TY 2012 Form 990

(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)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)
(1) WILLIAM H ALEXANDER........................................................................ DIRECTOR	.25 .......................5.25	X		0	0
(2) E ALLEN DEAVER........................................................................ DIRECTOR	.25 .......................4.25	X		0	0
(3) DORRANCE R BELIN ESQUIRE........................................................................ VICE CHAIR,	.25 .......................4.25	X		0	0
(4) RICHARD A GRAFMYRE........................................................................ DIRECTOR	.25 .......................5.25	X		0	0
(5) WILLIAM R GRUVER........................................................................ DIRECTOR	.25 .......................4.50	X		0	0
(6) FRANK M HENRY........................................................................ DIRECTOR	.25 .......................4.25	X		0	0
(7) THOMAS H LEE JR MD........................................................................ DIRECTOR	.25 .......................5.00	X		0	0
(8) GLENN D STEELE JR MD PHD........................................................................ PRES,CHAIR,	0.00 .......................40.00	X	X	2,062,556	418,454
(9) ROBERT E POOLE........................................................................ DIRECTOR	.25 .......................4.50	X		0	0
(10) DON A ROSINI........................................................................ DIRECTOR	.25 .......................5.25	X		0	0
(11) DAVID J FELICIO ESQUIRE........................................................................ CLO, SECRETA	0.00 .......................40.00		X	512,681	140,659
(12) EDWARD J ZYCH ESQUIRE........................................................................ ACLO, ASST S	0.00 .......................40.00		X	344,575	65,798
(13) KEVIN F BRENNAN CPA FHFMA........................................................................ EVP, FINANCE	0.00 .......................40.00		X	1,079,326	202,187
(14) ALBERT BOTHE JR MD........................................................................ CMO	0.00 .......................40.00		X	1,071,539	189,516
(15) STEPHEN PAOLUCCI MD........................................................................ CMO	0.00 .......................40.00		X	448,514	41,131
(16) LISSA L BRYAN SMITH........................................................................ CAO	0.00 .......................40.00		X	414,636	30,767
(17) FRANK J TREMBULAK........................................................................ SR VP, TREAS	0.00 .......................40.00		X	1,245,352	216,867

(A) Name and business address	(B) Description of services	(C) Compensation
PYRAMID CONSTRUCTION SERVICE INC, 840 N FRONT STREETWORMLEYSBURGPA17043	CONSTRUCTION	2,239,293
LABORATORY CORPORATION OF AMERICA, PO BOX 12140BURLINGTONNC272162140	LAB SERVICES	1,144,228
MARIANO CONSTRUCTION INC, 1123 OLD BERWICK ROADBLOOMSBURGPA17815	CONSTRUCTION	247,557
MRO CORPORATION, PO BOX 61507KING OF PRUSSIAPA19406	ABSTRACTING SVC	221,107
HCSC LAUNDRY, 2171 28TH ST SWALLENTOWNPA18103	LINEN SERVICES	197,845
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 10

Do not include amounts reported on lines 6b, 7b, 8b, 9b, and 10b of Part VIII.	(A) Total expenses	(B) Program service expenses	(C) Management and general expenses	(D) Fundraising expenses
1	Grants and other assistance to governments and organizations in the United States. See Part IV, line 21
2	Grants and other assistance to individuals in the United States. See Part IV, line 22	300	300
3	Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16
4	Benefits paid to or for members
5	Compensation of current officers, directors, trustees, and key employees ....
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....
7	Other salaries and wages	16,206,110	13,548,714	2,632,721	24,675
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	171,923	143,951	27,972
9	Other employee benefits .......	2,220,604	1,858,623	361,981
10	Payroll taxes ...........	1,226,370	1,030,151	196,219
11	Fees for services (non-employees):
a	Management ......
b	Legal .........	1,640		1,640
c	Accounting ...........	48,739		48,739
d	Lobbying ...........	209		209
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......	18,026	10,029	7,997
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ........	3,491,775	3,203,824	287,951
12	Advertising and promotion ....	3,462		3,462
13	Office expenses .......	2,166,832	1,898,150	268,587	95
14	Information technology ......	150,950	134,600	16,350
15	Royalties ..
16	Occupancy ...........	986,633	625,185	361,448
17	Travel ............	44,118	38,096	5,969	53
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......
19	Conferences, conventions, and meetings ....	31,333	40	17,272	14,021
20	Interest ...........	188,861	158,643	30,218
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization .....	2,154,927	1,854,425	300,502
23	Insurance ..............	687,239	687,239
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	4,137,687	4,137,687
b	INTER-ENTITY SERVICES	1,473,024	1,218,790	254,234
c	BIOMEDICAL ENGINEERING	462,509	462,509
d	LICENSES	393,274	321,899	71,375
e	All other expenses	163,807	119,187	44,620
25	Total functional expenses. Add lines 1 through 24e	36,430,352	31,452,042	4,939,466	38,844
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 .............	100,912	1	1,169,981
2	Savings and temporary cash investments .........	445,932	2	1,655,838
3	Pledges and grants receivable, net ...........		3
4	Accounts receivable, net .............	3,022,919	4	2,171,207
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L ..................
			5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
			6
7	Notes and loans receivable, net .............		7
8	Inventories for sale or use ..............	517,999	8	393,258
9	Prepaid expenses and deferred charges ..........	90,549	9	146,886
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	14,864,665
b	Less: accumulated depreciation .....	10b	2,176,914	14,953,317	10c	12,687,751
11	Investments—publicly traded securities ..........		11
12	Investments—other securities. See Part IV, line 11 .....		12
13	Investments—program-related. See Part IV, line 11 .....	126,366	13	143,125
14	Intangible assets ...............		14
15	Other assets. See Part IV, line 11 ...........	10,843,314	15	9,456,572
16	Total assets. Add lines 1 through 15 (must equal line 34)......	30,101,308	16	27,824,618
	17	Accounts payable and accrued expenses .........	7,319,053	17	2,477,761
18	Grants payable .................		18
19	Deferred revenue ................		19
20	Tax-exempt bond liabilities .............	5,618,433	20
21	Escrow or custodial account liability. Complete Part IV of Schedule D..		21
22	Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........		22
23	Secured mortgages and notes payable to unrelated third parties ..	11,988,554	23
24	Unsecured notes and loans payable to unrelated third parties ....		24	17,448,058
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....................	13,933,012	25	17,768,068
26	Total liabilities. Add lines 17 through 25.........	38,859,052	26	37,693,887
		Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............	-16,675,252	27	-18,238,545
28	Temporarily restricted net assets ...........	64,589	28	81,799
29	Permanently restricted net assets ...........	7,852,919	29	8,287,477
	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 ...........	-8,757,744	33	-9,869,269
34	Total liabilities and net assets/fund balances ........	30,101,308	34	27,824,618

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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

GEISINGER-BLOOMSBURG HOSPITAL

Employer identification number

23-2193572

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:

- 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

GEISINGER-BLOOMSBURG HOSPITAL

Employer identification number

23-2193572

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

209

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

209

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
	SCHEDULE C, PART II-B, LINE 1	A PORTION OF MEMBERSHIP DUES PAID TO THE HOSPITAL AND HEALTHSYSTEM ASSOCIATION OF PENNSYLVANIA IS USED FOR LOBBYING ACTIVITIES.

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

GEISINGER-BLOOMSBURG HOSPITAL

Employer identification number

23-2193572

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 ....	7,917,508	4,333,417	4,128,199	3,972,720	4,309,492
b	Contributions ........	51,067	4,656,499	282,178	357,290	587,532
c	Net investment earnings, gains, and losses		-250,365	270,432	175,353	993
d	Grants or scholarships .....
e	Other expenditures for facilities and programs ........	34,087	822,043	347,392	377,164	925,297
f	Administrative expenses ....
g	End of year balance ......	8,369,275	7,917,508	4,333,417	4,128,199	3,972,720

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

99.000 %

Temporarily restricted endowment SchDMd Bullet

1.000 %

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)

Yes

(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 .................	422,883		422,883
b	Buildings ................	10,909,529	1,213,010	9,696,519
c	Leasehold improvements ............
d	Equipment ................	3,118,591	914,346	2,204,245
e	Other .................	413,662	49,558	364,104
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......				12,687,751

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) BENEFICIAL INT. PERPETUAL TRUST				8,287,477
(2) 457B DEFERRED COMP				750,796
(3) TRUST INDENTURE -LIMITED USE ASSETS				178,852
(4) DUE FROM AFFILIATES				139,990
(5) ACCRUED RENTS AND OTHER REC				96,896
(6) ACCRUED INTEREST				2,561



Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				9,456,572

Part X

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

1.(a) Description of liability		(b) Book value
Federal income taxes
PENSION COSTS		8,301,949
DUE TO AFFILIATES		3,391,675
EST. 3RD PARTY PAYOR SETTLEMENTS		3,295,986
MEDICAL MALPRACTICE CLAIMS		2,466,091
MEDICAL STAFF AND OTHER LIABILITY		281,050
DEFERRED RENTS/SECURITY DEPOSITS		31,317



Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)		17,768,068
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
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains on investments ..........	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d .....................		2e
3	Subtract line 2e from line 1.....................		3
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b.......................		4c
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1	Total expenses and losses per audited financial statements ...........		1
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities ..........	2a
b	Prior year adjustments ..............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d......................		2e
3	Subtract line 2e from line 1.....................		3
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.......................		4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5

Part XIII

Supplemental Information

Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Identifier	Return Reference	Explanation
INTENDED USES FOR ENDOWMENT FUNDS	SCHEDULE D, PAGE 2, PART V, LINE 4	PART V LINE 4 - PERMANENTLY RESTRICTED ENDOWMENT FUNDS ARE HELD AT UNRELATED FINANCIAL INSTITUTIONS WHO ARE RESPONSIBLE FOR MAINTAINING AND INVESTING THE PRINCIPLE AND THE DISTRIBUTION OF THE FUNDS IN ACCORDANCE WITH THE DONOR STIPULATIONS. DISTRIBUTIONS FROM THE FUNDS ARE MADE BY THE RESPECTIVE FINANCIAL INSTITIONS TO GEISINGER BLOOMSBURG HOSPITAL WHO USES THE FUNDS AS DIRECTED IN THE TRUST AGREEMENTS.
SUPPLEMENTAL FINANCIAL INFORMATION	SCHEDULE D, PAGE 4, PART XIII	EFFECTIVE JULY 1, 2007, GEISINGER HEALTH SYSTEM(1) ("GHS") ADOPTED FASB INTERPRETATION NO. 48, ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES, AN INTERPRETATION OF FASB STATEMENT NO. 109 ("FIN 48"). FIN 48 CLARIFIES THEACCOUTNING AND REPORTING FOR INCOME TAXES WHERE THE INTERPREATION OF THE TAX LAW MAY BE UNCERTAIN. FIN 48 PRESCRIBES A COMPREHENSIVE MODEL FOR THE FINANCIAL STATEMENT RECOGNITION, MANAGEMENT, PRESENTATION AND DISCLOURES OF INCOME TAX UNCERTAINTIES WITH RESPECT TO POSITIONS TAKEN OR EXPECTED TO BE TAKEN IN INCOME TAX RETURNS. THE ADOPTION OF FIN 48 HAD NO IMPACT ON UNRESTRICTED NET ASSETS AS OF JUNE 30, 2013 OR ANY PREVIOUS YEAR SINCE ADOPTION. ACCORDINGLY, NO FIN 48 FOOTNOTE DISCLOSURE WAS MADE IN THE JUNE 30, 2013 GHS CONSOLIDATED FINANCIAL STATEMENTS. (1)THROUGHOUT THIS DOCUMENT, THE ACRONYM "GHS" OR THE TERMS "SYSTEM", "GEISINGER", OR "GEISINGER HEALTH SYSTEM" SHALL REFER TO THE ENTIRE HEALTHCARE SYSTEM COMPRISED OF THE GEISINGER HEALTH SYSTEM FOUDNATION ("THE FOUNDATION") AS PARENT AND ALL SUBSIDIARY CORPORATE ENTITIES COMPRISING THE SYSTEM.

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

GEISINGER-BLOOMSBURG HOSPITAL

Employer identification number

23-2193572

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: .........

Yes

200% 250% 300% 350% 400% Other 380.000 %

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? ..........

Yes

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

Yes

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		(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) ..	225,244		225,244	0.620 %
b	Medicaid (from Worksheet 3, column a) ....	4,186,479	2,477,198	1,709,281	4.690 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) .
d	Total Financial Assistance and Means-Tested Government Programs .	4,411,723	2,477,198	1,934,525	5.310 %
Other Benefits		3,160		3,160	0.010 %
e	Community health improvement services and community benefit operations (from Worksheet 4) ..	3,160		3,160	0.010 %
f	Health professions education (from Worksheet 5) ..
g	Subsidized health services (from Worksheet 6) ..
h	Research (from Worksheet 7)
i	Cash and in-kind contributions for community benefit (from Worksheet 8)
j	Total. Other Benefits ..	3,160		3,160	0.010 %
k	Total. Add lines 7d and 7j .	4,414,883	2,477,198	1,937,685	5.320 %

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

Schedule H (Form 990) 2012

Page

Part II

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

		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total

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. ......

2,643,294

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. ......

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).....

5,281,990

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

7,719,809

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

-2,437,819

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	GEISINGER-BLOOMSBURG HOSPITAL 549 FAIR STREET BLOOMSBURG,PA17815 WWWGEISINGEREDU	X	X	X

Schedule H (Form 990) 2012

Page

Part VFacility Information (continued)

Section B. Facility Policies and Practices

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

	GEISINGER-BLOOMSBURG 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 11

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

Yes

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 ........

Yes

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

Page

Part VFacility Information (continued)

Financial Assistance Policy			Yes	No
9	Did the hospital facility have in place during the tax year a written financial assistance policy that:
	Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care?	9	Yes
10	Used federal poverty guidelines (FPG) to determine eligibility for providing free care?...........	10	Yes
	If "Yes," indicate the FPG family income limit for eligibility for free care: 200.0% If "No," explain in Part VI the criteria the hospital facility used.
11	Used FPG to determine eligibility for providing discounted care?.................	11	Yes
	If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 380.0% 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	Yes
14	Included measures to publicize the policy within the community served by the hospital facility?.......	14	Yes
	If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a	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	Yes
16	Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a	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

Page

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

Page

Part VFacility Information (continued)

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

Schedule H (Form 990) 2012

Page

Part VI

Supplemental Information

Complete this part to provide the following information.

