2018-05-15T10:08:23-05:00 2017-06-30 440160260 BKD LLP 910 E St Louis St Springfield MO 658062523 990 2016-07-01 251765538 Tioga Health Care Providers Inc TIOG 5703268753 1705 Warren Ave No 302 Williamsport PA 17701 Eric D Pohjala Executive Vice President/CFO 5703213175 2018-05-15 1 Brian D Todd P00422601 4178658701 2016 2022-09-23 18:48:47Z Steven P Johnson 700 High Street Williamsport PA 17701 9304453 0 X SUSQUEHANNAHEALTH.ORG X 1995 PA Tioga Health Care Providers is a subsidiary of UPMC Susquehanna. The mission of UPMC Susquehanna and affiliates is as follows: To extend God's healing love by improving the health of those we serve. Our vision is to create a world-class health system. Our values are to carefully place our patients and their families first, share ownership with all of our caregivers and lead with a servant's heart. 15 12 37 15 0 0 0 10000 9180962 9272292 11414 22161 0 0 9192376 9304453 0 0 0 0 10408762 11372767 0 0 0 3832794 3210677 14241556 14583444 -5049180 -5278991 8521474 11341140 27908105 36006762 -19386631 -24665622 X Tioga Health Care Providers is a subsidiary of UPMC Susquehnanna The mission of UPMC Susquehanna is as follows: To extend God's healing love by improving the health of those we serve. Our vision is to create a world-class health system. Our values are putting patients first, sharing ownership and being servant leaders. 0 0 14341800 9272292 Tioga Health Care Providers (THCP) is comprised of a group of emergency, internal medicine, and specialty physicians. The services primarily serve Tioga county. For the fiscal year ended June 30, 2017 there were approximately 36,654 outpatient visits and 6,685 inpatient visits for THCP. 14341800 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 1 0 0 37 0 0 0 0 0 0 0 0 0 0 0 X 15 12 0 0 0 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 Dsvie Jane Gilmour Ph D 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 10.00 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 Poirer Director 2.00 14.00 X 0 0 0 Thomas M Owlett Esquire Director 2.00 14.00 X 0 0 0 Jill A Burns MD Director 40.00 12.00 X 259810 0 33044 Keith Kuzio Director 2.00 12.00 X 0 0 0 Shailesh Patel Director 2.00 10.00 X 0 0 0 Patrick Wilson Director 2.00 10.00 X 0 0 0 Steven P Johnson President/CEO UPMC Susqueh 2.00 50.00 X 0 960096 13925 Eric D Pohjala Exec VP/CFO 2.00 42.00 X 0 430438 32395 David Lopatofsky MD Exec VP/CMO 2.00 40.00 X 0 593514 37048 Jan E Fisher Exec VP/COO 2.00 44.00 X 0 551981 31238 Donald Golobek Physician 40.00 X 699367 0 27180 Walter Laibinis Physician 40.00 X 414730 0 30151 Darius Abadi Physician 40.00 X 407031 0 35704 Perry E Doan Jr MD Physician 40.00 X 388187 0 36290 Herbert Roberts Physician 40.00 X 387647 0 8091 Ronald J Butler Former Exec VP/CBO Retired 0.00 X 0 335670 0 2556772 4185497 347521 30 1 1 0 Alliance Recruiting Resource Inc PO Box 678416 Dallas TX 75267 Locum Services 696783 Medicus Emergency Room Service 22 Roulston Rd Windham NH 03087 Locum Services 671796 CompHealth Medical Staffing PO Box 972651 Dallas TX 75397 Locum Services 326130 Barton Associates Inc PO Box 417844 Boston MA 02241 Locum Services 326130 4 10000 10000 Emergency Department 621111 1918499 1918499 Inter-Entity SSA 621110 1605192 1605192 Internal Medicine 621111 1263389 1263389 Orthopedics 621111 956611 956611 Anesthesia 621111 765829 765829 2762772 2762772 9272292 22161 22161 9304453 9272292 0 22161 259810 259810 9760527 9707576 52951 258283 252877 5406 683433 670259 13174 410714 403241 7473 141789 141789 487205 487205 4304 4304 53485 52902 583 580 580 518544 518078 466 8736 5595 3141 64227 63366 861 126382 112460 13922 589596 589562 34 Provision for Doubtful 720302 720302 Medical Supplies 299078 299078 Minor Equipment 45348 45348 Books/Subscriptions/Due 35404 35247 157 115697 114010 1687 14583444 14341800 241644 0 1914637 1087019 1443101 1243074 9394 136612 92656 68741 35840 1610384 575123 438343 1035261 4520040 7837896 8521474 11341140 1694204 663568 26213901 35343194 27908105 36006762 X -19386631 -24665622 -19386631 -24665622 8521474 11341140 -5278991 0 X 0 1 X 1 0 X X 1 Soldiers and Sailors Memorial Hospital 232176963 3 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1610384 575123 1035261 1035261 Due From Affiliates 7837896 7837896 Other Liabilities 189710 Due to Affiliates 35153484 35343194 Part X Line 2 Management has evaluated their income tax positions under the guidance included in ASC 740. Based on that review, management has not identified any material uncertain tax positions to be recorded or disclosed in the financial statements. 1 0 0 0 0 1 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 A Burns MD Director 224371 0 34600 0 839 0 9950 0 23094 0 292854 0 0 0 Steven P Johnson President/CEO UPMC Susqueh 0 703292 0 226453 0 30351 0 19346 0 0 0 979442 0 0 Eric D Pohjala Exec VP/CFO 0 362196 0 66436 0 1806 0 9950 0 22445 0 462833 0 0 David Lopatofsky MD Exec VP/CMO 0 425773 0 141731 0 26010 0 11275 0 25773 0 630562 0 0 Jan E Fisher Exec VP/COO 0 401814 0 138186 0 11981 0 9950 0 21288 0 583219 0 0 Donald Golobek Physician 698401 0 0 0 966 0 7950 0 19230 0 726547 0 0 0 Walter Laibinis Physician 229365 0 173818 0 11547 0 9950 0 20201 0 444881 0 0 0 Darius Abadi Physician 371890 0 13360 0 21781 0 9950 0 25754 0 442735 0 0 0 Perry E Doan Jr MD Physician 333567 0 2500 0 52120 0 9950 0 26340 0 424477 0 0 0 Herbert Roberts Physician 387647 0 0 0 0 0 8091 0 0 0 395738 0 0 0 Ronald J Butler Former Exec VP/CBO Retired 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 Bonuses may be paid to a physician contingent upon the practice's net income. The practice's net income is determined from total charges less contractual adjustments less practice expense. A Physician's compensation may be increased by an amount equal to the excess net income. 