UPMC: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- UPMC (EIN 24-0806023)
- Tax period
- 2015-07-01 to 2016-06-30
- Filed
- 2017-05-02
- IRS object ID
- 201711229349300106
- 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 C
- Schedule D
- Schedule F
- Schedule G
- Schedule H
- Schedule I
- Schedule J
- Schedule K
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-05-02T07:40:30-05:00 | 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 Street | AddressLine1Txt |
| City | Springfield | CityNm |
| State Abbreviation | MO | StateAbbreviationCd |
| ZIP | 65806 | 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 | 240806023 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Muncy Valley Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | MUNC | BusinessNameControlTxt |
| Phone | 5703207900 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 215 East Water Street | AddressLine1Txt |
| City | Muncy | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 17756 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Eric D Pohjala | PersonNm |
| Person Title | Executive Vice President / CFO | PersonTitleTxt |
| Phone | 5703207900 | PhoneNum |
| Signature | 2017-05-02 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Brian D Todd | 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 | $81,818,204 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.upmcsusquehannahealth.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1922 | FormationYr |
| Legal Domicile State | PA | LegalDomicileStateCd |
| Activity Or Mission | Muncy Valley Hospital (MVH) is a 25 bed, critical access hospital, primarily serving Lycoming and surrounding counties. MVH also provides a full range of outpatient and emergency services, as well as, 139 hospital based Long Term Care beds. | ActivityOrMissionDesc |
| Voting Members Governing Body | 20 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 16 | VotingMembersIndependentCnt |
| Total Employee | 306 | TotalEmployeeCnt |
| Total Volunteers | 130 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $77,584 | PYContributionsGrantsAmt |
| CY Contributions Grants | $82,790 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $50,998,125 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $51,245,818 | CYProgramServiceRevenueAmt |
| PY Investment Income | $1,146,005 | PYInvestmentIncomeAmt |
| CY Investment Income | $870,450 | CYInvestmentIncomeAmt |
| PY Other Revenue | $95,518 | PYOtherRevenueAmt |
| CY Other Revenue | $124,841 | CYOtherRevenueAmt |
| PY Total Revenue | $52,317,232 | PYTotalRevenueAmt |
| CY Total Revenue | $52,323,899 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $4,025,663 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $4,600,591 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $17,394,425 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $17,584,823 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $7,690 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $27,985,752 | PYOtherExpensesAmt |
| CY Other Expenses | $27,932,094 | CYOtherExpensesAmt |
| PY Total Expenses | $49,405,840 | PYTotalExpensesAmt |
| CY Total Expenses | $50,117,508 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $2,911,392 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $2,206,391 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $64,724,155 | TotalAssetsBOYAmt |
| Total Assets EOY | $68,498,741 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $11,046,044 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $13,295,688 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $53,678,111 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $55,203,053 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | Muncy Valley Hospital (MVH) is a subsidiary of UPMC Susquehanna. The mission of UPMC Susquehanna and affiliates is as follows: To extend God's healing love by improving the health of those we serve. Our vision is to create an integrated community health system that delivers world class care. Our values are to carefully place our patients and their families first, share ownership with all of our caregivers and lead with a servant's heart. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $42,437,900 | ExpenseAmt |
| Grant | $4,600,591 | GrantAmt |
| Revenue | $51,264,178 | RevenueAmt |
| Desc | During the fiscal year ended June 30, 2016, the Hospital admitted 631 acute care patients, rendering 4,102 patient days and registered approximately 49,354 outpatients. Long Term Care days totaled 44,904. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | MVH treats all patients without regard to their ability to pay. In addition, the Hospital treats Medicare and Medical Assistance patients and maintains a Medicare / Medical Assistance policy that provides patients enrolled in such programs with access to all covered inpatient, outpatient and diagnostic services that are available to non-Medicare / Medical Assistance patients. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | On an annual basis, MVH devotes a portion of its revenue and assets to community program services. The following reflects the breakout of $8,158,838 in quantifiable community benefits reported for FY 2016: Charity Care (at cost) $68,042; Bad Debt (at cost) $1,061,006; Government-sponsored health care (unpaid cost of Medicare, Medicaid, indigent care programs, SCHIP and other safety net programs) $6,967,000. In addition, various other programs such as Research, Health Professions Education, Community Building, Financial and In-Kind Contributions and Community Benefit Operations totaling $62,790. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $42,437,900 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | 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 | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | 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 | Yes (1) | 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 | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| 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 | 4 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 306 | 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 | 0 | QuidProQuoContributionsInd |
| 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 | 20 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 16 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | 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 | Management | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 5703207900 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1205 Grampian Boulevard | AddressLine1Txt |
| City | Williamsport | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 17701 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (31 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 | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|---|
| Christian DeWald | ||||||||||
| Chair | 2.00 | 4.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| Keith Kuzio | ||||||||||
| Vice Chair | 2.00 | 6.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| Kathleen Pagana | ||||||||||
| Secretary | 2.00 | 2.00 | Yes (X) | Yes (X) | $0 | $1,845 | $0 | |||
| Geneva Peck | ||||||||||
| Treasurer | 2.00 | 4.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| Daniel Beringer | ||||||||||
| Director | 2.00 | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| Mark Beyer DO | ||||||||||
| Director | 2.00 | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| Sister Teresa Ann Jacobs | ||||||||||
| Director | 2.00 | 6.00 | Yes (X) | $0 | $0 | $0 | ||||
| Roger D Jarrett | ||||||||||
| Director | 2.00 | 4.00 | Yes (X) | $0 | $0 | $0 | ||||
| Kevin W Kist DO | ||||||||||
| Director | 2.00 | 46.00 | Yes (X) | $0 | $432,005 | $36,767 | ||||
| Patrick Marty | ||||||||||
| Director | 2.00 | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| Robert E More | ||||||||||
| Director | 2.00 | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| Paul Moulton | ||||||||||
| Director | 2.00 | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| Alexander R Nesbitt MD | ||||||||||
| Director | 2.00 | 46.00 | Yes (X) | $0 | $222,603 | $30,549 | ||||
| Shailesh Patel MD | ||||||||||
| Director | 2.00 | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| Kent Trachte PhD | ||||||||||
| Director | 2.00 | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| Peter B Trevouledes MD | ||||||||||
