2018-05-15T08:26:01-05:00 2017-06-30 BKD LLP 910 E St Louis St Springfield MO 658062523 990 2016-07-01 232751183 UPMC Susquehanna UPMC 5703207900 1205 Grampian Blvd 2nd Floor Williamsport PA 17701 Eric D Pohjala Executive Vice President/CFO 5703213171 2018-05-15 1 Brian D Todd CPA P00422601 4178658701 2016 2022-09-23 18:48:47Z Steven P Johnson 700 High Street Williamsport PA 17701 243344711 0 X www.susquehannahealth.org X 1994 PA UPMC Susquehanna provides management services to its exempt healthcare subsidiaries. 25 22 4467 22 0 0 80000 3000 1478 2175 1688550 13267776 -926068 -2180 843960 13270771 2306852 0 0 0 92 0 0 0 0 1500301 770995 3807245 770995 -2963285 12499776 95201150 84820495 8241764 16186102 86959386 68634393 X The mission of UPMC Susquehanna and affiliates is as follows: Our Mission - to extend God's healing love by providing outstanding patient care and shaping tomorrow's health care through clinical and technological innovation and education. Our Vision - to create an integrated community health system that delivers world class care. Our Values - to carefully place our patients and their families first, share ownership with all caregivers and lead with a servant's heart. 0 0 770995 2175 UPMC Susquehanna is organized and operated to coordinate the activities of the exempt 501(c)(3) supported organizations as they pursue their charitable, educational, benevolent, and other purposes related to health care, health education and training, health facilities, and scientific research and health. The Supported Organizations include: The Williamsport Hospital & Medical Center, Divine Providence Hospital of the Sisters of Christian Charity, Muncy Valley Hospital, and Susquehanna Physician Services. UPMC Susquehanna also is operated to establish, sponsor, and develop, directly or indirectly, facilities and programs for the accommodation, care and treatment of individuals suffering from illness, injury, disease, disability or infirmity, including but not limited to hospitals, nursing homes, residential facilities for the elderly, life care centers, ambulatory medical treatment facilities, clinics, rehabilitation centers, alcoholism treatment centers, home health programs, mental health centers, hospice programs, pharmacies, laboratories, and training and research facilities as are performed and carried out by UPMC Susquehanna's supported organizations. 770995 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 665 0 1 4467 1 0 1 CJ 0 0 0 0 0 0 0 0 X 25 22 1 0 1 0 1 1 1 1 1 0 0 0 1 1 1 1 1 0 0 0 PA X Eric D Pohjala Executive VPCFO 5703207900 700 High Street Williamsport PA 17701 Ann S Pepperman Esquire Chairperson 2.00 12.00 X X 0 0 0 Davie Jane Gilmour PhD Vice Chairperson 2.00 10.00 X X 0 0 0 Sister Teresa Ann Jacobs Secretary 2.00 10.00 X X 0 0 0 Ronald E DiSimone MD Director 2.00 48.00 X 0 1072681 31403 Daniel A Klingerman Director 2.00 10.00 X 0 0 0 Lynda Livingston Director 2.00 10.00 X 0 0 0 Philip H Johnson Treasurer 2.00 12.00 X X 0 0 0 Alexander R Nesbitt MD Director 2.00 48.00 X 0 241117 31052 Dr J Dennis Murray Director 2.00 14.00 X 0 0 0 Glenn Poirier Director 2.00 14.00 X 0 0 0 Thomas M Owlett Esquire Director 2.00 14.00 X 0 0 0 Jill Burns MD Director 2.00 50.00 X 0 259810 33044 Leslie Davis Director 2.00 X 0 0 0 Robert DeMichiei Director 2.00 X 0 0 0 Durriya Esaa MD Director 2.00 8.00 X 0 0 0 Keith Kuzio Director 2.00 12.00 X 0 0 0 Donald Leathers MD Director 2.00 8.00 X 0 0 0 Sandra McAnallen Director 2.00 