2021-05-17T13:16:06-05:00 2020-06-30 BKD LLP 910 E ST LOUIS 200/PO BOX 1190 SPRINGFIELD MO 658062523 990 2019-07-01 250965579 TITUSVILLE AREA HOSPITAL % JILL NEELY TITU 8148271851 406 WEST OAK STREET TITUSVILLE PA 16354 LEE CLINTON CEO 2021-05-08 true Brian D Todd P00422601 4178658701 2019 2022-09-23 18:48:47Z LEE M CLINTON 406 WEST OAK STREET TITUSVILLE PA 16354 44150752 false X WWW.TITUSVILLEHOSPITAL.ORG X 1900 PA TAH IS A COMMUNITY BASED, ACUTE CARE, CRITICAL ACCESS HOSPITAL PROVIDING INPATIENT, OUTPATIENT AND EMERGENCY SERVICES TO MORE THAN 30,000 PEOPLE IN 4 COUNTIES IN PA. 11 11 262 75 0 0 144980 2038140 34320732 41379840 -51553 -180338 640583 629682 35054742 43867324 0 0 0 0 15647216 24573387 0 0 0 17937303 20775030 33584519 45348417 1470223 -1481093 27810176 30410868 24225937 27412683 3584239 2998185 X TITUSVILLE AREA HOSPITAL IS COMMITTED TO PROVIDING QUALITY HEALTHCARE SERVICES WITH AN EMPHASIS ON PERSONAL ATTENTION, COMPASSION AND RESPECT. true false 38546826 41379840 TITUSVILLE AREA HOSPITAL IS AN ACUTE CARE, CRITICAL ACCESS RURAL HOSPITAL WITH 661 ADMISSIONS, 3,512 PATIENT DAYS AND 54,018 OUTPATIENT VISITS. 38546826 true true false true false false false false false false true true false false true false false true false false false false false false false false true true false false true false false false false false false false false false false false false false true true true false false true X 0 0 262 true false false false false false false false false false false false false X 11 11 true false false false true true true true true false false true true true true true true true true false PA X JILL NEELY 8148271851 406 WEST OAK STREET TITUSVILLE PA 16354 MICHAEL DVORKIN PHYSICIAN 40.0 0.0 X 620340 0 21383 DWAIN ROGERS PHYSICIAN 40.0 0.0 X 452852 0 23222 LEE M CLINTON CEO/PRESIDENT 35.0 5.0 X 277606 0 36902 MARIA MUNOZ PHYSICIAN 40.0 0.0 X 241302 0 12993 JAMES WILKENS PHYSICIAN 40.0 0.0 X 215823 0 22282 MARY GIDOR PHYSICIAN END 12/19 40.0 0.0 X 167871 0 18511 JILL NEELY CFO/TREASURER 35.0 5.0 X 146904 0 26346 JASON REAGLE CHAIRMAN 1.0 1.0 X X 0 0 0 RICHARD CARR DIRECTOR 1.0 1.0 X 0 0 0 STEPHEN COLEMAN SECRETARY 1.0 1.0 X X 0 0 0 SCOTT MCALLISTER MD DIRECTOR 1.0 1.0 X 0 0 0 LARRY FLEDDERMAN VICE CHAIRMAN 1.0 2.0 X X 0 0 0 PATRICIA WALKER DIRECTOR 1.0 1.0 X 0 0 0 JOSEPH CARTER DIRECTOR 1.0 1.0 X 0 0 0 MICHAEL R THOMSON DIRECTOR 1.0 1.0 X 0 0 0 MARK MEHLENBACHER DIRECTOR 1.0 1.0 X 0 0 0 KENNETH WINGER DIRECTOR 1.0 2.0 X 0 0 0 BRIAN NAGEOTTE DIRECTOR BEG 3/19 1.0 1.0 X 0 0 0 2122698 0 161639 8 false true false OIL VALLEY INTERNAL MEDICINE ASSOCI 339 W SPRING ST TITUSVILLE PA 16354 MEDICAL PURCH SVCS 1756305 OIL VALLEY PHYSICAL THERAPY 228 E CENTRAL AVE TITUSVILLE PA 16354 PHYSICAL THERAPY 1048532 EMCARE 7032 COLLECTION CENTER DR CHICAGO IL 60693 ER PHYSICIANS 892869 OIL VALLEY HOSPITALISTS 339 W SPRING ST TITUSVILLE PA 16354 HOSPITALIST 534745 CPS LLC 6409 N QUAIL HOLLOW RD MEMPHIS TN 38120 PHARMACY ADMIN SVCS 495048 11 25744 1786851 225545 2038140 NET PATIENT SERVICE REVENUE 621990 40435489 40435489 PHARMACY REVENUE 446110 433749 433749 RHC REVENUE 621498 254226 254226 CAFETERIA REVENUE 811000 106290 106290 OTHER REVENUE 900099 150086 150086 41379840 0 0 0 109750 41636 68114 0 