2024-11-15T12:54:56-05:00 2023-12-31 920460586 PWC US TAX LLP 2001 MARKET ST SUITE 1800 PHILADELPHIA PA 19103 990 2023-01-01 231352187 GEISINGER-LEWISTOWN HOSPITAL GEIS 5702716624 100 N ACADEMY AVE MC 49-70 DANVILLE PA 178229800 KEVIN V ROBERTS MBA CPA EVP, CFO, TREASURER 5702716624 2024-11-14 false ROBERT W FRIZ P00438748 2673303000 2024-11-15 2023 2024-10-15 13:58:12Z TERRY GILLILAND MD JD 100 N ACADEMY AVE MC 22-01 DANVILLE PA 178229800 238487629 false X WWW.GEISINGER.ORG X 1905 PA STRIVE TO MAKE BETTER HEALTH EASIER BY PROVIDING ACCESS TO AFFORDABLE, HIGH QUALITY HEALTH SERVICES THROUGH EQUITABLE, INNOVATIVE, AND INCLUSIVE CARE MODELS THAT SUPPORT PATIENT CARE, EDUCATION, RESEARCH, & COMMUNITY SERVICE. 7 4 1226 42 3455 61774 7168233 198321709 229529704 1259893 274468 1115500 1515224 200758876 238487629 0 0 71333050 79578385 0 0 112167573 126447861 183500623 206026246 17258253 32461383 110202932 122972539 50856058 54451473 59346874 68521066 X STRIVE TO MAKE BETTER HEALTH EASIER BY PROVIDING ACCESS TO AFFORDABLE, HIGH QUALITY HEALTH SERVICES THROUGH EQUITABLE, INNOVATIVE, AND INCLUSIVE CARE MODELS THAT SUPPORT PATIENT CARE, EDUCATION, RESEARCH, & COMMUNITY SERVICE. false false 195103238 230412607 I. GENERAL INFORMATION GEISINGER-LEWISTOWN HOSPITAL (GLH), A 501(C)(3) NOT-FOR-PROFIT CORPORATION AND MEMBER OF GEISINGER, OWNS AND OPERATES A 133-BED ACUTE CARE HOSPITAL IN LEWISTOWN, PA. GLH IS CONVENIENTLY LOCATED ONLY A FEW MILES FROM SEVERAL CENTRAL PENNSYLVANIA MAJOR HIGHWAYS. THE FACILITY OPENED IN 1905 IN RESPONSE TO A PRESSING NEED FOR HEALTH AND WELLNESS CARE IN THE COMMUNITY. IN 2023, GLH WAS RATED A 5-STAR HOSPITAL IN PATIENT SAFETY AND QUALITY BY CMS. THE HOSPITAL STAR RATING SYSTEM, ALSO A MEASURE OF PATIENT EXPERIENCE, ALLOWS CONSUMERS OF HEALTH CARE TO EASILY ASSESS THE PATIENT EXPERIENCE OF CARE INFORMATION PROVIDED ON THE HOSPITAL COMPARE WEBSITE. GLH ALSO ACHIEVE LEAPFROG A STATUS WHICH EVALUATED THE SAFETY AND QUALITY OF HEALTHCARE FACILITIES IN THEIR COMMUNITY. GENERAL MEDICAL CARE IS PROVIDED BY IN-HOUSE HOSPITALISTS AND SUPPORTED BY CONSULTATIVE SERVICES IN THE AREAS OF CARDIOLOGY, INFECTIOUS DISEASE, NEUROLOGY, PULMONOLOGY, ORTHOPEDICS, HEMATOLOGY/ONCOLOGY, OTOLARYNGOLOGY, AND GASTROENTEROLOGY. A FULLY-STAFFED SURGICAL SERVICES SUITE OFFERING SIX OPERATING ROOMS EQUIPPED FOR VARIOUS TYPES OF INPATIENT AND OUTPATIENT GENERAL AND SPECIALTY SURGICAL PROCEDURES, INCLUDING ROBOTIC ASSISTED CASES. AN ENDOSCOPY AMBULATORY SURGICAL CENTER, OPERATING AS HOSPITAL OUTPATIENT SITE, IS ALSO AVAILABLE FOR OUTPATIENT ENDOSCOPIC PROCEDURES. A MULTI- SPECIALTY ADULT AND PEDIATRIC AMBULATORY SURGICAL CENTER OPERATING AS A HOSPITAL OUTPATIENT SITE AT THE STATE COLLEGE HEALTHPLEX WAS ADDED IN JULY 2022. THIS SITE INCLUDES FOUR OPERATING ROOMS, FOUR ENDOSCOPY SUITES, AND TWO INTERVENTIONAL PAIN ROOMS. THE EMERGENCY DEPARTMENT (ED) IS COMMITTED TO PROVIDING HIGH QUALITY, PROMPT EMERGENCY SERVICES. GLH'S ED IS STAFFED 24/7 WITH FULL-TIME PHYSICIANS AND NURSES WHO ARE TRAINED IN ALL SPECIALTIES FROM PEDIATRICS TO CRITICAL CARE. IMMEDIATE ACCESS IS AVAILABLE TO LABORATORY SERVICES; IMAGING SERVICES SUCH AS CT SCANS, ULTRASOUND AND MRI; AND SURGICAL SERVICES. IN THE FALL OF 2021, THE EMERGENCY DEPARTMENT RECEIVED A LEVEL IV TRAUMA CENTER DESIGNATION. GLH, HAVING ALREADY RECEIVED ACUTE STROKE READY CERTIFICATION IN 2019, RECEIVED PRIMARY STROKE CENTER DESIGNATION BY THE JOINT COMMISSION AND THE AMERICAN HEART ASSOCIATION IN 2021. THIS DESIGNATION SHOWS COMMITMENT TO ENSURING STROKE PATIENTS RECEIVE IMMEDIATE DIAGNOSTICS AND THE MOST ADVANCED TREATMENTS OPTIONS. OB/GYN FOCUSES ON ALL ASPECTS OF WOMEN'S HEALTH AND EDUCATION, PROVIDING OBSTETRICAL AND GYNECOLOGICAL CARE FOR WOMEN OF ALL AGES. SERVICES INCLUDE BUT ARE NOT LIMITED TO ROUTINE VISITS AND TREATMENTS, PREVENTATIVE HEALTHCARE, BIRTH CONTROL EDUCATION, FAMILY PLANNING, OBSTETRICS, SURGERY & SURGERY CONSULTATIONS, MENOPAUSE COUNSELING, AND MIDWIFERY. MENTAL HEALTH & PSYCHIATRIC SERVICES PROVIDES ADULT INPATIENT SERVICES DESIGNED TO HELP INDIVIDUALS LIVE AS INDEPENDENTLY AS POSSIBLE. PATIENTS CAN ACCESS QUICK, EFFICIENT ADMISSION 24/7 AND RECEIVE TREATMENT THROUGH A PSYCHIATRIST AVAILABLE ON A DAILY BASIS. ADMISSIONS ARE CONFIDENTIAL AND MAY BE MADE BY PROFESSIONALS AS WELL BY INDIVIDUALS CONCERNED ABOUT THEMSELVES OR OTHERS. DURING HOSPITALIZATION, PATIENT CARE IS PROVIDED THROUGH MULTIPLE PROFESSIONALS WHO COMPRISE THE TREATMENT TEAM. OTHER SERVICES INCLUDE: CARDIAC SERVICES OTHER SURGERY SPECIALTIES CLINICAL NUTRITION OTOLARYNGOLOGY GASTROENTEROLOGY PAIN MANAGEMENT GENERAL SURGERY PATHOLOGY GYNECOLOGY PEDIATRICS ICCU PHYSICAL THERAPY LABORATORY SERVICES PODIATRY NEPHROLOGY PULMONARY/VASCULAR NEUROSURGERY RADIOLOGY NEWBORN NURSERY RESPIRATORY SERVICES ONCOLOGY/COMMUNITY CANCER TREATMENT SLEEP CENTER OPHTHALMOLOGY UROLOGY ORTHOPEDIC WOUND MANAGEMENT INTERVENTIONAL RADIOLOGY GEISINGER LEWISTOWN HOSPITAL ALSO OPERATED A DIPLOMA NURSING PROGRAM AS A DEPARTMENT WITHIN ITS ORGANIZATION THROUGH AUGUST 13TH, 2023 WHEN THE PROGRAM TRANSITIONED TO THE GEISINGER COMMONWEALTH SCHOOL OF MEDICINE. IT OPENED IN 2005 AND ACCREDITED BY THE NATIONAL LEAGUE OF NURSING IN 2009, THE PROGRAM IS A 2-YEAR, SIX SEMESTER PROGRAM THAT ALSO OFFERS AN LPN ADVANCED PLACEMENT OPTION. THE GEISINGER LEWISTOWN HOSPITAL SCHOOL OF NURSING (GLHSON) EXISTS TO PROVIDE QUALITY NURSING EDUCATION AND SEEKS TO ENGAGE A DIVERSE GROUP OF STUDENTS IN A MANNER THAT ENABLES ITS GRADUATES TO BECOME LEADERS IN PROVIDING COMPETENT AND SAFE BEDSIDE NURSING CARE ACROSS THE CONTINUUM AND THROUGHOUT THE SURROUNDING COMMUNITY. THE GLHSON HAS A 94% PASS RATE OVER THE LAST THREE YEARS FOR THE NCLEX/RN EXAM, WHICH IS A COMPETENCY AND LICENSURE EXAM USED BY ALL STATE NURSING BOARDS IN THE US. THIS HIGH EXAM PASS RATE ALONG WITH THE PROGRAM'S HIGH ADMISSION STANDARDS ARE TWO REASONS THAT THE PROGRAM HAS BEEN NAMED ONE OF THE TOP RANKED RN PROGRAMS IN PA BY REGISTERED NURSING.ORG, A NATIONAL RANKING ORGANIZATION, FOR SEVERAL OF THE LAST FEW YEARS. IN FY18, GLH COMPLETED PREPARATIONS FOR A FAMILY PRACTICE RESIDENCY PROGRAM. THE UNREIMBURSED COST OF HEALTH PROFESSIONS EDUCATION WAS 1,879,476 DURING THE YEAR ENDED DECEMBER 31, 2023. IN THE FALL OF 2018, GLH ENTERED INTO A LEASE AGREEMENT FOR SPACE FOR A LABORATORY DRAW STATION IN A NEARBY, NEWLY CONSTRUCTED MEDICAL OFFICE BUILDING OWNED BY A PRIMARY HEALTH NETWORK, A FEDERALLY QUALIFIED HEALTH CENTER. IN ADDITION TO LEASING LAB SPACE IN THIS BUILDING, GLH COLLABORATES WITH THE LIFE GEISINGER PROGRAM AND THE FRESH FOOD PHARMACY PROGRAM WHICH ARE ALSO CO-LOCATED IN THAT BUILDING. IN FY19, GLH BECAME ELIGIBLE UNDER THE 340(B) DRUG PURCHASING PROGRAM. THIS ALLOWS THE HOSPITAL TO PURCHASE OUTPATIENT DRUGS AT SIGNIFICANTLY REDUCED PRICES REACHING MORE ELIGIBLE PATIENTS AND PROVIDING MORE COMPREHENSIVE SERVICES TO THOSE PATIENTS. IN LATE FY20, GLH ESTABLISHED A PHARMACY RESIDENCY PROGRAM FOR TWO RESIDENTS ON A 2-YEAR ROTATION. THE PURPOSE OF PHARMACY RESIDENCY PROGRAM AT GEISINGER LEWISTOWN HOSPITAL IS TO EXPAND UPON DIDACTIC TRAINING AND PROFESSIONAL EXPERIENCES TO FOSTER CLINICAL PHARMACISTS WITH THE SKILLS NECESSARY TO PROVIDE MEDICATION-RELATED CARE ACROSS A VAST RANGE OF CONDITIONS. GLH STARTED A WESTERN CAMPUS FOR THIRD AND FOURTH YEAR MEDICAL STUDENTS FROM OUR GEISINGER COMMONWEALTH SCHOOL OF MEDICINE. II. UNCOMPENSATED CARE GLH RECOGNIZES THAT ITS MISSION IS TO SERVE ALL THE MEMBERS OF THE COMMUNITY WITH RESPECT TO THE PROVISION OF HEALTHCARE SERVICES AND HEALTHCARE EDUCATION. GLH PROVIDES QUALITY MEDICAL HEALTHCARE REGARDLESS OF RACE, RELIGION, ETHNICITY, SEXUAL ORIENTATION, GENDER IDENTITY CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE OR ABILITY TO PAY. IN THIS REGARD, GLH PROVIDES FREE CARE OR SUBSIDIZED CARE, TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS AT OR BELOW COST AND PROVIDES VARIOUS HEALTH ACTIVITIES AND PROGRAMS IN SUPPORT OF THE COMMUNITIES WHERE GLH PRACTICES. A.CHARITY CARE THE PRIMARY CONCERN OF GLH IS THE DELIVERY OF HEALTH CARE TO ALL CITIZENS OF CENTRAL PENNSYLVANIA REGARDLESS OF THEIR ABILITY TO PAY. THE UNREIMBURSED COST OF CHARITY CARE REPRESENTS THE COST GLH INCURS BY PROVIDING FREE OR DISCOUNTED SERVICES TO THOSE WHO CANNOT AFFORD TO PAY. THE TOTAL COST OF THE CHARITY CARE WAS 1,277,235 DURING THE YEAR ENDED DECEMBER 31, 2023. B. MEDICARE/MEDICAID IN RECOGNIZING ITS MISSION TO THE COMMUNITY, GLH PROVIDES SERVICES TO THE ELDERLY (MEDICARE) AND THE INDIGENT (MEDICAID). GLH PROVIDES CARE, BELOW COST, TO PERSONS COVERED BY THESE GOVERNMENTAL PROGRAMS TO THE EXTENT THE GOVERNMENT REIMBURSEMENT IS BELOW THE COST OF PROVIDING HEALTH CARE. THE UNREIMBURSED VALUE OF MEDICARE AND/OR MEDICAID IS EQUAL TO THE COST OF PROVIDING SERVICES LESS THE AMOUNT RECEIVED AS REIMBURSEMENT UNDER THE PROGRAM. THE COST OF PROVIDING HEALTHCARE SERVICES TO MEDICARE, MEDICAID AND OTHER GOVERNMENTAL PATIENTS EXCEEDED REIMBURSEMENT BY APPROXIMATELY 26,200,757 DURING THE YEAR ENDED DECEMBER 31, 2023. III. RESEARCH SUPPORT GEISINGER LEWISTOWN HOSPITAL CONTRIBUTED 868,385 TO GEISINGER CLINIC TO SUPPORT ITS CHARITABLE MISSION THROUGH MEDICAL RESEARCH ACTIVITIES AT TWO FACILITIES ON THE CAMPUS OF GEISINGER MEDICAL CENTER: THE SIEGFRIED AND JANET WEIS CENTER FOR RESEARCH (WEIS CENTER) AND THE HENRY HOOD CENTER FOR HEALTH RESEARCH. THE WEIS CENTER PROVIDES A FOCUS FOR LABORATORY RESEARCH AND RESEARCH TRAINING AND SUPPORTS THE CLINICAL STAFF IN ITS RESEARCH PROGRAMS. THE PRIMARY MISSION OF THE WEIS CENTER IS TO CONDUCT ORIGINAL AND INNOVATIVE RESEARCH THAT CONTRIBUTES NEW KNOWLEDGE TO BIOMEDICAL SCIENCE. THE CENTER'S SCIENTISTS APPLY MODERN MOLECULAR AND CELLULAR APPROACHES TO DIVERSE RESEARCH PROBLEMS IN THE AREAS OF CARDIOVASCULAR FUNCTION, CANCER AND DEVELOPMENTAL BIOLOGY. THE HENRY HOOD CENTER FOR HEALTH RESEARCH CONDUCTS HEALTH SERVICES, EPIDEMIOLOGIC AND POPULATION GENETICS RESEARCH ON THE BROAD RANGE OF CONDITIONS TYPICALLY SEEN IN PRIMARY AND SPECIALTY CARE SETTINGS. THE CENTER ALSO INVESTIGATES EXTRAMURAL SOURCES OF FUNDING FOR CLINICAL RESEARCH. TOGETHER, THE WEIS CENTER AND HENRY HOOD CENTER ARE BUILDING CAPABILITY FOR IMPROVED POPULATION-BASED GENETICS RESEARCH. IV. COMMUNITY HEALTH, EDUCATION, 195103238 true true false true false false false false false true true false false false true false false true false false false false false false false false true true false false true false false false false false false false false false false false false false true true true true false true X 57 0 true 1226 true true true false false false false false false false false false false false X 7 4 true false false false true true true true true false false true true true true true true true true false PA X ERIN FITZGERALD CPA VP AND CAO 5702142299 100 N ACADEMY AVE MC 49-70 DANVILLE PA 178229800 JAEWON RYU MD JD PRESIDENT, D 40.00 X X 0 5492112 1571914 KEVIN V ROBERTS MBA CPA EVP, CFO, TR 40.00 X 0 3588266 60007 MATTHEW WALSH DIRECTOR 40.00 X 0 1500068 314234 STEVEN B BENDER ESQUIRE EVP, CLO, SE 40.00 X 0 1008985 246564 GERALD V MALONEY DO DIRECTOR 40.00 X 0 815329 127061 MICHAEL T HEGSTROM MD CMO 40.00 X 0 532194 59681 ROSS ELLISON MD INTERIM CMO 40.00 X 0 502071 64744 LORI R GRAMLEY ESQUIRE ACLO, ASST. 40.00 X 0 354475 47949 KIRK E THOMAS FACHE MHA RRT CAO 40.00 X 311950 0 38775 STACEY M OSBORNE DNPMSNRNNEA-BC VP, CNO 40.00 X 222246 0 27081 KRISTY M HINE FORMER 5 HIG 40.00 X 0 199002 49373 AARON J HARTSOCK AVP CLINICAL 40.00 X 172225 0 43642 BRIAN D SIMPKINS PHARMD BCPS DIRECTOR, PH 40.00 X 163945 0 45785 KATHRYN COLE RN INPATIENT RN 40.00 X 179807 0 29706 KEITH S GRAHAM ACUTE CARE P 40.00 X 128594 28343 25169 OLIVER