2017-05-01T06:46:02-05:00 2016-06-30 BKD LLP 910 E St Louis St Springfield MO 658062523 990 2015-07-01 232416166 Williamsport Area Ambulance Service Cooperative WILL 5703207900 700 High Street Williamsport PA 17701 Eric D Pohjala Executive Vice President/CFO 5703213171 2017-05-01 1 Brian D Todd CPA P00422601 4178658701 2015 2021-01-29 14:40:06Z Steven P Johnson 700 High Street Williamsport PA 17701 5814948 0 X www.susquehannahealth.org X 1986 PA WAASC is a nonprofit cooperative which provides ambulance services. 10 7 92 8 10891 0 510930 508460 4989494 5303488 0 3000 286 0 5500710 5814948 0 0 0 0 2963805 3324425 0 0 0 2048003 2090788 5011808 5415213 488902 399735 2078882 2349434 435533 306350 1643349 2043084 X WAASC 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 place patients and their families first, share ownership with all our caregivers and lead with a servant's heart. 0 0 3128258 2518909 Williamsport Area Ambulance Service Cooperative transports emergency patients in the greater Lycoming County area through the County 911 system. For FY 2016 WAASC transported 6,246 emergency patients. 1429889 2773688 Williamsport Area Ambulance Service Cooperative transports non-emergency patients in the greater Lycoming County area. For FY 2016 WAASC transported 6,443 non-emergency patients. On an annual basis WAASC devotes a portion of its revenue and assets to community program services. Community Building Activities and other Financial Contributions totaling $131,523 reflects the amount of quantifiable community benefits reported for FY 2016. 4558147 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 X 0 0 1 92 1 1 1 0 0 0 0 0 0 0 0 0 X 10 7 1 0 0 0 1 1 0 1 1 0 0 0 1 1 1 1 1 0 0 0 PA X UPMC Susquehanna Finance Department 5703207900 1205 Grampian Blvd Williamsport PA 17701 Joseph Neyhart Chairperson 2.00 X X 0 0 0 Robert Kane Vice Chair/VP Ancillary Svcs 2.00 40.00 X X 0 227852 28465 Craig Kropp Secretary 2.00 X X 0 0 0 R Mark Lusk Treasurer 2.00 X X 0 0 0 Gregory R Frailey Director 2.00 X 0 0 0 Charles Kiessling Director 2.00 X 0 0 0 John Bubb Assistant Treasurer 2.00 40.00 X 0 111762 29898 Jeffrey Neyhart Director 2.00 X 0 0 0 Charles Stutzman Director 2.00 X 0 0 0 Karen Zinoble Director 2.00 40.00 X 0 152600 16778 Steven P Johnson President/CEO 2.00 52.00 X 0 832199 35182 Eric D Pohjala Exec VP/CFO 2.00 40.00 X 0 255157 27349 Jan E Fisher Exec VP/COO 2.00 42.00 X 0 459806 31992 David Lopatofsky MD Exec VP/CMO 2.00 42.00 X 0 437276 38887 Charles J Santangelo Former Exec VP/CFO-Retired 5/2/15 0.00 40.00 X 0 338073 24988 William C McCauley MD Former Exec VP/CMO-Retired 1/31/15 0.00 40.00 X 0 185372 4271 Ronald J Butler Former Exec VP/CBO-Retired 4/15/15 0.00 42.00 X 0 518626 13502 0 3518723 251312 0 1 1 0 0 8460 500000 508460 Net patient revenue 621910 4734370 4734370 Fire company patient t 621910 307977 307977 Cancer Patient transpo 621910 218841 218841 Fuel rebate 621910 23350 23350 Fire company billing 561499 10891 10891 8059 8059 5303488 3000 0 3000 3000 3000 5814948 5292597 10891 3000 2625098 2369484 255614 107548 97076 10472 385086 331996 53090 206693 187676 19017 256899 256899 354 354 195645 189792 5853 481 481 118595 90624 27971 11489 10861 628 251 251 156219 124498 31721 2108 1921 187 7227 4709 2518 339611 325795 13816 225003 75888 149115 Bad Debt Expense 446430 446430 Repairs and Maintenance 177335 147524 29811 Medical Supplies 153141 153141 5415213 4558147 857066 0 310060 942349 696732 486552 25196 18510 2263787 1547544 966432 716243 80462 185780 2078882 2349434 275043 305793 160490 557 435533 306350 X 1636252 2035987 7097 7097 1643349 2043084 2078882 2349434 399735 0 X X 0 1 X 1 0 X 533716 548755 516961 510930 508460 2618822 3586356 3877450 3959703 4980504 5292597 21696610 4120072 4426205 4476664 5491434 5801057 24315432 0 0 0 24315432 7536 7068 7272 9276 10891 42043 4127608 4433273 4483936 5500710 5811948 24357475 X Form 990, Schedule A, Part III, Line 12, col (e) Did not include gain on sale of ambulance of $3,000 for 2015. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2263787 1547544 716243 716243 Other Accounts Receivable 82316 Due from affiliates 103464 185780 Due to Affiliates 557 557 X 5368518 -446430 -446430 5814948 0 5814948 4968783 0 4968783 446430 446430 5415213 Part XI, Line 2d - Other Adjustments: Bad Debt Expense -446,430. Part XII, Line 4b - Other Adjustments: Bad Debt Expense 446,430. Form 990, Part X, Line 2 Management has evaluated their income tax positions under the guidance included in ASC 740. Based on their review, management has not identified any material uncertain tax positions to be recorded or disclosed in the financial statements. Central America 0 1 Program Services Captive insurance company 128576 0 1 0 0 0 1 128576 0 128576 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Robert Kane Vice Chair/VP Ancillary Svcs 0 201735 0 21284 0 4833 0 11064 0 17401 0 256317 0 0 Karen Zinoble Director 0 141383 0 9866 0 1351 0 6623 0 10155 0 169378 0 0 Steven P Johnson President/CEO 0 668195 0 133858 0 30146 0 15925 0 19257 0 867381 0 0 Eric D Pohjala Exec VP/CFO 0 252402 0 0 0 2755 0 9720 0 17629 0 282506 0 0 Jan E Fisher Exec VP/COO 0 409956 0 36987 0 12863 0 9950 0 22042 0 491798 0 0 David Lopatofsky MD Exec VP/CMO 0 412757 0 18458 0 6061 0 11275 0 27612 0 476163 0 0 Charles J Santangelo Former Exec VP/CFO-Retired 5/2/15 0 186916 0 71895 0 79262 0 9950 0 15038 0 363061 0 0 William C McCauley MD Former Exec VP/CMO-Retired 1/31/15 0 108272 0 45384 0 31716 0 0 0 4271 0 189643 0 0 Ronald J Butler Former Exec VP/CBO-Retired 4/15/15 0 112293 0 32105 0 374228 0 9950 0 3552 0 532128 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 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. Form 990, Part VI, Section A, line 2 Board Member Joseph Neyhart and board member Jeffrey Neyhart have a family relationship. Form 990, Part VI, Section A, line 6 The Williamsport Hospital, Duboistown Fire Department, Old Lycoming Township Volunteer Fire Company, and South Williamsport Fire Department are members of the governing body. Form 990, Part VI, Section A, line 7a Each member may elect or remove one or more board members to the governing body. 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 All top management is employed by The Williamsport Hospital EIN #24-0795508. The following paragraph describes the process they use. The Board of Directors, through the Executive Compensation Committee, retains an independent outside consultant to provide guidance with respect to the annual establishment of the rebuttable 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, 92 employees payroll expenses were recorded by Williamsport Area Ambulance Service Cooperative #23-2416166. 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 Susquehanna Health Foundation 1100 Grampian Blvd Williamsport PA 17701 232743470 Fundraising for Affiliated entities PA 501(c)(3) Line 11a, I 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 N/A 0 Susquehanna Physician Services 1201 Grampian Blvd Williamsport PA 17701 232449454 Physician services & MRI services PA 501(c)(3) Line 3 UPMC Susquehanna 0 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 of affiliated entities PA 501(c)(3) Line 11a, I UPMC Susquehanna 0 Community Basket LLC 1205 Grampian Blvd Williamsport PA 17701 201195739 Rents real estate PA UPMC Susquehanna & Susquehanna Health Foundation excluded from tax 0 0 Susquehanna Ventures Inc 1201 Grampian Blvd Williamsport PA 17701 232470263 Pharmacy & Infusion Services PA UPMC Susquehanna C 0 Susquehanna Health System Insurance Network LTD PO Box 1159 CJ 980458722 Captive Insurance Company CJ UPMC Susquehanna 0 Tyoga Carenet 15 Meade Street Wellsboro PA 16901 251810967 Integrate Health Care PA UPMC Susquehanna C 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 Form 990, Schedule R, Part IV 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.