2016-05-13T10:32:52-05:00 2015-06-30 BKD LLP 910 E ST LOUIS 200/PO BOX 1190 SPRINGFIELD MO 658062523 990 2014-07-01 250965579 TITUSVILLE AREA HOSPITAL % JILL NEELY TITU 8148271851 406 WEST OAK STREET TITUSVILLE PA 16354 ANTHONY J NASRALLA CEO 8148271851 2016-05-11 true Brian D Todd P00422601 4178658701 2014 2016-08-17 19:52:53Z ANTHONY J NASRALLA 406 WEST OAK STREET TITUSVILLE PA 16354 26137211 false X WWW.TITUSVILLEHOSPITAL.ORG X 1900 PA TITUSVILLE AREA HOSPITAL IS A COMMUNITY BASED, ACUTE CARE HOSPITAL PROVIDING INPATIENT, OUTPATIENT, EMERGENCY & HOME CARE SERVICES TO MORE THAN 30,000 PEOPLE IN 4 COUNTIES IN PA. 14 10 312 75 0 0 464698 259378 24835850 24939762 252504 49878 779622 845982 26332674 26095000 0 0 0 0 16183108 14422331 0 0 0 13790595 13390673 29973703 27813004 -3641029 -1718004 20009250 19428444 12496248 12964965 7513002 6463479 X TITUSVILLE AREA HOSPITAL IS COMMITTED TO PROVIDING QUALITY HEALTHCARE SERVICES WITH AN EMPHASIS ON PERSONAL ATTENTION, COMPASSION AND RESPECT. true false 19504492 24939762 TITUSVILLE AREA HOSPITAL IS AN ACUTE CARE RURAL HOSPITAL WITH 1,016 ADMISSIONS, 4,635 PATIENT DAYS AND 53,169 OUTPATIENT VISITS. 19504492 true true false true false false false false false false true true false true true false false false false false false false false false false false true true false false true false false false false false false false false false false false false false true true true false false true 57 0 true 312 true true true false false false false false false false false false X 14 10 true false false false true true true true true false false true true true true true true true true false PA X JILL NEELY 8148271851 406 WEST OAK STREET TITUSVILLE PA 16354 ANTHONY J NASRALLA CEO/PRESIDENT 35.0 5.0 X X 378797 0 8091 JASON REAGLE DIRECTOR 1.0 0.0 X 0 0 0 RICHARD CARR DIRECTOR 1.0 1.0 X 0 0 0 STEPHEN COLEMAN SECRETARY 1.0 1.0 X X 0 0 0 EDWARD GRIFFIN MD DIRECTOR 1.0 40.0 X 0 34360 1503 DWAIN ROGERS MD DIRECTOR BEGINNING 1/15 1.0 40.0 X 0 28464 826 SCOTT MCALLISTER MD DIRECTOR 1.0 0.0 X 0 0 0 LYNN PEDENSKY CHAIRMAN 1.0 1.0 X X 0 0 0 LARRY FLEDDERMAN DIRECTOR 1.0 2.0 X 0 0 0 ANIL DUTT MD DIRECTOR 1.0 40.0 X 0 28550 1105 CHERYL WALKER DIRECTOR 1.0 0.0 X 0 0 0 JAY PERTZ DIRECTOR 1.0 0.0 X 0 0 0 PATRICIA WALKER DIRECTOR 1.0 0.0 X 0 0 0 NANCY WORDEN DIRECTOR 1.0 0.0 X 0 0 0 BRIAN LOS MD DIRECTOR ENDING 12/14 1.0 0.0 X 0 0 0 JILL NEELY CFO/TREASURER 35.0 5.0 X 114099 0 6485 JEFF SAINTZ VP HUMAN RESOURCES 40.0 0.0 X 120446 0 6480 LINDA HARRIS VP PATIENT SERVICES 40.0 0.0 X 141472 0 2229 MARIO D'ALESSANDRO ER DIRECTOR 40.0 0.0 X 250137 0 