2016-05-16T14:33:37-05:00 2015-06-30 990 2014-07-01 250965274 BUTLER HEALTHCARE PROVIDERS BUTL 7242844429 ONE HOSPITAL WAY BUTLER PA 16001 Anne B Krebs VP of Finance 7242844400 2016-05-16 2014 2016-08-17 19:52:53Z Butler Memorial Hospital Kenneth P DeFurio ONE HOSPITAL WAY BUTLER PA 16001 261105302 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. 10 8 1992 280 4594621 404376 2199213 1882509 229410713 246653831 1191272 2930999 7744463 9637963 240545661 261105302 50000 50200 0 0 102746207 107018530 0 0 0 115225176 119901842 218021383 226970572 22524278 34134730 310231968 320336569 170599369 181184338 139632599 139152231 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 190104703 50200 251699492 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 over 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 12,600 acute care patients (admissions) and over 501,000 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 60 convenient, low cost outpatient sites that are located in communities through Butler County and the surrounding area. 190104703 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 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 1 0 0 0 0 1 1 1 1 0 0 1 111 0 1992 1 1 1 0 0 0 0 0 0 0 0 0 X 10 8 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 1143703 0 214742 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 Trustee 0.80 0.20 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 273161 11168 Anne B Krebs Chief Financial Officer 40.00 15.00 X 460752 0 80157 Stephanie Roskovski Chief Operating Officer 35.00 25.00 X 441709 0 62135 Karen Allen VP Patient Svc,CNO, 55.00 0.00 X 318100 0 54942 A Thomas McGill MD VP Quality & Safety/CIO 40.00 15.00 X 590274 0 104243 John C Reefer MD VP Prof Affairs & CMO 52.00 8.00 X 541140 0 98479 Paula L Hooper VP General Counsel 30.00 26.00 X 403247 0 63123 Thomas Genevro VP Facilities/Human Resources 45.00 10.00 X 300750 0 55723 Kevin M Stansbury Former VP Business Development 0.00 0.00 X 188560 0 0 4388235 273161 744712 67 1 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 1680364 Three Rivers Cardiac 400 Holiday Drive Suite 101 Pittsburgh PA 152203610 Cardiology 1662612 20 359458 898532 624519 1882509 Net Patient Revenue 621500 246653831 244136047 2517784 246653831 2930999 2319 2928680 Other Income 900099 5174396 4822605 351791 Retail Pharmacy 446110 1574662 1574662 Dietary 722210 1407115 1407115 1481790 1333725 148065 9637963 261105302 251699492 4594621 2928680 50200 50200 2083385 2083385 82319155 71086760 11232395 9271908 7157063 2114845 7559166 5834983 1724183 5784916 5079220 705696 456251 39095 417156 58753 58753 867074 83424 783650 55692628 55303443 389185 1885316 1876818 8498 5544385 5410206 134179 772865 228453 544412 132974 84422 48552 5782119 5782119 13089281 6109294 6979987 1837755 14272 1823483 Purchased Services 14271980 11414671 2857309 Bad Debt 8968216 8968216 Physician Fees 7515707 4597048 2918659 Miscellaneous 3026538 984996 2041542 226970572 190104703 36865869 0 3374 3374 68770899 39755032 30296023 34037803 674577 655648 2961830 3164628 2963678 2743937 316558008 190506400 133786555 126051608 58385799 99787641 7436522 9917282 4952711 4219616 310231968 320336569 26385985 23594120 130785372 150900327 13428012 6689891 170599369 181184338 X 138700318 137924301 932281 1227930 139632599 139152231 310231968 320336569 X 34134730 -609559 -34005539 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 87082763 37829055 49253708 7780798 4257571 3523227 207876668 142741396 65135272 11240198 5678378 5561820 126051608 Pension 4725604 Third Party Settlements 1964287 6689891 X Part X, Line 2: The System follows the guidance for accounting for uncertainty in income taxes recognized in a company's financial statements that prescribes 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 not met. The guidance also addresses derecognition, classification, interest and penalties, accounting in interim periods, and disclosure. Management has determined that this guidance had no material effect on the consolidated financial statements. The System's policy is to recognize interest related to unrecognized tax benefits in interest expense and penalties in professional fees and miscellaneous expenses. There were no interest or penalties recognized on the consolidated statements of operation and changes in net assets as a result of this guidance. Generally, tax returns for year ended June 30, 2012, and thereafter remain subject to examination by federal and state tax authorities. 