2017-05-15T14:36:16-05:00 2016-06-30 390859910 BAKER TILLY VIRCHOW KRAUSE LLP 1650 MARKET STREET SUITE 4500 PHILADELPHIA PA 191037341 990 2015-07-01 251842046 INDIANA HEALTHCARE PHYSICIAN SERVICES INC INDI 7243577008 PO BOX 788 INDIANA PA 15701 ROBERT GONGAWARE SENIOR VP FINANCE 7243577008 2017-05-15 1 JULIUS C GREEN CPA P00350393 2159720701 2015 2021-01-29 14:40:06Z STEPHEN A WOLFE PO BOX 788 INDIANA PA 15701 16497705 0 X WWW.INDIANARMC.ORG X 2000 PA PROVIDE HEALTH SERVICES 9 7 219 6 777159 -85293 0 0 11113200 15376947 0 0 1066610 1120758 12179810 16497705 0 0 0 0 8209955 7691824 0 0 0 8781730 13658677 16991685 21350501 -4811875 -4852796 2468433 2778573 368810 679274 2099623 2099299 X PREVENTIVE HEALTH SERVICES, GENERAL/OTHER: INDIANA HEALTHCARE PHYSICIAN SERVICES, INC IS A NON-PROFIT HOSPITAL OWNED GROUP OF PRACTICES OWNED AND OPERATED TO SERVE THE RURAL AREAS OF INDIANA AND SURROUNDING COMMUNITIES. ITS MISSION IS TO SUPPORT THE MISSIONS AND VALUES OF INDIANA REGIONAL MEDICAL CENTER IN PROVIDING HEALTH CARE AND EDUCATIONAL SERVICES TO ALL WHO SEEK HEALTHCARE WITHOUT DISCRIMINATION. WE PROVIDE ACCESSIBLE, COST EFFECTIVE QUALITY HEALTHCARE WITHIN THE RURAL COMMUNITIES OF INDIANA AND SURROUNDING COUNTIES. 0 0 21307405 15376947 PREVENTATIVE HEALTH SERVICES, GENERAL/OTHER:INDIANA HEALTHCARE PHYSICIAN SERVICES, INC. ("IHPS") IS A NON-PROFIT HOSPITAL OWNED GROUP OF PRACTICES OWNED AND OPERATED TO SERVE THE RURAL AREAS OF INDIANA AND SURROUNDING COMMUNITIES. ITS MISSION IS TO SUPPORT THE MISSIONS AND VALUES OF INDIANA REGIONAL MEDICAL CENTER IN PROVIDING HEALTH CARE AND EDUCATIONAL SERVICES TO ALL WHO SEEK HEALTHCARE WITHOUT DISCRIMINATION. WE PROVIDE ACCESSIBLE, COST EFFECTIVE QUALITY HEALTHCARE WITHIN THE RURAL COMMUNITIES OF INDIANA AND SURROUNDING COUNTIES. CHARITY CARE PROVIDED DURING THE FISCAL YEAR ENDED JUNE 30, 2016 WAS $30,910.OWNERSHIP OF PHYSICIAN OFFICES - IHPS FOCUSES ON REBUILDING THE REVENUE CYCLE AND COST STRUCTURE OF PHYSICIAN OFFICES WITHIN THE COMMUNITY. IHPS ALSO FOCUSES ON RECRUITING PHYSICIANS THAT OFFER A NEW OR NEEDED SERVICE WITHIN THE COMMUNITY.WE SUPPORT AND WORK COLLABORATIVELY WITH OTHER NON-PROFIT AGENCIES WITHIN OUR SITES. SOME OF THE SERVICES ARE LISTED BELOW, BUT ARE NOT LIMITED TO:- OPEN DOOR PROGRAM - PROVIDES DRUG AND ALCOHOL REHABILITATION AND COUNSELING- HEALTHY WOMEN'S PROGRAM - OB/GYN EXAMS FOR ALL WOMEN WITH NO LIMITATIONS (REGARDLESS OF RACE, AGE, CREED, RELIGIOUS BELIEFS, OR ABILITY TO PAY).- FREE HEALTH CARE FOR LOW INCOME FAMILIES THROUGH THE "WE CARE" PROGRAM.- SPEAKING ENGAGEMENTS RELATED TO HEALTH ISSUES OR WELLNESS TO ANY AND ALL COMMUNITY GROUPS, CHURCHES, AND OR OTHER NON-PROFIT ORGANIZATIONS. ACTIVE PARTICIPATION IN HEALTH PROGRAMS WITHIN THE SCHOOLS. - FREE PARKING FOR PATIENTS AND EMPLOYEES.