TY 2013 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) VICTOR EWY........................................................................ CHAIRPERSON BEGINNING 10/13	1.0 .......................2.0	X	X		0	0	0
(2) MICHAEL CHERICO........................................................................ CHAIRMAN ENDING 10/13	1.0 .......................0.0	X	X		0	0	0
(3) ARTHUR DORTORT........................................................................ TREASURER	1.0 .......................1.0	X	X		0	60,523	0
(4) BARRY GEORGE........................................................................ VICE CHAIRMAN	1.0 .......................0.0	X	X		0	0	0
(5) BRUCE MCCLEARY........................................................................ SECRETARY	1.0 .......................1.0	X	X		0	0	0
(6) JANICE SEMEYN........................................................................ DIRECTOR	1.0 .......................0.0	X			0	0	0
(7) JOSEPH GRUNENWALD........................................................................ DIRECTOR	1.0 .......................0.0	X			0	0	0
(8) JAMES CARROLL........................................................................ DIRECTOR	1.0 .......................0.0	X			0	0	0
(9) AJ BARRETT DO........................................................................ DIRECTOR	1.0 .......................0.0	X			0	0	0
(10) FRED PORT........................................................................ DIRECTOR BEGINNING 10/13	1.0 .......................0.0	X
(11) VINCENT LAMORELLA........................................................................ CFO	40.0 .......................5.0		X		0	0	0
(12) BYRON QUINTON........................................................................ CEO	40.0 .......................1.0		X		0	0	0
(13) CHARLES BARTLEY........................................................................ CRNA	40.0 .......................0.0			X	156,860	0	24,919
(14) WENDY STIVANSON........................................................................ CRNA	40.0 .......................0.0			X	135,107	0	26,459
(15) CLARA MICKLISH........................................................................ CRNA	40.0 .......................0.0			X	141,853	0	13,770
(16) WILLIAM SIMPSON........................................................................ PHARMACIST MANAGER	40.0 .......................0.0			X	127,572	0	26,082
(17) TOM MORGO........................................................................ CRNA	40.0 .......................			X	117,767	0	25,592

(A) Name and business address	(B) Description of services	(C) Compensation
CLARION REHABILITATION SRVCS,	PHYSICAL THERAPY	2,288,616
DJD ANESTHESIA ASSOC,	DOCTOR	494,190
ADVANCED LITHO CARE LTD,	MOBILE UNIT	187,414
SENECA PATHOLOGY ASSOCIATES LLC,	PHYSICIAN SERVICES	160,153
DR CHONG MIN PARK,	PHYSICIAN SERVICES	109,000
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 6

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	0
2	Grants and other assistance to individuals in the United States. See Part IV, line 22	0
3	Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16	0
4	Benefits paid to or for members	0
5	Compensation of current officers, directors, trustees, and key employees ....	0
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....	51,772	0	51,772	0
7	Other salaries and wages	17,967,617	15,630,714	2,336,903	0
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	867,000	752,069	114,931	0
9	Other employee benefits .......	3,010,819	2,611,701	399,118	0
10	Payroll taxes ...........	1,341,082	1,163,306	177,776	0
11	Fees for services (non-employees):
a	Management ......	867,651	0	867,651	0
b	Legal .........	59,833	0	59,833	0
c	Accounting ...........	98,512	0	98,512	0
d	Lobbying ...........	7,086	0	7,086	0
e	Professional fundraising services. See Part IV, line 17	0
f	Investment management fees ......	90,445	0	90,445	0
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ........	6,492,176	4,765,859	1,726,317	0
12	Advertising and promotion ....	301,971	119	301,852	0
13	Office expenses .......	2,396,301	1,389,846	1,006,455	0
14	Information technology ......	429,783	0	429,783	0
15	Royalties ..	0
16	Occupancy ...........	1,518,995	648,853	870,142	0
17	Travel ............	15,042	1,991	13,051	0
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......	0
19	Conferences, conventions, and meetings ....	83,254	58,800	24,454	0
20	Interest ...........	276,734	220,716	56,018	0
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization .....	1,772,067	1,413,359	358,708	0
23	Insurance ..............	632,538	462,923	169,615	0
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	MEDICAL SUPPLIES & DRUGS	10,701,588	10,701,588		0
b	BAD DEBT	3,581,587	3,581,587		0
c	RECRUITING & RETENTION	566,991		566,991	0
d	LICENSES, DUES, SUBSCRIPTIONS	147,866	110,985	36,881	0
e	All other expenses	248,779	171,502	77,277
25	Total functional expenses. Add lines 1 through 24e	53,527,489	43,685,918	9,841,571	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

Part X Balance Sheet Check if Schedule O contains a response or note to any line in this Part X ..............
	1	Cash–non-interest-bearing .............	3,490	1	3,776
2	Savings and temporary cash investments .........	3,433,922	2	2,238,942
3	Pledges and grants receivable, net ...........	0	3	0
4	Accounts receivable, net .............	5,908,605	4	5,123,163
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L ..................
		0	5	0
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
		0	6	0
7	Notes and loans receivable, net .............	0	7	0
8	Inventories for sale or use ..............	1,315,183	8	1,277,461
9	Prepaid expenses and deferred charges ..........	591,362	9	849,238
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	61,930,128
b	Less: accumulated depreciation .....	10b	48,699,450	10,665,346	10c	13,230,678
11	Investments—publicly traded securities ..........	9,744,289	11	9,038,724
12	Investments—other securities. See Part IV, line 11 .....	4,096,834	12	3,855,665
13	Investments—program-related. See Part IV, line 11 .....	0	13	0
14	Intangible assets ...............	0	14	0
15	Other assets. See Part IV, line 11 ...........	1,542,050	15	804,891
16	Total assets. Add lines 1 through 15 (must equal line 34)......	37,301,081	16	36,422,538
	17	Accounts payable and accrued expenses .........	5,084,902	17	6,551,760
18	Grants payable .................	0	18	0
19	Deferred revenue ................	0	19	0
20	Tax-exempt bond liabilities .............	0	20	0
21	Escrow or custodial account liability. Complete Part IV of Schedule D..	0	21	0
22	Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........	0	22	0
23	Secured mortgages and notes payable to unrelated third parties ..	6,735,172	23	5,943,811
24	Unsecured notes and loans payable to unrelated third parties ....	244,274	24	125,791
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....................	1,241,063	25	1,119,578
26	Total liabilities. Add lines 17 through 25.........	13,305,411	26	13,740,940
		Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............	22,736,136	27	21,639,722
28	Temporarily restricted net assets ...........	1,091,743	28	852,968
29	Permanently restricted net assets ...........	167,791	29	188,908
	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 ...........	23,995,670	33	22,681,598
34	Total liabilities and net assets/fund balances ........	37,301,081	34	36,422,538

- TIN:

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.
right arrow

Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2013

Open to Public
Inspection

Name of the organization

CLARION HOSPITAL

Employer identification number

25-1010039

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) 2013

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) 2009	(b) 2010	(c) 2011	(d) 2012	(e) 2013	(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) 2009	(b) 2010	(c) 2011	(d) 2012	(e) 2013	(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 2013 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2012 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2013. 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—2012. 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—2013. 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—2012. 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) 2013

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) 2009	(b) 2010	(c) 2011	(d) 2012	(e) 2013	(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) 2009	(b) 2010	(c) 2011	(d) 2012	(e) 2013	(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 2013 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2012 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2012 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests—2013. 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—2012. 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) 2013

Page 4

Part IV

Supplemental Information. 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) 2013

Additional Data

Software ID:
Software Version:

- TIN:

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

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

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

Information about Schedule B (Form 990, 990-EZ, or 990-PF) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2013

Name of the organization

CLARION HOSPITAL

Employer identification number

25-1010039

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

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

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

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

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

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

Special Rules

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

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

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

Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on its Form 990PF, Part I, line 2, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

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

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2013)

Schedule B (Form 990, 990-EZ, or 990-PF) (2013)

Page 2

Name of organization CLARION HOSPITAL

Part I	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	RESTRICTED RESTRICTED RESTRICTED RESTRICTED, RESTRICTEDRESTRICTED	$RESTRICTED	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2013)

Schedule B (Form 990, 990-EZ, or 990-PF) (2013)

Page 3

Name of organization CLARION HOSPITAL

Part II	Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2013)

Schedule B (Form 990, 990-EZ, or 990-PF) (2013)

Page 4

Name of organization
CLARION HOSPITAL

Employer identification number

25-1010039

Part III

Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
that total more than $1,000 for the year. Complete columns (a) through (e) and the following line entry.
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet

$
Use duplicate copies of Part III if additional space is needed.

