2017-05-15T13:21:19-05:00 2016-06-30 990 2015-07-01 250965274 BUTLER HEALTHCARE PROVIDERS BUTL 7242844429 ONE HOSPITAL WAY BUTLER PA 16001 Anne B Krebs VP of Finance 7242844400 2017-05-15 2015 2021-01-29 14:40:06Z Butler Memorial Hospital Kenneth P DeFurio ONE HOSPITAL WAY BUTLER PA 16001 279045602 0 X www.butlerhealthsystem.org X 1898 PA The mission of Butler Memorial Hospital is to be a healing presence in the communities we serve. We exist to make a positive difference in the lives of people by providing compassionate, high quality care and comfort, and inspiring health and well-being. 9 7 1995 289 4903538 831940 1882509 2001456 246653831 261839305 2930999 4603429 9637963 10601412 261105302 279045602 50200 53900 0 0 107018530 112601078 0 0 0 119901842 120445829 226970572 233100807 34134730 45944795 320336569 348613993 181184338 192104470 139152231 156509523 X The mission of Butler Memorial Hospital is to be a healing presence in the communities we serve. We exist to make a positive difference in the lives of people by providing compassionate, high quality care and comfort, and inspiring health and well-being. 0 0 195181602 53900 267538191 Butler Memorial Hospital (BMH) is an independent, community-based hospital that has served Butler County, PA, and the surrounding area for over 100 years. BMH employs approximately 2,000 people. The hospital has grown into a regional referral center for the areas. It is the largest hospital facility between Pittsburgh and Erie. It is comprised of 296 acute care beds and a 25 bed skilled nursing facility. BMH serves approximately 13,000 acute care patients (admissions) and over 516,000 outpatients each year. The Hospital maintains a deep commitment to its community, as is demonstrated through its broad services offering. It provides all levels of general medical and surgical care, emergency services, a robust psychiatric service, drug & alcohol treatment, family services, preventative & wellness programs and tertiary cardiovascular care. It also has a network of approximately 60 convenient, low cost outpatient sites that are located in communities through Butler County and the surrounding area. 195181602 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 103 0 1995 1 1 1 0 0 0 0 0 0 0 0 0 X 9 7 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 PA X X Anne Krebs 7242844429 One Hospital Way Butler PA 16001 Kenneth P DeFurio President & CEO 40.00 22.00 X X 730033 0 217864 Marcia Segraves Trustee 0.80 1.00 X X 0 0 0 Margaret Irvine-Weir Chairperson 2.00 2.00 X X 0 0 0 Patrick Hampson Trustee 0.80 0.20 X 0 0 0 David E Foreman Corporate Secretary 1.00 1.00 X X 0 0 0 Kathryn S Helfer Trustee 0.80 0.20 X 0 0 0 Patti-Ann Kanterman Corporate Secretary 0.80 0.20 X X 0 0 0 Douglas K McClaine Trustee 0.80 0.20 X 0 0 0 Robert M Smith PhD Trustee 0.80 0.20 X 0 0 0 Dennis Demby MD Trustee 0.80 40.20 X 0 280737 10654 Timothy Morgus Trustee 1.00 1.00 X 0 0 0 Don Shamey Trustee 1.00 1.00 X 0 0 0 Anne B Krebs Chief Financial Officer 40.00 15.00 X 386041 0 81932 Stephanie Roskovski Chief Operating Officer 35.00 25.00 X 400741 0 69915 Karen Allen VP Patient Svc,CNO, 55.00 0.00 X 330436 0 71151 A Thomas McGill MD VP Quality & Safety/CIO 40.00 15.00 X 507306 0 94913 John C Reefer MD VP Prof Affairs & CMO 52.00 8.00 X 444124 0 100100 Paula L Hooper VP General Counsel 30.00 26.00 X 374639 0 63703 Thomas Genevro VP Facilities/Human Resour 45.00 10.00 X 289867 0 59475 3463187 280737 769707 60 0 1 0 Metz Culinary Management Two Woodland Drive Dallas PA 18612 Dietary 2248357 Butler Anesthesia Associates PO Box 737 East Butler PA 16029 Anesthesiology 2110433 Quest Diagnostics 875 Greentree Road Pittsburgh PA 152203610 Laboratory Services 1688367 Advanced Imaging PO Box 62395 Pittsburgh PA 15241 Imaging Services 1680365 Three Rivers Cardiac 400 Holiday Drive Suite 101 Pittsburgh PA 152203610 Cardiology 1662612 23 532733 1128742 339981 2001456 Net Patient Revenue 621500 261839305 259060390 2778915 261839305 4603429 1012 4602417 Other Income 900099 5581037 5240124 340913 Retail Pharmacy 446110 1603243 1603243 Dietary 722210 1474090 1474090 1943042 1763587 179455 10601412 279045602 267538191 4903538 4602417 53900 53900 1973470 1973470 85696221 75797007 9899214 3017356 2497239 520117 15770993 13358450 2412543 6143038 5423293 719745 553796 43658 510138 58541 58541 7466849 4859162 2607687 920055 6898 913157 59177880 58781087 396793 1989076 1969526 19550 5441503 5287212 154291 700440 244449 455991 156767 90859 65908 4478008 4478008 11804469 5487877 6316592 1838361 29773 1808588 Purchased Services 15859988 12604414 3255574 Bad Debt 7780133 7780133 Miscellaneous 2219963 866665 1353298 233100807 195181602 37919205 0 3374 3474 39755032 49872670 34037803 34412893 655648 623758 3164628 3166024 2743937 3005674 323751236 201587278 126051608 122163958 99787641 118603717 9917282 12692650 4219616 4069175 320336569 348613993 23594120 24754227 150900327 157296700 6689891 10053543 181184338 192104470 X 137924301 155334900 1227930 1174623 139152231 156509523 320336569 348613993 X 45944795 -1140072 -27447431 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 3600 3600 0 Part II-B, Line 1: A portion of the annual dues paid to Hospital Council of Western Pennsylvania are used for lobbying. 2577581 2577581 87598717 40694267 46904450 7835041 4825208 3009833 213192236 149683597 63508639 12547661 6384206 6163455 122163958 Pension 8284028 Third Party Settlements 1769515 10053543 1 1 1 X 1 X 1 1 0 1 1 3573036 3573036 0.01590 27595451 20457939 7137512 0.03170 0 0 31168487 20457939 10710548 0.04760 107660 0 107660 0.00050 190092 0 190092 0.00080 11768370 7734294 4034076 0.01790 131401 0 131401 0.00060 12197523 7734294 4463229 0.01980 43366010 28192233 15173777 0.06740 1 7650000 4131000 34687336 35642633 -955297 X 1 1 1 Butler Physicians Realty LLC Leases medical office space 0.15790 0.10530 1 1 Butler Memorial Hospital One Hospital Way Butler PA 160014670 www.butlerhealthsystem.org 023-701 X X X Butler Memorial Hospital 1 0 0 1 X X X X X X X X 15 1 0 0 1 X http://www.butlerhealthsystem.org/InTheCommunity/Pages/Community-Health-Ass X 1 15 1 http://www.butlerhealthsystem.org/InTheCommunity/Pages/Community-Health-Ass 0 0 1 X 200.000000000000 300.000000000000 X 1 1 X X X 1 X http://www.butlerhealthsystem.org/AboutBHS/Pages/Policies.aspx X http://www.butlerhealthsystem.org/AboutBHS/Pages/Policies.aspx X http://www.butlerhealthsystem.org/AboutBHS/Pages/Policies.aspx X X X X X 1 X 0 X X X X 1 X 0 0 Butler Memorial Hospital