2019-05-14T17:28:15-05:00 2018-06-30 BKD LLP 910 E ST LOUIS 200/PO BOX 1190 SPRINGFIELD MO 658062523 990 2017-07-01 250979346 CLEARFIELD HOSPITAL % ROBERT SPICHER CLEA 8147655341 809 TURNPIKE AVENUE CLEARFIELD PA 16830 RHONDA HALSTEAD PRESIDENT 8147655341 2019-05-15 true Brian D Todd P00422601 4178658701 167.68.126.162 43032920191345000034 2019-05-14 P 353840E92A19E57AE3D09FB5FB5D869273682438 C3432A87FBFF9491E59BD7298F2E512B0D9B3700 2017 2019-02-21 02:37:17Z PENN HIGHLANDS CLEARFIELD RHONDA HALSTEAD 809 TURNPIKE AVENUE CLEARFIELD PA 16830 43509235 false X WWW.PHHEALTHCARE.ORG 1901 PA PENN HIGHLANDS CLEARFIELD EXISTS TO POSITIVELY IMPACT THE HEALTH STATUS OF THE REGION BY PROVIDING QUALITY HEALTHCARE COUPLED WITH QUALITY SERVICE. 8 4 455 66 0 265 3842134 652138 44418567 41268434 355250 114489 897342 1014788 49513293 43049849 0 0 0 0 22043929 21765053 0 0 0 27839229 25975831 49883158 47740884 -369865 -4691035 48017455 47515726 25256061 29200262 22761394 18315464 TO PROVIDE THE COMMUNITY WITH EXCEPTIONAL CARE THROUGH OUR COMMUNITY-BASED HEALTH SYSTEM WHILE MAINTAINING A REVERENCE FOR LIFE. false false 42042901 41268434 AS A PART OF PENN HIGHLANDS HEALTHCARE, PENN HIGHLANDS CLEARFIELD CONTINUES ITS RICH TRADITION OF PROVIDING EXCELLENT CARE TO THE COMMUNITIES IT SERVES. IT CONTINUES TO EXPAND AND CREATE ACCESS TO A LARGE NUMBER OF MEDICAL, SURGICAL AND SUPPORT SERVICES. ITS AWARD-WINNING HOME HEALTH CARE SERVES A LARGE GEOGRAPHIC REGION. PENN HIGHLANDS CLEARFIELD CONSISTS OF AN ACTIVE EMERGENCY DEPARTMENT, MEDICAL-SURGICAL UNITS, BEHAVIORAL HEALTH SERVICES, CARDIAC DIAGNOSTIC SERVICES, REHABILITATION SERVICES, CARDIAC REHAB, CHEMOTHERAPY, IMAGING SERVICES, LABORATORY SERVICES, NUTRITION COUNSELING, PULMONARY REHABILITATION, SURGICAL SERVICES, WOUND CARE AND A SWING-BED PROGRAM. 42042901 true true false false false false false false false true true true 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 false false false false false false false true true true false false true 57 0 true 455 true false false false false false false false false false false X 8 4 true true false false true true true true true false false true true true true true true true false true true PA X ROBERT SPICHER 8143756136 100 HOSPITAL AVENUE DUBOIS PA 15801 X RHONDA HALSTEAD PRESIDENT BEGIN 6/2018 40.0 0.0 X X 0 0 0 DAVID LEZZER CHAIRMAN 1.0 0.0 X X 0 0 0 GERALDINE RADOMSKY TREASURER 1.0 0.0 X X 0 0 0 KEVIN TYLER DO PRESIDENT OF MEDICAL STAFF 1.0 40.0 X X 0 317808 31878 THOMAS CARNEVALE SECRETARY 1.0 40.0 X X 0 409637 26760 GEORGIA IRWIN BOARD MEMBER 1.0 0.0 X 0 0 0 ROBERT E STEWARD JR BOARD MEMBER 1.0 40.0 X 0 215933 28182 BRIAN WINGARD VICE CHAIRMAN 1.0 0.0 X X 0 0 0 GARY MACIOCE PRESIDENT END 11/2017 40.0 0.0 X X 0 304473 36321 