2012-05-14T16:47:58-04:00 2011-06-30 BKD LLP 910 E ST LOUIS 200/PO BOX 1190 SPRINGFIELD MO 658062523 990 2010-07-01 250984595 BROOKVILLE HOSPITAL BROO 8148492312 100 HOSPITAL ROAD BROOKVILLE PA 15825 JULIANNE PEER 2012-05-11 true Brian D Todd 4178658701 2010 2016-02-24 21:20:13Z JOHN S SUTIKA 100 HOSPITAL ROAD BROOKVILLE PA 15825 28913193 false X WWW.BROOKVILLEHOSPITAL.ORG X 1915 PA BROOKVILLE HOSPITAL PROVIDES QUALITY HEALTHCARE SERVICES, INCLUDING OUTPATIENT, INPATIENT, PHYSICAL THERAPY, OCCUPATIONAL THERAPY, SPEECH THERAPY, AND LAB SERVICES, AMONG OTHERS, TO ITS COMMUNITY. 9 3 284 40 0 0 315950 272249 26553772 28536712 59156 49191 23196 34529 26952074 28892681 0 3210 0 0 12053825 12285432 0 0 0 14098547 15425266 26152372 27713908 799702 1178773 20871606 23573285 11937398 13464824 8934208 10108461 X TO PROVIDE QUALITY HEALTHCARE SERVICES TO THE COMMUNITIES THAT WE SERVE IN A COST-EFFECTIVE MANNER. SEE SCHEDULE O FOR ADDITIONAL INFORMATION. false true 19076390 22829370 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. 4769098 5707342 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. 23845488 true true false true false false false false false true false false true false false false true false false false false false false true false true true false false true false false false true false false true false false false false false false true false true false false true 42 0 true 284 true false false false false false true true false false false false X 9 3 true true false false true true true true true false false true true true true true true true true true false PA X JULIANNE PEER 8148491408 100 HOSPITAL ROAD BROOKVILLE PA 15825 JOHN SUTIKA 40.0 X X 0 0 0 L GENE HOAK 3.0 X X 0 0 0 RONALD KING 3.0 X X 0 0 0 TROY HARPER 3.0 X X 0 0 0 TIMOTHY PENDLETON MD 1.0 X 0 0 0 RICHARD PFINGSTLER 3.0 X X 0 0 0 RAYMOND GRAECO 1.0 X 0 0 0 SCOTT FORADORA 3.0 X 0 0 0 W JAY CHAMBERLAIN 1.0 X 0 0 0 EDWARD S NASUTI 1.0 X 0 0 0 JULIANNE PEER 40.0 X 95917 0 0 JAYESHKUMAR PATEL MD 40.0 X 280009 0 15264 CRAIG BURKE DO 40.0 X 186853 0 15264 PAUL HARVEY MD 40.0 X 196976 0 10836 EMERSON TURNBULL 40.0 X 164544 0 15264 ERNEST BARCH 40.0 X 201458 0 15264 1125757 0 71892 6 false true false NORTHFORK REHABILITATION PHYSICAL THERAPY 765353 SHARED IMAGING INC MRI SERVICES 235752 MEDICUS HEALTHCARE SOLUTIONS PHYSICIAN SERVICES 1708671 ASSOCIATED CLINICAL LABORATORIES LAB TESTING 334961 DUBOIS REGIONAL MED CENTER HOSPITAL MGMT 2094572 12 27127 193922 51200 272249 NET PATIENT SERVICE REVENUE 621110 26086071 26086071 MEDICAL RECORDS 900099 1941 1941 MEAL TICKETS 722210 76025 76025 OTHER REVENUE 900099 2372675 2372675 28536712 34678 34678 0 0 37713 37713 37713 37713 19207 4694 14513 14513 14513 7235 27127 12293 -5058 -5058 5399 3525 1874 1874 0 0 28892681 28536712 83720 3210 3210 0 0 0 95917 95917 158454 158454 9322959 8769364 553595 6280 5750 530 2057280 1883723 173557 644542 590167 54375 2094572 1598833 495739 51033 51033 89152 89152 0 0 0 5086021 4423175 662846 55340 55340 605935 314099 291836 22068 13925 8143 0 625241 421549 203692 54334 