UPMC: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- UPMC (EIN 24-0795488)
- Tax period
- 2015-07-01 to 2016-06-30
- Filed
- 2017-05-02
- IRS object ID
- 201741229349300244
- Schema version
- 2015v3.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-05-02T11:39:07-05:00 | ReturnTs |
| Tax Period End | 2016-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 440160260 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BKD LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 910 E St Louis 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 | 240795488 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LAUREL HEALTH SYSTEM | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | LAUR | BusinessNameControlTxt |
| Phone | 5707230605 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 32-36 Central Ave No Acctg | AddressLine1Txt |
| City | WELLSBORO | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 16901 | 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) |
|---|---|---|
| Address Change | Yes (X) | AddressChangeInd |
| Principal Officer | STEVEN P JOHNSON | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 700 HIGH ST | AddressLine1Txt |
| City | WILLIAMSPORT | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 17701 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $20,016 | 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 | 1989 | FormationYr |
| Legal Domicile State | PA | LegalDomicileStateCd |
| Activity Or Mission | Laurel Health System is a subsidiary of UPMC Susquehanna. The mission of UPMC Susquehanna and affiliates is as follows: To extend God's healing love by improving the health of those we serve. Our vision is to create a world-class health system. Our values are putting patients first, sharing ownership and being servant leaders. | ActivityOrMissionDesc |
| Voting Members Governing Body | 15 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 12 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 15 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $61,104 | PYContributionsGrantsAmt |
| CY Contributions Grants | $0 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $0 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| PY Investment Income | $67,274 | PYInvestmentIncomeAmt |
| CY Investment Income | $20,016 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $128,378 | PYTotalRevenueAmt |
| CY Total Revenue | $20,016 | 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 | $0 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $0 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $74,096 | PYOtherExpensesAmt |
| CY Other Expenses | $13,010 | CYOtherExpensesAmt |
| PY Total Expenses | $74,096 | PYTotalExpensesAmt |
| CY Total Expenses | $13,010 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $54,282 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $7,006 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $41,734,017 | TotalAssetsBOYAmt |
| Total Assets EOY | $120,647,919 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $38,013,751 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $116,920,647 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $3,720,266 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $3,727,272 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | Laurel Health System is a subsidiary of UPMC Susquehanna. The mission of UPMC Susquehanna and affiliates is as follows: To extend God' healing love by improving the health of those we serve. Our vision is to create a world-class health system. Our values are putting patients first, sharing ownership and being servant leaders. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $13,010 | ExpenseAmt |
| Desc | Expenditures in support of affiliated entities that provide a wide range of health and human services from primary and acute care to long-term care and preventive health services. Organizations supported over the past year include: one rural acute care hospital with 2,813 admissions and 105,251 outpatient visits; one skilled nursing facility with 38,833 resident days; an assisted living home with 24 units occupied; an emergency room physicians group with 17,249 visits; an anesthesia services group with 3,001 procedures; one OBGYN practice, two surgical practices and an internal medicine practice that, combined, delivered 96 babies, performed 1,574 surgeries, 2,161 procedures, 6,209 inpatient visits, and 43,170 office visits; and one alternative medicine practice with 3,434 patient treatments. | Desc |