Part V, Section B, Line 5: Input from Community and Data Sources:Beth Herold, Director Area Agency on Aging represented needs of elderlyAmber Crowe Catholic Charities special needs of the poorTracy Futscher RN, Broad St Elementary School ( children in an impoverished neighborhood) Linda Starosta, RN, Seneca Valley Schools other children in Butler County.Amy Hammonds, RN, BHS Behavioral health Outreach behavioral healthDr. Plank DO, Family practice smaller town and more rural butler county.The BHRFSS for non-Allegheny County western PA was compared to prior our community oversampling survey. No significant differences were found so oversampling was not repeated this cycle. Butler Memorial Hospital Part V, Section B, Line 11: Mobile heal scanner deployed to PCP office to assess yield on this type of osteoporosis screening. Fall risk assessment incorporated into EMRs to identify high risk patients.Disparities in birth outcomes: S Minion's research proposal under review by PhD committee, complete data set compiled.Asthma in children is behind schedule.Childhood immunization: work group examining barriers and how clinics could report to state immunization databaseBMH is an active participant in Butler County Opioid Task force. Opioid prescribing Medical education offered to all members of medical staff. Medical Staff rules and regulations incorporate requirements to use PDMP website before opioid prescribing.Obesity - wellness program started at BMH with intent to offer to local businesses once value demonstrated - about 18 months Butler Memorial Hospital Part V, Section B, Line 22d: The Hospital uses the look-back method to calculate the amounts generally billed. Part V,Section B, line 2 The CHNA was last conducted during the organization's 2015 tax year, which is equivalent to its fiscal year ended June 30, 2016. The implementation strategy was also adopted during that same fiscal year. 2 1 - Butler Healthcare Providers SNF One Hospital Way Butler PA 16001 Skilled Nursing Facility 2 - Butler Healthcare Providers Psych One Hospital Way Butler PA 16001 Psychiatric and Chemical Dependency Part I, Line 7: The costing methodology is based on the ratio of cost to charges from our Butler Memorial Hospital's accounting system. Part I, Ln 7 Col(f): The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), was subtracted for purposes of calculating the percentage in this column is $7,780,132. Part II, Community Building Activities: Supporting those in need: Our Charity Care and Community Benefit BMH provides free care to those patients who have an obligation after insurance payments, if any. The amount of free care is determined based on the patient's income and family size. Free care is provided to those with incomes up to 300% of the Federal Poverty Guideline.To inform patients of this program, signs are posted in all the registration areas notifying the public of the availability of our free care program. More information is available in the Patient Handbook and on the System website www.butlerhealthsystem.org on the "About BHS" page. At the time of registration, any patient who is uninsured is given a "Patient Notice of Financial Aid notice. The notice instructs the patient to call or visit the Patient Financial Assistance Department to seek more information about how to qualify for free or discounted care.The monthly collection statements that are mailed to patients inform them that they may contact the Patient Financial Assistance Department to discuss their eligibility for free care. Financial representatives receive and make many calls to the patients. During the calls, financial representatives will discuss with the patients the availability of free care programs and will mail out applications to patients wanting to apply. BMH also contracts with representatives to assist patients in applying for Medical Assistance coverage. These representatives will also discuss with patients the availability of free care, especially for those who may not be eligible for the government healthcare plan.Government Program SubsidiesIn addition to providing free and discounted care to uninsured patients or patients that need financial help, BMH subsidizes the difference between the costs of care and the amount paid by government-sponsored programs such as Medicare and Medicaid. Last year, that amounted to more than $8.1 million. As provisions of the Patient Protection and Affordable Care Act are implemented, BMH expects this burden on our patients and the health system to increase. To that end and to remain a viable healthcare provider to our community, BMH continually evaluates ways to keep costs low and maintain high quality. Billing and CollectionsBMH is diligent in providing bills that are accurate and easy to understand. Every bill and statement includes information about how to contact financial representatives and arrange payment plans. BMH is committed to finding ways to help every patient pay the portion of their bill they are responsible for without experiencing an overwhelming financial burden. In addition to making the billing process easy to understand and ensuring ready access to charity care and financial assistance, upon request BMH will provide cost information to patients, in advance of services or treatment.Providing Needed Care and Services Plays a Critical Role in Meeting Patient Needs Butler Memorial Hospital subsidizes many of the critical services it offers, such as the Transitional Care Facility, Family Services, obstetrical services, psychiatric services, prevention and wellness services, and primary care services offered through our physician clinics. Last year, BMH provided $4,034,076 in subsidized care and services.BMH actively supports the Community Health Clinic. It provides financial support as well as operational and technical support for many of the diagnostic services provided at the Clinic. Many BMH physicians and employees volunteer time to treat patients at the Clinic.Building Our Community Strengthening the community is a responsibility for all local businesses and something the System takes very seriously. For example, the System offers space for meetings and community education; the System helps local residents escape violent situations, the System employees volunteer to help those in need; the System provides education to new and expectant parents; and the System provides community health outreach and patient advocacy. Opening System Facilities for Local MeetingsThe