TY 2019 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) Kevin Mosser...................................................................... Former CEO - WellSpan Health	0.00 ................. 0.00			0	1,583,936	1,630,258
(2) Roxanna Gapstur...................................................................... CEO-WSH/Dir.	1.00 ................. 40.00	X	X	0	1,292,495	177,068
(3) Patrick O'Donnell...................................................................... President	1.00 ................. 40.00		X	0	1,218,544	108,731
(4) Michael F O'Connor...................................................................... CFO-WSH	1.00 ................. 40.00		X	0	831,632	330,778
(5) Charlie Chodroff...................................................................... Director	1.00 ................. 40.00	X		0	798,829	307,030
(6) Kimberly Rzomp...................................................................... Treas end 12/19	1.00 ................. 40.00	X	X	0	600,057	71,957
(7) Roger Robertson...................................................................... Director	1.00 ................. 40.00	X		0	612,698	24,950
(8) Kevin Lorentsen...................................................................... Dir beg 01/20	1.00 ................. 40.00	X		0	473,919	24,999
(9) Scott Card...................................................................... Physician	40.00 ................. 0.00			328,065	0	39,976
(10) Melissa Dubrow...................................................................... VP & COO	40.00 ................. 0.00			319,023	0	47,266
(11) Clarence Miller...................................................................... Pathologist	40.00 ................. 0.00			212,001	0	32,181
(12) Jill Keller-Reyka...................................................................... VP of Nursing Services	40.00 ................. 0.00			203,233	0	38,971
(13) Kevin Sanders...................................................................... Physician	40.00 ................. 0.00			178,191	0	30,570
(14) Jarett Logsdon...................................................................... Manager-Pharmacy	40.00 ................. 0.00			150,838	0	22,905
(15) Sarah Hawbaker...................................................................... Pharmacist	40.00 ................. 0.00			132,673	0	31,243
(16) Jeff Carty...................................................................... VP of Finance	40.00 ................. 0.00			129,471	0	21,175
(17) Nancy Myers...................................................................... Chairman	1.00 ................. 0.00	X	X	0	0	0

- 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

WAYNESBORO HOSPITAL

Employer identification number

23-1360854

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:	19009920
Software Version:	2019v5.0

- 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

WAYNESBORO HOSPITAL

Employer identification number

23-1360854

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 WAYNESBORO HOSPITAL

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
RESTRICTED	,	$ RESTRICTED	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

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

Page 3

Name of organization WAYNESBORO HOSPITAL		Employer identification number 23-1360854

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 WAYNESBORO HOSPITAL			Employer identification number 23-1360854
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:	19009920
Software Version:	2019v5.0

- 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

WAYNESBORO HOSPITAL

Employer identification number

23-1360854

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 ....	10,782,030	10,228,229	9,507,802	8,591,208	8,609,595
b	Contributions ...	108,272	128,383	136,108	128,985	138,437
c	Net investment earnings, gains, and losses	-101,647	1,024,925	597,504	800,942	-143,310
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...	10,766,040	-593,517	-8,251	-8,675	-8,509
f	Administrative expenses ....		-5,990	-4,510	-4,658	-5,005
g	End of year balance ......	22,615	10,782,030	10,228,229	9,507,802	8,591,208

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

Term endowment SchDMd Bullet

100.000 %

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 .....	2,174,114		2,174,114
b	Buildings ....	41,546,370	16,595,148	24,951,222
c	Leasehold improvements
d	Equipment ....	49,698,428	40,240,969	9,457,459
e	Other .....	1,172,284	1,021,270	151,014
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				36,733,809

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.)	54,427,149

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

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

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
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	15,369,703
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	72,857,700
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a	172,162
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	172,162
3	Subtract line 2e from line 1..................			3	72,685,538
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	-1,020,461
c	Add lines 4a and 4b....................			4c	-1,020,461
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......			5	71,665,077

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	64,847,408
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	1,257,031
e	Add lines 2a through 2d....................			2e	1,257,031
3	Subtract line 2e from line 1...................			3	63,590,377
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	30,340,413
c	Add lines 4a and 4b.....................			4c	30,340,413
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......			5	93,930,790

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
Part X : FIN48 Footnote	In June 2006, the Financial Accounting Standards Board (FASB) issued Interpretation NO. 48, Accounting for Uncertainty in Income Taxes-an interpretation of FASB Statement NO. 109, Accounting for Income Taxes (FIN 48), which creates a single model to address uncertainty in tax positions and clarifies the accounting for income taxes by prescribing the minimum recognition threshold a tax position is required to meet before being recognized in the financial statements. Under the requirements of FIN 48, tax-exempt organizations could now be required to record an obligation as the result of a tax position they have historically taken or various tax exposure items. Prior to FIN 48, the determination of when to record a liability for tax exposure was based on whether a liability was considered probable and reasonably estimable in accordance with SFAS No.5, Accounting for Contingencies. On July 1, 2007, the parent company, WellSpan Health, adopted FIN 48. WellSpan Health determined that it does not have any uncertain tax positions through June 30, 2020.
Part XII, Line 2d: Other expenses and losses per audited F/S	Rental expense netted with revenue $1257031
Part XII, Line 4b: Other revenue amounts included on 990 but not included in F/S	Transfer to Summit Health Foundation $19234637 Revenue netted with expense $105776 Transfer to Summit Physician Services $11000000

Schedule D (Form 990) 2019

Additional Data

Software ID:	19009920
Software Version:	2019v5.0

- 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

WAYNESBORO HOSPITAL

Employer identification number

23-1360854

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 30000.0000000 %

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? . . . . . . . . .

Yes

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

Yes

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

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .	1	3,632	566,249		566,249	0.600 %
b	Medicaid (from Worksheet 3, column a) . . . . .	1	57,408	10,109,916	4,277,100	5,832,816	6.210 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	2	61,040	10,676,165	4,277,100	6,399,065	6.810 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).					61,739	0.070 %
f	Health professions education (from Worksheet 5) . . .					18,912	0.020 %
g	Subsidized health services (from Worksheet 6) . . . .			1,684		1,684
h	Research (from Worksheet 7) .			18,892		18,892	0.020 %
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .			113,575		113,575	0.120 %
j	Total. Other Benefits . .			134,151		214,802	0.230 %
k	Total. Add lines 7d and 7j .	2	61,040	10,810,316	4,277,100	6,613,867	7.040 %

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.

		(c) Total community building expense	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support	43,357	43,357	0.050 %
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	43,357	43,357	0.050 %

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. ......

2,294,345

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. ......

22,943

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).....

21,106,803

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

29,634,097

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

-8,527,294

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?1Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
1	Waynesboro Hospital 501 East Main Street Waynesboro,PA17268 http://www.wellspan.org 234301	X	X	X

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)


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 18

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

Yes

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

Yes

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

Hospital facility’s website (list url): http://www.wellspan.org

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

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

Other (describe in Section C)

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

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 19

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

Yes

If "Yes" (list url): http://www.wellspan.org

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

10b

Yes

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

12a

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

12a

If "Yes" 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)


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 300.0000%
and FPG family income limit for eligibility for discounted care of 350.0000%

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):

http://www.wellspan.org

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

http://www.wellspan.org

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


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)


