2013-05-15T08:56:31-05:00 2012-06-30 BKD LLP 910 E ST LOUIS 200/PO BOX 1190 SPRINGFIELD MO 658062523 990 2011-07-01 250984595 BROOKVILLE HOSPITAL % JULIANNE PEER BROO 8148492312 100 HOSPITAL ROAD BROOKVILLE PA 15825 JULIANNE PEER 2013-05-03 true Brian D Todd 4178658701 2011 2016-02-24 21:20:13Z ROSE CAMPBELL 100 HOSPITAL ROAD BROOKVILLE PA 15825 29090526 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 2 294 47 0 0 272249 836307 28536712 28023673 49191 177576 34529 38901 28892681 29076457 3210 3435 0 0 12285432 12294032 0 0 0 15425266 15567871 27713908 27865338 1178773 1211119 23573285 21440417 13464824 10107678 10108461 11332739 TO PROVIDE QUALITY HEALTHCARE SERVICES TO THE COMMUNITIES THAT WE SERVE IN A COST-EFFECTIVE MANNER. SEE SCHEDULE O FOR ADDITIONAL INFORMATION. false false 19293266 3435 22138702 BROOKVILLE HOSPITAL PROVIDES A WIDE VARIETY OF OUTPATIENT SERVICES TO THE COMMUNITY. WE HAVE A PHYSICIAN STAFFED 24 HOUR EMERGENCY DEPARTMENT THAT PROVIDED OVER 9,800 VISITS THIS YEAR AND A FAMILY PRACTICE CLINIC THAT HAD OVER 6,500 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 OVER 1,840 SURGERIES AND OUR HOME HEALTH AGENCY PROVIDED OVER 5,900 VISITS. SEE SCHEDULE O FOR ADDITIONAL INFORMATION. 5128590 5884971 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. 24421856 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 true true false false false false false true true true false false true 43 0 true 294 true false false false false false true true false false false false X 9 2 true true true false true true true true true false false true true true true true true true true false PA X JULIANNE PEER 8148491408 100 HOSPITAL ROAD BROOKVILLE PA 15825 X JOHN SUTIKA 40.0 X X 0 315365 10386 L GENE HOAK 3.0 X X 0 0 RONALD KING 3.0 X X 0 0 TROY HARPER 3.0 X X 0 0 TIMOTHY PENDLETON MD 1.0 X 0 364876 14904 RICHARD PFINGSTLER 3.0 X X 0 0 RAYMOND GRAECA 1.0 X 0 674083 23685 SCOTT FORADORA 3.0 X 0 0 ROSE CAMPBELL 40.0 X X 146168 0 5752 EDWARD S NASUTI 1.0 X 0 0 JULIANNE PEER 40.0 X 123407 14800 GARY MACOICE 40.0 X 0 270203 21454 SHANA STEVENS 40.0 X 138187 4035 ALAN CORNMAN 40.0 X 137472 0 23320 PAUL HARVEY MD 40.0 X 156451 0 18379 EMERSON TURNBULL 40.0 X 157843 0 23766 TANIS PENDLETON MD 40.0 X 115388 6003 974916 1624527 166484 7 false true false DUBOIS REGIONAL MEDICAL CENTER HOSPITAL MANAGEMENT 2072303 NORTHWEST EMERGENCY PHYSICIANS EMERGENCY PHYSICIANS 971424 NORTHFORK REHABILITATION PHYSICAL THERAPY 797123 MEDICUS HEALTHCARE SOLUTIONS PHYSICIAN SERVICES 442439 ASSOCIATED CLINICAL LABORATORIES LAB TESTING 410498 14 28118 768940 39249 836307 NET PATIENT SERVICE REVENUE 621110 27066900 27066900 EHR REVENUE 621110 700000 700000 MEAL TICKETS 722210 74053 74053 PHARMACY REVENUE 621110 109698 109698 OTHER REVENUE 900099 73022 73022 28023673 175745 175745 0 0 35333 35333 35333 35333 1831 0 1831 1831 1831 11281 28118 10144 1137 1137 6356 3925 2431 2431 0 0 29076457 28023673 216477 3435 3435 0 0 0 290127 290127 40548 40548 0 9278946 8751669 527277 279348 262113 17235 1670939 1534696 