2023-05-15T08:02:27-05:00 2022-06-30 390859910 BAKER TILLY US LLP 1570 FRUITVILLE PIKE SUITE 400 LANCASTER PA 17601 990 2021-07-01 571138956 THE FOUNDATION FOR MOUNT NITTANY MEDICAL CENTER INC FOUN 8142317000 1800 EAST PARK AVENUE STATE COLLEGE PA 168036796 BRYAN ROACH SR. EXECUTIVE VP & CFO 8142317000 2023-05-10 1 BRYAN ROACH 999009999 KERRI N BOGDA CPA P00760402 7177404863 2023-05-10 X 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z MOUNT NITTANY HEALTH FOUNDATION KATHLEEN RHINE 1800 EAST PARK AVENUE STATE COLLEGE PA 168036796 19564090 0 X WWW.MOUNTNITTANY.ORG X 2003 PA PROVIDE FUNDRAISING & SUPPORT TO FURTHER THE CHARITABLE, EDUCATIONAL & SCIENTIFIC PURPOSES OF MNMC. 11 10 8 185 0 0 2206123 2174998 0 0 463645 3925917 -11959 -21831 2657809 6079084 3134176 1838041 0 0 663639 698756 0 0 842784 344534 299842 4142349 2836639 -1484540 3242445 18337133 15006858 316431 262022 18020702 14744836 X TO PROVIDE FUNDRAISING AND OTHER SUPPORT TO FURTHER THE CHARITABLE, EDUCATIONAL, AND SCIENTIFIC PURPOSES OF ITS CONTROLLING ENTITY, MOUNT NITTANY HEALTH SYSTEM. 0 0 1838041 1838041 0 THE FOUNDATION FOR MOUNT NITTANY MEDICAL CENTER, INC. IS AN AFFILIATE OF MOUNT NITTANY HEALTH SYSTEM (HEALTH SYSTEM) WHICH INCLUDES AN ACUTE CARE HOSPITAL WITH 260 BEDS (MOUNT NITTANY MEDICAL CENTER), MOUNT NITTANY MEDICAL CENTER HEALTH SERVICES, INC., MOUNT NITTANY PHYSICIAN GROUP, CENTRE COUNTY CHILDREN'S ADVOCACY CENTER, AND THE FOUNDATION FOR MOUNT NITTANY MEDICAL CENTER, INC. THE MISSION IS DEDICATED TO IMPROVING THE QUALITY OF LIFE FOR PEOPLE OF OUR REGION BY SUPPORTING THE ADVANCEMENT OF HEALTHCARE AT MOUNT NITTANY HEALTH.CONTINUED ON SCHEDULE O.THE FOUNDATION SUPPORTS FUNDRAISING AND OTHER ACTIVITIES TO FURTHER THE CHARITABLE, EDUCATIONAL, AND SCIENTIFIC PURPOSES OF MOUNT NITTANY MEDICAL CENTER ("MNMC"). ACTIVITIES WITHIN FISCAL YEAR 2022 INCLUDED THE FOLLOWING:MOUNT NITTANY HEALTH FOUNDATION RAISED IN CASH GIFTS, $2,287,415 AND $162,500 IN PLEDGE COMMITMENTS FOR THE CHILD ADVOCACY CENTER.THE 30TH ANNUAL GOLF CLASSIC RAISED $201,400 TO SUPPORT CARDIOVASCULAR SERVICES AT MOUNT NITTANY MEDICAL CENTER. THE 74TH ANNUAL CHARITY BALL WAS HELD AT MEDLAR FIELD AT LUBRANO PARK. THE EVENT RAISED $120,000 FOR MOUNT NITTANY HEALTH'S WOMEN AND CHILDREN'S SERVICES.PLEDGE PAYMENTS:- CARDIOVASCULAR PAVILION - COLLECTED $69,449 FROM PAST PLEDGES - PHARMACY FUND - COLLECTED $5,000, FROM A PAST PLEDGES- LINEAR