UPMC: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- UPMC (EIN 23-2743470)
- Tax period
- 2015-07-01 to 2016-06-30
- Filed
- 2017-05-01
- IRS object ID
- 201701219349300700
- Schema version
- 2015v3.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule G
- Schedule I
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-05-01T06:51:30-05:00 | ReturnTs |
| Tax Period End | 2016-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BKD LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 910 E St Louis St | AddressLine1Txt |
| City | Springfield | CityNm |
| State Abbreviation | MO | StateAbbreviationCd |
| ZIP | 658062523 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2015-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 232743470 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Susquehanna Health Foundation | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | SUSQ | BusinessNameControlTxt |
| Phone | 5703207900 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1100 Grampian Boulevard | AddressLine1Txt |
| City | Williamsport | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 17701 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Eric D Pohjala | PersonNm |
| Person Title | Executive Vice President/CFO | PersonTitleTxt |
| Phone | 5703213171 | PhoneNum |
| Signature | 2017-05-01 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Brian D Todd CPA | PreparerPersonNm |
| PTIN | P00422601 | PTIN |
| Phone | 4178658701 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Steven P Johnson | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 700 High Street | AddressLine1Txt |
| City | Williamsport | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 17701 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $22,030,889 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.susquehannahealth.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1986 | FormationYr |
| Legal Domicile State | PA | LegalDomicileStateCd |
| Activity Or Mission | SHF provides fundraising, investment, and financial support to UPMC Susquehanna and its affiliates. | ActivityOrMissionDesc |
| Voting Members Governing Body | 18 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 17 | VotingMembersIndependentCnt |
| Total Employee | 5 | TotalEmployeeCnt |
| Total Volunteers | 20 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $2,188,138 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,373,211 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $0 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| PY Investment Income | $809,172 | PYInvestmentIncomeAmt |
| CY Investment Income | $562,513 | CYInvestmentIncomeAmt |
| PY Other Revenue | $29,827 | PYOtherRevenueAmt |
| CY Other Revenue | $18,993 | CYOtherRevenueAmt |
| PY Total Revenue | $3,027,137 | PYTotalRevenueAmt |
| CY Total Revenue | $1,954,717 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $393,268 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $3,639,506 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $561,398 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $579,780 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $419,170 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $560,994 | PYOtherExpensesAmt |
| CY Other Expenses | $441,347 | CYOtherExpensesAmt |
| PY Total Expenses | $1,515,660 | PYTotalExpensesAmt |
| CY Total Expenses | $4,660,633 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $1,511,477 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$2,705,916 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $19,906,930 | TotalAssetsBOYAmt |
| Total Assets EOY | $16,821,133 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $214,630 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $289,698 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $19,692,300 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $16,531,435 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | SHF is a subsidiary of UPMC Susquehanna. The mission of UPMC Susquehanna and affiliates is as follows: Our Mission - to extend God's healing love by improving the health of those we serve. Our Vision - to create a clinically integrated community health system that delivers world class care. Our Values - to carefully place patients and their families first, share ownership with all of our caregivers and lead with a servant's heart. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $4,014,299 | ExpenseAmt |
