2024-05-14T06:23:17-05:00 2023-06-30 390859910 BAKER TILLY US LLP 1570 FRUITVILLE PIKE SUITE 400 LANCASTER PA 17601 990 2022-07-01 800663092 MOUNT NITTANY HEALTH SYSTEM MOUN 8142317000 1800 EAST PARK AVENUE STATE COLLEGE PA 16803 BRYAN ROACH EXECUTIVE VP & CFO 8142317000 2024-05-10 1 BRYAN ROACH 999009999 1 KERRI N BOGDA CPA P00760402 7177404863 2024-05-10 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z KATHLEEN RHINE 1800 EAST PARK AVENUE STATE COLLEGE PA 16803 769944 0 X WWW.MOUNTNITTANY.ORG X 2011 PA TO PROVIDE MANAGEMENT AND ADMINISTRATIVE SERVICES TO ALL MOUNT NITTANY HEALTH SUBSIDIARIES. 15 10 0 11 0 0 593483 769944 0 0 0 0 0 0 593483 769944 0 0 0 0 0 0 0 0 0 593483 769944 593483 769944 0 0 0 0 0 0 0 0 TO PROVIDE MANAGEMENT AND ADMINISTRATIVE SERVICES TO ALL MOUNT NITTANY HEALTH SUSIDIARIES. 0 0 769944 769944 MOUNT NITTANY HEALTH SYSTEM IS AN AFFILIATION WHICH INCLUDES AN ACUTE CARE HOSPITAL (MOUNT NITTANY MEDICAL CENTER), MOUNT NITTANY MEDICAL CENTER HEALTH SERVICES, INC., CENTRE COUNTY CHILDREN'S ADVOCACY CENTER, AND THE FOUNDATION FOR MOUNT NITTANY MEDICAL CENTER INC. TO PROVIDE MANAGEMENT AND ADMINISTRATIVE SERVICES TO MOUNT NITTANY MEDICAL CENTER, MOUNT NITTANY MEDICAL CENTER HEALTH SERVICES, INC. (D/B/A MOUNT NITTANY PHYSICIAN GROUP) AND ALL SUBSIDIARIES. THE HEALTH SYSTEM IS A NOT-FOR-PROFIT CORPORATION FORMED TO COORDINATE AND MANAGE THE INTEGRATION OF THE DELIVERY OF HEALTHCARE SERVICES AND PERFORM ACTIVITIES THAT SUPPORT AND BENEFIT ITS AFFILIATES. 769944 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 15 10 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 PA X BRYAN ROACH EXECUTIVE VP CFO 8142317000 1800 EAST PARK AVENUE STATE COLLEGE PA 16803 KATHLEEN RHINE PRESIDENT & CEO 2.00 38.00 X X 0 1133705 128780 MARTIN BRADLEY CHAIR 2.00 0.00 X X 0 0 0 H FORD STRYKER VICE CHAIR 2.00 0.00 X X 0 0 0 PETE ROY MD SECRETARY 2.00 38.00 X X 0 479345 31352 EMILY PETERSON MD DIRECTOR 2.00 2.00 X 0 624098 28780 THOMAS BROWN DIRECTOR 2.00 0.00 X 0 0 0 WILLIAM D JOSEPH DIRECTOR 2.00 0.00 X 0 0 0 KRISTIE KAUFMAN MD DIRECTOR 2.00 38.00 X 0 330951 23425 R KEVIN MURRAY DIRECTOR 2.00 2.00 X 0 0 0 EVE POWARS-BAHR DIRECTOR 2.00 0.00 X 0 0 0 WAYNE SEBASTIANELLI MD DIRECTOR 2.00 0.00 X 0 0 0 THOMAS J TARICANI DIRECTOR 2.00 2.00 X 0 0 0 TOM KING DIRECTOR 2.00 0.00 X 0 0 0 THOMAS QUIGLEY DIRECTOR 2.00 2.00 X 0 0 0 THEODORE ZIFF MD DIRECTOR 2.00 2.00 X 0 0 0 BRYAN ROACH EXECUTIVE VP & CFO 2.00 38.00 X 0 606771 58178 LANCE ROSE FORMER CEO/OFFICER/DIRECTOR 0.00 0.00 X 0 14721 0 0 3189591 270515 0 1 1 0 0 769944 769944 769944 0 0 0 ADMINISTRATIVE EXPENSES 769944 769944 769944 769944 0 0 0 0 0 0 X 0 0 0 0 0 0 X 0 1 X 1 0 X X X 1 MOUNT NITTANY MEDICAL CENTER 240795682 3 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SCHEDULE A, PART IV, SECTION C LINE 1: THE BOARD OF MOUNT NITTANY HEALTH SYSTEM ("MNHS") OPERATES AS THE PARENT OVER MOUNT NITTANY MEDICAL CENTER ("MNMC") AND RELATED ENTITIES. THE MANAGEMENT TEAM OF MNHS IS THE SAME MANAGEMENT TEAM FOR MNMC AND AFFILIATES. THERE IS ALSO AN OVERLAP OF BOARD MEMBERS FOR MNHS AND MNMC AND AFFILIATES. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 1 0 0 0 0 0 1 0 KATHLEEN RHINE PRESIDENT & CEO 0 869394 0 244713 0 19598 0 116039 0 12741 0 1262485 0 0 BRYAN ROACH EXECUTIVE VP & CFO 0 501969 0 101429 0 3373 0 19884 0 38294 0 664949 0 0 EMILY PETERSON MD DIRECTOR 0 595091 0 6000 0 23007 0 203 0 28577 0 652878 0 0 PETE ROY MD SECRETARY 0 437398 0 16100 0 25847 0 203 0 31149 0 510697 0 0 KRISTIE KAUFMAN MD DIRECTOR 0 274360 0 36176 0 20415 0 203 0 23222 0 354376 0 0 LANCE ROSE FORMER CEO/OFFICER/DIRECTOR 0 0 0 0 0 14721 0 0 0 0 0 14721 0 0 PART I, LINE 3 THE CEO IS AN EMPLOYEE OF MOUNT NITTANY MEDICAL CENTER ("MNMC"). MNMC USES ALL OF THE METHODS UNDER LINE 3 OTHER THAN REVIEWING 990S OF OTHER ORGANIZATIONS TO ESTABLISH HER COMPENSATION. PART I, LINES 4A-B THE FORMER CEO, LANCE ROSE, RECEIVED A NONQUALIFIED RETIREMENT PLAN PAYMENT OF $14,721 DURING THE CALENDAR YEAR. THE CHIEF EXECUTIVE OFFICER, KATHLEEN RHINE, PARTICIPATES IN 457(F) NON-QUALIFIED RETIREMENT PLAN. CONTRIBUTIONS MADE DURING THE CALENDAR YEAR WERE $96,155. PART I, LINE 7 THE EXECUTIVE TEAM MEMBERS OF MOUNT NITTANY MEDICAL CENTER RECEIVED A PORTION OF THEIR ANNUAL VARIABLE-PAY BASED UPON THE CONSOLIDATED OPERATING MARGIN, MOUNT NITTANY MEDICAL CENTER HEALTH SERVICES' (D/B/A MOUNT NITTANY PHYSICIAN GROUP) OPERATING MARGIN, CONTRIBUTIONS, AND OTHER CORPORATE GOALS. THE CORPORATE GOALS FOCUSED ON (1) PROVIDING LOCALIZED CARE, INTEGRATED CARE, EFFICIENT CARE, AND ALIGNED CARE; (2) FINANCE; (3) QUALITY/PATIENT SAFETY; AND (4) THE WORK ENVIRONMENT. ADAM J MURRAY SEE PART V 101812 SEE PART V 0 SCH L, PART IV: (A) NAME OF INTERESTED PERSON: ADAM J. MURRAY(B) RELATIONSHIP BETWEEN INTEREST PERSON AND ORGANIZATION: ADAM J. MURRAY IS A FAMILY MEMBER OF R. KEVIN MURRAY WHO IS A BOARD DIRECTOR.(D) DESCRIPTION OF TRANSACTION: SALARY COMPENSATION FROM MOUNT NITTANY MEDICAL CENTER, A RELATED ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11B THE 990 WAS PROVIDED TO THE BOARD OF DIRECTORS AND TO THE MOUNT NITTANY HEALTH SYSTEM AUDIT COMMITTEE BEFORE BEING FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY, THE CONFLICT OF INTEREST POLICY IS DISTRIBUTED TO KEY MEMBERS OF THE ORGANIZATION INCLUDING BOARD MEMBERS, OFFICERS, AND KEY EMPLOYEES. EACH PERSON MUST REPORT ANY POTENTIAL CONFLICTS OF INTEREST. REPORTED CONFLICTS ARE THEN REVIEWED BY THE CORPORATE