UPMC: Form 990, tax year 2015

View the entire original 990 at ProPublica ↗

Organization: UPMC (EIN 24-0799343)
Tax period: 2015-07-01 to 2016-06-30
Filed: 2017-05-02
IRS object ID: 201731229349300308
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	2017-05-02T07:38:49-05:00	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 Suite 200	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	240799343	EIN

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	Divine Providence Hospital of the	BusinessNameLine1Txt
Business Name Line2	Sisters of Christian Charity	BusinessNameLine2Txt

Field	Value	IRS element (for citing)
Business Name Control	DIVI	BusinessNameControlTxt
Phone	5703207900	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	1100 Grampian Boulevard	AddressLine1Txt
City	Williamsport	CityNm
State Abbreviation	PA	StateAbbreviationCd
ZIP	17701	ZIPCd

Business Officer BusinessOfficerGrp

Field	Value	IRS element (for citing)
Person	Eric D Pohjala	PersonNm
Person Title	Executive Vice President / CFO	PersonTitleTxt
Phone	5703213175	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	$167,640,598	GrossReceiptsAmt
Group Return For Affiliates	0	GroupReturnForAffiliatesInd
Group Exemption	0928	GroupExemptionNum
Organization501c3	Yes (X)	Organization501c3Ind
Website Address	www.upmcsusquehannahealth.org	WebsiteAddressTxt
Type Of Organization Corp	Yes (X)	TypeOfOrganizationCorpInd
Formation	1947	FormationYr
Legal Domicile State	PA	LegalDomicileStateCd
Activity Or Mission	Divine Providence Hospital of the Sisters of Christian Charity (DPH) is a 31 bed specialty hospital that offers inpatient psychiatric services and a wide array of outpatient hospital services, primarily serving Lycoming and surrounding counties. Effective January 1, 2004, through a merger with Susquehanna Regional Home Health (EIN # 24-0795499), DPH began providing home health services.	ActivityOrMissionDesc
Voting Members Governing Body	20	VotingMembersGoverningBodyCnt
Voting Members Independent	16	VotingMembersIndependentCnt
Total Employee	412	TotalEmployeeCnt
Total Volunteers	253	TotalVolunteersCnt
Total Gross UBI	$0	TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm	$0	NetUnrelatedBusTxblIncmAmt
PY Contributions Grants	$938,294	PYContributionsGrantsAmt
CY Contributions Grants	$844,733	CYContributionsGrantsAmt
PY Program Service Revenue	$93,633,576	PYProgramServiceRevenueAmt
CY Program Service Revenue	$99,007,867	CYProgramServiceRevenueAmt
PY Investment Income	$2,965,840	PYInvestmentIncomeAmt
CY Investment Income	$1,684,737	CYInvestmentIncomeAmt
PY Other Revenue	$220,244	PYOtherRevenueAmt
CY Other Revenue	$212,693	CYOtherRevenueAmt
PY Total Revenue	$97,757,954	PYTotalRevenueAmt
CY Total Revenue	$101,750,030	CYTotalRevenueAmt
PY Grants And Similar Paid	$10,640,232	PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid	$11,955,862	CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members	$0	PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members	$0	CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid	$28,279,301	PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid	$30,299,748	CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns	$0	PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns	$0	CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense	$4,808	CYTotalFundraisingExpenseAmt
PY Other Expenses	$57,014,773	PYOtherExpensesAmt
CY Other Expenses	$59,726,659	CYOtherExpensesAmt
PY Total Expenses	$95,934,306	PYTotalExpensesAmt
CY Total Expenses	$101,982,269	CYTotalExpensesAmt
PY Revenues Less Expenses	$1,823,648	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	-$232,239	CYRevenuesLessExpensesAmt
Total Assets BOY	$125,289,168	TotalAssetsBOYAmt
Total Assets EOY	$127,701,804	TotalAssetsEOYAmt
Total Liabilities BOY	$30,451,476	TotalLiabilitiesBOYAmt
Total Liabilities EOY	$34,361,459	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	$94,837,692	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	$93,340,345	NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part III	Yes (X)	InfoInScheduleOPartIIIInd
Mission	Divine Providence Hospital of the Sisters of Christian Charity (DPH) 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 out 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	$89,791,086	ExpenseAmt
Grant	$11,955,862	GrantAmt
Revenue	$98,923,843	RevenueAmt
Desc	For the fiscal year ended June 30, 2016, the hospital admitted 637 patients rendering 5,648 patient days and registered approximately 132,046 outpatients and provided 103,088 home health visits.	Desc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

