2018-05-11T10:56:08-05:00 2017-06-30 BKD LLP 910 E ST LOUIS 200/PO BOX 1190 SPRINGFIELD MO 658062523 990 2016-07-01 251810488 LAUREL HEALTH FOUNDATION % GRETCHEN REGINA CFO LAUR 5707230605 32-36 CENTRAL AVE Suite ACCTG WELLSBORO PA 16901 GRETCHEN E REGINA CFO 2018-03-26 true Brian D Todd P00422601 4178658701 2016 2022-09-23 18:48:47Z RONALD BUTLER 32-36 CENTRAL AVE ACCTG WELLSBORO PA 16901 560094 false X WWW.SUSQUEHANNAHEALTH.ORG X 1998 PA LAUREL HEALTH FOUNDATION IS AN AFFILIATE OF UPMC SUSQUEHANNA. ITS MISSION IS AS FOLLOWS: TO EXTEND GOD'S HEALING LOVE BY IMPROVING THE HEALTH OF THOSE WE SERVE. 9 6 0 9 0 0 0 0 0 357275 560094 0 0 357275 560094 810777 380348 0 0 0 0 0 0 0 72234 66801 883011 447149 -525736 112945 19057718 21410861 51187 61520 19006531 21349341 THE SPECIFIC PURPOSES OF THE LAUREL HEALTH FOUNDATION ARE TO SUPPORT, PROMOTE, ADVANCE AND STRENGTHEN THE SOLDIERS AND SAILORS MEMORIAL HOSPITAL, THE GREEN HOME, NORTH PENN COMPREHENSIVE HEALTH SERVICES AND THE WELLSBORO COMMUNITY FOUNDATION. false false 434839 380348 LAUREL HEALTH FOUNDATION PROVIDES FINANCIAL SUPPORT FOR ITS RELATED TAX-EXEMPT SUPPORTED ORGANIZATIONS, SOLDIERS AND SAILORS MEMORIAL HOSPITAL, THE GREEN HOME, NORTH PENN COMPREHENSIVE HEALTH SERVICES, AND THE WELLSBORO COMMUNITY FOUNDATION. 434839 true false false false false false false false false true false false false true true false false true false false false false false false false false false true false true false false false false false false false false false false false false false true false false false true 0 0 0 false false false false false false false false false false X 9 6 true false false false false true true true true false false true true true true true true false false false X GRETCHEN REGINA CFO 5707230605 32-36 CENTRAL AVE WELLSBORO PA 16901 RONALD J BUTLER PRESIDENT 2.0 0.0 X X 0 335670 0 R ROBERT DECAMP SECRETARY 2.0 0.0 X X 0 0 0 WALTER J LAIBINIS DO DIRECTOR 2.0 42.0 X 0 414730 30151 KATHY J WRIGHT PHD TREASURER 2.0 2.0 X X 0 0 0 J DENNIS MURRAY PHD DIRECTOR 2.0 12.0 X 0 0 0 THOMAS M OWLETT ESQ CHAIRMAN 2.0 6.0 X X 0 0 0 GLENN B POIRIER VICE CHAIRMAN 2.0 12.0 X X 0 0 0 JAN E FISHER EXECUTIVE VP 2.0 40.0 X 0 551981 31238 KAREN CHAMBERS DIRECTOR 2.0 0.0 X 0 0 0 GRETCHEN E REGINA VP/CFO 2.0 40.0 X 0 108376 6742 RONALD M GILBERT FORMER VP/CFO ENDING 02/2015 0.0 0.0 X 0 212989 19385 0 1623746 87516 0 true true false 0 0 0 384748 384748 0 0 0 0 0 175346 175346 175346 175346 0 0 0 0 0 0 0 0 0 0 560094 560094 380348 380348 0 0 0 0 0 0 0 0 0 0 0 3580 3580 0 0 54392 54392 99 99 0 358 358 0 0 0 0 0 0 0 0 0 8372 8372 447149 434839 12310 0 0 0 460073 818434 0 0 0 0 0 0 0 0 0 0 0 0 6279 6279 0 0 16128361 18236749 0 0 0 0 0 0 2463005 2349399 19057718 21410861 11631 8591 0 0 0 0 0 0 0 0 0 0 0 0 0 0 39556 52929 51187 61520 X 18880050 21074708 0 0 126481 274633 19006531 21349341 19057718 