Tioga Health Care Providers Inc: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- Tioga Health Care Providers Inc (EIN 25-1765538)
- Tax period
- 2015-07-01 to 2016-06-30
- Filed
- 2017-05-11
- IRS object ID
- 201721319349303562
- 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 ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-05-11T13:44:47-05:00 | ReturnTs |
| Tax Period End | 2016-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 440160260 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BKD LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 910 E St Louis St | AddressLine1Txt |
| City | Springfield | CityNm |
| State Abbreviation | MO | StateAbbreviationCd |
| ZIP | 658062523 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2015-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 251765538 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Tioga Health Care Providers Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | TIOG | BusinessNameControlTxt |
| Phone | 5703268753 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1705 Warren Ave No 302 | AddressLine1Txt |
| City | Williamsport | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 17701 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Eric D Pohjala | PersonNm |
| Person Title | Executive Vice President/CFO | PersonTitleTxt |
| Phone | 5703213175 | PhoneNum |
| Signature | 2017-05-11 | 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) |
|---|---|---|
| Address Change | Yes (X) | AddressChangeInd |
| 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 | $9,192,376 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | SUSQUEHANNAHEALTH.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1995 | FormationYr |
| Legal Domicile State | PA | LegalDomicileStateCd |
| Activity Or Mission | Tioga Health Care Providers 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 a world-class health system. 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. | ActivityOrMissionDesc |
| Voting Members Governing Body | 16 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 11 | VotingMembersIndependentCnt |
| Total Employee | 65 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $0 | PYContributionsGrantsAmt |
| CY Contributions Grants | $0 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $9,206,331 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $9,180,962 | CYProgramServiceRevenueAmt |
| PY Investment Income | $12,246 | PYInvestmentIncomeAmt |
| CY Investment Income | $11,414 | CYInvestmentIncomeAmt |
| PY Other Revenue | -$35,709 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $9,182,868 | PYTotalRevenueAmt |
| CY Total Revenue | $9,192,376 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $10,232,526 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $10,408,762 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $3,401,151 | PYOtherExpensesAmt |
| CY Other Expenses | $3,832,794 | CYOtherExpensesAmt |
| PY Total Expenses | $13,633,677 | PYTotalExpensesAmt |
| CY Total Expenses | $14,241,556 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$4,450,809 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$5,049,180 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $5,020,265 | TotalAssetsBOYAmt |
| Total Assets EOY | $8,521,474 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $19,357,716 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $27,908,105 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | -$14,337,451 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | -$19,386,631 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | Tioga Health Care Providers is a subsidiary of UPMC Susquehnanna The mission of SHS is as follows: To extend God's healing love by improving the health of those we serve. Our vision is to create a world-class health system. Our values are putting patients first, sharing ownership and being servant leaders. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $13,921,968 | ExpenseAmt |
| Revenue | $9,180,962 | RevenueAmt |
| Desc | Tioga Health Care Providers (THCP) is comprised of a group of emergency, internal medicine, and specialty physicians. The services primarily serve Tioga county. For the fiscal year ended June 30, 2016 there were approximately 43,170 outpatient visits and 6,209 inpatient visits for THCP. | Desc |
