UPMC: Form 990, tax year 2014
View the entire original 990 at ProPublica ↗
- Organization
- UPMC (EIN 23-2176963)
- Tax period
- 2014-07-01 to 2015-06-30
- Filed
- 2016-05-20
- IRS object ID
- 201621419349300512
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule G
- Schedule H
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2016-05-20T10:27:48-05:00 | ReturnTs |
| Tax Period End | 2015-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 440160260 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BKD LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 910 E St Louis Street Suite 200 | AddressLine1Txt |
| City | Springfield | CityNm |
| State Abbreviation | MO | StateAbbreviationCd |
| ZIP | 65806 | 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 | 232176963 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Soldiers and Sailors Memorial Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | SOLD | BusinessNameControlTxt |
| Phone | 5707230605 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 32-36 Central Avenue | AddressLine1Txt |
| City | Wellsboro | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 16901 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Eric D Pohjala | PersonNm |
| Person Title | Chief Financial Officer | PersonTitleTxt |
| Phone | 5703213175 | PhoneNum |
| Signature | 2016-05-20 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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) |
|---|---|---|
| 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 | 16901 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $64,682,172 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | susquehannahealth.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1919 | FormationYr |
| Legal Domicile State | PA | LegalDomicileStateCd |
| Activity Or Mission | Soldiers & Sailors Memorial Hospital is a subsidiary of Susquehanna Health System (SHS). The mission of SHS and affiliates is as follows: To extend God's healing love by improving the health of those we serve. Our vision is to create a world-class health system. Our values are putting patients first, sharing ownership and being servant leaders. | ActivityOrMissionDesc |
| Voting Members Governing Body | 16 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 12 | VotingMembersIndependentCnt |
| Total Employee | 496 | TotalEmployeeCnt |
| Total Volunteers | 88 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $844,097 | PYContributionsGrantsAmt |
| CY Contributions Grants | $481,561 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $61,098,714 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $62,924,956 | CYProgramServiceRevenueAmt |
| PY Investment Income | $94,783 | PYInvestmentIncomeAmt |
| CY Investment Income | $782,980 | CYInvestmentIncomeAmt |
| PY Other Revenue | $403,324 | PYOtherRevenueAmt |
| CY Other Revenue | $410,678 | CYOtherRevenueAmt |
| PY Total Revenue | $62,440,918 | PYTotalRevenueAmt |
| CY Total Revenue | $64,600,175 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $2,000 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $1,100 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $30,041,210 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $28,831,700 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $27,761,582 | PYOtherExpensesAmt |
| CY Other Expenses | $29,552,837 | CYOtherExpensesAmt |
| PY Total Expenses | $57,804,792 | PYTotalExpensesAmt |
| CY Total Expenses | $58,385,637 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $4,636,126 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $6,214,538 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $61,203,069 | TotalAssetsBOYAmt |
| Total Assets EOY | $91,358,783 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $29,288,557 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $51,680,634 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $31,914,512 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $39,678,149 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | Soldiers & Sailors Memorial Hospital is a subsidiary of Susquehanna Health System (SHS). The mission of SHS and affiliates is as follows: To extend God's healing love by improving the health of those we serve. Our Vision is to create a world-class health system. Our values are putting patients first, sharing ownership and being servant leaders. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $51,265,919 | ExpenseAmt |
| Grant | $1,100 | GrantAmt |
| Revenue | $62,924,956 | RevenueAmt |
| Desc | The hospital is an 67 bed acute care hospital, which provides care to patients who meet certain criteria without charge or at amounts less than its established rates. The hospital does not pursue collection of amounts determined to qualify as charity care, nor are such amounts reported as revenue. The charity care charges foregone amounted to $1,435,595 in 2015. The following is a summary of the services provided to patients in 2015;Inpatient admissions 1,883Outpatient visits 106,643Newborn deliveries 306Emergency department visits 17,594Surgeries performed 3,335Laboratory tests 257,691CAT Scans 5,590Ultrasound tests 7,297Radiology tests 28,020MRI tests 1,781Nuclear Medicine tests 975PT treatments 54,478Speech Therapy treatments 3,342Occ Therapy treatments 15,427Oncology Procedures 1,604During 2015 Medicare and Medical Assistance charges accounted for 66% of the hospital's total charges. | Desc |
| Total Program Service Expenses | $51,265,919 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | 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 | Yes (1) | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (1) | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | Yes (1) | 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 | Yes (1) | 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 | 496 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 16 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 12 | 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 | 0 | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | 0 | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | 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 | Management | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 5707230605 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 15 Meade Street Suite U-6 | AddressLine1Txt |
| City | Wellsboro | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 16901 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (28 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|---|
| James D Baker Jr | |||||||||
| Director | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| RRobert DeCamp | |||||||||
| Secretary | 1.00 | 4.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| Lisa V Feil Psy D | |||||||||
