2011-05-13T11:26:12-05:00 2010-06-30 Carbis Walker LLP 5700 Corporate Drive Ste 650 Pittsburgh PA 15237 990 2009-07-01 232242854 BLOOMSBURG HEALTH CARE CENTER BLOO 5703872100 549 EAST FAIR STREET BLOOMSBURG PA PA 17815 JOSEPH DEVITO 5703872100 2011-05-11 1 Jeffrey J Petrell CPA 4126356270 2009 2016-02-24 21:20:13Z REGIS P CABONOR 549 EAST FAIR STREET BLOOMSBURG PA 17815 11665402 0 X WWW.BLOOMHEALTHCARE.COM X 1983 PA BLOOMSBURG HEALTH CARE CENTER IS COMMITTED TO PROVIDING LONG-TERM CARE SERVICES TO THE MEDICALLY UNDERSERVED AND FINANCIALLY NEEDY INDIVIDUALS LOCATED IN BLOOMSBURG, PA, AS WELL AS THE SURROUNDING COMMUNITIES OF COLUMBIA AND MONTOUR COUNTIES. 14 7 176 83 0 0 0 10773310 11624399 40157 38466 3419 2537 10816886 11665402 0 0 5477237 5678710 0 0 5114958 5411976 10592195 11090686 224691 574716 8526509 7658282 8202961 7918001 323548 -259719 BLOOMSBURG HEALTH CARE CENTER IS COMMITTED TO PROVIDING LONG-TERM CARE SERVICES TO THE MEDICALLY UNDERSERVED AND FINANCIALLY NEEDY INDIVIDUALS LOCATED IN BLOOMSBURG, PA, AS WELL AS THE SURROUNDING COMMUNITIES OF COLUMBIA AND MONTOUR COUNTIES. 0 0 9952660 10237436 TO OPERATE A SKILLED NURSING FACILITY AND PROVIDE CARE TO MEDICALLY UNDERSERVED AND FINANCIALLY NEEDY INDIVIDUALS IN BLOOMSBURG, PA AND SURROUNDING COMMUNITIES IN COLUMBIA AND MONTOUR COUNTIES. TO PROVIDE LONG-TERM CARE SERVICES TO ALL INDIVDIUALS ABLE TO PAY FOR THAT CARE EITHER THEMSELVES, THROUGH PRIVATE HEALTH INSURANCE OR WITH THE AID OF PUBLIC PROGRAMS SUCH AS MEDICARE AND MEDICAL ASSISTANCE. RESidents WILL NOT BE DENIED LONG-TERM CARE SERVICES ON ACCOUNT OF THEIR INABILITY TO PAY. THE FACILITY IS AGGRESSIVE IN REHABILITATION AND FIFTY (50) PERCENT OF THE DISCHARGES WERE TO HOME OR OTHER LESS ACUTE SETTINGS. 736347 1386963 SKILLED PHYSICAL, OCCUPATIONAL, AND SPEECH THERAPY IS PROVIDED TO ALL RESIDENTS AS SPECIFIED IN THE MEDICAL CARE RECORD OF THE ATTENDING PHYSICIAN AND LICENSED THERAPIST. THE MISSION IS TO REHABILITATE RESIDENTS IN THE MOST EFFICIENT AND COST EFFECTIVE MANNER TO ACHIEVE THEIR HIGHEST LEVEL OF FUNCTIONING WITH THE GOAL OF DISCHARGING TO A LESSER SKILLED SETTING PREFERABLY TO HOME OR ASSISTED LIVING. 10689007 1 0 0 0 0 0 0 0 0 1 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 1 2 0 1 176 1 0 0 0 0 0 0 0 0 0 0 14 7 0 1 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 1 0 PA X JOSEPH DEVITO 5703872100 549 EAST FAIR STREET BLOOMSBURG PA 17815 X REGIS P CABONOR 6.00 X X 0 252606 29570 JOSEPH DEVITO 6.00 X 0 224066 32486 RICHARD M ANGELO PHD 1.00 X X 0 0 0 LUCILLE F LUKAS 1.00 X X 0 0 0 JOHN R THOMPSON 1.00 X X 0 0 0 GEORGE A TURNER 1.00 X X 0 0 0 Jan Swan 1.00 X 0 0 0 FRANCIS J WELK PT DPT 1.00 X 0 24950 1909 Beverly Ribble 1.00 X 0 0 0 PATRICK J ERWIN MD 1.00 X 0 347718 25461 GLENN E HALTERMAN 1.00 X 0 0 0 VIRGINIA L HENRIE 1.00 X 0 0 0 Michael C Marino DO 1.00 X 0 240410 23707 JAMES W JOSEPH MD 1.00 X 0 148000 22630 Thomas E Leipold Esquire 1.00 X 0 0 0 0 1237750 135763 0 0 1 0 SELECT MEDICAL REHAB PO BOX 643920 PITTSBURGH PA 15264 THERAPY SERVICES 591848 GEISINGER HEALTH PLAN PO BOX 822434 PHILADELPHIA PA 19182 INSURANCE 430291 CARE FIRST PHARMACY 1015 N VINE STREET BERWICK PA 18603 PHARMACY SERVICES 412860 JDK MANAGEMENT 1388 STATE ROUTE 487 BLOOMSBURG PA 17815 MANAGEMENT SERVICES 286092 RELIABLE STAFFING 85 RHODOMOYER ROAD MILLVILLE PA 17846 NURSE STAFFING SERVICES 189733 7 NET PATIENT SERVICE RE 623000 11624399 11624399 11624399 38466 38466 MISCELLANEOUS REVENUE 623000 1829 1829 VENDING MACHINE REVENU 623000 708 708 2537 11665402 11624399 0 41003 4601725 4601725 625829 625829 451156 451156 282406 282406 18715 18715 35813 35813 1241608 1238542 3066 43069 43069 411120 393350 17770 363433 363433 408915 408915 339860 339860 123584 123584 PA NURSING HOME ASSESSM 1016500 1016500 PHARMACY COSTS 379441 379441 FOOD COSTS 292663 292663 Repairs & Maintenance 137386 137386 BAD DEBT 131496 131496 185967 185127 840 11090686 10689007 401679 0 1200 1200 701991 1190417 1724410 1198363 54069 68869 8867563 4042381 5099453 4825182 945386 374251 8526509 7658282 1195431 1094963 6979867 6788645 27663 34393 8202961 7918001 X 323548 -259719 323548 -259719 8526509 7658282 X 0 1 1 X 1 1 X 6801 6801 10299622 10284980 10107096 10773310 11624399 53089407 10306423 10284980 10107096 10773310 11624399 53096208 0 0 0 53096208 73446 75394 56906 40157 38466 284369 73446 75394 56906 40157 38466 284369 3243 8203 5614 3419 2537 23016 10383112 10368577 10169616 10816886 11665402 53403593 0.99420 0.99400 0.00530 0.00560 X 330935 330935 5514325 1829247 3685078 2960926 2160286 800640 61377 52848 8529 4825182 RESIDENT FUNDS 34393 34393 11665402 11090686 574716 -1157983 -1157983 -583267 Part X: Description of Uncertain Tax Positions Under FIN 48: The System adopted the standard for accounting for uncertainty in income taxes recognized in a company's financial statements that prescribes a recognition threshold of more-likely-than-not to be sustained upon examination by the appropriate taxing authority. Measurement of the tax uncertainty occurs if the recognition threshold has not been met. The standard also provides guidance on derecognition, classification, interest and penalties, accounting for interim periods, and disclosure. Management has determined that the adoption of the standard did not have a material effect on the consolidated financial statements. The System's federal Forms 990, Return of Organization Exempt from Income Tax, for the years ended June 30, 2009, 2008, and 2007, remain subject to examination by the Internal Revenue Service and various state agencies. Part XI, Line 8 - Other Adjustments: TRANSFER TO AFFILIATE: -1157983. X X 0 0 0 0 0 0 0 0 0 REGIS P CABONOR 0 252606 0 0 0 0 0 0 0 29570 0 282176 0 0 JOSEPH DEVITO 0 224066 0 0 0 0 0 0 0 32486 0 256552 0 0 PATRICK J ERWIN MD 0 282000 0 40322 0 25396 0 5719 0 19742 0 373179 0 0 Michael C Marino DO 0 223154 0 17256 0 0 0 4200 0 19507 0 264117 0 0 JAMES W JOSEPH MD 0 148000 0 0 0 0 0 2960 0 19670 0 170630 0 0 Form 990, Part VI, Section A, line 3 BLOOMSBURG HEALTH CARE CENTER ENGAGES JDK MANAGEMENT COMPANY, LLP TO PROVIDE SERVICES CONSISTING OF GENERAL OVERALL MANAGEMENT OF THE ORGANIZATION, INCLUDING PATIENT CARE, FINANCIAL OVERSIGHT, HUMAN RESOURCES management, AND MATERIALS MANAGEMENT SERVICES. Form 990, Part VI, Section A, line 6 THE SOLE MEMBER OF THE CORPORATION IS BLOOMSBURG HEALTH SYSTEM, INC. Form 990, Part VI, Section A, line 7a The board members are elected by the SOLE MEMBER (BLOOMSBURG HEALTH SYSTEM, INC.) Form 990, Part VI, Section A, line 7b The following powers are specifically reserved to the SOLE MEMBER (BLOOMSBURG HEALTH SYSTEM, INC.) and may only be undertaken by the board with the approval of the sole member. 1. Amendment of the Articles of Incorporation or the Bylaws of the Corporation 2. Purchase, sale, lease or encumbrance with debt, in any way, of the real property of the Corporation or creation of any encumbrance upon or execution of any debt instrument affecting or restricting any asset of the Corporation, in excess of an amount specified from time to time by resolution of the Sole Member 3. Transfer of any assets of the Corporation if the amount involved in any such transaction is in excess of an amount specified from time to time by resolution of the Sole Member 4. Election and removal of members of the Board of Directors of the Corporation 5. Approval of the annual operating and capital budgets of the Corporation 6. Approval of non-budgeted expenditures in excess of amounts as determined from time to time by the Sole Member 7. Selection and retention of investment advisors, outside legal counsel and auditor 8. Merger, consolidation or dissolution of the Corporation or any subsidiary 9. Expenditures (including, but not limited to any transfer of funds by gift, grant or loan), borrowings or other financial commitments by the Corporation or any subsidiary in amounts which individually or in aggregate, materially exceed those provided for in the approved annual budget or approved modifications thereto for the Corporation or any subsidiary 10. Any other matter that by law would require the approval of the members of a non-profit corporation in Pennsylvania Form 990, Part VI, Section B, line 11 Bloomsburg Health Care Center has A CPA FIRM PREPARE ITS FORM 990. The return is completed in draft form and reviewed by management of the organization before it is filed. Form 990, Part VI, Section B, line 12c BLOOMSBURG HEALTH CARE CENTER ANNUALLY REQUIRES ITS BOARD MEMBERS, OFFICERS, AND KEY EMPLOYEES TO COMPLETE A CONFLICTS OF INTEREST FORM. DURING BOARD MEETINGS, IF AN INTERESTED PARTY HAS A CONFLICT, HE/SHE RECUSES THEMSELVES FROM VOTING. Form 990, Part VI, Section B, line 15 BLOOMSBURG HEALTH CARE CENTER'S BOARD OF DIRECTORS DETERMINES THE COMPENSATION OF THE CHIEF EXECUTIVE OFFICER. THE CHIEF EXECUTIVE OFFICER SETS THE SALARY FOR THE OTHER KEY EMPLOYEES AND OFFICERS. SALARIES ARE REVIEWED ANNUALLY BY THE BOARD OF DIRECTORS AND THE CHIEF EXECUTIVE OFFICER. THE COMPENSATION AMOUNTS ARE ALSO COMPARED TO A COMPREHENSIVE EXECUTIVE COMPENSATION STUDY WHICH WAS PERFORMED BY THE ORGANIZATION APPROXIMATELY TWO YEARS AGO. Form 990, Part VI, Section C, line 18 BLOOMSBURG HEALTH CARE CENTER MAKES ITS FORM 990 AVAILABLE TO THE PUBLIC. Form 990, Part VI, Section C, line 19 AT THIS TIME, BLOOMSBURG HEALTH CARE CENTER ONLY MAKES ITS GOVERNING DOCUMENTS AVAILABLE TO THE PUBLIC TO THE EXTENT THAT THE DOCUMENTS ARE REQUIRED DISCLOSURES OR ATTACHMENTS TO OTHER PUBLICLY AVAILABLE INFORMATION. ALL OTHER GOVERNING DOCUMENTS, THE CONFLICT OF INTEREST POLICIES, AND THE CONSOLIDATED FINANCIAL STATEMENTS ARE NOT AVAILABLE TO THE GENERAL PUBLIC. FORM 990, PART XI, LINE 2C: Bloomsburg Health Care Center has an audit committee that is responsible for the oversight of the audit and selection of the independent auditors. The process has not changed from prior year. FORM 990, PART VII, SECTION A, LINE 1A: THE OFFICERS REGIS P. CABONOR, CEO AND JOSEPH DEVITO, CFO SPLIT THE HOURS WORKED PER WEEK BETWEEN EACH OF THE BLOOMSBURG ENTITIES IN THE FOLLOWING MANNER: THE BLOOMSBURG HOSPITAL - 25 HR BLOOMSBURG HEALTH SYSTEM, INC. - 1 HR COLUMBIA MONTOUR VISITING NURSES - 2 HR BLOOMSBURG HEALTH CARE CENTER - 6 HR BLOOMSBURG PHYSICIANS SERVICES - 4 HR BLOOMSBURG HEALTH SYSTEM INC 549 EAST FAIR STREET BLOOMSBURG PA 17815 232262540 HEALTH CARE PA 501(C)(3) 509(a)(1) BLOOMSBURG PHYSICIAN SERVICES 549 EAST FAIR STREET BLOOMSBURG PA 17815 232979856 HEALTH CARE PA 501(C)(3) 509(a)(1) BLOOMSBURG HEALTH SYSTEM INC COLUMBIA MONTOUR HOME HEALTH SERVICESVISITING NURSE ASSOC 410 GLENN AVENUE SUITE 200 BLOOMSBURG PA 17815 231704399 HEALTH CARE PA 501(C)(3) 509(a)(1) BLOOMSBURG HEALTH SYSTEM INC BLOOMSBURG HOSPITAL 549 EAST FAIR STREET BLOOMSBURG PA 17815 232193572 HEALTH CARE PA 501(C)(3) 509(a)(1) BLOOMSBURG HEALTH SYSTEM INC BLOOMSBURG HOSPITAL MEDICAL PROF LIABILITY SELF-INS TRUST 549 EAST FAIR STREET BLOOMSBURG PA 17815 146222837 HEALTH CARE PA 501(C)(3) 509(a)(2) BLOOMSBURG HEALTH SYSTEM INC BLOOMSBURG HEALTH VENTURES 549 EAST FAIR STREET BLOOMSBURG PA 17815 202852206 HEALTH CARE PA 501(C)(3) 509(a)(2) BLOOMSBURG HEALTH SYSTEM INC 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0