2021-05-17T11:53:49-05:00 2020-06-30 BKD LLP 910 E ST LOUIS 200/PO BOX 1190 SPRINGFIELD MO 658062523 990 2019-07-01 251490707 DUBOIS REGIONAL MEDICAL CENTER % BRIAN S KLINE DUBO 8143756377 PO BOX 447 100 HOSPITAL AVENUE DUBOIS PA 15801 JOHN S SUTIKA PRESIDENT 8143754321 2021-04-13 true Brian D Todd P00422601 4178658701 2019 2022-09-23 18:48:47Z PENN HIGHLANDS DUBOIS JOHN SUTIKA PO BOX 447 DUBOIS PA 15801 414814646 false X WWW.PHHEALTHCARE.ORG X 1985 PA DRMC OFFERS RESIDENTS A COMBINATION OF ADVANCED HEALTHCARE IN A FRIENDLY ENVIRONMENT. DRMC FOCUSES ON CLINICAL EXCELLENCE WITH A FOCUS ON PATIENT-CENTERED CARE. 21 13 2806 210 2170216 390295 719229 7485309 349959406 369223289 6266730 4866835 -3434199 -3343503 353511166 378231930 0 0 0 0 172783263 176334289 0 0 0 162294906 178094358 335078169 354428647 18432997 23803283 387337378 453154072 160316308 204668426 227021070 248485646 TO PROVIDE THE PATIENT WITH EXCEPTIONAL CARE THROUGH OUR COMMUNITY-BASED HEALTH SYSTEM WHILE MAINTAINING A REVERENCE FOR LIFE. IT'S THE VISION OF THE SYSTEM TO BE THE INTEGRATED HEALTH SYSTEM OF CHOICE THROUGH EXCELLENT QUALITY, SERVICE AND OUTCOMES. false false 319604775 369223289 DUBOIS REGIONAL MEDICAL CENTER PROVIDES A VARIETY OF COMPREHENSIVE INPATIENT CARE AND OUTPATIENT MEDICAL SERVICES TO THE RESIDENTS OF WESTERN PENNSYLVANIA. THE FACILITY IS LICENSED FOR 216 BEDS. IN FISCAL YEAR 2020, DRMC SERVICED 9,856 INPATIENTS WITH A TOTAL OF 46,821 INPATIENT DAYS AND PROVIDED MORE THAN 725,513 OUTPATIENTS VISITS. IN ADDITION TO DIRECT MEDICAL SERVICES, THE HOSPITAL ALSO PROVIDES OTHER MEDICAL PROGRAMS TO THE COMMUNITY INCLUDING OUTREACH PROGRAMS, CLINICS, SUPPORT GROUPS, EDUCATION PROGRAMS, HEALTH FAIRS AND HEALTH SCREENINGS. 319604775 true true false true false false false false false true true false false true true false false true false false true false false false false false true true false false true false false false false false false true false false false false false false true true true false false true 182 0 true 2806 true true true false false false false false false false false false false false X 21 13 true false false false true true true true true false false true true true true true true true true true true PA X BRIAN S KLINE 8143756377 100 HOSPITAL AVENUE DUBOIS PA 15801 X DR STEPHEN IORFIDO PHYSICIAN 40.0 0.0 X 1620355 0 31493 DR SANDEEP BANSAL PHYSICIAN 40.0 0.0 X 1495786 0 29553 DR GASSAN BEJJANI PHYSICIAN 40.0 0.0 X 1293504 0 20214 DR TERRY T BROWN PHYSICIAN 40.0 0.0 X 1142064 0 7872 STEVE FONTAINE TRUSTEE, PRESIDENT/CEO PHH 2.0 40.0 X X 0 991774 82616 DR SUZANNE IORFIDO PHYSICIAN 40.0 0.0 X 1028262 0 11829 JOHN SUTIKA PRESIDENT 40.0 0.0 X X 442679 0 64855 MARK NORMAN TRUSTEE, COO PHH 2.0 40.0 X X 0 406793 49465 BRIAN KLINE VP CHIEF FINANCIAL OFFICE 40.0 2.0 X X 303161 0 31212 M TODD MILLER CHAIRMAN 5.0 2.0 X X 0 0 0 EDWARD V YAHNER TRUSTEE 2.0 0.0 X 0 0 0 LISA M ZOCCO TREASURER 3.0 0.0 X X 0 0 0 JOYCE FAIRMAN SECRETARY 3.0 0.0 X X 0 0 0 MIKE ARMANINI TRUSTEE 2.0 0.0 X 0 0 0 JOSH BENTON TRUSTEE 2.0 0.0 X 0 0 0 W JAY CHAMBERLIN TRUSTEE 2.0 0.0 X 0 0 0 JAMES CURTIS TRUSTEE 2.0 0.0 X 0 0 0 DR JAMES E DEVLIN TRUSTEE 2.0 0.0 X 0 0 0 RAYMOND E DONATI TRUSTEE 2.0 0.0 X 0 0 0 DR HAZEM F EL KASSAS TRUSTEE 2.0 0.0 X 0 0 0 SISTER LISA MARY MCCARTNEY TRUSTEE 2.0 0.0 X 0 0 0 SALLY MORAN TRUSTEE 2.0 0.0 X 0 0 0 SISTER MARGARET PARK TRUSTEE 2.0 0.0 X 0 0 0 DR GREGORY ROSCOE TRUSTEE 2.0 0.0 X 0 0 0 TODD STOLTZ TRUSTEE 2.0 0.0 X 0 0 0 ANTHONY VIGLIONE TRUSTEE 2.0 0.0 X 0 0 0 7325811 1398567 329109 344 false true false AMN HEALTHCARE INC 12400 HIGH BLUFF DRIVE SAN DIEGO CA 92130 LOCUM SERVICES 3610875 APOGEE HEALTHCARE INC 15059 N SCOTTSDALE ROAD SCOTTSDALE AZ 85254 LOCUM SERVICES 5978809 ASSOCIATED CLINICAL LABS 1526 PEACH ST ERIE PA 16501 LAB TESTING SERVICES 2694978 LUNG INNOVATIONS NETWORK 1402 TREASURE LAKE DUBOIS PA 15801 PHYSICIAN SERVICES 3936102 SYNERGY 678 SIMMONS LANE BOZEMAN MT 59715 LOCUM SERVICES 2782996 45 39000 6554200 892109 7485309 Net Patient Service Revenue 621990 332701783 332701783 Pharmacy 446110 31088754 28918538 2170216 Other Service Revenue 621990 3290387 3290387 Cafeteria 722514 940883 940883 Rent From Affiliates 900099 1201482 1201482 369223289 4822426 4822426 0 0 0 0 0 36581198 45927 36561619 21097 19579 24830 44409 44409 0 0 0 