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 251773035 PUNXSUTAWNEY MEDICAL SERVICES INC PUNX 8149381800 81 HILLCREST DRIVE PUNXSUTAWNEY PA 15767 MICHAEL F ICKOWSKI CFO 8149381800 2025-04-17 1 0 X KELLY A BROCIOUS CPA P01254262 4126976400 2025-04-17 X 2023 2025-03-06 01:10:19Z JOHN G SISK 81 HILLCREST DRIVE PUNXSUTAWNEY PA 15767 839965 0 X N/A X 1995 PA TO PROVIDE PHYSICIAN SPECIALISTS TO THE SERVICE AREA OF PUNXSUTAWNEY AREA HOSPITAL. 3 0 0 0 0 0 0 0 772368 833856 0 0 2574 6109 774942 839965 0 0 0 0 759314 1632380 0 0 0 1552022 502393 2311336 2134773 -1536394 -1294808 129295 363643 0 240269 129295 123374 TO PROVIDE HIGH QUALITY PHYSICIAN SPECIALISTS TO THE PRIMARY AND SECONDARY SERVICE AREA OF PUNXSUTAWNEY AREA HOSPITAL FOR THE HEALTH BENEFITS OF THE COMMUNITY MEMBERS. 0 0 2048769 839965 PUNXSUTAWNEY MEDICAL SERVICES PROVIDES ANESTHESIA SERVICES TO ALL SURGICAL PATIENTS SERVED AT PUNXSUTAWNEY AREA HOSPITAL. SERVICE PROVIDED TO APPROXIMATELY 2,500 PATIENTS WITHOUT REGARD TO THE PATIENTS ABILITY TO PAY. 2048769 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 3 0 0 0 0 0 0 1 0 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 JOHN G SISK PRESIDENT 2.00 38.00 X X 0 299789 22014 BENEDICT HUGHES VICE CHAIR/DIRECTOR OF PRO 2.00 38.00 X X 0 158264 12078 TIMOTHY CLARK SIMPSON MD CHAIRMAN/PHYSICIAN 2.00 38.00 X X 0 561062 23229 ROBERT A GONGAWARE CFO 1.00 39.00 X 0 312538 48510 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 DANIEL D BLOUGH JR FORMER CEO 0.00 X 0 166614 2025 0 2578717 154511 0 1 1 0 0 NET PATIENT SERVICES 900099 833856 833856 833856 BAD DEBT RECOVERY 900099 6109 6109 6109 839965 839965 0 0 X 1451286 1378722 72564 98630 93698 4932 82464 78341 4123 443768 443768 11721 7336 4385 7044 7044 20336 20336 MEDICAL SUPPLIES & DRUG 10202 10202 REPAIRS & MAINTENANCE 9322 9322 2134773 2048769 86004 0 3119 298555 68102 65025 58074 63 129295 363643 240269 0 240269 X 129295 123374 129295 123374 129295 363643 X -1294808 1288887 X 0 1 X 1 0 X 0 X PART X, LINE 2: PUNXSUTAWNEY MEDICAL SERVICES IS A TAX-EXEMPT ORGANIZATION AND NOT SUBJECT TO FEDERAL OR STATE INCOME TAXES IN ACCORDANCE WITH SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. ON SUCH BASIS, IT WILL NOT INCUR ANY LIABILITY FOR INCOME TAXES, EXCEPT FOR POSSIBLE UNRELATED BUSINESS INCOME. MANAGEMENT ANNUALLY REVIEWS ITS TAX PROVISIONS AND HAS DETERMINED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS THAT REQUIRE RECOGNITION IN THE CONSOLIDATED FINANCIAL STATEMENTS. 0 1 0 0 0 0 0 0 0 STEPHEN A WOLFE CEO 0 615927 0 88595 0 182381 0 26677 0 19978 0 933558 0 0 TIMOTHY CLARK SIMPSON MD CHAIRMAN/PHYSICIAN 0 519957 0 18605 0 22500 0 1917 0 21312 0 584291 0 0 ROBERT A GONGAWARE CFO 0 308552 0 0 0 3986 0 28801 0 19709 0 361048 0 0 JOHN G SISK PRESIDENT 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 BENEDICT HUGHES VICE CHAIR/DIRECTOR OF PRO 0 151753 0 6511 0 0 0 2195 0 9883 0 170342 0 0 DANIEL D BLOUGH JR FORMER CEO 0 115862 0 44910 0 5842 0 2025 0 0 0 168639 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 7A THE PARENT COMPANY, PUNXSUTAWNEY AREA HOSPITAL, HAS THE POWER TO ELECT AND APPOINT BOARD MEMBERS. 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 PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 380,070. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 380,070. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 63,698. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 63,698. FORM 990, PART XI, LINE 9: TRANSFER FROM AFFILIATES 1,288,887. 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 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 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 1 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1