2024-05-15T17:31:07-05:00 2023-06-30 FORVIS LLP 910 E ST LOUIS 200/PO BOX 1190 SPRINGFIELD MO 658062523 990 2022-07-01 232208596 WAYNE MEMORIAL HEALTH FOUNDATION INC % JAMES PETTINATO WAYN 5702538100 601 PARK STREET HONESDALE PA 18431 JAMES PETTINATO CEO 4178658701 2024-05-15 true JAMES PETTINATO XXX-XX-XXXX Brian D Todd P00422601 4178658701 2024-05-15 2 2022 2023-04-26 12:10:37Z JAMES PETTINATO 601 PARK STREET HONESDALE PA 18431 1946972 false X WWW.WMH.ORG X 1981 PA FUNDRAISING, FUND MANAGEMENT AND RELATED ACTIVITIES TO SUPPORT AND ASSIST RELATED ORGANIZATIONS. 13 12 0 20 0 0 274073 233270 142704 142364 327738 249375 4657 39179 749172 664188 348792 54950 0 0 0 0 0 0 0 364392 308888 713184 363838 35988 300350 11077234 11812629 449171 459976 10628063 11352653 X WAYNE MEMORIAL HEALTH FOUNDATION WILL DEVELOP, ACQUIRE, AND MANAGE RESOURCES WHICH WILL ASSIST ORGANIZATIONS THAT HELP IMPROVE THE HEALTH STATUS OF THE COMMUNITY. false false 254873 54950 142364 DURING THE FOUNDATION'S FISCAL YEAR, JULY 1, 2022 THROUGH JUNE 30, 2023, THE FOUNDATION SUPPORTED ITS MISSION THROUGH SEVERAL ACTIVITIES, INCLUDING GRANTS AND SUPPORT IN VARIOUS WAYS TO WAYNE MEMORIAL HEALTH SYSTEM AND ITS AFFILIATES AND LOCAL ORGANIZATIONS. SEE SCHEDULE O FOR ADDITIONAL INFORMATION. 254873 true true false false false false false false false true true false false false true false false true false false false false false false true false false true false true false false false false false false false false false false false false false true true false false false true 5 0 true 0 false false false false false true true false false false false false false X 13 12 true true false false true true true true true false false true true true true true true false false true false PA X JAMES PETTINATO 5702538100 601 PARK STREET HONESDALE PA 18431 JAMES PETTINATO CEO 1.0 39.0 X 0 338430 47871 PATRICIA DUNSINGER CFO 2.4 37.6 X 0 180601 14272 BROOKE JAMES TRUSTEE 0.5 0.0 X 0 0 0 CINDA TIETJEN TRUSTEE/VICE CHAIR 0.5 0.0 X X 0 0 0 CLAYTON LACOE TREASURER 0.5 0.0 X X 0 0 0 DIANE WYLAM TRUSTEE 0.5 0.0 X 0 0 0 DR LAUREN RUTKOWSKI TRUSTEE 0.5 0.0 X 0 0 0 JEFF GOGOLOSKI TRUSTEE 0.5 0.0 X 0 0 0 JEFF OLSOMMER TRUSTEE 0.5 0.0 X 0 0 0 JEFFREY SKIER TRUSTEE 0.5 0.0 X 0 0 0 KEVIN BURKE TRUSTEE 0.5 0.0 X 0 0 0 LEONARD SCHWARTZ TRUSTEE 0.5 0.0 X 0 0 0 MARTHA WILSON TRUSTEE 0.5 0.0 X 0 0 0 NANCY PROPST CHAIR 0.5 1.6 X X 0 0 0 PETER BOCHNOVICH ASST SECT/TREAS/SECT 0.5 0.0 X X 0 0 0 0 519031 62143 0 false true false 0 41941 191329 233270 RENTAL INCOME FROM AFFILIATE 531120 142273 142273 OTHER REVENUE 900099 91 91 142364 145228 145228 0 0 153753 116126 37627 0 37627 37627 1250175 1146028 104147 104147 104147 22182 41941 20630 1552 1552 0 0 0 0 0 0 0 664188 142364 288554 54950 54950 0 0 0 0 0 0 0 0 0 80900 80900 0 8900 8900 0 0 0 36201 33034 3167 0 40267 36744 3523 0 0 79730 72756 6974 0 0 0 36000 32851 3149 0 25568 23332 2236 1322 1206 116 0 363838 254873 108965 0 0 0 1910414 2360772 562003 157297 0 1200 0 0 0 0 0 0 0 0 6429 16960 3811573 1389817 2464507 2421756 5769773 6506350 300000 300000 0 0 0 0 64108 48294 11077234 11812629 3274 4765 0 0 0 33035 0 0 0 0 0 0 0 0 0 0 