WILLIAMSPORT AREA AMBULANCE SERVICE COOPERATIVE: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- WILLIAMSPORT AREA AMBULANCE SERVICE COOPERATIVE (EIN 23-2416166)
- Tax period
- 2012-07-01 to 2013-06-30
- Filed
- 2014-05-13
- IRS object ID
- 201431339349302138
- 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 ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2014-05-13T10:39:58-05:00 | 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 St | AddressLine1 |
| City | Springfield | City |
| State | MO | State |
| ZIP Code | 658062523 | 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 | 232416166 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Williamsport Area Ambulance Service Cooperative | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | WILL | NameControl |
| Phone | 5703207900 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 700 High Street | 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 Vice President/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
| 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 | 700 High Street | AddressLine1 |
| City | Williamsport | City |
| State | PA | State |
| ZIP Code | 17701 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 4433273 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | www.susquehannahealth.org | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1986 | YearFormation |
| State Legal Domicile | PA | StateLegalDomicile |
| Activity Or Mission Description | WAASC is a nonprofit cooperative which provides ambulance services. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 11 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 9 | NbrIndependentVotingMembers |
| Total Nbr Employees | 76 | TotalNbrEmployees |
| Total Nbr Volunteers | 10 | TotalNbrVolunteers |
| Total Gross UBI | 7068 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 533716 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 548755 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 3593892 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 3884224 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 2000 | InvestmentIncomePriorYear |
| Investment Income Current Year | 0 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 0 | OtherRevenuePriorYear |
| Other Revenue Current Year | 294 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 4129608 | TotalRevenuePriorYear |
| Total Revenue Current Year | 4433273 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | 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 | 2279541 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 2159097 | 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 | 1893580 | OtherExpensePriorYear |
| Other Expenses Current Year | 1762236 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 4173121 | TotalExpensesPriorYear |
| Total Expenses Current Year | 3921333 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -43513 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 511940 | RevenuesLessExpensesCY |
| Total Assets BOY | 897334 | TotalAssetsBOY |
| Total Assets EOY | 1153332 | TotalAssetsEOY |
| Total Liabilities BOY | 517716 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 261774 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 379618 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 891558 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | WAASC is a subsidiary of SHS. The mission of SHS and affiliates is as follows: Our Mission-to extend God's healing love by improving the health of those we serve. Our Vision-to create a world-class health system. Our Values-putting patients first, sharing ownership and being servant leaders. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 2402532 | Expense |
| Revenue | 1937141 | Revenue |
| Description | Williamsport Area Ambulance Service Cooperative transports emergency patients in the greater Lycoming County area through the County 911 system. For FY 2013 WAASC transported 5,503 emergency patients. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 967233 | Expense |
| Grants | 0 | Grants |
| Revenue | 1940309 | Revenue |
| Description | Williamsport Area Ambulance Service Cooperative transports non-emergency patients in the greater Lycoming County area. For FY 2013 WAASC transported 6,375 non-emergency patients. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 3369765 | 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 | 1 | 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 | 0 | 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 |
| Info In Schedule O Part V | X | InfoInScheduleOPartV |
| Number Forms Transmitted With1096 | 0 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 76 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 1 | UnrelatedBusinessIncome |
| Form990-T Filed | 1 | Form990-TFiled |