| Total Program Service Expenses | $13,921,968 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 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 | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | Yes (1) | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 65 | 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 | 16 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 11 | 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 | UPMC Susquehanna Medical Group Finance | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 5703268756 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1705 Warren Ave Suite 302 | AddressLine1Txt |
| City | Williamsport | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 17701 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (27 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|---|
| Ronald V Defeo Jr | ||||||||||
| Director | 2.00 | 4.00 | Yes (X) | $0 | $0 | $0 | ||||
| Ann S Pepperman Esquire | ||||||||||
| Chairperson | 2.00 | 4.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |||
| Dsvie Jane Gilmour Ph D | ||||||||||
| Vice-Chairperson | 2.00 | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |||
| Sister Teresa Ann Jacobs | ||||||||||
| Secretary | 2.00 | 4.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |||
| Ronald E DiSimone MD | ||||||||||
| Director | 2.00 | 42.00 | Yes (X) | $0 | $1,066,958 | $34,314 | ||||
| Steven P Johnson | ||||||||||
| President/CEO UPMC Susquehanna | 2.00 | 50.00 | Yes (X) | $0 | $832,199 | $35,182 | Yes (X) | |||
| Daniel A Klingerman | ||||||||||
| Director | 2.00 | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| Lynda Livingston | ||||||||||
| Director | 2.00 | 4.00 | Yes (X) | $0 | $0 | $0 | ||||
| Philip H Johnson | ||||||||||
| Director | 2.00 | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| James E Mothersbaugh | ||||||||||
| 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 | ||||
| Kevin Kist MD | ||||||||||
| Director | 2.00 | 46.00 | Yes (X) | $0 | $432,065 | $34,767 | ||||
| Dr J Dennis Murray | ||||||||||
| Director | 2.00 | 4.00 | Yes (X) | $0 | $0 | $0 | ||||
| Glenn Poirer | ||||||||||
| Director | 2.00 | 4.00 | Yes (X) | $0 | $0 | $0 | ||||
| Thomas M Owlett Esquire | ||||||||||
| Director | 2.00 | 4.00 | Yes (X) | $0 | $0 | $0 | ||||
| Jill A Burns MD | ||||||||||
| Director | 40.00 | 2.00 | Yes (X) | $296,503 | $0 | $37,541 | ||||
| Eric D Pohjala | ||||||||||
| Exec VP/CFO | 2.00 | 40.00 | $0 | $255,157 | $27,349 | Yes (X) | ||||
| Jan E Fisher | ||||||||||
| Exec VP/COO | 2.00 | 40.00 | $0 | $459,806 | $31,992 | Yes (X) | ||||
| David Lopatofsky MD | ||||||||||
| Exec VP/CMO | 2.00 | 40.00 | $0 | $437,276 | $38,887 | Yes (X) | ||||
| Donald Golobek | ||||||||||
| Physician | 40.00 | $709,052 | $0 | $28,225 | Yes (X) | |||||
| Robert E Metts MD | ||||||||||
| Physician | 40.00 | $334,583 | $0 | $19,149 | Yes (X) | |||||
| Perry E Doan Jr MD | ||||||||||
| Physician | 40.00 | $362,134 | $0 | $39,000 | Yes (X) | |||||
| Rhichard M Thompson DO | ||||||||||
| physician | 40.00 | $356,783 | $0 | $32,124 | Yes (X) | |||||
| Donald Shaw MD | ||||||||||
| Physician | 40.00 | $355,161 | $0 | $33,128 | Yes (X) | |||||
| Charles J Santangelo | ||||||||||
| Former Evec VP/CFO - Retired5/2/16 | 0.00 | 40.00 | $0 | $338,073 | $24,988 | Yes (X) | ||||
| William C McCauley MD | ||||||||||
| Former Exec VP/CMO Retired /Per Diem 1/31/15 | 0.00 | 40.00 | $0 | $185,372 | $4,271 | Yes (X) | ||||
| Ronald J Butler | ||||||||||
| Former Evec VP/CBO - Retired 4/15/16 | 0.00 | 40.00 | $0 | $518,626 | $13,502 | Yes (X) | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,414,216 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $4,748,135 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $464,968 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 31 | 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 (3 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Medicus Emergency Room Service | |||||
| 22 Roulston Rd | Windham | NH | 03087 | Locum Services | $563,110 |
| CompHealth Medical Staffing | |||||
| PO Box 972651 | Dallas | TX | 75397 | Locum Services | $455,295 |
| Alliance Recruiting Resource Inc | |||||