RUIZ MD PHY. HOSPITA 40.00 X 34714 118187 16402 JEFFREY A JACOBSON CHAIR, DIREC 0.25 2.75 X 0 0 0 BENJAMIN K CHU MD MPH MACP DIRECTOR 0.25 3.25 X 0 0 0 VIRGINIA MCGREGOR DIRECTOR 0.25 3.00 X 0 0 0 V CHRIS HOLCOMBE PE VICE CHAIR, 0.25 2.75 X 0 0 0 1213481 14139032 2768087 97 true true false ENCOMPASS HEALTH OF NITTANY VALLEY 550 WEST COLLEGE AVENUE PLEASANT GAP PA 16823 REHAB SERVICES 1136436 MEDIFIS CONSOLIDATED PO BOX 5068 NEW YORK NY 100875068 AGENCY STAFFING 1056451 RENAL TREATMENT CENTERS PO BOX 781607 PHILADELPHIA PA 191781607 MEDICAL SERV 572317 HOSPITAL CENTRAL SERVICES COOP INC PO BOX 8016 LANCASTER PA 17604 LINEN/LAUNDRY 546535 SIEMENS MEDICAL SOLUTIONS USA PO BOX 2134 CAROL STREAM IL 601322134 COMPUTER SERV 516109 12 X 7151047 17186 7168233 NET PATIENT REVENUE 621110 227021545 227021545 INTERCOMPANY REVENUE - RENTAL 531120 1224063 1224063 SCHOOL OF NURSING TUITION 611519 437083 437083 PATIENT CARE PHARMACY 456110 433181 433181 INTERCOMPANY REVENUE 541900 291319 291319 122513 119058 3455 229529704 274468 274468 PURCHASE DISCOUNTS 900099 882903 882903 CAFETERIA SALES 722514 429201 429201 GIFT SHOP SALES 459420 126699 126699 76421 76421 1515224 238487629 229185089 3455 2130852 843616 843616 59118030 57847893 1270137 2641489 2585536 55953 12547158 12281378 265780 4428092 4334294 93798 46554 46554 9328 9328 3497 3497 74026 4429 69597 17000593 16304115 696478 1032 1032 4118521 3848184 270337 398935 321645 77290 3876549 3671024 205525 238114 186868 51246 27086 27086 1237021 1171437 65584 6367502 6029913 337589 1425397 1223543 201854 MEDICAL SUPPLIES 46460987 46368211 92776 INTERCOMPANY EXPENSE 42266847 35157177 7109670 MA MODERNIZATION FEE 2604574 2604574 BOOKS, LICENSES AND FEES 250708 250693 15 40590 40590 206026246 195103238 10923008 0 559 559 29771529 34058634 18536819 19068692 1593549 2981270 3896292 7079480 616566 665561 108925853 56130297 54932545 52795556 444388 464487 410685 5858300 110202932 122972539 2161903 1435842 373142 24456 34994373 34096452 2974712 2468504 10351928 16426219 50856058 54451473 X 58873383 68027477 473491 493589 59346874 68521066 110202932 122972539 X 32461383 20310 -23307501 X X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false true false false false false true 478 false true 3497 3975 false SCHEDULE C, PART II-B, LINE 1 LINE 1B AND 1G: AMOUNT REPORTED ON LINE 1G REPRESENTS THE WAGES AND BENEFITS OF EMPLOYEES WHO ASSIST THE GOVERNMENT RELATIONS DEPARTMENT OF THE ORGANIZATION'S AFFILIATE, GEISINGER SYSTEM SERVICES. THE PRIMARY PURPOSE OF THE GOVERNMENT RELATIONS DEPARTMENT IS TO MAINTAIN CONTACT WITH FEDERAL, STATE, AND LOCAL GOVERNMENT OFFICIALS. THE DEPARTMENT PROMOTES LEGISLATIVE ACTIONS WITH RESPECT TO HEALTHCARE RELATED ISSUES THAT COULD IMPACT THE ORGANIZATION AND ITS AFFILIATES. LINE 1I: OTHER LOBBYING ACTIVITIES REPORTED ON LINE 1I REPRESENTS THE PORTION OF MEMBERSHIP DUES, PAID BY THE ORGANIZATION TO TRADE OR PROFESSIONAL ASSOCIATIONS, ATTRIBUTABLE TO LOBBYING ACTIVITIES. 361844539 1066000 15229000 4466000 373673539 385529539 1170000 -20189000 4666000 361844539 372822539 699000 19881000 7873000 385529539 369339179 1328000 20022280 17866920 372822539 373664778 290000 -501599 4114000 369339179 0.75510 0.18170 0.06320 false true true 2695687 2695687 35521210 17916570 17604640 64452577 37730450 26722127 6256379 483277 5773102 52795556 DUE TO AFFILIATES 14124722 ESTIMATED 3RD PARTY PAYOR SETTLEMENT 1622247 ACCOUNTS RECEIVABLE CREDIT BALANCES 679250 16426219 SCHEDULE D, PAGE 2, PART V, LINE 4 ENDOWMENT FUNDS ARE USED BY GEISINGER(1) TO SUPPORT PATIENT CARE, RESEARCH, EDUCATION, CAPITAL AND PROGRAM EXPENSES. SCHEDULE D, PAGE 4, PART XIII EFFECTIVE JULY 1, 2007, GEISINGER ADOPTED ACCOUNTING STANDARDS CODIFICATION 740 (FIN 48), (FORMERLY KNOWN AS "STATEMENT 109: ACCOUNTING FOR INCOME TAXES- OR "FAS 109"). FIN 48 CLARIFIES THE ACCOUNTING AND REPORTING FOR INCOME TAXES WHERE INTERPRETATION OF THE TAX LAW MAY BE UNCERTAIN. FIN 48 PRESCRIBES A COMPREHENSIVE MODEL FOR THE FINANCIAL STATEMENT RECOGNITION, MEASUREMENT, PRESENTATION AND DISCLOSURE OF INCOME TAX UNCERTAINTIES WITH RESPECT TO POSITIONS TAKEN OR EXPECTED TO BE TAKEN IN INCOME TAX RETURNS. THE ADOPTION OF FIN 48 HAD NO IMPACT ON UNRESTRICTED NET ASSETS AS OF THE END OF THE CALENDAR YEAR OR ANY PREVIOUS YEAR SINCE ADOPTION. ACCORDINGLY, NO FIN 48 FOOTNOTE DISCLOSURE WAS MADE IN THE GEISINGER CONSOLIDATED FINANCIAL STATEMENTS. true true X true X 3.000000000000 false true true false true true 1666531 1666531 0.00810 31083806 22120938 8962868 0.04350 763003 742571 20432 0.00010 33513340 22863509 10649831 0.05170 1258432 1258432 0.00610 3705375 1825899 1879476 0.00910 873477 873477 0.00420 5837284 1825899 4011385 0.01950 39350624 24689408 14661216 0.07120 true 23772063 27351263 -3579200 X true true 1 1 GEISINGER-LEWISTOWN HOSPITAL 400 HIGHLAND AVENUE LEWISTOWN PA 17044 WWW.GEISINGER.ORG 121501 X X X X GEISINGER-LEWISTOWN HOSPITAL 1 false false true X X X X X X X X X X 20 true true false true X WWW.GEISINGER.ORG X X true 21 true REFER TO RESPONSE TO 7D false false true X 300.000000000000 X X X X X true true X X X X true X WWW.GEISINGER.ORG - REFER TO SECTION C X WWW.GEISINGER.ORG - REFER TO SECTION C X WWW.GEISINGER.ORG - REFER TO SECTION C X X X X X X X true X false X X X X X true X false false FACILITY 1, GEISINGER-LEWISTOWN HOSPITAL - PART V, LINE 3E PRIORITIZED COMMUNITY HEALTH NEEDS TO WORK TOWARD HEALTH EQUITY, IT IS IMPERATIVE TO PRIORITIZE RESOURCES AND ACTIVITIES TOWARD THE MOST PRESSING AND CROSS-CUTTING HEALTH NEEDS WITHIN THE COMMUNITY. PRIORITIES WERE JOINTLY DETERMINED BY THE CHNA COLLABORATING HEALTH SYSTEMS USING FEEDBACK FROM COMMUNITY STAKEHOLDERS. THROUGH THIS PROCESS, CHNA PARTNERS AFFIRMED THE FOLLOWING PRIORITY HEALTH NEEDS: ACCESS TO CARE BEHAVIORAL HEALTH CHRONIC DISEASE PREVENTION AND MANAGEMENT THESE PRIORITIES ARE CONSISTENT WITH THOSE DETERMINED IN THE PREVIOUS FY2019 CHNA AND REFLECT COMPLEX NEEDS REQUIRING SUSTAINED COMMITMENT AND RESOURCES. MATERNAL AND CHILD HEALTH NEEDS ARE ALSO PREVALENT ACROSS THE SERVICE AREA. WHILE CHNA PARTNERS DID NOT IDENTIFY MATERNAL AND CHILD HEALTH AS A PRIORITY ISSUE DUE TO THE NEED TO FOCUS AVAILABLE RESOURCES, MANY OF THE HOSPITALS SUPPORT MATERNAL AND CHILD HEALTH STRATEGIES AS PART OF THEIR IMPLEMENTATION PLAN. THESE STRATEGIES INCLUDE FREE OR LOW-COST CLASSES AND SUPPORT GROUPS FOR PREGNANT AND NEW MOTHERS, LACTATION CONSULTATION, TREATMENT AND SUPPORT SERVICES FOR MOTHERS IN RECOVERY, SOCIAL ASSISTANCE, AND POSTPARTUM DEPRESSION SCREENING, AMONG OTHERS. CHNA IMPLEMENTATION PLAN TO DIRECT COMMUNITY BENEFIT AND HEALTH IMPROVEMENT ACTIVITIES, CHNA PARTNERS CREATED INDIVIDUAL HOSPITAL IMPLEMENTATION PLANS TO DETAIL THE RESOURCES AND SERVICES THAT WILL BE USED TO ADDRESS HEALTH PRIORITIES. THE IMPLEMENTATION PLANS BUILD UPON PREVIOUS HEALTH IMPROVEMENT ACTIVITIES AND TAKE INTO CONSIDERATION NEW HEALTH NEEDS AND THE CHANGING HEALTH CARE DELIVERY ENVIRONMENT AS DETAILED IN THE 2021 CHNA. FACILITY 1, GEISINGER-LEWISTOWN HOSPITAL - PART V, LINE 5 SECTION B., COMMUNITY HEALTH NEEDS ASSESSMENT, LINES 3, 5 AND 6A: CHNA COLLABORATING HEALTH SYSTEMS THE 2021 GEISINGER COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) WAS CONDUCTED IN PARTNERSHIP WITH GEISINGER, ALLIED SERVICES INTEGRATED HEALTH SYSTEM, AND EVANGELICAL COMMUNITY HOSPITAL. THE STUDY AREA INCLUDED 15 COUNTIES ACROSS CENTRAL AND NORTHEASTERN PENNSYLVANIA, WHICH REPRESENTED THE HEALTH SYSTEMS' COLLECTIVE SERVICE AREAS. COLLABORATION IN THIS WAY CONSERVES VITAL COMMUNITY RESOURCES WHILE FOSTERING A PLATFORM FOR "COLLECTIVE IMPACT" THAT ALIGNS COMMUNITY EFFORTS TOWARD A COMMON GOAL OR ACTION. TO DISTINGUISH UNIQUE SERVICE AREAS AMONG HOSPITALS, REGIONAL RESEARCH AND REPORTING WAS DEVELOPED. CHNA LEADERSHIP THE 2021 CHNA WAS OVERSEEN BY A PLANNING COMMITTEE OF REPRESENTATIVES FROM EACH HEALTH SYSTEM, AS WELL AS A REGIONAL ADVISORY COMMITTEE OF HOSPITAL AND HEALTH SYSTEM REPRESENTATIVES. COMMUNITY HEALTH CONSULTANTS ASSISTED IN ALL PHASES OF THE CHNA, INCLUDING PROJECT MANAGEMENT, DATA COLLECTION AND ANALYSIS, AND REPORT WRITING. CHNA METHODOLOGY THE 2021 CHNA WAS CONDUCTED FROM JULY TO DECEMBER 2020. QUANTITATIVE AND QUALITATIVE METHODS, REPRESENTING BOTH PRIMARY AND SECONDARY RESEARCH, WERE USED TO ILLUSTRATE AND COMPARE HEALTH AND SOCIAL TRENDS AND DISPARITIES ACROSS EACH REGION AND HOSPITAL SERVICE AREA. THE FOLLOWING RESEARCH METHODS WERE USED TO DETERMINE COMMUNITY HEALTH NEEDS: -STATISTICAL ANALYSIS OF HEALTH AND SOCIOECONOMIC DATA INDICATORS; A FULL LISTING OF DATA REFERENCES IS INCLUDED IN THE CHNA -ELECTRONIC SURVEY OF KEY STAKEHOLDERS, INCLUDING EXPERTS IN PUBLIC HEALTH AND INDIVIDUALS REPRESENTING MEDICALLY UNDERSERVED, LOW-INCOME AND MINORITY POPULATIONS; A LIST OF KEY INFORMANTS AND THEIR RESPECTIVE ORGANIZATIONS IS INCLUDED IN THE CHNA -DISCUSSION AND PRIORITIZATION OF COMMUNITY HEALTH NEEDS TO DETERMINE THE MOST PRESSING HEALTH ISSUES ON WHICH TO FOCUS COMMUNITY HEALTH IMPROVEMENT EFFORTS COMMUNITY ENGAGEMENT COMMUNITY ENGAGEMENT WAS AN INTEGRAL PART OF THE 2021 CHNA. A VIRTUAL TOWN HALL WAS HELD IN AUGUST 2020 TO ANNOUNCE THE ONSET OF THE CHNA AND ENCOURAGE BROAD STAKEHOLDER PARTICIPATION. A KEY INFORMANT SURVEY WAS SENT TO NEARLY 1,000 COMMUNITY STAKEHOLDERS TO SOLICIT INPUT ON HEALTH DISPARITIES, OPPORTUNITIES FOR COLLABORATION, COVID-19 RESPONSE, COMMUNITY HEALTH PRIORITIES, AMONG OTHER INSIGHTS. CONTINUED COMMUNITY ENGAGEMENT ACTIVITIES ARE PLANNED TO ENSURE ONGOING DIALOGUE AND A FORUM FOR ADDRESSING COMMUNITY HEALTH NEEDS. CHNA IMPLEMENTATION PLAN TO DIRECT COMMUNITY BENEFIT AND HEALTH IMPROVEMENT ACTIVITIES, CHNA PARTNERS CREATED INDIVIDUAL HOSPITAL IMPLEMENTATION PLANS TO DETAIL THE RESOURCES AND SERVICES THAT WILL BE USED TO ADDRESS HEALTH PRIORITIES. THE IMPLEMENTATION PLANS BUILD UPON PREVIOUS HEALTH IMPROVEMENT ACTIVITIES AND TAKE INTO CONSIDERATION NEW HEALTH NEEDS AND THE CHANGING HEALTH CARE DELIVERY ENVIRONMENT AS DETAILED IN THE 2021 CHNA. BOARD APPROVAL THE 2021 CHNA WAS CONDUCTED IN A TIMELINE TO COMPLY WITH IRS TAX CODE 501 (R) REQUIREMENTS TO CONDUCT A CHNA EVERY THREE YEARS AS SET FORTH BY THE AFFORDABLE CARE ACT (ACA). THE RESEARCH FINDINGS WILL BE USED TO GUIDE COMMUNITY BENEFIT INITIATIVES FOR THE HOSPITALS AND ENGAGE LOCAL PARTNERS TO COLLECTIVELY ADDRESS IDENTIFIED HEALTH NEEDS. THE CHNA REPORT WAS PRESENTED TO THE GEISINGER BOARD OF DIRECTORS AND APPROVED IN DECEMBER 2020. GEISINGER IS COMMITTED TO ADVANCING INITIATIVES AND COMMUNITY COLLABORATION TO SUPPORT THE ISSUES IDENTIFIED THROUGH THE CHNA. FOLLOWING THE BOARD'S APPROVAL, ALL CHNA REPORTS WERE MADE AVAILABLE TO THE PUBLIC VIA THE GEISINGER WEBSITE AT HTTPS://WWW.GEISINGER.ORG/ABOUT- GEISINGER/COMMUNITY-ENGAGEMENT/CHNA. THROUGHOUT THIS DOCUMENT, THE TERMS "GEISINGER- OR "GEISINGER HEALTH" SHALL REFER TO THE ENTIRE HEALTH CARE SYSTEM COMPRISED OF GEISINGER HEALTH FOUNDATION (THE "FOUNDATION") AS PARENT AND ALL SUBSIDIARY CORPORATE ENTITIES COMPRISING THE HEALTH CARE SYSTEM. IN ADDITION, THROUGHOUT THIS DOCUMENT, THE TERM "SYSTEM" SHALL REFER TO THE ENTIRE HEALTH CARE SYSTEM AS PREVIOUSLY DEFINED PLUS ITS AFFILIATES. FACILITY 1, GEISINGER-LEWISTOWN HOSPITAL - PART V, LINE 6A ALLIED SERVICES REHABILITATION HOSPITAL, HEINZ REHABILITATION HOSPITAL, EVANGELICAL COMMUNITY HOSPITAL, GEISINGER MEDICAL CENTER (INCLUDES GEISINGER-SHAMOKIN AREA COMMUNITY HOSPITAL), GEISINGER ENCOMPASS HEALTH LIMITED LIABILITY COMPANY (DBA GEISINGER ENCOMPASS HEALTH REHABILITATION HOSPITAL), GEISINGER WYOMING VALLEY MEDICAL CENTER (INCLUDES GEISINGER SOUTH WILKES-BARRE), GEISINGER-BLOOMSBURG HOSPITAL, COMMUNITY MEDICAL CENTER (DBA GEISINGER COMMUNITY MEDICAL CENTER), GEISINGER JERSEY