2014-05-13T10:39:58-05:00 2013-06-30 BKD LLP 910 E St Louis St Springfield MO 658062523 990 2012-07-01 232416166 Williamsport Area Ambulance Service Cooperative WILL 5703207900 700 High Street Williamsport PA 17701 Charles J Santangelo 5703213171 2014-05-13 1 Brian D Todd P00422601 4178658701 2012 2015-11-30 17:44:51Z Steven P Johnson 700 High Street Williamsport PA 17701 4433273 0 X www.susquehannahealth.org X 1986 PA WAASC is a nonprofit cooperative which provides ambulance services. 11 9 76 10 7068 0 533716 548755 3593892 3884224 2000 0 0 294 4129608 4433273 0 0 0 0 2279541 2159097 0 0 0 1893580 1762236 4173121 3921333 -43513 511940 897334 1153332 517716 261774 379618 891558 X 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. 0 0 2402532 1937141 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. 967233 0 1940309 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. 3369765 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 X 0 0 1 76 1 1 1 0 0 0 0 0 0 0 0 0 X 11 9 0 0 0 0 1 1 0 1 1 0 0 0 1 1 1 1 1 0 0 0 PA X Susquehanna Health Finance Department 5703207900 1205 Grampian Blvd Williamsport PA 17701 X Joseph Neyhart 1.00 0.00 X X 0 0 0 Robert Kane 1.00 40.00 X X 0 178511 26508 Craig Kropp 1.00 0.00 X X 0 0 0 R Mark Lusk 1.00 0.00 X X 0 0 0 Gregory R Frailey 1.00 0.00 X 0 0 0 Charles Kiessling 1.00 0.00 X 0 0 0 John Bubb 1.00 40.00 X 0 89588 26698 Jeffrey Neyhart 1.00 0.00 X 0 0 0 Charles Stutzman 1.00 0.00 X 0 0 0 Jim Webb Sr 1.00 0.00 X 0 0 0 Richard Knecht 1.00 0.00 X 0 0 0 Steven P Johnson 0.00 44.00 X 0 962143 32509 Charles J Santangelo 0.00 40.00 X 0 358326 29369 Jan E Fisher 0.00 40.00 X 0 333591 22798 William C McCauley MD 0.00 40.00 X 0 403160 31423 Ronald J Butler 0.00 40.00 X 0 367109 19857 Neil G Armstrong 0.00 40.00 X 0 293762 27670 0 2986190 216832 0 0 1 0 0 9370 500000 3500 35885 548755 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 3884224 Other misc revenue 900099 294 294 294 4433273 3877450 7068 0 1751404 1523452 227952 66361 57724 8637 199888 175756 24132 141444 123327 18117 10158 10158 261531 238520 23011 1100 1100 169885 145217 24668 976 930 46 995 436 559 331948 295864 36084 2096 492 1604 2935 2107 828 134 134 125027 95700 29327 188782 71272 117510 Bad Debt Expense 512660 512660 Repairs and Maintenance 138345 125208 13137 Taxes 15664 15664 3921333 3369765 551568 0 112531 271182 457904 574321 6706 73997 964966 738285 300103 226681 20090 7151 897334 1153332 189749 246249 327967 15525 517716 261774 X 375672 883462 3946 8096 379618 891558 897334 1153332 511940 0 X X 0 1 X 1 0 X 533716 548755 1082471 3586356 3877450 7463806 4120072 4426205 8546277 0 0 0 8546277 7536 7068 14604 4127608 4433273 8560881 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 964966 738285 226681 226681 Due to Affiliates 15525 15525 X 3916463 -510860 -510860 4427323 5950 5950 4433273 3408673 0 3408673 512660 512660 3921333 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. Central America 0 1 Program Services Captive insurance company 109143 0 1 0 0 0 1 109143 0 109143 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 Robert Kane 0 162646 0 12424 0 3441 0 9123 0 17385 0 205019 0 0 Steven P Johnson 0 511232 0 139282 0 311629 0 13250 0 19259 0 994652 0 0 Charles J Santangelo 0 331316 0 19112 0 7898 0 9500 0 19869 0 387695 0 0 Jan E Fisher 0 283326 0 49437 0 828 0 10346 0 12452 0 356389 0 0 William C McCauley MD 0 376235 0 23425 0 3500 0 9500 0 21923 0 434583 0 0 Ronald J Butler 0 293922 0 72441 0 746 0 13971 0 5886 0 386966 0 0 Neil G Armstrong 0 276505 0 14286 0 2971 0 15750 0 11920 0 321432 0 0 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. 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. Number reported in Box 3 of Form 1096 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 or employees reported on Form W-3 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. 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 N/A 0 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 Community Basket LLC 1205 Grampian Blvd Williamsport PA 17701 201195739 Rents real estate PA Susquehanna Health System & Susquehanna Health Foundation excluded from tax 0 0 Susquehanna Ventures Inc 1201 Grampian Blvd Williamsport PA 17701 232470263 Pharmacy & Infusion Services PA N/A C 0 Susquehanna Health System Insurance Network LTD PO Box 1159 CJ 980458722 Captive Insurance Company CJ N/A 0 Tyoga Carenet 15 Meade Street Wellsboro PA 16901 251810967 Integrate Health Care PA N/A C 0 Tioga Management Services Org 15 Meade Street Wellsboro PA 16901 232886336 Manage Physician Practices PA N/A C 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 Form 990, Schedule R Part IV Susquehanna Health System Insurance Network, LTD (SHSIN), EIN #98-0458722 is a foreign corporation, incorporated under the laws of the Cayman Islands. There are no income, capital or premium taxes levied in the Cayman Islands and SHSIN has been granted an exemption until September 2022 for any such taxes that might be introduced. SHSIN's sole shareholder, Susquehanna Health System EIN #23-2751183, is a 501 (c)(3) organization exempt from federal income taxes. SHSIN conducts no business in the United States. It files an 1120F protective filing which implies that its income is not subject to US federal income tax.