUM REVENUE 623000 25523 25523 15858833 10150 10150 41619 2003 39616 39616 39616 4501 0 4501 4501 4501 MA MODERNIZATION 624310 51548 51548 PHYSICIAN PFP 624310 14211 14211 CRYSTELLA MEMBERSHIPS 624310 13917 13917 79676 18208202 15858833 0 133943 X 1047889 844711 203178 4813246 4540774 272472 1058417 1001217 57200 415936 383906 32030 543 543 56955 56955 1870 1870 3248000 3184454 63546 2757 2676 81 2442093 2252506 189587 244774 217962 26812 31567 31567 359316 359316 134179 134179 BAD DEBT EXPENSE 938407 938407 DRUGS 372862 372862 REPAIRS & MAINTENANCE 265853 265853 MEANINFUL USE IMPLEMENT 77891 77891 205494 165948 39546 15718049 14696338 1021711 0 300 300 458680 1114128 2205667 2293741 355802 327738 34009 35892 19946480 4281114 4304773 15665366 798273 1191762 58109 1196289 8215613 21825216 1189208 5483835 1670835 0 458543 9031367 197000 250000 189828 58828 3705414 14824030 X 4504236 6445223 5963 555963 4510199 7001186 8215613 21825216 2490153 834 0 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 1870 1870 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: A PORTION OF THE ORGANIZATION'S DUES PAID TO THE HOSPITAL ASSOCIATION OF PENNSYLVANIA ("HAP") ARE USED FOR LOBBYING PURPOSES. 183786 183786 1547857 932891 614966 4627490 3317488 1310002 13587347 30735 13556612 15665366 DEFERRED FINANCING COSTS 115741 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 1080548 1196289 WORKING CAPITAL ADVANCE 58828 58828 X 18211039 834 834 18210205 -2003 -2003 18208202 15720052 2003 2003 15718049 0 15718049 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: THE HOSPITAL AND FOUNDATION ARE NOT-FOR-PROFIT CORPORATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND ARE EXEMPT FROM FEDERAL INCOME TAXES ON THEIR EXEMPT INCOME UNDER SECTION 501(A) OF THE INTERNAL REVENUE CODE. THE CORPORATION ACCOUNTS FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN A COMPANY'S FINANCIAL STATEMENTS AND PRESCRIBES A RECOGNITION THRESHOLD OF MORE-LIKELY-THAN-NOT TO BE SUSTAINED UPON EXAMINATION BY THE APPROPRIATE TAXING AUTHORITY. MEASUREMENT OF THE TAX UNCERTAINTY OCCURS IF THE RECOGNITION THRESHOLD HAS BEEN MET. MANAGEMENT DETERMINED THERE WERE NO TAX UNCERTAINTIES THAT MET THE RECOGNITION THRESHOLD IN 2012 AND 2011. THE CORPORATION'S FEDERAL EXEMPT ORGANIZATION BUSINESS INCOME TAX RETURNS FOR YEARS PRIOR TO 2009 NO LONGER REMAIN SUBJECT TO EXAMINATION BY THE IRS. PART XI, LINE 4B - OTHER ADJUSTMENTS: RENTAL EXPENSES -2,003. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 2,003. 1 1 1 X 1 X 1 1 1 0 0 35127 35127 0.00210 246851 246851 0.01480 281978 281978 0.01690 258402 162504 95898 0.00580 11210 11210 0.00070 269612 162504 107108 0.00650 551590 162504 389086 0.02340 1 938407 195741 4406038 4362414 43624 X 1 1 1 1 ENDLESS MOUNTAINS HEALTH SYSTEMS INC

3 GROW AVENUE MONTROSE PA 18801