| Director | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| Robert PFitzgerald | |||||||||
| Director | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| Harold F Hoose III | |||||||||
| Director | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| Michael W Lichty | |||||||||
| Director | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| Craig G Litchfield | |||||||||
| Treasurer | 1.00 | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| JDennis Murray PhD | |||||||||
| Director | 1.00 | 4.00 | Yes (X) | $0 | $0 | $0 | |||
| Thomas M Owlett Esq | |||||||||
| Chairman | 1.00 | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| Glenn BPoirier | |||||||||
| Vice Chairman | 1.00 | 4.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| Wendy SSwartz CPA | |||||||||
| Director | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| Aneurin J Williams Jr | |||||||||
| Director | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| Donna R Wilson | |||||||||
| Director | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| Kathy J Wright PhD | |||||||||
| Director | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| Jill ABurns MD | |||||||||
| Director | 1.00 | 41.00 | Yes (X) | $0 | $264,986 | $34,311 | |||
| Walter J Laibinis DO | |||||||||
| Director | 1.00 | 44.00 | Yes (X) | $0 | $208,775 | $26,866 | |||
| Janie M Hilfiger | |||||||||
| SSMH/TGH/THCP President | 40.00 | 1.00 | $174,511 | $0 | $23,764 | Yes (X) | |||
| Ronald J Butler | |||||||||
| LHS President(Retired 4/2015) | 1.00 | 40.00 | $0 | $344,778 | $22,032 | Yes (X) | |||
| Steven P Johnson | |||||||||
| SHS President | 0.00 | 44.00 | $0 | $906,099 | $31,524 | Yes (X) | |||
| Charles Santangelo | |||||||||
| CFO(Retired 4/2015) | 0.00 | 40.00 | $0 | $356,800 | $31,856 | Yes (X) | |||
| William C McCauley MD | |||||||||
| Executive VP(Retired 1/2015) | 0.00 | 40.00 | $0 | $410,053 | $34,276 | Yes (X) | |||
| David Lopatofsky MD | |||||||||
| Executive VP (Hired 2/2015) | 0.00 | 40.00 | $0 | $336,647 | $35,227 | Yes (X) | |||
| Jan E Fisher | |||||||||
| Executive Vice President | 0.00 | 40.00 | $0 | $413,779 | $29,747 | Yes (X) | |||
| Enrico Doganiero | |||||||||
| Physician | 40.00 | 0.00 | $486,798 | $0 | $32,788 | Yes (X) | |||
| Leonard Dale | |||||||||
| Physician | 40.00 | 0.00 | $179,511 | $0 | $12,063 | Yes (X) | |||
| Craig Devenport | |||||||||
| Pharmacist | 40.00 | 0.00 | $135,234 | $0 | $14,004 | Yes (X) | |||
| Craig Konzen | |||||||||
| Pharmacist | 40.00 | 0.00 | $129,451 | $0 | $27,071 | Yes (X) | |||
| Craig Osborn | |||||||||
| Director of Radiology | 40.00 | 0.00 | $115,622 | $0 | $19,108 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,221,127 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $3,241,917 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $374,637 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 6 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (2 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Laboratory Corp of America | |||||
| PO Box 12140 | Burlington | NC | 27216 | Lab testing | $193,538 |
| Nightrays PA | |||||
| PO Box 204367 | Dallas | TX | 75320 | Interpretation services | $133,247 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 2 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $51,869 | GovernmentGrantsAmt |
| All Other Contributions | $429,692 | AllOtherContributionsAmt |
| Total Contributions | $481,561 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Patient service revenu | 621990 | $59,878,265 | $59,878,265 |
| Electronic Health Ince | 900099 | $1,410,804 | $1,410,804 |
| Employee Pharmacy reve | 900099 | $721,683 | $721,683 |
| Paramedic revenue | 446110 | $479,253 | $479,253 |
| Cafeteria revenue | 722210 | $262,634 | $262,634 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $172,317 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $172,317 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $62,924,956 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $297,295 | TotalRevenueColumnAmt |
| Exclusion | $297,295 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $387,997 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $387,997 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $387,997 | TotalRevenueColumnAmt |
| Exclusion | $387,997 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $528,143 | SecuritiesAmt |
| Other | $360 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $42,818 | SecuritiesAmt |
| Other | $0 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $485,325 | SecuritiesAmt |
| Other | $360 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $485,685 | TotalRevenueColumnAmt |
| Exclusion | $485,685 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gaming Gross Income | $61,860 | GamingGrossIncomeAmt |
| Gaming Direct Expenses | $39,179 | GamingDirectExpensesAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $22,681 | TotalRevenueColumnAmt |
| Exclusion | $22,681 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $64,600,175 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $62,924,956 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1,193,658 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,100 | TotalAmt |
| Program Services | $1,100 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $198,275 | TotalAmt |
| Management And General | $198,275 | ManagementAndGeneralAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $43,646 | TotalAmt |
| Program Services | $43,646 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $21,282,162 | TotalAmt |
| Program Services | $19,613,489 | ProgramServicesAmt |
| Management And General | $1,668,673 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,204,292 | TotalAmt |
| Program Services | $1,099,880 | ProgramServicesAmt |
| Management And General | $104,412 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,569,462 | TotalAmt |
| Program Services | $4,173,290 | ProgramServicesAmt |
| Management And General | $396,172 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,533,863 | TotalAmt |
| Program Services | $1,400,877 | ProgramServicesAmt |
| Management And General | $132,986 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,422,504 | TotalAmt |
| Management And General | $3,422,504 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,284 | TotalAmt |
| Management And General | $1,284 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,416 | TotalAmt |
| Management And General | $1,416 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,234 | TotalAmt |
| Management And General | $7,234 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,268,586 | TotalAmt |
| Program Services | $2,370,720 | ProgramServicesAmt |
| Management And General | $897,866 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,375 | TotalAmt |
| Program Services | $7,781 | ProgramServicesAmt |