51833 2501 0 29608 13630 15978 287514 219466 68048 0 1436763 1096713 340050 437190 95470 341720 BAD DEBT 1502241 1502241 LICENSES, DUES & SUBSCRIPTIONS 95895 43697 52198 REPAIRS & MAINTENANCE 200998 170346 30652 MEDICAL SUPPLIES & DRUGS 2593721 2593721 RECRUITING 130314 7250 123064 27326 27326 27713908 23845488 3868420 0 2368282 46079 3592972 5583658 4372196 3811635 67682 22563 60468 86382 0 441386 480016 441139 462187 38975681 29853920 7474452 9121761 30395 17607 1996720 3967311 20871606 23573285 4640343 5262847 10640 658945 7286415 7543032 11937398 13464824 X 8664491 9835803 96988 104449 172729 168209 8934208 10108461 20871606 23573285 X 1178773 -4520 X false true true X false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false true 12538 false true 3603 16141 false false DIRECT CONTACT WITH LEGISLATORS SCHEDULE C, PART II-B, LINE 1(G) THE ORGANIZATION CONTRACTED WITH S.R. WOJDAK AND ASSOC. FOR STATE FUNDING LOBBYING 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 8138354 5887764 2250590 204286 185401 18885 29004401 22585468 6418933 1423094 1195287 227807 9121761 OTHER RECEIVABLES 2309600 INTEREST RECEIVABLE 23512 OTHER ASSETS 12991 BEN INT IN PERPETUAL TRUST 168209 EST AMT DUE FROM THIRD PARTIES 86363 DUE FROM AFFILIATES 1366636 3967311 28892681 27713908 1178773 -4520 -4520 1174253 28903979 -4520 -4520 28908499 -15818 -15818 28892681 27729726 15818 15818 27713908 27713908 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 CHANGE IN BENEFICIAL INTEREST IN TRUST $(4,520) OTHER REVENUE INCLUDED ON LINE 1, BUT NOT ON FORM 990, PART VIII, LINE 12 SCHEDULE D, PART XII, LINE 2D CHANGE IN BENEFICIAL INTEREST IN TRUST $(4,520) OTHER REVENUE INCLUDED ON FORM 990, PART VIII, LINE 12, BUT NOT ON LINE 1 SCHEDULE D, PART XII, LINE 4B SPECIAL EVENTS EXPENSES RECLASSED TO REVENUE $(15,818) OTHER EXPENSE INCLUDED ON LINE 1, BUT NOT ON FORM 990, PART IX, LINE 25 SCHEDULE D, PART XIII, LINE 2D SPECIAL EVENTS EXPENSES RECLASSED TO REVENUE $15,818 GOLF OUTING 23424 18520 4904 2220 2160 2744 1736 1-100 EVENT 10938 8607 2331 445 2331 657 0 34362 27127 7235 2220 445 4491 2744 2393 12293 -5058 true true X true X false true true false false 90968 0 90968 0.00350 2615496 2082604 532892 0.02030 294559 86233 208326 0.00790 3001023 2168837 832186 0.03170 26062 7659 18403 0.00070 3210 3210 0.00010 29272 7659 21613 0.00080 3030295 2176496 853799 0.03250 false 683649 93660 10429068 10576876 -147808 X true true 1 1 BROOKVILLE HOSPITAL

100 HOSPITAL ROAD BROOKVILLE PA 15825

X X X X BROOKVILLE HOSPITAL 1 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 CLINIC, GENERAL RADIOLOGY, HOME HLTH DAVID L MILLER MEDICAL CENTER

BROOKVILLE STREET FAIRMOUNT CITY PA 16224

