2024-05-14T15:04:12-05:00 2023-06-30 FORVIS LLP 910 E ST LOUIS 200/PO BOX 1190 SPRINGFIELD MO 658062523 990 2022-07-01 251517854 TITUSVILLE AREA HEALTH CENTER FOUNDATION % CORY JACKSON TITU 8148271851 406 WEST OAK STREET TITUSVILLE PA 16354 LEE CLINTON CEO 8148271851 2024-05-15 true LEE CLINTON 999009999 Brian D Todd P00422601 4178658701 3 2022 2023-04-26 12:10:37Z LEE M CLINTON 406 WEST OAK STREET TITUSVILLE PA 16354 448848 false X WWW.TITUSVILLEHOSPITAL.ORG X 1984 PA TO RAISE FUNDS ON BEHALF OF TITUSVILLE AREA HOSPITAL THROUGH VARIOUS EVENTS AND MAINTAIN ENDOWMENT AND FUNDED DEPRECIATION INVESTMENTS FOR THE HOSPITAL. 9 9 0 9 0 0 438367 409651 0 0 115626 24361 -5359 -2298 548634 431714 0 0 0 0 29851 32138 0 0 32972 18375 27922 48226 60060 500408 371654 2416105 2143464 0 0 2416105 2143464 X IT IS THE PURPOSE OF THE TITUSVILLE AREA HEALTH CENTER FOUNDATION TO PROVIDE FUNDS TO FURTHER SUPPORT THE OPERATION AND MAINTENANCE OF SERVICES AND PROGRAMS OF ITS AFFILIATED ENTITIES. SEE SCHEDULE O FOR ADDITIONAL INFORMATION. false false 20780 FUNDRAISING PROGRAMS TO RAISE FUNDS ON BEHALF OF TITUSVILLE AREA HOSPITAL THROUGH VARIOUS EVENTS AND MAINTAINING ENDOWMENT AND FUNDED DEPRECIATION INVESTMENTS FOR THE HOSPITAL. 20780 true true false false false false false false false false true false false false false false false true false false false false false false true false false false false true false false false false false false false false false false false false false true false false false true X 0 0 true 0 false false false false false true true false false false false false false X 9 9 true false false false true true true true true false false true true true true true true false false false PA X CORY JACKSON 8143335766 704 N MAIN ST MEADVILLE PA 16335 X LEE CLINTON CEO/PRESIDENT 2.0 38.0 X 22680 430905 38015 CORY JACKSON MMC CONTROLLER/TREAS END 10/22 2.0 46.0 X 0 184335 55326 KEN WINGER CHAIRMAN 1.0 2.0 X X 0 0 0 LARRY FLEDDERMAN VICE CHAIRMAN/SECRETARY 1.0 2.0 X X 0 0 0 KAREN RANDALL TREASURER BEG 10/22 1.0 0.0 X X 0 0 0 HOLLI WOLFE DIRECTOR BEG 10/22 1.0 0.0 X 0 0 0 BARBARA ENGLISH DIRECTOR 1.0 0.0 X 0 0 0 TIM GEIBEL DIRECTOR 1.0 1.0 X 0 0 0 AMY FELTON DIRECTOR 1.0 0.0 X 0 0 0 ABBE POPESCU DIRECTOR BEG 10/22 1.0 0.0 X 0 0 0 JOYCE MILBERG DIRECTOR BEG 10/22 1.0 0.0 X 0 0 0 22680 615240 93341 0 false true false 0 40973 368678 409651 0 24361 24361 0 0 0 0 0 0 12951 40973 16305 -3354 -3354 1885 829 1056 1056 0 0 0 0 431714 22063 0 0 0 0 0 0 0 0 29985 29985 0 0 2153 2153 0 0 0 0 0 0 