Laurel Management Services: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- Laurel Management Services (EIN 25-1644910)
- Tax period
- 2015-07-01 to 2016-06-30
- Filed
- 2017-05-02
- IRS object ID
- 201741229349301054
- 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 | 2017-05-02T11:35:14-05:00 | 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 2 | AddressLine1Txt |
| City | Springfiled | 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 | 251644910 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Laurel Management Services | 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 Avenue 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 Street | AddressLine1Txt |
| City | Williamsport | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 17701 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $659,602 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.upmcsusquehannahealth.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1991 | FormationYr |
| Legal Domicile State | PA | LegalDomicileStateCd |
| Activity Or Mission | See Schedule O | ActivityOrMissionDesc |
| Contract Termination | Yes (X) | ContractTerminationInd |
| Voting Members Governing Body | 15 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 12 | VotingMembersIndependentCnt |
| Total Employee | 14 | TotalEmployeeCnt |
| Total Volunteers | 11 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $0 | PYContributionsGrantsAmt |
| CY Contributions Grants | $0 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $2,598,260 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $659,602 | CYProgramServiceRevenueAmt |
| PY Investment Income | $1,424 | PYInvestmentIncomeAmt |
| CY Investment Income | $0 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $2,599,684 | PYTotalRevenueAmt |
| CY Total Revenue | $659,602 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $3,325 | 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 | $1,440,978 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $777,995 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $1,262,305 | PYOtherExpensesAmt |
| CY Other Expenses | $128,312 | CYOtherExpensesAmt |
| PY Total Expenses | $2,706,608 | PYTotalExpensesAmt |
| CY Total Expenses | $906,307 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$106,924 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$246,705 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $1,064,063 | TotalAssetsBOYAmt |
| Total Assets EOY | $439,510 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $1,633,060 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $1,255,212 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | -$568,997 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | -$815,702 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | Laurel Management 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. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | Yes (1) | SignificantChangeInd |
| Expense | $717,494 | ExpenseAmt |
| Revenue | $659,602 | RevenueAmt |
| Desc | Provides clinical services for employers including physicals, substance abuse testing, medical surveillance, Workers' compensation injury management and on-site services. | Desc |
| Total Program Service Expenses | $717,494 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | Yes (1) | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| Info In Schedule O Part V | Yes (X) | InfoInScheduleOPartVInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 14 | 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 | 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 | 0 | 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 |
| 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 Acctg | 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 |
|---|---|---|---|---|---|---|---|---|---|
| Lisa VFeil Psy D | |||||||||
| 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 | |||
| Michael W Lichty | |||||||||
| Director | 0.33 | 1.67 | Yes (X) | $0 | $0 | $0 | |||
| J Dennis Murray Ph D | |||||||||
| 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 Ph D | |||||||||
| Secretery | 0.33 | 1.67 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| Jill A Burns MD | |||||||||
| Director | 0.33 | 45.67 | Yes (X) | $0 | $296,503 | $37,541 | |||
| Walter J Laibinis DO | |||||||||
| Director | 0.33 | 43.67 | Yes (X) | $0 | $293,550 | $33,435 | |||
| Steven P Johnson | |||||||||
| President/CEO | 0.33 | 53.67 | Yes (X) | $0 | $832,199 | $35,182 | Yes (X) | ||
| James D Baker Jr | |||||||||
| Director | 0.33 | 1.67 | Yes (X) | $0 | $0 | $0 | |||
| Craig Litchfield | |||||||||
| Treasurer (ended 6/2015) | 0.33 | 3.67 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| Eric D Pohjala | |||||||||
| Exec VP/CFO (hired 3/30/15) | 1.00 | 42.00 | $0 | $255,157 | $27,349 | Yes (X) | |||
| David Lopatofsky MD | |||||||||
| Exec VP/CMO (hired 1/31/15) | 1.00 | 42.00 | $0 | $437,276 | $38,887 | Yes (X) | |||
| Jan Fisher | |||||||||
| Executive VP/COO | 1.00 | 40.00 | $0 | $459,806 | $31,992 | Yes (X) | |||
| Janie Hilfiger | |||||||||
| President/SSMH | 0.33 | 41.67 | $0 | $177,958 | $17,488 | Yes (X) | |||
| Charles Santangelo | |||||||||
| Former Exec VP/CFO (retired 5/2/15) | 0.00 | 0.00 | $0 | $338,073 | $24,988 | Yes (X) | |||
| William McCauley MD | |||||||||
| Former Exec VP/CMO (retired 1/31/15) | 0.00 | 0.00 | $0 | $185,372 | $4,271 | Yes (X) | |||
| Ronald J Butler | |||||||||
| Former Exec VP/ CBO (retired 4/15/15) | 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 | $3,794,520 | 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 |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Other income | 900099 | $296,557 | $296,557 |
| Net patient service re | 900099 | $245,909 | $245,909 |
| CMBA and EMBA revenue | 900099 | $116,247 | $116,247 |
| Bad Debt recoveries | 900099 | $889 | $889 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $659,602 | TotalProgramServiceRevenueAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $659,602 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $659,602 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $568,371 | TotalAmt |
| Program Services | $430,497 | ProgramServicesAmt |
| Management And General | $137,874 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $42,386 | TotalAmt |
| Program Services | $32,086 | ProgramServicesAmt |
| Management And General | $10,300 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $129,169 | TotalAmt |
| Program Services | $97,781 | ProgramServicesAmt |
| Management And General | $31,388 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $38,069 | TotalAmt |
| Program Services | $28,818 | ProgramServicesAmt |
| Management And General | $9,251 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,130 | TotalAmt |
| Program Services | $5,130 | ProgramServicesAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,304 | TotalAmt |
| Program Services | $5,304 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $19,742 | TotalAmt |
| Program Services | $19,742 | ProgramServicesAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $44,971 | TotalAmt |
| Program Services | $44,971 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,835 | TotalAmt |
| Program Services | $5,835 | ProgramServicesAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,087 | TotalAmt |
| Program Services | $2,087 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,360 | TotalAmt |
| Program Services | $6,360 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $557 | TotalAmt |
| Program Services | $557 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| CMBA | $18,396 | $18,396 |
| Medical Supplies | $15,260 | $15,260 |
| Telephone | $3,735 | $3,735 |
| Sales Taxes | $386 | $386 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $549 | TotalAmt |
| Program Services | $549 | ProgramServicesAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $906,307 | TotalAmt |
| Program Services | $717,494 | ProgramServicesAmt |
| Management And General | $188,813 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $71,434 | BOYAmt |
| EOY | $241,686 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $150,433 | BOYAmt |
| EOY | $87,677 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $115,123 | BOYAmt |
| EOY | $65,797 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $75,152 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $48,010 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $702,108 | BOYAmt |
| EOY | $27,142 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $24,965 | BOYAmt |
| EOY | $17,208 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,064,063 | BOYAmt |
| EOY | $439,510 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $177,774 | BOYAmt |
| EOY | $139,299 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,455,286 | BOYAmt |
| EOY | $1,115,913 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,633,060 | BOYAmt |