Field	Value	IRS element (for citing)
Desc	DPH 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, DPH devotes a portion of its revenue and assets to community program services. The following reflects the breakout of $19,974,845 in quantifiable community benefits reported for FY 2016: Charity Care (at cost) $176,493; Bad Debts (at cost) $514,458; Government-sponsored health care (unpaid cost of Medicare, Medicaid, Indigent care programs, SCHIP and other safety net programs) $18,358,849. In addition, various Education, Community Health Services, Subsidized Health Services, Community Building, Financial and In-Kind Contributions and Community Benefit Operations totaling $925,045.	Desc

Field	Value	IRS element (for citing)
Total Program Service Expenses	$89,791,086	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	0	IRPDocumentCnt
IRP Document W2 G	0	IRPDocumentW2GCnt
Employee	412	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 C Berninger
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	$459,806	$31,992	Yes (X)
Robert E Kane
President	40.00	0.00			$227,852	$0	$28,465		Yes (X)
Rajesh Manoharan
Medical Physicist	40.00	0.00			$199,709	$0	$33,501		Yes (X)
Candace P Dewar
Dir DON/DPH & INF Prev Control	40.00	0.00			$159,677	$0	$21,183		Yes (X)
Patricia A McGee
Executive Director Home Ca	40.00	0.00			$147,277	$0	$7,392		Yes (X)
Harry E Hefty
Physical Therapist	40.00	0.00			$149,947	$0	$26,302		Yes (X)
Charles J Santangelo
Former Exec VP/CFO (retired 5/2/15)	0.00	40.00			$0	$338,073	$24,988			Yes (X)
William C McCauley MD
Former Exec VP/CMO (retired 1/31/15)	0.00	40.00			$0	$185,372	$4,271			Yes (X)
Ronald J Butler
Former Exec VP/CBO (retired 4/15/15)	0.00	40.00			$0	$518,626	$13,502			Yes (X)

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	$884,462	TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org	$3,682,962	TotReportableCompRltdOrgAmt
Total Other Compensation	$360,330	TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K	20	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
The Williamsport Hospital
700 High Street	Williamsport	PA	17701	Management services	$9,743,931
Aramark Healthcare
24863 Network Place	Chicago	IL	60673	Management / environmental services	$9,283,515
Susquehanna Lithotripsy
100 West 3rd Avenue	Columbus	OH	43201	Lithotripsy services	$629,000
Varian Medical Systems
70140 Network Place	Chicago	IL	60673	Oncology services	$566,948
Michele Tedesco
1626 Meade Street	Williamsport	PA	17701	Home Health Physical Therapist	$191,435

Field	Value	IRS element (for citing)
Cntrct Rcvd Greater Than100 K	13	CntrctRcvdGreaterThan100KCnt
Fundraising	$9,414	FundraisingAmt
Related Organizations	$330,778	RelatedOrganizationsAmt
Government Grants	$496,716	GovernmentGrantsAmt
All Other Contributions	$7,825	AllOtherContributionsAmt
Total Contributions	$844,733	TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (4 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt	ExclusionExclusionAmt
Net patient service revenue	621990	$96,214,490	$96,214,490
Affiliate rent income	531120	$2,011,776	$2,011,776
Sports Medicine - athletic traine	621400	$602,158	$602,158
Cafeteria	722514	$179,443		$179,443

Field	Value	IRS element (for citing)
Total Program Service Revenue	$99,007,867	TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$834,774	TotalRevenueColumnAmt
Exclusion	$834,774	ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

Field	Value	IRS element (for citing)
Securities	$66,688,463	SecuritiesAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

Field	Value	IRS element (for citing)
Securities	$65,838,500	SecuritiesAmt

Gain Or Loss GainOrLossGrp

Field	Value	IRS element (for citing)
Securities	$849,963	SecuritiesAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$849,963	TotalRevenueColumnAmt
Exclusion	$849,963	ExclusionAmt

Field	Value	IRS element (for citing)
Fundraising Gross Income	$86,016	FundraisingGrossIncomeAmt
Contri Rpt Fundraising Event	$9,414	ContriRptFundraisingEventAmt
Fundraising Direct Expenses	$52,068	FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$33,948	TotalRevenueColumnAmt
Exclusion	$33,948	ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	ExclusionExclusionAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
Auxiliary activity	900099	$71,839	$71,839
Oncology - clinical trials	900099	$31,228		$31,228
Fitness center	900099	$25,311		$25,311

