2018-05-15T09:32:39-05:00 2017-06-30 351178661 Blue & Co LLC 8800 Lyra Drive Suite 450 Columbus OH 43240 990 2016-07-01 250965274 Butler Healthcare Providers BUTL 7242844429 One Hospital Way Butler PA 16001 Steve Karls Controller 7242844429 2018-05-15 1 Matthew Dasta P00544683 6148852583 2018-05-15 2016 2022-09-23 18:48:47Z Butler Memorial Hospital Steve Karls One Hospital Way Butler PA 16001 291994799 0 X WWW.BUTLERHEALTHSYSTEM.ORG X 1898 PA The mission of Butler Healthcare Providers d/b/a Butler Memorial Hospital is to be a healing presence in the communities we serve. Butler Memorial Hospital and Butler Health System exist to make a positive difference in the lives of people by providing compassionate, high quality care and comfort, and inspiring health and well-being. 9 7 2079 289 4181491 803359 2001456 1591514 261839305 275665687 4603429 2849758 10601412 11333654 279045602 291440613 53900 56875 0 0 112601078 119283713 0 0 0 120445829 128895145 233100807 248235733 45944795 43204880 348613993 374074540 192104470 179067429 156509523 195007111 X The mission of Butler Healthcare Providers d/b/a Butler Memorial Hospital is to be a healing presence in the communities we serve. Butler Memorial Hospital and Butler Health System exist to make a positive difference in the lives of people by providing compassionate, high quality care and comfort, and inspiring health and well-being. 0 0 212109812 56875 286999341 Butler Healthcare Providers d/b/a Butler Memorial Hospital (BMH) is an independent, community-based hospital that has served Butler County, PA, and the surrounding area for over 100 years. BMH employs approximately 2,000 people. BMH has grown into a regional referral center for the areas. It is the largest hospital facility between Pittsburgh and Erie. It is comprised of 296 acute care beds and a 25 bed skilled nursing facility. BMH serves approximately 14,000 acute care patients (admissions) and over 475,000 outpatients each year. BMH maintains a deep commitment to its community, as is demonstrated through its broad services offering. It provides all levels of general medical and surgical care, emergency services, obstetrics and gynecology services, a robust psychiatric service, drug & alcohol treatment, family services, preventative & wellness programs and tertiary cardiovascular care. It also has a network of approximately 60 convenient, low cost outpatient sites that are located in communities through Butler County and the surrounding area. 212109812 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 1 0 0 1 2079 1 1 1 0 0 0 0 0 0 0 0 0 X 9 7 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X X Steve Karls 7242844429 one hospital way butler PA 16001 Kenneth P DeFurio President & CEO 40.00 22.00 X X 753015 0 218026 Margaret Irvine-Weir chair until 12/31/16 0.80 0.20 X X 0 0 0 Patrick Hampson Trustee 0.80 0.20 X 0 0 0 Patti-Ann Kanterman chair as of 1/1/17 2.00 2.00 X X 0 0 0 Douglas K McClaine Trustee 0.80 0.20 X 0 0 0 Robert M Smith PhD Trustee 0.80 0.20 X 0 0 0 Dennis Demby MD Trustee 0.80 40.20 X 0 272320 10878 Timothy Morgus corporate secretary 1.00 1.00 X X 0 0 0 Don Shamey Trustee 0.80 0.20 X 0 0 0 Anne B Krebs Chief Financial Officer 40.00 15.00 X 404463 0 84164 Stephanie Roskovski Chief Operating Officer 35.00 25.00 X 407103 0 70954 Karen Allen VP Patient Svc,CNO, 55.00 0.00 X 399482 0 74033 A Thomas McGill MD VP Quality & Safety/CIO 40.00 15.00 X 518090 0 105174 John C Reefer MD VP Prof Affairs & CMO 52.00 8.00 X 456962 0 94751 Paula L Hooper VP General Counsel 30.00 26.00 X 388364 0 65805 Thomas Genevro VP Facilities/Human Resour 45.00 10.00 X 288440 0 59724 3615919 272320 783509 19 0 1 0 Butler Anesthesia Associates PO Box 737 East Butler PA 16029 Anesthesiology 2710138 Metz Culinary Management Two Woodland Drive Dallas PA 18612 Dietary 2562436 Three Rivers Cardiac 400 Holiday Drive Suite 101 Pittsburgh PA 152203610 Cardiology 2128874 Quest Diagnostics 875 Greentree Road Pittsburgh PA 152203610 Laboratory Services 1944017 Advanced Imaging PO Box 62395 Pittsburgh PA 15241 Imaging Services 1714126 5 1391398 200116 1591514 Prog.serv.revenue-Related-990 621500 275665687 275665687 275665687 3263473 3263473 369885 0 369885 369885 369885 140471 0 554186 140471 -554186 -413715 -413715 Miscellaneous Income 900099 6511679 4009289 2502390 Pharmacy 446110 1679101 1679101 Cafeteria 900099 1638157 1638157 1134832 1134832 10963769 291440613 282817850 4181491 2849758 X 56875 56875 93272609 79281718 13990891 2692325 2288476 403849 16723139 14214668 2508471 6595640 5606294 989346 449125 381756 67369 61669 52419 9250 27463751 23344188 4119563 1118036 950331 167705 4159067 3535207 623860 2128793 1809474 319319 2962440 2518074 444366 248832 211507 37325 435858 370479 65379 4630276 3935735 694541 12427622 10563479 1864143 1855683 1577331 278352 Medical and Other Suppl 61266147 52076225 9189922 Bad Debt 7396259 7396259 Miscellaneous 1962629 1659703 302926 Bank and Credit Card fe 264139 224518 39621 64819 55096 9723 248235733 212109812 36125921 0 3474 1000 49872670 49307900 34412893 25203151 623758 3166024 3816533 3005674 2853948 333688942 209553097 122163958 124135845 118603717 132701493 12692650 11932056 4069175 24122614 348613993 374074540 24754227 23050680 157296700 151280791 10053543 4735958 192104470 179067429 X 155334900 193744602 1174623 1262509 156509523 195007111 348613993 374074540 X 43204880 4462269 -9169561 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 17279 17279 0 Part II-B, Line 1: A portion of the annual dues paid to the Hospital Association of Pennsylvania and the American HospITAL Association are used for lobbying. 