2021-05-17T14:00:21-05:00 2020-06-30 460722692 SICKLER TARPEY & ASSOCIATES 227 JEFFERSON AVENUE TYRONE PA 16686 990 2019-07-01 240701920 BUCKTAIL MEDICAL CENTER BUCK 5709231000 1001 PINE STREET RENOVO PA 177641618 TIMOTHY REEVES NHA ADMINISTRATOR 5709231000 2021-05-17 1 CHRISTOPHER DEANTONIO EA P00976440 8146844640 2021-05-17 2019 2022-09-23 18:48:47Z TIMOTHY REEVES NHA 1001 PINE STREET RENOVO PA 177641618 9992698 0 X N/A X 1909 PA BUCKTAIL MEDICAL CENTER IS A CRITICAL ACCESS HOSPITAL, NURSING HOME FACILITY AND A COMMUNITY CLINIC SERVING THE HEALTHCARE NEEDS OF WESTERN CLINTON COUNTY, PA. BUCKTAIL MEDICAL CENTER OFFERS 16 HOSPITAL BEDS, 43 NURSING HOME BEDS, AND A COMMUNITY CLINIC OFFERING OUT PATIENT SERVICES. 9 9 110 0 0 0 1275806 4434617 6326188 5557612 405 469 0 0 7602399 9992698 0 0 0 0 3361548 3365584 0 0 0 3937502 4180378 7299050 7545962 303349 2446736 2324854 5959067 3472176 4664648 -1147322 1294419 X BUCKTAIL MEDICAL CENTER IS A CRITICAL ACCESS HOSPITAL, NURSING HOME FACILITY AND A COMMUNITY CLINIC SERVING THE HEALTHCARE NEEDS OF WESTERN CLINTON COUNTY, PA. BUCKTAIL MEDICAL CENTER OFFERS 16 HOSPITAL BEDS, 43 NURSING HOME BEDS, AND A COMMUNITY CLINIC OFFERING OUT PATIENT SERVICES. 0 0 3729889 3114433 BUCKTAIL MEDICAL CENTER PROVIDES HOSPITAL INPATIENT AND OUTPATIENT SERVICES. THE CENTER HAS 16 BEDS TO MEET ITS CRITICAL ACCESS NEEDS AS WELL AS AN EMERGENCY ROOM AND COMMUNITY CLINIC. 2925207 2443179 BUCKTAIL MEDICAL CENTER PROVIDES NURSING HOME FACILITIES WITH 43 BEDS. SERVICES ALSO INCLUDE PHYSICAL THERAPY, OCCUPATIONAL THERAPY, SPEECH THERAPY, EXERCISE AND RECREATIONAL ACTIVITIES. 6655096 1 1 0 0 0 0 1 0 0 0 1 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 18 0 1 110 1 0 0 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X THE ORGANIZATION 5709231000 1001 PINE STREET RENOVO PA 177641618 ROBERT GETZ SR BOARD PRESIDENT 1.00 X X 0 0 0 JOHN LUGG BOARD VICE PRESIDENT 1.00 X 0 0 0 CONSTANCE LINBERG BOARD MEMBER 1.00 X 0 0 0 JOHN KURUTZ BOARD MEMBER 1.00 X 0 0 0 MARTHA SYKES BOARD SEC/TREAS. 1.00 X X 0 0 0 WILLIAM FORNWALT BOARD MEMBER 1.00 X 0 0 0 BRIDGETTE MORGAN BOARD MEMBER 1.00 X 0 0 0 TRACY BRUNO BOARD MEMBER 1.00 X 0 0 0 MICHAEL DAIKEN CONTROLLER 40.00 X 0 0 0 ALAN EDWARDS MD MEDICAL DIRECTOR 40.00 X 0 0 0 TIMOTHY REEVES NHS DIRECTOR 40.00 X 90683 0 0 GEORGE GERBER FORMER CONTROLLER 40.00 X 92250 0 0 182933 0 0 0 0 0 0 EMCARE INC 7032 COLLECTION CENTER DRIVE CHICAGO IL 60693 PHYSICIAN SERVICES 623217 BENCHMARK THERAPIES INC PO BOX 870 HUNTINGDON PA 16652 THERAPY SERVICES 510081 PLEXSUM STAFFING SOLUTIONS