UPMC: Form 990, tax year 2014
View the entire original 990 at ProPublica ↗
- Organization
- UPMC (EIN 24-0799343)
- Tax period
- 2014-07-01 to 2015-06-30
- Filed
- 2016-05-13
- IRS object ID
- 201641349349304404
- 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 F
- Schedule G
- Schedule H
- Schedule I
- Schedule J
- Schedule K
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2016-05-13T12:50:18-05:00 | 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 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 | 240799343 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Divine Providence Hospital of the | BusinessNameLine1Txt |
| Business Name Line2 | Sisters of Christian Charity | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | DIVI | BusinessNameControlTxt |
| Phone | 5703207900 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1100 Grampian Boulevard | AddressLine1Txt |
| City | Williamsport | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 17701 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Eric D Pohjala | PersonNm |
| Person Title | Executive Vice President / CFO | PersonTitleTxt |
| Phone | 5703213175 | PhoneNum |
| Signature | 2016-05-13 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | 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 | 2016-12-15 16:53:06Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Steven P Johnson | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 700 High Street | AddressLine1Txt |
| City | Williamsport | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 17701 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $164,908,653 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Group Exemption | 0928 | GroupExemptionNum |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.susquehannahealth.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1947 | FormationYr |
| Legal Domicile State | PA | LegalDomicileStateCd |
| Activity Or Mission | Divine Providence Hospital of the Sisters of Christian Charity (DPH) is a 31 bed specialty hospital that offers inpatient psychiatric services and a wide array of outpatient hospital services, primarily serving Lycoming and surrounding counties. Effective January 1, 2004, through a merger with Susquehanna Regional Home Health (EIN # 24-0795499), DPH began providing home health services. | ActivityOrMissionDesc |
| Voting Members Governing Body | 12 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 8 | VotingMembersIndependentCnt |
| Total Employee | 430 | TotalEmployeeCnt |
| Total Volunteers | 195 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $1,312,423 | PYContributionsGrantsAmt |
| CY Contributions Grants | $938,294 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $89,297,600 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $93,633,576 | CYProgramServiceRevenueAmt |
| PY Investment Income | $2,156,354 | PYInvestmentIncomeAmt |
| CY Investment Income | $2,965,840 | CYInvestmentIncomeAmt |
| PY Other Revenue | $170,066 | PYOtherRevenueAmt |
| CY Other Revenue | $220,244 | CYOtherRevenueAmt |
| PY Total Revenue | $92,936,443 | PYTotalRevenueAmt |
| CY Total Revenue | $97,757,954 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $8,047,206 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $10,640,232 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $27,405,607 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $28,279,301 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $2,295 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $52,140,786 | PYOtherExpensesAmt |
| CY Other Expenses | $57,014,773 | CYOtherExpensesAmt |
| PY Total Expenses | $87,593,599 | PYTotalExpensesAmt |
| CY Total Expenses | $95,934,306 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $5,342,844 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $1,823,648 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $118,311,037 | TotalAssetsBOYAmt |
| Total Assets EOY | $125,289,168 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $25,029,251 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $30,451,476 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $93,281,786 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $94,837,692 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | Divine Providence Hospital of the Sisters of Christian Charity (DPH) 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 an integrated community health system that delivers world class care. Our values are to carefully place out patients and their families first, share ownership with all of our caregivers and lead with a servant's heart. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $82,904,957 | ExpenseAmt |
| Grant | $10,640,232 | GrantAmt |
| Revenue | $93,628,752 | RevenueAmt |
| Desc | For the fiscal year ended June 30, 2015, the hospital admitted 663 patients rendering 6,190 patient days and registered approximately 116,707 outpatients and provided 101,269 home health visits. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DPH treats all patients without regard to their ability to pay. In addition, the Hospital treats 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. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | On an annual basis, DPH devotes a portion of its revenue and assets to community program services. The following reflects the breakout of $16,551,704 in quantifiable community benefits reported for FY 2015: Charity Care (at cost) $263,080; Bad Debts (at cost) $678,168; Government-sponsored health care (unpaid cost of Medicare, Medicaid, Indigent care programs, SCHIP and other safety net programs) $14,622,932. In addition, various Education, Community Health Services, Subsidized Health Services, Community Building, Financial and In-Kind Contributions and Community Benefit Operations totaling $987,524. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $82,904,957 | 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 | Yes (1) | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | Yes (1) | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| Info In Schedule O Part V | Yes (X) | InfoInScheduleOPartVInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 430 | 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 | 12 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 8 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (1) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | 0 | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | PA | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Management | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 5703207900 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1205 Grampian Boulevard | AddressLine1Txt |
| City | Williamsport | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 17701 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (23 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|---|
| Christian Dewald | |||||||||
| Chair | 1.00 | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| Keith Kuzio | |||||||||
| Vice Chair | 1.00 | 3.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| Kathleen Pagana | |||||||||
| Secretary | 1.00 | 1.00 | Yes (X) | Yes (X) | $0 | $2,431 | $0 | ||
| Patrick Marty | |||||||||
| Treasurer | 1.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| Kevin W Kist DO | |||||||||
| Director | 1.00 | 43.00 | Yes (X) | $0 | $418,691 | $34,026 | |||
| Paul Moulton | |||||||||
| Director | 1.00 | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| Alexander R Nesbitt MD | |||||||||
| Director | 1.00 | 42.00 | Yes (X) | $0 | $202,673 | $27,681 | |||
| Shailesh Patel MD | |||||||||
| Director (Elected June 2014) | 1.00 | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| Melissa E Welch | |||||||||
| Director | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| Patrick Wilson | |||||||||
| Director | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| Mary Wolf | |||||||||
| Director | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| Steven P Johnson | |||||||||
| President / CEO | 1.00 | 46.00 | Yes (X) | Yes (X) | $0 | $906,099 | $31,524 | ||
| Charles J Santangelo | |||||||||
| Executive VP / CFO (Retired 5/2/15) | 1.00 | 42.00 | Yes (X) | $0 | $356,800 | $31,856 | |||
| Eric D Pohjala | |||||||||
| Exective VP / CFO (Hired 3/30/15) | 0.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| William C McCauley MD | |||||||||
