TY 2023 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/1099-NEC)
(1) FRANK BORELLI...................................................................... TREASURER END; TRUSTEE BEG 10/23	0.8 ................. 0.8	X	X	0	0
(2) HUGH RECHNER...................................................................... CHAIRMAN	0.8 ................. 1.0	X	X	0	0
(3) JOANN HUDAK...................................................................... 1ST VICE CHAIR	0.8 ................. 0.8	X	X	0	0
(4) KATE BRYANT...................................................................... TREASURER BEG 10/23	0.8 ................. 0.8	X	X	0	0
(5) MARY BETH WOOD...................................................................... VICE CHAIR BEG 10/23	0.8 ................. 0.8	X	X	0	0
(6) MARY BURNS HOFF...................................................................... SECRETARY	0.8 ................. 0.8	X	X	0	0
(7) WENDELL HUNT...................................................................... 2ND VICE CHAIR END 12/23	0.8 ................. 0.8	X	X	0	0
(8) BRAD KIESENDAHL...................................................................... TRUSTEE	0.8 ................. 0.8	X		0	0
(9) CHRISTINE RECHNER...................................................................... TRUSTEE	0.8 ................. 2.4	X		0	0
(10) DIANE POPOVICH...................................................................... TRUSTEE	0.8 ................. 0.8	X		0	0
(11) DR JASON ZIELINSKI...................................................................... TRUSTEE/PRES MED STAFF	0.8 ................. 0.8	X		0	0
(12) DR SEAN MCVEIGH...................................................................... TRUSTEE/CHIEF OF MEDICAL STAFF	39.2 ................. 0.8	X		544,740	24,063
(13) DR SYBIL RICKARD...................................................................... TRUSTEE/VICE PRESIDENT OF MEDICAL STAFF	39.2 ................. 0.8	X		300,287	24,768
(14) KEITH GUNUSKEY...................................................................... TRUSTEE	0.8 ................. 0.8	X		0	0
(15) NANCY MORO...................................................................... TRUSTEE END 09/23	0.8 ................. 1.0	X		0	0
(16) NANCY PROPST...................................................................... TRUSTEE	0.8 ................. 1.3	X		0	0
(17) PAUL KARPIAK...................................................................... TRUSTEE	0.8 ................. 0.8	X		0	0

(A) Name and business address	(B) Description of services	(C) Compensation
ADVANCED INPATIENT MEDICINE ADINFINITIS 7250 PARKWAY DRIVE SUITE 500 HANOVER,MD21076	HOSPITALISTS	3,495,649
CARDIOSOLUTION PHYSICIANS CA PC 4675 CORNELL RD SUITE 100 CINCINATTI,OH45241	PHYSICIANS	2,987,687
DIANON SYSTEMS LABORATORY CORP OF AMERICA 1 FOREST PARKWAY SHELTON,CT06484	LABORATORY SERVICES	2,182,675
DR JOSEPH CENTA 1711 SEMINARY ROAD MILAN,OH44846	SURGEON	1,952,046
FOUNDATION RADIOLOGY PC 6400 BROOKTREE COURT WEXFORD,PA15090	RADIOLOGY	1,092,364
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 9

- TIN:

SCHEDULE A
(Form 990)

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

2023

Open to Public
Inspection

Name of the organization

WAYNE MEMORIAL HOSPITAL

Employer identification number

24-0798839

Part I

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

The organization is not a private foundation because it is: (For lines 1 through 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).)

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 33 1/3% 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 33 1/3% 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 on 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) 2023

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) 2019	(b) 2020	(c) 2021	(d) 2022	(e) 2023	(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) 2019	(b) 2020	(c) 2021	(d) 2022	(e) 2023	(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 5 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 2023 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2022 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2023. 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—2022. 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—2023. 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—2022. 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) 2023

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) 2019	(b) 2020	(c) 2021	(d) 2022	(e) 2023	(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) 2019	(b) 2020	(c) 2021	(d) 2022	(e) 2023	(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 on 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 5 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 2023 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2022 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2023 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2022 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests-2023. 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—2022. 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) 2023

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked box 12a, of Part I, complete Sections A and B. If you checked box 12b, of Part I, complete Sections A and C. If you checked box 12c, of Part I, complete Sections A, D, and E. If you checked box12d, 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 lines 3b and 3c 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 box 12a or 12b in Part I, answer lines 4b and 4c 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 lines 5b and 5c 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) .

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

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

Did one or more disqualified persons (as defined on 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 on 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) 2023

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 on lines 11b and 11c below, the governing body of a supported organization?

11a

A family member of a person described on 11a above?

11b

A 35% controlled entity of a person described on line 11a or 11b above? If “Yes” to 11a, 11b, or 11c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the officers, 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 line 2 above, 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 lines 2a and 2b 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 on line 2a, above 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 lines 3a and 3b 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?If "Yes" or "No", 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) 2023

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 0.015 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 0.035	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) 2023

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	1
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity	2
3 Administrative expenses paid to accomplish exempt purposes of supported organizations	3
4 Amounts paid to acquire exempt-use assets	4
5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI)	5
6 Other distributions (describe in Part VI). See instructions	6
7Total annual distributions. Add lines 1 through 6.	7
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions	8
9 Distributable amount for 2023 from Section C, line 6	9
10 Line 8 amount divided by Line 9 amount	10

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2023	(iii) Distributable Amount for 2023
1 Distributable amount for 2023 from Section C, line 6
2 Underdistributions, if any, for years prior to 2023 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2023:
a From 2018.......
b From 2019.......
c From 2020.......
d From 2021.......
e From 2022.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2023 distributable amount
i Carryover from 2018 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from line 3f.
4Distributions for 2023 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2023 distributable amount
c Remainder. Subtract lines 4a and 4b from line 4.
5 Remaining underdistributions for years prior to 2023, 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 2023. 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 2024. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2019.....
b Excess from 2020.....
c Excess from 2021.....
d Excess from 2022.....
e Excess from 2023.....

Schedule A (Form 990) (2023)

Schedule A (Form 990) 2023

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) 2023

Additional Data

Software ID:	23017437
Software Version:	2023v6.0

- TIN:

Schedule B
(Form 990)

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

2023

Name of the organization

WAYNE MEMORIAL HOSPITAL

Employer identification number

24-0798839

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

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

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

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

501(c)(3) taxable private foundation

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

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or 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) (2023)

Schedule B (Form 990) (2023) Page 2

Name of organization WAYNE MEMORIAL 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) (2023)

Schedule B (Form 990) (2023)

Page 3

Name of organization WAYNE MEMORIAL HOSPITAL		Employer identification number 24-0798839

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) (2023)

Schedule B (Form 990) (2023)

Page 4


Name of organization WAYNE MEMORIAL HOSPITAL			Employer identification number 24-0798839
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) $ 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) (2023)

Additional Data

Software ID:	23017437
Software Version:	2023v6.0

- TIN:

SCHEDULE C
(Form 990)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527

right arrow

Complete if the organization is described below. 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

2022

Open to Public
Inspection

If the organization answered "Yes" on Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" on Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet

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

Name of the organization

WAYNE MEMORIAL HOSPITAL

Employer identification number

24-0798839

Part I-A

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

Provide a description of the organization’s direct and indirect political campaign activities in Part IV. See instructions for definition of “political campaign activities."

Political campaign activity expenditures. See instructions .................................................................... right arrow

Volunteer hours for political campaign activities. See instructions ..................................................................

Part I-B

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

Enter the amount of any excise tax incurred by the organization under section 4955 ................................ right arrow

Enter the amount of any excise tax incurred by organization managers under section 4955 ....................... right arrow

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

Yes No

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

Yes No

If "Yes," describe in Part IV.

Part I-C

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

Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... right arrow

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

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

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

Yes No

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

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.
1
2
3
4
5
6

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

Cat. No. 50084S

Schedule C (Form 990) 2022

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check right arrow

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check right arrow

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......................
b	Total lobbying expenditures to influence a legislative body (direct lobbying) ........................
c	Total lobbying expenditures (add lines 1a and 1b) ............................................................
d	Other exempt purpose expenditures ...............................................................................
e	Total exempt purpose expenditures (add lines 1c and 1d) ..................................................
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) .................................................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................................................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................................................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ...................................................................................................................	Yes No

4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2019	(b) 2020	(c) 2021	(d) 2022	(e) Total

2a	Lobbying nontaxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990) 2022

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each "Yes" response on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes|No

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? ...........................................................................................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........

Media advertisements? ...................................................................................................

Mailings to members, legislators, or the public? .............................................................................

Publications, or published or broadcast statements? ...........................................................

Grants to other organizations for lobbying purposes? ..........................................................

Direct contact with legislators, their staffs, government officials, or a legislative body? .......................

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

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

Yes

14,710

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

14,710

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 ...........................................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? ........................

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ...............................................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................

Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."

Dues, assessments and similar amounts from members ......................................................................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).

Current year .............................................................................................................................

Carryover from last year ............................................................................................................

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

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ......................................................................................................................

Taxable amount of lobbying and political expenditures. See Instructions .........................................

Part IV

Supplemental Information

Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY	WAYNE MEMORIAL HOSPITAL PAYS ANNUAL MEMBERSHIP DUES TO THE HOSPITAL & HEALTH SYSTEM ASSOCIATION OF PENNSYLVANIA (HAP) AND AMERICAN HOSPITAL ASSOCIATION (AHA). THE HOSPITAL IS NOTIFIED EACH YEAR THAT A PORTION OF THE MEMBERSHIP DUES IS USED FOR LOBBYING ACTIVITIES. THE PORTION OF FEES PAID REPRESENTING LOBBYING EXPENDITURES WAS $14,710.

Schedule C (Form 990) 2022

Additional Data

Software ID:	23017437
Software Version:	2023v6.0

- 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.
right arrow

Attach to Form 990.
right arrow

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

OMB No. 1545-0047

2022

Open to Public Inspection

Name of the organization

WAYNE MEMORIAL HOSPITAL

Employer identification number

24-0798839

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" 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 July 25, 2006, 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 right arrow

Number of states where property subject to conservation easement is located right arrow

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
right arrow

Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
right arrow

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 ......................... right arrow

(ii)

Assets included in Form 990, Part X ............................... right arrow

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 .......................... right arrow

Assets included in Form 990, Part X ............................... right arrow

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

Cat. No. 52283D

Schedule D (Form 990) 2022

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 ....
b	Contributions ...
c	Net investment earnings, gains, and losses
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...
f	Administrative expenses ....
g	End of year balance ......

