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
COLUMBIA-MONTOUR HOME HEALTH SVCS-
VISITING NURSES ASSOCIATION INC
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
100 NORTH ACADEMY AVENUE MC 49-70
 
Room/suite
City or town, state or country, and ZIP + 4
DANVILLE, PA17822
D Employer identification number

23-1704399
E Telephone number

G Gross receipts $ 6,827,368
F Name and address of principal officer:
GLENN D STEELE MD PHD
100 NORTH ACADEMY AVENUE MC 22-01
DANVILLE,PA17822
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.CMHHS.NET
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: 1967
M State of legal domicile: PA
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: COLUMBIA MONTOUR HOME HEALTH SERVICES (CMHHS) SHALL DELIVER COMPREHENSIVE HOME HEALTH SERVICES OF HIGH QUALITY TO MEMBERS OF THE COMMUNITY WITHOUT REGARD TO AGE, GENDER, COLOR, CREED, NATIONAL ORIGIN, DISABILITY STATUS, DIAGNOSIS OR SOCIO-ECONOMIC STATUS WITHIN THE CONSTRAINT OF MAINTAINING FINANCIAL VIABILITY.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 4
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 0
5 Total number of individuals employed in calendar year 2011 (Part V, line 2a) ...... 5 108
6 Total number of volunteers (estimate if necessary) ............. 6 89
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 0
b Net unrelated business taxable income from Form 990-T, line 34 ......... 7b  
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 510,422 510,589
9 Program service revenue (Part VIII, line 2g) ......... 3,988,816 4,023,004
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 14 -5,753
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 315,764 878
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 4,815,016 4,528,718
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...   0
14 Benefits paid to or for members (Part IX, column (A), line 4).....   0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 3,553,787 3,499,009
16a Professional fundraising fees (Part IX, column (A), line 11e).....   0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 1,197,388 1,249,754
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 4,751,175 4,748,763
19 Revenue less expenses. Subtract line 18 from line 12....... 63,841 -220,045
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 5,439,510 3,002,122
21 Total liabilities (Part X, line 26)............. 344,895 105,470
22 Net assets or fund balances. Subtract line 21 from line 20..... 5,094,615 2,896,652
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: COLUMBIA MONTOUR HOME HEALTH SERVICES (CMHHS) SHALL DELIVER COMPREHENSIVE HOME HEALTH SERVICES OF HIGH QUALITY TO MEMBERS OF THE COMMUNITY WITHOUT REGARD TO AGE, GENDER, COLOR, CREED, NATIONAL ORIGIN, DISABILITY STATUS, DIAGNOSIS OR SOCIO-ECONOMIC STATUS WITHIN THE CONSTRAINT OF MAINTAINING FINANCIAL VIABILITY.
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 $ 4,079,208 including grants of $   ) (Revenue $ 4,014,252 )
SEE SCHEDULE O I. GENERAL PROGRAM SERVICE INFORMATION CMHHS WAS ESTABLISHED IN JULY 1967 AS A 501(C)(3) NOT-FOR-PROFIT CORPORATION TO PROVIDE HOME HEALTH AND HOSPICE SERVICES IN CENTRAL PENNSYLVANIA. CMHHS IS LOCATED IN BLOOMSBURG, PA. CMHHS INCLUDES THREE MAJOR PROGRAMS: COLUMBIA MONTOUR HOME HEALTH: A HOME HEALTH PROGRAM THAT PROVIDES SERVICES TO PATIENTS IN CENTRAL PENNSYLVANIA. SKILLED NURSING, HOME HEALTH AIDE, MEDICAL SOCIAL WORK, AS WELL AS PHYSICAL, OCCUPATIONAL AND SPEECH THERAPY SERVICES WHICH ARE AVAILABLE 24 HOURS A DAY. IN ADDITION, THE AGENCY PROVIDES LIMITED MATERNAL/CHILD HEALTH SERVICES. COLUMBIA MONTOUR HOME HOSPICE: A HOSPICE PROGRAM THAT PROVIDES CARE TO THE PATIENT WHO IS TERMINALLY ILL WITH A LIFE EXPECTANCY OF 6 MONTHS OR LESS. BASE SERVICES INCLUDE: SKILLED NURSING, HOSPICE AIDE, MEDICAL SOCIAL WORK, SPIRITUAL CARE, BEREAVEMENT. IN ADDITION, PHYSICAL THERAPY, OCCUPATIONAL THERAPY, AND SPEECH THERAPY ARE UTILIZED WHEN THE PATIENT CAN BENEFIT FROM THOSE DISCIPLINES. NEEDS OF THE HOSPICE PATIENT FAMILY ARE ALSO ADDRESSED BY THE HOSPICE TEAM, IE. CAREGIVER STRESS, DEPRESSION, ANXIETY. HOSPICE SERVICES ARE PROVIDED TO PATIENTS IN CENTRAL PENNSYLVANIA AND ARE AVAILABLE 24 HOURS A DAY. PATIENTS ARE SERVED IN THEIR PLACE OF RESIDENCE - THEIR HOME, SKILLED NURSING FACILITY OR ASSISTED LIVING FACILITY. THE HOME HEALTH AND HOSPICE PROGRAMS ARE BOTH MEDICARE AND MEDICAID CERTIFIED, AND THEREFORE MAY PROVIDE HOME HEALTH AND HOSPICE SERVICES TO ALL PAYOR CATEGORIES. NURSE FAMILY PARTNERSHIP: A RESEARCH BASED MOM/BABY PROGRAM PROVIDED VIA GRANT FUNDING TO ELIGIBLE CLIENTS IN COLUMBIA, MONTOUR, SNYDER, LOWER LUZERNE, AND UPPER NORTHUMBERLAND COUNTIES IN CENTRAL PENNSYLVANIA. GOALS OF THE PROGRAM ARE: IMPROVE HEALTH DURING PREGNANCY, PROMOTE HEALTH CHILD DEVELOPMENT, AND PROMOTE A POSITIVE MATERNAL LIFE COURSE. II. UNCOMPENSATED CARE CMHHS RECOGNIZES THAT ITS MISSION IS TO DELIVER COMPREHENSIVE HOME HEALTH SERVICES OF HIGH QUALITY TO MEMBERS OF THE COMMUNITY WITHOUT REGARD TO AGE, GENDER, COLOR, CREED, NATIONAL ORIGIN, DISABILITY STATUS, DIAGNOSIS OR SOCIO-ECONOMIC STATUS WITHIN THE CONSTRAINT OF MAINTAINING FINANCIAL VIABILITY. IN THIS REGARD, CMHHS PROVIDES FREE OR SUBSIDIZED CARE BELOW COST AND SUPPORTS VARIOUS HEALTH ACTIVITIES AND PROGRAMS IN SUPPORT OF THE COMMUNITY. A. MEDICARE/MEDICAID IN RECOGNIZING ITS MISSION TO THE COMMUNITY, CMHHS PROVIDES CARE, BELOW COST, TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS. TO THE EXTENT REIMBURSEMENT IS BELOW THE COST OF PROVIDING HEALTHCARE, CMHHS IS FURTHERING ITS MISSION TO THE COMMUNITY. THE UNREIMBURSED VALUE OF MEDICARE AND/OR MEDICAID IS EQUAL TO THE COST OF PROVIDING SERVICES LESS THE AMOUNT RECEIVED AS REIMBURSEMENT UNDER THE PROGRAM. THE UNREIMBURSED VALUE OF PROVIDING CARE TO THESE PATIENTS WAS 95,321 DURING THE FISCAL YEAR ENDED JUNE 30, 2013. B. OTHER UNCOMPENSATED PATIENT SERVICES IN ADDITION TO THE ABOVE, CMHHS PROVIDES OTHER PATIENT SERVICES FOR WHICH FULL PAYMENT IS NOT RECEIVED. THE UNCOMPENSATED COST OF PROVIDING SUCH PATIENT SERVICES DURING THE FISCAL YEAR ENDED JUNE 30, 2013 WAS 1,631. III.RESEARCH SUPPORT CMHHS CONTRIBUTED 66,409 TO GEISINGER CLINIC TO SUPPORT ITS CHARITABLE MISSION THROUGH MEDICAL RESEARCH ACTIVITIES AT TWO FACILITIES ON THE CAMPUS OF THE GEISINGER MEDICAL CENTER: THE SIEGFRIED AND JANET WEIS CENTER FOR RESEARCH (WEIS CENTER) AND THE GEISINGER CENTER FOR HEALTH RESEARCH (GCHR). WEIS CENTER PROVIDES A FOCUS FOR LABORATORY RESEARCH AND RESEARCH TRAINING, AND SUPPORTS THE CLINICAL STAFF IN ITS RESEARCH PROGRAMS. THE PRIMARY MISSION OF THE WEIS CENTER IS TO CONDUCT ORIGINAL AND INNOVATIVE RESEARCH THAT CONTRIBUTES NEW KNOWLEDGE TO BIOMEDICAL SCIENCE. THIS RESEARCH CENTER IS HOME TO THE HENRY HOOD RESEARCH PROGRAM. THE PREEMINENT FUNCTION OF THE HOOD RESEARCH PROGRAM IS TO CONDUCT ORIGINAL AND INNOVATIVE RESEARCH OF WORLD CLASS QUALITY. THE CENTER'S SCIENTISTS APPLY MODERN MOLECULAR AND CELLULAR APPROACHES TO DIVERSE RESEARCH PROBLEMS IN THE AREAS OF CARDIOVASCULAR FUNCTION, CANCER AND DEVELOPMENTAL BIOLOGY. GCHR CONDUCTS HEALTH SERVICES, EPIDEMIOLOGIC AND POPULATION GENETICS RESEARCH ON THE BROAD RANGE OF CONDITIONS TYPICALLY SEEN IN PRIMARY AND SPECIALTY CARE SETTINGS. GCHR ALSO INVESTIGATES EXTRAMURAL RESOURCES FOR FUNDING OF CLINICAL RESEARCH. TOGETHER WITH THE WEIS CENTER, GCHR IS ALSO BUILDING THE CAPABILITY FOR POPULATION-BASED GENETICS RESEARCH. IV. COMMUNITY HEALTH, EDUCATION, AND OUTREACH CMHHS SERVES THE COMMUNITY THRU PROVISION OF THE FOLLOWING UNCOMPENSATED PROGRAMS VALUED AT 18,136 FOR FISCAL YEAR ENDED JUNE 30, 2013: HEALTH FAIRS AND SCREENINGS COMMUNITY BEREAVEMENT GROUPS BEREAVEMENT CAMP FOR CHILDREN BEREAVEMENT RETREAT FOR PARENTS COMMUNITY HEALTH EDUCATION V. VOLUNTEER SERVICES THE VOLUNTEERS OF THE HOSPICE PROGRAM ARE AN ACTIVE AND VITAL PART OF THE ACTIVITIES AND MISSION OF COLUMBIA MONTOUR HOME HEALTH SERVICE. VOLUNTEERS FROM LOCAL COMMUNITIES HAVE CONTRIBUTED 6,948 HOURS TOWARD THE COMMON PURPOSE OF SERVICING THE HEALTHCARE OF THE COMMUNITY. THE VALUE OF THIS CONTRIBUTION IS GIVEN BACK TO THE COMMUNITY THROUGH LOWER COSTS, VALUED AT 159,248. VI. COMMUNITY BENEFIT SUMMARY MEDICARE/MEDICAID SHORTFALL 95,321 OTHER COMPENSATED CARE 1,631 RESEARCH SUPPORT 66,409 COMMUNITY HEALTH, EDUCATION, AND OUTREACH 18,136 VOLUNTEER SERVICES (VALUED AT 01/01/2013 STATEWIDE AVERAGE WEEKLY WAGE) 159,248 TOTAL 340,745 VI. OPERATIONAL CHANGES EXPECTED DURING FISCAL 2014 DURING FISCAL 2014, THE NURSE FAMILY PARTNERSHIP PROGRAM WILL BE TRANSITIONED TO GEISINGER CLINIC, A 501(C)(3) AFFILIATE OF CMHHS.
4b (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4c (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4d Other program services (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet4,079,208
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 IClick to see attachment..........
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 IIClick to see attachment........
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If “Yes,” complete Schedule C,
Part IIIClick to see attachment............................
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts 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
 
