2017-05-09T09:30:24-05:00 2016-06-30 BKD LLP 910 E ST LOUIS 200/PO BOX 1190 SPRINGFIELD MO 658062523 990 2015-07-01 251810488 LAUREL HEALTH FOUNDATION % ACCOUNTING LAUR 5707230605 32-36 CENTRAL AVE Suite ACCTG WELLSBORO PA 16901 GRETCHEN E REGINA CFO 5707230605 2017-03-02 true BRIAN D TODD P00422601 4178658701 2015 2021-01-29 14:40:06Z X RONALD BUTLER 32-36 CENTRAL AVE ACCTG WELLSBORO PA 16901 9172957 false X WWW.SUSQUEHANNAHEALTH.ORG X 1998 PA LAUREL HEALTH FOUNDATION IS AN AFFILIATE OF UPMC SUSQUEHANNA. ITS MISSION IS AS FOLLOWS: TO EXTEND GOD'S HEALING LOVE BY IMPROVING THE HEALTH OF THOSE WE SERVE. 9 6 0 9 0 0 0 0 0 546482 357275 0 0 546482 357275 132046 810777 0 0 0 0 0 0 0 70915 72234 202961 883011 343521 -525736 20288938 19057718 40047 51187 20248891 19006531 THE SPECIFIC PURPOSES OF THE LAUREL HEALTH FOUNDATION ARE TO SUPPORT, PROMOTE, ADVANCE AND STRENGTHEN THE SOLDIERS AND SAILORS MEMORIAL HOSPITAL, THE GREEN HOME, NORTH PENN COMPREHENSIVE HEALTH SERVICES AND THE WELLSBORO COMMUNITY FOUNDATION. false false 877956 810777 PROVIDING FINANCIAL SUPPORT FOR SOLDIERS AND SAILORS MEMORIAL HOSPITAL, THE GREEN HOME, NORTH PENN COMPREHENSIVE HEALTH SERVICES, AND THE WELLSBORO COMMUNITY FOUNDATION. 877956 true false false false false false false false false true false false false true true false false true false false false false false false false false false true false true false false false false false false false false false false false false false true false false false true 0 0 0 false false false false false false false false false false X 9 6 true false false false false true true true true false false true true true true true true false false false X ACCOUNTING 5707230605 32-36 CENTRAL AVE WELLSBORO PA 16901 RONALD J BUTLER PRESIDENT 2.0 0.0 X X 0 518626 13502 R ROBERT DECAMP SECRETARY 2.0 0.0 X X 0 0 0 WALTER J LAIBINIS DO DIRECTOR 2.0 42.0 X 0 293550 33435 CRAIG G LITCHFIELD TREASURER 2.0 2.0 X X 0 0 0 J DENNIS MURRAY PHD DIRECTOR 2.0 6.0 X 0 0 0 THOMAS M OWLETT ESQ CHAIRMAN 2.0 6.0 X X 0 0 0 GLENN B POIRIER VICE CHAIRMAN 2.0 6.0 X X 0 0 0 JAN E FISHER EXECUTIVE VP 2.0 40.0 X 0 459806 31992 KAREN CHAMBERS DIRECTOR 2.0 0.0 X 0 0 0 GRETCHEN E REGINA VP/CFO 2.0 40.0 X 0 103113 6610 RONALD M GILBERT FORMER VP/CFO ENDING 2/2015 0.0 0.0 X 0 210923 19671 0 1586018 105210 0 true true false 0 0 0 351993 351993 0 0 0 0 0 8820964 8815682 5282 5282 5282 0 0 0 0 357275 357275 810777 810777 0 0 0 0 0 0 0 0 0 0 0 4440 4440 0 0 59393 59393 0 0 29 29 0 0 0 0 0 0 0 0 0 8372 7786 586 883011 877956 5055 0 0 0 961995 460073 0 0 0 0 0 0 0 0 0 0 0 0 6279 6279 0 19320664 16128361 0 0 0 0 0 0 0 2463005 20288938 19057718 12331 11631 