136243 734124 669299 64825 2072303 1645124 427179 77342 77342 128886 128886 0 0 0 4897856 4477669 420187 59328 59328 892431 558477 333954 20818 16508 4310 0 580247 456772 123475 64926 59161 5765 0 22974 1193 21781 259325 205868 53457 0 1835294 1456972 378322 302297 20872 281425 BAD DEBT 1804457 1804457 MEDICAL SUPPLIES & DRUGS 2447872 2447872 LICENSES, DUES, SUBSCRIPTIONS 90951 39199 51752 RECRUITING & RETENTION 10564 10500 64 27865338 24421856 3443482 0 46079 617446 5583658 5069442 0 0 3811635 4219696 22563 71630 60468 0 0 0 480016 526257 462187 491932 39924698 31614773 9121761 8309925 0 0 17607 22761 0 0 0 0 3967311 2111328 23573285 21440417 5262847 3316057 0 0 658945 51011 0 0 0 0 0 0 7543032 6451432 0 0 0 289178 13464824 10107678 X 9835803 11047744 104449 103627 168209 181368 10108461 11332739 23573285 21440417 X 1211119 13159 X false true true X false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false true 17500 false true 5467 22967 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. OTHER LOBBYING ACTIVITIES SCHEDULE C, PART II-B, LINE 1(I) THE ORGANIZATION PAYS DUES TO THE HOSPITAL COUNCIL AND TO THE HOSPITAL AND HEALTH SYSTEM ASSOCIATION OF PA (HAP). A PORTION OF THESE DUES ARE USED FOR LOBBYING ACTIVITIES. 205546 205546 8118573 6063806 2054767 204286 190826 13460 29688203 24123883 5564320 1708090 1236258 471832 8309925 BEN INT IN PERPETUAL TRUST 181368 OTHER RECEIVABLES 388874 INTEREST RECEIVABLE 48688 OTHER ASSETS 12991 DUE FROM AFFILIATE 1479407 2111328 0 EST AMT DUE TO THIRD PARTIES 289178 289178 29076457 27865338 1211119 13159 13159 1224278 27299228 -1791298 -1791298 29090526 -14069 -14069 29076457 26074950 14069 14069 26060881 1804457 1804457 27865338 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 RECONCILING CHANGE IN NET ASSETS SCHEDULE D, PART XI, LINE 8 $13,159 CHANGE IN BENEFICIAL INTEREST IN TRUST OTHER REVENUE INCLUDED ON LINE 1, BUT NOT ON FORM 990, PART VIII, LINE 12 SCHEDULE D, PART XII, LINE 2D $(1,804,457) BAD DEBT EXPENSE 13,159 CHANGE IN BENEFICIAL INTEREST IN TRUST ---------- $(1,791,298) TOTAL OTHER REVENUE INCLUDE ON LINE 1 BUT NOT ON FORM 990 OTHER REVENUE INCLUDED ON FORM 990, PART VIII, LINE 12, BUT NOT ON LINE 1 SCHEDULE D, PART XII, LINE 4B $(14,069) SPECIAL EVENT AND GAMING EXPENSES OTHER EXPENSE INCLUDED ON LINE 1, BUT NOT ON FORM 990, PART IX, LINE 25 SCHEDULE D, PART XIII, LINE 2D $14,069 SPECIAL EVENT AND GAMING EXPENSES OTHER EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25 BUT NOT ON LINE 1 SCHEDULE D, PART XIII, LINE 4B $1,804,457 BAD DEBT EXPENSE GOLF OUTING 21250 18458 2792 2220 2505 1537 1-100 EVENT 18149 9660 8489 445 3060 377 0 39399 28118 11281 2220 445 5565 1914 10144 1137 true true X true X false true true true false false 270270 0 270270 0.01040 2251023 1526927 724096 0.02780 150736 66789 83947 0.00320 2672029 1593716 1078313 0.04140 29922 7653 22269 0.00090 3435 3435 0.00010 33357 7653 25704 0.00100 2705386 1601369 1104017 0.04240 true 1804457 254428 11749735 12482522 -732787 X true true 1 1 BROOKVILLE HOSPITAL

