UPMC: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- UPMC (EIN 23-2449454)
- Tax period
- 2015-07-01 to 2016-06-30
- Filed
- 2017-05-11
- IRS object ID
- 201731319349303703
- Schema version
- 2015v3.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule F
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-05-11T13:27:58-05:00 | 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 | 232449454 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Susquehanna Physician Services | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | SUSQ | BusinessNameControlTxt |
| Phone | 5703207900 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1705 Grampian Blvd No 302 | AddressLine1Txt |
| City | Williamsport | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 17701 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Eric D Pohjala | PersonNm |
| Person Title | Executive VP/CFO | PersonTitleTxt |
| Phone | 5703213171 | PhoneNum |
| Signature | 2017-05-11 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Brian D Todd | PreparerPersonNm |
| PTIN | P00422601 | PTIN |
| Phone | 4178658701 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Change | Yes (X) | AddressChangeInd |
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Susquehanna Health Medical Group | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Steven P Johnson | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 777 Rural Avenue | AddressLine1Txt |
| City | Williamsport | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 17701 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $97,856,415 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.susquehannahealth.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1987 | FormationYr |
| Legal Domicile State | PA | LegalDomicileStateCd |
| Activity Or Mission | To effect a continuum of compassionate care which assures quality for our patients and value for those who provide it. | ActivityOrMissionDesc |
| Voting Members Governing Body | 16 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 11 | VotingMembersIndependentCnt |
| Total Employee | 594 | TotalEmployeeCnt |
| Total Volunteers | 30 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $25,390,300 | PYContributionsGrantsAmt |
| CY Contributions Grants | $28,168,231 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $65,637,069 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $69,688,184 | CYProgramServiceRevenueAmt |
| PY Investment Income | $0 | PYInvestmentIncomeAmt |
| CY Investment Income | $0 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $91,027,369 | PYTotalRevenueAmt |
| CY Total Revenue | $97,856,415 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $73,268,448 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $79,223,951 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $17,982,116 | PYOtherExpensesAmt |
| CY Other Expenses | $18,524,256 | CYOtherExpensesAmt |
| PY Total Expenses | $91,250,564 | PYTotalExpensesAmt |
| CY Total Expenses | $97,748,207 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$223,195 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $108,208 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $15,457,219 | TotalAssetsBOYAmt |
| Total Assets EOY | $16,774,823 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $11,889,587 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $13,098,983 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $3,567,632 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $3,675,840 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | Susquehanna Physician Services is a subsidiary of UPMC Susquehanna. The mission of UPMC Susquehanna and affiliates is as follows: To extend God's healing love by improving the health of those we serve. Our vision is to create an integrated community health system that delivers world class care. Our values are to carefully place our patients and their families first, share ownership with all of our caregivers and lead with a servant's heart. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $92,296,620 | ExpenseAmt |
| Revenue | $69,688,184 | RevenueAmt |
| Desc | Susquehanna Physician Services (SPS) is comprised of a groupof primary care and specialty physicians. The services primarily serve Lycoming and surrounding counties. For fiscal year ended June 30, 2016there were approximately 705,412 patient visits for SPS. | Desc |
