Tioga Health Care Providers Inc: Form 990, tax year 2013
View the entire original 990 at ProPublica ↗
- Organization
- Tioga Health Care Providers Inc (EIN 25-1765538)
- Tax period
- 2013-07-01 to 2014-06-30
- Filed
- 2015-05-15
- IRS object ID
- 201521359349302902
- 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 | 2015-05-15T07:45:41-07:00 | 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 | 251765538 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TIOGA HEALTH CARE PROVIDERS | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | TIOG | BusinessNameControlTxt |
| 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 |
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 | 2014-10-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | BRIAN D TODD | 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 | 22 WALNUT ST | AddressLine1 |
| City | WELLBSORO | City |
| State | PA | State |
| ZIP Code | 16901 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $8,750,513 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | LAURELHS.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1995 | FormationYr |
| Legal Domicile State | PA | LegalDomicileStateCd |
| Activity Or Mission | Tioga Health Care Providers is a subsidiary of Susquehanna Health System (SHS.) The mission of SHS is as follows: To extend God's healing love by improving the health of those we serve. Our visions 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 | 60 | TotalEmployeeCnt |
| Total Volunteers | 14 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| CY Contributions Grants | $0 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $8,136,969 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $8,608,252 | CYProgramServiceRevenueAmt |
| CY Investment Income | $10,853 | CYInvestmentIncomeAmt |
| CY Other Revenue | $131,408 | CYOtherRevenueAmt |
| PY Total Revenue | $8,136,969 | PYTotalRevenueAmt |
| CY Total Revenue | $8,750,513 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $39,388 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $7,355,292 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $9,181,695 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $2,634,735 | PYOtherExpensesAmt |
| CY Other Expenses | $2,387,649 | CYOtherExpensesAmt |
| PY Total Expenses | $10,029,415 | PYTotalExpensesAmt |
| CY Total Expenses | $11,569,344 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$1,892,446 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$2,818,831 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $1,777,505 | TotalAssetsBOYAmt |
| Total Assets EOY | $2,354,066 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $8,845,316 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $12,240,708 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | -$7,067,811 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | -$9,886,642 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | Tioga Health Care Providers is a subsidiary of | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $2,401,107 | ExpenseAmt |
| Revenue | $2,350,928 | RevenueAmt |
| Desc | TIOGA HEALTH CARE PROVIDERS EMERGENCY ROOM PHYSICIANS SAW 17,698 EMERGENCY ROOM PATIENTS. MEDICARE, MEDICAL ASSISTANCE, SELF-PAY, AND COMMERCIAL CHARGES AMOUNTED TO 34%, 20%, 11%, AND 35% RESPECTIVELY OF TOTAL CHARGES. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $1,940,238 | ExpenseAmt |
| Revenue | $1,439,349 | RevenueAmt |
| Desc | TIOGA HEALTH CARE PROVIDERS INTERNAL MEDICINE PRACTICE HAD 10,123 VISITS. AND PERFORMED 886 ENDOSCOPIES. MEDICARE, MEDICAL ASSISTANCE, SELF-PAY, AND COMMERCIAL CHARGES AMOUNTED TO 45%, 1%, 8%, AND 46% RESPECTIVELY OF TOTAL CHARGES. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $1,849,292 | ExpenseAmt |
| Revenue | $780,872 | RevenueAmt |
| Desc | TIOGA HEALTH CARE PROVIDERS SURGICAL SERVICES PERFORMED 457 SURGERIES, 210 ENDOSCOPIES, AND 203 OTHER PROCEDURES. THERE WERE PATIENT 2,192 VISITS. MEDICARE, MEDICAL ASSISTANCE, SELF-PAY, AND COMMERCIAL CHARGES AMOUNTED TO 32%, 3%, 3%, AND 62% RESPECTIVELY OF TOTAL CHARGES. | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp (2 entries)
| ExpenseExpenseAmt | RevenueRevenueAmt | DescDesc |
|---|---|---|
| $5,121,759 | $4,037,103 | There are five other practices providing services: An anesthesia practice performed 3,104 procedures. An anesthesia practice performed 3,104 procedures. An anesthesia practice performed 3,104 procedures. An anesthesia practice performed 3,104 procedures. An anesthesia practice performed 3,104 procedures. An anesthesia practice performed 3,104 procedures. |
