UPMC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization: UPMC (EIN 24-0806023)
Tax period: 2011-07-01 to 2012-06-30
Filed: 2013-05-02
IRS object ID: 201311229349300546
Schema version: 2011v1.2
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 C
Schedule D
Schedule F
Schedule G
Schedule H
Schedule I
Schedule J
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Timestamp	2013-05-02T12:03:52-05:00	Timestamp
Tax Period End Date	2012-06-30	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	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	2011-07-01	TaxPeriodBeginDate

Filer Filer

Field	Value	IRS element (for citing)
EIN	240806023	EIN

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	Muncy Valley Hospital	BusinessNameLine1

Field	Value	IRS element (for citing)
Name Control	MUNC	NameControl
Phone	5703207900	Phone

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	215 East Water Street	AddressLine1
City	Muncy	City
State	PA	State
ZIP Code	17756	ZIPCode

Officer Officer

Field	Value	IRS element (for citing)
Name	Charles J Santangelo	Name
Title	Executive Vice President / CFO	Title
Phone	5703207900	Phone
Date Signed	2013-05-02	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	2011	TaxYear
Build TS	2016-02-25 16:41:14Z	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	117643675	GrossReceipts
Group Return For Affiliates	0	GroupReturnForAffiliates
Organization501c3	X	Organization501c3
Web Site	www.susquehannahealth.org	WebSite
Type Of Organization Corporation	X	TypeOfOrganizationCorporation
Year Formation	1922	YearFormation
State Legal Domicile	PA	StateLegalDomicile
Activity Or Mission Description	Muncy Valley Hospital (MVH) is a 25 bed, critical access hospital, primarily serving Lycoming and surrounding counties. MVH also provides a full range of outpatient and emergency services, as well as, 139 hospital based Long Term Care beds.	ActivityOrMissionDescription
Nbr Voting Members Governing Body	12	NbrVotingMembersGoverningBody
Nbr Independent Voting Members	9	NbrIndependentVotingMembers
Total Nbr Employees	363	TotalNbrEmployees
Total Nbr Volunteers	140	TotalNbrVolunteers
Total Gross UBI	0	TotalGrossUBI
Net Unrelated Business Txbl Income	0	NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year	32176	ContributionsGrantsPriorYear
Contributions Grants Current Year	1000164	ContributionsGrantsCurrentYear
Program Service Revenue Prior Year	43579973	ProgramServiceRevenuePriorYear
Program Service Revenue CY	44236972	ProgramServiceRevenueCY
Investment Income Prior Year	463188	InvestmentIncomePriorYear
Investment Income Current Year	1071491	InvestmentIncomeCurrentYear
Other Revenue Prior Year	96801	OtherRevenuePriorYear
Other Revenue Current Year	278565	OtherRevenueCurrentYear
Total Revenue Prior Year	44172138	TotalRevenuePriorYear
Total Revenue Current Year	46587192	TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year	1993292	GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY	2030802	GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year	0	BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY	0	BenefitsPaidToMembersCY
Salaries Etc Prior Year	15967499	SalariesEtcPriorYear
Salaries Etc Current Year	15692078	SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year	0	TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY	0	TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year	2221	TotalFundrsngExpCurrentYear
Other Expense Prior Year	21322007	OtherExpensePriorYear
Other Expenses Current Year	23461576	OtherExpensesCurrentYear
Total Expenses Prior Year	39282798	TotalExpensesPriorYear
Total Expenses Current Year	41184456	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	4889340	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	5402736	RevenuesLessExpensesCY
Total Assets BOY	37511605	TotalAssetsBOY
Total Assets EOY	41704225	TotalAssetsEOY
Total Liabilities BOY	4571061	TotalLiabilitiesBOY
Total Liabilities EOY	3594973	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	32940544	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	38109252	NetAssetsOrFundBalancesEOY
Info In Schedule O Part III	X	InfoInScheduleOPartIII
Mission Description	Muncy Valley Hospital (MVH) 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	36085070	Expense
Grants	2030802	Grants
Revenue	44395403	Revenue
Description	During the fiscal year ended June 30, 2012, the Hospital admitted 755 acute care patients, rendering 4,670 patient days and registered approximately 53,003 outpatients. Long Term Care days totaled 46,733.	Description

Activity2 Activity2

Field	Value	IRS element (for citing)
Description	MVH treats all patients without regard to their ability to pay. In addition, the Hospital treats Medicare and Medical Assistance patients and maintains a Medicare / Medical Assistance policy that provides patients enrolled in such programs with access to all covered inpatient, outpatient and diagnostic services that are available to non-Medicare / Medical Assistance patients.	Description

Activity3 Activity3

Field	Value	IRS element (for citing)
Description	On an annual basis, MVH devotes a portion of its revenue and assets to community program services. The following reflects the breakout of $4,443,229 in quantifiable community benefits reported for FY 2012: Charity Care (at cost) $201,913; Bad Debt (at cost) $1,003,763; Government-sponsored health care (unpaid cost of Medicare, Medicaid, indigent care programs, SCHIP and other safety net programs) $3,173,000. In addition, various other programs such as Research, Health Professions Education, Community Building, Financial and In-Kind Contributions and Community Benefit Operations totaling $64,553.	Description

Field	Value	IRS element (for citing)
Total Program Service Expense	36085070	TotalProgramServiceExpense
Described In501 C3	1	DescribedIn501C3
Schedule B Required	1	ScheduleBRequired
Political Activities	0	PoliticalActivities
Lobbying Activities	1	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	1	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	1	FundraisingActivities
Gaming	0	Gaming
Hospital	1	Hospital
Financial Stmt Attached	1	FinancialStmtAttached
Grants To Organizations	1	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
Transaction Related Entity	0	TransactionRelatedEntity
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	4	NumberFormsTransmittedWith1096
Number W2 G Included	0	NumberW2GIncluded
Compliance With Backup Witholding	1	ComplianceWithBackupWitholding
Number Of Employees	363	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	12	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	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	5703207900	TelephoneNumber

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	1205 Grampian Boulevard	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 (18 entries)