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

Identifier	ReturnReference	Explanation
RELATED ORGANIZATION INFORMATION	PART I LINE 6A	A SUMMARY OF THE COMMUNITY BENEFIT PROVIDED BY GEISINGERBLOOMSBURG HOSPITAL GBH AND ITS RELATED CHARITABLE ORGANIZATIONS IS AVAILABLE AT GEISINGERORG AND MADE AVAILABLE TO THE PUBLIC UPON REQUEST GO TO HTTPWWWGEISINGERORGABOUTMISSIONHTML AND CLICK ON 2013 ANNUAL REPORT
COSTING METHODOLOGY EXPLANATION	PART I LINE 7	A COST ACCOUNTING SYSTEM WAS USED TO DETERMINE THE COSTS REPORTED ON LINE 7 AND ADDRESSED PATIENT SEGMENTS BY PAYOR EG MEDICARE MEDICAID COMMERCIAL PAYERS SELFPAY ETC
BAD DEBT EXPENSE EXPLANATION	PART III LINE 4	GEISINGERBLOOMSBURG HOSPITAL GBH IS A MEMBER OF A GROUP WITH CONSOLIDATED FINANCIAL STATEMENTS PER THE FOOTNOTE RELATED TO ACCOUNTS RECEIVABLE THE ORGANIZATIONS WRITE OFF ALL ACCOUNTS THAT HAVE BEEN IDENTIFIED AS UNCOLLECTABLE AN ALLOWANCE FOR UNCOLLECTABLES IS RECORDED FOR ACCOUNTS NOT YET WRITTEN OFF THAT ARE ANTICIPATED TO BECOME COLLECTABLE IN FUTURE PERIODS SEE PAGE 13 OF THE ATTACHED GEISINGER HEALTH SYSTEM CONSOLIDATED FINANCIAL STATEMENTS JUNE 30 2013 AND JUNE 30 2012
MEDICARE EXPLANATION	PART III LINE 8	LINE 6 ONLY INCLUDES THOSE COSTS THAT ARE REPORTED ON GBHS MEDICARE COST REPORT THAT IS FILED WITH THE FEDERAL GOVERNMENT THESE COSTS DO NOT INCLUDE ALL OF THE COSTS THAT ARE REQUIRED TO TREAT MEDICARE PATIENTS WHEN ALL OR GBHS COSTS ARE INCLUDED THE TOTAL COST OF PROVIDING CARE EXCEEDS REVENUE BY 3576672 THIS SHORTFALL IS THE TOTAL COMMUNITY BENEFIT PROVIDED THROUGH THE MEDICARE PROGRAM ALONG WITH PROVIDING CARE TO MEDICAID PATIENTS AND PROVIDING FREE OR DISCOUNTED CARE TO OTHER LOW INCOME PATIENTS THE IRS COMMUNITY BENEFIT STANDARD INCLUDES THE PROVISION OF CARE TO THE ELDERLY AND MEDICARE PATIENTS FOR MANY OF THE MEDICAL SERVICES PROVIDED BY THE HOSPITAL MEDICARE DOES NOT PROVIDE SUFFICIENT REIMBURSEMENT TO COVER THE COST OF PROVIDING CARE TO THESE PATIENTS FORCING GBH TO USE OTHER FUNDS TO COVER THE SHORTFALL MEDICARE SHORTFALLS MUST BE ABSORBED BY GBH IN ORDER TO CONTINUE TREATING THE ELDERLY IN OUR COMMUNITY GBH PROVIDES CARE REGARDLESS OF THE MEDICARE SHORTFALL AND IS THEREBY PROVIDING ACCESS TO MEDICAL SERVICES FOR THE ELDERLY AND RELIEVING THE FEDERAL GOVERNMENT OF THE BURDEN OF PAYING THE FULL COST FOR PROVIDING CARE TO MEDICARE PATIENTS ABSENT THE MEDICARE PROGRAM IT IS LIKELY THAT MEDICARE PATIENTS WOULD BE ELIGIBLE FOR CHARITY CARE OR OTHER NEEDS BASED GOVERNMENT PROGRAMS THE AMOUNT EXPENDED TO COVER THE SHORTFALL IS MONEY NOT AVAILABLE FOR FINANCIAL ASSISTANCE AND OTHER COMMUNITY BENEFIT NEEDS PENNSYLVANIA REQUIRES NONPROFIT HOSPITALS LIKE GBH TO PROVIDE A MINIMUM LEVEL OF COMMUNITY BENEFIT TO RETAIN EXEMPTION FROM STATE AND LOCAL TAXES ACCORDING TO STATE GUIDANCE AND CASE LAW THE UNREIMBURSED COST OF MEDICARE IS CONSIDERED TO BE COMMUNITY BENEFIT FOR STATE TAX EXEMPTION PURPOSES
COLLECTION PRACTICES EXPLANATION	PART III LINE 9B	PATIENTS KNOWN TO QUALIFY FOR CHARITY CARE OR FINANCIAL ASSISTANCE ARE HANDLED IN ACCORDANCE WITH CHARITY CARE GUIDELINES AND EXCLUDED FROM BAD DEBT COLLECTION PRACTICES GBH IS COMMITTED TO PROVIDING MEDICAL NECESSARY SERVICES TO PATIENTS REGARDLESS OF THEIR ABILITY TO PAY AND GBHS COLLECTION ACTIONS ARE CONSISTENTLY APPLIED TO ALL PATIENTS IT IS GBH POLICY TO PROVIDE FINANCIAL ASSISTANCE AND COUNSELING TO PATIENTS WITH LIMITED FINANCIAL MEANS A PATIENT MAY BECOME ELIGIBLE FOR FINANCIAL ASSISTANCE AT ANY TIME DURING TREATMENT OR DURING THE CONTINUUM OF THE FINANCIALBILLING AND COLLECTION PROCESS IN ANY STAGE OF THE BILLING PROCESS COLLECTION ACTIONS ARE NOT PURSUED WHENEVER A PATIENT APPLIES AND IS BEING EVALUATED FOR FINANCIAL ASSISTANCE UNDER NO CIRCUMSTANCE WILL GBH FREEZE OR ATTACH BANK ACCOUNTS OF A PATIENT ENFORCE LIENS ACTIVELY PURSUE ASSETS FROM A PRIOR JUDGMENT OR GARNISH THE WAGES OF A PATIENT ANDOR FAMILY MEMBER BEFORE DETERMINING IF THE PATIENT IS ELIGIBLE FOR ASSISTANCE UNDER GBHS FINANCIAL ASSISTANCE PROGRAM
NEEDS ASSESSMENT	PART VI	GBH ALONG WITH OTHER NONPROFIT HOSPITALS WITHIN GBHS MULTICOUNTY SERVICE AREA HAS HISTORICALLY PARTNERED WITH ACTION HEALTH TO ENGAGE THE COMMUNITIES TO ASSESS AND IDENTIFY THE HEALTH NEEDS OF THE COMMUNITIES SERVED AND TO FACILITATE THE PARTNERS COMMUNITY BENEFIT EFFORTS PARTICIPATING PARTNERS HAVE INCLUDED BERWICK HOSPITAL GEISINGER MEDICAL CENTER GEISINGER HEALTHSOUTH REHABILITATION HOSPITAL EVANGELICAL COMMUNITY HOSPITAL SHAMOKIN AREA COMMUNITY HOSPITAL AND SUNBURY HOSPITAL ACTION HEALTHS 501C3 CHARITABLE MISSION WAS TO PROVIDE COMMUNITY HEALTH OUTREACH AND EDUCATION THROUGH EASILY ACCESSIBLE HEALTH PROGRAMS FOCUSED ON ENHANCING COMMUNITY SERVICES AND DEVELOPING NEW INITIATIVES TO ADDRESS UNMET HEALTH AND WELLNESS NEEDS DATA FROM A VARIETY OF SPONSORS AND REFERENCE RESOURCES WAS REVIEWED TO DETERMINE THE COMMUNITIES SPECIFICS NEEDS INCLUDING PENNSYLVANIA DEPARTMENT OF HEALTH PENNSYLVANIAS STATE HEALTH IMPROVEMENT PLAN SHIP SPECIAL REPORT AND PLAN TO IMPROVE RURAL HEALTH STATUS PENNSYLVANIA DEPARTMENT OF HEALTH AND THE PENNSYLVANIA ADVOCATES FOR NUTRITION ACTIVITY PENNSYLVANIA NUTRITION PHYSICAL ACTIVITY PLAN TO PREVENT OBESITY AND RELATED CHRONIC DISEASES THE GOVERNORS INTERAGENCY COORDINATING COUNCIL ON CHILD NUTRITION HEALTH PHYSICAL EDUCATION PENNSYLVANIA CHILD WELLNESS PLAN 200607 2006 GOVERNORS CABINET ON CHILDREN FAMILIES PA HEALTHY KIDS PENNSYLVANIA STRATEGY FOR BALANCING NUTRITION AND EXERCISE IN KIDS U S DEPARTMENT OF HEALTH AND HUMAN SERVICES HEALTHY PEOPLE 2010 AND HEALTHY PEOPLE 2020 DATA BY COUNTY MONTOUR COLUMBIA NORTHUMBERLAND SNYDER UNION NATIONAL ACADEMY OF SCIENCES PREVENTING CHILDHOOD OBESITY HEALTH IN THE BALANCE COLUMBIA COUNTY HUMAN SERVICE COALITION COLUMBIA COUNTY NEEDS ASSESSMENT 2006 STEPS TO HEALTHIER PA LUZERNE COUNTY STEPPING INTO A HEALTHIER FUTURE CENTER COUNTY PARTNERSHIP FOR COMMUNITY HEALTH SHIP PARTNER 2007 BEHAVIORAL HEALTH RISKS OF CENTRE COUNTY ADULTS GEISINGER HEALTH SYSTEM IS ALSO AN ACTIVE PARTICIPANT IN MULTIPLE COMMUNITYBASED ORGANIZATIONS THAT STRIVE TO IMPROVE THE HEALTH AND WELLBEING OF THE COMMUNITY INCLUDING CONDUCTING COMMUNITY NEEDS ASSESSMENTS OF VARYING SCOPE THESE RELATIONSHIPS HAVE ENABLED GEISINGER TO PARTICIPATE AND UNDERSTAND MORE CLEARLY THE UNDERLYING REASONS FOR A SPECIFIC COMMUNITYS HEALTH STATUS AND TO USE THAT INFORMATION IN MAKING FOCUSED DECISIONS ABOUT APPROPRIATE SERVICE MIX AND COMMUNITY OUTREACH SERVICES
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE	PART VI	FOR URGENT AND EMERGENT SERVICES PATIENTS ARE PROVIDED CARE REGARDLESS OF THEIR ABILITY TO PAY IN THE EVENT A PATIENT HAS AN EMERGENCY MEDICAL CONDITION TREATMENT IS NOT DELAYED TO PERMIT AN INQUIRY REGARDING A PATIENTS METHOD OF PAYMENT OR INSURANCE STATUS FOR OTHER THAN URGENT AND EMERGENT SERVICES THE HOSPITAL PROVIDES UNCOMPENSATED CARE FREE OF CHARGE OR ON A DISCOUNTED BASIS TO THOSE PATIENTS WHO DEMONSTRATE AN INABILITY TO PAY DEPENDING UPON FAMILY SIZE AND INCOME FREE OR DISCOUNTED SERVICES ARE AVAILABLE TO A PATIENT WITH FAMILY INCOME RANGING FROM 200 UP TO 380 OF THE FEDERAL POVERTY GUIDELINES IT IS GEISINGER POLICY TO PROVIDE FINANCIAL ASSISTANCE AND FINANCIAL COUNSELING TO PATIENTS OF LIMITED MEANS A PATIENT MAY BECOME ELIGIBLE FOR CHARITY CARE OR FINANCIAL ASSISTANCE AT ANY TIME DURING TREATMENT OR DURING THE CONTINUUM OF THE FINANCIALBILLING PROCESS INFORMATION SIGNS BROCHURES ETC REGARDING GEISINGERS CHARITY CARE AND FINANCIAL ASSISTANCE POLICIES ARE PROVIDED AT THE EMERGENCY ROOM REGISTRATION AND VARIOUS ACCESS POINTS THROUGHOUT THE HOSPITAL REGISTRATION PERSONNEL ALSO REFER UNINSURED ANDOR LOW INCOME PATIENTS TO FINANCIAL COUNSELORS TO DISCUSS THE FINANCIAL ASSISTANCE POLICY NOTICE OF GEISINGERS CHARITY CARE AND FINANCIAL ASSISTANCE POLICIES CAN ALSO BE FOUND ON THE GEISINGER WEB SITE AT WWWGEISINGERORG PATIENTS ARE ALSO PROVIDED INFORMATION ON GEISINGERS CHARITY CARE AND FINANCIAL ASSISTANCE POLICIES WITH EACH PATIENT BILL
COMMUNITY INFORMATION	PART VI	GEISINGERBLOOMSBURG HOSPITALS SERVICE AREA INCLUDES ONE COUNTY IN CENTRAL PENNSYLVANIA COLUMBIA THE APPROXIMATE 2013 TOTAL POPULATION WITHIN THIS SERVICE AREA WAS 71369 THIS POPULATION IS EXPECTED TO INCREASE BY 08 BY 2018 WHICH IS LESS THAN RATE OF POPULATION GROWTH EXPECTED IN THE COMMONWEALTH 10 AND THE NATION 33 THE 65 AND OVER AGE GROUP WAS 176 OF THE TOTAL POPULATION WHICH IS GREATER THAN THE STATE 164 AND NATIONAL 139 PROPORTIONS ADDITIONALLY THE 65 AND OVER AGE GROUP IS PROJECTED TO EXPERIENCE THE SECOND LARGEST FIVEYEAR POPULATION GROWTH AT 128 THE LARGEST GROWTH IN POPULATION IS WITHIN THE 2534 AGE GROUP WHICH IS PROJECTED TO SEE A 241 INCREASE THE REGION WHICH INCLUDES COLUMBIA COUNTY IS PRIMARILY RURAL AVERAGE HOUSEHOLD INCOME IN 2013 WAS 53121 WITH APPROXIMATELY 139 OF THE POPULATION FALLING BELOW FEDERAL POVERTY GUIDELINES IN 2012 WHICH IS A GREATER PROPORTION THAN THE STATE AND SMALLER PROPORTION THAN THE NATION 137 AND 159 RESPECTIVELY THE 2012 AVERAGE ANNUAL UNEMPLOYMENT RATE THE MOST CURRENT FULL YEAR OF COUNTY LEVEL DATA AVAILABLE FROM THE BUREAU OF LABOR STATISTICS WAS 81 WHICH IS HIGHER THAN THE COMMONWEALTH RATE OF 79 BUT COMPARABLE TO THE NATIONAL RATE OF 81 WITHIN THE ONE COUNTY SERVICE AREA 152 OF GBHS INPATIENT DISCHARGES DURING FISCAL YEAR 2013 WERE SELF PAY CHARITY CARE OR MEDICAID RECIPIENTS COMPARATIVELY OF ALL HOSPITAL INPATIENTS FROM THE REGION REGARDLESS OF THEIR SOURCE OF CARE 143 WERE SELF PAY CHARITY CARE OR MEDICAID RECIPIENTS THE REGION WHICH INCLUDES COLUMBIA COUNTY INCLUDES MULTIPLE MEDICALLY UNDERSERVED AREAS AND POPULATIONS DURING THE ASSOCIATED TIME PERIOD THERE WAS ONE GENERAL MEDICALSURGICAL GEISINGER HOSPITAL GBH AND ONE GENERAL MEDICALSURGICAL NONGEISINGER HOSPITAL IN COLUMBIA COUNTY
HEALTH OF COMMUNITY IN RELATION TO EXEMPT PURPOSE	PART VI	SEE THE STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTSCOMMUNITY BENEFIT REPORTED IN SCHEDULE O
AFFILIATED HEALTH CARE INFORMATION	PART VI	GEISINGERBLOOMSBURG HOSPITAL GBH IS 501C3 NOTFORPROFIT CORPORATION OWNING AND OPERATING A 72BED HOSPITAL IN BLOOMSBURG PA GBH IS AN AFFILIATE WITHIN THE GEISINGER HEALTH SYSTEM GHS OR SYSTEM WHICH IS ONE OF THE LARGEST RURAL HEALTH CARE SYSTEMS IN THE NATION AND COVERS A 20000 SQUARE MILE AREA IN NORTHERN AND CENTRAL PENNSYLVANIA AS AN INTEGRATED HEALTH CARE SYSTEM IT SERVES MORE THAN TWO MILLION PEOPLE IN 41 OF PENNSYLVANIAS 67 COUNTIES WITH A VARIETY OF CHARITABLE HEALTH CARE PROVIDERS AND A NONPROFIT HMO GEISINGER HEALTH SYSTEM FOUNDATION GHSF IS A 501C3 NOTFORPROFIT CORPORATION THAT SERVES AS CORPORATE PARENT WHICH COORDINATES AND SUPERVISES THE ACTIVITIES OF THE SYSTEMS AFFILIATED ENTITIES GHSF IS NOT A LICENSED HEALTH CARE PROVIDER NOT DOES IT PROVIDE HEALTH CARE SERVICES PATIENTS IT SERVES TO ENSURE THAT THE SYSTEM AFFILIATED ENTITIES HAVE ADEQUATE FINANCIAL RESOURCES TO FULFILL THEIR CHARITABLE MISSIONS AND TO INITIATE AND ADMINISTER GRANT AND PHILANTHROPIC SUPPORT PROGRAMS FOR ALL GEISINGER ENTITIES THE SYSTEM MISSION IS TO ENHANCE THE QUALITY OF LIFE THROUGH AN INTEGRATED HEALTH SERVICE ORGANIZATION BASED ON A BALANCED PROGRAM OF PATIENT CARE EDUCATION RESEARCH AND COMMUNITY SERVICE GEISINGER MEDICAL CENTER GMC A 501C3 NOTFORPROFIT CORPORATION IS A 404 BED TERTIARY AND QUATERNARY MEDICAL CENTER IS LOCATED IN DANVILLE PENNSYLVANIA A SMALL COMMUNITY OF 6000 PEOPLE SINCE ITS BEGINNING IN 1915 GHS HAS EMPHASIZED MULTISPECIALTY CARE AND HAS MORE THAN 80 MEDICAL SPECIALTIES AND SUBSPECIALTIES GMC IS A LEVEL 1 REGIONAL RESOURCE TRAUMA CENTER AND HAS RECENTLY BEEN NAMED TO THE TOP 100 HOSPITALS IN THE COUNTRY THE MEDICAL CENTER HAS ALSO BEEN DESIGNATED AS A MAGNET HOSPITAL BY THE AMERICAN NURSES CREDENTIALING CENTER ANCC GHS PHYSICIANS WERE LISTED IN THE BEST DOCTORS IN AMERICA AND THE GHS INTEGRATED COSTEFFECTIVE DELIVERY OF MANAGED CARE WAS FEATURED IN A FRONTPAGE NEW YORK TIMES ARTICLE MEDICAL EDUCATION HAS PLAYED A PROMINENT ROLE AT THE GMC WITH MORE THAN 200 RESIDENTS AND FELLOWS RECEIVING POSTDOCTORAL TRAINING AND RESEARCH EXPOSURE