GREEN HOME: Form 990, tax year 2013
View the entire original 990 at ProPublica ↗
- Organization
- GREEN HOME (EIN 24-0804365)
- Tax period
- 2013-07-01 to 2014-06-30
- Filed
- 2015-05-14
- IRS object ID
- 201521349349304542
- Schema version
- 2013v4.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2015-05-14T11:24:55-07:00 | ReturnTs |
| Tax Period End | 2014-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BKD LLP | BusinessNameLine1 |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 910 E St Louis/PO BOX 1190 | AddressLine1 |
| City | SPRINGFIELD | City |
| State | MO | State |
| ZIP Code | 658062523 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2013-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 240804365 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | The Green Home | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | GREE | BusinessNameControlTxt |
| Phone | 5707230603 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 37 Central Ave | AddressLine1 |
| City | Wellsboro | City |
| State | PA | State |
| ZIP Code | 16901 | ZIPCode |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | CHARLES J SANTANGELO | PersonNm |
| Person Title | EXECUTIVE VICE PRESIDENT/CFO | PersonTitleTxt |
| Phone | 5707230603 | PhoneNum |
| Signature | 2015-05-12 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | BKD LLP | PreparerPersonNm |
| Phone | 4178658701 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2013 | TaxYr |
| Build TS | 2016-02-25 16:41:14Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | JANIE HILFIGER | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 32-36 Central Ave | AddressLine1 |
| City | Wellsboro | City |
| State | PA | State |
| ZIP Code | 16901 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $10,620,776 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | susquehannahealth.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1974 | FormationYr |
| Legal Domicile State | PA | LegalDomicileStateCd |
| Activity Or Mission | The Green Home is a subsidiary of Susquehanna Health System (SHS). The mission of SHS and affiliates is as follows: To extend God's healing love by improving the health of those we serve. Our vision is to create a world-class health system. Our values are putting patients first, sharing ownership and being servant leaders. | ActivityOrMissionDesc |
| Voting Members Governing Body | 16 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 14 | VotingMembersIndependentCnt |
| Total Employee | 186 | TotalEmployeeCnt |
| Total Volunteers | 24 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $1,225 | PYContributionsGrantsAmt |
| CY Contributions Grants | $2,840 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $9,866,419 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $10,537,455 | CYProgramServiceRevenueAmt |
| PY Investment Income | $155,285 | PYInvestmentIncomeAmt |
| CY Investment Income | $25,517 | CYInvestmentIncomeAmt |
| PY Other Revenue | $4,307 | PYOtherRevenueAmt |
| CY Other Revenue | $4,677 | CYOtherRevenueAmt |
| PY Total Revenue | $10,027,236 | PYTotalRevenueAmt |
| CY Total Revenue | $10,570,489 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $6,212,722 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $6,463,107 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $3,917,249 | PYOtherExpensesAmt |
| CY Other Expenses | $4,528,457 | CYOtherExpensesAmt |
| PY Total Expenses | $10,129,971 | PYTotalExpensesAmt |
| CY Total Expenses | $10,991,564 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$102,735 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$421,075 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $7,692,041 | TotalAssetsBOYAmt |
| Total Assets EOY | $5,736,198 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $1,655,469 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $1,677,450 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $6,036,572 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $4,058,748 | NetAssetsOrFundBalancesEOYAmt |
| Mission | The Green Home is a subsidiary of | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $9,021,951 | ExpenseAmt |
| Revenue | $9,670,483 | RevenueAmt |
| Desc | THE GREEN HOME OPERATED A 120-BED SKILLED NURSING FACILITY THAT PROVIDED BOTH LONG-TERM CARE AND SHORT-TERM SERVICES FOR RESIDENTS. SERVICES PROVIDED INCLUDE ROUND-THE-CLOCK PROFESSIONAL NURSING; PHYSICAL, OCCUPATIONAL, AND SPEECH REHABILITATION SERVICES; MEDICAL SOCIAL WORK AND COUNSELING SERVICES; NUTRITION SERVICES; PODIATRY SERVICES; RADIOLOGY SERVICES; DENTISTRY; AND A VARIETY OF ACTIVITIES AND RECREATIONAL PROGRAMS. THE AVERAGE DAILY CENSUS WAS 106. THE PAYOR MIX WAS 69% MEDICAID, 15% MEDICARE AND 16% SELF-PAY RESIDENTS. REHABILITATION SERVICES PROVIDED INCLUDED 17,238 PHYSICAL THERAPY TREATMENTS, 15,866 OCCUPATIONAL THERAPY TREATMENTS AND 3,632 SPEECH THERAPY TREATMENTS. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $916,239 | ExpenseAmt |