No
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
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part 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
 
No
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....
20a
 
No
b
If “Yes” to line 20a, did the organization attach a copy of its audited financial statements to this return?
20b
 
 
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...
21
 
No
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........
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........................... Click to see attachment
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II...................... Click to see attachment
32
Yes
 
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
Yes
 
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
6
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
108
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
 
No
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
 
 
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
4
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
0
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
Yes
 
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? ...........................
4
Yes
 
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
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
 
No
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O.......
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
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
 
No
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
 
 
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:
MediumBulletSCOTT GALLAGHER DIRECTOR FINANCE109 WOODBINE LANEDANVILLEPA17821 (570) 271-7087
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) GLENN D STEELE JR MD PHD........................................................................
PRES,CHAIR,
 0.00
.......................40.00 		X   X       0 2,062,556 418,454
(2) DENISE B PRINCE........................................................................
DIRECTOR
 0.00
.......................40.00 		X           0 373,596 30,282
(3) FRANK J TREMBULAK........................................................................
SR VP, TREAS
 0.00
.......................40.00 		X   X       0 1,245,352 216,867
(4) JOANNE E WADE........................................................................
DIRECTOR
 0.00
.......................40.00 		X           0 1,170,997 201,114
(5) DAVID J FELICIO ESQUIRE........................................................................
CLO, SECRETA
 0.00
.......................40.00 		    X       0 512,681 140,659
(6) EDWARD J ZYCH ESQUIRE........................................................................
ASSISTANT SE
 0.00
.......................40.00 		    X       0 344,575 65,798
(7) KEVIN F BRENNAN CPA FHFMA........................................................................
EVP, FINANCE
 0.00
.......................40.00 		    X       0 1,079,326 202,187
(8) JANE GITTLER RN MSN........................................................................
CEO
 40.00
.......................0.00 		    X       126,690 0 20,337
(9) SUSAN S SMITH MSN CHPN........................................................................
HOSPICE MANA
 40.00
.......................0.00 		        X   117,159 0 23,081
(10) PATRICIA A MAANI FOGELMAN CRNPDNP........................................................................
NURSE PRACTI
 40.00
.......................0.00 		        X   781 104,323 18,117
(11) MARY HOWE........................................................................
PERSONNEL DI
 40.00
.......................0.00 		        X   57,232 55,647 12,111
(12) LOREEN G COMSTOCK RN........................................................................
ADMINSTRATOR
 40.00
.......................0.00 		        X   108,722 0 15,581










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;


























1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 410,584 6,949,053 1,364,588
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet5
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
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet  
Form 990 (2012)
Form 990 (2012)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response to any question in this Part VIII ..............
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, Gifts, Grants and Other Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d  
e Government grants (contributions)1e  
f All other contributions, gifts, grants, and
similar amounts not included above1f 		510,589
g Noncash contributions included in lines
1a-1f:$ 		 
h Total. Add lines 1a-1f.......MediumBullet 510,589
Program Service Revenue Business Code
2a NET PATIENT SERVICE REVENUE 621610 4,011,389 4,011,389    
b RENT FROM AFFILIATE 531120 9,630     9,630
c IC SHARED SERVICE 541900 1,985 1,985    
d
e
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 4,023,004
Other Revenue 3 Investment income (including dividends, interest, and other similar amounts).......MediumBullet 2,989     2,989
4 Income from investment of tax-exempt bond proceeds..MediumBullet        
5 Royalties...........MediumBullet        
(i) Real (ii) Personal
6a Gross rents    
b Less: rental expenses    
c Rental income or (loss)    
d Net rental income or (loss).......MediumBullet        
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 2,289,908  
b Less: cost or other basis and sales expenses 2,298,650  
c Gain or (loss) -8,742  
d Net gain or (loss)..........MediumBullet -8,742     -8,742
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 OTHER OPERATING REVENUE 900099 878 878    
b            
c            
d All other revenue ....        
e Total. Add lines 11a–11d ...... MediumBullet 878
12 Total revenue. See Instructions......MediumBullet 4,528,718 4,014,252   3,877
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    
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 .... 147,027   147,027  
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .... 140,240 140,240    
7 Other salaries and wages 2,560,670 2,309,921 250,749  
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 111,298 95,753 15,545  
9 Other employee benefits ....... 329,028 283,072 45,956  
10 Payroll taxes ........... 210,746 202,317 8,429  
11 Fees for services (non-employees):        
a Management ......        
b Legal .........        
c Accounting ........... 13,164   13,164  
d Lobbying ........... 112   112  
e Professional fundraising services. See Part IV, line 17    
f Investment management fees ...... 1,989   1,989  
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ........ 246,024 210,204 35,820  
12 Advertising and promotion .... 10,271 5,569 4,702  
13 Office expenses ....... 200,227 154,181 46,046  
14 Information technology ...... 372 372    
15 Royalties ..        
16 Occupancy ........... 17,958 15,427 2,531  
17 Travel ............ 134,824 125,996 8,828  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ......        
19 Conferences, conventions, and meetings .... 2,134 2,134    
20 Interest ...........        
21 Payments to affiliates .......        
22 Depreciation, depletion, and amortization ..... 15,218 13,073 2,145  
23 Insurance .............. 21,980 21,980    
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 DRUGS AND PHARMACEUTICALS 246,465 246,465    
b INTERCOMPANY EXPENSES 223,185 138,503 84,682  
c MEDICAL SUPPLIES 68,841 68,841    
d LICENSES AND FEES 34,960 33,130 1,830  
e All other expenses 12,030 12,030    
25 Total functional expenses. Add lines 1 through 24e 4,748,763 4,079,208 669,555 0
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 ............. 43,587 1  
2 Savings and temporary cash investments ......... 1,383,282 2 2,534,780
3 Pledges and grants receivable, net ...........   3  
4 Accounts receivable, net ............. 555,500 4 424,965
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 .............. 23,179 8  
9 Prepaid expenses and deferred charges .......... 29,680 9  
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 15,218
b Less: accumulated depreciation ..... 10b 15,218 92,510 10c  
11 Investments—publicly traded securities .......... 2,395,007 11  
12 Investments—other securities. See Part IV, line 11 .....   12  
13 Investments—program-related. See Part IV, line 11 .....   13  
14 Intangible assets ...............   14  
15 Other assets. See Part IV, line 11 ........... 916,765 15 42,377
16 Total assets. Add lines 1 through 15 (must equal line 34)...... 5,439,510 16 3,002,122
Liabilities 17 Accounts payable and accrued expenses ......... 334,263 17 97,382
18 Grants payable .................   18  
19 Deferred revenue ................   19  
20 Tax-exempt bond liabilities .............   20  
21 Escrow or custodial account liability. Complete Part IV of Schedule D..   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 ....   24  
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.................... 10,632 25 8,088
26 Total liabilities. Add lines 17 through 25......... 344,895 26 105,470
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 .............. 3,213,828 27 2,896,652
28 Temporarily restricted net assets ........... 1,758,650 28  
29 Permanently restricted net assets ........... 122,137 29  
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 ........... 5,094,615 33 2,896,652
34 Total liabilities and net assets/fund balances ........ 5,439,510 34 3,002,122
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
4,528,718
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
4,748,763
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
-220,045
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
5,094,615
5
Net unrealized gains (losses) on investments ...............
5
59,321
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
-2,037,239
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))
10
2,896,652
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
COLUMBIA-MONTOUR HOME HEALTH SVCS-
VISITING NURSES ASSOCIATION INC
Employer identification number

