2025-05-05T10:57:52-05:00 2024-06-30 390859910 BAKER TILLY ADVISORY GROUP LP 20 STANWIX STREET PITTSBURGH PA 15222 990 2023-07-01 250965210 PUNXSUTAWNEY AREA HOSPITAL INC PUNX 8149381800 81 HILLCREST DRIVE PUNXSUTAWNEY PA 15767 MICHAEL F ICKOWSKI CFO 8149381800 2025-04-16 1 0 X KELLY A BROCIOUS CPA P01254262 4126976400 2025-04-16 X 2023 2025-03-06 01:10:19Z JOHN G SISK 81 HILLCREST DRIVE PUNXSUTAWNEY PA 15767 57829975 0 X WWW.PAH.ORG X 1889 PA VALUED AS HIGHEST QUALITY COMMUNITY HOSPITAL IN THE REGION AND PRIMARY HEALTH CARE PROVIDER, COMMITTED TO CONTINUOUSLY IMPROVING SERVICES WHILE CONTAINING COST. 13 8 494 9 0 0 2089318 339764 53195796 55850184 546116 805268 25021 623297 55856251 57618513 0 0 0 0 30813695 26874054 0 0 0 22731729 21316912 53545424 48190966 2310827 9427547 43878525 68438199 13288163 34802719 30590362 33635480 X TO PROVIDE HIGH QUALITY, COST EFFECTIVE, PRIMARY HEALTH CARE AND TO COORDINATE CARE FOR PATIENTS REQUIRING SECONDARY AND TERTIARY SERVICES. 0 0 32558034 49787172 PUNXSUTAWNEY AREA HOSPITAL PROVIDES ACUTE CARE INPATIENT AND OUTPATIENT HEALTH CARE TO PATIENTS IN A THREE COUNTY AREA. FOR THE FISCAL YEAR ENDED; THERE WERE 1,226 ADMISSIONS TO THE ACUTE CARE SETTING THAT GENERATED 3,809 PATIENT DAYS. THE HOSPITAL ALSO PROVIDED 88,852 OUTPATIENT VISITS TO PATIENTS. ALSO, THE HOSPITAL PROVIDED OVER $734,145 OF CHARITY CARE FOR 1,253 CUSTOMER ENCOUNTERS WHERE THE PATIENT DID NOT HAVE THE MEANS TO PAY FOR SERVICES RENDERED. NO PATIENTS WERE TURNED AWAY FOR LACK OF INSURANCE. SERVICES PROVIDED INCLUDE CARDIOPULMONARY, CLINICAL NUTRITION, COUNSELING, EMERGENCY, INTENSIVE CARE, SURGICAL, PHARMACY, RADIOLOGY, REHABILITATION, AND SHORT PROCEDURE. 2556727 3226858 PUNXSUTAWNEY AREA HOSPITAL PROVIDES HOME HEALTH CARE TO PATIENTS IN A THREE COUNTY AREA. FOR THE FISCAL YEAR ENDED THERE WERE 19,156 HOME HEALTH VISITS PROVIDED. NO PATIENTS WERE TURNED AWAY FOR LACK OF INSURANCE. THE HOME HEALTH CARE STAFF IS DEDICATED TO PROVIDING THE HIGHEST QUALITY OF PROFESSIONAL HOME HEALTH CARE TO THE PATIENTS THEY SERVE. THE STAFF WORKS WITH EACH PATIENT'S PHYSICIAN TO DEVELOP A DETAILED PLAN OF CARE PERSONALIZED TO THE PATIENT AND FAMILY. PROFESSIONAL NURSES NOT ONLY PROVIDE DIRECT PATIENT CARE, BUT ALSO PROVIDE COUNSELING/EDUCATION IN MEDICATIONS, NUTRITION, AND SPECIFIC DISEASES.SEE SCHEDULE O FOR ADDITIONAL INFORMATION.THE CARE IF THE PROVISION OF SKILLED SERVICES NEEDED BY THE PATIENT ON A DAILY BASIS, ORDERED BY A PHYSICIAN, REQUIRING CARE FURNISHED DIRECTLY BY OR UNDER SUPERVISION OF TECHNICAL OR PROFESSIONAL PERSONNEL, NOT LIMITED TO REGISTERED NURSES, LICENSED PRACTICAL NURSES, SPEECH PATHOLOGISTS, PHYSICAL THERAPISTS, AND OCCUPATIONAL THERAPISTS. THE CARE INCLUDES SKILLED NURSING, SKILLED REHABILITATION, OR RESTORATIVE CARE THAT BECAUSE OF SPECIAL MEDICAL CONDITIONS REQUIRED THAT THE CARE BE MONITORED BY OR UNDER THE DIRECT OBSERVATION AND ASSESSMENT OF SKILLED NURSING OR REHABILITATION PERSONNEL. 536020 2836154 PUNXSUTAWNEY AREA HOSPITAL PROVIDES SKILLED NURSING SERVICES TO PATIENTS IN A THREE COUNTY AREA. FOR THE FISCAL YEAR ENDED THERE WERE 158 ADMISSIONS INTO THE LONG-TERM CARE UNIT WHICH GENERATED 2,052 PATIENT DAYS. NO PATIENTS WERE TURNED AWAY FOR LACK OF INSURANCE. THE SERVICE PROVIDES SUPERVISED NURSING CARE, MEDICAL, AND OTHER HEALTH SERVICES TO INDIVIDUALS NOT IN NEED OF ACUTE INPATIENT HOSPITALIZATION, BUT WHOSE NEEDS CAN ONLY BE MET IN A SKILLED CARE FACILITY ON AN INPATIENT BASIS BECAUSE OF AGE, ILLNESS, DISEASE, INJURY, CONVALESCENCE, OR PHYSICAL OR MENTAL INFIRMITY. SEE SCHEDULE O FOR ADDITIONAL INFORMATION.PROGRAM ACHIEVEMENTS:SPECIALTY NURSING PROGRAMS INCLUDE: MATERNAL/CHILD CARE, IV THERAPY ANDENTEROSTOMAL CARE. IN ADDITION TO PROFESSIONAL NURSING SERVICES, THE AGENCY PROVIDES REHABILITATIVE SERVICES INCLUDING PHYSICAL, SPEECH, AND OCCUPATIONAL THERAPIES. 