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
Facility: - Part V, Section B, Line 5	The Summit Health Management Team, the Summit Health Community Services Team, the Healthy Franklin County Leadership Advisory Committee, and the Center for Opinion Research at Franklin and Marshall College, led by Berwood Yost, contributed to the development of the Community Health Needs Assessment (CHNA) and the Community Health Improvement Plan (CHIP). The Healthy Franklin County Leadership Advisory Committee, and the Center for Opinion Research at Franklin and Marshall College, led by Berwood Yost, contributed to the development of the Community Health Needs Assessment (CHNA) and the Community Health Improvement Plan (CHIP). The Healthy Franklin County Leadership Advisory Committee, composed of a cross-section of stakeholders in Franklin County, brought significant insight and meaningful engagement to the CHNA process. The Community Services team coordinated and/or facilitated a series of seven focus groups with community members in the Summit Health Service area. The goal of these focus groups was to gather information about Franklin County's top community health needs from the perspective of targeted community informants that included schools, low-income, minority and senior populations. Focus groups were held with Franklin County school nurses and Chambersburg and Waynesboro area school counselors, respectively. Additionally, Dr. Jose Ricardo-Osorio, a professor at Shippensburg University and a member of Healthy Franklin County Leadership team, led a focus group of Spanish-speaking Hispanic community members. Dr. Annette Searfoss, the President and CEO of First Start Partnerships for Children and Families (formerly Franklin County Head Start) and a member of Healthy Franklin County Leadership team, also led a focus groups with a group of currently-enrolled First Start families in Chambersburg while Education and Family Services staff led a second group with the same target population in Waynesboro. Last, Dr. Annette Searfoss later facilitated a focus group in Chambersburg with working adults of retirement age who must continue to work because they do not have enough savings or a retirement fund to support themselves. The goal of each of these focus groups was to gather information about Franklin Countys top community health needs from the perspective of targeted community informants.A second tool was a survey of 51 veterans conducted by the Community Services team atSummit Health. This survey was designed to closely mirror the community behavioral risk factor survey and provide more details about the health conditions, risks, and behaviors of this population.In addition to the focus groups and veterans survey, Summit Health hosted a stakeholder forum on April 15, 2019, with members of the Healthy Franklin County Leadership Advisory Group. The three primary goals of the forum were to: (1) explain the CHNA process and the role of community stakeholders; (2) present the analytic framework and preliminary community health data included in the summary; and (3) gather input from these community stakeholders who have public health expertise or serve medically underserved, low income, and minority populations in Franklin County, about community health needs and community resources.
Facility: - Part V, Section B, Line 6a	The Chambersburg Hospital
Facility: - Part V, Section B, Line 7d	Facility: WellSpan Waynesboro HospitalA printed copy of the report may be obtained upon request to: WellSpan Summit Health, Ann Spottswood, Director of Community Services, HYPERLINK "mailto:Aspottswood2@wellspan.org" Aspottswood2@wellspan.orgWith each iteration of the CHNA process, WellSpan- Summit and its community partners continue to refine and enhance the system by which it obtains data, share it with key community, hospital and system leaders, and integrate it into the system-wide and entity-level planning processes. The key findings from the CHNA and the selected community health priorities were presented at an open community forum: BUILDING A CULTURE OF HEALTH IN FRANKLIN COUNTY, on June 5, 2019. 120 community members were given an opportunity to discuss the priorities identified and give input about how to address them through a health equity lens.The 2018 CHNA results and related priorities identified by Healthy Franklin County Leadership Advisory Group were then shared with Summit Health Management, Waynesboro Hospital, Chambersburg Hospital, and Summit Health Boards.
Facility: - Part V, Section B, Line 11	The Community Health Needs Assessment process encourages communities to reflect on the initiatives that they have undertaken and their successes in addressing the health priorities they have established. Since 2015, Summit Health's Community Services team engaged with the community to establish specific activities targeted to improving community health in seven priority areas. The community priorities, goals, and activities resulting from the 2015 Community Health Needs Assessment process are fully described in Appendix I of the 2018-2019 Summit Health Community Health Needs Assessment.The seven priority areas established in 2015 include access to primary care services, nutrition, physical activity, mental health and substance use and prevention, education and community based education, early childhood education, and adolescent health. Table 8 of the 2018-2019 Summit Health Community Health Needs Assessment shows the number of initiatives implemented and health indicators related to each. The community, led by Summit Health and the Healthy Franklin County Leadership Group, created many community interventions, with the most effort dedicated to nutrition, followed by mental health and substance use and prevention, physical activity, and access to care. Unfortunately all of these activities have not yet produced much community-level change. Access to care has remained virtually unchanged with the exception of higher rates of dental visits. Indicators related to nutrition and physical activity have gotten worse. Mental health indicators have also declined. Education and community based education indicators have remained virtually unchanged. Access to early childhood education has improved as have teen birth rates and teen chlaamydia rates. These results are reminders of at least two important truths about improving public health. First, effecting change will require more than three or four years. Most of the public health problems in our communities have emerged over long periods of time and it will require a long-term and sustained investment to produce change. Second, most of the indicators used here are trailing indicators that reflect at least in part social and structural contexts that are likely to move once those underlying conditions begin to change. Put simply, time and social change are necessary conditions for improving the health of a community. The priorities and impacts established by the 2015 Community Health Needs Assessment (CHNA) provide a summary of the work implemented guided by the results of the previous CHNA regarding the seven priority areas indicated above. To access progress towards these goals, community indicators from the 2015 CHNA and 2019 CHNA were compared in the categories of organizational indicators and presented in a table in the CHNA assessment report. Access to care has remained virtually unchanged with the exception of higher rates of dentist visits.Nutrition and physical activity has gotten worse for all indicators, despite the many activities completed at an organizational level to address these issues. Mental health indicators have also declined. Education and community based education indicators have remained virtually unchanged. Access to early childhood education has improved. Teen birth rate and teen chlamydia rates have gone down, while the chlamydia rate for young adults has increased. These results should be viewed while considering one important point - it takes time in order to see changes at the community level; simply because an indicator has not changed or has declined does not mean that the intervention has failed - there may be more reasons why a positive changed has not occurred.See attached 2019 WellSpan Summit Health Community Health Improvement Plan, also available online at www.wellspan.org in Community Benefits section.
Facility: - Part V, Section B, Line 13h	WellSpan Health is committed to caring for all the members of its communities, regardless of their ability to pay. In recent years, overall charity care has decreased slightly as more people have obtained health insurance coverage through the Affordable Care Act and the expansion of Pennsylvanias Medical Assistance (Medicaid) program. WellSpan is proud to be a leading partner in the Healthy Community Network, which works to address the needs of uninsured and underinsured individuals in our community. In addition, the health system recently enhanced its financial assistance policy and the discounts that it provides on services. For example, if a patients income is less than 300 percent of the federal poverty level, that patient would be eligible for a 100 percent discount on the services provided. Additionally, significant discounts are available for patients whose income is between 300 percent and 350 percent of the federal poverty level. For more information on WellSpans Financial Assistance program, visit www.WellSpan.org/FinancialAssistance.
Facility: - Part V, Section B, Line 16j	In an effort to make patients, families and others in our communities aware of the newly expanded Financial Assistance Policy, WellSpan broadly publicized its policy via promotional signage and the distribution of easy-to-read informational materials at registration sites throughout our communities. WellSpan provided information on the Financial Assistance Policy on its billing statements and included information in patient discharge materials. In addition, the materials and information are easily accessible via WellSpans website at www.WellSpan.org/FinancialAssistance. The site reflects WellSpans newly enhanced policy, as well as informational and application materials. It was also publicized via WellSpans on-hold phone messaging system and in its direct-to-consumer community newsletter/magazine, which is distributed by mail, email and Web. In addition, WellSpan placed posters and signage at its various sites of care to publicize its Financial Assistance Policy. Printed copies of WellSpan Healths entire financial assistance policy and the plain language summary of the policy, both of which are available in English and Spanish, may be obtained at no cost by visiting or calling one of the WellSpan patient financial services offices.The Financial Assistance Policy, Financial Assistance Application and Financial Assistance Policy Plain Language Summary are all available in Spanish.