442836 754 443590 442082 754 442836 441977 105 442082 438686 3291 441977 440373 -1687 438686 1.00000 0 1 1 2577581 2577581 100220252 49328639 50891613 6210767 4162220 2048547 223514137 156062238 67451899 1166205 1166205 124135845 Other Assets 1814471 Other Receivables 5504175 Interest in Net Assets of BHS Found 862358 Pension Assets 1814895 investments in affiliates 14126715 24122614 Accrued Interest Payable 2200629 Third Party Payable 2535329 4735958 X Part V, Line 4: Investment earnings will be used to support Butler Healthcare Providers or other related organizations per their restrictive purpose (e.g. technology and charity care) or if no restrictive purpose, at the discretion of the Board to support its mission. Part X, Line 2: The Hospital, BHS, the Foundation, Nixsar, and BMP are not-for-profit corporations and are exempt from income taxes under Section 501(c)(3) of the Internal Revenue Code (Code). Accordingly, no provision for income taxes has been provided. The Surgery Center's members have elected to have the Surgery Center's income taxed as a partnership under the provisions of the Code; therefore, taxable income or loss is reported to the partners for inclusion in their respective tax returns. No provision for federal or state income taxes is included in the accompanying consolidated financial statements. PCA is a for-profit corporation subject to federal and state income taxes. Management believes the tax impact of PCA is immaterial to the consolidated financial statements as a whole. BHS FastERcare, PHO, and BHS FastERcare Lab are Pennsylvania limited liability companies and, therefore, taxable income or loss is reported to the members for inclusion in their respective tax returns. No provision for federal or state income taxes is included in the accompanying consolidated financial statements. Accounting principles generally accepted in the United States of America require management to evaluate tax positions taken by the System and recognize a tax liability if an uncertain position has been taken that more likely than not would not be sustained upon examination by various federal and state taxing authorities. Management has analyzed the tax positions taken by these entities and has concluded that as of June 30, 2017 and 2016, there are no uncertain positions taken or expected to be taken that would require recognition of a liability or disclosure in the accompanying consolidated financial statements. The System has filed its federal and state income tax returns for periods through June 30, 2016 and is subject to routine audits by taxing jurisdictions. However, as of the date the consolidated financial statements were issued, there were no audits for any tax periods in progress. These income tax returns are generally open to examination by the relevant taxing authorities for a period of three years from the later of the date the return was filed or its due date (including approved extensions). 1 1 1 X 1 X 1 1 1 0 1 1 3426426 3426426 0.01380 29148576 23006417 6142159 0.02470 290784 277698 13086 0.00010 32865786 23284115 9581671 0.03860 106604 106604 0.00040 192110 192110 0.00080 14749393 10297381 4452012 0.01790 108135 108135 0.00040 15156242 10297381 4858861 0.01950 48022028 33581496 14440532 0.05810 1 7396259 3967000 40064029 42703748 -2639719 X 1 1 1 butler physicians realty llc leases medical office space 0.16670 0.11110 1 1 butler memorial hospital one hospital way butler PA 160014670 www.butlerhealthsystem.org X X X butler memorial hospital 1 0 0 1 X X X X X X X X X 15 1 0 0 1 X http://www.butlerhealthsystem.org/InTheCommunity/Pages/Community-Health-Ass X 1 15 1 http://www.butlerhealthsystem.org 0 1 X 200.000000000000 300.000000000000 X 1 1 X X X 1 X http://www.butlerhealthsystem.org/AboutBHS/Pages/Policies.aspx X http://www.butlerhealthsystem.org/AboutBHS/Pages/Policies.aspx X http://www.butlerhealthsystem.org/AboutBHS/Pages/Policies.aspx X X X X X 1 X 0 X X X X 1 X 0 0 butler memorial hospital Part V, Section B, Line 5: Input from Community and Data Sources:Beth Herold, Director Area Agency on Aging, represented needs of elderlyAmber Crowe Catholic Charities special needs of the poorTracy Futscher RN, Broad St Elementary School ( children in an impoverished neighborhood) Linda Starosta, RN, Seneca Valley Schools other children in Butler County.Amy Hammonds, RN, BHS Behavioral health Outreach behavioral healthDr. Plank DO, Family practice smaller town and more rural butler county.The BHRFSS for non-Allegheny County western PA was compared to prior our community oversampling survey. No significant differences were found so oversampling was not repeated this cycle. butler memorial hospital Part V, Section B, Line 11: Mobile heal scanner deployed to PCP office to assess yield on this type of osteoporosis screening. Fall risk assessment incorporated into EMRs to identify high risk patients.Disparities in birth outcomes: S Minion's research proposal under review by PhD committee, complete data set compiled.Asthma in children is behind schedule.Childhood immunization: work group examining barriers and how clinics could report to state immunization databaseBMH is an active participant in Butler County Opioid Task force. Opioid prescribing Medical education offered to all members of medical staff. Medical Staff rules and regulations incorporate requirements to use PDMP website before opioid prescribing.Obesity - wellness program started at BMH with intent to offer to local businesses once value demonstrated - about 18 months. The hospital could not address the needs for Alzheimer's and oral health due to being unable to financially provide resources to address these issues at this time. It is also not within the organization's strategic priorities. 3 1 - butler healthcare providers snf one hospital way butler PA 16001 skilled nursing facility 2 - butler healthcare providers psych one hospital way butler PA 16001 psychiatric and chemical dependency 3 - Butler Healthcare Providers OP PSych 216 North Washington street butler PA 16001 Outpatient Behavioral Health Clinic Part I, Line 7: The costing methodology is based on the ratio of cost to charges from Butler Memorial Hospital's accounting system. Part II, Community Building Activities: Supporting those in need: BMH Charity Care and Community Benefit BMH provides free care to those patients who have an obligation after insurance payments, if any. The amount of free care is determined based on the patient's income and family size. Free care is provided to those with incomes up to 300% of the Federal Poverty Guideline.To inform patients of this program, signs are posted in all the registration areas notifying the public of the availability of our free care program. More information is available in the Patient Handbook and on the System website www.butlerhealthsystem.org on the "About BHS" page. At the time of registration, any patient who is uninsured is given a "Patient Notice of Financial Aid notice. The notice instructs the patient to call or visit the Patient Financial Assistance Department to seek more information about how to qualify for free or discounted care.The monthly collection statements that are mailed to patients inform them that they may contact the Patient Financial Assistance