2024-05-13T15:08:37-05:00 2023-06-30 390859910 BAKER TILLY US LLP 20 STANWIX STREET PITTSBURGH PA 15222 990 2022-07-01 900406301 INDIANA JEFFERSON ONCOLOGY LLC INDI 7243577008 835 HOSPITAL ROAD INDIANA PA 15701 MICHAEL F ICKOWSKI CFO 7243577008 2024-05-09 1 MICHAEL ICKOWSKI 999009999 1 JEFFREY J PETRELL P00138808 4126976400 2024-05-01 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z STEPHEN A WOLFE 835 HOSPITAL ROAD INDIANA PA 15701 28601595 0 X WWW.INDIANARMC.ORG X 2008 PA ONCOLOGY SERVICES OFFERED IN INDIANA AND JEFFERSON COUNTIES, PA AND SURROUNDING AREAS. 5 0 0 0 0 0 0 0 29413524 28601595 0 0 0 0 29413524 28601595 0 0 0 0 2297680 2660898 0 0 0 22532278 23215363 24829958 25876261 4583566 2725334 76804 76804 0 0 76804 76804 INDIANA REGIONAL MEDICAL CENTER AND PUNXSUTAWNEY AREA HOSPITAL JOINTLY FORMED INDIANA JEFFERSON ONCOLOGY, INC. FOR THE PURPOSE OF ENHANCING THE QUALITY AND AVAILABILITY OF ONCOLOGY SERVICES OFFERED TO PATIENTS IN INDIANA AND JEFFERSON COUNTIES, PA AND SURROUNDING AREAS. 0 0 23435712 28601595 INDIANA REGIONAL MEDICAL CENTER AND PUNXSUTAWNEY AREA HOSPITAL JOINTLY FORMED INDIANA JEFFERSON ONCOLOGY, INC. FOR THE PURPOSE OF ENHANCING THE QUALITY AND AVAILABILITY OF ONCOLOGY SERVICES OFFERED TO PATIENTS IN INDIANA AND JEFFERSON COUNTIES, PA AND SURROUNDING AREAS. 23435712 1 0 0 0 0 0 0 0 0 0 1 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 X 0 0 0 0 0 0 0 0 0 0 0 0 0 X 5 0 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X ROBERT A GONGAWARE CFO 7243577008 835 HOSPITAL ROAD INDIANA PA 15701 DANIEL D BLOUGH JR PRESIDENT (UNTIL 9/22) 1.00 39.00 X X 0 351010 18452 JOHN G SISK VP & ASSISTANT SECRETARY 1.00 39.00 X X 0 257088 18554 ROBERT A GONGAWARE CFO & TREASURER 1.00 39.00 X X 0 323825 34321 STEPHEN A WOLFE PRESIDENT/CEO & CHAIRMAN 1.00 39.00 X X 0 802111 42593 RICHARD NEFF MD CMO & SECRETARY 1.00 39.00 X X 0 397918 28299 0 2131952 142219 0 0 1 0 0 RADIATION ONCOLOGY SVCS. 621990 28601595 28601595 28601595 28601595 28601595 0 0 X 2071936 2071936 588962 588962 6465777 4593584 1872193 741451 493339 248112 MEDICAL SUPPLIES 15683107 15683107 LEASES & RENTAL 292832 292832 MISCELLANEOUS 32196 4784 27412 25876261 23435712 2440549 0 3192490 3115686 76804 76804 76804 76804 0 0 X 76804 76804 76804 76804 76804 76804 X 2725334 -2725334 X 0 1 X 1 0 X X X 2 INDIANA REGIONAL MEDICAL CENTER 250965404 3 1 0 0 PUNXSUTAWNEY AREA HOSPITAL 250965210 3 1 0 0 2 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 3192490 3115686 76804 76804 X PART X, LINE 2: INDIANA JEFFERSON ONCOLOGY, INC. 