2017-05-12T11:40:21-07:00 2016-06-30 990 2015-07-01 251490707 DuBois Regional Medical Center DUBO 8143756117 PO Box 447 100 Hospital Avenue DuBois PA 15801 John Sutika President 8143756107 2017-05-15 2015 2021-01-29 14:40:06Z Penn Highlands DuBois John Sutika PO Box 447 DuBois PA 15801 273156998 0 X www.phhealthcare.org X 1985 PA DuBois Regional Medical Center offers residents of West Central Pennsylvania a combination of advanced healthcare in a warm, friendly environment. DRMC is an oasis of clinical and technical excellence, with a focus on patient-centered care. 21 10 2352 224 0 0 1380187 1327336 264717923 266409651 3329498 3494000 2433606 1644135 271861214 272875122 0 0 0 0 157041870 140084001 0 0 0 109782078 123517430 266823948 263601431 5037266 9273691 245188936 244952958 80903114 73709818 164285822 171243140 DuBois Regional Medical Center offers residents of West Central Pennsylvania a rare combination of advanced healthcare in a warm, friendly environment. DRMC is an oasis of clinical and technical excellence, with a focus on patient-centered care. See Statement of Community Benefit. 0 0 231795248 267998365 DuBois Regional Medical Center provides a variety of comprehensive inpatient care and outpatient medical services to the residents of West Central Pennsylvania. The facility is licensed for 231 beds. In fiscal year 2014, DRMC serviced 10,113 inpatients with a total of 40,603 inpatient days and provided more than 666,891 outpatients visits. In addition to direct medical services, the hospital also provides other medical programs to the community outreach programs, clinics, support groups, education programs, health fairs and health screenings. 0 0 0 231795248 1 1 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 1 0 0 0 0 0 0 1 0 1 1 0 0 1 0 0 0 0 0 1 1 1 0 0 0 0 0 1 1 1 0 0 1 195 0 1 2352 1 1 1 0 0 0 0 1 1 0 0 0 0 0 0 X 21 10 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X X Brian S Kline CFO 8143756377 PO Box 447 100 Hospital Avenue DuBois PA 15801 Nancy J Micks Secretary 3.0 0 X X 0 0 0 Sister Mary Ann Bader RSM Trustee 2 0 X 0 0 0 Dr James E Devlin Trustee 2 0 X 0 0 0 Sister Lisa Mary McCartney Trustee 2 0 X 0 0 0 Dr Hazem F El Kassas Trustee 2 0 X 0 0 0 Gene Hoak Trustee 2 0 X 0 0 0 Todd Miller Trustee 2 0 X 0 0 0 Edward S Nasuti Trustee 2 0 X 0 0 0 Sister Margaret Park Trustee 2 0 X 0 0 0 Dr Gregory Roscoe Trustee 2 0 X 0 0 0 Sharon Varischetti Trustee 2 0 X 0 0 0 Anthony Viglione Trustee 2 0 X 0 0 0 William Young Trustee 2 0 X 0 0 0 Lisa Zocco Trustee 2 0 X 0 0 0 Joyce R Fairman Trustee 2 0 X 0 0 0 Edward Yahner Trustee 2 0 X 0 0 0 Sally Moran Trustee 1 0 X 0 0 0 Todd Stoltz Chairman 5 0 X X 0 0 0 Melanie Hatch Vice Chairman 3 0 X X 0 0 0 Richard Pfingstler Treasurer 3 0 X X 0 0 0 Brian Kline Vice Presdient 40 X 284154 0 29930 Robert McKee Vice President 40 X 256886 0 37868 Janice Hamscher Vice President 40 X 263025 0 36557 Steven M Fontaine COO Penn Highlands Healthcare 40 40 X 0 406308 39549 Raymond A Graeca President Penn Highlands Healthcare 0 40 X 0 692297 111549 John Sutika President 40 X 401107 0 59641 Travis Millinder VP COO Physician Network 40 X 238127 0 10719 Russell Cameron VP Chief Medical Officer 40 0 X 493907 0 42557 Richard Latuska Physician 40 X 892304 0 28231 Mohamed Hassan Physician 40 X 957975 0 27755 Sandeep Bansal Physician 40 0 X 821728 0 26892 Grae Schuster Physician 40 X 860587 0 11973 Raj Kaushik Physician 40 X 686667 0 16708 6156467 1098605 479929 211 0 1 0 Associated Clinical Labs 1526 Peach Street Erie PA 16501 Lab Services 1577773 Allied Resources Medical Staffing 135 Dowlin Forge Road Exton PA 19341 Staffing Services 1370592 Apogee Medical Management 15059 N Scottsdale Road Suite 600 Scottsdale AZ 85254 Healthcare Staffing 1342651 Secure Healthcare Information Management 1605 N Cedar