Department to discuss their eligibility for free care. Financial representatives receive and make many calls to the patients. During the calls, financial representatives will discuss with the patients the availability of free care programs and will mail out applications to patients wanting to apply. BMH also contracts with representatives to assist patients in applying for Medical Assistance coverage. These representatives will also discuss with patients the availability of free care, especially for those who may not be eligible for the government healthcare plan.Government Program SubsidiesIn addition to providing free and discounted care to uninsured patients or patients that need financial help, BMH subsidizes the difference between the costs of care and the amount paid by government-sponsored programs such as Medicare and Medicaid. Last year, that amounted to more than $8.7 million. As provisions of the Patient Protection and Affordable Care Act are implemented, BMH expects this burden on our patients and the health system to increase. To that end and to remain a viable healthcare provider to our community, BMH continually evaluates ways to keep costs low and maintain high quality. Billing and CollectionsBMH is diligent in providing bills that are accurate and easy to understand. Every bill and statement includes information about how to contact financial representatives and arrange payment plans. BMH is committed to finding ways to help every patient pay the portion of their bill they are responsible for without experiencing an overwhelming financial burden. In addition to making the billing process easy to understand and ensuring ready access to charity care and financial assistance, upon request BMH will provide cost information to patients, in advance of services or treatment.Providing Needed Care and Services Plays a Critical Role in Meeting Patient Needs Butler Memorial Hospital subsidizes many of the critical services it offers, such as the Transitional Care Facility, Family Services, obstetrical services, psychiatric services, prevention and wellness services, and primary care services offered through our physician clinics. Last year, BMH provided $4,452,012 in subsidized care and services.BMH actively supports the Community Health Clinic. It provides financial support as well as operational and technical support for many of the diagnostic services provided at the Clinic. Many BMH physicians and employees volunteer time to treat patients at the Clinic.Building Our Community Strengthening the community is a responsibility for all local businesses and something BMH and its affiliates (collectively "the System") takes very seriously. For example, the System offers space for meetings and community education; the System helps local residents escape violent situations, the System employees volunteer to help those in need; the System provides education to new and expectant parents; and the System provides community health outreach and patient advocacy. Opening System Facilities for Local MeetingsThe Knowledge Center at Butler Memorial Hospital offers modern meeting and education space for local and regional conferences. Last year, the System hosted the seventh annual Carol Dietrich Memorial Health Symposium to physicians, nurses and other providers, entitled "Opiates: Concepts and Controversies". The day-long program provided a variety of high quality programs at no cost to participants. Through its accredited Continuing Medical Education Department, Butler Memorial Hospital also offers a series of programs which are made available to health care professionals throughout the region. In cooperation with local institutions such as Slippery Rock University and Butler County Community College, as well as others throughout Butler County and the region, BMH is fully-committed to maintaining high-quality professional health education for students and practitioners alike. Classroom space is provided for programs within the Knowledge Center, and students are given real-life clinical experience as they work with staff in the care and treatment of patients. BMH works closely with local school districts in supporting high school health occupation programs. The Simulation Laboratory is available for seminars that give students hands-on experience, exposing them to the highly complex world of health care delivery. Part III, Line 2: The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), was subtracted for purposes of calculating the percentage in this column is $7,396,259. Part III, Line 4: The text of the footnote ot the organization's financial statements that describes bad debt expense is found on pages 12-13. Part III, Line 8: The cost used to determine the Medicare payment shortfall comes from the CMS required filing of the Medicare cost report. The methodology uses a ratio of cost to charges to determine the cost assigned to the Medicare services. BMH is committed to serving the healthcare needs of all members of our community. BMH considers the revenue shortfall from the Medicare program payments to be part of its community contribution. Part III, Line 9b: Patients who have previously applied and been approved for the BMH charity care program are automatically qualified for any additional services provided over the next six months after application approval. BMH will presumptively qualify patients for charity care if they meet criteria such as being food stamp eligible and qualifying for Section 8 housing. Part VI, Line 2: Executive SummaryButler Memorial Hospital (BMH) is proud to serve its community. In furtherance of its charitable mission, BMH provided $17.1 million in support in the form of charity care, unreimbursed care, community health improvement, health education, subsidized services and contributions to community organizations. This support accounts for over 6.9% of total expenses. BMH demonstrates its commitment by improving the overall health of our community through the operation of an efficient and effective health care system and by actively supporting appropriate community services. Summary of Services and Community SupportHelping People to Live Better, Every DayAt BMH, a key goal is to strengthen the health and well-being of the community. BMH understands that as a sole community hospital it plays an important role in the health of Butler County residents. This role is taken very seriously. Last year, BMH provided over $17.1 