| Total Program Service Expenses | $13,010 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | 0 | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 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 | Yes (1) | 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 |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 0 | EmployeeCnt |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| 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 | 15 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 12 | 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 | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | 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 | 5707230605 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 32-36 Central Ave Accounting | AddressLine1Txt |
| City | WELLSBORO | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 16901 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (23 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 | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|
| James D Baker Jr | |||||||||
| Director | 0.33 | 1.67 | Yes (X) | $0 | $0 | $0 | |||
| Jill A Burns MD | |||||||||
| Director | 0.33 | 45.67 | Yes (X) | $0 | $296,503 | $37,541 | |||
| Lisa V Feil PsyD | |||||||||
| Director | 0.33 | 3.67 | Yes (X) | $0 | $0 | $0 | |||
| Robert P Fitzgerald | |||||||||
| Director | 0.33 | 1.67 | Yes (X) | $0 | $0 | $0 | |||
| Harold F Hoose III | |||||||||
| Director | 0.33 | 1.67 | Yes (X) | $0 | $0 | $0 | |||
| Steven P Johnson | |||||||||
| CEO | 0.33 | 53.67 | Yes (X) | $0 | $832,199 | $35,182 | Yes (X) | ||
| Walter J Laibinis DO | |||||||||
| Director | 0.33 | 41.67 | Yes (X) | $0 | $293,550 | $33,435 | |||
| Michael W Lichty | |||||||||
| Director | 0.33 | 1.67 | Yes (X) | $0 | $0 | $0 | |||
| Craig G Litchfield | |||||||||
| Treasurer (ending 6/15) | 0.33 | 1.67 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| J Dennis Murray | |||||||||
| Director | 0.33 | 7.67 | Yes (X) | $0 | $0 | $0 | |||
| Thomas M Owlett Esq | |||||||||
| Chairman | 0.33 | 7.67 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| Glenn B Poirier | |||||||||
| Vice Chairman | 0.33 | 7.67 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| Wendy S Swartz CPA | |||||||||
| Director | 0.33 | 1.67 | Yes (X) | $0 | $0 | $0 | |||
| Aneurin J Williams Jr | |||||||||
| Director | 0.33 | 1.67 | Yes (X) | $0 | $0 | $0 | |||
| Donna R Wilson | |||||||||
| Director | 0.33 | 1.67 | Yes (X) | $0 | $0 | $0 | |||
| Kathy J Wright PhD | |||||||||
| Secretary | 0.33 | 1.67 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| Janie M Hilfiger | |||||||||
| President SSMH | 0.33 | 41.67 | $0 | $180,881 | $17,488 | Yes (X) | |||
| Eric D Pohjala | |||||||||
| Exec VP/CFO | 1.00 | 42.00 | $0 | $257,157 | $27,349 | Yes (X) | |||
| Jan E Fisher | |||||||||
| Exec VP/COO | 1.00 | 42.00 | $0 | $459,806 | $31,992 | Yes (X) | |||
| David Lopatofsky MD | |||||||||
| Exec VP/CMO | 1.00 | 42.00 | $0 | $437,276 | $38,887 | Yes (X) | |||
| Charles J Santangelo | |||||||||
| Former Exec VP/CFO | 0.00 | $0 | $338,073 | $24,988 | Yes (X) | ||||
| William C McCauley MD | |||||||||
| Former Exec VP/CMO | 0.00 | $0 | $185,372 | $4,271 | Yes (X) | ||||
| Ronald J Butler | |||||||||
| Former Exec VP/CBO | 0.00 | 2.00 | $0 | $518,626 | $13,502 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $3,799,443 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $264,635 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $20,016 | TotalRevenueColumnAmt |
| Exclusion | $20,016 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $20,016 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $20,016 | ExclusionAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,768 | TotalAmt |
| Program Services | $9,768 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Banking & License Fees | Desc |
| Total | $3,242 | TotalAmt |
| Program Services | $3,242 | ProgramServicesAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,010 | TotalAmt |
| Program Services | $13,010 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,362,914 | BOYAmt |
| EOY | $2,552,151 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $39,951 | BOYAmt |
| EOY | $53,760 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $739,200 | BOYAmt |
| EOY | $712,800 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $582 | BOYAmt |
