TY 2014 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) JOANN HUDAK........................................................................ 2ND VICE CHAIR	0.8 .......................0.8	X	X
(2) SUSAN MANCUSO........................................................................ SECRETARY BEGINNING 11/2014	0.8 .......................0.8	X	X
(3) FRANK BORELLI........................................................................ TRUSTEE	0.8 .......................0.8	X	X
(4) WENDELL HUNT........................................................................ TRUSTEE	0.8 .......................0.8	X
(5) JOSEPH HARCUM........................................................................ TRUSTEE	0.8 .......................0.8	X
(6) JULIE SEILER........................................................................ TRUSTEE	0.8 .......................0.8	X
(7) HUGH RECHNER........................................................................ TRUSTEE BEGINNING 10/2014	0.8 .......................0.2	X	X
(8) GARY BEILMAN........................................................................ TRUSTEE BEGINNING 10/2014	0.8 .......................0.8	X
(9) DIRK MUMFORD........................................................................ CHAIR BEGINNING 10/2014	3.0 .......................2.1	X	X
(10) TED EDGAR........................................................................ TREASURER	0.8 .......................0.8	X	X
(11) WILLIAM R DEWAR III MD........................................................................ TRUSTEE	0.8 .......................0.8	X
(12) SCOTT EPSTEIN MD........................................................................ TRUSTEE	0.8 .......................0.8	X
(13) JAMES LABAR........................................................................ TRUSTEE BEGINNING 1/2015	0.8 .......................1.0	X
(14) MILTON ROEGNER........................................................................ TRUSTEE	0.8 .......................1.3	X
(15) MARTHA WILSON........................................................................ TRUSTEE	0.8 .......................0.8	X
(16) JULIANN DOYLE........................................................................ TRUSTEE	0.8 .......................0.8	X
(17) TIMOTHY FARLEY........................................................................ TRUSTEE	0.8 .......................0.8	X

(A) Name and business address	(B) Description of services	(C) Compensation
N AMERICAN PTRS IN ANESTHESIA,	ANESTHESIOLOGY SVCS	1,306,788
WAYNE MEMORIAL HEALTH SYSTEM,	ADMINISTRATIVE SVCS	1,163,472
LABORATORY CORP OF AMERICA,	LABORATORY SVCS	781,670
AIMADVANCE INPATIENT MEDICINE,	HOSPITALIST SVCS	604,007
GOOD SHEPHERD REHABILITAION HOSP,	REHAB SERVICES	466,857
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 17

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 domestic organizations and domestic governments. See Part IV, line 21 ....	1,630,270	1,630,270
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ....	0
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. 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) ....	20,145	20,145
7	Other salaries and wages ....	31,301,648	22,905,215	8,396,433
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	1,852,165	1,351,752	500,413
9	Other employee benefits .......	3,575,535	2,609,506	966,029
10	Payroll taxes ...........	2,246,397	1,639,471	606,926
11	Fees for services (non-employees):
a	Management ......	1,163,472		1,163,472
b	Legal .........	177,962		177,962
c	Accounting ...........	91,575		91,575
d	Lobbying ...........	0
e	Professional fundraising services. See Part IV, line 17	0
f	Investment management fees ......	346,166		346,166
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ....	6,370,377	5,596,892	773,485
12	Advertising and promotion ....	219,368		219,368
13	Office expenses .......	7,697,166	5,058,299	2,638,867
14	Information technology ......	0
15	Royalties ..	0
16	Occupancy ...........	1,550,884	999,429	551,455
17	Travel ............	250,727	244,264	6,463
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......	0
19	Conferences, conventions, and meetings ....	66,997	52,029	14,968
20	Interest ...........	569,389	441,363	128,026
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization .....	3,038,368	2,355,194	683,174
23	Insurance ..............	628,493	487,177	141,316
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	9,992,732	9,992,732
b	BAD DEBT	8,012,792	8,012,792
c	REPAIRS & MAINTENANCE	1,991,385	1,024,863	966,522
d	LICENSES, DUES, SUBSCRIPTIONS	145,106	67,135	77,971
e	All other expenses
25	Total functional expenses. Add lines 1 through 24e	82,939,119	64,488,528	18,450,591	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 .............	1,470	1	1,570
2	Savings and temporary cash investments .........	15,154,522	2	20,630,813
3	Pledges and grants receivable, net ...........	0	3	0
4	Accounts receivable, net .............	8,703,280	4	8,263,849
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 ..............	632,605	8	586,798
9	Prepaid expenses and deferred charges ..........	1,253,918	9	1,281,280
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	86,599,141
b	Less: accumulated depreciation .....	10b	64,142,444	22,151,039	10c	22,456,697
11	Investments—publicly traded securities ..........	50,777,732	11	50,939,033
12	Investments—other securities. See Part IV, line 11 .....	638,682	12	772,456
13	Investments—program-related. See Part IV, line 11 .....	5,020,528	13	4,691,812
14	Intangible assets ...............	0	14	0
15	Other assets. See Part IV, line 11 ...........	4,057,319	15	3,823,743
16	Total assets. Add lines 1 through 15 (must equal line 34)......	108,391,095	16	113,448,051
	17	Accounts payable and accrued expenses .........	15,624,988	17	17,623,990
18	Grants payable .................	0	18	0
19	Deferred revenue ................	0	19	0
20	Tax-exempt bond liabilities .............	23,967,635	20	21,997,403
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 ..	47,440	23	592,216
24	Unsecured notes and loans payable to unrelated third parties ....	0	24	0
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D....................	2,508,984	25	2,292,617
26	Total liabilities. Add lines 17 through 25.........	42,149,047	26	42,506,226
		Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............	63,932,044	27	68,576,508
28	Temporarily restricted net assets ...........	248,241	28	288,206
29	Permanently restricted net assets ...........	2,061,763	29	2,077,111
	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 ...........	66,242,048	33	70,941,825
34	Total liabilities and net assets/fund balances ........	108,391,095	34	113,448,051

- 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.
right arrow

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

OMB No. 1545-0047

2014

Open to Public
Inspection

Name of the organization

WAYNE MEMORIAL HOSPITAL

Employer identification number

24-0798839

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)

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

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

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

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

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

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

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

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

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

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

receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of

its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses

acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

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

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

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations .............................

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

(i)Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i)Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

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

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2014

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) 2010	(b) 2011	(c) 2012	(d) 2013	(e) 2014	(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) 2010	(b) 2011	(c) 2012	(d) 2013	(e) 2014	(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 VI.)..
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 section 501(c)(3) organization, check this box and stop here........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2014 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2013 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2014. 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—2013. 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—2014. 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 VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2013. 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 VI 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) 2014

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) 2010	(b) 2011	(c) 2012	(d) 2013	(e) 2014	(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) 2010	(b) 2011	(c) 2012	(d) 2013	(e) 2014	(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 VI.) ..
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 section 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2014 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2013 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2014 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2013 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests—2014. 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—2013. 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) 2014

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 11 of Part I. If you checked 11a of Part I, complete Sections A and B. If you checked 11b of Part I, complete Sections A and C. If you checked 11c of Part I, complete Sections A, D, and E. If you checked 11d of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 11a or 11b in Part I, answer (b) and (c) below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations....

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed, (ii) the reasons for each such action, (iii) the authority under the organization's organizing document authorizing such action, and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (a) its supported organizations; (b) individuals that are part of the charitable class benefited by one or more of its supported organizations; or (c) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in IRC 4958(c)(3)(C)), a family member of a substantial contributor, or a 35-percent controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part II of Schedule L (Form 990).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined in line 9(a)) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined in line 9(a)) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of IRC 4943 because of IRC 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?

11a

A family member of a person described in (a) above?

11b

A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.

11c

Schedule A (Form 990 or 990-EZ) 2014

Page 5

Part IV

Supporting Organizations (continued)

Section B. Type I Supporting Organizations

Yes

Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (1) a written notice describing the type and amount of support provided during the prior tax year, (2) a copy of the Form 990 that was most recently filed as of the date of notification, and (3) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer (a) and (b) below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer (a) and (b) below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI the role played by the organization in this regard.

Schedule A (Form 990 or 990-EZ) 2014

Page 6

Part V – Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

1. Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970. See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1
2	Recoveries of prior-year distributions	2
3	Other gross income (see instructions)	3
4	Add lines 1 through 3	4
5	Depreciation and depletion	5
6	Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions)	6
7	Other expenses (see instructions)	7
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a
b	Average monthly cash balances	1b
c	Fair market value of other non-exempt-use assets	1c
d	Total (add lines 1a, 1b, and 1c)	1d
e	Discount claimed for blockage or other factors (explain in detail in Part VI):
2	Acquisition indebtedness applicable to non-exempt use assets	2
3	Subtract line 2 from line 1d	3
4	Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions).	4
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5
6	Multiply line 5 by .035	6
7	Recoveries of prior-year distributions	7
8	Minimum Asset Amount (add line 7 to line 6)	8

	Section C - Distributable Amount		Current Year
1	Adjusted net income for prior year (from Section A, line 8, Column A)	1
2	Enter 85% of line 1	2
3	Minimum asset amount for prior year (from Section B, line 8, Column A)	3
4	Enter greater of line 2 or line 3	4
5	Income tax imposed in prior year	5
6	Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions)	6
7	Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990 or 990-EZ) 2014

Page 7

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity
3 Administrative expenses paid to accomplish exempt purposes of supported organizations
4 Amounts paid to acquire exempt-use assets
5 Qualified set-aside amounts (prior IRS approval required)
6 Other distributions (describe in Part VI). See instructions
7Total annual distributions. Add lines 1 through 6.
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions
9 Distributable amount for 2014 from Section C, line 6
10 Line 8 amount divided by Line 9 amount

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2014	(iii) Distributable Amount for 2014
1 Distributable amount for 2014 from Section C, line 6
2 Underdistributions, if any, for years prior to 2014 (reasonable cause required--see instructions)
3 Excess distributions carryover, if any, to 2014:
a From 2009.......X
b From 2010.......X
c From 2011.......X
d From 2012.......X
e From 2013.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2014 distributable amount
i Carryover from 2009 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2014 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2014 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2014, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions)
6 Remaining underdistributions for 2014. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions)
7 Excess distributions carryover to 2015. Add lines 3j and 4c.
8 Breakdown of line 7:
a From 2010.......X
b From 2011.......X
c From 2012.......X
d From 2013.......
e From 2014.......

Schedule A (Form 990 or 990-EZ) (2014)

Schedule A (Form 990 or 990-EZ) 2014

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990 or 990-EZ) 2014

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

2014

Name of the organization

WAYNE MEMORIAL HOSPITAL

Employer identification number

24-0798839

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

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

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

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

501(c)(3) taxable private foundation

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

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or
property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) 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), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions 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 an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 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 an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled 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 totaling $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) (2014)

Schedule B (Form 990, 990-EZ, or 990-PF) (2014)

Page 2

Name of organization WAYNE MEMORIAL HOSPITAL

Part I	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	,	$RESTRICTED	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) (2014)

Schedule B (Form 990, 990-EZ, or 990-PF) (2014)

Page 3

Name of organization WAYNE MEMORIAL HOSPITAL

Part II	Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2014)

Schedule B (Form 990, 990-EZ, or 990-PF) (2014)

Page 4

Name of organization
WAYNE MEMORIAL HOSPITAL

Employer identification number

24-0798839

Part III

Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10)
that total more than $1,000 for the year from any one contributor. 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) (2014)

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

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

OMB No. 1545-0047

2014

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) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

WAYNE MEMORIAL HOSPITAL

Employer identification number

24-0798839

Part I-A

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

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

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

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

Part I-B

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

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

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

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

Yes No

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

Yes No

If "Yes," describe in Part IV.

Part I-C

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

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

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

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

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

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.

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

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2014

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 separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2011	(b) 2012	(c) 2013	(d) 2014	(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) 2014

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

5,976

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

5,976

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, lines 1 and 2 (see instructions), 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)	LOBBYING EXPENDITURES: WAYNE MEMORIAL HOSPITAL PAYS ANNUAL MEMBERSHIP DUES TO THE HOSPITAL & HEALTH SYSTEM ASSOCIATION OF PENNSYLVANIA (HAP) AND AMERICAN HOSPITAL ASSOCIATION (AHA). THE HOSPITAL IS NOTIFIED EACH YEAR THAT A PORTION OF THE MEMBERSHIP DUES IS USED FOR LOBBYING ACTIVITIES. THE PORTION OF FEES PAID REPRESENTING LOBBYING EXPENDITURES WAS $810 FOR HAP AND $5,166 FOR AHA, TOTALING $5,976 IN LOBBYING EXPENDITURES.