| Management And General | $1,594 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,962,083 | TotalAmt |
| Program Services | $1,798,302 | ProgramServicesAmt |
| Management And General | $163,781 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $50,201 | TotalAmt |
| Management And General | $50,201 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,064,227 | TotalAmt |
| Program Services | $1,064,227 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $153,654 | TotalAmt |
| Program Services | $150,454 | ProgramServicesAmt |
| Management And General | $3,200 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $54,192 | TotalAmt |
| Program Services | $52,097 | ProgramServicesAmt |
| Management And General | $2,095 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $691,994 | TotalAmt |
| Program Services | $691,994 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,641,472 | TotalAmt |
| Program Services | $2,641,472 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $706,222 | TotalAmt |
| Program Services | $706,222 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Medical Supplies and Dr | $6,889,608 | $6,888,337 | $1,271 |
| Bad Debt Expenses | $4,398,643 | $4,398,643 | |
| Repairs and Maintenance | $1,491,648 | $1,491,558 | $90 |
| Physician Services | $1,094,919 | $1,094,919 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,643,575 | TotalAmt |
| Program Services | $1,576,911 | ProgramServicesAmt |
| Management And General | $66,664 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $58,385,637 | TotalAmt |
| Program Services | $51,265,919 | ProgramServicesAmt |
| Management And General | $7,119,718 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,521,509 | BOYAmt |
| EOY | $7,853,946 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $478,344 | BOYAmt |
| EOY | $810,971 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,356,183 | BOYAmt |
| EOY | $5,684,694 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,854,589 | BOYAmt |
| EOY | $1,023,462 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,124,621 | BOYAmt |
| EOY | $1,382,762 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $658,042 | BOYAmt |
| EOY | $645,453 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $83,735,002 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $47,792,498 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $33,862,136 | BOYAmt |
| EOY | $35,942,504 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $113,811 | BOYAmt |
| EOY | $71,064 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $233,834 | BOYAmt |
| EOY | $37,943,927 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $61,203,069 | BOYAmt |
| EOY | $91,358,783 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,796,259 | BOYAmt |
| EOY | $12,222,964 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,417,258 | BOYAmt |
| EOY | $17,150,839 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $75,040 | BOYAmt |
| EOY | $453,616 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $21,853,215 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $29,288,557 | BOYAmt |
| EOY | $51,680,634 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $31,155,828 | BOYAmt |
| EOY | $38,703,448 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $758,684 | BOYAmt |
| EOY | $974,701 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $31,914,512 | BOYAmt |
| EOY | $39,678,149 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $61,203,069 | BOYAmt |
| EOY | $91,358,783 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $6,214,538 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$18,904 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $1,568,003 | 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) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $977 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $977 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part II-B, Line 1: | FormAndLineReferenceDesc |
| Explanation | Lobbying fees associated with dues payments. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $810,767 | OtherCostOrOtherBasisAmt |
| Book Value | $810,767 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $41,578,345 | OtherCostOrOtherBasisAmt |
| Depreciation | $17,395,649 | DepreciationAmt |
| Book Value | $24,182,696 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $108,914 | OtherCostOrOtherBasisAmt |
| Depreciation | $98,755 | DepreciationAmt |
| Book Value | $10,159 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $36,126,523 | OtherCostOrOtherBasisAmt |
| Depreciation | $28,862,496 | DepreciationAmt |
| Book Value | $7,264,027 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $5,110,453 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,435,598 | DepreciationAmt |
| Book Value | $3,674,855 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $35,942,504 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (3 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| Due from Affiliates | $35,522,752 |
| Deferred Financing costs | $205,395 |
| Assets designated for capital acquisition | $2,215,780 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $37,943,927 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Due To Other Affiliates | Desc |
| Amt | $21,853,215 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $21,853,215 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $59,881,755 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | -$18,906 | NetUnrealizedGainsInvstAmt |
| Other Revenue | $17,146 | OtherRevenueAmt |
| Revenue Not Reported | -$1,760 | RevenueNotReportedAmt |
| Revenue Subtotal | $59,883,515 | RevenueSubtotalAmt |
| Other Revenues Not Included | $4,716,660 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $4,716,660 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $64,600,175 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $54,004,138 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $17,146 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $17,146 | ExpensesNotReportedAmt |
| Expenses Subtotal | $53,986,992 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $4,398,645 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $4,398,645 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $58,385,637 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part X, Line 2: | Management has evaluated their income tax positions under the guidance included in ASC 740. Based on that review, management has not identified any material uncertain tax positions to be recorded or disclosed in the financial statements. |
| Part XI, Line 2d - Other Adjustments: | Reclass of gaming expenses 17146. |
| Part XI, Line 4b - Other Adjustments: | Bad Debt Expense added back to net revenue 4398643. TRNA Donations 318017. |
| Part XII, Line 2d - Other Adjustments: | Reclass of gaming expenses 17146. |