Knowledge Center at Butler Memorial Hospital offers modern meeting and education space for local and regional conferences. Last year, the System hosted the seventh annual Carol Dietrich Memorial Health Symposium to physicians, nurses and other providers, entitled "Opiates: Concepts and Controverssies". The day-long program provided a variety of high quality programs at no cost to participants. Through its accredited Continuing Medical Education Department, Butler Memorial Hospital also offers a series of programs which are made available to health care professionals throughout the region. In cooperation with local institutions such as Slippery Rock University and Butler County Community College, as well as others throughout Butler County and the region, BMH is fully-committed to maintaining high-quality professional health education for students and practitioners alike. Classroom space is provided for programs within the Knowledge Center, and students are given real-life clinical experience as they work with staff in the care and treatment of patients. BMH works closely with local school districts in supporting high school health occupation programs. The Simulation Laboratory is available for seminars that give students hands-on experience, exposing them to the highly complex world of health care delivery. Part III, Line 4: Patient accounts receivable are reported at estimated net realizable value after deduction of allowances for doubtful accounts. The allowance for doubtful accounts is based on historical losses and an analysis of currently outstanding amounts for its major payor sources. Management regularly reviews data about these major payor sources of revenue in evaluating the sufficiency of the allowance for doubtful accounts. For receivables associated with services provided to patients who have third-party coverage, the Hospital analyzes contractually due amounts and provides an allowance for doubtful accounts and a provision for bad debts, if necessary (for example, for expected uncollectible deductibles and copayments on accounts for which the third-party payor has not yet paid). For receivables associated with self-pay patients (which includes both patients without insurance and patients with deductible and payment balances due for which third-party coverage exists for part of the bill), the Hospital records a significant portion for bad debts in the period of service on the basis of its past experience, which indicates that many patients are unable or unwilling to pay the portion of their bill for which they are financially responsible. The difference between the standard rates (or discounted rates if negotiated) and the amounts actually collected after all reasonable collection efforts have been exhausted is charged off against the allowance for doubtful accounts.The costing methodology is based on the ratio of cost to charges from our Butler Memorial Hospital's accounting system. Part III, Line 8: The cost used to determine the Medicare payment shortfall comes from the CMS required filing of the Medicare cost report. The methodology uses a ratio of cost to charges to determine the cost assigned to the Medicare services. Butler Memorial Hospital is committed to serving the healthcare needs of all members of our community. We consider the revenue shortfall from the Medicare program payments to be part of our community contribution. Part III, Line 9b: Patients who have previously applied and been approved for our charity care program are automatically qualified for any additional services provided over the next six months after application approval. We also will presumptively qualify patients for charity care if they meet criteria such as being food stamp eligible and qualifying for Section 8 housing. Part VI, Line 2: Executive SummaryButler Memorial Hospital (BMH) is proud to serve our community. In furtherance of our charitable mission, BMH provided over $16.1 million in support in the form of charity care, unreimbursed care, community health improvement, health education, subsidized services and contributions to community organizations. This support accounts for over 6.74% of total expenses. BMH demonstrates its commitment by improving the overall health of our community through the operation of an efficient and effective health care system and by actively supporting appropriate community services. Summary of Services and Community SupportHelping People to Live Better, Every DayAt Butler Memorial Hospital, a key goal is to strengthen the health and well-being of the community. BMH understand that as a sole community hospital it plays an important role in the health of Butler County residents. This role is taken very seriously. Last year, BMH provided over $16.1 million in total community benefit support. This accounts for over 6.74% of our total expenses. The services BMH provides are essential to not only the community's overall health, but also to the quality of life of every resident. Butler Health SystemButler Memorial Hospital has a sole corporate member, Butler Health System ("System"). Butler Health System is an integrated health organization serving a multi-county area in western Pennsylvania. It employs more than 192 physicians and midlevels with another 201 on active medical staff. Its scope includes acute hospital care, ambulatory care, urgent care, and a network of laboratory services to more than 150 clients. Primary community health care. The 296-bed general acute care Hospital provides essential services to the community including emergency services, surgical intensive care, medical intensive care, geriatric and adult psychiatry, chemical dependency, and obstetrics (with 949 deliveries in fiscal year 2016). Inpatient and acute observation patients account for approximately 18,260 admissions each year. The Emergency Department treated 48,448 patients last year. All major specialties and consultants are available, including general surgery, orthopedics, neurology, pathology, anesthesia, radiology, pulmonary/critical care medicine, cardiology, urology, otolaryngology, gastroenterology, ophthalmology, palliative care, electrophysiology, endocrinology, neurosurgery, radiation and medical oncology, and a hospitalist service. A 25-bed skilled nursing unit is also located within the hospital building. The Skilled Nursing Facility provides a safety net by treating patients with more complex and costly to treat conditions that other skilled nursing facilities often may not care