SHORE HOSPITAL, GEISINGER-LEWISTOWN HOSPITAL, AND GEISINGER MEDICAL CENTER MUNCY. FACILITY 1, GEISINGER-LEWISTOWN HOSPITAL - PART V, LINE 7D THE HOSPITAL'S CHNA AND CHNA IMPLEMENTATION STRATEGY ARE POSTED ON THE HOSPITAL'S WEBSITE AT WWW.GEISINGER.ORG/ABOUT-GEISINGER/COMMUNITY- ENGAGEMENT/CHNA. FACILITY 1, GEISINGER-LEWISTOWN HOSPITAL - PART V, LINE 11 GEISINGER, AS PART OF ITS ENDURING DEDICATION TO COMMUNITY WELL-BEING, METICULOUSLY CONDUCTS COMPREHENSIVE COMMUNITY HEALTH NEEDS ASSESSMENTS (CHNAS) IN CLOSE COLLABORATION WITH VARIOUS PARTNERS. AS A HEALTH SYSTEM, WE REMAIN STEADFAST IN OUR COMMITMENT TO MEETING THE DIVERSE NEEDS OF THE COMMUNITIES WITHIN OUR OPERATIONAL FOOTPRINT. WE STRIVE TO DELIVER HIGHLY LOCALIZED SUPPORT TO THE AREAS SURROUNDING OUR FACILITIES AND LINES OF BUSINESS. ACCESS TO CARE: OUR ASSESSMENTS CONSISTENTLY HIGHLIGHTED THE PRESSING NEED FOR HEALTHCARE ACCESS, PARTICULARLY AMONG VULNERABLE POPULATIONS. THESE GROUPS ENCOMPASSED INDIVIDUALS RESIDING IN RURAL AREAS, FACING A SCARCITY OF HEALTHCARE PROFESSIONALS, PATIENTS LACKING TRANSPORTATION, ELDERLY INDIVIDUALS WITH COMPLEX MEDICAL CONDITIONS, THE HOMEBOUND, THOSE WITH INADEQUATE INSURANCE COVERAGE, AND INDIVIDUALS WHO REFRAINED FROM SEEKING MEDICAL CARE DUE TO CULTURAL REASONS. BEARING THESE CHALLENGES IN MIND, GEISINGER TAILORED ITS ACCESS TO CARE COMMUNITY INITIATIVES TO ENSURE REGULAR AND DEPENDABLE ACCESS TO HEALTH SERVICES, ENABLING EARLY DETECTION, TREATMENT OF ILLNESSES, AND EFFECTIVE DISEASE MANAGEMENT AND PREVENTION FOR OUR DIVERSE PATIENT POPULATION. GEISINGER'S COVID-19 RESPONSE IN RESPONSE TO THE FORMIDABLE CHALLENGE POSED BY THE PANDEMIC, GEISINGER SWIFTLY ADAPTED ITS OPERATIONS TO SUPPORT THE COMMUNITIES WE SERVE, MANIFESTING IN THE FOLLOWING WAYS: - VACCINE DISTRIBUTION: GEISINGER FACILITATED THE DISTRIBUTION OF OVER 320,000 VACCINES TO DATE. WE REPURPOSED VACANT OFFICE SPACES INTO VACCINATION CENTERS, EFFICIENTLY INOCULATING BOTH OUR EMPLOYEES AND THE WIDER COMMUNITY. - OUR WALK-IN CARE LOCATIONS SEAMLESSLY TRANSITIONED INTO TESTING FACILITIES, PROVIDING ESSENTIAL TESTING SERVICES AND ACTING AS A VALUABLE RESOURCE FOR SCHOOLS AND EMPLOYERS SEEKING TESTING AND RETURN TO WORK/SCHOOL DOCUMENTATION. - A COLLABORATIVE EFFORT INVOLVED COORDINATING 2,300 DEPLOYMENTS/INTERVENTIONS WITH SKILLED NURSING FACILITIES ACROSS THE STATE. WE PROVIDED CRUCIAL ASSISTANCE IN RAPID RESPONSE, ENSURING ADEQUATE PPE, CONDUCTING NECESSARY TESTING, IMPLEMENTING INFECTION PREVENTION MEASURES, AND ADMINISTERING VACCINES. - CONTACT TRACING: WHILE TYPICALLY A RESPONSIBILITY OF PUBLIC HEALTH, GEISINGER TOOK PROACTIVE MEASURES TO INTERCEPT THE VIRUS'S SPREAD THROUGH COMPREHENSIVE CONTACT TRACING EFFORTS. WE REDEPLOYED DOZENS OF EMPLOYEES TO BOLSTER OUR CONTACT TRACING INITIATIVES. IN THE SPRING AND SUMMER OF 2020, GEISINGER SUCCESSFULLY COMPLETED OVER 3,000 NOTIFICATIONS AS PART OF OUR EXTENSIVE CONTACT TRACING EFFORTS. - COMMUNITY SUPPORT: GEISINGER ORCHESTRATED A SERIES OF INFORMATIVE WEBINARS, TOWN HALLS, AND DIGITAL RESOURCES AIMED AT KEEPING SCHOOLS, COMMUNITY GROUPS, CHAMBERS, AND EMPLOYERS WELL-INFORMED ABOUT THE EVER- EVOLVING PANDEMIC. OUR FRESH FOOD FARMACY INITIATIVE PLAYED A VITAL ROLE BY PROVIDING AN IMPRESSIVE 42,000 MEALS PER MONTH TO PARTICIPANTS, ADDRESSING A CRUCIAL NEED IN THE COMMUNITY. FURTHER EXTENDING OUR SUPPORT, OUR 65 FORWARD LOCATIONS ORGANIZED OUTDOOR EXERCISE CLASSES AND DISTRIBUTED CARE PACKAGES CONTAINING ESSENTIAL PERSONAL CARE ITEMS TO INDIVIDUALS WHO WERE CONFINED TO THEIR HOMES. ANY PLAN AIMED AT REDUCING BARRIERS TO CARE HAD TO INCORPORATE TELEMEDICINE OPTIONS. THE COVID-19 PANDEMIC SAW A SIGNIFICANT SURGE IN TELEHEALTH UTILIZATION ACROSS THE NATION, AND GEISINGER CAPITALIZED ON THIS OPPORTUNITY, EMERGING AS A LEADING TELEHEALTH NETWORK IN THE US, SURPASSING NATIONAL AVERAGES FOR TELEMEDICINE USE. AS PART OF OUR ROUTINE SCHEDULING PROCESS, WE INQUIRED IF PATIENTS PREFERRED A TELEHEALTH VISIT. IF SO, WE PROMPTLY ARRANGED THE APPOINTMENT AND SENT AN EMAIL WITH A DIRECT LINK TO THEIR PROVIDER OR ANY OF THE 72 SPECIALTIES AVAILABLE FOR VIRTUAL CONSULTATIONS. FOR PATIENTS LACKING INTERNET ACCESS AT HOME, GEISINGER OFFERED TELEHEALTH VISITS AT THEIR NEAREST HEALTH CLINIC. TELEMEDICINE NOT ONLY BENEFITED PATIENTS WITHOUT TRANSPORTATION BUT ALSO CATERED TO THOSE WHO ENDURED LENGTHY DRIVES OR CHALLENGING WEATHER CONDITIONS TO VISIT THEIR DOCTOR, CIRCUMSTANCES THAT MIGHT HAVE LED TO APPOINTMENT CANCELLATIONS. IN MANY CASES, TELEMEDICINE ENABLED WAGE-EARNING PATIENTS TO CONSULT THEIR DOCTOR WITHOUT CLOCKING OUT AND LOSING PAY, AS OUR DOCTORS COULD CONNECT WITH THEM BEFORE WORK OR DURING THEIR LUNCH HOUR. GEISINGER HAD INTEGRATED CLINICAL AND POPULATION HEALTH EXPERTISE TO ADDRESS ACCESS NEEDS FOR TWO DISTINCT PATIENT POPULATIONS: THOSE BURDENED BY THE RISING COSTS OF HEALTHCARE SERVICES AND THE RAPIDLY GROWING SENIOR POPULATION. WE HAD INTEGRATED A RANGE OF HEALTH AND WELLNESS SERVICES CRUCIAL FOR THESE DEMOGRAPHICS, INCORPORATING CARE MODELS SUCH AS TRADITIONAL HOSPITAL SERVICES, 65 FORWARD (SENIOR PRIMARY CARE), CONVENIENT CARE (WALK-IN CLINICS AND URGENT CARE), COMMUNITY CARE CLINICS (URGENT CARE AND PRIMARY CARE), AND VIRTUAL HEALTH INITIATIVES. THIS INTEGRATION ENABLED US TO EFFICIENTLY ADDRESS ACUTE, CHRONIC, AND URGENT CARE NEEDS IN THE MOST COST-EFFECTIVE SETTINGS WHILE ENHANCING ACCESS TO OUTPATIENT CARE FOR DISEASE MANAGEMENT AND PREVENTION. IN 2022, GEISINGER COMMONWEALTH SCHOOL OF MEDICINE (GCSOM) MADE STRIDES TOWARD SOLIDIFYING A PARTNERSHIP TO REOPEN THE LEAHY CLINIC, A PROVIDER OF FREE NON-EMERGENCY HEALTHCARE, AT THE UNIVERSITY OF SCRANTON, TRANSFORMING IT INTO A LONGITUDINAL FREE CLINIC FOR LACKAWANNA COUNTY. IN LINE WITH THIS COMMITMENT, GEISINGER HAD CONTRIBUTED TO "A COMMUNITY CLINIC", WHICH PROVIDED HEALTHCARE FOR THE UNINSURED IN SUNBURY, OFFERING SUPPORT IN MARKETING, REFERRALS, AND PROVIDING LAB AND X-RAY SUPPORT TO THE CLINIC. IN THE PURSUIT OF HEALTH EQUITY, GEISINGER HAD DEVELOPED OUTREACH PROGRAMS IN COLLABORATION WITH COMMUNITY ORGANIZATIONS, NONPROFITS, AND FAITH-BASED GROUPS, AIMED AT EDUCATING, INFORMING, AND GUIDING INDIVIDUALS TOWARDS WELLNESS CARE. ENSURING HEALTHCARE ACCESS HAD NECESSITATED AN ADEQUATE NUMBER OF HEALTHCARE PROFESSIONALS TO SERVE THE PATIENT POPULATION. GEISINGER HAD SUCCESSFULLY RECRUITED AND RETAINED HEALTHCARE PROFESSIONALS WITHIN THE SYSTEM THROUGH A SERIES OF INITIATIVES. OUR SYSTEMWIDE CLINICAL CO-OP PROGRAM ENGAGED HIGH SCHOOL AND TECHNICAL SCHOOL SENIORS INTERESTED IN HEALTHCARE, PROVIDING THEM THE OPPORTUNITY TO WORK AS NURSING ASSISTANTS FOR A YEAR. THEY GAINED EXPOSURE BY SHADOWING OUR NURSES IN PHLEBOTOMY OR SURGICAL TECH. THESE CO-OP PROGRAMS ENCOURAGED MANY TO ENROLL IN NURSING SCHOOL WITH OUR SUPPORT AND SUBSEQUENTLY JOIN GEISINGER UPON GRADUATION. OUR NURSE RESIDENCY PROGRAM HAD TARGETED RECENT NURSING GRADUATES, SUPPORTING THEM THROUGH THEIR INITIAL AND OFTEN CHALLENGING YEAR OF NURSING PRACTICE BY PROVIDING EDUCATION THROUGH RESIDENCY SESSIONS, CLASSES, AND SIMULATIONS CONDUCTED BY OUR STAFF. AS PART OF THIS PROGRAM, WE HAD OFFERED A SIX-MONTH MEDICAL SURGICAL FELLOWSHIP FOR NEW NURSES SEEKING SPECIALIZATION IN CARDIAC, ONCOLOGY, TRAUMA, OR SURGERY. FELLOWSHIP COURSES WERE LED BY OUR EXPERIENCED NURSES, PHYSICIAN ASSISTANTS, AND SURGEONS. THE ABIGAIL GEISINGER SCHOLARS PROGRAM HAD CATERED TO GCSOM STUDENTS WILLING TO WORK AT GEISINGER AS PHYSICIANS IN FAMILY MEDICINE, INTERNAL MEDICINE, MEDICINE/PEDIATRICS, OR PSYCHIATRY. IN EXCHANGE FOR A WORK COMMITMENT OF UP TO FOUR YEARS, SELECTED SCHOLARS HAD RECEIVED TUITION SUPPORT AND A MONTHLY STIPEND. MOREOVER, AN ABIGAIL GEISINGER SCHOLAR PROGRAM WAS OPEN TO ANYONE WORKING IN OUR NURSING DEPARTMENT. WHEN THEY MET THE CRITERIA, WE HAD ASSISTED THEM IN ENROLLING IN NURSING SCHOOL. THESE COMPETITIVE RECRUITMENT PROGRAMS HAD ENSURED A CONSISTENT PIPELINE OF NURSES AND PHYSICIANS TO SERVE OUR COMMUNITIES IN THE FUTURE. GEISINGER COMMONWEALTH SCHOOL OF MEDICINE (GCSOM) HAD RECEIVED A SIGNIFICANT PASMART ADVANCING COMPUTER SCIENCE AND STEM EDUCATION GRANT FROM THE PENNSYLVANIA DEPARTMENT OF EDUCATION. THE GRANT, AMOUNTING TO 494,262, HAD BEEN AIMED AT FOSTERING PARTNERSHIPS WITH VARIOUS SCHOOLS TO PREPARE STUDENTS IN HAZLETON, SCRANTON, WILKES-BARRE, COLUMBIA, AND NORTHUMBERLAND COUNTIES FOR CAREERS IN MEDICINE AND STEM-RELATED FIELDS. THIS INITIATIVE, KNOWN AS THE PA PHYSICIAN READY PROGRAM, HAD NOT ONLY ADDRESSED THE PHYSICIAN SHORTAGE BUT HAD ALSO INCREASED DIVERSITY IN MEDICAL CAREERS AND MET THE HEALTHCARE WORKFORCE DEMANDS IN PENNSYLVANIA. TO ADDRESS THE NEEDS OF MEDICALLY COMPLEX PATIENTS LACKING TRANSPORTATION MEANS, GEISINGER HAD EXPANDED A FEDERALLY FUNDED GRANT PROGRAM CALLED 4RIDE TRANSPORTATION BY COLLABORATING WITH A MOBILITY SERVICE VENDOR, RABBIT TRANSIT. ELIGIBLE PATIENTS WERE CONNECTED TO PUBLIC TRANSPORTATION, TAXIS, RIDE SERVICE CARRIERS LIKE LYFT, OR OTHER MEDICARE/MEDICAID SERVICES FOR THEIR MEDICAL APPOINTMENTS. NOTABLY, THIS SERVICE HAD EXTENDED TO ESSENTIAL DESTINATIONS SUCH AS FOOD BANKS AND PHARMACIES. FOLLOWING A TRIP, PATIENTS HAD RECEIVED ONGOING FOLLOW-UP TO TACKLE ANY ADDITIONAL SOCIAL OBSTACLES THEY MAY HAVE ENCOUNTERED. SEVERAL GEISINGER HOSPITALS HAD RECEIVED RECOGNITION FROM THE AMERICAN HEART ASSOCIATION FOR THEIR ADHERENCE TO PROVEN CARE GUIDELINES FACILITY 1, GEISINGER-LEWISTOWN HOSPITAL - PART V, LINE 13B RECENT WAGE STATEMENTS, UNEMPLOYMENT OR OTHER DOCUMENTATION OF BENEFITS OR COMPENSATION RECEIVED MAY BE CONSIDERED IN DETERMINING FINANCIAL ASSISTANCE ELIGIBILITY. FACILITY 1, GEISINGER-LEWISTOWN HOSPITAL - PART V, LINE 16J THE FAP, FAP APPLICATION, AND A PLAIN LANGUAGE SUMMARY OF THE FAP ARE WIDELY AVAILABLE AT HTTPS://WWW.GEISINGER.ORG/PATIENT-CARE/PATIENTS-AND- VISITORS/BILLING-AND-INSURANCE/NEED-HELP. IN ADDITION, REGISTRATION PERSONNEL ALSO REFER UNINSURED AND/OR LOW INCOME PATIENTS TO FINANCIAL COUNSELORS TO DISCUSS THE FINANCIAL ASSISTANCE POLICY. FACILITY 1, GEISINGER-LEWISTOWN HOSPITAL - PART V, LINE 20E REFER TO RESPONSE FOR PART III, LINE 9B SCHEDULE H, PART I, LINE 3C SUPPORTING DOCUMENTATION FOR ELIGIBILITY MAY CONSIST OF INCOME AND ASSET INFORMATION, INCLUSIVE BUT NOT LIMITED TO: FEDERAL INCOME TAX FORM 1040 FROM THE PRIOR YEAR, PAY STUB COPIES, WRITTEN VERIFICATION OF ANY OTHER INCOME RECEIVED (I.E. SOCIAL SECURITY, ADC, CHILD SUPPORT, ALIMONY, ETC.), CURRENT CREDIT REPORTS AND ASSET VERIFICATION. THE HOSPITAL MAY ALSO UTILIZE INDUSTRY TESTED EXTERNAL ANALYTICAL TOOLS TO QUALIFY PATIENTS FOR UNCOMPENSATED CARE (AKA PRESUMPTIVE CHARITY). GEISINGER PROVIDERS, WITHOUT DISCRIMINATION, CARE FOR ALL EMERGENCY MEDICAL CONDITIONS TO INDIVIDUALS REGARDLESS OF THEIR FINANCIAL ASSISTANCE ELIGIBILITY OR ABILITY TO PAY. IT IS THE POLICY OF GEISINGER HOSPITAL FACILITIES TO COMPLY WITH THE STANDARDS OF THE FEDERAL EMERGENCY MEDICAL TREATMENT AND ACTIVE LABOR TRANSPORT ACT OF 1986 ("EMTLA") AND REGULATIONS IN PROVIDING MEDICAL SCREENING EXAMINATION AND SUCH FURTHER TREATMENT AS MAY BE NECESSARY TO STABILIZE AN EMERGENCY MEDICAL CONDITION FOR ANY INDIVIDUAL PRESENTING TO THE EMERGENCY DEPARTMENT SEEKING TREATMENT. SCHEDULE H, PART I, LINE 6A COMMUNITY BENEFIT REPORT: A COMMUNITY BENEFIT REPORT IS PROVIDED BY THE HOSPITAL AND ITS RELATED CHARITABLE ORGANIZATIONS TO THE GEISINGER HEALTH FINANCE COMMITTEE EACH YEAR. SCHEDULE H, PART I, LINE 7G THERE ARE NO PHYSICIAN CLINICAL SERVICES INCLUDED IN SUBSIDIZED HEALTH SERVICES. SCHEDULE H, PART I, LINE 7 A COST ACCOUNTING SYSTEM WAS USED TO DETERMINE THE COSTS REPORTED ON LINE 7 AND ADDRESSED PATIENT SEGMENTS BY PAYOR (E.G. MEDICARE, MEDICAID, COMMERCIAL PAYERS, SELF-PAY, ETC.). A COST TO