2015-06-16T14:24:50-07:00 2014-06-30 990 2013-07-01 251490707 DuBois Regional Medical Center DUBO 8143756107 PO Box 447 100 Hospital Avenue DuBois PA 15801 John Sutika President 8143756107 2015-04-22 2013 2016-04-25 22:37:26Z X Penn Highlands DuBois John Sutika PO Box 447 100 Hospital Avenue DuBois PA 15801 263703346 0 X www.phhealthcare.org X 1985 PA DuBois Regional Medical Center offers residents of West Central Pennsylvania a combination of advanced healthcare in a warm, friendly environment. DRMC is an oasis of clinical and technical excellence, with a focus on patient-centered care. 21 16 2073 234 0 0 215183 213792 224465191 239535514 1800901 2617304 3882594 6301364 230363869 248667974 0 0 134727035 139831758 0 152126 97177261 101220439 231904296 241052197 -1540427 7615777 222847152 243063539 74826495 82847820 148020657 160215719 DuBois Regional Medical Center offers residents of West Central Pennsylvania a rare combination of advanced healthcare in a warm, friendly environment. DRMC is an oasis of clinical and technical excellence, with a focus on patient-centered care. See Statement of Community Benefit. 0 0 211737775 248667974 DuBois Regional Medical Center provides a variety of comprehensive inpatient care and outpatient medical services to the residents of West Central Pennsylvania. The facility is licensed for 221 beds. In fiscal year 2014, DRMC serviced 9,200 inpatients with a total of 40,366 inpatient days and provided more than 446,096 outpatients visits. In addition to direct medical services, the hospital also provides other medical programs to the community outreach programs, clinics, support groups, education programs, health fairs and health screenings. 0 0 0 211737775 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 0 0 1 0 0 0 0 0 0 1 0 1 1 0 0 1 0 0 0 0 0 1 1 1 0 0 0 0 0 1 1 1 0 0 1 197 0 1 2073 1 0 0 0 0 0 1 1 0 0 0 0 X 21 16 0 0 0 0 0 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 PA X Brian S Kline CFO 8143756377 PO Box 447 100 Hospital Avenue DuBois PA 15801 Dr Rajat Malik Trustee 40 0 X X 149112 0 6074 Dr Jonathan Pope Trustee 40 0 X 342925 0 25698 Edward Yahner Chairman 1 0 X 0 0 0 Todd Stoltz Vice Chairman 1 0 X 0 0 0 James D Curtis Treasurer 1 0 X 0 0 0 Nancy J Micks Secretary 1 0 X 0 0 0 Sister Mary Ann Bader RSM Trustee 1 0 X 0 0 0 Dr James E Devlin Trustee 1 0 X 0 0 0 Sister Lisa Mary McCartney Trustee 1 0 X 0 0 0 Dr Hazem F El Kassas Trustee 1 0 X 0 0 0 Raymond A Graeca President Penn Highlands Healthcare 1 40 X 0 589743 112330 Gene Hoak Trustee 1 0 X 0 0 0 Todd Miller Trustee 1 0 X 0 0 0 Edward S Nasuti Trustee 1 0 X 0 0 0 Melanie Hatch Trustee 1 0 X 0 0 0 Sister Margaret Park Trustee 1 0 X 0 0 0 Richard Pfingstler Trustee 1 0 X 0 0 0 Dr Gregory Roscoe Trustee 1 0 X 0 0 0 Sharon Varischetti Trustee 1 0 X 0 0 0 Anthony Viglione Trustee 1 0 X 0 0 0 William Young Trustee 1 0 X 0 0 0 Lisa Zocco Trustee 1 0 X 0 0 0 John Sutika President 40 0 X 358477 0 47603 Dr Gary Dugan Vice President 40 0 X 352863 0 41381 Brian Kline Vice Presdient 40 0 X 232066 0 20240 Robert McKee Vice President 40 0 X 231010 0 32287 Janice Hamscher Vice President 40 0 X 226082 0 31738 Dr Richard Latuska Physician 40 0 X 708564 0 24572 Dr Mohamed Hassan Physician 40 X 649256 0 24380 Dr Martin Gillespie Physician 40 0 X 700255 0 16666 Dr Adolfo Rapaport Physician 40 0 X 618242 0 25443 Dr John Fabre Physician 40 0 X 646114 0 20938 Patricia Cressley Former Officer 0 0 X 49575 0 6830 5264541 589743 436180 168 1 1 0 Associated Clinical Labs 1526 Peach Street Erie PA 16501 Lab Services 1806536 Comphealth PO Box 972651 Dallas TX 75397 Staffing Services 1486063 Linde Healthcare Staffing PO Box 915214 Dallas TX 75391 Staffing Services 1327033 Allied Resources Medical Staffing 135 Dowlin Forge Road Exton PA 19341 Staffing Services 1226591 SHIM LLC 