ACCELERATOR - COLLECTED $50,000 FROM A PAST PLEDGESPROGRAMMATIC FUNDINGCHILDREN'S ADVOCACY CENTER (CAC):THE SUPPORT TO THE CAC TOTALED $338,280 WHICH WAS CUMULATIVE FUNDING CENTRE COUNTY JURY PROGRAM, BRIDGE-A-RAMA, CENTRE GIVES, AND GENERAL COMMUNITY SUPPORT.DR. WAYNE J. SEBASTIANELLI LEADERSHIP DEVELOPMENT ENDOWMENT:CREATED THROUGH A LEAD GIFT FROM MOUNT NITTANY MEDICAL CENTER MEDICAL STAFF IN HONOR OF THE SERVICE OF THE CHIEF OF STAFF FOR 20 YEARS, THIS ENDOWMENT WILL SUPPORT PHYSICIANS AND OTHER MEDICAL STAFF ACCESS TO LEADERSHIP TRAINING FOR THE BENEFIT OF MOUNT NITTANY MEDICAL CENTER. OVER $38,000 WAS RAISED IN THIS FISCAL YEAR. OUTPATIENT BUILDING:CLOSE SUPPORTERS OF MOUNT NITTANY HEALTH SUPPORTED THE PLANNING OF THIS EFFORT WITH $100,000. 1838041 1 1 0 0 0 0 0 0 0 1 1 1 0 0 1 0 1 1 0 0 0 0 0 0 1 0 0 1 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 X 0 2 8 0 0 0 0 0 0 1 1 0 0 0 0 0 0 X 11 10 0 0 0 0 0 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 PA X BRYAN ROACH SR EXECUTIVE VP & CFO 8142317000 1800 EAST PARK AVENUE STATE COLLEGE PA 168036796 WILLIAM P HAYES CHAIR 2.00 X X 0 0 0 KAY KUSTANBAUTER VICE CHAIR 2.00 X X 0 0 0 KASANDRA A BOTTI DO SECRETARY 2.00 X X 0 0 0 BETH KALENAK TREASURER 2.00 X X 0 0 0 KATHLEEN RHINE PRESIDENT/CEO 2.00 38.00 X X 0 1099600 134367 THOMAS J TARICANI TREASURER 2.00 2.00 X X 0 0 0 JOHN CARDER DDS DIRECTOR 2.00 X 0 0 0 MICHAEL HAWBAKER DIRECTOR 2.00 X 0 0 0 PAUL TOMCZUK DIRECTOR 2.00 X 0 0 0 THEODORE ZIFF MD DIRECTOR 2.00 2.00 X 0 0 0 TED OYLER DIRECTOR 2.00 X 0 0 0 BRYAN ROACH EXECUTIVE VP/CFO 2.00 38.00 X 0 599631 49022 SIMON CORBY EXECUTIVE DIRECTOR (UNTIL 5/22) 40.00 X 195765 0 19808 LANCE ROSE FORMER CEO/OFFICER/DIRECTOR 0.00 0.00 X 0 14721 0 195765 1713952 203197 1 1 1 0 0 300036 1874962 30862 2174998 16707 16707 17268442 13359232 3909210 3909210 3909210 103943 300036 125774 -21831 -21831 6079084 0 0 3904086 1838041 1838041 555950 555950 15600 15600 82008 82008 45198 45198 45330 45330 15900 15900 94379 94379 24428 24428 60400 60400 992 992 205 205 CONTRIBUTOR RECOGNITION 21594 21594 MINOR EQUIPMENT 5103 5103 DUES & SUBSCRIPTIONS 3242 3242 SPECIAL EVENTS 176 176 28093 28093 2836639 1838041 155814 842784 390824 859088 458044 453826 65 291 13500 13500 204 0 736985 149608 16751011 13544045 18337133 15006858 112975 46376 203456 215646 316431 262022 X 11428617 9035706 6592085 5709130 18020702 14744836 18337133 15006858 3242445 -6518311 0 X 0 1 X 1 0 X X 1 MOUNT NITTANY MEDICAL CENTER 240795682 3 1 1696610 0 1 1696610 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 PART IV, SECTION B, LINE 1: BOARD MEMBERS OF THE FOUNDATION ARE APPOINTED BY THE MOUNT NITTANY HEALTH SYSTEM (MNHS). MNHS IS THE PARENT ENTITY FOR BOTH THE FOUNDATION AND MOUNT NITTANY MEDICAL CENTER (MNMC), THE SUPPORTED ORGANIZATION. MNMC EFFECTIVELY SUPERVISES/CONTROLS THE ACTIVITIES OF THE FOUNDATION THROUGH COMMON MANAGEMENT AND COMMON PARENT ENTITY OVERSEEING BOTH ENTITIES. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 4158932 30000 -691528 3497404 3414155 10250 734527 4158932 3422460 10000 -18305 3414155 2541959 720554 159947 3422460 2394232 58475 89252 2541959 0.19660 0.80340 0 0 13500 13500 0 0 ALTERNATIVE INVESTMENTS 13544045 F 13544045 REFUNDABLE ADVANCE FROM MOUNT NITTANY MEDICAL CENTER 156060 CHARITABLE GIFT ANNUITY LIABILITY 59586 215646 -407832 -6518311 -94379 -6612690 6204858 -125774 -125774 6079084 2868034 125774 125774 2742260 94379 94379 2836639 PART V, LINE 4: PERMANENT ENDOWMENT FUNDS ARE HELD BY THE FOUNDATION FOR MOUNT NITTANY MEDICAL CENTER, INC. AND EARNINGS ARE DESIGNATED TO FUND FUTURE EXPENDITURES AND CAPITAL ACQUISITIONS FOR MOUNT NITTANY MEDICAL CENTER. PART XI, LINE 2D - OTHER ADJUSTMENTS: INVESTMENT FEES NETTED AGAINST REVENUE ON FINANCIALS -94,379. PART XI, LINE 4B - OTHER ADJUSTMENTS: FUNDRAISING EVENT EXPENSES -125,774. PART XII, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EVENT EXPENSES 125,774. PART XII, LINE 4B - OTHER ADJUSTMENTS: INVESTMENT FEES NETTED AGAINST REVENUE ON FINANCIALS 94,379. GOLF CLASSIC 201400 160407 40993 10306 16011 16262 4371 CHARITY BALL 202579 139629 62950 78824 403979 300036 103943 10306 16011 16262 83195 125774 -21831 1 MOUNT NITTANY MEDICAL CENTER 1800 EAST PARK AVENUE STATE COLLEGE PA 16803 240795682 501(C)(3) 1696610 0 N/A N/A PROVIDE FINANCIAL SUPPORT TO AFFILIATE CENTRE COUNTY CHILDREN'S ADVOCACY CENTER 1800 EAST PARK AVENUE STATE COLLEGE PA 16803 460871813 501(C)(3) 141431 0 N/A N/A PROVIDE FINANCIAL SUPPORT TO AFFILIATE 2 0 PART I, LINE 2: ASSISTANCE IS PROVIDED TO RELATED ENTITIES FOR FINANCIAL SUPPORT. MANAGEMENT OF THE HEALTH SYSTEM OVERSEES THE USE OF FUNDS AT THE AFFILIATED ENTITIES. 