(a) No.
from
Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2013)

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. SchCMd Bullet

Information about Schedule C (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2013

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

CLARION HOSPITAL

Employer identification number

25-1010039

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) 2013

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) 2010	(b) 2011	(c) 2012	(d) 2013	(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) 2013

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

7,086

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

7,086

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

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.

Return Reference	Explanation
SCHEDULE C, PART II-B, LINE 1(I)	OTHER LOBBYING ACTIVITY: A PORTION OF DUES PAID IN FISCAL YEAR 2014 TO THE AHA, HAP AND HCWP WERE ATTRIBUTABLE TO LOBBYING, TOTALING $7,086.

Schedule C (Form 990 or 990EZ) 2013

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. SchDMd Bullet

Information about Schedule D (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2013

Open to Public Inspection

Name of the organization

CLARION HOSPITAL

Employer identification number

25-1010039

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) 2013

Page 2

Part III

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

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

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

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

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

Yes No

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


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

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

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ........

Part V

Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.

		(a)Current year	(b)Prior year	b (c)Two years back	(d)Three years back	(e)Four years back
1a	Beginning of year balance ....
b	Contributions ........
c	Net investment earnings, gains, and losses
d	Grants or scholarships .....
e	Other expenditures for facilities and programs ........
f	Administrative expenses ....
g	End of year balance ......

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

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Temporarily restricted endowment SchDMd Bullet

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

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

Yes

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

3a(i)

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

3a(ii)

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

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(b)Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value
1a	Land .................	473,420		473,420
b	Buildings ................	25,952,231	19,432,354	6,519,877
c	Leasehold improvements ............	602,163	320,765	281,398
d	Equipment ................	30,102,254	27,020,670	3,081,584
e	Other .................	4,800,060	1,925,661	2,874,399
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......				13,230,678

Schedule D (Form 990) 2013

Page 3

Part VII

InvestmentsOther Securities. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11b. 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	2,578,350
(3)Other (A) INVEST INT IN CHART	1,277,315	C








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)	3,855,665

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment		(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. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value









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

Part X

Other Liabilities. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability		(b) Book value
Federal income taxes		0
EST AMT DUE TO THIRD PARTY PAYERS		990,936
DUE TO AFFILIATES		128,642







Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)		1,119,578
2. Liability for uncertain tax positions 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) 2013

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......			1	48,911,282
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains on investments ..........	2a	161,812
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d	-4,774,032
e	Add lines 2a through 2d .....................			2e	-4,612,220
3	Subtract line 2e from line 1.....................			3	53,523,502
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	-61,794
c	Add lines 4a and 4b.......................			4c	-61,794
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......			5	53,461,708

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........			1	50,007,696
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	61,794
e	Add lines 2a through 2d......................			2e	61,794
3	Subtract line 2e from line 1.....................			3	49,945,902
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	3,581,587
c	Add lines 4a and 4b.......................			4c	3,581,587
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......			5	53,527,489

Part XIII

Supplemental Information

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.

Return Reference	Explanation
SCHEDULE D, PART X, LINE 2	UNCERTAIN TAX POSITIONS: MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS.
SCHEDULE D, PART XI, LINE 2D	OTHER REVENUE ON LINE 1, BUT NOT FORM 990, PART VIII, LINE 12: $(3,581,587) PROVISION FOR UNCOLLECTIBLE ACCOUNTS (1,556,996) TRANSFERS TO AFFILIATES 364,551 CHANGE IN INTEREST IN NET ASSETS OF CLARION HOSPITAL FDN ------------ $(4,774,032) TOTAL
SCHEDULE D, PART XI, LINE 4B	OTHER REVENUE ON FORM 990, PART VIII, LINE 12 BUT NOT LINE 1: $( 61,794) RENTAL EXPENSES
SCHEDULE D, PART XII, LINE 2D	OTHER EXPENSES ON LINE 1, BUT NOT FORM 990, PART IX, LINE 25: $ 61,794 RENTAL EXPENSES
SCHEDULE D, PART XII, LINE 4B	OTHER EXPENSES ON FORM 990, PART IX, LINE 25, BUT NOT LINE 1: $ 3,581,587 PROVISION FOR UNCOLLECTIBLE ACCOUNTS

Schedule D (Form 990) 2013

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.
MediumBullet

Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2013

Open to Public Inspection

Name of the organization

CLARION HOSPITAL

Employer identification number

25-1010039

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 %

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"? ..............

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? ......

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) ..	216,893		216,893	0.430 %
b	Medicaid (from Worksheet 3, column a) ....	6,274,679	3,524,930	2,749,749	5.510 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) .
d	Total Financial Assistance and Means-Tested Government Programs .	6,491,572	3,524,930	2,966,642	5.940 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4) ..
f	Health professions education (from Worksheet 5) ..	916,944	708,995	207,949	0.420 %
g	Subsidized health services (from Worksheet 6) ..	3,812,139	1,790,306	2,021,833	4.050 %
h	Research (from Worksheet 7)
i	Cash and in-kind contributions for community benefit (from Worksheet 8)
j	Total. Other Benefits ..	4,729,083	2,499,301	2,229,782	4.470 %
k	Total. Add lines 7d and 7j .	11,220,655	6,024,231	5,196,424	10.410 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2013

Schedule H (Form 990) 2013

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. ......

3,581,587

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. ......

655,430

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).....

16,228,673

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

14,385,360

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

1,843,313

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) 2013

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, primary website address, and state license number
1	CLARION HOSPITAL ONE HOSPITAL DRIVE CLARION,PA16214 WWW.CLARIONHOSPITAL.ORG 297801	X	X	X	X

Schedule H (Form 990) 2013

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)

	CLARION HOSPITAL
Name of hospital facility or facility reporting group

If reporting on Part V, Section B for a single hospital facility only: line number of
hospital facility (from Schedule H, Part V, Section A)

Yes

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

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

Yes

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

A definition of the community served by the hospital facility

Demographics of the community

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

How data was obtained

The health needs of the community

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

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

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

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

Other (describe in Part VI)

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

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

Yes

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

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

Yes

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

Hospital facility’s website (list url): WWW.CLARIONHOSPITAL.ORG/UPLOADS/FILES/

Other website (list url):

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 as of the end of the tax year):

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

Execution of the implementation strategy

Participation in the development of a community-wide plan

Participation in the execution of a community-wide plan

Inclusion of a community benefit section in operational plans

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

Prioritization of health needs in its community

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

Other (describe in Part VI)

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

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

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

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

Schedule H (Form 990) 2013

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.% 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: 250.% 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	Residency
i	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		No
16	Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’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 Section C)
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 individual’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 Section C)

Schedule H (Form 990) 2013

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 individuals regarding the individuals’ bills

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

Other (describe in Section C)

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 individual 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 individual an amount equal to the gross charge for any service provided to that individual? .........................

If "Yes," explain in Part VI.

