LAUREL HEALTH FOUNDATION: Form 990, tax year 2014
View the entire original 990 at ProPublica ↗
- Organization
- LAUREL HEALTH FOUNDATION (EIN 25-1810488)
- Tax period
- 2014-07-01 to 2015-06-30
- Filed
- 2016-05-13
- IRS object ID
- 201621349349302867
- Schema version
- 2014v6.0
- 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 | 2016-05-13T10:36:58-05:00 | ReturnTs |
| Tax Period End | 2015-06-30 | 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 200/PO BOX 1190 | AddressLine1Txt |
| City | SPRINGFIELD | CityNm |
| State Abbreviation | MO | StateAbbreviationCd |
| ZIP | 658062523 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2014-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 251810488 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LAUREL HEALTH FOUNDATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of | % MANAGEMENT | InCareOfNm |
| Business Name Control | LAUR | BusinessNameControlTxt |
| Phone | 5707230605 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 15 MEADE ST U-6 | AddressLine1Txt |
| City | WELLSBORO | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 16901 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | GRETCHEN E REGINA | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 5707230603 | PhoneNum |
| Signature | 2016-04-19 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | 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 | 2014 | TaxYr |
| Build TS | 2016-08-17 19:52:53Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Change | Yes (X) | AddressChangeInd |
| Principal Officer | RONALD BUTLER | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 15 MEADE ST U-6 | AddressLine1Txt |
| City | WELLSBORO | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 16901 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $5,026,458 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.SUSQUEHANNAHEALTH.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1998 | FormationYr |
| Legal Domicile State | PA | LegalDomicileStateCd |
| Activity Or Mission | LAUREL HEALTH FOUNDATION IS AN AFFILIATE OF SUSQUEHANNA HEALTH SYSTEM. ITS MISSION IS AS FOLLOWS: TO EXTEND GOD'S HEALING LOVE BY IMPROVING THE HEALTH OF THOSE WE SERVE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 5 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 9 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $14,420 | PYContributionsGrantsAmt |
| CY Contributions Grants | $0 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $0 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| PY Investment Income | $987,490 | PYInvestmentIncomeAmt |
| CY Investment Income | $546,482 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $1,001,910 | PYTotalRevenueAmt |
| CY Total Revenue | $546,482 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $132,046 | 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 | $47,185 | PYOtherExpensesAmt |
| CY Other Expenses | $70,915 | CYOtherExpensesAmt |
| PY Total Expenses | $47,185 | PYTotalExpensesAmt |
| CY Total Expenses | $202,961 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $954,725 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $343,521 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $20,735,415 | TotalAssetsBOYAmt |
| Total Assets EOY | $20,288,938 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $28,769 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $40,047 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $20,706,646 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $20,248,891 | NetAssetsOrFundBalancesEOYAmt |
| Mission | THE SPECIFIC PURPOSES OF THE LAUREL HEALTH FOUNDATION ARE TO SUPPORT, PROMOTE, ADVANCE AND STRENGTHEN THE SOLDIERS & SAILORS MEMORIAL HOSPITAL, THE GREEN HOME, AND TIOGA HEALTH CARE PROVIDERS. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $198,479 | ExpenseAmt |
| Grant | $132,046 | GrantAmt |
| Desc | PROVIDING FINANCIAL SUPPORT FOR SOLDIERS AND SAILORS MEMORIAL HOSPITAL, THE GREEN HOME, AND TIOGA HEALTH CARE PROVIDERS. | Desc |
| Total Program Service Expenses | $198,479 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | false | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Temp Or Permanent Endowments | Yes (true) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | false | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | false | OperateHospitalInd |
