2016-12-20T12:31:19-06:00 2016-06-30 341897225 HILL BARTH & KING LLC 3110 HIGHLAND ROAD HERMITAGE PA 16148 990 2015-07-01 250979377 CHRISTIAN H BUHL LEGACY TRUST CHRI 7249812640 701 PIERCE AVENUE NO 1 SHARPSVILLE PA 16150 JOHN HUDSON CHAIRMAN 7244182640 2016-12-19 1 DOMINIC MASTROPIETRO P00949738 7249817550 2016-12-15 2015 2017-02-10 21:41:12Z X JOHN HUDSON 701 PIECE AVENUE STE 1 SHARPSVILLE PA 16150 3376289 0 X N/A X 1896 PA CHRISTIAN H BUHL LEGACY TRUST, PREVIOUSLY KNOWN AS SHARON REGIONAL HEALTH SYSTEM, PROVIDES HIGH QUALITY INPATIENT, OUTPATIENT AND EMERGENCY CARE SERVICES TO OUR COMMUNITIES. 9 9 10 9 0 0 18997 0 1330372 515821 263252 194931 2858490 2134175 4471111 2844927 0 4450 0 0 1494532 608505 0 0 0 5288872 1343006 6783404 1955961 -2312293 888966 46080335 44251398 4905625 1984168 41174710 42267230 THE MISSION OF CHRISTIAN H BUHL LEGACY TRUST, THROUGH MARCH 2014, WAS TO PROVIDE THE HIGHEST QUALITY, ADVANCED HEALTHCARE SERVICES TO COMMUNITIES WITHIN OUR REGION. 0 0 191307 4450 2649996 CHRISTIAN H BUHL LEGACY TRUST, PREVIOUSLY KNOWN AS SHARON REGIONAL HEALTH SYSTEM, PROVIDED INPATIENT SERVICES FOR ACUTE CARE, INTENSIVE CARE, HEART CENTER, OB/GYN, NURSERY, SKILLED NURSING, IP REHAB AND IP ADULT AND CHILD BEHAVIORAL HEALTH SERVICES THROUGH MARCH 2014. AT THAT TIME THE ASSETS WERE SOLD TO AN UNRELATED ENTITY AND THESE PROGRAMS WERE NO LONGER PERFORMED BY THE ORGANIZATION. THE ORGANIZATION CONTINUES TO EXIST IN ORDER TO WIND DOWN OPERATIONS, COLLECT RECEIVABLES AND SETTLE PAYABLES. 191307 1 0 0 0 0 0 0 0 0 0 0 1 0 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 20 0 10 1 0 0 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 PA X JEFFREY A CHROBAK 7244182640 701 PIERCE AVENUE STE 1 SHARPSVILLE PA 16150 JAMES E FEENEY VICE CHAIR (ALT) 1.00 X X 0 0 0 STEPHEN J GURGOVITS BOARD MEMBER 1.00 X 0 0 0 JAMES EPSTEIN BOARD MEMBER 1.00 X 0 0 0 ROBERT G LIPTAK BOARD MEMBER 1.00 X 0 0 0 MARY ODEM BOARD MEMBER 1.00 X 0 0 0 JOHN M HUDSON BOARD CHAIRMAN 1.00 X X 0 0 0 WILLIAM J STRIMBU BOARD MEMBER 1.00 X 0 0 0 KENNETH R JAMES BOARD MEMBER 1.00 X 0 0 0 ANGELA M PALUMBO SEC-TREAS 1.00 X X 0 0 0 JEFFREY A CHROBAK CEO 40.00 1.00 X 173335 0 19410 JOHN JANOSO JR FORMER PRES AND CEO 40.00 1.00 X 136500 0 0 309835 0 19410 2 1 1 0 MERCER PO BOX 730182 DALLAS TX 75373 CONSULTING 452416 EVANS GARVEY LACKEY OCHS PO BOX 949 SHARON PA 16146 LEGAL 184296 2 PATIENT REVENUE 621990 331626 331626 OPERATING REVENUE 621990 184195 184195 515821 726293 726293 531362 -531362 -531362 -531362 RECOVERY OF ESCROW LIABILITY 621110 1228728 1228728 REFUNDS 621110 568683 568683 REBATES 621990 296541 296541 40223 40223 2134175 2844927 2649996 0 194931 X 4450 4450 177472 177472 260066 260066 44585 44585 126382 126382 291980 291980 185593 185593 83062 83062 246622 246622 10674 10674 50102 50102 87788 87788 5026 5026 644 644 43699 43699 REFUNDS 154110 154110 0 OTHER DIRECT EXPENSES 71902 8169 63733 COLLECTION FEES 61865 0 61865 MEDICAL SERVICES 24578 24578 0 25361 25361 1955961 191307 1764654 0 2926257 3520188 7425160 485119 92091 187996 40515 109961 19930399 29697062 7028916 7032633 8636997 3218439 46080335 44251398 1570025 1500885 3335600 483283 4905625 1984168 X 40700624 41832997 474086 434233 41174710 42267230 46080335 44251398 888966 203554 0 X 0 1 X 0 0 X 0 0 0 13117956 16264 13134220 12505049 612907 13117956 10264189 2240860 12505049 10970716 -706527 10264189 0 MERCER COUNTY PHO 153602 C CHART 6879031 C 7032633 RECEIVABLE - HELD IN ESCROW 2008459 WORKERS COMP REV TRUST 1209980 3218439 ESTIMATED SELF-INSURANCE COSTS 349561 DEFERRED COMPENSATION 133722 483283 2479797 203554 203554 2276243 568684 568684 2844927 1387276 0 1387276 568685 568685 1955961 PART V, LINE 4: INTENDED USE