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?
Name and address		Type of Facility (describe)
1	WellSpan Rehabilitation 500 E Main St Waynesboro,PA17268	Rehabilitation
2	WellSpan Lab Services 24 Antrim Commons Dr Greencastle,PA17225	Lab Draw site
3	WellSpan Lab Services 6155 Anthony Hwy Mont Alto,PA17237	Lab Draw Site
4
5
6
7
8
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
Part I, Line 3c - Charity Care Eligibility Criteria (FPG Is Not Used)	Patients 401% of poverty level and greater do not qualify for financial assistance.Patients/guarantors who complete an application for Financial Assistancewhose gross income falls between 351-400% of the FPL level and meet allother Financial Assistance qualifications (MAP 118) will be eligible for a 40%discount of self-pay balances.
Part I, Line 6a - Related Organization Community Benefit Report	Community Benefit Information is included in the Community Benefit Report for WellSpan Health.
Part III, Line 2 - Methodology Used To Estimate Bad Debt Expense	The number was calculated using the cost to charge ratio factor applied against actual patient bad debt write-offs. These numbers are included after all efforts have been exhausted to determine if the patient meets our charity care write-off policy based on federal poverty levels.
Part III, Line 3 - Methodology of Estimated Amount & Rationale for Including in Community Benefit	The estimate of bad debt attributable to charity care policy was calculated by dividing the bad debt amount that was originally coded bad debt but later found to qualify as charity care by the amount coded to the charity care write-off codes. This ratio is applied to the bad debt cost factor expense.
Part III, Line 4 - Bad Debt Expense	The Company provides an allowance for doubtful accounts for estimated losses resulting from the unwillingness or inability of patients to make payments for services. The allowance is determined by analyzing specific amounts and historical data and trends. Patient accounts receivable are charged off against the allowance for doubtful accounts when management determines that recovery is unlikely and the Company ceases collection efforts. Losses have been consistent with management's expectations in all material respects.
Part III, Line 8 - Explanation Of Shortfall As Community Benefit	Waynesboro Hospital maintains records to identify and monitor the level of charity care and community service it provides. These records include the amount of charges forgone based on established rates for services and supplies furnished under its charity care and community service policies and the estimated cost of those services. Payments from Medicare are generally less than Waynesboro Hospital's costs of providing the service.
Part III, Line 9b - Provisions On Collection Practices For Qualified Patients	Guidelines for suggested minimum number of phone attempts and letters to be sent before the account is turned over to an outside collection agency are included in the Patient Administrative Services Policy. Upon final PARO (Payment Assistance Rank Ordering) scoring, if a patient qualifies for presumptive charity, their account would not be forwarded to any third party collections. It shall be the policy of Patient Administrative Services to recommend accounts to Bad Debt on a timely basis. Inpatient/Outpatient accounts will go to bad debt automatically after the account has been in the financial class Pending Bad Debt for 30 days. All accounts must follow the approved limits for refunds and write offs, as established in Policy PF-102, before being transferred. The primary agencies will work the accounts for 6 months or until they feel it is uncollectable and return the account. The accounts are forwarded to secondary agencies from the primary agencies Closed and Return Reports. The financial class is changed to Bad Debt Other after the Closed and Return Reports are received from the Secondary Agency. The agencies must get written approval from the manager in the relatively rare instance of legal action being taken to collect the debt.
Part VI, Line 2 - Needs Assessment	WellSpan Summit Health and its entities have a long history of working to better understand and respond to the health and healthcare needs of our communities and the populations we serve. Throughout the last two decades, Summit Health has made great changes to programs and services based on the findings of the CHNAs conducted in 2008, 2012, 2015 and 2018. The data played a large role in the overall strategic planning process for Summit Health.The Patient Protection and Affordable Care Act of 2010 required non-profit hospitals to conduct community health needs assessments every three years. Summit Health, and its affiliates, Chambersburg Hospital and Waynesboro Hospital, completed a CHNA report and CHIP in 2015. The 2015 CHNA report identified community health priorities of access to care; obesity, nutrition, and physical activity; mental health, substance use, and prevention; educational and community- based engagement; early childhood education; and adolescent health. Based on the data, plans were created to address the identified needs by developing education, screenings, recruitment, partnerships, and needed infrastructure.The programs helped community members gain access to needed prescriptions, primary care providers and specialists. New facilities were constructed to offer the care the community needed. Free screenings, camps and classes were put into motion and awareness was created through advertising, speaking events, health fairs, and social media. Several grants were awarded to community non- profits through Summit Endowment whose projects address key health priorities of Franklin County. While many of the goals were accomplished, others went unmet. It became clear, to be more effective, Summit Health needed to further work with community partners to determine the health needs and key priorities of the community and to work together to develop strategies to address them, a process that is constantly evolving The 2018 CHNA was developed utilizing consulting support and guidance through a contract with the Floyd Institute for Public Policy at Franklin and Marshall College. Dr. Berwood Yost, Institute Director and Project Lead has an extensive background conducting and analyzing community and corporate surveys and was integral to the prior CHNA conducted in 2015. The Summit Health Community Services team facilitated planning and collaboration with community stakeholders who determined the survey questions to be asked of the community;discussed data collection methodology, including sample size and method of obtaining data; reviewed the raw data and supporting charts/ graphs; identified potential community health priorities, and; developed the process by which results and priorities were to be shared with the community. The telephone survey was conducted by staff of the Floyd Institute for Public Policy at Franklin and Marshall College with 506 adult residents throughout Franklin County completing responses.WellSpan Health held a meeting of the Healthy Franklin County leadership team on April 15, 2019. The three primary goals of the forum were to explain the CHNA process and the role of community stakeholders, present the analytic framework and preliminary community health data included in this summary, and gather input from community stakeholders, particularly those with public health expertise and individuals and organizations serving medically underserved, low-income, and minority populations in Franklin County, about community health needs and community resources. After a brief presentation of community health data, including demographics, social determinants such as education and income, health behaviors, and health outcomes, attendees answered three specific questions: what are the most important health needs in our community? How important is addressing this need to our communitys overall health and well-being? How likely is it that our community could implement the changes needed to address this problem?Four working groups then created a final list of 35 distinct health needs, which were ranked. Based on scope, severity, and community perceptions of severity and potential impact, and considering the community initiatives taken since 2015, Franklin Countys most significant needs focus on two social determinants and two behavioral health priorities: Establishing and maintaining the basic conditions that support health, including, access to care, family-sustaining incomes, accessible transportation, reduced stress, and affordable and quality housingEstablishing and maintaining systems that assure that children and families have access to high quality educational opportunities throughout the lifespanSupporting improved mental health including reducing and treating substance useSupporting active living, healthy eating, and less obesityThe identified priorities and associated data were subsequently presented to the WellSpan-Chambersburg and Waynesboro Hospital Boards for their adoption. Board members discussed the data and identified priorities within the context of existing staffing and financial resources, current and future entity initiatives, and community partnership opportunities to address systemic community change. The final CHNA report, along with the WellSpan Summit Community Health Improvement Plan (CHIP) was presented in September 2019 to the Summit Health Board for their review and approval. This information is included in the 2018 Community Health Needs Assessment Summary Report available at www.wellspan.org.
Part VI, Line 5 - Promotion of Community Health	As a charitable, community-based healthcare organization, our commitment to improving the lives and well-being of the people and communities we serve is carried out every day. Our Community Health Improvement Plan framework is constructed with Healthy People 2020 Leading Health Indicators and objectives. Further, our work at the local level aligns with similar goals and objectives in the 2017 Pennsylvania Department of Healths State Health Improvement Plan. Over the last three years, Summit Health provided over $101 million of charity care to the community. Below are a few examples of the work accomplished in the various priority areas since 2016. Often, we benefited from strong partnership with other community organizations. The impact of innovative thinking, and leveraging scarce resources is not only profound, it is smart.And, although several activities were planned between March and June 2020, our focus and methodology came to an abrupt halt. The beginning of our COVID-19 facing work follows, as well as Pre-COVID-19 programs and services. The COVID-19 PandemicEducation Resources Campaign: During May 2020, 2,050 individuals were engaged with COVID-19 mitigation education materials. 550 packets were distributed to Hispanic grocery stores, the Chambersburg Hispanic American Center and through the Chambersburg School District and churches. The COVID-19 Pandemic--Mask Campaign: Between March and June 2020, 1,304 individuals were provided masks via Community Services team members. 872 of those masks were received by Franklin County Housing Authority residents. The COVID-19 PandemicHealthy Behaviors at Home Campaign: During MarchApril 2020, 1,151 encounters were recorded virtually via the Healthy Franklin County website and Facebook. Waynesboro Hospital Health Fair - 1,687 individuals attended this annual event on March 5, 2020. 587 individuals completed blood work screening; 209 screenings for Bone Density were conducted with 66 identified as having low bone density results; 178 individuals had BP screening; 52 received Diabetic Foot Screening; 457 received Grip Strength screening; 61 received simple lung function; 228 completed In-body testing; 98 completed eye screenings; 14 children completed eye screenings. School-Based Clinic - Keystone Health, the Federally Qualified Health Center (FQHC) serving Franklin County, established a school-based clinic at the Chambersburg Area Senior High School in the fall of 2016 and has seen over 2400 students since it opened. As the FQHC, Keystone Health has worked with its Navigators to increase access to health insurance by assisting 363 individuals to sign up for Childrens Health Insurance Program (CHIP), 2345 sign up for Medicaid and 1662 sign up for the Marketplace (1580 enrolled in the Marketplace). Keystone Navigators attended over 130 events to reach uninsured individuals and assisted over 13,000 clients. Creating and supporting careers in healthcare are essential to providing quality healthcare. Greencastle -Antrim Endowment, a component of Summit Health Endowment, a funding mechanism which supports programs aligned with the CHNA priorities. From 2017-2020, $102,000 were awarded via 57 college scholarships to Greencastle-Antrim high school students pursuing a career in healthcare. 16 pre-med students participated in a summer work experience at Summit Health and 12 medical students participated in a resident internship in the Emergency Room at Summit Health. Summit Physician Services established a work group, created a plan and received funding from Summit Endowment to establish a community health worker program in 2017 to serve vulnerable, low-resourced seniors. This grant supports two Community Health Workers, who serve as liaisons between health and social services, and the community, to facilitate access to services. In 2018, the workers focused on targeted populations in the community, specifically residents of the Towers of Falling Spring in Chambersburg and diabetic patients with HgA1C greater than 9 percent. In 2019, the program expanded services to the Cottages, a senior-living apartment complex in Shippensburg. Both Keystone Health and Summit Health providers are using health risk assessments to collect data to better understand and act on their patients social determinants of health. Keystone Health adopted and implemented a plan to reach linguistically isolated individuals which is reviewed annually.Summit Community Services supports Healthy Communities Partnership of Greater Franklin County in their coordination of Chambersburg Cares, a community-wide effort to engage community members and aligns resources, to promote healthy youth behaviors and reduce risk factors. Chambersburg Cares uses a data-driven process and the Communities That Care model. The group determines risks and root causes, working together to target the prioritized risks through evidence-based programs in schools and other community organizations. The Healthy Franklin County Leadership committee formed an ad hoc diversity, inclusion and discrimination committee in the fall of 2017 as a result of heightened racial tensions occurring nationally which also emerged locally. The ad hoc committee conducted an environmental scan to see how these issues were being addressed in the community and to gain a better understanding of what the committees role could be in addressing them. The research done by the committee uncovered the connection between the Social Determinants of Health (SDOH) and health equity. As a result, the Healthy Franklin County Leadership committee determined that it and its partners should take steps to address the SDOH more intentionally with their work. Healthy Franklin County coordinated a Public Health 101 Training which focused on the SDOH in June 2018. To gain more understanding about the SDOH in Franklin County, a SDOH module was included in the primary telephone survey conducted by Franklin and Marshall Center for Opinion Research as part of the 2018 Community Health Needs Assessment (CHNA). During the same time, several grass roots groups have emerged in the community to champion the need for more diversity and inclusion training, increase the awareness and acceptance of the LGBTQ+ and the importance of racial reconciliation. The Healthy Franklin County Leadership committee will evaluate the results from the 2018 CHNA and determine next steps as to how to address health equity, systemic issues related to discrimination, racism and oppression and the SDOH in the Community Health Improvement Plan (CHIP) over the next 3 years. Critical to the systems change required to increase the proportion of children who are ready for school in all five domains of healthy development, is cross-sector collaboration. The United Way of Franklin County formed the Early Childhood Partnership (ECP) in 2013 to start this process with early childhood providers and intervention service providers. Over the last three years, the ECP convened 16 meetings which strengthened relationships, increased awareness of services in Franklin County and fostered new initiatives, like the annual Early Childhood Expo, which in 2019 changed its name to Learn and Play Day with United Way. In August, 2019, the Chambersburg Police Department, invited various community partners to participate in this nationally recognized community event. Summit Community Services team members engaged 266 individuals, during a block party event in downtown Chambersburg. An additional 24 children experienced the Born Learning Trail. In 2018, a local group of community leaders formed Hope From the Start to spark an initiative to focus on children pre-natal to age 3. On June 15, 2018, the group organized a free community event called Our Babies, Our Future: The Science Behind Early Childhood Education for Children and Families. Dr. Brenda Jones Harden, nationally renowned early childhood expert and professor at the University of Maryland, College Park, and the past board president of Zero to Three, presented research everyone needs to know about the first years of life. A task force emerged from this effort called Hope From The Start, which formally came under Healthy Franklin County in the fall of 2018. The task force created an action plan to improve systems of care, establish family centers and to provide parenting classes. The ultimate goals of Hope From the Start are to increase the proportion of children who are ready for school in all five domains of healthy development: physical development, social-emotional development, approaches to learning, language, and cognitive development. One of the challenges uncovered by the Hope From the Start committee in assessing school readiness is the lack of a standardized tool in all six school districts in Franklin County. The Hope From the Start committee advocated for all six districts to use the KEI about the Kindergarten Entry Inventory (KEI), which offers teachers an instructional strategy for underst
Part VI - Additional Information	Part VI Line 5 ContinuedAs well, collaborative efforts are underway to work with Shippensburg University to support the creation of a CDA credential for students pursuing an Early Childhood career while completing high school graduation requirements. During 2019, staff planned and implemented Parent Cafs an evidence-based approach to supporting parents and helping guide them through challenging parenting scenarios with peer engaged successful outcomes.Another program that evolved from the Hope From the Start task force, is the development of a warm hand-off process between expectant mothers receiving pre-natal care from Keystone Womens Care with the Early Head Start program. The federally funded program, which began eight years ago under Franklin County Head Start, focuses on early child and family development services for low-income families. It serves a total of 72 children ages 6 weeks to 3 years old, with three of these slots reserved for pregnant mothers, through either home- or center-based programs. The collaboration means Early Head Start case managers will be placed in Keystone's clinic in order to make care more streamlined for patients. Through the process, nurses will work to identify patients who would benefit from the service and then make a "warm handoff" to the case manager. Keystone Womens Care hired a Nurse Educator in 2019 to help facilitate this process. To help create more awareness about the prevention of child abuse, Summit Health Community Services partnered with the Childs Advocacy Center to promote the message of Read, Play, Sing Every Day with their children to parents and caregivers. This has been proven to strengthen family connections and build social and emotional readiness for school. Pinwheels for prevention were planted at 20 locations throughout Franklin County. Staff also participated in other events such as the United Ways Early Childhood Expo, the YMCA Healthy Kids Days, and Novel Reels reaching about 700 addition people with their message. In support of the Read, Play, Sing initiative, Summit Health sponsored the purchase of 100 Ferdinand the Bull books that aligned with a free movie screening. A total of 190 children and adults attended this event at Waynesboro Theatre. Inside each of the books were vouchers for children to return to the library to receive a second free book. Sixty-seven children, or 35%, returned to the Alexander Hamilton Memorial Library to receive the second free book; 14, or 20%, signed up for a new library card (16 already had a library card); 36, or 53%, signed up for the summer reading program (21 were already signed up). In August, 2019, Summit Community Services team members distributed 46 Super Health Hero capes to children who completed a social-emotional health activity.512 individuals attended the annual Autism Fair in September 2019. 102 individuals returned evaluations and, of that group, 83% attended to find resources; 88% found resources they did not know about before attending; 70% have a child with Autism. From 2016 to 2018, over 1,000 people participated in 3 annual Summit Health Autism Fairs designed to create more awareness about autism and the local resources available for families. Out of the 176 post-evaluation surveys returned from the 2017 and 2018 fairs, 119, or 67%, indicated they are a caregiver of a child with autism and 155, or 86%, of the families stated they found resources that they did not know existed. In June 2020, 57 school nurses and 1 school counselor participated in virtual training that included presentations regarding Public Health & Community Building, Resources & Strategies to Help Grieving Students, Anxiety & Depression, and Deescalating Training. 55 of those 57 individuals returned evaluations. Of those 55, 100% strongly agree or agree that they have a better understanding of local resources available for grieving children, teens and families; they understand the difference between resilience and post-traumatic growth, they know how to identify positive coping skills and activities in order to help grieving students and their families, and free mental health apps to recommend as appropriate. Since the debut issue from Fall 2016, six editions of the Living Healthy Magazine have been mailed to roughly 300,000 households in Franklin County as a free health resource. Spearheaded by the Summit Health Public Relations and Community Services teams, topics covered in the magazine focus on top community health priorities including overdose, diabetes prevention and management, stroke, nutrition, and physical activity. Features in the Living Healthy Magazine raise awareness on important health screenings, prevention strategies, and disease management through a combination of real-life accounts from Summit Health patients and community health program participants and educational articles. Summit Health Community Services coordinated a colorectal cancer awareness and prevention campaign in March 2019. The goals of the campaign were to increase awareness on when people should be talking with their PCP to get screenings and to increase awareness on healthy lifestyle behaviors for cancer prevention. Activities including speaking engagements, cooking and conversations and a grocery store tour. Free community yoga sessions were offered in Waynesboro and Chambersburg in honor of Heart Month by Summit Health Community Services. In February 2020, 20 participants attended and all returned evaluations. 36% reported that this was their first time trying yoga, 86% reported getting at least 30+ minutes of physical activity on 1-2 days or more in the last week; 93% reported feeling less stressed and more relaxed after the yoga session, and 94% strongly agreed or agreed that they had a better understanding of how chronic stress can affect heart health and ideas on healthier ways to manage stress after the yoga session. As well, Chambersburg and Waynesboro YMCAs partnered with Summit Community Services in February 2018 and February 2019 to provide Yoga for a Healthy Heart for a total of 42 participants. Based on pre- and post- assessment questionnaires, 40 or 95% of participants reported feelings of less stress/more relaxed after the sessions. In 2019, 15 of 16 participants of 93% reported they strongly agree or agree they developed a better understanding of how can stress can affect heart health and 14 of 16 participants or 87% reported they strongly agree or agree they developed a better understanding of ideas on healthier ways to manage stress. Summit Community Services partnered with the Chambersburg YMCA to introduce this fun, aerobic activity on February 20, 2020. 13 individuals participated. Of the 13 that returned evaluations, 85% reported that this was their first time doing a POUND Class; 85% reported that they exercised at least 1-2 days in the week for 30+ minutes, and 54% reported that they had more energy and less stress after the class.September is National Suicide Prevention Month. Every year, Summit Health and the Suicide Prevention Coalition both coordinate awareness campaigns to highlight the risks and warning signs of suicide and resources available to those in need. Summit Healths Spread Kindness Not Rumorscampaign brought 489 people to its website to find resources on suicide prevention, bullying, and ways to spread kindness. The Suicide Prevention Coalition, which is part of the Healthy Franklin County Mental Health Task Force, coordinates the annual Franklin County Commissioners Proclamation of September as Suicide Prevention Month, speaking events and suicide prevention training opportunities during the month. The Healthy Franklin County Mental Health Task Force provided a Mental Health First Aid training on May 22 & 23, 2019. The evidence-based program helps participants grow their knowledge of signs, symptoms and risk factors of mental illnesses and addictions; identify multiple types of professional and self-help resources for individuals with a mental illness or addiction; increase their confidence in and likelihood to help an individual in distress; and show increased mental wellness themselves. The task force targeted case managers, educators, guidance counselors, first responders, the faith community, non-profit organizations, human resources professionals and human services providers. The event was open and free to the general public. The two primary health care systems in Franklin County, Keystone Health and Summit Health, screen all patients for depression using the PHQ2 and PHQ9. 114,341 patients were screened at Summit Health using the PHQ2 (some patients were screened more than one time); 784,300 PHQ2 screening were negative and 83,665 PHQ2 screenings were positive (negative PHQ2 screenings result in the administration of a PHQ9 screening). 21,144 patients were screened at Keystone Health using the PHQ2; and 13,959 were screened at Keystone Health with the PHQ9. An evidenced-based, Center for Disease Control (CDC) Re