| Executive VP / CMO (Retired 1/31/15) | 1.00 | 40.00 | $0 | $410,053 | $34,276 | Yes (X) | |||
| David Lopatofsky MD | |||||||||
| Executive VP / CMO (Hired 1/31/15) | 1.00 | 40.00 | $0 | $336,647 | $35,227 | Yes (X) | |||
| Jan E Fisher | |||||||||
| Executive VP / COO | 1.00 | 40.00 | $0 | $413,779 | $29,747 | Yes (X) | |||
| Ronald J Butler | |||||||||
| Executive VP / CBO (Retired 4/15/15) | 1.00 | 41.00 | $0 | $344,778 | $22,032 | Yes (X) | |||
| Robert E Kane | |||||||||
| President | 40.00 | 1.00 | $210,475 | $0 | $26,120 | Yes (X) | |||
| Rajesh Manoharan | |||||||||
| Medical Physicist | 40.00 | 0.00 | $197,640 | $0 | $29,023 | Yes (X) | |||
| Patricia A McGee | |||||||||
| Executive Director Home Care | 40.00 | 0.00 | $127,553 | $0 | $6,617 | Yes (X) | |||
| Joseph B Lecrone | |||||||||
| Pharmacist | 40.00 | 0.00 | $127,552 | $0 | $25,401 | Yes (X) | |||
| Michelle R Gaida | |||||||||
| Executive Director / Cancer Services | 40.00 | 0.00 | $126,172 | $0 | $15,606 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $789,392 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $3,391,951 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $349,136 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 13 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Susquehanna Health System | |||||
| 1001 Grampian Boulevard | Williamsport | PA | 17701 | Management services | $9,293,143 |
| Aramark Healthcare | |||||
| 24863 Network Place | Chicago | IL | 60673 | Management / environmental services | $8,326,053 |
| Susquehanna Lithotripsy | |||||
| 100 West 3rd Avenue | Columbus | OH | 43201 | Lithotripsy services | $686,800 |
| Varian Medical Systems | |||||
| 70140 Network Place | Chicago | IL | 60673 | Oncology services | $481,348 |
| Michele Tedesco | |||||
| 1626 Meade Street | Williamsport | PA | 17701 | Home Health Physical Therapist | $186,669 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 12 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $10,205 | FundraisingAmt |
| Related Organizations | $324,540 | RelatedOrganizationsAmt |
| Government Grants | $592,705 | GovernmentGrantsAmt |
| All Other Contributions | $10,844 | AllOtherContributionsAmt |
| Total Contributions | $938,294 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | ExclusionExclusionAmt |
|---|---|---|---|---|
| Net patient service revenue | 621990 | $90,010,730 | $90,010,730 | |
| Affiliate rent income | 621990 | $2,883,984 | $2,883,984 | |
| Sports Medicine - athletic traine | 621400 | $604,779 | $604,779 | |
| Cafeteria | 624200 | $134,083 | $134,083 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $93,633,576 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $768,243 | TotalRevenueColumnAmt |
| Exclusion | $768,243 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $63,793,866 | SecuritiesAmt |
| Other | $5,524,661 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $62,039,802 | SecuritiesAmt |
| Other | $5,081,128 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $1,754,064 | SecuritiesAmt |
| Other | $443,533 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,197,597 | TotalRevenueColumnAmt |
| Exclusion | $2,197,597 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $55,576 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $10,205 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $29,769 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $25,807 | TotalRevenueColumnAmt |
| Exclusion | $25,807 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | ExclusionExclusionAmt |
|---|---|---|---|---|
| FQHC | 621400 | $58,031 | $58,031 | |
| Auxiliary activity | 900099 | $47,734 | $47,734 | |
| Miscellaneous | 900099 | $35,375 | $17,931 | $17,444 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $53,297 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $53,297 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $194,437 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $97,757,954 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $93,628,752 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $3,190,908 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,640,232 | TotalAmt |
| Program Services | $10,640,232 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $22,327,121 | TotalAmt |
| Program Services | $20,560,371 | ProgramServicesAmt |
| Management And General | $1,764,937 | ManagementAndGeneralAmt |
| Fundraising | $1,813 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,150,439 | TotalAmt |
| Program Services | $1,059,405 | ProgramServicesAmt |
| Management And General | $90,941 | ManagementAndGeneralAmt |
| Fundraising | $93 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,170,740 | TotalAmt |
| Program Services | $2,919,839 | ProgramServicesAmt |
| Management And General | $250,644 | ManagementAndGeneralAmt |
| Fundraising | $257 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,631,001 | TotalAmt |
| Program Services | $1,501,940 | ProgramServicesAmt |
| Management And General | $128,929 | ManagementAndGeneralAmt |
| Fundraising | $132 | FundraisingAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,293,143 | TotalAmt |
| Management And General | $9,293,143 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,845 | TotalAmt |
| Management And General | $8,845 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $185,534 | TotalAmt |
| Management And General | $185,534 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,556,357 | TotalAmt |
| Program Services | $8,277,501 | ProgramServicesAmt |
| Management And General | $278,856 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,488 | TotalAmt |
| Program Services | $8,870 | ProgramServicesAmt |
| Management And General | $618 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,585,574 | TotalAmt |
| Program Services | $1,267,138 | ProgramServicesAmt |
| Management And General | $318,436 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $208,016 | TotalAmt |
| Program Services | $81,702 | ProgramServicesAmt |
| Management And General | $126,314 | ManagementAndGeneralAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $42,705 | TotalAmt |
| Program Services | $41,637 | ProgramServicesAmt |
| Management And General | $1,068 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,727,554 | TotalAmt |
| Program Services | $3,433,989 | ProgramServicesAmt |
| Management And General | $293,565 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $562,560 | TotalAmt |
| Program Services | $538,222 | ProgramServicesAmt |
| Management And General | $24,338 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $38,771 | TotalAmt |
| Program Services | $35,110 | ProgramServicesAmt |
| Management And General | $3,661 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $881,752 | TotalAmt |
| Program Services | $881,752 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,952,131 | TotalAmt |
| Program Services | $3,952,131 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $491,962 | TotalAmt |
| Program Services | $491,962 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Medical supplies | $20,154,224 | $20,111,563 | $42,661 |
| Inter-entity costs | $2,698,916 | $2,698,916 | |
| Bad debt | $2,601,750 | $2,601,750 | |
| Repairs and maintenance | $1,396,086 | $1,358,749 | $37,337 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $619,405 | TotalAmt |
| Program Services | $442,178 | ProgramServicesAmt |
| Management And General | $177,227 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $95,934,306 | TotalAmt |
| Program Services | $82,904,957 | ProgramServicesAmt |
| Management And General | $13,027,054 | ManagementAndGeneralAmt |
| Fundraising | $2,295 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $879,746 | BOYAmt |
| EOY | $8,541,542 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,374,486 | BOYAmt |
| EOY | $10,705,084 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,222,260 | BOYAmt |
| EOY | $1,847,406 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,458,923 | BOYAmt |
| EOY | $2,717,515 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $108,794,133 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $79,106,667 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $34,387,445 | BOYAmt |
| EOY | $29,687,466 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $46,882,657 | BOYAmt |
