2015-05-14T14:26:30-05:00 2014-06-30 390859910 BAKER TILLY VIRCHOW KRAUSE LLP 1650 MARKET STREET SUITE 4500 PHILADELPHIA PA 19103 990 2013-07-01 250965404 INDIANA REGIONAL MEDICAL CENTER INDI 7243577008 835 HOSPITAL ROAD INDIANA PA 15701 ROBERT GONGAWARE SENIOR VP FINANCE 7243577008 2015-05-13 1 JULIUS C GREEN CPA JD P00350393 2159720701 2013 2016-02-25 16:41:14Z STEPHEN WOLFE 835 HOSPITAL ROAD INDIANA PA 15701 200440496 0 X WWW.INDIANARMC.ORG X 1944 PA TO SERVE THE HEALTHCARE NEEDS OF EVERY LIFE WE TOUCH WITH COMPASSION, RESPECT, AND DIGNITY. 12 11 1556 150 0 169626 336950 657238 131597843 139354508 4953966 7482940 10138269 3658744 147027028 151153430 0 3976472 0 0 72766060 76246357 0 0 0 64309185 68794657 137075245 149017486 9951783 2135944 197378362 246491050 70789651 102960106 126588711 143530944 X THE MISSION OF INDIANA REGIONAL MEDICAL CENTER IS TO SERVE THE HEALTHCARE NEEDS OF EVERY LIFE WE TOUCH WITH COMPASSION, RESPECT, AND DIGNITY. 0 0 121991928 3976472 139354508 HEALTH DIAGNOSTIC, INTERVENTION & TREATMENT SERVICE:INDIANA REGIONAL MEDICAL CENTER ("IRMC") IS A NON-PROFIT, COMMUNITY BASED HEALTH SYSTEM THAT OFFERS A WIDE RANGE OF SERVICES INCLUDING DIAGNOSTICS, MEDICINE, SURGERY, PEDIATRICS, OBSTETRICS, GERIATRIC BEHAVIORAL HEALTHCARE AND REHABILITATIVE NURSING. IRMC DEMONSTRATES AN ONGOING COMMITMENT TO THE COMMUNITY BY CONTINUALLY REVIEWING AND IMPROVING ITS SERVICES TO ENSURE THAT THE COMMUNITY RECEIVES TOP-QUALITY, EFFICIENT, ACCESSIBLE, COST-EFFECTIVE HEALTHCARE AND QUALITY OUTREACH AND HEALTH PROMOTION SERVICES. IRMC CONTINUES TO PROVIDE MOBILE HEALTH SERVICES TO RURAL AREAS OF THE COUNTY. IN ADDITION TO PRIMARY CARE PHYSICIANS, IRMC WAS SUCCESSFUL IN RECRUITING TWO PAIN MANAGEMENT PHYSICIANS, EMERGENCY DEPARTMENT PHYSICIANS AND A CLINICAL PSYCHOLOGIST.MASS HEALTH SCREENING: IRMC'S MOBILE MEDICAL SERVICES CONTINUES TO PROVIDE FREE BLOOD PRESSURE SCREENINGS IN 19 LOCATIONS IN INDIANA COUNTY. WE ALSO CONTINUE TO PARTICIPATE IN NUMEROUS FREE COMMUNITY EVENTS PROVIDING EDUCATION, SCREENINGS PROGRAMS AND FIRST AID SERVICES.HEALTH FAIRS:THE PROVISION OF HEALTH SERVICES AND INFORMATION THROUGH HEALTH FAIRS, CLASSES AND PROGRAMS - THE INSTITUTE FOR HEALTHY LIVING AT IRMC OFFERS HEALTH SERVICES AND EDUCATION PROGRAMS TO THE COMMUNITY AT NO CHARGE.HEALTH CARE DELIVERY & MANAGEMENT:THE COMMUNITY HEALTH ADVISORY COUNCIL OF INDIANA COUNTY, WHICH WAS FORMED IN 1996, SERVES AS A STATE HEALTH IMPROVEMENT PARTNERSHIP. THE GOAL OF THE COUNCIL IS TO IDENTIFY OR DEVELOP RESOURCES TO ADDRESS TOP HEALTH PRIORITIES IN THE COUNTY. THE COUNCIL CONTINUES TO PROMOTE AN ANNUAL INFLUENZA CAMPAIGN. THE COUNCIL IMPLEMENTED A COUNTY PRESCRIPTION ASSISTANCE PROGRAM TO ASSIST RESIDENTS WITH ACCESSING PHARMACEUTICALS FREE OR AT A REDUCED COST BASED ON INCOME.HEALTH CARE PROGRAMS, GENERAL/OTHER: THE CENTER FOR DIABETES CARE CONTINUES TO OFFER FREE EDUCATION SERVICES AT VARIOUS LOCATIONS THROUGHOUT THE COUNTY. IN ADDITION, THEY CONTINUE TO BE THE PRIMARY SPONSOR OF THE COUNTY'S DIABETES WALK. EACH MONTH STAFF AND MANAGEMENT AT IRMC PROVIDE SUPPORT TO A LOCAL FOOD BANK. FOR THE THIRD YEAR, IRMC WAS NAMED ONE OF THE BEST PLACES TO WORK IN PA. PREVENTIVE HEALTH SERVICES, GENERAL/OTHER: M. DORCAS CLARK WOMEN'S IMAGING CENTER: THE WOMEN'S IMAGING CENTER AND THEIR STAFF HAVE PARTICIPATED IN NUMEROUS COMMUNITY EVENTS PROVIDING INFORMATION ABOUT THE IMPORTANCE OF BREAST HEALTH. BIRDIE'S CLOSET, A PROJECT DESIGNED TO HELP WOMEN COPE WITH APPEARANCE-RELATED SIDE-EFFECTS OF CANCER TREATMENT, WAS OPENED IN THE WOMEN'S IMAGING CENTER. 121991928 1 1 0 1 0 0 0 0 0 1 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 229 0 1 1556 1 1 1 0 0 0 0 0 0 0 0 0 X 12 11 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 PA X ROBERT GONGAWARE SVP FINANCE 7243577008 835 HOSPITAL ROAD INDIANA PA 15701 TODD BRICE CHAIRMAN 1.00 2.00 X X 0 0 0 BEVERLY GAZZA ESQ VICE CHAIRMAN 1.00 2.00 X X 0 0 0 ANNE WHITE SECRETARY 1.00 1.00 X X 0 0 0 JOSEPH GEARY TREASURER 1.00 1.00 X X 0 0 0 STEPHEN A WOLFE PRESIDENT & CEO 35.00 5.00 X X 447762 0 80756 MARK BOYKIW MD BOARD MEMBER 1.00 1.00 X 0 0 0 RUSSELL DROZDIAK MD BOARD MEMBER 1.00 1.00 X 0 0 0 NATHAN KOVALCHICK BOARD MEMBER 1.00 1.00 X 0 0 0 MARK R MCGOWAN PHD BOARD MEMBER 1.00 1.00 X 0 0 0 T MICHAEL PRICE BOARD MEMBER 1.00 X 0 0 0 GREG SIPOS BOARD MEMBER 1.00 X 0 0 0 DAVID BIZOUSKY MD BOARD MEMBER 1.00 X 0 0 0 ROBERT A GONGAWARE SR VP FINANCE 38.00 2.00 X X 230870 0 8037 BRUCE A BUSH MD SR VP MEDICAL DIRECTOR 37.00 3.00 X 308868 0 27922 DOMINIC PACCAPANICCIA