for. The Hospital also offers a broad range of community programs off-site including Family Services Center, focused on psycho-social issues that affect families and the health of the home.Tertiary care. Over the years, the Hospital has continued to expand the scope and depth of tertiary services so residents have access to services locally without the need for patients and families to travel to Pittsburgh. These services include open heart surgery (with 332 cases in fiscal year 2016), electrophysiology services, thoracic and vascular surgery, advanced orthopedics, palliative care, endocrinology, radiation and medical oncology, neurosurgery and spine surgery. The Hospital's goal is to expand services throughout its service areas so that its community has access to the highest quality tertiary services matching or exceeding the levels of care provided in Pittsburgh hospitals at a reasonable cost. BMH costs are typically lower than Pittsburgh hospitals providing an identical service. This range and complexity of service is not offered by any other entity in Butler County.Ambulatory ExpansionSince 1999, the System has recognized and embarked upon the necessity for an available, low-cost, high-quality, ambulatory network. This network now includes over 60 convenient locations where regional residents can access a broad range of services. This network of services continues to grow, with locations in six counties. In addition to serving Butler County, services have been expanded in Lawrence, Venango, Mercer, Clarion and Armstrong Counties. A comprehensive array of ambulatory services is available where patients can access advanced imaging, cardiac testing, wellness, primary care, specialty care and walk-in/urgent care, often providing a continuum of services just short of acute inpatient care. The BHS Crossroads Campus, which is approximately one-half mile from the Hospital, serves as the System's largest ambulatory location. The original building houses the Cardiovascular and Musculoskeletal Centers. Due to the growth in the System's services, in November 2015, a new medical office building was opened. This campus now houses cardiology testing, medical and interventional cardiologists, cardiovascular surgeons, electrophysiologists, neurosurgeons, orthopedic surgeons, laboratory/x-ray/pre-admission testing, pulmonology, general surgery, women's imaging, obstetricians/gynecologists, medical oncologists, palliative care and endocrinology. In addition, the System has four urgent care centers. These urgent care centers are strategically located in the Hospital's primary and secondary markets. The urgent care centers were created as a joint venture with the Hospital's emergency room physicians. The System focuses on strong relationships with the medical staff. This joint venture is one example of the partnerships developed with physicians.Another example of the System engaging with physicians is the development of a Provider Hospital Organization (PHO) in 2015. Participants of this PHO include both employed and independent members of the Butler Memorial Hospital Medical Staff. The PHO is a vehicle that will allow the Hospital and its physician partners to work collaboratively to provide high level, cost effective care to the patients of the communities in which we service in a manner that results in an exceptional experience.Surrounding our services, are a robust complement of primary and specialty physicians. These physicians include family practice, internal medicine, adult and pediatric hospitalist, intensivist, radiation oncology, pathology, palliative care, electrophysiology, endocrinology, neurology, cardiology, oncology, surgery, orthopedics, radiology, gynecology/obstetrics, infectious disease and dermatology. Providing convenient care with a positive experience is the focus of such physician practices. With 192 physician and mid-level providers in over 60 offices covering six counties, these providers offer office visits and testing close to home while referring inpatient business to the Hospital. Part VI, Line 3: Community Health AssessmentButler Memorial Hospital (BMH) has conducted Community Health Assessments for over 20 years to guide resource allocation and service development. Past major initiatives that have been started or programs that have received ongoing support due to the recognized community needs have been:Maternal Services Program 1990Family First (support) 1992Mammography Outreach 1996Women's Imaging Center 1999Cardiovascular Surgery 1999Best Practices Stroke Care 2005Community Hospital Comprehensive Cancer Program 2006Tumor Registry 2006Community Health Clinic (support) 2008Pediatric Hospitalist Program 2012Lung Cancer Screening 2014"The BMH Committee" has used numerous data sources to identify gaps or unmet community health needs. These are prioritized to address needs that may have the greatest impact on overall health status of the populations affected.Previously Identified and Ongoing:Obesity and Lack of Exercise: Obesity and lack of exercise are associated with Type 2 Diabetes. Obesity is a national phenomenon. There is little evidence that community level interventions have a significant impact on obesity. The geography and population density of Butler County require that most residents drive or ride to work, school, and to nearly all destinations for shopping. For instance, in the Behavioral Risk Factor Surveillance Study, 39 to 40% of respondents report a long commute to work. In 2010 25% of county residents were obese, in 2015 30% were obese; this is consistent with national trends. From 2011 to 2012 the percent reporting physical inactivity fell from 24% to 23% but physical inactivity has remained steady at 23% for the last 4 years in spite of more access to exercise: from 72% to 79% between 2014 and 2015.A recent report by Raj Chetty in JAMA suggested that location of residence and thus local policy might have an impact on health separately from income. The Committee will monitor this topic to see if this observation is proven to be substantiated by other investigators. (http://www.nytimes.com/interactive/2016/04/11/upshot/where-the-poor-live-longer-how-your-area-compares.html?