| Part XII, Line 4b - Other Adjustments: | Bad Debt Expense added to expenses 4398643. Rounding issue 2. |
Schedule G IRS990ScheduleG
Gaming Information GamingInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Revenue Other Gaming | $61,860 | GrossRevenueOtherGamingAmt |
| Rent Fclty Costs Other Gaming | $39,179 | RentFcltyCostsOtherGamingAmt |
| Volunteer Labor Other Gaming | 0 | VolunteerLaborOtherGamingInd |
| Gross Revenue Total Gaming | $61,860 | GrossRevenueTotalGamingAmt |
| Rent Fclty Costs Total Gaming | $39,179 | RentFcltyCostsTotalGamingAmt |
| Direct Expense Summary Gaming | $39,179 | DirectExpenseSummaryGamingAmt |
| Net Gaming Income Summary | $22,681 | NetGamingIncomeSummaryAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| States Where Gaming Conducted | PA | StatesWhereGamingConductedCd |
| Licensed | Yes (1) | LicensedInd |
| License Suspended Etc | 0 | LicenseSuspendedEtcInd |
| Gaming With Nonmembers | Yes (1) | GamingWithNonmembersInd |
| Member Of Other Entity | 0 | MemberOfOtherEntityInd |
| Gaming Own Facility | 0.99000 | GamingOwnFacilityPct |
| Gaming Other Facility | 0.01000 | GamingOtherFacilityPct |
Persons With Books Name PersonsWithBooksName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Gretchen Regina | BusinessNameLine1Txt |
Persons With Books US Address PersonsWithBooksUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 15 Meade Street | AddressLine1Txt |
| City | Wellsboro | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 16901 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct With3rd Prty For Game Rev | 0 | CntrctWith3rdPrtyForGameRevInd |
Gaming Manager Business Name GamingManagerBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Melissa Coolidge Special Events Coordinator SHS | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gaming Manager Compensation | $55,993 | GamingManagerCompensationAmt |
| Gaming Manager Services Prov | Chairperson of a 15 member committee that coordinates raffle activities. | GamingManagerServicesProvTxt |
| Gaming Manager Is Employee | Yes (X) | GamingManagerIsEmployeeInd |
| Charitable Distribution Rqr | 0 | CharitableDistributionRqrInd |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent300 | Yes (X) | Percent300Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $425,824 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $425,824 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00790 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $7,913,896 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,317,507 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,596,389 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04810 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8,339,720 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,317,507 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,022,213 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05600 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8,339,720 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,317,507 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,022,213 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05600 | TotalExpensePct |
Health Improvement Advocacy HealthImprovementAdvocacyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $74,342 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $74,342 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00140 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $74,342 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $74,342 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00140 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $4,398,643 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $439,864 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $13,596,390 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $16,118,322 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$2,521,932 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Soldiers & Sailors Memorial Hospital | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 32-36 Central Avenue | AddressLine1Txt |
| City | Wellsboro | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 16901 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | susquehannahealth.org | WebsiteAddressTxt |
| State License | 390043 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Soldiers & Sailors Memorial Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Information Gaps | Yes (X) | InformationGapsInd |
| CHNA Conducted | 12 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (1) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | www.susquehannahealth.org | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 12 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | www.susquehannahealth.org | StrategyWebsiteURLTxt |
| Strategy Attached | 0 | StrategyAttachedInd |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 300.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | www.susquehannahealth.org | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | www.susquehannahealth.org | FAPAppAvailableOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Notice Displayed | Yes (X) | FAPNoticeDisplayedInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Lowest Negotiated Rates | Yes (X) | LowestNegotiatedRatesInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Soldiers & Sailors Memorial Hospital | Part V, Section B, Line 5: In conducting its CHNA, the hospital took into account input from representatives of the community served, including those with special knowledge of or expertise in public health. This was accomplished by conducting 25 Key Informant Interviews, as well as developing and disseminating a Community Health Input Questionnaire. A web-based tool was utilized to conduct the community input process; however, paper questionnaires identical to the electronic version were distributed to populations who may not have had access to the internet or generally are more likely to complete a paper questionnaire. For more details concerning the Key Informant Interview Process or the Community Health Input Questionnaire process, including a list of those individuals interviewed, a copy of the Community Health Input Questionnaire, and results gathered you may view the CHNA and related Implementation Plan at www.susquehannahealth.org. |
