2018-05-15T16:28:36-05:00 2017-06-30 390859910 Baker Tilly Virchow Krause LLP 1650 Market Street Suite 4500 Philadelphia PA 191037341 990 2016-07-01 250965404 Indiana Regional Medical Center INDI 7243577008 835 Hospital Road Indiana PA 15701 Robert A Gongaware Senior VP Finance 7243577008 2018-05-15 1 Julius C Green CPA P00350393 2159720701 96.89.178.154 2018-05-15 15:21:33 ED P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 9D0D8DD59390B7764A3ECE0F40BBFE3618018605 2016 2021-01-29 14:40:06Z Stephen A Wolfe 835 Hospital Road Indiana PA 15701 202505300 0 X www.indianarmc.org X 1944 PA TO SERVE THE HEALTHCARE NEEDS OF EVERY LIFE WE TOUCH WITH COMPASSION, RESPECT, AND DIGNITY. 12 10 1389 130 8419555 445417 359324 152604 139047052 149071180 4476522 5124698 7267034 12508230 151149932 166856712 0 0 0 0 80063247 83592608 0 0 0 64170000 71409535 144233247 155002143 6916685 11854569 239409301 246705223 126337454 110960191 113071847 135745032 X The mission of Indiana Regional Medical Center is to serve the healthcare needs of every life we touch with compassion, respect, and dignity. 0 0 125101139 149071180 Health Diagnostic, Intervention & Treatment Service:Indiana Regional Medical Center ("IRMC") is a non-profit, community based health system that offers a wide range of services including diagnostics, medicine, surgery, pediatrics, obstetrics, geriatric behavioral healthcare and rehabilitative nursing. IRMC demonstrates an ongoing commitment to the community by continually reviewing and improving its services to ensure that the community receives top-quality, efficient, accessible, cost-effective healthcare and quality outreach and health promotion services. IRMC continues to provide mobile health services to rural areas of the county. In addition to primary care physicians, IRMC was successful in recruiting an ENT (Ears, Nose and Throat) physician, a Podiatrist, 2 OB/GYN doctors, a Urologist, and a Cardiologist within the IPG Corporation to help continue to satisfy the needs of the community.Mass Health Screening: IRMC's Mobile Medical Services continues to provide free blood pressure screenings in 19 locations in Indiana County. We also continue to participate in numerous free community events providing education, screening programs and first aid services.Health Fairs:The provision of health services and information through health fairs, classes and programs - The Institute for Healthy Living at IRMC offers health services and educational programs to the community at no charge such as:Indiana Chamber of Commerce Business ExpoAgony of DeFeetBike to School DayStress to Clark MetalClymer Church Health FairCold Hands Warm HeartSpirit of Women Day of DanceDowntown Indiana ChristmasFamily Fun Fest Family Fun Day at Chestnut RidgeFitness Seminar to "B!Well"From Shoulders to FingertipsSpirit of Women - Girls Night OutSouth of the Border - Veins, Low Back Pain & Pelvic Health"B!Well" Farmers MarketIRMC "B!Well" Health FairKeystone Generating Station Health FairsLifeline program to Kiwanis and St. Andrew's VillageOlympic Day & Joint Center PicnicDOC - Pine Grove - healthy eating on a budget lunch seminarProstate Education SeminarExercise at Range ResourcesS&T Health FairSmall Change Big ChoicesSmall Choices Big ChangeTeen TalkTorrance State Hospital health FairHealth Care Delivery & Management:The Community Health Advisory Council of Indiana County, which was formed in 1996, serves as a State Health Improvement Partnership. The goal of the council is to identify or develop resources to address top health priorities in the county. The council continues to promote an annual influenza campaign. The Council implemented a county prescription assistance program to assist residents with accessing pharmaceuticals free or at a reduced cost based on income.Health Care Programs, General/Other: The Center for Diabetes Care continues to offer free education services at various locations throughout the county. In addition, they continue to be the primary sponsor of the county's diabetes walk. Each month staff and management at IRMC provide support to a local food bank. IRMC has been a previous multi-year recipient of the Best Places to Work in PA. Preventive Health Services, General/Other: M. Dorcas Clark Women's Imaging Center: The Women's Imaging Center and their staff have participated in numerous community events providing information about the importance of breast health. Birdie's Closet, a project designed to help women cope with appearance-related side-effects of cancer treatment, was opened in the Women's Imaging Center. 