2026-05-15T12:37:51+00:00 2025-06-30 440160260 Forvis Mazars LLP 910 E St Louis 200 PO Box 1190 Springfield MO 658062523 990 2024-07-01 240798681 BARNES-KASSON COUNTY HOSPITAL BARN 5708533135 2872 TURNPIKE STREET SUSQUEHANNA PA 18847 JAMES PETTINATO CEO 5702538100 2026-05-15 true true Brian Todd P00422601 4178658701 2026-05-15 2024 2025-03-06 01:10:19Z JAMES PETTINATO 601 PARK STREET HONESDALE PA 18431 18013280 false X WWW.BARNES-KASSON.ORG X 1904 PA BARNES-KASSON COUNTY HOSPITAL IS A 501(C)(3) NON-PROFIT HOSPITAL. AS SUCH, OUR FACILITY'S MISSION IS TO PROVIDE ACCESS TO AFFORDABLE HIGH QUALITY HEALTH CARE SERVICES IN OUR RURAL COMMUNITY. (SEE ON SCHEDULE O) 9 7 265 9 0 0 1732598 169827 17445329 17787582 14809 20579 334186 28950 19526922 18006938 0 0 0 9861795 9807084 0 0 0 10582124 8721148 20443919 18528232 -916997 -521294 9705610 10288190 3889088 3991536 5816522 6296654 BARNES-KASSON COUNTY HOSPITAL IS A 501 (C)(3) NON-PROFIT HOSPITAL. AS SUCH, OUR FACILITIES MISSION IS TO PROVIDE ACCESS TO AFFORDABLE, HIGH QUALITY HEALTH CARE SERVICES TO THE POPULATION OF RURAL SUSQUEHANNA COUNTY AND SURROUNDING AREAS. (SEE ON SCHEDULE O) false false 16386975 0 17787582 BARNES-KASSON COUNTY HOSPITAL PROVIDES HEALTH CARE SERVICES TO THE POPULATION OF RURAL SUSQUEHANNA COUNTY AND SURROUNDING AREAS. OUR FACILITY PROVIDES AN ARRAY OF HEALTH CARE SERVICES, INCLUDING EMERGENCY CARE, RADIOLOGY, LABORATORY, PHYSICAL AND OCCUPATIONAL THERAPY, AND SKILLED NURSING. OUR FACILITY'S RURAL HEALTH CLINIC PROVIDES PRIMARY/SPECIALTY PHYSICIAN AND DENTAL SERVICES. THE DENTISTRY SERVICE PROVIDED IN THE RURAL HEALTH CLINIC IS THE ONLY DENTISTRY SERVICE IN THE IMMEDIATE AREA THAT PROVIDES SERVICE TO MEDICAID BENEFICIARIES. DURING THE 2025 FISCAL YEAR, WE HAD 313 INPATIENT ADMISSIONS. OF THOSE, 172 WERE MEDICARE RECIPIENTS AND 14 WERE MEDICAID RECIPIENTS. THE SKILLED NURSING FACILITY PROVIDED 12,845 DAYS OF SERVICE. 16386975 true true false false false false false false false false true false false true true false false true false false false false false false false false true true false false true false false false false false false false false true false false false false false false true false false false false true 22 0 true 265 true false false false false false false false false false false false false X 9 7 false true true false true true true true true false false false true true true true true true false false false false PA X JAMES PETTINATO 5702538100 601 PARK STREET HONESDALE PA 18431 JOSEPH WHITE VICE PRESIDENT 0.5 0 X X 0 0 0 PATRICK AHEARN PRESIDENT 1.0 0.5 X X 0 0 0 CHARLES ALIANO ESQ TRUSTEE/ATTORNEY 20.0 0 X 39998 0 0 DONALD BUTTON TRUSTEE 0.5 0 X 0 0 0 GEORGE STOVER III TRUSTEE 0.5 0 X 0 0 0 LAURETTA CLOWES