INC PO BOX 568 REEDSVILLE PA 17084 AGENCY-STAFFING 447659 OMNICARE INC PO BOX 78000 DETROIT MI 48278 PHARMACY SERVICES 167052 ALLIED RESOURCES STAFFING SOLUTIONS 135 DOWLIN FORGE ROAD EXTON PA 19341 AGENCY-NURSING 158637 5 4212166 222451 4434617 PATIENT SERVICE REVENU 621990 3114433 3114433 LONG TERM CARE FACILIT 623000 2443179 2443179 5557612 469 469 9992698 5557612 0 469 90683 90683 2564221 1998504 565717 710680 534971 175709 120709 120709 116826 116826 103827 103827 SUPPLIES 2702113 2643356 58757 PROFESSIONAL FEES 826817 826817 BAD DEBT EXPENSE 310086 310086 7545962 6655096 890866 0 274098 3943029 166108 166108 813756 782354 82854 76812 66642 73717 8259924 7396803 862159 863121 10884 5889 11857 11857 36496 36180 2324854 5959067 1400080 1519535 1843959 1798705 228137 1346408 3472176 4664648 X -1247095 1227228 99773 67191 -1147322 1294419 2324854 5959067 2446736 -4995 0 X 0 1 X 0 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED X X 2 685.00 0 144218 144218 3371621 2936676 434945 352958 326909 26049 4391127 4133218 257909 863121 MEDICARE PAYABLE 119200 LINE OF CREDIT 500000 CAPITAL LEASE OBLIGATION 18825 SBA - PAYROLL PROTECTION LOAN 640900 EXPANDED ACCELERATED AND ADVANCES PAYMENTS PROGRAM 67483 1346408 X PART X, LINE 2: THE CENTER ACCOUNTS FOR UNCERTAINTY IN INCOME TAXES BY PRESCRIBING A RECOGNITION THRESHOLD OF MORE-LIKELY-THAN-NOT TO BE SUSTAINED UPON EXAMINATION BY THE APPROPRIATE TAXING AUTHORITY. MEASUREMENT OF THE TAX UNCERTAINTY OCCURS IF THE RECOGNITION THRESHOLD IS MET. MANAGEMENT DETERMINED THERE WAS NO TAX UNCERTAINTIES THAT MET THE REGONITION THRESHOLD FOR FISCAL YEAR END JUNE 30, 2020. SCHEDULE D PART XI LINE 1 THE AUDITED FINANCIAL STATEMENTS INCLUDE THE PROVISION FOR BAD DEBT IN THE AMOUNT OF 310,086 IN THE GROSS REVENUE. FOR TAX PURPOSES THIS IS PART OF THE EXPENSES. 1 1 X 1 X 1 X 399.000000000000 0 1 0 0 2619 2619 0.00030 2351444 2049335 302109 0.04000 1286 1229 57 0.00000 2355349 2050564 304785 0.04030 74832 74832 0.00990 3217 625 2592 0.00030 78049 625 77424 0.01020 2433398 2051189 382209 0.05050 56970 32752 24218 0.00320 1665 1665 0.00020 700 700 0.00010 2426 940 1486 0.00020 1235 1235 0.00020 62996 33692 29304 0.00390 1 310086 121022 1321252 1347241 -25989 X 1 1 1 1 BUCKTAIL MEDICAL CENTER 1001 PINE STREET RENOVO PA 17764 549601 X X X X BUCKTAIL MEDICAL CENTER 1 0 0 0 0 1 X 200.000000000000 399.000000000000 X X X X 1 1 X X X X 1 X WWW.BUCKTAILMEDICALCENTER.ORG X WWW.BUCKTAILMEDICALCENTER.ORG X WWW.BUCKTAILMEDICALCENTER.ORG X X X X 1 X 0 X 1 X 0 0 BUCKTAIL MEDICAL CENTER PART V, SECTION B, LINE 