2024-05-03T14:54:40-05:00 2023-06-30 390859910 BAKER TILLY US LLP 20 STANWIX STREET PITTSBURGH PA 15222 990 2022-07-01 240798681 BARNES-KASSON COUNTY HOSPITAL BARN 5708533135 2872 TURNPIKE STREET SUSQUEHANNA PA 18847 SARA F ADORNATO EXECUTIVE DIRECTOR 5708533135 2024-05-02 1 SARA ADORNATO 999009999 1 JEFFREY J PETRELL P00138808 4126976400 2024-05-02 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z SARA F ADORNATO 2872 TURNPIKE STREET SUSQUEHANNA PA 18847 19647549 0 X WWW.BARNESKASSON.ORG X 1904 PA BARNES-KASSON COUNTY HOSPITAL IS A 501(C)(3) CRITICAL ACCESS HOSPITAL. 11 7 279 9 0 0 3857366 2138499 18632496 17156707 8115 8244 198088 344099 22696065 19647549 0 0 0 0 10218525 10615944 0 0 0 11073151 9356337 21291676 19972281 1404389 -324732 10989831 10781434 3931580 4047915 7058251 6733519 X BARNES-KASSON COUNTY HOSPITAL IS A 501(C)(3) NON-PROFIT HOSPITAL. AS SUCH,OUR FACILITY'S MISSION IS TO PROVIDE ACCESS TO AFFORDABLE HIGH QUALITY HEALTH CARE SERVICES IN OUR RURAL COMMUNITY. OUR FACILITY PROVIDES AN ARRAY OF HEALTH CARE SERVICES, INCLUDING EMERGENCY CARE, RADIOLOGY, LABORATORY, PHYSICAL AND OCCUPATIONAL THERAPY, AND SKILLED NURSING. OUR FACILITY'S RURAL HEALTH CLINIC PROVIDES PRIMARY/SPECIALTY PHYSICIAN AND DENTAL SERVICES. 0 0 15008388 17488556 BARNES-KASSON COUNTY HOSPITAL PROVIDES HEALTH CARE SERVICES TO THE POPULATION OF RURAL SUSQUEHANNA COUNTY AND SURROUNDING AREAS. OUR FACILITY PROVIDES AN ARRAY OF HEALTH CARE SERVICES, INCLUDING EMERGENCY CARE, RADIOLOGY, LABORATORY, PHYSICAL AND OCCUPATIONAL THERAPY, AND SKILLED NURSING. OUR FACILITY'S RURAL HEALTH CLINIC PROVIDES PRIMARY/SPECIALTY PHYSICIAN AND DENTAL SERVICES. THE DENTISTRY SERVICE PROVIDED IN THE RURAL HEALTH CLINIC IS THE ONLY DENTISTRY SERVICE IN THE IMMEDIATE AREA THAT PROVIDES SERVICE TO MEDICAID BENEFICIARIES. DURING THE 2023 FISCAL YEAR, WE HAD 432 INPATIENT ADMISSIONS. OF THOSE, 200 WERE MEDICARE RECIPIENTS AND 33 WERE MEDICAID RECIPIENTS. THE SKILLED NURSING FACILITY PROVIDED 15.294 DAYS OF SERVICE. 15008388 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 24 0 279 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 11 7 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 PA X BARNES-KASSON MANAGEMENT 5708533135 2872 TURNPIKE STREET SUSQUEHANNA PA 18847 SARA F ADORNATO EXECUTIVE DIRECTOR 40.00 0.00 X X 131471 0 25381 PATRICK AHEARN PRESIDENT 1.00 0.00 X X 0 0 0 JOSEPH WHITE VICE PRESIDENT 0.50 0.00 X X 0 0 0 