| 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 | 11 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 9 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | 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 | Susquehanna Health Finance Department | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 5703207900 | TelephoneNumber |
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) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (17 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 |
|---|---|---|---|---|---|---|---|---|
| Joseph Neyhart | ||||||||
| Chairperson | 1.00 | 0.00 | X | X | 0 | 0 | 0 | |
| Robert Kane | ||||||||
| Vice Chairman | 1.00 | 40.00 | X | X | 0 | 178511 | 26508 | |
| Craig Kropp | ||||||||
| Secretary | 1.00 | 0.00 | X | X | 0 | 0 | 0 | |
| R Mark Lusk | ||||||||
| Treasurer | 1.00 | 0.00 | X | X | 0 | 0 | 0 | |
| Gregory R Frailey | ||||||||
| Director | 1.00 | 0.00 | X | 0 | 0 | 0 | ||
| Charles Kiessling | ||||||||
| Director | 1.00 | 0.00 | X | 0 | 0 | 0 | ||
| John Bubb | ||||||||
| Assistant Treasurer | 1.00 | 40.00 | X | 0 | 89588 | 26698 | ||
| Jeffrey Neyhart | ||||||||
| Director | 1.00 | 0.00 | X | 0 | 0 | 0 | ||
| Charles Stutzman | ||||||||
| Director | 1.00 | 0.00 | X | 0 | 0 | 0 | ||
| Jim Webb Sr | ||||||||
| Director | 1.00 | 0.00 | X | 0 | 0 | 0 | ||
| Richard Knecht | ||||||||
| Director | 1.00 | 0.00 | X | 0 | 0 | 0 | ||
| Steven P Johnson | ||||||||
| President/CEO | 0.00 | 44.00 | X | 0 | 962143 | 32509 | ||
| Charles J Santangelo | ||||||||
| Exec VP/CFO | 0.00 | 40.00 | X | 0 | 358326 | 29369 | ||
| Jan E Fisher | ||||||||
| Exec VP/COO | 0.00 | 40.00 | 0 | 333591 | 22798 | X | ||
| William C McCauley MD | ||||||||
| Sr. VP/President SPS | 0.00 | 40.00 | 0 | 403160 | 31423 | X | ||
| Ronald J Butler | ||||||||
| Exec VP/CBO | 0.00 | 40.00 | 0 | 367109 | 19857 | X | ||
| Neil G Armstrong | ||||||||
| Exec VP/COO thru 12/31/12 | 0.00 | 40.00 | 0 | 293762 | 27670 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 0 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 2986190 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 216832 | TotalOtherCompensation |
| Number Individuals GT100 K | 0 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
| Number Of Contractors GT100 K | 0 | NumberOfContractorsGT100K |
| Membership Dues | 9370 | MembershipDues |
| Related Organizations | 500000 | RelatedOrganizations |
| Government Grants | 3500 | GovernmentGrants |
| All Other Contributions | 35885 | AllOtherContributions |
| Total Contributions | 548755 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (5 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | Unrelated Business RevenueUnrelatedBusinessRevenue |
|---|---|---|---|---|
| Net patient revenue | 621910 | 3724448 | 3724448 | |
| Cancer Patient transpo | 621910 | 152065 | 152065 | |
| Fire company billing | 561499 | 7068 | 7068 | |
| Shale training standby | 621910 | 520 | 520 | |
| Medical records copyin | 621910 | 123 | 123 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 3884224 | TotalProgramServiceRevenue |
Other Revenue Misc OtherRevenueMisc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Other misc revenue | Description |
| Business Code | 900099 | BusinessCode |
| Total Revenue Column | 294 | TotalRevenueColumn |
| Related Or Exempt Function Income | 294 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 294 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 4433273 | TotalRevenueColumn |
| Related Or Exempt Function Income | 3877450 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 7068 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1751404 | Total |
| Program Services | 1523452 | ProgramServices |
| Management And General | 227952 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 66361 | Total |
| Program Services | 57724 | ProgramServices |
| Management And General | 8637 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 199888 | Total |
| Program Services | 175756 | ProgramServices |
| Management And General | 24132 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 141444 | Total |
| Program Services | 123327 | ProgramServices |
| Management And General | 18117 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 10158 | Total |
| Management And General | 10158 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 261531 | Total |
| Program Services | 238520 | ProgramServices |
| Management And General | 23011 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1100 | Total |
| Program Services | 1100 | ProgramServices |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 169885 | Total |
| Program Services | 145217 | ProgramServices |
| Management And General | 24668 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 976 | Total |
| Program Services | 930 | ProgramServices |
| Management And General | 46 | ManagementAndGeneral |
Royalties Royalties
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 995 | Total |
| Program Services | 436 | ProgramServices |
