UPMC: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- UPMC (EIN 23-2449454)
- Tax period
- 2012-07-01 to 2013-06-30
- Filed
- 2014-05-13
- IRS object ID
- 201411339349302186
- Schema version
- 2012v2.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule F
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2014-05-13T11:03:54-05:00 | Timestamp |
| Tax Period End Date | 2013-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BKD LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 910 E St Louis Street Suite 200 | AddressLine1 |
| City | Springfield | City |
| State | MO | State |
| ZIP Code | 65806 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 232449454 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Susquehanna Physician Services | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | SUSQ | NameControl |
| Phone | 5703207900 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1201 Grampian Boulevard | AddressLine1 |
| City | Williamsport | City |
| State | PA | State |
| ZIP Code | 17701 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Charles J Santangelo | Name |
| Title | Executive VP/CFO | Title |
| Phone | 5703213171 | Phone |
| Date Signed | 2014-05-13 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Brian D Todd | Name |
| PTIN | P00422601 | PTIN |
| Phone | 4178658701 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
Doing Business As DoingBusinessAs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Susquehanna Health Medical Group | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | Steven P Johnson | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 777 Rural Avenue | AddressLine1 |
| City | Williamsport | City |
| State | PA | State |
| ZIP Code | 17701 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 73830615 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | www.susquehannahealth.org | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1987 | YearFormation |
| State Legal Domicile | PA | StateLegalDomicile |
| Activity Or Mission Description | To effect a continuum of compassionate care which assures quality for our patients and value for those who provide it. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 24 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 14 | NbrIndependentVotingMembers |
| Total Nbr Employees | 609 | TotalNbrEmployees |
| Total Nbr Volunteers | 43 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 13207042 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 16375486 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 62288386 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 57437589 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 3097 | InvestmentIncomePriorYear |
| Investment Income Current Year | 12673 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 0 | OtherRevenuePriorYear |
| Other Revenue Current Year | 0 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 75498525 | TotalRevenuePriorYear |
| Total Revenue Current Year | 73825748 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 181305 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 58675258 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 58935460 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 17976175 | OtherExpensePriorYear |
| Other Expenses Current Year | 16239361 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 76832738 | TotalExpensesPriorYear |
| Total Expenses Current Year | 75174821 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -1334213 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -1349073 | RevenuesLessExpensesCY |
| Total Assets BOY | 15960966 | TotalAssetsBOY |
| Total Assets EOY | 14521972 | TotalAssetsEOY |
| Total Liabilities BOY | 10362546 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 10272625 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 5598420 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 4249347 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | Susquehanna Physician Services 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 high quality patient centered integrated delivery system. Our values are to demonstrate extraordinary CARE for those who receive our services; share ownership with those who provide our services; and be servant leaders whose behaviors are rooted in quality service, dedicated partnership, responsible stewardship, and commitment to our regional community. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 69197715 | Expense |
| Revenue | 56301158 | Revenue |