| Revenue | $867,809 | RevenueAmt |
| Desc | THE GREEN HOME OPERATED THE LAURELS, A 30 UNIT PERSONAL CARE HOME SERVING INDIVIDUALS AGED 62 AND OLDER. THE LAURELS HAD AN OCCUPANCY RATE OF 91% WITH 100% SELF PAY RESIDENTS. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $9,938,190 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | false | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | Yes (true) | CreditCounselingInd |
| Temp Or Permanent Endowments | Yes (true) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (true) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | false | OperateHospitalInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | Yes (true) | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | false | TransactionWithControlEntInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 186 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 16 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 14 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (true) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | false | MembersOrStockholdersInd |
| Election Of Board Members | Yes (true) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (true) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | false | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Ronald M Gilbert Jr CPA | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 5707230603 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 22 Walnut St | AddressLine1 |
| City | Wellsboro | City |
| State | PA | State |
| ZIP Code | 16901 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionAGrp (22 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Key EmployeeKeyEmployeeInd |
|---|---|---|---|---|---|---|---|
| DARIUS E ABADI DO | |||||||
| Director | 1.00 | Yes (X) | $0 | $352,603 | $31,491 | ||
| JAMES D BAKER JR | |||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| R ROBERT DECAMP | |||||||
| Secretary | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| LISA V FEIL PSY D | |||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| ROBERT FITZGERALD | |||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| HAROLD F HOOSE III | |||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| WALTER J LAIBINIS DO | |||||||
| Director | 1.00 | Yes (X) | $0 | $252,873 | $14,783 | ||
| MICHAEL W LICHTY | |||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| CRAIG G LITCHFIELD | |||||||
| Treasurer | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| J DENNIS MURRAY PHD | |||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| THOMAS M OWLETT ESQ | |||||||
| Chairman | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| GLENN B POIRIER | |||||||
| Vice Chairman | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| WENDY S SWARTZ CPA | |||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| ANEURIN J WILLIAMS JR | |||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| DONNA R WILSON | |||||||
| Director | 1 | Yes (X) | |||||
| KATHY J WRIGHT PHD | |||||||
| Director | 1 | Yes (X) | |||||
| RONALD J BUTLER | |||||||
| Executive Vice President | $324,224 | $15,277 | Yes (X) | ||||
| JAN E FISHER | |||||||
| Executive Vice President | $387,968 | $19,385 | Yes (X) | ||||
| JANIE M HILFIGER | |||||||
| President | $143,686 | $27,220 | Yes (X) | ||||
| STEVEN P JOHNSON | |||||||
| President/CEO | $539,105 | $31,861 | Yes (X) | ||||
| CHARLES J SANTANGELO | |||||||
| Executive Vice President/CFO | $338,408 | $29,440 | Yes (X) | ||||
| WILLIAM C MCCAULEY MD | |||||||
| Senior Vice President | $379,609 | $30,350 | Yes (X) | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tot Reportable Comp Rltd Org | $2,718,476 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $199,807 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (2 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1 | CityContractorAddress/USAddress/City | StateContractorAddress/USAddress/State | ZIP CodeContractorAddress/USAddress/ZIPCode | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Functional Pathways | |||||
| 317 Ebenezer Road | Knoxville | TN | 37923 | Rehabilitation Services | $149,735 |
| Genesis Eldercare Rehab | |||||
| 101 East State St | Kennett Square | PA | 19348 | Rehabilitation Services | $580,290 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 2 | CntrctRcvdGreaterThan100KCnt |
| All Other Contributions | $2,840 | AllOtherContributionsAmt |
| Total Contributions | $2,840 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt |
|---|---|---|
| Skilled Nursing Care | 623000 | $9,654,700 |
| Personal Care Home | 623000 | $867,809 |
| Employee & Guest Meals | 722210 | $9,408 |
| Beauty Shop | 812900 | $5,538 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $10,537,455 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $21,275 | TotalRevenueColumnAmt |
| Exclusion | $21,275 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $3,840 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $3,840 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $3,840 | TotalRevenueColumnAmt |
| Exclusion | $3,840 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $35,029 | SecuritiesAmt |
| Other | $19,500 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $35,911 | SecuritiesAmt |
| Other | $14,376 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | -$882 | SecuritiesAmt |
| Other | $5,124 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $4,242 | TotalRevenueColumnAmt |
| Exclusion | $4,242 | ExclusionAmt |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $837 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $837 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $837 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $10,570,489 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $10,538,292 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $29,357 | ExclusionAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,787,850 | TotalAmt |
| Program Services | $4,550,600 | ProgramServicesAmt |
| Management And General | $237,250 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $208,455 | TotalAmt |
| Program Services | $198,126 | ProgramServicesAmt |
| Management And General | $10,329 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,124,264 | TotalAmt |
| Program Services | $1,069,313 | ProgramServicesAmt |
| Management And General | $54,951 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $342,538 | TotalAmt |
| Program Services | $325,564 | ProgramServicesAmt |
| Management And General | $16,974 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $633,181 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $633,181 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,130 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $14,130 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,080 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $15,080 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,823 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $1,823 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $916,974 | TotalAmt |
| Program Services | $909,403 | ProgramServicesAmt |
| Management And General | $7,571 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,565 | TotalAmt |
| Program Services | $9,016 | ProgramServicesAmt |
| Management And General | $3,549 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $340,300 | TotalAmt |
| Program Services | $310,361 | ProgramServicesAmt |
| Management And General | $29,939 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,036 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $2,036 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,142 | TotalAmt |
| Program Services | $11,966 | ProgramServicesAmt |
| Management And General | $2,176 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $510,187 | TotalAmt |
| Program Services | $508,440 | ProgramServicesAmt |
| Management And General | $1,747 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,675 | TotalAmt |
| Program Services | $8,731 | ProgramServicesAmt |
| Management And General | $2,944 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,526 | TotalAmt |
| Program Services | $6,990 | ProgramServicesAmt |
| Management And General | $536 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,087 | TotalAmt |
| Program Services | $18,087 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $286,690 | TotalAmt |
| Program Services | $286,690 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,692 | TotalAmt |
| Program Services | $10,692 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Other Expenses OtherExpensesGrp (3 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| Resident Care Supplies | $1,722,690 | $1,710,470 | $12,220 | $0 |
| Dues | $8,305 | $1,367 | $6,938 | $0 |
| Bad Debt | $2,374 | $2,374 | $0 | $0 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,991,564 | TotalAmt |
| Program Services | $9,938,190 | ProgramServicesAmt |
| Management And General | $1,053,374 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $750 | BOYAmt |
| EOY | $750 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,095,215 | BOYAmt |
| EOY | $938,468 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,262,912 | BOYAmt |
| EOY | $1,539,942 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $616,021 | BOYAmt |
| EOY | $113,205 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,661 | BOYAmt |
| EOY | $9,524 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $38,425 | BOYAmt |
| EOY | $27,761 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $10,684,455 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $7,577,907 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,084,494 | BOYAmt |
| EOY | $3,106,548 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,581,563 | BOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,692,041 | BOYAmt |
| EOY | $5,736,198 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $941,615 | BOYAmt |
| EOY | $977,921 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,842 | BOYAmt |
| EOY | $176,506 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $75,424 | BOYAmt |
| EOY | $52,426 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $627,588 | BOYAmt |
| EOY | $470,597 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,655,469 | BOYAmt |
| EOY | $1,677,450 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,036,572 | BOYAmt |
| EOY | $4,058,748 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,036,572 | BOYAmt |
| EOY | $4,058,748 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,692,041 | BOYAmt |
| EOY | $5,736,198 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$421,075 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $69,283 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$1,626,032 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consol And Sep Basis Fincl Stmt | Yes (X) | ConsolAndSepBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | Yes (X) | PubliclySupportedOrg509a2Ind |
| Public Support Total170 | $0 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY170 | 0 | PublicSupportCY170Pct |
Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $8,714 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $8,512 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $6,623 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,225 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $2,840 | CurrentTaxYearAmt |
| Total | $27,914 | TotalAmt |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $10,294,626 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $10,302,258 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $10,441,744 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $9,866,886 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $10,538,592 | CurrentTaxYearAmt |
| Total | $51,444,106 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $10,303,340 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $10,310,770 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $10,448,367 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $9,868,111 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $10,541,432 | CurrentTaxYearAmt |
| Total | $51,472,020 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $51,472,020 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $79,828 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $213,626 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | -$1,759 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $114,578 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $25,115 | CurrentTaxYearAmt |
| Total | $431,388 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $79,828 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $213,626 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | -$1,759 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $114,578 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $25,115 | CurrentTaxYearAmt |
| Total | $431,388 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $51,903,408 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.99170 | PublicSupportCY509Pct |
| Public Support PY509 | 0.99330 | PublicSupportPY509Pct |
| Investment Income CY | 0.00830 | InvestmentIncomeCYPct |
| Investment Income PY | 0.00300 | InvestmentIncomePYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Agent Trustee Etc | false | AgentTrusteeEtcInd |
| Incl Escrow Custodial Acct Liab | Yes (true) | InclEscrowCustodialAcctLiabInd |
| Explanation Provided | Yes (X) | ExplanationProvidedInd |
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $305,800 | BeginningYearBalanceAmt |
| Contributions | -$335,097 | ContributionsAmt |
| Investment Earnings Or Losses | $29,815 | InvestmentEarningsOrLossesAmt |
| Administrative Expenses | $518 | AdministrativeExpensesAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $272,788 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $34,234 | InvestmentEarningsOrLossesAmt |
| Administrative Expenses | $1,222 | AdministrativeExpensesAmt |
| End Year Balance | $305,800 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $278,971 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | -$5,086 | InvestmentEarningsOrLossesAmt |
| Administrative Expenses | $1,097 | AdministrativeExpensesAmt |
| End Year Balance | $272,788 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $254,837 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $25,237 | InvestmentEarningsOrLossesAmt |
| Administrative Expenses | $1,103 | AdministrativeExpensesAmt |
| End Year Balance | $278,971 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $243,283 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $12,619 | InvestmentEarningsOrLossesAmt |
| Administrative Expenses | $1,065 | AdministrativeExpensesAmt |
| End Year Balance | $254,837 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 1.00000 | BoardDesignatedBalanceEOYPct |
| Endowments Held Unrelated Org | false | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | Yes (true) | EndowmentsHeldRelatedOrgInd |
| Related Org List Sch R | Yes (true) | RelatedOrgListSchRInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $310,099 | OtherCostOrOtherBasisAmt |
| Book Value | $310,099 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $7,374,413 | OtherCostOrOtherBasisAmt |
| Depreciation | $4,863,742 | DepreciationAmt |
| Book Value | $2,510,671 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,682,715 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,534,868 | DepreciationAmt |
| Book Value | $147,847 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $317,228 | OtherCostOrOtherBasisAmt |
| Depreciation | $179,297 | DepreciationAmt |
| Book Value | $137,931 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $3,106,548 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| Notes Payable Affiliates - Long Term | $319,107 |
| Notes Payable Affiliates - Current | $151,490 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $470,597 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $10,637,398 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $69,283 | NetUnrealizedGainsInvstAmt |
| Revenue Not Reported | $69,283 | RevenueNotReportedAmt |
| Revenue Subtotal | $10,568,115 | RevenueSubtotalAmt |
| Other Revenues Not Included | $2,374 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $2,374 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $10,570,489 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $10,989,190 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Subtotal | $10,989,190 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $2,374 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $2,374 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $10,991,564 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Pt IV Line 2b | Security deposits and personal care account funds |
| Pt V Line 4 | The endowment funds are used to fund the mission of the organization. |
| Pt XI Line 4b | Bad Debt $2,374 |
| Pt XII Line 4b | Bad Debt $2,374 |
| Pt X Line 2 | The System companies, with the exception of SVI, CB, SHSIN, TMSO and TCN, have been recognized as exempt from income taxes under Section 501 of the Internal Revenue Code and a similar provision of state law. However, these entities are subject |
| Pt X Line 2 | to federal income tax on any unrelated business taxable income. SVI, CB, SHSIN, TMSO and TCN account for income taxes in accordance with income tax accounting guidance (ASC 740 Income Taxes). |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | false | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (8 entries)
| Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt |
|---|---|---|---|---|---|
| DARIUS E ABADI DO | |||||
| $352,103 | $500 | $14,403 | $17,088 | $384,094 | |
| WALTER J LAIBINIS DO | |||||
| $182,813 | $70,060 | $6,069 | $8,714 | $267,656 | |
| RONALD J BUTLER | |||||
| $320,062 | $9,650 | $5,627 | $339,501 | $4,162 | |
| JAN E FISHER | |||||
| $383,073 | $9,650 | $9,735 | $407,353 | $4,895 | |
| JANIE M HILFIGER | |||||
| $143,686 | $7,220 | $20,000 | $170,906 | ||
| STEVEN P JOHNSON | |||||
| $524,745 | $13,475 | $18,386 | $570,966 | $14,360 | |
| CHARLES J SANTANGELO | |||||
| $331,702 | $9,650 | $19,790 | $367,848 | $6,706 | |
| WILLIAM C MCCAULEY MD | |||||
| $376,409 | $9,650 | $20,700 | $409,959 | $3,200 | |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | SUSQUEHANNA VENTURES | PersonNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | Common officers/board members | RelationshipDescriptionTxt |
| Transaction | $338,624 | TransactionAmt |
| Transaction | Pharmacy and Infusion Services | TransactionDesc |
| Sharing Of Revenues | false | SharingOfRevenuesInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (99 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Pt VI, Line 2 | Key employee Charles Santangelo and board member Steve Johnson |
| Pt VI, Line 2 | both serve on the board of a related taxable organization. |
| Pt VI, Line 7a | Susquehanna Health System (SHS), EIN 23-2751183, may elect |
| Pt VI, Line 7a | or remove members of the governing body. |
| Pt VI, Line 7b | All the business and affairs of the Entity shall be managed |
| Pt VI, Line 7b | and controlled by the Board of Directors, subject to the oversight |
| Pt VI, Line 7b | of the sole Member, Susquehanna Health System (SHS), of the |
| Pt VI, Line 7b | management and operation of the Entity, except that the |
| Pt VI, Line 7b | following powers are reserved exclusively to the sole Member of the |
| Pt VI, Line 7b | Entity, and no attempted exercise of any such powers by anyone |
| Pt VI, Line 7b | other than the sole Member shall be valid of any force or |
| Pt VI, Line 7b | effect whatsoever. The sole Member shall exercise its powers |
| Pt VI, Line 7b | through its Board of Directors. The sole Member shall have |
| Pt VI, Line 7b | the exclusive authority to exercise the following powers: |
| Pt VI, Line 7b | A) to appoint or elect the directors B) to appoint and |
| Pt VI, Line 7b | remove the President following consultation with the Entity |
| Pt VI, Line 7b | C) to approve the nominees for elected officers and to |
| Pt VI, Line 7b | return the list of approved nominees to the governing bodies |
| Pt VI, Line 7b | for election D) to remove, with or without cause, any director |
| Pt VI, Line 7b | or any elected officer E) to amend the Governing Instruments |
| Pt VI, Line 7b | and to approve all amendments to the Governing Instruments |
| Pt VI, Line 7b | which are proposed for adoption F) to approve the annual |
| Pt VI, Line 7b | operating and capital budgets G) to establish requirements |
| Pt VI, Line 7b | for a unified budget H) to approve the incurrence or issuance of |
| Pt VI, Line 7b | debt proposed by Entity and the encumbrance of any Entity |
| Pt VI, Line 7b | assets to secure any such incurred debt I) to incur debt |
| Form 990EZ, Part I, Line 8 | EMPLOYEE & GUEST MEALS MISCELLANEOUS BEAUTY SHOP RENTAL INCOME |
| Form 990EZ, Part I, Line 16 | INSURANCE BAD DEBT PAYMENT IN LIEU OF TAXES UTILITIES MANAGEMENT FEES |
| Form 990EZ, Part II, Line 24 | ACCOUNTS RECEIVABLE - NET INVENTORIES PREPAIDS INVESTMENTS DUE FROM AFFILIATES |
| Form 990EZ, Part II, Line 26 | ACCOUNTS PAYABLE & ACCRUED EXPENSES BONDS, MORTGAGES & OTHER NOTES ESTIMATED THIRD PARTY SETTLEMENT |
| Pt VI, Line 7b | (or to cause debt to be incurred) on behalf of the Entity J) |
| Pt VI, Line 7b | to require contributions in cash or cash equivalents to |
| Pt VI, Line 7b | support the working capital needs or capital projects of any |
| Pt VI, Line 7b | one or more System Entities K) to require that any debt |
| Pt VI, Line 7b | incurred on a System-wide basis by or at the direction of SHS |
| Pt VI, Line 7b | shall be the joint and several obligation of each System |
| Pt VI, Line 7b | Entity L) to direct or approve any cash contributions or any |
| Pt VI, Line 7b | other capital contributions made by one System Entity to |
| Pt VI, Line 7b | another System Entity M) to allocate any financial resources |
| Pt VI, Line 7b | in such manner as SHS determines to be necessary N) to approve |
| Pt VI, Line 7b | the sale, transfer or other disposition of Entity or Entity |
| Pt VI, Line 7b | property unless it is made in the ordinary course of business or |
| Pt VI, Line 7b | involves assets with a fair market value of less than one |
| Pt VI, Line 7b | hundred thousand dollars O) to direct the transfer of property |
| Pt VI, Line 7b | from the Entity to one or more other System Entities P) to approve |
| Pt VI, Line 7b | of any investment of assets by Entity not within the limits |
| Pt VI, Line 7b | of the System's approved investment policy Q) to establish |
| Pt VI, Line 7b | requirements for the approval of the acquisition, purchase, |
| Pt VI, Line 7b | sale, transfer, encumberance, leasing, construction or demolition |
| Pt VI, Line 7b | of land or buildings outside the ordinary course of business |
| Pt VI, Line 7b | R) to approve any decision with respect to the addition, |
| Pt VI, Line 7b | modification or discontinuance of any patient care or |
| Pt VI, Line 7b | diagnostic program or health care service S) to approve |
| Pt VI, Line 7b | of any change in licensure of Entity; licensure of any |
| Pt VI, Line 7b | Facility; certification, registration, accreditation, permit, |
| Pt VI, Line 7b | or related approval of any activity T) to require Entity |
| Pt VI, Line 7b | to add, modify, relocate or discontinue any patient care or |
| Pt VI, Line 7b | diagnostic program or health care service U) to approve |
| Pt VI, Line 7b | or direct any merger, consolidation, organization, |
| Pt VI, Line 7b | reorganization, joint venture, corporate division, sale |
| Pt VI, Line 7b | conversion, lease or exchange of substantially all the assets, |
| Pt VI, Line 7b | dissolution, liquidation or any other modification of |
| Pt VI, Line 7b | corporate structure or affiliations affecting the autonomy, |
| Pt VI, Line 7b | governance, or operations, and the creation or acquisition |
| Pt VI, Line 7b | of any new affiliate by Entity V) to dissolve or terminate |
| Pt VI, Line 7b | the existance of Entity and to determine the distribution |
| Pt VI, Line 7b | of assets upon such termination or dissolution W) to |
| Pt VI, Line 7b | coordinate managed care plans involving Entity, including |
| Pt VI, Line 7b | decisions concerning entry into or renewal of any contract |
| Pt VI, Line 7b | or agreement relating thereto X) to develop and/or enter |
| Pt VI, Line 7b | into key strategic relationships on behalf of Entity Y) |
| Pt VI, Line 7b | to select any outside financial auditors, general legal |
| Pt VI, Line 7b | counsel or investment advisors to provide services on |
| Pt VI, Line 7b | behalf of Entity. |
| Pt VI, Line 11b | A high-level overview of Forms 990 is presented to the parent |
| Pt VI, Line 11b | Board of Directors (Susquehanna Health System, #23-2751183) |
| Pt VI, Line 11b | before filing and complete drafts of all returns are made |
| Pt VI, Line 11b | available to all Board members through the CEO's and CFO's |
| Pt VI, Line 11b | office. |
| Pt VI, Line 12c | Annually on the 1st day of January, the Susquehanna Health System CEO |
| Pt VI, Line 12c | sends to all Directors, Officers, Management staff and contracted |
| Pt VI, Line 12c | physicians a questionnaire to be completed and returned by |
| Pt VI, Line 12c | January 15. A report is submitted to the Board of Directors to notify |
| Pt VI, Line 12c | them of any conflicts of interest disclosed. |
| Pt VI, Line 15a | On a bi-annual basis an independent compensation consulting firm |
| Pt VI, Line 15b | performs an analysis of the Leadership salary structure in |
| Pt VI, Line 15b | relationship to the labor market using data from four different |
| Pt VI, Line 15b | salary surveys. Their analysis is reviewed with the Governance |
| Pt VI, Line 15b | Committee of the Board of Directors. The firm then outlines it's |
| Pt VI, Line 15b | recommendations for the proposed executive salary structure |
| Pt VI, Line 15b | to the Committee for their consideration and approval. |
| Pt VI, Line 19 | Governing documents and financial statements are available to the |
| Pt VI, Line 19 | public upon request. The conflict of interest policy is also |
| Pt VI, Line 19 | available to the public. |
| Pt XI | Line 9 comprised of Net Assets Released from Restriction $1,770, |
| Pt XI | Pension Liability adjustment $17,815 and Transfers to |
| Pt XI | Affiliates ($1,645,617). |
| Pt V, Line 1a | All 1099s were issued by Susquehanna Health System (EIN 23-2751183). |
| Pt V, Line 1a | All expenses were then allocated back to the related entities. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (14 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| Laurel Health System | ||||||||||
| 22 Walnut St | Wellsboro | PA | 16901 | 240795488 | Support entities affiliated with Laurel Health System | PA | 501(c)(3) | 11 B II | Susquehanna Health System | false |
| Laurel Management Services | ||||||||||
| 22 Walnut St | Wellsboro | PA | 16901 | 251644910 | Management consulting and supervisory services | PA | 501(c)(3) | 11 B II | Susquehanna Health System | false |
| Soldiers Sailors Memorial Hospital | ||||||||||
| 32-36 Central Ave | Wellsboro | PA | 16901 | 232176963 | Operate acute care hospital | PA | 501(c)(3) | 3 | Susquehanna Health System | false |
| Tioga Health Care Providers | ||||||||||
| 15 Meade St | Wellsboro | PA | 16901 | 251765538 | Employ physician specialists | PA | 501(c)(3) | 11 B II | Susquehanna Health System | false |
| Laurel Realty | ||||||||||
| 15 Meade St | Wellsboro | PA | 16901 | 231403678 | Own and manage real estate in support of Laurel Health | PA | 501(c)(2) | Susquehanna Health System | false | |
| Divine Providence Hospital | ||||||||||
| 1100 Grampian Blvd | Williamsport | PA | 17701 | 240799343 | HOSPITAL | PA | 501(c)(3) | 3 | Susquehanna Health System | false |
| Muncy Valley Hospital | ||||||||||
| 215 E Water St | Muncy | PA | 17756 | 240806023 | HOSPITAL | PA | 501(c)(3) | 3 | Susquehanna Health System | false |
| The Williamsport Hospital | ||||||||||
| 700 High Street | Williamsport | PA | 17701 | 240795508 | HOSPITAL | PA | 501(c)(3) | 3 | Susquehanna Health System | false |
| Susquehanna Health Foundation | ||||||||||
| 1100 Grampian Blvd | Williamsport | PA | 17701 | 232743470 | Fundraising for affiliated entities | PA | 501(c)(3) | 11 A I | Susquehanna Health System | false |
| Susquehanna Physician Services | ||||||||||
| 1201 Grampian Blvd | Williamsport | PA | 17701 | 232449454 | Physician services & MRI services | PA | 501(c)(3) | 3 | Susquehanna Health System | false |
| Williamsport Area Ambulance Service Cooperative | ||||||||||
| 700 High Street | Williamsport | PA | 17701 | 232416166 | AMBULANCE TRANSPORTS | PA | 501(c)(3) | 9 | NA | false |
| Susquehanna Health System | ||||||||||
| 1205 Grampian Blvd | Williamsport | PA | 17701 | 232751183 | Coordinate and manage the delivery of healthcare | PA | 501(c)(3) | 11 B II | NA | false |
| Laurel Health Foundation | ||||||||||
| 15 Meade St | Wellsboro | PA | 16901 | 251810488 | Fundraising for affiliated entities | PA | 501(c)(3) | 11 A I | Laurel Health System | false |
| North Penn Comprehensive Health Services | ||||||||||
| 22 Walnut St | Wellsboro | PA | 16901 | 231889724 | Provides general health and social services | PA | 501(c)(3) | 3 | Laurel Health System | false |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Community Basket LLC | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1205 Grampian Blvd | AddressLine1 |
| City | Williamsport | City |
| State | PA | State |
| ZIP Code | 17701 | ZIPCode |
| 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 | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Predominant Income Type | Excluded from tax | PredominantIncomeTypeTxt |
| Disproportionate Allocations | false | DisproportionateAllocationsInd |
| General Or Managing Partner | false | GeneralOrManagingPartnerInd |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (3 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Entity TypeEntityTypeTxt | OwnershipOwnershipPct | Controlled OrganizationControlledOrganizationInd | Address Line1ForeignAddress/AddressLine1 | CityForeignAddress/City | CountryForeignAddress/Country | Legal Domicile Foreign CountryLegalDomicileForeignCountryCd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Tyoga Carenet | ||||||||||||||
| 22 Walnut St | Wellsboro | PA | 16901 | 251810967 | INTEGRATE HEALTH CARE | PA | Laurel Health System | C | 0.00000 | false | ||||
| Susquehanna Ventures Inc | ||||||||||||||
| 1201 Grampian Blvd | Williamsport | PA | 17701 | 232470263 | Pharmacy & Infusion services | PA | Susquehanna Health System | C | 0.00000 | false | ||||
| Susquehanna Health System Insurance Network LTD | ||||||||||||||
| 980458722 | Captive Insurance Company | Susquehanna Health System | 0.00000 | false | PO Box 1159 | Grand Caymans | CJ | CJ | ||||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | false | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | Yes (true) | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (true) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | false | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (true) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (true) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |
Supplemental Information Detail SupplementalInformationDetail (16 entries)
| ExplanationExplanationTxt |
|---|
| Part III, Identification of Related Organizations Taxable as Partnership |
| Name of Related Organization: |
| Community Basket, LLC |
| Direct Controlling Entity: Susquehanna Health System & Susquehanna Health |
| Foundation |
| 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 tax. |