125101139 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 264 0 1 1389 1 1 1 0 0 0 0 0 0 0 0 0 X 12 10 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 PA X Robert A Gongaware SVP Finance 7243577008 835 Hospital Road Indiana PA 15701 Anne White Chair 1.00 2.00 X X 0 0 0 Nathan Kovalchick Vice Chair 1.00 1.00 X X 0 0 0 T Michael Price Treasurer 1.00 1.00 X X 0 0 0 Mark R McGowan PHD Secretary 1.00 1.00 X X 0 0 0 Stephen A Wolfe President & CEO 34.00 6.00 X X 413504 0 110684 Todd Brice Board Member 1.00 2.00 X 0 0 0 Russell A Drozdiak MD Board Member 1.00 1.00 X 0 0 0 Mark E Boykiw MD Board Member 1.00 40.00 X 0 291750 18409 Beverly Gazza Esq Board Member 1.00 1.00 X 0 0 0 James R Martin Board Member 1.00 1.00 X 0 0 0 Greg Sipos Board Member 1.00 X 0 0 0 David Bizousky MD Board Member/MED STAFF President 1.00 X 0 0 0 Dominic Paccapaniccia Chief Operating Officer 38.00 2.00 X 235346 0 41445 Brett Braun COO, IPG 40.00 X 168314 0 29311 Jim Kinneer VP, Org Dev 40.00 X 128211 0 30661 Mark Richards VP, Marketing 40.00 X 107245 0 14818 Robert A Gongaware SR VP Finance 36.00 4.00 X 217381 0 23658 Bruce A Bush MD Sr VP Medical Director 36.00 4.00 X 280238 0 34278 Cindy Virgil Sr VP Patient Services 39.00 1.00 X 183165 0 19255 Dr Anthony L Sico Physician 40.00 X 256723 0 23273 Dr Patrick Shannon physician 40.00 X 254955 0 59631 Dr Jason Rasefske physician 40.00 X 244739 0 43611 Gregory Hay Physician 40.00 X 207740 0 29557 Dr Wendy Angelo physician 40.00 X 203542 0 29691 2901103 291750 508282 52 0 1 0 A MARTINI & COMPANY INC 320 GRANT STREET VERONA PA 15147 CONSTRUCTION services FOR NEW BUILDING 13345828 Cerner Corporation PO Box 959156 St Louis MO 63195 Software System Installation 2654696 CURA HOSPITALITY INC PO BOX 743676 ATLANTA GA 30374 OUTSIDE FOOD AND NUTRITION SERVICES 946248 MAYO COLLABORATIVE SERVICS INC PO BOX 9146 MINNEAPOLIS MN 55480 OUTSIDE LAB SERVICES 893902 PMHA 150 McCracken Run Rd Dubois PA 15801 Billing & Revenue Cycle Services 550380 29 152604 152604 Net Patient Svc Rev 621990 148538087 148538087 Rental Revenue-Affiliates 531120 313132 313132 Health Classes/Counsel 624100 127342 127342 Hospice Prescriptions 621990 92619 92619 149071180 2526892 2526892 1924 1924 1733497 1472040 261457 261457 261457 36654354 120000 33589938 586610 3064416 -466610 2597806 2597806 LAB SERVICES 621500 7907833 7907833 Leased Employees 900099 1348341 1348341 Cafeteria Rev 722210 982908 982908 2005767 511722 1494045 12244849 166856712 149071180 8419555 9213373 60190745 48116482 12074263 5053722 4039945 1013777 13966599 11164899 2801700 4381542 3502605 878937 574931 574931 119504 119504 1043 1043 270085 270085 13972245 11243466 2728779 910047 35401 874646 1438268 1410366 27902 3346191 1205967 2140224 2830161 2079036 751125 295068 163468 131600 16484 16484 1950811 1950811 9524085 8278335 1245750 1968299 1573458 394841 Medical Supplies & Phar 23600024 23142184 457840 Bad Debt Expense 3172787 3172787 Repairs & Maintenance 2862639 2288394 574245 Cleaning Services & Sup 1242227 993036 249191 3314636 2674826 639810 155002143 125101139 29901004 0 7505 7707 3379224 3846073 12407997 18760220 2741012 1782995 2438456 3005097 3237534 8992239 198566223 104111202 92302979 94455021 96928044 92114107 20853175 11592236 278242 7418661 4835133 4730867 239409301 246705223 18230947 16165241 51061521 49145968 1495929 1314409 55549057 44334573 126337454 110960191 X 105696471 130313948 7375376 5431084 113071847 135745032 239409301 246705223 X 11854569 5282608 5536008 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 1043 1043 0 Part II-B, Line 1: The Medical Center is a member of national and state hospital and healthcare associations that perform lobbying activities. A portion of the dues paid to these organizations is listed as lobbying expenditures. 7375000 795000 2738000 5432000 7085000 850000 560000 7375000 6057000 1351000 323000 7085000 2973000 3099000 15000 6057000 3188000 337000 552000 2973000 1.00000 0 0 2700339 2700339 71448632 32669616 38779016 118263127 68892403 49370724 6154125 2549183 3604942 94455021 Post-Retirement Liability 204100 Pension Liability 33630966 Estimated Third Party Payor Settlements 1281990 Due to Affiliates 3906032 estimated medical malpractice claims liability 3560343 Deferred Compensation Liability 1590015 CAPITAL LEASE OBLIGATIONS 161127 44334573 X 178604289 5282608 4992929 10275537 168328752 -1472040 -1472040 166856712 153031311 1472040 1472040 151559271 3442872 3442872 155002143 Part V, Line 4: Endowment funds are used primarily to purchase capital equipment. Part X, Line 2: The Hospital accounts for uncertainty in income taxes using 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 met. Management determined there were no tax uncertainties that met the recognition threshold in 2017 and 2016. The Hospital's policy is to recognize interest related to unrecognized tax benefits in interest expense and penalties in operating expenses. Part XI, Line 2d - Other Adjustments: Bad Debts netted on financial statements -3,172,787. investment management fees netted on financials -270,085. CHANGE IN INTEREST IN INDIANA HEALTHCARE FOUNDATION -1,633,627. Pension and post-retirement liabilities adjustment 10,336,112. noncontrolling intererst in affiliates -155,514. Equity Distributions to noncontrolling interest -111,170. Part XI, Line 4b - Other Adjustments: RENTAL EXPENSES -1,472,040. Part XII, Line 2d - Other Adjustments: rental expenses 1,472,040. Part XII, Line 4b - Other Adjustments: bad debts netted on financial statements 3,172,787. investment management fees netted on financials 270,085. 