TitleTitle	Average Hours Per WeekAverageHoursPerWeek	Individual Trustee Or DirectorIndividualTrusteeOrDirector	OfficerOfficer	Reportable Comp From OrganizationReportableCompFromOrganization	Reportable Comp From Related OrgsReportableCompFromRelatedOrgs	Other CompensationOtherCompensation	Key EmployeeKeyEmployee	Highest Compensated EmployeeHighestCompensatedEmployee
Daniel C Berninger
Chair	1.00	X	X	0	0	0
Geneva Peck
Vice Chair	1.00	X	X	0	0	0
Robert E More
Secretary	1.00	X	X	0	0	0
Roger D Jarrett
Treasurer	1.00	X	X	0	0	0
Dr Mark Beyer
Director	1.00	X		0	0	0
Sister Teresa Ann Jacobs
Director	1.00	X		0	0	0
Dr Kevin Kist
Director	1.00	X		0	342044	25034
Paul Moulton
Director	1.00	X		0	0	0
Dale Stebner
Director	1.00	X		0	0	0
Dr Peter B Trevouledes
Director	1.00	X		0	0	0
Steven E Yordy MD
Director	1.00	X		0	183880	26221
Steven P Johnson
President / CEO	1.00	X	X	0	635348	96200
Charles J Santangelo
Executive Vice President/CFO	1.00		X	0	317516	27276
Christine A Ballard
MVH President / VP Operati	40.00		X	147786	0	14413
Neil G Armstrong
Executive Vice President/COO	1.00			0	271346	25747	X
George A Manchester MD
Executive Vice President/CMO	1.00			0	314240	34427	X
Margaret M Austin
Registered Nurse	40.00			108097	0	13523		X
Anne E Holladay
Nursing Home Administrator	40.00			102779	0	6379		X

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	358662	TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs	2064374	TotalReportableCompFrmRltdOrgs
Total Other Compensation	269220	TotalOtherCompensation
Number Individuals GT100 K	3	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
Susquehanna Health System
1001 Grampian Boulevard	Williamsport	PA	17701	Management services	3897121
Aramark Healthcare
PO Box 33170	Newark	NJ	01788	Management / environmental services	3132505
Alexander Building Construction LLC
315 Vaughn Street	Harrisburg	PA	17110	Construction services	1186490
Sundance Rehabilitation
6549 Paysphere Circle	Chicago	IL	60674	Therapy services	883155
Emcare Inc
7032 Collection Center Drive	Chicago	IL	60693	ER management services	389064

Field	Value	IRS element (for citing)
Number Of Contractors GT100 K	12	NumberOfContractorsGT100K
Fundraising Events	6335	FundraisingEvents
Related Organizations	918637	RelatedOrganizations
Government Grants	65889	GovernmentGrants
All Other Contributions	9303	AllOtherContributions
Total Contributions	1000164	TotalContributions

Program Service Revenue ProgramServiceRevenue (4 entries)

DescriptionDescription	Business CodeBusinessCode	Total Revenue ColumnTotalRevenueColumn	Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome
Net patient service re	621990	42850336	42850336
Supplemental payments	623000	1250479	1250479
Affiliate rental incom	621990	103559	103559
Sports Medicine - athl	621990	32598	32598

Field	Value	IRS element (for citing)
Total Program Service Revenue	44236972	TotalProgramServiceRevenue

Investment Income InvestmentIncome

Field	Value	IRS element (for citing)
Total Revenue Column	236405	TotalRevenueColumn
Exclusion	$236,405	ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

Field	Value	IRS element (for citing)
Securities	68948390	Securities
Other	2931000	Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

Field	Value	IRS element (for citing)
Securities	68628668	Securities
Other	2415636	Other

Gain Or Loss GainOrLoss

Field	Value	IRS element (for citing)
Securities	319722	Securities
Other	515364	Other

Net Gain Or Loss Investments NetGainOrLossInvestments

Field	Value	IRS element (for citing)
Total Revenue Column	835086	TotalRevenueColumn
Exclusion	$835,086	ExclusionAmount

Field	Value	IRS element (for citing)
Gross Income Fundraising Events	43880	GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events	6335	CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses	12179	FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

Field	Value	IRS element (for citing)
Total Revenue Column	31701	TotalRevenueColumn
Exclusion	$31,701	ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescription	Business CodeBusinessCode	Total Revenue ColumnTotalRevenueColumn	Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome	ExclusionExclusionAmount
EHR - Meaningful Use	900099	150000	150000
Cafeteria	624200	72916		$72,916
Television	900099	7446		$7,446

Miscellaneous Revenue MiscellaneousRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	16502	TotalRevenueColumn
Related Or Exempt Function Income	8431	RelatedOrExemptFunctionIncome
Exclusion	$8,071	ExclusionAmount

Field	Value	IRS element (for citing)
Total Other Revenue	246864	TotalOtherRevenue

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	46587192	TotalRevenueColumn
Related Or Exempt Function Income	44395403	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	0	UnrelatedBusinessRevenue
Exclusion	$1,191,625	ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

Field	Value	IRS element (for citing)
Total	2030802	Total
Program Services	2030802	ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

Field	Value	IRS element (for citing)
Total	162199	Total
Management And General	162199	ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

Field	Value	IRS element (for citing)
Total	12364240	Total
Program Services	11883983	ProgramServices
Management And General	478486	ManagementAndGeneral
Fundraising	1771	Fundraising

Pension Plan Contributions PensionPlanContributions

Field	Value	IRS element (for citing)
Total	486343	Total
Program Services	461931	ProgramServices
Management And General	24343	ManagementAndGeneral
Fundraising	69	Fundraising

Other Employee Benefits OtherEmployeeBenefits

Field	Value	IRS element (for citing)
Total	1767000	Total
Program Services	1691995	ProgramServices
Management And General	74753	ManagementAndGeneral
Fundraising	252	Fundraising

Payroll Taxes PayrollTaxes

Field	Value	IRS element (for citing)
Total	912296	Total
Program Services	866503	ProgramServices
Management And General	45664	ManagementAndGeneral
Fundraising	129	Fundraising

Fees For Services Management FeesForServicesManagement

Field	Value	IRS element (for citing)
Total	3897121	Total
Management And General	3897121	ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

Field	Value	IRS element (for citing)
Total	2000	Total
Program Services	2000	ProgramServices

Fees For Services Lobbying FeesForServicesLobbying

Field	Value	IRS element (for citing)
Total	6306	Total
Management And General	6306	ManagementAndGeneral

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

Field	Value	IRS element (for citing)
Total	55770	Total
Management And General	55770	ManagementAndGeneral

Fees For Services Other FeesForServicesOther

Field	Value	IRS element (for citing)
Total	6426377	Total
Program Services	6288866	ProgramServices
Management And General	137511	ManagementAndGeneral

Advertising Advertising

Field	Value	IRS element (for citing)
Total	4510	Total
Program Services	2358	ProgramServices
Management And General	2152	ManagementAndGeneral

Office Expenses OfficeExpenses

Field	Value	IRS element (for citing)
Total	5082795	Total
Program Services	5020709	ProgramServices
Management And General	62086	ManagementAndGeneral

Information Technology InformationTechnology

Field	Value	IRS element (for citing)
Total	136056	Total
Program Services	133710	ProgramServices
Management And General	2346	ManagementAndGeneral

Royalties Royalties

Field	Value	IRS element (for citing)
Total	23118	Total
Program Services	23103	ProgramServices
Management And General	15	ManagementAndGeneral