| Grant | $3,639,506 | GrantAmt |
| Desc | SHF is organized and operated to carry out the charitable health care mission of the 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. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | 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. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | 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 $21,783 reflects the amount of quantifiable community benefits reported for FY 2016. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $4,014,299 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | Yes (1) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | Yes (1) | FundraisingActivitiesInd |
| Gaming Activities | Yes (1) | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| Info In Schedule O Part V | Yes (X) | InfoInScheduleOPartVInd |
| IRP Document | 8 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 5 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | Yes (1) | QuidProQuoContributionsInd |
| Quid Pro Quo Contri Discl | Yes (1) | QuidProQuoContriDisclInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 18 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 17 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (1) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | 0 | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | PA | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | UPMC Susquehanna Finance Department | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 5703207900 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1205 Grampian Blvd | AddressLine1Txt |
| City | Williamsport | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 17701 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (25 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|
| Keith Kuzio | |||||||||
| Chairperson | 2.00 | 6.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| Steven P Johnson | |||||||||
| President/CEO | 2.00 | 50.00 | Yes (X) | Yes (X) | $0 | $832,199 | $35,182 | ||
| Douglas Doherty | |||||||||
| Director | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| Roger D Jarrett | |||||||||
| Director | 2.00 | 4.00 | Yes (X) | $0 | $0 | $0 | |||
| Stephen D Keener | |||||||||
| Director | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| Lynda Livingston | |||||||||
| Director | 2.00 | 4.00 | Yes (X) | $0 | $0 | $0 | |||
| Richard L Michael | |||||||||
| Director | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| Geneva Peck | |||||||||
| Director | 2.00 | 4.00 | Yes (X) | $0 | $0 | $0 | |||
| Paul Rooney | |||||||||
| Director | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| Robert P Crockett | |||||||||
| Director | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| Barbara Hudock | |||||||||
| Treasurer | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| Mark A Huffman | |||||||||
| Director | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| Joseph L Reighard | |||||||||
| Director | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| Jerry Wertz | |||||||||
| Secretary | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| Donna Bastian | |||||||||
| Director | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| John Young | |||||||||
| Director | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| Lisa Feil | |||||||||
| Director | 2.00 | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| Ronald Frick | |||||||||
| Director | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| Eric D Pohjala | |||||||||
| Exec VP/CFO | 2.00 | 40.00 | Yes (X) | $0 | $255,157 | $27,349 | |||
| Jan E Fisher | |||||||||
| Exec VP/COO | 2.00 | 42.00 | $0 | $459,806 | $31,992 | Yes (X) | |||
| David Lopatofsky MD | |||||||||
| Exec VP/CMO | 2.00 | 42.00 | $0 | $437,276 | $38,887 | Yes (X) | |||
| Sherry E Watts | |||||||||
| VP Development | 40.00 | $0 | $170,552 | $8,192 | Yes (X) | ||||
| Charles J Santangelo | |||||||||
| Former Exec VP/CFO-Retired 5/2/15 | 0.00 | 40.00 | $0 | $338,073 | $24,998 | Yes (X) | |||
| William C McCauley MD | |||||||||
| Former Exec VP/CMO-Retired 1/31/15 | 0.00 | 40.00 | $0 | $185,372 | $4,271 | Yes (X) | |||
| Ronald J Butler | |||||||||
| Former Exec VP/CBO-Retired 4/15/15 | 0.00 | 42.00 | $0 | $518,626 | $13,502 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $3,197,061 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $184,373 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $148,369 | FundraisingAmt |