23-1704399
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.") . 532,030 512,555 660,676 510,422 510,589 2,726,272
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...... 3,753,648 4,022,611 4,535,677 3,988,816 4,023,004 20,323,756
3 Gross receipts from activities that are not an unrelated trade or business under section 513..         9,630 9,630
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. 4,285,678 4,535,166 5,196,353 4,499,238 4,543,223 23,059,658
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.)           23,059,658
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... 4,285,678 4,535,166 5,196,353 4,499,238 4,543,223 23,059,658
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. 9,652 6,360 6,400 14 2,989 25,415
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.            
c Add lines 10a and 10b. 9,652 6,360 6,400 14 2,989 25,415
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.) .. 291,111 296,830 385,106 322,025 878 1,295,950
13 Total support. (Add lines 9, 10c, 11, and 12.).. 4,586,441 4,838,356 5,587,859 4,821,277 4,547,090 24,381,023
14
Section C. Computation of Public Support Percentage
15
15
94.580 %
16
16
93.970 %
Section D. Computation of Investment Income Percentage
17
17
0 %
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
2008: 17,208 SUPPORT SERVICES 202,051 AFFLILIATE SUPPORT SERVICES 65,960 ADMINISTRATIVE FEES 2,772 FLU CLINIC 3,120 TELEMONITORING 2009: 2,716 SUPPORT SERVICES 218,074 AFFLILIATE SUPPORT SERVICES 70,550 ADMINISTRATIVE FEES 5,450 TELEMONITORING 40 MISCELLANEOUS 2010: 4,541 SUPPORT SERVICES 223,573 AFFLILIATE SUPPORT SERVICES 68,510 ADMINISTRATIVE FEES 85,105 NET ASSETS RELEASED FROM RESTRICTION 3,290 TELEMONITORING 87 MISCELLANEOUS 2011: 3,341 SUPPORT SERVICES 159,023 AFFLILIATE SUPPORT SERVICES 64,345 ADMINISTRATIVE FEES 87,966 NET ASSETS RELEASED FROM RESTRICTION 7,350 TELEMONITORING 2012: 604 FLEX SPENDING FORFEITURES 274 REBATES
 
 
 
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
COLUMBIA-MONTOUR HOME HEALTH SVCS-
VISITING NURSES ASSOCIATION INC
Employer identification number

23-1704399
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
COLUMBIA-MONTOUR HOME HEALTH SVCS-
VISITING NURSES ASSOCIATION INC 		Employer identification number

23-1704399
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
COLUMBIA-MONTOUR HOME HEALTH SVCS-
VISITING NURSES ASSOCIATION INC 		Employer identification number

23-1704399
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
COLUMBIA-MONTOUR HOME HEALTH SVCS-
VISITING NURSES ASSOCIATION INC 		Employer identification number

23-1704399
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 C
(Form 990 or 990-EZ)

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

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet Complete if the organization is described below.SchCMd Bullet Attach to Form 990 or Form 990-EZ.
SchCMd Bullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public
Inspection
If the organization answered “Yes” to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet Section 527 organizations: Complete Part I-A only.
If the organization answered “Yes” to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered “Yes” to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, Part V, line 35c (Proxy Tax), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
COLUMBIA-MONTOUR HOME HEALTH SVCS-
VISITING NURSES ASSOCIATION INC
Employer identification number

23-1704399
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization’s direct and indirect political campaign activities in Part IV.
2
Political expenditures ....................................SchCMd Bullet
$  
3
Volunteer hours ........................................
 

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

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

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










For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2012

Schedule C (Form 990 or 990-EZ) 2012
Page 2
Part II-A
Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).
A Check SchCMd Bulletexpenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.) 		(a) Filing
organization's
totals 		(b) Affiliated group
totals
1a Total lobbying expenditures to influence public opinion (grass roots lobbying) ......    
b Total lobbying expenditures to influence a legislative body (direct lobbying) .......    
c Total lobbying expenditures (add lines 1a and 1b) ...................    
d Other exempt purpose expenditures ........................    
e Total exempt purpose expenditures (add lines 1c and 1d) ...............    
f Lobbying nontaxable amount. Enter the amount from the following table in both
columns.		    
  If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:    
  Not over $500,00020% of the amount on line 1e.    
  Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.    
  Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.    
  Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.    
  Over $17,000,000$1,000,000.    
       
g Grassroots nontaxable amount (enter 25% of line 1f) .................    
h Subtract line 1g from line 1a. If zero or less, enter -0-. ................    
i Subtract line 1f from line 1c. If zero or less, enter -0-. ................    
j If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting
section 4911 tax for this year? ......................................

4-Year Averaging Period Under Section 501(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five
columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
  Calendar year (or fiscal year
beginning in) 		(a) 2009 (b) 2010 (c) 2011 (d) 2012 (e) Total
             
2a Lobbying nontaxable amount          
             
b Lobbying ceiling amount
(150% of line 2a, column(e)) 		         
             
c Total lobbying expenditures          
             
d Grassroots nontaxable amount          
             
e Grassroots ceiling amount
(150% of line 2d, column (e))		          
             
f Grassroots lobbying expenditures          
Schedule C (Form 990 or 990-EZ) 2012


Schedule C (Form 990 or 990-EZ) 2012
Page 3
Part II-B
Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).
For each “Yes” response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.
(a)
No
Yes
(b)
Amount
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? .........................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....
 
No
c
Media advertisements? ....................................
 
No
 
d
Mailings to members, legislators, or the public? .........................
 
No
 
e
Publications, or published or broadcast statements? .......................
 
No
 
f
Grants to other organizations for lobbying purposes? .......................
 
No
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? ........
 
No
 
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
 
No
 
i
Other activities? ..........................
Yes
 
112
j
Total. Add lines 1c through 1i ...............................
112
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 .................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....
 
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......
 
 
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members? ................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ................
2
 
 
3
Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered “No” OR (b) Part III-A, line 3, is answered “Yes."
1
Dues, assessments and similar amounts from members .....................
1
 
2
Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).
a
Current year .........................................
2a
 
b
Carryover from last year ....................................
2b
 
c
Total ............................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) ..............
5
 
Part IV
Supplemental Information
Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, line 2; and Part ll-B, line 1. Also, complete this part for any additional information.
Identifier Return Reference Explanation
  SCHEDULE C, PART II-B, LINE 1 A PORTION OF MEMBERSHIP DUES PAID TO THE PENNSYLVANIA HOSPICE NETWORK AND THE NATIONAL HOSPICE AND PALLATIVE CARE ORGANIZATION WAS USED FOR LOBBYING ACTIVITIES.
Schedule C (Form 990 or 990EZ) 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
COLUMBIA-MONTOUR HOME HEALTH SVCS-
VISITING NURSES ASSOCIATION INC
Employer identification number

23-1704399
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 .... 80,086,000 77,598,000 75,302,000 71,078,000 88,270,000
b Contributions ........ 8,933,000 5,172,000 627,000 1,148,000 1,005,000
c Net investment earnings, gains, and losses 9,257,000 -9,000 13,943,000 8,379,000 -13,762,000
d Grants or scholarships .....          
e Other expenditures for facilities
and programs ........ 		-3,614,000 -2,675,000 -12,274,000 -5,303,000 -4,435,000
f Administrative expenses ....          
g End of year balance ...... 94,662,000 80,086,000 77,598,000 75,302,000 71,078,000
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet25.000 %
b
Permanent endowment SchDMd Bullet65.000 %
c
Temporarily restricted endowment SchDMd Bullet10.000 %
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)
 
No
(ii) related organizations ........................
3a(ii)
Yes
 
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
Yes
 
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 .................      
b Buildings ................        
c Leasehold improvements ............        
d Equipment ................   15,218 15,218  
e Other .................        
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet  
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    
Other








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








Total. (Column (b) 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








Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet  
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of liability (b) Book value
Federal income taxes  
MEDICAL LEGAL CLAIMS ALLOWANCE 8,088
DUE TO AFFILIATE  







Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 8,088
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
SUPPLEMENTAL FINANCIAL INFORMATION SCHEDULE D, PAGE 4, PART XIII PART V, LINE 4 - INTENDED USES FOR ENDOWMENT FUNDS ENDOWMENT FUNDS ARE USED BY THE GEISINGER HEALTH SYSTEM TO SUPPORT PATIENT CARE, RESEARCH, EDUCATION, AND CAPITAL AND PROGRAM EXPENSES. PART X - LIABILITY UNDER FIN 48 FOOTNOTE EFFECTIVE JULY 1, 2007, GEISINGER HEALTH SYSTEM(1) ("GHS") ADOPTED FASB INTERPRETATION NO. 48, ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES, AN INTERPRETATION OF FASB STATEMENT NO. 109 ("FIN 48"). FIN 48 CLARIFIES THE ACCOUNTING AND REPORTING FOR INCOME TAXES WHERE INTERPRETATION OF THE TAX LAW MAY BE UNCERTAIN. FIN 48 PRESCRIBES A COMPREHENSIVE MODEL FOR THE FINANCIAL STATEMENT RECOGNITION, MEASUREMENT, PRESENTATION AND DISCLOSURE OF INCOME TAX UNCERTAINTIES WITH RESPECT TO POSITIONS TAKEN OR EXPECTED TO BE TAKEN IN INCOME TAX RETURNS. THE ADOPTION OF FIN 48 HAD NO IMPACT ON UNRESTRICTED NET ASSETS AS OF JUNE 30, 2013 OR ANY PREVIOUS YEARS SINCE ADOPTION. ACCORDINGLY, NO FIN 48 FOOTNOTE DISCLOSURE WAS MADE IN THE JUNE 30, 2013 GHS CONSOLIDATED FINANCIAL STATEMENTS. (1) THROUGHOUT THIS DOCUMENT, THE ACRONYM "GHS" OR THE TERMS "SYSTEM", "GEISINGER", OR "GEISINGER HEALTH SYSTEM" SHALL REFER TO THE ENTIRE HEALTHCARE SYSTEM COMPRISED OF THE GEISINGER HEALTH SYSTEM FOUNDATION ("THE FOUNDATION") AS PARENT AND ALL SUBSIDIARY CORPORATE ENTITIES COMPRISING THE SYSTEM.
Schedule D (Form 990) 2012

Additional Data


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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
COLUMBIA-MONTOUR HOME HEALTH SVCS-
VISITING NURSES ASSOCIATION INC
Employer identification number

23-1704399
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
Yes
 
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)GLENN D STEELE JR MD PHDPRESCHAIR DIRECTOR (i)
(ii)		  
1,021,563 		 
920,000 		 
120,993 		 
388,588 		 
29,866 		 
2,481,010 		 
 