Occupancy Occupancy

Field	Value	IRS element (for citing)
Total	786345	Total
Program Services	711092	ProgramServices
Management And General	75253	ManagementAndGeneral

Travel Travel

Field	Value	IRS element (for citing)
Total	14859	Total
Program Services	12994	ProgramServices
Management And General	1865	ManagementAndGeneral

Conferences Meetings ConferencesMeetings

Field	Value	IRS element (for citing)
Total	29385	Total
Program Services	24206	ProgramServices
Management And General	5179	ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

Field	Value	IRS element (for citing)
Total	1535839	Total
Program Services	1535839	ProgramServices

Insurance Insurance

Field	Value	IRS element (for citing)
Total	550090	Total
Program Services	550090	ProgramServices

Other Expenses OtherExpenses (4 entries)

DescriptionDescription	TotalTotal	Program ServicesProgramServices	Management And GeneralManagementAndGeneral
Bad Debt Expense	2769213	2769213
Miscellaneous	1428486	1364807	63679
Repairs & maintenance	701127	698690	2437
Auxiliary activity	12179	12179

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	41184456	Total
Program Services	36085070	ProgramServices
Management And General	5097165	ManagementAndGeneral
Fundraising	2221	Fundraising

Savings And Temp Cash Investments SavingsAndTempCashInvestments

Field	Value	IRS element (for citing)
BOY	7997891	BOY
EOY	6430910	EOY

Accounts Receivable AccountsReceivable

Field	Value	IRS element (for citing)
BOY	5232980	BOY
EOY	5385690	EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	484184	EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

Field	Value	IRS element (for citing)
BOY	154763	BOY
EOY	124648	EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

Field	Value	IRS element (for citing)
BOY	137071	BOY
EOY	139170	EOY

Field	Value	IRS element (for citing)
Land Buildings Equipment Basis	38451537	LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec	26272859	LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

Field	Value	IRS element (for citing)
BOY	13853913	BOY
EOY	12178678	EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

Field	Value	IRS element (for citing)
BOY	10005153	BOY
EOY	14705309	EOY

Other Assets Total OtherAssetsTotal

Field	Value	IRS element (for citing)
BOY	129834	BOY
EOY	2255636	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	37511605	BOY
EOY	41704225	EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Field	Value	IRS element (for citing)
BOY	2826935	BOY
EOY	2465896	EOY

Other Liabilities OtherLiabilities

Field	Value	IRS element (for citing)
BOY	1744126	BOY
EOY	1129077	EOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	4571061	BOY
EOY	3594973	EOY

Field	Value	IRS element (for citing)
Follow SFAS117	X	FollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	32622097	BOY
EOY	37816175	EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	106575	BOY
EOY	83542	EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	211872	BOY
EOY	209535	EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	32940544	BOY
EOY	38109252	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	37511605	BOY
EOY	41704225	EOY

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	X	InfoInScheduleOPartXI
Reconcilation Revenue Expenses	5402736	ReconcilationRevenueExpenses
Reconcilation Other Changes	-234028	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
Audit Committee	1	AuditCommittee
Financial Statement Consolidated	X	FinancialStatementConsolidated
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 C IRS990ScheduleC

Field	Value	IRS element (for citing)
Volunteers	0	Volunteers
Paid Staff Or Management	0	PaidStaffOrManagement
Media Advertisements	0	MediaAdvertisements
Mailings Members	0	MailingsMembers
Publications Or Broadcast	0	PublicationsOrBroadcast
Grants Other Organizations	1	GrantsOtherOrganizations
Grants Other Organizations	$6,306	GrantsOtherOrganizationsAmount
Direct Contact Legislators	0	DirectContactLegislators
Rallies Demonstrations	0	RalliesDemonstrations
Other Activities	0	OtherActivities
Total Lobbying Expenditures IIB	6306	TotalLobbyingExpendituresIIB
Not Described In501c3	0	NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

Field	Value	IRS element (for citing)
Identifier	Explanation of Lobbying Activities:	Identifier
Return Reference	Part II-B, Line 1:	ReturnReference
Explanation	The Hospital holds memberships in the American Hospital Association, (AHA) and the Hospital Association of Pennsylvania, (HAP) both of which engage in lobbying as part of their mission to represent the interests of hospitals at both the Federal and State levels. For the year ended 06/30/12, the amount of dues paid to HAP totaled $11,201 of which 25.04% or $2,805, was used for lobbying purposes. Dues paid to AHA totaled $14,232, of which 24.6% or $3,501, was used for lobbying purposes. On occasion, HAP requests the help of member providers to communicate concerns to legislators regarding pending legislation which could impact hospitals. This can involve direct contact with legislators or letter-writing. This occurs infrequently, and the cost to the Hospital is negligible.	Explanation

Schedule D IRS990ScheduleD

Land Land

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	390346	OtherCostOrOtherBasis
Book Value	390346	BookValue

Buildings Buildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	21635306	OtherCostOrOtherBasis
Depreciation	14894578	Depreciation
Book Value	6740728	BookValue

Leasehold Improvements LeaseholdImprovements

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	15678	OtherCostOrOtherBasis
Depreciation	15678	Depreciation
Book Value	0	BookValue

Equipment Equipment

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	15007466	OtherCostOrOtherBasis
Depreciation	10988716	Depreciation
Book Value	4018750	BookValue

Other Land Buildings OtherLandBuildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	1402741	OtherCostOrOtherBasis
Depreciation	373887	Depreciation
Book Value	1028854	BookValue

Field	Value	IRS element (for citing)
Total Of Book Value Land Buildings	12178678	TotalOfBookValueLandBuildings

Other Assets OtherAssets (3 entries)

DescriptionDescription	Book ValueBookValue
Other receivables	273705
Interest in net affiliates	73783
Due from affiliates, net	1908148

Field	Value	IRS element (for citing)
Total Book Value Other Assets	2255636	TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescription	AmountAmount
Estimated third party settlements	$969,077
Estimated medical legal liability costs	$160,000

Field	Value	IRS element (for citing)
Total Of Amounts	1129077	TotalOfAmounts
Total Revenue	46587192	TotalRevenue
Total Expenses	41184456	TotalExpenses
Excess Or Deficit For Year	5402736	ExcessOrDeficitForYear
Net Unrealized GL On Investments	-204508	NetUnrealizedGLOnInvestments
Other	-$29,520	OtherAmount
Total Adjustments	-234028	TotalAdjustments
Excess Or Deficit Per FS	5168708	ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt	43571772	TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments	-204508	NetUnrealizedGainsInvestments
Other Revenues	-2810912	OtherRevenues
Revenue Not Rptd F990	-3015420	RevenueNotRptdF990
Revenue Subtotal	46587192	RevenueSubtotal
Revenue Not Rptd On Fin Stmt	0	RevenueNotRptdOnFinStmt
Total Revenue Per Form990	46587192	TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt	38432584	TotExpensesEtcAuditedFinclStmt
Other Expenses Included	29520	OtherExpensesIncluded
Expenses Not Rptd F990	29520	ExpensesNotRptdF990
Expenses Subtotal	38403064	ExpensesSubtotal
Other Expenses Not Included	2781392	OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt	2781392	ExpensesNotRptdOnFinStmt
Total Expenses Per Form990	41184456	TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (5 entries)