Return Reference

Explanation

SCHEDULE C, PART II-B, LINE 1(I)

LOBBYING EXPENDITURES: WAYNE MEMORIAL HOSPITAL PAYS ANNUAL MEMBERSHIP DUES TO THE HOSPITAL & HEALTH SYSTEM ASSOCIATION OF PENNSYLVANIA (HAP) AND AMERICAN HOSPITAL ASSOCIATION (AHA). THE HOSPITAL IS NOTIFIED EACH YEAR THAT A PORTION OF THE MEMBERSHIP DUES IS USED FOR LOBBYING ACTIVITIES. THE PORTION OF FEES PAID REPRESENTING LOBBYING EXPENDITURES WAS $810 FOR HAP AND $5,166 FOR AHA, TOTALING $5,976 IN LOBBYING EXPENDITURES.

Schedule C (Form 990 or 990EZ) 2014

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

OMB No. 1545-0047

2014

Open to Public Inspection

Name of the organization

WAYNE MEMORIAL HOSPITAL

Employer identification number

24-0798839

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate value of contributions to (during year)
3	Aggregate value of 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)

Revenue 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:

Revenue 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) 2014

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, for escrow or custodial account liability?

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 .................	2,076,704		2,076,704
b	Buildings ................	32,638,519	23,212,287	9,426,232
c	Leasehold improvements ............	3,138,363	1,829,533	1,308,830
d	Equipment ................	46,621,585	38,073,823	8,547,762
e	Other .................	2,123,970	1,026,801	1,097,169
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......				22,456,697

Schedule D (Form 990) 2014

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
Other








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

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. MALPRACTICE CLAIMS		2,292,617








Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)		2,292,617
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) 2014

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	79,687,745
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a	-3,538,326
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d	-9,323,343
e	Add lines 2a through 2d .....................			2e	-12,861,669
3	Subtract line 2e from line 1.....................			3	92,549,414
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	-441,438
c	Add lines 4a and 4b.......................			4c	-441,438
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......			5	92,107,976

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	75,043,281
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	463,120
e	Add lines 2a through 2d......................			2e	463,120
3	Subtract line 2e from line 1.....................			3	74,580,161
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	346,166
b	Other (Describe in Part XIII.) ............	4b	8,012,792
c	Add lines 4a and 4b.......................			4c	8,358,958
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......			5	82,939,119

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	AMOUNTS INCLUDED ON LINE 1, BUT NOT ON FORM 990, PART VIII, LINE 12: $ (8,012,792) BAD DEBT EXPENSE ( 346,166) INVESTMENT MANAGEMENT FEES (1,089,916) CHANGE IN DEFINED BENEFIT PENSION PLAN 98,849 TRANSFER FROM AFFILIATE 26,682 NET ASSETS RELEASED FROM RESTRICTION ------------- $ (9,323,343)
SCHEDULE D, PART XI, LINE 4B	AMOUNTS INCLUDED ON FORM 990, PART VIII, LINE 12, BUT NOT ON LINE 1: $ (463,120) RENTAL EXPENSES 21,682 TEMPORARILY RESTRICTED CONTRIBUTIONS -------------- $ (441,438)
SCHEDULE D, PART XII, LINE 2D	AMOUNTS INCLUDED ON LINE 1 BUT NOT ON FORM 990, PART IX, LINE 25: $ 463,120 RENTAL EXPENSES
SCHEDULE D, PART XII, LINE 4B	AMOUNTS INCLUDED ON FORM 990, PART IX, LINE 25, BUT NOT ON LINE 1: $ 8,012,792 BAD DEBT EXPENSE

Schedule D (Form 990) 2014

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H (Form 990)

Department of the TreasuryInternal Revenue Service

Hospitals

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

Attach to Form 990.
MediumBullet

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

OMB No. 1545-0047

2014

Open to Public Inspection

Name of the organization

WAYNE MEMORIAL HOSPITAL

Employer identification number

24-0798839

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

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

Yes

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

Yes

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

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

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

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

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

Yes

100% 150% 200% Other %

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

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

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

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

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

Yes

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

Yes

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

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

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

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

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

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) ..			317,783		317,783	0.420 %
b	Medicaid (from Worksheet 3, column a) ....			9,383,085	8,458,402	924,683	1.230 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) .
d	Total Financial Assistance and Means-Tested Government Programs .			9,700,868	8,458,402	1,242,466	1.650 %
Other Benefits		20	13,608	191,413	450	190,963	0.250 %
e	Community health improvement services and community benefit operations (from Worksheet 4) ..	20	13,608	191,413	450	190,963	0.250 %
f	Health professions education (from Worksheet 5) ..	2	14	296,610		296,610	0.400 %
g	Subsidized health services (from Worksheet 6) ..
h	Research (from Worksheet 7)
i	Cash and in-kind contributions for community benefit (from Worksheet 8)	1		1,630,245		1,630,245	2.180 %
j	Total. Other Benefits ..	23	13,622	2,118,268	450	2,117,818	2.830 %
k	Total. Add lines 7d and 7j .	23	13,622	11,819,136	8,458,852	3,360,284	4.480 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2014

Schedule H (Form 990) 2014

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	3		90,977		90,977	0.120 %
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building	1	125	8,373	500	7,873	0.010 %
7	Community health improvement advocacy
8	Workforce development	1	26	1,823		1,823
9	Other
10	Total	5	151	101,173	500	100,673	0.130 %

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. ......

8,012,792

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. ......

2,318,902

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).....

31,437,789

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

28,277,578

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

3,160,211

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) 2014

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 (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
1	WAYNE MEMORIAL HOSPITAL 601 PARK STREET HONESDALE,PA18431 WWW.WMH.ORG 230501	X	X	X

Schedule H (Form 990) 2014

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)

	WAYNE MEMORIAL HOSPITAL
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a State as a hospital facility in the current tax year or the immediately preceding tax year?.......................

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C..........

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 12....................

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 significant 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 Section C)

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 Section C 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 Section C................................

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Yes

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

Yes

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

Hospital facility’s website (list url): https://www.wmh.org/news__events

Other website (list url): www.unitedwaypike.org

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. .............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 13

Is the hospital facility's most recently adopted implementation strategy posted on a website? ........

If "Yes" (list url):

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Yes

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

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

12a

If "Yes" to line 12a, did the organization file Form 4720 to report the section 4959 excise tax? ......

12b

If "Yes" to line 12b, 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) 2014

Page

Part VFacility Information (continued)

	WAYNE MEMORIAL HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

Financial Assistance Policy (FAP)

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 included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 200.%
and FPG family income limit for eligibility for discounted care of 0.%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application.

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application.

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process.

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications.

Other (describe in Section C)

Included measures to publicize the policy within the community served by the hospital facility?.......

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url): https://www.wmh.org

The FAP application form was widely available on a website (list url): https://www.wmh.org

A plain language summary of the FAP was widely available on a website (list url):
https://www.wmh.org

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Notice of availability of the FAP was conspicuously displayed throughout the hospital facility

Notified members of the community who are most likely to require financial assistance about availability of the FAP

Other (describe in Section C)

Billing and Collections

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 all of the actions the hospital facility or other authorized party may take upon non-payment?..................................

Yes

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:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Schedule H (Form 990) 2014

Page

Part VFacility Information (continued)

	WAYNE MEMORIAL HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility or other 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?.........

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 18. (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)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required 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 Section C)

Other (describe in Section C)

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 Section C)

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 Section C.

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 Section C.

Schedule H (Form 990) 2014

Page

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16i, 18d, 19d, 20e, 21c, 21d, 22d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
SCHEDULE H, PART V, SECTION B, LINE 5	COMMUNITY INPUT: NUMEROUS ORGANIZATIONS AND COMMUNITY GROUPS PARTICIPATED IN THE ASSESSMENT. THE PUBLIC HEALTH AREA WAS INCLUDED WITHIN THE ASSESSMENT THROUGH UTILIZATION AND ANALYSIS OF INFORMATION ROUTINELY EVALUATED BY PUBLIC HEALTH AGENCIES AND ORGANIZATIONS WITH PREVENTIVE HEALTH PROGRAM CAPACITIES. THE AREA DOES NOT HAVE ORGANIZED COUNTY PUBLIC DEPARTMENTS PER SE BUT IS A PART OF THE STATE'S NORTHEAST PUBLIC HEALTH REGION. STATE HEALTH DEPARTMENT REPRESENTATION WAS INCLUDED IN THE ADVISORY GROUP AND HMS ASSOCIATES WORKED WITH PENNSYLVANIA DEPARTMENT OF HEALTH PERSONNEL DIRECTLY ON ACCESSING REPORTS ON VITAL STATISTICS DATA. GREGORY BONK, THE LEAD HMS CONSULTANT OF THE ASSESSMENT ASSISTED PUBLIC HEALTH AGENCIES IN COMPLETING HEALTH NEEDS ASSESSMENTS IN THE 1990S AND HAS WORKED ON MANY PROJECTS INVOLVING PUBLIC HEALTH AGENCIES IN SEVERAL STATES. HE HAS BEEN AN ADJUNCT FACULTY MEMBER AT THE STATE UNIVERSITY OF NEW YORK AT BUFFALO, SCHOOL OF MEDICINE AND BIOMEDICAL SCIENCES, DEPARTMENT OF FAMILY MEDICINE SINCE 1988.
SCHEDULE H, PART V, SECTION B, LINE 6B	COLLABORATIVE PARTNERS: COLLABORATIVE PARTNERS INCLUDED THE 17 MEMBERS OF THE ADVISORY COMMITTEE, THE 47 ORGANIZATIONS WHICH AGREED TO DISTRIBUTE THE EMAIL SURVEY AND THE 31 HEALTH CARE, COMMUNITY LEADERS AND CONSUMERS WHO PARTICIPATED IN INDIVIDUAL CONVERSATIONS ABOUT HEALTH CARE NEEDS IN THE AREA. ORGANIZATIONS: CARBONDALE AREA SCHOOL DISTRICT PIKE COUNTY STAFF WAYNE HIGHLANDS SCHOOL DISTRICT CARBONDALE MINISTERIUM PIKE CO UNITED WAY WAYNE MEMORIAL COMMUNITY HEALTH CENTERS CARBONDALE YMCA PIKE COUNTY AAA WAYNE MEMORIAL HEALTH SYSTEM STAFF COTTAGE HOSE COMPANY PIKE COUNTY BUILDERS ASSOCIATION WAYNE WIN/LINK DELAWARE VALLEY SCHOOL DISTRICT PIKE COUNTY CHAMBER WEDCO DOWNTOWN HAWLEY PARTNERSHIP PIKE COUNTY EDA/PIKE COUNTY CHAMBER WESTERN WAYNE SCHOOL DISTRICT FOREST CITY SCHOOL DISTRICT PIKE COUNTY INTERAGENCY COUNCIL WMH AUXILIARY GREATER CARBONDALE CHAMBER PIKE COUNTY LINK ELLEN MEMORIAL HEALTH CENTER GREATER HONESDALE PARTNERSHIP POCONO LAKE REGION CHAMBER WALLENPAUPACK LAKE ESTATES LACKAWANNA COLLEGE SOUTHERN WAYNE CHAMBER GOLD KEY MEDICAL STAFF WMH WALLENPAUPACK AREA SCHOOL DISTRICT WILD ACRES NHS - NORTHWEST HUMAN SERVICES (BH) WAYNE CO QUALITY COUNSEL FAWN LAKE NORTH POCONO SCHOOL DISTRICT WAYNE COUNTY AREA AGENCY ON AGING WOODLOCH NORTHAMPTON COMMUNITY COLLEGE WAYNE COUNTY BUILDERS ASSOCIATION GRACE EPISCOPAL CHURCH NORTHEAST INNOVATION ALLIANCE WAYNE COUNTY CHAMBER LUTHERAN CHURCH PA STATE HEALTH IMPROVEMENT PLAN WAYNE COUNTY EMS THE ASSESSMENT WAS GUIDED BY A 17 MEMBER ADVISORY COMMITTEE REPRESENTATIVE OF HEALTH, EDUCATION AND GOVERNMENT CAPACITIES SERVING THE NORTHEASTERN PENNSYLVANIA AREA: KEN BANNON, WAYNE MEMORIAL COMMUNITY HEALTH CENTER SEN. LISA BAKER, PENNSYLVANIA STATE SENATE PAUL CANEVARI, PENNSYLVANIA POWER + LIGHT RICH CARIDI, PIKE COUNTY COMMISSIONERS DONNA DECKER, WAYNE MEMORIAL HOSPITAL JACK DENNIS, WAYNE MEMORIAL HOSPITAL BILL DEWAR, WAYNE MEMORIAL HOSPITAL SALVADOR GUERRERO, WAYNE MEMORIAL HOSPITAL KATHY FINSTERBUSCH, PENNSYLVANIA DEPARTMENT OF HEALTH DAVE HOFF, WAYNE MEMORIAL HOSPITAL JOANN HUDAK, WALLENPAUPACK SCHOOL DISTRICT FRED JACKSON, WAYNE MEMORIAL COMMUNITY HEALTH CENTER WENDELL KAY, WAYNE COUNTY COMMISSIONERS PAUL MEAGHER, REMAX LEE OAKES, WAYNE MEMORIAL HOSPITAL BOARD JIM PETTINATO, WAYNE MEMORIAL HOSPITAL MARTHA WILSON, WAYNE MEMORIAL HOSPITAL COMMUNITY ADVISORY BOARD
SCHEDULE H, PART V, SECTION B, LINE 11	ADDRESSING IDENTIFIED NEEDS: ALTHOUGH WAYNE MEMORIAL HOSPITAL RECOGNIZES THE IMPORTANCE OF ALL THE NEEDS IDENTIFIED BY THE COMMUNITY, CERTAIN NEEDS ARE NOT WITHIN THE PURVIEW OF WMH AND ARE NOT ADDRESSED. THE ATTACHED IMPLEMENTATION STRATEGY DESCRIBES THE NEEDS BEING MET, AS WELL AS THE ORGANIZATION RESPONSIBLE TO ADDRESS THE IDENTIFIED NEEDS AND THE STATUS OF THE STRATEGY TO ADDRESS SUCH NEEDS.
SCHEDULE H, PART V, SECTION B, LINE 22D	MAXIMUM AMOUNTS CHARGED TO FAP-ELIGIBLE INDIVIDUALS: IF A PATIENT IS FAP-ELIGIBLE, THEY WOULD RECEIVE A 100% DISCOUNT. THEREFORE, THEY WOULD NOT BE CHARGED MORE THAN ANY OTHER INDIVIDUAL.