| Director | 2.00 | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| Patrick Wilson | ||||||||||
| Director | 2.00 | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| Mary Wolf | ||||||||||
| Director | 2.00 | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| Steven E Yordy MD | ||||||||||
| Director | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| Steven P Johnson | ||||||||||
| President / CEO | 2.00 | 52.00 | Yes (X) | Yes (X) | $0 | $832,199 | $35,182 | |||
| Eric D Pohjala | ||||||||||
| Executive VP / CFO | 2.00 | 42.00 | Yes (X) | $0 | $255,157 | $27,349 | ||||
| David Lopatofsky MD | ||||||||||
| Executive VP / CMO | 2.00 | 42.00 | $0 | $437,276 | $38,887 | Yes (X) | ||||
| Jan E Fisher | ||||||||||
| Executive VP / COO | 2.00 | 40.00 | $0 | $459,796 | $31,992 | Yes (X) | ||||
| Ronald J Reynolds | ||||||||||
| President | 40.00 | 0.00 | $206,950 | $0 | $32,534 | Yes (X) | ||||
| Anne E Holladay | ||||||||||
| Nursing Home Administrator | 40.00 | 0.00 | $137,343 | $0 | $9,001 | Yes (X) | ||||
| Charlotte C Whipple | ||||||||||
| Director of Nursing | 40.00 | 0.00 | $123,804 | $0 | $25,699 | Yes (X) | ||||
| Bobbie J Woolcock | ||||||||||
| Director of Nsg / Nsg Home | 40.00 | 0.00 | $117,556 | $0 | $5,890 | Yes (X) | ||||
| Sharon R Adams | ||||||||||
| Mgr. Patient Care | 40.00 | 0.00 | $107,258 | $0 | $6,118 | Yes (X) | ||||
| Charles J Santangelo | ||||||||||
| Former Exec VP/CFO (Retired 5/2/15) | 0.00 | 40.00 | $0 | $338,163 | $25,001 | Yes (X) | ||||
| William C McCauley MD | ||||||||||
| Former Exec VP/CMO (Retired 1/31/15) | 0.00 | 40.00 | $0 | $185,372 | $4,272 | Yes (X) | ||||
| Ronald J Butler | ||||||||||
| Former Exec VP/CBO (Retired 4/15/15) | 0.00 | 40.00 | $0 | $518,626 | $13,503 | Yes (X) | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $692,911 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $3,683,042 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $322,744 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 11 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Aramark Healthcare | |||||
| 24863 Network Place | Chicago | IL | 60673 | Management / environmental services | $6,840,485 |
| The Williamsport Hospital | |||||
| 700 High Street | Williamsport | PA | 17701 | Management services | $6,202,323 |
| Genesis Eldercare Rehab | |||||
| PO Box 821322 | Philadelphia | PA | 19182 | Rehab services | $1,129,877 |
| Respiratory Health Services LLC | |||||
| PO Box 821322 | Philadelphia | PA | 19182 | Respiratory services | $831,076 |
| Emcare Inc | |||||
| 7032 Collection Center Drive | Chicago | IL | 60693 | ER management services | $726,956 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 6 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $21,665 | FundraisingAmt |
| Related Organizations | $32,577 | RelatedOrganizationsAmt |
| Government Grants | $24,842 | GovernmentGrantsAmt |
| All Other Contributions | $3,706 | AllOtherContributionsAmt |
| Total Contributions | $82,790 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Net patient service revenue | 621990 | $49,649,949 | $49,649,949 |
| Supplemental payments associated | 623000 | $1,436,752 | $1,436,752 |
| Affiliate rental income | 621990 | $102,588 | $102,588 |
| Sports Medicine - athletic traine | 621990 | $36,385 | $36,385 |
| Meaningful use revenue | 621990 | $20,144 | $20,144 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $51,245,818 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $421,624 | TotalRevenueColumnAmt |
| Exclusion | $421,624 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $29,846,099 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $29,397,273 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $448,826 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $448,826 | TotalRevenueColumnAmt |
| Exclusion | $448,826 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $101,902 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $21,665 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $97,032 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $4,870 | TotalRevenueColumnAmt |
| Exclusion | $4,870 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|---|
| Cafeteria | 624200 | $68,404 | $68,404 | |
| Miscellaneous | 900099 | $36,773 | $18,413 | $18,360 |
| Television | 900099 | $9,114 | $9,114 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $5,680 | TotalRevenueColumnAmt |
| Exclusion | $5,680 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $119,971 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $52,323,899 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $51,264,178 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $976,931 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,600,591 | TotalAmt |
| Program Services | $4,600,591 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,548,650 | TotalAmt |
| Program Services | $12,844,232 | ProgramServicesAmt |
| Management And General | $698,493 | ManagementAndGeneralAmt |
| Fundraising | $5,925 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $639,435 | TotalAmt |
| Program Services | $606,189 | ProgramServicesAmt |
| Management And General | $32,966 | ManagementAndGeneralAmt |
| Fundraising | $280 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,421,573 | TotalAmt |
| Program Services | $2,295,671 | ProgramServicesAmt |
| Management And General | $124,843 | ManagementAndGeneralAmt |
| Fundraising | $1,059 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $975,165 | TotalAmt |
| Program Services | $924,465 | ProgramServicesAmt |
| Management And General | $50,274 | ManagementAndGeneralAmt |
| Fundraising | $426 | FundraisingAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,202,518 | TotalAmt |
| Management And General | $6,202,518 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $481 | TotalAmt |
| Management And General | $481 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12 | TotalAmt |
| Management And General | $12 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,929 | TotalAmt |
| Management And General | $5,929 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $97,037 | TotalAmt |
| Management And General | $97,037 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,658,960 | TotalAmt |
| Program Services | $7,398,934 | ProgramServicesAmt |
| Management And General | $260,026 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,239 | TotalAmt |
| Program Services | $4,239 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,371,832 | TotalAmt |
| Program Services | $1,302,888 | ProgramServicesAmt |
| Management And General | $68,944 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $103,387 | TotalAmt |
| Program Services | $103,387 | ProgramServicesAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $22,568 | TotalAmt |
| Program Services | $19,529 | ProgramServicesAmt |
| Management And General | $3,039 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $728,576 | TotalAmt |
| Program Services | $676,782 | ProgramServicesAmt |
| Management And General | $51,794 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $16,483 | TotalAmt |
| Program Services | $13,670 | ProgramServicesAmt |
| Management And General | $2,813 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $31,619 | TotalAmt |
| Program Services | $30,669 | ProgramServicesAmt |
| Management And General | $950 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,198,217 | TotalAmt |
| Program Services | $1,198,217 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $446,418 | TotalAmt |
| Program Services | $446,418 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Medical supplies | $4,167,027 | $4,166,870 | $157 |
| Bad Debt Expense | $3,670,031 | $3,670,031 | |
| Miscellaneous | $1,425,376 | $1,370,333 | $55,043 |
| Repairs & maintenance | $781,384 | $764,785 | $16,599 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $50,117,508 | TotalAmt |
| Program Services | $42,437,900 | ProgramServicesAmt |
| Management And General | $7,671,918 | ManagementAndGeneralAmt |
| Fundraising | $7,690 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,059,114 | BOYAmt |
| EOY | $10,578,877 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,943,906 | BOYAmt |
| EOY | $7,129,625 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $181,582 | BOYAmt |
| EOY | $188,133 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $217,333 | BOYAmt |