Miscellaneous Revenue MiscellaneousRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$50,367	TotalRevenueColumnAmt
Related Or Exempt Func Income	$38,880	RelatedOrExemptFuncIncomeAmt
Exclusion	$11,487	ExclusionAmt

Field	Value	IRS element (for citing)
Other Revenue Total	$178,745	OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$101,750,030	TotalRevenueColumnAmt
Related Or Exempt Func Income	$98,923,843	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$0	UnrelatedBusinessRevenueAmt
Exclusion	$1,981,454	ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

Field	Value	IRS element (for citing)
Total	$11,955,862	TotalAmt
Program Services	$11,955,862	ProgramServicesAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

Field	Value	IRS element (for citing)
Total	$23,570,400	TotalAmt
Program Services	$22,788,733	ProgramServicesAmt
Management And General	$777,927	ManagementAndGeneralAmt
Fundraising	$3,740	FundraisingAmt

Pension Plan Contributions PensionPlanContributionsGrp

Field	Value	IRS element (for citing)
Total	$1,194,879	TotalAmt
Program Services	$1,155,253	ProgramServicesAmt
Management And General	$39,436	ManagementAndGeneralAmt
Fundraising	$190	FundraisingAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

Field	Value	IRS element (for citing)
Total	$3,846,438	TotalAmt
Program Services	$3,718,879	ProgramServicesAmt
Management And General	$126,949	ManagementAndGeneralAmt
Fundraising	$610	FundraisingAmt

Payroll Taxes PayrollTaxesGrp

Field	Value	IRS element (for citing)
Total	$1,688,031	TotalAmt
Program Services	$1,632,051	ProgramServicesAmt
Management And General	$55,712	ManagementAndGeneralAmt
Fundraising	$268	FundraisingAmt

Fees For Services Management FeesForServicesManagementGrp

Field	Value	IRS element (for citing)
Total	$9,744,243	TotalAmt
Management And General	$9,744,243	ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

Field	Value	IRS element (for citing)
Total	$1,286	TotalAmt
Management And General	$1,286	ManagementAndGeneralAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

Field	Value	IRS element (for citing)
Total	$10,168	TotalAmt
Management And General	$10,168	ManagementAndGeneralAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

Field	Value	IRS element (for citing)
Total	$183,629	TotalAmt
Management And General	$183,629	ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

Field	Value	IRS element (for citing)
Total	$9,822,500	TotalAmt
Program Services	$9,479,771	ProgramServicesAmt
Management And General	$342,729	ManagementAndGeneralAmt

Advertising AdvertisingGrp

Field	Value	IRS element (for citing)
Total	$12,649	TotalAmt
Program Services	$9,681	ProgramServicesAmt
Management And General	$2,968	ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

Field	Value	IRS element (for citing)
Total	$1,628,235	TotalAmt
Program Services	$1,277,750	ProgramServicesAmt
Management And General	$350,485	ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

Field	Value	IRS element (for citing)
Total	$223,311	TotalAmt
Program Services	$81,150	ProgramServicesAmt
Management And General	$142,161	ManagementAndGeneralAmt

Royalties RoyaltiesGrp

Field	Value	IRS element (for citing)
Total	$62,644	TotalAmt
Program Services	$57,678	ProgramServicesAmt
Management And General	$4,966	ManagementAndGeneralAmt

Occupancy OccupancyGrp

Field	Value	IRS element (for citing)
Total	$2,624,880	TotalAmt
Program Services	$2,482,844	ProgramServicesAmt
Management And General	$142,036	ManagementAndGeneralAmt

Travel TravelGrp

Field	Value	IRS element (for citing)
Total	$609,829	TotalAmt
Program Services	$589,036	ProgramServicesAmt
Management And General	$20,793	ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

Field	Value	IRS element (for citing)
Total	$52,946	TotalAmt
Program Services	$39,569	ProgramServicesAmt
Management And General	$13,377	ManagementAndGeneralAmt

Interest InterestGrp

Field	Value	IRS element (for citing)
Total	$905,799	TotalAmt
Program Services	$905,799	ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

Field	Value	IRS element (for citing)
Total	$3,532,049	TotalAmt
Program Services	$3,532,049	ProgramServicesAmt