CHIEF OPERATING OFFICER 39.00 1.00 X 256136 0 44288 CINDY VIRGIL SR VP PATIENT SERVICES 39.00 1.00 X 189614 0 25330 WADE PATRICK SR VP INFORMATION SERVICES 40.00 X 192869 0 18377 LARRY SEDLEMEYER SR VP BUS. DEVELOPMENT 40.00 X 166003 0 19207 ANTHONY L SICO PHYSICIAN 40.00 X 413953 0 19315 MICHAEL F STALTERI PHYSICIAN 40.00 X 382393 0 18454 JOHN P CAWLEY PHYSICIAN 40.00 X 373374 0 7438 DONNA L BALEWICK PHYSICIAN 40.00 X 365796 0 7934 GEOFFREY PAZDER PHYSICIAN 40.00 X 363965 0 417 3691603 0 277475 77 1 1 0 MAYO COLLABORATIVE SERVICES INC PO BOX 1450 MINNEAPOLIS MN 55485 OUTSIDE LAB SERVICES 813068 REHABCARE GROUP INC PO BOX 502096 ST LOUIS MO 63150 REHAB CARE SERVICES 480513 SCRIBEAMERICA LLC PO BOX 417756 BOSTON MA 022417756 EMERGENCY ROOM DICTATION 328906 JENNIFER CUNNINGHAM SPEECH SERVICES 545 CUNNINGHAM RD INDIANA PA 15701 SPEECH THERAPY SERVICES 309824 MATT KLAIN MD 25 COLONY BLVD BLAIRSVILLE PA 15717 PHYSICIAN SERVICES 300555 12 361393 295845 657238 NET PATIENT SVC REV 621990 138704842 138704842 RENTAL REVENUE-AFFILIATES 531120 274932 274932 LIFELINE REVENUE 900099 182251 182251 HEALTH CLASSES/COUNSEL 624100 139300 139300 HOSPICE PRESCRIPTIONS 621990 53183 53183 139354508 3176680 3176680 1806193 1340870 465323 465323 465323 52188811 63645 47946196 0 4242615 63645 4306260 4306260 LEASED EMPLOYEES 900099 1429017 1429017 CAFETERIA REV 722210 855108 855108 MEANINGFUL USE REVENUE 900099 364753 364753 544543 544543 3193421 151153430 139354508 0 11141684 X 3976472 3976472 2039487 1075104 964383 53335077 43125747 10209330 4709794 3822513 887281 11985233 9589068 2396165 4176766 3339070 837696 371014 371014 104840 104840 240000 240000 16319538 13132395 3187143 812217 31581 780636 3466300 3399082 67218 2648701 954463 1694238 1781602 1308808 472794 299075 165673 133402 65817 65817 789244 789244 7765986 6750121 1015865 1688751 1350054 338697 MEDICAL SUPPLIES 17711476 17368019 343457 BAD DEBT EXPENSE 8634459 8634459 MAINTENANCE & REPAIRS 2629323 2101983 527340 FOOD 1050305 839655 210650 2416009 961844 1454165 149017486 121991928 27025558 0 6185 6405 145769 3123545 13323808 14761625 2995705 2995408 1837336 1946696 4803539 4400672 148436901 85662378 53847783 62774523 101540358 133479989 13318241 15816730 446935 952508 5112703 6232949 197378362 246491050 13297886 11640890 20679950 54788959 3798343 3230195 33013472 33300062 70789651 102960106 X 123617014 137475232 2971697 6055712 126588711 143530944 197378362 246491050 X 2135944 7735681 226766 6843842 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 8831 8831 0 PART II-B, LINE 1: THE MEDICAL CENTER IS A MEMBER OF NATIONAL AND STATE HOSPITAL AND HEALTHCARE ASSOCIATIONS THAT PERFORM LOBBYING ACTIVITIES. A PORTION OF THE DUES PAID TO THESE ORGANIZATIONS IS LISTED AS LOBBYING EXPENDITURES. 2973000 3099000 15000 6057000 3188000 337000 552000 2973000 3070000 363000 245000 3188000 3253000 872000 1055000 3070000 2376000 1812000 935000 3253000 1.00000 0 0 227375 3004591 3231966 58210332 30017503 28192829 86880727 55644875 31235852 113876 113876 62774523 15816730 C 15816730 POST-RETIREMENT LIABILITY 742454 PENSION LIABILITY 22264836 ESTIMATED THIRD PARTY PAYOR SETTLEMENTS 1164999 DUE TO AFFILIATES 2213077 ESTIMATED MEDICAL MALPRACTICE CLAIMS LIABILITY 3203508 DEFERRED COMPENSATION LIABILITY 907263 CONSTRUCTION PAYABLE 2803925 33300062 X 153210273 7735681 -7019708 715973 152494300 -1340870 -1340870 151153430 136494806 1340870 1340870 135153936 240000 13623550 13863550 149017486 PART V, LINE 4: ENDOWMENT FUNDS ARE USED PRIMARILY TO PURCHASE CAPITAL EQUIPMENT. PART X, LINE 2: THE HOSPITAL 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 2014 AND 2013. THE HOSPITAL'S POLICY IS TO RECOGNIZE INTEREST RELATED TO UNRECOGNIZED TAX BENEFITS IN INTEREST EXPENSE AND PENALTIES IN OPERATING EXPENSES. THE HOSPITAL'S FEDERAL AND STATE INCOME TAX RETURNS ARE NO LONGER SUBJECT TO EXAMINATION BY FEDERAL OR STATE TAXING AUTHORITIES FOR FISCAL YEARS BEFORE 2010. PART XI, LINE 2D - OTHER ADJUSTMENTS: PENSION AND POST RETIREMENT LIABILITIES ADJUSTMENT 4,040,987. BAD DEBTS NETTED ON FINANCIAL STATEMENTS -8,634,459. CHANGE IN INTEREST IN INDIANA HEALTHCARE FOUNDATION 2,802,855. INVESTMENT MANAGEMENT FEES -240,000. TRANSFERS TO AFFILIATES -3,976,472. LOSS ON REFINANCING -1,012,619. PART XI, LINE 4B - OTHER ADJUSTMENTS: RENTAL EXPENSES -1,340,870. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 1,340,870. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBTS NETTED ON FINANCIAL STATEMENTS 8,634,459. TRANSFERS TO AFFILIATES 3,976,472. LOSS ON REFINANCING 1,012,619. 