| Related Organizations | $5,000 | RelatedOrganizationsAmt |
| All Other Contributions | $1,219,842 | AllOtherContributionsAmt |
| Noncash Contributions | $6,100 | NoncashContributionsAmt |
| Total Contributions | $1,373,211 | TotalContributionsAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $259,246 | TotalRevenueColumnAmt |
| Exclusion | $259,246 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $20,280,500 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $19,977,233 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $303,267 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $303,267 | TotalRevenueColumnAmt |
| Exclusion | $303,267 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $77,189 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $148,369 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $64,148 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $13,041 | TotalRevenueColumnAmt |
| Exclusion | $13,041 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gaming Gross Income | $40,743 | GamingGrossIncomeAmt |
| Gaming Direct Expenses | $34,791 | GamingDirectExpensesAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $5,952 | TotalRevenueColumnAmt |
| Exclusion | $5,952 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,954,717 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $581,506 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,639,506 | TotalAmt |
| Program Services | $3,639,506 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $501,550 | TotalAmt |
| Program Services | $200,620 | ProgramServicesAmt |
| Fundraising | $300,930 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,512 | TotalAmt |
| Program Services | $6,205 | ProgramServicesAmt |
| Fundraising | $9,307 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $27,791 | TotalAmt |
| Program Services | $11,116 | ProgramServicesAmt |
| Fundraising | $16,675 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $34,927 | TotalAmt |
| Program Services | $13,971 | ProgramServicesAmt |
| Fundraising | $20,956 | FundraisingAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $102,348 | TotalAmt |
| Management And General | $102,348 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $62,793 | TotalAmt |
| Management And General | $62,793 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $16,665 | TotalAmt |
| Fundraising | $16,665 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $42,181 | TotalAmt |
| Program Services | $16,872 | ProgramServicesAmt |
| Fundraising | $25,309 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $50,484 | TotalAmt |
| Management And General | $23,318 | ManagementAndGeneralAmt |
| Fundraising | $27,166 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $30,651 | TotalAmt |
| Management And General | $30,651 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,423 | TotalAmt |
| Program Services | $2,423 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,603 | TotalAmt |
| Program Services | $1,441 | ProgramServicesAmt |
| Fundraising | $2,162 | FundraisingAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,015 | TotalAmt |
| Program Services | $4,015 | ProgramServicesAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,062 | TotalAmt |
| Program Services | $6,062 | ProgramServicesAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $31,530 | TotalAmt |
| Program Services | $31,530 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,242 | TotalAmt |
| Management And General | $7,242 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $812 | TotalAmt |
| Management And General | $812 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| Gifts in Kind | $41,399 | $41,399 |
| Donor recognition gala | $25,120 | $25,120 |
| Use of Funds-misc expen | $11,969 | $11,969 |
| Bad Debt-Uncollectible | $2,050 | $2,050 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,660,633 | TotalAmt |
| Program Services | $4,014,299 | ProgramServicesAmt |
| Management And General | $227,164 | ManagementAndGeneralAmt |
| Fundraising | $419,170 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,314,226 | BOYAmt |
| EOY | $967,264 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,361,012 | BOYAmt |
| EOY | $1,248,199 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $192 | BOYAmt |
| EOY | $2,009 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $24,436 | BOYAmt |