| 4,964 chiropractic treatments. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $5,121,759 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Revenue | $4,037,103 | TotalOtherProgSrvcRevenueAmt |
| Total Program Service Expenses | $11,312,396 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | false | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Temp Or Permanent Endowments | false | 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 | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | false | OperateHospitalInd |
| Grants To Organizations | 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 | false | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | false | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | Yes (true) | TrnsfrExmptNonChrtblRltdOrgInd |
| 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 | 60 | 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 |
| Excess Business Holdings | false | ExcessBusinessHoldingsInd |
| 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 | Yes (true) | 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 GILBERT JR | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 5707230603 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 22 WALNUT STREET | AddressLine1 |
| City | WELLSBORO | City |
| State | PA | State |
| ZIP Code | 16901 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionAGrp (25 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| DARIUS E ABADI DO | ||||||||
| Director | 41.00 | Yes (X) | $352,603 | $0 | $31,491 | |||
| JAMES D BAKER JR | ||||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| RONALD J BUTLER | ||||||||
| Executive Vice President | 0.00 | $0 | $324,224 | $15,277 | Yes (X) | |||
| R ROBERT DECAMP | ||||||||
| Secretary | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| LISA V FEIL PSYD | ||||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| ROBERT P FITZGERALD | ||||||||
| 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 | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| KATHY J WRIGHT PHD | ||||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| JANIE M HILFIGER | ||||||||
| Director/President | 1.00 | $0 | $143,686 | $27,220 | Yes (X) | |||
| HAROLD F HOOSE III | ||||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| WALTER J LAIBINIS DO | ||||||||
| Director | 41 | Yes (X) | $252,873 | $14,783 | ||||
| MICHAEL W LICHTY | ||||||||
| Director | 1 | Yes (X) | ||||||
| CRAIG G LITCHFIELD | ||||||||
| Treasurer | 1 | Yes (X) | Yes (X) | |||||
| J DENNIS MURRAY PH D | ||||||||
| Director | 1 | Yes (X) | ||||||
| STEVEN P JOHNSON | ||||||||
| President/CEO | 0 | $539,105 | $31,861 | Yes (X) | ||||
| CHARLES SANTANGELO | ||||||||
| Executive Vice President/CFO | 0 | $338,408 | $29,440 | Yes (X) | ||||
| WILLIAM C MCCAULEY MD | ||||||||
| Executive Vice President/CMO | 0 | $379,609 | $30,350 | Yes (X) | ||||
| JAN E FISHER | ||||||||
| Executive Vice President/COO | 0 | $387,968 | $19,385 | Yes (X) | ||||
| DONALD GOLOBEK | ||||||||
| Orthopedic Physician | 40 | $627,007 | $18,960 | Yes (X) | ||||
| EDWARD HESS | ||||||||
| Surgeon | 40 | $390,200 | $19,433 | Yes (X) | ||||
| RICHARD THOMPSON | ||||||||
| Anesthesiologist | 40 | $346,022 | $36,454 | Yes (X) | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,584,670 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $2,113,000 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $332,845 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 22 | 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 |
|---|---|---|---|---|---|
| Practice Management Advisors | |||||
| 850 Grove St | Orwigsburg | PA | 17961 | Billing Services | $320,910 |
| Comphealth Medical Staffing | |||||
| PO Box 972651 | Dallas | TX | 75397 | Locum Services | $266,262 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 2 | CntrctRcvdGreaterThan100KCnt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt |
|---|---|---|
| Internal Medicine | 621111 | $1,439,349 |
| OB/GYN | 621111 | $1,035,212 |
| Emergency Department | 621111 | $2,350,928 |
| Anesthesia | 621111 | $983,825 |
| Orthopedic Services | 621111 | $975,745 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,823,193 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $8,608,252 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $10,853 | TotalRevenueColumnAmt |
| Exclusion | $10,853 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Unused STD | Desc |
| Business | 621111 | BusinessCd |
| Total Revenue Column | $131,408 | TotalRevenueColumnAmt |
| Exclusion | $131,408 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $131,408 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $8,750,513 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $8,608,252 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $142,261 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $631,278 | TotalAmt |