68114 68114 61454 241792 -180338 -180338 -180338 0 0 0 0 0 0 0 0 0 INCOME FROM EQUITY INVESTEE 900099 561568 561568 561568 43867324 41379840 449344 X 0 0 0 0 487758 487758 0 18338766 15572331 2766435 414897 218520 196377 4012844 3338664 674180 1319122 1048853 270269 690984 690984 37010 37010 126094 126094 0 0 0 7736348 7199965 536383 82703 82703 646076 458270 187806 0 0 1907234 1907234 57564 50317 7247 0 18086 15755 2331 2054 2054 0 1205821 964657 241164 1410583 1363557 47026 MEDICAL SUPPLIES & DRUGS 6335248 6103667 231581 MISCELLANEOUS EXPENSE 373211 156843 216368 LICENSES, DUES, SUBSCRIPTIONS 146014 63436 82578 45348417 38546826 6801591 0 2970405 2176930 238291 24630 0 0 5640861 6960455 0 0 0 0 0 0 1067261 1007137 281702 442257 41202800 29458859 9772483 11743941 4423234 4651699 2749978 2910779 120000 0 0 0 545961 493040 27810176 30410868 2854910 2895324 0 0 0 3223113 0 0 0 0 0 0 603446 36994 0 0 20767581 21257252 24225937 27412683 X -57352 -573007 3641591 3571192 3584239 2998185 27810176 30410868 X -1481093 -4492 899531 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 8744 8744 false SCHEDULE C, PART II-B, LINE I OTHER LOBBYING ACTIVITIES: THE ORGANIZATION PAYS DUES TO THE AMERICAN HOSPITAL ASSOCIATION, OF WHICH $8,744 IS ATTRIBUTABLE TO LOBBYING. 667995 667995 13730247 11069921 2660326 173486 46837 126649 23533109 16639652 6893457 3097963 1702449 1395514 11743941 INVESTMENT - VANTAGE 94432 F INVESTMENT - CHART 2816347 C 2910779 0 DUE TO AFFILIATES 14583274 EST AMOUNTS TO 3RD PARTY 2457095 CONTRACT LIABILITIES 4216883 21257252 44014407 -4492 -70399 -74891 44089298 -221974 -221974 43867324 45570391 221974 221974 45348417 45348417 SCHEDULE D, PART X, LINE 2 UNCERTAIN TAX POSITION: MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. SCHEDULE D, PART XI, LINE 2D OTHER REVENUE ON LINE 1, BUT NOT ON FORM 990, PART VIII, LINE 12: $ (70,399) CHANGE IN BENEFICIAL INTEREST SCHEDULE D, PART XI, LINE 4B OTHER REVENUE ON FORM 990, PART VIII, LINE 12, BUT NOT ON LINE 1: $ (180,338) LOSS ON DISPOSAL OF ASSETS (41,636) RENTAL EXPENSES ------------- $ (221,974) SCHEDULE D, PART XII, LINE 2D OTHER EXPENSES ON LINE 1, BUT NOT ON FORM 990, PART IX, LINE 25: $ 180,338 LOSS ON DISPOSAL OF ASSETS 41,636 RENTAL EXPENSES ------------ $ 221,974 true true X true X true X true true true false true true 163891 163891 0.00360 6407518 4310326 2097192 0.04620 6571409 4310326 2261083 0.04980 1200 1200 1255 1255 2455 2455 6573864 4310326 2263538 0.04980 false 3104685 750812 9683971 9425691 258280 X true false 1 1 TITUSVILLE AREA HOSPITAL 406 WEST OAK STREET TITUSVILLE PA 16354 WWW.TITUSVILLEHOSPITAL.ORG 200901 X X X X TITUSVILLE AREA HOSPITAL 1 false false true X X X X X X X X X 18 true true true true X SEE PART V, SECTION C X SEE PART V, SECTION C X true 18 true SEE PART V, SECTION C false true X 200. 