35650781 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 56 0 494 1 1 1 0 0 0 0 0 0 0 0 0 X 13 8 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 PA X MICHAEL F ICKOWSKI CFO 8149381800 81 HILLCREST DRIVE PUNXSUTAWNEY PA 15767 NATHAN KOVALCHICK CHAIRMAN 1.00 X X 0 0 0 T MICHAEL PRICE VICE CHAIRMAN 1.00 X X 0 0 0 FRANK ROBERTS SECRETARY 1.00 X X 0 0 0 REBECCA STAPLETON TREASURER 1.00 X X 0 0 0 STEPHEN A WOLFE DIRECTOR/PRESIDENT & CEO 1.00 39.00 X X 0 886903 46655 HILLARY CREELY DIRECTOR 1.00 X 0 0 0 RUSSELL A DROZDIAK MD DIRECTOR/PHYSICIAN 1.00 39.00 X 0 166992 5461 LAURIE A KUZNESKI DIRECTOR 1.00 X 0 0 0 JAMES R MARTIN DIRECTOR 1.00 X 0 0 0 TIMOTHY CLARK SIMPSON MD DIRECTOR/PHYSICIAN 39.00 1.00 X 561062 0 23229 TODD BRICE DIRECTOR 1.00 X 0 0 0 CHRISTINA LUBOLD MD DIRECTOR 1.00 39.00 X 0 37920 0 JOHN G SISK PRESIDENT 38.00 2.00 X X 299789 0 22014 ROBERT A GONGAWARE CFO 1.00 39.00 X 0 312538 48510 MICHAEL F ICKOWSKI CHIEF FINANCIAL OFFICER 1.00 39.00 X 0 193547 0 BRYAN DOVERSPIKE DO PHYSICIAN 40.00 X 431911 0 21442 EYAD KHABBAZ MD PHYSICIAN 40.00 X 761966 0 19478 KYLE LINGENFELTER MD PHYSICIAN 40.00 X 439407 0 21502 BRYAN DEMPSEY MD PHYSICIAN 40.00 X 400781 0 22773 MICHAEL STEVER DO PHYSICIAN 40.00 X 507033 0 13501 DANIEL D BLOUGH JR FORMER CEO 0.00 X 166614 0 2025 3568563 1597900 246590 45 1 1 0 LABORATORY CORP OF AMERICA HOLDINGS PO BOX 12140 BURLINGTON NC 16501 LAB SERVICES 572941 AYA HEALTHCARE INC DEPT 3519 PO BOX 123519 DALLAS TX 75312 STAFFING SERVICE 533913 CURA HOSPITALITY LLC 2400 ANSYS DRIVE SUITE 404 CANONSBURG PA 15317 FOOD SERVICE 470971 PENNSYLVANIA MOUNTAINS HEALTHCARE 150 MCCRACKEN RUN ROAD DUBOIS PA 15801 REVENUE CYCLE 360422 PLEXSUM STAFFING INC 1375 MARTIN ST SUITE 201 STATE COLLEGE PA 16803 STAFFING SERVICE 216246 12 339764 339764 NET PATIENT SERVICES REVENUE 621990 55252267 55252267 OTHER PROGRAM REVENUE 621990 597917 597917 55850184 800991 800991 353579 211462 142117 142117 142117 4277 0 4277 4277 4277 CONTRACTED LABOR REV. 541900 353148 353148 JV BILLING 900099 128032 128032 481180 57618513 55850184 0 1428565 1005612 1005612 20652363 16496437 4155926 595903 455261 140642 3157904 2462538 695366 1462272 1117155 345117 6765 6765 58973 58973 53833 53833 4150466 2658749 1491717 195342 195342 829792 619683 210109 410618 259047 151571 222971 222971 2850 2850 1751420 619307 1132113 673517 72496 601021 MEDICAL SUPPLIES & DRUG 9475721 9475721 REPAIRS & MAINTENANCE 1574977 289087 1285890 BAD DEBT EXPENSE 1113482 1113482 EQUIPMENT LEASED & RENT 634225 634225 161960 69912 92048 48190966 35650781 12540185 0 850860 1767514 3577234 1439842 5250054 5324454 132795 150931 1029173 818840 1518142 1564566 46503020 35460936 9001594 11042084 17703641 40399882 1669625 1708939 1113659 1113659 2031748 3107488 43878525 68438199 7526242 9048244 20812451 5761921 4942024 13288163 34802719 X 30111444 33257840 478918 377640 30590362 33635480 43878525 68438199 X 9427547 1239318 -1366758 -6254989 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 51000 0 1 2833 53833 0 PART II-B, LINE 1: A PORTION OF THE HOSPITAL'S DUES TO THE HOSPITAL & HEALTHSYSTEM ASSOCIATION OF PENNSYLVANIA (HAP) AND THE HOSPITAL 340 (B) HEALTH ARE USED FOR LOBBYING. 