2011-05-16T15:41:14-05:00 2010-06-30 ParenteBeard LLC 1650 Market Street Suite 4500 Philadelphia PA 19103 990 2009-07-01 250965404 Indiana Regional Medical Center INDI 7243577008 835 Hospital Road Indiana PA 15701 Robert Gongaware 7243577008 2011-05-16 1 Julius Green CPA 2159720701 2009 2016-02-24 21:20:13Z Stephen Wolfe 835 Hospital Road Indiana PA 15701 173299512 0 X www.indianarmc.org X 1944 PA TO SERVE THE HEALTHCARE NEEDS OF EVERY LIFE WE TOUCH WITH COMPASSION, RESPECT, AND DIGNITY. 12 10 1537 160 2010694 634097 661200 1660228 126183600 126023102 -3156592 5576442 1664988 3084921 125353196 136344693 0 0 0 0 74215380 75923738 0 0 0 51268570 55139782 125483950 131063520 -130754 5281173 170611336 175520117 69898145 72970602 100713191 102549515 The mission of Indiana Regional Medical Center is to serve the healthcare needs of every life we touch with compassion, respect, and dignity. 0 0 105411598 124428416 Health Diagnostic, Intervention & Treatment Service:Indiana Regional Medical Center ("IRMC") is a non-profit, community based health system that offers a wide range of services including diagnostics, medicine, surgery, pediatrics, obstetrics, geriatric behavioral healthcare and rehabilitative nursing. The medical center demonstrates an ongoing commitment to the community by continually reviewing and improving its services to ensure that the community receives top-quality, efficient, accessible, cost-effective healthcare and quality outreach and health promotion services. The medical center continues to provide mobile health services to rural areas of the county. In addition to primary care physicians, Indiana Regional Medical Center was successful in recruiting two pain management physicians, emergency department physicians and a clinical psychologist.Mass Health Screening: Indiana Regional Medical Center's Mobile Medical Services continues to provide free blood pressure screenings in 19 locations in Indiana County. We also continue to participate in numerous free community events providing education, screenings programs and first aid services.Health Fairs: The provision of health services and information through health fairs, classes and programs - The Institute for Healthy Living at Indiana Regional Medical Center offers health services and education programs to the community at no-charge.Health Care Delivery & Management: The Community Health Advisory Council of Indiana County, which was formed in 1996, serves as a State Health Improvement Partnership. The goal of the council is to identify or develop resources to address top health priorities in the county. The council continues to promote an annual influenza campaign. The Council implemented a county prescription assistance program to assist residents with accessing pharmaceuticals free or at a reduced cost based on income.Health Care Programs, General/Other: The Center for Diabetes Care continues to offer free education services at various locations throughout the county. In addition, they continue to be the primary sponsor of the county's diabetes walk. Each month staff and management at IRMC provide support to a local food bank. For the third year, Indiana Regional Medical Center was named one of the Best Places to Work in PA. (4,383 Participants)Preventive Health Services, General/Other: M. Dorcas Clark Women's Imaging Center: The Women's Imaging Center and their staff have participated in numerous community events providing information about the importance of breast health. Birdie's Closet, a project designed to help women cope with appearance-related side-effects of cancer treatment was opened in the Women's Imaging Center. (17,175 Counts) 105411598 1 1 0 1 0 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 231 0 1 1537 1 1 1 0 0 0 0 0 0 0 0 12 10 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 PA X Robert Gongaware 7243577008 835 Hospital Road Indiana PA 15701 John Dolan 1.00 X X 0 0 0 Todd Brice 1.00 X X 0 0 0 Beverly Gazza 1.00 X X 0 0 0 Joseph Geary 1.00 X X 0 0 0 Mark Boykiw 1.00 X 0 0 0 Nathan Kovalchick 1.00 X 0 0 0 Thomas McCoy 1.00 X 0 0 0 Robert Rout 1.00 X 0 0 0 Edward McDowell 1.00 X 0 0 0 Mark Staszkiewicz 1.00 X 0 0 0 Ann White 1.00 X 0 0 0 Stephen A Wolfe 40.00 X X 444714 0 57869 Robert Gongaware 40.00 X 185455 0 10827 Bruce A Bush MD 40.00 X 295342 0 9557 Dominic Paccapaniccia 40.00 X 242964 0 30126 Cindy Virgil 40.00 X 187697 0 18344 Wade Patrick 40.00 X 193051 0 17764 Larry Sedlemeyer 40.00 X 169252 0 10530 Luis Tomacruz 40.00 X 385032 0 18897 John Polenta 40.00 X 350908 0 18761 Anthony Sico 40.00 X 316169 0 19345 Vineet Goel 40.00 X 312643 0 19284 John Patrick Cawley 40.00 X 304248 0 6624 3387475 0 237928 54 0 1 0 Leonard S Fiore 5506 6th Avenue Altoona PA 16602 Construction Contractor 4288990 Lighthouse Electric 1957 Rt 519 South Cannonsburg PA 15317 Construction Contractor 1178575 Mayo Collaborative Services Inc PO Box 1450 Minneapolis MN 55485 Outside Lab Service 976021 Indiana Open MRI LLC PO Box 450 New Station PA 15672 MRI Service 671696 National Healing Corp PO Box 93340 Atlanta GA 31193 Wound Care Service 545976 25 51008 1609220 1660228 Net Patient Scv Rev 621990 123761418 123761418 Laboratory Revenue 621500 1905275 1905275 Rental Revenue-Affilia 531120 356409 356409 126023102 3136764 71091 3065673 907743 823192 84551 84551 84551 38466173 105132 35906997 224630 2559176 -119498 2439678 2439678 Leased Employees 900099 1750327 1750327 Cafeteria Rev 722210 524796 524796 Miscellaneous Rev 900099 172194 172194 553053 310589 34328 208136 3000370 136344693 124428416 2010694 8245355 1873491 784029 1089462 55105093 43791788 11313305 5280965 4221809 1059156 9712536 7764580 1947956 3951653 3159106 792547 133652 560 133092 86825 86825 165000 165000 9992316 8040856 1951460 886961 34487 852474 19481118 19103345 377773 1646707 593393 1053314 2256007 1657317 598690 419117 232171 186946 1409107 1409107 7390120 6423422 966698 1487973 1189544 298429 UBI Taxes 544507 544507 Bad Debt Expense 5042890 5042890 Maintenance & Repairs 2566620 2051856 514764 Food 748612 598470 150142 Recruitment Costs 451183 360693 90490 431067 361282 69785 131063520 105411598 25651922 0 6191 7326192 877376 9051000 11147274 1478706 1263535 3174523 3938710 142638425 86239385 52547181 56399040 91027166 95973044 5185940 1964520 724982 541213 3317066 187794 170611336 175520117 16199165 13207854 32402242 29521511 173321 1594000 2000000 19702738 28067916 69898145 72970602 X 98337191 99296133 2376000 3253382 100713191 102549515 170611336 175520117 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 0 0 0 0 0 Part II-B, Line 1i: Explanation of Other Lobbying Activities: Paid part-time staff member occasionally lobbies local and federal governments specifically on healthcare reform topics. 2376000 1812000 935000 3253000 3262000 680036 1566036 2376000 1.00000 0.00000 0.00000 0 0 227375 2862228 3089603 39003156 22680385 16322771 93017629 62196844 30820785 7528037 1362156 6165881 56399040 Post-Retirement Liability 657269 Pension Liability 25374031 Estimated Third Party Payor Settlements 683847 Due to Affiliates 1352769 28067916 136344693 131063520 5281173 4449677 -344250 -7550276 -3444849 1836324 135912735 4449677 -5704827 -1255150 137167885 -823192 -823192 136344693 133732161 3089728 3089728 130642433 421087 421087 131063520 Part V, Line 4: Description of Intended Use of Endowment Funds: Endowment funds are used primarily to purchase capital equipment. Part X: Description of Uncertain Tax Positions Under FIN 48: The Hospital accounts for uncertainty in income taxes using 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 is met. Management determined there were no tax uncertainties that met the recognition threshold in 2010. The Hospital's policies are to recognize interest related to unrecognized tax benefits in interest expense and penalties in operating expenses. Part XI, Line 8 - Other Adjustments: Pension and Post-Retirement Liabilities Adjustment: -5283740. Transfer to affiliates: -2266536. Part XII, Line 2d - Other Adjustments: Pension and Post-Retirement Liabilities Adjustment: -5283740. Investment Fees: -165000. Tax Expense Netted with Income on Financials: -256087. Part XII, Line 4b - Other Adjustments: RENTAL EXPENSES: -823192. Part XIII, Line 2d - Other Adjustments: Transfer to affiliates: 2266536. RENTAL EXPENSES: 823192. Part XIII, Line 4b - Other Adjustments: Investment Fees: 165000. Tax Expense Netted with Income on Financials: 256087. 1 1 1 X 1 X 100.000000000000 0 1 1 0 0 1600278 1600278 0.01270 13736184 9807589 3928595 0.03120 15336462 9807589 5528873 0.04390 536582 55000 481582 0.00380 8760881 3945469 4815412 0.03820 41992 41992 0.00030 9339455 4000469 5338986 0.04230 24675917 13808058 10867859 0.08620 315500 315500 0.00250 315500 315500 0.00250 1 1714000 0 28902121 26884111 2018010 X 1 1 Indiana Regional Medical Center

835 Hospital Road Indiana PA 15701

X X X Part I, Line 7: The Hospital used a cost-to-charge ratio in determining the figures reported in this table. This cost-to-charge ratio was derived from Worksheet 2 Ratio of Patient Care Cost to Charges. Part I, Line 7g: No costs attributable to a physician clinic were included in the amount on Part I, line 7g. Part I, Line 7f: The amount of bad debt expense included on Form 990, Part IX, line 25, but subtracted for purposes of calculating the percentage in this column is $5,042,890. Part III, Line 4: The following is the text of the footnote from the audited financial statements that describes bad debt expense: Accounts receivable, patients, are reported at net realizable value. Accounts are written off when they are determined to be uncollectible based upon management's assessment of individual accounts. The allowance for doubtful collections is estimated based on a periodic review of the accounts receivable aging, payor classifications, and application of historical write-off percentages. Part III, Line 8: The Medicare cost report was used to determine the amount reported on line 6. Part III, Line 9b: Patients are expected to pay all balances in full within seven days of a final billing. If this is not possible, patients will be counseled on the use of Medical Assistance or the present Charity Care program.On a monthly basis, the Credit Supervisor will compile a report listing all accounts, which have been billed to Medicare, and any secondary insurance carrier where applicable. Accounts which have been billed to Medical Assistance as a secondary payor will come to the Credit Supervisor for an automatic write off after Medical Assistance has processed the account. Accounts which have balances after Medicare and all secondary payors have been billed will be placed with an outside collection agency after two unanswered statements. An exception will be made in the event a patient/guarantor does not follow through with the Medical Assistance application process, when requested to do so. The agency will attempt to collect the account for six months. After that time the account will be written off as Medicare Bad Debt. Part VI, Line 3: IRMC will post at all points of registration, a notice of the charity care policy. The Medical Center will also provide notice of the charity care policy in patients' bills and to local social service agencies. At the earliest feasible time, the Medical Center personnel will attempt to determine patient eligibility for coverage of part or all of their bill.All pre-registration, registration, business office, and patient financial services staff shall receive training as to the charity care policy and are to be familiar with the availability of charitable assistance and the criteria for such assistance. Part VI, Line 4: Since opening its doors in 1914, Indiana Regional Medical Center (IRMC) has maintained a goal of serving the community with quality, progressive, compassionate patient care. As the county's sole, full-service healthcare provider, IRMC has continually risen to the challenge of meeting the needs of its community. IRMC resides in Indiana, Pennsylvania in the heart of the county. The hospital sits on a 75-acre campus and admits over 8,700 patients and accommodates another quarter-million outpatient encounters each year. As an acute care facility, IRMC is licensed for 162 beds and provides a broad range of medical and educational services at its main campus and satellite locations across Indiana County. As the only hospital located in this rural county, IRMC provides services to a diverse population of 89,605 residents spread over 831 square miles.Over the years, IRMC has developed programs and services that address improving access to care, preventive services, and community health education. IRMC has found a way to not only succeed when other rural hospitals are closing their doors, but also expand and provide care to the residents of five surrounding counties. IRMC is the number two employer in the county with 1,400 employees and continues to attract and retain a quality workforce through the achievement of numerous recognitions, such as the #1 Best Place to Work in PA, the #2 Best Place to Work in the Nation according to Modern Healthcare Magazine, achieved notable status by scoring at the Mastery Level in Pennsylvania's KAPE program, and recently named to Fortune's 100 Best Companies to Work For. Further, IRMC is currently pursuing the Malcolm Baldrige National Quality Award - a prestigious honor achieved by few. Part VI, Line 5: Our mission is to serve the healthcare needs of every life we touch with compassion, respect and dignity. All of the programs offered meet Community Benefit Objectives and are related to our mission. IRMC offers programs that improve access to health care services, enhance health of the community we serve, provide advanced medical or healthcare knowledge and relieves some of the financial or programmatic burden of government or our community. Indiana Regional Medical Center provides numerous community programs and activities that provide treatment or promote health and healing to our communities. Our Mobile Medical Services continues to provide free blood pressure screenings in 19 locations in Indiana County. We also continue to participate in numerous free community events providing education, screening programs and first aid services. We also provide numerous Health Fairs, Classes and Education Programs. The Institute for Healthy Living at Indiana Regional Medical Center offers health services and education programs to the community at no charge.Health Care Delivery & Management - The Community Health Advisory Council of Indiana County, which was formed in 1996, serves as a State Health Improvement Partnership. The goal of the council is to identify or develop resources to address top health priorities in the county. The council continues to promote an annual influenza campaign. The council implemented a county prescription assistance program to assist residents with accessing pharmaceuticals free or at a reduced cost based on income.The Center for Diabetes Care continues to offer free education services at various locations throughout the county. In addition, they continue to be the primary sponsor of the county's Diabetes Walk. Each month Staff and Management at IRMC provide support to a local Food Bank. Preventive Health Services - M. Dorcas Clark Women's Imaging Center and their staff have participated in numerous community events providing information about the importance of Breast Health. Birdie's Closet, a project designed to help women cope with appearance related side-effects of cancer treatment was opened in the Women's Imaging Center and provided services to 17,175 individual visits (counts).Support Health GroupsFamily Programs - Early Pregnancy, Maternity Tour, Doctor Dad, BOF Series, Breastfeeding, All about Baby, Lamaze, Home Alone, Babysitting, Let's Talk Girls, Big Brother, CPR, Heartsaver. 432 contacts for the year.Community Classes - PACE, Tai Chi, Yoga, Cancer, Strong Women, Drop Weight, Ornish, Diabetes, Drop 10. 5,030 class hours.In this current fiscal year, Indiana Regional Medical Center opened a brand new facility offering Urgent Care Services in the Blairsville community as a response to medical services needed in that area. Part VI, Line 7: Indiana Regional Medical Center has the following affiliated entities:Indiana Healthcare Foundation conducts fundraising activities, such as the Columbus Day Golf Outing and Love of Life Gala, in support of Indiana Regional Medical Center. INDIANA REGIONAL MEDICAL CENTER AND PUNXSUTAWNEY AREA HOSPITAL JOINTLY FORMED INDIANA JEFFERSON RADIATION ONCOLOGY, INC. FOR THE PURPOSE OF ENHANCING THE QUALITY AND AVAILABILITY OF RADIATION ONCOLOGY SERVICES OFFERED TO PATIENTS IN INDIANA AND JEFFERSON COUNTIES, PA AND SURROUNDING AREAS.Indiana Healthcare Physician Services, Inc. is a non-profit hospital owned group of practices owned and operated to serve the rural areas of Indiana and surrounding communities. We provide accessible, cost effective quality healthcare within the rural communities of Indiana and surrounding counties. We support and work collaboratively with other non-profit agencies within our sites.Indiana Healthcare Properties holds and manages property in support of Indiana Regional Medical Center. X 1 1 X X X X X 0 0 0 0 0 0 0 1 0 Stephen A Wolfe 371477 0 65000 0 8237 0 44449 0 13420 0 502583 0 0 0 Robert Gongaware 158859 0 26596 0 0 0 9816 0 1011 0 196282 0 0 0 Bruce A Bush MD 277241 0 18101 0 0 0 2891 0 6666 0 304899 0 0 0 Dominic Paccapaniccia 217097 0 25867 0 0 0 13013 0 17113 0 273090 0 0 0 Cindy Virgil 171169 0 16528 0 0 0 6447 0 11897 0 206041 0 0 0 Wade Patrick 172078 0 20973 0 0 0 1975 0 15789 0 210815 0 0 0 Larry Sedlemeyer 156511 0 12741 0 0 0 3263 0 7267 0 179782 0 0 0 Luis Tomacruz 368433 0 16599 0 0 0 0 0 18897 0 403929 0 0 0 John Polenta 348067 0 2841 0 0 0 0 0 18761 0 369669 0 0 0 Anthony Sico 260938 0 55231 0 0 0 0 0 19345 0 335514 0 0 0 Vineet Goel 307138 0 5505 0 0 0 0 0 19284 0 331927 0 0 0 John Patrick Cawley 303405 0 843 0 0 0 0 0 6624 0 310872 0 0 0 Part I, Line 1a Indiana Regional Medical Center pays country club membership dues for President & CEO, Stephen Wolfe, which is not included in his compensation. The membership is a corporate membership used for business purposes only. Part I, Line 7 Bonuses may be granted at the discretion of the board and are based on factors such as performance and meeting goals and objectives. Indiana County Hospital Authority 251697319 2003-01-15 10000000 Advance refund 1992 bonds and finance capital improvements 0 0 Indiana County Hospital Authority 251697319 2004-12-08 10000000 Finance capital improvements 0 0 PA Economic Development Financing Authority 232899801 708693AB2 2006-06-29 3750000 Finance equipment 0 0 Indiana County Hospital Authority 251697319 2009-02-12 10000000 Finance capital projects 0 0 10000000 50000 9950000 2003 0 0 1 1 10000000 91500 9908500 2006 0 0 1 1 3750000 85000 3650000 2007 0 0 1 1 10000000 61000 9939000 2010 0 0 1 1 0 0 0 0 1 0.00000 0.00000 0.00000 1 0 0 0 0 1 0.00000 0.00000 0.00000 1 0 0 0 0 1 0.00000 0.00000 0.00000 1 0 0 0 0 1 0.00000 0.00000 0.00000 1 0 0 0 0 0 1 0 1 0 0 0 1 0 0 0 0 0 1 0 1 0 0 0 1 Form 990, Part VI, Section A, line 6 Indiana Healthcare Corporation ("IHC") is the sole corporate member of Indiana Regional Medical Center ("IRMC"). Form 990, Part VI, Section A, line 7a IHC has the power to fill vacancies, nominate and approve the election of, and approve removal of the Board of Directors of IRMC. Form 990, Part VI, Section A, line 7b IRMC shall obtain the approval of IHC before action on any of the following matters becomes final and effective for IRMC: (1) amendment of the articles of incorporation and bylaws; (2) the sale, lease or exchange of all or substantially all of the property or assets of IRMC; (3) merger or consolidation with any other corporation; (4) dissolution of IRMC; (5) approval of an annual operating and capital budget for IRMC; (6) any other matter that by law would require the approval of members of a nonprofit corporation. Form 990, Part VI, Section B, line 11 Each board member will be contacted individually and given the opportunity to receive a copy of the complete return by e-mail, postal service, or picked up at 835 Hospital Road in the Chief Financial Officer's office. The return is also presented at a board meeting before filing with the Internal Revenue Service. Form 990, Part VI, Section B, line 12c Every member of the Board, and every individual appointed to the Board or Board committees, as well as all key management personnel and physician leaders, are required to execute a conflict of interest disclosure statement, which will be updated at least on an annual basis or as additional conflicting interests arise. In addition, every member of the Board will specifically acknowledge the conflict of interest policy and his/her attempt to abide by it by signing the acknowledgement form. Every Board committee member, officer, key management employee, and physician leader is required to sign this acknowledgement as well. The acknowledgement and disclosure forms will be kept on file by the Chief Executive Officer, and the Chairman and Vice-Chairman will be familiar with the statements that are filed by Board members in order to guide their conduct in the event a conflict arises. Every person covered by this Policy shall submit in writing to the Chief Executive Officer a Conflict of Interest Disclosure Statement listing all financial and conflicting interests. Each statement will be resubmitted with any necessary changes each year or as any additional conflicting or financial interests arise. The Chairman of the Board shall become familiar with all such disclosure statements in case a conflict arises. The Vice Chairman of the Board shall be familiar with the Disclosure Statement filed by the Chairman. Penalties for non-compliance: Failure to comply with this policy shall constitute grounds for removal from office and, in the case of Key Management Personnel, termination of employment. Form 990, Part VI, Section B, line 15 Positions for Officers and Key Employees are reviewed on an annual basis. Appropriate comparisons are made on a regional and national level in order to maintain a fair and equitable compensation structure. All recommendations are approved by the Board of Directors and documented in the Board Minutes. Form 990, Part VI, Section C, line 19 Governing documents, conflict of interest policy, and financial statements are available to the public upon request. Schedule K Supplental Information Schedule K, Part II, line 5: The amount reported on line 5 for Bond C includes the following: $45,263 of issuance costs and $39,737 of credit enhancement fees. Indiana Healthcare Foundation 835 Hospital Road Indiana PA 15701 251574302 Fundraising in Support of Indiana Regional Medical Center PA 501(c)(3) Line 11a, I N/A Indiana Healthcare Corporation 835 Hospital Road Indiana PA 15701 251547379 Parent Corporation PA 501(c)(3) Line 7 N/A Indiana Jefferson Radiation Oncology Inc 835 Hospital Road Indiana PA 15701 900406301 Radiation Oncology services PA 501(c)(3) Line 11a, I N/A Indiana Healthcare Physician Services Inc 835 Hospital Road Indiana PA 15701 251842046 Provide health care PA 501(c)(3) Line 3 N/A Indiana Healthcare Properties 835 Hospital Road Indiana PA 15701 251524635 Hold & Manage property in Support of Indiana Regional Medical Center PA 501(c)(3) Line 11a, I N/A 0 0 0 0 0 0 0 0 0 1 0 1 0 0 1 1 0 1 Indiana Jefferson Radiation Oncology Inc O 70950 Indiana Jefferson Radiation Oncology Inc P 944289