| EOY | $181,720 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $46,966,746 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $30,774,140 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,318,844 | BOYAmt |
| EOY | $16,192,606 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $22,618,397 | BOYAmt |
| EOY | $22,970,651 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,384,979 | BOYAmt |
| EOY | $11,257,129 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $64,724,155 | BOYAmt |
| EOY | $68,498,741 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,815,020 | BOYAmt |
| EOY | $3,428,138 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $168,201 | BOYAmt |
| EOY | $847,995 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,062,823 | BOYAmt |
| EOY | $9,019,555 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,046,044 | BOYAmt |
| EOY | $13,295,688 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $53,273,159 | BOYAmt |
| EOY | $54,811,266 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $178,392 | BOYAmt |
| EOY | $163,471 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $226,560 | BOYAmt |
| EOY | $228,316 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $53,678,111 | BOYAmt |
| EOY | $55,203,053 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $64,724,155 | BOYAmt |
| EOY | $68,498,741 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $2,206,391 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$666,526 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$14,923 | 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) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| 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) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
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 C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | Yes (1) | GrantsOtherOrganizationsInd |
| Grants Other Organizations | $5,929 | GrantsOtherOrganizationsAmt |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | 0 | OtherActivitiesInd |
| Total Lobbying Expenditures | $5,929 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part II-B, Line 1: | FormAndLineReferenceDesc |
| Explanation | The Hospital holds memberships in the American Hospital Association, (AHA) and the Hospital Association of Pennsylvania, (HAP) both of which engage in lobbying as part of their mission to represent the interests of hospitals at both the Federal and State levels. For the year ended 06/30/16, the amount of dues paid to HAP totaled $10,076 of which 24.94% or $2,513, was used for lobbying purposes. Dues paid to AHA totaled $15,443, of which 22.12% or $3,416, was used for lobbying purposes. On occasion, HAP requests the help of member providers to communicate concerns to legislators regarding pending legislation which could impact hospitals. This can involve direct contact with legislators or letter-writing. This occurs infrequently, and the cost to the Hospital is negligible. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $390,346 | OtherCostOrOtherBasisAmt |
| Book Value | $390,346 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $22,604,006 | OtherCostOrOtherBasisAmt |
| Depreciation | $16,832,779 | DepreciationAmt |
| Book Value | $5,771,227 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $15,678 | OtherCostOrOtherBasisAmt |
| Depreciation | $15,678 | DepreciationAmt |
| Book Value | $0 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $17,390,727 | OtherCostOrOtherBasisAmt |
| Depreciation | $13,487,550 | DepreciationAmt |
| Book Value | $3,903,177 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $6,565,989 | OtherCostOrOtherBasisAmt |
| Depreciation | $438,133 | DepreciationAmt |
| Book Value | $6,127,856 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $16,192,606 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (3 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| Other receivables | $134,621 |
| Interest in net affiliates | $149,145 |
| Due from affiliates, net | $10,973,363 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $11,257,129 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (4 entries)
| DescDesc | AmtAmt |
|---|---|
| Estimated third party settlements | $374,898 |
| Estimated medical legal liability costs | $204,000 |
| Due to affiliates, net | $8,282,467 |
| Other liabilities | $158,190 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $9,019,555 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $47,956,391 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | -$666,526 | NetUnrealizedGainsInvstAmt |
| Other Revenue | -$3,638,102 | OtherRevenueAmt |
| Revenue Not Reported | -$4,304,628 | RevenueNotReportedAmt |
| Revenue Subtotal | $52,261,019 | RevenueSubtotalAmt |
| Other Revenues Not Included | $62,880 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $62,880 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $52,323,899 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $41,846,886 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $41,846,886 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $8,270,622 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $8,270,622 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $50,117,508 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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. |
| Part XI, Line 2d - Other Adjustments: | Net assets released from restrictions 31,929. Bad debt expense -3,670,031. |
| Part XI, Line 4b - Other Adjustments: | Contributions received 28,547. Investment return 1,756. Transfer from affiliate - SHF 32,577. |
| Part XII, Line 4b - Other Adjustments: | Bad Debt expense 3,670,031. Transfer to affiliate - SHMG 4,600,591. |
Schedule F IRS990ScheduleF
Account Activities Outside US AccountActivitiesOutsideUSGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Region | Central America | RegionTxt |
| Offices | 0 | OfficesCnt |
| Employee | 1 | EmployeeCnt |
| Type Of Activities Conducted | Program services | TypeOfActivitiesConductedTxt |
| Specific Services Provided | Captive insurance company | SpecificServicesProvidedTxt |
| Region Total Expenditures | $280,638 | RegionTotalExpendituresAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Subtotal Offices | 0 | SubtotalOfficesCnt |
| Subtotal Employees | 1 | SubtotalEmployeesCnt |
| Continutation Total Office | 0 | ContinutationTotalOfficeCnt |
| Continutation Total Employee | 0 | ContinutationTotalEmployeeCnt |
| Total Office | 0 | TotalOfficeCnt |
| Total Employee | 1 | TotalEmployeeCnt |
| Subtotal Spent | $280,638 | SubtotalSpentAmt |
| Continuation Spent | $0 | ContinuationSpentAmt |
| Total Spent | $280,638 | TotalSpentAmt |
| Transfer To Foreign Corp | 0 | TransferToForeignCorpInd |
| Interest In Foreign Trust | 0 | InterestInForeignTrustInd |
| Foreign Corp Ownership | 0 | ForeignCorpOwnershipInd |
| Passive Foreign Investmest Co | 0 | PassiveForeignInvestmestCoInd |
| Foreign Partnership | 0 | ForeignPartnershipInd |
| Boycott Countries | 0 | BoycottCountriesInd |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | Lawn Party | Event1Nm |
| Gross Receipts Event1 | $57,696 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $15,510 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $42,186 | GrossRevenueEvent1Amt |
| Other Direct Expenses Event1 | $37,233 | OtherDirectExpensesEvent1Amt |
| Event2 | Gift Box | Event2Nm |
| Gross Receipts Event2 | $23,120 | GrossReceiptsEvent2Amt |
| Charitable Contri Event2 | $0 | CharitableContriEvent2Amt |
| Gross Revenue Event2 | $23,120 | GrossRevenueEvent2Amt |
| Other Direct Expenses Event2 | $19,953 | OtherDirectExpensesEvent2Amt |
| Other Events Total | 8 | OtherEventsTotalCnt |
| Gross Receipts Other Events | $42,751 | GrossReceiptsOtherEventsAmt |
| Charitable Contri Other Events | $6,155 | CharitableContriOtherEventsAmt |
| Gross Revenue Other Events | $36,596 | GrossRevenueOtherEventsAmt |
| Oth Direct Expnss Other Events | $39,846 | OthDirectExpnssOtherEventsAmt |
| Gross Receipts Total | $123,567 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $21,665 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $101,902 | GrossRevenueTotalEventsAmt |
