2018-05-08T09:52:33-05:00 2017-06-30 BKD LLP 910 E ST LOUIS 200/PO BOX 1190 SPRINGFIELD MO 658062523 990 2016-07-01 250965579 TITUSVILLE AREA HOSPITAL % JILL NEELY TITU 8148271851 406 WEST OAK STREET TITUSVILLE PA 16354 JILL NEELY CFO 2018-01-26 true Brian D Todd P00422601 4178658701 2016 2022-09-23 18:48:47Z LEE M CLINTON 406 WEST OAK STREET TITUSVILLE PA 16354 25714118 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. 14 13 275 75 0 0 197335 162670 25803783 25034234 13570 11139 -1915452 491884 24099236 25699927 0 0 0 0 14476788 12734257 0 0 0 13267003 14777022 27743791 27511279 -3644555 -1811352 18664238 19882417 16646128 19463980 2018110 418437 X TITUSVILLE AREA HOSPITAL IS COMMITTED TO PROVIDING QUALITY HEALTHCARE SERVICES WITH AN EMPHASIS ON PERSONAL ATTENTION, COMPASSION AND RESPECT. false false 20804130 25034234 TITUSVILLE AREA HOSPITAL IS AN ACUTE CARE, CRITICAL ACCESS RURAL HOSPITAL WITH 1,038 ADMISSIONS, 4,543 PATIENT DAYS AND 52,471 OUTPATIENT VISITS. OUTPATIENT VISITS. 20804130 true true false true false false false false false false true true false true 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 42 0 true 275 true false false false false false false false false false false X 14 13 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 JASON REAGLE CHAIRMAN BEGINNING 9/2016 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 LYNN PEDENSKY DIRECTOR BEGINNING 9/2016 1.0 1.0 X 0 0 0 LARRY FLEDDERMAN VICE CHAIRMAN BEGINNING 9/2016 1.0 2.0 X X 0 0 0 JAY PERTZ DIRECTOR 1.0 1.0 X 0 0 0 PATRICIA WALKER DIRECTOR 1.0 1.0 X 0 0 0 LEE M CLINTON CEO/PRESIDENT 35.0 5.0 X X 141174 0 3716 MARK STEVENS DIRECTOR 1.0 2.0 X 0 0 0 JOSEPH CARTER DIRECTOR BEGINNING 1/2017 1.0 1.0 X 0 0 0 MICHAEL R THOMSON DIRECTOR BEGINNING 1/2017 1.0 1.0 X 0 0 0 MARK MEHLENBACHER DIRECTOR BEGINNING 1/2017 1.0 1.0 X 0 0 0 KENNETH WINGER DIRECTOR BEGINNING 1/2017 1.0 2.0 X 0 0 0 JILL NEELY CFO/TREASURER 35.0 5.0 X 126333 0 4088 MARIO D'ALESSANDRO ER DIRECTOR 40.0 0.0 X 196533 0 9098 EDWARD GRIFFIN PHYSICIAN 40.0 0.0 X 365568 0 28524 DWAIN ROGERS PHYSICIAN 40.0 0.0 X 307298 0 5813 ANIL DUTT PHYSICIAN 40.0 0.0 X 252050 0 10561 SCOTT SMITH ANESTHESIAOLOGIST 40.0 0.0 X 250151 0 9020 PHIL ERDELJAC ANESTHESIAOLOGIST 40.0 0.0 X 225253 0 5656 1864360 0 76476 12 false true false CPS LLC MEMPHIS TN 38120 PHARMACY ADMIN SVCS 473182 ASSOCIATED CLINICAL ERIE PA 16501 DIAGNOSTIC LAB SVCS 266750 OIL VALLEY HOSPITALISTS TITUSVILLE PA 16354 HOSPITALIST 535200 BKD LLP SPRINGFIELD MO 65801 AUDIT/TAX/CONSULTING 130371 REGIONAL HEART NETWORK ERIE PA 16544 MEDICAL SVCS 116553 5 15112 147558 162670 NET PATIENT SERVICE REVENUE 621990 24601064 24601064 EHR INCENTIVE REVENUE 900099 191059 191059 CAFETERIA REVENUE 811000 127510 127510 OTHER REVENUE 900099 114601 114601 25034234 0 0 0 184942 14191 170751 0 170751 170751 11139 11139 11139 11139 0 0 0 0 0 0 0 0 0 INCOME FROM EQUITY INVESTEE 900099 476555 476555 GAIN/(L0SS) ON EXTINGUISHMENT OF DEBT 900099 -155422 -155422 321133 25699927 25034234 503023 X 0 0 0 0 437548 437548 0 9222210 6266959 2955251 212171 146495 65676 2135102 1081965 1053137 727226 460146 267080 60419 60419 24946 24946 35310 35310 0 0 0 3952070 3269744 682326 98106 98106 648501 443882 204619 0 0 1188117 1188117 26547 12649 13898 0 5427 2807 2620 195132 22557 172575 0 606675 485340 121335 1407274 1348207 59067 