2014-05-14T14:22:14-05:00 2013-06-30 BKD LLP 910 E ST LOUIS 200/PO BOX 1190 SPRINGFIELD MO 658062523 990 2012-07-01 250984595 BROOKVILLE HOSPITAL % JESSICA PARK BROO 8148492312 100 HOSPITAL ROAD Suite BROOKVILLE PA 15825 JULIANNE PEER 8148492312 2014-05-13 true Brian D Todd 4178658701 2012 2015-11-30 17:44:51Z JULIANNE PEER 100 HOSPITAL ROAD BROOKVILLE PA 15825 27653271 false X WWW.BROOKVILLEHOSPITAL.ORG X 1915 PA BROOKVILLE HOSPITAL IS A 35 BED CRITICAL ACCESS HOSPITAL THAT PROVIDES QUALITY INPATIENT AND OUTPATIENT HEALTHCARE SERVICES. OUTPATIENT SERVICES INCLUDE RADIOLOGY, LAB, REHABILITATION, AND HOME HEALTH. 9 6 284 38 0 0 836307 126287 28023673 27381792 177576 82242 38901 47159 29076457 27637480 3435 2997 0 0 12294032 13676108 0 0 0 15567871 15470531 27865338 29149636 1211119 -1512156 21440417 20417412 10107678 10583881 11332739 9833531 X TO PROVIDE QUALITY HEALTHCARE SERVICES TO THE COMMUNITIES THAT WE SERVE IN A COST-EFFECTIVE MANNER. SEE SCHEDULE O FOR ADDITIONAL INFORMATION. false false 19033869 20452583 BROOKVILLE HOSPITAL PROVIDES A WIDE VARIETY OF OUTPATIENT SERVICES TO THE COMMUNITY. WE HAVE A PHYSICIAN STAFFED 24 HOUR EMERGENCY DEPARTMENT THAT PROVIDED OVER 9,500 VISITS THIS YEAR AND 3 FAMILY PRACTICE CLINICS THAT HAD OVER 14,000 VISITS. WE ALSO PROVIDE OUTPATIENT PHYSICAL, OCCUPATIONAL, AND SPEECH THERAPY, GENERAL RADIOLOGY, CAT SCAN, MRI, PET, ULTRASOUND, NUCLEAR MEDICINE, CARDIOLOGY, LABORATORY SERVICES AND A PAIN CLINIC, AND OUTPATIENT PSYCH SERVICES. OUR SURGEONS PERFORMED ALMOST 1,700 SURGERIES AND OUR HOME HEALTH AGENCY PROVIDED OVER 5,000 VISITS. SEE SCHEDULE O FOR ADDITIONAL INFORMATION. 6344623 6929209 BROOKVILLE HOSPITAL IS A 35 BED HOSPITAL THAT PROVIDED INPATIENT SERVICES TO 1,292 PATIENTS THIS YEAR. INPATIENT SERVICES INCLUDED TREATMENTS FOR BOTH MEDICAL AND SURGICAL PATIENTS. MANY OF OUR PATIENTS WERE TREATED IN THE GERO-PSYCHIATRIC UNIT OF THE HOSPITAL. THIS UNIT SPECIALIZES IN PSYCHIATRIC DISORDERS FOR PATIENTS OVER THE AGE OF 55. 25378492 true true false true false false false false false false true false false true true false false true false false false false false false true false true true false false true false false false true false false false true false false false false false true true true false false true 28 0 true 284 true false false false false false true true false false false false X 9 6 true true false false true true true true true false false true true true true true true true true false PA X JESSICA PARK 8148491408 100 HOSPITAL ROAD BROOKVILLE PA 15825 JOHN SUTIKA 3.0 40.0 X 0 341105 37911 L GENE HOAK 3.0 0.0 X X 0 0 RONALD KING 3.0 0.0 X X 0 0 TROY HARPER 3.0 0.0 X X 0 0 TIMOTHY PENDLETON MD 1.0 40.0 X 0 399609 15381 ROSE CAMPBELL 3.0 40.0 X X 0 146168 5752 WILLIAM YOUNG 3.0 0.0 X X 0 0 TODD P STOLTZ 3.0 0.0 X 0 0 EDWARD YAHNER 3.0 0.0 X 0 0 JULIANNE PEER 40.0 0.0 X 125365 0 4555 ALAN CORNMAN 40.0 0.0 X 138632 0 6761 EMERSON TURNBULL 40.0 0.0 X 153704 0 5733 TANIS PENDLETON MD 40.0 0.0 X 300188 0 0 CYRIL GAMIS MD 40.0 0.0 X 125236 0 0 DAVID GIRARDI DO 40.0 0.0 X 251229 0 1327 GARY MACIOCE 0.0 40.0 X 0 283902 35943 1094354 1170784 113363 7 true true false DUBOIS REGIONAL MEDICAL CENTER HOSPITAL MANAGEMENT 2644185 NORTHWEST EMERGENCY PHYSICIANS EMERGENCY PHYSICIANS 1074381 NORTHFORK REHABILITATION PHYSICAL THERAPY 835824 PENN HIGHLANDS HEALTHCARE HOSPITAL MANAGEMENT 423383 ASSOCIATED CLINICAL LABORATORIES LAB TESTING 299555 14 16592 13540 43182 52973 126287 NET PATIENT SERVICE REVENUE 621110 26920877 26920877 EHR REVENUE 621110 252092 252092 MEAL TICKETS 722513 76215 76215 OTHER REVENUE 900099 43413 43413 PHARMACY REVENUE 446110 89195 89195 27381792 80455 