Schedule H (Form 990) 2014

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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?
Name and address		Type of Facility (describe)
1
2
3
4
5
6
7
8
9
10

Schedule H (Form 990) 2014

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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 I, LINE 7I	CONTRIBUTIONS TO THE COMMUNITY: THE HOSPITAL SUBSIDIZED BOTH IN & OUT OF SCOPE (NON PRIMARY CARE SERVICES - PEDIATRICS, SURGEONS AND SPECIALIST) SERVICES OF WAYNE MEMORIAL COMMUNITY HEALTH CENTERS (WMCHC) WITH A CASH CONTRIBUTION OF $1,630,245. WMCHC'S SURGEONS AND SPECIALIST PROVIDE INPATIENT AND OUTPATIENT CARE AT WAYNE MEMORIAL HOSPITAL AS WELL AS SERVICES OUT OF THEIR HEALTH CENTER OFFICES. WMCHC PEDIATRIC PRACTITIONERS PROVIDE INPATIENT AND OUTPATIENT CARE AT WAYNE MEMORIAL HOSPITAL AND OUTPATIENT SERVICES IN THE HONESDALE AND CARBONDALE AREA. WMCHC WOULD NOT BE ABLE TO PROVIDE THESE SERVICES AND THEY WOULD NOT BE AVAILABLE IN THE COMMUNITY WITHOUT THE SUBSIDY.
SCHEDULE H, PART I, LINE 7, COLUMN F	PERCENT OF TOTAL EXPENSE: TO ARRIVE AT THE PERCENT OF TOTAL EXPENSES, THE DENOMINATOR WHICH EQUALS TOTAL EXPENSES PER PART IX, LINE 25, OF THE FORM 990 WAS REDUCED BY BAD DEBT EXPENSE. THE AMOUNT OF BAD DEBT EXPENSE THAT WAS REMOVED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN SCHEDULE H, PART I, LINE 7, COLUMN (F) WAS $8,012,792.
SCHEDULE H, PART I, LINE 7	COSTING METHODOLOGY: THE COST TO CHARGE RATIO CALCULATED ON IRS WORKSHEET 2 WAS USED IN THE CALCULATION OF COST ON IRS WORKSHEETS 1 AND 3.
SCHEDULE H, PART II	COMMUNITY BUILDING ACTIVITIES: WAYNE MEMORIAL HOSPITAL AND ITS AFFILIATES PROMOTE THE HEALTH AND WELLBEING OF THE COMMUNITIES IT SERVES THROUGH A VARIETY OF COMMUNITY BUILDING ACTIVITIES. WE FOCUS ON THE UNDERSERVED AND UNDERPRIVILEGED WITHIN OUR SERVICE AREA. THE RATIONALE, PROGRAM METHODOLOGY AND IMPLEMENTATION FOR THE FOLLOWING PROGRAMS ARE TYPICAL OF THE OTHER PROGRAMS DESCRIBED HEREIN AND SHOULD SERVE AS A MODEL FOR THOSE PROGRAMS IN ADDRESSING THE REQUIREMENTS OF THIS SECTION OF THE FORM. - THE IN-SCHOOL WALKING PROGRAM IS A PARTNERSHIP OF WAYNE MEMORIAL HOSPITAL, FOREST CITY REGIONAL SCHOOL DISTRICT (FCRSD), WALLENPAUPACK AREA (WASD), WAYNE HIGHLANDS (WHSD), AND WESTERN WAYNE SCHOOL DISTRICTS (WWSD). WMH PROVIDES LEADERSHIP, DIRECTION, TRACKING AND FACILITATION FOR THE PROGRAM THAT RUNS MONDAY THROUGH THURSDAY, FROM 6PM TO 8 PM, WHENEVER THE SCHOOLS ARE IN SESSION. THIS PROVIDES A SAFE AND FRIENDLY ENVIRONMENT FOR YOUNG, OLD, OR DISABLED PEOPLE TO EXERCISE. ALL SITES ARE HANDICAP ACCESSIBLE. IT ALSO PROVIDES A USER-FRIENDLY MODALITY TO DISTRIBUTE EDUCATIONAL MATERIALS. - HEALTH PROBLEMS: SEDENTARY LIFESTYLE, POOR NUTRITION, AND POOR BEHAVIORAL HEALTH SKILLS. THESE HAVE BEEN IDENTIFIED AS LEADING RISK FACTORS BY THE CENTERS FOR DISEASE CONTROL (CDC) AND THE PENNSYLVANIA DEPARTMENT OF HEALTH FOR OBESITY, HEART DISEASE, HYPERTENSION, AND A NUMBER OF OTHER CHRONIC DISEASES. - NEED/PROBLEM IDENTIFICATION: LOCALLY, THE NEED WAS IDENTIFIED IN TWO ASSESSMENT TOOLS. WMH'S 2013 COMMUNITY HEALTH NEEDS ASSESSMENT IDENTIFIED PREVENTION OF CHRONIC DISEASE AS A REGIONAL PRIORITY. THE TOGETHER FOR HEALTH PROGRAM (TFH) IS A PARTNERSHIP OF WMH AND WASD, WHSD, FCRSD, AND COMMUNITY AGENCIES THAT IDENTIFY AND ADDRESS THE NEEDS OF THE YOUTH. ONE COMPONENT OF THE PROGRAM ASSESSES THE HEALTH AND WELLNESS OF SEVENTH AND NINTH GRADERS BY A SELF-REPORTING ASSESSMENT TOOL. IN 2014-2015, 36% OF NINTH GRADERS AND 33% OF SEVENTH GRADERS SURVEYED WERE OVERWEIGHT AND 47% OF NINTH GRADERS AND 53% OF SEVENTH GRADERS HAD LESS THAN 5 DAYS A WEEK WITH PHYSICAL ACTIVITY. PARALLEL NEGATIVE DATA ALSO OCCURRED IN THE AREA OF NUTRITION AND BEHAVIORAL HEALTH SKILLS. THIS PROVIDES DIRECTION FOR IN-SCHOOL TFH WORKSHOPS AND OTHER COMMUNITY BENEFIT ACTIVITIES, INCLUDING THE IN-SCHOOL WALKING PROGRAM. - IMPORTANCE OF HEALTH PROBLEM: LACK OF EXERCISE, POOR NUTRITION AND POOR BEHAVIORAL HEALTH SKILLS HAS MANIFOLD NEGATIVE EFFECTS ON INDIVIDUALS OF ALL AGES AND INCOME LEVELS AS SEEN IN OUR HIGH RATE OF CHRONIC DISEASE. RURAL, LOW INCOME, ELDERLY OR DISABLED INDIVIDUALS ARE PARTICULARLY VULNERABLE. THE IN-SCHOOL WALKING PROGRAM PROVIDES AN OPPORTUNITY TO LEARN, WALK, AND SOCIALIZE WHILE BEING IN A SAFE ATMOSPHERE CLOSE TO THEIR HOME. THE IN-SCHOOL WALKING PROGRAM PROVIDES ACCESS OF SERVICES TO ABOUT 400 PEOPLE WITHIN SCHOOL HALLWAYS NOT IN USE BY THE SCHOOL DURING THOSE HOURS. - ACTIVITY IMPACT: PARTICIPANTS' RESPONSES TO THE PROGRAMS INDICATE THAT IT HELPS MOTIVATE THEM TO FEEL BETTER, LOSE WEIGHT, ENJOY FELLOWSHIP, INCREASE ENERGY LEVELS, AND HOLD A BETTER SELF-IMAGE THAN PRIOR TO THEIR PARTICIPATION. THEY ALSO HAVE AN IMPROVED KNOWLEDGE BASE ON AWARENESS AND PREVENTION OF MANY HEALTH ISSUES - STROKE, HEART DISEASE, DIABETES, TRAUMA, ASTHMA, COPD, SLEEP APNEA, JUST TO NAME A FEW. - COMMUNITY BENEFIT: ENHANCING PUBLIC HEALTH, ADVANCING THE QUALITY OF LIFE, ULTIMATELY, AND RELIEF OF THE BURDEN OF SOCIETY OF CARING FOR THOSE WITH PREVENTABLE CHRONIC ILLNESS. INDIVIDUALS WHO HAVE SEDENTARY AND NEGATIVE LIFESTYLES ARE THE PRINCIPAL BENEFICIARIES OF THIS PROGRAM. - PURPOSE: THE WMH COMMUNITY HEALTH DEPARTMENT HAS RESPONDED TO OPPORTUNITIES FOR INVOLVEMENT IN COMMUNITY BENEFIT INITIATIVES BY ENTHUSIASTICALLY DEDICATING THEIR TIME, EXPERTISE, AND RESOURCES. THE PRIMARY SUPPORT OF THE IN-SCHOOL WALKING PROGRAM COMES FROM THE FOUR SCHOOL DISTRICTS AND WMH USE OF SOCIAL MEDIA, WEB PAGES, IN-KIND SERVICES, ETC. THE 700+ MEMBERS OF PENNSYLVANIA STATE HEALTH IMPROVEMENT PLAN (SHIP) PARTNERSHIP FOR WAYNE AND PIKE COUNTIES SUPPORT THE WALKING PROGRAM THROUGH POSTING FLYERS, SOCIAL MEDIA, PRESENTATIONS, AND PARTICIPATION. WMH IS THE LEAD AGENCY FOR THE PIKE/WAYNE SHIP PARTNERSHIP. THE SHIP PARTNERSHIP IDENTIFIES NEEDS AND BECOMES A CATALYST FOR CHANGE TO ACCOMPLISH A HEALTHIER COMMUNITY AND REDUCES THE BURDEN ON MANY GOVERNMENT ENTITIES. BOLD GOLD MEDIA, A LOCAL RADIO STATION, PROVIDES PUBLIC SERVICE ANNOUNCEMENTS AND WMH COMMUNITY HEALTH DEPARTMENT PROVIDES A WEEKLY RADIO BROADCAST "HEALTHWORKS" THAT AIRS ON TWO STATIONS. DURING FYE 6/30/15, THE ABOVE METHODOLOGY COULD BE APPLIED TO ANY OF THE GREATER THAN 225 PROGRAMS PROVIDING SERVICES TO GREATER THAN 13,900 PEOPLE. THIS INCLUDES HEALTH FAIRS, RESOURCE DAYS, SPEAKERS, PRESENTERS, RADIO SHOWS, WORKSHOPS, SEMINARS, WELLNESS PROGRAMS, NUTRITION CLASSES, DIABETES CLASSES, STROKE AWARENESS, SMOKING CESSATION, AND DEPRESSION SCREENING, TO NAME A FEW.
SCHEDULE H, PART III, SECTION A, LINE 2	BAD DEBT EXPENSE: THE BAD DEBT COST ENTERED ON LINE 2 WAS CALCULATED BY TAKING THE BAD DEBT EXPENSE SHOWN ON THE HOSPITAL'S FINANCIALS STATEMENT ($8,012,792).
SCHEDULE H, PART III, SECTION A, LINE 3	BAD DEBT EXPENSE ATTRIBUTABLE TO CHARITY CARE: THE HOSPITAL DOES NOT TRACK BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY. IF THIS HOSPITAL IS AWARE OR BECOMES AWARE OF A PATIENT'S ELIGIBILITY FOR CHARITY CARE THEN BAD DEBT EXPENSE WOULD NOT BE RECORDED FOR SUCH A PATIENT. CHARITY CARE WOULD BE RECORDED IF THAT PATIENT IS ELIGIBLE.