X 0 0 0 Robert Montler Director 2.00 X 0 0 0 Stephen Nimmo ESQ Director 2.00 X 0 0 0 Shailesh Patel MD Director 2.00 10.00 X 0 0 0 David Russell Director 2.00 X 0 0 0 Mark Sevco Director 2.00 X 0 0 0 Marshall Webster MD Director 2.00 X 0 0 0 Patrick Wilson Director 2.00 10.00 X 0 0 0 Steven P Johnson President/CEO 2.00 50.00 X 0 960096 33271 Eric D Pohjala Exec VP/CFO 2.00 42.00 X 0 430438 32395 Jan E Fisher Exec VP/COO 2.00 44.00 X 0 551981 31238 David Lopatofsky MD Exec VP/CMO 2.00 40.00 X 0 593514 37048 Ronald J Butler Former Exec VP/CBO-Retired 4/15/15 0.00 40.00 X 0 335670 0 0 4445307 229451 0 1 1 0 Kaufman Hall & Associates Inc 8610 Solution Center Chicago IL 60677 Consulting 103749 1 3000 3000 Support allocation income 900003 1347 1347 Misc other income 900003 828 828 2175 754707 754707 242587009 230073940 12513069 12513069 12513069 Loss on inv in equity investee 900099 -2180 -2180 -2180 13270771 2175 0 13265596 X 238771 238771 152996 152996 117060 117060 70953 70953 88081 88081 99835 99835 1317 1317 635 635 1347 1347 770995 770995 0 0 312912 850613 235 0 762929 759562 4714 3367 44208289 25926174 50675000 58040341 95201150 84820495 246679 26303 7995085 16159799 8241764 16186102 X 83315878 64979873 506229 517241 3137279 3137279 86959386 68634393 95201150 84820495 X 12499776 -10632111 -20192658 X X 0 1 X 0 0 X X 5 The Williamsport Hospital & Medical Center 240795508 3 1 0 0 Divine Providence Hospital 240799343 3 1 0 0 Muncy Valley Hospital 240806023 3 1 0 0 Susquehanna Physician Services 232449454 3 1 0 0 Soldiers & Sailors Memorial Hospital 232176963 3 1 0 0 5 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 43445 0 9012 1000 51457 41841 750 1854 1000 43445 40199 2642 1000 41841 38919 2280 1000 40199 38043 100 1776 1000 38919 0.64630 0.35370 0 0 762929 759562 3367 3367 Cash Value of Life Insurance 18629 Interest in Net Affiliate 37819655 Due from exempt affiliates 11202057 Investment in exempt affiliate 9000000 58040341 Deferred Annuity 5976 Due to exempt affiliates 16153823 16159799 X Part V, Line 4: The Arthur R. Taylor, M.D. Endowment Fund for Continuing Medical Education will provide financial support for continuing medical education programs at UPMC Susquehanna with a focus on primary care. These educational programs will be for the benefit of the physicians of Susquehanna Health and surrounding regions. Form 990, Part X, Line 2 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. Central America 0 1 Program services Captive insurance company-Total investment 41650240 0 1 0 0 0 1 41650240 0 41650240 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 Ronald E DiSimone MD Director 0 1007081 0 27445 0 38155 0 9950 0 21453 0 1104084 0 0 Alexander R Nesbitt MD Director 0 215177 0 23675 0 2265 0 12965 0 18087 0 272169 0 0 Jill Burns MD Director 0 224371 0 34600 0 839 0 9950 0 23094 0 292854 0 0 Steven P Johnson President/CEO 0 703292 0 226453 0 30351 0 13925 0 19346 0 993367 0 0 Eric D Pohjala Exec VP/CFO 0 362196 0 66436 0 1806 0 9950 0 22445 0 462833 0 0 Jan E Fisher Exec VP/COO 0 401814 0 138186 0 11981 0 9950 0 21288 0 583219 0 0 David Lopatofsky MD Exec VP/CMO 0 425773 0 141731 0 26010 0 11275 0 25773 0 630562 0 0 Ronald J Butler Former Exec VP/CBO-Retired 4/15/15 0 0 0 0 0 335670 0 0 0 0 0 335670 0 0 Part I, Line 3 The Williamsport Hospital EIN #24-0795508, a related organization, uses the following resources to establish the compensation of the top management officials: compensation committee, independent