MARK NORMAN INTERIM PRESIDENT 11/17-05/18 40.0 0.0 X X 0 308875 34937 BRIAN KLINE CHIEF FINANCIAL OFFICER 8.0 40.0 X 0 341194 29448 ROBERT R COLL PHYSICIAN 40.0 0.0 X 367070 0 31499 SHAUNAK PATEL PHYSICIAN 40.0 0.0 X 322781 0 18321 THOMAS L YEAGER PHARMACIST 40.0 0.0 X 120344 0 34808 KATHY BEDGER CHIEF NURSING OFFICER 40.0 0.0 X 116895 0 32374 KENNETH J SHURER PHARMACIST 40.0 0.0 X 102001 0 31506 1029091 1897920 336034 5 false true false STAFF CARE 12400 HIGH BLUFF DR SAN DIEGO CA 92130 STAFFING SERVICES 759769 ASSOCIATED CLINICAL LABORATORIES 15832 COLLECTION CTR DR CHICAGO IL 60693 LAB SERVICES 589865 CLEARFIELD COUNTY INVESTIGATORS 624 ARROWHEAD WAY CLEARFIELD PA 16830 SECURITY SERVICES 172920 VANTAGE MOBILE SERVICES 1305 S MAIN STREET MEADVILLE PA 16335 MEDICAL SERVICES 113200 ALLIED RESOURCES MEDICAL STAFFING 4949 LIBERTY LANE SUITE 330 ALLENTOWN PA 18106 STAFFING SERVICES 107944 5 8645 18120 625373 652138 NET PATIENT SERVICE REVENUE 621990 40016666 40016666 CAFETERIA 722514 129992 129992 PHARMACY 446110 99499 99499 OTHER REVENUE 621990 1022277 1022277 41268434 111437 111437 0 0 790317 435836 354481 0 354481 354481 3052 3052 3052 3052 6326 8645 5264 1062 1062 0 0 0 30536 18286 12250 12250 Equity Investee 900099 646995 646995 646995 43049849 41268434 1129277 X 0 0 0 0 340794 340794 0 16870238 15998025 872213 730271 643620 86651 2413698 2073096 340602 1410052 1204517 205535 2261150 2261150 36106 36106 100167 100167 0 0 35554 35554 8788310 6538660 2249650 0 2095 2095 1508265 1000399 507866 0 0 1339958 1079003 260955 45613 45540 73 0 39112 36608 2504 449085 383624 65461 0 2603745 2224212 379533 1190599 1028075 162524 MEDICAL SUPPLIES & DRUGS 4711014 4711014 BAD DEBT 2508641 2508641 REPAIRS AND MAINTENANCE 320648 291782 28866 LICENSES, DUES, SUBSCRIPTIONS 35769 14935 20834 47740884 42042901 5697983 0 X 36292 677032 5806849 3861439 0 40000 5086430 4129202 0 0 0 0 0 0 341114 305582 658673 332440 82511889 62357103 20722916 20154786 7529745 9322148 4600042 5084151 5000 5000 1368347 1185907 1862047 2418039 48017455 47515726 8145615 7054041 0 0 16000 30304 9929306 14764430 0 0 0 0 5138900 222403 0 0 2026240 7129084 25256061 29200262 X 21197466 16635040 805103 880162 758825 800262 22761394 18315464 48017455 47515726 X -4691035 203668 41437 X false true X false false X 264223 -235 1611 262377 239593 26045 1415 264223 242452 -1163 1696 239593 227326 16843 1717 242452 196807 32128 1609 227326 1.00000 true false 987690 987690 38497164 24147411 14349753 40766235 37495265 3270970 2260800 714427 1546373 20154786 0 BENEFICIAL INTEREST IN TRUST 788984 DUE FROM AFFILIATE 755276 INSURANCE RECEIVABLE 450010 OTHER RECEIVABLE 315652 INTEREST RECEIVABLE 67171 SECURITY DEPOSITS 8030 OTHER ASSET 32916 2418039 0 DUE TO AFFILIATE 5169083 DUE TO THIRD PARTY 1065393 DEFERRED COMPENSATION LIABILITY 894608 7129084 SCHEDULE D, PART V, LINE 4 ENDOWMENT FUNDS: INTENDED USES OF ENDOWMENT FUNDS ARE DIRECTED BY THE BOARD OF CLEARFIELD HOSPITAL AND FOR THE GOOD OF CLEARFIELD HOSPITAL IN CONTINUING THE CHARITABLE AND NON-PROFIT ACTIVITIES OF CLEARFIELD HOSPITAL. 