21410861 X 112945 2125320 104545 X false true X true false X X 4 SSMH 232176963 3 true 253231 0 GREEN HOME 240804365 10 true 36367 0 NORTH PENN 231889724 3 true 0 0 WELLSBORO C F 202680321 8 true 90750 0 4 380348 true false false false false false false false false false false false false false false true SCHEDULE A, PART I, LINE 12G ORGANIZATIONS SUPPORTED: THE COMPLETE NAMES OF THE ORGANIZATIONS SUPPORTED ARE AS FOLLOWS: (A) SOLDIERS & SAILORS MEMORIAL HOSPITAL (B) THE GREEN HOME (C) NORTH PENN COMPREHENSIVE HEALTH SERVICES (D) WELLSBORO COMMUNITY FOUNDATION 12780921 113606 2101133 380348 37760 14577552 15744999 -380234 710126 1832173 41545 12780921 16284168 271234 776184 34219 15744999 14945981 1358906 20719 16284168 1.00000 true false DUE FROM EXEMPT AFFILIATES 2349399 2349399 0 DUE TO EXEMPT AFFILIATES 52929 52929 SCHEDULE D, PART V, LINE 4 ENDOWMENT FUNDS: THE ENDOWMENT FUNDS ARE USED TO FUND THE MISSION OF THE ORGANIZATION. true SOLDIERS SAILORS MEMORIAL HOSPITAL 32-36 CENTRAL AVE WELLSBORO PA 16901 232176963 501(C)(3) 253231 SUPPORT THE GREEN HOME 37 CENTRAL AVE WELLSBORO PA 16901 240804365 501(C)(3) 36367 SUPPORT WELLSBORO COMMUNITY FOUNDATION PO BOX 243 WELLSBORO PA 16901 202680321 501(C)(3) 90750 SUPPORT 3 SCHEDULE I, PART I, LINE 2 GRANT MONITORING PROCESS: ALL GRANTEES ARE REQUIRED TO COMPLETE A GRANT COMPLIANCE REPORT AT THE COMPLETION OF THEIR PROJECT. ADDITIONALLY, ALL GRANTEE ORGANIZATIONS ARE SUPPORTED TAX-EXEMPT ORGANIZATIONS AND, THEREFORE, SHARE COMMON MANAGEMENT. true false false false false false false true false RONALD J BUTLER PRESIDENT 0 0 0 0 0 335670 0 0 0 0 0 335670 0 0 WALTER J LAIBINIS DO DIRECTOR 0 229365 0 173818 0 11547 0 9950 0 20201 0 444881 0 0 JAN E FISHER EXECUTIVE VP 0 401814 0 138186 0 11981 0 9950 0 21288 0 583219 0 0 RONALD M GILBERT FORMER VP/CFO ENDING 02/2015 0 187967 0 23993 0 1029 0 8483 0 10902 0 232374 0 0 SCHEDULE J, PART I, LINE 4A SEVERANCE PAYMENT: 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. SCHEDULE J, PART I, LINE 6 EXECUTIVE COMPENSATION: 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 THE CONSOLIDATED SYSTEM-LEVEL BASIS. INDIVIDUAL GOALS AND OBJECTIVES RELATED TO THE VCIP MAY ALSO INCLUDE INDIVIDUAL ENTITY OPERATING PERFORMANCE. THERE WERE NO PAYMENTS TO THE OFFICERS LISTED ON FORM 990, PART VII, THIS YEAR. FORM 990, PART VI, SECTION A, LINE 2 FAMILY RELATIONSHIP: ROBERT DECAMP AND KAREN CHAMBERS, VOTING DIRECTORS, HAVE A FAMILY RELATIONSHIP. BUSINESS RELATIONSHIP: RONALD J BUTLER, WALTER J LAIBINIS, JAN E FISHER, GRETCHEN E REGINA, AND RONALD M GILBERT ALL HAVE A BUSINESS RELATIONSHIP THROUGH EMPLOYMENT WITH A RELATED TAX-EXEMPT ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A ELECTING MEMBERS OF THE GOVERNING BODY: AT LEAST 50% OF THE BOARD OF DIRECTORS MUST CONSIST OF INDIVIDUALS SERVING AS BOARD MEMBERS OF THE LAUREL SYSTEM ENTITIES AS SYSTEM