Schedule H (Form 990) 2013

Page

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B.Provide descriptions required for Part V, Section B, lines 1j, 3, 4, 5d, 6i, 7, 10, 11, 12i, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22. If applicable, provide separate descriptions for each facility in a facility reporting group, designated by "Facility A," "Facility B," etc.
Form and Line Reference	Explanation
SCHEDULE H, PART V, SECTION B, LINE 3	COMMUNITY INPUT: CLARION HOSPITAL ORGANIZED AROUND 20 PEOPLE FROM THE COMMUNITY TO SIT IN ON THE COMMUNITY HEALTH NEEDS ASSESSMENT MEETING. THIS GROUP INCLUDED THE FOLLOWING INDIVIDUALS: DEBBIE THOMPSON STRATEGY SOLUTIONS ROB COTTER STRATEGY SOLUTIONS JOHN STROUP CLARION HOSPITAL FOUNDATION EXECUTIVE DIRECTOR CONNIE BEICHNER CLARION HOSPITAL MEDICAL CLINICS KAREN HAZLETT CLARION HOSPITAL MARKETING DAVID LOTT CLARION UNIVERSITY BUTCH CAMPBELL CLARION COUNTY COMMISSIONER DONNA OBERLANDER PA STATE REPRESENTATIVE PETER M. WINKLER AID TO CONGRESSMAN THOMPSON 5TH CONGRESSIONAL DIST. JAMIE LEFEVER CLARION COUNTY ECONOMIC DEVELOPMENT JESSE KELLEY CLARION COUNTY YMCA KERRY KIFER CLARION COUNTY BEHAVIORAL HEALTH PAM ZAHORAN CITIZEN AND FORMER UNITED WAY DIRECTOR ROBIN LUTZ AID TO STATE SENATE SCOTT HUTCHINSON SHELIA SCHREIDER CLARION COUNTY PROMISE KAY RUPERT CLARION COUNTY WELFARE MARK AARON CLARION COUNTY DA RITA WOODARD CLARION/ARMSTRONG/INDIANA DRUG AND ALCOHOL REHAB MISSY POLITO CLARION HOSPITAL QUALITY ASSURANCE KOLAYA HORNE CLARION/ARMSTRONG/INDIANA DRUG AND ALCOHOL REHAB NICOLE SALVO CLARION/ARMSTRONG/INDIANA DRUG AND ALCOHOL REHAB THE GROUP MET 5 TIMES TO ENGAGE THESE INDIVIDUALS AS WELL AS REPORT SURVEY FINDINGS. THE ORGANIZATION ALSO ENGAGED STRATEGY SOLUTIONS INC. TO ASSIST IN DEVELOPING SURVEYS AS WELL AS DEVELOPING GOALS AND IMPLEMENTATION STRATEGIES.
SCHEDULE H, PART V, LINE 6	IMPLEMENTATION STRATEGY: IN RESPONSE TO THE RESULTS OF CLARION HOSPITAL'S MOST RECENTLY CONDUCTED COMMUNITY HEALTH NEEDS ASSESSMENT, THE ORGANIZATION ADOPTED AN IMPLEMENTATION STRATEGY. THE PDF OF THE IMPLEMENTATION STRATEGY CAN BE FOUND AT WWW.CLARIONHOSPITAL.ORG UNDER THE LINK FOR THE CHNA AT THE BOTTOM OF THE PAGE. ON JULY 29, 2014, CLARION HOSPITAL (CLARION) HELD A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) EVALUATION MEETING TO REVIEW THE PROGRESS TO DATE OF THE IMPLEMENTATION STRATEGIES, KICKING OFF AN EVALUATION PROCESS THAT INCLUDED UPDATING THE PLAN. THIS MEETING WAS FACILITATED BY DEBBIE THOMPSON, OF STRATEGY SOLUTIONS, INC., WHOSE COMPANY ALSO FACILITATED THE CHNA PROCESS. A TOTAL OF FOUR HOSPITAL REPRESENTATIVES ATTENDED THIS MEETING TO REVIEW CLARION'S IMPLEMENTATION STRATEGIES THAT HAVE BEEN UNDERWAY OVER THE LAST YEAR. THE PROCESS INCLUDED A REVIEW OF EACH OF CLARION'S GOALS, OBJECTIVES, IMPLEMENTATION STRATEGIES AND ACCOMPLISHMENTS, ALONG WITH DISCUSSION ON UPDATING THE IMPLEMENTATION ACTION PLAN FOR THE UPCOMING FISCAL YEAR. A DETAILED REVIEW OF THE IMPLEMENTATION STRATEGIES WAS CONDUCTED, DETERMINING WHAT ACTION ITEMS WERE STARTED, COMPLETED OR TABLED DURING THE FIRST YEAR OF IMPLEMENTATION. THE CHNA IMPLEMENTATION STRATEGY GOT OFF TO A SLOW START AND DID NOT MEET THE INITIAL MILESTONE DEADLINES ORIGINALLY IDENTIFIED DUE TO A TEN MONTH DELAY IN THE HIRING OF A COORDINATOR. EVEN WITH THIS DELAY, CLARION MADE PROGRESS ON A NUMBER OF ITS IMPLEMENTATION STRATEGIES THAT THAT WERE DEVELOPED IN RESPONSE TO ITS MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT: -SEVERAL OBJECTIVES REGARDING CLARION'S GOAL TO INCREASE PHYSICAL ACTIVITY THROUGHOUT THE COMMUNITY BY DEVELOPING A WORKPLACE WELLNESS PROGRAM WERE REACHED DURING YEAR 1, INCLUDING THE HIRING OF A COORDINATOR, BRIDGET THORNTON. BEST PRACTICES IN WELLNESS PROGRAMS WERE RESEARCHED. SHE CONDUCTED TWO SITE VISITS WITH OTHER HOSPITALS IN PA THAT WERE OPERATING SUCCESSFUL WORKPLACE WELLNESS PROGRAMS. SUPPORT PERSONNEL (DIETICIAN, FITNESS TRAINER, HUMAN RESOURCE MGMT., YMCA, ETC.) FOR CLARION'S WELLNESS PROGRAM WERE IDENTIFIED, AND A PLANNING COMMITTEE WAS ESTABLISHED. -CLARION'S GOAL TO REDUCE CHILDHOOD OBESITY BY EDUCATING SCHOOL-AGED CHILDREN WAS INITIATED THROUGH A PARTNERSHIP WITH THE YMCA'S FUN AND FIT CLUB. DISCUSSION IS CURRENTLY UNDERWAY TO DEVELOP MORE ROBUST OUTCOMES MEASURES FOR THE PROGRAM. -THE OBJECTIVE REGARDING CLARION'S GOAL TO IMPACT THE DIABETES EPIDEMIC BY PROVIDING A BETTER CONTINUITY OF CARE THROUGH A PARTNERSHIP WITH SEMEYN FAMILY PRACTICE MET ITS YEAR 1 MILESTONES, WITH THE PHYSICIAN PRACTICES IMPLEMENTING DIABETES MANAGEMENT PROGRAM. ADDITIONAL OBJECTIVES FOR YEAR 2 WILL BE ADDED TO THIS GOAL. CLARION IS CONTINUING TO WORK ON THE FOLLOWING ACTION ITEMS THAT COULDN'T BEGIN IN 2014 DUE TO TIME AND RESOURCE CONSTRAINTS, AS WELL AS THE FACT THAT THE HIRING OF THE COORDINATOR WAS DELAYED: -CLARION'S GOAL OF CREATING A WELLNESS PROGRAM WAS PUSHED BACK FOUR MONTHS DUE TO THE DELAY IN THE HIRING OF THE COORDINATOR. THE HOSPITAL IS PLANNING TO INTRODUCE THE WELLNESS PROGRAM TO ITS EMPLOYEES IN JANUARY 2015. -REGARDING CLARION'S GOAL OF REDUCING CHILDHOOD OBESITY, THE FOLLOWING OBJECTIVES WILL BE THE FOCUS OF YEAR 2 OF THE HOSPITAL'S IMPLEMENTATION STRATEGY: ENTERING INTO DISCUSSIONS WITH THE CLARION COUNTY YMCA IN ORDER TO FORM A PARTNERSHIP THAT WOULD EXPAND THEIR CURRENT "FUN 'N FIT CLUB" CURRICULUM, ADDRESS THE ISSUE OF TRANSPORTATION TO ENSURE THAT CHILDREN CAN ATTEND THE "FUN 'N FIT CLUB," AND BRAINSTORM WAYS TO GROW THE PROGRAM IN CLARION COUNTY. ALL OF THE REMAINING OBJECTIVES ARE ACHIEVABLE DURING THE FINAL TWO YEARS OF THE PLAN. THE IMPLEMENTATION STRATEGY TO INCLUDE OTHER COMMUNITY BENEFIT PROGRAMS THAT ARE CURRENTLY UNDERWAY RELATED TO THE NEEDS IDENTIFIED IN THE CHNA, AS WELL AS A PLAN TO AUTOMATE SOME OF THE OUTCOMES REPORTING.
SCHEDULE H, PART V, SECTION B, LINE 7	ADDRESSING IDENTIFIED NEEDS: AFTER ALL PRIMARY AND SECONDARY DATA WERE REVIEWED AND ANALYZED; THE DATA SUGGESTED A TOTAL OF 28 DISTINCT ISSUES, NEEDS AND POSSIBLE PRIORITY AREAS FOR INTERVENTION. THE STEERING COMMITTEE PRIORITIZED AND DISCUSSED THE NEEDS AND IDENTIFIED CHRONIC DISEASE/HIGH BLOOD PRESSURE, LACK OF PHYSICAL ACTIVITY, OBESITY, DIABETES, AND DRUG ABUSE AS TOP PRIORITIES IN RESPONSE TO THE NEEDS IDENTIFIED IN THE ASSESSMENT. THE IMPLEMENTATION STRATEGIES SELECTED BY THE HOSPITAL AND COMMUNITY PARTNERS ADDRESS THESE NEEDS THROUGH A VARIETY OF STRATEGIES. NEEDS IDENTIFIED BY THE CHNA THAT ARE NOT BEING ADDRESSED THROUGH THESE IMPLEMENTATION STRATEGIES ARE ALREADY BEING ADDRESSED BY EXISTING COMMUNITY ASSETS, NECESSARY RESOURCES TO MEET THESE NEEDS ARE LACKING, OR THESE NEEDS FALL OUTSIDE OF THE CLARION HOSPITAL MISSION.
SCHEDULE H, PART V, SECTION B, LINE 14	MEASURES TO PUBLICIZE: THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY DOES NOT INCLUDE THE MEASURES TO PUBLICIZE THE POLICY WITHIN THE COMMUNITY. THE ORGANIZATION DOES, HOWEVER, PUBLICIZE THE POLICY USING THE FOLLOWING MEASURES: B. THE POLICY WAS ATTACHED TO BILLING INVOICES. F. THE POLICY WAS AVAILABLE UPON REQUEST.

