INDIANA HEALTHCARE PHYSICIAN SERVICES INC: Form 990, tax year 2013
View the entire original 990 at ProPublica ↗
- Organization
- INDIANA HEALTHCARE PHYSICIAN SERVICES INC (EIN 25-1842046)
- Tax period
- 2013-07-01 to 2014-06-30
- Filed
- 2015-05-14
- IRS object ID
- 201501349349305330
- Schema version
- 2013v4.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2015-05-14T14:26:30-05:00 | ReturnTs |
| Tax Period End | 2014-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 390859910 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BAKER TILLY VIRCHOW KRAUSE LLP | BusinessNameLine1 |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1650 MARKET STREET SUITE 4500 | AddressLine1 |
| City | PHILADELPHIA | City |
| State | PA | State |
| ZIP Code | 19103 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2013-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 251842046 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | INDIANA HEALTHCARE PHYSICIAN SERVICES INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | INDI | BusinessNameControlTxt |
| Phone | 7243577008 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 788 | AddressLine1 |
| City | INDIANA | City |
| State | PA | State |
| ZIP Code | 15701 | ZIPCode |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | ROBERT GONGAWARE | PersonNm |
| Person Title | SENIOR VP FINANCE | PersonTitleTxt |
| Phone | 7243577008 | PhoneNum |
| Signature | 2015-05-13 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | JULIUS C GREEN CPA JD | PreparerPersonNm |
| PTIN | P00350393 | PTIN |
| Phone | 2159720701 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2013 | TaxYr |
| Build TS | 2016-02-25 16:41:14Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | STEPHEN A WOLFE | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 788 | AddressLine1 |
| City | INDIANA | City |
| State | PA | State |
| ZIP Code | 15701 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $8,396,845 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.INDIANARMC.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2000 | FormationYr |
| Legal Domicile State | PA | LegalDomicileStateCd |
| Activity Or Mission | PROVIDE HEALTH SERVICES | ActivityOrMissionDesc |
| Voting Members Governing Body | 8 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 6 | VotingMembersIndependentCnt |
| Total Employee | 170 | TotalEmployeeCnt |
| Total Volunteers | 6 | TotalVolunteersCnt |
| Total Gross UBI | $601,885 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | -$5,324 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $200,000 | PYContributionsGrantsAmt |
| CY Contributions Grants | $0 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $5,428,094 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $7,438,593 | CYProgramServiceRevenueAmt |
| PY Investment Income | $0 | PYInvestmentIncomeAmt |
| CY Investment Income | $0 | CYInvestmentIncomeAmt |
| PY Other Revenue | $747,195 | PYOtherRevenueAmt |
| CY Other Revenue | $958,252 | CYOtherRevenueAmt |
| PY Total Revenue | $6,375,289 | PYTotalRevenueAmt |
| CY Total Revenue | $8,396,845 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $7,408,816 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $9,189,176 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $2,440,869 | PYOtherExpensesAmt |
| CY Other Expenses | $3,141,996 | CYOtherExpensesAmt |
| PY Total Expenses | $9,849,685 | PYTotalExpensesAmt |
| CY Total Expenses | $12,331,172 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$3,474,396 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$3,934,327 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $1,504,082 | TotalAssetsBOYAmt |
| Total Assets EOY | $1,646,688 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $193,369 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $322,117 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $1,310,713 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $1,324,571 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | 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. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | Yes (1) | SignificantChangeInd |
| Expense | $10,500,493 | ExpenseAmt |
| Revenue | $8,446,165 | RevenueAmt |
| Desc | 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, 2014 WAS $107,052.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. | Desc |
| Total Program Service Expenses | $10,500,493 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | Yes (1) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| Info In Schedule O Part V | Yes (X) | InfoInScheduleOPartVInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 170 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 8 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 6 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (1) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | ROBERT GONGAWARE SVP FINANCE | PersonNm |
