2019-05-08T11:56:09-07:00 2018-06-30 135381590 WellSpan Health 3350 WHITEFORD ROAD YORK PA 17402 990 2017-07-01 251832359 GOOD SAMARITAN PHYSICIAN SERVICES GOOD 7178513055 PO BOX 2767 YORK PA 17405 Michael O'Connor CFO 2019-05-08 false See Attached P01871563 7038930600 2017 2019-02-21 02:37:17Z Kevin Mosser MD 5032863 false false X WWW.WELLSPAN.ORG X 2001 PA Good Samaritan Physician Services provides medical care to patients in and around Lebanon County, Pennsylvania, without regard for the patient's ability to pay. 12 3 0 13 0 4422798 4990318 38220816 42545 0 0 42643614 5032863 0 0 31297466 0 0 0 11346148 42545 42643614 42545 4990318 4516315 0 9506633 0 -4990318 0 X Good Samaritan Physician Services' mission is improving the health of patients and our communities as a multi-specialty group, built on a foundation of primary care and prevention, and coordinated within a comprehensive system of care to deliver exceptional and affordable health services. Good Samaritan Physician Services provides care without regard for an individual's health status or ability to pay. false true 42545 42545 Good Samaritan Physician Services is a non-profit group of physician practices that provides preventive services, primary care, as well as specialty services to the residents of Lebanon County and surrounding communities.See Attached 2018 WellSpan Health Community Benefit Report 42545 true true false false false false false false false false false false false false false true 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 false false false false true false false false true 0 0 false 0 false false false false false false false false false 0 false false false false false false false false false false X 12 3 true false false false true true true true true false false true true true true true true true true false PA X DAVID P RIZZUTO 7178513055 3350 WHITEFORD ROAD YORK PA 174029081 X Larry Miller Director 1.00 0.00 X 0 0 0 Harris Baderak DO Director 1.00 40.00 X 0 395069 57494 Maria Royce Director 1.00 40.00 X 0 502621 324535 Megan Shreve Director 1.00 0.00 X 0 0 0 Carleen Warner MD Chairman 1.00 40.00 X X 0 158739 89976 Kevin Mosser CEO-WSH/Direct. 1.00 40.00 X X 0 1432923 760166 Jeff Lobach Director 1.00 0.00 X 0 0 0 Lee Maddox MD Director 1.00 40.00 X 0 570304 60993 Angie Heiland MD Vice-Chairman 1.00 40.00 X X 0 193844 45756 Robert Pargament MD Director 1.00 40.00 X 0 247265 54036 Gilbert Sager Director 1.00 0.00 X 0 0 0 Mark Smith MD Director 1.00 40.00 X 0 580107 59564 Michael O'Connor CFO-WSH 1.00 40.00 X 0 790085 474403 Karen Jones MD Pres/Secretary 1.00 40.00 X 0 543149 72283 Robert Longo Former President 0.00 0.00 X 0 416469 40038 5830575 2039244 0 true true false Weatherby Locums Inc PO Box 972633 Dallas TX 75397 Staffing Physicians Comphealth PO Box 972651 Dallas TX 75397 Staffing Physicians Jackson and Coker PO Box 277638 Atlanta GA 30306 Staffing Physicians Shavkat Ruziev dba Qualimed LLC 25 Ridge Avenue Lebanon PA 17042 Staffing Physicians Medicus Hospitalists LLC 22 Roulston Road Windham NH 03087 Staffing Physicians 0 4990318 4990318 Health Care Services 621110 42545 42545 42545 0 0 0 0 0 0 0 0 0 5032863 42545 X 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 42545 42545 0 0 0 0 0 0 0 0 0 0 0 0 0 42545 42545 0 0 1750 0 692632 0 0 1639701 0 0 0 0 0 35672 0 187853 0 0 0 0 0 1958707 0 4516315 0 9506633 9506633 0 X -4990318 -4990318 0 4516315 0 4990318 X false true X true false X 1987 4422798 4990318 9415103 13026595 12051381 27027557 38220816 90326349 0 0 0 13028582 12051381 27027557 42643614 4990318 99741452 0 0 99741452 0 0 0 32444 165281 197725 13061026 12216662 27027557 42643614 4990318 99939177 0.99800 0.99560 0.00000 X X 5032863 5032863 5032863 42545 42545 42545 Part X : FIN48 Footnote In June 2006, the Financial Accounting Standards Board (FASB) issued Interpretation NO. 48, Accounting for Uncertainty in Income Taxes-an interpretation of FASB Statement NO. 109, Accounting for Income Taxes (FIN 48), which creates a single model to address uncertainty in tax positions and clarifies