SCHEDULE H, PART III, SECTION A, LINE 4	BAD DEBT EXPENSE FOOTNOTE: THE HOSPITAL'S FINANCIAL STATEMENTS DID NOT CONTAIN A FOOTNOTE THAT DESCRIBED BAD DEBT EXPENSE. THE HOSPITAL RECORDS BAD DEBT EXPENSE AS THE BALANCE IS WRITTEN OFF ON A GIVEN ACCOUNT. IF THERE ARE NO PAYMENTS OR ADJUSTMENTS ON THE ACCOUNT THE AMOUNT WRITTEN OFF WOULD REPRESENT THE AMOUNT CHARGED FOR SERVICES. IF THERE ARE PAYMENTS AND/OR ADJUSTMENTS THEN THE AMOUNT WRITTEN OFF WOULD BE THE NET BALANCE OF THE ACCOUNT. THE ADJUSTMENTS ON THE ACCOUNT WOULD BE FOR CONTRACTUAL ADJUSTMENTS WITH THIRD PARTIES INCLUDING MEDICARE, MEDICAID AND COMMERCIAL INSURERS AS WELL AS ANY OTHER DISCOUNT AVAILABLE TO ALL PATIENTS. ACCOUNTS ARE WRITTEN OFF WHEN THEY ARE DETERMINED TO BE UNCOLLECTIBLE BASED UPON MANAGEMENT'S ASSESSMENT OF INDIVIDUAL ACCOUNTS. THE ALLOWANCE OF DOUBTFUL COLLECTIONS IS ESTIMATED BASED UPON A PERIODIC REVIEW OF THE ACCOUNTS RECEIVABLE AGING, PAYER CLASSIFICATIONS AND APPLICATION OF HISTORICAL WRITE-OFF PERCENTAGES.
SCHEDULE H, PART III, SECTION B, LINE 8	COMMUNITY BENEFIT: THE HOSPITAL BECAME A SOLE COMMUNITY HOSPITAL (SCH) EFFECTIVE DECEMBER 8, 2013. PRIOR TO THAT THE HOSPITAL WAS MEDICARE DEPENDENT HOSPITAL (MDH). A MDH MUST HAVE 60% OF ITS INPATIENT DAYS OR ADMISSIONS ATTRIBUTABLE TO ITS MEDICARE PATIENTS IN 2 OUT OF 3 OF ITS MOST RECENT FISCAL YEARS. MDH IS PAID SIMILARLY TO A SOLE COMMUNITY HOSPITAL BUT AT A LESSER RATE. A MDH IS PAID THE GREATER OF THE FEDERAL INPATIENT PROSPECTIVE PAYMENT SYSTEM (IPPS) RATES OR 75% OF THE DIFFERENCE BETWEEN THE HOSPITAL SPECIFIC COST FOR A BASE PERIOD ROLLED FORWARD FOR MARKET BASKET INCREASES FROM THE BASE PERIOD AND THE IPPS RATES. A SCH RECEIVES 100% OF THE HOSPITAL SPECIFIC COST ROLLED FORWARD FOR FUTURE PERIODS BY MARKET BASKET INCREASES DETERMINED BY THE MEDICARE PROGRAM.
SCHEDULE H, PART III, SECTION C, LINE 9B	COLLECTION POLICY: THE WRITTEN HOSPITAL COLLECTION POLICY CONTAINS PROVISION FOR FINANCIAL COUNSELING FOR PATIENT INCLUDING APPLYING TO INSURANCE AVAILABLE SUCH AS BLUE CHIP OR ADULT BASIC. ASSISTANCE WILL ALSO BE PROVIDED TO HELP PATIENT WITH MEDICAL ASSISTANCE APPLICATIONS AND CHARITY CARE APPLICATIONS. CHARITY CARE APPLICANTS ARE URGED TO APPLY FOR MEDICAL ASSISTANCE BUT IT IS NOT A REQUIREMENT. QUALIFICATION FOR CHARITY CARE IS BASED ON 200% OF THE CURRENT FEDERAL POVERTY GUIDELINES. THE PATIENT ACCOUNTS MANAGER REVIEWS THE APPLICATIONS AND NOTIFIES THE APPLICANT WHETHER THEIR APPLICATION HAS BEEN APPROVED. THOSE PATIENTS QUALIFYING FOR CHARITY CARE HAVE THEIR PATIENT ACCOUNT BALANCES WRITTEN OFF COMPLETELY. IF A PATIENT HAS FUTURE BILLS THEY ARE REVIEWED AND IF FINANCIAL INFORMATION IS STILL CURRENT THEY ARE ALSO WRITTEN OFF. IF THE PATIENT HAS A FUTURE BILL AND THE FINANCIAL INFORMATION IS NOT CURRENT WE REQUEST THE CURRENT INFORMATION SO WE CAN REVIEW FOR CHARITY CARE.
SCHEDULE H, PART VI, LINE 2	NEEDS ASSESSMENT: THE COMMUNITY NEEDS ASSESSMENT METHODOLOGY THAT WAYNE MEMORIAL HOSPITAL USED RELATED TO THE TIME FRAME 7/1/2012 - 6/30/2013 FOLLOWED A MODEL THAT INVOLVED CONTRACTING WITH AN OUTSIDE ORGANIZATION, A CONSULTING FIRM, TO CONDUCT THE STUDY. THIS ASSESSMENT CONFORMS TO THE IRS REQUIREMENT THAT NONPROFIT HOSPITALS MUST COMPLETE A COMMUNITY NEEDS ASSESSMENT EVERY THREE YEARS. WAYNE MEMORIAL HOSPITAL BEGAN A NEW COMPLIANT NEEDS ASSESSMENT IN DECEMBER 2012 AND COMPLETED IT IN JUNE OF 2013. - BACKGROUND: IN THE FALL OF 2012, UNDER THE GUIDANCE OF WAYNE MEMORIAL HOSPITAL, A GROUP OF INDIVIDUALS REPRESENTING VARIOUS HEALTH CARE AND HUMAN SERVICE PROVIDERS IN WAYNE AND PIKE COUNTIES, PA AND THE COMMUNITY OF CARBONDALE IN LACKAWANNA COUNTY, PA MET TO CONSIDER A PLAN TO PRODUCE A COMPREHENSIVE NEEDS AND RESOURCE ASSESSMENT FOR THE AREA. THE PRODUCT WOULD BENEFIT HEALTH CARE AND HUMAN SERVICE PROVIDER ORGANIZATIONS/AGENCIES AND LOCAL GOVERNMENTS IN PIKE AND WAYNE COUNTIES IN TERMS OF ORGANIZATIONAL POLICY CONSIDERATIONS AND IN PREPARATION OF FUNDING PROPOSALS TO GOVERNMENTAL AND PRIVATE FUNDERS. AS A RESULT OF THAT ORIGINAL MEETING, A COMMUNITY NEEDS ASSESSMENT STEERING COMMITTEE WAS STARTED AS AN INDEPENDENT GRASS ROOTS COLLABORATION OF COMMUNITY ACTIVISTS, HEALTH CARE PROVIDERS AND EDUCATORS THAT BEGAN REGULAR MEETINGS TO COMPOSE A REQUEST FOR PROPOSALS (RFP) TO ACCOMPLISH THE ASSESSMENT. THE COMMITTEE INCLUDED REPRESENTATIVES FROM WAYNE MEMORIAL HOSPITAL (WMH), WAYNE MEMORIAL COMMUNITY HEALTH CENTERS, THE CARBONDALE AREA, WAYNE AND PIKE COUNTY GOVERNMENTS, PPL, INC., THE PIKE INTERAGENCY COUNCIL AND AREA SCHOOL DISTRICTS. AN RFP WAS CREATED AND SENT TO QUALIFIED REGIONAL CONSULTING FIRMS TO COMPLETE A COMMUNITY HEALTH AND HUMAN SERVICES NEEDS AND RESOURCES ASSESSMENT FOR THE COUNTIES OF PIKE AND WAYNE AND THE COMMUNITY OF CARBONDALE IN LACKAWANNA AND SURROUNDING AREAS IN NORTHEASTERN PENNSYLVANIA. - THE ASSESSMENT: IN JANUARY 2013, A FIRM WAS CHOSEN, HMS ASSOCIATES OF GETZVILLE, NY, THAT HAD PERFORMED A SIMILAR HEALTH NEEDS ASSESSMENT FOR WAYNE AND PIKE IN 2009 AND ANOTHER SIMILAR ASSESSMENT FOR PIKE COUNTY IN 2004. FROM FEBRUARY THROUGH JUNE 2013 THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) WAS PERFORMED INVOLVING STATISTICAL DATA COLLECTION FROM SOURCES IN PENNSYLVANIA, NEW YORK AND NEW JERSEY WAS CONSIDERED ALONG WITH COMMUNITY PERCEPTIONS AND LOCAL EXPERT OPINIONS GATHERED THROUGH NUMEROUS FOCUS GROUPS, ONE-ON-ONE INTERVIEWS AND AN IN-DEPTH ONLINE COMMUNITY SURVEY DEVELOPED BY HMS. - GEOGRAPHIC AREA ASSESSED: THE AREA ASSESSED WERE THE COUNTIES OF WAYNE AND PIKE, PA AND THE COMMUNITY OF CARBONDALE AND ITS SURROUNDINGS IN LACKAWANNA AND PORTIONS OF SUSQUEHANNA COUNTY, PA. - HOW FREQUENTLY THE ASSESSMENT IS CONDUCTED: THE FIRST INCIDENCE OF A NEEDS ASSESSMENT OF THIS DEPTH FOR THE HOSPITAL'S SERVICE AREA WAS THE ONE PERFORMED IN 2009, REFERRED TO IN THE ASSESSMENT ABOVE. PRIOR TO THAT, CHNAS WERE PERFORMED INTERNALLY APPROXIMATELY EVERY THREE YEARS UNDER THE DIRECTION OF THE WAYNE MEMORIAL HOSPITAL COMMUNITY ADVISORY BOARD STARTING IN 1996. IT IS THE INTENTION OF WAYNE MEMORIAL TO FULFILL THE REQUIREMENT OF THE IRS COMMUNITY BENEFIT MANDATE TO PERFORM A SIMILAR NEEDS ASSESSMENT TO THE 2009 STUDY EVERY THREE YEARS. - PROCESS FOR PRIORITIZING NEEDS: AN IN-DEPTH ANALYSIS WAS MADE OF ALL COLLECTED DATA, WHICH WAS WEIGHTED THROUGH A FORMULA DEVELOPED THAT JUXTAPOSED DATA COLLECTED FOLLOWING MASLOW'S HIERARCHY OF NEEDS AND EMPIRICAL EMPHASIS IDENTIFIED BY EXPERTS AND PROVIDERS INVOLVED IN THE STUDY. THIS FORMULA WAS USED TO ESTABLISH A FINAL ACTIONABLE LIST OF THE HIGHEST PRIORITY HEALTH SERVICE NEEDS FOR THE TWO-COUNTY REGION. THOSE PRIORITY ITEMS WERE ANALYZED AND PRIORITIZED BY THE HOSPITAL'S STRATEGY COMMITTEE AND AN IMPLEMENTATION PLAN WAS DEVELOPED BY THE COMMITTEE AND ULTIMATELY APPROVED BY THE WAYNE MEMORIAL HOSPITAL BOARD OF TRUSTEES IN OCTOBER 2013 (THE EXTENDED DEADLINE APPROVED BY THE IRS FOR THIS YEAR'S CHNA IMPLEMENTATION PLAN). THE TOP IDENTIFIED NEEDS WERE: 1. MENTAL HEALTH AND SUBSTANCE ABUSE 2. CHRONIC DISEASES 3. NEWBORN HEALTH 4. PREVENTABLE INPATIENT CARE 5. IMPROVED ACCESS TO PHYSICIAN SPECIALISTS 6. TRANSPORTATION 7. TRANSLATION 8. COUNSELING 9. HELP UNDERSTANDING MEDICAL CARE AND ACCESS 10. SUPPORT GROUPS - AVAILABILITY OF THE ASSESSMENT TO THE COMMUNITY: THE FINAL ASSESSMENT PRODUCT WAS MADE AVAILABLE TO THE GENERAL PUBLIC VIA WAYNE MEMORIAL HOSPITAL'S WEB SITE AND INCLUDES A 21 PAGE CHNA EXECUTIVE SUMMARY AND AN 89 PAGE CHNA USER GUIDE THAT CAN BE PRINTED. THE USER GUIDE INCLUDES THE DETAILED RESULTS OF THE ONLINE COMMUNITY SURVEY PERFORMED AS PART OF THE STUDY.