| Management And General | 559 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 331948 | Total |
| Program Services | 295864 | ProgramServices |
| Management And General | 36084 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2096 | Total |
| Program Services | 492 | ProgramServices |
| Management And General | 1604 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2935 | Total |
| Program Services | 2107 | ProgramServices |
| Management And General | 828 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 134 | Total |
| Management And General | 134 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 125027 | Total |
| Program Services | 95700 | ProgramServices |
| Management And General | 29327 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 188782 | Total |
| Program Services | 71272 | ProgramServices |
| Management And General | 117510 | ManagementAndGeneral |
Other Expenses OtherExpenses (3 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| Bad Debt Expense | 512660 | 512660 | |
| Repairs and Maintenance | 138345 | 125208 | 13137 |
| Taxes | 15664 | 15664 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3921333 | Total |
| Program Services | 3369765 | ProgramServices |
| Management And General | 551568 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 112531 | BOY |
| EOY | 271182 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 457904 | BOY |
| EOY | 574321 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6706 | BOY |
| EOY | 73997 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 964966 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 738285 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 300103 | BOY |
| EOY | 226681 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 20090 | BOY |
| EOY | 7151 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 897334 | BOY |
| EOY | 1153332 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 189749 | BOY |
| EOY | 246249 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 327967 | BOY |
| EOY | 15525 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 517716 | BOY |
| EOY | 261774 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 375672 | BOY |
| EOY | 883462 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3946 | BOY |
| EOY | 8096 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 379618 | BOY |
| EOY | 891558 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 897334 | BOY |
| EOY | 1153332 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | 511940 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 0 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| 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) |
|---|---|---|
| Publicly Supported Org509a2 | X | PubliclySupportedOrg509a2 |
Gifts Grants Contrib Received509 GiftsGrantsContribReceived509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus1 Year | 533716 | CurrentTaxYearMinus1Year |
| Current Tax Year | 548755 | CurrentTaxYear |
| Total | 1082471 | Total |
Gross Receipts From Admissions GrossReceiptsFromAdmissions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus1 Year | 3586356 | CurrentTaxYearMinus1Year |
| Current Tax Year | 3877450 | CurrentTaxYear |
| Total | 7463806 | Total |
Total509 Total509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus1 Year | 4120072 | CurrentTaxYearMinus1Year |
| Current Tax Year | 4426205 | CurrentTaxYear |
| Total | 8546277 | Total |
Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Amts From Subst Contributors AmtsFromSubstContributors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Support From DQ Ps Etc SupportFromDQPsEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | 8546277 | PublicSupportTotal509 |
Net Income From Other UBI NetIncomeFromOtherUBI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus1 Year | 7536 | CurrentTaxYearMinus1Year |
| Current Tax Year | 7068 | CurrentTaxYear |
| Total | 14604 | Total |
Total Support Total TotalSupportTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus1 Year | 4127608 | CurrentTaxYearMinus1Year |
| Current Tax Year | 4433273 | CurrentTaxYear |
| Total | 8560881 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| First5 Years509 | X | First5Years509 |
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
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 964966 | OtherCostOrOtherBasis |
| Depreciation | 738285 | Depreciation |
| Book Value | 226681 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 226681 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Due to Affiliates | Description |
| Amount | $15,525 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 15525 | TotalOfAmounts |
| Footnote In Part XIII | X | FootnoteInPartXIII |
| Tot Revenue Etc Audited Fincl Stmt | 3916463 | TotRevenueEtcAuditedFinclStmt |
| Other Revenues | -510860 | OtherRevenues |
| Revenue Not Rptd F990 | -510860 | RevenueNotRptdF990 |
| Revenue Subtotal | 4427323 | RevenueSubtotal |
