2014-05-15T14:42:13-05:00 2013-06-30 990 2012-07-01 250965274 BUTLER HEALTHCARE PROVIDERS BUTL 7242844429 ONE HOSPITAL WAY BUTLER PA 16001 Anne B Krebs 7242844400 2014-05-15 2012 2015-11-30 17:44:51Z Butler Memorial Hospital Kenneth P DeFurio ONE HOSPITAL WAY BUTLER PA 16001 227811415 0 X www.butlerhealthsystem.org X 1898 PA The mission of Butler Memorial Hospital is to be a healing presence in the communities we serve. We exist to make a positive difference in the lives of people by providing compassionate, high quality care and comfort, and inspiring health and wellbeing. 12 9 2016 286 4778433 828089 2307488 1679857 209233549 216023303 1112075 959657 8944168 9148598 221597280 227811415 50350 55342 0 0 99980607 103129470 0 0 0 112251580 114180939 212282537 217365751 9314743 10445664 311663633 306653836 188837518 170545363 122826115 136108473 X The mission of Butler Memorial Hospital is to be a healing presence in the communities we serve. We exist to make a positive difference in the lives of people by providing compassionate, high quality care and comfort, and inspiring health and wellbeing. 0 0 177627443 55342 220395065 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 over 2,000 people, making it the largest employer in Butler County. The hospital 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 33 bed skilled nursing facility. BMH serves approximately 12,100 acute care patients (admissions) and over 466,000 outpatients each year. The Hospital 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, a robust psychiatric service, drug & alcohol treatment, family services, preventative & wellness programs and tertiary cardiovascular care. It also has a network of 32 convenient, low cost outpatient site that are located in communities through Butler County and the surrounding area. 177627443 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 0 0 1 124 0 1 2016 1 1 1 0 0 0 0 0 0 0 0 0 X 12 9 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 PA X X Finance Department 7242844429 One Hospital Way Butler PA 16001 Fiore C Londino 2.00 1.00 X X 0 0 0 Kenneth P DeFurio 40.00 20.00 X X 646340 0 194822 Marcia Segraves 0.80 1.00 X X 0 0 0 Margaret Irvine 2.00 2.00 X X 0 0 0 Patrick Hampson 0.80 0.20 X 0 0 0 Mario Kinsella MD 0.80 0.20 X 0 0 0 T T Channapati MD 0.80 0.20 X 17500 0 0 David E Foreman 0.80 0.20 X 0 0 0 Kathryn S Helfer 0.80 0.20 X 0 0 0 Patti-Ann Kanterman 0.80 0.20 X 0 0 0 Douglas K McClaine 0.80 0.20 X 0 0 0 Robert M Smith PhD 0.80 0.20 X 0 0 0 Tony Maalouf MD 0.80 0.20 X 0 0 0 Dennis Demby MD 0.80 0.20 X 0 0 0 D Kelly Agnew MD 0.80 0.20 X 0 0 0 Anne B Krebs 40.00 10.00 X 323509 0 75685 Stephanie Roskovski 40.00 20.00 X 301258 0 62871 Karen Allen 50.00 X 244048 0 58550 A Thomas McGill MD 45.00 10.00 X 389531 0 79518 John C Reefer MD 40.00 10.00 X 384650 0 90831 Paula L Hooper 30.00 26.00 X 284867 0 56453 Kevin M Stansbury 45.00 5.00 X 229966 0 57000 Maureen A Gray 50.00 X 262906 0 55688 3084575 0 731418 48 0 1 0 Metz Environmental Services Two Woodland Drive Dallas PA 18612 Environmental/Dietary 1847840 Quest Diagnostics 875 Greentree Road Pittsburgh PA 152203610 Laboratory Services 1841435 Advanced Imaging PO Box 62395 Pittsburgh PA 15241 Imaging Services 1194958 Butler Anesthesia Associates PO Box 737 East Butler PA 16029 Anesthesiology 1085979 Point Security Company 201 Smith Drive Cranberry Twp PA 16066 Security Services 1043586 18 5024 455339 1150599 68895 1679857 Net Patient Revenue 621500 216023303 212920028 3103275 216023303 959657 1597 958060 Other Income 900099 4030157 3920579 109578 Meaningful Use 900099 1379469 1379469 Dietary 722210 1319164 1319164 2419808 855825 1563983 9148598 227811415 220395065 4778433 958060 55342 55342 1958731 1958731 78790042 68264565 10525477 8572565 6515149 2057416 8237419 6260438 1976981 5570713 4900463 670250 383926 383926 54500 54500 682605 197061 485544 54951069 53823495 1127574 576555 568830 7725 5284665 4965475 319190 513268 219029 294239 144321 106149 38172 6435268 6435268 13227476 10052882 3174594 1431520 8054 1423466 Purchased Services 13001600 10036332 2965268 Bad Debt 9076549 90191 8986358 Physician Fees 6007902 4299185 1708717 Miscellaneous 2409715 829535 1580180 217365751 177627443 39738308 0 2850 3374 44447448 57600287 29756714 28085164 1220393 789285 2940699 2940869 3127347 2895047 304401423 164417630 149319649 139983793 71970788 62028612 3737922 7072341 5139823 5255064 311663633 306653836 23009461 22131328 133449557 131524926 32378500 16889109 188837518 170545363 X 121680563 134870362 1145552 1238111 122826115 136108473 311663633 306653836 X 10445664 -130867 