1 1 1 X 1 X 1 1 0 1 1 3750748 0 3750748 0.01720 25878715 16715835 9162880 0.04200 306244 215705 90539 0.00040 29935707 16931540 13004167 0.05960 116965 0 116965 0.00050 141858 0 141858 0.00070 18532009 13822444 4709565 0.02160 0 0 165172 0 165172 0.00080 18956004 13822444 5133560 0.02360 48891711 30753984 18137727 0.08320 1 8846000 4778000 38379090 44941433 -6562343 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 12 1 0 0 1 X www.butlerhealthsystem.org X 1 12 1 www.butlerhealthsystem.org 0 0 1 X 200.000000000000 300.000000000000 X 1 1 X X X 1 X www.butlerhealthsystem.org X www.butlerhealthsystem.org X www.butlerhealthsystem.org 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: Health statistics and qualitative data, as well as a BHS sponsored survey of the health status and health issues of 673 households have been reviewed within the framework of Pennsylvania State Health Improvement Plan, Healthy People 2010, and Healthy People 2020 goals to identify and prioritize community health needs. Input from Community and Data Sources:2011 BHS sponsored survey of 673 householdsBehavioral Risk Factor Surveillance Study, Butler Beaver regionPennsylvania Department of Health: Health StatisticsInterviews with Butler County school nursesHealthy People 2010 and 2020 goals and statistics. The Butler County State Health Improvement Plan (SHIP) district is undergoing reorganization Butler Memorial Hospital Cancer Registry and Cancer Committee (includes representation from American Cancer Society)Advisors with public health expertise:Tripp Umbaugh, IncPrometheus, LLC Butler Memorial Hospital Part V, Section B, Line 11: Butler County obesity rates are below 2020 goals. However, effective community based obesity interventions are not well understood. Therefore, adult obesity will not be addressed in our plan as the hospital has limited resources to fully address this particular issue. Butler Memorial Hospital Part V, Section B, Line 22d: The Hospital used the average payment to charge ratio of all the commercial insurance plans. The ratio is updated annually based on the prior year's payment ratio. Part V,Section B, line 2 The CHNA was last conducted during the organization's 2012 tax year, which is equivalent to its fiscal year ended June 30, 2013. The implementation strategy was also adopted during that same fiscal year. Part V, Section B, Line 16 Financial Assistance Policy Website Availability Butler Memorial Hospital Part V, Section B, line 16a website: www.butlerhealthsystem.org Butler Memorial Hospital Part V, Section B, line 16b website: www.butlerhealthsystem.org Butler Memorial Hospital Part V, Section B, line 16c website: www.butlerhealthsystem.org 2 Butler Healthcare Providers SNF One Hospital Way Butler PA 16001 Skilled Nursing Facility 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 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 $8,968,216. 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 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 $24.7 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 10.9% 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. Part VI, Line 3: 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 $24.7 million in total community benefit support. This accounts for over 10.9% 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 is a wholly owned subsidiary of the Butler Health System ("System"). Butler Health System is an integrated health organization serving a multi-county area in western Pennsylvania. It employs more than 144 physicians and midlevels with another 215 on active medical staff. Its scope includes acute hospital care, ambulatory care, urgent care, and a network of laboratory services to more than 130 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 814 deliveries in fiscal year 2015). Inpatient and acute observation patients account for approximately 17,600 admissions each year. The Emergency Department treated 48,700 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, 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 approximately 300 cases in fiscal year 2015), electrophysiology services, thoracic and vascular surgery, advanced orthopedics, 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. 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 (6) counties. 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 (4) 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 (1) example of the partnerships developed with physicians.Another example of the System engaging with physicians is the development of a Provider Hospital Organization (PHO) over the past year. 