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

Board designated or quasi-endowment right arrow

Permanent endowment right arrow

Term endowment right arrow

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 .....	2,892,690		2,892,690
b	Buildings ....	59,289,008	36,404,644	22,884,364
c	Leasehold improvements	3,028,049	2,145,407	882,642
d	Equipment ....	85,354,880	63,250,247	22,104,633
e	Other .....	4,348,999	1,645,675	2,703,324
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				51,467,653

Schedule D (Form 990) 2022

Page 3

Part VII

Investments - Other 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
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

Investments - Program Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment	(b) Book value	(c) Method of valuation: Cost or end-of-year market value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
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
(1)OTHER RECEIVABLES				10,185,752
(2)EST AMOUNT FROM 3RD PARTY				3,920,580
(3)RIGHT OF USE ASSETS				3,483,485
(4)DUE FROM AFFILIATE				2,596,400
(5)BENEFICIAL INT IN PRPTL TRUSTS				2,330,102
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				22,516,319

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
PROFESSIONAL LIABILITY CLAIMS	7,439,226
DUE TO THIRD PARTIES	6,624,316
LEASE LIABILITY	4,111,332






Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	18,174,874
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) 2022

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	120,249,876
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a	3,569,643
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ...........	2d	1,249,003
e	Add lines 2a through 2d .....................			2e	4,818,646
3	Subtract line 2e from line 1..................			3	115,431,230
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	396,052
b	Other (Describe in Part XIII.) ...........	4b	451,375
c	Add lines 4a and 4b....................			4c	847,427
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......			5	116,278,657

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	119,644,192
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	315,092
e	Add lines 2a through 2d....................			2e	315,092
3	Subtract line 2e from line 1...................			3	119,329,100
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	396,052
b	Other (Describe in Part XIII.) ...........	4b	-534,241
c	Add lines 4a and 4b.....................			4c	-138,189
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......			5	119,190,911

Part XIII

Supplemental Information

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

Return Reference	Explanation
Schedule D, Part X, Line 2 UNCERTAIN TAX POSITIONS	MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS.
Schedule D, Part XI, Line 2(d) Other revenues in audited financial statements not in form 990	NET ASSETS RELEASED FROM RESTRICTION - 714762 PENSION EXPENSE - 534241
Schedule D, Part XI, Line 4(b) Other revenues in form 990 not in audited financial statements	TEMPORARILY RESTRICTED GRANT REVENUE - 766467 RENTAL EXPENSES - -315092
Schedule D, Part XII, Line 2(d) Other expenses in audited financial statements not in form 990	RENTAL EXPENSES - 315092
Schedule D, Part XII, Line 4(b) Other expenses in form 990 not in audited financial statements	PENSION EXPENSE - -534241

Schedule D (Form 990) 2022

Additional Data

Software ID:	23017437
Software Version:	2023v6.0

- 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 20a.
Medium right arrow

Attach to Form 990.
Medium right arrow

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

OMB No. 1545-0047

2023

Open to Public Inspection

Name of the organization

WAYNE MEMORIAL HOSPITAL

Employer identification number

24-0798839

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

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

Yes

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

Yes

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

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

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

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

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

Yes

100% 150% 200% Other %

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

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

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

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

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

Yes

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

Yes

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

Yes

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

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

Yes

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

Yes

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

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(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) . . .		384	166,959		166,959	0.14 %
b	Medicaid (from Worksheet 3, column a) . . . . .			17,303,386	12,935,876	4,367,510	3.66 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .					0	0 %
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	0	384	17,470,345	12,935,876	4,534,469	3.80 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	21	6,987	318,630		318,630	0.27 %
f	Health professions education (from Worksheet 5) . . .	1	1	4,185		4,185	0 %
g	Subsidized health services (from Worksheet 6) . . . .					0	0 %
h	Research (from Worksheet 7) .					0	0 %
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	1		1,350		1,350	0 %
j	Total. Other Benefits . .	23	6,988	324,165	0	324,165	0.27 %
k	Total. Add lines 7d and 7j .	23	7,372	17,794,510	12,935,876	4,858,634	4.08 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2023

Schedule H (Form 990) 2023

Page

Part II

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

		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing					0	0 %
2	Economic development					0	0 %
3	Community support	2		15,793		15,793	0.01 %
4	Environmental improvements					0	0 %
5	Leadership development and training for community members					0	0 %
6	Coalition building					0	0 %
7	Community health improvement advocacy					0	0 %
8	Workforce development	2	286	22,096		22,096	0.02 %
9	Other					0	0 %
10	Total	4	286	37,889	0	37,889	0.03 %

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. ......

13,497,637

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. ......

3,524,233

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).....

25,592,094

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

28,299,927

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

-2,707,833

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) 2023

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	WAYNE MEMORIAL HOSPITAL 601 PARK STREET HONESDALE,PA18431 WWW.WMH.ORG 230501	X	X	X

Schedule H (Form 990) 2023

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)

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

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

Yes

Community Health Needs Assessment

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

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

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12......................

Yes

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

A definition of the community served by the hospital facility

Demographics of the community

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

How data was obtained

The significant health needs of the community

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

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

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

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 21

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

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

Yes

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

Yes

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

Hospital facility’s website (list url): https://www.wmh.org/chna-community-health-needs-assessment/

Other website (list url):

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

Other (describe in Section C)

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

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 21

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

Yes

If "Yes" (list url): https://www.wmh.org/chna-community-health-needs-assessment/

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

10b

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

12a

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

12a

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

12b

If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2023

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

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

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

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

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 200.0%
and FPG family income limit for eligibility for discounted care of %

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):

https://www.wmh.org/financial-assistance/

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

https://www.wmh.org/financial-assistance/

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

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) 2023

Page 6

Part VFacility Information (continued)

Billing and Collections

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

Yes

Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon nonpayment?..................................

Yes

Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

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

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............

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

Reporting to credit agency(ies)

Selling an individual’s debt to another party

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

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

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

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

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

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

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..................

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Schedule H (Form 990) 2023

Page 7

Part VFacility Information (continued)

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

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

Yes

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

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

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

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

The hospital facility used a prospective Medicare or Medicaid method

During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ...............................

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2023

Page 8

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
Schedule H, Part V, Section B, Line 3E	The emergence of COVID-19 has dramatically impacted all facets of life, including the community's health. Though data collection for this CHNA corresponded to a period of eased pandemic restrictions, widespread vaccine availability, and lower disease transmission in the community, evidence of the pandemic's presence remains. Mental Health Services: Clear community concern for mental health was conveyed in every phase of CHNA completion. Our local counties have fewer mental healthcare providers per population size than does the state, on average. Combined with increasing need for treatment among both youth and adult populations, mental health is a significant challenge across our community. Substance Abuse: Overdose deaths and alcohol use have risen across the United States during the pandemic; opioid misuse was already of particular concern throughout rural Pennsylvania pre-pandemic. Local data reflects national and state trends and brings additional medical concerns to the healthcare and social services systems. Improved Access to Care: Despite suboptimal population-to-provider ratios which limit access, most who do receive primary care are satisfied with that care. Improved access to specialty services remains concern for community members. Pike County has no emergency care within its boundaries and ambulance service is limited there and across the region. Public transportation is also lacking. These factors combine to limit timely access to care for some in our rural community, particularly when facing health emergencies. Older Adult Services: WMH's service area is older, on average, than the balance of Pennsylvania. Beyond the expected medical care for older adults, our region is challenged by a higher-than-expected Alzheimer's rate, even after accounting for age. Elevated average age can also increase the chronic disease burden and demand for nursing home care, which is limited locally. Not surprisingly, requests for caregiver support groups as well as engagement opportunities for older adults themselves were among the survey results. Cancer & Heart Disease: Deaths prior to age 75 are considered premature deaths. Although our region reflects the statewide average for years of potential life lost due to premature death, efforts to further reduce mortality associated with cancer and heart disease have the potential to positively impact many in the WMH community. Local counties retain modifiable community and behavioral risk factors that can be addressed to improve health outcomes.
Schedule H, Part V, Section B, Line 5 Facility , 1	Facility , 1 - WAYNE MEMORIAL HOSPITAL. THE 2022 CHNA WAS CONDUCTED IN ASSOCIATION WITH THE INSTITUTE FOR PUBLIC HEALTH RESEARCH AND INNOVATION AT EAST STROUDSBURG UNIVERSITY. THE METHODOLOGY INVOLVED BOTH QUANTITATIVE AND QUALITY ASSESSMENTS. DATA WAS COLLECTED FROM THE PENNSYLVANIA DEPARTMENT OF HEALTH, THE 2022 COUNTY HEALTH RANKINGS AND ROADMAPS, THE CENTER FOR RURAL PENNSYLVANIA, THE U.S. CENSUS, WAYNE AND PIKE COUNTY STATISTICS AND OTHER PUBLIC SOURCES TO IDENTIFY POPULATION GROUPS, DISEASE TRENDS, MORTALITY RATES AND CAUSES, AND VACCINATION UPTAKE IN THE COMMUNITIES SERVED BY WAYNE MEMORIAL HOSPITAL. THIS INFORMATION WAS AUGMENTED WITH AN ONLINE PUBLIC SURVEY (526 RESPONDENTS), INTERVIEWS WITH COMMUNITY STAKEHOLDERS AND FOCUS GROUPS TO FORM A MORE VIBRANT, COHESIVE PICTURE OF THE COMMUNITY AS A WHOLE TO ASSESS ITS NEEDS ACCORDINGLY AND DETERMINE HOW TO STRATEGIZE MEETING THOSE NEEDS.
Schedule H, Part V, Section B, Line 6b Facility , 1	Facility , 1 - WAYNE MEMORIAL HOSPITAL. THE CNHA PROCESS WAS GUIDED BY A LOCAL STEERING COMMITTEE CONSISTING OF REPRESENTATIVES FROM WAYNE MEMORIAL HOSPITAL, WAYNE MEMORIAL COMMUNITY HEALTH CENTERS, WAYNE AND PIKE COUNTY GOVERNMENTS INCLUDING LOCAL DEPARTMENT OF HEALTH REPRESENTATIVES, WAYNE AND PIKE COUNTY HUMAN SERVICE AGENCIES, FOREST CITY (SUSQUEHANNA COUNTY) AND CARBONDALE AREA (LACKAWANNA COUNTY) COMMUNITY REPRESENTATIVES, AND COMMUNITY REPRESENTATIVES AND OFFICIALS FROM AREA SCHOOL DISTRICTS.
Schedule H, Part V, Section B, Line 11 Facility , 1	Facility , 1 - WAYNE MEMORIAL HOSPITAL. ALTHOUGH WAYNE MEMORIAL HOSPITAL RECOGNIZES THE IMPORTANCE OF ALL THE NEEDS IDENTIFIED BY THE COMMUNITY, CERTAIN NEEDS ARE NOT WITHIN THE PURVIEW OF WMH AND ARE NOT ADDRESSED. THE IMPLEMENTATION STRATEGY DESCRIBES THE NEEDS BEING MET, AS WELL AS THE ORGANIZATION RESPONSIBLE TO ADDRESS THE IDENTIFIED NEEDS AND THE STATUS OF THE STRATEGY TO ADDRESS SUCH NEEDS.

Schedule H (Form 990) 2023

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?0
Name and address		Type of Facility (describe)
1
2
3
4
5
6
7
8
9
10

Schedule H (Form 990) 2023

Page 10

Part VI

Supplemental Information

Provide the following information.