2967561 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2577581 2577581 85092586 32201442 52891144 7174664 3099838 4074826 199419014 124861389 74557625 10137578 4254961 5882617 139983793 Pension 14249448 Third Party Settlements 2639661 16889109 X Description of Uncertain Tax Positions Under FIN 48: Part X, Line 2: The System follows the guidance for accounting for uncertainty in income taxes recognized in a company's financial statements that prescribes 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 not met. The guidance also addresses derecognition, classification, interest and penalties, accounting in interim periods, and disclosure. Management has determined that this guidance had no material effect on the consolidated financial statements. The System's policy is to recognize interest related to unrecognized tax benefits in interest expense and penalties in professional fees and miscellaneous expenses. There were no interest or penalties recognized on the consolidated statements of operation and changes in net assets as a result of this guidance. Generally, tax returns for year ended June 30, 2010, and thereafter remain subject to examination by federal and state tax authorities. 1 1 1 X 1 X 1 1 1 0 1 1 3050509 0 3050509 0.01460 24301801 16217521 8084280 0.03880 186086 177169 8917 0.00000 27538396 16394690 11143706 0.05340 208130 14605 193525 0.00090 423496 0 423496 0.00200 17277109 13302586 3974523 0.01910 0 0 135518 0 135518 0.00070 18044253 13317191 4727062 0.02270 45582649 29711881 15870768 0.07610 4752 4752 0.00000 4752 4752 1 9076549 4853000 37736872 41143949 -3407077 X 1 1 1 1 Butler Memorial Hospital

One Hospital Way Butler PA 160014670

X X X Butler Memorial Hospital 1 1 X X X X X X X X 12 1 0 1 X X X X X X X X 0 0 1 1 200.000000000000 1 300.000000000000 1 X 1 1 X X X X X X 1 0 X X X X 1 X 0 0 2 Butler Healthcare Providers SNF

One Hospital Way Butler PA 16001

Skilled Nursing Facility Butler Healthcare Providers Psych

One Hospital Way Butler PA 16001

Psychiatric and Chemical Dependency Part I, Line 7: The costing methodology is based on the ratio of cost to charges from our hospital's accounting system. Part I, L7 Col(f): 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 $9,076,549. Part III, Line 4: Patient accounts receivable are reported at estimated net realizable value after deduction of allowances for doubtful accounts. The allowance for doubtful accounts is based on historical losses and an analysis of currently outstanding amounts for its major payor sources. Management regularly reviews data about these major payor sources of revenue in evaluating the sufficiency of the allowance for doubtful accounts. For receivables associated with services provided to patients who have third-party coverage, the Hospital analyzes contractually due amounts and provides an allowance for doubtful accounts and a provision for bad debts, if necessary (for example, for expected uncollectible deductibles and copayments on accounts for which the third-party payor has not yet paid). For receivables associated with self-pay patients (which includes both patients without insurance and patients with deductible and payment balances due for which third-party coverage exists for part of the bill), the Hospital records a significant portion for bad debts in the period of service on the basis of its past experience, which indicates that many patients are unable or unwilling to pay the portion of their bill for which they are financially responsible. The difference between the standard rates (or discounted rates if negotiated) and the amounts actually collected after all reasonable collection efforts have been exhausted is charged off against the allowance for doubtful accounts.The costing methodology is based on the ratio of cost to charges from our hospital's accounting system. 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. Butler Memorial Hospital is committed to serving the healthcare needs of all members of our Community. We consider the revenue shortfall from the Medicare program payments to be part of our community contribution. Part III, Line 9b: Patients who have previously applied and been approved for our charity care program are automatically qualified for any additional services provided over the next six months after application approval. We also will presumptively qualify patients for charity care if they meet criteria such as being food stamp eligible and qualifying for section 8 housing. Schedule H, Part V, question 2, - The CHNA was completed during the current fiscal year 2013 (July 1, 2012 