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
2012
Open to Public Inspection
A For the 2012 calendar year, or tax year beginning 07-01-2012 , 2012, and ending 06-30-2013
BCheck if applicable:
CName of organization
Jeanes Hospital
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
3509 N Broad Street No 936
 
Room/suite
City or town, state or country, and ZIP + 4
Philadelphia, PA19140
D Employer identification number

23-2826045
E Telephone number

G Gross receipts $ 153,832,882
F Name and address of principal officer:
Raymond Lefton
3509 N Broad Street No 936
Philadelphia,PA19140
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
www.jeanes.com
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: 1996
M State of legal domicile: PA
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: To maintain and enhance the quality of life for individuals in the communities we serve.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 9
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 8
5 Total number of individuals employed in calendar year 2011 (Part V, line 2a) ...... 5 1,206
6 Total number of volunteers (estimate if necessary) ............. 6 317
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 281,257
b Net unrelated business taxable income from Form 990-T, line 34 ......... 7b 32,277
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 2,906,425 1,683,274
9 Program service revenue (Part VIII, line 2g) ......... 156,404,815 144,531,428
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 2,234,272 4,906,230
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 910,495 115,963
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 162,456,007 151,236,895
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 3,809,050 7,013,350
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) 74,879,917 76,177,882
16a Professional fundraising fees (Part IX, column (A), line 11e)..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet130,640    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 92,833,658 82,532,098
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 171,522,625 165,723,330
19 Revenue less expenses. Subtract line 18 from line 12....... -9,066,618 -14,486,435
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 117,835,737 107,394,779
21 Total liabilities (Part X, line 26)............. 99,183,763 97,615,651
22 Net assets or fund balances. Subtract line 21 from line 20..... 18,651,974 9,779,128
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 Use Only
Print/Type preparer's name
 
Preparer's signature
Date
PTIN
Firm's name MediumBullet

Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ............
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2012)
Form 990 (2012)
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: Jeanes Hospital's mission statement, as approved by its board of directors and executives is:In furtherance of the mission of Temple University Health System, the mission of Jeanes Hospital is to maintain and enhance the quality of life for individuals in the communities we serve. We emphasize the Quaker belief that in each person there resides a spirit that creates a common bond among us all. Our health care services include maintenance and enhancement of health, which quickens the spirit and enhances the vitality of our lives.
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 organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations 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 $ 16,270,970 including grants of $   ) (Revenue $ 14,469,004 )
The Cardiovascular program at Jeanes Hospital provides healthcareservices aimed at preventing, diagnosing, and treating cardiovascular diseases.Cardiovascular diseases are the leading cause of death in the UnitedStates. The services provided by Jeanes Hospital target the full rangeof conditions related to the heart and vascular system, includingcongestive heart failure, hypertension, and narrowing of the arteriesand peripheral disease. The services are provided to both inpatientsand outpatients.Cardiovascular services at Jeanes Hospital span the continuum of heartcare. Included are open heart surgery, diagnostic and interventional cardiac catheterization, electrophysiology studies, stress testing,cardiac and thoracic surgery, echocardiograms, EKGs, holter monitortests and cardiopulmonary rehab. The hospital's vascular servicesprovide both open and closed vascular procedures in surgery, cath laband vascular lab. Jeanes Hospital is the recipient of the AmericanHeart Association's Stroke Gold Plus Quality Achievement Award.
4b (Code:   ) (Expenses $ 9,947,232 including grants of $   ) (Revenue $ 10,147,398 )
Gastroenterology/Digestive Disease. Jeanes Hospital gives patients themost advanced, safest and proven medical and surgical treatmentsprimarily focused on the gastrointestinal tract. The services offeredby Jeanes Hospital under this specialty are: surgical weight loss,colorectal surgery, nutritional counseling, and gastroenterology andhepatology services aimed at treating patients with disorders of theesophagus, liver, gall bladder and stomach. Services are provided toboth inpatients and outpatients.
4c (Code:   ) (Expenses $ 13,784,320 including grants of $   ) (Revenue $ 11,678,482 )
Pulmonary. Jeanes Hospital provides comprehensive pulmonary complexmedical and rehabilitation programs for patients with acute and chronicpulmonary conditions. Services provided range from inpatientventilation management and weaning, to outpatient pulmonaryrehabilitation delivered by an interdisciplinary team of highly trainedand board certified pulmonologists, respiratory therapists and nurses.
(Code:   ) (Expenses $ 110,866,441 including grants of $ 7,013,350 ) (Revenue $ 108,236,544 )
In concert with cardiovascular, digestive and pulmonary services at Jeanes Hospital, a full continuum of additional services creates a comprehensive medical and surgical center for our community and its physicians. Services range from diagnostic to therapeutic, medical to surgical, and outpatient to critical care. Here is a roster of some of the more prominent services at Jeanes Hospital:General Medicine consists of diagnosis, management and non-surgical treatment of disease processes.Emergency Services are available to the community 24 hours a day for patients who suffer illness or injury.We have a full range of ambulatory diagnostic testing, including path lab services and radiology. Diagnostic imaging services include general X-ray, digital mammography, ultrasound, MRI, CT, interventional imaging and nuclear medicine. Advanced technology MRI, CT and PET scanning are available at Jeanes Hospital for critical diagnoses. Services, both medical and surgical, are available for disorders of the ears, nose, throat and eyes. Women's health services at Jeanes Hospital include screening and diagnostic digital mammography, ultrasound services, breast surgery, fertility services and a compendium of gynecological surgical services.Orthopaedics at Jeanes Hospital ranges from conservative treatment to high acuity surgery. Surgery includes tertiary-level joint replacement procedures and rehab, and spine procedures.Neurosurgery services at Jeanes Hopsital offers an alternative to orthopaedics for spine surgery patients. General surgery encompasses an array of interventional procedures for our patients, including oncologic, vascular, gastrointestinal, bariatric surgeries, etc. In step with surgical trends, Jeanes Hospital offers more and more minimally-invasive alternatives such as laparoscopic surgery.Dermatology and plastic surgery both have a full-time presence at Jeanes Hospital.Anesthesiologists on the Jeanes Hospital medical staff offer a formal pain management program for chronic pain patients, including interventional procedures. A hospitalist program was established at Jeanes Hospital, allowing physicians to rely on specially trained inpatient coverage while tending to their practices more efficiently. Additional services include urology, nephrology, neurology, infectious disease, psychiatry and psychology, podiatry, rheumatology, and endocrinology.Community Benefit Overview:Jeanes Hospital takes great pride in the broad array of community services that we provide to our surrounding neighborhoods. Founded in 1928 by virtue of a bequest in the Will of Philadelphia Quaker leader Anna T. Jeanes, we continue her vision of serving as the destination for those who need ambulatory, inpatient, surgical, and home care in Northeast Philadelphia by combining the compassionate nature of a Quaker founded community hospital with the advanced capabilities of an academic medical center. Jeanes Hospital is firmly committed to advancing the health of people and quality of life in our communities. Below is a summary of some of the programs and activities operated in our FYE June 30, 2013 of which we are most proud.Reaching out to the Community. Jeanes reached more than 7,300 seniors, adults, and children, providing free health screenings; support groups for patients and families dealing with disease; immunization for flu; stroke awareness, and other topics, and many other outreach activities. Wellness Track: Jeanes offers a safe, park-like walking trail for community members to enjoy healthy outdoor exercise. Increasingly, we are hosting some of our community education sessions outdoors on this track, where cardiologists and other health professionals explain firsthand the need to stay fit and healthy. Food, Book, Clothing, and Toy Drive: Reflecting the compassion of our Quaker heritage, Jeanes employees contributed food, new coats, toys and financial contributions to support low income families living in our communities. We partnered with Salvation Army, Feast of Justice, local food banks, churches and other community organizations on these initiatives.Blood Drives: In partnership with the American Red Cross, Jeanes collected more than 72 productive pints of blood. Health & Wellness Education: More than 400 community members joined our Community Classroom series, which focused on stroke awareness, arthritis, osteoporosis, healthy diet, exercise, stress, cancer, and other topics of interest to our community. Investing in Health Professions Education. Jeanes helps provide the education and training necessary to develop a professional healthcare workforce to benefit the broader community. Fostering Volunteerism. A majority of the members of Jeanes Hospitals Board of Directors is comprised of local volunteers who offer expertise and govern the organization without compensation. Similarly, members of Jeanes Hospitals executive staff routinely participate in not-for-profit community health and social service organizations, as members of their boards-of-directors and in partnership with their outreach services. Fueling our Communitys Economic Engine. Jeanes employed nearly 1,000 people and paid $78 million in salaries and benefits. For every $1.00 of hospital employee compensation, about $.92 additional compensation is spent elsewhere in the community (about $72 million) million). For every job at Jeanes Hospital, about 1.2 additional jobs are generated elsewhere (about 1,200 spin-off jobs).Reducing the Government Burden. In 2013, Jeanes Hospital incurred more than $6.7 million in charity care expenses. In addition, Jeanes Hospital maintains strong affiliations with government and community organizations to help ensure access to care for our vulnerable population.
4d Other program services (Describe in Schedule O.)
(Expenses $ 110,866,441 including grants of $ 7,013,350 ) (Revenue $ 108,236,544 )
4e Total program service expensesMediumBullet150,868,963
Form 990 (2012)
Form 990 (2012)
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 (see instructions)? 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 I..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If “Yes,” complete Schedule C, Part II........
4
 