| EOY | $29,134 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $228,144 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $113,724 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $121,662 | BOYAmt |
| EOY | $114,420 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,920,553 | BOYAmt |
| EOY | $14,280,674 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $164,849 | BOYAmt |
| EOY | $179,433 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,906,930 | BOYAmt |
| EOY | $16,821,133 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $65,747 | BOYAmt |
| EOY | $60,114 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $148,883 | BOYAmt |
| EOY | $229,584 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $214,630 | BOYAmt |
| EOY | $289,698 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,725,269 | BOYAmt |
| EOY | $5,982,879 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,962,031 | BOYAmt |
| EOY | $10,543,556 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,000 | BOYAmt |
| EOY | $5,000 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,692,300 | BOYAmt |
| EOY | $16,531,435 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,906,930 | BOYAmt |
| EOY | $16,821,133 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$2,705,916 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$454,949 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consol And Sep Basis Fincl Stmt | Yes (X) | ConsolAndSepBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | Yes (X) | SupportingOrganization509a3Ind |
| Supporting Org Type1 | Yes (X) | SupportingOrgType1Ind |
| IRS Written Determination | Yes (X) | IRSWrittenDeterminationInd |
| Supported Organizations | 6 | SupportedOrganizationsCnt |
Supported Org Information SupportedOrgInformationGrp (6 entries)
| EINEIN | Organization TypeOrganizationTypeCd | Governing Document ListedGoverningDocumentListedInd | SupportSupportAmt | Other SupportOtherSupportAmt |
|---|---|---|---|---|
| Divine Providence Hospital of the Sisters of Christian Charity | ||||
| 240799343 | 3 | Yes (1) | $330,777 | $0 |
| Muncy Valley Hospital | ||||
| 240806023 | 3 | Yes (1) | $32,577 | $0 |
| The Williamsport Hospital & Medical Center | ||||
| 240795508 | 3 | Yes (1) | $2,408,676 | $0 |
| Susquehanna Physician Services | ||||
| 232449454 | 3 | Yes (1) | $4,933 | $0 |
| Soldiers & Sailors Memorial Hospital | ||||
| 232176963 | 3 | Yes (1) | $862,543 | $0 |
| The Green Home | ||||
| 240804365 | 3 | Yes (1) | $0 | $0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supported Organizations Total | 6 | SupportedOrganizationsTotalCnt |
| Support Sum | $3,639,506 | SupportSumAmt |
| Other Support Sum | $0 | OtherSupportSumAmt |
Form990 Sch A Supporting Org Form990SchASupportingOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Listed By Name Governing Doc | Yes (1) | ListedByNameGoverningDocInd |
| Suprt Org No IRS Determination | 0 | SuprtOrgNoIRSDeterminationInd |
| Supported Org Section C456 | 0 | SupportedOrgSectionC456Ind |
| Supported Org Not Organized US | 0 | SupportedOrgNotOrganizedUSInd |
| Organization Change Suprt Org | 0 | OrganizationChangeSuprtOrgInd |
| Support Non Supported Org | 0 | SupportNonSupportedOrgInd |
| Payment Substantial Contribtr | 0 | PaymentSubstantialContribtrInd |
| Loan Disqualified Person | 0 | LoanDisqualifiedPersonInd |
| Controlled Disqualified Prsn | 0 | ControlledDisqualifiedPrsnInd |
| Disqualified Prsn Controll Int | 0 | DisqualifiedPrsnControllIntInd |
| Disqualified Prsn Ownr Int | 0 | DisqualifiedPrsnOwnrIntInd |
| Excess Business Holdings Rules | 0 | ExcessBusinessHoldingsRulesInd |
| Contribution Controller | 0 | ContributionControllerInd |
| Contribution Family | 0 | ContributionFamilyInd |
| Contribution35 Controlled | 0 | Contribution35ControlledInd |
Form990 Sch A Type1 Suprt Org Form990SchAType1SuprtOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Power Appoint Majority Dir Trst | Yes (1) | PowerAppointMajorityDirTrstInd |
| Operate Benefit Non Suprt Org | 0 | OperateBenefitNonSuprtOrgInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $6,802 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $1,314 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $250 | GrantsOrScholarshipsAmt |
| End Year Balance | $7,866 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $5,578 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $1,474 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $250 | GrantsOrScholarshipsAmt |