Insurance InsuranceGrp

Field	Value	IRS element (for citing)
Total	$466,529	TotalAmt
Program Services	$466,529	ProgramServicesAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDesc	TotalTotalAmt	Program ServicesProgramServicesAmt	Management And GeneralManagementAndGeneralAmt
Medical supplies	$22,816,962	$22,812,788	$4,174
Inter-entity costs	$3,036,088	$3,036,088
Bad debt	$2,052,607	$2,052,607
Repairs and maintenance	$1,470,160	$1,431,216	$38,944

All Other Expenses AllOtherExpensesGrp

Field	Value	IRS element (for citing)
Total	$470,145	TotalAmt
Program Services	$285,753	ProgramServicesAmt
Management And General	$184,392	ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$101,982,269	TotalAmt
Program Services	$89,791,086	ProgramServicesAmt
Management And General	$12,186,375	ManagementAndGeneralAmt
Fundraising	$4,808	FundraisingAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

Field	Value	IRS element (for citing)
BOY	$8,541,542	BOYAmt
EOY	$2,406,148	EOYAmt

Accounts Receivable AccountsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$10,705,084	BOYAmt
EOY	$12,116,069	EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

Field	Value	IRS element (for citing)
BOY	$1,847,406	BOYAmt
EOY	$1,671,825	EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

Field	Value	IRS element (for citing)
BOY	$2,717,515	BOYAmt
EOY	$789,399	EOYAmt

Field	Value	IRS element (for citing)
Land Bldg Equip Cost Or Other Bss	$117,099,662	LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec	$82,465,993	LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

Field	Value	IRS element (for citing)
BOY	$29,687,466	BOYAmt
EOY	$34,633,669	EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

Field	Value	IRS element (for citing)
BOY	$50,392,314	BOYAmt
EOY	$51,755,974	EOYAmt

Other Assets Total OtherAssetsTotalGrp

Field	Value	IRS element (for citing)
BOY	$21,397,841	BOYAmt
EOY	$24,328,720	EOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$125,289,168	BOYAmt
EOY	$127,701,804	EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

Field	Value	IRS element (for citing)
BOY	$6,210,415	BOYAmt
EOY	$6,531,997	EOYAmt

Deferred Revenue DeferredRevenueGrp

Field	Value	IRS element (for citing)
BOY	$313,761	BOYAmt
EOY	$374,471	EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$17,393,805	BOYAmt
EOY	$20,521,213	EOYAmt

Other Liabilities OtherLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$6,533,495	BOYAmt
EOY	$6,933,778	EOYAmt

Total Liabilities TotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$30,451,476	BOYAmt
EOY	$34,361,459	EOYAmt

Field	Value	IRS element (for citing)
Organization Follows SFAS117	Yes (X)	OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$92,735,576	BOYAmt
EOY	$91,291,118	EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$1,139,846	BOYAmt
EOY	$1,085,957	EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$962,270	BOYAmt
EOY	$963,270	EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$94,837,692	BOYAmt
EOY	$93,340,345	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$125,289,168	BOYAmt
EOY	$127,701,804	EOYAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	Yes (X)	InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss	-$232,239	ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst	-$1,488,732	NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets	$223,624	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	$10,168	GrantsOtherOrganizationsAmt
Direct Contact Legislators	0	DirectContactLegislatorsInd
Rallies Demonstrations	0	RalliesDemonstrationsInd
Other Activities	0	OtherActivitiesInd
Total Lobbying Expenditures	$10,168	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 to HAP totaled $18,808 of which 24.94% or $4,691, was used for lobbying purposes. Dues paid to AHA totaled $24,760 of which 22.12% or $5,477, 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	$163,100	OtherCostOrOtherBasisAmt
Book Value	$163,100	BookValueAmt

Buildings BuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$57,818,892	OtherCostOrOtherBasisAmt
Depreciation	$42,814,460	DepreciationAmt
Book Value	$15,004,432	BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$275,159	OtherCostOrOtherBasisAmt
Depreciation	$76,418	DepreciationAmt
Book Value	$198,741	BookValueAmt

Equipment EquipmentGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$47,356,388	OtherCostOrOtherBasisAmt
Depreciation	$37,163,221	DepreciationAmt
Book Value	$10,193,167	BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$11,486,123	OtherCostOrOtherBasisAmt
Depreciation	$2,411,894	DepreciationAmt
Book Value	$9,074,229	BookValueAmt

Field	Value	IRS element (for citing)
Total Book Value Land Buildings	$34,633,669	TotalBookValueLandBuildingsAmt