| PO Box 678416 | Dallas | TX | 75267 | Locum Services | $123,192 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 3 | CntrctRcvdGreaterThan100KCnt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Emergency Department | 621111 | $2,382,344 | $2,382,344 |
| Internal Medicine | 621111 | $1,526,753 | $1,526,753 |
| Inter-Entity SSA | 621110 | $1,177,584 | $1,177,584 |
| Anesthesia | 621111 | $888,986 | $888,986 |
| General Surgery | 621111 | $785,058 | $785,058 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,420,237 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $2,420,237 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $9,180,962 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $11,414 | TotalRevenueColumnAmt |
| Exclusion | $11,414 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $9,192,376 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $9,180,962 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $11,414 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $296,503 | TotalAmt |
| Program Services | $296,503 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,697,127 | TotalAmt |
| Program Services | $8,605,061 | ProgramServicesAmt |
| Management And General | $92,066 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $290,856 | TotalAmt |
| Program Services | $288,056 | ProgramServicesAmt |
| Management And General | $2,800 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $714,105 | TotalAmt |
| Program Services | $700,204 | ProgramServicesAmt |
| Management And General | $13,901 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $410,171 | TotalAmt |
| Program Services | $403,128 | ProgramServicesAmt |
| Management And General | $7,043 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $130,612 | TotalAmt |
| Management And General | $130,612 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,587,096 | TotalAmt |
| Program Services | $1,541,077 | ProgramServicesAmt |
| Management And General | $46,019 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,506 | TotalAmt |
| Program Services | $6,506 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $367,246 | TotalAmt |
| Program Services | $357,603 | ProgramServicesAmt |
| Management And General | $9,643 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $943 | TotalAmt |
| Program Services | $943 | ProgramServicesAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $346,393 | TotalAmt |
| Program Services | $345,389 | ProgramServicesAmt |
| Management And General | $1,004 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,914 | TotalAmt |
| Program Services | $2,576 | ProgramServicesAmt |
| Management And General | $338 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $64,175 | TotalAmt |
| Program Services | $63,203 | ProgramServicesAmt |
| Management And General | $972 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $53,603 | TotalAmt |
| Program Services | $39,424 | ProgramServicesAmt |
| Management And General | $14,179 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $632,005 | TotalAmt |
| Program Services | $631,499 | ProgramServicesAmt |
| Management And General | $506 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Provision for Doubtful | $507,264 | $507,264 | |
| Maintenance Contracts | $55,596 | $55,506 | $90 |
| Books/Subscriptions/Due | $38,316 | $37,901 | $415 |
| Minor Equipment | $24,359 | $24,359 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,766 | TotalAmt |
| Program Services | $15,766 | ProgramServicesAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,241,556 | TotalAmt |
| Program Services | $13,921,968 | ProgramServicesAmt |
| Management And General | $319,588 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $220,420 | BOYAmt |
| EOY | $1,914,637 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,008,358 | BOYAmt |
| EOY | $1,443,101 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $182,466 | BOYAmt |
| EOY | $136,612 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $116,302 | BOYAmt |
| EOY | $68,741 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $887,084 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $448,741 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $173,218 | BOYAmt |
