2024-05-07T12:10:49-05:00 2023-06-30 WithumSmithBrown PC 1835 MARKET STREET SUITE 1710 PHILADELPHIA PA 19103 990 2022-07-01 240800337 TROY COMMUNITY HOSPITAL % MICHELE SISTO TROY 5708874625 275 GUTHRIE DRIVE TROY PA 16947 paul vervalin evp/coo 5708874625 2024-05-03 true paul vervalin 000000000 Scott J Mariani P00642486 2155462140 2 2022 2023-04-26 12:10:37Z LORI BARNETT 275 GUTHRIE DRIVE TROY PA 16947 36082020 false X WWW.GUTHRIE.ORG X 1951 PA THE PROVISION OF CHARITABLE HEALTHCARE SERVICES TO ALL INDIVIDUALS IN A NON-DISCRIMINATORY MANNER REGARDLESS RACE, COLOR, CREED, SEX, NATIONAL ORIGIN OR ABILITY TO PAY. 14 10 189 19 0 0 1009125 76213 33431772 35165649 9499 37976 67338 77880 34517734 35357718 500 2000 0 0 10793902 11792913 0 0 0 15315363 18408623 26109765 30203536 8407969 5154182 58027032 93748095 41108220 72021338 16918812 21726757 X TROY COMMUNITY HOSPITAL IS A 25-BED, SHORT-TERM STAY CRITICAL ACCESS HOSPITAL AND OFFERS A WIDE RANGE OF INPATIENT AND OUTPATIENT SERVICES INCLUDING DIAGNOSTIC TESTING, REHABILITATION, MEDICAL AND SURGICAL CARE. TROY COMMUNITY HOSPITAL ALSO MAINTAINS 24-HOUR EMERGENCY SERVICES AS WELL AS VERY SUCCESSFUL SUB-ACUTE AND VENTILATOR MANAGEMENT PROGRAMS. false false 19950194 2000 35165649 TROY COMMUNITY HOSPITAL IS A 25-BED, SHORT-TERM STAY CRITICAL ACCESS HOSPITAL AND OFFERS A WIDE RANGE OF INPATIENT AND OUTPATIENT SERVICES INCLUDING DIAGNOSTIC TESTING, REHABILITATION, MEDICAL AND SURGICAL CARE. TROY COMMUNITY HOSPITAL ALSO MAINTAINS 24-HOUR EMERGENCY SERVICES, AS WELL AS VERY SUCCESSFUL SUB-ACUTE AND VENTILATOR MANAGEMENT PROGRAMS. 19950194 true true false true false false false false false false true false false true true true false true false false false false false false false false true true false false true false false false false false false false false false false false false false true false false false true X 0 0 189 true false false false false false false false false false false false false false false X 14 10 false false false false true true true true true false false true true true true true true true true false PA X MICHELE SISTO 5708874625 ONE GUTHRIE SQUARE SAYRE PA 18840 X PAUL G VERVALIN DIRECTOR - EVP/COO TGC 55.0 0.0 X 0 645540 85036 DEBRA RAUPERS DIRECTOR 55.0 0.0 X 0 413648 18621 FRANCIS M MACAFEE CFO (7/1/22-12/31/22) 55.0 0.0 X 0 328800 38582 LORI BARNETT DIRECTOR - PRESIDENT 55.0 0.0 X X 214634 0 13199 JENNIFER FLEURY REGISTERED NURSE 55.0 0.0 X 194144 0 10193 JEFFREY S JENKINS DIR-SR DIR POST (TERM 12/31) 55.0 0.0 X 0 187477 13994 BRENDA L BOOR MANAGER, NURSING 55.0 0.0 X 161496 0 18540 FAITH MCNEAL REGISTERED NURSE 55.0 0.0 X 126383 0 30931 MICHELLE JELLIFF DIRECTOR, NURSING (TERMED) 55.0 0.0 X 145339 0 7293 SANDRA LIEWELLYN REGISTERED NURSE 55.0 0.0 X 128690 0 23747 TAYLOR SKERPON SR. DIRECTOR/CFO (EFF 1/1/23) 55.0 0.0 X 0 92365 18994 ELIZABETH KLEBER DIR-SR DIR POST (EFF 1/1/23) 55.0 0.0 X 0 5000 150 KENNETH R LEVITZKY ESQ CHAIRMAN - DIRECTOR 1.0 0.0 X X 0 0 0 JANET LEWIS SECRETARY/TREASURER - DIRECTOR 1.0 0.0 X X 0 0 0 JERRY E CARR DIRECTOR 1.0 0.0 X 0 0 0 JOHN ESTEP DIRECTOR 1.0 0.0 X 0 0 0 VANCE A GOOD MD DIRECTOR 1.0 0.0 X 0 0 0 DENISE IVES DIRECTOR 1.0 0.0 X 0 0 0 EDWARD L JONES MD DIRECTOR 1.0 0.0 X 0 0 0 MEADE T MURTLAND DIRECTOR 1.0 0.0 X 0 0 0 RICHARD M ROBINSON DIRECTOR 1.0 0.0 X 0 0 0 JANEEN SHEEHE DIRECTOR 1.0 0.0 X 0 0 0 970686 1672830 279280 19 false true false 0 18419 57794 76213 NET PATIENT SERVICE REVENUE 621990 33952489 33952489 OTHER HEALTHCARE RELATED REVENUE 900099 1018018 1018018 RENTAL INCOME - AFFILIATES 531110 195142 195142 35165649 25255 0 25255 0 0 0 0 0 736338 685 724302 0 12036 685 12721 12721 0 0 0 0 0 0 0 0 0 CAFETERIA REVENUE 900099 77880 77880 77880 35357718 35165649 0 115856 X 0 2000 2000 0 0 227833 192124 35709 0 9155397 7720433 1434964 353186 297830 55356 1370279 1155509 214770 686218 576634 109584 4008243 4008243 0 0 1107 1107 0 2957 2957 6900425 6358431 541994 0 3770 1738 2032 1054082 240382 813700 455968 153321 302647 0 473348 2246 471102 11707 9520 2187 0 8866 7377 1489 644239 644239 0 1631075 1631075 417 417 MEDICAL SUPPLIES 3191183 3221673 -30490 0 OTHER EXPENSES 21236 10976 10260 0 30203536 19950194 10253342 0 X 0 0 0 0 0 0 4368593 4456703 0 0 0 0 0 0 145077 134923 326984 386589 39341192 22018446 17600091 17322746 1007721 892242 3966 0 0 0 0 0 34574600 70554892 58027032 93748095 3311737 2531193 0 0 0 0 0 0 0 0 0 0 0 0 0 0 37796483 69490145 41108220 72021338 X 16425634 21529331 493178 197426 16918812 21726757 58027032 93748095 X 5154182 17520 -363757 X X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 1107 1107 false SCHEDULE C, PART II-B, LINE 1I THIS ORGANIZATION IS A MEMBER OF THE AMERICAN HOSPITAL ASSOCIATION AND THE HOSPITAL & HEALTH SYSTEM ASSOCIATION OF PENNSYLVANIA WHICH ENGAGE IN LOBBYING EFFORTS ON BEHALF OF THEIR MEMBER ORGANIZATIONS. A PORTION OF THE DUES PAID TO THESE ORGANIZATIONS HAS BEEN ALLOCATED TO LOBBYING ACTIVITIES PERFORMED ON BEHALF OF THE ORGANIZATION DURING THE YEAR ENDED JUNE 30, 2023. THIS ALLOCATION AMOUNTED TO $1,107 DURING THE YEAR ENDED JUNE 30, 2023. 526313 526313 22514090 10560857 11953233 11807352 9656987 2150365 4493437 1800602 2692835 17322746 DUE FROM AFFILIATES 70300428 OTHER ASSETS 254464 70554892 0 THIRD PARTY PAYABLE 1055400 TGC - BOND PAYABLE 27637373 DUE TO AFFILIATES 40797372 CONTRACT LIABILITY - CMS 0 69490145 X SCHEDULE D, PART X, LINE 2 THE ORGANIZATION IS AN AFFILIATE WITHIN THE GUTHRIE CLINIC AND AFFILIATES; A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY SYSTEM ("SYSTEM"). THE SYSTEM'S PARENT ENTITY IS THE GUTHRIE CLINIC. AN INDEPENDENT CPA FIRM AUDITED THE CONSOLIDATED FINANCIAL STATEMENTS OF THE SYSTEM AND ALL ENTITIES WITHIN THE SYSTEM FOR THE YEARS ENDED JUNE 30, 2023 AND JUNE 30, 2022; INCLUDING THIS ORGANIZATION; RESPECTIVELY. THE INDEPENDENT CPA FIRM ISSUED AN UNMODIFIED OPINION WITH RESPECT TO THE AUDITED CONSOLIDATED FINANCIAL STATEMENTS. THE FOLLOWING FOOTNOTE IS INCLUDED IN THE SYSTEMS'S AUDITED CONSOLIDATED FINANCIAL STATEMENTS THAT REPORTS THE SYSTEM'S LIABILITY FOR UNCERTAIN TAX POSITIONS UNDER FIN 48 (ASC 740): ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE THE CORPORATION TO EVALUATE TAX POSITIONS TAKEN BY THE CORPORATION AND RECOGNIZE A TAX LIABILITY (OR ASSET) IF THE CORPORATION HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD BE SUSTAINED UPON EXAMINATION BY THE INTERNAL REVENUE SERVICE. THE CORPORATION HAS CONCLUDED THAT AS OF JUNE 30, 2023 AND 2022, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY (OR ASSET) OR DISCLOSURE IN THE CONSOLIDATED FINANCIAL STATEMENTS. true true X true X true X true true true false false 191367 24704 166663 0.00550 4698569 2492771 2205798 0.07300 4889936 2517475 2372461 0.07850 10088296 5798422 4289874 0.14200 10088296 5798422 4289874 0.14200 14978232 8315897 6662335 0.22050 true 1510139 151014 7482696 7626207 -143511 X true true 1 1 TROY COMMUNITY HOSPITAL 275 GUTHRIE DRIVE TROY PA 16947 WWW.GUTHRIE.ORG 460101 X X X X TROY COMMUNITY HOSPITAL 1 false false true X X X X X X X X X 21 true false false true X WWW.GUTHRIE.ORG X true 21 true WWW.GUTHRIE.ORG false true X 200. 400. X X X X X X true true X X X true X WWW.GUTHRIE.ORG X WWW.GUTHRIE.ORG X WWW.GUTHRIE.ORG X X X X X X true X false X X X X true X false false SCHEDULE H, PART V, SECTION B, QUESTION 5 The troy community hospital ("tch") community health needs assessment ("chna") began with collecting primary data through a 20 question community stakeholder survey from december 20, 2021-february 11, 2022. This community stakeholder survey incorporated the feedback of individuals who represent the broad interests of the community served by troy community hospital including; individuals living in poverty and in need of emergency assistance or housing, individuals with mental health or substance use disorders, individuals with developmental disorders, older adults, children and youth. Troy community hospital has not received written comments on the last chna or implementation plan. The community stakeholder survey was conducted with outreach to forty-seven community stakeholders that provide services throughout bradford county: Survey responses were received from the following organizations: - abuse & rape crisis center of bradford county (services to eliminate interpersonal violence) - bradford county public health department - bradford tioga high school (high school students) - bradford, sullivan, susquehanna and tioga counties area agency on aging (older adults) - canton k-12 schools (children and youth) - endless mountain mission center (temporary emergency assistance) - futures community support services (services for individuals with emotional and/or developmental disabilities) - harbor counseling (mental health and substance use disorder treatment) - martha lloyd community services (services for people with intellectual disabilities and autism) - north penn legal services (free legal assistance) - salvation army (emergency assistance) - sayre public library - the main link (non-clinical consumer run services for mental health consumers) Survey results ranked the biggest problems impacting bradford county in sequential order from highest to lowest as: mental health conditions, alcohol and other substance use disorders, poverty, covid-19 and unemployment. When asked to identify what population experiences the poorest health outcomes in bradford county, community stakeholders identified the top there populations as: individuals living with mental health conditions, individuals living at or near the federal poverty level and individuals in rural areas and individuals with substance use disorders. Stakeholders identified economic stability as the social factor with the most negative influence on the health of bradford county including poverty, household food insecurity, high housing costs and poor housing quality. The secondary data sources used in the chna included data pulled from community commons, data collected through the strategic marketing department (demographic information, discharge data, etc.) And data compiled by guthrie medical group when screening for social determinants of health. Recent indicators of health were collected from community commons and compared to state and national data. All information was assembled and a chna committee composed of community members, health care providers (physicians, nurses and social workers), administrators, and an individual with experience in public health were invited to review the findings. The data retrieved from community commons was stratified into eight categories which included clinical care, health behaviors, health outcomes, covid-19, economic stability, social and community context, education and neighborhood and built environment. Within the primary service area for tch, thirty-one indicators of health were identified to be below the state, national, or healthy people 2030 goal. Once the thirty-one