300. X X X X true true X X X true X SEE PART V, SECTION C X SEE PART V, SECTION C X SEE PART V, SECTION C X X X true X false X X X X true X false false SCHEDULE H, PART V, SECTION B, LINE 5 COMMUNITY INPUT: THE RESEARCH PROCESS INCLUDED A WIDE BASED SURVEY OF THE POPULATION. THE SURVEY INCLUDED INPUT FROM UNDERREPRESENTED GROUPS IN PUBLIC HOUSING. BOTH ELECTRONIC SURVEYS AND FACE TO FACE PAPER SURVEYS WERE COMPLETED. A GOOD DIVERSITY OF RESPONSE WAS REALIZED. SCHEDULE H, PART V, SECTION B, LINE 6A OTHER HOSPITAL FACILITIES: THE CHNA REPORT WAS CONDUCTED WITH MEADVILLE MEDICAL CENTER, AN AFFILIATED ENTITY. SCHEDULE H, PART V, SECTION B, LINE 6B OTHER ORGANIZATIONS OTHER THAN HOSPITAL FACILITIES: THE CHNA REPORT WAS CONDUCTED WITH CRAWFORD HEALTH IMPROVEMENT COALITION AND ALLEGHENY COLLEGE. SCHEDULE H, PART V, SECTION B, LINE 7A HOSPITAL FACILITY'S WEBSITE: HTTPS://WWW.TITUSVILLEHOSPITAL.ORG/PATIENT-VISITORS/COMMUNITY-HEALTH-NEEDS -ASSESSMENT.ASPX SCHEDULE H, PART V, SECTION B, LINE 7B OTHER WEBSITE: HTTP://WWW.MMCHS.ORG/PATIENT-VISITORS/COMMUNITY-HEALTH-NEEDS-ASSESSMENT.AS PX SCHEDULE H, PART V, SECTION B, LINE 10 IMPLEMENATION STRATEGY WEBSITE: HTTPS://WWW.TITUSVILLEHOSPITAL.ORG/PATIENT-VISITORS/COMMUNITY-HEALTH-NEEDS -ASSESSMENT.ASPX SCHEDULE H, PART V, SECTION B, LINE 11 ADDRESSING IDENTIFIED NEEDS: IN RESPONSE TO THE RESULTS OF TITUSVILLE AREA HOSPITAL'S MOST RECENTLY CONDUCTED COMMUNITY HEALTH NEEDS ASSESSMENT, THE ORGANIZATION ADOPTED AN IMPLEMENTATION STRATEGY. THE 2019 COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) CONDUCTED IN COLLABORATION BETWEEN MEADVILLE MEDICAL CENTER, TITUSVILLE AREA HOSPITAL AND ALLEGHENY COLLEGE LOOKED AT DATA COLLECTED FROM MORE THAN 1,100 ADULT PARTICIPANTS FROM ACROSS CRAWFORD COUNTY. ONLINE AND IN PERSON SURVEYS FOCUSED ON CANCER PREVENTION, WHICH SHOWED TO BE THE PRIMARY HEALTHCARE ISSUE IN THE 2015 CHNA. THE 2019 CHNA SHOWED THAT THE RATE OF CANCER INCIDENCE IN CRAWFORD COUNTY WAS HIGHER THAN BOTH THE COMMONWEALTH OF PENNSYLVANIA AND THE UNITED STATES, AT RATES OF 494.4 IN CRAWFORD COUNTY, 481.7 IN PENNSYLVANIA AND 441.2 NATIONWIDE PER 100,000 PEOPLE. LUNG CANCER IS 48% HIGHER THAN THE NATIONAL RATE, COLON CANCER IS 28% HIGHER, AND CERVICAL CANCER IS 20% HIGHER. THE MORTALITY RATE FROM CANCER IS ALSO HIGHER IN CRAWFORD COUNTY AT 183.5 PER 100,000, AS COMPARED TO PENNSYLVANIA WHICH IS 171.6 PER 100,000 AND NATIONWIDE AT 163.5 PER 100,000. THE LEADING RISK FACTORS FOR THE INCREASED RATE OF CANCER IN THE COUNTY IS A RESULT OF SMOKING, UNDERSTANDING HUMAN PAPILLOMAVIRUS (HPV) AND PREVENTATIVE SCREENINGS. 35% OF ALL RESPONDENTS REPORTED BEING A CURRENT OR FORMER SMOKER, WITH 70% OF THEM BEING BETWEEN THE AGES OF 18-54. TYPICALLY, THESE RESPONDENTS WERE ASSOCIATED WITH A LOWER LEVEL OF EDUCATION, LOWER RATES OF SCREENING AND/OR DID NOT HAVE A PRIMARY CARE PHYSICIAN. BETWEEN 2015 AND 2018 THE CHNA RESULTS SHOWED A 14% DECREASE IN THE NUMBER OF RESIDENTS REPORTING THEY HAVE A PRIMARY CARE PHYSICIAN. TITUSVILLE AREA HOSPITAL IS COMMITTED TO DECREASING THE RATE OF CANCER AMONG THE RESIDENTS OF CRAWFORD COUNTY BY INCREASING SMOKING CESSATION EDUCATION, INCREASING HPV VACCINATIONS AND CONNECTING RESIDENTS WITH PRIMARY CARE PHYSICIANS. SCHEDULE H, PART V, SECTION B, LINES 16A, 16B, & 16C FAP, FAP APPLICATION, AND PLS WEBSITE: https://www.titusvillehospital.org/Patient-Visitors/Billing-Insurance/Fina ncial-Assistance.aspx 7 CONNEAUT VALLEY HEALTH CENTER 906 WASHINGTON ST CONNEAUTVILLE PA 16406 FAMILY MEDICINE CAMBRIDGE SPRINGS HEALTH CENTER 118 RAILROAD ST CAMBRIDGE PA 16403 FAMILY MEDICINE CONNEAUT LAKE HEALTH CENTER 10926 PA-18 CONNEAUT LAKE PA 16316 FAMILY MEDICINE MEADVILLE