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 547619 0 0 0 0 547619 547619 false false false false false false true true X true X true X true true false false 45353 45353 0.00100 6059284 4271868 1787416 0.03910 6104637 4271868 1832769 0.04010 14 2515 41904 12950 28954 0.00060 6019 0.00010 14 2515 47923 12950 28954 0.00070 14 2515 6152560 4284818 1861723 0.04080 true 2508641 250864 12141372 13539848 -1398476 X true true 1 1 PENN HIGHLANDS CLEARFIELD 809 TURNPIKE AVENUE CLEARFIELD PA 16830 WWW.PHHEALTHCARE.ORG 291301 X X X PENN HIGHLANDS CLEARFIELD 1 false false true X X X X X X X X X 17 true true false true X SEE PART V, SECTION C 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 AND THE ASSOCIATED HOSPITALS HIRED THE FIRM TRIPP UMBACH TO FACILITATE THE PREPARATION OF THE CHNA AND COLLABORATED WITH HOSPITALS AND OUTSIDE ORGANIZATIONS 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 AND EMS SERVICES TO JUST NAME A FEW. THE PROCESS INCLUDED PUBLIC COMMENTARY, SECONDARY DATA COLLECTION AND ANALYSIS, STAKEHOLDER INTERVIEWS, HAND-DISTRIBUTED SURVEYS AND COMMUNITY HEALTH FORUM/RETREAT. THE HOSPITAL WORKED WITH LEADERS WITHIN THE HEALTHCARE SYSTEM AS WELL AS WITH SEVERAL MEMBERS OUTSIDE OF THE SYSTEM FROM VARIOUS ORGANIZATIONS AND BACKGROUNDS. THIS LIST IS INCLUDED IN THE CHNA REPORT. SCHEDULE H, PART V, SECTION B, LINE 6A CHNA CONDUCTED WITH OTHER HOSPITAL FACILITIES: PENN HIGHLANDS DUBOIS, PENN HIGHLANDS BROOKVILLE, AND PENN HIGHLANDS ELK WHICH ARE ALL PART OF THE PENN HIGHLANDS HEALTHCARE SYSTEM. SCHEDULE H, PART V, SECTION B, LINE 7D CHNA REPORT URL: HTTPS://WWW.PHHEALTHCARE.ORG/HEALTH-WELLNESS/COMMUNITY-HEALTH-NEEDS-ASSESS MENT SCHEDULE H, PART V, SECTION B, LINE 10A IMPLEMENTATION STRATEGY URL: 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 ASSESSING 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 THE ISSUES AND THE NEXT STEPS TO TAKE TO ATTAIN THESE GOALS. THE REPORT ADDRESSES THE TOP FIVE HEALTH NEEDS OF THE COMMUNITY AND FOCUSES ON THOSE ISSUES. THE IMPLEMENTATION PLAN ONLINE INCLUDES DETAIL OF ANNUAL ACTIVITIES. SCHEDULE H, PART V, SECTION B, LINES 16A, B, AND C FAP, FAP APPLICATION, PLAIN LANGUAGE SUMMARY URL: 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, THE DENOMINATOR WHICH EQUALS TOTAL OPERATING EXPENSES PER PART IX, LINE 25 OF THE FORM 990, WAS REDUCED BY BAD DEBT EXPENSE OF $2,508,641. 