445897 422176 449171 459976 X 9796926 10822384 831137 530269 10628063 11352653 11077234 11812629 X 300350 427153 -2913 X false true X true false X X 2 WM HOSPITAL 240798839 3 true 16913 0 WM LT CARE 232719336 10 true 0 0 2 16913 0 true false false false false false false false false false false false false false false true false RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 187099 6472 193571 178036 9063 187099 170901 7135 178036 168091 2810 170901 145690 25440 7441 10480 168091 0.68230 0.31770 false false 0 1575746 1575746 0 2183418 1337408 846010 0 1648 1648 0 0 50761 50761 0 0 2421756 0 CHARTIABLE FIRST ANN. PAYABLE 179048 DUE TO AFFILIATES 194834 ROU LEASE LIABILITY 48294 422176 1505422 427153 427849 855002 650420 13768 13768 664188 479964 116126 116126 363838 363838 SCHEDULE D, PART V, LINE 4 PURPOSE OF ENDOWMENT: THE ENDOWMENT FUND IS TO BE USED FOR PROVIDING NURSING SCHOLARSHIPS. SCHEDULE D, PART X, LINE 2 UNCERTAIN TAX POSITIONS: MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. SCHEDULE D, PART XI, LINE 2D AMOUNTS INCLUDED ON LINE 1, BUT NOT ON FORM 990, PART VIII, LINE 12: $ 430,762 NET ASSETS RELEASED FROM RESTRICTION (2,913) TRANSFER TO AFFILIATE ---------- $ 427,849 SCHEDULE D, PART XI, LINE 4B AMOUNTS INCLUDED ON FORM 990, PART VIII, LINE 12 BUT NOT ON LINE 1: $ 123,384 TEMPORARILY RESTRICTED CONTRIBUTIONS 6,510 TEMPORARILY RESTRICTED INVESTMENT RETURN (116,126) RENTAL EXPENSES ------------ $ 13,768 SCHEDULE D, PART XII, LINE 2D AMOUNTS INCLUDED ON LINE 1 BUT NOT ON FORM 990, PART IX, LINE 25: $ 116,126 RENTAL EXPENSES HARTSOOK COMPANIES INC PLANNING false GOLF TOURNAMENT 64123 41941 22182 20470 160 0 64123 41941 22182 20470 160 20630 1552 true WAYNE MEMORIAL HOSPITAL 601 PARK STREET HONESDALE PA 18431 240798839 501(C)(3) 14000 SUPPORT WAYNE MEMORIAL COMMUNITY HEALTH CENTERS 601 PARK STREET HONESDALE PA 18431 232180889 501(C)(3) 15950 SUPPORT 2 SCHEDULE I, PART I, LINE 2 MONITORING THE USE OF GRANT FUNDS: GRANTS TO ORGANIZATIONS LISTED IN PART II ARE PROVIDED TO AFFILIATED ORGANIZATIONS WHO CAN MONITOR THE USE OF GRANT FUNDS. false true false false false false false false false JAMES PETTINATO CEO 0 309052 0 0 0 29378 0 27610 0 20261 0 386301 0 0 PATRICIA DUNSINGER CFO 0 180601 0 0 0 0 0 10895 0 3377 0 194873 0 0 SCHEDULE J, PART I, LINE 3 CEO COMPENSATION: WAYNE MEMORIAL HEALTH SYSTEM, A RELATED ORGANIZATION, DETERMINES THE COMPENSATION OF THE CEO USING THE FOLLOWING METHODS: COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. THE BOARD MAKES THE FINAL DECISION USING THE INFORMATION PROVIDED BY THE CONSULTANT. SCHEDULE J, PART I, LINE 4B SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN: WAYNE MEMORIAL HEALTH SYSTEM, A RELATED ORGANIZATION, COVERS JAMES PETTINATO WITH A 457(F) SUPPLEMENTAL RETIREMENT AGREEMENT (SERP). IN THE CURRENT YEAR THE FOLLOWING CONTRIBUTION WAS MADE: $ 9,310 FORM 990, PART III, LINE 4A PROGRAM SERVICE: THE FOLLOWING WAS UNDERTAKEN AND/OR ACCOMPLISHED: I. AWARDED GRANTS TO SEVERAL LOCAL AREA NON PROFIT ORGANIZATIONS. II. THE FOUNDATION CONTINUED TO OWN, OPERATE, MAINTAIN AND SUBSEQUENTLY LEASE TO WAYNE MEMORIAL HOSPITAL, AN AFFILIATE OF WAYNE