2024-05-14T12:35:55-05:00 2023-06-30 390859910 BAKER TILLY US LLP 20 STANWIX STREET PITTSBURGH PA 15222 990 2022-07-01 251463381 MEDICAL CENTER BEAVER PA INC WORKERS COMPENSATION TRUST FUND MEDI 4127416600 25 HECKEL ROAD 4TH FLOOR MCKEES ROCK PA 15136 GARRETT RICHARDSON ASSOCIATE VP, FINANCE 4127416600 2024-04-25 1 GARRETT RICHARDSON 999009999 1 JEFFREY J PETRELL P00138808 4126976400 2024-04-25 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z NORMAN F MITRY 720 BLACKBURN ROAD SEWICKLEY PA 15108 328 0 X N/A X 1982 PA PROVIDES WORKER'S COMPENSATION BENEFITS TO EMPLOYEES OF VALLEY MEDICAL FACILITIES INC., DBA HERITAGE VALLEY, BEAVER. 19 16 0 16 0 0 0 0 0 0 17 328 0 0 17 328 0 0 101332 0 0 0 0 0 0 1 17 101333 17 -101316 311 8763 9074 39871 39871 -31108 -30797 PROVIDES WORKER'S COMPENSATION BENEFITS TO EMPLOYEES OF VALLEY MEDICAL FACILITIES INC., DBA HERITAGE VALLEY, BEAVER. 0 0 PROVIDES WORKER'S COMPENSATION BENEFITS TO EMPLOYEES OF HERITAGE VALLEY, BEAVER. 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 19 16 0 0 0 0 1 1 1 1 1 0 1 1 1 1 1 1 1 1 0 0 0 PA X LINDA SCHAEFER 4127497021 25 HECKEL ROAD 4TH FLOOR MCKEES ROCKS PA 15136 NORMAN F MITRY PRESIDENT & CEO 2.00 64.75 X X 0 760654 42768 SCOTT M ELSTE CHAIR 2.00 2.00 X X 0 0 0 SUSAN PAONE DHA VICE-CHAIR 2.00 2.00 X X 0 0 0 BOB TERWILLIGER SECRETARY 2.00 2.00 X X 0 0 0 ELISA DITOMMASO CPA TREASURER 2.00 2.00 X X 0 0 0 LYNN GEORGE PHD EMERITUS BOARD CHAIR 2.00 2.00 X 0 0 0 FRED CLERICI DIRECTOR 2.00 2.00 X 0 0 0 MICHAEL MALKOWSKI MD DIRECTOR/PHYSICIAN 2.00 41.25 X 0 571473 35861 KEVIN FLANNERY DIRECTOR 2.00 2.00 X 0 0 0 THOMAS LEYDIG DIRECTOR 2.00 2.00 X 0 0 0 JEFFREY HEIN MD DIRECTOR/PHYSICIAN 2.00 40.00 X 0 632270 35723 ROGER DAVIS EDD DIRECTOR 2.00 2.00 X 0 0 0 CHARLES KELLY ESQ DIRECTOR 2.00 2.00 X 0 0 0 RICHARD BOWERS MD DIRECTOR 2.00 2.00 X 0 0 0 KAREN JEROME-ZAPADKA MD DIRECTOR 2.00 2.00 X 0 0 0 MARK BRENNAN DIRECTOR 2.00 2.00 X 0 0 0 MICHAEL DICLEMENTE DIRECTOR 2.00 2.00 X 0 0 0 DIANA KOZLINA-PERETIC DNP DIRECTOR 2.00 2.00 X 0 0 0 SRIDHAR TAYURM PHD DIRECTOR 2.00 2.00 X 0 0 0 SHARON LOFTUS ESQ ASST. SECRETARY 2.00 40.00 X 0 282031 34869 GARRETT RICHARDSON ASSOCIATE VP, FINANCE 2.00 40.00 X 0 222290 12580 ROBERT ROSENBERGER FORMER CFO 0.00 0.00 X 0 502040 6329 0 2970758 168130 0 1 1 0 0 328 328 328 0 0 328 17 17 17 0 17 0 8756 9037 7 37 8763 9074 39871 39871 39871 39871 X -31108 -30797 -31108 -30797 8763 9074 311 0 X 0 1 X 1 0 X X 1 HERITAGE VALLEY BEAVER PA DIVISION 251801532 3 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 X 1 1 PART IV, SECTION E, LINE 2A: THE ORGANIZATION MAINTAINS THE WORKERS COMPENSATION TRUST FUND OF THE ORGANIZATION IT SUPPORTS. PART IV, SECTION E, LINE 2B: THE ORGANIZATION MAINTAINS THE WORKERS COMPENSATION TRUST FUND OF THE ORGANIZATION IT SUPPORTS. PART IV, SECTION D, LINE 3: THE ORGANIZATION HAS THE SAME BOARD MEMBERS AS THE BOARD OF THE ORGANIZATION IT SUPPORTS. 