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. SCHEDULE H, PART III, SECTION A, LINE 2 BAD DEBT EXPENSE: BASED ON HISTORICAL EXPERIENCES, A SIGNIFICANT PORTION OF THE SYSTEMS UNINSURED PATIENTS WILL BE UNABLE OR UNWILLING TO PAY FOR THE SERVICES PROVIDED. THUS THE SYSTEM RECORDS A SIGNIFICANT PROVISION FOR UNCOLLECTABLE ACCOUNTS RELATED TO THESE PATIENTS IN THE PERIOD THAT THE SERVICES ARE PROVIDED. THIS PROVISION FOR UNCOLLECTIBLE ACCOUNTS IS PRESENTED ON THE CONSOLIDATED STATEMENT OF OPERATIONS AS A COMPONENT OF NET PATIENT SERVICE REVENUE. SCHEDULE H, PART III, SECTION A, LINE 3 BAD DEBT ATTRIBUTABLE TO CHARITY CARE: HISTORICALLY THE AMOUNT OF BAD DEBT ATTRIBUTABLE TO CHARITY IS ABOUT 10% OF BAD DEBT EXPENSE. SCHEDULE H, PART III, SECTION A, LINE 4 BAD DEBT EXPENSE FOOTNOTE: THE HOSPITAL'S FINANCIAL STATEMENTS DID NOT CONTAIN A FOOTNOTE THAT DESCRIBED BAD DEBT EXPENSE. THEY DO HOWEVER HAVE A FOOTNOTE THAT DESCRIBES THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS OF PATIENTS ACCOUNTS RECEIVABLE. SEE FOOTNOTE 1 ON PAGE 12 OF THE AUDIT REPORT. ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE SYSTEM ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYER SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR UNCOLLECTIBLE ACCOUNTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYER SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE SYSTEM ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR UNCOLLECTIBLE ACCOUNTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYER HAS NOT YET PAID, OR FOR PAYERS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD- PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE SYSTEM RECORDS A SIGNIFICANT PROVISION FOR UNCOLLECTIBLE ACCOUNTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED OR PROVIDED BY POLICY) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. SCHEDULE H, PART III, SECTION B, LINE 8 COMMUNITY BENEFIT: THE ENTIRE AMOUNT REPORTED SHOULD BE TREATED AS COMMUNITY BENEFIT AS IT REPRESENTS THE AMOUNT NOT RECOVERED BY MEDICARE. THE SOURCE USED FOR THIS WAS THE MEDICARE COST REPORT FOR THE SAME FISCAL YEAR. 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 THIS 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: PENN HIGHLANDS CLEARFIELD PARTICIPATED IN A COMMUNITY HEALTH NEEDS ASSESSMENT CONDUCTED BY TRIPP UMBACH. SCHEDULE H, PART VI, LINE 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: THE HOSPITAL NOTIFIED INDIVIDUALS OF THE FINANCIAL ASSISTANCE POLICY ON ADMISSION AND PRIOR TO DISCHARGE. THE HOSPITAL ALSO NOTIFIES INDIVIDUALS OF OUR FINANCIAL ASSISTANCE POLICY WHEN DISCUSSING BILLING MATTER'S WITH THE PATIENT. SCHEDULE H, PART VI, LINE 4 COMMUNITY INFORMATION: CLEARFIELD HOSPITAL SERVES SEVERAL COUNTIES IN WESTERN AND CENTRAL PA. OUR CORE POPULATION