2014-05-14T16:35:18-05:00 2013-06-30 BKD LLP 910 E ST LOUIS 200/PO BOX 1190 SPRINGFIELD MO 658062523 990 2012-07-01 250965579 TITUSVILLE AREA HOSPITAL % JILL NEELY TITU 8148271851 406 WEST OAK STREET Suite TITUSVILLE PA 16354 ANTHONY J NASRALLA 8148271851 2014-04-04 true Brian D Todd 4178658701 2012 2015-11-30 17:44:51Z ANTHONY J NASRALLA 406 WEST OAK STREET TITUSVILLE PA 16354 31875310 false X WWW.TITUSVILLEHOSPITAL.ORG X 1900 PA TITUSVILLE AREA HOSPITAL IS A COMMUNITY BASED, ACUTE CARE HOSPITAL PROVIDING INPATIENT, OUTPATIENT, EMERGENCY AND HOME CARE SERVICES TO MORE THAN 30,000 PEOPLE IN FOUR COUNTIES IN PENNSYLVANIA. 15 11 350 60 1939 939 111640 276891 33149694 30852804 145443 86692 365511 297511 33772288 31513898 5000 9399 0 0 16864274 17189889 0 0 0 15383780 16059321 32253054 33258609 1519234 -1744711 19295236 19814251 14570759 16327300 4724477 3486951 TITUSVILLE AREA HOSPITAL IS COMMITTED TO PROVIDING QUALITY HEALTHCARE SERVICES WITH AN EMPHASIS ON PERSONAL ATTENTION, COMPASSION AND RESPECT. false false 24097800 9399 30852804 TITUSVILLE AREA HOSPITAL IS AN ACUTE CARE RURAL HOSPITAL WITH 1,612 ADMISSIONS, 7,058 PATIENT DAYS, 169 BIRTHS AND 64,016 OUTPATIENT VISITS. 24097800 true true false true false false false false false false true true false false true false false true false false false false false false false false true true false false true false false false false false false false true false false false false false true true true false false true 43 0 true 350 true true true false false false false false false false false false X 15 11 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 35.0 5.0 X X 280324 0 7495 JASON REAGLE 1.0 0.0 X X 0 0 JUDY COCHRAN 1.0 0.0 X 0 0 RICHARD CARR 1.0 1.0 X 0 0 STEPHEN COLEMAN 1.0 1.0 X X 0 0 EDWARD GRIFFIN MD 1.0 40.0 X 0 440975 39075 BRIAN LOS MD 1.0 0.0 X 0 0 SCOTT MCALLISTER MD 1.0 0.0 X 0 0 LYNN PEDENSKY 1.0 1.0 X 0 0 LARRY FLEDDERMAN 1.0 2.0 X 0 0 DONNA POPIESKI 1.0 0.0 X 0 0 ANIL DUTT MD 1.0 40.0 X 0 329796 23258 CHERYL WALKER 1.0 0.0 X 0 0 JAY PERTZ 1.0 0.0 X 0 0 PATRICIA WALKER 1.0 0.0 X 0 0 LEONARD FERREIRA MD 1.0 0.0 X 0 0 THOMAS CHESAR MD 1.0 40.0 X 0 163191 19851 JILL NEELY 35.0 5.0 X 122179 0 19812 JEFF SAINTZ 40.0 0.0 X 119577 0 17603 LINDA HARRIS 40.0 0.0 X 130841 0 8529 MARIO D'ALESSANDRO DO 40.0 0.0 X 263492 0 24654 ARTHUR LEWIS MD 40.0 0.0 X 225180 0 18404 MARY WETHLI MD 40.0 0.0 X 220622 0 21939 SCOTT SMITH 40.0 0.0 X 209351 0 21705 ROCK BAKER 40.0 0.0 X 161729 0 35563 JEFFRY KARNS 40.0 0.0 X 148524 0 21584 1881819 933962 279472 13 false true false CPS INC PHARMACY ADMIN SVCS 516120 CONIFER HEALTH SOLUTIONS BILLING/CODING 400000 MAXIT HEALTHCARE LLC CONSULTING 346308 ASSOCIATED CLINICAL DIAGNOSTIC LAB SVCS 310532 WARREN GENERAL HOSPITAL ONCOLOGY SVCS 157252 8 25000 114076 137815 276891 NET PATIENT SERVICE REVENUE 900099 29056261 29056261 