IdentifierIdentifier	ExplanationExplanation
Part XI, Line 8 - Other Adjustments:	Change in interest in net assets of affiliate -29,520.
Part XII, Line 2d - Other Adjustments:	Change in interest of net assets of affiliates -29,520. Bad Debt expense -2,769,213. MVH Auxiliary -12,179.
Part XIII, Line 2d - Other Adjustments:	Change in interest in net assets of affiliate 29,520.
Part XIII, Line 4b - Other Adjustments:	Bad Debt expense 2,769,213. MVH Auxiliary 12,179.
	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	481289	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	481289	SubtotalAmountSpent
Cont Amount Spent	0	ContAmountSpent
Total Amount Spent	481289	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 G IRS990ScheduleG

Events Information EventsInformation

Field	Value	IRS element (for citing)
Name Of Event1	Lawn Party	NameOfEvent1
Gross Receipts Event1	35898	GrossReceiptsEvent1
Gross Revenue Event1	35898	GrossRevenueEvent1
Other Direct Expenses Event1	9231	OtherDirectExpensesEvent1
Name Of Event2	Lights of Love	NameOfEvent2
Gross Receipts Event2	6335	GrossReceiptsEvent2
Charitable Contributions Event2	6335	CharitableContributionsEvent2
Other Direct Expenses Event2	305	OtherDirectExpensesEvent2
Total Number Of Other Events	7	TotalNumberOfOtherEvents
Gross Receipts Other Events	7982	GrossReceiptsOtherEvents
Gross Revenue Other Events	7982	GrossRevenueOtherEvents
Other Direct Expenses Other Events	2643	OtherDirectExpensesOtherEvents
Gross Receipts Total	50215	GrossReceiptsTotal
Charitable Contributions Total	6335	CharitableContributionsTotal
Gross Revenue Total Events	43880	GrossRevenueTotalEvents
Other Direct Expenses Total Events	12179	OtherDirectExpensesTotalEvents
Direct Expense Summary Events	12179	DirectExpenseSummaryEvents
Net Income Summary	31701	NetIncomeSummary

Schedule H IRS990ScheduleH

Field	Value	IRS element (for citing)
Charity Care Policy	1	CharityCarePolicy
Written Policy	1	WrittenPolicy
Policy Applied To All Hospitals	X	PolicyAppliedToAllHospitals
FPG Reference Free Care	1	FPGReferenceFreeCare
Pcent200	X	Pcent200
FPG Reference Discounted Care	1	FPGReferenceDiscountedCare
Pcent300	X	Pcent300
Free Disc Care Medically Indigent	1	FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care	1	AmountsBudgetedForCharityCare
Expenses Exceeded Budget	1	ExpensesExceededBudget
Unable To Provide Care	0	UnableToProvideCare
Annual Community Benefit Report	1	AnnualCommunityBenefitReport
Report Publically Available	1	ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

Field	Value	IRS element (for citing)
Total Community Benefit Expense	201877	TotalCommunityBenefitExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Benefit Expense	201877	NetCommunityBenefitExpense
Percent Of Total Expense	0.00490	PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

Field	Value	IRS element (for citing)
Total Community Benefit Expense	10673751	TotalCommunityBenefitExpense
Direct Offsetting Revenue	8532484	DirectOffsettingRevenue
Net Community Benefit Expense	2141267	NetCommunityBenefitExpense
Percent Of Total Expense	0.05200	PercentOfTotalExpense

Unreimbursed Costs UnreimbursedCosts

Field	Value	IRS element (for citing)
Total Community Benefit Expense	0	TotalCommunityBenefitExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue

Total Charity Care TotalCharityCare

Field	Value	IRS element (for citing)
Total Community Benefit Expense	10875628	TotalCommunityBenefitExpense
Direct Offsetting Revenue	8532484	DirectOffsettingRevenue
Net Community Benefit Expense	2343144	NetCommunityBenefitExpense
Percent Of Total Expense	0.05690	PercentOfTotalExpense

Community Health Services CommunityHealthServices

Field	Value	IRS element (for citing)
Total Community Benefit Expense	9404	TotalCommunityBenefitExpense
Direct Offsetting Revenue	715	DirectOffsettingRevenue
Net Community Benefit Expense	8689	NetCommunityBenefitExpense
Percent Of Total Expense	0.00020	PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

Field	Value	IRS element (for citing)
Total Community Benefit Expense	2240	TotalCommunityBenefitExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Benefit Expense	2240	NetCommunityBenefitExpense
Percent Of Total Expense	0.00010	PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

Field	Value	IRS element (for citing)
Total Community Benefit Expense	1835	TotalCommunityBenefitExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Benefit Expense	1835	NetCommunityBenefitExpense
Percent Of Total Expense	0.00000	PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

Field	Value	IRS element (for citing)
Total Community Benefit Expense	9313	TotalCommunityBenefitExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Benefit Expense	9313	NetCommunityBenefitExpense
Percent Of Total Expense	0.00020	PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

Field	Value	IRS element (for citing)
Total Community Benefit Expense	22792	TotalCommunityBenefitExpense
Direct Offsetting Revenue	715	DirectOffsettingRevenue
Net Community Benefit Expense	22077	NetCommunityBenefitExpense
Percent Of Total Expense	0.00050	PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

Field	Value	IRS element (for citing)
Total Community Benefit Expense	10898420	TotalCommunityBenefitExpense
Direct Offsetting Revenue	8533199	DirectOffsettingRevenue
Net Community Benefit Expense	2365221	NetCommunityBenefitExpense
Percent Of Total Expense	0.05740	PercentOfTotalExpense

Workforce Development WorkforceDevelopment

Field	Value	IRS element (for citing)
Total Community Building Expense	2474	TotalCommunityBuildingExpense
Net Community Building Expense	2474	NetCommunityBuildingExpense
Percent Of Total Expense	0.00010	PercentOfTotalExpense

Total Total

Field	Value	IRS element (for citing)
Total Community Building Expense	2474	TotalCommunityBuildingExpense
Net Community Building Expense	2474	NetCommunityBuildingExpense
Percent Of Total Expense	0.00010	PercentOfTotalExpense

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	1	BadDebtExpenseReported
Bad Debt Expense	$2,769,213	BadDebtExpenseAmount
Amount Attributable To	304613	AmountAttributableTo
Amount Reimbursed By Medicare	11915836	AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare	12947369	CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall	-1031533	MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