compensation consultant, written employment contract, compensation survey or study, and approval by the board. Part I, Line 4a Ronald J. Butler, Former Exec VP/CBO retired on 4/15/15. His entire reportable compensation, $335,670 paid by a related organization, is a severance payment. Part I, Line 6 In order for the Leadership Team to participate in the annual Variable Compensation Incentive Program (VCIP), a minimum operating margin must be achieved for the most recently completed year on a consolidated system-level basis. Individual goals and objectives related to the VCIP may also include individual entity operating performance. For FY 2017, the minimum threshold was met that would trigger a VCIP payment. In September 2016, President/CEO Steven P. Johnson received a variable compensation award in the amount of $226,453. Form 990, Part VI, Section A, line 2 Board members Dr. Jill Burns, Dr. Ronald DiSimone, Dr. Durriya Esaa, Davie Jane Gilmour, Philip Johnson, Sister Teresa Ann Jacobs, Daniel Klingerman, Keith Kuzio, Donald Leathers, Lynda Livingston, J. Dennis Murray, Dr. Alexander Nesbitt, Thomas Owlett, Dr. Shailesh Patel, Ann Pepperman, Glenn Poirier, and Patrick Wilson all serve on the board of a related taxable organization. Form 990, Part VI, Section A, line 4 Effective October 1, 2016 an amendment to the bylaws for UPMC Susquehanna was adopted by the Board of Directors pursuant to an affiliation agreement with UPMC. Article I: The name of the corporation is UPMC Susquehanna. Article II: The physical address of the registered office of the corporation is 700 High Street, Williamsport, Lycoming County, PA 17701. Article VI: There shall be one member of the corporation, which shall be UPMC (the "Member"), a Pennsylvania nonprofit corporation which has been formed exclusively for charitable, scientific and educational purposes within the meaning of Section 501(c)(3) of the Code and has been determined as such by the Internal Revenue Service. Article VII: The business, property and affairs of the corporation shall be managed and controlled by the Board of Directors, subject to the reserved powers of the Member. Form 990, Part VI, Section A, line 6 UPMC, a federally tax exempt 501(c)(3) nonprofit corporation, is the sole member of UPMC Susquehanna. Form 990, Part VI, Section A, line 7a Two-thirds (2/3) of the total number of Directors shall be UPMC Susquehanna Directors. One-third (1/3) of the total number of Directors shall be UPMC Designated Directors, who shall be appointed by the sole member - UPMC. One member of the board of directors shall be appointed by the Sisters of Christian Charity Health Care Corporation. This director shall have all of the powers provided to the other directors except they shall not have the power to vote to appoint the President of the Corporation and they shall not participate in the discussions of, or vote on any matters contrary to the Directives. Form 990, Part VI, Section A, line 7b The affairs of the corporation shall be managed and controlled by its Board of Directors, subject to the reserved powers of the sole member UPMC. During the 5 year integration period commencing on the closing date (October 1, 2016), the following actions will require joint approval of the Board and UPMC: a) Approval of operating and capital budgets of UPMC Susquehanna and UPMC Susquehanna entities. b) Approval of plans for application and use of the Capital Expenitures and Strategic Opportunities