| EOY | $50,392,314 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,105,520 | BOYAmt |
| EOY | $21,397,841 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $118,311,037 | BOYAmt |
| EOY | $125,289,168 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,773,271 | BOYAmt |
| EOY | $6,210,415 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,213 | BOYAmt |
| EOY | $313,761 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,330,855 | BOYAmt |
| EOY | $17,393,805 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,918,912 | BOYAmt |
| EOY | $6,533,495 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,029,251 | BOYAmt |
| EOY | $30,451,476 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $91,208,624 | BOYAmt |
| EOY | $92,735,576 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,112,892 | BOYAmt |
| EOY | $1,139,846 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $960,270 | BOYAmt |
| EOY | $962,270 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $93,281,786 | BOYAmt |
| EOY | $94,837,692 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $118,311,037 | BOYAmt |
| EOY | $125,289,168 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $1,823,648 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$175,811 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$91,931 | 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 | Yes (1) | GrantsOtherOrganizationsInd |
| Grants Other Organizations | $8,845 | GrantsOtherOrganizationsAmt |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | 0 | OtherActivitiesInd |
| Total Lobbying Expenditures | $8,845 | 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 | The hospital holds memberships in the American Hospital Association (AHA)and the Hospital Association of Pennsylvania, (HAP), both of which engage in lobbying as part of their mission to represent the interests of hospitals at both the Federal and State levels. For the year ended 06/30/15, the amount of dues to HAP totaled $18,555 of which 17.77% or $3,297, was used for lobbying purposes. Dues paid to AHA totaled $24,334 of which 22.80% or $5,548, was used for lobbying purposes. On occasion, HAP requests the help of member providers to communicate concerns to legislators regarding pending legislation which could impact hospitals. This can involve direct contact with legislators or letter-writing. This occurs infrequently, and the cost to the hospital is negligible. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $163,100 | OtherCostOrOtherBasisAmt |
| Book Value | $163,100 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $56,029,493 | OtherCostOrOtherBasisAmt |
| Depreciation | $41,577,863 | DepreciationAmt |
| Book Value | $14,451,630 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $275,159 | OtherCostOrOtherBasisAmt |
| Depreciation | $48,012 | DepreciationAmt |
| Book Value | $227,147 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $44,897,779 | OtherCostOrOtherBasisAmt |
| Depreciation | $35,182,553 | DepreciationAmt |
| Book Value | $9,715,226 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $7,428,602 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,298,239 | DepreciationAmt |
| Book Value | $5,130,363 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $29,687,466 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (4 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| Investment in net assets of affiliates | $664,441 |
| Due from affiliates | $19,980,822 |
| Other Receivables | $317,790 |
| Other | $434,788 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $21,397,841 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (4 entries)
| DescDesc | AmtAmt |
|---|---|
| Accrued medical malpractice cost | $155,000 |
| Estimated third party settlements / deferred reimbursement | $1,304,576 |
| Asbestos abatement | $179,525 |
| Due to Affiliates, net | $4,894,394 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $6,533,495 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $94,685,312 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | -$175,811 | NetUnrealizedGainsInvstAmt |
| Other Revenue | -$2,402,117 | OtherRevenueAmt |
| Revenue Not Reported | -$2,577,928 | RevenueNotReportedAmt |
| Revenue Subtotal | $97,263,240 | RevenueSubtotalAmt |
| Other Revenues Not Included | $494,714 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $494,714 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $97,757,954 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $82,719,568 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $82,719,568 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $13,214,738 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $13,214,738 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $95,934,306 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (4 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 their review, management has not identified any material uncertain tax positions to be recorded or disclosed in the financials statements. |
| Part XI, Line 2d - Other Adjustments: | Auxiliary activity -13,510. Bad Debt expense -2,601,750. Net assets released from restrictions 213,143. |
| Part XI, Line 4b - Other Adjustments: | Contributions received 1,825. Transfer from affiliates - SHF 324,540. Investment return 84,603. Auxiliary activity 83,746. |
| Part XII, Line 4b - Other Adjustments: | Auxiliary activity 97,256. Bad Debt expense 2,601,750. Transfer to affiliate - SHMG 10,515,732. |
Schedule F IRS990ScheduleF
Account Activities Outside US AccountActivitiesOutsideUSGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Region | Central America | RegionTxt |
| Offices | 0 | OfficesCnt |
| Employee | 1 | EmployeeCnt |
| Type Of Activities Conducted | Program services | TypeOfActivitiesConductedTxt |
| Specific Services Provided | Captive insurance company | SpecificServicesProvidedTxt |
| Region Total Expenditures | $259,126 | RegionTotalExpendituresAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Subtotal Offices | 0 | SubtotalOfficesCnt |
| Subtotal Employees | 1 | SubtotalEmployeesCnt |
| Continutation Total Office | 0 | ContinutationTotalOfficeCnt |
| Continutation Total Employee | 0 | ContinutationTotalEmployeeCnt |
| Total Office | 0 | TotalOfficeCnt |
| Total Employee | 1 | TotalEmployeeCnt |
| Subtotal Spent | $259,126 | SubtotalSpentAmt |
| Continuation Spent | $0 | ContinuationSpentAmt |
| Total Spent | $259,126 | TotalSpentAmt |
| Transfer To Foreign Corp | 0 | TransferToForeignCorpInd |
| Interest In Foreign Trust | 0 | InterestInForeignTrustInd |
| Foreign Corp Ownership | 0 | ForeignCorpOwnershipInd |
| Passive Foreign Investmest Co | 0 | PassiveForeignInvestmestCoInd |
| Foreign Partnership | 0 | ForeignPartnershipInd |
| Boycott Countries | 0 | BoycottCountriesInd |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | Fall Festival | Event1Nm |
| Gross Receipts Event1 | $27,228 | GrossReceiptsEvent1Amt |
| Gross Revenue Event1 | $27,228 | GrossRevenueEvent1Amt |
| Other Direct Expenses Event1 | $10,698 | OtherDirectExpensesEvent1Amt |
| Event2 | Lights of Love | Event2Nm |
| Gross Receipts Event2 | $10,205 | GrossReceiptsEvent2Amt |
| Charitable Contri Event2 | $10,205 | CharitableContriEvent2Amt |
| Other Direct Expenses Event2 | $332 | OtherDirectExpensesEvent2Amt |
| Other Events Total | 11 | OtherEventsTotalCnt |
| Gross Receipts Other Events | $28,348 | GrossReceiptsOtherEventsAmt |
| Gross Revenue Other Events | $28,348 | GrossRevenueOtherEventsAmt |
| Oth Direct Expnss Other Events | $18,739 | OthDirectExpnssOtherEventsAmt |
| Gross Receipts Total | $65,781 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $10,205 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $55,576 | GrossRevenueTotalEventsAmt |