million in total community benefit support. This accounts for over 6.9% of our total expenses. The services BMH provides are essential to not only the community's overall health, but also to the quality of life of every resident. Butler Health SystemButler Memorial Hospital has a sole corporate member, Butler Health System ("System"). Butler Health System is an integrated health organization serving a multi-county area in western Pennsylvania. Through its affiliate, Butler Medical Providers, the System employs more than 189 physicians and advanced practice providers with another 201 physicians on the BMH active medical staff. Its scope includes acute hospital care, ambulatory care, urgent care, and a network of laboratory services to more than 150 clients. Primary community health care. The 296-bed general acute care hospital provides essential services to the community including emergency services, surgical intensive care, medical intensive care, geriatric and adult psychiatry, chemical dependency, and obstetrics (with 1,068 deliveries in fiscal year 2017). Inpatient and acute observation patients account for approximately 18,870 admissions each year. The Emergency Department treated 47,380 patients last year. All major specialties and consultants are available, including general surgery, orthopedics, neurology, pathology, anesthesia, radiology, pulmonary/critical care medicine, cardiology, urology, otolaryngology, gastroenterology, ophthalmology, palliative care, electrophysiology, endocrinology, neurosurgery, radiation and medical oncology, and a hospitalist service. A 25-bed skilled nursing facility (SNF) is also located within the hospital building. In addition to being a choice available to patients requiring skilled nursing or rehabilitation, the SNF at times provides a safety net by treating patients with more complex and costly to treat conditions that other skilled nursing facilities often may not care for or be willing to accept. BMH also offers a broad range of community programs off-site including its Family Services Center, focused on psycho-social issues that affect families and the health of the home.Tertiary care. Over the years, BMH has continued to expand the scope and depth of tertiary services so residents have access to services locally without the need for patients and families to travel to Pittsburgh. These services include open heart surgery (with 309 cases in fiscal year 2017), electrophysiology services, thoracic and vascular surgery, advanced orthopedics, palliative care, endocrinology, radiation and medical oncology, neurosurgery and spine surgery. For years, BMH has added services ranging from primary ambulatory care to advanced tertiary services, assuring the community access to the services matching or exceeding the levels of care provided in Pittsburgh hospitals. BMH costs are typically lower than Pittsburgh hospitals providing an identical service. This range and complexity of service is not offered by any other entity in Butler County.Ambulatory ExpansionSince 1999, the System has recognized and embarked upon the necessity for an available, low-cost, high-quality, ambulatory network. This network now includes over 70 convenient locations where regional residents can access a broad range of services. This network of services continues to grow, with locations in six counties. In addition to serving Butler County, services have been expanded in Lawrence, Venango, Mercer, Clarion, Armstrong and Indiana Counties. A comprehensive array of ambulatory services is available to patients, including advanced imaging, cardiac testing, wellness, primary care, specialty care and walk-in/urgent care, often providing a continuum of services just short of acute inpatient care. BHS Crossroads Campus, which is approximately one-half mile from BMH, serves as the System's largest ambulatory location. The original building houses the Cardiovascular and Musculoskeletal Centers. Due to the growth in the System's services, in November 2015, a new medical office building was opened. This campus now houses cardiology testing, medical and interventional cardiologists, cardiovascular surgeons, electrophysiologists, neurosurgeons, orthopedic surgeons, laboratory/x-ray/pre-admission testing, pulmonology, general surgery, women's imaging, obstetricians/gynecologists, medical oncologists, palliative care and endocrinology. In addition, the System has four urgent care centers. These urgent care centers are strategically located in BMH's primary and secondary markets. The urgent care centers were created as a joint venture with BMH's emergency room physicians. The System focuses on strong relationships with the medical staff. This joint venture is one example of the partnerships developed with physicians.Another example of the System engaging with physicians is the development of a Provider Hospital Organization (PHO) in 2015. Participants of this PHO include both employed and independent members of the Butler Memorial Hospital Medical Staff. The PHO is a vehicle that will allow BMH and its physician partners to work collaboratively to provide high level, cost effective care to the patients of the communities in which we service in a manner that results in an exceptional experience.Surrounding the System's services is a robust complement of primary and specialty physicians. These physicians include family practice, internal medicine, adult and pediatric hospitalist, intensivist, radiation oncology, pathology, palliative care, electrophysiology, endocrinology, neurology, cardiology, oncology, surgery, orthopedics, radiology, gynecology/obstetrics, infectious disease and dermatology. Providing convenient care with a positive experience is the focus of such physician practices. With 189 physician and mid-level providers in over 60 offices covering six counties, these providers offer office visits and testing close to home while referring inpatient business to BMH. Part VI, Line 3: Community Health AssessmentButler Memorial Hospital (BMH) has conducted Community Health Assessments for over 20 years to guide resource allocation and service development. Past major initiatives that have been started or programs that have received ongoing support due to the recognized community needs have been:Maternal Services Program 1990Family First (support) 1992Mammography Outreach 1996Women's Imaging Center 1999Cardiovascular Surgery 1999Best Practices Stroke Care 