1 1 X 1 X 1 X 1 1 1 0 1 1 2608 1843106 1843106 0.01310 28097 13289217 7135597 6153620 0.04380 30705 15132323 7135597 7996726 0.05690 7888 2174150 235385 1938765 0.01380 42097 11122996 6508291 4614705 0.03290 49985 13297146 6743676 6553470 0.04670 80690 28429469 13879273 14550196 0.10360 2660 342700 40600 302100 0.00220 2660 342700 40600 302100 0.00220 1 3108240 777060 25177701 25503165 -325464 X 1 1 1 COSM REALTY GROUP LTD REAL ESTATE 0.40000 0.00000 0.30000 2 INDIANA AMBULATORY SURGICAL ASSOCIATES LLC AMBULATORY SURGERY 0.70000 0.00000 0.30000 3 INDIANA TOTAL THERAPY LLC THERAPY SERVICES 0.50000 0.00000 0.50000 1 1 INDIANA REGIONAL MEDICAL CENTER 835 HOSPITAL ROAD INDIANA PA 15701 090701 X X X URGENT CARE FACILITY INDIANA REGIONAL MEDICAL CENTER 1 1 X X X X X X X X X 11 1 0 1 X HTTP://WWW.INDIANARMC.ORG/ABOUT-HEALTHY-C X X X X X X X X X X 0 0 1 1 100.000000000000 1 400.000000000000 1 X X X X X X X 1 1 X X X X X 1 0 X X X X 1 X 0 1 INDIANA REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 3: THE HEALTH PRIORITIES FOR THE RESIDENTS OF INDIANA COUNTY WERE IDENTIFIED BY 4 SOURCES. THE FIRST SOURCE USED WAS THE 2011 COUNTY HEALTH RANKINGS REPORT PUBLISHED BY THE ROBERT WOOD JOHNSON FOUNDATION AND THE UNIVERSITY OF WISCONSIN POPULATION HEALTH INSTITUTE. FACTORS SUCH AS COUNTY HEALTH OUTCOMES, HEALTH BEHAVIORS AND FACTORS, CLINICAL CARE, SOCIAL AND ECONOMIC FACTORS AND PHYSICAL ENVIRONMENT RESULTS FOR INDIANA COUNTY WERE COMPARED WITH RESULTS FOR THE STATE OF PENNSYLVANIA.THE PENNSYLVANIA DEPARTMENT OF HEALTH COUNTY HEALTH PROFILE 2010 PROVIDED DATA ON DEMOGRAPHICS, POPULATION, NATALITY AND REPORTED PREGNANCIES, MORBIDITY, CANCER INCIDENCE, MORTALITY AND DRUG AND ALCOHOL TREATMENT. THIS INFORMATION WAS ALSO COMPARED TO DATA FOR THE STATE TO DETERMINE AREAS WHERE INDIANA COUNTY UNFAVORABLY COMPARED.IN ADDITION, INDIANA REGIONAL MEDICAL CENTER PROVIDED PARTIAL FUNDING FOR AN OVERSAMPLING OF THE COUNTY ADULT RESIDENTS USING THE CENTER FOR DISEASE CONTROL AND PREVENTION'S BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (BRFSS). THE DATA WAS GATHERED THROUGH PHONE INTERVIEWS THAT WERE CONDUCTED OVER AN ENTIRE YEAR. THE SURVEY ASKED QUESTIONS ABOUT HEALTH AND HEALTH-RELATED BEHAVIORS INCLUDING GENERAL HEALTH, HEALTHCARE ACCESS, EXERCISE, TOBACCO USE, ASTHMA, DIABETES AND IMMUNIZATION. THE USE OF THIS SURVEY ALLOWS FOR COMPARISON WITH THE STATE AND NATIONAL RESULTS. FORTY ADDITIONAL QUESTIONS WERE ADDED TO THE CORE SURVEY. QUESTIONS ADDED WERE CHOSEN BY INPUT FROM MEMBERS OF THE IRMC SENIOR TEAM AND THE INDIANA COUNTY COMMUNITY HEALTH ADVISORY COUNCIL (CHAC). LOCALLY ADDED QUESTIONS ADDRESSED HEALTHY DAYS (SYMPTOMS), CARDIOVASCULAR HEALTH, ACTIONS TO CONTROL HIGH BLOOD PRESSURE, WOMEN'S HEALTH, COLORECTAL CANCER SCREENING, CANCER SURVIVORSHIP, ADULT ASTHMA HISTORY, ARTHRITIS MANAGEMENT, GENERAL PREPAREDNESS, CHILDHOOD ASTHMA PREVALENCE AND FALLS. THE RESULTS FROM THESE QUESTIONS WILL SERVE AS A BASELINE FOR FUTURE SURVEYS. THE COST OF THIS SURVEY WAS SHARED BY IRMC AND THE PENNSYLVANIA DEPARTMENT OF HEALTH.THE FOURTH SOURCE WAS PUBLIC INPUT. THIS WAS GATHERED BY PROVIDING THE COMMUNITY MEMBERS WITH THE OPPORTUNITY TO SUBMIT WRITTEN HEALTH CONCERNS OR HEALTH NEEDS TO THE HOSPITAL. AN AD WAS PLACED REQUESTING INPUT IN TWO LOCAL NEWSPAPERS, INDIANA GAZETTE AND THE BLAIRSVILLE DISPATCH FOR 2 WEEKS. INDIANA REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 5D: MADE AVAILABLE THROUGH A COMMUNITY MAILING INDIANA REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 7: EACH YEAR THE TOP 7 PRIORITIES ARE IDENTIFIED AND ADDRESSED.IRMC'S CHNA LOOKED AT 19 DIFFERENT ISSUES OF COMMUNITY HEALTH. ALL 19 WERE RANKED ACCORDING TO PRIORITY NEED--HIGH, MODERATE AND LOW. THE ASSIGNMENT OF EACH HEALTH CONCERN TO ONE OF THESE PRIORITY STATES WAS BASED UPON FOUR ESSENTIAL CRITERIA:1. PRIORITY VARIES SIGNIFICANTLY FROM STATE, NATIONAL AND HEALTHY PEOPLE 2020 GOALS2. RESOURCES ARE AVAILABLE WITHIN THE MEDICAL CENTER OR COMMUNITY TO ADDRESS THE PRIORITY3. ACTIONS OR INTERVENTIONS WOULD LIKELY SUCCEED IN IMPROVEMENT4. ACTIONS OR INTERVENTIONS WOULD BE ALIGNED WITH THE MISSION OF THE MEDICAL CENTERTHE DESIGNATIONS OF INDIVIDUAL RANKING, AS WELL THE DECISION TO ADDRESS ONLY THE "HIGH PRIORITY" ISSUES OVER THE NEXT THREE YEARS, REPRESENTED THE COLLECTIVE INPUT FROM 1) THE INDIANA COUNTY COMMUNITY HEALTH ADVISORY COUNCIL (CHAC), A MULTI-STAKEHOLDER GROUP COMPRISED OF REPRESENTATIVES FROM VARIOUS COMMUNITY AGENCIES, ORGANIZATIONS AND SCHOOLS. THE CHAC HAS BEEN ACTIVE SINCE 1996. 