indicators were identified, they were reviewed and ranked by each individual of the chna committee using the hanlon method. In addition to the chna group, this report in its entirety will be shared during regular meetings throughout 2022 and 2023 with the s2ay rural health network, east central division of the american cancer society, tioga partnership for community health, and the bradford, tioga, chemung, schuyler, and steuben health departments for their review, input, and solicitation of written comments. SCHEDULE H, PART V, SECTION B, QUESTION 7A THE ORGANIZATION IS AN AFFILIATE WITHIN THE GUTHRIE CLINIC AND AFFILIATES; A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY SYSTEM ("SYSTEM"). DUE TO CHARACTER LIMITATIONS, THE WEBSITE LISTED IN SCHEDULE H, PART V, SECTION B, QUESTION 7A, IS THE HOME PAGE FOR THE SYSTEM. THE CHNA CAN BE ACCESSED AT THE FOLLOWING PAGE INCLUDED IN THE SYSTEM'S WEBSITE: https://www.guthrie.org/about-us/community-benefits/community-health-needs -assessment SCHEDULE H, PART V, SECTION B, QUESTION 10A THE ORGANIZATION IS AN AFFILIATE WITHIN THE GUTHRIE CLINIC AND AFFILIATES; A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY SYSTEM ("SYSTEM"). DUE TO CHARACTER LIMITATIONS, THE WEBSITE LISTED IN SCHEDULE H, PART V, SECTION B, QUESTION 10A, IS THE HOME PAGE FOR THE SYSTEM. THE MOST RECENTLY ADOPTED IMPLEMENTATION STRATEGY CAN BE ACCESSED AT THE FOLLOWING PAGE INCLUDED IN THE SYSTEM'S WEBSITE: https://www.guthrie.org/about-us/community-benefits/community-health-needs -assessment SCHEDULE H, PART V, SECTION B, QUESTION 11 FOR A COMPLETE DESCRIPTION ON HOW THE ORGANIZATION IS ADDRESSING THE NEEDS IDENTIFIED IN THE MOST RECENTLY COMPLETED CHNA, SEE THE FOLLOWING: https://www.guthrie.org/about-us/community-benefits/community-health-needs -assessment DUE TO RESOURCE LIMITATIONS, THE FOLLOWING IDENTIFIED NEEDS WERE NOT ABLE TO BE ADDRESSED IN THE IMPLEMENTATION PLAN: - PREVENTABLE HOSPITAL EVENTS - HIV SCREENINGS SCHEDULE H, PART V, SECTION B, QUESTION 16 THE ORGANIZATION IS AN AFFILIATE WITHIN THE GUTHRIE CLINIC AND AFFILIATES; A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY SYSTEM ("SYSTEM"). DUE TO CHARACTER LIMITATIONS, THE WEBSITE LISTED IN SCHEDULE H, PART V, SECTION B, QUESTION 16 IS THE HOME PAGE FOR THE SYSTEM. THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY, FINANCIAL ASSISTANCE APPLICATION, AND PLAIN LANGUAGE SUMMARY ARE MADE WIDELY AVAILABLE ON THE ORGANIZATION'S WEBSITE. THESE DOCUMENTS CAN BE ASSESSED AT THE FOLLOWING PAGE INCLUDED IN THE SYSTEM'S WEBSITE: HTTPS://WWW.GUTHRIE.ORG/PATIENTS-VISITORS/PAY-MY-BILL/FINANCIAL-ASSISTANCE SCHEDULE H, PART I, QUESTION 7 INFORMATION REPORTED ON THE SCHEDULE H, PART I, LINE 7 TABLE WAS DERIVED UTILIZING THE RATIO OF COST TO CHARGES CALCULATED USING WORKSHEET 2, EXCEPT LINE 7B, WHICH WAS TAKEN FROM THE MEDICARE COST REPORT, AND LINE 7G, WHICH WAS CALCULATED BASED UPON AN INTERNAL COST ACCOUNTING SYSTEM. WITHIN THE COST ACCOUNTING SYSTEM, SOME PATIENT SEGMENTS WERE BASED ON A RATIO OF COST TO CHARGE - TOTAL DEPARTMENTAL EXPENSE PLUS ALLOCATED OVERHEAD SPREAD BASED ON CHARGES. SCHEDULE H, PART III, SECTION A, QUESTIONS 2, 3 & 4 THE COSTING METHODOLOGY USED IN DETERMINING THE AMOUNTS REPORTED ON LINES 2 AND 3 ARE BASED ON ACTUAL CHARGES WRITTEN OFF (AMOUNTS THAT ARE DEEMED TO BE UNCOLLECTIBLE AND RECORDED AS IMPLICIT PRICE CONCESSIONS UNDER ACCOUNTING PRONOUNCEMENT ASC 606). TROY COMMUNITY HOSPITAL PROVIDES CARE TO ALL PATIENTS WHO NEED IT, REGARDLESS OF THEIR ABILITY TO PAY. THIS IS PART OF THE HOSPITAL'S MISSION. THE HOSPITAL ESTIMATES THAT 10% OF THE BAD DEBT EXPENSE AT COST IS ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY THAT HAVE NOT FILLED OUT THE PROPER FORMS OR PROVIDED THE PROPER INFORMATION TO QUALIFY FOR THE PROGRAM. THE TEXT OF THE BAD DEBT FOOTNOTE CAN BE FOUND ON PAGE 13 OF THE ELECTONICALLY ATTACHED AUDITED FINANCIAL STATEMENTS FOR THE GUTHRIE CLINIC AND AFFILIATES. SCHEDULE H, PART III, SECTION C, QUESTION 8 MEDICARE COSTS WERE DERIVED FROM THE 2022 MEDICARE COST REPORT. THE ORGANIZATION FEELS THAT MEDICARE UNDERPAYMENTS (SHORTFALL), BAD DEBT AND ASSOCIATED COSTS ARE COMMUNITY BENEFIT AND ARE INCLUDABLE ON THE FORM 990, SCHEDULE H, PART I. AS OUTLINED MORE FULLY BELOW, THE ORGANIZATION BELIEVES THAT THESE SERVICES AND RELATED COSTS PROMOTE THE HEALTH OF THE COMMUNITY AS A WHOLE AND ARE RENDERED IN CONJUNCTION WITH THE ORGANIZATION'S CHARITABLE TAX-EXEMPT PURPOSES AND MISSION IN PROVIDING MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUALS IN A NON-DISCRIMINATORY MANNER WITHOUT REGARD TO RACE, COLOR, CREED, SEX, NATIONAL ORIGIN OR ABILITY TO PAY AND CONSISTENT WITH THE COMMUNITY BENEFIT STANDARD PROMULGATED BY THE IRS. THE COMMUNITY BENEFIT STANDARD IS THE CURRENT STANDARD FOR A HOSPITAL FOR RECOGNITION AS A TAX-EXEMPT AND CHARITABLE ORGANIZATION UNDER INTERNAL REVENUE CODE ("IRC") 501(C)(3). THE ORGANIZATION IS RECOGNIZED AS A TAX-EXEMPT ENTITY AND CHARITABLE ORGANIZATION UNDER 501(C)(3) OF THE IRC. ALTHOUGH THERE IS NO DEFINITION IN THE TAX CODE FOR THE TERM "CHARITABLE" A REGULATION PROMULGATED BY THE DEPARTMENT OF THE TREASURY PROVIDES SOME GUIDANCE AND STATES THAT "THE TERM CHARITABLE IS USED IN SECTION 501(C)(3) IN ITS GENERALLY ACCEPTED LEGAL SENSE,PROVIDES EXAMPLES OF CHARITABLE PURPOSES, INCLUDING THE RELIEF OF THE POOR OR UNPRIVILEGED; THE PROMOTION OF SOCIAL WELFARE; AND THE ADVANCEMENT OF EDUCATION, RELIGION, AND SCIENCE. NOTE IT DOES NOT EXPLICITLY ADDRESS THE ACTIVITIES OF HOSPITALS. IN THE ABSENCE OF EXPLICIT STATUTORY OR REGULATORY REQUIREMENTS APPLYING THE TERM "CHARITABLE" TO HOSPITALS, IT HAS BEEN LEFT TO THE IRS TO DETERMINE THE CRITERIA HOSPITALS MUST MEET TO QUALIFY AS IRC 501(C)(3) CHARITABLE ORGANIZATIONS. THE ORIGINAL STANDARD WAS KNOWN AS THE CHARITY CARE STANDARD. THIS STANDARD WAS REPLACED BY THE IRS WITH THE COMMUNITY BENEFIT STANDARD WHICH IS THE CURRENT STANDARD. CHARITY CARE STANDARD IN 1956, THE IRS ISSUED REVENUE RULING 56-185, WHICH ADDRESSED THE REQUIREMENTS HOSPITALS NEEDED TO MEET IN ORDER TO QUALIFY FOR IRC 501(C)(3) STATUS. ONE OF THESE REQUIREMENTS IS KNOWN AS THE "CHARITY CARE STANDARD." UNDER THE STANDARD, A HOSPITAL MUST PROVIDE, TO THE EXTENT OF ITS FINANCIAL ABILITY, FREE OR REDUCED-COST CARE TO PATIENTS WHO CANNOT PAY FOR SUCH SERVICES. A HOSPITAL THAT EXPECTED FULL PAYMENT DID NOT, ACCORDING TO THE RULING, PROVIDE CHARITY CARE BASED ON THE FACT THAT SOME PATIENTS ULTIMATELY FAILED TO PAY. THE RULING EMPHASIZED THAT A LOW LEVEL OF CHARITY CARE DID NOT NECESSARILY MEAN THAT A HOSPITAL HAD FAILED TO MEET THE REQUIREMENT SINCE THAT LEVEL COULD REFLECT ITS FINANCIAL ABILITY TO PROVIDE SUCH CARE. THE RULING ALSO NOTED THAT PUBLICLY SUPPORTED COMMUNITY HOSPITALS WOULD NORMALLY QUALIFY AS CHARITABLE ORGANIZATIONS BECAUSE THEY SERVE THE ENTIRE COMMUNITY AND A LOW LEVEL OF CHARITY CARE WOULD NOT AFFECT A HOSPITAL'S EXEMPT STATUS IF IT WAS DUE TO THE SURROUNDING COMMUNITY'S LACK OF CHARITABLE DEMANDS. COMMUNITY BENEFIT STANDARD IN 1969, THE IRS ISSUED REVENUE RULING 69-545, WHICH "REMOVED" FROM REVENUE RULING 56-185 "THE REQUIREMENTS RELATING TO CARING FOR PATIENTS WITHOUT CHARGE OR AT RATES BELOW COST." UNDER THE STANDARD DEVELOPED IN REVENUE RULING 69-545, WHICH IS KNOWN AS THE "COMMUNITY BENEFIT STANDARD," HOSPITALS ARE JUDGED ON WHETHER THEY PROMOTE THE HEALTH OF A BROAD CLASS OF INDIVIDUALS IN THE COMMUNITY. THE RULING INVOLVED A HOSPITAL THAT ONLY ADMITTED INDIVIDUALS WHO COULD PAY FOR THE SERVICES (BY THEMSELVES, PRIVATE INSURANCE, OR PUBLIC PROGRAMS SUCH AS MEDICARE), BUT OPERATED A FULL-TIME EMERGENCY ROOM THAT WAS OPEN TO EVERYONE. THE IRS RULED THAT THE HOSPITAL QUALIFIED AS A CHARITABLE ORGANIZATION BECAUSE IT PROMOTED THE HEALTH OF PEOPLE IN ITS COMMUNITY. THE IRS REASONED THAT BECAUSE THE PROMOTION OF HEALTH WAS A CHARITABLE PURPOSE ACCORDING TO THE GENERAL LAW OF CHARITY, IT FELL WITHIN THE "GENERALLY ACCEPTED LEGAL SENSE" OF THE TERM "CHARITABLE," AS REQUIRED BY THE DEPARTMENT OF TREASURY REG. 1.501(C)(3)-1(D)(2). THE IRS RULING STATED THAT THE PROMOTION OF HEALTH, LIKE THE RELIEF OF POVERTY AND THE ADVANCEMENT OF EDUCATION AND RELIGION, IS ONE OF THE PURPOSES IN THE GENERAL LAW OF CHARITY THAT IS DEEMED BENEFICIAL TO THE COMMUNITY AS A WHOLE EVEN THOUGH THE CLASS OF BENEFICIARIES ELIGIBLE TO RECEIVE A DIRECT BENEFIT FROM ITS ACTIVITIES DOES NOT INCLUDE ALL MEMBERS OF THE COMMUNITY, SUCH AS INDIGENT MEMBERS OF THE COMMUNITY, PROVIDED THAT THE CLASS IS NOT SO SMALL THAT ITS RELIEF IS NOT OF BENEFIT TO THE COMMUNITY. THE IRS CONCLUDED THAT THE HOSPITAL WAS "PROMOTING THE HEALTH OF A CLASS OF PERSONS THAT IS BROAD ENOUGH TO BENEFIT THE COMMUNITY" BECAUSE ITS EMERGENCY ROOM WAS OPEN TO ALL AND IT PROVIDED CARE TO EVERYONE WHO COULD PAY, WHETHER DIRECTLY OR THROUGH THIRD-PARTY REIMBURSEMENT. OTHER CHARACTERISTICS OF THE HOSPITAL THAT THE IRS HIGHLIGHTED INCLUDED THE FOLLOWING: ITS SURPLUS FUNDS WERE USED TO IMPROVE PATIENT CARE, EXPAND HOSPITAL FACILITIES, AND ADVANCE MEDICAL TRAINING, EDUCATION AND RESEARCH; IT WAS CONTROLLED BY A BOARD OF TRUSTEES THAT CONSISTED OF INDEPENDENT CIVIC LEADERS; AND HOSPITAL MEDICAL STAFF PRIVILEGES WERE AVAILABLE TO ALL QUALIFIED PHYSICIANS. THE AMERICAN HOSPITAL ASSOCIATION ("AHA") FEELS THAT MEDICARE UNDERPAYMENTS (SHORTFALL) AND BAD DEBT ARE COMMUNITY BENEFIT AND THUS INCLUDABLE ON THE FORM 990, SCHEDULE H, PART I. THIS ORGANIZATION AGREES WITH THE AHA'S POSITION. AS OUTLINED IN THE AHA'S LETTER TO THE IRS DATED AUGUST 21, 2007 WITH RESPECT TO THE FIRST PUBLISHED DRAFT OF THE NEW FORM 990 AND SCHEDULE H, THE AHA FELT THAT THE IRS SHOULD INCORPORATE THE FULL VALUE OF THE COMMUNITY BENEFIT THAT HOSPITALS PROVIDE BY COUNTING MEDICARE UNDERPAYMENTS (SHORTFALL) AS QUANTIFIABLE COMMUNITY BENEFIT FOR THE FOLLOWING REASONS: - PROVIDING CARE FOR THE ELDERLY AND SERVING MEDICARE PATIENTS IS AN ESSENTIAL PART OF THE COMMUNITY BENEFIT STANDARD - MEDICARE, LIKE MEDICAID, DOES NOT PAY THE FULL COST OF CARE. FROM THE LATEST DATA PROVIDED BY THE AHA, MEDICARE REIMBURSES HOSPITALS ONLY 87 CENTS FOR EVERY DOLLAR THEY SPEND TO TAKE CARE OF MEDICARE PATIENTS. - MANY MEDICARE BENEFICIARIES, LIKE THEIR MEDICAID COUNTERPARTS, ARE POOR. MORE THAN 42 PERCENT OF MEDICARE SPENDING IS FOR BENEFICIARIES WHOSE INCOME IS BELOW 200 PERCENT OF THE FEDERAL POVERTY LEVEL. MANY OF THOSE MEDICARE BENEFICIARIES ARE ALSO ELIGIBLE FOR MEDICAID -- SO CALLED ELIGIBLE." THERE IS EVERY COMPELLING PUBLIC POLICY REASON TO TREAT MEDICARE AND MEDICAID UNDERPAYMENTS SIMILARLY FOR PURPOSES OF A HOSPITAL'S COMMUNITY BENEFIT AND INCLUDE THESE COSTS ON FORM 990, SCHEDULE H, PART I. MEDICARE UNDERPAYMENT MUST BE SHOULDERED BY THE HOSPITAL IN ORDER TO CONTINUE TREATING THE COMMUNITY'S ELDERLY AND POOR. THESE UNDERPAYMENTS REPRESENT A REAL COST OF SERVING THE COMMUNITY AND SHOULD COUNT AS A QUANTIFIABLE COMMUNITY BENEFIT. BOTH THE AHA AND THIS ORGANIZATION ALSO FEEL THAT PATIENT BAD DEBT