100 HOSPITAL ROAD BROOKVILLE PA 15825

X X X X BROOKVILLE HOSPITAL 1 true true 200. false true X X X X true true true false X X X X true X false false 4 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 PERCENT OF TOTAL EXPENSE SCHEDULE H, PART I, LINE 7 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. 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 14.1 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. CRITERIA FOR DISCOUNTED CARE SCHEDULE H, PART V, SECTION B, LINE 10 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. CHARGES FOR MEDICAL CARE SCHEDULE H, PART V, SECTION B, LINE 19D THE ORGANIZATION DETERMINED THE MAXIMUM AMOUNTS THAT CAN BE CHARGED TO FAP-ELIGIBLE INDIVIDUALS USING THE HIGHEST COMMERCIAL PAYOR CONTRACT. 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. OTHER INFORMATION: 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 254308 0 53054 0 8003 0 9569 0 817 0 325751 0 0 ALAN CORNMAN 137441 0 0 0 31 0 3877 0 19443 0 160792 0 0 0 PAUL HARVEY MD 156394 0 0 0 57 0 4180 0 14199 0 174830 0 0 0 EMERSON TURNBULL 157798 0 0 0 45 0 4323 0 19443 0 181609 0 0 0 TIMOTHY PENDLETON MD 0 364400 0 0 0 476 0 9800 0 5104 0 379780 0 0 RAYMOND GRAECA 0 487835 0 115860 0 70388 0 9800 0 13885 0 697768 0 0 ROSE CAMPBELL 123386 0 17782 0 5000 0 4935 0 817 0 151920 0 0 0 GARY MACIOCE 0 239238 0 29702 0 1263 0 11255 0 10199 0 291657 0 0 NONQUALIFIED RETIREMENT PLAN SCHEDULE J, PART I, LINE 4B RAYMOND GRAECA PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN THROUGH THE RELATED ORGANIZATIONS, DUBOIS REGIONAL MEDICAL CENTER AND PENN HIGHLANDS HEALTHCARE. PAYMENTS WERE $37,278 AND $16,922, RESPECTIVELY. NON-FIXED PAYMENTS SCHEDULE J, PART I, LINE 7 A PORTION OF ROSE CAMPBELLS BONUS WAS BASED ON BOARD DISCRETION, WHILE THE MAJORITY WAS BASED ON FORMULAS USING INFORMATION BASED ON FINANCE, GROWTH, QUALITY/SAFETY, PEOPLE, AND SERVICE. TANIS PENDLETON MD X 185000 34553 false true true TANIS PENDLETON MD X 45000 37077 false true true 71630 LINDA GRINDER SISTER OF RON KING 40548 EMPLOYEE OF HOSPITAL false BROOKCARE INC SEE PART V 102673 SEE PART V false BUSINESS TRANSACTIONS WITH INTERESTED PERSONS SCHEDULE L, PART IV, LINE 3 BOARD MEMBERS JOHN SUTIKA, RON KING, TROY HARPER, L. GENE HOAK, RICHARD PFINGSTLER, AND ROSE CAMPBELL ARE ALSO BOARD MEMBERS OF BROOKCARE, INC., A RELATED, CONTROLLED TAXABLE ENTITY. TRANSACTIONS INCLUDE RENT PAID TO BROOKCARE OF $102,673. THE ORGANIZATIONS ALSO SHARE SOME OTHER SERVICES, SUCH AS MAINTENANCE AND ACCOUNTING, BUT NO DOLLARS ARE EXCHANGED. BOARD MEMBER INDEPENDENCE FORM 990, PART I, LINE 4 AND PART VI, SECTION A, LINE 1B BOARD MEMBERS JOHN SUTIKA, RON KING, TROY HARPER, L. GENE HOAK, RICHARD PFINGSTLER AND ROSE CAMPBELL ARE BOARD MEMBERS OF BROOKCARE, INC., A RELATED, CONTROLLED TAXABLE ENTITY. JOHN SUTIKA, TROY HARPER, L. GENE HOAK, RICHARD PFINGSTLER AND ROSE CAMPBELL ARE CONSIDERED NON-INDEPENDENT SOLELY BECAUSE OF THIS RELATIONSHIP. SEE SCHEDULE L FOR DETAILS. 