2024-05-13T15:29:14-05:00 2023-06-30 390859910 BAKER TILLY US LLP 20 STANWIX STREET PITTSBURGH PA 15222 990 2022-07-01 232923182 INDIANA AMBULATORY SURGICAL ASSOCIATES INC INDI 7244651922 841 HOSPITAL ROAD INDIANA PA 15701 MICHAEL F ICKOWSKI CFO 7244651922 2024-05-10 1 MICHAEL ICKOWSKI 999009999 1 JEFFREY J PETRELL P00138808 4126976400 2024-05-01 X 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z STEPHEN A WOLFE 841 HOSPITAL ROAD INDIANA PA 15701 2584076 0 X WWW.INDIANARMC.ORG X 2018 PA PROVIDES SURGICAL SERVICES FOR REGIONAL SURGEONS AND PHYSICIANS. 5 1 30 1 0 0 72786 0 2743412 2558354 0 0 16132 25722 2832330 2584076 0 0 0 0 1063246 1148437 0 0 0 1973064 2211005 3036310 3359442 -203980 -775366 2369109 2256841 399398 0 1969711 2256841 X PROVIDES SURGICAL SERVICES FOR REGIONAL SURGEONS AND PHYSICIANS. 0 0 3357602 2558354 INDIANA AMBULATORY SURGICAL ASSOCIATES, INC. ("IASA") IS A NON-PROFIT, HOSPITAL OWNED, OUTPATIENT AMBULATORY SURGICAL CENTER. ITS MISSION IS TO SUPPORT INDIANA REGIONAL MEDICAL CENTER IN PROVIDING HEALTH CARE AND PROVIDING DIAGNOSTIC, THERAPEUTIC, AND SURGICAL SERVICES TO HELP PATIENTS MAINTAIN A HEALTHY LIFESTYLE.IASA PROVIDES OUTPATIENT SERVICES FOR OPHTHALMOLOGY, ORAL AND MAXILLOFACIAL, UROLOGICAL, ORTHOPEDIC, AND SURGICAL PROCEDURES, OB/GYN, AND WEIGHT MANAGEMENT AND BARIATRIC SURGERY. FOR THE FISCAL YEAR, ENDED JUNE 30, 2023, IASA PERFORMED 2,039 CASES IN THE SPECIALTY FIELDS LISTED ABOVE.CHARITY CARE PROVIDED DURING THE FISCAL YEAR ENDED JUNE 30, 2023, WAS $12,715. 3357602 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 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 X 0 0 30 1 0 0 0 0 0 0 0 0 0 0 0 0 X 5 1 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 PA X ROBERT A GONGAWARE CFO 7243577008 835 HOSPITAL ROAD INDIANA PA 15701 RICHARD NEFF MD CHAIRMAN/CMO 2.00 38.00 X X 0 397918 28299 SANDRA J LUTTNER VICE CHAIR/SECRETARY 2.00 38.00 X X 0 167028 17964 JAMES KINNEER DIRECTOR/VP, ORG. DEVELOPMENT 2.00 38.00 X X 0 227352 34514 GREGG W WILSON DMD DIRECTOR/MEDICAL DIRECTOR 6.00 X 40437 0 0 THOMAS TREVORROW MD DIRECTOR 2.00 X 0 0 0 STEPHEN A WOLFE PRESIDENT & CEO 1.00 39.00 X 0 802111 42593 ROBERT GONGAWARE CHIEF FINANCIAL OFFICER 1.00 39.00 X 0 323825 34321 40437 1918234 157691 0 0 1 0 0 PATIENT SERVICE REVENU 621910 2558354 2558354 2558354 CERNER REVENUE 900099 25722 25722 25722 2584076 2558354 0 25722 997696 997696 74263 74263 76478 76478 1840 1840 74737 74737 105077 105077 3042 3042 508401 508401 945 945 293743 293743 450 450 MEDICAL SUPPLIES 1049063 1049063 EQUIPMENT RENTAL 63936 63936 REPAIRS & MAINTENANCE 55068 55068 BAD DEBT EXPENSE 38297 38297 16406 16406 3359442 3357602 1840 0 303720 203970 148420 269040 41000 1706145 1484197 70602 221948 1767759 1514365 37608 47518 2369109 2256841 399398 0 399398 0 X 1969711 2256841 1969711 2256841 2369109 2256841 X -775366 1062496 X 0 1 X 1 0 X X X 1 INDIANA REGIONAL MEDICAL CENTER 250965404 3 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1706145 1484197 221948 221948 X PART X, LINE 2: INDIANA AMBULATORY SURGICAL ASSOCIATES 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 607396 0 93339 0 101376 0 23994 0 18599 0 844704 0 0 RICHARD NEFF MD CHAIRMAN/CMO 0 359873 0 38045 0 0 0 9150 0 19149 0 426217 0 0 ROBERT GONGAWARE CHIEF FINANCIAL OFFICER 0 297705 0 26120 0 0 0 21386 0 12935 0 358146 0 0 JAMES KINNEER DIRECTOR/VP, ORG. DEVELOPMENT 0 206778 0 20574 0 0 0 15365 0 19149 0 261866 0 0 SANDRA J LUTTNER VICE CHAIR/SECRETARY 0 167028 0 0 0 0 0 10176 0 7788 0 184992 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. NO AMOUNTS WERE PAID TO HIM, AND CONTRIBUTIONS TO THE PLAN WERE $90,000 DURING CALENDAR YEAR 2022. FORM 990, PART V, LINES 1: THE ORGANIZATION DOES NOT FILE FORMS 1096 OR W-3. ALL VENDORS AND ALL EMPLOYEES ARE PAID THROUGH A COMMON PAYMASTER/REPORTING AGENT. THE COMMON PAYMASTER/REPORTING AGENT IS INDIANA REGIONAL MEDICAL CENTER, EIN: 25-0965404. INDIANA REGIONAL MEDICAL CENTER IS A RELATED, TAX-EXEMPT ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 6 INDIANA REGIONAL MEDICAL CENTER ("IRMC") IS THE SOLE CORPORATE MEMBER OF INDIANA AMBULATORY SURGICAL ASSOCIATES, INC. ("IASA"). FORM 990, PART VI, SECTION A, LINE 7A IRMC HAS THE POWER TO FILL VACANCIES, NOMINATE AND APPROVE THE ELECTION OF, AND APPROVE REMOVAL OF THE BOARD OF DIRECTORS OF IASA. FORM 990, PART VI, SECTION A, LINE 7B IASA SHALL OBTAIN THE APPROVAL OF IRMC BEFORE ACTION ON ANY OF THE FOLLOWING MATTERS BECOMES FINAL AND EFFECTIVE FOR IASA: (1) AMENDMENT OF THE ARTICLES OF INCORPORATION AND BYLAWS; (2) THE SALE, LEASE OR EXCHANGE OF ALL OR SUBSTANTIALLY ALL OF THE PROPERTY OR ASSETS OF IASA; (3) MERGER OR CONSOLIDATION WITH ANY OTHER CORPORATION; (4) DISSOLUTION OF IASA; (5) APPROVAL OF AN ANNUAL OPERATING AND CAPITAL BUDGET FOR IASA; (6) ANY OTHER MATTER THAT BY LAW WOULD REQUIRE THE APPROVAL OF 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: TRANSFER FROM AFFILIATES 1,062,496. 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 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 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 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 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0