GMC IS ALSO HOME TO THE JANET WEIS WOMENS AND CHILDRENS HOSPITAL THE FIRST RURAL ACUTECARE CHILDRENS HOSPITAL IN THE NATION THE 85 BED CHILDRENS HOSPITAL WAS CONSTRUCTED IN 1995 ENTIRELY FROM DONATIONS AND BOASTS A NEONATAL INTENSIVE CARE UNIT A PEDIATRIC INTENSIVE CARE UNIT AND TWO FLOORS OF MEDICALSURGICAL INPATIENT ROOMS IN JANUARY OF 2000 THE TWOSTORY WOMENS PAVILION OPENED AND STRATEGICALLY ADJOINS THE CHILDRENS HOSPITAL FOSTERING FAMILYCENTERED CARE FOR ALL OBSTETRICAL AND NEWBORN SERVICES THE PAVILION FEATURES 19 LABOR DELIVERY RECOVERY POSTPARTUM ROOMS AND HAS THE STATES FIRST PASSTHROUGH WINDOWS FROM TWO HIGHRISK AND CSECTION DELIVERY ROOMS DIRECTLY INTO THE ADJOINING NEONATAL INTENSIVE CARE UNIT GEISINGER WYOMING VALLEY MEDICAL CENTER GWV IS A 501C3 NOTFORPROFIT CORPORATION THAT SERVES PATIENTS IN THE GREATER WYOMING VALLEY AND WESTERN POCONO REGION OF THE STATE WITH A COMPREHENSIVE MATERNITY PROGRAM PEDIATRIC SERVICES MEDICAL AND SURGICAL UNITS THE FRANK M AND DOROTHEA HENRY CANCER CENTER A COMPLETE EMERGENCY DEPARTMENT AS WELL AS OFFERING AN EXTENSIVE COMMUNITYHEALTH EDUCATION PROGRAM OPENING IN THE FALL OF 2001 AND CONNECTED DIRECTLY TO GWV WAS THE REGIONS FIRST AND ONLY HEART HOSPITAL THE THREESTORY STRUCTURE OFFERED LIFESAVING HEART PROCEDURES THAT WERE NOT CURRENTLY AVAILABLE IN THE REGION AS WELL AS A RESEARCH PROGRAM NEW THERAPIES AND SPECIAL HEART SERVICES THE ENTIRE HEALTH SYSTEM IS SERVED BY LIFE FLIGHT THE 20 PLUSYEAR OLD AIRMEDICAL TRANSPORT PROGRAM ONE HELICOPTER IS HOUSED ON THE CAMPUS OF GEISINGER MEDICAL CENTER AND ANOTHER IS STATIONED AT THE UNIVERSITY PARK AIRPORT IN STATE COLLEGE GHS PROVIDED THE FIRST FULLSERVICE FULLTIME MEDICAL HELICOPTER STATIONED IN THE WILKESBARRESCRANTON AREA BY ADDING A THIRD HELICOPTER IN THE FLEET IN JULY 2001 A FOURTH HELICOPTER WAS ADDED IN WILLIAMSPORT IN 2005 WITH A FIFTH GOING ONLINE IN POTTSVILLE IN 2006 COMMUNITY MEDICAL CENTER DBA GEISINGERCOMMUNITY MEDICAL CENTER GCMC IS 501C3 NOTFORPROFIT CORPORATION OWNING AND OPERATING A 297BED ACUTE CARE HOSPITAL IN SCRANTON PA GEISINGER CLINIC GC IS A 501C3 NOTFORPROFIT CORPORATION OPERATING A MULTISPECIALTY GROUP PRACTICE GEISINGER CLINIC PROVIDES PATIENT STAFF FOR PATIENT CARE EDUCATION AND RESEARCH THERE ARE MORE THAN 1000 EMPLOYED PHYSICIANS PRACTICING AT AN ARRAY OF HEALTH CARE DELIVERY PROVIDER FACILITIES AT 61 MEDICAL GROUPS SERVING 31 COUNTIES OPERATED WITHIN THE GEISINGER CLINIC ORGANIZATION THE WEIS CENTER FOR RESEARCH LOCATED ON THE CAMPUS OF GEISINGER MEDICAL CENTER IS HOME TO THE HENRY HOOD RESEARCH PROGRAM THE PREEMINENT FUNCTION OF THE HOOD RESEARCH PROGRAM IS TO CONDUCT ORIGINAL AND INNOVATIVE RESEARCH OF WORLD CLASS QUALITY OUR SCIENTISTS APPLY MODERN MOLECULAR AND CELLULAR APPROACHES TO DIVERSE RESEARCH PROBLEMS IN THE AREAS OF CARDIOVASCULAR FUNCTION CANCER AND DEVELOPMENTAL BIOLOGY COMMUNITY MEDICAL CARE INC IS A 501C3 NOTFORPROFIT CORPORATION THAT EMPLOYS AND ENGAGES PHYSICIANS AND OTHER HEALTH CARE PROFESSIONALS WHO PROVIDE PROFESSIONAL SERVICES TO PATIENTS BEGUN IN 1972 THE GEISINGER HEALTH PLAN IS A 501C4 NOTFORPROFIT CORPORATION THAT HAS GROWN TO BE ONE OF THE LARGEST RURAL HMOS IN THE COUNTRY IT CURRENTLY SERVES APPROXIMATELY 200000 MEMBERS IN A 42COUNTY SERVICE AREA MARWORTH IS A 501C 3 NOTFORPROFIT ORGANIZATION AND OPERATES A 77 BED CENTER THAT ALSO OFFERS A BROADBASED OUTPATIENT PROGRAM FOR THE TREATMENT OF ALCOHOL AND CHEMICAL DEPENDENCY MARWORTH IS LOCATED IN WAVERLY PA AND IS ANNUALLY RANKED AMONG THE TOP 20 TREATMENT CENTERS IN THE UNITED STATES GEISINGER COMMUNITY HEALTH SERVICES IS A 501C3 NOTFORPROFIT CORPORATION DESIGNED TO CONDUCT CHARITABLE SCIENTIFIC AND EDUCATIONAL ACTIVITIES FOR THE CITIZENS OF THE COMMUNITIES SERVED BY THE SYSTEM INCLUDING THE OPERATION OF A MEDICARECERTIFIED HOME HEALTH AGENCY PROVIDING HEALTH CARE SERVICES IN A PATIENTS PLACE OF RESIDENCE COLUMBIAMONTOUR HOME HEALTH AND HOSPICEVISITING NURSE ASSOCIATION INCORPORATED DBA GEISINGER COLUMBIA MONTOUR HOME HEALTH SERVICES IS A 501C3 NOTFORPROFIT CORPORATION THAT PROVIDES COMPREHENSIVE HOME HEALTH SERVICES GEISINGERBLOOMSBURG HEALTH CARE CENTER IS A 501C3 NOTFORPROFIT CORPORATION OPERATING A 149BED LONGTERM CARE NURSING HOME IN BLOOMSBURG PA MOUNTAIN VIEW NURSING HOME INC DBA MOUNTAIN VIEW CARE CENTER IS A 501 C3 NOTFORPROFIT CORPORATION OPERATING A 180BED LONGTERM CARE SKILLED NURSING AND REHABILITATION FACILITY PROVIDING SKILLED NURSING CARE IN SCRANTON PA THE FACILITY FEATURES A SPECIALIZED 24BED UNIT DEDICATED TO THE SPECIAL NEEDS AND CARE OF PEOPLE WITH ALZHEIMERS OR MEMORYRELATED ILLNESSES THESE PATIENTS NEED A SAFE AND SECURE PLACE TO LIVE MOUNTAIN VIEW HAS DEVELOPED A SEPARATE UNIT DEDICATED TO THE SPECIAL NEEDS OF PEOPLE WITH ALZHEIMERS MOUNTAIN VIEW ALSO PROVIDES HOSPICE CARE SPECIFICALLY DEVOTED TO THE SPECIAL NEEDS OF SERIOUSLY ILL RESIDENTS THE HOSPICE TEAM PROVIDES COMPASSIONATE CARE WITH DIGNITY GEISINGERBLOOMSBURG HEALTH CARE CENTER IS A 501C3 NOTFORPROFIT CORPORATION OPERATING A 149BED LONGTERM CARE NURSING HOME IN BLOOMSBURG PA GEISINGER SYSTEM SERVICES IS A 501C3 NOTFORPROFIT SUPPORT SERVICE CORPORATION PROVIDING FINANCIAL SERVICES HUMAN RESOURCES INFORMATION SYSTEMS INTERNAL AUDITS LEGAL SERVICES STRATEGIC PLANNING MARKETING AND PUBLIC RELATIONS AND FACILITIES SERVICES TO AFFILIATES WITHIN THE SYSTEM GEISINGER INSURANCE CORPORATION RISK RETENTION GROUP IS A 501C3 NOT FORPROFIT CORPORATION DOMICILED IN VERMONT AND REGISTERED BY THE PENNSYLVANIA INSURANCE DEPARTMENT PROVIDING PRIMARY PROFESSIONAL LIABILITY COVERAGE FOR SEVERAL SYSTEM ENTITIES INCLUDING GEISINGER MEDICAL CENTER GEISINGER CLINIC GEISINGER WYOMING VALLEY MEDICAL CENTER GEISINGER COMMUNITY MEDICAL CENTER GEISINGERBLOOMSBURG HOSPITAL AND GEISINGER COMMUNITY HEALTH SERVICES MEDICAL DIMENSIONS INC IS A 501C2 NOTFORPROFIT CORPORATION OPERATING AS A REAL ESTATE HOLDING COMPANY WHICH HOLDS TITLE TO PROPERTY LIFESOURCE GEISINGER BLOOD CENTER LLC IS A PENNSYLVANIA NONPROFIT LIMITED LIABILITY COMPANY REPRESENTING A JOINT VENTURE BETWEEN GMC AND INSTITUTE FOR TRANSFUSION MEDICINE ITXM A PENNSYLVANIA NOTFORPROFIT CORPORATION TO ENGAGE IN BLOOD COLLECTION MANUFACTURING AND DISTRIBUTION SERVICES GEISINGER MEDICAL MANAGEMENT CORPORATION GMMC IS A WHOLLY OWNED FOR PROFIT SUBSIDIARY OF THE FOUNDATION ITS MISSION IS TO CREATE BUSINESSES AND PARTNERSHIPS THAT DISSEMINATE GEISINGERS EXPERTISE TECHNOLOGY AND KNOWHOW WHILE GENERATING ADDITION SOURCES OF CAPITAL FOR GEISINGERS CORE OF PATIENT CARE ON JANUARY 1 2013 INTERNATIONAL SHARED SERVICES INC ISS DBA ISS SOLUTIONS MERGED INTO GMMC PRIOR TO THAT DATE ISS HAD BEEN A WHOLLY OWNED COMPANY OF GMMC ISS SOLUTIONS PROVIDES BIOMEDICAL AND INFORMATION TECHNOLOGY EQUIPMENT AND MAINTENANCE SERVICES IN 21 STATES AND DISTRICT OF COLUMBIA GEISINGER INDEMNITY INSURANCE COMPANY GIIC IS A WHOLLYOWNED FORPROFIT SUBSIDIARY OF THE FOUNDATION PROVIDING INDEMNITY HEALTH INSURANCE GEISINGER QUA
ADDITIONAL INFORMATION	PART VI	FORM 990 SCHEDULE H PART V LINE 21 DID THE HOSPITAL FACILITY CHARGE ANY OF ITS PATIENTS WHO WERE ELIGIBLE FOR ASSISTANCE UNDER THE HOSPITAL FACILITYS FINANCIAL ASSISTANCE POLICY AND TO WHOM THE HOSPITAL FACILITY PROVIDED EMERGENCY OR OTHER MEDICALLY NECESSARY SERVICES MORE THAN THE AMOUNTS GENERALLY BILLED TO INDIVIDUALS WHO HAD INSURANCE COVERING SUCH CARE GBH POLICY ALLOWS FOR A MINIMUM DISCOUNT OF 70 TO PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE WITH INCOME AT 260 TO 380 OF THE FEDERAL POVERTY GUIDELINES WHICH RESULTS IN AMOUNTS LESS THAN THE AVERAGE OF THREE BEST NEGOTIATED COMMERCIAL RATES PATIENTS WHO ARE AT LESS THAN 260 OF THE FEDERAL POVERTY GUIDELINES ARE ELIGIBLE TO RECEIVE UP TO A 100 DISCOUNT FORM 990 SCHEDULE H PART VI LINE 7 STATE FILING OF COMMUNITY BENEFIT REPORT AT THIS TIME GBH AND ITS AFFILIATES ARE NOT REQUIRED TO FILE A COMMUNITY BENEFIT REPORT WITH ANY STATE
GEISINGERBLOOMSBURG HOSPITAL LINE NUMBER 1 PART V LINE 3	PART V LINE 3	ACTION HEALTH A COLLABORATIVE PARTNERSHIP IN THE CENTRAL SUSQUEHANNA VALLEY THAT INCLUDES GEISINGER MEDICAL CENTER GEISINGER HEALTH SOUTH REHABILITATION HOSPITAL GEISINGER SHAMOKIN AREA COMMUNITY HOSPITAL EVANGELICAL COMMUNITY HOSPITAL GEISINGERBLOOMSBURG HOSPITAL AND BLOOMSBURG UNIVERSITY CONTRACTED WITH TRIPP UMBACH TO FACILITATE A COMPREHENSIVE COMMUNITY HEALTH NEEDS ASSESSMENT CHNA THE CHNA WAS CONDUCTED BETWEEN NOVEMBER 2011 AND APRIL 2012 AND RESULTED IN FIVE SEPARATE CHNA REPORTS FOUR THAT ASSESSED THE HEALTH NEEDS OF THE COMMUNITIES WITHIN EACH HOSPITAL SERVICE AREA AS WELL AS AN ASSESSMENT OF THE REGIONAL NEEDS WITHIN THE FIVECOUNTY SERVICE AREA COLUMBIA MONTOUR NORTHUMBERLAND SNYDER AND UNION COUNTY TRIPP UMBACH IS A RECOGNIZED NATIONAL LEADER IN CONDUCTING CHNA HAVING CONDUCTED MORE THAN 200 CHNA OVER THE PAST 20 YEARS PAUL UMBACH FOUNDER AND PRESIDENT OF TRIPP UMBACH IS AMONG THE MOST EXPERIENCED COMMUNITY HEALTH PLANNERS IN THE NATION HAVING DIRECTED PROJECTS IN EVERY STATE AND INTERNATIONALLY TRIPP UMBACH HAS WRITTEN TWO NATIONAL GUIDE BOOKS ON THE TOPIC OF COMMUNITY HEALTH AND HAS PRESENTED AT MORE THAN 50 STATE AND NATIONAL HEALTH CONFERENCES THE CHNA PROCESS INCLUDED INPUT FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVED BY GEISINGERBLOOMSBURG HOSPITAL INCLUDING THOSE WITH SPECIAL KNOWLEDGE AND EXPERTISE IN PUBLIC HEALTH ISSUES COMMUNITY HEALTH ASSESSMENT PLANNING A SERIES OF MEETINGS WERE CONDUCTED CONSISTING OF LEADERSHIP FROM GBH AND THE OTHER PARTICIPATING HOSPITALS AND ORGANIZATIONS GEISINGER SHAMOKIN AREA COMMUNITY HOSPITAL EVANGELICAL COMMUNITY HOSPITAL GEISINGER MEDICAL CENTER AND BLOOMSBURG UNIVERSITY SECONDARY DATA THE HEALTH OF THE COMMUNITY IS LARGELY RELATED TO THE CHARACTERISTICS OF ITS RESIDENTS TRIPP UMBACH COMPLETED COMPREHENSIVE ANALYSIS OF HEALTH STATUS AND SOCIOECONOMIC FACTORS RELATED TO THE HEALTH OF RESIDENTS WITHIN THE COMMUNITY FROM EXISTING DATA SOURCES SUCH AS STATE AND COUNTY PUBLIC HEALTH AGENCIES THE CENTERS FOR DISEASE CONTROL AND PREVENTION COUNTY HEALTH RANKINGS THOMSON REUTERS COMMUNITY NEED INDEX PREVENTION QUALITY INDICATORS INDEX THE CENTER OF RURAL PA PENNDOT AND OTHER DATA SOURCES INTERVIEWS WITH KEY COMMUNITY STAKEHOLDERS WORKING CLOSELY WITH ACTION HEALTH TRIPP UMBACH IDENTIFIED LEADERS FROM ORGANIZATIONS THAT HAVE SPECIAL KNOWLEDGE OR EXPERTISE IN PUBLIC HEALTH AND A SERIES OF 18 INTERVIEWS WERE CONDUCTED WITH THESE KEY STAKEHOLDERS IE GEISINGER MEDICAL CENTER PENNSYLVANIA OFFICE OF RURAL HEALTH CARE MONTOUR COUNTY ASSISTANCE OFFICE AMONG OTHERS FOCUS GROUPS WITH COMMUNITY RESIDENTS TO ASSURE THAT COMMUNITY MEMBERS INCLUDING UNDERREPRESENTED RESIDENTS WERE INCLUDED IN THE NEEDS ASSESSMENT THREE FOCUS GROUPS WERE CONDUCTED BY TRIPP UMBACH SECONDARY DATA WAS USED TO IDENTIFY HEALTH NEEDS AND DEFICITS IN TARGETED POPULATIONS FOCUS GROUP AUDIENCES INCLUDED NURSES EMPLOYED BY A PUBLIC SCHOOL SMALL BUSINESS OWNERS FARMERS AND WORKING PROFESSIONALS WITH YOUNG CHILDREN IDENTIFICATION OF TOP COMMUNITY HEALTH NEEDS NEEDS WERE PRIORITIZED BY COMMUNITY LEADERS DURING A REGIONAL COMMUNITY HEALTH NEEDS IDENTIFICATION FORUM HELD APRIL 5 2012 THE FINDINGS PRESENTED WERE FROM ANALYZING DATA KEY STAKEHOLDERS INTERVIEWS AND FOCUS GROUP INPUTS COMMUNITY LEADERS DISCUSSED THE DATA PRESENTED SHARED THEIR VISIONS AND PLANS FOR COMMUNITY HEALTH IMPROVEMENT IN THEIR COMMUNITIES AND IDENTIFIED THE TOP HEALTH NEEDS IN THE GBH COMMUNITY
GEISINGERBLOOMSBURG HOSPITAL LINE NUMBER 1 PART V LINE 4	PART V LINE 4	GEISINGER MEDICAL CENTER GEISINGER HEALTH SOUTH REHABILITATION HOSPITAL GEISINGER SHAMOKIN AREA COMMUNITY HOSPITAL EVANGELICAL COMMUNITY HOSPITAL AND GEISINGERBLOOMSBURG HOSPITAL PARTICIPATED IN THE CHNA
GEISINGERBLOOMSBURG HOSPITAL LINE NUMBER 1 PART V LINE 5C	PART V LINE 5C	THE COMMUNITY HEALTH NEEDS ASSESSMENT AND RELATED IMPLEMENTATION STRATEGIES ARE LOCATED AT WWWGEISINGERORGCHNA
GEISINGERBLOOMSBURG HOSPITAL LINE NUMBER 1 PART V LINE 14G	PART V LINE 14G	REGISTRATION PERSONNEL ALSO REFER UNINSURED ANDOR LOW INCOME PATIENTS TO FINANCIAL COUNSELORS TO DISCUSS THE FINANCIAL ASSISTANCE POLICY