| Description | Susquehanna Physician Services (SPS) is comprised of a groupof primary care and specialty physicians. The services primarily serve Lycoming and surrounding counties. For fiscal year ended June 30, 2013there were approximately 615,750 patient visits for SPS. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 1007320 | Expense |
| Revenue | 1136431 | Revenue |
| Description | Susquehanna Physician Services operates an outpatient MRI center that services patients from Lycoming and surrounding communities. During the fiscal year ended 6/30/13 the center did 1,882 scans. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 70205035 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 0 | ReportOtherLiabilities |
| Report Fin48 Footnote | 0 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 1 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 1 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 0 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 609 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 24 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 14 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 1 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 0 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 0 | CompensationProcessCEO |
| Compensation Process Other | 0 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | PA | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Management | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 5703268756 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1201 Grampian Blvd | AddressLine1 |
| City | Williamsport | City |
| State | PA | State |
| ZIP Code | 17701 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (41 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Average Hours Per Week RelatedAverageHoursPerWeekRelated | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|---|
| Ronald V DeFeo Jr | |||||||||
| Chairperson | 1.00 | 1.00 | X | X | 0 | 0 | 0 | ||
| Ann S Pepperman Esquire | |||||||||
| Vice Chairperson | 1.00 | 1.00 | X | X | 0 | 0 | 0 | ||
| Davie Jane Gilmour Ph D | |||||||||
| Secretary | 1.00 | 1.00 | X | X | 0 | 0 | 0 | ||
| Sister Teresa Ann Jacobs | |||||||||
| Director | 1.00 | 2.00 | X | 0 | 0 | 0 | |||
| John M Burks MD | |||||||||
| director | 40.00 | 1.00 | X | 423058 | 0 | 29130 | |||
| Leonard R Collins MD | |||||||||
| Director | 40.00 | 3.00 | X | 260644 | 0 | 24456 | |||
| Ronald E DiSimone MD | |||||||||
| Director | 40.00 | 1.00 | X | 971504 | 0 | 30107 | |||
| James Douthat Ed D | |||||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||||
| Lynda Livingston | |||||||||
| Director | 1.00 | 2.00 | X | 0 | 0 | 0 | |||
| Timothy M Gage | |||||||||
| Director | 1.00 | 1.00 | X | 0 | 0 | 0 | |||
| Daniel J Glunk MD | |||||||||
| Director | 20.00 | 21.00 | X | 0 | 201627 | 6578 | |||
| Sister Joan Daniel Healy | |||||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||||
| Steven P Johnson | |||||||||
| President/CEO | 1.00 | 43.00 | X | X | 0 | 962143 | 32509 | ||
| Daniel A Klingerman | |||||||||
| Director | 1.00 | 1.00 | X | 0 | 0 | 0 | |||
| Philip H Johnson | |||||||||
| Director | 1.00 | 1.00 | X | 0 | 0 | 0 | |||
| Dr Stephen Weber | |||||||||
| Director | 40.00 | X | 300370 | 0 | 25535 | ||||
| James E Mothersbaugh | |||||||||
| Treasurer | 1.00 | 1.00 | X | X | 0 | 0 | 0 | ||
| Alexander R Nesbitt MD | |||||||||
| Director | 40.00 | 3.00 | X | 186910 | 0 | 29074 | |||
| Kevin W Kist Jr DO | |||||||||
| Director | 40.00 | 4.00 | X | 351380 | 0 | 33016 | |||
| Robert DeCamp | |||||||||
| Director | 1.00 | 3.00 | X | 0 | 0 | 0 | |||
| Walter Laibinis | |||||||||
| Director | 1.00 | 43.00 | X | 0 | 235052 | 12795 | |||
| Dr J Dennis Murray | |||||||||
| Director | 1.00 | 3.00 | X | 0 | 0 | 0 | |||
| Glenn Poirier | |||||||||
| Director | 1.00 | 3.00 | X | 0 | 0 | 0 | |||
| Charles J Santangelo | |||||||||
| Exec VP/CFO | 1.00 | 40.00 | X | 0 | 358326 | 29369 | |||
| Susan A Branton | |||||||||
| Director | 40.00 | X | 417490 | 0 | 28702 | ||||
| Rene Rigal MD | |||||||||
| Director | 40.00 | X | 346471 | 0 | 37898 | ||||
| Dr James Campbell | |||||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||||
| Melissa Welch | |||||||||
| Director | 1.00 | 3.00 | X | 0 | 0 | 0 | |||
| Paul Rooney | |||||||||
| Director | 1.00 | 1.00 | X | 0 | 0 | 0 | |||
| George Manchester MD | |||||||||
| Director | 1.00 | 40.00 | X | 0 | 354682 | 21682 | |||
| Richard Schluter | |||||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||||
