2024-05-13T09:40:59-05:00 2023-06-30 FORVIS LLP 910 E ST LOUIS 200/PO BOX 1190 SPRINGFIELD MO 658062523 990 2022-07-01 204648477 ARMSTRONG CENTER FOR MEDICINE & HEALTH INC % MATTHEW KOCIOLA ARMS 7245488618 ONE NOLTE DR KITTANNING PA 16201 NICHOLE D GERACI PRESIDENT AND CEO 7245438181 2024-04-02 true NICOLE D GERACI 999009999 Brian D Todd P00422601 4178658701 2024-04-02 2 2022 2023-04-26 12:10:37Z NICHOLE D GERACI ONE NOLTE DRIVE KITTANNING PA 16201 873412 false X WWW.ACMG.ORG X 2006 PA THE ORGANIZATION IS DEDICATED TO THE PROVISION OF QUALITY HEALTHCARE AND IMPROVEMENT OF THE HEALTH AND WELLNESS OF THE PEOPLE OF ARMSTRONG AND NEIGHBORING COUNTIES. 12 9 13 9 0 0 25489 0 926408 873412 0 0 0 0 951897 873412 0 0 0 0 2289778 2309555 0 0 0 900 1042 2290678 2310597 -1338781 -1437185 287437 160744 287438 160745 -1 -1 THE ORGANIZATION SHALL PROVIDE PLANNING, SUPPORT AND COORDINATION OF THE CHARITABLE ACTIVITIES OF ARMSTRONG COUNTY MEMORIAL HOSPITAL AND ITS OTHER SUBSIDIARIES THAT PROMOTE HEALTH TO THE COMMUNITY. false false 2309697 873412 THE ORGANIZATION PROVIDES ANESTHESIA SERVICES TO THE COMMUNITY THROUGH ITS 100% OWNERSHIP OF ACMH ANESTHESIA SERVICES, LLC. ANESTHESIA SERVICES WERE PROVIDED TO 6,543 PATIENTS DURING THE YEAR. 2309697 true false false false false false false false false false false false false false true false false true false false false false false false false false false false false true false false false false false false false false false false false false true true true true false false true X 0 0 true 13 true false false false false false false false false false false false false X 12 9 true false false false false false false true true false false true true true true true true false false false PA X MATTHEW KOCIOLA 7245438618 ONE NOLTE DR KITTANNING PA 16201 X JOHN I LEWIS PRESIDENT AND CEO 1.0 39.0 X X 0 475702 60947 JAMES BACKSTROM CHIEF MEDICAL OFFICER 1.0 39.0 X 0 371834 55514 MATTHEW KOCIOLA CHIEF FINANCIAL OFFICER 1.0 39.0 X 0 265921 58717 CHAD SHAFFER DIRECTOR 1.0 39.0 X 0 273355 30453 LORI CAMPBELL NURSE ANESTHETIST 40.0 0.0 X 209279 0 38576 LETITIA BOWERS NURSE ANESTHETIST 40.0 0.0 X 231156 0 5632 ANDREW LATTANZIO NURSE ANESTHETIST 40.0 0.0 X 172538 0 34167 BRITTANEY KOPAS NURSE ANESTHETIST 40.0 0.0 X 179542 0 17501 ANDREW MILLER NURSE ANESTHETIST 40.0 0.0 X 173979 0 14788 CHRIS DILLICK DIRECTOR 1.0 1.0 X 0 0 0 COLLEEN MANTINI DIRECTOR 1.0 1.0 X 0 0 0 DONALD TYLINSKI DIRECTOR 1.0 1.0 X 0 0 0 ELIZABETH WHITE DIRECTOR 1.0 1.0 X 0 0 0 MARY KRAULAND SECRETARY/TREASURER 1.0 1.0 X X 0 0 0 SAMUEL FRIEDE DIRECTOR 1.0 1.0 X 0 0 0 SANDY BRADIGAN DIRECTOR 1.0 1.0 X 0 0 0 VOLKER ZAUN VICE CHAIRMAN 1.0 3.0 X X 0 0 0 W STEVEN DAVIS CHAIRMAN 1.0 1.0 X X 0 0 0 966494 1386812 316295 5 false true false 0 0 PATIENT SERVICE REVENUE 900099 873164 873164 OTHER REVENUE 900999 248 248 873412 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 