Schedule H (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

GEISINGER-BLOOMSBURG HOSPITAL

Employer identification number

23-2193572

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

Yes

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)GLENN D STEELE JR MD PHDPRESCHAIR DIRECTOR	(i) (ii)	1,021,563	920,000	120,993	388,588	29,866	2,481,010
(2)DAVID J FELICIO ESQUIRECLO SECRETARY	(i) (ii)	313,540	152,506	46,635	120,520	20,139	653,340
(3)EDWARD J ZYCH ESQUIREACLO ASST SECRETARY	(i) (ii)	250,888	74,435	19,252	43,763	22,035	410,373
(4)KEVIN F BRENNAN CPA FHFMAEVP FINANCE CFO	(i) (ii)	501,671	290,967	286,688	181,114	21,073	1,281,513	247,768
(5)ALBERT BOTHE JR MDCMO	(i) (ii)	528,879	268,143	274,517	178,224	11,292	1,261,055	221,209
(6)STEPHEN PAOLUCCI MDCMO	(i) (ii)	309,000	112,999	26,515	18,096	23,035	489,645
(7)LISSA L BRYAN SMITHCAO	(i) (ii)	261,065	74,070	79,501	18,096	12,671	445,403	30,414
(8)FRANK J TREMBULAKSR VP TREASURER	(i) (ii)	592,806	305,296	347,250	203,077	13,790	1,462,219	274,280
(9)REGIS P CABONORCEO	(i) (ii)	10,515 256,470		126,179	1,367 2,565	8,884	138,061 267,919
(10)JOSEPH M DEVITOCFO	(i) (ii)	9,175 260,635		111,488	1,207 2,606	115 13,025	121,985 276,266
(11)JEAN R THOMAS CRNACRNA	(i) (ii)	203,384			2,034	8,625	214,043
(12)JOSPEH P RUDA CRNACRNA	(i) (ii)	209,296 37,638		208	2,093 1,854	16,789	228,178 39,700
(13)LINDA D BRENNAN CRNACRNA	(i) (ii)	204,613			2,046	8,521	215,180
(14)PENNY E YENCHICK CRNACRNA	(i) (ii)	2,532 197,368	300	15,795	13,569	18 12,828	2,550 239,860
(15)THOMAS G SMITH CRNACRNA	(i) (ii)	46,646 294,459	300	7,833	18,096	18 18,185	46,664 338,873
(16)PATRICK J ERWIN MDFORMER OFFICER	(i) (ii)	343,046		6,287	10,638	28,568	388,539

Schedule J (Form 990) 2012

Page 3

Part III

Supplemental Information

Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II.
Also complete this part for any additional information.

Identifier	Return Reference	Explanation
SEVERANCE, NONQUALIFIED, AND EQUITY-BASED PAYMENTS	SCHEDULE J, PAGE 1, PART I, LINE 4	KEVIN F. BRENNAN, CPA, FHFMA 0 247,768 0 ALBERT BOTHE, JR., M.D. 0 221,209 0 LISSA L. BRYAN SMITH 0 59,838 0 FRANK J. TREMBULAK 0 276,507 0 REGIS P. CABONOR 126,179 0 0 JOSEPH M. DEVITO 111,488 0 0
OTHER ADDITIONAL INFORMATION	SCHEDULE J, PART III	PART I, LINE 4A - SEVERANCE PAYMENT: UPON INVOLUNTARY SEPARATION, EMPLOYEES MAY BE ELIGIBLE TO RECEIVE CONTINUATION OF SALARY FOR A TERM THAT IS BASED ON THEIR YEARS OF GEISINGER HEALTH SYSTEM SERVICE AND POSITION. PART I, LINE 4B - SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN COMPENSATION FOR ELIGIBLE EMPLOYEES MAY BE DEFERRED TO A 457(F) NONQUALIFIED PLAN THAT VESTS WITH COMPLETION OF SERVICE, DEATH AND/OR PERMANENT DISABILITY. __________________________________________________________________________ FOOTNOTE: THROUGHOUT FORM 990, THE TERMS "GEISINGER HEALTH SYSTEM" AND "SYSTEM" OR THE ACRONYM "GHS" SHALL REFER TO THE ENTIRE HEALTHCARE SYSTEM COMPRISED OF GEISINGER HEALTH SYSTEM FOUNDATION ("THE FOUNDATION") AS PARENT AND ALL SUBSIDIARY CORPORATIONS COMPRISING THE SYSTEM.

Schedule J (Form 990) 2012

Additional Data

Software ID:
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

GEISINGER-BLOOMSBURG HOSPITAL

Employer identification number

23-2193572

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) GEISINGER INDEMNITY INSURANCE CO	BUSINESS	249,147	IC SHARED SRVC. REV.		No
(2) GEISINGER QUALITY OPTIONS INC	BUSINESS	700,210	IC SHARED SRVC. REV.		No
(3) INTERNATIONAL SHARED SERVICES INC	BUSINESS	268,319	IC SHARED SRVC. EXP.		No
(4) GEISINGER MEDICAL MANAGEMENT CORP	BUSINESS	194,190	IC SHARED SRVC. EXP.		No
(5) GEISINGER ASSURANCE COMPANY LTD	BUSINESS	321,204	IC SHARED SRVC. EXP.		No
(6) LAURA A DEVITO	FAMILY MEMBER	18,120	EMPLOYEECOMPENSATION		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
ADDITIONAL INFORMATION	SCHEDULE L PART V	LAURA A DEVITO IS A FAMILY MEMBER OF JOSEPH M DEVITO A KEY EMPLOYEE OF GEISINGERBLOOMSBURG HOSPITAL GEISINGERBLOOMSBURG HOSPITAL GBH IS CLOSELY AFFILIATED WITH SEVERAL OTHER ORGANIZATIONS IN THE NORMAL COURSE OF OPERATIONS OF THESE AFFILIATED ORGANIZATIONS THERE ARE NUMEROUS INTERORGANIZATIONAL TRANSACTIONS WHICH MAY INCLUDE SALES EXCHANGES AND LEASE OF PROPERTY EXTENSIONS OF CREDIT FURNISHING OF GOODS SERVICES AND FACILITIES AND TRANSFERS OF ASSETS THESE TYPES OF INTERORGANIZATIONAL TRANSACTIONS WERE DESCRIBED TO THE INTERNAL REVENUE SERVICE IRS IN A RULING APPLICATION AND WERE RECOGNIZED BY THE NATIONAL OFFICE OF THE IRS IN A SERIES OF PRIVATE LETTER RULINGS AS BEING ENTIRELY CONSISTENT WITH THE ORGANIZATIONS TAX EXEMPT STATUS THE FOLLOWING ORGANIZATIONS REPRESENT THE AFFILIATED FORPROFIT ORGANIZATIONS WITHIN THE GEISINGERBLOOMSBURG HOSPITAL FOR WHOM BUSINESS TRANSACTIONS MUST BE DISCLOSED FOR PURPOSES OF SCHEDULE L PART IV TRANSACTIONS WITH INTERESTED PERSONS GEISINGER MEDICAL MANAGEMENT CORPORATION GEISINGER QUALITY OPTIONS INC GEISINGER INDEMNITY INSURANCE COMPANY INTERNATIONAL SHARED SERVICES INC GEISINGER ASSURANCE COMPANY LTD THE FOLLOWING OFFICERS ANDOR DIRECTORS OF GEISINGERBLOOMSBURG HOSPITAL ARE OFFICERS ANDOR DIRECTORS OF SOME OR ALL OF THESE ORGANIZATIONS WILLIAM H ALEXANDER DAVID J FELICIO ESQUIRE RICHARD A GRAFMYRE WILLIAM R GRUVER THOMAS H LEE JR MD ROBERT E POOLE DON A ROSINI GLENN D STEELE MD PHD FRANK J TREMBULAK EDWARD J ZYCH ESQUIRE FOOTNOTE THROUGHOUT FORM 990 THE TERMS GEISINGER HEALTH SYSTEM AND SYSTEM OR THE ACRONYM GHS SHALL REFER TO THE ENTIRE HEALTHCARE SYSTEM COMPRISED OF GEISINGER HEALTH SYSTEM FOUNDATION THE FOUNDATION AS PARENT AND ALL SUBSIDIARY CORPORATIONS COMPRISING THE SYSTEM

Schedule L (Form 990 or 990-EZ) 2012

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE N
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Liquidation, Termination, Dissolution, or Significant Disposition of Assets

Complete if the organization answered "Yes" to Form 990, Part IV, lines 31 or 32; or Form 990-EZ, line 36.
bullet

Attach certified copies of any articles of dissolution, resolutions, or plans.
bullet

Attach to Form 990 or 990-EZ.

OMB No. 1545-0047

2012

Open to Public
Inspection

Name of the organization
GEISINGER-BLOOMSBURG HOSPITAL

Employer identification number
23-2193572

Part I

Liquidation, Termination, or Dissolution. Complete this part if the organization answered "Yes" to Form 990, Part IV, line 31, or Form 990-EZ, line 36.
Part I can be duplicated if additional space is needed.

1(a)Description of asset(s) distributed or transaction expenses paid	(b)Date of distribution	(c)Fair market value of asset(s) distributed or amount of transaction expenses	(d)Method of determining FMV for asset(s) distributed or transaction expenses	(e)EIN of recipient	(f)Name and address of recipient	(g)IRC section of recipient(s) (if tax-exempt) or type of entity

Yes

Did or will any officer, director, trustee, or key employee of the organization:

Become a director or trustee of a successor or transferee organization? . . . . . . . . . . . . . . . . . . . . .

Become an employee of, or independent contractor for, a successor or transferee organization? . . . . . . . . . . . . . . . .

Become a direct or indirect owner of a successor or transferee organization? . . . . . . . . . . . . . . . . . . . .

Receive, or become entitled to, compensation or other similar payments as a result of the organization's liquidation, termination, or dissolution? . . . . .

If the organization answered "Yes" to any of the questions in this line, provide the name of the person involved and explain in Part III. bullet

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

Cat. No. 50087Z

Schedule N (Form 990 or 990-EZ) (2012)

Page 2

Part I

Liquidation, Termination, or Dissolution (continued)

Note. If the organization distributed all of its assets during the tax year, then Form 990, Part X, column (B), line 16 (Total assets), and line 26 (Total liabilities), should equal -0-.

Yes

Did the organization distribute its assets in accordance with its governing instrument(s)? If “No,” describe in Part III . . . . . . . . . . .

Is the organization required to notify the attorney general or other appropriate state official of its intent to dissolve, liquidate, or terminate? . . . . . .

If “Yes,” did the organization provide such notice? . . . . . . . . . . . . . . . . . . . . . . . . . .

Did the organization discharge or pay all of its liabilities in accordance with state laws? . . . . . . . . . . . . . . . . .

Did the organization have any tax-exempt bonds outstanding during the year? . . . . . . . . . . . . . . . . . . . .

Did the organization discharge or defease all of its tax-exempt bond liabilities during the tax year in accordance with the Internal Revenue Code and state laws? .

If "Yes" to line 6b, describe in Part III how the organization defeased or otherwise settled these liabilities. If “No,” explain in Part III.

Part II

Sale, Exchange, Disposition, or Other Transfer of More Than 25% of the Organization's Assets. Complete this part if the organization answered "Yes" to Form 990, Part IV, line 32, or Form 990-EZ, line 36. Part II can be duplicated if additional space is needed.

1(a) Description of asset(s) distributed or transaction expenses paid	(b) Date of distribution	(c) Fair market value of asset(s) distributed or amount of transaction expenses	(d) Method of determining FMV for asset(s) distributed or transaction expenses	(e) EIN of recipient	(f) Name and address of recipient	(g) IRC section of recipient(s) (if tax-exempt) or type of entity
CASH AND EQUIVALENTS	07-01-2012	111,589	FMV	23-1995911	GEISINGER HEALTH SYSTEM FOUNDATION 100 NORTH ACADEMY AVENUE MC 49-40 DANVILLE,PA17822	501C3
ASSETS HELD BY TRUSTEE	07-01-2012	55,765	FMV	23-1995911	GEISINGER HEALTH SYSTEM FOUNDATION 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822	501C3
ACCOUNTS RECEIVABLE	07-01-2012	2,673,805	BOOK VALUE	23-1995911	GEISINGER HEALTH SYSTEM FOUNDATION 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822	501C3
INVENTORIES	07-01-2012	517,998	BOOK VALUE	23-1995911	GEISINGER HEALTH SYSTEM FOUNDATION 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822	501C3
PREPAID EXPENSES	07-01-2012	220,423	BOOK VALUE	23-1995911	GEISINGER HEALTH SYSTEM FOUNDATION 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822	501C3
LT LIMITED USE ASSETS	07-01-2012	1,048,886	FMV	23-1995911	GEISINGER HEALTH SYSTEM FOUNDATION 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822	501C3
PROPERTY AND EQUIPMENT	07-01-2012	12,277,459	BOOK VALUE	23-1995911	GEISINGER HEALTH SYSTEM FOUNDATION 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822	501C3
RESTRICTED CASH	07-01-2012	197,441	FMV	23-1995911	GEISINGER HEALTH SYSTEM FOUNDATION 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822	501C3
457B DEFERRED COMP	07-01-2012	217,410	FMV	23-1995911	GEISINGER HEALTH SYSTEM FOUNDATION 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822	501C3
BENEFICIAL INTEREST TR	07-01-2012	7,852,919	FMV	23-1995911	GEISINGER HEALTH SYSTEM FOUNDATION 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822	501C3

Yes

Did or will any officer, director, trustee, or key employee of the organization:

Become a director or trustee of a successor or transferee organization? . . . . . . . . . . . . . . . . . . . . .

Become an employee of, or independent contractor for, a successor or transferee organization? . . . . . . . . . . . . . . . .

Become a direct or indirect owner of a successor or transferee organization? . . . . . . . . . . . . . . . . . . . . .