_r=0)Cancer: Cancer remains the leading cause of premature death in Butler County. Lung Cancer and breast cancer are the two most common types of cancer causing premature death. Cancer screening programs are in place for these two diseases. The Cancer Committee monitors the performance and outcomes of these programs. These are also reported by BMH at its annual community report.New Topics:Asthma In Children:Is associated with adult smoking and particulate air pollution: 18-19% of adults smoke, Butler County has the second highest level of small particulate air pollution (PM 2.5) in Pennsylvania. Particles less than 2.5 microns are not filtered by the upper airway defense systems and reach the lung and are absorbed into the body. School nurses identify asthma as the leading chronic health condition for which they oversee medication administration or use at school. Reliable access to medication is a problem that school nurses identify for a segment of the children in school.Maternal Fetal Health:Countywide maternal fetal health statistics have shown a small decline in the health of this population after many years of steady improvement. A county has many neighborhoods and subgroups. BMH has engaged an epidemiologist to perform an investigation to understand this change in long term trends with a focus on identifying areas that may benefit from targeted outreach.High Rates of Osteoporosis Fractures: While there has been an improvement in hip fractures in women over 65 since 2003, Butler County has a relatively high rate of hip fractures in this population group. A hip fracture requires surgery, may ultimately be fatal, limits mobility and may force the person to leave their home.Low Rates of Early Childhood Immunization:Early Childhood immunization rates in Butler County are lower than Pennsylvania averages. Pennsylvania is lower than US national rates. By 7th grade Butler County children are up-to-date on their immunizations. Barriers to immunizations based on time, transportation and money are part of this problem.Opioid Overdose Epidemic:National and State Authorities across the country have identified opioid addiction and overdoses as a national crisis. BMH will fully participate in these programs as they apply to physician education and best practices and patient education.Achieving Quality Measure in Patient CareButler Health System offers exceptional quality of care and has been recognized for superior clinical excellences. Achieved 4 STARS rating and Physician Quality Report System PQRS goals as identified by payors, 2016. American Heart Association/American Stroke Association's"Get With the Guidelines Stroke" recognized the System as Gold Plus Quality Achievement Award with Target Stroke Honor roll Elite. American College of Radiology designated BHS a Lung Cancer Screening Center. Intersocietal Accreditation Commission accreditation echocardiograph all six sites. Society of Cardiovascular Patient Care gave a three year accreditation to BHS as a Chest Pain Center with Percutaneous Coronary Intervention. US Department of Health and Human Services has awarded a $200,000 grant to Butler Health System and Madison, WI based Wellbe as part of the Rural Health Care Services Outreach Grant program to support diabetes self-management using online patient engagement.The Women's Choice Award named the System as one of America's Best Hospitals for Patient Safety, and one of America's Best for Emergency and Orthopedic care (3 years). BHS was chosen by the state of Pennsylvania to be a Center of Excellence for Opioid Use/Disorders. Enhancing our Services to the CommunityNewly Renovated Women's Imaging Center including Breast Tomosynthesis unit and Radioactive Seed Localization ProcedureWe implemented this technology in December 2015. In the past 12 months we have screened 10,479 patients and have diagnosed 124 cancers. The new 3D Breast Tomosynthesis technology has been shown to be superior to digital mammography because it allows doctors to examine breast tissue one layer at a time. As part of an annual screening, 3D Breast Tomosynthesis may be used in conjunction with traditional digital mammography in order to capture more breast images. This technology is helping physicians find very small cancers and reduce the number of women called back for diagnostic mammograms each year. Recent studies have shown about a 30% increase in cancer detection and a 15% decrease in women recalled for additional imaging. Radioactive Seed Localization Procedure- This procedure utilizes small radioactive seed implanted by the radiologist to localize the lesion for the surgeon. The use of this radioactive seed in lieu of the standard wire localization approach reduces incidence of positive margins, allowing for improved surgical approach and removal of lesion. Part VI, Line 4: Hybrid OR Suite/TAVR ProgramWe built a hybrid operating room suite. This is a surgical theatre that is equipped with advanced medical imaging devices. The last few years have seen a paradigm shift in the treatment of cardiovascular-related diseases, from once traditional open surgical modalities to the entire cardiovascular tree being amenable to percutaneous interventions. The tremendous advances in transcatheter endovascular procedures currently being applied to the heart and the peripheral vasculature have resulted in a treatment paradigm shift in the care of the cardiovascular patient. To allow these procedures, operating rooms with integrated x-ray imaging capabilities have to be installed.A fully integrated interventional suite combines surgical sterility with flat-panel cardiovascular imaging, a linked workstation, post processing and storage facilities. Supportive equipment is available in the room, includes patient monitoring, anesthesia, intravascular ultrasound, three-dimensional (3D) transesophageal echocardiogram or rotational angiography. The ability for open conversion or hybrid intervention, as well as endovascular supplies and devices, are all located within the hybrid OR suite. The new Hybrid OR suite provided the platform to perform transcatheter aortic valve replacement procedures. This is a minimally invasive surgical procedure in which the Aortic heart valve is repaired without removing the old, damaged valve, instead it wedges a replacement valve into the aortic valves place. Usually valve replacement requires an open heart procedure with a "sternotomy", in which the chest is surgically separated (open) for the procedure. The TAVR or TAVI procedures can be done through very small openings that leave all the chest bones in place. The TAVR procedure is performed using one of two different approaches, allowing the cardiologist or surgeon to choose which one provides the best and safest way to access the valve:Entering