| Grants To Organizations | Yes (true) | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | false | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 0 | EmployeeCnt |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 9 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 5 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (true) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | false | MembersOrStockholdersInd |
| Election Of Board Members | Yes (true) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (true) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | false | CompensationProcessCEOInd |
| Compensation Process Other | false | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | MANAGEMENT | PersonNm |
| Phone | 5707230605 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 15 MEADE ST SUITE U-6 | AddressLine1Txt |
| City | WELLSBORO | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 16901 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (12 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 |
|---|---|---|---|---|---|---|---|
| RONALD J BUTLER | |||||||
| PRESIDENT | 1.0 | 41.0 | Yes (X) | Yes (X) | $0 | $344,778 | $22,032 |
| R ROBERT DECAMP | |||||||
| SECRETARY | 1.0 | 3.0 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| WALTER J LAIBINIS DO | |||||||
| DIRECTOR | 1.0 | 43.0 | Yes (X) | $0 | $208,775 | $26,866 | |
| CRAIG G LITCHFIELD | |||||||
| TREASURER | 1.0 | 1.0 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| J DENNIS MURRAY PHD | |||||||
| DIRECTOR | 1.0 | 3.0 | Yes (X) | $0 | $0 | $0 | |
| THOMAS M OWLETT ESQ | |||||||
| CHAIRMAN | 1.0 | 1.0 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| GLENN B POIRIER | |||||||
| VICE CHAIRMAN | 1.0 | 3.0 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| JAN E FISHER | |||||||
| EXECUTIVE VP | 1.0 | 41.0 | Yes (X) | Yes (X) | $0 | $413,779 | $29,747 |
| KAREN CHAMBERS | |||||||
| DIRECTOR BEGINNING 07/2014 | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | |
| MARY E WORTHINGTON | |||||||
| DIRECTOR ENDING 07/2014 | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | |
| RONALD M GILBERT | |||||||
| VP/CFO ENDING 02/2015 | 1.0 | 42.0 | Yes (X) | $0 | $234,827 | $19,429 | |
| GRETCHEN E REGINA | |||||||
| VP/CFO BEGINNING 02/2015 | 1.0 | 42.0 | Yes (X) | $0 | $77,478 | $5,514 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $1,279,637 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $103,588 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| Total Contributions | $0 | TotalContributionsAmt |
| Total Program Service Revenue | $0 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $387,354 | TotalRevenueColumnAmt |
| Exclusion | $387,354 | ExclusionAmt |
Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Royalties Revenue RoyaltiesRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $4,639,104 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $4,479,976 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $159,128 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $159,128 | TotalRevenueColumnAmt |
| Exclusion | $159,128 | ExclusionAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $0 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $546,482 | TotalRevenueColumnAmt |
| Exclusion | $546,482 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $132,046 | TotalAmt |
| Program Services | $132,046 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Foreign Grants ForeignGrantsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Benefits To Members BenefitsToMembersGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $966 | TotalAmt |
| Management And General | $966 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,300 | TotalAmt |
| Management And General | $3,300 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $64,472 | TotalAmt |
| Program Services | $64,472 | ProgramServicesAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $84 | TotalAmt |
| Management And General | $84 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,093 | TotalAmt |
| Program Services | $1,961 | ProgramServicesAmt |
| Management And General | $132 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $202,961 | TotalAmt |
| Program Services | $198,479 | ProgramServicesAmt |
