TY 2012 Form 990

(A) Name and business address	(B) Description of services	(C) Compensation
WAYNE MEMORIAL HEALTH SYSTEM,	ADMINISTRATIVE SVCS	1,082,292
N AMERICAN PTRS IN ANESTHESIA,	ANESTHESIOLOGY SVCS	652,723
LABORATORY CORP OF AMERICA,	LABORATORY SVCS	626,838
AIMADVANCE INPATIENT MEDICINE,	HOSPITALIST SVCS	561,745
ANESTHESIOLOGY SOLUTIONS,	ANESTHESIOLOGY SVCS	542,477
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 16

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	1,843,366	1,843,366
2	Grants and other assistance to individuals in the United States. See Part IV, line 22	0
3	Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16	0
4	Benefits paid to or for members	0
5	Compensation of current officers, directors, trustees, and key employees ....	455,076	455,076
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....	20,302	20,302
7	Other salaries and wages	29,282,103	20,563,732	8,718,371
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	2,093,420	1,513,373	580,047
9	Other employee benefits .......	3,571,459	2,584,993	986,466
10	Payroll taxes ...........	2,102,788	1,535,230	567,558
11	Fees for services (non-employees):
a	Management ......	1,461,997		1,461,997
b	Legal .........	111,530		111,530
c	Accounting ...........	86,607		86,607
d	Lobbying ...........	0
e	Professional fundraising services. See Part IV, line 17	0
f	Investment management fees ......	233,026		233,026
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ........	7,439,304	6,473,472	965,832
12	Advertising and promotion ....	168,790		168,790
13	Office expenses .......	7,381,635	4,969,148	2,412,487
14	Information technology ......	549	549
15	Royalties ..	0
16	Occupancy ...........	1,569,480	997,148	572,332
17	Travel ............	220,326	208,916	11,410
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......	0
19	Conferences, conventions, and meetings ....	92,231	67,976	24,255
20	Interest ...........	824,406	650,646	173,760
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization .....	2,709,900	2,138,736	571,164
23	Insurance ..............	613,801	484,430	129,371
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	MEDICAL SUPPLIES & DRUGS	7,691,668	7,691,668
b	BAD DEBT	6,116,891	6,116,891
c	REPAIRS & MAINTENANCE	1,883,518	1,016,133	867,385
d	LICENSES, DUES & SUBSCRIPTIONS	78,208	71,067	7,141
e	All other expenses
25	Total functional expenses. Add lines 1 through 24e	78,052,381	59,402,852	18,649,529	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 if following SOP 98-2 (ASC 958-720).

Part X Balance Sheet Check if Schedule O contains a response to any question in this Part X ...............
	1	Cashnon-interest-bearing .............	1,595	1	1,520
2	Savings and temporary cash investments .........	13,194,935	2	10,923,473
3	Pledges and grants receivable, net ...........	0	3	0
4	Accounts receivable, net .............	12,305,470	4	10,225,148
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L ..................
		0	5	0
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
		0	6	0
7	Notes and loans receivable, net .............	0	7	0
8	Inventories for sale or use ..............	725,334	8	778,118
9	Prepaid expenses and deferred charges ..........	1,524,927	9	1,566,616
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	80,765,642
b	Less: accumulated depreciation .....	10b	58,950,513	22,020,254	10c	21,815,129
11	Investments—publicly traded securities ..........	40,068,048	11	44,621,807
12	Investments—other securities. See Part IV, line 11 .....	24,184	12	615,308
13	Investments—program-related. See Part IV, line 11 .....	4,570,739	13	4,790,002
14	Intangible assets ...............	0	14	0
15	Other assets. See Part IV, line 11 ...........	4,262,764	15	5,179,984
16	Total assets. Add lines 1 through 15 (must equal line 34)......	98,698,250	16	100,517,105
	17	Accounts payable and accrued expenses .........	16,300,996	17	15,140,037
18	Grants payable .................	0	18	0
19	Deferred revenue ................	0	19	0
20	Tax-exempt bond liabilities .............	26,477,717	20	24,463,925
21	Escrow or custodial account liability. Complete Part IV of Schedule D..	0	21	0
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..........	0	22	0
23	Secured mortgages and notes payable to unrelated third parties ..	138,941	23	92,556
24	Unsecured notes and loans payable to unrelated third parties ....	0	24	0
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....................	2,881,987	25	1,904,174
26	Total liabilities. Add lines 17 through 25.........	45,799,641	26	41,600,692
		Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............	51,025,706	27	56,794,513
28	Temporarily restricted net assets ...........	78,801	28	154,050
29	Permanently restricted net assets ...........	1,794,102	29	1,967,850
	Organizations that do not follow SFAS 117 (ASC 958), check here 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 ...........	52,898,609	33	58,916,413
34	Total liabilities and net assets/fund balances ........	98,698,250	34	100,517,105

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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.

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

WAYNE MEMORIAL HOSPITAL

Employer identification number

24-0798839

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.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E.)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in

section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross

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.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box that describes the type of supporting organization and complete lines 11e through 11h.

Type I

Type II

Type III - Functionally integrated

Type III - Non-functionally integrated

By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).

If the organization received a written determination from the IRS that it is a Type I, Type II, or Type III supporting organization, check this box ..................................................

Since August 17, 2006, has the organization accepted any gift or contribution from any of the
following persons?

(i) A person who directly or indirectly controls, either alone or together with persons described in (ii)

Yes

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)

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(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
(i) Name of supported organization	(ii) EIN	Yes	No	Yes	No	Yes	No	(vii) Amount of monetary support


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

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)		(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)		(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).

Gross receipts from related activities, etc. (see instructions) ..................

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

Public support percentage for 2012 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2011 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2012. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2011. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2012. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2011. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

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

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)		(a) 2008	(b) 2009	(c) 2010	(d) 2011	(e) 2012	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3	Gross receipts from activities that are not an unrelated trade or business under section 513..
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge..
6	Total. Add lines 1 through 5.
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons...
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2008	(b) 2009	(c) 2010	(d) 2011	(e) 2012	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

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

Public support percentage for 2012 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2011 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2012 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2011 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests—2012. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ........ right arrow

33 1/3% support tests—2011. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ..... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions ..... right arrow

Schedule A (Form 990 or 990-EZ) 2012

Page 4

Part IV

Supplemental Information. Complete this part to provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and Part III, line 12. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Explanation

Schedule A (Form 990 or 990-EZ) 2012

Additional Data

Software ID:
Software Version:

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Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

OMB No. 1545-0047

2012

Name of the organization

WAYNE MEMORIAL HOSPITAL

Employer identification number

24-0798839

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

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

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, $5,000 or more (in money or
property) from any one contributor. Complete Parts I and II.

Special Rules

For a section 501(c)(3) organization filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi) and received from any one contributor, during the year, a contribution of the
greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For a section 501(c)(7), (8), or (10) organization filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 for use exclusively for religious, charitable,
scientific, literary, or educational purposes, or the prevention of cruelty to children or animals. Complete Parts I, II, and
III.

For a section 501(c)(7), (8), or (10) organization filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions for use exclusively for religious, charitable, etc., purposes, but these contributions did
not total to more than $1,000. If this box is checked, enter here the total contributions that were received during
the year for an exclusively religious, charitable, etc., purpose. Do not complete any of the parts unless the General Rule
applies to this organization because it received nonexclusively religious, charitable, etc., contributions of $5,000 or more
during the year ......................... 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 WAYNE MEMORIAL HOSPITAL

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	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (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 WAYNE MEMORIAL HOSPITAL

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
WAYNE MEMORIAL HOSPITAL

Employer identification number

24-0798839

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

(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

(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

(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

(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:

- TIN:

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

WAYNE MEMORIAL HOSPITAL

Employer identification number

24-0798839

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV.

Political expenditures .................................... SchCMd Bullet

Volunteer hours ........................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ......... SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ...... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............

Yes No

Was a correction made? .........................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ................................... SchCMd Bullet

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

Did the filing organization file Form 1120-POL for this year? ..........................

Yes No

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

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 Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(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? ......................................	Yes No

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

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)

Yes

(b)

Amount

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:

Volunteers? .........................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....

Media advertisements? ....................................

Mailings to members, legislators, or the public? .........................

Publications, or published or broadcast statements? .......................

Grants to other organizations for lobbying purposes? .......................

Direct contact with legislators, their staffs, government officials, or a legislative body? ........

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......

Other activities? ..........................

Yes

11,154

Total. Add lines 1c through 1i ...............................

11,154

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 .................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....

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

Were substantially all (90% or more) dues received nondeductible by members? ................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ................

Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........

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."

Dues, assessments and similar amounts from members .....................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).

Current year .........................................

Carryover from last year ....................................

Total ............................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

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? ................................

Taxable amount of lobbying and political expenditures (see instructions) ..............

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
LOBBYING EXPENDITURES	SCHEDULE C, PART II-B, LINE 1(I)	WAYNE MEMORIAL HOSPITAL PAYS ANNUAL MEMBERSHIP DUES TO THE HOSPITAL & HEALTH SYSTEM ASSOCIATION OF PENNSYLVANIA (HAP) AND AMERICAN HOSPITAL ASSOCIATION (AHA). THE HOSPITAL IS NOTIFIED EACH YEAR THAT A PORTION OF THE MEMBERSHIP DUES IS USED FOR LOBBYING ACTIVITIES. THE PORTION OF FEES PAID REPRESENTING LOBBYING EXPENDITURES WAS $5,906 FOR HAP AND $5,248 FOR AHA, TOTALING $11,154 IN LOBBYING EXPENDITURES.

Schedule C (Form 990 or 990EZ) 2012

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

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

WAYNE MEMORIAL HOSPITAL

Employer identification number

24-0798839

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 ........

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? ............

Yes No

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? ...................................

Yes No

Part II

Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

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.


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

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet

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)? .......................................

Yes No

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.

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.

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

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:

Revenues included in Form 990, Part VIII, line 1 .......................... SchDMd Bullet

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

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

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):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

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?........

Yes No

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.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No

If "Yes," explain the arrangement in Part XIII and complete the following table:


c	Beginning balance .................................	1c
d	Additions during the year ..............................	1d
e	Distributions during the year .............................	1e
f	Ending balance ...................................	1f

Did the organization include an amount on Form 990, Part X, line 21? .....................

Yes No

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 ....
b	Contributions ........
c	Net investment earnings, gains, and losses
d	Grants or scholarships .....
e	Other expenditures for facilities and programs ........
f	Administrative expenses ....
g	End of year balance ......

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Temporarily restricted endowment SchDMd Bullet

The percentages in lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) unrelated organizations ........................

3a(i)

(ii) related organizations ........................

3a(ii)

If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........

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		(b)Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value
1a	Land .................	1,984,110		1,984,110
b	Buildings ................	32,287,891	21,287,706	11,000,185
c	Leasehold improvements ............	1,974,315	1,568,882	405,433
d	Equipment ................	42,566,819	35,175,471	7,391,348
e	Other .................	1,952,507	918,454	1,034,053
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......				21,815,129

Schedule D (Form 990) 2012

Page 3

Part VII

InvestmentsOther 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.)

Part VIII

InvestmentsProgram 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.)

Part IX

Other Assets. See Form 990, Part X, line 15.

(a) Description				(b) Book value
(1) BEN. INT. IN PERPETUAL TRUSTS				1,863,936
(2) DUE FROM AFFILIATES				2,512,237
(3) EST. AMOUNT DUE- 3RD PARTIES				803,811






Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				5,179,984

Part X

Other Liabilities. See Form 990, Part X, line 25.