TRUSTEE END 02/25 0.5 0 X 0 0 0 PRAVINCHANDRA PATEL MD TRUSTEE/MEDICAL STAFF PRES 40.0 0 X 415995 0 0 ROBERT PAGE TRUSTEE 0.5 0 X 0 0 0 ROSARIA ARMETTA TRUSTEE 0.5 0 X 0 0 0 JAMES PETTINATO WMHS CHIEF EXECUTIVE OFFICER 0.1 40.0 X 0 353924 54007 KELLI KANE CHIEF FINANCIAL OFFICER 40.0 0 X 98281 0 25109 PATRICIA DUNSINGER WMHS CHIEF FINANCIAL OFFICER 1.0 40.0 X 0 211723 12763 SARA ADORNATO EXECUTIVE DIRECTOR 40.0 0 X 132633 0 25109 AMY VIVONA DON/RNAC 40.0 0 X 148764 0 15401 BHUPENDRA PATEL MD PHYSICIAN 40.0 0 X 599249 0 22004 DANIEL COSTER MD PHYSICIAN 40.0 0 X 297977 0 0 KIRK HINKLEY MD PHYSICIAN 40.0 0 X 356067 0 16511 PATRICK MACCONNELL DPM PHYSICIAN 40.0 0 X 146779 0 9168 2235743 565647 180072 13 false true false Computer Programs and Systems PO Box 850309 Mobile AL 36685 Computer Program Support 382100 Qualivis LLC PO Box 674913 Dallas TX 75267 Staffing Agency 188191 Blue Ridge Family Health LLC PO Box 602 New Milford PA 18834 Nurse Practioner Services 141800 TQCS LLC 2533 Tingley Lake Rd New Milford PA 18834 Cleaning Services 112535 K4MD Inc 880 Colwell Rd Susquehanna PA 18847 Emergency Department Physician 103850 6 143000 26827 169827 NET PATIENT SERVICE REVENUE 623000 12843775 12843775 PA RURAL HEALTH MODEL REVENUE 623000 4783858 4783858 PHARMACY REVENUE 446110 88743 88743 CAFETERIA 722514 46041 46041 OTHER REVENUE 900099 25165 25165 0 0 0 0 17787582 26921 26921 28950 28950 0 28950 28950 0 6342 0 -6342 -6342 -6342 0 0 0 0 0 18006938 17787582 0 49529 X 737125 415995 321130 7413297 6825491 587806 922365 816969 105396 734297 616809 117488 4327046 3877215 449831 0 530188 213679 316509 3154 2649 505 432689 378908 53781 2516 1443 1073 8279 7983 296 106986 89868 17118 588104 494007 94097 335406 281741 53665 MEDICAL SUPPLIES & DRUGS 2224823 2224823 REPAIRS & MAINTENANCE 136902 118349 18553 LICENSES, DUES, SUBCRIPTIONS 25055 21046 4009 0 0 0 0 18528232 16386975 2141257 0 1456159 94004 10000 1436911 3164435 2173789 0 0 240800 152541 102635 99892 5159320 588104 2693412 4571216 38781 0 367582 0 162000 2038169 1191474 9705610 10288190 2673316 1939498 0 668382 411891 547390 1640147 3889088 3991536 X 5816522 6296654 5816522 6296654 9705610 10288190 X -521294 1001426 X false true true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 85000 85000 3725263 324668 3400595 1145386 222741 922645 203671 40695 162976 4571216 DUE FROM THIRD PARTY 1191474 1191474 Federal Income Taxes DUE TO THIRD PARTY 1130159 ROU LIABILITY 509988 1640147 0 0 0 0 0 0 0 0 0 0 0 0 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. true true true X true X 44025 44025 0.00238 2734465 537773 2196692 0.11856 0 0.0 0 0 2778490 537773 2240717 0.12094 8180 1040 7140 0.00039 0 0.0 0 0.0 0 0.0 0 0.0 0 0 8180 1040 7140 0.00039 0 0 