0 0 0 0 0 0 Loss on Equity Investees 900099 -3343503 -3343503 -3343503 378231930 367053073 2170216 1523332 0 0 0 0 841907 507534 334373 846623 748415 98208 141749233 125522965 16226268 4115697 3653605 462092 16852857 14902665 1950192 11927972 10544327 1383645 35590672 31462154 4128518 253835 253835 89025 89025 0 0 517411 517411 27858773 24705853 3152920 4243 3751 492 5483798 4861989 621809 0 0 6329067 5594895 734172 513509 453942 59567 0 545980 482646 63334 1340659 1185143 155516 0 13005084 11496494 1508590 3916584 3462260 454324 MEDICAL SUPPLIES & DRUGS 59976912 59976912 LICENSES, DUES, SUBSCRIPTIONS 16564101 14642665 1921436 REPAIRS AND MAINTENANCE 4449193 3933087 516106 All other expenses 1540000 1361360 178640 115512 102113 13399 354428647 319604775 34823872 0 13547212 400296 6863834 90494308 925785 532479 38143732 33876694 0 0 0 0 0 0 6478830 6294651 4274950 2678212 322381162 202565609 98018149 119815553 162496579 138632825 4221305 3794467 0 0 5937555 4162170 46429447 52472417 387337378 453154072 38948367 38594923 0 0 0 9962607 112716143 110615471 0 0 0 0 868678 565826 0 0 7783120 44929599 160316308 204668426 X 223934217 245463742 3086853 3021904 227021070 248485646 387337378 453154072 X 23803283 -2254723 -83984 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 4329 4329 false SCHEDULE C, PART II-B, LINE 1I LOBBYING ACTIVITIES: THE ORGANIZATION IS A MEMBER OF THE HEALTHCARE COUNCIL. A PORTION OF DUES PAID TO THIS ORGANIZATION ARE ATTRIBUTABLE TO LOBBYING. 50469 230 35 50734 50014 420 35 50469 49179 801 34 50014 48818 327 34 49179 48784 34 48818 1.00000 true false 12799323 12799323 82388090 34225260 48162830 88073664 63539007 24534657 119346913 100123031 19223882 19773172 4678311 15094861 119815553 Due from Affiliates 43020158 Other Receivable 4889931 Other Assets 17427 PHYSICIAN & EMPLOYEE ADVANCES 1548689 Assets held in Def Comp Plan 1681531 Due from Third Party Payer 539895 Benef int in perp trust 460476 Accrued Interest 314310 52472417 0 Due to Third Party Payers 5490207 Due to Affiliates 490997 Deferred Compensation 1681531 Contract Liabilities 37266864 44929599 SCHEDULE D, PART V, LINE 4 ENDOWMENT FUNDS: ENDOWMENT FUNDS WILL BE USED FOR THE PURCHASE OF CAPITAL ITEMS USED IN PATIENT CARE. 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. Central America and the Caribbean 0 0 Investments 10108381 0 0 0 0 10108381 10108381 false false false false false false true true X true X true X true true true false true true 2080577 2080577 0.00590 49108108 37358998 11749110 0.03310 51188685 37358998 13829687 0.03900 445674 445674 0.00130 936000 936000 0.00260 139160 139160 0.00040 1520834 1520834 0.00430 52709519 37358998 15350521 0.04330 true 11159903 4463961 81784067 84054330 -2270263 X true true 1 1 DUBOIS REGIONAL MEDICAL CENTER 100 HOSPITAL AVENUE DUBOIS PA 15801 WWW.PHHEALTHCARE.ORG 135501 X X X DUBOIS REGIONAL MEDICAL CENTER 1 false false true X X X X X X X X X 17 true true false true X SEE PART V, SECTION C X true 17 true SEE PART V, SECTION C false true X 200. 300. X X X X true true X X X X true X SEE PART V, SECTION C X SEE PART V, SECTION C X SEE PART V, SECTION C X X X X X X true X false X X X X X true X false false SCHEDULE H, PART V, SECTION B, LINE 5 COMMUNITY INPUT: PENN HIGHLANDS HEALTHCARE HIRED THE FIRM OF TRIPP UMBACH TO FACILITATE THE PREPARATION OF THE CHNA AND COLLABORATED WITH HOSPITALS AND OUTSIDE ORGANIZATION IN THE SURROUNDING REGION DURING THE CHNA PROCESS INCLUDING ALCOHOL AND DRUG ABUSE SERVICES, ALCOHOLICS ANONYMOUS, FREE CLINIC OF DUBOIS, POLICE DEPARTMENTS, CHAMBER OF COMMERCE, EMS SERVICES JUST TO NAME A FEW. THE PROCESS INCLUDED PUBLIC COMMENTARY, SECONDARY DATA COLLECTION AND ANALYSIS, STAKEHOLDER INTERVIEWS, HAND-DISTRIBUTED SURVEYS, AND A COMMUNITY HEALTH FORUM/RETREAT. THE HOSPITAL WORKED WITH LEADERS WITHIN THE HEALTHCARE SYSTEMS AS WELL AS WITH SEVERAL MEMBERS OUTSIDE OF THE SYSTEM FROM VARIOUS ORGANIZATION AND BACKGROUNDS. THIS LIST IS INCLUDED IN THE CHNA REPORTS. SCHEDULE H, PART V, SECTION B, LINE 6A CHNA CONDUCTED WITH OTHER HOSPITAL FACILITIES: THE CHNA WAS CONDUCTED WITH PENN HIGHLANDS ELK, PENN HIGHLANDS BROOKVILLE, PENN HIGHLANDS HUNTINGDON AND PENN HIGHLANDS CLEARFIELD WHICH ARE HOSPITALS IN THE PENN HIGHLANDS HEALTHCARE SYSTEM. SCHEDULE H, PART V, SECTION B, LINE 7A WEBSITE