FAMILY CARE CENTERS INC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
FAMILY CARE CENTERS INC (EIN 23-2349341)
Tax period
2011-07-01 to 2012-06-30
Filed
2013-05-13
IRS object ID
201341339349301349
Schema version
2011v1.5
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

FieldValueIRS element (for citing)
Timestamp2013-05-13T16:37:59-05:00Timestamp
Tax Period End Date2012-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN232932984EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1PARENTEBEARD LLCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line11650 MARKET STREET SUITE 4500AddressLine1
CityPHILADELPHIACity
StatePAState
ZIP Code19103ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN232349341EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1FAMILY CARE CENTERS INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlFAMINameControl
Phone5704214000Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1206 EAST BROWN STREETAddressLine1
CityEAST STROUDSBURGCity
StatePAState
ZIP Code18301ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameMICHAEL A WILKName
TitleSVP FINANCE/CFOTitle
Phone5704214000Phone
Date Signed2013-05-09DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameJULIUS GREEN CPAName
PTINP00350393PTIN
Phone2159720701Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonKATHLEEN KUCKNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1206 EAST BROWN STREETAddressLine1
CityEAST STROUDSBURGCity
StatePAState
ZIP Code18301ZIPCode
FieldValueIRS element (for citing)
Gross Receipts25305047GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.POCONOHEALTHSYSTEM.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1985YearFormation
State Legal DomicilePAStateLegalDomicile
Activity Or Mission DescriptionTO PREVENT ILLNESS, PROMOTE WELLNESS AND RESTORE HEALTH IN THE POCONO AREA.ActivityOrMissionDescription
Nbr Voting Members Governing Body6NbrVotingMembersGoverningBody
Nbr Independent Voting Members3NbrIndependentVotingMembers
Total Nbr Employees162TotalNbrEmployees
Total Nbr Volunteers3TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year4158391ContributionsGrantsPriorYear
Contributions Grants Current Year7450984ContributionsGrantsCurrentYear
Program Service Revenue Prior Year13073698ProgramServiceRevenuePriorYear
Program Service Revenue CY17853970ProgramServiceRevenueCY
Investment Income Prior Year5410InvestmentIncomePriorYear
Investment Income Current Year93InvestmentIncomeCurrentYear
Other Revenue Prior Year0OtherRevenuePriorYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year17237499TotalRevenuePriorYear
Total Revenue Current Year25305047TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year11543845SalariesEtcPriorYear
Salaries Etc Current Year19311666SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year6555930OtherExpensePriorYear
Other Expenses Current Year5618741OtherExpensesCurrentYear
Total Expenses Prior Year18099775TotalExpensesPriorYear
Total Expenses Current Year24930407TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-862276RevenuesLessExpensesPriorYear
Revenues Less Expenses CY374640RevenuesLessExpensesCY
Total Assets BOY4183650TotalAssetsBOY
Total Assets EOY5019053TotalAssetsEOY
Total Liabilities BOY1282398TotalLiabilitiesBOY
Total Liabilities EOY1743161TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY2901252NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY3275892NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionOUR MISSION IS WHO WE ARE AND WHAT WE DO: TO PROVIDE WORLD CLASS CARE CLOSE TO HOME. OUR VISION IS WHAT WE AIM FOR TO BEST SERVE OUR COMMUNITY: TO BUILD A HEALTHIER COMMUNITY.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense23063238Expense
Revenue17853970Revenue