623 478 145 1952 1498 454 24491 18529 5625 337 0 0 0 0 0 0 0 0 497 497 0 LICENSES, DUES, SUBSCRIPTIONS 359 275 84 60060 20780 6308 32972 1109311 788860 33189 35125 0 0 0 0 0 0 0 0 0 0 0 0 0 0 39505 22482 17524 17023 1154564 1260055 0 0 0 0 0 0 101517 42401 2416105 2143464 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 1705002 1810916 711103 332548 2416105 2143464 2416105 2143464 X 371654 96819 -741114 X false true X true false X X X 3 TAH 250965579 3 true 741114 0 THS 251517865 3 true 0 0 TAHC 250965579 7 true 0 0 3 741114 0 true false false false false false false false false false false false false false false true false SCHEDULE A, LINE 12G, COLUMN I NAME OF SUPPORTED ORGANIZATIONS: THE FULL NAMES OF THE SUPPORTED ORGANIZATIONS ARE AS FOLLOWS: TAH: TITUSVILLE AREA HOSPITAL THS: TITUSVILLE HEALTH SERVICES, INC. TAHC: TITUSVILLE AREA HEALTH CENTER, INC. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 14816 14816 24689 22482 2207 17023 924222 96819 764292 861111 63111 368603 368603 431714 77194 17134 17134 60060 60060 SCHEDULE D, PART X, LINE 2 UNCERTAIN TAX POSITION: MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. SCHEDULE D, PART XI, LINE 2D AMOUNTS INCLUDED ON LINE 1 BUT NOT ON FORM 990, PART VIII, LINE 12: $ 764,292 NET ASSETS RELEASED FROM RESTRICTION SCHEDULE D, PART XI, LINE 4B AMOUNTS INCLUDED ON FORM 990, PART VIII, LINE 12, BUT NOT ON LINE 1: $ 385,737 TEMPORARILY RESTRICTED NET ASSETS ( 17,134) SPECIAL EVENTS EXPENSE ---------- $ 368,603 SCHEDULE D, PART XII, LINE 2D AMOUNTS INCLUDED ON LINE 1 BUT NOT ON FORM 990, PART IX, LINE 25: $ 17,134 SPECIAL EVENTS EXPENSE GOLF OUTING 53924 40973 12951 1950 4480 4248 5627 0 53924 40973 12951 1950 4480 4248 5627 16305 -3354 false false false false false true false false false LEE CLINTON CEO/PRESIDENT 22665 430626 0 0 15 279 812 15431 1089 20683 24581 467019 0 0 CORY JACKSON MMC CONTROLLER/TREAS END 10/22 0 183746 0 0 0 589 0 16166 0 39160 0 239661 0 0 SCHEDULE J, PART I, LINE 3 CEO COMPENSATION: THE COMPENSATION OF THE CEO IS ESTABLISHED BY TITUSVILLE AREA HOSPITAL, A RELATED ORGANIZATION. THE HOSPITAL USES THE FOLLOWING METHODS IN ESTABLISHING THE CEO'S COMPENSATION: - COMPENSATION COMMITTEE - COMPENSATION SURVEY OR STUDY - APPROVAL BY BOARD OR COMPENSATION COMMITTEE SCHEDULE J, PART I, LINE 6A CONTINGENT COMPENSATION: TITUSVILLE AREA HOSPITAL, A RELATED ORGANIZATION, PAYS AN INCENTIVE TO ITS OFFICERS, KEY EMPLOYEES AND HIGHEST COMPENSATED EMPLOYEES THAT ARE CONTINGENT ON A POSITIVE TOTAL MARGIN OF THE