WHERE CHNA IS AVAILABLE: HTTPS://WWW.PHHEALTHCARE.ORG/HEALTH-WELLNESS/COMMUNITY-HEALTH-NEEDS-ASSESS MENT SCHEDULE H, PART V, SECTION B, LINE 10A WEBSITE WHERE IMPLEMENTATION STRATEGY IS AVAILABLE: HTTPS://WWW.PHHEALTHCARE.ORG/HEALTH-WELLNESS/COMMUNITY-HEALTH-NEEDS-ASSESS MENT SCHEDULE H, PART V, SECTION B, LINE 11 ADDRESSING IDENTIFIED NEEDS: THE HOSPITAL'S CHNA GIVES A VERY DETAILED OVERVIEW OF THE METHODS AND ACTIVITIES THAT WENT INTO DEVELOPING A STRATEGIC PLAN FOR ACCESSING THE NEEDS OF THE COMMUNITY AND CHOOSING WHAT THE MOST IMPORTANT AND ATTAINABLE GOALS WOULD BE. THESE NEEDS ARE PRESENTED IN THE CHNA WITH A DETAILED EXPLANATION OF THE ISSUES, HOW THIS INFORMATION WAS GATHERED, INCLUDING PRIMARY AND SECONDARY DATA, WHAT THE GOALS ARE TO DEAL WITH THIS ISSUE AND THE NEXT STEPS TO ATTAIN THESE GOALS. THE REPORT ADDRESSES THE TOP FIVE HEALTH NEEDS OF THE COMMUNITY AND FOCUSES ON THOSE ISSUES. THE IMPLEMENTATION PLAN ONLINE SHOWS THE ANNUAL ACTIVITY AND PROGRESS. SCHEDULE H, PART V, SECTION B, LINES 16A, 16B, & 16C FINANCIAL ASSISTANCE POLICY: HTTPS://WWW.PHHEALTHCARE.ORG/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE-POLICY SCHEDULE H, PART V, SECTION B, LINE 20E OTHER EFFORTS: THE BILLING STATEMENT STATES THAT THERE IS A FAP AVAILABLE AND GIVES INFORMATION ON HOW TO CONTACT SOMEONE FOR THE APPLICATION. SCHEDULE H, PART I, LINE 7, COLUMN F PERCENT OF TOTAL EXPENSE: TO ARRIVE AT THE PERCENT OF TOTAL EXPENSES, TOTAL OPERATING EXPENSES PER PART IX, LINE 25 OF THE FORM 990 WAS USED AS THE DENOMINATOR. SCHEDULE H, PART I, LINE 7 COSTING METHODOLOGY: THE COST TO CHARGE RATIO COMPUTED ON IRS WORKSHEET 2 WAS USED IN THE CALCULATIONS ON IRS WORKSHEETS 1 AND 3. WORKSHEET 6 USED ACTUAL COST DATA. SCHEDULE H, PART III, SECTION A, LINE 2 BAD DEBT EXPENSE METHODOLOGY: THE HOSPITAL HAS ADOPTED THE NEW REVENUE RECOGNITION STANDARD ASU 014-09. UNDER ASU 2014-09, THE ESTIMATED AMOUNTS DUE FROM PATIENTS FOR WHICH THE HOSPITAL DOES NOT EXPECT TO BE ENTITLED OR COLLECT FROM THE PATIENTS ARE CONSIDERED IMPLICIT PRICE CONCESSIONS AND EXCLUDED FROM THE HOSPITAL'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, 2020. 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, SECTION A, LINE 3 BAD DEBT ATTRIBUTABLE TO CHARITY CARE: BAD DEBT IS ESTIMATED BASED ON APPLYING PRE-ESTABLISHED PERCENTAGES TO EACH PAYOR BALANCE IN THE ORGANIZATION'S ACCOUNTS RECEIVABLE. SELF-PAY BALANCE PERCENTAGES ARE BASED ON HISTORICAL BAD DEBT INFORMATION AND ASSISTANCE FROM THE ORGANIZATION'S FINANCIAL AUDITORS. SCHEDULE H, PART III, SECTION A, LINE 4 BAD DEBT EXPENSE 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 PAGE 15 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS. SCHEDULE H, PART III, SECTION B, LINE 8 COMMUNITY BENEFIT: 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. MEDICARE TOTAL REVENUE RECEIVED AND ALLOWABLE COSTS ARE CALCULATED USING VARIOUS LINES FROM THE MEDICARE COST REPORT. FOR THE PROFESSIONAL COMPONENT REVENUE, INTERNAL REPORTS ARE USED. THE PROFESSIONAL COST IS CALCULATED USING THE NON-ALLOWABLE PHYSICIAN COSTS FROM THE COST REPORT MULTIPLIED BY THE PERCENTAGE OF MEDICARE PCS TO TOTAL PCS. SCHEDULE H, PART III, SECTION C, LINE 9B COLLECTION POLICY: THE ACTIONS THAT PHH/PHPN MAY TAKE WITH REGARD TO THE NON-PAYMENT BY AN INDIVIDUAL WHO IS ABLE TO PAY FOR SERVICES, INCLUDING COLLECTION ACTIONS AND POSSIBLE REPORTING TO CREDIT AGENCIES ARE CONTAINED IN PHH/PHPN'S BILLING AND COLLECTION POLICY. FOR INDIVIDUALS WHO QUALIFY FOR FAP AND WHO ARE COOPERATING IN GOOD FAITH TO RESOLVE THEIR DISCOUNTED MEDICAL BILLS, PHH/PHPN WILL NOT SEND UNPAID BILLS TO OUTSIDE COLLECTIONS AGENCIES. PHH/PHPN WILL NOT IMPOSE EXTRAORDINARY COLLECTIONS ACTIONS (ECA) SUCH AS LAWSUITS, LIENS ON RESIDENCES OR OTHER SIMILAR LEGAL ACTIONS FOR ANY INDIVIDUAL WITHOUT FIRST MAKING REASONABLE EFFORTS TO DETERMINE WHETHER THAT INDIVIDUAL IS ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THE FAP. REASONABLE EFFORTS SHALL INCLUDE: A) NOTIFYING THE INDIVIDUAL OF THE FAP UPON ADMISSION, IN WRITTEN AND ORAL COMMUNICATIONS WITH THE INDIVIDUAL REGARDING THEIR BILL AND INCLUDING INFORMATION ON THE FAP ON STATEMENTS; B) WRITTEN DOCUMENTATION THAT PHH/PHPN HAS ATTEMPTED TO OFFER THE INDIVIDUAL THE OPPORTUNITY TO APPLY FOR FINANCIAL ASSISTANCE PURSUANT TO HIS POLICY