2026-05-12T11:43:08-05:00 2025-06-30 390859910 BAKER TILLY ADVISORY GROUP LP 20 STANWIX STREET PITTSBURGH PA 15222 990 2024-07-01 250965404 INDIANA REGIONAL MEDICAL CENTER INDI 7243577008 835 HOSPITAL ROAD INDIANA PA 15701 MICHAEL F ICKOWSKI CFO 7243577008 2026-05-11 1 1 KELLY A BROCIOUS P01254262 4126976400 2026-05-11 2024 2025-03-06 01:10:19Z STEPHEN A WOLFE 835 HOSPITAL ROAD INDIANA PA 15701 276686055 0 X WWW.INDIANARMC.ORG X 1944 PA TO SERVE THE HEALTHCARE NEEDS OF EVERY LIFE WE TOUCH WITH COMPASSION, RESPECT, AND DIGNITY. 13 8 1264 107 281526 214014 8062250 13534204 214412707 245070610 5201242 6478476 7568616 10372948 235244815 275456238 0 0 0 0 92161833 96942889 0 0 0 126150084 149738277 218311917 246681166 16932898 28775072 264471539 298182339 119646417 140720485 144825122 157461854 X 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 200467145 245070610 IRMC CONTINUES TO BE A RESOURCE TO THE COMMUNITY PROVIDING FREE HEALTHCARE RELATED EVENTS PROMOTING EDUCATION, SCREENING PROGRAMS AND FIRST AID SERVICE. THE INSTITUTE FOR HEALTHY LIVING AT IRMC OFFERS HEALTH SERVICES AND EDUCATIONAL PROGRAMS AT NO CHARGE SUCH AS: ANGEL WINGSBLOOD PRESSURE CLINICBONE DENSITY SCREENINGBREAST HEALTH EVENT - DR. CLARK VIRTUAL EVENTCHEERS TO YOUR HEARTCHOLESTEROL SCREENINGCOLORECTAL CANCER HEALTH FAIR & SEMINARCOMMUNITY HEALTH COACHINGDIABETES EDUCATION & GROCERY STORE TOUR & INSULIN PUMP SUPPORT GROUPDR. SCHOLL - VIRTUAL CHRONIC PAIN EVENTFREE S&T WELLNESS GYM MEMBERSHIPSFUN IN THE PARK GINGERBREAD MAN SPORTS NUTRITION HEART HEALTH/CARDIO COMMUNITY EDUCATION AND PILATES - DR. LINTON FRAZIERHERNIA SCREENINGINDIANA CHAMBER OF COMMERCE WOMEN'S SUMMITINDIANA COUNTY FAIR IUP HEALTH FAIRJOURNEY TO LEANKIDS CAMPLISTEN TO YOUR HEART - HEART HEALTH SCREENINGLOVE OF LIFE 5K LUNG CANCER SCREENING DAY MENTAL HEALTH & DIABETESPAD VASCULAR WALKPARKINSON SUPPORT GROUP EDUCATIONPERSONAL CARE HOME TRAININGPROSTATE SCREENINGSENIOR EXPOSMOKING CESSATION PROGRAMSTF WALK FOR A WONDERFUL LIFE STROKE EDUCATION EVENTTOUCHDOWN FOR HEALTH ORTHOPEDIC EDUCATIONUNTIL THERE'S A CURE - WOMEN'S CANCER EDUCATIONWALK WITH THE DOCSWEIGHT LOSS SUPPORT GROUPWOMEN'S HEALTH MAMMO GLAM PREVENTIVE HEALTH SERVICES, GENERAL/OTHER: 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. 200467145 1 1 0 1 0 0 0 0 0 0 1 1 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 220 0 1264 1 1 1 0 0 0 0 0 0 0 1 0 X 13 8 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 PA X MICHAEL F ICKOWSKI CFO 7243577008 835 HOSPITAL ROAD INDIANA PA 15701 NATHAN KOVALCHICK CHAIRMAN 1.00 1.00 X X 0 0 0 T MICHAEL PRICE VICE CHAIRMAN 1.00 1.00 X X 0 0 0 FRANK ROBERTS SECRETARY 1.00 1.00 X X 0 0 0 REBECCA STAPLETON TREASURER 1.00 X X 0 0 0 STEPHEN A WOLFE PRESIDENT & CEO 34.00 6.00 X X 1005085 0 53066 TODD BRICE BOARD MEMBER 1.00 1.00 X 0 0 0 HILLIARY CREELY BOARD MEMBER 1.00 1.00 X 0 0 0 RUSSELL A DROZDIAK MD BOARD MEMBER 40.00 1.00 X 175349 0 4882 LAURIE A KUZNESKI BOARD MEMBER 1.00 X 0 0 0 CHRISTINA B LUBOLD MD BOARD MEMBER 5.00 X 37920 0 0 JAMES R MARTIN BOARD MEMBER 1.00 1.00 X 0 0 0 TIMOTHY CLARK SIMPSON MD BOARD MEMBER 1.00 39.00 X 0 651049 23631 MATTHEW N KLAIN MD BOARD MEMBER 1.00 X 0 0 0 MICHAEL F ICKOWSKI CHIEF FINANCIAL OFFICER 34.00 6.00 X 408665 0 4417 RICHARD NEFF MD CHIEF MEDICAL OFFICER 34.00 6.00 X 426758 0 34734 BRETT BRAUN CHIEF OPERATING OFFICER (UNTIL 05/2024) 34.00 6.00 X 0 129753 18124 WENDY HAISLIP CHIEF NURSING OFFICER 34.00 6.00 X 219282 0 27279 JAMES KINNEER CHIEF HUMAN RESOURCE OFFICER 20.00 20.00 X 266766 0 46745 MARK VOLOVIC CHIEF INFORMATION OFFICER 34.00 6.00 X 301517 0 43094 ADENIRAN HAASTRUP MD PHYSICIAN 40.00 X 689482 0 35068 TOLUTOPE OZAH MD PHYSICIAN 40.00 X 522743 0 32731 BENJAMIN L PARK DO PHYSICIAN 40.00 X 498762 0 29200 KYUNG PARK MD PHYSICIAN 40.00 X 509394 0 35779 GREGORY OLENIC MD PHYSICIAN 40.00 X 394781 0 33156 ROBERT A GONGAWARE FORMER CFO 0.00 0.00 X 238963 0 32038 5695467 780802 453944 93 1 1 0 MBM CONTRACTING 4999 OLD CLAIRTON ROAD PITTSBURGH PA 15236 BUILDING CONTRACTOR 14672239 HEALTHTRUST WORKFORCE SOLUTIONS PO BOX 742697 ATLANTA GA 30374 CONTRACTED LABOR 3550541 AHN HOSPITALISTS PO BOX 645948 CINCINNATI OH 45264 CONTRACTED LABOR 2573792 QUEST DIAGNOSTICS PO BOX 645740 PITTSBURGH PA 15264 DIAGNOSTIC SERVICES 1383719 CORROHEALTH 6509 WINDCREST DRIVE SUITE 165 PLANO TX 75024 CONTRACTED LABOR 1125303 31 5854830 7679374 13534204 NET PATIENT SVC REV 621990 244877298 