No
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 III............................
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which 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 for escrow or custodial account liability; 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
Yes
 
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, 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, line 10?
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 VIIClick to see attachment.......
11b
Yes
 
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 VIIIClick 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 IXClick to see attachment............
11d
Yes
 
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part XClick 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 XClick to see attachment.........................
11f
 
No
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If “Yes,” complete Schedule D, Parts XI and XII Click to see attachment.................
12a
 
No
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 and XII 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, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If “Yes,” complete Schedule F, Parts I and IV.........
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 United States? If “Yes,” complete Schedule F, Parts II and IV
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 United States? If “Yes,” complete Schedule F, Parts III and IV...
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 (see instructions)....
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
 
No
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
20a
Did the organization operate one or more hospital facilities? If “Yes,” complete Schedule H.... Click to see attachment
20a
Yes
 
b
If “Yes” to line 20a, did the organization attach a copy of its audited financial statements to this return? Click to see attachment
20b
Yes
 
Form 990 (2012)
Form 990 (2012)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants and other assistance to any government or organization 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
 
No
23
Did the organization answer “Yes” to Part VII, Section A, line 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 lines 24b through 24d and complete Schedule K. If “No,” go to line 25................
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
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
 
 
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
 
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........
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...................
25b
 
No
26
Was a loan to or by a current or former officer, director, trustee, key employee, highest compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II..........................
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If “Yes,” complete Schedule L, Part III.........
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 ..........................
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV.....................
28b
 
No
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 direct or indirect owner? If “Yes,” complete Schedule L, Part IV...
28c
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule M..
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M.............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I...........................
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, Part II, III, or IV, and Part V, line 1........................ Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, 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
35b
Yes
 
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 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2012)
Form 990 (2012)
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
112
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
1,206
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, securities account, or other financial 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 as charitable contributions?...
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
 
No
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
 
 
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. See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the 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 amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
 
Form 990 (2012)
Form 990 (2012)
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
9
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent ...................
1b
8
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
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
Yes
 
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
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If “Yes,” did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
 
 
11a
Has the organization provided a complete 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 this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this was done.......................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did 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 15a or 15b, 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
Yes
 
b
If “Yes,” did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
Yes
 
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 made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how), the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization:
MediumBulletRaymond Lefton3509 N Broad Street Room 936PhiladelphiaPA19140 (215) 707-7766
Form 990 (2012)
Form 990 (2012)
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. 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 organization compensated any current officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(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) Joseph Evans........................................................................
Chair
 2.00
.......................2.00 		X           0 0 0
(2) Dr Thomas Lewis........................................................................
Vice Chair
 2.00
.......................0.00 		X           0 0 0
(3) Francis Devlin........................................................................
Director
 2.00
.......................0.00 		X           0 0 0
(4) Larry Kaiser MD........................................................................
Director
 2.00
.......................48.00 		X           0 1,504,576 20,624
(5) Charles Lockyer........................................................................
Director
 2.00
.......................2.00 		X           0 0 0
(6) Martin Ogletree........................................................................
Director
 2.00
.......................0.00 		X           0 0 0
(7) David Kraynik........................................................................
Director
 2.00
.......................0.00 		X           0 0 0
(8) Lewis Gould........................................................................
Director
 2.00
.......................6.00 		X           0 0 0
(9) Robert Taylor........................................................................
Director
 2.00
.......................0.00 		X           0 0 0
(10) Verdi DisSesa MD........................................................................
Ex Officio - Non Voting
 3.00
.......................47.00 		X           0 820,873 44,901
(11) Paul Karlin MD........................................................................
Ex Officio - Non Voting
 5.00
.......................45.00 		X           0 320,506 42,302
(12) Eleanor Reinhardt........................................................................
Ex Officio - Non Voting
 2.00
.......................0.00 		X           0 0 0
(13) Linda Grass........................................................................
President & CEO
 48.00
.......................2.00 		    X       362,830 0 7,171
(14) Beth Koob........................................................................
Secretary
 3.00
.......................47.00 		    X       0 528,081 88,175
(15) Anne Rudloff........................................................................
Asst Secretary
 50.00
.......................0.00 		    X       54,870 0 21,283
(16) Betty McAdams........................................................................
Asst Secretary
 2.00
.......................48.00 		    X       0 80,588 22,822
(17) Ray Lefton........................................................................
Treasurer / CFO
 50.00
.......................0.00 		    X       0 0 1,269
Form 990 (2012)
Form 990 (2012)
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 (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(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) Robert Lux........................................................................
Asst Treasurer
 3.00
.......................47.00 		    X       0 604,747 129,704
(19) Thomas Albenesi........................................................................
Treasurer / CFO
 25.00
.......................25.00 		    X       0 419,783 47,740
(20) Andrea McCoy........................................................................
Chief Medical Officer
 50.00
.......................0.00 		      X     281,864 0 41,462
(21) Denise Frasca........................................................................
AHD - Patient Services
 50.00
.......................0.00 		      X     180,018 0 35,283
(22) Stephanie Kao........................................................................
Medical Director
 50.00
.......................0.00 		        X   198,321 0 27,736
(23) John Woodward........................................................................
Physician
 50.00
.......................0.00 		        X   209,962 0 0
(24) Frank Shipp........................................................................
AHD
 50.00
.......................0.00 		        X   161,141 0 15,968
(25) Joseph Schofield........................................................................
AHD
 50.00
.......................0.00 		        X   186,436 0 6,483
(26) Hardik Patel........................................................................
AHD
 50.00
.......................0.00 		        X   162,321 0 6,534