E H R INCENTIVE REVENUE 900099 1564645 1564645 CAFETERIA REVENUE 722513 95235 95235 OTHER INCOME 900099 136663 136663 30852804 31040 31040 0 0 54717 54717 0 54717 54717 407064 10000 318820 42592 88244 -32592 55652 55652 0 0 0 INCOME FROM EQUITY INVESTEE 900099 240855 240855 INCOME FROM INVESTMENTS HELD AT COST 900099 1939 1939 242794 31513898 30852804 1939 382264 X 4399 4399 5000 5000 0 0 1024884 1024884 0 34292 34292 12035585 9392099 2643486 336882 248897 87985 2844959 2037133 807826 913287 672802 240485 0 66016 66016 83000 83000 0 0 0 3663902 1929897 1734005 110317 7679 102638 477018 323357 153661 569076 569076 0 1883329 1506663 376666 39281 32575 6706 0 17460 11710 5750 392430 34258 358172 0 1076111 860888 215223 422208 393962 28246 SUPPLIES 4084898 3589394 495504 BAD DEBT EXPENSE 2967957 2967957 LICENSES, DUES, SUBSCRIPTIONS 140146 44328 95818 MISCELLANEOUS EXPENSE 66172 510 65662 33258609 24097800 9160809 0 0 0 1021683 655227 0 0 5365642 4734686 0 0 0 0 0 0 579980 625484 413155 390499 38925174 31421295 8108337 7503879 0 3580163 3250043 1427828 0 120000 0 0 556396 776485 19295236 19814251 6579372 6732338 0 0 10648 0 0 0 0 0 0 0 1779846 2314544 0 0 6200893 7280418 14570759 16327300 X 1790479 378238 0 0 2933998 3108713 4724477 3486951 19295236 19814251 X -1744711 -77909 585094 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true false OTHER LOBBYING ACTIVITIES SCHEDULE C, PART II-B, LINE 1I A PORTION OF THE ORGANIZATION'S DUES TO HOSPITAL COUNCIL AND AMERICAN HOSPITAL ASSOCIATION ARE USED FOR LOBBYING. 287721 287721 14999307 10526016 4473291 22527460 20242681 2284779 1110686 652598 458088 7503879 INVESTMENT - CHART 1378828 F INVESTMENT - VANTAGE HOLDING 49000 C 1427828 0 EST AMT DUE TO 3RD PTY PYR 910863 DUE TO AFFILIATES 6369555 7280418 27018502 -77909 -4415548 -4493457 31511959 1939 1939 31513898 30290652 30290652 2967957 2967957 33258609 UNCERTAIN TAX POSITION 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. AMOUNTS INCLUDED ON LINE 1 BUT NOT ON FORM 990, PART VIII, LINE 12 SCHEDULE D, PART XI, LINE 2D $(2,967,957) BAD DEBT EXPENSE 174,715 CHANGE IN BENEFICIAL INTEREST (1,622,306) TRANSFER TO AFFILIATES ------------ $(4,415,548) AMOUNTS INCLUDED ON FORM 990, PART VIII, LINE 12, BUT NOT ON LINE 1 SCHEDULE D, PART XI, LINE 4B $ 1,939 INCOME FROM INVESTMENT RECORDED AT COST AMOUNTS INCLUDED ON FORM 990, PART IX, LINE 25, BUT NOT ON LINE 1 SCHEDULE D, PART XII, LINE 4B $ 2,967,957 BAD DEBT EXPENSE true true true X false false true true false false 341627 341627 0.01130 4403646 2892685 1510961 0.04990 4745273 2892685 1852588 0.06120 35367 310 35057 0.00120 9138 9138 0.00030 44505 310 44195 0.00150 4789778 2892995 1896783 0.06270 4399 4399 0.00010 4399 4399 0.00010 false 2967957 480809 12198957 13859478 -1660521 X true false 1 1 TITUSVILLE AREA HOSPITAL

406 WEST OAK STREET TITUSVILLE PA 16354