RADIOLOGY, LAB, PHYSICAL AND OCCUPATIONAL THERAPY 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 AT COST BY TAKING THE BAD DEBT ATTRIBUTABLE TO PATIENT ACCOUNTS TIMES THE RATIO OF PATIENT CARE COST TO CHARGES USED FOR SCHEDULE H, PART I CALCULATIONS. 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 13.7 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. NEEDS ASSESSMENT: A COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED BY TRIPP UMBACH BETWEEN MARCH AND AUGUST 2011 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 false false false false true false true false JAYESHKUMAR PATEL MD 279964 0 0 0 45 0 0 0 15264 0 295273 0 0 0 CRAIG BURKE DO 186655 0 0 0 198 0 0 0 15264 0 202117 0 0 0 PAUL HARVEY MD 196595 0 0 0 381 0 0 0 10836 0 207812 0 0 0 EMERSON TURNBULL 164475 0 0 0 69 0 0 0 15264 0 179808 0 0 0 ERNEST BARCH 201401 0 0 0 57 0 0 0 15264 0 216722 0 0 0 BONUS AND NON-FIXED PAYMENTS SCHEDULE J, PART I, LINES 6A & 7 JULIANNE PEER, VP OF FINANCE, RECEIVED A BONUS DURING CALENDAR YEAR 2010. THE BONUS WAS DETERMINED BASED ON VARIOUS GOALS OBJECTIVES, ENCOMPASSING FINANCIAL, GROWTH, QUALITY/SAFETY, PEOPLE, AND SERVICE ASPECTS OF PERFORMANCE. PART OF THE BONUS IS DETERMINED BASED ON OPERATING INCOME, AND THE BONUS IS PARTLY DETERMINED BASED ON BOARD DISCRETION. TIMOTHY PENDLETON MD X 135358 22563 false true true TANIS PENDLETON MD X 185000 60468 false true true 83031 TANIS PENDLETON SISTER OF T PENDLETON 120000 MEDICAL DIRECTOR FEES false LINDA GRINDER SISTER OF RON KING 38454 EMPLOYEE OF HOSPITAL false BROOKCARE INC SEE PART V 103401 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, AND RICHARD PFINGSTLER ARE ALSO BOARD MEMBERS OF BROOKCARE, INC., A RELATED, CONTROLLED TAXABLE ENTITY. TRANSACTIONS INCLUDE RENT PAID TO BROOKCARE OF $88,810 AND PAYMENTS FOR HOUSEKEEPING SERVICES OF $14,591. 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, AND RICHARD PFINGSTLER ARE BOARD MEMBERS OF BROOKCARE, INC., A RELATED, CONTROLLED TAXABLE ENTITY. JOHN SUTIKA, TROY HARPER, GENE HOAK, AND RICHARD PFINGSTLER 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. CHANGES TO PROGRAM SERVICES FORM 990, PART III, LINE 3 BROOKVILLE HOSPITAL CLOSED THE INTENSIVE CARE UNIT OF THE HOSPITAL ON JANUARY 1, 2011. 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, 2011, THIS SHORTFALL IS BEING COMPENSATED BY THE STATE AND FEDERAL GOVERNMENT. UNCOMPENSATED CHARITY CARE UNCOMPENSATED CHARITY CARE CHARGES WRITTEN OFF WERE $590,000. 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 $1,502,241 IN FY 2011. 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 25 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, CARDIO-VASCULAR 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 WEIGH 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 2011. BOARD MEMBER RELATIONSHIPS FORM 990, PART VI, SECTION A, LINE 2 RAY GRAECA AND JOHN SUTIKA HAVE A BUSINESS RELATIONSHIP. DELEGATED MANAGEMENT DUTIES FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION HAS A MANAGEMENT CONTRACT WITH DUBOIS REGIONAL MEDICAL CENTER (DRMC) IN WHICH DRMC PROVIDES INDIVIDUALS WHO PERFORM DUTIES AS THE CEO AND VP OF PATIENT CARE SERVICES FOR BROOKVILLE. THESE INDIVIDUALS REPORT TO THE BOARD OF THE HOSPITAL. MEMBERS/STOCKHOLDERS FORM 990, PART VI, SECTION A, LINE 6 DUBOIS REGIONAL MEDICAL CENTER (DRMC) IS THE SOLE MEMBER OF BROOKVILLE HOSPITAL. DECISION APPROVALS FORM 990, PART VI, SECTION A, LINE 