2024-05-13T15:28:54-05:00 2023-06-30 390859910 BAKER TILLY US LLP 20 STANWIX STREET PITTSBURGH PA 15222 990 2022-07-01 251574302 INDIANA HEALTHCARE FOUNDATION INDI 7243577008 835 HOSPITAL ROAD INDIANA PA 15701 MICHAEL F ICKOWSKI CFO 7243577008 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 835 HOSPITAL ROAD INDIANA PA 15701 1019029 0 X WWW.INDIANARMC.ORG X 1987 PA TO PROVIDE SUPPORT FOR INDIANA REGIONAL MEDICAL CENTER. 10 8 2 8 0 0 1136936 802703 0 0 289728 149388 12813 9627 1439477 961718 5000 0 0 0 133891 111153 0 0 149644 36286 38491 175177 149644 1264300 812074 18706678 18244352 2332426 90989 16374252 18153363 TO ADVANCE HEALTHCARE THROUGH PHILANTHROPY, INNOVATION, EDUCATION, AND ADVOCACY. 0 0 INDIANA HEALTHCARE FOUNDATION ("IHF") CONDUCTS FUNDRAISING ACTIVITIES, SUCH AS THE COLUMBUS DAY GOLF OUTING, LOVE OF LIFE GALA AND RELAY, AND TEDDY BEAR FUND DRIVE TO SUPPORT THE FUNCTIONS AND FACILITIES OF INDIANA REGIONAL MEDICAL CENTER ("IRMC"). IHF ALSO MAINTAINS FUNDS TO ASSIST PROSPECTIVE STUDENTS OF THE MEDICAL FIELD THROUGH THE PREMED SUMMER INTERNSHIP PROGRAM, PROVIDE NECESSARY SUPPLIES FOR WOMEN'S IMAGING DEPARTMENT AND BIRDIE'S CLOSET, ASSIST THE ONCOLOGY DEPARTMENT, SUPPORT THE NEW BEHAVIORAL HEALTH FACILITY CURRENTLY UNDER CONSTRUCTION, AS WELL AS OTHER FUNDS TO SUPPORT VARIOUS DEPARTMENTS OF IRMC. AS A WAY OF SUPPORTING IRMC'S MISSION, IHF RECENTLY PURCHASED 2 NEW TRANSPORT VANS FOR PATIENTS AND HAS SUBSIDIZED THE DA VINCI SURGICAL ROBOT FOR THE OR IN PAST YEARS. 1 1 0 0 0 0 0 0 0 1 1 1 0 0 0 1 0 1 0 0 0 0 0 0 1 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 2 1 0 0 0 0 0 1 1 0 0 0 0 X 10 8 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 JOSEPH RESCHINI CHAIRMAN 1.00 1.00 X X 0 0 0 CHAD FRICK VICE CHAIRMAN 1.00 X X 0 0 0 JENNIFER MYERS SECRETARY/TREASURER 1.00 X X 0 0 0 NAZNEEN BILLIMORIA MD BOARD MEMBER/PHYSICIAN 1.00 39.00 X 0 318621 32315 ROBERT MANZI JR BOARD MEMBER 1.00 X 0 0 0 CHAD MARTIN BOARD MEMBER 1.00 X 0 0 0 LAURA C MUSSER BOARD MEMBER 1.00 X 0 0 0 CJ SPADAFORA BOARD MEMBER 1.00 X 0 0 0 C BRETT STEWART BOARD MEMBER 1.00 X 0 0 0 STEPHEN A WOLFE PRESIDENT & CEO/BOARD MEMB 1.00 39.00 X X 0 802111 42593 ROBERT A GONGAWARE CHIEF FINANCIAL OFFICER 1.00 39.00 X 0 323825 34321 0 1444557 109229 0 0 1 0 0 130191 672512 802703 149388 149388 52200 130191 57311 -5111 -5111 ADMIN LEASED EMPLOYEES 561300 14738 14738 14738 961718 0 0 159015 X 95376 95376 3490 3490 5436 5436 6851 6851 4960 4960 21811 21811 4090 4090 3977 3977 1626 1626 827 827 1200 1200 149644 0 0 149644 3163198 2046804 368819 448951 37824 25 44167 44167 0 0 8299350 8630512 6837487 7118060 18706678 18244352 14954 90989 2317472 0 2332426 90989 X 5910009 6714836 10464243 11438527 16374252 18153363 18706678 18244352 X 812074 185906 781131 X 0 1 X 1 0 X X X 1 INDIANA REGIONAL MEDICAL CENTER 250965404 3 1 55716 0 1 55716 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 6837487 280572 7118059 8282163 -1444676 6837487 6937129 1291132 8228261 6991031 245098 299000 6937129 6933696 373335 316000 6991031 1.00000 1 0 44167 