| Management And General | $4,482 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $937,887 | BOYAmt |
| EOY | $961,995 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $6,279 | EOYAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,797,528 | BOYAmt |
| EOY | $19,320,664 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,735,415 | BOYAmt |
| EOY | $20,288,938 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,691 | BOYAmt |
| EOY | $12,331 | EOYAmt |
Grants Payable GrantsPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,078 | BOYAmt |
| EOY | $27,716 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $28,769 | BOYAmt |
| EOY | $40,047 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,579,090 | BOYAmt |
| EOY | $20,119,125 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $127,556 | BOYAmt |
| EOY | $129,766 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,706,646 | BOYAmt |
| EOY | $20,248,891 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,735,415 | BOYAmt |
| EOY | $20,288,938 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $343,521 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$129,276 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$672,000 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | 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 | false | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | Yes (X) | SupportingOrganization509a3Ind |
| Supporting Org Type2 | Yes (X) | SupportingOrgType2Ind |
| Supported Organizations | 4 | SupportedOrganizationsCnt |
Supported Org Information SupportedOrgInformationGrp (4 entries)
| EINEIN | Organization TypeOrganizationTypeCd | Governing Document ListedGoverningDocumentListedInd | SupportSupportAmt | Other SupportOtherSupportAmt |
|---|---|---|---|---|
| SSMH | ||||
| 232176963 | 3 | Yes (true) | $422,000 | $0 |
| NORTH PENN | ||||
| 231889724 | 3 | Yes (true) | $57,930 | $0 |
| GREEN HOME | ||||
| 240804365 | 9 | Yes (true) | $250,000 | $0 |
| WELLSBORO C F | ||||
| 202680321 | 8 | Yes (true) | $74,116 | $0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supported Organizations Total | 4 | SupportedOrganizationsTotalCnt |
| Support Sum | $804,046 | SupportSumAmt |
| Other Support Sum | $0 | OtherSupportSumAmt |
Form990 Sch A Supporting Org Form990SchASupportingOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Listed By Name Governing Doc | Yes (true) | ListedByNameGoverningDocInd |
| Suprt Org No IRS Determination | false | SuprtOrgNoIRSDeterminationInd |
| Supported Org Section C456 | false | SupportedOrgSectionC456Ind |
| Supported Org Not Organized US | false | SupportedOrgNotOrganizedUSInd |
| Organization Change Suprt Org | false | OrganizationChangeSuprtOrgInd |
| Support Non Supported Org | false | SupportNonSupportedOrgInd |
| Payment Substantial Contribtr | false | PaymentSubstantialContribtrInd |
| Loan Disqualified Person | false | LoanDisqualifiedPersonInd |
| Controlled Disqualified Prsn | false | ControlledDisqualifiedPrsnInd |
| Disqualified Prsn Controll Int | false | DisqualifiedPrsnControllIntInd |
| Disqualified Prsn Ownr Int | false | DisqualifiedPrsnOwnrIntInd |
| Excess Business Holdings Rules | false | ExcessBusinessHoldingsRulesInd |
| Contribution Controller | false | ContributionControllerInd |
| Contribution Family | false | ContributionFamilyInd |
| Contribution35 Controlled | false | Contribution35ControlledInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Majority Dir Trst Supported Org | Yes (true) | MajorityDirTrstSupportedOrgInd |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE A, PART I, LINE 11H | FormAndLineReferenceDesc |
| Explanation | 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 | ExplanationTxt |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amounts | ArtPublicExhibitionAmountsGrp | |
| Held Works Art | HeldWorksArtGrp |
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $16,284,168 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $271,234 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $776,184 | GrantsOrScholarshipsAmt |
| Administrative Expenses | $34,219 | AdministrativeExpensesAmt |
| End Year Balance | $15,744,999 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributions | $14,945,981 | ContributionsAmt |
