| FORM 990, PART III, LINE 4A |
PROGRAM SERVICE ACCOMPLISHMENTS, ACTIVITY #1: IF A PATIENT NEEDS A RIDE TO SEE THE DOCTOR OR GET OTHER HELP, THE MEDICAL ASSISTANCE TRANSPORTATION SERVICE OF CHS CAN FACILITATE. RIDES CAN BE ANYWHERE IN CRAWFORD COUNTY. SOME TRIPS TO PLACES OUTSIDE THE COUNTY ARE PERMITTED. PATIENTS MIGHT BE ELIGIBLE FOR RIDES AT NO CHARGE TO THESE DESTINATIONS: PHYSICIANS, DENTISTS, PODIATRISTS, CHIROPRACTORS, MIDWIVES, OPTOMETRISTS, GENERAL HOSPITALS, PUBLIC PSYCHIATRIC HOSPITALS, REHABILITATION HOSPITALS, INDEPENDENT LABORATORIES, PHARMACIES, MEDICAL SUPPLIERS, INDEPENDENT MEDICAL/SURGICAL CLINICS, DRUG AND ALCOHOL CLINICS, FAMILY PLANNING CLINICS, HOME HEALTH AGENCIES, RURAL HEALTH AGENCIES, MENTAL HEALTH/PARTIAL HOSPITALIZATION, NURSING FACILITIES, HEALTH MAINTENANCE ORGANIZATIONS, RENAL DIALYSIS CENTERS, EPSDT PROVIDERS, EARLY INTERVENTION PROGRAMS, WOMEN, INFANTS & CHILDREN PROGRAMS, COUNSELING, COUNTY ASSISTANCE OFFICES, AND SOCIAL SECURITY OFFICES. ALL APPROVED TRIPS ARE FREE OF CHARGE. PATIENTS MAY NEED TO BE CURRENT HOLDERS OF A PENNSYLVANIA ACCESS CARD (ISSUED THROUGH THE MEDICAL ASSISTANCE PROGRAM OF THE STATE OF DEPARTMENT OF PUBLIC THE WELFARE.) THE PROGRAMS REIMBURSE FOR MILEAGE EXPENSE IF PATIENTS DRIVE THEIR OWN VEHICLE OR GET A FRIEND OR NEIGHBOR TO DRIVE THEM TO AN ALLOWABLE DESTINATION. IF PATIENTS HAVE NO OTHER MEANS OF TRAVEL, THE ORGANIZATION WILL ARRANGE A RIDE FOR THEM BY BUS OR VOLUNTEER DRIVER. IF THE PATIENT IS A CRAWFORD COUNTY RESIDENT AND IS MEDICAL ASSISTANCE ELIGIBLE, THE ORGANIZATION'S TRANSPORTATION PROGRAMS CAN PAY FOR TRIPS TO: -RECEIVE MEDICAL EVALUATION OR TREATMENT AT A PHYSICIAN'S OR DENTIST'S OFFICE, HOSPITAL, CLINIC OR OTHER HEALTH -CARE FACILITY -BUY PRESCRIPTION DRUGS AT A PHARMACY -PURCHASE MEDICAL EQUIPMENT FROM A SUPPLIER -OBTAIN SOCIAL SERVICES SUCH AS COUNSELING |
| FORM 990, PART III, LINE 4B |
PROGRAM SERVICE ACCOMPLISHMENTS, ACTIVITY #2: COMMUNITY HEALTH SERVICES, INC., OPERATES MEADVILLE DENTAL CENTER WHICH PROVIDES ROUTINE ORAL EXAMS, DENTAL CLEANING, FLUORIDE TREATMENTS, X-RAYS, SEALANTS ROOT PLANNING/PERIODONTICS, EXTRACTIONS, RESTORATIONS, LIMITED ROOT CANAL THERAPY, CROWNS/BRIDGES, SPACE MAINTAINERS, FULL AND PARTIAL DENTURE, AND DENTURE/PARTIAL REPAIRS AND RELINES. SERVICES ARE PROVIDED BY LICENSED DENTISTS AND DENTAL HYGIENISTS. |
| FORM 990, PART III, LINE 4C |