REPRESENTATIVES. WITH RESPECT TO THE SYSTEM REPRESENTATIVE POSITIONS, UPMC SUSQUEHANNA SUBMITS A LIST OF ITS RECOMMENDED SYSTEM REPRESENTATIVE CANDIDATES TO THE NOMINATING COMMITTEE, WHO REVIEWS THE LIST AND UPON APPROVAL, NOMINATES APPROVED REPRESENTATIVES TO THE BOARD. FORM 990, PART VI, SECTION A, LINE 7B DECISIONS SUBJECT TO APPROVAL BY MEMBERS: THE BYLAWS REQUIRE PRIOR WRITTEN APPROVAL OF UPMC SUSQUEHANNA ON ANY BYLAW AMENDMENT RELATING TO THE FOLLOWING MATTERS: -ELECTION OR REMOVAL OF DIRECTORS OR OFFICERS -CORPORATE MEMBERS OR MEMBERSHIP OF THE CORPORATION -NUMBER, COMPOSITION, ATTENDANCE, COMPENSATION, VOTING, QUORUM, POWERS, DUTIES, RESPONSIBILITIES OR MANNER OF ACTING OF THE BOARD OF DIRECTORS, OFFICERS OR COMMITTEES -TERMS, QUALIFICATIONS OR DUTIES OF, OR NOTICE TO, DIRECTORS AND/OR OFFICERS -USE OF THE CORPORATION'S FUNDS -CORPORATE PURPOSES, POWERS OR LIMITATIONS -COMPLIANCE WITH SECTION 501(C)(3) OF THE CODE AND/OR ANY OTHER LAW -CONFLICT OF INTEREST POLICIES OR PROCEDURES -INDEMNIFICATION RIGHTS OR OBLIGATIONS -AMENDMENT OF THE ARTICLES OF INCORPORATION OR BYLAWS OR ENGAGEMENT IN ANY FUNDAMENTAL TRANSACTIONS -MATERIAL RIGHTS OR OBLIGATIONS OF UPMC SUSQUEHANNA AND/OR ITS AFFILIATES FORM 990, PART VI, SECTION B, LINE 11B PROCESS TO REVIEW THE FORM 990: THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM BASED ON THE AUDITED FINANCIAL STATEMENTS AND INFORMATION PROVIDED BY MANAGEMENT. A HIGH-LEVEL OVERVIEW OF THE FORM 990 IS PRESENTED TO THE BOARD OF DIRECTORS BEFORE FILING, AND COMPLETE DRAFTS OF ALL RETURNS ARE MADE AVAILABLE TO ALL BOARD MEMBERS THROUGH THE CEO'S AND CFO'S OFFICES. FORM 990, PART VI, SECTION B, LINE 12C MONITORING COMPLIANCE WITH CONFLICT OF INTEREST POLICY: ANNUALLY ON THE 1ST DAY OF JANUARY, UPMC SUSQUEHANNA SENDS TO ALL DIRECTORS, OFFICERS, MANAGEMENT STAFF AND CONTRACTED PHYSICIANS A QUESTIONNAIRE TO BE COMPLETED AND RETURNED BY JANUARY 15. A REPORT IS SUBMITTED TO THE BOARD OF DIRECTORS TO NOTIFY THEM OF ANY CONFLICTS OF INTEREST DISCLOSED. FORM 990, PART VI, SECTION B, LINES 15A & 15B COMPENSATION REVIEW: ALL TOP MANAGEMENT IS EMPLOYED BY THE WILLIAMSPORT HOSPITAL (TWH), AND THE BOARD OF TWH USES THE FOLLOWING PROCESS TO ESTABLISH COMPENSATION. ON A BI-ANNUAL BASIS, AN INDEPENDENT COMPENSATION CONSULTING FIRM PERFORMS AN ANALYSIS OF THE LEADERSHIP SALARY STRUCTURE IN RELATIONSHIP TO THE LABOR MARKET USING DATA FROM FOUR DIFFERENT SALARY SURVEYS. THEIR ANALYSIS IS REVIEWED WITH THE GOVERNANCE COMMITTEE OF THE BOARD OF DIRECTORS. THE FIRM THEN OUTLINES ITS RECOMMENDATIONS FOR THE PROPOSED EXECUTIVE SALARY STRUCTURE TO THE COMMITTEE FOR THEIR CONSIDERATION AND APPROVAL. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENT DISCLOSURE: GOVERNING DOCUMENTS, FINANCIAL STATEMENTS, AND CONFLICT OF INTEREST POLICIES ARE AVAILABLE UPON REQUEST. FORM 990, PART VII, LINE 1A BOARD MEMBER COMPENSATION: NO BOARD MEMBERS RECEIVE COMPENSATION FOR THEIR DUTIES AS BOARD MEMBERS. WALTER LAIBINIS AND JAN FISHER ARE COMPENSATED BY RELATED ORGANIZATIONS FOR THEIR MANAGEMENT AND/OR PHYSICIAN POSITIONS. RONALD BUTLER RETIRED FROM A RELATED EXEMPT ORGANIZATION IN APRIL 2015. HIS COMPENSATION IS SEVERANCE FROM THAT RELATED ORGANIZATION. SEE SCHEDULE J FOR ADDITIONAL INFORMATION. FORM 990, PART XI, LINE 9 OTHER CHANGES IN NET ASSETS: $104,545 TRANSFERS FROM AFFILIATES FORM 990, PART XII, LINE 2C OVERSIGHT & SELECTION OF INDEPENDENT ACCOUNTANT: THE OVERSIGHT PROCESS AND INDEPENDENT ACCOUNTANT SELECTION ARE PERFORMED BY UPMC SUSQUEHANNA, A RELATED TAX-EXEMPT ORGANIZATION. 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600 GRANT STREET PITTSBURGH PA 15219 251786209 HEALTHCARE PA NA N/A false false LIFE HOME CARE LP 600 GRANT STREET PITTSBURGH PA 15219 251847839 HOMECARE PA NA N/A false false SHADYSIDE MEDICAL CENTER ASSOC 600 GRANT STREET PITTSBURGH PA 15219 251608318 MED OFFICE BL PA NA N/A false false CHARTWELL PA LP 600 GRANT STREET PITTSBURGH PA 15219 251729714 HOME HEALTH PA NA N/A false false LIFE CARE HOME SRV OF NW PA 1647 SASSAFRAS ST ERIE PA 16507 251536879 HOME HEALTH PA NA N/A false false HAMOT-KCH REAL ESTATE VENTURE 300 STATE ST ERIE PA 16507 263691782 MEDICAL OFFICE PA NA N/A false false HAMOT SURGERY CENTER LLC 200 STATE STREET ERIE PA 16507 251863661 AMBULATORY SURG PA NA N/A false false EPN-HAMOT URGENT CARE LLC 600 GRANT STREET PITTSBURGH PA 15219 272147949 URGENT CARE PA NA N/A false false MOUNTAIN VIEW MEDICAL ONCOLOGY 600 GRANT STREET PITTSBURGH PA 15219 461449241 HEALTHCARE PA NA N/A false false LAWRENCE COUNTY MRI & DIAGNOST 2526 WILMINGTON AVE NEW CASTLE PA 16105 270219891 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LEXINGTON TWO INC HOWARD AVE 7TH ST ALTOONA PA 16601 251555689 RENTAL EQPT PA NA C CORP false LEXINGTON FOUR INC 620 HOWARD AVE ALTOONA PA 16601 251793736 HOLDING CO PA NA C CORP false ALLEGHENY HEALTHCARE STAFFING INC 620 HOWARD AVE ALTOONA PA 16601 271657362 EMPLOYMENT SVC PA NA C CORP false UPMC ALTOONA REGIONAL HELATH SERVICES 1414 9TH AVE ALTOONA PA 16602 251219302 MEDICAL SVCS PA NA C CORP false LEXINGTON ANESTHESIA ASSOCIATES INC 620 HOWARD AVE ALTOONA PA 16601 251897765 MEDICAL SVCS PA NA C CORP false NORTHERN CAMBRIA MEDICAL CENTER INC 620 HOWARD AVE ALTOONA PA 16601 251530860 MEDICAL SVCS PA NA C CORP false PATTON FAMILY MEDICAL CENTER INC 620 HOWARD AVE ALTOONA PA 16601 251793735 MEDICAL SVCS PA NA C CORP false MEDCPU 100 WALL STREET NEW YORK NY 10005 383805381 SOFTWARE DEV DE NA C CORP false UPMC ECESS PL TR 600 GRANT STREET PITTSBURGH PA 15219 826254351 TRUST PA NA TRUST false RXANTE INC 511 CONGRESS STREET PORTLAND ME 04101 454040219 MEDICATION MGT DE NA C CORP false 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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.