2018-05-15T13:15:35-05:00 2017-06-30 460722692 SICKLER TARPEY & ASSOCIATES 227 JEFFERSON AVENUE TYRONE PA 16686 990 2016-07-01 240701920 BUCKTAIL MEDICAL CENTER BUCK 5709231000 1001 PINE STREET RENOVO PA 177641618 TIMOTHY REEVES NHA ADMINISTRATOR 5709231000 2018-05-15 1 CHRISTOPHER DEANTONIO P00976440 8146844640 2018-05-15 2016 2022-09-23 18:48:47Z TIMOTHY REEVES NHA 1001 PINE STREET RENOVO PA 177641618 6635661 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 21 HOSPITAL BEDS, 43 NURSING HOME BEDS, AND A COMMUNITY CLINIC OFFERING OUT PATIENT SERVICES. 9 9 121 50 0 0 903167 1195271 5857282 5440040 346 350 0 0 6760795 6635661 0 0 0 0 3486407 3337184 0 0 0 3295144 3701315 6781551 7038499 -20756 -402838 3040550 2662815 4612991 4636236 -1572441 -1973421 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 21 HOSPITAL BEDS, 43 NURSING HOME BEDS, AND A COMMUNITY CLINIC OFFERING OUT PATIENT SERVICES. 0 0 3978593 3571256 BUCKTAIL MEDICAL CENTER PROVIDES HOSPITAL INPATIENT AND OUTPATIENT SERVICES. THE CENTER HAS 21 BEDS TO MEET ITS CRITICAL ACCESS NEEDS AS WELL AS AN EMERGENCY ROOM AND COMMUNITY CLINIC. 2359260 1868784 BUCKTAIL MEDICAL CENTER PROVIDES NURSING HOME FACILITIES WITH 43 BEDS. SERVICES ALSO INCLUDE PHYSICAL THERAPY, OCCUPATIONAL THERAPY, SPEECH THERAPY, EXERCISE AND RECREATIONAL ACTIVITIES. 6337853 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 19 0 121 1 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 HARRIET NUSS BOARD PRESIDENT 1.00 X X 0 0 0 JOHN KURUTZ BOARD MEMBER 1.00 X 0 0 0 ANNA KNAUFF BOARD VICE PRESIDENT 1.00 X X 0 0 0 WILLIAM FORNWALT BOARD MEMBER 1.00 X 0 0 0 ALAN EDWARDS MD MEDICAL DIRECTOR 40.00 X X 0 0 0 ROBERT GETZ SR BOARD MEMBER 1.00 X 0 0 0 ALINE PETERSEN BOARD MEMBER 1.00 X 0 0 0 CARLA FLACK BOARD SEC/TREAS. 1.00 X 0 0 0 GEORGE GERBER CONTROLLER 40.00 X 75197 0 0 TIMOTHY REEVES NHS DIRECTOR 40.00 X 85096 0 0 160293 0 0 0 0 0 0 EMCARE INC 815 SOUTH PALAFOX 3RD FLOOR PENSACOLA FL 32502 PHYSICIAN SERVICES 649244 BENCHMARK THERAPIES 403 6TH STREET HUNTINGDON PA 16652 THERAPY SERVICES 245590 OMNICARE INC 3570 W 4TH STREET WILLIAMSPORT PA 17701 PHARMACY SERVICES 221225 ALLIED RESOURCES STAFFING SOLUITONS 135 DOWLIN FORGE ROAD EXTON PA 19341 AGENCY-NURSING 207148 BRIDGEPORT CAPITAL FUNDING PO BOX 101004 ATLANTA GA 30392 AGENCY-LABORATORY 191341 5 1059767 135504 1195271 PATIENT SERVICE REVENU 900099 3571256 3571256 LONG TERM CARE FACILIT 623000 1868784 1868784 5440040 350 350 6635661 5440040 0 350 160293 160293 2587400 2147313 440087 589491 489225 100266 128948 128948 199700 199700 129485 129485 SUPPLIES 2268075 2268075 PROFESSIONAL FEES 790416 790416 BAD DEBT EXPENSE 184691 184691 7038499 6337853 700646 0 875098 657549 24584 136585 789228 646721 91784 88006 86697 95608 8017199 7026877 1137224 990322 10886 12744 25049 35280 3040550 2662815 2269310 2480931 98160 0 2063022 1923036 182499 232269 4612991 4636236 X -1621580 -2020021 49139 46600 -1572441 -1973421 3040550 2662815 -402838 1858 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED X X 2 685.00 0 144218 144218 3331998 2704236 627762 352958 314170 38788 4188025 4008471 179554 990322 BANKRUPTCY RESERVE 111283 ESTIMATED THIRD PARTY SETTLEMENTS 120986 232269 X 6450970 -184375 -184375 6635345 0 6635345 6853808 0 6853808 316 184375 184691 7038499 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, 2017. PART XI, LINE 2D - OTHER ADJUSTMENTS: BAD DEBT PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT SCHEDULE D PART XI LINE 1 THE AUDITED FINANCIAL STATEMENTS INCLUDE THE PROVISION FOR BAD DEBT IN THE AMOUNT OF 184,375 IN THE GROSS REVENUE. FOR TAX PURPOSES THIS IS PART OF THE EXPENSES. 1 1 X 1 X 1 X 0 0 0 5139 5139 0.00070 2835456 2668859 166597 0.02370 2840595 2668859 171736 0.02440 188864 188864 0.02680 5402 5402 0.00080 194266 194266 0.02760 3034861 2668859 366002 0.05200 1260 1260 0.00020 1817 1140 677 0.00010 4796 4796 0.00070 7873 1140 6733 0.00100 1 184375 184375 1380279 1533885 -153606 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 1 X X X X X X X X 15 1 0 1 1 X 0 0 1 X 200.000000000000 300.000000000000 X X X X X 1 1 X X X 1 X X X X X 1 X 0 X X X X 1 X 0 0 BUCKTAIL MEDICAL CENTER PART V, SECTION B, LINE 5: BUCKTAIL MEDICAL CENTER POLLED COMMUNITY MEMBERS, OTHER HEALTH PROFESSIONALS, 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. BUCKTAIL MEDICAL CENTER PART V, SECTION B, LINE 18E: PROMPT PAYMENT DISCOUNT OFFER; PAYMENT PLAN OFFER; FAP APPLICATION. BUCKTAIL MEDICAL CENTER PART V, SECTION B, LINE 20E: IN PERSON OR PHONE CONTACT TO ASSIST PATIENT WITH APPLICAITON COMPLETION; ASSIST PATIENT IN EXPLORING ALTERNATE SOURCES OF PAYMENT AND COVERAGE. 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 VI, LINE 2: BUCKTAIL MEDICAL CENTER CONDUCTED THE NEEDS ASSESSMENT WITH THE ASSISTANCE OF VARIOUS COMMUNITY ORGANIZATIONS. PART VI, LINE 4: BUCKTAIL MEDICAL CENTER SERVICE AREA INCLUDES WESTERN CLINTON AND SOUTHERN POTTER COUNTIES. IT SERVES THE COMMUNITIES OF RENOVO, SOUTH RENOVO, NORTH BEND, HYNER, SHINTOWN, WESTPORT, AND HAMERSLEY FORK LOCATED IN CLINTON COUNTY. IT ALSO SERVES CROSS FORK LOCATED 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. 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. FORM 990 PART XII LINE 2C THE BOARD REVIEWS THE FINANCIAL STATEMENTS AND APPROVES AS IN PAST YEARS.