1.(a) Description of liability		(b) Book value
Federal income taxes		0
EST. MALPRACTICE CLAIMS		1,504,174
DUE TO THIRD PARTIES		400,000







Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)		1,904,174
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

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	78,051,338
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains on investments ..........	2a	2,460,094
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d	-4,480,296
e	Add lines 2a through 2d .....................			2e	-2,020,202
3	Subtract line 2e from line 1.....................			3	80,071,540
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	-331,070
c	Add lines 4a and 4b.......................			4c	-331,070
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......			5	79,740,470

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1	Total expenses and losses per audited financial statements ...........			1	72,033,534
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	331,070
e	Add lines 2a through 2d......................			2e	331,070
3	Subtract line 2e from line 1.....................			3	71,702,464
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	233,026
b	Other (Describe in Part XIII.) ............	4b	6,116,891
c	Add lines 4a and 4b.......................			4c	6,349,917
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......			5	78,052,381

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
UNCERTAIN TAX POSITIONS	SCHEDULE D, PART X, LINE 2	MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS.
AMOUNTS INCLUDED ON LINE 1 BUT NOT ON FORM 990, PART VIII, LINE 12	SCHEDULE D, PART XI, LINE 2D	BAD DEBT EXPENSE $(6,116,891) DEFINED BENEFIT PENSION PLAN 1,602,692 INVESTMENT MANAGEMENT FEES (233,026) BENEFICIAL INTEREST IN PERPETUAL TRUST 173,748 INTEREST IN NET ASSETS OF FOUNDATION 82,747 TRANSFER FROM AFFILIATE 10,434 ----------- $(4,480,296)
AMOUNTS INCLUDED ON FORM 990, PART VIII, LINE 12, BUT NOT ON LINE 1	SCHEDULE D, PART XI, LINE 4B	RENTAL EXPENSES $( 331,070)
AMOUNTS INCLUDED ON LINE 1 BUT NOT ON FORM 990, PART IX, LINE 25	SCHEDULE D, PART XII, LINE 2D	RENTAL EXPENSES $ 331,070
AMOUNTS INCLUDED ON FORM 990, PART IX, LINE 25, BUT NOT ON LINE 1	SCHEDULE D, PART XII, LINE 4B	BAD DEBT EXPENSE $ 6,116,891

Schedule D (Form 990) 2012

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H (Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990. MediumBullet

See separate instructions.

OMB No. 1545-0047

2012

Open to Public Inspection

Name of the organization

WAYNE MEMORIAL HOSPITAL

Employer identification number

24-0798839

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a ...

Yes

If "Yes," was it a written policy? .......................

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: .........

200% 250% 300% 350% 400% Other %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? ..............

Yes

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

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? ......

Yes

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? ..............

Did the organization prepare a community benefit report during the tax year? ..........

If "Yes," did the organization make it available to the public? ..............

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) ..			480,771		480,771	0.670 %
b	Medicaid (from Worksheet 3, column a) ....			8,627,926	4,969,235	3,658,691	5.090 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) .
d	Total Financial Assistance and Means-Tested Government Programs .			9,108,697	4,969,235	4,139,462	5.760 %
Other Benefits		20	9,499	255,147	11,703	243,444	0.340 %
e	Community health improvement services and community benefit operations (from Worksheet 4) ..	20	9,499	255,147	11,703	243,444	0.340 %
f	Health professions education (from Worksheet 5) ..	1	14	386,104		386,104	0.540 %
g	Subsidized health services (from Worksheet 6) ..
h	Research (from Worksheet 7)
i	Cash and in-kind contributions for community benefit (from Worksheet 8)	1		1,843,366		1,843,366	2.560 %
j	Total. Other Benefits ..	22	9,513	2,484,617	11,703	2,472,914	3.440 %
k	Total. Add lines 7d and 7j .	22	9,513	11,593,314	4,980,938	6,612,376	9.200 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2012

Schedule H (Form 990) 2012

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community building expense	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support	3		88,196	88,196	0.120 %
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building	1	135	10,351	10,351	0.010 %
7	Community health improvement advocacy
8	Workforce development	2	547	6,179	6,179	0.010 %
9	Other
10	Total	6	682	104,726	104,726	0.140 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................

Yes

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

6,116,891

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

740,144

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

28,760,285

Enter Medicare allowable costs of care relating to payments on line 5.....

27,433,495

Subtract line 6 from line 5. This is the surplus (or shortfall)........

1,326,790

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2012

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions) How many hospital facilities did the organization operate during the tax year?1 Name, address, and primary website address
1	WAYNE MEMORIAL HOSPITAL 601 PARK STREET HONESDALE,PA18431 WWW.WMH.ORG	X	X	X

Schedule H (Form 990) 2012

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Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	WAYNE MEMORIAL HOSPITAL
Name of hospital facility or facility reporting group

For single facility filers only: line Number of Hospital Facility (from Schedule H, Part V, Section A)

Yes

Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9....................

Yes

If “Yes,” indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

Information gaps that limit the hospital facility’s ability to assess the community’s health needs

Other (describe in Part VI)

Indicate the tax year the hospital facility last conducted a CHNA: 20 12

In conducting its most recent CHNA, did the hospital facility take into account input from representatives of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted ....................

Yes

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI................................

Did the hospital facility make its CHNA report widely available to the public? .............

Yes

If “Yes,” indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website

Available upon request from the hospital facility

Other (describe in Part VI)

If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply to date):

Adoption of an implementation strategy that addresses each of the community health needs identified through the CHNA

Execution of the implementation strategy

Participation in the development of a community-wide plan

Participation in the execution of a community-wide plan

Inclusion of a community benefit section in operational plans

Adoption of a budget for provision of services that address the needs identified in the CHNA

Prioritization of health needs in its community

Prioritization of services that the hospital facility will undertake to meet health needs in its community

Other (describe in Part VI)

Did the hospital facility address all of the needs identified in its most recently conducted CHNA? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs ........

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ...........................

If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ......

If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2012

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Part VFacility Information (continued)

Financial Assistance Policy			Yes	No
9	Did the hospital facility have in place during the tax year a written financial assistance policy that:
	Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care?	9	Yes
10	Used federal poverty guidelines (FPG) to determine eligibility for providing free care?...........	10	Yes
	If "Yes," indicate the FPG family income limit for eligibility for free care: 200.% If "No," explain in Part VI the criteria the hospital facility used.
11	Used FPG to determine eligibility for providing discounted care?.................	11		No
	If “Yes,” indicate the FPG family income limit for eligibility for discounted care: % If "No," explain in Part VI the criteria the hospital facility used.
12	Explained the basis for calculating amounts charged to patients?.................	12	Yes
	If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a	Income level
b	Asset level
c	Medical indigency
d	Insurance status
e	Uninsured discount
f	Medicaid/Medicare
g	State regulation
h	Other (describe in Part VI)
13	Explained the method for applying for financial assistance?...................	13		No
14	Included measures to publicize the policy within the community served by the hospital facility?.......	14	Yes
	If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a	The policy was posted on the hospital facility’s website
b	The policy was attached to billing invoices
c	The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d	The policy was posted in the hospital facility’s admissions offices
e	The policy was provided, in writing, to patients on admission to the hospital facility
f	The policy was available upon request
g	Other (describe in Part VI)
Billing and Collections
15	Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?.......	15		No
16	Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a	Reporting to credit agency
b	Lawsuits
c	Liens on residences
d	Body attachments
e	Other similar actions (describe in Part VI)
17	Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?..........	17		No
	If “Yes,” check all actions in which the hospital facility or a third party engaged:
a	Reporting to credit agency
b	Lawsuits
c	Liens on residences
d	Body attachments
e	Other similar actions (describe in Part VI)

Schedule H (Form 990) 2012

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Part VFacility Information (continued)

Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

Notified individuals of the financial assistance policy in communications with the patients regarding the patients’ bills

Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy

Other (describe in Part VI)

Policy Relating to Emergency Medical Care

Yes

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..........

Yes

If “No,” indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)

Other (describe in Part VI)

Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged

The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged

The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged

Other (describe in Part VI)

During the tax year, did the hospital facility charge any FAP-eligible individuals to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care? ............................

If “Yes,” explain in Part VI.

During the tax year, did the hospital facility charge any FAP-eligible individuals an amount equal to the gross charge for any service provided to that individual? .........................

If “Yes,” explain in Part VI.

Schedule H (Form 990) 2012

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Part VFacility Information (continued)

Section C. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?
Name and address		Type of Facility (describe)
1
2
3
4
5
6
7
8
9
10

Schedule H (Form 990) 2012

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Part VI

Supplemental Information

Complete this part to provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; Part V, Section A; and Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 10, 11, 12h, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any needs assessments reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
8	Facility reporting group(s). If applicable, for each hospital facility in a facility reporting group provide the descriptions required for Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 10, 11, 12h, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22.