through the femoral artery (large artery in the groin), called the transfemoral approach, which does not require a surgical incision in the chestor using a minimally invasive surgical approach with a small incision in the chest and entering through a large artery in the chest or through the tip of the left ventricle (the apex), which is known as the transapical approach.We began our program in Sept 2016 and have performed 56 TAVR procedures to date. Palliative CareButler Memorial Hospital added palliative care services in 2015 to our broad array of specialties. Palliative care service was initially offered to people suffering serious illness who were being treated as an inpatient of the hospital. In 2016, the service was expanded to include outpatient services. An additional physician and office offers patients continued care and allows primary care doctors to refer other seriously ill patients and families. Assertive Community Treatment (ACT)Butler Memorial Hospital, in working with local agencies, is now staffing a much needed service. The Assertive Community Treatment, or ACT, is a way of delivering a full range of services to people who have been diagnosed with a serious mental illness. ACT's goal is to give consumers outstanding community care and to help them have a life that is not dominated by their mental illness. With ACT, consumers get help taking care of their basic needs, from taking medications to getting out and getting through the day. ACT teams work closely with consumers to see which medications and therapies work best for them. They help consumers find housing, apply for food stamps, go back to school or get a job and become productive members of society. The ACT team has been successful in reducing the number of hospitalized days for clients in our region.The Patient and Family Advisory CouncilAs part of BMH's commitment to excellent service, The Patient and Family Advisory Council was formed in September of 2014. The Committee is made up of former patients and a few BMH employees. The Committee is dedicated to strengthening collaboration between patients, family members and the health care team. The System wants to assure we are providing patient-centered care and believes the patients are the right people to provide direction on what is most important to patients. Since its inception, the Committee has provided valuable input to many initiatives, including but not limited to: the Patient Handbook, the System website, Emergency Room waiting experience, quiet at night, patient experience video and call bell response time.The Patient and Family Advisory Council approved the implementation of two service improvement projects. First, a support group for patients with cardiac disease and secondly, a patient information privacy code system to allow family to obtain patient information and protect patient privacy. The new support group for cardiac patients, Heart and Soul, was designed, implemented and meets regularly and provides emotional support to those who have experienced cardiac disease. The patient information privacy code was implemented in May of 2016.24 Hour Electroencephalographic (EEG) video monitoringA 24 hour electroencephalographic video monitoring service was implemented to improve inpatient outcome by permitting accurate diagnoses and modified therapy of seizure disorders for in-patients. This procedure is widely regarded as safe and effective for evaluating seizures disorders. The American Epilepsy Society has stated that this technique is the method of choice for the evaluation of intractable and/or undiagnosed seizure disorders. Additionally, many studies have reported the usefulness of this technique, and recommended its use for the diagnosis of psychogenic seizures. Electroencephalographic (EEG) video monitoring medically necessary for the following indications, where the diagnosis cannot be made by neurological examination, standard EEG studies, and ambulatory EEG monitoring, and non-neurological causes of symptoms (e.g., syncope, cardiac arrhythmias) have been ruled out. To differentiate epileptic events from psychogenic seizures; or to establish the first diagnosis of a seizure disorder; or to establish the specific type of epilepsy in poorly characterized seizure types where such characterization is medically necessary to select the most appropriate therapeutic regimen.Interventional Neurology Services Interventional Neurology Services added a BiPlane Imaging Interventional Procedure Lab in 2014. Treatment of Cerebral Vascular Aneurysm Endovascular Coiling Studies have shown that patients with a ruptured aneurysm tend to do better in the long term after a coiling procedure. A coiling procedure is performed as an extension of the angiogram. Most elective patients will go home the next day after surgery and are back to normal activities the following day. Interventional Radiology Cancer Treatments Yttrium-90 treatment of nonresectable liver cancer, was implemented in 2014. Interventional radiologists use intra-arterial yttrium-90 (Y-90) radioembolization, to treat liver cancer. Studies show that treating liver tumors with doses of Y-90, provides results when chemotherapies have failed, preserves the patient's quality of life, and can be done on an outpatient basis. Radioembolization is a minimally invasive procedure that combines embolization and radiation therapy to treat liver cancer. It can help extend the lives of patients with inoperable tumors and improve their quality of life.Electrophysiology Cryoablation ProceduresElectrophysiology Cryoablation Procedures were implemented in 2015. Cryoablation is a therapy that uses the removal of heat from tissue to treat cardiac arrhythmias. Part VI, Line 5: Employees in the CommunityEvery year, the System and its employees support a variety of community support programs. These include the Caring Angel Program, the United Way, the American Heart Association, the American Cancer Society, the Butler YMCA and the March of Dimes. In addition to these activities, employees participate in a variety of community service initiatives, such as Habitat for Humanity, Doctors without Borders, Ride for the Cure, Produce to the People and local student mentoring programs. SummaryThe System physicians, nurses, employees, volunteers and volunteer leadership maintain deep connections to the communities they serve. They live and work in the multi-county area that Butler Health System serves, and they are acutely aware of the needs of