CHARGE RATIO, CALCULATED PURSUANT TO WORKSHEET 2 OF THE FORM 990 INSTRUCTIONS, WAS USED TO CALCULATE THE COST OF CHARITY CARE. SCHEDULE H, PART III, LINE 4 EXPLICIT AND IMPLICIT PRICE CONCESSIONS TO PATIENT SERVICE REVENUE ARE RECORDED AT THE TIME THE PERFORMANCE OBLIGATIONS ARE SATISFIED. SUBSTANTIALLY ALL CHANGES TO THESE CONCESSIONS, AS A RESULT OF SUBSEQUENT REASSESSMENT, ARE RECOGNIZED IN THE PERIOD THE CHANGE IS IDENTIFIED AS ADJUSTMENTS TO PATIENT SERVICE REVENUE. AMOUNTS RECOGNIZED DUE TO CHANGES IN ESTIMATES OF EXPLICIT AND IMPLICIT PRICE CONCESSIONS FOR THE YEARS ENDED DECEMBER 31, 2023 AND 2022 ARE NOT SIGNIFICANT. SUBSEQUENT CHANGES THAT ARE DETERMINED TO BE A RESULT OF AN ADVERSE CHANGE IN THE PATIENT'S OR PAYOR'S ABILITY TO PAY AND ARE MATERIAL ARE RECORDED AS BAD DEBT EXPENSE. NO BAD DEBT EXPENSE WAS RECORDED FOR THE YEARS ENDED DECEMBER 31, 2023 AND 2022 RELATED TO PATIENT SERVICE REVENUE. SCHEDULE H, PART III, LINE 8 MEDICARE COSTS WERE DERIVED FROM THE MEDICARE COST REPORT AND THE COST ACCOUNTING SYSTEM. THE ORGANIZATION BELIEVES THE MEDICARE UNDERPAYMENTS (SHORTFALL) ARE COMMUNITY BENEFIT AND SHOULD BE INCLUDED ON FORM 990, SCHEDULE H, PART I. AS OUTLINED MORE FULLY BELOW, THE ORGANIZATION BELIEVES THAT THESE SERVICES AND RELATED COSTS PROMOTE THE HEALTH OF THE COMMUNITY AS A WHOLE AND ARE RENDERED IN CONJUNCTION WITH THE ORGANIZATION'S CHARITABLE TAX-EXEMPT PURPOSES AND MISSION IN PROVIDING MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUALS IN A NON-DISCRIMINATORY MANNER WITHOUT REGARD TO RACE, COLOR, CREED, SEX, NATIONAL ORIGIN, RELIGION OR ABILITY TO PAY AND IS CONSISTENT WITH THE COMMUNITY BENEFIT STANDARD PROMULGATED BY THE IRS. THE COMMUNITY BENEFIT STANDARD IS THE CURRENT STANDARD FOR A TAX-EXEMPT AND CHARITABLE ORGANIZATION UNDER THE INTERNAL REVENUE CODE ("IRC") 501(C)(3). SATISFYING THE "COMMUNITY BENEFIT STANDARD," AS ARTICULATED BY THE INTERNAL REVENUE SERVICE (IRS) IN REVENUE RULING 69-545, IS CURRENTLY REQUIRED FOR A HOSPITAL TO BE RECOGNIZED AS A CHARITABLE ORGANIZATION UNDER INTERNAL REVENUE CODE (IRC) 501(C)(3). THIS RULING REMOVED THE PREVIOUS REQUIREMENT OF REVENUE RULING 56-185, KNOWN AS THE "CHARITY CARE STANDARD," THAT IN ORDER TO BE A CHARITABLE ORGANIZATION, A HOSPITAL HAD TO PROVIDE, TO THE EXTENT OF ITS FINANCIAL ABILITY, FREE OR REDUCED-COST CARE TO PATIENTS UNABLE TO PAY FOR THEIR CARE. THIS EARLIER RULING EMPHASIZED THAT A LOW LEVEL OF CHARITY CARE DID NOT MEAN THAT A HOSPITAL WAS CHARITABLE SINCE THAT LEVEL COULD REFLECT THE HOSPITAL'S FINANCIAL ABILITY TO PROVIDE SUCH CARE. REVENUE RULING 56-185 ALSO NOTED THAT PUBLICLY SUPPORTED COMMUNITY HOSPITALS WOULD NORMALLY QUALIFY AS CHARITABLE BECAUSE THEY SERVE THE ENTIRE COMMUNITY AND A LOW LEVEL OF CHARITY CARE WOULD NOT IMPACT A HOSPITAL'S CHARITABLE STATUS IF IT WAS DUE TO THE SURROUNDING COMMUNITY'S LACK OF CHARITABLE DEMANDS. AS DEVELOPED IN REVENUE RULING 69-545, UNDER THE COMMUNITY BENEFIT STANDARD, HOSPITALS WERE JUDGED ON WHETHER THEY PROMOTE THE HEALTH OF A BROAD CLASS OF INDIVIDUALS IN THE COMMUNITY. THIS RULING INVOLVED A HOSPITAL THAT ONLY ADMITTED THOSE WHO COULD PAY FOR THE SERVICES EITHER BY THEMSELVES, THROUGH PRIVATE INSURANCE OR PUBLIC PROGRAMS SUCH AS MEDICARE. IN ADDITION, THE HOSPITAL OPERATED A FULL-TIME EMERGENCY ROOM THAT WAS OPEN TO EVERYONE. THE IRS RULED THAT THE HOSPITAL WAS CHARITABLE BECAUSE IT PROMOTED THE HEALTH OF PEOPLE IN ITS COMMUNITY. THE IRS REASONED THAT BECAUSE THE PROMOTION OF HEALTH WAS A CHARITABLE PURPOSE ACCORDING TO THE GENERAL LAW OF CHARITY, IT FELL WITHIN THE "GENERALLY ACCEPTED LEGAL SENSE" OF THE TERM CHARITABLE, AS REQUIRED BY TREASURY REGULATION SECTION 1.501 (C)(3)-1(D)(2). THE IRS RULED THAT THE PROMOTION OF HEALTH, LIKE RELIEF OF POVERTY AND THE ADVANCEMENT OF EDUCATION AND RELIGION, IS ONE OF THE PURPOSES OF THE GENERAL LAW OF CHARITY THAT IS DEEMED BENEFICIAL TO THE COMMUNITY AS A WHOLE EVEN THOUGH THE CLASS OF BENEFICIARIES ELIGIBLE TO RECEIVE A DIRECT BENEFIT FROM ITS ACTIVITIES DOES NOT INCLUDE ALL MEMBERS OF THE COMMUNITY, SUCH AS INDIGENT MEMBERS OF THE COMMUNITY, PROVIDED THAT THE CLASS IS NOT SO SMALL THAT ITS RELIEF IS NOT OF BENEFIT TO THE COMMUNITY. THE IRS CONCLUDED THAT THE HOSPITAL WAS "PROMOTING THE HEALTH OF A CLASS OF PERSONS THAT IS BROAD ENOUGH TO BENEFIT THE COMMUNITY" BECAUSE ITS EMERGENCY ROOM WAS OPEN TO ALL AND IT PROVIDED CARE TO THOSE WHO COULD PAY, WHETHER DIRECTLY OR THROUGH THIRD-PARTY REIMBURSEMENT. OTHER FACTORS THAT DEMONSTRATED COMMUNITY BENEFIT INCLUDED: SURPLUS FUNDS WERE USED TO IMPROVE PATIENT CARE, EXPAND FACILITIES AND ADVANCE MEDICAL TRAINING, EDUCATION AND RESEARCH; AND IT WAS CONTROLLED BY A BOARD OF DIRECTORS THAT CONSISTED OF INDEPENDENT CIVIC LEADERS. THE AMERICAN HOSPITAL ASSOCIATION ("AHA") BELIEVES THE MEDICARE UNDERPAYMENTS (SHORTFALLS) SHOULD BE REPORTED AS COMMUNITY BENEFIT ON FORM 990, SCHEDULE H, PART I, LINE 7. THIS ORGANIZATION AGREES WITH THE AHA'S LETTER TO THE IRS DATED AUGUST 21, 2007 RESPONDING TO A DRAFT OF THE NEW FORM 990 AND SCHEDULE H, THE AHA ARGUED THAT MEDICARE UNDERPAYMENTS (SHORTFALLS) IS COMMUNITY BENEFIT FOR THE FOLLOWING REASONS: -PROVIDING CARE FOR THE ELDERLY AND SERVING MEDICARE PATIENTS REMAINS AN ESSENTIAL PART OF THE COMMUNITY BENEFIT STANDARD. -MEDICARE, LIKE MEDICAID, DOES NOT PAY THE FULL COST OF CARE. RECENTLY, MEDICARE REIMBURSES ONLY 92 CENTS FOR EVERY DOLLAR HOSPITALS SPEND TO CARE FOR MEDICARE PATIENTS. THE MEDICARE PAYMENT ADVISORY COMMISSION ("MEDPAC") IN ITS MARCH 2007 REPORT TO CONGRESS CAUTIONED THAT UNDERPAYMENT WILL GET EVEN WORSE, WITH MARGINS REACHING A 10 YEAR LOW AT NEGATIVE 5.4 PERCENT. -MANY MEDICARE PATIENTS, LIKE THEIR MEDICAID COUNTERPARTS, ARE POOR. MORE THAN 46% OF MEDICARE SPENDING IS FOR BENEFICIARIES WHOSE INCOME IS BELOW 200% OF THE FEDERAL POVERTY LEVEL. MANY ARE ALSO ELIGIBLE FOR MEDICAID, SO CALLED -DUAL ELIGIBLES". PENNSYLVANIA REQUIRES NON-PROFIT HOSPITALS TO PROVIDE A MINIMUM LEVEL OF COMMUNITY BENEFIT TO RETAIN EXEMPTION FROM STATE AND LOCAL TAXES. ACCORDING TO STATE GUIDANCE AND CASE LAW, THE UNREIMBURSED COST OF MEDICARE AND BAD DEBT IS CONSIDERED TO BE COMMUNITY BENEFIT FOR STATE TAX EXEMPTION PURPOSES. PART III, LINE 6 ONLY INCLUDES THOSE COSTS THAT ARE PERMITTED TO BE REPORTED IN THE HOSPITAL'S MEDICARE COST REPORT THAT IS REQUIRED TO BE FILED WITH THE FEDERAL GOVERNMENT. THE HOSPITAL CONSIDERS THE TOTAL MEDICARE UNDERPAYMENTS (SHORTFALL) OF 17,217,456 SHOULD BE REPORTED AS COMMUNITY BENEFIT ON THE FORM 990, SCHEDULE H, PART I, LINE 7. ALONG WITH PROVIDING CARE TO MEDICAID PATIENTS AND PROVIDING FREE OR DISCOUNTED CARE TO OTHER LOW-INCOME PATIENTS, THE IRS COMMUNITY BENEFIT STANDARD INCLUDES THE PROVISION OF CARE TO THE ELDERLY AND MEDICARE PATIENTS. LIKE MEDICAID, MEDICARE DOES NOT PAY THE FULL COST OF PROVIDING CARE TO THESE PATIENTS, FORCING THE HOSPITAL TO USE OTHER FUNDS TO COVER THE SHORTFALL. MEDICARE SHORTFALLS MUST BE ABSORBED BY THE HOSPITAL IN ORDER TO CONTINUE TREATING THE ELDERLY IN OUR COMMUNITIES. THE HOSPITAL PROVIDES CARE REGARDLESS OF THE MEDICARE SHORTFALL AND IS THEREBY PROVIDING ACCESS TO MEDICAL SERVICES FOR THE ELDERLY AND RELIEVING THE FEDERAL GOVERNMENT OF THE BURDEN OF PAYING THE FULL COST FOR PROVIDING CARE TO MEDICARE PATIENTS. ABSENT THE MEDICARE PROGRAM, IT IS LIKELY THAT MANY MEDICARE PATIENTS WOULD BE ELIGIBLE FOR CHARITY CARE OR OTHER NEED-BASED GOVERNMENT PROGRAMS. THE AMOUNT EXPENDED TO COVER THE SHORTFALL IS MONEY NOT AVAILABLE FOR FINANCIAL ASSISTANCE AND OTHER COMMUNITY BENEFIT NEEDS. SCHEDULE H, PART III, LINE 9B THE HOSPITAL IS COMMITTED TO PROVIDING MEDICALLY NECESSARY SERVICES TO PATIENTS REGARDLESS OF THEIR ABILITY TO PAY AND THE HOSPITAL'S COLLECTION ACTIONS ARE CONSISTENTLY APPLIED TO ALL PATIENTS. IT IS THE HOSPITAL'S POLICY TO PROVIDE FINANCIAL ASSISTANCE AND COUNSELING TO PATIENTS WITH LIMITED FINANCIAL MEANS. A PATIENT MAY BECOME ELIGIBLE FOR FINANCIAL ASSISTANCE AT ANY TIME DURING TREATMENT OR DURING THE CONTINUUM OF THE FINANCIAL/BILLING AND COLLECTION PROCESS. IN ANY STAGE OF THE BILLING PROCESS, COLLECTION ACTIONS ARE NOT PURSUED WHENEVER A PATIENT APPLIES AND IS BEING EVALUATED FOR FINANCIAL ASSISTANCE. UNDER NO CIRCUMSTANCES WILL THE HOSPITAL FREEZE OR ATTACH BANK ACCOUNTS OF A PATIENT, ENFORCE LIENS, ACTIVELY PURSUE ASSETS FROM A PRIOR JUDGMENT OR GARNISH THE WAGES OF A PATIENT AND/OR FAMILY MEMBER BEFORE DETERMINING IF THE PATIENT IS ELIGIBLE FOR ASSISTANCE UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM. GEISINGER MANAGEMENT HAS DEVELOPED POLICIES AND PROCEDURES FOR INTERNAL AND EXTERNAL COLLECTION PRACTICES THAT TAKE INTO ACCOUNT THE EXTENT TO WHICH THE PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE, A PATIENT'S GOOD FAITH EFFORT TO APPLY FOR GOVERNMENTAL PROGRAMS OR FINANCIAL ASSISTANCE FROM GEISINGER AND A PATIENT'S GOOD FAITH EFFORT TO COMPLY WITH HIS OR HER PAYMENT AGREEMENTS. BILLING AND COLLECTION POLICY: THE BILLING AND COLLECTION POLICY IS ADMINISTERED IN ACCORDANCE WITH THE MISSION AND VALUES OF THE HOSPITAL AS WELL AS FEDERAL AND STATE LAW. THE POLICY IS DESIGNED TO PROMOTE APPROPRIATE ACCESS TO MEDICAL CARE FOR ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY WHILE MAINTAINING GEISINGER'S FISCAL RESPONSIBILITY TO MAXIMIZE REIMBURSEMENT AND MINIMIZE BAD DEBT. THE ORGANIZATION'S BILLING AND COLLECTION POLICY IS INTENDED TO TAKE INTO ACCOUNT EACH INDIVIDUAL'S ABILITY TO CONTRIBUTE TO THE COST OF HIS OR HER CARE. THE ORGANIZATION MAKES SURE THAT PATIENTS ARE ASSISTED IN OBTAINING HEALTH INSURANCE COVERAGE FROM PRIVATELY AND PUBLICLY FUNDED SOURCES, WHENEVER POSSIBLE. ALL BUSINESS OFFICE CUSTOMER SERVICE DEPARTMENT REPRESENTATIVES ARE EDUCATED ON ALL ASPECTS OF THE BILLING AND COLLECTION POLICY AND ARE EXPECTED TO ADMINISTER THE POLICY ON A REGULAR AND CONSISTENT BASIS. BUSINESS OFFICE CUSTOMER SERVICE REPRESENTATIVES ARE HELD ACCOUNTABLE TO TREAT ALL PATIENTS WITH COURTESY, RESPECT, CONFIDENTIALITY AND CULTURAL SENSITIVITY. THE BILLING AND COLLECTION POLICY IS ADMINISTERED IN CONJUNCTION WITH THE PROCEDURES OUTLINED IN INTERNAL ADMINISTRATIVE POLICIES. THE GEISINGER EXECUTIVE VICE PRESIDENT, CHIEF FINANCIAL OFFICER AND VICE PRESIDENT, CHIEF REVENUE OFFICER HAVE OVERALL RESPONSIBILITY FOR THE BILLING AND COLLECTION ACTIVITIES OF THE HOSPITAL. THE BUSINESS OFFICE CUSTOMER SERVICE DEPARTMENT STAFF IS RESPONSIBLE FOR THE DAY-TO-DAY ENFORCEMENT OF APPROVED POLICIES AND PROCEDURES. GEISINGER MAY OFFER EXTENDED PAYMENT PLANS TO PATIENTS WHO ARE COOPERATING IN GOOD FAITH TO RESOLVE THEIR HOSPITAL BILLS. EMERGENCY & MEDICALLY NECESSARY SERVICES: GEISINGER DOES NOT ENGAGE IN ANY ACTIONS THAT DISCOURAGE INDIVIDUALS FROM SEEKING EMERGENCY MEDICAL CARE. THE ORGANIZATION WILL NEVER DEMAND THAT AN EMERGENCY DEPARTMENT PATIENT PAY BEFORE RECEIVING TREATMENT FOR EMERGENCY MEDICAL CONDITIONS. ADDITIONALLY, GEISINGER DOES NOT PERMIT DEBT COLLECTION ACTIVITIES IN THE EMERGENCY DEPARTMENT OR OTHER AREAS WHERE SUCH ACTIVITIES COULD INTERFERE WITH THE PROVISION OF EMERGENCY CARE ON A NONDISCRIMINATORY BASIS. ALL MEDICALLY NECESSARY HOSPITAL SERVICES ARE PROVIDED WITHOUT CONSIDERATION OF ABILITY TO PAY AND ARE NOT DELAYED PENDING APPLICATION OR APPROVAL OF MEDICAL ASSISTANCE OR THE GEISINGER FINANCIAL ASSISTANCE PROGRAM. ADVANCE PAYMENT IS NOT REQUIRED FOR ANY MEDICALLY NECESSARY SERVICES. COMPLIANCE WITH INTERNAL REVENUE CODE SECTION 501(R)(6): GEISINGER DOES NOT ENGAGE IN ANY EXTRAORDINARY COLLECTION ACTIONS ("ECAS") AS DEFINED BY INTERNAL REVENUE CODE SECTION 501(R)(6) PRIOR TO THE EXPIRATION OF THE NOTIFICATION PERIOD. THE NOTIFICATION PERIOD IS DEFINED AS A 120-DAY PERIOD OR GREATER, WHICH BEGINS ON THE DATE OF THE 1ST POST-DISCHARGE BILLING STATEMENT, IN WHICH NO ECAS ARE INITIATED AGAINST THE PATIENT. SUBSEQUENT TO THE NOTIFICATION PERIOD GEISINGER, OR ANY THIRD PARTIES ACTING ON ITS BEHALF, MAY INITIATE THE FOLLOWING ECAS AGAINST A PATIENT FOR AN UNPAID BALANCE IF THE FINANCIAL ASSISTANCE ELIGIBILITY DETERMINATION HAS NOT BEEN MADE OR IF AN INDIVIDUAL IS INELIGIBLE FOR FINANCIAL ASSISTANCE. GEISINGER MAY AUTHORIZE THIRD PARTIES TO REPORT ADVERSE INFORMATION ABOUT THE INDIVIDUAL TO CONSUMER CREDIT REPORTING AGENCIES OR CREDIT BUREAUS ON DELINQUENT PATIENT ACCOUNTS AFTER THE NOTIFICATION PERIOD. THE ORGANIZATION ENSURES REASONABLE EFFORTS HAVE BEEN TAKEN TO DETERMINE WHETHER AN INDIVIDUAL IS ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THE FINANCIAL ASSISTANCE POLICY AND ENSURES THE FOLLOWING ACTIONS ARE TAKEN AT LEAST 30 DAYS PRIOR TO INITIATING ANY ECA: 1) THE PATIENT IS PROVIDED WITH WRITTEN NOTICE WHICH: INDICATES THAT FINANCIAL ASSISTANCE IS AVAILABLE FOR ELIGIBLE PATIENTS; IDENTIFIES THE ECA(S) THAT GEISINGER INTENDS TO INITIATE TO OBTAIN PAYMENT FOR THE CARE; AND STATES A DEADLINE AFTER WHICH SUCH ECAS MAY BE INITIATED. 