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, 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 144 physician and mid-level providers in over 30 offices covering six (6) counties, these providers offer office visits and testing close to home while referring inpatient business to the Hospital. Community Health AssessmentButler Health System periodically has surveyed up to 1,000 Butler County residents. The analytic tool used is the Centers for Disease Control Behavioral Risk Factor Surveillance System. The Community Health Assessment measures health status, disease burden and diagnosis, disease prevention, exercise and activity levels, nutrition status, access to care and overall health literacy. Responses to the survey are carefully evaluated by a specialist in Public Health and the results are shared with clinical staff. The findings are then put into action by improving service and addressing the health needs of community residents. The Community Health Assessment identified four (4) particular areas that the System addressed.1. Cancer premature death: lung and breast - Lung cancer is the leading cause of deaths in Butler County. Early detection of lung cancer is key to significantly decreasing lung cancer deaths, resulting in up to 60% of cases being treated successfully. As a result, the System initiated a best practice lung cancer screening program for people with high risk of lung cancer. A low dose CT scan is a successful program that can reduce death rates by 20% due to early detection. 2. Breast Cancer - The Hospital provided mammograms to over 11,000 women during Fiscal Year 2015.3. Better understanding of the use of prescription behavioral health medications in the children of Butler County - the System has a Children's Partial Hospitalization program and an Intensive Outpatient program at Family Services. 4. Growing Adult and Pediatric Hospitalist Program - The Hospital provides a 24/7 inpatient hospitalist service, providing specialty inpatient care to many primary care and specialist practices. Implementation of this program has been widely supported by Hospital physicians, will serve to improve continuous and efficient care in the Hospital, and will permit physicians to concentrate on their practices, thereby expanding community access to primary care services. The addition of three (3) pediatric hospitalists allowed us to offer convenience to our community as well as to continue to support our ob/gyn department. In addition to deliveries, the pediatric hospitalists treated 134 children, allowing that care to remain local. The pediatric hospitalists serve on the Board of the Butler County Alliance for Children-Child Advocacy Center and are certified in providing services to child victims of abuse. Part VI, Line 4: Achieving Quality Measure in Patient CareButler Health System offers exceptional quality of care and has been recognized for superior clinical excellences. The Society for Thoracic Surgeons (STS) ranks BHS' Coronary Artery Bypass Surgery 6th in the State and 13th in the Country. Healthgrades recognized BHS with five stars Cardiac Surgery Excellence Award. Butler Memorial Hospital has been designated a Lung Cancer Screening Center by American College of Radiology (ACR). The ACR Lung Cancer Screening Center designation is given to facilities that are accredited by the ACR in computer tomography in the chest module, as well as undergo a rigorous assessment of its lung cancer screening protocol. BHS Chest Pain Center with Percutaneous Coronary Intervention received a three year accreditation by the Society of Cardiovascular Patient Care. The Women's Choice Award named the System as one of America's Best Hospitals for Patient Safety, and one of America's Best Emergency and Orthopedic care (3 years). "Get With the Guidelines Stroke" recognized the System as Gold Plus, maintaining guidelines set by the American Heart Association (AHA) for the care of stroke patients. AHA also recognized the System with the Mission: Lifeline Silver Plus Award. BHS Heart Failure Clinic was established to manage needed services for patients diagnosed with heart failure. The Heart Failure Clinic provides consultations with a cardiologist, follow up visits, nutritional counseling and education. In January 2015, BHS Valve Clinic was established to evaluate patients with valvular heart disease, such as aortic stenosis or mitral regurgitation. Patients are reviewed by a multidisciplinary panel to determine an optimal, customized treatment plan. As part of the valve clinic, we use state-of the-art imaging including advanced 3-D echocardiography to provide the most precise diagnostic information. A collaborative approach is then undertaken to see what the best treatment option is for each patient. New approaches are now available that give high-risk patients treatment options that were not previously available to them. The valve clinic maintains a robust clinical database to support research and advances in the treatment of this disease. Also, the