| James J Turri | |||||||||
| Sr. Vice President/COO | 40.00 | 227641 | 0 | 10510 | X | ||||
| Jan E Fisher | |||||||||
| Exec VP/C00 | 0.00 | 40.00 | 0 | 333591 | 22798 | X | |||
| Ronald J Butler | |||||||||
| Exec VP/CBO | 0.00 | 40.00 | 0 | 367109 | 19857 | X | |||
| William C McCauley MD | |||||||||
| Sr. VP/President SPS | 40.00 | 403160 | 0 | 31423 | X | ||||
| Neil G Armstrong | |||||||||
| Executive Vice President/COO | 0.00 | 40.00 | 0 | 293762 | 27670 | X | |||
| Sabrina Dowd MD | |||||||||
| Physician | 40.00 | 703566 | 0 | 29939 | X | ||||
| Karla Anderson MD | |||||||||
| Physician | 40.00 | 538387 | 0 | 22570 | X | ||||
| Michael V Hoffman MD | |||||||||
| Physician | 40.00 | 626047 | 0 | 28672 | X | ||||
| Dr Edward Wyshock | |||||||||
| Physician | 40.00 | 1324069 | 0 | 28358 | X | ||||
| David C Schaefer | |||||||||
| Physician | 40.00 | 681262 | 0 | 9019 | X | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 7761959 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 3106292 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 571667 | TotalOtherCompensation |
| Number Individuals GT100 K | 107 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| Comphealth Medical Staffing | |||||
| PO Box 972651 | Dallas | TX | 75397 | Temporary Employment | 595814 |
| Susquehanna Imaging Associates | |||||
| 700 High Street | Williamsport | PA | 17701 | MRI Scans | 231500 |
| Linde Healthcare Staffing | |||||
| PO Box 915241 | Dallas | TX | 75391 | Temporary Employment | 195407 |
| LocumTenenscom | |||||
| PO Box 405547 | Atlanta | GA | 30384 | Temporary Employment | 179973 |
| The Crimson Intiative | |||||
| PO Box 79461 | Baltimore | MD | 21279 | Decision Support | 135400 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 13 | NumberOfContractorsGT100K |
| Related Organizations | 16375486 | RelatedOrganizations |
| Total Contributions | 16375486 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (5 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| Net Patient Services | 621110 | 45757365 | 45757365 |
| Inter-Entity SSA | 621110 | 7185702 | 7185702 |
| MRI Scans | 621400 | 1136431 | 1136431 |
| Capitation Payments | 621110 | 647149 | 647149 |
| Inter-Entity Revenue | 621110 | 337430 | 337430 |
Total Oth Program Service Revenue TotalOthProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 2373512 | TotalRevenueColumn |
| Related Or Exempt Function Income | 2373512 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 57437589 | TotalProgramServiceRevenue |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 17540 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 4867 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 12673 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 12673 | TotalRevenueColumn |
| Exclusion | $12,673 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 73825748 | TotalRevenueColumn |
| Related Or Exempt Function Income | 57437589 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $12,673 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3118751 | Total |
| Program Services | 2715591 | ProgramServices |
| Management And General | 403160 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 47284699 | Total |
| Program Services | 45054834 | ProgramServices |
| Management And General | 2229865 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1758114 | Total |
| Program Services | 1634109 | ProgramServices |
| Management And General | 124005 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4199525 | Total |
| Program Services | 3966759 | ProgramServices |
| Management And General | 232766 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2574371 | Total |
| Program Services | 2415521 | ProgramServices |
| Management And General | 158850 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 911410 | Total |
| Management And General | 911410 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3420 | Total |
| Management And General | 3420 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1013084 | Total |
| Program Services | 1013084 | ProgramServices |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 86004 | Total |
| Program Services | 86004 | ProgramServices |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 314036 | Total |
| Program Services | 294118 | ProgramServices |
| Management And General | 19918 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 700776 | Total |
| Program Services | 427285 | ProgramServices |