7A & 7B PER THE BYLAWS, ARTICLE IV, SECTION 4.3, APART FROM EX-OFFICIO BOARD MEMBERS, THE BOARD SHALL BE DIVIDED INTO TWO CATEGORIES DESIGNATED AS THE BROOKVILLE HOSPITAL DIRECTORS AND THE DRMC MEMBERS. FOR EACH DRMC CATEGORY DIRECTOR POSITION WHOSE TERM IS DUE TO EXPIRE, THE REMAINING DRMC CATEGORY DIRECTORS SHALL NOMINATE CANDIDATE(S) TO FILL SUCH POSITION DURING THE NEXT TERM TO THE SOLE MEMBER'S NOMINATING COMMITTEE AT LEAST THIRTY (30) DAYS PRIOR TO THE ANNUAL MEETING OF THE SOLE MEMBER (OR A SPECIAL MEETING CALLED FOR THE PURPOSE OF APPROVING DIRECTORS). THE SOLE MEMBER'S NOMINATING COMMITTEE SHALL REVIEW EACH CANDIDATE IN ACCORDANCE WITH THE POLICIES, RULES AND REGULATIONS OF THE SOLE MEMBER. THE SOLE MEMBER'S NOMINATING COMMITTEE MAY DECLINE ANY CANDIDATE IN GOOD FAITH AND SHALL BE REQUIRED TO SUBMIT THE BASIS THEREOF TO DRMC CATEGORY DIRECTORS WHO NOMINATED SUCH CANDIDATE. IF A CANDIDATE IS DECLINED, THE DRMC CATEGORY DIRECTORS MUST NOMINATE ALTERNATIVE CANDIDATE(S) TO THE SOLE MEMBER'S NOMINATING COMMITTEE AND THE SAME PROCESS SHALL APPLY. PER THE ORGANIZATIONS BYLAWS ARTICLE III, SECTION 3.1(C): RESERVED POWERS. EXCEPT AS TO MATTERS DELEGATED EXCLUSIVELY TO THE BH CATEGORY DIRECTORS PURSUANT TO SECTION 4.1 1D(III), WITH RESPECT TO WHICH THE APPROVAL OF THE SOLE MEMBER SHALL NOT BE REQUIRED, THE BOARD OF DIRECTORS SHALL NOT HAVE THE POWER OR AUTHORITY TO TAKE ANY OF THE FOLLOWING ACTIONS ON BEHALF OF THE CORPORATION UNLESS (A) A PROPOSAL FOR ANY SUCH ACTION HAS BEEN ADOPTED BY THE BOARD OF DIRECTORS IN THE MANNER CONTEMPLATED BY ARTICLE IV OF THESE BYLAWS AND SUBMITTED TO THE SOLE MEMBER AND (B) THE ACTION HAS BEEN APPROVED BY THE SOLE MEMBER: (I) APPROVE ALL FUNDAMENTAL TRANSACTIONS OF THE CORPORATION AS DESCRIBED IN CHAPTER 59 OF THE NPCL, INCLUDING, WITHOUT LIMITATION, ANY AMENDMENTS TO ARTICLES OF THE CORPORATION AND ANY MERGER, CONSOLIDATION, DIVISION, TRANSFER OF ALL OR SUBSTANTIALLY ALL ASSETS, DISSOLUTION, OR LIQUIDATION OF THE CORPORATION OR ANY TRANSACTION OUTSIDE OF THE ORDINARY COURSE OF BUSINESS; (II) APPROVE ALL STRATEGIC PLANS, ALL CAPITAL AND OPERATING BUDGETS, AND ALL FEASIBILITY PLANS OF THE CORPORATION AND ANY AMENDMENTS THERETO; (III) APPROVE THE INCURRENCE, RE-FINANCING OR PREPAYMENT OF ALL INDEBTEDNESS OF THE CORPORATION IN EXCESS OF $10,000 WITH RESPECT TO EITHER A SINGLE TRANSACTION OR IN THE AGGREGATE FOR ANY ROLLING TWELVE-MONTH PERIOD OR THE DEFEASANCE OF ANY SUCH INDEBTEDNESS, OR SUCH OTHER AMOUNTS AS ESTABLISHED BY RESOLUTION OF THE SOLE MEMBER FROM TIME TO TIME; (IV) APPROVE THE SECURING OF ANY MORTGAGE, DEED OF TRUST, PLEDGE, SECURITY INTEREST OR OTHER ENCUMBRANCE OF SOME OR ALL OF THE CORPORATION'S ASSETS, OTHER THAN SECURITY INTERESTS ARISING FROM PURCHASE MONEY INDEBTEDNESS INCURRED BY THE CORPORATION AT THE TIME OF, OR WITHIN 20 DAYS AFTER, THE INITIAL ACQUISITION OF ANY FIXED ASSETS BY CORPORATION FOR THE PURPOSE OF FINANCING ALL OR ANY PART OF THE ACQUISITION COST THEREOF AND SECURED ONLY BY SUCH ASSETS ACQUIRED PROVIDED SUCH INDEBTEDNESS DOES NOT NEED TO OTHERWISE BE APPROVED AS SET FORTH IN (III) ABOVE OR (V) BELOW; (V) EXCEPT AS MAY BE INVOLVED THEREAFTER IN ORDINARY REPAIRS, MAINTENANCE AND REPLACEMENT, MAKE ANY CAPITAL EXPENDITURES OR ANY CAPITAL ADDITIONS OR IMPROVEMENTS REQUIRING THE PAYMENT OF MORE THAN (A) $10,000 FOR ANY ONE CAPITAL ITEM OR (B) IF ANY ONE CAPITAL ITEM IS LESS THAN SAID AMOUNT, $25,000 IN THE AGGREGATE FOR ANY ROLLING TWELVE-MONTH PERIOD, OR SUCH OTHER AMOUNTS AS ESTABLISHED BY RESOLUTION OF THE SOLE MEMBER FROM TIME TO TIME; (VI) APPROVE ANY AND ALL AMENDMENTS OF THE ARTICLES AND/OR THESE BYLAWS; (VII) APPROVE ANY CHANGE IN MISSION OR DIRECTION OF THE CORPORATION, INCLUDING, WITHOUT LIMITATION, APPROVE ANY DECISION TO ADD OR DISCONTINUE A LINE OF SERVICE, ADD OR DISCONTINUE AN INPATIENT OR OUTPATIENT LOCATION OR UNIT, OR ADD OR DISCONTINUE ANY OF THE CLINICAL SERVICES PROVIDED BY THE CORPORATION EITHER DIRECTLY OR INDIRECTLY; (VIII) APPROVE THE ESTABLISHMENT OF, OR TERMINATION OR WITHDRAWAL FROM, ANY SUBSIDIARY, JOINT VENTURE, OR OTHER PARTNERSHIP OR SHARED GOVERNANCE ARRANGEMENT; (IX) APPROVE ENTERING INTO OR AMENDING ANY AGREEMENT PURSUANT TO WHICH THE CORPORATION PAYS OR RECEIVES COMPENSATION ABOVE $50,000 DURING A PERIOD OF ONE YEAR OR LESS; (X) APPROVE ENTERING INTO, AMENDING, OR TERMINATING (A) ANY AGREEMENT WITH A MATERIAL THIRD PARTY PAYOR OF THE CORPORATION, AS DETERMINED BY THE SOLE MEMBER IN ITS SOLE DISCRETION, OR (B) ANY AGREEMENT BETWEEN THE CORPORATION AND THE SOLE MEMBER; (XI) APPROVE ENTERING INTO, AMENDING, OR TERMINATING ANY UNION OR COLLECTIVE BARGAINING AGREEMENT; AND (XII) APPROVE AND/OR TAKE ANY OTHER ACTIONS AS ARE RESERVED TO THE SOLE MEMBER BY VIRTUE OF THESE BYLAWS OR ANY RESOLUTIONS OF THE BOARD OF DIRECTORS ENACTED FROM TIME TO TIME OR AS REQUIRED OF THE SOLE MEMBER BY VIRTUE OF ITS STATUS AS MEMBER OF THE CORPORATION. 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. HIS SALARY IS ULTIMATELY APPROVED BY THE BOARD OF DRMC. COMPENSATION WAS LAST REVIEWED IN JUNE 2011. OFFICER, KEY EMPLOYEE COMPENSATION REVIEW FORM 990, PART VI, SECTION B, LINE 15B THE BOARD OF DIRECTORS USE AN INDEPENDENT CONSULTANT TO REVIEW BOTH THE VP OF FINANCE AND VP OF PATIENT CARE SERVICES SALARIES. SALARIES ARE APPROVED BY THE BOARD OF DIRECTORS. COMPENSATION WAS LAST REVIEWED IN JUNE 2011. DOCUMENT DISCLOSURE FORM 990, PART VI, SECTION C, LINE 19 A FINANCIAL SUMMARY IS PUBLISHED IN THE PAPER EACH YEAR WITH THE ANNUAL REPORT TO THE COMMUNITY. THIS FINANCIAL SUMMARY AND ANNUAL REPORT CAN ALSO BE REVIEWED IN THE HOSPITAL ADMINISTRATIVE OFFICES. THE GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT AVAILABLE TO THE PUBLIC. OTHER CHANGES IN NET ASSETS FORM 990, PART XI, LINE 5 CHANGE IN BENEFICIAL INTEREST IN TRUST $(4,520) BROOKCARE INC 100 HOSPITAL ROAD BROOKVILLE PA 15825 251477768 OFFICE SPACE PA NA C CORP 18445 891750 1.00000 JOSEPH BEACH TRUST PO BOX 220 INDIANA PA 15701 256171730 TRUST PA NA TRUST 0 168209 1.00000 false false false false false false false false false true false false true true true true false false BROOKCARE INC J 88810