DescriptionTHE ORGANIZATION OPERATES SEVERAL PHYSICIAN PRACTICES, INCLUDING FAMILY MEDICINE, HEMATOLOGY AND ONCOLOGY, INTERNAL MEDICINE, AND OBSTETRICS AND GYNECOLOGY. ALSO, THE ORGANIZATION PROVIDES PHYSICIAN PRACTICE SUPPORT SERVICES INCLUDING: BILLING, INFORMATION TECHNOLOGY, AND TELECOMMUNICATIONS. IN ADDITION, THE ORGANIZATION HAS ENHANCED THE OUTPATIENT SERVICES AVAILABLE TO PERSONS IN THE AREA, INCLUDING SERVICES TO THE INDIGENT AND UNDERINSURED. THE ORGANIZATION PROVIDES SERVICES TO THE SURROUNDING AREA REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE OR ABILITY TO PAY.THE ORGANIZATION AIMS TO PROVIDE EXCELLENT QUALITY CARE TO OUR DIVERSE AND GROWING COMMUNITY AND STILL PROVIDES FOR NEEDED CAPITAL FOR THE FUTURE. ALL RESOURCES AND PROGRAM SERVICE EXPENSES ARE UTILIZED TO OFFER OUR PATIENTS QUALITY CARE THROUGH MULTIPLE SERVICE LINES.THESE SERVICES INCLUDE, BUT ARE NOT LIMITED TO: FAMILY PRACTICE, OBSTETRICS AND GYNECOLOGY, DIAGNOSTIC TESTING, OCCUPATIONAL MEDICINE, ONCOLOGY, ANESTHESIOLOGY SERVICES, CARDIOLOGY SERVICES AND PULMONARY CARE. THE INTERNAL MEDICINE TEAM PAVES THE WAY IN PROVIDING SPECIALIZED CARE TO ADULT PATIENTS. AS PART OF THE POCONO HEALTH SYSTEM, FAMILY CARE CENTERS OFFERS THE FINEST PHYSICIANS AND TECHNOLOGY TO THE AREA AND CONNECTS THEM TO THE POCONO MEDICAL CENTER WHEN A GREAT DEGREE OF SERVICE IS REQUIRED.FAMILY CARE CENTERS CONSTANTLY ASSESSES AND IMPROVES, WHEN POSSIBLE, EQUIPMENT USED, QUALITY REVIEW MEASURER, AND SCHEDULING CONSIDERATIONS IN ORDER TO MEET OR EXCEED THE STANDARD OF CARE EXPECTED FOR THESE SERVICES. TO FACILITATE CARE, MANY OF OUR PRACTICES OFFER MULTIPLE SITES AND EXTENDED OFFICE HOURS. OUR FACILITIES ARE LOCATED IN AREAS THAT ARE CONSIDERED UNDERSERVED WITHIN THE COMMUNITY. CARE IS PROVIDED FOR BOTH PREVENTATIVE SERVICES AND ACUTE AND CHRONIC MEDICAL CONDITIONS.THE POCONO MEDICAL CENTER PHYSICIAN ASSOCIATES HAS SIX PRACTICES, THEIR VISITS INCLUDED THE FOLLOWING:PMCPA - HEMATOLOGY AND ONCOLOGY - 14,689PMC - HOSPITALISTS - 29,625OB/GYN - 24,436INTERNAL MEDICINE - 7,318FAMILY MEDICINE - WEST END - 6,364MOUNTAIN FAMILY CARE CENTERS - 5,432CARDIOLOGY - 9,855PEDIATRIC VISITS - 2,431PULMONARY CARE VISITS - 11,723TOTAL VISITS FOR FCC PRACTICES - 111,873Description
Total Program Service Expense23063238TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities0ReportOtherLiabilities
Report Fin48 Footnote0ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With10969NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees162NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members6NbrVotingGoverningBodyMembers
Number Independent Voting Members3NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledPAStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1MICHAEL A WILK SVP FINANCECFOBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number5704204912TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1206 EAST BROWN STREETAddressLine1
CityEAST STROUDSBURGCity
StatePAState
ZIP Code18301ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (12 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployee
HORACE COLE
CHAIRMAN1.00XX000
R DOUGLAS OLMSTEAD
VICE CHAIRMAN1.00XX000
SUZANNE VIECHNICKI
SECRETARY/TREASURER1.00XX000
KATHLEEN KUCK
PRESIDENT/CEO1.00XX0741805339624
CHARLES HERMAN MD
DIRECTOR1.00X056092523272
CHRISTOPHER POMRINK MD
DIRECTOR/PHYSICIAN40.00X288195019301
MICHAEL WILK
SVP FINANCE/CFO1.00X038341865958
WILLIAM RYAN
PHYSICIAN40.00436914060697X
GERVIAS CHARLES
PHYSICIAN40.00379759024121X
OLUNTUNDE ODEYEMI
PHYSICIAN40.00376761022147X
ROY KEDEM
PHYSICIAN40.00311804023875X
JOSE BORDAS
PHYSICIAN40.00292830031161X
FieldValueIRS element (for citing)
Total Reportable Comp From Org2086263TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs1686148TotalReportableCompFrmRltdOrgs
Total Other Compensation610156TotalOtherCompensation
Number Individuals GT100 K40NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
WEATHERBY LOCUMS
PO BOX 97263DALLASTX75397LOCUM PHYSICIANS291147
SPREAD EAGLE
200 PLAZA COURT SUITE AEAST STROUDSBURGPA18301CONSTRUCTION211003
COMP HEALTH ASSOCIATION
PO BOX 972651DALLASTX75397LOCUM PHYSICIANS170747
LOCUMTENENSCOM
PO BOX 405547ATLANTAGA30353LOCUM PHYSICIANS146352
LEHIGH VALLEY PHYSICIAN GROUP
PO BOX 1754ALLENTOWNPA18105ULTRASOUND102015
FieldValueIRS element (for citing)
Number Of Contractors GT100 K5NumberOfContractorsGT100K
Related Organizations7450984RelatedOrganizations
Total Contributions7450984TotalContributions

