2018-05-15T08:28:21-05:00 2017-06-30 BKD LLP 910 E St Louis St Springfield MO 658062523 990 2016-07-01 232743470 Susquehanna Health Foundation SUSQ 5703207900 1100 Grampian Boulevard 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 26553319 0 X www.susquehannahealth.org X 1986 PA Susquehanna Health Foundation (SHF) provides fundraising, investment, and financial support to UPMC Susquehanna and its affiliates. 18 14 0 17 0 0 1373211 1618741 0 0 562513 2096062 18993 15435 1954717 3730238 3639506 5692499 0 0 579780 646646 0 0 466113 441347 465936 4660633 6805081 -2705916 -3074843 16821133 12966243 289698 272594 16531435 12693649 X Susquehanna Health Foundation (SHF) is a subsidiary of the exempt organization UPMC Susquehanna. SHF is a supporting organization founded to carry out the charitable missions of its supported organizations. The mission of UPMC Susquehanna 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 6072412 5692499 SHF is organized and operated to carry out the charitable health care mission of its supported organizations which include: The Williamsport Hospital, Divine Providence Hospital of the Sisters of Christian Charity, Muncy Valley Hospital, Soldiers and Sailors Memorial Hospital, The Green Home, and Susquehanna Physician Services. SHF also is operated to solicit and raise funds and endowments, and to receive by way of gift, purchase, grant, devise, will or otherwise, property, real, personal or mixed, and to hold, use, maintain, lease, donate, pledge, encumber, sell, convey and otherwise dispose of all such property in the futherance of the objectives and purposes of this Corporation. On an annual basis SHF devotes a portion of its revenue and assets to community program services. Community Building Activities and other Financial Contributions totaling $22,720 reflects the amount of quantifiable community benefits reported for FY 2017. 6072412 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 0 0 1 0 0 0 0 0 0 1 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 7 0 1 0 0 0 0 0 0 1 1 0 0 0 0 X 18 14 1 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 Keith Kuzio Director 2.00 12.00 X 0 0 0 Steven P Johnson President/CEO 2.00 50.00 X X 0 960096 33271 Lynda Livingston Director 2.00 10.00 X 0 0 0 Ann Pepperman Chairperson 2.00 12.00 X X 0 0 0 Davie Jane Gilmour 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 Philip Johnson Treasurer 2.00 12.00 X X 0 0 0 Jill Burns MD Director 2.00 50.00 X 0 259810 33044 Ronald DiSimone MD Director 2.00 48.00 X 0 1072681 31403 Durriya Esaa MD Director 2.00 8.00 X 0 0 0 Daniel Klingerman Director 2.00 10.00 X 0 0 0 Donald Leathers MD Director 2.00 8.00 X 0 0 0 J Dennis Murray Director 2.00 14.00 X 0 0 0 Alexander Nesbitt MD Director 2.00 48.00 X 0 241117 31060 Thomas Owlett Esq Director 2.00 14.00 X 0 0 0 Shailesh Patel MD Director 2.00 10.00 X 0 0 0 Glenn Poirer Director 2.00 14.00 X 0 0 0 Patrick Wilson Director 2.00 10.00 X 0 0 0 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 Sherry E Watts VP Development 40.00 X 0 201178 31107 Ronald J Butler Former Exec VP/CBO-Retired 4/15/15 0.00 40.00 X 0 335670 0 0 4646485 260566 0 1 1 0 0 147534 1471207 5612 1618741 364853 364853 24501735 22770526 1731209 1731209 1731209 67990 147534 52555 15435 15435 3730238 0 0 2111497 5692499 5692499 557841 223136 334705 18794 7518 11276 33377 13351 20026 36634 14654 21980 110397 110397 51603 51603 29976 29976 35795 14318 21477 41351 15981 25370 81333 81333 1317 1317 2171 868 1303 4621 4621 5040 5040 31653 31653 7242 7242 Donor recognition gala 25120 25120 Gifts in Kind 23035 23035 Miscellaneous expenses 15282 15282 6805081 6072412 266556 466113 967264 1772026 1248199 714121 2009 2485 29134 0 228144 120966 114420 107178 14280674 10169985 179433 200448 16821133 12966243 60114 41965 229584 230629 289698 272594 X 5982879 6169651 10543556 6518998 5000 5000 16531435 12693649 16821133 12966243 -3074843 -762943 0 X X 0 1 X 0 0 X X X 6 Divine Providence Hospital of the Sisters of Christian Charity 240799343 3 1 1664456 0 Muncy Valley Hospital 240806023 3 1 0 0 The Williamsport Hospital & Medical Center 240795508 3 1 3991249 0 Susquehanna Physician Services 232449454 3 1 14703 0 Soldiers & Sailors Memorial Hospital 232176963 3 1 22091 0 The Green Home 240804365 3 1 0 0 6 5692499 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 7866 50000 8937 250 66553 6802 1314 250 7866 5578 1474 250 6802 5170 658 250 5578 5065 355 250 5170 0.07510 0.92490 0 0 228144 120966 107178 107178 Deferred Gift Annuities 109385 Due to exempt Affiliates 121244 230629 X Part V, Line 4: The Life's Work Award for Nursing Excellence Endowment Fund was created to provide an annual award to a deserving nurse who has been nominated by his/her peers. The Continuing Medical Education Endowment Fund was created to provide financial support for continuing medical education programs at UPMC Susquehanna. 