16599 ROCK BAKER ANESTHESIOLOGIST 40.0 0.0 X 338244 0 7753 MARY C WETHLI ER PHYSICIAN 40.0 0.0 X 219288 0 8442 ARTHUR LEWIS ER PHYSICIAN 40.0 0.0 X 217110 0 8245 SCOTT SMITH ANESTHESIOLOGIST 40.0 0.0 X 232404 0 12987 PHIL ERDELJAC ANESTHESIOLOGIST 40.0 0.0 X 207814 0 1597 2219811 91374 82342 24 false true false CPS LLC PHARMACY ADMIN SVCS 524150 CONIFER HEALTH SOLUTIONS BILLING/CODING 447683 ASSOCIATED CLINICAL LABORATORIES DIAGNOSTIC LAB SVCS 292269 WEATHERBY LOCUMS LOCUM TENENS 214646 KL GATES LLP LEGAL 152253 9 14310 245068 259378 NET PATIENT SERVICE REVENUE 621990 23770617 23770617 E H R INCENTIVE REVENUE 900099 747960 747960 CAFETERIA REVENUE 811000 80483 80483 OTHER REVENUE 900099 340702 340702 24939762 25442 25442 0 0 79164 79164 0 79164 79164 66647 42211 24436 24436 24436 0 0 0 INCOME FROM EQUITEE INVESTEE 900099 184518 184518 GAIN ON INVESTMENT POOLS 900099 582300 582300 766818 26095000 24939762 895860 0 0 0 0 1039103 1039103 0 9690373 7254350 2436023 291840 205870 85970 2650238 1767218 883020 750777 521575 229202 0 127963 127963 92960 92960 0 0 0 2700813 1965770 735043 27566 100 27466 400045 142249 257796 664838 664838 0 1769216 1769216 30460 23696 6764 0 4847 957 3890 179698 46615 133083 0 1359233 271847 1087386 475078 443331 31747 SUPPLIES 3313019 2948277 364742 BAD DEBT EXPENSE 2104075 2104075 DUES/SUBSCRIPTIONS 81182 33074 48108 MISCELLANEOUS EXPENSE 59680 6272 53408 27813004 19504492 8308512 0 0 13862 358271 7226 0 0 3654425 2956560 0 0 0 0 0 0 684001 663082 14072 9502 40999148 31374620 8931961 9624528 3945582 3388454 1591796 1591796 120000 120000 0 0 709142 1053434 20009250 19428444 6348325 7086218 0 0 0 0 0 0 0 0 0 0 5621247 5161627 0 0 526676 717120 12496248 12964965 X 4065122 3075025 0 0 3447880 3388454 7513002 6463479 20009250 19428444 X -1718004 -141205 809686 X false false false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 1600 1600 false SCHEDULE C, PART II-B, LINE 1I OTHER LOBBYING ACTIVITIES: THE ORGANIZATION PAYS DUES TO AMERICAN HOSPITAL ASSOCIATION, OF WHICH $1,600 IS ATTRIBUTABLE TO LOBBYING. 207615 207615 14024433 10547765 3476668 23489205 20166552 3322653 3277895 660303 2617592 9624528 INVESTMENT - CHART 1542796 F INVESTMENT - VANTAGE 49000 C 1591796 DUE FROM AFFILIATES 43494 OTHER RECEIVABLES 1009940 1053434 0 EST AMT DUE TO 3RD PTY PYR 312354 DUE TO AFFILIATES 404766 717120 SCHEDULE D, PART X, LINE 2 UNCERTAIN TAX POSITION: MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. true true X true X false false true false false 160551 160551 0.00620 3101621 2126041 975580 0.03790 3262172 2126041 1136131 0.04410 24280 24280 0.00090 2452 2452 0.00010 26732 26732 0.00100 3288904 2126041 1162863 0.04510 false 2104075 313507 13160514 9820080 3340434 X true false 1 1 TITUSVILLE AREA HOSPITAL 406 WEST OAK STREET TITUSVILLE PA 16354 www.titusvillehospital.org 200901 X X X X TITUSVILLE AREA HOSPITAL 1 false false true X X X 12 true true true true X www.titusvillehospital.org true 12 false true false true X 150. 