HAS MEDICARE OR MEDICAID. PENN HIGHLANDS CLEARFIELD IS DESIGNATED AS A MEDICARE DEPENDENT HOSPITAL. SCHEDULE H, PART VI, LINE 5 PROMOTION OF COMMUNITY HEALTH: CLEARFIELD HOSPITAL, DBA PENN HIGHLANDS CLEARFIELD, IS VITAL TO THE COMMUNITIES IT HAS SERVED FOR MORE THAN 100 YEARS. LOCATED IN NORTHWEST CENTRAL PENNSYLVANIA, IT PROVIDES HEALTHCARE ACCESS TO A POPULATION THAT WOULD HAVE TO TRAVEL MORE THAN 20-45 MILES OR NOT RECEIVE CARE AT ALL IF IT DIDN'T EXIST. IT PROVIDES MEDICAL, SURGICAL AND SUPPORT SERVICES, INCLUDING: EMERGENCY SERVICES, A TELEMETRY UNIT, SURGICAL SUITES, CARDIOPULMONARY, CARDIAC REHABILITATION, A WOUND CLINIC, NUCLEAR MEDICINE, CT, MRI, PET SCANNING, LABORATORY SERVICES, AND OCCUPATIONAL, SPEECH AND PHYSICAL THERAPY. PH CLEARFIELD TREATS ALL PATIENTS, REGARDLESS OF THEIR ABILITY TO PAY. PATIENTS ARE GIVEN PAYMENT OPTIONS FOR ALL LEVELS OF FINANCIAL NEEDS. THEY MAY BE DIRECTED TO PROGRAMS THAT THEY QUALIFY FOR, SUCH AS MEDICARE, MEDICAID OR VETERANS SERVICES, OR THEY MAY QUALIFY FOR THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM THAT GIVES DISCOUNTS UP TO 100 PERCENT. OUTSIDE OF THE HOSPITAL, EMPLOYEES ATTEND EVENTS TO PROVIDE INFORMATION ON HEALTH AND SAFETY TO THE COMMUNITY. PH CLEARFIELD IS A VALUABLE ASSET, AND WITH THE GUIDANCE OF COMMUNITY LEADERS, HOSPITAL LEADERS AND STAFF, IT WILL REMAIN SO FOR YEARS TO COME. SCHEDULE H, PART VI, LINE 6 AFFILIATED HEALTH CARE SYSTEM: PENN HIGHLANDS HEALTHCARE (PHH, SYSTEM) 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. PENN HIGHLANDS HEALTHCARE INCLUDES PENN HIGHLANDS NATURAL THERAPIES, LLC AND PENN HIGHLANDS APOTHECARY, INC. THESE COMPANIES WERE FORMED IN 2017 WITH NO ACTIVITY IN THE FISCAL YEAR. DUBOIS REGIONAL MEDICAL CENTER (DRMC) PRIMARILY EARNS REVENUES BY PROVIDING INPATIENT, OUTPATIENT AND EMERGENCY CARE SERVICES TO RESIDENTS IN DUBOIS, PENNSYLVANIA, AND SURROUNDING AREAS. DUBOIS INCLUDES 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. DUBOIS INCLUDES DUBOIS MEDICAL RISK RETENTION GROUP (DMRRG). DMRRG PROVIDES LIABILITY INSURANCE TO THE DUBOIS COMPANIES. DUBOIS IS THE SOLE MEMBER OF THE CLASS A VOTING AND PARTICIPATING CERTIFICATES OF DMRRG. DUBOIS INCLUDES DUBOIS REGIONAL MEDICAL GROUP (DRMG). DRMG PROVIDES PRIMARY CARE AND SPECIALTY PHYSICIAN SERVICES. 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. true false false false false false false false false KEVIN TYLER DO PRESIDENT OF MEDICAL STAFF 0 308852 0 0 0 8956 0 10810 0 21068 0 349686 0 0 BRIAN KLINE CHIEF FINANCIAL OFFICER 0 256000 0 50732 0 34462 0 23040 0 6408 0 370642 0 0 THOMAS CARNEVALE SECRETARY 0 409412 0 225 0 0 0 10800 0 15960 0 436397 0 0 ROBERT E STEWARD JR BOARD MEMBER 0 202953 0 0 0 12980 0 8118 0 20064 0 244115 0 0 GARY MACIOCE PRESIDENT