2) THE IRMC MEDICAL STAFF ALSO PROVIDED INPUT ON THE PRIORITIES. 3) THE SENIOR ADMINISTRATIVE TEAM AT IRMC. THE RESULT OF THIS INPUT JUDICIOUSLY ALLOCATED LIMITED RESOURCES TO THE GREATEST NEEDS.SOME OF THE LOW PRIORITY NEEDS WHICH WERE NOT ADDRESSED ARE LACK OF HEALTH INSURANCE; FOOD AND WATER BORNE ILLNESS; ACCESS TO HEALTHY FOODS AND RECREATIONAL FACILITIES; MENTAL HEALTH AND DEATHS DUE TO MOTOR VEHICLE CRASHES. THESE NEEDS WERE NOT ADDRESSED AS IRMC WAS FOCUSED ON HIGHER PRIORITY NEEDS. INDIANA REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 14G: A MESSAGE IS PROVIDED ON INVOICES THAT THE FINANCIAL ASSISTANCE POLICY IS AVAILABLE. INDIANA REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 20D: THE MEDICAL CENTER WILL APPLY GROSS CHARGES ALSO KNOWN AS THE TOTAL CHARGES AT THE ORGANIZATION'S FULL ESTABLISHED RATES FOR THE PROVISION OF THE PATIENT CARE SERVICES BEFORE DEDUCTIONS FROM REVENUE ARE APPLIED. INDIANA REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 22: ALL INDIVIDUALS, WHETHER APPLYING FOR CHARITY CARE OR NOT, WILL BE CHARGED THE HOSPITAL'S FULL ESTABLISHED OR GROSS RATES BEFORE ANY DEDUCTIONS FROM REVENUE ARE APPLIED. PART I, LINE 7: THE HOSPITAL USED A COST-TO-CHARGE RATIO IN DETERMINING THE FIGURES REPORTED IN THIS TABLE. THIS COST-TO-CHARGE RATIO WAS DERIVED FROM WORKSHEET 2 RATIO OF PATIENT CARE COST TO CHARGES. PART I, LINE 7G: NO COSTS ATTRIBUTABLE TO A PHYSICIAN CLINIC WERE INCLUDED IN THE AMOUNT ON PART I, LINE 7G. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 8,634,459. PART II, COMMUNITY BUILDING ACTIVITIES: OUR MISSION IS TO SERVE THE HEALTHCARE NEEDS OF EVERY LIFE WE TOUCH WITH COMPASSION, RESPECT AND DIGNITY. ALL OF THE PROGRAMS OFFERED MEET COMMUNITY BENEFIT OBJECTIVES AND ARE RELATED TO OUR MISSION. IRMC OFFERS PROGRAMS THAT IMPROVE ACCESS TO HEALTH CARE SERVICES, ENHANCES HEALTH OF THE COMMUNITY WE SERVE, PROVIDES ADVANCED MEDICAL OR HEALTHCARE KNOWLEDGE AND RELIEVES SOME OF THE FINANCIAL OR PROGRAMMATIC BURDEN OF GOVERNMENT OR OUR COMMUNITY. INDIANA REGIONAL MEDICAL CENTER PROVIDES NUMEROUS COMMUNITY PROGRAMS AND ACTIVITIES THAT PROVIDE TREATMENT OR PROMOTE HEALTH AND HEALING TO OUR COMMUNITIES. OUR MOBILE MEDICAL SERVICES CONTINUES TO PROVIDE FREE BLOOD PRESSURE SCREENINGS IN 19 LOCATIONS IN INDIANA COUNTY. WE ALSO CONTINUE TO PARTICIPATE IN NUMEROUS FREE COMMUNITY EVENTS PROVIDING EDUCATION, SCREENING PROGRAMS AND FIRST AID SERVICES. OVER THE PAST YEAR, THE MOBILE MEDICAL HEALTH LOGGED OVER 2,500 PARTICIPANTS. WE ALSO PROVIDE NUMEROUS HEALTH FAIRS REACHING ALMOST 2,200 PARTICIPANTS, AND CLASSES AND EDUCATION PROGRAMS WITH OVER 4,000 PARTICIPANTS. A FEW OF THE FAIRS OR SERVICES PROVIDED ARE: ARTHRITIS, KNEE PAIN AND OSTEOPOROSIS SESSIONS PUT ON BY THE ORTHOPEDIC PHYSICIANS AND THE IRMC SUPPORT CLINICIANS, "BIKE TO SCHOOL" (SAFETY FOR CHILDREN), CHESTNUT RIDGE HEALTH FAIR, DIABETES, EXERCISE FOR SENIOR CENTERS, FIRST COMMONWEALTH BANK WEIGHT MANAGEMENT, FORTIFY YOUR SPINE, HEALTHY KIDS DAY, ROUTINE MULTIPHASIC BLOOD DRAWS FOR RURAL AREAS AND COMMUNITY MEMBERS THAT MAY NOT SEEK OUT HEALTH CARE, SERVICES PROVIDED TO NEW FLORENCE SENIOR CENTER AND NORTH CAMBRIA SENIOR CENTER (RURAL FACILITIES IN OUR SECONDARY MARKET AREA AND NO HOSPITAL CLOSE TO THEM), PROSTATE SCREENINGS, VACCINES FOR VETS (VETERANS), SKIN SCREENINGS, AS WELL AS A NUMBER OF OTHERS. THE INSTITUTE FOR HEALTHY LIVING AT INDIANA REGIONAL MEDICAL CENTER OFFERS HEALTH SERVICES AND EDUCATION PROGRAMS TO THE COMMUNITY AT NO CHARGE.THE CENTER FOR DIABETES CARE CONTINUES TO OFFER FREE EDUCATION SERVICES AT VARIOUS LOCATIONS THROUGHOUT THE COUNTY. IN ADDITION, THEY CONTINUE TO BE THE PRIMARY SPONSOR OF THE COUNTY'S DIABETES WALK. EACH MONTH STAFF AND MANAGEMENT AT IRMC PROVIDE SUPPORT TO A LOCAL FOOD BANK. PREVENTIVE HEALTH SERVICES - M. DORCAS CLARK WOMEN'S IMAGING CENTER AND THEIR STAFF HAVE PARTICIPATED IN NUMEROUS COMMUNITY EVENTS PROVIDING INFORMATION ABOUT THE IMPORTANCE OF BREAST HEALTH. BIRDIE'S CLOSET, A PROJECT DESIGNED TO HELP WOMEN COPE WITH APPEARANCE RELATED SIDE-EFFECTS OF CANCER TREATMENT WAS OPENED IN THE WOMEN'S IMAGING CENTER. SUPPORT HEALTH GROUPSFAMILY PROGRAMS - EARLY PREGNANCY, MATERNITY TOUR, DOCTOR DAD, BOF SERIES, BREASTFEEDING, ALL ABOUT BABY, LAMAZE, HOME ALONE, BABYSITTING, LET'S TALK GIRLS, BIG BROTHER, CPR, HEARTSAVER. 1,164 CONTACTS FOR THE YEAR.COMMUNITY CLASSES - PACE, TAI CHI, YOGA, CANCER, STRONG WOMEN, DROP WEIGHT, ORNISH, DIABETES, DROP 10. 