44167 0 0 INVESTMENT IN IRREVOCABLE TRUST 7118060 F 7118060 X PART V, LINE 4: THE INCOME FROM THE JOHN MACK TRUST IS TO BE USED FOR THE "EXPANSION AND IMPROVEMENT" OF INDIANA REGIONAL MEDICAL CENTER. PART X, LINE 2: THE FOUNDATION 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. COLUMBUS DAY GOLF OUTING 99885 60874 39011 8480 11233 21585 LOVE OF LIFE RELAY AND GALA 82506 69317 13189 1765 5460 8788 182391 130191 52200 10245 16693 30373 57311 -5111 0 1 0 0 0 0 0 0 0 STEPHEN A WOLFE PRESIDENT & CEO/BOARD MEMB 0 607396 0 93339 0 101376 0 23994 0 18599 0 844704 0 0 ROBERT A GONGAWARE CHIEF FINANCIAL OFFICER 0 297705 0 26120 0 0 0 21386 0 12935 0 358146 0 0 NAZNEEN BILLIMORIA MD BOARD MEMBER/PHYSICIAN 0 318621 0 0 0 0 0 9150 0 23165 0 350936 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 HEALTHCARE FOUNDATION ("IHF"). 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 IHF. FORM 990, PART VI, SECTION A, LINE 7B IHF SHALL OBTAIN THE APPROVAL OF IRMC BEFORE ACTION ON ANY OF THE FOLLOWING MATTERS BECOMES FINAL AND EFFECTIVE FOR IHF: (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 IHF; (3) MERGER OR CONSOLIDATION WITH ANY OTHER CORPORATION; (4) DISSOLUTION OF IHF; (5) APPROVAL OF AN ANNUAL BUDGET FOR IHF; (6) ANY TRANSFER OF FUNDS BY GRANT, GIFT, OR LOAN FROM IHF; (7) VOTING ANY MEMBERSHIP OR SHAREHOLDER INTEREST HELD BY IHF IN ANY OTHER CORPORATION; (8) 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 IX, LINE 11G PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 21,811. TOTAL EXPENSES 21,811. FORM 990, PART XI, LINE 9: VALUATION GAIN ON INVESTMENT IN IRREVOCABLE TRUST 280,573. TRANSFER TO AFFILIATE 500,558. 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 PHYSICIAN SERVICES INC 835 HOSPITAL ROAD INDIANA PA 15701 251842046 PROVIDE HEALTH CARE PA 501(C)(3) LINE 3 INDIANA REGIONAL MEDICAL CENTER 0 INDIANA HEALTHCARE PROPERTIES 835 HOSPITAL ROAD INDIANA PA 15701 251524635 HOLD & MANAGE PROPERTY IN SUPPORT OF INDIANA REGIONAL MEDICAL CENTER PA 501(C)(3) LINE 12A, I INDIANA REGIONAL MEDICAL CENTER 0 SPIRITLIFE INC 170 FR MARTIN TELENSON LANE PENN RUN PA 15765 463997001 DETOXIFICATION AND REHABILITATIVE SERVICES PA 501(C)(3) LINE 10 INDIANA REGIONAL MEDICAL CENTER 0 INDIANA AMBULATORY SURGICAL ASSOCIATES INC 835 HOSPITAL ROAD INDIANA PA 15701 232923182 AMBULATORY SURGERY PA 501(C)(3) LINE 12A, I INDIANA REGIONAL MEDICAL CENTER 0 PENNSYLVANIA MOUNTAINS CARE NETWORK 835 HOSPITAL ROAD INDIANA PA 15701 474638568 SUPPORT FOR HEALTHCARE ORGNAIZATIONS PA 501(C)(3) LINE 12A, I N/A 0 PUNXSUTAWNEY AREA HOSPITAL INC 81 HILLCREST DRIVE PUNXSUTAWNEY PA 15767 250965210 HOSPITAL PA 501(C)(3) LINE 3 PENNSYLVANIA MOUNTAINS CARE NETWORK 0 PUNXSUTAWNEY AREA HOSPITAL FOUNDATION 81 HILLCREST DRIVE PUNXSUTAWNEY PA 15701 932244487 TO SUPPORT THE HOSPITAL PA 501(C)(3) LINE 12A, I PUNXSUTAWNEY AREA HOSPITAL INC 0 PUNXSUTAWNEY MEDICAL SERVICES INC 81 HILLCREST DRIVE PUNXSUTAWNEY PA 15767 251773035 ANESTHESIA SERVICES PA 501(C)(3) LINE 3 PUNXSUTAWNEY AREA HOSPITAL INC 0 0 1 0 0 0 0 0 0 1 0 0 1 0 1 1 1 0 0 0