Identifier	ReturnReference	Explanation
CONTRIBUTIONS TO THE COMMUNITY	SCHEDULE H, PART I, LINE 7I	THE HOSPITAL SUBSIDIZED BOTH IN & OUT OF SCOPE (NON PRIMARY CARE SERVICES - PEDIATRICS, SURGEONS AND SPECIALIST) SERVICES OF WAYNE MEMORIAL COMMUNITY HEALTH CENTERS (WMCHC) WITH A CASH CONTRIBUTION OF $1,843,366. WMCHC'S SURGEONS AND SPECIALIST PROVIDE INPATIENT AND OUTPATIENT CARE AT WAYNE MEMORIAL HOSPITAL AS WELL AS SERVICES OUT OF THEIR HEALTH CENTER OFFICES. WMCHC PEDIATRIC PRACTITIONERS PROVIDE INPATIENT AND OUTPATIENT CARE AT WAYNE MEMORIAL HOSPITAL AND OUTPATIENT SERVICES IN THE HONESDALE AND CARBONDALE AREA. WMCHC WOULD NOT BE ABLE TO PROVIDE THESE SERVICES AND THEY WOULD NOT BE AVAILABLE IN THE COMMUNITY WITHOUT THE SUBSIDY.
PERCENT OF TOTAL EXPENSE	SCHEDULE H, PART I, LINE 7, COLUMN F	TO ARRIVE AT THE PERCENT OF TOTAL EXPENSES, THE DENOMINATOR WHICH EQUALS TOTAL EXPENSES PER PART IX, LINE 25, OF THE FORM 990 WAS REDUCED BY BAD DEBT EXPENSE. THE AMOUNT OF BAD DEBT EXPENSE THAT WAS REMOVED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN SCHEDULE H, PART I, LINE 7, COLUMN (F) WAS $ 6,116,891.
COSTING METHODOLOGY	SCHEDULE H, PART I, LINE 7	THE COST TO CHARGE RATIO CALCULATED ON IRS WORKSHEET 2 WAS USED IN THE CALCULATION OF COST ON IRS WORKSHEETS 1 AND 3.
COMMUNITY BUILDING ACTIVITIES	SCHEDULE H, PART II	WAYNE MEMORIAL HOSPITAL AND ITS AFFILIATES PROMOTE THE HEALTH OF THE COMMUNITIES IT SERVES THROUGH A VARIETY OF COMMUNITY BUILDING ACTIVITIES. THE RATIONALE, PROGRAM METHODOLOGY AND IMPLEMENTATION FOR THE FOLLOWING PROGRAM IS TYPICAL OF THE OTHER PROGRAMS DESCRIBED HEREIN AND SHOULD SERVE AS THE MODEL FOR THOSE OTHER PROGRAMS IN ADDRESSING THE REQUIREMENTS OF THIS SECTION OF THE FORM. THE IN-SCHOOL WALKING PROGRAM IS A PARTNERSHIP OF WAYNE MEMORIAL HOSPITAL WITH THE WAYNE HIGHLANDS, WALLENPAUPACK AREA, FOREST CITY REGIONAL, AND WESTERN WAYNE SCHOOL DISTRICTS IN THE WMH SERVICE AREA. WMH PROVIDES LEADERSHIP, DIRECTION AND FACILITATION FOR THE PROGRAM THAT RUNS MONDAY THROUGH THURSDAY, FROM 6PM TO 8 PM, WHENEVER THE SCHOOLS ARE IN SESSION. - HEALTH PROBLEM-SEDENTARY LIFESTYLE OR LACK OF EXERCISE. A SEDENTARY LIFESTYLE OR LACK OF EXERCISE HAS BEEN IDENTIFIED AS A LEADING RISK FACTOR BY THE CENTERS FOR DISEASE CONTROL (CDC) AND THE PENNSYLVANIA DEPARTMENT OF HEALTH FOR OBESITY, HEART DISEASE, DIABETES, HYPERTENSION, AND A NUMBER OF OTHER CHRONIC DISEASES. - NEED/PROBLEM IDENTIFICATION: WMH'S TOGETHER FOR HEALTH (TFH) SCHOOL PROGRAM WAS ESTABLISHED IN 1995, FOLLOWING A SERIES OF MEETINGS INVOLVING THE HOSPITAL, SCHOOL DISTRICTS AND OTHER AREA HEALTH AND HUMAN SERVICE PROVIDERS. THE PROGRAM HAS BEEN RUN DURING THE FALL AND SPRING SEMESTERS SINCE THAT TIME AND RESULTS OF CLINICAL AND SELF- EVALUATIONS OF THE STUDENTS PROVIDED THE IMPETUS FOR OTHER COMMUNITY BENEFIT ACTIVITIES, INCLUDING THE IN-SCHOOL WALKING PROGRAM. THE TOGETHER FOR HEALTH PROGRAM ADDRESSES SCHOOL IDENTIFIED NEEDS OF YOUTH THROUGH PROVIDING SCREENINGS, RISK ASSESSMENT, AND HANDS ON PROGRAMS. THE PROGRAM OCCURS IN 3 SCHOOL DISTRICTS AND UTILIZING PARTNERSHIPS WITH COMMUNITY RESOURCES. DIRECT COMMUNITY BENEFIT IS THE DECISIONS OF YOUTH TO IMPROVE LIFESTYLE CHOICES AND ULTIMATELY, IMPROVING THE LONG RANGE COMMUNITY HEALTH STATUS. FOR EXAMPLE, IN THE TOGETHER FOR HEALTH PROGRAM, DURING THE STUDENT EVALUATION OF THE WORKSHOP "MEET THE CLINICIAN" WITH MONICA PEK MD, TO STATEMENT #1 "I WILL THINK ABOUT WHAT I CONSUME" - 93% ANSWERED YES AND 7% ANSWERED NO; STATEMENT # 2 "I WILL STRIVE TO BE HEALTHIER" 96% ANSWERED YES AND 4% ANSWERED NO. - IMPORTANCE OF THE HEALTH PROBLEM: LACK OF EXERCISE HAS MANIFOLD NEGATIVE AFFECTS ON INDIVIDUALS OF ALL AGES AND INCOME LEVELS. RURAL, LOW INCOME, ELDERLY AND INDIVIDUALS WITH DISABILITIES ARE PARTICULARLY VULNERABLE COMMUNITY MEMBERS WHOSE STATUS LEADS TO POOR ACCESS, AND POOR MOTIVATIONAL DRIVE TO ACCESS, LIMITED RESOURCES TO ADDRESS THIS ISSUE. MAKING SAFE, ACCESSIBLE AREAS FOR WALKING IN LARGE, PROTECTED BUILDINGS WHEN THEY ARE NOT IN USE, LED TO THE CONCEPT OF WALKING IN THE SCHOOLS. PROVIDING A SAFE ATMOSPHERE WITHIN THE SCHOOLS LOCATED NEAR WHERE THEY LIVE HAS ASSISTED MORE THAN 500 PEOPLE THIS YEAR. - ACTIVITY IMPACT: PARTICIPANT RESPONSES TO THE PROGRAM INDICATE THAT IT HAS HELPED THEM FEEL BETTER, LOSE WEIGHT, ENJOY FELLOWSHIP WITH PAST AND NEW FRIENDS, AND GIVEN THEM ENERGY, BETTER HEALTH AND A BETTER SELF IMAGE THAN PRIOR TO THEIR PARTICIPATION. - COMMUNITY BENEFIT: ENHANCING PUBLIC HEALTH, ADVANCING WELL BEING KNOWLEDGE AND, ULTIMATELY, RELIEF OF THE GOVERNMENTAL BURDEN OF CARING FOR THOSE INDIVIDUALS INVOLVED WHOSE SEDENTARY AND CARELESS LIFESTYLES WOULD OTHERWISE INHIBIT GOOD HEALTH ARE THE PRINCIPAL BENEFITS OF THE PROGRAM. THE PROGRAM IS OPEN TO ANY MEMBERS OF THE COMMUNITY WHO WISH TO PARTICIPATE. - PURPOSE: THE PURPOSE OF THE PROGRAM IS EXCLUSIVELY FOR THE BENEFIT OF THE INDIVIDUALS PARTICIPATING, WITH THE INCUMBENT BENEFIT OF IMPROVING THE HEALTH STATUS OF THE COMMUNITY. - SUPPORT: THERE ARE A NUMBER WAYS IN WHICH THE COMMUNITY SUPPORTS THE DESCRIBED PROGRAMS. THE LOCAL RADIO STATION PROVIDES PUBLIC SERVICE ANNOUNCEMENTS FREE OF CHARGE TO LET THE PUBLIC KNOW HOW THEY CAN PARTICIPATE. THE RADIO STATION NOW AIRES ON 2 STATIONS AND HAS A WEB POD AVAILABLE 24 HOURS A DAY. FLYERS ARE DISTRIBUTED THROUGH THE WAYNE/PIKE STATE HEALTH IMPROVEMENT PLAN (SHIP) PARTNERSHIP MEMBER BUSINESSES, ORGANIZATIONS, SCHOOLS, DOCTOR'S OFFICES, AND OTHERS. FURTHER, THE WAYNE MEMORIAL HOSPITAL COMMUNITY HEALTH DEPARTMENT HAS RESPONDED TO OPPORTUNITIES FOR INVOLVEMENT IN COMMUNITY BENEFIT INITIATIVES BY ENTHUSIASTICALLY DEDICATING THEIR TIME, EXPERTISE AND RESOURCES. THE PREVENTION INITIATIVE IS THE PENNSYLVANIA STATE HEALTH IMPROVEMENT PLAN(SHIP) PARTNERSHIP FOR WAYNE AND PIKE COUNTIES. IT IS COMPRISED OF GREATER THAN 300 ORGANIZATIONS, BUSINESS, CONCERNED PEOPLE THAT MEET TOGETHER TO IDENTIFY NEEDS, REVIEW AVAILABLE RESOURCES AND BECOME THE CATALYST FOR CHANGE ACCOMPLISHING A HEALTHIER COMMUNITY AND REDUCING THE BURDEN ON MANY GOVERNMENT ENTITIES.
BAD DEBT EXPENSE	SCHEDULE H, PART III, SECTION A, LINE 4	THE AUDITED FINANCIAL STATEMENTS DO NOT CONTAIN A FOOTNOTE THAT DESCRIBES BAD DEBT EXPENSE. THEY DO, HOWEVER, CONTAIN A FOOTNOTE THAT DESCRIBES PATIENT ACCOUNTS RECEIVABLE: ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE SYSTEM ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYER SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR UNCOLLECTIBLE ACCOUNTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYER SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. THE BAD DEBT ENTERED ON LINE 2, PART III OF SCHEDULE H WAS THE BAD DEBT EXPENSE SHOWN ON THE HOSPITAL'S FINANCIAL STATEMENTS. THE HOSPITAL DOES NOT TRACK BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY. IF THE HOSPITAL IS AWARE OR BECOMES AWARE OF A PATIENT'S ELIGIBILITY FOR CHARITY CARE THEN BAD DEBT EXPENSE WOULD NOT BE RECORDED FOR SUCH A PATIENT. CHARITY CARE WOULD BE RECORDED IF THAT PATIENT IS ELIGIBLE. THEREFORE, THE AMOUNT CALCULATED AS ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY WAS DETERMINED USING POVERTY LIMIT DEMOGRAPHIC INFORMATION OBTAINED THROUGH THE US CENSUS BUREAU. USING DATA FOR WAYNE COUNTY FOR 2008-2012, PERSONS BELOW POVERTY LEVEL WAS APPROXIMATELY 12.1%.
COMMUNITY BENEFIT	SCHEDULE H, PART III, SECTION B, LINE 8	SERVING PATIENTS WITH GOVERNMENT HEALTH BENEFITS, SUCH AS MEDICARE, IS A COMPONENT OF THE COMMUNITY BENEFIT STANDARD THAT TAX-EXEMPT HOSPITALS ARE HELD TO. THIS IMPLIES THAT SERVING MEDICARE PATIENTS IS A COMMUNITY BENEFIT AND THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. DURING FISCAL YEAR ENDING 6/30/13, THE MEDICARE SHORTFALL WAS $1,326,790. THE HOSPITAL IS A MEDICARE DEPENDENT HOSPITAL (MDH). A MDH MUST HAVE 60% OF ITS INPATIENT DAYS OR ADMISSIONS ATTRIBUTABLE TO ITS MEDICARE PATIENTS IN 2 OUT OF 3 OF ITS MOST RECENT FISCAL YEARS. A MDH IS PAID SIMILARLY TO A SOLE COMMUNITY HOSPITAL BUT AT A LESSER RATE. A MDH IS PAID THE GREATER OF THE FEDERAL INPATIENT PROSPECTIVE PAYMENT SYSTEM (IPPS) RATES OR 75% OF THE DIFFERENCE BETWEEN ITS HOSPITAL SPECIFIC COST FOR A BASE PERIOD ROLLED FORWARD FOR MARKET BASKET INCREASES FROM THE BASE PERIOD AND THE IPPS RATES. THE MDH EXTRA PAYMENT AMOUNTED TO JUST UNDER $2,150,000 IN FISCAL YEAR ENDED 6/30/13.
COLLECTION POLICY	SCHEDULE H, PART III, SECTION C, LINE 9B	THE WRITTEN HOSPITAL COLLECTION POLICY CONTAINS PROVISION FOR FINANCIAL COUNSELING FOR PATIENT INCLUDING APPLYING TO INSURANCE AVAILABLE SUCH AS BLUE CHIP OR ADULT BASIC. ASSISTANCE WILL ALSO BE PROVIDED TO HELP PATIENT WITH MEDICAL ASSISTANCE APPLICATIONS AND CHARITY CARE APPLICATIONS. CHARITY CARE APPLICANTS ARE URGED TO APPLY FOR MEDICAL ASSISTANCE BUT IT IS NOT A REQUIREMENT. QUALIFICATION FOR CHARITY CARE IS BASED ON 200 % OF THE CURRENT FEDERAL POVERTY GUIDELINES. THE PATIENT ACCOUNTS MANAGER REVIEWS THE APPLICATIONS AND NOTIFIES THE APPLICANT WHETHER THEIR APPLICATION HAS BEEN APPROVED. THOSE PATIENTS QUALIFYING FOR CHARITY CARE HAVE THEIR PATIENT ACCOUNT BALANCES WRITTEN OFF COMPLETELY. IF A PATIENT HAS FUTURE BILLS THEY ARE REVIEWED AND IF FINANCIAL INFORMATION IS STILL CURRENT THEY ARE ALSO WRITTEN OFF. IF THE PATIENT HAS A FUTURE BILL AND THE FINANCIAL INFORMATION IS NOT CURRENT WE REQUEST THE CURRENT INFORMATION SO WE CAN REVIEW FOR CHARITY CARE.
COMMUNITY INPUT	SCHEDULE H, PART V, SECTION B, LINE 3	NUMEROUS ORGANIZATIONS AND COMMUNITY GROUPS PARTICIPATED IN THE ASSESSMENT. THE PUBLIC HEALTH AREA WAS INCLUDED WITHIN THE ASSESSMENT THROUGH UTILIZATION AND ANALYSIS OF INFORMATION ROUTINELY EVALUATED BY PUBLIC HEALTH AGENCIES AND ORGANIZATIONS WITH PREVENTIVE HEALTH PROGRAM CAPACITIES. THE AREA DOES NOT HAVE ORGANIZED COUNTY PUBLIC DEPARTMENTS PER SE BUT IS A PART OF THE STATE'S NORTHEAST PUBLIC HEALTH REGION. STATE HEALTH DEPARTMENT REPRESENTATION WAS INCLUDED IN THE ADVISORY GROUP AND HMS ASSOCIATES WORKED WITH PENNSYLVANIA DEPARTMENT OF HEALTH PERSONNEL DIRECTLY ON ACCESSING REPORTS ON VITAL STATISTICS DATA. GREGORY BONK, THE LEAD HMS CONSULTANT OF THE ASSESSMENT ASSISTED PUBLIC HEALTH AGENCIES IN COMPLETING HEALTH NEEDS ASSESSMENTS IN THE 1990S AND HAS WORKED ON MANY PROJECTS INVOLVING PUBLIC HEALTH AGENCIES IN SEVERAL STATES. HE HAS BEEN AN ADJUNCT FACULTY MEMBER AT THE STATE UNIVERSITY OF NEW YORK AT BUFFALO, SCHOOL OF MEDICINE AND BIOMEDICAL SCIENCES, DEPARTMENT OF FAMILY MEDICINE SINCE 1988.