| Total Program Service Expenses | $92,296,620 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | Yes (1) | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | Yes (1) | 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 |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 594 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 16 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 11 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | 0 | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | PA | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Management | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 5703268756 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1705 Warren Avenue Suite 302 | AddressLine1Txt |
| City | Williamsport | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 17701 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (27 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|---|
| Ronald V DeFeo Jr | ||||||||||
| Director | 2.00 | 4.00 | Yes (X) | $0 | $0 | $0 | ||||
| Ann S Pepperman Esquire | ||||||||||
| Chairperson | 2.00 | 4.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |||
| Davie Jane Gilmour Ph D | ||||||||||
| Vice Chairperson | 2.00 | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |||
| Sister Teresa Ann Jacobs | ||||||||||
| Secretary | 2.00 | 6.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |||
| Ronald E DiSimone MD | ||||||||||
| Director | 42.00 | 2.00 | Yes (X) | $1,066,958 | $0 | $34,314 | ||||
| Lynda Livingston | ||||||||||
| Director | 2.00 | 4.00 | Yes (X) | $0 | $0 | $0 | ||||
| Steven P Johnson | ||||||||||
| President/CEO | 2.00 | 50.00 | Yes (X) | $0 | $832,199 | $35,182 | Yes (X) | |||
| Daniel A Klingerman | ||||||||||
| Director | 2.00 | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| Philip H Johnson | ||||||||||
| Director | 2.00 | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| James E Mothersbaugh | ||||||||||
| Treasurer | 2.00 | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |||
| Alexander R Nesbitt MD | ||||||||||
| Director | 42.00 | 6.00 | Yes (X) | $222,603 | $0 | $30,549 | ||||
| Kevin W Kist Jr DO | ||||||||||
| Director | 42.00 | 6.00 | Yes (X) | $432,005 | $0 | $36,767 | ||||
| Dr J Dennis Murray | ||||||||||
| Director | 2.00 | 4.00 | Yes (X) | $0 | $0 | $0 | ||||
| Glenn Poirier | ||||||||||
| Director | 2.00 | 4.00 | Yes (X) | $0 | $0 | $0 | ||||
| Jill Burns MD | ||||||||||
| director | 2.00 | 40.00 | Yes (X) | $0 | $296,503 | $37,541 | ||||
| Thomas M Owlett Esquire | ||||||||||
| Director | 2.00 | 4.00 | Yes (X) | $0 | $0 | $0 | ||||
| Eric D Pohjala | ||||||||||
| Exec VP/CFO | 2.00 | 40.00 | $0 | $255,157 | $27,349 | Yes (X) | ||||
| Jan E Fisher | ||||||||||
| Exec VP/COO | 2.00 | 40.00 | $0 | $459,806 | $31,992 | Yes (X) | ||||
| David Lopatofsky MD | ||||||||||
| Exec VP/CMO - hired 2/2015 | 42.00 | 2.00 | $488,432 | $0 | $37,934 | Yes (X) | ||||
| Michael J Lazar MD | ||||||||||
| Physician | 40.00 | $820,204 | $0 | $36,308 | Yes (X) | |||||
| Sabrina Dowd | ||||||||||
| Physician | 40.00 | $785,221 | $0 | $33,776 | Yes (X) | |||||
| Donald T Nardone MD | ||||||||||
| Physician | 40.00 | $747,289 | $0 | $37,704 | Yes (X) | |||||
| Michael V Hoffman MD | ||||||||||
| Physician | 40.00 | $855,847 | $0 | $33,919 | Yes (X) | |||||
| John H Bailey MD | ||||||||||
| physician | 40.00 | $896,944 | $0 | $34,264 | Yes (X) | |||||
| Charles J Santangelo | ||||||||||
| Former Exsc VP/CFO-Retired 5/2/15 | 0.00 | 0.00 | $0 | $338,073 | $24,988 | Yes (X) | ||||
| Ronald J Butler | ||||||||||
| Former Exec VP/CBO Retired 4/15/15 | 0.00 | 2.00 | $0 | $518,626 | $13,502 | Yes (X) | ||||
| William C McCauley MD | ||||||||||
| Former Exec VP/CMO Retired 1/31/15 | 0.00 | $185,372 | $0 | $4,271 | Yes (X) | |||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $6,500,875 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $2,700,364 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $490,360 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 156 | 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 |
|---|---|---|---|---|---|
| Comphealth Medical Staffing | |||||
| PO Box 972651 | Dallas | TX | 75397 | Temporary Employment | $2,192,000 |
| Locumtenens Com | |||||
| PO Box 405547 | Atlanta | GA | 30384 | Temporary Employment | $757,327 |
| Cerner Health Services | |||||
| PO Box 959167 | St Louis | MO | 63198 | Software | $533,827 |
| Weatherby Locums | |||||
| PO Box 972633 | Dallas | TX | 75397 | temporary Employment | $509,965 |
| The Advisory Board Company | |||||
| PO Box 79461 | Baltimore | MD | 21279 | Decision Support | $315,120 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 8 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $28,168,231 | RelatedOrganizationsAmt |