2786670 538813 2247857 0.12132 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0 0 0 0 0.0 true 1232505 9452 2120016 6087198 -3967182 X true true 1 1 BARNES-KASSON COUNTY HOSPITAL 2872 TURNPIKE ST SUSQUEHANNA PA 18847 WWW.BARNES-KASSON.ORG 02050101 X X X X SKILLED NURSING FACILITY 1 1 1 false false true X X X X X X X X X 24 true false false true X WWW.BARNES-KASSON.ORG X true 24 true WWW.BARNES-KASSON.ORG false true X 200.0 300.0 true true X X X true X HTTP://WWW.BARNES-KASSON.ORG/INDEX.PHP/RESOURCES/INSURANCE-AND-PAYMENT X HTTP://WWW.BARNES-KASSON.ORG/INDEX.PHP/RESOURCES/INSURANCE-AND-PAYMENT X HTTP://WWW.BARNES-KASSON.ORG/INDEX.PHP/RESOURCES/INSURANCE-AND-PAYMENT X X X X true X false X true X false false Schedule H, Part V, Section B, Line 5 Facility 1, 1 Facility 1, 1 - BARNES-KASSON COUNTY HOSPITAL. A COMMITTEE OF HEALTH PROFESSIONALS AND ADMINISTRATIVE PROFESSIONALS WAS FORMED, AT BARNES-KASSON, TO ASSESS THE HEALTH NEEDS OF THE COMMUNITY. AFTER LOOKING AT THE DEMOGRAPHICS OF OUR SERVICE AREA, A SURVEY WAS CREATED THAT WE DETERMINED WOULD HELP ASSESS THE COMMUNITY'S HEALTH NEEDS. IN TODAY'S TECHNOLOGICALLY ADVANCED WORLD, WE DECIDED TO MAKE OUR SURVEY AVAILABLE ONLINE WITH THE USE OF AN ONLINE SURVEY BUILDING WEBSITE CALLED SURVEYMONKEY.COM. THIS WEBSITE ALLOWED US TO CREATE OUR SURVEY EXACTLY AS WE WANTED, AS WELL AS KEEPING TRACK OF THE RESPONSES AND COMPILING THE RESULTS ONCE WE REMOVED THE SURVEY. Schedule H, Part V, Section B, Line 11 Facility 1, 1 Facility 1, 1 - BARNES-KASSON COUNTY HOSPITAL. ALTHOUGH BARNES-KASSON COUNTY HOSPITAL RECOGNIZES THE IMPORTANCE OF ALL THE NEEDS IDENTIFIED BY THE COMMUNITY, CERTAIN NEEDS ARE NOT WITHIN THE PURVIEW OF BKH AND ARE THEREFORE NOT ADDRESSED. THE IMPLEMENTATION STRATEGY DESCRIBES THE NEEDS BEING MET, AS WELL AS THE ORGANIZATION RESPONSIBLE TO ADDRESS THE IDENTIFIED NEEDS AND THE STRATEGY TO ADDRESS SUCH NEEDS. 0 Schedule H, Part III, Line 3 Bad Debt Expense Methodology THIS AMOUNT IS FOR FUNDS DIRECTLY WRITTEN OFF TO BAD DEBT ONCE DEEMED UNCOLLECTABLE. 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 A COST-TO-CHARGE RATIO CALCULATED FROM WORKSHEET 2, RATIO OF PATIENT CARE COSTS-TO-CHARGES IS THE COSTING METHODOLOGY USED TO DETERMINE THE AMOUNTS REPORTED ON PART III, LINE 6. Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance WHEN AN ACCOUNT IS REGISTERED AS A CASH ACCOUNT AND IS DEEMED THE RESPONSIBILITY OF THE PATIENT, THE ACCOUNT IS CROSS REFERENCED WITH THE HOSPITAL CHARITY CARE PROGRAM TO BE SURE THAT ANY ADJUSTMENT DUE HAS BEEN CORRECTLY TAKEN. IF THE PATIENT IS NOT INCLUDED IN THE ROSTER, A CASH LETTER IS THEN MAILED TO THE PATIENT WITH THE INITIAL BILLING. THIS LETTER ASKS THAT THE PATIENT CONTACT THE OFFICE REGARDING ANY