0 0 0 0 0 0 0 0 0 0 0 0 0 0 27716 39556 40047 51187 X 20119125 18880050 0 0 129766 126481 20248891 19006531 20288938 19057718 -525736 -716624 X X false true X true false X X 4 SSMH 232176963 3 true 340967 0 NORTH PENN 231889724 3 true 0 0 GREEN HOME 240804365 9 true 350000 0 WELLSBORO C F 202680321 8 true 119810 0 4 810777 true false false false false false false false false false false false false false false true SCHEDULE A, PART I, LINE 11H ORGANIZATIONS SUPPORTED: THE COMPLETE NAMES OF THE ORGANIZATIONS SUPPORTED ARE AS FOLLOWS: (A) SOLDIERS & SAILORS MEMORIAL HOSPITAL (B) NORTH PENN COMPREHENSIVE HEALTH SERVICES (C) THE GREEN HOME (D) WELLSBORO COMMUNITY FOUNDATION 15744999 -380234 710126 1832173 41545 12780921 16284168 271234 776184 34219 15744999 14945981 1358906 20719 16284168 1.00000 true false DUE FROM AFFILIATES 2463005 2463005 0 DUE TO AFFILIATES 39556 39556 -356064 -716624 -716624 360560 -3285 -3285 357275 192044 192044 690967 690967 883011 SCHEDULE D, PART V, LINE 4 ENDOWMENT FUNDS: THE ENDOWMENT FUNDS ARE USED TO FUND THE MISSION OF THE ORGANIZATION. SCHEDULE D, PART XI, LINE 4B OTHER REVENUE ON FORM 990, PART VIII, LINE 12 BUT NOT ON LINE 1: $ (3,285) TEMPORARILY RESTRICTED INVESTMENT INCOME SCHEDULE D, PART XII, LINE 4B AMOUNTS INCLUDED ON FORM 990, PART IX, LINE 25, BUT NOT ON LINE 1: $ 690,967 GRANTS PAID TO AFFILIATES true THE WELLSBORO COMMUNITY FOUNDATION PO BOX 243 WELLSBORO PA 16901 202680321 501(C)(3) 119810 SUPPORT SOLDIERS SAILORS MEMORIAL HOSPITAL 32-36 CENTRAL AVE WELLSBORO PA 16901 232176963 501(C)(3) 340967 SUPPORT THE GREEN HOME 37 CENTRAL AVENUE WELLSBORO PA 16901 240804365 501(C)(3) 350000 SUPPORT 3 SCHEDULE I, PART I, LINE 2 GRANT MONITORING PROCESS: ALL GRANTEES ARE REQUIRED TO COMPLETE A GRANT COMPLIANCE REPORT AT THE COMPLETION OF THEIR PROJECT. ADDITIONALLY, ALL GRANTEE ORGANIZATIONS ARE SUPPORTED ORGANIZATIONS AND, THEREFORE, SHARE COMMON MANAGEMENT. false false false false false false false false false RONALD J BUTLER PRESIDENT 0 112293 0 32105 0 374228 0 9950 0 3552 0 532128 0 0 WALTER J LAIBINIS DO DIRECTOR 0 231118 0 45655 0 16777 0 9950 0 23485 0 326985 0 0 JAN E FISHER EXECUTIVE VP 0 409956 0 36987 0 12863 0 9950 0 22042 0 491798 0 0 RONALD M GILBERT FORMER VP/CFO ENDING 2/2015 0 192314 0 17512 0 1097 0 8417 0 11254 0 230594 0 0 SCHEDULE J, PART I, LINE 6 EXECUTIVE COMPENSATION: 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. THERE WERE NO PAYMENTS TO THE OFFICERS LISTED ON FORM 990, PART VII, THIS YEAR. FORM 990, PART VI, SECTION A, LINE 2 FAMILY RELATIONSHIP: ROBERT DECAMP AND KAREN CHAMBERS, VOTING DIRECTORS, HAVE A FAMILY RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 