TY 2017 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) HONORABLE STEVEN SERFASS...................................................................... CHAIRMAN - TRUSTEE	1.0 ................. 0.0	X	X	0	0
(2) LOUIS SPORTELLI DC...................................................................... VICE CHAIRMAN - TRUSTEE	1.0 ................. 0.0	X	X	0	0
(3) ROBERT GROB DO...................................................................... SECRETARY/TREASURER - TRUSTEE	55.0 ................. 0.0	X	X	220,958	0
(4) CONRAD BIEGE...................................................................... TRUSTEE	1.0 ................. 0.0	X		0	0
(5) WILLIAM H FEGLEY JR...................................................................... TRUSTEE	1.0 ................. 0.0	X		0	0
(6) BARBARA GREEN...................................................................... TRUSTEE	1.0 ................. 0.0	X		0	0
(7) WILLIAM KISSNER...................................................................... TRUSTEE	1.0 ................. 0.0	X		0	0
(8) WILLIAM MARKSON MD...................................................................... TRUSTEE	1.0 ................. 0.0	X		0	0
(9) TERRENCE J PURCELL...................................................................... TRUSTEE - PRESIDENT(EFF 01/18)	55.0 ................. 0.0	X	X	159,789	50,347
(10) SHELBA SCHEFFNER...................................................................... TRUSTEE	1.0 ................. 0.0	X		0	0
(11) JAMES SHOBER III...................................................................... TRUSTEE	1.0 ................. 0.0	X		0	0
(12) NICK VARVARELIS DO...................................................................... TRUSTEE	1.0 ................. 0.0	X		0	0
(13) REVEREND ROBERT VONFRISCH...................................................................... TRUSTEE	1.0 ................. 0.0	X		0	0
(14) JOHN DEMATTE IV DC...................................................................... TRUSTEE (TERMED 10/25/17)	1.0 ................. 0.0	X		0	0
(15) PATRICK HANLEY DO...................................................................... TRUSTEE (TERMED 8/9/17)	1.0 ................. 0.0	X		22,750	0
(16) ANDREW E HARRIS...................................................................... TRUSTEE - PRES/CEO(TERM 12/17)	55.0 ................. 0.0	X	X	589,890	59,732
(17) JAIME MENDES...................................................................... TRUSTEE (TERMED 8/11/17)	1.0 ................. 0.0	X		0	0

(A) Name and business address	(B) Description of services	(C) Compensation
CARDIOLOGY ASSOCIATES, 1241 BLAKESLEE BOULEVARD EAST LEHIGHTON,PA18235	MEDICAL	1,274,468
BAKER TILLY VIRCHOW KRAUSE LLP, PO BOX 78975 MADISON,WI78975	AUDITING/ACCOUNTING	252,887
LABCORP, 531 SOUTH SPRING STREET BURLINGTON,NC27215	LABORATORY	241,110
STEVEN LAZICKI, 575 SOUTH 9TH STREET LEHIGHTON,PA18235	MEDICAL	222,612
ROBERT GROB DO, 5600 OLD MILL HILL ROAD OREFIELD,PA18069	MEDICAL	220,958
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 21

- 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.
right arrow

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization

BLUE MOUNTAIN HOSPITAL INC

Employer identification number

24-0795436

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 12, 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 (Form 990 or 990-EZ).)

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 agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

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 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

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 990-EZ.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2019

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 failed to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..
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) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(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 2019 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2018 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2019. 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—2018. 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—2019. 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—2018. 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) 2019

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 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) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(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) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(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 2019 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2018 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2019 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2018 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2019. 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—2018. 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) 2019

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked 12a of Part I, complete Sections A and B. If you checked 12b of Part I, complete Sections A and C. If you checked 12c of Part I, complete Sections A, D, and E. If you checked 12d 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 12a or 12b 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 (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) 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 section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .

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

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 9a) 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 9a) 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 section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b 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

Schedule A (Form 990 or 990-EZ) 2019

Page 5

Part IV

Supporting Organizations (continued)

Yes

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

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, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) 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) 2019

Page 6

Part V

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

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970 (explain in Part VI). 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

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) 2019

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations(continued)

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 2019 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-2019	(iii) Distributable Amount for 2019
1 Distributable amount for 2019 from Section C, line 6
2 Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2019:
a From 2014.......
b From 2015.......
c From 2016.......
d From 2017.......
e From 2018.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2019 distributable amount
i Carryover from 2014 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2019 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2019 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2019, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions.
6 Remaining underdistributions for 2019. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions.
7 Excess distributions carryover to 2020. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2015.....
b Excess from 2016.....
c Excess from 2017.....
d Excess from 2018.....
e Excess from 2019.....

Schedule A (Form 990 or 990-EZ) (2019)

Schedule A (Form 990 or 990-EZ) 2019

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) 2019

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.

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Name of the organization

BLUE MOUNTAIN HOSPITAL INC

Employer identification number

24-0795436

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 other 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. Don't 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 isn't covered by the General Rule and/or the Special Rules doesn't 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 doesn't 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) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019) Page 2

Name of organization BLUE MOUNTAIN HOSPITAL INC

Part I Contributors	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
		$	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) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Page 3

Name of organization BLUE MOUNTAIN HOSPITAL INC		Employer identification number 24-0795436

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) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Page 4


Name of organization BLUE MOUNTAIN HOSPITAL INC			Employer identification number 24-0795436
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.) $ 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) (2019)

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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

If the organization answered "Yes" on 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" on 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" on 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

BLUE MOUNTAIN HOSPITAL INC

Employer identification number

24-0795436

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 (see instructions for definition of “political campaign activities")

Political campaign activity expenditures (see instructions) .................................................................... SchCMd Bullet

Volunteer hours for political campaign activities (see instructions) ..................................................................

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-.
1
2
3
4
5
6

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

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2019

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) 2016	(b) 2017	(c) 2018	(d) 2019	(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) 2019

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 on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes|No

(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? .......................

Yes

40,307

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

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

Yes

1,758

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

42,065

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; QUESTION 1	THE ORGANIZATION ENGAGES IN LOBBYING EFFORTS ON A FEDERAL AND STATE LEVEL. DURING THE FISCAL YEAR ENDED JUNE 30, 2018, THE ORGANIZATION PAID AN INDEPENDENT LOBBYING FIRM A TOTAL OF $40,307 FOR LOBBYING CONSULTING SERVICES. ADDITIONALLY, THE ORGANIZATION IS A MEMBER OF THE HOSPITAL AND HEALTHSYSTEM ASSOCIATION OF PENNSYLVANIA WHICH ENGAGES IN LOBBYING EFFORTS ON BEHALF OF ITS MEMBER HOSPITALS. A PORTION OF DUES PAID TO THIS ORGANIZATION HAS BEEN ALLOCATED TO LOBBYING ACTIVITIES PERFORMED ON BEHALF OF THE ORGANIZATION. DURING THE FISCAL YEAR ENDED JUNE 30, 2018 THIS ALLOCATION AMOUNTED TO $1,758.

Return Reference

Explanation

SCHEDULE C, PART II-B; QUESTION 1

THE ORGANIZATION ENGAGES IN LOBBYING EFFORTS ON A FEDERAL AND STATE LEVEL. DURING THE FISCAL YEAR ENDED JUNE 30, 2018, THE ORGANIZATION PAID AN INDEPENDENT LOBBYING FIRM A TOTAL OF $40,307 FOR LOBBYING CONSULTING SERVICES. ADDITIONALLY, THE ORGANIZATION IS A MEMBER OF THE HOSPITAL AND HEALTHSYSTEM ASSOCIATION OF PENNSYLVANIA WHICH ENGAGES IN LOBBYING EFFORTS ON BEHALF OF ITS MEMBER HOSPITALS. A PORTION OF DUES PAID TO THIS ORGANIZATION HAS BEEN ALLOCATED TO LOBBYING ACTIVITIES PERFORMED ON BEHALF OF THE ORGANIZATION. DURING THE FISCAL YEAR ENDED JUNE 30, 2018 THIS ALLOCATION AMOUNTED TO $1,758.

Schedule C (Form 990 or 990EZ) 2019

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," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet

Attach to Form 990.
SchDMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

BLUE MOUNTAIN HOSPITAL INC

Employer identification number

24-0795436

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on 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" on 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 7/25/06, 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, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, 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" on Form 990, Part IV, line 8.

If the organization elected, as permitted under FASB 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 FASB 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 on 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 FASB ASC 958 relating to these items:

Revenue included on 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) 2019

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" on 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


b	If "Yes," explain the arrangement in Part XIII and complete the following table:		Amount
c	Beginning balance .............................	1c
d	Additions during the year ............................	1d
e	Distributions during the year ..........................	1e
f	Ending balance ................................	1f

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" on Form 990, Part IV, line 10.

		(a) Current year	(b) Prior year	(c) Two years back	(d) Three years back	(e) Four years back

1a	Beginning of year balance ....	979,300	36,229	50,338	62,955	66,907
b	Contributions ...	195,628	936,314
c	Net investment earnings, gains, and losses	364,371	6,757	-14,109	-12,617	-3,952
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...
f	Administrative expenses ....
g	End of year balance ......	1,539,299	979,300	36,229	50,338	62,955

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

84.920 %

Term endowment SchDMd Bullet

15.080 %

The percentages on 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" on 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" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(a) Cost or other basis (investment)	(b) Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value

1a	Land .....	4,192,188		4,192,188
b	Buildings ....	35,065,200	25,675,078	9,390,122
c	Leasehold improvements	1,534,869	850,961	683,908
d	Equipment ....	67,159,514	58,652,512	8,507,002
e	Other .....	1,606,844	1,436,056	170,788
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				22,944,008

Schedule D (Form 990) 2019

Page 3

Part VII

InvestmentsOther Securities.
Complete if the organization answered "Yes" on 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........
(3)Other
(B)
(C)
(D)
(E)
(F)
(G)
(H)
(I)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' on 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
(1)CASH & EQUIVALENTS	4,862,126	F
(2)GOVERNMENT SECURITIES	269,872	F
(3)CORPORATE BONDS	74,808	F
(4)COMMON & PREFERRED STOCK	407,720	F
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)	6,725,735

Part IX

Other Assets.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

Part X

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

1.(a) Description of liability	(b) Book value
(1) Federal income taxes	0
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	40,093,180
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) 2019

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......		1
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d .....................		2e
3	Subtract line 2e from line 1..................		3
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b....................		4c
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........		1
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities .........	2a
b	Prior year adjustments ............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d....................		2e
3	Subtract line 2e from line 1...................		3
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.....................		4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5

Part XIII

Supplemental Information

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 V; QUESTION 4

ENDOWMENT FUNDS ARE TO BE USED CONSISTENT WITH INTENT AND IN FURTHERANCE OF THE ORGANIZATION'S CHARITABLE TAX-EXEMPT PURPOSES. EFFECTIVE JANUARY 1, 2018 THE ORGANIZATION BECAME AN AFFILIATE WITHIN ST. LUKE'S UNIVERSITY HEALTH NETWORK ("NETWORK"); A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY NETWORK. ST. LUKE'S HEALTH NETWORK, INC. IS THE PARENT ENTITY OF THE NETWORK. AN INDEPENDENT CERTIFIED PUBLIC ACCOUNTING ("CPA") FIRM AUDITED THE CONSOLIDATED FINANCIAL STATEMENTS OF THE HOSPITAL AND ITS CONTROLLED AFFILIATE FOR THE YEAR ENDED JUNE 30, 2018 AND ISSUED AN AUDITED CONSOLIDATED FINANCIAL STATEMENT WITH CONSOLIDATING SCHEDULES BY ENTITY. THE FOLLOWING FOOTNOTE IS INCLUDED IN THE NETWORK'S AUDITED CONSOLIDATED FINANCIAL STATEMENTS THAT ADDRESSES THE NETWORK'S ENDOWMENT FUNDS: THE NETWORKS ENDOWMENT CONSISTS OF APPROXIMATELY $44,183,807 INDIVIDUAL DONOR RESTRICTED ENDOWMENT FUNDS AND $97,925,511 BOARD-DESIGNATED ENDOWMENT FUNDS FOR A VARIETY OF PURPOSES PLUS THE FOLLOWING WHERE THE ASSETS HAVE BEEN DESIGNATED FOR ENDOWMENT: SPLIT INTEREST AGREEMENTS, AND OTHER NET ASSETS. THE ENDOWMENT INCLUDES BOTH DONOR-RESTRICTED ENDOWMENT FUNDS AND FUNDS DESIGNATED BY THE BOARD OF TRUSTEES TO FUNCTION AS ENDOWMENTS. THE NET ASSETS ASSOCIATED WITH ENDOWMENT FUNDS INCLUDING FUNDS DESIGNATED BY THE BOARD OF TRUSTEES TO FUNCTION AS ENDOWMENTS, ARE CLASSIFIED AND REPORTED BASED ON THE EXISTENCE OR ABSENCE OF DONOR IMPOSED RESTRICTIONS. RETURN OBJECTIVES AND RISK PARAMETERS THE NETWORK HAS ADOPTED ENDOWMENT INVESTMENT AND SPENDING POLICIES THAT ATTEMPT TO PROVIDE A PREDICTABLE STREAM OF FUNDING TO PROGRAMS SUPPORTED BY ITS ENDOWMENT WHILE SEEKING TO MAINTAIN THE PURCHASING POWER OF ENDOWMENT ASSETS. UNDER THIS POLICY, THE RETURN OBJECTIVE FOR THE ENDOWMENT ASSETS, MEASURED OVER A FULL MARKET CYCLE, SHALL BE TO MAXIMIZE THE RETURN AGAINST A BLENDED INDEX, BASED ON THE ENDOWMENTS TARGET ALLOCATION APPLIED TO THE APPROPRIATE INDIVIDUAL BENCHMARKS. THE NETWORK EXPECTS ITS ENDOWMENT FUNDS OVER TIME, TO PROVIDE AN AVERAGE RATE OF RETURN APPROXIMATING THE S&P 500 STOCK INDEX (DOMESTIC PORTION), MSCI EAFE INDEX (INTERNATIONAL PORTION) AND LEHMAN BROTHERS INTERMEDIATE GOVERNMENT/CORPORATE INDEX (BOND PORTION). ACTUAL RETURNS IN ANY GIVEN YEAR MAY VARY FROM THE INDEX RETURN AMOUNTS. STRATEGIES EMPLOYED FOR ACHIEVING INVESTMENT OBJECTIVES TO ACHIEVE ITS LONG-TERM RATE OF RETURN OBJECTIVES, THE NETWORK RELIES ON A TOTAL RETURN STRATEGY IN WHICH INVESTMENT RETURNS ARE ACHIEVED THROUGH BOTH CAPITAL APPRECIATION (REALIZED AND UNREALIZED GAINS) AND CURRENT YIELD (INTEREST AND DIVIDENDS). THE NETWORK TARGETS A DIVERSIFIED ASSET ALLOCATION THAT PLACES GREATER EMPHASIS ON EQUITY-BASED INVESTMENTS TO ACHIEVE ITS LONG-TERM OBJECTIVES WITHIN PRUDENT RISK CONSTRAINTS. ENDOWMENT SPENDING ALLOCATION AND RELATIONSHIP OF SPENDING POLICY TO INVESTMENT OBJECTIVES THE BOARD OF TRUSTEES OF THE NETWORK DETERMINES THE METHOD TO BE USED TO APPROPRIATE ENDOWMENT FUNDS FOR EXPENDITURE. CALCULATIONS ARE PERFORMED FOR INDIVIDUAL ENDOWMENT FUNDS AT A RATE OF 4.5% OF A THREE-YEAR MOVING AVERAGE MARKET VALUE WITH A MINIMUM INCREASE OF 0% AND A MAXIMUM INCREASE OF 10% PER YEAR OVER THE PREVIOUS YEARS SPENDING AMOUNT. THE TOTAL IS REDUCED BY THE INCOME DISTRIBUTED FROM THE ENDOWMENT FUND IN ACCORDANCE WITH THE PREFERENCES/RESTRICTIONS MADE BY THE DONORS. THE CORRESPONDING CALCULATED SPENDING ALLOCATIONS ARE DISTRIBUTED ANNUALLY BY JUNE 30. IN ESTABLISHING THIS POLICY, THE BOARD CONSIDERED THE EXPECTED LONG TERM RATE OF RETURN ON ITS ENDOWMENT. ACCORDINGLY, OVER THE LONG TERM, THE NETWORK EXPECTS THE CURRENT SPENDING POLICY TO ALLOW ITS ENDOWMENT TO GROW AT AN AVERAGE OF 8% PERCENT ANNUALLY, CONSISTENT WITH ITS INTENTION TO MAINTAIN THE PURCHASING POWER OF THE ENDOWMENT ASSETS AS WELL AS TO PROVIDE ADDITIONAL REAL GROWTH THROUGH NEW GIFTS.

Schedule D (Form 990) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE G (Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information Regarding
Fundraising or Gaming Activities

Complete if the organization answered "Yes" on Form 990, Part IV, lines 17, 18, or 19, or if the organization entered more than $15,000 on Form 990-EZ, line 6a. right arrow

Attach to Form 990 or Form 990-EZ.
right arrow

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization
BLUE MOUNTAIN HOSPITAL INC

Employer identification number

24-0795436

Part I

Fundraising Activities.Complete if the organization answered "Yes" on Form 990, Part IV, line 17.

Form 990-EZ filers are not required to complete this part.

Indicate whether the organization raised funds through any of the following activities. Check all that apply.

a	Mail solicitations	e	Solicitation of non-government grants
b	Internet and email solicitations	f	Solicitation of government grants
c	Phone solicitations	g	Special fundraising events
d	In-person solicitations

Did the organization have a written or oral agreement with any individual (including officers, directors, trustees

or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services?

YesNo

If "Yes," list the 10 highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is
to be compensated at least $5,000 by the organization.

(i) Name and address of individual or entity (fundraiser)	(iii) Did fundraiser have custody or control of contributions?
	Yes	No










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

List all states in which the organization is registered or licensed to solicit contributions or has been notified it is exempt from registration or licensing.

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

Cat. No. 50083H

Schedule G (Form 990 or 990-EZ) 2019

Page 2

Part II

Fundraising Events. Complete if the organization answered "Yes" on Form 990, Part IV, line 18, or reported more than $15,000 of fundraising event contributions and gross income on Form 990-EZ, lines 1 and 6b. List events with gross receipts greater than $5,000.

		(a) Event #1 SLIP,SLIDE,SOLD (event type)	(d) Total events (add col. (a) through col. (c))
1	Gross receipts . . . . .	48,721	48,721
2	Less: Contributions . . . .	45,824	45,824
3	Gross income (line 1 minus line 2) . . . . . .	2,897	2,897

4	Cash prizes . . . . .	1,118	0	1,118
5	Noncash prizes . . . .	500	0	500
6	Rent/facility costs . . . .	0	0	0
7	Food and beverages . . .	0	0	0
8	Entertainment . . . .	600	0	600
9	Other direct expenses . . .	679	0	679
10	Direct expense summary. Add lines 4 through 9 in column (d) . . . . . . . . . .			2,897
11	Net income summary. Subtract line 10 from line 3, column (d). . . . . . . . . .

Part III

Gaming. Complete if the organization answered "Yes" on Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a.

		(a) Bingo	(b) Pull tabs/Instant bingo/progressive bingo	(c) Other gaming	(d) Total gaming (add col.(a) through col.(c))
1	Gross revenue . . . . .

2	Cash prizes . . . . .
3	Noncash prizes . . . .
4	Rent/facility costs . . . .
5	Other direct expenses . . .

Volunteer labor . . . .

	Yes %
	No

	Yes %
	No

	Yes %
	No

Direct expense summary. Add lines 2 through 5 in column (d) . . . . . . . . . . right arrow

Net gaming income summary. Subtract line 7 from line 1, column (d). . . . . . . . . right arrow

Enter the state(s) in which the organization conducts gaming activities:

Is the organization licensed to conduct gaming activities in each of these states? . . . . . . . .

YesNo

If "No," explain:

10a

Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? . . .

YesNo

If "Yes," explain:

Schedule G (Form 990 or 990-EZ) 2019

Page 3

Does the organization conduct gaming activities with nonmembers? . . . . . . . . . . .

YesNo

Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity

formed to administer charitable gaming? . . . . . . . . . . . . . . . . .

YesNo

Indicate the percentage of gaming activity conducted in:

The organization's facility . . . . . . . . . . . . . . . . . .

13a

An outside facility . . . . . . . . . . . . . . . . . . . .

13b

Enter the name and address of the person who prepares the organization's gaming/special events books and records:

Name

Address

15a

Does the organization have a contract with a third party from whom the organization receives gaming

revenue? . . . . . . . . . . . . . . . . . . . . . . . .

YesNo

If "Yes," enter the amount of gaming revenue received by the organization right arrow

$ and the

amount of gaming revenue retained by the third party right arrow

$ .

If "Yes," enter name and address of the third party:

Name

Address

Gaming manager information:

Name

Gaming manager compensation right arrow

Description of services provided right arrow

Director/officer Employee Independent contractor

Mandatory distributions:

Is the organization required under state law to make charitable distributions from the gaming proceeds to

retain the state gaming license? . . . . . . . . . . . . . . . . . . .

YesNo

Enter the amount of distributions required under state law distributed to other exempt organizations or spent

in the organization's own exempt activities during the tax year right arrow

Part IV

Supplemental Information. Provide the explanations required by Part I, line 2b, columns (iii) and (v); and Part III, lines 9, 9b, 10b, 15b, 15c, 16, and 17b, as applicable. Also provide any additional information. See instructions.

Return Reference	Explanation

Schedule G (Form 990 or 990-EZ) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

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

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990EZ for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

BLUE MOUNTAIN HOSPITAL INC

Employer identification number

24-0795436

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

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

Yes

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

Yes

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

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

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

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

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

Yes

100% 150% 200% Other %

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

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

Yes

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

If the organization used factors other than FPG in determining eligibility, describe in Part VI the 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		(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) . . .	1,389,205	112,528	1,276,677	1.400 %
b	Medicaid (from Worksheet 3, column a) . . . . .	11,795,669	6,856,766	4,938,903	5.410 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	13,184,874	6,969,294	6,215,580	6.810 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	358,050	76,684	281,366	0.310 %
f	Health professions education (from Worksheet 5) . . .
g	Subsidized health services (from Worksheet 6) . . . .	5,643,505	2,708,238	2,935,267	3.220 %
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .
j	Total. Other Benefits . .	6,001,555	2,784,922	3,216,633	3.530 %
k	Total. Add lines 7d and 7j .	19,186,429	9,754,216	9,432,213	10.340 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2019

Schedule H (Form 990) 2019

Page

Part II

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

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

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Healthcare 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. ......