| Total Contributions | $28,168,231 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Net Patient Services | 621110 | $55,588,571 | $55,588,571 |
| Inter-Entity SSA | 621110 | $10,687,743 | $10,687,743 |
| Other Revenue | 621110 | $2,500,248 | $2,500,248 |
| Inter-Entity Revenue | 621110 | $640,859 | $640,859 |
| Capitation Payments | 621110 | $270,763 | $270,763 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $69,688,184 | TotalProgramServiceRevenueAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $97,856,415 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $69,688,184 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,721,566 | TotalAmt |
| Program Services | $1,721,566 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $65,208,513 | TotalAmt |
| Program Services | $62,698,735 | ProgramServicesAmt |
| Management And General | $2,509,778 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,208,151 | TotalAmt |
| Program Services | $2,093,401 | ProgramServicesAmt |
| Management And General | $114,750 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,871,259 | TotalAmt |
| Program Services | $6,560,510 | ProgramServicesAmt |
| Management And General | $310,749 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,214,462 | TotalAmt |
| Program Services | $3,064,850 | ProgramServicesAmt |
| Management And General | $149,612 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,695,564 | TotalAmt |
| Program Services | $56 | ProgramServicesAmt |
| Management And General | $1,695,508 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $22,145 | TotalAmt |
| Program Services | $22,145 | ProgramServicesAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,983,737 | TotalAmt |
| Program Services | $1,983,737 | ProgramServicesAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $105,085 | TotalAmt |
| Program Services | $105,085 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,332,509 | TotalAmt |
| Program Services | $3,326,065 | ProgramServicesAmt |
| Management And General | $6,444 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $800,458 | TotalAmt |
| Program Services | $489,419 | ProgramServicesAmt |
| Management And General | $311,039 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,151,504 | TotalAmt |
| Program Services | $2,913,767 | ProgramServicesAmt |
| Management And General | $237,737 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $85,383 | TotalAmt |
| Program Services | $81,592 | ProgramServicesAmt |
| Management And General | $3,791 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $535,630 | TotalAmt |
| Program Services | $501,592 | ProgramServicesAmt |
| Management And General | $34,038 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $194,642 | TotalAmt |
| Program Services | $194,642 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,481,419 | TotalAmt |
| Program Services | $1,447,331 | ProgramServicesAmt |
| Management And General | $34,088 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,935,103 | TotalAmt |
| Program Services | $1,935,103 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (3 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Provision For Bad Debt | $2,565,225 | $2,565,225 | |
| Books Subscriptions Due | $371,134 | $346,397 | $24,737 |
| Minor Equipment | $264,718 | $245,402 | $19,316 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $97,748,207 | TotalAmt |
| Program Services | $92,296,620 | ProgramServicesAmt |
| Management And General | $5,451,587 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,206,024 | BOYAmt |
| EOY | $1,647,318 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,655,336 | BOYAmt |
| EOY | $5,457,839 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $121,405 | BOYAmt |
| EOY | $121,834 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,414,798 | BOYAmt |
| EOY | $1,486,108 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $275,983 | BOYAmt |
| EOY | $407,023 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $459,777 | BOYAmt |
| EOY | $518,080 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $21,723,852 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $15,099,471 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,230,591 | BOYAmt |
| EOY | $6,624,381 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,857 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $72,448 | BOYAmt |
| EOY | $512,240 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,457,219 | BOYAmt |
| EOY | $16,774,823 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,323,742 | BOYAmt |