80455 0 0 41056 41056 0 41056 41056 1787 1787 1787 1787 21894 16592 15791 6103 6103 0 0 0 27637480 27381792 129401 X 2997 2997 0 0 0 129920 129920 0 348176 348176 10027891 9475340 552551 278040 254493 23547 2150923 1937031 213892 741158 667456 73702 2075410 1736920 338490 56723 56723 168584 168584 0 0 0 5232966 4558743 674223 51055 51055 932735 586793 345942 28495 13443 15052 0 657351 523330 134021 57247 46824 10423 0 20964 4300 16664 214886 180109 34777 0 1732941 1452480 280461 290385 25030 265355 MEDICAL SUPPLIES & DRUGS 2266768 2266768 BAD DEBT 1573529 1573529 LICENSES, DUES, SUBSCRIPTIONS 95276 57690 37586 RECRUITING & RETENTION 15216 15216 29149636 25378492 3771144 0 617446 362734 5069442 4163287 0 0 4219696 4572188 71630 52772 0 0 0 0 526257 509935 491932 343528 41586338 33347712 8309925 8238626 0 0 22761 36198 0 0 0 0 2111328 2138144 21440417 20417412 3316057 4354037 0 0 51011 42869 0 0 0 0 0 0 6451432 5889903 0 0 289178 297072 10107678 10583881 X 11047744 9543805 103627 95410 181368 194316 11332739 9833531 21440417 20417412 X -1512156 12948 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false true 5000 false false 5000 false DIRECT CONTACT WITH LEGISLATORS SCHEDULE C, PART II-B, LINE 1(G) THE ORGANIZATION CONTRACTED WITH S.R. WOJDAK AND ASSOCIATES TO ASSIST WITH MEDICAL ASSISTANCE COST REIMBURSEMENT ACTIVITIES. 205546 205546 8168454 6310869 1857585 204286 196251 8035 30517231 25543696 4973535 2490821 1296896 1193925 8238626 BEN INT IN PERPETUAL TRUST 194316 OTHER RECEIVABLES 366374 INTEREST RECEIVABLE 85056 OTHER ASSETS 12991 DUE FROM AFFILIATES 1479407 2138144 0 EST AMT DUE TO THIRD PARTIES 297072 297072 26092690 -1560581 -1560581 27653271 -15791 -15791 27637480 27591898 15791 15791 27576107 1573529 1573529 29149636 UNCERTAIN TAX POSITIONS SCHEDULE D, PART X, LINE 2 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. OTHER REVENUE INCLUDED ON LINE 1, BUT NOT ON FORM 990, PART VIII, LINE 12 SCHEDULE D, PART XI, LINE 2D $(1,573,529) BAD DEBT EXPENSE 12,948 CHANGE IN BENEFICIAL INTEREST IN TRUST ------------ $(1,560,581) OTHER REVENUE INCLUDED ON FORM 990, PART VIII, LINE 12, BUT NOT ON LINE 1 SCHEDULE D, PART XI, LINE 4B $ (15,791) SPECIAL EVENT EXPENSE OTHER EXPENSE INCLUDED ON LINE 1, BUT NOT ON FORM 990, PART IX, LINE 25 SCHEDULE D, PART XII, LINE 2D $ 15,791 SPECIAL EVENT EXPENSE OTHER EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25 BUT NOT ON LINE 1 SCHEDULE D, PART XII, LINE 4B $ 1,573,529 BAD DEBT EXPENSE GOLF OUTING 20505 13262 7243 0 2220 2712 2707 0 532 1-100 EVENT 17981 3330 14651 3650 84 445 2915 0 526 0 0 0 0 0 0 0 0 0 0 38486 16592 21894 3650 2304 3157 5622 0 1058 15791 6103 true true X true X false true true false false 258960 258960 0.00940 888605 1254356 -365751 1644424 834162 810262 0.02940 2791989 2088518 703471 0.03880 19705 2449 17256 0.00060 2997 2997 0.00010 22702 2449 20253 0.00070 2814691 2090967 723724 0.03950 true 1573529 228162 14390392 14376842 13550 X true false 1 1 BROOKVILLE HOSPITAL

100 HOSPITAL ROAD BROOKVILLE PA 15825

X X X X BROOKVILLE HOSPITAL true X X X X 11 true true true X X false false true true 200. false true X X X X X true true X true false X X X X true X false false 5 PHYSICAL THERAPY BUILDING

88 INDUSTRIAL PARK RD BROOKVILLE PA 15825

OUTPATIENT PHYSICAL, OCCUPATIONAL AND SPEECH THERAPY CHARLES PROFESSIONAL BUILDING

240 ALLEGHENY BLVD BROOKVILLE PA 15825

FAMILY PRACTICE CLINICS, GENERAL RADIOLOGY, HOME HLTH DAVID L MILLER MEDICAL CENTER

BROOKVILLE STREET FAIRMOUNT PA 16224

RADIOLOGY, LAB, PHYSICAL AND OCCUPATIONAL THERAPY, AND RURAL HEALTH CLINIC ALLEGHENY HEALTH CENTER

22 INDUSTRIAL PARK RD BROOKVILLE PA 15825