1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 1,797,763 4,279,154 559,457
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet56
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. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
Temple University Health System3509 N Broad Street Room 936PhiladelphiaPA19140 Related organization services 9,946,745
Temple University Hospital3509 N Broad Street Room 936PhiladelphiaPA19140 Faculty support, lab 5,497,240
Temple Physicians Inc3509 N Broad Street Room 936PhiladelphiaPA19140 Related organization services 4,817,987
Temple University of the Commonwealth Sy300 Sullivan Hall 1330 W Berks StPhiladelphiaPA19122 Related organization services 4,613,566
Synthes USA Sales LLCPO Box 8538-662PO Box 8538-662PhiladelphiaPA19171 Medical Products 310,834
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet10
Form 990 (2012)
Form 990 (2012)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response to any question in this Part VIII ..............
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, Gifts, Grants and Other Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d 110,358
e Government grants (contributions)1e 1,555,289
f All other contributions, gifts, grants, and
similar amounts not included above1f 		17,627
g Noncash contributions included in lines
1a-1f:$ 		 
h Total. Add lines 1a-1f.......MediumBullet 1,683,274
Program Service Revenue Business Code
2a Net patient svc revenue 622110 139,222,871 138,980,422 242,449  
b Rental income 532000 4,440,519 4,440,519    
c Snack shop income 722210 532,437 532,437    
d Cafeteria income 722210 279,180 279,180    
e Service revenue 622110 55,707 55,707    
f All other program service revenue . 714 714    
g Total. Add lines 2a–2f........MediumBullet 144,531,428
Other Revenue 3 Investment income (including dividends, interest, and other similar amounts).......MediumBullet 3,488,724     3,488,724
4 Income from investment of tax-exempt bond proceeds..MediumBullet        
5 Royalties...........MediumBullet        
(i) Real (ii) Personal
6a Gross rents 77,155  
b Less: rental expenses 0  
c Rental income or (loss) 77,155  
d Net rental income or (loss).......MediumBullet 77,155     77,155
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 4,013,493  
b Less: cost or other basis and sales expenses 2,595,987  
c Gain or (loss) 1,417,506  
d Net gain or (loss)..........MediumBullet 1,417,506     1,417,506
8a Gross income from fundraising events (not including
$  
of contributions reported on line 1c). See Part IV, line 18 ..
a  
b Less: direct expenses ...b  
c Net income or (loss) from fundraising events..MediumBullet      
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities...MediumBullet        
10a Gross sales of inventory, less
returns and allowances .
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet        
Miscellaneous Revenue Business Code
11a Incm from other invsts 523000 38,808   38,808  
b            
c            
d All other revenue ....        
e Total. Add lines 11a–11d ...... MediumBullet 38,808
12 Total revenue. See Instructions......MediumBullet 151,236,895 144,288,979 281,257 4,983,385
Form 990 (2012)
Form 990 (2012)
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).Check if Schedule O contains a response to any question in this Part IX ...............
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 United States. See Part IV, line 21 7,013,350 7,013,350
2 Grants and other assistance to individuals in the United States. See Part IV, line 22    
3 Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16    
4 Benefits paid to or for members    
5 Compensation of current officers, directors, trustees, and key employees .... 1,050,620   1,050,620  
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 57,439,832 54,579,575 2,860,257  
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 3,755,596 3,504,347 251,249  
9 Other employee benefits ....... 9,665,266 8,941,489 723,777  
10 Payroll taxes ........... 4,266,568 3,981,135 285,433  
11 Fees for services (non-employees):        
a Management ...... 5,507,185   5,376,545 130,640
b Legal ......... 171,856   171,856  
c Accounting ...........        
d Lobbying ...........        
e Professional fundraising services. See Part IV, line 17    
f Investment management fees ...... 61,788   61,788  
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ........ 24,654,120 19,594,294 5,059,826  
12 Advertising and promotion .... 370,026 364,296 5,730  
13 Office expenses ....... 25,901,541 25,451,540 450,001  
14 Information technology ...... 4,737,822 4,426,911 310,911  
15 Royalties ..        
16 Occupancy ........... 1,710,874 4,056,991 -2,346,117  
17 Travel ............ 97,999 82,916 15,083  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ......        
19 Conferences, conventions, and meetings .... 11,766 11,542 224  
20 Interest ........... 2,718,181 2,718,181    
21 Payments to affiliates .......        
22 Depreciation, depletion, and amortization ..... 6,188,912 6,188,912    
23 Insurance .............. 581,577 581,733 -156  
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a Tax assessment expense 5,508,814 5,508,814    
b Equipment rental and ma 3,322,221 2,848,456 473,765  
c Loss on Disposal of Fix 428,110 374,493 53,617  
d
e All other expenses 559,306 639,988 -80,682  
25 Total functional expenses. Add lines 1 through 24e 165,723,330 150,868,963 14,723,727 130,640
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2012)
Form 990 (2012)
Page 11
Part X Balance Sheet Check if Schedule O contains a response to any question in this Part X ...............
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash—non-interest-bearing .............   1  
2 Savings and temporary cash investments ......... 799,082 2 1,640,443
3 Pledges and grants receivable, net ...........   3  
4 Accounts receivable, net ............. 24,531,748 4 22,365,056
5 Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L ..................
  5  
6 Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
  6  
7 Notes and loans receivable, net .............   7  
8 Inventories for sale or use .............. 3,393,028 8 3,771,529
9 Prepaid expenses and deferred charges .......... 1,271,367 9 972,535
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 127,037,205
b Less: accumulated depreciation ..... 10b 100,333,580 30,618,478 10c 26,703,625
11 Investments—publicly traded securities .......... 12,930,312 11 24,248,947
12 Investments—other securities. See Part IV, line 11 ..... 23,608,469 12 6,565,712
13 Investments—program-related. See Part IV, line 11 .....   13  
14 Intangible assets ...............   14  
15 Other assets. See Part IV, line 11 ........... 20,683,253 15 21,126,932
16 Total assets. Add lines 1 through 15 (must equal line 34)...... 117,835,737 16 107,394,779
Liabilities 17 Accounts payable and accrued expenses ......... 50,312,692 17 43,729,665
18 Grants payable .................   18  
19 Deferred revenue ................ 48,750 19 0
20 Tax-exempt bond liabilities .............   20  
21 Escrow or custodial account liability. Complete Part IV of Schedule D.. 163,244 21  
22 Loans and other 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 ..   23  
24 Unsecured notes and loans payable to unrelated third parties .... 469,600 24 200,959
25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D.................... 48,189,477 25 53,685,027
26 Total liabilities. Add lines 17 through 25......... 99,183,763 26 97,615,651
Net Assets or Fund Balance Organizations that follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets .............. 3,197,629 27 -6,701,877
28 Temporarily restricted net assets ........... 198,858 28 186,211
29 Permanently restricted net assets ........... 15,255,487 29 16,294,794
Organizations that do not follow SFAS 117 (ASC 958), 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 ........... 18,651,974 33 9,779,128
34 Total liabilities and net assets/fund balances ........ 117,835,737 34 107,394,779
Form 990 (2012)
Form 990 (2012)
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
151,236,895
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
165,723,330
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
-14,486,435
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
18,651,974
5
Net unrealized gains (losses) on investments ...............
5
-1,339,231
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
6,952,820
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))
10
9,779,128
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
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If “Yes,” to line 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?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
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 (2012)
Form 990, Special Condition Description:
Special Condition Description
Additional Data