Schedule H (Form 990) 2019

Additional Data

Software ID:	19009920
Software Version:	2019v5.0

- TIN:

Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

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

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

Attach to Form 990.
lBullet

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

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization
WAYNESBORO HOSPITAL

Employer identification number
23-1360854

Part I

General Information on Grants and Assistance

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

Yes No

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

Part II

Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient

that received more than $5,000. Part II can be duplicated if additional space is needed.

(a) Name and address of organization or government	(b) EIN	(c) IRC section (if applicable)	(d) Amount of cash grant	(h) Purpose of grant or assistance
(1) Borough of Waynesboro 55 East Main St Waynesboro,PA17268	23-6002956	Gov't	40,000	Community support
(2) Summit Health Foundation PO Box 2767 York,PA17405	83-1196554	501(c)(3)	19,234,637	Fund new system foundation
(3) Summit Physician Services PO Box 2767 York,PA17405	25-1716306	501(c)(3)	11,000,000	Community health
(4) Waynesboro Police Department 57 East Main Street Waynesboro,PA17268	23-6002956	Gov't	10,000	Community support

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

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

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

Cat. No. 50055P

Schedule I (Form 990) 2019

Page 2

Part III

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

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

(1)
(2)
(3)
(4)
(5)
(6)
(7)

Part IV

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

Return Reference

Explanation

Grantmaker's Description of How Grants are Used

All WellSpan entities follow WellSpan policies and procedures regarding grant projects to ensure that the use of grant funds are consistent with WellSpan's commitment to endeavor to improve the health status of the communities that we serve.The WellSpan foundations are supporting organizations and substantially all of the grants and other assistance they make furthers the exempt purposes of their "supported organizations", each of which are exempt affiliated organizations within the WellSpan Health system. Because the supported organizations identify the projects and exempt activities that will be funded by the foundations' grants and other assistance, and because there is a cross-over between the respective governing bodies and management of the foundations and their supported organizations, the foundations are able to effectively monitor that the grants they make are used for their intended purposes.