0. false true X true X X X X true true X true X false false SCHEDULE H, PART V, SECTION B, LINE 5 COMMUNITY INPUT: IN ORDER TO GAIN AN UNDERSTANDING AS TO THE HEALTH NEEDS OF THE COMMUNITY, A SURVEY WAS MADE AVAILABLE TO THE COMMUNITY OF CRAWFORD COUNTY. THE SURVEY WAS AVAILABLE ON THE INTERNET, PAPER FORMAT, AND VIA TELEPHONE. THE ORGANIZATIONS RECEIVED 734 COMPLETED SURVEYS. SCHEDULE H, PART V, SECTION B, LINES 6A & 6B CHNA REPORT: IN PREPARING THE CHNA REPORT, THE ORGANIZATION PARTNERED WITH THE CRAWFORD HEALTH IMPROVEMENT COALITION, WHICH IS A COALITION OF AREA HOSPITALS, GOVERNMENT SUBDIVISIONS, AND OTHER ORGANIZATIONS WITH AN INTEREST IN THE HEALTH OF THOSE THAT RESIDE IN CRAWFORD COUNTY, PENNSYLVANIA. SCHEDULE H, PART V, SECTION B, LINE 11 IMPLEMENTATION STRATEGY: IN RESPONSE TO THE RESULTS OF TITUSVILLE AREA HOSPITAL'S MOST RECENTLY CONDUCTED COMMUNITY HEALTH NEEDS ASSESSMENT, THE ORGANIZATION ADOPTED AN IMPLEMENTATION STRATEGY. THE IMPLEMENTATION STRATEGY IS ATTACHED. IN RESPONSE TO THE NEED OF DECREASING THE INCIDENCE OF CANCER DEATHS, TITUSVILLE AREA HOSPITAL HAS OFFERED LOW COST HEALTH SCREENINGS TARGETING COLORECTAL CANCER AS WELL AS PROSTATE CANCER. THE HOSPITAL HAS PARTNERED WITH LOCAL INTERESTS TO PROVIDE FUNDING THROUGH THE BREAST CANCER AWARENESS FUND TO AFFORD ACCESS TO MAMMOGRAMS AND SONOGRAPHIC BREAST STUDIES TO LOWER INCOME RESIDENTS. THE HOSPITAL ALSO EVALUATED AND UPGRADED ITS MRI TO ALLOW FOR ADVANCED BREAST IMAGING NOT CURRENTLY AVAILABLE LOCALLY. IN RESPONSE TO THE NEED OF REDUCING CHRONIC LUNG AND RENAL DISEASE, TITUSVILLE AREA HOSPITAL HAS PARTNERED WITH COUNTY AND STATE DEPARTMENTS TO PROVIDE TOBACCO CESSATION SERVICES FREE OF CHARGE TO RESIDENTS OF THE COMMUNITY. GROUP AND INDIVIDUAL CESSATION PROGRAMS WERE PROVIDED AS WELL AS REFERRAL TO STATEWIDE RESOURCES, AND BEDSIDE COUNSELING AND REFERRAL. THE HOSPITAL WORKED WITH THE CITY COUNCIL TO IMPLEMENT TOBACCO-FREE PARKS. IN RESPONSE TO THE NEED TO IMPROVE ACCESS TO DENTAL HEALTH SERVICES, THE HOSPITAL RECEIVED A GRANT WHICH HELPED TO EXPAND ITS DENTAL HEALTH SERVICES. SCHEDULE H, PART V, SECTION B, LINE 20D MAXIMUM AMOUNTS THAT CAN BE CHARGED TO FAP-ELIGIBLE INDIVIDUALS: ANY INDIVIDUAL THAT QUALIFIES