Receive, or become entitled to, compensation or other similar payments as a result of the organization’s significant disposition of assets? . . . . . . .

If the organization answered "Yes" to any of the questions in this line, provide the name of the person involved and explain in Part III. bullet

Schedule N(Form 990 or 990-EZ) (2012)

Schedule N (Form 990 or 990-EZ) (2012)

Page 3

Part III

Supplemental Information. Complete to provide the information required by Part I, lines 2e and 6c, and Part II, line 2e. Also complete this part to provide any additional information.

Identifier	Return Reference	Explanation
ADDITIONAL INFORMATION	SCHEDULE N	EFFECTIVE JULY 1 2012 THE BLOOMSBURG HOSPITAL NOW GEISINGERBLOOMSBURG HOSPITAL GBH AND ITS RELATED ENTITIES GEISINGERBLOOMSBURG HEALTH CARE CENTER FORMERLY BLOOMSBURG HEALTH CARE CENTER BLOOMSBURG PHYSICIANS SERVICES COLUMBIA MONTOUR HOME HEALTH SERVICES AND THE BLOOMSBURG HOSPITAL MEDICAL PROFESSIONAL SELFINSURANCE TRUST MERGED WITH GEISINGER HEALTH SYSTEM GEISINGER HEALTH SYSTEM FOUNDATION APPOINTED NEW OFFICERS AND A NEW BOARD OF DIRECTORS FOR GBH AND ALL RELATED ENTITIES SEE ATTACHED MERGER DOCUMENTS

Schedule N (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

GEISINGER-BLOOMSBURG HOSPITAL

Employer identification number

23-2193572

Identifier	Return Reference	Explanation
FIRST ACCOMPLISHMENT DESCRIPTION	FORM 990, PAGE 2, PART III, LINE 4A	I. MISSION: GEISINGER-BLOOMSBURG HOSPITAL IS COMMITTED TO PROVIDING EXCEPTIONAL INPATIENT, OUTPATIENT AND EMERGENCY CARE SERVICES FOR RESIDENTS OF BLOOMSBURG, PA AND THE SURROUNDING AREAS. THE ORGANIZATION PROMOTES, RESTORES, AND MAINTAINS COMMUNITY HEALTH THROUGH A FULLY INTEGRATED HEALTH SYSTEM AND PROVIDES A VARIETY OF SERVICES. II.GENERAL INFORMATION GEISINGER-BLOOMSBURG HOSPITAL(GBH), A 501(C)(3) NOT-FOR-PROFIT CORPORATION AND MEMBER OF GEISINGER HEALTH SYSTEM, OWNS AND OPERATES A 72 BED, ACUTE CARE, HOSPITAL IN BLOOMSBURG, PA. GBH IS CONVENIENTLY LOCATED ONLY A FEW MILES FROM SEVERAL MAJOR HIGHWAYS THROUGHOUT CENTRAL PA. THE FACILITY OPENED IN 1905, ANSWERING A PRESSING NEED FOR HEALTH AND WELLNESS CARE IN THE COMMUNITY. GBH PROVIDES QUALITY MEDICAL HEALTHCARE REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE, OR ABILITY TO PAY. SERVICES OFFERED BY GBH INCLUDE: GENERAL MEDICAL CARE PROVIDED BY INHOUSE HOSPITALIST AND SUPPORTED BY CONSULTATIVE SERVICES IN THE AREAS OF CARDIOLOGY,NEUROLOGY AND PULMONOLOGY. EMERGENCY DEPARTMENT IS COMMITTED TO PROVIDING HIGH QUALITY, PROMPT EMERGENCY SERVICES. GBH'S ED IS STAFFED 24/7 WITH FULL-TIME PHYSICIANS AND NURSES THAT ARE TRAINED IN ALL SPECIALTIES FROM PEDIATRICS TO CRITICAL CARE. IMMEDIATE ACCESS TO LABORATORY SERVICES, X-RAYS, CAT SCANS, 3D-4D ULTRASOUND, MRI AND SURGICAL SERVICES. ON AVERAGE PATIENTS IN THE EMERGENCY DEPARTMENT ARE TREATED AND RELEASED WITHIN 90 MINUTES. MOST INSURANCES, INCLUDING MEDICARE AND MEDICAID, ARE ACCEPTED AND NO PATIENT IS REFUSED TREATMENT BECAUSE OF INABILITY TO PAY. OB/GYN FOCUSES ON ALL ASPECTS OF WOMEN'S HEALTH AND EDUCATION, PROVIDING OBSTETRICAL AND GYNECOLOGICAL CARE FOR WOMEN OF ALL AGES. SERVICES INCLUDE BUT NOT LIMITED TO ROUTINE VISITS AND TREATMENTS, PREVENTATIVE HEALTHCARE, BIRTH CONTROL EDUCATION, FAMILY PLANNING, OBSTETRICS, SURGERY & SURGERY CONSULTATIONS, MENOPAUSE COUNSELING, AND MIDWIFERY. MENTAL HEALTH & PSYCHIATRIC SERVICES IS A DESIGNATED COUNT 302 TRIAGE SITE THAT PROVIDES BOTH INPATIENT AND OUTPATIENT SERVICES DESIGNED TO HELP INDIVIDUALS LIVE AS INDEPENDENTLY AS POSSIBLE. ALL AGE GROUPS FROM ADOLESCENTS TO GERIATRICS CAN ACCESS QUICK, EFFICIENT ADMISSION 24/7 AND RECEIVE TREATMENT THROUGH ONE-ON-ONE PATIENT COUNSELING, TREATMENT MEETINGS 5 DAYS PER WEEK, AND A PSYCHIATRIST AVAILABLE ON A DAILY BASIS. SUBSTANCE ABUSE COUNSELING IS ALSO AVAILABLE INCLUDING RELAPSE PREVENTION TEAM MEETINGS. ADMISSIONS ARE CONFIDENTIAL AND MAY BE MADE BY PROFESSIONALS AS WELL BY INDIVIDUALS CONCERNED ABOUT THEMSELVES OR OTHERS. HOSPITALIZATION MEANS PATIENT CARE IS PROVIDED THROUGH MULTIPLE PROFESSIONALS WHO COMPRISE THE TREATMENT TEAM. OTHER SERVICES INCLUDE: CARDIAC SERVICES SURGERY SPECIALTIES RADIOLOGY ORTHOPEDIC ICCU UROLOGY LABORATORY SERVICES GYNOCOLOGY PHYSICAL THERAPY OTOLARYNGOLOGY RESPIRATORY SERVICES GENERAL SURGERY III. UNCOMPENSATED CARE GEISINGER-BLOOMSBURG HOSPITAL RECOGNIZES ITS MISSION IS TO SERVE ALL MEMBERS OF THE COMMUNITY WITH RESPECT TO THE PROVISION OF HEALTHCARE SERVICES AND EDUCATION. IN THIS REGARD, GBH PROVIDES FREE OR SUBSIDIZED CARE BELOW COST AND SUPPORTS VARIOUS HEALTH-RELATED ACTIVITIES AND PROGRAMS IN SUPPORT OF THE COMMUNITY. A.CHARITY CARE THE PRIMARY CONCERN OF GBH IS THE DELIVERY OF HEALTH CARE TO ALL CITIZENS OF CENTRAL PENNSYLVANIA REGARDLESS OF THEIR ABILITY TO PAY. THE UNREIMBURSED COST OF CHARITY CARE REPRESENTS THE COST GBH INCURS BY PROVIDING FREE OR DISCOUNTED SERVICES TO THOSE WHO CANNOT AFFORD TO PAY. FOR THE FISCAL YEAR ENDED JUNE 30, 2013, THE COST OF THE CHARITY CARE WAS 225 THOUSAND. B.MEDICARE/MEDICAID IN RECOGNIZING ITS MISSION TO THE COMMUNITY, GBH PROVIDES SERVICES TO THE ELDERLY (MEDICARE) AND THE INDIGENT (MEDICAID). GBH PROVIDES CARE, BELOW COST, TO PERSONS COVERED BY THESE GOVERNMENTAL PROGRAMS TO THE EXTENT THE GOVERNMENT REIMBURSEMENT IS BELOW THE COST OF PROVIDING HEALTH CARE. THE UNREIMBURSED VALUE OF MEDICARE AND/OR MEDICAID IS EQUAL TO THE COST OF PROVIDING SERVICES LESS THE AMOUNT RECEIVED AS REIMBURSEMENT UNDER THE PROGRAM. THE COST OF PROVIDING HEALTHCARE SERVICES TO MEDICARE AND MEDICAID PATIENTS EXCEEDED REIMBURSEMENT BY APPROXIMATELY 5.3 MILLION DURING THE FISCAL YEAR ENDED JUNE 30, 2013. C.OTHER UNCOMPENSATED PATIENT SERVICES IN ADDITION, GBH PROVIDES SERVICES FOR WHICH FULL PAYMENT IS NOT RECEIVED. THE UNCOMPENSATED COST OF PROVIDING SUCH PATIENT SERVICES DURING THE FISCAL YEAR ENDED JUNE 30, 2013, WAS 664 THOUSAND. IV. VOLUNTEER SERVICES THE VOLUNTEERS OF GEISINGER-BLOOMSBURG HOSPITAL ARE AN ACTIVE AND VITAL PART OF THE ACTIVITIES OF THE HOSPITAL. THE HOURS OF VOLUNTEER SERVICES ARE AN IMPORTANT CONTRIBUTION TO THE MISSION OF GEISINGER-BLOOMSBURG HOSPITAL. THE VOLUNTEERS FROM LOCAL COMMUNITIES CONTRIBUTED 98 HOURS TOWARD THE COMMON PURPOSE OF SERVICING THE HEALTHCARE OF THE COMMUNITY. V.COMMUNITY HEALTH, EDUCATION, AND OUTREACH GBH STRIVES TO BE A VALUABLE RESOURCE FOR THE COMMUNITY AND ITS RESIDENTS. GBH PROVIDES MANY REDUCED-PRICE SERVICES AND FREE PROGRAMS THROUGHOUT THE YEAR THAT SERVE COMMUNITY HEALTH NEEDS. AT A COST OF 3 THOUSAND, THESE SERVICES AND PROGRAMS INCLUDED: SUPPORT GROUPS, COMMUNITY HEALTH EDUCATION, AND OTHER UNIQUE SERVICES. A.GROUPS GBH PROVIDES PROGRAMS FOR ALL DEMOGRAPHICS. SILVER CIRCLE IS A GROUP THAT PROVIDES BENEFITS FOR 55+ AGE INDIVIDUALS SUCH AS MONTHLY NEWSLETTER WITH HEALTH AND LIFESTYLE INFORMATION, FREE HEALTH SCREENINGS, YOGA CLASSES, HEALTHY EATING SEMINARS, TRAVEL OPPORTUNITIES, AND OTHER SOCIAL EVENTS. GBH CONTINUES TO MAKE INROADS WITH THE NEIGHBORING BLOOMSBURG UNIVERSITY WITH INVOLVEMENT BETWEEN LEADERSHIP AND STUDENTS WHO ARE INTERESTED IN COMMUNITY HEALTH CARE. B.COMMUNITY HEALTH EDUCATION COMMUNITY HEALTH NEEDS ASSESSMENT WOMEN'S HEALTH RELATED TOPICS CARDIAC AND DIABETIC COOKING CLASSES VI. COMMUNITY SERVICE SUMMARY AT COST CHARITY CARE 225,244 MEDICARE/MEDICAID 5,285,954 BAD DEBT 664,280 COMMUNITY HEALTH, EDUCATION, AND OUTREACH 3,160 VOLUNTEER SERVICES (VALUED AT 1/1/2013 PA STATEWIDE AVERAGE WEEKLY WAGE) 2,246 TOTAL 6,180,884 VII. STATISTICS GEISINGER-BLOOMSBURG HOSPTIAL FISCAL YEAR ENDED JUNE 30, 2013 ADMISSIONS (INCLUDING NEWBORNS) 2,351 ADMISSIONS (EXCLUDING NEWBORNS) 2,137 OUTPATIENT VISITS INCLUDING EMERGENCY DEPARTMENT 33,624 AVERAGE LENGTH OF STAY (EXCLUDING NEWBORNS AND PSYCH) 4.2 PERCENT OF OCCUPANCY (EXCLUDING NEWBORNS) 34.20% PATIENT DAYS (EXCLUDING NEWBORNS) 8,991 IN AND OUT SURGERY VISITS 2,407 BEDS (EXCLUDING BASSINETS) (SET UP AND STAFFED) 20 BASSINETS IN NURSERY 10
ADDITIONAL INFORMATION	FORM 990, PART VI	FORM 990, PART I, SECTION A, LINE 4: FORM 990, PART VI, SECTION A, LINE 1B: ENTER THE NUMBER OF VOTING MEMBERS THAT ARE INDEPENDENT. BASED ON THE FORM 990 DEFINITION OF "INDEPENDENCE" AS IT RELATES TO VOTING MEMBERS OF THE GOVERNING BODY, ONE VOTING MEMBER IS NOT INDEPENDENT BECAUSE HE IS COMPENSATED AS AN EMPLOYEE OF A RELATED TAX-EXEMPT ORGANIZATION. INCLUDING THE VOTING MEMBERS DESCRIBED ABOVE, A TOTAL OF SEVEN VOTING MEMBERS OF THE GOVERNING BODY ARE ALSO VOTING MEMBERS OF RELATED TAXABLE ORGANIZATIONS FOR WHICH BUSINESS TRANSACTIONS, BETWEEN GBH AND THE RELATED TAXABLE ORGANIZATION ARE REPORTED IN SCHEDULE L, PART IV. HOWEVER, IF THE RELATED TAXABLE ORGANIZATIONS WERE REQUIRED TO FILE SCHEDULE L, THESE TRANSACTIONS WOULD NOT BE OF A TYPE THAT WOULD BE REPORTABLE ON THEIR SCHEDULE L. IN ADDITION, THESE VOTING MEMBERS ARE NOT COMPENSATED BY THE RELATED TAXABLE ORGANIZATIONS FOR WHICH TRANSACTIONS ARE DISCLOSED IN SCHEDULE L, PART IV, DO NOT HAVE AN OWNERSHIP INTEREST IN OR RECEIVE ANY ECONOMIC BENEFIT FROM THE ACTIVITIES OF THESE RELATED TAXABLE ORGANIZATIONS, RECEIVE NO PRIVATE INUREMENT / PRIVATE BENEFIT FROM THE TRANSACTIONS WITH THE RELATED TAXABLE ORGANIZATIONS AND THE VOTING MEMBERS OF THE GOVERNING BODY ABSTAIN FROM VOTING AND ARE ABSENT FROM BOARD DELIBERATIONS AND DECISIONS ON MATTERS IF A CONFLICT EXISTS. REFER TO THE RESPONSE FOR FORM 990, PART VI, SECTION B, QUESTION 12A, 12B, AND 12C REGARDING THE GEISINGER HEALTH SYSTEM CONFLICTS OF INTEREST POLICY, DISCLOSURE, AND ENFORCEMENT. FORM 990, PART VI, SECTION A, LINE 2: DID ANY OFFICER, DIRECTOR, TRUSTEE, OR KEY EMPLOYEE HAVE A FAMILY RELATION- SHIP OR BUSINESS RELATIONSHIP WITH ANY OTHER OFFICER, DIRECTOR, TRUSTEE, OR KEY EMPLOYEE? GLENN D. STEELE, JR. M.D., PH.D., DAVID J. FELICIO, ESQUIRE, FRANK J. TREMBULAK, EDWARD J. ZYCH, ESQUIRE, WILLIAM H. ALEXANDER, RICHARD GRAFMYRE, WILLIAM R. GRUVER, THOMAS H. LEE, JR., M.D., ROBERT E. POOLE, AND DON A. ROSINI ALL HAVE A BUSINESS RELATIONSHIP WITH ONE ANOTHER BECAUSE THEY SERVE AS OFFICERS AND/OR DIRECTORS ON ONE OR MORE FOR-PROFIT AFFILIATES OF GEISINGER-BLOOMSBURG HOSPITAL. ALL OF THE AFFILIATES ARE PART OF THE GEISINGER HEALTH SYSTEM.
SIGNIFICANT CHANGES TO ORGANIZATIONAL DOCUMENTS	FORM 990, PAGE 6, PART VI, LINE 4	ON JULY 1, 2012, THE ORGANIZATION CHANGED ITS RESPECTIVE ARTICLES OF INCORPORATION AND CORPORATE BYLAWS TO REFLECT THE MERGER AND INTEGRATION BY AND BETWEEN BLOOMSBURG HEALTH SYSTEM AND GEISINGER HEALTH SYSTEM IN WHICH GEISINGER HEALTH SYSTEM FOUNDATION BECAME SOLE MEMBER OF EACH OF THE FOLLOWING NON-PROFIT ORGANIZATIONS: BLOOMSBURG HOSPITAL, NOW KNOWN AS GEISINGER-BLOOMSBURG HOSPITAL, BLOOMSBURG HEALTH CARE CENTER, NOW KNOWN AS GEISINGER-BLOOMSBURG HEALTH CARE CENTER, COLUMBIA MONTOUR HOME HEALTH SERVICES/VISITING NURSES ASSOCIATION, INC., AND BLOOMSBURG PHYSICIANS SERVICES, INC.
CLASSES OF MEMBERS OR STOCKHOLDERS	FORM 990, PAGE 6, PART VI, LINE 6	THE MEMBERS OF THE CORPORATION HAVE THE POWER AND AUTHORITY TO ELECT AND REMOVE THE DIRECTORS; ELECT AND REMOVE THE PRESIDENT AND FILL ANY VACANCY IN THE OFFICE OF THE PRESIDENT OF THE CORPORATION; AND, MAY APPROVE AMENDMENTS TO THE CORPORATE BYLAWS IN LIEU OF SUCH APPROVAL BY THE BOARD OF DIRECTORS. THE MEMBERS ALSO HAVE THE RESERVE POWERS AS SET FORTH IN THE PENNSYLVANIA NONPROFIT CORPORATION LAW.
ELECTION OF MEMBERS AND THEIR RIGHTS	FORM 990, PAGE 6, PART VI, LINE 7A	THE BOARD OF DIRECTORS OF THE CORPORATION SHALL SERVE AS THE GOVERNING BODY OF THE CORPORATION. THE PRESIDENT OF THE CORPORATION SHALL BE A DIRECTOR BY REASON OF HOLDING SUCH OFFICE. THE REMAINING DIRECTORS SHALL BE ELECTED BY THE MEMBERS AT THE ANNUAL MEETING OF THE MEMBERS. THE MEMBERS OF THE CORPORATION MAY SERVE AS DIRECTORS AND DIRECTORS MAY SUCCEED THEMSELVES FROM TERM TO TERM. VACANCIES ON THE BOARD OF DIRECTORS SHALL BE FILLED BY THE MEMBERS AT THEIR DISCRETION AT THE ANNUAL MEETING OF THE MEMBERS OR AT A SPECIAL MEETING CALLED FOR SUCH PURPOSE.
ORGANIZATION'S PROCESS USED TO REVIEW FORM 990	FORM 990, PAGE 6, PART VI, LINE 11B	ALL OFFICERS AND DIRECTORS WERE ELECTRONICALLY PROVIDED A FINAL COPY OF THE FORM 990 PRIOR TO FILING THE RETURN WITH THE IRS. AN EXECUTIVE SUMMARY OF THE INFORMATION REPORTED ON THE RETURN IS PROVIDED TO ASSIST IN THE REVIEW. IN ACCORDANCE WITH THE GEISINGER HEALTH SYSTEM FOUNDATION BOARD OF DIRECTOR'S FINANCE COMMITTEE CHARTER, STAFF PERIODICALLY REVIEWS THE GHS ORGANIZATIONS' FORM 990 FILINGS. THE FORM 990 IS PREPARED BY THE GEISINGER HEALTH SYSTEM (GHS) TAX AND FINANCIAL REPORTING DEPARTMENTS WITH INFORMATION PROVIDED FROM FINANCE, TAX, HUMAN RESOURCES, LEGAL SERVICES AND OTHER RELEVANT DEPARTMENTS WITHIN THE GEISINGER HEALTH SYSTEM. THE CHIEF FINANCIAL OFFICER (CFO) OF GHS AND THE INDIVIDUAL ORGANIZATIONS SENIOR FINANCIAL MANAGERS REVIEW THEIR RESPECTIVE FORM 990 PRIOR TO MAKING THE FINAL RETURN AVAILABLE TO THE BOARD. IN ADDITION, THE CHIEF LEGAL OFFICER AND CHIEF HUMAN RESOURCE OFFICER OF GHS REVIEW THE INFORMATION DISCLOSED ON THE FORM 990 RELEVANT TO THEIR RESPECTIVE AREAS OF RESPONSIBILITY. FOR PURPOSES OF THEIR ANNUAL AUDIT OF THE GHS CONSOLIDATED FINANCIAL STATEMENTS, INDEPENDENT AUDITORS REVIEW ALL FEDERAL TAX RETURNS FILED BY THE GHS ORGANIZATIONS TO IDENTIFY MATERIAL ITEMS, INCLUDING IF THERE ARE ANY UNCERTAIN TAX POSITIONS THAT MAY BE REQUIRED TO BE RECOGNIZED. THE COMPANY HAD NO UNCERTAIN TAX POSITIONS REQUIRED TO BE REPORTED FOR FISCAL YEAR.
ENFORCEMENT OF CONFLICTS POLICY	FORM 990, PAGE 6, PART VI, LINE 12C	THE OFFICERS AND DIRECTORS OF THE ORGANIZATION ARE SUBJECT TO THE GHS CONFLICT OF INTEREST POLICY FOR DIRECTORS, OFFICERS AND SENIOR LEADERS (MAY INCLUDE INDEPENDENT CONTRACTORS). AT LEAST ONCE EACH YEAR DIRECTORS, OFFICERS, KEY EMPLOYEES, SENIOR LEADERS (INCLUDING INDEPENDENT CONTRACTORS) AND OTHERS DESIGNATED BY THE BOARD OF DIRECTORS ARE REQUIRED TO DISCLOSE IN WRITING THE EXISTENCE OF ANY POTENTIAL FINANCIAL INTERESTS THAT MAY GIVE RISE TO A CONFLICT OF INTEREST WITH ANY AFFILIATE WITHIN THE GEISINGER HEALTH SYSTEM. THE DISCLOSURES ARE REVIEWED BY THE OFFICE OF THE CHIEF LEGAL OFFICER AND REPORTED TO THE AUDIT COMMITTEE AND BOARD OF DIRECTORS. AFTER REVIEW OF THE FINANCIAL INTEREST AND ALL MATERIAL FACTS, INPUT FROM DEPARTMENT OF LEGAL SERVICES AND ANY DISCUSSION WITH THE PERSON DESIRED BY THE BOARD OR COMMITTEE, THE BOARD DECIDES IF A CONFLICT EXISTS AND TAKES APPROPRIATE ACTION. THE INDIVIDUAL DISCLOSING THE FINANCIAL INTEREST IS ABSENT DURING THE BOARD DELIBERATIONS AND DECISIONS ON THE MATTER.
COMPENSATION PROCESS FOR TOP OFFICIAL	FORM 990, PAGE 6, PART VI, LINE 15A	THE PROCESS TO REVIEW AND APPROVE THE COMPENSATION OF GHS EMPLOYED BOARD DIRECTORS, OFFICERS AND EXECUTIVE MANAGEMENT IS DESIGNED TO SATISFY THE REBUTTABLE PRESUMPTION PROCEDURE AVAILABLE FOR INTERMEDIATE SANCTION PURPOSES. THE PROCESS REQUIRES A REVIEW OF COMPENSATION DETERMINATIONS BY DISINTERESTED PARTIES, USE OF APPROPRIATE COMPARABILITY DATA AND CONTEMPORANEOUS DOCUMENTATION OF THE PROCESS. ON AN ANNUAL BASIS AN INDEPENDENT, NATIONALLY RECOGNIZED COMPENSATION CONSULTANT COMPLETES A COMPARATIVE ASSESSMENT OF COMPENSATION FOR THE CEO AND SENIOR MANAGEMENT WITHIN GHS. THE CONSULTANT'S REPORT IS PRESENTED TO THE MANAGEMENT AND COMPENSATION COMMITTEE PRIOR TO ANY COMPENSATION ADJUSTMENT. THE REPORT SUPPORTS THE RIGOROUS REVIEW COMPLETED BY THE MANAGEMENT AND COMPENSATION COMMITTEE TO ENSURE THAT THE PROGRAM IS RESPONSIBLE TO THE GEISINGER CHARITABLE MISSION, REFLECTS REASONABLE COMPENSATION WITHIN THE NONPROFIT MARKET AND IS COMPLIANT WITH THE IRS'S INTERMEDIATE SANCTION REQUIREMENTS. THE SURVEY DATA IN THE COMPARATIVE ANALYSIS IS CAPTURED FOR FUNCTIONALLY COMPARABLE POSITIONS IN MULTIPLE SIMILAR NONPROFIT ORGANIZATIONS AND REFLECTS TOTAL REMUNERATION PROVIDED IN THE MARKET. ALL SURVEYS ARE CONDUCTED BY THIRD PARTY ORGANIZATIONS AND NOT CONDUCTED AT THE SPECIFIC DIRECTION OF GEISINGER. ANY COMPENSATION ADJUSTMENTS ARE APPROVED BY MANAGEMENT AND COMPENSATION COMMITTEE PRIOR TO THE EFFECTIVE DATE OF THE PAYMENT. THE MANAGEMENT AND COMPENSATION COMMITTEE AT ITS SOLE DISCRETION MAY POSITIVELY OR NEGATIVELY ADJUST ANY RECOMMENDED COMPENSATION.
COMPENSATION PROCESS FOR OFFICERS	FORM 990, PAGE 6, PART VI, LINE 15B	SEE SCHEDULE O RESPONSE TO FORM 990, PART VI, SECTION B, QUESTION 15A.
GOVERNING DOCUMENTS DISCLOSURE EXPLANATION	FORM 990, PAGE 6, PART VI, LINE 19	THE MISSION STATEMENT IS AVAILABLE ON THE GEISINGER HEALTH SYSTEM WEBSITE AT WWW.GEISINGER.ORG. THE ANNUAL REPORT FOR GEISINGER HEALTH SYSTEM, CONTAINING COMMUNITY BENEFIT INFORMATION, CONSOLIDATED FINANCIAL INFORMATION AND OTHER INFORMATION, ARE AVAILABLE ON THE GEISINGER HEALTH SYSTEM WEBSITE. GO TO: WWW.GEISINGER.ORG/ABOUT/MISSION.HTML AND SELECT 2013 ANNUAL REPORT. FINANCIAL STATEMENTS, THE COMPLETE FORM 990 AND FORM 990-T, THE CONFLICTS OF INTEREST POLICY, AND OTHER GOVERNING DOCUMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST.
OTHER CHANGES IN NET ASSETS EXPLANATION	FORM 990, PART XI, LINE 9	+ PENSION LIABILITY DECREASE 170,334 + TRANSFER FROM MALPRACTICE TRUST 1,943,522 + ENDOWMENT FUND GAINS 434,557 + TEMPORARILY RESTRICTED CONTRIBUTIONS 51,067 + TEMPORARILY RESTRICTED INTEREST INCOME 230 + TRANSFER FROM GHSF 9,474,373 - ACQUISITION ACCOUNTING-SEE EXPLANATION BELOW 9,120,596 - TRANSFER TO RRG 1,000 - MALPRACTICE TRUST FUNDING 302,000 TOTAL OTHER CHANGES 2,650,487 EFFECTIVE JULY 1, 2012, GEISINGER-BLOOMSBURG HOSPITAL ("GBH") AND ITS RELATED ENTITIES (GEISINGER-BLOOMSBURG HEALTHCARE CENTER ("GBHCC"), BLOOMSBURG PHYSICIANS SERVICES ("BPS"), COLUMBIA MONTOUR HOME HEATH SERVICES ("CMHHS") AND THE BLOOMSBURG HOSPITAL MEDICAL PROFESSIONAL LIABILITY SELF-INSURANCE TRUST ("BSIT")) MERGED WITH GEISINGER HEALTH SYSTEM. AS PART OF THAT MERGER, GBH EVALUATED ALL ASSETS AND LIABILITIES AND ADJUSTED TO FAIR MARKET VALUES.
ADDITIONAL INFORMATION	FORM 990, PART XII	FORM 990, PART XII, LINE 3A: AS A RESULT OF A FEDERAL AWARD, WAS THE ORGANIZATION REQUIRED TO UNDERGO AN AUDIT OR AUDITS AS SET FORTH IN THE AUDIT ACT OR OMB CIRCULAR A-133? FEDERAL AWARDS ARE AUDITED AS A PART OF THE GEISINGER HEALTH SYSTEM'S CONSOLIDATED REPORT ON FEDERAL AWARDS IN ACCORDANCE WITH OMB CIRCULAR A-133. FOOTNOTE: THROUGHOUT THE FORM 990, THE TERMS "GEISINGER HEALTH SYSTEM" AND SYSTEM OR THE ACRONYM "GHS" SHALL REFER TO THE ENTIRE HEALTHCARE SYSTEM COMPRISED OF GEISINGER HEALTH SYSTEM FOUNDATION ("THE FOUNDATION") AS PARENT AND ALL SUBSIDIARY CORPORATIONS COMPRISING THE SYSTEM.
CHANGE IN FINANCIAL REVIEW PROCESS	FORM 990, PAGE 12, PART XII, LINE 2C	EFFECTIVE JULY 1, 2012, GEISINGER-BLOOMSBURG HOSPITAL WAS INTEGRATED INTO THE GEISINGER HEALTH SYSTEM. AS A RESULT OF THAT INTEGRATION, THE GEISINGER HEALTH SYSTEM FORM 990 REVIEW PROCESS, AS DESCRIBED IN THE SCHEDULE O RESPONSE TO FORM 990 PART VI, LINE 11B, WAS IMPLEMENTED. IN ADDITION, THE GEISINGER HEALTH SYSTEM AUDIT COMMITTEE IS NOW RESPONSIBLE FOR THE OVERSIGHT OF THE CONSOLIDATED AUDIT AND SELECTION OF THE INDEPENDENT AUDITORS.