5: BUCKTAIL MEDICAL CENTER POLLED COMMUNITY MEMBERS, OTHER HEALTH PROFESSIOANLS, CLERGY AND BUSINESS COMMUNITY TO GATHER THE INPUT REQUIRED TO PRODUCE AN ACCURATE REPORT. BUCKTAIL MEDICAL CENTER PART V, SECTION B, LINE 6A: PRR AND CTA BUCKTAIL MEDICAL CENTER PART V, SECTION B, LINE 11: DEVELOPING PROGRAMS THAT MEET THE NEEDS THAT THE COMMUNITY FELT WERE THE MOST URGENT. BUCKTAIL MEDICAL CENTER PART V, SECTION B, LINE 13H: FAMILY SIZE; ESTIMATED EXPENSES. BUCKTAIL MEDICAL CENTER PART V, SECTION B, LINE 18E: FAP APPLICATION(S) AND ASSISTANCE; FAP MAILING(S); FOLLOW-UP LETTERS AND/OR PHONE CALLS; SUBEQUENT BILLING(S); PROMPT PAYMENT DISCOUNT; PAYMENT PLAN. BUCKTAIL MEDICAL CENTER PART V, SECTION B, LINE 20E: FAP APPLICATION(S) AND ASSISTANCE; FAP MAILING(S); FOLLOW-UP LETTERS AND/OR PHONE CALLS; SUBSEQUENT BILLING(S); PROMPT PAYMENT DISCOUNT; PAYMENT PLAN; ASSIST PATIENT IN EXPLORING ALTERNATIVE SOURCES OF COVERAGE AND PAYMENT. 3 1 - BUCKTAIL MEDICAL CENTER 1001 PINE STREET RENOVO PA 17764 LONG-TERM CARE 2 - BUCKTAIL MEDICAL CENTER 1001 PINE STREET RENOVO PA 17764 AMBULANCE 3 - BUCKTAIL MEDICAL CENTER COMMUNITY CLINIC 1001 PINE STREET RENOVO PA 17764 COMMUNITY CLINIC PART III, LINE 2: BUCKTAIL MEDICAL CENTER UTILIZES A MONTHLY CALCULATION TO DETERMINE THE AMOUNT OF BAD DEBT EXPENSE. BUCKTAIL UTILIZES AGED ACCOUNTS RECEIVABLE BY FINANCIAL CLASS; SERVICE TYPE; & CURRENT REIMBURSEMENT RATE(S) TO CALCULATE AN ESTIMATED AMOUNT OF COLLECTIBLE REVENUE BASED ON UNDER/OVER 120 DAYS, LESS ANY CONTRACTUAL ADJUSTMENT(S). PART III, LINE 3: BUCKTAIL MEDICAL CENTER USES THE FOLLOWING TO DETERMINE THE AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS POTENTIALLY ELIGIBLE UNDER THE FAP: DETAILED PATIENT BILLING AND SERVICES RECORDS THAT WOULD HAVE BEEN DESIGNATED PATIENT CRITERIA ELIBIGLE TO APPLY FOR FAP. THIS WOULD INCLUDE, BUT NOT BE LIMITED TO STANDARD CHARGES, CO-PAYS, DEDUCTIBLES, NON-COVERED OR LIMITED COVERED SERVICES; BILLING CYCLES; FAP APPLICATIONS/COMPLETION; FAP DENIAL; POTENTIAL INCLUSION IN PREVIOUS CHARITY CARE PROGRAM. PART III, LINE 4: FOOTNOTE CAN BE FOUND ON AUDITED FINANCIAL STATEMENTS, NOTE 1 - PATIENT ACCOUNTS RECEIVABLE PAGES 8 & 9. PART III, LINE 8: BASED ON MEDICARE DATA FOR 6/30/2020, BUCKTAIL IS REIMBURSED LESS THAN EXPENSE BECAUSE OF NON-ALLOWABLE MEDICARE BAD DEBT EXPENSE, DEDUCTION FOR CO-INSURANCES, DEDUCTIBLES AND SEQUESTRATION. THESE AMOUNTS ARE NOT INCLUDED IN PARTS III, SEC. B, LINE 3. BUCKTAIL MEDICAL CENTER UTILIZED THE MEDICARE COST REPORT TENTATIVE SETTLEMENT FOR FYE 06/30/2020 FOR MEDICARE