0 1 0 0 0 0 0 1 0 KATHLEEN RHINE PRESIDENT/CEO 0 818048 0 262763 0 18789 0 124052 0 10315 0 1233967 0 0 BRYAN ROACH EXECUTIVE VP/CFO 0 480727 0 107092 0 11812 0 19884 0 29138 0 648653 0 0 SIMON CORBY EXECUTIVE DIRECTOR (UNTIL 5/22) 184945 0 10502 0 318 0 9343 0 10465 0 215573 0 0 0 LANCE ROSE FORMER CEO/OFFICER/DIRECTOR 0 0 0 0 0 14721 0 0 0 0 0 14721 0 0 PART I, LINE 3 THE CEO IS AN EMPLOYEE OF MOUNT NITTANY MEDICAL CENTER ("MNMC"). MNMC USES ALL OF THE METHODS UNDER LINE 3 OTHER THAN REVIEWING 990S OF OTHER ORGANIZATIONS TO ESTABLISH HIS COMPENSATION. PART I, LINE 4B THE FORMER CEO, LANCE ROSE, RECEIVED A NONQUALIFIED RETIREMENT PLAN PAYMENT OF $14,721 DURING THE CALENDAR YEAR. THE CHIEF EXECUTIVE OFFICER, KATHLEEN RHINE, PARTICIPATES IN 457(F) NON-QUALIFIED RETIREMENT PLAN. CONTRIBUTIONS MADE DURING THE CALENDAR YEAR WERE $104,138. THERE WERE NO DISTIBUTIONS DURING THE CALENDAR YEAR. PART I, LINE 7 THE EXECUTIVE TEAM MEMBERS OF MOUNT NITTANY MEDICAL CENTER AND THE MOUNT NITTANY MEDICAL CENTER HEALTH SERVICES (D/B/A MOUNT NITTANY PHYSICIAN GROUP) EXECUTIVE DIRECTOR RECEIVED A PORTION OF THEIR ANNUAL VARIABLE-PAY BASED UPON THE CONSOLIDATED OPERATING MARGIN, MOUNT NITTANY MEDICAL CENTER HEALTH SERVICES' (D/B/A MOUNT NITTANY PHYSICIAN GROUP) OPERATING MARGIN, CONTRIBUTIONS, AND OTHER CORPORATE GOALS. THE CORPORATE GOALS FOCUSED ON (1) PROVIDING LOCALIZED CARE, INTEGRATED CARE, EFFICIENT CARE, AND ALIGNED CARE; (2) FINANCE; (3) QUALITY/PATIENT SAFETY; AND (4) THE WORK ENVIRONMENT. X 1 30862 CLOSING COST 0 0 0 FORM 990, PART V, LINE 2: ALL STAFF WORKING AT THE ORGANIZATION ARE EMPLOYEES OF A RELATED ORGANIZATION, MOUNT NITTANY MEDICAL CENTER ("MNMC"). MNMC FILES ALL REQUIRED EMPLOYMENT TAX RETURNS UNDER ITS EIN. FORM 990, PART VI, SECTION A, LINE 7A AS THE PARENT ENTITY, MOUNT NITTANY HEALTH SYSTEM (MNHS) HAS THE POWER TO APPOINT AND REMOVE, OR APPROVE THE REMOVAL OF, ANY AND ALL DIRECTORS OF THE CORPORATION, WITH THE EXCEPTION OF EX-OFFICIO DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B MNHS HAS THE FOLLOWING POWERS: (A) TO APPOINT AND REMOVE, OR APPROVE THE REMOVAL OF, ANY AND ALL DIRECTORS OF THE CORPORATION, WITH THE EXCEPTION OF THE EX-OFFICIO DIRECTOR; (B) TO APPROVE THE ELECTION OF AND TO REMOVE ANY AND ALL OFFICERS OF THE CORPORATION; (C) TO DEVELOP AND APPROVE ALL ANNUAL OPERATING AND CAPITAL BUDGETS OF THE CORPORATION (INCLUDING ALL AMENDMENTS THERETO); (D) TO APPROVE THE INCURRENCE, RE-FINANCING, OR PREPAYMENT OF ANY INDEBTEDNESS OF THE CORPORATION; (E) TO APPROVE THE SECURING OF ANY MORTGAGE, DEED OF TRUST, PLEDGE, SECURITY