Schedule I (Form 990) 2019

Additional Data

Software ID:	19009920
Software Version:	2019v5.0

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

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

WAYNESBORO HOSPITAL

Employer identification number

23-1360854

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

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)
1Charlie Chodroff Director	(i) (ii)	------------- 581,507	------------- 217,322	-------------	------------- 257,400	------------- 49,630	------------- 1,105,859	------------- 216,450
2Clarence Miller Pathologist	(i) (ii)	205,564 -------------	2,500 -------------	3,937 -------------	12,938 -------------	19,243 -------------	244,182 -------------	-------------
3Jarett Logsdon Manager-Pharmacy	(i) (ii)	141,146 -------------	-------------	9,692 -------------	9,187 -------------	13,718 -------------	173,743 -------------	-------------
4Jeff Carty VP of Finance	(i) (ii)	119,965 -------------	-------------	9,506 -------------	6,037 -------------	15,138 -------------	150,646 -------------	-------------
5Jill Keller-Reyka VP of Nursing Services	(i) (ii)	180,546 -------------	13,004 -------------	9,683 -------------	11,062 -------------	27,909 -------------	242,204 -------------	-------------
6Kevin Lorentsen Dir beg 01/20	(i) (ii)	------------- 422,742	------------- 49,500	------------- 1,677	------------- 8,400	------------- 16,599	------------- 498,918	-------------
7Kevin Mosser Former CEO - WellSpan Health	(i) (ii)	------------- 212,990	------------- 763,820	------------- 607,126	------------- 1,596,796	------------- 33,462	------------- 3,214,194	------------- 763,820
8Kevin Sanders Physician	(i) (ii)	178,041 -------------	-------------	150 -------------	10,848 -------------	19,722 -------------	208,761 -------------	-------------
9Kimberly Rzomp Treas end 12/19	(i) (ii)	------------- 423,023	------------- 148,554	------------- 28,480	------------- 55,245	------------- 16,712	------------- 672,014	-------------
10Melissa Dubrow VP & COO	(i) (ii)	198,740 -------------	88,471 -------------	31,812 -------------	14,895 -------------	32,371 -------------	366,289 -------------	-------------
11Michael F O'Connor CFO-WSH	(i) (ii)	------------- 605,042	------------- 226,590	-------------	------------- 279,133	------------- 51,645	------------- 1,162,410	------------- 226,590
12Patrick O'Donnell President	(i) (ii)	------------- 919,572	------------- 254,495	------------- 44,477	------------- 65,111	------------- 43,620	------------- 1,327,275	-------------
13Roger Robertson Director	(i) (ii)	------------- 568,553	------------- 15,172	------------- 28,973	------------- 8,400	------------- 16,550	------------- 637,648	-------------
14Roxanna Gapstur CEO-WSH/Dir.	(i) (ii)	------------- 988,473	------------- 271,790	------------- 32,232	------------- 121,240	------------- 55,828	------------- 1,469,563	-------------
15Sarah Hawbaker Pharmacist	(i) (ii)	132,586 -------------	-------------	87 -------------	8,245 -------------	22,998 -------------	163,916 -------------	-------------
16Scott Card Physician	(i) (ii)	316,302 -------------	-------------	11,763 -------------	16,800 -------------	23,176 -------------	368,041 -------------	-------------

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
Part I, Line 1a: Relevant information in regards to selections on 1a.	The officers receive an allowance that can be considered a discretionary spending account. The monies are in lieu of an automobile allowance, to purchase additional life insurance, etc. Results Fitness Club membership is available free of charge for any officer and active board member.

Schedule J (Form 990) 2019

Additional Data

Software ID:	19009920
Software Version:	2019v5.0

- TIN:

Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

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
WAYNESBORO HOSPITAL

Employer identification number
23-1360854

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	See Schedule O

Part Ⅱ

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................
2 Amount of bonds legally defeased ..............
3 Total proceeds of issue ..................
4 Gross proceeds in reserve funds .............
5 Capitalized interest from proceeds .............
6 Proceeds in refunding escrows ...............
7 Issuance costs from proceeds ...............
8 Credit enhancement from proceeds .............
9 Working capital expenditures from proceeds .............
10 Capital expenditures from proceeds .............
11 Other spent proceeds .............
12 Other unspent proceeds .............
13 Year of substantial completion .............
	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? ..........
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................

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? .............
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............

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? .............
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?
c Are there any research agreements that may result in private business use of bond-financed property? .............
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 ....
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? ...
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?.............
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? .............
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? ........

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? ...
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......
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? .....
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?
b Name of provider ..........
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)?
b Name of provider ..........
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?
7 Has the organization established written procedures to monitor the requirements of section 148? ...

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?