FOR FINANCIAL ASSISTANCE RECEIVES 100 PERCENT WRITE-OFF FOR SERVICES PROVIDED. THIS ENSURES NO FAP-ELIGIBLE PATIENTS PAYS MORE THAN THE AMOUNTS GENERALLY BILLED. SCHEDULE H, PART I, LINE 7, COLUMN F PERCENT OF TOTAL EXPENSE: TO ARRIVE AT THE PERCENT OF TOTAL EXPENSES, THE DENOMINATOR WHICH EQUALS TOTAL OPERATING EXPENSES PER PART IX, LINE 25 OF THE FORM 990, WAS REDUCED BY BAD DEBT EXPENSE OF $2,104,075. SCHEDULE H, PART I, LINE 7 COSTING METHODOLOGY: THE COST TO CHARGE RATIO CALCULATED ON IRS WORKSHEET 2 WAS USED IN THE CALCULATION OF COST ON IRS WORKSHEETS 1, 3 AND 6. SCHEDULE H, PART III, SECTION A, LINE 2 BAD DEBT EXPENSE: THE ORGANIZATION CALCULATED BAD DEBT USING THE AMOUNTS CALCULATED IN THE ORGANIZATION'S INTERNAL FINANCIAL STATEMENTS. SCHEDULE H, PART III, SECTION A, LINE 3 BAD DEBT EXPENSE ATTRIBUTABLE TO FAP-ELIGIBLE PATIENTS: BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY WAS DETERMINED USING POVERTY LIMIT DEMOGRAPHIC INFORMATION OBTAINED THROUGH THE US CENSUS BUREAU. THIS AMOUNT EXPENSED BY THE ORGANIZATION IS ATTRIBUTABLE TO LOW INCOME INDIVIDUALS IN THEIR TARGET COMMUNITY AND IS CONSIDERED A COMMUNITY BENEFIT. SCHEDULE H, PART III, SECTION A, LINE 4 BAD DEBT EXPENSE FOOTNOTE: THE AUDITED FINANCIAL STATEMENTS DO NOT CONTAIN A FOOTNOTE THAT DESCRIBES BAD DEBT EXPENSE. IT DOES, HOWEVER, CONTAIN A FOOTNOTE THAT DESCRIBES PATIENT ACCOUNTS RECEIVABLE. THAT FOOTNOTE READS AS FOLLOWS: ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE HEALTH CENTER ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYER SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR UNCOLLECTIBLE ACCOUNTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYER 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 HEALTH CENTER ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR UNCOLLECTIBLE ACCOUNTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYER HAS NOT YET PAID, OR FOR PAYERS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HEALTH CENTER RECORDS A SIGNIFICANT PROVISION FOR UNCOLLECTIBLE ACCOUNTS 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 THE DISCOUNTED RATES IF NEGOTIATED OR PROVIDED BY POLICY) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. SCHEDULE H, PART III, SECTION B, LINE 8 COMMUNITY BENEFIT RATIONALE: MEDICARE DATA COMPUTED USING THE MEDICARE COST REPORT FILED WITH CMS WAS UTILIZED FOR THE COMPUTATIONS IN PART III, SECTION B. SERVING PATIENTS WITH GOVERNMENT HEALTH BENEFITS, SUCH AS MEDICARE, IS A COMPONENT OF THE COMMUNITY BENEFIT STANDARD THAT TAX-EXEMPT HOSPITALS ARE HELD TO. THIS IMPLIES THAT SERVING MEDICARE PATIENTS