| EOY | $7,881,972 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,987,253 | BOYAmt |
| EOY | $2,755,291 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,578,592 | BOYAmt |
| EOY | $2,461,720 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,889,587 | BOYAmt |
| EOY | $13,098,983 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,567,632 | BOYAmt |
| EOY | $3,675,840 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,567,632 | BOYAmt |
| EOY | $3,675,840 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,457,219 | BOYAmt |
| EOY | $16,774,823 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $108,208 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $41,973 | OtherCostOrOtherBasisAmt |
| Book Value | $41,973 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $373,321 | OtherCostOrOtherBasisAmt |
| Depreciation | $373,154 | DepreciationAmt |
| Book Value | $167 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,231,059 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,486,520 | DepreciationAmt |
| Book Value | $744,539 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $15,012,434 | OtherCostOrOtherBasisAmt |
| Depreciation | $11,510,230 | DepreciationAmt |
| Book Value | $3,502,204 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,065,065 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,729,567 | DepreciationAmt |
| Book Value | $2,335,498 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $6,624,381 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| Third Party Payors | $370,004 |
| Due To Affliates | $2,091,716 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $2,461,720 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $67,118,927 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | -$2,564,325 | OtherRevenueAmt |
| Revenue Not Reported | -$2,564,325 | RevenueNotReportedAmt |
| Revenue Subtotal | $69,683,252 | RevenueSubtotalAmt |
| Other Revenues Not Included | $28,173,163 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $28,173,163 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $97,856,415 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $95,182,982 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $95,182,982 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $2,565,225 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $2,565,225 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $97,748,207 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule D | FormAndLineReferenceDesc |
| Explanation | Part X Line 2- Management has evaluated their income tax positions under the guidance included in ASC 740. Based on their review, management has not identified any material uncertain tax positions to be recorded or disclosed in the financial statements. Part XII Line 2d - Provision for doubtful accounts of -$2,565,225 and net assets released from restriction $900 are not included in net revenue on the audited financial statements. Part XII Line 4b- Susquehanna Physician Services received financial support from the following related entities The Williamsport Hospital & Medical Center $11,694,779 Divine Providence Hospital $11,872,861 Muncy Valley Hospital $4,600,591 and TRNA transfers from affiliates $4,932 Part XIII Line 4b - Provision for doubtful accounts of $2,565,225 are not included in expenses on the audited financial statements. | ExplanationTxt |
Schedule F IRS990ScheduleF
Account Activities Outside US AccountActivitiesOutsideUSGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Region | Central America | RegionTxt |
| Offices | 1 | OfficesCnt |
| Employee | 0 | EmployeeCnt |
| Type Of Activities Conducted | Program Services | TypeOfActivitiesConductedTxt |
| Specific Services Provided | Captive insurance company | SpecificServicesProvidedTxt |
| Region Total Expenditures | $1,935,103 | RegionTotalExpendituresAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Subtotal Offices | 1 | SubtotalOfficesCnt |
| Subtotal Employees | 0 | SubtotalEmployeesCnt |
| Continutation Total Office | 0 | ContinutationTotalOfficeCnt |
| Continutation Total Employee | 0 | ContinutationTotalEmployeeCnt |
| Total Office | 1 | TotalOfficeCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Subtotal Spent | $1,935,103 | SubtotalSpentAmt |
| Continuation Spent | $0 | ContinuationSpentAmt |
| Total Spent | $1,935,103 | 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 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 (16 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Ronald E DiSimone MD | ||||||||||||||