END 11/2017 0 277421 0 25751 0 1301 0 23175 0 13146 0 340794 0 0 ROBERT R COLL PHYSICIAN 367070 0 0 0 0 0 18353 0 13146 0 398569 0 0 0 SHAUNAK PATEL PHYSICIAN 322781 0 0 0 0 0 12911 0 5410 0 341102 0 0 0 THOMAS L YEAGER PHARMACIST 120344 0 0 0 0 0 21662 0 13146 0 155152 0 0 0 MARK NORMAN INTERIM PRESIDENT 11/17-05/18 0 250000 0 52875 0 6000 0 19039 0 15898 0 343812 0 0 SCHEDULE J, PART I, LINE 3 CEO COMPENSATION: PENN HIGHLANDS HEALTHCARE, INC. (PHH), A RELATED ORGANIZATION, DETERMINES THE COMPENSATION OF THE CEO. PHH USES THE FOLLOWING METHODS TO DETERMINE THE COMPENSATION: INDEPENDENT COMPENSATION CONSULTANT, WRITTEN EMPLOYMENT CONTRACT, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY BOARD OR COMPENSATION COMMITTEE. FORM 990, PART VI, SECTION A, LINE 2 BUSINESS RELATIONSHIP: KEVIN TYLER, DO, THOMAS CARNEVALE, MD, ROBERT STEWARD, JR, MD, BRIAN KLINE, MARK NORMAN AND GARY MACIOCE SHARE A BUSINESS RELATIONSHIP THROUGH THEIR EMPLOYMENT WITH A RELATED ORGANIZATION, PENN HIGHLANDS DUBOIS. FORM 990, PART VI, SECTION A, LINE 3 DELEGATION OF MANAGEMENT DUTIES: PENN HIGHLAND HEALTHCARE, PENN HIGHLAND CLEARFIELD'S RELATED TAX-EXEMPT PARENT ORGANIZATION, PROVIDES ADMINISTRATIVE SERVICES INCLUDING MANAGEMENT DUTIES. FORM 990, PART VI, SECTION A, LINES 6, 7A, AND 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. PENN HIGHLANDS HEALTHCARE (PHH) SHALL HAVE THE FOLLOWING POWERS WITH RESPECT TO THE ELECTION AND REMOVAL OF DIRECTORS OF THIS CORPORATION. NOMINATION AND ELECTION OF DIRECTORS: PRIOR TO THE END OF PHH'S FISCAL YEAR, THE PHH BOARD WILL MEET TO ELECT DIRECTORS TO FILL OPEN DIRECTOR POSITIONS, OTHER THAN EX-OFFICIO POSITIONS. AT LEAST SIXTY (60) DAYS IN ADVANCE OF THIS MEETING, PENN HIGHLANDS CLEARFIELD SHALL PROVIDE TO PHH'S GOVERNANCE/NOMINATING COMMITTEE (THE PHH GOVERNANCE/NOMINATING COMMITTEE) A LIST OF ONE OR MORE CANDIDATES (THE NUMBER OF CANDIDATES TO BE DETERMINED IN THE PHH GOVERNANCE/NOMINATING COMMITTEE'S DISCRETION) WHOM IT HAS APPROVED FOR EACH EXPIRING DIRECTOR POSITION (OTHER THAN EX OFFICIO POSITIONS). THE LIST OF CANDIDATES SHALL HAVE BEEN DEVELOPED IN CONSULTATION WITH THE BOARD OF PENN HIGHLANDS CLEARFIELD. THE PHH GOVERNANCE/NOMINATING COMMITTEE SHALL REVIEW EACH CANDIDATE IN ACCORDANCE WITH THE PHH BYLAWS, THE CRITERIA, IF ANY, SET FORTH IN THIS ORGANIZATION'S BYLAWS OR POLICIES FOR WHICH SAID CANDIDATE IS BEING CONSIDERED FOR BOARD SERVICE, AND THE POLICIES AND RULES OF PHH, INCLUDING, WITHOUT LIMITATION, THE CONFLICT OF INTEREST POLICY (ALL OF WHICH SHALL BE REFERRED TO COLLECTIVELY HEREIN AS THE ELIGIBILITY CRITERIA) AND DEVELOP A LIST OF ONE OR MORE CANDIDATES FOR EACH OPEN POSITION (THE NUMBER OF CANDIDATES TO BE DETERMINED IN THE PHH GOVERNANCE/NOMINATING COMMITTEE'S