1 1 X 1 X 1 X 1 1 0 1 1 4550 4305000 4305000 0.02840 43071 21416754 11331909 10084845 0.06640 36571 1336051 1336051 0.00880 84192 27057805 11331909 15725896 0.10360 14118 1655996 236488 1419508 0.00930 22500 82000 82000 0.00050 7895 15031000 5797310 9233690 0.06080 44513 16768996 6033798 10735198 0.07060 128705 43826801 17365707 26461094 0.17420 1 3171000 634200 27378185 28009859 -631674 X 1 1 1 COSM Realty Group Ltd Real Estate 0.40000 0.00000 0.30000 2 Indiana Ambulatory Surgical Associates LLC Ambulatory Surgery 0.70000 0.00000 0.30000 3 Indiana Total Therapy LLC Therapy Services 0.50000 0.00000 0.50000 1 1 Indiana Regional Medical Center 835 Hospital Road Indiana PA 15701 090701 X X X Urgent Care Facility; offsite testing centers Indiana Regional Medical Center 1 0 0 1 X X X X X X X X X 15 1 1 0 1 X http://www.indianarmc.org/about-us/community-health-needs-assessment/ X X 1 15 1 http://www.indianarmc.org/about-us/community-health-needs-assessment/ 0 1 X 100.000000000000 400.000000000000 X X X X X 1 1 X X X X 1 X http://www.indianarmc.org/financial-services/ X http://www.indianarmc.org/financial-services/ X http://www.indianarmc.org/financial-services/ X X X X X X 1 X 0 X X X X 1 X 0 0 Indiana Regional Medical Center Part V, Section B, Line 5: A steering committee made up of senior representatives of each hospital, as well as Representatives from local health departments, leading health and social service organizations and county government provided input FOR THE NEED ASSESSMENT.During this CHNA project, two dozen individuals were interviewed by representatives from all three hospitals including administrative and clinical staff from the hospitals, representatives from health and social service agencies, public health officers, warden, school district personnel, veteran's affairs, clergy, and other public and elected officials. STRATEGY SOLUTIONS INC. ("SSI") also conducted a community survey with 1,144 completed surveys. Finally information was gathered by the project team through a series of focus groups. These information-gathering efforts allowed the project team and steering committees to gain a better understanding of the health status, health care needs, service gaps and barriers to care of those living in the counties of Armstrong, Butler, Clarion, Clearfield, Forest, Indiana, Jefferson and Venango.Secondary public health data on disease incidence and mortality, as well as behavioral risk factors, were gathered from numerous sources including the Pennsylvania Department of Health, the Centers for Disease Control, Healthy People 2020, County Health Rankings, as well as a number of other reports and publications. Data were collected primarily for Indiana County and outlying area, although some selected national data is included where local/regional data was not available. Demographic data were collected from the Nielsen/Claritas demographic database. Primary qualitative data collected specifically for this assessment included a total of 24 in-depth interviews with individuals from different consistencies and interest groups with eight stakeholders specifically representing the needs of the IRMC service area. A community survey was conducted with 1,144 responses received from the region, with 573 from Indiana County. Inaddition to gathering input from stakeholder interviews, input and guidance also came from hospital and community representatives who served on the IRMC Steering Committee. Indiana Regional Medical Center Part V, Section B, Line 6a: CLARION HOSPITAL AND PUNXSUTAWNEY AREA HOSPITAL Indiana Regional Medical Center Part V, Section B, Line 7d: made available through a community mailing Indiana Regional Medical Center Part V, Section B, Line 11: Each year the top priorities are identified and addressed.IRMC's CHNA looked at different issues of community health. All were ranked according to priority need--high, moderate and low. The assignment of each health concern to one of these priority states was based upon four essential criteria:1. Accountable role - the extent to which the issue is an important priority to address for the hospital or the community2. magnitude of the problem - degree to which the problem leads to death, disability, or impaired quality of life3. impact on other health outcomes - extent to which the issue impacts health outcomes and/or is a driver of other conditions4. capacity to implement evidence based solutions - include