Part Ⅵ

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

Return Reference	Explanation

Schedule K (Form 990) 2019

Additional Data

Software ID:	19009920
Software Version:	2019v5.0

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

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

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization

WAYNESBORO HOSPITAL

Employer identification number

23-1360854

Return Reference	Explanation
Client Note 1	Client Note 1 - Paid Preparer ExplanationDue to a software limitation, we wish to clarify that WellSpan Health is the ERO.The paid preparer is:BDO USA, LLP13-53815908401 Greensboro Drive, Suite 800McLean, VA 22102(703) 893-0600The preparers name is Marc Berger, PTIN P01871563
Form 990, Part VI, Line 6: Explanation of Classes of Members or Shareholder	WellSpan Summit Health, a not-for-profit corporation, is the sole member of the Hospital.WellSpan Health, a not-for-profit corporation, is the sole member of WellSpan Summit Health.
Form 990, Part VI, Line 7a: How Members or Shareholders Elect Governing Body	Subject to any powers reserved to WellSpan Health or the Member (WellSpan Summit Health) by the bylaws, the governance of the Hospital shall be vested in the Board of Directors of the Hospital who shall have authority to manage the business, property and affairs of the Hospital as provided by the Act. In this capacity, the Board shall act as the governing body of the Hospital on all matters not reserved to WellSpan and the Member, including but not limited to, responsibility for the quality of care delivered by the Hospital and its Medical Staff, and for adherence to applicable licensure requirements established by the Pennsylvania Department of Health for acute care general hospitals, the Medicare Conditions of Participation established by CMS for hospitals, and the accreditation standards established by The Joint Commission (or similar accreditation organization), including requirements regarding medical staff appointments, credentialing and oversight. With respect to those powers and responsibilities reserved to WellSpan and the Member, the Board shall serve in an advisory capacity.
Form 990, Part VI, Line 7b: Describe Decisions of Governing Body Approval by Members or Shareholders	Rights of WellSpan. WellSpan may, with respect to the Hospital, initiate and implement any of the following actions, except as otherwise provided in the Affiliation Agreement, and if any of the following actions are otherwise initiated by the Hospital or the Member, such action shall not become effective unless approved by WellSpan:(a)adoption, amendment, restatement, repeal, termination or any other modification of any governing instrument of the Hospital; (b)any fundamental transactions involving the Hospital, including the reorganization, merger, consolidation, change of control, sale of all or substantially all the assets, conversion, dissolution, assignment for the benefit of creditors, filing of any bankruptcy petition, or similar transaction; provided however, for at least ten (10) years following the Effective Date, WellSpan shall not sell, transfer, convey, lease, exchange, or otherwise dispose of all or substantially all of Hospitals assets, unless otherwise approved by the Member and a majority of the Board;(c)except as otherwise provided in Section 10.4(d) of the Affiliation Agreement. investment of any Hospitals assets other than in accordance with WellSpans investment policy then in effect; provided, that any Hospital assets invested by WellSpan will be invested pro rata in accordance with WellSpans risk allocation strategy applicable to the assets of all other WellSpan entities; (d)incurrence of indebtedness in excess of limits established by WellSpans policy then in effect (which shall in no event be less than One Million Dollars ($1,000,000)) by the Hospital;(e)any sale, transfer, conveyance, lease, exchange, mortgage, encumbrance, pledge or other disposition of the Hospitals assets with fair market value in excess of limits established by WellSpans policy then in effect (which shall in no event be less than One Million Dollars ($1,000,000)), other than in the normal course of business; (f)adopting any annual operating or capital budgets for the Hospital, provided, however, that such operating budget shall include funding for community benefit programs;(g)any capital expenditures by the Hospital in excess of the WellSpan-approved annual capital budgets for the Hospital;(h)except as otherwise provided in the Affiliation Agreement, any material changes to licenses held by the Hospital; (i)selecting, hiring, contracting with, or otherwise entering into agreements with, whether oral or written, any outside financial auditors, legal counsel or investment advisors that may be recommended by the Hospital for its local needs or activities, other than the outside financial auditors, legal counsel or investment advisors selected by WellSpan;(j)review and approval of the Hospitals nominees for the Hospitals corporate officers before such nominees are appointed by the Board; (k)adopting the statement of mission and vision, strategic and operating plans and any amendments thereto for the Hospital; (l)creation of new (or material changes, including closure or cessation, to existing) lines of business, sites of business, subsidiaries, partnerships or joint venture by the Hospital (subject to WellSpans and the Members right to require the decision-making process described in Section 10.3(a)(iv) of the Affiliation Agreement, if applicable); and(m)Any change in the Hospitals tax-exempt status (subject to Section 10.1 of the Affiliation Agreement), charitable mission, or charity care policies and practices (which shall at all times comply with the integrated regional nonprofit health care systems charity care policies and practices in effect from time to time).Section 2.2Rights of the Member. Subject to WellSpans reserved powers in Section 2.1 above and in addition to all matters required by law or these By-Laws to be approved by the Member, the Member shall have the following rights and responsibilities: (a)recommending (for WellSpan approval) operating plans for the Hospital that are in conformance with System-approved priorities and plans;(b)monitoring the Hospitals accomplishment of the Hospitals operating plans;(c)recommending (for WellSpan approval) annual operating and capital budgets for the Hospital that are in conformance with System budget targets;(d)monitoring the Hospitals financial performance against the Hospitals operating and capital budgets;(e)monitoring the quality of and satisfaction with clinical services provided by the Hospital; (f)nominating the Hospitals corporate officers for review and approval by WellSpan before they are appointed by the Board; (g)ensuring that the governing board of the Hospital is effectively monitoring compliance with applicable licensure requirements established by the Pennsylvania Department of Health for acute care general hospitals, the Medicare Conditions of Participation established by The Centers for Medicare and Medicaid Services for hospitals, and the accreditation standards established by The Joint Commission (or similar accreditation organization), including requirements regarding medical staff appointments, credentialing, and oversight; (h)representing the interests of the community or population served by the Hospital;(i)recommending (for WellSpan approval) changes in the services provided by the Hospital (subject to WellSpans and the Members right to require the decision-making process described in Section 10.3(a)(iv) of the Affiliation Agreement, if applicable);(j)recommending (for WellSpan approval) amendments to the Hospitals Articles of Incorporation or By-Laws;(k)recommending (for WellSpan approval) fundamental transactions involving the Hospital, including the reorganization, merger, consolidation, change of control, sale of all or substantially all the assets, conversion, dissolution, assignment for the benefit of creditors, filing of any bankruptcy petition, or similar transaction;(l)except as otherwise provided in Section 10.4(d) of the Affiliation Agreement, recommending (for WellSpan approval) investment of any Hospitals assets other than in accordance with WellSpans investment policy then in effect;(m)recommending (for WellSpan approval) the Hospitals incurrence of indebtedness in excess of limits established by a WellSpan policy then in effect (which shall in no event be less than One Million Dollars ($1,000,000));(n)recommending (for WellSpan approval) the sale, transfer, conveyance, lease, exchange, mortgage, encumbrance, pledge or other disposition of the Hospitals assets with fair market value in excess of limits established by a WellSpan policy then in effect (which shall in no event be less than One Million Dollars ($1,000,000)), other than in the normal course of business;(o)recommending (for WellSpan approval) capital expenditures in excess of the WellSpan-approved annual capital budgets for the Hospital;(p)recommending (for WellSpan approval) material changes to licenses held by the Hospital;(q)recommending (for WellSpan approval) any outside financial auditors, legal counsel or investment advisors for the Hospitals local needs or activities, other than the outside financial auditors, legal counsel or investment advisors selected by the System;(r)recommending (for WellSpan approval) changes to the Hospitals statement of mission and vision, strategic and operating plans; (s)recommending (for WellSpan approval) the creation of new (or material changes, including closure or cessation, to existing) lines of business, sites of business, subsidiaries, partnerships or joint ventures by the Hospital (subject to WellSpans and the Members right to require the decision-making process described in Section 10.3(a)(iv) of the Affiliation Agreement, if applicable); and (t)recommending (for WellSpan approval) any change in any the Hospitals tax-exempt status, charitable mission or charity care policies and practices (which shall at all times comply with the Systems charity care policies and practices in effect from time to time).
Form 990, Part VI, Line 11b: Form 990 Review Process	Management provided an electronic copy of the form 990 to each voting member of the organization's governing body, prior to its filing with the IRS. The organization's finance management team provided a presentation to the Audit Committee on the organization's 990 return.
Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts	Officers, directors, and key employees fill out a WellSpan Health Conflict of Interest Disclosure Statement questionnaire annually. The questionnaire is administered by the Internal Audit Department of WellSpan Health, the Parent Company.There shall be full disclosure by any Director having a business or personal interest or relationship which may be in conflict with the interests of the Corporation. After such disclosure the Director shall abide by the determination of the Board of Directors as to whether a conflict exists, the extent to which, if at all, the Director will be permitted to be present during the Board of Directors' discussion of the matter in which the Director may be interested, and whether the Director will be permitted to participate in such discussion and cast a vote in such matter.
Form 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key Employees	The Compensation Committee of WellSpan Health is responsible for rewarding and reinforcing key executives for the achievement of annual and long-term performance objectives. The Compensation Committee shall consist of not more than six (6) persons, of whom two (2) shall be the Chairman and Vice Chairman of the Board of the Corporation, and the remaining members shall be such other persons as may be appointed by the Chairman of the Board of the Corporation, with the approval of the Board of Directors; provided, however, that the Compensation Committee shall not include any persons who are employed by the System. The Chairman of the Board of Gettysburg Hospital shall participate. The role of the Compensation Committee is to set the Executive Compensation Philosophy for the system and ensure adherence, evaluate performance and establish compensation for the WellSpan President, evaluate team performance of the executive team and establish awards, review and approve senior executive base salary ranges, and oversee employed physician compensation programs. The Committee will approve salary ranges for each executive position and review incumbent salaries annually. The Committee will be responsible for reviewing the President's salary each year, and if warranted, authorizing an adjustment to maintain competitiveness. The President will have the authority to make salary adjustments for subordinate positions. The Committee is responsible for approving and authorizing payment of the performance awards. The Committee will approve and authorize payment of the President's performance awards. Integrated Healthcare Strategies, Inc., based in Minneapolis Minnesota is the external consultant to the committee. This consultant focuses exclusively on executive and physician compensation in the health care industry. In summary, the executive and physician compensation review process consists of the following: 1) Cash compensation reviewed annually 2) Cash compensation reviewed by external consultant biennially 3) external total compensation (cash, incentives, benefits, perquisites) reviewed by external consultant periodically 4) Process is integrated with compensation analysis for other WellSpan positions 5) Committee decisions are documented in minutes maintained in Human Resources.
Form 990, Part VI, Line 19: Other Organization Documents Publicly Available	Governing documents, policies, and financial statements are available upon request.
Schedule K - Tax Exempt Bonds	$213,430,000 of Revenue bonds for Wellspan Health Obligated Group, Series 2014A were issued November 10, 2014 by General Authority of South Central Pennsylvania. The purpose of this bond issue was revenue refund for bonds issued 06/23/1993 and 11/12/2008. WellSpan Health, the parent organization, allocated portions of the proceeds of this tax exempt bond issue to York Hospital (23-1352222), Gettysburg Hospital (23-1352220), WellSpan Properties (22-2842252), WellSpan Specialty Services (23-2899911), and Ephrata Community Hospital (23-1370484). In order to remain consistent with the reporting on Form 8038, all outstanding liabilities associated with this tax-exempt bond issue is reported on the WellSpan Health (22-2517863) Schedule K. As of 6/30/20, the allocation of the Debt Capital program including issue premium was as follows: York Hospital $113,006,240, Gettysburg Hospital $7,607,130, WellSpan Properties $27,233,962, WellSpan Specialty Services $13,390,824, and Ephrata Community Hospital $27,945,016. These amounts are reported on the respective balance sheets for each of these entities.Arbitrage Rebate and Yield Restriction Liability Calculation was performed for the period of November 10, 2014 to November 10, 2019. No rebate was due.On May 22, 2015, the Lancaster Municipal Authority issued $36,572,083 of Revenue bonds, Series 2015A, to an Obligated Group consisting of York Hospital, Gettysburg Hospital and Ephrata Community Hospital. The purpose of this bond issue was to refund bonds issued on behalf of Ephrata Community Hospital, including the Lancaster Municipal Authority Revenue Notes Series 2009, 2010A, 2012, and 2013. In order to remain consistent with the reporting on Form 8038, all outstanding liabilities associated with this tax-exempt bond issue is reported on the WellSpan Health (22-2517863) Schedule K.As of 6/30/20, the $29,212,704 of outstanding liability is reported on the Ephrata Community Hospital return balance sheet.$34,877,000 of Revenue bonds for Wellspan Health Obligated Group, Series 2017A were issued March 13, 2018 by General Authority of South Central Pennsylvania to refinance Series 2017A Notes (taxable). Such notes were applied to refund 2008A Bonds. WellSpan Health, the parent organization, allocated portions of the proceeds of this tax exempt bond issue to York Hospital (23-1352222), Gettysburg Hospital (23-1352220), WellSpan Properties (22-2842252), WellSpan Specialty Services (23-2899911), and Good Samaritan Hospital (23-1794160). In order to remain consistent with the reporting on Form 8038, all outstanding liabilities associated with this tax-exempt bond issue is reported on the WellSpan Health (22-2517863) Schedule K. As of 6/30/20, the allocation of the Debt Capital program was as follows: York Hospital $15,775,109, Gettysburg Hospital $2,462,503, WellSpan Properties $2,879,066, WellSpan Specialty Services $4,563,048, Good Samaritan Hospital $220,004, and WellSpan Health $1,260,270. These amounts are reported on the respective balance sheets for each of these entities.$29,312,000 of Revenue Bonds, Series 2017B (tax exempt bonds) for WellSpan Health Obligated Group were issued 9/4/2018 by General Authority of South Central Pennsylvania to refinance Series 2017B Notes (taxable). Such notes were applied to refund 2008A Bonds. In order to remain consistent with the reporting on Form 8038, all outstanding liabilities associated with this tax-exempt bond issue is reported on the WellSpan Health (22-2517863) Schedule K. As of 6/30/20, the allocation of the Debt Capital program was as follows: York Hospital $16,385,530, Gettysburg Hospital $2,558,828, WellSpan Properties $2,990,472, WellSpan Specialty Services $4,739,616, Good Samaritan Hospital $228,517, and WellSpan Health $1,309,037. These amounts are reported on the respective balance sheets for each of these entities.$331,502,627 of Revenue bonds Series 2019A and 2019B for Wellspan Health Obligated Group were issued 4/3/2019 by General Authority of South Central Pennsylvania. The purpose of this bond issue was revenue refund for bonds issued 11/12/2008. WellSpan Health, the parent organization, allocated portions of the proceeds of this tax exempt bond issue to York Hospital (23-1352222), Chambersburg Hospital (23-0465970), WellSpan Properties (22-2842252), Chambersburg Health Services (25-1515376), Good Samaritan Hospital (23-1794160), Waynesboro Hospital (23-1360854), Summit Physician Services (25-1716306), Gettysburg Hospital (23-1352220), WellSpan Specialty Services (23-2899911) and Ephrata Community Hospital (23-1370484). In order to remain consistent with the reporting on Form 8038, all outstanding liabilities associated with this tax-exempt bond issue is reported on the WellSpan Health (22-2517863) Schedule K. As of 6/30/20, the allocation of the Debt Capital program was as follows: York Hospital $115,696,732, Waynesboro Hospital $461,652, Chambersburg Hospital $110,576,835, Chambersburg Health Services $18,680,280, Summit Physician Services $972,536. WellSpan Properties $66,489,250, Gettysburg Hospital $10,539,595, Ephrata Community Hospital $3,425,157, Good Samaritan Hospital $42,216, and WellSpan Specialty Services $1,419,163. These amounts are reported on the respective balance sheets for each of these entities.$212,690,000 of Revenue bonds Series 2019C, 2019D and 2019E for WellSpan Health Obligated Group were issued 4/3/2019 by General Authority of South Central Pennsylvania. The purpose of this bond issue was revenue refund for bonds issued 11/12/2008. WellSpan Health, the parent organization, allocated portions of the proceeds of this tax exempt bond issue to York Hospital (23-1352222), Gettysburg Hospital (23-1352220), WellSpan Properties (22-2842252), WellSpan Specialty Services (23-2899911), Good Samaritan Hospital (23-1794160) and WellSpan Health (22-2517863). In order to remain consistent with the reporting on Form 8038, all outstanding liabilities associated with this tax-exempt bond issue is reported on the WellSpan Health (22-2517863) Schedule K. As of 6/30/20, the allocation of the Debt Capital program was as follows: York Hospital $123,530,352, Gettysburg Hospital $19,290,983, WellSpan Properties $22,545,140, WellSpan Specialty Services $35,731,920, Good Samaritan Hospital $1,722,789, and WellSpan Health $9,868,816. These amounts are reported on the respective balance sheets for each of these entities.On April 30, 2014, $35,795,000 of Healthcare Revenue Bonds Series 2014A & 2014C were issued by Franklin County Industrial Authority. In order to remain consistent with the reporting on Form 8038, all outstanding liabilities associated with this tax-exempt bond issue is reported on the WellSpan Health (22-2517863) Schedule K. As of 6/30/20, the allocation of the Debt Capital program was as follows: Waynesboro Hospital (23-1360854) $6,771,865, Chambersburg Hospital (23-0465970) $19,824,238, and Chambersburg Health Services (25-1515376) $513,108. These amounts are reported on the respective balance sheets for each of these entities.
Signature Line - Paid Preparer Explanation	Paid Preparer ExplanationDue to a software limitation, we wish to clarify that WellSpan Health is the ERO.The paid preparer is:BDO USA, LLP13-53815908401 Greensboro Drive, Suite 800McLean, VA 22102(703) 893-0600