0 X PART X, LINE 2: VMF QUALIFIES AS A TAX-EXEMPT ORGANIZATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE "CODE") AND, THEREFORE, IS EXEMPT FROM INCOME TAX ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. VMF DOES NOT HAVE ANY MATERIAL UNCERTAIN TAX POSITIONS AS OF JUNE 30, 2023 AND 2022. 1 0 0 0 0 0 0 0 0 NORMAN F MITRY PRESIDENT & CEO 0 744104 0 0 0 16550 0 25980 0 16788 0 803422 0 0 JEFFREY HEIN MD DIRECTOR/PHYSICIAN 0 200000 0 395720 0 36550 0 12200 0 23523 0 667993 0 0 MICHAEL MALKOWSKI MD DIRECTOR/PHYSICIAN 0 360000 0 196123 0 15350 0 12200 0 23661 0 607334 0 0 ROBERT ROSENBERGER FORMER CFO 0 287831 0 0 0 214209 0 5757 0 572 0 508369 0 0 SHARON LOFTUS ESQ ASST. SECRETARY 0 281981 0 0 0 50 0 18269 0 16600 0 316900 0 0 GARRETT RICHARDSON ASSOCIATE VP, FINANCE 0 192240 0 25000 0 5050 0 11867 0 713 0 234870 0 0 PART I, LINE 3 HERITAGE VALLEY HEALTH SYSTEM'S BOARD OF DIRECTORS HAS APPOINTED AN EXECUTIVE COMPENSATION COMMITTEE TO REVIEW THE SALARIES FOR THE ORGANIZATION'S CEO AND OTHER SENIOR MANAGEMENT OFFICIALS. AS PART OF THE REVIEW, THE EXECUTIVE COMPENSATION COMMITTEE ENGAGED AN OUTSIDE CONSULTING FIRM TO REVIEW THE BASE SALARIES OF THE SENIOR MANAGEMENT TEAM INCLUDING THE CEO IN COMPARISON TO THE MARKET TO ENSURE REASONABLENESS OF COMPENSATION. MARKET ADJUSTMENTS ARE MADE ACCORDINGLY IN INSTANCES WHERE DATA SUPPORTED SUCH CHANGES FOR THIS PERIOD. BONUSES ARE PAID IN ACCORDANCE WITH AN INCENTIVE COMPENSATION PLAN WHICH WAS DEVELOPED AND APPROVED BY THE BOARD OF DIRECTORS SEVERAL YEARS AGO. PART I, LINE 4A ROBERT ROSENBERGER, FORMER CFO - $179,808 FORM 990, PART VI, SECTION A, LINE 6 THE WORKERS COMPENSATION TRUST FUND IS CONTROLLED BY VALLEY MEDICAL FACILITIES, INC. (THE HOSPITAL) WHICH IS CONTROLLED BY HERITAGE VALLEY HEALTH SYSTEM (THE SYSTEM), ITS PARENT COMPANY. FORM 990, PART VI, SECTION A, LINE 7A HERITAGE VALLEY HEALTH SYSTEM APPOINTS THE MEMBERS OF THE GOVERNING BODY. FORM 990, PART VI, SECTION A, LINE 7B HERITAGE VALLEY HEALTH SYSTEM ACTING BY AND THROUGH ITS BOARD OF DIRECTORS HAS THE RIGHT TO PARTICIPATE IN SELECTED MANAGEMENT DECISIONS. FORM 990, PART VI, SECTION B, LINE 11B A DRAFT OF THE COMPLETED FORM 990 AND ALL ASSOCIATED FORMS IS MADE AVAILABLE ELECTRONICALLY TO ALL BOARD OF DIRECTORS MEMBERS AND SENIOR MANAGEMENT FOR REVIEW AND COMMENT PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE (IRS). THE BOARD OF DIRECTORS HAS DELEGATED THE RESPONSIBILITY FOR REVIEW AND APPROVAL OF THE FORM 990 TO THE FINANCE COMMITTEE OF THE BOARD, WHICH WILL MEET, REVIEW, AND APPROVE THE FORM 990 PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C CERTAIN NON-MERIT EMPLOYEES WITH JOB RESPONSIBILITIES THAT PROVIDE AN OPPORTUNITY TO INFLUENCE BUSINESS DECISIONS ARE REQUIRED TO SIGN THE CONFLICT OF INTEREST FORM ANNUALLY. THESE CONFLICT OF INTEREST STATEMENTS ARE REVIEWED ANNUALLY BY THE DEPARTMENT DIRECTOR AND SYSTEM DIRECTOR FOR CORPORATE COMPLIANCE TO DETERMINE IF A CONFLICT EXISTS. ANY POTENTIAL CONFLICTS ARE REFERRED TO THE APPROPRIATE VICE PRESIDENT AND HUMAN RESOURCES TO CONFIRM AND RESOLVE THE CONFLICT. FOR MERIT EMPLOYEES, CONFLICT OF INTEREST STATEMENTS ARE REVIEWED ANNUALLY BY THE DEPARTMENT MANAGER, VICE-PRESIDENT OR CEO. ANY POTENTIAL CONFLICTS ARE MANAGED BY THE CEO. OTHER POTENTIALLY INTERESTED PARTIES, SUCH AS BOARD MEMBERS, OFFICERS AND HIGHLY COMPENSATED EMPLOYEES SIGN A STATEMENT ANNUALLY WHICH AFFIRMS SUCH PERSON HAS RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY, HAS READ AND UNDERSTANDS THE POLICY, HAS AGREED TO COMPLY WITH THE POLICY, AND UNDERSTANDS THAT THE ORGANIZATION IS A CHARITABLE ORGANIZATION AND THAT IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX EXEMPT PURPOSES. THE CHAIRPERSON OF THE BOARD REVIEWS ANNUALLY A SUMMARY OF THE DISCLOSURE STATEMENTS SO THAT THE BOARD MEMBERS ARE FAMILIAR WITH POTENTIAL CONFLICTS. FORM 990, PART VI, SECTION B, LINE 15 HERITAGE VALLEY HEALTH SYSTEM'S BOARD OF DIRECTORS HAS APPOINTED AN EXECUTIVE COMPENSATION COMMITTEE TO REVIEW THE SALARIES FOR THE ORGANIZATION'S CEO AND OTHER SENIOR MANAGEMENT OFFICIALS. AS PART OF THE REVIEW, THE EXECUTIVE COMPENSATION COMMITTEE ENGAGED AN OUTSIDE CONSULTING FIRM TO REVIEW THE BASE SALARIES OF THE SENIOR MANAGEMENT TEAM INCLUDING THE CEO IN COMPARISON TO THE MARKET TO ENSURE REASONABLENESS OF COMPENSATION. MARKET ADJUSTMENTS ARE MADE ACCORDINGLY IN INSTANCES WHERE DATA SUPPORTED SUCH CHANGES FOR THIS PERIOD. BONUSES ARE PAID IN ACCORDANCE WITH AN INCENTIVE COMPENSATION PLAN WHICH WAS DEVELOPED AND APPROVED BY THE BOARD OF DIRECTORS SEVERAL YEARS AGO. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION PUBLISHES CONDENSED FINANCIAL STATEMENTS FOR PUBLIC USE ON ITS WEBSITE WWW.HERITAGEVALLEY.ORG. GOVERNING DOCUMENTS AND POLICIES, INCLUDING CONFLICTS OF INTEREST, ARE MADE AVAILABLE UPON REQUEST. HERITAGE VALLEY HEALTH SYSTEM INC 1000 DUTCH RIDGE ROAD BEAVER PA 15009 251441518 PARENT SUPPORTING ORG PA 501(C)(3) 11C N/A 0 VALLEY MEDICAL FACILITIES INC 720 BLACKBURN ROAD SEWICKLEY PA 15143 251801532 HOSPITAL PA 501(C)(3) 3 HERITAGE VALLEY HEALTH SYSTEM 0 HOSPITALITY SHOP OF SEWICKLEY VALLEY 720 BLACKBURN ROAD SEWICKLEY PA 15143 251012989 FUNDRAISING PA 501(C)(3) 11C HERITAGE VALLEY HEALTH SYSTEM 0 THE MEDICAL CENTER AUXILIARY 1000 DUTCH RIDGE ROAD BEAVER PA 15009 251383145 FUNDRAISING PA 501(C)(3) 11C HERITAGE VALLEY HEALTH SYSTEM 0 HERITAGE VALLEY HEALTH SYSTEM FOUNDATION 25 HECKEL ROAD 4TH FLOOR MCKEES ROCK PA 15136 251801534 FUNDRAISING PA 501(C)(3) 11C HERITAGE VALLEY HEALTH SYSTEM 0 HERITAGE VALLEY HEALTHCARE NETWORK LLC 1000 DUTCH RIDGE ROAD BEAVER PA 15009 814233618 CLINICALLY INTEGRATED NETWORK PA 501(C)(3) 11C HERITAGE VALLEY HEALTH SYSTEM 0 HERITAGE VALLEY HEALTHCARE NETWORK ACO LLC 1000 DUTCH RIDGE ROAD BEAVER PA 15009 821646033 CLINICALLY INTEGRATED NETWORK PA 501(C)(3) 11C HERITAGE VALLEY HEALTH SYSTEM 0 OVH PROFESSIONAL LIABILITY SELF-INSURANCE 25 HECKEL ROAD 4TH FLOOR MCKEES ROCK PA 15136 251619844 MALPRACTICE INSURANCE PA 501(C)(3) 12B, II VALLEY MEDICAL FACILITIES INC 0 OVH WORKER COMPENSATION SELF-INSURANCE TRUST 25 HECKEL ROAD 4TH FLOOR MCKEES ROCK PA 15136 251619842 WORKERS COMPENSATION PA 501(C)(3) 12B, II VALLEY MEDICAL FACILITIES INC 0 CONSOLIDATED SUPPLY CHAIN SERVICES 25 HECKEL ROAD 4TH FLOOR MCKEES ROCK PA 15136 271055405 GROUP PURCHASING PA HERITAGE VALLEY HEALTH SYSTEM RELATED 0 0 EDGEWORTH COMMONS GROUP LLC 725 CHERRINGTON PARKWAY SUITE 200 MOON TOWNSHIP PA 15108 020713415 SURGERY CENTER PA HERITAGE VALLEY HEALTH SYSTEM RELATED 0 0 BEAVER VALLEY AMBULATORY SURGERY CENTER LLC 1030 BEANER HOLLOW ROAD BEAVER PA 15009 822918272 SURGERY CENTER PA HERITAGE VALLEY HEALTH SYSTEM RELATED 0 0 TRI-STATE OBSTETRICS & GYNECOLOGY 25 HECKEL ROAD 4TH FLOOR MCKEES ROCKS PA 15136 251776052 PHYSICIAN PRACTICE PA N/A C 0 HERITAGE VALLEY PEDIATRICS INC 25 HECKEL ROAD 4TH FLOOR MCKEES ROCKS PA 15136 251775950 PHYSICIAN PRACTICE PA N/A C 0 HERITAGE VALLEY MULTISPECIALTY GROUP INC 25 HECKEL ROAD 4TH FLOOR MCKEES ROCKS PA 15136 251775949 PHYSICIAN PRACTICE PA N/A C 0 TRI-STATE GYNECOLOGY INC 25 HECKEL ROAD 4TH FLOOR MCKEES ROCKS PA 15136 841647473 PHYSICIAN PRACTICE PA N/A C 0 HERITAGE VALLEY INSURANCE COMPANY PO BOX 1051 GRAND CAYMAN CJ 251441518 PROFESSIONAL LIABILITY CAPTIVE CJ N/A C 0 EMBROOKE INCORPORATED 25 HECKEL ROAD 4TH FLOOR MCKEES ROCKS PA 15136 300008536 AMBULANCE SERVICES PA N/A C 0 KBS ANESTHESIA INC 25 HECKEL ROAD 4TH FLOOR MCKEES ROCKS PA 15136 834184731 PROVIDES MEDICAL SERVICES PA N/A C 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1