| Other Revenues Not Included | 5950 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 5950 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 4433273 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 3408673 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 3408673 | ExpensesSubtotal |
| Other Expenses Not Included | 512660 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 512660 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 3921333 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII (4 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| Part XI, Line 2d - Other Adjustments: | Bad Debt Expense -512,660. Assets released from restriction 1,800. |
| Part XI, Line 4b - Other Adjustments: | Restricted net assets 5,950. |
| Part XII, Line 4b - Other Adjustments: | Bad Debt Expense 512,660. |
| Part X, Line 1 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. |
Schedule F IRS990ScheduleF
Accts Actvs Out US Table AcctsActvsOutUSTable
| Field | Value | IRS element (for citing) |
|---|---|---|
| Region | Central America | Region |
| Number Of Offices | 0 | NumberOfOffices |
| Number Of Employees | 1 | NumberOfEmployees |
| Type Of Activities Conducted | Program Services | TypeOfActivitiesConducted |
| Specific Services Provided | Captive insurance company | SpecificServicesProvided |
| Total Expenditures | 109143 | TotalExpenditures |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Subtotal Number Of Offices | 0 | SubtotalNumberOfOffices |
| Subtotal Number Of Employees | 1 | SubtotalNumberOfEmployees |
| Cont Number Of Offices | 0 | ContNumberOfOffices |
| Cont Number Of Employees | 0 | ContNumberOfEmployees |
| Total Number Of Offices | 0 | TotalNumberOfOffices |
| Total Number Of Employees | 1 | TotalNumberOfEmployees |
| Subtotal Amount Spent | 109143 | SubtotalAmountSpent |
| Cont Amount Spent | 0 | ContAmountSpent |
| Total Amount Spent | 109143 | 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 (7 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Robert Kane | ||||||||||||||
| Vice Chairman | 0 | 162646 | 0 | 12424 | 0 | 3441 | 0 | 9123 | 0 | 17385 | 0 | 205019 | 0 | 0 |
| Steven P Johnson | ||||||||||||||
| President/CEO | 0 | 511232 | 0 | 139282 | 0 | 311629 | 0 | 13250 | 0 | 19259 | 0 | 994652 | 0 | 0 |
| Charles J Santangelo | ||||||||||||||
| Exec VP/CFO | 0 | 331316 | 0 | 19112 | 0 | 7898 | 0 | 9500 | 0 | 19869 | 0 | 387695 | 0 | 0 |
| Jan E Fisher | ||||||||||||||
| Exec VP/COO | 0 | 283326 | 0 | 49437 | 0 | 828 | 0 | 10346 | 0 | 12452 | 0 | 356389 | 0 | 0 |
| William C McCauley MD | ||||||||||||||
| Sr. VP/President SPS | 0 | 376235 | 0 | 23425 | 0 | 3500 | 0 | 9500 | 0 | 21923 | 0 | 434583 | 0 | 0 |
| Ronald J Butler | ||||||||||||||
| Exec VP/CBO | 0 | 293922 | 0 | 72441 | 0 | 746 | 0 | 13971 | 0 | 5886 | 0 | 386966 | 0 | 0 |
| Neil G Armstrong | ||||||||||||||
| Exec VP/COO thru 12/31/12 | 0 | 276505 | 0 | 14286 | 0 | 2971 | 0 | 15750 | 0 | 11920 | 0 | 321432 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| Part I, Line 3 | The Williamsport Hospital EIN #24-0795508, a related organization, uses the following resources to establish the compensation of the top management officials: compensation committee, independent compensation consultant, written employment contract, compensation survey or study, and approval by the board. |
| Part I, Line 6 | In order for the Leadership Team to participate in the annual Variable Compensation Incentive Program (VCIP) a minimum operating margin must be acheived for the most recently completed year on a consolidated system-level basis. Individual goals and objectives related to the VCIP may also include individual entity operating performance. |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (9 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| Form 990, Part VI, Section A, line 6 | The Williamsport Hospital, Duboistown Fire Department, Old Lycoming Township Volunteer Fire Company, and South Williamsport Fire Department are members of the governing body. | |
| Form 990, Part VI, Section A, line 7a | Each member may elect or remove one or more board members to the governing body. | |
| 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 EIN #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 | All members of the Board of Directors are required to submit a statement annually disclosing any conflict of interest that may arise. Requests for the annual form are distributed individually to each Board Member by the Office of the President and CEO. The CEO's executive assistant ensures that she receives a completed form from every Board Member. All Board Members agree to abstain when any issue involving the parties with conflicting interest is called to motion. | |