3,580 CLASS HOURS.IN 2009, INDIANA REGIONAL MEDICAL CENTER OPENED A NEW FACILITY OFFERING URGENT CARE SERVICES IN THE BLAIRSVILLE COMMUNITY AS A RESPONSE TO MEDICAL SERVICES NEEDED IN THAT AREA. THIS FACILITY IS 12 MILES FROM THE HOSPITAL CAMPUS.IN 2012, INDIANA REGIONAL MEDICAL CENTER OPENED ITS SECOND URGENT CARE FACILITY TO SERVICE THE PRIMARY MARKET SHARE WHERE THERE WAS A NOTED DEMAND FOR THESE SERVICES. THE URGENT CARE CENTERS REQUIRE ADDITIONAL STAFFING ON BEHALF OF THE HOSPITAL AS IT IS A NEW/ADDED LOCATION; HOWEVER, THESE FACILITIES SIGNIFICANTLY IMPROVE THE CYCLE TIME OF THE PATIENT THROUGHOUT AND SERVICES FOR THE NON-EMERGENT SERVICES NEEDED. PART III, LINE 2: THE AMOUNT REPORTED IN PART III, LINE 2 IS DERIVED BY USING THE MEDICARE COST TO CHARGE RATIO FROM THE COST REPORT.FOR ACCOUNTS WITH INSURANCE, THE CONTRACTUAL ADJUSTMENTS ARE APPLIED TO THE TOTAL ACCOUNT TO DERIVE THE EXPECTED PAYMENT. THE BAD DEBT IS TYPICALLY A PORTION OF THE CO-PAYS OR DEDUCTIBLES. ON ACCOUNTS WITH NO INSURANCE, ALL FINANCIAL ASSISTANCE ADJUSTMENTS/CHARITY CARE ADJUSTMENTS/PROMPT PAYMENT DISCOUNTS/ETC. ARE APPLIED AND THE REMAINING BALANCE IS CAPTURED AS BAD DEBT EXPENSE. PART III, LINE 3: THE AMOUNT REPORTED IN PART III, LINE 3 IS DERIVED BY USING THE MEDICARE COST TO CHARGE RATIO FROM THE COST REPORT.A PORTION OF THE BAD DEBT SHOULD BE INCLUDED AS COMMUNITY BENEFIT AS THE HOSPITAL IS NOT ABLE TO DENY SERVICES TO ANY PATIENT PRESENTING TO THE EMERGENCY DEPARTMENT, REGARDLESS IF THE PATIENTS HAVE THE MEANS TO PAY. THE DEDUCTIBLE AND CO-INSURANCE BALANCES THAT ARE NOT PAID REDUCE THE NET REVENUES DUE TO THE HOSPITAL AS PART OF THE RESPECTIVE PATIENT'S INSURANCE COVERAGE. IN ADDITION, THERE IS A "COST" TO THE HOSPITAL FOR TREATING ALL PATIENTS. AS WITH THE UNREIMBURSED AMOUNTS OF THE MEDICAID PATIENT SERVICES, THE HOSPITAL SHOULD BE ABLE TO INCLUDE THE UNREIMBURSED COSTS OF THE SERVICES THAT RESULTED IN NO PAYMENT. PART III, LINE 4: THE FOLLOWING IS THE TEXT OF THE FOOTNOTE FROM THE AUDITED FINANCIAL STATEMENTS THAT DESCRIBES BAD DEBT EXPENSE: "ACCOUNTS RECEIVABLE, PATIENTS, ARE REPORTED AT NET REALIZABLE VALUE. ACCOUNTS ARE WRITTEN OFF WHEN THEY ARE DETERMINED TO BE UNCOLLECTIBLE BASED UPON MANAGEMENT'S ASSESSMENT OF INDIVIDUAL ACCOUNTS. THE ALLOWANCE FOR DOUBTFUL COLLECTIONS IS ESTIMATED BASED ON A PERIODIC REVIEW OF THE ACCOUNTS RECEIVABLE AGING, PAYOR CLASSIFICATIONS, AND APPLICATION OF HISTORICAL WRITE-OFF PERCENTAGES." PART III, LINE 8: THE MEDICARE COST REPORT WAS USED TO DETERMINE THE AMOUNT REPORTED ON LINE 6. ANY SHORTFALL REPORTED IN LINE 7 SHOULD BE TREATED AS COMMUNITY BENEFIT AS THE HOSPITAL IS PROVIDING MEDICAL CARE TO THESE PATIENTS, REGARDLESS OF THEIR ABILITY TO PAY. PART III, LINE 9B: PATIENTS ARE EXPECTED TO PAY ALL BALANCES IN FULL WITHIN FIFTEEN DAYS OF A FINAL BILLING. IF THIS IS NOT POSSIBLE, PATIENTS WILL BE COUNSELED ON THE USE OF MEDICAL ASSISTANCE OR THE INDIANA CHARITY CARE PROGRAM, I-CARE.ON A MONTHLY BASIS, THE CREDIT SUPERVISOR WILL COMPILE A REPORT LISTING ALL ACCOUNTS, WHICH HAVE BEEN BILLED TO MEDICARE, AND ANY SECONDARY INSURANCE CARRIER WHERE APPLICABLE. A LISTING OF ACCOUNTS WHICH HAVE BEEN BILLED TO MEDICAL ASSISTANCE AS A SECONDARY PAYOR ARE REVIEWED BY THE CREDIT SUPERVISOR FOR AN AUTOMATIC WRITE OFF AFTER MEDICAL ASSISTANCE HAS PROCESSED THE ACCOUNT. ACCOUNTS WHICH HAVE BALANCES AFTER MEDICARE AND ALL SECONDARY PAYORS HAVE BEEN BILLED WILL BE PLACED WITH AN OUTSIDE COLLECTION AGENCY AFTER TWO UNANSWERED STATEMENTS. AN EXCEPTION WILL BE MADE IN THE EVENT A PATIENT/GUARANTOR DOES NOT FOLLOW THROUGH WITH THE MEDICAL ASSISTANCE APPLICATION PROCESS, WHEN REQUESTED TO DO SO. THE AGENCY WILL ATTEMPT TO COLLECT THE ACCOUNT FOR SIX MONTHS. AFTER THAT TIME THE ACCOUNT WILL BE WRITTEN OFF AS MEDICARE BAD DEBT.THE IRMC COLLECTION POLICY CONTAINS PROVISIONS TO PROVIDE A SOFTER APPROACH FOR THOSE THAT IRMC HAS LEARNED WOULD QUALIFY FOR FINANCIAL ASSISTANCE. UPON RECEIPT OF THE CALL FROM THE PATIENT THAT THERE IS HARDSHIP IN PAYING THE BILL, THE IRMC COLLECTION REPRESENTATIVE SHARES THE INFORMATION FOR APPLICATION FOR BOTH MEDICAL ASSISTANCE AND CHARITY CARE. WHILE THE PATIENT'S ACCOUNT IS IN THIS PROCESS, THEIR ACCOUNT WILL NOT BE PROVIDED TO THE COLLECTION AGENCY. PART VI, LINE 2: DURING THE PAST YEAR, IRMC HAS BEEN REVIEWING INFORMATION AND DATA ABOUT THE HEALTH OF OUR COUNTY. INFORMATION WAS COLLECTED FROM THE BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM SURVEY, COUNTY HEALTH PROFILE, COUNTY HEALTH RANKINGS, COMMUNITY MEMBERS, MEDICAL STAFF AND HOSPITAL