DISCRETION). ONCE THE SLATE OF CANDIDATES FOR EACH OPEN DIRECTOR POSITION IS NOMINATED BY THE PHH GOVERNANCE/NOMINATING COMMITTEE, THE BOARD OF PENN HIGHLANDS CLEARFIELD SHALL SUBMIT SUCH SLATE OF CANDIDATES TO THE PHH BOARD FOR ELECTION. THE PHH BOARD MAY ELECT BY A VOTE OF THE MAJORITY OR REFUSE TO ELECT EACH CANDIDATE SUBMITTED BY THE BOARD OF PENN HIGHLANDS CLEARFIELD AND MAY NOT ELECT ANY CANDIDATE NOT SUBMITTED BY THE BOARD OF PENN HIGHLANDS CLEARFIELD AND NOMINATED BY THE PHH GOVERNANCE/NOMINATING COMMITTEE. IN THE EVENT THE PHH BOARD FAILS TO ELECT A CANDIDATE NOMINATED AS DESCRIBED ABOVE, THEN (I) PHH WILL NOTIFY THIS CORPORATION; AND (II) THE PROCESS DESCRIBED ABOVE SHALL CONTINUE UNTIL ALL OPEN BOARD POSITIONS OF PENN HIGHLANDS CLEARFIELD HAVE BEEN FILLED. UNLESS OTHERWISE SPECIFIED AT THE TIME OF ELECTION, NEW DIRECTORS SHALL BE INSTALLED AT THE FIRST MEETING OF THE BOARD OF DIRECTORS OF PENN HIGHLANDS CLEARFIELD FOLLOWING THEIR ELECTION. REMOVAL: WITH RESPECT TO ANY DIRECTOR OF PENN HIGHLANDS CLEARFIELD, THE BOARD OF PHH HAS THE POWER TO REMOVE SUCH DIRECTOR AT ANY TIME WITH OR WITHOUT CAUSE. VACANCIES: IN THE EVENT THAT PENN HIGHLANDS CLEARFIELD DESIRES TO FILL A VACANCY OCCURRING ON ITS BOARD, THE PHH GOVERNANCE/NOMINATING COMMITTEE AND THE BOARD OF PHH, AT THE REQUEST OF PENN HIGHLANDS CLEARFIELD, SHALL ACT TO FILL SUCH VACANCY. BYLAWS: SUBJECT TO THE APPROVAL OF PHH AS SET FORTH IN THE BYLAWS, THE ARTICLES AND THESE BYLAWS MAY BE ALTERED, AMENDED, OR REPEALED AND NEW ARTICLES OR BYLAWS MAY BE ADOPTED BY THE AFFIRMATIVE VOTE OF TWO-THIRDS (2/3) OF THE BOARD. WRITTEN NOTICE OF THE INTENT TO AMEND THE ARTICLES OR THESE BYLAWS 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 ARTICLES OR THESE BYLAWS 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 ACCOUNTING DEPARTMENT AND MANAGEMENT OF THE ORGANIZATION. THE DRAFT FORM 990 IS REVIEWED BY THE CFO AND THE ACCOUNTING MANAGER. AFTER ALL SUGGESTED CHANGES FROM THE CFO AND THE ACCOUNTING MANAGER ARE MADE, THE UPDATED DRAFT FORM 990 IS PROVIDED FOR REVIEW TO THE FULL BOARD. 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, LINES 15A & 15B COMPENSATION DETERMINATION: PENN HIGHLANDS HEALTHCARE, INC. (PHH) PERFORMS THE COMPENSATION REVIEW FOR THE PHH EXECUTIVES, INCLUDING THE CEO OF PH CLEARFIELD. AN INDEPENDENT COMPENSATION CONSULTANT, YAFFE AND COMPANY, IS CONTRACTED TO COMPLETE AN ANNUAL COMPENSATION REVIEW. INCLUDED IN THIS REVIEW IS COMPARATIVE DATA. THE PHH BOARD REVIEWS AND APPROVES THE COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENT AVAILABILITY: THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART VII, SECTION A BOARD MEMBER COMPENSATION: NO DIRECTORS RECEIVE ANY COMPENSATION FOR THEIR DIRECTOR DUTIES. GARY MACIOCE