425029 40048 6100 458977 400171 34683 9825 425029 478570 -69098 16617 400171 383904 101982 7316 478570 409994 -17074 9016 383904 0.29310 0.70690 1 0 40000 40000 14638450 11189279 3449171 29901900 23110800 6791100 1922670 1160857 761813 11042084 PENSION & POST-RETIREMENT LIABILITIES 1158466 ESTIMATED MEDICAL MALPRACTICE CLAIMS LIABILITY 1699220 CONTRACT LIABILITIES 1436687 FINANCE LEASE LIABILITY 647651 4942024 X 57874051 1239318 239459 1478777 56395274 1223239 1223239 57618513 47288946 211462 211462 47077484 1113482 1113482 48190966 PART V, LINE 4: INCOME FROM ENDOWMENT FUND IS USED TO PURCHASE CAPITAL EQUIPMENT. PART X, LINE 2: THE HOSPITAL IS A TAX-EXEMPT ORGANIZATION AND NOT SUBJECT TO FEDERAL OR STATE INCOME TAXES IN ACCORDANCE WITH SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. ON SUCH BASIS, IT WILL NOT INCUR ANY LIABILITY FOR INCOME TAXES, EXCEPT FOR POSSIBLE UNRELATED BUSINESS INCOME. MANAGEMENT ANNUALLY REVIEWS ITS TAX PROVISIONS AND HAS DETERMINED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS THAT REQUIRE RECOGNITION IN THE CONSOLIDATED FINANCIAL STATEMENTS. PART XI, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN EQUITY INVESTMENTS 239,459. PART XI, LINE 4B - OTHER ADJUSTMENTS: RENTAL EXPENSES -211,462. FUNDRAISING EXPENSES DONOR RESTRICTED CONTRIBUTIONS 321,219. BAD DEBT EXPENSE NETTED AGAINST REVENUE ON FINANCIALS 1,113,482. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 211,462. FUNDRAISING EXPENSES PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE NETTED AGAINST REVENUE ON FINANCIALS 1,113,482. 1 1 X 1 X 1 X 1 1 0 1 1 455341 455341 0.00970 9557269 8404523 1152746 0.02450 10012610 8404523 1608087 0.03420 27420 27420 0.00060 7855812 5623437 2232375 0.04740 5186 5186 0.00010 7888418 5623437 2264981 0.04810 17901028 14027960 3873068 0.08230 0 1113482 157001 7584267 6108349 1475918 X 1 1 1 1 PUNXSUTAWNEY AREA HOSPITAL 81 HILLCREST DRIVE PUNXSUTAWNEY PA 15767 WWW.PAH.ORG 163701 X X X SKILLED NURSING SERVICES PUNXSUTAWNEY AREA HOSPITAL 1 0 0 1 X X X X X X X X X 21 1 1 0 1 X PAH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT X IRMC.ORG/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT X 1 21 1 PAH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT 0 1 X 150.000000000000 250.000000000000 X X 1 1 X X X 1 X WWW.PAH.ORG/ABOUT/FINANCIAL-ASSISTANCE X WWW.PAH.ORG/ABOUT/FINANCIAL-ASSISTANCE X WWW.PAH.ORG/ABOUT/FINANCIAL-ASSISTANCE X X X X X 1 X 0 X X X 1 X 0 0 PUNXSUTAWNEY AREA HOSPITAL PART V, SECTION B, LINE 5: IN THE FALL OF 2020, INDIANA REGIONAL MEDICAL CENTER (IRMC) AND PUNXSUTAWNEY AREA HOSPITAL (PAH) FORMALIZED A COLLABORATION UNDER ONE GOVERNING BOARD OF DIRECTORS CALLED THE PENNSYLVANIA MOUNTAINS CARE NETWORK (PMCN). THIS COLLABORATION HELPS TO SUSTAIN A HIGH LEVEL OF PATIENT CARE RESIDENTS ALREADY RECEIVE IN BOTH INDIANA AND JEFFERSON COUNTY.THE HOSPITAL WORKED WITH A CONSULTING FIRM, STRATEGY SOLUTIONS, INC. (SSI). THE PROCESS WAS LED BY THE VP OF PROFESSIONAL AND CORPORATE SERVICES. THE 2021 IRMC AND PAH CHNA WAS CONDUCTED TO IDENTIFY PRIMARY HEALTH ISSUES, CURRENT HEALTH STATUS AND NEEDS TO PROVIDE CRITICAL INFORMATION TO THOSE IN A POSITION TO MAKE A POSITIVE IMPACT ON THE HEALTH OF THE REGION'S RESIDENTS. THE RESULTS ENABLE COMMUNITY MEMBERS TO MORE STRATEGICALLY ESTABLISH PRIORITIES, DEVELOP INTERVENTIONS, AND DIRECT RESOURCES TO IMPROVE THE HEALTH OF PEOPLE LIVING IN THE COMMUNITY.PUNXSUTAWNEY AREA HOSPITAL IDENTIFIED COMMUNITY HEALTH NEEDS THROUGH A COLLABORATIVE PROCESS WITH PENNSYLVANIA MOUNTAIN HEALTH CARE NETWORK (PMCN) HOSPITALS. BUILDING PAST INITIATIVES, THE FY2021 PROCESS INCLUDED A COMPREHENSIVE SURVEY PROCESS, A PAH CHNA TEAM PRIORITIZATION EXERCISE TO DETERMINE PRIORITIES AND ASSESSMENT OF PAST SUCCESSES AND FAILURES. AS THE CHNA LEVERAGED AND UTILIZED THE HOSPITAL'S