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. Darius Abadi Highest comp, employee Sign on Bonus X 43631 9394 0 0 1 9394 Form 990, Part VI, Section A, line 1 All 1099s were issued by UPMC Susquehanna, EIN 23-2751183. All expenses are then allocated back to all related entities. Form 990, Part VI, Section A, line 6 UPMC Susquehanna, EIN #23-2751183, is the sole member of the governing body Form 990, Part VI, Section A, line 7a UMPC Susquehanna, EIN 23-2751183, may elect or remove members of the governing body. Form 990, Part VI, Section A, line 7b All the business and affairs of the corporation shall be managed and controlled by the Board of Directors, subject to the oversight of the Member of the management and operation of the corporation, except that the following powers are reserved exclusively to the sole Member of the corporation, and no attempted exercise of any such powers by anyone other than the sole Member shall be valid or of any force or effect whatsoever. The sole member shall exercise its power through its Board of Directors. The Member shall have exclusive authority to exercise the following powers: A. To approve the appointment and removal of the President of the corporation. B. To elect and remove, with or without cause, a Director of the corporation. C. To establish the overall policy and long range plans of the corporation, determine or change the mission of the corporation, approve the programs, and services of the corporation, and monitor and maintain the philosophy, goals and purposes for which the corporation was formed and exists. D. To adopt, amend or repeal the Articles of Incorporation or the bylaws. E. To establish requirements for a unified budget, the approval of new capital debt, any increment to any existing capital debt, and/or any change in the capital debt obligations of the corporation. F. To establish requirements for the approval of the acquisition, purchase, sale, leasing outside the ordinary course of business, transfer outside the ordinary cause of business or encumbrance outside the normal course of business of land or buildings and the construction of demolition of buildings owned by the corporation. G. To require a certified audit of corporate funds at any time. H. To approve any guaranty of indebtedness of any person, the granting of any security interest in or the creation of any encumbrance on any asset of the corporation outside the ordinary course of business, or any transfer of any asset of the corporation outside the normal course of business, except transfers between or among affiliated corporations. I. To approve any merger, consolidation, organization, reorganization, joint venture or other modification of corporate structure or affiliations affecting to autonomy, governance or operations of the corporation. J. To dissolve or terminate the existence of the corporation and determine the distribution of assets upon such termination or dissolution, as provided in the bylaws. K. To appoint annually the external fiscal auditor of the corporation. L. To approve the nominees for elected officers of the Board of Directors of the corporation and to return the list of approved nominees to the Board of Directors for election. M. To remove any elected officer of the corporation. N. To approve the annual capital and operating budget of the corporation. O. To coordinate managed care plans, including decisions concerning entry into or renewal of ay contract or agreement relating thereto. 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, 23-2751183) 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 As required by law, SPS policy states that all members of the Board of Managers must sign a statement each year disclosing any conflict of interest that may arise and agree to abstain when issues involving those parties with conflicting interests are called to motion. Any conflicts of interest are reviewed by the System's attorneys. Form 990, Part VI, Section B, line 15 The board of directors, through the Executive Committee, retains an independent outside consultant to provide guidance with respect to the annual establishment of the rebuttable presumption or reasonableness relative to executive compensation and benefits. The consultant annually provides detailed market information from its annual Executive Compensation Survey of 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. 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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 866254351 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 ISLAND CJ 980458722 INSURANCE CJ UPMC SUSQUEHANNA C 0 SUSQUEHANNA VENTURES INC 1201 GRAMPIAN BLVD WILLIAMSPORT PA 17701 232470263 PHARMACY PA UPMC SUSQUEHANNA C 0 TYOGA CARENET 114 EAST AVE WELLSBORO PA 16901 251810967 INTEGRATE HEALTHCARE PA UPMC SUSQUEHANNA C 0 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 1 0 0 0 0 1 0 1 0 0 0 1 0 0 0 Laurel Realty J 291636 Market Value