Program Service Revenue ProgramServiceRevenue (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
PATIENT REVENUE6214001467426514674265
MSO BILLING REVENUE54190015937861593786
OTHER PROGRAM SERVICES62140015859191585919
FieldValueIRS element (for citing)
Total Program Service Revenue17853970TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column93TotalRevenueColumn
Exclusion$93ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column25305047TotalRevenueColumn
Related Or Exempt Function Income17853970RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$93ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total351930Total
Program Services351930ProgramServices

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total15232650Total
Program Services14289766ProgramServices
Management And General942884ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total648066Total
Program Services612788ProgramServices
Management And General35278ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total2271707Total
Program Services1913227ProgramServices
Management And General358480ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total807313Total
Program Services756033ProgramServices
Management And General51280ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total3492Total
Management And General3492ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total887204Total
Program Services702278ProgramServices
Management And General184926ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total2123Total
Program Services2123ProgramServices

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total483439Total
Program Services403472ProgramServices
Management And General79967ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total6510Total
Program Services6510ProgramServices

Occupancy Occupancy

FieldValueIRS element (for citing)
Total964313Total
Program Services883476ProgramServices
Management And General80837ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total82473Total
Program Services81555ProgramServices
Management And General918ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total433139Total
Program Services312528ProgramServices
Management And General120611ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total192112Total
Program Services192112ProgramServices

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
BAD DEBT18168991816899
MEDICAL SUPPLIES/DRUGS67110267107230
LICENSES/DUES/SUBSCRIPT75832672938539
MISCELLANEOUS EXPENSE103176-73

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total24930407Total
Program Services23063238ProgramServices
Management And General1867169ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
EOY870EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY1462887BOY
EOY1300349EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY1184855BOY
EOY1921561EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY133874BOY
EOY91346EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY71817BOY
EOY131163EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis4002991LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec2518853LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY1214901BOY
EOY1484138EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY115316BOY
EOY89626EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY4183650BOY
EOY5019053EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY1282398BOY
EOY1743161EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY1282398BOY
EOY1743161EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY2901252BOY
EOY3275892EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY2901252BOY
EOY3275892EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY4183650BOY
EOY5019053EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses374640ReconcilationRevenueExpenses
Reconcilation Other Changes0ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis557320OtherCostOrOtherBasis
Depreciation139855Depreciation
Book Value417465BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis3445671OtherCostOrOtherBasis
Depreciation2378998Depreciation
Book Value1066673BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings1484138TotalOfBookValueLandBuildings
Total Revenue25305047TotalRevenue
Total Expenses24930407TotalExpenses
Excess Or Deficit For Year374640ExcessOrDeficitForYear
Excess Or Deficit Per FS374640ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt23488151TotRevenueEtcAuditedFinclStmt
Other Revenues-1816896OtherRevenues
Revenue Not Rptd F990-1816896RevenueNotRptdF990
Revenue Subtotal25305047RevenueSubtotal
Revenue Not Rptd On Fin Stmt0RevenueNotRptdOnFinStmt
Total Revenue Per Form99025305047TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt23113511TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal23113511ExpensesSubtotal
Other Expenses Not Included1816896OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt1816896ExpensesNotRptdOnFinStmt
Total Expenses Per Form99024930407TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (3 entries)