AND THAT THE INDIVIDUAL HAS NOT COMPLIED WITH THE APPLICATION REQUIREMENTS; C) VALIDATING THAT THE INDIVIDUAL OWES THE UNPAID BILLS AND THAT ALL SOURCES OF THIRD-PARTY PAYMENTS HAVE BEEN IDENTIFIED AND BILLED BY PHH/PHPN; D) DOCUMENTATION THAT THE INDIVIDUAL HAS BEEN OFFERED A PAYMENT PLAN BUT HAS NOT HONORED THE TERMS OF THAT PLAN. SCHEDULE H, PART VI, LINE 2 NEEDS ASSESSMENT: THE HOSPITAL COLLECTS DATA ON AN ONGOING BASIS REGARDING PATIENTS WHO TRAVEL TO OUTLYING AREAS FOR SERVICES NOT OFFERED BY DRMC. BASED ON THIS DATA, SERVICES ARE ADDED AND IMPROVED UPON IN ORDER TO SERVE THE NEEDS OF THE COMMUNITY AS EFFECTIVELY AND EFFICIENTLY AS POSSIBLE. DRMC ROUTINELY SENDS PATIENT SATISFACTION SURVEYS TO THOSE RECEIVING MEDICAL SERVICES. THESE SURVEYS ALLOW PATIENTS TO OFFER SUGGESTIONS REGARDING HOW THE HOSPITAL COULD BETTER SERVE THEM AS PATIENTS AND THE COMMUNITY AS A WHOLE. DRMC OFFERS A VARIETY OF EDUCATION PROGRAMS THAT ALLOW EMPLOYEES TO INTERACT ON A ONE-ON-ONE BASIS WITH THE RESIDENTS OF THE COMMUNITY AS A WHOLE. IN ADDITION, THE MEDICAL STAFF OF THE HOSPITAL CONSISTENTLY PARTICIPATES IN RESEARCH AND CONTINUING MEDICAL EDUCATION. THIS KNOWLEDGE ALLOWS THE HOSPITAL TO REMAIN UPDATED ON THE LATEST MEDICAL NEWS AND TECHNIQUES IN ORDER TO OFFER PATIENTS THE HIGHEST AND MOST INNOVATIVE LEVELS OF CARE. DRMC HIRED AN OUTSIDE FIRM TO ASSIST WITH THE CREATION OF THE COMMUNITY HEALTH NEEDS ASSESSMENT. THE CONTRACTOR GATHERED SECONDARY DATA IN CLEARFIELD AND SURROUNDING COUNTIES, CONDUCTED VARIOUS FOCUS GROUPS WITH KEY AUDIENCES AND USERS OF HEALTHCARE AND SOCIAL SERVICES TO IDENTIFY AREAS FOR PERSPECTIVE IMPROVEMENT WITHIN THE COMMUNITY. THE CONTRACTOR HAS DEVELOPED A MASTER PLAN OF INITIATIVES FOR DRMC WHICH HAS BEEN POSTED ON THE HOSPITAL'S WEBSITE. SCHEDULE H, PART VI, LINE 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: DRMC POSTS A NOTICE OF CHARITY CARE AT ALL POINTS OF REGISTRATION, INCLUDING ALL EMPLOYED PHYSICIAN PRACTICES. THE NOTICE INCLUDES A STATEMENT AS TO THE AVAILABILITY OF CHARITY CARE AND HOW TO APPLY. DRMC EMPLOYS A FINANCIAL COUNSELOR WHO MEETS INDIVIDUALLY WITH ALL INPATIENTS ADMITTED TO THE FACILITY WHO INDICATE NO HEALTH CARE COVERAGE. THE FINANCIAL COUNSELOR INTERVIEWS THE PATIENT, AND, IF APPROPRIATE, DISCUSSES AND EDUCATES THE PATIENT RELATIVE TO MEDICAL ASSISTANCE, BLUE CHIP AND THE HOSPITAL'S CHARITY PROGRAM. THE FINANCIAL COUNSELOR COMPETES AND ASSISTS THE PATIENTS WITH THE NECESSARY APPLICATIONS AND FOLLOW-THRU WITH THE PHYSICIAN AND THE ASSIGNED COUNTY BOARD OF ASSISTANCE CASEWORK. THE FINANCIAL COUNSELOR ALSO CONTACT OTHER PATIENTS WITH LARGE DOLLAR ACCOUNT BALANCES TO DISCUSS AND EDUCATE THE PATIENT'S NEED FOR FINANCIAL ASSISTANCE. ADDITIONALLY, DRMC EMPLOYS A CREDIT COLLECTIONS STAFF WHO ALSO CONTACTS, EDUCATES AND OFFERS ASSISTANCE TO OTHER PATIENTS WITH FINANCIAL NEED TO HELP WITH HEALTH CARE COSTS. SCHEDULE H, PART VI, LINE 4 COMMUNITY INFORMATION: DRMC'S 216 LICENSED BEDS ARE HOUSED IN TWO FACILITIES IN DUBOIS, A SMALL TOWN IN CENTRAL PENNSYLVANIA. THE COMBINED TRADITION OF PROVIDING HIGH QUALITY, COMPASSIONATE CARE BEGAN WITH ITS PREDECESSORS, DUBOIS HOSPITAL AND MAPLE AVENUE HOSPITAL IN 1897. IN 1985, THE TWO ORGANIZATIONS JOINED TO CREATE DUBOIS REGIONAL MEDICAL CENTER, AND, SINCE THEN, THE MEDICAL CENTER HAS GROWN FOR THE BENEFIT OF THE ENTIRE COMMUNITY. DRMC WEST HOUSES ACUTE INPATIENT CARE AND A FULL RANGE OF ANCILLARY SERVICES. DRMC EAST IS THE SIGHT OF THE BEHAVIORAL HEALTH UNIT. IN ADDITION, DRMC OFFERS ACCESS TO PRIMARY AND SPECIALTY CARE HEALTH CENTERS IN SEVERAL COMMUNITIES AS ONE OF THE LARGEST PRIVATE EMPLOYERS IN THE AREA. SCHEDULE H, PART VI, LINE 5 PROMOTION OF COMMUNITY HEALTH: DUBOIS REGIONAL MEDICAL CENTER OFFERS RESIDENTS OF WEST CENTRAL PENNSYLVANIA THE COMBINATION OF ADVANCED HEALTHCARE IN A WARM, FRIENDLY ENVIRONMENT. WIDELY RECOGNIZED AS ONE OF THE LEADING HEALTH CENTERS OF ITS KIND IN THE COMMONWEALTH, DRMC IS AN OASIS OF CLINICAL AND TECHNICAL EXCELLENCE, WITH A FOCUS ON PATIENT-CENTERED CARE. OUR COMBINED VISION IS TO BE POSITIONED AS THE PREMIER PROVIDER OF COMPREHENSIVE, QUALITY SERVICES TO OUR BROAD REGION. PROVIDING INPATIENT AND OUTPATIENT HOSPITAL CARE REPRESENTS THE LARGEST PORTION OF THESE SERVICES. DRMC'S MISSION IN MAINTAINING THESE SERVICES IS ACCOMPLISHED