the capacity to and ease of implementing evidence based solutions.Teams are addressing the top priorities listed. Senior administration, along with the Board of Directors, oversee and support each strategy.Some of the low priority needs which were not addressed are lack of health insurance; food and water borne illness; access to healthy foods and recreational facilities; mental health and deaths due to motor vehicle crashes. These needs were not addressed as IRMC was focused on higher priority needs. Indiana Regional Medical Center Part V, Section B, Line 16j: A message is provided on invoices that the financial assistance policy is available. Part I, Line 7: The Hospital used a cost-to-charge ratio in determining the figures reported in this table. This cost-to-charge ratio was derived from Worksheet 2 Ratio of Patient Care Cost to Charges and as calculated and reported on the 6/30/16 Medicare cost report. Part I, Line 7g: No costs attributable to a physician clinic were included in the amount on Part I, line 7g. Part I, Line 7, Column (f): The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 3,172,787. Part II, Community Building Activities: Our mission is to serve the healthcare needs of every life we touch with compassion, respect and dignity. All of the programs offered meet Community Benefit Objectives and are related to our mission. IRMC offers programs that improve access to health care services, enhances health of the community we serve, provides advanced medical or healthcare knowledge and relieves some of the financial or programmatic burden of government or our community. Indiana Regional Medical Center provides numerous community programs and activities that provide treatment or promote health and healing to our communities. Our Mobile Medical Services continues to provide free blood pressure screenings in 19 locations in Indiana County. We also continue to participate in numerous free community events providing education, screening programs and first aid services. Over the past year, the Mobile Medical Health logged over 2,500 participants. We also provide numerous Health Fairs reaching almost 2,200 participants, and Classes and Education Programs with over 4,000 participants. A few of the fairs or services provided are: Arthritis, Knee Pain and osteoporosis sessions put on by the Orthopedic physicians and the IRMC support clinicians, "Bike to School" (safety for children), Chestnut Ridge Health Fair, Diabetes, Exercise for Senior Centers, First Commonwealth Bank Weight management, Fortify your spine, Healthy Kids day, routine Multiphasic Blood Draws for rural areas and community members that may not seek out health care, services provided to New Florence Senior Center and North Cambria Senior Center (rural facilities in our secondary market area and no hospital close to them), Prostate screenings, Vaccines for Vets (veterans), Skin screenings, as well as a number of others. The Institute for Healthy Living at Indiana Regional Medical Center offers health services and education programs to the community at no charge.The Center for Diabetes Care continues to offer free education services at various locations throughout the county. In addition, they continue to be the primary sponsor of the county's Diabetes Walk. Each month Staff and Management at IRMC provide support to a local Food Bank. Preventive Health Services - M. Dorcas Clark Women's Imaging Center and their staff have participated in numerous community events providing information about the importance of Breast Health. Birdie's Closet, a project designed to help women cope with appearance related side-effects of cancer treatment was opened in the Women's Imaging Center. Support Health GroupsFamily Programs - Early Pregnancy, Maternity Tour, Doctor Dad, BOF Series, Breastfeeding, All about Baby, Lamaze, Home Alone, Babysitting, Let's Talk Girls, Big Brother, CPR, Heartsaver. 1,164 contacts for the year.Community Classes - PACE, Tai Chi, Yoga, Cancer, Strong Women, Drop Weight, Ornish, Diabetes, Drop 10. 3,580 class hours.In 2009, Indiana Regional Medical Center opened a new facility offering Urgent Care Services in the Blairsville community as a response to medical services needed in that area. This facility is 12 miles from the hospital campus.In 2012, Indiana Regional Medical Center opened its second Urgent Care facility to service the primary market share where there was a noted demand for these services. The Urgent Care centers require additional staffing on behalf of the hospital as it is a new/added location; however, these facilities significantly improve the cycle time of the patient throughout and services for the non-emergent services needed. Part III, Line 2: The amount reported in Part III, line 2 is actual bad debts (at net, not gross charges) for the year. Part III, Line 3: The amount reported in Part