Software ID:  
Software Version:  
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
2012
Open to Public
Inspection
Name of the organization
Jeanes Hospital
 
Employer identification number

23-2826045
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 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
Provide the following information about the supported organization(s).
(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 monetary support
Yes No Yes No Yes No
Total                  

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 2
Part II
Support Schedule for Organizations Described in Sections 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) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (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) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (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. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..            
11 Total support (Add lines 7 through 10).            
12
12
 
13
First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization, check this box and stop here........................................right arrow
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 3
Part III
Support Schedule for Organizations Described in Section 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) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (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) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (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) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 4
Part IV
Supplemental Information. Complete this part to provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and 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) 2012

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
2012
Name of the organization
Jeanes Hospital
 
Employer identification number

23-2826045
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 on line H of its
Form 990-EZ or on Part I, 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) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page 2
Name of organization
Jeanes Hospital
  		Employer identification number

23-2826045
Part I
Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
     
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total 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)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  


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

     
 
   

$  


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

     
 
   

$  


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

     
 
   

$  


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

     
 
   

$  


(Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page 3
Name of organization
Jeanes Hospital
  		Employer identification number

23-2826045
Part II
Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
     
(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) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page 4
Name of organization
Jeanes Hospital
  		Employer identification number

23-2826045
Part III
Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
that total 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 $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
Use duplicate copies of Part III if additional space is needed.
(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) (2012)

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, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
Jeanes Hospital
 
Employer identification number

23-2826045
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 can 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 through 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, and not on a historic structure listed in the National Register .................... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax 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 section 170(h)(4)(B)(ii)? .......................................
9
In Part XIII, 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 (ASC 958), 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 XIII, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116 (ASC 958), 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 (ASC 958) 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 Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 52283D
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s acquisition, 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 XIII.
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 XIII 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 XIII. Check here if the explanation has been provided in Part XIII ........
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current year (b)Prior year b (c)Two years back (d)Three years back (e)Four years back
1a Beginning of year balance .... 15,256,626 15,864,051 13,783,220 12,963,338 16,733,256
b Contributions ........          
c Net investment earnings, gains, and losses 1,158,051 152,637 2,801,550 1,646,133 -2,840,933
d Grants or scholarships .....          
e Other expenditures for facilities
and programs ........ 		118,646 760,061 720,719 826,251 928,985
f Administrative expenses ....          
g End of year balance ...... 16,296,031 15,256,627 15,864,051 13,783,220 12,963,338
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet0 %
b
Permanent endowment SchDMd Bullet100.000 %
c
Temporarily restricted endowment SchDMd Bullet0 %
The percentages in lines 2a, 2b, and 2c should equal 100%.
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)
Yes
 
(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 XIII the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land ................. 12,775   12,775
b Buildings ................ 138,504 78,685,425 62,538,277 16,285,652
c Leasehold improvements ............   1,145,856 169,473 976,383
d Equipment ................   45,282,122 36,227,832 9,054,290
e Other .................   1,772,523 1,397,998 374,525
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 26,703,625
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
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    
(3)Other
(A) TIFF Absolute Return Pool II 		2,257,957 F

(B) P2 Capital Fund Ltd 		731,174 F

(C) GMO Forestry Fund 6b, LP 		20,437 F

(D) Pvt Advisors DO Fund, LP 		330,325 F

(E) PvtAdv SmCoBO Fund II, LP 		1,268,563 F

(F) FCOI II Holdings, LP 		547,944 F

(G) Forester Partners LP 		383,189 F

(H) MREP 2008 Distressed Co-Investment Fund, LP 		1,026,123 F

Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet 6,565,712
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) must 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
(1) Jeanes Physicians' Office Building Partnership 1,004,977
(2) Self insurance asset TU malpractice 2,257,355
(3) Self insurance asset TU Workers' Compensation 1,251,130
(4) Assets Limited As To Use -- Other, General 13,264
(5) Assets Limited As To Use -- Temporarily Restricted Funds 278,369
(6) Assets Limited As To Use -- Permanently Restricted Funds 75,000
(7) Assets Held in Trust -- Anna T. Jeanes Trust 14,079,841
(8) Assets Held in Trust -- Maude E.M. Boggs Trust 1,884,238
(9) Assets Held in Trust -- Edith Scot Paschall Trust 226,371
(10) Assets Held in Trust -- John E. Holcomb Trust 28,844
(11) Cash value of life insurance policy 27,543
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet 21,126,932
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of liability (b) Book value
Federal income taxes  
Long-term debt, inter-company 46,739,528
Estimated retroactive adj, 3rd party payers 1,253,238
Due to affiliated companies 5,692,261






Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 53,685,027
2. Fin 48 (ASC 740) Footnote. In Part XIII, 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 (ASC 740). Check here if the text of the footnote has been provided in Part XIII .....................................................
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 4
Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1 Total revenue, gains, and other support per audited financial statements ....... 1  
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIII.) ............ 2d  
e Add lines 2a through 2d ..................... 2e  
3 Subtract line 2e from line 1..................... 3  
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 XIII.) ........... 4b  
c Add lines 4a and 4b....................... 4c  
5 Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5  
Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1 Total expenses and losses per audited financial statements ........... 1  
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 XIII.) ............ 2d  
e Add lines 2a through 2d...................... 2e  
3 Subtract line 2e from line 1..................... 3  
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 XIII.) ............ 4b  
c Add lines 4a and 4b....................... 4c  
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5  
Part XIII
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, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.
Identifier Return Reference Explanation
    Part IV, line 2b: Jeanes Physicians' Office Building Partnership established with Jeanes Hospital an escrowed vacancy reserve fund to secure partnership obligations under a reimbursement and indemnification agreement. Part V, line 4: Use of the endowments will vary depending on the nature of the restrictions imposed by the donors. If an endowment is restricted as to purpose, the organization will use the endowment for the permitted purpose. If the endowment is restricted as to time, the organization draws income but accumulates principal.
Schedule D (Form 990) 2012

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
2012
Open to Public Inspection
Name of the organization
Jeanes Hospital
 
Employer identification number

23-2826045
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a ...
1a
Yes
 
b
If "Yes," was it a written policy? .......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
%
b
Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate
which of the following was the family income limit for eligibility for discounted care: .........
3b
Yes
 
%
c
If the organization used factors other than FPG in determining eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? ..............

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year? ............................