AVAILABLE INSURANCE INFORMATION NOT GIVEN AT TIME OF SERVICE AND POSSIBLE COMPLETION OF APPLICATION FOR MEDICAL ASSISTANCE AND ANY BARNES- KASSON PROGRAMS SUCH AS CHARITY CARE Schedule H, Part V, Section B, Line 16a FAP website 1 - BARNES-KASSON COUNTY HOSPITAL: Line 16a URL: HTTP://WWW.BARNES-KASSON.ORG/INDEX.PHP/RESOURCES/INSURANCE-AND-PAYMENT; Schedule H, Part V, Section B, Line 16b FAP Application website 1 - BARNES-KASSON COUNTY HOSPITAL: Line 16b URL: HTTP://WWW.BARNES-KASSON.ORG/INDEX.PHP/RESOURCES/INSURANCE-AND-PAYMENT; Schedule H, Part V, Section B, Line 16c FAP plain language summary website 1 - BARNES-KASSON COUNTY HOSPITAL: Line 16c URL: HTTP://WWW.BARNES-KASSON.ORG/INDEX.PHP/RESOURCES/INSURANCE-AND-PAYMENT; Schedule H, Part VI, Line 2 Needs assessment THE COMMUNITY THAT THE HOSPITAL SERVES IS SUSQUEHANNA COUNTY, PA AND CONTIGUOUS AREAS OF WAYNE COUNTY, PA, AND BROOME AND DELAWARE COUNTIES, NY. A LARGE MAJORITY OF THE SERVICES PROVIDED ARE FOR GOVERNMENT MEDICALLY ASSISTED HEALTH CARE NEEDS AND ARE DISCUSSED AT MONTHLY MEDICAL STAFF AND DEPARTMENT HEAD MEETINGS. IN ATTENDANCE ARE HOSPITAL, SKILLED AND FAMILY HEALTH CLINIC ADMINISTRATORS, PHYSICIANS, NURSES, AND DEPARTMENT HEADS OF THE HOSPITAL. NEEDS ARE ASSESSED BASED UPON EXPERIENCE, EDUCATION, OBSERVATION, RESEARCH, AND KNOWLEDGE AND UNDERSTANDING OF PATIENTS' NEEDS. THE BOARD OF DIRECTORS' MEETING HELD BI-MONTHLY IS ALSO A FORUM FOR COMMUNITY NEEDS DISCUSSION. THERE IS A PUBLIC MEETING OFFERED ONCE A YEAR AND ADVERTISED INVITING COMMUNITY. Schedule H, Part VI, Line 3 Patient education of eligibility for assistance WHEN OUT-PATIENT SERVICES ARE REGISTERED, IF A PATIENT DOES NOT HAVE INSURANCE THEY ARE ASKED TO COMPLETE AN APPLICATIONS FOR BOTH MEDICAL ASSISTANCE AND CHARITY CARE. THEY ARE THEN REFERRED TO A BARNES-KASSON SOCIAL WORKER. SOCIAL SERVICES SPEAKS TO IN-PATIENTS AT DISCHARGE AND EVALUATES THE ABOVE MENTIONED CRITERIA. Schedule H, Part VI, Line 4 Community information THE COMMUNITY THAT THE HOSPITAL SERVES IS SUSQUEHANNA COUNTY, PA AND CONTIGUOUS AREAS OF WAYNE COUNTY, PA, AND BROOME AND DELAWARE COUNTIES, NY. ACCORDING TO THE 2024 PENNSYLVANIA ABSTRACT OF THE US CENSUS REPORTING, SUSQUEHANNA COUNTY'S MEDIAN FAMILY INCOME RANKED 31ST POOREST OUT OF 67 COUNTIES. IN THE 2024 CENSUS, MEDIAN HOUSEHOLD INCOME IS $39,983. THIS MAKES THE AVERAGE HOUSEHOLD INCOME APPROXIMATELY 12.1% OF POVERTY. Schedule H, Part VI, Line 5 Promotion of community health COMBINING HOMETOWN QUALITY WITH NEW TECHNOLOGY, BARNES-KASSON HOSPITAL OFFERS A WIDE RANGE OF MEDICAL, SURGICAL, DIAGNOSTIC AND REFERRAL SERVICES, AS WELL AS FAMILY-CENTERED CARE, CORONARY/INTENSIVE CARE, OUTPATIENT REHABILITATION (INCLUDING PHYSICAL AND OCCUPATIONAL THERAPY