through June 30, 2013) Butler Memorial Hospital Part V, Section B, Line 3: Health statistics and qualitative data, as well as a BHS sponsored survey of the health status and health issues of 673 households have been reviewed within the framework of Pennsylvania State Health Improvement Plan, Healthy People 2010, and Healthy People 2020 goals to identify and prioritize community health needs. Input from Community and Data Sources:2011 BHS sponsored survey of 673 householdsBehavioral Risk Factor Surveillance Study, Butler Beaver regionPennsylvania Department of Health: Health StatisticsInterviews with Butler County school nursesHealthy People 2010 and 2020 goals and statistics. The Butler County State Health Improvement Plan (SHIP) district is undergoing reorganization Butler Memorial Hospital Cancer Registry and Cancer Committee (includes representation from American Cancer Society)Advisors with public health expertise:Tripp Umbaugh, IncPrometheus, LLC Butler Memorial Hospital Part V, Section B, Line 7: Butler County obesity rates are below 2020 goals. However, effective community based obesity interventions are not well understood. Therefore adult obesity will not be addressed in our plan and the hospital has limited resources to address all issues. Butler Memorial Hospital Part V, Section B, Line 20d: The Hospital used the average payment to charge ratio of all the commercial insurance plans. The ratio is updated annually based on the prior year's payment ratio. Part V,Section B,Line 3: BMH periodically surveys Butler County Residents about their healthcare needs. Included in the survey are questions from the Centers for Disease Control Behavioral Risk Factor Surveillance System. The goal is to assess health status, disease burden and diagnosis, disease prevention, exercise and nutrition status, access to care and overall health literacy. Responses to the survey are carefully evaluated by a specialist in Public Health and results are shared with BMH's clinical staff. The findings are then integrated into operations that meet the community's health needs. Part VI, Line 5: To Our Community: "Butler Memorial Hospital is privileged to be a healing presence in the communities we serve. We 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." This is the mission statement of Butler Memorial Hospital, and it guides the doctors and staff of BMH every day. The people of BMH are passionate about providing high quality care with a high level of service. It extends to a commitment to being an excellent corporate citizen, demonstrated by BMH remaining an independent community hospital - locally controlled - working diligently to meet your healthcare needs. BMH is proud of the high value care that it provides. It offers convenient facilities and technology that rival any in the region. BMH physicians and employees are exceptionally well-trained, committed to providing patients and families the best care possible. In 2013 BMH provided over $15.8 million in charity care and other uncompensated care. Critical support is provided to education endeavors through our partnerships with Slippery Rock University, Butler County Community College, local school districts, and various other educational institutions throughout the region. BMH makes its facilities and staff available to support training programs. BMH leaders are active members of the local business community, supporting Leadership Butler County, local Chambers of Commerce, Butler County Development Corporation, and a variety of civic and social groups. These include the American Heart Association, American Cancer Society, March of Dimes and Butler Road Race, providing college scholarships to student-athletes from Butler County. These are only a few ways BMH works to serve and live up to its mission of caring for neighbors. In total, BMH provides over $19.2 million in community support each year. This report outlines some of the ways BMH supports the health and lives of people throughout the region. It is a testimony to the commitment and leadership of the BMH medical staff, Board of Trustees, employees, volunteers, and community partners, whose dedication to service touches many lives and makes the community a better place.Respectfully Submitted: Kenneth P. DeFurio: President & CEO Margaret Irvine: Chairperson, Board of TrusteesFiscal Year 2013 Community Benefit Report 2012 IRS Form 990 Schedule HExecutive SummaryButler Memorial Hospital (BMH) is proud to serve our community. In furtherance of our charitable mission, BMH provided over $19.2 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 