IS A COMMUNITY BENEFIT AND THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. SCHEDULE H, PART VI, LINE 2 NEEDS ASSESSMENT: TITUSVILLE AREA HOSPITAL DOES NOT CURRENTLY HAVE A FORMALIZED METHOD TO ASSESS THE COMMUNITY FOR ITS HEALTH NEEDS. IN THE NEXT COUPLE YEARS, THE ORGANIZATION PLANS TO LAUNCH A MORE FORMALIZED PROCESS TO ASSESS COMMUNITY NEEDS. TAH IS PARTNERING WITH MEADVILLE MEDICAL CENTER AND WILL INCORPORATE THEIR FORMALIZED METHOD TO ASSESS COMMUNITY NEEDS. SCHEDULE H, PART VI, LINE 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: THE CHARITY CARE POLICY IS POSTED IN ADMISSIONS AND EMERGENCY ROOM AREAS. COPIES OF THE CHARITY CARE POLICY ARE AVAILABLE IN ADMISSIONS AREA AND EMERGENCY ROOM AREAS. IF A PERSON IS ADMITTED WITH NO INSURANCE THEY ARE VISITED BY A FINANCIAL AID COUNSELOR AND MADE AWARE OF THEIR OPTIONS. SCHEDULE H, PART VI, LINE 4 COMMUNITY INFORMATION: TITUSVILLE AREA HOSPITAL SERVES RESIDENTS OF CRAWFORD, FOREST, AND VENANGO COUNTIES IN PENNSYLVANIA. THE MAIN SERVICE AREA IS CRAWFORD COUNTY. CRAWFORD COUNTY IS A RURAL AREA WITH A POPULATION OF APPROXIMATELY 88,524. THE 2009 ESTIMATED MEDIAN HOUSEHOLD INCOME WAS $38,192 WHICH IS WELL BELOW THE PENNSYLVANIA ESTIMATED HOUSEHOLD INCOME OF $49,520. APPROXIMATELY 14.9% OF RESIDENTS LIVE IN POVERTY. SCHEDULE H, PART VI, LINE 5 PROMOTION OF COMMUNITY HEALTH: OUR STAFF IS COMMITTED TO THE CARE AND IMPROVEMENT OF LIFE. IN RECOGNITION OF THIS COMMITMENT, WE STRIVE TO DELIVER HIGH-QUALITY AND COST-EFFECTIVE HEALTHCARE WITH AN EMPHASIS ON COMPASSION, PERSONAL ATTENTION AND RESPECT. WE BELIEVE IN THE FOLLOWING VALUES: -WE WILL MEET OR EXCEED COMMUNITY STANDARDS FOR CARE EXPECTATIONS OF PATIENTS AND FAMILIES. -WE WILL MAINTAIN A POSITIVE AND FULFILLING WORKING ATMOSPHERE THAT BOTH MOTIVATES AND ALLOWS CAREGIVERS AND SUPPORT STAFF TO GIVE THEIR BEST. -WE WILL ENSURE THAT THE ORGANIZATION IS ADEQUATELY COMPENSATED FOR SERVICES PROVIDED, THEREBY MAINTAINING VIABILITY AS A CRITICAL REGIONAL HEALTHCARE AND ECONOMIC ASSET. -OUR VISION IS TO PROVIDE ACCESS TO HIGH QUALITY HEALTHCARE SERVICES ENHANCED BY HIGH TECHNOLOGY APPROPRIATE TO COMMUNITY NEED. -WE WILL MAINTAIN A HIGHLY QUALIFIED MEDICAL AND SUPPORT STAFF IN A POSITIVE WORKING ENVIRONMENT FOCUSED ON EXCELLENCE. A MAJORITY OF THE ORGANIZATION'S GOVERNING BODY IS COMPRISED OF PERSONS RESIDING IN PRIMARY SERVICE AREA AND ARE NOT EMPLOYEES OR CONTRACTORS OF THE ORGANIZATION OR FAMILY MEMBERS. THE ORGANIZATION USES SURPLUS FUND TO PROVIDE THE LATEST IN TECHNOLOGY TO IMPROVE PATIENT CARE. SCHEDULE H, PART VI, LINE 6 AFFILIATED HEALTH CARE SYSTEM: TITUSVILLE AREA HEALTH CENTER, INC. AND AFFILIATES (HEALTH CENTER) CONSISTS OF TITUSVILLE AREA HEALTH CENTER, INC. (PARENT), TITUSVILLE AREA HOSPITAL (HOSPITAL), THE TITUSVILLE AREA HEALTH CENTER FOUNDATION (FOUNDATION) AND TITUSVILLE AREA HEALTH SERVICES, INC. (HEALTH SERVICES). THE HOSPITAL PRIMARILY EARNS REVENUES BY PROVIDING INPATIENT, OUTPATIENT AND EMERGENCY CARE SERVICES TO PATIENTS IN TITUSVILLE, PENNSYLVANIA, AND THE SURROUNDING AREA. THE FOUNDATION WAS ESTABLISHED TO RECEIVE, ADMINISTER AND DISTRIBUTE FUNDS AND PROPERTY FOR THE BENEFIT AND SUPPORT OF THE HEALTH CENTER AND AFFILIATES. HEALTH SERVICES OPERATES SEPARATELY FROM THE HOSPITAL OFFERING MULTISPECIALTY FAMILY MEDICINE PEDIATRICS TO PATIENTS IN TITUSVILLE, PENNSYLVANIA, AND THE SURROUNDING AREA. X X X false false false false false true false true false ANTHONY J NASRALLA CEO/PRESIDENT 244955 0 12250 0 121592 0 6125 0 1966 0 386888 0 118326 0 ROCK BAKER ANESTHESIOLOGIST 162754 0 0 0 175490 0 2814 0 4939 0 345997 0 174530 0 MARY C WETHLI ER PHYSICIAN 217998 0 0 0 1290 0 5476 0 2966 0 227730 0 0 0 ARTHUR LEWIS ER PHYSICIAN 216281 0 0 0 829 0 0 0 8245 0 225355 0 0 0 SCOTT SMITH ANESTHESIOLOGIST 208089 0 0 0 24315 0 4836 0 8151 0 245391 0 22335 0 PHIL ERDELJAC ANESTHESIOLOGIST 196106 0 0 0 11708 0 0 0 1597 0 209411 0 10748 0 MARIO D'ALESSANDRO ER DIRECTOR 248157 0 0 0 1980 0 6411 0 10188 0 266736 0 0 0 SCHEDULE J, PART I, LINE 6A CONTINGENT COMPENSATION: THE ORGANIZATION PAYS AN INCENTIVE TO ITS OFFICERS, KEY EMPLOYEES AND HIGHEST COMPENSATED EMPLOYEES THAT ARE CONTINGENT ON A POSITIVE TOTAL MARGIN OF THE ORGANIZATION. SCHEDULE J, PART I, LINE 7 NON-FIXED PAYMENTS: THE CRNA'S RECEIVE AN ANNUAL BONUS BASED ON A PERCENTAGE OF THEIR COMPENSATION. SCHEDULE J, PART II, COLUMN F COMPENSATION REPORTED AS DEFERRED IN PRIOR FORM 990: THE AMOUNTS REPORTED IN PART II, COLUMN F FOR ANTHONY NASRALLA, ROCK BAKER, SCOTT SMITH, AND PHIL ERDELJAC ARE 457(B) DISTRIBUTIONS THAT WERE INCLUDED IN THE COMPENSATION FOR THESE INDIVIDUALS IN 2014. THE AMOUNTS WERE SUBJECT TO INCOME TAX AND WERE REPORTED ON THE INDIVIDUAL'S FORM W-2. FORM 990, PART III, LINE 2 CHANGE IN SIGNIFICANT ACTIVITIES: IN 2014, THE HOSPITAL MET THE REQUIREMENTS FOR PARTICIPATION IN THE MEDICARE PROGRAM AS A CRITICAL ACCESS HOSPITAL. FORM 990, PART IV, LINE 20B AUDITED FINANCIAL STATEMENTS: THE ORGANIZATION DID NOT RECEIVE AN AUDIT FOR THE FISCAL YEAR ENDING JUNE 30, 2015. IN ACCORDANCE WITH THE BYLAWS, WHICH WERE UPDATED AFTER JUNE 30, 2015, AS A RESULT OF A DEFINITIVE AGREEMENT WITH MEADVILLE MEDICAL CENTER DATED SEPTEMBER 20, 2015, THE ORGANIZATION