Other Assets Org OtherAssetsOrgGrp (4 entries)

DescDesc	Book ValueBookValueAmt
Investment in net assets of affiliates	$712,655
Due from affiliates	$22,872,417
Other Receivables	$398,697
Other	$344,951

Field	Value	IRS element (for citing)
Total Book Value Other Assets	$24,328,720	TotalBookValueOtherAssetsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (4 entries)

DescDesc	AmtAmt
Accrued medical malpractice cost	$161,000
Estimated third party settlements / deferred reimbursement	$1,374,947
Asbestos abatement	$168,947
Due to Affiliates, net	$5,228,884

Field	Value	IRS element (for citing)
Total Liability	$6,933,778	TotalLiabilityAmt
Footnote Text	Yes (X)	FootnoteTextInd
Total Rev Etc Audited Fincl Stmt	$98,204,544	TotalRevEtcAuditedFinclStmtAmt
Net Unrealized Gains Invst	-$1,488,732	NetUnrealizedGainsInvstAmt
Other Revenue	-$1,799,830	OtherRevenueAmt
Revenue Not Reported	-$3,288,562	RevenueNotReportedAmt
Revenue Subtotal	$101,493,106	RevenueSubtotalAmt
Other Revenues Not Included	$256,924	OtherRevenuesNotIncludedAmt
Revenue Not Reported Fincl Stmt	$256,924	RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990	$101,750,030	TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt	$88,012,796	TotExpnsEtcAuditedFinclStmtAmt
Expenses Not Reported	$0	ExpensesNotReportedAmt
Expenses Subtotal	$88,012,796	ExpensesSubtotalAmt
Other Expenses Not Included	$13,969,473	OtherExpensesNotIncludedAmt
Expenses Not Rpt Fincl Stmt	$13,969,473	ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990	$101,982,269	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 financials statements.
Part XI, Line 2d - Other Adjustments:	Bad Debt expense -2,052,607. Net assets released from restrictions 252,777.
Part XI, Line 4b - Other Adjustments:	Contributions received 325. Transfer from affiliates - SHF 330,778. Investment return -118,184. Auxiliary activity 44,005.
Part XII, Line 4b - Other Adjustments:	Auxiliary activity 44,005. Bad Debt expense 2,052,607. Transfer to affiliate - SHMG 11,872,861.

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	$284,016	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	$284,016	SubtotalSpentAmt
Continuation Spent	$0	ContinuationSpentAmt
Total Spent	$284,016	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	Fall Festival	Event1Nm
Gross Receipts Event1	$32,086	GrossReceiptsEvent1Amt
Gross Revenue Event1	$32,086	GrossRevenueEvent1Amt
Other Direct Expenses Event1	$9,736	OtherDirectExpensesEvent1Amt
Event2	Lights of Love	Event2Nm
Gross Receipts Event2	$9,414	GrossReceiptsEvent2Amt
Charitable Contri Event2	$9,414	CharitableContriEvent2Amt
Other Direct Expenses Event2	$1,038	OtherDirectExpensesEvent2Amt
Other Events Total	7	OtherEventsTotalCnt
Gross Receipts Other Events	$53,930	GrossReceiptsOtherEventsAmt
Gross Revenue Other Events	$53,930	GrossRevenueOtherEventsAmt
Oth Direct Expnss Other Events	$41,294	OthDirectExpnssOtherEventsAmt
Gross Receipts Total	$95,430	GrossReceiptsTotalAmt
Charitable Contributions Tot	$9,414	CharitableContributionsTotAmt
Gross Revenue Total Events	$86,016	GrossRevenueTotalEventsAmt
Oth Direct Expnss Total Events	$52,068	OthDirectExpnssTotalEventsAmt
Direct Expense Summary Events	$52,068	DirectExpenseSummaryEventsAmt
Net Income Summary	$33,948	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	$176,493	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$0	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$176,493	NetCommunityBenefitExpnsAmt
Total Expense	0.00180	TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$9,295,469	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$2,985,797	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$6,309,672	NetCommunityBenefitExpnsAmt
Total Expense	0.06310	TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$9,471,962	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$2,985,797	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$6,486,165	NetCommunityBenefitExpnsAmt
Total Expense	0.06490	TotalExpensePct