2005Community Hospital Comprehensive Cancer Program 2006Tumor Registry 2006Community Health Clinic (support) 2008Pediatric Hospitalist Program 2012Lung Cancer Screening 2014"The BMH Committee" has used numerous data sources to identify gaps or unmet community health needs. These are prioritized to address needs that may have the greatest impact on overall health status of the populations affected.Previously Identified and Ongoing:Obesity and Lack of Exercise: Obesity and lack of exercise are associated with Type 2 Diabetes. Obesity is a national phenomenon. There is little evidence that community level interventions have a significant impact on obesity. The geography and population density of Butler County require that most residents drive or ride to work, school, and to nearly all destinations for shopping. For instance, in the Behavioral Risk Factor Surveillance Study, 39 to 40% of respondents report a long commute to work. In 2010 25% of county residents were obese, in 2015 30% were obese; this is consistent with national trends. From 2011 to 2012 the percent reporting physical inactivity fell from 24% to 23% but physical inactivity has remained steady at 23% for the last 4 years in spite of more access to exercise: Access to exercise opportunities has increased from 72% to 79% between 2014 and 2015.A recent report by Raj Chetty in JAMA suggested that location of residence and thus local policy might have an impact on health separately from income. The Committee will monitor this topic to see if this observation is proven to be substantiated by other investigators. (http://www.nytimes.com/interactive/2016/04/11/upshot/where-the-poor-live-longer-how-your-area-compares.html?_r=0)The literature for interventions in childhood obesity was reviewed. School based programs have small to modest impact. Community programs have not been shown to have a beneficial impact. Combined community and school based programs are being studied.Cancer: Cancer remains the leading cause of premature death in Butler County. Lung Cancer and breast cancer are the two most common types of cancer causing premature death. Cancer screening programs are in place for these two diseases. The Cancer Committee monitors the performance and outcomes of these programs. These are also reported by BMH at its annual community report.New Topics:Asthma In Children:Is associated with adult smoking and particulate air pollution: 18-19% of adults smoke, Butler County has the second highest level of small particulate air pollution (PM 2.5) in Pennsylvania. Particles less than 2.5 microns are not filtered by the upper airway defense systems and reach the lung and are absorbed into the body. School nurses identify asthma as the leading chronic health condition for which they oversee medication administration or use at school. Reliable access to medication is a problem that school nurses identify for a segment of the children in school.Maternal Fetal Health:Countywide maternal fetal health statistics have shown a small decline in the health of this population after many years of steady improvement. A county has many neighborhoods and subgroups. BMH has engaged an epidemiologist to perform an investigation to understand this change in long term trends with a focus on identifying neighborhoods that may benefit from targeted outreach. BMH is providing funding for study of this issue.High Rates of Osteoporosis Fractures: While there has been an improvement in hip fractures in women over 65 since 2003, Butler County has a relatively high rate of hip fractures in this population group. A hip fracture requires surgery, may ultimately be fatal, limits mobility and may force the person to leave their home. Plan: Increased screening and treatment for osteoporosis and fall risk assessment and prevention.Low Rates of Early Childhood Immunization:Early Childhood immunization rates in Butler County are lower than Pennsylvania averages. Pennsylvania is lower than US national rates. By 7th grade Butler County children are up-to-date on their immunizations. Barriers to immunizations based on time, transportation and money are part of this problem. Butler County now matches state and national vaccination rates for kindergarteners.Opioid Overdose Epidemic:National and State Authorities across the country have identified opioid addiction and overdoses as a national crisis. BMH will fully participate in these programs as they apply to physician education and best practices and patient education. In January, 2017 BHS received the designation as Center of Excellence for Opioid Treatment and a $500,000 grant for education. BMH implemented an education and clinical decision support for hydromorphone prescribers that resulted in a 50% reduction in the average dose and a 60% reduction in the cumulative dose during each hospital stay. Part VI, Line 4: Hybrid OR Suite/TAVR ProgramBMH recently added a hybrid operating room suite. This is a surgical suite that is equipped with advanced medical imaging technology. The last few years have seen a paradigm shift in the treatment of cardiovascular-related diseases, from once traditional open surgical modalities to the entire cardiovascular tree being amenable to percutaneous interventions. The tremendous advances in trans-catheter endovascular procedures currently being applied to the heart and the peripheral vasculature have resulted in a treatment paradigm shift in the care of the cardiovascular patient. To allow these procedures, operating rooms with integrated x-ray imaging capabilities have to be installed.A fully integrated interventional suite combines surgical sterility with flat-panel cardiovascular imaging, a linked workstation, post processing and storage facilities. Supportive equipment is available in the room, includes patient monitoring, anesthesia, intravascular ultrasound, three-dimensional (3D) transesophageal echocardiogram or rotational angiography. The ability for open conversion or hybrid intervention, as well as endovascular supplies and devices, are all located within the hybrid OR suite. The new Hybrid OR suite provided the platform to perform trans-catheter aortic valve replacement procedures. ("TAVR") This is a minimally invasive surgical procedure in which the Aortic heart valve is repaired without removing the old, damaged valve, instead it wedges a replacement valve into the aortic valves place. Usually valve replacement requires an open heart procedure