1605 North Cedar Crest Blvd Allentown PA 18104 Misc Services 768716 33 0 0 59792 0 0 154000 0 213792 Ancillary OP and Physician 622000 399030078 399030078 0 0 R&B Ancillary IP 622000 175803852 175803852 0 0 Other Program Revenue 622000 7641896 7641896 0 0 Contractual Adjustments 622000 -342940312 -342940312 0 0 0 0 0 0 239535514 2116814 0 0 2116814 0 0 0 0 0 0 0 0 645610 0 0 0 645610 0 645610 645610 0 0 728556 14807306 410213 14625159 318343 182147 500490 500490 0 0 59792 Other Income 622000 1652198 1652198 0 0 Earnings from Affiliates 622000 3838110 3838110 0 0 Restricted Operating Revenue 622000 165446 165446 0 0 0 0 0 0 5655754 248667974 246337368 0 2116814 2955054 610053 2345001 0 112245672 100766586 11360303 118783 2889004 2542324 346680 14420868 12690364 1730504 7321160 6442621 878539 4918915 4328645 590270 331741 331741 109350 109350 12368949 10884675 1484274 529168 465668 63500 858205 755220 100654 2331 4975549 4378483 597066 4019783 3537409 482374 395443 347990 47415 38 402276 354003 48248 25 1352802 1190466 162336 14581991 12832152 1749839 3538242 3113653 424589 Supplies 34074886 29985900 4086397 2589 Bad Debt 6399410 5631481 767929 0 Maintenance 1843561 1622334 220676 551 Purchased Services 9258969 8147893 1083629 27447 1261199 1109855 150982 362 241052197 211737775 29162296 152126 1633087 19633143 1047006 1409082 32676525 33506016 3717326 4084287 225988176 127813830 102998068 98174346 55249876 56399262 25525264 29857403 222847152 243063539 25108977 24848483 1781591 2002366 30576851 47041814 15225920 7305127 2133156 1650030 74826495 82847820 X 146674500 158622931 1346157 1592788 0 0 148020657 160215719 222847152 243063539 X 7615777 4150119 0 0 0 429166 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 1 20000 0 1 0 1 0 0 0 20000 0 Schedule C, Part II-B, Line 1 DuBois Regional Medical Center pays an organization, Wojak & Associates each month for providing support in the lobbying efforts for health care related issues. 47469 1253 28 0 0 0 48750 41013 6401 55 0 0 0 47469 38372 2545 96 0 0 0 41013 36194 1965 213 0 0 0 38372 33369 2553 272 0 0 0 36194 0 1 0 1 0 0 3758414 3758414 0 126184160 64037129 62147031 0 715144 443279 271865 0 91001056 59884073 31116983 0 4329402 3449349 880053 98174346 Deferred Pension Plan 2032169 Deferred Financing 922774 Goodwill 1722398 Inventory For Use 4375125 Investment in Affiliates 9600124 Miscellaneous Receivables 10179066 Other Assets 1025154 Pledged Guarantees - Workers Comp 593 29857403 Third Party Rate Adj & Compliance Adj 1650030 1650030 253247259 4150119 0 0 0 4150119 249097140 0 -429166 -429166 248667974 241052197 0 0 0 0 0 241052197 0 0 0 241052197 Schedule D, Part V, Line 4 Endowment funds will be used for purchases of capital items used in patient care. Schedule D, Part XI, Line 4b Other increase to net assets Golf Tournament 71892 59792 12100 12824 0 8044 6178 0 0 0 0 71892 59792 12100 12824 0 8044 6178 0 0 27046 -14946 1 1 1 X 0 1 1 1 0 1 1 2010641 2010641 0.0083 36793227 28856514 7936713 0.033 0 0 38803868 28856514 9947354 0.0413 484810 484810 0.002 813546 813546 0.0034 586663 586663 0.0024 11640 11640 0.0 0 0 1896659 0 1896659 0.0078 0 0 40700527 28856514 11844013 0.0491 1 2751746 0 64274344 65946939 -1672595 X 1 1 Kidney Care Services LLC Dialysis Services 0.74 0.26 Kidney Care Services DuBois Dialysis Services 0.69 0.31 1 1 DuBois Regional Medical Center 100 Hospital Avenue DuBois PA 15801 www.phhealthcare.org X X X DuBois Regional Medical Center 1 1 X X X X X X X X X 12 1 0 1 X www.phhealthcare.org X X X X X X X X 1 0 1 1 200 0 1 X X X X X X 1 1 X X X X 1 0 1 X 0 0 Schedule H, Part V, Section B, Line 3-DuBois Regional Medical Center In order to complete the Community Health Needs Assessment, DuBois Regional Medical Center spoke to several community leaders including business owners, politicians