IS A COMMUNITY BENEFIT AND THUS INCLUDABLE ON THE FORM 990, SCHEDULE H, PART I. LIKE MEDICARE UNDERPAYMENT (SHORTFALLS), THERE ALSO ARE COMPELLING REASONS THAT PATIENT BAD DEBT SHOULD BE COUNTED AS QUANTIFIABLE COMMUNITY BENEFIT AS FOLLOWS: - A SIGNIFICANT MAJORITY OF BAD DEBT IS ATTRIBUTABLE TO LOW-INCOME PATIENTS, WHO, FOR MANY REASONS, DECLINE TO COMPLETE THE FORMS REQUIRED TO ESTABLISH ELIGIBILITY FOR HOSPITALS' CHARITY CARE OR THOSE WHO DO NOT PAY ALL, OR A PORTION OF THE ALREADY DISCOUNTED BILLED AMOUNTS UNDER OUR FINANCIAL ASSISTANCE POLICY. A 2006 CONGRESSIONAL BUDGET OFFICE ("CBO") REPORT, NONPROFIT HOSPITALS AND THE PROVISION OF COMMUNITY BENEFITS, CITED TWO STUDIES INDICATING THAT "THE GREAT MAJORITY OF BAD DEBT WAS ATTRIBUTABLE TO PATIENTS WITH INCOMES BELOW 200% OF THE FEDERAL POVERTY LINE." - THE REPORT ALSO NOTED THAT A SUBSTANTIAL PORTION OF BAD DEBT IS PENDING CHARITY CARE. UNLIKE BAD DEBT IN OTHER INDUSTRIES, HOSPITAL BAD DEBT IS COMPLICATED BY THE FACT THAT HOSPITALS FOLLOW THEIR MISSION TO THE COMMUNITY AND TREAT EVERY PATIENT THAT COMES THROUGH THEIR EMERGENCY DEPARTMENT, REGARDLESS OF ABILITY TO PAY. PATIENTS WHO HAVE OUTSTANDING BILLS ARE NOT TURNED AWAY, UNLIKE OTHER INDUSTRIES. BAD DEBT IS FURTHER COMPLICATED BY THE AUDITING INDUSTRY'S STANDARDS ON REPORTING CHARITY CARE. MANY PATIENTS CANNOT OR DO NOT PROVIDE THE NECESSARY, EXTENSIVE DOCUMENTATION REQUIRED TO BE DEEMED CHARITY CARE BY AUDITORS. AS A RESULT, ROUGHLY 40% OF BAD DEBT IS PENDING CHARITY CARE. THE CBO CONCLUDED THAT ITS FINDINGS "SUPPORT THE VALIDITY OF THE USE OF UNCOMPENSATED CARE [BAD DEBT AND CHARITY CARE] AS A MEASURE OF COMMUNITY BENEFIT" ASSUMING THE FINDINGS ARE GENERALIZABLE NATIONWIDE; THE EXPERIENCE OF HOSPITALS AROUND THE NATION REINFORCES THAT THEY ARE GENERALIZABLE. AS OUTLINED BY THE AHA, DESPITE THE HOSPITAL'S BEST EFFORTS AND DUE DILIGENCE, PATIENT BAD DEBT IS A PART OF THE HOSPITAL'S MISSION AND CHARITABLE PURPOSES. BAD DEBT REPRESENTS PART OF THE BURDEN HOSPITALS SHOULDER IN SERVING ALL PATIENTS RE SCHEDULE H, PART III, SECTION C, QUESTION 9B ONCE A PATIENT IS APPROVED FOR CHARITY CARE OR AN INSTALLMENT PLAN, THEIR ACCOUNT IS TRANSFERRED TO EITHER THE BUDGET OR CHARITY CARE FINANCIAL CLASS. ACCOUNTS IN THESE FINANCIAL CLASSES ARE NOT PLACED WITH COLLECTION. SCHEDULE H, PART VI, QUESTION 2 Troy community hospital ("tch") and the guthrie clinic ("tgc") emphasize primary health care services, health promotion, and chronic disease prevention and management for the community we serve. Tch's overall approach to community benefit is to examine the intersection of documented unmet community needs and match these needs with organizational strengths. These unmet community needs can be defined as a discrepancy or gap between what is currently available and what the community desires. The overarching goals of this community health needs assessment (chna) are to (1) identify strengths and limitations within tch's service area; (2) define the needs and assets associated with the community we serve; (3) describe resources such as health professionals, regional economics and communication networks whose goal is to maximize community health. The identified needs will result in the formation of an implementation plan that will build upon the continuum of care currently offered at tch by clearly linking our clinical services with our community-based services through this community benefit process. The implemented community benefit plan will be integrated into the strategic organizational goals of tch. The plan progress will be monitored to ensure timely implementation. Further collaborative partnerships will be integral to the success of the plan. The troy community hospital (tch) community health needs assessment (chna) began with collecting primary data through a 20 question community stakeholder survey from december 20, 2021-february 11, 2022. This community stakeholder survey incorporated the feedback of individuals who represent the broad interests of the community served by troy community hospital including; individuals living in poverty and in need of emergency assistance or housing, individuals with mental health or substance use disorders, individuals with developmental disorders, older adults, children and youth. Troy community hospital has not received written comments on the last chna or implementation plan. The community stakeholder survey was conducted with outreach to forty-seven community stakeholders that provide services throughout bradford county: Survey responses were received from the following organizations: - abuse & rape crisis center of bradford county (services to eliminate interpersonal violence) - bradford county public health department - bradford tioga high school (high school students) - bradford, sullivan, susquehanna and tioga counties area agency on aging (older adults) - canton k-12 schools (children and youth) - endless mountain mission center (temporary emergency assistance) - futures community support services (services for individuals with emotional and/or developmental disabilities) - harbor counseling (mental health and substance use disorder treatment) - martha lloyd community services (services for people with intellectual disabilities and autism) - north penn legal services (free legal assistance) - salvation army (emergency assistance) - sayre public library - the main link (non-clinical consumer run services for mental health consumers) Survey results ranked the biggest problems impacting bradford county in sequential order from highest to lowest as: mental health conditions, alcohol and other substance use disorders, poverty, covid-19 and unemployment. When asked to identify what population experiences the poorest health outcomes in bradford county, community stakeholders identified the top there populations as: individuals living with mental health conditions, individuals living at or near the federal poverty level and individuals in rural areas and individuals with substance use disorders. Stakeholders identified economic stability as the social factor with the most negative influence on the health of bradford county including poverty, household food insecurity, high housing costs and poor housing quality. The secondary data sources used in the chna included data pulled from community commons, data collected through the strategic marketing department (demographic information, discharge data, etc.) And data compiled by guthrie medical group when screening for social determinants of health. Recent indicators of health were collected from community commons and compared to state and national data. All information was assembled and a chna committee composed of community members, health care providers (physicians, nurses and social workers), administrators, and an individual with experience in public health were invited to review the findings. The data retrieved from community commons was stratified into eight categories which included clinical care, health behaviors, health outcomes, covid-19, economic stability, social and community context, education and neighborhood and built environment. Within the primary service area for tch, thirty-one indicators of health were identified to be below the state, national, or healthy people 2030 goal. Once the thirty-one indicators were identified, they were reviewed and ranked by each individual of the chna committee using the hanlon method. The hanlon method uses a two-step process to score indicators of health. The first step ensures that each need meets the pearl test which includes: propriety - is an intervention suitable?; economics- does it make economic sense to address the need?; acceptability- is the community open to addressing this need and will it accept the intervention?; resources- are resources available?; legality- is the intervention lawful?. The second step of the hanlon method includes assigning a score from 0-10 for each need regarding the (1) size of the problem (2) seriousness of the problem and (3) effectiveness potential of an intervention. Using this methodology, the chna group scored each of the unmet needs from which several priority needs were identified for the primary service area of tch. Once scored and weighted according to the hanlon method, the results were shared with the chna group for discussion. The group was also given the opportunity to adjust any rankings. The hanlon method prioritized five areas of unmet health care needs. The chna committee integrated the results of the stakeholder survey taking into account their understanding of the resources available and experience in providing services. From their discussion and review, the committee identified, in sequential order (highest to lowest score) these priority needs: mental health, obesity, emergency department utilization, high blood pressure, and diabetes. The chna committee assessed which of the top five priorities tch has capacity to address in the next 3 fiscal years. Due to available resources, the following needs were identified as priorities for intervention over the next three years: 1. Obesity 2. Mental health Many of the chronic health conditions have the same risk factors, indicating the need for lifestyle changes that address the underlying risk factors (i.e. obesity) contributing to these conditions. Obesity was selected as a priority to address over the next three years. A prevention approach focusing on obesity would likely have a favorable impact on diabetes and high blood pressure, addressing a need that cascades into other pressing concerns. Taking into consideration the community's prioritization of mental health, the committee selected mental health as the second priority area to address. Additionally, in reviewing resources to address ed utilization, the chna committee identified mental health concerns as one the most pressing concerns related to emergency department utilization. Additionally, youth struggling with mental health challenges are being seen in the primary care setting and the emergency department, highlighting the need for a community response to address this unmet need. Addressing emergency department utilization for mental health needs and convening a community response to the rise in bullying will be focus areas of the mental health priority. In addition to the priorities set by the chna group three more unmet community needs were identified and will be described within this chna as areas for potential health improvement. However, due to available resources these needs will not be addressed through an implementation strategy in the subsequent fiscal years. These needs include: - emergency department utilization - high blood pressure - diabetes SCHEDULE H, PART VI, QUESTION 3 Charity care availability and contact information are posted in all registration areas and in the hospital's business office. The charity care policy, application, and