III, line 3 IS derived by using the Medicare cost to charge ratio from the cost report.A portion of the Bad Debt should be included as Community Benefit as the hospital is not able to deny services to any patient presenting to the Emergency Department, regardless if the patients have the means to pay. The deductible and co-insurance balances that are not paid reduce the Net Revenues due to the hospital as part of the respective patient's insurance coverage. In addition, there is a "cost" to the hospital for treating all patients. As with the unreimbursed amounts of the Medicaid patient services, the hospital should be able to include the unreimbursed costs of the services that resulted in no payment. Part III, Line 4: The following is the text of the footnote from the audited financial statements that describes bad debt expense: "Accounts receivable, patients, are reported at net realizable value. Accounts are written off when they are determined to be uncollectible based upon management's assessment of individual accounts. The allowance for doubtful collections is estimated based on a periodic review of the accounts receivable aging, payor classifications, and application of historical write-off percentages." Part III, Line 8: The Medicare cost report was used to determine the amount reported on line 6. Any shortfall reported in line 7 should be treated as community benefit as the hospital is providing medical care to these patients, regardless of their ability to pay. Part III, Line 9b: Patients are expected to pay all balances in full within fifteen days of a final billing. If this is not possible, patients will be counseled on the use of Medical Assistance or the Indiana Charity Care program, I-Care.On a monthly basis, the Credit Supervisor will compile a report listing all accounts, which have been billed to Medicare, and any secondary insurance carrier where applicable. A listing of accounts which have been billed to Medical Assistance as a secondary payor are reviewed by the Credit Supervisor for an automatic write off after Medical Assistance has processed the account. Accounts which have balances after Medicare and all secondary payors have been billed will be placed with an outside collection agency after two unanswered statements. An exception will be made in the event a patient/guarantor does not follow through with the Medical Assistance application process, when requested to do so. The agency will attempt to collect the account for six months. After that time the account will be written off as Medicare Bad Debt.The IRMC Collection Policy contains provisions to provide a softer approach for those that IRMC has learned would qualify for financial assistance. Upon receipt of the call from the patient that there is hardship in paying the bill, the IRMC collection representative shares the information for application for both Medical Assistance and Charity Care. While the patient's account is in this process, their account will not be provided to the collection agency. Part VI, Line 2: THE hospital leadership team formed a Steering Committee in the local service area that consisted of hospital and community leaders who represented the broad interests of their local region. These included representatives who understood the needs and issues related to various underrepresented groups including medically underserved populations, low-income persons, minority groups, and those with chronic disease needs, individuals with expertise in public health, and internal program managers. The staff, Steering Committee members and consulting team made significant efforts to ensure that the entire regional service territory, all socio-demographic groups and all potential needs, issues and underrepresented populations were considered in the assessment.SEE PART V OF SCHEDULE H FOR FURTHER DISCUSSION ON NEEDS ASSESSMENT. Part VI, Line 3: IRMC posts, at all points of registration, a notice of the charity care policy. The Medical Center also provides notice of the charity care policy in patients' bills and to local social service agencies. The Medical Center also provides this information on the Indiana Regional Medical Center's internet home page. At the earliest feasible time, the Medical Center personnel will attempt to determine patient eligibility for coverage of part or all of their patient bill.All pre-registration, registration, business office, and patient financial services staff receive training as to the charity care policy and are to be familiar with the availability of charitable assistance and the criteria for such assistance. Part VI, Line 4: Since opening its doors in 1914, Indiana Regional Medical Center (IRMC) has maintained a goal of serving the community with quality, progressive, compassionate patient care. As the county's sole, full-service healthcare provider, IRMC has continually