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2012

Additional Data

Software ID:
Software Version:

- 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

GEISINGER-BLOOMSBURG HOSPITAL

Employer identification number

23-2193572

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) GEISNGER HEALTH SYSTEM FOUNDATION 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822 23-1995911	PHILANTHOP	PA	501C3	7	N/A	Yes
(2) GEISINGER MEDICAL CENTER 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822 24-0795959	HOSPITAL	PA	501C3	3	GHSF	Yes
(3) GEISINGER CLINIC 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822 23-6291113	PHYS SVCS	PA	501C3	11A	GHSF	Yes
(4) GEISINGER WYOMING VALLEY MED CTR 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822 23-1996150	HOSPITAL	PA	501C3	3	GHSF	Yes
(5) MARWORTH 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822 23-2171417	D&A REHAB	PA	501C3	3	GHSF	Yes
(6) GEISINGER HEALTH PLAN 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822 23-2311553	HEALTH INS	PA	501C4		GHSF	Yes
(7) HERSHEY MEDICAL CENTER 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822 23-2891807	HOSPITAL	PA	501C3	3	GHSF	Yes
(8) GEISINGER SYSTEM SERVICES 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822 23-2164794	SUPPORT SV	PA	501C3	11A	GHSF	Yes
(9) GEISINGER COMMUNITY HEALTH SERVICES 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822 23-2967235	HEALTHCARE	PA	501C3	9	GSS	Yes
(10) GEISINGER INSURANCE CORPORATIONRRG 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822 14-1909894	SELF INS	VT	501C3	11A	GHSF	Yes
(11) GEISINGER MED CTR PROF LIAB TRUST 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822 25-6220019	SELF INS	PA	501C3	11A	GMC	Yes
(12) GEISINGER EXCESS COV PROF LIAB TR 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822 23-6852932	SELF INS	PA	501C3	11A	GMC	Yes
(13) COMMUNITY MEDICAL CENTER 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822 24-0862246	HOSPITAL	PA	501C3	3	GHSF	Yes
(14) COMMUNITY MEDICAL CARE INC 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822 23-2429776	PHYS SVCS	PA	501C3	9	GHSF	Yes
(15) MEDICAL DIMENSIONS INC 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822 23-2369788	HOLDING CO	PA	501C2		GHSF	Yes
(16) CMC HEALTHCARE SYS MED PROF LIAB TR 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822 04-6990600	SELF INS	PA	501C3	11A	GHSF	Yes
(17) MOUNTAIN VIEW NURSING HOME INC 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822 23-2568288	LONG TERM	PA	501C3	9	GHSF	Yes
(18) COMMUNITY MEDICAL CTR HEALTHCARE SY 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822 23-2279376	SUPPORT SV	PA	501C3	11A	GHSF	Yes
(19) NORTHEAST CANCER CENTER INC 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822 20-1687320	HEALTHCARE	PA	501C3	3	NA	Yes
(20) HEALTH CARE CORP OF NORTHEAST PA 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822 23-2337286	SUPPORT SV	PA	501C3	11A	NA	Yes
(21) BLOOMSBURG PHYSICIANS SERVICES 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822 23-2979856	PHYS SVCS	PA	501C3	3	GHSF	Yes
(22) GEISINGER-BLOOMSBURG HEALTHCARE CTR 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822 23-2242854	SKLD NURSE	PA	501C3	9	GHSF	Yes
(23) COLUMBIA-MONTOUR HOME HEALTH SVC 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822 23-1704399	HOME HLTH	PA	501C3	9	GHSF	Yes
(24) BLOOMSBURG HOSP MED PROF LIAB TRUST 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822 14-6222837	SELF INS	PA	501C3	11B	GHSF	Yes