| EOY | $207 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,504,970 | BOYAmt |
| EOY | $996,717 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $38,086,400 | BOYAmt |
| EOY | $116,332,284 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $41,734,017 | BOYAmt |
| EOY | $120,647,919 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $379,030 | BOYAmt |
| EOY | $212,850 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $37,634,721 | BOYAmt |
| EOY | $116,707,797 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $38,013,751 | BOYAmt |
| EOY | $116,920,647 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $222,144 | BOYAmt |
| EOY | $428,058 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,778 | BOYAmt |
| EOY | $4,778 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,493,344 | BOYAmt |
| EOY | $3,294,436 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,720,266 | BOYAmt |
| EOY | $3,727,272 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $41,734,017 | BOYAmt |
| EOY | $120,647,919 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $7,006 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | 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) |
|---|---|---|
| Supporting Organization509a3 | Yes (X) | SupportingOrganization509a3Ind |
| Supporting Org Type2 | Yes (X) | SupportingOrgType2Ind |
| Supported Organizations | 3 | SupportedOrganizationsCnt |
Supported Org Information SupportedOrgInformationGrp (3 entries)
| EINEIN | Organization TypeOrganizationTypeCd | Governing Document ListedGoverningDocumentListedInd | SupportSupportAmt | Other SupportOtherSupportAmt |
|---|---|---|---|---|
| The Green Home | ||||
| 240804365 | 9 | Yes (1) | $0 | $0 |
| Soldiers Sailors Memorial Hospital | ||||
| 232176963 | 3 | Yes (1) | $0 | $0 |
| North Penn Comprehensive Health Services | ||||
| 232176963 | 3 | Yes (1) | $0 | $0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supported Organizations Total | 3 | SupportedOrganizationsTotalCnt |
| Support Sum | $0 | SupportSumAmt |
| Other Support Sum | $0 | OtherSupportSumAmt |
Form990 Sch A Supporting Org Form990SchASupportingOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Listed By Name Governing Doc | Yes (1) | ListedByNameGoverningDocInd |
| Suprt Org No IRS Determination | 0 | SuprtOrgNoIRSDeterminationInd |
| Supported Org Section C456 | 0 | SupportedOrgSectionC456Ind |
| Supported Org Not Organized US | 0 | SupportedOrgNotOrganizedUSInd |
| Organization Change Suprt Org | 0 | OrganizationChangeSuprtOrgInd |
| Support Non Supported Org | 0 | SupportNonSupportedOrgInd |
| Payment Substantial Contribtr | 0 | PaymentSubstantialContribtrInd |
| Loan Disqualified Person | 0 | LoanDisqualifiedPersonInd |
| Controlled Disqualified Prsn | 0 | ControlledDisqualifiedPrsnInd |
| Disqualified Prsn Controll Int | 0 | DisqualifiedPrsnControllIntInd |
| Disqualified Prsn Ownr Int | 0 | DisqualifiedPrsnOwnrIntInd |
| Excess Business Holdings Rules | 0 | ExcessBusinessHoldingsRulesInd |
| Contribution Controller | 0 | ContributionControllerInd |
| Contribution Family | 0 | ContributionFamilyInd |
| Contribution35 Controlled | 0 | Contribution35ControlledInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Majority Dir Trst Supported Org | Yes (1) | MajorityDirTrstSupportedOrgInd |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $0 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (4 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| Invested Educational Funds | $47,620 |
| Matt Wood Memorial Account | $4,781 |
| Beneficiary Interest Trust | $3,246,921 |
| Due from related parties | $113,032,962 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $116,332,284 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Due to related parties | Desc |
| Amt | $116,707,797 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $116,707,797 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $218,924 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Not Reported | $0 | RevenueNotReportedAmt |
| Revenue Subtotal | $218,924 | RevenueSubtotalAmt |
| Other Revenues Not Included | -$198,908 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | -$198,908 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $20,016 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $13,010 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $13,010 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $13,010 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part X, Line 2: | Management has evaluated their income tax positions under the guidance included in ASC 740. Based on that review, management has not identified any material uncertain tax positions to be recorded or disclosed in the financial statements. |