244877298 HEALTH CLASSES/COUNSEL 624100 152370 152370 RENTAL REVENUE-AFFILIATES 531120 40942 40942 245070610 3868687 3868687 3015 3015 2613382 1214402 1398980 1398980 1398980 2625204 0 15415 2625204 -15415 2609789 2609789 MISCELLANEOUS 900099 3816784 3816784 PURCH DISC & REBATES 900099 1218987 1218987 CAFETERIA REV 900099 1030556 1030556 2904626 281526 2623100 8970953 275456238 245070610 281526 16569898 X 1962834 1962834 71858416 58876662 12981754 3333729 2664983 668746 14772985 11945569 2827416 5014925 4008931 1005994 940591 940591 1032403 1032403 240497 240497 75240 75240 303782 303782 41306238 33224436 8081802 806654 31379 775275 1685801 1651154 34647 4867825 1754364 3113461 2323818 1549504 774314 313264 173548 139716 45691 45691 2417337 2417337 9390039 8093732 1296307 3344862 2673883 670979 MEDICAL SUPPLIES 62214096 61007143 1206953 BAD DEBT EXPENSE 5610356 5610356 MA ASSESSMENT 4519508 3612895 906613 CLEANING SVCS & SUPPLIE 2567929 2052802 515127 5732346 4607892 1124454 246681166 200467145 46214021 0 7308 7408 3518242 14189836 27744526 39655414 2900875 2921967 2589002 3231482 255019192 134978323 108583988 120040869 86556463 84817312 18141126 17012587 551520 472146 13878489 15833318 264471539 298182339 35666902 49547138 30014102 28933951 17029509 16164197 36935904 46075199 119646417 140720485 X 127738706 150227683 17086416 7234171 144825122 157461854 264471539 298182339 X 28775072 2660246 -18798586 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 75240 0 1 7321 82561 0 PART II-B, LINE 1: THE MEDICAL CENTER IS A MEMBER OF NATIONAL AND STATE HOSPITAL AND HEALTHCARE ASSOCIATIONS THAT PERFORM LOBBYING ACTIVITIES. A PORTION OF THE DUES PAID TO THESE ORGANIZATIONS IS LISTED AS LOBBYING EXPENDITURES. 3282303 3282303 94253198 39874309 54378889 141073508 91469459 49604049 16410183 3634555 12775628 120040869 17012587 C 17012587 MALPRACTICE INSURANCE RECOVERIES 5491931 DEFERRED COMPENSATION 3229230 OTHER ASSETS 255247 OPERATING LEASE RIGHT OF USE ASSETS 4006337 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 2850573 15833318 ESTIMATED 3RD PARTY 1250000 OPERATING LEASE OBLIGATIONS 4088457 MALPRACTICE LIABILITY 7914893 PENSION LIABILITY 7427517 DEFERRED COMPENSATION LIABILITY 502783 CAPITAL LEASE OBLIGATIONS 4447334 CONTRACT LIABILITIES 14944215 LINE OF CREDIT 5500000 46075199 X 266660357 2660246 2263136 4923382 261736975 13719263 13719263 275456238 241981430 1214402 1214402 240767028 5914138 5914138 246681166 PART X, LINE 2: INDIANA REGIONAL MEDICAL CENTER IS A TAX-EXEMPT ORGANIZATION AND NOT SUBJECT TO FEDERAL OR STATE INCOME TAXES IN ACCORDANCE WITH SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. ON SUCH BASIS, IT WILL NOT INCUR ANY LIABILITY FOR INCOME TAXES, EXCEPT FOR POSSIBLE UNRELATED BUSINESS INCOME. MANAGEMENT ANNUALLY REVIEWS ITS TAX PROVISIONS AND HAS DETERMINED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS THAT REQUIRE RECOGNITION IN THE CONSOLIDATED FINANCIAL STATEMENTS. PART XI, LINE 2D - OTHER ADJUSTMENTS: NET ASSETS RELEASED 1,048,734. RENTAL EXPENSES 1,214,402. PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBTS NETTED AGAINST REVENUE ON FINANCIALS 5,610,356. INVESTMENT MGT. FEES NETTED AGAINST REVENUE ON FINANCIALS 303,782. RESTRICTED CONTRIBUTIONS 7,571,125. RESTRICTED GRANTS 234,000. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 1,214,402. PART XII, LINE 4B - OTHER ADJUSTMENTS: INVESTMENT MANAGEMENT FEES NETTED AGAINST REVENUE ON FINANCIALS 303,782. BAD DEBTS NETTED AGAINST REVENUE ON FINANCIALS 5,610,356. 1 1 X 1 X 1 X 1 1 0 1 1 985747 985747 0.00410 30439775 14100978 16338797 0.06780 31425522 14100978 17324544 0.07190 802808 98375 704433 0.00290 2943477 2085613 857864 0.00360 3746285 2183988 1562297 0.00650 35171807 16284966 18886841 0.07840 1 5608000 32521399 29567247 2954152 X 1 1 1 COSM REALTY GROUP LTD REAL ESTATE 0.40000 0.00000 0.30000 2 INDIANA REHABILITATION SERVICES REHABILITATION SERVICES 0.51000 0.00000 0.49000 1 1 INDIANA REGIONAL MEDICAL CENTER 835 HOSPITAL ROAD INDIANA PA 15701 WWW.INDIANARMC.ORG 090701 X X X X URGENT CARE FACILITY; OFFSITE TESTING CENTERS INDIANA REGIONAL MEDICAL CENTER 1 0 0 1 X X X X X X X X X 24 1 1 0 1 X IRMC.ORG/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT X PAH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT X 1 24 1 IRMC.ORG/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ 0 1 X 100.000000000000 400.000000000000 X X X X X 1 1 X X X X 1 X