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

Cat. No. 50135Y

Schedule R (Form 990) 2012

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
(1) KEYSTONE ACCOUNTABLE CARE ORG LLC 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822 45-4475297	ACO	PA	N/A				No			No
(2) LIFESOURCE GEISINGER BLOOD CTR LLC 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822 36-4718005	BLOOD COLL	PA	N/A				No			No
(3) MERIDIAN GEISINGER HLTH NTWRK LLC 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822 45-5484165	ORG DL SYS	NJ	N/A				No			No
(4) HEALTHSOUTH GHS LLC 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822 72-1398803	PHY THERAP	PA	N/A				No			No
(5) EVANGELICAL-GEISINGER HEALTH LLC 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822 46-0567687	HEALTHCARE	PA	N/A				No			No
(6) GEISINGER-SCA HOLDINGS LLC 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822 46-1615328	HOLDING CO	DE	N/A				No			No
(7) LACKAWANNA PHYSICIANS AMB SURG CTR 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822 23-3024998	HEALTHCARE	PA	N/A				No			No
(8) KEYSTONE ACCOUNTABLE CARE ORG LLC 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822 45-4475297	ACO	PA	N/A				No			No
(9) LIFESOURCE GEISINGER BLOOD CTR LLC 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822 36-4718005	BLOOD COLL	PA	N/A				No			No
(10) MERIDIAN GEISINGER HLTH NTWRK LLC 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822 45-5484165	ORG DL SYS	NJ	N/A				No			No
(11) HEALTHSOUTH GHS LLC 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822 72-1398803	PHY THERAP	PA	N/A				No			No
(12) EVANGELICAL-GEISINGER HEALTH LLC 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822 46-0567687	HEALTHCARE	PA	N/A				No			No
(13) GEISINGER-SCA HOLDINGS LLC 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822 46-1615328	HOLDING CO	DE	N/A				No			No
(14) LACKAWANNA PHYSICIANS AMB SURG CTR 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822 23-3024998	HEALTHCARE	PA	N/A				No			No

Part IV

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(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) GEISINGER MEDICAL MANAGEMENT CORP 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822 23-2077663	HOTEL/REST	PA	N/A				Yes
(2) INTERNATIONAL SHARED SERVICES INC 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822 23-2159597	COMPUTER	PA	N/A				Yes
(3) GEISINGER INDEMNITY INSURANCE COMP 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822 23-2815174	HLTH INSUR	PA	N/A				Yes
(4) GEISINGER QUALITY OPTIONS INC 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822 20-4275139	HLTH INSUR	PA	N/A				Yes
(5) GEISINGER ASSURANCE COMPANY LTD PO BOX 2196GT GRAND CAYMAN CJ 98-1016737	INSURANCE	CJ	N/A				Yes
(6) XG HEALTH SOLUTIONS INC 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822 46-1657345	CONSULTING	DE	N/A				Yes
(7) GEISINGER MEDICAL MANAGEMENT CORP 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822 23-2077663	HOTEL/REST	PA	N/A				Yes
(8) INTERNATIONAL SHARED SERVICES INC 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822 23-2159597	COMPUTER	PA	N/A				Yes
(9) GEISINGER INDEMNITY INSURANCE COMP 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822 23-2815174	HLTH INSUR	PA	N/A				Yes
(10) GEISINGER QUALITY OPTIONS INC 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822 20-4275139	HLTH INSUR	PA	N/A				Yes
(11) GEISINGER ASSURANCE COMPANY LTD PO BOX 2196GT GRAND CAYMAN CJ 98-1016737	INSURANCE	CJ	N/A				Yes
(12) XG HEALTH SOLUTIONS INC 100 NORTH ACADEMY AVENUE MC 49-70 DANVILLE,PA17822 46-1657345	CONSULTING	DE	N/A				Yes

Schedule R (Form 990) 2012

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

Yes

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

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

Yes

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

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) . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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) . . . . . . . . . . . . . . . . . . . .

Yes

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) . . . . . . . . . . . . . . . . . . . . .

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

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

Yes

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

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
(1) BLOOMSBURG HOSP MED PROF LIAB TRUST	S	2,131,801	FMV
(2) BLOOMSBURG PHYSICIANS SERVICES	M	114,193	FMV
(3) BLOOMSBURG PHYSICIANS SERVICES	A	99,519	FMV
(4) BLOOMSBURG PHYSICIANS SERVICES	L	74,903	FMV
(5) COLUMBIA MONTOUR HOME HEALTH SVC	A	158,283	FMV
(6) GEISINGER ASSURANCE COMPANY LTD	M	321,204	FMV
(7) GEISINGER BLOOMSBURG HEALTHCARE CTR	L	88,299	FMV
(8) GEISINGER CLINIC	P	618,510	FMV
(9) GEISINGER CLINIC	A	422,078	FMV
(10) GEISINGER CLINIC	L	1,279,458	FMV
(11) GEISINGER COMMUNITY HEALTH SERVICES	A	5,775	FMV
(12) GEISINGER HEALTH PLAN	M	1,734,649	FMV
(13) GEISINGER HEALTH PLAN	L	5,198,107	FMV
(14) GEISINGER HEALTH SYSTEM FOUNDATION	C	25,795,851	GAAP
(15) GEISINGER INDEMNITY INSURANCE COMPA	L	249,147	FMV
(16) GEISINGER INSURANCE CORPORATION RRG	M	1,430,000	FMV
(17) GEISINGER MEDICAL CENTER	P	100,908	FMV
(18) GEISINGER MEDICAL MANAGEMENT CORP	M	194,190	FMV
(19) GEISINGER QUALITY OPTIONS INC	L	700,210	FMV
(20) GEISINGER SYSTEM SERVICES	P	611,210	FMV
(21) GEISINGER WYOMING VALLEY MED CTR	M	176,460	FMV
(22) HEALTHSOUTH GHS LLC	A	18,150	FMV
(23) INTERNATIONAL SHARED SERVICES INC	M	268,319	FMV
(24) GEISINGER HEALTH SYSTEM FOUNDATION	C	9,500,510	FMV
(25) GEISINGER HEALTH SYSTEM FOUNDATION	S	7,950	FMV
(26) BLOOMSBURG HOSP MED PROF LIAB TRUST	S	2,131,801	FMV
(27) BLOOMSBURG PHYSICIANS SERVICES	M	114,193	FMV
(28) BLOOMSBURG PHYSICIANS SERVICES	A	99,519	FMV
(29) BLOOMSBURG PHYSICIANS SERVICES	L	74,903	FMV
(30) COLUMBIA MONTOUR HOME HEALTH SVC	A	158,283	FMV
(31) GEISINGER ASSURANCE COMPANY LTD	M	321,204	FMV
(32) GEISINGER BLOOMSBURG HEALTHCARE CTR	L	88,299	FMV
(33) GEISINGER CLINIC	P	618,510	FMV
(34) GEISINGER CLINIC	A	422,078	FMV
(35) GEISINGER CLINIC	L	1,279,458	FMV
(36) GEISINGER COMMUNITY HEALTH SERVICES	A	5,775	FMV
(37) GEISINGER HEALTH PLAN	M	1,734,649	FMV
(38) GEISINGER HEALTH PLAN	L	5,198,107	FMV
(39) GEISINGER HEALTH SYSTEM FOUNDATION	C	25,795,851	GAAP
(40) GEISINGER INDEMNITY INSURANCE COMPA	L	249,147	FMV
(41) GEISINGER INSURANCE CORPORATION RRG	M	1,430,000	FMV
(42) GEISINGER MEDICAL CENTER	P	100,908	FMV
(43) GEISINGER MEDICAL MANAGEMENT CORP	M	194,190	FMV
(44) GEISINGER QUALITY OPTIONS INC	L	700,210	FMV
(45) GEISINGER SYSTEM SERVICES	P	611,210	FMV
(46) GEISINGER WYOMING VALLEY MED CTR	M	176,460	FMV
(47) HEALTHSOUTH GHS LLC	A	18,150	FMV
(48) INTERNATIONAL SHARED SERVICES INC	M	268,319	FMV
(49) GEISINGER HEALTH SYSTEM FOUNDATION	C	9,500,510	FMV
(50) GEISINGER HEALTH SYSTEM FOUNDATION	S	7,950	FMV
(51) BLOOMSBURG HOSP MED PROF LIAB TRUST	S	2,131,801	FMV
(52) BLOOMSBURG PHYSICIANS SERVICES	M	114,193	FMV
(53) BLOOMSBURG PHYSICIANS SERVICES	A	99,519	FMV
(54) BLOOMSBURG PHYSICIANS SERVICES	L	74,903	FMV
(55) COLUMBIA MONTOUR HOME HEALTH SVC	A	158,283	FMV
(56) GEISINGER ASSURANCE COMPANY LTD	M	321,204	FMV
(57) GEISINGER BLOOMSBURG HEALTHCARE CTR	L	88,299	FMV
(58) GEISINGER CLINIC	P	618,510	FMV
(59) GEISINGER CLINIC	A	422,078	FMV
(60) GEISINGER CLINIC	L	1,279,458	FMV
(61) GEISINGER COMMUNITY HEALTH SERVICES	A	5,775	FMV
(62) GEISINGER HEALTH PLAN	M	1,734,649	FMV
(63) GEISINGER HEALTH PLAN	L	5,198,107	FMV
(64) GEISINGER HEALTH SYSTEM FOUNDATION	C	25,795,851	GAAP
(65) GEISINGER INDEMNITY INSURANCE COMPA	L	249,147	FMV
(66) GEISINGER INSURANCE CORPORATION RRG	M	1,430,000	FMV
(67) GEISINGER MEDICAL CENTER	P	100,908	FMV
(68) GEISINGER MEDICAL MANAGEMENT CORP	M	194,190	FMV
(69) GEISINGER QUALITY OPTIONS INC	L	700,210	FMV
(70) GEISINGER SYSTEM SERVICES	P	611,210	FMV
(71) GEISINGER WYOMING VALLEY MED CTR	M	176,460	FMV
(72) HEALTHSOUTH GHS LLC	A	18,150	FMV
(73) INTERNATIONAL SHARED SERVICES INC	M	268,319	FMV
(74) GEISINGER HEALTH SYSTEM FOUNDATION	C	9,500,510	FMV
(75) GEISINGER HEALTH SYSTEM FOUNDATION	S	7,950	FMV
(76) BLOOMSBURG HOSP MED PROF LIAB TRUST	S	2,131,801	FMV
(77) BLOOMSBURG PHYSICIANS SERVICES	M	114,193	FMV
(78) BLOOMSBURG PHYSICIANS SERVICES	A	99,519	FMV
(79) BLOOMSBURG PHYSICIANS SERVICES	L	74,903	FMV
(80) COLUMBIA MONTOUR HOME HEALTH SVC	A	158,283	FMV
(81) GEISINGER ASSURANCE COMPANY LTD	M	321,204	FMV
(82) GEISINGER BLOOMSBURG HEALTHCARE CTR	L	88,299	FMV
(83) GEISINGER CLINIC	P	618,510	FMV
(84) GEISINGER CLINIC	A	422,078	FMV
(85) GEISINGER CLINIC	L	1,279,458	FMV
(86) GEISINGER COMMUNITY HEALTH SERVICES	A	5,775	FMV
(87) GEISINGER HEALTH PLAN	M	1,734,649	FMV
(88) GEISINGER HEALTH PLAN	L	5,198,107	FMV
(89) GEISINGER HEALTH SYSTEM FOUNDATION	C	25,795,851	GAAP
(90) GEISINGER INDEMNITY INSURANCE COMPA	L	249,147	FMV
(91) GEISINGER INSURANCE CORPORATION RRG	M	1,430,000	FMV
(92) GEISINGER MEDICAL CENTER	P	100,908	FMV
(93) GEISINGER MEDICAL MANAGEMENT CORP	M	194,190	FMV
(94) GEISINGER QUALITY OPTIONS INC	L	700,210	FMV
(95) GEISINGER SYSTEM SERVICES	P	611,210	FMV
(96) GEISINGER WYOMING VALLEY MED CTR	M	176,460	FMV
(97) HEALTHSOUTH GHS LLC	A	18,150	FMV
(98) INTERNATIONAL SHARED SERVICES INC	M	268,319	FMV
(99) GEISINGER HEALTH SYSTEM FOUNDATION	C	9,500,510	FMV
(100) GEISINGER HEALTH SYSTEM FOUNDATION	S	7,950	FMV
(101) BLOOMSBURG HOSP MED PROF LIAB TRUST	S	2,131,801	FMV
(102) BLOOMSBURG PHYSICIANS SERVICES	M	114,193	FMV
(103) BLOOMSBURG PHYSICIANS SERVICES	A	99,519	FMV
(104) BLOOMSBURG PHYSICIANS SERVICES	L	74,903	FMV
(105) COLUMBIA MONTOUR HOME HEALTH SVC	A	158,283	FMV
(106) GEISINGER ASSURANCE COMPANY LTD	M	321,204	FMV
(107) GEISINGER BLOOMSBURG HEALTHCARE CTR	L	88,299	FMV
(108) GEISINGER CLINIC	P	618,510	FMV
(109) GEISINGER CLINIC	A	422,078	FMV
(110) GEISINGER CLINIC	L	1,279,458	FMV
(111) GEISINGER COMMUNITY HEALTH SERVICES	A	5,775	FMV
(112) GEISINGER HEALTH PLAN	M	1,734,649	FMV
(113) GEISINGER HEALTH PLAN	L	5,198,107	FMV
(114) GEISINGER HEALTH SYSTEM FOUNDATION	C	25,795,851	GAAP
(115) GEISINGER INDEMNITY INSURANCE COMPA	L	249,147	FMV
(116) GEISINGER INSURANCE CORPORATION RRG	M	1,430,000	FMV
(117) GEISINGER MEDICAL CENTER	P	100,908	FMV
(118) GEISINGER MEDICAL MANAGEMENT CORP	M	194,190	FMV
(119) GEISINGER QUALITY OPTIONS INC	L	700,210	FMV
(120) GEISINGER SYSTEM SERVICES	P	611,210	FMV
(121) GEISINGER WYOMING VALLEY MED CTR	M	176,460	FMV
(122) HEALTHSOUTH GHS LLC	A	18,150	FMV
(123) INTERNATIONAL SHARED SERVICES INC	M	268,319	FMV
(124) GEISINGER HEALTH SYSTEM FOUNDATION	C	9,500,510	FMV
(125) GEISINGER HEALTH SYSTEM FOUNDATION	S	7,950	FMV

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 INFORMATION	SCHEDULE R	INFORMATION REGARDING TRANSFERS TO AND FROM CONTROLLED ORGANIZATIONS GEISINGERBLOOMSBURG HOSPITAL IS CLOSELY AFFILIATED WITH SEVERAL OTHER ORGANIZATIONS IN THE NORMAL COURSE OF THE OPERATIONS OF THESE AFFILIATED ORGANIZATIONS THERE ARE NUMEROUS INTERORGANIZATIONAL TRANSACTIONS WHICH MAY INCLUDE SALES EXCHANGES AND LEASES OF PROPERTY EXTENSIONS OF CREDIT FURNISHING OF GOODS SERVICES AND FACILITIES AND TRANSFERS OF ASSETS THESE TYPES OF INTERORGANIZATIONAL TRANSACTIONS WERE DESCRIBED TO THE INTERNAL REVENUE SERVICE IN A RULING APPLICATION AND WERE RECOGNIZED BY THE NATIONAL OFFICE OF THE IRS IN A SERIES OF PRIVATE LETTER RULINGS AS BEING ENTIRELY CONSISTENT WITH THE ORGANIZATIONS TAX EXEMPT STATUS

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: GEISINGER-BLOOMSBURG HOSPITAL IS COMMITTED TO PROVIDING EXCEPTIONAL INPATIENT, OUTPATIENT AND EMERGENCY CARE SERVICES FOR RESIDENTS OF BLOOMSBURG, PA AND THE SURROUNDING AREAS...SEE SCHEDULE O
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	10
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	9
5	Total number of individuals employed in calendar year 2011 (Part V, line 2a) ......	5	542
6	Total number of volunteers (estimate if necessary) .............	6	78
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