RURAL HEALTH CLINIC MARIENVILLE FAMILY HEALTH

125 CHESTNUT ST MARIENVILLE PA 16239

RURAL HEALTH CLINIC PERCENT OF TOTAL EXPENSE SCHEDULE H, PART I, LINE 7, COLUMN F 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 $1,573,529. COST TO CHARGE RATIO SCHEDULE H, PART I, LINE 7 THE COST TO CHARGE RATIO COMPUTED ON IRS WORKSHEET 2 WAS USED IN THE CALCULATIONS ON IRS WORKSHEETS 1 AND 3. BAD DEBT EXPENSE SCHEDULE H, PART III, SECTION A, LINE 4 THE AUDITED FINANCIAL STATEMENTS DO NOT CONTAIN A FOOTNOTE THAT DESCRIBES BAD DEBT EXPENSE. THEY DO, HOWEVER, CONTAIN A FOOTNOTE THAT DESCRIBES PATIENT ACCOUNTS RECEIVABLE: THE HOSPITAL REPORTS PATIENT ACCOUNTS RECEIVABLE FOR SERVICES RENDERED AT NET REALIZABLE AMOUNTS FROM THIRD-PARTY PAYERS, PATIENTS AND OTHERS. THE HOSPITAL PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED UPON A REVIEW OF OUTSTANDING RECEIVABLES, HISTORICAL COLLECTION INFORMATION AND EXISTING ECONOMIC CONDITIONS. AS A SERVICE TO THE PATIENT, THE HOSPITAL BILLS THIRD-PARTY PAYERS DIRECTLY AND BILLS THE PATIENT WHEN THE PATIENT'S LIABILITY IS DETERMINED. PATIENT ACCOUNTS RECEIVABLE ARE DUE IN FULL WHEN BILLED. ACCOUNTS ARE CONSIDERED DELINQUENT AND SUBSEQUENTLY WRITTEN OFF AS BAD DEBTS BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE ACCOUNT. THE ORGANIZATION CALCULATED BAD DEBT USING THE BAD DEBT ATTRIBUTABLE TO PATIENT ACCOUNTS PER THE AUDITED FINANCIAL STATEMENTS. BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY WAS DETERMINED USING POVERTY LIMIT DEMOGRAPHIC INFORMATION OBTAINED THROUGH THE U.S. CENSUS BUREAU. THE MOST RECENT US CENSUS BUREAU INDICATES THAT 14.5 PERCENT OF JEFFERSON COUNTY WAS CONSIDERED TO LIVE IN POVERTY. COMMUNITY BENEFIT SCHEDULE H, PART III, SECTION B, LINE 8 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. COLLECTION POLICY SCHEDULE H, PART III, SECTION C, LINE 9B A CHARITY CARE APPLICATION IS GOOD FOR SIX MONTHS ONCE APPROVED. ALSO PATIENTS ARE SENT THREE STATEMENTS BEFORE BEING SENT TO COLLECTION AGENCY, SO THEY HAVE TIME TO CONTACT THE BILLING OFFICE FOR CHARITY CARE. COMMUNITY INPUT SCHEDULE H, PART V, SECTION B, LINE 3 THE ORGANIZATION TOOK INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE COMMUNITY BY CONDUCTING INTERVIEWS WITH KEY COMMUNITY STAKEHOLDERS AND FOCUS GROUPS WITH COMMUNITY RESIDENTS AS WELL AS HOLDING A COMMUNITY HEALTH PLANNING RETREAT. CHNA CONDUCTED WITH OTHER HOSPITAL FACILITIES SCHEDULE H, PART V, SECTION B, LINE 4 THE CHNA WAS CONDUCTED ALONG WITH DUBOIS REGIONAL MEDICAL CENTER, A RELATED ORGANIZATION. IMPLEMENTATION STRATEGY SCHEDULE H, PART V, SECTION B, LINE 6 IN RESPONSE TO THE RESULTS OF BROOKVILLE HOSPITAL'S MOST RECENTLY CONDUCTED COMMUNITY HEALTH NEEDS ASSESSMENT, THE ORGANIZATION ADOPTED AN IMPLEMENTATION STRATEGY. THE IMPLEMENTATION STRATEGY IS ATTACHED. ADDRESSING IDENTIFIED NEEDS SCHEDULE H, PART V, SECTION B, LINE 7 BROOKVILLE HOSPITAL AND DUBOIS REGIONAL MEDICAL CENTER HAVE DEMONSTRATED THAT THEY WISH TO LISTEN TO COMMUNITY CONCERNS, ANALYZE HEALTHCARE UTILIZATION AND COSTS, EXPLORE ACCESS ISSUES, AND COLLABORATE WITH AND DEVELOP EFFECTIVE PROGRAMS TO IMPROVE THE HEALTH OF THOSE IN WEST CENTRAL PA. BASED ON THE COMMUNITY HEALTH NEEDS ASSESSMENT FINDINGS AND THE PRIORITIZED NEEDS, THREE COMMUNITY NEEDS WILL BE IMPLEMENTED AND FURTHER EXPLORED. IT IS IMPORTANT TO NOTE THAT WHILE PROVIDER WORKFORCE WAS NOT A COMMUNITY NEED THAT WAS A DIRECT RESULT OF THE CHNA, BROOKVILLE HOSPITAL AND DRMC WILL TACKLE THIS ISSUE IN ORDER TO INCREASE THE MANPOWER AND WORKFORCE ISSUES THAT DIRECTLY AFFECT COMMUNITY RESIDENTS. TACKLING THE LACK OF AVAILABLE PHYSICIANS AND ALLIED HEALTH PROFESSIONALS IN THE AREA WILL ALSO HELP TO IMPROVE