Crest Blvd Allentown PA 18104 Healthcare Billing 910138 Synergy Surgicalists 678 Simmons Lane Bozeman MT 59715 Medical Staffing 2160436 33 0 0 28755 0 0 1298581 0 1327336 Ancillary OP and Physician 622000 465204868 465204868 0 0 R&B Ancillary IP 622000 188716761 188716761 0 0 Other Program Revenue 622000 11614152 11614152 0 0 Contractual Adjustments 622000 -399126130 -399126130 0 0 0 0 0 0 266409651 3549421 0 0 3549421 0 0 0 0 0 0 0 0 832060 0 0 0 832060 0 832060 832060 0 0 223333 3122 281876 0 -58543 3122 -55421 -55421 0 0 0 Other Income 622000 2476718 2476718 0 0 Earnings from Affiliates 622000 -2047617 -2047617 0 0 Restricted Operating Revenue 622000 382974 382974 0 0 0 0 0 0 812075 272875122 267998365 0 3549421 2097313 869847 1227466 113919032 101224537 12694495 3134879 2758694 376185 12967185 11411123 1556062 7965592 7009721 955871 10704090 9419599 1284491 197220 197220 520 520 18745689 16496206 2249483 905 796 109 933324 821325 111999 5337848 4697306 640542 4314075 3796386 517689 447498 393798 53700 490687 431805 58882 1403095 1234724 168371 0 14807941 13030988 1776953 2903438 2555025 348413 Supplies 40914950 36005156 4909794 0 Bad Debt 6537368 5752884 784484 0 Maintenance Contracts 2392833 2105693 287140 0 Purchased Services 11244010 9894729 1349281 0 2141939 1884906 257033 263601431 231795248 31806183 0 23180501 39568281 37103440 27556988 4088738 3536024 243554263 152784128 96591573 90770135 57843755 58258320 26380929 25263210 245188936 244952958 28298619 25333306 2121623 2255759 44764193 42542107 2350208 1967001 3368471 1611645 80903114 73709818 X 162468517 169710949 1817305 1532191 0 0 164285822 171243140 245188936 244952958 9273691 0 0 0 -2316373 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 48784 0 34 0 0 0 48818 48750 0 34 0 0 0 48784 47469 1253 28 0 0 0 48750 41013 6401 55 0 0 0 47469 38372 2545 96 0 0 0 41013 0 1 0 1 0 0 3851646 3851646 0 61459320 35739150 25720170 0 81319043 73735327 7583716 0 96924254 43309651 53614603 0 0 0 0 90770135 Deferred Pension Plan 2255759 Deferred Financing 553665 Goodwill 565826 Inventory for Use 4091601 Miscellaneous Receivables 8818324 Other Assets 1700921 Investment in Affiliates 7277114 25263210 Third Party Rate Adj & Compliance Adj 1611645 1611645 Schedule D, Part V, Line 4 Endowment funds will be used to purchases of capital items used in patient care. Penn Highlands DuBois Golf Tournament 38437 0 38437 3749 0 1923 2456 0 1554 0 0 38437 0 38437 3749 0 1923 2456 0 1554 9682 28755 1 1 1 X 1 X 1 1 0 0 1720880 1720880 0.007 36207815 28836867 7370948 0.031 0 0 37928695 28836867 9091828 0.038 478821 478821 0.002 761500 761500 0.003 368332 368332 0.001 0 0 1608653 0 1608653 0.006 0 0 39537348 28836867 10700481 0.044 1 2739157 0 71936295 76982951 -5046656 X 1 1 Kidney Care Services LLC Dialysis Services 0.74 0 0.26 Kidney Care Services DuBois Dialysis Services 0.69 0 0.31 1 1 DuBois Regional Medical Center 100 Hospital Avenue DuBois PA 15801 www.phhealthcare.org X X X DuBois Regional Medical Center 1 0 0 1 X X X X X X X X X 15 1 1 1 1 X www.phhealthcare.org 1 15 1 www.phhealthcare.org 0 0 1 X 200 300 X X X X 1 1 X X X X 1 X www.phhealthcare.org X www.phhealthcare.org X X X X X 1 0 X X X 1 X 0 0 Schedule H, Part V, Section B, Line 5-DuBois Regional Medical Center Penn Highlands Healthcare hired the firm of Tripp Umbach to facilitate the preparation of the CHNA and collaborated with hospitals and outside organization in the surrounding region during the CHNA process including Alcohol and drug abuse services, Alcoholics Anonymous, Free Clinic of DuBois, Police departments, Chamber of Commerce, EMS services just to name a few. The process included public commentary, secondary data collection and analysis, stakeholder interviews, hand-distributed surveys, and a community health forum/retreat. The