(2)DENISE B PRINCEDIRECTOR (i)
(ii)		  
283,073 		 
81,938 		 
8,585 		 
11,250 		 
19,032 		 
403,878 		 
 
(3)FRANK J TREMBULAKSR VP TREASURER (i)
(ii)		  
592,806 		 
305,296 		 
347,250 		 
203,077 		 
13,790 		 
1,462,219 		 
274,280
(4)JOANNE E WADEDIRECTOR (i)
(ii)		  
574,175 		 
286,871 		 
309,951 		 
191,976 		 
9,138 		 
1,372,111 		 
272,636
(5)DAVID J FELICIO ESQUIRECLO SECRETARY (i)
(ii)		  
313,540 		 
152,506 		 
46,635 		 
120,520 		 
20,139 		 
653,340 		 
 
(6)EDWARD J ZYCH ESQUIREASSISTANT SECRETARY (i)
(ii)		  
250,888 		 
74,435 		 
19,252 		 
43,763 		 
22,035 		 
410,373 		 
 
(7)KEVIN F BRENNAN CPA FHFMAEVP FINANCE CFO (i)
(ii)		  
501,671 		 
290,967 		 
286,688 		 
181,114 		 
21,073 		 
1,281,513 		 
247,768
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
SEVERANCE, NONQUALIFIED, AND EQUITY-BASED PAYMENTS SCHEDULE J, PAGE 1, PART I, LINE 4 FRANK J. TREMBULAK 0 276,507 0 JOANNE E. WADE 0 272,636 0 KEVIN F. BRENNAN, CPA, FHFMA 0 247,768 0
OTHER ADDITIONAL INFORMATION SCHEDULE J, PART III PART I, LINE 4B - SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN COMPENSATION FOR ELIGIBLE EMPLOYEES MAY BE DEFERRED TO A 457(F) NONQUALIFIED PLAN THAT VESTS WITH COMPLETION OF SERVICE, DEATH AND/OR PERMANENT DISABILITY. __________________________________________________________________________ FOOTNOTE: THROUGHOUT FORM 990, THE TERMS "GEISINGER HEALTH SYSTEM" AND "SYSTEM" OR THE ACRONYM "GHS" SHALL REFER TO THE ENTIRE HEALTHCARE SYSTEM COMPRISED OF GEISINGER HEALTH SYSTEM FOUNDATION ("THE FOUNDATION") AS PARENT AND ALL SUBSIDIARY CORPORATIONS COMPRISING THE SYSTEM.
Schedule J (Form 990) 2012

Additional Data


Software ID:  
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SCHEDULE N
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Liquidation, Termination, Dissolution, or Significant Disposition of Assets
bullet Complete if the organization answered "Yes" to Form 990, Part IV, lines 31 or 32; or Form 990-EZ, line 36.
bullet Attach certified copies of any articles of dissolution, resolutions, or plans.
bullet Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
COLUMBIA-MONTOUR HOME HEALTH SVCS-
VISITING NURSES ASSOCIATION INC
Employer identification number
23-1704399
Part I
Liquidation, Termination, or Dissolution. Complete this part if the organization answered "Yes" to Form 990, Part IV, line 31, or Form 990-EZ, line 36.
Part I can be duplicated if additional space is needed.
1(a)Description of asset(s)
distributed or transaction
expenses paid		 (b)Date of
distribution		 (c)Fair market value of
asset(s) distributed or
amount of transaction
expenses		 (d)Method of
determining FMV for
asset(s) distributed or
transaction expenses		 (e)EIN of recipient (f)Name and address of recipient (g)IRC section
of recipient(s) (if
tax-exempt) or type
of entity




















Yes
No
2
Did or will any officer, director, trustee, or key employee of the organization:
a
Become a director or trustee of a successor or transferee organization? . . . . . . . . . . . . . . . . . . . . .
2a
 
 
b
Become an employee of, or independent contractor for, a successor or transferee organization? . . . . . . . . . . . . . . . .
2b
 
 
c
Become a direct or indirect owner of a successor or transferee organization? . . . . . . . . . . . . . . . . . . . .
2c
 
 
d
Receive, or become entitled to, compensation or other similar payments as a result of the organization's liquidation, termination, or dissolution? . . . . .
2d
 
 
e
If the organization answered "Yes" to any of the questions in this line, provide the name of the person involved and explain in Part III. bullet
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or Form 990-EZ.
Cat. No. 50087Z
Schedule N (Form 990 or 990-EZ) (2012)

Schedule N (Form 990 or 990-EZ) (2012)
Page 2
Part I
Liquidation, Termination, or Dissolution (continued)
Note. If the organization distributed all of its assets during the tax year, then Form 990, Part X, column (B), line 16 (Total assets), and line 26 (Total liabilities), should equal -0-.
Yes
No
3
Did the organization distribute its assets in accordance with its governing instrument(s)? If “No,” describe in Part III . . . . . . . . . . .
3
 
 
4a
Is the organization required to notify the attorney general or other appropriate state official of its intent to dissolve, liquidate, or terminate? . . . . . .
4a
 
 
b
If “Yes,” did the organization provide such notice? . . . . . . . . . . . . . . . . . . . . . . . . . .
4b
 
 
5
Did the organization discharge or pay all of its liabilities in accordance with state laws? . . . . . . . . . . . . . . . . .
5
 
 
6a
Did the organization have any tax-exempt bonds outstanding during the year? . . . . . . . . . . . . . . . . . . . .
6a
 
 
b
Did the organization discharge or defease all of its tax-exempt bond liabilities during the tax year in accordance with the Internal Revenue Code and state laws? .
6b
 
 
c
If "Yes" to line 6b, describe in Part III how the organization defeased or otherwise settled these liabilities. If “No,” explain in Part III.

Part II
Sale, Exchange, Disposition, or Other Transfer of More Than 25% of the Organization's Assets. Complete this part if the organization answered "Yes" to Form 990, Part IV, line 32, or Form 990-EZ, line 36. Part II can be duplicated if additional space is needed.
1(a) Description of asset(s)
distributed or transaction
expenses paid		 (b) Date of
distribution		 (c) Fair market value of
asset(s) distributed or
amount of transaction
expenses		 (d) Method of
determining FMV for
asset(s) distributed or
transaction expenses		 (e) EIN of recipient (f) Name and address of recipient (g) IRC section
of recipient(s) (if
tax-exempt) or type
of entity
CASH 07-01-2012 3,787,896 FMV 23-1995911 GEISINGER HEALTH SYSTEM FOUNDATION
100 NORTH ACADEMY AVENUE MC 49-70
DANVILLE,PA17822 		501(C)(3)
ACCOUNTS RECEIVABLE 07-01-2012 433,702 BOOK VALUE 23-1995911 GEISINGER HEALTH SYSTEM FOUNDATION
100 NORTH ACADEMY AVENUE MC 49-70
DANVILLE,PA17822 		501(C)(3)
OTHER RECEIVABLES 07-01-2012 913,585 BOOK VALUE 23-1995911 GEISINGER HEALTH SYSTEM FOUNDATION
100 NORTH ACADEMY AVENUE MC 49-70
DANVILLE,PA17822 		501(C)(3)
PREPAID EXPENSES 07-01-2012 92,417 BOOK VALUE 23-1995911 GEISINGER HEALTH SYSTEM FOUNDATION
100 NORTH ACADEMY AVENUE MC 49-70
DANVILLE,PA17822 		501(C)(3)
PROPERTY & EQUIPMENT 07-01-2012 15,218 BOOK VALUE 23-1995911 GEISINGER HEALTH SYSTEM FOUNDATION
100 NORTH ACADEMY AVENUE MC 49-70
DANVILLE,PA17822 		501(C)(3)
CASH 07-01-2012 66,409 FMV 23-6291113 GEISINGER CLINIC
100 NORTH ACADEMY AVENUE MC 49-70
DANVILLE,PA17822 		501(C)(3)






Yes
No
2
Did or will any officer, director, trustee, or key employee of the organization:
a
Become a director or trustee of a successor or transferee organization? . . . . . . . . . . . . . . . . . . . . .
2a
 
 
b
Become an employee of, or independent contractor for, a successor or transferee organization? . . . . . . . . . . . . . . . .
2b
 
 
c
Become a direct or indirect owner of a successor or transferee organization? . . . . . . . . . . . . . . . . . . . . .
2c
 
 
d
Receive, or become entitled to, compensation or other similar payments as a result of the organization’s significant disposition of assets? . . . . . . .
2d
 
 
e
If the organization answered "Yes" to any of the questions in this line, provide the name of the person involved and explain in Part III. bullet
Schedule N(Form 990 or 990-EZ) (2012)

Schedule N (Form 990 or 990-EZ) (2012)
Page 3
Part III
Supplemental Information. Complete to provide the information required by Part I, lines 2e and 6c, and Part II, line 2e. Also complete this part to provide any additional information.
Identifier Return Reference Explanation
ADDITIONAL INFORMATION SCHEDULE N EFFECTIVE JULY 1 2012 THE COLUMBIA MONTOUR HOME HEALTH SERVICESVISITING NURSES ASSOCIATION INC CMHHS AND ITS RELATED ENTITIES BLOOMSBURG HOSPITALNOW GEISINGERBLOOMSBURG HOSPITAL BLOOMSBURG HEALTH CARE CENTER NOW GEISINGERBLOOMSBURG HEALTH CARE CENTER BLOOMSBURG PHYSICIANS SERVICES AND THE BLOOMSBURG HOSPITAL MEDICAL PROFESSIONAL SELFINSURANCE TRUST MERGED WITH GEISINGER HEALTH SYSTEM GEISINGER HEALTH SYSTEM FOUNDATION APPOINTED NEW OFFICERS AND A NEW BOARD OF DIRECTORS FOR CMHHS AND ALL RELATED ENTITIES REFER TO THE MERGER DOCUMENTS ATTACHED TO FORM 990
Schedule N (Form 990 or 990-EZ) (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
COLUMBIA-MONTOUR HOME HEALTH SVCS-
VISITING NURSES ASSOCIATION INC
Employer identification number