COMMUNITY RESIDENTS' ABILITY TO ACCESS HEALTH SERVICES (BRIDGING THE GAP BETWEEN SERVICE PROVIDERS AND END-USERS) AND HEALTH INFORMATION. THIS PRIORITIZED NEED WAS A DIRECT HEALTH NEED FROM THE COMMUNITY HEALTH ASSESSMENT. THE PROGRAMS DESCRIBED IN THE FOLLOWING IMPLEMENTATION PLAN ADDRESSES THE TARGETED HEALTH PRIORITIES THAT HOSPITAL LEADERS BELIEVE WILL HAVE THE MOST IMPACT WITHIN THE COMMUNITY. OF THE IDENTIFIED CHNA AND PRIORITIZED HEALTH NEEDS, BROOKVILLE HOSPITAL AND DRMC WILL FOCUS ON THREE OF THE COMMUNITY REQUIREMENTS: 1. ACCESS TO CARE 2. DENTAL CARE 3. PROVIDER WORKFORCE EACH OF THE HEALTH NEEDS IDENTIFIED WITHIN THE CHNA ARE IMPORTANT AND ARE BEING ADDRESSED TO SOME DEGREE BY ORGANIZATIONS, PROGRAMS/INITIATIVES OPERATED BY REGIONAL AND LOCAL COMMUNITY-BASED ORGANIZATIONS OR BY BROOKVILLE HOSPITAL AND/OR DRMC. THROUGH ANALYSIS AND DISCUSSIONS RESULTING FROM A WORK SESSION HELD WITH REPRESENTATIVES FROM BROOKVILLE HOSPITAL AND DRMC, THE FOLLOWING NEEDS IDENTIFIED IN THE CHNA THAT WILL NOT BE ADDRESSED ARE: 1. ACCESSING HEALTH INFORMATION / LACK OF ACCESS (BRIDGING GAP BETWEEN SERVICE PROVIDERS AND END-USERS) 2. DRUG/ALCOHOL PREVENTION 3. HEALTH EDUCATION AND COMMUNICATION CRITERIA FOR DISCOUNTED CARE SCHEDULE H, PART V, SECTION B, LINE 11 ALL PATIENTS THAT ARE PROVIDED CARE BUT PRESENT WITHOUT INSURANCE ARE GRANTED A 20% DISCOUNT. ONLY FREE CARE IS PROVIDED USING THE FEDERAL POVERTY GUIDELINES. NEEDS ASSESSMENT A COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED BY TRIPP UMBACH BETWEEN MARCH AND AUGUST 2012 FOR CLEARFIELD AND JEFFERSON COUNTIES. NEEDS IDENTIFIED INCLUDED LACK OF ECONOMIC DEVELOPMENT AND GROWTH, HIGH UNEMPLOYMENT RATES, AND AN UNATTRACTIVE REGION FOR YOUNG FAMILIES REGARDING POOR ECONOMIC CONDITIONS. THE OVERALL WELL-BEING OF THE AREA INDICATES CHRONIC DISEASES, ENGAGEMENT OF POOR HEALTH BEHAVIORS, LACK OF HEALTH EDUCATION, DIET AND EXERCISE OPTIONS, DRUG AND ALCOHOL ABUSE, AND MENTAL HEALTH ISSUES. THERE ARE LIMITED FUNDING RESOURCES AT HEALTH AND COMMUNITY ORGANIZATIONS, TRANSPORTATION ISSUES, AND HOUSING LIMITATIONS, AS WELL AS ACCESS ISSUES FOR LARGE UNDERINSURED AND UNINSURED POPULATIONS, LIMITED PROGRAMS TO ADDRESS HEALTH NEEDS, LIMITED BASIC CARE SERVICES, AND AN INABILITY AND/OR LACK OF KNOWLEDGE ON HOW TO ACCESS EXISTING HEALTH SERVICES. THE TOP COMMUNITY HEALTH NEEDS IDENTIFIED WERE ACCESSING PRIMARY HEALTHCARE AND PREVENTIVE CARE, BASIC COMMUNITY SERVICES (ESPECIALLY DENTAL SERVICES), DRUG/ALCOHOL PREVENTION, AND HEALTH EDUCATION/COMMUNICATION. PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE INFORMATION IS POSTED AT REGISTRATION AREA AND IN WAITING AREAS. SELF PAY PATIENTS ARE GIVEN INFORMATION WITH THE FIRST BILL. THE CARE MANAGEMENT DEPARTMENT WORKS WITH ALL INPATIENTS AND WITH OUTPATIENTS AS NEEDED/REQUESTED. COMMUNITY INFORMATION BROOKVILLE HOSPITAL SERVES BROOKVILLE AND THE SURROUNDING COMMUNITIES. THE SERVICE AREA EXTENDS NORTH TO MARIENVILLE AND SOUTH TO NEW BETHLEHEM, AND INCLUDES JEFFERSON COUNTY, FOREST COUNTY AND CLARION COUNTY. THIS SERVICE AREA IS IN A RURAL PART OF WESTERN PENNSYLVANIA, WITH MANY RESIDENTS LIVING BELOW OR WELL BELOW THE NATIONAL AND STATE INCOME AVERAGE. ACCORDING TO THE US CENSUS BUREAU'S MOST RECENT DATA, APPROXIMATELY 14 PERCENT OF INDIVIDUALS LIVING IN THIS AREA WERE CONSIDERED TO LIVE IN POVERTY. THE MEDIAN HOUSEHOLD INCOME IN THE SERVICE AREA IS APPROXIMATELY $38,500. FROM THE RECENTLY COMPLETED COMMUNITY HEALTH NEEDS ASSESSMENT, THE SERVICE AREA INCLUDES 22% OF UNINSURED ADULTS, 7.8% OF CHILDREN WHO ARE UNINSURED. UNEMPLOYMENT RATES FOR CLEARFIELD AND JEFFERSON COUNTY WERE JUST OVER 8%. THE MEDIAN AGE OF THE