MEMORIAL HEALTH SYSTEM, PROPERTIES IMMEDIATELY ADJACENT TO THE HOSPITAL, LOCATED AT 601 PARK STREET, HONESDALE, PENNSYLVANIA. III. WAYNE MEMORIAL HOSPITAL SERVES AS A MEMORIAL TO 55 WAYNE COUNTY RESIDENTS, WHO LOST THEIR LIVES DURING COMBAT IN WORLD WAR I. MORE RECENTLY, THE HOSPITAL WAS REDEDICATED TO ALL SERVICEMEN AND WOMEN FROM WAYNE AND PIKE COUNTIES, PENNSYLVANIA, WHO HAVE LOST THEIR LIVES IN THE SERVICE OF THEIR COUNTRY. EACH YEAR, THE FOUNDATION COLLABORATES WITH AREA VETERANS' ORGANIZATIONS TO REMEMBER AND HONOR THESE BRAVE MEN AND WOMEN BY CONDUCTING MEMORIAL SERVICES AT THE HOSPITAL ON DECEMBER 7TH AND VETERANS DAY. IV. FOUNDATION STAFF CONTINUES TO COLLABORATE WITH THE STAFF OF WAYNE MEMORIAL HOSPITAL'S DEPARTMENT OF COMMUNITY HEALTH TO CONDUCT THE TOGETHER FOR HEALTH SCHOOL PROGRAM, OFFERING EDUCATION AND WELLNESS PROGRAMS FOR STUDENTS OF WESTERN WAYNE, WAYNE HIGHLANDS AND WALLENPAUPACK AREA SCHOOL DISTRICTS. RACHAEL'S CHALLENGE A PROGRAM DESIGNED TO EMPOWER STUDENTS AND ADULTS WITH SKILLS AND TOOLS TO COMBAT BULLYING AND ALLAY FEELINGS OF ISOLATION AND DESPAIR BY CREATING A CULTURE OF KINDNESS AND COMPASSION. CONTINUING THIS PROGRAM REACHES MORE THAN 10,000 STUDENTS, TEACHERS, SCHOOL ADMINISTRATORS AND STAFF IN FOUR SCHOOL DISTRICTS. FORM 990, PART VI, SECTION A, LINE 2 BUSINESS & FAMILY RELATIONSHIPS: JAMES PETTINATO, CEO, AND PATRICIA DUNSINGER, CFO, ARE COMPENSATED BY WAYNE MEMORIAL HEALTH SYSTEM, A RELATED ORGANIZATION. BROOKE JAMES, TRUSTEE, HAS A FAMILY RELATIONSHIP WITH BRAD KIESENDAHL, A TRUSTEE OF WAYNE MEMORIAL HEALTH SYSTEM, INC., A RELATED ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 3 MANAGEMENT DUTIES: WAYNE MEMORIAL HEALTH SYSTEM, INC., PROVIDES MANAGEMENT OVER THE ORGANIZATION THROUGH DIRECT EMPLOYMENT OF THE DIRECTORS AND OFFICERS OF THE ORGANIZATION. THE MANAGEMENT SERVICES PROVIDED ARE REIMBURSED TO WAYNE MEMORIAL HEALTH SYSTEM THROUGH A MANAGEMENT FEE. FORM 990, PART VI, SECTION A, LINE 6, 7A & 7B MEMBERS OR STOCKHOLDERS: THE FOUNDATION BYLAWS INDICATE THAT THE BOARD SHALL CONSIST OF NO FEWER THAN TEN AND NO MORE THAN TWENTY TRUSTEES, INCLUDING THE CHAIRMAN OF THE BOARD OF DIRECTORS OF WAYNE HEALTH SERVICES, INC., THE FOUNDATION SUBSIDIARY, ALL OF WHOM SHALL BE APPROVED BY WAYNE MEMORIAL HEALTH SYSTEM, INC, A RELATED ORGANIZATION. THE FOLLOWING DECISIONS OF THE GOVERNING BODY ARE SUBJECT TO APPROVAL BY WAYNE MEMORIAL HEALTH SYSTEM, INC.: (A) AMENDMENT OF THE BYLAWS OR THE ARTICLES OF CORPORATION (B) MERGER OR CONSOLIDATION WITH ANY OTHER ENTITY (C) DISSOLUTION AND DISTRIBUTION OF ASSETS IN CONNECTION THEREWITH (D) ELECTION OF OFFICERS OF THIS CORPORATION (E) ADOPTION OF INVESTMENT POLICIES AND SELECTION OF INVESTMENT ADVISORS (F) INVESTMENT OF RESTRICTED GIFTS (G) SELECTION OF AUDITORS AND ATTORNEYS (H) ADOPTION OF OPERATING AND CAPITAL BUDGETS (I) APPROVAL OF FUND-RAISING PROGRAMS (J) DONATION OR TRANSFER OF ANY ASSET WITH AN AGGREGATE VALUE IN EXCESS OF SUCH AMOUNT AS MAY BE DETERMINED BY THE BOARD OF WAYNE MEMORIAL HEALTH SYSTEM FROM TIME TO TIME (K) CREATION OF ANY LIEN OR SECURITY INTEREST IN ASSETS OF THE CORPORATION (L) DESIGNATION OR RESTRICTION OF GIFTS