BY PROVIDING ACCESS TO HEALTHCARE SERVICES FOR ALL, INCLUDING INDIVIDUALS WHO ARE UNABLE TO PAY FOR SUCH SERVICES. DRMC HAS A TRADITION OF SERVING THE POOR AND UNDER-PRIVILEGED OF THE AREA BY PROVIDING CARE PROGRAMS AND SERVICES TO ENHANCE THEIR QUALITY OF LIFE. BEYOND THE INPATIENT AND OUTPATIENT HOSPITAL CARE, THERE ARE MANY OTHER WAYS IN WHICH DRMC AND OUR EMPLOYEES SERVE OUR COMMUNITY EVERY DAY. IN ADDITION TO GIVING TO ORGANIZATIONS, THEY PROVIDE INFORMATION ON HEALTH AND SAFETY TO THE COMMUNITY. THEY PROVIDE DIRECT PATIENT CARE ON A VOLUNTEER BASIS AT THE LOCAL DUBOIS FREE CLINIC. THE CLINIC WAS ESTABLISHED FOR LOW-INCOME PEOPLE WHO COULD NOT AFFORD HEALTH INSURANCE. THE SUCCESS AND REPUTATION OF DRMC IS A DIRECT RESULT OF THE DEDICATED EFFORTS OF OUR BOARD OF DIRECTORS, ADMINISTRATION, PHYSICIANS AND STAFF WITH THE CONTINUED SUPPORT OF THE DRMC FAMILY AND THE COMMUNITIES WE SERVE, DRMC WILL REMAIN A VALUABLE RESOURCE TO OUR AREA. SCHEDULE H, PART VI, LINE 6 AFFILIATED HEALTH CARE SYSTEM: DUBOIS REGIONAL MEDICAL CENTER IS PART OF PENN HIGHLANDS HEALTHCARE (PHH, SYSTEM). PHH IS A NOT-FOR-PROFIT CORPORATION ORGANIZED TO COORDINATE AND MANAGE THE INTEGRATION OF THE DELIVERY OF HEALTHCARE SERVICES TO THE NORTH CENTRAL PENNSYLVANIA AREA. THE SYSTEM INCLUDES THE CONSOLIDATED FINANCIAL STATEMENTS OF PENN HIGHLANDS HEALTHCARE, PENN HIGHLANDS DUBOIS, PENN HIGHLANDS ELK, PENN HIGHLANDS CLEARFIELD AND PENN HIGHLANDS HUNTINGDON. THE PENN HIGHLANDS DUBOIS PORTION OF THE PHH SYSTEM INCLUDES THE FOLLOWING ENTITIES AND OPERATIONS: -DUBOIS REGIONAL MEDICAL CENTER (DRMC) PRIMARILY EARNS REVENUES BY PROVIDING INPATIENT, OUTPATIENT AND EMERGENCY CARE SERVICES TO RESIDENTS IN DUBOIS, PENNSYLVANIA, AND SURROUNDING AREAS. -BROOKVILLE HOSPITAL (BROOKVILLE), A CRITICAL ACCESS HOSPITAL IN BROOKVILLE, PENNSYLVANIA. BROOKVILLE EARNS REVENUES BY PROVIDING INPATIENT, OUTPATIENT AND EMERGENCY CARE SERVICES. -BROOKVILLE INCLUDES BROOKCARE, A CORPORATION WHOSE PRIMARY BUSINESS IS TO RENT OFFICE SPACE TO PHYSICIANS AND VARIOUS DEPARTMENTS OF BROOKVILLE HOSPITAL. -JEFFCO HEALTH SERVICES, A POST-ACUTE SERVICE PROVIDER. -DUBOIS MEDICAL RISK RETENTION GROUP (DMRRG), PROVIDES LIABILITY INSURANCE TO DUBOIS COMPANIES AS WELL AS EMPLOYEE HEALTH INSURANCE FOR THE SYSTEM. DUBOIS IS THE SOLE MEMBER OF THE CLASS A VOTING AND PARTICIPATING CERTIFICATES OF DMRRG. -DUBOIS REGIONAL MEDICAL GROUP (DRMG), PROVIDES PRIMARY CARE AND SPECIALTY PHYSICIAN SERVICES. THE PENN HIGHLANDS ELK (ELK) PORTION OF THE PHH SYSTEM INCLUDES THE FOLLOWING ENTITIES AND OPERATIONS: -ELK REGIONAL HEALTH CENTER (ELK) PROVIDES PRIMARY ACUTE CARE MEDICAL SERVICES AT TWO CAMPUSES, THE ST. MARYS HEALTH CENTER IN ST. MARYS, PENNSYLVANIA, AND THE RIDGWAY HEALTH CENTER IN RIDGWAY, PENNSYLVANIA. -COMMUNITY NURSES, INC. AND SUBSIDIARIES (COMMUNITY NURSES), IS COMPRISED OF COMMUNITY NURSES HOME HEALTH AND HOSPICE, INC., WHICH PROVIDES SKILLED NURSING, PROFESSIONAL HOME HEALTH AND HOSPICE SERVICES, HOME HEALTH AIDE, PHYSICAL THERAPY, SPEECH THERAPY AND OCCUPATIONAL THERAPY; AND COMMUNITY NURSES HOME HEALTH SUPPORT SERVICES, INC., WHICH PROVIDES VARIOUS NONPROFESSIONAL HOME HEALTH RELATED SUPPORTIVE SERVICES. -ELK REGIONAL PROFESSIONAL GROUP, INC., IS COMPRISED OF VARIOUS PHYSICIAN PRACTICES. -ELCO HOUSING, INC., WAS FORMED TO OPERATE EXCLUSIVELY FOR THE BENEFIT OF, TO PERFORM THE FUNCTIONS OF AND TO CARRY OUT THE PURPOSES OF ELK BY SERVING AS A GENERAL PARTNER IN ELCO GLEN LIMITED PARTNERSHIP, THE PURPOSE OF WHICH IS TO ACQUIRE, CONSTRUCT, PROVIDE AND OPERATE RENTAL HOUSING AND RELATED FACILITIES SUITED TO THE NEEDS AND LIVING REQUIREMENTS OF ELIGIBLE OCCUPANTS AS DETERMINED BY THE FARMERS HOME ADMINISTRATION (FMHA). -ELK VENTURES, LLC (ELK VENTURES), A SINGLE MEMBER LLC OF ELK REGIONAL HEALTH CENTER, WAS FORMED TO OPERATE EXCLUSIVELY FOR THE BENEFIT OF, TO PERFORM THE FUNCTIONS OF AND TO CARRY OUT THE PURPOSES OF ELK. THE PENN HIGHLANDS CLEARFIELD (CLEARFIELD) PORTION OF THE PHH SYSTEM INCLUDES THE FOLLOWING ENTITIES AND OPERATIONS: -CLEARFIELD HOSPITAL PRIMARILY EARNS REVENUES BY PROVIDING INPATIENT, OUTPATIENT AND EMERGENCY CARE SERVICES TO PATIENTS IN CLEARFIELD COUNTY AND THE SURROUNDING AREAS. -CLEARFIELD MEDICAL ASSOCIATES (CMA), OWNS AND OPERATES THE MEDICAL ARTS BUILDING LOCATED ON CLEARFIELD