| Oth Direct Expnss Total Events | $97,032 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $97,032 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | $4,870 | NetIncomeSummaryAmt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent150 | Yes (X) | Percent150Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent300 | Yes (X) | Percent300Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $68,042 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $68,042 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00150 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $14,146,970 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $9,524,643 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,622,327 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.09950 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $14,215,012 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $9,524,643 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,690,369 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.10100 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,344 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,344 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $0 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $360 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $360 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Research ResearchGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $0 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,869 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,869 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,573 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $3,573 | NetCommunityBenefitExpnsAmt |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $14,218,585 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $9,524,643 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,693,942 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.10100 | TotalExpensePct |
Leadership Development LeadershipDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,449 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,449 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,449 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,449 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $3,670,031 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $183,502 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $14,124,061 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $16,468,709 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$2,344,648 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost Accounting System | Yes (X) | CostAccountingSystemInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Muncy Valley Hospital | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 215 East Water Street | AddressLine1Txt |
| City | Muncy | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 17756 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.upmcsusquehannahealth.org | WebsiteAddressTxt |
| State License | 134301 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Muncy Valley Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Information Gaps | Yes (X) | InformationGapsInd |
| CHNA Conducted | 15 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (1) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | See Part V, Page 7 | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 15 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | See Part V, Page 7 | StrategyWebsiteURLTxt |
| Strategy Attached | 0 | StrategyAttachedInd |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 150.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 300.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | See Part V, Page 7 | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | See Part V, Page 7 | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | See Part V, Page 7 | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| FAP Notice Displayed | Yes (X) | FAPNoticeDisplayedInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified Before Discharge | Yes (X) | FAPNotifiedBeforeDischargeInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Other Method Used | Yes (X) | OtherMethodUsedInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Muncy Valley Hospital | Part V, Section B, Line 5: In conducting its CHNA, the hospital took into account input from representatives of the community served, including those with special knowledge of or expertise in public health. This was accomplished by conducting 9 key informant meetings with 55 people answering the key informant interview. A web-based tool was utilized to conduct the key informant interview; however, paper questionnaires identical to the electronic version were distributed to those who may not have had access to the internet or generationally are more likely to complete a paper questionnaire. For more details concerning the key informant meeting process or the key informant interview process, including a list of those individuals interviewed, a copy of the key informant interview, and results gathered you may view the CHNA and related Implementation Plan at www.upmcsusquehanna.org/communityhealth. |
| Muncy Valley Hospital | Part V, Section B, Line 6a: The Muncy Valley Hospital; located in Muncy, PA is one of four hospitals that comprise UPMC Susquehanna based in Williamsport, Pennsylvania. For purposes of conducting CHNA's, three of these hospitals, The Williamsport Hospital (DBA: Williamsport Regional Medical Center), Divine Providence Hospital, and Muncy Valley Hospital, share the same definition of community served, which is Lycoming County, PA. The fourth hospital that is part of UPMC Susquehanna is Soldiers & Sailors Memorial Hospital located in Wellsboro, PA and their defined community is Tioga County, PA. The health systems approach to providing community benefit is to leverage the assets and expertise of all four hospitals to meet the needs and improve the health status of those who reside in the communities located in Lycoming and Tioga counties. Accordingly, a certain amount of collaboration between these related hospitals occurred in the development of their CHNA's and related Implementation Plans. For more details concerning these four hospitals, as well as their definition of community served you may view the CHNA and related Implementation Plans as www.upmcsusquehanna.org/communityhealth. |
| Muncy Valley Hospital | Part V, Section B, Line 11: Health needs were identified based on information gathered and analyzed through the 2016 CHNA conducted by the Health System. For the health needs prioritization process, the Health System engaged a hospital leadership team to review the most significant health needs reported the prior CHNA using the following criteria, 1) Current area of hospital focus. 2) Established relationships with community partners to address the health need. 3) Organizational capacity and existing infrastructure to address the health need.Based on the criteria outlined above, the leadership team ranked each of the health needs. As a result of the priority setting process, the identified priority areas that will be addressed through the Health System's Implementation Strategy for fiscal years 2017 through 2019 will be, 1) Substance abuse 2) Lack of mental health services 3) Heart disease 4) Financial barriers/poverty/low socioeconomic 5) Cancer 6) Lack of preventative care 7) Lack of health knowledge/education 8) Obesity 9) Lack of primary care physicians.The Health System's next step included developing an Implementation Strategy to address these priority areas which can be found at www.upmcsusquehanna.org/communityhealth.In some cases the hospital does not have the resources and specialty staff that would be required to adequately address all the identified needs. In other words, there may already be other agencies and healthcare providers working to effect change in these areas by providing related community resources and services. For more detailed discussion regarding identified health needs you may view the CHNA and related implementation strategy at www.upmcsusquehanna.org/communityhealth. |
| Muncy Valley Hospital | Part V, Section B, Line 16i: Other method - brochure |
| Muncy Valley Hospital | Part V, Section B, Line 22d: They may also be eligible for discounts of 50%, 60%, 80%, and 100% of charges following application to our Financial Assistance Program which is a greater discount than what has been computed as amounts generally billed utilizing a look back method. |
| Part V, line 7a | https://www.susquehannahealth.org/in-the-community/community-health-nee ds-assessments |
| Part V, line 10a | https://www.susquehannahealth.org/in-the-community/community-health-nee ds-assessments |