contact information are posted on the hospital's website. Self pay patients are referred to the hospital's financial counselor from physician offices, social workers, or self referred. The financial counselor as well as the business office staff follow up with self pay patients to assess their need and assist in determining their eligibility for securing a payment source (i.e. cobra coverage, special needs program, medicaid, other federal/state programs, or charity care). Staff also assist with the application process as requested by self pay patients. The hospital's billing statements also have information regarding who to contact in case a patient needs assistance meeting its financial obligations. SCHEDULE H, PART VI, QUESTION 4 Troy community hospital ("tch") is a not-for-profit, 25-bed critical access hospital and a member of the guthrie clinic ("tgc"). Tch is located in troy, pa and is a critical access hospital that serves a primary service area of bradford county, pa. In fiscal year 2023, tch had over 660 inpatient visits, more than 1,111 short procedures, 26 inpatient surgeries and 736 outpatient surgeries. The tch emergency department had over 7,600 visits and managed over 14,690 outpatient visits. In 2017, tch was awarded full trauma center accreditation as an adult level iv trauma center. Tch is also accredited by the american osteopathic association. The hospital has also received national awards for high quality patient care such as the women's choice award recognizing america's best hospitals for emergency care and national committee for quality assurance (ncqa) patient-centered medical home (pcmh) recognition for quality patient-centered care. Tch is a regional level iv trauma center, accredited by the pennsylvania trauma systems foundation and is equipped to stabilize injured patients to transfer them quickly to a higher-level trauma center. This is an important link in the trauma system, especially in remote areas like troy where weather and distance play a critical factor in trauma patient survival. Tch offers a range of services, including emergency care, laboratory services, medical imaging, rehabilitation, sleep studies, sub-acute care, surgical care, a ventilator management program, and other supporting services. Tch serves a rural population over the geographic area of bradford county, pennsylvania. The primary service area is defined as four contiguous zip codes from which we derive at least 75% of our inpatient population. From the american community survey (2015-2019), the four contiguous zip codes include 60,963 people, the majority of which are white, non-hispanic and 65 years or older. In this geographic area, 50.8% of individuals aged 18 or older have at least a high school degree with 47.0% and 15.3% having some college and 18.7% bachelor's degree/higher. Twenty percent of the population in bradford county is 65 years of age or older whereas in the united states this age group makes up only fifteen percent of the population. SCHEDULE H, PART VI, QUESTION 5 PLEASE REFER TO THE ORGANIZATION'S COMMUNITY BENEFIT STATEMENT IN SCHEDULE O FOR MORE INFORMATION REGARDING HOW THE HOSPITAL FURTHERS ITS EXEMPT PURPOSE BY PROMOTING THE HEALTH OF THE COMMUMNITY. SCHEDULE H, PART VI, QUESTION 6 THE ORGANIZATION IS AN AFFILIATE WITHIN THE GUTHRIE CLINIC AND AFFILIATES; A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY SYSTEM ("SYSTEM"). ALL AFFILIATES ARE COMMITTED TO ENHANCING THE OVERALL HEALTH STATUS OF THE COMMUNITY BY PROVIDING THE HIGHEST QUALITY HEALTHCARE AND RELATED SERVICES IN A COST-EFFECTIVE MANNER AND REGARDLESS OF ABILITY TO PAY. THE SYSTEM STRIVES TO EXCEED THE PATIENTS' EXPECTATIONS BY EMPHASIZING COMMITMENT, COMPETENCE, COLLABORATION, COMMUNICATION AND COMPASSION. THE GUTHRIE CLINIC IS AN ORGANIZATION RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS TAX-EXEMPT PURSUANT TO INTERNAL REVENUE CODE 501(C)(3) AND AS A SUPPORTING ORGANIZATION PURSUANT TO INTERNAL REVENUE CODE 509(A)(3). THE GUTHRIE CLINIC OPERATES AS THE TAX-EXEMPT PARENT ENTITY OF A MULTI-CORPORATE HEALTHCARE SYSTEM. IT WAS CREATED TO COORDINATE, SUPERVISE AND ENSURE THE CONTINUATION AND IMPROVEMENT OF THE QUALITY OF HEALTHCARE SERVICES PROVIDED BY ITS QUALIFYING AFFILIATES TO THE COMMUNITY. THE GUTHRIE CLINIC ENSURES THAT ITS SYSTEM PROVIDES MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUALS REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN OR ABILITY TO PAY. THE SOLE MEMBER OR STOCKHOLDER OF EACH ENTITY WITHIN THE SYSTEM IS EITHER THE GUTHRIE CLINIC OR ANOTHER SYSTEM AFFILIATE CONTROLLED OR OWNED BY THE GUTHRIE CLINIC. OUTLINED BELOW IS A SUMMARY OF THE ENTITIES WHICH COMPRISE THE SYSTEM. ACTIVE HOSPITAL LEGAL ENTITIES INCLUDE CORNING HOSPITAL, GUTHRIE CORTLAND MEDICAL CENTER, ROBERT PACKER HOSPITAL AND TROY COMMUNITY HOSPITAL, INC. EACH OF THESE HOSPITALS OPERATES CONSISTENTLY WITH THE FOLLOWING CRITERIA OUTLINED IN IRS REVENUE RULING 69-545: 1. EACH PROVIDE MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUALS REGARDLESS OF ABILITY TO PAY, INCLUDING CHARITY CARE, SELF-PAY, MEDICARE AND MEDICAID PATIENTS; 2. EACH ACUTE CARE HOSPITAL OPERATES AN ACTIVE EMERGENCY DEPARTMENT FOR ALL PERSONS, WHICH IS OPEN 24 HOURS A DAY, 7 DAYS A WEEK, 365 DAYS PER YEAR; 3. EACH MAINTAINS AN OPEN MEDICAL STAFF, WITH PRIVILEGES AVAILABLE TO ALL QUALIFIED PHYSICIANS; 4. CONTROL OF EACH RESTS WITH ITS BOARD OF DIRECTORS AND THE BOARD OF DIRECTORS OF THE GUTHRIE CLINIC (BOTH BOARDS ARE COMPRISED OF INDEPENDENT CIVIC LEADERS AND OTHER PROMINENT MEMBERS OF THE COMMUNITY); AND 5. SURPLUS FUNDS ARE USED TO IMPROVE THE QUALITY OF PATIENT CARE, EXPAND AND RENOVATE FACILITIES AND ADVANCE MEDICAL CARE, PROGRAMS AND ACTIVITIES. AFFILIATED GUTHRIE CLINIC ENTITIES ARE AS FOLLOWS: CORNING HOSPITAL ("CH") IS A 65-BED NON-PROFIT ACUTE CARE MEDICAL CENTER LOCATED IN CORNING, NEW YORK. CH IS RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS AN INTERNAL REVENUE CODE 501(C)(3) TAX-EXEMPT ORGANIZATION. PURSUANT TO ITS CHARITABLE PURPOSES, CH PROVIDES MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUALS IN A NON-DISCRIMINATORY MANNER REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN OR ABILITY TO PAY. MOREOVER, CH OPERATES CONSISTENTLY WITH THE CRITERIA OUTLINED IN IRS REVENUE RULING 69-545. GUTHRIE CORTLAND MEDICAL CENTER ("GCMC") IS A 144-BED NON-PROFIT ACUTE CARE MEDICAL CENTER LOCATED IN CORTLAND, NEW YORK. GCMC IS RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS AN INTERNAL REVENUE CODE 501(C)(3) TAX-EXEMPT ORGANIZATION. PURSUANT TO ITS CHARITABLE PURPOSES, GCMC PROVIDES MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUALS IN A NON-DISCRIMINATORY MANNER REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN OR ABILITY TO PAY. MOREOVER, GCMC OPERATES CONSISTENTLY WITH THE CRITERIA OUTLINED IN IRS REVENUE RULING 69-545. ROBERT PACKER HOSPITAL ("RPH") IS A 267-BED NON-PROFIT TERTIARY CARE REFERRAL CENTER LOCATED IN SAYRE, PENNSYLVANIA THAT ALSO OPERATES ROBERT PACKER HOSPITAL AT TOWANDA CAMPUS, A 35-BED NON-PROFIT ACUTE CARE MEDICAL CENTER LOCATED IN TOWANDA, PENNSYLVANIA. RPH IS RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS AN INTERNAL REVENUE CODE 501(C)(3) TAX-EXEMPT ORGANIZATION. PURSUANT TO ITS CHARITABLE PURPOSES, RPH PROVIDES MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUALS IN A NON-DISCRIMINATORY MANNER REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN OR ABILITY TO PAY. MOREOVER, RPH OPERATES CONSISTENTLY WITH THE CRITERIA OUTLINED IN IRS REVENUE RULING 69-545. TROY COMMUNITY HOSPITAL, INC. ("TCH") IS A 25-BED NON-PROFIT CRITICAL ACCESS HOSPITAL LOCATED IN TROY, PENNSYLVANIA. TCH IS RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS AN INTERNAL REVENUE CODE 501(C)(3) TAX-EXEMPT ORGANIZATION. PURSUANT TO ITS CHARITABLE PURPOSES, TCH PROVIDES MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUALS IN A NON-DISCRIMINATORY MANNER REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN OR ABILITY TO PAY. MOREOVER, TCH OPERATES CONSISTENTLY WITH THE CRITERIA OUTLINED IN IRS REVENUE RULING 69-545. CORTLAND MEMORIAL FOUNDATION, INC. IS AN ORGANIZATION RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS TAX-EXEMPT PURSUANT TO INTERNAL REVENUE CODE 501(C)(3) AND AS A NON-PRIVATE FOUNDATION PURSUANT TO INTERNAL REVENUE CODE 509(A)(1). THROUGH FUNDRAISING ACTIVITIES, THE ORGANIZATION SUPPORTS THE CHARITABLE PURPOSES, PROGRAMS AND SERVICES OF GCMC; A RELATED INTERNAL REVENUE CODE 501(C)(3) TAX-EXEMPT ORGANIZATION, THAT PROVIDES MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUALS IN A NON-DISCRIMINATORY MANNER REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN OR ABILITY TO PAY. DONALD GUTHRIE FOUNDATION IS AN ORGANIZATION RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS TAX-EXEMPT PURSUANT TO INTERNAL REVENUE CODE 501(C)(3) AND AS A NON-PRIVATE FOUNDATION PURSUANT TO INTERNAL REVENUE CODE 509(A)(1). THE ORGANIZATION DEVELOPS, GROWS AND CONDUCTS MEANINGFUL QUALITY RESEARCH TO IMPROVE THE LIVES OF PATIENTS AND IS COMPRISED OF THE THREE RESEARCH DEPARTMENTS OF CLINICAL RESEARCH, LEAP TESTING SERVICE AND THE INSTITUTIONAL REVIEW BOARD. THE ORGANIZATION SUPPORTS THE CHARITABLE PURPOSES, PROGRAMS AND SERVICES OF THE SYSTEM; WHICH PROVIDES MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUALS IN A NON-DISCRIMINATORY MANNER REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN OR ABILITY TO PAY. GUTHRIE HOME CARE IS AN ORGANIZATION RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS TAX-EXEMPT PURSUANT TO INTERNAL REVENUE CODE 501(C)(3) AND AS A NON-PRIVATE FOUNDATION PURSUANT TO INTERNAL REVENUE CODE 509(A)(2). THE ORGANIZATION'S MISSION IS TO ESTABLISH, MAINTAIN, AND SUPPORT HOME HEALTH AGENCY, PROVIDE FOR HOME HEALTH SERVICES, PROVIDE FOR HOSPICE SERVICES TO ALL INDIVIDUALS IN A NON-DISCRIMINATORY MANNER REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN OR ABILITY TO PAY. GUTHRIE MEDICAL GROUP, P.C. IS AN ORGANIZATION RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS TAX-EXEMPT PURSUANT TO INTERNAL REVENUE CODE 501(C)(3) AND AS A NON-PRIVATE FOUNDATION PURSUANT TO INTERNAL REVENUE CODE 509(A)(1). THE ORGANIZATION SUPPORTS THE HEALTH CARE SYSTEM; PRIMARILY ITS TAX-EXEMPT ACUTE CARE HOSPITALS, WHICH PROVIDE MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUALS IN A NON-DISCRIMINATORY MANNER REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN, RELIGION OR ABILITY TO PAY. GUTHRIE RISK RETENTION GROUP IS AN ORGANIZATION RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS TAX-EXEMPT PURSUANT TO INTERNAL REVENUE CODE 501(C)(3) AND AS A SUPPORTING ORGANIZATION PURSUANT TO INTERNAL REVENUE CODE 509(A)(3). THE ORGANIZATION OPERATES AS A RISK RETENTION GROUP UNDER THE FEDERAL LIABILITY RISK RETENTION ACT OF 1986 TO THE SYSTEM. THE ORGANIZATION SUPPORTS THE CHARITABLE PURPOSES, PROGRAMS AND SERVICES OF THE SYSTEM; WHICH PROVIDES MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUALS IN A NON-DISCRIMINATORY MANNER REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN OR ABILITY TO PAY. REGIONAL MEDICAL PRACTICE, PC IS AN ORGANIZATION RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS TAX-EXEMPT PURSUANT TO INTERNAL REVENUE CODE 501(C)(3) AND AS A NON-PRIVATE FOUNDATION PURSUANT TO INTERNAL REVENUE CODE 509(A)(1). THE ORGANIZATION SUPPORTS GCMC, WHICH PROVIDES MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUALS IN A NON-DISCRIMINATORY MANNER REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN, RELIGION OR ABILITY TO PAY. SAYRE HOUSE OF HOPE IS AN ORGANIZATION RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS TAX-EXEMPT PURSUANT TO INTERNAL REVENUE CODE 501(C)(3) AND AS A NON-PRIVATE FOUNDATION PURSUANT TO INTERNAL REVENUE CODE 509(A)(1). THE ORGANIZATION ALLEVIATES THE ADDITIONAL FINANCIAL AND EMOTIONAL BURDENS ON PATIENTS AND FAMILIES WHILE ENDURING A MEDICAL CRISIS BY PROVIDING TEMPORARY HOUSING AND SUPPORT. THE ORGANIZATION SUPPORTS THE CHARITABLE PURPOSES, PROGRAMS AND SERVICES OF THE SYSTEM; WHICH PROVIDES MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUALS IN A NON-DISCRIMINATORY MANNER REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN OR ABILITY TO PAY. OTHER GUTHRIE CLINIC LEGAL ENTITIES INCLUDE THE FOLLOWING: CMH SERVICES, INC. IS AN ENTITY WHOSE SOLE SHAREHOLDER IS GCMC. THE ORGANIZATION PROVIDE DURABLE MEDICAL EQUIPMENT. THE ORGANIZATION S SCHEDULE H, PART VI, QUESTION 7 NOT APPLICABLE. X X X X true true false false false false false true false PAUL G VERVALIN DIRECTOR - EVP/COO TGC 0 484690 0 109037 0 51813 0 66054 0 18982 0 730576 0 40006 DEBRA RAUPERS DIRECTOR 0 293517 0 70529 0 49602 0 18300 0 321 0 432269 0 0 FRANCIS M MACAFEE CFO (7/1/22-12/31/22) 0 294250 0 34550 0 0 0 19825 0 18757 0 367382 0 0 LORI BARNETT DIRECTOR - PRESIDENT 182531 0 32103 0 0 0 12878 0 321 0 227833 0 0 0 JENNIFER FLEURY REGISTERED NURSE 192557 0 1587 0 0 0 10193 0 0 0 204337 0 0 0 JEFFREY S JENKINS DIR-SR DIR POST (TERM 12/31) 0 173243 0 14234 0 0 0 5624 0 8370 0 201471 0 0 BRENDA L BOOR MANAGER, NURSING 152836 0 8660 0 0 0 10497 0 8043 0 180036 0 0 0 FAITH MCNEAL REGISTERED NURSE 124796 0 1587 0 0 0 6635 0 24296 0 157314 0 0 0 MICHELLE JELLIFF DIRECTOR, NURSING (TERMED) 97595 0 0 0 47744 0 5856 0 1437 0 152632 0 0 0 SANDRA LIEWELLYN REGISTERED NURSE 122103 0 6587 0 0 0 8365 0 15382 0 152437 0 0 0 PART VII AND SCHEDULE J IN ACCORDANCE WITH INTERNAL REVENUE SERVICE FORM 990 RULES, REGULATIONS AND INSTRUCTIONS, THE COMPENSATION REPORTED IN CORE FORM, PART VII AND SCHEDULE J, PART II OF THIS FORM 990 IS DERIVED FROM 2022 FORMS W-2 AND FORMS 1099 (IF APPLICABLE). SCHEDULE J, PART I; QUESTION 4A THE FOLLOWING INDIVIDUAL RECEIVED A SEVERANCE PAYMENT DURING CALENDAR YEAR 2022 WHICH WAS INCLUDED IN HER 2022 FORM W-2, BOX 5, AS TAXABLE MEDICARE WAGES: MICHELLE JELLIFF, $37,011. SCHEDULE J, PART I; QUESTION 4B THE GUTHRIE CLINIC ("TGC") HAS ESTABLISHED AN EMPLOYEE BENEFIT PLAN KNOWN AS THE GUTHRIE CLINIC 457(F) DEFERRED COMPENSATION PLAN (THE "PLAN") WHICH IS DESIGNED TO PROVIDE ELIGIBLE EMPLOYEES WITH DEFERRED COMPENSATION BENEFITS IN RECOGNITION OF THEIR DEDICATED AND VALUABLE SERVICE TO TGC. THE PLAN IS INTENDED TO BE AN INELIGIBLE DEFERRED COMPENSATION PLAN AS DESCRIBED IN SECTION 457(F) OF THE INTERNAL REVENUE CODE. EACH CONTRIBUTION VESTS AFTER THREE YEARS OF EMPLOYMENT PROVIDED THE PARTICIPANT REMAINS CONTINUOUSLY EMPLOYED. A PARTICIPANT SHALL BECOME FULLY VESTED IN THE PARTICIPANT'S 457(F) ACCOUNT BENEFIT UPON ATTAINING AGE 62, WITH 5 YEARS OF SERVICE. TGC SHALL DISTRIBUTE THE PARTICIPANT'S 457(F) ACCOUNT BENEFIT, LESS TAXES WITHHELD, THIRTY DAYS AFTER THE PARTICIPANT FIRST BECOMES VESTED IN THE PLAN. FOR YEARS SUBSEQUENT TO A PARTICIPANT ATTAINING AGE 62, THE PARTICIPANT SHALL BE ENTITLED TO THE PARTICIPANT'S DEFERRED COMPENSATION AMOUNT AS OF JULY 1ST IMMEDIATELY SUBSEQUENT TO THE DATE WHEN CREDITED. THE AMOUNTS REFLECTED IN SCHEDULE J, PART II, COLUMN B(III) FOR THE FOLLOWING INDIVIDUALS INCLUDE CURRENT YEAR VESTING IN AN INTERNAL REVENUE CODE SECTION 457(F) PLAN (NON-QUALIFIED DEFERRED COMPENSATION PLAN) AS THE AMOUNTS WERE NO LONGER SUBJECT TO A SUBSTANTIAL RISK OF COMPLETE FORFEITURE. THE AMOUNTS OUTLINED HEREIN WERE INCLUDED IN EACH INDIVIDUAL'S 2022 FORM W-2 AS TAXABLE WAGES: PAUL G. VERVALIN, $40,006; AND DEBRA RAUPERS, $29,102. THE DEFERRED COMPENSATION AMOUNT REFLECTED IN SCHEDULE J, PART II, COLUMN C FOR THE FOLLOWING INDIVIDUAL INCLUDES UNVESTED BENEFITS IN AN INTERNAL REVENUE CODE SECTION 457(F) PLAN (NON-QUALIFIED DEFERRED COMPENSATION PLAN) WHICH IS SUBJECT TO A SUBSTANTIAL RISK OF COMPLETE FORFEITURE. ACCORDINGLY, THE INDIVIDUAL MAY NEVER ACTUALLY RECEIVE THIS UNVESTED BENEFIT AMOUNT. THE AMOUNT OUTLINED HEREIN WAS NOT INCLUDED IN HIS 2022 FORM W-2, BOX 5, AS TAXABLE MEDICARE WAGES: PAUL G. VERVALIN, $47,754. SCHEDULE J, PART I; QUESTION 7 CERTAIN INDIVIDUALS INCLUDED IN SCHEDULE J, PART II RECEIVED A BONUS DURING CALENDAR YEAR 2022 WHICH AMOUNTS WERE INCLUDED IN COLUMN B(II) HEREIN AND IN EACH INDIVIDUAL'S 2022 FORM W-2, BOX 5, AS TAXABLE MEDICARE WAGES. PLEASE REFER TO THIS SECTION OF THE FORM 990, SCHEDULE J FOR THIS INFORMATION BY PERSON BY AMOUNT. SCHEDULE J, PART II; COLUMN F THE AMOUNTS REPORTED IN SCHEDULE J, PART II, COLUMN (F) INCLUDE VESTED BENEFITS IN A DEFERRED COMPENSATION PLAN AS THESE AMOUNTS WERE NO LONGER SUBJECT TO A SUBSTANTIAL RISK OF FORFEITURE. THESE AMOUNTS WERE REPORTED AS DEFERRED COMPENSATION ON PRIOR YEARS' FORMS 990 AND ARE NOW BEING REPORTED AGAIN ON THIS YEAR'S FORM 990. THESE HAVE BEEN TREATED AS TAXABLE INCOME AND REPORTED ON EACH INDIVIDUAL'S FORM W-2, BOX 5, AS TAXABLE MEDICARE WAGES. CORE FORM, PART III, STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS The Guthrie Clinic is a tax-exempt nonprofit health care organization incorporated for the purpose of conducting exclusively charitable, scientific and educational activities. The Guthrie Clinic ("TGC") acts as the tax-exempt parent of the system ("Guthrie"), a tax-exempt section 501(c)(3) integrated health care delivery system. The sole member of each entity is either TGC or another Guthrie system affiliate controlled or owned by TGC. Guthrie offers patients a full-spectrum of health services incorporating primary care, complex specialty care, behavioral health services, surgical services, inpatient care, durable medical equipment services, home health, long-term care, palliative care and hospice care. Our integrated approach creates a better experience for our patients and is working to decrease the cost of the delivery of health care. Guthrie serves a large population of people over a wide geographic area. Regardless of how patients enter the Guthrie system, our electronic health records enables our specialists and primary care physicians to actively collaborate - literally and virtually - to coordinate patient care. Our robust electronic health records enables Guthrie physicians and clinicians to quickly gain a comprehensive understanding of patients' health needs and our patient portal, eguthrie, allows patients to access their health information easily on a computer, tablet or smart phone. Guthrie mission & values ======================== As a non-profit tax-exempt health care system, Guthrie, its physicians and employees are focused on improving the health and well-being of the communities it serves. Guthrie's mission, vision and values statements articulate the principles on which the organization was founded and exists today. Mission ------- Guthrie works with the communities we serve to help each person attain optimal, life-long health and well-being. We will do so by providing integrated, clinically-advanced services that prevent, diagnose, and treat disease, within an environment of compassion, learning, and discovery. Vision ------ Improving health through clinical excellence and compassion; every patient; every time. Values ------ - patient-centeredness - teamwork - excellence A long history of service and growth ==================================== Guthrie Medical Group --------------------- Guthrie Medical Group is tax-exempt multispecialty group practice that was founded in 1910 by Dr. Donald Guthrie. Within a year of his arrival, Dr. Guthrie expanded services at Guthrie Robert Packer Hospital as he recruited physician specialists to join Guthrie, which he intended to model after the Mayo Clinic where he had just completed his residency. Learning and education ---------------------- Academics are a distinguishing characteristic of the Guthrie organization, which date back to 1901 when the School of Nursing was founded. The Donald Guthrie Research Foundation started in 1942 and with funds from the Emily Guthrie estate, the Guthrie Research Institute was formed in 1980. Guthrie's commitment to learning and education includes the internal medicine residency program in 1958, general surgery residency program in 1959, and the family practice residency program in 1993. Regional offices ---------------- Guthrie has grown in size and capability in the last century, and now serves as a major regional referral center where more than 1,600 physicians send their patients. In 1977, Guthrie opened its first regional office in Troy, Pa. Today, Guthrie has 76 regional offices located across 10,000 square miles, providing primary and specialty care and testing to its patients, close to where they live. Five hospitals -------------- In addition to its longstanding relationship with Robert Packer Hospital, Guthrie acquired Troy Community Hospital in 1985, Corning Hospital in 1999, Towanda Memorial Hospital in 2015 and Cortland Medical Center in 2019. Guthrie today ------------- Today, one of the longest established group practices in the country, Guthrie has close to 1,000 primary and specialty care physicians and advance practice practitioners and has more than 1.5 million patient visits each year in 29 communities in Pennsylvania and New York. Guthrie's commitment to its core values of patient centeredness, teamwork and excellence-the defining values upon which Guthrie Clinic was founded- remains robust and unchanging. Guthrie services ================ Guthrie hospitals are recognized by the Internal Revenue Service ("IRS") as internal revenue code section 501(c)(3) tax-exempt organizations. Pursuant to its charitable purposes, the Guthrie hospitals provide medically necessary healthcare services to all individuals in a non-discriminatory manner regardless of race, color, creed, sex, gender identity, sexual orientation, national origin or ability to pay. Moreover, the Guthrie hospitals operate consistently with the following criteria outlined in IRS revenue ruling 69-545: 1. Provided medically necessary healthcare services to all individuals regardless of ability to pay, including charity care, self-pay, medicare and medicaid patients; 2. Operates an active emergency departments for all persons that are open 24 hours a day, 7 days a week, 365 days per year; 3. Maintains an open medical staff, with privileges available to all qualified physicians; 4. Control of each hospital rests with its board of trustees and the board of trustees of TGC; the tax-exempt parent organization of Guthrie. Both boards are comprised of independent civic leaders and other prominent members of the represented communities; and 5. Surplus funds are used to improve the quality of patient care, expand and renovate facilities/equipment and advance and improve medical care, programs and activities through patient care and medical training, education and research. The operations of each hospital, as shown through the factors outlined above and other information contained herein, clearly demonstrate that the use and control of each hospital is for the benefit of the public and that no part of the income or net earnings of the organizations inures to the benefit of any private individual, nor is any private interest being served other than incidentally. Guthrie Robert Packer Hospital ============================== A 288-bed tertiary care referral center, Guthrie Robert Packer Hospital, Sayre, PA., is the recipient of numerous national awards for the high-quality care it provides to patients. The hospital is a regional level II trauma center, accredited by the Pennsylvania Trauma Systems Foundation, and is served by Guthrie Air, a regional aeromedical helicopter program. Guthrie Robert Packer Hospital offers a full range of diagnostic, medical and surgical services, including: - Guthrie breast care center - Guthrie cancer center - Guthrie cardiac and vascular center - Guthrie musculoskeletal services - Guthrie imaging services - Guthrie specialty eye care - Guthrie surgical services - Guthrie weight loss center - Level II trauma center - medical/surgical and intensive care services Guthrie Corning Hospital ======================== Guthrie Corning Hospital, located in Corning, N.Y., opened a new 65-bed hospital and regional cancer center in 2014. The new facility provides the region emergency, icu, labor and delivery, surgical, inpatient and outpatient services including wound care, cardiology, medical imaging and cancer care services, including: - 24-hour emergency services with 24-hour laboratory, radiology and ultrasound support - ambulatory surgery - breast care center - cancer center - coronary care, cardiology stress testing and outpatient rehabilitation - endoscopy - laboratory services - labor and delivery care - medical/surgical and intensive care services - imaging services - musculoskeletal services CORE FORM, PART III, STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS Guthrie Cortland Medical Center =============================== Guthrie Cortland Medical Center, an independent, nonprofit, 162-bed acute care facility with an attached 80-bed residential care facility, joined the Guthrie healthcare system in January 2019. For over 125 years, the people of Cortland have turned to us first for the best in medical care. - acute and inpatient care - cancer care - emergency care - infusion services - labor and delivery care - laboratory services - imaging and radiology - mental health service - outpatient therapy services - respiratory services - surgical services Robert Packer Hospital at Towanda campus ======================================== Robert Packer Hospital at Towanda campus, a 21-bed community hospital in Towanda, PA, joined Guthrie in April 2015. Robert Packer Hospital at Towanda campus serves Bradford and Sullivan counties as well as the surrounding communities and offers additional specialty care services including pain management and hand surgery. Long-term care services are provided for patients at Robert Packer Hospital at Towanda campus with a skilled nursing unit and 94-bed personal care home. - imaging services - medical/surgical services - orthopedic surgery - 24-hour emergency services with 24-hour laboratory, radiology and ultrasound support - ambulatory surgery - cardiology stress testing - laboratory services - rehabilitation - physical and occupational therapy - sub-acute care - EMS services Guthrie Troy Community Hospital =============================== Located in Troy, PA., Guthrie Troy Community Hospital is 25-bed, critical access hospital. A new facility was built in 2013 and offers a wide range of inpatient and outpatient services including sub-acute and ventilator management programs and is a level IV trauma center. - imaging services - medical/surgical services - orthopedic surgery - 24-hour emergency services with 24-hour laboratory, radiology and ultrasound support - ambulatory surgery - coronary care, cardiology stress testing - rehabilitation - sub-acute care - ventilator management program Guthrie Medical Group ===================== Guthrie values are founded on the life and work of Donald Guthrie, MD, who came to the booming railroad town of Sayre, PA. In 1910. After a three-year surgical residency under the exacting tutelage of Drs. Charles A. and William Mayo of the Mayo Clinic, Dr. Guthrie began to replicate the Mayo's multi-specialty group practice model to create the organization that now bears his name. Guthrie Medical Group is a multi-specialty group practice of more than 372 physicians and 274 advanced practice providers have more than 1,380,000 patient visits each year. With its headquarters in a large medical office complex adjacent to Guthrie Robert Packer Hospital in Sayre, PA., the regional office network encompasses 45 subspecialty and primary sites in 29 communities throughout Pennsylvania and New York. Guthrie's primary care network encompasses all of the major population centers in the twin tiers and provides easy and convenient access to the best medical care available in the region. Guthrie Foundation for Education and Research ============================================= The Guthrie Foundation for Education and Research is a 501(c)(3) and separate entity within The Guthrie Clinic. The foundation was established in 1942 with an initial gift of $25,000 from Dr. Guthrie. This was prior to governmental funded research and the original charter specified that these funds were to be used to "foster education and research on the campus of the Robert Packer Hospital". Since the initial inception, the foundation has grown and evolved however, still maintains a similar vision to develop, grow and conduct meaningful quality research to improve the lives of patients in the twin tiers community. In 2014, under a broader organizational re-structure the foundation was re-named the Donald Guthrie Foundation however, still maintained its same mission statement. With the re-structure the foundation is now comprised of the three research departments of clinical research, leap testing service and the institutional review board. Medical Education ================= Includes the Mansfield University/Robert Packer department of health sciences -- nursing program, the radiology technology program and the respiratory therapy program. These education programs are all co-sponsored by Mansfield University. Other educational programs include the medical technology/medical laboratory science program, and the medical education department. The Guthrie/Robert Packer Hospital medical education department offers residency programs in family medicine, internal medicine, pharmacy, general surgery, nursing, emergency medicine, anesthesiology and orthopedic surgery. Medical student training is provided for students from affiliated medical schools (SUNY Upstate Medical University, Drexel Medical College, Lake Erie College of Osteopathic Medicine and Jefferson). The department also offers a three year cardiovascular disease fellowship, a gastroenterology fellowship and a pulmonary disease and critical care medicine fellowship. Medical education also offers continuing medical education courses, sponsors medical grand rounds each week, and supports the guthrie scholars program, which offers early acceptance to medical school for exceptional students from surrounding communities. Other services ============== Guthrie home care, home health is licensed in both Pennsylvania and New York and hospice is licensed in Pennsylvania. Home care provides various levels of care in the home, based on patient need, including: - nursing care - personal care - physical, occupational and speech therapies - hommed monitoring system for patients with chronic conditions - hospice care for terminally ill patients Quality and awards ================== Quality data ------------ Guthrie physicians, advanced practitioners and staff are dedicated to providing our patients quality health care. By measuring outcomes data and creating an environment in which quality improvement is part of the health care team's every day work, guthrie ensures patients receive the level of care and compassion they deserve. Awards ------ Guthrie has received numerous independent awards for clinical excellence, quality patient care and hospital performance. The awards span the entire spectrum of care, from excellence in nursing to recognition for specialized areas of care. The Guthrie Clinic is proud to announce that two of its hospitals have been recognized in the latest U.S. News and World Report Hospital Rankings for 2022-23. Guthrie Robert Packer Hospital (RPH) in Sayre, PA was rated as High Performing for treatment of COPD, heart failure, stroke, hip replacement and kidney disease. Guthrie Cortland Medical Center (GCMC) in Cortland, NY was rated a High Performer for the treatment of pneumonia. U.S. News generates these ranking by evaluating data from nearly 5,000 hospitals to help patients decide where to receive care. To be nationally ranked in a specialty, a hospital must excel in caring for the sickest, most medically complex patients. Guthrie Corning Hospital received an "A" Hospital Safety Grade from The Leapfrog Group as part of its Fall 2022 scorecard. This national distinction recognizes Guthrie Corning's achievements in protecting patients from preventable harm and error in the hospital, and it follows another "A" rating from the spring of this year. Guthrie Corning Hospital has been certified as a Primary Stroke Center by the Joint Commission. Guthrie Surgeon Dr. Anne Rizzo has been recognized by Castle Connolly Top Doctors on their 2022 list of "Exceptional Women in Medicine." Dr. Rizzo is the System Surgical Chair and President of Surgical Services at The Guthrie Clinic. She specializes in General Surgery, Trauma and Acute Care Surgery. She is certified by the American Board of Surgery in General Surgery, Hospice and Palliative Care and Surgical Critical Care.? In addition to being granted reaccreditation by the Intersocietal Accreditation Commission (IAC) in Echocardiography, The Guthrie Clinic has also received special recognition for its long-time commitment to quality patient care in this specialty. Guthrie is proud to be part of the select group of IAC Bronze Milestone Award recipients, celebrating 20 years of excellence in Echocardiography. CORE FORM, PART III, STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS Guthrie Robert Packer Hospital has earned two Achievement Awards from The Hospital and Health system Association of Pennsylvania (HAP) for its outstanding efforts to improve health care in the communities it serves. Winners were chosen for their exceptional work in employing innovative approaches to strengthening the safety and quality of care, enhancing operations and patients' experience, and partnering with their communities to address public health needs. Guthrie represented two of the twelve winning projects, selected from a group of 82 total submissions and was awarded the following recognitions: - Optimal Operations Award for implementing a new team-based approach to nursing to reduce staff turnover and vacancies, improve patient and staff satisfaction, and improve quality. - In Safe Hands Award for implementing new procedures to reduce hospital-acquired infections. Guthrie Robert Packer Hospital was recognized as a 2023 Outpatient Joint Replacement Excellence AwardT recipient by Healthgrades, the leading marketplace connecting doctors and patients. This achievement reflects Guthrie Robert Packer Hospital's outstanding clinical outcomes for outpatient knee and hip replacement and distinguishes Guthrie Robert Packer Hospital in the top 10% nationwide for outpatient joint replacement. Covid-19 response ----------------- Guthrie's response to covid-19 was rapid and coordinated, with system-wide interdisciplinary teams addressing everything from escalating the delivery of personal protective equipment, to creating infection prevention practices, to ensuring constant community updates and education. Guthrie's response teams focused on patient and staff safety. The organization was committed to maintaining a patient-centered approach throughout its response. The health care system also decided on a coordinated system approach to ensure a consistent response to a rapidly changing emergency spanning guthrie's wide geography. Evolution was immediate in dealing with treatment protocols for patients, safety protections, acquisition of supplies, or testing. The organization implemented outdoor testing tents at Guthrie Robert Packer Hospital in Sayre, Guthrie Cortland Medical Center and Guthrie Corning hospital in an effort to keep covid-19 outside of its facilities. In an effort to slow the spread of covid while continuing to care for patients, Guthrie's physicians and clinical staff expanded its telemedicine program. In total, the information technology department delivered and set up more than 300 webcams, 260 laptops, and 525 ipads. Before covid, Guthrie performed a small number of specialty-based telemedicine visits, approximately 12 per week, and by May 2020, the health system had rolled out virtual care for ambulatory visits and was doing more than 3,000 a week. Guthrie was heavily involved in covid vaccine distribution. Guthrie leaders recognized its unique position in the community, given the 12-county area the health system serves. This is a much broader area than Guthrie's regional health care partners, so there was a unique responsibility to distribute and administer as many vaccines as possible. The organization used its network of regional offices, offered vaccinations at some of its hospitals, and created a mass-vaccination center in a former department store in Sayre, PA. This space allowed for proper social distancing and accommodated up to 700 patients a day. The health system also coordinated with local public health departments, community leaders, businesses, and human services agencies to help improve access and overcome barriers to vaccination. Guthrie's mass-vaccination site was recognized for its efficient and patient-focused care with a visit from Pennsylvania governor Tom Wolf on April 21, 2021. Community benefit ----------------- Guthrie tax-exempt hospitals provide significant community benefit for purposes of form 990 schedule h part i reporting. Schedule h part i follows the catholic health association ("cha") model when quantifying community benefit costs. Under the cha methodology guthrie hospitals reported a total of net community benefit costs of $120,361,331; which represented a community benefit percentage of 15.13%. Most recent information published by irs (2020 year reporting) shows an overall community benefit average nationwide of approximately 11.30%. The irs and cha methodology does not include community building activities, estimated charity care amounts included in bad debt nor medicare shortfall for the year ending june 30, 2023. The american hospital association ("aha") disagrees with irs and cha and believes that a tax-exempt organization should include community building activities, estimated charity care amounts included in bad debt and medicare shortfall in community benefit reporting. Aha calls this methodology "total benefits to the community". Using this methodology guthrie hospitals reported a total of net community benefit costs of $111,016,362; which represented a community benefit percentage of 13.93% for the year ending june 30, 2023. Most recent information published by aha (2020 year reporting based upon all schedule h's filed) shows an overall total benefits to the community average nationwide of approximately 15.5%. CORE FORM, PART V; QUESTION 1A & CORE FORM, PART VII; SECTION B THE ORGANIZATION IS AN AFFILIATE WITHIN THE GUTHRIE CLINIC AND AFFILIATES; A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY SYSTEM. THE ORGANIZATION'S FORM 990 REFLECTS NO TOP FIVE INDEPENDENT CONTRACTORS FOR SERVICES AND REPORTS THAT NO FORMS 1099 WERE FILED WITH THE INTERNAL REVENUE SERVICE ("IRS"). THE GUTHRIE CLINIC, A RELATED INTERNAL REVENUE CODE SECTION 501(C)(3) TAX-EXEMPT ORGANIZATION PAYS ALL OUTSTANDING ACCOUNTS PAYABLE INVOICES ON BEHALF OF THIS ORGANIZATION. IN CONJUNCTION WITH THIS SERVICE, THE GUTHRIE CLINIC ALSO PREPARES AND ISSUES FORMS 1099 TO THESE VENDORS RECEIVING PAYMENTS WHERE APPLICABLE AND FILES THESE FORMS 1099 WITH THE IRS. THE GUTHRIE CLINIC ALLOCATES THESE PAYMENTS TO THE ORGANIZATION VIA AN INTERCOMPANY ACCOUNT. CORE FORM, PART VI, SECTION A; QUESTIONS 6 & 7 THE GUTHRIE CLINIC IS THE SOLE MEMBER OF THIS ORGANIZATION. THE GUTHRIE CLINIC HAS THE RIGHT TO ELECT THE MEMBERS OF THIS ORGANIZATION'S BOARD OF DIRECTORS AND HAS CERTAIN RESERVED POWERS AS DEFINED IN THIS ORGANIZATION'S BYLAWS. CORE FORM, PART VI, SECTION B; QUESTION 11B THE ORGANIZATION IS AN AFFILIATE WITHIN THE GUTHRIE CLINIC AND AFFILIATES; A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY SYSTEM ("SYSTEM"). THE GUTHRIE CLINIC IS THE TAX-EXEMPT PARENT ENTITY OF THE SYSTEM. THE ORGANIZATION'S FEDERAL FORM 990 WAS PROVIDED TO EACH VOTING MEMBER OF THE ORGANIZATION'S GOVERNING BODY (ITS BOARD OF DIRECTORS) PRIOR TO THE FILING OF THE FEDERAL FORM 990 WITH THE INTERNAL REVENUE SERVICE ("IRS"). AS PART OF THE TAX RETURN PREPARATION PROCESS THE ORGANIZATION HIRED A PROFESSIONAL CERTIFIED PUBLIC ACCOUNTING ("CPA") FIRM WITH EXPERIENCE AND EXPERTISE IN BOTH HEALTHCARE AND NOT-FOR-PROFIT TAX RETURN PREPARATION TO PREPARE THE FEDERAL FORM 990. THE CPA FIRM'S TAX PROFESSIONALS WORKED CLOSELY WITH THE ORGANIZATION'S FINANCE PERSONNEL AND INTERNAL WORKING GROUP TO OBTAIN THE INFORMATION NEEDED IN ORDER TO PREPARE A COMPLETE AND ACCURATE TAX RETURN. THE CPA FIRM PREPARED A DRAFT FEDERAL FORM 990 AND FURNISHED IT TO THE ORGANIZATION'S FINANCE PERSONNEL AND INTERNAL WORKING GROUP FOR THEIR REVIEW. THE ORGANIZATION'S FINANCE PERSONNEL AND INTERNAL WORKING GROUP REVIEWED THE DRAFT FEDERAL FORM 990 AND DISCUSSED QUESTIONS AND COMMENTS WITH THE CPA FIRM. REVISIONS WERE MADE TO THE DRAFT FEDERAL FORM 990 WHERE NECESSARY AND A FINAL DRAFT WAS FURNISHED BY THE CPA FIRM TO THE ORGANIZATION'S FINANCE PERSONNEL AND INTERNAL WORKING GROUP FOR FINAL REVIEW AND APPROVAL. FOLLOWING THIS REVIEW, THE FINAL FORM 990 WAS PROVIDED TO EACH VOTING MEMBER OF THIS ORGANIZATION'S GOVERNING BODY PRIOR TO FILING WITH THE IRS. CORE FORM, PART VI, SECTION B; QUESTION 12 THE CONFLICT OF INTEREST DISCLOSURE POLICY SETS FORTH THAT ALL PERSONS, INCLUDING EMPLOYEES, AGENTS AND BOARD/COMMITTEE MEMBERS, PARTICULARLY THOSE INVOLVED IN DECISION-MAKING FOR THE GUTHRIE CLINIC ("TGC"), ACT IN AN APPROPRIATE MANNER AND WILL NOT PARTICIPATE IN ANY ACTIONS THAT MIGHT CREATE A PERSONAL OR PROFESSIONAL CONFLICT OF INTEREST AND/OR NOT BE IN THE BEST INTEREST OF TGC. ALL MEMBERS OF ANY TGC BOARD/COMMITTEE AND TGC SENIOR MANAGEMENT MUST MAKE FULL DISCLOSURE OF ANY POSSIBLE CONFLICT OF INTEREST THROUGH THE USE OF THE CONFLICT OF INTEREST DISCLOSURE FORM AND REFRAIN FROM VOTING OR PARTICIPATING IN DECISION-MAKING INVOLVING ANY POSSIBLE CONFLICT OF INTEREST. THE FORM IS DISTRIBUTED TO ALL BOARD/COMMITTEE MEMBERS AND EMPLOYEES (WHEN APPLICABLE) ANNUALLY BY THE TGC ADMINISTRATION OFFICE. TGC BOARD/COMMITTEE MEMBERS OR EMPLOYEES MUST COMPLETE THE CONFLICT OF INTEREST DISCLOSURE FORM. THIS FORM SHOULD BE COMPLETED WHEN THERE IS ANY SITUATION WHERE A POSSIBLE CONFLICT OF INTEREST EXISTS, AND/OR ON AN ANNUAL BASIS AND/OR AT THE TIME OF APPOINTMENT OR ELECTION OF NEW BOARD/COMMITTEE MEMBERS. IF THE FORM IS NOT COMPLETED WITHIN 13 MONTHS OF THE LAST SIGNING, THE TGC BOARD CHAIRMAN WILL BE ADVISED. ANY INDIVIDUAL HAVING A CONFLICT OF INTEREST OR POSSIBLE CONFLICT OF INTEREST ON ANY MATTER SHOULD EXCUSE THEMSELVES FROM THE PORTION OF THE MEETING OR MEETINGS WHERE THE MATTER IS DISCUSSED AND NOT VOTE OR USE HIS OR HER PERSONAL INFLUENCE ON THE MATTER. THE MINUTES OF THE MEETING OR MEETINGS SHOULD REFLECT THE DISCLOSURE, THE ABSTENTION FROM VOTING, AND ANY ACTION TAKEN TO DETERMINE WHETHER A CONFLICT OF INTEREST EXISTED. CORE FORM, PART VI, SECTION B; QUESTION 15 THE ORGANIZATION IS AN AFFILIATE WITHIN THE GUTHRIE CLINIC AND AFFILIATES; A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY SYSTEM WHICH INCLUDES THE GUTHRIE CLINIC ("TGC"); A RELATED INTERNAL REVENUE CODE SECTION 501(C)(3) TAX-EXEMPT ORGANIZATION. TGC'S BOARD OF DIRECTORS MAINTAINS THE GUTHRIE CLINIC COMPENSATION COMMITTEE ("COMMITTEE"). THE COMMITTEE HAS ADOPTED A WRITTEN EXECUTIVE COMPENSATION PHILOSOPHY WHICH IT FOLLOWS WHEN IT REVIEWS AND APPROVES OF THE COMPENSATION AND BENEFITS OF TGC'S SENIOR MANAGEMENT. THE COMMITTEE ALSO REVIEWS THE COMPENSATION AND BENEFITS OF OTHER OFFICERS AND KEY EMPLOYEES OF THE GUTHRIE CLINIC AND AFFILIATES; INCLUDING, WITHOUT LIMITATION, THE CHIEF EXECUTIVE OFFICERS OF THE GUTHRIE CLINIC AND AFFILIATES HOSPITALS AND MEDICAL CENTERS. THE COMMITTEE, WHICH IS REQUIRED BY THE CORPORATION'S BYLAWS TO BE COMPRISED SOLELY OF INDEPENDENT DIRECTORS, SEEKS GUIDANCE AND SUBSTANTIATION FROM A