HAS ADOPTED A NEW FISCAL YEAR, ENDING SEPTEMBER 30. TITUSVILLE AREA HOSPITAL IS INCLUDED IN THE CONSOLIDATED AUDIT OF THE TITUSVILLE AREA HEALTH CENTER, INC. AND AFFILIATES FOR THE YEAR ENDED SEPTEMBER 30, 2015, WHICH IS ATTACHED TO THIS RETURN. FORM 990, PART VI, SECTION A, LINE 2 FAMILY/BUSINESS RELATIONSHIPS: STEPHEN COLEMAN AND RICHARD CARR HAVE A BUSINESS RELATIONSHIP. STEPHEN COLEMAN AND JASON REAGLE HAVE A BUSINESS RELATIONSHIP. SCOTT MCALLISTER AND BRIAN LOS HAVE A BUSINESS RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 6 CLASSES OF MEMBERS OR STOCKHOLDERS: TITUSVILLE AREA HOSPITAL HAS TWO CLASSES OF MEMBERSHIP. CORPORATE MEMBERSHIP CONSISTS OF ONE MEMBER, TITUSVILLE AREA HEALTH CENTER, INC. COMMUNITY MEMBERSHIP SHALL CONSIST OF FORMER HOLDERS OF SHARES OF THE CORPORATION WHO ELECT TO CONTINUE AS SUCH MEMBERS AND OTHER PERSONS WHO ELECT TO BECOME SUCH MEMBERS OF THE CORPORATION. COMMUNITY MEMBERS SHALL NOT BE ENTITLED TO VOTE ON ANY MATTERS RESPECTING THE ACTIONS OR GOVERNANCE OF THE CORPORATION, SUCH ENTITLEMENT HAVING BEEN RESERVED SOLELY UNTO THE CORPORATION'S CORPORATE MEMBER, AND SHALL HAVE NO INTEREST IN THE PROPERTY, ASSETS OR BUSINESS OF THE CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A POWER TO ELECT MEMBERS OR STOCKHOLDERS: DIRECTORS SHALL BE APPOINTED BY THE BOARD OF DIRECTORS OF THE CORPORATE MEMBER (TITUSVILLE AREA HEALTH CENTER, INC). FORM 990, PART VI, SECTION A, LINE 7B GOVERNANCE DECISIONS: THE FOLLOWING POWERS ARE RESERVED UNTO THE BOARD OF DIRECTORS OF THE TITUSVILLE AREA HEALTH CENTER, INC.: A.) REVIEW AND APPROVAL OF THE CAPITAL OPERATING BUDGETS, B.) APPROVAL OF CAPITAL EXPENDITURES IN EXCESS OF AN ESTABLISHED AMOUNT AS MAY BE SET FROM TIME TO TIME BY THE BOARD OF DIRECTORS OF THE CORPORATE MEMBER, C.) APPOINTMENT OF CANDIDATES FOR BOARD MEMBERSHIP, D.) APPROVAL OF BYLAWS AND ANY AMENDMENTS THERETO AND TO THE ARTICLES OF INCORPORATION, E.) APPROVAL OF ANY CORPORATE BORROWING OR ANY ENCUMBERING OF ASSETS, ANY SALES OR LEASES OF CORPORATE THE PROPERTY OR ANY OTHER ACTIONS NOT IN THE ORDINARY COURSE OF BUSINESS OF THE CORPORATION, F.) APPOINTMENT OF THE CHAIRMAN AND PRESIDENT OF THE CORPORATION, AND G.) APPROVAL OF ANY PLAN OF MERGER, CONSOLIDATION, DIVISION OR DISSOLUTION. ORDINARY COURSE OF BUSINESS OF THE CORPORATION. FORM 990, PART VI, SECTION B, LINE 11B PROCESS TO REVIEW FORM 990: THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM BASED ON THE INTERNAL FINANCIAL STATEMENTS AND INFORMATION PROVIDED BY THE ACCOUNTING DEPARTMENT OF THE ORGANIZATION. THE RETURN IS COMPLETED IN DRAFT FORM AND REVIEWED BY