23-1704399
Identifier Return Reference Explanation
ORGANIZATION'S MISSION FORM 990 - ORGANIZATION'S MISSION COLUMBIA MONTOUR HOME HEALTH SERVICES (CMHHS) SHALL DELIVER COMPREHENSIVE HOME HEALTH SERVICES OF HIGH QUALITY TO MEMBERS OF THE COMMUNITY WITHOUT REGARD TO AGE, GENDER, COLOR, CREED, NATIONAL ORIGIN, DISABILITY STATUS, DIAGNOSIS OR SOCIO-ECONOMIC STATUS WITHIN THE CONSTRAINT OF MAINTAINING FINANCIAL VIABILITY.
FIRST ACCOMPLISHMENT DESCRIPTION FORM 990, PAGE 2, PART III, LINE 4A I. GENERAL PROGRAM SERVICE INFORMATION CMHHS WAS ESTABLISHED IN JULY 1967 AS A 501(C)(3) NOT-FOR-PROFIT CORPORATION TO PROVIDE HOME HEALTH AND HOSPICE SERVICES IN CENTRAL PENNSYLVANIA. CMHHS IS LOCATED IN BLOOMSBURG, PA. CMHHS INCLUDES THREE MAJOR PROGRAMS: COLUMBIA MONTOUR HOME HEALTH: A HOME HEALTH PROGRAM THAT PROVIDES SERVICES TO PATIENTS IN CENTRAL PENNSYLVANIA. SKILLED NURSING, HOME HEALTH AIDE, MEDICAL SOCIAL WORK, AS WELL AS PHYSICAL, OCCUPATIONAL AND SPEECH THERAPY SERVICES WHICH ARE AVAILABLE 24 HOURS A DAY. IN ADDITION, THE AGENCY PROVIDES LIMITED MATERNAL/CHILD HEALTH SERVICES. COLUMBIA MONTOUR HOME HOSPICE: A HOSPICE PROGRAM THAT PROVIDES CARE TO THE PATIENT WHO IS TERMINALLY ILL WITH A LIFE EXPECTANCY OF 6 MONTHS OR LESS. BASE SERVICES INCLUDE: SKILLED NURSING, HOSPICE AIDE, MEDICAL SOCIAL WORK, SPIRITUAL CARE, BEREAVEMENT. IN ADDITION, PHYSICAL THERAPY, OCCUPATIONAL THERAPY, AND SPEECH THERAPY ARE UTILIZED WHEN THE PATIENT CAN BENEFIT FROM THOSE DISCIPLINES. NEEDS OF THE HOSPICE PATIENT FAMILY ARE ALSO ADDRESSED BY THE HOSPICE TEAM, IE. CAREGIVER STRESS, DEPRESSION, ANXIETY. HOSPICE SERVICES ARE PROVIDED TO PATIENTS IN CENTRAL PENNSYLVANIA AND ARE AVAILABLE 24 HOURS A DAY. PATIENTS ARE SERVED IN THEIR PLACE OF RESIDENCE - THEIR HOME, SKILLED NURSING FACILITY OR ASSISTED LIVING FACILITY. THE HOME HEALTH AND HOSPICE PROGRAMS ARE BOTH MEDICARE AND MEDICAID CERTIFIED, AND THEREFORE MAY PROVIDE HOME HEALTH AND HOSPICE SERVICES TO ALL PAYOR CATEGORIES. NURSE FAMILY PARTNERSHIP: A RESEARCH BASED MOM/BABY PROGRAM PROVIDED VIA GRANT FUNDING TO ELIGIBLE CLIENTS IN COLUMBIA, MONTOUR, SNYDER, LOWER LUZERNE, AND UPPER NORTHUMBERLAND COUNTIES IN CENTRAL PENNSYLVANIA. GOALS OF THE PROGRAM ARE: IMPROVE HEALTH DURING PREGNANCY, PROMOTE HEALTH CHILD DEVELOPMENT, AND PROMOTE A POSITIVE MATERNAL LIFE COURSE. II. UNCOMPENSATED CARE CMHHS RECOGNIZES THAT ITS MISSION IS TO DELIVER COMPREHENSIVE HOME HEALTH SERVICES OF HIGH QUALITY TO MEMBERS OF THE COMMUNITY WITHOUT REGARD TO AGE, GENDER, COLOR, CREED, NATIONAL ORIGIN, DISABILITY STATUS, DIAGNOSIS OR SOCIO-ECONOMIC STATUS WITHIN THE CONSTRAINT OF MAINTAINING FINANCIAL VIABILITY. IN THIS REGARD, CMHHS PROVIDES FREE OR SUBSIDIZED CARE BELOW COST AND SUPPORTS VARIOUS HEALTH ACTIVITIES AND PROGRAMS IN SUPPORT OF THE COMMUNITY. A. MEDICARE/MEDICAID IN RECOGNIZING ITS MISSION TO THE COMMUNITY, CMHHS PROVIDES CARE, BELOW COST, TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS. TO THE EXTENT REIMBURSEMENT IS BELOW THE COST OF PROVIDING HEALTHCARE, CMHHS IS FURTHERING ITS MISSION TO THE COMMUNITY. THE UNREIMBURSED VALUE OF MEDICARE AND/OR MEDICAID IS EQUAL TO THE COST OF PROVIDING SERVICES LESS THE AMOUNT RECEIVED AS REIMBURSEMENT UNDER THE PROGRAM. THE UNREIMBURSED VALUE OF PROVIDING CARE TO THESE PATIENTS WAS 95,321 DURING THE FISCAL YEAR ENDED JUNE 30, 2013. B. OTHER UNCOMPENSATED PATIENT SERVICES IN ADDITION TO THE ABOVE, CMHHS PROVIDES OTHER PATIENT SERVICES FOR WHICH FULL PAYMENT IS NOT RECEIVED. THE UNCOMPENSATED COST OF PROVIDING SUCH PATIENT SERVICES DURING THE FISCAL YEAR ENDED JUNE 30, 2013 WAS 1,631. III.RESEARCH SUPPORT CMHHS CONTRIBUTED 66,409 TO GEISINGER CLINIC TO SUPPORT ITS CHARITABLE MISSION THROUGH MEDICAL RESEARCH ACTIVITIES AT TWO FACILITIES ON THE CAMPUS OF THE GEISINGER MEDICAL CENTER: THE SIEGFRIED AND JANET WEIS CENTER FOR RESEARCH (WEIS CENTER) AND THE GEISINGER CENTER FOR HEALTH RESEARCH (GCHR). WEIS CENTER PROVIDES A FOCUS FOR LABORATORY RESEARCH AND RESEARCH TRAINING, AND SUPPORTS THE CLINICAL STAFF IN ITS RESEARCH PROGRAMS. THE PRIMARY MISSION OF THE WEIS CENTER IS TO CONDUCT ORIGINAL AND INNOVATIVE RESEARCH THAT CONTRIBUTES NEW KNOWLEDGE TO BIOMEDICAL SCIENCE. THIS RESEARCH CENTER IS HOME TO THE HENRY HOOD RESEARCH PROGRAM. THE PREEMINENT FUNCTION OF THE HOOD RESEARCH PROGRAM IS TO CONDUCT ORIGINAL AND INNOVATIVE RESEARCH OF WORLD CLASS QUALITY. THE CENTER'S SCIENTISTS APPLY MODERN MOLECULAR AND CELLULAR APPROACHES TO DIVERSE RESEARCH PROBLEMS IN THE AREAS OF CARDIOVASCULAR FUNCTION, CANCER AND DEVELOPMENTAL BIOLOGY. GCHR CONDUCTS HEALTH SERVICES, EPIDEMIOLOGIC AND POPULATION GENETICS RESEARCH ON THE BROAD RANGE OF CONDITIONS TYPICALLY SEEN IN PRIMARY AND SPECIALTY CARE SETTINGS. GCHR ALSO INVESTIGATES EXTRAMURAL RESOURCES FOR FUNDING OF CLINICAL RESEARCH. TOGETHER WITH THE WEIS CENTER, GCHR IS ALSO BUILDING THE CAPABILITY FOR POPULATION-BASED GENETICS RESEARCH. IV. COMMUNITY HEALTH, EDUCATION, AND OUTREACH CMHHS SERVES THE COMMUNITY THRU PROVISION OF THE FOLLOWING UNCOMPENSATED PROGRAMS VALUED AT 18,136 FOR FISCAL YEAR ENDED JUNE 30, 2013: HEALTH FAIRS AND SCREENINGS COMMUNITY BEREAVEMENT GROUPS BEREAVEMENT CAMP FOR CHILDREN BEREAVEMENT RETREAT FOR PARENTS COMMUNITY HEALTH EDUCATION V. VOLUNTEER SERVICES THE VOLUNTEERS OF THE HOSPICE PROGRAM ARE AN ACTIVE AND VITAL PART OF THE ACTIVITIES AND MISSION OF COLUMBIA MONTOUR HOME HEALTH SERVICE. VOLUNTEERS FROM LOCAL COMMUNITIES HAVE CONTRIBUTED 6,948 HOURS TOWARD THE COMMON PURPOSE OF SERVICING THE HEALTHCARE OF THE COMMUNITY. THE VALUE OF THIS CONTRIBUTION IS GIVEN BACK TO THE COMMUNITY THROUGH LOWER COSTS, VALUED AT 159,248. VI. COMMUNITY BENEFIT SUMMARY MEDICARE/MEDICAID SHORTFALL 95,321 OTHER COMPENSATED CARE 1,631 RESEARCH SUPPORT 66,409 COMMUNITY HEALTH, EDUCATION, AND OUTREACH 18,136 VOLUNTEER SERVICES (VALUED AT 01/01/2013 STATEWIDE AVERAGE WEEKLY WAGE) 159,248 TOTAL 340,745 VI. OPERATIONAL CHANGES EXPECTED DURING FISCAL 2014 DURING FISCAL 2014, THE NURSE FAMILY PARTNERSHIP PROGRAM WILL BE TRANSITIONED TO GEISINGER CLINIC, A 501(C)(3) AFFILIATE OF CMHHS.