Community Health Services CommunityHealthServicesGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$282,073	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$2,365	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$279,708	NetCommunityBenefitExpnsAmt
Total Expense	0.00280	TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$18,712	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$0	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$18,712	NetCommunityBenefitExpnsAmt
Total Expense	0.00020	TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$0	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$0	DirectOffsettingRevenueAmt

Research ResearchGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$209,123	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$32,228	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$176,895	NetCommunityBenefitExpnsAmt
Total Expense	0.00180	TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$144,460	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$144,460	NetCommunityBenefitExpnsAmt
Total Expense	0.00140	TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$654,368	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$34,593	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$619,775	NetCommunityBenefitExpnsAmt
Total Expense	0.00620	TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$10,126,330	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$3,020,390	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$7,105,940	NetCommunityBenefitExpnsAmt
Total Expense	0.07110	TotalExpensePct

Community Support CommunitySupportGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$520	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$0	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$520	NetCommunityBenefitExpnsAmt
Total Expense	0.00000	TotalExpensePct

Workforce Development WorkforceDevelopmentGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$11,346	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$500	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$10,846	NetCommunityBenefitExpnsAmt
Total Expense	0.00010	TotalExpensePct

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$11,866	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$500	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$11,366	NetCommunityBenefitExpnsAmt
Total Expense	0.00010	TotalExpensePct

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	Yes (1)	BadDebtExpenseReportedInd
Bad Debt Expense	$2,052,607	BadDebtExpenseAmt
Bad Debt Expense Attributable	$102,630	BadDebtExpenseAttributableAmt
Reimbursed By Medicare	$27,891,087	ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr	$39,838,360	CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall	-$11,947,273	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	Divine Providence Hospital	BusinessNameLine1Txt

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	1100 Grampian Boulevard	AddressLine1Txt
City	Williamsport	CityNm
State Abbreviation	PA	StateAbbreviationCd
ZIP	17701	ZIPCd

Field	Value	IRS element (for citing)
Website Address	www.upmcsusquehannahealth.org	WebsiteAddressTxt
State License	041001	StateLicenseNum
Licensed Hospital	Yes (X)	LicensedHospitalInd
General Medical And Surgical	Yes (X)	GeneralMedicalAndSurgicalInd
Other	Wide array of outpatient hospital services	OtherDesc

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

Field	Value	IRS element (for citing)
Business Name Line1	Divine Providence 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
Divine Providence 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 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.
Divine Providence Hospital	Part V, Section B, Line 6a: Divine Providence Hospital; located in Williamsport, PA is one of four hospitals that comprise of 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 located in Wellsboro, PA and their defined community is Tioga County, PA. UPMC Susquehanna's 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.
Divine Providence 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.
Divine Providence Hospital	Part V, Section B, Line 16i: Other - Brochure
Divine Providence 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

Field	Value	IRS element (for citing)
Facility	2	FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (2 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	FacilityFacilityTxt
1 - The Meadows
2160 Warrensville Road	Montoursville	PA	17754	Assisted living facility
2 - The Wenner Building
1705 Warren Avenue	Williamsport	PA	17701	Outpatient diagnostics

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:	The Divine Providence 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(C), but subtracted for purposes of calculating the percentage in this column is $2,052,607.
Part II, Community Building Activities:	Community building activities at Divine Providence Hospital (DPH) center on workforce development through providing student observations and the development of volunteens. By supporting volunteens in a health care setting, some budding nurses, doctors and other allied health professionals are developed. DPH also supports/provides a physical site for the statewide radio system. This system is critical to the emergency preparedness system.
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 a 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 upon 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 guideline 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 SHS 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 SHS 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 and 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 the 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 CHNA and related implementation plan at www.upmcsusquehannahealh.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:	Divine Providence Hospital (DPH) 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 SHS. 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 (2 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	Recipient EINRecipientEIN	IRC SectionIRCSectionDesc	Cash GrantCashGrantAmt	Purpose Of GrantPurposeOfGrantTxt
Susquehanna Physician Services
1201 Grampian Boulevard	Williamsport	PA	17701	232449454	501(c)(3)	$11,872,861	Support of affiliate
Susquehanna Community Health and Dental Clinic
469-471 Hepburn Street	Williamsport	PA	17701	208979596	501(c)(3)	$83,001	Financial support