| Investment Earnings Or Losses | $1,358,906 | InvestmentEarningsOrLossesAmt |
| Administrative Expenses | $20,719 | AdministrativeExpensesAmt |
| End Year Balance | $16,284,168 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| CY Minus2 Yr Endwmt Fund | CYMinus2YrEndwmtFundGrp | |
| CY Minus3 Yr Endwmt Fund | CYMinus3YrEndwmtFundGrp | |
| CY Minus4 Yr Endwmt Fund | CYMinus4YrEndwmtFundGrp | |
| Board Designated Balance EOY | 1.00000 | BoardDesignatedBalanceEOYPct |
| Endowments Held Unrelated Org | Yes (true) | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | false | EndowmentsHeldRelatedOrgInd |
| Land | LandGrp | |
| Buildings | BuildingsGrp | |
| Leasehold Improvements | LeaseholdImprovementsGrp | |
| Equipment | EquipmentGrp | |
| Other Land Buildings | OtherLandBuildingsGrp | |
| Federal Income Tax Liability | $0 | FederalIncomeTaxLiabilityAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DUE TO AFFILIATES | Desc |
| Amt | $27,716 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $27,716 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $414,996 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | -$129,276 | NetUnrealizedGainsInvstAmt |
| Revenue Not Reported | -$129,276 | RevenueNotReportedAmt |
| Revenue Subtotal | $544,272 | RevenueSubtotalAmt |
| Other Revenues Not Included | $2,210 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $2,210 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $546,482 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $202,961 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Subtotal | $202,961 | ExpensesSubtotalAmt |
| Total Expenses Per Form990 | $202,961 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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: $2,210 TEMPORARILY RESTRICTED INVESTMENT INCOME |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (true) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Valuation Method UsedValuationMethodUsedDesc | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|---|
| NORTH PENN COMPREHENSIVE HEALTH SERVICES | ||||||||
| 22 WALNUT ST | WELLSBORO | PA | 16901 | 231889724 | 501(C)(3) | $57,930 | CASH | SUPPORT |
| THE WELLSBORO COMMUNITY FOUNDATION | ||||||||
| PO BOX 243 | WELLSBORO | PA | 16901 | 202680321 | 501(C)(3) | $74,116 | CASH | SUPPORT |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 2 | Total501c3OrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE I, PART I, LINE 2 | FormAndLineReferenceDesc |
| Explanation | 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. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | false | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (4 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| RONALD J BUTLER | ||||||||||||||
| PRESIDENT | $0 | $329,125 | $0 | $10,897 | $0 | $4,756 | $0 | $9,800 | $0 | $12,232 | $0 | $366,810 | $0 | $0 |
| WALTER J LAIBINIS DO | ||||||||||||||
| DIRECTOR | $0 | $172,016 | $0 | $0 | $0 | $36,759 | $0 | $8,153 | $0 | $18,713 | $0 | $235,641 | $0 | $0 |
| JAN E FISHER | ||||||||||||||
| EXECUTIVE VP | $0 | $395,220 | $0 | $10,795 | $0 | $7,764 | $0 | $9,800 | $0 | $19,947 | $0 | $443,526 | $0 | $0 |
| RONALD M GILBERT | ||||||||||||||
| VP/CFO ENDING 02/2015 | $0 | $186,091 | $0 | $48,098 | $0 | $638 | $0 | $9,026 | $0 | $10,403 | $0 | $254,256 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE J, PART I, LINE 6 | FormAndLineReferenceDesc |
| Explanation | 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. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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, SUSQUEHANNA HEALTH SYSTEM 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. SUSQUEHANNA HEALTH SYSTEM (SHS), EIN 23-2751183 MAY ELECT OR REMOVE MEMBERS OF THE GOVERNING BODY. |
| FORM 990, PART VI, SECTION A, LINE 7B | DECISIONS SUBJECT TO APPROVAL BY MEMBERS: THE BYLAWS REQUIRE PRIOR WRITTEN APPROVAL OF SUSQUEHANNA HEALTH SYSTEM ON 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 SUSQUEHANNA HEALTH SYSTEM 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, SUSQUEHANNA HEALTH SYSTEM 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 XI, LINE 9 | OTHER CHANGES IN NET ASSETS: $(672,000) TRANSFERS TO AFFILIATES |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (16 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Public Charity StatusPublicCharityStatusTxt |
