UPMC: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- UPMC (EIN 47-1600873)
- Tax period
- 2015-07-01 to 2016-06-30
- Filed
- 2017-05-01
- IRS object ID
- 201711219349300701
- 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 | 2017-05-01T06:35:51-05:00 | ReturnTs |
| Tax Period End | 2016-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BKD LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 910 E St Louis St | AddressLine1Txt |
| City | Springfield | CityNm |
| State Abbreviation | MO | StateAbbreviationCd |
| ZIP | 658062523 | 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 | 471600873 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Susquehanna Health Innovation Center | BusinessNameLine1Txt |
| Business Name Line2 | Inc | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | SUSQ | BusinessNameControlTxt |
| Phone | 5703207900 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 700 High Street | AddressLine1Txt |
| City | Williamsport | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 17701 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Eric D Pohjala | PersonNm |
| Person Title | Executive Vice President/CFO | PersonTitleTxt |
| Phone | 5703213171 | PhoneNum |
| Signature | 2017-05-01 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Brian D Todd CPA | PreparerPersonNm |
| PTIN | P00422601 | PTIN |
| Phone | 4178658701 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2017-02-10 21:41:12Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 | $354,525 | 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 | 2013 | FormationYr |
| Legal Domicile State | PA | LegalDomicileStateCd |
| Activity Or Mission | Supporting organization of UPMC Susquehanna. | ActivityOrMissionDesc |
| Voting Members Governing Body | 6 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 4 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 4 | 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 | $145,835 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $350,004 | CYProgramServiceRevenueAmt |
| PY Investment Income | $7,904 | PYInvestmentIncomeAmt |
| CY Investment Income | $4,521 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $153,739 | PYTotalRevenueAmt |
| CY Total Revenue | $354,525 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $2,000,000 | 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 | $540,900 | PYOtherExpensesAmt |
| CY Other Expenses | $1,369,820 | CYOtherExpensesAmt |
| PY Total Expenses | $540,900 | PYTotalExpensesAmt |
| CY Total Expenses | $3,369,820 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$387,161 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$3,015,295 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $28,790,813 | TotalAssetsBOYAmt |
| Total Assets EOY | $25,775,518 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $18,177,974 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $18,177,974 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $10,612,839 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $7,597,544 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | The mission of UPMC Susquehanna and affiliates is as follows: Our mission - to extend God's healing love by improving the health of those we serve. Our vision - to create a clinically integrated community health system that delivers world class care. Our values - to place patients and their families first, share ownership with all of our caregivers, and lead with a servant's heart. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $3,312,268 | ExpenseAmt |
| Grant | $2,000,000 | GrantAmt |
| Revenue | $350,004 | RevenueAmt |
| Desc | SHICI is a supporting organization for The Williamsport Hospital, Divine Providence Hospital, Muncy Valley Hospital, and Susquehanna Physician Services. | Desc |
| Total Program Service Expenses | $3,312,268 | 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 | 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 | Yes (1) | 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 | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| 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 | 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 | 6 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 4 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (1) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | 0 | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | PA | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | UPMC Susquehanna Finance Department | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 5703207900 | PhoneNum |
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 |
Form990 Part VII Section A Form990PartVIISectionAGrp (11 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|
| Christian DeWald | |||||||||
| Chairperson | 2.00 | 4.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| Keith Kuzio | |||||||||
| Vice Chairman | 2.00 | 6.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| Ann Pepperman | |||||||||
| Secretary | 2.00 | 4.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| Ronald DeFeo | |||||||||
| Treasurer | 2.00 | 4.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| Steven P Johnson | |||||||||
| President/CEO | 2.00 | 50.00 | Yes (X) | Yes (X) | $0 | $832,199 | $35,182 | ||
| Eric D Pohjala | |||||||||
| Exec VP/CFO-elected 8/27/15 | 2.00 | 40.00 | Yes (X) | Yes (X) | $0 | $255,157 | $27,349 | ||
| Jan E Fisher | |||||||||
| Exec VP/COO | 2.00 | 42.00 | $0 | $459,806 | $31,992 | Yes (X) | |||