Field	Value	IRS element (for citing)
Total501c3 Org	2	Total501c3OrgCnt

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	Part I, Line 2:	FormAndLineReferenceDesc
Explanation	Susquehanna Physician Services is a related organization and part of UPMC Susquehanna with consistent management oversight ensuring the use of funds for charitable purposes. Susquehanna Community Health and Dental Clinic is a former service of UPMC Susquehanna that is being converted to a Federally Qualified Health Clinic (FQHC). "Look-alike" status was received effective 12/6/11. Susquehanna Health System continues to support the clinics financially until full FQHC status is obtained and they are able to operate by their own means. All requests for funding are supported by detailed records of cash receipts and disbursements, as well as cash flow projections prepared by an independent accounting firm.	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 (14 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	$12,863	$0	$9,950	$0	$22,042	$0	$491,798	$0	$0
Robert E Kane
President	$201,735	$0	$21,284	$0	$4,833	$0	$11,064	$0	$17,401	$0	$256,317	$0	$0	$0
Rajesh Manoharan
Medical Physicist	$199,425	$0	$0	$0	$284	$0	$8,193	$0	$25,308	$0	$233,210	$0	$0	$0
Candace P Dewar
Dir DON/DPH & INF Prev Control	$91,915	$0	$8,481	$0	$59,281	$0	$7,524	$0	$13,659	$0	$180,860	$0	$0	$0
Patricia A McGee
Executive Director Home Ca	$131,294	$0	$15,224	$0	$759	$0	$6,406	$0	$986	$0	$154,669	$0	$0	$0
Harry E Hefty
Physical Therapist	$149,166	$0	$0	$0	$781	$0	$6,581	$0	$19,721	$0	$176,249	$0	$0	$0
Charles J Santangelo
Former Exec VP/CFO (retired 5/2/15)	$0	$186,916	$0	$71,895	$0	$79,262	$0	$9,950	$0	$15,038	$0	$363,061	$0	$0
William C McCauley MD
Former Exec VP/CMO (retired 1/31/15)	$0	$108,272	$0	$45,384	$0	$31,716	$0	$0	$0	$4,271	$0	$189,643	$0	$0
Ronald J Butler
Former Exec VP/CBO (retired 4/15/15)	$0	$112,293	$0	$32,105	$0	$374,228	$0	$9,950	$0	$3,552	$0	$532,128	$0	$0

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDesc

ExplanationExplanationTxt

Part I, Line 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 (2 entries)

Bond ReferenceBondReferenceCd	Bond Issuer EINBondIssuerEIN	CUSIPCUSIPNum	Bond IssuedBondIssuedDt	Issue PriceIssuePriceAmt	PurposePurposeDesc	DefeasedDefeasedInd	On Behalf Of IssuerOnBehalfOfIssuerInd	Pool FinancingPoolFinancingInd
Lycoming County Authority
A	236760375	550804AH1	2009-10-22	$17,445,802	See Part VI	0	0	0
Lycoming County Authority
B	236760375	NoneAvail	2015-06-18	$4,400,000	See Part VI	0	0	0

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (2 entries)

Bond ReferenceBondReferenceCd	Total ProceedsTotalProceedsAmt	In Reserve FundInReserveFundAmt	Issuance Costs From ProceedsIssuanceCostsFromProceedsAmt	Capital ExpendituresCapitalExpendituresAmt	Substantial CompletionSubstantialCompletionYr	Current RefundingCurrentRefundingInd	Advance RefundingAdvanceRefundingInd	Final Allocation MadeFinalAllocationMadeInd	Adequate Books And Rec MaintAdequateBooksAndRecMaintInd	UnspentUnspentAmt
A	$17,428,769	$1,252,810	$324,433	$15,851,526	2010	0	0	Yes (1)	Yes (1)
B	$4,400,000		$37,485	$3,101,943		0	0	0	Yes (1)	$1,260,572

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (2 entries)

Bond ReferenceBondReferenceCd	Owning Bond Financed PropertyOwningBondFinancedPropertyInd	Any Lease ArrangementsAnyLeaseArrangementsInd	Mgmt Contract Bond Fincd PropMgmtContractBondFincdPropInd	Any Research AgreementsAnyResearchAgreementsInd	Engage Bond Counsel ResearchEngageBondCounselResearchInd	Private Bus Use By OthersPrivateBusUseByOthersPct	Private Bus Concerning UBIPrivateBusConcerningUBIPct	Total Private Business UseTotalPrivateBusinessUsePct	Bond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestInd	Change In Use Bond Financed PropChangeInUseBondFinancedPropInd	Procs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd
A	0	0	0	Yes (1)	Yes (1)	0.00000	0.00000	0.00000	0	0	Yes (1)
B	0	0	0	Yes (1)	Yes (1)	0.00000	0.00000	0.00000	0	0	Yes (1)