LEADERSHIP. OVERALL, THE HEALTH OF INDIANA COUNTY RESIDENTS IS BETTER OR EQUAL TO THOSE IN THE SURROUNDING COUNTIES. HOWEVER, SEVERAL AREAS WERE IDENTIFIED AS AREAS FOR IMPROVEMENT.OUR REPORT OUTLINES THE 19 COMMUNITY NEEDS ORIGINALLY IDENTIFIED THROUGH THE SURVEY AND DATA SOURCES. THE TOP SEVEN PRIORITIES THAT IRMC WILL BE FOCUSING ON IN THE NEXT THREE YEARS ARE: EARLY PRENATAL CARECHOLESTEROL TESTINGINFLUENZA/PNEUMONIA DEATHSNUMBER OF PRIMARY CARE PHYSICIANSOVERWEIGHT/OBESITY RATESDRUG ABUSEPREVENTABLE HOSPITALIZATIONS PART VI, LINE 3: IRMC WILL POST, AT ALL POINTS OF REGISTRATION, A NOTICE OF THE CHARITY CARE POLICY. THE MEDICAL CENTER WILL ALSO PROVIDE NOTICE OF THE CHARITY CARE POLICY IN PATIENTS' BILLS AND TO LOCAL SOCIAL SERVICE AGENCIES. THE MEDICAL CENTER ALSO PROVIDES THIS INFORMATION ON THE INDIANA REGIONAL MEDICAL CENTER'S INTERNET HOME PAGE. AT THE EARLIEST FEASIBLE TIME, THE MEDICAL CENTER PERSONNEL WILL ATTEMPT TO DETERMINE PATIENT ELIGIBILITY FOR COVERAGE OF PART OR ALL OF THEIR PATIENT BILL.ALL PRE-REGISTRATION, REGISTRATION, BUSINESS OFFICE, AND PATIENT FINANCIAL SERVICES STAFF RECEIVE TRAINING AS TO THE CHARITY CARE POLICY AND ARE TO BE FAMILIAR WITH THE AVAILABILITY OF CHARITABLE ASSISTANCE AND THE CRITERIA FOR SUCH ASSISTANCE. PART VI, LINE 4: SINCE OPENING ITS DOORS IN 1914, INDIANA REGIONAL MEDICAL CENTER (IRMC) HAS MAINTAINED A GOAL OF SERVING THE COMMUNITY WITH QUALITY, PROGRESSIVE, COMPASSIONATE PATIENT CARE. AS THE COUNTY'S SOLE, FULL-SERVICE HEALTHCARE PROVIDER, IRMC HAS CONTINUALLY RISEN TO THE CHALLENGE OF MEETING THE NEEDS OF ITS COMMUNITY. IRMC RESIDES IN INDIANA, PENNSYLVANIA IN THE HEART OF THE COUNTY. THE HOSPITAL SITS ON A 75-ACRE CAMPUS AND ADMITS OVER 7,700 PATIENTS, DELIVERS MORE THAN 600 BABIES, AND ACCOMMODATES ANOTHER QUARTER-MILLION OUTPATIENT ENCOUNTERS EACH YEAR. AS AN ACUTE CARE FACILITY, IRMC IS LICENSED FOR 164 BEDS AND PROVIDES A BROAD RANGE OF MEDICAL AND EDUCATIONAL SERVICES AT ITS MAIN CAMPUS AND SATELLITE LOCATIONS ACROSS INDIANA COUNTY. AS THE ONLY HOSPITAL LOCATED IN THIS RURAL COUNTY, IRMC PROVIDES SERVICES TO A DIVERSE POPULATION OF 89,000 RESIDENTS SPREAD OVER 830 SQUARE MILES.OVER THE YEARS, IRMC HAS DEVELOPED PROGRAMS AND SERVICES THAT ADDRESS IMPROVING ACCESS TO CARE, PREVENTIVE SERVICES, AND COMMUNITY HEALTH EDUCATION. IRMC HAS FOUND A WAY TO NOT ONLY SUCCEED WHEN OTHER RURAL HOSPITALS ARE CLOSING THEIR DOORS, BUT ALSO EXPAND AND PROVIDE CARE TO THE RESIDENTS OF FIVE SURROUNDING COUNTIES. IRMC IS THE NUMBER TWO EMPLOYER IN THE COUNTY WITH 1,300 EMPLOYEES AND CONTINUES TO ATTRACT AND RETAIN A QUALITY WORKFORCE THROUGH THE ACHIEVEMENT OF NUMEROUS RECOGNITIONS, SUCH AS THE #1 BEST PLACE TO WORK IN PA, THE #2 BEST PLACE TO WORK IN THE NATION ACCORDING TO MODERN HEALTHCARE MAGAZINE, ACHIEVED NOTABLE STATUS BY SCORING AT THE MASTERY LEVEL IN PENNSYLVANIA'S KAPE PROGRAM, AND NAMED TO FORTUNE'S 100 BEST COMPANIES TO WORK FOR. FURTHER, IRMC IS CURRENTLY PURSUING THE MALCOLM BALDRIGE NATIONAL QUALITY AWARD - A PRESTIGIOUS HONOR ACHIEVED BY FEW. PART VI, LINE 5: IN THE MID-NINETIES, HOSPITALS AND HEALTHCARE FACILITIES BEGAN TO SHIFT THEIR ATTENTION FROM JUST SICK OR HOSPITAL BASED CARE TO INCLUDE ADDRESSING COMMUNITY HEALTH AND DISEASE PREVENTION. AS A FIRST STEP IN THAT DIRECTION, IRMC FORMED A COMMUNITY SERVICE DEPARTMENT WHOSE PURPOSE WAS TO DELIVER EDUCATION AND PREVENTATIVE SCREENINGS TO THE COMMUNITY-AT-LARGE. IN 2005, REALIZING THAT ALMOST EVERY DEPARTMENT IN THE HOSPITAL HAD OPPORTUNITIES TO PROMOTE HEALTH AND WELLNESS, IRMC CREATED THE INSTITUTE FOR HEALTHY LIVING, A VIRTUAL ORGANIZATION COORDINATING ALL ASPECTS OF COMMUNITY OUTREACH AND HEALTH IMPROVEMENT. IMPROVING AND SUSTAINING COMMUNITY HEALTH, HOWEVER, IS A COLLABORATIVE ENDEAVOR THAT INTEGRATES AS MANY KEY STAKEHOLDERS AS POSSIBLE. IN THAT REGARD, IRMC SPEARHEADED THE FORMATION OF THE INDIANA COUNTY COMMUNITY HEALTH ADVISORY COUNCIL (CHAC), AN ENTERPRISE REPRESENTING MEMBERS FROM VARIOUS COMMUNITY AGENCIES, ORGANIZATIONS AND SCHOOLS WHOSE PURPOSE IT IS TO IDENTIFY HEALTH NEEDS IN OUR COUNTY AND TO FIND WAYS TO MEET THEM. THE CHAC HAS BEEN ACTIVE SINCE 1996 AND IRMC SERVES AS ITS BASE AND CHAIRMANSHIP. THE IRMC / INSTITUTE FOR HEALTHY LIVING 2011 COMMUNITY HEALTH NEEDS ASSESSMENT AND REPORT IS THE PRODUCT OF AN 18-MONTH PROCESS THAT SOUGHT COMMUNITY INPUT, MEDICAL STAFF INPUT, INVOLVED KEY INTEREST GROUPSSUCH AS THE CHAC, AND SELECTED PRIMARY AND SECONDARY SOURCES OF SURVEY INPUT TO IDENTIFY TARGET AREAS FOR IMPROVEMENT WITH SPECIFIC ACTION