COMPLIANCE OFFICER AND THE HEALTH SYSTEM'S AUDIT COMMITTEE. THE CONFLICT OF INTEREST REPORT IS THEN SUBMITTED TO THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD OF DIRECTORS' EXECUTIVE & PHYSICIAN COMPENSATION COMMITTEE REVIEWS COMPENSATION PAID TO EXECUTIVE MANAGEMENT TEAM IN CONJUNCTION WITH AN INDEPENDENT THIRD PARTY CONSULTING FIRM TO ENSURE COMPENSATION IS REASONABLE AND APPROPRIATE FOR DUTIES AND RESPONSIBILITES ASSIGNED. THE PROCESS IS DESIGNED TO ENABLE THE HEALTH SYSTEM TO ATTRACT, MOTIVATE, AND RETAIN THE HIGHLY SKILLED EXECUTIVE TALENT NEEDED TO CARRY OUT ITS MISSION AND STRATEGIC OBJECTIVES THROUGH THE ESTABLISHMENT OF SALARIES, BENEFITS, AND VARIABLE PAY OPPORTUNITIES THAT ARE REASONABLE, COMPARABLE WITH THOSE FOR SIMILAR POSITIONS IN SIMILARLY SITUATED NOT-FOR-PROFIT ORGANIZATIONS, AND REWARD ACHIEVEMENT OF ORGANIZATIONAL AND INDIVIDUAL OBJECTIVES. THE EXECUTIVE & PHYSICIAN COMPENSATION COMMITTEE ENSURES THAT THE BOARD FULLY UNDERSTANDS THE PROCESS BY WHICH THE ORGANIZATION'S OFFICERS/KEY EMPLOYEE COMPENSATION DECISIONS ARE MADE. THE COMMITTEE REVIEWS AND APPROVES EXECUTIVE COMPENSATION IN A MANNER THAT QUALIFIES FOR THE REBUTTABLE PRESUMPTION OF REASONABLENESS UNDER THE IRS INTERMEDIATE SANCTIONS RULES. THE COMMITTEE REPORTS ITS ACTIVITIES TO THE BOARD, INCLUDING THE SPECIFIC DETAILS OF COMPENSATION ACTIONS. THE BOARD HAS DELEGATED TO THE COMMITTEE THE AUTHORITY TO MAKE COMPENSATION DECISIONS. THE BOARD BEARS THE ULTIMATE RESPONSIBILITY FOR ENSURING SOUND DECISION-MAKING IN THIS AREA. REVIEW AND APPROVAL OF COMPENSATION IS DOCUMENTED VIA MINUTES OF COMMITTEE MEETINGS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. MOUNT NITTANY MEDICAL CENTER 1800 EAST PARK AVE STATE COLLEGE PA 16803 240795682 HEALTHCARE PA 501(C)(3) LINE 3 MOUNT NITTANY HEALTH SYSTEM 1 MOUNT NITTANY MEDICAL CENTER WORKMEN'S COMPENSATION SELF INSURANCE TRUST 1800 EAST PARK AVE STATE COLLEGE PA 16803 256440788 PROVIDE WORKMEN'S COMPENSATION BENEFITS TO EMPLOYEES OF AFFILIATE PA 501(C)(3) LINE 12A, I MOUNT NITTANY MEDICAL CENTER 0 MOUNT NITTANY MEDICAL CENTER HEALTH SERVICES INC 1800 EAST PARK AVE STATE COLLEGE PA 16803 510426500 PROFESSIONAL SERVICES TO SUPPORT AFFILIATE PA 501(C)(3) LINE 10 MOUNT NITTANY HEALTH SYSTEM 1 THE FOUNDATION FOR MOUNT NITTANY MEDICAL CENTER INC 1800 EAST PARK AVE STATE COLLEGE PA 16803 571138956 FUNDRAISING AND SUPPORT OF AFFILIATES PA 501(C)(3) LINE 12A, I MOUNT NITTANY MEDICAL CENTER 0 CENTRE COUNTY CHILDREN'S ADVOCACY CENTER 1800 EAST PARK AVE STATE COLLEGE PA 16803 460871813 CHILD-FOCUSED APPROACH TO CHILD ABUSE CASES PA 501(C)(3) LINE 7 MOUNT NITTANY MEDICAL CENTER 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 MOUNT NITTANY MEDICAL CENTER C 769944 CASH