2016-05-13T10:34:44-05:00 2015-06-30 390859910 BAKER TILLY VIRCHOW KRAUSE LLP 1650 MARKET STREET SUITE 4500 PHILADELPHIA PA 19103 990 2014-07-01 251842046 INDIANA HEALTHCARE PHYSICIAN SERVICES INC INDI 7243577008 PO BOX 788 INDIANA PA 15701 ROBERT GONGAWARE SENIOR VP FINANCE 7243577008 2016-05-12 1 JULIUS C GREEN CPA JD P00350393 2159720701 2014 2016-08-17 19:52:53Z STEPHEN A WOLFE PO BOX 788 INDIANA PA 15701 12179810 0 X WWW.INDIANARMC.ORG X 2000 PA PROVIDE HEALTH SERVICES 9 6 195 0 566047 0 0 0 7438593 11113200 0 0 958252 1066610 8396845 12179810 0 0 0 0 9189176 8209955 0 0 0 3141996 8781730 12331172 16991685 -3934327 -4811875 1646688 2468433 322117 368810 1324571 2099623 X PREVENTIVE HEALTH SERVICES, GENERAL/OTHER: 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. ITS MISSION IS TO SUPPORT THE MISSIONS AND VALUES OF INDIANA REGIONAL MEDICAL CENTER IN PROVIDING HEALTH CARE AND EDUCATIONAL SERVICES TO ALL WHO SEEK HEALTHCARE WITHOUT DISCRIMINATION. WE PROVIDE ACCESSIBLE, COST EFFECTIVE QUALITY HEALTHCARE WITHIN THE RURAL COMMUNITIES OF INDIANA AND SURROUNDING COUNTIES. 0 0 13807036 11113200 PREVENTATIVE HEALTH SERVICES, GENERAL/OTHER:INDIANA HEALTHCARE PHYSICIAN SERVICES, INC. ("IHPS") IS A NON-PROFIT HOSPITAL OWNED GROUP OF PRACTICES OWNED AND OPERATED TO SERVE THE RURAL AREAS OF INDIANA AND SURROUNDING COMMUNITIES. ITS MISSION IS TO SUPPORT THE MISSIONS AND VALUES OF INDIANA REGIONAL MEDICAL CENTER IN PROVIDING HEALTH CARE AND EDUCATIONAL SERVICES TO ALL WHO SEEK HEALTHCARE WITHOUT DISCRIMINATION. WE PROVIDE ACCESSIBLE, COST EFFECTIVE QUALITY HEALTHCARE WITHIN THE RURAL COMMUNITIES OF INDIANA AND SURROUNDING COUNTIES. CHARITY CARE PROVIDED DURING THE FISCAL YEAR ENDED JUNE 30, 2015 WAS $36,378.OWNERSHIP OF PHYSICIAN OFFICES - IHPS FOCUSES ON REBUILDING THE REVENUE CYCLE AND COST STRUCTURE OF PHYSICIAN OFFICES WITHIN THE COMMUNITY. IHPS ALSO FOCUSES ON RECRUITING PHYSICIANS THAT OFFER A NEW OR NEEDED SERVICE WITHIN THE COMMUNITY. WE SUPPORT AND WORK COLLABORATIVELY WITH OTHER NON-PROFIT AGENCIES WITHIN OUR SITES. SOME OF THE SERVICES ARE LISTED BELOW, BUT ARE NOT LIMITED TO:- OPEN DOOR PROGRAM - PROVIDES DRUG AND ALCOHOL REHABILITATION AND COUNSELING- HEALTHY WOMEN'S PROGRAM - OB/GYN EXAMS FOR ALL WOMEN WITH NO LIMITATIONS (REGARDLESS OF RACE, AGE, CREED, RELIGIOUS BELIEFS, OR ABILITY TO PAY).- FREE HEALTH CARE FOR LOW INCOME FAMILIES THROUGH THE "WE CARE" PROGRAM.- SPEAKING ENGAGEMENTS RELATED TO HEALTH ISSUES OR WELLNESS TO ANY AND ALL COMMUNITY GROUPS, CHURCHES, AND OR OTHER NON-PROFIT ORGANIZATIONS. ACTIVE PARTICIPATION IN HEALTH PROGRAMS WITHIN THE SCHOOLS. - FREE PARKING FOR PATIENTS AND EMPLOYEES.- HEALTH SCREENING PARTICIPATION WITH LOCAL AGENCIES AND NON-PROFIT FUNDRAISING EVENTS WITHIN THE COMMUNITY. - STAFF PARTICIPATES IN THE UNITED WAY CAMPAIGN.