Schedule H (Form 990) 2013

Page

Part VFacility Information (continued)

Section D. 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?3
Name and address		Type of Facility (describe)
1	SEMEYN FAMILY PRACTICE 82 TOWN RUN RD NEW BETHLEHEM,PA16224	ROUTINE X-RAY SERVICES
2	CRICKLEWOOD 1008 S FIFTH AVE CLARION,PA16214	SCREENING MAMMOGRAPHY SERVICES
3	AC VALLEY MEDICAL CENTER 855 ROUTE 58 FOXBURG,PA16036	CLINIC SERVICES
4
5
6
7
8
9
10

Schedule H (Form 990) 2013

Page

Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs 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.

Form and Line Reference	Explanation
SCHEDULE H, PART V, SECTION B, LINE 3	COMMUNITY INPUT: CLARION HOSPITAL ORGANIZED AROUND 20 PEOPLE FROM THE COMMUNITY TO SIT IN ON THE COMMUNITY HEALTH NEEDS ASSESSMENT MEETING. THIS GROUP INCLUDED THE FOLLOWING INDIVIDUALS: DEBBIE THOMPSON STRATEGY SOLUTIONS ROB COTTER STRATEGY SOLUTIONS JOHN STROUP CLARION HOSPITAL FOUNDATION EXECUTIVE DIRECTOR CONNIE BEICHNER CLARION HOSPITAL MEDICAL CLINICS KAREN HAZLETT CLARION HOSPITAL MARKETING DAVID LOTT CLARION UNIVERSITY BUTCH CAMPBELL CLARION COUNTY COMMISSIONER DONNA OBERLANDER PA STATE REPRESENTATIVE PETER M. WINKLER AID TO CONGRESSMAN THOMPSON 5TH CONGRESSIONAL DIST. JAMIE LEFEVER CLARION COUNTY ECONOMIC DEVELOPMENT JESSE KELLEY CLARION COUNTY YMCA KERRY KIFER CLARION COUNTY BEHAVIORAL HEALTH PAM ZAHORAN CITIZEN AND FORMER UNITED WAY DIRECTOR ROBIN LUTZ AID TO STATE SENATE SCOTT HUTCHINSON SHELIA SCHREIDER CLARION COUNTY PROMISE KAY RUPERT CLARION COUNTY WELFARE MARK AARON CLARION COUNTY DA RITA WOODARD CLARION/ARMSTRONG/INDIANA DRUG AND ALCOHOL REHAB MISSY POLITO CLARION HOSPITAL QUALITY ASSURANCE KOLAYA HORNE CLARION/ARMSTRONG/INDIANA DRUG AND ALCOHOL REHAB NICOLE SALVO CLARION/ARMSTRONG/INDIANA DRUG AND ALCOHOL REHAB THE GROUP MET 5 TIMES TO ENGAGE THESE INDIVIDUALS AS WELL AS REPORT SURVEY FINDINGS. THE ORGANIZATION ALSO ENGAGED STRATEGY SOLUTIONS INC. TO ASSIST IN DEVELOPING SURVEYS AS WELL AS DEVELOPING GOALS AND IMPLEMENTATION STRATEGIES.
SCHEDULE H, PART V, LINE 6	IMPLEMENTATION STRATEGY: IN RESPONSE TO THE RESULTS OF CLARION HOSPITAL'S MOST RECENTLY CONDUCTED COMMUNITY HEALTH NEEDS ASSESSMENT, THE ORGANIZATION ADOPTED AN IMPLEMENTATION STRATEGY. THE PDF OF THE IMPLEMENTATION STRATEGY CAN BE FOUND AT WWW.CLARIONHOSPITAL.ORG UNDER THE LINK FOR THE CHNA AT THE BOTTOM OF THE PAGE. ON JULY 29, 2014, CLARION HOSPITAL (CLARION) HELD A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) EVALUATION MEETING TO REVIEW THE PROGRESS TO DATE OF THE IMPLEMENTATION STRATEGIES, KICKING OFF AN EVALUATION PROCESS THAT INCLUDED UPDATING THE PLAN. THIS MEETING WAS FACILITATED BY DEBBIE THOMPSON, OF STRATEGY SOLUTIONS, INC., WHOSE COMPANY ALSO FACILITATED THE CHNA PROCESS. A TOTAL OF FOUR HOSPITAL REPRESENTATIVES ATTENDED THIS MEETING TO REVIEW CLARION'S IMPLEMENTATION STRATEGIES THAT HAVE BEEN UNDERWAY OVER THE LAST YEAR. THE PROCESS INCLUDED A REVIEW OF EACH OF CLARION'S GOALS, OBJECTIVES, IMPLEMENTATION STRATEGIES AND ACCOMPLISHMENTS, ALONG WITH DISCUSSION ON UPDATING THE IMPLEMENTATION ACTION PLAN FOR THE UPCOMING FISCAL YEAR. A DETAILED REVIEW OF THE IMPLEMENTATION STRATEGIES WAS CONDUCTED, DETERMINING WHAT ACTION ITEMS WERE STARTED, COMPLETED OR TABLED DURING THE FIRST YEAR OF IMPLEMENTATION. THE CHNA IMPLEMENTATION STRATEGY GOT OFF TO A SLOW START AND DID NOT MEET THE INITIAL MILESTONE DEADLINES ORIGINALLY IDENTIFIED DUE TO A TEN MONTH DELAY IN THE HIRING OF A COORDINATOR. EVEN WITH THIS DELAY, CLARION MADE PROGRESS ON A NUMBER OF ITS IMPLEMENTATION STRATEGIES THAT THAT WERE DEVELOPED IN RESPONSE TO ITS MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT: -SEVERAL OBJECTIVES REGARDING CLARION'S GOAL TO INCREASE PHYSICAL ACTIVITY THROUGHOUT THE COMMUNITY BY DEVELOPING A WORKPLACE WELLNESS PROGRAM WERE REACHED DURING YEAR 1, INCLUDING THE HIRING OF A COORDINATOR, BRIDGET THORNTON. BEST PRACTICES IN WELLNESS PROGRAMS WERE RESEARCHED. SHE CONDUCTED TWO SITE VISITS WITH OTHER HOSPITALS IN PA THAT WERE OPERATING SUCCESSFUL WORKPLACE WELLNESS PROGRAMS. SUPPORT PERSONNEL (DIETICIAN, FITNESS TRAINER, HUMAN RESOURCE MGMT., YMCA, ETC.) FOR CLARION'S WELLNESS PROGRAM WERE IDENTIFIED, AND A PLANNING COMMITTEE WAS ESTABLISHED. -CLARION'S GOAL TO REDUCE CHILDHOOD OBESITY BY EDUCATING SCHOOL-AGED CHILDREN WAS INITIATED THROUGH A PARTNERSHIP WITH THE YMCA'S FUN AND FIT CLUB. DISCUSSION IS CURRENTLY UNDERWAY TO DEVELOP MORE ROBUST OUTCOMES MEASURES FOR THE PROGRAM. -THE OBJECTIVE REGARDING CLARION'S GOAL TO IMPACT THE DIABETES EPIDEMIC BY PROVIDING A BETTER CONTINUITY OF CARE THROUGH A PARTNERSHIP WITH SEMEYN FAMILY PRACTICE MET ITS YEAR 1 MILESTONES, WITH THE PHYSICIAN PRACTICES IMPLEMENTING DIABETES MANAGEMENT PROGRAM. ADDITIONAL OBJECTIVES FOR YEAR 2 WILL BE ADDED TO THIS GOAL. CLARION IS CONTINUING TO WORK ON THE FOLLOWING ACTION ITEMS THAT COULDN'T BEGIN IN 2014 DUE TO TIME AND RESOURCE CONSTRAINTS, AS WELL AS THE FACT THAT THE HIRING OF THE COORDINATOR WAS DELAYED: -CLARION'S GOAL OF CREATING A WELLNESS PROGRAM WAS PUSHED BACK FOUR MONTHS DUE TO THE DELAY IN THE HIRING OF THE COORDINATOR. THE HOSPITAL IS PLANNING TO INTRODUCE THE WELLNESS PROGRAM TO ITS EMPLOYEES IN JANUARY 2015. -REGARDING CLARION'S GOAL OF REDUCING CHILDHOOD OBESITY, THE FOLLOWING OBJECTIVES WILL BE THE FOCUS OF YEAR 2 OF THE HOSPITAL'S IMPLEMENTATION STRATEGY: ENTERING INTO DISCUSSIONS WITH THE CLARION COUNTY YMCA IN ORDER TO FORM A PARTNERSHIP THAT WOULD EXPAND THEIR CURRENT "FUN 'N FIT CLUB" CURRICULUM, ADDRESS THE ISSUE OF TRANSPORTATION TO ENSURE THAT CHILDREN CAN ATTEND THE "FUN 'N FIT CLUB," AND BRAINSTORM WAYS TO GROW THE PROGRAM IN CLARION COUNTY. ALL OF THE REMAINING OBJECTIVES ARE ACHIEVABLE DURING THE FINAL TWO YEARS OF THE PLAN. THE IMPLEMENTATION STRATEGY TO INCLUDE OTHER COMMUNITY BENEFIT PROGRAMS THAT ARE CURRENTLY UNDERWAY RELATED TO THE NEEDS IDENTIFIED IN THE CHNA, AS WELL AS A PLAN TO AUTOMATE SOME OF THE OUTCOMES REPORTING.
SCHEDULE H, PART V, SECTION B, LINE 7	ADDRESSING IDENTIFIED NEEDS: AFTER ALL PRIMARY AND SECONDARY DATA WERE REVIEWED AND ANALYZED; THE DATA SUGGESTED A TOTAL OF 28 DISTINCT ISSUES, NEEDS AND POSSIBLE PRIORITY AREAS FOR INTERVENTION. THE STEERING COMMITTEE PRIORITIZED AND DISCUSSED THE NEEDS AND IDENTIFIED CHRONIC DISEASE/HIGH BLOOD PRESSURE, LACK OF PHYSICAL ACTIVITY, OBESITY, DIABETES, AND DRUG ABUSE AS TOP PRIORITIES IN RESPONSE TO THE NEEDS IDENTIFIED IN THE ASSESSMENT. THE IMPLEMENTATION STRATEGIES SELECTED BY THE HOSPITAL AND COMMUNITY PARTNERS ADDRESS THESE NEEDS THROUGH A VARIETY OF STRATEGIES. NEEDS IDENTIFIED BY THE CHNA THAT ARE NOT BEING ADDRESSED THROUGH THESE IMPLEMENTATION STRATEGIES ARE ALREADY BEING ADDRESSED BY EXISTING COMMUNITY ASSETS, NECESSARY RESOURCES TO MEET THESE NEEDS ARE LACKING, OR THESE NEEDS FALL OUTSIDE OF THE CLARION HOSPITAL MISSION.
SCHEDULE H, PART V, SECTION B, LINE 14	MEASURES TO PUBLICIZE: THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY DOES NOT INCLUDE THE MEASURES TO PUBLICIZE THE POLICY WITHIN THE COMMUNITY. THE ORGANIZATION DOES, HOWEVER, PUBLICIZE THE POLICY USING THE FOLLOWING MEASURES: B. THE POLICY WAS ATTACHED TO BILLING INVOICES. F. THE POLICY WAS AVAILABLE UPON REQUEST.