| Director | $1,031,528 | $0 | $0 | $0 | $35,430 | $0 | $9,950 | $0 | $24,364 | $0 | $1,101,272 | $0 | $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 |
| Alexander R Nesbitt MD | ||||||||||||||
| Director | $219,808 | $0 | $0 | $0 | $2,795 | $0 | $12,116 | $0 | $18,433 | $0 | $253,152 | $0 | $0 | $0 |
| Kevin W Kist Jr DO | ||||||||||||||
| Director | $333,862 | $0 | $10,206 | $0 | $87,937 | $0 | $9,950 | $0 | $26,817 | $0 | $468,772 | $0 | $0 | $0 |
| Jill Burns MD | ||||||||||||||
| director | $0 | $247,243 | $0 | $44,446 | $0 | $4,814 | $0 | $9,950 | $0 | $27,591 | $0 | $334,044 | $0 | $0 |
| Eric D Pohjala | ||||||||||||||
| Exec VP/CFO | $0 | $252,402 | $0 | $0 | $0 | $2,755 | $0 | $9,720 | $0 | $17,629 | $0 | $282,506 | $0 | $0 |
| Jan E Fisher | ||||||||||||||
| Exec VP/COO | $0 | $409,956 | $0 | $36,987 | $0 | $12,863 | $0 | $9,950 | $0 | $22,042 | $0 | $491,798 | $0 | $0 |
| David Lopatofsky MD | ||||||||||||||
| Exec VP/CMO - hired 2/2015 | $408,670 | $0 | $61,045 | $0 | $18,717 | $0 | $11,275 | $0 | $26,659 | $0 | $526,366 | $0 | $0 | $0 |
| Michael J Lazar MD | ||||||||||||||
| Physician | $714,057 | $0 | $60,000 | $0 | $46,147 | $0 | $9,950 | $0 | $26,356 | $0 | $856,510 | $0 | $0 | $0 |
| Sabrina Dowd | ||||||||||||||
| Physician | $743,372 | $0 | $41,195 | $0 | $654 | $0 | $9,950 | $0 | $23,826 | $0 | $818,997 | $0 | $0 | $0 |
| Donald T Nardone MD | ||||||||||||||
| Physician | $524,706 | $0 | $0 | $0 | $222,583 | $0 | $9,950 | $0 | $27,754 | $0 | $784,993 | $0 | $0 | $0 |
| Michael V Hoffman MD | ||||||||||||||
| Physician | $798,184 | $0 | $57,017 | $0 | $646 | $0 | $9,950 | $0 | $23,969 | $0 | $889,766 | $0 | $0 | $0 |
| John H Bailey MD | ||||||||||||||
| physician | $576,569 | $0 | $210,620 | $0 | $109,755 | $0 | $9,950 | $0 | $24,314 | $0 | $931,208 | $0 | $0 | $0 |
| Charles J Santangelo | ||||||||||||||
| Former Exsc 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 |
| 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 |
| William C McCauley MD | ||||||||||||||
| Former Exec VP/CMO Retired 1/31/15 | $108,272 | $0 | $45,384 | $0 | $31,716 | $0 | $0 | $0 | $4,271 | $0 | $189,643 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 5 | Part I, Line 3 The Williamsport Hospital EIN#24-0795508, a related organization, uses the following resources to establish the compensation of top management officials: compensation committee, independent compensation consultant, written employment contract, compensation survey or study, and approval by the board. |
| Part I, Line 6 | In order for the Leadership Team to participate in the annual Variable Compensation Incentive Program (VCIP), a minimum operating margin must be achieved for the most recently completed year on a consolidated system-level basis. Individual goals and objectives related to the VCIP may also include individual entity operating performance. For FY 2016, the minimum threshold was met that would trigger a VCIP payment. In December 2015, President/CEO Steven P. Johnson received a variable compensation award in the amount of $133,858. |
Schedule L IRS990ScheduleL
Loans Btwn Org Interested Prsn LoansBtwnOrgInterestedPrsnGrp (3 entries)
| Relationship With OrgRelationshipWithOrgTxt | Loan PurposeLoanPurposeTxt | Loan From OrganizationLoanFromOrganizationInd | Original PrincipalOriginalPrincipalAmt | Balance DueBalanceDueAmt | DefaultDefaultInd | Board Or Committee ApprovalBoardOrCommitteeApprovalInd | Written AgreementWrittenAgreementInd |
|---|---|---|---|---|---|---|---|
| John H Bailey MD | |||||||
| Employee | Sign On | Yes (X) | $100,000 | $50,748 | 0 | 0 | Yes (1) |
| Michael J Lazar MD | |||||||
| Employee | Recruitment | Yes (X) | $120,000 | $31,812 | 0 | 0 | Yes (1) |
| David Lopatofsky MD | |||||||
| Employee | Educational Assistance | Yes (X) | $43,757 | $39,274 | 0 | 0 | Yes (1) |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Balance Due | $121,834 | TotalBalanceDueAmt |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule L, Part 2, Loans To and From Interested Persons: | Name of Person: John H. Bailey, MDDisqualified Person Code: 1 of top 5 highest compensatedPurpose of Loan: Sign on BonusOriginal Amount: $100,000Balance Due: $50,748Loan in Default? = NoApproved by Board or Committee? = NoWritten Agreement? = Yes |
| Schedule L, Part 2, Loans To and From Interested Persons | Name of Person: Michael J. Lazar, MDDisqualified Person Code: 1 of top 5 highest compensatedPurpose of Loan: Recruitment BonusOriginal Amount: $120,000Balance Due: $31,812Loan in Default? = NoApproved by Board or Committee? = NoWritten Agreement? = Yes |