| Program Services | $631,278 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,152,659 | TotalAmt |
| Program Services | $7,147,329 | ProgramServicesAmt |
| Management And General | $5,330 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $327,241 | TotalAmt |
| Program Services | $327,167 | ProgramServicesAmt |
| Management And General | $74 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $698,433 | TotalAmt |
| Program Services | $638,971 | ProgramServicesAmt |
| Management And General | $59,462 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $372,084 | TotalAmt |
| Program Services | $371,910 | ProgramServicesAmt |
| Management And General | $174 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $550 | TotalAmt |
| Program Services | $550 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $186,434 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $186,434 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,007 | TotalAmt |
| Program Services | $2,007 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $55,517 | TotalAmt |
| Program Services | $54,811 | ProgramServicesAmt |
| Management And General | $706 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $49,627 | TotalAmt |
| Program Services | $49,467 | ProgramServicesAmt |
| Management And General | $160 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $256,120 | TotalAmt |
| Program Services | $256,120 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,764 | TotalAmt |
| Program Services | $3,764 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $56,266 | TotalAmt |
| Program Services | $56,266 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $39,928 | TotalAmt |
| Program Services | $39,725 | ProgramServicesAmt |
| Management And General | $203 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $576,706 | TotalAmt |
| Program Services | $575,506 | ProgramServicesAmt |
| Management And General | $1,200 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| Bad Debt | $810,551 | $810,551 | $0 | $0 |
| Medical Supplies & Drugs | $223,927 | $223,927 | $0 | $0 |
| Utilities | $47,688 | $47,688 | $0 | $0 |
| Dues & Subscriptions | $29,690 | $28,272 | $1,418 | $0 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $48,874 | TotalAmt |
| Program Services | $47,087 | ProgramServicesAmt |
| Management And General | $1,787 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,569,344 | TotalAmt |
| Program Services | $11,312,396 | ProgramServicesAmt |
| Management And General | $256,948 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part X | Yes (X) | InfoInScheduleOPartXInd |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $804,119 | BOYAmt |
| EOY | $1,240,027 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $745,434 | BOYAmt |
| EOY | $717,308 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $94,760 | BOYAmt |
| EOY | $105,608 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $544,967 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $342,421 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $133,192 | BOYAmt |
| EOY | $202,546 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $88,577 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,777,505 | BOYAmt |
| EOY | $2,354,066 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $605,313 | BOYAmt |
| EOY | $749,401 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,240,003 | BOYAmt |
| EOY | $11,491,307 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,845,316 | BOYAmt |
| EOY | $12,240,708 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$7,067,811 | BOYAmt |
| EOY | -$9,886,642 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$7,067,811 | BOYAmt |
| EOY | -$9,886,642 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,777,505 | BOYAmt |
| EOY | $2,354,066 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$2,818,831 | ReconcilationRevenueExpnssAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | Yes (X) | SupportingOrganization509a3Ind |
| Supporting Org Type2 | Yes (X) | SupportingOrgType2Ind |
| Certification | Yes (X) | CertificationInd |
| Contribution Controller | false | ContributionControllerInd |
| Contribution Family | false | ContributionFamilyInd |
| Contribution35 Controlled | false | Contribution35ControlledInd |
Supported Org Information SupportedOrgInformationGrp
Supported Organization Name SupportedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Soldiers and Sailors Memorial Hospital | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 232176963 | EIN |
| Organization Type | 501(c)(3) | OrganizationTypeDesc |
| Governing Document Listed | Yes (true) | GoverningDocumentListedInd |
| Supported Org Notified | Yes (true) | SupportedOrgNotifiedInd |
| US Organized | Yes (true) | USOrganizedInd |
| Support | $1 | SupportAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supported Organizations Total | 1 | SupportedOrganizationsTotalCnt |
| Support Sum | $1 | SupportSumAmt |
| 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 |
| Public Support Total509 | $0 | PublicSupportTotal509Amt |
| Public Support CY509 | 0 | PublicSupportCY509Pct |
| Investment Income CY | 0 | InvestmentIncomeCYPct |
Schedule D IRS990ScheduleD
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $544,967 | OtherCostOrOtherBasisAmt |
| Depreciation | $342,421 | DepreciationAmt |
| Book Value | $202,546 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $202,546 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| Medical Legal Liability Cost | $60,000 |
| Due to Affiliates | $11,431,307 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $11,491,307 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $7,939,962 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | -$810,551 | OtherRevenueAmt |
| Revenue Not Reported | -$810,551 | RevenueNotReportedAmt |
| Revenue Subtotal | $8,750,513 | RevenueSubtotalAmt |
| Total Revenue Per Form990 | $8,750,513 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $10,758,793 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Subtotal | $10,758,793 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $810,551 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $810,551 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $11,569,344 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Pt X Line 2 | Management has evaluated their income tax positions under the guidance included in ASC 740. Based on that review, management has not identified any material uncertain tax positions to be recorded or disclosed in the financial statements. |
| Pt XI Line 2d | Bad Debt |
| Pt XII Line 4b | Bad Debt |
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 | Yes (true) | 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 (13 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|
| DARIUS E ABADI DO | |||||||||
| $352,103 | $500 | $10,578 | $17,088 | $380,269 | |||||
| RONALD J BUTLER | |||||||||
| $320,062 | $4,162 | $9,650 | $5,627 | $339,501 | |||||
| JANIE M HILFIGER | |||||||||
| $143,686 | $5,029 | $20,000 | $168,715 | ||||||
| WALTER J LAIBINIS DO | |||||||||
| $182,813 | $70,060 | $6,069 | $8,714 | $267,656 | |||||
| STEVEN P JOHNSON | |||||||||
| $524,745 | $14,360 | $13,475 | $18,386 | $570,966 | |||||
| CHARLES SANTANGELO | |||||||||
| $331,702 | $6,706 | $9,650 | $19,790 | $367,848 | |||||
| WILLIAM C MCCAULEY MD | |||||||||
| $376,409 | $3,200 | $9,650 | $20,700 | $409,959 | |||||
| JAN E FISHER | |||||||||
| $383,073 | $4,895 | $9,650 | $9,735 | $407,353 | |||||
| DONALD GOLOBEK | |||||||||
| $627,007 | $15,048 | $3,912 | $645,967 | ||||||
| EDWARD HESS | |||||||||
| $390,200 | $15,608 | $405,808 | |||||||
| RICHARD THOMPSON | |||||||||
| $346,022 | $12,111 | $20,519 | $378,652 | ||||||
| CHADWICK LEO | |||||||||
| $280,715 | $40,000 | $3,528 | $17,602 | $341,845 | |||||
| EDWARD BELLINGER | |||||||||
| $295,250 | $11,810 | $17,603 | $324,663 | ||||||
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Pt I Line 6a | FormAndLineReferenceDesc |
| Explanation | Bonuses may be paid to a physician contingent upon the practice's net income. The practice's net income is determined from total charges less contractual adjustments less practice expense. A Physician's compensation may be increased by an amount equal to the excess net income. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (101 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Pt VI, Line 1a | All 1099s were issued by Susquehanna Health System EIN 23-2751183. |
| Pt VI, Line 1a | All expenses are then allocated back to all related entities. |
| 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 6 | The THCP Corporation is organized upon a nonstock basis |
| Pt VI, Line 6 | and has a sole corporate member. |
| Pt VI, Line 7a | The Members have the power to elect and remove the Board of |
| Pt VI, Line 7a | Directors of the THCP Corporation. The Bylaws do not address the |
| Pt VI, Line 7a | powers and authorities of the Board of Directors. |
| 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 |
| Pt VI, Line 7b | oversight of the sole member, Susquehanna Health System |
| Pt VI, Line 7b | (SHS), of the management and operation of the Entity, except |
| Pt VI, Line 7b | that the following powers are reserved and exclusively to the |
| Pt VI, Line 7b | sole member of the Entity, and no attempted exercise of any |
| Pt VI, Line 7b | such powers by anyone other than the sole member shall |
| Pt VI, Line 7b | be valid of any force or effect whatsoever. The sole member |
| Pt VI, Line 7b | shall exercise its powers through its Board of Directors. |
| Pt VI, Line 7b | The sole member shall have the exclusive authority to |
| Pt VI, Line 7b | exercise the following powers: A) to appoint or elect the |
| Pt VI, Line 7b | directors B) to appoint and remove the President following |
| Pt VI, Line 7b | consultation with the Entity C) to approve the nominees for |
| Pt VI, Line 7b | elected officers and to return the list of approved nominees |
| Pt VI, Line 7b | to the governing bodies for election D) to remove, with |
| Form 990, Part III, Line 4d | THERE ARE FIVE OTHER PRACTICES PROVIDING SERVICES: 5121759. 0. 4037103. 4,964 CHIROPRACTIC TREATMENTS. 0. 0. 0. |
| Form 990, Part IX, Line 24f | INVENTORY ADJUSTMENTS 100. 100. INTER-ENTITY FOOD SALES 322. 322. MINOR EQUIP/FURNITURE 6970. 6970. UNIFORMS 70. 70. GROUNDS 1050. 1050. BANK FEES 41. 15. 26. LICENSES/FEES 10808. 10762. 46. MEDICAL NON-PHYS 950. 950. INTER-ENTITY-HSKPG-TIOGA 15422. 15422. REPAIRS 1847. 1847. REPAIRS-EQUIPMENT 3975. 3975. TAXES 7319. 5604. 1715. |
| Pt VI, Line 7b | or without cause, any director or any elected officer E) to amend |
| Pt VI, Line 7b | the governing instruments and to approve all ammendments |
| Pt VI, Line 7b | to the governing instruments which are proposed for |
| Pt VI, Line 7b | adoption F) to approve the annual operating and capital |
| Pt VI, Line 7b | budgets G) to establish requirements for a unified budget |
| Pt VI, Line 7b | H) to approve the incurrence or issuance of debt proposed |
| Pt VI, Line 7b | by Entity and the encumberance of any Entity assets to |
| Pt VI, Line 7b | secure any such incurred debt I) to incur debt (or to cause |
| Pt VI, Line 7b | debt to be incurred) on behalf of the Entity J) to require |
| Pt VI, Line 7b | contributions in cash or cash equivalents to support the |
| Pt VI, Line 7b | working capital needs or capital projects of any one or |
| Pt VI, Line 7b | more System Entities K) to require that any debt incurred |
| Pt VI, Line 7b | on a System-wide basis by or at the direction of SHS shall |
| Pt VI, Line 7b | be the joint and several obligation of each System Entity |
| Pt VI, Line 7b | L) to direct or approve any cash contributions or any other |
| Pt VI, Line 7b | capital contributions made by on System entity to another |
| Pt VI, Line 7b | System entity M) to allocate any financial resources in such |
| Pt VI, Line 7b | manner as SHS determines to be necessary N) to approve the |
| Pt VI, Line 7b | sale, transfer or other disposition of entity or entity |
| Pt VI, Line 7b | property unless it is made in the ordinary course of |
| Pt VI, Line 7b | business or involves assets with a fair market value of |
| Pt VI, Line 7b | less than one hundred thousand dollars O) to direct the |
| Pt VI, Line 7b | transfer of property from the entity to one or more other |
| Pt VI, Line 7b | System entities P) to approve of any investment of assets |
| Pt VI, Line 7b | by entity not within the limits of the System's approved |
| Pt VI, Line 7b | investment policy Q) to establish requirements for the |
| Pt VI, Line 7b | approval of the acquisition, purchase, sale, transfer, |
| Pt VI, Line 7b | encumberance, leasing, construction or demolition of land |
| Pt VI, Line 7b | or buildings outside the ordinary course or business R) |
| Pt VI, Line 7b | 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, |
| Pt VI, Line 7b | permit, or related approval of any activity T) to require |
| Pt VI, Line 7b | entity to add, modify, relocate or discontinue any patient |
| Pt VI, Line 7b | care or diagnostic program or health care service U) to |
| Pt VI, Line 7b | approve 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 |
| Pt VI, Line 7b | assets, dissolution, liquidation or any other modification |
| Pt VI, Line 7b | of corporate structure or affiliations affecting the autonomy, |
| Pt VI, Line 7b | goverance, or operations, and the creation or acquistion |
| Pt VI, Line 7b | of any new affiliates by entity V) to dissolve or terminate |
| Pt VI, Line 7b | the existence 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 | Members of the Board of Directors of Susquehanna Health System are provided a copy |
| Pt VI, Line 11b | of the form 990 prior to filing. The CFO reviews the Form 990 with the |
| Pt VI, Line 11b | Finance Committee of the Board of Directors and responds to any questions. |