- HEALTH SCREENING PARTICIPATION WITH LOCAL AGENCIES AND NON-PROFIT FUNDRAISING EVENTS WITHIN THE COMMUNITY. - STAFF PARTICIPATES IN THE UNITED WAY CAMPAIGN.- EMPLOYEE/TIMESHARE SERVICES - IHPS FOCUSES ON PROVIDING QUALITY WELL-TRAINED SUPPORT STAFF TO MULTIPLE INDEPENDENT PHYSICIANS WITHIN THE COMMUNITY.- PHYSICIAN BILLING SERVICES - IHPS FOCUSES ON PROVIDING QUALITY BILLING SERVICES THAT MAXIMIZES REIMBURSEMENT TO MULTIPLE INDEPENDENT PHYSCIANS WITHIN THE COMMUNITY. 21307405 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 X 0 0 219 1 1 1 0 0 0 0 0 0 0 0 0 X 9 7 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X ROBERT GONGAWARE SVP FINANCE 7243577008 835 HOSPITAL ROAD INDIANA PA 15701 BEVERLY GAZZA ESQ CHAIR 1.00 2.00 X X 0 0 0 ANNE WHITE VICE CHAIR 1.00 1.00 X X 0 0 0 EDWARD MCDOWELL CHAIRMAN, NETWORK OPERATIONS COUNCIL 40.00 13.00 X X 362689 0 18138 NATHAN KOVALCHICK SECRETARY 1.00 1.00 X X 0 0 0 T MICHAEL PRICE TREASURER 1.00 1.00 X X 0 0 0 JOSEPH GEARY BOARD MEMBER 1.00 1.00 X 0 0 0 MARK E BOYKIW BOARD MEMBER 1.00 1.00 X 0 0 0 TODD BRICE BOARD MEMBER 1.00 1.00 X 0 0 0 STEPHEN A WOLFE PRESIDENT & CEO 1.00 39.00 X X 0 416137 96493 ISLAM MOHAMMED N PHYSICIAN 40.00 40.00 X 450008 0 73372 NOWAK MIHAELA PHYSICIAN 40.00 40.00 X 357919 0 17637 NOROHNA BOSCO PHYSICIAN 40.00 40.00 X 690042 0 27709 GATUMU SARAH N PHYSICIAN 40.00 40.00 X 364555 0 21079 MALIVER LEONARD E PHYSICIAN 40.00 40.00 X 357724 0 8745 2582937 416137 263173 34 0 1 0 MATT KLAIN MD 25 COLONY BLVD SUITE 102 BLAIRSVILLE PA 15717 PRIMARY CARE SERVICES 391108 GREENWAY HEALTH 121 GREEN WAY BLVD CARROLLTON GA 30117 EMR AND INFORMATION SYSTEM 283666 2 OUTPATIENT REVENUE 621400 15376947 15376947 15376947 EMPLOYEE TIMESHARE SVCS 541900 615918 615918 INSURANCE INCENTIVES 900099 185374 185374 PHYSICIAN BILLING SERVICES 561000 161241 161241 158225 158225 1120758 16497705 15376947 777159 343599 X 5225104 5225104 159802 159802 1500703 1500703 806215 806215 21000 21000 15041 15041 10350565 10350565 13789 13789 270006 270006 359311 359311 958393 958393 26543 26543 51650 51650 383903 383903 295915 295915 MEDICAL SUPPLIES & DRUG 555591 555591 BAD DEBT 330882 330882 REPAIRS & MAINTENANCE 19033 19033 RECRUITING & RETENTION 3767 3767 3288 3288 21350501 21307405 43096 0 1673 2248 25542 96563 1160701 1525728 74578 107494 2427167 1380627 1205939 1046540 2468433 2778573 173921 679274 194889 0 368810 679274 X 2093938 2099299 5685 0 2099623 2099299 2468433 2778573 X -4852796 4852472 X 0 1 X 1 0 X 5685 5685 67895 62210 5685 117211 49316 67895 200000 82789 117211 0.00000 0.00000 1.00000 0 0 2427167 