5a

Yes

 
b
If "Yes," did the organization's financial assistance 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 discountedcare to a patient who was eligibile for free or discounted care? ..............
5c
 
No
6a
Did the organization prepare a community benefit report during the tax year? ..........
6a
Yes
 
b
If "Yes," did 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
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance 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 Financial Assistance at cost
(from Worksheet 1) .. 		    3,197,757 0 3,197,757 1.930 %
b Medicaid (from Worksheet 3,
column a) .... 		    17,544,868 14,024,331 3,520,537 2.120 %
c Costs of other means-tested
government programs (from
Worksheet 3, column b) . 		           
d Total Financial Assistance
and Means-Tested
Government Programs . 		    20,742,625 14,024,331 6,718,294 4.050 %
Other Benefits
 54 7,371 159,298 0 159,298 0.100 %
e Community health
improvement services and
community benefit operations
(from Worksheet 4) ..
f Health professions education
(from Worksheet 5) .. 		    1,947,003 742,468 1,204,535 0.730 %
g Subsidized health services
(from Worksheet 6) .. 		           
h Research (from Worksheet 7)            
i Cash and in-kind
contributions for community
benefit (from Worksheet 8) 		           
j Total. Other Benefits .. 54 7,371 2,106,301 742,468 1,363,833 0.830 %
k Total. Add lines 7d and 7j . 54 7,371 22,848,926 14,766,799 8,082,127 4.880 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(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            
3 Community support     9,500   9,500 0.010 %
4 Environmental improvements            
5 Leadership development and training for community members            
6 Coalition building            
7 Community health improvement advocacy            
8 Workforce development            
9 Other            
10 Total     9,500   9,500 0.010 %
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did 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. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
3,421,714
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......
3
0
4
Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
33,096,499
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
39,716,918
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-6,620,419
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
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

9b

Yes

 
Part IV
Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)
(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) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest—see instructions)
How many hospital facilities did the organization operate during the tax year?1
Name, address, and primary website address 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital Research Facility ER-24Hours ER-Other Other (Describe) Facility reporting group
1 Jeanes Hospital
7600 Central Avenue
Philadelphia,PA191112442 		X X   X     X   Home health care  
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
Jeanes Hospital
Name of hospital facility or facility reporting group  
For single facility filers only: line Number of Hospital Facility (from Schedule H, Part V, Section A) 1
Yes No
Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)
1 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9.................... 1 Yes  
If “Yes,” indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
2 Indicate the tax year the hospital facility last conducted a CHNA: 20 12
3 In conducting its most recent CHNA, did the hospital facility take into account input from representatives of the community served by the hospital facility, including those with special knowledge of or expertise in public health? 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 Yes  
4 Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI................................ 4   No
5 Did the hospital facility make its CHNA report widely available to the public? ............. 5 Yes  
If “Yes,” indicate how the CHNA report was made widely available (check all that apply):
a
b
c
6 If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply to date):
a
b
c
d
e
f
g
h
i
7 Did the hospital facility address all of the needs identified in its most recently conducted CHNA? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs ........ 7   No
8a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ........................... 8a   No
b If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ...... 8b    
c If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Financial Assistance Policy Yes No
9 Did the hospital facility have in place during the tax year a written financial assistance policy that:
Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 9 Yes  
10 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 10 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 100.000000000000%
If "No," explain in Part VI the criteria the hospital facility used.
11 Used FPG to determine eligibility for providing discounted care?................. 11 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 300.000000000000%
If "No," explain in Part VI the criteria the hospital facility used.
12 Explained the basis for calculating amounts charged to patients?................. 12 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a
b
c
d
e
f
g
h
13 Explained the method for applying for financial assistance?................... 13 Yes  
14 Included measures to publicize the policy within the community served by the hospital facility?....... 14 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a
b
c
d
e
f
g
Billing and Collections
15 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 15 Yes  
16 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a
b
c
d
e
17 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 17   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