| End Year Balance | $6,802 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $5,170 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $658 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $250 | GrantsOrScholarshipsAmt |
| End Year Balance | $5,578 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $5,065 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $355 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $250 | GrantsOrScholarshipsAmt |
| End Year Balance | $5,170 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $4,872 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $193 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $5,065 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prmnnt Endowment Balance EOY | 0.63570 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.36430 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $228,144 | OtherCostOrOtherBasisAmt |
| Depreciation | $113,724 | DepreciationAmt |
| Book Value | $114,420 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $114,420 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| Deferred Gift Annuities | $129,876 |
| Due to Affiliates | $99,708 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $229,584 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $455,678 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | -$454,949 | NetUnrealizedGainsInvstAmt |
| Donated Services And Use Fclts | $36,103 | DonatedServicesAndUseFcltsAmt |
| Other Revenue | $185,840 | OtherRevenueAmt |
| Revenue Not Reported | -$233,006 | RevenueNotReportedAmt |
| Revenue Subtotal | $688,684 | RevenueSubtotalAmt |
| Other Revenues Not Included | $1,266,033 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $1,266,033 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $1,954,717 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $1,156,169 | TotExpnsEtcAuditedFinclStmtAmt |
| Donated Services Use Fclts | $36,103 | DonatedServicesUseFcltsAmt |
| Other Expenses Included | $98,939 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $135,042 | ExpensesNotReportedAmt |
| Expenses Subtotal | $1,021,127 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $3,639,506 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $3,639,506 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $4,660,633 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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. |
| Part XI, Line 2d - Other Adjustments: | Assets released from restriction 185,840. |
| Part XI, Line 4b - Other Adjustments: | Restricted Grants 5,000. Temporarily Restricted Contributions 1,358,908. Temporarily Restricted Investment Return 1,064. Golf Tournament & Gaming expenses -98,939. |
| Part XII, Line 2d - Other Adjustments: | Golf Tournament & Gaming expenses 98,939. |
| Part XII, Line 4b - Other Adjustments: | Restricted grants 3,639,506. |
| 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. |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | SH Golf Tournament | Event1Nm |
| Gross Receipts Event1 | $133,565 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $98,380 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $35,185 | GrossRevenueEvent1Amt |
| Cash Prizes Event1 | $4,050 | CashPrizesEvent1Amt |
| Non Cash Prizes Event1 | $3,200 | NonCashPrizesEvent1Amt |
| Rent Facility Costs Event1 | $22,129 | RentFacilityCostsEvent1Amt |
| Food And Beverage Event1 | $0 | FoodAndBeverageEvent1Amt |
| Other Direct Expenses Event1 | $3,918 | OtherDirectExpensesEvent1Amt |
| Event2 | Breast Health Golf Tournament | Event2Nm |
| Gross Receipts Event2 | $44,681 | GrossReceiptsEvent2Amt |
| Charitable Contri Event2 | $26,835 | CharitableContriEvent2Amt |
| Gross Revenue Event2 | $17,846 | GrossRevenueEvent2Amt |
| Cash Prizes Event2 | $0 | CashPrizesEvent2Amt |
| Non Cash Prizes Event2 | $0 | NonCashPrizesEvent2Amt |
| Rent Facility Costs Event2 | $10,908 | RentFacilityCostsEvent2Amt |
| Other Direct Expenses Event2 | $697 | OtherDirectExpensesEvent2Amt |
| Other Events Total | 2 | OtherEventsTotalCnt |
| Gross Receipts Other Events | $47,312 | GrossReceiptsOtherEventsAmt |
| Charitable Contri Other Events | $23,154 | CharitableContriOtherEventsAmt |
| Gross Revenue Other Events | $24,158 | GrossRevenueOtherEventsAmt |
| Cash Prizes Other Events | $0 | CashPrizesOtherEventsAmt |
