2016-03-21T11:16:52-05:00 2015-06-30 341897225 HILL BARTH & KING LLC 3110 HIGHLAND ROAD HERMITAGE PA 16148 990 2014-07-01 251640802 CHBLT SUBSIDIARY CO CHBL 7244182640 7 WEST STATE STREET NO 208 SHARON PA 16146 ROBERT LIPTAK PRESIDENT 7244182640 2016-03-05 1 DOMINIC MASTROPIETRO P00949738 7249817550 2016-03-05 2014 2016-08-17 19:52:53Z ROBERT LIPTAK 7 W STATE ST SUITE 208 SHARON PA 16146 4654 0 X N/A X 1990 PA THE MISSION OF THE ORGANIZATION IS TO PROMOTE THE HEALTH AND WELL BEING OF INDIVIDUALS IN OUR COMMUNITY BY PROVIDING ADVANCED SPECIALTY CARE CLOSE TO HOME. 1 1 172 1 0 0 0 0 10565558 4654 0 0 0 0 10565558 4654 0 0 0 0 15839783 0 0 0 0 3435904 204352 19275687 204352 -8710129 -199698 2217915 1534407 487746 3936 1730169 1530471 X THE MISSION OF CHBLT SUBSIDIARY CO., PREVIOUSLY KNOWN AS SHARON REGIONAL PHYSICIANS SERVICES, IS TO PROVIDE THE HIGHEST QUALITY, ADVANCED HEALTHCARE SERVICES TO ALL COMMUNITIES WITHIN OUR REGION. 0 0 196281 4654 CHBLT SUBSIDIARY CO., SOLD A MAJORITY OF ITS ASSETS IN APRIL 2014. THE ORGANIZATION IS PAYING EXPENSES AND COLLECTING RECEIVABLES FROM ITS ORIGINAL OPERATIONS. PRIOR TO APRIL 2014, THE ORGANIZATION:- PROVIDED AMBULATORY CARDIOLOGY SERVICES- ORTHOPEDIC SURGICAL CARE- PRIMARY CARE SERVICES- GENERAL SURGERY- OB/GYN- VASCULAR SURGERY- OTOLARYNGOLOGY/ALLERGY, ENDOCRINOLOGY, PULMONARY/CRITICAL CARE MEDICINE- GASTROENTEROLOGY AND CARDIOTHORACIC SURGERYTO INDIVIDUALS OF THE SHENANGO VALLEY IN WESTERN PENNSYLVANIA 196281 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 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 27 0 1 172 1 0 0 0 0 0 0 0 0 0 0 X 1 1 0 0 0 0 1 0 1 1 1 0 0 1 1 1 1 1 1 1 1 0 PA X JEFFREY A CHROBAK 7244182640 7 WEST STATE ST SUITE 208 SHARON PA 16146 ROBERT G LIPTAK CHAIRMAN 12.00 1.00 X X 0 0 0 RONNIE MIGNELLA CARDIOLOGIST 40.00 0.00 X 239624 0 4798 JAMES RYAN CARDIOLOGIST 40.00 0.00 X 227487 0 5360 JOSE MILLAN CARDIOLOGIST 40.00 0.00 X 220632 0 5790 BRANDON MIKOLICH CARDIOLOGIST 40.00 0.00 X 150148 0 1614 BRIAN SHANNON ORTHOPEDIC SURGEON 40.00 0.00 X 149611 0 3806 MATTHEW LIBURDI FORMER VICE PRESIDENT 1.00 40.00 X 0 361113 4061 JEFFREY A CHROBAK FORMER VICE PRESIDENT/CFO 1.00 40.00 X 0 896726 5179 JOHN DAVIDSON FORMER VICE PRESIDENT 1.00 40.00 X 0 420857 4181 JOHN JANOSO JR FORMER PRESIDENT/CEO 1.00 40.00 X 0 857268 3882 LINDE FINSRUD WILSON FORMER PRESIDENT/CEO 0.00 0.00 X 0 104520 3705 987502 2640484 42376 5 1 1 0 0 INPATIENT REVENUE 621110 4654 4654 4654 4654 4654 0 0 8442 371 8071 448 448 BAD DEBTS 172591 172591 THIRD PARTY REFUNDS 19371 19371 MEDICAL SUPPLIES 2750 2750 MISCELLANEOUS 750 750 204352 196281 8071 0 965707 20989 325023 1513418 927185 0 2217915 1534407 15559 3936 472187 0 487746 3936 X 1730169 1530471 1730169 1530471 2217915 1534407 -199698 0 X 1 X 0 1 0 X 15013569 14136654 13674975 10565558 4654 53395410 15013569 