| Part XI, Line 4b - Other Adjustments: | Permanently restricted investment returns -198908. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (10 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Jill A Burns MD | ||||||||||||||
| Director | $0 | $247,243 | $0 | $44,446 | $0 | $4,814 | $0 | $9,950 | $0 | $27,591 | $0 | $334,044 | $0 | $0 |
| Steven P Johnson | ||||||||||||||
| CEO | $0 | $668,195 | $0 | $133,858 | $0 | $30,146 | $0 | $15,925 | $0 | $19,257 | $0 | $867,381 | $0 | $0 |
| Walter J Laibinis DO | ||||||||||||||
| Director | $0 | $231,118 | $0 | $45,655 | $0 | $16,777 | $0 | $9,950 | $0 | $23,485 | $0 | $326,985 | $0 | $0 |
| Janie M Hilfiger | ||||||||||||||
| President SSMH | $0 | $163,729 | $0 | $14,229 | $0 | $2,923 | $0 | $7,416 | $0 | $10,072 | $0 | $198,369 | $0 | $0 |
| Eric D Pohjala | ||||||||||||||
| Exec VP/CFO | $0 | $254,402 | $0 | $0 | $0 | $2,755 | $0 | $9,720 | $0 | $17,629 | $0 | $284,506 | $0 | $0 |
| Jan E Fisher | ||||||||||||||
| Exec VP/COO | $0 | $409,956 | $0 | $36,987 | $0 | $12,863 | $0 | $9,950 | $0 | $22,042 | $0 | $491,798 | $0 | $0 |
| David Lopatofsky MD | ||||||||||||||
| Exec VP/CMO | $0 | $412,757 | $0 | $18,458 | $0 | $6,061 | $0 | $11,275 | $0 | $27,612 | $0 | $476,163 | $0 | $0 |
| Charles J Santangelo | ||||||||||||||
| Former Exec VP/CFO | $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 | $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 | $0 | $112,293 | $0 | $32,105 | $0 | $374,228 | $0 | $9,950 | $0 | $3,552 | $0 | $532,128 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 3 | The Williamsport Hospital EIN #24-0795508, a related organization, uses the following resources to establish the compensation of the top management officials: compensation committee, independent compsensation 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 VCIP payment. In December 2015, President / CEO Steven P. Johnson received variable compensation award in the amount of $133,858. |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (2 entries)
| Bond ReferenceBondReferenceCd | Bond Issuer EINBondIssuerEIN | Bond IssuedBondIssuedDt | Issue PriceIssuePriceAmt | PurposePurposeDesc | DefeasedDefeasedInd | On Behalf Of IssuerOnBehalfOfIssuerInd | Pool FinancingPoolFinancingInd |
|---|---|---|---|---|---|---|---|
| Tioga County Industrial Development Authority | |||||||
| A | 251433720 | 2010-05-07 | $10,000,000 | see part VI | 0 | 0 | 0 |
| Tioga County Industrial Development Authority | |||||||
| B | 251433720 | 2011-12-30 | $10,000,000 | see part VI | 0 | 0 | 0 |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (2 entries)
| Bond ReferenceBondReferenceCd | Total ProceedsTotalProceedsAmt | Issuance Costs From ProceedsIssuanceCostsFromProceedsAmt | Capital ExpendituresCapitalExpendituresAmt | Substantial CompletionSubstantialCompletionYr | Current RefundingCurrentRefundingInd | Advance RefundingAdvanceRefundingInd | Final Allocation MadeFinalAllocationMadeInd | Adequate Books And Rec MaintAdequateBooksAndRecMaintInd | Working Capital ExpendituresWorkingCapitalExpendituresAmt |
|---|---|---|---|---|---|---|---|---|---|
| A | $10,000,000 | $96,527 | $9,903,473 | 2012 | 0 | 0 | Yes (1) | Yes (1) | |
| B | $8,771,468 | $106,789 | $8,664,679 | 2013 | 0 | 0 | Yes (1) | Yes (1) | $474,899 |
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 | Bond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestInd | Change In Use Bond Financed PropChangeInUseBondFinancedPropInd | Procs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd |
|---|---|---|---|---|---|---|---|
| A | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| B | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
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 | Yes (1) | 0 | 0 | Yes (1) | 0 | 0 | 0 | 0 |
| B | 0 | Yes (1) | 0 | 0 | Yes (1) | 0 | 0 | 0 | 0 |
Procedures Corrective Action ProceduresCorrectiveActionGrp (2 entries)
| Bond ReferenceBondReferenceCd | Procedures Corrective ActionProceduresCorrectiveActionInd |
|---|---|
| A | 0 |