IMPLEMENTATION STRATEGY	SCHEDULE H, PART V, LINE 6	IN RESPONSE TO THE RESULTS OF WAYNE MEMORIAL HOSPITAL'S MOST RECENTLY CONDUCTED COMMUNITY HEALTH NEEDS ASSESSMENT, THE ORGANIZATION ADOPTED AN IMPLEMENTATION STRATEGY. THE IMPLEMENTATION STRATEGY IS ATTACHED.
ADDRESSING IDENTIFIED NEEDS	SCHEDULE H, PART V, SECTION B, LINE 7	ALTHOUGH WAYNE MEMORIAL HOSPITAL RECOGNIZES THE IMPORTANCE OF ALL THE NEEDS IDENTIFIED BY THE COMMUNITY, CERTAIN NEEDS ARE NOT WITHIN THE PURVIEW OF WMH AND ARE NOT ADDRESSED.
NO FPG DISCOUNT USED	SCHEDULE H, PART V, SECTION B, LINE 10	THE HOSPITAL DID NOT PROVIDE DISCOUNTED CARE AS IT ONLY PROVIDES FREE CARE AT THE 200% FPG LEVEL.
MAXIMUM AMOUNTS CHARGED TO FAP-ELIGIBLE INDIVIDUALS	SCHEDULE H, PART V, SECTION B, LINE 20D	AS THE ORGANIZATION ONLY OFFERS FREE CARE, THERE ARE NO AMOUNTS CHARGED TO FAP-ELIGIBLE INDIVIDUALS.
NEEDS ASSESSMENT		THE COMMUNITY NEEDS ASSESSMENT METHODOLOGY THAT WAYNE MEMORIAL HOSPITAL USED RELATED TO THE TIME FRAME 7/1/2012 - 6/30/2013 FOLLOWED A MODEL THAT INVOLVED CONTRACTING WITH AN OUTSIDE ORGANIZATION, A CONSULTING FIRM, TO CONDUCT THE STUDY. THIS ASSESSMENT CONFORMS TO THE IRS REQUIREMENT THAT NONPROFIT HOSPITALS MUST COMPLETE A COMMUNITY NEEDS ASSESSMENT EVERY THREE YEARS. WAYNE MEMORIAL HOSPITAL BEGAN A NEW COMPLIANT NEEDS ASSESSMENT IN DECEMBER 2012 AND COMPLETED IT IN JUNE OF 2013. - BACKGROUND: IN THE FALL OF 2012, UNDER THE GUIDANCE OF WAYNE MEMORIAL HOSPITAL, A GROUP OF INDIVIDUALS REPRESENTING VARIOUS HEALTH CARE AND HUMAN SERVICE PROVIDERS IN WAYNE AND PIKE COUNTIES, PA AND THE COMMUNITY OF CARBONDALE IN LACKAWANNA COUNTY, PA MET TO CONSIDER A PLAN TO PRODUCE A COMPREHENSIVE NEEDS AND RESOURCE ASSESSMENT FOR THE AREA. THE PRODUCT WOULD BENEFIT HEALTH CARE AND HUMAN SERVICE PROVIDER ORGANIZATIONS/AGENCIES AND LOCAL GOVERNMENTS IN PIKE AND WAYNE COUNTIES IN TERMS OF ORGANIZATIONAL POLICY CONSIDERATIONS AND IN PREPARATION OF FUNDING PROPOSALS TO GOVERNMENTAL AND PRIVATE FUNDERS. AS A RESULT OF THAT ORIGINAL MEETING, A COMMUNITY NEEDS ASSESSMENT STEERING COMMITTEE WAS STARTED AS AN INDEPENDENT GRASS ROOTS COLLABORATION OF COMMUNITY ACTIVISTS, HEALTH CARE PROVIDERS AND EDUCATORS THAT BEGAN REGULAR MEETINGS TO COMPOSE A REQUEST FOR PROPOSALS (RFP) TO ACCOMPLISH THE ASSESSMENT. THE COMMITTEE INCLUDED REPRESENTATIVES FROM WAYNE MEMORIAL HOSPITAL (WMH), WAYNE MEMORIAL COMMUNITY HEALTH CENTERS, THE CARBONDALE AREA, WAYNE AND PIKE COUNTY GOVERNMENTS, PPL, INC., THE PIKE INTERAGENCY COUNCIL AND AREA SCHOOL DISTRICTS. AN RFP WAS CREATED AND SENT TO QUALIFIED REGIONAL CONSULTING FIRMS TO COMPLETE A COMMUNITY HEALTH AND HUMAN SERVICES NEEDS AND RESOURCES ASSESSMENT FOR THE COUNTIES OF PIKE AND WAYNE AND THE COMMUNITY OF CARBONDALE IN LACKAWANNA AND SURROUNDING AREAS IN NORTHEASTERN PENNSYLVANIA. - THE ASSESSMENT: IN JANUARY 2013, A FIRM WAS CHOSEN, HMS ASSOCIATES OF GETZVILLE, NY, THAT HAD PERFORMED A SIMILAR HEALTH NEEDS ASSESSMENT FOR WAYNE AND PIKE IN 2009 AND ANOTHER SIMILAR ASSESSMENT FOR PIKE COUNTY IN 2004. FROM FEBRUARY THROUGH JUNE 2013 THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) WAS PERFORMED INVOLVING STATISTICAL DATA COLLECTION FROM SOURCES IN PENNSYLVANIA, NEW YORK AND NEW JERSEY WAS CONSIDERED ALONG WITH COMMUNITY PERCEPTIONS AND LOCAL EXPERT OPINIONS GATHERED THROUGH NUMEROUS FOCUS GROUPS, ONE-ON-ONE INTERVIEWS AND AN IN-DEPTH ONLINE COMMUNITY SURVEY DEVELOPED BY HMS. - GEOGRAPHIC AREA ASSESSED: THE AREA ASSESSED WERE THE COUNTIES OF WAYNE AND PIKE, PA AND THE COMMUNITY OF CARBONDALE AND ITS SURROUNDINGS IN LACKAWANNA AND PORTIONS OF SUSQUEHANNA COUNTY, PA. - HOW FREQUENTLY THE ASSESSMENT IS CONDUCTED: THE FIRST INCIDENCE OF A NEEDS ASSESSMENT OF THIS DEPTH FOR THE HOSPITAL'S SERVICE AREA WAS THE ONE PERFORMED IN 2009, REFERRED TO IN THE ASSESSMENT ABOVE. PRIOR TO THAT, CHNAS WERE PERFORMED INTERNALLY APPROXIMATELY EVERY THREE YEARS UNDER THE DIRECTION OF THE WAYNE MEMORIAL HOSPITAL COMMUNITY ADVISORY BOARD STARTING IN 1996. IT IS THE INTENTION OF WAYNE MEMORIAL TO FULFILL THE REQUIREMENT OF THE IRS COMMUNITY BENEFIT MANDATE TO PERFORM A SIMILAR NEEDS ASSESSMENT TO THE 2009 STUDY EVERY THREE YEARS. - PROCESS FOR PRIORITIZING NEEDS: AN IN-DEPTH ANALYSIS WAS MADE OF ALL COLLECTED DATA, WHICH WAS WEIGHTED THROUGH A FORMULA DEVELOPED THAT JUXTAPOSED DATA COLLECTED FOLLOWING MASLOW'S HIERARCHY OF NEEDS AND EMPIRICAL EMPHASIS IDENTIFIED BY EXPERTS AND PROVIDERS INVOLVED IN THE STUDY. THIS FORMULA WAS USED TO ESTABLISH A FINAL ACTIONABLE LIST OF THE HIGHEST PRIORITY HEALTH SERVICE NEEDS FOR THE TWO-COUNTY REGION. THOSE PRIORITY ITEMS WERE ANALYZED AND PRIORITIZED BY THE HOSPITAL'S STRATEGY COMMITTEE AND AN IMPLEMENTATION PLAN WAS DEVELOPED BY THE COMMITTEE AND ULTIMATELY APPROVED BY THE WAYNE MEMORIAL HOSPITAL BOARD OF TRUSTEES IN OCTOBER 2013 (THE EXTENDED DEADLINE APPROVED BY THE IRS FOR THIS YEAR'S CHNA IMPLEMENTATION PLAN). THE TOP IDENTIFIED NEEDS WERE: 1. MENTAL HEALTH AND SUBSTANCE ABUSE 2. CHRONIC DISEASES 3. NEWBORN HEALTH 4. PREVENTABLE INPATIENT CARE 5. IMPROVED ACCESS TO PHYSICIAN SPECIALISTS 6. TRANSPORTATION 7. TRANSLATION 8. COUNSELING 9. HELP UNDERSTANDING MEDICAL CARE AND ACCESS 10. SUPPORT GROUPS - AVAILABILITY OF THE ASSESSMENT TO THE COMMUNITY: THE FINAL ASSESSMENT PRODUCT WAS MADE AVAILABLE TO THE GENERAL PUBLIC VIA WAYNE MEMORIAL HOSPITAL'S WEB SITE AND INCLUDES A 21 PAGE CHNA EXECUTIVE SUMMARY AND AN 89 PAGE CHNA USER GUIDE THAT CAN BE PRINTED. THE USER GUIDE INCLUDES THE DETAILED RESULTS OF THE ONLINE COMMUNITY SURVEY PERFORMED AS PART OF THE STUDY.
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE		THE HOSPITAL EDUCATES AND INFORMS PATIENTS AND PERSONS WHO MAY BE BILLED FOR PATIENT CARE ABOUT THEIR ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL, STATE OR LOCAL GOVERNMENT PROGRAMS OR UNDER THE HOSPITAL'S CHARITY CARE POLICY THROUGH ITS SCHEDULING, REGISTRATION, SOCIAL SERVICES AND BILLING DEPARTMENTS. ITS PATIENTS AND PERSONS WHO MAY BE BILLED FOR PATIENT CARE ARE ALSO MADE AWARE OF THEIR ELIGIBILITY THROUGH WMCHC A CLINICAL AFFILIATE OF THE HOSPITAL WHO RECEIVES SUBSTANTIAL FINANCIAL SUPPORT FROM THE HOSPITAL AND IS A FEDERALLY QUALIFIED HEALTH CENTER. FEDERALLY QUALIFIED HEALTH CENTERS IMPROVE THE HEALTH OF THE NATION'S UNDERSERVED COMMUNITIES AND VULNERABLE POPULATIONS BY ASSURING ACCESS TO COMPREHENSIVE, CULTURALLY COMPETENT, QUALITY PRIMARY HEALTH CARE SERVICES. HEALTH CENTER PROGRAM GRANTS SUPPORT A VARIETY OF COMMUNITY-BASED AND PATIENT-DIRECTED HEALTH CARE SERVICES, PRINCIPALLY TO AN INCREASING NUMBER OF THE NATION'S UNDERSERVED. WMCHC RECEIVED AN ANNUAL BASE GRANT OF $813,118 TO PROVIDE SERVICES TO THE AREA'S UNINSURED AND UNDERINSURED POPULATIONS. IN FY 2013, WMCHC RECEIVED ADDITIONAL FUNDING IN THE AMOUNT OF $61,542 FROM THE MEDICAL HOME GRANT, $593,107 OF CAPITAL GRANT FUNDING, $22705 FROM KORNBURG SCHOOL OF DENTISTRY, $ 10,000 FROM THE HIDALGO MEDICAL SERVICE GRANT AND $37,500 FROM THE WRIGHT CENTER. PATIENTS AND OTHERS ARE MADE AWARE OF THE PROGRAMS AVAILABLE ANYTIME FROM THE SCHEDULING OF AN APPOINTMENT TO FINAL DISPOSITION OF THEIR BILL IF THERE IS ANY INDICATION OF THE NEED OR REQUEST FOR HELP IN PAYING FOR SERVICES BEING SCHEDULED, PROVIDED OR BILLED FOR. WAYNE MEMORIAL IS THE LEAD AGENT FOR THE PENNSYLVANIA STATE HEALTH IMPROVEMENT PLAN PARTNERSHIP FOR WAYNE AND PIKE COUNTIES WITH ABOUT 300 MEMBERS. THIS NETWORKING PARTNERSHIP PROVIDES A MODALITY TO ASSIST THE LOW INCOME AND THE UNINSURED. THE TOGETHER FOR HEALTH PROGRAM RUN BY THE HOSPITAL FOR 700 SEVENTH GRADERS AND 700 ELEVENTH GRADERS PROVIDES SCREENINGS FOR ANEMIA, LEUKEMIA, DIABETES, HYPERTENSION, ELEVATED BMI, MENTAL ILLNESS, ELEVATED CHOLESTEROL, ETC. EDUCATIONAL WRITTEN MATERIALS, LIFESTYLE TOOLS AND PROFESSIONAL PRESENTATION ARE PROVIDED. STUDENTS PARTICIPATE IN THE PROGRAM FOR ABOUT 6 HOURS. THE STUDENTS THAT DO NOT HAVE A PRIMARY CARE PROVIDER ARE TOLD ABOUT THE LOCAL FEDERALLY QUALIFIED HEALTH CARE CENTERS (WMCHC) THAT PROVIDES PRIMARY CARE, BEHAVIORAL HEALTH AND DENTAL SERVICES. A COPY OF OUR COLLECTION POLICY, CHARITY CARE APPLICATION AND "DOES WAYNE MEMORIAL PARTICIPATE WITH MY INSURANCE?" IS MADE AVAILABLE AT MANY LOCATIONS. HEALTH AND HUMAN SERVICES AGENCIES ARE MADE AWARE OF THE WAYNE MEMORIAL COLLECTION POLICY, CHARITY CARE APPLICATION PROCESS AND KEPT INFORMED OF INSURANCE PARTICIPATION THROUGH A WELL-ESTABLISHED NETWORK. THIS INCLUDES BUT IS NOT LIMITED TO A DISCUSSION AND WRITTEN MATERIAL AT COUNTY INTERAGENCY MEETING, SHIP PARTNERSHIP DISTRIBUTION LIST, LOBBY DISPLAYS, PHYSICIAN PRACTICES NETWORK MEETINGS, "HEALTHWORKS" A 15 MINUTE WEEKLY RADIO SHOW, TO NAME A FEW. IN THE EVENT OF A LANGUAGE BARRIER IT IS THE POLICY OF WAYNE MEMORIAL HOSPITAL TO OBTAIN ASSISTANCE FOR NON-ENGLISH SPEAKING PATIENTS AND/OR THOSE WITH A LANGUAGE BARRIER. AN AUXILIARY AID OR INDIVIDUAL CERTIFIED IN SIGN LANGUAGE OR TRANSLATION WILL BE PROVIDED AT THE REQUEST OF THE PATIENT, OR PATIENT'S AUTHORIZED REPRESENTATIVE, OR AS OTHERWISE DETERMINED TO BE NECESSARY.