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 PRESIDENT/CEO & CHAIRMAN 0 607396 0 93339 0 101376 0 23994 0 18599 0 844704 0 0 RICHARD NEFF MD CMO & SECRETARY 0 359873 0 38045 0 0 0 9150 0 19149 0 426217 0 0 DANIEL D BLOUGH JR PRESIDENT (UNTIL 9/22) 0 246262 0 29487 0 75261 0 0 0 18452 0 369462 0 0 ROBERT A GONGAWARE CFO & TREASURER 0 297705 0 26120 0 0 0 21386 0 12935 0 358146 0 0 JOHN G SISK VP & ASSISTANT SECRETARY 0 198405 0 23183 0 35500 0 0 0 18554 0 275642 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, LINE 1: THE ORGANIZATION DOES NOT FILE FORM 1096. ALL VENDORS ARE PAID THROUGH A COMMON REPORTING AGENT. THE COMMON REPORTING AGENT IS INDIANA REGIONAL MEDICAL CENTER, EIN: 25-0965404. INDIANA REGIONAL MEDICAL CENTER IS A RELATED, TAX-EXEMPT ORGANIZATION. FORM 990, PART V, LINE 2: THE SALARY AND WAGES REPORTED ON FORM 990 PART IX REPRESENT THE WAGES FOR EMPLOYEES LEASED FROM RELATED PARTY, UNIVERSITY OF PITTSBURGH CANCER INSTITUTE CANCER SERVICES. ALL PAYROLL FILINGS ARE DONE BY THE RELATED PARTY. FORM 990, PART VI, SECTION A, LINE 6 INDIANA JEFFERSON ONCOLOGY COMPANY, LLC (IJO) IS A PENNSYLVANIA LIMITED LIABILITY COMPANY THAT PROVIDES RADIATION ONCOLOGY AND OTHER HEALTHCARE SERVICES TO THE COMMUNITY WITHIN INDIANA COUNTY AND JEFFERSON COUNTY, PENNSYLVANIA. INDIANA REGIONAL MEDICAL CENTER (IRMC) AND PUNXSUTAWNEY AREA HOSPITAL (PAH) HOLD A COMBINED OWNERSHIP INTEREST OF 50.04% AND IJO IS A CONSOLIDATED ENTITY WITHIN IRMC, BASED ON IRMC'S CONTROL. FORM 990, PART VI, SECTION A, LINE 7A MEMBERS CAN SEPARATELY APPOINT SUCH NUMBERS OF DIRECTORS OF THE CORPORATION AS DESCRIBED IN ARTICLE III OF THE BYLAWS AND REMOVE SUCH DIRECTORS WITH OR WITHOUT CAUSE. FORM 990, PART VI, SECTION A, LINE 7B THE MEMBERS HAVE THE POWER TO ADOPT, AMEND, MODIFY, OR RESTATE THE ARTICLES OF INCORPORATION OR BYLAWS OF THE CORPORATION. MEMBERS HAVE THE POWER TO AMEND OR TERMINATE THE CORPORATE MEMBERSHIP AGREEMENT BETWEEN THE MEMBERS OR THE SERVICE AGREEMENT BETWEEN THE CORPORATION AND INDIANA REGIONAL MEDICAL CENTER. MEMBERS CAN MAKE MATERIAL CHANGES IN THE PURPOSES OF THE CORPORATION OR THE NATURE OR SCOPE OF THE BUSINESS CONDUCTED BY THE 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 729,440. MANAGEMENT AND GENERAL EXPENSES 1,872,193. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,601,633. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 3,864,144. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,864,144. FORM 990, PART XI, LINE 9: TRANSFER FROM/(TO) AFFILIATES -2,725,334. INDIANA REGIONAL MEDICAL CENTER 835 HOSPITAL ROAD INDIANA PA 15701 250965404 HOSPITAL PA 501(C)(3) LINE 3 PENNSYLVANIA MOUNTAINS CARE NETWORK 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 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 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0