9.3% 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 Butler Memorial Hospital, 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 $19.2 million in total community benefit support. This accounts for over 9.3% 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. Community Health AssessmentButler Memorial Hospital periodically surveys up to 1000 Butler County residents. The analytic tool used is the Centers for Disease Control Behavioral Risk Factor Surveillance System. The community health assessment measures health status, disease burden and diagnosis, disease prevention, exercise and activity levels, nutrition status, access to care and overall health literacy. Responses to the survey are carefully evaluated by a specialist in Public Health and results are shared with clinical staff. The findings are then put into action by improving service and addressing the health needs of community residents. Butler Health SystemButler Health System is an integrated health organization serving a multi-county area in western Pennsylvania. It employs more than 100 physicians with another 200 on active medical staff. Its scope includes acute hospital care, ambulatory care, urgent care, and a network of laboratory services to more than 130 clients. Butler Memorial Hospital has 339 licensed beds (237 medical/surgical, 59 behavioral, 25 skilled nursing and 18 nursery). Services include Critical Care, Surgical Services, Medical Care, Psychiatric Treatment, Drug & Alcohol Rehabilitation, Obstetrics and Skilled Nursing. Inpatient and acute observation patients account for approximately 15,000 admissions each year. The Emergency Department treated nearly 48,000 patients last year. This range and complexity of service is not offered by any other entity in Butler County. Butler Health System has a broad ambulatory care system, comprised of 32 locations throughout the region. Outpatient care services include diagnostic and treatment services: imaging, cardiac diagnostics, laboratory services, family resources, physical therapy, urgent care and physician care. Services have been expanded in Lawrence, Venango and Armstrong Counties.BMH recognizes the need to establish medical care available in the evenings and weekends. To that end, BMH has partnered with local physicians to establish urgent care services, called BHS FastERcare. This service is offered in Butler Township, Saxonburg, Slippery Rock and Kittanning, and offers high quality walk-in medical care throughout the day and into the evening.BHS added new services in the past year, all aimed at improving value, service, and access. BHS partnered with and established a joint venture in oncology care with UPMC Cancer Care. This service includes medical and radiation oncology. BHS also partnered with Highmark with a clinical affiliation in neurosurgery, The Pennsylvania Brain and Spine Institute. BHS partnered with the Jewish Healthcare Foundation to create the Primary Care Resource Center (PCRC). The focus of PCRC is to implement preventive and support measures that result in better outcomes, lower costs, and fewer hospital admissions and readmissions for patients diagnosed with congestive heart failure, chronic obstructive pulmonary disease (emphysema and bronchitis), and acute myocardial infarction (heart attack). The care team focusing on this value improvement process includes physicians, nurses, and pharmacists.Supporting those in need: Our 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 through a Patient Handbook and on the BHS 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." The notice instructs the patient to call or visit the Patient Financial Assistance Department to seek more information about how BMH may be able to help pay for part or all of their 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 makes up 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 $11.4 million. As provisions of the Patient Protection and Affordable Care Act are implemented, Part VI, Line 5: 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 to patients cost information, 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, and prevention and wellness services and primary care services offered through our Physician Clinics. Last year, BMH provided $3,974,523 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 takes very seriously. For example: BMH offers space for meetings and community education; it helps local residents escape violent situations, employees volunteer to help those in need; BMH provides education to new and expectant parents; and BMH provides community health outreach and patient advocacy. Opening Our Facilities for Local MeetingsThe Knowledge Center at Butler Memorial Hospital offers modern meeting and education space for local and regional conferences. Last year, BMH hosted the fourth annual Carol Dietrich Memorial Health Symposium to physicians, nurses and other providers, entitled "Oncology Screening and Update." 