PAYMENT AND COST DATA. PART III, LINE 9B: SEE BUCKTAIL MEDICAL CENTER BILLING & COLLECTION POLICY. PART VI, LINE 2: BUCKTAIL MEDICAL CENTER CONDUCTED THE NEEDS ASSESSMENT WITH THE ASSISTANCE OF VARIOUS COMMUNITY ORGANIZATIONS FOR CHNA. BUCKTAIL MEDICAL CENTER COORDINATES WITH LOCAL EMS AND REGIONAL EMERGENCY/COUNTY PROVIDERS TO DETERMINE COMMUNITY NEED(S). SCHEDULE H - PART VI, LINE 3 BUCKTAIL MEDICAL CENTER UTILIZES THE FOLLOWING TO INFORM/EDUCATE PATIENTS FOR ASSISTANCE: 1) PROMINENTLY POSTS, IN ALL REGISTRATION/SERVICE AREAS, FAP PLAIN LANGUAGE SUMMARY; STATE MEDICAID RESOURCE/COMPASS POSTER; CHIP (CHILDREN'S HEALTH INSURANCE PROGRAM) POSTER. 2) MAKES FAP PACKET AVAILABLE AT THE FOLLOWING SERVICE LOCATIONS: PATIENT REGISTRATION; EMERGENCY ROOM; COMMUNITY CLINIC; BUSINESS OFFICE; AND PROVIDES FAP PACKETS IN THE FOLLOWING ADMISSION PACKETS; ACUTE/SWING BED AND SKILLED NURSING/LONG TERM CARE SO FAP IS INCLUDED WITH ADMISSIONS DOCUMENT REVIEW WITH PATIENT. 3) FAP APPLICATION PACKET IS OFFERED TO PATIENT(S) AT TIME OF SERVICE WHEN ABLE TO REGISTER PRIOR TO ANY MEDICALLY NECESSARY/EMERGENCY SERVICE(S). SCHEDULE H - PART VI, LINE 4 BUCKTAIL MEDICAL CENTER SERVES AN AREA THAT INCLUDES WESTERN CLINTON AND SOUTHERN POTTER COUNTIES. COMMUNITIES SERVED INCLUDE: RENOVO, SOUTH RENOVO, NORTH BEND, HYNER, SHINTOWN, WESTPORT AND HAMMERSLEY FORK IN CLINTON COUNTY AND CROSS FORK IN POTTER COUNTY. THE POPULATION OF THE AREA IS APPROXIMATELY 1,600. THE HOSPITAL IS ISOLATED AND SURROUNDED BY PENNSYLVANIA STATE PARKS AND GAME LAND KNOWN AS THE PENNSYLVANIA WILDS. BUCKTAIL SERVICES A MEDICALLY UNDERSERVED AREA (MUA) AND A HEALTH PROFESSIONAL SHORTAGE AREA (HPSA). FORM 990, PART VI, SECTION B, LINE 11B THE BOARD OF DIRECTORS ARE PROVIDED WITH A DRAFT COPY OF THE TAX FORM 990 AND RELATED SCHEDULES AS WELL AS A DRAFT COPY OF THE AUDITED FINANCIAL STATEMENTS TO REVIEW AND APPROVE BEFORE FINAL SUBMISSION. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS SIGN CONFLICT OF INTEREST STATEMENTS AT THE BEGINNING OF THE FISCAL YEAR AND ANY TIME THERE IS A BOARD MEMBER CHANGE. BOARD MEMBERS ARE REQUIRED TO RECUSE THEMSELVES IN THE EVENT THERE EVER COULD BE A CONFLICT OF INTEREST DURING THE COURSE OF OPERATIONS. FORM 990, PART VI, SECTION B, LINE 15 SALARY DETERMINATION FOR TOP MANAGEMENT AND KEY EMPLOYEES IS SET AFTER COMPARISION TO MARKET REQUIREMENTS AND PEER GROUP BENCHMARKS. FORM 990, PART VI, SECTION C, LINE 18 ALL DOCUMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART VI, SECTION C, LINE 19 ALL GOVERNING DOCUMENTS ARE AVAILABLE UPON REQUEST.