SCHEDULE H, PART VI, LINE 3	PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: THE HOSPITAL EDUCATES AND INFORMS PATIENTS AND PERSONS WHO MAY BE BILLED FOR PATIENT CARE ABOUT THEIR ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL, STATE OR LOCAL GOVERNMENT PROGRAMS OR UNDER THE HOSPITAL'S CHARITY CARE POLICY THROUGH ITS SCHEDULING, REGISTRATION, SOCIAL SERVICES AND BILLING DEPARTMENTS. ITS PATIENTS AND PERSONS WHO MAY BE BILLED FOR PATIENT CARE ARE ALSO MADE AWARE OF THEIR ELIGIBILITY THROUGH WMCHC A CLINICAL AFFILIATE OF THE HOSPITAL WHO RECEIVES SUBSTANTIAL FINANCIAL SUPPORT FROM THE HOSPITAL AND IS A FEDERALLY QUALIFIED HEALTH CENTER. FEDERALLY QUALIFIED HEALTH CENTERS IMPROVE THE HEALTH OF THE NATION'S UNDERSERVED COMMUNITIES AND VULNERABLE POPULATIONS BY ASSURING ACCESS TO COMPREHENSIVE, CULTURALLY COMPETENT, QUALITY PRIMARY HEALTH CARE SERVICES. HEALTH CENTER PROGRAM GRANTS SUPPORT A VARIETY OF COMMUNITY-BASED AND PATIENT-DIRECTED HEALTH CARE SERVICES, PRINCIPALLY TO AN INCREASING NUMBER OF THE NATION'S UNDERSERVED. PATIENTS AND OTHERS ARE MADE AWARE OF THE PROGRAMS AVAILABLE ANYTIME FROM THE SCHEDULING OF AN APPOINTMENT TO FINAL DISPOSITION OF THEIR BILL IF THERE IS ANY INDICATION OF THE NEED OR REQUEST FOR HELP IN PAYING FOR SERVICES BEING SCHEDULED, PROVIDED OR BILLED FOR. WAYNE MEMORIAL HOSPITAL, THROUGH ITS NETWORK OF 700 STATE HEALTH IMPROVEMENT PLAN (SHIP) PARTNERS (ORGANIZATIONS, AGENCIES, BUSINESSES, SCHOOLS, TASK FORCES, COALITIONS, RELIGIOUS GROUPS, AND INDIVIDUALS) PROVIDE THE MODALITY FOR DELIVERING WRITTEN INFORMATION, VERBAL EXPLANATION AND ASSISTANCE IN COMPLETING FORMS FOR THE MOST VULNERABLE POPULATION. THE INFORMATION & SERVICES ARE AVAILABLE AT MANY OF OUR OUTREACH FUNCTIONS. THE BROCHURE "FINANCIAL AID POLICY & GUIDELINES" IS AVAILABLE AT OUTPATIENT REGISTRATION DESKS AND AT APPROPRIATE COMMUNITY OUTREACH FUNCTIONS. IT CONTAINS INFORMATION OF ELIGIBILITY FOR FINANCIAL AID AT WMH, AND HOW TO APPLY FOR MEDICAL ASSISTANCE, MEDICAID, OR FINANCIAL AID. IT CONTAINS THE CONTACT INFORMATION FOR THE WAYNE MEMORIAL COMMUNITY HEALTH CENTERS' OUTREACH AND ENROLLMENT COORDINATORS AND THE 2016 US POVERTY INCOME GUIDELINES. PHYSICIAN DIRECTORS ARE AVAILABLE AT OUTREACH PROGRAMS. ON THE WMH WEBSITE, THERE IS A "FIND A DOC" TAB TO ASSIST PATIENTS IN FINDING AN APPROPRIATE PHYSICIAN AND WMH COMMUNITY HEALTH HAS A PHYSICIAN REFERRAL PHONE LINE PROVIDING PERSONAL ASSISTANCE. THIS INFORMATION IS DISCUSSED PERIODICALLY ON THE "HEALTHWORKS" WEEKLY RADIO SHOW. WHEN NECESSARY, WE PROVIDE ASSISTANCE FOR THOSE WITH LANGUAGE BARRIERS IN BOTH TRANSLATION AND SIGN LANGUAGE.
SCHEDULE H, PART VI, LINE 4	COMMUNITY INFORMATION: THE PRIMARY SERVICE AREA OF WAYNE MEMORIAL HOSPITAL INCLUDES ALL OF WAYNE COUNTY, PENNSYLVANIA AND ALL OF WESTERN, NORTHERN AND PORTIONS OF EASTERN AND SOUTHERN PIKE COUNTY, PA; THE SOUTHEASTERN PORTION OF SUSQUEHANNA COUNTY, PA; THE COMMUNITY OF CARBONDALE AND ITS IMMEDIATELY SURROUNDING COMMUNITIES IN LACKAWANNA COUNTY, PA; AND THE SOUTHWESTERN PORTION OF WESTERN SULLIVAN COUNTY, NEW YORK. THE SECONDARY SERVICE AREA INCLUDES THE BALANCE OF PIKE COUNTY AND EASTERN PORTIONS OF LACKAWANNA AND SUSQUEHANNA AND NORTHERN MONROE COUNTY IN PENNSYLVANIA. ALTHOUGH SOME PORTIONS OF PIKE COUNTY THAT ARE INCLUDED IN THE NEWBURGH, NY MSA (METROPOLITAN STATISTICAL AREA) AND ALL OF LACKAWANNA COUNTY, WHICH ARE CLASSIFIED AS URBAN, THE WMH SERVICE AREA IS PREDOMINANTLY RURAL. - SERVICE AREA CONGRESSIONAL DISTRICTS: THE CONGRESSIONAL DISTRICTS INCLUDED IN THE WMH SERVICE AREA ARE PA-10 AND NY-22. - SERVICE AREA CENSUS TRACTS: THE CENSUS TRACTS INCLUDED IN THE WMH SERVICE AREA ARE THE FOLLOWING: 9502, 9523, 9524, 9601, 9602, 9603, 9604, 9605, 9606, 9607, 9608, 9609, 9610, 9611, 9612, 9613, 9614, 1101, 1106, 1107, 1108, AND 1109. - SERVICE AREA ZIP CODES: THE ZIP CODES INCLUDED IN THE WMH SERVICE AREA ARE THE FOLLOWING: 12723, 12741, 12748, 12764, 18324, 18328, 18336, 18337, 18403, 18405, 18407, 18413, 18414, 18415, 18417, 18421, 18425, 18426, 18427, 18428, 18431, 18433, 18436, 18437, 18439, 18443, 18444, 18445, 18453, 18455, 18461, 18462, 18463, 18470, 18472. - HOSPITALS IN SERVICE AREA: THE ONLY HOSPITAL IN WAYNE CO., PA IS WAYNE MEMORIAL HOSPITAL, A NONPROFIT ACUTE CARE COMMUNITY-BASED HOSPITAL; THERE IS NO HOSPITAL LOCATED IN PIKE COUNTY, PA; THE ONLY HOSPITAL IN THE PORTION OF MONROE CO., PA THAT IS PART OF WMH'S SERVICE AREA IS POCONO MEDICAL CENTER, A NONPROFIT ACUTE CARE HOSPITAL; THE ONLY HOSPITAL IN THE PORTION OF LACKAWANNA CO., PA THAT IS PART OF WMH'S SERVICE AREA WAS MARION COMMUNITY HOSPITAL, A CRITICAL ACCESS HOSPITAL THAT CLOSED ITS DOORS ON FEBRUARY 28, 2012; THERE ARE NO HOSPITALS IN THE PORTIONS OF SULLIVAN CO., NY OR SUSQUEHANNA COUNTY, PA THAT ARE PARTS OF WMH'S SERVICE AREA. - MEDICALLY UNDERSERVED AREAS: FEDERALLY DESIGNATED MEDICALLY UNDERSERVED AREAS (MUAS) IN THE WMH SERVICE AREA INCLUDE THE FOLLOWING: LACKAWANNA CO., MUA - 8 CENSUS TRACTS; MONROE CO., STROUDSBURG - LOW INCOME MUP; PIKE CO. - GREENE SERVICE AREA, MUA; WAYNE CO. - DAMASCUS SERVICE AREA MUA; SULLIVAN CO., NY - 3 LOW INCOME MUPS. HEALTH PROFESSIONAL SHORTAGE AREAS (HPSAS) INCLUDE LACKAWANNA - 4 SERVICE AREAS; PIKE -4 SERVICE AREAS; SUSQUEHANNA - 8 SERVICE AREAS; WAYNE - 10 SHORTAGE AREAS. - COMMUNITY DEMOGRAPHICS: BESIDES THE INCREASE IN WMH'S SERVICE AREA CAUSED BY THE AFOREMENTIONED CLOSURE OF MARION COMMUNITY HOSPITAL IN CARBONDALE, THE CONTINUED RATE OF RAPID GROWTH OF THE POPULATION OVER THE PAST DECADE IS ONE OF THE MOST SIGNIFICANT ASPECTS OF THE WMH SERVICE AREA. THE MOST RECENT POPULATION ESTIMATE PROVIDED BELOW FOR THE 2013, HOWEVER, SHOWS A REVERSAL OF THE DECADES-LONG GROWTH FOR PIKE COUNTY. THE TARGET POPULATION FOR WMH AND WMCHC SERVICES IS COMPRISED OF PREDOMINANTLY LOW INCOME, DISPROPORTIONATELY ELDERLY, MOBILITY/TRANSPORTATION CHALLENGED, OFTEN SIGNIFICANTLY OVERWEIGHT AND PRONE TO REFRAIN FROM HEALTH-RELATED PHYSICAL ACTIVITIES. THEY ARE FREQUENTLY UNMOTIVATED TO TAKE RESPONSIBILITY FOR THEIR HEALTH STATUS. THE CORE OF THE HOSPITAL'S USERS CONSISTS IN LARGE PART OF RURAL LOW TO MODERATE INCOME RESIDENTS. ANOTHER DOMINANT FACTOR OF SERVICE AREA DEMOGRAPHICS IS THE SIGNIFICANT IN-MIGRATION THAT WAYNE, AND ESPECIALLY PIKE, COUNTIES' POPULATIONS HAVE EXPERIENCED IN RECENT TIMES. THE 2010 U. S. CENSUS SHOWED THAT THE AREA POPULATION INCREASED FOR THE SERVICE AREAS FROM THE 2000 CENSUS : PIKE SHOWED THE LARGEST GROWTH 23.9% TO 57,369; WAYNE GREW 10.7% TO 52,822; SULLIVAN (NY) 4.9% TO 77,547; AND, LACKAWANNA 0.6% TO 214,437. 