| Phone | 7243577008 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 835 HOSPITAL ROAD | AddressLine1 |
| City | INDIANA | City |
| State | PA | State |
| ZIP Code | 15701 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionAGrp (13 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| TODD BRICE | ||||||||
| CHAIRMAN | 1.00 | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| BEVERLY GAZZA ESQ | ||||||||
| VICE CHAIRMAN | 1.00 | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| ANNE WHITE | ||||||||
| SECRETARY | 1.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| JOSEPH GEARY | ||||||||
| TREASURER | 1.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| MARK E BOYKIW | ||||||||
| BOARD MEMBER | 1.00 | 1.00 | Yes (X) | $8,789 | $0 | $0 | ||
| NATHAN KOVALCHICK | ||||||||
| BOARD MEMBER | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| BRUCE A BUSH MD | ||||||||
| BOARD MEMBER | 1.00 | 39.00 | Yes (X) | $308,868 | $0 | $27,922 | ||
| STEPHEN A WOLFE | ||||||||
| PRESIDENT & CEO | 1.00 | 39.00 | Yes (X) | Yes (X) | $447,762 | $0 | $80,756 | |
| ISLAM MOHAMMED N | ||||||||
| PHYSICIAN | 40.00 | 40.00 | $444,588 | $0 | $17,015 | Yes (X) | ||
| GUDDETI MURALIDHAR R | ||||||||
| PHYSICIAN | 40.00 | 40.00 | $322,907 | $0 | $17,212 | Yes (X) | ||
| SYED MUSHTAQ A | ||||||||
| PHYSICIAN | 40.00 | 40.00 | $308,038 | $0 | $15,837 | Yes (X) | ||
| PATHAN KARAM K | ||||||||
| PHYSICIAN | 40.00 | 40.00 | $280,951 | $0 | $13,991 | Yes (X) | ||
| CONTI JOSEPH D | ||||||||
| PHYSICIAN | 40.00 | 40.00 | $253,892 | $0 | $10,263 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,375,795 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $182,996 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 22 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (2 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1 | CityContractorAddress/USAddress/City | StateContractorAddress/USAddress/State | ZIP CodeContractorAddress/USAddress/ZIPCode | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| MATT KLAIN MD | |||||
| 25 COLONY BLVD SUITE 102 | BLAIRSVILLE | PA | 15717 | PRIMARY CARE SERVICES | $286,581 |
| LOCUMTENENSCOM | |||||
| PO BOX 532869 | ATLANTA | GA | 30353 | PSYCHIATRIC SERVICES | $239,862 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 2 | CntrctRcvdGreaterThan100KCnt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| OUTPATIENT REVENUE | 621400 | $7,277,064 | $7,277,064 |
| PHYSICIAN SERVICES | 621400 | $161,529 | $161,529 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $7,438,593 | TotalProgramServiceRevenueAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt | ExclusionExclusionAmt |
|---|---|---|---|---|
| EMPLOYEE TIMESHARE SVC | 541900 | $375,602 | $375,602 | |
| PHYSICIAN BILLING SERV | 561000 | $226,283 | $226,283 | |
| MEANINGFUL USE REVENUE | 900099 | $203,099 | $203,099 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $153,268 | TotalRevenueColumnAmt |
| Exclusion | $153,268 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $958,252 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $8,396,845 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $7,438,593 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $601,885 | UnrelatedBusinessRevenueAmt |
| Exclusion | $356,367 | ExclusionAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,010,202 | TotalAmt |
| Program Services | $7,072,545 | ProgramServicesAmt |
| Management And General | $937,657 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $91,477 | TotalAmt |
| Program Services | $54,606 | ProgramServicesAmt |
| Management And General | $36,871 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $637,396 | TotalAmt |
| Program Services | $479,988 | ProgramServicesAmt |
| Management And General | $157,408 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $450,101 | TotalAmt |
| Program Services | $385,440 | ProgramServicesAmt |
| Management And General | $64,661 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $21,000 | TotalAmt |
| Management And General | $21,000 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $992,374 | TotalAmt |
| Program Services | $824,790 | ProgramServicesAmt |
| Management And General | $167,584 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,635 | TotalAmt |
| Program Services | $3,488 | ProgramServicesAmt |
| Management And General | $1,147 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $152,184 | TotalAmt |