| Soldiers & Sailors Memorial Hospital | Part V, Section B, Line 6a: Soldiers and Sailors Memorial Hospital; located in Wellsboro, PA is one of four hospitals that comprise the Susquehanna Health System (the System) based in Williamsport, PA. For purposes of conducting CHNA's, three of these hospitals, The Williamsport Hospital (DBA:Williamsport Regional Medical Center), Divine Providence Hospital, and Muncy Hospital, share the same definition of community served, which is Lycoming County, PA. The fourth hospital that is part of the System, Soldiers and Sailors Memorial Hospital located in Wellsboro, PA and their defined community is Tioga County, PA. The Systems approach to providing community benefits is to leverage the assets and expertise of all four hospitals to meet the needs and improve the health status of those who reside in the communities located in Lycoming and Tioga counties. Accordingly, a certain amount of collaboration between these related hospitals occurred in the development of their CHNA's and related Implementation Plans. for more details concerning these four hospitals, as well as their definition of community served you may view the CHNA and related Implementation Plans at www.susquehannahealth.org. |
| Soldiers & Sailors Memorial Hospital | Part V, Section B, Line 11: A number of health needs were identified in the CHNA that will not be addressed in this first 3 year assessment cycle. In some cases the hospital does not have the resources and specialty staff that would be required to adequately address all the identified needs. In others, there may already be other agencies and healthcare providers working to effect change in these areas by providing related community resources and services. For a more detailed discussion regarding identified health needs you may view the CHNA and related Implementation Plan at www.susquehannahealth.org. Throughout the first full year subsequent to its initial CHNA, SSMH, along with MVH, DPH and TWH, have worked collaboratively to address identified health needs in Lycoming and Tioga counties.Highlights of year 1 accomplishments include, 1) the October 1, 2014 opening of a new cancer center on the SSMH campus to increase access to cancer services in Tioga county. 2) Conducted a transportation study, including 5 focus groups, to help identify and remedy transportation barriers for cancer patients in Lycoming and Tioga counties. 3) Conducted a physicain needs study to access and document community need for various physician specialties in Lycoming and Tioga counties. 4) Based upon the physician needs study, revised the physician recruitment plan as to number and mix of physicians and advanced practice professionals needed. 5) Implemented a primary care extended hours clinic in Lycoming county to provide additional patient access for evening and weekend hours. 6) Increased the number of Mental Health providers in Lycoming county by adding additional per diem psychiatrists and an additional certified registered nurse practioner to increase patient access to services. 7) Implemented telepsychiaty consult services with local nursing homes to increase access to Mental Health services to nursing home patients. 8) Completed plans for Mental Health facility upgrades and renovations. 9) Implemented new group therapy programs to expand access to Mental Health services. 10) Developed a primary care physician (PCP) outreach program to educate PCP's in how to better identify Mental Health needs amoung their patients and better understand the community resources that are available. In addition to continued work on the initiatives highlighted as year 1 accomplishments, year 2 highlights include a new, expanded program to provide smoking-cessation counseling and low-dose computed tomography lung cancer screeeings. The new program follows guidelines established by the National Lung Screening Trial, and the Centers for Medicaid and Medicare services and provides lung screening navigators in Lycoming and Tioga counties with resources to help patients and providers determine eligibility, offer complete shared decision making conversations around the benefits and harms of low-dose computed tomography, provide counseling on smoking cessation and follow up on future screenings. |
| Soldiers & Sailors Memorial Hospital | Part V, Section B, Line 13b: Uninsured patients receive a 45% discount from charges paid within 30 days from the first statement. They may also be eligible for discounts of 60% to 100% of charges follwing application to our Financial Assistance Program which is a greater discount than what has been computed as amounts generally billed utilizing a look back method. |
| Soldiers & Sailors Memorial Hospital | Part V, Section B, Line 16i: Other Method Brochure |
| Part V, Section B, Line 16 | Financial Assistance Policy Website Availability |
| Soldiers & Sailors Memorial Hospital Part V, Section B, line 16a website: | www.susquehannahealth.org |
| Soldiers & Sailors Memorial Hospital Part V, Section B, line 16b website: | www.susquehannahealth.org |
Supplemental Information Detail SupplementalInformationDetail (13 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 7, Column (f): | The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 4398643. |
| Part II, Community Building Activities: | The organization participates in community building through various means such as making parts of the building (conference rooms cafeteria, etc) available for public meetings, blood drives, CPR classes, expectant parent classes, and EMS education among others. The hospital has a large group of volunteers from the community who donate time to assist the organization providing care and well being to the community it serves. For fiscal year 2015, SSMH had 88 volunteers donate approximately 10318 hours of their time. |
| Part III, Line 2: | The bad debt expense reported on Line 2 is bad debt per the audited financial statements. |
| Part III, Line 3: | The estimated amount of Bad Debts attributable to the organization's financial assistance policy is 10% of the total expense. |
| Part III, Line 4: | The System reports patient accounts receivable for services rendered at net realizable amounts from third-party, patients and others. The System provides an allowance for doubtful accounts based upon a review of outstanding receivables, historical collection information and existing economic conditions. As a service to the patient, the System bills third-party payers directly and bills the patient when the patient's liability is determined. Patient accounts receivable are due in full when billed. Accounts are considered delinquent and subsequently written off as bad debts based on individual credit evaluation and specific circumstances of the account. |
| Part III, Line 8: | The Medicare cost report uses a cost per day for the routine service costs times the number of Medicare days. Ancillary costs are calculated based on the cost to charge ratio by department. The Medicare cost report does not capture all charges and reimbursements provided to the facility under Medicare. For the fiscal year, the facility had approximately $14 million in Medicare charges provided at a cost of approximately $16 million. This resulted in a $2 million shortfall for the fiscal year. |