| Management And General | 273491 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2748929 | Total |
| Program Services | 2380354 | ProgramServices |
| Management And General | 368575 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 65367 | Total |
| Program Services | 51445 | ProgramServices |
| Management And General | 13922 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 351047 | Total |
| Program Services | 317193 | ProgramServices |
| Management And General | 33854 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 235637 | Total |
| Program Services | 235637 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1020844 | Total |
| Program Services | 927570 | ProgramServices |
| Management And General | 93274 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2030227 | Total |
| Program Services | 2028824 | ProgramServices |
| Management And General | 1403 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| Medical Supplies | 3059776 | 3059776 | |
| Provision For Bad Debt | 2366583 | 2366583 | |
| Books Subscriptions Due | 276951 | 237980 | 38971 |
| Minor Equipment | 108886 | 96941 | 11945 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 946384 | Total |
| Program Services | 895427 | ProgramServices |
| Management And General | 50957 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 75174821 | Total |
| Program Services | 70205035 | ProgramServices |
| Management And General | 4969786 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1146260 | BOY |
| EOY | 828560 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6217690 | BOY |
| EOY | 5780094 | EOY |
Receivables From Officers Etc ReceivablesFromOfficersEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 26121 | BOY |
| EOY | 8969 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 876919 | BOY |
| EOY | 884044 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 700000 | BOY |
| EOY | 330853 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 681036 | BOY |
| EOY | 521093 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 18073036 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 11925534 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6292083 | BOY |
| EOY | 6147502 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 20857 | BOY |
| EOY | 20857 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 15960966 | BOY |
| EOY | 14521972 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9562546 | BOY |
| EOY | 9472625 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 800000 | BOY |
| EOY | 800000 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10362546 | BOY |
| EOY | 10272625 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5598420 | BOY |
| EOY | 4249347 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5598420 | BOY |
| EOY | 4249347 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 15960966 | BOY |
| EOY | 14521972 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | -1349073 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 0 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 41973 | OtherCostOrOtherBasis |
| Book Value | 41973 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 373321 | OtherCostOrOtherBasis |
| Depreciation | 373046 | Depreciation |
| Book Value | 275 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1945985 | OtherCostOrOtherBasis |
| Depreciation | 1208826 | Depreciation |
| Book Value | 737159 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 11133945 | OtherCostOrOtherBasis |
| Depreciation | 9417099 | Depreciation |
| Book Value | 1716846 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 4577812 | OtherCostOrOtherBasis |
| Depreciation | 926563 | Depreciation |
| Book Value | 3651249 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 6147502 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Third Party Payors | Description |
| Amount | $800,000 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 800000 | TotalOfAmounts |
| Tot Revenue Etc Audited Fincl Stmt | 55083679 | TotRevenueEtcAuditedFinclStmt |
| Other Revenues | -2366583 | OtherRevenues |
| Revenue Not Rptd F990 | -2366583 | RevenueNotRptdF990 |
| Revenue Subtotal | 57450262 | RevenueSubtotal |
| Other Revenues Not Included | 16375486 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 16375486 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 73825748 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 72808238 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 72808238 | ExpensesSubtotal |