| Pt VI, Line 11b | Subsequent to the meeting, the Finance Comittee then recommends to the |
| Pt VI, Line 11b | Board of Directors that the Form 990 be approved for filing. |
| Pt VI, Line 12c | Annually, on the 1st of January, Susquehanna Health sends to all |
| Pt VI, Line 12c | directors, officers, management staff and contracted physicians |
| Pt VI, Line 12c | a questionnaire to be completed and returned by January 15. |
| Pt VI, Line 12c | 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 | See line below. |
| Pt VI, Line 15b | On a bi-annual basis an independent compensation consulting firm performs |
| Pt VI, Line 15b | an analysis of the leadership salary structure in relationship |
| Pt VI, Line 15b | to the labor market using data from four different salary |
| Pt VI, Line 15b | surveys. Their analysis is reviewed with the Governance |
| Pt VI, Line 15b | Committee of the Board of Directors. The firm then outlines |
| Pt VI, Line 15b | its recommendations for the proposed executive salary |
| Pt VI, Line 15b | structure to the Committee for their consideration and approval. |
| Pt VI, Line 19 | Governing documents and financial statements are available to the public |
| Pt VI, Line 19 | upon request. The conflict of interest policy is also available upon request. |
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 Inc | ||||||||||
| 22 Walnut St | Wellsboro | PA | 16901 | 240795488 | Support entitities affiliated with Laurel Health | PA | 501(c)(3) | 11(b)(II) | Susquehanna Health System | false |
| Laurel Realty | ||||||||||
| 22 Walnut St | Wellsboro | PA | 16901 | 231403678 | Own and manage real estate in support of Laurel Health | PA | 501(c)(2) | N/A | 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 |
| Susquehanna Health System | ||||||||||
| 1205 Grampian Blvd | Williamsport | PA | 17701 | 232751183 | Coordinate & manage the delivery of healthcare | PA | 501(c)(3) | 11 B II | NA | false |
| The Green Home | ||||||||||
| 37 Central Ave | Wellsboro | PA | 16901 | 240804365 | Operate skilled nursing & assisted living facility | PA | 501(c)(3) | 9 | Susquehanna Health System | false |
| Divine Providence Hospital | ||||||||||
| 110 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 St | 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 Health St | Williamsport | PA | 17701 | 232416166 | AMBULANCE TRANSPORTS | PA | 501(c)(3) | 9 | NA | false |
| Laurel Health Foundation | ||||||||||
| 22 Walnut St | Wellsboro | PA | 16901 | 251810488 | Fundraising for affiliated entities | PA | 501(c)(3) | 11 A I | Susquehanna Health System | false |
| North Penn Comprehensive Health Services | ||||||||||
| 22 Walnut St | Wellsboro | PA | 16901 | 231889724 | Provide general health and social service programs | 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 | Controlled OrganizationControlledOrganizationInd | Address Line1ForeignAddress/AddressLine1 | CityForeignAddress/City | CountryForeignAddress/Country | Legal Domicile Foreign CountryLegalDomicileForeignCountryCd | OwnershipOwnershipPct |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Tyoga Carenet | ||||||||||||||
| 114 East Avenue | Wellsboro | PA | 16901 | 251810967 | Intergrate Health care regionally | PA | Laurel Health System | C | false | |||||
| Susquehanna Health System Insurance Network LTD | ||||||||||||||
| 980458722 | Captive Insurance Company | Susquehanna Health System | false | PO Box 1159 | Grand Caymans | CJ | CJ | 0.00000 | ||||||
| Susquehanna Ventures Inc | ||||||||||||||
| 1201 Grampian Blvd | Williamsport | PA | 17701 | 232470263 | Pharmacy & Infusion Services | PA | Susquehanna Health System | C | false | 0.00000 | ||||
| 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 | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | Yes (true) | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (true) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (true) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | false | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | false | SharingOfFacilitiesInd |
| Paid Employees Sharing | false | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (true) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp
Other Organization Name OtherOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Laurel Realty | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | j | TransactionTypeTxt |
| Involved | $232,315 | InvolvedAmt |
| Method Of Amount Determination | Market Value | MethodOfAmountDeterminationTxt |
Supplemental Information Detail SupplementalInformationDetail (16 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | 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. |