PROGRAM SERVICE ACCOMPLISHMENTS, ACTIVITY #3: CHS OVERSEES THE WOMEN, INFANTS AND CHILDREN NUTRITION (WIC) PROGRAM WHICH OFFERS NUTRITION COUNSELING, BREASTFEEDING INFORMATION AND SUPPORT, GROWTH CHECK-UPS FOR CHILDREN, AND HEALTHY FOODS AT NO COST FOR MOTHERS AND CHILDREN REGARDLESS OF HEALTH INSURANCE. WIC HAS BEEN HELPING FAMILIES IN PENNSYLVANIA FOR MORE THAN 30 YEARS. WIC MEANS HEALTHIER MOTHERS AND HEALTHIER CHILDREN. WIC PROVIDES FOODS LIKE MILK, EGGS, CEREAL, AND JUICE AT NO COST. WIC FAMILIES GET HEALTHY FOOD HIGH IN PROTEIN, IRON, VITAMIN C, AND CALCIUM THAT ARE GOOD FOR BRAIN DEVELOPMENT AND STRONG BONES AND MUSCLES. IN SOME AREAS, YOU MAY ALSO GET PENNSYLVANIA-GROWN FRUITS AND VEGETABLES. WIC IS FOR ALL FAMILIES. YOU CAN HAVE A JOB OR BE UNEMPLOYED. YOU CAN BE MARRIED, SINGLE, OR LIVE WITH YOUR PARENTS. FATHERS, MOTHERS, GUARDIANS, OR GRANDPARENTS MAY APPLY FOR CHILDREN UNDER AGE FIVE. CHILDREN UNDER AGE FIVE AND WOMEN WHO ARE PREGNANT, BREASTFEEDING OR RECENTLY HAD A BABY WHO ALSO HAVE A NUTRITIONAL NEED, LIVE IN PENNSYLVANIA AND MEET THE INCOME GUIDELINES ARE ELIGIBLE TO PARTICIPATE. WIC BRINGS MORE TO THE TABLE THAN GOOD FOOD, AT WIC YOU ALSO GET: -ANSWERS TO HEALTH, FOOD AND NUTRITION QUESTIONS SUCH AS HOW TO SAVE ON YOUR GROCERY BILL; EAT WHEN PREGNANT; FIX HEALTHY MEALS IN A HURRY, DEAL WITH PICKY EATERS -ONE ON ONE NUTRITION COUNSELING AS AVAILABLE -BREASTFEEDING INFORMATION AND SUPPORT -GROWTH CHECK-UPS FOR YOUR CHILDREN WITH HEALTHY SCREENINGS -RECIPES, NEWSLETTERS, EDUCATION MATERIALS -HEALTHY FOODS AT NO COST -INFORMATION ON OTHER SERVICES IN THE AREA AND REFERRALS TO COMMUNITY SERVICES |
| FORM 990, PART VI, SECTION A, LINE 3 |
MANAGEMENT DUTIES: THE ORGANIZATION'S PARENT ORGANIZATION, MEADVILLE MEDICAL CENTER (MMC), PROVIDES MANAGEMENT DUTIES. THE ORGANIZATION PAYS A MANAGEMENT FEE AS PART OF A CONTRACT WITH MMC, AS SHOWN IN FORM 990, PART IX, LINE 11A. |
| FORM 990, PART VI, SECTION A, LINES 6, 7A & 7B |
MEMBERS: THE ORGANIZATION'S PARENT ORGANIZATION, MEADVILLE MEDICAL CENTER (MMC) IS THE ORGANIZATION'S SOLE MEMBER. MMC SHALL HAVE THE POWER TO TAKE THE FOLLOWING ACTIONS WITH RESPECT TO CHS: (A) NOMINATE AND ELECT ALL OF THE OFFICERS AND DIRECTORS AND REMOVE AT ANY TIME, WITH OR WITHOUT CAUSE, ANY AND/OR ALL SUCH OFFICERS AND DIRECTORS; (B) APPROVE OR DISAPPROVE ANY CHANGE IN THE NUMBER OF DIRECTORS; (C) APPROVE OR DISAPPROVE