14136654 13674975 10565558 4654 53395410 0 0 0 53395410 15013569 14136654 13674975 10565558 4654 53395410 1.00000 1.00000 0.00000 0.00000 X 1 1 0 0 0 0 0 0 0 RONNIE MIGNELLA CARDIOLOGIST 214957 0 24667 0 0 0 0 0 4798 0 244422 0 0 0 JAMES RYAN CARDIOLOGIST 214395 0 13092 0 0 0 0 0 5360 0 232847 0 0 0 JOSE MILLAN CARDIOLOGIST 213965 0 6667 0 0 0 0 0 5790 0 226422 0 0 0 BRANDON MIKOLICH CARDIOLOGIST 147248 0 0 0 2900 0 0 0 1614 0 151762 0 0 0 BRIAN SHANNON ORTHOPEDIC SURGEON 149611 0 0 0 0 0 0 0 3806 0 153417 0 0 0 MATTHEW LIBURDI FORMER VICE PRESIDENT 0 43435 0 0 0 317678 0 0 0 4061 0 365174 0 158364 JEFFREY A CHROBAK FORMER VICE PRESIDENT/CFO 0 124950 0 0 0 771776 0 0 0 5179 0 901905 0 477991 JOHN DAVIDSON FORMER VICE PRESIDENT 0 39224 0 0 0 381633 0 0 0 4181 0 425038 0 0 JOHN JANOSO JR FORMER PRESIDENT/CEO 0 95785 0 0 0 761483 0 0 0 3882 0 861150 0 370458 LINDE FINSRUD WILSON FORMER PRESIDENT/CEO 0 104520 0 0 0 0 0 0 0 3705 0 108225 0 0 PART I, LINES 4A-B SCHEDULE J, PART I, LINE 4A SEVERANCE PAYMENTS: THE FOLLOWING OFFICERS/DIRECTORS AND FORMER OFFICER/DIRECTORS RECEIVED A SEVERANCE PAYMENT FROM CHRISTIAN H BUHL LEGACY TRUST, A RELATED ORGANIZATION, DURING CALENDAR YEAR 2014: MATTHEW LIBURDI $48,158 JEFFREY A. CHROBAK $27,200 JOHN DAVIDSON $38,726 JOHN JANOSO JR $151,404 LISA BERTOLASIO $36,250 THESE AMOUNTS WERE REPORTED IN SCHEDULE J, PART II, COLUMN B(III) SCHEDULE J, PART I, LINE 4B SUPPLEMENTAL NONQUALFIED RETIREMENT PLAN: CHRISTIAN H BUHL LEGACY TRUST, A RELATED ORGANIZATION, PROVIDES A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) TO PROVIDE A MARKET COMPETITIVE SUPPLEMENTAL RETIREMENT BENEFIT TO ATTRACT AND RETAIN EXECUTIVE TALENT. THE FOLLOWING INDIVIDUALS PARTICIPATED IN THE PLAN DURING THE FISCAL YEAR: JEFFREY CHROBAK, JOHN JANOSO JR., JOHN DAVIDSON, LISA BERTOLASIO AND MATTHEW LIBURDI. THERE WERE NO BENEFIT ACCRUALS DURING THE YEAR. COMPENSATION IS REPORTED ON THE FORM 990 IN THE YEAR THAT THE COMPENSATION IS EARNED BY OR AWARDED TO AN INDIVIDUAL, EVEN IF THE COMPENSATION IS NOT PAID TO THE INDIVIDUAL, IS NOT FULLY VESTED, OR IS SUBJECT TO SUBSTANTIAL RISK OF FORFEITURE. IF COMPENSATION IS EARNED OR AWARDED IN ONE YEAR BUT PAID IN A LATER YEAR, THEN THE COMPENSATION IS REPORTED A SECOND TIME ON FORM 990 IN THE YEAR THE COMPENSATION IS VESTED OR PAID TO THE INDIVIDUAL. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF THE ORGANIZATION IS CHRISTIAN H BUHL LEGACY TRUST, PREVIOUSLY KNOWN AS SHARON REGIONAL HEALTH SERVICES. FORM 990, PART VI, SECTION A, LINE 7B ACCORDING TO THE ORGANIZATION'S BYLAWS, THE BOARD MUST OBTAIN THE APPROVAL OF CHRISTIAN H BUHL LEGACY TRUST BEFORE ANY ACTION ON ANY OF THE FOLLOWING MATTERS BECOME FINAL AND EFFECTIVE: 1. AMENDMENT OF THE ARTICLES OF INCORPORATION OF THIS CORPORATION OR OF THE BYLAWS; 2. THE SALE, LEASE, OR EXCHANGE OF ALL OR SUBSTANTIALLY ALL THE PROPERTY OR ASSETS OF THIS CORPORATION; 3. MERGER OR CONSOLIDATION WITH ANY OTHER CORPORATION; 4. DISSOLUTION OF THE CORPORATION 5. APPROVAL OF AN ANNUAL BUDGET FOR THIS CORPORATION 6. ANY TRANSFER OF FUNDS BY GRANT, GIFT, OR LOAN FROM THIS CORPORATION; 7. ANY OTHER MATTERS THAT BY LAW WOULD REQUIRE THE APPROVAL OF MEMBERS OF A PENNSYLVANIA NONPROFIT CORPORATION. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS SUBMITTED FOR INTERNAL REVIEW BY THE CHAIRMAN AS WELL AS THE BOARD OF DIRECTORS OF THE CHRISTIAN H BUHL LEGACY TRUST PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST POLICY: THE BOARD OF DIRECTORS OF CHBLT SUBSIDIARY CO. MAINTAINS A WRITTEN POLICY DEFINING CONFLICT OF INTERESTS OF ITS DIRECTORS AND OFFICERS. ALL NEW DIRECTORS AND OFFICERS ARE ORIENTED ON THIS POLICY. ANNUALLY, THE OFFICERS AND THE MEMBERS OF THE BOARD OF DIRECTORS RECEIVE A COPY OF THE POLICIES AND EACH DIRECTOR AND OFFICER COMPLETES A CONFLICT OF INTEREST QUESTIONNAIRE. THE CHAIRMAN OF THE BOARD OF DIRECTORS REVIEWS ALL RESPONSES AND CONSULTS WITH LEGAL COUNSEL. THE CHAIRMAN CONSIDERS COMMITTEE MEMBERSHIP AND RECUSAL FROM DISCUSSION AND VOTES IN LIGHT OF POTENTIAL CONFLICTS AND BOARD MEMBERS ROUTINELY VOLUNTARILY RECUSE THEMSELVES EVEN IF THE CONFLICT IS ONLY PERCEIVED. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION'S CEO IS COMPENSATED BY CHRISTIAN H. BUHL LEGACY TRUST, A RELATED ORGANIZATION. THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS OF CHRISTIAN H. BUHL LEGACY TRUST REVIEWS AND RECOMMENDS THE COMPENSATION OF THE OFFICERS AND THE BOARD OF DIRECTORS APPROVES THESE RECOMMENDATIONS ANNUALLY. THE COMPENSATION COMMITTEE IS COMPOSED OF MEMBERS WHO HAVE NO INTEREST WITH THE OFFICERS. THE COMPENSATION COMMITTEE RETAINS AN INDEPENDENT CONSULTANT TO REVIEW MARKET DATA AND ESTABLISH COMPENSATION RANGES FOR EACH OFFICER IN COMPARISON WITH SIMILAR POSITIONS AT SIMILAR SIZED HOSPITALS AND HEALTH SYSTEMS. THE COMPENSATION COMMITTEE ANNUALLY REVIEWS THE PERFORMANCE OF THE CHIEF EXECUTIVE OFFICER AND ACCEPTS THE PERFORMANCE REVIEWS CONDUCTED BY THE CHIEF EXECUTIVE OFFICER OF OTHER OFFICERS. THE MEDICAL GROUP MANAGEMENT ASSOCIATION (MGMA) COMPARISONS ARE USED FOR BENCHMARKING THE PHYSICIANS SALARIES. FORM 990, PART VI, SECTION C, LINE 19 ALL DOCUMENTS OF THE ORGANIZATION ARE DISTRIBUTED UPON REQUEST, AS REQUIRED BY LAW. CHRISTIAN H BUHL LEGACY TRUST 7 W STATE ST SUITE 208 SHARON PA 16146 250979377 HEALTHCARE PA 501(C)(3) LINE 3 N/A 0 SHARON REGIONAL HEALTH FOUNDATION 7 W STATE ST SUITE 208 SHARON PA 16146 455247666 SUPPORT PA 501(C)(3) LINE 7 CHBLT 0 CHATWOOD COMMONS CONDOMINIUM ASSOCIATION 7 WEST STATE ST SUITE 208 SHARON PA 16146 251678608 REAL ESTATE PA N/A 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 CHRISTIAN H BUHL LEGACY TRUST D 1513418 FAIR MARKET VALUE