PLANS.USING THE THREE SURVEY INPUTS OF THE PA BEHAVIORAL RISK FACTOR SURVEILLANCE SURVEY (BRFSS), THE ROBERT WOOD JOHNSON COUNTY HEALTH RANKINGS, AND THE PA DEPARTMENT OF HEALTH ANNUAL COUNTY HEALTH PROFILES, IRMC WAS ABLE TO IDENTIFY AND SET PRIORITIES AMONG 19 AREAS FOR COMMUNITY HEALTH IMPROVEMENT THAT DIFFERED SIGNIFICANTLY FROM STATE OR NATIONAL BENCHMARKS. IRMC THEN TARGETED SEVEN OF THOSE NEED AREAS FOR SPECIFIC INTERVENTION AND ACTION. INDIANA REGIONAL MEDICAL CENTER USES ITS OWN FUNDS TO ENHANCE BOTH THE CLINICAL STRATEGIES AND THE COMMUNITY STRATEGIES.CLINICAL STRATEGIES (A FEW EXAMPLES): RECRUITING ADDITIONAL PHYSICIANS FOR IDENTIFIED COMMUNITY NEEDS, EXPLORE DEVELOPMENT OF A FAMILY PRACTICE RESIDENCY PROGRAM TO FACILITATE RECRUITMENT AND RETENTION, ENLARGE THE MEDICAL FITNESS CENTER, ESTABLISH A WEIGHT LOSS TASK FORCE, DEVELOP A MEDICAL WEIGHT MANAGEMENT CENTER, PROVIDE FLU SHOTS TO ALL INPATIENTS DURING FLU SEASON, PROVIDE PNEUMONIA VACCINE TO ALL NON-VACCINATED INPATIENTS, ETC. COMMUNITY STRATEGIES (A FEW EXAMPLES): PARTNER WITH AGENCIES PROVIDING SERVICES AND EDUCATION TO YOUNG TEENS AND WOMEN, EVALUATE A PARTNERSHIP WITH EARLY HEAD START, IMPROVE VISIBILITY AND INFORMATION AVAILABLE ABOUT THE OB/GYN CLINIC, WORKED TO ESTABLISH PRACTICES IN THE MORE RURAL AREAS OF THE COUNTY THAT REQUIRE THE MEDICAL CENTER TO SUBSIDIZE DELIVERING CARE THERE, ESTABLISHED THE INDIANA AT CHESTNUT RIDGE FACILITY THAT OFFERS PRIMARY CARE AND URGENT-CARE AND WAS A SIGNIFICANT CAPITAL INVESTMENT, IMPLEMENT A PATIENT PORTAL TO IMPROVE PATIENT ACCESS TO MEDICAL RECORDS, BECAME A PROVIDER OF THE WE CAN! (WAYS TO ENHANCE CHILDREN'S ACTIVITY AND NUTRITION), PARTNERED WITH 7 ELEMENTARY SCHOOLS TO INSTALL PROJECT FIT AMERICA, IMPLEMENTED GROCERY STORE TOURS TO ASSIST PEOPLE WITH SEEKING HEALTHY CHOICES, PARTNER WITH 4 GROCERY STORES TO HAVE A DIETICIAN AVAILABLE TO HELP SHOPPERS MAKE HEALTHY CHOICES, CONDUCT THE ANNUAL "VACCINE FOR VETERANS" PROGRAM ON VETERANS DAY, EVALUATE THE POTENTIAL FOR PUBLIC PNEUMONIA VACCINE CLINICS, CONTINUE TO PROVIDE FREE FLU AND PNEUMONIA VACCINE TO HIGH-RISK, LOW INCOME RESIDENTS, ETC. PART VI, LINE 6: INDIANA REGIONAL MEDICAL CENTER HAS THE FOLLOWING AFFILIATED ENTITIES:INDIANA HEALTHCARE FOUNDATION CONDUCTS FUNDRAISING ACTIVITIES, SUCH AS THE COLUMBUS DAY GOLF OUTING AND LOVE OF LIFE GALA, IN SUPPORT OF INDIANA REGIONAL MEDICAL CENTER. INDIANA REGIONAL MEDICAL CENTER AND PUNXSUTAWNEY AREA HOSPITAL JOINTLY FORMED INDIANA JEFFERSON RADIATION ONCOLOGY, INC. FOR THE PURPOSE OF ENHANCING THE QUALITY AND AVAILABILITY OF RADIATION ONCOLOGY SERVICES OFFERED TO PATIENTS IN INDIANA AND JEFFERSON COUNTIES, PA AND SURROUNDING AREAS.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. WE PROVIDE ACCESSIBLE, COST EFFECTIVE QUALITY HEALTHCARE WITHIN THE RURAL COMMUNITIES OF INDIANA AND SURROUNDING COUNTIES. WE SUPPORT AND WORK COLLABORATIVELY WITH OTHER NON-PROFIT AGENCIES WITHIN OUR SITES.INDIANA HEALTHCARE PROPERTIES HOLDS AND MANAGES PROPERTY IN SUPPORT OF INDIANA REGIONAL MEDICAL CENTER. PART VI, LINE 7 N/A 1 INDIANA HEALTHCARE PHYSICIANS SERVICES 835 HOSPITAL ROAD INDIANA PA 15701 251842046 501(C)(3) 3948186 0 CASH N/A RELATED PARTY ASSISTANCE INDIANA HEALTHCARE CORPORATION 835 HOSPITAL ROAD INDIANA PA 15701 251547379 501(C)(3) 28286 0 CASH N/A RELATED PARTY ASSISTANCE 2 0 PART I, LINE 2: ASSISTANCE IS PROVIDED TO RELATED ENTITIES FOR FINANCIAL SUPPORT. MANAGEMENT OF THE MEDICAL CENTER OVERSEES THE USE OF FUNDS AT THE AFFILIATED ENTITIES. X 1 1 X X X X X 0 1 0 0 0 0 0 1 0 STEPHEN A WOLFE PRESIDENT & CEO 382452 0 59258 0 6052 0 62701 0 18055 0 528518 0 0 0 ROBERT A GONGAWARE SR VP FINANCE 203918 0 26952 0 0 0 6738 0 1299 0 238907 0 0 0 BRUCE A BUSH MD SR VP MEDICAL DIRECTOR 275356 0 33512 0 0 0 0 0 27922 0 336790 0 0 0 DOMINIC PACCAPANICCIA CHIEF OPERATING OFFICER 222209 0 33927 0 0 0 18144 0 26144 0 300424 0 0 0 CINDY VIRGIL SR VP PATIENT SERVICES 174177 0 15437 0 0 0 13710 0 11620 0 214944 0 0 0 WADE PATRICK SR VP INFORMATION SERVICES 169142 0 23727 0 0 0 6954 0 11423 0 211246 0 0 0 LARRY SEDLEMEYER SR VP BUS. DEVELOPMENT 153933 0 12070 0 0 0 10810 0 8397 0 185210 0 0 0 ANTHONY L SICO PHYSICIAN 412638 0 1315 0 0 0 0 0 19315 0 433268 0 0 0 MICHAEL F STALTERI PHYSICIAN 370200 0 12193 0 0 0 0 0 18454 0 400847 0 0 0 JOHN P CAWLEY PHYSICIAN 373374 0 0 0 0 0 0 0 7438 0 380812 0 0 0 DONNA L BALEWICK PHYSICIAN 351590 0 14206 0 0 0 0 0 7934 0 373730 0 0 0 GEOFFREY PAZDER PHYSICIAN 361377 0 2588 0 0 0 0 0 417 0 364382 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 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 2013. STEPHEN WOLFE'S CONTRIBUTION TO THE PLAN FOR 2013 WAS $38,305. 