HOSPITAL'S CAMPUS. -CLEAR-CARE CORPORATION (CLEAR-CARE), PROVIDES MEDICAL EQUIPMENT TO CUSTOMERS. SCHEDULE H, PART VI, LINE 7 STATE FILING OF COMMUNITY BENEFIT REPORT: PA X X X X X false true false false false true false false false JOHN SUTIKA PRESIDENT 372872 0 51687 0 18120 0 48487 0 16368 0 507534 0 0 0 STEVE FONTAINE TRUSTEE, PRESIDENT/CEO PHH 0 697673 0 263935 0 30166 0 63351 0 19265 0 1074390 0 0 BRIAN KLINE VP CHIEF FINANCIAL OFFICE 263355 0 39551 0 255 0 23703 0 7509 0 334373 0 0 0 MARK NORMAN TRUSTEE, COO PHH 0 328731 0 71198 0 6864 0 30200 0 19265 0 456258 0 0 DR SANDEEP BANSAL PHYSICIAN 1001946 0 493738 0 102 0 11200 0 18353 0 1525339 0 0 0 DR STEPHEN IORFIDO PHYSICIAN 1218801 0 401454 0 100 0 11200 0 20293 0 1651848 0 0 0 DR GASSAN BEJJANI PHYSICIAN 1280172 0 10000 0 3332 0 0 0 20214 0 1313718 0 0 0 DR TERRY T BROWN PHYSICIAN 690240 0 432380 0 19444 0 0 0 7872 0 1149936 0 0 0 DR SUZANNE IORFIDO PHYSICIAN 639389 0 388773 0 100 0 11200 0 629 0 1040091 0 0 0 SCHEDULE J, PART I, LINE 4B NONQUALIFIED RETIREMENT PLAN: THE FOLLOWING INDIVIDUALS RECEIVED CONTRIBUTIONS TO A 457(F) PLAN DURING THE YEAR: $ 33,151 STEVE FONTAINE $ 18,287 JOHN SUTIKA $ 2,545 MARK NORMAN SCHEDULE J, PART I, LINE 6A COMPENSATION CONTINGENT ON NET EARNINGS: MEMBERS OF THE MANAGEMENT TEAM ARE ELIGIBLE FOR AN INCENTIVE BONUS EACH YEAR BASED ON PREDETERMINED CRITERIA. SUCH CRITERIA INCLUDES MULTIPLE FACTORS SUCH AS MEETING STRATEGIC AND OTHER PERFORMANCE METRICS INCLUDING GROWTH OF SERVICES, CUSTOMER SATISFACTION, FINANCIAL PERFORMANCE, QUALITY IMPROVEMENTS, AMONG OTHER GOALS. MICHELLE SUTIKA BENNETT RELATIVE OF OFFICER 154361 COMPENSATION false TRICIA BRIGGER RELATIVE OF TRUSTEE 90113 COMPENSATION false MEGAN DEVLIN BUSSARD RELATIVE OF TRUSTEE 138035 COMPENSATION false DOUGLAS DALE RELATIVE OF OFFICER 38691 COMPENSATION false LAUREN DALE HOSPODAR RELATIVE OF OFFICER 69973 COMPENSATION false MARK STOLTZ RELATIVE OF TRUSTEE 65228 COMPENSATION false MARISSO ZOCCO RELATIVE OF TRUSTEE 99552 COMPENSATION false SCHEDULE L, PART IV, COLUMN B RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: (1) MICHELLE SUTIKA BENNETT IS A RELATIVE OF JOHN SUTIKA, OFFICER (2) TRICIA BRIGGER IS A RELATIVE OF ANTHONY VIGLIONE, TRUSTEE (3) MEGAN DEVLIN BUSSARD IS A RELATIVE OF JAMES DEVLIN, TRUSTEE (4) AND (5) DOUGLAS DALE AND LAUREN DALE HOSPODAR ARE RELATIVES OF JOHN SUTIKA, OFFICER (6) MARK STOLTZ IS A RELATIVE OF TODD STOLTZ, TRUSTEE (7) MARISSO ZOCCO IS A RELATIVE OF LISA ZOCCO, TRUSTEE FORM 990, PART VI, SECTION A, LINE 2 BUSINESS RELATIONSHIPS: COMPENSATED TRUSTEES AND OFFICERS SHARE A BUSINESS RELATIONSHIP THROUGH THEIR EMPLOYMENT WITH A RELATED ORGANIZATION. FORM 990, PART VI, SECTION A, LINES 6, 7A, & 7B MEMBERS: PENN HIGHLANDS HEALTHCARE (PHH) HOLDS CERTAIN POWERS, INCLUDING THE APPROVAL OF THE ELECTION AND REMOVAL OF OFFICERS AND DIRECTORS AND APPROVAL OF ANY AND ALL AMENDMENTS TO THE BYLAWS OR OTHER ORGANIZATIONAL/GOVERNANCE DOCUMENTS. PHH SHALL HAVE THE FOLLOWING POWERS WITH RESPECT TO THE ELECTION AND REMOVAL OF DIRECTORS: PRIOR TO THE END OF PHH'S FISCAL YEAR, THE PHH BOARD WILL MEET TO ELECT THE DIRECTORS, WITH THE EXCEPTION OF EX-OFFICIO DIRECTORS. AT LEAST SIXTY (60) DAYS IN ADVANCE OF THIS MEETING, ALL INDIVIDUALS BEING CONSIDERED FOR APPOINTMENT AS A DIRECTOR (WHETHER ELECTED OR EX-OFFICIO) SHALL BE REFERRED TO THE BOARD OF THIS CORPORATION AND/OR THIS CORPORATION'S GOVERNANCE/NOMINATING COMMITTEE, IF APPLICABLE. THE BOARD AND/OR GOVERNANCE/NOMINATING COMMITTEE SHALL REVIEW THE QUALIFICATIONS THEREOF AND SUBMIT ITS RECOMMENDATIONS TO THE PHH GOVERNANCE/NOMINATING COMMITTEE. IN ACCORDANCE WITH THE COVENANT AGREEMENT, THE SISTERS OF MERCY SHALL HAVE THE PREROGATIVE TO NOMINATE UP TO 3 OF ITS MEMBERS TO THE BOARD. TO THE EXTENT POSSIBLE, THE SISTERS OF MERCY SHALL NOMINATE THESE INDIVIDUALS IN A FASHION SO THAT THE TERMS OF THE INDIVIDUALS ARE STAGGERED. THE INDIVIDUALS SELECTED BY THE SISTERS OF MERCY TO SERVE ON THE BOARD SHALL FIRST BE SUBMITTED TO THE BOARD FOR REVIEW AND RECOMMENDATION PRIOR TO BEING NOMINATED AND ELECTED. THE BOARD OF PHH HAS THE POWER TO REMOVE SUCH DIRECTOR AT ANY TIME WITH OR WITHOUT CAUSE. ONCE THE SLATE OF CANDIDATES IS NOMINATED BY THE PHH GOVERNANCE/NOMINATING COMMITTEE, THE BOARD OF DRMC SHALL SUBMIT TO THE PHH BOARD FOR ELECTION