| David Lopatofsky MD | |||||||||
| Exec VP/CMO | 2.00 | 42.00 | $0 | $437,276 | $38,887 | Yes (X) | |||
| Charles J Santangelo | |||||||||
| Former Exec VP/CFO-Retired 5/2/15 | 0.00 | 40.00 | $0 | $338,073 | $24,988 | Yes (X) | |||
| William C McCauley MD | |||||||||
| Former Exec VP/CMO-Retired 1/31/15 | 0.00 | 40.00 | $0 | $185,372 | $4,271 | Yes (X) | |||
| Ronald J Butler | |||||||||
| Former Exec VP/CBO-Retired 4/15/15 | 0.00 | 42.00 | $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 | $3,026,509 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $176,171 | 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Affiliate rent income | Desc |
| Business | 621990 | BusinessCd |
| Total Revenue Column | $350,004 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $350,004 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $350,004 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $4,521 | TotalRevenueColumnAmt |
| Exclusion | $4,521 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $354,525 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $350,004 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $4,521 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,000,000 | TotalAmt |
| Program Services | $2,000,000 | ProgramServicesAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $20,452 | TotalAmt |
| Management And General | $20,452 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,100 | TotalAmt |
| Management And General | $2,100 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $35,000 | TotalAmt |
| Management And General | $35,000 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $235,752 | TotalAmt |
| Program Services | $235,752 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,076,516 | TotalAmt |
| Program Services | $1,076,516 | ProgramServicesAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,369,820 | TotalAmt |
| Program Services | $3,312,268 | ProgramServicesAmt |
| Management And General | $57,552 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,948,772 | BOYAmt |
| EOY | $24,863 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,152,978 | BOYAmt |
| EOY | $1,000,058 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $24,309,656 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $1,211,755 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,607,295 | BOYAmt |
| EOY | $23,097,901 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,081,768 | BOYAmt |
| EOY | $1,652,696 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $28,790,813 | BOYAmt |
| EOY | $25,775,518 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,600,000 | BOYAmt |
| EOY | $17,600,000 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $577,974 | BOYAmt |
| EOY | $577,974 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,177,974 | BOYAmt |
| EOY | $18,177,974 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,612,839 | BOYAmt |
| EOY | $7,597,544 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,612,839 | BOYAmt |
| EOY | $7,597,544 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $28,790,813 | BOYAmt |
| EOY | $25,775,518 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$3,015,295 | 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 Type1 | Yes (X) | SupportingOrgType1Ind |
| IRS Written Determination | Yes (X) | IRSWrittenDeterminationInd |
| Supported Organizations | 4 | SupportedOrganizationsCnt |
Supported Org Information SupportedOrgInformationGrp (4 entries)
| EINEIN | Organization TypeOrganizationTypeCd | Governing Document ListedGoverningDocumentListedInd | SupportSupportAmt | Other SupportOtherSupportAmt |
|---|---|---|---|---|
| The Williamsport Hospital | ||||
| 240795508 | 3 | Yes (1) | $727,273 | $0 |
| Susquehanna Physician Services | ||||
| 232449454 | 3 | Yes (1) | $0 | $0 |
| Divine Providence Hospital | ||||
| 240799343 | 3 | Yes (1) | $0 | $0 |
| Muncy Valley Hospital | ||||
| 240806023 | 3 | Yes (1) | $1,272,727 | $0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supported Organizations Total | 4 | SupportedOrganizationsTotalCnt |
| Support Sum | $2,000,000 | 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 |
Form990 Sch A Type1 Suprt Org Form990SchAType1SuprtOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Power Appoint Majority Dir Trst | Yes (1) | PowerAppointMajorityDirTrstInd |
| Operate Benefit Non Suprt Org | 0 | OperateBenefitNonSuprtOrgInd |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,300,000 | OtherCostOrOtherBasisAmt |
| Book Value | $2,300,000 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $15,247,638 | OtherCostOrOtherBasisAmt |
| Depreciation | $678,600 | DepreciationAmt |
| Book Value | $14,569,038 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $5,169,384 | OtherCostOrOtherBasisAmt |
| Depreciation | $341,756 | DepreciationAmt |
| Book Value | $4,827,628 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,592,634 | OtherCostOrOtherBasisAmt |
| Depreciation | $191,399 | DepreciationAmt |
| Book Value | $1,401,235 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $23,097,901 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (2 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| Other Assets | $252,000 |
| Due from affiliates | $1,400,696 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $1,652,696 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Due to affiliates | Desc |