PLANNING STAFF, A MULTI-PART PROCESS WAS EMPLOYED TO DEVELOP THIS IMPLEMENTATION STRATEGY AND COMMUNITY BENEFIT PLAN, INCLUDING THE FOLLOWING:- QUANTITATIVE DATA REVIEW AND ANALYSIS- LITERATURE REVIEWS TO IDENTITY STATE AND NATIONAL BENCHMARKS, AND EVIDENCE BASED STRATEGIES THAT RELATED TO THE INDICATORS/METRICS MEASURED THROUGH THE QUANTITATIVE DATA SOURCES- QUALITATIVE DATA PROVIDED THROUGH THE SURVEY PROCESS AND DIALOGUES WITH COMMUNITY AND HEALTHCARE LEADERS IN THE REGION. THE CHNAS UTILIZATIONS OF MULTIPLE TYPES OF RESEARCH ALLOWED FOR DATA COLLECTION ACROSS A BROAD RANGE OF INDICATORS RELATED TO OVERALL POPULATION HEALTH, SOCIAL DETERMINANTS OF HEALTH INCLUDED GEOGRAPHIC LOCATION DIFFERENCES IN HEALTH OUTCOMES AND THE NEEDS OF DISADVANTAGED POPULATIONS INCLUDING UNINSURED PERSON, LOW INCOME PERSONS AND MINORITY GROUPS WITHIN THE REGION. THE PENNSYLVANIA MOUNTAIN HEALTH CARE NETWORK HOSPITALS ARE COMMITTED TO SERVING PATIENTS IN THE REGION AND ARE USING SOUND AVAILABLE DATA TO GUIDE THE PLANNING PROCESS. IN ADDITION TO DATA COLLECTION AND RESEARCH, THE PAH CHNA TEAM CONDUCTED A COMPREHENSIVE ONLINE SURVEY TO ASSESS THE NEEDS OF THE COMMUNITY AND IDENTIFY HEALTH PRIORITIES AT THE LOCAL LEVEL.IN ADDITION TO THE ASSESSMENT PUNXSUTAWNEY AREA HOSPITALS CHNA ALSO REVIEWED ITS EXISTING COMMUNITY BENEFIT ACTIVITIES- BOTH INTERNALLY AND IN CONJUNCTION WITH ITS PMCN PARTNERS TO ASSESS WHETHER THESE SERVICES WERE PROVIDING VALUE CONSISTENT WITH THE NEEDS OF THE COMMUNITY AND ITS RESIDENTS. SPECIFICALLY, THESE CONSIDERED KEY HEALTH FACTORS AND OUTCOMES RESULTANT FROM ASSOCIATED DEMOGRAPHIC, SOCIAL AND ECONOMIC IMPACTS, THE PHYSICAL ENVIRONMENT, HEALTHCARE ACCESS AND RESOURCE COORDINATION AND BEHAVIORAL TRENDS. BASICALLY CONNECTING THE REGIONS NEEDS TO THAT OF STATE AND NATION. WITH HEALTHY PEOPLE 2020, AND THE CMS STRATEGY CONNECTED TO THE PENNSYLVANIA DEPARTMENT OF HEALTH PRIORITIES, THIS CHNA IS CONNECTED TO EVIDENCE AND DATA BASED PRIORITIES. PUNXSUTAWNEY AREA HOSPITAL PART V, SECTION B, LINE 6A: THE COMMUNITY NEEDS ASSESSMENT SERVED PUNXSUTAWNEY AREA HOSPITAL AND INDIANA REGIONAL MEDICAL CENTER. PUNXSUTAWNEY AREA HOSPITAL PART V, SECTION B, LINE 11: PAH CONDUCTED AN EVALUATION OF THE IMPLEMENTATION STRATEGIES UNDERTAKEN SINCE THE COMPLETION OF THEIR 2018 CHNA. ALTHOUGH THE STATUS FOR MOST COUNTY LEVEL INDICATORS DID NOT MOVE SUBSTANTIALLY, IT IS CLEAR PAH IS WORKING TO IMPROVE THE HEALTH OF THE COMMUNITY. THE FOLLOWING HIGHLIGHTS THE AREAS OF MAJOR ACCOMPLISHMENTS THAT THE HOSPITAL MADE IN EACH OF THE FIVE GOALS THAT WERE OUTLINED IN THE IMPLEMENTATION STRATEGY ACTION PLAN. IT IS IMPORTANT TO NOTE THAT PAH'S ABILITY TO IMPLEMENT SEVERAL ACTIVITIES IN ITS IMPLEMENTATION STRATEGY ACTION PLAN WERE LIMITED DUE TO COVID-19 RESTRICTIONS DURING 2020 AND 2021.GOAL ONE - REDUCE OBESITY IN THE COMMUNITY THROUGH AN INCREASE IN PHYSICAL ACTIVITY AND OTHER WELLNESS/PREVENTION STRATEGIES:- OPERATIONALIZED RAPID CARE WALK-IN CLINIC WITH EXPANDED EVENING AND WEEKEND HOURS TO MEET THE NEEDS OF THE COMMUNITY- CONTINUED TO COLLABORATE WITH LOCAL SCHOOL DISTRICT, CHAMBER AND BUSINESSES- WELLNESS PROGRAM WAS DELAYED DUE TO COVID BUT HAD APPROXIMATELY 10% OF PAH EMPLOYEES PARTICIPATING - OCCUPATIONAL HEALTH SERVICES EXPANDED TO INCLUDE 8 LOCAL BUSINESSESGOAL TWO - IMPROVE PREVENTATIVE CARE/SCREENINGS AND EDUCATE THE COMMUNITY REGARDING INFECTIOUS AND CHRONIC DISEASE TO IMPACT POPULATION HEALTH:- IMPLEMENTED COMPREHENSIVE VACCINE CLINICS WHICH HAVE PROVIDED OVER 4,700 COVID-19 VACCINES- NEW TRACKING SYSTEM COMING ONLINE IN 2021 TO TRACK THE USAGE OF PROVIDERS IN THE COMMUNITY THAT