risen to the challenge of meeting the needs of its community. IRMC resides in Indiana, Pennsylvania in the heart of the county. The hospital sits on a 75-acre campus and admits over 7,200 inpatients and services over 2,500 outpatients observed in-house, delivers more than 600 babies, and provides services to over 260,000 outpatients each year. As an acute care facility, IRMC is licensed for 164 beds and provides a broad range of medical and educational services at its main campus and satellite locations across Indiana County. As the only hospital located in this rural county, IRMC provides services to a diverse population of 89,000 residents spread over 830 square miles.Over the years, IRMC has developed programs and services that address improving access to care, preventive services, and community health education. IRMC has found a way to not only succeed when other rural hospitals are closing their doors, but also expand and provide care to the residents of five surrounding counties. IRMC is the number two employer in the county with 1,300 employees and continues to attract and retain a quality workforce through the achievement of numerous recognitions, such as the #1 Best Place to Work in PA, the #2 Best Place to Work in the Nation according to Modern Healthcare Magazine, achieved notable status by scoring at the Mastery Level in Pennsylvania's KAPE program, and named to Fortune's 100 Best Companies to Work For. Further, IRMC continues to pursue the Malcolm Baldrige National Quality Award - a prestigious honor achieved by few. Part VI, Line 5: In the mid-nineties, hospitals and healthcare facilities began to shift their attention from just sick or hospital based care to include addressing community health and disease prevention. As a first step in that direction, IRMC formed a community service department whose purpose was to deliver education and preventative screenings to the community-at-large. In 2005, realizing that almost every department in the hospital had opportunities to promote health and wellness, IRMC created the Institute for Healthy Living, a virtual organization coordinating all aspects of community outreach and health improvement. Improving and sustaining community health, however, is a collaborative endeavor that integrates as many key stakeholders as possible. In that regard, IRMC spearheaded the formation of the Indiana County Community Health Advisory Council (CHAC), an enterprise representing members from various community agencies, organizations and schools whose purpose it is to identify health needs in our county and to find ways to meet them. The CHAC has been active since 1996 and IRMC serves as its base and chairmanship. The IRMC / Institute for Healthy Living 2011 Community Health Needs Assessment and Report is the product of an 18-month process that sought community input, medical staff input, involved key interest groupssuch as the CHAC, and selected primary and secondary sources of survey input to identify target areas for improvement with specific action plans.Using the three survey inputs of the PA Behavioral Risk Factor Surveillance Survey (BRFSS), the Robert Wood Johnson County Health Rankings, and the PA Department of Health annual county health profiles, IRMC was able to identify and set priorities among THE areas for community health improvement that differed significantly from state or national benchmarks. IRMC then targeted seven of those need areas for specific intervention and action. Indiana Regional Medical Center uses its own funds to enhance both the Clinical Strategies and the Community Strategies.Clinical Strategies (a few examples): recruiting additional physicians for identified community needs, explore development of a Family Practice Residency program to facilitate recruitment and retention, enlarge the medical fitness center, establish a weight loss task force, develop a medical weight management center, provide flu shots to all inpatients during flu season, provide pneumonia vaccine to all non-vaccinated inpatients, etc. Community Strategies (a few examples): Partner with agencies providing services and education to young teens and women, evaluate a partnership with Early Head Start, improve visibility and information available about the OB/GYN Clinic, worked to establish practices in the more rural areas of the county that require the Medical Center to subsidize delivering care there, established the Indiana at Chestnut Ridge facility that offers primary care and urgent-care and was a significant capital investment, implement a patient portal to improve patient access to medical records, became a provider of the We Can! (ways to enhance children's activity and nutrition), partnered with 7 elementary schools to install Project Fit America, implemented grocery store tours to assist people with seeking healthy choices, partner