IdentifierIdentifierExplanationExplanation
PART XII, LINE 2D - OTHER ADJUSTMENTS:PROVISION FOR UNCOLLECTIBLE ACCOUNTS -1,816,896.
PART XIII, LINE 4B - OTHER ADJUSTMENTS:PROVISION FOR UNCOLLECTIBLE ACCOUNTS 1,816,896.
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.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan1SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments1AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (9 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
KATHLEEN KUCK
0430119013724901744370326151013473010814290164673
CHARLES HERMAN MD
037991501810100007700015572058419700
CHRISTOPHER POMRINK MD
23745005074500046230146780307496000
MICHAEL WILK
02857760404280572140494500165080449376048364
WILLIAM RYAN
385541051373000442500164470497611000
GERVIAS CHARLES
34020003955900074100167110403880000
OLUNTUNDE ODEYEMI
33892003784100065750155720398908000
ROY KEDEM
28120003060400016150077250335679000
JOSE BORDAS
205812087018000144500167110323991000

Form990 Schedule J Part III Form990ScheduleJPartIII (3 entries)

Return ReferenceReturnReferenceExplanationExplanation
PART I, LINE 3THE FOLLOWING METHODS ARE USED BY POCONO MEDICAL CENTER (PMC) TO ESTABLISH COMPENSATION OF THE PRESIDENT/CEO, AS PMC COMPENSATES THE PRESIDENT/CEO FOR SERVICES TO PMC AND ALL RELATED ENTITIES: COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, COMPENSATION SURVEY OR STUDY, APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE.
PART I, LINE 4BTHE FOLLOWING INDIVIDUALS PARTICIPATED IN THE 457(F) SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN OF POCONO MEDICAL CENTER, A RELATED ORGANIZATION, AND RECEIVED THE FOLLOWING DISTRIBUTIONS WHICH WERE INCLUDED IN THE 2011 FORM W-2: KATHLEEN KUCK, PRESIDENT/CEO - $164,673.32 MICHAEL WILK, SVP FINANCE/CFO - $48,363.68 CHARLES HERMAN ALSO PARTICIPATED IN THE 457(F) SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN OF POCONO MEDICAL CENTER, BUT DID NOT RECEIVE A DISTRIBUTION FROM THE PLAN IN CALENDAR YEAR 2011. THE FOLLOWING INDIVIDUALS LISTED BELOW PARTICIPATED IN THE 457(F) SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN OF FAMILY CARE CENTERS, BUT DID NOT RECEIVE A DISTRIBUTION FROM THE PLAN IN CALENDAR YEAR 2011: CHRISTOPHER POMRINK WILLIAM RYAN GERVIAS CHARLES OLUNTUNDE ODEYEMI ROY KEDEM JOSE BORDAS
PART I, LINE 7PHYSICIANS RECEIVE NON-FIXED BONUS AND INCENTIVE COMPENSATION BASED ON THEIR RESPECTIVE CONTRACT, AND INCENTIVES ARE EITHER BASED ON A PERCENTAGE OF PAYMENTS RECEIVED ABOVE REQUIRED EXPENSE COVERAGE THRESHOLD OR RELATIVE VALUE UNIT THRESHOLD.