1380627 1046540 1046540 X 21019295 4521590 4521590 16497705 0 16497705 21019619 0 21019619 330882 330882 21350501 PART X, LINE 2: THE CORPORATION ACCOUNTS FOR UNCERTAINTY IN INCOME TAXES USING 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 WERE NO TAX UNCERTAINTIES THAT MET THE RECOGNITION THRESHOLD IN 2016 AND 2015. THE CORPORATION'S POLICY IS TO RECOGNIZE INTEREST RELATED TO UNRECOGNIZED TAX BENEFITS IN INTEREST EXPENSE AND PENALTIES IN OPERATING EXPENSES. PART XI, LINE 2D - OTHER ADJUSTMENTS: TRANSFER FROM AFFILIATE 4,852,472. BAD DEBT EXPENSE -330,882. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 330,882. X 1 1 0 1 0 0 0 0 0 1 0 EDWARD MCDOWELL CHAIRMAN, NETWORK OPERATIONS COUNCIL 225746 0 136943 0 0 0 0 0 18138 0 380827 0 0 0 STEPHEN A WOLFE PRESIDENT & CEO 0 409230 0 0 0 6907 0 68951 0 27542 0 512630 0 0 ISLAM MOHAMMED N PHYSICIAN 450008 0 0 0 0 0 50000 0 23372 0 523380 0 0 0 NOWAK MIHAELA PHYSICIAN 261016 0 96903 0 0 0 0 0 17637 0 375556 0 0 0 NOROHNA BOSCO PHYSICIAN 431974 0 258068 0 0 0 0 0 27709 0 717751 0 0 0 GATUMU SARAH N PHYSICIAN 221779 0 142776 0 0 0 0 0 21079 0 385634 0 0 0 MALIVER LEONARD E PHYSICIAN 305324 0 52400 0 0 0 0 0 8745 0 366469 0 0 0 PART I, LINE 1A INDIANA REGIONAL MEDICAL CENTER PAYS COUNTRY CLUB MEMBERSHIP DUES FOR PRESIDENT & CEO, STEPHEN WOLFE, WHICH IS NOT INCLUDED IN HIS COMPENSATION. THE MEMBERSHIP IS A CORPORATE MEMBERSHIP USED FOR BUSINESS PURPOSES ONLY. PART I, LINE 3 THE FOLLOWING METHODS ARE USED BY INDIANA REGIONAL MEDICAL CENTER (IRMC) TO ESTABLISH COMPENSATION OF THE PRESIDENT/CEO, AS IRMC COMPENSATES THE PRESIDENT/CEO FOR SERVICES TO IRMC AND ALL RELATED ENTITIES: COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, WRITTEN EMPLOYMENT CONTRACT, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. PART I, LINE 4B INDIANA REGIONAL MEDICAL CENTER HAS A SUPPLEMENTAL, NONQUALIFIED RETIREMENT PLAN UNDER IRC SECTION 457(F) FOR PRESIDENT & CEO STEPHEN WOLFE. NO AMOUNTS WERE PAID TO HIM FROM THIS PLAN DURING 2015. STEPHEN WOLFE'S CONTRIBUTION TO THE PLAN FOR 2015 WAS $40,000. INDIANA HEALTHCARE PHYSICIAN SERVICES HAS A 457(F) PLAN AVAILABLE FOR THEIR PHYSICIANS. DR. MOHAMMED N. ISLAM WAS A MEMBER OF THIS PLAN DURING 2015. NO AMOUNTS WERE PAID TO HIM IN 2015. CONTRIBUTIONS TO THIS PLAN WERE $50,000 IN 2015. PART I, LINE 7 BONUSES MAY BE GRANTED AT THE DISCRETION OF THE BOARD AND ARE BASED ON FACTORS SUCH AS PERFORMANCE AND MEETING GOALS AND OBJECTIVES. BONUSES FOR PHYSICIANS ARE DETERMINED BY "RVU" PRODUCTIVITY, PROFITABILITY OF PRACTICE, OR QUALITY INCENTIVES. FORM 990, PART V, LINES 1 AND 2 THE ORGANIZATION DOES NOT FILE FORMS 1096 OR W-3. ALL VENDORS AND ALL EMPLOYEES ARE PAID THROUGH A