2022-05-16T18:15:32-05:00 2021-06-30 366055558 GRANT THORNTON LLP 2001 MARKET STREET SUITE 700 PHILADELPHIA PA 19103 990 2020-07-01 851620990 PENN STATE HEALTH LANCASTER MEDICAL CENTER PENN 7175318477 100 CRYSTAL A DRIVE MC CA210 HERSHEY PA 17033 PAULA TINCH TREAS/EVP & CFO 8002431455 2022-05-16 1 PAULA TINCH 999009999 RUSSLEE ARMSTRONG P00288383 2155614200 0 AAL1 IAL1 2020 2022-09-23 18:48:47Z STEPHEN MASSINI 500 UNIVERSITY DRIVE HERSHEY PA 17033 0 0 X WWW.PENNSTATEHEALTH.ORG X 2020 PA TO PROMOTE HEALTH THROUGH THE DEVELOPMENT AND OPERATION OF AN ACUTE CARE (CONTINUED ON SCHEDULE O) HOSPITAL AND THE PROVISION OF HEALTH CARE SERVICES IN LANCASTER, PENNSYLVANIA. 4 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 39558 0 39558 0 -39558 0 162532161 0 162697351 0 -165190 TO PROMOTE HEALTH THROUGH THE DEVELOPMENT AND OPERATION OF AN ACUTE CARE HOSPITAL AND THE PROVISION OF HEALTH CARE SERVICES IN LANCASTER, PENNSYLVANIA. 0 0 31646 PSHLMC INTENDS TO OPERATE A NEW 129-BED, FIVE-STORY ACUTE CARE HOSPITAL IN LANCASTER, PENNSYLVANIA. EXPECTED TO OPEN IN THE FALL OF 2022, OUR NEW FACILITY WILL HELP ENSURE RESIDENTS IN NEARBY COMMUNITIES HAVE ACCESS, QUALITY AND CHOICE OF CARE AS CLOSE TO HOME AS POSSIBLE. AS CURRENTLY PLANNED, THE FACILITY WILL FEATURE ALL PRIVATE INPATIENT BEDS, AN EMERGENCY DEPARTMENT, PHYSICIAN OFFICES, VARIOUS SPECIALTY INPATIENT SERVICES, IMAGING AND LABORATORY SERVICES, AND COMPLETE MEDICAL AND SURGICAL CAPABILITIES. 31646 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 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 1 0 0 0 1 X 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 4 0 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 PA X STEPHEN MASSINI 8002431455 500 UNIVERSITY DRIVE HERSHEY PA 17033 STEPHEN MASSINI CHAIR/PSH CEO 1.00 49.00 X X 0 1317348 150412 PAULA TINCH TREASURER/PSH EVP&CFO 1.00 49.00 X X 0 606379 121832 JOSEPH FRANK PRESIDENT 1.00 39.00 X X 0 420660 63805 JUDITH HLAFCSAK DIR/PSH SR VP&CHIEF OF STAFF 1.00 39.00 X 0 386716 41497 ANNEMARIE BOYAN SECRETARY/PSH ASSOC GC 1.00 39.00 X 0 548004 53177 0 3279107 430723 0 0 1 0 0 0 0 0 0 X 25258 20206 5052 102 82 20 12729 10183 2546 TAXES, LICENSES, AND FE 1469 1175 294 39558 31646 7912 0 341882 162190279 0 0 162190279 0 162532161 13876618 0 148820733 0 162697351 X -165190 0 -165190 0 162532161 X -39558 -125632 X 0 1 X 1 0 X 10847582 10847582 151342697 151342697 162190279 DUE TO AFFILIATES 148820733 148820733 0 1 0 0 0 0 0 0 0 STEPHEN MASSINI CHAIR/PSH CEO 0 1285930 0 0 0 31418 0 129539 0 20873 0 1467760 0 0 PAULA TINCH TREASURER/PSH EVP&CFO 0 593613 0 0 0 12766 0 101118 0 20714 0 728211 0 0 ANNEMARIE BOYAN SECRETARY/PSH ASSOC GC 0 538490 0 0 0 9514 0 26477 0 26700 0 601181 0 0 JOSEPH FRANK PRESIDENT 0 411909 0 0 0 8751 0 61732 0 2073 0 484465 0 0 JUDITH HLAFCSAK DIR/PSH SR VP&CHIEF OF STAFF 0 369935 0 0 0 16781 0 32949 0 8548 0 428213 0 0 PART I, LINE 4B DURING THE CALENDAR YEAR