| Part III, Line 9b: | Susquehanna Health System will provide financial assistance under the Charity Care Assistance Program for patients that require medically necessary services during the period in which family income and financial resources meets the defined guidelines, and after all other payment resources have been exhausted. The SHS Charity Care Assistance Program is always the coverage of the last resort.Eligible services include inpatient and outpatient hospital services which are medically necessary and are provided directly by Susquehanna Health System (Hospitals and Susquehanna Physician Services) or by employees of SHS for the treatment of an illness or injury.All payer resources must be exhausted. Pennsylvania Medical Assistance screening must be completed for all considered individuals. All other payment arrangements must be explored. All self pay balances identified in the Charity Care application must be paid in full to maintain eligibility.The income guidelines source is the annual poverty income published in the Federal Register by the Department of Health and Human Services. The federal poverty guidelines are used to determine three tiers of SHS Charity Care eligibility. Income guidelines are updated annually during the month of April. Family income must be at or below the eligibility guidelines for program consideration.It is the responsibility for the patient or guarantor to initiate the SHS Charity Care Assistance Program by applying. |
| Part VI, Line 2: | Throughout the first full year subsequent to its initial CHNA, Soldiers & Sailors Memorial Hospital (SSMH), along with Lycoming County affiliates; Williamsport Hospital, Divine Providence Hospital, and Muncy Valley Hospital, have worked collaboratively to address identified health needs in Lycoming and Tioga counties. Highlights include; 1) the opening on October 1, 2014 the new Cancer Center on the campus of SSMH to increase access to cancer services in Tioga County, 2) conducted a Transportation Study, including 5 separate Focus Groups, to help identify and remedy transportation barriers for cancer patients, 3) conducted a Physician needs study to access and document community needs for various physician specialties, 4)Based upon the Physician needs study mentioned above, revised the Physician Recruitment Plan as to number and mix of both Physicians and Advanced Practice Professionals, 5) implemented a Primary Care extended hours clinic in Lycoming County to provide additional patient access for evening and weekend hours, 6) increased the number of Mental Health providers to increase patient access to services, by adding additional per diem Psychiatrists and an additional Certified Registered Nurse Practitioner, 7) implemented Telepsychiatry consult services with local nursing homes to increase access to Mental Health evaluations and services. 8) completed plans for Mental Health facility upgrades and renovations, 9) implemented new group therapy programs to expand Mental Health services, 10) developed a Primary Care Physician (PCP) Outreach Program to educate PCP's in how to better identify Mental Health needs among their patients and better understand the Community resources that are available to them. |
| Part VI, Line 3: | The organization's Patient Financial Assistance policy is posted at every registration office including the patient account representatives offices and the Emergency Department. The policy is also advertised annually in the newspaper, |
| Part VI, Line 4: | The organization serves Tioga County and surrounding areas. Tioga County is located in rural North Central Pennsylvania and has a population 41,981 as of the 2010 census. The median household income was $44,187 with 15.3 percent of the residents below two times the Federal Poverty level. |
| Part VI, Line 5: | The facility has an open medical policy. The Board of Directors is composed of various community leaders who provide insight on the needs of the community and how best to guide the organization to best serve those needs. Surplus funds are reinvested into the facility to allow the system to better serve the community. |
| Part VI, Line 6: | Soldiers and Sailors Memorial Hospital (SSMH) is one of four hospitals which are part of Susquehanna Health System (SHS). The mission of SHS is to promote health by acting as the parent of a nonprofit health system in North Central Pennsylvania and by raising funds and otherwise supporting the system.SSMH is an acute care community hospital providing diagnostic and treatment facilities, educational and training programs and a rehabilitation facility.Divine Providence Hospital (DVH) is a speciality hospital that offers inpatient psychiatric services and a wide array of outpatient hospital services, as well as, home health and hospice services.Muncy Valley Hospital (MVH) is a critical access hospital, primarily serving Lycoming and surrounding counties. MVH also provides a full range of outpatient and emergency services, as well as, operates a long-term care facility. The Williamsport Hosital (TWH)is an acute care community hospital providing diagnostic and treatment facilities, educational and training programs, and a rehabilitation facility.The hospitals treat Medicare and Medical Assistance patients and maintains a Medicare/Medical Assistance policy that provides patients enrolled in such programs with access to all covered inpatient, outpatient and diagnostic services that are available to non-Medicare/Medical Assistance patients.The community benefit report is prepared on a system-wide basis under SHS. On an annual basis, SHS devotes a portion of its revenue and assets to community program services. The following reflects the breakout of $95,031,419 in quantifiable community benefits reported for FY2015: Charity Care (at cost) $2,068,338; Bad Debts (at cost) $10,803,145; Government sponsored health care (unpaid cost of Medicare, Medicaid, indigent care programs, SCHIP and other safety net programs)$65,763,932. In addition, various other programs such as Research, Health Professions Education, Community Building, Financial and In-Kind contributions, and Community Benefit Operations totaling $6,396,004. |
| Part VI, Line 7, Reports Filed With States | PA |
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 (12 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Jill ABurns MD | ||||||||||||||
| Director | $0 | $203,544 | $0 | $33,050 | $0 | $28,392 | $0 | $9,800 | $0 | $24,511 | $0 | $299,297 | $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 |
| Janie M Hilfiger | ||||||||||||||
| SSMH/TGH/THCP President | $157,424 | $0 | $15,893 | $0 | $1,194 | $0 | $7,036 | $0 | $16,728 | $0 | $198,275 | $0 | $0 | $0 |
| Ronald J Butler | ||||||||||||||
| LHS President(Retired 4/2015) | $0 | $329,125 | $0 | $10,897 | $0 | $4,756 | $0 | $9,800 | $0 | $12,232 | $0 | $366,810 | $0 | $0 |