and other government workers, hospital administration and personnel and others involved in the area's healthcare community. Several organizations were invited to meet with the committee including Susan Ford from the county Drug and Alcohol Commission, Nancy Mattison from Catholic Charities, Robert Newell from the American Red Cross and Gene Kephert from Senclair Child Services, just to name a few. Schedule H, Part V, Section B, Line 11-DuBois Regional Medical Center A discount of 25% is extended to uninsured patients not qualifying for charity care. Additionally, a 40% discount is offered to uninsured/under-insured patients who have a patient-pay balance exceeding 25% of the family annual income but are not eligible for charity care. A 60% discount is applied for patients with non-covered pharmacy expenses. Schedule H, Part V, Section B, Line 20-DuBois Regional Medical Center A 25% discount is provided to uninsured patients not eligible for charity care to allow for a match to the 25% discount provided to the Intergroup/Vantage large multi-payer groups. These multi-payer groups are our Commercial Insurances that are outside of a managed care contract. All uninsured patients receive this discount regardless of income. The only qualification is for the patient to be uninsured. In addition, a 40% discount is provided to uninsured and underinsured patients not eligible for charity care with a patient-pay balance exceeding 25% of the family's annual income. There are no income guidelines. Proof of income is requested only to verify that the patient-pay balance exceeds 25% of the family's annual income Schedule H, Part I, Line 3c A discount of 25% is extended to uninsured patients not qualifying for charity care. Additionally, a 40% discount is offered to uninsured/under-insured patients who have a patient-pay balance exceeding 25% of the family annual income but are not eligible for charity care. A 60% discount is applied for patients with non-covered pharmacy expenses. Schedule H, Part I, Line 7 Actual amounts are used to calculate these figures Schedule H, Part III, Section A, Line 4 Bad debt is estimated based on applying pre-established percentages to each payor balance in the organizations accounts receivable. Self-pay balance percentages are applied based on the accounts receivable aging. The percentages are based on historical bad debt information and assistance from the oranization's financial auditors. Schedule H, Part III, Section B, Line 8 Medicare total revenue received and allowable costs are calculated using various lines form the Medicare cost report. To include professional component revenue, internal reports are used. The professional cost is calculated using the non-allowable physician costs frm the cost report multiplied by the percentage of Medicare PCs to total PCs. Schedule H, Part III, Section C, Line 9b The hospital offers free charity care to those patients who qualify. A patient with family income at or below 200% of Schedule A of the poverty guidelines, or below this level due to medical indigency, is eligible to receive free medical services provided liquid assets are not in excess of $25,000. See (3) (below) "Patient Education of Eligibility for Assistance" for "Notice of Charity Care" policy. Schedule H, Part VI, Line 2 The hospital collects data on an ongoing basis regarding patients who travel to outlying areas for services not offered by DRMC. Based on this data, services are added and improved upon in order to serve the needs of the community as effectively and efficiently as possible. DRMC routinely sends patient satisfaction surveys to those receiving medical services. These surveys allow patients to offer suggestions regarding how the hospital could better serve them as patients and the community as a whole. DRMC