- EMPLOYEE/TIMESHARE SERVICES - IHPS FOCUSES ON PROVIDING QUALITY WELL-TRAINED SUPPORT STAFF TO MULTIPLE INDEPENDENT PHYSICIANS WITHIN THE COMMUNITY. - PHYSICIAN BILLING SERVICES - IHPS FOCUSES ON PROVIDING QUALITY BILLING SERVICES THAT MAXIMIZES REIMBURSEMENT TO MULTIPLE INDEPENDENT PHYSCIANS WITHIN THE COMMUNITY. 13807036 1 0 0 0 0 0 0 0 0 1 1 0 0 0 1 1 0 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 0 0 0 1 X 0 0 1 195 0 1 1 0 0 0 0 0 0 0 0 0 X 9 6 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X ROBERT GONGAWARE SVP FINANCE 7243577008 835 HOSPITAL ROAD INDIANA PA 15701 BEVERLY GAZZA ESQ CHAIRMAN 1.00 2.00 X X 0 0 0 ANNE WHITE VICE CHAIRMAN 1.00 1.00 X X 0 0 0 EDWARD MCDOWELL CHAIRMAN, NETWORK OPERATIONS COUNCIL 40.00 13.00 X X 324508 15000 16615 NATHAN KOVALCHICK SECRETARY 1.00 1.00 X X 0 0 0 JOSEPH GEARY TREASURER 1.00 1.00 X X 0 0 0 MARK E BOYKIW BOARD MEMBER 1.00 1.00 X 0 1500 0 TODD BRICE CHAIRMAN 1.00 1.00 X 0 0 0 BRUCE A BUSH MD BOARD MEMBER 1.00 39.00 X 0 283064 23429 STEPHEN A WOLFE BOARD MEMBER 1.00 39.00 X X 0 400117 94279 ISLAM MOHAMMED N PHYSICIAN 40.00 40.00 X 443919 0 19487 NOWAK MIHAELA PHYSICIAN 40.00 40.00 X 361377 0 15683 GUDDETI MURALIDHAR R PHYSICIAN 40.00 40.00 X 322067 0 21143 SYED MUSHTAQ A PHYSICIAN 40.00 40.00 X 320712 0 16782 CONTI JOSEPH D PHYSICIAN 40.00 40.00 X 317445 0 19939 2090028 699681 227357 6 0 1 0 MATT KLAIN MD 25 COLONY BLVD SUITE 102 BLAIRSVILLE PA 15717 PRIMARY CARE SERVICES 260186 LOCUMTENENSCOM PO BOX 532869 ATLANTA GA 30353 PSYCHIATRIC SERVICES 171115 2 OUTPATIENT REVENUE 621400 10911446 10911446 PHYSICIAN SERVICES 621400 201754 201754 11113200 EMPLOYEE TIMESHARE SVCS 541900 392959 392959 INSURANCE INCENTIVES 900099 257225 257225 PHYSICIAN BILLING SERVICES 561000 173088 173088 243338 243338 1066610 12179810 11113200 566047 500563 X 6494125 4326184 2167941 115253 77421 37832 972430 749089 223341 628147 539333 88814 21000 21000 5794149 5553335 240814 9096 3761 5335 231103 231103 317853 171198 146655 841497 747513 93984 43497 8705 34792 29502 29502 310117 214669 95448 399526 399526 MEDICAL SUPPLIES & DRUG 389999 385015 4984 BAD DEBT 329383 329383 RECRUITING & RETENTION 28842 6225 22617 CONTRACT LABOR 25000 25000 11166 10074 1092 16991685 13807036 3184649 0 1573 1673 13386 25542 806392 1160701 42167 74578 2202663 996724 783170 1205939 1646688 2468433 127228 173921 194889 194889 322117 368810 X 1256676 2093938 67895 5685 1324571 2099623 1646688 2468433 X -4811875 5586927 X 0 1 X 1 0 X 67895 62210 5685 117211 49316 67895 200000 82789 117211 2000 2000 1.00000 0 0 2202663 996724 1205939 1205939 ESTIMATED MEDICAL MALPRACTICE CLAIMS LIABILITY 194889 194889 X 17437354 5257544 5257544 12179810 0 12179810 16662302 0 16662302 329383 329383 16991685 PART X, LINE 2: THE CORPORATION 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 2015 AND 2014. THE CORPORATION'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: TRANSFER FROM AFFILIATE 5,586,927. BAD DEBT EXPENSE NETTED ON THE FINANCIAL STATEMENTS -329,383. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE NETTED ON THE FINANCIAL STATEMENTS 329,383. X 1 1 0 1 0 0 0 0 0 1 0 EDWARD MCDOWELL CHAIRMAN, NETWORK OPERATIONS COUNCIL 324508 15000 0 0 0 0 0 0 0 16615 324508 31615 0 0 BRUCE A BUSH MD BOARD MEMBER 0 283064 0 0 0 0 0 0 0 23429 0 306493 0 0 STEPHEN A WOLFE BOARD MEMBER 0 394019 0 0 0 6098 0 66646 0 27633 0 494396 0 0 ISLAM MOHAMMED N PHYSICIAN 443919 0 0 0 0 0 0 0 19487 0 463406 0 0 0 NOWAK MIHAELA PHYSICIAN 361377 0 0 0 0 0 0 0 15683 0 377060 0 0 0 GUDDETI MURALIDHAR R PHYSICIAN 320567 0 1500 0 0 0 0 0 21143 0 343210 0 0 0 SYED MUSHTAQ A PHYSICIAN 320712 0 0 0 0 0 0 0 16782 0 337494 0 0 0 CONTI JOSEPH D PHYSICIAN 317445 0 0 0 0 0 0 0 19939 0 337384 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 3 THE FOLLOWING METHODS ARE USED BY INDIANA REGIONAL MEDICAL CENTER (IRMC) TO ESTABLISH COMPENSATION OF THE PRESIDENT/CEO, AS IRMC COMPENSATES THE PRESIDENT/CEO FOR SERVICES TO IRMC AND ALL RELATED ENTITIES: COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, WRITTEN EMPLOYMENT CONTRACT, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. 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 2014. STEPHEN WOLFE'S CONTRIBUTION TO THE PLAN FOR 2014 WAS $39,000. INDIANA HEALTHCARE PHYSICIAN SERVICES HAS A 457(F) PLAN AVAILABLE FOR THEIR PHYSICIANS. DR. MOHAMMED N. ISLAM WAS A MEMBER OF THIS PLAN DURING 2014. NO AMOUNTS WERE PAID TO HIM FROM THIS PLAN, AND HIS CONTRIBUTION TO THE PLAN FOR 2014 WAS $49,094. 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. BONUSES FOR PHYSICIANS ARE DETERMINED BY "RVU" PRODUCTIVITY, PROFITABILITY OF PRACTICE, OR QUALITY INCENTIVES. FORM 990, PART V, LINES 1 AND 2 THE ORGANIZATION DOES NOT FILE FORMS 1096 OR W-3. ALL VENDORS AND ALL EMPLOYEES ARE PAID THROUGH A COMMON PAYMASTER/REPORTING AGENT. THE COMMON PAYMASTER/REPORTING AGENT IS INDIANA REGIONAL MEDICAL CENTER, EIN: 25-0965404. INDIANA REGIONAL MEDICAL CENTER IS A RELATED, TAX-EXEMPT ORGANIZATION. THE NUMBER OF W-2'S REPORTED ON FORM 990, PART V, LINE 2 REPRESENTS THE NUMBER OF W-2'S FILED BY THE COMMON PAYMASTER ON BEHALF OF THIS ENTITY. 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 HEALTHCARE PHYSICIAN SERVICES ("IHPS"). 