7A ELECTING MEMBERS OF THE GOVERNING BODY: AT LEAST 50% OF THE BOARD OF DIRECTORS MUST CONSIST OF INDIVIDUALS SERVING AS BOARD MEMBERS OF THE LAUREL SYSTEM ENTITIES AS SYSTEM REPRESENTATIVES. WITH RESPECT TO THE SYSTEM REPRESENTATIVE POSITIONS, UPMC SUSQUEHANNA SUBMITS A LIST OF ITS RECOMMENDED SYSTEM REPRESENTATIVE CANDIDATES TO THE NOMINATING COMMITTEE, WHO REVIEWS THE LIST AND UPON APPROVAL, NOMINATES APPROVED REPRESENTATIVES TO THE BOARD. FORM 990, PART VI, SECTION A, LINE 7B DECISIONS SUBJECT TO APPROVAL BY MEMBERS: THE BYLAWS REQUIRE PRIOR WRITTEN APPROVAL OF UPMC SUSQUEHANNA ON ANY BYLAW AMENDMENT RELATING TO THE FOLLOWING MATTERS: -ELECTION OR REMOVAL OF DIRECTORS OR OFFICERS -CORPORATE MEMBERS OR MEMBERSHIP OF THE CORPORATION -NUMBER, COMPOSITION, ATTENDANCE, COMPENSATION, VOTING, QUORUM, POWERS, DUTIES, RESPONSIBILITIES OR MANNER OF ACTING OF THE BOARD OF DIRECTORS, OFFICERS OR COMMITTEES -TERMS, QUALIFICATIONS OR DUTIES OF, OR NOTICE TO, DIRECTORS AND/OR OFFICERS -USE OF THE CORPORATION'S FUNDS -CORPORATE PURPOSES, POWERS OR LIMITATIONS -COMPLIANCE WITH SECTION 501(C)(3) OF THE CODE AND/OR ANY OTHER LAW -CONFLICT OF INTEREST POLICIES OR PROCEDURES -INDEMNIFICATION RIGHTS OR OBLIGATIONS -AMENDMENT OF THE ARTICLES OF INCORPORATION OR BYLAWS OR ENGAGEMENT IN ANY FUNDAMENTAL TRANSACTIONS -MATERIAL RIGHTS OR OBLIGATIONS OF UPMC SUSQUEHANNA AND/OR ITS AFFILIATES FORM 990, PART VI, SECTION B, LINE 11B PROCESS TO REVIEW THE FORM 990: THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM BASED ON THE AUDITED FINANCIAL STATEMENTS AND INFORMATION PROVIDED BY MANAGEMENT. A HIGH-LEVEL OVERVIEW OF THE FORM 990 IS PRESENTED TO THE BOARD OF DIRECTORS 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 MONITORING COMPLIANCE WITH CONFLICT OF INTEREST POLICY: 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, LINES 15A & 15B COMPENSATION REVIEW: ALL TOP MANAGEMENT IS EMPLOYED BY THE WILLIAMSPORT HOSPITAL (TWH), AND THE BOARD OF TWH USES THE FOLLOWING PROCESS TO ESTABLISH COMPENSATION. 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 DOCUMENT DISCLOSURE: GOVERNING DOCUMENTS, FINANCIAL STATEMENTS, AND CONFLICT OF INTEREST POLICIES ARE AVAILABLE UPON REQUEST FROM THE DEPARTMENT LISTED AS POSSESSOR OF THE INFORMATION ON LINE 20. FORM 990, PART VII, LINE 1A BOARD MEMBER COMPENSATION: NO BOARD MEMBERS RECEIVE COMPENSATION FOR THEIR DUTIES AS BOARD MEMBERS. RONALD BUTLER, WALTER LAIBINIS, AND JAN FISHER ARE ALL COMPENSATED BY RELATED ORGANIZATIONS FOR THEIR MANAGEMENT AND/OR PHYSICIAN POSITIONS. FORM 990, PART XII, LINE 2C OVERSIGHT & SELECTION OF INDEPENDENT ACCOUNTANT: THE OVERSIGHT PROCESS