| Oth Direct Expnss Total Events | $29,769 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $29,769 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | $25,807 | NetIncomeSummaryAmt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| 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 | $263,080 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $263,080 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00280 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8,520,035 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,213,638 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,306,397 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04610 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8,783,115 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,213,638 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,569,477 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04890 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $269,477 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,365 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $267,112 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00290 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8,986 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $8,986 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Research ResearchGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $208,132 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $28,970 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $179,162 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00190 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $179,792 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $179,792 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00190 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $666,387 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $31,335 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $635,052 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00680 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $9,449,502 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,244,973 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $5,204,529 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05570 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $467 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $467 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Workforce Development WorkforceDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $11,326 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $500 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $10,826 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $11,793 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $500 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $11,293 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $2,601,750 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $130,088 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $19,916,998 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $30,124,407 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$10,207,409 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost Accounting System | Yes (X) | CostAccountingSystemInd |
| 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 | Divine Providence Hospital | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1100 Grampian Boulevard | AddressLine1Txt |
| City | Williamsport | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 17701 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.susquehannahealth.org | WebsiteAddressTxt |
| State License | 041001 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Other | Wide array of outpatient hospital services | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Divine Providence 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 |
| 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 |
| FAP Notified Before Discharge | Yes (X) | FAPNotifiedBeforeDischargeInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Other Method Used | Yes (X) | OtherMethodUsedInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Divine Providence 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 access to the internet or generationally 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. |
| Divine Providence Hospital | Part V, Section B, Line 6a: Divine Providence Hospital; located in Williamsport, PA is one of four hospitals that comprise the Susquehanna Health System (the System) based in Williamsport, Pennsylvania. For purposes of conducting CHNA's, three of these hospitals, The Williamsport Hospital (DBA: Williamsport Regional Medical Center), Divine Providence Hospital, and Muncy Valley Hospital, share the same definition of community served, which is Lycoming County, PA. The fourth hospital that is part of the System is Soldiers & Sailors located in Wellsboro, PA and their defined community is Tioga County, PA. The Systems approach to providing community benefit 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 as www.susquehannahealth.org. |
| Divine Providence 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 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, MVH, along with TWH, DPH, and SSMH, 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 campus of SSMH 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 physician needs study to assess and document community need for various physician specialties in Lycoming and Tioga counties. 4) Based upon the physician needs study noted above, revised 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 practitioner to increase patient access to services. 7) Implemented telepsychiatry 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 among 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 included a new, expanded program to provide smoking-cessation counseling and low-dose computed tomography lung cancer screenings. 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. |
| Divine Providence Hospital | Part V, Section B, Line 16i: Other - Brochure |
| Divine Providence Hospital | Part V, Section B, Line 22d: 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 following 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. |
| Part V, Section B, Line 16 | Financial Assistance Policy Website Availability |
| Divine Providence Hospital Part V, Section B, line 16a website: | www.susquehannahealth.org |
| Divine Providence Hospital Part V, Section B, line 16b website: | www.susquehannahealth.org |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 2 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| The Meadows | ||||
| 2160 Warrensville Road | Montoursville | PA | 17754 | Assisted living facility |
| The Wenner Building | ||||
| 1705 Warren Avenue | Williamsport | PA | 17701 | Outpatient diagnostics |
Supplemental Information Detail SupplementalInformationDetail (14 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 6a: | The community benefit report is prepared on a system wide basis under Susquehanna Health System. |
| Part I, Line 7g: | The Divine Providence Hospital has various subsidized services which are included within the Medicare and Medical Assistance unreimbursed costs. |
| Part I, Line 7, Column (f) | The Bad Debt expense included on Form 990, Part IX, Line 25(C), but subtracted for purposes of calculating the percentage in this column is $2,601,750 |
| Part II, Community Building Activities: | Community building activities at Divine Providence Hospital (DPH) center on workforce development through providing student observations and the development of volunteens. By supporting volunteens in a health care setting, some budding nurses, doctors and other allied health professionals are developed. DPH also supports/provides a physical site for the statewide radio system. This system is critical to the emergency preparedness system. |
| Part III, Line 2: | Bad debt consists of the actual bad debt written off, plus a reserve calculation based on a progressive percentage for self-pay and other non-contract accounts receivable aging categories. |
| Part III, Line 3: | An estimate of 5% is used based on looking at patients that were in a bad debt status and eventually through the annual bad debt sale, determined they did not have the resources to pay and were really charity care. |
| Part III, Line 4: | The System reports patient accounts receivable for services rendered at net realizable amounts from third-party payers, 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 costing methodology is based on a modified cost accounting system. We cost our patient data for the previous fiscal year and then we apply relational factors to the costs based upon the change in charges from the prior fiscal year to the current fiscal year.Serving patients with government health benefits, such as Medicare, is a component of the community benefit standard that tax-exempt hospitals are held to. This implies that serving Medicare patients is a community benefit and that the hospital operates to promote the health of the community. |