ADDITIONAL INFORMATION FORM 990, PART VI FORM 990, PART I, SECTION A, LINE 4: FORM 990, PART VI, SECTION A, LINE 1B: ENTER THE NUMBER OF VOTING MEMBERS THAT ARE INDEPENDENT. BASED ON THE FORM 990 DEFINITION OF "INDEPENDENCE" AS IT RELATES TO VOTING MEMBERS OF THE GOVERNING BODY, FOUR VOTING MEMBER ARE NOT INDEPENDENT BECAUSE THEY ARE COMPENSATED AS EMPLOYEES OF RELATED ORGANIZATIONS. FORM 990, PART VI, SECTION A, LINE 2: DID ANY OFFICER, DIRECTOR, TRUSTEE, OR KEY EMPLOYEE HAVE A FAMILY RELATION- SHIP OR BUSINESS RELATIONSHIP WITH ANY OTHER OFFICER, DIRECTOR, TRUSTEE, OR KEY EMPLOYEE? GLENN D. STEELE, JR. M.D., PH.D., DAVID J. FELICIO, ESQUIRE, DENISE B. PRINCE, FRANK J. TREMBULAK, EDWARD J. ZYCH, ESQUIRE, AND JOANNE E. WADE ALL HAVE A BUSINESS RELATIONSHIP WITH ONE ANOTHER BECAUSE THEY SERVE AS OFFICERS AND/OR DIRECTORS ON ONE OR MORE FOR-PROFIT AFFILIATES OF COLUMBIA MONTOUR HOME HEALTH SERVICES/VISITING NURSES ASSOCIATION, INC. ALL OF THE AFFILIATES ARE PART OF THE GEISINGER HEALTH SYSTEM.
SIGNIFICANT CHANGES TO ORGANIZATIONAL DOCUMENTS FORM 990, PAGE 6, PART VI, LINE 4 ON JULY 1, 2012, THE ORGANIZATION CHANGED ITS RESPECTIVE ARTICLES OF INCORPORATION AND CORPORATE BYLAWS TO REFLECT THE MERGER AND INTEGRATION BY AND BETWEEN BLOOMSBURG HEALTH SYSTEM AND GEISINGER HEALTH SYSTEM IN WHICH GEISINGER HEALTH SYSTEM FOUNDATION BECAME SOLE MEMBER OF EACH OF THE FOLLOWING NON-PROFIT ORGANIZATIONS: BLOOMSBURG HOSPITAL, NOW KNOWN AS GEISINGER-BLOOMSBURG HOSPITAL, BLOOMSBURG HEALTH CARE CENTER, NOW KNOWN AS GEISINGER-BLOOMSBURG HEALTH CARE CENTER, COLUMBIA MONTOUR HOME HEALTH SERVICES/VISITING NURSES ASSOCIATION, INC., AND BLOOMSBURG PHYSICIANS SERVICES, INC.
CLASSES OF MEMBERS OR STOCKHOLDERS FORM 990, PAGE 6, PART VI, LINE 6 THE MEMBERS OF THE CORPORATION HAVE THE POWER AND AUTHORITY TO ELECT AND REMOVE THE DIRECTORS; ELECT AND REMOVE THE PRESIDENT AND FILL ANY VACANCY IN THE OFFICE OF THE PRESIDENT OF THE CORPORATION; AND, MAY APPROVE AMENDMENTS TO THE CORPORATE BYLAWS IN LIEU OF SUCH APPROVAL BY THE BOARD OF DIRECTORS. THE MEMBERS ALSO HAVE THE RESERVE POWERS AS SET FORTH IN THE PENNSYLVANIA NONPROFIT CORPORATION LAW.
ELECTION OF MEMBERS AND THEIR RIGHTS FORM 990, PAGE 6, PART VI, LINE 7A THE BOARD OF DIRECTORS OF THE CORPORATION SHALL SERVE AS THE GOVERNING BODY OF THE CORPORATION. THE PRESIDENT OF THE CORPORATION SHALL BE A DIRECTOR BY REASON OF HOLDING SUCH OFFICE. THE REMAINING DIRECTORS SHALL BE ELECTED BY THE MEMBERS AT THE ANNUAL MEETING OF THE MEMBERS. THE MEMBERS OF THE CORPORATION MAY SERVE AS DIRECTORS AND DIRECTORS MAY SUCCEED THEMSELVES FROM TERM TO TERM. VACANCIES ON THE BOARD OF DIRECTORS SHALL BE FILLED BY THE MEMBERS AT THEIR DISCRETION AT THE ANNUAL MEETING OF THE MEMBERS OR AT A SPECIAL MEETING CALLED FOR SUCH PURPOSE.
ORGANIZATION'S PROCESS USED TO REVIEW FORM 990 FORM 990, PAGE 6, PART VI, LINE 11B ALL OFFICERS AND DIRECTORS WERE ELECTRONICALLY PROVIDED A FINAL COPY OF THE FORM 990 PRIOR TO FILING THE RETURN WITH THE IRS. AN EXECUTIVE SUMMARY OF THE INFORMATION REPORTED ON THE RETURN IS PROVIDED TO ASSIST IN THE REVIEW. IN ACCORDANCE WITH THE GEISINGER HEALTH SYSTEM FOUNDATION BOARD OF DIRECTOR'S FINANCE COMMITTEE CHARTER, STAFF PERIODICALLY REVIEWS THE GHS ORGANIZATIONS' FORM 990 FILINGS. THE FORM 990 IS PREPARED BY THE GEISINGER HEALTH SYSTEM (GHS) TAX AND FINANCIAL REPORTING DEPARTMENTS WITH INFORMATION PROVIDED FROM FINANCE, TAX, HUMAN RESOURCES, LEGAL SERVICES AND OTHER RELEVANT DEPARTMENTS WITHIN THE GEISINGER HEALTH SYSTEM. THE CHIEF FINANCIAL OFFICER (CFO) OF GHS AND THE INDIVIDUAL ORGANIZATIONS SENIOR FINANCIAL MANAGERS REVIEW THEIR RESPECTIVE FORM 990 PRIOR TO MAKING THE FINAL RETURN AVAILABLE TO THE BOARD. IN ADDITION, THE CHIEF LEGAL OFFICER AND CHIEF HUMAN RESOURCE OFFICER OF GHS REVIEW THE INFORMATION DISCLOSED ON THE FORM 990 RELEVANT TO THEIR RESPECTIVE AREAS OF RESPONSIBILITY. FOR PURPOSES OF THEIR ANNUAL AUDIT OF THE GHS CONSOLIDATED FINANCIAL STATEMENTS, INDEPENDENT AUDITORS REVIEW ALL FEDERAL TAX RETURNS FILED BY THE GHS ORGANIZATIONS TO IDENTIFY MATERIAL ITEMS, INCLUDING IF THERE ARE ANY UNCERTAIN TAX POSITIONS THAT MAY BE REQUIRED TO BE RECOGNIZED. THE COMPANY HAD NO UNCERTAIN TAX POSITIONS REQUIRED TO BE REPORTED FOR FISCAL YEAR.