COMMUNITY HEALTH 747 TERRACE ST MEADVILLE PA 16335 FAMILY MEDICINE SAEGERTOWN MEDICAL ASSOCIATES 707 ERIE ST SAEGERTOWN PA 16443 FAMILY MEDICINE VALLEY DENTAL CENTER 906 WASHINGTON STREET CONNEAUTVILLE PA 16406 DENTAL SERVICES ALDEN PRIMARY CARE 640 ALDEN ST MEADVILLE PA 16335 FAMILY MEDICINE SCHEDULE H, PART I, LINE 7, COLUMN F PERCENT OF TOTAL EXPENSE: TO ARRIVE AT THE PERCENT OF TOTAL EXPENSES, THE DENOMINATOR WHICH EQUALS TOTAL OPERATING EXPENSES PER PART IX, LINE 25 OF THE FORM 990. SCHEDULE H, PART I, LINE 7 COSTING METHODOLOGY: THE COST TO CHARGE RATIO CALCULATED ON IRS WORKSHEET 2 WAS USED IN THE CALCULATION OF COST ON IRS WORKSHEETS 1, 3 AND 6. SCHEDULE H, PART III, SECTION A, LINE 2 BAD DEBT EXPENSE: THE HOSPITAL HAS ADOPTED THE NEW REVENUE RECOGNITION STANDARD ASU 014-09. UNDER ASU 2014-09, THE ESTIMATED AMOUNTS DUE FROM PATIENTS FOR WHICH THE HEALTH SYSTEM DOES NOT EXPECT TO BE ENTITLED OR COLLECT FROM THE PATIENTS ARE CONSIDERED IMPLICIT PRICE CONCESSIONS AND EXCLUDED FROM THE HEALTH SYSTEM'S ESTIMATION OF THE TRANSACTION PRICE OR REVENUE RECORDED. BAD DEBT EXPENSE WAS NOT SIGNIFICANT TO THE AUDITED FINANCIAL STATEMENTS FOR THE YEAR ENDED JUNE 30, 2020. HOWEVER, THE HOSPITAL INTERNALLY TRACKS BAD DEBT EXPENSE CONSISTENT WITH HISTORICAL PRACTICES AND THAT AMOUNT HAS BEEN REPORTED ON SCHEDULE H, PART III, SECTION A, LINE 2. SCHEDULE H, PART III, SECTION A, LINE 3 BAD DEBT EXPENSE ATTRIBUTABLE TO FAP-ELIGIBLE PATIENTS: BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY WAS DETERMINED USING POVERTY LIMIT DEMOGRAPHIC INFORMATION OBTAINED THROUGH THE US CENSUS BUREAU. THIS AMOUNT EXPENSED BY THE ORGANIZATION IS ATTRIBUTABLE TO LOW INCOME INDIVIDUALS IN THEIR TARGET COMMUNITY AND IS CONSIDERED A COMMUNITY BENEFIT. SCHEDULE H, PART III, SECTION A, LINE 4 BAD DEBT EXPENSE FOOTNOTE: THE AUDITED FINANCIAL STATEMENTS DO NOT CONTAIN A FOOTNOTE THAT DESCRIBES BAD DEBT EXPENSE. THEY DO, HOWEVER, CONTAIN A FOOTNOTE THAT DESCRIBES PATIENT ACCOUNTS RECEIVABLE, THAT NOTE CAN BE FOUND ON PAGE 13 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS. SCHEDULE H, PART III, SECTION B, LINE 8 COSTING SOURCE: MEDICARE DATA COMPUTED USING THE MEDICARE COST REPORT FILED WITH CMS WAS UTILIZED FOR THE COMPUTATIONS IN PART III, SECTION B. SCHEDULE H, PART VI, LINE 2 NEEDS ASSESSMENT: TITUSVILLE AREA HOSPITAL DOES NOT CURRENTLY HAVE A FORMALIZED METHOD TO ASSESS THE COMMUNITY FOR ITS HEALTH NEEDS. IN THE NEXT COUPLE YEARS, THE ORGANIZATION PLANS TO LAUNCH A MORE FORMALIZED PROCESS TO ASSESS COMMUNITY NEEDS. TAH IS PARTNERING WITH MEADVILLE MEDICAL CENTER AND WILL INCORPORATE THEIR FORMALIZED METHOD TO ASSESS COMMUNITY NEEDS. SCHEDULE H, PART VI, LINE 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: THE CHARITY CARE POLICY IS POSTED IN ADMISSIONS AND EMERGENCY ROOM AREAS. COPIES OF THE CHARITY CARE POLICY ARE AVAILABLE IN ADMISSIONS AREA AND EMERGENCY ROOM AREAS. IF A PERSON IS ADMITTED WITH NO INSURANCE THEY ARE VISITED BY A FINANCIAL AID COUNSELOR AND MADE AWARE OF THEIR OPTIONS. SCHEDULE H, PART VI, LINE 4 COMMUNITY INFORMATION: TITUSVILLE AREA HOSPITAL SERVES RESIDENTS OF CRAWFORD, FOREST, AND VENANGO COUNTIES IN PENNSYLVANIA. THE MAIN SERVICE AREA IS CRAWFORD COUNTY. CRAWFORD COUNTY IS A RURAL