with 4 grocery stores to have a dietician available to help shoppers make healthy choices, conduct the annual "Vaccine for Veterans" program on Veterans Day, evaluate the potential for public pneumonia vaccine clinics, continue to provide free flu and pneumonia vaccine to high-risk, low income residents, etc. Part VI, Line 6: Indiana Regional Medical Center has the following affiliated entities:Indiana Healthcare Foundation conducts fundraising activities, such as the Columbus Day Golf Outing and Love of Life Gala, in support of Indiana Regional Medical Center. INDIANA REGIONAL MEDICAL CENTER AND PUNXSUTAWNEY AREA HOSPITAL JOINTLY FORMED INDIANA JEFFERSON RADIATION ONCOLOGY, INC. FOR THE PURPOSE OF ENHANCING THE QUALITY AND AVAILABILITY OF RADIATION ONCOLOGY SERVICES OFFERED TO PATIENTS IN INDIANA AND JEFFERSON COUNTIES, PA AND SURROUNDING AREAS.Indiana Healthcare Physician Services, Inc. is a non-profit hospital owned group of practices owned and operated to serve the rural areas of Indiana and surrounding communities. We provide accessible, cost effective quality healthcare within the rural communities of Indiana and surrounding counties. We support and work collaboratively with other non-profit agencies within our sites.Indiana Healthcare Properties holds and manages property in support of Indiana Regional Medical Center. Part VI, line 7: N/A X 1 1 X X X X X 0 1 0 0 0 0 0 1 0 Stephen A Wolfe President & CEO 413504 0 0 0 0 0 78425 0 32259 0 524188 0 0 0 Mark E Boykiw MD Board Member 0 291750 0 0 0 0 0 0 0 18409 0 310159 0 0 Dominic Paccapaniccia Chief Operating Officer 235346 0 0 0 0 0 21215 0 20230 0 276791 0 0 0 Brett Braun COO, IPG 168314 0 0 0 0 0 6927 0 22384 0 197625 0 0 0 Jim Kinneer VP, Org Dev 128211 0 0 0 0 0 11539 0 19122 0 158872 0 0 0 Robert A Gongaware SR VP Finance 217381 0 0 0 0 0 19564 0 4094 0 241039 0 0 0 Bruce A Bush MD Sr VP Medical Director 280238 0 0 0 0 0 0 0 34278 0 314516 0 0 0 Cindy Virgil Sr VP Patient Services 183165 0 0 0 0 0 14653 0 4602 0 202420 0 0 0 Dr Anthony L Sico Physician 256723 0 0 0 0 0 0 0 23273 0 279996 0 0 0 Dr Patrick Shannon physician 254955 0 0 0 0 0 40000 0 19631 0 314586 0 0 0 Dr Jason Rasefske physician 244739 0 0 0 0 0 20000 0 23611 0 288350 0 0 0 Gregory Hay Physician 207740 0 0 0 0 0 10374 0 19183 0 237297 0 0 0 Dr Wendy Angelo physician 203542 0 0 0 0 0 0 0 29691 0 233233 0 0 0 Part I, Line 1a Indiana Regional Medical Center pays country club membership dues for President & CEO, Stephen Wolfe, which is not included in his compensation. The membership is a corporate membership used for business purposes only. Part I, Line 4b Indiana Regional Medical Center has a supplemental, nonqualified retirement plan under IRC Section 457(f) for President & CEO Stephen Wolfe. No amounts were paid to him from this plan during 2016, and contributions to the plan were $41,350. THE FOLLOWING ALSO HAD CONTRIBUTIONS TO A SECTION 457(F) PLAN FOR 2016: JASON P. RASEFSKE - $20,000 Patrick Shannon - $40,000 Part I, Line 7 Bonuses may be granted at the discretion of the board and are based on factors such as performance and meeting goals and objectives. A Indiana County Hospital Authority 251697319 2009-02-12 10000000 FINANCE CAPITAL PROJECTS 0 0 0 B Indiana County Hospital Authority - SERIES 2014A 251697319 2014-01-01 25455000 FINANCE CAPITAL PROJECTS, FUND RESERVES AND PAY ISSUANCE COSTS 0 0 0 C Indiana County Hospital Authority - SERIES 2014B 251697319 2014-01-01 10200000 FINANCE CAPITAL PROJECTS, FUND RESERVES AND PAY ISSUANCE COSTS 0 0 0 D INdiana County Hospital Authority - SERIES 2014C 251697319 2014-01-01 12715000 REFINANCING AND PAY ISSUANCE COSTS 0 0 0 A 4892588 10000000 61000 9939000 2010 0 0 1 1 B 1990000 25455000 342791 25112209 2015 0 0 1 1 C 10200000 169750 10030250 2015 0 0 0 1 D 2171498 12715000 133512 12581488 2013 0 0 1 1 A 0 0 0 0 0 0 1 B 0 0 0 0 0 0 1 C 0 0 0 0 0 0 1 D 0 0 0 0 0 0 1 A 0 0 1 0 0 0 0 0 1 B 0 1 0 0 0 0 0 0 1 C 0 1 0 0 1 0 0 0 1 D 0 0 1 0 0 0 0 0 1 A 1 B 1 C 1 D 1 Form 990, Part VI, Section A, line 2 The following board members have a business relationship: Todd Brice and Anne White. Form 990, Part VI, Section A, line 6 Indiana Healthcare Corporation ("IHC") is the sole corporate member of Indiana Regional Medical Center ("IRMC"). Form 990, Part VI, Section A, line 7a IHC has the power to fill vacancies, nominate and approve the election of, and approve removal of the Board of Directors of IRMC. Form 990, Part VI, Section A, line 7b IRMC shall obtain the approval of IHC before action on any of the following matters becomes final and effective for IRMC: (1) amendment of the articles of incorporation and bylaws; (2) the sale, lease or exchange of all or substantially all of the property or assets of IRMC; (3) merger or consolidation with any other corporation; (4) dissolution of IRMC; (5) approval of an annual operating and