7,036,581

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. ......

703,658

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).....

30,221,694

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

34,346,114

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

-4,124,420

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) 2019

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?2Name, 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)					Facility reporting group
1	GNADEN HUETTEN MEMORIAL HOSPITAL 211 NORTH 12TH STREET LEHIGHTON,PA18235 WWW.SLHN.ORG 070501	X	X	X	1
2	PALMERTON HOSPITAL 135 LAFAYETTE AVENUE PALMERTON,PA18071 WWW.SLHN.ORG 070501	X	X	X	1

Schedule H (Form 990) 2019

Page 4

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)

	BLUE MOUNTAIN 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

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 16

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

6 a

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

Yes

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

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

Yes

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

Hospital facility’s website (list url): WWW.SLHN.ORG

Other website (list url):

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 16

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

Yes

If "Yes" (list url): WWW.SLHN.ORG

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

10b

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

12b

If "Yes" on 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) 2019

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	BLUE MOUNTAIN HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

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 400.%

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)

Was widely publicized 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):

WWW.SLHN.ORG

The FAP application form was widely available on a website (list url):

WWW.SLHN.ORG

A plain language summary of the FAP was widely available on a website (list url):
WWW.SLHN.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)

Individuals were notified about the FAP by being offered a paper copy of the plain language summary of the FAP, by
receiving a conspicuous written notice about the FAP on their billing statements, and via conspicuous public displays or
other measures reasonably calculated to attract patients' attention

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

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2019

Page 6

Part VFacility Information (continued)

Billing and Collections

	BLUE MOUNTAIN HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

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 nonpayment?..................................

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

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

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

Did the hospital facility or other authorized 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

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

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 19. (check all that apply):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs (if not, describe in Section C)

Made a reasonable effort to orally notify individuals about the FAP and FAP application process (if not, describe in
Section C)

Processed incomplete and complete FAP applications (if not, describe in Section C)

Made presumptive eligibility determinations (if not, describe in Section C)

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)

Schedule H (Form 990) 2019

Page 7

Part VFacility Information (continued)

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

	BLUE MOUNTAIN HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

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 a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicaid, either alone or in combination with
Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month
period

The hospital facility used a prospective Medicare or Medicaid method

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) 2019

Page 8

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, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 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, QUESTION 5	IN ITS MOST RECENTLY CONDUCTED COMMUNITY HEALTH NEEDS ASSESSMENT ("CHNA") THIS ORGANIZATION TOOK INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVED BY ITS HOSPITAL FACILITIES. THE CHNA INCLUDED THREE SEPARATE DATA COLLECTION STRATEGIES: 1) A FOCUS GROUP WAS HELD ON MAY 11, 2016 DURING A REGULARLY SCHEDULED MEETING OF THE CARBON COUNTY INTERAGENCY COUNCIL. THE CARBON COUNTY INTERAGENCY COUNCIL IS COMPOSED OF LEADERSHIP FROM NUMEROUS AGENCIES AND ORGANIZATIONS, REPRESENTING MATERNAL AND CHILD HEALTH, ELDER CARE, BEHAVIORAL HEALTH, COUNTY INFRASTRUCTURE, HEALTHCARE PROVIDERS AND SOCIAL SERVICES. IN ATTENDANCE AT THE MEETING WERE REPRESENTATIVES FROM THE FOLLOWING ORGANIZATIONS: - CARBON MONROE PIKE DRUG & ALCOHOL COMMISSION; - CARBON MONROE PIKE MENTAL HEALTH/DEVELOPMENT SERVICES; - DOMESTIC VIOLENCE SERVICE CENTER; - PATHSTONE/HEAD START; - VICTIMS RESOURCE CENTER; - PANTHER VALLEY SCHOOL DISTRICT; - TURN TO US; - OPERATION CAREER WEAR; - PA LINK TO AGING AND DISABILITIES; - COUNTY COMMISSIONERS GERHARD AND NOTHSTEIN; AND - STATE REPRESENTATIVE HEFFLEY. 2) KEY INFORMANT SURVEYS AND INTERVIEWS KEY INFORMANTS FROM THE FOLLOWING PROFESSIONAL FIELDS/WORKPLACES WERE SURVEYED: - FAMILY PRACTICE PHYSICIANS; - CARBON CAREER & TECHNICAL INSTITUTE; - THE ASSISTANT DIRECTOR OF WORKFORCE/COMMUNITY SERVICES AT A COMMUNITY COLLEGE; - FAMILY PRACTICE NURSE PRACTITIONERS; AND - STATE HEALTH NURSES WITH THE PA DEPARTMENT OF HEALTH. 3) AN ANALYSIS OF EXISTING SECONDARY DATA AND EXISTING COMMUNITY HEALTH MEASURES THE ORGANIZATION GATHERED THE MOST RECENT EXISTING PUBLIC HEALTH DATA FOR THE CARBON COUNTY AREA OF PENNSYLVANIA. FOR PURPOSES OF COMPARISON OF HEALTH INDICATORS AT THE COUNTY, STATE AND NATIONAL LEVEL, THE MAJORITY OF DATA WAS DRAWN FROM THE FOLLOWING SOURCES: - US CENSUS BUREAU (2010 CENSUS); - BUREAU OF LABOR STATISTICS; - PENNSYLVANIA DEPARTMENT OF HEALTH; - NATIONAL VITAL STATISTICS REPORT; - COUNTY HEALTH RANKINGS; - HEALTHY PEOPLE 2020; - THE NATIONAL CANCER INSTITUTE; - PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE; - THE STATE OF THE CHILD & FAMILY IN CARBON COUNTY; AND - CENTER FOR WORKFORCE INFORMATION & ANALYSIS.
SCHEDULE H, PART V, SECTION B, QUESTION 6A	THIS ORGANIZATION INCLUDES TWO HOSPITAL CAMPUSES, GNADEN HUETTON MEMORIAL HOSPITAL AND PALMERTON HOSPITAL. THESE HOSPITAL CAMPUSES ARE BOTH LOCATED IN CARBON COUNTY, PENNSYLVANIA AND THEREFORE HAVE IDENTICAL PRIMARY SERVICE AREAS. THE HOSPITAL FACILITIES WORKED TOGETHER TO ISSUE A JOINT COMMUNITY HEALTH NEEDS ASSESSMENT.
SCHEDULE H, PART V, SECTION B, QUESTION 7	THE ORGANIZATION IS AN AFFILIATE WITHIN ST. LUKE'S UNIVERSITY HEALTH NETWORK; A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY NETWORK ("NETWORK"). DUE TO CHARACTER LIMITATIONS, THE WEBSITE LISTED IN SCHEDULE H, PART V, SECTION B, QUESTION 7A, IS THE HOME PAGE FOR THE SYSTEM. THE ORGANIZATION'S CHNA CAN BE ACCESSED AT THE FOLLOWING PAGE INCLUDED IN THE NETWORK'S WEBSITE: WWW.SLHN.ORG/COMMUNITY-HEALTH/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/CAMPUS
SCHEDULE H, PART V, SECTION B, QUESTION 10	THE ORGANIZATIONS CHNA INCLUDES APPENDIX A, THE 2016 CHNA LOGIC MODEL GOALS & OBJECTIVES. THIS APPENDIX REPRESENTS THE ORGANIZATIONS WRITTEN IMPLEMENTATION STRATEGY AS REQUIRED UNDER INTERNAL REVENUE CODE SECTION 501(R)(3). THE IMPLEMENTATION STRATEGY INCLUDES INFORMATION WITH RESPECT TO EACH IDENTIFIED COMMUNITY HEALTH NEED AS WELL AS THE GOALS, OBJECTIVES, STRATEGIES, ACTION STEPS AND METRICS RELATED TO EACH IDENTIFIED NEED. THE ORGANIZATION'S IMPLEMENTATION STRATEGY IS INCLUDED WITHIN ITS CHNA. THESE DOCUMENTS ARE MADE WIDELY AVAILABLE ON THE ORGANIZATION'S WEBSITE. DUE TO CHARACTER LIMITATIONS, THE WEBSITE LISTED IN PART V, SECTION B, QUESTION 10, IS THE HOME PAGE FOR THE SYSTEM. THE CHNA AND IMPLEMENTATION STRATEGY CAN BE ACCESSED AT THE FOLLOWING PAGE INCLUDED IN THE SYSTEM'S WEBSITE: WWW.SLHN.ORG/COMMUNITY-HEALTH/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/CAMPUS
SCHEDULE H, PART V, SECTION B, QUESTION 11	THE COMMUNITY HEALTH NEEDS ASSESSMENT IDENTIFIED HEALTH PROBLEMS THE COMMUNITY FACES AND BARRIERS THAT KEEP RESIDENTS OF THE COMMUNITY FROM BEING HEALTHY. SEVERAL PRIORITY AREAS WERE IDENTIFIED THROUGHOUT THE ASSESSMENT PROCESS. THESE PRIORITY AREAS INCLUDED: - DRUG ADDICTION (HEROIN, OPIOIDS/NARCOTICS); - DIABETES; - OBESITY; - MENTAL HEALTH; - DENTAL HEALTH; AND - OTHER CHRONIC ILLNESSES (HEART DISEASE, HYPERTENSION/STROKE AND CANCER). ADDITIONALLY, THE BARRIERS TO GOOD HEALTH IDENTIFIED THROUGHOUT THE ASSESSMENT PROCESS WERE: - COMPLEXITY OF CURRENT HEALTHCARE SYSTEM AND NOTABLY HIGH DEDUCTIBLES; - ACCESS TO COMMUNITY SERVICES (PARTICULARLY PROVIDERS WHO ACCEPT MA AND UNINSURED POPULATIONS EMPHASIZING MENTAL AND DENTAL HEALTH); - LACK OF PREVENTION/EDUCATION/TREATMENT SERVICES (PARTICULARLY RELATED TO DRUG ADDICTION); - TRANSPORATION; AND - SEDENTARY LIFESTYLE AND POOR DIET CONTRIBUTING TO OBESITY PROBLEMS ACROSS ALL AGES. THE HOSPITAL CONTINUES TO WORK ACROSS MANY OF THE OTHER IDENTIFIED NEEDS. AS THE NEEDS THAT WERE IDENTIFIED ARE NOT MUTUALLY EXCLUSIVE FROM ONE ANOTHER, IT IS THE HOSPITALS HOPE THAT BY ADEQUATELY ADDRESSING THE ABOVE NEEDS AND BARRIERS, THE OTHER NEEDS AND BARRIERS WILL BE INDIRECTLY IMPACTED AS WELL. AS OUTLINED IN THE ORGANIZATIONS IMPLEMENTATION STRATEGY THE FOLLOWING GOALS, OBJECTIVES AND STRATEGIES WILL BE IMPLEMENTED TO ADDRESS THE ABOVE MENTIONED COMMUNITY HEALTH NEEDS. BEHAVIORAL HEALTH DRUG, ALCOHOL & TOBACCO USE ("ATOD") ======================================================== GOAL: REDUCE THE NEGATIVE IMPACT OF ATOD USE ON THE RESIDENTS OF CARBON COUNTY AND THE SURROUNDING COMMUNITIES. OBJECTIVE: IMPROVE THE HEALTH SYSTEMS CAPACITY TO EFFECTIVELY ADDRESS ATOD ISSUES. STRATEGY: MAINTAIN A COMPREHENSIVE ATOD INTERNAL AND EXTERNAL PREVENTION, INTERVENTION AND TREATMENT PLAN FOR THE SYSTEM. ACTION STEPS: 1) CONTINUE TO IDENTIFY KEY PERSONNEL AND CREATE A SYSTEM WIDE ATOD TASK FORCE; 2) CONTINUE TO CONVENE TASK FORCE MEETINGS AND BEGIN THE ATOD STRATEGIC PLANNING PROCESS; AND 3) CONTINUE TO DISSEMINATE THE PLAN, SEEK LEADERSHIP APPROVAL AND IMPLEMENT THE STRATEGIES. STRATEGY: EDUCATE AND TRAIN PERSONNEL ON THE LOCAL ATOD PROBLEM AND BUILD AN ATOD ASSESSMENT, INTERVENTION AND REFERRAL CAPACITIES SYSTEM WIDE. ACTION STEPS: 1) DEVELOP BASIS ATOD 101 CURRICULUM TO TRAIN STAFF; 2) PARTNER WITH CMP, D&A AND OTHERS TO SECURE TRAINING ON ESTABLISHING "WARM HANDOFF" WHERE POSSIBLE FOR UNINTENTIONAL OVERDOSE; AND 3) PARTNER WITH CMP D&A AND OTHER TO SECURE SPECIALIZED CONSULTATION SERVICES WHEN D&A INTERVENTION SERVICES ARE NEEDED IN ICU & MED/SURG. OBJECTIVE: INCREASE THE NUMBER OF HEALTHCARE PROVIDERS WHO DO BRIEF INTERVENTIONS WITH THEIR PATIENTS WHO USE TOBACCO. STRATEGY: EDUCATE PROVIDERS REGARDING HOW TO DO A BRIEF INTERVENTION WITH PATIENTS WHO USE TOBACCO AND PROVIDE AN ARRAY OF SERVICE TO SUPPORT TOBACCO USERS WHO ARE READY TO QUIT. ACTION STEPS: 1) WORK WITH TOBACCO FREE NORTHEAST AND EAST CENTRAL AHEC TO SCHEDULE BRIEF INTERVENTION TRAININGS FOR HEALTHCARE PROVIDERS; AND 2) INCLUDE INFORMATION ON LOCAL CESSATION SERVICES AVAILABLE, THE QUITLINE AND HOW TO ACCESS AND FAX TO QUIT AND HOW IT IS UTILIZED. SPECIALIZED BEHAVIORAL HEALTH SERVICES ====================================== GOAL: IMPROVE ACCESS TO MENTAL HEALTH SERVICES FOR THOSE RESIDENTS WHO ARE UN OR UNDER INSURED, OR WHO ARE INCARCERATED IN THE CARBON COUNTY CORRECTIONAL FACILITIES BY REMOVING OBSTACLES (REAL OR PERCEIVED) THAT PREVENT ACCESS TO INTERVENTION AND TREATMENT SERVICES. OBJECTIVE: CONTINUE TO MAINTAIN A FULL CONTINUUM OF CARE FOR RESIDENTS WHO ARE SEEKING TREATMENT FOR BEHAVIORAL HEALTHCARE SERVICES INCLUDING THE PROVISION OF BASIS MEDICAL AND PSYCHIATRIC SERVICES AT THE CARBON COUNTY CORRECTIONAL FACILITY. STRATEGY: CONTINUE TO BUILD THE BHU'S OUTPATIENT LEVEL OF CARES (LOC). ACTION STEPS: 1) MAINTAIN CURRENT COMPLEMENT OF PSYCHIATRIST DURING THE NEXT THREE YEARS; AND 2) CONTINUE TO PROVIDE MEDICAL AND PSYCHIATRIC SERVICES AT THE CARBON COUNTY CORRECTIONAL FACILITY. OBJECTIVE: PROVIDE COMMUNITY EDUCATION OR SUPPORT PROGRAMS OR SERVICES TO THE COMMUNITY FREE OF CHARGE. STRATEGY: PROVIDE SPACE FOR MEETINGS AND/OR ASSIGN STAFF TO FACILITATE OR CONSULT WITH COMMUNITY GROUPS/ORGANIZATIONS IN AN EFFORT TO PROVIDE EDUCATION AND SUPPORT SERVICES FOR INDIVIDUALS OR FAMILY MEMBERS WHO ARE AFFECTED BY MENTAL ILLNESS. ACTION STEPS: 1) CONTINUE TO SUPPLY MEETING SPACE AND SUPPORT FOR THE "SURVIVORS OF SUICIDE" SUPPORT GROUPS; 2) CONTINUE TO SUPPLY STAFF AND OTHER RESOURCES TO CONDUCT COMMUNITY BASED "DEPRESSION SCREENINGS" AS SCHEDULED; AND 3) CONTINUE TO SUPPLY, ON AN AD HOC BASIS, STAFF AND RESOURCES NEEDED TO CONDUCT OTHER TYPES OF INTERVENTION PROGRAMS OR SERVICES AS IDENTIFIED. OBJECTIVE: REMOVE FINANCIAL OBSTACLES WHENEVER POSSIBLE AND EVALUATE ALL CONSUMERS FOR ADMISSIONS TO ALL LEVELS OF SERVICE REGARDLESS OF THEIR ABILITY TO PAY. STRATEGY: OFFER FINANCIAL COUNSELING TO ALL CLIENTS WITH MENTAL HEALTH ISSUES AND WHEN POSSIBLE PROVIDE FULL OR PARTIAL REDUCTIONS IN CHARGES FOR THESE SERVICES. ACTION STEPS: 1) CONTINUE TO OFFER FINANCIAL COUNSELING TO ALL NON-INSURED OR UNDERINSURED PATIENTS; 2) ASSIST PATIENTS IN THE APPLICATION PROCESS FOR BOTH MEDICAID AND FINANCIAL ASSISTANCE; AND 3) GRANT FINANCIAL ASSISTANCE TO CERTAIN NON-EMERGENT, UNINSURED PATIENTS IDENTIFIED BY THE CRISIS WORKERS. DENTAL HEALTH ============= GOAL: CONTINUE TO PROVIDE DENTAL HEALTH SERVICES FOR UN AND UNDERINSURED CHILDREN IN CARBON COUNTY AND ITS SURROUNDING COMMUNITIES. OBJECTIVE: IMPROVE THE DENTAL HEALTH FOR LOW INCOME CHILDREN BY PROVIDING THEM WITH A MOBILE DENTAL HOME. STRATEGY: DEPLOY THE BMHS HEALTHY SMILES HAPPY KIDS MOBILE DENTAL VAN TO THE FIVE CARBON COUNTY SCHOOL DISTRICTS, THE TAMAQUA AREA SCHOOL DISTRICT AND THE CARBON & SCHUYLKILL COUNTY HEAD START PROGRAMS. ACTION STEPS: 1) CONTINUE TO PROVIDE ANNUAL DEPARTMENT OF HEALTH MANDATED DENTAL EXAMS TO ALL GRADE LEVEL APPROPRIATE STUDENTS AS REQUESTED BY THE SCHOOL DISTRICT; 2) CONTINUE TO PROVIDE BI-ANNUAL CHECK-UPS, CLEANINGS AND WHEN NECESSARY RESTORATION SERVICES; AND 3) CONTINUE TO PROVIDE REFERRAL SERVICES TO PEDIATRIC SPECIALIST OR HIGHER LEVEL OF CARE WHEN CLEANING OR RESTORATION CANNOT BE ACCOMPLISHED ON THE VAN. OBJECTIVE: ENSURE THE FUTURE SUSTAINABILITY OF THE DENTAL VAN STRATEGY: HOLD MEETINGS AND ENGAGE THE CARBON COUNTY CORPORATE COMMUNITY, COMMUNITY GROUPS AND OTHER INDIVIDUALS WITH WEALTH IN ANNUALLY FUNDRAISING EFFORTS. ACTION STEPS: 1) CONTINUE TO KEEP KEY PARTNERS INFORMED ON PROGRESS AND PROBLEMS BEING EXPERIENCED DURING SERVICE DELIVERY; AND 2) CONTINUE TO EXPLORE THE DEVELOPMENT OF AN HSHK AUXILIARY WITH THE CARBON COUNTY CHAMBER OF COMMERCE/ECONOMIC DEVELOPMENT OFFICE. CHRONIC ILLNESS ============== GOAL: TO IMPROVE THE HEALTH OF CARBON COUNTY AND ITS SURROUNDING COMMUNITIES BY CREATING A COMPREHENSIVE MENU OF SERVICES DESIGNED TO PRECLUDE OR REDUCE THE INCIDENCE OF CHRONIC DISEASE OR ILLNESSES. OBJECTIVE: PROVIDE EDUCATION, SCREENING AND COMMUNITY SUPPORT SERVICES THAT ADDRESS VARIOUS CHRONIC DISEASES AND ILLNESSES THAT AFFECT THE BMHS SERVICE AREA. STRATEGY: EDUCATE THE COMMUNITY BY PROVIDING ACCESS TO THE LATEST MEDICAL INFORMATION ON CHRONIC DISEASES AND ILLNESSES BY PROVIDING THEM WITH ACCESS TO LECTURES AND EDUCATIONAL MATERIALS ON THE PREVENTION, EARLY DETECTION AND TREATMENTS AVAILABLE. ACTION STEPS: 1) OBESITY: CONTINUE TO PROMOTE HEALTHY LIFESTYLE FROM CHILDHOOD THROUGH OLD AGE THROUGH EDUCATION OF ASSOCIATED RISK FACTORS, ADOPTION OF HEALTHY EATING HABITS AND BENEFITS OF EXERCISE; 2) DIABETES: CONTINUE TO PROMOTE SELF-MANAGEMENT OF DIABETES THROUGH EDUCATION TO PROMOTE HEALTHY EATING AND PHYSICAL ACTIVITY, UNDERSTANDING OF HYPOGLYCEMIC MEDICATIONS, AND KNOWLEDGE OF COMPLICATIONS ASSOCIATED WITH DIABETES; AND 3) HEART DISEASE: CONTINUE TO PROVIDE EDUCATION TO THE COMMUNITY ON THE PREVENTION OF HEART DISEASE, PROMOTION OF A HEALTHY LIFESTYLE THROUGH FREE BP AND CHOLESTEROL SCREENINGS AT HEALTH FAIRS, SENIOR CENTERS AND SHOPPING MALLS. STRATEGY #2: PROVIDE ACCESS TO ALL TYPES OF SCREENING AND INTERVENTIONAL SUPPORT SERVICES THAT WILL ASSIST INDIVIDUALS IN DETERMINING THEIR LEVEL OF RISK AND READINESS TO CHANGE AT RISK BEHAVIORS. ACTION STEPS: 1) PARTICIPATE IN AND/OR SPONSOR EVENTS THAT PROMOTE WELLNESS: ANNUAL GREAT AMERICAN SMOKE OUT, THE BMHS 5K RUNS AND LOCAL CANCER "RELAY FOR LIFE" EVENTS; 2) PROVIDE BLOOD PRESSURE, GLUCOSE, CHOLESTEROL AND BODY MASS INDEX SCREENINGS AT VARIOUS COMMUNITY HEALTH FAIRS AS WELL AS PROVIDE HOSPITAL BASED DIABETIC EDUCATION AND BARIATRIC SUPPORT GROUPS SERVICES TO THOSE MOST AT RISK; AND 3) PROVIDE FREE PNEUMONIA AND INFLUENZA INOCULATION CLINICS AT VARIOUS LOCATIONS ACROSS THE COUNTY FOR THE UNINSURED AND UNDER INSURED AS WELL AS OLDER ADULTS AND OTHER AT RISK GROUPS. OBJECTIVE: IMPROVE THE HEALTH OF UNINSURED OR UNDER INSURED WOMEN RESIDENTS OF CARBON COUNTY AND ITS SURROUNDING COMMUNITIES BY PROVIDING THEM WITH A COMPREHENSIVE CANCER
SCHEDULE H, PART V, SECTION B, QUESTION 16	THE ORGANIZATION IS AN AFFILIATE WITHIN ST. LUKE'S UNIVERSITY HEALTH NETWORK; A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY NETWORK ("NETWORK"). DUE TO CHARACTER LIMITATIONS, THE WEBSITE LISTED IN SCHEDULE H, PART V, SECTION B, QUESTION 16, IS THE HOME PAGE FOR THE NETWORK. THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY, FINANCIAL ASSISTANCE APPLICATION AND PLAIN LANGUAGE SUMMARY ARE MADE WIDELY AVAILABLE ON THE ORGANIZATION'S WEBSITE. THESE DOCUMENTS CAN BE ACCESSED AT THE FOLLOWING PAGE INCLUDED IN THE NETWORK'S WEBSITE: WWW.SLHN.ORG/PAY-BILLS/PAYMENT-OPTIONS/FINANCIAL-ASSISTANCE-POLICIES