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

Software ID:	19009920
Software Version:	2019v5.0

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

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

Attach to Form 990.
MediumBullet

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

WAYNESBORO HOSPITAL

Employer identification number

23-1360854

Part I

Identification of Disregarded Entities. Complete if the organization answered "Yes" on Form 990, Part IV, line 33.

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)Apple Hill Surgical Center Inc PO Box 2767 York,PA174052767 22-2842253	Sole GP in limited ptnrshp operating sur	PA	501(c)(3)	10	Wellspan Health Care Services		No
(2)Gettysburg Hospital PO Box 2767 York,PA174052767 23-1352220	Health Care Services	PA	501(c)(3)	3	Wellspan Health		No
(3)Gettysburg Hospital Foundation PO Box 2767 York,PA174052767 23-2251358	Fundraising for Gettysburg Hospital	PA	501(c)(3)	12 Type II	Gettysburg Hospital		No
(4)Healthy Community Pharmacy Inc PO Box 2767 York,PA174052767 20-0519121	Reduced rate prescription drugs	PA	501(c)(3)	12 Type I	Wellspan Health Care Services		No
(5)VNA Community Services PO Box 2767 York,PA174052767 23-2338591	Home personal care services for elderly	PA	501(c)(3)	10	Wellspan Specialty Services		No
(6)VNA Home Health Services PO Box 2767 York,PA174052767 23-1352573	Home health services	PA	501(c)(3)	10	Wellspan Specialty Services		No
(7)Wellspan Health PO Box 2767 York,PA174052767 22-2517863	Integrated Health System	PA	501(c)(3)	12 Type III	NA		No
(8)Wellspan Health Care Services PO Box 2767 York,PA174052767 23-2400237	Health-related activities in the service	PA	501(c)(3)	12 Type II	Wellspan Health		No
(9)Wellspan Medical Group PO Box 2767 York,PA174052767 23-2730785	Meidcal and surgical care	PA	501(c)(3)	10	Wellspan Health		No
(10)York Health Foundation PO Box 2767 York,PA174052767 23-3050192	CHaritable contributions for Wellspan	PA	501(c)(3)	12 Type III	Wellspan Health		No
(11)York Hospital PO Box 2767 York,PA174052767 23-1352222	Community teaching hospital	PA	501(c)(3)	3	Wellspan Health		No
(12)Wellspan Speciality Services PO Box 2767 York,PA174052767 23-2899911	Surgery and Rehabilitation Hospital	PA	501(c)(3)	3	Wellspan Health		No
(13)Wellspan Properties PO Box 2767 York,PA174052767 22-2842252	Leases facilities to affliates	PA	501(c)(3)	12 Type II	Wellspan Health Care Services		No
(14)Ephrata Community Hospital PO Box 2767 York,PA174052767 23-1370484	Health Care Services	PA	501(c)(3)	3	Wellspan Health		No
(15)Northern Lancaster County Medical Group PO Box 2767 York,PA174052767 20-3033058	Medical and surgical care	PA	501(c)(3)	12 Type II	Ephrata Community Hospital		No
(16)Phys Spec of North Lanc Co Med Gr PO Box 2767 York,PA174052767 45-2537633	Physician Practices	PA	501(c)(3)	12 Type II	Northern Lancaster County Medical Group		No
(17)Good Samaritan Hospital PO Box 2767 York,PA174052767 23-0794160	Health Care Services	PA	501(c)(3)	3	Wellspan Health		No
(18)Philhaven PO Box 2767 York,PA174052767 23-1549922	Health Care Services	PA	501(c)(3)	3	Wellspan Health		No
(19)Good Samaritan Health Service Foundation PO Box 2767 York,PA174052767 23-2356151	Fundraising	PA	501(c)(3)	12 Type I	Good Samaritan Hospital		No
(20)Good Samaritan Physician Services PO Box 2767 York,PA174052767 25-1832359	Medical and Surgical Care	PA	501(c)(3)	10	Good Sam Health Service Foundation		No
(21)Wellspan Summit Health PO Box 2767 York,PA174052767 25-1515371	Integrated Health System	PA	501(c)(3)	7	Wellspan Health		No
(22)Wellspan Summit Foundation PO Box 2767 York,PA174052767 83-1196554	Fundraising for health care system	PA	501(c)(3)	12 Type II	Wellspan Summit Health		No
(23)Chambersburg Hospital PO Box 2767 York,PA174052767 23-0465970	Health Care Services	PA	501(c)(3)	3	Wellspan Summit Health		No
(24)Summit Physician Services PO Box 2767 York,PA174052767 25-1716306	Medical and surgical care	PA	501(c)(3)	3	Wellspan Summit Health		No
(25)Chambersburg Health Services PO Box 2767 York,PA174052767 25-1515376	Health care services	PA	501(c)(3)	12 Type I	Wellspan Summit Health		No

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

Cat. No. 50135Y

Schedule R (Form 990) 2019

Page 2

Part III

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) Apple Hill Surgical Center Partners PO Box 2767 York,PA174052767 23-2489452	Surgical Center	PA	NA				No			No
(2) Central PA Alliance Laboratories LLC PO Box 2767 York,PA174052767 23-2910950	Ref. Lab	PA	NA				No			No
(3) Littlestown Health Care Partners 300 West King Street Littlestown,PA17340 23-2880464	Lease facility	PA	NA				No			No
(4) Cherry Tree Cancer Center LLP PO Box 2767 York,PA174052767 23-2915628	Radiation	PA	NA				No			No
(5) The Rehab Center 855 Springdale Drive Suite 20 Exton,PA19341 25-1687903	Physical Therapy Rehab	PA	NA				No			No
(6) Surgery Center Associates 785 5th Avenue Chambersburg,PA17201 25-1845304	Physician services	PA	Chambersburg Health				No			No
(7) Summit Surgery Center 785 5th Avenue Chambersburg,PA17201 25-1845303	Physician Services	PA	Chamberburg Health				No			No
(8) Cumberland Valley Mobile Services LLC 5 South Main Street Sugarloaf,PA18249 20-0884014	Mobile medical services	PA	Chambersburg Health				No			No