| Part V, line 16a, FAP website | https://www.susquehannahealth.org/patients-visitors/for-patients/billin g-insurance/financial-assistance-program |
| Part V, line 16b, FAP application website | https://www.susquehannahealth.org/patients-visitors/for-patients/billin g-insurance/financial-assistance-program |
| Part V, line 16c FAP plain language summary website | https://www.susquehannahealth.org/patients-visitors/for-patients/billin g-insurance/financial-assistance-program |
Supplemental Information Detail SupplementalInformationDetail (14 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 6a: | The community benefit report is prepared on a system wide basis under UPMC Susquehanna. |
| Part I, Line 7g: | Muncy Valley Hospital has various subsidized services which are included within the Medicare and Medical Assistance unreimbursed costs. |
| Part I, Line 7, Column (f) | The Bad Debt expense included on Form 990, Part IX, Line 25 (b), but subtracted for purposes of calculating the percentage in this column is $3,670,031. |
| Part II, Community Building Activities: | Community building activities at the Muncy Valley Hospital (MVH) involves staff participation / involvement on various boards and committees to help better serve the community. |
| Part III, Line 2: | Bad debt consists of the actual bad debt written off, plus a reserve calculation based on a progressive percentage for self pay and other non-contract accounts receivable aging categories. This figure is the amount of bad debt in the audited financial statements. |
| Part III, Line 3: | An estimate of 5% is used based on looking at patients that were in bad debt status and eventually through the annual bad debt sale, determined they did not have the resources to pay and were really charity care. |
| Part III, Line 4: | The System reports patient accounts receivable for services rendered at net realizable amounts from third-party payers, patients and others. The System provides an allowance for doubtful accounts based upon a review of outstanding receivables, historical collection information and existing economic conditions. As a service to the patient, the System bills third-party payers directly and bills the patient when the patient's liability is determined. Patient accounts receivable are due in full when billed. Accounts are considered delinquent and subsequently written off as bad debts based on individual credit evaluation and specific circumstances of the account. |
| Part III, Line 8: | The costing methodology is based on a modified cost accounting system. We cost our patient data for the previous fiscal year and then we apply relational factors to the costs based on the change in charges from the prior fiscal year to the current fiscal year.Serving patients with government health benefits, such as Medicare, is a component of the community benefit standard that tax-exempt hospitals are held to. This implies that serving Medicare patients is a community benefit and that the hospital operates to promote the health of the community. |
| Part III, Line 9b: | UPMC Susquehanna will provide financial assistance under the Financial Assistance Program for patients that require medically necessary services during the period in which family income and financial resources meets the defined guidelines, and after all other payment resources have been exhausted. The UPMC Susquehanna Financial Assistance Program is always the coverage of the last resort.Eligible services include inpatient and outpatient hospital services which are medically necessary and are provided directly by UPMC Susquehanna(Hospitals and Susquehanna Physician Services) or by employees of UPMC Susquehanna for the treatment of an illness or injury.All payer resources must be exhausted. Pennsylvania Medical Assistance screening and application must be completed for all considered individuals. All other payment arrangements must be explored.The income guidelines source is the annual poverty income published in the Federal Register by the Department of Health and Human Services. The federal poverty guidelines are used to determine four tiers of UPMC Susquehanna Financial Assistance Program eligibility. Income guidelines are updated annually according to federal poverty guideline updates. Family income must be at or below the eligibility guidelines for program consideration.It is the responsibility of the patient or guarantor to initiate and complete the UPMC Susquehanna Financial Assistance Program by applying. |
| Part VI, Line 2: | The Health System engaged BKD, LLP to conduct a formal CHNA. BKD, LLP is one of the largest CPA and advisory firms in the United States, with approximately 2,000 partners and employees in 34 offices. BKD serves more than 900 hospitals and health care systems across the country. The CHNA was conducted from February 2016 to June 2016.The following steps were conducted as part of the Health System's CHNA, 1) An evaluation of the impact of actions taken to address the significant health needs identified in the tax year 2012 CHNA was completed to understand the effectiveness of the Health System's current strategies and programs. 2) The "community" served by the Health System was defined by utilizing inpatient data regarding patient origin. This process is further described in Community Served by the Health System. 3) Population demographics and socioeconomic characteristics of the community were gathered and reported utilizing various third parties. The health status of the community was then reviewed. Information on the leading causes of death and morbidity information was analyzed in conjunction with health outcomes and factors reported for the community by the Center for Disease Control and Prevention (Community Health Status Indicators). Health factors with significant opportunity for improvement were noted. 4) Community input was provided through nine key stakeholder meetings and a community health survey. Results and findings are described in the Community Input - Key Stakeholder Interviews and Survey section of the CHNA at www.upmcsusquehanna.org/communityhealth. 5) Information gathered in the above steps was analyzed and reviewed to identify health issues of uninsured persons, low-income persons and minority groups and the community as a whole. Health needs were ranked utilizing a weighing method that weighs the size of the problem, the seriousness of the problem, the impact of the issues on vulnerable populations, the prevalence of common themes, how important the issue is to the community, and how the issue aligns with the Hospital's strategic plan. 6) An inventory of health care facilities and other community resources potentially available to address the significant health needs identified through the CHNA was prepared and collaborative efforts were identified.Health needs were then prioritized taking into account the perceived degree of influence the Health System has to impact the need and the health needs impact an overall health for the community.To help see the implementation plan come to fruition an implementation team has been formed which is comprised of various individuals from community organization throughout Lycoming and Tioga counties. Such partnered organizations include Lycoming County Health Improvement Coalition, Tioga County Partnership for Community Health, River Valley YMCA, Project Bald Eagle, STEP, YWCA, PA Department of Health, to name a few. |
| Part VI, Line 3: | UPMC Susquehanna will provide financial assistance under the Financial Assistance Program for patients that require medically necessary services during the period in which family income and financial resources meets the defined guidelines, and after all other payment resources have been exhausted. The UPMC Susquehanna Financial Assistance Program is always the coverage of the last resort.The UPMC Susquehanna Financial Assistance program is an income/assets based package designed to meet the healthcare financial needs of eligible individuals and households who receive medically necessary inpatient or outpatient services from TWH, DPH, MVH, or SSMH.The first hospital claim sent to guarantors of uninsured accounts will include a statement to briefly explain the availability and contacts for referral to the Financial Assistance program. Subsequent guarantor billings also reference the availability of The Financial Assistance program.It is the responsibility for the patient or guarantor to initiate UPMC Susquehanna Financial Assistance Program by applying. It is the responsibility of the UPMC Susquehanna Finance personnel to administrate the program according to this policy. |
