2013-05-13T16:37:59-05:00 2012-06-30 232932984 PARENTEBEARD LLC 1650 MARKET STREET SUITE 4500 PHILADELPHIA PA 19103 990 2011-07-01 232349341 FAMILY CARE CENTERS INC FAMI 5704214000 206 EAST BROWN STREET EAST STROUDSBURG PA 18301 MICHAEL A WILK 5704214000 2013-05-09 1 JULIUS GREEN CPA P00350393 2159720701 2011 2016-02-24 21:20:13Z KATHLEEN KUCK 206 EAST BROWN STREET EAST STROUDSBURG PA 18301 25305047 0 X WWW.POCONOHEALTHSYSTEM.ORG X 1985 PA TO PREVENT ILLNESS, PROMOTE WELLNESS AND RESTORE HEALTH IN THE POCONO AREA. 6 3 162 3 0 0 4158391 7450984 13073698 17853970 5410 93 0 0 17237499 25305047 0 0 0 0 11543845 19311666 0 0 0 6555930 5618741 18099775 24930407 -862276 374640 4183650 5019053 1282398 1743161 2901252 3275892 X OUR 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. 0 0 23063238 17853970 THE 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 - 111,873 23063238 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 9 0 1 162 1 0 0 0 0 0 0 0 0 0 0 X 6 3 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 PA X MICHAEL A WILK SVP FINANCECFO 5704204912 206 EAST BROWN STREET EAST STROUDSBURG PA 18301 X HORACE COLE 1.00 X X 0 0 0 R DOUGLAS OLMSTEAD 1.00 X X 0 0 0 SUZANNE VIECHNICKI 1.00 X X 0 0 0 KATHLEEN KUCK 1.00 X X 0 741805 339624 CHARLES HERMAN MD 1.00 X 0 560925 23272 CHRISTOPHER POMRINK MD 40.00 X 288195 0 19301 MICHAEL WILK 1.00 X 0 383418 65958 WILLIAM RYAN 40.00 X 436914 0 60697 GERVIAS CHARLES 40.00 X 379759 0 24121 OLUNTUNDE ODEYEMI 40.00 X 376761 0 22147 ROY KEDEM 40.00 X 311804 0 23875 JOSE BORDAS 40.00 X 292830 0 31161 2086263 1686148 610156 40 0 1 0 WEATHERBY LOCUMS PO BOX 97263 DALLAS TX 75397 LOCUM PHYSICIANS 291147 SPREAD EAGLE 200 PLAZA COURT SUITE A EAST STROUDSBURG PA 18301 CONSTRUCTION 211003 COMP HEALTH ASSOCIATION PO BOX 972651 DALLAS TX 75397 LOCUM PHYSICIANS 170747 LOCUMTENENSCOM PO BOX 405547 ATLANTA GA 30353 LOCUM PHYSICIANS 146352 LEHIGH VALLEY PHYSICIAN GROUP PO BOX 1754 ALLENTOWN PA 18105 ULTRASOUND 102015 5 7450984 7450984 PATIENT REVENUE 621400 14674265 14674265 MSO BILLING REVENUE 541900 1593786 1593786 OTHER PROGRAM SERVICES 621400 1585919 1585919 17853970 93 93 25305047 17853970 0 93 351930 351930 15232650 14289766 942884 648066 612788 35278 2271707 1913227 358480 807313 756033 51280 3492 3492 887204 702278 184926 2123 2123 483439 403472 79967 6510 6510 964313 883476 80837 82473 81555 918 433139 312528 120611 192112 192112 BAD DEBT 1816899 1816899 MEDICAL SUPPLIES/DRUGS 671102 671072 30 LICENSES/DUES/SUBSCRIPT 75832 67293 8539 MISCELLANEOUS EXPENSE 103 176 -73 24930407 23063238 1867169 0 870 1462887 1300349 1184855 1921561 133874 91346 71817 131163 4002991 2518853 1214901 1484138 115316 89626 4183650 5019053 1282398 1743161 1282398 1743161 X 2901252 3275892 2901252 3275892 4183650 5019053 374640 0 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 557320 139855 417465 3445671 2378998 1066673 1484138 25305047 24930407 374640 374640 23488151 -1816896 -1816896 25305047 0 25305047 23113511 0 23113511 1816896 1816896 24930407 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. 0 1 0 0 0 0 0 1 0 KATHLEEN KUCK 0 430119 0 137249 0 174437 0 326151 0 13473 0 1081429 0 164673 CHARLES HERMAN MD 0 379915 0 181010 0 0 0 7700 0 15572 0 584197 0 0 CHRISTOPHER POMRINK MD 237450 0 50745 0 0 0 4623 0 14678 0 307496 0 0 0 MICHAEL WILK 0 285776 0 40428 0 57214 0 49450 0 16508 0 449376 0 48364 WILLIAM RYAN 385541 0 51373 0 0 0 44250 0 16447 0 497611 0 0 0 GERVIAS CHARLES 340200 0 39559 0 0 0 7410 0 16711 0 403880 0 0 0 OLUNTUNDE ODEYEMI 338920 0 37841 0 0 0 6575 0 15572 0 398908 0 0 0 ROY KEDEM 281200 0 30604 0 0 0 16150 0 7725 0 335679 0 0 0 JOSE BORDAS 205812 0 87018 0 0 0 14450 0 16711 0 323991 0 0 0 PART I, LINE 3 THE 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 4B THE 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 7 PHYSICIANS 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. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF THE CORPORATION IS POCONO HEALTH SYSTEM (PHS), A PENNSYLVANIA NON-PROFIT CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A POCONO 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 7B THE 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 11 THE 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 12C ON 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 15 THESE 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 19 FINANCIAL 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 POCONO HEALTH SYSTEM 206 EAST BROWN STREET EAST STROUDSBURG PA 18301 232336285 SUPPORT POCONO MEDICAL CENTER PA 501(C)(3) LINE 11B, II N/A 0 POCONO HEALTHCARE PARTNERS 206 EAST BROWN STREET EAST STROUDSBURG PA 18301 233014006 HEALTHCARE PA 501(C)(3) LINE 3 POCONO HEALTH SYSTEM 0 POCONO AMBULATORY SERVICES INC 206 EAST BROWN STREET EAST STROUDSBURG PA 18301 232611474 HEALTHCARE PA 501(C)(3) LINE 3 POCONO HEALTH SYSTEM 0 POCONO MEDICAL CENTER 206 EAST BROWN STREET EAST STROUDSBURG PA 18301 240795623 HOSPITAL PA 501(C)(3) LINE 3 POCONO HEALTH SYSTEM 0 POCONO HEALTH FOUNDATION 206 EAST BROWN STREET EAST STROUDSBURG PA 18301 232516451 SUPPORT PA 501(C)(3) LINE 11A, I POCONO HEALTH SYSTEM 0 POCONO HEALTH SYSTEM MEDICAL PROFESSIONAL LIABILITY SELF-INSURANCE TRUST 206 EAST BROWN STREET EAST STROUDSBURG PA 18301 206560453 SELF-INSURANCE PA 501(C)(3) LINE 11A, I POCONO HEALTH SYSTEM 0 POCONO AMBULATORY SURGERY CENTER LTD ONE STORM STREET STROUDSBURG PA 18360 232611442 SURGERY PA N/A 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0