Commitment. c) Approval of any existing affiliations or contractual arrangements of UPMC Susquehanna. d) Approval of renewals or amendments to any existing material contract. e) Approval of strategic plans. f) Material changes to existing contractual arrangements with physicians. g) Entering into new or changing existing joint venture arrangements. h) Approval of selection of the President of UPMC Susquehanna. i) Approval of the terms of any management arrangements with an unrelated third party. j) Any material changes to clinincal programs. k) Any change to the corporate structure. l) Any sale, lease, joint venture, acquisition, merger, consolidation, affiliation, membership transfer or other transaction involving UPMC Susquehanna or any UPMC Susquehanna entity. m) Approval of any business plan with respect to the Regional Services Center. n) The determination that any UPMC Susquehanna Entity will no longer be licensed or operated as currently licensed. o) Any amendment of the Articles of Incorporation or the Bylaws, or other applicable governing documents. p) Any consolidation of UPMC Susquehanna's captive insurance company with UPMC's captive insurance program. q) Sale of any real estate of UPMC Susquehanna. r) Any material change to the residency programs at UPMC Susquehanna. s) Any changes to the Articles of Incorporation or the Bylaws of UPMC Susquehanna. Form 990, Part VI, Section B, line 11b A high-level overview of Forms 990 is presented to the parent Board of Directors (UPMC Susquehanna) before filing and complete drafts of all returns are made available to all Board members through the CEO's and CFO's office. Form 990, Part VI, Section B, line 12c All members of the Board of Directors are required to submit a statement annually disclosing any conflict of interest that may arise. Requests for the annual form are distributed individually to each Board Member by the Office of the President and CEO. The CEO's executive assistant ensures that she receives a completed form from every Board Member. All Board Members agree to abstain when any issue involving the parties with conflicting interest is called to motion. Form 990, Part VI, Section B, line 15 All top management is employed by The Williamsport Hospital. The following paragraph describes the process they use. The Board of Directors, through the Executive Compensation Committee, retains an independent outside consultant to provide guidance with respect to the annual establishment of the rebuttable presumptive or reasonableness relative to executive compensation and benefits. The consultant annually provides detailed market information from its annual Executive Compensation Survey for Health Systems. In addition, other regional survey data is provided in order to supply the health system with a "national" picture of compensation. With this process established, the Executive Compensation Committee takes the proper steps to educate the Board of Directors to understand all of the above-mentioned oversight and to appropriately prepare them for community or media inquiry. In addition, the Board is made aware of the Form 990 and its role in the communication of information to the public. Form 990, Part VI, Section C, line 19 These documents are available to members of the public who request them. Form 990, Part IX, line 11g Consulting fees: Program service expenses 117,060. Management and general expenses 0. Fundraising expenses 0. Total expenses 117,060. Form 990, Part XI, line 9: Unrestricted assets transferred to UPMC (parent) -20,192,658. Form 990, Part XII, Line 2c UPMC, the sole member of UPMC Susquehanna, has assumed the responsibility for oversight of the audited financial statements at a system level for FY 2017. UPMC SENIOR COMMUNITIES INC 600 GRANT STREET PITTSBURGH PA 15219 251574736 SR. LIVING PA 501(c)(3) Line 10 UPMC 1 PITTSBURGH LIFETIME CARE COMMUNITY 600 GRANT STREET PITTSBURGH PA 15219 251335247 CCRC PA 501(c)(3) Line 10 UPMC SR COMM 1 CANTERBURY PLACE 600 GRANT STREET PITTSBURGH PA 15219 250965334 SR. LIVING PA 501(c)(3) Line 10 UPMC SR COMM 1 SENECA PLACE 600 GRANT STREET PITTSBURGH PA 15219 721562844 SR. 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SERVICES 868 CORPORATE WAY WESTLAKE OH 44145 311521422 HOME HEALTH OH N/A C 0 HEALTH FIDELITY INC 210 S B ST SAN MATEO CA 94401 452538963 TECHNOLOGY CA N/A C 0 FLUENCE HEALTH INC 6425 PENN AVE PITTSBURGH PA 15206 472684174 SOFTWARE DE N/A C 0 CURAVI HEALTH INC 6425 PENN AVE PITTSBURGH PA 15206 811217377 HEALTHCARE DE N/A C 0 PENSIAMO INC 600 GRANT STREET PITTSBURGH PA 15219 812069236 SUPPLY CHAIN DE N/A C 0 ALTOONA FAMILY INC 620 HOWARD AVE ALTOONA PA 16601 251444935 MGMT SVCS PA N/A C 0 LEXINGTON HOLDINGS INC 620 HOWARD AVE ALTOONA PA 16601 251794386 MEDICAL SVCS PA N/A C 0 LEXINGTON ONE INC 620 HOWARD AVE ALTOONA PA 16601 251468889 RENTAL PA N/A C 0 LEXINGTON TWO INC HOWARD AVE 7TH ST ALTOONA PA 16601 251555689 RENTAL EQPT PA N/A C 0 LEXINGTON FOUR INC 620 HOWARD AVE ALTOONA PA 16601 251793736 HOLDING CO PA N/A C 0 ALLEGHENY HEALTHCARE STAFFING INC 620 HOWARD AVE ALTOONA PA 16601 271657362 EMPLOYMENT SVC PA N/A C 0 UPMC ALTOONA REGIONAL HEALTH SERVICES 1414 9TH AVE ALTOONA PA 16602 251219302 MEDICAL SVCS PA N/A C 0 LEXINGTON ANESTHESIA ASSOCIATES INC 620 HOWARD AVE ALTOONA PA 16601 251897765 MEDICAL SVCS PA N/A C 0 NORTHERN CAMBRIA MEDICAL CENTER INC 620 HOWARD AVE ALTOONA PA 16601 251530860 MEDICAL SVCS PA N/A C 0 PATTON FAMILY MEDICAL CENTER INC 620 HOWARD AVE ALTOONA PA 16601 251793735 MEDICAL SVCS PA N/A C 0 MEDCPU 100 WALL STREET NEW YORK NY 10005 383805381 SOFTWARE DEVE DE N/A C 0 UPMC EXCESS PL TR 600 GRANT STREET PITTSBURGH PA 15219 826254351 TRUST PA N/A T 0 RXANTE INC 511 CONGRESS STREET PORTLAND ME 04101 454040219 MEDICATION MGT DE N/A C 0 VINCENT PAYMENT SOLUTIONS INC 6425 PENN AVE PITTSBURGH PA 15219 821101143 PAYMENT SYSTEM DE N/A C 0 J HEALTH VENTURES INC 1211 WILMINGTON AVE NEW CASTLE PA 16105 251607893 INACTIVE PA N/A C 0 JER MEDICAL ASSOCIATES INC 1211 WILMINGTON AVE NEW CASTLE PA 16105 251609398 INACTIVE PA N/A C 0 SUSQUEHANNA HEALTH SYSTEM INSURANCE NETWORK LTD PO Box 1159 CAYMAN ISLANDS CJ 980458722 INSURANCE CJ UPMC SUSQUEHANNA C 2864787 41650240 1.00000 1 SUSQUEHANNA VENTURES INC 1201 GRAMPIAN BLVD WILLIAMSPORT PA 17701 232470263 PHARMACY PA UPMC SUSQUEHANNA C 2686722 2249790 1.00000 1 TYOGA CARENET 114 EAST AVE WELLSBORO PA 16901 251810967 INTEGRATE HEALTHCARE PA UPMC SUSQUEHANNA C 3561 1.00000 1 WCA SERVICE CORPORATION INC 207 FOOTE AVE JAMESTOWN NY 14701 161151438 NY N/A C 0 FRIENDS OF ALTOONA HOSPITAL 620 HOWARD AVE ALTOONA PA 16601 861140504 FUNDRAISING PA N/A C 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 Form 990, Schedule R, Part II, III, & IV All entities marked with an asterisk * are not related parties of the filing organization. However, they are listed on Schedule R to reflect that they are part of the UPMC system of entities, as they all share UPMC as their ultimate parent corporation.