| Amt | $577,974 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $577,974 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $354,525 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Not Reported | $0 | RevenueNotReportedAmt |
| Revenue Subtotal | $354,525 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $354,525 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $1,369,820 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $1,369,820 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $2,000,000 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $2,000,000 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $3,369,820 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part XII, Line 4b - Other Adjustments: | Transfer to affiliates 2,000,000. |
| Form 990, Part X, Line 2 | Management has evaluated their income tax positions under the guidance included in ASC 740. Based on their review, management has not identified any material uncertain tax positions to be recorded or disclosed in the financial statements. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Non Cash AssistanceNonCashAssistanceAmt | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|---|
| The Williamsport Hospital | ||||||||
| 700 High Street | Williamsport | PA | 17701 | 240795508 | 501(c)(3) | $727,273 | $0 | Support of affiliate |
| Muncy Valley Hospital | ||||||||
| 215 E Water Street | Muncy | PA | 17756 | 240806023 | 501(c)(3) | $1,272,727 | $0 | Support of affiliate |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 2 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 2: | FormAndLineReferenceDesc |
| Explanation | Grantees are related organizations and part of UPMC Susquehanna with consistent management oversight ensuring the use of funds for charitable purposes. | ExplanationTxt |
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 (7 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 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-elected 8/27/15 | $0 | $252,402 | $0 | $0 | $0 | $2,755 | $0 | $9,720 | $0 | $17,629 | $0 | $282,506 | $0 | $0 |
| Jan E Fisher | ||||||||||||||
| Exec VP/COO | $0 | $409,956 | $0 | $36,987 | $0 | $12,863 | $0 | $9,950 | $0 | $22,042 | $0 | $491,798 | $0 | $0 |
| David Lopatofsky MD | ||||||||||||||
| Exec VP/CMO | $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-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 C 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 committee, independent compensation consultant, written employment contract, compensation survey or study, and approval by the board. |
| Part I, Line 6 | In order for the Leadership Team to participate in the annual Variable Compensation Incentive Program (VCIP) a minimum operating margin must be achieved for the most recently completed year on a consolidated system-level basis. Individual goals and objectives related to the VCIP may also include individual entity operating performance. For FY 2016, the minimum threshold was met that would trigger a VCIP payment. In December 2015, President/CEO Steven P. Johnson received a variable compensation award in the amount of $133,858. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 2 | Board member Steve Johnson, Keith Kuzio, and Christian DeWald all serve on the board of a related taxable corporation. |
| Form 990, Part VI, Section A, line 6 | UPMC Susquehanna EIN #23-2751183 is the sole member of the governing body. |
| Form 990, Part VI, Section A, line 7a | UPMC Susquehanna EIN #23-2751183 may elect or remove one or more board members to the governing body. |
| Form 990, Part VI, Section A, line 7b | UPMC Susquehanna EIN #23-2751183, the sole member shall have exclusive authority to exercise the powers: To elect and remove, with or without cause, a Director of the Corporation. To establish the overall policy and long range plans of the corporation. To adopt, amend or repeal the Articles of Incorporation. To establish requirements for a unified budget, the approval of new capital debt, any increment to any existing capital debt, and/or any change in capital debt obligations of the corporation. To establish policies and requirement for the approval of the acquisition, purchase, sale, leasing, or encumbrance outside the ordinary course of business of land or buildings and the construction or demolition of buildings owned by the corporation. To cause debt to be incurred by the corporation. To require a certified audit of corporate funds at any time. To establish requirements and policies governing the approval of any guaranty of the indebtedness of any person, the granting of any security interest in or the creation of any encumbrance on any asset of the corporation. To approve any merger, consolidation, organization, reorganization, joint venture or other modification of corporate structure or affiliations affecting the autonomy, governance, or operations of the corporation. To dissolve or terminate the existence of the corporation and determine the distribution of assets upon such termination. To appoint annually the external fiscal auditor of the corporation. To approve the nominees for elected officers of the Board of Directors of the corporation. To remove any elected officer of the corporation. To adopt the annual capital and operating budget of the corporation. To coordinate manager care plans. To approve any change in licensure of the corporation. |