offers a variety of educational programs that allow employees to interact on a one-on-one basis with the residents of the community as a whole. In addition, the medical staff of the hospital consistently participates in research and continuing medical education. This knowledge allows the hospital to remain updated on the latest medical news and techniques in order to offer patients the highest and most innovative levels of care. DRMC hired an outside firm to assist with conducting a Community Health Needs Assessment. The assessment took place between March and August of 2011. The contractor gathered secondary data in Clearfield and surrounding counties, conducted various focus groups with key audiences and users of healthcare and social services to identify areas for perspective improvement within the community. DRMC held a community retreat with community leaders to report and present the findings of the collection phase. The community leaders provided input to help determine and prioritize which issues needed to be addressed within the community. The contractor is currently in the process of developing a master plan of initiatives for DRMC to be posted to its web site. Schedule H, Part VI, Line 3 DRMC posts a Notice of Charity Care at all points of registration, including all employed physician practices. The notices include a statement as to the availability of charity care and how to apply. DRMC employs a Financial Counselor who meets individually with all inpatients admitted to the facility who indicate no health care coverage. The Financial Counselor interviews the patient, and, if appropriate, discusses and educates the pateint relative to Medical Assistance, Blue Chip and the hospitals charity care program. The Financial Counselor competes and assists the patients with the necessary applications and follow-thru with the physician and the assigned County Board of Assistance caseworker. The Financial Counselor also contacts other patients with larger dollar account balances to discuss and educate the patient's need for financial assistance. Additionally, DuBois Regional Medical Center employs a credit collections staff who also contacts, educates and offers assistance to other patients with financial need to help with health care costs. Schedule H, Part VI, Line 4 DRMCs 221 licensed beds are housed in two facilities two miles from one another in DuBois, a small town in West Central Pennsylvania. The combined tradition of providing high quality, compassionate care began with its predecessors, DuBois Hospital and Maple Avenue Hospital in 1897. In 1985, the two organizations joined to create DRMC, and, since then the medical center has grown for the benefit of the entire community. DMRC West houses acute inpatient care and a full range of ancillary services. In addition DRMC offers access to primary and specialty care health centers in several communities. As one of the largest private employers in Clearfield County, DRMC is a significant part of the area's economy. We take pride in the role we play in shaping the quality of life for residents of the communities we serve. We also believe that the population we serve is both very proud and grateful to have DRMC as their primary health care provider. Schedule H, Part VI, Line 5 DuBois Regional Medical Center offers residents of West Central Pennsylvania a rare combination of advanced healthcare in a warm, friendly environment. Widely recognized as one of the leading health centers of its kind in the Commonwealth, DRMC is an oasis of clinical and technical excellence, with a focus on patient-centered care. Our combined vision is to be positioned as the premier provider of comprehensive, quality services to our broad region. Providing inpatient and outpatient hospital care represents the largest