2026-05-12T11:33:21-05:00 2025-06-30 390859910 BAKER TILLY ADVISORY GROUP LP 20 STANWIX STREET PITTSBURGH PA 15222 990 2024-07-01 992421431 INDIANA SKILLED NURSING INC INDI 7243577010 835 HOSPITAL ROAD INDIANA PA 157010788 MICHAEL F ICKOWSKI CFO 7243577010 2026-05-07 1 1 KELLY A BROCIOUS P01254262 4126976400 2026-04-09 2024 2025-03-06 01:10:19Z STEPHEN A WOLFE 835 HOSPITAL ROAD INDIANA PA 157010788 8444215 0 X WWW.BEACONRIDGE.NET X 2023 PA INDIANA SKILLED NURSING WAS ORGANIZED FOR THE PURPOSE OF OWNING & OPERATING A HEALTH CARE FACILITY TO PROVIDE SKILLED, NURSING CARE & REHABILITATION TO MEET THE NEEDS OF SENIORS IN INDIANA COUNTY PA WHO ARE NO LONGER ABLE TO LIVE ON THEIR OWN. 6 0 96 24 0 0 0 38841 546348 8160687 926123 5989 13402 238698 1485873 8444215 0 0 0 0 342211 4947508 0 0 0 322338 3724186 664549 8671694 821324 -227479 6179210 7282472 1103071 2433812 5076139 4848660 X INDIANA SKILLED NURSING WAS ORGANIZED FOR THE PURPOSE OF OWNING & OPERATING A HEALTH CARE FACILITY TO PROVIDE SKILLED, NURSING CARE & REHABILITATION TO MEET THE NEEDS OF SENIORS IN INDIANA COUNTY PA WHO ARE NO LONGER ABLE TO LIVE ON THEIR OWN. 0 0 8301412 8160687 THE ENTITY MAINTAINS 118 LICENSED SKILLED NURSING BEDS & THE FACILITY EXPECTS TO HAVE AN AVERAGE DAILY CENSUS BETWEEN 82 & 88 RESIDENTS & SERVICES A POPULATION MADE UP OF MOSTLY LOW-INCOME RESIDENTS FROM INDIANA COUNTY, PA & SURROUNDING COMMUNITIES. APPROXIMATELY 64 PERCENT OF THE RESIDENTS ARE COVERED BY THE MEDICAID PROGRAM & APPROXIMATELY 6 PERCENT OF RESIDENTS ARE COVERED BY THE MEDICARE PROGRAM. THROUGH THE SERVICES PROVIDED BY INDIANA SKILLED NURSING, THE ELDERLY POPULATION WILL BE PROVIDED WITH ESSENTIAL NEEDS OF HOUSING, HEALTH CARE & FINANCIAL SECURITY.THE SOLE ACTIVITY OF INDIANA SKILLED NURSING IS TO PROVIDE SKILLED NURSING TO ADDRESS THE NEEDS OF A GROWING ELDERLY POPULATION. THIS FACILITY IS SPECIFICALLY DESIGNED FOR SENIOR RESIDENTS WHO ARE UNABLE TO LIVE ON THEIR OWN TO ALLOW THEM TO AGE IN A COMFORTABLE AND SAFE ENVIRONMENT. THE FACILITY EMPLOYS NURSES WHO PROVIDE RESIDENTS WITH 24 HOURS OF EMERGENCY SUPPORT, WHICH WILL GIVE THEM, THEIR FAMILIES & THEIR LOVED ONES PEACE OF MIND. IN ADDITION, OTHER PROVIDED SERVICES INCLUDE MEALS, HOUSEKEEPING, RESIDENT ACTIVITIES, WELLNESS ACTIVITIES, & SOCIAL SERVICES. 8301412 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 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 7 0 96 1 0 0 0 0 0 0 0 0 0 0 X 6 0 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 7243577010 835 HOSPITAL ROAD INDIANA PA 157010788 MICHAEL F ICKOWSKI CHAIRMAN/CHIEF FINANCIAL OFFICER 1.00 39.00 X X 0 408665 4417 WENDY HAISLIP VICE CHAIRMAN/CHIEF NURSING OFFICER 1.00 39.00 X X 0 219282 27279 MARK RICHARDS SECRETARY & TREASURER/CHIEF GROWTH OFFICER 1.00 39.00 X X 0 208484 32622 STEPHEN A WOLFE PRESIDENT & CEO 1.00 39.00 X X 0 1005085 53066 RUSSELL DROZDIAK MD BOARD MEMBER/PHYSICIAN 1.00 39.00 X 0 175349 4882 JAMES KINNEER BOARD MEMBER/CHIEF HUMAN RESOURCES OFFICER 1.00 39.00 X 0 266766 46745 ROBERT GONGAWARE BOARD MEMBER/FORMER CFO 1.00 0.00 X 0 238963 32038 0 2522594 201049 0 1 1 0 MORRISON LIVING PO BOX 102289 ATLANTA GA 303682289 CULINARY SERVICES 474026 COREWORKS 13028 COLLECTION CENTER DRIVE CHICAGO IL 60693 SUPPORT SERVICES 237295 AFFINITY HEALTH SERVICES 942 PHILADELPHIA STREET INDIANA PA 15701 CONSULTING SERVICES 216187 FUNCTIONAL PATHWAYS OF TENNESSEE LLC 10133 SHERRIL BLVD STE 200 KNOXVILLE TN 379323347 FUNCTIONAL THERAPY 192173 FUSION MEDICAL STAFFING LLC PO BOX 30131 OMAHA NE 68103 NURSING AGENCY 169494 5 38841 38841 PATIENT SERVICE REVENU 623000 8160687 8160687 8160687 5989 5989 MISCELLANEOUS REVENUE 900099 165729 165729 CAFETERIA REVENUE 900099 72969 72969 238698 8444215 8160687 0 244687 X 4061739 4061739 632075 632075 253694 253694 291000 291000 1961797 1961797 11267 11267 