Part IV

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	Yes	No
(1) Wellspan Pharmacy Inc PO Box 2767 York,PA174052767 23-2374072	Dispense Rx's & prov	PA	NA	C corp				No
(2) WellSpan Reciprocal Risk Retention Group Po Box 2767 York,PA174052767 20-0048457	Risk Retention Group	PA	NA	C corp				No
(3) York Health Plan PO Box 2767 York,PA174052767 23-2664989	Preferred Provider	PA	NA	C corp				No
(4) Wellspan Provider Network PO Box 2767 York,PA174052767 23-2907828	Coordinated managed	PA	NA	C corp				No
(5) Apple Hill Condominium Association PO Box 2767 York,PA174052767 23-2504543	Condo Mgmt Association	PA	NA	Homeowners				No
(6) North Lanc Co Phys Hosp All PO Box 2767 York,PA174052767 23-2421885	Coord Phys & Hospital	PA	NA	C corp				No
(7) GSH Realty Inc PO Box 2767 York,PA174052767 25-1832359	Non-res rentals	PA	NA	C corp				No
(8) Ephrata Health Pavilion Condo Assoc PO Box 2767 York,PA174052767 47-5367279	Condo association	PA	Ephrata Hospital	C corp				No

Schedule R (Form 990) 2019

Page 3

Part V

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

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

Yes

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

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

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

Yes

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

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

Yes

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

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

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

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

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

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

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

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

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

Yes

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

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

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

Yes

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

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

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

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

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

Schedule R (Form 990) 2019

Page 4

Part VI

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

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

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

Schedule R (Form 990) 2019

Page 5

Part VII

Supplemental Information

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

Return Reference	Explanation

Schedule R (Form 990) 2019

Additional Data

Software ID:	19009920
Software Version:	2019v5.0

1	Briefly describe the organization’s mission or most significant activities: The Waynesboro Hospital is a regional nonprofit health care organization committed to the improvement of the health and well-being of the people in south-central Pennsylvania.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	15
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	11
5	Total number of individuals employed in calendar year 2019 (Part V, line 2a) ......	5	640
6	Total number of volunteers (estimate if necessary) .............	6	120
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	109,967
b	Net unrelated business taxable income from Form 990-T, line 39 .........	7b	-1,990

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	203,503	6,350,729
9	Program service revenue (Part VIII, line 2g) .........	83,099,067	63,463,108
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	6,278,639	1,467,893
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	471,339	383,347
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	90,052,548	71,665,077
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	65,000	30,284,637
14	Benefits paid to or for members (Part IX, column (A), line 4).....		0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	39,218,821	38,356,248
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....		0
b	Total fundraising expenses (Part IX, column (D), line 25) 11,848
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	33,981,375	25,289,905
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	73,265,196	93,930,790
19	Revenue less expenses. Subtract line 18 from line 12.......	16,787,352	-22,265,713
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	151,619,617	135,116,336
21	Total liabilities (Part X, line 26).............	27,916,683	33,608,600
22	Net assets or fund balances. Subtract line 21 from line 20.....	123,702,934	101,507,736

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 78,587,612 including grants of $ 30,284,637 ) (Revenue $ 63,477,009 )
	Waynesboro Hospital provides needed medical care to the community regardless of any patient's ability to pay. Health care services include inpatient routine, inpatient ancillary and outpatient care. See WellSpan Health - 2020 Community Benefit Report located at https://www.wellspan.org/about/wellspan-in-the-community/

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












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












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses78,587,612

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)		(D) Reportable compensation from the organization (W-2/1099-MISC)	(E) Reportable compensation from related organizations (W-2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and title
(18) R William Happel........................................................................ Vice Chairman	1.00 .......................0.00	X	X	0	0	0
(19) Rodger Savage........................................................................ Secretary	1.00 .......................0.00	X	X	0	0	0
(20) J Edward Beck........................................................................ Director	1.00 .......................0.00	X		0	0	0
(21) Demaree Deardorff........................................................................ Dir end 12/19	1.00 .......................0.00	X		0	0	0
(22) Philip Fague........................................................................ Director	1.00 .......................0.00	X		0	0	0
(23) Steve Holoviak........................................................................ Dir begin 01/20	1.00 .......................0.00	X		0	0	0
(24) Paul Luka........................................................................ Dir beg. 01/20	1.00 .......................0.00	X		0	0	0
(25) Richard Marks........................................................................ Director	1.00 .......................0.00	X		0	0	0
(26) Cheryl Plummer........................................................................ Director	1.00 .......................0.00	X		0	0	0
(27) Paul Schemel........................................................................ Director	1.00 .......................0.00	X		0	0	0
(28) Joseph Thornton........................................................................ Director	1.00 .......................0.00	X		0	0	0

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	1,653,495	7,412,110	2,940,058

(A) Name and business address	(B) Description of services	(C) Compensation
Mercy Health System PO Box 505125 St Louis,MO631505125	Safewatch Teleicu Fees	291,353
Quest Diagnostics PO Box 912512 Pasadena,CA911102512	Lab Services	263,699



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 2

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d
e	Government grants (contributions)		1e	6,114,705

f	All other contributions, gifts, grants, and similar amounts not included above		1f	236,024

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

h Total. Add lines 1a-1f.......		6,350,729

		Business Code
2a	Net Patient Services	621500	72,872,257	72,762,290	109,967
b	W/O Bad Debts	621500	-7,546,627	-7,546,627
c	W/O Free Service	621500	-1,862,522	-1,862,522
d
e
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		63,463,108

3 Investment income (including dividends, interest, and othersimilar amounts) ......			1,188,520			1,188,520
4 Income from investment of tax-exempt bond proceeds			0
5 Royalties...........			0
		(ii) Personal	(i) Real
6a	Gross rents		1,384,483	6a
b	Less: rental expenses		1,257,032	6b
c	Rental income or (loss)		127,451	6c
d	Net rental income or (loss).......			127,451			127,451
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	20,844	9,597,983	7a
b	Less: cost or other basis and sales expenses		9,339,454	7b
c	Gain or (loss)	20,844	258,529	7c
d	Net gain or (loss).........			279,373			279,373
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a
b	Less: direct expenses ...		8b
c	Net income or (loss) from fundraising events..			0
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a
b	Less: direct expenses ...		9b
c	Net income or (loss) from gaming activities..			0
10a	Gross sales of inventory, less returns and allowances ..
			10a
b	Less: cost of goods sold ..		10b
c	Net income or (loss) from sales of inventory..			0
Business Code			Miscellaneous Revenue
11a	Cafeteria Sales		722514	223,350			223,350
b	Medical Abstracts		541700	13,351	13,351
c	Physician Billing		561000	15,780			15,780
d	All other revenue ....			3,415	550		2,865
e	Total. Add lines 11a–11d ......			255,896
12	Total revenue. See instructions.....			71,665,077	63,367,042	109,967	1,837,339

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	30,284,637	30,284,637
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 ...........	759,139		759,139
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........	28,709,211	20,501,817	8,207,394
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	1,237,560	1,055,424	182,136
9	Other employee benefits .......	5,350,627	3,722,556	1,628,071
10	Payroll taxes ...........	2,299,711	1,778,166	521,545
11	Fees for services (non-employees):
a	Management ......	118,578		118,578
b	Legal .........	0
c	Accounting ...........	0
d	Lobbying ...........	0
e	Professional fundraising services. See Part IV, line 17	0
f	Investment management fees ......	43,928		43,928
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	4,880,640	4,407,959	460,833	11,848
12	Advertising and promotion ....	287,759		287,759
13	Office expenses .......	249,668	56,367	193,301
14	Information technology ......	36,426	36,426
15	Royalties ..	0
16	Occupancy ...........	218,019	210,411	7,608
17	Travel ............	30,132	14,123	16,009
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .	0
19	Conferences, conventions, and meetings ....	31,678	28,184	3,494
20	Interest ...........	5,995	5,995
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization ..	3,889,102	3,889,102
23	Insurance ...	786,842	786,842
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	Outside Services	6,013,039	4,434,723	1,578,316
b	Direct Supplies	4,643,813	4,517,416	126,397
c	Repair & Maintenance	1,797,235	724,825	1,072,410
d	Taxes & Licenses	1,412,748	1,375,184	37,564
e	All other expenses	844,303	757,455	86,848
25	Total functional expenses. Add lines 1 through 24e	93,930,790	78,587,612	15,331,330	11,848
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 ........			429	1	1,125
2	Savings and temporary cash investments .........			15,522,610	2	10,446,998
3	Pledges and grants receivable, net ......			17,035	3	4,045
4	Accounts receivable, net .............			5,153,116	4	4,358,822
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 .......
					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) ...
					6	0
7	Notes and loans receivable, net ...........			113,003	7	2,225
8	Inventories for sale or use ............			467,937	8	478,939
9	Prepaid expenses and deferred charges ......			787,375	9	767,961
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	94,591,196
b	Less: accumulated depreciation	10b	57,857,387	38,931,547	10c	36,733,809
11	Investments—publicly traded securities .			86,779,743	11	22,252,335
12	Investments—other securities. See Part IV, line 11 .....			9	12	54,427,149
13	Investments—program-related. See Part IV, line 11 ..				13	0
14	Intangible assets ...............			108,223	14	93,247
15	Other assets. See Part IV, line 11 ...........			3,738,590	15	5,549,681
16	Total assets. Add lines 1 through 15 (must equal line 33)...			151,619,617	16	135,116,336

17	Accounts payable and accrued expenses .....	8,764,129	17	4,751,588
18	Grants payable ...		18
19	Deferred revenue .........		19
20	Tax-exempt bond liabilities .........	7,143,140	20	7,233,517
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
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 .........
			22
23	Secured mortgages and notes payable to unrelated third parties ..	5,356,244	23	6,253,792
24	Unsecured notes and loans payable to unrelated third parties ..		24
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	6,653,170	25	15,369,703
26	Total liabilities. Add lines 17 through 25..	27,916,683	26	33,608,600

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	120,343,034	27	101,485,121
28	Net assets with donor restrictions ...........	3,359,900	28	22,615
	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 ...........	123,702,934	32	101,507,736
33	Total liabilities and net assets/fund balances ........	151,619,617	33	135,116,336