| Other Expenses Not Included | 2366583 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 2366583 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 75174821 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII (4 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| Part XI, Line 2d - Other Adjustments: | Provision for doubtful accounts |
| Part XI, Line 4b - Other Adjustments: | Transfers from affliates |
| Part XII, Line 4b - Other Adjustments: | Provision for doubtful accounts |
| Part X Line 2- Management has evaluated their income tax positions under the guidance included in ASC 740. Based on their review, management has not identified any material uncertain tax positions to be recorded or disclosed in the financial statements. Part XII Line 2d - Provision for doubtful accounts of -$2,366,583 are not included in net revenue on the audited financial statements. Part XII Line 4b- Susquehanna Physician Services received financial support from the following related entities The Williamsport Hospital & Medical Center $7,355,815 Divine Providence Hospital $6,375,321 and Muncy Valley Hospital $2,644,350. Part XIII Line 4b - Provision for doubtful accounts of $2,366,583 are not included in expenses on the audited financial statements. |
Schedule F IRS990ScheduleF
Accts Actvs Out US Table AcctsActvsOutUSTable
| Field | Value | IRS element (for citing) |
|---|---|---|
| Region | Central America | Region |
| Type Of Activities Conducted | Program Services | TypeOfActivitiesConducted |
| Specific Services Provided | Captive insurance company | SpecificServicesProvided |
| Total Expenditures | 2030227 | TotalExpenditures |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Subtotal Number Of Offices | 0 | SubtotalNumberOfOffices |
| Subtotal Number Of Employees | 0 | SubtotalNumberOfEmployees |
| Cont Number Of Offices | 0 | ContNumberOfOffices |
| Cont Number Of Employees | 0 | ContNumberOfEmployees |
| Total Number Of Offices | 0 | TotalNumberOfOffices |
| Total Number Of Employees | 0 | TotalNumberOfEmployees |
| Subtotal Amount Spent | 2030227 | SubtotalAmountSpent |
| Cont Amount Spent | 0 | ContAmountSpent |
| Total Amount Spent | 2030227 | TotalAmountSpent |
| Transfer To Foreign Corp | 0 | TransferToForeignCorp |
| Interest In Foreign Trust | 0 | InterestInForeignTrust |
| Own Foreign Corp | 0 | OwnForeignCorp |
| Passive Foreign Invest Co | 0 | PassiveForeignInvestCo |
| Foreign Partnership | 0 | ForeignPartnership |
| Boycott Countries | 0 | BoycottCountries |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 1 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 1 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (23 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| John M Burks MD | ||||||||||||||
| director | 396285 | 0 | 0 | 0 | 26773 | 0 | 9500 | 0 | 19630 | 0 | 452188 | 0 | 0 | 0 |
| Leonard R Collins MD | ||||||||||||||
| Director | 244600 | 0 | 0 | 0 | 16044 | 0 | 9500 | 0 | 14956 | 0 | 285100 | 0 | 0 | 0 |
| Ronald E DiSimone MD | ||||||||||||||
| Director | 845483 | 0 | 114684 | 0 | 11337 | 0 | 9500 | 0 | 20607 | 0 | 1001611 | 0 | 0 | 0 |
| Daniel J Glunk MD | ||||||||||||||
| Director | 0 | 183217 | 0 | 16693 | 0 | 1717 | 0 | 2899 | 0 | 3679 | 0 | 208205 | 0 | 0 |
| Steven P Johnson | ||||||||||||||
| President/CEO | 0 | 511232 | 0 | 139282 | 0 | 311629 | 0 | 13250 | 0 | 19259 | 0 | 994652 | 0 | 0 |
| Dr Stephen Weber | ||||||||||||||
| Director | 277854 | 0 | 18660 | 0 | 3856 | 0 | 12000 | 0 | 13535 | 0 | 325905 | 0 | 0 | 0 |
| Alexander R Nesbitt MD | ||||||||||||||
| Director | 174228 | 0 | 0 | 0 | 12682 | 0 | 10532 | 0 | 18542 | 0 | 215984 | 0 | 0 | 0 |
| Kevin W Kist Jr DO | ||||||||||||||
| Director | 350414 | 0 | 0 | 0 | 966 | 0 | 9500 | 0 | 23516 | 0 | 384396 | 0 | 0 | 0 |
| Walter Laibinis | ||||||||||||||
| Director | 0 | 178483 | 0 | 56569 | 0 | 0 | 0 | 5641 | 0 | 7154 | 0 | 247847 | 0 | 0 |
| Charles J Santangelo | ||||||||||||||
| Exec VP/CFO | 0 | 331316 | 0 | 19112 | 0 | 7898 | 0 | 9500 | 0 | 19869 | 0 | 387695 | 0 | 0 |
| Susan A Branton | ||||||||||||||
| Director | 344682 | 0 | 68469 | 0 | 4339 | 0 | 9500 | 0 | 19202 | 0 | 446192 | 0 | 0 | 0 |
| Rene Rigal MD | ||||||||||||||
| Director | 338594 | 0 | 0 | 0 | 7877 | 0 | 17625 | 0 | 20273 | 0 | 384369 | 0 | 0 | 0 |
| George Manchester MD | ||||||||||||||
| Director | 0 | 327809 | 0 | 21083 | 0 | 5790 | 0 | 0 | 0 | 21682 | 0 | 376364 | 0 | 0 |
| James J Turri | ||||||||||||||
| Sr. Vice President/COO | 207252 | 0 | 15644 | 0 | 4745 | 0 | 0 | 0 | 10510 | 0 | 238151 | 0 | 0 | 0 |