GERALDINE LAMB SECRETARY/TREASURER 20.00 0.00 X X 20366 0 0 CHARLES ALIANO ESQ TRUSTEE/ATTORNEY 40.00 0.00 X 81099 0 0 ROSARIA ARMETTA TRUSTEE 0.50 0.00 X 0 0 0 PRAVINCHANDRA PATEL MD TRUSTEE/MEDICAL STAFF PRES 40.00 0.00 X 431824 0 0 ROBERT PAGE TRUSTEE 0.50 0.00 X 0 0 0 DONALD BUTTON TRUSTEE 0.50 0.00 X 0 0 0 GEORGE STOVER III TRUSTEE 0.50 0.00 X 0 0 0 LAURETTA CLOWES TRUSTEE 0.50 0.00 X 0 0 0 KELLI KANE CFO 40.00 0.00 X 88197 0 25381 MICHAEL ASHMAN MD PHYSICIAN 40.00 0.00 X 162510 0 0 BHUPENDRA PATEL MD PHYSICIAN 40.00 0.00 X 635091 0 16665 KIRK HINKLEY MD PHYSICIAN 40.00 0.00 X 232808 0 0 ANTHONY PALONIS CRNA 40.00 0.00 X 168763 0 25381 DANIEL COSTER MD PHYSICIAN 40.00 0.00 X 287910 0 0 2240039 0 92808 10 0 1 0 COMPUTER PROGRAMS & SYSTEMS PO BOX 850309 MOBILE AL 36685 COMPUTER PROGRAM SUPPORT 396625 K4MD INC 880 COLWELL HILL ROAD SUSQUEHANNA PA 18847 PHYSICIAN SERVICES 117038 FREDRICK CASTON 7 ALICIA COURT STONY BROOK NY 11790 PHYSICIAN SERVICES 114765 3 2107009 31490 2138499 HEALTH CARE SERVICES PROVIDED 900099 17156707 17156707 17156707 7994 7994 12250 0 12250 12250 12250 250 0 250 250 250 PHARMACY 340B 900099 241646 241646 MISCELLANEOUS INCOME 900099 83676 83676 MEDICAL RECORDS FEES 900099 6527 6527 331849 19647549 17488556 0 20494 X 803718 803718 7949505 6212936 1736569 1106968 826536 280432 755753 539554 216199 3713439 3070166 643273 5329 532 4797 568970 98284 470686 3429 3429 527180 527180 76664 75686 978 48491 48491 540638 540638 265465 265465 MEDICAL SUPPLIES 2014317 2014317 BAD DEBT EXPENSE 679156 679156 MISCELLANEOUS 379602 49941 329661 FOOD/DIETARY 373462 373462 160195 160195 19972281 15008388 4963893 0 2272522 1445595 10000 10000 10414 3081992 3148671 260560 231676 147650 131681 13823796 11020460 3007602 2803336 2199091 3010475 10989831 10781434 2600138 2845140 420330 695466 939623 215646 263152 3931580 4047915 X 7058251 6733519 7058251 6733519 10989831 10781434 -324732 0 X X 0 1 X 1 0 X 26360 26360 6494769 4646354 1848415 6835151 5924257 910894 467516 449849 17667 2803336 LIMITED USE BOARD ASSETS (CAPITAL IMPROVEMENTS) 17460 RESIDENT TRUST FUNDS 17024 INVESTMENT IN RISK RETENTION GROUP 691788 ESTIMATED THIRD PARTY PAYER SETTLEMENT 1765447 RIGHT-OF-USE ASSETS 518756 3010475 RESIDENT TRUST FUNDS 17024 OPERATING LEASE LIABILITY 246128 263152 X 18968393 0 18968393 679156 679156 19647549 19293125 0 19293125 679156 679156 19972281 PART X, LINE 2: THE HOSPITAL IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (CODE) AND IS RECOGNIZED AS TAX EXEMPT UNDER 501(A) OF THE CODE. ACCORDINGLY, NO PROVISION FOR INCOME TAXES HAS BEEN PROVIDED. ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE THE HOSPITAL TO EVALUATE TAX POSITIONS TAKEN BY THE HOSPITAL AND RECOGNIZE A TAX LIABILITY OR ASSET IF THE HOSPITAL HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD BE SUSTAINED UPON EXAMINATION BY THE INTERNAL REVENUE SERVICES (IRS). THE HOSPITAL HAS CONCLUDED THAT AS OF JUNE 30, 2023 AND 2022, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR ASSET OR DISCLOSURE IN THE FINANCIAL STATEMENTS. GENERALLY, TAX RETURNS FOR YEARS ENDED JUNE 30, 2020, AND THEREAFTER REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES. PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT 679,156. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT 679,156. 1 1 1 X 1 X 1 0 1 1 40074 40074 0.00210 3102124 842495 2259629 0.11710 3142198 842495 2299703 0.11920 6727 920 5807 0.00030 6727 920 5807 0.00030 3148925 843415 2305510 0.11950 0 679156 4028856 6208818 -2179962 X 1 1 1 1 BARNES-KASSON COUNTY HOSPITAL 2872 TURNPIKE STREET SUSQUEHANNA PA 18847 WWW.BARNES-KASSON.ORG 02050101 X X X X SKILLED NURSING FACILITY BARNES-KASSON COUNTY HOSPITAL 1 0 0 1 X X X X X X X X X 21 1 0 0 1 X WWW.BARNES-KASSON.ORG X 1 21 1 WWW.BARNES-KASSON.ORG 0 1 X 100.000000000000 250.000000000000 X 1 1 X X X X 1 X WWW.BARNES-KASSON.ORG X WWW.BARNES-KASSON.ORG X X X X 1 0 1 X 0 0 BARNES-KASSON COUNTY HOSPITAL PART V, SECTION B, LINE 5: A COMMITTEE OF HEALTH PROFESSIONALS AND ADMINISTRATIVE PROFESSIONALS WAS FORMED, AT BARNES-KASSON, TO ASSESS THE HEALTH NEEDS OF THE COMMUNITY. AFTER LOOKING AT THE DEMOGRAPHICS OF OUR SERVICE AREA, A SURVEY WAS CREATED THAT WE DETERMINED WOULD HELP ASSESS THE COMMUNITY'S HEALTH NEEDS. IN TODAY'S TECHNOLOGICALLY ADVANCED WORLD, WE DECIDED TO MAKE OUR SURVEY AVAILABLE ONLINE WITH THE USE OF AN ONLINE SURVEY BUILDING WEBSITE CALLED SURVEYMONKEY.COM. THIS WEBSITE ALLOWED US TO CREATE OUR SURVEY EXACTLY AS WE WANTED, AS WELL AS KEEPING TRACK OF THE RESPONSES AND COMPILING THE RESULTS ONCE WE REMOVED THE SURVEY. THE SURVEY WAS ADVERTISED ON OUR WEBSITE, FACEBOOK PAGE, AND LOCAL NEWSPAPER, THE SUSQUEHANNA COUNTY INDEPENDENT. IT WAS MADE AVAILABLE FOR ONE MONTH. THE LOCAL SCHOOL DISTRICTS WERE ALSO CONTACTED AND ENCOURAGED TO HAVE THEIR EMPLOYEES AND STAFF PARTICIPATE IN THE SURVEY. THE SURVEY WAS ALSO GIVEN