HTTPS://WWW.IRMC.ORG/PATIENTS-AND-VISITORS/FINANCIAL-SERVICES/ X HTTPS://WWW.IRMC.ORG/PATIENTS-AND-VISITORS/FINANCIAL-SERVICES/ X HTTPS://WWW.IRMC.ORG/PATIENTS-AND-VISITORS/FINANCIAL-SERVICES/ X X X X X X 1 X 0 X X X 1 X 0 0 INDIANA REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 5: IN THE FALL OF 2020, INDIANA REGIONAL MEDICAL CENTER (IRMC) AND PUNXSUTAWNEY AREA HOSPITAL (PAH) FORMALIZED A COLLABORATION UNDER ONE GOVERNING BOARD OF DIRECTORS CALLED THE PENNSYLVANIA MOUNTAINS CARE NETWORK (PMCN). THIS COLLABORATION HELPS TO SUSTAIN A HIGH LEVEL OF PATIENT CARE RESIDENTS ALREADY RECEIVE IN BOTH INDIANA AND JEFFERSON COUNTY. THE HOSPITALS WORKED WITH A CONSULTING FIRM, STRATEGY SOLUTIONS, INC. (SSI), A PLANNING AND RESEARCH FIRM TO CONDUCT ITS CHNA. THE CHNA TOOK INTO ACCOUNT INPUT FROM THOSE WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITIES SERVED BY INDIANA REGIONAL MEDICAL CENTER (IRMC) AND PUNXSUTAWNEY AREA HOSPITAL (PAH), INCLUDING THOSE WITH KNOWLEDGE OF PUBLIC HEALTH, THE MEDICALLY UNDERSERVED, AND POPULATIONS WITH CHRONIC DISEASE. THE 2024 IRMC AND PAH CHNA WAS CONDUCTED TO IDENTIFY PRIMARY HEALTH ISSUES, CURRENT HEALTH STATUS AND NEEDS TO PROVIDE CRITICAL INFORMATION TO THOSE IN A POSITION TO MAKE A POSITIVE IMPACT ON THE HEALTH OF THE REGION'S RESIDENTS. THE RESULTS ENABLE COMMUNITY MEMBERS TO MORE STRATEGICALLY ESTABLISH PRIORITIES, DEVELOP INTERVENTIONS, AND DIRECT RESOURCES TO IMPROVE THE HEALTH OF PEOPLE LIVING IN THE COMMUNITY. TO GUIDE THIS ASSESSMENT, THE LEADERSHIP AT IRMC AND PAH FORMED A STEERING COMMITTEE THAT CONSISTED OF HOSPITAL AND COMMUNITY LEADERS WHO REPRESENTED THE BROAD INTERESTS OF THEIR LOCAL REGION. THESE INCLUDED REPRESENTATIVES WHO UNDERSTOOD THE NEEDS AND ISSUES RELATED TO VARIOUS UNDERREPRESENTED GROUPS INCLUDING MEDICALLY UNDERSERVED POPULATIONS, LOW-INCOME PERSONS, MINORITY GROUPS, AND THOSE WITH CHRONIC DISEASE NEEDS, INDIVIDUALS WITH EXPERTISE IN PUBLIC HEALTH, AND INTERNAL PROGRAM MANAGERS. THE IRMC AND PAH STEERING COMMITTEE MET TWICE BETWEEN MARCH 2024 AND APRIL 2024 TO PROVIDE GUIDANCE ON THE VARIOUS COMPONENTS OF THE CHNAA COMMUNITY SURVEY WAS MODELED AFTER THE SURVEY USED IN THE 2021 CHNA PROCESS. THE SURVEY WAS LAUNCHED ON FEBRUARY 13, 2024, AND REMAINED OPEN UNTIL APRIL 11, 2024. THE SURVEY LINK WAS SENT VIA EMAIL TO HOSPITAL AND PHYSICIANS' GROUP PATIENTS AND EMPLOYEES, STEERING COMMITTEE MEMBERS, AND POSTED VIA SEVERAL SOCIAL MEDIA AND OTHER DIGITAL PLATFORMS. PAPER COPIES WERE ALSO AVAILABLE AT SELECT COMMUNITY LOCATIONS. A TOTAL OF 944 SURVEYS WERE COMPLETED WITHIN IRMC AND PAH'S SERVICE AREA. INDIANA REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 6A: THE COMMUNITY NEEDS ASSESSMENT SERVED PUNXSUTAWNEY AREA HOSPITAL AND INDIANA REGIONAL MEDICAL CENTER. INDIANA REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 11: IRMC WILL FOCUS ON ADDRESSING THE HIGHEST PRIORITY ISSUES IDENTIFIED IN THE NEEDS ASSESSMENT. APPROPRIATE RESOURCES WILL BE ALLOCATED TO ACHIEVE HEALTH IMPROVEMENT GOALS RELATED TO THE PRIORITY ISSUES.GOAL 1: IMPROVE HEALTH STATUS BY INCREASING PARTICIPATION IN EDUCATION AND WELLNESS, FOCUSING ON OVERWEIGHT/OBESITY AND PHYSICAL ACTIVITY AND EXERCISE 1. CONTINUE TO OFFER BWELL WELLNESS PROGRAM TO IRMC EMPLOYEES AND COMMUNITY PARTNERS 2. PROMOTE HEALTH AND WELLNESS TO THE COMMUNITY AT-LARGEGOAL 2: IMPROVE THE HEALTH STATUS OF INDIVIDUALS LIVING WITH HEART DISEASE AND DIABETES 1. REDUCE RISK FOR HEART DISEASE 2. HELP PATIENTS MANAGE HEART DISEASE 3. PROVIDE COMMUNITY RESOURCES AND SUPPORTS AROUND DIABETES EDUCATION AND MANAGEMENTGOAL 3: INCREASE ACCESS TO PREVENTATIVE CARE AND SCREENINGS 1. IRMC EMPLOYEES WILL RECEIVE PREVENTATIVE CARE SCREENINGS 2. HELP INCREASE COMMUNITY ACCESS TO SCREENINGS 3. SUPPORT COMMUNITY EDUCATION EVENTSGOAL 4: INCREASE ACCESS TO MENTAL HEALTH SERVICES AND SUPPORTS 1. EXPAND SERVICES THROUGH IRMC'S INTEGRATED BEHAVIORAL HEALTH BUILDING 2. SERVE COMMUNITY NEED BY IMPLEMENTING A BH OUTREACH PROGRAM TO CONNECT EMERGENCY DEPARTMENT BH PATIENTS WITH OUTPATIENT 3. PROVIDE EDUCATION AND OUTREACH 4. ONLINE RESOURCES MADE AVAILABLE THROUGH THE HOSPITAL'S WEBPAGE 5. MAKE RESOURCES AVAILABLE IN COMMUNITYGOAL 5: DECREASE DRUG AND ALCOHOL USE IN INDIANA COUNTY BY COLLABORATING WITH THE ARMSTRONG-INDIANA-CLARION DRUG & ALCOHOL COMMISSION ON PREVENTION, EDUCATION, INTERVENTION, AND TREATMENT STRATEGIES 1. CONTINUE TO PARTNER WITH THE ARMSTRONG-INDIANA-CLARION DRUG AND ALCOHOL COMMISSION AND ARMOT (ADDICTION RECOVERY MOBILE OUTREACH TEAM), OVERDOSE TASK FORCE AND DRUG FREE COMMUNITY COALITION 2. INCREASE REFERRALS OF PATIENTS WHO PRESENT IN ED TO ARMOT AND OTHER COMMUNITY AGENCIES 3. EDUCATE STAFF, PROVIDERS, AND THE BROADER COMMUNITY IN AN EFFORT TO REDUCE THE STIGMA AROUND SUBSTANCE USE 4. INCREASE ACCESS TO INPATIENT REHAB 5. INCREASE COMMUNITY ACCESS TO NARCANAS WITH MOST HEATH CARE FACILITIES, IRMC HAS LIMITED FINANCIAL RESOURCES TO ADDRESS ALL ISSUES. INDIANA REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 16J: DIRECT MAILING TO THE COMMUNITY. 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 AND AS CALCULATED AND REPORTED ON THE MEDICARE COST REPORT. COMMUNITY PROGRAMS ARE RECORDED IN SPECIFIC GENERAL LEDGER COST CENTERS AND STRUCTURE ON THE COMMUNITY BENEFIT FORMS WITH NUMBER OF PERSONS SERVED. PART I, LINE 7G: NO COSTS ATTRIBUTABLE TO A PHYSICIAN CLINIC WERE INCLUDED IN THE AMOUNT ON PART I, LINE 7G. PART I, LN 7 COL(F): 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 $5,608,000. PART II, COMMUNITY BUILDING ACTIVITIES: 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, ENHANCES HEALTH OF THE COMMUNITY WE SERVE, PROVIDES ADVANCED MEDICAL OR HEALTHCARE KNOWLEDGE AND RELIEVES SOME OF THE FINANCIAL OR PROGRAMMATIC BURDEN OF GOVERNMENT ON 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 VARIOUS OUTLYING AREAS IN INDIANA COUNTY, INCLUDING STRONGSTOWN, SHELOCTA, BLACKLICK, AND SMICKSBURG. WE ALSO CONTINUE TO PARTICIPATE IN NUMEROUS FREE COMMUNITY EVENTS PROVIDING EDUCATION, SCREENING PROGRAMS, SOCIAL SERVICES, AND FIRST AID SERVICES. OVER THE PAST YEAR, THE MOBILE MEDICAL HEALTH AND/OR COMMUNITY PROGRAMS LOGGED OVER 2,000 PARTICIPANTS.WE ALSO PROVIDE NUMEROUS HEALTH FAIRS REACHING ALMOST 2,000 PARTICIPANTS, AND CLASSES AND EDUCATION PROGRAMS WITH OVER 2,000 PARTICIPANTS. A FEW OF THE FAIRS OR SERVICES PROVIDED ARE: FREE PROSTATE SCREENING, SKIN CANCER SCREENING, WEIGHT CHECKS, ORTHOPEDIC/JOINT REPLACEMENT SEMINAR, BREAST HEALTH SEMINAR, DIABETES EDUCATION PROGRAMS, PHYSICIAN/PROVIDER COMMUNITY MEET AND GREET, BARIATRIC SURGERY SEMINAR, WEIGHT LOSS SUPPORT GROUP, BREAST CANCER SUPPORT GROUP, COMMUNITY CHOLESTEROL SCREENING, COLORECTAL CANCER EVENT, BARIATRIC SURGERY SUPPORT GROUP, STROKE EDUCATION EVENT, HEALTHY KIDS CAMP, HEALTHY KIDS DAY, "BIKE TO SCHOOL" (SAFETY FOR CHILDREN), LUNCH AND LEARN FOR KEYSTONE GENERATING STATION, LUNCH AND LEARN FOR MOOREHEAD PLACE, SERVICES AT LOCAL SENIOR CENTERS, IRMC PARK EVENTS, AS WELL AS NUMEROUS OTHERS. THE INSTITUTE FOR HEALTHY LIVING AT INDIANA REGIONAL MEDICAL CENTER OFFERS HEALTH SERVICES AND EDUCATION PROGRAMS TO THE COMMUNITY AT NO CHARGE.THE DIABETES EDUCATION CENTER CONTINUES TO OFFER FREE EDUCATION SERVICES AT VARIOUS LOCATIONS THROUGHOUT THE COUNTY. EACH MONTH STAFF AND MANAGEMENT AT IRMC PROVIDE SUPPORT TO A LOCAL FOOD BANK (ICAAP). THE DIABETES EDUCATION CENTER PROVIDES DIABETIC COMPETENCY TRAININGS FOR EMPLOYEES OF PERSONAL CARE HOMES, ASSISTED LIVING FACILITIES AND HOME HEALTH AGENCIES. CENTER ALSO PROVIDES COMMUNITY SUPPORT PROGRAMS AT NO COST FOR INSULIN PUMP TRAINING, GLUCOSE MONITORING, AND MORE. PREVENTIVE HEALTH SERVICES - M. DORCAS CLARK WOMEN'S IMAGING CENTER/COMPREHENSIVE BREAST 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. WEIGHT LOSS SUPPORT SERVICES THE IRMC WEIGHT MANAGEMENT & BARIATRIC SURGERY INSTITUTE OPENED IN 2021. INSTITUTE FOR HEALTHY LIVING'S REGISTERED DIETITIANS ARE DEPLOYED TO THE INSTITUTE TO MEET WITH PATIENTS ON ONE AS PART OF THEIR PRE-SURGICAL REQUIREMENTS. REGISTERED DIETITIANS ALSO SUPPORT PATIENTS BY LEADING BARIATRIC SUPPORT GROUPS AND INFORMATIONAL SESSIONS. IRMC'S CONGESTIVE HEART FAILURE PROGRAM SUPPORTS PATIENTS WITH CARDIAC MONITORING.SUPPORT HEALTH GROUPSFAMILY PROGRAMS BREASTFEEDING BASICS, CHILDBIRTH PREP, NEWBORN BASICSCOMMUNITY CLASSES POP PILATES, JOURNEY TO LEAN, WALK WITH A DOC, AND THOSE LISTED ABOVEIN 2009, INDIANA REGIONAL MEDICAL CENTER OPENED A NEW FACILITY OFFERING URGENT CARE SERVICES IN THE BLAIRSVILLE COMMUNITY AS A RESPONSE TO MEDICAL SERVICES NEEDED IN THAT AREA. THIS FACILITY IS 12 MILES FROM THE HOSPITAL CAMPUS.IN 2012, INDIANA REGIONAL MEDICAL CENTER OPENED ITS SECOND URGENT CARE FACILITY TO SERVICE THE PRIMARY MARKET SHARE WHERE THERE WAS A NOTED DEMAND FOR THESE SERVICES. THE URGENT CARE CENTERS REQUIRE ADDITIONAL STAFFING ON BEHALF OF THE HOSPITAL AS IT IS A NEW/ADDED LOCATION; HOWEVER, THESE FACILITIES SIGNIFICANTLY IMPROVE THE CYCLE TIME OF THE PATIENT THROUGHOUT AND SERVICES FOR THE NON-EMERGENT SERVICES NEEDED. PART III, LINE 2: THE AMOUNT REPORTED IN PART III, LINE 2 IS ACTUAL BAD DEBTS (AT NET, NOT GROSS CHARGES) FOR THE YEAR. PART III, LINE 3: THE AMOUNT REPORTED IN PART III, LINE 3 IS DERIVED BY USING THE MEDICARE COST TO CHARGE RATIO FROM THE COST REPORT.A PORTION OF THE BAD DEBT SHOULD BE INCLUDED AS COMMUNITY BENEFIT AS THE HOSPITAL IS NOT ABLE TO DENY SERVICES TO ANY PATIENT PRESENTING TO THE EMERGENCY DEPARTMENT, REGARDLESS IF THE PATIENTS HAVE THE MEANS TO PAY. THE DEDUCTIBLE AND CO-INSURANCE BALANCES THAT ARE NOT PAID REDUCE THE NET REVENUES DUE TO THE HOSPITAL AS PART OF THE RESPECTIVE PATIENT'S INSURANCE COVERAGE. IN ADDITION, THERE IS A "COST" TO THE HOSPITAL FOR TREATING ALL PATIENTS. AS WITH THE UNREIMBURSED AMOUNTS OF THE MEDICAID PATIENT SERVICES, THE HOSPITAL SHOULD BE ABLE TO INCLUDE THE UNREIMBURSED COSTS OF THE SERVICES THAT RESULTED IN NO PAYMENT. PART III, LINE 4: THE FOLLOWING IS THE TEXT OF THE FOOTNOTE FROM THE AUDITED FINANCIAL STATEMENTS THAT DESCRIBES BAD DEBT EXPENSE: PATIENTS ACCOUNTS RECEIVABLE ARE RECORDED AT NET REALIZABLE VALUE AT THE TRANSACTION PRICE BASED ON STANDARD CHARGES FOR SERVICES PROVIDED, REDUCED BY CONTRACTUAL ADJUSTMENTS PROVIDED TO THIRD-PARTY PAYORS, DISCOUNTS PROVIDED TO UNINSURED OR UNDERINSURED PATIENTS IN ACCORDANCE WITH ORGANIZATION'S POLICIES, AND/OR IMPLICIT PRICE CONCESSIONS PROVIDED TO UNINSURED OR UNDERINSURED PATIENTS AND DO NOT BEAR INTEREST. SUBSEQUENT CHANGES TO THE ESTIMATE OF THE TRANSACTION PRICE ARE GENERALLY RECORDED AS ADJUSTMENTS TO PATIENT REVENUES IN THE PERIOD OF THE CHANGE. PART III, LINE 8: 100% OF THE SHORTFALL IS A COMMUNITY BENEFIT. THE MEDICARE PROGRAM WAS DESIGNED TO COVER THE COSTS OF THE HOSPITALS USING THE COST BASE YEAR(S). IRMC IS A VERY LOW COST PROVIDER AND IS NOT ABLE TO COVER COSTS SINCE THE SEQUESTRATION REDUCTION, THE LESS ALL THE OTHER DOWNWARD ADJUSTMENTS TO THE NET MBI WHILE THE COSTS OF DRUGS, SUPPLIES, IMPLANTS, CLINCAL STAFF AND HEALTH BENEFITS CONTINUE TO INCREASE 5-20%. IRMC IS A SOLE COMMUNITY PROVIDER NOT RECEIVING SUFFICIENT SCH ADD ON TO COVER COSTS FOR ALL CARE NEEDED (BASE YEAR WAS TOO LONG AGO AND NOT AS RELEVANT TO CURRENT COSTS) TO BE PROVIDED AS THE ONLY PROVIDER IN THE DEFINED GEOGRAPHICAL AREA. ACTUAL AMOUNTS PER THE MEDICARE COST REPORT THAT DETERMINE THE REIMBURSEMENTS, PAYMENTS RECEIVED (THUS SETTLEMENTS) AND COSTS. PART III, LINE 9B: PATIENTS ARE EXPECTED TO PAY ALL BALANCES IN FULL WITHIN FIFTEEN DAYS OF A FINAL BILLING. IF THIS IS NOT POSSIBLE, PATIENTS WILL BE COUNSELED ON THE USE OF MEDICAL ASSISTANCE OR THE INDIANA CHARITY CARE PROGRAM, I-CARE.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. A LISTING OF ACCOUNTS WHICH HAVE BEEN BILLED TO MEDICAL ASSISTANCE AS A SECONDARY PAYOR ARE REVIEWED BY 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 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.THE IRMC COLLECTION POLICY CONTAINS PROVISIONS TO PROVIDE A SOFTER APPROACH FOR THOSE THAT IRMC HAS LEARNED WOULD QUALIFY FOR FINANCIAL ASSISTANCE. UPON RECEIPT OF THE CALL FROM THE PATIENT THAT THERE IS HARDSHIP IN PAYING THE BILL, THE IRMC COLLECTION REPRESENTATIVE SHARES THE INFORMATION FOR APPLICATION FOR BOTH MEDICAL ASSISTANCE AND CHARITY CARE. WHILE THE PATIENT'S ACCOUNT IS IN THIS PROCESS, THEIR ACCOUNT WILL NOT BE PROVIDED TO THE COLLECTION AGENCY. PART VI, LINE 2: THE IRMC CHNA WAS CONDUCTED TO IDENTIFY PRIMARY HEALTH ISSUES, CURRENT HEALTH STATUS, AND HEALTH NEEDS TO PROVIDE CRITICAL INFORMATION TO THOSE IN A POSITION TO MAKE A POSITIVE IMPACT ON THE HEALTH OF THE REGION'S RESIDENTS. THE RESULTS ENABLE COMMUNITY MEMBERS TO MORE STRATEGICALLY ESTABLISH PRIORITIES, DEVELOP INTERVENTIONS, AND DIRECT RESOURCES TO IMPROVE THE HEALTH OF PEOPLE LIVING IN THE COMMUNITY.TO GUIDE THIS ASSESSMENT, THE LEADERSHIP AT IRMC FORMED A STEERING COMMITTEE THAT CONSISTED OF HOSPITAL AND COMMUNITY LEADERS WHO REPRESENTED THE BROAD INTERESTS OF THEIR LOCAL REGION. THESE INCLUDED REPRESENTATIVES WHO UNDERSTOOD THE NEEDS AND ISSUES RELATED TO VARIOUS UNDERREPRESENTED GROUPS INCLUDING MEDICALLY UNDERSERVED POPULATIONS, LOW-INCOME PERSONS, MINORITY GROUPS, AND THOSE WITH CHRONIC DISEASE NEEDS, INDIVIDUALS WITH EXPERTISE IN PUBLIC HEALTH, AND INTERNAL PROGRAM MANAGERS. THE IRMC STEERING COMMITTEE MET TWO TIMES BETWEEN MARCH 2021 AND APRIL 2021 TO PROVIDE GUIDANCE ON THE VARIOUS COMPONENTS OF THE CHNA.SEE PART V OF SCHEDULE H FOR FURTHER DISCUSSION ON NEEDS ASSESSMENT. PART VI, LINE 3: AT REGISTRATION, PATIENTS WITHOUT INSURANCE ARE PHYSICALLY PROVIDED INFORMATION ABOUT MEDICAID AND OUR CHARITY CARE POLICY AND ENCOURAGED TO ENROLL (WE ARE AVAILABLE TO ASSIST THE CUSTOMER WITH ENROLLMENT). SIGNAGE IS ALSO POSTED THROUGHOUT THE FACILITY OUTLINING OUR CHARITY CARE PROGRAM. ALSO, ALL PATIENT STATEMENTS REFLECT INFORMATION ABOUT FINANCIAL ASSISTANCE PROGRAMS AVAILABLE TO THE PATIENTS. CHARITY CARE INFORMATION IS ALSO REFERENCED ON THE HOSPITAL'S WEB SITE. PART VI, LINE 4: THE POPULATION IN INDIANA COUNTY HAS BEEN DECREASING AND IS PROJECTED TO CONTINUE TO DECREASE INTO 2026. THE POPULATION IS PREDOMINATELY CAUCASIAN (94.3%) AND THERE IS A COMPARABLE NUMBER OF MALES (50.1%) AND FEMALES (49.9%). THE MEDIAN AGE IS 40.2 AND IS PROJECTED TO REMAIN STEADY OVER THE NEXT FIVE YEARS. JUST UNDER HALF OF THE POPULATION IS MARRIED (47.1%), WHILE 9.1% ARE DIVORCED AND 5.6% ARE WIDOWED. ONE IN TEN RESIDENTS (9.7%) DID NOT GRADUATE HIGH SCHOOL, WHILE 42.7% ARE HIGH SCHOOL OR EQUIVALENT GRADUATES. ONE IN TEN (11.0%) HAVE AN ADVANCED DEGREE. THE AVERAGE HOUSEHOLD INCOME IS $65,781, WITH A MEDIAN INCOME OF $50,130. MOST OF THE LABOR FORCE IS EMPLOYED (94.1%), WITH APPROXIMATELY HALF OF THOSE EMPLOYED HOLDING WHITE COLLAR OCCUPATIONS (49.2%). PART VI, LINE 5: IN THE MID-NINETIES, HOSPITALS AND HEALTHCARE FACILITIES BEGAN TO SHIFT THEIR ATTENTION FROM JUST SICK OR HOSPITAL BASED CARE TO INCLUDE ADDRESSING COMMUNITY HEALTH AND DISEASE PREVENTION. AS A FIRST STEP IN THAT DIRECTION, IRMC FORMED A COMMUNITY SERVICE DEPARTMENT WHOSE PURPOSE WAS TO DELIVER EDUCATION AND PREVENTATIVE SCREENINGS TO THE COMMUNITY-AT-LARGE. IN 2005, REALIZING THAT ALMOST EVERY DEPARTMENT IN THE HOSPITAL HAD OPPORTUNITIES TO PROMOTE HEALTH AND WELLNESS, IRMC CREATED THE INSTITUTE FOR HEALTHY LIVING, A VIRTUAL ORGANIZATION COORDINATING ALL ASPECTS OF COMMUNITY OUTREACH AND HEALTH IMPROVEMENT. IMPROVING AND SUSTAINING COMMUNITY HEALTH, HOWEVER, IS A COLLABORATIVE ENDEAVOR THAT INTEGRATES AS MANY KEY STAKEHOLDERS AS POSSIBLE. IN THAT REGARD, IRMC SPEARHEADED THE FORMATION OF THE INDIANA COUNTY COMMUNITY HEALTH ADVISORY COUNCIL (CHAC), AN ENTERPRISE REPRESENTING MEMBERS FROM VARIOUS COMMUNITY AGENCIES, ORGANIZATIONS AND SCHOOLS WHOSE PURPOSE IT IS TO IDENTIFY HEALTH NEEDS IN OUR COUNTY AND TO FIND WAYS TO MEET THEM. THE CHAC HAS BEEN ACTIVE SINCE 1996 AND IRMC SERVES AS ITS BASE AND CHAIRMANSHIP. INDIANA REGIONAL MEDICAL CENTER USES ITS OWN FUNDS TO ENHANCE BOTH THE CLINICAL STRATEGIES AND THE COMMUNITY STRATEGIES.CLINICAL STRATEGIES (A FEW EXAMPLES): RECRUITING ADDITIONAL PHYSICIANS FOR IDENTIFIED COMMUNITY NEEDS, EXPLORE DEVELOPMENT OF A FAMILY PRACTICE RESIDENCY PROGRAM TO FACILITATE RECRUITMENT AND RETENTION, ENLARGE THE MEDICAL FITNESS CENTER, ESTABLISH A WEIGHT LOSS TASK FORCE, DEVELOP A MEDICAL WEIGHT MANAGEMENT CENTER, PROVIDE FLU SHOTS TO ALL INPATIENTS DURING FLU SEASON, PROVIDE PNEUMONIA VACCINE TO ALL NON-VACCINATED INPATIENTS, ETC. COMMUNITY STRATEGIES (A FEW EXAMPLES): PARTNER WITH AGENCIES PROVIDING SERVICES AND EDUCATION TO YOUNG TEENS AND WOMEN, EVALUATE A PARTNERSHIP WITH EARLY HEAD START, IMPROVE VISIBILITY AND INFORMATION AVAILABLE ABOUT THE OB/GYN CLINIC, WORKED TO ESTABLISH PRACTICES IN THE MORE RURAL AREAS OF THE COUNTY THAT REQUIRE THE MEDICAL CENTER TO SUBSIDIZE DELIVERING CARE THERE, ESTABLISHED THE INDIANA AT CHESTNUT RIDGE FACILITY THAT OFFERS PRIMARY CARE AND URGENT-CARE AND WAS A SIGNIFICANT CAPITAL INVESTMENT, IMPLEMENT A PATIENT PORTAL TO IMPROVE PATIENT ACCESS TO MEDICAL RECORDS, BECAME A PROVIDER OF THE WE CAN! (WAYS TO ENHANCE CHILDREN'S ACTIVITY AND NUTRITION), PARTNERED WITH 7 ELEMENTARY SCHOOLS TO INSTALL PROJECT FIT AMERICA, IMPLEMENTED GROCERY STORE TOURS TO ASSIST PEOPLE WITH SEEKING HEALTHY CHOICES, PARTNER WITH 4 GROCERY STORES TO HAVE A DIETICIAN AVAILABLE TO HELP SHOPPERS MAKE HEALTHY CHOICES, CONDUCT THE ANNUAL "VACCINE FOR VETERANS" PROGRAM ON VETERANS DAY, EVALUATE THE POTENTIAL FOR PUBLIC PNEUMONIA VACCINE CLINICS, CONTINUE TO PROVIDE FREE FLU AND PNEUMONIA VACCINE TO HIGH-RISK, LOW INCOME RESIDENTS, ETC. PART VI, LINE 6: 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. PART VI, LINE 7: N/A X 1 1 X X X X 0 1 0 0 0 0 0 0 0 STEPHEN A WOLFE PRESIDENT & CEO 666004 0 42188 0 296893 0 31050 0 22016 0 1058151 0 0 0 ADENIRAN HAASTRUP MD PHYSICIAN 472749 0 62500 0 154233 0 11500 0 23568 0 724550 0 0 0 TIMOTHY CLARK SIMPSON MD BOARD MEMBER 0 620445 0 7604 0 23000 0 1846 0 21785 0 674680 0 0 TOLUTOPE OZAH MD PHYSICIAN 507158 0 15000 0 585 0 10715 0 22016 0 555474 0 0 0 KYUNG PARK MD PHYSICIAN 490533 0 15000 0 3861 0 14525 0 21254 0 545173 0 0 0 BENJAMIN L PARK DO PHYSICIAN 468806 0 15000 0 14956 0 7249 0 21951 0 527962 0 0 0 RICHARD NEFF MD CHIEF MEDICAL OFFICER 385637 0 15595 0 25526 0 11459 0 23275 0 461492 0 0 0 GREGORY OLENIC MD PHYSICIAN 382035 0 11400 0 1346 0 11140 0 22016 0 427937 0 0 0 MICHAEL F ICKOWSKI CHIEF FINANCIAL OFFICER 391262 0 13688 0 3715 0 3230 0 1187 0 413082 0 0 0 MARK VOLOVIC CHIEF INFORMATION OFFICER 289202 0 10969 0 1346 0 19819 0 23275 0 344611 0 0 0 JAMES KINNEER CHIEF HUMAN RESOURCE OFFICER 254837 0 9413 0 2516 0 23470 0 23275 0 313511 0 0 0 ROBERT A GONGAWARE FORMER CFO 161006 0 75741 0 2216 0 21771 0 10267 0 271001 0 0 0 WENDY HAISLIP CHIEF NURSING OFFICER 207184 0 9582 0 2516 0 5561 0 21718 0 246561 0 0 0 RUSSELL A DROZDIAK MD BOARD MEMBER 155609 0 15431 0 4309 0 3747 0 1135 0 180231 0 0 0 PART I, LINE 1A INDIANA REGIONAL MEDICAL CENTER PAYS COUNTRY CLUB MEMBERSHIP DUES FOR THE PRESIDENT & CEO, WHICH IS NOT INCLUDED IN HIS COMPENSATION. THE MEMBERSHIP IS A CORPORATE MEMBERSHIP USED FOR BUSINESS PURPOSES ONLY. PART I, LINE 4B INDIANA REGIONAL MEDICAL CENTER HAS A SUPPLEMENTAL, NONQUALIFIED RETIREMENT PLAN UNDER IRC SECTION 457(F) FOR THE PRESIDENT & CEO AND KEY EMPLOYEES DURING THE CALENDAR YEAR 2024: - STEPHEN A. WOLFE: PAY OUTS TO HIM WERE $246,070, AND CONTRIBUTIONS TO THE PLAN WERE $101,252. - JAMES KINNER: NO AMOUNTS WERE PAID TO HIM, AND CONTRIBUTIONS TO THE PLAN WERE $37,651. - MARK VOLOVIC: NO AMOUNTS WERE PAID TO HIM, AND CONTRIBUTIONS TO THE PLAN WERE $43,876. INDIANA HEALTHCARE PHYSICIAN SERVICES HAS A 457(F) PLAN AVAILABLE FOR THEIR PHYSICIANS. FOLLOWING PHYSICIANS WERE MEMBERS OF THE PLAN DURING THE CALENDAR YEAR 2024: - DR. ADENIRAN HAASTRUP: PAY OUTS TO HIM WERE $130,355, AND CONTRIBUTIONS TO THE PLAN WERE $39,487 . A INDIANA COUNTY HOSPITAL AUTHORITY - SERIES 2018 251697319 2018-06-01 36200000 SEE PART VI 0 0 0 B INDIANA COUNTY HOSPITAL AUTHORITY - SERIES 2022 251697319 2022-06-27 18873900 REFINANCING OF 2014A BONDS 0 0 0 A 7000000 36200000 369993 35830007 2020 1 1 1 1 B 1921069 18873900 242897 18631003 2022 1 1 1 1 A 0 0 0 0 0 0 1 B 0 0 0 0 0 0 1 A 0 1 0 0 0 0 0 0 1 B 0 1 0 0 0 0 0 0 1 A 1 B 1 SCHEDULE K, PART I, BOND ISSUES: (A) ISSUER NAME: INDIANA COUNTY HOSPITAL AUTHORITY - SERIES 2018 (F) DESCRIPTION OF PURPOSE: PAYMENT OF 2009 S&T NOTE, 2011 DEBT, 2014B BONDS, 2014C NOTE, FINANCE CAPITAL PROJECTS, AND PAY ISSUANCE COSTS THERESA KINNEER FAMILY MEMBER OF JAMES KINNEER, KEY EMPLOYEE 35688 EMPLOYEE OF INDIANA REGIONAL MEDICAL CENTER 0 MATTHEW KLAIN BOARD MEMBER 961522 MATTHEW KLAIN IS A MEMBER OF THE IRMC BOARD. HE IS THE OWNER OF THE MATTHEW KLAIN GROUP WHICH IS COMPENSATED FOR PHYSICIAN SERVICES PROVIDED TO IRMC. 0 FORM 990, PART VI, SECTION A, LINE 6 PENNSYLVANIA MOUNTAINS CARE NETWORK ("PMCN") IS THE SOLE CORPORATE MEMBER OF INDIANA REGIONAL MEDICAL CENTER ("IRMC"). FORM 990, PART VI, SECTION A, LINE 7A THE INDIVIDUALS WHO SERVE AS DIRECTORS OF PMCN SHALL CONSTITUTE THE BOARD OF THIS CORPORATION. THEIR TERM OF OFFICE SHALL COINCIDE WITH THEIR TERM OF OFFICE AS DIRECTORS OF PMCN. RESIGNATION OR REMOVAL AS A DIRECTOR OF PMCN SHALL CONSTITUTE RESIGNATION OR REMOVAL AS A DIRECTOR OF THIS CORPORATION. FORM 990, PART VI, SECTION A, LINE 7B PMCN SHALL POSSESS ALL OF THE RIGHTS OF A MEMBER, AS DEFINED BY THE PENNSYLVANIA NONPROFIT CORPORATION LAW, AND SHALL EXERCISE THE FOLLOWING RESERVED POWERS WITH RESPECT TO THIS CORPORATION: (A) AMENDMENT TO THE ARTICLES OF INCORPORATION OR BYLAWS OF THIS CORPORATION; (B) THE SALE, LEASE OR EXCHANGE OF ALL OR SUBSTANTIALLY ALL THE PROPERTY OR ASSETS OF THIS CORPORATION; (C) MERGER OR CONSOLIDATION OF THIS CORPORATION WITH ANY OTHER CORPORATION; (D) DISSOLUTION OF THIS CORPORATION; (E) APPROVAL OF THE OPERATING AND CAPITAL BUDGETS FOR THIS CORPORATION; AND (F) ANY OTHER MATTER RELATING TO THIS CORPORATION THAT BY LAW REQUIRES THE APPROVAL OF THE MEMBERS OF A NONPROFIT CORPORATION. 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. PRIOR TO FILING, A DRAFT OF THE 990 WILL BE REVIEWED BY TOP MANAGEMENT AND WILL BE DISCUSSED AT A MEETING OF THE FINANCE COMMITTEE OF THE BOARD OF DIRECTORS. A FINAL DRAFT IS PROVIDED TO THE FULL BOARD OF DIRECTORS. 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. AN EXTERNAL CONSULTANT IS UTILIZED TO PREPARE COMPARATIVE SALARY DATA FOR THE BOARD'S REVIEW. ALL RECOMMENDATIONS ARE APPROVED BY IRMC'S 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. FORM 990, PART IX, LINE 11G PHYSICIANS FEES: PROGRAM SERVICE EXPENSES 18,703,660. MANAGEMENT AND GENERAL EXPENSES 4,539,362. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 23,243,022. CONSULTATION FEES: PROGRAM SERVICE EXPENSES 3,580,548. MANAGEMENT AND GENERAL EXPENSES 887,257. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,467,805. COLLECTIONS: PROGRAM SERVICE EXPENSES 1,179,594. MANAGEMENT AND GENERAL EXPENSES 286,287. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,465,881. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 5,449,729. MANAGEMENT AND GENERAL EXPENSES 1,322,644. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,772,373. PRINTING & MICROFILMING: PROGRAM SERVICE EXPENSES 43,580. MANAGEMENT AND GENERAL EXPENSES 10,577. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 54,157. OUTSIDE MEDICAL FEES: PROGRAM SERVICE EXPENSES 1,740,684. MANAGEMENT AND GENERAL EXPENSES 422,462. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,163,146. MAINTENANCE SERVICES: PROGRAM SERVICE EXPENSES 2,491,955. MANAGEMENT AND GENERAL EXPENSES 604,795. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,096,750. RECRUITMENT SERVICES: PROGRAM SERVICE EXPENSES 34,686. MANAGEMENT AND GENERAL EXPENSES 8,418. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 43,104. FORM 990, PART XI, LINE 9: TRANSFER (TO)/FROM AFFILIATES -20,438,367. CHANGE IN INTEREST IN INDIANA HEALTHCARE FOUNDATION -1,218,842. CHANGE IN PENSION AND POST-RETIREMENT LIABILITIES 2,851,717. OTHER CHANGES TO NET ASSETS 6,906. INDIANA JEFFERSON ONCOLOGY LLC 835 HOSPITAL ROAD INDIANA PA 15701 900406301 RADIATION ONCOLOGY SERVICES PA 501(C)(3) LINE 12A, I INDIANA REGIONAL MEDICAL CENTER 1 INDIANA TOTAL THERAPY INC 835 HOSPITAL ROAD INDIANA PA 15701 263843582 THERAPY SERVICES PA 501(C)(3) LINE 10 INDIANA HEALTHCARE PHYSICIAN SERVICES 0 INDIANA HEALTHCARE FOUNDATION 835 HOSPITAL ROAD INDIANA PA 15701 251574302 FUNDRAISING IN SUPPORT OF INDIANA REGIONAL MEDICAL CENTER PA 501(C)(3) LINE 12A, I INDIANA REGIONAL MEDICAL CENTER 1 INDIANA HEALTHCARE PHYSICIAN SERVICES INC 835 HOSPITAL ROAD INDIANA PA 15701 251842046 PROVIDE HEALTH CARE PA 501(C)(3) LINE 3 INDIANA REGIONAL MEDICAL CENTER 1 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 12A, I INDIANA REGIONAL MEDICAL CENTER 1 SPIRITLIFE INC 170 FR MARTIN TELENSON LANE PENN RUN PA 15765 463997001 DETOXIFICATION AND REHABILITATIVE SERVICES PA 501(C)(3) LINE 10 INDIANA REGIONAL MEDICAL CENTER 1 INDIANA AMBULATORY SURGICAL ASSOCIATES INC 835 HOSPITAL ROAD INDIANA PA 15701 232923182 AMBULATORY SURGERY PA 501(C)(3) LINE 12A, I INDIANA REGIONAL MEDICAL CENTER 1 PENNSYLVANIA MOUNTAINS CARE NETWORK 835 HOSPITAL ROAD INDIANA PA 15701 474638568 SUPPORT FOR HEALTHCARE ORGNAIZATIONS PA 501(C)(3) LINE 12A, I N/A 0 PUNXSUTAWNEY AREA HOSPITAL INC 81 HILLCREST DRIVE PUNXSUTAWNEY PA 15767 250965210 HOSPITAL PA 501(C)(3) LINE 3 PENNSYLVANIA MOUNTAINS CARE NETWORK 0 PUNXSUTAWNEY AREA HOSPITAL FOUNDATION 81 HILLCREST DRIVE PUNXSUTAWNEY PA 15701 932244487 TO SUPPORT THE HOSPITAL PA 501(C)(3) LINE 12A, I PUNXSUTAWNEY AREA HOSPITAL INC 0 PUNXSUTAWNEY MEDICAL SERVICES INC 81 HILLCREST DRIVE PUNXSUTAWNEY PA 15767 251773035 ANESTHESIA SERVICES PA 501(C)(3) LINE 3 PUNXSUTAWNEY AREA HOSPITAL INC 0 INDIANA SKILLED NURSING INC 835 HOSPITAL ROAD INDIANA PA 15701 992421431 SKILLED NURSING FACILITY PA 501(C)(3) LINE 10 INDIANA REGIONAL MEDICAL CENTER 1 ARMSTRONG COUNTY MEMORIAL HOSPITAL ONE NOLTE DRIVE KITTANNING PA 16201 250965237 HOSPITAL PA 501(C)(3) LINE 3 ARMSTRONG COUNTY MEMORIAL HOSPITAL 0 ACMH PHYSICIAN SERVICES ONE NOLTE DRIVE KITTANNING PA 16201 204648195 PRIMARY CARE PA 501(C)(3) LINE 3 ARMSTRONG COUNTY MEMORIAL HOSPITAL 0 ARMSTRONG HEALTH & EDUCATION FOUNDATION ONE NOLTE DRIVE KITTANNING PA 16201 251655867 FOUNDATION PA 501(C)(3) LINE 12A, I ARMSTRONG COUNTY MEMORIAL HOSPITAL 0 ARMSTRONG CENTER FOR MEDICINE & HEALTH ONE NOLTE DRIVE KITTANNING PA 16201 204648477 PARENT CORP. 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