ARE DIRECTLY RELATED TO OUR COMMUNITY HEALTH EFFORTS AND IF THE COMMUNITY HEALTH EDUCATIONAL EFFORTS ARE SHOWING RESULTS- CONTINUED TO PARTICIPATE IN COMMUNITY EVENTS AND OUTREACH INITIATIVES TO OFFER EDUCATION AND SCREENINGS TO RESIDENTSGOAL THREE - INCREASE AWARENESS AND PREVENTION OF CARDIOVASCULAR DISEASE (HEART DISEASE, CHOLESTEROL, ETC.):- EXPANDED CARDIOLOGY SERVICE LINE AT PAH- DEVELOPED TRANSFORMATIONAL PLAN DESIGNED TO REDUCE READMISSIONS THROUGH CHRONIC CARE MANAGEMENTGOAL FOUR - POSITION THE HOSPITAL AND COMMUNITY TO RESPOND TO THE NATIONAL OPIOD CRISIS BY USING EVIDENCE BASED PRACTICES AND RESEARCH WHILE PARTNERING TO ENSURE EFFICACY:- DEVELOPED COLLABORATIVE PARTNERSHIPS IN THE COMMUNITY TO IMPROVE SERVICE DELIVERY- UPDATED HOSPITAL WEBPAGE TO INCLUDE LINKS TO STATE AND NATIONAL RESOURCES- WORKING COLLABORATIVELY WITH THE PA DEPARTMENT OF HEALTH TO POTENTIALLY OFFER A MEDICAL CLEARANCE DETOX PROGRAMGOAL FIVE - EXPLORE TELE HEALTH/TELE MEDICINE TO IMPROVE ACCESS TO CARE ISSUES FOR RURAL RESIDENTS.- RECEIVED TELEHEALTH GRANT AND ARE CURRENTLY IN IMPLEMENTATION PHASE FOCUSED ON TELEHEALTH RELATED TO NEUROLOGY, BEHAVIORAL HEALTH, OPIOIDS AND OVERALL HEALTH EDUCATION- DURING COVID WAS ABLE TO PROVIDE TELEHEALTH SERVICES FOR RAPID CARE, NEUROLOGY, UROLOGY AND PRIMARY CARE PUNXSUTAWNEY AREA HOSPITAL PART V, SECTION B, LINE 13H: THERE IS A PRESUMPTIVE CHARITY SCORE PROCESS USING ACCOUNTS WITH MEDICARE OR DUAL ELIGIBILITY. SCHEDULE H, PART V, SECTION B, LINE 16I: LEP TRANSLATIONS:THERE ARE NO GROUPS WITH LIMITED ENGLISH PROFICIENCY THAT RISE TO THE THRESHOLD REQUIRED UNDER IRC SECTION 501(R). HOWEVER, LANGUAGE TRANSLATIONS OF THE FINANCIAL ASSISTANCE POLICY AND APPLICATION ARE AVAILABLE BY REQUEST AT THE FINANCIAL COUNSELING DEPARTMENT OF THE HOSPITAL. 1 1 - HHCS OF PUNXSUTAWNEY AREA HOSPITAL 240 WEST MAHONING STREET PUNXSUTAWNEY PA 15767 MEDICARE CERTIFIED HOME HEALTH AGENCY PART I, LINE 7: THE COST TO CHARGE RATIO CALCULATED ON IRS WORKSHEET 2 WAS USED IN THE CALCULATION OF COST ON IRS WORKSHEETS 1 AND 3.COST COMPUTED ON IRS WORKSHEET 6 WAS COMPUTED FROM THE ORGANIZATIONS COST ACCOUNTING SOFTWARE INCLUDING DIRECT COSTS PLUS OVERHEAD ALLOCATIONS COMPUTED IN COST ACCOUNTING. PART I, LN 7 COL(F): THE AMOUNT OF BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 24, BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $1,113,482. PART III, LINE 2: THE AMOUNT REPORTED FOR BAD DEBT IS THE TOTAL ACTUAL ACCOUNT BALANCES TRANSFERRED TO A COLLECTION AGENCY OFFSET BY MONIES COLLECTED FROM THE AGENCY. ALSO AN ESTIMATE BASED ON HISTORICAL COLLECTION PERCENTAGES OF SELF PAY FOR THE ACTIVE ACCOUNTS RECEIVABLE BALANCE IS CALCULATED MONTHLY AND THIS DIFFERENCE IS ADDED TO OR SUBTRACTED FROM BAD DEBT EXPENSE. PART III, LINE 3: WE BELIEVE THAT A PORTION OF OUR BAD DEBTS RESULTS FROM SERVICES PROVIDED TO PATIENTS WHO MEET THE CHARITY CARE GUIDELINES BUT WERE UNABLE OR UNWILLING TO PROVIDE THE APPROPRIATE DOCUMENTATIONS TO ALLOW THAT CLASSIFICATION. THIS FIGURE WAS CALCULATED USING THE ESTIMATED PERSONS UNDER POVERTY FOR JEFFERSON COUNTY OF 14.1%.PUNXSUTAWNEY AREA HOSPITAL PROVIDES CARE TO ALL PATIENTS WHO NEED IT, REGARDLESS OF THEIR ABILITY TO PAY. THIS IS PART OF THE HOSPITAL'S MISSION PART III, LINE 4: THE AUDIT FOOTNOTE ADDRESSING BAD DEBT EXPENSE AND PATIENT ACCOUNTS RECEIVABLE IS FOUND ON PAGE 8 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS UNDER NOTES TO CONSOLIDATED FINANCIAL STATEMENTS, SECTION 2. PART III, LINE 8: SERVING PATIENTS WITH GOVERNMENT HEALTH BENEFITS, SUCH AS MEDICARE, IS A COMPONENT OF THE COMMUNITY BENEFIT STANDARD THAT TAX-EXEMPT