INTEREST, OR OTHER ENCUMBRANCE OF THE CORPORATION; (F) EXCEPT AS MAY BE INVOLVED THEREAFTER IN ORDINARY REPAIRS, MAINTENANCE, AND REPLACEMENT, AND EXCEPT AS MAY HAVE ALREADY BEEN APPROVED AS PART OF THE CAPITAL BUDGET, TO APPROVE THE MAKING OF ANY CAPITAL EXPENDITURE OR CAPITAL ADDITION OR IMPROVEMENT; (G) TO APPROVE ALL UNBUDGETED EXPENDITURES IN EXCESS OF 1% OF EACH SUCH BUDGET; (H) TO APPROVE THE MOVEMENT OF FUNDS TO AND FROM THIS CORPORATION TO THE PARENT OR OTHER ENTITIES RELATED TO THE PARENT; (I) TO APPROVE ALL STRATEGIC PLANS OF THE CORPORATION; (J) TO SELECT THE INDEPENDENT AUDITORS AND LEGAL COUNSEL OF THE CORPORATION; (K) TO AMEND OR TO APPROVE AMENDMENTS, ALTERATIONS AND MODIFICATIONS TO OR REPEALS OF THE ARTICLES OF INCORPORATION AND BYLAWS OF THE CORPORATION IN ACCORDANCE WITH SECTION 10.1 HEREOF; (L) TO ENTER INTO, AMEND, OR TERMINATE ANY AGREEMENT WITH A MATERIAL THIRD PARTY, AS DETERMINED BY THE PARENT IN ITS SOLE DISCRETION; (M) TO APPROVE ALL AMENDMENTS TO ARTICLES OF INCORPORATION, MERGERS, CONSOLIDATIONS, DIVISIONS, SALES OF SUBSTANTIALLY ALL ASSETS, LIQUIDATION OR DISSOLUTION OF THE CORPORATION, AND ALL OTHER FUNDAMENTAL CHANGE TRANSACTIONS, AS WELL AS ALL TRANSACTIONS OUTSIDE THE ORDINARY COURSE OF BUSINESS; (N) TO ESTABLISH, TERMINATE, OR WITHDRAW FROM ANY SUBSIDIARY, JOINT VENTURE, OR OTHER PARTNERSHIP OR SHARED GOVERNANCE AGREEMENT; (O) TO ENTER INTO, AMEND, OR TERMINATE ANY AGREEMENT BETWEEN THE CORPORATION AND THE PARENT; (P) TO ENTER INTO, AMEND, OR TERMINATE AN AFFILIATION AGREEMENT WITH ANY HOSPITAL, PROVIDER, PAYOR, OR HEALTH CARE SYSTEM; AND (Q) TO TAKE ANY OTHER ACTION THAT IS RESERVED TO THE PARENT FROM TIME TO TIME BY THE CORPORATION'S BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11B THE 990 WAS PROVIDED TO THE BOARD OF DIRECTORS AND TO THE MOUNT NITTANY HEALTH SYSTEM AUDIT COMMITTEE BEFORE BEING FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY, THE CONFLICT OF INTEREST POLICY IS DISTRIBUTED TO KEY MEMBERS OF THE ORGANIZATION INCLUDING BOARD MEMBERS, OFFICERS, AND KEY EMPLOYEES. EACH PERSON MUST REPORT ANY POTENTIAL CONFLICTS OF INTEREST. REPORTED CONFLICTS ARE THEN REVIEWED BY THE CORPORATE COMPLIANCE OFFICER AND THE HEALTH SYSTEM'S AUDIT COMMITTEE. THE CONFLICT OF INTEREST REPORT IS THEN SUBMITTED TO THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD OF DIRECTORS' EXECUTIVE & PHYSICIAN COMPENSATION COMMITTEE REVIEWS