AREA WITH A POPULATION OF APPROXIMATELY 88,524. THE 2009 ESTIMATED MEDIAN HOUSEHOLD INCOME WAS $38,192 WHICH IS WELL BELOW THE PENNSYLVANIA ESTIMATED HOUSEHOLD INCOME OF $49,520. APPROXIMATELY 14.9% OF RESIDENTS LIVE IN POVERTY. SCHEDULE H, PART VI, LINE 5 PROMOTION OF COMMUNITY HEALTH: OUR STAFF IS COMMITTED TO THE CARE AND IMPROVEMENT OF LIFE. IN RECOGNITION OF THIS COMMITMENT, WE STRIVE TO DELIVER HIGH-QUALITY AND COST-EFFECTIVE HEALTHCARE WITH AN EMPHASIS ON COMPASSION, PERSONAL ATTENTION AND RESPECT. WE BELIEVE IN THE FOLLOWING VALUES: -WE WILL MEET OR EXCEED COMMUNITY STANDARDS FOR CARE EXPECTATIONS OF PATIENTS AND FAMILIES. -WE WILL MAINTAIN A POSITIVE AND FULFILLING WORKING ATMOSPHERE THAT BOTH MOTIVATES AND ALLOWS CAREGIVERS AND SUPPORT STAFF TO GIVE THEIR BEST. -WE WILL ENSURE THAT THE ORGANIZATION IS ADEQUATELY COMPENSATED FOR SERVICES PROVIDED, THEREBY MAINTAINING VIABILITY AS A CRITICAL REGIONAL HEALTHCARE AND ECONOMIC ASSET. -OUR VISION IS TO PROVIDE ACCESS TO HIGH QUALITY HEALTHCARE SERVICES ENHANCED BY HIGH TECHNOLOGY APPROPRIATE TO COMMUNITY NEED. -WE WILL MAINTAIN A HIGHLY QUALIFIED MEDICAL AND SUPPORT STAFF IN A POSITIVE WORKING ENVIRONMENT FOCUSED ON EXCELLENCE. A MAJORITY OF THE ORGANIZATION'S GOVERNING BODY IS COMPRISED OF PERSONS RESIDING IN PRIMARY SERVICE AREA AND ARE NOT EMPLOYEES OR CONTRACTORS OF THE ORGANIZATION OR FAMILY MEMBERS. THE ORGANIZATION USES SURPLUS FUNDS TO PROVIDE THE LATEST IN TECHNOLOGY TO IMPROVE PATIENT CARE. SCHEDULE H, PART VI, LINE 6 AFFILIATED HEALTH CARE SYSTEM: MEADVILLE MEDICAL CENTER (MMC) IS A CORPORATE MEMBER ALONG WITH TITUSVILLE AREA HEALTH CENTER. AS OF THE DATE OF ACQUISITION, MMC HAS DIRECT AUTHORITY OVER THE STRATEGIC, FINANCIAL, AND OPERATIONAL DIRECTION OF TITUSVILLE AREA HEALTH CENTER, INC. AND AFFILIATES. TITUSVILLE AREA HEALTH CENTER, INC. AND AFFILIATES (HEALTH CENTER) CONSISTS OF TITUSVILLE AREA HEALTH CENTER, INC. (PARENT), TITUSVILLE AREA HOSPITAL (HOSPITAL), THE TITUSVILLE AREA HEALTH CENTER FOUNDATION (FOUNDATION) AND TITUSVILLE AREA HEALTH SERVICES, INC. (HEALTH SERVICES). THE HOSPITAL PRIMARILY EARNS REVENUES BY PROVIDING INPATIENT, OUTPATIENT AND EMERGENCY CARE SERVICES TO PATIENTS IN TITUSVILLE, PENNSYLVANIA, AND THE SURROUNDING AREA. THE FOUNDATION WAS ESTABLISHED TO RECEIVE, ADMINISTER AND DISTRIBUTE FUNDS AND PROPERTY FOR THE BENEFIT AND SUPPORT OF THE HEALTH CENTER AND AFFILIATES. HEALTH SERVICES OPERATES SEPARATELY FROM THE HOSPITAL OFFERING MULTISPECIALTY FAMILY MEDICINE PEDIATRICS TO PATIENTS IN TITUSVILLE, PENNSYLVANIA, AND THE SURROUNDING AREA. X X X false false false false false true false true false JILL NEELY CFO/TREASURER 137147 0 9344 0 413 0 3250 0 23096 0 173250 0 0 0 LEE M CLINTON CEO/PRESIDENT 236469 0 40912 0 225 0 9300 0 27602 0 314508 0 0 0 JAMES WILKENS PHYSICIAN 213346 0 497 0 1980 0 5434 0 16848 0 238105 0 0 0 DWAIN ROGERS PHYSICIAN 428519 0 23043 0 1290 0 0 0 23222 0 476074 0 0 0 MARIA MUNOZ PHYSICIAN 185783 0 53539 0 1980 0 4305 0 8688 0 254295 0 0 0 MARY GIDOR PHYSICIAN END 12/19 158268 0 8913 0 690 0 3077 0 15434 0 186382 0 0 0 MICHAEL DVORKIN PHYSICIAN 618360 0 0 0 1980 0 1154 0 20229 0 641723 0 0 0 SCHEDULE J, PART I, LINE 6A CONTINGENT COMPENSATION: THE ORGANIZATION PAYS AN INCENTIVE TO