| EOY | $438,343 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,319,501 | BOYAmt |
| EOY | $4,520,040 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,020,265 | BOYAmt |
| EOY | $8,521,474 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,145,641 | BOYAmt |
| EOY | $1,694,204 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,212,075 | BOYAmt |
| EOY | $26,213,901 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,357,716 | BOYAmt |
| EOY | $27,908,105 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$14,337,451 | BOYAmt |
| EOY | -$19,386,631 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$14,337,451 | BOYAmt |
| EOY | -$19,386,631 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,020,265 | BOYAmt |
| EOY | $8,521,474 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$5,049,180 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| 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) |
|---|---|---|
| Supporting Organization509a3 | Yes (X) | SupportingOrganization509a3Ind |
| Supporting Org Type2 | Yes (X) | SupportingOrgType2Ind |
| Supported Organizations | 1 | SupportedOrganizationsCnt |
Supported Org Information SupportedOrgInformationGrp
Supported Organization Name SupportedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Soldiers and Sailors Memorial Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 232176963 | EIN |
| Organization Type | 3 | OrganizationTypeCd |
| Governing Document Listed | Yes (1) | GoverningDocumentListedInd |
| Support | $0 | SupportAmt |
| Other Support | $0 | OtherSupportAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supported Organizations Total | 1 | SupportedOrganizationsTotalCnt |
| Support Sum | $0 | SupportSumAmt |
| Other Support Sum | $0 | OtherSupportSumAmt |
Form990 Sch A Supporting Org Form990SchASupportingOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Listed By Name Governing Doc | Yes (1) | ListedByNameGoverningDocInd |
| Suprt Org No IRS Determination | 0 | SuprtOrgNoIRSDeterminationInd |
| Supported Org Section C456 | 0 | SupportedOrgSectionC456Ind |
| Supported Org Not Organized US | 0 | SupportedOrgNotOrganizedUSInd |
| Organization Change Suprt Org | 0 | OrganizationChangeSuprtOrgInd |
| Support Non Supported Org | 0 | SupportNonSupportedOrgInd |
| Payment Substantial Contribtr | 0 | PaymentSubstantialContribtrInd |
| Loan Disqualified Person | 0 | LoanDisqualifiedPersonInd |
| Controlled Disqualified Prsn | 0 | ControlledDisqualifiedPrsnInd |
| Disqualified Prsn Controll Int | 0 | DisqualifiedPrsnControllIntInd |
| Disqualified Prsn Ownr Int | 0 | DisqualifiedPrsnOwnrIntInd |
| Excess Business Holdings Rules | 0 | ExcessBusinessHoldingsRulesInd |
| Contribution Controller | 0 | ContributionControllerInd |
| Contribution Family | 0 | ContributionFamilyInd |
| Contribution35 Controlled | 0 | Contribution35ControlledInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Majority Dir Trst Supported Org | Yes (1) | MajorityDirTrstSupportedOrgInd |
Schedule D IRS990ScheduleD
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $637,888 | OtherCostOrOtherBasisAmt |
| Depreciation | $448,741 | DepreciationAmt |
| Book Value | $189,147 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $249,196 | OtherCostOrOtherBasisAmt |
| Book Value | $249,196 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $438,343 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Due From Affiliates | Desc |
| Book Value | $4,520,040 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $4,520,040 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| Estimated Legal Liabilities Cost | $159,960 |
| Due to Affiliates | $26,053,941 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $26,213,901 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $8,685,112 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | -$507,264 | OtherRevenueAmt |
| Revenue Not Reported | -$507,264 | RevenueNotReportedAmt |
| Revenue Subtotal | $9,192,376 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $9,192,376 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $13,734,292 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $13,734,292 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $507,264 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $507,264 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $14,241,556 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (3 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 that review, management has not identified any material uncertain tax positions to be recorded or disclosed in the financial statements. |