COMPENSATION PAID TO EXECUTIVE MANAGEMENT TEAM IN CONJUNCTION WITH AN INDEPENDENT THIRD PARTY CONSULTING FIRM TO ENSURE COMPENSATION IS REASONABLE AND APPROPRIATE FOR DUTIES AND RESPONSIBILITES ASSIGNED. THE PROCESS IS DESIGNED TO ENABLE THE HEALTH SYSTEM TO ATTRACT, MOTIVATE, AND RETAIN THE HIGHLY SKILLED EXECUTIVE TALENT NEEDED TO CARRY OUT ITS MISSION AND STRATEGIC OBJECTIVES THROUGH THE ESTABLISHMENT OF SALARIES, BENEFITS, AND VARIABLE PAY OPPORTUNITIES THAT ARE REASONABLE, COMPARABLE WITH THOSE FOR SIMILAR POSITIONS IN SIMILARLY SITUATED NOT-FOR-PROFIT ORGANIZATIONS, AND REWARD ACHIEVEMENT OF ORGANIZATIONAL AND INDIVIDUAL OBJECTIVES. THE EXECUTIVE & PHYSICIAN COMPENSATION COMMITTEE ENSURES THAT THE BOARD FULLY UNDERSTANDS THE PROCESS BY WHICH THE ORGANIZATION'S OFFICERS/KEY EMPLOYEE COMPENSATION DECISIONS ARE MADE. THE COMMITTEE REVIEWS AND APPROVES EXECUTIVE COMPENSATION IN A MANNER THAT QUALIFIES FOR THE REBUTTABLE PRESUMPTION OF REASONABLENESS UNDER THE IRS INTERMEDIATE SANCTIONS RULES. THE COMMITTEE REPORTS ITS ACTIVITIES TO THE BOARD, INCLUDING THE SPECIFIC DETAILS OF COMPENSATION ACTIONS. THE BOARD HAS DELEGATED TO THE COMMITTEE THE AUTHORITY TO MAKE COMPENSATION DECISIONS. THE BOARD BEARS THE ULTIMATE RESPONSIBILITY FOR ENSURING SOUND DECISION-MAKING IN THIS AREA. REVIEW AND APPROVAL OF COMPENSATION IS DOCUMENTED VIA MINUTES OF COMMITTEE MEETINGS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. MOUNT NITTANY MEDICAL CENTER 1800 EAST PARK AVE STATE COLLEGE PA 16803 240795682 HEALTHCARE PA 501(C)(3) LINE 3 MOUNT NITTANY HEALTH SYSTEM 0 MOUNT NITTANY MEDICAL CENTER WORKMEN'S COMPENSATION SELF INSURANCE TRUST 1800 EAST PARK AVE STATE COLLEGE PA 16803 256440788 PROVIDE WORKMEN'S COMPENSATION BENEFITS TO EMPLOYEES OF AFFILIATE PA 501(C)(3) LINE 12A, I MOUNT NITTANY MEDICAL CENTER 0 MOUNT NITTANY MEDICAL CENTER HEALTH SERVICES INC 1800 EAST PARK AVE STATE COLLEGE PA 16803 510426500 PROFESSIONAL SERVICES TO SUPPORT AFFILIATE PA 501(C)(3) LINE 10 MOUNT NITTANY HEALTH SYSTEM 0 MOUNT NITTANY HEALTH SYSTEM 1800 EAST PARK AVE STATE COLLEGE PA 16803 800663092 PROVIDE MANAGEMENT AND ADMINISTRATIVE SUPPORT TO AFFILIATES PA 501(C)(3) LINE 12A, I N/A 0 CENTRE COUNTY CHILDREN'S ADVOCACY CENTER 1800 EAST PARK AVE STATE COLLEGE PA 16803 460871813 CHILD-FOCUSED APPROACH TO CHILD ABUSE CASES PA 501(C)(3) LINE 7 MOUNT NITTANY MEDICAL CENTER 0 0 1 1 0 0 0 0 0 0 0 0 1 0 1 1 0 0 1 1