ENDING WITHIN THIS FISCAL YEAR ENDED JUNE 30, 2021, CERTAIN OFFICERS AND KEY EMPLOYEES PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN. THE BELOW LISTED INDIVIDUALS' CONTRIBUTIONS HAVE NOT YET VESTED; UNVESTED CONTRIBUTIONS ARE REPORTED ON SCHEDULE J, PART II, COLUMN C, RETIREMENT AND OTHER DEFERRED COMPENSATION. - STEPHEN MASSINI - $81,924 - PAULA TINCH - $34,003 - JOSEPH FRANK - $14,117 - JUDY HLAFCSAK - $11,334 PART I, LINE 7 BONUSES, PAID BY A RELATED ORGANIZATION THAT EMPLOYS THE INDIVIDUALS, ARE BASED ON A NUMBER OF VARIABLES INCLUDING BUT NOT LIMITED TO INDIVIDUAL GOAL ACHIEVEMENTS AS WELL AS ORGANIZATION OPERATION ACHIEVEMENTS. THE FINAL DETERMINATION OF THE BONUS AMOUNT IS DETERMINED AND APPROVED BY THE APPLICABLE BOARD AS PART OF THE OVERALL COMPENSATION REVIEW OF THE OFFICERS, KEY EMPLOYEES AND HIGHEST COMPENSATED. FORM 990, PART V, LINE 1: FORM 1096 FOR THE FILIING ORGANIZATION IS PROCESSED AND REPORTED BY ITS RELATED ORGANIZATION PENN STATE HEALTH (EIN 47-3769205). FORM 990, PART VI, SECTION A, LINE 2 CERTAIN LISTED OFFICERS AND BOARD MEMBERS ALSO SERVE AS OFFICERS AND BOARD MEMBERS OF A TAXABLE ENTITY. FORM 990, PART VI, SECTION A, LINE 6 CLASSES OF MEMBERS OR STOCKHOLDERS: THE FILING ORGANIZATION'S SOLE MEMBER IS PENN STATE HEALTH, A PENNSYLVANIA NONPROFIT CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A ELECTING MEMBERS OF GOVERNING BODY: DIRECTORS SHALL BE ELECTED BY THE SOLE MEMBER. PURSUANT TO SPECIFICATIONS DEFINED IN THE BYLAWS, THE SOLE MEMBER MAY AT ANY TIME REMOVE, WITH OR WITHOUT CAUSE, ANY MEMBER OF THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B DECISIONS REQUIRING APPROVAL BY MEMBERS OR STOCKHOLDERS PURSUANT TO SPECIFICATIONS DEFINED IN THE BYLAWS THE CORPORATE MEMBERS HAVE RESERVED POWERS AS FOLLOWS: - TO DETERMINE THE NUMBER OF AND TO ELECT AND REMOVE, WITH OR WITHOUT CAUSE, THE DIRECTORS OF THE FILING ORGANIZATION; - TO ELECT AND REMOVE, WITH OR WITHOUT CAUSE, THE CHAIRPERSON AND VICE CHAIRPERSON OF THE FILING ORGANIZATION; - TO INITIATE OR APPROVE ANY AND ALL AMENDMENTS TO THE ARTICLES OF INCORPORATION AND BYLAWS OF THE FILING ORGANIZATION; - TO INITIATE OR APPROVE ALL FUNDAMENTAL CHANGE TRANSACTIONS AND ALL OTHER TRANSACTIONS NOT IN THE ORDINARY COURSE OF BUSINESS, INCLUDING WITHOUT LIMITATION, ALL MERGERS, CONSOLIDATIONS, DIVISIONS, SALES OF SUBSTANTIALLY ALL ASSETS, AND LIQUIDATION OR DISSOLUTION OF THE FILING ORGANIZATION; - TO GIVE SUCH OTHER APPROVALS AND TAKE SUCH OTHER ACTIONS AS ARE SPECIFICALLY RESERVED TO MEMBERS OF PENNSYLVANIA NONPROFIT CORPORATIONS. FORM 990, PART VI, SECTION B, LINE 11B REVIEW OF FORM 990 BY GOVERNING BODY: THE FORM 990 IS PREPARED BY AN EXTERNAL ACCOUNTING FIRM; IT IS REVIEWED BY ACCOUNTING/FINANCE DEPARTMENT PERSONNEL AND THE CHIEF FINANCIAL OFFICER, AND THEN DISTRIBUTED TO ALL MEMBERS OF THE BOARD FOR REVIEW AND COMMENT BEFORE IT IS FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST POLICY: THE FILING ORGANIZATION REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH ITS CONFLICT OF INTEREST (COI) POLICIES FOR OFFICERS, DIRECTORS, AND KEY EMPLOYEES (COVERED PERSONS). PER THE POLICY, NO COVERED PERSONS MAY ENGAGE IN ANY TRANSACTION OR ARRANGEMENT OR UNDERTAKE POSITIONS WITH OTHER ORGANIZATIONS THAT INVOLVE A CONFLICT OF INTEREST, EXCEPT IN COMPLIANCE WITH THE POLICY. EVERY COVERED PERSON SHALL DISCLOSE ALL ACTUAL AND POTENTIAL CONFLICTS THROUGH AN ANNUAL WRITTEN DISCLOSURE STATEMENT AND AS MATTERS INVOLVING AN ACTUAL OR POTENTIAL CONFLICT ARISE. THE BOARD WILL EVALUATE THE DISCLOSURES AND THE MATERIAL FACTS RELATING TO THE TRANSACTION OR ARRANGEMENT GIVING RISE TO THE POTENTIAL CONFLICT TO DETERMINE WHETHER THEY INVOLVE ACTUAL CONFLICTS OF INTEREST AND MAY ATTEMPT TO DEVELOP ALTERNATIVES TO REMOVE THE CONFLICT FROM THE TRANSACTION OR ARRANGEMENT. A COVERED PERSON WHO HAS AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST SHALL NOT BE PRESENT FOR OR SHALL LEAVE ANY PORTION OF A MEETING AT WHICH THE BOARD OF DIRECTORS OR A COMMITTEE IS VOTING TO DETERMINE WHETHER A CONFLICT EXISTS, BUT MAY BE PRESENT PRIOR TO THE VOTE TO MAKE PRESENTATION TO THE BOARD OR COMMITTEE TO DISCLOSE ADDITIONAL FACTS, OR TO RESPOND TO QUESTIONS. THE FILING ORGANIZATION MAY ENTER INTO A TRANSACTION OR ARRANGEMENT IN WHICH A COVERED PERSON HAS AN ACTUAL CONFLICT OF INTEREST IF A MAJORITY OF DIRECTORS WHO HAVE NO INTEREST IN THE TRANSACTION OR ARRANGEMENT APPROVE THE TRANSACTION OR ARRANGEMENT AT A BOARD OR COMMITTEE MEETING AFTER DETERMINING THAT THE TRANSACTION OR ARRANGEMENT IS FAIR AND REASONABLE TO THE CORPORATION, ANY COVERED PERSON WHO HAS A CONFLICT WITH RESPECT TO THE TRANSACTION OR ARRANGEMENT DOES NOT PARTICIPATE IN AND IS NOT PRESENT FOR THE VOTE REGARDING SUCH TRANSACTION OR ARRANGEMENT (EXCEPT THAT THE COVERED PERSON MAY APPEAR AT A MEETING TO ANSWER QUESTIONS), AND IF THE TRANSACTION OR ARRANGEMENT INVOLVES COMPENSATION OR OTHER FINANCIAL BENEFIT TO THE COVERED PERSON, THE BOARD RELIES ON APPROPRIATE COMPARABILITY DATA TO DETERMINE REASONABLENESS. THE FILING ORGANIZATION WILL DOCUMENT THE FOREGOING IN THE MINUTES OF BOARD AND COMMITTEE MEETINGS, AS APPLICABLE. EACH COVERED PERSON MUST SIGN A STATEMENT THAT AFFIRMS THAT HE OR SHE HAS RECEIVED A COPY OF THE COI POLICY, HAS READ AND UNDERSTANDS IT, AND HAS AGREED TO COMPLY WITH IT. IF THE BOARD OF DIRECTORS HAS REASONABLE CAUSE TO BELIEVE THAT A COVERED PERSON HAS FAILED TO COMPLY WITH THE POLICY, THE BOARD MAY COUNSEL THE COVERED PERSON REGARDING SUCH FAILURE AND, IF THE ISSUE IS NOT RESOLVED TO THE BOARD'S SATISFACTION, MAY CONSIDER ADDITIONAL CORRECTIVE ACTION, INCLUDING REMOVAL FROM THE BOARD OF DIRECTORS OR OTHER POSITION WITH THE FILING ORGANIZATION, AS APPROPRIATE. FORM 990, PART VI, LINES 13 & 14: WHISTLEBLOWER POLICY AND DOCUMENT RETENTION/DESTRUCTION POLICY THE FILING ORGANIZATION FOLLOWS THE WHISTLEBLOWER