2025-05-05T11:13:40-05:00 2024-06-30 390859910 BAKER TILLY ADVISORY GROUP LP 20 STANWIX STREET PITTSBURGH PA 15222 990 2023-07-01 932244487 PUNXSUTAWNEY AREA HOSPITAL FOUNDATION PUNX 8149381800 81 HILLCREST DRIVE PUNXSUTAWNEY PA 15767 MICHAEL F ICKOWSKI CFO 8149381800 2025-04-16 1 0 X KELLY A BROCIOUS CPA P01254262 4126976400 2025-04-16 2023 2025-03-06 01:10:19Z JOHN G SISK 81 HILLCREST DRIVE PUNXSUTAWNEY PA 15767 402085 0 X WWW.PAH.ORG X 2023 PA THE PUNXSUTAWNEY AREA HOSPITAL FOUNDATION WILL ADVANCE COMMUNITY HEALTH AND WELLNESS THROUGH PHILANTHROPY AND SUPPORT OF PUNXSUTAWNEY AREA HOSPITAL. 7 5 0 5 0 0 0 378105 0 0 0 0 0 1047 0 379152 0 0 0 0 0 0 0 0 8033 0 20734 0 20734 0 358418 0 234822 0 0 0 234822 X TO ADVANCE COMMUNITY HEALTH AND WELLNESS THROUGH PHILANTHROPY AND SUPPORT OF PUNXSUTAWNEY AREA HOSPITAL. 0 0 9914 THE FOUNDATION FULFILLS ITS MISSION BY RAISING MONEY TO ENHANCE PUNXSUTAWNEY AREA HOSPITAL'S PROGRAMS, SERVICES, MEDICAL TECHNOLOGY AND EQUIPMENT, AS WELL AS THE RECRUITMENT AND RETENTION OF PHYSICIANS, AND BY ENGAGING THE COMMUNITY AS PARTNERS IN HEALTH IMPROVEMENT. THE FOUNDATION OPERATES TO RECEIVE, MANAGE, INVEST AND DISBURSE FUNDS TO MEET CURRENT HOSPITAL NEEDS AS WELL AS ENSURE THE LONG-TERM GROWTH AND VIABILITY OF THE HOSPITAL AS THE LOCAL HEALTHCARE PROVIDER. THE PUNXSUTAWNEY AREA HOSPITAL FOUNDATION WORKS TO PROMOTE COMMUNITY COLLABORATIONS, BUILD LOYALTY AND IMPROVE AWARENESS OF THE HOSPITAL'S SERVICES. THE HOSPITAL FOUNDATION PROVIDES INDIVIDUALS AND ORGANIZATIONS WITH A RELIABLE AND EFFECTIVE MEANS TO DEMONSTRATE PHILANTHROPY, VOLUNTEER THEIR SUPPORT AND INVEST IN THEIR COMMUNITY'S WELLNESS. 9914 1 1 0 0 0 0 0 0 0 0 0 0 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 0 0 0 0 0 0 0 0 0 0 0 0 0 X 7 5 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 PA X MICHAEL F ICKOWSKI CFO 8149381800 81 HILLCREST DRIVE PUNXSUTAWNEY PA 15767 TIMOTHY CLARK SIMPSON MD CHAIR 1.00 39.00 X X 0 561062 23229 JON JOHNSTON VICE CHAIR 1.00 X X 0 0 0 JOHN G SISK SECRETARY/TREASURER 1.00 39.00 X X 0 299789 22014 FRANK ROBERTS DIRECTOR 1.00 X 0 0 0 SAM SMITH DIRECTOR 1.00 X 0 0 0 COURTNEY GRUBE PHAR MD DIRECTOR 1.00 X 0 0 0 JIM CURTIS CLU DIRECTOR 1.00 X 0 0 0 STEPHEN A WOLFE CEO 1.00 39.00 X 0 886903 46655 MICHAEL F ICKOWSKI CHIEF FINANCIAL OFFICER 1.00 39.00 X 0 193547 0 0 1941301 91898 0 0 1 0 0 28660 349445 378105 23980 28660 22933 1047 1047 379152 0 0 1047 X 7090 4963 2127 2277 2277 2197 877 660 660 MISCELLANEOUS EXPENSE 5096 5096 EQUIPMENT LEASED & RENT 4074 4074 20734 9914 2787 8033 186509 48313 0 234822 0 0 X 1815 233007 0 234822 0 234822 X 358418 1815 -125411 X 0 1 X 1 0 X X 1 PUNXSUTAWNEY AREA HOSPITAL INC 250965210 3 1 0 0 1 0 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 0 X PART X, LINE 2: PUNXSUTAWNEY AREA HOSPITAL 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. GOLF TOURNAMENT 39160 23560 15600 3000 4160 6175 3538 FALL GALA CHARITY BALL 13480 5100 8380 3060 3000 52640 28660 23980 3000 4160 9235 3000 3538 22933 1047 0 1 0 0 0 0 0 0 0 STEPHEN A WOLFE CEO 0 615927 0 88595 0 182381 0 26677 0 19978 0 933558 0 0 TIMOTHY CLARK SIMPSON MD CHAIR 0 519957 0 18605 0 22500 0 1917 0 21312 0 584291 0 0 JOHN G SISK SECRETARY/TREASURER 0 255723 0 21566 0 22500 0 2195 0 19819 0 321803 0 0 MICHAEL F ICKOWSKI CHIEF FINANCIAL OFFICER 0 182891 0 0 0 10656 0 0 0 0 0 193547 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. PAY OUTS TO HIM WERE $138,553, AND CONTRIBUTIONS TO THE PLAN WERE $94,502 DURING CALENDAR YEAR 2023. PUNXSUTAWNEY AREA HOSPITAL HAS A SUPPLEMENTAL, NONQUALIFIED RETIREMENT PLAN UNDER IRC SECTION 457(F) FOR DR. KHABBAZ. DURING 2023, $30,000 WAS CONTRIBUTED TO THE PLAN. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF PUNXSUTAWNEY AREA HOSPITAL FOUNDATION IS PUNXSUTAWNEY AREA HOSPITAL. FORM 990, PART VI, SECTION A, LINE 7A THE MEMBER, PUNXSUTAWNEY AREA HOSPITAL SHALL BE ENTITLED TO VOTE IN THE ELECTION OF DIRECTORS AND TO CAST ONE VOTE FOR EACH DIRECTOR TO BE ELECTED. FORM 990, PART VI, SECTION A, LINE 7B THE BOARD SHALL OBTAIN THE APPROVAL OF PUNXSUTAWNEY AREA HOSPITAL AS THE SOLE MEMBER OF THE FOUNDATION BEFORE ACTION ON ANY OF THE FOLLOWING MATTERS BECOMES FINAL AND EFFECTIVE: (A) AMENDMENT OF THE ARTICLES OF INCORPORATION OF THE FOUNDATION OR OF THESE BYLAWS; (B) THE SALE, LEASE OR EXCHANGE OF ALL OR SUBSTANTIALLY ALL THE PROPERTY OR ASSETS OF THE FOUNDATION; (C) MERGER OR CONSOLIDATION WITH ANY OTHER CORPORATION; (D) DISSOLUTION OF THE FOUNDATION; (E) APPROVAL OF AN ANNUAL BUDGET FOR THE FOUNDATION; (F) VOTING ANY MEMBERSHIP OR SHAREHOLDER INTEREST HELD BY THE CORPORATION IN ANY OTHER ORGANIZATION; (G) ANY OTHER MATTER THAT BY LAW REQUIRES THE APPROVAL OF THE 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 OTHER FEES: PROGRAM SERVICE EXPENSES 4,963. MANAGEMENT AND GENERAL EXPENSES 2,127. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 7,090. FORM 990, PART XI, LINE 9: TRANSFERS TO AFFILIATES -125,411. INDIANA REGIONAL MEDICAL CENTER 835 HOSPITAL ROAD INDIANA PA 15701 250965404 HOSPITAL PA 501(C)(3) LINE 3 PENNSYLVANIA MOUNTAINS CARE NETWORK 0 INDIANA JEFFERSON ONCOLOGY LLC 835 HOSPITAL ROAD INDIANA PA 15701 900406301 RADIATION ONCOLOGY SERVICES PA 501(C)(3) LINE 12A, I INDIANA REGIONAL MEDICAL CENTER 0 INDIANA TOTAL THERAPY INC 835 HOSPITAL ROAD INDIANA PA 15701 263843582 THERAPY SERVICES PA 501(C)(3) LINE 10 INDIANA HEALTHCARE PHYSICIAN SERVICES 0 INDIANA HEALTHCARE FOUNDATION 835 HOSPITAL ROAD INDIANA PA 15701 251574302 FUNDRAISING IN SUPPORT OF INDIANA REGIONAL MEDICAL CENTER PA 501(C)(3) LINE 12A, I INDIANA REGIONAL MEDICAL CENTER 0 INDIANA HEALTHCARE PHYSICIAN SERVICES INC 835 HOSPITAL ROAD INDIANA PA 15701 251842046 PROVIDE HEALTH CARE PA 501(C)(3) LINE 3 INDIANA REGIONAL MEDICAL CENTER 0 INDIANA HEALTHCARE PROPERTIES 835 HOSPITAL ROAD INDIANA PA 15701 251524635 HOLD & MANAGE PROPERTY IN SUPPORT OF INDIANA REGIONAL MEDICAL CENTER PA 501(C)(3) LINE 12A, I INDIANA REGIONAL MEDICAL CENTER 0 SPIRITLIFE INC 170 FR MARTIN TELENSON LANE PENN RUN PA 15765 463997001 DETOXIFICATION AND REHABILITATIVE SERVICES PA 501(C)(3) LINE 10 INDIANA REGIONAL MEDICAL CENTER 0 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 15701 250965210 HOSPITAL PA 501(C)(3) LINE 3 PENNSYLVANIA MOUNTAINS CARE NETWORK 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 INDIANA SKILLED NURSING INC 835 HOSPITAL ROAD INDIANA PA 15701 992421431 SKILLED NURSING FACILITY PA 501(C)(3) LINE 10 INDIANA REGIONAL MEDICAL CENTER 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0