Schedule H (Form 990) 2013

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, line 23.
SchJMediumBullet

Attach to Form 990. SchJMediumBullet

See separate instructions.
SchJMediumBullet

Information about Schedule J (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2013

Open to Public Inspection

Name of the organization

CLARION HOSPITAL

Employer identification number

25-1010039

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
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked in line 1a? ..

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

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

During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:

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

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

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) 2013

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)CHARLES BARTLEYCRNA	(i) (ii)	156,860 0	0 0	0 0	7,843 0	17,076 0	181,779 0	0 0
(2)WENDY STIVANSONCRNA	(i) (ii)	135,107 0	0 0	0 0	6,755 0	19,704 0	161,566 0	0 0
(3)CLARA MICKLISHCRNA	(i) (ii)	141,853 0	0 0	0 0	7,093 0	6,677 0	155,623 0	0 0
(4)WILLIAM SIMPSONPHARMACIST MANAGER	(i) (ii)	127,572 0	0 0	0 0	6,379 0	19,704 0	153,655 0	0 0

Schedule J (Form 990) 2013

Page 3

Part III

Supplemental Information

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.

Return Reference

Explanation

SCHEDULE J, PART I, LINE 3

COMPENSATION OF ORGANIZATION'S CEO: CLARION HOSPITAL CONTRACTED WITH QUORUM HEALTH RESOURCES, AN UNRELATED MANAGEMENT COMPANY, FOR THE SERVICES OF BYRON QUINTON, CEO, AND VINCENT LAMORELLA, CFO. AMOUNTS PAID TO QUORUM HEALTH RESOURCES ARE REPORTED IN FORM 990, PART VII, SECTION B, AND ARE FOR SERVICES PROVIDED BY THE INDIVIDUALS AS WELL AS OTHER SERVICES PROVIDED BY THE COMPANY. NO COMPENSATION WAS REPORTED FOR EITHER INDIVIDUAL ON FORM 990, PART VII OR SCHEDULE J, PART II.

Schedule J (Form 990) 2013

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.
MediumBullet

Information about Schedule L (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2013

Open to Public Inspection

Name of the organization

CLARION HOSPITAL

Employer identification number

25-1010039

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) 2013

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) MARLA MCCLEARY	SPOUSE OF BRUCE	51,772	COMPENSATION		No

Part V

Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).

Return Reference	Explanation

Schedule L (Form 990 or 990-EZ) 2013

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.
MediumBullet

Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.