Field	Value	IRS element (for citing)
Cost Accounting System	X	CostAccountingSystem

Field	Value	IRS element (for citing)
Written Debt Collection Policy	1	WrittenDebtCollectionPolicy
Provision For Charity Care	1	ProvisionForCharityCare
Number Of Hospital Facilities	1	NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

Field	Value	IRS element (for citing)
Facility Number	1	FacilityNumber

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	Muncy Valley Hospital	BusinessNameLine1

Address Address

Field	Value	IRS element (for citing)
Address Line1	215 East Water Street	AddressLine1
City	Muncy	City
State	PA	State
ZIP Code	17756	ZIPCode

Field	Value	IRS element (for citing)
Licensed Hospital	X	LicensedHospital
Critical Access Hospital	X	CriticalAccessHospital
Er24 Hours	X	Er24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

Field	Value	IRS element (for citing)
Business Name Line1	Muncy Valley Hospital	BusinessNameLine1

Field	Value	IRS element (for citing)
Hospital Facility Number	1	HospitalFacilityNumber
Eligibility Criteria Explained	1	EligibilityCriteriaExplained
Uses FPG Free	1	UsesFPGFree
FPG Free Percent	200.000000000000	FPGFreePercent
Uses FPG Discounted	1	UsesFPGDiscounted
FPG Discount Percent	300.000000000000	FPGDiscountPercent
Explains Basis	1	ExplainsBasis
Income Level	X	IncomeLevel
Asset Level	X	AssetLevel
Medical Indigency	X	MedicalIndigency
Insurance Status	X	InsuranceStatus
Uninsured Discount	X	UninsuredDiscount
Explains Application Method	1	ExplainsApplicationMethod
Includes Publicity Measures	1	IncludesPublicityMeasures
Posted On Website	X	PostedOnWebsite
Attached To Invoices	X	AttachedToInvoices
Posted In Emergency Room	X	PostedInEmergencyRoom
Provided On Admission	X	ProvidedOnAdmission
Available On Request	X	AvailableOnRequest
Other Publicity	X	OtherPublicity
Actions On Nonpayment	1	ActionsOnNonpayment
Collection Activities	0	CollectionActivities
Notify Upon Admission	X	NotifyUponAdmission
Notify Before Discharge	X	NotifyBeforeDischarge
Notified All Patients	X	NotifiedAllPatients
Documented Determination	X	DocumentedDetermination
Nondiscrim Emergency Care Policy	1	NondiscrimEmergencyCarePolicy
Used Other Method	X	UsedOtherMethod
Amounts Generally Billed	0	AmountsGenerallyBilled
Gross Charges	0	GrossCharges

Form990 Schedule H Part VI Form990ScheduleHPartVI (13 entries)