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. A INDIANA COUNTY HOSPITAL AUTHORITY 251697319 2009-02-12 10000000 FINANCE CAPITAL PROJECTS 0 0 0 B INDIANA COUNTY HOSPITAL AUTHORITY - SERIES 2014A 251697319 2014-01-01 25455000 FINANCE CAPITAL PROJECTS, FUND RESERVES AND PAY ISSUANCE COSTS 0 0 0 C INDIANA COUNTY HOSPITAL AUTHORITY - SERIES 2014B 251697319 2014-01-01 10200000 FINANCE CAPITAL PROJECTS, FUND REVERVES AND PAY ISSUANCE COSTS 0 0 0 D INDIANA COUNTY HOSPITAL AUTHORITY - SERIES 2014C 251697319 2014-01-01 12715000 REFINANCING AND PAY ISSUANCE COSTS 0 0 0 A 2790000 10000000 61000 9939000 2010 0 0 1 1 B 330000 25455000 342791 6347815 18764394 0 0 0 1 C 10200000 169750 1030250 0 0 0 1 D 265000 12715000 133512 12581488 2013 0 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 C 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 D 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 1 0 0 0 0 0 1 B 0 0 0 0 0 0 0 0 1 C 0 0 0 0 1 0 0 0 1 D 0 0 0 0 0 0 0 0 1 A 1 B 1 C 1 D 1 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 REGIONAL MEDICAL CENTER ("IRMC"). 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 IRMC. FORM 990, PART VI, SECTION A, LINE 7B IRMC SHALL OBTAIN THE APPROVAL OF IHC BEFORE ACTION ON ANY OF THE FOLLOWING MATTERS BECOMES FINAL AND EFFECTIVE FOR IRMC: (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 IRMC; (3) MERGER OR CONSOLIDATION WITH ANY OTHER CORPORATION; (4) DISSOLUTION OF IRMC; (5) APPROVAL OF AN ANNUAL OPERATING AND CAPITAL BUDGET FOR IRMC; (6) 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. THE RETURN WAS ALSO PROVIDED TO ALL BOARD MEMBERS FOR REVIEW AT A BOARD MEETING BEFORE FILING WITH THE INTERNAL REVENUE SERVICE. 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/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 ACKNOWLEDGEMENT AS WELL. THE ACKNOWLEDGEMENT AND DISCLOSURE FORMS WILL BE KEPT ON FILE BY THE CHIEF EXECUTIVE OFFICER, AND THE CHAIRMAN AND VICE-CHAIRMAN WILL BE FAMILIAR 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 CHIEF EXECUTIVE OFFICER 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 INTERESTS 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 PHYSICIANS FEES: PROGRAM SERVICE EXPENSES 5,392,600. MANAGEMENT AND GENERAL EXPENSES 1,308,747. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,701,347. CONSULTATION FEES: PROGRAM SERVICE EXPENSES 411,905. MANAGEMENT AND GENERAL EXPENSES 99,967. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 511,872. COLLECTIONS: PROGRAM SERVICE EXPENSES 180,514. MANAGEMENT AND GENERAL EXPENSES 43,810. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 224,324. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 7,147,376. MANAGEMENT AND GENERAL EXPENSES 1,734,619. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 8,881,995. FORM 990, PART XI, LINE 9: CHANGE IN INTEREST IN INDIANA HEALTHCARE FOUNDATION 2,802,855. PENSION AND POST-RETIREMENT LIABILITIES ADJUSTMENT 4,040,987. 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 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 1 INDIANA HEALTHCARE PHYSICIAN SERVICES INC 835 HOSPITAL ROAD INDIANA PA 15701 251842046 PROVIDE HEALTH CARE PA 501(C)(3) LINE 3 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 REHABILITATION SERVICES LLC 855 SPRINGDALE DR STE 200 EXTON PA 19341 202214391 REHABILITATION SERVICES PA N/A UNRELATED 72294 171260 0 0 0.51000 INDIANA AMBULATORY SURGICAL ASSOCIATES LLC 841 HOSPITAL ROAD INDIANA PA 15701 232923182 AMBULATORY SURGERY PA INDIANA REGIONAL MEDICAL CENTER UNRELATED -22152 4278578 0 0 0.70000 COSM REALTY GROUP LTD 1265 WAYNE AVENUE STE 307 INDIANA PA 15701 030439684 REAL ESTATE PA INDIANA REGIONAL MEDICAL CENTER UNRELATED -22284 4480128 0 -17444 0 0.40000 PENNSYLVANIA MOUNTAINS HEALTHCARE ALLIANCE LLC 150 MCCRACKEN RUN ROAD DUBOIS PA 15801 251852975 HEALTHCARE SERVICES PA INDIANA REGIONAL MEDICAL CENTER UNRELATED 26098 28845 0 1 0.08330 INDIANA TOTAL THERAPY LLC 120 IRMC DRIVE STE 160 INDIANA PA 15701 263843582 THERAPY SERVICES PA N/A UNRELATED 254964 442583 0 0 0.50000 INDIANA HEALTHCARE ENTERPRISES 835 HOSPITAL ROAD INDIANA PA 15701 470973444 SALE OF HEALTHCARE RELATED ITEMS, GIFT SHOP PA N/A C 0 0 1 0 1 0 0 0 0 0 1 1 0 1 0 0 1 1 0 0 INDIANA JEFFERSON RADIATION ONCOLOGY INC J 171142 COST INDIANA JEFFERSON RADIATION ONCOLOGY INC P 1945256 COST INDIANA JEFFERSON RADIATION ONCOLOGY INC Q 996587 COST