| B | 0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule K, Part I, Line A | The purpose of the May 7, 2010 tax exempt financing is to provide funds for the acquisition, construction, and equipping of certain additions, improvements, and renovations to the hospital facilities owned and operated by Soldiers + Sailors Memorial Hospital (the "Occupant"), a wholly owned subsidiary of the Borrower, situated and maintained at the Occupant's principal place of business and used within its exempt purposes as an organization described in Sectin 501(c)3 of the Internal Revenue code of 1986, amended. |
| Schedule K, Part I, Line B | The purpose of the December 30, 2011 tax exempt financing is to finance various capital projects of 32-36 Central Avenue in the Borough of Wellsboro, to construct a same day surgery unit, upgrade heating, ventilation and air conditioning systems, repair the roof and parking lot, replace fan coil units, renovate the obstetrics unit and replace doors, relocate the pharmacy, and acquire and renovate a building for physical therapy services located at 11893 Route 6, Wellsboro, Pennsylvania (the "Soldiers + Sailors Project"); (b)for the North Penn comprehensive Health Services facilities, renovate and iimprove the Laurel Health facilities at 11 Water Street in the Borough of Wellsboro, and to acquire property and construct health care faciliites at 1442 S Main Street or 1625 Central Avenue in the Borough of Wellsboro, replace the boiler (the "Green Home Project and together with the Soldiers + Sailors Project and the North Penn Project, the "Projects"), to be used within the exempt purposes of each organization, as described in Section 501(c)3 of the Internal Revenue Code of 1986, as amended. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part V, Line 2a & 2b | Explanation: UPMC Susquehanna EIN #23-2751183 utilizes a common paymaster which includes the following entities: Divine Providence Hospital EIN #24-0499343 Muncy Valley Hospital EIN #24-0806023 The Williamsport Hospital EIN #24-0795508 Susquehanna Health Foundation EIN #23-2743470 Susquehanna Physician Services EIN #23-2449454 Williamsport Area Ambulance Service Cooperative EIN #23-2416166 Laurel Realty EIN #23-1403678 Laurel Management Services EIN #25-1644910 Soldiers + Sailors Memorial Hospital EIN #23-2176963 The Green Home EIN #24-0804365 Tioga Health Care Providers Inc 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, 0 employees' payroll expenses were recorded by Laurel Health System. |
| Form 990, Part VI, Section A, line 6 | The Laurel Health System (LHS) has one corporate member, UPMC Susquehanna. Effective October 1, 2016 the University of Pittsburgh Medical Center (UPMC) became the sole corporate member of Susquehanna Health System (EIN# 23-2751183) and the name was formally changed to UPMC Susquehanna. |
| 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 Entity shall be managed and controlled by the Board of Directors, subject to the oversight of the sole member, UPMC Susquehanna, of the management and operation of the Entity, except that the following powers are reserved exclusively to the sole Member of the Entity, and no attempted exercise of any such powers by anyone other than the sole Member shall be valid of any force or effect whatsoever. The sole Member shall exercise its powers through its Board of Directors. The sole Member shall have the exclusive authority to exercise the following powers: A) to appoint or elect the directors B) to appoint and remove the President following consultation with the Entity C) to approve the nominees for elected offices and to return the list of approved nominees to the governing bodies for election D) to remove, with or without cause, any director or any elected officer E) to amend the Governing Instruments and to approve all amendments to the Governing Instruments which are proposed for adoption F) to approve the annual operating and capital budgets G) to establish requirements for a unified budget H) to approve the incurrence or issuance of debt proposed by Entity and the encumbrance of any Entity assets to secure any such incurred debt I) to incur debt (or to cause debt to be incurred) on behalf of the Entity J) to require contributions in cash or cash equivalents to support the working capital needs or capital projects of any one or more System Entities K) to require that any debt incurred on a System-wide basis by or at the direction of UPMC Susquehanna shall be the joint and several obligation of each System Entity L) to direct or approve any cash contributions or any other capital contributions