SUPPLIES 3691549 3509742 181807 BAD DEBT 2267096 2267096 MISCELLANEOUS EXPENSE 456293 170898 285395 LICENSES, DUES, SUBSCRIPTIONS 113560 29420 84140 27511279 20804130 6707149 0 188002 918889 2128 0 0 0 2526437 2840895 0 0 0 0 0 0 652793 792793 350684 380944 38814345 31406601 7140920 7407744 3250145 3461824 1938653 2155053 120000 120000 0 0 2494476 1804275 18664238 19882417 2744137 1754325 0 0 0 0 0 0 0 0 0 0 2196895 1616939 0 0 11705096 16092716 16646128 19463980 X -1232035 -3043387 0 0 3250145 3461824 2018110 418437 18664238 19882417 X -1811352 211679 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 8160 8160 false SCHEDULE C, PART II-B, LINE 1I OTHER LOBBYING ACTIVITIES: THE ORGANIZATION PAYS DUES TO AMERICAN HOSPITAL ASSOCIATION, OF WHICH $8,160 IS ATTRIBUTABLE TO LOBBYING. 583217 583217 13929923 11657353 2272570 20464641 17946442 2518199 3836564 1802806 2033758 7407744 INVESTMENT - CHART 2080958 F INVESTMENT - VANTAGE 74095 C 2155053 DUE FROM AFFILIATES 93295 OTHER RECEIVABLES 931565 DUE FROM 3RD PARTY 779415 1804275 0 DUE TO AFFILIATES 16092716 16092716 23647562 -2055417 -2055417 25702979 -3052 -3052 25699927 25247235 3052 3052 25244183 2267096 2267096 27511279 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: $ (2,267,096) BAD DEBT EXPENSE 211,679 CHANGE IN BENEFICIAL INTEREST ------------ $ (2,055,417) SCHEDULE D, PART XI, LINE 4B OTHER REVENUE ON FORM 990, PART VIII, LINE 12, BUT NOT ON LINE 1: $ 11,139 GAIN ON DISPOSAL OF ASSETS (14,191) RENTAL EXPENSES ------------ $ (3,052) SCHEDULE D, PART XII, LINE 2D OTHER EXPENSES ON LINE 1, BUT NOT ON FORM 990, PART IX, LINE 25: $ (11,139) GAIN ON DISPOSAL OF ASSETS 14,191 RENTAL EXPENSES ------------ $ 3,052 SCHEDULE D, PART XII, LINE 4B OTHER EXPENSES ON FORM 990, PART IX, LINE 25, BUT NOT ON LINE 1: $ 2,267,096 BAD DEBT EXPENSE true true X true X 300. false false true true false false 68973 68973 0.00270 4070346 2209453 1860893 0.07370 4139319 2209453 1929866 0.07640 2452 2452 0.00010 2452 2452 0.00010 4141771 2209453 1932318 0.07650 false 2267097 659725 10674046 10260698 413348 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 15 true true true true X SEE PART V, SECTION C X SEE PART V, SECTION C X true 15 true SEE PART V, SECTION C false true X 300. 0. 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 REVIEW OF HOSPITAL AND PUBLIC HEALTH SURVEILLANCE DATA AS WELL AS THE COLLECTION OF COMMUNITY PERCEPTIONS DATA AND A COMMUNITY-WIDE SURVEY. THE SURVEY FOCUSED ON ACCESS TO HEALTH CARE, CANCER SCREENING, NUTRITION, HOUSEHOLD HAZARDS, AND BARRIERS TO HEALTH. THE RESEARCH TEAM USED FOCUS GROUPS TO COLLECT INPUT ABOUT SURVEY QUESTIONS FROM COMMUNITY LEADERS AND MEMBERS. THE FINAL SET OF QUESTIONS FOCUSED ON FIVE MAIN THEMES: GENERAL HEALTH, INSURANCE AND ACCESS TO HEALTH CARE, PHYSICAL ACTIVITY/NUTRITION, HOUSEHOLD HAZARDS, AND BARRIERS TO LEADING A HEALTHY LIFE. DURING THE SUMMER OF 2015, 1005 ADULTS IN CRAWFORD COUNTY COMPLETED THE CHNA SURVEY. TO ENSURE THAT A REPRESENTATIVE SAMPLE OF INDIVIDUALS WAS SURVEYED, THE RESEARCHERS VARIED THE TIME A AND LOCATION OF SURVEY COLLECTION. 