ALL OPERATING AND CAPITAL BUDGETS AND AMENDMENTS THERETO; (D) APPROVE OR DISAPPROVE ALL AFFILIATIONS, MERGERS, AND OTHER TRANSACTIONS NOT IN THE ORDINARY COURSE OF BUSINESS; (E) APPROVE OR DISAPPROVE ALL AMENDMENTS TO ARTICLES OF INCORPORATION AND BYLAWS; (F) DIRECT THE CORPORATION TO MAKE CHANGES IN ITS BYLAWS AND/OR ARTICLES OF INCORPORATION AND IN THE ABSENCE OF SUCH ACTION BY THE CORPORATION, AMEND THE CORPORATION'S ARTICLES OF INCORPORATION AND/OR BYLAWS ON ITS OWN MOTION; (G) APPROVE OR DISAPPROVE ALL LONG RANGE PLANS; (H) APPROVE OR DISAPPROVE ALL INDEBTEDNESS (I) WHICH INDIVIDUALLY EXCEEDS AN AMOUNT ESTABLISHED BY MMC OR (II) IF SUCH INDIVIDUAL INDEBTEDNESS IS LESS THAN SAID AMOUNT, SUCH INDEBTEDNESS WHICH, WHEN ADDED TO THE AGGREGATE UNPAID BALANCE OF ALL OF THE CORPORATION'S OUTSTANDING INDEBTEDNESS (EXCLUSIVE OF MORTGAGED REAL ESTATE), CAUSES THE CORPORATION'S AGGREGATE INDEBTEDNESS TO EXCEED AN AMOUNT ESTABLISHED BY MMC FROM TIME TO TIME; AND (I) EXERCISE WHATEVER OTHER POWERS OR PERFORM SUCH OTHER TASKS AS ARE RESERVED TO OR REQUIRED OF MMC BY VIRTUE OF ANY OTHER PROVISIONS OF THE BYLAWS OR MMC'S BYLAWS OR BY RESOLUTIONS ENACTED BY THIS CORPORATION OR MMC FROM TIME TO TIME. |
| FORM 990, PART VI, SECTION B, LINE 11B |
FORM 990 REVIEW PROCESS: THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM BASED ON THE AUDITED FINANCIAL STATEMENTS AND INFORMATION PROVIDED BY THE ACCOUNTING DEPARTMENT OF THE ORGANIZATION. THE 990 IS INITIALLY INTERNALLY REVIEWED IN-DEPTH BY THE CFO AND CONTROLLER OF MEADVILLE MEDICAL CENTER. AFTER THIS REVIEW, IT IS PRESENTED BY THE CFO AND CONTROLLER TO THE BOARD OF DIRECTORS AT THE MONTHLY BOARD MEETING, PROVIDING OPPORTUNITIES FOR QUESTIONS, COMMENTS, OR CHANGES BEFORE THE FINAL FORM 990 IS FILED. |
| FORM 990, PART VI, SECTION B, LINE 12C |
MONITORING COMPLIANCE WITH CONFLICT OF INTEREST POLICY: THE ORGANIZATION HAS AN ANNUAL CONFLICT OF INTEREST DISCLOSURE STATEMENT. ANY ACTUAL OR POTENTIAL CONFLICTS ARE EVALUATED AND DEEMED TO EITHER MAKE THE INTERESTED PERSON DISQUALIFIED OR INELIGIBLE TO SERVE. THROUGHOUT THE YEAR, EACH AFFECTED PERSON IS ALSO OBLIGATED TO FILE A SUPPLEMENTARY DISCLOSURE STATEMENT IF THERE IS A CHANGE IN CIRCUMSTANCES WHICH COULD CREATE CONFLICT. DETERMINATION OF ACTUAL CONFLICT WILL BE CONDUCTED BY THE BOARD OF DIRECTORS. ANY DIRECTOR, OFFICER OR DISQUALIFIED PERSON WHO IS DEEMED BY