| 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 guideline 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: | Susquehanna Health System (SHS) which is comprised of The Williamsport Hospital (TWH), Divine Providence Hospital (DPH) and Muncy Valley Hospital (MVH), supports and collaborates with the Lycoming County Health Improvement Coalition (LCHIC). LCHIC conducts periodic conduct community health needs assessments in Lycoming county. In addition, Soldiers & Sailors Memorial Hospital (SSMH) located in Wellsboro, PA and is in Tioga County is also part of SHS.LCHIC is a healthy community's initiative in existence since 1994. It is a voluntary collaboration of 37 board members and over 100 Task Force Team volunteers representing various sectors of the community, including religious organizations, schools and higher education, minority groups, municipal and county government, public health, health care, civic and community organizations, the private sector, and social welfare organizations.The mission of LCHIC is to improve the health status of the Lycoming county community by identifying and facilitating response to priority health and wellness issues through a collaborative, community-driven process.In addition to these assessments SHS also looks at assessments from the United Way and The Commonwealth Medical College (TCMC). The LCHIC assessment is structured heavily around the Behavioral Risk Factor Surveillance System (BRFSS). In addition to this LCHIC also conducts the PA Youth Survey for all students in grades 6, 8, 10 and 12 in the county every other year. Each of the above mentioned surveys except the TCMC survey are county focused. TCMC is regional in nature but has future implications in the development of local community benefit activities. For example, it highlighted the need to do primary research in the Amish communities in Lycoming County and the need to further investigate the increasing incidence of STD in the county as well. To enhance the quantitative data of these surveys LCHIC also conducts focus groups for the following sub populations: women, low income families, employers and seniors. LCHIC has historically prioritized the needs, developed a strategic plan and distributed the results to the community.In order to faciliate support for LCHIC's strategic plan, SHS has created a community benefit group. This workgroup reports to the Mission and Ethics Committee of the SHS Board of Directors. On this workgroup are respresentatives from all three hospital campuses, the Department of Health, LCHIC, The United Way, The Williamsport-Lycoming Foundation, TCMC, and The Susquehanna Community Medical and Dental Clinic Inc. (an independent FQHC).The role of the workgroup is to develop systems and processes to improve and promote the integrity of community benefit. To develop and/or adopt best practices in community benefit operations.The workgroup will be comprised of at least one representative from each hospital and Susquehanna Physician Services (SPS), a representative from LCHIC, SHS director of Community Benefit, key community leaders and 1 or 2 members of the mission & effectiveness committee. |
| Part VI, Line 3: | Susquehanna Health System (SHS) 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. The SHS Charity Care Assistance program is an income based package designed to meet the healthcare financial needs of eligible individuals and households who receive medically necessary inpatient and outpatient services from TWH, DPH, MVH, SSMH or SPS.The first hospital claim sent to guarantors of uninsured accounts will include a statement to briefly explain the availability and contacts for referral to the Charity Care program. Subsequent guarantor billings also reference the availability of Charity Care.It is the responsibility for the patient or guarantor to initiate the SHS Charity Care Assistance Program by applying. It is the responsibility of the SHS Finance personnel to administrate the program according to this policy. |
| Part VI, Line 4: | The hospitals that comprise Susquehanna Health System's (SHS) Lycoming county operations are: The Williamsport Hospital (TWH), Divine Providence Hospital (DPH) and Muncy Valley Hospital (MVH. The county is in the north central region of the state, about three and half hours northeast of Pittsburgh and the same distance northwest of Philadelphia. Lycoming County is designated as rural and has small towns nestled within a stunning natural landscape. The City of Williamsport, with the majestic Susquehanna River running through it, is designated as urban, and is the home of Little League World Series. Unfortunately, the City of Williamsport and the surrounding rural area are also home for many individuals and families who cannot afford the primary health and dental care services provided in their county. In addition, Soldiers & Sailors Memorial Hospital (SSMH) located in Wellsboro, PA, Tioga County, is also part of SHS.For a more detailed discussion regarding the community served, as well as associate socio-economic characteristics, you may view CHNA and related implementation plan at www.susquehannahealh.org |
| Part VI, Line 5: | The hospitals of Susquehanna Health System (SHS) all have entity specific boards that are composed of persons who reside in Lycoming County. In addition to this SHS extends medical staff privileges to all qualified physicians in the county in all areas of primary and specialty care according to Susquehanna Health Medical Staff Bylaws. Bylaws excerpts pertaining to this area are as follows:3.1 Nature of Membership - Medical Staff membership is available to qualified physicians, dentists, maxillofacial/oral surgeons, and podiatrists and confers both responsibilities and prerogatives, but only as provided in these Bylaws. No physician, dentist, or podiatrist, including those employed by or otherwise under contract with the Hospital(s), may admit a patient or independently provide patient care services in the Hospital(s) unless he is a Medical Staff member with applicable clinical privileges pursuant to these Bylaws. A member shall have only those clinical privileges, including admitting privileges, as have been granted in accordance with these Bylaws.3.2 Qualifications - No individual shall be considered eligible for appointment on reappointment to the Medical Staff unless he meets each of the following required qualifications/criteria. If any change in personal or professional status occurs which would inhibit practitioner's ability to effectively meet the obligations for patient care and Medical Staff membership under these Bylaws, the practitioner shall immediately notify the Medical Director.3.2-1 Professional Licensure Qualification - A member must be a physician, dentist, or podiatrist and must be fully licensed to practice in the Commonwealth of Pennsylvania.3.2-2 Clinical Privileges Qualification - A member of the Medical Staff must have clinical privileges (or in the case of a new applicant, is granted clinical privileges at the time of the appointment), except those appointed to the Emeritus Staff or as otherwise specified in these Bylaws.3.2-3 Professional Competence - A member must demonstrate sufficient professional education, training, experience, competence, and good judgment to perform Medical Staff responsibilities and clinical privileges requested.3.2-4 Health Status - A member must have sufficient physical and mental health to perform Medical Staff responsibilities and exercise clinical privileges requested.3.2-5 Basic Responsibilities - A member must discharge the basic responsibilities of Medical Staff membership noted in 3.3-2.3.2-6 Board Certification Requirement - All practitioners who are current staff members at SHS as of 7/1/14 and who have met prior qualifications for membership shall be exempt from board certification requirements.3.2-7 Departmental Qualifications - Each department will reserve the right to further specify qualifications for membership (as noted in individual departmental Bylaws), which may be more restrictive than those specified here. Any initial applicant for Medical Staff membership must meet both the general criteria for Medical Staff membership as specified in these Bylaws and the criteria for membership established by the department