with a "sternotomy", in which the chest is surgically separated (open) for the procedure. The TAVR or TAVI procedures can be done through very small openings that leave all the chest bones in place. The TAVR procedure is performed using one of two different approaches, allowing the cardiologist or surgeon to choose which one provides the best and safest way to access the valve:Entering through the femoral artery (large artery in the groin), called the trans femoral approach, which does not require a surgical incision in the chest or using a minimally invasive surgical approach with a small incision in the chest and entering through a large artery in the chest or through the tip of the left ventricle (the apex), which is known as the trans apical approach.We began our program in Sept 2016 and have performed 56 TAVR procedures to date. Palliative CareBMH added palliative care services in 2015 to our broad array of specialties. Palliative care service was initially offered to people suffering serious illness who were being treated as an inpatient of the hospital. In 2016, the service was expanded to include outpatient services. An additional physician and office offers patients continued care and allows primary care doctors to refer other seriously ill patients and families. Assertive Community Treatment (ACT)BMH, working with local agencies, is now staffing a much needed service. The Assertive Community Treatment, or ACT, is a way of delivering a full range of services to people who have been diagnosed with a serious mental illness. ACT's goal is to give consumers outstanding community care and to help them have a life that is not dominated by their mental illness. With ACT, consumers get help taking care of their basic needs, from taking medications to getting out and getting through the day. ACT teams work closely with consumers to see which medications and therapies work best for them. They help consumers find housing, apply for food stamps, go back to school or get a job and become productive members of society. The ACT team has been successful in reducing the number of hospitalized days for clients in our region.The Patient and Family Advisory CouncilAs part of BMH's commitment to excellent service, The Patient and Family Advisory Council was formed in September of 2014. The Council is made up of former patients and a few BMH employees. The Council is dedicated to strengthening collaboration between patients, family members and the health care team. The System wants to assure we are providing patient-centered care and believes the patients are the right people to provide direction on what is most important to patients. Since its inception, the Council has provided valuable input to many initiatives, including but not limited to: the Patient Handbook, the System website, Emergency Room waiting experience, quiet at night, patient experience video and call bell response time.The Patient and Family Advisory Council approved the implementation of two service improvement projects. First, a support group for patients with cardiac disease and secondly, a patient information privacy code system to allow family to obtain patient information and protect patient privacy. The new support group for cardiac patients, Heart and Soul, was designed, implemented and meets regularly and provides emotional support to those who have experienced cardiac disease. The patient information privacy code was implemented in May of 2016.24 Hour Electroencephalographic (EEG) video monitoringA 24 hour electroencephalographic (EEG) video monitoring service was implemented to improve inpatient outcome by permitting accurate diagnoses and modified therapy of seizure disorders for in-patients. This procedure is widely regarded as safe and effective for evaluating seizures disorders. The American Epilepsy Society has stated that this technique is the method of choice for the evaluation of intractable and/or undiagnosed seizure disorders. Additionally, many studies have reported the usefulness of this technique, and recommended its use for the diagnosis of psychogenic seizures. EEG video monitoring is medically necessary for the following indications, where the diagnosis cannot be made by neurological examination, standard EEG studies, and an ambulatory EEG monitoring, and non-neurological causes of symptoms (e.g., syncope, cardiac arrhythmias) have been ruled out: to differentiate epileptic events from psychogenic seizures; or to establish the first diagnosis of a seizure disorder; or to establish the specific type of epilepsy in poorly characterized seizure types where such characterization is medically necessary to select the most appropriate therapeutic regimen.Interventional Neurology Services Interventional Neurology Services added a BiPlane Imaging Interventional Procedure Lab in 2014. Treatment of Cerebral Vascular Aneurysm Endovascular Coiling Studies have shown that patients with a ruptured aneurysm tend to do better in the long term after a coiling procedure. A coiling procedure is performed as an extension of the angiogram. Most elective patients will go home the next day after surgery and are back to normal activities the following day. Interventional Radiology Cancer Treatments Yttrium-90 treatment of nonresectable liver cancer, was implemented in 2014. Interventional radiologists use intra-arterial yttrium-90 (Y-90) radioembolization, to treat liver cancer. Studies show that treating liver tumors with doses of Y-90, provides results when chemotherapies have failed, preserves the patient's quality of life, and can be done on an outpatient basis. Radioembolization is a minimally invasive procedure that combines embolization and radiation therapy to treat liver cancer. It can help extend the lives of patients with inoperable tumors and improve their quality of life.Electrophysiology Cryoablation ProceduresElectrophysiology Cryoablation Procedures were implemented in 2015. Cryoablation is a therapy that uses the removal of heat from tissue to treat cardiac arrhythmias. Part VI, Line 5: Employees in the CommunityEvery year, the System and its employees support a variety of community support programs. These include the Caring Angel Program, the United Way, the American Heart Association, the American Cancer Society, the Butler YMCA and the March of Dimes, among others. In addition to these activities, employees participate in a variety of community service initiatives, such