| Part XI Line 2d | Bad Debt $(507,264) |
| Part XII Line 4b | Bad Debt $507,264 |
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 | Yes (1) | 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 (16 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Ronald E DiSimone MD | ||||||||||||||
| Director | $0 | $1,031,528 | $0 | $0 | $0 | $35,430 | $0 | $9,950 | $0 | $24,364 | $0 | $1,101,272 | $0 | $0 |
| Steven P Johnson | ||||||||||||||
| President/CEO UPMC Susquehanna | $0 | $668,195 | $0 | $133,858 | $0 | $30,146 | $0 | $15,925 | $0 | $19,257 | $0 | $867,381 | $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 |
| Kevin Kist MD | ||||||||||||||
| Director | $0 | $333,862 | $0 | $10,206 | $0 | $87,997 | $0 | $9,950 | $0 | $26,817 | $0 | $468,832 | $0 | $0 |
| Jill A Burns MD | ||||||||||||||
| Director | $247,243 | $0 | $44,446 | $0 | $4,814 | $0 | $9,950 | $0 | $27,591 | $0 | $334,044 | $0 | $0 | $0 |
| Eric D Pohjala | ||||||||||||||
| Exec VP/CFO | $0 | $252,402 | $0 | $0 | $0 | $2,755 | $0 | $9,720 | $0 | $17,629 | $0 | $282,506 | $0 | $0 |
| Jan E Fisher | ||||||||||||||
| Exec VP/COO | $0 | $409,956 | $0 | $36,987 | $0 | $12,863 | $0 | $9,950 | $0 | $22,042 | $0 | $491,798 | $0 | $0 |
| David Lopatofsky MD | ||||||||||||||
| Exec VP/CMO | $0 | $412,757 | $0 | $18,458 | $0 | $6,061 | $0 | $11,275 | $0 | $27,612 | $0 | $476,163 | $0 | $0 |
| Donald Golobek | ||||||||||||||
| Physician | $706,126 | $0 | $0 | $0 | $2,926 | $0 | $7,950 | $0 | $20,275 | $0 | $737,277 | $0 | $0 | $0 |
| Robert E Metts MD | ||||||||||||||
| Physician | $323,726 | $0 | $0 | $0 | $10,857 | $0 | $9,800 | $0 | $9,349 | $0 | $353,732 | $0 | $0 | $0 |
| Perry E Doan Jr MD | ||||||||||||||
| Physician | $312,613 | $0 | $2,500 | $0 | $47,021 | $0 | $9,950 | $0 | $29,050 | $0 | $401,134 | $0 | $0 | $0 |
| Rhichard M Thompson DO | ||||||||||||||
| physician | $353,904 | $0 | $0 | $0 | $2,879 | $0 | $9,950 | $0 | $22,174 | $0 | $388,907 | $0 | $0 | $0 |
| Donald Shaw MD | ||||||||||||||
| Physician | $296,307 | $0 | $6,100 | $0 | $52,754 | $0 | $9,950 | $0 | $23,178 | $0 | $388,289 | $0 | $0 | $0 |
| Charles J Santangelo | ||||||||||||||
| Former Evec VP/CFO - Retired5/2/16 | $0 | $186,916 | $0 | $71,895 | $0 | $79,262 | $0 | $9,950 | $0 | $15,038 | $0 | $363,061 | $0 | $0 |
| William C McCauley MD | ||||||||||||||
| Former Exec VP/CMO Retired /Per Diem | $0 | $108,272 | $0 | $45,384 | $0 | $31,716 | $0 | $0 | $0 | $4,271 | $0 | $189,643 | $0 | $0 |
| Ronald J Butler | ||||||||||||||
| Former Evec VP/CBO - Retired 4/15/16 | $0 | $112,293 | $0 | $32,105 | $0 | $374,228 | $0 | $9,950 | $0 | $3,552 | $0 | $532,128 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 3 | The Williamsport Hospital EIN #24-0795508, a related organization, uses the following resources to establish the compensation of the top management officials: compensation committee, independent compensation consultant, written employment contract, compensation survey or study, and approval by the board. |
| Part I, Line 6 | Bonuses may be paid to a physician contingent upon the practice's net income. The practice's net income is determined from total charges less contractual adjustments less practice expense. A Physician's compensation may be increased by an amount equal to the excess net income. In order for the Leadership Team to participate in the annual Variable Compensation Incentive Program (VCIP), a minimum operating margin must be achieved for the most recently completed year on a consolidated system-level basis. Individual goals and objectives related to the VCIP may also include individual entity operating performance. For FY 2016, the minimum threshold was met that would trigger a VCIP payment. In December 2015, President/CEO Steven P. Johnson received a variable compensation award in the amount of $133,858. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 1 | All 1099s were issued by UPMC Susquehanna, EIN 23-2751183. All expenses are then allocated back to all related entities. |