18 Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):
a
b
c
d
e
Policy Relating to Emergency Medical Care
Yes No
19 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?.......... 19 Yes  
If “No,” indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)
20 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
21 During the tax year, did the hospital facility charge any FAP-eligible individuals 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? ............................ 21   No
If “Yes,” explain in Part VI.
22 During the tax year, did the hospital facility charge any FAP-eligible individuals an amount equal to the gross charge for any service provided to that individual? ......................... 22   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Section C. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, from largest to smallest)
How many non-hospital health care 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) 2012
Schedule H (Form 990) 2012
Page
Part VI
Supplemental Information
Complete this part to provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; Part V, Section A; and Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 10, 11, 12h, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any 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.
8 Facility reporting group(s). If applicable, for each hospital facility in a facility reporting group provide the descriptions required for Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 10, 11, 12h, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22.
Identifier ReturnReference Explanation
    Part I, Line 7: Part 1, Line 7Costing methodologyA ratio of cost to charges derived from Worksheet 2 was used in determining the amounts reported on Part I, lines 7a through 7d. The amounts are reported at cost and include both direct and indirect costs. Direct costs include salaries, employee benefits, supplies, and other costs that are directly attributable to the services. These direct costs would not exist if the service or program did not exist. Indirect costs are expenses not directly attributable to the service or programs but are included in the calculation of costs for total charity care and means-tested government programs. These costs include but are not limited to human resources, finance departments, insurance, support departments and overhead expenses.
    Part I, L7 Col(f): Per the financials, accounts receivable are written off against the allowance for doubtful accounts when management determines that recovery is unlikely and the Health System ceases collection efforts.
    Part II: Community Building ActivitiesIn addition to the extensive community health improvement services quantified in Schedule H, Part I and described more fully in Schedule O, Jeanes Hospital also engages in a number of community building activities. These include periodic blood drives held in partnership with the American Red Cross, as well as our promotion of healthy diet and exercise, including our new Farms to Family partnership with Common Market. While this program was started during our FYE June 30, 2014, expenses for planning and implementation were incurred during this reporting tax year.
    Part III, Line 4: The ratio of cost to charge method is used in determining the amounts reported on lines 2 and 3. The amounts on lines 2 and 3 are reported at cost and include both direct and indirect costs. Direct costs include salaries, employee benefits, supplies, and other costs that are directly attributable to the service and that would not exist if the service or program did not exist. Indirect costs are costs not attributed to the services or programs that are included in the calculation of costs for community benefit. These costs include but are not limited to human resources, finance departments, insurance, support departments and overhead expenses.
    Part III, Line 8: As a response to efforts to improve the health and quality of life of people living in the community, Jeanes Hospital provided $6,620,419 in unreimbursed services to patients enrolled in Medicare programs. Jeanes Hospital believes that the Medicare shortfall of $6,620,419 should be treated as a community benefit since it has a clear mission to serving and improving the health status of the elderly. For the nine months ended March 31, 2013, approximately 56% of all inpatients treated at Jeanes Hospital were over the age of 65 and if Jeanes should cease to exist, this shortfall would have to be absorbed by another hospital provider in the Jeanes community. In addition, Jeanes Hospital is designated as a Medicare Disproportionate Share Hospital (DSH). DSH hospitals are "safety net" hospitals because they serve predominantly low-income communities and have a substantial number of Medicare patients that also qualify for Medicaid coverage. The associated costs with providing care to these patients are frequently not covered by government sponsored programs.
    Part III, Line 9b: Jeanes Hospital's collection policy contains provisions on the collection practices to be followed for patients who are known to qualify for charity care. If an account does not qualify for charity care or qualifies for only a charity care discount, the normal billing process of four (4) statements over a span of at least 120 days will occur. If no patient response is received, a write-off request form will be completed by the collection specialist and submittted for proper signature authority for agency referral. Once approved, the account will be transferred to the Bad Debt Financial Class log . The account will be forwarded to the collection agency for additional collection effort.
Jeanes Hospital   Part V, Section B, Line 6i: As a member of the Temple University Health System, Jeanes Hospital participated in the development of the Pennsylvania Statewide Innovation Model lead by the Pennsylvania Department of Health. Through the Health system, Jeanes also participated in the Philadelphia Department of Health's Policy Working Group, which is focused on building a data-related public health infrastructure to address specific health needs such as hypertension, adult immunization, and cancer screening.
Jeanes Hospital   Part V, Section B, Line 7: Jeanes is addressing many of the needs identified in the CHNA. Some needs, such as dental care, however, are not among the clinical service that is provided by our hospital. To address cancer care, we are working in partnership with our affiliated Fox Chase Cancer Center. Although the federal government and HHS-funded Marketplace Navigators are in a better position to address needs of the uninsured, our Financial Services Departments continues to provide services for our patients and families, and is partnering with community stakeholders as our resources allow. All unmet needs are identified in our CHNA Implementation strategy, which is posted in plain view on our hospitals website at http://www.jeanes.com/content/community_health_information.htm. Our approach to unmet needs is explained in Section 7 of that report.
Jeanes Hospital   Part V, Section B, Line 18e: Jeanes Hospital made no such efforts in relation to Line 17.
Jeanes Hospital   Part V, Section B, Line 20d: Jeanes Hospital used a multiple of two times the base Medicaid rate.
Needs Assessment Tax Year Part V, Section B, Line 2 Please note the last needs assessment for Jeanes Hospital was done in FY 2013. However, 2013 could not be entered into the system due to fiscal year and calender year differences. As such, 2012 was entered in the line.
    Part VI, Line 2: Needs assessmentIn assessing community needs, Jeanes Hospital uses comprehensive sets of internal and external data sources. Externally, we rely largely on health data compiled by federal, state, and community-based health organizations, including the following: Community health assessment survey results from the Public Health Management Corporation (PHMC), including data on chronic health con- ditions, adult asthma, arthritis, diabetes, blood pressure, cholesterol, mental health, smoking, adult obesity, exercise, colonoscopies and PAP exams, mammograms and clinical breast exams; Disease rate data from the United States Center for Disease Control; Market data and quality assessments from the Pennsylvania Health Care Cost Containment Council (PHC4); Philadelphia Department of Public Health, including: the Philadelphia Vital Statistics Report, the Philadelphia Vital Statistics by Census Tract and Zip Code Report, the annual Health Center Service Area Report, and the Taking Philadelphia's Temperature report; Medpar data from the Centers for Medicare and Medicaid Services (CMS); Care Science Quality Manager from Premier; Other data from the Pennsylvania Department of Health, Delaware Valley Healthcare Council, etc.Internally, we rely on the following sources: Collaboration of Medical School and Hospital leadership; Consensus discussion with key clinical providers; Performance Improvement, Risk Management and Patient Safety outcomes; Historic, service line specific utilization data; Organizational community risk assessments (Infection Control, Environ- ment of Care, Emergency Management, Fire Safety Management, Disaster Response);In addition to data sources, we have assembled a community advisory board,for the past two decades, that reflects the needs and opinions of our service area. That board meets quarterly and it is used on an ad-hoc basis to represent the community we serve.
    Part VI, Line 3: The Financial Counselors assigned to Jeanes Hospital screen all uninsured and underinsured patients (including those with high deductibles and co-pays) who are hospitalized or require elective outpatient hospital services to determine their eligibility for government funded medical insurance coverage such as Medicaid and CHIP.Patients that meet the qualifications for these programs are assisted byfinancial counseling staff throughout each step of the applicationprocess. Medicaid applications are submitted by Jeanes Hospital on thepatients' behalf and tracked until final determination.Patients who do not qualify for government-funded programs are screenedfor Temple University Health System's Charity Care/Self Pay program todetermine their eligibility for free or reduced cost care.The Charity Care/Self Pay discounting policy is not restricted toEmergency Department patients, but is available to inpatients andoutpatients as well.Patients who contact the Hospital's Business Office concerning bills theyhave received that they cannot afford to pay are also screened for CharityCare eligibility.The Financial Counseling Staff at Jeanes Hospital also offers assistancein obtaining supplemental coverage as well as prescription drug benefits.Patients are informed of our financial services, and direction on howto access these services, through the following means:Posters in plain view at inpatient, outpatient and emergencyregistration areas and billing offices;Patient discharge summaries, billing invoices and vendor collectionnotices;Hospital website.
    Part VI, Line 4: Jeanes Hospital Service Area Community ProfileJeanes Hospital service area consists of the following zip codes: 19027, 19111, 19115, 19116, 19120, 19124, 19135, 19136, 19149 and 19152. This is an area with a high percentage of poor and undereducated population.A. Population and Population Growth The total population in Jeanes' service area has slightly increased over the past decade and is projected to increase by 1.2% from 2012 to 2017. In contrast, the total U.S. population has grown over the past decade, and is projected to grow by 3.9% over the next five years.B. Age Distribution Approximately 25% of the total population within Jeanes' service area is under the age of 18, consistent with the national average. 25.3% of the Jeanes service area population is age 18-34, 9.1% higher than the national average of 23.2%. 36.4% of the Jeanes service area population is age 35-64, 7.9% lower than the national average. 13.1% of the Jeanes service area population is over 65 years old, which is 1.7% higher than the national average of 12.9%. The average age of the Jeanes service area is projected to increase slightly over the next five years. Under 18 population is projected to increase by 2.1% from 2012 to 2017. The 65 and over population is projected to increase from 77,599 in 2012 to 82,065 in 2017, a projected increase of 5.8%.C. Education Level In 2012, the population in the Jeanes service area consisted of 61.0% with high school education or less, a rate approximately 40% higher than the national average of 43.7%. The Jeanes service area population consists of 39.0% with education beyond high school, approximately 31% lower than the national average of 56.3%.D. Unemployment and Household Income Unemployment In the city of Philadelphia, 10.6% of the total population were unemployed in 2011, approximately 34% higher than the state unemployment rate of 7.9% and 18% higher than the national unemployment rate of 9.0%.(Source: Bureau of Labor Statistics, US Department of Labor) Household Income Approximately 63% of households in the Jeanes service area earn less than $50,000 per year, approximately 24% greater than the national average of 50.4%. 37.3% of Jeanes service area households earn over $50,000 per year, which is approximately 25% lower than the national average of 49.6%.E. Population Below Federal Poverty Level There are 5 out of the total 10 zip codes within the Jeanes service area that the percentage of population living under the Federal poverty level is greater than the national level of 15.1%.F. Race/Ethnicity In Jeanes' service area, 40.5% of the total population is White, approximately 36% lower than the national level of 62.8%. Black is the second largest population in Jeanes' service area, comprising 27.2% of the population, compared to the national average of 12.3%. The percentage of Hispanics is 31.5% greater than the national level of 17.0%. Asian & Pacific is approximately 8% of the total population, 50.9% greater than the national average of 5.0%.G. Payer Mix in 2011 Approximately 72% of people in the Jeanes service area are covered by either Medicaid or Medicare; 35% for Medicaid and 37% for Medicare. This represents over twice the national average of 16.5% for Medicaid, and over two times of the national level of 15.2% for Medicare.
    Part VI, Line 5: Promotion of community healthJeanes Hospital is a nonprofit corporation that strives to be the destination for all who need ambulatory, inpatient acute, surgical and home care in Northeast Philadelphia and surrounding areas, by combining the compassionate nature of a Quaker-founded community hospital with the advanced capabilities of an academic medical center. Jeanes Hospital achieves this by espousing the following ideals: Create an extraordinary experience for everyone who enters our facilities for any reason; provide equal access to care for patients without regard to race, creed, religion, color, national origin, sex or sexual preference; make safety and continuous quality improvement a primary endeavor; promote the basic values of our Quaker heritage, to include kindness, equality and peace; combine the individual strengths of our hospital, medical staff, and health system; devote manpower and budgetary resources to provide health screenings, vaccinations and health education opportunities to our community; ensure that emotional, cultural and spiritual needs are met; provide a work environment that attracts, retains and develops the best employees; maintain a position of leadership in our community; value the wisdom of our board members, community and foundation liaisons, physician leaders and volunteers; use evidence-based research to understand the health needs of our community and respond accordingly, and espouse the core principles and stated values of the Temple University Health System.In addition to open medical staff, community board and reinvesting, Jeanes Hospital promotes the health of the community via: Free educational opportunities for the community; An arrangement with a diabetes education organization to offer on- campus education;
    Part VI, Line 6: Affiliated health care systemThe mission of the Temple University Health System, Inc. is to provide access to the highest quality of health care in both the community and academic settings. In furtherance of the mission of the Temple University Health System, the mission of Jeanes Hospital is to maintain and enhance the quality of life for individuals in the communities we serve. We emphasize the Quaker belief that in each person there resides a spirit that creates a common bond among us all. Jeanes' health care services include maintenance and enhancement of health, which quickens the spirit and enhances the vitality of our lives. The missions of other members of the Temple University Health System similarly advance its goals: Temple University Hospital supports Temple University and its Health Sciences Center academic programs by providing the clinical environment and service to support the highest quality teaching and training programs for health care professionals and to support the highest quality research programs; the Temple Health System Transport Team, Inc.'s mission is to provide the highest level of critical care transport services available in the mid-Atlantic region, and Temple Physicians, Inc.'s mission is to provide the highest quality of clinical care as well as to support the System's clinical, administrative, and corporate activities.
Schedule H (Form 990) 2012
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
2012
Open to Public
Inspection
Name of the organization
Jeanes Hospital
 