hospital worked with leaders within the healthcare systems as well as with several members outside of the system from various organizations and backgrounds. This list is included in the CHNA report. Schedule H, Part V, Section B, Line 6a-DuBois Regional Medical Center Penn Highlands Elk, Penn Highlands Brookville, and Penn Highlands Clearfield which are all hospitals in the Penn Highlands healthcare system. Schedule H, Part V, Section B, Line 6b-DuBois Regional Medical Center Penn Highlands Brookville, Penn Highlands Elk, and Penn Highlands Clearfield. Penn Highlands Healthcare also partnered with various local organizations in a collaborative manner during 2016 in order to carry out the intended goals and outcomes of our previous CHNA strategy. Schedule H, Part V, Section B, Line 11-DuBois Regional Medical Center The Hospital's CHNA gives a very detailed overview of the methods and activities that went into developing a strategic plan for accessing the needs of the community and choosing what the most important and attainable goals would be. These needs are presented in the CHNA with a detailed explanation of the issues, how this information was gathered, including primary and secondary data, what the goals are to deal with this issue and the next steps to attain these goals. The report addresses the top five health needs of the community and focuses on those issues. Schedule H, Part V, Section B, Line 22d-DuBois Regional Medical Center The discounts available to individuals under the policy will be at least equal to the average discount given to individuals with certain insurance plans. This minimum discount is calculated by determining what is called the amounts generally billed (AGB). The AGB establishes the limit as to what can be charged to an individual that qualifies for financial assistance. PHH/PHPN has chosen to use the look back method which reflects the average payment over a recent 12 month period of payments made to PHH/PHPN by Medicare and all private insurers. This AGB and if necessary the related discounts given to individuals will be updated at least annually. Schedule H, Part I, Line 3c A discount of 40% is extended to uninsured patients not qualifying for charity care. A 60% discount is applied for patients with non-covered pharmacy expenses. Schedule H, Part I, Line 7 Actual amounts are used to calculate these figures. Schedule H, Part III, Section A, Line 4 Bad debt is estimated based on applying pre-established percentages to each payor balance in the organizations accounts receivable. Self-pay balance percentages are applied based on the accounts receivable aging. The percentages are based on historical bad debt information and assistance from the organization's financial auditors. Schedule H, Part III, Section B, Line 8 Medicare total revenue received and allowable costs are calculated using various lines from the Medicare cost report. To include professional component revenue, internal reports are used. The professional cost is calculated using the non-allowable physician costs from the cost report multiplied by the percentage of Medicare PCs to total PCs. Schedule H, Part III, Section C, Line 9b The hospital offers free and discounted charity care to those patients who qualify. A patient with family income at or below 200% of Schedule A of the poverty guidelines, or below this level due to medical indigency, is eligible to receive free medical services. Discounted services are offered to patients with a family income between 201% and 300% of Schedule A of the poverty guidelines. Schedule H, Part VI, Line 2 The hospital collects data on an ongoing basis regarding patients who travel to outlying areas for services not offered by DRMC. Based on this data, services are added and improved upon in order to serve the needs of