| 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 | UMPC 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 power through its Board of Directors. The Member shall have exclusive authority to exercise the following powers: A. To approve the appointment and removal of the President of the corporation. 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 monitor and maintain the philosophy, goals and purposes for which the corporation was formed and exists. D. To adopt, amend or repeal the Articles of Incorporation or the 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 the 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 cause of business or encumbrance outside the normal course of business of land or buildings and the construction of 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 indebtedness of any person, the granting of any security interest in or the creation of any encumbrance on any asset of the corporation outside the ordinary course of business, or any transfer of any asset of the corporation outside the normal 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 to 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 the 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 ay 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, SPS 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 System's attorneys. |
| Form 990, Part VI, Section B, line 15 | The board of directors, through the Executive 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 of Health Systems. In addition, other regional survey data is provided in order to supply the health system with a "national" picture of compensation. With this process established, the executive compensation committee takes the proper steps to educate the Board of Directors to understand all of the above mentioned oversight and to appropriately prepare them for community or media inquiry. In addition, the Board is made aware of the form 990 and its role in the communication of information to the public. |
| Form 990, Part VI, Section C, line 19 | The organization makes its governing documents, conflict of interest policy, and financial statements available to the public upon request. |
| Form 990, Part IX, line 11g | Billing Service Fees: Program service expenses 391,402. Management and general expenses 0. Fundraising expenses 0. Total expenses 391,402. Inter Entity Tioga: Program service expenses 1,100. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,100. Inter Entity Hskpg Tioga: Program service expenses 18,785. Management and general expenses 0. Fundraising expenses 0. Total expenses 18,785. Other Purchased Services: Program service expenses 1,128,340. Management and general expenses 46,019. Fundraising expenses 0. Total expenses 1,174,359. Inter Entity Purchased Services: Program service expenses 1,450. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,450. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (15 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Laurel Health System Inc | |||||||||||
| 22 Walnut St | Wellsboro | PA | 16901 | 240795488 | Support entities affiliated with Laurel Health | PA | 501(c)(3) | Line 11b, II | UPMC Susquehanna | 0 | |
| Laurel Realty | |||||||||||
| 22 Walnut St | Wellsboro | PA | 16901 | 231403678 | Own and manage real estate in support of Laurel Health | PA | 501(c)(2) | N/A | UPMC Susquehanna | 0 | |
| Laurel Management Services | |||||||||||
| 22 Walnut St | Wellsboro | PA | 16901 | 251644910 | Management consulting and supervisory services | PA | 501(c)(3) | Line 11b, II | UPMC Susquehanna | 0 | |
| Soldiers and Sailors Memorial Hospital | |||||||||||
| 32-36 Central Ave | Wellsboro | PA | 16901 | 232176963 | Operate acute care hospital | PA | 501(c)(3) | Line 3 | UPMC Susquehanna | 0 | |
| UPMC Susquehanna | |||||||||||
| 1205 Grampian Blvd | Williamsport | PA | 17701 | 232751183 | Coordinate & manage the delivery of healthcare | PA | 501(c)(3) | Line 11b, II | 0 | N/A | |
| The Green Home | |||||||||||
| 37 Central Ave | Wellsboro | PA | 16901 | 240804365 | Operate skilled nursing & assisted living facility | PA | 501(c)(3) | Line 9 | UPMC Susquehanna | 0 | |
| Divine Providence Hospital | |||||||||||