X X X X ENDLESS MOUNTAINS HEALTH SYSTEMS INC 1 1 1 100.000000000000 1 200.000000000000 1 X 1 1 X X X 1 X X 1 X X X 1 X 0 0 PART I, LINE 7: GLOBAL COST TO CHARGE RATIO WAS UTILIZED TO COMPUTE COST OF CHARITY CARE PROVIDED. ALLOWABLE COST DIVIDED BY TOTAL CHARGES. PART I, LINE 7G: INCLUDED IN THE SUBSIDIZED HEALTH SERVICES ARE COSTS ATTRIBUTABLE TO A PHYSICIAN CLINIC. TOTAL PHYSICIAN CLINIC COSTS WERE $135,316. PART I, L7 COL(F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $938,407. PART II: EMHS AND ITS STAFF SUPPORT LOCAL HEALTH SERVICE AND COMMUNITY SERVICE PROJECTS. THE STAFF OF EMHS CONTRIBUTE BOTH THEIR TIME AND FINANCIALLY TO THE SUSQUEHANNA COUNTY LIBRARY, AMERICAN CANCER SOCIETY, UNITED WAY, AND OTHER WORTHWHILE CAUSES. EMHS WORKS WITH LOCAL EMS PROVIDERS IN PREPARATION FOR NATURAL DISASTERS AND MASS CASUALTY SITUATIONS. EMHS SUPPORTS THE CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM AND PROVIDED ITS STARTUP TRAINING FUNDING. THE AT-RISK ELDERLY AND LOW-INCOME POPULATIONS OF SUSQUEHANNA COUNTY AND SURROUNDING COUNTIES IS BETTER SERVED BY HAVING EMHS AS A PARTNER WITH MULTIPLE SOCIAL SERVICE, EMERGENCY RESPONSE, AND HUMAN SERVICE AGENCIES. PART III, LINE 4: ACCOUNTS RECEIVABLE, PATIENTS 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 IS ESTIMATED BASED UPON A PERIODIC REVIEW OF THE ACCOUNTS RECEIVABLE AGING, PAYOR CLASSIFICATIONS AND APPLICATION OF HISTORICAL WRITE-OFF PERCENTAGES. COST IS BASED ON THE OVERALL COST-TO-CHARGE RATIOS DEVELOPED FROM THE HCFA 2552-96. DISCOUNTS AND PAYMENTS ARE NETTED AGAINST ANY CHARGES BEFORE THE ACCOUNT IS WRITTEN OFF TO BAD DEBT. PART III, LINE 8: DUE TO EMHS' STATUS AS A CRITICAL ACCESS HOSPITAL (CAH), THERE IS NO SHORTFALL FOR MC REIMBURSEMENT PURPOSES. HCFA 2552-96. PART III, LINE 9B: COLLECTIONS ARE PURSUED UP TO THE POINT THAT A PATIENT COMPLETES AND IS APPROVED FOR CHARITY CARE. ONCE CHARITY CARE IS APPROVED, NO FURTHER COLLECTION EFFORTS ARE MADE. ENDLESS MOUNTAINS HEALTH SYSTEMS, INC. PART V, SECTION B, LINE 20D: THE FACILITY CHARGES ALL PATIENTS THE SAME AMOUNT. ANY DISCOUNTS ARE APPLIED TO GROSS CHARGES. ENDLESS MOUNTAINS HEALTH SYSTEMS, INC. PART V, SECTION B, LINE 22: IT IS OUR POLICY TO CHARGE ALL PATIENTS THE SAME RATE REGARDLESS OF INSURANCE OR SELF-PAY STATUS. PART VI, LINE 2: HEALTHCARE NEEDS ASSESSMENT IS ASSESSED BY DISCUSSIONS WITH PATIENTS, PHYSICIANS, AND COMMUNITY MEMBERS. PATIENT REFERRALS ARE ALSO REVIEWED TO DETERMINE QUANTITY AND TYPE OF UNMET NEEDS. PART VI, LINE 3: PATIENTS ARE INFORMED VIA WRITTEN POSTINGS AT THE INTAKE AREA AND FACE-TO-FACE AND TELEPHONE CONSULTATION WITH FINANCIAL SUPPORT STAFF. PART VI, LINE 4: ENDLESS MOUNTAINS HEALTH SYSTEMS PROVIDES SERVICE TO RESIDENTS OF SUSQUEHANNA COUNTY AND PARTS OF WYOMING, BRADFORD, LACKAWANNA COUNTIES IN PENNSYLVANIA AS WELL AS PORTIONS OF BROOME COUNTY NY. SUSQUEHANNA COUNTY'S POPULATION OF OVER 65 RESIDENTS IS 17.1% WITH 13.8% OF THE RESIDENTS LIVING BELOW THE POVERTY LEVEL (BASED ON 2009 PA COUNTY FACT SHEET). PART VI, LINE 5: EMHS HAS AN OPEN MEDICAL STAFF, A BOARD COMPOSED OF COMMUNITY MEMBERS FROM THE AREAS IT SERVES, UTILIZES INCOME TO FURTHER ITS PROVISION OF SERVICE AND ABILITY TO INCREASE THE AVAILABILITY OF MEDICAL CARE TO THE COMMUNITY. PART VI, LINE 6: N/A X X 0 0 0 0 0 0 0 0 0 IHAB DANA 557919 0 0 0 0 0 0 0 0 0 557919 0 0 0 JOSEPH SPEICHER 286792 0 0 0 0 0 0 0 0 0 286792 0 0 0 ALLYN HINDS VICE CHAIRMAN OF THE BOARD OF DIRECTORS 13727 EMHS PURCHASES HEATING OIL AT FMV FROM HINDS ENERGY OF WHICH ALLYN HINDS IS A PRINCIPAL. 