| Jan E Fisher | ||||||||||||||
| Exec VP/C00 | 0 | 283326 | 0 | 49437 | 0 | 828 | 0 | 10346 | 0 | 12452 | 0 | 356389 | 0 | 0 |
| Ronald J Butler | ||||||||||||||
| Exec VP/CBO | 0 | 293922 | 0 | 72441 | 0 | 746 | 0 | 13971 | 0 | 5886 | 0 | 386966 | 0 | 0 |
| William C McCauley MD | ||||||||||||||
| Sr. VP/President SPS | 376235 | 0 | 23425 | 0 | 3500 | 0 | 9500 | 0 | 21923 | 0 | 434583 | 0 | 0 | 0 |
| Neil G Armstrong | ||||||||||||||
| Executive Vice President/COO | 0 | 276505 | 0 | 14286 | 0 | 2971 | 0 | 15750 | 0 | 11920 | 0 | 321432 | 0 | 0 |
| Sabrina Dowd MD | ||||||||||||||
| Physician | 616287 | 0 | 81381 | 0 | 5898 | 0 | 9500 | 0 | 20439 | 0 | 733505 | 0 | 0 | 0 |
| Karla Anderson MD | ||||||||||||||
| Physician | 409865 | 0 | 123777 | 0 | 4745 | 0 | 9500 | 0 | 13070 | 0 | 560957 | 0 | 0 | 0 |
| Michael V Hoffman MD | ||||||||||||||
| Physician | 562020 | 0 | 58528 | 0 | 5499 | 0 | 9500 | 0 | 19172 | 0 | 654719 | 0 | 0 | 0 |
| Dr Edward Wyshock | ||||||||||||||
| Physician | 403995 | 0 | 867866 | 0 | 52208 | 0 | 9500 | 0 | 18858 | 0 | 1352427 | 0 | 0 | 0 |
| David C Schaefer | ||||||||||||||
| Physician | 675513 | 0 | 0 | 0 | 5749 | 0 | 0 | 0 | 9019 | 0 | 690281 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| Part I, Line 6 | In order for the Leadership Team to participate in the annual variable compensation program (VCIP), a minimum operating margin must be achieved for the most recently completed year on a consolidated, system-level basis. Individual goals & objectives related to the VCIP may also include individual entity operarating performance. | |
| Part III | Part I, Line 3: Susquehanna Health System (SHS), EIN # 23-2751183, a related organization, uses the following resources to establish the compensation of the top management officials; compensation committee, independent compensation consultant, written employment contract, compensation survey or study and approval by the board. | Supplemental Information |
Schedule L IRS990ScheduleL
Loan Table LoanTable
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | Dr David Schaefer | NamePerson |
| Relationship With Organization | Employed Physician | RelationshipWithOrganization |
| Purpose Of Loan | Start Up Loan | PurposeOfLoan |
| Loan From Organization | X | LoanFromOrganization |
| Original Principal | $50,000 | OriginalPrincipalAmount |
| Balance Due | 8969 | BalanceDue |
| Default | 0 | Default |
| Approved By Board | 0 | ApprovedByBoard |
| Written Agreement | 1 | WrittenAgreement |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Balance Due | 8969 | TotalBalanceDue |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (10 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| Form 990, Part VI, Section A, line 4 | On March 3, 2013 the Board of Directors of Susquehanna Physician Services were relieved of their responsibilities and replaced with the Susquehanna Health System Board of Directors. | |
| Form 990, Part VI, Section A, line 6 | Susquehanna Health System, EIN #23-2751183, is the sole member of the governing body | |
| Form 990, Part VI, Section A, line 7a | Susquehanna Health System, EIN # 23-2751183, may elect or remove members of the governing body. | |
| Form 990, Part VI, Section A, line 7b | All the business and affairs of the corporation shall be managed and controlled by the Board of Directors, subject to the oversight of the Member of the management and operation of the corporation, except that the following powers are reserved exclusively to the sole Member of the corporation, and no attempted exercise of any such powers by anyone other than the sole Member shall be valid or of any force or effect whatsoever. The sole member shall exercise its power through its Board of Directors. The Member shall have exclusive authority to exercise the following powers: A. To approve the appointment and removal of the President of the corporation. B. To elect and remove, with or without cause, a Director of the corporation. C. To establish the overall policy and long range plans of the corporation, determine or change the mission of the corporation, approve the programs, and services of the corporation, and monitor and maintain the philosophy, goals and purposes for which the corporation was formed and exists. D. To adopt, amend or repeal the Articles of Incorporation or the bylaws. E. To establish requirements for a unified budget, the approval of new capital debt, any increment to any existing capital debt, and/or