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (8 entries)

Return ReferenceReturnReferenceExplanationExplanation
FORM 990, PART VI, SECTION A, LINE 6THE SOLE MEMBER OF THE CORPORATION IS POCONO HEALTH SYSTEM (PHS), A PENNSYLVANIA NON-PROFIT CORPORATION.
FORM 990, PART VI, SECTION A, LINE 7APOCONO HEALTH SYSTEM, THE SOLE MEMBER OF THE CORPORATION, ELECTS/APPOINTS THE BOARD MEMBERS OF FAMILY CARE CENTERS (FCC).
FORM 990, PART VI, SECTION A, LINE 7BTHE FOLLOWING WAS NOTED IN SECTION 4-07 OF THE ORGANIZATION'S BYLAWS: "IN ADDITION TO ALL MATTERS REQUIRED BY LAW OR BY OTHER PROVISIONS OF THESE BYLAWS TO BE SUBMITTED TO A VOTE OF THE SOLE MEMBER, THE SOLE MEMBER IS EMPOWERED TO INITIATE AND IMPLEMENT ANY OF THE FOLLOWING ACTIONS WITH RESPECT TO THE CORPORATION AND IF ANY SUCH ACTION IS OTHERWISE INITIATED BY THE CORPORATION, SUCH ACTION WILL NOT BECOME EFFECTIVE UNLESS APPROVED BY THE SOLE MEMBER: (A) TO ADOPT OR CHANGE THE MISSION, PURPOSE, PHILOSOPHY OR OBJECTIVES OF THIS CORPORATION OR ANY SUBSIDIARY CORPORATION; (B) TO DISSOLVE, REORGANIZE, DIVIDE, CONVERT, LIQUIDATE OR WIND-UP ANY SUBSIDIARY CORPORATION OR CONSOLIDATE OR MERGE THIS CORPORATION WITH ANY OTHER CORPORATION OR ENTITY; (C) TO ANNUALLY APPROVE ALL CAPITAL AND OPERATING BUDGETS FOR THIS CORPORATION; (D) TO ANNUALLY APPROVE THE STRATEGIC AND OPERATING PLANS OR ANY CHANGES THERETO OF THIS CORPORATION; (E) TO APPROVE ANY UNBUDGETED EXPENSE ITEM OF THIS CORPORATION IN EXCESS OF FIVE HUNDRED THOUSAND ($500,000.00) DOLLARS; (F) TO RECEIVE, REVIEW, AND APPROVE FINANCIAL AND OPERATING REPORTS FROM THIS CORPORATION ON AT LEAST A QUARTERLY BASIS; (G) TO APPROVE ANY NEW LINE(S) OF BUSINESS AND/OR MATERIAL CHANGES IN EXISTING SERVICES AND/OR PARTICIPATION BY THIS CORPORATION WITH ANY OTHER ENTITY WHERE LICENSURE BY THE COMMONWEALTH OF PENNSYLVANIA IS REQUIRED AS A PRECONDITION FOR ANY SUCH ACTION, BUSINESS, SERVICE, OR PARTICIPATION; (H) TO APPROVE THE INCURRENCE OF INDEBTEDNESS BY THIS CORPORATION IN EXCESS OF ONE HUNDRED THOUSAND ($100,000) DOLLARS; (I) TO APPROVE THE AMENDMENT OF THE ARTICLES OF INCORPORATION OR BYLAWS OF THIS CORPORATION; (J) TO SPECIFY THE NUMBER OF AND TO ELECT OR REMOVE THE MEMBERS OF THE BOARD OF DIRECTORS OF THIS CORPORATION; (K) TO APPROVE THE ELECTION OR REMOVAL OF THE CHAIRPERSON OF THE BOARD OF DIRECTORS OF THIS CORPORATION; (L) TO REQUIRE EACH DIRECTOR OF THIS CORPORATION AND THE PRESIDENT, EACH VICE PRESIDENT, AND ALL KEY MANAGEMENT PERSONNEL OF THIS CORPORATION TO ANNUALLY SUBMIT TO THE BOARD OF DIRECTORS OF THIS CORPORATION A CONFLICT OF INTEREST STATEMENT IN FORM FIRST APPROVED BY THE BOARD OF DIRECTORS OF THE SOLE MEMBER; (M) TO AT LEAST ANNUALLY EVALUATE THE PERFORMANCE OF THIS CORPORATION'S BOARD OF DIRECTORS IN OVERSEEING THE MANAGEMENT AND PERFORMANCE OF THIS CORPORATION; AND (N) TO REQUIRE THAT THIS CORPORATION'S GOVERNANCE, DELIBERATIONS, AND ACTIONS ARE ORIENTED TO COMMUNITY SERVICE."
FORM 990, PART VI, SECTION B, LINE 11THE ORGANIZATION HAS AN EXTENSIVE 990 REVIEW PROCESS. THE 990 IS FIRST REVIEWED BY THE ACCOUNTING DEPARTMENT AND THE CFO. AFTER ANY NECESSARY CHANGES ARE MADE, A REVIEW IS PERFORMED BY THE CORPORATE COMPLIANCE OFFICER, THE FINANCE COMMITTEE, AND THE CEO. AFTER ALL CHANGES ARE MADE, THE FINAL COPY IS PROVIDED TO ALL BOARD MEMBERS FOR REVIEW AND COMMENT BEFORE FILING WITH THE IRS.