2) THE PATIENT IS PROVIDED WITH A COPY OF THE PLAIN LANGUAGE SUMMARY; AND 3) REASONABLE EFFORTS ARE MADE TO ORALLY NOTIFY THE PATIENT ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE AND HOW THE INDIVIDUAL MAY OBTAIN ASSISTANCE WITH THE FINANCIAL ASSISTANCE APPLICATION PROCESS. GEISINGER PROCESSES ALL APPLICATIONS FOR FINANCIAL ASSISTANCE SUBMITTED DURING THE APPLICATION PERIOD. THE APPLICATION PERIOD BEGINS ON THE DATE THE CARE IS PROVIDED AND ENDS ON THE 240TH DAY AFTER THE DATE OF THE FIRST POST-DISCHARGE BILLING STATEMENT. SCHEDULE H, PART VI, LINE 2 CHNA COLLABORATING HEALTH SYSTEMS THE 2021 GEISINGER COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) WAS CONDUCTED IN PARTNERSHIP WITH GEISINGER, ALLIED SERVICES INTEGRATED HEALTH SYSTEM, AND EVANGELICAL COMMUNITY HOSPITAL. THE STUDY AREA INCLUDED 15 COUNTIES ACROSS CENTRAL AND NORTHEASTERN PENNSYLVANIA, WHICH REPRESENTED THE HEALTH SYSTEMS' COLLECTIVE SERVICE AREAS. COLLABORATION IN THIS WAY CONSERVES VITAL COMMUNITY RESOURCES WHILE FOSTERING A PLATFORM FOR "COLLECTIVE IMPACT" THAT ALIGNS COMMUNITY EFFORTS TOWARD A COMMON GOAL OR ACTION. TO DISTINGUISH UNIQUE SERVICE AREAS AMONG HOSPITALS, REGIONAL RESEARCH AND REPORTING WAS DEVELOPED. 2021 CHNA GEOGRAPHIC REGIONS AND PRIMARY SERVICE COUNTIES 1- CENTRAL REGION INCLUDING THE COUNTIES OF COLUMBIA, MONTOUR, NORTHUMBERLAND, SCHUYLKILL, SNYDER AND UNION REPRESENTED BY GEISINGER- BLOOMSBURG HOSPITAL, GEISINGER MEDICAL CENTER (INCLUDES GEISINGER SHAMOKIN AREA COMMUNITY HOSPITAL), GEISINGER ENCOMPASS HEALTH LIMITED LIABILITY COMPANY (DBA GEISINER ENCOMPASS HEALTH REHABILITATION HOSPITAL) AND EVANGELICAL COMMUNITY HOSPITAL. 2- NORTH CENTRAL REGION INCLUDING THE COUNTIES OF CLINTON AND LYCOMING REPRESENTED BY GEISINGER JERSEY SHORE HOSPITAL AND GEISINGER MEDICAL CENTER MUNCY (LICENSED/OPERATIONAL JANUARY 2022) 3- NORTHEAST REGION INCLUDING THE COUNTIES OF LACKAWANNA, LUZERNE, WAYNE AND WYOMING REPRESENTED BY ALLIED SERVICES REHAB HOSPITAL, COMMUNITY MEDICAL CENTER (DBA GEISINGER COMMUNITY MEDICAL CENTER, GEISINGER WYOMING VALLEY MEDICAL CENTER (INCLUDES GEISINGER SOUTH WILKES-BARRE) AND HEINZ REHAB HOSPITAL. 4- WESTERN REGION INCLUDING THE COUNTIES OF CENTRE, JUNIATA AND MIFFLIN REPRESENTED BY GEISINGER-LEWISTOWN HOSPITAL. GEISINGER SYSTEMWIDE CHNA APPROACH THE 2021 CHNA FOCUSED ON THE PRIMARY SERVICE AREAS OF EACH OF GEISINGER'S NINE HOSPITAL CAMPUSES. UNDERSTANDING OVERLAPPING GEOGRAPHIC BOUNDARIES, SOCIOECONOMICS, AND RELATED COMMUNITY INDICATORS, GEISINGER HOSPITALS WERE GROUPED INTO REGIONS TO ALLOW FOR LOCALIZED DATA COMPARISONS. SYSTEMWIDE PRIORITIES WERE DETERMINED TO ADDRESS COMMON NEEDS ACROSS THE WHOLE SERVICE AREA, WHILE INDIVIDUAL HOSPITAL IMPLEMENTATION PLANS OUTLINED SPECIFIC STRATEGIES TO GUIDE LOCAL EFFORTS AND COLLABORATION WITH COMMUNITY PARTNERS. SEE ALSO THE DISCUSSION RELATED TO THE RESPONSE TO PART V, LINE 5. SCHEDULE H, PART VI, LINE 3 GEISINGER IS COMMITTED TO PROVIDING THE HIGHEST QUALITY HEALTHCARE SERVICES TO OUR COMMUNITY. GEISINGER IS COMMITTED TO A SERVICE EXCELLENCE PHILOSOPHY THAT STRIVES TO MEET OR EXCEED PATIENT EXPECTATIONS. ALL PATIENTS WILL RECEIVE A UNIFORM STANDARD OF CARE THROUGHOUT ALL GEISINGER FACILITIES, REGARDLESS OF SOCIAL, CULTURAL, FINANCIAL, RELIGIOUS, RACIAL, GENDER OR SEXUAL ORIENTATION. GEISINGER STRIVES TO ENSURE THAT ALL PATIENTS RECEIVE ESSENTIAL EMERGENCY AND OTHER MEDICALLY NECESSARY HEALTH SERVICES REGARDLESS OF THEIR ABILITY TO PAY. FOR URGENT AND EMERGENT SERVICES, PATIENTS ARE PROVIDED CARE REGARDLESS OF THEIR ABILITY TO PAY. IN THE EVENT A PATIENT HAS AN EMERGENCY MEDICAL CONDITION; TREATMENT IS NOT DELAYED TO PERMIT AN INQUIRY REGARDING A PATIENT'S METHOD OF PAYMENT OR INSURANCE STATUS. FOR OTHER THAN URGENT AND EMERGENT SERVICES, THE HOSPITAL PROVIDES UNCOMPENSATED CARE, FREE OF CHARGE, OR ON A 100% DISCOUNTED BASIS, TO THOSE PATIENTS WHO DEMONSTRATE AN INABILITY TO PAY. DEPENDING UPON FAMILY SIZE AND INCOME, FREE OR 100% DISCOUNTED SERVICES ARE AVAILABLE TO A PATIENT WITH FAMILY INCOME OF 300% OR LESS OF THE FEDERAL POVERTY GUIDELINES. IT IS THE HOSPITAL'S POLICY TO PROVIDE FINANCIAL ASSISTANCE AND FINANCIAL COUNSELING TO PATIENTS OF LIMITED MEANS. A PATIENT MAY BECOME ELIGIBLE FOR CHARITY CARE OR FINANCIAL ASSISTANCE AT ANY TIME DURING TREATMENT OR DURING THE CONTINUUM OF THE FINANCIAL/BILLING PROCESS. INFORMATION (SIGNS, BROCHURES, ETC.) REGARDING THE HOSPITAL'S CHARITY CARE AND FINANCIAL ASSISTANCE POLICIES ARE PROVIDED AT THE EMERGENCY ROOM, REGISTRATION AND VARIOUS ACCESS POINTS THROUGHOUT THE HOSPITAL. REGISTRATION PERSONNEL ALSO REFER UNINSURED AND/OR LOW INCOME PATIENTS TO FINANCIAL COUNSELORS TO DISCUSS THE FINANCIAL ASSISTANCE POLICY. NOTICE OF THE HOSPITAL'S CHARITY CARE AND FINANCIAL ASSISTANCE POLICIES CAN ALSO BE FOUND ON THE GEISINGER WEB SITE AT WWW.GEISINGER.ORG. PATIENTS ARE ALSO PROVIDED INFORMATION ON THE HOSPITAL'S CHARITY CARE AND FINANCIAL ASSISTANCE POLICIES WITH EACH PATIENT BILL. THE FINANCIAL ASSISTANCE POLICY ("FAP"), THE FAP APPLICATION AND PLAIN LANGUAGE SUMMARY ("PLS") ARE AVAILABLE ON-LINE. PAPER COPIES ARE AVAILABLE UPON REQUEST WITHOUT CHARGE BY MAIL OR ARE AVAILABLE AT REGISTRATION AREAS WHICH INCLUDES EMERGENCY ROOMS, ADMITTING AND REGISTRATION DEPARTMENTS, HOSPITAL-BASED CLINICS AND PATIENT FINANCIAL SERVICES DEPARTMENTS. ALL FAP DOCUMENTS ARE AVAILABLE IN ENGLISH AND IN THE PRIMARY LANGUAGE OF POPULATIONS WITH LIMITED ENGLISH PROFICIENCY ("LEP") THAT CONSTITUTE THE LESSER OF 1,000 INDIVIDUALS OR 5% OF THE HOSPITAL'S SERVICE AREA. SIGNS OR DISPLAYS ARE CONSPICUOUSLY POSTED IN PUBLIC HOSPITAL LOCATIONS INCLUDING THE EMERGENCY DEPARTMENT, ADMISSIONS DEPARTMENT AND REGISTRATION DEPARTMENT THAT INFORM PATIENTS OF THE AVAILABILITY OF FINANCIAL ASSISTANCE. ALL PATIENTS ARE OFFERED A COPY OF THE PLS AS PART OF THE INTAKE AND DISCHARGE PROCESSES. ADDITIONALLY, FINANCIAL COUNSELORS AND CUSTOMER SERVICE REPRESENTATIVES ARE AVAILABLE TO ASSIST PATIENTS WITH CONCERNS. SCHEDULE H, PART VI, LINE 4 FOR THE PURPOSES OF THE 2021 CHNA, GLH DEFINED ITS PRIMARY SERVICE AREA AS 11 ZIP CODES, PRIMARILY WITHIN THE WESTERN REGION. THE PRIMARY SERVICE AREA WAS IDENTIFIED BASED ON THE PATIENT ZIP CODES OF ORIGIN COMPRISING 80% OR MORE OF HOSPITAL DISCHARGES IN FISCAL YEAR 2019. WESTERN REGION POPULATION TRENDS THE WESTERN REGION IS PREDOMINANTLY RURAL. THE TOTAL POPULATION OF THE REGION IS APPROXIMATELY 240,000; 70% OF THE TOTAL POPULATION IS LOCATED WITHIN CENTRE COUNTY, DRIVEN PREDOMINANTLY BY STATE COLLEGE, HOME TO PENN STATE UNIVERSITY (PSU) MAIN CAMPUS AND THE LARGEST MUNICIPAL POPULATION DENSITY IN THE WESTERN REGION. THE CENTRE COUNTY POPULATION IS PROJECTED TO CONTINUE TO GROW BY 3.5% THROUGH 2025. CENTRE COUNTY'S POPULATION IS ECONOMICALLY AND DEMOGRAPHICALLY IMPACTED BY PSU. AGE STRATIFICATION AND RACIAL DIVERSITY IN CENTRE COUNTY REFLECT THIS IMPACT. CENTRE COUNTY HAS A SIGNIFICANTLY LOWER MEDIAN AGE THAN BOTH THE STATE AND NATION AND NEARLY 1 IN 3 RESIDENTS IS AGE 15 TO 24 YEARS. CENTRE COUNTY ALSO BENEFITS FROM MORE ETHNIC AND RACIAL DIVERSITY THAN SURROUNDING COUNTIES WITH ABOUT 7% ASIAN (HIGHER THAN STATE (4%) AND NATION (6%)); ALMOST 4% BLACK; AND 3% LATINX POPULATIONS. THE SMALLEST OF THE THREE COUNTIES THAT MAKE UP THE WESTERN REGION, JUNIATA COUNTY, EXPERIENCED THE LARGEST POPULATION GROWTH FROM THE FY2019 CHNA AND-CONSISTENT WITH STRONG HISTORICAL GROWTH TRENDS-GROWTH IS ANTICIPATED THROUGH 2025. MIFFLIN AND MIFFLINTOWN ARE THE LARGEST POPULATION DENSITY CENTERS IN JUNIATA COUNTY. OF PARTICULAR NOTE IS THE GROWTH OF THE LATINX POPULATION WITHIN JUNIATA COUNTY, WHICH AT 4.5% IS THE HIGHEST IN THE WESTERN REGION AND PROJECTED TO INCREASE TO 5.5% BY 2025. MIFFLIN COUNTY HAS THE OLDEST POPULATION IN THE WESTERN REGION WITH APPROXIMATELY 22% OF RESIDENTS AGE 65 OR OLDER, COMPARED TO CENTRE (14%), JUNIATA (20%), THE STATE (19%), AND THE NATION (17%). THE TOTAL MIFFLIN COUNTY POPULATION DECLINED APPROXIMATELY 1% SINCE THE FY2019 CHNA AND IS EXPECTED TO CONTINUE TO DECLINE 0.5% THROUGH 2025. THE WESTERN REGION IS HOME TO THE LARGEST AMISH POPULATION IN THE CHNA SERVICE AREA WITH 8,642 AMISH RESIDENTS, ABOUT 3.5% OF THE REGION'S TOTAL POPULATION. MIFFLIN COUNTY HAS THE LARGEST SETTLEMENT WITH 4,089 AMISH, MAKING UP NEARLY 9% OF THE COUNTY POPULATION. THE CLOISTERED TENDENCIES OF AMISH AND OTHER PLAIN POPULATIONS MAKE TRACKING HEALTH TRENDS-AND RESPONDING TO NEEDS-MORE CHALLENGING. SOCIOECONOMIC TRENDS THE WESTERN REGION IS PREDOMINANTLY RURAL AND HAS A LONG HERITAGE OF AGRICULTURE AND MANUFACTURING. CENTRE COUNTY DIFFERS FROM MIFFLIN AND JUNIATA COUNTIES WITH A HIGHER PERCENTAGE OF WORKERS IN THE HEALTHCARE AND EDUCATION SECTORS. THE REGION HAS A PREDOMINANTLY BLUE-COLLAR WORKFORCE, WITH THE EXCEPTION OF STATE COLLEGE (CENTRE COUNTY), DRIVEN DIRECTLY BY PSU MAIN CAMPUS. EDUCATION ATTAINMENT IN MIFFLIN AND JUNIATA COUNTIES IS APPROXIMATELY HALF THE STATE AND NATIONAL AVERAGES, WHILE CENTRE COUNTY EXCEEDS THESE BENCHMARKS. ABOUT 40% OF KEY INFORMANT SURVEY RESPONDENTS NAMED POVERTY AMONG THE TOP THREE CONTRIBUTING FACTORS TO HEALTH CONCERNS, RANKING IT AS THE 1 CONTRIBUTOR IN THE REGION. RELATED SOCIOECONOMIC FACTORS, INCLUDING TRANSPORTATION OPTIONS AND AFFORDABLE HOUSING, WERE ALSO INDICATED AS TOP COMMUNITY NEEDS. THE POPULATION OF STUDENTS AND YOUNG PEOPLE LIVING ON OR NEAR PSU MAIN CAMPUS IMPACTS ECONOMIC MEASURES FOR CENTRE COUNTY, WHICH REPORTS 18% OF THE TOTAL POPULATION LIVING IN POVERTY. A CLOSER LOOK AT DATA FOR STATE COLLEGE AND NEIGHBORING COMMUNITIES REVEALS THAT THIS PERCENTAGE IS LIKELY DRIVEN BY A MORE DIVERSE, YOUNGER POPULATION, VERSUS PERMANENT FULLTIME RESIDENTS. THE PERCENTAGE OF CHILDREN IN POVERTY IS A MORE RELIABLE DATA POINT BY WHICH TO COMPARE. NEARLY 24% OF MIFFLIN COUNTY CHILDREN LIVE IN POVERTY COMPARED TO 18.5% OF CHILDREN IN JUNIATA COUNTY, 12% IN CENTRE COUNTY, 18% IN THE STATE, AND 19.5% IN THE NATION. THE AMISH POPULATION IN MIFFLIN COUNTY LIKELY CONTRIBUTES TO THE HIGH PERCENTAGE OF CHILDREN LIVING IN POVERTY. JUNIATA AND MIFFLIN COUNTY RESIDENTS ARE MORE LIKELY TO OWN THEIR HOME, AND HOMES ARE GENERALLY MORE AFFORDABLE WHEN COMPARED TO THE STATE AND NATION, WITH FEWER RESIDENTS CONSIDERED HOUSING COST BURDENED. HOUSING COST BURDEN IS DEFINED AS SPENDING 30% OR MORE OF HOUSEHOLD INCOME ON RENT OR MORTGAGE EXPENSES. CENTRE COUNTY HOUSING IS THE NEWEST AND MOST EXPENSIVE, ALTHOUGH HOMEOWNERS ARE THE LEAST LIKELY WITHIN THE REGION TO BE HOUSING COST BURDENED. BOTH RENTALS AND RENTAL HOUSING COST BURDEN ARE HIGHER IN