AND SPORTS MEDICINE), A 58-BED SKILLED-NURSING FACILITY, AND 24-HOUR EMERGENCY CARE. THE HOSPITAL ALSO OPERATES THREE RURAL HEALTH CLINICS. THE RURAL HEALTH CLINICS ARE PHYSICIAN OFFICES OFFERING A WIDE VARIETY OF PRIMARY AND SPECIALTY CARE SERVICES. SOME OF THE SERVICES AVAILABLE ARE INTERNAL MEDICINE, FAMILY MEDICINE, DENTAL, AND CARDIOLOGY. THE HOSPITAL MAINTAINS STRONG TIES WITH OTHER LOCAL BUSINESSES AND DEVELOPS EFFECTIVE PROGRAMS TO MEET THEIR NEEDS THOUGH ITS INDUSTRIAL HEALTH SERVICES PROGRAM. BARNES-KASSON COUNTY HOSPITAL IS AN ACTIVE HEALTH INFORMATION AND EDUCATION RESOURCE FOR THE ENTIRE COUNTY. 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, WAYNE MEMORIAL LONG TERM CARE (WMLTC, WHICH OPERATES WAYNE WOODLANDS MANOR), AND WAYNE MEMORIAL HOSPITAL. WAYNE MEMORIAL HOSPITAL IS A NOT-FOR-PROFIT HOSPITAL THAT OPERATES A 90-BED ACUTE CARE INPAITIENT, A WIDE VARIETY OF OUTPATIENT SERVICES, AND 24 HOUR EMERGENCY CARE SERVICES. 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. 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 ADMINISTRATIVELY. WMCHC SERVES A NUMBER OF MEDICALLY UNDERSERVED AREAS AND POPULATIONS. 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. X X false false false false false false false false false PRAVINCHANDRA PATEL MD TRUSTEE/MEDICAL STAFF PRES 415995 0 0 0 0 0 0 0 0 0 415995 0 0 0 JAMES PETTINATO WMHS CHIEF EXECUTIVE OFFICER 0 330924 0 0 0 23000 0 32096 0 21911 0 407931 0 0 PATRICIA DUNSINGER WMHS CHIEF FINANCIAL OFFICER 0 211723 0 0 0 0 0 12763 0 0 0 224486 0 0 SARA ADORNATO EXECUTIVE DIRECTOR 132633 0 0 0 0 0 0 0 25109 0 157742 0 0 0 DANIEL COSTER MD PHYSICIAN 297977 0 0 0 0 0 0 0 0 0 297977 0 0 0 KIRK HINKLEY MD PHYSICIAN 356067 0 0 0 0 0 0 0 16511 0 372578 0 0 0 PATRICK MACCONNELL DPM PHYSICIAN 146779 0 0 0 0 0 0 0 9168 0 155947 0 0 0 BHUPENDRA PATEL MD PHYSICIAN 599249 0 0 0 0 0 0 0 22004 0 621253 0 0 0 AMY VIVONA DON/RNAC 148764 0 0 0 0 0 0 0 15401 0 164165 0 0 0 JOSEPH ADORNATO SARA ADORNATO'S SPOUSE 90372 EDUCATION DIRECTOR WAGES false MICHAEL IVESON SARA ADORNATO'S BROTHER 66630 FACILITY MANAGER WAGES false ROBERT IVESON SARA ADORNATO'S BROTHER 48097 RADIOLOGY TECHNICIAN WAGES false LEXIS IVESON SARA ADORNATO'S NIECE 1913 EMT WAGES false MATTHEW KANE KELLI KANE'S SON 22291 RADIOLOGY ASSISTANT WAGES false BENEDICT KANE KELLI KANE'S SON 46660 QUALITY ASSURANCE ASSISTANT WAGES false AMANDA IVESON SARA ADORNATO'S NIECE 3771 NURSING ASSISTANT WAGES false Form 990, Part I, Line 1 BRIEF MISSION OUR FACILITY PROVIDES AN ARRAY OF HEALTH CARE SERVICES, INCLUDING EMERGENCY CARE, RADIOLOGY, LABORATORY, PHYSICAL AND OCCUPATIONAL THERAPY, AND SKILLED NURSING. OUR FACILITY'S RURAL HEALTH CLINIC PROVIDES PRIMARY/SPECIALTY PHYSICIAN AND DENTAL SERVICES. THE