Schedule H (Form 990) 2019

Page 9

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?8
Name and address		Type of Facility (describe)
1	PHYSICAL THERAPY AT ST LUKE'S 614 INTERCHANGE ROAD KRESGEVILLE,PA18333	OUTPATIENT SERVICES- PHYSICAL THERAPY
2	ST LUKE'S WOUND MGMT & HYPERBARIC CTR 525 IRON STREET LEHIGHTON,PA18235	OUTPATIENT SERVICES- WOUND CARE & ADULT DAY CARE
3	PHYSICAL THERAPY AT ST LUKE'S 217 FRANKLIN AVENUE PALMERTON,PA18071	OUTPATIENT SERVICES - PHYSICAL THERAPY
4	PHYSICAL THERAPY AT ST LUKE'S 426 WEST RAILROAD STREET NESQUEHONING,PA18240	OUTPATIENT SERVICES - PHYSICAL THERAPY
5	ST LUKE'S HEART & VASCULAR CENTER 1241 BLAKESLEE DRIVE EAST LEHIGHTON,PA18235	OUTPATIENT SERVICES - CARDIAC & NUCLEAR TESTING
6	ST LUKE'S HEART & VASCULAR CENTER 17 WEST BROAD STREET TAMAQUA,PA18252	OUTPATIENT SERVICES - CARDIOLOGY
7	ST LUKE'S HEART & VASCULAR CENTER 1510 FAWN VALLEY ROAD KRESGEVILLE,PA18322	OUTPATIENT SERVICES - CARDIOLOGY & VASCULAR LAB
8	ST LUKE'S LABORATORY SERVICES 1580 CENTER AVENUE JIM THORPE,PA18229	OUTPATIENT SERVICES - BLOOD DRAW LAB
9
10

