Form990
Click to see attachment
Department of the Treasury
Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation)

MediumBullet The organization may have to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-0047
2010
Open to Public Inspection
A For the calendar year, or tax year beginning 07-01-2010 and ending 06-30-2011
BCheck if applicable:
CName of organization
LEWISTOWN HOSPITAL
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
400 HIGHLAND AVENUE
 
Room/suite
City or town, state or country, and ZIP + 4
LEWISTOWN, PA17044
D Employer identification number

23-1352187
E Telephone number

G Gross receipts $ 96,850,830
F Name and address of principal officer:
KAY HAMILTON
400 HIGHLAND AVENUE
LEWISTOWN,PA17044
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.LEWISTOWNHOSPITAL.ORG
H(a)
Is this a group return for
affiliates?
H(b)
Are all affiliates included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:
 
L Year of formation: 1905
M State of legal domicile: PA
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: TO PROVIDE PERSONAL, HIGH-QUALITY, ECONOMICAL HEALTHCARE FOR OUR COMMUNITIES.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) .... 3 15
4 Number of independent voting members of the governing body (Part VI, line 1b) .... 4 12
5 Total number of individuals employed in calendar year 2010 (Part V, line 2a) ... 5 1,108
6 Total number of volunteers (estimate if necessary) .... 6 130
7a Total unrelated business revenue from Part VIII, column (C), line 12 .. 7a 1,632,693
b Net unrelated business taxable income from Form 990-T, line 34 .. 7b 641,042
Revenues; Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 1,094,863 181,471
9 Program service revenue (Part VIII, line 2g) ......... 87,817,917 91,424,410
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 652,451 726,818
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 1,791,897 3,494,052
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 91,357,128 95,826,751
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 3,328,297 3,496,963
14 Benefits paid to or for members (Part IX, column (A), line 4) .... 0 0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 45,693,639 46,778,979
16a Professional fundraising fees (Part IX, column (A), line 11e).... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet634,566    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f).... 40,550,095 43,108,767
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 89,572,031 93,384,709
19 Revenue less expenses. Subtract line 18 from line 12...... 1,785,097 2,442,042
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............ 87,901,083 90,391,492
21 Total liabilities (Part X, line 26)............ 64,859,043 55,364,995
22 Net assets or fund balances. Subtract line 21 from line 20 ..... 23,042,040 35,026,497
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title.
Paid Preparer's Use Only Preparer's
signatureBig Right Arrow 		Date
right pointing bullet image Preparer’s taxpayer identification number
(see instructions)
Firm’s name (or yours
if self-employed),
address, and ZIP + 4Big Right Arrow




 		EIN right pointing bullet image
Phone no. right pointing bullet image
May the IRS discuss this return with the preparer shown above? (see instructions) .........
For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2010)
Form 990 (2010)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response to any question in this Part III . . . . . . . . . .
1
Briefly describe the organization’s mission: TO PROVIDE PERSONAL, HIGH-QUALITY, ECONOMICAL HEALTHCARE FOR OUR COMMUNITIES.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ....................
If “Yes,” describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ..........................
If “Yes,” describe these changes on Schedule O.
4
Describe the exempt purpose achievements for each of the organization’s three largest program services by expenses.
Section 501(c)(3) and 501(c)(4) organizations and section 4947(a)(1) trusts are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 88,551,355 including grants of $ 3,489,463 ) (Revenue $ 92,422,167 )
PROVIDED INPATIENT, OUTPATIENT, WELLNESS, AND COMMUNITY SERVICES TO RESIDENTS OF LEWISTOWN, PA AND SURROUNDING COMMUNITIES. PROVIDED CARE, TO PATIENTS WHO MEET CERTAIN CRITERIA, WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. CHARGES FORGONE FOR SERVICES RENDERED AND SUPPLIES FURNISHED WERE APPROXIMATELY $4,318,000.
4b (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4c (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4d Other program services. (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet$ 88,551,355
Form 990 (2010)
Form 990 (2010)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,” complete Schedule AClick to see attachment.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors? Click to see attachment........
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If “Yes,” complete Schedule C, Part IClick to see attachment..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities? If “Yes,” complete Schedule C,
Part IIClick to see attachment.........................
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If “Yes,” complete Schedule C, Part IIIClick to see attachment........................
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts where donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If “Yes,” complete
Schedule D, Part IClick to see attachment.......................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas or historic structures? If “Yes,” complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If “Yes,”
complete Schedule D, Part IVClick to see attachment...................
9
 
No
10
Did the organization, directly or through a related organization, hold assets in term, permanent,or quasi-endowments? If “Yes,” complete Schedule D, Part VClick to see attachment
10
Yes
 
11
If the organization’s answer to any of the following questions is ‘Yes,’ then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable:
a
Did the organization report an amount for land, buildings, and equipment in Part X, line10? If “Yes,” complete Schedule D, Part VI.Click to see attachment
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VII.Click to see attachment
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIII.Click to see attachment
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part IX.Click to see attachment
11d
 
No
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part X.Click to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If “Yes,” complete Schedule D, Part X.Click to see attachment
11f
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year? If “Yes,” complete Schedule D, Parts XI, XII, and XIII Click to see attachment
12a
Yes
 
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If “Yes,” and if the organization answered ‘No’ to line 12a, then completing Schedule D, Parts XI, XII, and XIII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, and program service activities outside the United States? If “Yes,” complete Schedule F, Part I.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization or entity located outside the U.S.? If “Yes,” complete Schedule F, Part II..
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals located outside the U.S.? If “Yes,” complete Schedule F, Part III..
16
 
No
17
Did the organization report a total of more than $15,000, of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If “Yes,” complete Schedule G, Part I
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If “Yes,” complete Schedule G, Part II..........
18
Yes
 
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If “Yes,” complete Schedule G, Part III...................
19
 
No
Form 990 (2010)
Form 990 (2010)
Page 4
Part IV
Checklist of Required Schedules (continued)
20a
Did the organization operate one or more hospitals? If “Yes,” complete Schedule H..... Click to see attachment
20a
Yes
 
b
Did the organization attach its audited financial statement to this return? Note: All Form 990 filers that operate one or more hospitals must attach audited financial statements. ..... Click to see attachment
20b
Yes
 
21
Did the organization report more than $5,000 of grants and other assistance to governments and organizations in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II.. Click to see attachment
21
Yes
 
22
Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III..... Click to see attachment
22
Yes
 
23
Did the organization answer “Yes” to Part VII, Section A, questions 3, 4, or 5, about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If “Yes,” complete Schedule J................ Click to see attachment
23
Yes
 
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? If “Yes,” answer questions 24b–24d and complete Schedule K. If “No,” go to line 25................ Click to see attachment
24a
Yes
 
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
No
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................
24c
 
No
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
No
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If “Yes,” complete Schedule L, Part I...... Click to see attachment
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I................ Click to see attachment
25b
 
No
26
Was a loan to or by a current or former officer, director, trustee, key employee, highly compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II........................... Click to see attachment
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor, or a grant selection committee member, or to a person related to such an individual? If “Yes,” complete Schedule L, Part III............... Click to see attachment
27
 
No
28
Was the organization a party to a business transaction with one of the following parties? (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV ......................... Click to see attachment
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV................... Click to see attachment
28b
Yes
 
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or owner? If “Yes,” complete Schedule L, Part IV.. Click to see attachment
28c
Yes
 
29
Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule MClick to see attachment
29
Yes
 
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M............ Click to see attachment
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I........................... Click to see attachment
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II.......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I........ Click to see attachment
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Parts II, III, IV, and V, line 1..................... Click to see attachment
34
Yes
 
35
Is any related organization a controlled entity within the meaning of section 512(b)(13)? .....
35
 
No
a
Did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If “Yes,” complete Schedule R, Part V, line 2... Click to see attachment
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If “Yes,” complete Schedule R, Part V, line 2........... Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If “Yes,” complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11 and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2010)
Form 990 (2010)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response to any question in this Part V . . . . . . . . . .
Yes
No
1a
Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable. .......
1a
77
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable.
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax Statements filed for the calendar year ending with or within the year covered by this return .....................
2a
1,108
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?

Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file. (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?.............................
3a
Yes
 
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
Yes
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account or securities account)?.......................
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If “Yes” to line 5a or 5b, did the organization file Form 8886-T? ........
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible?..........
6a
 
No
b
If “Yes,” did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
Yes
 
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
Yes
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If “Yes,” indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?..........................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?...................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?...............
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?................
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?.........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If “Yes,” enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. All 501(c)(29) organizations must list in Schedule O each state in which they are licensed to issue qualified health plans, the amount of reserves required by each state, and the amount of reserves the organization allocated to each state.
13a
 
 
b
Enter the aggregate amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans.
13b
 
c
Enter the aggregate amount of reserves on hand.
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
 
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
 
Form 990 (2010)
Form 990 (2010)
Page 6
Part VI
Governance, Management, and Disclosure For each “Yes” response to lines 2 through 7b below, and for a “No” response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response to any question in this Part VI . . . . . . . . . .
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year ..............
1a
15
b
Enter the number of voting members included in line 1a, above, who are independent .................
1b
12
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? ..
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed?
4
Yes
 
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Does the organization have members or stockholders? ................
6
 
No
7a
Does the organization have members, stockholders, or other persons who may elect one or more members of the governing body? .........................
7a
 
No
b
Are any decisions of the governing body subject to approval by members, stockholders, or other persons? ..
7b
 
No
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O .....
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal
Revenue Code.)
Yes
No
10a
Does the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If “Yes,” does the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with those of the organization? ....
10b
 
 
11a
Has the organization provided a copy of this Form 990 to all members of its governing body before filing the form?
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review the Form 990. .....
12a
Does the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Are officers, directors or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ...........................
12b
Yes
 
c
Does the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this is done ....................
12c
Yes
 
13
Does the organization have a written whistleblower policy? ...............
13
Yes
 
14
Does the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes" to line a or b, describe the process in Schedule O. (See instructions.)
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
 
No
b
If “Yes,” has the organization adopted a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and taken steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
PA
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you make these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how), the organization makes its governing documents, conflict of interest policy, and financial statements available to the public.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization: MediumBullet
RANDY TEWKSBURY CFO
400 HIGHLAND AVENUE
LEWISTOWN,PA17044
(717) 242-7650
Form 990 (2010)
Form 990 (2010)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response to any question in this Part VII . . . . . . . . . .
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation, and current key employees. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organizations compensated any current or former officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (check all that apply) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(1) KAY HAMILTON
PRESIDENT/CEO
 36.00 X   X       297,474 0 42,610
(2) JEFFREY W ANDERSON
DIRECTOR
 .80 X           0 0 0
(3) BRIAN D SCHELL
VICE CHAIR
 .80 X   X       0 0 0
(4) DANA L PATTERSON
TREASURER
 .80 X   X       0 0 0
(5) FRANCIS EVANITSKY
CHAIR
 .80 X   X       0 0 0
(6) GURPREET S BHALLA MD
DIRECTOR
 .80 X           0 0 0
(7) DONALD CHAPMAN
DIRECTOR
 .80 X           0 0 0
(8) WILLIAM F HERKERT
DIRECTOR
 .80 X           0 0 0
(9) CHARLES EVERHART JR MD
DIRECTOR
 .80 X           0 0 0
(10) SHASHPAL K MALHOTRA MD
DIRECTOR
 .80 X           0 0 0
(11) MARSHA A SOULT PHD
SECRETARY
 .80 X   X       0 0 0
(12) DIANE SPOKUS PHD CHES
DIRECTOR
 .80 X           0 0 0
(13) JON ZIMMERMAN
DIRECTOR
 .80 X           0 0 0
(14) OKSANA DEARMENT
EX-OFFICIO BOARD MEMBER
 .80 X           0 0 0
(15) DANIEL REIFSNYDER
EX-OFFICIO BOARD MEMBER
 .80 X           0 0 0
(16) RANDY TEWKSBURY
VP FINANCE/CFO
 36.00     X       166,536 0 37,753
(17) KIRK E THOMAS
SR. VP OPERATIONS/COO
 38.00     X       133,077 0 19,036
Form 990 (2010)
Form 990 (2010)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (check all that apply) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(18) NANCY S REINKE
VP HUMAN RESOURCES
 34.00     X       111,752 0 16,453
(19) RONALD M COWAN
CIO
 39.00     X       114,515 0 16,428
(20) CHRISTINE W MATHEWS
VP NURSING CARE SERVICES
 40.00     X       121,800 0 23,635
(21) NITIN V SHETH MD
PSYCHIATRIST
 40.00         X   607,922 0 18,137
(22) DAVID M NELSON
RADIATION PHYSICIST
 40.00         X   203,849 0 43,102
(23) RICHARD F STOMACKIN
PHARMACIST
 40.00         X   145,510 0 27,315
(24) LEWIS ALLSHOUSE III
PHARMACIST
 40.00         X   120,999 0 25,066
(25) ROBERT A MONTGOMERY
PHARMACIST
 40.00         X   120,417 0 34,311










1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 2,143,851 0 303,846
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 in reportable compensation from the organizationMediumBullet13
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If “Yes,” complete Schedule J for such individual .............
3
 