made by one System Entity to another System Entity M) to allocate any financial resources in such manner as UPMC Susquehanna determines to be necessary N) to approve the sale, transfer or other disposition of Entity or Entity property unless it is made in the ordinary course of business or involves assets with a fair market value of less than one hundred thousand dollars O) to direct the transfer of property from the Entity to one or more other System Entities P) to approve of any investment of assets by Entity not within the limits of the System's approved investment policy Q) to establish requirements for the approval of the acquisition, purchase, sale, transfer, encumbrance, leasing, construction or demolition of land or building outside the ordinary course of business R) to approve any decision with respect to the addition, modification or discontinuance of any patient care or diagnostic program or health care service S) to approve of any change in licensure of Entity; licensure of any Facility; certification, registration, accreditation, permit, or related approval of any activity T) to require Entity to add, modify, relocate or discontinue any patient care of diagnostic program or health care service U) to approve or direct any merger, consolidation, organization, reorganization, joint venture, corporate division, sale, conversion, lease or exchange of substantially all the assets, dissolution, liquidation or any other modification of corporate structure or affiliations affecting the autonomy, governance, or operations, and the creation or acquisition of any new affiliate by Entity V) to dissolve or terminate the existence of Entity and to determine the distribution of assets upon such termination or dissolution W) to coordinate managed care plans involving Entity, including decisions concerning entry into or renewal of any contract or agreement relation thereto X) to develop and/or enter into key strategic relationships on behalf of Entity Y) to select any outside financial auditors, general legal counsel or investment advisors to provide services on behalf of the Entity. |
| 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 offices. |
| Form 990, Part VI, Section B, line 12c | Annually on the 1st day of January, UPMC Susquehanna sends to all directors, officers, management staff and contracted physicians a questionnaire to be completed and returned by January 15. A report is submitted to the Board of Directors to notify them of any conflicts of interest disclosed. |
| Form 990, Part VI, Section B, line 15 | On a bi-annual basis, an independent compensation consulting firm performs an analysis of the leadership salary structure in relationship to the labor market using data from four different salary surveys. Their analysis is reviewed with the Governance committee of the Board of Directors. The firm then outlines its recommendations for the proposed executive salary structure to the committee for their consideration and approval. |
| Form 990, Part VI, Section C, line 19 | Governing documents, financial statements, and conflict of interest policies are available upon request from the person listed as possessor of the information on line 20. |
| Form 990, Part XII, Line 2c: | The organization has changed neither the oversight process nor the independent accountant selection process during the fiscal year. |
| Part V, Line 1a | All 1099's were issued by UPMC Susquehanna(EIN 23-2751183) for the twelve months ended June 30, 2016. All expenses were then allocated back to the entities. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (15 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Public Charity StatusPublicCharityStatusTxt | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Laurel Realty | |||||||||||
| 15 Meade St Suite U-6 | Wellsboro | PA | 16901 | 231403678 | Own & manage real estate | PA | 501(c)(2) | UPMC Susquehanna | 0 | ||
| Laurel Management Services | |||||||||||
| 15 Meade St Suite U-6 | Wellsboro | PA | 16901 | 251644910 | Management consulting and supervisory services | PA | 501(c)(3) | UPMC Susquehanna | 0 | Line 11b, II | |
| The Green Home | |||||||||||
| 37 Central Ave | Wellsboro | PA | 16901 | 240804365 | Skilled nursing & assisted living facilities | PA | 501(c)(3) | UPMC Susquehanna | 0 | Line 9 | |
| Solders Sailors Memorial Hospital | |||||||||||
| 32-36 Central Ave | Wellsboro | PA | 16901 | 232176963 | Hospital | PA | 501(c)(3) | UPMC Susquehanna | 0 | Line 3 | |