873412 873412 0 0 0 0 0 0 0 0 2136980 2136980 57978 57978 114597 114597 0 0 0 900 900 0 0 0 0 0 142 142 0 0 0 0 0 0 0 0 0 0 2310597 2309697 900 0 213791 68125 0 0 0 0 73646 92619 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 287437 160744 5012 4784 0 0 0 0 0 0 0 0 0 0 0 0 0 0 282426 155961 287438 160745 X -1 -1 0 0 -1 -1 287437 160744 X -1437185 1437185 X false true X true false X 0 19476 0 25489 0 44965 901962 827119 882389 926408 873412 4411290 0 0 0 901962 846595 882389 951897 873412 4456255 0 0 0 4456255 0 0 0 0 0 901962 846595 882389 951897 873412 4456255 1.00000 1.00000 0.00000 0.00000 X 0 DUE TO AFFILIATE 155961 155961 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. false true false false false false false true false CHAD SHAFFER DIRECTOR 0 206174 0 67181 0 0 0 1875 0 28578 0 303808 0 0 JAMES BACKSTROM CHIEF MEDICAL OFFICER 0 371596 0 0 0 238 0 30111 0 25403 0 427348 0 0 JOHN I LEWIS PRESIDENT AND CEO 0 412745 0 0 0 62957 0 34125 0 26822 0 536649 0 55000 MATTHEW KOCIOLA CHIEF FINANCIAL OFFICER 0 265766 0 0 0 155 0 57183 0 1534 0 324638 0 0 ANDREW LATTANZIO NURSE ANESTHETIST 170573 0 1965 0 0 0 4435 0 29732 0 206705 0 0 0 ANDREW MILLER NURSE ANESTHETIST 171579 0 2400 0 0 0 14788 0 0 0 188767 0 0 0 BRITTANEY KOPAS NURSE ANESTHETIST 171284 0 1725 0 6533 0 4412 0 13089 0 197043 0 0 0 LETITIA BOWERS NURSE ANESTHETIST 229606 0 1550 0 0 0 4253 0 1379 0 236788 0 0 0 LORI CAMPBELL NURSE ANESTHETIST 206204 0 3075 0 0 0 10117 0 28459 0 247855 0 0 0 SCHEDULE J, PART I, LINE 3 COMPENSATION: ARMSTRONG COUNTY MEMORIAL HOSPITAL, A RELATED ORGANIZATION, USES THE FOLLOWING TO ESTABLISH THE COMPENSATION OF THE TOP MANAGEMENT OFFICIAL: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - WRITTEN EMPLOYMENT CONTRACT - COMPENSATION SURVEY OR STUDY - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE SCHEDULE J, PART I, LINE 4B SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN: THE FOLLOWING INDIVIDUAL PARTICIPATED IN A 457(F) NONQUALIFIED RETIREMENT PLAN AND RECEIVED THE FOLLOWING 457(F) CONTRIBUTIONS OR DISTRIBUTIONS: $ 55,000 JOHN I. LEWIS - DISTRIBUTIONS $ 29,954.34 MATTHEW KOCIOLA - CONTRIBUTIONS THE 457(F) CONTRIBUTION PLAN THAT ARMSTRONG COUNTY MEMORIAL HOSPITAL ESTABLISHED FOR A SELECT GROUP OF MANAGEMENT INCLUDES THE FOLLOWING TERMS: A PARTICIPANT SHALL BECOME FULLY VESTED IN HIS DEFERRED COMPENSATION ACCOUNT, AND INCOME, GAINS AND LOSSES ATTRIBUTABLE THERETO, IF HE REMAINS IN SERVICE WITH THE EMPLOYER UNTIL THE FIRST OF THE FOLLOWING EVENTS OCCUR: (A) THE DEATH OF THE PARTICIPANT; (B) THE DISABILITY OF THE PARTICIPANT; (C) THE DATE THE PARTICIPANT ATTAINS AGE 65; OR (D) THE DATE A PARTICIPANT IS TERMINATED FROM EMPLOYMENT WITH THE EMPLOYER DUE TO A CHANGE OF CONTROL EVENT. (E) THE PARTICIPANT WILL BE VESTED AT 5 YEARS, AT WHICH TIME PAYMENTS WILL BEGIN. UPON VESTING, THE DEFERRED COMPENSATION ACCOUNT WILL BE INCLUDIBLE IN THE GROSS INCOME OF THE PARTICIPANT PURSUANT TO CODE SECTION 457(F). SCHEDULE J, PART I, LINES 5A & 6A CONTINGENT COMPENSATION: MANAGEMENT USES MGMA PUBLISHED STANDARDS TO ESTABLISH A BASE SALARY FOR PROVIDERS. IN ADDITION TO THE BASE SALARY, PROVIDERS HAVE THE ABILITY TO EARN INCENTIVES BASED UPON THEIR PRODUCTIVITY AS REFLECTED IN WORK RVU MEASURES. IN ADDITION, THE CEO PRESENTS GOALS TO THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS OF WHAT THE ORGANIZATION HOPES TO ACHIEVE DURING EACH FISCAL YEAR. THESE GOALS ARE BASED ON REVENUES, NET EARNINGS, AND OTHER MEASURES. DEPENDING ON THE RESULTS, THE EXECUTIVE COMMITTEE OF THE BOARD, WITH INPUT FROM THE CEO, DETERMINES WHAT AMOUNT OF BONUSES (IF ANY) WILL BE PAID. IF APPROVED, BONUSES ARE PAID BY ARMSTRONG COUNTY MEMORIAL HOSPITAL. FORM 990, PART V, LINE 2A AND PART IX, LINES 7, 8, & 9 W-2'S FILED AND COMPENSATION: ARMSTRONG CENTER FOR MEDICINE AND HEALTH, INC. (ACMH) DID NOT DIRECTLY COMPENSATE EMPLOYEES, BUT RATHER, EMPLOYEES ARE COMPENSATED THROUGH ARMSTRONG COUNTY MEMORIAL HOSPITAL, A RELATED ORGANIZATION. THE SALARY AND RELATED BENEFIT EXPENSES FOR ARMSTRONG CENTER FOR MEDICINE AND HEALTH, INC.'S EMPLOYEES ARE ALLOCATED FROM THE HOSPITAL TO ARMSTRONG CENTER FOR MEDICINE AND HEALTH, INC. ON A MONTHLY BASIS. THE W-2'S RELATED TO THIS SALARY EXPENSE ARE FILED BY THE HOSPITAL, AND REPRESENT THE NUMBER ON FORM 990, PART V, LINE 2A. FORM 990, PART VI, SECTION A, LINE 2 BUSINESS RELATIONSHIP: JAMES BACKSTROM, MD, JOHN LEWIS AND MATTHEW KOCIOLA SHARE A BUSINESS RELATIONSHIP AS THEY ARE EMPLOYED BY A RELATED TAX-EXEMPT ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11B REVIEW OF FORM 990: 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 TENTATIVE DRAFT OF THE 990 IS REVIEWED BY THE DIRECTOR OF FINANCE, THE VICE PRESIDENT OF FINANCE, AND THE PRESIDENT/CEO BEFORE BEING PRESENTED TO THE BOARD OF DIRECTORS. THE 990 IS REVIEWED AND APPROVED AT THE BOARD MEETING AND FINAL REPORTS ARE PLACED ON THE BOARD OF DIRECTORS PORTAL ONCE OFFICIALLY FILED. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST POLICY: THE ORGANIZATION MONITORS COMPLIANCE WITH ITS CONFLICT OF INTEREST POLICY BY REQUESTING ON AN ANNUAL BASIS THAT MEMBERS OF THE BOARD OF DIRECTORS, ALL CORPORATE OFFICERS, AND ALL KEY EMPLOYEES COMPLETE A QUESTIONNAIRE LISTING ALL ORGANIZATIONS WITH WHICH THEY HAVE AN AFFILIATION. THE POLICY OF THE ORGANIZATION DESCRIBES HOW ANY CONFLICTS OF INTEREST ARE TO BE ADDRESSED. 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 STATEMENT FILED BY THE CHAIRMAN. IF A CONFLICT OF INTEREST SHOULD ARISE, THE MEMBERS ABSTAIN FROM THE VOTE RELATING TO THAT MATTER AND THE BOARD REVIEWS WHETHER THE MEMBER SHOULD BE REMOVED FROM THE BOARD OF DIRECTORS. FORM 990 PART VI, SECTION B, LINES 15A & 15B COMPENSATION REVIEW: THE ORGANIZATION'S CEO, EXECUTIVE DIRECTOR OR TOP MANAGEMENT OFFICIAL IS PAID BY ARMSTRONG COUNTY MEMORIAL HOSPITAL (ACMH HOSPITAL). THE PROCESS ACMH HOSPITAL USES TO DETERMINE IF THE OFFICERS OF THE ORGANIZATION ARE TO RECEIVE A WAGE ADJUSTMENT IS AS FOLLOWS: 1) A SALARY COMPARISON PREPARED BY SURVEY DATA OBTAINED FROM YAFFE, WATSON WYATT AND SULLIVAN COTTON; 2) THE INFORMATION IS COMPILED BY THE VP OF HUMAN RESOURCES AND GIVEN TO THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS FOR THEIR CONSIDERATION AND INPUT; 3) CHANGES TO EXECUTIVE COMPENSATION REQUIRE A SIGNED DOCUMENT FROM THE CHAIR OF THE HOSPITAL BOARD OF DIRECTORS. EXECUTIVE COMPENSATION IS REVIEWED AS DESCRIBED ABOVE, ON AN AS NEEDED BASIS AND WAS LAST COMPLETED IN MARCH 2021. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENT DISCLOSURE: THE ORGANIZATION TAKES THE FOLLOWING ACTIONS RELEASING INFORMATION REGARDING ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, OR FINANCIAL STATEMENTS: IF A REQUEST IS MADE TO REVIEW THE UNAUDITED FINANCIAL STATEMENTS, IT IS DISCUSSED AND DETERMINED ON A CASE BY CASE BASIS AS TO WHETHER THE INFORMATION WILL BE RELEASED. THE AUDITED FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE ORGANIZATIONS THAT REQUEST THEM. A CODE OF CONDUCT FOR THE ORGANIZATION IS AVAILABLE TO THE PUBLIC ON ITS WEBSITE AT WWW.ACMH.ORG. THE CORPORATION'S GOVERNING DOCUMENTS ARE KEPT IN THE ADMINISTRATIVE DEPARTMENT OF THE HOSPITAL. THESE DOCUMENTS CAN BE VIEWED UPON REQUEST, BUT THEY ARE NOT ALLOWED TO BE TAKEN FROM THEIR DESIGNATED AREA OR HAVE COPIES MADE WITHOUT PERMISSION. FORM 990, PART VII, SECTION A BOARD MEMBER COMPENSATION: NO BOARD MEMBERS RECEIVE ANY COMPENSATION FOR THEIR DIRECTOR DUTIES. JOHN I. LEWIS IS COMPENSATED BY ARMSTRONG COUNTY MEMORIAL HOSPITAL (ACMH HOSPITAL), A RELATED TAX-EXEMPT ORGANIZATION, AS PRESIDENT/CEO. MATTHEW KOCIOLA IS COMPENSATED BY ACMH HOSPITAL AS VICE PRESIDENT OF FINANCE/CFO. JAMES BACKSTROM, MD, IS COMPENSATED BY ACMH HOSPITAL AS CHIEF MEDICAL OFFICER. CHAD SHAFFER IS COMPENSATED BY ACMH HOSPITAL AS A PHYSICIAN. FORM 990, PART XI, LINE 9 OTHER CHANGES IN NET ASSETS: $1,437,185 TRANSFER FROM AFFILIATE ACMH ANESTHESIA SERVICES LLC ONE NOLTE DRIVE KITTANNING PA 16204 205597436 ANESTHESIA SV PA 873412 160744 ACMH ARMSTRONG COUNTY MEMORIAL HOSPITAL ONE NOLTE DRIVE KITTANNING PA 16201 250965237 HOSPITAL PA 501(C)(3) 3 ACMH true ACMH PHYSICIAN SERVICES ONE NOLTE DRIVE KITTANNING PA 16201 204648195 PRIMARY CARE PA 501(C)(3) 3 ACMH true ARMSTRONG HEALTH & EDUCATION FOUNDATION ONE NOLTE DRIVE KITTANNING PA 16201 251655867 FOUNDATION PA 501(C)(3) 12A I ACMH true GLADE RUN MEDICAL ASSOCIATES INC ONE NOLTE DRIVE KITTANNING PA 16201 264750523 PHYSICIAN PRA PA 501(C)(3) 12A I ACMH true false false false false true false false false false false false false false true true true false false true ARMSTRONG COUNTY MEMORIAL HOSPITAL P 2310455 FMV ARMSTRONG COUNTY MEMORIAL HOSPITAL S 1437185 FMV