DENTISTRY SERVICE PROVIDED IN THE RURAL HEALTH CLINIC IS THE ONLY DENTISTRY SERVICE IN THE IMMEDIATE AREA THAT PROVIDES SERVICE TO MEDICAID BENEFICIARIES. Form 990, Part III, Line 1 ORGANIZATION'S MISSION OUR FACILITY PROVIDES AN ARRAY OF HEALTH CARE SERVICES, INCLUDING EMERGENCY CARE, RADIOLOGY, LABORATORY, PHYSICAL AND OCCUPATIONAL THERAPY, AND SKILLED NURSING. OUR FACILITY'S RURAL HEALTH CLINIC PROVIDES PRIMARY/SPECIALTY PHYSICIAN AND DENTAL SERVICES. THE DENTISTRY SERVICE PROVIDED IN THE RURAL HEALTH CLINIC IS THE ONLY DENTISTRY SERVICE IN THE IMMEDIATE AREA THAT PROVIDES SERVICE TO MEDICAID BENEFICIARIES. 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 BARNES-KASSN COUNTY 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 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. Form 990, Part VI, Line 4 Significant changes to organizational documents BARNES-KASSON COUNTY HOSPITAL'S GOVERNING DOCUMENTS WERE UPDATED TO REFLECT THEIR ACQUISITION BY WAYNE MEMORIAL HEALTH SYSTEM, THE SOLE MEMBER. WAYNE MEMORIAL HEALTH SYSTEM'S RESPONSIBILITIES INCLUDE ELECTING ONE-FOURTH OF THE NON-EX-OFFICIO TRUSTEES, APPROVING THE BOARD OF TRUSTEES, ETC. 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 THESE FORMS ARE ON OUR WEBSITE AND ARE PRESENTED UPON REQUEST. Form 990, Part IX, Line 11g Other Fees PROFESSIONAL FEES - Total Expense: 2985551, Program Service Expense: 2868551, Management and General Expenses: 117000, Fundraising Expenses: ; CONTRACT SERVICES - Total Expense: 1116907, Program Service Expense: 803486, Management and General Expenses: 313421, Fundraising Expenses: ; PURCHASE FEES - Total Expense: 99795, Program Service Expense: 95255, Management and General Expenses: 4540, Fundraising Expenses: ; PROCESSING FEES - Total Expense: 80423, Program Service Expense: 67555, Management and General Expenses: 12868, Fundraising Expenses: ; OTHER SERVICES - Total Expense: 44370, Program Service Expense: 42368, Management and General Expenses: 2002, Fundraising Expenses: ; Form 990, Part XI, Line 9 Other changes in net assets or fund balances ASSET ADJUSTMENT FOR WAYNE MEMORIAL HEALTH SYSTEM ACQUISITION - 1001426; Total - 1001426; WAYNE MEMORIAL HEALTH SYSTEM INC 601 PARK STREET HONESDALE PA 18431 232221292 OVERSIGHT PA 501(c)(3) Type II NA false WAYNE MEMORIAL HEALTH FOUNDATION INC 601 PARK STREET HONESDALE PA 18431 232208596 FUNDRAISING PA 501(c)(3) Type I WMHS false WAYNE MEMORIAL LONG TERM CARE 37 WOODLANDS DRIVE WAYMART PA 18472 232719336 NURSING HOME PA 501(c)(3) 10 WMHS false WAYNE MEMORIAL HOSPITAL 601 PARK STREET HONESDALE PA 18431 240798839 HOSPITAL PA 501(c)(3) 3 WMHS false false false false false true false false false false false false true false true true false false false