| Non Cash Prizes Other Events | $5,286 | NonCashPrizesOtherEventsAmt |
| Rent Fclty Costs Other Events | $9,969 | RentFcltyCostsOtherEventsAmt |
| Food And Beverage Other Events | $3,036 | FoodAndBeverageOtherEventsAmt |
| Oth Direct Expnss Other Events | $955 | OthDirectExpnssOtherEventsAmt |
| Gross Receipts Total | $225,558 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $148,369 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $77,189 | GrossRevenueTotalEventsAmt |
| Cash Prizes Total Events | $4,050 | CashPrizesTotalEventsAmt |
| Non Cash Prizes Total Events | $8,486 | NonCashPrizesTotalEventsAmt |
| Rent Fclty Costs Total Events | $43,006 | RentFcltyCostsTotalEventsAmt |
| Food And Beverage Total Events | $3,036 | FoodAndBeverageTotalEventsAmt |
| Oth Direct Expnss Total Events | $5,570 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $64,148 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | $13,041 | NetIncomeSummaryAmt |
Gaming Information GamingInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Revenue Other Gaming | $40,743 | GrossRevenueOtherGamingAmt |
| Cash Prizes Other Gaming | $20,820 | CashPrizesOtherGamingAmt |
| Rent Fclty Costs Other Gaming | $9,889 | RentFcltyCostsOtherGamingAmt |
| Oth Direct Expnss Other Gaming | $4,082 | OthDirectExpnssOtherGamingAmt |
| Volunteer Labor Other Gaming | 0 | VolunteerLaborOtherGamingInd |
| Gross Revenue Total Gaming | $40,743 | GrossRevenueTotalGamingAmt |
| Cash Prizes Total Gaming | $20,820 | CashPrizesTotalGamingAmt |
| Rent Fclty Costs Total Gaming | $9,889 | RentFcltyCostsTotalGamingAmt |
| Oth Direct Expnss Total Gaming | $4,082 | OthDirectExpnssTotalGamingAmt |
| Direct Expense Summary Gaming | $34,791 | DirectExpenseSummaryGamingAmt |
| Net Gaming Income Summary | $5,952 | NetGamingIncomeSummaryAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| States Where Gaming Conducted | PA | StatesWhereGamingConductedCd |
| Licensed | Yes (1) | LicensedInd |
| License Suspended Etc | 0 | LicenseSuspendedEtcInd |
| Gaming With Nonmembers | 0 | GamingWithNonmembersInd |
| Member Of Other Entity | 0 | MemberOfOtherEntityInd |
| Gaming Own Facility | 1.00000 | GamingOwnFacilityPct |
| Individual With Books | Sherry Watts VP Development Susqu | IndividualWithBooksNm |
Persons With Books US Address PersonsWithBooksUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1100 Grampian Boulevard | AddressLine1Txt |
| City | Williamsport | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 17701 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct With3rd Prty For Game Rev | 0 | CntrctWith3rdPrtyForGameRevInd |
| Gaming Manager Person | Sherry Watts VP Development Susqu | GamingManagerPersonNm |
| Gaming Manager Services Prov | Manages raffle income and cash prizes as part of her job as VP Development. | GamingManagerServicesProvTxt |
| Gaming Manager Is Employee | Yes (X) | GamingManagerIsEmployeeInd |
| Charitable Distribution Rqr | 0 | CharitableDistributionRqrInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Form 990, Schedule G, Part II Line 11 and Part III Line 8 | FormAndLineReferenceDesc |
| Explanation | All net income from fundraising and gaming is used to carry out the charitable health care mission of the supported organizations. | ExplanationTxt |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (4 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|
| Divine Providence Hospital | |||||||
| 1100 Grampian Blvd | Williamsport | PA | 17701 | 240799343 | 501(c)(3) | $330,777 | Used for general expenses 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) | $2,408,676 | Used for general expenses of The Williamsport Hospital including building funds for Heart & Vascular renovations and Residency department. |
| Muncy Valley Hospital | |||||||
| 215 E Water Street | Muncy | PA | 17756 | 240806023 | 501(c)(3) | $32,577 | Beauty Shop renovations for the skilled nursing unit. |
| Soldiers & Sailors Memorial Hospital | |||||||
| 32-36 Central Avenue | Wellsboro | PA | 16901 | 232176963 | 501(c)(3) | $862,543 | Building funds for the Emergency Department renovations. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 4 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 2: | FormAndLineReferenceDesc |