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 IHPS. FORM 990, PART VI, SECTION A, LINE 7B IHPS SHALL OBTAIN THE APPROVAL OF IHC BEFORE ACTION ON ANY OF THE FOLLOWING MATTERS BECOMES FINAL AND EFFECTIVE FOR IHPS: (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 IHPS; (3) MERGER OR CONSOLIDATION WITH ANY OTHER CORPORATION; (4) DISSOLUTION OF IHPS; (5) APPROVAL OF AN ANNUAL BUDGET FOR IHPS; (6) ANY TRANSFER OF FUNDS BY GRANT, GIFT, OR LOAN FROM IHPS; (7) ANY OTHER MATTER THAT BY LAW WOULD REQUIRE THE APPROVAL OF MEMBERS OF A NONPROFIT CORPORATION. FORM 990, PART VI, SECTION B, LINE 11 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 OR 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 ACKNOWLEDGMENT AS WELL. THE ACKNOWLEDGMENT AND DISCLOSURE FORMS WILL BE KEPT ON FILE BY THE CHIEF EXECUTIVE OFFICER, AND THE CHAIRMAN AND VICE-CHAIRMAN WILL BE FAMILAR 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 CEO 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 INTESTS 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 IX, LINE 11G OUTSIDE PRINTING: PROGRAM SERVICE EXPENSES 3,942. MANAGEMENT AND GENERAL EXPENSES 12,648. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 16,590. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 618,009. MANAGEMENT AND GENERAL EXPENSES 68,258. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 686,267. PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 4,931,384. MANAGEMENT AND GENERAL EXPENSES 45,886. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,977,270. CONSULTATION FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 114,022. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 114,022. FORM 990, PART XI, LINE 9: TRANSFER FROM AFFILIATE 5,586,927. INDIANA REGIONAL MEDICAL CENTER 835 HOSPITAL ROAD INDIANA PA 15701 250965404 HOSPITAL PA 501(C)(3) LINE 3 INDIANA HEALTHCARE CORPORATION 0 INDIANA HEALTHCARE FOUNDATION 835 HOSPITAL ROAD INDIANA PA 15701 251574302 FUNDRAISING IN SUPPORT OF INDIANA REGIONAL MEDICAL CENTER PA 501(C)(3) LINE 11A, I 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 11A, 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 11A, I INDIANA REGIONAL MEDICAL CENTER 0 INDIANA AMBULATORY SURGICAL ASSOCIATES LLC 841 HOSPITAL ROAD INDIANA PA 15701 232923182 AMBULATORY SURGERY PA N/A INDIANA REHABILITATION SERVICES LLC 855 SPRINGDALE DR STE 200 EXTON PA 19341 202214391 REHABILITATION SERVICES PA N/A COSM REALTY GROUP LTD 1265 WAYNE AVENUE STE 307 INDIANA PA 15701 030439684 REAL ESTATE PA N/A PENNSYLVANIA MOUNTAINS HEALTHCARE ALLIANCE LLC 150 MCCRACKEN RUN ROAD DUBOIS PA 15801 251852975 HEALTHCARE SERVICES PA N/A INDIANA TOTAL THERAPY LLC 120 IRMC DRIVE STE 160 INDIANA PA 15701 263843582 THERAPY SERVICES PA N/A INDIANA HEALTHCARE ENTERPRISES 835 HOSPITAL DRIVE INDIANA PA 15701 470973344 HEALTHCARE RETAIL PA N/A C 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 1 0 0