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. Employees in the CommunityEvery year, BMH and its employees support a variety of community support programs. These include the Caring Angel Program, the United Way and organizations like the American Heart Association, the American Cancer Society, the Butler YMCA and the March of Dimes. This year, employees, physicians, nurses, and board members volunteered to give back to the community. In addition to these activities, employees participate in a variety of community service initiatives, from Habitat for Humanity, to Doctors without Borders, to local student mentoring programs. SummaryBMH 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 Butler Health System serves, and they are acutely aware of the needs of residents. As a tax-exempt charitable organization, BMH is careful to manage its resources to meet the current and future healthcare needs of residents. BMH is proud of its independence and pledges to always strive to provide high quality, low cost care in a comfortable and supporting environment. Part VI, Line 3: There are signs posted in all registration areas indicating that free care is provided to those people in need. Information is provided to all self pay patients at time of registration indicating that help is available if the patient meets the criteria. A notice is also posted on the hospital's web site. Each patient statement that is mailed out has a notice of the availability of free care and how to apply. The Hospital provides assistance to patients to determine if they are eligible for the Pennsylvania Medical Assistance program. The Patient Financial Assistance staff notifies patients of the availability of free care during phone conversations about the collection of balances due. Part VI,Line 5:A majority of the Governing Body of Butler Memorial Hospital 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 284 physicians, podiatrists and dentists hold privileges on the Butler Memorial Hospital Medical Staff. Privileges are offered based on qualifications and community need without regard to other factors such as race, sex, color, creed, or national origin. Annually, Butler Memorial Hospital establishes operating and capital budgets designed to efficiently allocate funds for its ongoing operation 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 for approval by the Board of Trustees. 0 Community Health Clinic of Butler County 103 Bonnie Drive Butler PA 16002 204852135 501 (c) (3) 55342 General Support to provide medical care of indigent patients 1 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, 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 X 1 1 0 0 0 0 0 1 0 Kenneth P DeFurio 485319 0 130712 0 30309 0 155458 0 39364 0 841162 0 0 0 Anne B Krebs 266576 0 40229 0 16704 0 48275 0 27410 0 399194 0 0 0 Stephanie Roskovski 239600 0 48002 0 13656 0 41489 0 21382 0 364129 0 0 0 Karen Allen 192471 0 39141 0 12436 0 25441 0 33109 0 302598 0 0 0 A Thomas McGill MD 306796 0 60786 0 21949 0 51885 0 27633 0 469049 0 0 0 John C Reefer MD 303574 0 60786 0 20290 0 53472 0 37359 0 475481 0 0 0 Paula L Hooper 234448 0 35849 0 14570 0 19976 0 36477 0 341320 0 0 0 Kevin M Stansbury 197411 0 20084 0 12471 0 26110 0 30890 0 286966 0 0 0 Maureen A Gray 118999 0 33297 0 110610 0 29001 0 26687 0 318594 0 0 0 Part I, Lines 4a-b 4 (b) Maureen Gray received payment of 3,275 as part of a Senior Executive Benefit Plan for a tax-deferred Capital Accumulation Account. The amount represents the amount paid out after a two year vesting period. The program was discontinued in January, 2009. However, in some cases payments have been deferred into future years. 