the accounting for income taxes by prescribing the minimum recognition threshold a tax position is required to meet before being recognized in the financial statements. Under the requirements of FIN 48, tax-exempt organizations could now be required to record an obligation as the result of a tax position they have historically taken or various tax exposure items. Prior to FIN 48, the determination of when to record a liability for tax exposure was based on whether a liability was considered probable and reasonably estimable in accordance with SFAS No.5, Accounting for Contingencies. On July 1, 2007, the parent company, WellSpan Health, adopted FIN 48. WellSpan Health determined that it does not have any uncertain tax positions through June 30, 2018. Part XI, Line 4b: Other revenue amounts included on 990 but not included in F/S Grant - Good Sam Hospital $4990318 WMG Income reported on GSPS 1099 $42545 Part XII, Line 4b: Other revenue amounts included on 990 but not included in F/S WMG Income reported on GSPS 1099 $42545 X X X X X true true false false false false false false false false Angie Heiland MD Vice-Chairman 178837 15007 11266 34490 239600 Carleen Warner MD Chairman 130899 27840 8159 81817 248715 Harris Baderak DO Director 387964 7105 15027 42467 452563 Karen Jones MD Pres/Secretary 446624 96525 31985 40298 615432 Kevin Mosser CEO-WSH/Direct. 985110 409640 38173 703900 56266 2193089 409640 Lee Maddox MD Director 525054 45250 14406 46587 631297 Maria Royce Director 360059 128436 14126 278092 46443 827156 127680 Mark Smith MD Director 532308 47799 14318 45246 639671 Michael O'Connor CFO-WSH 573485 216600 425958 48445 1264488 216600 Robert Longo Former President 416469 40038 456507 Robert Pargament MD Director 238003 9262 13616 40420 301301 Barley Snyder LLC Partner Lobach 1180831 Legal Serv WSH affil false Client Note 1 Client Note 1 - Paid Preparer ExplanationDue to a software limitation, we wish to clarify that WellSpan Health is the ERO.The paid preparer is:BDO USA, LLP13-53815908401 Greensboro Drive, Suite 800McLean, VA 22102(703) 893-0600The preparers name is Marc Berger, PTIN P01871563 Form 990, Part III, Line 3: Ceased Conducting or Significant Changes To Services All activities of Good Samaritan Physician Services are conducted through WellSpan Medical Group, a related entity. Good Samaritan Physician Services and WellSpan Medical Group share a common parent organization, WellSpan Health. Form 990, Part VI, Line 6: Explanation of Classes of Members or Shareholder Good Samaritan Health Services Foundation, a not for profit corporation, is the sole member of Good Samaritan Physician Services. Form 990, Part VI, Line 7a: How Members or Shareholders Elect Governing Body The Board of Directors shall consist of ten persons, not counting the Executive Director (President)(who shall serve ex officio without the right to vote). Five Directors shall be physicians employed by the Corporation, at least three of whom shall be engaged in primary care practice. Primary care practice for purposes of this Section shall include family practice, general practice, general internal medicine and general pediatrics. Five Directors shall be persons nominated by the Board of Directors of the Member. The person serving from time to time as the Chief Executive Officer of the Member shall be one of the five System Directors. Form 990, Part VI, Line 7b: Describe Decisions of Governing Body Approval by Members or Shareholders An affirmative action of the Member is required with regard to the following actions:a) Submission of actions required to be approved by the Memberb) Filling of vacancies in the Board of Directorsc) The adoption, amendment or repeal of the By-Laws.d) The amendment or repeal of any resolution of the Board.e) Action on matters committed by the By-Laws or resolution of the Board of Directors to another committee of the Board Form 990, Part VI, Line 11b: Form 990 Review Process Management provided an electronic copy of the form 990 to each voting member of the organization's governing body, prior to its filing with the IRS. The organization's finance management team provided a presentation to the Audit Committee on the organization's 990 return. Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts Officers, directors, and key employees fill out a WellSpan Health Conflict of Interest Disclosure Statement questionnaire annually. The questionnaire is administered by the Internal Audit Department of WellSpan Health, the Parent Company.There shall be full disclosure by any Director having a business or personal interest or relationship which may be in conflict with the interests of the Corporation. After such disclosure the Director shall abide by the determination of the Board of Directors as to whether a conflict exists, the extent to which, if at all, the Director will be permitted to be present during the Board of Directors' discussion of the matter in which the Director may be interested, and whether the Director will be permitted to participate in such discussion and cast a vote in such matter. Form 990, Part VI, Line 15a: Compensation Review & Approval Process - CEO, Top Management see following explanation for 15b. Description for compensation and approval of CEO, executive director or top management is included here. Form 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key Employees The Compensation Committee of WellSpan Health is responsible for rewarding and reinforcing key executives for the achievement of annual and long-term performance objectives. The Compensation Committee shall consist of not more than six (6) persons, of whom two (2) shall be the Chairman and Vice Chairman of the Board of the Corporation, and the remaining members shall be such other persons as may be appointed by the Chairman of the Board of the Corporation, with the approval of the Board of Directors; provided, however, that the Compensation Committee shall not include any persons who are employed by the System. The Chairman of the Board of Gettysburg Hospital shall participate. The role of the Compensation Committee is to set the Executive Compensation Philosophy for the system and ensure adherence, evaluate performance and establish compensation for the WellSpan President, evaluate team performance of the executive team and establish awards, review and approve senior executive base salary ranges, and oversee employed physician compensation programs. The Committee will approve salary ranges for each executive position and review incumbent salaries annually. The Committee will be responsible for reviewing the President's salary each year, and if warranted, authorizing an adjustment to maintain competitiveness. The President will have the authority to make salary adjustments for subordinate positions. The Committee is responsible for approving and authorizing payment of the performance awards. The Committee will approve and authorize payment of the President's performance awards. Integrated Healthcare Strategies, Inc., based in Minneapolis Minnesota is the external consultant to the committee. This consultant focuses exclusively on executive and physician compensation in the health care industry. In summary, the executive and physician compensation review process consists of the following: 1) Cash compensation reviewed annually 2) Cash compensation reviewed by external consultant biennially 3) external total compensation (cash, incentives, benefits, perquisites) reviewed by external consultant periodically 4) Process is integrated with compensation analysis for other WellSpan positions 5) Committee decisions are documented in minutes maintained in Human Resources. Form 990, Part VI, Line 19: Other Organization Documents Publicly Available Governing documents, policies, and financial statements are available upon request. Signature Block - Paid Preparer Explanation Paid Preparer ExplanationDue to a software limitation, we wish to clarify that WellSpan Health is the ERO.The paid preparer is:BDO USA, LLP13-53815908401 Greensboro Drive, Suite 800McLean, VA 22102(703) 893-0600The preparers name is Marc Berger, PTIN P01871563 Gettysburg Hospital PO Box 2767 York PA 174052767 231352220 Health Care Services PA 501(c)(3) 3 NA false Gettysburg Hospital Foundation PO Box 2767 York PA 174052767 232251535 Fundraising for GH PA 501(c)(3) 12 Type I NA false Healthy Community Pharmacy PO Box 2767 York PA 174052767 200519121 Reduced Rate prescription drugs PA 501(c)(3) 12 Type I NA false VNA Community Services PO BOx 2767 York PA 174052767 232338591 Home personal care services for elderly PA 501(c)(3) 10 NA false VNA Home Health Services PO Box 2767 York PA 174052767 231352573 Home health services PA 501(c)(3) 10 NA false Wellspan Health PO Box 2767 York PA 174052767 222517863 Integrated Health System PA 501(c)(3) 12 Type III NA false Wellspan Health Care Services PO Box 2767 York PA 174052767 232400237 Health Related activities in service are PA 501(c)(3) 12 Type II NA false Wellspan Medical Group PO Box 2767 York PA 174052767 232730785 Medical and surgical care PA 501(c)(3) 10 NA false York Health Foundation PO Box 2767 York PA 174052767 233050192 Charitable contributions for Wellspan PA 501(c)(3) 12 Type III NA false York Hospital PO Box 2767 York PA 174052767 231352222 Community Teaching Hospital PA 501(c)(3) 3 NA false Wellspan Specialty Services PO Box 2767 York PA 174052767 232899911 Surgery and Rehabilitation Hospital PA 501(c)(3) 3 NA false Wellspan Properties Inc PO Box 2767 York PA 174052767 222842252 Leases facilities to affiliates PA 501(c)(3) 12 Type II NA false Ephrata Community Hospital PO Box 2767 York PA 174052767 231370484 Health Care Services PA 501(c)(3) 3 NA false Ephrata Community Health Foundation PO Box 2767 York PA 174052767 800940005 Fundraising for Ephrata Hospital PA 501(c)(3) 12 Type I Ephrata Community Hospital false Northern Lancaster County Medical Group Po box 2767 York PA 174052767 203033058 Medical and surgical care PA 501(c)(3) 12 Type II Ephrata Community Hospital false Good Samaritan Hospital PO Box 2767 York PA 174052767 230794160 Health Care Services PA 501(c)(3) 3 NA false Philhaven PO Box 2767 York PA 174052767 231549922 Health Care Services PA 501(c)(3) 3 NA false Good Samaritan Health Services Foundatio PO Box 2767 York PA 174052767 232356151 Fundraising for Good Samaritan PA 501(c)(3) 12 Type I NA false Phys Spec Of Northern Lanc Co Med Group PO Box 2767 York PA 174052767 452537633 Physician practices PA 501(c)(3) 12 Type II Northern Lancaster County Medical Group false Apple Hill Surgical Center Inc PO Box 2767 York PA 174052767 222842253 Sole GP in limited ptnrshp operating sur PA 501(c)(3) 10 NA false Apple Hill Surgical Center Partners PO Box 2767 York PA 174052767 232489452 Surgical Cn PA NA false false Central PA Alliance Laboratories LLC PO Box 2767 York PA 174052767 232910950 Ref. Lab PA NA false false Littlestown Health Care Partners 300 West King Street Littlestown PA 17340 232880464 Lease Facility PA NA false false Cherry Tree Cancer Center LLP PO Box 2767 York PA 174052767 232915628 Radiation PA NA false false The Rehab Center 855 Springdale Drive Suite 20 Exton PA 19341 251687903 Physical Therapy Rehab PA NA false false GSH Realty Inc PO Box 2767 York PA 174052767 251832359 Rent of non res. real estate PA WSH Care Services C corp false Wellspan Pharmacy Inc PO Box 2767 York PA 174052767 232374072 Dispense Rx & provides IV therapy PA NA C corp false Wellspan Reciprocal Risk Retention Group PO Box 2767 York PA 174052767 200048457 Risk Retention Group PA NA C corp false York Health Plan PO Box 2767 York PA 174052767 232664989 Preferred Provider Organization PA NA C corp false Wellspan Provider Network PO Box 2767 York PA 174052767 232907828 Coord. managed car risk contracts PA NA C corp false Apple Hill Condominium Association PO Box 2767 York PA 174052767 232504543 Condo Mgmt Association PA NA Homeowner Assoc false Northern Lanc Co Phys Hosp Alliance PO Box 2767 York PA 174052767 232421885 Coord Phys & Hospital PA NA C corp false false false true false false false false false false false false false false false false false false false false