OMB No. 1545-0047

2013

Open to Public
Inspection

Name of the organization

CLARION HOSPITAL

Employer identification number

25-1010039

Return Reference	Explanation
FORM 990 PART I, LINE 1	ORGANIZATION'S MISSION: MISSION: CLARION HOSPITAL, AS THE COMMUNITY'S RESOURCE FOR THE DELIVERY OF QUALITY-BASED HEALTHCARE, IS COMMITTED TO PROVIDE EMERGENT, ACUTE, TRANSITIONAL, AND LONG-TERM MEDICAL SERVICES FOR THE RESIDENTS OF CLARION COUNTY AND ITS SURROUNDING COMMUNITIES. PURPOSE: CLARION HOSPITAL EXISTS TO PROVIDE COMPREHENSIVE, QUALITY HEALTH CARE, APPROPRIATE TO THE NEEDS OF OUR COMMUNITY, IN A COMPASSIONATE AND EMPATHETIC MANNER. THE HOSPITAL ACKNOWLEDGES THE IMPORTANCE OF PREVENTIVE MEDICINE AND FOCUSES ON THE PROMOTION OF A HEALTHY LIFESTYLE FOR ALL. EVERY DEPARTMENT WITHIN CLARION HOSPITAL CONTRIBUTES AN INVALUABLE SERVICE TOWARD THE PROVISION OF QUALITY HEALTH CARE FROM THE ORGANIZATION AS A WHOLE. EACH DEPARTMENT EXISTS FOR A SPECIFIC PURPOSE, YET NO DEPARTMENT EXISTS SOLELY ON ITS OWN. WE ARE ALL INTER-DEPENDENT UPON EACH OTHER. VALUES: WE BELIEVE IN BEING CUSTOMER FOCUSED. WE BELIEVE IN COMPETENCY. WE BELIEVE IN HONESTY. WE BELIEVE IN CARING. WE BELIEVE IN COMMITMENT. WE BELIEVE IN BEING TEAM PLAYERS. WE BELIEVE IN DEMONSTRATING PROFESSIONALISM. WE BELIEVE IN THE PRESERVATION OF DIGNITY FOR THOSE WE SERVE. WE BELIEVE IN MAINTAINING CONFIDENTIALITY. WE BELIEVE IN EDUCATION AND CONTINUAL LEARNING. WE BELIEVE IN CONTINUAL IMPROVEMENT. WE BELIEVE IN DEMONSTRATING MUTUAL RESPECT FOR OUR CO-WORKERS. VISION: CLARION HOSPITAL ENDEAVORS TO EXCEED THE COMMUNITY'S HEALTHCARE EXPECTATIONS THROUGH THE IMPLEMENTATION OF CONTINUOUS QUALITY IMPROVEMENTS, BY REASSESSING THE COMMUNITY'S EVOLVING NEEDS, BY DEVELOPING INNOVATIVE FAMILY-ORIENTED HEALTHCARE SERVICES, AND BY PROVIDING EDUCATIONAL PROGRAMS FOR OUR FUTURE HEALTHCARE PROVIDERS.
FORM 990, PART I, LINE 6	NUMBER OF VOLUNTEERS: VOLUNTEER SERVICES OF CLARION HOSPITAL CONSISTS OF APPROXIMATELY 57 VOLUNTEERS WHO WORK WITHIN 25 VARIOUS DEPARTMENTS ASSISTING EMPLOYEES, PATIENTS, AND STAFF TO DELIVER QUALITY BASED HEALTHCARE. IN ADDITION, THE MEMBERS OF THE BOARD OF DIRECTORS WHO SERVED DURING THE YEAR ARE CONSIDERED VOLUNTEERS.
FORM 990, PART VI, SECTION A, LINE 3	MANAGEMENT DUTIES: CLARION HOSPITAL HAS A MANAGEMENT CONTRACT WITH QUORUM HEALTH RESOURCES TO PROVIDE MANAGEMENT SERVICES. IN ADDITION, QUORUM HEALTH RESOURCES PROVIDES COMPENSATION FOR THE HOSPITAL'S CEO & CFO. THE HOSPITAL REIMBURSES QUORUM HEALTH RESOURCES WITH MONTHLY MANAGEMENT FEES FOR THE COMPENSATION PAID AND OTHER SERVICES PROVIDED.
FORM 990, PART VI, SECTION A, LINES 6, 7A & 7B	MEMBERS OF THE ORGANIZATION: THE BOARD OF CLARION HOSPITAL SHALL CONSIST OF NINE (9) MEMBERS AND SHALL BE APPOINTED BY THE BOARD OF DIRECTORS OF CLARION HEALTHCARE SYSTEM, INC. IN ACCORDANCE WITH HOSPITAL BYLAWS. THE BOARD MEMBERS SHALL BE THE SAME PERSONS WHO SERVE AS THE EXECUTIVE COMMITTEE OF CLARION HEALTHCARE SYSTEM, INC. WHICH INCLUDE THE CHAIRPERSON, VICE CHAIRPERSON, SECRETARY, TREASURER, FORMER CHAIRPERSON (IF APPLICABLE), PRESIDENT & CEO (NON-VOTING), CHIEF OF STAFF (WITH VOTING RIGHTS), ONE MEDICAL STAFF REPRESENTATIVE, AND ANY OTHER DIRECTORS SELECTED BY THE CHAIRPERSON. BYLAWS MAY ONLY BE AMENDED OR REPEALED AND NEW BYLAWS ADOPTED BY THE BOARD OF DIRECTORS OF CLARION HEALTHCARE SYSTEM, INC.
FORM 990, PART VI, SECTION B, LINE 11B	FORM 990 REVIEW PROCESS: THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM BASED ON THE AUDITED FINANCIAL STATEMENTS AND INFORMATION PROVIDED BY THE ACCOUNTING DEPARTMENT OF THE ORGANIZATION. PRIOR TO FILING, A DRAFT OF THE RETURN IS REVIEWED BY THE CFO IN DETAIL. A FINAL DRAFT IS THEN PRESENTED TO THE FINANCE COMMITTEE OF THE BOARD OF DIRECTORS AND THE FULL BOARD FOR REVIEW.
FORM 990, PART VI, SECTION B, LINE 12C	CONFLICT OF INTEREST POLICY: CLARION HOSPITAL, INC. BOARD MEMBERS ARE ASKED TO COMPLETE A CONFLICT OF INTEREST FORM ON AN ANNUAL BASIS. IF A CONFLICT ARISES, THE BOARD MEMBER WITH A CONFLICT ABSTAINS FROM VOTING ON ANY MATTER RELATED TO THE CONFLICT. POLICY: MEMBERS OF THE GOVERNING BODY SHALL NOT MAINTAIN SUBSTANTIAL PERSONAL OR BUSINESS INTERESTS WHICH CONFLICT WITH THOSE OF THE HOSPITAL. PROCEDURES: ALL GOVERNING BODY MEMBERS SHALL EXECUTE A CONFLICT OF INTEREST STATEMENT. MEMBERS OF THE GOVERNING BODY SHALL NOT ENGAGE IN THE FOLLOWING FORMS OF SELF DEALINGS: A) THE SALE, EXCHANGE, OR LEASING OF PROPERTY OR SERVICES BETWEEN THE HOSPITAL AND A GOVERNING BOARD MEMBER, HIS EMPLOYER, OR AN ORGANIZATION SUBSTANTIALLY CONTROLLED BY HIM ON A BASIS LESS FAVORABLE TO THE HOSPITAL THAN THAT ON WHICH SUCH PROPERTY OR SERVICE IS MADE AVAILABLE TO THE GENERAL PUBLIC. B) FURNISHING OF GOODS, SERVICES, OR FACILITIES BY THE HOSPITAL TO A GOVERNING BOARD MEMBER, UNLESS SUCH FURNISHING IS MADE ON A BASIS NOT MORE FAVORABLE THAN THAT ON WHICH SUCH GOODS, SERVICES, OR FACILITIES ARE MADE AVAILABLE TO THE GENERAL PUBLIC OR EMPLOYEES OF THE HOSPITAL. C) ANY TRANSFER TO OR USE BY OR FOR THE BENEFIT OF A GOVERNING BOARD MEMBER OF THE INCOME OR ASSETS OF THE HOSPITAL EXCEPT BY PURCHASE FOR FAIR MARKET VALUE. ANY DIRECTOR, OFFICER, EMPLOYEE, OR COMMITTEE MEMBER HAVING AN INTEREST IN A CONTRACT OR OTHER TRANSACTION PRESENTED TO THE BOARD OF DIRECTORS OR A COMMITTEE THEREOF FOR AUTHORIZATION, APPROVAL OR RATIFICATION SHALL GIVE PROMPT, FULL AND FRANK DISCLOSURE OF HIS INTEREST TO THE BOARD OR COMMITTEE PRIOR TO ITS ACTING ON SUCH CONTRACT OR TRANSACTION. THE BODY TO WHICH SUCH DISCLOSURE IS MADE SHALL THEREUPON DETERMINE, BY MAJORITY VOTE, WHETHER THE DISCLOSURE SHOWS THAT A CONFLICT OF INTEREST EXISTS OR CAN REASONABLY BE CONSTRUED TO EXIST. IF A CONFLICT IS DEEMED TO EXIST, SUCH PERSON SHALL NOT VOTE ON, NOR USE HIS PERSONAL INFLUENCE ON, NOR PARTICIPATE (OTHER THAN TO PRESENT FACTS) IN THE DISCUSSIONS OR DELIBERATIONS WITH RESPECT TO SUCH CONTRACT OR TRANSACTION. SUCH PERSON MAY NOT BE COUNTED IN DETERMINING THE EXISTENCE OF A QUORUM AT ANY MEETING WHERE THE CONTRACT OR TRANSACTION IS UNDER DISCUSSION OR IS BEING VOTED UPON. THE MINUTES OF THE MEETING SHALL REFLECT THE DISCLOSURE MADE, THE VOTE THEREON AND, WHERE APPLICABLE, THE ABSTENTION FROM VOTING AND PARTICIPATING, AND WHETHER A QUORUM WAS PRESENT.