FORM 990, PART VI, SECTION B, LINE 12CON AN ANNUAL BASIS, BOARD MEMBERS AND KEY MANAGEMENT PERSONNEL ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE FORM. ALL FORMS ARE SUBMITTED TO THE CORPORATE COMPLIANCE OFFICER OF POCONO HEALTH SYSTEM. INTERESTED PERSONS HAVE A CONTINUING OBLIGATION TO DISCLOSE, THROUGH A WRITTEN DESCRIPTION, THE EXISTENCE AND NATURE OF ANY ACTUAL, APPARENT, OR POTENTIAL CONFLICT OF INTEREST HE/SHE MAY HAVE. THE AUDIT AND COMPLIANCE COMMITTEE SHALL REVIEW THE MATTER AND DETERMINE WHETHER A CONFLICT OF INTEREST EXISTS. ONCE ALL NECESSARY INFORMATION HAS BEEN OBTAINED, THE AUDIT AND COMPLIANCE COMMITTEE SHALL MAKE A FINDING AS TO WHETHER A CONFLICT OF INTEREST INDEED EXISTS, AND SHALL FORWARD THAT FINDING TO THE BOARD OF DIRECTORS FOR DISCUSSION AND VOTE. ONLY DISINTERESTED DIRECTORS MAY VOTE TO DETERMINE WHETHER A CONFLICT OF INTEREST EXISTS. THE SUBJECT INTERESTED PERSON MAY NOT BE PRESENT WHEN THIS VOTE IS TAKEN. FOR ALL IDENTIFIED CONFLICTS, THE INTERESTED PERSONS ARE REQUIRED TO LEAVE THE ROOM WHILE THE RELATED MATTERS ARE DISCUSSED AND VOTED ON.
FORM 990, PART VI, SECTION B, LINE 15THESE ACTIVITIES ARE UNDERTAKEN BY POCONO MEDICAL CENTER'S BOARD, AS POCONO MEDICAL CENTER COMPENSATES THE CEO AND CFO FOR SERVICES TO POCONO MEDICAL CENTER AND ALL RELATED ENTITIES: ONCE EVERY THREE YEARS, OR SOONER IF NECESSARY, COMPENSATION REVIEWS ARE CONDUCTED FOR THE CEO AND TOP MANAGEMENT. A COMPENSATION COMMITTEE RECOMMENDS TO THE BOARD THE COMPENSATION OF THE PRESIDENT AND CEO AND COMPENSATION RANGES FOR THE VICE PRESIDENTS. THE CEO SHALL THEN SET THE COMPENSATION OF THE VICE PRESIDENTS WITHIN THE APPROVED RANGES. IN MAKING RECOMMENDATIONS TO THE BOARD ON COMPENSATION AND COMPENSATION RANGES, THE COMPENSATION COMMITTEE RELIES ON REPORTS FROM AN INDEPENDENT COMPENSATION CONSULTANT SELECTED BY THE COMMITTEE. TO ASSURE INDEPENDENCE, THE CONSULTANT SHALL PERFORM NO OTHER SERVICES FOR PMC. THE CONSULTANT WAS MOST RECENTLY USED IN 2009. THE COMMITTEE REPORTS ITS DECISIONS TO THE BOARD AT ITS NEXT EXECUTIVE SESSION, AT WHICH TIME THE BOARD SHALL EITHER RATIFY THE DECISION OR SEND IT BACK TO THE COMMITTEE FOR FURTHER DELIBERATION. ONCE A FINAL DECISION IS REACHED, THE BOARD CHAIRMAN INFORMS THE CEO OF THE DECISIONS OF THE COMMITTEE AND RATIFICATION BY THE BOARD REGARDING THE CEO'S SALARY AND THE SALARY RANGES FOR THE VICE PRESIDENTS. MINUTES OF THE COMMITTEE AND THE EXECUTIVE SESSION PORTION OF THE BOARD ARE PREPARED AND RETAINED IN THE ADMINISTRATION OFFICES AND CONTAIN SUFFICIENT INFORMATION TO SUBSTANTIATE THE DELIBERATION AND DECISION.
FORM 990, PART VI, SECTION C, LINE 19FINANCIAL RESULTS ARE PUBLISHED IN THE ANNUAL REPORT, A COPY OF WHICH IS DISTRIBUTED IN A VARIETY OF PUBLIC FORUMS AND WOULD OTHERWISE BE PROVIDED UPON REQUEST. THE CONFLICT OF INTEREST POLICY WOULD BE AVAILABLE FOR VIEWING IN THE BUSINESS OR ADMINISTRATIVE OFFICES OF PMC, UPON REQUEST, TO ENSURE THE MOST CURRENT COPY IS ALWAYS THE ONE BEING MADE AVAILABLE. THE GOVERNING DOCUMENTS ARE GENERALLY NOT AVAILABLE FOR PUBLIC INSPECTION.
FORM 990, PART VII, SECTION A, COLUMN B:THE FOLLOWING OFFICERS AND DIRECTORS WORK APPROXIMATELY 40 HOURS PER WEEK BETWEEN FAMILY CARE CENTERS, INC. AND ALL RELATED ORGANIZATIONS OF POCONO HEALTH SYSTEM, THE PARENT COMPANY. KATHLEEN KUCK, PRESIDENT/CEO MICHAEL WILK, SVP FINANCE/CFO CHARLES HERMAN, MD