| Schedule L, Part 2, Loans To and From Interested Persons | Name of Person: David Lopatofsky, MDDisqualified Person Code: Key EmployeePurpose of Loan: Educational AssistanceOriginal Amount: $43,757Balance Due: $39,274Loan in Default? = NoApproved by Board or Committee? = NoWritten Agreement? = Yes |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 6 | UPMC Susquehanna, EIN #23-2751183, is the sole member of the governing body |
| Form 990, Part VI, Section A, line 7a | UPMC Susquehanna, EIN # 23-2751183, may elect or remove members of the governing body. |
| Form 990, Part VI, Section A, line 7b | All the business and affairs of the corporation shall be managed and controlled by the Board of Directors, subject to the oversight of the Member of the management and operation of the corporation, except that the following powers are reserved exclusively to the sole Member of the corporation, and no attempted exercise of any such powers by anyone other than the sole Member shall be valid or of any force or effect whatsoever. The sole member shall exercise its power through its Board of Directors. The Member shall have exclusive authority to exercise the following powers: A. To approve the appointment and removal of the President of the corporation. B. To elect and remove, with or without cause, a Director of the corporation. C. To establish the overall policy and long range plans of the corporation, determine or change the mission of the corporation, approve the programs, and services of the corporation, and monitor and maintain the philosophy, goals and purposes for which the corporation was formed and exists. D. To adopt, amend or repeal the Articles of Incorporation or the bylaws. E. To establish requirements for a unified budget, the approval of new capital debt, any increment to any existing capital debt, and/or any change in the capital debt obligations of the corporation. F. To establish requirements for the approval of the acquisition, purchase, sale, leasing outside the ordinary course of business, transfer outside the ordinary cause of business or encumbrance outside the normal course of business of land or buildings and the construction of demolition of buildings owned by the corporation. G. To require a certified audit of corporate funds at any time. H. To approve any guaranty of indebtedness of any person, the granting of any security interest in or the creation of any encumbrance on any asset of the corporation outside the ordinary course of business, or any transfer of any asset of the corporation outside the normal course of business, except transfers between or among affiliated corporations. I. To approve any merger, consolidation, organization, reorganization, joint venture or other modification of corporate structure or affiliations affecting to autonomy, governance or operations of the corporation. J. To dissolve or terminate the existence of the corporation and determine the distribution of assets upon such termination or dissolution, as provided in the bylaws. K. To appoint annually the external fiscal auditor of the corporation. L. To approve the nominees for elected officers of the Board of Directors of the corporation and to return the list of approved nominees to the Board of Directors for election. M. To remove any elected officer of the corporation. N. To approve the annual capital and operating budget of the corporation. O. To coordinate managed care plans, including decisions concerning entry into or renewal of ay contract or agreement relating thereto. |
| Form 990, Part VI, Section B, line 11 | A high-level overview of Forms 990 is presented to the parent Board of Directors (UPMC Susquehanna, 23-2751183) before filing and complete drafts of all returns are made available to all Board members through the CEO's and CFO's office. |
| Form 990, Part VI, Section B, line 12c | As required by law, SPS policy states that all members of the Board of Managers must sign a statement each year disclosing any conflict of interest that may arise and agree to abstain when issues involving those parties with conflicting interests are called to motion. Any conflicts of interest are reviewed by the System's attorneys. |
| Form 990, Part VI, Section B, line 15 | The board of directors, through the Executive Committee, retains an independent outside consultant to provide guidance with respect to the annual establishment of the rebuttable presumption or reasonableness relative to executive compensation and benefits. The consultant annually provides detailed market information from its annual Executive Compensation Survey of Health Systems. In addition, other regional survey data is provided in order to supply the health system with a "national" picture of compensation. With this process established, the executive compensation committee takes the proper steps to educate the Board of Directors to understand all of the above mentioned oversight and to appropriately prepare them for community or media inquiry. In addition, the Board is made aware of the form 990 and its role in the communication of information to the public. |