CENTRE COUNTY THAN STATE AND NATIONAL AVERAGES, DRIVEN PREDOMINANTLY BY PSU. AS A RESULT OF THE COVID-19 PANDEMIC, THE WESTERN REGION UNEMPLOYMENT RATE MORE THAN DOUBLED FROM MAY 2019 TO MAY 2020. AS OF MAY 2020, UNEMPLOYMENT RATES AMONG WESTERN REGION COUNTIES (8%-11%) WERE LOWER THAN THE STATE AND NATION (13%). RACIAL AND ETHNIC SOCIOECONOMIC DISPARITIES EXIST ACROSS THE WESTERN REGION, ALTHOUGH FINDINGS SHOULD BE INTERPRETED WITH CAUTION DUE TO LOW POPULATION COUNTS AND THE IMPACT OF PSU. MOST NOTABLY, BLACK RESIDENTS IN CENTRE COUNTY AND LATINX RESIDENTS IN JUNIATA AND MIFFLIN COUNTIES ARE AMONG THE MOST LIKELY TO LIVE IN POVERTY AND LEAST LIKELY TO ATTAIN HIGHER EDUCATION. HEALTH TRENDS ACCESS TO HEALTHCARE GENERALLY, MORE HEALTHCARE PROVIDERS AND SOCIAL SERVICES ARE AVAILABLE IN CENTRE COUNTY THAN JUNIATA AND MIFFLIN COUNTIES. THE CENTRE COUNTY PRIMARY AND MENTAL HEALTH PROVIDER DENSITY RATES ARE MORE CLOSELY ALIGNED WITH THE STATE AND NATION. MIFFLIN AND JUNIATA COUNTIES' PRIMARY CARE PROVIDER RATES ARE APPROXIMATELY 25 TO 50 POINTS (RESPECTIVELY) BELOW CENTRE COUNTY, AND MENTAL HEALTH PROVIDER RATES ARE MORE THAN 100 POINTS LOWER. JUNIATA AND MIFFLIN COUNTIES ARE MENTAL HEALTH PROFESSIONAL SHORTAGE AREAS (HPSAS); JUNIATA COUNTY IS ALSO A PRIMARY CARE HPSA. OF NOTE, ALL THREE COUNTIES HAVE FEWER DENTAL PROVIDERS AND ARE DENTAL HPSAS FOR LOW-INCOME RESIDENTS. KEY INFORMANT SURVEY RESPONDENTS AFFIRMED THE NEED FOR ADDITIONAL BEHAVIORAL HEALTH SERVICES, PARTICULARLY MENTAL HEALTH SERVICES. MENTAL HEALTH SERVICES WERE THE TOP RANKED MISSING RESOURCE IN THE REGION, IDENTIFIED BY 66% OF RESPONDENTS. SUBSTANCE USE DISORDER SERVICES WERE THE SIXTH RANKED MISSING RESOURCE, POTENTIALLY INDICATING AN AWARENESS OF CAPACITY AMONG EXISTING PROVIDERS. THE TOTAL UNINSURED POPULATION CONTINUED TO DECLINE ACROSS THE REGION, ALTHOUGH JUNIATA (10.5%) AND MIFFLIN (12.5%) COUNTIES HAVE A HIGHER PERCENTAGE OF UNINSURED THAN CENTRE COUNTY (5.5%), THE STATE (6%), AND THE NATION (9%). JUNIATA AND MIFFLIN COUNTIES HAVE A HIGHER PERCENTAGE OF UNINSURED RESIDENTS ACROSS ALL AGE BANDS, WITH THE HIGHEST DISPARITY IN CHILDREN UNDER AGE 6. NEARLY 23% OF ALL CHILDREN UNDER AGE 6 IN MIFFLIN COUNTY AND NEARLY 20% IN JUNIATA ARE UNINSURED, COMPARED TO 5% STATEWIDE. THE PROMINENT AMISH POPULATION-WHICH IS LESS LIKELY TO PARTICIPATE IN HEALTH INSURANCE PROGRAMS-IMPACTS THIS DISPARITY, HOWEVER LATINX RESIDENTS IN THESE COUNTIES ARE MORE LIKELY TO BE UNINSURED THAN WHITES. IN CENTRE COUNTY, BLACK AND/OR LATINX RESIDENTS ARE MORE LIKELY TO BE UNINSURED THAN WHITES. CHRONIC DISEASE PREVENTION AND MANAGEMENT IN GENERAL, CENTRE COUNTY RESIDENTS REPORT BETTER OVERALL HEALTH MEASURES THAN RESIDENTS IN JUNIATA AND MIFFLIN COUNTIES, WHICH IS CONSISTENT WITH SOCIOECONOMIC FINDINGS. HOWEVER, OBESITY CONTINUES TO BE A CONCERN ACROSS THE REGION. ADULT OBESITY HAS BEEN STEADILY DECREASING OVER THE PAST FOUR YEARS IN CENTRE AND JUNIATA COUNTIES, WHILE MIFFLIN COUNTY HAS BEEN MOSTLY CLIMBING AND IS THE HIGHEST OF THE COUNTIES AT 35% OF ADULTS. MIFFLIN COUNTY ADULT OBESITY EXCEEDS STATE AND NATIONAL (31%) AVERAGES. MIFFLIN COUNTY HAS HISTORICALLY HAD A HIGHER PERCENTAGE OF OBESE YOUTH. PRIOR TO THE 2017-2018 SCHOOL YEAR, 18% OF STUDENTS IN GRADES K-6 AND 24% OF STUDENTS IN GRADES 7-12 WERE OBESE, HIGHER THAN THE STATE AVERAGES OF 16% AND 19%, RESPECTIVELY. YOUTH OBESITY HAS BEEN STEADILY RISING IN JUNIATA COUNTY SINCE 2013 AND IS CURRENTLY THE HIGHEST IN THE REGION, AFFECTING 23% OF STUDENTS IN GRADES K-6 AND 27% OF STUDENTS IN GRADES 7-12. CENTRE COUNTY YOUTH OBESITY HAS HISTORICALLY BEEN LOWER THAN STATE AVERAGES, BUT INCREASED FOR YOUTH IN GRADES 7-12. KEY INFORMANTS SAW HEALTH HABITS AS A TOP CONTRIBUTING FACTOR TO ADULT AND YOUTH OBESITY, AS WELL AS OTHER REGIONAL HEALTH CONCERNS. IN LINE WITH THE STATE AND THE NATION, TOBACCO USE WAS DECLINING ACROSS THE WESTERN REGION; HOWEVER, THERE WAS AN UPTICK IN TOBACCO USE FROM 2016-2017 IN PA AND THE WESTERN REGION, WHILE THE NATION CONTINUED TO DECLINE. THIS REVERSE TREND MAY BE RELATED TO THE POPULARITY OF E-CIGARETTES. MIFFLIN COUNTY HAS THE HIGHEST RATE OF ADULT SMOKING AT 19%, CONSISTENT WITH THE STATE, WHILE JUNIATA (18%) AND CENTRE (17%) COUNTIES ARE BELOW THE STATE. DATA FOR TOBACCO USE AMONG YOUTH IS LIMITED ACROSS THE WESTERN REGION, BUT STATEWIDE TRENDS SHOW A STEADY INCREASE IN E-CIGARETTES AND VAPING SINCE 2015 WITH NEARLY 20% OF STUDENTS USING E-CIGARETTES IN THE PAST SCHEDULE H, PART VI, LINE 5 SCHEDULE H, PART I IN ADDITION TO THE NET COMMUNITY BENEFIT COSTS INCURRED BY THE ORGANIZATION AS REPORTED IN SCHEDULE H, PART I, LINE 7; PLEASE REFER TO SCHEDULE O OF THIS FORM 990 FOR THE ORGANIZATION'S NARRATIVE COMMUNITY BENEFIT STATEMENT FOR ADDITIONAL INFORMATION ON HOW THE ORGANIZATION PROMOTES HEALTH AND PROVIDES HEALTHCARE SERVICES TO THE COMMUNITY REGARDLESS OF THE INDIVIDUAL'S ABILITY TO PAY IN FURTHERANCE OF ITS CHARITABLE TAX EXEMPT PURPOSE. SCHEDULE H, PART VI, LINE 6 GEISINGER HEALTH AND ITS SUBSIDIARIES (COLLECTIVELY REFERRED TO AS "GEISINGER") COMPRISE A PHYSICIAN-LED, INTEGRATED HEALTH SERVICES ORGANIZATION THAT HAS AS ITS MAIN COMPONENTS: (I) AN ARRAY OF HEALTH SERVICES PROVIDERS, INCLUDING SIX WHOLLY-CONTROLLED ACUTE-CARE HOSPITALS WITH MULTIPLE CAMPUSES, A JOINT VENTURE HOSPITAL AND A DRUG AND ALCOHOL TREATMENT FACILITY; (II) MULTISPECIALTY PHYSICIAN GROUP PRACTICES; (III) INSURANCE OPERATIONS, INCLUDING A LICENSED HEALTH MAINTENANCE ORGANIZATION; AND (IV) A COMMUNITY-BASED MEDICAL COLLEGE AND DEGREE-GRANTING INSTITUTION. GEISINGER OPERATES IN 46 OF PENNSYLVANIA'S 67 COUNTIES, WITH A SIGNIFICANT PRESENCE IN CENTRAL AND NORTHEASTERN PENNSYLVANIA. THE HOSPITAL IS AN AFFILIATE WITHIN GEISINGER. CORPORATE STRUCTURE. THE ORGANIZATIONAL STRUCTURE OF GEISINGER REFLECTS THE STRATEGIC GOAL OF OPERATING AS A FULLY INTEGRATED HEALTHCARE SYSTEM WHOSE CORPORATE COMPONENTS SHARE THE COMMON GOALS OF MANAGING AND IMPROVING THE HEALTHCARE OF ITS PATIENTS AND MEMBERS, WHILE RECOGNIZING AND RESPECTING THE CORPORATE IDENTITY OF EACH ENTITY. THIS INTEGRATION LINKS THE AREAS OF PHYSICIANS, HOSPITALS/CLINICS, AND HEALTHCARE INSURANCE. HISTORY. GEISINGER HAD ITS BEGINNINGS IN THE SMALL COMMUNITY OF DANVILLE, LOCATED IN CENTRAL PENNSYLVANIA ON THE NORTHERN BRANCH OF THE SUSQUEHANNA RIVER. THERE, IN 1915, ABIGAIL A. GEISINGER FOUNDED THE GEORGE F. GEISINGER MEMORIAL HOSPITAL IN MEMORY OF HER HUSBAND. FROM THE BEGINNING, THE NEW HOSPITAL WAS DESIGNED AS A COMPREHENSIVE HEALTHCARE INSTITUTION THAT WOULD OFFER SPECIALIZED MEDICAL CARE TO PEOPLE IN THE RURAL AREAS OF CENTRAL AND NORTHEASTERN PENNSYLVANIA. UNLIKE MOST HEALTHCARE SYSTEMS, WHICH EVOLVED WITH A HOSPITAL FOCUS, GEISINGER'S HISTORY AND TRADITION IS THAT OF A PHYSICIAN-LED AND PHYSICIAN-DRIVEN HEALTHCARE ORGANIZATION. THIS TRADITION BEGAN WHEN MRS. GEISINGER BROUGHT DR. HAROLD FOSS, A MAYO CLINIC TRAINED PHYSICIAN, TO BE HER HOSPITAL'S FIRST CHIEF OF STAFF. TODAY, GEISINGER IS REGARDED AS A NATIONAL MODEL OF HEALTHCARE DELIVERY CENTERED ON A SOPHISTICATED MULTISPECIALTY GROUP PRACTICE. SINCE THE 1970S, GEISINGER'S STRATEGY OF INTEGRATING PHYSICIANS AND HOSPITALS EXPANDED TO INCLUDE THE MANAGEMENT OF HEALTH AND THE FINANCING OF HEALTHCARE SERVICES THROUGH ITS WHOLLY CONTROLLED HEALTH MAINTENANCE ORGANIZATION, GEISINGER HEALTH PLAN. TWO INDEMNITY HEALTH INSURERS, GEISINGER INDEMNITY INSURANCE COMPANY AND GEISINGER QUALITY OPTIONS, INC. WERE ALSO ADDED. SEE SCHEDULE R FOR A LIST OF THE AFFILIATED ORGANIZATIONS COMPRISING GEISINGER. SCHEDULE H, PART VI PART VI, LINE 7: FORM 990, SCHEDULE H, PART VI, LINE 7, STATE FILING OF COMMUNITY BENEFIT REPORT: AT THIS TIME, THE HOSPITAL AND ITS AFFILIATES ARE NOT REQUIRED TO FILE A COMMUNITY BENEFIT REPORT WITH ANY STATE. X true true X X X X X X true true false false false false false false false JAEWON RYU MD JD PRESIDENT, DIRECTOR 4389743 1102369 1528292 43622 7064026 1064507 KEVIN V ROBERTS MBA CPA EVP, CFO, TREASURER 1697460 1890806 23292 36715 3648273 1488942 MATTHEW WALSH DIRECTOR 1248929 251139 273292 40942 1814302 219524 STEVEN B BENDER ESQUIRE EVP, CLO, SECRETARY 879843 129142 203292 43272 1255549 88396 GERALD V MALONEY DO DIRECTOR 699927 115402 95392 31669 942390 64210 MICHAEL T HEGSTROM MD CMO 517063 15131 23292 36389 591875 ROSS ELLISON MD INTERIM CMO 398078 103993 23292 41452 566815 LORI R GRAMLEY ESQUIRE ACLO, ASST. SECY. 326632 27843 23292 24657 402424 KIRK E THOMAS FACHE MHA RRT CAO 226251 85699 15919 22856 350725 STACEY M OSBORNE DNPMSNRNNEA-BC VP, CNO 209740 12506 13639 13442 249327 KRISTY M HINE FORMER 5 HIGHEST 195894 3108 12278 37095 248375 AARON J HARTSOCK AVP CLINICAL OPS. 156598 15627 8337 35305 215867 BRIAN D SIMPKINS PHARMD BCPS DIRECTOR, PHARMACY 158736 5209 8700 37085 209730 KATHRYN COLE RN INPATIENT RN 162310 10000 7497 9769 19937 209513 KEITH S GRAHAM ACUTE CARE PHARM. 120211 27858 1458 200 6925 285 6291 1452 14075 3351 148960 33146 OLIVER RUIZ MD PHY. HOSPITALIST 34590 102247 124 15940 5724 7004 3674 41718 127585 SCHEDULE J, PAGE 1, PART I, LINE 1A TAX INDEMNIFICATION AND GROSS-UP PAYMENTS - FROM TIME TO TIME, THE GEISINGER BOARD OF DIRECTORS OR GEISINGER SENIOR MANAGEMENT APPROVE THE GROSS-UP OF EXPENSES, WHICH FURTHER GEISINGER BUSINESS, FOR TAX OBLIGATIONS. SCHEDULE J, PAGE 1, PART I, LINE 4 JAEWON RYU, MD, JD 0 1,064,507 0 KEVIN V. ROBERTS, MBA, CPA 0 1,488,942 0 MATTHEW WALSH 0 219,524 0 STEVEN B. BENDER, ESQUIRE 0 88,396 0 GERALD V. MALONEY, DO 0 64,210 0 KIRK E. THOMAS, FACHE, MHA, RRT 65,795 0 0 SCHEDULE J, PART III PART I, LINE 4A - SEVERANCE PAYMENT UPON INVOLUNTARY SEPARATION, EMPLOYEES MAY BE ELIGIBLE TO RECEIVE CONTINUATION OF SALARY FOR A TERM THAT IS BASED ON THEIR YEARS OF GEISINGER SERVICE AND POSITION. PART I, LINE 4B - SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN COMPENSATION FOR ELIGIBLE EMPLOYEES MAY BE DEFERRED TO A 457(F) NONQUALIFIED PLAN THAT VESTS WITH COMPLETION OF SERVICE, DEATH AND/OR PERMANENT DISABILITY. FORM 990 FORM 990, PART IV, LINE 24A: DID THE ORGANIZATION HAVE A TAX-EXEMPT BOND ISSUE WITH AN OUTSTANDING PRINCIPAL AMOUNT OF MORE THAN 100,000 AS OF THE LAST DAY OF THE YEAR, THAT WAS ISSUED AFTER DECEMBER 31, 2002? GEISINGER HEALTH (GH) IS CURRENTLY THE SOLE OBLIGOR UNDER A SERIES OF BOND ISSUES, INCLUDING TAX-EXEMPT BONDS ISSUED PRIOR TO DECEMBER 31, 2002, WITH A TOTAL OUTSTANDING BALANCE AT DECEMBER 31, 2023 OF 1,637,871,513, INCLUSIVE OF UNAMORTIZED ORIGINAL ISSUE DISCOUNT. BECAUSE THE BOND PROCEEDS ARE DISBURSED TO GH SUBSIDIARIES, THE TAX-EXEMPT BOND LIABILITIES ARE REFLECTED ON THE BALANCE SHEETS OF THE FOLLOWING SUBSIDIARY ORGANIZATIONS: GEISINGER MEDICAL CENTER EIN: 24-0795959 GEISINGER WYOMING VALLEY MEDICAL CENTER EIN: 23-1996150 GEISINGER CLINIC EIN: 23-6291113 MARWORTH EIN: 23-2171417 GEISINGER SYSTEM SERVICES EIN: 23-2164794 COMMUNITY MEDICAL CENTER EIN: 24-0862246 GEISINGER-BLOOMSBURG HOSPITAL EIN: 23-2193572 GEISINGER-LEWISTOWN HOSPITAL EIN: 23-1352187 GEISINGER COMMONWEALTH SCHOOL OF MEDICINE EIN: 26-0812968 GEISINGER JERSEY SHORE HOSPITAL EIN: 24-0792115 SCHEDULE K WAS PREPARED ON A CONSOLIDATED BASIS AND IS INCLUDED IN THE FORM 990 FILING OF GEISINGER HEALTH, EIN: 23-1995911. FORM 990, PAGE 2, PART III, LINE 4A I. GENERAL INFORMATION GEISINGER-LEWISTOWN HOSPITAL (GLH), A 501(C)(3) NOT-FOR-PROFIT CORPORATION AND MEMBER OF GEISINGER, OWNS AND OPERATES A 133-BED ACUTE CARE HOSPITAL IN LEWISTOWN, PA. GLH IS CONVENIENTLY LOCATED ONLY A FEW MILES FROM SEVERAL CENTRAL PENNSYLVANIA MAJOR HIGHWAYS. THE FACILITY OPENED IN 1905 IN RESPONSE TO A PRESSING NEED FOR HEALTH AND WELLNESS CARE IN THE COMMUNITY. IN 2023, GLH WAS RATED A 5-STAR HOSPITAL IN PATIENT SAFETY AND QUALITY BY CMS. THE