| Steven P Johnson | ||||||||||||||
| SHS President | $0 | $531,335 | $0 | $345,329 | $0 | $29,435 | $0 | $13,700 | $0 | $17,824 | $0 | $937,623 | $0 | $0 |
| Charles Santangelo | ||||||||||||||
| CFO(Retired 4/2015) | $0 | $341,221 | $0 | $10,767 | $0 | $4,812 | $0 | $9,800 | $0 | $22,056 | $0 | $388,656 | $0 | $0 |
| William C McCauley MD | ||||||||||||||
| Executive VP(Retired 1/2015) | $0 | $390,991 | $0 | $15,748 | $0 | $3,314 | $0 | $9,800 | $0 | $24,476 | $0 | $444,329 | $0 | $0 |
| David Lopatofsky MD | ||||||||||||||
| Executive VP (Hired 2/2015) | $0 | $312,802 | $0 | $15,628 | $0 | $8,217 | $0 | $11,100 | $0 | $24,127 | $0 | $371,874 | $0 | $0 |
| Jan E Fisher | ||||||||||||||
| Executive Vice President | $0 | $395,220 | $0 | $10,795 | $0 | $7,764 | $0 | $9,800 | $0 | $19,947 | $0 | $443,526 | $0 | $0 |
| Enrico Doganiero | ||||||||||||||
| Physician | $485,877 | $0 | $0 | $0 | $921 | $0 | $9,800 | $0 | $22,988 | $0 | $519,586 | $0 | $0 | $0 |
| Leonard Dale | ||||||||||||||
| Physician | $179,511 | $0 | $0 | $0 | $0 | $0 | $7,385 | $0 | $4,678 | $0 | $191,574 | $0 | $0 | $0 |
| Craig Konzen | ||||||||||||||
| Pharmacist | $129,086 | $0 | $0 | $0 | $365 | $0 | $5,873 | $0 | $21,198 | $0 | $156,522 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990 Part 1 Line 3 | Explanation: 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 of the board. |
| Form 990 Part 1 Line 6 | Explanation: 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 the FY2015, the minimum threshold was met that would trigger any VCIP payments. In September 2014, President/CEO Steven P Johnson received a payout from a 3 year Performance Goals Plan that covered the period of July 1, 2011 through June 30, 2014. Payment was in the amount of $271,788. |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (2 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| Richard Fisher | |||
| Son of Executive Vice President | $43,646 | Compensation | 0 |
| Owlett & Lewis PC | |||
| Owned by a Board Member | $496,647 | Legal Fees | 0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990 Part V Line 2A and 2B | Explanation: Susquehanna Health System EIN # 23-2751183 utilizes a common paymaster which includes the following entities: Divine Providence Hospital EIN # 24-0499343 Muncy Valley Hospital EIN # 24-0806023 The Williamsport Hospital EIN # 24-0795508 Susquehanna Health Foundation EIN # 23-2743470 Susquehanna Physician Services EIN # 23-2449454 Williamsport Area Ambulance Service Cooperative EIN # 23-2416166 Laurel Realty EIN # 23-1403678 Laurel Management Services EIN # 25-1644910 Soldiers & Sailors Memorial Hospital EIN # 23-2176963 The Green Home EIN # 24-0804365 Tioga Healthcare Providers EIN # 25-1765538 Tyoga Carenet EIN # 25-1810967 The total number of employees reported on Form W-3 would be 3956 for Susquehanna Health System EIN # 23-2751183. Of that total 496 employees payroll expenses were recorded by Soldiers & Sailors Memorial Hospital. |
| Form 990, Part VI, Section A, line 2 | Key employees Steve Johnson and Charlie Santangelo serve on the board of a related taxable organization. |
| Form 990, Part VI, Section A, line 7a | Susquehanna Health System (SHS), EIN 23-2751183, may elect or remove members of the governing body. |
| Form 990, Part VI, Section A, line 7b | All the business and affairs of the corporation shall be managed and controlled by the Board of Directors, subject to the oversight of the sole Member, Susquehanna Health System (SHS), except that the following powers are reserved exclusively to the sole Member of the corporation, and no attempted exercise of any such powers by anyone other than the sole Member shall be valid of any force or effort whatsoever. The sole Member shall exercise its power through its Board of Directors. The sole Member shall have the exclusive authority to exercise the following powers: A.)to appoint or elect the directors B.) to appoint and remove the President following consultation with the Entity, C.) to approve the nominees elected officers and to return the list of approved nominees to the governing bodies for election, D.) to remove, with or without cause, any director or any elected officer, E.) to amend the Governing Instruments and to approve all amendments to the Governing Instruments which are proposed for adoption, F.) to approve the annual operating and capital budgets, G.) to establish requirements for a unified budget, H.) to approve the incurrence or issuance of debt proposed by Entity and the encumbrance of any Entity assets to secure such incurred debt, I.) to incur debt (or cause debt to be incurred) on behalf of the Entity, J.) to require contributions in cash or cash equivalents to support the working capital needs or capital projects of any one or more System entities, K.) to require that any debt incurred on a System-wide basis by or at the direction of SHS shall be the joint and several obligation of each Entity, L.) to direct or approve any cash contributions or any other capital contributions made by one System Entity to another System Entity. M.) to allocate any financial resources in such manner as SHS determines to be necessary, N.) to approve the sale, transfer or other disposition of Entity or Entity property unless it is made in the ordinary course of business or involves assets with a fair market value of less than one hundred thousand dollars, O.) to direct the transfer of property from the Entity to one within or not within the limits of the System's approved investment policy, P.) to approve any investment of assets by Entity not within the limits of the System's approved investment policy, Q.) to establish requirements for the approval of the acquisition, purchase, sale, transfer, encumbrance, leasing, construction or demolition of land or building outside the ordinary course of business, R.) to approve any decision with respect to the addition, modification or discontinuance of any patient care or diagnostic program or health care service, S.) to approve of any change in licensure of Entity; licensure of any Facility certification, registration, accreditation, permit or related approval of any activity, T.) to require Entity to add, modify, relocate or discontinue any patient care or diagnostic program or health care service. U.) to approve or direct any merger, consolidation, organization, reorganization, joint venture, corporate division, sale, conversion,lease or exchange of substantially all the assets, dissolution, liquidation or any other modification of corporate structure or affiliations affecting the autonomy, governance, or operations, and the creation or acquisition of any new affiliate by Entity, V.) to dissolve or terminate the existence of Entity and dissolve or terminate the existence of assets upon such termination or dissolution, W.) to coordinate managed care plans involving Entity, including decisions concerning entry into or renewal of any contract or agreement relating there to, X.) to develop and/or enter into key strategic relationships on behalf of Entity, Y.) to select any outside financial auditors, general legal counsel or investment advisors to provide services on behalf of the Entity. |
| Form 990, Part VI, Section B, line 11 | A high-level overview of Form 990 is presented to the parent Board of Directors (Susquehanna Health System, EIN 23-2751183) before filing and complete drafts of all returns are made available to all Board members through the CEO's and CFO's office. |
| Form 990, Part VI, Section B, line 12c | Annually on the 1st day of January, Susquehanna Health System sends to all directors, officers, management staff and contracted physicians a questionnaire to be completed and returned by January 15th. A report is submitted to the Board of Directors to notify them of any conflicts of interest disclosed. |
| Form 990, Part VI, Section B, line 15 | On a bi-annual basis an independent compensation consulting firm performs an analysis of the leadership salary structure in relationship to the labor market using data from four different salary surveys. Their analysis is reviewed with the Governance Committee of the Board of Directors. The firm then outlines its recommendations for the proposed executive salary structure to the committee for their consideration and approval. |
| Form 990, Part VI, Section C, line 19 | Governing documents and financial statements are available to the public upon request. The conflict of interest policy is also available upon request. |
| Form 990, Part XI, line 9: | Pension Liability Adjustment -1648414. Postretirement benefit liability adjustment 627351. Transfers from other affiliates 2589066. |
| Part XII, Line 2C | The organization did not change its oversight process or selection process. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (15 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Laurel Health System | |||||||||||
| 15 Meade Street | Wellsboro | PA | 16901 | 240795488 | Support entities affiliated with Laurel Health Systems | PA | 501(c)(3) | Line 11a, I | Susquehanna Health System | 0 | |
| Laurel Realty | |||||||||||
| 15 Meade Street | Wellsboro | PA | 16901 | 231403678 | Owns and manages real estate in support of Laurel Health System | PA | 501(c)(2) | Susquehanna Health System | 0 | ||
| Laurel Management Services | |||||||||||
| 15 Meade Street | Wellsboro | PA | 16901 | 251644910 | Management, consulting and supervisory services | PA | 501(c)(3) | Line 11b, II | Susquehanna Health System | 0 | |
| The Green Home | |||||||||||
| 37 Central Avenue | Wellsboro | PA | 16901 | 240804365 | Operates skilled nursing & assisted living facilities. | PA | 501(c)(3) | Line 9 | Susquehanna Health System | 0 | |
| Tioga Health Care Providers | |||||||||||
| 22 Walnut Street | Wellsboro | PA | 16901 | 251765538 | Employs physician specialists | PA | 501(c)(3) | Line 11b, II | Susquehanna Health System | 0 | |
| North Penn Comprehensive Health Services | |||||||||||
| 22 Walnut Street | Wellsboro | PA | 16901 | 231889724 | Provides General Health and Social services | PA | 501(c)(3) | Line 11b, II | Susquehanna Health System | 0 | |
| Divine Providence Hospital | |||||||||||
| 1100 Grampian Blvd | Williamsport | PA | 17701 | 240799343 | Hospital | PA | 501(c)(3) | Line 3 | Susquehanna Health System | 0 | |
| Muncy Valley Hospital | |||||||||||
| 215 East Water Street | Muncy | PA | 17756 | 240806023 | Hospital | PA | 501(c)(3) | Line 3 | Susquehanna Health System | 0 | |
| The Williamsport Hospital | |||||||||||
| 700 High Street | Williamsport | PA | 17701 | 240795508 | Hospital | PA | 501(c)(3) | Line 3 | Susquehanna Health System | 0 | |
| Susquehanna Health Foundation | |||||||||||
| 1100 Grampian Blvd | Williamsport | PA | 17701 | 232743470 | Fundraising for affiliated entities | PA | 501(c)(3) | Line 11a, I | Susquehanna Health System | 0 | |
| Susquehanna Physician Services | |||||||||||
| 1201 Grampian Blvd | Williamsport | PA | 17701 | 232449454 | Physician Services and MRI services | PA | 501(c)(3) | Line 3 | Susquehanna Health System | 0 | |
| Williamsport Area Ambulance Services | |||||||||||
| 700 High Street | Williamsport | PA | 17701 | 232416166 | Ambulance transport | PA | 501(c)(3) | Line 9 | 0 | N/A | |
| Susquehanna Health System | |||||||||||
| 1205 Grampian Blvd | Williamsport | PA | 17701 | 232751183 | Coordinate & Manage the delivery of healthcare | PA | 501(c)(3) | Line 11b, II | 0 | N/A | |
| Laurel Health Foundation | |||||||||||
| 22 Walnut Street | Wellsboro | PA | 16901 | 251810488 | Manages Endowments and other investments | PA | 501(c)(3) | Line 11a, I | 0 | N/A | |
| Susquehanna Health Innovation Center Inc | |||||||||||
| 700 High Street | Williamsport | PA | 17701 | 471600873 | Supporting organization of affilaited entities | PA | 501(c)(3) | Line 11b, II | Susquehanna 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 | Susquehanna Health System | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Predominant Income Type | Excluded from tax | PredominantIncomeTypeTxt |
| Disproportionate Allocations | 0 | DisproportionateAllocationsInd |
| General Or Managing Partner | 0 | GeneralOrManagingPartnerInd |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd | Address Line1ForeignAddress/AddressLine1Txt | Province Or StateForeignAddress/ProvinceOrStateNm | CountryForeignAddress/CountryCd | Legal Domicile Foreign CountryLegalDomicileForeignCountryCd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Tyoga Carenet | |||||||||||||
| 15 Meade Street | Wellsboro | PA | 16901 | 251810967 | Integrate Healthcare Regionally | PA | Laurel Health System | C | 0 | ||||
| Susquehanna Ventures Inc | |||||||||||||
| 1201 Grampian Blvd | Williamsport | PA | 17701 | 232470263 | Pharmacy and Infusion Services | PA | Susquehanna Health System | C | 0 | ||||
| Susquehanna Health System Insurance Network LTD | |||||||||||||
| 980458722 | Captive Insurance Company | Susquehanna Health System | 0 | PO Box 1159 | Grand Caymans | CJ | CJ | ||||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | Yes (1) | 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 |
Transactions Related Org TransactionsRelatedOrgGrp (2 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| Laurel Realty | ||
| D | $56,910 | FMV |
| Laurel Realty | ||
| O | $35,915 | At cost |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part IV | 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 is Susquehanna Health System 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 taxes. |
| Part III | Name of Related Organization: Community Basket, LLC Direct Controlling Entity: Susquehanna Health System & Susquehanna Health Foundation. |