as Habitat for Humanity, Doctors without Borders, Ride for the Cure, Produce to the People, and local student mentoring programs.SummaryThe System physicians, nurses, employees, volunteers and volunteer leadership maintain deep connections to the communities they serve. They live and work in the multi-county area that the System serves, and they are acutely aware of the needs of residents. As a tax-exempt charitable organization, The System is careful to manage its resources to meet the current and future healthcare needs of residents. The System is proud of its independence and pledges to always strive to provide high quality, low cost care in a comfortable and supporting environment.A majority of the Governing Body of BMH reside in our primary service area. Per the Corporate Bylaws 60% of the Trustees must work or reside in the service area. Medical Staff Privileges are offered to all qualified physicians subject to the recommendation of the Hospital Medical Staff and in compliance with the policies of the Board of Trustees. Currently 283 physicians, podiatrists and dentists hold privileges on the BMH Medical Staff. Privileges are offered based on qualifications and community need without regard to other factors suchas race, sex, color, creed, or national origin.Annually, BMH establishes operating and capital budgets designed to efficiently allocate funds for its ongoingoperation and for the additional investment in new and replacement patient care equipment; plant and infrastructure; and technology. Upon preparation by management staff the final budget is presented forapproval by the Board of Trustees. Part VI, Line 6: Butler Health System is the sole corporate member of Butler Healthcare Providers. 0 Community Health Clinic of Butler County 103 Bonnie Drive Butler PA 16002 204852135 501c3 56875 General support to provide medical care of indigent patients Part I, Line 2: The organization's bylaws control the contributions that can be made and the process related to such. X X X X X 0 1 0 0 0 0 0 1 0 Kenneth P DeFurio President & CEO 551595 0 165479 0 35941 0 175756 0 42270 0 971041 0 0 0 Dennis Demby MD Trustee 0 163925 0 88950 0 19445 0 0 0 10878 0 283198 0 0 Anne B Krebs Chief Financial Officer 307715 0 76929 0 19819 0 54926 0 29238 0 488627 0 0 0 Stephanie Roskovski Chief Operating Officer 310170 0 77542 0 19391 0 47019 0 23935 0 478057 0 0 0 Karen Allen VP Patient Svc,CNO, 268258 0 67064 0 64160 0 34873 0 39160 0 473515 0 0 0 A Thomas McGill MD VP Quality & Safety/CIO 389459 0 97365 0 31266 0 64735 0 40439 0 623264 0 0 0 John C Reefer MD VP Prof Affairs & CMO 345322 0 86330 0 25310 0 59439 0 35312 0 551713 0 0 0 Paula L Hooper VP General Counsel 295838 0 73960 0 18566 0 26638 0 39167 0 454169 0 0 0 Thomas Genevro VP Facilities/Human Resour 229632 0 57408 0 1400 0 20740 0 38984 0 348164 0 0 0 Part I, Line 4b 4 (b) The organization utilizes a Supplemental Executive Retirement Program (SERP) to recruit and retain leadership talent. Vesting periods are 5 and 10 years, and for all executives, with the exception of the President/CEO, at age 65. The third vesting period for the president/CEO is age 60. Eligible executives receive distributions upon reaching the vesting periods. All contributions to the SERP have been reported previously and are reported annually. The annual accrual amounts for calender year 2016 were: Kenneth P. DeFurio, $157,756; Anne B. Krebs $36,926; Stephanie J. Roskovski $37,220; A. Thomas McGill MD $46,735; John C. Reefer MD $41,439; Paula L. Hooper $20,709; Karen A. Allen 1$8,778; Thomas A. Genevro 1$6,074. Part I, Line 7 Employees are eligible and received bonus compensation. Bonuses are not guaranteed and are awarded based on Board approved metrics which include quality, services, and strategic financial performance. A BUTLER COUNTY HOSPITAL AUTHORITY 251458912 123592dr5 2015-03-18 100481533 REFUND PRIOR ISSUE 4/29/09 0 0 0 B BUTLER COUNTY HOSPITAL AUTHORITY 251458912 1235926QB 2009-04-29 50000000 CONSTRUCTION OF ADDITION TO HOSPITAL 0 0 0 A 1831777 100481533 1411658 2015 0 1 1 1 B 10665000 9000000 50000000 833495 49166505 2010 0 0 0 1 A 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 A 0 0 1 0 0 0 0 0 0 B 0 0 0 1 1 0 0 0 0 Date Rebate Computation Performed Issuer Name: BUTLER COUNTY HOSPITAL AUTHORITY Date the Rebate Computation was Performed: 08/11/2015 Form 990, Part VI, Section A, line 6 Per the By-Laws of the organization, the organization shall have one corporate member, Butler Health System, Inc. There shall be no other members. Form 990, Part VI, Section A, line 7a Butler Health System, Inc., the corporate member of the organization, appoints the members of the Board of Trustees. Form 990, Part VI, Section A, line 7b As per the By-Laws of the organization, the subject matters of the powers reserved to the Member are as follows: a. The number of Trustees that will comprise the Board. b. The election of Trustees. c. The removal of any Trustee for cause from the Corporation's Board of Trustees and approval of the replacement of any such removed Trustee for the unexpired portion of the term. d. The election, re-election, appointment and reappointment of all Officers of the Board. e. The amendment, revision, or restatement of the Corporation's Articles of Incorporation and/or By-Laws. f. The adoption or change in the mission, purpose, philosophy or objectives of the Corporation. g. The change in the general structure of the Corporation as a voluntary, nonprofit corporation. h. The dissolution, division, conversion or liquidation of the Corporation, the consolidation or merger of the Corporation with another corporation or entity, or the acquisition of substantially all of the assets of another corporation or entity, subject to the provision of the Articles of Incorporation. i. The Corporation's borrowing of money, issuance of indebtedness and/or incurrence of guarantees, whether in a single transaction or a series of related transactions, whether or not such borrowings or guarantees are to be secured by a mortgage, pledge or other lien on the Corporation's current or future real property, personal property or endowment funds. j. Approval of the annual capital and operating budgets of the Corporation and any amendments thereto. k. Approval of any charitable donation by the Corporation, other than to the Member or any nonprofit entity in which the Member is a sole member, in an amount exceeding $15,000 or in an