| Form 990, Part VI, Section C, line 19 | The organization makes its governing documents, conflict of interest policy, and financial statements available to the public upon request. |
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 | |||||||||||
| 777 Rural Avenue | Williamsport | PA | 17701 | 240795508 | Hospital | PA | 501 (c) (3) | Line 3 | UPMC Susquehanna | 0 | |
| Divine Providence Hospital | |||||||||||
| 1100 Grampian Blvd | Williamsport | PA | 17701 | 240799343 | Hospital | PA | 501 (c) (3) | Line 3 | UPMC Susquehanna | 0 | |
| Muncy Valley Hospital | |||||||||||
| 215 East Water Street | Muncy | PA | 17756 | 240806023 | hospital | PA | 501 (c) (3) | Line 3 | UPMC Susquehanna | 0 | |
| Susquehanna Health Foundation | |||||||||||
| 1100 Grampian Blvd | Williamsport | PA | 17701 | 232743470 | Fundraising and affiliated activities | PA | 501 (c) (3) | Line 11a, I | UPMC Susquehanna | 0 | |
| UPMC Susquehanna | |||||||||||
| 1205 Grampian Blvd | Williamsport | PA | 17701 | 232751183 | Coordinate & manage the delivery of healthcare | PA | 501 (c) (3) | Line 11b, II | 0 | N/A | |
| Williamsport Area Ambulance Service Cooperative | |||||||||||
| 700 High Street | Williamsport | PA | 17701 | 232416166 | Ambulance Transports | PA | 501 (c) (3) | Line 9 | 0 | N/A | |
| Soliders & Sailors Memorial Hospital | |||||||||||
| 32-36 Central Avenue | Wellsboro | PA | 16901 | 232176963 | Hospital | PA | 501 (c) (3) | Line 3 | UPMC Susquehanna | 0 | |
| The Green Home | |||||||||||
| 37 Central Ave | Wellsboro | PA | 16901 | 240804365 | Skilled nursing & assisted living | PA | 501 (c) (3) | Line 9 | UPMC Susquehanna | 0 | |
| Tioga Health Care Partners | |||||||||||
| 15 Meade Street | Wellsboro | PA | 16901 | 251765538 | Physician Services | PA | 501 (c) (3) | Line 11b, II | UPMC Susquehanna | 0 | |
| Laurel Management Services | |||||||||||
| 15 Meade Street | Wellsboro | PA | 16901 | 251644910 | Mgmt consulting & supervisory services | PA | 501 (c) (3) | Line 11b, II | UPMC Susquehanna | 0 | |
| Laurel Realty | |||||||||||
| 15 Meade Street | wellsboro | PA | 16901 | 231403678 | Own & manage real estate | PA | 501 (c) (2) | N/A | UPMC Susquehanna | 0 | |
| Laurel Health System | |||||||||||
| 15 Meade Street | Wellsboro | PA | 16901 | 240795488 | Coordinate & manage the delivery of healthcare | PA | 501 (c) (3) | Line 11b, II | UPMC Susquehanna | 0 | |
| Laurel Health Foundation | |||||||||||
| 15 Meade Street | Wellsboro | PA | 16901 | 251810488 | Fundraising and affiliated activities | PA | 501 (c) (3) | Line 11a, I | Laurel Health System | 0 | |
| Susquehanna Health Innovation Center Inc | |||||||||||
| 700 High Street | wIlliamsport | PA | 17701 | 471600873 | Supporting organization of affiliated entities | PA | 501 (c) (3) | Line 11a, I | UPMC Susquehanna | 0 | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Community Basket LLC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1205 Grampian Blvd | AddressLine1Txt |
| City | Williamsport | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 17701 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 201195739 | EIN |
| Primary Activities | Rents real estate | PrimaryActivitiesTxt |
| Legal Domicile State | PA | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | UPMC Susquehanna | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Predominant Income Type | excluded from tax | PredominantIncomeTypeTxt |
| Disproportionate Allocations | 0 | DisproportionateAllocationsInd |
| General Or Managing Partner | 0 | GeneralOrManagingPartnerInd |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd | Address Line1ForeignAddress/AddressLine1Txt | CityForeignAddress/CityNm | CountryForeignAddress/CountryCd | Foreign PostalForeignAddress/ForeignPostalCd | Legal Domicile Foreign CountryLegalDomicileForeignCountryCd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Susquehanna Ventures | ||||||||||||||
| 1201 Grampian Blvd | Williamsport | PA | 17701 | 232470263 | Pharmacy and 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 | 0 | 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 | Yes (1) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |