2025-08-27T14:29:22-05:00 2024-12-31 251306171 URISH POPECK & CO LLC 444 LIBERTY AVENUE SUITE 1400 PITTSBURGH PA 15222 990 2024-01-01 251777063 FORBES MEDICAL STAFF FUND FORB 4128582489 2570 HAYMAKER ROAD MONROEVILLE PA 151463592 DR B B PETICCA PRESIDENT 4128582489 2025-07-31 1 0 ROBERT O WATERS III P01058580 4123911994 2025-07-31 2024 2025-03-06 01:10:19Z DR ANDREW POGOZELSKI 2570 HAYMAKER ROAD MONROEVILLE PA 15146 297924 0 X N/A X 1996 PA TO PROVIDE A SYSTEM FOR REVIEWING AND RECOMMENDING THE GRANTING OF MEDICAL STAFF MEMBERSHIP AND CLINICAL PRIVILEGES TO ALL MEMBERS OF THE MEDICAL STAFF, AS WELL AS PURSUING CLINICAL UTILIZATION REVIEW AND QUALITY ASSURANCE FOR ALL PATIENTS WHO ARE PROVIDED SERVICES WITHIN THE SYSTEM. 26 0 0 0 0 0 0 0 202100 204575 18031 49240 43 64 220174 253879 0 0 0 0 62000 62000 0 0 0 129771 118322 191771 180322 28403 73557 983603 1065673 0 502 983603 1065171 SEE ATTACHED 0 0 175474 253879 SEE ATTACHED 175474 1 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 6 0 0 0 0 0 0 0 0 0 0 0 0 X 26 0 0 0 0 0 0 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 PA X ALEXANDRA KUCHTA 4128582489 2570 HAYMAKER ROAD MONROEVILLE PA 151463592 GIATH SHARI MD CHAIR, PHARMACY & THERAPEU 1.00 X 5000 0 5000 MICHAEL J AZAR MD CHAIR, MEDICAL RECORDS COM 1.00 X 5000 0 5000 MICHAEL FILIAGGI DO SECRETARY/TREASURER 1.00 X 12000 0 12000 BENJAMIN B PETICCA MD PRESIDENT 1.00 X 10000 0 10000 ANDREW POGOZELSKI MD PRESIDENT - ELECT 1.00 X 22000 0 22000 PATRICK DIGIACOMO MD SECRETARY/TREASURER 1.00 X 8000 0 8000 62000 0 62000 0 0 0 0 0 DUES 900099 204575 204575 204575 41861 41861 51424 44045 7379 7379 7379 MISCELLANEOUS INCOME 900099 64 64 64 253879 253879 0 0 62000 62000 280 280 4568 4568 21528 21528 GIFTS 91871 91871 BANK SERVICE CHARGES 75 75 180322 175474 4848 0 38513 0 22090 0 923000 1065673 983603 1065673 0 502 0 502 X 983603 1065171 983603 1065171 983603 1065673 73557 8011 0 X 0 0 0 X 173875 202800 203450 202100 204575 986800 173875 202800 203450 202100 204575 986800 0 0 0 986800 59232 43399 13205 20301 41861 177998 59232 43399 13205 20301 41861 177998 233107 246199 216655 222401 246436 1164798 0.84720 0.82900 0.15280 0.17100 X 0 X PART X, LINE 2: THE ASSOCIATION IS EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. PURSUANT TO GUIDELINES PRESCRIBED IN ASC 740, INCOME TAXES, MANAGEMENT HAS PERFORMED AN ANALYSIS OF ALL TAX POSITIONS TO DETERMINE WHETHER THE POSITION IS MORE LIKELY THAN NOT TO BE SUSTAINED UPON EXAMINATION BY TAXING AUTHORITIES, INCLUDING RESOLUTION OF ANY RELATED APPEALS OR LITIGATION PROCESSES BASED ON THE TECHNICAL MERITS OF THE POSITION. MANAGEMENT HAS DETERMINED THERE WAS NO EFFECT ON THE ASSOCIATION'S FINANCIAL STATEMENTS FROM THE ADOPTION OF THE GUIDANCE. MANAGEMENT'S CONCLUSIONS MAY BE SUBJECT TO REVIEW AND ADJUSTMENT AT A LATER DATE BASED ON CONTINUOUS ANALYSIS OF AND CHANGES TO TAX LAWS, REGULATIONS AND INTERPRETATIONS. THE ASSOCIATION IS SUBJECT TO AUDITS BY TAXING JURISDICTIONS FOR THE YEARS ENDED DECEMBER 31, 2021, 2022, 2023, 2024; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIOD IN PROGRESS. FORM 990, PART VI, SECTION A, LINE 7A THE FORBES MEDICAL STAFF FUND (THE ORGANIZATION") EXISTS UNDER THE AUSPICE OF THE FORBES REGIONAL MEDICAL CENTER (THE "MEDICAL CENTER"). 7A AND B THE ORGANIZATION IS GOVERNED BY ITS BY-LAWS WHICH: -EMPOWER ITS MEMBERS TO ELECT MEMBERS OF ITS GOVERNING BODY. -SUBJECT CERTAIN GOVERNANCE ACTION TO THE APPROVAL OF ITS MEMBERSHIP 12A, B AND C THE ORGANIZATION IS SUBJECT TO AND HAS ADOPTED THE MEDICAL CENTER'S CONFLICT OF INTEREST POLICY, ADHERENCE TO WHICH IS REGULARLY AND CONSISTENTLY MONITORED BY BOTH THE ORGANIZATION AND THE MEDICAL CENTER. 15A AND B ON AN ANNUAL BASIS, THE FORBES MEDICAL STAFF FINANCE COMMITTEE MEETS AND DEVELOPS A PROPOSED BUDGET FOR THE CALENDAR YEAR. THE BUDGET INCLUDES COMPENSATION FOR THE MEDICAL STAFF OFFICER POSITIONS AND LOCAL CRUCIAL COMMITTEE CHAIRS. FORBES HOSPITAL (MEDICAL EXECUTIVE COMMITTEE) MUST APPROVE THE MEDICAL STAFF FUND BUDGET. THE HOSPITAL ALSO SHARES THE COST OF SUCH COMPENSATION EQUALLY WITH THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7B SEE ANSWER TO PART VI, SECTION A, 7A. FORM 990, PART VI, SECTION B, LINE 11B THE BOARD REVIEWS THE AMOUNTS ENTERED AND DISCUSSES THE QUESTIONS PRESENTED ON THE 990. FORM 990, PART VI, SECTION B, LINE 12C SEE ANSWER TO PART VI, SECTION A, 7A. FORM 990, PART VI, SECTION B, LINE 15 SEE ANSWER TO PART VI, SECTION A, 7A. FORM 990, PART VI, SECTION C, LINE 19 ALL ITEMS AVAILABLE UPON REQUEST