| Tioga Health Care Providers | |||||||||||
| 15 Meade St Suite U-6 | Wellsboro | PA | 16901 | 251765538 | Physician services | PA | 501(c)(3) | UPMC Susquehanna | 0 | Line 11b, II | |
| UPMC Susquehanna | |||||||||||
| 1205 Grampian Blvd | Williamsport | PA | 17701 | 232751183 | Coordinate & manage the delivery of healthcare | PA | 501(c)(3) | 0 | Line 11b, II | N/A | |
| Divine Providence Hospital | |||||||||||
| 1100 Grampian Blvd | Williamsport | PA | 17701 | 240799343 | Hospital | PA | 501(c)(3) | UPMC Susquehanna | 0 | Line 3 | |
| Muncy Valley Hospital | |||||||||||
| 215 E Water St | Muncy | PA | 17756 | 240806023 | Hospital | PA | 501(c)(3) | UPMC Susquehanna | 0 | Line 3 | |
| The Williamsport Hospital | |||||||||||
| 700 High St | Williamsport | PA | 17701 | 240795508 | Hospital | PA | 501(c)(3) | UPMC Susquehanna | 0 | Line 3 | |
| Susquehanna Health Foundation | |||||||||||
| 1100 Grampian Blvd | Williamsport | PA | 17701 | 232743470 | Fundraising for affiliated entities | PA | 501(c)(3) | UPMC Susquehanna | 0 | Line 11a, I | |
| Susquehanna Physician Services | |||||||||||
| 1201 Grampian Blvd | Williamsport | PA | 17701 | 232449454 | Physician services & MRI services | PA | 501(c)(3) | UPMC Susquehanna | 0 | Line 3 | |
| Williamsport Area Ambulance Services Coop | |||||||||||
| 700 High St | Williamsport | PA | 17701 | 232416166 | Ambulance transport | PA | 501(c)(3) | 0 | Line 9 | N/A | |
| Laurel Health Foundation | |||||||||||
| 15 Meade St Suite U-6 | Wellsboro | PA | 16901 | 251810488 | Fundraising for affiliated entities | PA | 501(c)(3) | Laurel Health System | 0 | Line 11a, I | |
| North Penn Comprehensive Health Services | |||||||||||
| 22 Walnut St | Wellsboro | PA | 16901 | 231889724 | Provide general health and social services | PA | 501(c)(3) | 0 | Line 3 | N/A | |
| Susquehanna Health Innovation Center Inc | |||||||||||
| 700 High St | Williamsport | PA | 17701 | 471600873 | Supporting organization of affiliated entities | PA | 501(c)(3) | UPMC Susquehanna | 0 | Line 11a, I | |
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 & Susquehanna Health Foundation | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Predominant Income Type | Excluded from tax | PredominantIncomeTypeTxt |
| Disproportionate Allocations | 0 | DisproportionateAllocationsInd |
| General Or Managing Partner | 0 | GeneralOrManagingPartnerInd |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd | Address Line1ForeignAddress/AddressLine1Txt | Province Or StateForeignAddress/ProvinceOrStateNm | CountryForeignAddress/CountryCd | Legal Domicile Foreign CountryLegalDomicileForeignCountryCd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Tyoga Carenet | |||||||||||||
| 15 Meade St Suite U-6 | Wellsboro | PA | 16901 | 251810967 | Integrate health care regionally | PA | UPMC Susquehanna | C | 0 | ||||
| Susquehanna Ventures Inc | |||||||||||||
| 1201 Grampian Blvd | Williamsport | PA | 17701 | 232470263 | Pharmacy & infusion services | PA | UPMC Susquehanna | C | 0 | ||||
| Susquehanna Health Systems Insurance Network LTD | |||||||||||||
| 980458722 | Captive insurance company | UPMC Susquehanna | 0 | PO Box 1159 | Grand Caymans | CJ | CJ | ||||||
| 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 | Yes (1) | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | Yes (1) | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | 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 | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | 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 |
Transactions Related Org TransactionsRelatedOrgGrp
Other Organization Name OtherOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Laurel Realty | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | E | TransactionTypeTxt |
| Involved | $2,927,187 | InvolvedAmt |
| Method Of Amount Determination | cost | MethodOfAmountDeterminationTxt |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| For 990, Schedule R, Part IV | Susquehanna Health System Insurance Network, LTD (SHSIN) 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 such taxes that might be introduced. SHSIN's sole shareholder, UPMC Susquehanna, 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. |
| Part III, Identification of Related Organizations Taxable as a Partnership | Name of Related Organization: Community Basket, LLC Direct Controlling Entity: UPMC Susquehanna & Susquehanna Health Foundation |