residents. As a tax-exempt charitable organization, The System is careful to manage its resources to meet the current and future healthcare needs of residents. BHS is proud of its independence and pledges to always strive to provide high quality, low cost care in a comfortable and supporting environment. Part VI, Line 6: This organization is not part of an affiliated health care system.Part VI, Line 3: There are signs posted in all registration areasindicating that free care is provided to those people in need.Information is provided to all self pay patients at time ofregistration indicating that help is available if the patient meets thecriteria. A notice is also posted on the hospital's web site. Eachpatient statement that is mailed out has a notice of the availabilityof free care and how to apply. The Hospital provides assistance topatients to determine if they are eligible for the Pennsylvania MedicalAssistance program. The Patient Financial Assistance staff notifiespatients of the availability of free care during phone conversationsabout the collection of balances due.Part VI,Line 5:A majority of the Governing Body of Butler MemorialHospital reside in our primary service area. Per the Corporate Bylaws60% of the Trustees must work or reside in the service area.Medical Staff Privileges are offered to all qualified physicianssubject to the recommendation of the Hospital Medical Staff and incompliance with the policies of the Board of Trustees. Currently 283physicians, podiatrists and dentists hold privileges on the ButlerMemorial Hospital Medical Staff. Privileges are offered based onqualifications and community need without regard to other factors suchas race, sex, color, creed, or national origin.Annually, Butler Memorial Hospital establishes operating and capitalbudgets designed to efficiently allocate funds for its ongoingoperation and for the additional investment in new and replacementpatient care equipment; plant and infrastructure; and technology. Uponpreparation by management staff the final budget is presented forapproval by the Board of Trustees. 0 Community Health Clinic of Butler County 103 Bonnie Drive Butler PA 16002 204852135 501 (c) (3) 53900 General Support to provide medical care of indigent patients 1 Part I, Line 2: The organization's bylaws control the contributions that can be made and the process related to such. X X X X X 0 1 0 0 0 0 0 1 0 Kenneth P DeFurio President & CEO 524020 0 160655 0 45358 0 176114 0 41750 0 947897 0 0 0 Dennis Demby MD Trustee 0 158444 0 103068 0 19225 0 0 0 10654 0 291391 0 0 Anne B Krebs Chief Financial Officer 294509 0 73263 0 18269 0 52749 0 29183 0 467973 0 0 0 Stephanie Roskovski Chief Operating Officer 305716 0 76019 0 19006 0 45923 0 23992 0 470656 0 0 0 Karen Allen VP Patient Svc,CNO, 249588 0 62676 0 18172 0 32591 0 38560 0 401587 0 0 0 A Thomas McGill MD VP Quality & Safety/CIO 378067 0 95451 0 33788 0 64927 0 29986 0 602219 0 0 0 John C Reefer MD VP Prof Affairs & CMO 333450 0 84635 0 26039 0 60054 0 40046 0 544224 0 0 0 Paula L Hooper VP General Counsel 284007 0 72509 0 18123 0 24702 0 39001 0 438342 0 0 0 Thomas Genevro VP Facilities/Human Resour 220540 0 55734 0 13593 0 20797 0 38678 0 349342 0 0 0 Part I, Line 4b 4 (b) The organization utilizes a Supplemental Executive Retirement Program (SERP) to recruit and retain leadership talent. Vesting periods are 5 and 10 years, and for all executives, with the exception of the President/CEO, at age 65. The thrid vesting period for the president/CEO is age 60. Eligible executives receive distributions upon reaching the vesting periods. All contributions to the SERP have been reported previously and are reported annually. The annual accrual amounts for calender year 2015 were: Kenneth P DeFurio, 153,158; Anne B Krebs 35,166; Stephanie J Roskovski 36,489; A Thomas McGill MD 45,817; John C Reefer MD 40,625; Paula L Hooper 20,302; Karen A Allen 17,549; Thomas A Genevro 15,605. Part I, Line 7 Employees are eligible and received bonus compensation. Bonuses are not guaranteed and are awarded based on Board approved metrics which include quality, services, and strategic financial performance. A Butler County Hospital Authority 251458912 123592DR5 2015-03-18 100481533 Refund prior issue 4/29/09 0 0 0 B Butler County Hospital Authority 251458912 1235926QB 2009-04-29 50000000 Construction of addition to hospital 1 0 0 A 1831777 100481533 1411658 2015 0 1 1 1 B 10665000 9000000 50000000 833495 49166505 2010 0 0 0 1 A 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 A 0 0 1 0 0 0 0 0 0 B 0 0 0 1 1 0 0 0 0 A 0 B 0 Date Rebate Computation Performed Issuer Name: Butler County Hospital Authority Date the Rebate Computation was Performed: 08/11/2015 Form 990, Part VI, Section A, line 6 Per the By-Laws of the organization, the organization shall have one corporate member, Butler Health System, Inc. There shall be no other members. Form 990, Part VI, Section A, line 7a Butler Health System, Inc., the corporate member of the organization, appoints the members of the Board of Trustees. Form 990, Part VI, Section A, line 7b As per the By-Laws of the organization, the subject matters of the powers reserved to the Member are as follows: a. The number of Trustees that will comprise the Board. b. The election of Trustees. c. The removal of any Trustee for cause from the Corporation's Board of Trustees and approval of the replacement of any such removed Trustee for the unexpired portion of the term. d. The election, re-election, appointment and reappointment of all Officers of the Board. e. The amendment, revision, or restatement of the Corporation's Articles of Incorporation and/or By-Laws. f. The adoption or change in the mission, purpose, philosophy or objectives of the Corporation. g. The change in the general structure of the Corporation as a voluntary, nonprofit corporation. h. The dissolution, division, conversion or liquidation of the Corporation, the consolidation or merger of the Corporation with another corporation or entity, or the acquisition of substantially all of the assets of another corporation or entity, subject to the provision of the Articles of Incorporation. i. The Corporation's borrowing of money, issuance of indebtedness and/or incurrence of guarantees, whether in a single transaction or a series of related transactions, whether or not such borrowings or guarantees are to be secured by a mortgage, pledge or other lien on the Corporation's current or future real property, personal