No
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If “Yes,” complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If “Yes,” complete Schedule J for such person .....
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
CERNER CORPORATION
43 KENSICO DRIVE
MT KISCO,NY105491009 		MAINTENANCE/REMOTE HOSTING FOR CLINICAL 1,663,793
EPA
307 SOUTH EVERGREEN AVE
WOODBURY,NJ08096 		EMERGENCY DEPT. PHYSICIANS 840,014
QUEST DIAGNOSTICS NICHOLS INSTITUTE
12436 COLLECTIONS CENTER DRIVE
CHICAGO,IL606932436 		DIAGNOSTIC LABORATORY TESTING SERVICES 723,111
OPTIMAL IMX INC
2350 19TH STREET SOUTH STE 350
BIRMINGHAM,AL35209 		DIAGNOSTIC IMAGE READING & RELATED SERVI 528,508
MCKESSON
PO BOX 98347
CHICAGO,IL606932436 		FINANCIAL/CLINICAL SOFTWARE SUPPORT 496,407
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 in compensation from the organization MediumBullet23
Form 990 (2010)
Form 990 (2010)
Page 9
Part VIII
Statement of Revenue
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, gifts, grants and other similar amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c 51,937
d Related organizations...1d 4,006
e Government grants (contributions)1e 37,296
f All other contributions, gifts, grants, and
similar amounts not included above1f 		88,232
g Noncash contributions included in lines 1a-1f:$ 47,838
h Total. Add lines 1a-1f.......MediumBullet 181,471
Program Service Revenue Business Code
2a NET PATIENT SERVICE RE 621,400 91,424,410 91,424,410    
b
c
d
e
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 91,424,410
Other Revenue 3 Investment income (including dividends, interest
and other similar amounts).....MediumBullet 583,507     583,507
4 Income from investment of tax-exempt bond proceeds..MediumBullet        
5 Royalties............MediumBullet        
(i) Real (ii) Personal
6a Gross Rents    
b Less: rental expenses    
c Rental income or (loss)    
d Net rental income or (loss).......MediumBullet        
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 1,000,015 32,840
b Less: cost or other basis and sales expenses 889,544  
c Gain or (loss) 110,471 32,840
d Net gain or (loss)..........MediumBullet 143,311     143,311
8a Gross income from fundraising events (not including
$ 51,937
of contributions reported on line 1c). See Part IV, line 18 ...
a 44,466
b Less: direct expenses ...b 44,181
c Net income or (loss) from fundraising events..MediumBullet 285   285
9a Gross income from gaming activities.
See Part IV, line 19 ...
a 6,206
b Less: direct expenses ...b 2,506
c Net income or (loss) from gaming activities...MediumBullet 3,700     3,700
10a Gross sales of inventory, less
returns and allowances .
a 128,862
b Less: cost of goods sold ..b 87,848
c Net income or (loss) from sales of inventory..MediumBullet 41,014     41,014
Miscellaneous Revenue Business Code
11a LAB SERVICE REVENUE 621,500 1,607,873   1,607,873  
b CAFETERIA REVENUE 722,210 449,381     449,381
c INTERCOMPANY REVENUE 900,099 392,540 392,540    
d All other revenue .... 999,259 605,217 24,820 369,222
e Total. Add lines 11a–11d ......MediumBullet 3,449,053
12 Total revenue. See Instructions....MediumBullet 95,826,751 92,422,167 1,632,693 1,590,420
Form 990 (2010)
Form 990 (2010)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A) but are not required to complete columns (B), (C), and (D).
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising expenses
1 Grants and other assistance to governments and organizations in the U.S. See Part IV, line 21 3,472,963 3,472,963
2 Grants and other assistance to individuals in the U.S. See Part IV, line 22 24,000 24,000
3 Grants and other assistance to governments, organizations, and individuals outside the U.S. See Part IV, lines 15 and 16    
4 Benefits paid to or for members    
5 Compensation of current officers, directors, trustees, and key employees .... 1,171,301 326,753 844,548  
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....        
7 Other salaries and wages 33,679,453 32,392,792 1,114,548 172,113
8 Pension plan contributions (include section 401(k) and section 403(b) employer contributions) .... 3,101,712 2,924,269 162,032 15,411
9 Other employee benefits ....... 6,304,746 6,081,523 190,848 32,375
10 Payroll taxes ........... 2,521,767 2,393,285 116,660 11,822
11 Fees for services (non-employees):        
a Management ......        
b Legal ......... 105,334   105,334  
c Accounting ........... 87,050   87,050  
d Lobbying ........... 14,350   14,350  
e Professional fundraising. See Part IV, line 17..    
f Investment management fees ...... 4,258   4,258  
g Other .......... 7,791,907 6,670,352 933,529 188,026
12 Advertising and promotion .... 299,636 108,311 12,743 178,582
13 Office expenses ....... 14,710,605 14,643,678 37,734 29,193
14 Information technology ...... 71,608 66,912 4,163 533
15 Royalties ..        
16 Occupancy ........... 1,824,577 1,657,901 165,035 1,641
17 Travel ............ 72,968 45,708 25,672 1,588
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ......        
19 Conferences, conventions, and meetings .... 82,608 69,810 11,991 807
20 Interest ........... 1,250,279 1,250,279    
21 Payments to affiliates .......        
22 Depreciation, depletion, and amortization ..... 5,906,467 5,906,467    
23 Insurance .............. 157,405 157,405    
24 Other expenses. Itemize expenses not covered above. (Expenses grouped together and labeled miscellaneous may not exceed 5% of total expenses shown on line 25 below.)
a FEDERAL INCOME TAXES 202,770   202,770  
b BAD DEBT EXPENSE 4,745,793 4,745,793    
c REPAIRS AND MAINTENANCE 4,448,799 4,446,049 2,750  
d MA ASSESSMENT 891,137 891,137    
e MEMBERSHIP FEES 160,481 88,984 70,409 1,088
f All other expenses 280,735 186,984 92,364 1,387
25 Total functional expenses. Add lines 1 through 24f 93,384,709 88,551,355 4,198,788 634,566
26 Joint costs. Check here MediumBullet if following
SOP 98-2 (ASC 958-720). Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation 		       
Form 990 (2010)
Form 990 (2010)
Page 11
Part X Balance Sheet
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash—non-interest-bearing .......... 1,849 1 1,820
2 Savings and temporary cash investments ....... 11,020,406 2 13,883,416
3 Pledges and grants receivable, net .........   3  
4 Accounts receivable, net ......... 8,523,804 4 8,918,281
5 Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L ..........   5  
6 Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
Schedule L ..........   6  
7 Notes and loans receivable, net ............. 1,051,551 7 714,572
8 Inventories for sale or use .............. 2,205,958 8 2,118,024
9 Prepaid expenses and deferred charges ............ 2,459,475 9 2,540,938
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 104,162,006
b Less: accumulated depreciation. ..... 10b 73,628,783 32,933,803 10c 30,533,223
11 Investments—publicly traded securities .......... 28,379,832 11 30,178,953
12 Investments—other securities. See Part IV, line 11 ...... 148,000 12 690,861
13 Investments—program-related. See Part IV, line 11 ..   13  
14 Intangible assets .........   14  
15 Other assets. See Part IV, line 11 ........... 1,176,405 15 811,404
16 Total assets. Add lines 1 through 15 (must equal line 34)... 87,901,083 16 90,391,492
Liabilities 17 Accounts payable and accrued expenses . 34,764,584 17 26,548,913
18 Grants payable ..........   18  
19 Deferred revenue ..........   19  
20 Tax-exempt bond liabilities .......... 21,815,000 20 21,215,000
21 Escrow or custodial account liability. Complete Part IV of Schedule D..   21  
22 Payables to current and former officers, directors, trustees, key
employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L..........   22  
23 Secured mortgages and notes payable to unrelated third parties .. 2,281,296 23 1,855,672
24 Unsecured notes and loans payable to unrelated third parties ....   24  
25 Other liabilities. Complete Part X of Schedule D..... 5,998,163 25 5,745,410
26 Total liabilities. Add lines 17 through 25..... 64,859,043 26 55,364,995
Net Assets or Fund Balance Organizations that follow SFAS 117, check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets ..... 22,260,436 27 34,190,991
28 Temporarily restricted net assets ..... 272,023 28 274,698
29 Permanently restricted net assets ..... 509,581 29 560,808
Organizations that do not follow SFAS 117, check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds .....   30  
31 Paid-in or capital surplus, or land, building or equipment fund .....   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ..... 23,042,040 33 35,026,497
34 Total liabilities and net assets/fund balances ..... 87,901,083 34 90,391,492
Form 990 (2010)
Form 990 (2010)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response to any question in this Part XI . . . . . . . . . .
1
Total revenue (must equal Part VIII, column (A), line 12) . . .
1
95,826,751
2
Total expenses (must equal Part IX, column (A), line 25) . . . . .
2
93,384,709
3
Revenue less expenses. Subtract line 2 from line 1 . . . .
3
2,442,042
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) . .
4
23,042,040
5
Other changes in net assets or fund balances (explain in Schedule O) . . . .
5
9,542,415
6
Net assets or fund balances at end of year. Combine lines 3, 4, and 5 (must equal Part X, line 33, column (B)) . . . . . .
6
35,026,497
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response to any question in this Part XII . . . . . . . . . .
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?..
2a
 
No
b
Were the organization’s financial statements audited by an independent accountant?........
2b
Yes
 
c
If “Yes,” to 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O............................
2c
Yes
 
d
If “Yes” to line 2a or 2b, check a box below to indicate whether the financial statements for the year were issued on a separate basis, consolidated basis, or both:
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133? ................
3a
 
No
b
If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits. ..
3b
 
 
Form 990 (2010)
Additional Data


Software ID:  
Software Version:  
Form 990, Special Condition Description:
Special Condition Description
SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service
Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
OMB No. 1545-0047
2010
Open to Public
Inspection
Name of the organization
LEWISTOWN HOSPITAL
 
Employer identification number

23-1352187
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
f
g
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the the supported organization? ................
11g(i)
 
 
(ii) a family member of a person described in (i) above? ......................
11g(ii)
 
 
(iii) a 35% controlled entity of a person described in (i) or (ii) above? ................
11g(iii)
 
 
h
(i)
Name of supported organization 		(ii)
EIN 		(iii)
Type of organization (described on lines 1- 9 above or IRC section (see instructions)) 		(iv)
Is the organization in col. (i) listed in your governing document? 		(v)
Did you notify the organization in col. (i) of your support? 		(vi)
Is the organization in col. (i) organized in the U.S.? 		(vii)
Amount of support?
Yes No Yes No Yes No
Total                  

For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 2
Part II
Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year(or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....            
2 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......            
3 The value of services or facilities furnished by a governmental unit to the organization without charge..            
4 Total. Add lines 1 through 3..            
5 The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..            
6 Public Support. Subtract line 5 from line 4.            
Section B. Total Support
Calendar year(or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
7 Amounts from line 4..            
8 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
9 Net income from unrelated business activities, whether or not the business is regularly carried on..            
10 Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..            
11 Total support (Add lines 7 through 10).            
12
12
 
13
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 3
Part III
Support Schedule for Organizations Described in IRC 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year(or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .            
2 Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......            
3 Gross receipts from activities that are not an unrelated trade or business under section 513..            
4 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...            
5 The value of services or facilities furnished by a governmental unit to the organization without charge..            
6 Total. Add lines 1 through 5.            
7a Amounts included on lines 1, 2, and 3 received from disqualified persons...            
b Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.            
c Add lines 7a and 7b..            
8 Public Support (Subtract line 7c from line 6.)            
Section B. Total Support
Calendar year (or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
9 Amounts from line 6...            
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.            
c Add lines 10a and 10b.            
11 Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.            
12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)            
13 Total support (Add lines 9, 10c, 11 and 12.).            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 4
Part IV
Supplemental Information. Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Explanation
 
 
 
 
Schedule A (Form 990 or 990-EZ) 2010

Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
OMB No. 1545-0047
2010
Name of organization
LEWISTOWN HOSPITAL
 
Employer identification number

23-1352187
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule—
Special Rules
......................... Arrow Bullet   $    
Caution. An Organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2 of its Form 990, or check the box in the heading of its
Form 990-EZ, or on line 2 of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.
Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2010)

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
Page 1 of 1 of Part I
Name of organization
LEWISTOWN HOSPITAL
  		Employer identification number

23-1352187
Part I
Contributors (see Instructions)
     
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
RESTRICTED
RESTRICTED
 

     
RESTRICTED
RESTRICTED  
RESTRICTED, RESTRICTED   RESTRICTED

$RESTRICTED




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
Page 1 of 1 of Part II
Name of organization
LEWISTOWN HOSPITAL
  		Employer identification number

23-1352187
Part II
Noncash Property (see Instructions)
     
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
Page 1 of 1 of Part III
Name of organization
LEWISTOWN HOSPITAL
  		Employer identification number

23-1352187
Part III
Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
aggregating more than $1,000 for the year. (Complete columns (a) through (e) and the following line entry.)
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet $  
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Additional Data


Software ID:  
Software Version:  
SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet Complete if the organization is described below.
SchCMd Bullet Attach to Form 990 or Form 990-EZ. SchCMd Bullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public
Inspection
If the organization answered “Yes,” to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet Section 527 organizations: Complete Part I-A only.
If the organization answered “Yes,” to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)) Complete Part II-A. Do not complete Part II-B.
Round Bullet Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered “Yes,” to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, Part V, line 35a (Proxy Tax), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
LEWISTOWN HOSPITAL
 
Employer identification number

23-1352187
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization's direct and indirect political campaign activities on behalf of or in opposition to candidates for public office in Part IV.
2
Political expenditures ....................................SchCMd Bullet
$  
3
Volunteer hours ........................................
 

Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955 .........SchCMd Bullet
$  
2
Enter the amount of any excise tax incurred by organization managers under section 4955 ......SchCMd Bullet
$  
3
If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............
4a
Was a correction made? .........................................
b
If "Yes," describe in Part IV.
Part I-C
Complete if the organization is exempt under section 501(c) except section 501(c)(3).
1
Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet
$  
2
Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt funtion activities ....................................SchCMd Bullet

$  
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b..SchCMd Bullet

$  
4
Did the filing organization file Form 1120-POL for this year? ..........................
5
Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.
(a) Name (b) Address (c) EIN (d) Amount paid from filing organization's funds. If none, enter -0-. (e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.










For Privacy Act and Paperwork Reduction Act Notice, see the instructions for Form 990.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2010

Schedule C (Form 990 or 990-EZ) 2010
Page 2
Part II-A
Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).
A Check
B Check
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.) 		(a) Filing
Organization's
Totals 		(b) Affiliated Group
Totals
1a Total lobbying expenditures to influence public opinion (grass roots lobbying) ......    
b Total lobbying expenditures to influence a legislative body (direct lobbying) .......    
c Total lobbying expenditures (add lines 1a and 1b) ...................    
d Other exempt purpose expenditures ........................    
e Total exempt purpose expenditures (add lines 1c and 1d) ...............    
f Lobbying nontaxable amount. Enter the amount from the following table in both
columns.		    
  If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:    
  Not over $500,00020% of the amount on line 1e.    
  Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.    
  Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.    
  Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.    
  Over $17,000,000$1,000,000.    
       
g Grassroots nontaxable amount (enter 25% of line 1f) .................    
h Subtract line 1g from line 1a. If zero or less, enter -0-. ................    
i Subtract line 1f from line 1c. If zero or less, enter -0-. ................    
j If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting
section 4911 tax for this year? ......................................

4-Year Averaging Period Under Section 501(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five
columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
  Calendar year (or fiscal year
beginning in) 		(a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) Total
             
2a Lobbying non-taxable amount          
             
b Lobbying ceiling amount
(150% of line 2a, column(e)) 		         
             
c Total lobbying expenditures          
             
d Grassroots non-taxable amount          
             
e Grassroots ceiling amount
(150% of line 2d, column (e))		          
             
f Grassroots lobbying expenditures          
Schedule C (Form 990 or 990-EZ) 2010


Schedule C (Form 990 or 990-EZ) 2010
Page 3
Part II-B
Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).
(a)
Yes
No
(b)
Amount
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? .........................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....
 
No
c
Media advertisements? ....................................
 
No
 
d
Mailings to members, legislators, or the public? .........................
 
No
 
e
Publications, or published or broadcast statements? .......................
 
No
 
f
Grants to other organizations for lobbying purposes? .......................
 
No
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? ........
 
No
 
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
 
No
 
i
Other activities? If "Yes," describe in Part IV ..........................
Yes
 
14,350
j
Total. lines 1c through 1i ...................................
14,350
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 .................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....
 
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......
 
 
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members? ................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ................
2
 
 
3
Did the organization agree to carryover lobbying and political expenditures from the prior year? ..........
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) if BOTH Part III-A, lines 1 and 2 are answered “No” OR if Part III-A, line 3 is answered “Yes”.
1
Dues, assessments and similar amounts from members .....................
1
 
2
Section 162(e) non-deductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).
a
Current year .........................................
2a
 
b
Carryover from last year ....................................
2b
 
c
Total ...........................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) ..............
5
 
Part IV
Supplemental Information
Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; and Part ll-B, line 1i.
Also, complete this part for any additional information.
Identifier Return Reference Explanation
EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: A PORTION (25.82%) OF OUR ANNUAL DUES PAID TO THE HOSPITAL AND HEALTHSYSTEM ASSOCIATION OF PENNSYLVANIA (HAP) IS ATTRIBUTABLE TO LOBBYING EXPENSES. A PORTION (23.76%) OF OUR ANNUAL DUES PAID TO THE AMERICAN HOSPITAL ASSOCIATION (AHA) IS ATTRIBUTABLE TO LOBBYING EXPENSES.
Schedule C (Form 990 or 990EZ) 2010

Additional Data


Software ID:  
Software Version:  

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11, or 12.
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
LEWISTOWN HOSPITAL
 
Employer identification number

23-1352187
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .......    
2 Aggregate contributions to (during year) ...    
3 Aggregate grants from (during year) ...    
4 Aggregate value at end of year .......    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds may be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit. ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a–2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ....................... 2a  
b Total acreage restricted by conservation easements .................. 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 8/17/06 ........ 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the taxable year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting and enforcing conservation easements during the year SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section
170(h)(4)(B)(i) and 170(h)(4)(B)(ii)? ....................................
9
In Part XIV, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116, not to report in its revenue statement and balance sheet works of
art, historical treasures, or other similar assets held for public exhibition, education or research in furtherance of public service,
provide, in Part XIV, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116, to report in its revenue statement and balance sheet works of art,
historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service,
provide the following amounts relating to these items:
(i)
Revenues included in Form 990, Part VIII, line 1 ........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ..............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 relating to these items:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 52283D
Schedule D (Form 990) 2010

Schedule D (Form 990) 2010
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s accession and other records, check any of the following that are a significant use of its collection
items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIV.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIV and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
If “Yes,” explain the arrangement in Part XIV.
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current Year (b)Prior Year (c)Two Years Back (d)Three Years Back (e)Four Years Back
1a Beginning of year balance .... 80,371 69,171 63,766
b Contributions ........ 91,939 4,750 4,495
c Investment earnings or losses ... 3,266 7,758 2,070
d Grants or scholarships ..... 1,000 1,000 1,000
e Other expenditures for facilities
and programs ........ 		     
f Administrative expenses .... 389 308 160
g End of year balance ...... 174,187 80,371 69,171
2
Provide the estimated percentage of the year end balance held as:
a
Board designated or quasi-endowment: SchDMd Bullet  
b
Permanent endowment: SchDMd Bullet100.000 %
c
Term endowment: SchDMd Bullet  
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
No
(ii) related organizations ........................
3a(ii)
 
No
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
Describe in Part XIV the intended uses of the organization's endowment funds.
Part VI
Investments—Land, Buildings, and Equipment. See Form 990, Part X, line 10.
Description of investment (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................   224,654 224,654
b Buildings ................   45,822,466 30,039,519 15,782,947
c Leasehold improvements ............        
d Equipment ................   55,944,113 42,300,433 13,643,680
e Other .................   2,170,773 1,288,831 881,942
Total. Add lines 1a-1e. (Column (d) should equal Form 990, Part X, column (B), line 10(c).)........SchDMdBullet 30,533,223
Schedule D (Form 990) 2010

Schedule D (Form 990) 2010
Page 3
Part VII
Investments—Other Securities. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)		 (b)Book value (c) Method of valuation:
Cost or end-of-year market value
(1)Financial derivatives    
(2)Closely-held equity interests    
Other








Total. (Column (b) should equal Form 990, Part X, col.(B) line 12.)Small Bullet  
Part VIII
Investments—Program Related. See Form 990, Part X, line 13.
(a) Description of investment type (b) Book value (c) Method of valuation:
Cost or end-of-year market value








Total. (Column (b) should equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets. See Form 990, Part X, line 15.
(a) Description (b) Book value








Total. (Column (b) should equal Form 990, Part X, col.(B) line 15.)...........Small Bullet  
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of Liability (b) Amount
Federal Income Taxes  
OBLIGATIONS UNDER CAPITAL LEASE 2,978,971
DUE TO AFFILIATES 95,014
ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 1,861,252
BLUE CROSS CURRENT FINANCING ADVANCE 381,800
ESTIMATED MEDICAL MALPRACTICE CLAIMS 428,373




Total. (Column (b) should equal Form 990, Part X, col.(B) line 25.)Small Bullet 5,745,410
2. Fin 48 (ASC 740) Footnote. In Part XIV, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC740).
Schedule D (Form 990) 2010