Schedule H (Form 990) 2019

Page 10

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 3C	THE ORGANIZATION HAS A LONG TRADITION OF SERVING THE POOR, THE NEEDY, AND ALL WHO REQUIRE HEALTHCARE SERVICES. IN ORDER TO PROMOTE THE HEALTH AND WELL-BEING OF THE COMMUNITY SERVED, INDIVIDUALS WITH LIMITED FINANCIAL RESOURCES WHO ARE UNABLE TO ACCESS ENTITLEMENT PROGRAMS SHALL BE ELIGIBLE FOR FREE OR DISCOUNTED EMERGENCY OR MEDICALLY NECESSARY HEALTHCARE SERVICES BASED ON ESTABLISHED CRITERIA. ELIGIBILITY CRITERIA IS BASED UPON THE FEDERAL POVERTY GUIDELINES AND IS UPDATED ANNUALLY IN CONJUNCTION WITH THE PUBLISHED UPDATES BY THE UNITED STATES DEPARTMENT OF HEALTH AND HUMAN SERVICES. IF A DETERMINATION IS MADE THAT THE PATIENT HAS THE ABILITY TO PAY ALL OR A PORTION OF THEIR BILL, SUCH A DETERMINATION DOES NOT PREVENT A REASSESSMENT OF THE PERSON'S ABILITY TO PAY AT A LATER DATE. IN ACCORDANCE WITH THE ORGANIZATIONS FINANCIAL ASSISTANCE POLICY, PATIENTS ARE ELIGIBLE FOR A 100% REDUCTION FROM CHARGES (I.E. FULL WRITE-OFF) IF THE PATIENTS HOUSEHOLD INCOME IS AT OR BELOW 200 PERCENT OF THE CURRENT FEDERAL POVERTY GUIDELINES. PATIENTS WITH HOUSEHOLD INCOME THAT EXCEEDS 200% BUT IS LESS THAN 400% OF THE FEDERAL POVERTY GUIDELINES WILL BE ELIGIBLE FOR A SLIDING SCALE DISCOUNT. ADDITIONALLY, THE FINANCIAL ASSISTANCE COMMITTEE WILL CONSIDER MEDICALLY NEEDY PATIENT ACCOUNTS ON A CASE BY CASE BASIS. THE DISCOUNT TO BE APPLIED WILL BE BASED ON A DETERMINATION OF WHAT THE FAMILY COULD REASONABLY BE EXPECTED TO PAY, BASED ON A REVIEW OF CURRENT DISPOSABLE INCOME AND EXPENSES.
SCHEDULE H, PART I, LINE 6A	NOT APPLICABLE.
SCHEDULE H, PART I, LINE 7	SUBSIDIZED HEALTH SERVICES INCLUDED WITHIN SCHEDULE H, PART I, LINE 7 FOR GNADEN HUETTEN MEMORIAL HOSPITAL AND PALMERTON HOSPITAL INCLUDE PRIMARY CARE AND EMERGENCY DEPARTMENT SERVICES. THE EMERGENCY DEPARTMENTS LOCATED AT GNADEN HUETTEN MEMORIAL HOSPITAL AND PALMERTON HOSPITAL PROVIDE AROUND-THE-CLOCK EMERGENCY SERVICES TO THE SURROUNDING COMMUNITIES WITHIN CARBON COUNTY. THESE HEALTHCARE SERVICES ARE PROVIDED TO ALL PATIENTS, REGARDLESS OF THEIR ABILITY TO PAY OR THEIR INSURANCE STATUS.
SCHEDULE H, PART II	BLUE MOUNTAIN HOSPITAL HAS DIRECT INVOLVEMENT IN NUMEROUS COMMUNITY BUILDING ACTIVITIES THAT PROMOTE AND IMPROVE THE HEALTH STATUS AND GENERAL BETTERMENT OF THE COMMUNITIES SERVED BY THE HOSPITAL. THIS IS ACCOMPLISHED THROUGH SERVICE ON STATE AND REGIONAL ADVOCACY COMMITTEES AND BOARDS, VOLUNTEERISM WITH LOCAL COMMUNITY-BASED NON-PROFIT ADVOCACY GROUPS, AND PARTICIPATION IN CONFERENCES AND OTHER EDUCATIONAL ACTIVITIES TO PROMOTE UNDERSTANDING OF THE ROOT CAUSES OF HEALTH CONCERNS. THIS ORGANIZATION PROVIDES EDUCATIONAL MATERIALS, CONDUCTS COMMUNITY HEALTH FAIRS AND HOLDS HEALTH EDUCATION SEMINARS AND OUTREACH SESSIONS FOR ITS PATIENTS AND FOR COMMUNITY PROVIDERS. PRESENTATIONS ARE PROVIDED BY PHYSICIANS, NURSES AND OTHER HEALTHCARE PROFESSIONALS.
SCHEDULE H, PART III, LINES 2, 3 & 4	BAD DEBT EXPENSE WAS CALCULATED USING THE ORGANIZATION'S BAD DEBT EXPENSE FROM ITS AUDITED FINANCIAL STATEMENTS. THE ORGANIZATION AND ITS AFFILIATES PREPARE AND ISSUE AUDITED CONSOLIDATED FINANCIAL STATEMENTS. THE SYSTEM'S ALLOWANCE FOR DOUBTFUL ACCOUNTS (BAD DEBT EXPENSE) METHODOLOGY AND CHARITY CARE POLICIES ARE CONSISTENTLY APPLIED ACROSS ALL HOSPITAL AFFILIATES. THE ATTACHED TEXT WAS OBTAINED FROM THE FOOTNOTES TO THE AUDITED FINANCIAL STATEMENTS OF THE ORGANIZATION. ALLOWANCE FOR DOUBTFUL ACCOUNTS ------------------------------- THE NETWORK RECORDS AN ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR ESTIMATED LOSSES RESULTING FROM THE UNWILLINGNESS OF PATIENTS TO MAKE PAYMENTS FOR SERVICES. THE ALLOWANCE IS DETERMINED BY ANALYZING HISTORICAL DATA AND TRENDS. ACCOUNTS RECEIVABLE ARE WRITTEN OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS WHEN MANAGEMENT DETERMINES THAT RECOVERY IS UNLIKELY AND COLLECTION EFFORTS CEASE. CHARITY CARE ------------ THE NETWORK PROVIDES CARE TO ALL PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. CHARGES FOR SERVICES TO PATIENTS WHO MEET THE NETWORK'S GUIDELINES FOR CHARITY CARE ARE NOT REFLECTED IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. THE CHARGES ASSOCIATED WITH THESE SERVICES FOR CHARITY CARE PROVIDED BY THE NETWORK APPROXIMATE $64,508,825 AND $100,156,452 IN 2018 AND 2017, RESPECTIVELY. THE COSTS INCURRED TO PROVIDE SUCH CARE IS DETERMINED USING A COST TO CHARGE RATIO AND WERE APPROXIMATELY $8,000,000 AND $13,500,000 FOR 2018 AND 2017, RESPECTIVELY.
SCHEDULE H, PART III, LINE 8	MEDICARE COSTS WERE DERIVED FROM THE MEDICARE COST REPORT FILED BY THE ORGANIZATION. THE ORGANIZATION FEELS THAT MEDICARE UNDERPAYMENTS (SHORTFALL) AND BAD DEBT ARE COMMUNITY BENEFIT AND ASSOCIATED COSTS ARE INCLUDABLE ON THE FORM 990, SCHEDULE H, PART I. AS OUTLINED MORE FULLY BELOW THE ORGANIZATION BELIEVES THAT THESE SERVICES AND RELATED COSTS PROMOTE THE HEALTH OF THE COMMUNITY AS A WHOLE AND ARE RENDERED IN CONJUNCTION WITH THE ORGANIZATION'S CHARITABLE TAX-EXEMPT PURPOSES AND MISSION IN PROVIDING MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUALS IN A NON-DISCRIMINATORY MANNER WITHOUT REGARD TO RACE, COLOR, CREED, SEX, NATIONAL ORIGIN OR ABILITY TO PAY AND CONSISTENT WITH THE COMMUNITY BENEFIT STANDARD PROMULGATED BY THE INTERNAL REVENUE SERVICE ("IRS"). THE COMMUNITY BENEFIT STANDARD IS THE CURRENT STANDARD FOR A HOSPITAL FOR RECOGNITION AS A TAX-EXEMPT AND CHARITABLE ORGANIZATION UNDER INTERNAL REVENUE CODE ("IRC") 501(C)(3). THE ORGANIZATION IS RECOGNIZED AS A TAX-EXEMPT ENTITY AND CHARITABLE ORGANIZATION UNDER 501(C)(3) OF THE IRC. ALTHOUGH THERE IS NO DEFINITION IN THE TAX CODE FOR THE TERM "CHARITABLE", A REGULATION PROMULGATED BY THE DEPARTMENT OF THE TREASURY PROVIDES SOME GUIDANCE AND STATES THAT "[T]HE TERM CHARITABLE IS USED IN 501(C)(3) IN ITS GENERALLY ACCEPTED LEGAL SENSE,PROVIDES EXAMPLES OF CHARITABLE PURPOSES, INCLUDING THE RELIEF OF THE POOR OR UNPRIVILEGED; THE PROMOTION OF SOCIAL WELFARE; AND THE ADVANCEMENT OF EDUCATION, RELIGION, AND SCIENCE. NOTE: IT DOES NOT EXPLICITLY ADDRESS THE ACTIVITIES OF HOSPITALS. IN THE ABSENCE OF EXPLICIT STATUTORY OR REGULATORY REQUIREMENTS APPLYING THE TERM "CHARITABLE" TO HOSPITALS, IT HAS BEEN LEFT TO THE IRS TO DETERMINE THE CRITERIA HOSPITALS MUST MEET TO QUALIFY AS IRC 501(C)(3) CHARITABLE ORGANIZATIONS. THE ORIGINAL STANDARD WAS KNOWN AS THE CHARITY CARE STANDARD. THIS STANDARD WAS REPLACED BY THE IRS WITH THE COMMUNITY BENEFIT STANDARD WHICH IS THE CURRENT STANDARD. CHARITY CARE STANDARD IN 1956, THE IRS ISSUED REVENUE RULING 56-185, WHICH ADDRESSED THE REQUIREMENTS HOSPITALS NEEDED TO MEET IN ORDER TO QUALIFY FOR IRC 501(C)(3) STATUS. ONE OF THESE REQUIREMENTS IS KNOWN AS THE "CHARITY CARE STANDARD." UNDER THE STANDARD, A HOSPITAL HAD TO PROVIDE, TO THE EXTENT OF ITS FINANCIAL ABILITY, FREE OR REDUCED-COST CARE TO PATIENTS UNABLE TO PAY FOR IT. A HOSPITAL THAT EXPECTED FULL PAYMENT DID NOT, ACCORDING TO THE RULING, PROVIDE CHARITY CARE BASED ON THE FACT THAT SOME PATIENTS ULTIMATELY FAILED TO PAY. THE RULING EMPHASIZED THAT A LOW LEVEL OF CHARITY CARE DID NOT NECESSARILY MEAN THAT A HOSPITAL HAD FAILED TO MEET THE REQUIREMENT SINCE THAT LEVEL COULD REFLECT ITS FINANCIAL ABILITY TO PROVIDE SUCH CARE. THE RULING ALSO NOTED THAT PUBLICLY SUPPORTED COMMUNITY HOSPITALS WOULD NORMALLY QUALIFY AS CHARITABLE ORGANIZATIONS BECAUSE THEY SERVE THE ENTIRE COMMUNITY AND A LOW LEVEL OF CHARITY CARE WOULD NOT AFFECT A HOSPITAL'S EXEMPT STATUS IF IT WAS DUE TO THE SURROUNDING COMMUNITY'S LACK OF CHARITABLE DEMANDS. COMMUNITY BENEFIT STANDARD IN 1969, THE IRS ISSUED REVENUE RULING 69-545, WHICH "REMOVE[D]" FROM REVENUE RULING 56-185 "THE REQUIREMENTS RELATING TO CARING FOR PATIENTS WITHOUT CHARGE OR AT RATES BELOW COST." UNDER THE STANDARD DEVELOPED IN REVENUE RULING 69-545, WHICH IS KNOWN AS THE "COMMUNITY BENEFIT STANDARD," HOSPITALS ARE JUDGED ON WHETHER THEY PROMOTE THE HEALTH OF A BROAD CLASS OF INDIVIDUALS IN THE COMMUNITY. THE RULING INVOLVED A HOSPITAL THAT ONLY ADMITTED INDIVIDUALS WHO COULD PAY FOR THE SERVICES (BY THEMSELVES, PRIVATE INSURANCE, OR PUBLIC PROGRAMS SUCH AS MEDICARE), BUT OPERATED A FULL-TIME EMERGENCY ROOM THAT WAS OPEN TO EVERYONE. THE IRS RULED THAT THE HOSPITAL QUALIFIED AS A CHARITABLE ORGANIZATION BECAUSE IT PROMOTED THE HEALTH OF PEOPLE IN ITS COMMUNITY. THE IRS REASONED THAT BECAUSE THE PROMOTION OF HEALTH WAS A CHARITABLE PURPOSE ACCORDING TO THE GENERAL LAW OF CHARITY, IT FELL WITHIN THE "GENERALLY ACCEPTED LEGAL SENSE" OF THE TERM "CHARITABLE," AS REQUIRED BY TREAS. REG. 1.501(C)(3)-1(D)(2). THE IRS RULING STATED THAT THE PROMOTION OF HEALTH, LIKE THE RELIEF OF POVERTY AND THE ADVANCEMENT OF EDUCATION AND RELIGION, IS ONE OF THE PURPOSES IN THE GENERAL LAW OF CHARITY THAT IS DEEMED BENEFICIAL TO THE COMMUNITY AS A WHOLE EVEN THOUGH THE CLASS OF BENEFICIARIES ELIGIBLE TO RECEIVE A DIRECT BENEFIT FROM ITS ACTIVITIES DOES NOT INCLUDE ALL MEMBERS OF THE COMMUNITY, SUCH AS INDIGENT MEMBERS OF THE COMMUNITY, PROVIDED THAT THE CLASS IS NOT SO SMALL THAT ITS RELIEF IS NOT OF BENEFIT TO THE COMMUNITY. THE IRS CONCLUDED THAT THE HOSPITAL WAS "PROMOTING THE HEALTH OF A CLASS OF PERSONS THAT IS BROAD ENOUGH TO BENEFIT THE COMMUNITY" BECAUSE ITS EMERGENCY ROOM WAS OPEN TO ALL AND IT PROVIDED CARE TO EVERYONE WHO COULD PAY, WHETHER DIRECTLY OR THROUGH THIRD-PARTY REIMBURSEMENT. OTHER CHARACTERISTICS OF THE HOSPITAL THAT THE IRS HIGHLIGHTED INCLUDED THE FOLLOWING: ITS SURPLUS FUNDS WERE USED TO IMPROVE PATIENT CARE, EXPAND HOSPITAL FACILITIES, AND ADVANCE MEDICAL TRAINING, EDUCATION, AND RESEARCH; IT WAS CONTROLLED BY A BOARD OF TRUSTEES THAT CONSISTED OF INDEPENDENT CIVIC LEADERS; AND HOSPITAL MEDICAL STAFF PRIVILEGES WERE AVAILABLE TO ALL QUALIFIED PHYSICIANS. THE AMERICAN HOSPITAL ASSOCIATION ("AHA") FEELS THAT MEDICARE UNDERPAYMENTS (SHORTFALL) AND BAD DEBT ARE COMMUNITY BENEFIT AND THUS INCLUDABLE ON THE FORM 990, SCHEDULE H, PART I. THIS ORGANIZATION AGREES WITH THE AHA POSITION. AS OUTLINED IN THE AHA LETTER TO THE IRS DATED AUGUST 21, 2007 WITH RESPECT TO THE FIRST PUBLISHED DRAFT OF THE NEW FORM 990 AND SCHEDULE H, THE AHA FELT THAT THE IRS SHOULD INCORPORATE THE FULL VALUE OF THE COMMUNITY BENEFIT THAT HOSPITALS PROVIDE BY COUNTING MEDICARE UNDERPAYMENTS (SHORTFALL) AND BAD DEBT AS QUANTIFIABLE COMMUNITY BENEFIT FOR THE FOLLOWING REASONS: - PROVIDING CARE FOR THE ELDERLY AND SERVING MEDICARE PATIENTS IS AN ESSENTIAL PART OF THE COMMUNITY BENEFIT STANDARD. - MEDICARE, LIKE MEDICAID, DOES NOT PAY THE FULL COST OF CARE. RECENTLY, MEDICARE REIMBURSES HOSPITALS ONLY 92 CENTS FOR EVERY DOLLAR THEY SPEND TO TAKE CARE OF MEDICARE PATIENTS. THE MEDICARE PAYMENT ADVISORY COMMISSION ("MEDPAC") IN ITS MARCH 2007 REPORT TO CONGRESS CAUTIONED THAT UNDERPAYMENT WILL GET EVEN WORSE, WITH MARGINS REACHING A 10-YEAR LOW AT NEGATIVE 5.4 PERCENT. - MANY MEDICARE BENEFICIARIES, LIKE THEIR MEDICAID COUNTERPARTS, ARE POOR. MORE THAN 46 PERCENT OF MEDICARE SPENDING IS FOR BENEFICIARIES WHOSE INCOME IS BELOW 200 PERCENT OF THE FEDERAL POVERTY LEVEL. MANY OF THOSE MEDICARE BENEFICIARIES ARE ALSO ELIGIBLE FOR MEDICAID -- SO CALLED ELIGIBLES." THERE IS EVERY COMPELLING PUBLIC POLICY REASON TO TREAT MEDICARE AND MEDICAID UNDERPAYMENTS SIMILARLY FOR PURPOSES OF A HOSPITAL'S COMMUNITY BENEFIT AND INCLUDE THESE COSTS ON FORM 990, SCHEDULE H, PART I. MEDICARE UNDERPAYMENT MUST BE SHOULDERED BY THE HOSPITAL IN ORDER TO CONTINUE TREATING THE COMMUNITY'S ELDERLY AND POOR. THESE UNDERPAYMENTS REPRESENT A REAL COST OF SERVING THE COMMUNITY AND SHOULD COUNT AS A QUANTIFIABLE COMMUNITY BENEFIT. BOTH THE AHA AND THIS ORGANIZATION ALSO FEEL THAT PATIENT BAD DEBT IS A COMMUNITY BENEFIT AND THUS INCLUDABLE ON THE FORM 990, SCHEDULE H, PART I. THERE ARE COMPELLING REASONS THAT PATIENT BAD DEBT SHOULD BE COUNTED AS QUANTIFIABLE COMMUNITY BENEFIT AS FOLLOWS: - A SIGNIFICANT MAJORITY OF BAD DEBT IS ATTRIBUTABLE TO LOW-INCOME PATIENTS, WHO, FOR MANY REASONS, DECLINE TO COMPLETE THE FORMS REQUIRED TO ESTABLISH ELIGIBILITY FOR HOSPITALS' CHARITY CARE OR FINANCIAL ASSISTANCE PROGRAMS. A 2006 CONGRESSIONAL BUDGET OFFICE ("CBO") REPORT, NONPROFIT HOSPITALS AND THE PROVISION OF COMMUNITY BENEFITS, CITED TWO STUDIES INDICATING THAT "THE GREAT MAJORITY OF BAD DEBT WAS ATTRIBUTABLE TO PATIENTS WITH INCOMES BELOW 200% OF THE FEDERAL POVERTY LINE." - THE REPORT ALSO NOTED THAT A SUBSTANTIAL PORTION OF BAD DEBT IS PENDING CHARITY CARE. UNLIKE BAD DEBT IN OTHER INDUSTRIES, HOSPITAL BAD DEBT IS COMPLICATED BY THE FACT THAT HOSPITALS FOLLOW THEIR MISSION TO THE COMMUNITY AND TREAT EVERY PATIENT THAT COMES THROUGH THEIR EMERGENCY DEPARTMENT, REGARDLESS OF ABILITY TO PAY. PATIENTS WHO HAVE OUTSTANDING BILLS ARE NOT TURNED AWAY, UNLIKE OTHER INDUSTRIES. BAD DEBT IS FURTHER COMPLICATED BY THE AUDITING INDUSTRY'S STANDARDS ON REPORTING CHARITY CARE. MANY PATIENTS CANNOT OR DO NOT PROVIDE THE NECESSARY, EXTENSIVE DOCUMENTATION REQUIRED TO BE DEEMED CHARITY CARE BY AUDITORS. AS A RESULT, ROUGHLY 10% OF BAD DEBT IS PENDING CHARITY CARE. - THE CBO CONCLUDED THAT ITS FINDINGS "SUPPORT THE VALIDITY OF THE USE OF UNCOMPENSATED CARE [BAD DEBT AND CHARITY CARE] AS A MEASURE OF COMMUNITY BENEFITS" ASSUMING THE FINDINGS ARE GENERALIZABLE NATIONWIDE; THE EXPERIENCE OF HOSPITALS AROUND THE NATION REINFORCES THAT THEY ARE GENERALIZABLE. AS OUTLINED BY THE AHA, DESPITE THE HOSPITAL'S BEST EFFORTS AND DUE DILIGENCE, PATIENT BAD DEBT IS A PART OF THE HOSPITAL'S MISSION AND CHARITABLE PURPOSES. BAD DEBT REPRESENTS
SCHEDULE H, PART III, LINE 9B	THE ORGANIZATION DEVELOPED POLICIES AND PROCEDURES FOR INTERNAL AND EXTERNAL COLLECTION PRACTICES THAT TAKE INTO ACCOUNT THE EXTENT TO WHICH THE PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE, A PATIENTS GOOD FAITH EFFORT TO APPLY FOR A GOVERNMENTAL PROGRAM OR FINANCIAL ASSISTANCE AND A PATIENTS GOOD FAITH EFFORT TO COMPLY WITH HIS OR HER PAYMENT AGREEMENTS. THE CREDIT AND COLLECTION POLICY IS ADMINISTERED IN ACCORDANCE WITH THE MISSION AND VALUES OF THE HOSPITAL AS WELL AS FEDERAL AND STATE LAW. THE POLICY IS DESIGNED TO PROMOTE APPROPRIATE ACCESS TO MEDICAL CARE FOR ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY WHILE MAINTAINING THE FISCAL RESPONSIBILITY TO MAXIMIZE REIMBURSEMENT AND MINIMIZE BAD DEBT. ALL PATIENTS WITH AN OUTSTANDING BALANCE ARE SENT A STATEMENT. INCLUDED IN THIS STATEMENT IS THE CONTACT INFORMATION TO PURSUE FINANCIAL ASSISTANCE. PAYMENT OF OUTSTANDING PATIENT BALANCES ARE PURSUED USING THE ORGANIZATIONS STANDARD COLLECTION PRACTICES WHICH INCLUDE: - 30 DAY BILLING CYCLE WITH A TOTAL OF 5 BILLS SENT TO THE PATIENT; - ACCOUNT BALANCE NOT ON A PAYMENT PLAN OR NOT PAID IN FULL AFTER THE 120 DAY BILLING CYCLE ARE SENT TO A PRIMARY COLLECTION AGENCY; - IF PRIMARY COLLECTION AGENCY IS UNABLE TO COLLECT PAYMENT WITHIN 120 DAYS THE ACCOUNT WILL BE SENT TO A SECONDARY COLLECTION AGENCY; - BALANCES NOT PAID TO THE SECONDARY COLLECTION AGENCY WILL BE REPORTED TO THE CREDIT BUREAU AND LOGGED AS BAD DEBT; - BAD DEBT RECOVERIES WILL BE OFFSET WITHIN THE FISCAL YEAR THE RECOVERY OCCURS. THE ORGANIZATION MAY OFFER EXTENDED PAYMENT PLANS TO PATIENTS WHO ARE COOPERATING IN GOOD FAITH TO RESOLVE THEIR HOSPITAL BILLS. TO IDENTIFY CIRCUMSTANCES WHEN THE ORGANIZATION MAY PROVIDE CARE FOR A PATIENT WHOSE FINANCIAL STATUS MAKES IT IMPRACTICAL OR IMPOSSIBLE TO PAY THE PATIENT PORTION BALANCE IN A LUMP SUM PAYMENT. THE PROVISION OF PAYMENT ARRANGEMENTS WILL FOLLOW THE CURRENT PAYMENT PLAN GUIDELINES ESTABLISHED AT THE TIME OF THE DETERMINATION. DISCUSSION WITH THE PATIENT ABOUT THEIR FINANCIAL RESPONSIBILITIES WILL BE MADE WITH AN ACCOUNT RESOLUTION APPROACH. TO ASSIST THE PATIENT IN MEETING THEIR FINANCIAL RESPONSIBILITIES, THE ORGANIZATION ALLOWS FOR PATIENTS TO MAKE PAYMENT ARRANGEMENTS. IF THE PATIENT/GUARANTOR QUALIFIES FOR A PAYMENT PLAN, THEN THE CUSTOMER SERVICE REPRESENTATIVE/FINANCIAL COUNSELOR/PATIENT FINANCIAL SERVICES REPRESENTATIVE WILL INFORM THE PATIENT ABOUT THEIR RESPONSIBILITIES UNDER THE PAYMENT ARRANGEMENT PROGRAM AS DETAILED IN THE PAYMENT PLAN GUIDELINES ALONG WITH UPDATING THE PATIENT ACCOUNTING SYSTEM TO AUTOMATICALLY PROCESS THE PAYMENT SCHEDULE. ALL FINANCIAL COUNSELORS WILL INFORM THE PATIENT/GUARANTOR OF THE PAYMENT PLAN POLICY. IF THE PATIENT CANNOT MEET THE PAYMENT ARRANGEMENT PROGRAM, THE PATIENT WILL BE EVALUATED FOR FINANCIAL ASSISTANCE. PAYMENT PLANS ON PARTIAL CHARITY ACCOUNTS NEED TO BE INDIVIDUALLY DEVELOPED WITH THE PATIENT FOLLOWING THE GUIDELINES ESTABLISHED FOR PAYMENT PLANS. THE ORGANIZATION DOES NOT ENGAGE IN ANY ACTIONS THAT DISCOURAGE INDIVIDUALS FROM SEEKING EMERGENCY MEDICAL CARE. THE ORGANIZATION WILL NEVER DEMAND THAT AN EMERGENCY DEPARTMENT PATIENT PAY BEFORE RECEIVING TREATMENT FOR EMERGENCY MEDICAL CONDITIONS. ADDITIONALLY, DEBT COLLECTION ACTIVITIES ARE NOT PERMITTED IN THE EMERGENCY DEPARTMENT OR OTHER AREAS WHERE SUCH ACTIVITIES COULD INTERFERE WITH THE PROVISION OF EMERGENCY CARE ON A NONDISCRIMINATORY BASIS. ALL MEDICALLY NECESSARY HOSPITAL SERVICES ARE PROVIDED WITHOUT CONSIDERATION OF ABILITY TO PAY AND ARE NOT DELAYED PENDING APPLICATION OR APPROVAL OF MEDICAL ASSISTANCE OR FINANCIAL ASSISTANCE. THE ORGANIZATION DOES NOT ENGAGE IN EXTRAORDINARY COLLECTION ACTIONS AGAINST AN INDIVIDUAL TO OBTAIN PAYMENT FOR CARE BEFORE MAKING REASONABLE EFFORTS TO DETERMINE WHETHER THE INDIVIDUAL QUALIFIES FOR FINANCIAL ASSISTANCE. COLLECTION PROCEDURES MAY INCLUDE: LETTERS REQUESTING PAYMENT, PHONE CALLS REQUESTING THE RESOLUTION OF THE PATIENT BALANCE, LETTERS INDICATING THE ACCOUNT MAY BE SENT TO AN ATTORNEY OR COLLECTION AGENCY. IN SOME CASES THE ORGANIZATION MAY AUTHORIZE LEGAL ACTION PER PENNSYLVANIA LAW. SUCH LEGAL ACTION MAY RESULT IN A JUDGMENT BEING ENTERED AGAINST THE PATIENT.
SCHEDULE H, PART VI; QUESTION 2	THE ORGANIZATION CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT AND DEVELOPED AN IMPLEMENTATION PLAN WITH STRATEGIES TO ADDRESS IDENTIFIED COMMUNITY HEALTH NEEDS. THE PROCESS, CONDUCTED BY EAST CENTRAL PA AREA HEALTH EDUCATION CENTER ("ECPA AHEC"), USED AN ANALYSIS OF EXISTING SECONDARY DATA AND EXISTING COMMUNITY HEALTH MEASURES, KEY INFORMANT SURVEYS AND INTERVIEWS, AND A FOCUS GROUP TO IDENTIFY AND PRIORITIZE HEALTH PROBLEMS AND RISK FACTORS IN THE CARBON COUNTY SERVICE AREA. AFTER ANALYZING THIS DATA AND MAPPING EXISTING INTERNAL AND COMMUNITY BASED RESOURCES, BMHS DEVELOPED AN IMPLEMENTATION PLAN WITH EVIDENCE-BASED STRATEGIES. THE IMPLEMENTATION PLAN WAS REVIEWED AND APPROVED BY THE BOARD OF TRUSTEES AT THE ANNUAL STRATEGIC PLANNING RETREAT ON JULY 23, 2016. THE FINAL APPROVED VERSION OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION PLAN IS AVAILABLE TO THE PUBLIC ON THE HEALTH SYSTEMS WEBSITE. WITH THE COLLABORATION AFFORDED BY BLUE MOUNTAIN LEADERSHIP AND KEY COMMUNITY PARTNERS, THE GOALS, OBJECTIVES, AND OUTCOME MEASURES DEFINED FOR THE IMPLEMENTATION PLAN WILL BE REVIEWED ON AN ANNUAL BASIS FOR THE IMPROVEMENT AND POSITIVE IMPACT OF THE IDENTIFIED/PERCEIVED HEALTH NEEDS OF THE COMMUNITY. POST-ASSESSMENT MEETINGS WERE HELD WITH BOTH THE BLUE MOUNTAIN HEALTH SYSTEMS COMMUNITY BENEFIT PLAN STEERING COMMITTEE AND THE CARBON COUNTY INTERAGENCY COUNCIL TO REPORT THE FINDINGS AND GAIN FURTHER INPUT AND ASSISTANCE WITH THE PRIORITIZATION OF HEALTH NEEDS.
SCHEDULE H, PART VI; QUESTION 3	THE ORGANIZATION IS COMMITTED TO PROVIDING THE HIGHEST QUALITY HEALTHCARE SERVICES TO OUR COMMUNITY AND IS COMMITTED TO A SERVICE EXCELLENCE PHILOSOPHY THAT STRIVES TO MEET OR EXCEED PATIENT EXPECTATIONS. ALL PATIENTS WILL RECEIVE A UNIFORM STANDARD OF CARE THROUGHOUT ALL SYSTEM HEALTH FACILITIES, REGARDLESS OF SOCIAL, CULTURAL, FINANCIAL, RELIGIOUS, RACIAL, GENDER OR SEXUAL ORIENTATION FACTORS. THE ORGANIZATION STRIVES TO ENSURE THAT ALL PATIENTS RECEIVE ESSENTIAL EMERGENCY AND OTHER MEDICALLY NECESSARY HEALTHCARE SERVICES REGARDLESS OF THEIR ABILITY TO PAY. THE ORGANIZATION IS COMMITTED TO PROVIDING FINANCIAL ASSISTANCE TO PERSONS WHO HAVE HEALTHCARE NEEDS AND ARE UNINSURED, INELIGIBLE FOR GOVERNMENT ASSISTANCE, OR OTHERWISE UNABLE TO PAY, FOR MEDICALLY NECESSARY CARE BASED ON THEIR INDIVIDUAL FINANCIAL SITUATION. ALL PERSONS WHO PRESENT THEMSELVES FOR EMERGENCY OR OTHER MEDICALLY NECESSARY HEALTHCARE SERVICES ARE ADMITTED AND TREATED; THEY ARE REGISTERED AS PATIENTS OF THE HOSPITAL AND RECEIVE ANY NECESSARY SERVICES AS PRESCRIBED BY THE PATIENTS PHYSICIAN. A PROSPECTIVE PATIENT IS NEVER DENIED NECESSARY HEALTHCARE SERVICES ON THE BASIS OF THEIR ABILITY TO PAY. THE ORGANIZATION DOES ITS BEST TO EDUCATE AND INFORM PATIENTS ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE. FOR THE BENEFIT OF THE PATIENTS, THE FINANCIAL ASSISTANCE POLICY, FINANCIAL ASSISTANCE APPLICATION AND PLAIN LANGUAGE SUMMARY ARE ALL AVAILABLE ON-LINE. ADDITIONALLY, PAPER COPIES ARE AVAILABLE UPON REQUEST WITHOUT CHARGE BY MAIL AND ARE AVAILABLE THE HOSPITAL FACILITY REGISTRATION AREAS WHICH INCLUDE EMERGENCY ROOMS, ADMITTING AND REGISTRATION DEPARTMENTS AND PATIENT FINANCIAL SERVICES. THE FINANCIAL ASSISTANCE POLICY, FINANCIAL ASSISTANCE APPLICATION AND PLAIN LANGUAGE SUMMARY ARE AVAILABLE IN ENGLSH AND IN THE PRIMARY LANGUAGE OF POPULATIONS WITH LIMITED PROFICIENCY IN ENGLISH ("LEP") THAT CONSTITUTES THE LESSER OF 1,000 INDIVIDUALS OR 5% OF THE SYSTEM'S PRIMARY SERVICE AREA. SIGNS OR DISPLAYS ARE CONSPICUOUSLY POSTED IN PUBLIC HOSPITAL LOCATIONS INCLUDING THE EMERGENCY DEPARTMENT, ADMISSIONS DEPARTMENT AND REGISTRATION DEPARTMENT THAT NOTIFY AND INFORM PATIENTS ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE. THE ORGANIZATION ALSO MAKES REASONABLE EFFORTS TO INFORM MEMBERS OF THE COMMUNITY ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE. FINANCIAL ASSISTANCE REFERRALS CAN BE MADE BY A MEMBER OF THE HOSPITAL STAFF OR MEDICAL STAFF, INCLUDING PHYSICIANS, NURSES, FINANCIAL COUNSELORS, SOCIAL WORKERS, CASE MANAGERS, CHAPLAINS AND RELIGIOUS SPONSORS. ALL PATIENTS ARE OFFERED A COPY OF THE PLAIN LANGUAGE SUMMARY AS PART OF THE INTAKE OR DISCHARGE PROCESS. ADDITIONALY, FINANCIAL COUNSELORS AND REPRESENTATIVES ARE AVAILABLE TO ASSIST PATIENTS WITH QUESTIONS CONCERNING CHARGES, PAYMENTS OR ANY OTHER CONCERNS.