TO MANY SENIOR CITIZENS THAT TAKE ADVANTAGE OF THE ACTIVE LIVING CENTERS IN THE COUNTY. BARNES-KASSON COUNTY HOSPITAL PART V, SECTION B, LINE 11: AS WITH MOST HEATH CARE FACILITIES, WE HAVE LIMITED FINANCIAL RESOURCES TO ADDRESS ALL ISSUES IDENTIFIED IN THE CHNA. PART I, LINE 7: A COST-TO-CHARGE RATIO CALCULATED FROM WORKSHEET 2, RATIO OF PATIENT CARE COSTS-TO-CHARGES IS THE COSTING METHODOLOGY USED TO DETERMINE THE AMOUNTS REPORTED ON PART I, LINE 7. PART I, LN 7 COL(F): THE BAD DEBT EXPENSE OF 679,156 INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN A WAS SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE OF TOTAL EXPENSES. PART III, LINE 4: ACCOUNTS ARE WRITTEN OFF WHEN THEY WERE DETERMINED TO BE UNCOLLECTABLE, BASED UPON MANAGEMENT'S ASSESSMENT OF INDIVIDUAL ACCOUNTS.A COST-TO-CHARGE RATIO CALCULATED FROM WORKSHEET 2, RATIO OF PATIENT CARE COSTS-TO-CHARGES IS THE COSTING METHODOLOGY USED TO DETERMINE THE AMOUNTS REPORTED ON LINES 2 AND 3 OF PART III. PART III, LINE 8: A COST-TO-CHARGE RATIO CALCULATED FROM WORKSHEET 2, RATIO OF PATIENT CARE COSTS-TO-CHARGES IS THE COSTING METHODOLOGY USED TO DETERMINE THE AMOUNTS REPORTED ON PART III, LINE 6. PART III, LINE 9B: WHEN AN ACCOUNT IS REGISTERED AS A CASH ACCOUNT AND IS DEEMED THE RESPONSIBILITY OF THE PATIENT, THE ACCOUNT IS CROSS REFERENCED WITH THE HOSPITAL CHARITY CARE PROGRAM TO BE SURE THAT ANY ADJUSTMENT DUE HAS BEEN CORRECTLY TAKEN. IF THE PATIENT IS NOT INCLUDED IN THE ROSTER, A CASH LETTER IS THEN MAILED TO THE PATIENT WITH THE INITIAL BILLING. THIS LETTER ASKS THAT THE PATIENT CONTACT THE OFFICE REGARDING ANY AVAILABLE INSURANCE INFORMATION NOT GIVEN AT TIME OF SERVICE AND POSSIBLE COMPLETION OF APPLICATION FOR MEDICAL ASSISTANCE AND ANY BARNES- KASSON PROGRAMS SUCH AS CHARITY CARE. PART VI, LINE 2: THE COMMUNITY THAT THE HOSPITAL SERVES IS SUSQUEHANNA COUNTY, PA AND CONTIGUOUS AREAS OF WAYNE COUNTY, PA, AND BROOME AND DELAWARE COUNTIES, NY. A LARGE MAJORITY OF THE SERVICES PROVIDED ARE FOR GOVERNMENT MEDICALLY ASSISTED HEALTH CARE NEEDS AND ARE DISCUSSED AT MONTHLY MEDICAL STAFF AND DEPARTMENT HEAD MEETINGS. IN ATTENDANCE ARE HOSPITAL, SKILLED AND FAMILY HEALTH CLINIC ADMINISTRATORS, PHYSICIANS, NURSES, AND DEPARTMENT HEADS OF THE HOSPITAL. NEEDS ARE ASSESSED BASED UPON EXPERIENCE, EDUCATION, OBSERVATION, RESEARCH, AND KNOWLEDGE AND UNDERSTANDING OF PATIENTS' NEEDS. THE BOARD OF DIRECTORS' MEETING HELD ONCE A MONTH IS ALSO A FORUM FOR COMMUNITY NEEDS DISCUSSION. THERE IS A PUBLIC MEETING OFFERED ONCE A YEAR AND ADVERTISED INVITING COMMUNITY ATTENDANCE. PART VI, LINE 3: WHEN OUT-PATIENT SERVICES ARE REGISTERED, IF A PATIENT DOES NOT HAVE INSURANCE THEY ARE ASKED TO COMPLETE AN APPLICATIONS FOR BOTH MEDICAL ASSISTANCE AND CHARITY CARE. THEY ARE THEN REFERRED TO A BARNES-KASSON SOCIAL WORKER. SOCIAL SERVICES SPEAKS TO IN-PATIENTS AT DISCHARGE AND EVALUATES THE ABOVE MENTIONED CRITERIA. PART VI, LINE 4: THE COMMUNITY THAT THE HOSPITAL SERVES IS SUSQUEHANNA COUNTY, PA AND CONTIGUOUS AREAS OF WAYNE COUNTY, PA, AND BROOME AND DELAWARE COUNTIES, NY. ACCORDING TO THE 2002 PENNSYLVANIA ABSTRACT OF THE US CENSUS REPORTING, SUSQUEHANNA COUNTY'S MEDIAN FAMILY INCOME RANKED 43RD POOREST OUT OF 67 COUNTIES. IN THE 2004 CENSUS, MEDIAN HOUSEHOLD INCOME IS $36,104. THIS MAKES THE AVERAGE HOUSEHOLD INCOME APPROXIMATELY 196% OF POVERTY. PART VI, LINE 5: COMBINING HOMETOWN QUALITY WITH NEW TECHNOLOGY, BARNES-KASSON HOSPITAL OFFERS A WIDE RANGE OF MEDICAL, SURGICAL, DIAGNOSTIC AND REFERRAL SERVICES, AS WELL AS FAMILY-CENTERED CARE, CORONARY/INTENSIVE CARE, OUTPATIENT REHABILITATION (INCLUDING PHYSICAL AND OCCUPATIONAL THERAPY AND SPORTS MEDICINE), A 58-BED SKILLED-NURSING FACILITY, AND 24-HOUR EMERGENCY CARE. THE HOSPITAL ALSO OPERATES THREE RURAL HEALTH CLINICS. THE RURAL HEALTH CLINICS ARE PHYSICIAN OFFICES OFFERING A WIDE VARIETY OF PRIMARY AND SPECIALTY CARE SERVICES. SOME OF THE SERVICES AVAILABLE ARE INTERNAL MEDICINE, FAMILY MEDICINE, DENTAL, CARDIOLOGY, AND ORTHOPEDICS. THE HOSPITAL MAINTAINS STRONG TIES WITH OTHER LOCAL BUSINESSES AND DEVELOPS EFFECTIVE PROGRAMS TO MEET THEIR NEEDS THOUGH ITS INDUSTRIAL HEALTH SERVICES PROGRAM. BARNES-KASSON COUNTY HOSPITAL IS AN ACTIVE HEALTH INFORMATION AND EDUCATION RESOURCE FOR THE ENTIRE COUNTY. X X 0 0 0 0 0 0 0 0 0 BHUPENDRA PATEL MD PHYSICIAN 635091 0 0 0 0 0 0 0 16665 0 651756 0 0 0 PRAVINCHANDRA PATEL MD TRUSTEE/MEDICAL STAFF PRES 431824 0 0 0 0 0 0 0 0 0 431824 0 0 0 DANIEL COSTER MD PHYSICIAN 287910 0 0 0 0 0 0 0 0 0 287910 0 0 0 KIRK HINKLEY MD PHYSICIAN 232808 0 0 0 0 0 0 0 0 0 232808 0 0 0 ANTHONY PALONIS CRNA 168763 0 0 0 0 0 0 0 25381 0 194144 0 0 0 MICHAEL ASHMAN MD PHYSICIAN 162510 0 0 0 0 0 0 0 0 0 162510 0 0 0 SARA F ADORNATO EXECUTIVE DIRECTOR 131471 0 0 0 0 0 0 0 25381 0 156852 0 0 0 A TRI-BORO MUNICIPAL AUTHORITY 231938140 2004-07-13 4670702 RETIRE CERTAIN OUTSTANDING DEBT OF THE HOSPITAL 0 0 0 A 4670702 4670702 366335 93414 4210953 2004 1 0 1 1 A 0 0 0 0 0 0 0 A 0 0 1 0 1 0 0 0 0 A 0 JOSEPH ADORNATO FAMILY MEMBER OF SARA ADORNATO, OFFICER/EXECUTIVE DIRECTOR 85884 EMPLOYEE OF BARNES-KASSON COUNTY HOSPITAL 0 MARY IVESON FAMILY MEMBER OF SARA ADORNATO, OFFICER/EXECUTIVE DIRECTOR 33087 EMPLOYEE OF BARNES-KASSON COUNTY HOSPITAL 0 MICHAEL IVESON FAMILY MEMBER OF SARA ADORNATO, OFFICER/EXECUTIVE DIRECTOR 66863 EMPLOYEE OF BARNES-KASSON COUNTY HOSPITAL 0 ROBERT IVESON FAMILY MEMBER OF SARA ADORNATO, OFFICER/EXECUTIVE DIRECTOR 53267 EMPLOYEE OF BARNES-KASSON COUNTY HOSPITAL 0 TINA HALL FAMILY MEMBER OF GERALDINE LAMB, TRUSTEE 43799 EMPLOYEE OF BARNES-KASSON COUNTY HOSPITAL 0 ROBERT HALL FAMILY MEMBER OF GERALDINE LAMB, TRUSTEE 32172 EMPLOYEE OF BARNES-KASSON COUNTY HOSPITAL 0 MATTHEW KANE FAMILY MEMBER OF KELLI KANE, CFO 17668 EMPLOYEE OF BARNES-KASSON COUNTY HOSPITAL 0 BENEDICT KANE FAMILY MEMBER OF KELLI KANE, CFO 38173 EMPLOYEE OF BARNES-KASSON COUNTY HOSPITAL 0 FORM 990, PART VI, SECTION B, LINE 11B BARNES-KASSON COUNTY HOSPITAL HAS A CPA FIRM PREPARE ITS FORM 990. THE RETURN IS COMPLETED IN DRAFT FORM AND REVIEWED BY MANAGEMENT OF THE ORGANIZATION. THE FORM 990 IS THEN PROVIDED TO THE BOARD OF DIRECTORS FOR REVIEW BEFORE IT IS FILED. FORM 990, PART VI, SECTION B, LINE 12C BARNES-KASSON COUNTY HOSPITAL ANNUALLY REQUIRES ITS BOARD MEMBERS, OFFICERS AND KEY EMPLOYEES TO FILL OUT A CONFLICTS OF INTEREST FORM. DURING BOARD MEETINGS, IF AN INTERESTED PARTY HAS A CONFLICT, HE OR SHE RECUSES THEMSELVES FROM VOTING. FORM 990, PART VI, SECTION B, LINE 15A BARNES-KASSON COUNTY HOSPITAL'S BOARD OF DIRECTORS ANNUALLY REVIEWS AND APPROVES THE COMPENSATION OF THEIR ORGANIZATION'S TOP MANAGEMENT. FORM 990, PART VI, SECTION C, LINE 18 BARNES-KASSON COUNTY HOSPITAL MAKES ITS FORM 990, FORM 1023, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VI, SECTION C, LINE 19 AT THIS TIME, BARNES-KASSON COUNTY HOSPITAL DOES NOT MAKE ITS GOVERNING DOCUMENTS AND CONFLICTS OF INTEREST POLICY AVAILABLE TO THE GENERAL PUBLIC. FORM 990, PART IX, LINE 11G OTHER FEES: PROGRAM SERVICE EXPENSES 3,070,166. MANAGEMENT AND GENERAL EXPENSES 643,273. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,713,439. FORM 990, PART XII, LINE 2C: THE ORGANIZATION'S BOARD OF DIRECTORS ARE RESPONSIBLE FOR THE OVERSIGHT OF THE AUDIT AND SELECTION OF THE INDEPENDENT AUDITORS. THE PROCESS HAS NOT CHANGED FROM PRIOR YEAR.