Employer identification number
23-2826045
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. Part II can be duplicated if additional space is needed.
(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) Temple University Health System
3509 N Broad Street Room 936
Philadelphia,PA19140 		23-2825881 501(c)(3) 7,000,000   N/A N/A General support






















2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................ Bullet Image
1
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
0
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2012

Schedule I (Form 990) 2012
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.
Part III can be duplicated 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












Part IV
Supplemental Information.
Complete this part to provide the information required in Part I, line 2, Part III, column (b), and any other additional information.
Identifier Return Reference Explanation
    The over $5,000 grant was made only for tax-exempt purposes to a related organization under common control. This grant is subject to review by the governing bodies and management of the related organizations.
Schedule I (Form 990) 2012


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
2012
Open to Public Inspection
Name of the organization
Jeanes Hospital
 
Employer identification number

23-2826045
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 or provision of all of the expenses described above? If "No," complete Part III to explain....
1b
 
 
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
 
 
3
Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
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 Regulations 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 Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2012

Schedule J (Form 990) 2012
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is 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) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.
(A) Name and Title (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 as deferred
in prior Form 990
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1)Larry Kaiser MDDirector (i)
(ii)		 0
1,384,709 		0
100,000 		0
19,867 		0
0 		0
20,624 		0
1,525,200 		0
0
(2)Verdi DisSesa MDEx Officio - Non Voting (i)
(ii)		 0
745,873 		0
0 		0
75,000 		0
0 		0
44,901 		0
865,774 		0
0
(3)Paul Karlin MDEx Officio - Non Voting (i)
(ii)		 0
289,448 		0
30,622 		0
436 		0
12,500 		0
29,802 		0
362,808 		0
0
(4)Linda GrassPresident & CEO (i)
(ii)		 316,660
0 		40,170
0 		6,000
0 		0
0 		7,171
0 		370,001
0 		0
0
(5)Beth KoobSecretary (i)
(ii)		 0
401,883 		0
99,096 		0
27,102 		0
33,212 		0
54,963 		0
616,256 		0
0
(6)Robert LuxAsst Treasurer (i)
(ii)		 0
444,107 		0
136,573 		0
24,067 		0
52,995 		0
76,709 		0
734,451 		0
0
(7)Thomas AlbenesiTreasurer / CFO (i)
(ii)		 0
366,008 		0
35,000 		0
18,775 		0
9,616 		0
38,124 		0
467,523 		0
0
(8)Andrea McCoyChief Medical Officer (i)
(ii)		 256,628
0 		25,236
0 		0
0 		12,500
0 		28,962
0 		323,326
0 		0
0
(9)Denise FrascaAHD - Patient Services (i)
(ii)		 163,089
0 		16,480
0 		449
0 		11,187
0 		24,096
0 		215,301
0 		0
0
(10)Stephanie KaoMedical Director (i)
(ii)		 198,244
0 		0
0 		77
0 		12,901
0 		14,835
0 		226,057
0 		0
0
(11)John WoodwardPhysician (i)
(ii)		 152,287
0 		0
0 		57,675
0 		0
0 		0
0 		209,962
0 		0
0
(12)Frank ShippAHD (i)
(ii)		 149,555
0 		7,759
0 		3,827
0 		0
0 		15,968
0 		177,109
0 		0
0
(13)Joseph SchofieldAHD (i)
(ii)		 109,525
0 		0
0 		76,911
0 		5,547
0 		936
0 		192,919
0 		0
0
(14)Hardik PatelAHD (i)
(ii)		 161,835
0 		486
0 		0
0 		0
0 		6,534
0 		168,855
0 		0
0
Schedule J (Form 990) 2012

Schedule J (Form 990) 2012
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II.
Also complete this part for any additional information.
Identifier Return Reference Explanation
Schedule J (Form 990) 2012

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
2012
Open to Public
Inspection
Name of the organization
Jeanes Hospital
 