|---|---|---|---|---|---|---|---|---|---|---|
| LAUREL REALTY | ||||||||||
| 15 MEADE STREET | WELLSBORO | PA | 16901 | 231403678 | REAL ESTATE | PA | 501(C)(2) | SHS | false | |
| LAUREL MANAGEMENT SERVICES | ||||||||||
| 15 MEADE STREET | WELLSBORO | PA | 16901 | 251644910 | MGT CONSULT | PA | 501(C)(3) | SHS | false | 11B II |
| THE GREEN HOME | ||||||||||
| 37 CENTRAL AVENUE | WELLSBORO | PA | 16901 | 240804365 | SNF | PA | 501(C)(3) | SHS | false | 9 |
| SOLDIERS AND SAILORS MEMORIAL HOSPITAL | ||||||||||
| 32-36 CENTRAL AVENUE | WELLSBORO | PA | 16901 | 232176963 | HOSPITAL | PA | 501(C)(3) | SHS | false | 3 |
| TIOGA HEALTH CARE PROVIDERS | ||||||||||
| 15 MEADE STREET | WELLSBORO | PA | 16901 | 251765538 | SPECIALISTS | PA | 501(C)(3) | SHS | false | 11B II |
| SUSQUEHANNA HEALTH SYSTEM | ||||||||||
| 1205 GRAMPIAN BLVD | WILLIAMSPORT | PA | 17701 | 232751183 | MANAGEMENT | PA | 501(C)(3) | NA | false | 11B II |
| DIVINE PROVIDENCE HOSPITAL | ||||||||||
| 1100 GRAMPIAN BLVD | WILLIAMSPORT | PA | 17701 | 240799343 | HOSPITAL | PA | 501(C)(3) | SHS | false | 3 |
| MUNCY VALLEY HOSPITAL | ||||||||||
| 215 E WATER ST | MUNCY | PA | 17756 | 240806023 | HOSPITAL | PA | 501(C)(3) | SHS | false | 3 |
| THE WILLIAMSPORT HOSPITAL | ||||||||||
| 700 HIGH ST | WILLIAMSPORT | PA | 17701 | 240795508 | HOSPITAL | PA | 501(C)(3) | SHS | false | 3 |
| SUSQUEHANNA HEALTH FOUNDATION | ||||||||||
| 1100 GRAMPIAN BLVD | WILLIAMSPORT | PA | 17701 | 232743470 | FUNDRAISING | PA | 501(C)(3) | SHS | false | 11A I |
| SUSQUEHANNA PHYSICIAN SERVICES | ||||||||||
| 1201 GRAMPIAN BLVD | WILLIAMSPORT | PA | 17701 | 232449454 | SPECIALISTS | PA | 501(C)(3) | SHS | false | 3 |
| WILLIAMSPORT AREA AMBULANCE SERVICES | ||||||||||
| 700 HIGH ST | WILLIAMSPORT | PA | 17701 | 232416166 | AMBULANCE | PA | 501(C)(3) | SHS | false | 9 |
| NORTH PENN COMPREHENSIVE HEALTH SERVICES | ||||||||||
| 22 WALNUT ST | WELLSBORO | PA | 16901 | 231889724 | GENERAL HLTH | PA | 501(C)(3) | SHS | false | 3 |
| LAUREL HEALTH SYSTEM | ||||||||||
| 15 MEADE STREET | WELLSBORO | PA | 16901 | 240795488 | MANAGEMENT | PA | 501(C)(3) | SHS | false | 11B II |
| WELLSBORO COMMUNITY FOUNDATION | ||||||||||
| 114 MAIN STREET | WELLSBORO | PA | 16901 | 202680321 | FUNDRAISING | PA | 501(C)(3) | NA | false | 7 |
| SUSQUEHANNA HEALTH INNOVATION CENTER | ||||||||||
| 700 HIGH STREET | WILLIAMSPORT | PA | 17701 | 471600873 | SUPPORT AFF. | PA | 501(C)(3) | SHS | false | 11B II |
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 | REAL ESTATE | PrimaryActivitiesTxt |
| Legal Domicile State | PA | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SHS | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Predominant Income Type | N/A | PredominantIncomeTypeTxt |
| Disproportionate Allocations | false | DisproportionateAllocationsInd |
| General Or Managing Partner | false | 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 | CityForeignAddress/CityNm | Province Or StateForeignAddress/ProvinceOrStateNm | CountryForeignAddress/CountryCd | Legal Domicile Foreign CountryLegalDomicileForeignCountryCd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| TYOGA CARENET | ||||||||||||||
| 15 MEADE STREET | WELLSBORO | PA | 16901 | 251810967 | INTEGRATION | PA | LHS | C CORP | false | |||||
| SUSQUEHANNA VENTURES INC | ||||||||||||||
| 1201 GRAMPIAN BLVD | WILLIAMSPORT | PA | 17701 | 232470263 | PHARMACY | PA | SHS | C CORP | false | |||||
| SUSQUEHANNA HEALTH SYS INSUR NETWORK LTD | ||||||||||||||
| 980458722 | CAPTIVE INSURANCE | SHS | false | PO BOX 1159 KY1-1102 | GRAND CAYMANS | CAYMAN ISLANDS | CJ | CJ | ||||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (true) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | false | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | Yes (true) | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | false | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | false | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (true) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (true) | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE R, PART IV, LINE 3 | FormAndLineReferenceDesc |
| Explanation | 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, SUSQUEHANNA HEALTH, 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 |