79282 79282 177570 177570 13069 13069 26833 26833 110325 110325 106649 106649 MEDICAL SUPPLIES 427844 427844 FOOD EXPENSE 282785 282785 DUES & SUBSCRIPTIONS 81606 81606 REPAIRS & MAINTENANCE 51421 51421 102738 102738 8671694 8301412 370282 0 240426 252779 644193 1778440 144600 211053 5200000 159800 5149991 5040200 6179210 7282472 1101460 2433090 1611 722 1103071 2433812 X 5076139 4848660 5076139 4848660 6179210 7282472 -227479 0 X 0 1 X 1 0 X 38841 38841 546348 8160687 8707035 546348 8199528 8745876 0 0 0 8745876 5989 5989 5989 5989 13402 238698 252100 559750 8444215 9003965 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 405500 405500 4479597 128310 4351287 314903 31490 283413 5040200 PENSION LIABILITY 722 722 X PART X, LINE 2: INDIANA SKILLED NURSING 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. 0 1 0 0 0 0 0 0 0 STEPHEN A WOLFE PRESIDENT & CEO 0 666004 0 42188 0 296893 0 31050 0 22016 0 1058151 0 0 MICHAEL F ICKOWSKI CHAIRMAN/CHIEF FINANCIAL OFFICER 0 391262 0 13688 0 3715 0 3230 0 1187 0 413082 0 0 JAMES KINNEER BOARD MEMBER/CHIEF HUMAN RESOURCES O 0 254837 0 9413 0 2516 0 23470 0 23275 0 313511 0 0 ROBERT GONGAWARE BOARD MEMBER/FORMER CFO 0 161006 0 75741 0 2216 0 21771 0 10267 0 271001 0 0 WENDY HAISLIP VICE CHAIRMAN/CHIEF NURSING OFFICER 0 207184 0 9582 0 2516 0 5561 0 21718 0 246561 0 0 MARK RICHARDS SECRETARY & TREASURER/CHIEF GROWTH O 0 199301 0 7529 0 1654 0 16177 0 16445 0 241106 0 0 RUSSELL DROZDIAK MD BOARD MEMBER/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 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 KINNEER: NO AMOUNTS WERE PAID TO HIM, AND CONTRIBUTIONS TO THE PLAN WERE $37,651. - MARK RICHARDS: NO AMOUNTS WERE PAID TO HIM, AND CONTRIBUTIONS TO THE PLAN WERE $25,766. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF INDIANA SKILLED NURSING IS PENNSYLVANIA MOUNTAINS CARE NETWORK (PMCN). FORM 990, PART VI, SECTION A, LINE 7A PMCN IS ENTITLED TO APPOINT AND REMOVE DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B THE BOARD SHALL OBTAIN THE APPROVAL OF THE CORPORATE MEMBER (PMCN) BEFORE ACTION ON ANY OF THE FOLLOWING MATTERS BECOMES FINAL AND EFFECTIVE: (I) AMENDMENT OF THE ARTICLES OF INCORPORATION OF THIS CORPORATION OR OF THESE BYLAWS. (II) THE SALE, LEASE OR EXCHANGE OF ALL OR SUBSTANTIALLY ALL THE PROPERTY OR ASSETS OF THIS CORPORATION. (III) MERGER OR CONSOLIDATION WITH ANY OTHER CORPORATION. (IV) DISSOLUTION OF THIS CORPORATION. (V) APPROVAL OF AN ANNUAL BUDGET FOR THIS CORPORATION. (VI) ANY TRANSFER OF FUNDS BY GRANT, GIFT OR LOAN FROM THIS CORPORATION. (VII) ANY OTHER MATTER THAT BY LAW WOULD REQUIRE THE APPROVAL OF A MEMBER OR OTHER BODY OF A PENNSYLVANIA 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 IX, LINE 11G PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 1,961,797. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,961,797. INDIANA REGIONAL MEDICAL CENTER 835 HOSPITAL ROAD INDIANA PA 15701 250965404 HOSPITAL PA 501(C)(3) LINE 3 PENNSYLVANIA MOUNTAINS CARE NETWORK 0 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 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 0 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 0 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 0 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 0 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 0 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 TOTAL THERAPY INC 835 HOSPITAL ROAD INDIANA PA 15701 263843582 THERAPY SERVICES PA 501(C)(3) LINE 10 INDIANA HEALTHCARE PHYSICIAN SERVICES 0 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. PA 501(C)(3) LINE 10 N/A 0 GLADE RUN MEDICAL ASSOCIATES INC ONE NOLTE DRIVE KITTANNING PA 16201 264750523 PHSYICIAN PRA PA 501(C)(3) LINE 12A, I ARMSTRONG COUNTY MEMORIAL HOSPITAL 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0