WITH A MARKET VALUE IN EXCESS OF SUCH AMOUNT AS MAY BE DETERMINED BY THE BOARD OF WAYNE MEMORIAL HEALTH SYSTEM FROM TIME TO TIME, AND (M) ANY OTHER MATTER THAT WOULD REQUIRE THE APPROVAL OF THE MEMBERS OF A PENNSYLVANIA NONPROFIT CORPORATION. FORM 990, PART VI, SECTION B, LINE 11B 990 REVIEW POLICY: 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. A COPY OF THE FORM 990 WILL BE REVIEWED WITH THE RESOURCE MANAGEMENT COMMITTEE WHICH IS RESPONSIBLE FOR THE FINANCIAL OVERSIGHT OF ALL ENTITIES OF THE WAYNE MEMORIAL HEALTH SYSTEM. A COPY OF THE 990 WILL BE DISTRIBUTED VIA E-MAIL TO EACH BOARD MEMBER BEFORE THE RETURN IS SUBMITTED TO THE IRS. MANAGEMENT WILL DISCUSS ANY QUESTIONS THAT ANY BOARD MEMBER MAY HAVE AT THE NEXT FULL BOARD MEETING. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST POLICY: CONFLICT OF INTEREST STATEMENTS ARE COMPLETED BY EVERY BOARD MEMBER AND MANAGER ANNUALLY. EACH INDIVIDUAL IS REQUIRED TO SIGN AND RETURN THE STATEMENTS TO THE ADMINISTRATION OFFICE. THE AUDIT COMMITTEE IS RESPONSIBLE FOR MONITORING COMPLIANCE WITH ANY CONFLICT OF INTEREST THROUGHOUT THE YEAR. IF A CONFLICT OF INTEREST ARISES, THE PERSON WITH THE CONFLICT WILL RECUSE THEMSELVES FROM VOTING AND/OR DISCUSSING THE MATTER. FORM 990, PART VI, SECTION B, LINES 15A & 15B COMPENSATION REVIEW: WAYNE MEMORIAL HEALTH SYSTEM, INC., (AND ALL RELATED ENTITIES) UTILIZES A COMPENSATION COMMITTEE OF THE BOARD TO SET COMPENSATION OF ITS CEO AND OTHER SENIOR MANAGERS, INCLUDING CFO, DIRECTOR OF PATIENT CARE SERVICES, DIRECTOR OF HUMAN RESOURCES, DIRECTOR OF FACILITY SERVICES, DIRECTOR OF ANCILLARY SERVICES AND THE EXECUTIVE DIRECTOR OF THE WAYNE MEMORIAL HEALTH FOUNDATION. THE COMPENSATION COMMITTEE IS MADE UP OF INDEPENDENT DIRECTORS, WHO, WITH THE ASSISTANCE OF A NATIONAL COMPENSATION CONSULTING FIRM, UTILIZE COMPARABLE DATA FROM THE MARKETPLACE, LOOKING AT SUCH THINGS AS COMPARABLE ORGANIZATIONS IN TERMS OF REVENUE, SIZE, COMPLEXITY AND GEOGRAPHIC REGION. THE ORGANIZATION HAS ADOPTED A PHILOSOPHY OF PAYING AT THE 50TH PERCENTILE OF THE MARKETPLACE. ALL MEETINGS OF THE COMPENSATION COMMITTEE ARE DOCUMENTED AND MINUTES ARE MAINTAINED OF THE DELIBERATION AND DECISION-MAKING PROCESS. THE PROCESS NORMALLY OCCURS FROM JUNE TO OCTOBER OF THE YEAR THE COMPENSATION CHANGES ARE GRANTED. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENT DISCLOSURE: THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND/OR FINANCIAL STATEMENTS AVAILABLE TO PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9 RECONCILIATION OF NET ASSETS: $ (2,913) TRANSFERS TO AFFILIATES WAYNE MEMORIAL HOSPITAL 601 PARK STREET HONESDALE PA 18431 240798839 HOSPITAL PA 501(C)3 3 WMHS false WAYNE MEMORIAL HEALTH SYSTEM INC 601 PARK STREET HONESDALE PA 18431 232221292 OVERSIGHT PA 501(C)3 12 B II NA false WAYNE MEMORIAL LONG-TERM CARE 37 WOODLANDS DRIVE WAYMART PA 18472 232719336 NURSING HOME PA 501(C)3 10 WMHS false WAYNE HEALTH SERVICES INC 601 PARK STREET HONESDALE PA 18431 232376183 DME, RENT, PHARM PA WMHF C-CORPORATION 1033189 2052172 0.99000 true false true false false false false false false false true false true true true true false false true false