COMMON PAYMASTER/REPORTING AGENT. THE COMMON PAYMASTER/REPORTING AGENT IS INDIANA REGIONAL MEDICAL CENTER, EIN: 25-0965404. INDIANA REGIONAL MEDICAL CENTER IS A RELATED, TAX-EXEMPT ORGANIZATION. THE NUMBER OF W-2'S REPORTED ON FORM 990, PART V, LINE 2 REPRESENTS THE NUMBER OF W-2'S FILED BY THE COMMON PAYMASTER ON BEHALF OF THIS ENTITY. FORM 990, PART VI, SECTION A, LINE 2 THE FOLLOWING BOARD MEMBERS HAVE A BUSINESS RELATIONSHIP: TODD BRICE AND ANNE WHITE. FORM 990, PART VI, SECTION A, LINE 6 INDIANA HEALTHCARE CORPORATION ("IHC") IS THE SOLE CORPORATE MEMBER OF INDIANA HEALTHCARE PHYSICIAN SERVICES ("IHPS"). FORM 990, PART VI, SECTION A, LINE 7A IHC HAS THE POWER TO FILL VACANCIES, NOMINATE AND APPROVE THE ELECTION OF, AND APPROVE REMOVAL OF THE BOARD OF DIRECTORS OF IHPS. FORM 990, PART VI, SECTION A, LINE 7B IHPS SHALL OBTAIN THE APPROVAL OF IHC BEFORE ACTION ON ANY OF THE FOLLOWING MATTERS BECOMES FINAL AND EFFECTIVE FOR IHPS: (1) AMENDMENT OF THE ARTICLES OF INCORPORATION AND BYLAWS; (2) THE SALE, LEASE OR EXCHANGE OF ALL OR SUBSTANTIALLY ALL OF THE PROPERTY OR ASSETS OF IHPS; (3) MERGER OR CONSOLIDATION WITH ANY OTHER CORPORATION; (4) DISSOLUTION OF IHPS; (5) APPROVAL OF AN ANNUAL BUDGET FOR IHPS; (6) ANY TRANSFER OF FUNDS BY GRANT, GIFT, OR LOAN FROM IHPS; (7) ANY OTHER MATTER THAT BY LAW WOULD REQUIRE THE APPROVAL OF MEMBERS OF A NONPROFIT CORPORATION. FORM 990, PART VI, SECTION B, LINE 11 THE RETURN WAS REVIEWED IN DETAIL BY THE DIRECTOR OF FINANCE/CONTROLLER AND REVIEWED BY THE CFO. EACH BOARD MEMBER WAS NOTIFIED THAT THE RETURN WAS AVAILABLE FOR REVIEW ON THE "BOARD SHARED DRIVE" BEFORE FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C EVERY MEMBER OF THE BOARD, AND EVERY INDIVIDUAL APPOINTED TO THE BOARD OR BOARD COMMITTEES, AS WELL AS ALL KEY MANAGEMENT PERSONNEL AND PHYSICIAN LEADERS, ARE REQUIRED TO EXECUTE A CONFLICT OF INTEREST DISCLOSURE STATEMENT, WHICH WILL BE UPDATED AT LEAST ON AN ANNUAL BASIS OR AS ADDITIONAL CONFLICTING INTERESTS ARISE. IN ADDITION, EVERY MEMBER OF THE BOARD WILL SPECIFICALLY ACKNOWLEDGE THE CONFLICT OF INTEREST POLICY AND HIS OR HER ATTEMPT TO ABIDE BY IT BY SIGNING THE ACKNOWLEDGEMENT FORM. EVERY BOARD COMMITTEE MEMBER, OFFICER, KEY MANAGEMENT EMPLOYEE, AND PHYSICIAN LEADER IS REQUIRED TO SIGN THIS ACKNOWLEDGMENT AS WELL. THE ACKNOWLEDGMENT AND DISCLOSURE FORMS WILL BE KEPT ON FILE BY THE CHIEF EXECUTIVE OFFICER, AND THE CHAIRMAN AND VICE-CHAIRMAN WILL BE FAMILAR WITH THE STATEMENTS THAT ARE FILED BY BOARD MEMBERS IN ORDER TO GUIDE THEIR CONDUCT IN THE EVENT A CONFLICT ARISES. EVERY PERSON COVERED BY THIS POLICY SHALL SUBMIT IN WRITING TO THE CEO A CONFLICT OF INTEREST DISCLOSURE STATEMENT LISTING