ORGANIZATION. FORM 990, PART III, LINE 1 ORGANIZATION'S MISSION: THE TITUSVILLE AREA HEALTH CENTER FOUNDATION WILL RAISE AND MANAGE FUNDS NECESSARY FOR THE PROMOTION AND ADVANCEMENT OF HEALTHCARE WITHIN THE SERVICE AREAS SERVED BY THE TITUSVILLE AREA HOSPITAL. IT WILL ADMINISTER, INVEST, AND DISPERSE FUNDS IN CONJUNCTION WITH THE MISSION AND ESTABLISHED GOALS OF THE TITUSVILLE AREA HEALTH CENTER, INC., THE TITUSVILLE AREA HOSPITAL, AND THEIR AFFILIATES. FORM 990, PART V, LINE 1A, 2A & 2B AND PART IX, LINES 5-10 REPORTING AGENT: MEADVILLE MEDICAL CENTER (EIN: 25-1512436), A RELATED ORGANIZATION, FILES ALL INFORMATIONAL RETURNS ON BEHALF OF TITUSVILLE AREA HEALTH CENTER FOUNDATION AND RELATED ORGANIZATIONS WITHIN THE HEALTH SYSTEM. THE NUMBER OF 1099'S FILED FOR THE FOUNDATION HAS BEEN REPORTED AS ZERO ON PART V, LINE 1A AS THE FOUNDATION SHARES VENDORS WITH OTHER RELATED ENTITIES AND NO SEPARATE VENDORS WERE USED SOLELY FOR THE FOUNDATION. THESE SHARED VENDOR 1099S ARE REPORTED ON THE RELATED ORGANIZATIONS' FORM 990S AND ARE ALL INCLUDED ON THE FORM 1096 FILED BY MEADVILLE MEDICAL CENTER. MEADVILLE MEDICAL CENTER ALSO FILES ALL EMPLOYMENT TAX RETURNS ON BEHALF OF THE FOUNDATION AND OTHER RELATED ORGANIZATIONS. THE FOUNDATION DOES NOT HAVE ANY EMPLOYEES THAT WORK EXCLUSIVELY FOR THE FOUNDATION. EMPLOYEES OF OTHER RELATED ORGANIZATIONS SPEND PART OF THEIR TIME PERFORMING DUTIES FOR THE FOUNDATION. AS SUCH, THE AMOUNT OF SALARIES, PENSIONS, PAYROLL TAXES, AND EMPLOYEE BENEFITS RELATED TO TIME SPENT FOR THE FOUNDATION HAVE BEEN ALLOCATED AND REPORTED ON PART IX, LINES 5-10. THE NUMBER OF W-2'S FILED ON BEHALF OF THE FOUNDATION ON PART V, LINE 2A HAS BEEN REPORTED AS ZERO. THE NUMBER OF W-2'S RELATED TO THESE SHARED EMPLOYEES HAS BEEN REPORTED ON THE FORM 990S OF THE RELATED ORGANIZATIONS THAT DIRECTLY EMPLOYEE THESE INDIVIDUALS. MEADVILLE MEDICAL CENTER INCLUDES ALL OF THESE EMPLOYEES ON THEIR FORM W-3 FILING. FORM 990, PART VI, SECTION A, LINE 2 BUSINESS RELATIONSHIPS: LEE CLINTON, PRESIDENT/CEO, AND CORY JACKSON, CONTROLLER, ARE COMPENSATED BY MEADVILLE MEDICAL CENTER, A RELATED ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 6 CLASSES OF MEMBERS OR STOCKHOLDERS: THE ORGANIZATION HAS TWO MEMBERS WHICH INCLUDE TITUSVILLE AREA HEALTH CENTER, INC AND MEADVILLE MEDICAL CENTER. FORM 990, PART VI, SECTION A, LINE 7A MEMBERS OR STOCKHOLDERS WHO CAN ELECT MEMBERS OF THE GOVERNING BODY: A MAJORITY OF THE DIRECTORS OF TITUSVILLE AREA HEALTH CENTER FOUNDATION SHALL BE DIRECTORS OF TITUSVILLE