COMMUNITY INFORMATION		THE PRIMARY SERVICE AREA OF WAYNE MEMORIAL HOSPITAL INCLUDES ALL OF WAYNE COUNTY, PENNSYLVANIA AND ALL OF WESTERN, NORTHERN AND PORTIONS OF EASTERN AND SOUTHERN PIKE COUNTY, PA; THE SOUTHEASTERN PORTION OF SUSQUEHANNA COUNTY, PA; THE COMMUNITY OF CARBONDALE AND ITS IMMEDIATELY SURROUNDING COMMUNITIES IN LACKAWANNA COUNTY, PA; AND THE SOUTHWESTERN PORTION OF WESTERN SULLIVAN COUNTY, NEW YORK. THE SECONDARY SERVICE AREA INCLUDES THE BALANCE OF PIKE COUNTY AND EASTERN PORTIONS OF LACKAWANNA AND SUSQUEHANNA AND NORTHERN MONROE COUNTY IN PENNSYLVANIA. ALTHOUGH SOME PORTIONS OF PIKE COUNTY THAT ARE INCLUDED IN THE NEWBURGH, NY MSA (METROPOLITAN STATISTICAL AREA) AND ALL OF LACKAWANNA COUNTY, WHICH ARE CLASSIFIED AS URBAN, THE WMH SERVICE AREA IS PREDOMINANTLY RURAL. - SERVICE AREA CONGRESSIONAL DISTRICTS: THE CONGRESSIONAL DISTRICTS INCLUDED IN THE WMH SERVICE AREA ARE PA-10 AND NY-22. (UPDATED 2012) SERVICE AREA CENSUS TRACTS: THE CENSUS TRACTS INCLUDED IN THE WMH SERVICE AREA ARE THE FOLLOWING: 9502, 9523, 9524, 9601, 9602, 9603, 9604, 9605, 9606, 9607, 9608, 9609, 9610, 9611, 9612, 9613, 9614, 1101, 1106, 1107, 1108, AND 1109. (UPDATED 2012) SERVICE AREA ZIP CODES: THE ZIP CODES INCLUDED IN THE WMH SERVICE AREA ARE THE FOLLOWING: 12723, 12741, 12748, 12764, 18324, 18328, 18336, 18337, 18403, 18405, 18407, 18413, 18414, 18415, 18417, 18421, 18425, 18426, 18427, 18428, 18431, 18433, 18436, 18437, 18439, 18443, 18444, 18445, 18453, 18455, 18461, 18462, 18463, 18470, 18472, . - HOSPITALS IN SERVICE AREA: THE ONLY HOSPITAL IN WAYNE CO., PA IS WAYNE MEMORIAL HOSPITAL, A NONPROFIT ACUTE CARE COMMUNITY-BASED HOSPITAL; THERE IS NO HOSPITAL LOCATED IN PIKE COUNTY, PA; THE ONLY HOSPITAL IN THE PORTION OF MONROE CO., PA THAT IS PART OF WMH'S SERVICE AREA IS POCONO MEDICAL CENTER, A NONPROFIT ACUTE CARE HOSPITAL; THE ONLY HOSPITAL IN THE PORTION OF LACKAWANNA CO., PA THAT IS PART OF WMH'S SERVICE AREA WAS MARION COMMUNITY HOSPITAL, A CRITICAL ACCESS HOSPITAL THAT CLOSED ITS DOORS ON FEBRUARY 28, 2012; THERE ARE NO HOSPITALS IN THE PORTIONS OF SULLIVAN CO., NY OR SUSQUEHANNA COUNTY, PA THAT ARE PARTS OF WMH'S SERVICE AREA. - MEDICALLY UNDERSERVED AREAS: FEDERALLY DESIGNATED MEDICALLY UNDERSERVED AREAS (MUAS) IN THE WMH SERVICE AREA INCLUDE THE FOLLOWING: LACKAWANNA CO., MUA - 8 CENSUS TRACTS; MONROE CO., STROUDSBURG - LOW INCOME MUP; PIKE CO. - GREENE SERVICE AREA, MUA; WAYNE CO. - DAMASCUS SERVICE AREA MUA; SULLIVAN CO., NY - 3 LOW INCOME MUPS. HEALTH PROFESSIONAL SHORTAGE AREAS (HPSAS) INCLUDE LACKAWANNA - 4 SERVICE AREAS; PIKE -4 SERVICE AREAS; SUSQUEHANNA - 8 SERVICE AREAS; WAYNE - 10 SHORTAGE AREAS. - COMMUNITY DEMOGRAPHICS: BESIDES THE INCREASE IN WMH'S SERVICE AREA CAUSED BY THE AFOREMENTIONED CLOSURE OF MARION COMMUNITY HOSPITAL IN CARBONDALE, THE CONTINUED RATE OF RAPID GROWTH OF THE POPULATION OVER THE PAST DECADE IS ONE OF THE MOST SIGNIFICANT ASPECTS OF THE WMH SERVICE AREA. THE MOST RECENT POPULATION ESTIMATE PROVIDED BELOW FOR THE 2013, HOWEVER, SHOWS A REVERSAL OF THE DECADES-LONG GROWTH FOR PIKE COUNTY. THE TARGET POPULATION FOR WMH AND WMCHC SERVICES IS COMPRISED OF PREDOMINANTLY LOW INCOME, DISPROPORTIONATELY ELDERLY, MOBILITY/TRANSPORTATION CHALLENGED, OFTEN SIGNIFICANTLY OVERWEIGHT AND PRONE TO REFRAIN FROM HEALTH-RELATED PHYSICAL ACTIVITIES. THEY ARE FREQUENTLY UNMOTIVATED TO TAKE RESPONSIBILITY FOR THEIR HEALTH STATUS. THE CORE OF THE HOSPITAL'S USERS CONSISTS IN LARGE PART OF RURAL LOW TO MODERATE INCOME RESIDENTS. ANOTHER DOMINANT FACTOR OF SERVICE AREA DEMOGRAPHICS IS THE SIGNIFICANT IN-MIGRATION THAT WAYNE, AND ESPECIALLY PIKE, COUNTIES' POPULATIONS HAVE EXPERIENCED IN RECENT TIMES. THE 2010 U. S. CENSUS SHOWED THAT THE AREA POPULATION INCREASED FOR THE SERVICE AREAS FROM THE 2000 CENSUS : PIKE SHOWED THE LARGEST GROWTH 23.9% TO 57,369; WAYNE GREW 10.7% TO 52,822; SULLIVAN (NY) 4.9% TO 77,547; AND, LACKAWANNA 0.6% TO 214,437. 2012 U. S. CENSUS BUREAU POPULATION ESTIMATES (THE MOST RECENT AVAILABLE FOR THE AREA) SHOWED A DROP IN POPULATION FOR THE AREA, WITH THE EXCEPTION OF LACKAWANNA CO., WHICH REMAINED ESSENTIALLY STABLE : LACKAWANNA + 0.1%; PIKE - 0.9%; SULLIVAN (NY) -1.0%; SUSQUEHANNA -1.6%; AND WAYNE -1.7%. A SIGNIFICANT NUMBER OF THE NEW RESIDENTS THAT ARRIVED IN THE 2000-2010 DECADE CAME WITHOUT ESTABLISHED CARE PATTERNS. THE TWO-HOUR PROXIMITY TO NEW YORK CITY ACCELERATED THIS MIGRATION AFTER THE TERRORIST ATTACKS OF 2001. THESE MIGRANTS, IN LARGE PART, CONSIST OF LOW INCOME, YOUNG ADULTS AND FAMILIES SEEKING TO ESCAPE THE HIGH COST OF THE URBAN AREAS, ALONG WITH RETIREES MOVING FOR THE SAME REASON. THE RETIREES CONSIST OF BOTH MEDICARE AGE POPULATION AND A SIGNIFICANT NUMBER OF 55 TO 65 YEAR OLD RETIREES WITHOUT THE BENEFIT OF CORPORATE RETIREMENT BENEFITS AND THEY OFTEN PRESENT SEEKING SLIDING FEE SCALE SERVICES. BOTH MIGRANT GROUPS REPRESENT A SIGNIFICANT NEED FOR THE COMMUNITY. HAVING MOVED TO A DISTANT COMMUNITY, THESE PATIENTS OFTEN SEEK EPISODIC CARE AT VARIOUS LOCATIONS AND ARE ABUSERS OF EMERGENCY ROOM SERVICES. - RATES OF UNINSURED AND UNDERINSURED: (NOTE: SOME DATA SETS ARE NOT AVAILABLE IN THE 06-DEC-2012 OR 20133 SET. THE DATA PROVIDED ARE FROM THE 2006-2008 AMERICAN COMMUNITY SURVEY 3-YEAR ESTIMATES SURVEY.) ACCORDING TO THE U. S. CENSUS BUREAU, 2006-2008 ACS ESTIMATES, SERVICE AREA POPULATION OF UNINSURED NUMBERS IS 8,849, OR 8.0% OF THE POPULATION. - PERCENT OF FAMILIES ON MEDICAID OR OTHER ASSISTANCE: ACCORDING TO THE U. S. CENSUS BUREAU, 2006-2008 AMERICAN COMMUNITY SURVEY 3-YEAR ESTIMATES, THE NUMBER OF FAMILIES IN THE SERVICE AREA ON MEDICAID IS 16,639, OR 15.1% OF THE POPULATION. - AGE BREAKDOWN AND RECENT TRENDS: ACCORDING TO THE U. S. CENSUS BUREAU, 2006-2008 AMERICAN COMMUNITY SURVEY 3-YEAR ESTIMATES, AGE BREAKDOWN OF THE SERVICE AREA POPULATION IS AS FOLLOWS: UNDER 5 YEARS OF AGE 4,954 OR 4.5% 5-17 YEARS 12,373 OR 11.2% 18-34 YEARS 18,070 OR 16.4% 35-64 YEARS 46,874 OR 42.5% 65 AND OLDER 27,297 OR 24.8% - PERCENTAGES OF NON-ENGLISH SPEAKING POPULATIONS: ACCORDING TO THE U. S. CENSUS BUREAU AMERICAN COMMUNITY SURVEY, 06-DEC-2012, NON-ENGLISH SPEAKING POPULATIONS IN THE SERVICE AREA AVERAGE 6.9% OF THE TOTAL POPULATION. - MAJOR HEALTH PROBLEMS AND HEALTH STATISTICS: THE FOLLOWING SELECT HEALTH CAUSES OF DEATH AND STATISTICS ARE INDICATIVE OF MAJOR AREAS OF CONCERN FOR THE SERVICE AREA (ALL DERIVE FROM HEALTHY PEOPLE 2020 INITIATIVES, 2009 DATA SETS): (NOTE: CARBONDALE DATA IS ENCOMPASSED IN LACKAWANNA COUNTY STATISTICS.) CORONARY HEART DISEASE - (# OF DEATHS/100,000): PIKE - 116.3; WAYNE - 174.6; LACKAWANNA - 166.7; PA - 128.3; HP2020 TARGET - 100.8 BREAST CANCER - (#OF DEATHS/100,000): PIKE - 21.2; WAYNE 27.7; LACKAWANNA - 21.6; PA 24.0; HP2020 TARGET - 20.6 PROSTATE CANCER - (# OF DEATHS/100,000): PIKE - 23.5; WAYNE - 29.3; LACKAWANNA - 24.0; PA - 21.0; HP 2020 TARGET - 21.2 UNINTENTIONAL INJURY - (# OF DEATHS/100,000) PIKE - 37.6; WAYNE 57.0; LACKAWANNA - 42.8; PA 39.2; HP2020 TARGET - 36.0 MOTOR VEHICLE CRASH - (# OF DEATHS/100,000): PIKE - 15.8; WAYNE - 26.9; LACKAWANNA - 14.8; PA - 12.2; HP 2020 TARGET - 10.2 SUICIDE - (# OF DEATHS /100,000) PIKE - 10.3; WAYNE - 16.3; LACKAWANNA - 14.8; PA - 12.2; HP 2020 TARGET - 10.2 YOUNG ADULT - (# OF DEATHS/100,000): PIKE - 192.8; WAYNE - 166.3; LACKAWANNA - 106.7; PA - 85.9; HP 2020 TARGET - 88.5 ALL CANCER - (# OF DEATHS/100,000): PIKE - 153.5; WAYNE - 197.2; LACKAWANNA - 195.4; PA - 184.0; HP 2020 TARGET - 160.6
PROMOTION OF COMMUNITY HEALTH		THE MAJORITY OF MEMBERS OF THE WAYNE MEMORIAL HOSPITAL GOVERNING BOARD ARE INDEPENDENT BOARD MEMBERS, COMPRISED OF RESIDENTS OF THE ORGANIZATION'S PRIMARY SERVICE AREA OF WAYNE AND PIKE COUNTY, PENNSYLVANIA. THERE ARE ONLY THREE OUT OF FOURTEEN BOARD MEMBERS THAT ARE EMPLOYEES OF THE HOSPITAL OR PROVIDE SERVICES OR MERCHANDISE TO THE HOSPITAL OR RELATED ENTITIES. - THE WAYNE MEMORIAL HOSPITAL EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY FOR ALL OF ITS DEPARTMENTS, WITH THE EXCEPTION OF ANESTHESIOLOGY, LABORATORY AND RADIOLOGY, AS SERVICES IN THESE DEPARTMENTS ARE PROVIDED ON AN EXCLUSIVE BASIS TO BENEFIT PATIENT CARE. MEMBERS OF OUR MEDICAL STAFF ARE REQUIRED, WHILE PARTICIPATING AT THE HOSPITAL, TO TREAT ALL PATIENTS, REGARDLESS OF THEIR ABILITY TO PAY OR THEIR INSURANCE STATUS. - WAYNE MEMORIAL HOSPITAL UTILIZES ANY EXCESS FUNDS OVER EXPENSES TO IMPROVE PATIENT CARE, CONDUCT MEDICAL EDUCATION, OR SUPPORT OTHER NOT FOR PROFIT ORGANIZATIONS. - WAYNE MEMORIAL HOSPITAL'S EMERGENCY DEPARTMENT SERVES ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. - THE HOSPITAL PARTICIPATES IN MEDICARE, MEDICAID, CHAMPUS, TRI-CARE AND OTHER GOVERNMENTAL SPONSORED HEALTHCARE PROGRAMS. FURTHER, THE HOSPITAL HAS A CHARITY CARE POLICY, WHICH STRIVES TO QUALIFY THOSE PATIENTS FOR CHARITY CARE, WHO MEET CERTAIN INCOME LEVELS. - THE HOSPITAL IS A SAFETY NET HOSPITAL IN RURAL PENNSYLVANIA, AS IT IS A DESIGNATED MEDICARE DEPENDENT HOSPITAL.
AFFILIATED HEALTH CARE SYSTEM		THE HOSPITAL IS PART OF AN AFFILIATED HEALTH CARE SYSTEM UNDER COMMON GOVERNANCE AND CONTROL THAT INCLUDES THE HOSPITAL AND WAYNE MEMORIAL LONG TERM CARE WHICH OPERATES WAYNE WOODLANDS MANOR. IT IS ALSO A CLINICAL AFFILIATE OF WAYNE MEMORIAL COMMUNITY HEALTH CENTERS (WMCHC) WHICH IT SUPPORTS CLINICALLY AND FINANCIALLY. WAYNE WOODLANDS MANOR WAS OPENED IN 1994 AND HAS PROVIDED AND CONTINUES TO PROVIDE SERVICES PRIMARILY TO MEDICAID RECIPIENTS (OVER 75% OF ITS RESIDENTS). MOST COUNTIES IN PENNSYLVANIA HAVE COUNTY OWNED AND OPERATED NURSING HOMES THAT PROVIDE SERVICES TO THIS SEGMENT OF THEIR COUNTY POPULATION. WAYNE COUNTY DOES NOT HAVE A "COUNTY" NURSING HOME. THIS COMMUNITY NEED IS MET BY WAYNE MEMORIAL LONG TERM CARE BY ITS OPERATION OF WAYNE WOODLANDS MANOR. THE HOSPITAL HAS SUPPORTED WMCHC WHICH SERVES A NUMBER OF MUA'S AND MUP'S. THE HOSPITAL HAS FINANCED WMCHC WORKING CAPITAL NEEDS WITH A LINE OF CREDIT THAT WAS AND CONTINUES TO BE NECESSARY BECAUSE THE COMMONWEALTH OF PENNSYLVANIA'S MEDICAID PROGRAM DID NOT PAY ADEQUATELY (PRIOR TO NOVEMBER 2010) NOR MAKE TIMELY SETTLEMENTS FOR CARE PROVIDED. IN ADDITION, THE WAYNE MEMORIAL HOSPITAL HAS AN AFFILIATION WITH THE COMMONWEALTH MEDICAL COLLEGE (SCRANTON, PA) FOR THE PROVISION OF CLINICAL EDUCATION EXPERIENCES AT THE HOSPITAL AND WITHIN THE COMMUNITY. THE HOSPITAL CONSIDERS THIS A RESPONSIBILITY CONSISTENT WITH ITS MISSION TO BE INVOLVED IN EDUCATION. WAYNE MEMORIAL HEALTH SYSTEM AND THE WAYNE MEMORIAL HOSPITAL PROVIDE SIGNIFICANT COMMUNITY BENEFITS IN TERMS OF NEEDED HEALTH CARE SERVICES, PROVIDING SERVICES REGARDLESS OF THE ABILITY TO PAY, CLINICAL EDUCATION, AND PROVIDING A VAST NETWORK OF PRIMARY CARE PHYSICIANS IN ITS SERVICE AREA.