ALL FINANCIAL AND CONFLICTING INTERESTS. EACH STATEMENT WILL BE RESUBMITTED WITH ANY NECESSARY CHANGES EACH YEAR OR AS ANY ADDITIONAL CONFLICTING OR FINANCIAL INTESTS ARISE. THE CHAIRMAN OF THE BOARD SHALL BECOME FAMILIAR WITH ALL SUCH DISCLOSURE STATEMENTS IN CASE A CONFLICT ARISES. THE VICE CHAIRMAN OF THE BOARD SHALL BE FAMILIAR WITH THE DISCLOSURE STATEMENT FILED BY THE CHAIRMAN. PENALTIES FOR NON-COMPLIANCE FAILURE TO COMPLY WITH THIS POLICY SHALL CONSTITUTE GROUNDS FOR REMOVAL FROM OFFICE AND, IN THE CASE OF KEY MANAGEMENT PERSONNEL, TERMINATION OF EMPLOYMENT. FORM 990, PART VI, SECTION B, LINE 15 POSITIONS FOR OFFICERS AND KEY EMPLOYEES ARE REVIEWED ON AN ANNUAL BASIS. APPROPRIATE COMPARISONS ARE MADE ON A REGIONAL AND NATIONAL LEVEL IN ORDER TO MAINTAIN A FAIR AND EQUITABLE COMPENSATION STRUCTURE. ALL RECOMMENDATIONS ARE APPROVED BY THE BOARD OF DIRECTORS AND DOCUMENTED IN THE BOARD MINUTES. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G OUTSIDE PRINTING: PROGRAM SERVICE EXPENSES 10,350,565. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 10,350,565. FORM 990, PART XI, LINE 9: TRANSFER FROM AFFILIATE 4,852,472. INDIANA REGIONAL MEDICAL CENTER 835 HOSPITAL ROAD INDIANA PA 15701 250965404 HOSPITAL PA 501(C)(3) LINE 3 INDIANA HEALTHCARE CORPORATION 0 INDIANA HEALTHCARE FOUNDATION 835 HOSPITAL ROAD INDIANA PA 15701 251574302 FUNDRAISING IN SUPPORT OF INDIANA REGIONAL MEDICAL CENTER PA 501(C)(3) LINE 11A, I INDIANA HEALTHCARE CORPORATION 0 INDIANA HEALTHCARE PROPERTIES 835 HOSPITAL ROAD INDIANA PA 15701 251524635 HOLD & MANAGE PROPERTY IN SUPPORT OF INDIANA REGIONAL MEDICAL CENTER PA 501(C)(3) LINE 11A, I INDIANA HEALTHCARE CORPORATION 0 INDIANA HEALTHCARE CORPORATION 835 HOSPITAL ROAD INDIANA PA 15701 251547379 PARENT CORPORATION PA 501(C)(3) LINE 7 N/A 0 INDIANA JEFFERSON RADIATION ONCOLOGY INC 835 HOSPITAL ROAD INDIANA PA 15701 900406301 RADIATION ONCOLOGY SERVICES PA 501(C)(3) LINE 11A, I INDIANA REGIONAL MEDICAL CENTER 0 INDIANA AMBULATORY SURGICAL ASSOCIATES LLC 841 HOSPITAL ROAD INDIANA PA 15701 232923182 AMBULATORY SURGERY PA N/A INDIANA REHABILITATION SERVICES LLC 855 SPRINGDALE DR STE 200 EXTON PA 19341 202214391 REHABILITATION SERVICES PA N/A COSM REALTY GROUP LTD 1265 WAYNE AVENUE STE 307 INDIANA PA 15701 030439684 REAL ESTATE PA N/A PENNSYLVANIA MOUNTAINS HEALTHCARE ALLIANCE LLC 150 MCCRACKEN RUN ROAD DUBOIS PA 15801 251852975 HEALTHCARE SERVICES PA N/A INDIANA TOTAL THERAPY LLC 120 IRMC DRIVE STE 160 INDIANA PA 15701 263843582 THERAPY SERVICES PA N/A INDIANA HEALTHCARE ENTERPRISES 835 HOSPITAL DRIVE INDIANA PA 15701 470973344 HEALTHCARE RETAIL PA N/A C 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 1 0 0