HOSPITALS ARE HELD TO. THIS IMPLIES THAT SERVING MEDICARE PATIENTS IS A COMMUNITY BENEFIT AND THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. THE HOSPITAL USES THE COST-TO-CHARGE RATIO TO DETERMINE THE MEDICARE ALLOWABLE COSTS. PART III, LINE 9B: PATIENTS WHO QUALIFY FOR CHARITY CARE ARE FLAGGED IN ORDER TO PROCESS THEM SEPERATELY FROM OTHER SELF PAY ACCOUNTS. PART VI, LINE 2: THE HOSPITAL DETERMINES COMMUNITY NEEDS BASED ON MULTIPLE SURVEYS AND MEETINGS WITH MEMBERS OF THE BUSINESS COMMUNITY, MEDICAL STAFF PHYSICIANS AND RANDOM COMMUNITY MEMBERS FROM THE SERVICE AREA.SEE ALSO SCHEDULE H PART V FOR COMMUNITY HEALTH NEEDS ASSESSMENT INFORMATION. PART VI, LINE 3: AT REGISTRATION, PATIENTS WITHOUT INSURANCE ARE PHYSICALLY PROVIDED INFORMATION ABOUT MEDICAID AND OUR CHARITY CARE POLICY AND ENCOURAGED TO ENROLL (WE ARE AVAILABLE TO ASSIST THE CUSTOMER WITH ENROLLMENT). SIGNAGE IS ALSO POSTED THROUGHOUT THE FACILITY OUTLINING OUR CHARITY CARE PROGRAM. ALSO, ALL PATIENT STATEMENTS REFLECT INFORMATION ABOUT FINANCIAL ASSISTANCE PROGRAMS AVAILABLE TO THE PATIENTS. CHARITY CARE INFORMATION IS ALSO REFERENCED ON THE HOSPITAL'S WEB SITE. PART VI, LINE 4: STATISTICS AVAILABLE FROM THE UNITED STATES CENSUS NUREAU REVEAL THAT JEFFERSON COUNTY HAS A POPULATION OF JUST UNDER 44,326 IN APPROXIMATELY 650 SQUARE MILES. THE POPULATION AGED 65 AND OLDER IS 21.0%. THE POPULATION WITH INCOME BELOW THE POVERTY LEVEL IS 14.1% AND THE COUNTY'S PER CAPITA PERSONAL INCOME IS $30,280. PART VI, LINE 5: THE HOSPITAL CONDUCTS SEVERAL FREE HEALTH SCREENINGS EACH YEAR THAT ARE OFFERED TO MEMBERS OF THE COMMUNITY WITHOUT HEALTH INSURANCE. ALSO, MULTIPLE FREE MEDICAL EDUCATION PROGRAMS ARE OFFERED TO PROVIDE AWARENESS OF TOPICAL AND TIMELY HEALTH ISSUES.PAH PROVIDES THE STUDENTS AT THE PUNXSUTAWNEY AREA SCHOOL DISTRICT WITH HYGIENE ITEMS FOR THE STUDENTS AS PART OF THE RURAL HEALTH MODEL. THESE ITEMS ARE DISTRIBUTED TO THE STUDENTS IN NEED BY THE SCHOOL NURSES AND SOCIAL WORKERS. PAH HAS FOOD AVAILABLE FOR PATIENTS WHO SCREEN POSITIVE FOR FOOD INSECURITY AND CAN PROVIDE A LIST OF RESOURCES TO ASSIST WITH ALL SOCIAL DETERMINANTS OF HEALTH. PAH HAS A COMPASSION CLOSET THAT HAS GARMENTS AVAILABLE FOR PATIENTS WHO ARE IN NEED PRIOR TO THEIR DISCHARGE. PAH HOLDS MONTHLY FREE EDUCATIONAL SEMINARS FOR ALL TO ATTEND ON VARIOUS HEALTH TOPICS AS PART OF THE WELLNESS CONNECTIONS PROGRAM. PART VI, LINE 6: PUNXSUTAWNEY AREA HOSPITAL AND ITS WHOLLY OWNED SUBSIDIARY, PUNXSUTAWNEY MEDICAL SERVICES, INC., PRIMARILY EARN REVENUES BY PROVIDING INPATIENT, OUTPATIENT AND EMERGENCY CARE SERVICES TO PATIENTS IN THE PUNXSUTAWNEY, PENNSYLVANIA, AREA AND ALSO OPERATES A HOME HEALTH AGENCY. 0 1 0 0 0 0 0 0 0 STEPHEN A WOLFE DIRECTOR/PRESIDENT & CEO 0 615927 0 88595 0 182381 0 26677 0 19978 0 933558 0 0 EYAD KHABBAZ MD PHYSICIAN 672805 0 87919 0 1242 0 0 0 19478 0 781444 0 0 0 TIMOTHY CLARK SIMPSON MD DIRECTOR/PHYSICIAN 519957 0 18605 0 22500 0 1917 0 21312 0 584291 0 0 0 MICHAEL STEVER DO PHYSICIAN 500175 0 0 0 6858 0 2195 0 11306 0 520534 0 0 0 KYLE LINGENFELTER MD PHYSICIAN 414056 0 0 0 25351 0 2195 0 19307 0 460909 0 0 0 BRYAN DOVERSPIKE DO PHYSICIAN 431425 0 0 0 486 0 0 0 21442 0 453353 0 0 0 BRYAN DEMPSEY MD PHYSICIAN 400781 0 0 0 0 0 2195 0 20578 0 423554 0 0 0 ROBERT A GONGAWARE CFO 0 308552 0 0 0 3986 0 28801 0 19709 0 361048 0 0 JOHN G SISK PRESIDENT 255723 0 21566 0 22500 0 2195 0 19819 0 321803 0 0 0 MICHAEL F ICKOWSKI CHIEF FINANCIAL OFFICER 0 182891 0 0 0 10656 0 0 0 0 0 193547 0 0 RUSSELL A DROZDIAK MD DIRECTOR/PHYSICIAN 0 155838 0 6901 0 4253 0 4471 0 990 0 172453 0 0 DANIEL D BLOUGH JR FORMER