to which he is applying.3.2-8 Waiver - The Board Certification requirement described in 3.2-6 may be waived under very special circumstances in which an applicant for Medical Staff membership is capable of providing specific unique expertise presently not available or insufficiently available on the Medical Staff which will fulfill an unmet medical need in the community. Such waiver may be granted by the Board(s) only upon recommendation of the Department Chairman, Credentials Committee, and the Medical Executive Committee (MEC)3.2-9 Prohibited Criteria - Medical Staff membership or assignment to a Medical Staff category shall not be denied, terminated, revoked, suspended, modified, or otherwise restricted based upon:(a) Gender, race, creed, color, national origin, handicap, or disability, if the individual is otherwise qualified under these Bylaws, or(b) Economic considerations as the sole or primary criterion, or(c) Any criterion not set forth as a required qualification in these Bylaws, or(d) Any other criterion lacking professional or ethical justification.The volunteer program at SHS supports the services at our 4 campuses, MVH, DPH, TWH and SSMH, as well as our LifeCenter located within the River Valley Regional YMCA in Williamsport, PA. Volunteers, ranging in age from 14, assist staff and patients in almost every department.The volunteers come from Lycoming and surrounding counties to support our services. They provide over 75,000 hours of service in both office, customer service and patient care areas to support our service partners. They become ambassadors for the hospital, make new friends, financially support the hospital, become involved in the auxiliary, remain an active member of society, often stay healthier longer, enjoy the camaraderie with staff and other volunteers, serve on hospital committees, recruit other volunteers, increase their volunteer hours and offer constructive suggestions for improvement. Volunteers are recruited through fairs, internet information and on-line applications, volunteer referrals and presentations to groups. They are a highly regarded, integral part of our operational support system. |
| Part VI, Line 6: | Divine Providence Hospital (DPH) 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. 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.Divine Providence Hospital (DPH) is a specialty hospital that offers inpatient psychiatric services and a wide array of outpatient hospital services, as well as, home health and Hospice services.The Williamsport Hospital (TWH) is an acute care community hospital providing diagnostic and treatment facilities, educational and training programs, and a rehabilitation facility.Soldiers & Sailors Memorial Hospital (SSMH) 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 $85,031,419 in quantifiable community benefits reported for FY 2015: Charity Care (at cost) $2,068,338; Bad Debt (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. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|
| Susquehanna Physician Services | |||||||
| 1201 Grampian Boulevard | Williamsport | PA | 17701 | 232449454 | 501(c)(3) | $10,515,732 | Support of affiliate |
| Susquehanna Community Health and Dental Clinic | |||||||
| 469-471 Hepburn Street | Williamsport | PA | 17701 | 208979596 | 501(c)(3) | $124,500 | Financial 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 | Part I, Line 2: | FormAndLineReferenceDesc |
| Explanation | Susquehanna Physician Services is a related organization and part of the Susquehanna Health System with consistent management oversight ensuring the use of funds for charitable purposes. Susquehanna Community Health and Dental Clinic is a former service of the Susquehanna Health System that is being converted to a Federally Qualified Health Clinic (FQHC). "Look-alike" status was received effective 12/6/11. Susquehanna Health System continues to support the clinics financially until full FQHC status is obtained and they are able to operate by their own means. All requests for funding are supported by detailed records of cash receipts and disbursements, as well as cash flow projections prepared by an independent accounting firm. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (11 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Kevin W Kist DO | ||||||||||||||
| Director | $0 | $329,222 | $0 | $12,706 | $0 | $76,763 | $0 | $9,800 | $0 | $24,226 | $0 | $452,717 | $0 | $0 |
| Alexander R Nesbitt MD | ||||||||||||||
| Director | $0 | $181,666 | $0 | $5,618 | $0 | $15,389 | $0 | $11,067 | $0 | $16,614 | $0 | $230,354 | $0 | $0 |
| Steven P Johnson | ||||||||||||||
| President / CEO | $0 | $531,335 | $0 | $345,329 | $0 | $29,435 | $0 | $13,700 | $0 | $17,824 | $0 | $937,623 | $0 | $0 |
| Charles J Santangelo | ||||||||||||||
| Executive VP / CFO (Retired 5/2/15) | $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 / CMO (Retired 1/31/15) | $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 / CMO (Hired 1/31/15) | $0 | $312,802 | $0 | $15,628 | $0 | $8,217 | $0 | $11,100 | $0 | $24,127 | $0 | $371,874 | $0 | $0 |
| Jan E Fisher | ||||||||||||||
| Executive VP / COO | $0 | $395,220 | $0 | $10,795 | $0 | $7,764 | $0 | $9,800 | $0 | $19,947 | $0 | $443,526 | $0 | $0 |
| Ronald J Butler | ||||||||||||||
| Executive VP / CBO (Retired 4/15/15) | $0 | $329,125 | $0 | $10,897 | $0 | $4,756 | $0 | $9,800 | $0 | $12,232 | $0 | $366,810 | $0 | $0 |
| Robert E Kane | ||||||||||||||
| President | $187,092 | $0 | $19,079 | $0 | $4,304 | $0 | $10,029 | $0 | $16,091 | $0 | $236,595 | $0 | $0 | $0 |
| Rajesh Manoharan | ||||||||||||||
| Medical Physicist | $197,368 | $0 | $0 | $0 | $272 | $0 | $7,921 | $0 | $21,102 | $0 | $226,663 | $0 | $0 | $0 |
| Joseph B Lecrone | ||||||||||||||
| Pharmacist | $127,453 | $0 | $0 | $0 | $99 | $0 | $5,824 | $0 | $19,577 | $0 | $152,953 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 6 | In order for the Leadership Team to participate in the annual Variable Compensation Incentive Program (VCIP) a minimum operating margin must be achieved for the most recently completed year on a consolidated system-level basis. Individual goals and objectives related to the VCIP may also include individual entity operating performance. For FY 2015, the minimum threshold was met that would trigger any VCIP payments. In September 2014, President / CEO Steven P. Johnson received 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. |
| Part I, Line 3 | The Williamsport Hospital EIN #24-0795508, a related organization, uses the following resources to establish the compensation of the top management officials, compensation committee, independent compensation consultant, written employment contract, compensation survey or study and approval by the board. |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (2 entries)
| Bond ReferenceBondReferenceCd | Bond Issuer EINBondIssuerEIN | CUSIPCUSIPNum | Bond IssuedBondIssuedDt | Issue PriceIssuePriceAmt | PurposePurposeDesc | DefeasedDefeasedInd | On Behalf Of IssuerOnBehalfOfIssuerInd | Pool FinancingPoolFinancingInd |
|---|---|---|---|---|---|---|---|---|
| Lycoming County Authority | ||||||||
| A | 236760375 | 550804AH1 | 2009-10-22 | $17,445,802 | See Part VI | 0 | 0 | 0 |
| Lycoming County Authority | ||||||||
| B | 236760375 | NoneAvail | 2015-06-18 | $4,400,000 | See Part VI | 0 | 0 | 0 |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (2 entries)
| Bond ReferenceBondReferenceCd | Total ProceedsTotalProceedsAmt | In Reserve FundInReserveFundAmt | Issuance Costs From ProceedsIssuanceCostsFromProceedsAmt | Capital ExpendituresCapitalExpendituresAmt | Substantial CompletionSubstantialCompletionYr | Current RefundingCurrentRefundingInd | Advance RefundingAdvanceRefundingInd | Final Allocation MadeFinalAllocationMadeInd | Adequate Books And Rec MaintAdequateBooksAndRecMaintInd | UnspentUnspentAmt |
|---|---|---|---|---|---|---|---|---|---|---|
| A | $17,433,839 | $1,257,880 | $324,433 | $15,851,526 | 2010 | 0 | 0 | Yes (1) | Yes (1) | |
| B | $4,400,000 | $37,485 | 0 | 0 | 0 | Yes (1) | $4,362,515 |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (2 entries)