MANAGEMENT OF THE ORGANIZATION. THE COMPLETED 990 IS MADE AVAILABLE TO BOARD MEMBERS FOR REVIEW AND QUESTIONS PRIOR TO SUBMISSION. FORM 990, PART VI, SECTION B, LINE 12C PROCESS FOR MONITORING COMPLIANCE WITH CONFLICT OF INTEREST POLICY: TITUSVILLE AREA HOSPITAL ANNUALLY REQUIRES ITS BOARD MEMBERS, OFFICERS AND KEY EMPLOYEES TO FILL OUT A CONFLICTS OF INTEREST FORM DURING BOARD MEETINGS. ANY CONFLICT OF INTEREST IS REVIEWED BY THE BOARD OF DIRECTORS. IF AN INTERESTED PARTY HAS A CONFLICT, HE OR SHE RECUSES THEMSELVES FROM VOTING. FORM 990, PART VI, SECTION B, LINE 15A & B REVIEW OF CEO AND OTHER OFFICER COMPENSATION: AN INDEPENDENT CONSULTING FIRM COMPILED THE SALARY ADMINISTRATION AND PERFORMANCE MANAGEMENT GUIDELINES WHICH THE HOSPITAL UTILIZES ANY TIME A NEW POSITION IS CREATED OR AN EXISTING POSITION'S DESCRIPTION CHANGES. A JOB FACTOR WORKSHEET IS COMPLETED WHICH EVALUATES 6 AREAS BASED ON A POINT SYSTEM. THE SIX AREAS ARE LISTED BELOW: 1.) EDUCATION 2.) EXPERIENCE 3.) CONTACTS 4.) GUIDELINES 5.) BUDGET ACCOUNTABILITY 6.) SUPERVISORY/ACCOUNTABILITY THE TOTAL POINTS ARE USED TO ARRIVE AT A PAY GRADE ON THE SALARY ADMINISTRATION POLICY MANAGEMENT PAY SCALE. THE MANAGEMENT PAY SCALE IS REVIEWED ANNUALLY, AND UPDATED IF NECESSARY, BASED ON THE HOSPITAL COUNCIL OF WESTERN PENNSYLVANIA SURVEYS, WHICH PROVIDES COMPARABLE DATA OF OTHER HOSPITALS IN THE AREA. THE DELIBERATIONS AND DECISIONS OF THE COMPENSATION COMMITTEE ARE DOCUMENTED IN THE COMMITTEE MINUTES. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS: TITUSVILLE AREA HOSPITAL MAKES ITS FORM 990 AND FORM 1023 AVAILABLE TO THE PUBLIC UPON REQUEST. AT THIS TIME, TITUSVILLE AREA HOSPITAL DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICY OR FINANCIAL STATEMENTS AVAILABLE TO THE GENERAL PUBLIC. FORM 990, SECTION XI, LINE 9 OTHER CHANGES IN NET ASSETS: $ 869,112 TRANSFER FROM AFFILIATES (59,426) CHANGE IN BENEFICIAL INTEREST ----------- $ 809,686 TITUSVILLE AREA HEALTH CENTER INC 406 WEST OAK STREET TITUSVILLE PA 16354 251517855 HOLDING CO PA 501(C)(3) 7 N/A false TITUSVILLE HEALTH SERVICES INC 406 WEST OAK STREET TITUSVILLE PA 16354 251517865 COMM HLT CLNC PA 501(C)(3) 3 HEALTH CNTR false TITUSVILLE AREA HEALTH CENTER FOUNDATION 406 WEST OAK STREET TITUSVILLE PA 16354 251517854 SUPPORT PA 501(C)(3) 11AI HEALTH CNTR false PERPETUAL TRUST TRUST PA TAH TRUST 2661 68315 1.00000 true PERPETUAL TRUST TRUST PA TAH TRUST 10556 271039 1.00000 true PERPETUAL TRUST TRUST PA TAH TRUST 1063 28058 1.00000 true false false true false true false false false false true false false true true true true true true true