Schedule H (Form 990) 2012

Additional Data

Software ID:
Software Version:

- TIN:

Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990

OMB No. 1545-0047

2012

Open to Public
Inspection

Name of the organization
WAYNE MEMORIAL HOSPITAL

Employer identification number
24-0798839

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21, for any recipient that received more than $5,000. Part II can be duplicated if additional space is needed.

(a) Name and address of organization or government	(b) EIN	(c) IRC Code section if applicable	(d) Amount of cash grant	(h) Purpose of grant or assistance
(1) WAYNE MEMORIAL COMMUNITY HEALTH CENTER 601 PARK STREET HONESDALE,PA18431	23-2180889	501(C)(3)	1,843,366	EXEMPT PURPOSES

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................ Bullet Image

Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50055P

Schedule I (Form 990) 2012

Page 2

Part III

Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.

(a)Type of grant or assistance	(b)Number of recipients	(c)Amount of cash grant	(d)Amount of non-cash assistance	(e)Method of valuation (book, FMV, appraisal, other)	(f)Description of non-cash assistance

Part IV

Supplemental Information.

Complete this part to provide the information required in Part I, line 2, Part III, column (b), and any other additional information.

Identifier	Return Reference	Explanation
MONITORING USE OF GRANT FUNDS	SCHEDULE I, PART I, LINE 2	THE BOARD MONITORS THE FUNDS GIVEN TO WAYNE MEMORIAL COMMUNITY HEALTH CENTERS ("WMCHC") BY REVIEWING THE WORKINGS AND PROGRESS OF THAT CORPORATION. THERE IS A CLINICAL RELATIONSHIP AND THE HOSPITAL WORKS DIRECTLY WITH WMCHC SO THEY ARE ABLE TO MAKE SURE THE FUNDS ARE BEING USED PROPERLY.

Schedule I (Form 990) 2012

Additional Data

Software ID:
Software Version:

- TIN:

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

WAYNE MEMORIAL HOSPITAL

Employer identification number

24-0798839

Part I

Questions Regarding Compensation

Yes

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.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

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....

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? .......

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.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

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:

Receive a severance payment or change-of-control payment? ................

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? .........

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.

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:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 5a or 5b, describe in Part III.

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:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 6a or 6b, describe in Part III.

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 ............

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 .............................

If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

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
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable 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
(1)DR DAVID CAUCCITRUSTEE	(i) (ii)	420,476 0	0 0	0 0	15,300 0	14,660 0	450,436 0	0 0
(2)DAVID HOFFCEO	(i) (ii)	0 276,350	0 150,386	0 14,081	0 69,945	0 13,695	0 524,457	0 0
(3)MICHAEL CLIFFORDCFO	(i) (ii)	0 171,240	0 30,801	0 7,073	0 46,013	0 12,729	0 267,856	0 0
(4)JEFFERY MOGERMANPHYSICIAN	(i) (ii)	718,787 0	0 0	0 0	15,300 0	13,610 0	747,697 0	0 0
(5)IFTIKHAR CHOUDRYPHYSICIAN	(i) (ii)	296,948 0	0 0	0 0	15,300 0	14,660 0	326,908 0	0 0
(6)LILLIAN LONGENDORFERPHYSICIAN	(i) (ii)	242,912 0	0 0	0 0	14,362 0	459 0	257,733 0	0 0
(7)THERESA KELLYCERTIFIED RN ANESTHETIST	(i) (ii)	169,353 0	0 0	0 0	5,667 0	0 0	175,020 0	0 0
(8)SHERIE L MORGANTICERTIFIED RN ANESTHETIST	(i) (ii)	168,809 0	0 0	0 0	8,009 0	0 0	176,818 0	0 0

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
CEO COMPENSATION	SCHEDULE J, PART I, LINE 3	WAYNE MEMORIAL HEALTH SYSTEM, A RELATED ORGANIZATION, DETERMINES THE COMPENSATION OF THE CEO USING THE FOLLOWING METHODS: COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. THE BOARD MAKES THE FINAL DECISION USING THE INFORMATION PROVIDED BY THE CONSULTANT.
SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN	SCHEDULE J, PART I, LINE 4B	WAYNE MEMORIAL HEALTH SYSTEM, A RELATED ORGANIZATION, COVERS THE FOLLOWING INDIVIDUALS WITH 457(F) SUPPLEMENTAL RETIREMENT AGREEMENTS (SERP) WHICH WERE FUNDED THIS YEAR BY THE AMOUNTS SHOWN BELOW: DAVID HOFF $ 31,442 MICHAEL CLIFFORD $ 1,513

Schedule J (Form 990) 2012

Additional Data

Software ID:
Software Version:

- TIN:

Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
SchKMediumBullet

Attach to Form 990. SchKMediumBullet

See separate instructions.