| Bond ReferenceBondReferenceCd | Owning Bond Financed PropertyOwningBondFinancedPropertyInd | Any Lease ArrangementsAnyLeaseArrangementsInd | Mgmt Contract Bond Fincd PropMgmtContractBondFincdPropInd | Any Research AgreementsAnyResearchAgreementsInd | Engage Bond Counsel ResearchEngageBondCounselResearchInd | Bond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestInd | Change In Use Bond Financed PropChangeInUseBondFinancedPropInd | Procs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd | Private Bus Use By OthersPrivateBusUseByOthersPct | Private Bus Concerning UBIPrivateBusConcerningUBIPct | Total Private Business UseTotalPrivateBusinessUsePct |
|---|---|---|---|---|---|---|---|---|---|---|---|
| A | 0 | 0 | 0 | Yes (1) | Yes (1) | 0 | 0 | Yes (1) | |||
| B | 0 | 0 | 0 | Yes (1) | Yes (1) | 0 | 0 | Yes (1) | 0.00000 | 0.00000 | 0.00000 |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (2 entries)
| Bond ReferenceBondReferenceCd | Form8038 T FiledForm8038TFiledInd | Rebate Not Due YetRebateNotDueYetInd | Exception To RebateExceptionToRebateInd | No Rebate DueNoRebateDueInd | Variable Rate IssueVariableRateIssueInd | Hedge Identified In Bks And RecHedgeIdentifiedInBksAndRecInd | Gross Proceeds Invested In GICGrossProceedsInvestedInGICInd | Gross Proceeds InvestedGrossProceedsInvestedInd | Written Proc To Monitor ReqsWrittenProcToMonitorReqsInd |
|---|---|---|---|---|---|---|---|---|---|
| A | 0 | 0 | 0 | Yes (1) | 0 | 0 | 0 | 0 | Yes (1) |
| B | 0 | 0 | Yes (1) | 0 | Yes (1) | 0 | 0 | 0 | Yes (1) |
Procedures Corrective Action ProceduresCorrectiveActionGrp (2 entries)
| Bond ReferenceBondReferenceCd | Procedures Corrective ActionProceduresCorrectiveActionInd |
|---|---|
| A | Yes (1) |
| B | Yes (1) |
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Schedule K, Part I, Bond A (e) and (f) | The total issue price per Form 8038, Part III(b) is $165,134,534. Of this total, $17,445,802 was allocated to Divine Providence Hospital at the time of issue, while the balance of $147,688,732 was allocated to The Williamsport Hospital (EIN #24-0795508). The proceeds of the Lycoming County Authority, Series 2009A bonds were used, together with other available funds, to undertake a project consisting of the expansion and renovation of the Cancer Treatment Center at Divine Providence Hospital. |
| Form 990, Schedule K, Part II, Bond A, Line 3 | The difference between the Total Proceeds of Issue and the amount reflected in Part I, (e) is due to accumulated investment results, net of accumulated Investment Management Fees. |
| Form 990, Schedule K, Part IV, Bond A, Line 2c | Rebate calculations are performed annually, the most recent being from the issue date of October 22, 2009 to October 21, 2014. |
| Form 990, Schedule K, Part I, Bond B, (e) and (f) | The total issue price per Form 8038, Part III (b) is $40,000,000. Of this total, $4,400,000 was allocated to Divine Providence Hospital at the time of issue, while $11,200,000 was allocated to Muncy Valley Hospital (EIN #24-0806023) and $24,400,000 was allocated to The Williamsport Hospital (EIN #24-0795508). The proceeds of the financing will be used to finance all, or a portion of projects consisting of (i) construction at Williamsport Hospital, Patient Tower 4th Floor of three (3) Operating Rooms, four (4) Cardiology procedural rooms, and related clinical equipment; (ii) renovation at Williamsport Hospital, East Building 2nd Floor of existing entrance and interior hallway space to improve patient throughput; create a new Pre-Admission Testing area; and expand clinical staff locker area; (iii) installation at Williamsport Hospital, Energy Services Center, of 1,000 ton chiller and cooling tower creating new capacity to support the added demand from the Health Innovation Center and Patient Tower and creating additional back-up capacity; (iv) replacement at Williamsport Hospital, West Building and Energy Center, of the hot water system with hot water sourced from the Energy Services Center, thus providing more efficient hot water and heating to the West Building; (v) construction of Muncy Valley Hospital, Emergency Room expansion and renovation of a 5,400 square foot addition and 11,000 square feet of renovation to upgrade and expand the Emergency Department, installing eight (8) private bed rooms and five (5) specialty rooms, upgraded Radiology; and site-work to relocate Shady Lane, and create a new walk-in entrance, parking lot, and helipad; (vi) renovation at Divine Providence Hospital, Health Sciences Building 2nd Floor, to accommodate the relocation of Sports Medicine from the hospital, creating additional examination rooms and offices to accommodate seven (7) clinical providers and two (2) additional Radiology rooms, with related clinical equipment; (vii) renovation at Divine Providence Hospital, 1st Floor, to accommodate the expansion of the Work Center and relocation of Radiology services; (viii)renovation at Divine Providence Hosital, 1st Floor, to accommodate expansion of the Cancer Center to provide twelve (12) additional examination rooms, physician and management offices and nurse stations; (ix) the funding of any necessary reserves, and (x) the payment of all or a portion of the costs of the Financing. |
| Form 990, Schedule K, Part II, Bond B, Line 3 | This issue is a draw-down obligation from which funds are not requested and drawn until capital expenditures have been incurred. |
| Form 990, Schedule K, Part IV, Bond B, Line 2c | As a draw-down obligation with no funds held in investments, rebate calculation requirements are not applicable. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part V, Line 1A | All 1099's are issued by Susquehanna Health System EIN #23-2751183. All expenses are then allocated back to all related entities. |
| Form 990, Part V, Line 2A & 2B | Susquehanna Health System EIN #23-2751183 utilizes a common paymaster which includes the following entities: Divine Providence Hospital EIN #24-0799343 Muncy Valley Hospital EIN #24-0806023 The Williamsport Hospital EIN #24-0795508 Susquehanna Health Foundation EIN #23-2743470 Susquehanna Physician Services EIN #23-2449454 Susquehanna Ventures, Inc. EIN #23-2470263 Williamsport Are Ambulance Services EIN #23-2416166 Laurel Management Services EIN #25-1644910 Laurel Realty EIN #23-1403678 Soldiers & Sailors Memorial Hospital EIN #23-2176963 The Green Home EIN #24-0804365 Tioga Health Care Providers EIN #25-1765538 Tyoga Carenet EIN #25-1810967 The total number of employees reported on Form W-3 would be 3,956 for Susquehanna Health System EIN #23-2751183. Of that total, 430 employees payroll expenses were recorded by Divine Providence Hospital. |
| Form 990, Part VI, Section A, line 2 | Key employee Charles Santangelo and board member Steven Johnson both serve on the board of a related taxable organization. |
| Form 990, Part VI, Section A, line 6 | Susquehanna Health System, EIN # 23-2751183, is a sole member of the governing body. |
| Form 990, Part VI, Section A, line 7a | Susquehanna Health System, EIN # 23-2751183, may elect or remove members of the governing body. |
| Form 990, Part VI, Section A, line 7b | All business and affairs of the corporation shall be managed and controlled by the Board of Directors, subject to the oversight of the Member of the management and operation of the corporation, 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 or of any force or effect whatsoever. The sole Member shall exercise its powers through its Board of Directors. The Member shall have the exclusive authority to exercise the following powers: A) To approve the appointment and removal of the President of the corporation, subject to all applicable provisions of the Creation Agreement. B) To elect and remove, with or without cause, a Director of the corporation. C) To establish the overall policy and long range plans of the corporation, determine or change the mission of the corporation, approve the programs and services of the corporation and the termination of any programs of services of the corporation, and monitor and maintain the philosophy, goals and purposes for which the corporation was formed and exists, subject to an in accordance with the provisions of the Creation Agreement. D) To adopt, amend or repeal the Articles of Incorporation or these bylaws. E) To establish requirements for a unified budget, the approval of new capital debt, any increment to any existing capital debt, and/or any change in capital debt obligations of the corporation. F) To establish requirements for the approval of the acquisition, purchase, sale, leasing outside the ordinary course of business, transfer outside the ordinary course of business or encumbrance outside the ordinary course of business of land or buildings and the construction or demolition of buildings owned by the corporation. G) To require a certified audit of corporate funds at any time. H) To approve any guaranty of the indebtedness of any person, the granting of any security interest in or the creation of any encumbrance on any assets of the corporation outside the ordinary course of business, or any transfer of any asset of the corporation outside the ordinary course of business, except transfers between or among affiliated corporations. I) To approve any merger, consolidation, organization, reorganization, joint venture or other modification of corporate structure or affiliations affecting the autonomy, governance, or operations of the corporation. J) To dissolve or terminate the existence of the corporation and determine the distribution of assets upon such termination or dissolution, as provided in these bylaws. K) To appoint annually the external fiscal auditor of the corporation. L) To approve the nominees for elected officers of the Board of Directors of the corporation, and to return the list of approved nominees to the Board of Directors for election. M) To remove any elected officer of the corporation; N) To approve the annual capital and operating budget of the corporation; O) To coordinate managed care plans, including decisions concerning entry into or renewal of any contract or agreement relating thereto. |
| Form 990, Part VI, Section B, line 11 | A high-level overview of Forms 990 is presented to the parent Board of Directors (Susquehanna Health System, #23-2751183) before filing and complete drafts of all returns were made available to all Board members through the CEO's and CFO's office. |
| Form 990, Part VI, Section B, line 12c | As required by law, Hospital policy states that all members of the Board of Managers must sign a statement each year disclosing any conflict of interest that may arise and agree to abstain when issues involving those parties with conflicting interests are called to motion. Any conflicts of interest are reviewed by the Hospital's attorneys. |
| Form 990, Part VI, Section B, line 15 | Form 990, Part VI, Line 15a & 15b: All top management officials are paid by The Williamsport Hospital, EIN # 24-0795508. The Board of Directors, through the Executive Compensation Committee, retains an independent outside consultant to provide guidance with respect to the annual establishment of the rebuttable presumption or reasonableness relative to executive compensation and benefits. The consultant annually provides detailed market information from its annual Executive Compensation Survey for Health Systems. In addition, other regional survey data is provided in order to supply the health system with a "national" picture of compensation. With this process established, the Executive Compensation Committee takes the proper steps to educate the Board of Directors to understand all of the above mentioned oversight and to appropriately prepare them for the community or media inquiry. In addition, the Board is made aware of the Form 990 and its role in the communication of information to the public. |
| Form 990, Part VI, Section C, line 19 | The organization makes its governing documents, conflict of interest policy, and financial statements available to the public upon request. |
| Form 990, Part XI, line 9: | Change in interest in net assets of affiliate -91,931. |
| Form 990, Part XII, Line 2C | The organization did not change it oversight process or selection process |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (14 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| The Williamsport Hospital | |||||||||||
| 700 High Street | Williamsport | PA | 17701 | 240795508 | Hospital | PA | 501(c)(3) | 3 | Susquehanna Health System | 0 | |
| The Muncy Valley Hospital | |||||||||||
| 215 East Water Street | Muncy | PA | 17756 | 240806023 | Hospital | PA | 501(c)(3) | 3 | Susquehanna Health System | 0 | |
| Susquehanna Health Foundation | |||||||||||
| 1100 Grampian Boulevard | Williamsport | PA | 17701 | 232743470 | Fundraising for affiliated entities | PA | 501(c)(3) | 11 A I | Susquehanna Health System | 0 | |
| Susquehanna Health System | |||||||||||
| 1205 Grampian Boulevard | Williamsport | PA | 17701 | 232751183 | Coordinate & manage the delivery of healthcare | PA | 501(c)(3) | 11 A I | 0 | N/A | |
| Susquehanna Physician Services | |||||||||||
| 1201 Grampian Boulevard | Williamsport | PA | 17701 | 232449454 | Physician services & MRI services | PA | 501(c)(3) | 3 | Susquehanna Health System | 0 | |
| Williamsport Area Ambulance Service Cooperative | |||||||||||
| 700 High Street | Williamsport | PA | 17701 | 232416166 | Ambulance transport | PA | 501(c)(3) | 9 | 0 | N/A | |
| Soldiers & Sailors Memorial Hospital | |||||||||||
| 32-36 Central Avenue | Wellsboro | PA | 16901 | 232176963 | Hospital | PA | 501(c)(3) | 3 | Susquehanna Health System | 0 | |
| The Green Home | |||||||||||
| 37 Central Avenue | Wellsboro | PA | 16901 | 240804365 | Skilled nursinng & assisted living | PA | 501(c)(3) | 9 | Susquehanna Health System | 0 | |
| Tioga Health Care Providers | |||||||||||
| 15 Meade Street | Wellsboro | PA | 16901 | 251765538 | Physician services | PA | 501(c)(3) | 11 B II | Susquehanna Health System | 0 | |
| Laurel Management Services | |||||||||||
| 15 Meade Street | Wellsboro | PA | 16901 | 251644910 | Mgmt consulting & supervisory svcs | PA | 501(c)(3) | 11 B II | Susquehanna Health System | 0 | |
| Laurel Realty | |||||||||||
| 15 Meade Street | Wellsboro | PA | 16901 | 231403678 | Own & manage real estate | PA | 501(c)(2) | N/A | Susquehanna Health System | 0 | |
| Laurel Health Systems | |||||||||||
| 15 Meade Street | Wellsboro | PA | 16901 | 240795488 | Coordinate & manage the delivery of healthcare | PA | 501(c)(3) | 11 B II | Susquehanna Health System | 0 | |
| Laurel Health Foundation | |||||||||||
| 15 Meade Street | Wellsboro | PA | 16901 | 251810488 | Fundraising for affiliated entities | PA | 501(c)(3) | 11 A I | Laurel Health System | 0 | |
| Susquehanna Health Innovation Center Inc | |||||||||||
| 700 High Street | Williamsport | PA | 17701 | 471600873 | Supporting organization of affiliated entities | PA | 501 (c)(3) | 11 B 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 Boulevard | 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 & Susquehanna Health Foundation | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Predominant Income Type | excluded from tax | PredominantIncomeTypeTxt |
| Disproportionate Allocations | 0 | DisproportionateAllocationsInd |
| General Or Managing Partner | 0 | GeneralOrManagingPartnerInd |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd | Address Line1ForeignAddress/AddressLine1Txt | CityForeignAddress/CityNm | CountryForeignAddress/CountryCd | Foreign PostalForeignAddress/ForeignPostalCd | Legal Domicile Foreign CountryLegalDomicileForeignCountryCd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Susquehanna Ventures Inc | ||||||||||||||
| 1201 Grampian Boulevard | Williamsport | PA | 17701 | 232470263 | Pharmacy & infusion services | PA | N/A | C | 0 | |||||
| Susquehanna Health System Insurance Network LTD | ||||||||||||||
| 980458722 | Captive insurance company | N/A | 0 | PO Box 1159 | Grand Caymans | CJ | KY1-1102 | CJ | ||||||
| Tyoga Carenet | ||||||||||||||
| 15 Meade Street | Wellsboro | PA | 16901 | 251810967 | Integrate health care | PA | N/A | C | 0 | |||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (1) | 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 | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (1) | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (1) | TransferFromOtherOrgInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Form 990, Schedule R, Part IV | FormAndLineReferenceDesc |
| Explanation | Susquehanna Health System Insurance Network, LTD (SHSIN) EIN #98-0458722, is a foreign corporation, incorporated under the laws of the Cayman Islands. There are no income, capital, or premium taxes levied in the Cayman Islands and SHSIN has been granted an exemption until September 2022 for any such taxes that might be introduced. SHSIN's sole shareholder, 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 tax. | ExplanationTxt |