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	167,545	42,504
9	Program service revenue (Part VIII, line 2g) .........	38,800,903	32,121,758
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	-68,087	145,251
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	905,442	358,827
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	39,805,803	32,668,340
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...		300
14	Benefits paid to or for members (Part IX, column (A), line 4).....		0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	20,791,644	19,825,007
16a	Professional fundraising fees (Part IX, column (A), line 11e).....		0
b	Total fundraising expenses (Part IX, column (D), line 25) 38,844
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	22,277,637	16,605,045
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	43,069,281	36,430,352
19	Revenue less expenses. Subtract line 18 from line 12.......	-3,263,478	-3,762,012
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	30,101,308	27,824,618
21	Total liabilities (Part X, line 26).............	38,859,052	37,693,887
22	Net assets or fund balances. Subtract line 21 from line 20.....	-8,757,744	-9,869,269

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 31,452,042 including grants of $ 300 ) (Revenue $ 31,470,796 )
	TO OPERATE A 72 BED GENERAL MEDICAL AND SURGICAL HOSPITAL WHICH PROVIDED 5,733 PATIENT DAYS; 3,292 BEHAVIOR HEALTH SERVICES PATIENT DAYS; 526 NURSERY PATIENT DAYS; 2,058 SANE DAY SURGICAL PROCEDURES; 14,051 EMERGENCY ROOM VISITS DURIGN THE YEAR ENDED JUNE 30, 2013. THE ORGANIZATION ALSO PROVIDED CHARTIY CARE TO PATIENTS WHO MET CERTAIN CRITERIA WITHOUT CHARGE OR AT AMOUNTS LESS THAN ESTABLISHED RATES. SEE SCHEDULE O I. MISSION: GEISINGER-BLOOMSBURG HOSPITAL IS COMMITTED TO PROVIDING EXCEPTIONAL INPATIENT, OUTPATIENT AND EMERGENCY CARE SERVICES FOR RESIDENTS OF BLOOMSBURG, PA AND THE SURROUNDING AREAS. THE ORGANIZATION PROMOTES, RESTORES, AND MAINTAINS COMMUNITY HEALTH THROUGH A FULLY INTEGRATED HEALTH SYSTEM AND PROVIDES A VARIETY OF SERVICES. II.GENERAL INFORMATION GEISINGER-BLOOMSBURG HOSPITAL(GBH), A 501(C)(3) NOT-FOR-PROFIT CORPORATION AND MEMBER OF GEISINGER HEALTH SYSTEM, OWNS AND OPERATES A 72 BED, ACUTE CARE, HOSPITAL IN BLOOMSBURG, PA. GBH IS CONVENIENTLY LOCATED ONLY A FEW MILES FROM SEVERAL MAJOR HIGHWAYS THROUGHOUT CENTRAL PA. THE FACILITY OPENED IN 1905, ANSWERING A PRESSING NEED FOR HEALTH AND WELLNESS CARE IN THE COMMUNITY. GBH PROVIDES QUALITY MEDICAL HEALTHCARE REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE, OR ABILITY TO PAY. SERVICES OFFERED BY GBH INCLUDE: GENERAL MEDICAL CARE PROVIDED BY INHOUSE HOSPITALIST AND SUPPORTED BY CONSULTATIVE SERVICES IN THE AREAS OF CARDIOLOGY,NEUROLOGY AND PULMONOLOGY. EMERGENCY DEPARTMENT IS COMMITTED TO PROVIDING HIGH QUALITY, PROMPT EMERGENCY SERVICES. GBH'S ED IS STAFFED 24/7 WITH FULL-TIME PHYSICIANS AND NURSES THAT ARE TRAINED IN ALL SPECIALTIES FROM PEDIATRICS TO CRITICAL CARE. IMMEDIATE ACCESS TO LABORATORY SERVICES, X-RAYS, CAT SCANS, 3D-4D ULTRASOUND, MRI AND SURGICAL SERVICES. ON AVERAGE PATIENTS IN THE EMERGENCY DEPARTMENT ARE TREATED AND RELEASED WITHIN 90 MINUTES. MOST INSURANCES, INCLUDING MEDICARE AND MEDICAID, ARE ACCEPTED AND NO PATIENT IS REFUSED TREATMENT BECAUSE OF INABILITY TO PAY. OB/GYN FOCUSES ON ALL ASPECTS OF WOMEN'S HEALTH AND EDUCATION, PROVIDING OBSTETRICAL AND GYNECOLOGICAL CARE FOR WOMEN OF ALL AGES. SERVICES INCLUDE BUT NOT LIMITED TO ROUTINE VISITS AND TREATMENTS, PREVENTATIVE HEALTHCARE, BIRTH CONTROL EDUCATION, FAMILY PLANNING, OBSTETRICS, SURGERY & SURGERY CONSULTATIONS, MENOPAUSE COUNSELING, AND MIDWIFERY. MENTAL HEALTH & PSYCHIATRIC SERVICES IS A DESIGNATED COUNT 302 TRIAGE SITE THAT PROVIDES BOTH INPATIENT AND OUTPATIENT SERVICES DESIGNED TO HELP INDIVIDUALS LIVE AS INDEPENDENTLY AS POSSIBLE. ALL AGE GROUPS FROM ADOLESCENTS TO GERIATRICS CAN ACCESS QUICK, EFFICIENT ADMISSION 24/7 AND RECEIVE TREATMENT THROUGH ONE-ON-ONE PATIENT COUNSELING, TREATMENT MEETINGS 5 DAYS PER WEEK, AND A PSYCHIATRIST AVAILABLE ON A DAILY BASIS. SUBSTANCE ABUSE COUNSELING IS ALSO AVAILABLE INCLUDING RELAPSE PREVENTION TEAM MEETINGS. ADMISSIONS ARE CONFIDENTIAL AND MAY BE MADE BY PROFESSIONALS AS WELL BY INDIVIDUALS CONCERNED ABOUT THEMSELVES OR OTHERS. HOSPITALIZATION MEANS PATIENT CARE IS PROVIDED THROUGH MULTIPLE PROFESSIONALS WHO COMPRISE THE TREATMENT TEAM. OTHER SERVICES INCLUDE: CARDIAC SERVICES SURGERY SPECIALTIES RADIOLOGY ORTHOPEDIC ICCU UROLOGY LABORATORY SERVICES GYNOCOLOGY PHYSICAL THERAPY OTOLARYNGOLOGY RESPIRATORY SERVICES GENERAL SURGERY III. UNCOMPENSATED CARE GEISINGER-BLOOMSBURG HOSPITAL RECOGNIZES ITS MISSION IS TO SERVE ALL MEMBERS OF THE COMMUNITY WITH RESPECT TO THE PROVISION OF HEALTHCARE SERVICES AND EDUCATION. IN THIS REGARD, GBH PROVIDES FREE OR SUBSIDIZED CARE BELOW COST AND SUPPORTS VARIOUS HEALTH-RELATED ACTIVITIES AND PROGRAMS IN SUPPORT OF THE COMMUNITY. A.CHARITY CARE THE PRIMARY CONCERN OF GBH IS THE DELIVERY OF HEALTH CARE TO ALL CITIZENS OF CENTRAL PENNSYLVANIA REGARDLESS OF THEIR ABILITY TO PAY. THE UNREIMBURSED COST OF CHARITY CARE REPRESENTS THE COST GBH INCURS BY PROVIDING FREE OR DISCOUNTED SERVICES TO THOSE WHO CANNOT AFFORD TO PAY. FOR THE FISCAL YEAR ENDED JUNE 30, 2013, THE COST OF THE CHARITY CARE WAS 225 THOUSAND. B.MEDICARE/MEDICAID IN RECOGNIZING ITS MISSION TO THE COMMUNITY, GBH PROVIDES SERVICES TO THE ELDERLY (MEDICARE) AND THE INDIGENT (MEDICAID). GBH PROVIDES CARE, BELOW COST, TO PERSONS COVERED BY THESE GOVERNMENTAL PROGRAMS TO THE EXTENT THE GOVERNMENT REIMBURSEMENT IS BELOW THE COST OF PROVIDING HEALTH CARE. THE UNREIMBURSED VALUE OF MEDICARE AND/OR MEDICAID IS EQUAL TO THE COST OF PROVIDING SERVICES LESS THE AMOUNT RECEIVED AS REIMBURSEMENT UNDER THE PROGRAM. THE COST OF PROVIDING HEALTHCARE SERVICES TO MEDICARE AND MEDICAID PATIENTS EXCEEDED REIMBURSEMENT BY APPROXIMATELY 5.3 MILLION DURING THE FISCAL YEAR ENDED JUNE 30, 2013. C.OTHER UNCOMPENSATED PATIENT SERVICES IN ADDITION, GBH PROVIDES SERVICES FOR WHICH FULL PAYMENT IS NOT RECEIVED. THE UNCOMPENSATED COST OF PROVIDING SUCH PATIENT SERVICES DURING THE FISCAL YEAR ENDED JUNE 30, 2013, WAS 664 THOUSAND. IV. VOLUNTEER SERVICES THE VOLUNTEERS OF GEISINGER-BLOOMSBURG HOSPITAL ARE AN ACTIVE AND VITAL PART OF THE ACTIVITIES OF THE HOSPITAL. THE HOURS OF VOLUNTEER SERVICES ARE AN IMPORTANT CONTRIBUTION TO THE MISSION OF GEISINGER-BLOOMSBURG HOSPITAL. THE VOLUNTEERS FROM LOCAL COMMUNITIES CONTRIBUTED 98 HOURS TOWARD THE COMMON PURPOSE OF SERVICING THE HEALTHCARE OF THE COMMUNITY. V.COMMUNITY HEALTH, EDUCATION, AND OUTREACH GBH STRIVES TO BE A VALUABLE RESOURCE FOR THE COMMUNITY AND ITS RESIDENTS. GBH PROVIDES MANY REDUCED-PRICE SERVICES AND FREE PROGRAMS THROUGHOUT THE YEAR THAT SERVE COMMUNITY HEALTH NEEDS. AT A COST OF 3 THOUSAND, THESE SERVICES AND PROGRAMS INCLUDED: SUPPORT GROUPS, COMMUNITY HEALTH EDUCATION, AND OTHER UNIQUE SERVICES. A.GROUPS GBH PROVIDES PROGRAMS FOR ALL DEMOGRAPHICS. SILVER CIRCLE IS A GROUP THAT PROVIDES BENEFITS FOR 55+ AGE INDIVIDUALS SUCH AS MONTHLY NEWSLETTER WITH HEALTH AND LIFESTYLE INFORMATION, FREE HEALTH SCREENINGS, YOGA CLASSES, HEALTHY EATING SEMINARS, TRAVEL OPPORTUNITIES, AND OTHER SOCIAL EVENTS. GBH CONTINUES TO MAKE INROADS WITH THE NEIGHBORING BLOOMSBURG UNIVERSITY WITH INVOLVEMENT BETWEEN LEADERSHIP AND STUDENTS WHO ARE INTERESTED IN COMMUNITY HEALTH CARE. B.COMMUNITY HEALTH EDUCATION COMMUNITY HEALTH NEEDS ASSESSMENT WOMEN'S HEALTH RELATED TOPICS CARDIAC AND DIABETIC COOKING CLASSES VI. COMMUNITY SERVICE SUMMARY AT COST CHARITY CARE 225,244 MEDICARE/MEDICAID 5,285,954 BAD DEBT 664,280 COMMUNITY HEALTH, EDUCATION, AND OUTREACH 3,160 VOLUNTEER SERVICES (VALUED AT 1/1/2013 PA STATEWIDE AVERAGE WEEKLY WAGE) 2,246 TOTAL 6,180,884 VII. STATISTICS GEISINGER-BLOOMSBURG HOSPTIAL FISCAL YEAR ENDED JUNE 30, 2013 ADMISSIONS (INCLUDING NEWBORNS) 2,351 ADMISSIONS (EXCLUDING NEWBORNS) 2,137 OUTPATIENT VISITS INCLUDING EMERGENCY DEPARTMENT 33,624 AVERAGE LENGTH OF STAY (EXCLUDING NEWBORNS AND PSYCH) 4.2 PERCENT OF OCCUPANCY (EXCLUDING NEWBORNS) 34.20% PATIENT DAYS (EXCLUDING NEWBORNS) 8,991 IN AND OUT SURGERY VISITS 2,407 BEDS (EXCLUDING BASSINETS) (SET UP AND STAFFED) 20 BASSINETS IN NURSERY 10

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses31,452,042

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)				(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) REGIS P CABONOR........................................................................ CEO	40.00 .......................0.00	X			136,694	256,470	12,816
(19) JOSEPH M DEVITO........................................................................ CFO	40.00 .......................0.00	X			120,663	260,635	16,953
(20) JEAN R THOMAS CRNA........................................................................ CRNA	40.00 .......................0.00		X		203,384	0	10,659
(21) JOSPEH P RUDA CRNA........................................................................ CRNA	40.00 .......................0.00		X		209,296	37,846	20,736
(22) LINDA D BRENNAN CRNA........................................................................ CRNA	40.00 .......................0.00		X		204,613	0	10,567
(23) PENNY E YENCHICK CRNA........................................................................ CRNA	40.00 .......................0.00		X		2,532	213,463	26,415
(24) THOMAS G SMITH CRNA........................................................................ CRNA	40.00 .......................0.00		X		46,646	302,592	36,299
(25) PATRICK J ERWIN MD........................................................................ FORMER OFFIC	0.00 .......................40.00			X	0	349,333	39,206

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	923,828	8,599,518	1,479,030

				(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

f	All other contributions, gifts, grants, and similar amounts not included above1f		42,504

g	Noncash contributions included in lines 1a-1f:$
h	Total. Add lines 1a-1f.......			42,504
			Business Code
2a	PATIENT SERVICE REVENUE		621110	29,816,814	29,816,814
b	IC SHARED SERVICE		541900	1,505,809	1,505,809
c	RENTAL TO AFFILIATE		531120	685,656			685,656
d	RENTALS TO OTHER HEALTH PROV		531120	113,479			113,479
e
f	All other program service revenue .
g	Total. Add lines 2a–2f........			32,121,758
3	Investment income (including dividends, interest, and other similar amounts).......			144,638	144,638
4	Income from investment of tax-exempt bond proceeds..
5	Royalties...........
		(i) Real	(ii) Personal
6a	Gross rents	127,226
b	Less: rental expenses	7,944
c	Rental income or (loss)	119,282
d	Net rental income or (loss).......			119,282			119,282
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory		1,000
b	Less: cost or other basis and sales expenses		387
c	Gain or (loss)		613
d	Net gain or (loss)..........			613			613
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..
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...
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..
Miscellaneous Revenue			Business Code
11a	CAFETERIA SALES		900099	164,139			164,139
b	GIFT SHOP SALES		900099	48,563			48,563
c	FITNESS OTHER PT		900099	12,640			12,640
d	All other revenue ....			14,203	2,922		11,281
e	Total. Add lines 11a–11d ......			239,545
12	Total revenue. See Instructions......			32,668,340	31,470,183		1,155,653


				(A) Beginning of year		(B) End of year
1	Cashnon-interest-bearing .............			100,912	1	1,169,981
2	Savings and temporary cash investments .........			445,932	2	1,655,838
3	Pledges and grants receivable, net ...........				3
4	Accounts receivable, net .............			3,022,919	4	2,171,207
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L ..................
					5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
					6
7	Notes and loans receivable, net .............				7
8	Inventories for sale or use ..............			517,999	8	393,258
9	Prepaid expenses and deferred charges ..........			90,549	9	146,886
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	14,864,665
b	Less: accumulated depreciation .....	10b	2,176,914	14,953,317	10c	12,687,751
11	Investments—publicly traded securities ..........				11
12	Investments—other securities. See Part IV, line 11 .....				12
13	Investments—program-related. See Part IV, line 11 .....			126,366	13	143,125
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........			10,843,314	15	9,456,572
16	Total assets. Add lines 1 through 15 (must equal line 34)......			30,101,308	16	27,824,618
17	Accounts payable and accrued expenses .........			7,319,053	17	2,477,761
18	Grants payable .................				18
19	Deferred revenue ................				19
20	Tax-exempt bond liabilities .............			5,618,433	20
21	Escrow or custodial account liability. Complete Part IV of Schedule D..				21
22	Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........				22
23	Secured mortgages and notes payable to unrelated third parties ..			11,988,554	23
24	Unsecured notes and loans payable to unrelated third parties ....				24	17,448,058
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....................			13,933,012	25	17,768,068
26	Total liabilities. Add lines 17 through 25.........			38,859,052	26	37,693,887
	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............			-16,675,252	27	-18,238,545
28	Temporarily restricted net assets ...........			64,589	28	81,799
29	Permanently restricted net assets ...........			7,852,919	29	8,287,477
	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 ...........			-8,757,744	33	-9,869,269
34	Total liabilities and net assets/fund balances ........			30,101,308	34	27,824,618