FORM 990, PART VI, SECTION B, LINES 15A & 15B	COMPENSATION REVIEW POLICY: CLARION HOSPITAL CONTRACTED WITH QUORUM HEALTH RESOURCES, AN UNRELATED MANAGEMENT COMPANY, FOR THE SERVICES OF BYRON QUINTON, CEO, AND VINCENT LAMORELLA, CFO. AMOUNTS PAID TO QUORUM HEALTH RESOURCES ARE REPORTED IN FORM 990, PART VII, SECTION B, AND ARE FOR SERVICES PROVIDED BY THE INDIVIDUALS AS WELL AS OTHER SERVICES PROVIDED BY THE COMPANY. NO COMPENSATION WAS REPORTED FOR EITHER INDIVIDUAL ON FORM 990, PART VII OR SCHEDULE J, PART II. ALTHOUGH THE ORGANIZATION DID NOT DIRECTLY PAY THE COMPENSATION OF THE CEO OR CFO DURING THE YEAR, THE ORGANIZATION DOES HAVE A COMPENSATION REVIEW POLICY IN PLACE. IT SHALL BE THE POLICY OF THE BOARD OF DIRECTORS TO ESTABLISH AND MAINTAIN AN EXECUTIVE COMPENSATION PROGRAM FOR THE PRESIDENT/CEO AND CHIEF FINANCIAL OFFICER WHICH: (1) ENABLES THE BOARD TO ATTRACT AND RETAIN THE EXECUTIVES NEEDED TO EFFECTIVELY CARRY OUT THE MISSION OF THE ORGANIZATION AND THE POLICIES OF THE BOARD. (2) RESPONDS TO MARKET TRENDS. (3) REFLECTS THE VALUE OF THE FUNCTIONAL DEMANDS OF EXECUTIVE WORK. (4) REWARDS PERFORMANCE RESULTS. (5) IS BASED ON FACTORS THAT PROVIDE FOR JUST AND REASONABLE COMPENSATION. COMPENSATION ACTIONS APPROVED BY THE BOARD OF DIRECTORS MUST BE DOCUMENTED, AND SUCH DOCUMENTATION SHALL INCLUDE THE BASES OF EACH COMMITTEE'S ACTIONS AND THE NAMES OF THE COMMITTEE MEMBERS INVOLVED IN THE ACTIONS. THE DOCUMENTED PROCESS FOR DETERMINING EXECUTIVE COMPENSATION SHALL INCLUDE: (1) TERMS OF THE COMPENSATION ARRANGEMENTS. (2) APPROVAL DATE. (3) NAMES OF BOARD MEMBERS WHO APPROVED THE COMPENSATION DECISIONS. (4) DATA USED IN THE COMPENSATION DECISION. (5) DISCLOSURES OF CONFLICT OF INTEREST, IF ANY. (6) ANNUAL REVIEW OF COMPENSATION RECORDS. THE BOARD OF DIRECTORS AUTHORIZES THE HUMAN RESOURCE COMMITTEE TO REVIEW AND RECOMMEND COMPENSATION DECISIONS FOR THE PRESIDENT/CEO. THE BOARD OF DIRECTORS AUTHORIZES THE FINANCE COMMITTEE TO REVIEW AND RECOMMEND COMPENSATION DECISIONS FOR THE CHIEF FINANCIAL OFFICER. SUCH RECOMMENDATIONS ARE REPORTED TO AND ACTED UPON BY THE FULL BOARD OF DIRECTORS. GUIDELINES FOR DETERMINING PROPOSED COMPENSATION FOR THE PRESIDENT/CEO AND THE CHIEF FINANCIAL OFFICER (A) A REVIEW AND APPROVAL OF THE OFFICER'S COMPENSATION SHALL OCCUR INITIALLY UPON HIRE OF THE OFFICER AND WHENEVER THE OFFICER'S COMPENSATION IS MODIFIED. (B) ANNUALLY, THE HUMAN RESOURCE COMMITTEE OF THE BOARD OF DIRECTORS SHALL ESTABLISH PERFORMANCE STANDARDS FOR THE PRESIDENT/CEO WHICH SHALL BE USED IN DETERMINING COMPENSATION ACTIONS. THE HUMAN RESOURCE COMMITTEE SHALL HAVE THE AUTHORITY TO REVIEW THE PERFORMANCE OF THE PRESIDENT/CEO AND RECOMMEND A COMPENSATION ADJUSTMENT, IF WARRANTED IN THE JUDGMENT OF THE COMMITTEE. (C) ANNUALLY, THE PRESIDENT/CEO SHALL ESTABLISH PERFORMANCE STANDARDS FOR THE CHIEF FINANCIAL OFFICER WHICH SHALL BE USED IN DETERMINING COMPENSATION ACTIONS. THE PRESIDENT/CEO SHALL HAVE THE AUTHORITY TO REVIEW THE PERFORMANCE OF THE CHIEF FINANCIAL OFFICER AND PROPOSE A COMPENSATION ADJUSTMENT, IF WARRANTED IN THE JUDGMENT OF THE PRESIDENT/CEO, TO THE FINANCE COMMITTEE. (D) INFORMATION GATHERED AND USED IN COMPENSATION ACTIONS SHALL INCLUDE: 1. COMPENSATION PAID BY SIMILAR ORGANIZATIONS. 2. QHR WILL PROVIDE COMPENSATION COMPARABILITY DATA FOR THE POSITION COMPILED BY INDEPENDENT ORGANIZATIONS. THE DATA MAY BE BASED ON INDUSTRY SURVEYS, EXPERT COMPENSATION STUDIES, OR OTHER COMPARABLE DATA. 3. REFERENCE TO FUNCTIONALLY COMPARABLE POSITIONS. 4. THE AVAILABILITY OF SIMILAR SERVICES IN THE GEOGRAPHIC SERVICE AREA. COMPENSATION WAS LAST REVIEWED, USING THE ABOVE METHOD, IN FEBRUARY 2011.
FORM 990, PART VI, SECTION C, LINE 19	DOCUMENT DISCLOSURE: GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE BY WRITTEN REQUEST FOR A LEGITIMATE BUSINESS PURPOSE, AS DETERMINED BY TOP MANAGEMENT. REQUESTED DOCUMENTS WILL BE MAILED TO THE REQUESTOR.
FORM 990, PART VII, SECTION A	COMPENSATION OF BOARD MEMBERS: ARTHUR DORTORT, DIRECTOR, IS COMPENSATED BY HEALTH SERVICES OF CLARION, A RELATED ORGANIZATION, FOR HIS SERVICES AS AN EMPLOYEE OF THAT ORGANIZATION. HE DID NOT RECEIVE ANY COMPENSATION FOR HIS SERVICES AS A MEMBER OF THE BOARD OF DIRECTORS OF CLARION HOSPITAL.
FORM 990, PART IX, LINE 11G	OTHER FEES FOR SERVICES: $2,254,424 REHAB PURCHASED SERVICES 1,945,299 OTHER PURCHASED SERVICES 1,573,381 MEDICAL PURCHASED SERVICES 435,484 PHYSICIAN FEES 283,588 COLLECTION FEES ----------- $6,492,176
FORM 990, PART XI, LINE 9	OTHER CHANGES IN NET ASSETS: $(1,556,996) TRANSFER TO AFFILIATES 125,776 CHANGE IN INTEREST IN NET ASSETS OF CLARION HOSPITAL FDN 21,117 CHANGE IN INTEREST IN TRUST ------------- $(1,410,103) TOTAL