NATIONALLY RECOGNIZED COMPENSATION CONSULTANT. THE COMMITTEE REVIEWS THE "TOTAL COMPENSATION" OF THE INDIVIDUALS WHICH IS INTENDED TO INCLUDE BOTH CURRENT AND DEFERRED COMPENSATION AND ALL EMPLOYEE BENEFITS, BOTH QUALIFIED AND NON-QUALIFIED. THE COMMITTEE'S REVIEW IS DONE ON AT LEAST AN ANNUAL BASIS AND ENSURES THAT THE "TOTAL COMPENSATION" OF SENIOR MANAGEMENT OF THE ORGANIZATION IS REASONABLE. THE ACTIONS TAKEN BY THE COMMITTEE ENABLE THE ORGANIZATION TO RECEIVE THE REBUTTABLE PRESUMPTION OF REASONABLENESS FOR PURPOSES OF INTERNAL REVENUE CODE SECTION 4958 WITH RESPECT TO THE TOTAL COMPENSATION OF CERTAIN MEMBERS OF THE SENIOR MANAGEMENT TEAM. THE THREE FACTORS WHICH MUST BE SATISFIED IN ORDER TO RECEIVE THE REBUTTABLE PRESUMPTION OF REASONABLENESS ARE THE FOLLOWING: 1. THE COMPENSATION ARRANGEMENT IS APPROVED IN ADVANCE BY AN "AUTHORIZED BODY" OF THE APPLICABLE TAX-EXEMPT ORGANIZATION WHICH IS COMPOSED ENTIRELY OF INDIVIDUALS WHO DO NOT HAVE A "CONFLICT OF INTEREST" WITH RESPECT TO THE COMPENSATION ARRANGEMENT; 2. THE AUTHORIZED BODY OBTAINED AND RELIED UPON "APPROPRIATE DATA AS TO COMPARABILITY" PRIOR TO MAKING ITS DETERMINATION; AND 3. THE AUTHORIZED BODY "ADEQUATELY DOCUMENTED THE BASIS FOR ITS DETERMINATION" CONCURRENTLY WITH MAKING THAT DETERMINATION. THE COMMITTEE IS COMPRISED OF MEMBERS OF THE BOARD OF DIRECTORS EACH OF WHO ARE INDEPENDENT AND ARE FREE FROM ANY CONFLICTS OF INTEREST. THE COMMITTEE RELIED UPON APPROPRIATE COMPARABLE DATA; SPECIFICALLY, THE COMMITTEE OBTAINED A WRITTEN COMPENSATION STUDY FROM AN INDEPENDENT FIRM WHICH SPECIALIZES IN THE REVIEW OF HOSPITAL AND HEALTHCARE SYSTEM EXECUTIVE COMPENSATION AND BENEFITS THROUGHOUT THE UNITED STATES. THIS STUDY USED COMPARABLE GEOGRAPHIC AND DEMOGRAPHIC MARKET DATA INCLUDING, BUT NOT LIMITED TO, SIMILARLY SIZED HEALTHCARE SYSTEMS AND HOSPITALS, # OF LICENSED BEDS AND NET PATIENT SERVICE REVENUE. THE COMMITTEE ADEQUATELY DOCUMENTED THE BASIS FOR ITS DETERMINATION THROUGH THE TIMELY PREPARATION OF WRITTEN MINUTES OF THE COMPENSATION COMMITTEE MEETINGS DURING WHICH THE EXECUTIVE COMPENSATION AND BENEFITS WAS REVIEWED AND SUBSEQUENTLY APPROVED. THE ACTIONS OUTLINED ABOVE WITH RESPECT TO THE COMMITTEE AND THE ESTABLISHMENT OF THE REBUTTABLE PRESUMPTION OF REASONABLENESS APPLIES TO CERTAIN TGC SENIOR MANAGEMENT PERSONNEL. THE COMPENSATION AND BENEFITS OF CERTAIN OTHER INDIVIDUALS CONTAINED IN THIS FORM 990, WHERE APPLICABLE, ARE REVIEWED ANNUALLY BY THE GUTHRIE CLINIC AND AFFILIATES PRESIDENT/CHIEF EXECUTIVE OFFICER WITH ASSISTANCE FROM THE ORGANIZATION'S HUMAN RESOURCES DEPARTMENT IN CONJUNCTION WITH THE INDIVIDUAL'S JOB PERFORMANCE DURING THE YEAR AND IS BASED UPON OTHER OBJECTIVE FACTORS DESIGNED TO ENSURE THAT REASONABLE AND FAIR MARKET VALUE COMPENSATION IS PAID BY THE ORGANIZATION. OTHER OBJECTIVE FACTORS INCLUDE MARKET SURVEY DATA FOR COMPARABLE POSITIONS, INDIVIDUAL GOALS AND OBJECTIVES, PERSONNEL REVIEWS, EVALUATIONS, SELF-EVALUATIONS AND PERFORMANCE FEEDBACK MEETINGS. CORE FORM, PART VI, SECTION C; QUESTION 19 THE ORGANIZATION IS AN AFFILIATE WITHIN THE GUTHRIE CLINIC AND AFFILIATES; A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY SYSTEM ("SYSTEM"). THE GUTHRIE CLINIC IS THE TAX-EXEMPT PARENT ENTITY OF THE SYSTEM. THE GUTHRIE CLINIC HAS ISSUED TAX EXEMPT BONDS TO FINANCE VARIOUS CAPITAL IMPROVEMENT PROJECTS, RENOVATIONS AND EQUIPMENT. IN CONJUNCTION WITH THE ISSUANCE OF THESE TAX-EXEMPT BONDS, THE ORGANIZATION'S FINANCIAL STATEMENTS WERE INCLUDED WITH THE TAX-EXEMPT BOND PROSPECTUS WHICH WAS MADE AVAILABLE TO THE GENERAL PUBLIC FOR REVIEW. IN ADDITION, THE ORGANIZATION'S FILED CERTIFICATE OF INCORPORATION AND ANY AMENDMENTS CAN BE OBTAINED AND REVIEWED THROUGH THE COMMONWEALTH OF PENNSYLVANIA. THE ORGANIZATION'S CONFLICT OF INTEREST POLICY AND QUESTIONNAIRE IS NOT OPEN FOR PUBLIC INSPECTION. CORE FORM, PART VII AND SCHEDULE J CORE FORM, PART VII AND SCHEDULE J REFLECT CERTAIN BOARD MEMBERS AND OFFICERS RECEIVING COMPENSATION AND BENEFITS FROM THIS ORGANIZATION AND/OR RELATED ORGANIZATIONS. PLEASE NOTE THIS REMUNERATION WAS FOR SERVICES RENDERED AS FULL-TIME EMPLOYEES OF THIS ORGANIZATION OR A RELATED ORGANIZATION AND NOT FOR SERVICES RENDERED AS A VOTING MEMBER OR OFFICER OF THIS ORGANIZATION'S BOARD OF DIRECTORS. FRANCIS M. MACAFEE SERVED AS THE CHIEF FINANCIAL OFFICER OF THE ORGANIZATION UNTIL DECEMBER 31, 2022. MR. MACAFEE IS STILL EMPLOYED WITHIN THE GUTHRIE CLINIC IN THE ROLE OF SPECIAL PROJECTS, M&A EXECUTIVE. CORE FORM, PART VII, SECTION A, COLUMN B THIS ORGANIZATION IS AN AFFILIATE WITHIN THE GUTHRIE CLINIC AND AFFILIATES; A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY SYSTEM ("SYSTEM"). CERTAIN BOARD OF DIRECTORS MEMBERS, OFFICERS AND/OR DIRECTORS LISTED ON CORE FORM, PART VII AND SCHEDULE J OF THIS FORM 990 MAY HOLD SIMILAR POSITIONS WITH BOTH THIS ORGANIZATION AND OTHER AFFILIATES WITHIN THE SYSTEM. THE HOURS SHOWN ON THIS FORM 990, FOR BOARD MEMBERS WHO RECEIVE NO COMPENSATION FOR SERVICES RENDERED IN A NON-BOARD CAPACITY, REPRESENT THE ESTIMATED HOURS DEVOTED PER WEEK FOR THIS ORGANIZATION. TO THE EXTENT THESE INDIVIDUALS SERVE AS A MEMBER OF THE BOARD OF DIRECTORS OF OTHER RELATED ORGANIZATIONS IN THE SYSTEM, THEIR RESPECTIVE HOURS PER WEEK PER ORGANIZATION ARE APPROXIMATELY THE SAME AS REFLECTED IN CORE FORM, PART VII OF THIS FORM 990. THE HOURS REFLECTED ON CORE FORM, PART VII OF THIS FORM 990, FOR BOARD MEMBERS WHO RECEIVE COMPENSATION FOR SERVICES RENDERED IN A NON-BOARD CAPACITY, PAID OFFICERS AND KEY EMPLOYEES, REFLECT TOTAL HOURS WORKED PER WEEK ON BEHALF OF THE GUTHRIE CLINIC AND AFFILIATES; NOT SOLELY THIS ORGANIZATION. FORM 990, PART XI, LINE 9 OTHER CHANGES IN NET ASSETS OR FUND BALANCE INCLUDES: - MINIMUM PENSION LIABILITY ADJUSTMENT - ($55,290); - TEMPORARILY RESTRICTED NET ASSETS RELEASED FROM RESTRICTION - ($127,390); - TEMPORARILY RESTRICTED NET ASSETS RELEASED FROM GRANTS - ($204,295); - TEMPORARILY RESTRICTED PLEDGES - ($10,356); - TEMPORARILY RESTRICTED NPV FUTURE INSTALLMENT - ($882); - TEMPORARILY RESTRICTED PP&E DONATIONS - $60,000; - TEMPORARILY RESTRICTED PP&E GRANTS - $47,825; - TEMPORARILY RESTRICTED EQUITY TRANSFERS - ($23) - RESTRUCTURING EXPENSE - ($39,843); AND - OTHER COMPREHENSIVE NET PERIODIC PENSION COST - ($33,503). CORE FORM, PART XII; QUESTION 2 THE ORGANIZATION IS AN AFFILIATE WITHIN THE GUTHRIE CLINIC AND AFFILIATES; A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY SYSTEM ("SYSTEM"). THE GUTHRIE CLINIC IS THE TAX-EXEMPT PARENT ENTITY OF THE SYSTEM. AN INDEPENDENT CPA FIRM AUDITED THE CONSOLIDATED FINANCIAL STATEMENTS OF THE GUTHRIE CLINIC AND ALL ENTITIES WITHIN THE SYSTEM FOR THE YEARS ENDED JUNE 30, 2023 AND JUNE 30, 2022; RESPECTIVELY. THE INDEPENDENT CPA FIRM ISSUED AN UNMODIFIED OPINION WITH RESPECT TO THE AUDITED CONSOLIDATED FINANCIAL STATEMENTS. CORE FORM, PART XII; QUESTION 3 THIS ORGANIZATION IS AN AFFILIATE WITHIN THE GUTHRIE CLINIC AND AFFILIATES; A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY SYSTEM ("SYSTEM"). THE SYSTEM ENGAGED AN INDEPENDENT ACCOUNTING FIRM TO PREPARE AND ISSUE A SYSTEM WIDE CONSOLIDATED AUDIT UNDER THE SINGLE AUDIT ACT AND OMB CIRCULAR A-133 AUDIT. THIS ORGANIZATION WAS INCLUDED IN THE SYSTEM WIDE A-133 AUDIT. FORM 990, SCHEDULE D, PART X & SCHEDULE K THE ORGANIZATION IS A MEMBER OF THE GUTHRIE CLINIC; A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY SYSTEM ("SYSTEM"). THE SYSTEM HAS A NUMBER OF OUTSTANDING LONG-TERM OBLIGATED GROUP DEBT LIABILITIES, INCLUDING THE FOLLOWING BOND ISSUANCES: - HEALTH CARE FACILITIES AUTHORITY OF SAYRE, HEALTH CARE REVENUE BONDS, SERIES 2007; AND - CENTRAL BRADFORD PROGRESS AUTHORITY, HEALTH CARE REVENUE BONDS, SERIES 2021A; SERIES 2021B; SERIES 2021C; AND SERIES 2021D. THE BONDS OUTLINED ABOVE AND VARIOUS OTHER LONG-TERM BORROWINGS ARE ALLOCATED BY THE GUTHRIE CLINIC ("TGC"); THE TAX-EXEMPT PARENT OF THE SYSTEM, TO THE FOLLOWING SYSTEM MEMBER HOSPITALS AND CERTAIN OTHER AFFILIATES. THE BALANCE SHEET OF THESE RESPECTIVE MEMBER HOSPITALS AND CERTAIN OTHER AFFILIATES REFLECTS A TGC OBLIGATED GROUP LIABILITY. ACCORDINGLY, THIS TGC OBLIGATED GROUP LIABILITY IS REFLECTED ON THE BALANCE SHEET OF THE FOLLOWING SUBSIDIARY ORGANIZATIONS: - CORNING HOSPITAL, EIN: 16-0393490 - GUTHRIE CORTLAND MEDICAL CENTER, EIN: 15-0532079 - GUTHRIE MEDICAL GROUP, P.C., EIN: 25-0815795 - ROBERT PACKER HOSPITAL, EIN: 24-0795463 - TROY COMMUNITY HOSPITAL, EIN: 24-0800337 SCHEDULE K WAS PREPARED ON A CONSOLIDATED BASIS AND IS INCLUDED IN THE FORM 990 OF THE GUTHRIE CLINIC, EIN: 23-3055017. FORM 990 PART IX LINE 11G DESCRIPTION:PURCHASED SERVICES TOTAL FEES:6900425 THE GUTHRIE CLINIC ONE GUTHRIE SQUARE SAYRE PA 18840 233055017 SUPPORTING PA 501(c)(3) 12B NA false GUTHRIE MEDICAL GROUP PC ONE GUTHRIE SQUARE SAYRE PA 18840 250815795 HEALTHCARE PA 501(c)(3) 3 TGC false ROBERT PACKER HOSPITAL ONE GUTHRIE SQUARE SAYRE PA 18840 240795463 HEALTHCARE PA 501(c)(3) 3 TGC false DONALD GUTHRIE FOUNDATION 200 S WILBUR AVE SAYRE PA 18840 246022957 MED RESEARCH PA 501(c)(3) 7 TGC false GUTHRIE HOME CARE 421 TOMAHAWK ROAD TOWANDA PA 18848 232394345 HOME HEALTH PA 501(c)(3) 10 TGC false SAYRE HOUSE OF HOPE ONE GUTHRIE SQUARE SAYRE PA 18840 203979472 HEALTHCARE PA 501(c)(3) 7 TGC false CORNING HOSPITAL ONE GUTHRIE DRIVE CORNING NY 14830 160393490 HEALTHCARE NY 501(c)(3) 3 TGC false GUTHRIE RISK RETENTION GROUP 151 MEETING STREET CHARLESTON SC 29401 201090801 SUPPORTING SC 501(c)(3) 12A TGC false GUTHRIE CORTLAND MEDICAL CENTER 134 HOMER AVENUE CORTLAND NY 13045 150532079 HEALTHCARE NY 501(c)(3) 3 TGC false CORTLAND MEMORIAL FOUNDATION INC 134 HOMER AVENUE CORTLAND NY 13045 222230692 SUPPORTING NY 501(c)(3) 7 GCMC false REGIONAL MEDICAL PRACTICE PC 134 HOMER AVENUE CORTLAND NY 13045 204848729 HEALTHCARE NY 501(C)(3) 3 TGC false TWIN TIER MANAGEMENT CORP INC PO BOX 310 SAYRE PA 18840 232209439 MANAGEMENT CORP PA NA C Corp false CORNING PROPERTIES INC 1 GUTHRIE DRIVE CORNING NY 14830 383977095 REAL ESTATE HOLD NY NA C CORP false CMH SERVICES INC 160 HOMER AVENUE CORTLAND NY 13045 161370440 DURABLE MED EQUIP NY NA C CORP false CORTLAND MEMORIAL PROPERTIES INC 134 HOMER AVENUE CORTLAND NY 13045 161266826 INCOME ALLOCATION NY NA C CORP false true false false false false false true true false true true true true false true true true false false SCHEDULE R, PART V THIS ORGANIZATION IS A MEMBER OF THE GUTHRIE CLINIC AND AFFILIATES; A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY SYSTEM. FUNDS ARE ROUTINELY TRANSFERRED BETWEEN AFFILIATES AND BUSINESS ACTIVITIES ARE COMMON ON BEHALF OF THE SYSTEM'S AFFILIATES, INCLUDING THIS ORGANIZATION. THESE TRANSACTIONS MAY BE RECORDED ON THE REVENUE/EXPENSE AND BALANCE SHEET STATEMENTS OF THIS ORGANIZATION AND OTHER AFFILIATES. THESE ENTITIES WORK TOGETHER TO DELIVER HIGH QUALITY COST EFFECTIVE HEALTHCARE AND WELLNESS SERVICES TO THEIR COMMUNITIES REGARDLESS OF ABILITY TO PAY AND IN FURTHERANCE OF CHARITABLE TAX-EXEMPT PURPOSES.