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

Form and Line Reference	Explanation
Schedule H, Part V, Section B, Line 22 MAXIMUM AMOUNTS CHARGED TO FAP-ELIGIBLE INDIVIDUALS	A FINANCIAL ASSISTANCE ELIGIBLE INDIVIDUAL WILL NOT BE CHARGED MORE FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE THAN AGB. IF A PATIENT IS FAP ELIGIBLE, THEY WOULD RECEIVE A 100% DISCOUNT. THE HOSPITAL USES THE PROSPECTIVE MEDICARE METHOD FOR CALCULATING AGB.
Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance	THE COST TO CHARGE RATIO CALCULATED ON IRS WORKSHEET 2 WAS USED IN THE CALCULATION OF COST ON IRS WORKSHEETS 1 AND 3.
Schedule H, Part II Community Building Activities	WAYNE MEMORIAL HOSPITAL (WMH) AND ITS AFFILIATES PROMOTE THE HEALTH AND WELLBEING OF THE COMMUNITIES AND INDIVIDUALS IT SERVES THROUGH A VARIETY OF COMMUNITY BENEFIT AND COMMUNITY BUILDING ACTIVITIES. WE FOCUS ON THE UNDERSERVED AND UNDERPRIVILEGED WITHIN OUR SERVICE AREA. WE ENDEAVOR TO IMPROVE THE LITERACY LEVEL AND PRIORITIZE INFORMATION GIVEN ON PREVENTION AND TREATMENT FOR CHRONIC DISEASE. OUR GOAL IS TO IMPACT ROOT CAUSES OF POOR HEALTH BY BECOMING A CATALYST FOR HEALTHY LIFESTYLE CHANGES IN OUR SERVICE AREA. THE RATIONALE, PROGRAM METHODOLOGY AND IMPLEMENTATION FOR THE FOLLOWING PROGRAMS ARE TYPICAL OF THE OTHER PROGRAMS DESCRIBED BELOW AND SHOULD SERVE AS A MODEL FOR THOSE PROGRAMS IN ADDRESSING THE REQUIREMENTS OF THIS SECTION OF THE FORM. -THE IN-SCHOOL WALKING PROGRAM IS A PARTNERSHIP OF WAYNE MEMORIAL HOSPITAL, FOREST CITY REGIONAL AND THE FOLLOWING SCHOOL DISTRICTS WITHIN ITS SERVICE AREA: FOREST CITY, WALLENPAUPACK AREA, WAYNE HIGHLANDS AND WESTERN WAYNE. WMH PROVIDES LEADERSHIP, DIRECTION, TRACKING AND FACILITATION FOR THE PROGRAM IN NINE LOCAL SCHOOLS THAT RUNS MONDAY THROUGH THURSDAY 6PM TO 8PM, WHENEVER SCHOOLS ARE IN SESSION. THIS PROVIDES A SAFE FRIENDLY ENVIRONMENT FOR YOUNG, OLD OR DISABLED PEOPLE TO EXERCISE. ALL SITES ARE HANDICAPPED ACCESSIBLE. IT ALSO PROVIDES A USER-FRIENDLY MODALITY TO DISTRIBUTE EDUCATIONAL MATERIALS. -HEALTH PROBLEMS: SEDENTARY LIFESTYLE, POOR NUTRITION, AND POOR BEHAVIORAL HEALTH SKILLS HAVE BEEN IDENTIFIED AS LEADING RISK FACTORS BY THE CENTER FOR DISEASE CONTROL (CDC) AND THE PENNSYLVANIA DEPARTMENT OF HEALTH FOR OBESITY, HEART DISEASE, HYPERTENSION, AND A NUMBER OF OTHER CHRONIC DISEASES. - NEED/PROBLEM IDENTIFICATION: THE NEED WAS IDENTIFIED BY THE WMH COMMUNITY NEEDS ASSESSMENT OF 2019 WHICH IDENTIFIED THE PREVENTION OF CHRONIC DISEASE AS A REGIONAL PRIORITY. A PARTNERSHIP BETWEEN THE TOGETHER FOR HEALTH PROGRAM (TFH), WMH, THE WALLENPAUPACK, WAYNE HIGHLANDS, AND FOREST CITY SCHOOL DISTRICTS, AND COMMUNITY AGENCIES ADDRESSED THE NEEDS OF COMMUNITY MEMBERS AND YOUTH. ONE COMPONENT OF THE PROGRAM, THE RESOURCE DAY, HAS BECOME A CATALYST THAT ENHANCES THE HEALTH AND WELLNESS OF 7TH GRADERS AND 9TH GRADERS. A DAY FILLED WITH 5 SMALL GROUP INTERACTIVE WORKSHOPS FACILITATED BY PROFESSIONALS ON SUCH SUBJECTS AS NUTRITION, YOGA, RELATIONSHIPS, SUICIDE AWARENESS, DRUG AND ALCOHOL, GOAL SETTING, ETC. THE STUDENTS' PARTICIPATION AND THEIR FEEDBACK PROVIDES WMH, SCHOOL DISTRICTS, AND THE COMMUNITY WITH AN AWARENESS OF THE STUDENTS' NEEDS AND HOW TO POSITIVELY IMPACT THE STUDENTS. ULTIMATELY THE FEEDBACK PROVIDES DIRECTION FOR IN-SCHOOL COMMUNITY BENEFITS ACTIVITIES INCLUDING THE IN SCHOOL WALKING PROGRAM AND IN-SCHOOL EDUCATIONAL PRESENTATIONS BY WMH & LOCAL HEALTH CARE PROFESSIONALS. -IMPORTANCE OF HEALTH PROBLEM: LACK OF EXERCISE, POOR NUTRITION AND POOR BEHAVIORAL HEALTH SKILLS HAS MANIFOLD NEGATIVE EFFECTS ON INDIVIDUALS OF ALL AGES AND INCOME LEVELS WITHIN THE REGION'S HIGH RATE OF CHRONIC DISEASE INDIVIDUALS. RURAL, LOW INCOME, ELDERLY OR DISABLED INDIVIDUALS ARE PARTICULARLY VULNERABLE. THE IN-SCHOOL WALKING PROGRAM PROVIDES AN OPPORTUNITY TO LEARN, WALK AND SOCIALIZE WHILE BEING IN A SAFE ATMOSPHERE CLOSE TO THEIR HOME. THE IN-SCHOOL WALKING PROGRAM PROVIDES ACCESS OF SERVICES TO ABOUT 400 PEOPLE WITHIN SCHOOL HALLWAYS NOT IN USE BY THE SCHOOL DURING THOSE HOURS. -ACTIVITY IMPACT AND OUTCOMES: PARTICIPANT RESPONSES TO THE PROGRAM INDICATE THAT IT HELPS MOTIVATE THEM TO FEEL BETTER, LOSE WEIGHT, ENJOY FELLOWSHIP, INCREASE ENERGY LEVELS AND HOLD A BETTER SELF-IMAGE THAN PRIOR TO THEIR PARTICIPATION. THEY ALSO IMPROVED THEIR KNOWLEDGE BASE REGARDING AWARENESS AND PREVENTION OF MANY HEALTH ISSUES. (STROKE, HEART DISEASE, DIABETES, TRAUMA, ASTHMA, COPD, AND SLEEP APNEA, TO NAME A FEW). -COMMUNITY BENEFIT: ENHANCING PUBLIC HEALTH, ADVANCING THE QUALITY OF LIFE, AND RELIEF OF THE BURDEN OF SOCIETY OF CARING FOR THOSE WITH PREVENTABLE CHRONIC ILLNESS. INDIVIDUALS WHO HAVE SEDENTARY AND NEGATIVE LIFESTYLES ARE THE PRINCIPAL BENEFICIARIES OF THE PROGRAM. -SUPPORT: THE WMH COMMUNITY HEALTH DEPARTMENT HAS RESPONDED TO OPPORTUNITIES FOR INVOLVEMENT IN COMMUNITY BENEFIT INITIATIVES BY ENTHUSIASTICALLY DEDICATING THEIR TIME, EXPERTISE AND RESOURCES. THE PRIMARY SUPPORT OF THE IN-SCHOOL WALKING PROGRAM COMES FROM THE FOUR SCHOOL DISTRICTS AND WMH USE OF SOCIAL MEDIA, WEB PAGES, IN-KIND SERVICES, ETC. WMH PROVIDED OVERSITE TO MAINTAIN APPROPRIATE LITERACY LEVELS WITH THE EDUCATIONAL INFORMATION. THE 700+ MEMBERS OF PENNSYLVANIA STATE HEALTH IMPROVEMENT PLAN (SHIP) PARTNERSHIP FOR WAYNE AND PIKE COUNTIES SUPPORT THE WALKING PROGRAM THROUGH POSTING FLYERS, SOCIAL MEDIA, PRESENTATIONS AND PARTICIPATION. WMH IS THE LEAD AGENCY FOR THE PIKE/WAYNE SHIP PARTNERSHIP. THE PARTNERSHIP IDENTIFIES NEEDS AND BECOMES A CATALYST FOR CHANGE TO ACCOMPLISH A HEALTHIER COMMUNITY AND REDUCES THE BURDEN ON MANY GOVERNMENT ENTITIES. BOLD GOLD MEDIA, A LOCAL RADIO STATION, PROVIDES PUBLIC SERVICE ANNOUNCEMENTS AND WMH COMMUNITY HEALTH DEPARTMENT PROVIDES A PERIODIC RADIO BROADCAST, HEALTHWORKS, THAT AIRS ON LOCAL STATIONS. DURING FYE 6/30/2024, THE ABOVE METHODOLOGY COULD BE APPLIED TO ANY OF THE PROGRAMS PROVIDING SERVICES TO THOUSANDS OF RESIDENTS WITHIN THE LOCAL COMMUNITY. SOME OF THE OTHER PROGRAMS INCLUDE HEALTH/RESOURCE AIRS, SEMINARS & WORKSHOPS, EMPLOYEE WELLNESS PROGRAMS, NUTRITION CLASSES, DIABETES CLASSES, TRAUMA AWARENESS, STROKE AWARENESS, OPIOID AWARENESS, BEHAVIORAL HEALTH, STRESS MANAGEMENT AND PAIN MANAGEMENT WITHOUT OPIOIDS, TO NAME A FEW.
Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount	THE HOSPITAL HAS ADOPTED REVENUE RECOGNITION STANDARD ASU 2014-09. UNDER ASU 2014-09, THE ESTIMATED AMOUNTS DUE FROM PATIENTS FOR WHICH THE HEALTH SYSTEM DOES NOT EXPECT TO BE ENTITLED OR COLLECT FROM ITS PATIENTS ARE CONSIDERED IMPLICIT PRICE CONCESSIONS AND EXCLUDED FROM THE HEALTH SYSTEM'S ESTIMATION OF THE TRANSACTION PRICE OR REVENUE RECORDED. BAD DEBT EXPENSE WAS NOT SIGNIFICANT TO THE AUDITED FINANCIAL STATEMENTS FOR THE YEAR ENDED JUNE 30, 2023. HOWEVER, THE HOSPITAL INTERNALLY TRACKS BAD DEBT EXPENSE CONSISTENT WITH HISTORICAL PRACTICES AND THAT AMOUNT HAS BEEN REPORTED ON SCHEDULE H, PART III, SECTION A, LINE 2.
Schedule H, Part III, Line 3 Bad Debt Expense Methodology	THE HOSPITAL DOES NOT TRACK BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY. IF THIS HOSPITAL IS AWARE OR BECOMES AWARE OF A PATIENT'S ELIGIBILITY FOR CHARITY CARE THEN BAD DEBT EXPENSE WOULD NOT BE RECORDED FOR SUCH A PATIENT. CHARITY CARE WOULD BE RECORDED IF THAT PATIENT IS ELIGIBLE. TO DETERMINE THE AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO CHARITY CARE SHOWN ON LINE 3, THE ORGANIZATION APPLIED ITS RATIO OF PATIENT CARE COST TO CHARGES OF 26.11% TO THE TOTAL BAD DEBT EXPENSE SHOWN ON THE HOSPITAL'S FINANCIAL STATEMENT OF $13,497,637.
Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote	THE AUDITED FINANCIAL STATEMENTS DO NOT CONTAIN A FOOTNOTE THAT DESCRIBES BAD DEBT EXPENSE. THEY DO, HOWEVER, CONTAIN A FOOTNOTE THAT DESCRIBES PATIENT ACCOUNTS RECEIVABLE, THAT NOTE CAN BE FOUND ON THE ATTACHED AUDITED FINANCIAL STATEMENTS.
Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs	THE HOSPITAL BECAME A SOLE COMMUNITY HOSPITAL (SCH) EFFECTIVE DECEMBER 8, 2013. PRIOR TO THAT THE HOSPITAL WAS A MEDICARE DEPENDENT HOSPITAL (MDH). A MDH MUST HAVE 60% OF ITS INPATIENT DAYS OR ADMISSIONS ATTRIBUTABLE TO ITS MEDICARE PATIENTS IN 2 OUT OF 3 OF ITS MOST RECENT FISCAL YEARS. MDH IS PAID SIMILARLY TO A SOLE COMMUNITY HOSPITAL BUT AT A LESSER RATE. A MDH IS PAID THE GREATER OF THE FEDERAL INPATIENT PROSPECTIVE PAYMENT SYSTEM (IPPS) RATES OR 75% OF THE DIFFERENCE BETWEEN THE HOSPITAL SPECIFIC COST FOR A BASE PERIOD ROLLED FORWARD FOR MARKET BASKET INCREASES FROM THE BASE PERIOD AND THE IPPS RATES. AN SCH RECEIVES 100% OF THE HOSPITAL SPECIFIC COST ROLLED FORWARD FOR FUTURE PERIODS BY MARKET BASKET INCREASES DETERMINED BY THE MEDICARE PROGRAM. DESPITE THE REIMBURSEMENT RATE, WMH EXPERIENCES A SHORTFALL OF MEDICARE COSTS OVER REVENUE YET CONTINUES TO PROVIDE SERVICES TO THE COMMUNITY, PARTICULARLY THE UNDER- AND UNINSURED.
Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance	THE WRITTEN HOSPITAL COLLECTION POLICY CONTAINS PROVISIONS FOR FINANCIAL COUNSELING FOR PATIENTS WHICH INCLUDES APPLYING FOR COMMERCIAL INSURANCE, SUBSIDIZED GOVERNMENT PROGRAMS, AND CHARITY CARE. CHARITY CARE APPLICANTS ARE URGED TO APPLY FOR STATE SPONSORED MEDICAL ASSISTANCE BUT IT IS NOT A REQUIREMENT. QUALIFICATION FOR CHARITY CARE IS BASED ON 200% OF THE CURRENT FEDERAL POVERTY GUIDELINES. THE PATIENT ACCOUNTS MANAGER REVIEWS THE APPLICATIONS AND NOTIFIES THE APPLICANT WHETHER THEIR APPLICATION HAS BEEN APPROVED. PATIENTS QUALIFYING FOR CHARITY CARE HAVE THEIR PATIENT ACCOUNT BALANCES WRITTEN OFF. IF A CHARITY CARE ELIGIBLE PATIENT HAS FUTURE INVOICES, THEY ARE REVIEWED AT THAT TIME. IF THEIR FINANCIAL INFORMATION REMAINS CURRENT THE ADDITIONAL BALANCES ARE ALSO WRITTEN OFF. IF THE PATIENT HAS A FUTURE BILL AND THE FINANCIAL INFORMATION IS NOT CURRENT, THEY MUST REAPPLY FOR CHARITY CARE.
Schedule H, Part V, Section B, Line 16a FAP website	- WAYNE MEMORIAL HOSPITAL: Line 16a URL: https://www.wmh.org/financial-assistance/;
Schedule H, Part V, Section B, Line 16b FAP Application website	- WAYNE MEMORIAL HOSPITAL: Line 16b URL: https://www.wmh.org/financial-assistance/;
Schedule H, Part V, Section B, Line 16c FAP plain language summary website	- WAYNE MEMORIAL HOSPITAL: Line 16c URL: https://www.wmh.org/financial-assistance/;
Schedule H, Part VI, Line 2 Needs assessment	WAYNE MEMORIAL HOSPITAL CONDUCTS A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) EVERY THREE YEARS, AS PER IRS REQUIREMENTS. THE MOST RECENT CHNA WAS COMPLETED AND WIDELY DISTRIBUTED ON 6/30/2022. THE ASSESSMENT ENCOMPASSED THE HOSPITAL'S SERVICE AREA: WAYNE AND PIKE COUNTIES, THE GREATER CARBONDALE REGION OF LACKAWANNA COUNTY AND FOREST CITY IN SUSQUEHANNA COUNTY. HISTORICALLY, WAYNE MEMORIAL CONTRACTS WITH AN IRS-COMPLIANT OUTSIDE ORGANIZATION TO HELP ASSESS AND RECORD THE COMMUNITY'S HEALTH NEEDS. THE ORGANIZATION IS CHOSEN AND THE PROCESS IS GUIDED BY A LOCAL STEERING COMMITTEE CONSISTING OF REPRESENTATIVES FROM WAYNE MEMORIAL HOSPITAL (WMH), WAYNE MEMORIAL COMMUNITY HEALTH CENTERS (WMCHC, AN FQHC), WAYNE AND PIKE COUNTY GOVERNMENTS INCLUDING LOCAL DEPARTMENT OF HEALTH REPRESENTATIVES, WAYNE AND PIKE COUNTY HUMAN SERVICE AGENCIES, FOREST CITY AND CARBONDALE AREA COMMUNITY REPRESENTATIVES AND OFFICIALS FROM AREA SCHOOL DISTRICTS. THE 2022 CHNA WAS CONDUCTED IN ASSOCIATION WITH THE INSTITUTE FOR PUBLIC HEALTH RESEARCH AND INNOVATION AT EAST STROUDSBURG UNIVERSITY. THE METHODOLOGY INVOLVED BOTH QUANTITATIVE AND QUALITY ASSESSMENTS. DATA WAS COLLECTED FROM THE PENNSYLVANIA DEPARTMENT OF HEALTH, THE 2022 COUNTY HEALTH RANKINGS AND ROADMAPS, THE CENTER FOR RURAL PENNSYLVANIA, THE U.S. CENSUS, WAYNE AND PIKE COUNTY STATISTICS, AND OTHER PUBLIC SOURCES TO IDENTIFY POPULATION GROUPS, DISEASE TRENDS, MORTALITY RATES AND CAUSES, AND VACCINATION UPTAKE IN THE COMMUNITIES SERVED BY WAYNE MEMORIAL HOSPITAL. THIS INFORMATION WAS AUGMENTED WITH AN ONLINE PUBLIC SURVEY (526 RESPONDENTS), INTERVIEWS WITH COMMUNITY STAKEHOLDERS, AND FOCUS GROUPS TO FORM A MORE VIBRANT, COHESIVE PICTURE OF THE COMMUNITY AS A WHOLE TO ASSESS ITS NEEDS ACCORDINGLY AND DETERMINE HOW TO STRATEGIZE MEETING THOSE NEEDS. THE INSTITUTE FOR PUBLIC HEALTH RESEARCH AND INNOVATION CONDUCTED A DESCRIPTIVE AND INFERENTIAL STATISTICAL ANALYSIS OF THE SURVEY DATA USING THE SPSS V27.0 SOFTWARE PACKAGE. THESE FINDINGS WERE COMBINED WITH THE QUALITATIVE FINDINGS (INTERVIEWS, FOCUS GROUPS) TO ELUCIDATE PRIMARY DATA RESULTS FOR THE REGION, SPECIFICALLY LEADING HEALTH NEEDS THAT DEEPLY IMPACT THE WAYNE MEMORIAL COMMUNITY THROUGH FREQUENCY OF OCCURRENCE AND SEVERITY OF OUTCOMES AS WELL AS THOSE EXPERIENCED AT DISPROPORTIONATELY HIGH RATES RELATIVE TO OTHER COMMUNITIES. AN IMPLEMENTATION STRATEGY WAS DEVELOPED AND ADOPTED BY THE WAYNE MEMORIAL HOSPITAL AND HEALTH SYSTEM BOARD OF TRUSTEES AND IS DISTRIBUTED VIA THE HOSPITAL'S WEBSITE AT: HTTPS://WWW.WMH.ORG/CHNA-COMMUNITY-HEALTH-NEEDS-ASSESSMENT/
Schedule H, Part VI, Line 3 Patient education of eligibility for assistance	THE HOSPITAL EDUCATES AND INFORMS PATIENTS AND PERSONS WHO MAY BE BILLED FOR PATIENT CARE ABOUT THEIR ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL, STATE OR LOCAL GOVERNMENT PROGRAMS OR UNDER THE HOSPITAL'S CHARITY CARE POLICY THROUGH ITS SCHEDULING, REGISTRATION, SOCIAL SERVICES AND BILLING DEPARTMENTS. PATIENTS AND PERSONS WHO MAY BE BILLED FOR PATIENT CARE ARE ALSO MADE AWARE OF THEIR ELIGIBILITY THROUGH WMCHC (A CLINICAL AFFILIATE OF THE HOSPITAL WHO RECEIVES SUBSTANTIAL FINANCIAL SUPPORT FROM THE HOSPITAL AND IS A FEDERALLY QUALIFIED HEALTH CENTER). PATIENTS RECEIVE THIS EDUCATION WHEN, DURING THE SCHEDULING OF AN APPOINTMENT TO FINAL DISPOSITION OF THEIR BILL, THERE IS ANY INDICATION OF THE NEED OR REQUEST FOR HELP IN PAYING FOR SERVICES BEING SCHEDULED, PROVIDED OR BILLED. WAYNE MEMORIAL HOSPITAL, THROUGH ITS NETWORK OF 700 STATE HEALTH IMPROVEMENT PLAN PARTNERS ('SHIP' PARTNERS ARE ORGANIZATIONS, AGENCIES, BUSINESSES, SCHOOLS, TASK FORCES, COALITIONS, RELIGIOUS GROUPS, AND INDIVIDUALS) PROVIDES THE MODALITY FOR DELIVERING WRITTEN INFORMATION, VERBAL EXPLANATION AND ASSISTANCE IN COMPLETING FORMS FOR THE MOST VULNERABLE POPULATION. THE INFORMATION AND SERVICES ARE AVAILABLE AT MANY OF WMH'S OUTREACH FUNCTIONS. THE FINANCIAL AID POLICY BROCHURE AND GUIDELINES IS AVAILABLE AT OUTPATIENT REGISTRATION DESKS AND AT APPROPRIATE COMMUNITY OUTREACH FUNCTIONS. IT CONTAINS INFORMATION REGARDING ELIGIBILITY FOR FINANCIAL AID AT WMH, AND HOW TO APPLY FOR MEDICAL ASSISTANCE, MEDICAID, OR FINANCIAL AID. IT CONTAINS THE CONTACT INFORMATION FOR THE WAYNE MEMORIAL COMMUNITY HEALTH CENTERS' OUTREACH AND ENROLLMENT COORDINATORS AND THE MOST RECENTLY RELEASED US POVERTY INCOME GUIDELINES. PHYSICIAN DIRECTORS ARE AVAILABLE AT OUTREACH PROGRAMS. ON THE WMH WEBSITE, THERE IS A FIND A DOC TAB TO ASSIST PATIENTS IN FINDING AN APPROPRIATE PHYSICIAN AND WMH COMMUNITY HEALTH HAS A PHYSICIAN REFERRAL PHONE LINE PROVIDING PERSONAL ASSISTANCE. THIS INFORMATION IS DISCUSSED PERIODICALLY ON THE HEALTHWORKS WEEKLY RADIO SHOW. WHEN NECESSARY, ASSISTANCE IS PROVIDED FOR THOSE WITH LANGUAGE BARRIERS IN BOTH TRANSLATION AND SIGN LANGUAGE.
Schedule H, Part VI, Line 4 Community information	WAYNE MEMORIAL HOSPITAL'S PRIMARY SERVICE AREA COMPRISES APPROXIMATELY 120,000 PEOPLE ACROSS ALL OF WAYNE COUNTY, PA; THE WESTERN, NORTHERN AND PORTIONS OF EASTERN AND SOUTHERN PIKE COUNTY, PA; THE SOUTHEAST PORTION OF SUSQUEHANNA COUNTY, PA; THE COMMUNITY OF CARBONDALE AND ITS IMMEDIATELY SURROUNDING COMMUNITIES IN LACKAWANNA COUNTY, PA; AND THE SOUTHWEST PORTION OF SULLIVAN COUNTY, NY. THE SECONDARY SERVICE AREA INCLUDES THE BALANCE OF PIKE COUNTY AND EASTERN PORTIONS OF LACKAWANNA AND SUSQUEHANNA COUNTY IN NORTHEASTERN PENNSYLVANIA. THE WAYNE MEMORIAL HOSPITAL (WMH) SERVICE AREA IS PREDOMINANTLY RURAL, NON HISPANIC WHITE AND SIGNIFICANTLY LESS DIVERSE THAN PENNSYLVANIA ON AVERAGE. UNEMPLOYMENT IS HIGHER THAN THE U.S. RATE IN 2022 OF 3.7%* -- WAYNE (9%), PIKE (10.6%) AND SUSQUEHANNA (7.3%) COUNTIES. THE POVERTY RATE* IN THOSE COUNTIES IS SLIGHTLY BELOW THE PENNSYLVANIA AVERAGE OF 11.8% AND THE U.S. RATE OF 12.6% -- WAYNE (10.8%), PIKE (9.4%) AND SUSQUEHANNA (11.6%). IN BOTH WAYNE AND PIKE, THE TWO LARGEST BLOCKS IN OUR SERVICE AREA, A SIGNIFICANT PORTION - ABOUT 1/3-OF THE POPULATION IS ELDERLY, AND SERVICES FOR OLDER ADULTS IS CITED AS A TOP NEED ON THE 2022 COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). WAYNE MEMORIAL IS CLASSIFIED IN THE 8TH UNITED STATES CONGRESSIONAL DISTRICT AND INCLUDES FEDERALLY CLASSIFIED MEDICALLY UNDERSERVED AREAS: ALL OF SUSQUEHANNA COUNTY AND TWO TOWNSHIPS IN WAYNE (DAMASCUS) AND PIKE (GREENE) COUNTIES. PARTS OF OUR SERVICE AREA ARE ALSO DESIGNATED HEALTH PROFESSIONAL SHORTAGE AREAS, PARTICULARLY IN MENTAL HEALTH AND DENTAL HEALTH. OVERALL HEALTH: WAYNE MEMORIAL HOSPITAL IS THE ONLY HOSPITAL IN WAYNE COUNTY, AND THERE IS NO HOSPITAL IN PIKE COUNTY. HEALTH STATISTICS (FOUND IN OUR 2022 CHNA) SHOW PIKE AND WAYNE COUNTIES RANK IN THE TOP 50-75% OF PA COUNTIES FOR OVERALL HEALTH OUTCOMES AND HEALTH FACTORS. SUSQUEHANNA COUNTY, WHICH HAS A SMALL CRITICAL-ACCESS HOSPITAL (BUT NOT IN OUR SERVICE AREA), IS ALSO IN THE TOP 50-75% FOR HEALTH OUTCOMES BUT ONLY 25-50% FOR HEALTH FACTORS. LACKAWANNA COUNTY'S HEALTH OUTCOMES ARE LOWER, 0-25%, THOUGH HEALTH FACTORS, 50-75%, ARE STRONG. US BUREAU OF LABOR STATISTICS COUNTYHEALTHRANKINGS.ORG **CENSUSREPORTER.ORG DATA PRESENTED IN CENSUSREPORTER IS COLLECTED BY THE US CENSUS BUREAU. IN GENERAL, THE DATA IS FROM THE MOST RECENTLY RELEASED AMERICAN COMMUNITY SURVEY (ACS).
Schedule H, Part VI, Line 5 Promotion of community health	WAYNE MEMORIAL HOSPITAL (WMH) IS ACTIVELY INVOLVED IN THE COMMUNITY IT SERVES WITH THE INTENTION OF PROMOTING THE HEALTH OF OUR COMMUNITY AT LARGE. THIS INCLUDES LOCAL INDEPENDENT COMMUNITY REPRESENTATIVES AS A MAJORITY OF OUR BOARD, AGGRESSIVE RESEARCH FOR AND USE OF GRANTS FOR PROJECTS TO PROMOTE HEALTH, MEDIA PUBLICATIONS (INCLUDING SOCIAL MEDIA) TO DISSEMINATE NEWS OF OUR SERVICES AND HEALTH INFORMATION, AND A MEDICAL STAFF WILLING TO PARTNER ON PRESENTATIONS AND PROJECTS THAT BENEFIT THE COMMUNITY. WAYNE MEMORIAL HOSPITAL UTILIZES ANY EXCESS FUNDS OVER EXPENSES TO IMPROVE PATIENT CARE, CONDUCT MEDICAL AND HEALTH EDUCATION, OR SUPPORT OTHER NOT FOR PROFIT ORGANIZATIONS. WAYNE MEMORIAL HOSPITAL'S MEDICAL STAFF IS OPEN. THE HOSPITAL EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY FOR ALL OF ITS DEPARTMENTS, WITH THE EXCEPTION OF ANESTHESIOLOGY, PATHOLOGY AND RADIOLOGY, AS SERVICES IN THESE DEPARTMENTS ARE PROVIDED ON AN EXCLUSIVE BASIS TO BENEFIT PATIENT CARE. MEMBERS OF OUR MEDICAL STAFF ARE REQUIRED, WHILE PARTICIPATING AT THE HOSPITAL, TO TREAT ALL PATIENTS, REGARDLESS OF THEIR ABILITY TO PAY OR THEIR INSURANCE STATUS. THE HOSPITAL ACCEPTS PUBLIC ASSISTANCE, MOST PRIVATE INSURANCES AND OFFERS CHARITY CARE TO PATIENTS WHO MEET FEDERAL POVERTY INCOME LEVELS. COMMUNITY INPUT: OUR COMMUNITY ADVISORY BOARD MEETS BI-MONTHLY TO ADVISE THE HOSPITAL ON COMMUNITY NEEDS AND RECOMMEND ACTIONS. IT IS COMPRISED OF ALL VOLUNTEERS, INCLUDING UP TO FOUR HIGH SCHOOL STUDENTS, FROM EVERY PART OF OUR SERVICE AREA, REPRESENTING BUSINESS, EDUCATION, GOVERNMENT AND SOCIAL SERVICE AGENCIES. ALL OF THE BOARD MEMBERS, WHO ARE CITIZENS UN-AFFILIATED WITH THE HOSPITAL, WORK WITH THE HOSPITAL TO ASSURE THE HIGHEST QUALITY OF CARE IS MEETING THE NEEDS OF THEIR COMMUNITY. IN TURN, BOARD MEMBERS PROMOTE THE HOSPITAL AND INFORM THE COMMUNITY ABOUT WAYNE MEMORIAL SERVICES. COMMUNITY OUTREACH: BASED ON THE HOSPITAL'S COMMUNITY HEALTH NEEDS ASSESSMENTS (2022, 2019, ETC.), WE DEVELOP PROGRAMS DESIGNED TO MEET THE NEEDS OUTLINED IN THE SUMMARY DATA. FOR EXAMPLE, WE HAVE A WAYNE MEMORIAL FOOD PRESCRIPTION PROGRAM (WM FRX), FUNDED BY A PRIVATE FOUNDATION GRANT, WHICH OFFERS FOOD, COUPONS AND DIETARY ADVICE FOR PEOPLE WITH CONGESTIVE HEART FAILURE, COPD, HYPERTENSION AND DIABETES - ALL IDENTIFIED AS CRITICAL NEEDS IN THE CHNA-WHO HAVE ALSO EXPRESSED FOOD INSECURITY, A SOCIAL DETERMINANT OF HEALTH. THE HOSPITAL ALSO HAS REPRESENTATIVES ON MANY COMMUNITY ORGANIZATIONS WHICH ARE DIRECTLY LINKED TO AREAS OF CONCERN CITED IN THE CHNA, SUCH AS THE COVID-19 PANDEMIC, MENTAL HEALTH SERVICES, SUBSTANCE ABUSE, IMPROVED ACCESS TO CARE, OLDER ADULT SERVICES AND CANCER AND HEART DISEASE. THESE ORGANIZATIONS INCLUDE BUT ARE NOT LIMITED TO: WAYNE COUNTY SYSTEM OF CARE, WAYNE/PIKE NORTHEAST SUICIDE PREVENTION INITIATIVE, WAYNE TOMORROW! HEALTH AND WELLNESS TASK FORCE, THE NORTHEAST REGIONAL CANCER INSTITUTE, AND THE AMERICAN HEART ASSOCIATION. HOSPITAL STAFF PARTICIPATES REGULARLY IN COMMUNITY FAIRS WITH HEALTH AND HOSPITAL RELATED MATERIALS, ON-SITE BLOOD PRESSURE CHECKS AND PRESENTATIONS ON HEALTH ISSUES SUCH AS THE IMPORTANCE OF CANCER SCREENINGS (COLON, BREAST, ETC.). COMMUNITY OUTREACH, EVENTS AND EDUCATIONAL PROGRAMS ARE OFFERED TO COMMUNITY ORGANIZATIONS, AGENCIES AND COMMUNITY MEMBERS FREE OF CHARGE. HOSPITAL STAFF PROVIDE MENTORING, JOB SHADOWING, AND PRECEPTORSHIP FOR STUDENTS IN OR INTERESTED IN THE MEDICAL FIELD. SYSTEM INITIATIVES: A SAFETY NET HOSPITAL IN RURAL NORTHEAST PENNSYLVANIA AND DESIGNATED A SOLE COMMUNITY PROVIDER BY THE FEDERAL GOVERNMENT, WAYNE MEMORIAL HOSPITAL IS A FOUNDING MEMBER OF THE KEYSTONE ACO, WHICH COORDINATES HEALTH DATA AMONG PROVIDERS TO STREAMLINE QUALITY CARE FOR PATIENTS. THE HOSPITAL IS ALSO A CHARTER MEMBER OF THE PENNSYLVANIA RURAL HEALTH MODEL, FEDERALLY FUNDED TO ASSIST HOSPITALS IN BECOMING FINANCIALLY STABLE.
Schedule H, Part VI, Line 6 Affiliated health care system	THE HOSPITAL IS PART OF AN AFFILIATED HEALTH CARE SYSTEM UNDER COMMON GOVERNANCE AND CONTROL THAT INCLUDES THE HOSPITAL AND WAYNE MEMORIAL LONG TERM CARE (WMLTC, WHICH OPERATES WAYNE WOODLANDS MANOR). WAYNE WOODLANDS MANOR IS A 24 HOUR NURSING FACILITY THAT PROVIDES SERVICES PRIMARILY TO MEDICAID RECIPIENTS (OVER 75% OF ITS RESIDENTS). MOST COUNTIES IN PENNSYLVANIA HAVE COUNTY OWNED AND OPERATED NURSING HOMES THAT PROVIDE SERVICES TO THIS SEGMENT OF THEIR COUNTY POPULATION. WAYNE COUNTY DOES NOT HAVE A COUNTY NURSING HOME. THIS COMMUNITY NEED IS MET BY WAYNE MEMORIAL LONG TERM CARE BY ITS OPERATION OF WAYNE WOODLANDS MANOR. WMH IS ALSO A CLINICAL AFFILIATE OF WAYNE MEMORIAL COMMUNITY HEALTH CENTERS (WMCHC), WHICH IT SUPPORTS CLINICALLY AND FINANCIALLY. WMCHC SERVES A NUMBER OF MUA'S AND MUP'S. THE HOSPITAL HAS FINANCED WMCHC'S AND WMLTC'S WORKING CAPITAL NEEDS WITH LINES OF CREDIT THAT ARE NECESSARY SUBSIDIES BECAUSE OF THE TIME DELAY BETWEEN SERVICE PERFORMANCE AND REIMBURSEMENTS RECEIVED FROM GOVERNMENT AND COMMERCIAL INSURERS. IN ADDITION, THE WAYNE MEMORIAL HOSPITAL HAS AN AFFILIATION WITH THE GEISINGER COMMONWEALTH SCHOOL OF MEDICINE (SCRANTON, PA) FOR THE PROVISION OF CLINICAL EDUCATION EXPERIENCES AT THE HOSPITAL AND WITHIN THE COMMUNITY. THE HOSPITAL CONSIDERS THIS A RESPONSIBILITY CONSISTENT WITH ITS MISSION TO BE INVOLVED IN EDUCATION. UNDER A CONTRACTUAL PARTNERSHIP WITH WMH, GEISINGER HOSPITAL ALSO PROVIDES BOARD-CERTIFIED EMERGENCY PHYSICIANS TO STAFF ITS EMERGENCY DEPARTMENT.
Schedule H, Part VI, Line 7 State filing of community benefit report	PA

Schedule H (Form 990) 2023

Additional Data

Software ID:	23017437
Software Version:	2023v6.0

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

OMB No. 1545-0047

2023

Open to Public Inspection

Name of the organization

WAYNE MEMORIAL HOSPITAL

Employer identification number

24-0798839

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed 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 .....

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? ....

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) 2023

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, 1099-MISC compensation, and/or 1099-NEC			(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)
1DR SEAN MCVEIGH TRUSTEE/CHIEF OF MEDICAL STAFF	(i) (ii)	544,740 ------------- 0	0 ------------- 0	0 ------------- 0	1,300 ------------- 0	22,763 ------------- 0	568,803 ------------- 0	0 ------------- 0
2DR SYBIL RICKARD TRUSTEE/VICE PRESIDENT OF MEDICAL STAFF	(i) (ii)	300,287 ------------- 0	0 ------------- 0	0 ------------- 0	9,102 ------------- 0	15,666 ------------- 0	325,055 ------------- 0	0 ------------- 0
3JAMES PETTINATO CHIEF EXECUTIVE OFFICER	(i) (ii)	0 ------------- 302,454	0 ------------- 0	0 ------------- 22,500	0 ------------- 25,500	0 ------------- 21,451	0 ------------- 371,905	0 ------------- 0
4PATRICIA DUNSINGER CHIEF FINANCIAL OFFICER	(i) (ii)	0 ------------- 217,115	0 ------------- 0	0 ------------- 0	0 ------------- 12,405	0 ------------- 0	0 ------------- 229,520	0 ------------- 0
5JAMES HOCKENBURY CHIEF OF ANCILLARY SERVICES	(i) (ii)	0 ------------- 204,631	0 ------------- 0	0 ------------- 0	0 ------------- 11,818	0 ------------- 7,784	0 ------------- 224,233	0 ------------- 0
6CHANDRA ROBERTS CHIEF OF PATIENT CARE SERVICES	(i) (ii)	0 ------------- 150,075	0 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 15,666	0 ------------- 165,741	0 ------------- 0
7DR CLIFFORD CARROL PHYSICIAN	(i) (ii)	677,489 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 0	14,007 ------------- 0	691,496 ------------- 0	0 ------------- 0
8DR DAVID CAUCCI PHYSICIAN	(i) (ii)	645,945 ------------- 0	0 ------------- 0	0 ------------- 0	8,190 ------------- 0	21,588 ------------- 0	675,723 ------------- 0	0 ------------- 0
9DR UZOMA ANAELE PHYSICIAN	(i) (ii)	580,077 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 0	21,588 ------------- 0	601,665 ------------- 0	0 ------------- 0
10DR KEITH CORDISCHI PHYSICIAN	(i) (ii)	533,849 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 0	19,387 ------------- 0	553,236 ------------- 0	0 ------------- 0
11DR JOSEPH LAURETI PHYSICIAN	(i) (ii)	502,834 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 0	21,588 ------------- 0	524,422 ------------- 0	0 ------------- 0

Schedule J (Form 990) 2023

Page 3

Part III

Supplemental Information

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

Return Reference	Explanation
Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation	WAYNE MEMORIAL HEALTH SYSTEM, A RELATED ORGANIZATION, DETERMINES THE COMPENSATION OF THE CEO USING THE FOLLOWING METHODS: COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. THE BOARD MAKES THE FINAL DECISION USING THE INFORMATION PROVIDED BY THE CONSULTANT.
Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan	WAYNE MEMORIAL HEALTH SYSTEM, A RELATED ORGANIZATION, COVERS JAMES PETTINATO WITH A 457(F) SUPPLEMENTAL RETIREMENT AGREEMENT (SERP). IN THE CURRENT YEAR THE FOLLOWING CONTRIBUTION WAS MADE: $ 7,500

Schedule J (Form 990) 2023

Additional Data

Software ID:	23017437
Software Version:	2023v6.0

- 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.
Attach to Form 990.
Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2023

Open to Public
Inspection

Name of the organization
WAYNE MEMORIAL HOSPITAL

Employer identification number
24-0798839

Part Ⅰ

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	WAYNE CO HOSPITAL AND HEALTH FACILITIES AUTHORITY	23-2152053	946016JX9	09-01-2017	37,609,342	FINANCE, DESIGN, CONSTRUCTION, & EQUIPMENT		X	X			X
B	WAYNE COUNTY HOSPITAL AND HEALTH FACILITIES AUTHORITY	23-2152053	946016GS5	10-25-2012	9,997,040	REUND '05 AND A PART OF '07 BONDS		X	X			X
C	WAYNE COUNTY HOSPITAL AND HEALTH FACILITIES AUTHORITY	23-2152053	946016HU9	12-20-2012	4,703,786	REFUND REMAINING 2007 BONDS		X	X			X
D	WAYNE COUNTY HOSPITAL AND HEALTH FACILITY AUTHORITY	23-2152053		12-01-2017	8,000,000	FINANCING DESIGN, CONSTRUCTION, AND EQUIPMENT		X	X			X

Part Ⅱ

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................	30,000		7,480,000		4,180,000		1,608,479
2 Amount of bonds legally defeased ..............	0		0		0		0
3 Total proceeds of issue ..................	37,609,342		9,997,040		4,703,786		8,000,000
4 Gross proceeds in reserve funds .............	136,950		461,420		254,563		0
5 Capitalized interest from proceeds .............	0		0		0		0
6 Proceeds in refunding escrows ...............	0		9,255,837		4,315,090		0
7 Issuance costs from proceeds ...............	679,633		187,404		93,600		157,818
8 Credit enhancement from proceeds .............	0		92,379		40,533		0
9 Working capital expenditures from proceeds .............	0		0		0		0
10 Capital expenditures from proceeds .............	35,560,559		0		0		7,842,182
11 Other spent proceeds .............	0		0		0		0
12 Other unspent proceeds .............	0		0		0		0
13 Year of substantial completion .............	2019		2012		2012		2019
	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 2020, a current refunding issue)? ........	X		X		X		X
15 Were the bonds issued as part of an advance refunding issue of taxable bonds (or, if issued prior to 2020, an advance refunding issue)? ........		X		X		X		X
16 Has the final allocation of proceeds been made? ..........	X		X		X		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X		X		X		X

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

Cat. No. 50193E

Schedule K (Form 990) 2023

Page 2

Part Ⅲ

Private Business Use

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

Part Ⅳ

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...		X		X		X		X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......		X		X		X		X
b Exception to rebate? ........		X		X		X		X
c No rebate due? .........	X		X		X		X
If "Yes" to line 2c, provide in Part Ⅵ the date the rebate computation was performed ......
3 Is the bond issue a variable rate issue? .....		X		X		X		X

Schedule K (Form 990) 2023

Page 3

Part Ⅳ

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X		X		X		X
b Name of provider ..........
c Term of hedge .........
d Was the hedge superintegrated? ......
e Was the hedge terminated? ........
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?		X		X		X		X
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?		X		X		X		X
7 Has the organization established written procedures to monitor the requirements of section 148? ...		X		X		X		X

Part Ⅴ

Procedures To Undertake Corrective Action

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

Part Ⅵ

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

Return Reference	Explanation
Schedule K, Part IV, Line 2c COLUMN A	Issuer name: WAYNE CO HOSPITAL AND HEALTH FACILITIES AUTHORITY The calculation for computing no rebate due was performed on 10/06/2022
Schedule K, Part IV, Line 2c COLUMN B	Issuer name: WAYNE COUNTY HOSPITAL AND HEALTH FACILITIES AUTHORITY The calculation for computing no rebate due was performed on 11/27/2022
Schedule K, Part IV, Line 2c COLUMN C	Issuer name: WAYNE COUNTY HOSPITAL AND HEALTH FACILITIES AUTHORITY The calculation for computing no rebate due was performed on 07/11/2024
Schedule K, Part IV, Line 2c COLUMN D	Issuer name: WAYNE COUNTY HOSPITAL AND HEALTH FACILITY AUTHORITY The calculation for computing no rebate due was performed on 10/06/2022

Schedule K (Form 990) 2023

Additional Data

Software ID:	23017437
Software Version:	2023v6.0

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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.
Attach to Form 990.
Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2023

Open to Public Inspection

Name of the organization

WAYNE MEMORIAL HOSPITAL

Employer identification number

24-0798839

Part I

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

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

Part II

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)WAYNE MEMORIAL HEALTH FOUNDATION INC 601 PARK STREET HONESDALE,PA18431 23-2208596	FUNDRAISING	PA	501(c)(3)	Type I	WMHS		No
(2)WAYNE MEMORIAL HEALTH SYSTEM INC 601 PARK STREET HONESDALE,PA18431 23-2221292	OVERSIGHT	PA	501(c)(3)	Type II	NA		No
(3)WAYNE MEMORIAL LONG TERM CARE 37 WOODLANDS DRIVE WAYMART,PA18472 23-2719336	NURSING HOME	PA	501(c)(3)	10	WMHS		No

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

Cat. No. 50135Y

Schedule R (Form 990) 2023

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?		(k) Percentage ownership
(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	(k) Percentage ownership

Part IV

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	Yes	No
(1) WAYNE HEALTH SERVICES INC 601 PARK STREET HONESDALE,PA18431 23-2376183	RENT	PA	WMH System	C Corporation					No
(2) CHARITABLE TRUST	TRUST	PA	WMH	Trust	481	29,471	100.00 %	Yes

Schedule R (Form 990) 2023

Page 3

Part V

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

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

Yes

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

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

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

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

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

Yes

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

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

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

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

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

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

Yes

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

Yes

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

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

Yes

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

Yes

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

Yes

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

Yes

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

Yes

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

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

Yes

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

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

Schedule R (Form 990) 2023

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?		(k) Percentage ownership
(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	(k) Percentage ownership

Schedule R (Form 990) 2023

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) 2023

Additional Data

Software ID:	23017437
Software Version:	2023v6.0

1	Briefly describe the organization’s mission or most significant activities: WAYNE MEMORIAL HOSPITAL IS A NON-PROFIT, COMMUNITY-CONTROLLED HOSPITAL THAT STRIVES TO OFFER THE HIGHEST QUALITY IN INPATIENT AND OUTPATIENT MEDICAL CARE.
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	12
5	Total number of individuals employed in calendar year 2023 (Part V, line 2a) ......	5	943
6	Total number of volunteers (estimate if necessary) .............	6	131
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	2,662
b	Net unrelated business taxable income from Form 990-T, Part I, line 11 .........	7b	609

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	12,512,024	766,467
9	Program service revenue (Part VIII, line 2g) .........	104,409,553	109,700,100
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	2,816,131	5,042,900
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	1,157,131	769,190
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	120,894,839	116,278,657
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	2,305,291	26,000
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)	55,912,202	58,886,603
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....		0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	59,587,952	60,278,308
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	117,805,445	119,190,911
19	Revenue less expenses. Subtract line 18 from line 12.......	3,089,394	-2,912,254
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	189,530,684	193,293,138
21	Total liabilities (Part X, line 26).............	78,405,306	80,238,238
22	Net assets or fund balances. Subtract line 21 from line 20.....	111,125,378	113,054,900

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 74,704,626 including grants of $ 26,000 ) (Revenue $ 81,847,300 )
	A VARIETY OF OUTPATIENT SERVICES ARE OFFERED INCLUDING LAB, RADIOLOGY, INTERVENTIONAL RADIOLOGY, AND REHABILITATION SERVICES SUCH AS CARDIAC, PHYSICAL, OCCUPATIONAL AND SPEECH THERAPIES. WMH ALSO PROVIDES OUTPATIENT EMERGENCY AND DIAGNOSTIC SERVICES AND A WOMEN'S HEALTH CENTER. OUR PHYSICIAN SPECIALTY CLINIC OFFERS OUTPATIENT PULMONARY, GASTROENTEROLOGY, UROLOGY, UROGYNECOLOGY, CARDIOLOGY, NEPHROLOGY, NEUROLOGY, SLEEP, AND GENERAL SURGERY SERVICES. WMH FEATURES OVER 30 MEDICAL SPECIALTIES AND INCLUDES A CERTIFIED PRIMARY STROKE CENTER, A LEVEL IV TRAUMA CENTER AND A CERTIFIED CARDIAC CATHETERIZATION LABORATORY. OUR EMERGENCY DEPARTMENT OFFERS PHYSICIAN CARE 24 HOURS A DAY TO ALL, REGARDLESS OF ABILITY TO PAY.

4b	(Code: ) (Expenses $ 22,766,468 including grants of $ ) (Revenue $ 24,951,904 )
	INPATIENT SERVICES PROVIDES A FULL CONTINUUM OF CARE, FROM BIRTHING SUITES TO ENDOSCOPY, CARDIOLOGY PROCEDURES, RESPIRATORY THERAPY, IMAGING SCANS, AND HOSPICE CARE FOR THE POPULATION WE SERVE OF APPROXIMATELY 100,000 PEOPLE IN MOSTLY RURAL WAYNE AND PIKE COUNTIES AND SURROUNDING AREAS IN NORTHEASTERN PENNSYLVANIA. OUR HOSPITAL HAS 90 ACUTE-CARE BEDS, INCLUDING 50 IN PRIVATE ROOMS, AND AN ADDITIONAL 14 BEDS DEDICATED TO INPATIENT REHABILITATION.

4c	(Code: ) (Expenses $ 2,646,819 including grants of $ ) (Revenue $ 2,900,896 )
	THE ORGANIZATION PROVIDED HOSPICE SERVICES AND RELATED SUPPORT TO THE COMMUNITY.

4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses100,117,913

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)				(D) Reportable compensation from the organization (W-2/1099-MISC/1099-NEC)	(E) Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and title
(18) JAMES PETTINATO........................................................................ CHIEF EXECUTIVE OFFICER	36.9 .......................3.1	X			0	324,954	46,951
(19) PATRICIA DUNSINGER........................................................................ CHIEF FINANCIAL OFFICER	18.8 .......................21.2	X			0	217,115	12,405
(20) CHANDRA ROBERTS........................................................................ CHIEF OF PATIENT CARE SERVICES	39.2 .......................0.8		X		0	150,075	15,666
(21) JAMES HOCKENBURY........................................................................ CHIEF OF ANCILLARY SERVICES	34.0 .......................6.0		X		0	204,631	19,602
(22) DR CLIFFORD CARROL........................................................................ PHYSICIAN	40.0 .......................0.0			X	677,489	0	14,007
(23) DR DAVID CAUCCI........................................................................ PHYSICIAN	40.0 .......................0.0			X	645,945	0	29,778
(24) DR JOSEPH LAURETI........................................................................ PHYSICIAN	40.0 .......................0.0			X	502,834	0	21,588
(25) DR KEITH CORDISCHI........................................................................ PHYSICIAN	40.0 .......................0.0			X	533,849	0	19,387
(26) DR UZOMA ANAELE........................................................................ PHYSICIAN	40.0 .......................0.0			X	580,077	0	21,588

1b	Sub-Total..............
c	Total from continuation sheets to Part VII, Section A..
d	Total (add lines 1b and 1c).........	3,785,221	896,775	249,803

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	125,000
e	Government grants (contributions)		1e	500,000

f	All other contributions, gifts, grants, and similar amounts not included above		1f	141,467

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

h Total. Add lines 1a-1f.......		766,467

		Business Code
2a	PA RURAL HEALTH MODEL REVENUE	623000	61,482,078	61,482,078
b	NET PATIENT SERVICE REVENUE	623000	47,060,455	47,060,455
c	OTHER REVENUE	900099	886,688	886,688
d	CAFETERIA	722514	270,879	270,879
e
f	All other program service revenue.		0	0	0	0
g	Total. Add lines 2a–2f .....		109,700,100

3 Investment income (including dividends, interest, and othersimilar amounts) ......			2,507,491			2,507,491
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
			(i) Real	(ii) Personal
6a	Gross rents	6a	461,757
b	Less: rental expenses	6b	315,092
c	Rental income or (loss)	6c	146,665	0
d	Net rental income or (loss).......			146,665			146,665
			(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory	7a	21,403,704
b	Less: cost or other basis and sales expenses	7b	18,868,295
c	Gain or (loss)	7c	2,535,409	0
d	Net gain or (loss).........			2,535,409			2,535,409
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..
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..
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..

Business Code
11a	GAIN/(LOSS) ON EQUITY INVESTEE		900099	622,525		2,662	619,863
b
c
d	All other revenue ....			0	0	0	0
e	Total. Add lines 11a–11d ......			622,525
12	Total revenue. See instructions.....			116,278,657	109,700,100	2,662	5,809,428

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	26,000	26,000
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............
4	Benefits paid to or for members .......
5	Compensation of current officers, directors, trustees, and key employees ...........	893,858	893,858
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........
7	Other salaries and wages........	47,484,393	39,850,070	7,634,323
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	1,568,701	1,319,259	249,442
9	Other employee benefits .......	5,443,884	4,577,874	866,010
10	Payroll taxes ...........	3,495,767	2,943,561	552,206
11	Fees for services (non-employees):
a	Management ......	970,452		970,452
b	Legal .........	217,566		217,566
c	Accounting ...........	260,778		260,778
d	Lobbying ...........
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......	396,052		396,052
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	22,883,824	20,842,123	2,041,701	0
12	Advertising and promotion ....	186,648		186,648
13	Office expenses .......	2,330,757	640,970	1,689,787
14	Information technology ......
15	Royalties ..
16	Occupancy ...........	1,827,685	1,478,328	349,357
17	Travel ............	111,546	100,598	10,948
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	47,511	34,115	13,396
20	Interest ...........	1,646,196	1,381,390	264,806
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	6,369,231	5,344,685	1,024,546
23	Insurance ...	1,393,407	1,169,265	224,142
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	MEDICAL SUPPLIES & DRUGS	17,769,003	17,769,003
b	REPAIRS & MAINTENANCE	3,799,365	1,678,991	2,120,374
c	LICENSES, DUES, SUBCRIPTIONS	68,287	67,823	464
d
e	All other expenses	0	0	0	0
25	Total functional expenses. Add lines 1 through 24e	119,190,911	100,117,913	19,072,998	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			63,130	1	10,963
2	Savings and temporary cash investments .........			35,007,876	2	27,617,649
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			10,152,495	4	11,724,645
5	Loans and other receivables from any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
				0	5	0
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
				0	6	0
7	Notes and loans receivable, net ...........				7
8	Inventories for sale or use ............			2,306,521	8	2,333,049
9	Prepaid expenses and deferred charges ......			4,465,804	9	7,080,013
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	154,913,626
b	Less: accumulated depreciation	10b	103,445,973	53,834,584	10c	51,467,653
11	Investments—publicly traded securities .			63,997,001	11	66,665,999
12	Investments—other securities. See Part IV, line 11 .....			516,765	12	461,602
13	Investments—program-related. See Part IV, line 11 ..			3,284,261	13	3,291,746
14	Intangible assets ...............			0	14	123,500
15	Other assets. See Part IV, line 11 ...........			15,902,247	15	22,516,319
16	Total assets. Add lines 1 through 15 (must equal line 33)...			189,530,684	16	193,293,138