property or endowment funds. j. Approval of the annual capital and operating budgets of the Corporation and any amendments thereto. k. Approval of any charitable donation by the Corporation, other than to the Member or any nonprofit entity in which the Member is a sole member, in an amount exceeding $15,000 or in an amount exceeding $150,000 in the aggregate during any one fiscal year. l. Approval of any transfer other than charitable donations of the Corporation's assets unless specifically authorized in the Corporation's approved budgets. m. Approval of change of membership or voting rights of the Member. Form 990, Part VI, Section B, line 11 The completed 990 was reviewed by the Chief Financial Officer and an outside independent public accounting firm. Relevant sections were reviewed by the Vice President and General Counsel. Highlights of the Form 990 were reviewed with the Finance Committee and the Board of Trustees. After these reviews, but prior to filing, the full Board of Trustees and the Finance Committee was notified that the completed Form 990 was available for review on the Board's secure website. Form 990, Part VI, Section B, line 12c The responses to the Conflict of Interest Disclosure form are collected and reviewed annually by General Counsel, who then reviews the same with the Audit and Compliance Committee of the Board of Trustees. Conflict of Interest Disclosure forms are completed by all Trustees, Officers, Committee Members as well as the Executive Team. In the event a relationship results in a potential conflict for an issue being discussed by the Board, the Trustee recuses himself/herself from the discussion and vote. The recusal is documented in the minutes. The Vice President and General Counsel attends all Board meetings and ensures that any needed recusals occur. Form 990, Part VI, Section B, line 15 The Board of Trustees recognizes the great challenges and difficulties that healthcare executives face, particularly in the current era of national and state healthcare reform. In addition, the Pittsburgh regional market is highly competitive and changing rapidly. The Board competes for and seeks executive talent on a national basis. It engages expert compensation consultants, utilizing national comparative data to guide the determination of competitive, appropriate levels of compensation. The total compensation program for executives consists of cash compensation and benefits. Factors taken into consideration in determining compensation for executives include: market demand and competition for similar positions, experience and tenure,and actual performance and effectiveness. Based on these and other pertinent criteria, BHS targets total compensation to fall within a range of the 25th to 75th percentile of the market. BHS executive compensation generally will not exceed the 75th percentile of the market. Exceptions to this may be subject to review and recommendation by the Compensation Committee, which in-turn is subject to review and approval by the Board of Trustees. Exception must be supported by organizational and /or individual performance, or a retention/recruitment circumstance that warrants such compensation. The Compensation Committee consists exclusively of independent individuals with no real or perceived conflicts of interest in recommending executive compensation guidelines and levels. While benefits are accounted for in Schedule J, actual "take home" pay to the executive typically consists only of base salary and any incentive award earned. Applicable taxes and other withholding are deducted. Annual increases in base pay, if any, are based on competitive market trends from the comparison group. Supplemental retirement benefits are used as a vehicle for executive recruitment and retention with appropriate vesting periods. The Board of Trustees reviews and approves executive compensation in its entirety, including the use of "tally sheets", which disclose 100% executive compensation. The Board of Trustees engages external compensation and legal expertise to assure reasonableness of executive compensation levels. Form 990, Part VI, Section C, line 19 Historical financial information is provided to the public at the annual public board meeting. Bylaws, Articles of Incorporation and the Conflict of Interest Policy are posted on the website. Form 990, Part XI, line 9: Transfers (to) from affiliates -22,900,000. Accumulated liability for pension benefits -4,364,898. Decrease in interest in net assests of Butler Health System Foundation -53,307. Distribution to Butler Urgent Care Associates -129,226. Part XII Line 2c explanation The organization has not changed its process for reviewing the audited financials or the selection of an independent auditor during the year. Butler Health System Provider Hospital Organization One Hospital Way Butler PA 16001 474212217 Provider Hospital Organization PA 234120 446144 Butler Healthcare Providers Butler Health System One Hospital Way Butler PA 16001 251441855 Healthcare Delivery System PA 501(c)(3) Line 3 0 Butler Medical Providers One Hospital Way Butler PA 16001 251441855 Physician Practices PA 501(c)(3) Line 3 Butler Health System 0 Butler Health System Foundation One Hospital Way Butler PA 16001 261543883 Fundraising on behalf of Butler Health System PA 501(c)(3) Line 11a, I Butler Health System 0 Nixsar Corporation One Hospital Way Butler PA 16001 251441960 Own and Operate real estate PA 501(c)(3) Line 3 Butler Health System 0 BHS Nallathambi Medical Associates One Hospital Way Butler PA 16001 264746949 Physician Practice PA 501(c)(3) Line 3 Butler Medical Providers 0 Butler Imaging and Interventional Associates One Hospital Way Butler PA 16001 264263364 Physician Practice PA 501(c)(3) Line 3 Butler Medical Providers 0 BHS Seneca Medical Center LLC One Hospital Way Butler PA 16001 464444529 Physician Practice PA 501(c)(3) Line 3 Butler Medical Providers 0 BHS Dermatology Associates LLC One Hospital Way Butler PA 16001 800929620 Physician Practice PA 501(c)(3) Line 3 Butler Medical Providers 0 Butler Ambulatory Surgery Center 102 Technology Drive Butler PA 16001 061728190 Surgery PA N/A BHS FasterCare One Hospital Way Butler PA 16001 271961562 Urgent Care PA Butler Healthcare Providers Related 19080 1362202 0 1 0.51000 PCA of Butler Pc 480 East Jefferson Street Butler PA 16001 251351445 Physician Office Practice PA C 0 0 0 1 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0 BHS FasterCare J 309857 BHS FasterCare Q 3900347