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (6 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusDirect Controlling Entity NADirectControllingEntityNAControlled OrgControlledOrgBusiness Name Line1DirectControllingEntityName/BusinessNameLine1
POCONO HEALTH SYSTEM
206 EAST BROWN STREETEAST STROUDSBURGPA18301232336285SUPPORT POCONO MEDICAL CENTERPA501(C)(3)LINE 11B, IIN/A0
POCONO HEALTHCARE PARTNERS
206 EAST BROWN STREETEAST STROUDSBURGPA18301233014006HEALTHCAREPA501(C)(3)LINE 30POCONO HEALTH SYSTEM
POCONO AMBULATORY SERVICES INC
206 EAST BROWN STREETEAST STROUDSBURGPA18301232611474HEALTHCAREPA501(C)(3)LINE 30POCONO HEALTH SYSTEM
POCONO MEDICAL CENTER
206 EAST BROWN STREETEAST STROUDSBURGPA18301240795623HOSPITALPA501(C)(3)LINE 30POCONO HEALTH SYSTEM
POCONO HEALTH FOUNDATION
206 EAST BROWN STREETEAST STROUDSBURGPA18301232516451SUPPORTPA501(C)(3)LINE 11A, I0POCONO HEALTH SYSTEM
POCONO HEALTH SYSTEM MEDICAL PROFESSIONAL LIABILITY SELF-INSURANCE TRUST
206 EAST BROWN STREETEAST STROUDSBURGPA18301206560453SELF-INSURANCEPA501(C)(3)LINE 11A, I0POCONO HEALTH SYSTEM

Form990 Schedule R Part III Form990ScheduleRPartIII

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1POCONO AMBULATORY SURGERY CENTER LTDBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1ONE STORM STREETAddressLine1
CitySTROUDSBURGCity
StatePAState
ZIP Code18360ZIPCode
FieldValueIRS element (for citing)
EIN232611442EIN
Primary ActivitySURGERYPrimaryActivity
Legal Domicile StatePALegalDomicileState
Direct Controlling Entity NAN/ADirectControllingEntityNA
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org1GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities1SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org1ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Comments

Anonymous: no account or email. Up to 2,000 characters, at most one link. Comments are checked automatically; some wait for review.