0 FORM 990, PART VI, SECTION B, LINE 11 THE DRAFT REPORT WILL BE DISTRIBUTED TO THE EXECUTIVE COMMITTEE OF THE BOARD FOR REVIEW AND COMMENT. THE ENTIRE BOARD IS DISTRIBUTED A COPY OF THE RETURN PRIOR TO ISSUANCE. FORM 990, PART VI, SECTION B, LINE 12C ENDLESS MOUNTAINS HEALTH SYSTEMS REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY BY BEING FAMILIAR WITH ANY CONFLICTS THAT EACH BOARD MEMBER IDENTIFIES ON HIS/HER ANNUAL CONFLICT OF INTEREST STATEMENT. THE EXECUTIVE ADMINISTRATIVE ASSISTANT ENSURES THE COMPLETION OF THE CONFLICT OF INTEREST POLICY BY THE BOARD MEMBERS AND CEO REVIEWS THE COMPLETED FORM AND EVALUATES ANY ISSUES NOTED. EACH BOARD MEMBER IS REQUIRED TO IDENTIFY ANY POTENTIAL CONFLICTS THAT MAY ARISE IN THE COURSE OF THEIR DUTY AS A DIRECTOR AND WILL NOT BE COUNTED AS A VOTE FOR THE ITEM AND WILL BE ASKED TO WITHDRAW FROM THE ROOM AND DISCUSSION AS LONG AS THE ITEM BEING DISCUSSED IS A CONFLICT. FORM 990, PART VI, SECTION B, LINE 15 WAGE SURVEYS OF COMPARABLE FACILITIES ARE USED BY THE BOARD IN DETERMINING EXECUTIVE COMPENSATION. THE ORGANIZATION REVIEWS OTHER CRITICAL ACCESS HOSPITAL 990S AND PA CRITICAL ACCESS WAGE AND SALARY SURVERY. THE ORGANIZATION USES THIS DATA TO DETERMINE FAIR MARKET VALUE OF SALARIES WHEN SALARY INCREASES ARE CONSIDERED AND ALSO AT RANDOM INTERVALS. THE PROCESS IS DOCUMENTED IN THE BOARD MINUTES AND THE EMPLOYEE PERSONNEL FILES. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. OTHER FEES FORM 990, PART IX, LINE 11G MED SURG PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 15,467. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 15,467. ER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 353,010. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 353,010. LAB PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 238,029. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 238,029. ANESTHESIA PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 514,398. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 514,398. RADIOLOGY PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 86,160. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 86,160. PHARMACY PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 51,510. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 51,510. THERAPY PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 35,711. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 35,711. CLINIC PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 1,887,658. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,887,658. MISC PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 2,511. MANAGEMENT AND GENERAL EXPENSES 314. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,825. CONSULTING SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 63,232. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 63,232. FORM 990, PART XI, LINE 2C: THE ORGANIZATION HAS A COMMITTEE THAT ASSUMES RESPONSIBILITY FOR OVERSIGHT DURING THE AUDIT AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. ENDLESS MOUNTAINS MEDICAL CARE FOUNDATION 3 GROW AVENUE MONTROSE PA 18801 232934943 PROVIDES FINANCIAL SUPPORT TO ENDLESS MOUNTAINS HEALTH SYSTEMS, INC. PA 501(C)(3) 11A N/A 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ENDLESS MOUNTAINS MEDICAL CARE FOUNDATION C 250480 CASH