CEO 115862 0 44910 0 5842 0 2025 0 0 0 168639 0 0 0 PART I, LINE 3 THE CEO'S COMPENSATION IS PAID BY INDIANA REGIONAL MEDICAL CENTER. INDIANA REGIONAL MEDICAL CENTER USES THE FOLLOWING METHODS TO ESTABLISH THE COMPENSATION OF THE CEO: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - COMPENSATION SURVEY OR STUDY - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE PART I, LINE 4B INDIANA REGIONAL MEDICAL CENTER HAS A SUPPLEMENTAL, NONQUALIFIED RETIREMENT PLAN UNDER IRC SECTION 457(F) FOR PRESIDENT & CEO, STEPHEN A. WOLFE. PAY OUTS TO HIM WERE $138,553, AND CONTRIBUTIONS TO THE PLAN WERE $94,502 DURING CALENDAR YEAR 2023. PUNXSUTAWNEY AREA HOSPITAL HAS A SUPPLEMENTAL, NONQUALIFIED RETIREMENT PLAN UNDER IRC SECTION 457(F) FOR DR. KHABBAZ. DURING 2023, $30,000 WAS CONTRIBUTED TO THE PLAN. SHANNON BYERLY SEE PART V 81488 WAGES 0 SCH L, PART IV, BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS: SHANNON BYERLY IS THE DAUGHTER OF PHYLLIS BYERLY, FORMER DIRECTOR, AND IS AN EMPLOYEE OF PUNXSUTAWNEY AREA HOSPITAL. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF PUNXSUTAWNEY AREA HOSPITAL, INC. IS PENNSYLVANIA MOUNTAINS CARE NETWORK ("PMCN"). FORM 990, PART VI, SECTION A, LINE 7A THE INDIVIDUALS WHO SERVE AS DIRECTORS OF PMCN SHALL CONSTITUTE THE BOARD OF THIS CORPORATION. THEIR TERM OF OFFICE SHALL COINCIDE WITH THEIR TERM OF OFFICE AS DIRECTORS OF PMCN. RESIGNATION OR REMOVAL AS A DIRECTOR OF PMCN SHALL CONSTITUTE RESIGNATION OR REMOVAL AS A DIRECTOR OF THIS CORPORATION. FORM 990, PART VI, SECTION A, LINE 7B PMCN SHALL POSSESS ALL OF THE RIGHTS OF A MEMBER, AS DEFINED BY THE PENNSYLVANIA NONPROFIT CORPORATION LAW, AND SHALL EXERCISE THE FOLLOWING RESERVED POWERS WITH RESPECT TO THIS CORPORATION: (A) AMENDMENT TO THE ARTICLES OF INCORPORATION OR BYLAWS OF THIS CORPORATION; (B) THE SALE, LEASE OR EXCHANGE OF ALL OR SUBSTANTIALLY ALL THE PROPERTY OR ASSETS OF THIS CORPORATION; (C) MERGER OR CONSOLIDATION OF THIS CORPORATION WITH ANY OTHER CORPORATION; (D) DISSOLUTION OF THIS CORPORATION; (E) APPROVAL OF THE OPERATING AND CAPITAL BUDGETS FOR THIS CORPORATION; AND (F) ANY OTHER MATTER RELATING TO THIS CORPORATION THAT BY LAW REQUIRES THE APPROVAL OF THE MEMBERS OF A NONPROFIT CORPORATION. FORM 990, PART VI, SECTION B, LINE 11B 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. PRIOR TO FILING, A DRAFT OF THE 990 WILL BE REVIEWED BY TOP MANAGEMENT AND WILL BE DISCUSSED AT A MEETING OF THE FINANCE COMMITTEE OF THE BOARD OF DIRECTORS. A FINAL DRAFT IS PROVIDED TO THE FULL BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 12C EVERY MEMBER OF THE BOARD, AND EVERY INDIVIDUAL APPOINTED TO THE BOARD OR BOARD COMMITTEES, AS WELL AS ALL KEY MANAGEMENT PERSONNEL AND PHYSICIAN LEADERS, ARE REQUIRED TO EXECUTE A CONFLICT OF INTEREST DISCLOSURE STATEMENT, WHICH WILL BE UPDATED AT LEAST ON AN ANNUAL BASIS OR AS ADDITIONAL CONFLICTING INTERESTS ARISE. IN ADDITION, EVERY MEMBER OF THE BOARD WILL SPECIFICALLY ACKNOWLEDGE THE CONFLICT OF INTEREST POLICY AND HIS/HER ATTEMPT TO ABIDE BY IT BY SIGNING THE ACKNOWLEDGEMENT FORM. EVERY BOARD COMMITTEE MEMBER, OFFICER, KEY MANAGEMENT EMPLOYEE, AND PHYSICIAN LEADER IS REQUIRED TO SIGN THIS ACKNOWLEDGEMENT AS WELL. THE ACKNOWLEDGEMENT AND DISCLOSURE FORMS WILL BE KEPT ON FILE BY THE CHIEF EXECUTIVE OFFICER, AND THE CHAIRMAN AND VICE-CHAIRMAN WILL BE FAMILIAR WITH THE STATEMENTS THAT ARE FILED BY BOARD MEMBERS IN ORDER TO GUIDE THEIR CONDUCT IN THE EVENT A CONFLICT ARISES. EVERY PERSON COVERED BY THIS POLICY SHALL SUBMIT IN WRITING TO THE CHIEF EXECUTIVE OFFICER A CONFLICT OF INTEREST DISCLOSURE STATEMENT LISTING ALL