the community as effectively and efficiently as possible. DRMC routinely sends patient satisfaction surveys to those receiving medical services. These surveys allow patients to offer suggestions regarding how the hospital could better serve them as patients and the community as a whole. DRMC offers a variety of education programs that allow employees to interact on a one-on-one basis with the residents of the community as a whole. In addition, the medical staff of the hospital consistently participates in research and continuing medical education. This knowledge allows the hospital to remain updated on the latest medical news and techniques in order to offer patients the highest and most innovative levels of care. DRMC hired an outside firm to assist with conduction a Community Health Needs Assessment. The contractor gathered secondary data in Clearfield and surrounding counties, conducted various focus groups with key audiences and users of healthcare and social services to identify areas for perspective improvement within the community. The contractor has developed a master plan of initiatives for DRMC which has been posted on the hospital's website. Schedule H, Part VI, Line 3 DRMC posts a Notice of Charity Care at all points of registration, including all employed physician practices. The notice includes a statement as to the availability of charity care and how to apply. DRMC employs a Financial Counselor who meets individually with all inpatients admitted to the facility who indicate no health care coverage. The Financial Counselor interviews the patient, and, if appropriate, discusses and educates the patient relative to Medical Assistance, Blue Chip and the hospital's charity program. The Financial Counselor competes and assists the patients with the necessary applications and follow-thru with the physician and the assigned County Board of Assistance casework. The Financial Counselor also contacts other patients with large dollar account balances to discuss and educate the patient's need for financial assistance. Additionally, DRMC employs a credit collections staff who also contacts, educates and offers assistance to other patients with financial need to help with health care costs. Schedule H, Part VI, Line 4 DRMC's 221 licensed beds are house in two facilities in DuBois, a small town in West Central Pennsylvania. The combined tradition of providing high quality, compassionate care began with its predecessors, DuBois Hospital and Maple Avenue Hospital in 1897. In 1985, the two organizations joined to create DuBois Regional Medical Center, and, since then, the medical center has grown for the benefit of the entire community. DRMC west houses acute inpatient care and a full range of ancillary services. DRMC East is the sight of the Behavioral Health unit. In addition, DRMC offers access to primary and specialty care health centers in several communities. As on of the largest private employers in Clearfield County, DRMC is a significant part of the area's economy. We take pride in the role we play in shaping the quality of life for residents of the communities we serve. We also believe that the population we serve is both very proud and grateful to have DRMC as their primary health care provider. Schedule H, Part VI, Line 5 DuBois Regional Medical Center offers residents of West Central Pennsylvania the combination of advanced healthcare in a warm, friendly environment. Widely recognized as one of the leading health centers of its kind in the Commonwealth, DRMC is an oasis of clinical and technical excellence, with a focus on patient-centered care. Our combined vision is to be positioned as the premier provider of comprehensive, quality services to our broad region. Providing inpatient and outpatient hospital care represents the largest portion of these services. DRMC's mission in maintaining these services is accomplished by providing assess to healthcare services for all, including individuals who are unable to pay for such services. DRMC has a tradition of serving the poor and under-priviledged of the area by providing care programs and services to enhance their quality of life. Beyond the inpatient and outpatient hospital care, there are many other ways in which DRMC and our employees serve our community every day. In addition to giving to organizations, they provide information on health and safety to the community. They provide direct patient care on a volunteer basis at the local DuBois Free Clinic. The clinic was established for low-income people who could not afford health insurance. The success and reputation of DRMC is a direct result of the dedicated efforts of our Board of Directors, Administration, Physicians and Staff. With the continued support of the DRMC family and the communities we serve, DRMC will remain a valuable resource to our area. Schedule H, Part VI, Line 7 Pennsylvania X X X X X 0 1 0 0 0 1 0 0 0 Raymond A Graeca President Penn Highlands Healthcare 0 559163 0 115150 0 17984 0 94474 0 17075 0 803846 0 John Sutika President 330506 0 50589 0 20012 0 43651 0 15991 0 460749 0 0 0 Steven M Fontaine COO Penn Highlands Healthcare 0 333546 0 62836 0 9925 0 21642 0 17908 0 445857 0 Brian Kline Vice Presdient 254892 0 29262 0 0 0 22985 0 6945 0 314084 0 0 Janice Hamscher Vice President 233093 0 29932 0 0 0 20589 0 15969 0 299583 0 0 Travis Millinder VP COO Physician Network 214385 0 23742 0 0 0 19319 0 15996 0 273442 0 0 0 Russell Cameron VP Chief Medical Officer 398404 0 90901 0 4602 0 28600 0 13958 0 536465 0 0 0 Richard Latuska Physician 612400 0 279904 0 0 0 10600 0 17631 0 920535 0 0 0 Mohamed Hassan Physician 556000 0 401975 0 0 0 10600 0 17155 0 985730 0 0 0 Grae Schuster Physician 565642 0 294945 0 0 0 0 0 11973 0 872560 0 0 Raj Kaushik Physician 675000 0 0 0 11667 0 3115 0 13593 0 703375 0 0 0 Sandeep Bansal Physician 489275 0 332453 0 0 0 10600 0 16292 0 848620 0 0 0 Schedule J, Part I, Line 4 Raymond Graeca - $18,000, John Sutika - $18,000, Steve Fontaine - $16,686, Brian Kline - $12,745, Janice Hamscher - $11,655, Travis Millinder - $10,719, Russell Cameron - $18,000 Schedule J, Part I, Line 6 Members of the management team are eligible for an incentive bonus each year based on predetermined criteria. Such criteria includes multiple factors such as meeting strategic and other performance metrics including growth of services, new services, customer satisfaction, financial performance, quality improvements, among others goals. Michelle Sutika Bennett Relative of officers 128514 Compensation 0 Steven Graeca Relative of Board Member 528813 Compensation 0 Linda McKee Relative of Officer 26318 Compensation 0 Kristie Yount Relative of Board Member 90138 Compensation 0 Douglas Dale Relative of Board Member 36693 Compensation 0 Andrew Sutika Relative of Board Member 109733 Compensation 0 Lauren Dale Hospodar Relative of Board Member 55647 Compensation 0 Megan Devlin Bussard Relative of Board Member 109566 Compensation 0 Tricia Brigger Relative of Board Member 81510 Compensation 0 Ann Curtis Relative of Board Member 30175 Compensation 0 Julianne Hassan Relative of Board Member 66649 Compensation 0 Mark Stoltz Relative of Board Member 59589 Compensation 0 Cody Millinder Relative of Board Member 45080 Compensation 0 Kylee Millinder Relative of Board Member 39878 Compensation 0 Oncology Hematology Associates Owned by a Board Member 658798 Medical Services 0 William Nasuti Relative of a Board Member 32674 Compensation 0 Dr Gregory Roscoe Board Member 100270 Lease of Office Space from Trustee 0 Dr James Devlin Trustee 50855 Stipends and Medical Director Payments 0 Schedule L, Part IV Dr. C. Marchioli and Dr. H. El Kassas are owners of Oncology Hematology Associates of Northern Pennsylvania, PC. Form 990, Part VI, Section A, Line 7a Effective October 1, 2011, Penn Highlands Healthcare became the other of DRMC. It holds certain reserved powers over DRMC, including the power to elect the directors of DRMC (other than ex-officio directors) from a panel of individuals submitted to PHH by DRMC's board and nominated by PHH's Governance/Nominating Committee. The Sisters of Mercy have a right to nominate up to three of its sisters to sit on the DRMC board of Directors (subject to certain restrictions). PHH also have the power to remove directors. Form 990, Part VI, Section B, Line 11b DRMC will be submitting the Form 990 to meet the May 15th deadline for filing. The complete Form 990 will be provided to the finance committee and board of directors at the May 2017 meetings. At that time, the committees will review the Form 990 and have the opportunity to discuss any information contained within the document. Form 990, Part VI, Section B, Line 12c Yearly, Board members are required to complete a new conflict of interest statement. At any time, any board member may question a possible conflict of interest and a thorough review would then be completed. Form 990, Part VI, Section B, Line 15 An independent firm is hired t compare, review, and recommend all senior officers' compensation. The Board of directors provides the final approval. Form 990, Part VI, Section C, Line 18 A copy of the Form 990 tax return is located in the administrative offices of DuBois Regional Medical Center. It is available for public inspection at any time upon request. Form 990, Part VI, Section C, Line 19 The conflict of interest statement and other governing documents are available to the public at the public's request. They are located tin a "Public Binder" in the administrative offices of DRMC Nathan D Yingling Cancer Center 815 Doctors Drive Clearfield PA 16830 205114093 Radiation and Oncology Services PA 501 (c) (3) 3 Clearfield Hospital DuBois Regional Medical Center 1 Brookville Hospital 100 Hospital Road Brookville PA 15825 250984595 Hospital PA 501 (c) (3) 3 Penn Highlands Healthcare 1 Clearfield Hospital 809 Turnpike Avenue Clearfield PA 16830 250979346 Hospital PA 501 (c) (3) 3 Penn Highlands Healthcare 1 Penn Highlands Healthcare 100 Hospital Avenue DuBois PA 15801 320345810 Hospital Mgmt Services PA 501 (c) (3) 11c N/A 0 Elk Regional Health Center 763 Johnsonburg Road St Marys PA 15857 250585230 Hospital PA 501 (c) (3) 3 Penn Highlands Healthcare 1 Kidney Care Services LLC 635 Maple Ave Suite D DuBois PA 15801 510644566 Dialysis Services PA N/A Related -2784 6563 0 1 0.74 Kidney Care Services DuBois 635 Maple Ave Suite D DuBois PA 15801 510644542 Dialysis Services PA N/A Related 4097 9790 0 1 0.69 DuBois Regional Medical Group PO Box 447 DuBois PA 15801 251856569 Pediatric Services PA N/A C -2367119 2061572 1 0 DuBois Medical Risk Retention Group PO Box 447 DuBois PA 15801 200324622 Insurance Services PA N/A C 244609 11531731 1 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 0 0 DuBois Medical Risk Retention Group m 980865 Cost Brookville Hospital k 36521 Brookville Hospital p 88173 Cost Elk Regional Health Center k 392712 Cost Elk Regional Health Center p 318623 Cost Clearfield Hospital k 129533 Cost Clearfield Hospital p 34173 Cost Penn Highlands Healthcare m 9388189 Cost DuBois Medical Risk Retention Group l 12000 Cost Brookville Hospital j 81422 Cost Brookville Hospital q 1150815 Cost Clearfield Hospital j 27943 Cost Clearfield Hospital q 971685 No Elk Regional Health Center q 1312721 Cost Penn Highlands Healthcare q 7401382 Cost DuBois Regional Medical Group q 7391202 Cost DuBois Regional Medical Group p 203669 Cost