HOSPITAL STAR RATING SYSTEM, ALSO A MEASURE OF PATIENT EXPERIENCE, ALLOWS CONSUMERS OF HEALTH CARE TO EASILY ASSESS THE PATIENT EXPERIENCE OF CARE INFORMATION PROVIDED ON THE HOSPITAL COMPARE WEBSITE. GLH ALSO ACHIEVE LEAPFROG A STATUS WHICH EVALUATED THE SAFETY AND QUALITY OF HEALTHCARE FACILITIES IN THEIR COMMUNITY. GENERAL MEDICAL CARE IS PROVIDED BY IN-HOUSE HOSPITALISTS AND SUPPORTED BY CONSULTATIVE SERVICES IN THE AREAS OF CARDIOLOGY, INFECTIOUS DISEASE, NEUROLOGY, PULMONOLOGY, ORTHOPEDICS, HEMATOLOGY/ONCOLOGY, OTOLARYNGOLOGY, AND GASTROENTEROLOGY. A FULLY-STAFFED SURGICAL SERVICES SUITE OFFERING SIX OPERATING ROOMS EQUIPPED FOR VARIOUS TYPES OF INPATIENT AND OUTPATIENT GENERAL AND SPECIALTY SURGICAL PROCEDURES, INCLUDING ROBOTIC ASSISTED CASES. AN ENDOSCOPY AMBULATORY SURGICAL CENTER, OPERATING AS HOSPITAL OUTPATIENT SITE, IS ALSO AVAILABLE FOR OUTPATIENT ENDOSCOPIC PROCEDURES. A MULTI- SPECIALTY ADULT AND PEDIATRIC AMBULATORY SURGICAL CENTER OPERATING AS A HOSPITAL OUTPATIENT SITE AT THE STATE COLLEGE HEALTHPLEX WAS ADDED IN JULY 2022. THIS SITE INCLUDES FOUR OPERATING ROOMS, FOUR ENDOSCOPY SUITES, AND TWO INTERVENTIONAL PAIN ROOMS. THE EMERGENCY DEPARTMENT (ED) IS COMMITTED TO PROVIDING HIGH QUALITY, PROMPT EMERGENCY SERVICES. GLH'S ED IS STAFFED 24/7 WITH FULL-TIME PHYSICIANS AND NURSES WHO ARE TRAINED IN ALL SPECIALTIES FROM PEDIATRICS TO CRITICAL CARE. IMMEDIATE ACCESS IS AVAILABLE TO LABORATORY SERVICES; IMAGING SERVICES SUCH AS CT SCANS, ULTRASOUND AND MRI; AND SURGICAL SERVICES. IN THE FALL OF 2021, THE EMERGENCY DEPARTMENT RECEIVED A LEVEL IV TRAUMA CENTER DESIGNATION. GLH, HAVING ALREADY RECEIVED ACUTE STROKE READY CERTIFICATION IN 2019, RECEIVED PRIMARY STROKE CENTER DESIGNATION BY THE JOINT COMMISSION AND THE AMERICAN HEART ASSOCIATION IN 2021. THIS DESIGNATION SHOWS COMMITMENT TO ENSURING STROKE PATIENTS RECEIVE IMMEDIATE DIAGNOSTICS AND THE MOST ADVANCED TREATMENTS OPTIONS. OB/GYN FOCUSES ON ALL ASPECTS OF WOMEN'S HEALTH AND EDUCATION, PROVIDING OBSTETRICAL AND GYNECOLOGICAL CARE FOR WOMEN OF ALL AGES. SERVICES INCLUDE BUT ARE NOT LIMITED TO ROUTINE VISITS AND TREATMENTS, PREVENTATIVE HEALTHCARE, BIRTH CONTROL EDUCATION, FAMILY PLANNING, OBSTETRICS, SURGERY & SURGERY CONSULTATIONS, MENOPAUSE COUNSELING, AND MIDWIFERY. MENTAL HEALTH & PSYCHIATRIC SERVICES PROVIDES ADULT INPATIENT SERVICES DESIGNED TO HELP INDIVIDUALS LIVE AS INDEPENDENTLY AS POSSIBLE. PATIENTS CAN ACCESS QUICK, EFFICIENT ADMISSION 24/7 AND RECEIVE TREATMENT THROUGH A PSYCHIATRIST AVAILABLE ON A DAILY BASIS. ADMISSIONS ARE CONFIDENTIAL AND MAY BE MADE BY PROFESSIONALS AS WELL BY INDIVIDUALS CONCERNED ABOUT THEMSELVES OR OTHERS. DURING HOSPITALIZATION, PATIENT CARE IS PROVIDED THROUGH MULTIPLE PROFESSIONALS WHO COMPRISE THE TREATMENT TEAM. OTHER SERVICES INCLUDE: CARDIAC SERVICES OTHER SURGERY SPECIALTIES CLINICAL NUTRITION OTOLARYNGOLOGY GASTROENTEROLOGY PAIN MANAGEMENT GENERAL SURGERY PATHOLOGY GYNECOLOGY PEDIATRICS ICCU PHYSICAL THERAPY LABORATORY SERVICES PODIATRY NEPHROLOGY PULMONARY/VASCULAR NEUROSURGERY RADIOLOGY NEWBORN NURSERY RESPIRATORY SERVICES ONCOLOGY/COMMUNITY CANCER TREATMENT SLEEP CENTER OPHTHALMOLOGY UROLOGY ORTHOPEDIC WOUND MANAGEMENT INTERVENTIONAL RADIOLOGY GEISINGER LEWISTOWN HOSPITAL ALSO OPERATED A DIPLOMA NURSING PROGRAM AS A DEPARTMENT WITHIN ITS ORGANIZATION THROUGH AUGUST 13TH, 2023 WHEN THE PROGRAM TRANSITIONED TO THE GEISINGER COMMONWEALTH SCHOOL OF MEDICINE. IT OPENED IN 2005 AND ACCREDITED BY THE NATIONAL LEAGUE OF NURSING IN 2009, THE PROGRAM IS A 2-YEAR, SIX SEMESTER PROGRAM THAT ALSO OFFERS AN LPN ADVANCED PLACEMENT OPTION. THE GEISINGER LEWISTOWN HOSPITAL SCHOOL OF NURSING (GLHSON) EXISTS TO PROVIDE QUALITY NURSING EDUCATION AND SEEKS TO ENGAGE A DIVERSE GROUP OF STUDENTS IN A MANNER THAT ENABLES ITS GRADUATES TO BECOME LEADERS IN PROVIDING COMPETENT AND SAFE BEDSIDE NURSING CARE ACROSS THE CONTINUUM AND THROUGHOUT THE SURROUNDING COMMUNITY. THE GLHSON HAS A 94% PASS RATE OVER THE LAST THREE YEARS FOR THE NCLEX/RN EXAM, WHICH IS A COMPETENCY AND LICENSURE EXAM USED BY ALL STATE NURSING BOARDS IN THE US. THIS HIGH EXAM PASS RATE ALONG WITH THE PROGRAM'S HIGH ADMISSION STANDARDS ARE TWO REASONS THAT THE PROGRAM HAS BEEN NAMED ONE OF THE TOP RANKED RN PROGRAMS IN PA BY REGISTERED NURSING.ORG, A NATIONAL RANKING ORGANIZATION, FOR SEVERAL OF THE LAST FEW YEARS. IN FY18, GLH COMPLETED PREPARATIONS FOR A FAMILY PRACTICE RESIDENCY PROGRAM. THE UNREIMBURSED COST OF HEALTH PROFESSIONS EDUCATION WAS 1,879,476 DURING THE YEAR ENDED DECEMBER 31, 2023. IN THE FALL OF 2018, GLH ENTERED INTO A LEASE AGREEMENT FOR SPACE FOR A LABORATORY DRAW STATION IN A NEARBY, NEWLY CONSTRUCTED MEDICAL OFFICE BUILDING OWNED BY A PRIMARY HEALTH NETWORK, A FEDERALLY QUALIFIED HEALTH CENTER. IN ADDITION TO LEASING LAB SPACE IN THIS BUILDING, GLH COLLABORATES WITH THE LIFE GEISINGER PROGRAM AND THE FRESH FOOD PHARMACY PROGRAM WHICH ARE ALSO CO-LOCATED IN THAT BUILDING. IN FY19, GLH BECAME ELIGIBLE UNDER THE 340(B) DRUG PURCHASING PROGRAM. THIS ALLOWS THE HOSPITAL TO PURCHASE OUTPATIENT DRUGS AT SIGNIFICANTLY REDUCED PRICES REACHING MORE ELIGIBLE PATIENTS AND PROVIDING MORE COMPREHENSIVE SERVICES TO THOSE PATIENTS. IN LATE FY20, GLH ESTABLISHED A PHARMACY RESIDENCY PROGRAM FOR TWO RESIDENTS ON A 2-YEAR ROTATION. THE PURPOSE OF PHARMACY RESIDENCY PROGRAM AT GEISINGER LEWISTOWN HOSPITAL IS TO EXPAND UPON DIDACTIC TRAINING AND PROFESSIONAL EXPERIENCES TO FOSTER CLINICAL PHARMACISTS WITH THE SKILLS NECESSARY TO PROVIDE MEDICATION-RELATED CARE ACROSS A VAST RANGE OF CONDITIONS. GLH STARTED A WESTERN CAMPUS FOR THIRD AND FOURTH YEAR MEDICAL STUDENTS FROM OUR GEISINGER COMMONWEALTH SCHOOL OF MEDICINE. II. UNCOMPENSATED CARE GLH RECOGNIZES THAT ITS MISSION IS TO SERVE ALL THE MEMBERS OF THE COMMUNITY WITH RESPECT TO THE PROVISION OF HEALTHCARE SERVICES AND HEALTHCARE EDUCATION. GLH PROVIDES QUALITY MEDICAL HEALTHCARE REGARDLESS OF RACE, RELIGION, ETHNICITY, SEXUAL ORIENTATION, GENDER IDENTITY CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE OR ABILITY TO PAY. IN THIS REGARD, GLH PROVIDES FREE CARE OR SUBSIDIZED CARE, TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS AT OR BELOW COST AND PROVIDES VARIOUS HEALTH ACTIVITIES AND PROGRAMS IN SUPPORT OF THE COMMUNITIES WHERE GLH PRACTICES. A.CHARITY CARE THE PRIMARY CONCERN OF GLH IS THE DELIVERY OF HEALTH CARE TO ALL CITIZENS OF CENTRAL PENNSYLVANIA REGARDLESS OF THEIR ABILITY TO PAY. THE UNREIMBURSED COST OF CHARITY CARE REPRESENTS THE COST GLH INCURS BY PROVIDING FREE OR DISCOUNTED SERVICES TO THOSE WHO CANNOT AFFORD TO PAY. THE TOTAL COST OF THE CHARITY CARE WAS 1,277,235 DURING THE YEAR ENDED DECEMBER 31, 2023. B. MEDICARE/MEDICAID IN RECOGNIZING ITS MISSION TO THE COMMUNITY, GLH PROVIDES SERVICES TO THE ELDERLY (MEDICARE) AND THE INDIGENT (MEDICAID). GLH PROVIDES CARE, BELOW COST, TO PERSONS COVERED BY THESE GOVERNMENTAL PROGRAMS TO THE EXTENT THE GOVERNMENT REIMBURSEMENT IS BELOW THE COST OF PROVIDING HEALTH CARE. THE UNREIMBURSED VALUE OF MEDICARE AND/OR MEDICAID IS EQUAL TO THE COST OF PROVIDING SERVICES LESS THE AMOUNT RECEIVED AS REIMBURSEMENT UNDER THE PROGRAM. THE COST OF PROVIDING HEALTHCARE SERVICES TO MEDICARE, MEDICAID AND OTHER GOVERNMENTAL PATIENTS EXCEEDED REIMBURSEMENT BY APPROXIMATELY 26,200,757 DURING THE YEAR ENDED DECEMBER 31, 2023. III. RESEARCH SUPPORT GEISINGER LEWISTOWN HOSPITAL CONTRIBUTED 868,385 TO GEISINGER CLINIC TO SUPPORT ITS CHARITABLE MISSION THROUGH MEDICAL RESEARCH ACTIVITIES AT TWO FACILITIES ON THE CAMPUS OF GEISINGER MEDICAL CENTER: THE SIEGFRIED AND JANET WEIS CENTER FOR RESEARCH (WEIS CENTER) AND THE HENRY HOOD CENTER FOR HEALTH RESEARCH. THE WEIS CENTER PROVIDES A FOCUS FOR LABORATORY RESEARCH AND RESEARCH TRAINING AND SUPPORTS THE CLINICAL STAFF IN ITS RESEARCH PROGRAMS. THE PRIMARY MISSION OF THE WEIS CENTER IS TO CONDUCT ORIGINAL AND INNOVATIVE RESEARCH THAT CONTRIBUTES NEW KNOWLEDGE TO BIOMEDICAL SCIENCE. THE CENTER'S SCIENTISTS APPLY MODERN MOLECULAR AND CELLULAR APPROACHES TO DIVERSE RESEARCH PROBLEMS IN THE AREAS OF CARDIOVASCULAR FUNCTION, CANCER AND DEVELOPMENTAL BIOLOGY. THE HENRY HOOD CENTER FOR HEALTH RESEARCH CONDUCTS HEALTH SERVICES, EPIDEMIOLOGIC AND POPULATION GENETICS RESEARCH ON THE BROAD RANGE OF CONDITIONS TYPICALLY SEEN IN PRIMARY AND SPECIALTY CARE SETTINGS. THE CENTER ALSO INVESTIGATES EXTRAMURAL SOURCES OF FUNDING FOR CLINICAL RESEARCH. TOGETHER, THE WEIS CENTER AND HENRY HOOD CENTER ARE BUILDING CAPABILITY FOR IMPROVED POPULATION-BASED GENETICS RESEARCH. IV. COMMUNITY HEALTH, EDUCATION, FORM 990, PART V FORM 990, PART V, LINE 1A: ENTER THE NUMBER REPORTED IN BOX 3 OF FORM 1096, ANNUAL SUMMARY AND TRANSMITTAL OF U.S. INFORMATION RETURNS. GEISINGER SYSTEM SERVICES (GSS), AN AFFILIATE OF THE ORGANIZATION, PROVIDES A CENTRALIZED ACCOUNTS PAYABLE FUNCTION FOR ALL GEISINGER ORGANIZATIONS. AS THE ACCOUNTS PAYABLE PROCESSOR, GSS PREPARES AND FILES FORM 1099 UNDER ITS EIN FOR CERTAIN REPORTABLE PAYMENTS OF THE FILING ORGANIZATION. THE NUMBER OF 1099'S FILED BY GSS FOR THE 2023 REPORTING PERIOD ON BEHALF OF ITSELF AND ITS AFFILIATES WAS 1,321. THE RESPONSE ENTERED ON LINE 1A FOR THE ORGANIZATION INCLUDES ONLY THOSE FORM 1099S FILED UNDER THE ORGANIZATION'S EIN, WHICH INCLUDED 56 FORM 1098-T AND 1 FORM 1099-MISC. IT DOES NOT INCLUDE THOSE FILED BY GSS ON ITS BEHALF. FORM 990, PART VI FORM 990, PART VI, SECTION A, LINE 2: DID ANY OFFICER, DIRECTOR, TRUSTEE, OR KEY EMPLOYEE HAVE A FAMILY RELATION- SHIP OR BUSINESS RELATIONSHIP WITH ANY OTHER OFFICER, DIRECTOR, TRUSTEE, OR KEY EMPLOYEE? BENJAMIN K. CHU, MD, MPH, MACP, GERALD V. MALONEY, DO , JAEWON RYU, MD, JD, JEFFREY A. JACOBSON, KEVIN V. ROBERTS, MBA, CPA, LORI R. GRAMLEY, ESQUIRE, MATTHEW WALSH, STEVEN B. BENDER, ESQUIRE, V. CHRIS HOLCOMBE, PE, AND VIRGINIA MCGREGOR ALL HAVE A BUSINESS RELATIONSHIP WITH ONE ANOTHER BECAUSE THEY SERVE AS OFFICERS AND/OR DIRECTORS ON ONE OR MORE FOR-PROFIT AFFILIATES OF THE ENTITY. ALL AFFILIATES ARE PART OF GEISINGER. FORM 990, PAGE 6, PART VI, LINE 1A THERE WAS A DELEGATION OF AUTHORITY TO THE GEISINGER HEALTH EMERGENCY ACTION COMMITTEE, WHICH IS COMPRISED OF THE CHAIR OF THE BOARD, VICE-CHAIR OF THE BOARD, THE PRESIDENT AND CEO (EX-OFFICIO DIRECTOR), CHAIR OF THE FINANCE COMMITTEE AND CHAIR OF THE PATIENT EXPERIENCE, ACADEMIC AFFAIRS AND QUALITY COMMITTEE. UNDER THE NONPROFIT CORPORATION LAW AND UNDER GEISINGER HEALTH'S CORPORATE BYLAWS, THE EMERGENCY ACTION COMMITTEE SHALL EXERCISE THE POWER AND AUTHORITY OF THE BOARD OF DIRECTORS TO ACT ON EMERGENCY MATTERS BETWEEN MEETINGS OF THE BOARD OF DIRECTORS. FORM 990, PAGE 6, PART VI, LINE 6 THE MEMBERS OF THE CORPORATION HAVE THE POWER AND AUTHORITY TO ELECT AND REMOVE THE DIRECTORS; ELECT AND REMOVE THE PRESIDENT AND FILL ANY VACANCY IN THE OFFICE OF THE PRESIDENT OF THE CORPORATION; AND, MAY APPROVE AMENDMENTS TO THE CORPORATE BYLAWS IN LIEU OF SUCH APPROVAL BY THE BOARD OF DIRECTORS. THE MEMBERS ALSO HAVE THE RESERVE POWERS AS SET FORTH IN THE PENNSYLVANIA NONPROFIT CORPORATION LAW. FORM 990, PAGE 6, PART VI, LINE 7A THE BOARD OF DIRECTORS OF THE CORPORATION SHALL SERVE AS THE GOVERNING BODY OF THE CORPORATION. THE PRESIDENT OF THE CORPORATION SHALL BE A DIRECTOR BY REASON OF HOLDING SUCH OFFICE. THE REMAINING DIRECTORS SHALL BE ELECTED BY THE MEMBERS AT THE ANNUAL MEETING OF THE MEMBERS. THE MEMBERS OF THE CORPORATION MAY SERVE AS DIRECTORS AND DIRECTORS MAY SUCCEED THEMSELVES FROM TERM TO TERM. VACANCIES ON THE BOARD OF DIRECTORS SHALL BE FILLED BY THE MEMBERS AT THEIR DISCRETION AT THE ANNUAL MEETING OF THE MEMBERS OR AT A SPECIAL MEETING CALLED FOR SUCH PURPOSE. FORM 990, PAGE 6, PART VI, LINE 7B THE MEMBERS OF THE CORPORATION HAVE THE