2017-05-02T11:35:14-05:00 2016-06-30 440160260 BKD LLP 910 E St Louis Street Suite 2 Springfiled MO 65806 990 2015-07-01 251644910 Laurel Management Services LAUR 5707230605 32-36 Central Avenue No Acctg Wellsboro PA 16901 Eric D Pohjala Executive Vice President / CFO 5703213175 2017-05-02 1 Brian D Todd P00422601 4178658701 2015 2021-01-29 14:40:06Z X Steven P Johnson 700 High Street Williamsport PA 17701 659602 0 X www.upmcsusquehannahealth.org X 1991 PA See Schedule O X 15 12 14 11 0 0 0 0 2598260 659602 1424 0 0 0 2599684 659602 3325 0 0 0 1440978 777995 0 0 0 1262305 128312 2706608 906307 -106924 -246705 1064063 439510 1633060 1255212 -568997 -815702 X 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. 0 1 717494 659602 Provides clinical services for employers including physicals, substance abuse testing, medical surveillance, Workers' compensation injury management and on-site services. 717494 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 1 X 0 0 1 14 1 0 0 0 0 0 0 0 0 0 0 X 15 12 0 0 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 0 0 0 X Management 5707230605 32-36 Central Ave Acctg Wellsboro PA 16901 Lisa VFeil Psy D Director 0.33 3.67 X 0 0 0 Robert P Fitzgerald Director 0.33 1.67 X 0 0 0 Harold F Hoose III Director 0.33 1.67 X 0 0 0 Michael W Lichty Director 0.33 1.67 X 0 0 0 J Dennis Murray Ph D Director 0.33 7.67 X 0 0 0 Thomas M Owlett Esq Chairman 0.33 7.67 X X 0 0 0 Glenn B Poirier Vice Chairman 0.33 7.67 X X 0 0 0 Wendy S Swartz CPA Director 0.33 1.67 X 0 0 0 Aneurin J Williams Jr Director 0.33 1.67 X 0 0 0 Donna R Wilson Director 0.33 1.67 X 0 0 0 Kathy J Wright Ph D Secretery 0.33 1.67 X X 0 0 0 Jill A Burns MD Director 0.33 45.67 X 0 296503 37541 Walter J Laibinis DO Director 0.33 43.67 X 0 293550 33435 Steven P Johnson President/CEO 0.33 53.67 X X 0 832199 35182 James D Baker Jr Director 0.33 1.67 X 0 0 0 Craig Litchfield Treasurer (ended 6/2015) 0.33 3.67 X X 0 0 0 Eric D Pohjala Exec VP/CFO (hired 3/30/15) 1.00 42.00 X 0 255157 27349 David Lopatofsky MD Exec VP/CMO (hired 1/31/15) 1.00 42.00 X 0 437276 38887 Jan Fisher Executive VP/COO 1.00 40.00 X 0 459806 31992 Janie Hilfiger President/SSMH 0.33 41.67 X 0 177958 17488 Charles Santangelo Former Exec VP/CFO (retired 5/2/15) 0.00 0.00 X 0 338073 24988 William McCauley MD Former Exec VP/CMO (retired 1/31/15) 0.00 0.00 X 0 185372 4271 Ronald J Butler Former Exec VP/ CBO (retired 4/15/15) 0.00 2.00 X 0 518626 13502 0 3794520 264635 0 1 1 0 0 Other income 900099 296557 296557 Net patient service re 900099 245909 245909 CMBA and EMBA revenue 900099 116247 116247 Bad Debt recoveries 900099 889 889 659602 659602 659602 0 0 568371 430497 137874 42386 32086 10300 129169 97781 31388 38069 28818 9251 5130 5130 5304 5304 19742 19742 44971 44971 5835 5835 2087 2087 6360 6360 557 557 CMBA 18396 18396 Medical Supplies 15260 15260 Telephone 3735 3735 Sales Taxes 386 386 549 549 906307 717494 188813 0 71434 241686 150433 87677 115123 65797 75152 48010 702108 27142 24965 17208 1064063 439510 177774 139299 1455286 1115913 1633060 1255212 X -568997 -815702 -568997 -815702 1064063 439510 -246705 0 X X 0 1 X 1 0 X X 1 North Penn Comprehensive Health Services 231889724 9 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 75152 48010 27142 27142 Due to Other Entities 1115913 1115913 658713 0 658713 889 889 659602 905418 0 905418 889 889 906307 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. 0 0 0 0 0 0 0 0 0 Jill A Burns MD Director 0 247243 0 44446 0 4814 0 9950 0 27591 0 334044 0 0 Walter J Laibinis DO Director 0 231118 0 45655 0 16777 0 9950 0 23485 0 326985 0 0 Steven P Johnson President/CEO 0 668195 0 133858 0 30146 0 15925 0 19257 0 867381 0 0 Eric D Pohjala Exec VP/CFO (hired 3/30/15) 0 252402 0 0 0 2755 0 9720 0 17629 0 282506 0 0 David Lopatofsky MD Exec VP/CMO (hired 1/31/15) 0 412757 0 18458 0 6061 0 11275 0 27612 0 476163 0 0 Jan Fisher Executive VP/COO 0 409956 0 36987 0 12863 0 9950 0 22042 0 491798 0 0 Janie Hilfiger President/SSMH 0 163729 0 14229 0 0 0 7416 0 10072 0 195446 0 0 Charles Santangelo Former Exec VP/CFO (retired 5/2/15) 0 186916 0 71895 0 79262 0 9950 0 15038 0 363061 0 0 William McCauley MD Former Exec VP/CMO (retired 1/31/15) 0 108272 0 45384 0 31716 0 0 0 4271 0 189643 0 0 Ronald J Butler Former Exec VP/ CBO (retired 4/15/15 0 112293 0 32105 0 374228 0 9950 0 3552 0 532128 0 0 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. Various Fixed Assets 2015-09-30 10399 Net Book Value 240795508 The Williamsport Hospital 700 High Street Williamsport PA 17701 501 (C) (3) 0 1 0 0 Schedule N Part II Line 2B 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. 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. 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 N/A 0 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 N/A 0 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 Community Basket 1205 Grampian Blvd Williamsport PA 17701 201195739 Rents real estate PA UPMC Susquehanna & Susquehanna Health Foundation Excluded from tax 0 0 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 PO Box 1159 Cayman Islands CJ 980458722 Captive Insurance Company CJ UPMC Susquehanna 0 Tyoga Carenet 114 East Avenue Wellsboro PA 16901 251810967 Integrate Healthcare regionally PA UPMC Susquehanna C 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 Form 990, Part IV 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.