X X X TITUSVILLE AREA HOSPITAL 1 true X X X 11 true true true X X X X true false true true 150. false true X true true X X X true false X X true X false false 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 ($33,258,609), WAS REDUCED BY BAD DEBT EXPENSE ($2,967,957). COSTING METHODOLOGY SCHEDULE H, PART I, LINE 7 THE COST TO CHARGE RATIO CALCULATED ON IRS WORKSHEET 2 WAS USED IN THE CALCULATION OF COST ON IRS WORKSHEETS 1, 3 AND 6. COMMUNITY SUPPORT SCHEDULE H, PART II, LINE 3, COLUMN C COMMUNITY SUPPORT DONATIONS ARE MADE TO VARIOUS ORGANIZATIONS SUCH AS THE YMCA, YWCA, BIG BROTHERS/SISTERS, MARCH OF DIMES, AMERICAN CANCER SOCIETY, AND TITUSVILLE AREA SENIOR CITIZENS. THESE DONATIONS HELP TO SUPPORT ORGANIZATIONS THAT PROMOTE HEALTHY ACTIVITY AND LIVING CHOICES. SOME OF THE DONATIONS ALSO SUPPORT RESEARCH FOR CURES TO CANCER AND BIRTH DEFECTS. BAD DEBT EXPENSE SCHEDULE H, PART III, SECTION A, LINES 2, 3 & 4 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. THE ORGANIZATION CALCULATED BAD DEBT USING THE AMOUNTS CALCULATED IN THE ORGANIZATION'S 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 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. COMMUNITY BENEFIT RATIONALE SCHEDULE H, PART III, SECTION B, LINE 8 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. COMMUNITY INPUT SCHEDULE H, PART V, SECTION B, LINE 3 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 TELEPHONY. THE ORGANIZATIONS RECEIVED 734 COMPLETED SURVEYS. CHNA REPORT SCHEDULE H, PART V, SECTION B, LINE 4 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. IMPLEMENTATION STRATEGY SCHEDULE H, PART V, SECTION B, LINE 6 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. WHILE TITUSVILLE AREA HOSPITAL HAS TAKEN ACTION WITH RESPECT TO THE NEEDS IDENTIFIED IN ITS CHNA AND HAS REVIEWED THESE NEEDS AND THE RESPONSES TO THE NEEDS WITH ITS COMMUNITY HEALTH COMMITTEE, THE BOARD NOR THE COMMITTEE DID NOT FORMALLY APPROVE THE IMPLEMENTATION STRATEGY. THE ORGANIZATION'S LEADERSHIP TEAM JUST DISCOVERED THIS IN MAY, 2014 WHEN COMPLETING THE JUNE 30, 2013 FORM 990. MAXIMUM AMOUNTS THAT CAN BE CHARGED TO FAP-ELIGIBLE INDIVIDUALS SCHEDULE H, PART V, SECTION B, LINE 20D 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. NEEDS ASSESSMENT SCHEDULE H, PART VI, LINE 2 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. PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE SCHEDULE H, PART VI, LINE 3 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. COMMUNITY INFORMATION SCHEDULE H, PART VI, LINE 4 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 13% OF RESIDENTS LIVE IN POVERTY. PROMOTION OF COMMUNITY HEALTH SCHEDULE H, PART VI, LINE 5 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. AFFILIATED HEALTH CARE SYSTEM SCHEDULE H, PART VI, LINE 6 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 210074 0 67564 