capital budget for IRMC; (6) any other matter that by law would require the approval of members of a nonprofit corporation. Form 990, Part VI, Section B, line 11b The return was reviewed in detail by the Director of Finance/Controller and reviewed by the CFO. Each board member was notified that the return was available for review on the "board shared drive" before filing with the IRS. Form 990, Part VI, Section B, line 12c Every member of the Board, and every individual appointed to the Board or Board committees, as well as all key management personnel and physician leaders, are required to execute a conflict of interest disclosure statement, which will be updated at least on an annual basis or as additional conflicting interests arise. In addition, every member of the Board will specifically acknowledge the conflict of interest policy and his/her attempt to abide by it by signing the acknowledgement form. Every Board committee member, officer, key management employee, and physician leader is required to sign this acknowledgement as well. The acknowledgement and disclosure forms will be kept on file by the Chief Executive Officer, and the Chairman and Vice-Chairman will be familiar with the statements that are filed by Board members in order to guide their conduct in the event a conflict arises. Every person covered by this Policy shall submit in writing to the Chief Executive Officer a Conflict of Interest Disclosure Statement listing all financial and conflicting interests. Each statement will be resubmitted with any necessary changes each year or as any additional conflicting or financial interests arise. The Chairman of the Board shall become familiar with all such disclosure statements in case a conflict arises. The Vice Chairman of the Board shall be familiar with the Disclosure Statement filed by the Chairman. Penalties for non-compliance: Failure to comply with this policy shall constitute grounds for removal from office and, in the case of Key Management Personnel, termination of employment. Form 990, Part VI, Section B, line 15 Positions for Officers and Key Employees are reviewed on an annual basis. Appropriate comparisons are made on a regional and national level in order to maintain a fair and equitable compensation structure. All recommendations are approved by the Board of Directors and documented in the Board Minutes. Form 990, Part VI, Section C, line 19 Governing documents, conflict of interest policy, and financial statements are available to the public upon request. Form 990, Part XI, line 9: CHANGE IN INTEREST IN INDIANA HEALTHCARE FOUNDATION -1,633,627. Pension and post-retirement liabilities adjustment 10,336,112. noncontrolling interest in affiliates -155,514. Equity Distributions to noncontrolling interest -111,170. net transfers to affiliates -2,356,880. other change in investment of affiliates -542,913. Indiana Healthcare Foundation 835 Hospital Road Indiana PA 15701 251574302 Fundraising in Support of Indiana Regional Medical Center PA 501(c)(3) Line 12a, I Indiana Healthcare Corporation 0 Indiana Healthcare Corporation 835 Hospital Road Indiana PA 15701 251547379 Parent Corporation PA 501(c)(3) Line 7 N/A 0 Indiana Jefferson Radiation Oncology Inc 835 Hospital Road Indiana PA 15701 900406301 Radiation Oncology services PA 501(c)(3) Line 12a, I Indiana Regional Medical Center 1 Indiana Healthcare Physician Services Inc 835 Hospital Road Indiana PA 15701 251842046 Provide health care PA 501(c)(3) Line 3 Indiana Healthcare Corporation 0 Indiana Healthcare Properties 835 Hospital Road Indiana PA 15701 251524635 Hold & Manage property in Support of Indiana Regional Medical Center PA 501(c)(3) Line 12a, I Indiana Healthcare Corporation 0 Indiana Rehabilitation Services LLC 855 Springdale Dr Ste 200 Exton PA 19341 202214391 Rehabilitation Services PA N/A UNRELATED 30244 142619 0 0 0.51000 Indiana Ambulatory Surgical Associates LLC 841 Hospital Road Indiana PA 15701 232923182 Ambulatory Surgery PA Indiana Regional Medical Center UNRELATED 57686 3470777 0 0 0.70000 COSM REALTY GROUP LTD 1265 WAYNE AVENUE STE 307 INdiana PA 15701 030439684 REAL ESTATE PA INDIANA Regional Medical Center UNRELATED 0 0 0.40000 PENNSYLVANIA MOUNTAINS HEALTHCARE ALLIANCE LLC 150 MCCRACKEN RUN ROAD DUBOIS PA 15801 251852975 HEALTHCARE SERVICES PA Indiana Regional Medical Center UNRELATED 20483 104464 0 1 0.09310 INDIANA TOTAL THERAPY LLC 120 IRMC DRIVE STE 160 INDIANA PA 15701 263843582 THERAPY SERVICES PA N/A UNRELATED 229424 147371 0 0 0.50000 MEDCARE EQUIPMENT COMPANY LLC 115 EQUITY DRIVE GREENSBURG PA 15601 261361520 EQUIPMENT PA N/A UNRELATED 251349 1140598 0 0 0.01750 INDIANA HEALTHCARE ENTERPRISES 835 HOSPITAL ROAD INDIANA PA 15701 470973444 SALE OF HEALTHCARE RELATED ITEMS, GIFT SHOP PA N/A C 0 0 1 1 1 0 0 0 0 0 1 1 0 1 0 1 1 1 0 0 Indiana Jefferson Radiation Oncology Inc P 1683719 COST