System was approved to be a recipient of the Health Resources and Services Administration grant to improve diabetes self-management skills in both city and rural parts of Butler and surrounding counties. Enhancing our Services to the CommunityPalliative CareButler Memorial Hospital is proud to add palliative care services to our broad array of specialties. Palliative care is a team approach to care for the seriously ill patient. It focuses on providing patients and their family with relief from the symptoms, pain and stress of serious illnesses - whatever the diagnosis. It is care that meets the special needs of each person. Palliative care treats the whole person, including physical, spiritual and emotional needs. Palliative care treats people suffering from illnesses such as kidney failure, cancer, respiratory disease, HIV/AIDS, multiple sclerosis, Alzheimer's, Parkinson's, cardiac disease such as congestive heart failure, ALS, COPD, CHF and more. This care is administered at any stage of illness and along with treatment meant to cure the patient. This is not the same as hospice care. 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 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 System 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 (2) 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. 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: 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. 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, 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 225physicians, 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) 50200 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 X 1 1 0 0 0 0 0 1 0 Kenneth P DeFurio President & CEO 543319 0 157504 0 442880 0 173154 0 41588 0 1358445 0 0 0 Dennis Demby MD Trustee 0 170230 0 84239 0 18692 0 0 0 11168 0 284329 0 0 Anne B Krebs Chief Financial Officer 293536 0 56356 0 110860 0 50720 0 29437 0 540909 0 0 0 Stephanie Roskovski Chief Operating Officer 285348 0 66102 0 90259 0 38783 0 23352 0 503844 0 0 0 Karen Allen VP Patient Svc,CNO, 243838 0 59124 0 15138 0 16555 0 38387 0 373042 0 0 0 A Thomas McGill MD VP Quality & Safety/CIO 386976 0 74863 0 128435 0 64447 0 39796 0 694517 0 0 0 John C Reefer MD VP Prof Affairs & CMO 336783 0 81380 0 122977 0 58593 0 39886 0 639619 0 0 0 Paula L Hooper VP General Counsel 282261 0 55245 0 65741 0 24291 0 38832 0 466370 0 0 0 Thomas Genevro VP Facilities/Human Resources 211888 0 41092 0 47770 0 18525 0 37198 0 356473 0 0 0 Kevin M Stansbury Former VP Business Development 0 0 0 0 188560 0 14352 0 0 0 202912 0 0 0 Part I, Lines 4a-b 4 (a) Kevin M Stansbury received severance pay of 188,560 for duties associated with the position of VP Business Development. 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 at age 65. Eligible executives receive distributions upon reaching the vesting periods. The reported period represents the first time that the 5-year vesting distribution of the plan was achieved. All contributions to the SERP have been and are reported annually. Eligible executives for the reported 5-year distribution were Ken P. DeFurio, President & CEO; Anne B. Krebs, Chief Financial Officer; Stephanie J. Roskovski, Chief Operating Officer; A. Thomas McGill MD, Vice President of Quality & Safety/CIO; John C. Reefer MD, Vice President of Professional Affairs & CMO; Paula L. Hooper, Vice President of General Counsel; Karen Allen, Vice President of Patient Services/CNO; Thomas A. Genevro Vice President of Facilities & Human Resources. The annual accrual amounts for calender year 2014 were: Kenneth P DeFurio, 150,154; Anne B Krebs 33,813; Stephanie J Roskovski 31,729; A Thomas McGill MD 44,918; John C Reefer MD 39,062; Paula L Hooper 19,336; Karen A Allen 16,555; Thomas A Genevro 14,382. 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 0 0 0 A 100481533 1411658 2015 0 1 1 1 B 9595000 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 Dennis Demby MD Trustee of Organization;Limited partner in Butler Physicians Realty, LLC 45000 Butler Healthcare Providers leases space from Butler Physicians Realty, LLC. Butler Physicians Realty, LLC is a joint venture that Dennis Demby and Butler Healthcare Providers are members of. 0 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 -17,000,000. Loss on Extinguishment of Debt -20,264,341. Accumulated liability for pension benefits 2,963,141. Increase in interest in net assests of Butler Health System Foundation 295,661. 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 226000 226000 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 -40567 1577769 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 269406 BHS FastERcare Q 2827718