ITS OFFICERS, KEY EMPLOYEES AND HIGHEST COMPENSATED EMPLOYEES THAT ARE CONTINGENT ON A POSITIVE TOTAL MARGIN OF THE ORGANIZATION. SCHEDULE J, PART I, LINE 7 NON-FIXED PAYMENTS: PHYSICIANS RECEIVE A BONUS BASED ON RVU (RELATED VALUE UNITS), WHICH IS A MEASUREMENT SET BY MEDICARE. FORM 990, PART III, LINE 2 SIGNIFICANT PROGRAM SERVICES ACQUIRED: ON JUNE 1, 2020, TIONESTA HEALTH CENTER TRANSITIONED FROM TITUSVILLE HEALTH SERVICES INC TO TITUSVILLE AREA HOSPITAL UNDER RURAL HEALTH STATUS. FORM 990, PART V, LINE 1A COMMON PAYMASTER: MEADVILLE MEDICAL CENTER, AN AFFILIATED ORGANIZATION, FILED ALL U.S. INFORMATIONAL RETURNS IN 2019 ON BEHALF OF TITUSVILLE AREA HOSPITAL. THEREFORE, PART V, LINE 1A IS REPORTED AS ZERO AND ALL 1099S APPLICABLE TO TITUSVILLE AREA HOSPITAL ARE INCLUDED IN THE NUMBER REPORTED ON THE MEADVILLE MEDICAL CENTER FORM 990. FORM 990, PART VI, SECTION A, LINE 2 FAMILY/BUSINESS RELATIONSHIPS: STEPHEN COLEMAN HAS A BUSINESS RELATIONSHIP WITH RICHARD CARR AND JASON REAGLE. FORM 990, PART VI, SECTION A, LINE 6 CLASSES OF MEMBERS OR STOCKHOLDERS: TITUSVILLE AREA HOSPITAL HAS TWO CLASSES OF MEMBERSHIP. CORPORATE MEMBERSHIP CONSISTS OF ONE MEMBER, TITUSVILLE AREA HEALTH CENTER. COMMUNITY MEMBERSHIP SHALL CONSIST OF FORMER HOLDERS OF SHARES OF THE CORPORATION WHO ELECT TO CONTINUE AS SUCH MEMBERS AND OTHER PERSONS WHO ELECT TO BECOME SUCH MEMBERS OF THE CORPORATION. COMMUNITY MEMBERS SHALL NOT BE ENTITLED TO VOTE ON ANY MATTERS RESPECTING THE ACTIONS OR GOVERNANCE OF THE CORPORATION, SUCH ENTITLEMENT HAVING BEEN RESERVED SOLELY UNTO THE CORPORATION'S CORPORATE MEMBER, AND SHALL HAVE NO INTEREST IN THE PROPERTY, ASSETS OR BUSINESS OF THE CORPORATION. MEADVILLE MEDICAL CENTER IS A CORPORATE MEMBER ALONG WITH TITUSVILLE AREA HEALTH CENTER. FORM 990, PART VI, SECTION A, LINE 7A POWER TO ELECT MEMBERS OR STOCKHOLDERS: A MAJORITY OF THE DIRECTORS SHALL BE APPOINTED BY THE BOARD OF DIRECTORS OF THE CORPORATE MEMBER (TITUSVILLE AREA HEALTH CENTER, INC). MEADVILLE MEDICAL CENTER (MMC) SHALL APPOINT THE MMC BOARD APPOINTEE TO SERVE ON THE BOARD. FORM 990, PART VI, SECTION A, LINE 7B DECISIONS OF GOVERNING BODY SUBJECT TO APPROVAL BY MEMBERS OR STOCKHOLDERS: THE FOLLOWING POWERS ARE RESERVED UNTO MEADVILLE MEDICAL CENTER (MMC): A) NOMINATE AND ELECT THE MMC BOARD APPOINTEE, AND REMOVE SAID APPOINTEE AT ANY TIME, WITH OR WITHOUT CAUSE; B) APPROVE OR DISAPPROVE IN WHOLE OR IN PART THE CORPORATION'S BUDGET AND AMENDMENTS THERETO; C) APPROVE OR DISAPPROVE PROJECTS OR EXPENDITURES WHICH ARE NOT IN THE BUDGET OR WHICH ARE VARIANCES THERETO INCLUDING THE AUTHORITY TO ESTABLISH A DOLLAR THRESHOLD BELOW WHICH THE CORPORATION WILL NOT NEED TO OBTAIN APPROVAL FROM MMC; D) APPROVE OR DISAPPROVE ALL LONG RANGE PLANS OF THE CORPORATION; E) APPROVE OR DISAPPROVE ALL AFFILIATIONS, MERGERS AND OTHER TRANSACTIONS BY THE CORPORATION NOT IN THE ORDINARY COURSE OF BUSINESS; F) APPROVE OR DISAPPROVE ALL AMENDMENTS TO THE CORPORATION'S ARTICLES OF INCORPORATION AND BYLAWS; G) DIRECT THE CORPORATION TO MAKE CHANGES IN ITS ARTICLES OF INCORPORATION OR BYLAWS AND IN THE ABSENCE OF SUCH ACTION BY THE CORPORATION, OR A RECOMMENDATION BY TITUSVILLE AREA HEALTH CENTER, INC. (TAHC), TO DIRECTLY AMEND ITS ARTICLES OF INCORPORATION