POLICY AND DOCUMENT RETENTION AND DESTRUCTION POLICY OF A RELATED ORGANIZATION. FORM 990, PART VI, SECTION C, LINE 19 REQUIRED DOCUMENTS AVAILABLE TO THE PUBLIC: THE ORGANIZATION'S CONFLICT OF INTEREST POLICY AND GOVERNING DOCUMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. THE AUDITED CONSOLIDATED FINANCIAL STATEMENTS OF THE PENNSYLVANIA STATE UNIVERSITY AND ITS SUBSIDIARIES (WHICH INCLUDE PENN STATE HEALTH LANCASTER MEDICAL CENTER) ARE AVAILABLE AT WWW.PSU.EDU. FORM 990, PART IX, LINE 11G OTHER FEES FOR SERVICES: PROGRAM SERVICE EXPENSES 20,206. MANAGEMENT AND GENERAL EXPENSES 5,052. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 25,258. FORM 990, PART XI, LINE 9: NET ASSETS ADJUSTMENT DUE TO MERGER WITH LPADC LLC -125,632. ST JOSEPH REGIONAL HEALTH NETWORK 2500 BERNVILLE RD PO BOX 316 READING PA 19605 231352211 HEALTHCARE PA 501(C)(3) LINE 3 PSH 0 ST JOSEPH MEDICAL CENTER FOUNDATION 2500 BERNVILLE RD PO BOX 316 READING PA 19605 232649362 FUNDRAISING PA 501(C)(3) LINE 12A, I SJRHN 0 ST JOSEPH MEDICAL GROUP 2500 BERNVILLE RD PO BOX 316 READING PA 19605 208544021 HEALTHCARE PA 501(C)(3) LINE 10 PSH 0 THE PENNSYLVANIA STATE UNIVERSITY ONE OLD MAIN UNIVERSITY PARK PA 16802 246000376 EDUCATION PA 115 N/A 0 PENN STATE HEALTH 500 UNIVERSITY DRIVE MC H162 HERSHEY PA 17033 473769205 HEALTHCARE PA 501(C)(3) LINE 12A, I 0 THE MILTON S HERSHEY MEDICAL CENTER 90 HOPE DRIVE HERSHEY PA 17033 251854772 HEALTHCARE PA 115 PSH 0 PENN STATE HEALTH HAMPDEN MEDICAL CENTER 100 CRYSTAL A DRIVE MC CA210 HERSHEY PA 17033 851608328 HEALTHCARE PA 501(C)(3) LINE 3 PSH 0 PENN STATE HEALTH HOLY SPIRIT MEDICAL CENTER 100 CRYSTAL A DRIVE MC CA210 HERSHEY PA 17033 231512747 HEALTHCARE PA 501(C)(3) LINE 3 PSH 0 HOLY SPIRIT CORPORATION 100 CRYSTAL A DRIVE MC CA210 HERSHEY PA 17033 232214540 REAL ESTATE PA 501(C)(2) PSHHSMC 0 SPIRIT PHYSICIAN SERVICES INC 100 CRYSTAL A DRIVE MC CA210 HERSHEY PA 17033 251766971 PHYSICIAN SERVICES PA 501(C)(3) LINE 10 PSH 0 HOLY SPIRIT HEALTH SYSTEM (END 103120) 100 CRYSTAL A DRIVE MC CA210 HERSHEY PA 17033 251865142 PHILANTHROPY PA 501(C)(3) LINE 12A, I PSH 0 HERSHEY OUTPATIENT SURGERY CENTER LP 15305 DALLAS PKWY ADDISON TX 75001 HEALTHCARE PA NITTANY HLTH 0 0 CGH REALTY ASSOCIATES 145 N 6TH STREET READING PA 19601 REAL ESTATE PA CGH REALTY CO 0 0 NITTANY HEALTH - VALUEHEALTH JOINT 11221 ROE AVE LEAWOOD KS 66211 851154159 HEALTHCARE PA NITTANY HLTH 0 0 NITTANY HEALTH INC 500 UNIVERSITY DRIVE HERSHEY PA 17033 251769611 HOMECARE INTEGRTN PA PSH C 0 CGH REALTY CO INC 2500 BERNVILLE ROAD READING PA 19605 232326801 REAL ESTATE PA SJRHN C 0 HOLY SPIRIT VENTURES INC 100 CRYSTAL A DRIVE MC CA210 HERSHEY PA 17033 232407709 REAL ESTATE PA PSHHSMC C 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 SUPPLEMENTAL INFORMATION: SCHEDULE R LISTS ONLY THOSE RELATED ORGANIZATIONS THAT RELATE TO THE HEALTH CARE OPERATIONS UNDER THE COMMON CONTROL OF THE PENNSYLVANIA STATE UNIVERSITY.