any change in the capital debt obligations of the corporation. F. To establish requirements for the approval of the acquisition, purchase, sale, leasing outside the ordinary course of business, transfer outside the ordinary cause of business or encumbrance outside the normal course of business of land or buildings and the construction of demolition of buildings owned by the corporation. G. To require a certified audit of corporate funds at any time. H. To approve any guaranty of indebtedness of any person, the granting of any security interest in or the creation of any encumbrance on any asset of the corporation outside the ordinary course of business, or any transfer of any asset of the corporation outside the normal course of business, except transfers between or among affiliated corporations. I. To approve any merger, consolidation, organization, reorganization, joint venture or other modification of corporate structure or affiliations affecting to autonomy, governance or operations of the corporation. J. To dissolve or terminate the existence of the corporation and determine the distribution of assets upon such termination or dissolution, as provided in the bylaws. K. To appoint annually the external fiscal auditor of the corporation. L. To approve the nominees for elected officers of the Board of Directors of the corporation and to return the list of approved nominees to the Board of Directors for election. M. To remove any elected officer of the corporation. N. To approve the annual capital and operating budget of the corporation. O. To coordinate managed care plans, including decisions concerning entry into or renewal of ay contract or agreement relating thereto. | |
| Form 990, Part VI, Section B, line 11 | A high-level overview of Forms 990 is presented to the parent Board of Directors (Susquehanna Health System, 23-2751183) before filing and complete drafts of all returns are made available to all Board members through the CEO's and CFO's office. | |
| Form 990, Part VI, Section B, line 12c | As required by law, SPS policy states that all members of the Board of Managers must sign a statement each year disclosing any conflict of interest that may arise and agree to abstain when issues involving those parties with conflicting interests are called to motion. Any conflicts of interest are reviewed by the System's attorneys. | |
| The board of directors, through the Executive Committee, retains an independent outside consultant to provide guidance with respect to the annual establishment of the rebuttable presumption or reasonableness relative to executive compensation and benefits. The consultant annually provides detailed market information from its annual Executive Compensation Survey of Health Systems. In addition, other regional survey data is provided in order to supply the health system with a "national" picture of compensation. With this process established, the executive compensation committee takes the proper steps to educate the Board of Directors to understand all of the above mentioned oversight and to appropriately prepare them for community or media inquiry. In addition, the Board is made aware of the form 990 and its role in the communication of information to the public. | ||
| Form 990, Part VI, Section C, line 19 | The organization makes its governing documents, conflict of interest policy, and financial statements available to the public upon request. | |
| Form 990, Part V, Line 1A | All 1099's are issued by Susquehanna Health System, EIN # 23-2751183. All expenses are then allocated back to all related entities. | NUMBER REPORTED IN BOX 3 OF FORM 1096 |
| FORM 990, PART V, LINES 2A & 2B | Susquehanna Health System (SHS), EIN # 23-2751183 utilizes a common paymaster which includes the following entities: Divine Providence Hospital of the Sisters of Christian Charity, EIN # 24-0799343 Muncy Valley Hospital, EIN # 24-0806023 The Williamsport Hospital, EIN # 24-0795508 Susquehanna Health Foundation, EIN # 23-2743470 Susquehanna Physician Services, EIN # 23-2449454 Williamsport Area Ambulance Service Cooperative, EIN # 23-2416166 Providence Cancer Treatment Services, EIN # 23-2925354 The total number of employees reported on Form W-3 would be 3,482 for Susquehanna Health System. Included in that total were 609 employees whose expenses were reported by Susquehanna Physician Services. | NUMBER OF EMPLOYEES REPORTED ON FORM W-3 |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (13 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|---|---|---|---|
| The Williamsport Hospital | |||||||||||
| 777 Rural Avenue | Williamsport | PA | 17701 | 240795508 | Hospital | PA | 501 (c) (3) | Line 3 | Susquehanna Health System | 0 | |
| Divine Providence Hospital | |||||||||||
| 1100 Grampian Blvd | Williamsport | PA | 17701 | 240799343 | Hospital | PA | 501 (c) (3) | Line 3 | Susquehanna Health System | 0 | |
| Muncy Valley Hospital | |||||||||||
| 215 East Water Street | Muncy | PA | 17756 | 240806023 | hospital | PA | 501 (c) (3) | Line 3 | Susquehanna Health System | 0 | |
| Susquehanna Health Foundation | |||||||||||
| 1100 Grampian Blvd | Williamsport | PA | 17701 | 232743470 | Fundraising and affiliated activities | PA | 501 (c) (3) | Line 11a, I | Susquehanna Health System | 0 | |
| Susquehanna Health System | |||||||||||
| 1205 Grampian Blvd | Williamsport | PA | 17701 | 232751183 | Coordinate & manage the delivery of healthcare | PA | 501 (c) (3) | Line 11a, I | 0 | N/A | |
| Williamsport Area Ambulance Service Cooperative | |||||||||||
| 700 High Street | Williamsport | PA | 17701 | 232416166 | Ambulance Transports | PA | 501 (c) (3) | Line 9 | 0 | ||
| Soliders & Sailors Memorial Hospital | |||||||||||
| 32-36 Central Avenue | Wellsboro | PA | 16901 | 232176963 | Hospital | PA | 501 (c) (3) | Line 3 | Susquehanna Health System | 0 | |
| The Green Home | |||||||||||
| 37 Central Ave | Wellsboro | PA | 16901 | 240804365 | Skilled nursing & assisted living | PA | 501 (c) (3) | Line 9 | Susquehanna Health System | 0 | |
| Tioga Health Care Partners | |||||||||||
| 15 Meade Street | Wellsboro | PA | 16901 | 251765538 | Physician Services | PA | 501 (c) (3) | Line 11b, II | Susquehanna Health System | 0 | |
| Laurel Management Services | |||||||||||
| 15 Meade Street | Wellsboro | PA | 16901 | 251644910 | Mgmt consulting & supervisory services | PA | 501 (c) (3) | Line 11b, II | Susquehanna Health System | 0 | |
| Laurel Realty | |||||||||||
| 15 Meade Street | wellsboro | PA | 16901 | 231403678 | Own & manage real estate | PA | 501 (c) (2) | N/A | Susquehanna Health System | 0 | |
| Laurel Health System | |||||||||||
| 15 Meade Street | Wellsboro | PA | 16901 | 240795488 | Coordinate & manage the delivery of healthcare | PA | 501 (c) (3) | Line 11b, II | Susquehanna Health System | 0 | |
| Laurel Health Foundation | |||||||||||
| 15 Meade Street | Wellsboro | PA | 16901 | 251810488 | Fundraising and affiliated activities | PA | 501 (c) (3) | Line 11a, I | Laurel Health System | 0 | |
Form990 Schedule R Part III Form990ScheduleRPartIII
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Community Basket LLC | BusinessNameLine1 |
Address US AddressUS
| 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 Activity | Rents real estate | PrimaryActivity |
| Legal Domicile State | PA | LegalDomicileState |
| Direct Controlling Entity NA | N/A | DirectControllingEntityNA |
| Predominant Income Type | excluded from tax | PredominantIncomeType |
| Disproportionate Allocations | 0 | DisproportionateAllocations |
| General Or Managing Partner | 0 | GeneralOrManagingPartner |
Form990 Schedule R Part IV Form990ScheduleRPartIV (4 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Direct Controlling Entity NADirectControllingEntityNA | Type Of EntityTypeOfEntity | Controlled OrgControlledOrg | Address Line1AddressForeign/AddressLine1 | CityAddressForeign/City | CountryAddressForeign/Country | Postal CodeAddressForeign/PostalCode | Legal Domicile Foreign CountryLegalDomicileForeignCountry | Business Name Line1DirectControllingEntityName/BusinessNameLine1 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Susquehanna Ventures | |||||||||||||||
| 1201 Grampian Blvd | Williamsport | PA | 17701 | 232470263 | Pharmacy and infusion services | PA | N/A | C | 0 | ||||||
| Susquehanna Health System Insurance Network LTD | |||||||||||||||
| 980458722 | Captive insurance company | 0 | PO Box 1159 | Grand Caymans | CJ | KY1-1102 | CJ | Susquehanna Health System | |||||||
| Tyoga Carenet | |||||||||||||||
| 15 Meade Street | Wellsboro | PA | 16901 | 251810967 | Integrate Health Care | PA | N/A | C | 0 | ||||||
| Tioga Management Services Org | |||||||||||||||
| 15 Meade Street | Wellsboro | PA | 16901 | 232886336 | Manage Physician Practices | PA | N/A | C | 0 | ||||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | 0 | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 1 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 1 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |