2026-05-12T11:29:59-05:00 2025-06-30 390859910 BAKER TILLY ADVISORY GROUP LP 20 STANWIX STREET PITTSBURGH PA 15222 990 2024-07-01 250965210 PUNXSUTAWNEY AREA HOSPITAL INC PUNX 8149381800 81 HILLCREST DRIVE PUNXSUTAWNEY PA 15767 MICHAEL F ICKOWSKI CFO 8149381800 2026-05-07 1 1 KELLY A BROCIOUS P01254262 4126976400 2026-04-20 X 2024 2025-03-06 01:10:19Z JOHN G SISK 81 HILLCREST DRIVE PUNXSUTAWNEY PA 15767 72156742 0 X WWW.PAH.ORG X 1889 PA VALUED AS HIGHEST QUALITY COMMUNITY HOSPITAL IN THE REGION AND PRIMARY HEALTH CARE PROVIDER, COMMITTED TO CONTINUOUSLY IMPROVING SERVICES WHILE CONTAINING COST. 15 10 494 16 180545 0 339764 48426 55850184 70164897 805268 911678 623297 751486 57618513 71876487 0 0 0 0 26874054 37535563 0 0 0 21316912 28117517 48190966 65653080 9427547 6223407 68438199 76601235 34802719 35008658 33635480 41592577 X TO PROVIDE HIGH QUALITY, COST EFFECTIVE, PRIMARY HEALTH CARE AND TO COORDINATE CARE FOR PATIENTS REQUIRING SECONDARY AND TERTIARY SERVICES. 0 0 49044305 64004883 PUNXSUTAWNEY AREA HOSPITAL PROVIDES ACUTE CARE INPATIENT AND OUTPATIENT HEALTH CARE TO PATIENTS IN A THREE COUNTY AREA. FOR THE FISCAL YEAR ENDED; THERE WERE 1,298 ADMISSIONS TO THE ACUTE CARE SETTING THAT GENERATED 4,031 PATIENT DAYS. THE HOSPITAL ALSO PROVIDED 88,560 OUTPATIENT VISITS TO PATIENTS. ALSO, THE HOSPITAL PROVIDED OVER $930,373 OF CHARITY CARE FOR 1,418 CUSTOMER ENCOUNTERS WHERE THE PATIENT DID NOT HAVE THE MEANS TO PAY FOR SERVICES RENDERED. NO PATIENTS WERE TURNED AWAY FOR LACK OF INSURANCE. SERVICES PROVIDED INCLUDE CARDIOPULMONARY, CLINICAL NUTRITION, COUNSELING, EMERGENCY, INTENSIVE CARE, SURGICAL, PHARMACY, RADIOLOGY, REHABILITATION, AND SHORT PROCEDURE. 2844305 3745313 PUNXSUTAWNEY AREA HOSPITAL PROVIDES HOME HEALTH CARE TO PATIENTS IN A THREE COUNTY AREA. FOR THE FISCAL YEAR ENDED THERE WERE 20,215 HOME HEALTH VISITS PROVIDED. NO PATIENTS WERE TURNED AWAY FOR LACK OF INSURANCE. THE HOME HEALTH CARE STAFF IS DEDICATED TO PROVIDING THE HIGHEST QUALITY OF PROFESSIONAL HOME HEALTH CARE TO THE PATIENTS THEY SERVE. THE STAFF WORKS WITH EACH PATIENT'S PHYSICIAN TO DEVELOP A DETAILED PLAN OF CARE PERSONALIZED TO THE PATIENT AND FAMILY. PROFESSIONAL NURSES NOT ONLY PROVIDE DIRECT PATIENT CARE, BUT ALSO PROVIDE COUNSELING/EDUCATION IN MEDICATIONS, NUTRITION, AND SPECIFIC DISEASES.SEE SCHEDULE O FOR ADDITIONAL INFORMATION.THE CARE IF THE PROVISION OF SKILLED SERVICES NEEDED BY THE PATIENT ON A DAILY BASIS, ORDERED BY A PHYSICIAN, REQUIRING CARE FURNISHED DIRECTLY BY OR UNDER SUPERVISION OF TECHNICAL OR PROFESSIONAL PERSONNEL, NOT LIMITED TO REGISTERED NURSES, LICENSED PRACTICAL NURSES, SPEECH PATHOLOGISTS, PHYSICAL THERAPISTS, AND OCCUPATIONAL THERAPISTS. THE CARE INCLUDES SKILLED NURSING, SKILLED REHABILITATION, OR RESTORATIVE CARE THAT BECAUSE OF SPECIAL MEDICAL CONDITIONS REQUIRED THAT THE CARE BE MONITORED BY OR UNDER THE DIRECT OBSERVATION AND ASSESSMENT OF SKILLED NURSING OR REHABILITATION PERSONNEL. 547592 2414701 PUNXSUTAWNEY AREA HOSPITAL PROVIDES SKILLED NURSING SERVICES TO PATIENTS IN A THREE COUNTY AREA. FOR THE FISCAL YEAR ENDED THERE WERE 137 ADMISSIONS INTO THE LONG-TERM CARE UNIT WHICH GENERATED 1,803 PATIENT DAYS. NO PATIENTS WERE TURNED AWAY FOR LACK OF INSURANCE. THE SERVICE PROVIDES SUPERVISED NURSING CARE, MEDICAL, AND OTHER HEALTH SERVICES TO INDIVIDUALS NOT IN NEED OF ACUTE INPATIENT HOSPITALIZATION, BUT WHOSE NEEDS CAN ONLY BE MET IN A SKILLED CARE FACILITY ON AN INPATIENT BASIS BECAUSE OF AGE, ILLNESS, DISEASE, INJURY, CONVALESCENCE, OR PHYSICAL OR MENTAL INFIRMITY. SEE SCHEDULE O FOR ADDITIONAL INFORMATION.PROGRAM ACHIEVEMENTS:SPECIALTY NURSING PROGRAMS INCLUDE: MATERNAL/CHILD CARE, IV THERAPY ANDENTEROSTOMAL CARE. IN ADDITION TO PROFESSIONAL NURSING SERVICES, THE AGENCY PROVIDES REHABILITATIVE SERVICES INCLUDING PHYSICAL, SPEECH, AND OCCUPATIONAL THERAPIES. 52436202 1 0 0 1 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 50 0 494 1 1 1 0 0 0 0 0 0 0 0 0 X 15 10 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 PA X MICHAEL F ICKOWSKI CFO 8149381800 81 HILLCREST DRIVE PUNXSUTAWNEY PA 15767 NATHAN KOVALCHICK CHAIRMAN 1.00 X X 0 0 0 LAURIE A KUZNESKI VICE CHAIRMAN 1.00 X X 0 0 0 FRANK ROBERTS SECRETARY 1.00 X X 0 0 0 JAMES R MARTIN TREASURER 1.00 X X 0 0 0 T MICHAEL PRICE DIRECTOR 1.00 X 0 0 0 REBECCA STAPLETON DIRECTOR 1.00 X 0 0 0 HILLARY CREELY DIRECTOR 1.00 X 0 0 0 TODD BRICE DIRECTOR 1.00 X 0 0 0 WENDELL STEVEN DAVIS DIRECTOR 1.00 X 0 0 0 MARY KRAULAND DIRECTOR 1.00 X 0 0 0 CHAD SHAFFER MD DIRECTOR/PHYSICIAN 1.00 39.00 X 0 320683 36307 CHRISTINA LUBOLD MD DIRECTOR 1.00 39.00 X 0 37920 0 STEPHEN A WOLFE DIRECTOR/PRESIDENT & CEO 1.00 39.00 X X 0 1005085 53066 RUSSELL A DROZDIAK MD DIRECTOR/PHYSICIAN 1.00 39.00 X 0 175349 4882 TIMOTHY CLARK SIMPSON MD DIRECTOR/PHYSICIAN 39.00 1.00 X 651049 0 23631 JOHN G SISK PRESIDENT 38.00 2.00 X 303356 0 24907 MICHAEL F ICKOWSKI CHIEF FINANCIAL OFFICER 1.00 39.00 X 0 408665 4417 BRYAN DOVERSPIKE DO PHYSICIAN 40.00 X 534701 0 26565 EYAD KHABBAZ MD PHYSICIAN 40.00 X 575974 0 16262 MARCELINO MURILLO MD PHYSICIAN 40.00 X 497808 0 12944 BRYAN DEMPSEY MD PHYSICIAN 40.00 X 476288 0 25701 MICHAEL STEVER DO PHYSICIAN 40.00 X 503206 0 16190 ROBERT A GONGAWARE FORMER CFO 0.00 0.00 X 0 238963 32038 3542382 2186665 276910 51 1 1 0 LABORATORY CORP OF AMERICA HOLDINGS PO BOX 12140 BURLINGTON NC 16501 LAB SERVICES 675042 CURA HOSPITALITY LLC 2400 ANSYS DRIVE SUITE 404 CANONSBURG PA 15317 FOOD SERVICE 504423 PENNSYLVANIA MOUNTAINS HEALTHCARE 150 MCCRACKEN RUN ROAD DUBOIS PA 15801 REVENUE CYCLE 437526 JPT ARCHITECTS PC 244 WALNUT ST JOHNSTOWN PA 15901 ARCHITECTURAL DESIGN 168612 NURSE STAR MEDICAL PARTNERS 100 AVENUE OF THE CHAMPIONS STE 12 PALM BEACH GARDENS FL 33418 STAFFING SERVICE 167697 7 48426 48426 NET PATIENT SERVICES REVENUE 621990 68360589 68360589 OTHER PROGRAM REVENUE 621990 1804308 1804308 70164897 914565 914565 374237 277368 96869 96869 96869 2887 -2887 -2887 -2887 CONTRACTED LABOR REV. 541900 313313 313313 NONPATIENT LAB 541380 180545 180545 JV BILLING 900099 160759 160759 654617 71876487 70164897 180545 1482619 941558 941558 29647506 25273688 4373818 678875 525748 153127 4226298 3498423 727875 2041326 1683484 357842 129026 129026 21484 21484 5827981 4234907 1593074 326733 326733 1015735 679788 335947 468185 302054 166131 258119 258119 87 87 2255592 1732651 522941 1066668 457482 609186 MEDICAL SUPPLIES & DRUG 10782004 10782004 BAD DEBT EXPENSE 1829889 1829889 EQUIPMENT LEASED & RENT 1565396 1565396 REPAIRS & MAINTENANCE 1522556 131645 1390911 1048062 983993 64069 65653080 52436202 13216878 0 1767514 1770942 1439842 2964318 5324454 7329926 150931 320000 818840 911904 1564566 1664125 62674233 37003474 11042084 25670759 40399882 29633268 1708939 1784743 1113659 1113659 3107488 3437591 68438199 76601235 9048244 10256142 20812451 20819283 4942024 3933233 34802719 35008658 X 33257840 41190151 377640 402426 33635480 41592577 68438199 76601235 X 6223407 974848 2194986 -1436144 X 0 1 X 1 0 X 0 0 0 0 0 0 1 18750 0 1 2734 21484 0 PART II-B, LINE 1: A PORTION OF THE HOSPITAL'S DUES TO THE HOSPITAL & HEALTHSYSTEM ASSOCIATION OF PENNSYLVANIA (HAP) AND THE HOSPITAL 340 (B) HEALTH ARE USED FOR LOBBYING. 458977 29446 12245 476178 425029 40048 6100 458977 400171 34683 9825 425029 478570 -69098 16617 400171 383904 101982 7316 478570 0.30190 0.69810 1 0 40000 40000 27820769 11915782 15904987 31790952 23854037 7936915 3022512 1233655 1788857 25670759 PENSION & POST-RETIREMENT LIABILITIES 1431492 ESTIMATED MEDICAL MALPRACTICE CLAIMS LIABILITY 2020478 CONTRACT LIABILITIES 353301 FINANCE LEASE LIABILITY 127962 3933233 X 71530706 974848 250779 1225627 70305079 1571408 1571408 71876487 64100559 277368 277368 63823191 1829889 1829889 65653080 PART V, LINE 4: INCOME FROM ENDOWMENT FUND IS USED TO PURCHASE CAPITAL EQUIPMENT. PART X, LINE 2: THE HOSPITAL 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: CHANGE IN EQUITY INVESTMENTS 250,779. PART XI, LINE 4B - OTHER ADJUSTMENTS: RENTAL EXPENSES -277,368. DONOR RESTRICTED CONTRIBUTIONS 18,887. BAD DEBT EXPENSE NETTED AGAINST REVENUE ON FINANCIALS 1,829,889. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 277,368. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE NETTED AGAINST REVENUE ON FINANCIALS 1,829,889. 1 1 X 1 X 1 X 1 1 0 1 1 654368 654368 0.01030 10536025 9280095 1255930 0.01970 11190393 9280095 1910298 0.03000 38303 38303 0.00060 8381770 6036695 2345075 0.03670 6339 6339 0.00010 8426412 6036695 2389717 0.03740 19616805 15316790 4300015 0.06740 0 1829889 284657 8219029 6474204 1744825 X 1 1 1 1 PUNXSUTAWNEY AREA HOSPITAL 81 HILLCREST DRIVE PUNXSUTAWNEY PA 15767 WWW.PAH.ORG 163701 X X X SKILLED NURSING SERVICES PUNXSUTAWNEY AREA HOSPITAL 1 0 0 1 X X X X X X X X X 24 1 1 0 1 X PAH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT X IRMC.ORG/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT X 1 24 1 PAH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT 0 1 X 150.000000000000 250.000000000000 X X 1 1 X X X 1 X WWW.PAH.ORG/ABOUT/FINANCIAL-ASSISTANCE X WWW.PAH.ORG/ABOUT/FINANCIAL-ASSISTANCE X WWW.PAH.ORG/ABOUT/FINANCIAL-ASSISTANCE X X X X X 1 X 0 X X X 1 X 0 0 PUNXSUTAWNEY AREA HOSPITAL 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. PUNXSUTAWNEY AREA HOSPITAL PART V, SECTION B, LINE 6A: THE COMMUNITY NEEDS ASSESSMENT SERVED PUNXSUTAWNEY AREA HOSPITAL AND INDIANA REGIONAL MEDICAL CENTER. PUNXSUTAWNEY AREA HOSPITAL PART V, SECTION B, LINE 11: PAH CONDUCTED AN EVALUATION OF THE IMPLEMENTATION STRATEGIES UNDERTAKEN SINCE THE COMPLETION OF THEIR 2021 CHNA. ALTHOUGH THE STATUS FOR MOST COUNTY LEVEL INDICATORS DID NOT MOVE SUBSTANTIALLY, IT IS CLEAR PAH IS WORKING TO IMPROVE THE HEALTH OF THE COMMUNITY.GOAL 1: INCREASE AWARENESS AND PREVENTION OF LYME DISEASE AND DIABETES OBJECTIVE A: INCREASE AWARENESS OF LYME DISEASE AND AVAILABLE COMMUNITY RESOURCES OBJECTIVE B: CONDUCT ANNUAL BLOOD SCREENING PROGRAM OBJECTIVE C: PROVIDE EDUCATION TO THE COMMUNITYGOAL 2: INCREASE AWARENESS AND PREVENTION OF CARDIOVASCULAR DISEASE (HEART DISEASE, HIGH BLOOD PRESSURE, ETC.)OBJECTIVE A: DECREASE READMISSIONS THROUGH BETTER CHRONIC CARE MANAGEMENTOBJECTIVE B: OFFER COMMUNITY BLOOD SCREENINGOBJECTIVE C: PROMOTE THE HOSPITAL'S CONGESTIVE HEART FAILURE (CHF) CLINIC AND INCREASE THE NUMBER OF PATIENTS UTILIZING THE CLINIC ANNUALLYOBJECTIVE D: REACH OUT TO THE AMERICAN HEART ASSOCIATION TO SUPPORT THEIR REGIONAL AND NATIONAL INITIATIVESOBJECTIVE E: MANAGE HIGH RISK POPULATIONOBJECTIVE F: PROVIDE EDUCATION TO THE COMMUNITYGOAL 3: POSITION THE HOSPITAL AND COMMUNITY TO RESPOND TO THE NATIONAL OPIOID CRISIS BY USING EVIDENCE-BASED PRACTICES AND RESEARCH WHILE PARTNERING TO ENSURE EFFICACY OBJECTIVE A: IDENTIFY HEALTH AND HUMAN SERVICE IN THE LOCAL REGION TO PARTNER OBJECTIVE B: ONLINE RESOURCES MADE AVAILABLE THROUGH THE HOSPITAL'S WEBPAGE OBJECTIVE C: CONNECT TO REGIONAL PLAYERS FOR BETTER COLLABORATION OF SERVICES OBJECTIVE D: PROVIDE RESOURCE LIST TO PHYSICIANS AND PROVIDERS IN THE REGION OBJECTIVE E: STATE DATA PROVIDED THROUGH THE WEBPAGE AND SHARED WITH COLLABORATIVE PARTNERS OBJECTIVE F: COLLABORATIVE GRANT IDENTIFIED OBJECTIVE G: CREATE A PMCN STRATEGY TO IMPROVE REGIONAL EFFORTS OBJECTIVE H: CREATE AN OPIOID STRATEGY DOCUMENT TO ADDRESS LOCAL NEEDSGOAL 4: IMPROVE ACCESS TO MENTAL HEALTH SERVICES AND SUPPORTS OBJECTIVE A: ER EXPANSION PROJECT OBJECTIVE B: DEVELOP A DATABASE OF AVAILABLE COMMUNITY SERVICES OBJECTIVE C: ESTABLISH RELATIONSHIP WITH IRMC FOR NEW BEHAVIORAL HEALTH UNIT OBJECTIVE D: EXPAND SERVICES THROUGH IRMC'S INTEGRATED BEHAVIORAL HEALTH BUILDING OBJECTIVE E: DECREASE THE NUMBER OF SUICIDES OBJECTIVE F: COLLABORATE WITH CLEARFIELD JEFFERSON DRUG AND ALCOHOL COMMISSION TO MAKE THE PREP PROGRAM AVAILABLE OBJECTIVE G: SERVE COMMUNITY NEED BY SUPPORTING IRMC'S BH OUTREACH PROGRAM TO CONNECT EMERGENCY DEPARTMENT BH PATIENTS WITH OUTPATIENT OBJECTIVE H: INCREASE ACCESS TO INPATIENT REHAB OBJECTIVE I: INCREASE AWARENESS OF AVAILABLE SERVICESGOAL 5: INCREASE ACCESS TO RESOURCES AND HEALTH LITERACY OBJECTIVE A: CREATE COMMUNITY HEALTH RESOURCE DIRECTORY OBJECTIVE B: IMPROVE HEALTH LITERACYGOAL 6: INCREASE AWARENESS AND STRATEGIES TO REDUCE OBESITY AND MAINTAIN A HEALTHY WEIGHT OBJECTIVE A: PROVIDE EDUCATION, RESOURCES AND SUPPORT TO THE COMMUNITY OBJECTIVE B: IMPROVE THE QUALITY OF FOOD AVAILABLE AT PAH OBJECTIVE C: COLLABORATED WITH IRMC TO PROVIDE BARIATRIC SERVICESAS WITH MOST HEATH CARE FACILITIES, PAH HAS LIMITED FINANCIAL RESOURCES TO ADDRESS ALL ISSUES. PUNXSUTAWNEY AREA HOSPITAL PART V, SECTION B, LINE 13H: THERE IS A PRESUMPTIVE CHARITY SCORE PROCESS USING ACCOUNTS WITH MEDICARE OR DUAL ELIGIBILITY. SCHEDULE H, PART V, SECTION B, LINE 16I: LEP TRANSLATIONS:THERE ARE NO GROUPS WITH LIMITED ENGLISH PROFICIENCY THAT RISE TO THE THRESHOLD REQUIRED UNDER IRC SECTION 501(R). HOWEVER, LANGUAGE TRANSLATIONS OF THE FINANCIAL ASSISTANCE POLICY AND APPLICATION ARE AVAILABLE BY REQUEST AT THE FINANCIAL COUNSELING DEPARTMENT OF THE HOSPITAL. 1 1 - HHCS OF PUNXSUTAWNEY AREA HOSPITAL 240 WEST MAHONING STREET PUNXSUTAWNEY PA 15767 MEDICARE CERTIFIED HOME HEALTH AGENCY PART I, LINE 7: THE COST TO CHARGE RATIO CALCULATED ON IRS WORKSHEET 2 WAS USED IN THE CALCULATION OF COST ON IRS WORKSHEETS 1 AND 3.COST COMPUTED ON IRS WORKSHEET 6 WAS COMPUTED FROM THE ORGANIZATIONS COST ACCOUNTING SOFTWARE INCLUDING DIRECT COSTS PLUS OVERHEAD ALLOCATIONS COMPUTED IN COST ACCOUNTING. PART I, LN 7 COL(F): THE AMOUNT OF BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 24, BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $1,829,889. PART III, LINE 2: THE AMOUNT REPORTED FOR BAD DEBT IS THE TOTAL ACTUAL ACCOUNT BALANCES TRANSFERRED TO A COLLECTION AGENCY OFFSET BY MONIES COLLECTED FROM THE AGENCY. ALSO AN ESTIMATE BASED ON HISTORICAL COLLECTION PERCENTAGES OF SELF PAY FOR THE ACTIVE ACCOUNTS RECEIVABLE BALANCE IS CALCULATED MONTHLY AND THIS DIFFERENCE IS ADDED TO OR SUBTRACTED FROM BAD DEBT EXPENSE. PART III, LINE 3: WE BELIEVE THAT A PORTION OF OUR BAD DEBTS RESULTS FROM SERVICES PROVIDED TO PATIENTS WHO MEET THE CHARITY CARE GUIDELINES BUT WERE UNABLE OR UNWILLING TO PROVIDE THE APPROPRIATE DOCUMENTATIONS TO ALLOW THAT CLASSIFICATION. THIS FIGURE WAS CALCULATED USING THE ESTIMATED PERSONS UNDER POVERTY FOR JEFFERSON COUNTY OF 14.1%.PUNXSUTAWNEY AREA HOSPITAL PROVIDES CARE TO ALL PATIENTS WHO NEED IT, REGARDLESS OF THEIR ABILITY TO PAY. THIS IS PART OF THE HOSPITAL'S MISSION PART III, LINE 4: THE AUDIT FOOTNOTE ADDRESSING BAD DEBT EXPENSE AND PATIENT ACCOUNTS RECEIVABLE IS FOUND ON PAGE 8 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS UNDER NOTES TO CONSOLIDATED FINANCIAL STATEMENTS, SECTION 2. PART III, 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. THE HOSPITAL USES THE COST-TO-CHARGE RATIO TO DETERMINE THE MEDICARE ALLOWABLE COSTS. PART III, LINE 9B: PATIENTS WHO QUALIFY FOR CHARITY CARE ARE FLAGGED IN ORDER TO PROCESS THEM SEPERATELY FROM OTHER SELF PAY ACCOUNTS. PART VI, LINE 2: THE HOSPITAL DETERMINES COMMUNITY NEEDS BASED ON MULTIPLE SURVEYS AND MEETINGS WITH MEMBERS OF THE BUSINESS COMMUNITY, MEDICAL STAFF PHYSICIANS AND RANDOM COMMUNITY MEMBERS FROM THE SERVICE AREA.SEE ALSO SCHEDULE H PART V FOR COMMUNITY HEALTH NEEDS ASSESSMENT INFORMATION. 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: STATISTICS AVAILABLE FROM THE UNITED STATES CENSUS NUREAU REVEAL THAT JEFFERSON COUNTY HAS A POPULATION OF JUST UNDER 44,099 IN APPROXIMATELY 650 SQUARE MILES. THE POPULATION AGED 65 AND OLDER IS 21.0%. THE POPULATION WITH INCOME BELOW THE POVERTY LEVEL IS 15.3% AND THE COUNTY'S PER CAPITA PERSONAL INCOME IS $31,091. PART VI, LINE 5: THE HOSPITAL CONDUCTS SEVERAL FREE HEALTH SCREENINGS EACH YEAR THAT ARE OFFERED TO MEMBERS OF THE COMMUNITY WITHOUT HEALTH INSURANCE. ALSO, MULTIPLE FREE MEDICAL EDUCATION PROGRAMS ARE OFFERED TO PROVIDE AWARENESS OF TOPICAL AND TIMELY HEALTH ISSUES.PAH PROVIDES THE STUDENTS AT THE PUNXSUTAWNEY AREA SCHOOL DISTRICT WITH HYGIENE ITEMS FOR THE STUDENTS AS PART OF THE RURAL HEALTH MODEL. THESE ITEMS ARE DISTRIBUTED TO THE STUDENTS IN NEED BY THE SCHOOL NURSES AND SOCIAL WORKERS. PAH HAS FOOD AVAILABLE FOR PATIENTS WHO SCREEN POSITIVE FOR FOOD INSECURITY AND CAN PROVIDE A LIST OF RESOURCES TO ASSIST WITH ALL SOCIAL DETERMINANTS OF HEALTH. PAH HAS A COMPASSION CLOSET THAT HAS GARMENTS AVAILABLE FOR PATIENTS WHO ARE IN NEED PRIOR TO THEIR DISCHARGE. PAH HOLDS MONTHLY FREE EDUCATIONAL SEMINARS FOR ALL TO ATTEND ON VARIOUS HEALTH TOPICS AS PART OF THE WELLNESS CONNECTIONS PROGRAM. PART VI, LINE 6: PUNXSUTAWNEY AREA HOSPITAL AND ITS WHOLLY OWNED SUBSIDIARY, PUNXSUTAWNEY MEDICAL SERVICES, INC., PRIMARILY EARN REVENUES BY PROVIDING INPATIENT, OUTPATIENT AND EMERGENCY CARE SERVICES TO PATIENTS IN THE PUNXSUTAWNEY, PENNSYLVANIA, AREA AND ALSO OPERATES A HOME HEALTH AGENCY. 0 1 0 0 0 0 0 0 0 STEPHEN A WOLFE DIRECTOR/PRESIDENT & CEO 0 666004 0 42188 0 296893 0 31050 0 22016 0 1058151 0 0 TIMOTHY CLARK SIMPSON MD DIRECTOR/PHYSICIAN 620445 0 7604 0 23000 0 1846 0 21785 0 674680 0 0 0 EYAD KHABBAZ MD PHYSICIAN 524109 0 51140 0 725 0 4650 0 11612 0 592236 0 0 0 BRYAN DOVERSPIKE DO PHYSICIAN 534215 0 0 0 486 0 4650 0 21915 0 561266 0 0 0 MICHAEL STEVER DO PHYSICIAN 496348 0 0 0 6858 0 4650 0 11540 0 519396 0 0 0 MARCELINO MURILLO MD PHYSICIAN 496566 0 0 0 1242 0 2400 0 10544 0 510752 0 0 0 BRYAN DEMPSEY MD PHYSICIAN 438201 0 38087 0 0 0 4650 0 21051 0 501989 0 0 0 MICHAEL F ICKOWSKI CHIEF FINANCIAL OFFICER 0 391262 0 13688 0 3715 0 3230 0 1187 0 413082 0 0 CHAD SHAFFER MD DIRECTOR/PHYSICIAN 0 227512 0 93171 0 0 0 1875 0 34432 0 356990 0 0 JOHN G SISK PRESIDENT 269668 0 10688 0 23000 0 4650 0 20257 0 328263 0 0 0 ROBERT A GONGAWARE FORMER CFO 0 161006 0 75741 0 2216 0 21771 0 10267 0 271001 0 0 RUSSELL A DROZDIAK MD DIRECTOR/PHYSICIAN 0 155609 0 15431 0 4309 0 3747 0 1135 0 180231 0 0 PART I, LINE 3 THE CEO'S COMPENSATION IS PAID BY INDIANA REGIONAL MEDICAL CENTER. INDIANA REGIONAL MEDICAL CENTER USES THE FOLLOWING METHODS TO ESTABLISH THE COMPENSATION OF THE CEO: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - COMPENSATION SURVEY OR STUDY - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE PART I, LINE 4B INDIANA REGIONAL MEDICAL CENTER HAS A SUPPLEMENTAL, NONQUALIFIED RETIREMENT PLAN UNDER IRC SECTION 457(F) FOR PRESIDENT & CEO, STEPHEN A. WOLFE. PAY OUTS TO HIM WERE $246,070, AND CONTRIBUTIONS TO THE PLAN WERE $ 101,252 DURING CALENDAR YEAR 2024. SHANNON BYERLY SEE PART V 82995 WAGES 0 SCH L, PART IV, BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS: SHANNON BYERLY IS THE DAUGHTER OF PHYLLIS BYERLY, FORMER DIRECTOR, AND IS AN EMPLOYEE OF PUNXSUTAWNEY AREA HOSPITAL. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF PUNXSUTAWNEY AREA HOSPITAL, INC. IS PENNSYLVANIA MOUNTAINS CARE NETWORK ("PMCN"). 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 THE CEO'S COMPENSATION IS PAID BY INDIANA REGIONAL MEDICAL CENTER (IRMC). 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 XI, LINE 9: TRANSFERS TO AFFILIATES -1,656,079. CHANGE IN INVESTMENT IN IRREVOCABLE TRUST 12,238. CHANGE IN EQUITY INVESTMENTS 250,779. NET ASSET RELEASED FROM RESTRICTION -26,339. EQUITY DISTRIBUTION - NONCONTROLLING -44,154. CONTRIBUTIONS AND GRANTS FOR LONG-TERM PURPOSES 27,411. 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