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2013

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" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990. MediumBullet

See separate instructions.
MediumBullet

Information about Schedule R (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2013

Open to Public Inspection

Name of the organization

CLARION HOSPITAL

Employer identification number

25-1010039

Part I

Identification of Disregarded Entities Complete if the organization answered "Yes" on 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" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled 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) HEALTH SERVICES OF CLARION ONE HOSPITAL DRIVE CLARION,PA16214 75-3126134	PHYSICIAN GRP	PA	501(C)(3)	3	CLARION HS		No
(2) CLARION HEALTHCARE SYSTEM INC ONE HOSPITAL DRIVE CLARION,PA16214 25-1534023	HOLDING CO	PA	501(C)(3)	11A I	NA		No

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

Cat. No. 50135Y

Schedule R (Form 990) 2013

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.

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

Part IV

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(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) CLARION DEVELOPMENT CORPORATION 24 DOCTORS LANE CLARION,PA16214 25-1516298	PHARMACY	PA		C CORP				No

Schedule R (Form 990) 2013

Page 3

Part V

Transactions With Related Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest (ii) annuities (iii) royalties or (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

Yes

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

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

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

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

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

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

Yes

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

Yes

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

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

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

Yes

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

Yes

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

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

Yes

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

Yes

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

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 related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved

Schedule R (Form 990) 2013

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 37.

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V?UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(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 V?UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2013

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R (see instructions).

Return Reference	Explanation

Schedule R (Form 990) 2013

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: CLARION HOSPITAL IS THE COMMUNITY'S DYNAMIC RESOURCE FOR QUALITY HEALTHCARE, CONTINUOUS EDUCATION AND THE PROMOTION OF WELLNESS. SEE SCHEDULE O FOR ADDITIONAL INFORMATION.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	9
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	7
5	Total number of individuals employed in calendar year 2013 (Part V, line 2a) ......	5	573
6	Total number of volunteers (estimate if necessary) .............	6	57
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	0
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	61,303	45,771
9	Program service revenue (Part VIII, line 2g) .........	50,545,569	52,042,308
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	698,423	1,109,310
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	237,941	264,319
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	51,543,236	53,461,708
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	0	0
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	23,187,985	23,238,290
16a	Professional fundraising fees (Part IX, column (A), line 11e).....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	27,771,265	30,289,199
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	50,959,250	53,527,489
19	Revenue less expenses. Subtract line 18 from line 12.......	583,986	-65,781
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	37,301,081	36,422,538
21	Total liabilities (Part X, line 26).............	13,305,411	13,740,940
22	Net assets or fund balances. Subtract line 21 from line 20.....	23,995,670	22,681,598

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 31,834,352 including grants of $ ) (Revenue $ 36,511,550 )
	CLARION HOSPITAL PROVIDED SERVICES TO 125,719 OUTPATIENTS AS WELL AS 17,516 EMERGENCY ROOM VISITS. SERVICES INCLUDE, BUT ARE NOT LIMITED TO, RADIOLOGY SERVICES WHICH INCLUDE MRI, ULTRASOUND, CT, NUCLEAR MEDICINE AND X-RAY SERVICES, LABORATORY SERVICES, EKG AND PHYSICAL THERAPY SERVICES. THE ORGANIZATION ALSO OFFERS SAME-DAY SURGERY, GENETIC COUNSELING, DRUG AND ALCOHOL TESTING, AND OUTPATIENT PHYSICAL THERAPY AND REHABILITATION SERVICES.

4b	(Code: ) (Expenses $ 8,978,926 including grants of $ ) (Revenue $ 10,298,130 )
	CLARION HOSPITAL PROVIDED SERVICES TO 1,748 INPATIENTS FOR MEDICAL AND SURGICAL SERVICES AS WELL AS INTENSIVE CARE SERVICES. CLARION HOSPITAL ALSO PROVIDED OBSTETRIC CARE FOR 143 NEW MOTHERS AND BABIES. THE ORGANIZATION ALSO OFFERS AN INPATIENT REHABILITATION CENTER WHERE PATIENTS WHO HAVE SUFFERED MAJOR INJURIES OR TRAUMA CAN HAVE 24-HOUR NURSING CARE, ALONGSIDE INTENSIVE PHYSICAL, OCCUPATIONAL, AND/OR SPEECH THERAPY.

4c	(Code: ) (Expenses $ 2,872,640 including grants of $ ) (Revenue $ 5,232,628 )
	CLARION HOSPITAL PROVIDED 30 EDUCATION AND SCREENING OPPORTUNITIES FOR THE COMMUNITY ATTENDED BY 2,355 MEMBERS OF THE COMMUNITY. CLASSES ARE AVAILABLE FOR EXPECTANT MOTHERS, PEOPLE WITH DIABETES, AND WORKERS LOOKING FOR SAFER ENVIRONMENTS. THE ORGANIZATION ALSO OFFERS CPR AND EMT TRAINING COURSES.

4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses43,685,918

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	679,159	60,523	116,822

				(A) Total revenue	(B) Related or exempt function revenue	(C) Unrelated business revenue	(D) Revenue excluded from tax under sections 512-514
1a	Federated campaigns..1a
b	Membership dues....1b
c	Fundraising events....1c
d	Related organizations...1d
e	Government grants (contributions)1e		33,507

f	All other contributions, gifts, grants, and similar amounts not included above1f		12,264

g	Noncash contributions included in lines 1a-1f:$
h	Total. Add lines 1a-1f.......			45,771
			Business Code
2a	PATIENT REVENUE		621990	50,391,274	50,391,274
b	AMBULANCE		621910	147,196	147,196
c	EHR INCENTIVE		900099	945,929	945,929
d	CAFETERIA		722514	385,879	385,879
e	DAYCARE		624410	145,069	145,069
f	All other program service revenue .			26,961	26,961
g	Total. Add lines 2a–2f........			52,042,308
3	Investment income (including dividends, interest, and other similar amounts).......			294,996			294,996
4	Income from investment of tax-exempt bond proceeds..			0
5	Royalties...........			0
		(i) Real	(ii) Personal
6a	Gross rents	103,284
b	Less: rental expenses	61,794
c	Rental income or (loss)	41,490	0
d	Net rental income or (loss).......			41,490			41,490
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory	7,303,577	3,506
b	Less: cost or other basis and sales expenses	6,492,769
c	Gain or (loss)	810,808	3,506
d	Net gain or (loss)..........			814,314			814,314
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ..
	a
b	Less: direct expenses ...b
c	Net income or (loss) from fundraising events..			0
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from gaming activities...			0
10a	Gross sales of inventory, less returns and allowances .
	a
b	Less: cost of goods sold ..b
c	Net income or (loss) from sales of inventory..			0
Miscellaneous Revenue			Business Code
11a	GAIN ON EQUITY INVESTEE		900099	222,829			222,829
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......			222,829
12	Total revenue. See Instructions......			53,461,708	52,042,308		1,373,629


				(A) Beginning of year		(B) End of year
1	Cash–non-interest-bearing .............			3,490	1	3,776
2	Savings and temporary cash investments .........			3,433,922	2	2,238,942
3	Pledges and grants receivable, net ...........			0	3	0
4	Accounts receivable, net .............			5,908,605	4	5,123,163
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L ..................
				0	5	0
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
				0	6	0
7	Notes and loans receivable, net .............			0	7	0
8	Inventories for sale or use ..............			1,315,183	8	1,277,461
9	Prepaid expenses and deferred charges ..........			591,362	9	849,238
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	61,930,128
b	Less: accumulated depreciation .....	10b	48,699,450	10,665,346	10c	13,230,678
11	Investments—publicly traded securities ..........			9,744,289	11	9,038,724
12	Investments—other securities. See Part IV, line 11 .....			4,096,834	12	3,855,665
13	Investments—program-related. See Part IV, line 11 .....			0	13	0
14	Intangible assets ...............			0	14	0
15	Other assets. See Part IV, line 11 ...........			1,542,050	15	804,891
16	Total assets. Add lines 1 through 15 (must equal line 34)......			37,301,081	16	36,422,538
17	Accounts payable and accrued expenses .........			5,084,902	17	6,551,760
18	Grants payable .................			0	18	0
19	Deferred revenue ................			0	19	0
20	Tax-exempt bond liabilities .............			0	20	0
21	Escrow or custodial account liability. Complete Part IV of Schedule D..			0	21	0
22	Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........			0	22	0
23	Secured mortgages and notes payable to unrelated third parties ..			6,735,172	23	5,943,811
24	Unsecured notes and loans payable to unrelated third parties ....			244,274	24	125,791
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....................			1,241,063	25	1,119,578
26	Total liabilities. Add lines 17 through 25.........			13,305,411	26	13,740,940
	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............			22,736,136	27	21,639,722
28	Temporarily restricted net assets ...........			1,091,743	28	852,968
29	Permanently restricted net assets ...........			167,791	29	188,908
	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 ...........			23,995,670	33	22,681,598
34	Total liabilities and net assets/fund balances ........			37,301,081	34	36,422,538