AND INDEPENDENT ACCOUNTANT SELECTION ARE PERFORMED BY UPMC SUSQUEHANNA, A RELATED ORGANIZATION. LAUREL REALTY 15 MEADE STREET WELLSBORO PA 16901 231403678 REAL ESTATE PA 501(C)(2) UPMC SUSQ false LAUREL MANAGEMENT SERVICES 15 MEADE STREET WELLSBORO PA 16901 251644910 MGT CONSULT PA 501(C)(3) 11B II UPMC SUSQ false THE GREEN HOME 37 CENTRAL AVENUE WELLSBORO PA 16901 240804365 SNF PA 501(C)(3) 9 UPMC SUSQ false SOLDIERS AND SAILORS MEMORIAL HOSPITAL 32-36 CENTRAL AVENUE WELLSBORO PA 16901 232176963 HOSPITAL PA 501(C)(3) 3 UPMC SUSQ false TIOGA HEALTH CARE PROVIDERS 15 MEADE STREET WELLSBORO PA 16901 251765538 SPECIALISTS PA 501(C)(3) 11B II UPMC SUSQ false UPMC SUSQUEHANNA 1205 GRAMPIAN BLVD WILLIAMSPORT PA 17701 232751183 MANAGEMENT PA 501(C)(3) 11B II NA false DIVINE PROVIDENCE HOSPITAL 1100 GRAMPIAN BLVD WILLIAMSPORT PA 17701 240799343 HOSPITAL PA 501(C)(3) 3 UPMC SUSQ false MUNCY VALLEY HOSPITAL 215 E WATER ST MUNCY PA 17756 240806023 HOSPITAL PA 501(C)(3) 3 UPMC SUSQ false THE WILLIAMSPORT HOSPITAL 700 HIGH ST WILLIAMSPORT PA 17701 240795508 HOSPITAL PA 501(C)(3) 3 UPMC SUSQ false SUSQUEHANNA HEALTH FOUNDATION 1100 GRAMPIAN BLVD WILLIAMSPORT PA 17701 232743470 FUNDRAISING PA 501(C)(3) 11A I UPMC SUSQ false SUSQUEHANNA PHYSICIAN SERVICES 1201 GRAMPIAN BLVD WILLIAMSPORT PA 17701 232449454 SPECIALISTS PA 501(C)(3) 3 UPMC SUSQ false WILLIAMSPORT AREA AMBULANCE SERVICES 700 HIGH ST WILLIAMSPORT PA 17701 232416166 AMBULANCE PA 501(C)(3) 9 UPMC SUSQ false NORTH PENN COMPREHENSIVE HEALTH SERVICES 22 WALNUT ST WELLSBORO PA 16901 231889724 GENERAL HLTH PA 501(C)(3) 3 NA false LAUREL HEALTH SYSTEM 15 MEADE STREET WELLSBORO PA 16901 240795488 MANAGEMENT PA 501(C)(3) 11B II UPMC SUSQ false WELLSBORO COMMUNITY FOUNDATION 114 MAIN STREET WELLSBORO PA 16901 202680321 FUNDRAISING PA 501(C)(3) 7 NA false SUSQUEHANNA HEALTH INNOVATION CENTER 700 HIGH STREET WILLIAMSPORT PA 17701 471600873 SUPPORT AFF. PA 501(C)(3) 11A I UPMC SUSQ false COMMUNITY BASKET 1205 GRAMPIAN BLVD WILLIAMSPORT PA 17701 201195739 REAL ESTATE PA UPMC SUSQ & FDN N/A false false TYOGA CARENET 15 MEADE STREET WELLSBORO PA 16901 251810967 INTEGRATION PA UPMC SUSQ C CORP false SUSQUEHANNA VENTURES INC 1201 GRAMPIAN BLVD WILLIAMSPORT PA 17701 232470263 PHARMACY PA UPMC SUSQ C CORP false SUSQUEHANNA HEALTH SYS INSUR NETWORK LTD PO BOX 1159 KY1-1102 GRAND CAYMANS CAYMAN ISLANDS CJ 980458722 CAPTIVE INSURANCE CJ UPMC SUSQ false false true false true true false false false false false false false false false true false false true true SCHEDULE R, PART IV, LINE 3 FOREIGN RELATED ORGANIZATION TAXABLE AS A CORPORATION: 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.