ExplanationExplanation	IdentifierIdentifier
Part I, Line 6a: The community benefit report is prepared on a system wide basis under Susquehanna Health System.
Part I, Line 7g: Muncy Valley Hospital has various subsidized services which are included within the Medicare and Medical Assistance unreimbursed costs.
Part II: Community building activities at the Muncy Valley Hospital (MVH) center on workforce development thru providing observations and the development of volunteens. By supporting volunteens in a health care setting, some budding nurses, doctors and other allied health professionals are developed.
Part III, Line 4: The System reports patient accounts receivable for services rendered at net realizable amounts from third-party payers, patients and others. The System provides an allowance for doubtful accounts based upon a review of outstanding receivables, historical collection information and existing economic conditions. As a service to the patient, the System bills third-party payers directly and bills the patient when the patient's liability is determined. Patient accounts receivable are due in full when billed. Accounts are considered delinquent and subsequently written off as bad debts based on individual credit evaluation and specific circumstances of the account.
Part III, Line 8: The costing methodology is based on a modified cost accounting system. We cost our patient data for the previous fiscal year and then we apply relational factors to the costs based on the change in charges from the prior fiscal year to the current fiscal year.Serving patients with government health benefits, such as Medicare, is a component of the community benefit standard that tax-exempt hospitals are held to. This implies that serving Medicare patients is a community benefit and that the hospital operates to promote the health of the community.
Part III, Line 9b: Susquehanna Health System will provide financial assistance under the Charity Care Assistance Program for patients that require medically necessary services during the period in which family income and financial resources meets the defined guidelines, and after all other payment resources have been exhausted. The SHS Charity Care Assistance Program is always the coverage of the last resort.Eligible services include inpatient and outpatient hospital services which are medically necessary and are provided directly by Susquehanna Health System (Hospitals and Susquehanna Physician Services) or by employees of SHS for the treatment of an illness or injury.All payer resources must be exhausted. Pennsylvania Medical Assistance screening must be completed for all considered individuals. All other payment arrangements must be explored. All self pay balances identified in the Charity Care application must be paid in full to maintain eligibility.The income guidelines source is the annual poverty income published in the Federal Register by the Department of Health and Human Services. The federal poverty guidelines are used to determine three tiers of SHS Charity Care eligibility. Income guidelines are updated annually during the month of April. Family income must be at or below the eligibility guidelines for program consideration.It is the responsibility for the patient or guarantor to initiate the SHS Charity Care Assistance Program by applying.
Part V, Section B, Line 13g: Other method - brochure	Muncy Valley Hospital
Part V, Section B, Line 19d: Uninsured patients receive a 45% discount from charges paid within 30 days from the first statement. They may also be eligible for discounts of 60% to 100% of charges following application to our Financial Assistance Program.	Muncy Valley Hospital
Part VI, Line 2: Susquehanna Health System (SHS) which is comprised of The Williamsport Hospital (TWH), Divine Providence Hospital (DPH) and Muncy Valley Hospital (MVH), as a member of the Lycoming County Health Improvement Coalition (LCHIC) conducts a community health needs assessment every 2 years.LCHIC is a healthy community's initiative in existence since 1994. It is a voluntary collaboration of 37 board members and over 100 Task Force Team volunteers respresenting various sectors of the community, including religious organizations, schools and higher education, minority groups, municipal and county government, public health, health care, civic and community organizations, the private sector, and social welfare organizations.The mission of LCHIC is to improve the health status of the Lycoming County community by identifying and facilitating response to priority health and wellness issues through a collaborative, community-driven process.In addition to this assessment SHS also looks at assessments from the United Way and The Commonwealth Medical College (TCMC). The LCHIC assessment is structured heavily around the Behavioral Risk Factor Surveillance System (BRFSS). In addition to this LCHIC also conducts the PA Youth Survey for all students in grades 6, 8, 10 and 12 in the county every other year. Each of the above mentioned surveys except the TCMC survey are county focused. TCMC is regional in nature but has future implications in the development of local community benefit activities. For example, it highlighted the need to do primary research in the Amish communities in Lycoming County and the need to further investigate the increasing incidence of STD in the county as well. To enhance the quantitative data of these surveys LCHIC also conducts focus groups for the following sub populations: women, low income families, employers and seniors. LCHIC has historically prioritized the needs, developed a strategic plan and distributed the results to the community.In order to faciliate support for LCHIC's strategic plan, SHS has a newly created community benefit group. This workgroup reports to the Mission and Ethics Committee of the SHS Board of Directors. On this workgroup are respresentatives from all three hospital campuses, the Department of Health, LCHIC, The United Way, The Williamsport-Lycoming Foundation, TCMC, and The Susquehanna Community Medical and Dental Clinic Inc. (an independent FQHC).The role of the workgroup is to develop systems and processes to improve and promote the integrity of community benefit. To develop and/or adopt best practices in community benefit operations.The workgroup will be comprised of at least one representative from each hospital and Susquehanna Physician Services (SPS), a representative from LCHIC, SHS director of Community Benefit, key community leaders and 1 or 2 members of the mission & effectiveness committee.The duties of the workgroup is to participate in conducting a "community health assessment" using data that already exists. Developing the community benefit plan with strategic goals and interventions, review and validate current system-wide reporting structure, share ideas and best practices on program evaluation, and advocates for the community benefit program, both internally and externally.Using the various assessments and the LCHIC strategic plan as a basis, the workgroup decides what goals and objectives SHS can support with the talent and resources it has available. These are opportunities that meet the mission of the SHS family of hospitals. Once decided they are then communicated at the campus level and to service line managers by the campus administrator and the Director of Community Benefits for SHS. Though ongoing communication, staffing allocations and scheduling to permit participation in the community benefit programming (that supports needs identified by LCHIC) is achieved.
Part VI, Line 3: Susquehanna Health System (SHS) will provide financial assistance under the Charity Care Assistance Program for patients that require medically necessary services during the period in which family income and financial resources meets the defined guidelines, and after all other payment resources have been exhausted. The SHS Charity Care Assistance Program is always the coverage of the last resort.The SHS Charity Care Assistance program is an income based package designed to meet the healthcare financial needs of eligible individuals and households who receive medically necesary inpatient or outpatient services from TWH, DPH, MVH or SPS.The first hospital claim sent to guarantors of uninsured accounts will include a statement to briefly explain the availability and contacts for referral to the Charity Care program. Subsequent guarantor billings also reference the availability of Charity Care.It is the responsibility for the patient or guarantor to initiate the SHS Charity Care Assistance Program by applying. It is the responsiblity of the SHS Finance personnel to administrate the program according to this policy.
Part VI, Line 4: The hospitals that comprise Susquehanna Health System (SHS) are: The Williamsport Hospital (TWH), Divine Providence Hospital (DPH) and Muncy Valley Hospital (MVH) are all located in Lycoming County, Pennsylvania. The county is in the north central region of the state, about three and half hours northeast of Pittsburgh and the same distance northwest of Philadelphia. Lycoming County is designated as rural and has small towns nestled within a stunning natural landscape. The City of Williamsport, with the majestic Susquehanna River running through it, is designated as urban, and is the home of Little League World Series. Unfortunately, the City of Williamsport and the surrounding rural area are also home for many individuals and families who cannnot afford the primary health and dental care services provided in their county.The population is the underserved of the county and the target population of our community outreach. It is comprised of residents with income at or below 200% of the Federal Poverty Level and amounts to about 38,931 individuals. This population lives mainly in three Medically Underserved Areas (MUAs) and three Priminary Care Health Professional Shortage Areas(HPSAs). There is also a Dental Health HPSA in the City of Williamsport and a Mental Health HPSA throughout the entire county. No priminary health or dental providers in the county are accepting under and uninsured patients.MUA listing:ID#02975 - Cogan House Service Area - Designated 12/5/94 - IMU score 55.80ID#02976 - Jordan Service Area - Designated 12/5/94 - IMU score 54.20ID#07495 - Western Williamsport - Designated 8/9/05 - IMU score 58.40HPSA listing:ID#142999422Q - Eastern Lycoming County - Geographic area - score 11ID#14299942E9 - Canton Service Area - Geographic area - score 7ID#64299942OF - Low-income Dental/Wmspt - Population group - score 15ID#74299942K8 - Clinton/Lycoming Mental Health - Geographic area -score 12Compared to the overall population of Pennsylvania, Lycoming County residents are older, earn less per capita, have received less formal education, and are more likely to be uninsured and unemployed. Furthermore, Lycoming County residents face health disparities compared to state and national levels. The health issues below are of particular concerns in Lycoming County because they all occur at frequencies that do not meet national benchmarks. All except the diabetes measure do not meet the "severe benchmark".* Diabetes - Diabetes Mortality Rate = 30 per 100,000 people* Cardiovascular Disease - Adults reporting diagnosis of high blood pressure = 28%* Cancer - Percent of women 18 and older with no Pap test in past 3 years = 20%* Prenatal and Perinatal Health - Cigarette use during pregnancy = 22%* Child Health - Pediatric asthma hospital admission rate = 357.2 per 100,000* Behavioral Health - Heavy alcohol use, Binge drinkers = 16%* Asthma - Adult current asthma prevalance = 8%Socio-Economic characteristics in PA and Lycoming County (US Census Bureau, 2006-2008)* High school graduates - PA 86.8% - Lycoming County 84.5%* Bachelor's degree or higher - PA 25.9% - Lycoming County 18.7%* Population age 65 or over - PA 15.2% - Lycoming County 16.4%* Unemployment rate - PA 5.4% - Lycoming County 6.0%* Per capita income - PA $27,025 - Lycoming County $21,868* Median household income - PA $50,272 - Lycoming County $50,856* Population with income below poverty level - PA 11.9% - Lycoming County 13.9%Our community benefit programming focuses on 2 sub-groups that are culturally unique, ethnically diverse, and challenging to quantify:1) Vulnerable urban residents who live within the City of Williamsport who have no medical or dental home and have a history of being non-compliant, in that they often do not show up for appointments. They are mostly without insurance or depend on that which is government funded. This includes the 1,016 people living in public and Section 8 housing and the 222 homeless individuals.2) Individuals, and their families, who work on small farms, at businesses, and in manufacturing settings who do have adequate insurance or access to primary health care or dental care. This population is predominantly Caucasian, aging, and has a high incidence of chronic illness, including diabetes and hypertension. Many in this population exhibit poor health habits and a lack of knowledge about health related concepts. A lack of transportation is a large barrier for this population, especially for individuals living in rural parts of the county.
Part VI, Line 5: The hospitals of Susquehanna Health System (SHS) all have entity specific boards that are composed of persons who reside in Lycoming County.In addition to this SHS extends medical staff privileges to all qualified physicians in the county in all areas of primary and specialty care according to Susquehanna Health Medical Staff Bylaws. Bylaws excerpts pertaining to this area are as follows:3.1) Nature of Membership - Medical Staff membership is available to qualified physicians, dentists, maxillofacial/oral surgeons, and podiatrists and confers both responsibilities and prerogatives, but only as provided in these Bylaws. No physician, dentist, or podiatrist, including those employed by or otherwise under contract with the Hospital(s), may admit a patient or independently provide patient care services in the Hospital(s) unless he is a Medical Staff member with applicable clinical priviledges pursuant to these Bylaws. A member shall have only those clinical privileges, including admitting privileges, as have been granted in accordance with these Bylaws.3.2) Qualifications - No individual shall be considered eligible for appointment on reappointment to the Medical Staff unless he meets each of the following required qualifications/criteria. If any change in personal or professional status occurs which would inhibit practitioner's ability to effectively meet the obligations for patient care and Medical Staff membership under these Bylaws, the practitioner shall immediately notify the Medical Director.3.2-1) Professional Licensure Qualification - A member must be a physician, dentist, or podiatrist and must be dully licensed to practice in the Commonwealth of Pennsylvania.3.2-2) Clinical Privileges Qualification - A member of the Medical Staff must have clinical privileges (or in the case of a new applicant, is granted clinical privileges at the time of the appointment), except those appointed to the Emeritus Staff or as otherwise specified in these Bylaws.3.2-3) Professional Competence - A member must demonstrate sufficient professional education, training, experience, competence, and good judgement to perform Medical Staff responsibilities and clinical privileges requested.3.2-4) Health Status - A member must have sufficient physical and mental health to perform Medical Staff responsibilities and exercise clinical privileges requested.3.2-5) Basic Responsibilites - A member must discharge the basic responsibilities of Medical Staff membership noted in 3.3-2.3.2-6) Board Certification Requirement - All practitioners who are current staff members at SHS as of 7/1/10 and who have met prior qualifications for membership shall be exempt from board certification requirements.3.2-7) Departmental Qualifications - Each department will reserve the right to further specify qualifications for membership (as noted in individual departmental Bylaws), which may be more restrictive than those specified here. Any initial applicant for Medical Staff membership must meet both the general criteria for Medical Staff membership as specified in these Bylaws and the criteria for membership established by the department to which he is applying.3.2-8) Waiver - The Board Certification requirement described in (H) may be waived under very special circumstances in which an applicant for Medical Staff membership is capable of providing specific unique expertise presently not available or insufficiently available on the Medical Staff which will fulfill an unmet medical need in the community. Such waiver may be granted by the Board(s) only upon recommendation of the Department Chairman, Credentials Committee, and the Medical Executive Committee (MEC)3.2-9) Prohibited Criteria - Medical Staff membership or assignment to a Medical Staff category shall not be denied, terminated, revoked, suspended, modified, or otherwise restricted based upon:(a) Gender, race, creed, color, national origin, handicap, or disability, if the individual is otherwise qualified under these Bylaws, or(b) Economic considerations as the sole or primary criterion, or(c) Any criterion not set forth as a required qualification in these Bylaws, or(d) Any other criterion lacking professional or ethical justification.The volunteer program at SHS supports the services at our 3 campuses, MVH, DPH and TWH, as well as our LifeCenter in Lycoming Mall. Volunteers, ranging in age from 14, assist staff and patients in almost every department.The volunteers come from Lycoming and surrounding counties to support our services. They provide over 75,000 hours of service in both office, customer service and patient care areas to support our service partners. They become ambassadors for the hospital, make new friends, financially support the hospital, become involved in the auxiliary, remain an active member of society, often stay healthier longer, enjoy the camaraderie with staff and other volunteers, serve on hospital committees, recruit other volunteers, increase their volunteer hours and offer constructive suggestions for improvement. Volunteers are recruited through fairs, internet information and on-line applications, volunteer referrals and presentations to groups. They are a highly regarded, integral part of our operational support system.
Part VI, Line 6: Muncy Valley Hospital (MVH) is one of three hospitals which is part of Susquehanna Health System (SHS). The mission of SHS is to promote health by acting as the parent of a nonprofit health system in North Central Pennsylvania and by raising funds and otherwise supporting the system. MVH is a critical access hospital, primarily serving Lycoming and surrounding counties. MVH also provides a full range of outpatient and emergency services, as well as, operates a long-term care facility.Divine Providence Hospital (DPH) is a specialty hospital that offers inpatient psychiatric services and a wide array of outpatient hospital services, as well as, home health services.The Williamsport Hospital (TWH) is an acute care community hospital providing diagnostic and treatment facilities, educational and training programs, and a rehabiliation facility.The hospitals treat Medicare and Medical Assistance patients and maintains a Medicare / Medical Assistance policy that provides patients enrolled in such programs with access to all covered inpatient, outpatient and diagnostic services that are available to non-Medicare / Medical Assistance patients.The community benefit report is prepared on a system-wide basis under SHS. On an annual basis, SHS devotes a portion of its revenue and assets to community program services. The following reflects the breakout of $64,636,443 in quantifiable community benefits reported for FY 2012: Charity Care (at cost) $1,514,665; Bad Debt (at cost) $8,954,593; Government-sponsored health care (unpaid cost of Medicare, Medicaid, indigent care programs, SCHIP and other safety net programs) $47,969,226. In addition, various other programs such as Research, Health Professions Education, Community Building, Financial and In-Kind Contributions, and Community Benefit Operations totaling $6,197,958.