| Part VI, Line 4: | The hospitals that comprise UPMC Susquehanna Lycoming county operations are: The Williamsport Hospital (TWH), Divine Providence Hospital (DPH) and Muncy Valley Hospital (MVH). The county is in the north central region of the state, about three and half hours northeast of Pittsburgh and the same distance northwest of Philadelphia. Lycoming County is designated as rural and has small towns nestled within a stunning natural landscape. The City of Williamsport, with the majestic Susquehanna River running through it, is designated as urban, and is the home of Little League World Series. Unfortunately, the City of Williamsport and the surrounding rural area are also home for many individuals and families who cannot afford the primary health and dental care services provided in their county. In addition, Soldiers & Sailors Memorial Hospital (SSMH) located in Wellsboro, PA, Tioga county, is also part of UPMC Susquehanna. For a more detailed discussion regarding the community served, as well as associate socio-economic characteristics, you may view the CHNA and related Implementation plan at www.upmcsusquehannahealth.org. |
| Part VI, Line 5: | The hospitals of UPMC Susquehanna all have entity specific boards that are composed of persons who reside in Lycoming County.In addition to this UPMC Susquehanna extends medical staff privileges to all qualified physicians in the county in all areas of primary and specialty care according to the UPMC Susquehanna Medical Staff Bylaws. Bylaws excerpts pertaining to this area are as follows:3.1) Nature of Membership - Medical Staff membership is available to qualified physicians, dentists, maxillofacial/oral surgeons, and podiatrists and confers both responsibilities and prerogatives, but only as provided in these Bylaws. No physician, dentist, or podiatrist, including those employed by or otherwise under contract with the Hospital(s), may admit a patient or independently provide patient care services in the Hospital(s) unless he is a Medical Staff member with applicable clinical privileges pursuant to these Bylaws. A member shall have only those clinical privileges, including admitting privileges, as have been granted in accordance with these Bylaws.3.2) Qualifications - No individual shall be considered eligible for appointment on reappointment to the Medical Staff unless he meets each of the following required qualifications/criteria. If any change in personal or professional status occurs which would inhibit practitioner's ability to effectively meet the obligations for patient care and Medical Staff membership under these Bylaws, the practitioner shall immediately notify the Medical Director.3.2-1) Professional Licensure Qualification - A member must be a physician, dentist, or podiatrist and must be duly licensed to practice in the Commonwealth of Pennsylvania.3.2-2) Clinical Privileges Qualification - A member of the Medical Staff must have clinical privileges (or in the case of a new applicant, is granted clinical privileges at the time of the appointment), except those appointed to the Emeritus Staff or as otherwise specified in these Bylaws.3.2-3) Professional Competence - A member must demonstrate sufficient professional education, training, experience, competence, and good judgement to perform Medical Staff responsibilities and clinical privileges requested.3.2-4) Health Status - A member must have sufficient physical and mental health to perform Medical Staff responsibilities and exercise clinical privileges requested.3.2-5) Basic Responsibilities - A member must discharge the basic responsibilities of Medical Staff membership noted in 3.3-2.3.2-6) Board Certification Requirement - All practitioners who are current staff members at UPMC Susquehanna as of 7/1/10 and who have met prior qualifications for membership shall be exempt from board certification requirements.3.2-7) Standing with Federal Payors - A member must not be excluded from participation in federally funded programs such as Medicare and Medicaid.3.2-8) Waiver - The Board Certification requirement described in 3.2-6 may be waived under very special circumstances in which an applicant for Medical Staff membership is capable of providing specific unique expertise presently not available or insufficiently available on the Medical Staff which will fulfill an unmet medical need in the community. Such waiver may be granted by the Board(s) only upon recommendation of the Department Chairman, Credentials Committee, and the Medical Executive Committee (MEC)3.2-9) Prohibited Criteria - Medical Staff membership or assignment to a Medical Staff category shall not be denied, terminated, revoked, suspended, modified, or otherwise restricted based upon:(a) Gender, race, creed, color, national origin, handicap, or disability, if the individual is otherwise qualified under these Bylaws, or(b) Economic considerations as the sole or primary criterion, or(c) Any criterion not set forth as a required qualification in these Bylaws, or(d) Any other criterion lacking professional or ethical justification.3.2-10) Effect of Other Affiliations - No individual shall be granted Medical Staff membership or be assigned to any Medical Staff category merely because he:(a) Holds a certain degree,(b) Is licensed to practice in the Commonwealth of Pennsylvania or any other state,(c) Is a member of any professional organization,(d) Is certified by any clinical Board,(e) Had, or presently has, Medical Staff membership or clinical privileges at another health care facility,(f) Is employed by or is otherwise under contract with the Hospital(s) or(g) Is employed by or otherwise practices with a group composed of one or Medical Staff members. The volunteer program at UPMC Susquehanna supports the services at our 4 campuses, MVH, DPH, TWH, and SSMH as well as our LifeCenter located within the River Valley Regional YMCA in Williamsport, PA. Volunteers, ranging in age from 14, assist staff and patients in almost every department.The volunteers come from Lycoming and surrounding counties to support our services. They provide over 70,000 hours of service in both office, customer service and patient care areas to support our service partners. They become ambassadors for the hospital, make new friends, financially support the hospital, become involved in the auxiliary, remain an active member of society, often stay healthier longer, enjoy the camaraderie with staff and other volunteers, serve on hospital committees, recruit other volunteers, increase their volunteer hours and offer constructive suggestions for improvement. Volunteers are recruited through fairs, internet information and on-line applications, volunteer referrals and presentations to groups. They are a highly regarded, integral part of our operational support system. |
| Part VI, Line 6: | Muncy Valley Hospital (MVH) is one of four hospitals which are part of UPMC Susquehanna. The mission of UPMC Susquehanna is to promote health by acting as the parent of a nonprofit health system in North Central Pennsylvania and by raising funds and otherwise supporting the system. MVH is a critical access hospital, primarily serving Lycoming and surrounding counties. MVH also provides a full range of outpatient and emergency services, as well as, operates a long-term care facility.Divine Providence Hospital (DPH) is a specialty hospital that offers inpatient psychiatric services and a wide array of outpatient hospital services, as well as, home health and hospice services.The Williamsport Hospital (TWH) is an acute care community hospital providing diagnostic and treatment facilities, educational and training programs, and a rehabilitation facility.Soldiers & Sailors Memorial Hospital (SSMH) is an acute care community hospital providing diagnostic and treatment facilities, educational and training programs, and a rehabilitation facility.The hospitals treat Medicare and Medical Assistance patients and maintains a Medicare / Medical Assistance policy that provides patients enrolled in such programs with access to all covered inpatient, outpatient and diagnostic services that are available to non-Medicare / Medical Assistance patients.The community benefit report is prepared on a system-wide basis under UPMC Susquehanna. On an annual basis, UPMC Susquehanna devotes a portion of its revenue and assets to community program services. The following reflects the breakout of $94,467,383 in quantifiable community benefits reported for FY 2016: Charity Care (at cost) $1,524,334; Bad Debt (at cost) $8,097,385; Government-sponsored health care (unpaid cost of Medicare, Medicaid, indigent care programs, SCHIP and other safety net programs) $78,563,849. In addition, various other programs such as Research, Health Professions Education, Community Building, Financial and In-Kind Contributions, and Community Benefit Operations totaling $6,281,815. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Susquehanna Physician Services | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1201 Grampian Boulevard | AddressLine1Txt |