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 CARE MEDICAL ASSISTANCE/MA HMO SHORTFALL THE MEDICAL ASSISTANCE SHORTFALL IS THE DIFFERENCE BETWEEN THE COST TO PROVIDE HEALTH CARE TO MA PATIENTS AND WHAT THE HOSPITAL GETS PAID. FOR THE FISCAL YEAR ENDED JUNE 30, 2012, THIS SHORTFALL IS BEING PARTIALLY COMPENSATED BY THE STATE AND FEDERAL GOVERNMENT. UNCOMPENSATED CHARITY CARE UNCOMPENSATED CHARITY CARE CHARGES WRITTEN OFF WERE $651,566. 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 $1,804,457 IN FY 2012. CHARITY CARE SERVICE THE HOSPITAL OWNS AND OPERATES THE ALLEGHENY HEALTH CENTER, A RURAL HEALTH CLINIC THAT IS AVAILABLE TO THE COMMUNITY. CHARITY CARE IS OFFERED TO PATIENTS OF THE CLINIC. 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 2012. BOARD MEMBER RELATIONSHIPS FORM 990, PART VI, SECTION A, LINE 2 RAY GRAECA, 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. CHANGES TO GOVERNING DOCUMENTS FORM 990, PART VI, SECTION A, LINE 4 ON OCTOBER 1, 2011, BROOKVILLE HOSPITAL AMENDED ITS BYLAWS TO REFLECT THE CREATION OF A NEW PARENT ENTITY FOR BROOKVILLE HOSPITAL'S SOLE MEMBER, DUBOIS REGIONAL MEDICAL CENTER ("DRMC"). PENN HIGHLANDS HEALTHCARE, A PENNSYLVANIA NONPROFIT CORPORATION ("PHH") BECAME THE OTHER BODY OF DRMC AS SUCH TERM IS DEFINED IN SECTION 5103 OF THE PENNSYLVANIA NONPROFIT CORPORATION LAW OF 1988, AS AMENDED, AND NOW SERVES AS THE PARENT CORPORATION OF THE "PENN HIGHLANDS HEALTHCARE" SYSTEM. DRMC AND BROOKVILLE HOSPITAL GRANTED PHH THE AUTHORITY TO APPROVE ACTIONS TAKEN BY DRMC IN EXERCISING ITS RESERVED POWERS OVER BROOKVILLE HOSPITAL. OTHER AMENDMENTS TO BROOKVILLE HOSPITAL'S BYLAWS INCLUDE: 1) NEW PROVISIONS WHICH STATE THAT BROOKVILLE HOSPITAL IS SUBJECT TO A SYSTEM-WIDE CONFLICT OF INTEREST POLICY AND PASTORAL CARE PROGRAM TO BE DEVELOPED, IMPLEMENTED AND OVERSEEN BY PHH, 2) A NEW PROVISION THAT THE AUTHORITY OF BROOKVILLE HOSPITAL'S FINANCE/AUDIT AND COMPLIANCE COMMITTEE AND THE DEVELOPMENT COMMITTEE ARE SUBJECT TO THE OVERSIGHT OF DRMC'S FINANCE/AUDIT AND COMPLIANCE COMMITTEE, AND 3) A NEW PROVISION THAT THE AUTHORITY OF BROOKVILLE HOSPITAL'S QUALITY OVERSIGHT COMMITTEE IS SUBJECT TO DRMC'S PROFESSIONAL RELATIONS AND QUALITY OVERSIGHT COMMITTEE. 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 2012. 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 2012. 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. RELATED HOURS FORM 990, PART VII RAYMOND GRAECA, JOHN SUTIKA, AND TIMOTHY PENDLETON, MD, ARE EMPLOYEES OF DRMC AND WORK APRROXIMATELY 40 HOURS PER WEEK FOR THE ORGANIZATION. OTHER CHANGES IN NET ASSETS FORM 990, PART XI, LINE 5 $13,159 CHANGE IN BENEFICIAL INTEREST IN TRUST PENN HIGHLANDS HEALTHCARE 100 HOSPITAL AVENUE DUBOIS PA 15801 320345810 HEALTHCARE PA 501(C)(3) 11 A I N/A 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 -63292 940049 1.00000 JOSEPH BEACH TRUST PO BOX 220 INDIANA PA 15701 256171730 TRUST PA NA TRUST 13159 181368 1.00000 false false false false true false false false true true false false true true true true false false BROOKCARE INC J 102673 FMV