Employer identification number

23-2826045
Identifier Return Reference Explanation
  Form 990, Part VI, Section A, line 1 Pursuant to the organization's bylaws, the Executive Committee consists of no less than five members of the Board, including the Chair, the Vice Chair, and the chairs of the Standing Committees. The Executive Committee is authorized to act for the Board between its regular meetings.
  Form 990, Part VI, Section A, line 6 The sole member of the organization is Temple University Health System, Inc. The member has the power to appoint and remove the organization's Board of Directors. The approval of the member is required for any of the following actions by the organization: (a) any dissolution or liquidation; (b) any merger; (c) any amendments to the articles of incorporation; (d) any amendments to the bylaws regarding the member, the number of directors, quorum or voting requirements; (e) the sale, pledge, lease (but only a lease from the organization of substantially all of the organization's real property), or other transfer of the assets of the organization other than transactions occurring in the ordinary course of business; (f) any decision resulting in the organization's ceasing to provide appropriate sites for Temple University School of Medicine for comprehensive acute care services; (g) any decision to merge with, acquire, or enter into an affiliation with a medical school other than Temple University's or a medical school hospital other than Temple University Hospital, Inc.; (h) the deletion of any clinical programs that are needed for the accreditation of Temple University School of Medicine; (i) the adoption of the organization's annual capital and operating budgets; (j) the issuance or assumption of any indebtedness in excess of five hundred thousand ($500,000), and (k) the execution of any contract providing for the management of the organization.
  Form 990, Part VI, Section A, line 7a Please refer to the response for question 6
  Form 990, Part VI, Section A, line 7b Please refer to the response for question 6
  Form 990, Part VI, Section B, line 11 After review by management and outside tax counsel, the 990 and 990-T (if any) are posted to the website of the Secretary's Office. Each Board Member is contacted and provided with the web address. A Board Member without internet access is provided a paper copy to review. The website and paper mailing have an overview of the 990 and 990-T preparation process and internal reviews. Each Board Member is asked to review the 990 and 990-T within 2 weeks and contact the Chief Financial Officer about any questions. In addition to the above process, the Audit Committee is provided a copy and the 990 and 990-T are reviewed at a regularly scheduled meeting.
  Form 990, Part VI, Section B, line 12c The Office of the Secretary provides each director and officer with copies of the conflicts of interest policy and a disclosure statement to be completed on an annual basis. The Office of the Secretary reviews the completed disclosure statements which are then reviewed in summary format by a committee of the Board of Directors and any recommended actions presented to the full Board of Directors. In addition to completing the annual disclosure statement, directors and officers must disclose potential or actual conflicts on an ongoing basis as matters arise. All disclosures are evaluated and a determination of whether a conflict exists is made by the Board or a committee of the Board. All employees are subject to a conflicts of interest policy that is monitored by the Office of the Secretary.
  Form 990, Part VI, Section B, line 15 There is a compensation committee that reviews and approves all total compensation of executive / key personnel at Temple University Health System through an evaluation performed by an external compensation expert before the compensation is approved.
  Form 990, Part VI, Section C, line 19 The Unaudited Internal Financial Statements of the Temple University Health System and certain of its related organizations are distributed and made available to the public at the end of each quarter as per the System's Continuing Disclosure Agreement (Series of 2007 Bond Issue) through the Digital Assurance Corp (DAC), the Municipal Services Reporting Board's EMMA disclosure site and the Health System's financial web site. The Annual Audited Financial Statements are also released to the public in the same manner. To the extent required by applicable law, the organization makes its governing documents available to the public upon request.
Other Fees Form 990, Part IX, line 11g Agency: Program service expenses 371,634. Management and general expenses 0. Fundraising expenses 0. Total expenses 371,634. TU & TUHS Salary Charges: Program service expenses 5,522,854. Management and general expenses 532,255. Fundraising expenses 0. Total expenses 6,055,109. Professional Fees: Program service expenses 8,792,736. Management and general expenses 0. Fundraising expenses 0. Total expenses 8,792,736. Service Contracts: Program service expenses 179,543. Management and general expenses 4,184. Fundraising expenses 0. Total expenses 183,727. Purchased Services: Program service expenses 4,727,527. Management and general expenses 1,035,730. Fundraising expenses 0. Total expenses 5,763,257. Corporate Charge: Program service expenses 0. Management and general expenses 3,487,657. Fundraising expenses 0. Total expenses 3,487,657.
Changes in Net Assets or Fund Balances: Form 990, Part XI, line 9: Adjustment to funded status of pension liability 5,913,565. Fair Value Change of Permanently Restricted Trust 1,039,306. Rounding -51.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2012

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
2012
Open to Public Inspection
Name of the organization
Jeanes Hospital
 
Employer identification number

23-2826045
Part I
Identification of Disregarded Entities (Complete if the organization answered "Yes" to Form 990, Part IV, line 33.)
(a)
Name, address, and EIN (if applicable) 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" to 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 entity?
Yes No
(1) Temple University of the Commonwealth System

300 Sullivan Hall 1330 W Berks St

Philadelphia,PA19122
23-1365971 		Education PA 501c3 Line 2 N/A
 
No
(2) Temple University Health System Inc

3509 N Broad Street Room 936 c/o TU

Philadelphia,PA19140
23-2825881 		Health Care PA 501c3 Line 11a, I Temple University of the Commonwealth System
 
 
No
(3) Temple University Health System Foundation Inc

3509 N Broad Street Room 936 c/o TU

Philadelphia,PA19140
23-2916108 		Health Care PA 501c3 Line 11a, I Temple University Hospital Inc
 
 
No
(4) Temple University Hospital Inc

3509 N Broad Street Room 936 c/o TU

Philadelphia,PA19140
23-2825878 		Health Care PA 501c3 Line 3 Temple University Health System Inc
 
 
No
(5) Jeanes Hospital Auxiliary

7600 Central Avenue

Philadelphia,PA19111
23-1917776 		Health Care PA 501c3 Line 9 Jeanes Hospital
 
Yes
 
(6) Temple East Inc

3509 N Broad Street Room 936 c/o TU

Philadelphia,PA19140
23-2547305 		Health Care PA 501c3 Line 11a, I Temple University Hospital Inc
 
 
No
(7) Temple East Real Estate Inc

3509 N Broad Street Room 936 c/o TU

Philadelphia,PA19140
20-1776524 		Health Care PA 501c3 Line 11a, I Temple University Hospital Inc
 
 
No
(8) Temple Physicians Inc

3509 N Broad Street Room 936 c/o TU

Philadelphia,PA19140
23-2790607 		Health Care PA 501c3 Line 9 Temple University Health System Inc
 
 
No
(9) Temple Health System Transport Team Inc

3509 N Broad Street Room 936 c/o TU

Philadelphia,PA19140
75-3084023 		Health Care PA 501c3 Line 9 Temple University Health System Inc
 
 
No
(10) Episcopal Hospital

3509 N Broad Street Room 936 c/o TU

Philadelphia,PA19140
23-1365351 		Health Care PA 501c3 Line 11a, I Temple University Hospital Inc
 
 
No
(11) Anna T Jeanes Foundation

7600 Central Avenue

Philadelphia,PA19111
23-2203406 		Health Care PA 501c3 Line 11d, III-O N/A
 
No
(12) American Oncologic Hospital

3509 N Broad Street Room 936 c/o TU

Philadelphia,PA19140
23-1352156 		Health Care PA 501c3 Line 3 Temple University Health System Inc
 
 
No
(13) Institute for Cancer Research

3509 N Broad Street Room 936 c/o TU

Philadelphia,PA19140
23-6296135 		Health Care DE 501c3 Line 4 American Oncologic Hospital
 
 
No
(14) Fox Chase Cancer Medical Group

3509 N Broad Street Room 936 c/o TU

Philadelphia,PA19140
45-4540585 		Health Care PA 501c3 Line 3 American Oncologic Hospital
 
 
No
(15) Fox Chase Network Inc

3509 N Broad Street Room 936 c/o TU

Philadelphia,PA19140
23-2467337 		Health Care PA 501c3 Line 11b, II American Oncologic Hospital
 
 
No
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to 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" to 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
 		(i)
Section 512(b)(13) controlled entity?
Yes No
(1) TUHS Insurance Company LTD

3509 N Broad Street 9th Floor - c/o
Philadelphia,PA19140
 Malpractice insurance BD Temple University Health System Inc
  		          No
(2) Fox Chase Ltd

333 Cottman Avenue
Philadelphia,PA19111
   PA AOH
  		C         No










Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 3
Part V
Transactions With Related Organizations (Complete if the organization answered "Yes" to Form 990, Part IV, line 34, 35b, or 36.)
Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
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 or (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
 
No
b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
Yes
 
c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
Yes
 
d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
Yes
 
f Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
Yes
 
i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
Yes
 
k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1k
 
No
l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
Yes
 
m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1m
Yes
 
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1n
Yes
 
o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
Yes
 
p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
Yes
 
q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
Yes
 
r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
 
No
s Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1s
 
No
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-s) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1) Jeanes Hospital Auxiliary

 P 95,434 Cash received





Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to 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)
Predominant income (related, unrelated, excluded from tax under section 512-514)

(e)
Are all partners
section
501(c)(3)
organizations? 		(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 Yes No






























Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
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


Software ID:  
Software Version: