2015-05-12T07:32:56-05:00 2014-06-30 BKD LLP 910 E St Louis Street Suite 200 Springfield MO 65806 990 2013-07-01 240795508 The Williamsport Hospital WILL 5703207900 700 High Street Williamsport PA 17701 Charles J Santangelo Executive Vice President / CFO 5703207900 2015-05-12 1 Brian D Todd P00422601 4178658701 2013 2016-02-25 16:41:14Z Steven P Johnson 700 High Street Williamsport PA 17701 387183603 0 X www.susquehannahealth.org X 1873 PA The Williamsport Hospital (TWH) is a 223 bed acute care community hospital primarily serving Lycoming and surrounding counties. Services provided include, but are not limited to, Acute and Intensive Care, Surgical Services, Heart and Lung Services, Rehabilitation Services, Dialysis, Laboratory, Radiology, Psychology and Emergency Room Services. 12 7 2121 267 0 0 12287784 8068321 270933505 286211639 2192561 2279563 486107 469690 285899957 297029213 8144398 11982029 0 0 111026020 117563883 0 0 25064 152380565 161489689 271550983 291035601 14348974 5993612 369723419 382800708 229338540 231971101 140384879 150829607 X The Williamsport Hospital (TWH) 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 our patients and their families first, share ownership with all of our caregivers and lead with a servant's heart. 0 0 278232548 11982029 286348852 The Williamsport Hospital (TWH) is a 223 bed acute care community hospital primarily serving Lycoming and surrounding counties. Services provided include, but are not limited to, Acute and Intensive Care, Surgical Services, Heart and Lung Services, Rehabilitation Services, Dialysis, Laboratory, Radiology, Psychology and Emergency Room Services. TWH also provides Labor and Delivery Services while maintaining a 22 bed Nursery. During the fiscal year ended June 30, 2014, TWH admitted 11,833 patients rendering 53,447 patient days and registered approximately 234,096 outpatient procedures. TWH treats all patients without regard to their ability to pay. In addition, the Hospital treats Medicare / 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. On an annual basis, TWH devotes a portion of its revenue and assets to community program services. The following reflects the breakout of $57,950,277 in quantifiable community benefits for FY 2014: Charity Care (at cost) $1,757,600; Bad Debt (at cost) $6,065,843; Government-sponsored health care (unpaid cost of Medicare, Medicaid, indigent care programs, SCHIP and other safety net programs) $47,493,802. In addition, various other programs such as Research, Health Professions Education, Community Health Services, Subsidized Health Services, Community Building, Financial and In-kind Contributions and Community Benefit Operations totaling $2,633,033. 278232548 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 1 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 X 0 0 2121 1 0 0 0 0 0 0 0 0 0 0 X 12 7 1 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 1 0 PA X Management 5703207900 1205 Grampian Boulevard Williamsport PA 17701 Chris H Dewald Chair 1.00 1.00 X X 0 0 0 Keith Kuzio Vice Chair 1.00 2.00 X X 0 0 0 Kathleen D Pagana Secretary 1.00 1.00 X X 2431 0 0 Patrick Marty Treasurer 1.00 1.00 X X 0 0 0 Leonard R Collins MD Director 1.00 42.00 X 0 246377 25959 Kevin W Kist DO Director 1.00 43.00 X 0 379149 32818 Paul Moulton Director 1.00 2.00 X 0 0 0 Dr Alexander R Nesbitt Director 1.00 42.00 X 0 209772 28837 Melissa Welch Director 1.00 1.00 X 0 0 0 Patrick Wilson Director 1.00 1.00 X 0 0 0 Mary Wolf Director 1.00 1.00 X 0 0 0 Steven P Johnson President / CEO 40.00 4.00 X X 539105 0 31861 Charles J Santangelo Executive Vice President / 40.00 1.00 X 338408 0 29440 William C McCauley MD Sr. Vice President / Presi 40.00 0.00 X 379609 0 30350 Jan E Fisher Executive Vice President / 40.00 0.00 X 387968 0 19385 Ronald J Butler Executive Vice President/ 40.00 1.00 X 324224 0 15277 George Manchester MD Senior VP / Medical Affairs / CMO 40.00 0.00 X 336463 0 35282 Karen M Armstrong Former Sr. Vice President / CIO 40.00 0.00 X 242996 0 0 Kenneth B Young VP / Legal Services 40.00 0.00 X 249576 0 10206 Leo J Fitzpatrick CRNA 40.00 0.00 X 231680 0 17892 Timothy M Douglass CRNA 40.00 0.00 X 217740 0 30398 Neil G Armstrong Former Executive Vice President / COO 40.00 0.00 X 337478 0 4276 3587678 835298 311981 89 1 1 0 Aramark Healthcare 24863 Network Place Chicago IL 60673 Management / environmental services 14468600 Medical Solutions Inc 1010 N 102nd Street Suite 300 Omaha NE 68114 Locum tenen services 1570467 Anesthesia Associates 700 High Street Williamsport PA 17701 Anesthesia services 1344191 Phelps Group 901 Wilshire Blvd Santa Monica CA 90401 Advertising services 1218651 Paris Companies 670 Hoover Avenue Dubois PA 15801 Linen services 858411 37 228925 160484 7678912 8068321 Net patient revenue 621990 267449062 267449062 Support from alliance affiliates 900099 15900916 15900916 Affiliate rent income 621990 1311233 1311233 Cafeteria 722514 1217095 1217095 Aramark 900099 333333 333333 286211639 954498 954498 91320570 158885 89535792 618598 1784778 -459713 1325065 1325065 Purchase discounts 900099 248339 248339 Miscellaneous 900099 132583 48445 84138 Lab rebates 900099 45633 45633 43135 43135 469690 297029213 286348852 0 2612040 11982029 11982029 2132394 2132394 252342 252342 90787293 86909305 3858124 19864 4445832 4260788 184096 948 13462277 12901953 557454 2870 6483745 6213880 268483 1382 1597329 1596642 687 458292 458292 270383 5400 264983 43694 43694 237822 814 237008 20723034 18159997 2563037 1635104 1613120 21984 9747063 9236529 510534 5545633 5501943 43690 197847 157625 40222 5331733 5058028 273705 230698 229180 1518 341988 325510 16478 8174067 8174067 21364012 21364012 3820950 3820950 Medical Supplies 43858361 43855519 2842 Bad Debt 19275120 19275120 Repairs & maintenance 10072593 10043411 29182 Miscellaneous 4362484 458522 3903962 4201482 4201482 291035601 278232548 12777989 25064 16205830 15633866 28658202 28206242 3199263 4402766 6538602 6985872 438547768 178758056 249395619 259789712 62498704 58646426 3227199 9135824 369723419 382800708 31322767 35167255 14666666 8333333 163188377 159309512 20160730 29161001 229338540 231971101 X 139508745 149984831 672018 630538 204116 214238 140384879 150829607 369723419 382800708 X 5993612 4465156 -14040 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 21808 1 21886 0 0 43694 0 Part II-B, Line 1: 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 the State levels. For the year ended 6/30/14, the amount of dues paid to HAP totaled $52,365, of which 22.85% or $11,965, was used for lobbying purposes. Dues paid to AHA totaled $41,621, of which 23.65% or $9,843, 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 in negligible. On an annual basis the Hospital utilizes professional services to help procure various types of federal and state funding. Such services may include direct contact with legislators, their staff, and various government officials. For the year ended 6/30/14, the amount paid for such services amounted to $21,886. 24033480 24033480 175918441 80468301 95450140 91947 22987 68960 169592102 82730643 86861459 68911798 15536125 53375673 259789712 Due to third parties 3434356 Estimated medical legal liability costs 769000 Other liabilities 3646763 Due to affiliates, net 21004968 Interest rate swap agreement 305914 29161001 X 275845841 4465156 -19275120 -14809964 290655805 6373408 6373408 297029213 260926631 0 260926631 30108970 30108970 291035601 Part X, Line 2: Management has evaluated their income tax positions under the guidance included in ASC 740. Based on their review, management has not identified any material uncertain tax positions to be recorded or disclosed in the financial statements. Part XI, Line 2d - Other Adjustments: Bad debt expense -19,275,120. Part XI, Line 4b - Other Adjustments: Temporary restricted contributions 6,976,921. Net assets released -842,559. Permanently restricted investment contributions 10,122. Transfer from affiliates - SHF 174,461. Transfer from affiliates - SHS 54,463. Part XII, Line 4b - Other Adjustments: Bad debt expense 19,275,120. Transfer to affiliate - SHMG 10,789,379. Transfer to affiliate - SHF 44,471. Central America 0 1 Program services Captive insurance company 1801665 0 1 0 0 0 1 1801665 0 1801665 0 0 0 0 0 0 1 1 X 1 X 1 X 1 1 1 0 1 1 1757600 1757600 0.00650 35309881 16517291 18792590 0.06920 37067481 16517291 20550190 0.07570 498405 65420 432985 0.00160 296963 296963 0.00110 1460240 1460240 0.00540 2255608 65420 2190188 0.00810 39323089 16582711 22740378 0.08380 57677 57677 0.00020 636 636 0.00000 58313 58313 0.00020 1 19275120 963756 92300586 121001798 -28701212 X 1 1 1 1 The Williamsport Hospital 700 High Street Williamsport PA 17701 www.susquehannahealth.org 234601 X X X X The Williamsport Hospital 1 1 X X X X X X X X X 13 1 1 1 X www.susquehannahealth.org X X X X X 0 0 1 1 200.000000000000 1 300.000000000000 1 X X X X X 1 1 X X X X X X 1 0 X X X X 1 X 0 0 The Williamsport Hospital Part V, Section B, Line 3: In conducting its CHNA, the hospital took into account input from representatives of the community served, including those with special knowledge of or expertise in public health. This was accomplished by conducting 25 Key Informant Interviews, as well as developing and disseminating a Community Health Input Questionnaire. A web-based tool was utilized to conduct the community input process; however, paper questionnaires identical to the electronic version were distributed to populations who may not have had access to the internet or 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 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. The Williamsport Hospital Part V, Section B, Line 4: The Williamsport 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 the 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 Memorial Hospital located in Wellsboro, PA, and those 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 at www. susquehannahealth.org. The Williamsport Hospital Part V, Section B, Line 7: 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 other words, 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, TWH, along with DPH, MVH, 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) Copnducted a transportation study, including 5 focus groups, to help identify and remedy transportation barries 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 mis 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 Psyciatrists and an additional certified registered nurse practioner to increase access to services. 7) Implemented Telesychiatry 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 acess to Mental Health services. 10) Develop a primary care physician (PCP) outreach program to educate PCP's in how to better identify Mental Health needs among their patients and better understanding the community resources that are available. The Williamsport Hospital Part V, Section B, Line 14g: Other - Brochure The Williamsport Hospital Part V, Section B, Line 20d: 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. 3 The Medical Center 699 Rural Avenue Williamsport PA 17701 Outpatient clinic The Montoursville Clinic Savoy Plaza 900 Plaza Drive Montoursville PA 17754 Outpatient clinic / lab The Hepburn Plaza Outpatient Lab 465 Hepburn Plaza Williamsport PA 17701 Outpatient lab Part I, Line 6a: The community benefit report is prepared on a system wide basis under Susquehanna Health System. Part I, Line 7g: The Williamsport Hospital has various subsidized services which are included within the Medicare and Medical Assistance unreimbursed costs. Part II, Community Building Activities: Activities focus on leadership development and training for community members through support to Leadership Lycoming and Youth Leadership Lycoming. Leadership Lycoming is a training program designed to understand the needs of the communities it serves; then educate and motivate potential leaders to commit themselves to address those needs through a variety of community leadership roles.Graduates of Leadership Lycoming are seen throughout the community as participants on boards, committees, forums and task forces. Many find that the information they received as a Leadership Lycoming participant provides them with the insight to better understand the issues facing our community today and tomorrow.The Williamsport Hospital (TWH) supports workforce development through participation on health care career education programs and by providing student observations for nursing and allied health professionals. TWH also supports Special Response Team (SRT) training. 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 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 on 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 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 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 facilitate 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 representatives 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 or 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 cannnot 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 the CHNA and related Implementation Plan at www.susquehannahealth.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 priviledges 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 7/1/13 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 in Lycoming Mall. 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: The Williamsport Hospital (TWH) is one of four hospitals which is 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 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 $90,482,855 in quantifiable community benefits reported for FY 2014: Charity Care (at cost) $3,702,071; Bad Debt (at cost) $11,022,824; Government-sponsored health care (unpaid cost of Medicare, Medicaid, indigent care programs, SCHIP and other safety net programs) $69,261,993. In addition, various other programs such as Research, Health Professions Education, Community Building, Financial and In-Kind Contributions, and Community Benefit Operations totaling $6,495,967. 1 Susquehanna Physician Services 1201 Grampian Boulevard Williamsport PA 17701 232449454 501(c)(3) 10789379 Support of affiliate Susquehanna Community Health & Dental Clinic 469-471 Hepburn Street Williamsport PA 17701 208979596 501(c)(3) 648178 Financial support Williamsport Area Ambulance Service Cooperative 700 High Street Williamsport PA 17701 232416166 501(c)(3) 500000 Support of affiliate Susquehanna Health Foundation 1205 Grampian Boulevard Williamsport PA 17701 232751183 501(c)(3) 44472 Support of affiliate 4 Schedule I, Part 1, Line 2 Susquehanna Physician Services, Williamsport Area Ambulance Service Cooperative, and Susquehanna Health Foundation are related organizations 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 Susquehanna Health System that is being converted to a Federally Qualified Health Clinic (FQHC). "Look-alike" status was received effective 12/06/11. 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. X X X X X 0 0 0 0 0 0 0 0 0 Leonard R Collins MD Director 0 243795 0 0 0 2582 0 9410 0 16549 0 272336 0 0 Kevin W Kist DO Director 0 321749 0 2313 0 55087 0 9650 0 23168 0 411967 0 0 Dr Alexander R Nesbitt Director 0 177978 0 5618 0 26176 0 11553 0 17284 0 238609 0 0 Steven P Johnson President / CEO 524745 0 0 0 14360 0 13475 0 18386 0 570966 0 0 0 Charles J Santangelo Executive Vice President / 331702 0 0 0 6706 0 9650 0 19790 0 367848 0 0 0 William C McCauley MD Sr. Vice President / Presi 376409 0 0 0 3200 0 9650 0 20700 0 409959 0 0 0 Jan E Fisher Executive Vice President / 383073 0 0 0 4895 0 9650 0 9735 0 407353 0 0 0 Ronald J Butler Executive Vice President/ 320062 0 0 0 4162 0 9650 0 5627 0 339501 0 0 0 George Manchester MD Senior VP / Medical Affairs / CMO 327534 0 0 0 8929 0 13475 0 21807 0 371745 0 0 0 Karen M Armstrong Former Sr. Vice President / CIO 242996 0 0 0 0 0 0 0 0 0 242996 0 0 0 Kenneth B Young VP / Legal Services 248992 0 0 0 584 0 9470 0 736 0 259782 0 0 0 Leo J Fitzpatrick CRNA 230869 0 0 0 811 0 8365 0 9527 0 249572 0 0 0 Timothy M Douglass CRNA 217614 0 0 0 126 0 8582 0 21816 0 248138 0 0 0 Neil G Armstrong Former Executive Vice President / CO 280339 0 0 0 57139 0 0 0 4276 0 341754 0 0 0 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 acheived 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 2014, the minimum threshold was not met that would trigger any VCIP payments. A Lycoming County Authority 236760375 550804AH1 2009-10-22 147688732 See Part VI 0 0 0 B Lycoming County Authority 236760375 NoneAvail 2011-11-21 25000000 See Part VI 0 0 0 A 153750907 10626988 11118563 53252545 2696993 76055818 2012 1 0 1 1 B 25000000 25000000 2012 0 0 1 1 A 0 0 1 1 0 0 0 1 B 0 0 1 1 0 0 0 1 A 0 0 0 1 0 0 0 0 1 B 0 0 0 1 1 1 Manufacturers And Traders Trust 7.000000000000 0 0 0 0 1 A 1 B 1 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, $147,688,732 was allocated to The Williamsport Hospital at the time of issue, while the balance of $17,445,802 was allocated to Divine Providence Hospital (EIN #24-0799343). The proceeds of the Lycoming County Authority, Series 2009A bonds were used, together with other available funds, to undertake a project consisting of (i) construction at Williamsport Hospital of a new energy services center that will allow the hospital to meet current energy demands, provide capacity to support further growth, including hot and cold water, steam, electricity, heat and air conditioning, and installation of cogeneration equipment, constuction of a new patient service tower that will expand and remodel the hospital's Emergency Department, Diagnostic Imaging Center, and surgical suites, renovation of existing duel-occupancy patient rooms into private patient rooms, and provision of new private room patient nursing unit: (ii) refunding of the outstanding amount of the issuer's hospital revenue bonds (The Williamsport Hospital Project) Series of 2008, the proceeds of which were used to provide interim financing for certain of the construction projects; (iii) refunding of the outstanding amount of issuer's hospital revenue bonds (The Williamsport Hospital Obligated Group) 1995 series, the proceeds of which were used (a) for the advance refunding of the outstanding portion of the issuer's hospital revenue bonds, Series B of 1986 and (b) to finance certain capital facilities, including reimbursement of capital expenditures. Form 990, Schedule K, Part II, Bond A, Line 3 The difference between Total Proceeds of Issue and the amount reflected in Part I, (e) is due to investment earnings of $562,175 and deposit of State RACP grant funds into the Project fund in the amount of $5,500,000. In 2007, The Williamsport Hospital applied to the Commonwealth of Pennsylvania for RACP grant money in order to pay a portion of the costs of the Project more fully noted above, which included the construction of a new energy services center. On December 6, 2011, The Williamsport Hospital was informed that the RACP Grant was approved in the amount of $5,500,000 to cover the costs of the Energy Services Center and would be distributed upon execution of the RACP Grant Agreement with the State. The Hospital received $5,362,500 of the RACP Grant Funds on December 12, 2012 and deposited them into the Project account held by the trustee for the 2009 bonds. The Hospital received the remaining $137,500 of RACP Grant Funds on May 5, 2014 and also deposited them into the Project account held by the trustee for the 2009 bonds. Form 990, Schedule K, Part I, Bond B, (f) The proceeds of the Lycoming County Authority, Series 2011, Revenue Note was used together with other available funds to undertake a project consisting of the architectural and planning expenses of a new patient service tower, replacement of the Emergency Department and Diagnostic Imaging Center, replacement of surgical suites, replacement of the Nursery and OB/GYN areas, and the addition of new private patient rooms. Form 990, Schedule K, Part II, Bond B, Line 3 The note is a draw-down obligation which was fully drawn in the amount of $25,000,000 on October 29, 2012. Form 990, Schedule K, Part IV, Bond A, Line 2c Rebate computations are performed annually, the most recent being from the issue date of October 22, 2009 to October 21, 2013. 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. 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 the 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 the 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 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. 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 or services of the corporation, and monitor and maintain the philosophy, goals and purposes for which the corporation was formed and exists. 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 increments 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 of land or buildings and the construction or demolition of building 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 of the ordinary course of business, or any transfer of any assets 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 the 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 tot he 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 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 The Board of Directors, through the Executive Compensation Committee, retains an independent outside consultant to provide guidance with respect to the annual establishment of the rebuttable presumption or reasonableness relative to executive compensation and benefits. The consultant annually provides detailed market information from its annual Executive Compensation Survey for Health Systems. In addition, other regional survey data is provided in order to supply the health system with a "national" picture of compensation. With this process established, the Executive Compensation Committee takes the proper steps to educate the Board of Directors to understand all of the above mentioned oversight and to appropriately prepare them for community or media inquiry. In addition, the Board is made aware of the Form 990 and its role in the communication of information to the public. Form 990, Part VI, Section C, line 19 The organization makes its governing documents, conflict of interest policy, and financial statements available to the public upon request. Form 990, Part XI, line 9: Change in interest of net assets of affiliate -14,616. Change in fair value interest swap 576. FORM 990, PART XII, LINE 2C The organization did not change its oversight process or selection process. 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 utilized a common paymaster which includes the following entities: Divine Providence Hospital EIN #24-0499343 Muncy Valley Hospital EIN #24-0806023 The Williamsport Hospital EIN #24-0795508 Susquehanna Health Foundation EIN #23-2743470 Susquehanna Physician Services EIN #23-2449454 Williamsport Area Ambulance Service Cooperative EIN #23-2416166 The total number of employees reported on Form W-3 would be 3,500 for Susquehanna Health System EIN #23-2751183. Of that total, 2,121 employees payroll expenses were recorded by The Susquehanna Health System. Divine Providence Hospital of the Sisters of Christian Charity 1100 Grampian Boulevard Williamsport PA 17701 240799343 Hospital PA 501(c)(3) 3 Susquehanna Health System 0 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 N/A 0 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 transports PA 501(c)(3) 9 N/A 0 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 nursing & 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 Susquehanna Health System 0 Community Basket LLC 1205 Grampian Boulevard Williamsport PA 17701 201195739 Rents real estate PA Susquehanna Health System & Susquehanna Health Foundation excluded from tax 0 0 Susquehanna Ventures Inc 1201 Grampian Boulevard Williamsport PA 17701 232470263 Pharmacy & infusion services PA N/A C 0 Susquehanna Health System Insurance Network LTD PO Box 1159 Grand Caymans CJ KY1-1102 980458722 Captive insurance company CJ N/A 0 Tyoga Carenet 15 Meade Street Wellsboro PA 16901 251810967 Integrate health care PA N/A C 0 0 1 1 0 0 0 0 0 0 1 0 1 0 0 1 0 0 1 1 Form 990, Schedule R, Part IV Susquehanna Health System Insurance Network, LTD (SHSIN), EIN #98-0458722 is a foreign corporation, incorporated under the laws of the Cayman Islands. There are no income, capital, or premium taxes levied in the Cayman Islands and SHSIN has been granted an exemption until September 2022 for any such taxes that might be introduced. SHSIN's sole shareholder, Susquehanna Health System EIN #23-2751183, is a 501 (c)(3) organization exempt from federal income taxes. SHSIN conducts no business in the United States. It files an 1120F protective filing which implies that its income is not subject to US federal income taxes.