SCHEDULE H, PART VI; QUESTION 4	LOCATED IN NORTHEASTERN PENNSYLVANIA, APPROXIMATELY 90 MILES WEST OF NEW YORK CITY AND 90 MILES NORTHEAST OF PHILADELPHIA, CARBON COUNTY IS BORDERED ON THE NORTH BY LUZERNE COUNTY, ON THE EAST BY MONROE COUNTY, ON THE WEST BY SCHUYLKILL COUNTY AND ON THE SOUTH BY LEHIGH AND NORTHAMPTON COUNTIES. THE NORTHERN AND EASTERN PORTIONS OF THE COUNTY ARE PART OF THE POCONO MOUNTAINS REGION OF THE COMMONWEALTH. HALF OF THE COUNTYS GEOGRAPHIC AREA IS CONSIDERED "RURAL" ALTHOUGH DUE TO ITS PROXIMITY TO LEHIGH COUNTY IS TYPICALLY NOT CONSIDERED UNDERSERVED. AT THE CURRENT TIME, THE COUNTY IS EXPERIENCING GROWTH IN POPULATION AND INDUSTRY PRIMARILY RELATED TO THE WESTWARD MOVEMENT OF THE EAST COAST METROPOLITAN AREA. COMPARED TO 16.7% ON THE STATEWIDE LEVEL, 19.6% OF THE POPULATION OF CARBON COUNTY IS OLDER ADULTS, AGE 65 OR OLDER. THIS TREND IS EXPECTED TO CONTINUE. ACCORDING TO 2010 CENSUS ESTIMATES, APPROXIMATELY 96% OF INDIVIDUALS IN CARBON COUNTY IDENTIFIED THEIR RACE AS "WHITE". THE U.S. CENSUS BUREAUS 2014 ESIMATES REFLECT THE SAME APPROXIMATE PERCENTAGE (96.1%). THE COUNTY LAGS BEHIND THE STATE OF PA AS A WHOLE IN THE PROPORTION OF AFRICAN AMERICANS AND OTHER MINORITIES. NEIGHBORING LEHIGH AND NORTHAMPTON COUNTIES, HOWEVER, SHOW STATISTICS OF 20% AND 11% OF HISPANICS/LATINOS (COMPARED TO 6% STATEWIDE). ACCORDING TO THE CENTER FOR WORKFORCE INFORMATION & ANALYSIS, CARBON COUNTYS UNEMPLOYMENT RATE HAS BEEN TRENDING DOWNWARD SINCE A HIGH OF 11% IN 2009-2010. IT CURRENTLY STANDS AT 5.8%, RELATIVELY CLOSE TO THE STATE RATE OF 5.3%. PER CAPITA PERSONAL INCOME OF CARBON COUNTY RESIDENTS IS LOWER THAN THE STATE AVERAGE: $38,866 VS $47,679. MEDIAN HOUSEHOLD INCOME IS $49,913 VS THE STATES $53,115. OVERALL, CARBON COUNTY RANKS 58TH (OF 67 COUNTIES) IN HEALTH OUTCOMES RELATED TO MORTALITY, MORBIDITY, HEALTH BEHAVIORS, CLINICAL CARE, SOCIAL & ECONOMIC FACTORS AND PHYSICAL ENVIRONMENT. NOTE THAT THIS IS A DECREASE SINCE THE 2013 COMMUNITY HEALTH NEEDS ASSESSMENT, WHEN CARBON COUNTY WAS RANKED 49TH OF 67 COUNTIES. THE COUNTY IS RANKED 60TH IN LENGTH OF LIFE AND 46TH IN QUALITY OF LIFE, WHICH INCLUDES POOR OR FAIR HEALTH, POOR PHYSICAL HEALTH DAYS, POOR MENTAL HEALTH DAYS, AND LOW BIRTH WEIGHT. NATIONAL 2016 STATISTICS CITE THAT APPROXIMATELY 11% OF THE NATIONS POPULATION DID NOT HAVE ANY TYPE OF HEALTH INSURANCE AT SOME POINT DURING THE YEAR. IN CARBON COUNTY, ESTIMATES SUGGEST THAT ROUGHLY 12% OF ALL ADULTS BETWEEN THE AGES OF 18 AND 65 LACKED HEALTH INSURANCE. ANOTHER MEASURE OF ACCESS TO CARE RELATES TO THE PRIMARY CARE PROVIDER RATE, OR THE POPULATION TO PHYSICIAN RATIO. THE NATIONAL BENCHMARK FOR POPULATION TO PRIMARY PHYSICIAN RATIO IS 1,040:1. IN PENNSYLVANIA, THAT RATIO IS 1,220:1, AND IN CARBON COUNTY THE RATIO IS 2,090:1, WELL ABOVE BOTH NATIONAL AND STATE PERCENTAGES. IN THE ORAL HEALTH FIELD, THE NATIONAL BENCHMARK (FOR DENTISTS) IS 1,340:1. IN PENNSYLVANIA, THE RATIO IS 1,550:1 AND IN CARBON COUNTY 2,390:1. IN THE MENTAL HEALTH FIELD, THE NATIONAL BENCHMARK FOR MENTAL HEALTH PROVIDERS IS 370:1. IN PENNSYLVANIA, THE RATIO IS 580:1, AND IN CARBON COUNTY, 1,840:1.
SCHEDULE H, PART VI; QUESTION 5	THE ORGANIZATIONS MEDICAL STAFF IS AN OPEN MEDICAL STAFF ALLOWING SUBMISSIONS FOR PRIVILEGES AND CREDENTIALING FROM ANY INTERESTED PHYSICIAN OR SURGEON. THE BOARD OF TRUSTEES IS COMPRISED OF INDIVIDUALS FROM VARIOUS COMMUNITY ORGANIZATIONS SUCH AS FINANCIAL INSTITUTIONS, TELECOMMUNICATION, RECREATION AND REPRESENTATION FROM THE MEDICAL STAFF. HEALTH EDUCATION PROGRAMMING ============================ - PROVIDES MORE THAN 30 EDUCATIONAL PROGRAMS AND SCREENINGS (NATIONAL CHOLESTEROL MONTH DINNER & LECTURE PROGRAM, WEIGHT LOSS SURGERY, AARP DRIVING CLASS, LUNG CANCER EDUCATION, DIABETES EDUCATION, STRESS/STROKE SCREENINGS, CARBON COUNTY DOMESTIC VIOLENCE, FAMILY CAREGIVER TRAINING NIGHT, CARBON COUNTY DRUG & ALCOHOL PROGRAM; LOOK GOOD...FEEL BETTER WITH AMERICAN CANCER SOCIETY, NEW TO MEDICARE CO-SPONSORED WITH CARBON COUNTY AREA AGENCY ON AGING, HEART HEALTH FAIR, AMERICAN HEART MONTH LUNCH 'N LEARN, LETS TALK ABOUT WOUND CARE AND ADULT DAY SERVICE, CARBON COUNTY SAFE KIDS AND SENATOR YUDICHAK COMMUNITY SAFETY DAY, PANTHER VALLEY CAREER DAY, SAFE KIDS CAR SEAT CHECK, AND MENTAL HEALTH DEPRESSION OUTREACH ASSESSMENTS); - SERVES AS A MEDICAL TRAINING/CLINICAL EDUCATION SITE FOR AREA COLLEGES AND SCHOOLS SUCH AS CEDAR CREST COLLEGE, WILKES UNIVERSITY, KINGS COLLEGE, KUTZTOWN UNIVERSITY, DESALES UNIVERSITY, MARYWOOD UNIVERSITY, UNIVERSITY OF SCRANTON, LEHIGH CARBON COMMUNITY COLLEGE, LINCOLN TECHNICAL INSTITUTE, NORTHAMPTON AREA COMMUNITY COLLEGE, PENNSYLVANIA STATE UNIVERSITY, JOHNSON SCHOOL OF TECHNOLOGY, AND PENNSYLVANIA COLLEGE OF OSTEOPATHIC MEDICINE; - PROVIDES CPR/BLS/ACLS/PALS TRAINING TO COMMUNITY ORGANIZATIONS SUCH AS AMBULANCE/EMS, FIRE, POLICE AND TEACHERS; - PROVIDES "HEALTH IMAGES": A HEALTH SYSTEM-HOSTED TELEVISION PROGRAM FEATURING A VARIETY OF HEALTH AND WELLNESS INFORMATION AND EDUCATION; - HOSTS NEW SEASONS: A PROGRAM FOR ADULTS AGE 65 AND OLDER THAT OFFERS EXERCISE AND WELLNESS PROGRAMS SUCH AS YOGA AND LOW-IMPACT AEROBICS, NEW SEASONS HEARING AID BATTERY BANK, AND THE NEW SEASONS ANNUAL HEALTH & INFORMATION FAIR. DENTAL NEEDS ------------ IN A CONTINUED EFFORT TO SUPPORT DENTAL CARE THE ORGANIZATION: - PROVIDED ADMINISTRATIVE AND OPERATIONS OVERSIGHT OF THE HEALTHY SMILES HAPPY KIDS DENTAL VAN, WHICH IS THE DENTAL HOME FOR OVER 900 MEDICAID ELIGIBLE CHILDREN FROM CARBON AND NORTHERN SCHUYLKILL COUNTIES. AS THERE ARE NO LOCAL DENTISTS WHO ACCEPT MA AS A PAYER, THIS VAN PROVIDES THESE CHILDREN WITH TWICE ANNUAL DENTAL SCREENINGS AND CLEANINGS; - PROVIDED PATIENTS WITH BASIS EDUCATION ON BRUSHING, FLOSSING AND BASIS DENTAL HEALTH HYGIENE; - APPLIED SEALANTS AND VARNISHED AS INDICATED AND ADDRESSES DENTAL CARRIES AND BASIC RESTORATIVE SERVICES THAT CAN BE DONE SAFELY ON THE VAN. WHEN NECESSARY THE STAFF, IN CONSULTATION WITH PARENTS, REFERS CHILDREN FOR SPECIALTY CARE SERVICES. THIS PAST FISCAL YEAR, AFTER 11 YEARS ON THE ROAD, THE VAN WAS IN NEED OF SOME MAJOR REPAIRS. THE BIG TICKET ITEMS INCLUDED THE REPLACEMENT OF THE FORWARD GENERATOR ON THE VAN. THE LEVELING STABILIZERS WERE REPAIRED AND THE VANS POWER STEERING PUMP WAS REPLACED. SOME MINOR BODY AND FENDER REPAIRS WERE ALSO MADE. THE DENTAL VAN STAFF, IN PARTNERSHIP WITH THE ST. LUKE'S COMMUNITY HEALTH DEPARTMENT HAS BECOME INVOLVED IN A COMMUNITY DENTAL PLANNING INITIATIVE, THE GOAL OF WHICH IS TO FIND FUNDING TO GOOD WILL AND SUPPORT NEEDED TO ROLL OUT A FIXED DENTAL CLINIC FOR UNINSURED AND UNDERINSURED ADULTS IN OUR SERVICE REGION. DRUG ADDICTION (SPECIFICALLY HEROIN/OPIOIDS/NARCOTICS) ------------------------------------------------------ CARBON COUNTY CONTINUES TO BE IMPACTED BY THE NATIONAL OPIOID CRISIS OR EPIDEMIC. AN IN-HOUSE "WARM HANDOFF" TASK FORCE WAS FORMED AND MEETINGS CONVENED. THE GROUP SUCCESSFULLY CREATED AN APPROPRIATE BRIEF INTERVENTION STRATEGY TO BE DEPLOYED IN BOTH EMERGENCY DEPARTMENTS AND INTENSIVE CARE UNITS. A DETAILED "WARM HANDOFF" POLICY AND PROCEDURE WAS DEVELOPED IN PARTNERSHIP WITH THE CARBON-MONROE-PIKE D&A COMMISSION, THE LOCAL SINGLE COUNTY AUTHORITY ("SCA"), AS WELL AS WITH THE SCA ASSESSMENT AND EMERGENCY DETOXIFICATION PROVIDER PYRAMID HEALTHCARE. EMERGENCY DEPARTMENT, BHU CRISIS WORKER AND ICU NURSING TRAINING ON THE WARM HANDOFF P&P WAS DEVELOPED AND PROVIDED TO KEY INDIVIDUALS IN CRISIS, THE ED AND THE ICU. A SYSTEM TO TRACK PATIENT ENGAGEMENT WAS STARTED, AND MONTHLY MEETINGS TO TRACK PROGRESS BEGAN WELL OVER A YEAR AGO. EMERGENCY DEPARTMENT PHYSICIAN BUY-IN WITH THE WARM HANDOFF P&P REMAINS A SERIOUS PROBLEM, AS THEY ARE STILL NOT CONSISTENTLY CONSULTING CRISIS WORKERS WHEN THEY ARE TREATING AN UNINTENTIONAL OVERDOSE IN THE EMERGENCY DEPARTMENT. ANOTHER AREA IDENTIFIED FOR IMPROVEMENT IS THE HOSPITALS CONTINUED FAILURE TO UTILIZE THE SCAS RECOVERY SPECIALISTS WITHIN THE HOSPITALS ED, BHU AND/OR INTENSIVE CARE UNITS. THESE INDIVIDUALS ARE AVAILABLE TO CONSULT "REAL-TIME" WITH PATIENTS WHO COULD BENEFIT FROM A CONVERSATION WITH SOMEONE FAMILIAR WITH SUBSTANCE ABUSE DISORDERS, THE DISEASE OF ADDICTION AND IN THE RECOVERY PROCESS AND PROGRAMS. THE CRISIS DEPARTMENT HAS SUCCESSFULLY CREATED A "GRAB AND GO" COMMUNITY RESOURCE PACKET FOR THOSE PATIENTS WHO REFUSE TO PARTICIPATE IN THE MORE COMPREHENSIVE WARM HANDOFF PROCEDURE. THE PACKET IS READILY AVAILABLE AND EASY TO PUT INTO THE HANDS OF A PATIENT OR CONCERNED FAMILY MEMBER. DESPITE THE GOVERNORS OPIOID EMERGENCY DECLARATION THERE IS A GENERAL LACK OF LEADERSHIP WITH REGARD TO THE TIMELY AND ACCURATE COLLECTION OF DATA FORM OPIATE PATIENT ENCOUNTERS AND OUTCOMES HAPPENING DAILY IN MOST HOSPITALS ACROSS THE STATE OF PENNSYLVANIA. MENTAL HEALTH ------------- THE ORGANIZATION IS ONE OF THE LARGEST PROVIDERS OF INPATIENT MENTAL HEALTH SERVICES IN THE REGION. IT CURRENTLY MAINTAINS 22 ADULT BEDS AT ITS GH CAMPUS AND 27 OLDER ADULT BEDS AT ITS PH CAMPUS. THE SYSTEM ALSO PROVIDES A PARTIAL HOSPITALIZATION AND OUTPATIENT PROGRAM AT ITS MEDICAL PLAZA IN BOWMANSTOWN, PA. FOR THE PAST THREE YEARS, THE SYSTEM HAS SUCCESSFULLY PROVIDED BOTH MEDICAL AND PSYCHIATRIC FORENSIC SERVICES FOR THE CARBON COUNTY CORRECTIONAL FACILITY, AS WELL AS THE FACILITATION OF WOMEN PRISONER GROUP THERAPY SERVICES UTILIZING A TRAUMA INFORMED CARE APPROACH. THIS IS AN ORGANIZATIONAL STRUCTURE AND TREATMENT FRAMEWORK THAT INVOLVES UNDERSTANDING, RECOGNIZING, AND RESPONDING TO THE EFFECTS OF ALL TYPES OF TRAUMA. TRAUMA INFORMED CARE ALSO EMPHASIZES PHYSICAL, PSYCHOLOGICAL AND EMOTIONAL SAFETY FOR BOTH CONSUMERS AND PROVIDERS, AND HELPS SURVIVORS REBUILD A SENSE OF CONTROL AND EMPOWERMENT. THE ORGANIZATION HAS BEEN AN ACTIVE PARTNER WITHIN THE CARBON COUNTY CRIMINAL JUSTICE ADVISORY BOARD AND SUCCESSFULLY PARTICIPATED IN THE WRITING OF THE CARBON COUNTY CITIZENS REENTRY PROGRAM. THE GOAL OF THIS PROGRAM IS AIMED AT A SMOOTH TRANSITION OF HIGH RISK CITIZENS BEING RELEASED FROM THE PRISON BACK INTO THE COMMUNITY. IMPLEMENTATION EFFORTS ARE CURRENTLY UNDERWAY AND THE ORGANIZATION REMAINS A COMMITTED PARTNER. ALTHOUGH THE SYSTEM WAS SUCCESSFUL IN RECRUITING A SECOND PSYCHIATRIST A FEW YEARS AGO, IT HAS BEEN UNABLE TO RECRUIT A THIRD PROVIDER. CHRONIC ILLNESS WOMEN'S CANCER PREVENTION EARLY INTERVENTION SERVICES --------------------------------------------------------------------- THIS PAST YEAR, WITH THE ASSISTANCE OF A GRANT FROM THE WOMENS 5K GRANT COMMITTEE, THE ORGANIZATION PROVIDED 67 WOMEN WITH PRIMARY CARE PHYSICIAN SCREENING, DISEASE EDUCATION, MAMMOGRAM REFERRAL WHEN APPROPRIATE AND FOLLOW-UP. IN PARTNERSHIP WITH THE FOUNDATION RADIOLOGY GROUP, 70 WOMEN WERE PROVIDED ACCESS TO FREE OR REDUCED 3D MAMMOGRAMS SERVICES, AND OF THAT 70 WOMEN, 10 WOMEN WERE REFERRED ON FOR ADDITIONAL INTERVENTION AND RECEIVED DIAGNOSTIC ULTRASOUND STUDIES. WOMENS WISE PROGRAM & LADIES NIGHT OUT: THIS SERVICE IN AN ONGOING PREVENTION/EDUCATION AND AWARENESS PROGRAM THAT INCLUDES THE STAGING OF BMHS CLASSES AND PROGRAM ACTIVITIES SPECIFIC TO WOMENS CANCER PREVENTION AND EARLY INTERVENTION. ITS ESTIMATED THAT AN ADDITIONAL 2,000 WOMEN ARE REACHED THROUGH THESE EFFORTS.
SCHEDULE H, PART VI; QUESTION 6	OUTLINED BELOW IS A SUMMARY OF THE ENTITIES WHICH COMPRISE THE ST. LUKE'S UNIVERSITY HEALTH NETWORK: NOT FOR-PROFIT ST. LUKE'S UNIVERSITY HEALTH NETWORK ENTITIES: ============================================================= ST. LUKE'S HEALTH NETWORK, INC. ------------------------------- ST. LUKE'S HEALTH NETWORK, INC. IS THE TAX-EXEMPT PARENT OF THE ST. LUKE'S UNIVERSITY HEALTH NETWORK ("ST. LUKE'S"). THIS INTEGRATED HEALTHCARE DELIVERY SYSTEM CONSISTS OF A GROUP OF AFFILIATED HEALTHCARE ORGANIZATIONS. THIS ORGANIZATION IS THE SOLE MEMBER OR STOCKHOLDER OF EACH AFFILIATED ENTITY. ST. LUKE'S IS AN INTEGRATED NETWORK OF HEALTHCARE PROVIDERS THROUGHOUT THE STATES OF PENNSYLVANIA AND NEW JERSEY. ST. LUKE'S HEALTH NETWORK, INC. IS AN ORGANIZATION RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS TAX-EXEMPT PURSUANT TO INTERNAL REVENUE CODE 501(C)(3) AND AS A NON-PRIVATE FOUNDATION PURSUANT TO INTERNAL REVENUE CODE 509(A)(3). AS THE PARENT ORGANIZATION, ST. LUKE'S HEALTH NETWORK, INC. STRIVES TO CONTINUALLY DEVELOP AND OPERATE A MULTI-HOSPITAL HEALTHCARE NETWORK WHICH PROVIDES SUBSTANTIAL COMMUNITY BENEFIT THROUGH THE PROVISION OF A COMPREHENSIVE SPECTRUM OF HEALTHCARE SERVICES TO THE RESIDENTS OF PENNSYLVANIA AND NEW JERSEY AND SURROUNDING COMMUNITIES. ST. LUKE'S HEALTH NETWORK, INC. ENSURES THAT ITS NETWORK PROVIDES MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUALS REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN OR ABILITY TO PAY. THE ST. LUKE'S ACTIVE HOSPITALS INCLUDE: ST. LUKE'S HOSPITAL OF BETHLEHEM, PA, ST. LUKE'S HOSPITAL ANDERSON CAMPUS, ST. LUKE'S HOSPITAL MONROE CAMPUS, ST. LUKE'S QUAKERTOWN HOSPITAL, CARBON-SCHUYLKILL COMMUNITY HOSPITAL, INC. AND ST. LUKE'S WARREN HOSPITAL. EACH OF THESE HOSPITALS OPERATES CONSISTENTLY WITH THE FOLLOWING CRITERIA OUTLINED IN INTERNAL REVENUE SERVICE ("IRS") REVENUE RULING 69-545: 1. EACH PROVIDES MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUALS REGARDLESS OF ABILITY TO PAY, INCLUDING CHARITY CARE, SELF-PAY, MEDICARE AND MEDICAID PATIENTS; 2. EACH OPERATES AN ACTIVE EMERGENCY ROOM FOR ALL PERSONS; WHICH IS OPEN 24 HOURS A DAY, 7 DAYS A WEEK, 365 DAYS PER YEAR; 3. EACH MAINTAINS AN OPEN MEDICAL STAFF, WITH PRIVILEGES AVAILABLE TO ALL QUALIFIED PHYSICIANS; 4. CONTROL OF EACH RESTS WITH ITS BOARD OF TRUSTEES AND THE BOARD OF TRUSTEES OF ST. LUKE'S HEALTH NETWORK, INC. BOTH BOARDS ARE COMPRISED OF A MAJORITY OF INDEPENDENT CIVIC LEADERS AND OTHER PROMINENT MEMBERS OF THE COMMUNITY; AND 5. SURPLUS FUNDS ARE USED TO IMPROVE THE QUALITY OF PATIENT CARE, EXPAND AND RENOVATE FACILITIES AND ADVANCE MEDICAL CARE; PROGRAMS AND ACTIVITIES. ST. LUKE'S HOSPITAL OF BETHLEHEM, PENNSYLVANIA ---------------------------------------------- ST. LUKE'S HOSPITAL OF BETHLEHEM, PENNSYLVANIA IS COMPRISED OF TWO NON-PROFIT HOSPITAL CAMPUSES: A 480-BED CAMPUS IN BETHLEHEM, PENNSYLVANIA AND A 158 BED CAMPUS IN ALLENTOWN, PENNSYLVANIA. ST. LUKE'S HOSPITAL OF BETHLEHEM, PENNSYLVANIA IS RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS AN INTERNAL REVENUE CODE 501(C)(3) TAX-EXEMPT ORGANIZATION. PURSUANT TO ITS CHARITABLE PURPOSES, THE ORGANIZATION PROVIDES MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUALS REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN OR ABILITY TO PAY. MOREOVER, ST. LUKE'S HOSPITAL OF BETHLEHEM, PENNSYLVANIA OPERATES CONSISTENTLY WITH THE CRITERIA OUTLINED IN IRS REVENUE RULING 69-545. ST. LUKE'S AIRMED, LLC ---------------------- A LIMITED LIABILITY COMPANY DISREGARDED FOR FEDERAL INCOME TAX PURPOSES OWNED BY ST. LUKE'S HOSPITAL OF BETHLEHEM, PENNSYLVANIA. THIS ENTITY IS CURRENTLY INACTIVE. ST. LUKE'S HOMESTAR SERVICES, LLC --------------------------------- A LIMITED LIABILITY COMPANY DISREGARDED FOR FEDERAL INCOME TAX PURPOSES OWNED BY ST. LUKE'S HOSPITAL OF BETHLEHEM, PENNSYLVANIA. THIS ENTITY PROVIDES OUTPATIENT SERVICES IN BETHLEHEM, PENNSYLVANIA. POCONO MRI IMAGING AND DIAGNOSTIC CENTER, LLC --------------------------------------------- A LIMITED LIABILITY COMPANY DISREGARDED FOR FEDERAL INCOME TAX PURPOSES OWNED BY ST. LUKE'S HOSPITAL OF BETHLEHEM, PENNSYLVANIA. THIS ENTITY PROVIDES OUTPATIENT SERVICES IN BETHLEHEM, PENNSYLVANIA. EVANTAGE HEALTH, LLC -------------------- A LIMITED LIABILITY COMPANY DISREGARDED FOR FEDERAL INCOME TAX PURPOSES OWNED BY ST. LUKE'S HOSPITAL OF BETHLEHEM, PENNSYLVANIA. THIS ENTITY IS CURRENTLY INACTIVE. ST. LUKE'S CARE, LLC -------------------- A LIMITED LIABILITY COMPANY DISREGARDED FOR FEDERAL INCOME TAX PURPOSES OWNED BY ST. LUKE'S HOSPITAL OF BETHLEHEM, PENNSYLVANIA. THIS ENTITY PROVIDES CLINICAL SERVICES IN ALLENTOWN, PENNSYLVANIA. ST. LUKE'S SHARED SAVINGS PLAN, LLC ----------------------------------- A LIMITED LIABILITY COMPANY DISREGARDED FOR FEDERAL INCOME TAX PURPOSES OWNED BY ST. LUKE'S HOSPITAL OF BETHLEHEM, PENNSYLVANIA. THIS ENTITY IS LOCATED IN ALLENTOWN PENNSYLVANIA. THE ORGANIZATION IS CURRENTLY INACTIVE. ST. LUKE'S HOSPITAL ANDERSON CAMPUS ----------------------------------- ST. LUKE'S HOSPITAL ANDERSON CAMPUS IS A 108-BED NON-PROFIT HOSPITAL LOCATED IN EASTON, PENNSYLVANIA. ST. LUKE'S HOSPITAL ANDERSON CAMPUS IS RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS AN INTERNAL REVENUE CODE 501(C)(3) TAX-EXEMPT ORGANIZATION. PURSUANT TO ITS CHARITABLE PURPOSES, THE ORGANIZATION PROVIDES MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUALS REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN OR ABILITY TO PAY. MOREOVER, ST. LUKE'S HOSPITAL ANDERSON CAMPUS OPERATES CONSISTENTLY WITH THE CRITERIA OUTLINED IN IRS REVENUE RULING 69-545. ST. LUKE'S HOSPITAL MONROE CAMPUS --------------------------------- ST. LUKE'S HOSPITAL MONROE CAMPUS IS A 108-BED NON-PROFIT COMMUNITY HOSPITAL LOCATED IN BARTONSVILLE, PENNSYLVANIA, MONROE COUNTY. ST. LUKE'S HOSPITAL MONROE CAMPUS IS RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS AN INTERNAL REVENUE CODE 501(C)(3) TAX-EXEMPT ORGANIZATION. PURSUANT TO ITS CHARITABLE PURPOSES, THE ORGANIZATION PROVIDES MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUALS REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN OR ABILITY TO PAY. MOREOVER, ST. LUKE'S HOSPITAL MONROE CAMPUS OPERATES CONSISTENTLY WITH THE CRITERIA OUTLINED IN IRS REVENUE RULING 69-545. CARBON-SCHUYLKILL COMMUNITY HOSPITAL, INC. ------------------------------------------ CARBON-SCHUYLKILL COMMUNITY HOSPITAL, INC. DBA ST. LUKE'S MINERS MEMORIAL MEDICAL CENTER IS A 45-BED NON-PROFIT ACUTE CARE HOSPITAL LOCATED IN COALDALE, PENNSYLVANIA. CARBON-SCHUYLKILL COMMUNITY HOSPITAL, INC. IS RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS AN INTERNAL REVENUE CODE 501(C)(3) TAX-EXEMPT ORGANIZATION. PURSUANT TO ITS CHARITABLE PURPOSES, THE ORGANIZATION PROVIDES MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUALS REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN OR ABILITY TO PAY. MOREOVER, CARBON-SCHUYLKILL COMMUNITY HOSPITAL, INC. OPERATES CONSISTENTLY WITH THE CRITERIA OUTLINED IN IRS REVENUE RULING 69-545. ST. LUKE'S QUAKERTOWN HOSPITAL ------------------------------ ST. LUKE'S QUAKERTOWN HOSPITAL IS A 62-BED NON-PROFIT HOSPITAL LOCATED IN QUAKERTOWN, PENNSYLVANIA. ST. LUKE'S QUAKERTOWN HOSPITAL IS RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS AN INTERNAL REVENUE CODE 501(C)(3) TAX-EXEMPT ORGANIZATION. PURSUANT TO ITS CHARITABLE PURPOSES, THE ORGANIZATION PROVIDES MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUALS REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN OR ABILITY TO PAY. MOREOVER, ST. LUKE'S QUAKERTOWN HOSPITAL OPERATES CONSISTENTLY WITH THE CRITERIA OUTLINED IN IRS REVENUE RULING 69-545. ST. LUKE'S WARREN HOSPITAL, INC. -------------------------------- ST. LUKE'S WARREN HOSPITAL, INC. IS A 198-BED NON-PROFIT ACUTE CARE HOSPITAL LOCATED IN PHILLIPSBURG, NEW JERSEY. ST. LUKE'S WARREN HOSPITAL, INC. IS RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS AN INTERNAL REVENUE CODE 501(C)(3) TAX-EXEMPT ORGANIZATION. PURSUANT TO ITS CHARITABLE PURPOSES, THE ORGANIZATION PROVIDES MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUALS REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN OR ABILITY TO PAY. MOREOVER, ST. LUKE'S WARREN HOSPITAL, INC. OPERATES CONSISTENTLY WITH THE CRITERIA OUTLINED IN IRS REVENUE RULING 69-545. ST. LUKE'S PHYSICIAN GROUP, INC. -------------------------------- ST. LUKE'S PHYSICIAN GROUP, INC. IS AN ORGANIZATION RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS TAX-EXEMPT PURSUANT TO INTERNAL REVENUE CODE 501(C)(3) AND AS A NON-PRIVATE FOUNDATION PURSUANT TO INTERNAL REVENUE CODE 509(A)(3). THE ORGANIZATION PROVIDES MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUALS REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN OR ABILITY TO PAY. ST. LUKE'S EMERGENCY & TRANSPORT SERVICES, INC. ----------------------------------------------- ST. LUKE'S EMERGENCY & TRANSPORT SERVICES, INC. IS AN ORGANIZATION RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS TAX-EXEMPT PURSUANT TO INTERNAL REVENUE CODE 501(C)(3) AND AS A NON-PRIVATE FOUNDATION PURSUANT TO INTERNAL REVENUE CODE 170(B)(1)(A)(II
SCHEDULE H, PART VI; QUESTION 7	NOT APPLICABLE. THE ENTITY AND RELATED PROVIDER ORGANIZATIONS ARE LOCATED IN PENNSYLVANIA AND NEW JERSEY. NO COMMUNITY BENEFIT REPORT IS REQUIRED TO BE FILED WITH EITHER PENNSYLVANIA OR NEW JERSEY.