SUCH SLATE OF CANDIDATES FOR THE OPEN BOARD POSITIONS. THE PHH BOARD MAY ELECT BY A VOTE OF THE MAJORITY OR REFUSE TO ELECT EACH CANDIDATE SUBMITTED BY THE BOARD OF DRMC AND MAY NOT ELECT ANY CANDIDATE NOT SUBMITTED BY THE BOARD OF DRMC AND NOMINATED BY THE PHH GOVERNANCE/NOMINATING COMMITTEE. IN THE EVENT THAT THIS ORGANIZATION DESIRES TO FILL A VACANCY OCCURRING ON ITS BOARD, THE PHH GOVERNANCE/NOMINATING COMMITTEE AND THE BOARD OF PHH, AT THE REQUEST OF DRMC, SHALL ACT TO FILL SUCH VACANCY. SUBJECT TO THE APPROVAL OF PHH AS SET FORTH IN THE BYLAWS, THE ARTICLES AND THE BYLAWS MAY BE ALTERED, AMENDED, OR REPEALED AND NEW BYLAWS OR ARTICLES MAY BE ADOPTED BY THE AFFIRMATIVE VOTE OF TWO-THIRDS (2/3) OF THE BOARD. WRITTEN NOTICE OF THE INTENT TO AMEND THE BYLAWS OR THE ARTICLES AND A DRAFT OF THE PROPOSED CHANGE SHALL BE SENT TO ALL DIRECTORS, BY THE SECRETARY, AT LEAST FIVE (5) DAYS PRIOR TO ANY MEETING AT WHICH AMENDMENT OF THE BYLAWS OR THE ARTICLES IS INTENDED. 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 ORGANIZATION. THE COMPLETE FORM 990 WILL BE PROVIDED TO THE FINANCE COMMITTEE AND BOARD OF DIRECTORS. AT THAT TIME, THE COMMITTEE WILL REVIEW THE FORM 990 AND HAVE THE OPPORTUNITY TO DISCUSS ANY INFORMATION CONTAINED WITHIN THE DOCUMENT. FORM 990, PART VI, SECTION B, LINE 12C MONITORING COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY: PENN HIGHLANDS HEALTHCARE, INC. (PHH), MAINTAINS A CONFLICT OF INTEREST POLICY WHICH APPLIES TO ALL SUBSIDIARIES. THE CONFLICT OF INTEREST POLICY APPLIES TO BOARD MEMBERS, OFFICERS, EXECUTIVE EMPLOYEES, AND ANY OTHER MANAGER OR SUPERVISOR EXERCISING SUBSTANTIAL INFLUENCE OVER OPERATIONS. EACH COVERED PERSON WILL PROMPTLY AND FULLY DISCLOSE ALL MATERIAL FACTS OF EVERY ACTUAL OR POTENTIAL DUAL INTEREST EXISTING AT THE TIME WHEN HE/SHE BECOMES A COVERED PERSON, AND ANNUALLY THROUGH EACH PHH SYSTEM ENTITY'S DISCLOSURE STATEMENT, WHICH REQUESTS DISCLOSURE OF RELATIONSHIPS, INVESTMENTS, AND TRANSACTIONS THAT MAY LEAD TO AN ACTUAL CONFLICT OF INTEREST. ALL COMPLETED DISCLOSURE STATEMENTS WILL BE PROVIDED TO THE PHH GOVERNANCE/NOMINATING COMMITTEE. THIS COMMITTEE, IN CONSULTATION WITH THE CHAIRPERSON OR VICE CHAIRPERSON OF EACH PHH SYSTEM ENTITY'S BOARD, SHALL EVALUATE THE COMPLETED DISCLOSURE STATEMENTS AND DETERMINE IF THERE ARE ANY CONFLICTS THAT ARE SO PERVASIVE AS TO RENDER ANY COVERED PERSON INELIGIBLE FOR SERVICE. THE CHAIRPERSON OF EACH PHH SYSTEM ENTITY'S BOARD WILL DISCLOSE TO THE FULL BOARD OF SAID PHH SYSTEM ENTITY ALL DUAL INTERESTS REPORTED TO HIM OR HER UNDER THE POLICY AND WILL ALSO MAKE THE DISCLOSURE STATEMENTS OF ALL COVERED PERSONS AVAILABLE TO DIRECTORS AT ANY TIME DURING THE YEAR. IF A POTENTIAL DUAL INTEREST ARISES AS A RESULT OF A CONTEMPLATED PHH SYSTEM ENTITY BOARD (OR COMMITTEE) ACTION, THE CHAIRPERSON OF SAID PHH SYSTEM ENTITY'S BOARD OR THE INTERESTED PERSON SHALL, OR ANY OTHER DIRECTOR MAY, RAISE THE QUESTION OF THE INTERESTED PERSON'S DUAL INTEREST. THE DISINTERESTED MEMBERS OF THE PHH SYSTEM ENTITY'S BOARD (OR COMMITTEE) WILL EVALUATE THE DISCLOSURES AND THE MATERIAL FACTS RELATING TO THE TRANSACTION, ARRANGEMENT, OR POLICY GIVING RISE TO THE DUAL INTEREST TO DETERMINE WHETHER THEY INVOLVE ACTUAL CONFLICTS OF INTEREST AND MAY ATTEMPT TO DEVELOP ALTERNATIVES TO REMOVE THE CONFLICT FROM THE TRANSACTION, ARRANGEMENT, OR POLICY. A COVERED PERSON WHO HAS A DUAL INTEREST SHALL NOT BE PRESENT FOR OR SHALL LEAVE ANY PORTION OF A MEETING AT WHICH A PHH SYSTEM ENTITY'S BOARD (OR COMMITTEE) IS VOTING TO DETERMINE WHETHER A CONFLICT EXISTS, BUT MAY BE PRESENT PRIOR TO THE VOTE TO MAKE A PRESENTATION TO SAID BOARD (OR COMMITTEE), TO DISCLOSE ADDITIONAL FACTS, OR TO RESPOND TO QUESTIONS. IF A PHH SYSTEM ENTITY'S BOARD (OR COMMITTEE DETERMINES THAT AN ACTUAL CONFLICT OF INTEREST EXISTS, THE INTERESTED PERSON SHALL BE SO ADVISED AND THE CHAIRPERSON OF A PHH SYSTEM ENTITY'S BOARD OR COMMITTEE SHALL, IF APPROPRIATE, APPOINT A DISINTERESTED PERSON OR COMMITTEE OR DIRECT MANAGEMENT TO INVESTIGATE ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT, IF THIS HAS NOT ALREADY BEEN DONE. ANY INTERESTED PERSON WHO HAS AN ACTUAL CONFLICT OF INTEREST WITH RESPECT TO THE TRANSACTION OR ARRANGEMENT DOES NOT PARTICIPATE IN AND IS NOT PRESENT FOR THE VOTE REGARDING ANY SUCH TRANSACTION