OMB No. 1545-0047

2012

Open to Public
Inspection

Name of the organization
WAYNE MEMORIAL HOSPITAL

Employer identification number
24-0798839

Part I

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	THE WAYNE MEMORIAL HOSPITAL AND HEALTH AUTHORITY	23-2152053	946016HU9	12-20-2012	4,703,786	REFUND REMAINING 2007 BONDS, PAY I		X	X			X
B	THE WAYNE MEMORIAL HOSPITAL AND HEALTH AUTHORITY	23-2152053	946016JD5	01-30-2013	9,998,351	ADVANCE REFUND 2003 BONDS, PAY ISS	X		X			X
C	THE WAYNE MEMORIAL HOSPITAL & HEALTH AUTHORITY	23-2152053	940616GS5	10-25-2012	9,997,040	REFUND '05 & A PART OF '07 BONDS		X	X			X

Part II

Proceeds

	A		B		C		D
	1 Amount of bonds retired . . . . . . . . . . . . . .	0		0		0
2 Amount of bonds legally defeased . . . . . . . . . . .	0		0		0
3 Total proceeds of issue . . . . . . . . . . . . . .	4,651,757		9,894,478		9,997,040
4 Gross proceeds in reserve funds . . . . . . . . . . . .	254,563		692,238		461,420
5 Capitalized interest from proceeds . . . . . . . . . . .	0		0		0
6 Proceeds in refunding escrows . . . . . . . . . . . .	0		0		0
7 Issuance costs from proceeds . . . . . . . . . . . .	41,571		92,127		187,404
8 Credit enhancement from proceeds . . . . . . . . . . .	40,533		82,916		92,379
9 Working capital expenditures from proceeds . . . . . . . . .	0		0		0
10 Capital expenditures from proceeds . . . . . . . . . . .	0		0		0
11 Other spent proceeds . . . . . . . . . . . . . .	4,315,090		9,027,197		9,255,837
12 Other unspent proceeds . . . . . . . . . . . . . .	0		0		0
13 Year of substantial completion . . . . . . . . . . . .	2012		2013		2012
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue? . . . . .	X			X	X
15 Were the bonds issued as part of an advance refunding issue? . . . . .		X	X			X
16 Has the final allocation of proceeds been made? . . . . . . . .	X		X		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . . .	X		X		X

Part III

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . . . . . .		X		X		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . . . . .		X		X		X

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50193E

Schedule K (Form 990) 2012

Page 2

Part III

Private Business Use (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
3a Are there any management or service contracts that may result in private business use of bond-financed property? . . . . . . . . . . . .		X		X		X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property? . . . . . . . . . . . . . . . .
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . . . . . . . . . .		X		X		X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property? .
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . .	0%		0%		0%		%
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . . . . . . .	%		%		%		%
6 Total of lines 4 and 5 . . . . . . . . . . . . . . .	%		%		%		%
7 Does the bond issue meet the private security or payment test? . . . . .		X		X		X
8a Has there been a sale or disposition of any of the bond financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?. . . . . . . . . . . . . . . . .		X		X		X
b If “Yes” to line 8a, enter the percentage of bond-financed property sold or disposed of.	%		%		%		%
c If “Yes” to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? . . . . . . . . . . . . .		X		X		X
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2?	X		X		X

Part IV

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T? . . . . .		X		X		X
2 If "No" to line 1, did the following apply? . . . .
a Rebate not due yet? . . . . . . . .	X		X		X
b Exception to rebate? . . . . . . . .		X		X		X
c No rebate due? . . . . . . . . . .		X		X		X
If you checked "No rebate due" in line 2c, provide in Part VI the date the rebate computation was performed
3 Is the bond issue a variable rate issue? . . . .		X		X		X
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X		X		X
b Name of provider . . . . . . . . .	0		0		0
c Term of hedge . . . . . . . . . .
d Was the hedge superintegrated? . . . . . .
e Was a hedge terminated? . . . . . . .

Schedule K (Form 990) 2012

Page 3

Part IV

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . . . . .		X		X		X
b Name of provider . . . . . . . . .	0		0		0
c Term of GIC . . . . . . . . . .
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? . . . . .
6 Were any gross proceeds invested beyond an available temporary period? . . . . . . . .		X		X		X
7 Has the organization established written procedures to monitor the requirements of section 148? . . .		X		X		X

Part V

Procedures To Undertake Corrective Action

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations?		X		X		X

Part VI

Supplemental Information. Complete this part to provide additional information for responses to questions on Schedule K (see instructions).

Identifier	Return Reference	Explanation

Schedule K (Form 990) 2012

Additional Data

Software ID:
Software Version:

- TIN:

Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet

Attach to Form 990 or Form 990-EZ. MediumBullet

See separate instructions.

OMB No. 1545-0047

2012

Open to Public Inspection

Name of the organization

WAYNE MEMORIAL HOSPITAL

Employer identification number

24-0798839

Part I

Excess Benefit Transactions (section 501(c)(3) and section 501(c)(4) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.

1(a) Name of disqualified person	(c) Description of transaction	(d) Corrected?
1(a) Name of disqualified person	(c) Description of transaction	Yes	No

Enter the amount of tax incurred by organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image

Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ....... Bullet Image

Part II

Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22

(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	(d) Loan to or from the organization?		(e)Original principal amount	(f)Balance due	(g) In default?		(h) Approved by board or committee?		(i)Written agreement?
(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	To	From	(e)Original principal amount	(f)Balance due	Yes	No	Yes	No	Yes	No






Total ...... $

Part III

Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of assistance	(d) Type of assistance	(e) Purpose of assistance

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2012

Page 2

Part IV

Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) JEAN DEWAR	WIFE OF DR. WILLIAM DEWAR	20,302	COMPENSATION		No

Part V

Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule L (see instructions).

Identifier	Return Reference	Explanation

Schedule L (Form 990 or 990-EZ) 2012

Additional Data

Software ID:
Software Version:

- TIN:

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

WAYNE MEMORIAL HOSPITAL

Employer identification number

24-0798839

Identifier	Return Reference	Explanation
OTHER PROGRAM SERVICES	FORM 990, PART III, LINE 4D	THE ORGANIZATION PROVIDED GRANTS TO WAYNE MEMORIAL COMMUNITY HEALTH CENTER. SEE SCHEDULE I FOR MORE INFORMATION.
BUSINESS RELATIONSHIPS	FORM 990, PART VI, SECTION A, LINE 2	MAUREEN BEILMAN'S BROTHER-IN-LAW, GARY BEILMAN, IS A TRUSTEE FOR WAYNE MEMORIAL HEALTH FOUNDATION. MILTON ROEGNER AND WILLIAM CHATLOS, A TRUSTEE FOR WAYNE MEMORIAL HEALTH FOUNDATION, HAVE A BUSINESS RELATIONSHIP.
DELEGATE MANAGEMENT DUTIES	FORM 990, PART VI, SECTION A, LINE 3	WAYNE MEMORIAL HEALTH SYSTEM, INC., PROVIDES MANAGEMENT OVER THE ORGANIZATION THROUGH DIRECT EMPLOYMENT OF THE DIRECTORS AND OFFICERS OF THE ORGANIZATION. THE MANAGEMENT SERVICES PROVIDED ARE REIMBURSED TO WAYNE MEMORIAL HEALTH SYSTEM THROUGH A MANAGEMENT FEE.
MEMBERS OR STOCKHOLDERS	FORM 990, PART VI, SECTION A, LINES 6, 7A & 7B	THE BOARD SHALL CONSIST OF THOSE INDIVIDUALS WHO ARE TRUSTEES OF WAYNE MEMORIAL HEALTH SYSTEM, A RELATED ORGANIZATION. THEIR TERM OF OFFICE SHALL COINCIDE WITH THEIR TERM OF OFFICE ON THE BOARD OF WAYNE MEMORIAL HEALTH SYSTEM. RESIGNATION OR REMOVAL FROM THE BOARD OF WAYNE MEMORIAL HEALTH SYSTEM SHALL CONSTITUTE RESIGNATION OR REMOVAL FROM THE BOARD OF THIS CORPORATION. THE FOLLOWING DECISIONS OF THE GOVERNING BODY ARE SUBJECT TO APPROVAL BY WAYNE MEMORIAL HEALTH SYSTEM, INC.: (A) AMENDMENT OF THE BYLAWS OR THE ARTICLES OF CORPORATION (B) MERGER OR CONSOLIDATION WITH ANY OTHER ENTITY (C) DISSOLUTION AND DISTRIBUTION OF ASSETS IN CONNECTION THEREWITH (D) ELECTION OF OFFICERS OF THIS CORPORATION (E) ADOPTION OF INVESTMENT POLICIES AND SELECTION OF INVESTMENT ADVISORS (F) INVESTMENT OF RESTRICTED GIFTS (G) SELECTION OF AUDITORS AND ATTORNEYS (H) ADOPTION OF OPERATING AND CAPITAL BUDGETS (I) APPROVAL OF FUND-RAISING PROGRAMS (J) DONATION OR TRANSFER OF ANY ASSET WITH AN AGGREGATE VALUE IN EXCESS OF SUCH AMOUNT AS MAY BE DETERMINED BY THE BOARD OF WAYNE MEMORIAL HEALTH SYSTEM FROM TIME TO TIME (K) CREATION OF ANY LIEN OR SECURITY INTEREST IN ASSETS OF THE CORPORATION (L) DESIGNATION OR RESTRICTION OF GIFTS WITH A MARKET VALUE IN EXCESS OF SUCH AMOUNT AS MAY BE DETERMINED BY THE BOARD OF WAYNE MEMORIAL HEALTH SYSTEM FROM TIME TO TIME, AND (M) ANY OTHER MATTER THAT WOULD REQUIRE THE APPROVAL OF THE MEMBERS OF A PENNSYLVANIA NONPROFIT CORPORATION.
990 REVIEW POLICY	FORM 990, PART VI, SECTION B, LINE 11B	THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM BASED ON THE AUDITED FINANCIAL STATEMENTS AND INFORMATION PROVIDED BY THE ACCOUNTING DEPARTMENT OF THE ORGANIZATION. A COPY OF THE FORM 990 WILL BE REVIEWED WITH THE RESOURCE MANAGEMENT COMMITTEE WHICH IS RESPONSIBLE FOR THE FINANCIAL OVERSIGHT OF ALL ENTITIES OF THE WAYNE MEMORIAL HEALTH SYSTEM. A COPY OF THE 990 WILL BE DISTRIBUTED VIA E-MAIL TO EACH BOARD MEMBER BEFORE THE RETURN IS SUBMITTED TO THE IRS. MANAGEMENT WILL DISCUSS ANY QUESTIONS THAT ANY BOARD MEMBER MAY HAVE AT THE NEXT FULL BOARD MEETING.
CONFLICT OF INTEREST POLICY	FORM 990, PART VI, SECTION B, LINE 12C	CONFLICT OF INTEREST STATEMENTS ARE COMPLETED BY EVERY BOARD MEMBER AND MANAGER ANNUALLY. EACH INDIVIDUAL IS REQUIRED TO SIGN AND RETURN THE STATEMENTS TO THE ADMINISTRATION OFFICE. THE AUDIT COMMITTEE IS RESPONSIBLE FOR MONITORING COMPLIANCE WITH ANY CONFLICT OF INTEREST THROUGHOUT THE YEAR. IF A CONFLICT ARISES, THE PERSON WITH THE CONFLICT WILL RECUSE THEMSELVES FROM VOTING AND/OR DISCUSSING THE MATTER.
COMPENSATION REVIEW	FORM 990, SECTION VI, SECTION B, LINES 15A & 15B	WAYNE MEMORIAL HEALTH SYSTEM, INC., (AND ALL RELATED ENTITIES) UTILIZES A COMPENSATION COMMITTEE OF THE BOARD TO SET COMPENSATION OF ITS CEO AND OTHER SENIOR MANAGERS, INCLUDING CFO, DIRECTOR OF PATIENT CARE SERVICES, DIRECTOR OF HUMAN RESOURCES, DIRECTOR OF FACILITY SERVICES, DIRECTOR OF ANCILLARY SERVICES AND THE EXECUTIVE DIRECTOR OF THE WAYNE MEMORIAL HEALTH FOUNDATION. THE COMPENSATION COMMITTEE IS MADE UP OF INDEPENDENT DIRECTORS, WHO, WITH THE ASSISTANCE OF A NATIONAL COMPENSATION CONSULTING FIRM, UTILIZE COMPARABLE DATA FROM THE MARKETPLACE, LOOKING AT SUCH THINGS AS COMPARABLE ORGANIZATIONS IN TERMS OF REVENUE, SIZE, COMPLEXITY AND GEOGRAPHIC REGION. THE ORGANIZATION HAS ADOPTED A PHILOSOPHY OF PAYING AT THE 50TH PERCENTILE OF THE MARKETPLACE. ALL MEETINGS OF THE COMPENSATION COMMITTEE ARE DOCUMENTED AND MINUTES ARE MAINTAINED OF THE DELIBERATION AND DECISION-MAKING PROCESS. THE PROCESS NORMALLY OCCURS IN OCTOBER OF THE YEAR THE COMPENSATION CHANGES ARE GRANTED. THE LAST REVIEW OF EXECUTIVE COMPENSATION WAS 10/15/13.
DOCUMENT DISCLOSURE	FORM 990, PART VI, SECTION C, LINE 19	THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND/OR FINANCIAL STATEMENTS AVAILABLE TO PUBLIC UPON REQUEST.
RECONCILIATION OF NET ASSETS	FORM 990, PART XI, LINE 9	OTHER CHANGES IN NET ASSETS ARE AS FOLLOWS: DEFINED BENEFIT PENSION PLAN $ 1,602,692 BENEFICIAL INTEREST IN PERPETUAL TRUST 173,748 INTEREST IN NET ASSETS OF FOUNDATION 82,747 TRANSFER FROM AFFILIATE 10,434 ---------- $ 1,869,621

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:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBullet

Attach to Form 990. MediumBullet

See separate instructions.