| 110 Grampian Blvd | Williamsport | PA | 17701 | 240799343 | Hospital | PA | 501(c)(3) | Line 3 | UPMC Susquehanna | 0 | |
| Muncy Valley Hospital | |||||||||||
| 215 E Water St | Muncy | PA | 17756 | 240806023 | Hospital | PA | 501(c)(3) | Line 3 | UPMC Susquehanna | 0 | |
| The Williamsport Hospital | |||||||||||
| 700 High St | Williamsport | PA | 17701 | 240795508 | Hospital | PA | 501(c)(3) | Line 3 | UPMC Susquehanna | 0 | |
| Susquehanna Health Foundation | |||||||||||
| 1100 Grampian Blvd | Williamsport | PA | 17701 | 232743470 | Fundraising for affiliated entities | PA | 501(c)(3) | Line 11a, I | UPMC Susquehanna | 0 | |
| Susquehanna Physician Services | |||||||||||
| 1201 Grampian Blvd | Williamsport | PA | 17701 | 232449454 | Physician Services & MRI Services | PA | 501(c)(3) | Line 3 | UPMC Susquehanna | 0 | |
| Williamsport Area Ambulance Service Cooperative | |||||||||||
| 700 Health St | Williamsport | PA | 17701 | 232416166 | Ambulance Transports | PA | 501(c)(3) | Line 9 | 0 | N/A | |
| Laurel Health Foundation | |||||||||||
| 22 Walnut St | Wellsboro | PA | 16901 | 251810488 | Fundraising for affiliated entities | PA | 501(c)(3) | Line 11a, I | UPMC Susquehanna | 0 | |
| North Penn Comprehensive Health Services | |||||||||||
| 22 Walnut St | Wellsboro | PA | 16901 | 231889724 | Provide general health and social service programs | PA | 501(c)(3) | Line 3 | Laurel Health System | 0 | |
| Susquehanna Health Innovation | |||||||||||
| 700 High St | Williamsport | PA | 17701 | 471600873 | Supporting organization of affiliated entities | PA | 501(c)(3) | Line 11a, I | UPMC Susquehanna | 0 | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Community Basket LLC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1205 Grampian Blvd | AddressLine1Txt |
| City | Williamsport | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 17701 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 201195739 | EIN |
| Primary Activities | Rents real estate | PrimaryActivitiesTxt |
| Legal Domicile State | PA | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | UPMC Susquehanna | 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 | Province Or StateForeignAddress/ProvinceOrStateNm | CountryForeignAddress/CountryCd | Legal Domicile Foreign CountryLegalDomicileForeignCountryCd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Tyoga Carenet | |||||||||||||
| 114 East Avenue | Wellsboro | PA | 16901 | 251810967 | Integrate Healthcare regionally | PA | UPMC Susquehanna | C | 0 | ||||
| Susquehanna Health System Insurance Network LTD | |||||||||||||
| 980458722 | Captive Insurance Company | UPMC Susquehanna | 0 | PO Box 1159 | Grand Caymans | CJ | CJ | ||||||
| Susquehanna Ventures Inc | |||||||||||||
| 1201 Grampian Blvd | Williamsport | PA | 17701 | 232470263 | Pharmacy & Infusion Services | 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 | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | Yes (1) | 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 | Yes (1) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp
Other Organization Name OtherOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Laurel Realty | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | J | TransactionTypeTxt |
| Involved | $291,636 | InvolvedAmt |
| Method Of Amount Determination | Market Value | MethodOfAmountDeterminationTxt |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule R, Part III | Identification of Related Organizations Taxable as Partnership: Name of Related Organization: Community Basket, LLC. Direct Controlling Entity: Susquehanna Health System & Susuquehanna Health Foundation |
| Schedule R, Part IV | Susquehanna Health System Insurance Network, LTD (SHSIN), EIN #98-0458722 is a foreign corporation, incorporated under the laws of the Cayman Islands. There are no income, capital, or premium taxes levied in the Cayman Islands and SHSIN has been granted an exemption until September 2022 for any such taxes that might be introduced. SHSIN's sole shareholder, UPMC Susquehanna EIN #23-2751183, is a 501(c)(3) organization exempt from federal income taxes. SHSIN conducts no business in the United States. It files an 1120F protective filing which implies that its income is not subject to US federal income tax. |