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 IMPLEMENTATION STRATEGY WEBSITE: https://www.titusvillehospital.org/documents/Health-Improvement-Plan-Frame work-TAH-CHNA-2016.pdf SCHEDULE H, PART V, SECTION B, LINE 11 IMPLEMENTATION STRATEGY: IN RESPONSE TO THE RESULTS OF TITUSVILLE AREA HOSPITAL'S MOST RECENTLY CONDUCTED COMMUNITY HEALTH NEEDS ASSESSMENT, THE ORGANIZATION ADOPTED AN IMPLEMENTATION STRATEGY. THE IMPLEMENTATION STRATEGY IS ATTACHED. THE STRATEGIES IDENTIFIED ARE AS FOLLOWS: 1. CONTINUE SCREENING PROGRAMS FOR COMMON CONCERNS -THE HOSPITAL, THROUGH ITS OWN RESOURCES, COMMUNITY RESOURCES AND NATIONAL RESOURCES (THE KOMEN FOUNDATION), PROVIDES NO COST AND LOW COST MAMMOGRAPHY SCREENINGS TO THOSE REQUESTING THE SERVICE -TITUSVILLE AREA HOSPITAL IS WORKING WITH MEADVILLE MEDICAL CENTER TO EXPAND ITS FAMILY PLANNING SERVICES TO THE TITUSVILLE AREA. THIS WILL OFFER SCREENING, TREATMENT AND IMMUNIZATION FOR HPV AND PRECURSOR TO UTERINE AND CERVICAL CANCERS 2. ESTABLISH IMMUNIZATION CLINICS FOR CHILDHOOD DISEASES -IMMUNIZATIONS FOR VARICELLA AND PERTUSSIS ARE AVAILABLE AND THEIR EFFICACY IS WELL-DOCUMENTED -IMMUNIZATION FOR HPV IS NOW RECOMMENDED FOR YOUNG MALES AS WELL AS YOUNG FEMALES 3. TARGET HIGH RISK POPULATIONS FOR EDUCATION AND SCREENING -CHLAMYDIA, GONORRHEA AND HPV ARE PREVENTABLE WITH PRECAUTIONS. PROGRAMS IN CONJUNCTION WITH THE LOCAL SCHOOL DISTRICTS AND COLLEGES SHOULD BE DEVELOPED TO EDUCATE STUDENTS AND OFFER SCREENING AND TREATMENT OPTIONS THAT MAY BE DEVELOPED OR THAT ARE ALREADY IN PLACE IN THE COMMUNITY 4. CONTINUE TO PARTNER WITH COMMUNITY PHYSICIANS TO IDENTIFY PATIENTS WHO MIGHT BENEFIT FROM CHRONIC DISEASE MANAGEMENT PROGRAMS -MONITORING AND FREQUENT ASSESSMENT OF COPD PATIENTS, CHF PATIENTS AS WELL AS PAST MI PATIENTS 5. CONTINUED PARTNERING WITH AGENCIES OFFERING SMOKING CESSATION -SUPPORT ACCESS TO STATE AND FEDERAL FUNDING FOR COACHING AS WELL AS MEDICATION 6. WORK WITH MEADVILLE MEDICAL CENTER AND OTHER COMMUNITY AGENCIES TO IMPROVE ACCESS FOR MENTAL HEALTH SERVICES HEALTH SERVICES. SCHEDULE H, PART V, SECTION B, LINES 16A, 16B, & 16C FAP, FAP APPLICATION, AND PLS WEBSITE: http://www.titusvillehospital.org/Patient-Visitors/Billing-Insurance/Finan cial-Assistance.aspx SCHEDULE H, PART V, SECTION B, LINE 22D MAXIMUM AMOUNTS THAT CAN BE CHARGED TO FAP-ELIGIBLE INDIVIDUALS: TITUSVILLE AREA HOSPITAL USES THE LOOK BACK METHOD AS DEFINED IN SECTION 501 (R) (5) (B) (1) OF THE INTERNAL REVENUE CODE. TAH WILL LIMIT AMOUNTS CHARGED FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE PROVIDED TO INDIVIDUALS ELIGIBLE FOR ASSISTANCE UNDER THIS POLICY TO NOT MORE THAN AGB. TAH WILL UPDATE THE AGB ANNUALLY. FOR CALENDAR YEAR 2015, THE AGB DISCOUNT FOR TAH IS 51%. THE AGB WILL BE UPDATED ANNUALLY WITHIN 120 DAYS OF TAH'S FISCAL YEAR END. 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, WAS REDUCED BY BAD DEBT EXPENSE OF $2,267,096. 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 AND 3. SCHEDULE H, PART III, SECTION A, LINE 2 BAD DEBT EXPENSE: THE ORGANIZATION CALCULATED BAD DEBT USING THE AMOUNTS CALCULATED IN THE ORGANIZATION'S INTERNAL FINANCIAL STATEMENTS. 