Schedule I IRS990ScheduleI

Field	Value	IRS element (for citing)
Records Maintained	1	RecordsMaintained

Recipient Table RecipientTable

Recipient Name Business RecipientNameBusiness

Field	Value	IRS element (for citing)
Business Name Line1	Susquehanna Physician Services	BusinessNameLine1

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	1201 Grampian Boulevard	AddressLine1
City	Williamsport	City
State	PA	State
ZIP Code	17701	ZIPCode

Field	Value	IRS element (for citing)
EIN Of Recipient	232449454	EINOfRecipient
IRC Section	501(c)(3)	IRCSection
Amount Of Cash Grant	2028591	AmountOfCashGrant
Purpose Of Grant	Support of affiliate	PurposeOfGrant

Field	Value	IRS element (for citing)
Total Nbr Of501 C3 And Govt Grants	1	TotalNbrOf501C3AndGovtGrants

Form990 Schedule I Part IV Form990ScheduleIPartIV

Field	Value	IRS element (for citing)
Identifier	Procedure for Monitoring Grants in the U.S.:	Identifier
Return Reference	Part I, Line 2:	ReturnReference
Explanation	Schedule I, Part I, Line 2: Grantees are related organizations and part of the Susquehanna Health System with consistent management oversight ensuring the use of funds for charitable purposes.	Explanation

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Severance Payment	0	SeverancePayment
Supplemental Nonqual Retire Plan	1	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)

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
Dr Kevin Kist
0	323253	0	0	0	18791	0	8850	0	16184	0	367078	0	0
Steven E Yordy MD
0	175576	0	0	0	8304	0	7518	0	18703	0	210101	0	0
Steven P Johnson
0	497213	0	123453	0	14682	0	77384	0	18816	0	731548	0	0
Charles J Santangelo
0	292341	0	19176	0	5999	0	8850	0	18426	0	344792	0	0
Christine A Ballard
138764	0	7940	0	1082	0	5523	0	8890	0	162199	0	0	0
Neil G Armstrong
0	255796	0	12493	0	3057	0	14975	0	10772	0	297093	0	0
George A Manchester MD
0	295318	0	15048	0	3874	0	12525	0	21902	0	348667	0	0

Form990 Schedule J Part III Form990ScheduleJPartIII (3 entries)

Return ReferenceReturnReference	ExplanationExplanation	IdentifierIdentifier
Part I, Line 4b	Susquehanna Health System maintains an unfunded deferred compensation plan for the purpose of providing supplemental retirement benefits for Steven P. Johnson. An annual book-entry is recorded consisting of an annual contribution plus interest earnings. For 2011, the amount was $64,859.
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.
Part III	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.	Supplemental Information

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (12 entries)

Return ReferenceReturnReference	ExplanationExplanation	IdentifierIdentifier
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 powers through its Board of Directors. The Member shall have the exclusive authority to exercise the following powers: A) To approve the appointment and removal of the President of the corporation subject to all applicable provisions of the Creation agreement. 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 the termination of any programs or services of the corporation, and monitor and maintain the philosophy, goals and purposes for which the corporation was formed and exists, subject to and in accordance with the provisions of the Creation agreement. D) To adopt, amend or repeal the Articles of Incorporation or these 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 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 course of business or encumbrance outside the ordinary course of business of land or buildings and the construction or 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 the indebtedness of any person, the granting of any security interest in or the creation of any encumbrance on any assets of the corporation outside the ordinary course of business, or any transfer of any assets of the corporation outside the ordinary course of business, except transfes between or among affiliated corporations. I) To approve any merger, consolidation, organization, reorganization, joint venture or other modification of corporate structure or affiliations affecting the autonomy, goverance, 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 these 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 any contract or agreement relating thereto.
Form 990, Part VI, Section B, line 11	The IRS Form 990 was first reviewed by an independent accounting firm, then senior management, and then reviewed with the full Board of the Parent company (Susquehanna Health System, EIN # 23-2751183) before being filed electronically.
Form 990, Part VI, Section B, line 12c	As required by law, Hospital 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 Hospital's attorneys.
	Form 990, Part VI, line 15a & 15b: All top management officials are paid by The Williamsport Hospital, EIN # 24-0795508. 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 that 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 XI, line 5:	Net unrealized losses on investments: -204,508. Change in interest in net assets of affiliate -29,520. Total to Form 990, Part XI, Line 5: -234,028.	Changes in Net Assets or Fund Balances:
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 utlilizes 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 3,400 for Susquehanna Health System EIN #23-2751183. Of that total, 363 employees payroll expenses were recorded by Muncy Valley Hospital.	Number of employees reported on Form W-3
Form 990, Part VII, Section A, Line 1a, Column B	Steven P. Johnson, Charles J. Santangelo, Neil G. Armstrong, and George A. Manchester work 40 hours per week for the Williamsport Hospital EIN 24-0795508. In addition, they devote 1 hour per week to the following related organizations: Divine Providence Hospital 24-0799343 Muncy Valley Hospital 24-0806023 Susquehanna Health Foundation 23-2743470 Susquehanna Health System 23-2751183 Susquehanna Physician Services 23-2449454 Williamsport Area Ambulance Service Cooperative 23-2416166 Dr. Steven E. Yordy works 40 hours per week for Susquehanna Physician Services EIN 23-2449454. In addition, he devotes 1 hour per week to the Muncy Valley Hospital EIN 24-0806023. Dr. Kevin Kist works 40 hour per week for Susquehanna Physician Services EIN 23-2449454. In addition, he devotes 1 hour per week to the Muncy Valley Hospital EIN 24-0806023, Susquehanna Health System EIN 23-2751183, the Williamsport Hospital EIN 24-0795508, and Divine Providence Hospital 24-0799343.	Hours for Related Organizations

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (6 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 Sister of Christian Charity
1100 Grampian Boulevard	Williamsport	PA	17701	240799343	Hospital	PA	501(c)(3)	3	Susquehanna Health System	0
The Williamsport Hospital
700 High Street	Williamsport	PA	17701	240795508	Hospital	PA	501(c)(3)	3	Susquehanna Health System	0
Susquehanna Health System
1205 Grampian Boulevard	Williamsport	PA	17701	232751183	Coordinate & manage the delivery of healthcare	PA	501(c)(3)	11 A I		0	N/A
Susquehanna Health Foundation
1100 Grampian Boulevard	Williamsport	PA	17701	232743470	Fundraising for affiliated entities	PA	501(c)(3)	11 A I	Susquehanna Health System	0
Susquehanna Physician Services
1201 Grampian Boulevard	Williamsport	PA	17701	232449454	Physician services & MRI services	PA	501(c)(3)	3	Susquehanna Health System	0
Williamsport Area Ambulance Service Cooperative
700 High Street	Williamsport	PA	17701	232416166	Ambulance transports	PA	501(c)(3)	9		0	N/A

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 Boulevard	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 (3 entries)

Address Line1AddressUS/AddressLine1	CityAddressUS/City	StateAddressUS/State	ZIP CodeAddressUS/ZIPCode	EINEIN	Primary ActivityPrimaryActivity	Legal Domicile StateLegalDomicileState	Direct Controlling Entity NADirectControllingEntityNA	Type Of EntityTypeOfEntity	Address Line1AddressForeign/AddressLine1	CityAddressForeign/City	CountryAddressForeign/Country	Postal CodeAddressForeign/PostalCode	Legal Domicile Foreign CountryLegalDomicileForeignCountry
Susquehanna Ventures Inc
1201 Grampian Boulevard	Williamsport	PA	17701	232470263	Pharmacy & infusion services	PA	N/A	C
Central PA Provider Network
1205 Grampian Boulevard	Williamsport	PA	17701	232949121	Physician insurance for central PA	PA	N/A	C
Susquehanna Health System Insurance Network LTD
				980458722	Captive insurance company		N/A		PO Box 1159	Grand Caymans	CJ	KY1-1102	CJ

Field	Value	IRS element (for citing)
Receipt Of Int Ann Rents Royalties	0	ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org	1	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
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	0	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