Schedule D (Form 990) 2010
Page 4
Part XI Reconciliation of Change in Net Assets from Form 990 to Financial Statements
1 Total revenue (Form 990, Part VIII, column (A), line 12) .................... 1 95,826,751
2 Total expenses (Form 990, Part IX, column (A), line 25) ..................... 2 93,384,709
3 Excess or (deficit) for the year. Subtract line 2 from line 1 ............. 3 2,442,042
4 Net unrealized gains (losses) on investments .......................... 4 2,050,602
5 Donated services and use of facilities ............................. 5  
6 Investment expenses ................................... 6  
7 Prior period adjustments .................................. 7  
8 Other (Describe in Part XIV) ................................. 8 7,491,813
9 Total adjustments (net). Add lines 4 - 8 ............................. 9 9,542,415
10 Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 ......... 10 11,984,457
Part XII Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1 Total revenue, gains, and other support per audited financial statements ....... 1 105,499,695
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a 2,050,602
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIV): ............ 2d 7,491,813
e Add lines 2a through 2d ..................... 2e 9,542,415
3 Subtract line 2e from line 1..................... 3 95,957,280
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a  
b Other (Describe in Part XIV): ........... 4b -130,529
c Add lines 4a and 4b....................... 4c -130,529
5 Total Revenue. Add lines 3 and 4c. (This should equal Form 990, Part I, line 12.) ...... 5 95,826,751
Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1 Total expenses and losses per audited financial statements ............. 1 93,515,238
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities .......... 2a  
b Prior year adjustments .............. 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIV): ............ 2d 130,529
e Add lines 2a through 2d...................... 2e 130,529
3 Subtract line 2e from line 1..................... 3 93,384,709
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a  
b Other (Describe in Part XIV): ............ 4b  
c Add lines 4a and 4b....................... 4c 0
5 Total expenses. Add lines 3 and 4c. (This should equal Form 990, Part I, line 18.) ...... 5 93,384,709
Part XIV
Supplemental Information
Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X; Part XI, line 8; Part XII, lines 2d and 4b; and Part XIII, lines 2d and 4b. Also complete this part to provide any additional information.
Identifier Return Reference Explanation
DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THE EARNINGS ON THE FRIENDS LEGACY ENDOWMENT FUND WILL BE USED SOLELY FOR THE PURPOSES OF CAPITAL AND BUILDING EXPENDITURES. NO EXPENDITURES CAN BE MADE UNTIL THE FUND REACHES $1,000,000 AND THEN ONLY THE EARNINGS FROM THE INVESTMENT CAN BE USED FOR THOSE PURPOSES. THE EARNINGS ON THE SCHOOL OF NURSING SCHOLARSHIP FUNDS ARE USED FOR SCHOLARSHIPS FOR LEWISTON HOSPITAL SCHOOL OF NURSING STUDENTS SELECTED BY THE SCHOLARSHIP COMMITTEE BASED ON ESTABLISHED CRITERIA.
DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE HOSPITAL ACCOUNTS FOR UNCERTAINTY IN INCOME TAXES USING A RECOGNITION THRESHOLD OF MORE-LIKELY-THAN-NOT TO BE SUSTAINED UPON EXAMINATION BY THE APPROPRIATE TAXING AUTHORITY. MEASUREMENT OF THE TAX UNCERTAINTY OCCURS IF THE RECOGNITION THRESHOLD HAS BEEN MET. MANAGEMENT HAS DETERMINED THAT THERE WERE NO TAX UNCERTAINTIES THAT MET THE RECOGNITION THRESHOLD IN 2011 AND 2010.
PART XI, LINE 8 - OTHER ADJUSTMENTS:   VALUATION LOSS 51,227. PENSION LIABILITY ADJUSTMENT 7,440,586.
PART XII, LINE 2D - OTHER ADJUSTMENTS:   VALUATION GAIN 51,227. PENSION LIABILITY ADJUSTMENT 7,440,586.
PART XII, LINE 4B - OTHER ADJUSTMENTS:   SPECIAL EVENT EXPENSES -44,181. COST OF GOODS SOLD -87,848. GAMING EXPENSES -2,506. TRANSFERS FROM AFFILIATES NETTED ON FINANCIAL STATEMENTS 4,006.
PART XIII, LINE 2D - OTHER ADJUSTMENTS:   SPECIAL EVENT EXPENSES 44,181. COST OF GOODS SOLD 87,848. RENTAL EXPENSES TRANSFERS FROM AFFILIATES NETTED ON FINANCIAL STATEMENTS -4,006. GAMING EXPENSES 2,506.
Schedule D (Form 990) 2010

Additional Data


Software ID:  
Software Version:  




SCHEDULE G
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Supplemental Information Regarding
Fundraising or Gaming Activities
Complete if the organization answered "Yes" to Form 990, Part IV, lines 17, 18, or 19,
or if the organization entered more than $15,000 on Form 990-EZ, line 6a.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
LEWISTOWN HOSPITAL
 
Employer identification number

23-1352187
Part I
Fundraising Activities. Complete if the organization answered "Yes" to Form 990, Part IV, line 17.
1
Indicate whether the organization raised funds through any of the following activities. Check all that apply.
a e
b f
c g
d
2a
Did the organization have a written or oral agreement with any individual (including officers, directors, trustees
or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services?
b
If “Yes,” list the ten highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is
to be compensated at least $5,000 by the organization. Form 990-EZ filers are not required to complete this table.
(i) Name and address of individual
or entity (fundraiser) 		(ii) Activity (iii) Did fundraiser have custody or control of contributions? (iv) Gross receipts
from activity 		(v) Amount paid to
(or retained by)
fundraiser listed in
col. (i) 		(vi) Amount paid to
(or retained by)
organization
Yes No
Total .................right arrow      
3
List all states in which the organization is registered or licensed to solicit funds or has been notified it is exempt from registration or licensing.
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50083H
Schedule G (Form 990 or 990-EZ) 2010
Schedule G (Form 990 or 990-EZ) 2010
Page 2
Part II
Fundraising Events. Complete if the organization answered "Yes" to Form 990, Part IV, line 18, or reported more than $15,000 on Form 990-EZ, line 6a. List events with gross receipts greater than $5,000.
(a) Event #1

GOLF TOURNAMENT 2011
(event type) 		(b) Event #2

LEND-A-HAND EVENT 2011
(event type) 		(c) Other Events

  
(total number) 		(d) Total Events
(Add col. (a) through col. (c))
VerticalRevenue 1 Gross receipts . . . 55,908 27,201   83,109
2 Less: Charitable
contributions . . . 		31,836 20,101   51,937
3 Gross income (line 1
minus line 2) . . . 		24,072 7,100   31,172
VerticalDirectExpenses 4 Cash prizes . . .        
5 Non-cash prizes . . 2,710     2,710
6 Rent/facility costs . . 6,928 1,353   8,281
7 Food and beverages . . 12,864 7,915   20,779
8 Entertainment . . .   600   600
9 Other direct expenses . 10,778 1,033   11,811
10 Direct expense summary. Add lines 4 through 9 in column (d) ........... right arrow 44,181
11 Net income summary. Combine lines 3 and 10 in column (d)............ right arrow -13,009
Part III
Gaming. Complete if the organization answered "Yes" to Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a.
VerticalRevenue (a) Bingo (b) Pull tabs/Instant
bingo/progressive bingo 		(c) Other gaming (d) Total gaming (Add col. (a) through col. (c))
1 Gross revenue . . . .        
VerticalDirectExpenses 2 Cash prizes . . . .        
3 Non-cash prizes . . .        
4 Rent/facility costs . . .        
5 Other direct expenses . .        
6 Volunteer labor . . .
 
 
 
7 Direct expense summary. Add lines 2 through 5 in column (d) ........... right arrow  
8 Net gaming income summary. Combine lines 1 and 7 in column (d) .......... right arrow  
9
Enter the state(s) in which the organization operates gaming activities:
a
Is the organization licensed to operate gaming activities in each of these states? ............
b
If "No," Explain:
 
10a
Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? .....
b
If "Yes," Explain:
 
11
Does the organization operate gaming activities with nonmembers? .................
12
Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity
formed to administer charitable gaming? ...........................
Schedule G (Form 990 or 990-EZ) 2010
Schedule G (Form 990 or 990-EZ) 2010
Page 3
13
Indicate the percentage of gaming activity operated in:
a
The organization's facility ......................
13a
 
b
An outside facility ........................
13b
 
14
Provide the name and address of the person who prepares the organization's gaming/special events books and records:
Name right arrow
Address right arrow
15a
Does the organization have a contract with a third party from whom the organization receives gaming
revenue? ......................................
b
If "Yes," enter the amount of gaming revenue received by the organization right arrow $   and the
amount of gaming revenue retained by the third party right arrow $   .
c
If "Yes," enter name and address:
Name right arrow
Address right arrow
 
 
16
Gaming manager information:
Name right arrow
Gaming manager compensation right arrow $  
Description of services provided right arrow
 
17
Mandatory distributions:
a
Is the organization required under state law to make charitable distributions from the gaming proceeds to
retain the state gaming license? ............................
b
Enter the amount of distributions required under state law distributed to other exempt organizations or spent
in the organization's own exempt activities during the tax year right arrow$  
Part IV
Complete this part to provide additional information for responses to quuestion on Schedule G (see instructions.)
Identifier ReturnReference Explanation
Schedule G (Form 990 or 990-EZ) 2010
Additional Data


Software ID:  
Software Version:  
SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet Attach to Form 990. MediumBullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
LEWISTOWN HOSPITAL
 
Employer identification number

23-1352187
Part I
Charity Care and Certain Other Community Benefits at Cost
Yes
No
1a
Does the organization have a charity care policy? If "No," skip to question 6a...........
1a
Yes
 
b
If "Yes," is it a written policy? .......................
1b
Yes
 
2
If the organization has multiple hospitals, indicate which of the following best describes application of the charity care policy to the various hospitals.
3
Answer the following based on the charity care eligibility criteria that applies to the largest number of the organization's patients.
a
Does the organization use Federal Poverty Guidelines (FPG) to determine eligibility for providing free care to low
income individuals? If "Yes," indicate which of the following is the FPG family income limit for eligibility for free care:
3a
Yes
 
b
Does the organization use FPG to determine eligibility for providing discounted care to low income individuals? If
"Yes," indicate which of the following is the family income limit for eligibility for discounted care: .....
3b
 
No
c
If the organization does not use FPG to determine eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization uses an asset test or other threshold, regardless of income, to determine eligibility for free or discounted care.
4
Does the organization's policy provide free or discounted care to the "medically indigent"? ......
4
Yes
 
5a
Does the organization budget amounts for free or discounted care provided under its charity care policy? ...
5a
Yes
 
b
If "Yes," did the organization's charity care expenses exceed the budgeted amount?.........
5b
Yes
 
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discounted
care to a patient who was eligibile for free or discounted care?...............
5c
 
No
6a
Does the organization prepare an annual community benefit report?.............
6a
Yes
 
6b
If "Yes," does the organization make it available to the public? ..............
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Charity Care and Certain Other Community Benefits at Cost
Charity Care and
Means-Tested Government Programs		 (a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Charity care at cost (from
Worksheets 1 and 2) .. 		    1,680,131   1,680,131 1.800 %
b Unreimbursed Medicaid (from
Worksheet 3, column a) . 		    4,472,674 298,210 4,770,884 5.110 %
c Unreimbursed costs—other means-tested government programs (from Worksheet 3, column b) ....            
dTotal Charity Care and
Means-Tested Government Programs ..... 		    6,152,805 298,210 6,451,015 6.910 %
Other Benefits
e Community health improvement
services and community
benefit operations (from
(Worksheet 4) .... 		    93,052   93,052 0.100 %
f Health professions education
(from Worksheet 5) .. 		    39,534   39,534 0.040 %
g Subsidized health services
(from Worksheet 6) .. 		           
h Research (from Worksheet 7)            
i Cash and in-kind contributions
to community groups
(from Worksheet 8) .. 		    166   166 0 %
jTotal Other Benefits ...     132,752   132,752 0.140 %
kTotal. Add lines 7d and 7j. ..     6,285,557 298,210 6,583,767 7.050 %
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 2
Part II
Community Building Activities Complete this table if the organization conducted any community building activities.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development     2,387   2,387 0 %
3 Community support     29,980   29,980 0.030 %
4 Environmental improvements            
5 Leadership development and training for community members            
6 Coalition building            
7 Community health improvement advocacy     5,845   5,845 0.010 %
8 Workforce development     2,000   2,000 0 %
9 Other            
10 Total     40,212   40,212 0.040 %
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Does the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense (at cost).....
2
1,894,611
3
Enter the estimated amount of the organization's bad debt expense (at cost) attributable to patients eligible under the organization's charity care policy ..
3
 
4
Provide in Part VI the text of the footnote to the organization's financial statements that describes bad debt expense. In addition, describe the costing methodology used in determining the amounts reported on lines 2 and 3, and rationale for including a portion of bad debt amounts as community benefit.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
26,209,774
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
27,235,024
7
Subtract line 6 from line 5. This is the surplus or (shortfall)........
7
-1,025,250
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.
Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.
Check the box that describes the method used:
Section C. Collection Practices
9a
Does the organization have a written debt collection policy? ...............
9a
Yes
 
b
If "Yes," does the organization's collection policy contain provisions on the collection practices to be followed for patients who are known to qualify for charity care or financial assistance? Describe in Part VI......
9b
Yes
 
Part IV
Management Companies and Joint Ventures
(a) Name of entity (b) Description of primary
activity of entity 		(c) Organization's
profit % or stock
ownership % 		(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership% 		(e) Physicians'
profit % or stock
ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 3
Part VFacility Information
Section A. Hospital Facilities
(list in order of size, measured by total revenue per facility, from largest to smallest)
How many hospital facilities did the organization operate during the tax year?1
Name and address 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital Research Facility ER-24Hours ER-Other Other (Describe)
1 LEWISTOWN HOSPITAL
400 HIGHLAND AVENUE
LEWISTOWN,PA17044 		X X         X    
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
Name of Hospital Facility:NOT REQUIRED
Line Number of Hospital Facility (from Schedule H, Part V, Section A):1

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2010)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet those needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess all of the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Development of a community benefit plan for the facility
d Participation in community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the CHNA
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed together with the reasons why it has not addressed such needs. 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8    
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?.. 9    
If “Yes,” indicate the FPG family income limit for eligibility for free care:   %
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 5
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care to low income individuals?......... 10    
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
11 Explained the basis for calculating amounts charged to patients?................. 11    
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12    
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13    
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted at all times on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy that explained actions the hospital facility may take upon non-payment?........ 14    
15 Check all of the following collection actions against a patient that were permitted under the hospital facility's policies at any time during the tax year:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments or arrests
e Other (describe in Part VI)
16 Did the hospital facility engage in or authorize a third party to engage in any of the following collection actions during the tax year?................................... 16    
If “Yes,” check all collection actions in which the hospital facility or a third party engaged (check all that apply):
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other (describe in Part VI)
17 Indicate which actions the hospital facility took before initiating any of the collection actions checked in question 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether a patient who applied for financial assistance under the financial assistance policy qualified for financial assistance
e Other (describe in Part VI)
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 6
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18    
If “No,” indicate the reasons why (check all that apply):
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility did not have a policy relating to emergency medical care
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Charges for Medical Care
19 Indicate how the hospital facility determined the amounts generally billed to individuals who had insurance covering emergency or other medically necessary care (check all that apply):
a The hospital facility used the lowest negotiated commercial insurance rate for those services at the hospital facility
b The hospital facility used the average of the three lowest negotiated commercial insurance rates for those services at the hospital facility
c The hospital facility used the Medicare rate for those services
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20    
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its patients an amount equal to the gross charge for services provided to that patient?................................... 21    
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 7
Part VFacility Information (continued)