POWER AND AUTHORITY TO ELECT AND REMOVE THE DIRECTORS; ELECT AND REMOVE THE PRESIDENT AND FILL ANY VACANCY IN THE OFFICE OF THE PRESIDENT OF THE CORPORATION; AND, MAY APPROVE AMENDMENTS TO THE CORPORATE BYLAWS IN LIEU OF SUCH APPROVAL BY THE BOARD OF DIRECTORS. THE MEMBERS ALSO HAVE THE RESERVE POWERS AS SET FORTH IN PENNSYLVANIA NONPROFIT CORPORATION LAW. FORM 990, PAGE 6, PART VI, LINE 11B THE FORM 990 IS PREPARED BY GEISINGER TAX AND FINANCE DEPARTMENTS WITH INFORMATION PROVIDED FROM FINANCE, TAX, HUMAN RESOURCES, LEGAL SERVICES AND OTHER RELEVANT DEPARTMENTS WITHIN GEISINGER. PRIOR TO FINALIZATION, THE RETURN IS REVIEWED BY PWC US TAX, LLP. THE CHIEF FINANCIAL OFFICER OF GEISINGER AND THE INDIVIDUAL ORGANIZATIONS SENIOR FINANCIAL MANAGERS REVIEW THEIR RESPECTIVE FORM 990 PRIOR TO MAKING THE FINAL RETURN AVAILABLE TO THE BOARD. ALL OFFICERS AND DIRECTORS WERE ELECTRONICALLY PROVIDED A FINAL COPY OF THE FORM 990 PRIOR TO FILING THE RETURN WITH THE IRS. AN EXECUTIVE SUMMARY OF THE INFORMATION REPORTED ON THE RETURN IS PROVIDED TO ASSIST IN THE REVIEW. IN ACCORDANCE WITH THE GEISINGER HEALTH BOARD OF DIRECTOR'S FINANCE COMMITTEE CHARTER, GEISINGER ORGANIZATIONS' FORM 990 FILINGS ARE REVIEWED ANNUALLY. FORM 990, PAGE 6, PART VI, LINE 12C THE OFFICERS AND DIRECTORS OF THE ORGANIZATION ARE SUBJECT TO THE GEISINGER CONFLICT OF INTEREST POLICY FOR DIRECTORS, OFFICERS AND SENIOR LEADERS. AT LEAST ONCE EACH YEAR DIRECTORS, OFFICERS, KEY EMPLOYEES, SENIOR LEADERS AND OTHERS DESIGNATED BY THE BOARD OF DIRECTORS ARE REQUIRED TO DISCLOSE IN WRITING THE EXISTENCE OF ANY POTENTIAL FINANCIAL INTERESTS THAT MAY GIVE RISE TO A CONFLICT OF INTEREST WITH ANY AFFILIATE WITHIN GEISINGER. THE DISCLOSURES ARE REVIEWED BY THE OFFICE OF THE CHIEF COMPLIANCE OFFICER AND REPORTED TO THE AUDIT AND COMPLIANCE COMMITTEE AND/OR BOARD OF DIRECTORS. AFTER REVIEW OF THE FINANCIAL INTEREST AND ALL MATERIAL FACTS, INPUT FROM DEPARTMENT OF LEGAL SERVICES AND ANY DISCUSSION WITH THE PERSON DESIRED BY THE BOARD OR COMMITTEE, THE COMMITTEE/BOARD DECIDES IF A CONFLICT EXISTS AND TAKES APPROPRIATE ACTION. THE INDIVIDUAL DISCLOSING THE FINANCIAL INTEREST IS ABSENT DURING THE COMMITTEE/BOARD DELIBERATIONS AND DECISIONS ON THE MATTER. FORM 990, PAGE 6, PART VI, LINE 15A THE PROCESS TO REVIEW AND APPROVE THE COMPENSATION OF GEISINGER EMPLOYED BOARD DIRECTORS, OFFICERS, AND EXECUTIVE MANAGEMENT IS DESIGNED TO SATISFY THE REBUTTABLE PRESUMPTION PROCEDURE AVAILABLE FOR INTERMEDIATE SANCTION PURPOSES. THE PROCESS REQUIRES A REVIEW OF COMPENSATION DETERMINATIONS BY DISINTERESTED PARTIES, USE OF APPROPRIATE COMPARABILITY DATA AND CONTEMPORANEOUS DOCUMENTATION OF THE PROCESS. ON AN ANNUAL BASIS AN INDEPENDENT, NATIONALLY RECOGNIZED COMPENSATION CONSULTANT COMPLETES A COMPARATIVE ASSESSMENT OF COMPENSATION FOR THE CEO AND SENIOR MANAGEMENT WITHIN GEISINGER. THE CONSULTANT'S REPORT IS PRESENTED TO THE GEISINGER FAMILY COMMITTEE PRIOR TO ANY COMPENSATION ADJUSTMENT. THE REPORT SUPPORTS THE RIGOROUS REVIEW COMPLETED BY THE GEISINGER FAMILY COMMITTEE TO ENSURE THAT THE PROGRAM IS RESPONSIBLE TO THE GEISINGER CHARITABLE MISSION, REFLECTS REASONABLE COMPENSATION WITHIN THE NONPROFIT MARKET AND IS COMPLIANT WITH THE IRS'S INTERMEDIATE SANCTION REQUIREMENTS. THE SURVEY DATA IN THE COMPARATIVE ANALYSIS IS CAPTURED FOR FUNCTIONALLY COMPARABLE POSITIONS IN MULTIPLE SIMILAR NONPROFIT ORGANIZATIONS AND REFLECTS TOTAL REMUNERATION PROVIDED IN THE MARKET. ALL SURVEYS ARE CONDUCTED BY THIRD PARTY ORGANIZATIONS AND NOT CONDUCTED AT THE SPECIFIC DIRECTION OF GEISINGER. ANY COMPENSATION ADJUSTMENTS ARE APPROVED BY THE GEISINGER FAMILY COMMITTEE PRIOR TO THE EFFECTIVE DATE OF THE PAYMENT. THE GEISINGER FAMILY COMMITTEE AT ITS SOLE DISCRETION MAY POSITIVELY OR NEGATIVELY ADJUST ANY RECOMMENDED COMPENSATION. FORM 990, PAGE 6, PART VI, LINE 15B SEE SCHEDULE O RESPONSE TO FORM 990, PART VI SECTION B, QUESTION 15A. FORM 990, PAGE 6, PART VI, LINE 19 FINANCIAL STATEMENTS, FORM 990, FORM 990-T, THE CONFLICTS OF INTEREST POLICY, AND OTHER GOVERNING DOCUMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9 TRANSFER FROM PARENT, GEISINGER HEALTH 282,180 RELEASE FROM TEMPORARY RESTRICTED FUNDS -198 PENSION ADJUSTMENT 10,410,517 TRANSFER TO PARENT, GEISINGER HEALTH -34,000,000 TOTAL -23,307,501 FORM 990, PART XII FORM 990, PART XII, LINE 3A: AS A RESULT OF A FEDERAL AWARD, WAS THE ORGANIZATION REQUIRED TO UNDERGO AN AUDIT OR AUDITS AS SET FORTH IN THE UNIFORM GUIDANCE, 2 C.F.R. PART 200, SUBPART F? FEDERAL AWARDS ARE AUDITED AS A PART OF THE GEISINGER'S CONSOLIDATED REPORT ON FEDERAL AWARDS IN ACCORDANCE WITH UNIFORM GUIDANCE, 2 C.F.R. PART 200, SUBPART F. FOOTNOTE: THROUGHOUT THIS DOCUMENT, THE TERMS "GEISINGER- OR "GEISINGER HEALTH" SHALL REFER TO THE ENTIRE HEALTH CARE SYSTEM COMPRISED OF GEISINGER HEALTH FOUNDATION (THE "FOUNDATION") AS PARENT AND ALL SUBSIDIARY CORPORATE ENTITIES COMPRISING THE HEALTH CARE SYSTEM. IN ADDITION, THROUGHOUT THIS DOCUMENT, THE TERM "SYSTEM" SHALL REFER TO THE ENTIRE HEALTH CARE SYSTEM AS PREVIOUSLY DEFINED PLUS ITS AFFILIATES. GEISINGER HEALTH 100 NORTH ACADEMY AVE MC 49-70 DANVILLE PA 17822 231995911 PHILANTHRO PA 501C3 7 N/A false GEISINGER MEDICAL CENTER 100 NORTH ACADEMY AVE MC 49-70 DANVILLE PA 17822 240795959 HOSPITAL PA 501C3 3 GH true GEISINGER CLINIC 100 NORTH ACADEMY AVE MC 49-70 DANVILLE PA 17822 236291113 PHYSN SVCS PA 501C3 3 GH true GEISINGER WYOMING VALLEY MED CTR 100 NORTH ACADEMY AVE MC 49-70 DANVILLE PA 17822 231996150 HOSPITAL PA 501C3 3 GH true MARWORTH 100 NORTH ACADEMY AVE MC 49-70 DANVILLE PA 17822 232171417 D&A REHAB PA 501C3 3 GH true GEISINGER HEALTH PLAN 100 NORTH ACADEMY AVE MC 49-70 DANVILLE PA 17822 232311553 HMO PA 501C4 GH false GEISINGER SYSTEM SERVICES 100 NORTH ACADEMY AVE MC 49-70 DANVILLE PA 17822 232164794 SUPPORT SV PA 501C3 12A GH true GEISINGER COMMUNITY HEALTH SERVICES 100 NORTH ACADEMY AVE MC 49-70 DANVILLE PA 17822 232967235 HEALTHCARE PA 501C3 10 GSS true GEISINGER INSURANCE CORPORATIONRRG 100 NORTH ACADEMY AVE MC 49-70 DANVILLE PA 17822 141909894 SELF INS VT 501C3 12A GH true COMMUNITY MEDICAL CENTER 100 NORTH ACADEMY AVE MC 49-70 DANVILLE PA 17822 240862246 HOSPITAL PA 501C3 3 GH true GEISINGER-BLOOMSBURG HOSPITAL 100 NORTH ACADEMY AVE MC 49-70 DANVILLE PA 17822 232193572 HOSPITAL PA 501C3 3 GH true KEYSTONE HEALTH INFORMATION EXCH 100 NORTH ACADEMY AVE MC 49-70 DANVILLE PA 17822 464359893 RHIO PA 501C3 12A GH false WEST SHORE ADVANCED LIFE SUPP SVCS 100 NORTH ACADEMY AVE MC 49-70 DANVILLE PA 17822 232463002 HEALTHCARE PA 501C3 7 GC true GEISINGER COMMONWEALTH SCH OF MED 100 NORTH ACADEMY AVE MC 49-70 DANVILLE PA 17822 260812968 EDUCATION PA 501C3 2 GH false GEISINGER JERSEY SHORE HOSPITAL 100 NORTH ACADEMY AVE MC 49-70 DANVILLE PA 17822 240792115 HOSPITAL PA 501C3 3 GH true GEISINGER MEDICAL CENTER MUNCY 100 NORTH ACADEMY AVE MC 49-70 DANVILLE PA 17822 851226106 HOSPITAL PA 501C3 3 GHM false GNJ PHYSICIANS GROUP PC 100 NORTH ACADEMY AVE MC 49-70 DANVILLE PA 17822 820681884 PHYSN SVCS NJ 501C3 10 GH false GSL HOSPITAL 801 OSTRUM STREET BETHLEHEM PA 18015 824432109 HOSPITAL PA 501C3 3 N/A false GSLPG INC 801 OSTRUM STREET BETHLEHEM PA 18015 825423865 HEALTHCARE PA 501C3 3 GSL HOSP false KEYSTONE ACCOUNTABLE CARE ORG LLC 100 NORTH ACADEMY AVE MC 49-70 DANVILLE PA 17822 455484165 ACO PA N/A false false GEISINGER ENCOMPASS HEALTH LLC 100 NORTH ACADEMY AVE MC 49-70 DANVILLE PA 17822 721398803 PHY THERAP PA N/A false false EVANGELICAL-GEISINGER HEALTH LLC 100 NORTH ACADEMY AVE MC 49-70 DANVILLE PA 17822 460567687 HEALTHCARE PA N/A false false LACKAWANNA PHYS AMB SURG CTRLLC 100 NORTH ACADEMY AVE MC 49-70 DANVILLE PA 17822 233024998 HEALTHCARE PA N/A false false GEISINGER-HM JOINT VENTURE LLC 100 NORTH ACADEMY AVE MC 49-70 DANVILLE PA 17822 831871064 HEALTHCARE PA N/A false false PHARMACY INNOVATION ALLIANCE LLC 100 NORTH ACADEMY AVE MC 49-70 DANVILLE PA 17822 831871064 PURCHASING DE N/A false false KEYSTONE HEALTHCARE PARTNERSHIPLLC 901 HUGH WALLIS ROAD LAFAYETTE LA 70508 833134941 HOME HLTH PA N/A false false KKA VALUE FUND II GMBH & CO GIPSSTRABE 8 BERLIN GERMANY GM 10119 981686914 INVESTMENT GM N/A false false KKA CO-INVEST I GMBH & CO KG GIPSSTRABE 8 BERLIN GERMANY GM 10119 981685919 INVESTMENT GM N/A false false FORMENTERA PARTNERS FUND II-A LP 300 COLORADO ST STE 1900 AUSTIN TX 78701 882933731 INVESTMENT TX N/A false false VOLPI CAPITAL CARBON CO-INVEST SCSP 8 RUE LOU HEMMER SENNINGERBERG LUXENBOURG LU L-1748 981723571 INVESTMENT LU N/A false false ISS SOLUTIONS INC 100 NORTH ACADEMY AVE MC 49-70 DANVILLE PA 17822 232077663 CLINIC ENG PA N/A false GEISINGER INDEMNITY INSURANCE CO 100 NORTH ACADEMY AVE MC 49-70 DANVILLE PA 17822 232815174 HLTH INSUR PA N/A false GEISINGER QUALITY OPTIONS INC 100 NORTH ACADEMY AVE MC 49-70 DANVILLE PA 17822 204275139 HLTH INSUR PA N/A false GEISINGER ASSURANCE COMPANY LTD 23 LINE TREE BAY AVE PO BOX 1159 GRAND CAYMAN GRAND CAYMAN CJ KY1-1102 981016737 FINANCIAL CJ N/A false CT WAREHOUSE GMBH GIPSSTRABE 8 BERLIN BERLIN GM 10119 HOLDING CO GM N/A false KKA PROJECT 3 HOLDING GMBH GIPSSTRABE 8 BERLIN BERLIN GM 10119 HOLDING CO GM N/A false KKA PROJECT 4 HOLDING GMBH GIPSSTRABE 8 BERLIN BERLIN GM 10119 HOLDING CO GM N/A false RTNX TOP GMBH GIPSSTRABE 8 BERLIN BERLIN GM 10119 HOLDING CO GM N/A false KKA WAREHOUSE GMBH GIPSSTRABE 8 BERLIN BERLIN GM 10119 HOLDING CO GM N/A false KKA PROJECT 2 HOLDING GMBH GIPSSTRABE 8 BERLIN BERLIN GM 10119 HOLDING CO GM N/A false PROJECT 4 WAREHOUSE GMBH GIPSSTRABE 8 BERLIN BERLIN GM 10119 HOLDING CO GM N/A false SCHRODERS CAPITAL CODA FUND LTD PO BOX 309 UGLAND HOUSE GRAND CAYMAN CAYMAN ISLANDS CJ KY1-1104 INVESTMENT CJ N/A false SCHRODERS CAPITAL CODA MASTER FUND PO BOX 309 UGLAND HOUSE GRAND CAYMAN GRAND CAYMAN CJ KY1-1104 INVESTMENT CJ N/A false true true true false false false false false false false true true true false false true false false true GEISINGER CLINIC A 576148 FMV GEISINGER COMMUNITY HEALTH SERVICES A 495524 FMV GEISINGER HEALTH PLAN A 77016 FMV GEISINGER MEDICAL CENTER A 1739 FMV GEISINGER PHARMACY LLC A 15736 FMV GEISINGER SYSTEM SERVICES A 61355 FMV GEISINGER HEALTH B 34000000 GAAP GEISINGER CLINIC C 234628 GAAP GEISINGER CLINIC K 606235 FMV GEISINGER CLINIC L 2008049 GAAP GEISINGER COMMUNITY HEALTH SERVICES L 815951 GAAP GEISINGER HEALTH PLAN L 38007176 GAAP GEISINGER INDEMNITY INSURANCE CO L 10163685 GAAP GEISINGER QUALITY OPTIONS INC L 4520219 GAAP GEISINGER ASSURANCE COMPANY LTD M 206958 GAAP GEISINGER CLINIC M 6673569 GAAP GEISINGER HEALTH M 231778 GAAP GEISINGER MEDICAL CENTER M 5730429 GAAP GEISINGER PHARMACY LLC M 1428769 GAAP GEISINGER SYSTEM SERVICES M 29093173 GAAP ISS SOLUTIONS INC M 1013555 GAAP GEISINGER INSURANCE CORPORATIONRRG P 222265 GAAP GEISINGER HEALTH S 127320 GAAP SCHEDULE R FORM 990, SCHEDULE R, PART V - TRANSACTIONS WITH RELATED ORGANIZATIONS: AS SHOWN IN FORM 990, SCHEDULE R, GEISINGER-LEWISTOWN HOSPITAL IS CLOSELY AFFILIATED WITH SEVERAL OTHER ORGANIZATIONS. IN THE NORMAL COURSE OF THE OPERATIONS OF THESE AFFILIATED ORGANIZATIONS THERE ARE NUMEROUS INTER ORGANIZATIONAL TRANSACTIONS, WHICH MAY INCLUDE SALES, EXCHANGES AND LEASES OF PROPERTY, EXTENSIONS OF CREDIT, FURNISHING OF GOODS, SERVICES AND FACILITIES, AND TRANSFERS OF ASSETS. THESE INTERORGANIZATION TRANSACTIONS PROMOTE THE EFFICIENT OPERATION OF THE VARIOUS ORGANIZATIONS AND THE ATTAINMENT OF THEIR TAX EXEMPT PURPOSES. THESE TYPES OF INTER ORGANIZATION TRANSACTIONS WERE DESCRIBED TO THE INTERNAL REVENUE SERVICE IN A RULING APPLICATION AND WERE RECOGNIZED BY THE NATIONAL OFFICE OF THE IRS IN A SERIES OF GEISINGER PRIVATE RULINGS AS BEING ENTIRELY CONSISTENT WITH THE ORGANIZATIONS' TAX EXEMPT STATUS.