THE BOARD TO BE DISQUALIFIED BECAUSE OF AN ACTUAL OR APPARENT CONFLICT OF INTEREST ON ANY MATTER (I) SHALL NOT VOTE OR USE HIS OR HER PERSONAL INFLUENCE ON THE MATTER, (II) SHALL ABSTAIN FROM VOTING (ALTHOUGH UPON INVITATION OF THE CHAIRMAN, HE OR SHE MAY PARTICIPATE IN BOARD DISCUSSIONS) AND (III) SHALL NOT BE COUNTED IN DETERMINING THE QUORUM FOR THE MEETING, EVEN WHEN PERMITTED BY LAW. THE MINUTES OF THE MEETING SHALL REFLECT THAT A DISCLOSURE WAS MADE, THE ABSTENTION FROM VOTING, AND THE EFFECT ON THE QUORUM. AN INDIVIDUAL WHO HAS A RELATIONSHIP WITH AN ENTITY THAT IN THE BOARD'S VIEW MAKES IT DIFFICULT OR IMPOSSIBLE FOR THAT INDIVIDUAL OR ANY OF THE REMAINING DIRECTORS TO DISCHARGE HIS OR HER RESPONSIBILITIES MAY BE DECLARED INELIGIBLE TO SERVE AND SHALL EITHER RESIGN OR MAY BE REMOVED BY A MAJORITY VOTE OF ALL REMAINING DIRECTORS IN OFFICE. |
| FORM 990, PART VI, SECTION B, LINE 15A & 15B |
COMPENSATION DETERMINATION: THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS OF MEADVILLE MEDICAL CENTER (MMC), WHICH IS COMPRISED OF INDEPENDENT BOARD MEMBERS DETERMINED TO BE FREE OF ANY CONFLICT OF INTEREST, IS CHARGED WITH DETERMINING EXECUTIVE COMPENSATION AND ESTABLISHING PERFORMANCE CRITERIA ACCORDING TO AN APPROVED COMPENSATION PHILOSOPHY. THE COMMITTEE WORKS WITH AN INDEPENDENT EXECUTIVE COMPENSATION CONSULTING AND ADVISORY FIRM, YAFFE & COMPANY, THAT PROVIDES MARKET SURVEY DATA CONCERNING COMPENSATION AND BENEFIT LEVELS FOR FUNCTIONALLY COMPARABLE HEALTHCARE EXECUTIVES IN SIMILAR HOSPITALS ACROSS THE REGION AND THE NATION BASED ON SEVERAL FACTORS INCLUDING SIZE, GEOGRAPHY, HOSPITAL TYPE AND COMPLEXITY. THE COMMITTEE REVIEWS AND APPROVES THE COMPENSATION OF THE SENIOR EXECUTIVES AND ENSURES THAT ALL FORMS OF EXECUTIVE COMPENSATION ARE REASONABLE, APPROPRIATE AND CONSISTENT WITH ITS COMPENSATION PHILOSOPHY. THE COMMITTEE CONTEMPORANEOUSLY DOCUMENTS ITS DECISIONS IN MEETING MINUTES AND REPORTS ITS DECISIONS TO THE FULL BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION C, LINE 19 |
DOCUMENT DISCLOSURE: UPON REQUEST, PHOTOCOPIES OF GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE FOR PICKUP BY SUCH REQUESTING PERSON. |
| FORM 990, PART XI, LINE 9 |
OTHER CHANGES IN NET ASSETS: $ 1,210,192 VALLEY DENTAL CLINIC NET ASSETS TRANSFERRED TO CVHC 5,344 TRANSFER FROM AFFILIATES ----------- $ 1,215,536 |
Attach to Form 990 or 990-EZ.