| Program Services | $152,184 | ProgramServicesAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $229,830 | TotalAmt |
| Program Services | $81,050 | ProgramServicesAmt |
| Management And General | $148,780 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $601,627 | TotalAmt |
| Program Services | $533,927 | ProgramServicesAmt |
| Management And General | $67,700 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $38,965 | TotalAmt |
| Program Services | $3,370 | ProgramServicesAmt |
| Management And General | $35,595 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $42,239 | TotalAmt |
| Program Services | $42,239 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $218,810 | TotalAmt |
| Program Services | $164,472 | ProgramServicesAmt |
| Management And General | $54,338 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $364,853 | TotalAmt |
| Program Services | $302,964 | ProgramServicesAmt |
| Management And General | $61,889 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES & DRUG | $207,612 | $207,484 | $128 |
| BAD DEBT | $175,246 | $175,246 | |
| RECRUITING & RETENTION | $50,890 | $1,270 | $49,620 |
| MISCELLANEOUS EXPENSE | $26,579 | $309 | $26,270 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,152 | TotalAmt |
| Program Services | $15,121 | ProgramServicesAmt |
| Management And General | $31 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,331,172 | TotalAmt |
| Program Services | $10,500,493 | ProgramServicesAmt |
| Management And General | $1,830,679 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,323 | BOYAmt |
| EOY | $1,573 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $64,727 | BOYAmt |
| EOY | $13,386 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $548,571 | BOYAmt |
| EOY | $806,392 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $40,320 | BOYAmt |
| EOY | $42,167 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $1,531,586 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $748,416 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $849,141 | BOYAmt |
| EOY | $783,170 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,504,082 | BOYAmt |
| EOY | $1,646,688 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $60,369 | BOYAmt |
| EOY | $127,228 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $133,000 | BOYAmt |
| EOY | $194,889 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $193,369 | BOYAmt |
| EOY | $322,117 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,193,502 | BOYAmt |
| EOY | $1,256,676 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $117,211 | BOYAmt |
| EOY | $67,895 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,310,713 | BOYAmt |
| EOY | $1,324,571 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,504,082 | BOYAmt |
| EOY | $1,646,688 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$3,934,327 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $3,948,185 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | Yes (1) | AccountantCompileOrReviewInd |
Acct Compile Or Review Basis AcctCompileOrReviewBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $117,211 | BeginningYearBalanceAmt |
| Administrative Expenses | $49,316 | AdministrativeExpensesAmt |
| End Year Balance | $67,895 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributions | $200,000 | ContributionsAmt |
| Other Expenditures | $82,789 | OtherExpendituresAmt |
| End Year Balance | $117,211 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $2,000 | BeginningYearBalanceAmt |
| Grants Or Scholarships | $2,000 | GrantsOrScholarshipsAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $2,000 | BeginningYearBalanceAmt |
| End Year Balance | $2,000 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Term Endowment Balance EOY | 1.00000 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,531,586 | OtherCostOrOtherBasisAmt |
| Depreciation | $748,416 | DepreciationAmt |
| Book Value | $783,170 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $783,170 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | ESTIMATED MEDICAL MALPRACTICE CLAIMS LIABILITY | Desc |
| Amt | $194,889 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $194,889 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $12,169,784 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | $3,772,939 | OtherRevenueAmt |
| Revenue Not Reported | $3,772,939 | RevenueNotReportedAmt |
| Revenue Subtotal | $8,396,845 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $8,396,845 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $12,155,926 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $12,155,926 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $175,246 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $175,246 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $12,331,172 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART V, LINE 4: | A $200,000 GRANT WAS TRANSFERRED TO IHPS FROM IRMC DURING THE 2013 FISCAL YEAR TO START-UP AND FUND THE FREE CLINIC IN THE MARION CENTER LOCATION. AT THE END OF FISCAL YEAR 2013, $117,211 REMAINED FOR FUTURE YEARS. THROUGHOUT THE 2014 FISCAL YEAR, $49,316 OF THE GRANT WAS RELEASED AND USED TO FUND THE FREE CLINIC, LEAVING $67,895 OF FUNDS FOR FUTURE FISCAL YEARS. |
| 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 2014 AND 2013. THE CORPORATION'S POLICY IS TO RECOGNIZE INTEREST RELATED TO UNRECOGNIZED TAX BENEFITS IN INTEREST EXPENSE AND PENALTIES IN OPERATING EXPENSES. THE CORPORATION'S FEDERAL AND STATE INCOME TAX RETURNS ARE NO LONGER SUBJECT TO EXAMINATION BY FEDERAL OR STATE TAXING AUTHORITIES FOR FISCAL YEARS BEFORE JUNE 30, 2011. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | TRANSFER FROM AFFILIATE 3,948,185. BAD DEBT -175,246. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | BAD DEBT NETTED ON FINANCIAL STATEMENTS 175,246. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Club Dues Or Fees | Yes (X) | ClubDuesOrFeesInd |
| Written Policy Ref T And E Expnss | Yes (1) | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | Yes (1) | SubstantiationRequiredInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | Yes (1) | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (7 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| BRUCE A BUSH MD | ||||||||||||||
| BOARD MEMBER | $275,356 | $0 | $33,512 | $0 | $0 | $0 | $0 | $0 | $27,922 | $0 | $336,790 | $0 | $0 | $0 |
| STEPHEN A WOLFE | ||||||||||||||
| PRESIDENT & CEO | $382,452 | $0 | $59,258 | $0 | $6,052 | $0 | $62,701 | $0 | $18,055 | $0 | $528,518 | $0 | $0 | $0 |
| ISLAM MOHAMMED N | ||||||||||||||
| PHYSICIAN | $444,588 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $17,015 | $0 | $461,603 | $0 | $0 | $0 |
| GUDDETI MURALIDHAR R | ||||||||||||||
| PHYSICIAN | $322,907 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $17,212 | $0 | $340,119 | $0 | $0 | $0 |
| SYED MUSHTAQ A | ||||||||||||||
| PHYSICIAN | $303,566 | $0 | $4,472 | $0 | $0 | $0 | $0 | $0 | $15,837 | $0 | $323,875 | $0 | $0 | $0 |
| PATHAN KARAM K | ||||||||||||||
| PHYSICIAN | $280,951 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $13,991 | $0 | $294,942 | $0 | $0 | $0 |
| CONTI JOSEPH D | ||||||||||||||
| PHYSICIAN | $250,655 | $0 | $3,237 | $0 | $0 | $0 | $0 | $0 | $10,263 | $0 | $264,155 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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, FORM 990 OF OTHER ORGANIZATIONS, WRITTEN EMPLOYMENT CONTRACT, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. |
| PART I, LINE 4B | INDIANA REGIONAL MEDICAL CENTER, A RELATED ORGANIZATION, HAS A SUPPLEMENTAL, NONQUALIFIED RETIREMENT PLAN UNDER IRC SECTION 457(F) FOR PRESIDENT & CEO STEPHEN WOLFE AND MOHAMMED ISLAM. NO AMOUNTS WERE PAID TO THEM FROM THIS PLAN DURING 2013. STEPHEN WOLFE'S CONTRIBUTION TO THE PLAN FOR 2013 WAS $38,305. |
| 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. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART III, LINE 3 | 3 PRIMARY CARE PHYSICIANS LEFT IHPS (DR. SHARBAUGH, DR. NANJAIAH, AND DR. LEE) AND 2 PHYSICIANS SPECIALIZING IN PSYCHIATRY LEFT IHPS (DR. CASSONE AND DR. GATUMU). |
| 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 XI, LINE 9: | TRANSFER FROM AFFILIATE 3,948,185. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (5 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 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 | 0 | N/A | |
| 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 | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (5 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|
| 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 |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | INDIANA HEALTHCARE ENTERPRISES | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 835 HOSPITAL DRIVE | AddressLine1 |
| City | INDIANA | City |
| State | PA | State |
| ZIP Code | 15701 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 470973344 | EIN |
| Primary Activities | HEALTHCARE RETAIL | PrimaryActivitiesTxt |
| Legal Domicile State | PA | LegalDomicileStateCd |
| Direct Controlling NA | N/A | DirectControllingNACd |
| Entity Type | C | EntityTypeTxt |
| Controlled Organization | 0 | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | Yes (1) | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (1) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Comments