0 2686 0 5253 0 2242 0 287819 0 0 0 EDWARD GRIFFIN MD 0 438995 0 0 0 1980 0 23250 0 15825 0 480050 0 0 ANIL DUTT MD 0 329106 0 0 0 690 0 6250 0 17008 0 353054 0 0 MARIO D'ALESSANDRO DO 261512 0 0 0 1980 0 6250 0 18404 0 288146 0 0 0 ARTHUR LEWIS MD 224490 0 0 0 690 0 0 0 18404 0 243584 0 0 0 MARY WETHLI MD 219932 0 0 0 690 0 5550 0 16389 0 242561 0 0 0 SCOTT SMITH 183266 0 24105 0 1980 0 4630 0 17075 0 231056 0 0 0 ROCK BAKER 147121 0 13715 0 893 0 15922 0 19641 0 197292 0 0 0 JEFFRY KARNS 134498 0 13715 0 311 0 3431 0 18153 0 170108 0 0 0 THOMAS CHESAR MD 0 138778 0 24000 0 413 0 0 0 19851 0 183042 0 0 CONTINGENT COMPENSATION FORM 990, SCHEDULE J, PART I, LINE 6A 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. NON-FIXED PAYMENTS FORM 990, SCHEDULE J, PART I, LINE 7 CRNA RECEIVES ANNUAL BONUS BASED ON PERCENTAGE OF PAY. JOSEPH DUNN MD STEP-FATHER OF J. REAGLE 34292 NONEMPLOYEE COMPENSATION false FAMILY/BUSINESS RELATIONSHIPS FORM 990, PART VI, SECTION A, LINE 2 STEPHEN COLEMAN AND RICHARD CARR HAVE A BUSINESS RELATIONSHIP. CLASSES OF MEMBERS OR STOCKHOLDERS FORM 990, PART VI, SECTION A, LINE 6 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. POWER TO ELECT MEMBERS OR STOCKHOLDERS FORM 990, PART VI, SECTION A, LINE 7A DIRECTORS SHALL BE APPOINTED BY THE BOARD OF DIRECTORS OF THE CORPORATE MEMBER (TITUSVILLE AREA HEALTH CENTER, INC). GOVERNANCE DECISIONS FORM 990, PART VI, SECTION A, LINE 7B 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. PROCESS TO REVIEW FORM 990 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 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. PROCESS FOR MONITORING COMPLIANCE WITH CONFLICT OF INTEREST POLICY FORM 990, PART VI, SECTION B, LINE 12C 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. REVIEW OF CEO AND OTHER OFFICERS COMPENSATION FORM 990, PART VI, SECTION B, LINES 15A & B 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. GOVERNING DOCUMENTS FORM 990, PART VI, SECTION C, LINE 19 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. OTHER FEES FOR SERVICES FORM 990, PART IX, LINE 11G $ 3,225,576 PURCHASED SERVICES 333,554 PROFESSIONAL MEDICAL FEES 99,828 PHYSICIAN RECRUITING OUTSOURCING 3,543 COLLECTION EXPENSE 1,401 OTHER FEES ------------ $ 3,663,902 OTHER CHANGES IN NET ASSETS FORM 990, SECTION XI, LINE 9 $ 2,034,624 PRIOR PERIOD ADJUSTMENT (1,622,306) TRANSFER TO AFFILIATES 174,715 CHANGE IN BENEFICIAL INTEREST (1,939) INCOME FROM INVESTMENT RECORDED AT COST ------------ $ 585,094 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) 11A I HEALTH CNTR false PERPETUAL TRUST TRUST PA TAH TRUST 2369 250702 1.00000 true PERPETUAL TRUST TRUST PA TAH TRUST 597 63189 1.00000 true PERPETUAL TRUST TRUST PA TAH TRUST 245 25953 1.00000 true false false true false true false false false false true false false true true true true true true true