AREA HEALTH CENTER, INC AND SHALL INCLUDE THE CHAIRMAN OF TITUSVILLE AREA HEALTH CENTER, INC AND THE PRESIDENT OF SAID CORPORATION. ALL BUT ONE DIRECTOR SHALL BE APPOINTED BY THE BOARD OF DIRECTORS OF TITUSVILLE AREA HEALTH CENTER, INC. MEADVILLE MEDICAL CENTER (MMC) SHALL APPOINT THE MMC BOARD APPOINTEE TO SERVE ON THE BOARD. FORM 990, PART VI, SECTION A, LINE 7B DECISIONS OF GOVERNING BODY SUBJECT TO APPROVAL BY MEMBERS OR STOCKHOLDERS: THE FOLLOWING POWERS ARE RESERVED UNTO MEADVILLE MEDICAL CENTER (MMC): A) NOMINATE AND ELECT THE MMC BOARD APPOINTEE, AND REMOVE SAID APPOINTEE AT ANY TIME, WITH OR WITHOUT CAUSE; B) APPROVE OR DISAPPROVE IN WHOLE OR IN PART THE CORPORATION'S BUDGET AND AMENDMENTS C) APPROVE OR DISAPPROVE PROJECTS OR EXPENDITURES WHICH ARE NOT IN THE BUDGET OR WHICH ARE VARIANCES THERETO INCLUDING THE AUTHORITY TO ESTABLISH A DOLLAR THRESHOLD BELOW WHICH THE CORPORATION WILL NOT NEED TO OBTAIN APPROVAL FROM MMC; D) APPROVE OR DISAPPROVE ALL LONG RANGE PLANS OF THE CORPORATION; E) APPROVE OR DISAPPROVE ALL AFFILIATIONS, MERGERS AND OTHER TRANSACTIONS BY THE CORPORATION NOT IN THE ORDINARY COURSE OF BUSINESS; F) APPROVE OR DISAPPROVE ALL AMENDMENTS TO THE CORPORATION'S ARTICLES OF INCORPORATION AND BYLAWS; G) DIRECT THE CORPORATION TO MAKE CHANGES IN ITS ARTICLES OF INCORPORATION OR BYLAWS AND IN THE ABSENCE OF SUCH ACTION BY THE CORPORATION, OR A RECOMMENDATION BY TITUSVILLE AREA HEALTH CENTER, INC. (TAHC), TO DIRECTLY AMEND ITS ARTICLES OF INCORPORATION AND/OR BYLAWS ON ITS OWN MOTION; H) APPROVE OR DISAPPROVE ALL FINANCINGS OF INDEBTEDNESS BY THE CORPORATION FOR WHICH THE OBLIGATION TO REPAY EXCEEDS (I) A TERM OF TWELVE MONTHS OR (II) AN AGGREGATE DOLLAR THRESHOLD SET BY THE BOARD OF DIRECTORS OF MMC FROM TIME TO TIME, AND; I) EXERCISE SUCH OTHER POWERS OR PERFORM SUCH OTHER TASKS AS ARE RESERVED TO OR REQUIRED OF MMC. THE FOLLOWING POWERS ARE RESERVED UNTO TITUSVILLE AREA HEALTH CENTER, INC. (TAHC): A) NOMINATE AND ELECT THE REMAINING APPOINTEES TO THE BOARD OF DIRECTORS OF THE CORPORATION AND THE OFFICERS OF THE CORPORATION AND REMOVE SUCH DIRECTORS AND OFFICERS AT ANY TIME, WITH OR WITHOUT CAUSE; B) APPROVE OR DISAPPROVE ANY CHANGE IN THE NUMBER OF DIRECTORS; C) RECOMMEND TO MMC THE APPROVAL OR DISAPPROVAL IN WHOLE OR IN PART OF THE CORPORATION'S BUDGET AND AMENDMENTS THERETO; D) RECOMMEND TO MMC THE APPROVAL OR DISAPPROVAL OF PROJECTS OR EXPENDITURES WHICH ARE NOT IN THE BUDGET OR WHICH ARE VARIANCES THERETO INCLUDING RECOMMENDATION OF A DOLLAR THRESHOLD BELOW WHICH THE CORPORATION WILL NOT NEED TO OBTAIN APPROVAL FROM MMC; E) RECOMMEND TO MMC THE APPROVAL OR DISAPPROVAL OF ALL LONG RANGE PLANS OF THE CORPORATION; F) RECOMMEND TO MMC THE APPROVAL OR DISAPPROVAL OF ALL AFFILIATIONS, MERGERS, AND OTHER TRANSACTIONS BY THE CORPORATION NOT IN THE ORDINARY COURSE OF BUSINESS; G) RECOMMEND TO MMC THE APPROVAL OR DISAPPROVAL OF ALL AMENDMENTS TO THE CORPORATION'S ARTICLES OF INCORPORATION AND BYLAWS; H) RECOMMEND TO MMC THE APPROVAL OR DISAPPROVAL OF ALL FINANCINGS OR INDEBTEDNESS BY THE CORPORATION FOR WHICH THE OBLIGATION TO REPAY EXCEEDS (I) A TERM OF TWELVE MONTHS OR (II) AN AGGREGATE DOLLAR THRESHOLD SET BY THE BOARD OF DIRECTORS OF MMC FROM TIME TO TIME, AND; I) EXERCISE SUCH OTHER POWERS OR PERFORM SUCH OTHER TASKS AS ARE RESERVED TO OR REQUIRED OF TAHC. FORM 990, PART VI, SECTION B, LINE 11B 990 REVIEW PROCEDURES: 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. THE RETURN IS COMPLETED IN DRAFT FORM AND REVIEWED BY MANAGEMENT OF THE ORGANIZATION. THE COMPLETED 990 IS MADE AVAILABLE TO BOARD MEMBERS FOR REVIEW AND QUESTIONS PRIOR TO SUBMISSION. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST POLICY: TITUSVILLE AREA HOSPITAL ANNUALLY REQUIRES ITS BOARD MEMBERS, OFFICERS AND KEY EMPLOYEES TO FILL OUT A CONFLICTS OF INTEREST FORM DURING BOARD MEETINGS. ANY CONFLICT OF INTEREST IS REVIEWED BY THE BOARD OF DIRECTORS. IF AN INTERESTED PARTY HAS A CONFLICT, HE OR SHE RECUSES THEMSELVES FROM VOTING. FORM 990, PART VI, SECTION B, LINES 15A & 15B CEO COMPENSATION: THE COMPENSATION OF THE CEO IS DETERMINED AND PAID BY TITUSVILLE AREA HOSPITAL. THE COMPENSATION OF THE CONTROLLER IS DETERMINED AND PAID BY MEADVILLE MEDICAL CENTER. AN INDEPENDENT BOARD DETERMINES THE COMPENSATION PACKAGES BY USING COMPARABILITY SURVEYS. THE DELIBERATIONS AND DECISIONS OF THE BOARD ARE DOCUMENTED IN THE BOARD MINUTES. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENT DISCLOSURE: TITUSVILLE AREA HEALTH CENTER FOUNDATION MAKES ITS FORM 990 AVAILABLE TO THE PUBLIC. AT THIS TIME, TITUSVILLE AREA HEALTH CENTER FOUNDATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICY OR FINANCIAL STATEMENTS AVAILABLE TO THE GENERAL PUBLIC. FORM 990, PART VII, SECTION A BOARD MEMBER COMPENSATION: CORY JACKSON IS THE CONTROLLER FOR RELATED ORGANIZATION MEADVILLE MEDICAL CENTER (MMC). HE WAS THE ACTING BOARD TREASURER FOR TITUSVILLE AREA HEALTH CENTER FOUNDATION UNTIL OCTOBER 2022. HE DOES NOT HAVE VOTING POWER. HIS COMPENSATION LISTED IS BEING SHOWN AS