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 OF MEADVILLE MEDICAL CENTER DO NOT CONTAIN A FOOTNOTE THAT DESCRIBES BAD DEBT EXPENSE. IT DOES, HOWEVER, CONTAIN A FOOTNOTE THAT DESCRIBES PATIENT ACCOUNTS RECEIVABLE. THAT FOOTNOTE READS AS FOLLOWS: For receivables associated with services provided to patients who have third-party coverage, the Health System analyzes contractually due amounts and provides an allowance for uncollectible accounts and a provision for uncollectible accounts, if necessary (for example, for expected uncollectible deductibles and copayments on accounts for which the third-party payer has not yet paid, or for payers who are known to be having financial difficulties that make the realization of amounts due unlikely). For receivables associated with self-pay patients (which includes both patients without insurance and patients with deductible and copayment balances due for which third-party coverage exists for part of the bill), the Health System records a significant provision for uncollectible accounts 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 the discounted rates if negotiated or provided by policy) and the amounts actually collected after all reasonable collection efforts have been exhausted is charged off against the allowance for uncollectible accounts. SCHEDULE H, PART III, SECTION B, LINE 8 COMMUNITY BENEFIT RATIONALE: MEDICARE DATA COMPUTED USING THE MEDICARE COST REPORT FILED WITH CMS WAS UTILIZED FOR THE COMPUTATIONS IN PART III, SECTION B. SERVING PATIENTS WITH GOVERNMENT HEALTH BENEFITS, SUCH AS MEDICARE, IS A COMPONENT OF THE COMMUNITY BENEFIT STANDARD THAT TAX-EXEMPT HOSPITALS ARE HELD TO. THIS IMPLIES THAT SERVING MEDICARE PATIENTS IS A COMMUNITY BENEFIT AND THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. 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 FUND 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 EDWARD GRIFFIN PHYSICIAN 362491 0 0 0 3077 0 9077 0 19447 0 394092 0 0 0 DWAIN ROGERS PHYSICIAN 306743 0 0 0 555 0 0 0 5813 0 313111 0 0 0 ANIL DUTT PHYSICIAN 251246 0 0 0 804 0 5772 0 4789 0 262611 0 0 0 SCOTT SMITH ANESTHESIAOLOGIST 247779 0 0 0 2372 0 5555 0 3465 0 259171 0 0 0 PHIL ERDELJAC ANESTHESIAOLOGIST 209190 0 15067 0 996 0 5608 0 48 0 230909 0 0 0 MARIO D'ALESSANDRO ER DIRECTOR 177543 0 18000 0 990 0 4985 0 4113 0 205631 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: THE CRNA'S RECEIVE AN ANNUAL BONUS BASED ON A PERCENTAGE OF THEIR COMPENSATION. FORM 990, PART VI, SECTION A, LINE 2 FAMILY/BUSINESS RELATIONSHIPS: STEPHEN COLEMAN AND RICHARD CARR HAVE A BUSINESS RELATIONSHIP. STEPHEN COLEMAN AND JASON REAGLE HAVE A BUSINESS RELATIONSHIP. 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 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 IX, LINE 11G OTHER FEES FOR SERVICES: $ 2,166,768 PURCHASED SERVICES - MEDICAL 737,814 PURCHASED SERVICES - NON-MEDICAL 665,213 PHYSICIAN FEES 306,035 ASSOCIATED CLINICAL LAB 60,367 LAB OTHER 15,873 COLLECTION SERVICES ----------- $ 3,952,070 FORM 990, SECTION XI, LINE 9 OTHER CHANGES IN NET ASSETS: $ 211,679 CHANGE IN BENEFICIAL INTEREST TITUSVILLE AREA HEALTH CENTER INC 406 WEST OAK STREET TITUSVILLE PA 16354 251517855 HOLDING CO PA 501(C)(3) 7 NA false TITUSVILLE HEALTH SERVICES INC 406 WEST OAK STREET TITUSVILLE PA 16354 251517865 COMM HLT CLNC PA 501(C)(3) 3 HEALTH CNTR false TITUSVILLE AREA HEALTH CENTER FOUNDATION 406 WEST OAK STREET TITUSVILLE PA 16354 251517854 SUPPORT PA 501(C)(3) 12 A I HEALTH CNTR false PERPETUAL TRUST TRUST PA TAH TRUST 2810 68871 1.00000 true PERPETUAL TRUST TRUST PA TAH TRUST 11148 273244 1.00000 true PERPETUAL TRUST TRUST PA TAH TRUST 1154 28286 1.00000 true false false false false false false false false false true false false true true true false false false false