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (2 entries)

Bond ReferenceBondReferenceCd	Form8038 T FiledForm8038TFiledInd	Rebate Not Due YetRebateNotDueYetInd	Exception To RebateExceptionToRebateInd	No Rebate DueNoRebateDueInd	Variable Rate IssueVariableRateIssueInd	Hedge Identified In Bks And RecHedgeIdentifiedInBksAndRecInd	Gross Proceeds Invested In GICGrossProceedsInvestedInGICInd	Gross Proceeds InvestedGrossProceedsInvestedInd	Written Proc To Monitor ReqsWrittenProcToMonitorReqsInd
A	0	0	0	Yes (1)	0	0	0	0	Yes (1)
B	0	0	Yes (1)	0	Yes (1)	0	0	0	Yes (1)

Procedures Corrective Action ProceduresCorrectiveActionGrp (2 entries)

Bond ReferenceBondReferenceCd	Procedures Corrective ActionProceduresCorrectiveActionInd
A	Yes (1)
B	Yes (1)

Supplemental Information Detail SupplementalInformationDetail (6 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 $165,134,534. Of this total, $17,445,802 was allocated to Divine Providence Hospital at the time of issue, while the balance of $147,688,732 was allocated to The Williamsport Hospital (EIN #24-0795508). The proceeds of the Lycoming County Authority, Series 2009A bonds were used, together with other available funds, to undertake a project consisting of the expansion and renovation of the Cancer Treatment Center at Divine Providence Hospital.
Form 990, Schedule K, Part II, Bond A, Line 3	The difference between the Total Proceeds of Issue and the amount reflected in Part I, (e) is due to accumulated investment results, net of accumulated Investment Management Fees.
Form 990, Schedule K, Part IV, Bond A, Line 2c	Rebate calculations are performed annually, the most recent being from the issue date of October 22, 2009 to October 21, 2015.
Form 990, Schedule K, Part I, Bond B, (e) and (f)	The total issue price per Form 8038, Part III (b) is $40,000,000. Of this total, $4,400,000 was allocated to Divine Providence Hospital at the time of issue, while $11,200,000 was allocated to Muncy Valley Hospital (EIN #24-0806023) and $24,400,000 was allocated to The Williamsport Hospital (EIN #24-0795508). 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 Hosital, 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 B, 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 B, 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 (11 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 utilizes 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 Are 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, 412 employees payroll expenses were recorded by Divine Providence Hospital.
Form 990, Part VI, Section A, line 6	UPMC Susquehanna, EIN # 23-2751183, is a 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 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 of services of the corporation, and monitor and maintain the philosophy, goals and purposes for which the corporation was formed and exists, subject to an 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 asset 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 were 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 the proper steps to educate the Board of Directors to understand all of the above mentioned oversight and to appropriately prepare them for the 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 XI, line 9:	Change in interest in net assets of affiliate 48,213. Contributions released from permanent restrictions for use 175,411.
Form 990, Part XII, Line 2C	The organization did not change it 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
The Williamsport Hospital
700 High Street	Williamsport	PA	17701	240795508	Hospital	PA	501(c)(3)	3	UPMC Susquehanna	0
The Muncy Valley Hospital
215 East Water Street	Muncy	PA	17756	240806023	Hospital	PA	501(c)(3)	3	UPMC Susquehanna	0
Susquehanna Health Foundation
1100 Grampian Boulevard	Williamsport	PA	17701	232743470	Fundraising for affiliated entities	PA	501(c)(3)	11 A I	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 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 transport	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 Street	Wellsboro	PA	16901	251765538	Physician services	PA	501(c)(3)	11 B II	UPMC Susquehanna	0
Laurel Management Services
15 Meade Street	Wellsboro	PA	16901	251644910	Mgmt consulting & supervisory svcs	PA	501(c)(3)	11 B II	UPMC Susquehanna	0
Laurel Realty
15 Meade Street	Wellsboro	PA	16901	231403678	Own & manage real estate	PA	501(c)(2)	N/A	UPMC Susquehanna	0
Laurel Health System
15 Meade Street	Wellsboro	PA	16901	240795488	Coordinate & manage the delivery of healthcare	PA	501(c)(3)	11 B II	UPMC Susquehanna	0
Laurel Health Foundation
15 Meade Street	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	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