Section C. Other Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, measured by total revenue per facility, from largest to smallest)
How many non-hospital facilities did the organization operate during the tax year?  
Name and address Type of Facility (Describe)
1
2
3
4
5
6
7
8
9
10
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 8
Part VI
Supplemental Information
Complete this part to provide the following information.
1 Required descriptions. Provide the description required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; and Part V, Section B, lines 1j, 2, 4c, 6i, 7, 11i, 13i, 17l, 18l, 19e, 21d, 25, and 26.
2 Community health needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any community health needs assessments reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
Identifier ReturnReference Explanation
    PART I, LINE 3C: ELIGIBILITY FOR FREE CARE IS BASED ON FEDERAL POVERTY GUIDELINES. DISCOUNTS ARE AVAILABLE FOR PROMPT PAYMENT AND SELF PAY OVER CERTAIN DOLLAR LEVELS, REGARDLESS OF INCOME.
    PART I, L7 COL(F): BAD DEBT EXPENSE OF $4,745,793 WAS INCLUDED ON FORM 990, PART IX, LINE 25, BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN PART I LINE 7 COLUMN F.
    PART II: ECONOMIC DEVELOPMENT AND COMMUNITY BUILDING ACTIVITIES:MIFFLIN COUNTY INDUSTRIAL DEVELOPMENT CORPORATION - KAY HAMILTON, CEO, BOARD MEMBER THE MISSION OF THE MIFFLIN COUNTY INDUSTRIAL DEVELOPMENT CORPORATION IS TO PROMOTE THE GROWTH OF EMPLOYMENT AND INCOME IN MIFFLIN COUNTY BY USING TECHNICAL AND FINANCIAL RESOURCES FROM MCIDC AND FEDERAL, STATE, AND LOCAL AGENCIES AND INDIVIDUALS TO ENCOURAGE AND ASSIST BUSINESS AND INDUSTRIAL FORMATION, RETENTION, AND EXPANSION. MIFFLIN COUNTY PLANNING COMMISSION - KAY HAMILTON, CEO, MEMBER OF THE COMMISSIONTHE MISSION OF THE MIFFLIN COUNTY PLANNING COMMISSION IS TO PROVIDE STRATEGIC, COORDINATED, AND OBJECTIVE GUIDANCE AND OVERSIGHT TO THE GROWTH, PLANNING, AND DEVELOPMENT ACTIVITIES OF MIFFLIN COUNTY. IN DOING SO, IT IS THE GOAL OF THE COMMISSION TO ENSURE MIFFLIN COUNTY'S FUTURE IS CHARACTERIZED BY A HEALTHY ENVIRONMENT, ECONOMY, AND SOCIETY ACHIEVED THROUGH PROACTIVE PLANNING, CITIZEN REPRESENTATION, EFFECTIVE COMMUNICATION, AND THE PROVISION OF PROFESSIONAL SERVICES FROM THE MIFFLIN COUNTY PLANNING AND DEVELOPMENT DEPARTMENT.MIFFLIN JUNIATA CAREER TECH CENTER ADVISORY COMMITTEE - KAY HAMILTON, CEO, BOARD MEMBERTHE MIFFLIN JUNIATA CAREER AND TECHNOLOGY CENTER OFFERS VOCATIONAL-TECHNICAL EDUCATIONAL PROGRAMS FOR BOTH MIFFLIN AND JUNIATA COUNTY STUDENTS IN GRADES 10 - 12. PROGRAMS INCLUDE: HEALTH PROFESSIONS, ALLIED HEALTH SCIENCE, AGRICULTURE, CONSTRUCTION, CRIMINAL JUSTICE, ETC. MIFFLIN-JUNIATA PARTNERS ADVANCING TOMORROW'S HEALTH (MJ PATH) - KIRK THOMAS, VP OPERATIONS, BOARD CHAIRTHE MISSION OF THE MJ PATH GROUP IS TO PROMOTE THE HEALTH AND WELLNESS OF INDIVIDUALS AND THE COMMUNITIES OF MIFFLIN AND JUNIATA COUNTIES. THIS IS ACCOMPLISHED BY ENGAGING A BROAD SPECTRUM OF LOCAL COMMUNITY INDIVIDUALS AND ORGANIZATIONS WITH INTERESTS AND INFLUENCE ON LOCAL HEALTH STATUS BY WORKING TOGETHER TO PROMOTE EFFECTIVE HEALTH IMPROVEMENT STRATEGIES, INCLUDING PLANNING AND COORDINATION OF LOCAL RESOURCES. MEETINGS ARE HELD BI-MONTHLY. MIFFLIN-JUNIATA HEALTH CENTER - KIRK THOMAS, VP OPERATIONS, BOARD CHAIR THE MISSION OF THE MIFFLIN-JUNIATA HEALTH CENTER IS TO PROVIDE ACCESS TO PRIMARY AND PREVENTIVE HEALTH CARE SERVICES TO RESIDENTS OF ALL INCOME LEVELS WITHIN OUR SERVICE AREA, WITH SPECIAL EMPHASIS ON THE INDIGENT, THE UNINSURED, AND THE UNDERSERVED. THE HEALTH CENTER IS COLLABORATING WITH BROAD TOP MEDICAL CENTER, A FEDERALLY-QUALIFIED HEALTH CENTER, TO ESTABLISH AFFILIATE CLINICS IN MIFFLIN AND JUNIATA COUNTIES. AMISH HEALTH COUNCIL LIAISON - KIRK THOMAS, VP OPERATIONSAN INITIATIVE HAS BEEN IMPLEMENTED TO MEET THE HEALTH CARE NEEDS OF THE AMISH POPULATION IN MIFFLIN AND JUNIATA COUNTIES. TO ENCOURAGE ACCESS TO CARE, A DISCOUNT PAYMENT SCHEDULE HAS BEEN DEVELOPED. MIFFLIN-JUNIATA UNITED WAY - PHYLLIS MITCHELL, VP MARKETING & COMMUNITY AFFAIRS, BOARD MEMBERTHE MISSION OF THE MJ UNITED WAY IS TO IMPROVE PEOPLE'S LIVES BY MOBILIZING THE CARING POWER OF THE COMMUNITY. THE UNITED WAY SUPPORTS VARIOUS AGENCIES THROUGH FUNDING. THE COMMUNITY IMPACT FOCUS AREAS INCLUDE: BASIC NEEDS AND SELF SUFFICIENCY, COMMUNITY LIFE AND HEALTH, EDUCATION, AND SUCCESSFUL CHILDREN AND YOUTH. LEWISTOWN HOSPITAL EMPLOYEES AND MEDICAL-DENTAL STAFF CONTRIBUTE TO THE UNITED WAY FUND EACH YEAR TO SUPPORT THESE LOCAL COMMUNITY ORGANIZATIONS. JUNIATA VALLEY CHAMBER OF COMMERCE - PHYLLIS MITCHELL, BOARD MEMBERTHE JUNIATA VALLEY CHAMBER OF COMMERCE HELPS PROMOTE AND SUPPORT LOCAL BUSINESSES IN MIFFLIN AND JUNIATA COUNTIES. THE CHAMBER IS A RESPECTED SOURCE FOR INFORMATION ABOUT COMMUNITY BUSINESSES AND EVENTS IN THE AREA. EMERGENCY PREPAREDNESS COMMITTEE - COMMUNITY PLANNING IMITATIVETHE EMERGENCY PREPAREDNESS COMMITTEE IS ACTUALLY A SUB-COMMITTEE OF THE RISK MANAGEMENT & SAFETY COMMITTEE. THE PRIMARY FUNCTION WOULD BE TO ASSURE THE HOSPITAL IS PREPARED AS BEST AS POSSIBLE FOR ANY EMERGENCY SITUATION. WE WORK CLOSELY WITH BOTH THE MIFFLIN AND JUNIATA COUNTY EMERGENCY MANAGEMENT AGENCIES (EMA'S), AND EACH OF THEIR RESPECTIVE DIRECTORS SITS ON THE COMMITTEE IN AN EX-OFFICIO CAPACITY. THIS HELPS US IN DEVELOPING OUR PLANS AND DRILLS/EXERCISES SO WE ADDRESS CONCERNS OF EACH COUNTY AS IT RELATES TO THEIR HVA'S (HAZARDS VULNERABILITY ANALYSIS).IN ADDITION, WE COORDINATE AND WORK CLOSELY WITH THE SOUTH CENTRAL MOUNTAINS REGIONAL TASK FORCE (SCMRTF). THE REGION IS COMPRISED OF THE FOLLOWING COUNTIES: MIFFLIN, JUNIATA, SNYDER, HUNTINGDON, BLAIR, BEDFORD, FULTON, AND CENTRE. BY MEETING, PLANNING AND EXERCISING WITH THE HEALTH CARE PARTNERS, PRIMARILY HOSPITALS, IN THIS AREA, WE ARE ABLE TO DEVELOP PLANS AND CONTINGENCIES IN THE EVENT OF LOCAL, REGIONAL, STATE AND/OR NATIONAL INCIDENTS. BY KNOWING WHAT EACH OTHERS CAPABILITIES AND RESOURCES ARE IN ADVANCE, WE HOPE TO BE ABLE TO MAINTAIN OR RESTORE HEALTHCARE SERVICES AS QUICKLY AS POSSIBLE TO OUR AREAS. THIS IS ONE COMPONENT OF OUR COMMUNITY INTERACTION AND PLANNING FOR INCIDENTS WHICH COULD ADVERSELY AFFECT HEALTHCARE FOR OUR RESIDENTS, VISITORS AND PATIENTS. WE ALSO PLAN AT LEAST 2 EXTERNAL EXERCISES (DRILLS) WITHIN MIFFLIN AND/OR JUNIATA COUNTIES EACH YEAR. THIS INVOLVES NOT ONLY HOSPITAL ASSETS, BUT INCLUDES PERSONNEL AND EQUIPMENT FROM EMS, FIRE, LAW ENFORCEMENT, EMERGENCY MANAGEMENT, AND SEVEN MOUNTAINS EMS REGION, TO PRACTICE WHAT COULD OCCUR IN A VARIETY OF DIFFERENT SITUATIONS SUCH AS MAJOR FIRES, BUILDING COLLAPSES, BUS ACCIDENTS, OR TERRORIST TYPES OF ATTACKS.THE COMMITTEE IS COMPRISED OF: HOSPITAL RISK MANAGER (CHAIR), PCD'S FROM THE ED AND ICCU, VP OF NURSING, VP OF COMMUNITY RELATIONS, MANAGER OF EMPLOYEE HEALTH, STAFF MEMBERS FROM THE ED, SECURITY, AND THE LAB, DIRECTOR OF QUALITY IMPROVEMENT, COMMUNICATIONS SUPERVISOR, SENIOR FINANCIAL ACCOUNTANT, AND OTHERS. WE MEET MONTHLY AND REVIEW ANY & ALL ITEMS RELATED TO EMERGENCY PREPAREDNESS AND CONTINUITY OF OPERATIONS DURING AN EMERGENCY INCIDENT. WE ALSO REVIEW INCIDENTS WHICH MAY HAVE OCCURRED, EVALUATE INTERNAL/EXTERNAL COMMUNICATIONS AS NECESSARY, DISCUSS DISSEMINATION OF PUBLIC INFORMATION DURING INCIDENTS, AND APPROVE EXPENDITURES OF THE ASPR/OPHP (ASSISTANT SECRETARY OF PREPAREDNESS RESPONSE/OFFICE OF PUBLIC HEALTH PREPAREDNESS) ANNUAL GRANTS.INTERNSHIP PROGRAMS FOR VARIOUS DEPARTMENTSTHE HOSPITAL WORKS WITH MANY DIFFERENT ORGANIZATIONS SUCH AS SECONDARY EDUCATION INSTITUTIONS, AND MEDICAL SCHOOLS, TO PROVIDE JOB SHADOWING AND TRAINING INTERNSHIPS FOR PARTICIPANTS. MANY DIFFERENT DEPARTMENTS WORK WITH INTERNS TO PROVIDE A VALUABLE WORK EXPERIENCE. IN FY2011, WE HELD TWO DAYS OF JOB SHADOWING WITH PARTICIPATION FROM APPROXIMATELY 15 DIFFERENT DEPARTMENTS ACROSS THE ORGANIZATION SHADOWING APPROXIMATELY 45 INDIVIDUALS INTERESTED IN CAREERS IN THE HEALTH CARE FIELD. THIS IS A VALUABLE SERVICE TO THE EDUCATIONAL INSTITUTIONS OF THE COMMUNITY AS THE STUDENTS ARE ABLE TO EXPERIENCE FIRSTHAND WHAT THESE TYPES OF CAREERS HAVE TO OFFER, SOMETHING THAT A CLASSROOM SETTING COULD NOT PROVIDE. THIS PROGRAM IS OF NO COST TO THE EDUCATIONAL INSTITUTIONS AND IT IS AN EXCELLENT WAY FOR STUDENTS TO MAKE INFORMED CAREER CHOICES ULTIMATELY RESULTING IN A STRONGER WORKFORCE FOR THE COMMUNITY.EXPERIENCE WORKS PROGRAM SPONSOR.EXPERIENCE WORKS (FORMERLY GREEN THUMB) IS A FEDERAL EMPLOYMENT PROGRAM THAT IS FOCUSED ON MEETING THE TRAINING AND EMPLOYMENT NEEDS OF A RAPIDLY GROWING OLDER POPULATION. LEWISTOWN HOSPITAL IS A TRAINING AGENCY FOR EXPERIENCE WORKS INDIVIDUALS. CURRENTLY TWO EXPERIENCED WORKS PARTICIPANTS ARE WORKING AT THE HOSPITALLEWISTOWN HOSPITAL SCHOOL OF NURSINGMANY RURAL AREAS FACE SEVERE SHORTAGES OF NURSES. NO MEDICAL CENTER CAN WORK PROPERLY WITHOUT ENOUGH GOOD NURSES, AND LEWISTOWN HOSPITAL IS NO EXCEPTION. THE HOSPITAL HAD DIFFICULTY HIRING AND KEEPING RNS FOR YEARS. SO DID OTHER FACILITIES IN THE REGION, SUCH AS NURSING HOMES AND DOCTORS' OFFICES . IN RESPONSE TO THIS SHORTAGE OF NURSES, LEWISTOWN HOSPITAL APPEALED TO THE STATE BOARD OF NURSING TO OPEN ITS CURRENT SCHOOL OF NURSING. IN MAY 2005, THE PENNSYLVANIA STATE BOARD OF NURSING GRANTED INITIAL APPROVAL TO THE LEWISTOWN HOSPITAL TO ADMIT TWENTY-FIVE STUDENTS TO EACH OF TWO CLASSES. THE PENNSYLVANIA STATE BOARD EDUCATION ADVISORS REVIEWED THE PROGRAM IN OCTOBER 2007 AFTER THE FIRST CLASS GRADUATED, AND FULL APPROVAL WAS GRANTED TO THE PROGRAM IN DECEMBER 2007.
    PART III, LINE 4: ACCOUNTS RECEIVABLE, PATIENTS ARE REPORTED AT NET REALIZABLE VALUE. ACCOUNTS ARE WRITTEN OFF WHEN THEY ARE DETERMINED TO BE UNCOLLECTIBLE BASED UPON MANAGEMENT'S ASSESSMENT OF INDIVIDUAL ACCOUNTS. THE ALLOWANCE FOR DOUBTFUL COLLECTIONS IS ESTIMATED BASED UPON A PERIODIC REVIEW OF THE ACCOUNTS RECEIVABLE AGING, PAYOR CLASSIFICATIONS, AND APPLICATION OF HISTORICAL WRITE-OFF PERCENTAGES.THE COST-TO CHARGE RATIO WAS CALCULATED USING TOTAL COSTS AND TOTAL PATIENT CHARGES. THE MEDICARE STEPDOWN METHODOLOGY WAS USED BUT INCLUDED ALL EXPENSES, NET OF RELATED OTHER INCOME. THE TOTAL EXPENSES TIED TO THE AUDITED FINANCIAL STATEMENTS.
    PART III, LINE 8: THE HOSPITAL CONTINUES TO PROVIDE CARE TO ALL PRESENTING AND ADMITTED PATIENTS, REGARDLESS OF ABILITY OR PAY. NOTWITHSTANDING THE COSTS TO PROVIDE CARE, RECEIVING "LESS" THAN WHAT IT COSTS TO PROVIDE ADEQUATE CARE TO MEDICARE COVERED LIVES DOES THE HOSPITAL A DISSERVICE. THIS SHORTFALL SHOULD COUNT AS A COMMUNITY BENEFIT. OUR SERVICE AREA INCLUDES MANY MEDICARE RECIPIENTS THAT ARE ALSO DUALLY ELIGIBLE FOR MEDICAL ASSISTANCE, WHICH DENOTES SOME TYPE OF FINANCIAL NEED.MEDICARE COST-TO-CHARGE RATIOS FROM THE MEDICARE COST REPORT ARE USED TO DETERMINE THE COST OF THE PROGRAMS.
    PART III, LINE 9B: PER OUR CURRENT POLICIES, THE ONLY WAY WE ARE GUARANTEED TO KNOW IF SOMEONE IS INDIGENT IS IF THEY COMPLETE A CHARITY CARE APPLICATION. THERE IS A PROVISION IN THE COMMUNITY CARE POLICY (OUR CHARITY CARE POLICY) - THAT ONCE COMPLETED, A CHARITY CARE THE APPLICATION IS VALID FOR 6 MONTHS. THEREFORE IF ANOTHER DEBT IS INCURRED DURING THAT WINDOW, WE KNOW THEY MEET THE REQUIREMENTS AND WE EXTEND THE TERMS OF FINANCIAL ASSISTANCE/CHARITY CARE TO THAT PATIENT.