2012 U. S. CENSUS BUREAU POPULATION ESTIMATES (THE MOST RECENT AVAILABLE FOR THE AREA) SHOWED A DROP IN POPULATION FOR THE AREA, WITH THE EXCEPTION OF LACKAWANNA CO., WHICH REMAINED ESSENTIALLY STABLE : LACKAWANNA + 0.1%; PIKE - 0.9%; SULLIVAN (NY) -1.0%; SUSQUEHANNA -1.6%; AND WAYNE -1.7%. A SIGNIFICANT NUMBER OF THE NEW RESIDENTS THAT ARRIVED IN THE 2000-2010 DECADE CAME WITHOUT ESTABLISHED CARE PATTERNS. THE TWO-HOUR PROXIMITY TO NEW YORK CITY ACCELERATED THIS MIGRATION AFTER THE TERRORIST ATTACKS OF 2001. THESE MIGRANTS, IN LARGE PART, CONSIST OF LOW INCOME, YOUNG ADULTS AND FAMILIES SEEKING TO ESCAPE THE HIGH COST OF THE URBAN AREAS, ALONG WITH RETIREES MOVING FOR THE SAME REASON. THE RETIREES CONSIST OF BOTH MEDICARE AGE POPULATION AND A SIGNIFICANT NUMBER OF 55 TO 65 YEAR OLD RETIREES WITHOUT THE BENEFIT OF CORPORATE RETIREMENT BENEFITS AND THEY OFTEN PRESENT SEEKING SLIDING FEE SCALE SERVICES. BOTH MIGRANT GROUPS REPRESENT A SIGNIFICANT NEED FOR THE COMMUNITY. HAVING MOVED TO A DISTANT COMMUNITY, THESE PATIENTS OFTEN SEEK EPISODIC CARE AT VARIOUS LOCATIONS AND ARE ABUSERS OF EMERGENCY ROOM SERVICES. - RATES OF UNINSURED AND UNDERINSURED: (NOTE: SOME DATA SETS ARE NOT AVAILABLE IN THE 06-DEC-2012 OR 20133 SET. THE DATA PROVIDED ARE FROM THE 2006-2008 AMERICAN COMMUNITY SURVEY 3-YEAR ESTIMATES SURVEY.) ACCORDING TO THE U. S. CENSUS BUREAU, 2006-2008 ACS ESTIMATES, SERVICE AREA POPULATION OF UNINSURED NUMBERS IS 8,849, OR 8.0% OF THE POPULATION. - PERCENT OF FAMILIES ON MEDICAID OR OTHER ASSISTANCE: ACCORDING TO THE U. S. CENSUS BUREAU, 2006-2008 AMERICAN COMMUNITY SURVEY 3-YEAR ESTIMATES, THE NUMBER OF FAMILIES IN THE SERVICE AREA ON MEDICAID IS 16,639, OR 15.1% OF THE POPULATION. - AGE BREAKDOWN AND RECENT TRENDS: ACCORDING TO THE U. S. CENSUS BUREAU, 2006-2008 AMERICAN COMMUNITY SURVEY 3-YEAR ESTIMATES, AGE BREAKDOWN OF THE SERVICE AREA POPULATION IS AS FOLLOWS: UNDER 5 YEARS OF AGE 4,954 OR 4.5% 5-17 YEARS 12,373 OR 11.2% 18-34 YEARS 18,070 OR 16.4% 35-64 YEARS 46,874 OR 42.5% 65 AND OLDER 27,297 OR 24.8% - PERCENTAGES OF NON-ENGLISH SPEAKING POPULATIONS: ACCORDING TO THE U. S. CENSUS BUREAU AMERICAN COMMUNITY SURVEY, 06-DEC-2012, NON-ENGLISH SPEAKING POPULATIONS IN THE SERVICE AREA AVERAGE 6.9% OF THE TOTAL POPULATION. MAJOR HEALTH PROBLEMS AND HEALTH STATISTICS: THE FOLLOWING SELECT HEALTH CAUSES OF DEATH AND STATISTICS ARE INDICATIVE OF MAJOR AREAS OF CONCERN FOR THE SERVICE AREA (ALL DERIVE FROM HEALTHY PEOPLE 2020 INITIATIVES, 2009 DATA SETS): (NOTE: CARBONDALE DATA IS ENCOMPASSED IN LACKAWANNA COUNTY STATISTICS.) CORONARY HEART DISEASE - (# OF DEATHS/100,000): PIKE - 116.3; WAYNE - 174.6; LACKAWANNA - 166.7; PA - 128.3; HP2020 TARGET - 100.8 BREAST CANCER - (#OF DEATHS/100,000): PIKE - 21.2; WAYNE 27.7; LACKAWANNA - 21.6; PA 24.0; HP2020 TARGET -20.6 PROSTATE CANCER - (# OF DEATHS/100,000): PIKE - 23.5; WAYNE - 29.3; LACKAWANNA - 24.0; PA - 21.0; HP 2020 TARGET - 21.2 UNINTENTIONAL INJURY - (# OF DEATHS/100,000) PIKE - 37.6; WAYNE 57.0; LACKAWANNA - 42.8; PA 39.2; HP2020 TARGET -36.0 MOTOR VEHICLE CRASH - (# OF DEATHS/100,000): PIKE - 15.8; WAYNE - 26.9; LACKAWANNA - 14.8; PA - 12.2; HP 2020 TARGET - 10.2 SUICIDE - (# OF DEATHS /100,000): PIKE - 10.3; WAYNE - 16.3; LACKAWANNA - 14.8; PA - 12.2; HP 2020 TARGET - 10.2 YOUNG ADULT - (# OF DEATHS/100,000): PIKE - 192.8; WAYNE - 166.3; LACKAWANNA - 106.7; PA - 85.9; HP 2020 TARGET - 88.5 ALL CANCER - (# OF DEATHS/100,000): PIKE - 153.5; WAYNE - 197.2; LACKAWANNA - 195.4; PA - 184.0; HP 2020 TARGET - 160.6
SCHEDULE H, PART VI, LINE 5	PROMOTION OF COMMUNITY HEALTH: THE MAJORITY OF MEMBERS OF THE WAYNE MEMORIAL HOSPITAL GOVERNING BOARD ARE INDEPENDENT BOARD MEMBERS, COMPRISED OF RESIDENTS OF THE ORGANIZATION'S PRIMARY SERVICE AREA OF WAYNE AND PIKE COUNTY, PENNSYLVANIA. THERE IS ONLY ONE OF SEVENTEEN BOARD MEMBERS THAT HAS A RELATIONSHIP WITH AN EMPLOYEE OF THE HOSPITAL AND IS THEREFORE NOT INDEPENDENT. - THE WAYNE MEMORIAL HOSPITAL EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY FOR ALL OF ITS DEPARTMENTS, WITH THE EXCEPTION OF ANESTHESIOLOGY, LABORATORY AND RADIOLOGY, AS SERVICES IN THESE DEPARTMENTS ARE PROVIDED ON AN EXCLUSIVE BASIS TO BENEFIT PATIENT CARE. MEMBERS OF OUR MEDICAL STAFF ARE REQUIRED, WHILE PARTICIPATING AT THE HOSPITAL, TO TREAT ALL PATIENTS, REGARDLESS OF THEIR ABILITY TO PAY OR THEIR INSURANCE STATUS. - WAYNE MEMORIAL HOSPITAL UTILIZES ANY EXCESS FUNDS OVER EXPENSES TO IMPROVE PATIENT CARE, CONDUCT MEDICAL EDUCATION, OR SUPPORT OTHER NOT FOR PROFIT ORGANIZATIONS. - WAYNE MEMORIAL HOSPITAL'S EMERGENCY DEPARTMENT SERVES ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. - THE HOSPITAL PARTICIPATES IN MEDICARE, MEDICAID, CHAMPUS, TRI-CARE AND OTHER GOVERNMENTAL SPONSORED HEALTHCARE PROGRAMS. FURTHER, THE HOSPITAL HAS A CHARITY CARE POLICY, WHICH STRIVES TO QUALIFY THOSE PATIENTS FOR CHARITY CARE, WHO MEET CERTAIN INCOME LEVELS. - THE HOSPITAL IS A SAFETY NET HOSPITAL IN RURAL PENNSYLVANIA, AND IS DESIGNATED AS A MEDICARE DEPENDENT HOSPITAL. WMH COMMUNITY HEALTH UTILIZES THE SHIP PARTNERSHIP EMAIL STRING TO EMAIL TIMELY COMMUNICATION ON HEALTH AND WELLNESS OPPORTUNITIES. THE SHIP MEMBERSHIP UTILIZES WMH'S OFFER TO FORWARD APPROPRIATE INFORMATION THEREBY BUILDING COMMUNICATION AND BREAKING DOWN THE GAP IN COMMUNICATION. WMH PROVIDES SPACE IN THE LOBBY FOR WEEKLY DISPLAYS. WMH INTERVIEWS COMMUNITY PEOPLE ON THE WEEKLY RADIO SHOW. THE WAYNE MEMORIAL COMMUNITY ADVISORY BOARD IS MADE UP OF COMMUNITY MEMBERS FROM WAYNE, PIKE, AND LACKAWANNA COUNTIES. IT HAS 3 YOUTH MEMBERS PARTICIPATING ON THE BOARD. WMH IS REPRESENTED ON MANY COMMUNITY ADVISORY BOARDS, TASK FORCES, AND COALITIONS THAT ENHANCE THE HEALTH, WELLNESS, AND SAFETY OF OUR COMMUNITY AS WELL AS THE ECONOMIC GROWTH. WMH STAFF PROVIDES MENTORING, JOB SHADOWING, PROCTORSHIP, PRECEPTORSHIP FOR AND STUDENTS IN THE MEDICAL FIELD.
SCHEDULE H, PART VI, LINE 6	AFFILIATED HEALTH CARE SYSTEM: THE HOSPITAL IS PART OF AN AFFILIATED HEALTH CARE SYSTEM UNDER COMMON GOVERNANCE AND CONTROL THAT INCLUDES THE HOSPITAL AND WAYNE MEMORIAL LONG TERM CARE WHICH OPERATES WAYNE WOODLANDS MANOR. IT IS ALSO A CLINICAL AFFILIATE OF WAYNE MEMORIAL COMMUNITY HEALTH CENTERS (WMCHC) WHICH IT SUPPORTS CLINICALLY AND FINANCIALLY. WAYNE WOODLANDS MANOR WAS OPENED IN 1994 AND HAS PROVIDED AND CONTINUES TO PROVIDE SERVICES PRIMARILY TO MEDICAID RECIPIENTS (OVER 75% OF ITS RESIDENTS). MOST COUNTIES IN PENNSYLVANIA HAVE COUNTY OWNED AND OPERATED NURSING HOMES THAT PROVIDE SERVICES TO THIS SEGMENT OF THEIR COUNTY POPULATION. WAYNE COUNTY DOES NOT HAVE A "COUNTY" NURSING HOME. THIS COMMUNITY NEED IS MET BY WAYNE MEMORIAL LONG TERM CARE BY ITS OPERATION OF WAYNE WOODLANDS MANOR. THE HOSPITAL HAS SUPPORTED WMCHC WHICH SERVES A NUMBER OF MUA'S AND MUP'S. THE HOSPITAL HAS FINANCED WMCHC WORKING CAPITAL NEEDS WITH A LINE OF CREDIT THAT WAS AND CONTINUES TO BE NECESSARY BECAUSE THE COMMONWEALTH OF PENNSYLVANIA'S MEDICAID PROGRAM DID NOT PAY ADEQUATELY (PRIOR TO NOVEMBER 2010) NOR MAKE TIMELY SETTLEMENTS FOR CARE PROVIDED. IN ADDITION, THE WAYNE MEMORIAL HOSPITAL HAS AN AFFILIATION WITH THE COMMONWEALTH MEDICAL COLLEGE (SCRANTON, PA) FOR THE PROVISION OF CLINICAL EDUCATION EXPERIENCES AT THE HOSPITAL AND WITHIN THE COMMUNITY. THE HOSPITAL CONSIDERS THIS A RESPONSIBILITY CONSISTENT WITH ITS MISSION TO BE INVOLVED IN EDUCATION. WAYNE MEMORIAL HEALTH SYSTEM AND THE WAYNE MEMORIAL HOSPITAL PROVIDE SIGNIFICANT COMMUNITY BENEFITS IN TERMS OF NEEDED HEALTH CARE SERVICES, PROVIDING SERVICES REGARDLESS OF THE ABILITY TO PAY, CLINICAL EDUCATION, AND PROVIDING A VAST NETWORK OF PRIMARY CARE PHYSICIANS IN ITS SERVICE AREA.