Schedule H (Form 990) 2019

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
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Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
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Attach to Form 990.
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Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

BLUE MOUNTAIN HOSPITAL INC

Employer identification number

24-0795436

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 on 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 on 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 .........

Yes

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 on Line 1a? ..

Yes

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 on 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 on 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," on line 5a or 5b, describe in Part III.

For persons listed on 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," on line 6a or 6b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Yes

Were any amounts reported on 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" on 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) 2019

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 on 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 on 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)
1ROBERT GROB DO SECRETARY/TREASURER - TRUSTEE	(i) (ii)	-------------	-------------	220,958 -------------	-------------	-------------	220,958 -------------	-------------
2TERRENCE J PURCELL TRUSTEE - PRESIDENT(EFF 01/18)	(i) (ii)	159,506 -------------	-------------	283 -------------	16,787 -------------	33,560 -------------	210,136 -------------	-------------
3ANDREW E HARRIS TRUSTEE - PRES/CEO(TERM 12/17)	(i) (ii)	440,224 -------------	133,130 -------------	16,536 -------------	44,377 -------------	15,355 -------------	649,622 -------------	-------------
4ANDREA L ANDRAE VP/CFO (TERMED 12/31/17)	(i) (ii)	163,362 -------------	-------------	128 -------------	16,613 -------------	22,833 -------------	202,936 -------------	-------------
5HAMAYUN N AHMED MD PSYCHIATRIST	(i) (ii)	347,236 -------------	2,200 -------------	495 -------------	-------------	22,646 -------------	372,577 -------------	-------------
6MOHAMMAD K KHAN MD PSYCHIATRIST	(i) (ii)	265,933 -------------	60,194 -------------	242 -------------	-------------	26,997 -------------	353,366 -------------	-------------
7MUHAMMAD Z AJMAL MD ANESTHESIOLOGIST	(i) (ii)	305,931 -------------	-------------	15,696 -------------	-------------	25,523 -------------	347,150 -------------	-------------
8BRIAN A LEFROCK MD ANETHESIOLOGIST	(i) (ii)	312,313 -------------	-------------	670 -------------	-------------	21,920 -------------	334,903 -------------	-------------
9LARRY J MATURANI MD INTERNIST	(i) (ii)	246,358 -------------	46,978 -------------	2,794 -------------	-------------	24,021 -------------	320,151 -------------	-------------

Schedule J (Form 990) 2019

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
CORE FORM, PART VII AND SCHEDULE J	TAXABLE COMPENSATION REPORTED HEREIN IS DERIVED FROM 2017 FORMS W-2.
SCHEDULE J, PART I; QUESTION 1A	THE ORGANIZATION MAINTAINS A MEMBERSHIP IN A COUNTRY CLUB FOR BUSINESS PURPOSES. THE COUNTRY CLUB REQUIRES THAT AN INDIVIDUAL IS NAMED AS THE MEMBER; ACCORDINGLY DURING 2017 THE ORGANIZATION HAD DESIGNATED ITS PRESIDENT/CEO, ANDREW E. HARRIS, AS THE MEMBER.
SCHEDULE J, PART I; QUESTION 4B	THE DEFERRED COMPENSATION AMOUNTS REFLECTED IN SCHEDULE J, PART II, COLUMN C FOR THE FOLLOWING INDIVIDUALS INCLUDES UNVESTED BENEFITS IN AN INTERNAL REVENUE CODE SECTION 457(F) PLAN (NON-QUALIFIED DEFERRED COMPENSATION PLAN) WHICH ARE SUBJECT TO A SUBSTANTIAL RISK OF COMPLETE FORFEITURE. ACCORDINGLY, THE INDIVIDUALS MAY NEVER ACTUALLY RECEIVE THIS UNVESTED BENEFIT AMOUNT. THE AMOUNTS OUTLINED HEREIN WERE NOT INCLUDED IN EACH INDIVIDUAL'S 2017 FORM W-2, BOX 5, AS TAXABLE MEDICARE WAGES: TERRENCE J. PURCELL, $16,787; ANDREW E. HARRIS, $44,377 AND ANDREA L. ANDRAE, $16,613.
SCHEDULE J, PART I; QUESTION 7	CERTAIN INDIVIDUALS INCLUDED IN SCHEDULE J, PART II RECEIVED A BONUS COMPENSATION DURING CALENDAR YEAR 2017 WHICH WERE INCLUDED IN SCHEDULE J, PART II, COLUMN B(II) HEREIN AND IN EACH INDIVIDUAL'S 2017 FORM W-2, BOX 5, AS TAXABLE MEDICARE WAGES. PLEASE REFER TO THIS SECTION OF THE FORM 990, SCHEDULE J FOR THIS INFORMATION BY PERSON BY AMOUNT.

Schedule J (Form 990) 2019

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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 Ⅵ, line 24a. Provide descriptions,
explanations, and any additional information in Part Ⅵ.
SchKMediumBullet

Attach to Form 990.
SchKMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization
BLUE MOUNTAIN HOSPITAL INC

Employer identification number
24-0795436

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	CARBON COUNTY HOSPITAL AUTHORITY	23-2280834	140868EN6	02-23-2012	6,306,819	REFER TO SCHEDULE K, PART VI		X		X		X
B	CARBON COUNTY HOSPITAL AUTHORITY	23-2280834	140868EE6	02-23-2012	2,456,652	REFER TO SCHEDULE K, PART VI		X		X		X
C	CARBON COUNTY HOSPITAL AUTHORITY	23-2280834	140868EE6	12-31-2015	20,000,000	REFER TO SCHEDULE K, PART VI		X		X		X

Part Ⅱ

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................	1,551,819		0		0
2 Amount of bonds legally defeased ..............	0		0		0
3 Total proceeds of issue ..................	6,306,819		2,456,652		20,000,000
4 Gross proceeds in reserve funds .............	2,197,510		578		1,754,033
5 Capitalized interest from proceeds .............	0		0		0
6 Proceeds in refunding escrows ...............	0		0		0
7 Issuance costs from proceeds ...............	126,068		49,133		0
8 Credit enhancement from proceeds .............	41,940		15,809		0
9 Working capital expenditures from proceeds .............	0		0		0
10 Capital expenditures from proceeds .............	0		0		0
11 Other spent proceeds .............	6,138,810		2,387,228		0
12 Other unspent proceeds .............	0		0		0
13 Year of substantial completion .............	2012		2012		2015
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue of tax-exempt bonds (or, if issued prior to 2018, a current refunding issue)? ........
15 Were the bonds issued as part of an advance refunding issue of taxable bonds (or, if issued prior to 2018, an advance refunding issue)? ........
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) 2019

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?	X		X
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
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? ........
c No rebate due? .........
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		X
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X		X		X
b Name of provider ..........	0		0		0
c Term of hedge .........
d Was the hedge superintegrated? ......
e Was the hedge terminated? ........

Schedule K (Form 990) 2019

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, PART I, COLUMN F

THE PROCEEDS OF THE CARBON COUNTY HOSPITAL AUTHORITY SERIES 2012 (GNADEN) BONDS WERE USED TO REFUND THE SERIES 1999 BONDS, ESTABLISH A DEBT RESERVE FUND AND TO PAY THE COST OF ISSUANCE OF THE 2012 GNADEN BONDS. ADDITIONALLY, THE PROCEEDS OF THE CARBON COUNTY HOSPITAL AUTHORITY SERIES 2012 (PALMERTON) BONDS WERE USED TO REFUND THE HOSPITAL REVENUE BONDS, ESTABLISH A DEBT RESERVE FUND TO PAY COST OF ISSUANCE OF THE 2012 PALMERTON BONDS. THE PROCEEDS OF THE 2015 BONDS WERE USED TO FUND A PORTION OF THE HOSPITALS PENSION LIABILITY, FINANCE RENOVATION AND IMPROVEMENTS TO THE EXISTING FACILIATIES OF THE HOSPITAL, FINANCE VARIOUS OTHER CAPITAL IMPROVEMENTS, ESTABLISH A DEBT RESERVE FUND, AND TO PAY THE COSTS OF ISSUANCE OF THE 2015 BONDS.

Schedule K (Form 990) 2019

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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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

BLUE MOUNTAIN HOSPITAL INC

Employer identification number

24-0795436

Part I

Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and section 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 the 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) 2019

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) MAHONING VALLEY ORTHOPEDICS	TRUSTEE - GROB	156,443	MEDICAL SERVICES		No
(2) CARDIOLOGY ASSOCIATES	TRUSTEE - MARKSON	1,274,468	MEDICAL SERVICES		No

Part V

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

Return Reference

Explanation

SCHEDULE L, PART IV

ROBERT GROB, D.O., IS A TRUSTEE OF THE ORGANIZATION. DR. GROB IS A SHAREHOLDER OF MAHONING VALLEY ORTHOPEDICS. THE ORGANIZATION UTILIZED THE SERVICES OF MAHONING VALLEY ORTHOPEDICS, DURING THE YEAR ENDED JUNE 30, 2018. TOTAL FEES PAID TO MAHONING VALLEY ORTHOPEDICS WERE $156,443. SERVICES WERE RENDERED AT FAIR MARKET VALUE RATES PURSUANT TO ARM'S LENGTH NEGOTIATIONS. WILLIAM MARKSON, M.D. IS A TRUSTEE OF THE ORGANIZATION. DR. MARKSON IS A SHAREHOLDER OF CARDIOLOGY ASSOCIATES. THE ORGANIZATION UTILIZED THE SERVICES OF CARDIOLOGY ASSOCIATES, DURING THE YEAR ENDED JUNE 30, 2018. TOTAL FEES PAID TO CARDIOLOGY ASSOCIATES WERE $1,274,468. SERVICES WERE RENDERED AT FAIR MARKET VALUE RATES PURSUANT TO ARM'S LENGTH NEGOTIATIONS.

Schedule L (Form 990 or 990-EZ) 2019

Additional Data

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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