    CONTINUATION OF DESCRIPTION OF COMMUNITY BUILDING ACTIVITIES (PART II):THE SCHOOL OF NURSING HAS A FULL-TIME PROGRAM, WHICH TAKES TWO YEARS TO COMPLETE AND IS A TOTAL OF 102 CREDIT UNITS. STUDENTS MAY ALSO OPT FOR PART-TIME, AND THEY CAN CHOOSE A THREE- OR FOUR-YEAR OPTION. IN ADDITION, THE PROGRAM OFFERS AN LPN TO RN PROGRAM, AND IT COULD TAKE AS LITTLE AS FOUR SEMESTERS (14 MONTHS) TO COMPLETE. THE MISSION OF THE LEWISTOWN HOSPITAL SCHOOL OF NURSING IS TO PROVIDE QUALITY NURSING EDUCATION TO A DIVERSE GROUP OF STUDENTS IN A MANNER THAT ENABLES THE GRADUATES TO BECOME LEADERS IN PROVIDING COMPETENT AND SAFE CARE IN A VARIETY OF SETTINGS IN ORDER TO MEET THE CONTINUALLY CHANGING HEALTHCARE NEEDS OF THE HOSPITAL'S AND SCHOOL'S COMMUNITY.BESIDES EASING THE NURSING SHORTAGE, THE SCHOOL ALSO BOLSTERS LOCAL EMPLOYMENT AND WORKFORCE TRAINING. OUR AREA HAS SUFFERED BADLY IN THE RECENT RECESSION. A FIRST-CLASS NURSING SCHOOL PROVIDES RETRAINING FOR MANY. STUDENTS CAN MOVE INTO A CAREER THAT OFFERS REAL JOB OPPORTUNITIES. NURSES ALSO FIND THAT THEIR WORK IS WELL PAID, STABLE, AND PERSONALLY REWARDING. THE SCHOOL'S COMMUNITY FOCUS IS SHOWN IN NURSES' CAREER CHOICES. SEVENTY-FIVE PERCENT CHOOSE TO WORK IN THE LEWISTOWN AREA. IT IS NOT JUST LEWISTOWN HOSPITAL FILLING GAPS IN NURSING STAFF. LOCAL NURSING HOMES HAVE HIRED GRADUATES AS WELL. YEAR BY YEAR THE NURSE AVAILABILITY IN THE AREA HAS CONTINUED TO IMPROVE. SURVEYS THAT GO OUT TO EMPLOYERS A YEAR INTO THE NURSES' WORK HAVE SHOWN VERY POSITIVE RESPONSES. THE WHOLE COMMUNITY HAS BENEFITTED FROM THE LEWISTOWN HOSPITAL SCHOOL OF NURSING. FREE HEALTH EDUCATION WORKSHOPS, SUPPORT GROUPS, AND SEMINARSTHROUGH THE HOSPITAL'S SPEAKER BUREAU PROGRAM, A WIDE VARIETY OF PROGRAMS ARE OFFERED TO THE COMMUNITY FREE OF CHARGE AND THEY TARGET SPECIFIC MEDICAL CONDITIONS OR TOPICS SUCH AS CANCER AND DIABETES. FOR CANCER, THERE IS THE CANCER CARE SUPPORT GROUP AND THE PA CANCER EDUCATION NETWORK SESSIONS. FOR DIABETES, THERE IS A DIABETES SUPPORT GROUP AND THERE ARE ALSO EDUCATIONAL CLASSES (WITH ENROLLMENT FEES) OFFERED THROUGHOUT THE YEAR. FREE HEALTH SCREENINGSVARIOUS DEPARTMENTS OFFER HEALTH SCREENINGS AT LOCAL COMMUNITY EVENTS OR DURING A SPONSORED BUSINESS HEALTH FAIR. SCREENINGS INCLUDE: BONE DENSITY, BLOOD PRESSURE, CHOLESTEROL, BLOOD SUGAR, LUNG FUNCTION, DEPRESSION, AND SKIN CANCER. FREE CHILD SAFETY SEAT INSPECTIONSTHE FAMILY PLACE (MATERNITY CENTER) OFFERS QUARTERLY CHILD SAFETY SEAT INSPECTIONS AT THE HOSPITAL. FOR FAMILIES THAT DO NOT HAVE A SAFE CAR RESTRAINT FOR THEIR CHILDREN 0-8 YEARS OF AGE, THE HOSPITAL PROVIDES A NEW AND APPROPRIATE CHILD SAFETY SEAT. FLU SHOTSLEWISTOWN HOSPITAL, IN PARTNERSHIP WITH OTHER COMMUNITY ORGANIZATIONS, PROVIDES FLU SHOTS AT NO CHARGE TO PEOPLE AT HIGH RISK FOR CONTRACTING THE FLU.DENTAL HEALTH PRESENTATIONSLEWISTOWN HOSPITAL, IN PARTNERSHIP WITH UNITED WAY OF MIFFLIN-JUNIATA, ASSISTED WITH DENTAL PRESENTATIONS TO OVER 80 GROUPS OF CHILDREN WHICH INCLUDED: PRE-SCHOOLS, DAY CARE CENTERS, HEAD START PROGRAMS, AND KINDERGARTEN CLASSES. LEWIE B. HEALTHY PROGRAMLEWISTOWN HOSPITAL DEVELOPED A MASCOT ALONG HEALTH EDUCATIONAL MODULES GEARED FOR CHILDREN BETWEEN THE AGES OF 4 AND 8 YEARS OF AGE. THE PURPOSE OF THE PROGRAM IS TO PROMOTE HEALTHY LIFESTYLE CHOICES FOR YOUNG CHILDREN.QUICK ER CARE PROGRAMQUICK ER CARE, A NEW SERVICE INTRODUCED IN DECEMBER 2008, PROVIDES SEPARATE RESOURCES FOR NON-EMERGENCY CASES IN THE ER. THESE RESOURCES INCLUDE THREE ADDITIONAL PATIENT EXAMINATION ROOMS AND STAFF DEDICATED TO HANDLING THESE CASES. THESE ADDITIONAL RESOURCES PROVIDE ANOTHER PATH FOR PATIENTS TO BE TREATED.PEOPLE WHO NORMALLY HAVE TO WAIT FOR LONG PERIODS OF TIME IN THE ER, ARE USUALLY NOT THE SEVERE CASES. QUICK ER CARE REDUCES THE WAIT TIME FOR PATIENTS WHO COME TO THE ER BECAUSE THEY CAN'T GET AN APPOINTMENT OR DON'T HAVE AN ESTABLISHED PHYSICIAN RELATIONSHIP. QUICK ER CARE IS AVAILABLE AT LEWISTOWN HOSPITAL 7 DAYS A WEEK FROM 10:00AM - 8:00PM. QUICK ER CARE HAS A FULL-TIME PHYSICIAN ASSISTANT AND REGISTERED NURSE WHO PROVIDE MEDICAL SCREENING AND TREATMENT FOR PATIENTS WHO HAVE LESS URGENT CONDITIONS SUCH AS POTENTIAL FRACTURES, SPRAINS, MILD RASHES AND LOW GRADE FEVERS. BEFORE BEING ADMITTED TO QUICK ER CARE, ALL PATIENTS WILL BE TRIAGED AND ASSESSED BY A REGISTERED NURSE TO ENSURE THAT THEY ARE CANDIDATES FOR QUICK CARE. TELESTROKE PROGRAMLEWISTOWN HOSPITAL, COLLABORATING WITH GEISINGER HEALTH SYSTEM, HAS EXPANDED ITS STROKE SERVICES TO PROVIDE ADVANCED CARE FOR PATIENTS IN THE LEWISTOWN AREA. THROUGH A NEW TELEMEDICINE PROGRAM, THE EXPERTISE OF GEISINGER'S STROKE SPECIALISTS IS NOW AVAILABLE TO LEWISTOWN HOSPITAL EMERGENCY DEPARTMENT PHYSICIANS 24 HOURS A DAY, SEVEN DAYS A WEEK. A SECURE VIDEO MONITORING SYSTEM (POLYCOM MACHINE) PROVIDES A REAL-TIME LINK BETWEEN GEISINGER'S STROKE-TRAINED NEUROLOGISTS AND LEWISTOWN'S EMERGENCY DEPARTMENT. STROKE PATIENTS NOW RECEIVE ADVANCED TREATMENT FROM GEISINGER SPECIALISTS IN COLLABORATION WITH LEWISTOWN EMERGENCY PHYSICIANS. STROKE IS THE THIRD LEADING CAUSE OF DEATH IN THE UNITED STATES. AS THE POPULATION CONTINUES TO AGE, STROKES ARE LIKELY TO INCREASE. THE AMERICAN HEART ASSOCIATION AND THE AMERICAN COLLEGE OF EMERGENCY PHYSICIANS SAY THAT AGGRESSIVELY TREATING STROKE IN ITS EARLY STAGES SIGNIFICANTLY IMPROVES A PERSON'S CHANCE FOR A FULL RECOVERY.GEISINGER SPECIALISTS EVALUATE THE PATIENT, REVIEW BRAIN SCANS AND WORK WITH LEWISTOWN EMERGENCY DEPARTMENT PHYSICIANS AND STAFF TO PROVIDE THE BEST ACUTE STROKE CARE. TELECONFERENCING EQUIPMENT IS BROUGHT TO THE PATIENT'S BEDSIDE, ALLOWING GEISINGER STAFF TO ASSESS THE PATIENT, AND SPEAK DIRECTLY TO THE LEWISTOWN PHYSICIAN, PATIENT AND PATIENT'S FAMILY. SPONSORSHIPS FOR ORGANIZATIONS/COMMUNITY ACTIVITIES THAT PROMOTE HEALTH - THE HOSPITAL HAS A FOR-PROFIT SISTER ORGANIZATION, HEALTH ENTERPRISES, INC. THAT PROVIDED OVER $14,000 IN SPONSORSHIPS IN FY 2011 TO SUPPORT TO FOLLOWING HEALTH RELATED COMMUNITY ORGANIZATIONS AND ACTIVITIES.
    PART VI, LINE 2: QUARTERLY ADVISORY GROUPS:THE PATIENT SATISFACTION ADVISORY GROUP PURPOSE IS TO PROVIDE FEEDBACK REGARDING THE HOSPITAL'S PATIENT SATISFACTION EFFORTS. THE COMMITTEE IS COMPOSED OF FORMER AND CURRENT PATIENTS, AS WELL AS COMMUNITY MEMBERS. MEMBERS GIVE INSIGHT INTO WHAT THE COMMUNITY IS SAYING ABOUT THE HOSPITAL AND SUGGESTIONS FOR CHANGES TO MAKE THE HOSPITAL EXPERIENCE MORE PATIENT-FOCUSED.THE MARKETING ADVISORY COMMITTEE'S PURPOSE IS TO PROVIDE GUIDANCE FOR THE HOSPITAL'S MARKETING AND OUTREACH EFFORTS. FOCUS GROUP INTERVIEWS:THE HOSPITAL ENGAGED THE MELIOR GROUP TO CONDUCT INTERNAL AND EXTERNAL FOCUS GROUPS. THE OBJECTIVES OF THE RESEARCH WERE TO LEARN HOW LEWISTOWN HOSPITAL IS PERCEIVED; WHAT MAKES IT A HOSPITAL OF CHOICE OR NOT; WHAT ARE EXPERIENCES LIKE WITH THE HOSPITAL; AND WHAT SERVICES AND SPECIALTIES IT SHOULD FOCUS ON IN THE FUTURE. MEDICAL STAFF SURVEYS:THE PRIMARY OBJECTIVE OF THE MEDICAL STAFF ASSESSMENT PROCESS WAS TO CREATE A MEDICAL STAFF DEVELOPMENT PLAN FOR LEWISTOWN HOSPITAL THAT PROJECTS THE NEEDS FOR PHYSICIANS OVER THE NEXT SEVERAL YEARS, BY SPECIALTY, IN THE HOSPITAL'S PRIMARY AND SECONDARY SERVICE AREAS. IN ADDITION, THE SURVEY WAS USED TO CREATE A PHYSICIAN RECRUITMENT STRATEGY FOR THE HOSPITAL AND MEMBERS OF THE MEDICAL STAFF.UTILIZATION STATISTICS AND ANALYSIS:DECISION SUPPORT SOFTWARE WITHIN THE HOSPITAL'S FINANCE DEPARTMENT PROVIDES HISTORICAL AND CURRENT DATA ON THE UTILIZATION OF INPATIENT AND OUTPATIENT SERVICES. STATE HEALTH IMPROVEMENT PLAN PARTNERSHIP (SHIP) DATA:LEWISTOWN HOSPITAL IS A KEY MEMBER OF THE LOCAL SHIP (MIFFLIN -JUNIATA PARTNERS ADVANCING TOMORROW'S HEALTH). THE PURPOSE OF THIS GROUP IS TO SUPPORT THE HEALTH PLANNING INITIATIVES FROM THE PENNSYLVANIA DEPARTMENT OF HEALTH. THIS IS ACCOMPLISHED BY ENGAGING A BROAD SPECTRUM OF LOCAL COMMUNITY INDIVIDUALS AND ORGANIZATIONS WITH INTERESTS AND INFLUENCE ON LOCAL HEALTH STATUS BY WORKING TOGETHER TO PROMOTE EFFECTIVE HEALTH IMPROVEMENT STRATEGIES, INCLUDING PLANNING AND COORDINATION OF LOCAL RESOURCES. MEETINGS ARE HELD BI-MONTHLY. PA DEPARTMENT OF HEALTH STATISTICS:THE PA DEPARTMENT OF HEALTH WEBSITE PROVIDES A WEALTH OF HEALTH STATISTICS AND DATA FOR EACH COUNTY. THIS INCLUDES THE FOLLOWING:RATES FOR BIRTH, DEATH, CANCER, AND OTHER VITAL STATISTICSBEHAVIORAL RISK AND INJURY STATISTICSCOMMUNICABLE DISEASESHEALTH FACILITIESSCHOOL HEALTH PA DEPARTMENT OF HEALTH BEHAVIORAL RISK FACTOR SURVEY:THE BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (BRFSS) IS AN ANNUAL TELEPHONE SURVEY IMPLEMENTED NATIONWIDE UNDER A GRANT FROM THE CENTERS FOR DISEASE CONTROL AND PREVENTION. SINCE 1989, THE PENNSYLVANIA DEPARTMENT OF HEALTH HAS RELEASED ANNUAL REPORTS USING BRFSS DATA ON VARIOUS HEALTH RISK BEHAVIORS, SUCH AS SMOKING, DRINKING, SEAT BELT USAGE AND HEALTH STATUS.MIFFLIN-JUNIATA HUMAN SERVICES NEEDS ASSESSMENT - FROM MIFFLIN COUNTY COMMISSIONERS OFFICETHE MIFFLIN-JUNIATA COUNTY HUMAN NEEDS ASSESSMENT PROJECT BEGAN IN 2004 TO IDENTIFY CRITICAL AREAS WHERE THE ASSISTANCE OF THE HUMAN SERVICES DEPARTMENT WOULD BE MOST BENEFICIAL FOR INDIVIDUALS, FAMILIES AND THE COMMUNITY. THE HUMAN SERVICES DEPARTMENT COLLABORATED WITH PENN STATE UNIVERSITY TO CONDUCT A NEEDS ASSESSMENT IN BOTH JUNIATA AND MIFFLIN COUNTIES. THE ASSESSMENT WAS HELPFUL IN DETERMINING WHAT THE HIGHEST HUMAN SERVICE NEEDS WERE FOR THE TWO COUNTIES.IN LATE 2011, LEWISTOWN HOSPITAL BEGAN WORKING WITH MIFFLIN-JUNIATA HUMAN SERVICES DEPARTMENT, UNITED WAY OF MIFFLIN-JUNIATA AND PENN STATE EXTENSION SERVICE TO DEVELOP AND CONDUCT AN UPDATED COMMUNITY HUMAN SERVICES NEEDS ASSESSMENT. FOR LEWISTOWN HOSPITAL, THIS ASSESSMENT WILL BE ONE TOOL USED TO DETERMINE WHAT PRIORITY SHOULD BE GIVEN TO SPECIFIC HEALTH CARE NEEDS WITHIN OUR COMMUNITY AND TO IMPLEMENT A STRATEGY TO ADDRESS THOSE IDENTIFIED HEALTH CARE NEEDS. THE ASSESSMENT PROCESS WILL CONTINUE THROUGH 2012. HOW IS ALL OF THE ABOVE INFORMATION PULLED TOGETHER AND UTILIZED?VARIOUS HOSPITAL STAFF MEMBERS ASSIST WITH THE DATA COLLECTION. PRIMARY AND SECONDARY DATA IS ORGANIZED INTO COMPUTER FILES TO MAKE THE INFORMATION EASIER TO USE AND ANALYZE. ONCE THE HOSPITAL HAS THE PRIMARY AND SECONDARY DATA COLLECTED AND IN HAND, THE SENIOR TEAM SPENDS TIME ANALYZING THE DATA TO DISCERN PATTERNS AND THEMES. ASSESSMENT DATA FINDINGS ARE SHARED WITH A VARIETY OF GROUPS INTERNALLY AND EXTERNALLY (MANAGEMENT STAFF, MEDICAL-DENTAL STAFF, BOARD OF TRUSTEES, COMMUNITY ORGANIZATIONS).SINCE SUFFICIENT RESOURCES ARE NOT AVAILABLE TO ADDRESS ALL THE HEALTH CONCERNS IDENTIFIED IN THE ASSESSMENTS, CHOICES MUST BE MADE ABOUT WHICH ISSUES ARE DESIGNATED AS PRIORITIES FOR ACTION IN THE SHORT TO INTERMEDIATE TERM (ONE TO THREE YEARS). IN GENERAL, THE HOSPITAL AIMS FOR TWO TO THREE PRIORITIES.THE HOSPITAL COLLABORATES WITH OTHER COMMUNITY STAKEHOLDERS TO GAIN A GREATER COMMITMENT TO ACTION. A CONSENSUS IS REACHED WITH INPUT FROM HOSPITAL STAFF, MEDICAL STAFF, THE BOARD OF TRUSTEES, AND COMMUNITY MEMBERS. CRITERIA THAT ARE USED TO IDENTIFY THE MOST SIGNIFICANT HEALTH ISSUES INCLUDE:THE MAGNITUDE OF THE PROBLEMTHE SEVERITY OF THE PROBLEMA HIGH NEED AMONG VULNERABLE POPULATIONSCRITERIA THAT ARE USED TO EVALUATE WHICH HEALTH ISSUES THE HOSPITAL SHOULD PRIORITIZE INCLUDE:THE HOSPITAL'S CAPACITY TO ACT ON THE ISSUE, INCLUDING ECONOMIC, SOCIAL, AND CULTURAL CONSIDERATIONS.THE FEASIBILITY OF HAVING A MEASURABLE IMPACT ON THE ISSUECOMMUNITY RESOURCES ALREADY FOCUSED ON THE ISSUEWHETHER THE ISSUE IS A ROOT CAUSE OF OTHER PROBLEMS (THEREBY POSSIBLY AFFECTING MULTIPLE ISSUES)WHEN THE ISSUES HAVE BEEN PRIORITIZED, THE SENIOR TEAM AND BOARD OF TRUSTEES DISCUSS THE PRIORITIZED LIST AND ASK FOR ADDITIONAL INPUT AND VALIDATION. WHEN A FINAL DECISION IS MADE, A PLAN IS PUT INTO PLACE TO ADDRESS THE PRIORITIES AND IMPROVE COMMUNITY HEALTH. SPECIFIC GOALS HELP FOCUS THE SPECIFIC INTERVENTIONS AND PROVIDE A METHOD FOR VALUING EACH OPTION.
    PART VI, LINE 3: LEWISTOWN HOSPITAL PRODUCES DAILY REPORTS FOR HIGH TICKET SERVICES THAT IDENTIFY PATIENTS THAT ARE POTENTIALLY UNINSURED. WE CONTRACT WITH A THIRD PARTY THAT EMPLOYS A REPRESENTATIVE ON SITE AT THE HOSPITAL THAT WILL TAKE THE REPORT OF UNINSURED PATIENTS. THE REPRESENTATIVE WILL ATTEMPT TO PERSONALLY VISIT EACH PATIENT WHILE THEY ARE STILL AT THE HOSPITAL TO OUTLINE POSSIBLE OPTIONS. THE PRIMARY OPTION IS USUALLY MAKING APPLICATION FOR MEDICAL ASSISTANCE. THE REPRESENTATIVE IS HIGHLY EXPERIENCED IN THE MEDICAL ASSISTANCE APPLICATION PROCESS AND WILL ASSIST THE PATIENT IN COMPLETING THE APPLICATION PROCESS. THIS INCLUDES COMPLETING THE PAPERWORK, COPYING DOCUMENTS AND EVEN WILL REPRESENT THE PATIENT AT THE FACE TO FACE INTERVIEW AT THE COUNTY OFFICE IF NECESSARY. POST DISCHARGE ALL PATIENTS INDICATING THAT THEY ARE UNINSURED WILL RECEIVE A LETTER OFFERING A PROMPT PAY DISCOUNT. THERE ARE CONTACT PHONE NUMBERS ON THE LETTER SHOULD THE PATIENT HAVE ANY QUESTIONS CONCERNING OUR DISCOUNT PROGRAM. TELEPHONE CALLS ARE MADE TO PATIENTS IN AN ATTEMPT TO EXPLAIN OUR DISCOUNT POLICY, THE FACT THAT WE ACCEPT INTEREST FREE TIME PAYMENTS, WE ENCOURAGE PATIENTS TO MAKE APPLICATION FOR MEDICAL ASSISTANCE AND BLUECHIP AND IF WE DETERMINE THAT THERE TRULY IS AN INDIGENT SITUATION WHERE THERE ARE NO OTHER ALTERNATIVES WE DO OFFER A CHARITY PROGRAM WHEREBY PATIENTS MAY QUALIFY FOR FREE CARE.IN OUR PATIENT INFORMATION GUIDE, THERE IS WORDING THAT TELLS PATIENTS ABOUT FINANCIAL ASSISTANCE, OUR WEBSITE OFFERS INFORMATION REGARDING FINANCIAL ASSISTANCE, AND WE ALSO MAKE CHARITY CARE APPLICATIONS AVAILABLE AT REGISTRATION POINTS. WE ALSO HAVE TRANSLATORS AVAILABLE IF THE NEED ARISES.