OMB No. 1545-0047

2012

Open to Public Inspection

Name of the organization

WAYNE MEMORIAL HOSPITAL

Employer identification number

24-0798839

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?
(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	Yes	No
(1) WAYNE MEMORIAL HEALTH FOUNDATION INC 601 PARK STREET HONESDALE,PA18431 23-2208596	FUNDRAISING	PA	501(C)(3)	11 B II	WMHS		No
(2) WAYNE MEMORIAL HEALTH SYSTEM INC 601 PARK STREET HONESDALE,PA18431 23-2221292	OVERSIGHT	PA	501(C)(3)	11 A I	NA		No
(3) WAYNE MEMORIAL LONG TERM CARE 37 WOODLANDS DRIVE WAYMART,PA18472 23-2719336	NURSING HOME	PA	501(C)(3)	9	WMHS		No
(4) WAYNE COUNTY MEMORIAL HOSPITAL AUXILIARY 601 PARK STREET HONESDALE,PA184311445 23-2000791	FUNDRAISING	PA	501(C)(3)	11 D III-0	NA		No

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

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	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Part IV

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	(i) Section 512(b)(13) controlled entity?
(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		Yes	No
(1) WAYNE HEALTH SERVICES INC 601 PARK STREET HONESDALE,PA18431 23-2376183	DME, RENTAL	PA	WMHF	C-CORPORATION	378	35,667	1.000 %		No
(2) CHARITABLE TRUST	TRUST	PA	WMH	TRUST	163	20,769	100.000 %	Yes

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

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 . . . . . . . . . . . . . . . . . . . . . . .

b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

f Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

j Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .

m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .

Yes

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .

Yes

o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

s Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

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

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)	(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 VUBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2012

Page 5

Part VII

Supplemental Information

Complete this part to provide additional information for responses to questions on Schedule R (see instructions).

Identifier	Return Reference	Explanation

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: OPERATES A 98-BED ACUTE CARE HOSPITAL, WITH AN ADDITIONAL 14 BEDS DEDICATED TO INPATIENT REHAB
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	18
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	16
5	Total number of individuals employed in calendar year 2011 (Part V, line 2a) ......	5	802
6	Total number of volunteers (estimate if necessary) .............	6	189
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	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	302,332	331,541
9	Program service revenue (Part VIII, line 2g) .........	72,225,511	77,964,995
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	2,249,366	2,184,518
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	2,781,432	-740,584
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	77,558,641	79,740,470
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	1,707,109	1,843,366
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	34,529,318	37,525,148
16a	Professional fundraising fees (Part IX, column (A), line 11e).....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	37,355,675	38,683,867
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	73,592,102	78,052,381
19	Revenue less expenses. Subtract line 18 from line 12.......	3,966,539	1,688,089
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	98,698,250	100,517,105
21	Total liabilities (Part X, line 26).............	45,799,641	41,600,692
22	Net assets or fund balances. Subtract line 21 from line 20.....	52,898,609	58,916,413

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 31,864,022 including grants of $ ) (Revenue $ 53,805,402 )
	OUTPATIENT SERVICES ARE OFFERED IN A VARIETY OF AREAS, INCLUDING LAB, RADIOLOGY, REHABILITATION SERVICES SUCH AS PHYSICAL, OCCUPATIONAL AND SPEECH THERAPY, PRIMARY CARE, DENTAL AND BEHAVIORAL HEALTH. WMH ALSO PROVIDES OUTPATIENT EMERGENCY, DIAGNOSTIC, AND REHABILITATIVE SERVICES. OUR EMERGENCY DEPARTMENT OFFERS PHYSICIAN CARE 24 HOURS A DAY TO ALL, REGARDLESS OF ABILITY TO PAY.

4b	(Code: ) (Expenses $ 22,042,760 including grants of $ ) (Revenue $ 22,102,023 )
	INPATIENT SERVICES PROVIDES A FULL CONTINUUM OF CARE, FROM BIRTHING SUITES TO CHEMOTHERAPY, ENDOSCOPY, CARDIOLOGY PROCEDURES, RESPIRATORY THERAPY, IMAGING SCANS, HOME HEALTH AND HOSPICE CARE FOR THE POPULATION WE SERVE, APPROXIMATELY 100,000 PEOPLE IN MOSTLY RURAL WAYNE AND PIKE COUNTIES, PENNSYLVANIA.

4c	(Code: ) (Expenses $ 3,652,704 including grants of $ ) (Revenue $ 2,057,570 )
	INPATIENT REHABILITATION PROVIDES PHYSICAL, OCCUPATIONAL, AUDIOLOGY AND SPEECH THERAPY WITH SKILL CERTIFIED THERAPISTS. AN INDIVIDUALIZED REHABILITATION PROGRAM DESIGNED TO ENHANCE FUNCTION AND INDEPENDENCE IS DEVELOPED FOR EACH PATIENT BY A TEAM OF SPECIALIZED REHABILITATION PROFESSIONALS. EACH PATIENT'S EVALUATION AND PROGRESS IS DIRECTED AND MONITORED BY A PHYSIATRIST AND AN INTERDISCIPLINARY TEAM CONSISTING OF A PRIMARY REHABILITATION NURSE; PHYSICAL, OCCUPATIONAL AND SPEECH THERAPISTS; AND A SOCIAL WORKER.

4d	Other program services (Describe in Schedule O.)
	(Expenses $ 1,843,366 including grants of $ 1,843,366 ) (Revenue $ )
4e	Total program service expenses59,402,852

(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
(A) Name and Title
(1) LEE OAKES........................................................................ CHAIR	.8 ........................8	X	X	0	0
(2) DIRK MUMFORD........................................................................ 1ST VICE CHAIR	2.9 .......................2.9	X	X	0	0
(3) LEONARD TASSELMYER........................................................................ 2ND VICE CHAIR	.8 ........................8	X	X	0	0
(4) INGRID WARSHAW........................................................................ SECRETARY ENDING 10/2012	.8 ........................8	X	X	0	0
(5) JUDI MORTENSEN........................................................................ SECRETARY BEGINNING 10/2012	.8 ........................8	X	X	0	0
(6) TED EDGER........................................................................ TREASURER	.8 ........................8	X	X	0	0
(7) MAUREEN BEILMAN........................................................................ TRUSTEE ENDING 10/2012	.8 ........................8	X		0	0
(8) JOANN HUDAK........................................................................ TRUSTEE BEGINNING 11/2012	.8 ........................8	X		0	0
(9) HUGH RECHNER........................................................................ TRUSTEE BEGINNING 03/2013	.8 ........................8	X		0	0
(10) WENDELL HUNT........................................................................ TRUSTEE	.8 .......................1.0	X		0	0
(11) JULIE SEILER........................................................................ TRUSTEE	.8 ........................8	X		0	0
(12) DAVID MURRAY........................................................................ TRUSTEE	.8 ........................8	X		0	0
(13) SANDRA MEAGHER........................................................................ TRUSTEE	.8 ........................8	X		0	0
(14) DR DAVID CAUCCI........................................................................ TRUSTEE	39.2 ........................8	X		420,476	0	29,960
(15) JOSEPH HARCUM........................................................................ TRUSTEE	.8 ........................8	X		0	0
(16) WILLIAM R DEWAR III MD........................................................................ TRUSTEE	.8 ........................8	X		0	0
(17) SUSAN MANCUSO........................................................................ TRUSTEE BEGINNING 11/2012	.8 ........................8	X		0	0

(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
(A) Name and Title
(18) SCOTT EPSTEIN MD........................................................................ TRUSTEE	.8 ........................8	X			0	0
(19) FRANK BORELLI........................................................................ TRUSTEE BEGINNING 11/2012	.8 .......................1.0	X			0	0
(20) ALFRED G HOWELL........................................................................ TRUSTEE	.8 .......................1.3	X			0	0
(21) DAVID HOFF........................................................................ CEO	32.0 .......................8.0		X		0	440,817	83,640
(22) MICHAEL CLIFFORD........................................................................ CFO	18.8 .......................21.2		X		0	209,114	58,742
(23) JEFFERY MOGERMAN........................................................................ PHYSICIAN	40.0 .......................			X	718,787	0	28,910
(24) IFTIKHAR CHOUDRY........................................................................ PHYSICIAN	40.0 .......................			X	296,948	0	29,960
(25) LILLIAN LONGENDORFER........................................................................ PHYSICIAN	40.0 .......................			X	242,912	0	14,821
(26) THERESA KELLY........................................................................ CERTIFIED RN ANESTHETIST	40.0 .......................			X	169,353	0	5,667
(27) SHERIE L MORGANTI........................................................................ CERTIFIED RN ANESTHETIST	40.0 .......................			X	168,809	0	8,009

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	2,017,285	649,931	259,709

				(A) Total revenue	(B) Related or exempt function revenue	(C) Unrelated business revenue	(D) Revenue excluded from tax under sections 512, 513, or 514
1a	Federated campaigns..1a
b	Membership dues....1b
c	Fundraising events....1c
d	Related organizations...1d
e	Government grants (contributions)1e		274,075

f	All other contributions, gifts, grants, and similar amounts not included above1f		57,466

g	Noncash contributions included in lines 1a-1f:$
h	Total. Add lines 1a-1f.......			331,541
			Business Code
2a	NET PATIENT SERVICE REVENUE		623000	76,053,017	76,053,017
b	PHARMACY		446110	1,442,264	1,442,264
c	CAFETERIA		722514	288,243	288,243
d	OTHER REVENUE		900099	181,471	181,471
e
f	All other program service revenue .
g	Total. Add lines 2a–2f........			77,964,995
3	Investment income (including dividends, interest, and other similar amounts).......			1,186,548			1,186,548
4	Income from investment of tax-exempt bond proceeds..			0
5	Royalties...........			0
		(i) Real	(ii) Personal
6a	Gross rents	291,179
b	Less: rental expenses	331,070
c	Rental income or (loss)	-39,891	0
d	Net rental income or (loss).......			-39,891			-39,891
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory	13,702,832	4,500
b	Less: cost or other basis and sales expenses	12,709,362
c	Gain or (loss)	993,470	4,500
d	Net gain or (loss)..........			997,970			997,970
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..			0
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...			0
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..			0
Miscellaneous Revenue			Business Code
11a	LOSS ON REFINANCING		900099	-700,693			-700,693
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......			-700,693
12	Total revenue. See Instructions......			79,740,470	77,964,995		1,443,934


				(A) Beginning of year		(B) End of year
1	Cashnon-interest-bearing .............			1,595	1	1,520
2	Savings and temporary cash investments .........			13,194,935	2	10,923,473
3	Pledges and grants receivable, net ...........			0	3	0
4	Accounts receivable, net .............			12,305,470	4	10,225,148
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L ..................
				0	5	0
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
				0	6	0
7	Notes and loans receivable, net .............			0	7	0
8	Inventories for sale or use ..............			725,334	8	778,118
9	Prepaid expenses and deferred charges ..........			1,524,927	9	1,566,616
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	80,765,642
b	Less: accumulated depreciation .....	10b	58,950,513	22,020,254	10c	21,815,129
11	Investments—publicly traded securities ..........			40,068,048	11	44,621,807
12	Investments—other securities. See Part IV, line 11 .....			24,184	12	615,308
13	Investments—program-related. See Part IV, line 11 .....			4,570,739	13	4,790,002
14	Intangible assets ...............			0	14	0
15	Other assets. See Part IV, line 11 ...........			4,262,764	15	5,179,984
16	Total assets. Add lines 1 through 15 (must equal line 34)......			98,698,250	16	100,517,105
17	Accounts payable and accrued expenses .........			16,300,996	17	15,140,037
18	Grants payable .................			0	18	0
19	Deferred revenue ................			0	19	0
20	Tax-exempt bond liabilities .............			26,477,717	20	24,463,925
21	Escrow or custodial account liability. Complete Part IV of Schedule D..			0	21	0
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..........			0	22	0
23	Secured mortgages and notes payable to unrelated third parties ..			138,941	23	92,556
24	Unsecured notes and loans payable to unrelated third parties ....			0	24	0
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....................			2,881,987	25	1,904,174
26	Total liabilities. Add lines 17 through 25.........			45,799,641	26	41,600,692
	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............			51,025,706	27	56,794,513
28	Temporarily restricted net assets ...........			78,801	28	154,050
29	Permanently restricted net assets ...........			1,794,102	29	1,967,850
	Organizations that do not follow SFAS 117 (ASC 958), check here 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 ...........			52,898,609	33	58,916,413
34	Total liabilities and net assets/fund balances ........			98,698,250	34	100,517,105