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization

BLUE MOUNTAIN HOSPITAL INC

Employer identification number

24-0795436

Return Reference	Explanation
CORE FORM, PAGE 1, BOX C	PLEASE NOTE, THIS ORGANIZATION FILED THE FOLLOWING FICTITIOUS NAME WITH THE COMMONWEALTH OF PENNSYLVANIA AND OPERATES UNDER THE FOLLOWING: - ST. LUKE'S HOSPITAL - PALMERTON CAMPUS - ST. LUKE'S HOSPITAL - GNADEN HUETTEN CAMPUS - THE SUMMIT AT BLUE MOUNTAIN NURSING & REHAB CENTER
CORE FORM, PART III; STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS	ST. LUKE'S BLUE MOUNTAIN CAMPUSES --------------------------------- BLUE MOUNTAIN HOSPITAL (GNADEN HUETTEN AND PALMERTON CAMPUSES) BECAME PART OF ST. LUKE'S UNIVERSITY HEALTH NETWORK ON JANUARY 1, 2018, BECOMING THE EIGHTH AND NINTH HOSPITAL CAMPUSES IN THE NETWORK. THE EMERGENCY DEPARTMENT LOCATED A SL-BLUE MOUNTAIN GNADEN HUETTEN CAMPUS PROVIDES EMERGENCY SERVICES TO CARBON COUNTY AND THE SURROUNDING COMMUNITY 24-HOUR, SEVEN DAYS A WEEK, 365 DAYS A YEAR. CARE IS PROVIDED TO ALL PATIENTS, REGARDLESS OF THEIR ABILITY TO PAY OR THEIR INSURANCE STATUS. DURING FY2018, THE ST. LUKES BLUE MOUNTAIN GNADEN HUETTEN CAMPUS EMERGENCY DEPARTMENT SAW 15,600 PATIENTS. THE EMERGENCY DEPARTMENT LOCATED AT THE SL-BLUE MOUNTAIN PALMERTON CAMPUS PROVIDES AROUND-THE-CLOCK EMERGENCY SERVICES TO THE PALMERTON AREA AND SURROUNDING COMMUNITIES WITHIN CARBON COUNTY. CARE IS PROVIDED TO ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY OR THEIR INSURANCE STATUS. DURING FY2018, THE PALMERTON CAMPUS EMERGENCY DEPARTMENT SAW 10,693 PATIENTS. IN FY18 SL-BLUE MOUNTAIN HOSPITAL PROVIDED CARE FOR 5,625 ADMISSIONS AND OBSERVATIONS, 26,293 ED VISITS, AND 69,145 OUTPATIENT VISITS AND IS RECOGNIZED BY THE IRS AS AN INTERNAL REVENUE CODE SECTION 501(C)(3) TAX-EXEMPT ORGANIZATION. PURSUANT TO ITS CHARITABLE PURPOSES, SL-BLUE MOUNTAIN PROVIDES MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUALS IN A NON-DISCRIMINATORY MANNER REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN, RELIGION OR ABILITY TO PAY. MOREOVER, SL-BLUE MOUNTAIN OPERATES CONSISTENTLY WITH THE FOLLOWING CRITERIA OUTLINES IN THE IRS REVENUE RULING 69-545: 1) SL-BLUE MOUNTAIN PROVIDES MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUALS REGARDLESS OF ABILITY TO PAY, INCLUDING CHARITY CARE, SELF-PAY, MEDICARE AND MEDICAID PATIENTS; 2) SL-BLUE MOUNTAIN OPERATES AN ACTIVE EMERGENCY ROOM FOR ALL PERSONS; WHICH IS OPEN 24 HOURS A DAY, 7 DAYS A WEEK, 365 DAYS PER YEAR; 3) SL-BLUE MOUNTAIN MAINTAINS AN OPEN MEDICAL STAFF, WITH PRIVILEGES AVAILABLE TO ALL QUALIFIED PHYSICIANS; 4) CONTROL OF SL-BLUE MOUNTAIN RESTS WITH THE BOARD OF TRUSTEES OF ST. LUKE'S HEALTH NETWORK, INC., D.B.A. ST. LUKE'S UNIVERSITY HEALTH NETWORK. THE BOARD IS COMPRISED OF A MAJORITY OF INDEPENDENT CIVIC LEADERS AND OTHER PROMINENT MEMBERS OF THE COMMUNITY, AS WELL AS PHYSICIANS ON THE HOSPITAL/NETWORK MEDICAL STAFF; 5) SURPLUS FUNDS ARE USED TO IMPROVE THE QUALITY OF PATIENT CARE, EXPAND AND RENOVATE FACILITIES AND ADVANCE MEDICAL CARE; PROGRAMS AND ACTIVITIES. THE OPERATIONS OF SL-BLUE MOUNTAIN, AS SHOWN THROUGH THE FACTORS OUTLINED ABOVE AND OTHER INFORMATION CONTAINED HEREIN, CLEARLY DEMONSTRATE THAT THE USE AND CONTROL OF SL-BLUE MOUNTAIN IS FOR THE BENEFIT OF THE PUBLIC AND THAT NO PART OF THE INCOME OR NET EARNINGS OF THE ORGANIZATION INURES TO THE BENEFIT OF ANY PRIVATE INDIVIDUAL NOR IS ANY PRIVATE INTEREST BEING SERVED OTHER THAN INCIDENTALLY. ON JANUARY 1, 2018, BLUE MOUNTAIN HOSPITAL CONTINUED TO CARE FOR THE RESIDENTS OF CARBON COUNTY BY JOINING ST. LUKES UNIVERSITY HEALTH NETWORK AND BECAME ST. LUKES-BLUE MOUNTAIN WITH TWO CAMPUS LOCATIONS, GNADEN HUETTEN IN LEHIGHTON, PENNSYLVANIA, AND PALMERTON LOCATED IN PALMERTON, PENNSYLVANIA. SL-BLUE MOUNTAIN GNADEN HUETTEN AND PALMERTON CAMPUSES PROVIDE ACUTE INPATIENT AND OUTPATIENT MEDICAL AND SURGICAL CARE. THE SL-BLUE MOUNTAIN CAMPUS HAS AN ANNUAL CAPACITY FOR 8,200 INPATIENT AND OBSERVATION ADMISSIONS AND HAS A 9-BED EMERGENCY DEPARTMENT WITH AN ANNUAL CAPACITY FOR 62,000 VISITS. KINDRED HEALTHCARE OPERATES A 22-BED INPATIENT ACUTE REHABILITATION UNIT ON THE THIRD FLOOR OF THE SL-BLUE MOUNTAIN GNADEN HUETTEN CAMPUS. THE UNIT PROVIDES INPATIENT REHABILITATION FOR PATIENTS WHO HAVE EXPERIENCED STROKE, MAJOR-MULTI TRAUMAS, COMPLEX JOINT REPLACEMENTS, AMPUTATION, SEVERE ARTHRITIS, MULTIPLE SCLEROSIS AND OTHER PHYSICAL AND NEUROLOGICAL CONDITIONS. THE ACUTE REHABILITATION TEAM OFFERS SPECIALIZED REHABILITATION CARE IN BEAUTIFULLY-APPOINTED ROOMS AND IS THE MOST COMPREHENSIVE UNIT OF ITS TYPE IN THE CARBON COUNTY AREA. THE UNIT OPERATES UNDER THE SL-BLUE MOUNTAIN LICENSE. SL-BLUE MOUNTAIN SPECIALTY SERVICES INCLUDE: -------------------------------------------- - ADULT BEHAVIORAL HEALTH - ADULT PARTIAL HOSPITALIZATION - CARDIAC CATHETERIZATION - CARDIOLOGY - CRITICAL CARE - ECT - ELECTROCONVULSIVE THERAPY - EMERGENCY SERVIVES - ENDOSCOPIES - GYNECOLOGY - INFUSION SERVICES - NEUROLOGY - OLDER ADULT BEHAVIORAL HEALTH - ORTHOPEDICS, JOINT AND MUSCLE DISORDERS - PAIN MANAGEMENT - RADIOLOGY (ADVANCED, INTERVENTIONAL) - SLEEP DISORDERS CENTER - PHYSICAL AND OCCUPATIONAL THERAPY, REHABILITATION - SURGERY (GENERAL, SPECIALTY AND LAPAROSCOPIC) - VASCULAR SERVICES MISSION: -------- THE MISSION OF SL-BLUE MOUNTAIN IS TO PROVIDE COMPASSIONATE, EXCELLENT QUALITY AND COST-EFFECTIVE HEALTHCARE TO RESIDENTS OF THE COMMUNITIES SERVED REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN, RELIGION OR ABILITY TO PAY. THE MISSION OF SL-BLUE MOUNTAIN IS AN UNWAVERING COMMITMENT TO EXCELLENCE AS WE CARE FOR THE SICK AND INJURED; EDUCATE PHYSICIANS, NURSES AND OTHER HEALTHCARE PROVIDERS; AND IMPROVE ACCESS TO CARE IN THE COMMUNITIES WE SERVE, REGARDLESS OF A PATIENT'S ABILITY TO PAY FOR THEIR CARE. CARBON COMMUNITY OUTREACH: -------------------------- ST. LUKES UNIVERSITY HEALTH NETWORK PARTNERS WITH LOCAL SCHOOLS, CIVIC ORGANIZATIONS AND COMMUNITY RESOURCES TO IMPROVE THE HEALTH OF THE RESIDENTS OF CARBON COUNTY AND THE SURROUNDING AREA. SL-BLUE MOUNTAIN SUPPORTS THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) PRIORITY AREAS THAT ARE IDENTIFIED WITHIN THE CAMPUS SERVICE AREA BY COLLECTING AND ANALYZING DATA AND COMMUNITY INPUT. BASED ON THE IDENTIFIED NEEDS AND PRIORITIES, EACH CAMPUS DEVELOPS PLANS AND PROGRAMS TO IMPROVE THE HEALTH OF THOSE IN THE COMMUNITIES. THE SL-BLUE MOUNTAIN CAMPUS OFFERS A VARIETY OF FREE SCREENINGS/SERVICES FOR COMMUNITY-RUN EVENTS THROUGHOUT THE YEAR. COMMUNITY OUTREACH, INCLUDES, BUT IS NOT LIMITED TO, THE FOLLOWING: - UTILIZING MEDIA OUTLETS TO EDUCATE THE COMMUNITY ABOUT HEALTH ISSUES THAT MAY IMPACT THEM - CONDUCTING/PARTICIPATING IN MORE THAN 20 COMMUNITY HEALTH FAIRS PROVIDING A VARIETY OF SCREENINGS EMS, L.B. MORRIS ELEMENTARY SCHOOL, THE VILLAGE AT PALMERTON, CARBON COUNTY FAIR, PALMERTON COMMUNITY FESTIVAL, LEHIGHTON LIONESS AND LIONS CLUB, PALMERTON LIONS CLUB, PALMERTON ELEMENTARY SCHOOL, LEHIGHTON RECREATION SENIOR FAIR, REP. DOYLE HEFFLEY SENIOR FAIR, WEATHERLY SCHOOL DISTRICT WELLNESS FAIR, PLEASANT VALLEY ACADEMIC HEALTH FAIR, 28TH ANNUAL CHILDRENS HEALTH FAIR, AND COMMUNITY SAFETY DAY. - HOSTS FOUR HEALTH SUPPORT GROUPS IN THE COMMUNITY: BREAST CANCER, WEIGHT LOSS/BARIATRIC SURGERY, ADULT DAY CAREGIVER, THE SUMMIT CAREGIVER, AND OTHER SPECIALTY SUPPORT PROGRAMMING, SUCH AS 6-WEEK BEREAVEMENT WORKSHOP. - OFFERS FREE DIAGNOSTIC MAMMOGRAMS AND ULTRASOUNDS TO WOMEN AND MEN WHO ARE UNDER- OR NON-INSURED. - ADULT DAY CARE PROVIDES AN ALTERNATIVE TO NURSING CARE WHILE PROVIDING RESPITE FOR THOSE CARING FOR SOMEONE IN THEIR HOME. - PROVIDES A PHYSICIAN MEDICAL DIRECTOR FOR THE LOCAL ALS/BLS SERVICES IN THE SURROUNDING COMMUNITIES. - PROVIDES THE HEALTHY SMILES, HAPPY KIDS DENTAL VAN, PROVIDES PREVENTATIVE AND RESTORATIVE DENTAL CARE TO UNDER- AND NON-INSURED CHILDREN WITHIN CARBON COUNTY AND THE SURROUNDING AREAS. - HOSTS "LADIES NIGHT OUT," AN EDUCATIONAL EVENT FOR MORE THAN 200 PARTICIPANTS IN REGARDS TO AWARENESS ABOUT FEMALE CANCERS, ESPECIALLY BREAST CANCER. - SUPPORTS LOCAL COMMUNITY GROUPS, E.G., AMERICAN CANCER SOCIETY TELETHON, RELAY FOR LIFE, LIGHT THE NIGHT, AMERICAN LUNG ASSOCIATION, AND AMERICAN HEART ASSOCIATION. - VARIOUS STAFF MEMBERS PARTICIPATE IN LOCAL CIVIC ORGANIZATIONS SUCH AS EAST CENTRAL AREA HEALTH EDUCATION CONSORTIUM, CARBON COUNTY INTERAGENCY COUNCIL, KIDZONE PROGRAM, AMERICAN CANCER SOCIETY, LEHIGHTON ROTARY, JIM THORPE ROTARY, LEHIGHTON LIONESS AND LIONS CLUBS, PALMERTON LIONS AND LIONESS CLUB, CARBON COUNTY CHAMBER OF COMMERCE, AND PALMERTON CHAMBER OF COMMERCE. - PROMOTES VARIOUS PHYSICAL EXERCISE AND WELLNESS EVENT THROUGHOUT THE YEAR, INCLUDING WEAR RED DAYS. HOSTS THE 5K RUN/WALK THAT DRAWS 500 PARTICIPANTS ANNUALLY.
CORE FORM, PART III; STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS	SL-BLUE MOUNTAIN HEALTH EDUCATION PROGRAMMING: ---------------------------------------------- - PROVIDES MORE THAN 30 EDUCATIONAL PROGRAMS AND SCREENINGS NATIONAL CHOLESTEROL MONTH DINNER & LECTURE PROGRAM, WEIGHT LOSS SURGERY, AARP DRIVING CLASS, LUNG CANCER EDUCATION, DIABETES EDUCATION, STRESS/STROKE SCREENINGS, CARBON COUNTY DOMESTIC VIOLENCE, FAMILY CAREGIVER TRAINING NIGHT, CARBON COUNTY DRUG & ALCOHOL PROGRAM; LOOK GOOD . . . FEEL BETTER WITH AMERICAN CANCER SOCIETY, NEW TO MEDICARE CO-SPONSORED WITH CARBON COUNTY AREA AGENCY ON AGING, HEART HEALTH FAIR, AMERICAN HEART MONTH LUNCH 'N LEARN, LET'S TALK ABOUT WOUND CARE AND ADULT DAY SERVICE, CARBON COUNTY SAFE KIDS AND SENATOR YUDICHAK COMMUNITY SAFETY DAY, PANTHER VALLEY CAREER DAY, SAFE KIDS CAR SEAT CHECK, AND MENTAL HEALTH DEPRESSION OUTREACH ASSESSMENTS. - SERVES AS A MEDICAL TRAINING/CLINICAL EDUCATION SITE FOR AREA COLLEGES AND SCHOOLS SUCH AS CEDAR CREST COLLEGE, WILKES UNIVERSITY, KINGS COLLEGE, KUTZTOWN UNIVERSITY, DESALES UNIVERSITY, MARYWOOD UNIVERSITY, UNIVERSITY OF SCRANTON, LEHIGH CARBON COMMUNITY COLLEGE, LINCOLN TECHNICAL INSTITUTE, NORTHAMPTON AREA COMMUNITY COLLEGE, PENNSYLVANIA STATE UNIVERSITY, JOHNSON SCHOOL OF TECHNOLOGY, AND PENNSYLVANIA COLLEGE OF OSTEOPATHIC MEDICINE. - PROVIDE CPR/BLS/ACLS/PALS TRAINING TO COMMUNITY ORGANIZATIONS SUCH AS AMBULANCE/EMS, FIRE, POLICE, AND TEACHERS. - PROVIDES "HEALTH IMAGES," A HEALTH SYSTEM-HOSTED TELEVISION PROGRAM FEATURING A VARIETY OF HEALTH AND WELLNESS INFORMATION AND EDUCATION. - HOSTS NEW SEASONS, A PROGRAM FOR ADULTS AGE 65 AND OLDER THAT OFFERS EXERCISE AND WELLNESS PROGRAMS SUCH AS YOGA AND LOW-IMPACT AEROBICS, NEW SEASONS HEARING AID BATTERY BANK, AND THE NEW SEASONS ANNUAL HEALTH & INFORMATION FAIR. SL-BLUE MOUNTAIN DENTAL NEEDS: ------------------------------ - BMHS CONTINUED TO PROVIDE THE ADMINISTRATIVE AND OPERATIONS OVERSIGHT OF THE HEALTHY SMILES HAPPY KIDS DENTAL VAN, WHICH IS THE DENTAL HOME FOR OVER 900+MEDICAID ELIGIBLE CHILDREN FROM CARBON AND NORTHERN SCHUYLKILL COUNTIES. AS THERE ARE NO LOCAL DENTISTS WHO ACCEPT MA AS A PAYER, THIS VAN PROVIDES THESE CHILDREN WITH TWICE ANNUAL DENTAL SCREENINGS AND CLEANINGS. PROVIDES ALL OF ITS PATIENTS WITH BASIS EDUCATION ON BRUSHING, FLOSSING AND BASIS DENTAL HEALTH HYGIENE. THE STAFF APPLIES SEALANTS AND VARNISHED AS INDICATED AND ADDRESSES DENTAL CARRIES AND BASIC RESTORATIVE SERVICES THAT CAN BE DONE SAFELY ON THE VAN. WHEN NECESSARY THE STAFF, IN CONSULTATION WITH PARENTS, REFERS CHILDREN FOR SPECIALTY CARE SERVICES. - THE DENTAL VAN STAFF, IN PARTNERSHIP WITH THE ST. LUKES COMMUNITY HEALTH DEPARTMENT HAS BECOME INVOLVED IN A COMMUNITY DENTAL PLANNING INITIATIVE, THE GOAL OF WHICH IS TO FIND FUNDING TO GOOD WILL AND SUPPORT NEEDED TO ROLL OUT A FIXED DENTAL CLINIC FOR UN AND UNDER INSURED ADULTS IN OUR SERVICE REGION. VOLUNTEER HOURS: PALMERTON TOTAL HOURS: 9,299 HOURS AND GNADEN TOTAL HOURS: 6498.
CORE FORM, PART III; QUESTION 4D	EXPENSES INCURRED IN PROVIDING VARIOUS OTHER MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUALS IN A NON-DISCRIMINATORY MANNER REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN OR ABILITY TO PAY. PLEASE REFER TO THE ORGANIZATION'S COMMUNITY BENEFIT STATEMENT INCLUDED IN SCHEDULE O.
CORE FORM, PART VI, QUESTION 3; PART VII AND SCHEDULE J	THE ORGANIZATION IS AN AFFILIATE WITHIN ST. LUKES UNIVERSITY HEALTH NETWORK ("NETWORK"); A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY NETWORK. ST. LUKES HEALTH NETWORK, INC. IS THE TAX-EXEMPT PARENT ENTITY OF THE NETWORK. THIS ORGANIZATION OUTSOURCED ALL OF ITS FINANCE FUNCTIONS INCLUDING BUT NOT LIMITED TO, ACCOUNTING, FINANCE, PAYROLL, ACCOUNTS PAYABLE AND TAX, TO ST. LUKES HEALTH NETWORK, INC.; A RELATED INTERNAL REVENUE CODE SECTION 501(C)(3) TAX-EXEMPT ORGANIZATION. THOMAS P. LICHTENWALNER IS THE SENIOR VICE PRESIDENT OF FINANCE/CHIEF FINANCIAL OFFICER OF THE NETWORK. MR. LICHTENWALNER RECEIVES A FEDERAL FORM W-2 FROM ST. LUKES HOSPITAL OF BETHLEHEM PENNSYLVANIA, A RELATED INTERNAL REVENUE CODE SECTION 501(C)(3) TAX-EXEMPT ORGANIZATION. MR. LICHTENWALNERS REPORTABLE COMPENSATION, RETIREMENT/OTHER DEFERRED COMPENSATION AND NON-TAXABLE BENEFITS ARE REPORTED WITHIN CORE FORM, PART VII AND SCHEDULE J OF THE ST. LUKES HEALTH NETWORK, INC. (EIN: 23-2384282) FEDERAL FORM 990. PLEASE REFER TO THE ST. LUKES HEALTH NETWORK, INC. FORM 990 FOR THIS INFORMATION.
CORE FORM, PART VI, SECTION A; QUESTION 4	ON SEPTEMBER 11, 2017, ST. LUKE'S UNIVERSITY HEALTH NETWORK ("NETWORK") ENTERED INTO A DEFINITIVE AGREEMENT (THE "AFFILIATION AGREEMENT") WITH BLUE MOUNTAIN HEALTH SYSTEM, INC. ("BMHS"). AS OF THE DATE OF THE AFFILIATION AGREEMENT, BMHS WAS THE SOLE MEMBER OF BLUE MOUNTAIN HOSPITAL ("BMH") AND CMS MEDICAL CARE CORPORATION ("CMS"); A WHOLLY CONTROLLED SUBSIDIARY OF BMH. ON DECEMBER 31, 2017, SUBSEQUENT TO THE SATISFACTION OF ALL CONDITIONS PRECEDENT, THE BLUE MOUNTAIN AFFILIATION WAS COMPLETED AND CONSUMMATED. ACCORDINGLY, PURSUANT TO THE TERMS OF THE AFFILIATION AGREEMENT, BMHS WAS STATUTORILY MERGED INTO BMH. IN ADDITION, THE NETWORK BECAME THE SOLE MEMBER OF BMH AND CMS. BMH AND CMS ARE BOTH NON-PROFIT ORGANIZATIONS ORGANIZED UNDER THE LAW OF THE COMMONWEALTH OF PENNSYLVANIA AND RECOGNIZED AS TAX-EXEMPT ORGANIZATIONS PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. ACCORDINGLY, THIS ORGANIZATIONS ARTICLES OF INCORPORATION AND BYLAWS WERE AMENDED AND RESTATED TO REFLECT SLHN AS ITS SOLE MEMBER.
CORE FORM, PART VI, SECTION A; QUESTIONS 6 & 7	EFFECTIVE JANUARY 1, 2018, ST. LUKE'S HEALTH NETWORK, INC. ("SLHN") BECAME THE SOLE MEMBER OF THIS ORGANIZATION. SLHN HAS THE RIGHT TO ELECT THE MEMBERS OF THIS ORGANIZATION'S BOARD OF TRUSTEES AND HAS CERTAIN RESERVED POWERS AS DEFINED IN THIS ORGANIZATION'S BYLAWS.
CORE FORM, PART VI, SECTION B; QUESTION 11B	THE ORGANIZATION IS AN AFFILIATE WITHIN ST. LUKE'S UNIVERSITY HEALTH NETWORK ("NETWORK"); A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY NETWORK. ST. LUKE'S HEALTH NETWORK, INC. IS THE TAX-EXEMPT PARENT ENTITY OF THE NETWORK. THE ORGANIZATION'S FEDERAL FORM 990 WAS PROVIDED TO EACH VOTING MEMBER OF THE ORGANIZATION'S GOVERNING BODY (ITS BOARD OF TRUSTEES) PRIOR TO THE FILING WITH THE INTERNAL REVENUE SERVICE ("IRS"). IN ADDITION, THE ST. LUKE'S UNIVERSITY HEALTH NETWORK FINANCE COMMITTEE WAS UPDATED AS TO THIS ORGANIZATION'S CURRENT YEAR FORM 990 PRIOR TO FILING. ST. LUKE'S HEALTH NETWORK, INC. BOARD OF TRUSTEES HAS DELEGATED TO THE FINANCE COMMITTEE THE RESPONSIBILITY TO OVERSEE AND COORDINATE THE FEDERAL FORM 990 PREPARATION AND FILING PROCESS FOR THE TAX-EXEMPT AFFILIATES OF THE NETWORK. AS PART OF THE ORGANIZATION'S FEDERAL FORM 990 TAX RETURN PREPARATION PROCESS THE ORGANIZATION HIRED A PROFESSIONAL CERTIFIED PUBLIC ACCOUNTING ("CPA") FIRM WITH EXPERIENCE AND EXPERTISE IN BOTH HEALTHCARE AND NOT-FOR-PROFIT TAX RETURN PREPARATION TO PREPARE THE FEDERAL FORM 990. THE CPA FIRM'S TAX PROFESSIONALS WORKED CLOSELY WITH THE NETWORK'S FINANCE PERSONNEL, INCLUDING ITS SENIOR VICE PRESIDENT OF FINANCE, VICE PRESIDENT OF FINANCE, DIRECTOR OF ACCOUNTING AND VARIOUS OTHER NETWORK INDIVIDUALS ("INTERNAL WORKING GROUP") TO OBTAIN THE INFORMATION NEEDED IN ORDER TO PREPARE A COMPLETE AND ACCURATE TAX RETURN. THE CPA FIRM PREPARED A DRAFT FEDERAL FORM 990 AND FURNISHED IT TO THE NETWORK'S INTERNAL WORKING GROUP FOR THEIR REVIEW. THE NETWORK'S INTERNAL WORKING GROUP REVIEWED THE DRAFT FEDERAL FORM 990 AND DISCUSSED QUESTIONS AND COMMENTS WITH THE CPA FIRM. REVISIONS WERE MADE TO THE DRAFT FEDERAL FORM 990 WHERE NECESSARY AND A FINAL DRAFT WAS FURNISHED BY THE CPA FIRM TO THE NETWORK'S INTERNAL WORKING GROUP FOR FINAL REVIEW AND APPROVAL PRIOR TO PRESENTATION OF THE FEDERAL FORM 990 TO THE MEMBERS OF THE ST. LUKE'S HEALTH NETWORK, INC. FINANCE COMMITTEE. THEREAFTER, THE FINAL FEDERAL FORM 990 WAS PROVIDED TO EACH VOTING MEMBER OF THE ORGANIZATION'S GOVERNING BODY PRIOR TO FILING WITH THE IRS.
CORE FORM, PART VI, SECTION B; QUESTION 12	THE ORGANIZATION IS AN AFFILIATE WITHIN ST. LUKE'S UNIVERSITY HEALTH NETWORK ("NETWORK"); A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY NETWORK. ST. LUKE'S HEALTH NETWORK, INC. IS THE TAX-EXEMPT PARENT ENTITY OF THE NETWORK. THE NETWORK HAS A WRITTEN CONFLICT OF INTEREST POLICY AND REGULARLY MONITORS AND ENFORCES COMPLIANCE WITH THAT POLICY. THE POLICY REQUIRES THAT A CONFLICT OF INTEREST DISCLOSURE FORM CONSISTENT WITH BEST GOVERNANCE PRACTICES AND INTERNAL REVENUE SERVICE GUIDELINES BE CIRCULATED TO OFFICERS, TRUSTEES, BOARD COMMITTEE MEMBERS AND SENIOR MANAGEMENT ANNUALLY. THE NETWORK'S COMPLIANCE DEPARTMENT, INCLUDING ITS CORPORATE COMPLIANCE OFFICER AND SENIOR VICE PRESIDENT/GENERAL COUNSEL, ASSUME RESPONSIBILITY FOR THE COMPLETION OF THE CONFLICT OF INTEREST QUESTIONNAIRES AND ENFORCEMENT WITH THE POLICY. IF A TRUSTEE DISCLOSES AN INTEREST THAT COULD GIVE RISE TO A CONFLICT, THE TRUSTEE'S POTENTIAL CONFLICT MAY BE DISCLOSED TO THE ORGANIZATION'S GOVERNING BODY, WHICH EVALUATES THE CONFLICT AND ITS POTENTIAL IMPACT ON THE TRUSTEE'S PARTICIPATION ON THE BOARD. AFTER CONSULTATION AND DISCUSSION THE BOARD OF TRUSTEES MAY TAKE ACTION, IF APPROPRIATE AND NECESSARY, TO ADDRESS ANY SUCH CONFLICT IN A MANNER CONSISTENT WITH THE NETWORK'S CONFLICT OF INTEREST POLICY.
CORE FORM, PART VI, SECTION B; QUESTION 15	EFFECTIVE JANUARY 1, 2018 THIS ORGANIZATION BECAME AN AFFILIATE WITHIN ST. LUKE'S UNIVERSITY HEALTH NETWORK ("NETWORK"); A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY NETWORK. ST. LUKE'S HEALTH NETWORK, INC. IS THE TAX-EXEMPT PARENT ENTITY OF THE NETWORK. IN ACCORDANCE WITH THE INTERNAL REVENUE SERVICE RULES AND REGULATIONS AND FORM 990 INSTRUCTIONS, THE COMPENSATION INFORMATION FOR THIS FORM 990 REFLECTS COMPENSATION FOR THE YEAR ENDED DECEMBER 31, 2017. THEREFORE, THE REVIEW AND APPROVAL PROCESS INCLUDED BELOW REFLECTS THE PROCEDURES IN PLACE FOR THE COMPENSATION INCLUDED WITHIN THIS FORM 990. THE BLUE MOUNTAIN HOSPITAL BOARD OF TRUSTEES HAS AN EXECUTIVE COMMITTEE ("COMMITTEE"). THE COMMITTEE HAS ADOPTED A WRITTEN EXECUTIVE COMPENSATION PHILOSOPHY WHICH IT FOLLOWS WHEN IT REVIEWS AND APPROVES OF THE COMPENSATION AND BENEFITS OF THE ORGANIZATION'S SENIOR MANAGEMENT. THE COMMITTEE REVIEWS THE "TOTAL COMPENSATION" OF SENIOR MANAGEMENT WHICH IS INTENDED TO INCLUDE BOTH CURRENT AND DEFERRED COMPENSATION AND ALL EMPLOYEE BENEFITS, BOTH QUALIFIED AND NON-QUALIFIED. THE COMMITTEE'S REVIEW IS DONE ON AT LEAST AN ANNUAL BASIS AND ENSURES THAT THE "TOTAL COMPENSATION" OF SENIOR MANAGEMENT OF THE ORGANIZATION IS REASONABLE. THE ACTIONS TAKEN BY THE COMMITTEE ENABLE THE ORGANIZATION TO RECEIVE THE REBUTTABLE PRESUMPTION OF REASONABLENESS FOR PURPOSES OF INTERNAL REVENUE CODE SECTION 4958 WITH RESPECT TO THE TOTAL COMPENSATION OF SENIOR MANAGEMENT. THE THREE FACTORS WHICH MUST BE SATISFIED IN ORDER TO RECEIVE THE REBUTTABLE PRESUMPTION OF REASONABLENESS ARE THE FOLLOWING: 1. THE COMPENSATION ARRANGEMENT IS APPROVED IN ADVANCE BY AN "AUTHORIZED BODY" OF THE APPLICABLE TAX-EXEMPT ORGANIZATION WHICH IS COMPOSED ENTIRELY OF INDIVIDUALS WHO DO NOT HAVE A "CONFLICT OF INTEREST" WITH RESPECT TO THE COMPENSATION ARRANGEMENT; 2. THE AUTHORIZED BODY OBTAINED AND RELIED UPON "APPROPRIATE DATA AS TO COMPARABILITY" PRIOR TO MAKING ITS DETERMINATION; AND 3. THE AUTHORIZED BODY "ADEQUATELY DOCUMENTED THE BASIS FOR ITS DETERMINATION" CONCURRENTLY WITH MAKING THAT DETERMINATION. THE COMMITTEE IS COMPRISED OF MEMBERS OF THE BOARD OF TRUSTEES EACH OF WHO ARE INDEPENDENT AND ARE FREE FROM ANY CONFLICTS OF INTEREST. THE COMMITTEE RELIED UPON APPROPRIATE COMPARABLE DATA; SPECIFICALLY THE COMMITTEE OBTAINED VARIOUS SALARY SURVEYS. THE SURVEYS INCLUDE COMPARABLE GEOGRAPHIC AND DEMOGRAPHIC MARKET DATA INCLUDING BUT NOT LIMITED TO SIMILAR SIZED HOSPITALS, # OF LICENSED BEDS AND NET PATIENT SERVICE REVENUE. THE COMMITTEE ADEQUATELY DOCUMENTED ITS BASIS FOR ITS DETERMINATION THROUGH THE TIMELY PREPARATION OF WRITTEN MINUTES OF THE COMMITTEE MEETINGS DURING WHICH THE SENIOR MANAGEMENT COMPENSATION AND BENEFITS WERE REVIEWED AND SUBSEQUENTLY APPROVED. THE ACTIONS OUTLINED ABOVE WITH RESPECT TO THE COMMITTEE AND THE ESTABLISHMENT OF THE REBUTTABLE PRESUMPTION OF REASONABLENESS ONLY APPLIES TO SENIOR MANAGEMENT. THE COMPENSATION AND BENEFITS OF CERTAIN OTHER INDIVIDUALS CONTAINED IN THIS FORM 990 ARE REVIEWED ANNUALLY BY THE PRESIDENT/CHIEF EXECUTIVE OFFICER WITH ASSISTANCE FROM THE ORGANIZATION'S HUMAN RESOURCES DEPARTMENT IN CONJUNCTION WITH THE INDIVIDUAL'S JOB PERFORMANCE DURING THE YEAR AND IS BASED UPON OTHER OBJECTIVE FACTORS DESIGNED TO ENSURE THAT REASONABLE AND FAIR MARKET VALUE COMPENSATION IS PAID BY THE ORGANIZATION. OTHER OBJECTIVE FACTORS INCLUDE MARKET SURVEY DATA FOR COMPARABLE POSITIONS, INDIVIDUAL GOALS AND OBJECTIVES, PERSONNEL REVIEWS, EVALUATIONS, SELF-EVALUATIONS AND PERFORMANCE FEEDBACK MEETINGS.
CORE FORM, PART VI, SECTION C; QUESTION 19	THE ORGANIZATION IS AN AFFILIATE WITHIN ST. LUKE'S UNIVERSITY HEALTH NETWORK ("NETWORK"); A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY NETWORK. ST. LUKE'S HEALTH NETWORK, INC. IS THE TAX-EXEMPT PARENT ENTITY OF THE NETWORK. THE NETWORK HAS ISSUED TAX-EXEMPT BONDS TO FINANCE VARIOUS CAPITAL IMPROVEMENT PROJECTS, RENOVATIONS AND EQUIPMENT. IN CONJUNCTION WITH THE ISSUANCE OF THESE TAX-EXEMPT BONDS, THE ORGANIZATION'S FINANCIAL STATEMENTS WERE INCLUDED WITH THE TAX-EXEMPT BOND PROSPECTUS WHICH WAS MADE AVAILABLE TO THE GENERAL PUBLIC FOR REVIEW. IN ADDITION, THE ORGANIZATION'S FILED CERTIFICATE OF INCORPORATION AND ANY AMENDMENTS CAN BE OBTAINED AND REVIEWED THROUGH THE COMMONWEALTH OF PENNSYLVANIA.
CORE FORM, PART VII AND SCHEDULE J	CORE FORM, PART VII AND SCHEDULE J REFLECT CERTAIN BOARD MEMBERS AND OFFICERS RECEIVING COMPENSATION AND BENEFITS FROM THIS ORGANIZATION. PLEASE NOTE THIS REMUNERATION WAS FOR SERVICES RENDERED AS FULL-TIME EMPLOYEES OR INDEPENDENT CONTRACTORS OF THIS ORGANIZATION OR A RELATED ORGANIZATION AND NOT FOR SERVICES RENDERED AS A VOTING MEMBER OR OFFICER OF THIS ORGANIZATION'S BOARD OF TRUSTEES. PLEASE NOTE, THIS ORGANIZATION'S FORM 990 REFLECTS INDIVIDUALS WHO PROVIDE SERVICES TO OTHER ORGANIZATIONS. THIS ORGANIZATION ISSUES FORMS 1099 OR W-2'S TO THOSE INDIVIDUALS AND FILES THE APPLICABLE FORMS WITH THE INTERNAL REVENUE SERVICE. THIS ORGANIZATION ALLOCATES THESE PAYMENTS TO OTHER AFFILIATES VIA AN INTERCOMPANY ACCOUNT.
CORE FORM, PART VII AND SCHEDULE J	EFFECTIVE JANUARY 1, 2018 THE ORGANIZATION BECAME AN AFFILIATE WITHIN ST. LUKES UNIVERSITY HEALTH NETWORK ("NETWORK"); A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY NETWORK. AS A RESULT OF THIS AFFILIATION, THOMAS P. LICHTENWALNER, SENIOR VICE PRESIDENT OF FINANCE/CHIEF FINANCIAL OFFICER OF THE NETWORK, BECAME THE SENIOR FINANCIAL OFFICIAL OF THIS ORGANIZATION. THE ORGANIZATION'S VICE PRESIDENT/CHIEF FINANCIAL OFFICER, ANDREA ANDRAE, SERVED IN THIS CAPACITY THROUGH DECEMBER 31, 2017 AND REMAINS EMPLOYED AS THE ORGANIZATION'S DIRECTOR OF FINANCE.
CORE FORM, PART VII, SECTION A, COLUMN B	THE ORGANIZATION IS AN AFFILIATE WITHIN ST. LUKE'S UNIVERSITY HEALTH NETWORK ("NETWORK"); A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY NETWORK. THE NETWORK INCLUDES BOTH FOR-PROFIT AND NOT FOR-PROFIT ORGANIZATIONS. CERTAIN BOARD OF TRUSTEE MEMBERS AND OFFICERS LISTED ON CORE FORM, PART VII AND SCHEDULE J OF THIS FORM 990 MAY HOLD SIMILAR POSITIONS WITH BOTH THIS ORGANIZATION AND OTHER AFFILIATES WITHIN THE NETWORK. THE HOURS SHOWN ON THIS FORM 990 FOR BOARD MEMBERS WHO RECEIVE NO COMPENSATION FOR SERVICES RENDERED IN A NON-BOARD CAPACITY, REPRESENTS THE ESTIMATED HOURS DEVOTED PER WEEK FOR THIS ORGANIZATION. TO THE EXTENT THESE INDIVIDUALS SERVE AS A MEMBER OF THE BOARD OF TRUSTEES OF OTHER RELATED ORGANIZATIONS WITHIN THE NETWORK, THEIR RESPECTIVE HOURS PER WEEK PER ORGANIZATION ARE APPROXIMATELY THE SAME AS REFLECTED ON CORE FORM, PART VII OF THIS FORM 990. THE HOURS REFLECTED ON CORE FORM, PART VII OF THIS FORM 990, FOR INDIVIDUALS WHO RECEIVE COMPENSATION FOR SERVICES RENDERED IN A NON-BOARD CAPACITY, PAID OFFICERS AND KEY EMPLOYEES, REFLECT TOTAL HOURS WORKED PER WEEK ON BEHALF OF THE NETWORK; NOT SOLELY THIS ORGANIZATION.
CORE FORM, PART X	CERTAIN RECLASSIFICATIONS HAVE BEEN MADE TO THE PRIOR YEAR BALANCES PREVIOUSLY REPORTED TO CONFORM TO THE CURRENT YEAR PRESENTATION IN THE ORGANIZATION'S AUDITED CONSOLIDATED FINANCIAL STATEMENTS. THE RESTATEMENT HAD NO EFFECT ON THE ORGANIZATION'S NET ASSETS.
CORE FORM, PART XI; QUESTION 9	OTHER CHANGES IN NET ASSETS OR FUND BALANCES INCLUDE: - NET ACQUISITION BY ST. LUKE'S UNIVERSITY HEALTH NETWORK - $26,989,741; - RESTRUCTURING COSTS - ($2,796,703); - NET ASSETS RELEASED FROM RESTRICTIONS USED FOR PURCHASE OF PROPERTY AND EQUIPMENT - ($8,395); - CHANGE IN ADDITIONAL PENSION LIABILITY - $398,009; - TRANSFER OF NET ASSETS FROM BLUE MOUNTAIN HEALTH SYSTEM, INC. UPON CESSATION OF ACTIVITIES & OPERATIONS - $2,091,243; AND - PERMANENTLY RESTRICTED CHANGES IN NET ASSETS - $26,766.
CORE FORM, PART XII; QUESTION 2	THE ORGANIZATION IS AN AFFILIATE WITHIN ST. LUKE'S UNIVERSITY HEALTH NETWORK ("NETWORK"); A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY NETWORK. AN INDEPENDENT CERTIFIED PUBLIC ACCOUNTING ("CPA") FIRM AUDITED THE CONSOLIDATED FINANCIAL STATEMENTS OF THE NETWORK AND ITS CONTROLLED AFFILIATES FOR THE YEAR ENDED JUNE 30, 2018 AND ISSUED A CONSOLIDATED FINANCIAL STATEMENT WITH CONSOLIDATING SCHEDULES BY ENTITY. AN UNMODIFIED OPINION WAS ISSUED BY THE INDEPENDENT CPA FIRM. THE NETWORK'S EXECUTIVE COMMITTEE ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF THE NETWORK'S CONSOLIDATED FINANCIAL STATEMENTS AND THE SELECTION OF AN INDEPENDENT AUDITOR.