    PART VI, LINE 4: OUR SERVICE AREA IS COMPRISED OF MIFFLIN COUNTY, JUNIATA COUNTY, AND PARTS OF HUNTINGDON AND SNYDER COUNTIES. THIS RURAL AREA CONTAINS SOME 145,000 PEOPLE SPREAD OVER MORE THAN 2,500 SQUARE MILES OF RUGGED TERRAIN LOCATED IN THE HEART OF THE APPALACHIAN MOUNTAINS IN CENTRAL PENNSYLVANIA. THE AVERAGE POPULATION DENSITY IS APPROXIMATELY 60 PERSONS PER SQUARE MILE. THE JUNIATA RIVER RUNS ALONG THE VERDANT VALLEYS AND SLICES THROUGH NARROW MOUNTAIN PASSES TO CONNECT OUR RESIDENTS TOGETHER, WHICH IS WHY OUR AREA IS CALLED THE JUNIATA VALLEY.TRANSPORTATION BARRIERS PLAY A MAJOR ROLE IN ACCESS TO HEALTH CARE IN OUR REGION. THESE NATURAL BARRIERS INCLUDE NARROW ROADS THAT EITHER MEANDER ALONG STREAMS AND CREEKS OR CROSSOVER THE MOUNTAIN RANGES THAT TRAVERSE OUR APPALACHIAN RIDGE REGION. THESE BARRIERS ARE EVEN MORE DAUNTING GIVEN HAZARDOUS WINTER DRIVING CONDITIONS CAUSED BY SNOW OR ICE COVERED ROADS. LOW-INCOME AND SENIOR CITIZENS ALSO FACE TRANSPORTATION ISSUES, AS THERE IS NO PUBLIC TRANSPORTATION IN OUR SERVICE AREA. SENIOR CITIZENS AND MEDICAID-ELIGIBLE PERSONS CAN USE THE CARS VAN SYSTEM FOR TRANSPORTATION TO REGULARLY SCHEDULED APPOINTMENTS WITH A WEEKS' NOTICE BUT NOT FOR URGENT OR EMERGENCY CARE. LOW INCOME CITIZENS HAVE NO ACCESS TO ANY PUBLIC TRANSPORTATION AT ALL IN OUR COMMUNITY. IF A TRIP TO A SPECIALIST IS REQUIRED THE MAJOR SUPPORT HOSPITALS ARE OVER ONE AND HALF HOURS DRIVE AWAY (IN THE SUMMER).THE POPULATION OF OUR TOTAL SERVICE AREA IS JUST ABOUT 145,000 PERSONS BASED ON 2000 US CENSUS DATA. MIFFLIN COUNTY HAS A RELATIVELY FLAT GROWTH RATE AND HAS NOT GROWN SIGNIFICANTLY IN POPULATION SINCE THE 1950 CENSUS WHEN OVERALL POPULATION WAS ABOUT 46,000 PEOPLE. JUNIATA COUNTY, ON THE OTHER HAND, HAS SEEN SIGNIFICANT GROWTH WITH A 10.6% INCREASE IN POPULATION FROM 1990 TO 2000. IT IS BELIEVED THAT THIS GROWTH IS MOSTLY COMING FROM PEOPLE WHO WORK IN THE NEARBY HARRISBURG AREA WHO ARE LOOKING FOR A LOWER COST OF LIVING. WITH THE RECENT COMPLETION OF A NEW FOUR-LANE HIGHWAY NORTH OF HARRISBURG, THE COMMUTE TO HARRISBURG HAS BECOME MORE CONVENIENT RESULTING IN AN INCREASE IN JUNIATA COUNTY'S POPULATION AS PEOPLE MOVE FURTHER AWAY FROM THE URBAN AREAS TO LIVE IN THE COUNTRY. HIGHER GROWTH IN FULTON COUNTY IS EXPLAINED BY MIGRATION FROM MARYLAND AS PEOPLE TRY TO MOVE AWAY FROM HIGHER HOUSING COSTS IN MARYLAND. HUNTINGDON COUNTY'S GROWTH IS MOSTLY OCCURRING IN THE NORTHERN PORTION OF THE COUNTY THAT IS CLOSE ENOUGH TO STATE COLLEGE TO ALLOW RESIDENTS TO COMMUTE TO PENN STATE UNIVERSITY. THESE GROWTH RATES ARE STILL VERY LOW WHEN COMPARED TO A NATIONAL GROWTH RATE OF OVER 13 %.OTHER IMPORTANT DEMOGRAPHIC STATISTICS ARE OUTLINED IN THE CHART BELOW.STATISTICS: MIFFLIN COUNTY(MC), JUNIATA COUNTY(JC), PENNSYLVANIA(PA)POPULATION: 46,682(MC), 24,636(JC), 12,702,379(PA)POPULATION LESS THAN 18 YEARS OF AGE: 23.1%(MC), 24%(JC), 22%(PA)AGE 65 AND UP: 8.5%(MC), 16.8%(JC), 15.4%(PA)PERCENTAGE OF POPULATION BELOW THE POVERTY LEVEL (2009): 15.1%(JC), 10.4%(MC), 12.5% (PA)POVERTY RATE FOR CHILDREN UNDER AGE 18 (2009): 24.9%(JC), 17.1%(MC), 17.1%(PA)MEDIAN HOUSEHOLD INCOME: $38,310(JC), $43,604(MC), $49,501(PA)UNINSURED ADULTS (2009): 13.9%(JC), 16.6%(MC), 12.8%(PA)MIFFLIN COUNTY'S 65 AND OVER AGE GROUP IS 18.5 PERCENT (2009), WHILE JUNIATA COUNTY'S IS 16.8%, HUNTINGDON COUNTY'S, 16% AND FULTON COUNTY'S 16.7%. THE PENNSYLVANIA AVERAGE FOR THIS STATISTIC IS ON 15.4%. BOTH MIFFLIN AND JUNIATA COUNTIES HAVE HIGHER PERCENTAGES OF PERSONS LESS THAN 18 YEARS OF AGE, 23.1% AND 24% RESPECTIVELY, THAN THE PA AVERAGE OF 22%. BOTH OF THESE GROUPS REQUIRE MORE HEALTH CARE RESOURCES THAN OTHER AGE GROUPS IN OUR COMMUNITY. MIFFLIN COUNTY HAS 15.1% OF THE POPULATION WITH INCOME BELOW THE POVERTY LINE AND 24.9% OF CHILDREN UNDER 18 LIVING IN POVERTY. JUNIATA COUNTY HAS 10.4% OF THE POPULATION WITH INCOME BELOW THE POVERTY LINE, WHILE HUNTINGDON AND SNYDER COUNTIES ARE 13% AND 14% RESPECTIVELY. PER CAPITA PERSONAL INCOME (2009) FOR THE FOUR MAIN COUNTIES IN OUR SERVICE AREA ARE AS FOLLOWS: MIFFLIN $28.3K, JUNIATA $30.3K, HUNTINGDON $27.6K, AND SNYDER $30.8K. THE PERCENTAGES OF THE POPULATIONS WHO ARE UNINSURED (IN THE 18-64 AGE RANGE) FOR THOSE COUNTIES ARE AS FOLLOWS: MIFFLIN 19%, JUNIATA 19%, HUNTINGDON 19%, AND SNYDER 16%. DURING THE FISCAL YEAR 2011, APPROXIMATELY 14% OF OUR PATIENT POPULATION WAS MEDICAL ASSISTANCE, WHILE ANOTHER 3.5% WERE SELF PAY.THERE IS ONE OTHER HOSPITAL LOCATED WITHIN THE SERVICE AREA DESCRIBED ABOVE, JC BLAIR MEMORIAL HOSPITAL IN HUNTINGDON, PA. THERE ARE ALSO SEVERAL OTHER HOSPITALS LOCATED IN AREAS SURROUNDING OUR SERVICE AREA. THESE INCLUDE MT. NITTANY MEDICAL CENTER IN STATE COLLEGE, PA; GEISINGER MEDICAL CENTER IN DANVILLE, PA; HOLY SPIRIT HOSPITAL IN CAMP HILL, PA; THE PENN STATE MILTON S. HERSHEY MEDICAL CENTER IN HERSHEY, PA; AND SEVERAL CAMPUSES OF PINNACLE HEALTH IN THE HARRISBURG, PA AREA.THERE ARE ALSO SEVERAL FEDERALLY-DESIGNATED MEDICALLY UNDERSERVED AREAS WITHIN OUR SERVICE AREA. THERE ARE TWO LOCATED IN MIFFLIN COUNTY, ONE IN JUNIATA COUNTY, AND FOUR IN HUNTINGDON COUNTY.THE ADULT BEHAVIORAL HEALTH RISK FACTORS SURVEY (2006-2008) SHOWS THE FOLLOWING STATISTICS FOR THE POPULATION LIVING IN MIFFLIN AND JUNIATA COUNTIES:RISK FACTORS : PERCENTFAIR OR POOR GENERAL HEALTH: 20%OBESE: 29%OVERWEIGHT (INCLUDES OBESE): 66%EVER TOLD THEY HAD DIABETES: 12%CURRENTLY HAS ASTHMA: 10%CURRENT SMOKER: 26%FOR MIFFLIN AND JUNIATA COUNTIES, THE HEALTH PROFILE 2011 FROM THE PA DEPARTMENT OF HEALTH SHOW THE MAJOR CAUSES OF DEATH ARE DISEASES OF THE HEART, CANCER, STROKE, AND CHRONIC LOWER RESPIRATORY DISEASES. PROSTATE CANCER RANKS AS NUMBER ONE FOR THE HIGHEST INCIDENCE OF CANCER, FOLLOWED BY FEMALE BREAST CANCER. RANKING THIRD AND FOURTH ON THE LIST ARE LUNG CANCER AND COLON CANCER.
    PART VI, LINE 6: ALL OF THE ORGANIZATION'S BOARD MEMBERS RESIDE WITHIN THE ORGANIZATION'S PRIMARY SERVICE AREA. KAY HAMILTON, THE PRESIDENT, IS THE ONLY EMPLOYEE ON THE BOARD AND NONE OF THE BOARD MEMBERS ARE FAMILY MEMBERS OF EMPLOYEES WITHIN THE ORGANIZATION. DR. CHARLES EVERHART, JR, MD, BOARD MEMBER OWNS ENDOSCOPY CENTER OF PA, WHICH PROVIDES ENDOSCOPY SERVICES TO LEWISTOWN HOSPITAL; FRANCIS EVANITSKY , TREASURER OF THE BOARD IS FORMER PRESIDENT OF JUNIATA VALLEY BANK WHICH DOES PROVIDE BANKING SERVICES FOR LH. THE ORGANIZATION EXTENDS STAFF PRIVILEGES TO ALL QUALIFIED PHYSISIANS IN THE AREA.ANNUALLY DURING THE BUDGET PROCESS, A CASH FORECAST IS PREPARED TO DETERMINE THE AMOUNT OF CASH AVAILABLE FOR CAPITAL PURCHASES. CAPITAL REQUESTS ARE MADE BY MANAGEMENT OF THE ORGANIZATION DURING THE BUDGET PROCESS AS WELL. REQUESTS ARE REVIEWED AND APPROVED BY THE MEDICAL EXECUTIVE COMMITTEE ONCE ALL OF THE REQUESTS ARE COMPLETE. THE AMOUNT DETERMINED TO BE AVAILABLE AND APPROVED IS SET ASIDE INTO A FUNDED DEPRECIATION ACCOUNT IN WEEKLY INSTALLMENTS OVER THE COURSE OF THE FISCAL YEAR. LEWISTOWN HOSPITAL IS WHOLLY DEDICATED TO THE LIVES, HEALTH AND WELL-BEING OF THE INDIVIDUALS IN OUR COMMUNITY. ENSURING THAT ADEQUATE CAPITAL EQUIPMENT IS AVAILABLE TO PROVIDE THE BEST TREATMENT POSSIBLE FOR OUR PATIENTS IS AN EXAMPLE OF THAT DEDICATION.
    PART VI, LINE 7: WHILE NOT PART OF A HEALTH SYSTEM PER SE, LEWISTOWN HOSPITAL IS A PART OF THE LEWISTOWN HEALTHCARE FOUNDATION NETWORK OF RELATED ORGANIZATIONS. THE ROLE OF THE HOSPITAL AND ITS AFFILIATED ORGANIZATIONS ARE AS FOLLOWS:LEWISTOWN HOSPITAL:LEWISTOWN HOSPITAL IS A 123-BED ACUTE CARE COMMUNITY HOSPITAL SERVING THE RESIDENTS OF MIFFLIN AND JUNIATA COUNTIES AND MEMBERS OF THE SURROUNDING COUNTIES OF SNYDER, AND HUNTINGDON. ESTABLISHED IN 1905, THE HOSPITAL PROVIDES INPATIENT, OUTPATIENT, WELLNESS AND COMMUNITY SERVICES WHILE EMPLOYING OVER 1,000 FULL-TIME AND PART-TIME EMPLOYEES AND PROVIDING A MEDICAL STAFF CONSISTING OF 128 PHYSICIANS AND ALLIED HEALTH PRACTITIONERS REPRESENTING SPECIALTIES RANGING FROM FAMILY MEDICINE, INTERNAL MEDICINE, AND CARDIOLOGY TO INFECTIOUS DISEASE AND GENERAL/CARDIOVASCULAR SURGERY.THE MISSION OF LEWISTOWN HOSPITAL IS TO PROVIDE PERSONAL, HIGH-QUALITY ECONOMICAL HEALTHCARE FOR OUR COMMUNITIES.FAMILY HEALTH ASSOCIATES OF LEWISTOWN HOSPITAL (FHA):FHA, A PENNSYLVANIA NON-PROFIT CORPORATION, IS A MULTI-SPECIALTY PHYSICIAN/PRACTITIONER GROUP LOCATED IN CENTRAL PENNSYLVANIA. OUR PHYSICIANS ARE BOARD-CERTIFIED OR BOARD ELIGIBLE IN PRIMARY CARE AS WELL AS MANY SPECIALTY AREAS INCLUDING GENERAL SURGERY, PULMONARY MEDICINE, SLEEP MEDICINE, AND WEIGHT LOSS AND NUTRITION. WE ARE DEDICATED TO OUR MISSION OF PROVIDING PERSONAL, HIGH QUALITY, ECONOMICAL HEALTH CARE THAT MEETS THE NEEDS OF OUR COMMUNITIES.LEWISTOWN AMBULATORY CARE CORPORATION (LACC):LACC IS A PENNSYLVANIA NON-PROFIT ORGANIZATION THAT IS MAINLY A REAL ESTATE HOLDING COMPANY THAT OWNS AND/OR MANAGES THE NON-HOSPITAL REAL ESTATE ASSETS INCLUDING A MEDICAL OFFICE BUILDING THAT IS ATTACHED TO THE HOSPITAL. LACC ALSO MANAGES THE MEDIC 29 ADVANCED LIFE SUPPORT SERVICES (ALS). THE MEDIC 29 ALS SQUADS PROVIDE ALS SERVICE TO THE PEOPLE IN MIFFLIN AND JUNIATA COUNTIES, AS WELL AS TO PEOPLE IN PARTS OF HUNTINGDON, SNYDER, AND OCCASIONALLY PERRY COUNTIES. EMERGENCY MEDICAL TECHNICIANS - PARAMEDICS, OR PARAMEDICS FOR SHORT, STAFF THESE ALS SQUADS TWENTY-FOUR HOURS A DAY, SEVEN DAYS A WEEK. ALS SQUADS AUGMENT THE STAFF OF THE EXISTING BASIC LIFE SUPPORT (BLS) AMBULANCE TEAMS THAT OPERATE IN OUR AREAS. DURING AN EMERGENCY CALL, THE ALS SQUAD IS DISPATCHED, ALONG WITH THE BLS AMBULANCE, AND MEETS THE BLS AMBULANCE ON SCENE OR EN ROUTE TO THE HOSPITAL. THE PARAMEDIC TAKES HIS/HER EQUIPMENT AND JOINS THE BLS CREW IN THEIR AMBULANCE AND PROVIDES ALS CARE TO THE PATIENT WHILE EN ROUTE TO THE HOSPITAL. THIS ENSURES THAT YOU RECEIVE THE BEST POSSIBLE CARE AS SOON AS POSSIBLE. MEDIC 29 PRIMARILY TRANSPORTS PATIENTS TO LEWISTOWN HOSPITAL, BUT WILL ALSO TRANSPORT TO OTHER HOSPITALS BASED ON THE PATIENT'S NEEDS AND PREFERENCES. MEDIC 29 WAS ORIGINALLY PLACED IN SERVICE IN 1989 AS THE FIRST ALS PROVIDER IN THE AREA AND WAS RESPONSIBLE FOR PROVIDING ALS SERVICE TO MIFFLIN AND JUNIATA COUNTIES AND PARTS OF HUNTINGDON AND SNYDER COUNTIES. OVER THE YEARS, THE NEEDS OF THE COMMUNITY HAVE INCREASED AND MEDIC 29 HAS GROWN TO MEET THESE NEEDS BY PROVIDING FASTER ACCESS TO ALS CARE. IN 1992, MEDIC 29 INCREASED STAFF TO PROVIDE A SECOND ALS SQUAD BASED IN JUNIATA COUNTY. THE JUNIATA COUNTY PARAMEDIC SQUAD BROUGHT MUCH NEEDED ALS CARE FIFTEEN MINUTES CLOSER TO RESIDENTS IN JUNIATA COUNTY.HEALTH ENTERPRISES, INC. (HEI):HEI, A PENNSYLVANIA FOR-PROFIT ENTITY, THE ONLY ONE WITHIN THE LEWISTOWN HEALTHCARE FOUNDATION. THE MAIN PURPOSE OF HEI IS THE OPERATION OF OUR FOUR TOTAL LIFE CARE PHARMACIES (TLC PHARMACY). WE HAVE TAKEN THE ROAD LESS TRAVELED, LITERALLY, IN DETERMINING OUR SERVICE SITES. NOTICE THAT THEY ARE LOCATED IN THE MORE RURAL AREAS THROUGHOUT THE JUNIATA VALLEY TO PROVIDE CONVENIENCE AND CLOSE PROXIMITY TO OUR PHYSICIAN PRACTICES IN FAMILY HEALTH ASSOCIATES. LEWISTOWN HEALTHCARE FOUNDATION (LHF):LHF, IS A PENNSYLVANIA NON-PROFIT MEMBERSHIP CORPORATION. LEWISTOWN HOSPITAL IMPLEMENTED A CORPORATE REORGANIZATION PLAN IN 1985, ESTABLISHING LHF AS THE PARENT COMPANY OF WHICH LEWISTOWN HOSPITAL IS ONE OF ITS SUBSIDIARIES. LEWISTOWN HOSPITAL:85% OF COMMUNITY BENEFIT ACTIVITIES ARE CONTRIBUTED THROUGH LEWISTOWN HOSPITAL.FHA:FHA STAFF PARTICIPATES IN COMMUNITY HEALTH FAIRS AND SCREENINGS. SEVERAL PHYSICIANS ALSO PARTICIPATE IN MENTORSHIP PROGRAMS FOR INTERNS AND RESIDENTS. 8% OF COMMUNITY BENEFIT ACTIVITIES ARE CONTRIBUTED THROUGH FHA.LAC:THE DIRECTOR OF MEDIC 29 VOLUNTEERS MANY HOURS IN SERVICE TO SEVERAL DIFFERENT COMMUNITY ORGANIZATIONS INCLUDING:JUNIATA COUNTY AMBULANCE ASSOCIATION - 7 HOURS MIFFLIN COUNTY ALERT & ADVISORY COUNCIL - 6 HOURSLEPC - 3 HOURSEMS ASSOCIATION - 6 HOURSPA EMERGENCY HEALTH SERVICE COUNCIL - 5 HOURSIN ADDITION, THE DIRECTOR PARTICIPATES IN SEVERAL COMMUNITY HEALTH SCREENINGS. 2% OF COMMUNITY BENEFIT ACTIVITIES ARE CONTRIBUTED THROUGH MEDIC 29.HEI:MANY OF OUR SPONSORSHIPS AND CONTRIBUTIONS COME FROM HEI. IN 2011, AT TOTAL OF $17,335 WAS MADE TO THE FOLLOWING COMMUNITY ORGANIZATIONS:LEWISTOWN ROTARY4STEPUNITED WAY OF MIFFLIN-JUNIATAMIFFLIN JUNIATA PARTNERSHIPS RC & DMIFFLIN JUNIATA ARTS COUNCILJUNIATA COUNTY BUSINESS & PROFESSIONAL WOMENEXPERIENCE WORKS OF PAJUNIATA RIVER VALLEY VISITORS BUREAUPA ASSOCIATION OF HEALTHCARE AUXILIARIESMIFFLIN COUNTY YOUTH BASEBALL LEAGUEBIG BROTHERS BIG SISTERSAMERICAN RED CROSS OF SUSQUEHANNA VALLEYAMERICAN CANCER SOCIETYLEWISTOWN COUNTRY CLUBJUNIATA RIVER FESTJUNIATA VALLEY COUNCIL BOY SCOUTS ASSOCIATIONVNA - CENTRE HOME CARE5% OF COMMUNITY BENEFIT ACTIVITIES ARE CONTRIBUTED THROUGH HEI.
REPORTS FILED WITH STATES PART VI, LINE 7 PA
Schedule H (Form 990) 2010
Additional Data