4 (b) As part of the Senior Executive Benefit Plan, the organization contributes to a SERP plan. The SERP plan is a benefit used to retain executives. Executives do not receive any payment from the plan until they reach a vesting milestone at 5 years, 10 years and then finally at 65 years of age. Benefits paid to the participant are taxable. The organization contributed the following amounts to the SERP plan for the following individuals: 4 (b) Kenneth P DeFurio 138,458; Anne B Krebs 32,183; Maureen A Gray 26,637; Stephanie J Roskovski 26,687; A Thomas McGill MD 36,472; John C Reefer MD 36,472; Paula L Hooper 16,729; Karen A Allen 13,699; Kevin M Stansbury 14,059 4 (a) The following individuals received a severence for the organization: Maureen Gray received a severance of 102,451 for duties associated with the position of Chief Experience Officer Part I, Line 7 Officers and employees are eligible and received bonus compensation. Bonuses are not guaranteed and are awarded based on Board approved metrics which include quality, services and financial performances. Supplemental Information Part III Butler Health System Executive Compensation Philosophy and Process Although compensated through Butler Healthcare Providers, this philosophy and process applies to the following related nonprofit organizations; Butler Health System, Butler Health System Foundation, Butler Medical Providers and Nixsar. 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 and changing rapidly. 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. Exception 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. While benefits are accounted for in Schedule J, actual "take home" pay to the executive consists only of base salary and incentive award earned, if any. 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% executive compensation. The Board of Trustees engages external compensation and legal expertise to assure reasonableness of executive compensation levels. A Butler County Hospital Authority 251458912 1235926QB 2009-04-29 50000000 Construction of addition to hospital 0 1 0 B Butler County Hospital Authority 251458912 123592CPO 2009-04-29 74728451 Construction of addition to hospital 0 1 0 C Butler County Hospital Authority 251458912 000000000 2010-06-29 12165000 Construction of addition to hospital 0 1 0 A 5610000 50000000 833495 49166505 2010 0 0 0 1 B 74728451 6853385 1419179 66455887 2010 0 0 0 1 C 12165000 217226 0 0 0 1 A 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 C 0 0 0 0 0 0 0 A 0 0 0 0 1 0 0 0 0 B 0 0 0 0 0 0 0 0 0 C 0 0 0 0 1 0 0 0 0 Schedule K Part I, Bond Issues: (a) Issuer Name: Butler County Hospital Authority (f) Description of Purpose: Construction of addition to hospital (a) Issuer Name: Butler County Hospital Authority (f) Description of Purpose: Construction of addition to hospital (a) Issuer Name: Butler County Hospital Authority (f) Description of Purpose: Construction of addition to hospital 181450 0 Mario Kinsella MD Member of the Board of Trustees of Org;Officer of AIRMED with 14% ownership 641946 Assoc in Respiratory Mediciane, AIRMED,provides respiratory services for the organization 0 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 11 The completed 990 was reviewed by the Chief Financial Officer and an outside independent public accounting firm. Relevant sections were reviewed by the Vice President and General Counsel. Highlights of the Form 990 were 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 Boards 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 General Counsel, 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 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 recues himself/herself from the discussion and vote. The recusal is documented in the minutes. The Vice President and 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 and changing rapidly. 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. Exception 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. While benefits are accounted for in Schedule J, actual "take home" pay to the executive 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% executive compensation. The Board of Trustees engages external compensation and legal expertise to assure reasonableness of executive compensation levels. Form 990, Part VI, Section C, line 19 Historically 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. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 9: Transfers (to) from affiliates -6,800,000. Accumulated liability for pension benefits 9,675,002. Increase in interest in investment of BHS assets 92,559. 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 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 251441855 Physician Practices PA 501(c)(3) Line 3 Butler Health System 0 Butler Health System Foundation One Hospital Way Butler PA 16001 261543883 Fundraising on behalf of Butler Health System PA 501(c)(3) Line 11a, I 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 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 -308374 -419645 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 0 1 1 1 1 1 0 1 BHS FastERcare J 229754 BHS FastERcare Q 2110407