| All top management is employed by The Williamsport Hospital EIN #24-0795508. The following paragraph describes the process they use. The Board of Directors, through the Executive Compensation Committee, retains an independent outside consultant to provide guidance with respect to the annual establishment of the rebuttable presumption or reasonableness relative to executive compensation and benefits. The consultant annually provides detailed market information from its annual Executive Compensation Survey for Health Systems. In addition, other regional survey data is provided in order to supply the health system with a "national" picture of compensation. With this process established, the Executive Compensation Committee takes the proper steps to educate the Board of Directors to understand all of the above-mentioned oversight and to appropriately prepare them for community or media inquiry. In addition, the Board is made aware of the Form 990 and its role in the communication of information to the public. | ||
| Form 990, Part VI, Section C, line 19 | The organization makes its governing documents, conflict of interest policy, and financial statements available to members of the public who request them. They would be produced by the Corporate office. | |
| Form 990, Part XII, Line 2c | The organization did not change its oversight process or selection process. | |
| Form 990, Part V, Line 1a | All 1099's are issued by Susquehanna Health System EIN #23-2751183. All expenses are then allocated back to all related entities. | Number reported in Box 3 of Form 1096 |
| Form 990, Part V, Line 2a & 2b | Susquehanna Health System EIN #23-2751183 untilizes a common paymaster which includes the following entities: Divine Providence Hospital 24-0799343 Muncy Valley Hospital 24-0806023 The Williamsport Hospital 24-0795508 Susquehanna Health Foundation 23-2743470 Susquehanna Physician Services 23-2449454 Williamsport Area Ambulance Service Cooperative 23-2416166 The total number of employees reported on Form W-3 would be 3482 for Susquehanna Health System 23-2751183. Of that total, 76 employees payroll expenses were recorded by Williamsport Area Ambulance Service Cooperative 23-2416166. | Number or 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Divine Providence Hospital of the Sisters of Christian Charity | |||||||||||
| 1100 Grampian Blvd | Williamsport | PA | 17701 | 240799343 | Hospital | PA | 501(c)(3) | Line 3 | Susquehanna Health System | 0 | |
| Muncy Valley Hospital | |||||||||||
| 215 E Water Street | Muncy | PA | 17756 | 240806023 | Hospital | PA | 501(c)(3) | Line 3 | Susquehanna Health System | 0 | |
| The Williamsport Hospital | |||||||||||
| 700 High Street | Williamsport | PA | 17701 | 240795508 | Hospital | PA | 501(c)(3) | Line 3 | Susquehanna Health System | 0 | |
| Susquehanna Health Foundation | |||||||||||
| 1100 Grampian Blvd | Williamsport | PA | 17701 | 232743470 | Fundraising for Affiliated entities | 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 11b, II | 0 | N/A | |
| Susquehanna Physician Services | |||||||||||
| 1201 Grampian Blvd | Williamsport | PA | 17701 | 232449454 | Physician services & MRI services | PA | 501(c)(3) | Line 3 | Susquehanna Health System | 0 | |
| Soldiers & Sailors Memorial Hospital | |||||||||||
| 32-36 Central Ave | 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 Providers | |||||||||||
| 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 svcs | 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 for Affiliated entities | 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 Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Susquehanna Health System & Susquehanna Health Foundation | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 | CountryAddressForeign/Country | Legal Domicile Foreign CountryLegalDomicileForeignCountry |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Susquehanna Ventures Inc | ||||||||||||
| 1201 Grampian Blvd | Williamsport | PA | 17701 | 232470263 | Pharmacy & Infusion Services | PA | N/A | C | 0 | |||
| Susquehanna Health System Insurance Network LTD | ||||||||||||
| 980458722 | Captive Insurance Company | N/A | 0 | PO Box 1159 | CJ | CJ | ||||||
| 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 | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | 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 |
Form990 Schedule R Part VII Form990ScheduleRPartVII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Reference | Form 990, Schedule R Part IV | ReturnReference |
| Explanation | Susquehanna Health System Insurance Network, LTD (SHSIN), EIN #98-0458722 is a foreign corporation, incorporated under the laws of the Cayman Islands. There are no income, capital or premium taxes levied in the Cayman Islands and SHSIN has been granted an exemption until September 2022 for any such taxes that might be introduced. SHSIN's sole shareholder, Susquehanna Health System EIN #23-2751183, is a 501 (c)(3) organization exempt from federal income taxes. SHSIN conducts no business in the United States. It files an 1120F protective filing which implies that its income is not subject to US federal income tax. | Explanation |