| 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 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 | All members of the Board of Directors are required to submit a statement annually disclosing any conflict of interest that may arise. Requests for the annual form are distributed individually to each Board Member by the Office of the President and CEO. The CEO's executive assistant ensures that she receives a completed form from every Board Member. All Board Members agree to abstain when any issue involving the parties with conflicting interest is called to motion. |
| Form 990, Part VI, Section B, line 15 | All top management is employed by The Williamsport Hospital EIN #24-0795508. The following paragraph describes the process they use. The Board of Directors, through the Executive Compensation Committee, retains an independent outside consultant to provide guidance with respect to the annual establishment of the rebuttable presumption or reasonableness relative to executive compensation and benefits. The consultant annually provides detailed market information from its annual Executive Compensation Survey for Health Systems. In addition, other regional survey data is provided in order to supply the health system with a "national" picture of compensation. With this process established, the Executive Compensation Committee takes the proper steps to educate the Board of Directors to understand all of the above-mentioned oversight and to appropriately prepare them for community or media inquiry. In addition, the Board is made aware of the Form 990 and its role in the communication of information to the public. |
| Form 990, Part VI, Section C, line 19 | The organization makes its governing documents, conflict of interest policy, and financial statements available to members of the public who request them. They would be produced by the Corporate office. |
| Form 990, Part XII, Line 2c | The organization did not change its oversight process or selection process. |
| Form 990, Part V, Line 1a | Number reported in Box 3 of Form 1096 All 1099's are issued by UPMC Susquehanna EIN #23-2751183. All expenses are then allocated back to all related entities. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (14 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Divine Providence Hospital of the Sisters of Christian Charity | |||||||||||
| 1100 Grampian Blvd | Williamsport | PA | 17701 | 240799343 | Hospital | PA | 501(c)(3) | Line 3 | UPMC Susquehanna | 0 | |
| Muncy Valley Hospital | |||||||||||
| 215 E 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 | |||||||||||
| 1100 Grampian Blvd | Williamsport | PA | 17701 | 232743470 | Fundraising for Affiliated entities | PA | 501(c)(3) | Line 11a, I | UPMC Susquehanna | 0 | |
| UPMC Susquehanna | |||||||||||
| 1205 Grampian Blvd | Williamsport | PA | 17701 | 232751183 | Coordinate & manage the delivery of healthcare | PA | 501(c)(3) | Line 11b, II | 0 | N/A | |
| Susquehanna Physician Services | |||||||||||
| 1201 Grampian Blvd | Williamsport | PA | 17701 | 232449454 | Physician services | PA | 501(c)(3) | Line 3 | UPMC Susquehanna | 0 | |
| Williamsport Area Ambulance Service Cooperative | |||||||||||
| 700 High Street | Williamsport | PA | 17701 | 232416166 | Ambulance transports | PA | 501(c)(3) | Line 9 | 0 | N/A | |
| Soldiers & Sailors Memorial Hospital | |||||||||||
| 32-36 Central Ave | Wellsboro | PA | 16901 | 232176963 | Hospital | PA | 501(c)(3) | Line 3 | UPMC Susquehanna | 0 | |
| The Green Home | |||||||||||
| 37 Central Ave | Wellsboro | PA | 16901 | 240804365 | Skilled nursing & assisted living | PA | 501(c)(3) | Line 9 | UPMC Susquehanna | 0 | |
| Tioga Health Care Providers | |||||||||||
| 15 Meade Street | Wellsboro | PA | 16901 | 251765538 | Physician services | PA | 501(c)(3) | Line 11b, II | UPMC Susquehanna | 0 | |
| Laurel Managment Services | |||||||||||
| 15 Meade Street | Wellsboro | PA | 16901 | 251644910 | Mgmt consulting & supervisory svcs | PA | 501(c)(3) | Line 11b, II | UPMC Susquehanna | 0 | |
| Laurel Realty | |||||||||||
| 15 Meade Street | Wellsboro | PA | 16901 | 231403678 | Own & manage real estate | PA | 501(c)(2) | N/A | UPMC Susquehanna | 0 | |
| Laurel Health System | |||||||||||
| 15 Meade Street | Wellsboro | PA | 16901 | 240795488 | Coordinate & manage the delivery of healthcare | PA | 501(c)(3) | Line 11b, II | UPMC Susquehanna | 0 | |
| Laurel Health Foundation | |||||||||||
| 15 Meade Street | Wellsboro | PA | 16901 | 251810488 | Fundraising for Affiliated entities | PA | 501(c)(3) | Line 11a, I | 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 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 | CountryForeignAddress/CountryCd | Legal Domicile Foreign CountryLegalDomicileForeignCountryCd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Susquehanna Ventures Inc | ||||||||||||
| 1201 Grampian Blvd | Williamsport | PA | 17701 | 232470263 | Pharmacy & Infusion services | PA | UPMC Susquehanna | C | 0 | |||
| Susquehanna Health System Insurance Network LTD | ||||||||||||
| 980458722 | Captive Insurance Company | UPMC Susquehanna | 0 | PO Box 1159 | CJ | CJ | ||||||
| Tyoga Carenet | ||||||||||||
| 15 Meade Street | Wellsboro | PA | 16901 | 251810967 | Integrate Health Care | PA | UPMC Susquehanna | C | 0 | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | 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 | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Form 990, Schedule R, Part IV | FormAndLineReferenceDesc |
| Explanation | Susquehanna Health System Insurance Network, 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 |