POPULATION IS ABOUT 42, WITH ABOUT 18% 65 AND OVER. CLEARFIELD COUNTY HAS A 45.9% URBAN POPULATION, WHILE JEFFERSON HAS A 33.8% URBAN POPULATION. PROMOTION OF COMMUNITY HEALTH BROOKVILLE HOSPITAL PARTICIPATES IN AND PROVIDES MANY HEALTH FAIR AND COUNSELING OPPORTUNITIES THROUGHOUT THE YEAR, INCLUDING THOSE ASSOCIATED WITH MENTAL HEALTH, DIABETES, NUTRITION AND WEIGHT MANAGEMENT. ALSO, THE ORGANIZATION WORKS TO PROMOTE LEARNING THROUGH THE MEDICAL EXPLORERS PROGRAM AND LOCAL CAREER DAYS. AFFILIATED HEALTH CARE SYSTEM BROOKVILLE HOSPITAL HAS AN AFFILIATION AGREEMENT WITH DUBOIS REGIONAL MEDICAL CENTER, A 501(C)(3) NON-PROFIT ORGANIZATION. X X X X X false true false false false false false true false JOHN SUTIKA 0 282787 0 47018 0 11300 0 37194 0 717 0 379016 0 0 EMERSON TURNBULL 137504 0 16200 0 0 0 5733 0 0 0 159437 0 0 0 TANIS PENDLETON MD 300188 0 0 0 0 0 0 0 0 0 300188 0 0 0 TIMOTHY PENDLETON MD 0 399133 0 0 0 476 0 10000 0 5381 0 414990 0 0 ROSE CAMPBELL 0 123386 0 17782 0 5000 0 4935 0 817 0 151920 0 0 DAVID GIRARDI DO 210949 0 40280 0 0 0 0 0 1327 0 252556 0 0 0 GARY MACIOCE 0 253898 0 23936 0 6068 0 22011 0 13932 0 319845 0 0 NONQUALIFIED RETIREMENT PLAN SCHEDULE J, PART I, LINE 4B JOHN SUTIKA PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN THROUGH RELATED ORGANIZATION DUBOIS REGIONAL MEDICAL CENTER. HIS PAYMENT WAS $10,194. NON-FIXED PAYMENTS SCHEDULE J, PART I, LINE 7 A PORTION OF ROSE CAMPBELL AND JOHN SUTIKA'S BONUSES WERE BASED ON BOARD DISCRETION, WHILE THE MAJORITY WAS BASED ON FORMULAS USING INFORMATION BASED ON FINANCE, GROWTH, QUALITY/SAFETY, PEOPLE, AND SERVICE. JULIANNE PEER OFFICE EDUC. REIMB. X 20000 16137 false false true TANIS PENDLETON HCE INCOME SUB. X 185000 8638 false true true TANIS PENDLETON HCE INCOME SUB. X 45000 27997 false true true 52772 LINDA GRINDER SISTER OF RON KING 47988 EMPLOYEE OF HOSPITAL false TANIS PENDLETON SISTER OF T PENDLETON 300188 EMPLOYEE OF HOSPITAL false ORGANIZATION'S MISSION FORM 990, PART III, LINE 1 MISSION STATEMENT: OUR MISSION IS TO PROVIDE QUALITY HEALTHCARE SERVICES TO THE COMMUNITIES THAT WE SERVE IN A COST EFFECTIVE MANNER. VISION STATEMENT: OUR VISION IS TO BE THE PROVIDER OF CHOICE IN PROMOTING HEALTHCARE FOR THE COMMUNITIES THAT WE SERVE. VALUE STATEMENT: -SERVICE EXCELLENCE THAT IS RESPONSIVE TO THE NEEDS OF THOSE WE SERVE. -DIGNITY & COMPASSION IN CARING FOR PATIENTS AND THEIR FAMILIES. -RESPECT TREATING EACH OTHER WITH FAIRNESS, HONESTY, AND TRUST. -TEAMWORK CHARACTERIZED BY UNITY OF PURPOSE, FLEXIBILITY AND EMPOWERMENT OF PEOPLE. -PLANNING BUILDING ON THE PAST AND ANTICIPATING THE FUTURE TO MEET OUR GOALS. -FINANCIAL HEALTH TO ENSURE THE CONTINUATION OF OUR MISSION. -ACTIVE PARTICIPATION BY PATIENTS AND FAMILIES IN THEIR HEALTHCARE. PROGRAM SERVICE FORM 990, PART III, LINE 4A BROOKVILLE HOSPITAL ESTIMATED VALUE OF FREE CARE, COMMUNITY SERVICE, CHARITABLE CONTRIBUTIONS, AND PROFESSIONAL AND COMMUNITY EDUCATION UNCOMPENSATED CHARITY CARE UNCOMPENSATED CHARITY CARE CHARGES WRITTEN OFF WERE $512,932. THE TOTAL DOES NOT INCLUDE BAD DEBT. THE HOSPITAL'S DETERMINATION OF INABILITY TO PAY DIFFERENTIATES CHARITY CARE FROM BAD DEBT, WHICH IS DETERMINED BY ABILITY TO PAY BUT UNWILLINGNESS TO DO SO. BAD DEBT THE HOSPITAL'S BAD DEBT AMOUNT WRITTEN OFF WAS $1,573,529 IN FY 2013. CHARITY CARE SERVICE THE HOSPITAL OWNS AND OPERATES THE ALLEGHENY, NEW BETHLEHEM, AND MARIENVILLE HEALTH CENTERS. THESE ARE RURAL HEALTH CLINICS THAT ARE AVAILABLE TO THE COMMUNITY. CHARITY CARE IS OFFERED TO PATIENTS OF THESE CLINICS. COMMUNITY VOLUNTEER ASSISTANCE APPROXIMATELY 40 ACTIVE HOSPITAL VOLUNTEERS ASSISTED WITH THE PROVISION OF SERVICES BY THE HOSPITAL. THE AUXILIARY HAS ABOUT 28 MEMBERS THAT HOLD FUND RAISING EVENTS THROUGHOUT THE YEAR. THE FUNDS FROM THESE EVENTS ARE GIVEN BACK TO THE HOSPITAL FOR VARIOUS PROJECTS. PASTORAL CARE THE HOSPITAL HAS VOLUNTEER PASTORS THAT PERFORM MINISTRY TO THE HOSPITAL'S PATIENTS, PATIENTS' FAMILIES, AND STAFF. THIS SERVICE IS AVAILABLE 24 HOURS A DAY/7 DAYS A WEEK. PATIENT COMMENT SURVEYS THE HOSPITAL DISTRIBUTES SURVEYS TO INPATIENT, OUTPATIENTS, AMBULATORY SURGERY, EMERGENCY ROOM, AND HOME CARE PATIENTS TO ASSESS THE NEEDS OF THE PATIENTS IN OUR COMMUNITY REGARDING CARE AND OPPORTUNITIES TO IMPROVE THAT CARE. RESULTS ARE RECEIVED QUARTERLY AND COMPARED TO PRIOR RESULTS. TIME IS SPENT BY HOSPITAL STAFF IN EVALUATING RESULTS, WITH DEPARTMENTAL AND CONSUMER FOLLOW-UP AND WORK PROCESS REDESIGN TO IMPROVE CARE AND SATISFACTION. FOREIGN LANGUAGE & SIGN LANGUAGE INTERPRETING SERVICE THE HOSPITAL PROVIDES INTERPRETING SERVICES AT NO CHARGE TO FOREIGN LANGUAGE AND SIGN LANGUAGE SPEAKING PATIENTS AND PATIENT FAMILY MEMBERS. THESE SERVICES ARE PERFORMED ON AN ON-CALL BASIS. HOSPITAL EMPLOYEES WHO SPEAK A FOREIGN LANGUAGE OR ARE TRAINED IN SIGN LANGUAGE CAN BE USED TO TRANSLATE. THE HOSPITAL ALSO SUBSCRIBES TO AN ON-LINE INTERPRETING SERVICE, LANGUAGE LINE SERVICES. COMMUNITY EDUCATION / PUBLIC AFFAIRS ACTIVITIES IN OUR ROLES AS A LEADING PROVIDER OF HEALTH AND HEALTH-RELATED SERVICES TO JEFFERSON AND SURROUNDING COUNTIES, BROOKVILLE HOSPITAL RECOGNIZES OUR RESPONSIBILITY TO HELP THE PEOPLE OF OUR SERVICE AREA ACHIEVE AND MAINTAIN OPTIMUM HEALTH STATUS. THE ADMINISTRATION AND EDUCATION DEPARTMENT AND THE HEALTHY COMMUNITY COMMITTEE, OFFERS A SERIES OF PROGRAMS THROUGHOUT THE YEAR TO ACHIEVE THIS ROLE. BROOKVILLE HOSPITAL'S EDUCATIONAL EFFORTS ARE HEALTH-RELATED TO HELP FULFILL OUR MISSION OF HELPING PEOPLE IN OUR SERVICE AREA ACHIEVE AND MAINTAIN OPTIMUM HEALTH STATUS. EFFORTS IN THIS AREA INCLUDE FREE COMMUNITY HEALTH AND PATIENT EDUCATION PUBLICATIONS, MATERIALS TO PROMOTE HEALTH-RELATED ACTIVITIES, A PHYSICIAN REFERRAL LINE, AND PARTICIPATION IN LOCAL HEALTH FAIRS. PATIENT SUPPORT AND EDUCATION NUTRITIONAL COUNSELING A REGISTERED DIETITIAN IS AVAILABLE TO MEET WITH PATIENTS AND FAMILIES TO ASSESS NUTRITIONAL NEEDS AND DETERMINE APPROPRIATE NUTRITIONAL GOALS AND STRATEGIES. IN ADDITION, CLASSES ARE OFFERED THROUGHOUT THE YEAR TO THE COMMUNITY ON HEALTHY COOKING, LOW FAT DIET, DIABETES, CARDIOVASCULAR HEALTH. MAMMOGRAMS IN COOPERATION WITH AREA PHYSICIANS, THE HOSPITAL PROVIDES REDUCED FEE MAMMOGRAMS WITH INTERPRETATIONS ON AN ANNUAL BASIS FOR HIGH RISK WOMEN WHO ARE LOW INCOME AND GENERALLY UNINSURED. COMMUNITY CLASSES THE HOSPITAL OFFERS A VARIETY OF COMMUNITY EDUCATION CLASSES THAT INCLUDES CPR, DIABETES EDUCATION, AND A NEW WAY OF LIFE. COMMUNITY BLOOD PRESSURES BROOKVILLE/NEW BETHLEHEM HOME HEALTH CARE NURSES PROVIDED BLOOD PRESSURE SCREENINGS AT A VARIETY OF LOCATIONS AT THE REQUEST OF AREA AGENCIES OF AGING. PATIENT EDUCATION PUBLICATIONS INCLUDES A VARIETY OF PUBLICATIONS SUCH AS THE PATIENT VISITOR GUIDE, THE PATIENT RIGHTS & RESPONSIBILITIES BOOKLET, ADVANCE DIRECTIVES, ETC. MATERIALS TO PROMOTE HEALTH-RELATED ACTIVITIES MATERIALS INCLUDE PROMOTING A VARIETY OF ACTIVITIES INCLUDING HEALTH SCREENING ADS, CANCER ASSESSMENT AND BREAST HEALTH AWARENESS MATERIALS, AND DIABETES EDUCATION CLASSES. VOLUNTARISM BROOKVILLE HOSPITAL'S WORK FORCE, ONE OF THE LARGEST IN THE REGION, IS COMPRISED OF MANY INDIVIDUALS WHO ENGAGE IN PERSONAL COMMUNITY SERVICE. THESE INDIVIDUALS GIVE OF THEIR TIME, TALENT, AND RESOURCES TO MAKE OUR COMMUNITY A BETTER PLACE TO LIVE AND WORK. PHYSICIANS AND EMPLOYEES VOLUNTEER THEIR TIME INDIVIDUALLY, BENEFITING COMMUNITY ORGANIZATIONS AND CAUSES. DURING THE YEAR. EMPLOYEES SPEND TIME PROVIDING CARE, EDUCATING THE COMMUNITY, AND SERVING ON BOARDS OF SOCIAL SERVICE AGENCIES. EMPLOYEES ALSO VOLUNTEER THEIR TIME FOR ADOPT A HIGHWAY, MARCH OF DIMES WALK AMERICA, THE M/S WALK, AND SIT ON VARIOUS COMMUNITY BOARDS. CONTRIBUTIONS EACH YEAR, BROOKVILLE HOSPITAL RECEIVES REQUESTS FOR FINANCIAL SUPPORT FROM NUMEROUS ORGANIZATIONS PROVIDING VALUABLE SERVICES TO OUR COMMUNITY. WHILE WE ARE A NOT-FOR-PROFIT ORGANIZATION, WE DO PROVIDE SUPPORT ON A LIMITED BASIS. UNITED FUND CAMPAIGN BROOKVILLE HOSPITAL EMPLOYEES CONTRIBUTE FUNDS TO THE COMMUNITY THROUGH THE UNITED FUND CAMPAIGN. INFECTION CONTROL COMMUNITY SERVICE THE INFECTION CONTROL DEPARTMENT SHARES POLICIES, PROCEDURES, AND EXPERTISE WITH OTHER HOSPITALS, NURSING HOMES, AND HEALTH CARE PROVIDERS. IN SOLVING INFECTION-RELATED PROBLEMS, HELPING TO DEVELOP PROGRAMS, ETC., AS REQUESTED. THE INFECTION CONTROL DEPARTMENT ALSO PROVIDES FOLLOW-UP TO BLOOD/BODY FLUID EXPOSURES EXPERIENCED BY HOSPITAL PERSONNEL. FOLLOW-UP IS GENERALLY COMPLICATED AND INVOLVES BLOOD WORK FOR EMPLOYEES AND PATIENTS AND COUNSELING AS PROVIDED AFTER EACH EXPOSURE. INFECTION CONTROL COMMUNICATES REGULARLY WITH ALL AREA HEALTH BUREAUS REPORTING COMMUNICABLE DISEASES, THUS AFFORDING CONTINUITY OF FOLLOW-UP INVESTIGATION FOR POTENTIALLY EXPOSED PATIENTS AND STAFF. COMMUNITY EDUCATION WE WORK WITH HIGH SCHOOL STUDENTS TO EDUCATE THEM ABOUT HEALTHCARE CAREERS THROUGH JOB FAIRS AT THE SCHOOL AND BY OFFERING JOB SHADOWING OPPORTUNITIES. BROOKVILLE HOSPITAL PROVIDED SHADOWING OPPORTUNITIES FOR HIGH SCHOOL STUDENTS IN A VARIETY OF CLINICAL AND NON-CLINICAL POSITIONS IN 2013. BOARD MEMBER RELATIONSHIPS FORM 990, PART VI, SECTION A, LINE 2 JOHN SUTIKA, TIM PENDLETON, MD AND ROSE CAMPBELL HAVE A BUSINESS RELATIONSHIP. TIM PENDLETON, MD AND TANIS PENDLETON, MD, HAVE A FAMILY RELATIONSHIP. DELEGATED MANAGEMENT DUTIES FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION HAS A MANAGEMENT CONTRACT WITH DUBOIS REGIONAL MEDICAL CENTER (DRMC) IN WHICH DRMC PROVIDES INDIVIDUALS WHO PERFORM DUTIES AS THE CEO AND VP OF PATIENT CARE SERVICES FOR BROOKVILLE. THESE INDIVIDUALS REPORT TO THE BOARD OF THE HOSPITAL. MEMBERS/STOCKHOLDERS FORM 990, PART VI, SECTION A, LINE 6 DUBOIS REGIONAL MEDICAL CENTER (DRMC) IS THE SOLE MEMBER OF BROOKVILLE HOSPITAL. DECISION APPROVALS FORM 990, PART VI, SECTION A, LINE 7A AS THE SOLE MEMBER OF BROOKVILLE HOSPITAL, DRMC'S RESERVED POWERS INCLUDE THE RIGHT TO ELECT THE BOARD OF DIRECTORS OF BROOKVILLE HOSPITAL. CANDIDATES ARE SUBMITTED TO DRMC THROUGH A NOMINATING PROCESS THAT INVOLVES THE APPROVAL OF BROOKVILLE HOSPITAL'S BOARD. AS THE OTHER BODY OF DRMC, PHH HAS THE AUTHORITY TO APPROVE DRMC'S ELECTION OF BROOKVILLE HOSPITAL'S BOARD OF DIRECTORS. DECISION APPROVALS FORM 990, PART VI, SECTION A, LINE 7B AS THE SOLE MEMBER OF BROOKVILLE HOSPITAL, DRMC'S RESERVED POWERS INCLUDE: -APPROVAL OF ALL FUNDAMENTAL TRANSACTIONS; -APPROVAL OF ALL STRATEGIC PLANS, BUDGETS, AND FEASIBILITY PLANS; -APPROVAL OF THE INCURRENCE, RE-FINANCING OR PREPAYMENT OF ALL INDEBTEDNESS IN EXCESS OF $10,000; -WITH SOME EXCEPTIONS, THE APPROVAL OF THE SECURING OF ANY ENCUMBRANCE OF ASSETS; -WITH SOME EXCEPTIONS, APPROVAL OF THE MAKING OF ANY CAPITAL EXPENDITURES OR ANY CAPITAL ADDITIONS OR IMPROVEMENTS GREATER THAN $10,000; -APPROVAL OF ANY AND ALL AMENDMENTS OF THE ARTICLES AND/OR BYLAWS; -APPROVAL OF ANY CHANGE IN MISSION OR DIRECTION; -APPROVAL OF THE ESTABLISHMENT OF, OR TERMINATION OR WITHDRAWAL FROM, ANY SUBSIDIARY, JOINT VENTURE, OR OTHER PARTNERSHIP OR SHARED GOVERNANCE ARRANGEMENT; -APPROVAL OF AGREEMENTS OF $50,000 OR MORE; AND -APPROVAL OF THIRD PARTY PAYOR AGREEMENTS, COLLECTIVE BARGAINING AGREEMENTS AND AGREEMENTS BETWEEN BROOKVILLE HOSPITAL AND DRMC. AS THE OTHER BODY OF DRMC, PHH HAS THE POWER TO REVIEW AND APPROVE ANY ACTION TAKEN BY DRMC IN EXERCISING THE RESERVED POWERS LISTED ABOVE. 990 REVIEW PROCESS FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM BASED ON THE AUDITED FINANCIAL STATEMENTS AND INFORMATION PROVIDED BY THE ACCOUNTING DEPARTMENT OF THE ORGANIZATION. THE FORM 990 IS REVIEWED BY THE CFO AND CEO AND A COPY IS PROVIDED TO THE BOARD MEMBERS WHO HAVE AN OPPORTUNITY TO ASK QUESTIONS BEFORE THE 990 IS FILED. CONFLICT OF INTEREST POLICY FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST STATEMENTS ARE REVIEWED BY THE CEO. ANY BOARD MEMBER WITH A CONFLICT OR POTENTIAL CONFLICT WOULD ABSTAIN FROM VOTING ON ANY MATTER RELATED TO THAT CONFLICT. ADDITIONALLY, THE BOARD MEMBERS ARE GIVEN A QUESTIONNAIRE TO COMPLETE TO ASSIST THE ORGANIZATION IN PROPERLY ANSWERING THE QUESTIONS FOR THE NEW FORM 990. CORPORATE OFFICERS AND KEY EMPLOYEES ARE ALSO REQUIRED TO ANNUALLY DISCLOSE CONFLICTS OF INTEREST. CEO COMPENSATION REVIEW FORM 990, PART VI, SECTION B, LINE 15A THE CEO'S COMPENSATION IS NOT PAID BY BROOKVILLE HOSPITAL AS HIS SERVICES ARE PROVIDED TO THE HOSPITAL AS PART OF THE DUBOIS REGIONAL MEDICAL CENTER (DRMC) MANAGEMENT CONTRACT. DRMC DOES COMPLETE A SALARY REVIEW USING AN INDEPENDENT CONSULTANT AND A COMPENSATION COMMITTEE. THE INDEPENDENT CONSULTANT USES COMPARABILITY DATA IN THE REVIEW AND THE DECISION IS DOCUMENTED IN THE BOARD MINUTES. HIS SALARY IS ULTIMATELY APPROVED BY THE BOARDS OF BOTH DRMC AND BROOKVILLE HOSPITAL. COMPENSATION WAS LAST REVIEWED IN JUNE 2013. OFFICER, KEY EMPLOYEE COMPENSATION REVIEW FORM 990, PART VI, SECTION B, LINE 15B THE BOARD OF DIRECTORS USE AN INDEPENDENT CONSULTANT TO REVIEW THE VP OF FINANCE SALARY. THE INDEPENDENT CONSULTANT USES COMPARABILITY DATA IN THE REVIEW AND THE DECISION IS DOCUMENTED IN THE BOARD MINUTES. THE SALARY IS APPROVED BY THE BOARD OF DIRECTORS. COMPENSATION WAS LAST REVIEWED IN JUNE 2013. DOCUMENT DISCLOSURE FORM 990, PART VI, SECTION C, LINE 19 A FINANCIAL SUMMARY IS PUBLISHED IN THE PAPER EACH YEAR WITH THE ANNUAL REPORT TO THE COMMUNITY. THIS FINANCIAL SUMMARY AND ANNUAL REPORT CAN ALSO BE REVIEWED IN THE HOSPITAL ADMINISTRATIVE OFFICES. THE GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT AVAILABLE TO THE PUBLIC. OTHER FEES FOR SERVICES FORM 990, PART IX, LINE 11G, COLUMN A $2,153,747 PHYSICIAN FEES 1,796,210 OUTSIDE SERVICES 1,232,668 CONTRACT LABOR 50,341 SERVICE CONTRACTS ---------- $5,232,966 TOTAL OTHER FEES FOR SERVICES OTHER CHANGES IN NET ASSETS FORM 990, PART XI, LINE 9 $12,948 CHANGE IN BENEFICIAL INTEREST IN TRUST PRINCIPAL OFFICER FORM 990, HEADING, ITEM F JULIANNE PEER WAS APPOINTED INTERIM PRESIDENT IN AUGUST 2013 AND PRESIDENT IN FEBRUARY 2014. AS SUCH, SHE IS SHOWN AS THE PRINCIPAL OFFICER IN THE HEADING, ITEM F. HOWEVER, DURING THE FISCAL YEAR ENDING JUNE 30, 2013 SHE WAS THE VP OF FINANCE AS REFLECTED IN FORM 990, PART VII. PENN HIGHLANDS HEALTHCARE 100 HOSPITAL AVENUE DUBOIS PA 15801 320345810 HEALTHCARE PA 501(C)(3) 11 A I NA false DUBOIS REGIONAL MEDICAL CENTER 100 HOSPITAL AVENUE DUBOIS PA 15801 251490707 HEALTHCARE PA 501(C)(3) 3 PENN HIGHLND false BROOKCARE INC 100 HOSPITAL ROAD BROOKVILLE PA 15825 251477768 OFFICE SPACE PA NA C CORP 55216 1034186 1.00000 true JOSEPH BEACH TRUST PO BOX 220 INDIANA PA 15701 256171730 TRUST PA NA TRUST 12948 194316 1.00000 true true false true false true false false false false true true false false true true true true false false BROOKCARE INC A/J 97065 FMV