| City | Williamsport | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 17701 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 232449454 | RecipientEIN |
| IRC Section | 501(c)(3) | IRCSectionDesc |
| Cash Grant | $4,600,591 | CashGrantAmt |
| Purpose Of Grant | Support of affiliate | PurposeOfGrantTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 1 | Total501c3OrgCnt |
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 UPMC Susquehanna 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 (10 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Kevin W Kist DO | ||||||||||||||
| Director | $0 | $333,862 | $0 | $10,206 | $0 | $87,937 | $0 | $9,950 | $0 | $26,817 | $0 | $468,772 | $0 | $0 |
| Alexander R Nesbitt MD | ||||||||||||||
| Director | $0 | $219,808 | $0 | $0 | $0 | $2,795 | $0 | $12,116 | $0 | $18,433 | $0 | $253,152 | $0 | $0 |
| 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 | ||||||||||||||
| Executive VP / CFO | $0 | $252,402 | $0 | $0 | $0 | $2,755 | $0 | $9,720 | $0 | $17,629 | $0 | $282,506 | $0 | $0 |
| David Lopatofsky MD | ||||||||||||||
| Executive VP / CMO | $0 | $412,757 | $0 | $18,458 | $0 | $6,061 | $0 | $11,275 | $0 | $27,612 | $0 | $476,163 | $0 | $0 |
| Jan E Fisher | ||||||||||||||
| Executive VP / COO | $0 | $409,956 | $0 | $36,987 | $0 | $12,853 | $0 | $9,950 | $0 | $22,042 | $0 | $491,788 | $0 | $0 |
| Ronald J Reynolds | ||||||||||||||
| President | $186,722 | $0 | $19,574 | $0 | $654 | $0 | $8,353 | $0 | $24,181 | $0 | $239,484 | $0 | $0 | $0 |
| Charles J Santangelo | ||||||||||||||
| Former Exec VP/CFO (Retired 5/2/15) | $0 | $186,916 | $0 | $71,985 | $0 | $79,262 | $0 | $9,950 | $0 | $15,051 | $0 | $363,164 | $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 | $4,272 | $0 | $189,644 | $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 | $3,553 | $0 | $532,129 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 variable compensation award in the amount of $133,858. |
| 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. |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Lycoming County Authority | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 236760375 | BondIssuerEIN |
| CUSIP | NoneAvail | CUSIPNum |
| Bond Issued | 2015-06-18 | BondIssuedDt |
| Issue Price | $11,200,000 | IssuePriceAmt |
| Purpose | See Part VI | PurposeDesc |
| Defeased | 0 | DefeasedInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Pool Financing | 0 | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Total Proceeds | $11,200,000 | TotalProceedsAmt |
| Issuance Costs From Proceeds | $95,415 | IssuanceCostsFromProceedsAmt |
| Capital Expenditures | $752,580 | CapitalExpendituresAmt |
| Unspent | $10,352,005 | UnspentAmt |
| Current Refunding | 0 | CurrentRefundingInd |
| Advance Refunding | 0 | AdvanceRefundingInd |
| Final Allocation Made | 0 | FinalAllocationMadeInd |
| Adequate Books And Rec Maint | Yes (1) | AdequateBooksAndRecMaintInd |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedPropertyInd |
| Any Lease Arrangements | 0 | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | 0 | MgmtContractBondFincdPropInd |
| Any Research Agreements | 0 | AnyResearchAgreementsInd |
| Private Bus Use By Others | 0.00000 | PrivateBusUseByOthersPct |
| Private Bus Concerning UBI | 0.00000 | PrivateBusConcerningUBIPct |
| Total Private Business Use | 0.00000 | TotalPrivateBusinessUsePct |
| Bond Iss Meet Prvt Sec Pymt Test | 0 | BondIssMeetPrvtSecPymtTestInd |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedPropInd |
| Procs Nonqualified Bond Remdtd | Yes (1) | ProcsNonqualifiedBondRemdtdInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiledInd |
| Rebate Not Due Yet | 0 | RebateNotDueYetInd |
| Exception To Rebate | Yes (1) | ExceptionToRebateInd |
| No Rebate Due | 0 | NoRebateDueInd |
| Variable Rate Issue | Yes (1) | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | 0 | HedgeIdentifiedInBksAndRecInd |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGICInd |
| Gross Proceeds Invested | 0 | GrossProceedsInvestedInd |
| Written Proc To Monitor Reqs | Yes (1) | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | Yes (1) | ProceduresCorrectiveActionInd |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Schedule K, Part I, Bond A (e) and (f) | The total issue price per Form 8038, Part III (b) is $40,000,000. Of this total, $11,200,000 was allocated to Muncy Valley Hospital at the time of issue, while $24,400,000 was allocated to The Williamsport Hospital (EIN #24-0795508) and $4,400,000 was allocated to Divine Providence Hospital (EIN #24-0799343). The proceeds of the financing will be used to finance all, or a portion of projects consisting of (i) construction at Williamsport Hospital, Patient Tower 4th Floor of three (3) Operating Rooms, four (4) Cardiology procedural rooms, and related clinical equipment; (ii) renovation at Williamsport Hospital, East Building 2nd Floor of existing entrance and interior hallway space to improve patient throughput; create a new Pre-Admission Testing area; and expand clinical staff locker area; (iii) installation at Williamsport Hospital, Energy Services Center, of 1,000 ton chiller and cooling tower creating new capacity to support the added demand from the Health Innovation Center and Patient Tower and creating additional back-up capacity; (iv) replacement at Williamsport Hospital, West Building and Energy Center, of the hot water system with hot water sourced from the Energy Services Center, thus providing more efficient hot water and heating to the West Building; (v) construction of Muncy Valley Hospital, Emergency Room expansion and renovation of a 5,400 square foot addition and 11,000 square feet of renovation to upgrade and expand the Emergency Department, installing eight (8) private bed rooms and five (5) specialty rooms, upgraded Radiology; and site-work to relocate Shady Lane, and create a new walk-in entrance, parking lot, and helipad; (vi) renovation at Divine Providence Hospital, Health Sciences Building 2nd Floor, to accommodate the relocation of Sports Medicine from the hospital, creating additional examination rooms and offices to accommodate seven (7) clinical providers and two (2) additional Radiology rooms, with related clinical equipment; (vii) renovation at Divine Providence Hospital, 1st Floor, to accommodate the expansion of the Work Center and relocation of Radiology services; (viii)renovation at Divine Providence Hospital, 1st Floor, to accommodate expansion of the Cancer Center to provide twelve (12) additional examination rooms, physician and management offices and nurse stations; (ix) the funding of any necessary reserves, and (x) the payment of all or a portion of the costs of the Financing. |
| Form 990, Schedule K, Part II, Bond A, Line 3 | This issue is a draw-down obligation from which funds are not requested and drawn until capital expenditures have been incurred. |
| Form 990, Schedule K, Part IV, Bond A, Line 2c | As a draw-down obligation with no funds held in investments, rebate calculation requirements are not applicable. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part V, Line 1A | 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 | UPMC Susquehanna EIN #23-2751183 utilities a common paymaster which includes the following entities: Divine Providence Hospital EIN #24-0799343 Muncy Valley Hospital EIN #24-0806023 The Williamsport Hospital EIN #24-0795508 Susquehanna Health Foundation EIN #23-2743470 Susquehanna Physician Services EIN #23-2449454 Susquehanna Ventures, Inc. EIN #23-2470263 Williamsport Area Ambulance Services EIN #23-2416166 Laurel Management Services EIN #25-1644910 Laurel Realty EIN #23-1403678 Soldiers & Sailors Memorial Hospital EIN #23-2176963 The Green Home EIN #24-0804365 Tioga Health Care Providers EIN #25-1765538 Tyoga Carenet EIN #25-1810967 The total number of employees reported on Form W-3 would be 3,871 for UPMC Susquehanna EIN #23-2751183. Of that total, 306 employees payroll expenses were recorded by Muncy Valley Hospital. |