WAS COMPENSATED FOR HIS DUTIES AS PRESIDENT OF PENN HIGHLANDS CLEARFIELD. MARK NORMAN IS COMPENSATED FOR HIS DUTIES AS COO OF PHH WHILE SERVING AS INTERIM PRESIDENT OF PENN HIGHLANDS CLEARFIELD. KEVIN TYLER, DO, THOMAS CARNEVALE, MD, AND ROBERT STEWARD, JR, MD, ARE COMPENSATED BY A RELATED ORGANIZATION FOR THEIR DUTIES AS PHYSICIANS. FORM 990, PART XI, LINE 9 OTHER CHANGES IN NET ASSETS: $ 41,437 CHANGE IN BENEFICIAL INTEREST IN PERPETUAL TRUST FORM 990 PART IX LINE 11G DESCRIPTION:OUTSIDE SERVICES TOTAL FEES:2662929 FORM 990 PART IX LINE 11G DESCRIPTION:MAINTENANCE CONTRACTS TOTAL FEES:2464410 FORM 990 PART IX LINE 11G DESCRIPTION:CONSULTING SERVICES TOTAL FEES:158474 FORM 990 PART IX LINE 11G DESCRIPTION:PROFESSIONAL FEES TOTAL FEES:1969367 FORM 990 PART IX LINE 11G DESCRIPTION:CONTRACT LABOR TOTAL FEES:1533130 PENN HIGHLANDS HEALTHCARE PO BOX 447 DUBOIS PA 15801 320345810 MGMT SERVICES PA 501(C)(3) 12 C III-FI NA false CLEAR-MED CORPORATION 809 TURNPIKE AVEENUE CLEARFIELD PA 16830 251657668 OUTPAT. PHYS PA 501(C)(3) 3 PHH false ELCO HOUSING 763 JOHNSONBURG ROAD ST MARYS PA 15857 251639115 HOUSING PA 501(C)(3) 12 A I PHH false ELK REGIONAL PROFESSIONAL GROUP INC 763 JOHNSONBURG ROAD STE 200 ST MARYS PA 15857 251875183 HEALTHCARE PA 501(C)(3) 3 PHH false COMMUNITY NURSES HOME HEALTH AND HOSPICE 757 JOHNSONBURG ROAD STE 200 ST MARYS PA 15857 250996070 HEALTHCARE PA 501(C)(3) 10 CNI false COMMUNITY NURSES HOME SUPPORT SERVICES 757 JOHNSONBURG ROAD STE 200 ST MARYS PA 15857 251623601 HEALTHCARE PA 501(C)(3) 10 CNI false COMMUNITY NURSES INC 757 JOHNSONBURG ROAD STE 200 ST MARYS PA 15857 251623598 HEALTHCARE PA 501(C)(3) 7 PHH false DUBOIS REGIONAL MEDICAL CENTER 100 HOSPITAL AVENUE DUBOIS PA 15801 251490707 HOSPITAL PA 501(C)(3) 3 PHH false BROOKVILLE HOSPITAL 100 HOSPITAL ROAD BROOKVILLE PA 15825 250984595 HOSPITAL PA 501(C)(3) 3 PHH false DRMC EMPLOYEE BENEFITS PLAN TRUST 100 HOSPITAL AVE DUBOIS PA 15810 256332829 DRMC EMP BENE PA 501(C)(9) PHH false ELK REGIONAL HEALTH CENTER 763 JOHNSONBURG ROAD ST MARYS PA 15857 250585280 HOSPITAL PA 501(C)(3) 3 PHH false CLEARFIELD MEDICAL ASSOCIATES LP 807 TURNPIKE AVENUE CLEARFIELD PA 16830 251369635 PHYSICIAN OFFICES PA CLEARFIELD HOSP EXCLUDED 12673 739626 false true 0.80000 CLEAR-CARE CORPORATION PO BOX 1411 CLEARFIELD PA 16830 251512107 MEDICAL EQUIPMENT PA CLEARFIELD HOSP C-CORPORATION 115791 994783 1.00000 true CHARITABLE TRUST #1 PO BOX 171 CLEARFIELD PA 16830 256019042 INVESTMENTS PA CLEARFIELD HOSP TRUST 18821 715099 1.00000 true CHARITABLE TRUST #2 PO BOX 171 CLEARFIELD PA 16830 256019043 INVESTMENTS PA CLEARFIELD HOSP TRUST 2711 73885 1.00000 true false false true true true false false false false true true true true false true true false false false