FINANCIAL AND CONFLICTING INTERESTS. EACH STATEMENT WILL BE RESUBMITTED WITH ANY NECESSARY CHANGES EACH YEAR OR AS ANY ADDITIONAL CONFLICTING OR FINANCIAL INTERESTS ARISE. THE CHAIRMAN OF THE BOARD SHALL BECOME FAMILIAR WITH ALL SUCH DISCLOSURE STATEMENTS IN CASE A CONFLICT ARISES. THE VICE CHAIRMAN OF THE BOARD SHALL BE FAMILIAR WITH THE DISCLOSURE STATEMENT FILED BY THE CHAIRMAN. PENALTIES FOR NON-COMPLIANCE: FAILURE TO COMPLY WITH THIS POLICY SHALL CONSTITUTE GROUNDS FOR REMOVAL FROM OFFICE AND, IN THE CASE OF KEY MANAGEMENT PERSONNEL, TERMINATION OF EMPLOYMENT. FORM 990, PART VI, SECTION B, LINE 15 THE CEO'S COMPENSATION IS PAID BY INDIANA REGIONAL MEDICAL CENTER (IRMC). POSITIONS FOR OFFICERS AND KEY EMPLOYEES ARE REVIEWED ON AN ANNUAL BASIS. APPROPRIATE COMPARISONS ARE MADE ON A REGIONAL AND NATIONAL LEVEL IN ORDER TO MAINTAIN A FAIR AND EQUITABLE COMPENSATION STRUCTURE. AN EXTERNAL CONSULTANT IS UTILIZED TO PREPARE COMPARATIVE SALARY DATA FOR THE BOARD'S REVIEW. ALL RECOMMENDATIONS ARE APPROVED BY IRMC'S BOARD OF DIRECTORS AND DOCUMENTED IN THE BOARD MINUTES. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: TRANSFERS TO AFFILIATES -6,504,039. CHANGE IN INVESTMENT IN IRREVOCABLE TRUST 21,075. CHANGE IN EQUITY INVESTMENTS 239,459. NON-CONTROLLING INTEREST IN SUBSIDIARY 381,801. NET ASSET RELEASED FROM RESTRICTION -11,484. EQUITY DISTRIBUTION - NONCONTROLLING -337,647. NET INCOME OF NONCONTROLLING INTERESTS -44,154. INDIANA REGIONAL MEDICAL CENTER 835 HOSPITAL ROAD INDIANA PA 15701 250965404 HOSPITAL PA 501(C)(3) LINE 3 PENNSYLVANIA MOUNTAINS CARE NETWORK 0 INDIANA JEFFERSON ONCOLOGY LLC 835 HOSPITAL ROAD INDIANA PA 15701 900406301 RADIATION ONCOLOGY SERVICES PA 501(C)(3) LINE 12A, I INDIANA REGIONAL MEDICAL CENTER 0 INDIANA TOTAL THERAPY INC 835 HOSPITAL ROAD INDIANA PA 15701 263843582 THERAPY SERVICES PA 501(C)(3) LINE 10 INDIANA HEALTHCARE PHYSICIAN SERVICES 0 INDIANA HEALTHCARE FOUNDATION 835 HOSPITAL ROAD INDIANA PA 15701 251574302 FUNDRAISING IN SUPPORT OF INDIANA REGIONAL MEDICAL CENTER PA 501(C)(3) LINE 12A, I INDIANA REGIONAL MEDICAL CENTER 0 INDIANA HEALTHCARE PHYSICIAN SERVICES INC 835 HOSPITAL ROAD INDIANA PA 15701 251842046 PROVIDE HEALTH CARE PA 501(C)(3) LINE 3 INDIANA REGIONAL MEDICAL CENTER 0 INDIANA HEALTHCARE PROPERTIES 835 HOSPITAL ROAD INDIANA PA 15701 251524635 HOLD & MANAGE PROPERTY IN SUPPORT OF INDIANA REGIONAL MEDICAL CENTER PA 501(C)(3) LINE 12A, I INDIANA REGIONAL MEDICAL CENTER 0 SPIRITLIFE INC 170 FR MARTIN TELENSON LANE PENN RUN PA 15765 463997001 DETOXIFICATION AND REHABILITATIVE SERVICES PA 501(C)(3) LINE 10 INDIANA REGIONAL MEDICAL CENTER 0 INDIANA AMBULATORY SURGICAL ASSOCIATES INC 835 HOSPITAL ROAD INDIANA PA 15701 232923182 AMBULATORY SURGERY PA 501(C)(3) LINE 12A, I INDIANA REGIONAL MEDICAL CENTER 0 PENNSYLVANIA MOUNTAINS CARE NETWORK 835 HOSPITAL ROAD INDIANA PA 15701 474638568 SUPPORT FOR HEALTHCARE ORGNAIZATIONS PA 501(C)(3) LINE 12A, I N/A 0 PUNXSUTAWNEY AREA HOSPITAL FOUNDATION 81 HILLCREST DRIVE PUNXSUTAWNEY PA 15701 932244487 TO SUPPORT THE HOSPITAL PA 501(C)(3) LINE 12A, I PUNXSUTAWNEY AREA HOSPITAL INC 1 PUNXSUTAWNEY MEDICAL SERVICES INC 81 HILLCREST DRIVE PUNXSUTAWNEY PA 15767 251773035 ANESTHESIA SERVICES PA 501(C)(3) LINE 3 PUNXSUTAWNEY AREA HOSPITAL INC 1 INDIANA SKILLED NURSING INC 835 HOSPITAL ROAD INDIANA PA 15701 992421431 SKILLED NURSING FACILITY PA 501(C)(3) LINE 10 INDIANA REGIONAL MEDICAL CENTER 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 PUNXSUTAWNEY MEDICAL SERVICES INC O 597338 COST PUNXSUTAWNEY MEDICAL SERVICES INC P 835000 COST PUNXSUTAWNEY MEDICAL SERVICES INC S 1526549 COST