| Form 990, Part VI, Section A, line 6 | UPMC Susquehanna, EIN # 23-2751183, is the sole member of the governing body. |
| Form 990, Part VI, Section A, line 7a | UPMC Susquehanna, EIN # 23-2751183, may elect or remove members of the governing body. |
| Form 990, Part VI, Section A, line 7b | All the business and affairs of the corporation shall be managed and controlled by the Board of Directors, subject to the oversight of the Member of the management and operation of the corporation, except that the following powers are reserved exclusively to the sole Member of the corporation, and no attempted exercise of any such powers by anyone other than the sole Member shall be valid or of any force or effect whatsoever. The sole Member shall exercise its powers through its Board of Directors. The Member shall have the exclusive authority to exercise the following powers: A) To approve the appointment and removal of the President of the corporation subject to all applicable provisions of the Creation agreement. B) To elect and remove, with or without cause, a Director of the corporation. C) To establish the overall policy and long range plans of the corporation, determine or change the mission of the corporation, approve the programs and services of the corporation and the termination of any programs or services of the corporation, and monitor and maintain the philosophy, goals and purposes for which the corporation was formed and exists, subject to and in accordance with the provisions of the Creation agreement. D) To adopt, amend or repeal the Articles of Incorporation or these bylaws. E) To establish requirements for a unified budget, the approval of new capital debt, any increment to any existing capital debt, and/or any change in capital debt obligations of the corporation. F) To establish requirements for the approval of the acquisition, purchase, sale, leasing outside the ordinary course of business, transfer outside the ordinary 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. G) To require a certified audit of corporate funds at any time. H) 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 assets of the corporation outside the ordinary course of business, or any transfer of any assets of the corporation outside the ordinary course of business, except transfers between or among affiliated corporations. I) To approve any merger, consolidation, organization, reorganization, joint venture or other modification of corporate structure or affiliations affecting the autonomy, governance, or operations of the corporation. J) To dissolve or terminate the existence of the corporation and determine the distribution of assets upon such termination or dissolution, as provided in these bylaws. K) To appoint annually the external fiscal auditor of the corporation. L) To approve the nominees for elected officers of the Board of Directors of the corporation, and to return the list of approved nominees to the Board of Directors for election. M) To remove any elected officer of the corporation; N) To approve the annual capital and operating budget of the corporation; O) To coordinate managed care plans, including decisions concerning entry into or renewal of any contract or agreement relating thereto. |
| 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, #23-2751183) before filing and complete drafts of all returns are made available to all board members through the CEO's and CFO's office. |
| Form 990, Part VI, Section B, line 12c | As required by law, Hospital policy states that all members of the Board of Managers must sign a statement each year disclosing any conflict of interest that may arise and agree to abstain when issues involving those parties with conflicting interests are called to motion. Any conflicts of interest are reviewed by the Hospital's attorneys. |
| Form 990, Part VI, Section B, line 15 | Form 990, Part VI, line 15a & 15b: All top management officials are paid by The Williamsport Hospital, EIN # 24-0795508. 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 that 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 the public upon request. |
| Form 990, Part IX, line 11g | Other: Program service expenses 3,723,946. Management and general expenses 147,701. Fundraising expenses 0. Total expenses 3,871,647. Physician / Medical fees: Program service expenses 1,057,219. Management and general expenses 112,325. Fundraising expenses 0. Total expenses 1,169,544. Aramark contracted services: Program service expenses 2,617,769. Management and general expenses 0. Fundraising expenses 0. Total expenses 2,617,769. |
| Form 990, Part XI, line 9: | Change in net asset of affiliate -14,923. |
| Form 990, Part XII, Line 2C | The organization did not change its oversight process or selection process. |
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 Sister of Christian Charity | |||||||||||
| 1100 Grampian Boulevard | Williamsport | PA | 17701 | 240799343 | Hospital | PA | 501(c)(3) | 3 | UPMC Susquehanna | 0 | |
| The Williamsport Hospital | |||||||||||
| 700 High Street | Williamsport | PA | 17701 | 240795508 | Hospital | PA | 501(c)(3) | 3 | UPMC Susquehanna | 0 | |
| UPMC Susquehanna | |||||||||||
| 1205 Grampian Boulevard | Williamsport | PA | 17701 | 232751183 | Coordinate & manage the delivery of healthcare | PA | 501(c)(3) | 11 A I | 0 | N/A | |
| Susquehanna Health Foundation | |||||||||||
| 1100 Grampian Boulevard | Williamsport | PA | 17701 | 232743470 | Fundraising for affiliated entities | PA | 501(c)(3) | 11 A I | UPMC Susquehanna | 0 | |
| Susquehanna Physician Services | |||||||||||
| 1201 Grampian Boulevard | Williamsport | PA | 17701 | 232449454 | Physician services & MRI services | PA | 501(c)(3) | 3 | UPMC Susquehanna | 0 | |
| Williamsport Area Ambulance Service Cooperative | |||||||||||
| 700 High Street | Williamsport | PA | 17701 | 232416166 | Ambulance transports | PA | 501(c)(3) | 9 | 0 | N/A | |
| Soldiers & Sailors Memorial Hospital | |||||||||||
| 32-36 Central Avenue | Wellsboro | PA | 16901 | 232176963 | Hospital | PA | 501(c)(3) | 3 | UPMC Susquehanna | 0 | |
| The Green Home | |||||||||||
| 37 Central Avenue | Wellsboro | PA | 16901 | 240804365 | Skilled nursing & assisted living | PA | 501(c)(3) | 9 | UPMC Susquehanna | 0 | |
| Tioga Health Care Providers | |||||||||||
| 15 Meade Streeet | Wellsboro | PA | 16901 | 251765538 | Physician services | PA | 501(c)(3) | 11 B II | UPMC Susquehanna | 0 | |
| Laurel Management Services | |||||||||||
| 15 Meade Streeet | Wellsboro | PA | 16901 | 251644910 | Mgmt consulting & supervisory svcs | PA | 501(c)(3) | 11 B II | UPMC Susquehanna | 0 | |
| Laurel Realty | |||||||||||
| 15 Meade Streeet | Wellsboro | PA | 16901 | 231403678 | Own & manage real estate | PA | 501(c)(2) | N/A | UPMC Susquehanna | 0 | |
| Laurel Health System | |||||||||||
| 15 Meade Streeet | Wellsboro | PA | 16901 | 240795488 | Coordinate & manage the delivery of healthcare | PA | 501(c)(3) | 11 B II | UPMC Susquehanna | 0 | |
| Laurel Health Foundation | |||||||||||
| 15 Meade Streeet | Wellsboro | PA | 16901 | 251810488 | Fundraising for affiliated entities | PA | 501(c)(3) | 11 A 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) | 11 A 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 Boulevard | 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 |
| Disproportionate Allocations | 0 | DisproportionateAllocationsInd |
| General Or Managing Partner | 0 | GeneralOrManagingPartnerInd |
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 | CityForeignAddress/CityNm | CountryForeignAddress/CountryCd | Foreign PostalForeignAddress/ForeignPostalCd | Legal Domicile Foreign CountryLegalDomicileForeignCountryCd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Susquehanna Ventures Inc | ||||||||||||||
| 1201 Grampian Boulevard | 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 | Grand Caymans | CJ | KY1-1102 | 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 | Yes (1) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (1) | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (1) | 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 |