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. SH Golf Tournament 144750 105125 39625 5850 3200 21664 0 0 3601 Breast Health Golf Tournament 44281 29019 15262 0 0 9920 0 0 609 1 26493 13390 13103 820 6475 166 0 250 215524 147534 67990 5850 4020 38059 166 4460 52555 15435 1 Divine Providence Hospital 1100 Grampian Blvd Williamsport PA 17701 240799343 501(c)(3) 1664456 0 Used for general expenses and building renovations of the Divine Providence Hospital including Sports Medicine, Cancer Treatment Center, Gatehouse, and Home Care & Hospice. The Williamsport Hospital 700 High Street Williamsport PA 17701 240795508 501(c)(3) 3991249 0 Used for general expenses and building fund renovations of The Williamsport Hospital. Soldiers & Sailors Memorial Hospital 32-36 Central Avenue Wellsboro PA 16901 232176963 501(c)(3) 22091 0 Used for capital equipment for the OB department of Soldiers & Sailors Hospital. Susquehanna Physician Services 1201 Grampian Blvd Williamsport PA 17701 232449454 501(c)(3) 14703 0 Used for general expenses and capital equipment of Susquehanna Physician Services. 4 0 Part I, Line 2: Grantees are related tax exempt organizations and part of the UPMC Susquehanna system with consistent management oversight ensuring the use of funds for charitable purposes. 1 0 0 0 0 0 0 0 0 Steven P Johnson President/CEO 0 703292 0 226453 0 30351 0 13925 0 19346 0 993367 0 0 Jill Burns MD Director 0 224371 0 34600 0 839 0 9950 0 23094 0 292854 0 0 Ronald DiSimone MD Director 0 1007081 0 27445 0 38155 0 9950 0 21453 0 1104084 0 0 Alexander Nesbitt MD Director 0 215177 0 23675 0 2265 0 12965 0 18095 0 272177 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 Sherry E Watts VP Development 0 176285 0 24484 0 409 0 8186 0 22921 0 232285 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 All the foundation Board members serve on the board of a related taxable organization. Form 990, Part VI, Section A, line 6 UPMC Susquehanna is the sole member of the governing body. Form 990, Part VI, Section A, line 7a UPMC Susquehanna may elect or remove one or more board members to the governing body. Form 990, Part VI, Section A, line 7b UPMC Susquehanna, the sole member, shall have exclusive authority to exercise the powers: To appoint and remove the President of the Corporation. To elect and remove, with or without cause, a Director of the Corporation. To determine or change the mission and to monitor and maintain the philosophy, goals and purposes for which the Corporation was formed and exists. To adopt, amend or repeal the Articles of Incorporation. To establish requirements for the approval of new capital debt, any increment to any existing capital debt, and/or any change in capital debt obligations of the Corporation. To establish requirements for the approval of the acquisition, purchase, sale, leasing outside the ordinary course of business, transfer outside the ordinary course of business or encumbrance outside the ordinary course of business of land or buildings and the construction or demolition of buildings owned by the Corporation. To require a certified audit of corporate funds at any time. To approve any guaranty of the indebtedness of any person, the granting of any security interest in or the creation of any encumbrance on any asset of the Corporation outside of the ordinary course of business, or any transfer of any asset of the Corporation outside the ordinary course of business, except transfers between or among affiliated corporations. To approve any merger, consolidation, organization, reorganization, joint venture or other modification of corporate structure or affiliations affecting the autonomy, governance, or operations of the Corporation. To dissolve or terminate the existence of the Corporation and determine the distribution of assets upon such termination or dissolution, as provided in these bylaws. To appoint annually the external fiscal auditor of the Corporation. 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. To remove any elected officer of the Corporation. To approve the annual capital and operating budget of the Corporation. 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 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 presumption 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 The organization makes its governing documents, conflict of interest policy, and financial statements available to members of the public who request them. 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. 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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 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 1 0 0 0 0 0 0 0 0 0 1 1 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.