OR ARRANGEMENT. IF AN INDIVIDUAL WHOSE COMPANY OR EMPLOYER HAS A BUSINESS RELATIONSHIP WITH A PHH SYSTEM ENTITY, BUT THE INDIVIDUAL DOES NOT HAVE AN ACTUAL CONFLICT OF INTEREST WITH RESPECT TO THIS BUSINESS RELATIONSHIP, THE INDIVIDUAL MAY NONETHELESS VOLUNTARILY RECUSE HIM/HERSELF FROM VOTING ON ANY MATTERS RELATED TO THE RELATIONSHIP. FORM 990, PART VI, SECTION B, LINE 15A & 15B COMPENSATION DETERMINATION: AN INDEPENDENT FIRM IS HIRED TO COMPARE, REVIEW, AND RECOMMEND ALL SENIOR OFFICERS COMPENSATION. THE BOARD OF DIRECTORS PROVIDES THE FINAL APPROVAL. IN ADDITION, THE PENN HIGHLANDS HEALTHCARE EXECUTIVE COMPENSATION COMMITTEE CONSULTS WITH THE HEALTHCARE CONSULTING FIRM, YAFEE AND COMPANY TO OBTAIN COMPARABLE DATA TO MAKE RECOMMENDATIONS TO THE BOARD OF DIRECTORS REGARDING EXECUTIVE COMPENSATION. THE PENN HIGHLANDS HEALTHCARE BOARD OF DIRECTORS IS ACUTELY AWARE OF THE HEIGHTENED PUBLIC SCRUTINY OF EXECUTIVE COMPENSATION AND THE NEED TO CONSIDER REGULATORY COMPLIANCE WHEN SETTING EXECUTIVE PAY. COMPENSATION REVIEWS ARE DONE ON A CONTINUOUS BASIS. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENT AVAILABILITY: THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE LOCATED IN THE ADMINISTRATION OFFICES OF DUBOIS REGIONAL MEDICAL CENTER. THEY ARE AVAILABLE FOR PUBLIC INSPECTION UPON REQUEST. FORM 990, PART VII, SECTION A BOARD MEMBER COMPENSATION: NO TRUSTEES RECEIVE ANY COMPENSATION FOR THEIR TRUSTEE DUTIES. STEVE FONTAINE IS COMPENSATED AS CEO OF THE PENN HIGHLANDS HEALTHCARE SYSTEM. MARK NORMAN IS COMPENSATED AS CHIEF OPERATING OFFICER OF THE PENN HIGHLANDS HEALTHCARE SYSTEM. JOHN SUTIKA IS COMPENSATED AS PRESIDENT OF DUBOIS REGIONAL MEDICAL CENTER. FORM 990, PART XI, LINE 9 OTHER CHANGES IN NET ASSETS: $ (83,984) CHANGE IN BENEFICIAL INTEREST IN PERPETUAL TRUST BROOKVILLE HOSPITAL 100 HOSPITAL ROAD BROOKVILLE PA 15825 250984595 HOSPITAL PA 501(C)(3) 3 DRMC true CLEARFIELD HOSPITAL 809 TURNPIKE AVENUE CLEARFIELD PA 16830 250979346 HOSPITAL PA 501(C)(3) 3 PHH false PENN HIGHLANDS HEALTHCARE PO BOX 447 DUBOIS PA 15801 320345810 MGMT SERVICES PA 501(C)(3) 12 C III-FI NA false ELK REGIONAL HEALTH CENTER 763 JOHNSONBURG ROAD ST MARYS PA 15857 250585280 HOSPITAL PA 501(C)(3) 3 PHH false ELCO HOUSING 759 JOHNSONBURG ROAD ST MARYS PA 15857 251639115 HOUSING PA 501(C)(3) 12 A 1 PHH false ELK REGIONAL PROFESSIONAL GROUP INC 763 JOHNSONBURG ROAD ST MARYS PA 15857 251875183 HEALTH CARE PA 501(C)(3) 3 PHH false COMMUNITY NURSES HOME HEALTH AND HOSPICE 757 JOHNSONBURG ROAD STE 200 ST MARYS PA 15857 250996070 HEALTH CARE PA 501(C)(3) 10 CNI false COMMUNITY NURSES HOME SUPPORT SERVICES 757 JOHNSONBURG ROAD STE 200 ST MARYS PA 15857 251623601 HEALTH CARE PA 501(C)(3) 10 CNI false COMMUNITY NURSES INC 757 JOHNSONBURG ROAD STE 200 ST MARYS PA 15857 251623598 HEALTH CARE PA 501(C)(3) 7 PHH false DRMC EMPLOYEE BENEFITS PLAN TRUST 100 HOSPITAL AVE DUBOIS PA 15801 256332829 DRMC EMP BENE PA 501(C)(9) DRMC true DRMC WORKERS COMPENSATION TRUST PO BOX 447 DUBOIS PA 15801 251741497 SUPPORT PA 501(C)(3) 12 B II DRMC true CLEAR-MED PROVIDER CORPORATION PO BOX 1260 CLEARFIELD PA 16830 251657668 OUTPAT. PHYS. PA 501(C)(3) 3 PHH false JEFFCO HEALTH SERVICES 417 ROUTE 28 BROOKVILLE PA 15825 251505478 HEALTH CARE PA 501(C)(3) 10 BROOKVILLE false JC BLAIR MEMORIAL HOSPITAL 1225 WARM SPRINGS AVE HUNTINGDON PA 16652 231352159 HEALTH CARE PA 501(C)(3) 3 PHH false JC BLAIR MEMORIAL HOSPITAL FOUNDATION 935 14TH STREET HUNTINGDON PA 16652 251881377 SUPPORT PA 501(C)(3) 12 A I PHH false DUBOIS REGIONAL MEDICAL GROUP PO BOX 447 DUBOIS PA 15801 251856569 MEDICAL SERVICES PA DRMC C CORP 6975454 2112187 1.00000 true DUBOIS MEDICAL RISK RETENTION GROUP PO BOX 447 DUBOIS PA 15801 200324622 INSURANCE SERVICE PA DRMC C CORP 1347053 13619076 1.00000 true PERPETUAL TRUST TRUST PA DRMC TRUST 157879 1249 1.00000 true PENN HIGHLAND LIFE'S JOURNEY 100 HOSPITAL AVE DUBOIS PA 15801 824943778 MEDICAL SRVCS PA DRMC C CORP 7144312 1433115 1.00000 true false false true true false false false false false true true true true true true true true false false BROOKVILLE HOSPITAL J 148917 COST BROOKVILLE HOSPITAL L 195226 COST DUBOIS MEDICAL RISK RETENTION M 907080 COST BROOKVILLE HOSPITAL Q 1577684 COST BROOKVILLE HOSPITAL O 4186041 COST DUBOIS REGIONAL MEDICAL GROUP O 6995933 COST