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2019

Additional Data

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1	Briefly describe the organization’s mission or most significant activities: TO PROVIDE COMPASSIONATE, EXCELLENT QUALITY AND COST EFFECTIVE HEALTHCARE TO THE RESIDENTS OF THE COMMUNITIES WE SERVE.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	13
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	10
5	Total number of individuals employed in calendar year 2019 (Part V, line 2a) ......	5	1,192
6	Total number of volunteers (estimate if necessary) .............	6	370
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	0
b	Net unrelated business taxable income from Form 990-T, line 39 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	167,225	245,187
9	Program service revenue (Part VIII, line 2g) .........	73,826,748	75,719,721
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	210,426	-3,892,910
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	561,957	578,407
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	74,766,356	72,650,405
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	0	1,499
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)	42,731,462	43,473,697
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)....	31,573,343	47,766,553
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	74,304,805	91,241,749
19	Revenue less expenses. Subtract line 18 from line 12.......	461,551	-18,591,344
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	58,122,126	81,539,778
21	Total liabilities (Part X, line 26).............	55,696,207	71,004,542
22	Net assets or fund balances. Subtract line 21 from line 20.....	2,425,919	10,535,236

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	Type or print name and title


4a	(Code: ) (Expenses $ 7,167,761 including grants of $ 0 ) (Revenue $ 9,066,720 )
	EXPENSES INCURRED IN PROVIDING BEHAVIORAL HEALTH SERVICES TO ALL INDIVIDUALS IN A NON-DISCRIMINATORY MANNER REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN OR ABILITY TO PAY. PLEASE REFER TO SCHEDULE O FOR THE ORGANIZATION'S COMMUNITY BENEFIT STATEMENT.

4b	(Code: ) (Expenses $ 6,526,902 including grants of $ 0 ) (Revenue $ 8,051,948 )
	EXPENSES INCURRED IN OPERATING A SKILLED NURSING UNIT WHICH PROVIDES MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUALS IN A NON-DISCRIMINATORY MANNER REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN OR ABILITY TO PAY. PLEASE REFER TO SCHEDULE O FOR THE ORGANIZATION'S COMMUNITY BENEFIT STATEMENT.

4c	(Code: ) (Expenses $ 3,149,134 including grants of $ 0 ) (Revenue $ 2,118,322 )
	EXPENSES INCURRED IN PROVIDING EMERGENCY AND OTHER MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUALS IN A NON-DISCRIMINATORY MANNER REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN OR ABILITY TO PAY. PLEASE REFER TO SCHEDULE O FOR THE ORGANIZATION'S COMMUNITY BENEFIT STATEMENT.

4d	Other program services (Describe in Schedule O.)
	(Expenses $ 65,273,927 including grants of $ 1,499 ) (Revenue $ 56,482,731 )
4e	Total program service expenses82,117,724

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)			(D) Reportable compensation from the organization (W-2/1099-MISC)	(E) Reportable compensation from related organizations (W-2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and title
(18) ANDREA L ANDRAE........................................................................ VP/CFO (TERMED 12/31/17)	55.0 .......................0.0	X		163,490	0	39,446
(19) THOMAS P LICHTENWALNER........................................................................ SVP FINANCE & CFO (EFF 1/1/18)	55.0 .......................0.0	X		0	0	0
(20) HAMAYUN N AHMED MD........................................................................ PSYCHIATRIST	55.0 .......................0.0		X	349,931	0	22,646
(21) MOHAMMAD K KHAN MD........................................................................ PSYCHIATRIST	55.0 .......................0.0		X	326,369	0	26,997
(22) MUHAMMAD Z AJMAL MD........................................................................ ANESTHESIOLOGIST	55.0 .......................0.0		X	321,627	0	25,523
(23) BRIAN A LEFROCK MD........................................................................ ANETHESIOLOGIST	55.0 .......................0.0		X	312,983	0	21,920
(24) LARRY J MATURANI MD........................................................................ INTERNIST	55.0 .......................0.0		X	296,130	0	24,021

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	2,763,917	0	270,632

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c	45,824
d	Related organizations		1d
e	Government grants (contributions)		1e

f	All other contributions, gifts, grants, and similar amounts not included above		1f	199,363

g	Noncash contributions included in lines 1a - 1f:$		1g

h Total. Add lines 1a-1f.......		245,187

		Business Code
2a	NET PATIENT SERVICE REVENUE	541900	75,454,204	75,454,204
b	OTHER HEALTHCARE RELATED REVENUE	541900	265,517	265,517
c
d
e
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		75,719,721

3 Investment income (including dividends, interest, and othersimilar amounts) ......			432,174			432,174
4 Income from investment of tax-exempt bond proceeds			0
5 Royalties...........			0
		(ii) Personal	(i) Real
6a	Gross rents		284,023	6a
b	Less: rental expenses			6b
c	Rental income or (loss)	0	284,023	6c
d	Net rental income or (loss).......			284,023			284,023
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	0	0	7a
b	Less: cost or other basis and sales expenses	4,322,841	2,243	7b
c	Gain or (loss)	-4,322,841	-2,243	7c
d	Net gain or (loss).........			-4,325,084			-4,325,084
8a	Gross income from fundraising events (not including $ 45,824of contributions reported on line 1c). See Part IV, line 18 ....
			8a	2,897
b	Less: direct expenses ...		8b	2,897
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a	0
b	Less: direct expenses ...		9b	0
c	Net income or (loss) from gaming activities..			0
10a	Gross sales of inventory, less returns and allowances ..
			10a	0
b	Less: cost of goods sold ..		10b	0
c	Net income or (loss) from sales of inventory..			0
Business Code			Miscellaneous Revenue
11a	DIETARY REVENUE		722410	294,384			294,384
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......			294,384
12	Total revenue. See instructions.....			72,650,405	75,719,721		-3,314,503

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	1,499	1,499
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 ...........	1,306,402	1,175,762	130,640
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........	0
7	Other salaries and wages........	32,439,840	29,195,856	3,243,984
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	0
9	Other employee benefits .......	7,117,226	6,405,503	711,723
10	Payroll taxes ...........	2,610,229	2,349,206	261,023
11	Fees for services (non-employees):
a	Management ......	201,492	181,343	20,149
b	Legal .........	54,732	49,259	5,473
c	Accounting ...........	112,322	101,090	11,232
d	Lobbying ...........	42,065	37,858	4,207
e	Professional fundraising services. See Part IV, line 17	0
f	Investment management fees ......	0
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	566,157	509,542	56,615	0
12	Advertising and promotion ....	79,961	71,965	7,996
13	Office expenses .......	3,184,123	2,865,711	318,412
14	Information technology ......	9,170,509	8,253,458	917,051
15	Royalties ..	0
16	Occupancy ...........	1,554,877	1,399,389	155,488
17	Travel ............	26,745	24,071	2,674
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .	0
19	Conferences, conventions, and meetings ....	191,463	172,317	19,146
20	Interest ...........	1,013,163	911,847	101,316
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization ..	2,909,818	2,618,836	290,982
23	Insurance ...	1,233,100	1,109,790	123,310
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	8,955,245	8,059,720	895,525	0
b	PURCHASED SERVICES	8,934,652	8,041,187	893,465	0
c	REPAIRS & MAINTENANCE	857,776	771,998	85,778	0
d	DUES & SUBSCRIPTIONS	199,964	179,967	19,997	0
e	All other expenses	8,478,389	7,630,550	847,839
25	Total functional expenses. Add lines 1 through 24e	91,241,749	82,117,724	9,124,025	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).

1	Cash–non-interest-bearing ........			0	1	4,882,861
2	Savings and temporary cash investments .........			0	2	0
3	Pledges and grants receivable, net ......			0	3	0
4	Accounts receivable, net .............			9,735,469	4	6,482,058
5	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
				0	5	0
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
				0	6	0
7	Notes and loans receivable, net ...........			0	7	0
8	Inventories for sale or use ............			1,592,727	8	1,555,471
9	Prepaid expenses and deferred charges ......			721,562	9	846,639
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	109,558,615
b	Less: accumulated depreciation	10b	86,614,607	24,068,471	10c	22,944,008
11	Investments—publicly traded securities .			0	11	0
12	Investments—other securities. See Part IV, line 11 .....			0	12	0
13	Investments—program-related. See Part IV, line 11 ..			5,656,007	13	6,725,735
14	Intangible assets ...............			760,621	14	35,897,067
15	Other assets. See Part IV, line 11 ...........			15,587,269	15	2,205,939
16	Total assets. Add lines 1 through 15 (must equal line 33)...			58,122,126	16	81,539,778

17	Accounts payable and accrued expenses .....	19,303,314	17	7,347,037
18	Grants payable ...	0	18	0
19	Deferred revenue .........	0	19	0
20	Tax-exempt bond liabilities .........	26,082,779	20	21,853,582
21	Escrow or custodial account liability. Complete Part IV of Schedule D	0	21	0
22	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
		0	22	0
23	Secured mortgages and notes payable to unrelated third parties ..	2,852,424	23	1,710,743
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	7,457,690	25	40,093,180
26	Total liabilities. Add lines 17 through 25..	55,696,207	26	71,004,542

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........		27
28	Net assets with donor restrictions ...........		28
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds		31
32	Total net assets or fund balances ...........	2,425,919	32	10,535,236
33	Total liabilities and net assets/fund balances ........	58,122,126	33	81,539,778

(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)ST LUKE'S HEALTH NETWORK INC 801 OSTRUM STREET BETHLEHEM,PA18015 23-2384282	HEALTH SVCS.	PA	501(C)(3)	509(A)(3)	NA		No
(2)ST LUKE'S HOSPITAL OF BETHLEHEM PA 801 OSTRUM STREET BETHLEHEM,PA18015 23-1352213	HEALTH SVCS.	PA	501(C)(3)	HOSPITAL	SLHN		No
(3)ST LUKE'S HOSPITAL ANDERSON CAMPUS 801 OSTRUM STREET BETHLEHEM,PA18015 45-4394739	HEALTH SVCS.	PA	501(C)(3)	HOSPITAL	SLHN		No
(4)ST LUKE'S HOSPITAL MONROE CAMPUS 801 OSTRUM STREET BETHLEHEM,PA18015 46-5143606	HEALTH SVCS.	PA	501(C)(3)	HOSPITAL	SLHN		No
(5)ST LUKE'S QUAKERTOWN HOSPITAL 801 OSTRUM STREET BETHLEHEM,PA18015 23-1352203	HEALTH SVCS.	PA	501(C)(3)	HOSPITAL	SLHN		No
(6)CARBON-SCHUYLKILL COMMUNITY HOSPITAL 801 OSTRUM STREET BETHLEHEM,PA18015 25-1550350	HEALTH SVCS.	PA	501(C)(3)	HOSPITAL	SLHN		No
(7)ST LUKE'S PHYSICIAN GROUP INC 801 OSTRUM STREET BETHLEHEM,PA18015 23-2380812	HEALTH SVCS.	PA	501(C)(3)	509(A)(3)	SLHN		No
(8)ST LUKE'S EMERGENCY & TRANSPORT SVCS 801 OSTRUM STREET BETHLEHEM,PA18015 23-2179542	HEALTH SVCS.	PA	501(C)(3)	170B1AIII	SLHN		No
(9)QUAKERTOWN REHABILITATION CENTER 801 OSTRUM STREET BETHLEHEM,PA18015 23-2543924	INACTIVE	PA	501(C)(3)	170B1AIII	SLHN		No
(10)HOMESTAR MEDICAL EQUIP & INFUSION SVCS 801 OSTRUM STREET BETHLEHEM,PA18015 23-2418254	INACTIVE	PA	501(C)(3)	509(A)(2)	VNA		No
(11)VNA OF ST LUKE'S - HOME HEALTH HOSPICE 801 OSTRUM STREET BETHLEHEM,PA18015 24-0795497	HEALTH SVCS.	PA	501(C)(3)	509(A)(1)	SLB		No
(12)ST LUKE'S WARREN HOSPITAL INC 185 ROSEBERRY STREET PHILLIPSBURG,NJ08865 22-1494454	HEALTH SVCS.	NJ	501(C)(3)	HOSPITAL	SLHN		No
(13)BLUE MOUNTAIN HEALTH SYSTEM INC 211 NORTH 12TH STREET LEHIGHTON,PA18235 20-1311316	HEALTH SVCS.	PA	501(C)(3)	509(A)(3)	NA		No
(14)CMS MEDICAL CARE CORPORATION 211 NORTH 12TH STREET LEHIGHTON,PA18235 23-2473899	HEALTH SVCS.	PA	501(C)(3)	170B1AIII	SLHN		No
(15)SACRED HEART HEALTHCARE SYSTEM 421 W CHEW STREET ALLENTOWN,PA18102 23-2328297	HEALTH SVCS.	PA	501(C)(3)	509(A)(3)	SLHN		No
(16)SACRED HEART HOSPITAL OF ALLENTOWN 421 W CHEW STREET ALLENTOWN,PA18102 23-1352208	HEALTH SVCS.	PA	501(C)(3)	HOSPITAL	SLHN		No
(17)SACRED HEART FOUNDATION 421 W CHEW STREET ALLENTOWN,PA18102 23-2328300	FUNDRAISING	PA	501(C)(3)	509(A)(1)	SHH		No
(18)SH REALTY CORPORATION 421 W CHEW STREET ALLENTOWN,PA18102 23-2384986	HOLDING CO.	PA	501(C)(2)	N/A	SHH		No

(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
(1) SH ASSISTED LIVING 3910 ADLER PLACE BETHLEHEM,PA18017 20-0546001	MEDICAL OFFICE	PA	NA

(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