| Explanation | Grantees are related organizations and part of the UPMC Susquehanna system with consistent management oversight ensuring the use of funds for charitable purposes. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (8 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Steven P Johnson | ||||||||||||||
| President/CEO | $0 | $668,195 | $0 | $133,858 | $0 | $30,146 | $0 | $15,925 | $0 | $19,257 | $0 | $867,381 | $0 | $0 |
| Eric D Pohjala | ||||||||||||||
| Exec VP/CFO | $0 | $252,402 | $0 | $0 | $0 | $2,755 | $0 | $9,720 | $0 | $17,629 | $0 | $282,506 | $0 | $0 |
| Jan E Fisher | ||||||||||||||
| Exec VP/COO | $0 | $409,956 | $0 | $36,987 | $0 | $12,863 | $0 | $9,950 | $0 | $22,042 | $0 | $491,798 | $0 | $0 |
| David Lopatofsky MD | ||||||||||||||
| Exec VP/CMO | $0 | $412,757 | $0 | $18,458 | $0 | $6,061 | $0 | $11,275 | $0 | $27,612 | $0 | $476,163 | $0 | $0 |
| Sherry E Watts | ||||||||||||||
| VP Development | $0 | $154,074 | $0 | $16,175 | $0 | $303 | $0 | $7,123 | $0 | $1,069 | $0 | $178,744 | $0 | $0 |
| Charles J Santangelo | ||||||||||||||
| Former Exec VP/CFO-Retired 5/2/15 | $0 | $186,916 | $0 | $71,895 | $0 | $79,262 | $0 | $9,950 | $0 | $15,038 | $0 | $363,061 | $0 | $0 |
| William C McCauley MD | ||||||||||||||
| Former Exec VP/CMO-Retired 1/31/15 | $0 | $108,272 | $0 | $45,384 | $0 | $31,716 | $0 | $0 | $0 | $4,271 | $0 | $189,643 | $0 | $0 |
| Ronald J Butler | ||||||||||||||
| Former Exec VP/CBO-Retired 4/15/15 | $0 | $112,293 | $0 | $32,105 | $0 | $374,228 | $0 | $9,950 | $0 | $3,552 | $0 | $532,128 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 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 2016, the minimum threshold was met that would trigger a VCIP payment. In December 2015, President/CEO Steven P. Johnson received a variable compensation award in the amount of $133,858. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 2 | Board members Roger Jarrett, Steve Johnson, Keith Kuzio, and Geneva Peck all serve on the board of a related taxable organization. |
| Form 990, Part VI, Section A, line 6 | UPMC Susquehanna #23-2751183 is a sole member of the governing body. |
| Form 990, Part VI, Section A, line 7a | UPMC Susquehanna #23-2751183 may elect or remove one or more board members to the governing body. |
| Form 990, Part VI, Section A, line 7b | UPMC Susquehanna #23-2751183, 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 11 | A high-level overview of Forms 990 is presented to the parent Board of Directors (UPMC Susquehanna EIN #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 | 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. They would be produced by the Corporate Office. |
| Form 990, Part XII, Line 2c | The organization did not change its oversight process or selection process. |
| Form 990, Part V, Line 1a | Number reported in Box 3 of Form 1096 All 1099's are issued by UPMC Susquehanna EIN #23-2751183. All expenses are then allocated back to all related entities. |
| Form 990, Part V, Line 2a & 2b | Number of employees reported on Form W-3 UPMC Susquehanna EIN #23-2751183 utilizes a common paymaster which includes the following entities: Divine Providence Hospital #24-0799343 Muncy Valley Hospital #24-0806023 The Williamsport Hospital #24-0795508 Susquehanna Health Foundation #23-2743470 Susquehanna Physician Services #23-2449454 Susquehanna Ventures Inc. #23-2470263 Williamsport Area Ambulance Service Cooperative #23-2416166 Laurel Management Services #25-1644910 Laurel Realty #23-1403678 Soldiers & Sailors Memorial Hospital #23-2176963 The Green Home #24-0804365 Tioga Health Care Providers #25-1765538 Tyoga Carenet #25-1810967 The total number of employees reported on Form W-3 would be 3,871 for UPMC Susquehanna #23-2751183. Of that total, 5 employees payroll expenses were recorded by Susquehanna Health Foundation #23-2743470. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (14 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Divine Providence Hospital of the Sisters of Christian Charity | |||||||||||
| 1100 Grampian Blvd | Williamsport | PA | 17701 | 240799343 | Hospital | PA | 501(c)(3) | Line 3 | UPMC Susquehanna | 0 | |
| Muncy Valley Hospital | |||||||||||
| 215 E Water Street | Muncy | PA | 17756 | 240806023 | Hospital | PA | 501(c)(3) | Line 3 | UPMC Susquehanna | 0 | |
| The Williamsport Hospital | |||||||||||
| 700 High Street | Williamsport | PA | 17701 | 240795508 | Hospital | PA | 501(c)(3) | Line 3 | UPMC Susquehanna | 0 | |
| UPMC Susquehanna | |||||||||||
| 1205 Grampian Blvd | Williamsport | PA | 17701 | 232751183 | Coordinate & manage the delivery of healthcare | PA | 501(c)(3) | Line 11b, II | 0 | N/A | |
| Susquehanna Physician Services | |||||||||||
| 1201 Grampian Blvd | Williamsport | PA | 17701 | 232449454 | Physician services & MRI services | PA | 501(c)(3) | Line 3 | UPMC Susquehanna | 0 | |
| Williamsport Area Ambulance Service | |||||||||||
| 700 High Street | Williamsport | PA | 17701 | 232416166 | Ambulance transports | PA | 501(c)(3) | Line 9 | 0 | N/A | |
| Soldiers & Sailors Memorial Hospital | |||||||||||
| 32-36 Central Ave | Wellsboro | PA | 16901 | 232176963 | Hospital | PA | 501(c)(3) | Line 3 | UPMC Susquehanna | 0 | |
| The Green Home | |||||||||||
| 37 Central Ave | Wellsboro | PA | 16901 | 240804365 | Skilled nursing & assisted living | PA | 501(c)(3) | Line 9 | UPMC Susquehanna | 0 | |
| Tioga Health Care Providers | |||||||||||
| 15 Meade Street | Wellsboro | PA | 16901 | 251765538 | Physician services | PA | 501(c)(3) | Line 11b, II | UPMC Susquehanna | 0 | |
| Laurel Management Services | |||||||||||
| 15 Meade Street | Wellsboro | PA | 16901 | 251644910 | Mgmt consulting & supervisory svcs | PA | 501(c)(3) | Line 11b, II | UPMC Susquehanna | 0 | |
| Laurel Realty | |||||||||||
| 15 Meade Street | Wellsboro | PA | 16901 | 231403678 | Own & manage real estate | PA | 501(c)(2) | N/A | UPMC Susquehanna | 0 | |
| Laurel Health System | |||||||||||
| 15 Meade Street | Wellsboro | PA | 16901 | 240795488 | Coordinate & manage the delivery of healthcare | PA | 501(c)(3) | Line 11b, II | UPMC Susquehanna | 0 | |
| Laurel Health Foundation | |||||||||||
| 15 Meade Street | Wellsboro | PA | 16901 | 251810488 | Fundraising for affiliated entities | PA | 501(c)(3) | Line 11a, I | Laurel Health System | 0 | |
| Susquehanna Health Innovation Center Inc | |||||||||||
| 700 High Street | Williamsport | PA | 17701 | 471600873 | Supporting organization for affiliated entities | PA | 501(c)(3) | Line 11a, I | UPMC Susquehanna | 0 | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Community Basket LLC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1205 Grampian Blvd | AddressLine1Txt |
| City | Williamsport | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 17701 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 201195739 | EIN |
| Primary Activities | Rents real estate | PrimaryActivitiesTxt |
| Legal Domicile State | PA | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | UPMC Susquehanna & Susquehanna Health Foundation | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Predominant Income Type | Excluded from tax | PredominantIncomeTypeTxt |
| Share Of Total Income | $535 | ShareOfTotalIncomeAmt |
| Share Of EOY Assets | $7,011 | ShareOfEOYAssetsAmt |
| Disproportionate Allocations | 0 | DisproportionateAllocationsInd |
| General Or Managing Partner | 0 | GeneralOrManagingPartnerInd |
| Ownership | 0.50000 | OwnershipPct |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd | Address Line1ForeignAddress/AddressLine1Txt | CountryForeignAddress/CountryCd | Legal Domicile Foreign CountryLegalDomicileForeignCountryCd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Susquehanna Ventures Inc | ||||||||||||
| 1201 Grampian Blvd | Williamsport | PA | 17701 | 232470263 | Pharmacy & Infusion Services | PA | UPMC Susquehanna | C | 0 | |||
| Susquehanna Health System Insurance Network LTD | ||||||||||||
| 980458722 | Captive Insurance Company | UPMC Susquehanna | 0 | PO Box 1159 | CJ | CJ | ||||||
| Tyoga Carenet | ||||||||||||
| 15 Meade Street | Wellsboro | PA | 16901 | 251810967 | Integrate Health Care | PA | UPMC Susquehanna | C | 0 | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (1) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Form 990, Schedule R, Part IV | FormAndLineReferenceDesc |
| Explanation | Susquehanna Health System Insurance Network, LTD (SHSIN), EIN #98-0458722 is a foreign corporation, incorporated under the laws of the Cayman Islands. There are no income, capital, or premium taxes levied in the Cayman Islands and SHSIN has been granted an exemption until September 2022 for any such taxes that might be introduced. SHSIN's sole shareholder, UPMC Susquehanna EIN #23-2751183, is a 501(c)(3) organization exempt from federal income taxes. SHSIN conducts no business in the United States. It files an 1120F protective filing which implies that its income is not subject to US federal income tax. | ExplanationTxt |