OF ENDOWMENT FUNDS: ENDOWMENT FUNDS INCLUDE ASSETS SET ASIDE BY THE BOARD OF DIRECTORS FOR FUTURE CAPITAL IMPROVEMENTS, PENSION FUNDING REQUIREMENTS AND POST RETIREMENT BENEFIT OBLIGATIONS OVER WHICH THE BOARD RETAINS CONTROL AND MAY AT ITS DISCRETION SUBSEQUENTLY USE FOR OTHER PURPOSES. IN DECEMBER 2014, THE BOARD RELEASED THE RESTRICTIONS ON THE FUNDS AND TRANSFERRED THEM TO A CHECKING ACCOUNT. PART XI, LINE 4B - OTHER ADJUSTMENTS: REFUND REPORTED AS AN EXPENSE ON THE FINANCIAL STATEMENTS 568,683. ROUNDING 1. PART XII, LINE 4B - OTHER ADJUSTMENTS: REFUND REPORTED AS AN EXPENSE ON THE FINANCIAL STATEMENTS 568,683. ROUNDING 2. X X X X X 0 0 0 0 0 0 0 0 0 JEFFREY A CHROBAK CEO 173335 0 0 0 0 0 0 0 19410 0 192745 0 0 0 JOHN JANOSO JR FORMER PRES AND CEO 136500 0 0 0 0 0 0 0 0 0 136500 0 0 0 PART I, LINE 1A IN PREVIOUS YEARS, THE ORGANIZATION PAID HEALTH AND SOCIAL CLUB DUES FOR CERTAIN MEMBERS. IN THE CURRENT YEAR, NO HEALTH AND SOCIAL CLUB DUES WERE PAID TO ANY OFFICER, DIRECTOR OR HIGHLY COMPENSATED EMPLOYEE. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS PREPARED BY INDEPENDENT TAX ADVISORS WITH INFORMATION SUPPLIED BY THE CHIEF FINANCIAL OFFICER, DIRECTOR OF FINANCE AND OTHER FINANCIAL MANAGERS, AND LEGAL COUNSEL. THE PREPARED 990 IS SUBMITTED FOR INTERNAL REVIEW BEFORE FILING. ADDITIONALLY, THE BOARD WAS PROVIDED A COPY OF THE 990 PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST POLICY: THE BOARD OF DIRECTORS OF CHRISTIAN H BUHL LEGACY TRUST MAINTAINS A WRITTEN POLICY DEFINING CONFLICT OF INTERESTS OF ITS DIRECTORS AND OFFICERS. ALL NEW DIRECTORS AND OFFICERS ARE ORIENTED ON THE POLICY. ANNUALLY, THE OFFICERS AND THE MEMBERS OF THE BOARD OF DIRECTORS RECEIVE A COPY OF THE POLICIES AND EACH DIRECTOR AND OFFICER COMPLETES A CONFLICT OF INTEREST QUESTSIONNAIRE. THE CHAIRMAN OF THE BOARD OF DIRECTORS REVIEWS ALL RESPONSES AND CONSULTS LEGAL COUNSEL. THE CHAIRMAN CONSIDERS COMMITTEE MEMBERSHIP AND RECUSAL FROM DISCUSSION AND VOTES IN LIGHT OF POTENTIAL CONFLICTS AND BOARD MEMBERS ROUTINELY VOLUNTARILY RECUSE THEMSELVES EVEN IF CONFLICT IS ONLY PRECEIVED. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION DETERMINATION: THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS REVIEWS AND RECOMMENDS THE COMPENSATION OF THE OFFICERS OF CHRISTIAN H BUHL LEGACY TRUST AND THE BOARD OF DIRECTORS APPROVES THESE RECOMMENDATIONS ANNUALLY. THE COMPENSATION COMMITTEE IS COMPOSED OF MEMBERS WHO HAVE NO INTEREST WITH THE OFFICERS. THE COMPENSATION COMMITTEE RETAINS AN INDEPENDENT CONSULTANT TO REVIEW MARKET DATA AND ESTABLISH COMPENSATION RANGES FOR EACH OFFICER IN COMPARISION WITH SIMILAR EXECUTIVE POSITIONS. THE COMPENSATION COMMITTEE ANNUALLY REVIEWS THE PERFORMANCE OF THE CHIEF EXECUTIVE OFFICER AND ACCEPTS PERFORMANCE REVIEWS CONDUCTED BY THE CHIEF EXECUTIVE OFFICER AND THE OTHER OFFICERS. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENT DISCLOSURE: THE ORGANIZATION WILL MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE WHEN IT IS LEGALLY REQUIRED. FORM 990, PART IX, LINE 11G CONSULTING FEES : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 246,622. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 246,622. CHBLT SUBSIDIARY CO 701 PIERCE AVE STE 1 SHARPSVILLE PA 16150 251640802 PHYS PRACTICE PA 501(C)(3) LINE 9 CHRISTIAN H BUHL LEGACY TRUST 1 BUHL REGIONAL HEALTH FOUNDATION 701 PIERCE AVE STE 1 SHARPSVILLE PA 16150 455247666 SUPPORT PA 501(C)(3) LINE 7 CHRISTIAN H BUHL LEGACY TRUST 1 CHATWOOD COMMONS CONDO ASSOCIATION 701 PIERCE AVE STE 1 SHARPSVILLE PA 16150 251678608 REAL ESTATE PA EXCLUDED -32229 -31861 0 1 0.77650 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 CHBLT SUBSIDIARY CO E 1463342 FAIR MARKET VALUE