ENFORCEMENT OF CONFLICTS POLICY FORM 990, PAGE 6, PART VI, LINE 12C THE OFFICERS AND DIRECTORS OF THE ORGANIZATION ARE SUBJECT TO THE GHS CONFLICT OF INTEREST POLICY FOR DIRECTORS, OFFICERS AND SENIOR LEADERS (MAY INCLUDE INDEPENDENT CONTRACTORS). AT LEAST ONCE EACH YEAR DIRECTORS, OFFICERS, KEY EMPLOYEES, SENIOR LEADERS (INCLUDING INDEPENDENT CONTRACTORS) AND OTHERS DESIGNATED BY THE BOARD OF DIRECTORS ARE REQUIRED TO DISCLOSE IN WRITING THE EXISTENCE OF ANY POTENTIAL FINANCIAL INTERESTS THAT MAY GIVE RISE TO A CONFLICT OF INTEREST WITH ANY AFFILIATE WITHIN THE GEISINGER HEALTH SYSTEM. THE DISCLOSURES ARE REVIEWED BY THE OFFICE OF THE CHIEF LEGAL OFFICER AND REPORTED TO THE AUDIT COMMITTEE AND BOARD OF DIRECTORS. AFTER REVIEW OF THE FINANCIAL INTEREST AND ALL MATERIAL FACTS, INPUT FROM DEPARTMENT OF LEGAL SERVICES AND ANY DISCUSSION WITH THE PERSON DESIRED BY THE BOARD OR COMMITTEE, THE BOARD DECIDES IF A CONFLICT EXISTS AND TAKES APPROPRIATE ACTION. THE INDIVIDUAL DISCLOSING THE FINANCIAL INTEREST IS ABSENT DURING THE BOARD DELIBERATIONS AND DECISIONS ON THE MATTER.
COMPENSATION PROCESS FOR TOP OFFICIAL FORM 990, PAGE 6, PART VI, LINE 15A THE PROCESS TO REVIEW AND APPROVE THE COMPENSATION OF GHS EMPLOYED BOARD DIRECTORS, OFFICERS AND EXECUTIVE MANAGEMENT IS DESIGNED TO SATISFY THE REBUTTABLE PRESUMPTION PROCEDURE AVAILABLE FOR INTERMEDIATE SANCTION PURPOSES. THE PROCESS REQUIRES A REVIEW OF COMPENSATION DETERMINATIONS BY DISINTERESTED PARTIES, USE OF APPROPRIATE COMPARABILITY DATA AND CONTEMPORANEOUS DOCUMENTATION OF THE PROCESS. ON AN ANNUAL BASIS AN INDEPENDENT, NATIONALLY RECOGNIZED COMPENSATION CONSULTANT COMPLETES A COMPARATIVE ASSESSMENT OF COMPENSATION FOR THE CEO AND SENIOR MANAGEMENT WITHIN GHS. THE CONSULTANT'S REPORT IS PRESENTED TO THE MANAGEMENT AND COMPENSATION COMMITTEE PRIOR TO ANY COMPENSATION ADJUSTMENT. THE REPORT SUPPORTS THE RIGOROUS REVIEW COMPLETED BY THE MANAGEMENT AND COMPENSATION COMMITTEE TO ENSURE THAT THE PROGRAM IS RESPONSIBLE TO THE GEISINGER CHARITABLE MISSION, REFLECTS REASONABLE COMPENSATION WITHIN THE NONPROFIT MARKET AND IS COMPLIANT WITH THE IRS'S INTERMEDIATE SANCTION REQUIREMENTS. THE SURVEY DATA IN THE COMPARATIVE ANALYSIS IS CAPTURED FOR FUNCTIONALLY COMPARABLE POSITIONS IN MULTIPLE SIMILAR NONPROFIT ORGANIZATIONS AND REFLECTS TOTAL REMUNERATION PROVIDED IN THE MARKET. ALL SURVEYS ARE CONDUCTED BY THIRD PARTY ORGANIZATIONS AND NOT CONDUCTED AT THE SPECIFIC DIRECTION OF GEISINGER. ANY COMPENSATION ADJUSTMENTS ARE APPROVED BY MANAGEMENT AND COMPENSATION COMMITTEE PRIOR TO THE EFFECTIVE DATE OF THE PAYMENT. THE MANAGEMENT AND COMPENSATION COMMITTEE AT ITS SOLE DISCRETION MAY POSITIVELY OR NEGATIVELY ADJUST ANY RECOMMENDED COMPENSATION.
COMPENSATION PROCESS FOR OFFICERS FORM 990, PAGE 6, PART VI, LINE 15B SEE SCHEDULE O RESPONSE TO FORM 990, PART VI, SECTION B, QUESTION 15A.
GOVERNING DOCUMENTS DISCLOSURE EXPLANATION FORM 990, PAGE 6, PART VI, LINE 19 THE MISSION STATEMENT IS AVAILABLE ON THE GEISINGER HEALTH SYSTEM WEBSITE AT WWW.GEISINGER.ORG. THE ANNUAL REPORT FOR GEISINGER HEALTH SYSTEM, CONTAINING COMMUNITY BENEFIT INFORMATION, CONSOLIDATED FINANCIAL INFORMATION AND OTHER INFORMATION, ARE AVAILABLE ON THE GEISINGER HEALTH SYSTEM WEBSITE. GO TO: WWW.GEISINGER.ORG/ABOUT/MISSION.HTML AND SELECT 2013 ANNUAL REPORT. FINANCIAL STATEMENTS, THE COMPLETE FORM 990 AND FORM 990-T, THE CONFLICTS OF INTEREST POLICY, AND OTHER GOVERNING DOCUMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST.
OTHER CHANGES IN NET ASSETS EXPLANATION FORM 990, PART XI, LINE 9 TEMPORARILY RESTRICTED INVESTMENT INCOME 666 TEMPORARILY RESTRICTED CONTRIBUTIONS 12,383 REALIZED GAIN ON TEMPORARILY RESTRICTED NET ASSETS 43,701 REALIZED GAIN ON PERMANENTLY RESTRICTED NET ASSETS 4,145 TRANSFER TO PARENT-GEISINGER HEALTH SYS. FOUNDATIO -1,840,547 TRANSFER TO AFFILIATE-GEISINGER CLINIC -66,409 NET ASSETS RELEASED FROM RESTRICTION -12,326 FAIR VALUATION OF ASSETS AND LIABILITIES -178,852 TOTAL OTHER CHANGES IN NET ASSETS -2,037,239 EFFECTIVE JULY 1, 2012, COLUMBIA MONTOUR HOME HEALTH SERVICES/VISITING NURSES ASSOCIATION, INC. (CMHHS) WAS INTEGRATED INTO THE GEISINGER HEALTH SYSTEM (GHS). AS A PART OF THAT TRANSACTION, CMHHS EVALUATED ALL ASSETS AND LIABILITIES AND ADJUSTED THEM TO THEIR FAIR MARKET VALUES. THE NET ADJUSTMENT WAS: -178,852.
ADDITIONAL INFORMATION FORM 990, PART XII FORM 990, PART XII, LINE 3A: AS A RESULT OF A FEDERAL AWARD, WAS THE ORGANIZATION REQUIRED TO UNDERGO AN AUDIT OR AUDITS AS SET FORTH IN THE AUDIT ACT OR OMB CIRCULAR A-133? FEDERAL AWARDS ARE AUDITED AS A PART OF THE GEISINGER HEALTH SYSTEM'S CONSOLIDATED REPORT ON FEDERAL AWARDS IN ACCORDANCE WITH OMB CIRCULAR A-133. FOOTNOTE: THROUGOUT FORM 990, THE TERMS "GEISINGER HEALTH SYSTEM" AND SYSTEM OR THE ACRONYM "GHS" SHALL REFER TO THE ENTIRE HEALTHCARE SYSTEM COMPRISED OF GEISINGER HEALTH SYSTEM FOUNDATION ("THE FOUNDATION") AS PARENT AND ALL SUBSIDIARY CORPORATIONS COMPRISING THE SYSTEM
CHANGE IN FINANCIAL REVIEW PROCESS FORM 990, PAGE 12, PART XII, LINE 2C EFFECTIVE JULY 1, 2012, COLUMBIA-MONTOUR HOME HEALTH SERVICES, VISITING NURSES ASSOCIATION, INC. WAS INTEGRATED INTO THE GEISINGER HEALTH SYSTEM. AS A RESULT OF THAT INTEGRATION, THE GEISINGER HEALTH SYSTEM FORM 990 REVIEW PROCESS, AS DESCRIBED IN THE SCHEDULE O RESPONSE TO FORM 990 PART VI, LINE 11B, WAS IMPLEMENTED. IN ADDITION, THE GEISINGER HEALTH SYSTEM AUDIT COMMITTEE IS NOW RESPONSIBLE FOR THE OVERSIGHT OF THE CONSOLIDATED AUDIT AND SELECTION OF THE INDEPENDENT AUDITORS.
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
COLUMBIA-MONTOUR HOME HEALTH SVCS-
VISITING NURSES ASSOCIATION INC
Employer identification number