AND/OR BYLAWS ON ITS OWN MOTION; H) APPROVE OR DISAPPROVE ALL FINANCINGS OF INDEBTEDNESS BY THE CORPORATION FOR WHICH THE OBLIGATION TO REPAY EXCEEDS (I) A TERM OF TWELVE MONTHS OR (II) AN AGGREGATE DOLLAR THRESHOLD SET BY THE BOARD OF DIRECTORS OF MMC FROM TIME TO TIME, AND; I) EXERCISE SUCH OTHER POWERS OR PERFORM SUCH OTHER TASKS AS ARE RESERVED TO OR REQUIRED OF MMC. THE FOLLOWING POWERS ARE RESERVED UNTO TITUSVILLE AREA HEALTH CENTER, INC. (TAHC): A) NOMINATE AND ELECT THE REMAINING APPOINTEES TO THE BOARD OF DIRECTORS OF THE CORPORATION AND THE OFFICERS OF THE CORPORATION AND REMOVE SUCH DIRECTORS AND OFFICERS AT ANY TIME, WITH OR WITHOUT CAUSE; B) APPROVE OR DISAPPROVE ANY CHANGE IN THE NUMBER OF DIRECTORS; C) RECOMMEND TO MMC THE APPROVAL OR DISAPPROVAL IN WHOLE OR IN PART OF THE CORPORATION'S BUDGET AND AMENDMENTS THERETO; D) RECOMMEND TO MMC THE APPROVAL OR DISAPPROVAL OF PROJECTS OR EXPENDITURES WHICH ARE NOT IN THE BUDGET OR WHICH ARE VARIANCES THERETO INCLUDING RECOMMENDATION OF A DOLLAR THRESHOLD BELOW WHICH THE CORPORATION WILL NOT NEED TO OBTAIN APPROVAL FROM MMC; E) RECOMMEND TO MMC THE APPROVAL OR DISAPPROVAL OF ALL LONG RANGE PLANS OF THE CORPORATION; F) RECOMMEND TO MMC THE APPROVAL OR DISAPPROVAL OF ALL AFFILIATIONS, MERGERS, AND OTHER TRANSACTIONS BY THE CORPORATION NOT IN THE ORDINARY COURSE OF BUSINESS; G) RECOMMEND TO MMC THE APPROVAL OR DISAPPROVAL OF ALL AMENDMENTS TO THE CORPORATION'S ARTICLES OF INCORPORATION AND BYLAWS; H) RECOMMEND TO MMC THE APPROVAL OR DISAPPROVAL OF ALL FINANCINGS OR INDEBTEDNESS BY THE CORPORATION FOR WHICH THE OBLIGATION TO REPAY EXCEEDS (I) A TERM OF TWELVE MONTHS OR (II) AN AGGREGATE DOLLAR THRESHOLD SET BY THE BOARD OF DIRECTORS OF MMC FROM TIME TO TIME, AND; I) EXERCISE SUCH OTHER POWERS OR PERFORM SUCH OTHER TASKS AS ARE RESERVED TO OR REQUIRED OF TAHC. FORM 990, PART VI, SECTION B, LINE 11B 990 REVIEW PROCEDURES: THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM BASED ON THE AUDITED FINANCIAL STATEMENTS AND INFORMATION PROVIDED BY THE ACCOUNTING DEPARTMENT OF THE ORGANIZATION. THE RETURN IS COMPLETED IN DRAFT FORM AND REVIEWED BY MANAGEMENT OF THE ORGANIZATION. THE COMPLETED 990 IS MADE AVAILABLE TO BOARD MEMBERS FOR REVIEW AND QUESTIONS PRIOR TO SUBMISSION. FORM 990, PART VI, SECTION B, LINE 12C PROCESS FOR MONITORING COMPLIANCE WITH CONFLICT OF INTEREST POLICY: TITUSVILLE AREA HOSPITAL ANNUALLY REQUIRES ITS BOARD MEMBERS, OFFICERS AND KEY EMPLOYEES TO FILL OUT A CONFLICTS OF INTEREST FORM DURING BOARD MEETINGS. ANY CONFLICT OF INTEREST IS REVIEWED BY THE BOARD OF DIRECTORS. IF AN INTERESTED PARTY HAS A CONFLICT, HE OR SHE RECUSES THEMSELVES FROM VOTING. FORM 990, PART VI, SECTION B, LINE 15A & B REVIEW OF CEO AND OTHER OFFICER COMPENSATION: AN INDEPENDENT CONSULTING FIRM, MERCER, PERFORMED THE MOST RECENT COMPENSATION REVIEW IN JUNE 2020. THEY COMPILED THE SALARY ADMINISTRATION AND PERFORMANCE MANAGEMENT GUIDELINES WHICH THE HOSPITAL UTILIZES ANY TIME A NEW POSITION IS CREATED OR AN EXISTING POSITION'S DESCRIPTION CHANGES. A JOB FACTOR WORKSHEET IS COMPLETED WHICH EVALUATES 6 AREAS BASED ON A POINT SYSTEM. THE SIX AREAS ARE LISTED BELOW: 1.) EDUCATION 2.) EXPERIENCE 3.) CONTACTS 4.) GUIDELINES 5.) BUDGET ACCOUNTABILITY 6.) SUPERVISORY/ACCOUNTABILITY THE TOTAL POINTS ARE USED TO ARRIVE AT A PAY GRADE ON THE SALARY ADMINISTRATION POLICY MANAGEMENT PAY SCALE. THE MANAGEMENT PAY SCALE IS REVIEWED ANNUALLY, AND UPDATED IF NECESSARY, BASED ON THE HOSPITAL COUNCIL OF WESTERN PENNSYLVANIA SURVEYS, WHICH PROVIDES COMPARABLE DATA OF OTHER HOSPITALS IN THE AREA. THE DELIBERATIONS AND DECISIONS OF THE COMPENSATION COMMITTEE ARE DOCUMENTED IN THE COMMITTEE MINUTES. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS: TITUSVILLE AREA HOSPITAL MAKES ITS FORM 990 AND FORM 1023 AVAILABLE TO THE PUBLIC UPON REQUEST. AT THIS TIME, TITUSVILLE AREA HOSPITAL DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICY OR FINANCIAL STATEMENTS AVAILABLE TO THE GENERAL PUBLIC. FORM 990, SECTION XI, LINE 9 OTHER CHANGES IN NET ASSETS: $ (70,399) CHANGE IN BENEFICIAL INTEREST 969,930 TRANSFER FROM SUBSIDIARIES --------- $ 899,531 FORM 990 PART IX LINE 11G DESCRIPTION:PURCHASED SERVICES - MEDICAL TOTAL FEES:5190644 FORM 990 PART IX LINE 11G DESCRIPTION:PURCHASED SERVICES - NON MED TOTAL FEES:1509183 FORM 990 PART IX LINE 11G DESCRIPTION:PHYSICIAN FEES TOTAL FEES:780741 FORM 990 PART IX LINE 11G DESCRIPTION:ASSOCIATED CLINICAL LABS TOTAL FEES:175819 FORM 990 PART IX LINE 11G DESCRIPTION:LAB - OTHER TOTAL FEES:62405 FORM 990 PART IX LINE 11G DESCRIPTION:COLLECTION SERVICES TOTAL FEES:17556 TITUSVILLE AREA HEALTH CENTER INC 406 WEST OAK STREET TITUSVILLE PA 16354 251517855 HOLDING CO PA 501(C)(3) 7 MMC false TITUSVILLE HEALTH SERVICES INC 406 WEST OAK STREET TITUSVILLE PA 16354 251517865 COMM HLT CLNC PA 501(C)(3) 3 TAHC false TITUSVILLE AREA HEALTH CENTER FOUNDATION 406 WEST OAK STREET TITUSVILLE PA 16354 251517854 SUPPORT PA 501(C)(3) 12 A I TAHC false MEADVILLE MEDICAL CENTER 1034 GROVE STREET MEADVILLE PA 16335 251512436 HOSPITAL PA 501(C)(3) 3 NA false MEADVILLE MEDICAL CENTER FOUNDATION 1034 GROVE STREET MEADVILLE PA 16335 251681342 SUPPORT PA 501(C)(3) 7 MMC false HOSPICE OF CRAWFORD COUNTY INC 1034 GROVE STREET MEADVILLE PA 16335 251480565 HOSPICE PA 501(C)(3) 7 MMC false CONNEAUT VALLEY HEALTH CENTER 1034 GROVE STREET MEADVILLE PA 16335 251490887 HEALTH CENTER PA 501(C)(3) 3 MMC false MEADVILLE PHYSICIANS SERVICES 751 LIBERTY STREET MEADVILLE PA 16335 251602133 PHYS. OFFICES PA 501(C)(3) 10 MMC false COMMUNITY HEALTH SERVICES INC 1034 GROVE STREET MEADVILLE PA 16335 251490886 PHYS. OFFICES PA 501(C)(3) 10 MMC false MEADVILLE MEDICAL CENTER AUXILIARY 751 LIBERTY STREET MEADVILLE PA 16335 251512834 SUPPORT PA 501(C)(3) 12A I MMC false FRENCH CREEK INTERNAL MEDICINE 751 LIBERTY STREET MEADVILLE PA 16335 471870077 PHYS. OFFICES PA 501(C)(3) 10 MPS false PERPETUAL TRUST TRUST PA TAH TRUST 2736 70228 1.00000 true PERPETUAL TRUST TRUST PA TAH TRUST 10855 278628 1.00000 true PERPETUAL TRUST TRUST PA TAH TRUST 1124 28844 1.00000 true HOME CARE CONNECTIONS INC 751 LIBERTY STREET MEADVILLE PA 16335 251605314 HOLDING COMPANY PA MMC C CORP false MEADVILLE HOUSING CORPORATION 934 B STREET MEADVILLE PA 16335 250657800 HOUSING PA MMC C CORP false CHARITABLE TRUST 256196092 TRUST PA MMC TRUST false CHARITABLE TRUST 066031521 TRUST PA MMC TRUST false false false true false false false false false false true false false true true true false true false true