portion of these services. DRMC's mission in maintaining these services is accomplished by providing access to healthcare services for all, including individuals who are unable to pay for such services. DRMC has a tradition of serving the poor and underprivileged of the area by providing care programs and services to enhance their quality of life. Beyond the inpatient and outpatient hospital care, there are many other ways in which DRMC and our employees serve our community every day. DRMC has an ongoing commitment to the communities it serves with a range of community outreach programs, such as clinics, support groups, educational programs, health fairs and health screenings. Our employees volunteer their time and talents to improve our community in many ways. In addition to giving to organizations, they provide information on health and safety to the community. They provide direct patient care on a volunteer basis at the local DuBois Free Clinic. The Clinic was established for low-income people who could not afford health insurance. The success and reputation of DRMC is a direct result of the dedicated efforts of our Board of Directors, Administration, Physicians and Staff. With the continued support of the DRMC family and the communities we serve, DRMC will remain a valuable resource to our area. Schedule H, Part VI, Line 7 Pennsylvania X X X X X 0 1 0 0 0 0 0 0 0 Raymond A Graeca President Penn Highlands Healthcare 0 511761 0 63869 0 14113 0 89373 0 22957 0 702073 0 John Sutika President 300459 0 48000 0 10019 0 40716 0 6887 0 406081 0 0 Dr Gary Dugan Vice President 314549 0 38314 0 0 0 25928 0 15454 0 394245 0 0 Patricia Cressley Former Officer 49575 0 0 0 0 0 4582 0 2248 0 56405 0 0 Brian Kline Vice Presdient 182441 0 49625 0 0 0 14471 0 5768 0 252305 0 Robert McKee Vice President 197268 0 33742 0 0 0 17771 0 14517 0 263298 0 Janice Hamscher Vice President 205862 0 20220 0 0 0 16314 0 15424 0 257820 0 Dr Rajat Malik Trustee 149112 0 0 0 0 0 5964 0 109 0 155185 0 Dr Jonathan Pope Trustee 261000 0 81925 0 0 0 10200 0 15499 0 368624 0 Dr Richard Latuska Physician 607875 0 100689 0 0 0 10200 0 14372 0 733136 0 0 Dr Mohamed Hassan Physician 575231 0 74025 0 0 0 10200 0 14181 0 673637 0 Dr Martin Gillespie Physician 700255 0 0 0 0 0 4151 0 12515 0 716921 0 Dr Adolfo Rapaport Physician 617792 0 450 0 0 0 10200 0 15244 0 643686 0 Dr John Fabre Physician 645439 0 675 0 0 0 10200 0 10738 0 667052 0 Schedule J, Part I, Line 4 Raymond Graeca $17500 John Sutika $17500 Dr Gary Dugan $15728 Patricia Cressley $2583 Robert McKee $9864 Janice Hamscher $10293 Brian Kline $8077 Michelle Sutika Bennett Relative of Board Member 114446 Compensation 0 Dr Steven Graeca Relative of Board Member 543431 Compensation 0 Linda McKee Relative of Board Member 25164 Compensation 0 Kristie Yount Relative of Board Member 79178 Compensation 0 Douglas Dale Relative of Board Member 28533 Compensation 0 Andrew Sutika Relative of Board Member 98238 Compensation 0 Lauren Dale Relative of Board Member 53037 Compensation 0 Megan Devlin Bussard Relative of Board Member 106748 Compensation 0 Dr Brandon Roscoe Relative of Board Member 40000 Education Loan Payments 0 Dr Nico Roscoe Relative of Board Member 40000 Education Loan Payments 0 Tricia Brigger Relative of Board Member 46500 Compensation 0 Clearfield Jefferson Primary Care Owned by Relatives of Board Member 84774 Income Guarantee Payments 0 Oncology Hematology Associates Owned by a Board Member 475339 Payment for services 0 Ann Curtis Relative of Board Member 29781 Compensation 0 Julianne Hassan Relative of Board Member 64054 Compensation 0 Mark Stoltz Relative of Board Member 57622 Compensation 0 Matthew Stoltz Relative of Board Member 52497 Compensation 0 Form 990, Header, Line B Information reported on Schedule L regarding Related