Schedule H (Form 990) 2014

Additional Data

Software ID:
Software Version:

- TIN:

Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

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

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

Attach to Form 990.
lBullet

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

OMB No. 1545-0047

2014

Open to Public
Inspection

Name of the organization
WAYNE MEMORIAL HOSPITAL

Employer identification number
24-0798839

Part I

General Information on Grants and Assistance

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

Yes No

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

Part II

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

(a) Name and address of organization or government	(b) EIN	(c) IRC section if applicable	(d) Amount of cash grant	(h) Purpose of grant or assistance
(1) WAYNE MEMORIAL COMMUNITY HEALTH CENTER 601 PARK STREET HONESDALE,PA18431	23-2180889	501(C)(3)	1,630,245	EXEMPT PURPOSES

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

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

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

Cat. No. 50055P

Schedule I (Form 990) 2014

Page 2

Part III

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

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

Part IV

Supplemental Information. Provide the information required in Part I, line 2, Part III, column (b), and any other additional information.

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

Schedule I (Form 990) 2014

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

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

OMB No. 1545-0047

2014

Open to Public Inspection

Name of the organization

WAYNE MEMORIAL HOSPITAL

Employer identification number

24-0798839

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

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

Travel for companions Payments for business use of personal residence

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

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

If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain....

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
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? .........

Yes

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

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations 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) 2014

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 in column(B) 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)
1MIKE CLIFFORDCFO	(i) (ii)	0 ............................... 171,108	0 ............................... 33,259	0 ............................... 25,040	0 ............................... 28,084	0 ............................... 23,143	0 ............................... 280,634	0 ............................... 0
2DAVID HOFFCEO	(i) (ii)	0 ............................... 326,363	0 ............................... 78,441	0 ............................... 193,779	0 ............................... 22,912	0 ............................... 17,958	0 ............................... 639,453	0 ............................... 151,106
3JEFFERY MOGERMANPHYSICAN	(i) (ii)	647,771 ............................... 0	36,125 ............................... 0	0 ............................... 0	15,600 ............................... 0	16,672 ............................... 0	716,168 ............................... 0	0 ............................... 0
4LILLIAN LONGENDORFERPHYSICIAN	(i) (ii)	242,835 ............................... 0	0 ............................... 0	0 ............................... 0	13,817 ............................... 0	6,752 ............................... 0	263,404 ............................... 0	0 ............................... 0
5SHARIE L MORGANTICERTIFIED RN ANESTHETIST	(i) (ii)	160,208 ............................... 0	318 ............................... 0	0 ............................... 0	9,629 ............................... 0	0 ............................... 0	170,155 ............................... 0	0 ............................... 0
6DEBORAH H PUGHCERTIFIED RN ANESTHETIST	(i) (ii)	167,833 ............................... 0	314 ............................... 0	0 ............................... 0	0 ............................... 0	16,993 ............................... 0	185,140 ............................... 0	0 ............................... 0
7DAVID CAUCCIPHYSICIAN	(i) (ii)	420,478 ............................... 0	0 ............................... 0	0 ............................... 0	15,600 ............................... 0	17,958 ............................... 0	454,036 ............................... 0	0 ............................... 0
8JAMES PETTINATODIRECTOR OF PATIENT CARE SERVI	(i) (ii)	0 ............................... 116,406	0 ............................... 24,067	0 ............................... 18,146	0 ............................... 8,419	0 ............................... 17,958	0 ............................... 184,996	0 ............................... 0

Schedule J (Form 990) 2014

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

CEO COMPENSATION: WAYNE MEMORIAL HEALTH SYSTEM, A RELATED ORGANIZATION, DETERMINES THE COMPENSATION OF THE CEO USING THE FOLLOWING METHODS: COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. THE BOARD MAKES THE FINAL DECISION USING THE INFORMATION PROVIDED BY THE CONSULTANT.

SCHEDULE J, PART I, LINE 4B

SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN: WAYNE MEMORIAL HEALTH SYSTEM, A RELATED ORGANIZATION, COVERS THE FOLLOWING INDIVIDUALS WITH 457(F) SUPPLEMENTAL RETIREMENT AGREEMENTS (SERP). THE FOLLOWING INDIVIDUALS RECEIVED DISTRIBUTIONS THIS YEAR OF THE FOLLOWING AMOUNTS. THESE AMOUNTS ARE ALSO REPORTED ON SCHEDULE J, PART II, COLUMN F AS COMPENSATION DEFERRED ON PRIOR FORM 990S. DAVID HOFF: $151,106

Schedule J (Form 990) 2014

Additional Data

Software ID:
Software Version:

- TIN:

Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax Exempt Bonds

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

Attach to Form 990.
SchKMediumBullet

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

OMB No. 1545-0047

2014

Open to Public
Inspection

Name of the organization
WAYNE MEMORIAL HOSPITAL

Employer identification number
24-0798839

Part I

Bond Issues

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

Part II

Proceeds

	A		B		C		D
	1 Amount of bonds retired . . . . . . . . . . . . . .	325,000		5,000		165,000
2 Amount of bonds legally defeased . . . . . . . . . . .	0		0		0
3 Total proceeds of issue . . . . . . . . . . . . . .	4,651,757		9,894,478		9,997,040
4 Gross proceeds in reserve funds . . . . . . . . . . . .	254,563		692,238		461,420
5 Capitalized interest from proceeds . . . . . . . . . . .	0		0		0
6 Proceeds in refunding escrows . . . . . . . . . . . .	0		0		0
7 Issuance costs from proceeds . . . . . . . . . . . .	41,571		92,127		187,404
8 Credit enhancement from proceeds . . . . . . . . . . .	40,533		82,916		92,379
9 Working capital expenditures from proceeds . . . . . . . . .	0		0		0
10 Capital expenditures from proceeds . . . . . . . . . . .	0		0		0
11 Other spent proceeds . . . . . . . . . . . . . .	4,315,090		9,027,197		9,255,837
12 Other unspent proceeds . . . . . . . . . . . . . .	0		0		0
13 Year of substantial completion . . . . . . . . . . . .	2012		2013		2012
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue? . . . . .	X			X	X
15 Were the bonds issued as part of an advance refunding issue? . . . . .		X	X			X
16 Has the final allocation of proceeds been made? . . . . . . . .	X		X		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . . .	X		X		X

Part III

Private Business Use

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

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

Cat. No. 50193E

Schedule K (Form 990) 2014

Page 2

Part III

Private Business Use (Continued)

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

Part IV

Arbitrage

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

Schedule K (Form 990) 2014

Page 3

Part IV

Arbitrage (Continued)

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

Part V

Procedures To Undertake Corrective Action

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

Part VI

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

Return Reference	Explanation

Schedule K (Form 990) 2014

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

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

OMB No. 1545-0047

2014

Open to Public Inspection

Name of the organization

WAYNE MEMORIAL HOSPITAL

Employer identification number

24-0798839

Part I

Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and 501(c)(29) 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 Benefiting 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) 2014

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) ANNASTASIA HARCUM	JOE HARCUM - FAMILY	20,145	EMPLOYEE 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) 2014

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 990-EZ 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

2014

Open to Public
Inspection

Name of the organization

WAYNE MEMORIAL HOSPITAL

Employer identification number

24-0798839

Return Reference	Explanation
FORM 990, PART III, LINE 4D	OTHER PROGRAM SERVICES: THE ORGANIZATION PROVIDED GRANTS TO WAYNE MEMORIAL COMMUNITY HEALTH CENTER. SEE SCHEDULE I FOR MORE INFORMATION.
FORM 990, PART VI, SECTION A, LINE 2	BUSINESS & FAMILY RELATIONSHIPS: GARY BEILMAN HAS A FAMILY RELATIONSHIP WITH MAUREEN BEILMAN, A TRUSTEE ON THE BOARD OF WAYNE MEMORIAL FOUNDATION.
FORM 990, PART VI, SECTION A, LINE 3	DELEGATE MANAGEMENT DUTIES: WAYNE MEMORIAL HEALTH SYSTEM, INC., PROVIDES MANAGEMENT OVER THE ORGANIZATION THROUGH DIRECT EMPLOYMENT OF THE DIRECTORS AND OFFICERS OF THE ORGANIZATION. THE MANAGEMENT SERVICES PROVIDED ARE REIMBURSED TO WAYNE MEMORIAL HEALTH SYSTEM THROUGH A MANAGEMENT FEE.
FORM 990, PART VI, SECTION A, LINES 6, 7A & 7B	MEMBERS OR STOCKHOLDERS: THE BOARD SHALL CONSIST OF THOSE INDIVIDUALS WHO ARE TRUSTEES OF WAYNE MEMORIAL HEALTH SYSTEM, A RELATED ORGANIZATION. THEIR TERM OF OFFICE SHALL COINCIDE WITH THEIR TERM OF OFFICE ON THE BOARD OF WAYNE MEMORIAL HEALTH SYSTEM. RESIGNATION OR REMOVAL FROM THE BOARD OF WAYNE MEMORIAL HEALTH SYSTEM SHALL CONSTITUTE RESIGNATION OR REMOVAL FROM THE BOARD OF THIS CORPORATION. FOLLOWING DECISIONS OF THE GOVERNING BODY ARE SUBJECT TO APPROVAL BY WAYNE MEMORIAL HEALTH SYSTEM, INC.: (A) AMENDMENT OF THE BYLAWS OR THE ARTICLES OF CORPORATION (B) MERGER OR CONSOLIDATION WITH ANY OTHER ENTITY (C) DISSOLUTION AND DISTRIBUTION OF ASSETS IN CONNECTION THEREWITH (D) ELECTION OF OFFICERS OF THIS CORPORATION (E) ADOPTION OF INVESTMENT POLICIES AND SELECTION OF INVESTMENT ADVISORS (F) INVESTMENT OF RESTRICTED GIFTS (G) SELECTION OF AUDITORS AND ATTORNEYS (H) ADOPTION OF OPERATING AND CAPITAL BUDGETS (I) APPROVAL OF FUND-RAISING PROGRAMS (J) DONATION OR TRANSFER OF ANY ASSET WITH AN AGGREGATE VALUE IN EXCESS OF SUCH AMOUNT AS MAY BE DETERMINED BY THE BOARD OF WAYNE MEMORIAL HEALTH SYSTEM FROM TIME TO TIME (K) CREATION OF ANY LIEN OR SECURITY INTEREST IN ASSETS OF THE CORPORATION (L) DESIGNATION OR RESTRICTION OF GIFTS WITH A MARKET VALUE IN EXCESS OF SUCH AMOUNT AS MAY BE DETERMINED BY THE BOARD OF WAYNE MEMORIAL HEALTH SYSTEM FROM TIME TO TIME, AND (M) ANY OTHER MATTER THAT WOULD REQUIRE THE APPROVAL OF THE MEMBERS OF A PENNSYLVANIA NONPROFIT CORPORATION.
FORM 990, PART VI, SECTION B, LINE 11B	990 REVIEW POLICY: THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM BASED ON THE AUDITED FINANCIAL STATEMENTS AND INFORMATION PROVIDED BY THE ACCOUNTING DEPARTMENT OF THE ORGANIZATION. A COPY OF THE FORM 990 WILL BE REVIEWED WITH THE RESOURCE MANAGEMENT COMMITTEE WHICH IS RESPONSIBLE FOR THE FINANCIAL OVERSIGHT OF ALL ENTITIES OF THE WAYNE MEMORIAL HEALTH SYSTEM. A COPY OF THE 990 WILL BE DISTRIBUTED VIA E-MAIL TO EACH BOARD MEMBER BEFORE THE RETURN IS SUBMITTED TO THE IRS. MANAGEMENT WILL DISCUSS ANY QUESTIONS THAT ANY BOARD MEMBER MAY HAVE AT THE NEXT FULL BOARD MEETING.
FORM 990, PART VI, SECTION B, LINE 12C	CONFLICT OF INTEREST POLICY: CONFLICT OF INTEREST STATEMENTS ARE COMPLETED BY EVERY BOARD MEMBER AND MANAGER ANNUALLY. EACH INDIVIDUAL IS REQUIRED TO SIGN AND RETURN THE STATEMENTS TO THE ADMINISTRATION OFFICE. THE AUDIT COMMITTEE IS RESPONSIBLE FOR MONITORING COMPLIANCE WITH ANY CONFLICT OF INTEREST THROUGHOUT THE YEAR. IF A CONFLICT ARISES, THE PERSON WITH THE CONFLICT WILL RECUSE THEMSELVES FROM VOTING AND/OR DISCUSSING THE MATTER.
FORM 990, PART VI, SECTION B, LINES 15A & 15B	COMPENSATION REVIEW: WAYNE MEMORIAL HEALTH SYSTEM, INC., (AND ALL RELATED ENTITIES) UTILIZES A COMPENSATION COMMITTEE OF THE BOARD TO SET COMPENSATION OF ITS CEO AND OTHER SENIOR MANAGERS, INCLUDING CFO, DIRECTOR OF PATIENT CARE SERVICES, DIRECTOR OF HUMAN RESOURCES, DIRECTOR OF FACILITY SERVICES, DIRECTOR OF ANCILLARY SERVICES AND THE EXECUTIVE DIRECTOR OF THE WAYNE MEMORIAL HEALTH FOUNDATION. THE COMPENSATION COMMITTEE IS MADE UP OF INDEPENDENT DIRECTORS, WHO, WITH THE ASSISTANCE OF A NATIONAL COMPENSATION CONSULTING FIRM, UTILIZE COMPARABLE DATA FROM THE MARKETPLACE, LOOKING AT SUCH THINGS AS COMPARABLE ORGANIZATIONS IN TERMS OF REVENUE, SIZE, COMPLEXITY AND GEOGRAPHIC REGION. THE ORGANIZATION HAS ADOPTED A PHILOSOPHY OF PAYING AT THE 50TH PERCENTILE OF THE MARKETPLACE. ALL MEETINGS OF THE COMPENSATION COMMITTEE ARE DOCUMENTED AND MINUTES ARE MAINTAINED OF THE DELIBERATION AND DECISION-MAKING PROCESS. THE PROCESS NORMALLY OCCURS IN OCTOBER OF THE YEAR THE COMPENSATION CHANGES ARE GRANTED. THE LAST REVIEW OF EXECUTIVE COMPENSATION WAS 10/20/2015.
FORM 990, PART VI, SECTION C, LINE 19	DOCUMENT DISCLOSURE: THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND/OR FINANCIAL STATEMENTS AVAILABLE TO PUBLIC UPON REQUEST.
FORM 990, PART XI, LINE 9	RECONCILIATION OF NET ASSETS: OTHER CHANGES IN NET ASSETS ARE AS FOLLOWS: $ (1,089,916) CHANGE IN DEFINED BENEFIT PENSION PLAN 15,348 CHANGE IN BENEFICIAL INTEREST IN PERPETUAL TRUST 44,965 CHANGE IN INTEREST IN NET ASSETS OF FOUNDATION 98,849 TRANSFER FROM AFFILIATE ------------- $ ( 930,754)

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2014

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

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

OMB No. 1545-0047

2014

Open to Public Inspection

Name of the organization

WAYNE MEMORIAL HOSPITAL

Employer identification number

24-0798839

Part I

Identification of Disregarded Entities Complete if the organization answered "Yes" 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) WAYNE MEMORIAL HEALTH FOUNDATION INC 601 PARK STREET HONESDALE,PA18431 23-2208596	FUNDRAISING	PA	501(C)(3)	11 A I	WMHS		No
(2) WAYNE MEMORIAL HEALTH SYSTEM INC 601 PARK STREET HONESDALE,PA18431 23-2221292	OVERSIGHT	PA	501(C)(3)	11 B II	NA		No
(3) WAYNE MEMORIAL LONG TERM CARE 37 WOODLANDS DRIVE WAYMART,PA18472 23-2719336	NURSING HOME	PA	501(C)(3)	9	WMHS		No

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

Cat. No. 50135Y

Schedule R (Form 990) 2014

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	(h) Percentage ownership	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets		Yes	No
(1) WAYNE HEALTH SERVICES INC 601 PARK STREET HONESDALE,PA18431 23-2376183	DME, RENT, PHARM	PA	WMHF	C-CORPORATION	16,909	35,182	1.000 %		No
(2) CHARITABLE TRUST	TRUST	PA	WMH	TRUST	239	23,079	100.000 %	Yes

Schedule R (Form 990) 2014

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

Yes

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

Yes

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

Yes

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

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

Yes

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

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

Yes

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

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

Schedule R (Form 990) 2014

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) 2014

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) 2014

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: OPERATES A 98-BED ACUTE CARE HOSPITAL, WITH AN ADDITIONAL 14 BEDS DEDICATED TO INPATIENT REHAB.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	17
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	16
5	Total number of individuals employed in calendar year 2014 (Part V, line 2a) ......	5	835
6	Total number of volunteers (estimate if necessary) .............	6	187
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	85,131
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b	70,198

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	255,030	83,106
9	Program service revenue (Part VIII, line 2g) .........	80,633,641	86,572,581
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	3,717,440	5,602,299
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	-170,522	-150,010
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	84,435,589	92,107,976
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	1,286,154	1,630,270
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)	38,279,267	38,995,890
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)....	40,787,116	42,312,959
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	80,352,537	82,939,119
19	Revenue less expenses. Subtract line 18 from line 12.......	4,083,052	9,168,857
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	108,391,095	113,448,051
21	Total liabilities (Part X, line 26).............	42,149,047	42,506,226
22	Net assets or fund balances. Subtract line 21 from line 20.....	66,242,048	70,941,825

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 36,057,908 including grants of $ ) (Revenue $ 56,726,545 )
	OUTPATIENT SERVICES ARE OFFERED IN A VARIETY OF AREAS, INCLUDING LAB, RADIOLOGY, REHABILITATION SERVICES SUCH AS PHYSICAL, OCCUPATIONAL AND SPEECH THERAPY AND PRIMARY CARE. WMH ALSO PROVIDES OUTPATIENT EMERGENCY, DIAGNOSTIC, AND REHABILITATIVE SERVICES. OUR EMERGENCY DEPARTMENT OFFERS PHYSICIAN CARE 24 HOURS A DAY TO ALL, REGARDLESS OF ABILITY TO PAY.

4b	(Code: ) (Expenses $ 21,805,845 including grants of $ ) (Revenue $ 24,970,278 )
	INPATIENT SERVICES PROVIDES A FULL CONTINUUM OF CARE, FROM BIRTHING SUITES TO CHEMOTHERAPY, ENDOSCOPY, CARDIOLOGY PROCEDURES, RESPIRATORY THERAPY, IMAGING SCANS, HOME HEALTH AND HOSPICE CARE FOR THE POPULATION WE SERVE, APPROXIMATELY 100,000 PEOPLE IN MOSTLY RURAL WAYNE AND PIKE COUNTIES, PENNSYLVANIA.

4c	(Code: ) (Expenses $ 4,994,505 including grants of $ ) (Revenue $ 4,875,758 )
	INPATIENT REHABILITATION PROVIDES PHYSICAL, OCCUPATIONAL, AUDIOLOGY AND SPEECH THERAPY WITH SKILL CERTIFIED THERAPISTS. AN INDIVIDUALIZED REHABILITATION PROGRAM DESIGNED TO ENHANCE FUNCTION AND INDEPENDENCE IS DEVELOPED FOR EACH PATIENT BY A TEAM OF SPECIALIZED REHABILITATION PROFESSIONALS. EACH PATIENT'S EVALUATION AND PROGRESS IS DIRECTED AND MONITORED BY A PHYSIATRIST AND AN INTERDISCIPLINARY TEAM CONSISTING OF A PRIMARY REHABILITATION NURSE; PHYSICAL, OCCUPATIONAL AND SPEECH THERAPISTS; AND A SOCIAL WORKER.

4d	Other program services (Describe in Schedule O.)
	(Expenses $ 1,630,270 including grants of $ 1,630,270 ) (Revenue $ )
4e	Total program service expenses64,488,528

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)				(D) Reportable compensation from the organization (W- 2/1099-MISC)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and Title
(18) LEE OAKES........................................................................ CHAIR ENDING 10/2014	0.8 .......................0.8	X	X			0	0	0
(19) JUDI MORTENSEN........................................................................ SECRETARY ENDING 10/2014	0.8 .......................0.8	X	X			0	0	0
(20) MIKE CLIFFORD........................................................................ CFO	18.8 .......................21.2		X			0	229,407	51,227
(21) DAVID HOFF........................................................................ CEO	32.0 .......................8.0		X			0	598,583	40,870
(22) JAMES PETTINATO........................................................................ DIRECTOR OF PATIENT CARE SERVI	39.9 .......................0.1			X		0	158,619	26,377
(23) JEFFERY MOGERMAN........................................................................ PHYSICAN	40.0 .......................0.0				X	683,896	0	32,272
(24) LILLIAN LONGENDORFER........................................................................ PHYSICIAN	40.0 .......................0.0				X	242,835	0	20,569
(25) SHARIE L MORGANTI........................................................................ CERTIFIED RN ANESTHETIST	40.0 .......................0.0				X	160,526	0	9,629
(26) DEBORAH H PUGH........................................................................ CERTIFIED RN ANESTHETIST	40.0 .......................0.0				X	168,147	0	16,993
(27) DAVID CAUCCI........................................................................ PHYSICIAN	40.0 .......................0.0				X	420,478	0	33,558

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	1,675,882	986,609	231,495

				(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		21,234

f	All other contributions, gifts, grants, and similar amounts not included above1f		61,872

g	Noncash contributions included in lines 1a-1f:$
h	Total. Add lines 1a-1f.......			83,106
			Business Code
2a	NET PATIENT SERVICE REVENUE		623000	85,215,209	85,215,209
b	CAFETERIA		722514	298,815	298,815
c	OTHER REVENUE		900099	216,382	216,382
d	MEANINGFUL USE REVENUE		623000	842,175	842,175
e
f	All other program service revenue .
g	Total. Add lines 2a–2f........			86,572,581
3	Investment income (including dividends, interest, and other similar amounts).......			1,743,446			1,743,446
4	Income from investment of tax-exempt bond proceeds..			0
5	Royalties...........			0
		(i) Real	(ii) Personal
6a	Gross rents	529,740
b	Less: rental expenses	463,120
c	Rental income or (loss)	66,620	0
d	Net rental income or (loss).......			66,620			66,620
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory	30,063,442	94,825
b	Less: cost or other basis and sales expenses	25,942,326	357,088
c	Gain or (loss)	4,121,116	-262,263
d	Net gain or (loss)..........			3,858,853			3,858,853
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/(LOSS) ON EQUITY INVESTEE		900099	-216,630		85,131	-301,761
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......			-216,630
12	Total revenue. See Instructions......			92,107,976	86,572,581	85,131	5,367,158


				(A) Beginning of year		(B) End of year
1	Cash–non-interest-bearing .............			1,470	1	1,570
2	Savings and temporary cash investments .........			15,154,522	2	20,630,813
3	Pledges and grants receivable, net ...........			0	3	0
4	Accounts receivable, net .............			8,703,280	4	8,263,849
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 ..............			632,605	8	586,798
9	Prepaid expenses and deferred charges ..........			1,253,918	9	1,281,280
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	86,599,141
b	Less: accumulated depreciation .....	10b	64,142,444	22,151,039	10c	22,456,697
11	Investments—publicly traded securities ..........			50,777,732	11	50,939,033
12	Investments—other securities. See Part IV, line 11 .....			638,682	12	772,456
13	Investments—program-related. See Part IV, line 11 .....			5,020,528	13	4,691,812
14	Intangible assets ...............			0	14	0
15	Other assets. See Part IV, line 11 ...........			4,057,319	15	3,823,743
16	Total assets. Add lines 1 through 15 (must equal line 34)......			108,391,095	16	113,448,051
17	Accounts payable and accrued expenses .........			15,624,988	17	17,623,990
18	Grants payable .................			0	18	0
19	Deferred revenue ................			0	19	0
20	Tax-exempt bond liabilities .............			23,967,635	20	21,997,403
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 ..			47,440	23	592,216
24	Unsecured notes and loans payable to unrelated third parties ....			0	24	0
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D....................			2,508,984	25	2,292,617
26	Total liabilities. Add lines 17 through 25.........			42,149,047	26	42,506,226
	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............			63,932,044	27	68,576,508
28	Temporarily restricted net assets ...........			248,241	28	288,206
29	Permanently restricted net assets ...........			2,061,763	29	2,077,111
	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 ...........			66,242,048	33	70,941,825
34	Total liabilities and net assets/fund balances ........			108,391,095	34	113,448,051