Software ID:  
Software Version:  
Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990
OMB No. 1545-0047
2010
Open to Public
Inspection
Name of the organization
LEWISTOWN HOSPITAL
 
Employer identification number
23-1352187
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21 for any recipient that received more than $5,000. Check this box if no one recipient received more than $5,000. Use
Part IV and Schedule I-1 (Form 990) if additional space is needed ......................... lBullet
(a) Name and address of organization
or government		 (b) EIN (c) IRC Code section
if applicable		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
non-cash assistance		 (h) Purpose of grant
or assistance
(1) LEWISTOWN HEALTHCARE FOUNDATION400 HIGHLAND AVENUE
LEWISTOWN,PA17044 		23-2344363 501(C)(3) 3,472,963   CASH N/A NET ASSET TRANSFER TO FUND OPERATIONS OF RELATED ENTITY - FAMILY HEALTH ASSOCIATES OF LEWISTOWN HOSPITAL






















2
Enter total number of section 501(c)(3) and government organizations ......................... Bullet Image
1
3
Enter total number of other organizations ................................ . Bullet Image
 
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2010

Schedule I (Form 990) 2010
Page 2
Part III
Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Use Schedule I-1 (Form 990) if additional space is needed.
(a)Type of grant or assistance (b)Number of
recipients		 (c)Amount of
cash grant		 (d)Amount of
non-cash assistance		 (e)Method of valuation (book,
FMV, appraisal, other)		 (f)Description of non-cash assistance
(1) EDUCATIONAL SCHOLARSHIPS 21 24,000   CASH N/A













Part IV
Supplemental Information. Complete this part to provide the information required in Part I, line 2, and any other additional information.
Identifier Return Reference Explanation
PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: FUNDS WERE PROVIDED TO A RELATED ORGANIZATION UNDER COMMON MANAGEMENT TO SUPPORT OPERATIONS. THE PARTNERS IN EDUCATION SCHOLARSHIP IS A SCHOLARSHIP PROGRAM FOR EMPLOYEES OF LEWISTOWN HOSPITAL OR AN AFFILIATE WHO IS PURSUING A DIPLOMA, ASSOCIATES, BACHELORS, OR MASTERS DEGREE IN A HEALTH CARE RELATED FIELD. THE FUNDING FOR THIS IS MADE POSSIBLE THROUGH NET PROCEEDS FROM THE HOSPITAL GIFT SHOP. APPLICANTS MUST MEET CERTAIN CRITERIA AND MINIMUM TWO-PAGE ESSAY. THE APPLICATIONS AND ESSAYS ARE REVIEWED BY THE SCHOLARSHIP COMMITTEE WHICH IS COMPRISED OF 3 DIRECTOR LEVEL EMPLOYEES OF THE HOSPITAL. FINALISTS ARE AWARDED $1,000 EACH BY JUNE 1 OF EACH YEAR. THE SOPHIE SNOOK SCHOLARSHIP PROGRAM IS A SCHOLARSHIP PROGRAM IN MEMORY OF SOPHIE SNOOK, THE FIRST GRADUATE OF LEWISTOWN HOSPITAL SCHOOL OF NURSING. APPLICANTS MUST BE EITHER A FULL, PART-TIME, OR RELIEF EMPLOYEE FROM ANY OF THE HOSPITAL WHO IS PURSUING A SECONDARY DIPLOMA, CERTIFICATE OR DEGREE RELATING TO PATIENT CARE, OR A STUDENT WHO HAS BEEN ACCEPTED INTO THE LEWISTOWN HOSPITAL SCHOOL OF NURSING. APPLICANTS MUST MEET CERTAIN OTHER AND WRITE A MINIMUM TWO-PAGE ESSAGE. THE APPLICATIONS AND ESSAYS ARE REVIEWED BY THE SHOLARSHIP COMMITTEE WHICH IS COMPRISED OF MEMBERS OF THE FRIENDS OF LEWISTOWN HOSPITAL, FORMERLY THE LEWISTOWN HOSPITAL AUXILIARY. THE RECIPIENTS BY JULY 1 OF EACH YEAR. PROCEEDS TO FUND THE PROGRAM COME FROM THE FUNDRAISING ACTIVITIES OF THE FRIENDS OF LEWISTOWN HOSPITAL. SCHOLARSHIPS WILL BE OFFERED TO ENROLLED STUDENTS AT THE LEWISTOWN HOSPITAL SCHOOL OF NURSING TO OFFER FINANCIAL STUDENT SCHOLARSHIPS. TO BE ELIGIBLE, STUDENTS MUST HAVE A GPA OF 3.0 OR HIGHER, PROVE FINANCIAL NEED, SHOW ACADEMIC PROGRESSION, AND BE TAKING 6 CREDITS OR MORE. THEY MUST COMPLETE AN APPLICATION AND MEET ANY OTHER CRITERIA SPECIFIED BY THE GRANT DONORS. A SCHOLARSHIP COMMITTEE COMPRISED OF AT LEAST ONE MEMBER OF THE SCHOOL OF NURSING, ONE MEMBER OF THE FINACE DEPARTMENT, ONE MEMBER FROM THE LEWISTOWN HOSPITAL HR DEPARTMENT, AND ONE COMMUNITY MEMBER. THE COMMITTEE MEETS ON AT LEAST ANNUAL BASIS TO REVIEW APPLICATIONS. STUDENTS WHO ARE AWARDED MONIES WILL BE NOTIFIED VIA MAIL.
Schedule I (Form 990) 2010


Additional Data


Software ID:  
Software Version:  


Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet Attach to Form 990. SchJMediumBullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
LEWISTOWN HOSPITAL
 
Employer identification number

23-1352187
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement orprovision of all the expenses described above? If "No," complete Part III to explain....
1b
Yes
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
officers, directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? ....
2
Yes
 
3
Indicate which, if any, of the following the organization uses to establish the compensation of the
organization's CEO/Executive Director. Check all that apply.
4
During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ...............
4a
 
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? ........
4b
 
No
c
Participate in, or receive payment from, an equity-based compensation arrangement? ........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.
5
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
 
No
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regs. section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 50053T
Schedule J (Form 990) 2010

Schedule J (Form 990) 2010
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use Schedule J-1 if additional space needed.
For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.

Note. The sum of columns (B)(i)-(iii) must equal the applicable column (D) or column (E) amounts on Form 990, Part VII, line 1a.
(A) Name (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits		 (E) Total of columns
(B)(i)-(D) 		(F) Compensation
reported in prior
Form 990 or
Form 990-EZ
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1) KAY HAMILTON (i)
(ii)		 269,116
0 		25,000
0 		3,358
0 		34,545
0 		8,065
0 		340,084
0 		0
0
(2) RANDY TEWKSBURY (i)
(ii)		 166,020
0 		0
0 		516
0 		23,900
0 		13,853
0 		204,289
0 		0
0
(3) KIRK E THOMAS (i)
(ii)		 132,827
0 		0
0 		250
0 		19,036
0 		0
0 		152,113
0 		0
0
(4) NITIN V SHETH MD (i)
(ii)		 383,264
0 		224,400
0 		258
0 		0
0 		18,137
0 		626,059
0 		0
0
(5) DAVID M NELSON (i)
(ii)		 198,638
0 		5,000
0 		211
0 		29,118
0 		13,984
0 		246,951
0 		0
0
(6) RICHARD F STOMACKIN (i)
(ii)		 144,281
0 		0
0 		1,229
0 		20,546
0 		6,769
0 		172,825
0 		0
0
(7) ROBERT A MONTGOMERY (i)
(ii)		 120,337
0 		0
0 		80
0 		17,470
0 		16,841
0 		154,728
0 		0
0









Schedule J (Form 990) 2010

Schedule J (Form 990) 2010
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 4c, 5a, 5b, 6a, 6b, 7, and 8. Also complete this part for any additional information.
Identifier Return Reference Explanation
  PART I, LINE 1A AN AUTOMOBILE WAS LEASED FOR THE PRESIDENT AND CEO, KAY HAMILTON. THE VALUE OF THE LEASE PAYMENTS WERE RECORDED AS INCOME ON HER 2010 FORM W-2. THE AMOUNT WAS GROSSED UP FOR THE EMPLOYER SHARE OF FICA TAXES. THE TOTAL AMOUNT ADDED TO HER 2010 W-2 WAS $1,834.26. THIS ENDED MID-WAY THROUGH TAX YEAR 2010. LEWISTOWN HOSPITAL NO LONGER LEASES A CAR FOR KAY, BUT INSTEAD PROVIDES AN EXTRA ALLOWANCE IN HER SALARY.
Schedule J (Form 990) 2010

Additional Data


Software ID:  
Software Version:  
Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Schedule O (Form 990).
SchKMediumBullet Attach to Form 990. SchKMediumBullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public
Inspection
Name of the organization
LEWISTOWN HOSPITAL
 
Employer identification number
23-1352187
Part I
Bond Issues
(a) Issuer Name (b) Issuer EIN (c) CUSIP # (d) Date Issued (e) Issue Price (f) Description of Purpose (g) Defeased (h) On
Behalf of
Issuer 		(i) Pool
financing
Yes No Yes No Yes No
A MIFFLIN COUNTY HOSPITAL AUTHORITY
  		23-1352187 598520CE2 06-13-2007 21,723,377 REFUNDING ON AN ADVANCE BASIS A PORTION ($19,775,000) OF SERIES 2000 BONDS   X   X   X
Part II
Proceeds
A B C D
1 Amount of bonds retired. . . . .        
2 Amount of bonds defeased . . . .        
3 Total proceeds of issue . . . . 21,723,377      
4 Gross proceeds in reserve funds . . 1,722,381      
5 Capitalized interest from proceeds.        
6 Proceeds in refunding escrow. . . . . 19,561,939      
7 Issuance costs from proceeds . . . 434,468      
8 Credit enhancement from proceeds.        
9 Working capital expenditures from proceeds . .        
10 Capital expenditures from proceeds . .        
11 Other spent proceeds . .        
12 Other unspent proceeds. . . 4,589      
13 Year of substantial completion . . .
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue?   X            
15 Were the bonds issued as part of an advance refunding issue? X              
16 Has the final allocation of proceeds been made? . . X              
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . X              
Part III
Private Business Use
A B C D
Yes No Yes No Yes No Yes No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . .                
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . .                
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2010
Schedule K (Form 990) 2010
Page 2
Part III
Private Business Use (Continued)
A B C D
Yes No Yes No Yes No Yes No
3a Are there any management or service contracts that may result in private business use?                
b Are there any research agreements that may result in private business use of bond-financed property? . .                
c Does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts or research agreements relating to the financed property? .                
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . . . . . . . . . . . . . SchKMediumBullet        
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . SchKMediumBullet        
6 Total of lines 4 and 5 . . .. . . . . .        
7 Has the organization adopted management practices and procedures to ensure the post-issuance compliance of its tax-exempt bond liabilities?                
Part IV
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has a Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate, been filed with respect to the bond issue? . . .   X            
2 Is the bond issue a variable rate issue?   X            
3a Has the organization or the governmental issuer entered into a hedge with respect to the bond issue?   X            
b Name of provider .  
  		 