Party Transactions was erroneously omitted on the original form. Form 990, Part VI, Section A, Line 7a Effective October 1, 2011, Penn Highlands Healthcare became the other body of DRMC. It holds certain reserved powers over DRMC, including the power to elect the directors of DMRC (other than ex-officio directors) from a panel of individuals submitted to PHH by DRMC's board and nominated by PHH's Governance/Nominating Committee. The Sisters of Mercy have a right to nominate up to three of its sisters to sit on the DRMC board of directors (subject to certain restrictions). PHH also has the power to remove directors. Form 990, Part VI, Section A, Line 7b Penn Highlands Healthcare holds certain reserved powers over DRMC, including the power to make decisions on behalf of the organization or approving decisions made by the Board of Directors. Form 990, Part VI, Section B, Line 11b DRMC will be submitting the Form 990 to meet the May 15th deadline for filing. The complete Form 990 will be provided to the finance committee and board of directors at the May 2015 meetings. At that time, the committees will review the Form 990 and have an opportunity to discuss any information contained within the document. Form 990, Part VI, Section B, Line 12c Yearly, Board members are required to complete a new conflict of interest statement. At any time, any Board member may question a possible conflict of interest and a thorough review would then be completed. Form 990, Part VI, Section B, Line 15 An independant firm is hired to compare, review, and recommend all senior officers' compensation. The Board of Directors provides the final approval. Form 990, Part VI, Section C, Line 19 The conflict of interest statement and other governing documents are available to the public at the public's request. They are located in a "Public Binder" in the administrative offices of DRMC. Form 990, Part XI, Line 9 Other Change in Net Assets Nathan D Yingling Cancer Center 815 Doctors Drive Clearfield PA 16830 205114093 Radiation and Oncology Services PA 501 (c) (3) 3 Clearfield Hospital DuBois Regional Medical Center 1 Brookville Hospital 100 Hospital Road Brookville PA 15825 250984595 Hospital PA 501 (c) (3) 3 Penn Highlands Healthcare 1 Clearfield Hospital 809 Turnpike Avenue Clearfield PA 16830 250979346 Hospital PA 501 (c) (3) 3 Penn Highlands Healthcare 1 Penn Highlands Healthcare 100 Hospital Avenue DuBois PA 15801 320345810 Hospital Mgmt Services PA 501 (c) (3) 11c N/A 0 Elk Regional Health Center 763 Johnsonburg Road St Marys PA 15857 250585230 Hospital PA 501 (c) (3) 3 Penn Highlands Healthcare 1 Kidney Care Services LLC 635 Maple Ave Suite D DuBois PA 15801 510644566 Dialysis Services PA N/A Related 1861061 274665 0 1 0.74 Kidney Care Services DuBois 635 Maple Ave Suite D DuBois PA 15801 510644542 Dialysis Services PA N/A Related 2972624 631799 0 1 0.69 DuBois Regional Medical Group PO Box 447 DuBois PA 15801 251856569 Pediatric Services PA N/A C -410398 1150885 1 0 DuBois Medical Risk Retention Group PO Box 447 DuBois PA 15801 200324622 Insurance Services PA N/A C 736409 10352998 1 0 0 0 1 0 0 0 1 1 0 1 0 0 1 1 0 1 0 0 DuBois Medical Risk Retention Group m 1046176 Cost Kidney Care Services LLC a-i 53692 Cost Kidney Care Services DuBois a-i 32874 Cost Kidney Care Services DuBois q 51835 Cost Kidney Care Services DuBois k 77892 Cost Kidney Care Services DuBois m 240528 Cost Brookville Hospital j 168706 Cost Brookville Hospital k 50851 Cost Brookville Hospital o 939301 Cost Brookville Hospital q 491229 Cost Clearfield Hospital o 1242655 Cost Clearfield Hospital q 3072007 Cost DuBois Regional Medical Group k 68252 Cost DuBois Regional Medical Group q 2146099 Cost Penn Highlands Healthcare k 1641189 Cost Penn Highlands Healthcare q 708112 Penn Highlands Healthcare m 3408600 Cost