17	Accounts payable and accrued expenses .....	14,077,925	17	15,795,696
18	Grants payable ...		18
19	Deferred revenue .........	379,492	19	379,492
20	Tax-exempt bond liabilities .........	47,495,435	20	45,888,176
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 .........
		0	22	0
23	Secured mortgages and notes payable to unrelated third parties ..		23
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	16,452,454	25	18,174,874
26	Total liabilities. Add lines 17 through 25..	78,405,306	26	80,238,238

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	108,257,090	27	110,232,091
28	Net assets with donor restrictions ...........	2,868,288	28	2,822,809
	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 ...........	111,125,378	32	113,054,900
33	Total liabilities and net assets/fund balances ........	189,530,684	33	193,293,138

Return Reference	Explanation
Form 990, Part VI, Line 15a & 15B - COMPENSATION REVIEW	WAYNE MEMORIAL HEALTH SYSTEM, INC., (AND ALL RELATED ENTITIES) UTILIZES A COMPENSATION COMMITTEE OF THE BOARD TO SET COMPENSATION OF ITS CEO AND OTHER SENIOR MANAGERS, INCLUDING CFO, DIRECTOR OF PATIENT CARE SERVICES, DIRECTOR OF HUMAN RESOURCES, DIRECTOR OF FACILITY SERVICES, DIRECTOR OF ANCILLARY SERVICES AND THE EXECUTIVE DIRECTOR OF THE WAYNE MEMORIAL HEALTH FOUNDATION. THE COMPENSATION COMMITTEE IS MADE UP OF INDEPENDENT DIRECTORS, WHO, WITH THE ASSISTANCE OF A NATIONAL COMPENSATION CONSULTING FIRM, UTILIZE COMPARABLE DATA FROM THE MARKETPLACE, LOOKING AT SUCH THINGS AS COMPARABLE ORGANIZATIONS IN TERMS OF REVENUE, SIZE, COMPLEXITY AND GEOGRAPHIC REGION. THE ORGANIZATION HAS ADOPTED A PHILOSOPHY OF PAYING AT THE 50TH PERCENTILE OF THE MARKETPLACE. ALL MEETINGS OF THE COMPENSATION COMMITTEE ARE DOCUMENTED AND MINUTES ARE MAINTAINED OF THE DELIBERATION AND DECISION-MAKING PROCESS. THE PROCESS NORMALLY OCCURS FROM JUNE TO OCTOBER OF THE YEAR THE COMPENSATION CHANGES ARE GRANTED.
Form 990, Part VI, Line 6 7A & 7B - MEMBERS OR STOCKHOLDERS	WAYNE MEMORIAL HEALTH SYSTEM INC. (THE SYSTEM), A RELATED ORGANIZATION AND A PENNSYLVANIA NONPROFIT CORPORATION, IS THE SOLE MEMBER OF WAYNE MEMORIAL HOSPITAL. WAYNE MEMORIAL HEALTH SYSTEM, INC. IS ENTITLED TO APPROVE THE ELECTION OF THE BOARD MEMBERS AND OFFICERS OF WAYNE MEMORIAL HOSPITAL, INC. ALL OF WHOM SHALL BE APPROVED BY WAYNE MEMORIAL HEALTH SYSTEM, INC, A RELATED ORGANIZATION. THE FOLLOWING DECISIONS OF THE GOVERNING BODY ARE SUBJECT TO APPROVAL BY WAYNE MEMORIAL HEALTH SYSTEM, INC.: (A) AMENDMENT OF THE BYLAWS OR THE ARTICLES OF CORPORATION (B) MERGER OR CONSOLIDATION WITH ANY OTHER ENTITY (C) DISSOLUTION AND DISTRIBUTION OF ASSETS IN CONNECTION THEREWITH (D) ELECTION OF OFFICERS OF THIS CORPORATION (E) ADOPTION OF INVESTMENT POLICIES AND SELECTION OF INVESTMENT ADVISORS (F) INVESTMENT OF RESTRICTED GIFTS (G) SELECTION OF AUDITORS AND ATTORNEYS (H) ADOPTION OF OPERATING AND CAPITAL BUDGETS (I) APPROVAL OF FUND-RAISING PROGRAMS (J) DONATION OR TRANSFER OF ANY ASSET WITH AN AGGREGATE VALUE IN EXCESS OF SUCH AMOUNT AS MAY BE DETERMINED BY THE BOARD OF WAYNE MEMORIAL HEALTH SYSTEM FROM TIME TO TIME (K) CREATION OF ANY LIEN OR SECURITY INTEREST IN ASSETS OF THE CORPORATION (L) DESIGNATION OR RESTRICTION OF GIFTS WITH A MARKET VALUE IN EXCESS OF SUCH AMOUNT AS MAY BE DETERMINED BY THE BOARD OF WAYNE MEMORIAL HEALTH SYSTEM FROM TIME TO TIME, AND (M) ANY OTHER MATTER THAT WOULD REQUIRE THE APPROVAL OF THE MEMBERS OF A PENNSYLVANIA NONPROFIT CORPORATION.
Form 990, Part VI, Line 2 FAMILY/BUSINESS RELATIONSHIPS AMONGST INTERESTED PERSONS	HUGH RECHNER (BOARD CHAIRMAN) HAS A FAMILY RELATIONSHIP WITH CHRISTINE RECHNER, A TRUSTEE OF WAYNE MEMORIAL HOSPITAL, CHAIR OF THE WAYNE MEMORIAL LONG TERM CARE, AND MEMBER OF THE SYSTEM BOARD BY VIRTUE OF POSITION. JAMES PETTINATO (CEO), TIM HUBER (CHIEF FACILITIES OFFICER), JAMES HOCKENBURY (CHIEF OF ANCILLARY SERVICES), AND PATRICIA DUNSINGER (CFO), ARE COMPENSATED BY WAYNE MEMORIAL HEALTH SYSTEM, A RELATED ORGANIZATION. JAMES PETTINATO (CEO) SERVES ON THE BOARD OF TRUSTEES OF THE ORGANIZATION THAT EMPLOYS MARY BETH WOOD, A TRUSTEE OF WAYNE MEMORIAL HOSPITAL. BRAD KIESENDAHL (TRUSTEE) HAS A FAMILY RELATIONSHIP WITH BROOKE JAMES, A TRUSTEE OF WAYNE MEMORIAL HEALTH FOUNDATION INC., A RELATED ORGANIZATION.
Form 990, Part VI, Line 3 Delegation of management duties	WAYNE MEMORIAL HEALTH SYSTEM, INC., PROVIDES MANAGEMENT OVER THE ORGANIZATION THROUGH DIRECT EMPLOYMENT OF THE DIRECTORS AND OFFICERS OF THE ORGANIZATION. THE MANAGEMENT SERVICES PROVIDED ARE REIMBURSED TO WAYNE MEMORIAL HEALTH SYSTEM THROUGH A MANAGEMENT FEE.
Form 990, Part VI, Line 11b Review of form 990 by governing body	THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM BASED ON THE AUDITED FINANCIAL STATEMENTS AND INFORMATION PROVIDED BY THE ACCOUNTING DEPARTMENT OF THE ORGANIZATION. A COPY OF THE FORM 990 WILL BE REVIEWED WITH THE FINANCE COMMITTEE WHICH IS RESPONSIBLE FOR THE FINANCIAL OVERSIGHT OF ALL ENTITIES OF THE WAYNE MEMORIAL HEALTH SYSTEM. A COPY OF THE 990 WILL BE DISTRIBUTED VIA E-MAIL TO EACH BOARD MEMBER BEFORE THE RETURN IS SUBMITTED TO THE IRS. MANAGEMENT WILL DISCUSS ANY QUESTIONS THAT ANY BOARD MEMBER MAY HAVE AT THE NEXT FULL BOARD MEETING.
Form 990, Part VI, Line 12c Conflict of interest policy	CONFLICT OF INTEREST STATEMENTS ARE COMPLETED BY EVERY BOARD MEMBER AND MANAGER ANNUALLY. EACH INDIVIDUAL IS REQUIRED TO SIGN AND RETURN THE STATEMENTS TO THE ADMINISTRATION OFFICE. THE AUDIT COMMITTEE IS RESPONSIBLE FOR MONITORING COMPLIANCE WITH ANY CONFLICT OF INTEREST THROUGHOUT THE YEAR. IF A CONFLICT ARISES, THE PERSON WITH THE CONFLICT WILL RECUSE THEMSELVES FROM VOTING AND/OR DISCUSSING THE MATTER.
Form 990, Part VI, Line 19 Required documents available to the public	THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND/OR FINANCIAL STATEMENTS AVAILABLE TO PUBLIC UPON REQUEST.
Form 990, Part IX, Line 11g Other Fees	PROFESSIONAL SERVICE FEES - Total Expense: 9846688, Program Service Expense: 9846688, Management and General Expenses: , Fundraising Expenses: ; TEMPORARY/LEASED EMPLOYEE - Total Expense: 7138326, Program Service Expense: 7137047, Management and General Expenses: 1279, Fundraising Expenses: ; PURCHASED SERVICE FEES - Total Expense: 5476565, Program Service Expense: 3696606, Management and General Expenses: 1779959, Fundraising Expenses: ; COLLECTION EXPENSES - Total Expense: 250783, Program Service Expense: 6347, Management and General Expenses: 244436, Fundraising Expenses: ; MAINTENANCE CONTRACTS - Total Expense: 155435, Program Service Expense: 155435, Management and General Expenses: , Fundraising Expenses: ; TRUSTEE FEES - Total Expense: 16027, Program Service Expense: , Management and General Expenses: 16027, Fundraising Expenses: ;
Form 990, Part XI, Line 9 Other changes in net assets or fund balances	CHANGE IN DEFINED BENEFIT PENSION PLAN - 1360448; TRANSFER FROM AFFILIATE - 8869; CHANGE IN INTEREST IN NET ASSETS OF FOUNDATION - 7485; CHANGE IN BENEFICIAL INTEREST IN PERPETUAL TRUST - -104669;