amount exceeding $150,000 in the aggregate during any one fiscal year. l. Approval of any transfer other than charitable donations of the Corporation's assets unless specifically authorized in the Corporation's approved budgets. m. Approval of change of membership or voting rights of the Member. Form 990, Part VI, Section B, line 11b The completed 990 was reviewed by the Chief Executive Officer and an outside independent public accounting firm. Relevant sections were reviewed by the Controller and Chief Legal Officer. Form 990 was reviewed with the Finance Committee and the Board of Trustees. After these reviews, but prior to filing, the full Board of Trustees and the Finance Committee was notified that the completed Form 990 was available for review on the Board's secure website. Form 990, Part VI, Section B, line 12c The responses to the Conflict of Interest Disclosure form are collected and reviewed annually by the General Counsel and Corporate Compliance Officer, who then reviews the same with the Audit and Compliance Committee of the Board of Trustees. Conflict of Interest Disclosure forms are completed by all Trustees, Officers, Committee Members, members of management as well as the Executive Team. In the event a relationship results in a potential conflict for an issue being discussed by the Board, the Trustee recuses himself/herself from the discussion and vote. The recusal is documented in the minutes. The General Counsel attends all Board meetings and ensures that any needed recusals occur. Form 990, Part VI, Section B, line 15 The Board of Trustees recognizes the great challenges and difficulties that healthcare executives face, particularly in the current era of national and state healthcare reform. In addition, the Pittsburgh regional market is highly competitive. The Board competes for and seeks executive talent on a national basis. It engages expert compensation consultants, utilizing national comparative data to guide the determination of competitive, appropriate levels of compensation. The total compensation program for executives consists of cash compensation and benefits. Factors taken into consideration in determining compensation for executives include: market demand and competition for similar positions, experience and tenure, and actual performance and effectiveness. Based on these and other pertinent criteria, BHS targets total compensation to fall within a range of the 25th to 75th percentile of the market. BHS executive compensation generally will not exceed the 75th percentile of the market. Exceptions to this may be subject to review and recommendation by the Compensation Committee, which in turn is subject to review and approval by the Board of Trustees. Exceptions must be supported by organizational and /or individual performance, or a retention/recruitment circumstance that warrants such compensation. The Compensation Committee consists exclusively of independent individuals with no real or perceived conflicts of interest in recommending executive compensation guidelines and levels. The Board of Trustees has the final approval of all executive compensation decisions. While benefits are accounted for in Schedule J, actual "take home" pay to the executive typically consists only of base salary and any incentive award earned. Applicable taxes and other withholding are deducted. Annual increases in base pay, if any, are based on competitive market trends from the comparison group. Supplemental retirement benefits are used as a vehicle for executive recruitment and retention with appropriate vesting periods. The Board of Trustees reviews and approves executive compensation in its entirety, including the use of "tally sheets", which disclose 100% of each executive's compensation. The Board of Trustees engages external compensation consultants and external legal expertise to assure reasonableness of executive compensation levels. Form 990, Part VI, Section C, line 19 Historical financial information is provided to the public at the annual public board meeting. Bylaws, Articles of Incorporation and the Conflict of Interest Policy are posted on the website. Form 990, Part IX, line 11g Purchased Services: Program service expenses 23,344,188. Management and general expenses 4,119,563. Fundraising expenses 0. Total expenses 27,463,751. Form 990, Part XI, line 9: Transfers (to) from affiliates -13,463,689. decrease in interest in net assets of butler health system foundation -302,136. distributions to non-controlling interest -430,782. change in pension assets and liabilities 5,027,046. Part XII Line 2c explanation The organization has not changed its process for reviewing the audited financials or the selection of an independent auditor during the year. Butler Health System Provider Hospital Organization one hospital way butler PA 16601 474212217 provider hospital organization PA butler healthcare providers Butler Health System One Hospital Way Butler PA 16001 251441855 Healthcare Delivery System PA 501(c)(3) Line 3 0 Butler Medical Providers One Hospital Way Butler PA 16001 251441961 Physician Practices PA 501(c)(3) Line 3 Butler Health System 0 Nixsar Corporation One Hospital Way Butler PA 16001 251441960 Own and Operate real estate PA 501(c)(3) Line 3 Butler Health System 0 BHS Nallathambi Medical Associates One Hospital Way Butler PA 16001 264746949 Physician Practice PA 501(c)(3) Line 3 Butler Medical Providers 0 Butler Imaging and Interventional Associates One Hospital Way Butler PA 16001 264263364 Physician Practice PA 501(c)(3) Line 3 Butler Medical Providers 0 BHS Seneca Medical Center LLC One Hospital Way Butler PA 16001 464444529 Physician Practice PA 501(c)(3) Line 3 Butler Medical Providers 0 BHS Dermatology Associates LLC One Hospital Way Butler PA 16001 800929620 Physician Practice PA 501(c)(3) Line 3 Butler Medical Providers 0 BUTLER HEALTH SYSTEM FOUNDATION One Hospital Way Butler PA 16001 261543883 FUNDRAISING ON BEHALF OF BUTLER HEALTH SYSTEM PA 501(c)(3) Line 12a, I BUtler Health System 0 Butler Ambulatory Surgery Center 102 Technology Drive Butler PA 16001 061728190 Surgery PA N/A BHS FasterCare One Hospital Way Butler PA 16001 271961562 Urgent Care PA Butler Healthcare Providers Related 0 1 0.51000 PCA OF BUTLER PC 480 EAST JEFFERSON STREET BUTLER PA 16001 251351445 PHYSICIAN OFFICE PRACTICE PA C 0 0 0 1 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0 bhs fastercare J 203753 bhs fastercare Q 4511736