23-1704399
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) GEISNGER HEALTH SYSTEM FOUNDATION

100 NORTH ACADEMY AVENUE MC 49-70

DANVILLE,PA17822
23-1995911 		PHILANTHOP PA 501C3 7 N/A
Yes
 
(2) GEISINGER MEDICAL CENTER

100 NORTH ACADEMY AVENUE MC 49-70

DANVILLE,PA17822
24-0795959 		HOSPITAL PA 501C3 3 GHSF
 
Yes
 
(3) GEISINGER CLINIC

100 NORTH ACADEMY AVENUE MC 49-70

DANVILLE,PA17822
23-6291113 		PHYS SVCS PA 501C3 11A GHSF
 
Yes
 
(4) GEISINGER WYOMING VALLEY MED CTR

100 NORTH ACADEMY AVENUE MC 49-70

DANVILLE,PA17822
23-1996150 		HOSPITAL PA 501C3 3 GHSF
 
Yes
 
(5) MARWORTH

100 NORTH ACADEMY AVENUE MC 49-70

DANVILLE,PA17822
23-2171417 		D&A REHAB PA 501C3 3 GHSF
 
Yes
 
(6) GEISINGER HEALTH PLAN

100 NORTH ACADEMY AVENUE MC 49-70

DANVILLE,PA17822
23-2311553 		HEALTH INS PA 501C4   GHSF
 
Yes
 
(7) HERSHEY MEDICAL CENTER

100 NORTH ACADEMY AVENUE MC 49-70

DANVILLE,PA17822
23-2891807 		HOSPITAL PA 501C3 3 GHSF
 
Yes
 
(8) GEISINGER SYSTEM SERVICES

100 NORTH ACADEMY AVENUE MC 49-70

DANVILLE,PA17822
23-2164794 		SUPPORT SV PA 501C3 11A GHSF
 
Yes
 
(9) GEISINGER COMMUNITY HEALTH SERVICES

100 NORTH ACADEMY AVENUE MC 49-70

DANVILLE,PA17822
23-2967235 		HEALTHCARE PA 501C3 9 GSS
 
Yes
 
(10) GEISINGER INSURANCE CORPORATIONRRG

100 NORTH ACADEMY AVENUE MC 49-70

DANVILLE,PA17822
14-1909894 		SELF INS VT 501C3 11A GHSF
 
Yes
 
(11) GEISINGER MED CTR PROF LIAB TRUST

100 NORTH ACADEMY AVENUE MC 49-70

DANVILLE,PA17822
25-6220019 		SELF INS PA 501C3 11A GMC
 
Yes
 
(12) GEISINGER EXCESS COV PROF LIAB TR

100 NORTH ACADEMY AVENUE MC 49-70

DANVILLE,PA17822
23-6852932 		SELF INS PA 501C3 11A GMC
 
Yes
 
(13) COMMUNITY MEDICAL CENTER

100 NORTH ACADEMY AVENUE MC 49-70

DANVILLE,PA17822
24-0862246 		HOSPITAL PA 501C3 3 GHSF
 
Yes
 
(14) COMMUNITY MEDICAL CARE INC

100 NORTH ACADEMY AVENUE MC 49-70

DANVILLE,PA17822
23-2429776 		PHYS SVCS PA 501C3 9 GHSF
 
Yes
 
(15) MEDICAL DIMENSIONS INC

100 NORTH ACADEMY AVENUE MC 49-70

DANVILLE,PA17822
23-2369788 		HOLDING CO PA 501C2   GHSF
 
Yes
 
(16) CMC HEALTHCARE SYS MED PROF LIAB TR

100 NORTH ACADEMY AVENUE MC 49-70

DANVILLE,PA17822
04-6990600 		SELF INS PA 501C3 11A GHSF
 
Yes
 
(17) MOUNTAIN VIEW NURSING HOME INC

100 NORTH ACADEMY AVENUE MC 49-70

DANVILLE,PA17822
23-2568288 		LONG TERM PA 501C3 9 GHSF
 
Yes
 
(18) COMMUNITY MEDICAL CTR HEALTHCARE SY

100 NORTH ACADEMY AVENUE MC 49-70

DANVILLE,PA17822
23-2279376 		SUPPORT SV PA 501C3 11A GHSF
 
Yes
 
(19) NORTHEAST CANCER CENTER INC

100 NORTH ACADEMY AVENUE MC 49-70

DANVILLE,PA17822
20-1687320 		HEALTHCARE PA 501C3 3 NA
 
Yes
 
(20) HEALTH CARE CORP OF NORTHEAST PA

100 NORTH ACADEMY AVENUE MC 49-70

DANVILLE,PA17822
23-2337286 		SUPPORT SV PA 501C3 11A NA
 
Yes
 
(21) GEISINGER-BLOOMSBURG HOSPITAL

100 NORTH ACADEMY AVENUE MC 49-70

DANVILLE,PA17822
23-2193572 		HOSPITAL PA 501C3 3 GHSF
 
Yes
 
(22) BLOOMSBURG PHYSICIANS SERVICES

100 NORTH ACADEMY AVENUE MC 49-70

DANVILLE,PA17822
23-2979856 		PHYS SVCS PA 501C3 3 GHSF
 
Yes
 
(23) GEISINGER-BLOOMSBURG HEALTHCARE CTR

100 NORTH ACADEMY AVENUE MC 49-70

DANVILLE,PA17822
23-2242854 		SKLD NURSE PA 501C3 9 GHSF
 
Yes
 
(24) BLOOMSBURG HOSP MED PROF LIAB TRUST

100 NORTH ACADEMY AVENUE MC 49-70

DANVILLE,PA17822
14-6222837 		SELF INS PA 501C3 11B GHSF
 
Yes
 
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
(1) KEYSTONE ACCOUNTABLE CARE ORG LLC

100 NORTH ACADEMY AVENUE MC 49-70
DANVILLE,PA17822
45-4475297 		ACO PA N/A
         No     No  
(2) LIFESOURCE GEISINGER BLOOD CTR LLC

100 NORTH ACADEMY AVENUE MC 49-70
DANVILLE,PA17822
36-4718005 		BLOOD COLL PA N/A
         No     No  
(3) MERIDIAN GEISINGER HLTH NTWRK LLC

100 NORTH ACADEMY AVENUE MC 49-70
DANVILLE,PA17822
45-5484165 		ORG DL SYS NJ N/A
         No     No  
(4) HEALTHSOUTH GHS LLC

100 NORTH ACADEMY AVENUE MC 49-70
DANVILLE,PA17822
72-1398803 		PHY THERAP PA N/A
         No     No  
(5) EVANGELICAL-GEISINGER HEALTH LLC

100 NORTH ACADEMY AVENUE MC 49-70
DANVILLE,PA17822
46-0567687 		HEALTHCARE PA N/A
         No     No  
(6) GEISINGER-SCA HOLDINGS LLC

100 NORTH ACADEMY AVENUE MC 49-70
DANVILLE,PA17822
46-1615328 		HOLDING CO DE N/A
         No     No  
(7) LACKAWANNA PHYSICIANS AMB SURG CTR

100 NORTH ACADEMY AVENUE MC 49-70
DANVILLE,PA17822
23-3024998 		HEALTHCARE PA N/A
         No     No  
(8) KEYSTONE ACCOUNTABLE CARE ORG LLC

100 NORTH ACADEMY AVENUE MC 49-70
DANVILLE,PA17822
45-4475297 		ACO PA N/A
         No     No  
(9) LIFESOURCE GEISINGER BLOOD CTR LLC

100 NORTH ACADEMY AVENUE MC 49-70
DANVILLE,PA17822
36-4718005 		BLOOD COLL PA N/A
         No     No  
(10) MERIDIAN GEISINGER HLTH NTWRK LLC

100 NORTH ACADEMY AVENUE MC 49-70
DANVILLE,PA17822
45-5484165 		ORG DL SYS NJ N/A
         No     No  
(11) HEALTHSOUTH GHS LLC

100 NORTH ACADEMY AVENUE MC 49-70
DANVILLE,PA17822
72-1398803 		PHY THERAP PA N/A
         No     No  
(12) EVANGELICAL-GEISINGER HEALTH LLC

100 NORTH ACADEMY AVENUE MC 49-70
DANVILLE,PA17822
46-0567687 		HEALTHCARE PA N/A
         No     No  
(13) GEISINGER-SCA HOLDINGS LLC

100 NORTH ACADEMY AVENUE MC 49-70
DANVILLE,PA17822
46-1615328 		HOLDING CO DE N/A
         No     No  
(14) LACKAWANNA PHYSICIANS AMB SURG CTR

100 NORTH ACADEMY AVENUE MC 49-70
DANVILLE,PA17822
23-3024998 		HEALTHCARE PA N/A
         No     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) GEISINGER MEDICAL MANAGEMENT CORP

100 NORTH ACADEMY AVENUE MC 49-70
DANVILLE,PA17822
23-2077663 		HOTEL/REST PA N/A
         Yes  
(2) INTERNATIONAL SHARED SERVICES INC

100 NORTH ACADEMY AVENUE MC 49-70
DANVILLE,PA17822
23-2159597 		COMPUTER PA N/A
         Yes  
(3) GEISINGER INDEMNITY INSURANCE COMP

100 NORTH ACADEMY AVENUE MC 49-70
DANVILLE,PA17822
23-2815174 		HLTH INSUR PA N/A
         Yes  
(4) GEISINGER QUALITY OPTIONS INC

100 NORTH ACADEMY AVENUE MC 49-70
DANVILLE,PA17822
20-4275139 		HLTH INSUR PA N/A
         Yes  
(5) GEISINGER ASSURANCE COMPANY LTD

PO BOX 2196GT
  GRAND CAYMAN  
CJ
98-1016737 		INSURANCE CJ N/A
         Yes  
(6) XG HEALTH SOLUTIONS INC

100 NORTH ACADEMY AVENUE MC 49-70
DANVILLE,PA17822
46-1657345 		CONSULTING DE N/A
         Yes  
(7) GEISINGER MEDICAL MANAGEMENT CORP

100 NORTH ACADEMY AVENUE MC 49-70
DANVILLE,PA17822
23-2077663 		HOTEL/REST PA N/A
         Yes  
(8) INTERNATIONAL SHARED SERVICES INC

100 NORTH ACADEMY AVENUE MC 49-70
DANVILLE,PA17822
23-2159597 		COMPUTER PA N/A
         Yes  
(9) GEISINGER INDEMNITY INSURANCE COMP

100 NORTH ACADEMY AVENUE MC 49-70
DANVILLE,PA17822
23-2815174 		HLTH INSUR PA N/A
         Yes  
(10) GEISINGER QUALITY OPTIONS INC

100 NORTH ACADEMY AVENUE MC 49-70
DANVILLE,PA17822
20-4275139 		HLTH INSUR PA N/A
         Yes  
(11) GEISINGER ASSURANCE COMPANY LTD

PO BOX 2196GT
  GRAND CAYMAN  
CJ
98-1016737 		INSURANCE CJ N/A
         Yes  
(12) XG HEALTH SOLUTIONS INC

100 NORTH ACADEMY AVENUE MC 49-70
DANVILLE,PA17822
46-1657345 		CONSULTING DE N/A
         Yes  
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
Yes
 
b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
Yes
 
c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
 
No
d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
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
 
No
i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
Yes
 
j Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
 
No
k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1k
Yes
 
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
 
No
o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
 
No
p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
 
No
q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
 
No
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) GEISINGER-BLOOMSBURG HOSPITAL

 K 158,283 GAAP
(2) GEISINGER HEALTH PLAN

 L 143,566 GAAP
(3) GEISINGER HEALTH PLAN

 M 94,815 GAAP
(4) GEISINGER COMMUNITY HEALTH SERVICES

 A 8,256 GAAP
(5) GEISINGER HEALTH SYSTEM FOUNDATION

 C 79,934 GAAP
(6) GEISINGER HEALTH SYSTEM FOUNDATION

 B 3,057,377 GAAP
(7) GEISINGER CLINIC

 A 1,374 GAAP
(8) GEISINGER-BLOOMSBURG HOSPITAL

 K 158,283 GAAP
(9) GEISINGER HEALTH PLAN

 L 143,566 GAAP
(10) GEISINGER HEALTH PLAN

 M 94,815 GAAP
(11) GEISINGER COMMUNITY HEALTH SERVICES

 A 8,256 GAAP
(12) GEISINGER HEALTH SYSTEM FOUNDATION

 C 79,934 GAAP
(13) GEISINGER HEALTH SYSTEM FOUNDATION

 B 3,057,377 GAAP
(14) GEISINGER CLINIC

 A 1,374 GAAP
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 INFORMATION SCHEDULE R FORM 990 SCHEDULE R PART V TRANSACTIONS WITH RELATED ORGANIZATIONS AS SHOWN IN THE RESPONSE TO FORM 990 SCHEDULE R COLUMBIAMONTOUR HOME HEALTH SERVICES IS CLOSELY AFFILIATED WITH SEVERAL OTHER ORGANIZATIONS IN THE NORMAL COURSE OF THE OPERATIONS OF THESE AFFILIATED ORGANIZATIONS THERE ARE NUMEROUS INTER ORGANIZATIONAL TRANSACTIONS WHICH MAY INCLUDE SALES EXCHANGES AND LEASES OF PROPERTY EXTENSIONS OF CREDIT FURNISHING OF GOODS SERVICES AND FACILITIES AND TRANSFERS OF ASSETS THESE INTER ORGANIZATION TRANSACTIONS PROMOTE THE EFFICIENT OPERATION OF THE VARIOUS ORGANIZATIONS AND THE ATTAINMENT OF THEIR TAX EXEMPT PURPOSES THESE TYPES OF INTER ORGANIZATION TRANSACTIONS WERE DESCRIBED TO THE INTERNAL REVENUE SERVICE IN A RULING APPLICATION AND WERE RECOGNIZED BY THE NATIONAL OFFICE OF THE IRS IN A SERIES OF GHS PRIVATE RULINGS AS BEING ENTIRELY CONSISTENT WITH THE ORGANIZATIONS TAX EXEMPT STATUS

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