| EOY | $1,255,212 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$568,997 | BOYAmt |
| EOY | -$815,702 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$568,997 | BOYAmt |
| EOY | -$815,702 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,064,063 | BOYAmt |
| EOY | $439,510 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$246,705 | 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 | 1 | SupportedOrganizationsCnt |
Supported Org Information SupportedOrgInformationGrp
Supported Organization Name SupportedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | North Penn Comprehensive Health Services | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 231889724 | EIN |
| Organization Type | 9 | OrganizationTypeCd |
| Governing Document Listed | Yes (1) | GoverningDocumentListedInd |
| Support | $0 | SupportAmt |
| Other Support | $0 | OtherSupportAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supported Organizations Total | 1 | SupportedOrganizationsTotalCnt |
| Support Sum | $0 | SupportSumAmt |
| Other Support Sum | $0 | OtherSupportSumAmt |
Form990 Sch A Supporting Org Form990SchASupportingOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Listed By Name Governing Doc | Yes (1) | ListedByNameGoverningDocInd |
| Suprt Org No IRS Determination | 0 | SuprtOrgNoIRSDeterminationInd |
| Supported Org Section C456 | 0 | SupportedOrgSectionC456Ind |
| Supported Org Not Organized US | 0 | SupportedOrgNotOrganizedUSInd |
| Organization Change Suprt Org | 0 | OrganizationChangeSuprtOrgInd |
| Support Non Supported Org | 0 | SupportNonSupportedOrgInd |
| Payment Substantial Contribtr | 0 | PaymentSubstantialContribtrInd |
| Loan Disqualified Person | 0 | LoanDisqualifiedPersonInd |
| Controlled Disqualified Prsn | 0 | ControlledDisqualifiedPrsnInd |
| Disqualified Prsn Controll Int | 0 | DisqualifiedPrsnControllIntInd |
| Disqualified Prsn Ownr Int | 0 | DisqualifiedPrsnOwnrIntInd |
| Excess Business Holdings Rules | 0 | ExcessBusinessHoldingsRulesInd |
| Contribution Controller | 0 | ContributionControllerInd |
| Contribution Family | 0 | ContributionFamilyInd |
| Contribution35 Controlled | 0 | Contribution35ControlledInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Majority Dir Trst Supported Org | Yes (1) | MajorityDirTrstSupportedOrgInd |
Schedule D IRS990ScheduleD
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $75,152 | OtherCostOrOtherBasisAmt |
| Depreciation | $48,010 | DepreciationAmt |
| Book Value | $27,142 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $27,142 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Due to Other Entities | Desc |
| Amt | $1,115,913 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $1,115,913 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $658,713 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Not Reported | $0 | RevenueNotReportedAmt |
| Revenue Subtotal | $658,713 | RevenueSubtotalAmt |
| Other Revenues Not Included | $889 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $889 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $659,602 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $905,418 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $905,418 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $889 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $889 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $906,307 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part XI, Line 4b - Other Adjustments: | Bad Debt recoveries |
| Part XII, Line 4b - Other Adjustments: | Bad Debt recoveries |
| 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 | Bad Debt recovered during the year that were previously written off. |
| Part XII Line 4b Other Adjustments | Bad Debts recovered during the year that were previously written off. |
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 |
| 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 |
| Steven P Johnson | ||||||||||||||
| President/CEO | $0 | $668,195 | $0 | $133,858 | $0 | $30,146 | $0 | $15,925 | $0 | $19,257 | $0 | $867,381 | $0 | $0 |
| Eric D Pohjala | ||||||||||||||
| Exec VP/CFO (hired 3/30/15) | $0 | $252,402 | $0 | $0 | $0 | $2,755 | $0 | $9,720 | $0 | $17,629 | $0 | $282,506 | $0 | $0 |
| David Lopatofsky MD | ||||||||||||||
| Exec VP/CMO (hired 1/31/15) | $0 | $412,757 | $0 | $18,458 | $0 | $6,061 | $0 | $11,275 | $0 | $27,612 | $0 | $476,163 | $0 | $0 |
| Jan Fisher | ||||||||||||||
| Executive VP/COO | $0 | $409,956 | $0 | $36,987 | $0 | $12,863 | $0 | $9,950 | $0 | $22,042 | $0 | $491,798 | $0 | $0 |
| Janie Hilfiger | ||||||||||||||
| President/SSMH | $0 | $163,729 | $0 | $14,229 | $0 | $0 | $0 | $7,416 | $0 | $10,072 | $0 | $195,446 | $0 | $0 |
| Charles Santangelo | ||||||||||||||
| Former Exec VP/CFO (retired 5/2/15) | $0 | $186,916 | $0 | $71,895 | $0 | $79,262 | $0 | $9,950 | $0 | $15,038 | $0 | $363,061 | $0 | $0 |
| William McCauley MD | ||||||||||||||
| Former Exec VP/CMO (retired 1/31/15) | $0 | $108,272 | $0 | $45,384 | $0 | $31,716 | $0 | $0 | $0 | $4,271 | $0 | $189,643 | $0 | $0 |
| Ronald J Butler | ||||||||||||||
| Former Exec VP/ CBO (retired 4/15/15 | $0 | $112,293 | $0 | $32,105 | $0 | $374,228 | $0 | $9,950 | $0 | $3,552 | $0 | $532,128 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 3 | The Williamsport Hospital EIN# 24-0795508, a related organization, uses the following resources to establish the compensation of the top management officials; compensation commitee, 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 N IRS990ScheduleN
Disposition Of Assets Detail DispositionOfAssetsDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Assets Distri Or Expnss Paid | Various Fixed Assets | AssetsDistriOrExpnssPaidDesc |
| Distribution | 2015-09-30 | DistributionDt |
| Fair Market Value Of Asset | $10,399 | FairMarketValueOfAssetAmt |
| Method Of FMV Determination | Net Book Value | MethodOfFMVDeterminationTxt |
| EIN | 240795508 | EIN |
| Person | The Williamsport Hospital | PersonNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 700 High Street | AddressLine1Txt |
| City | Williamsport | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 17701 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRC Section | 501 (C) (3) | IRCSectionTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Director Of Successor2 | 0 | DirectorOfSuccessor2Ind |
| Employee Of Successor2 | Yes (1) | EmployeeOfSuccessor2Ind |
| Owner Of Successor2 | 0 | OwnerOfSuccessor2Ind |
| Receive Compensation2 | 0 | ReceiveCompensation2Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule N Part II Line 2B | FormAndLineReferenceDesc |
| Explanation | Steve Johnson, Janie Hilfiger, Jill Burns, MD, and Walter Laibinis, DO,LMS Directors, are employed by The Williamsport Hospital; Eric Pohjala, David Lopatofsky, MD, and Jan Fisher are employees of The Williamsport Hospital. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part III, line 3 | All shared management expenses were moved from Laurel Management Services to UPMC Susquehanna. Those services resulted in the elimination of management fees. |
| Form 990 Part V Line 2A and 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 Services 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 Healthcare Providers EIN# 25-1765538 Tyoga Carenet EIN# 25-1810967 |
| Form 990 Part V Line 2A and 2B | The total number of employees reported on Form W-3 would be 3871 for UPMC Susquehanna EIN# 23-2751183. Of that total 14 employees payroll expenses were recorded by Laurel Management Services. |
| 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 sole Member, UPMC Susquehanna, 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 of any force or effort whatsoever. 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 officers 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 such incurred debt. I.) to incur debt (or 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 SHS shall be the joint and several obligation of each 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 SHS 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 within or not within the limits of the System's approved investment policy, P.) to approve of any investment of assets by Entity not within the limits of the System's approved investment policies, 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 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 or 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 dissove or terminate the existence of Entity and dissolve or terminate the existence 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 relating there to, 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 Form 990 is presented to the parent Board of Directors (UPMC Susquehanna, EIN #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 | 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 15th. 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 and financial statements are available to the public upon request. The conflict of interest policy is also available upon request. |
| Form 990 Part XII Line 2c | The organization did not change its oversight process or selection process. |
| Form 990 | 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 I Line 1 | Laurel Management Services is a subsidiary of UPMC Susquehanna. The mission of UPMC Susquehanna 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. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (15 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Laurel Health System Inc | |||||||||||
| 32-36 Central Avenue | Wellsboro | PA | 16901 | 240795488 | Support entities affiliated with Laurel Health System | PA | 501(c)(3) | Line 11b, II | UPMC Susquehanna | 0 | |
| Laurel Realty | |||||||||||
| 32-36 Central Avenue | Wellsboro | PA | 16901 | 231403678 | Owns and Manages real estate in support of Laurel Health System | PA | 501(c)(2) | UPMC Susquehanna | 0 | ||
| The Green Home | |||||||||||
| 37 Central Avenue | Wellsboro | PA | 16901 | 240804365 | Skilled nursing & assisted living facilities | PA | 501(c)(3) | Line 9 | UPMC Susquehanna | 0 | |
| Tioga Health Care Providers | |||||||||||
| 1201 Grampian Blvd | Williamsport | PA | 17701 | 251765538 | Physician Services | PA | 501(c)(3) | Line 11b, II | UPMC Susquehanna | 0 | |
| Soldiers & Sailors Memorial Hospital | |||||||||||
| 32-36 Central Avenue | Wellsboro | PA | 16901 | 232176963 | Operates an acute care 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 | |
| The Williamsport Hospital | |||||||||||
| 700 High Street | Williamsport | PA | 17701 | 240795508 | Hospital | PA | 501(c)(3) | Line 3 | UPMC Susquehanna | 0 | |
| Susquehanna Health Foundation | |||||||||||
| 1201 Grampian Blvd | Williamsport | PA | 17701 | 232743470 | Fundraising for affiliated entities | PA | 501(c)(3) | Line 11a, I | UPMC Susquehanna | 0 | |
| Susquehanna Physician Services | |||||||||||
| 1201 Grampian Blvd | Williamsport | PA | 17701 | 232449454 | Physician Services & MRI Services | PA | 501(c)(3) | Line 3 | UPMC Susquehanna | 0 | |
| Williamsport Ambulance Services | |||||||||||
| 700 High Street | Williamsport | PA | 17701 | 232416166 | Ambulance Transports | PA | 501(c)(3) | Line 9 | 0 | N/A | |
| Laurel Health Foundation | |||||||||||
| 32-36 Central Avenue | Wellsboro | PA | 16901 | 251810488 | To provide financial assistance to affiliated organizations | PA | 501(c)(3) | Line 11a, I | Laurel Health System | 0 | |
| Susquehanna Health Innovation CenterInc | |||||||||||
| 700 High Street | Williamsport | PA | 17701 | 471600873 | Supporting organization of affiliated entities | PA | 501(c)(3) | Line 11a, I | UPMC Susquehanna | 0 | |
| UPMC Susquehanna | |||||||||||
| 1205 Grampian Blvd | Williamsport | PA | 17701 | 232751183 | Coordinate and Manage the delivery of Healthcare | PA | 501(c)(1) | Line 11b, II | 0 | N/A | |
| North Penn Comprehensive Health Services | |||||||||||
| 22 Walnut Street | Wellsboro | PA | 16901 | 231889724 | Provides general health and social services | PA | 501(c)(3) | Line 3 | Laurel Health System | 0 | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Community Basket | 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Susquehanna Ventures Inc | |||||||||||||
| 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 | Cayman Islands | CJ | CJ | ||||||
| Tyoga Carenet | |||||||||||||
| 114 East Avenue | Wellsboro | PA | 16901 | 251810967 | Integrate Healthcare regionally | PA | UPMC Susquehanna | C | 0 | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 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 | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | 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 | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (1) | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Form 990, Part IV | FormAndLineReferenceDesc |
| Explanation | Susquehanna Health System Insurance, LTD (SHSIN) EIN #98-0458722, is a foreign corporation, incorporated under the laws of the Cayman Islands. There are no income, capital, or premium taxes levied in the Cayman Islands and SHSIN has been granted an exemption until September 2022 for any such taxes that might be introduced. SHSIN's sole shareholder, UPMC Susquehanna EIN# 23-2751183 is a 501 (c) (3) organization exempt from federal income taxes. SHSIN conducts no business in the United States. It files an 1120F protective filing which implies that its income is not subject to US Federal income tax. | ExplanationTxt |