FROM A RELATED ORGANIZATION AS HE IS PAID BY MMC FOR HIS POSITION AS CONTROLLER. HE IS NOT COMPENSATED FOR HIS ROLE AS BOARD TREASURER. CEO COMPENSATION: LEE CLINTON IS THE CEO OF TITUSVILLE AREA HOSPITAL, TITUSVILLE HEALTH SERVICES, AND TITUSVILLE AREA HEALTH CENTER FOUNDATION. HIS COMPENSATION IS SPLIT BETWEEN THESE ENTITIES AND REPORTED ON PART VII, SECTION A, COLUMNS (D) - (F) AS BEING FROM THE ORGANIZATION AND FROM RELATED ORGANIZATIONS. NO COMPENSATION HAS BEEN LISTED ON PART IX, LINE 5 FOR HIM AS HIS COMPENSATION IS RECORDED ON PART IX OF THE FORM 990 FOR RELATED ORGANIZATION MEADVILLE MEDICAL CENTER. FORM 990, PART XI, LINE 9 OTHER CHANGES IN NET ASSETS: $ (741,114) TRANSFERS TO AFFILIATES TITUSVILLE AREA HEALTH CENTER INC 406 WEST OAK STREET TITUSVILLE PA 16354 251517855 HOLDING CO PA 501(C)(3) 7 MMC false TITUSVILLE HEALTH SERVICES INC 406 WEST OAK STREET TITUSVILLE PA 16354 251517865 COMM HLT CLNC PA 501(C)(3) 3 TAHC false TITUSVILLE AREA HOSPITAL 406 WEST OAK STREET TITUSVILLE PA 16354 250965579 HOSPITAL PA 501(C)(3) 3 TAHC false MEADVILLE MEDICAL CENTER 1034 GROVE STREET MEADVILLE PA 16335 251512436 HOSPITAL PA 501(C)(3) 3 NA false MEADVILLE MEDICAL CENTER FOUNDATION 1034 GROVE STREET MEADVILLE PA 16335 251681342 SUPPORT PA 501(C)(3) 7 MMC false HOSPICE OF CRAWFORD COUNTY INC 1034 GROVE STREET MEADVILLE PA 16335 251480565 HOSPICE PA 501(C)(3) 7 MMC false CONNEAUT VALLEY HEALTH CENTER 1034 GROVE STREET MEADVILLE PA 16335 251490887 HEALTH CENTER PA 501(C)(3) 3 MMC false MEADVILLE PHYSICIANS SERVICES 751 LIBERTY STREET MEADVILLE PA 16335 251602133 PHYS. OFFICES PA 501(C)(3) 10 MMC false COMMUNITY HEALTH SERVICES INC 1034 GROVE STREET MEADVILLE PA 16335 251490886 PHYS. OFFICES PA 501(C)(3) 10 MMC false MEADVILLE MEDICAL CENTER AUXILIARY 751 LIBERTY STREET MEADVILLE PA 16335 251512834 SUPPORT PA 501(C)(3) 12A I MMC false FRENCH CREEK INTERNAL MEDICINE 751 LIBERTY STREET MEADVILLE PA 16335 471870077 PHYS. OFFICES PA 501(C)(3) 10 MPS false HOME CARE CONNECTIONS INC 751 LIBERTY STREET MEADVILLE PA 16335 251605314 HOLDING COMPANY PA MMC C CORP false MEADVILLE HOUSING CORPORATION 934 B STREET MEADVILLE PA 16335 250657800 HOUSING PA MMC C CORP false CHARITABLE TRUST 256196092 TRUST PA MMC TRUST false CHARITABLE TRUST 066031521 TRUST PA MMC TRUST false PERPETUAL TRUST TRUST PA TAH TRUST false PERPETUAL TRUST TRUST PA TAH TRUST false PERPETUAL TRUST TRUST PA TAH TRUST false false false false true false false false false false false false true false true true true false true false