  		 
  		 
 
c Term of hedge . .        
d Was the hedge superintegrated? .                
e Was a hedge terminated? .                
4a Were gross proceeds invested in a GIC? .   X            
b Name of provider .  
  		 
  		 
  		 
 
c Term of GIC . .        
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? .                
5 Were any gross proceeds invested beyond an available temporary period? .   X            
6 Did the bond issue qualify for an exception to rebate? . . .   X            
Schedule K (Form 990) 2010

Schedule K (Form 990) 2010
Page 3
Part V
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule K (see instructions).
Identifier Return Reference Explanation
Schedule K (Form 990) 2010

Additional Data


Software ID:  
Software Version:  

Schedule L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V lines 38a or 40b.
MediumBullet Attach to Form 990 or Form 990-EZ. MediumBulletSee separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
LEWISTOWN HOSPITAL
 
Employer identification number

23-1352187
Part I
Excess Benefit Transactions (section 501(c)(3) and section 501 (c)(4) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.
1(a) Name of disqualified person (b) Description of transaction (c) Corrected?
Yes No





2
Enter the amount of tax imposed on the organization managers or disqualified persons during the year under section 4958. ......................... Bullet Image$
 
3
Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ....... Bullet Image$
 

Part II
Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 26, or Form 990-EZ, Part V, line 38a.
(a) Name of interested person and purpose (b) Loan to or from the organization? (c)Original principal amount (d)Balance due (e) In default? (f) Approved by board or committee? (g)Written agreement?
To From Yes No Yes No Yes No
Total ...............Small Bullet $  
Part III
Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.
(a) Name of interested person (b)Relationship between interested person and the organization (c)Amount of grant or type of assistance
For Privacy Act and Paperwork Reduction Act Notice, see the
Instructions for Form 990 or 990-EZ.
Cat. No. 50056A
Schedule L (Form 990 or 990-EZ) 2010
Schedule L (Form 990 or 990-EZ) 2010
Page 2
Part IV
Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of transaction (d) Description of transaction (e) Sharing of organization's revenues?
Yes No
(1) GAYLE COWAN DIRECTOR/MANAGER OF THE EDUCATION DEPARTMENT, WIFE OF RONALD COWAN, CIO 80,247 WAGES AND BENEFITS PAID TO GAYLE COWAN   No
(2) CHARLES EVERHART JR MD BOARD DIRECTOR 153,564 MONTHLY ENDOSCOPY SERVICES PROVIDED TO LH BY THE ENDOSCOPY CENTER OF PA. CHARLES EVERHART JR. HAS AN 80% OWNERSHIP INTEREST IN THE ENDOSCOPY CENTER.   No
(3) GURPREET S BHALLA MD BOARD MEMBER/PROPRIETOR OF PENN ANESTHESIA 280,000 CONTRACTUAL AGREEMENT WITH LH TO PROVIDE ANESTHESIA SERVICES TO THE HOSPITAL   No
Part V
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule L (see instructions).
Identifier Return Reference Explanation
Schedule L (Form 990 or 990-EZ) 2010

Additional Data


Software ID:  
Software Version:  




SCHEDULE M
(Form 990)

Department of the Treasury
Internal Revenue Service
NonCash Contributions
Right pointing arrow large imageComplete if the organization answered "Yes" on Form 990, Part IV, lines 29 or 30.
Right pointing arrow large image Attach to Form 990.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
LEWISTOWN HOSPITAL
 
Employer identification number

23-1352187
Part I
Types of Property
(a)
Check if applicable 		(b)
Number of Contributions or items contributed 		(c)
Contribution amounts reported on
Form 990, Part VIII, line 1g 		(d)
Method of determining
contribution amounts
1 Art—Works of art ....        
2 Art—Historical treasures .        
3 Art—Fractional interests ..        
4 Books and publications ..      
5 Clothing and household
goods ....... 		     
6 Cars and other vehicles ..        
7 Boats and planes ....        
8 Intellectual property ...        
9 Securities—Publicly traded .        
10 Securities—Closely held stock .        
11 Securities—Partnership, LLC,
or trust interests .... 		       
12 Securities—Miscellaneous ..        
13 Qualified conservation
contribution—Historic
structures ..... 		       
14 Qualified conservation
contribution—Other ... 		       
15 Real estate—Residential .        
16 Real estate—Commercial ..        
17 Real estate—Other ...        
18 Collectibles .....        
19 Food inventory ...        
20 Drugs and medical supplies .        
21 Taxidermy ......        
22 Historical artifacts ....        
23 Scientific specimens ..        
24 Archeological artifacts ...        
25 Other Right pointing arrow large image ( MEDICAL EQUIPMENT ) X 19 47,838 FMV OF INVOICE
26 Other Right pointing arrow large image( )
27 Other Right pointing arrow large image( )
28 Other Right pointing arrow large image ( )
29
Number of Forms 8283 received by the organization during the tax year for contributions
for which the organization completed Form 8283, Part IV, Donee Acknowledgement ...
29
 
Yes
No
30a
During the year, did the organization receive by contribution any property reported in Part I, lines 1-28 that it
must hold for at least three years from the date of the initial contribution, and which is not required to be used
for exempt purposes for the entire holding period? ..................
30a
 
No
b
If "Yes," describe the arrangement in Part II.
31
Does the organization have a gift acceptance policy that requires the review of any non-standard contributions?
31
 
No
32a
Does the organization hire or use third parties or related organizations to solicit, process, or sell non-cash
contributions? ............................
32a
 
No
b
If "Yes," describe in Part II.
33
If the organization did not report revenues in column (c) for a type of property for which column (a) is checked,
describe in Part II.
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 51227J
Schedule M (Form 990) 2010
Schedule M (Form 990) 2010
Page 2
Part II
Supplemental Information. Complete this part to provide the information required by Part I, lines 30b,
32b, and 33. Also complete this part for any additional information.
Identifier Return Reference Explanation
Schedule M (Form 990) 2010
Additional Data


Software ID:  
Software Version:  
SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2010
Open to Public
Inspection
Name of the organization
LEWISTOWN HOSPITAL
 
Employer identification number

23-1352187
Identifier Return Reference Explanation
FORM 990, PART VI, SECTION A, LINE 4   LEWISTOWN HOSPTIAL BYLAWS SECTION 7.1.3 "A MEDICAL STAFF MEMBER WHOSE APPOINTMENT HAS NOT BEEN RENEWED OR WHOSE CLINICAL PRIVILEGES ARE REDUCED, ALTERED OR SUSPENDED WILL BE ENTITLED TO A HEARING AND APPEAL." PREVIOUSLY A MEDICAL STAFF MEMBER WAS ONLY ENTITLED TO APPEAL. LEWISTOWN HOSPITAL BYLAWS SECTION 7.3: THIS SECTION WAS ALTERED, ACCORDING TO THE JOINT COMMISSION'S MEDICAL STAFF STANDARD 01.01.01, TO NO LONGER ALLOW THE HOSPITAL THE RIGHT TO UNILATERALLY AMEND THE HOSPITAL'S MEDICAL STAFF BYLAWS AS WAS ALLOWED HISTORICALLY.
FORM 990, PART VI, SECTION B, LINE 11   A FINAL DRAFT REVIEWED BY THREE LEVELS OF FINANCE STAFF WILL BE PRESENTED TO THE BOARD FOR REVIEW PRIOR TO BEING FILED. THE BOARD WILL REVIEW PRIOR TO MEETING AT A REGULARLY SCHEDULED MEETING AND DEVELOP QUESTIONS TO BE ASKED AT THE MEETING. ANY QUESTIONS SUBMITTED BY THE BOARD WILL BE RESEARCHED WITH THE PREPARER AND FINAL RESOLUTION WILL BE COMMUNICATED BACK TO THE BOARD BY THE FINANCE STAFF.
  FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY CONFLICT OF INTEREST STATEMENTS ARE COMPLETED BY ALL BOARD MEMBERS AND KEY EMPLOYEES. THESE STATEMENTS ARE REVIEWED BY THE CHAIR OF THE LEWISTOWN HEALTHCARE FOUNDATION (PARENT COMPANY) BOARD. THE CHAIR PERSON'S CONFLICT OF INTEREST STATEMENT IS REVIEWED BY THE VICE CHAIR OF THE FOUNDATION BOARD. ANY LISTED CONFLICTS ARE BROUGHT FORTH TO THE ENTIRE BOARD FOR REVIEW AND RESOLUTION IF NECESSARY.
  FORM 990, PART VI, SECTION B, LINE 15 THE SENIOR EXECUTIVE STAFF INCLUDES THE CEO AND OTHER KEY EMPLOYEES. THE SENIOR EXECUTIVE STAFF HAS THEIR SALARIES, RESPONSIBILITIES ANALYZED BY AN OUTSIDE CONSULTANT SPECIALIZING IN THE EXECUTIVE COMPENSATION AREA. RECOMMENDATIONS BASED ON THE ANALYSIS ARE THEN BROUGHT TO THE BOARD. THE BOARD DETERMINES ACTUAL INCREASES BASED ON THE RECOMMENDATIONS AND FINANCES OF THE HOSPITAL. THIS ANNUAL REVIEW AND APPROVAL PROCESS IS DOCUMENTED IN THE BOARD MINUTES.
  FORM 990, PART VI, SECTION C, LINE 19 AN ANNUAL REPORT IS AVAILABLE TO THE PUBLIC VIA THE ORGANIZATION'S WEBSITE. THIS REPORT SHOWS THE ANNUAL CONSOLIDATED STATEMENT OF OPERATIONS AND A CONSOLIDATED BALANCE SHEET. IT ALSO SHOWS ANNUAL OPERATING STATISTICS AND LISTS THE NAMES OF BOARD MEMBERS, SENIOR EXECUTIVE STAFF, AND THE MEMBERS OF THE MEDICAL EXECUTIVE COMMITTEE. CURRENTLY, THE GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT MADE AVAILABLE TO THE PUBLIC. THIS INFORMATION IS CONSIDERED PROPRIETARY AND IS NOT LEGALLY REQUIRED TO BE MADE AVAILABLE TO THE GENERAL PUBLIC.
  FORM 990, PART VII, SECTION A: AVERAGE HOURS PER WEEK FOR LEWISTOWN HOSPITAL AND RELATED ORGANIZATIONS ARE AS FOLLOWS: KAY HAMILTON - 40 HOURS RANDY TEWKSBURY - 40 HOURS KIRK THOMAS - 42 HOURS NANCY REINKE - 40 HOURS RONALD COWAN - 40 HOUR ALL BOARD DIRECTORS - 1 HOUR
CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 2,050,602. VALUATION LOSS 51,227. PENSION LIABILITY ADJUSTMENT 7,440,586. TOTAL TO FORM 990, PART XI, LINE 5: 9,542,415.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2010

Additional Data


Software ID:  
Software Version:  
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBulletAttach to Form 990. MediumBullet See separate instructions.

OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
LEWISTOWN HOSPITAL
 
Employer identification number

23-1352187
Part I
Identification of Disregarded Entities (Complete if the organization answered "Yes" on Form 990, Part IV, line 33.)
(a)
Name, address, and EIN of disregarded entity


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Total income
(e)
End-of-year assets


 		(f)
Direct controlling
entity

















Part II
Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.)
(a)
Name, address, and EIN of related organization


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Exempt Code section
(e)
Public charity status
(if section 501(c)(3))

 		(f)
Direct controlling
entity

 		(g)
Section 512(b)(13) controlled organization
Yes No
(1) LEWISTOWN AMBULATORY CARE CORPORATION

400 HIGHLAND AVENUE

LEWISTOWN,PA17044
23-2344362 		TO DEVELOP AND RENT REAL ESTATE TO ITS AFFILIATES PA 501(C)(3) 11B LEWISTOWN HEALTHCARE FOUNDATION
 
 
No
(2) LEWISTOWN HEALTHCARE FOUNDATION

400 HIGHLAND AVENUE

LEWISTOWN,PA17044
23-2344363 		TO CONDUCT FUNDRAISING AND GRANT-MAKING ACTIVITIES TO BENEFIT RELATED ORGS. PA 501(C)(3) 11B N/A
 
No
(3) FAMILY HEALTH ASSOCIATES OF LEWISTOWN HOSPITAL

400 HIGHLAND AVENUE

LEWISTOWN,PA17044
25-1651582 		TO EMPLOY PRIMARY CARE PHYSICIANS AND PROVIDE HEALTHCARE SERVICES PA 501(C)(3) 11B LEWISTOWN HEALTHCARE FOUNDATION
 
 
No








For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



 		(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




 		(i)
Code V—UBI
amount in box 20 of
Schedule K-1
(Form 1065)
 		(j)
General or
managing
partner?



 		(k)
Percentage
ownership
Yes No Yes No












Part IV
Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)
(a)
Name, address, and EIN of related organization



 		(b)
Primary activity



 		(c)
Legal domicile
(state or
foreign
country)
 		(d)
Direct controlling
entity


 		(e)
Type of entity
(C corp, S corp,
or trust)

 		(f)
Share of total income



 		(g)
Share of
end-of-year
assets

 		(h)
Percentage
ownership
(1) HEALTH ENTERPRISES INC
400 HIGHLAND AVENUE
LEWISTOWN,PA17044
23-2353212 		HEALTHCARE PA LEWISTOWN HEALTHCARE FOUNDATION
  		C      












Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 3
Part V
Transactions With Related Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35, 35A, or 36.)
Note. Complete line 1 if any entity is listed in Parts II, III or IV.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest (ii) annuities (iii) royalties (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
 
No
b Gift, grant, or capital contribution to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
Yes
 
c Gift, grant, or capital contribution from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
 
No
d Loans or loan guarantees to or for other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
Yes
 
e Loans or loan guarantees by other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Sale of assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Purchase of assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Exchange of assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Lease of facilities, equipment, or other assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
Yes
 
k Performance of services or membership or fundraising solicitations for other organization(s) . . . . . . . . . . . . . . . . . . . . . .
1k
 
No
l Performance of services or membership or fundraising solicitations by other organization(s) . . . . . . . . . . . . . . . . . . . . . .
1l
 
No
m Sharing of facilities, equipment, mailing lists, or other assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1m
 
No
n Sharing of paid employees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1n
Yes
 
o Reimbursement paid to other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
Yes
 
p Reimbursement paid by other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
Yes
 
q Other transfer of cash or property to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
Yes
 
r Other transfer of cash or property from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
Yes
 
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of other organization 		(b)
Transaction
type(a-r) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1)
(2)
(3)
(4)
(5)
(6)
Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 37.)
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity 		(b)
Primary activity 		(c)
Legal domicile
(state or foreign
country) 		(d)
Are all
partners
section
501(c)(3)
organizations? 		(e)
Share of
end-of-year
assets 		(f)
Disproprtionate allocations? 		(g)
Code V—UBI
amount in box
20 of Schedule K-1
(Form 1065) 		(h)
General or
managing
partner?
Yes No Yes No Yes No






























Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 5
Part VII
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule R (see instructions).
Identifier Return Reference Explanation
Additional Data


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Software Version: