UPMC: Form 990, tax year 2010
View the entire original 990 at ProPublica ↗
- Organization
- UPMC (EIN 24-0806023)
- Tax period
- 2010-07-01 to 2011-06-30
- Filed
- 2012-05-07
- IRS object ID
- 201211289349300501
- Schema version
- 2010v3.2
- 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 H
- Schedule I
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-05-07T07:12:38-05:00 | Timestamp |
| Tax Period End Date | 2011-06-30 | 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 | 2010-07-01 | 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 | 2012-05-07 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 4178658701 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2010 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | 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 | 52279236 | 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 | 349 | TotalNbrEmployees |
| Total Nbr Volunteers | 105 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 48422 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 32176 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 37531993 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 43579973 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 157548 | InvestmentIncomePriorYear |
| Investment Income Current Year | 463188 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 1207202 | OtherRevenuePriorYear |
| Other Revenue Current Year | 96801 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 38945165 | TotalRevenuePriorYear |
| Total Revenue Current Year | 44172138 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 2800350 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 1993292 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 15282160 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 15967499 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 4863 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 19381748 | OtherExpensePriorYear |
| Other Expenses Current Year | 21322007 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 37464258 | TotalExpensesPriorYear |
| Total Expenses Current Year | 39282798 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 1480907 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 4889340 | RevenuesLessExpensesCY |
| Total Assets BOY | 30769392 | TotalAssetsBOY |
| Total Assets EOY | 37511605 | TotalAssetsEOY |
| Total Liabilities BOY | 3419500 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 4571061 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 27349892 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 32940544 | 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 | 35246987 | Expense |
| Grants | 1993292 | Grants |
| Revenue | 43581398 | Revenue |
| Description | During the fiscal year ended June 30, 2011, the Hospital admitted 862 acute care patients, rendering 4,799 patient days and registered approximately 55,766 outpatients. Long Term Care days totaled 46,513. | 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 $3,812,377 in quantifiable community benefits reported for FY 2011: Charity Care (at cost) $222,237; Bad Debt (at cost) $1,037,606; Government-sponsored health care (unpaid cost of Medicare, Medicaid, indigent care programs, SCHIP and other safety net programs) $2,504,000. In addition, various other programs such as Research, Health Professions Education, Community Building, Financial and In-Kind Contributions and Community Benefit Operations totaling $48,534. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 35246987 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 0 | ReportOtherLiabilities |
| Report Fin48 Footnote | 0 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | 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 | 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 |
| Number Forms Transmitted With1096 | 4 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 349 | 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 |
Form990 Part VII Section A Form990PartVIISectionA (16 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Key EmployeeKeyEmployee |
|---|---|---|---|---|---|---|---|
| Paul E Heise | |||||||
| Chair | 1.00 | X | X | 0 | 0 | 0 | |
| Robert W More | |||||||
| Vice Chair | 1.00 | X | X | 0 | 0 | 0 | |
| David E Wallis | |||||||
| Secretary | 1.00 | X | X | 0 | 0 | 0 | |
| Daniel C Berninger | |||||||
| Treasurer | 1.00 | X | X | 0 | 0 | 0 | |
| Dr Mark Beyer | |||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||
| Jane Beachem | |||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||
| Dilip K Elangbam MD | |||||||
| Director | 1.00 | X | 0 | 559327 | 25955 | ||
| Sister Teresa Ann Jacobs | |||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||
| Roger D Jarrett | |||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||
| Geneva Peck | |||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||
| Steven E Yordy MD | |||||||
| Director | 1.00 | X | 0 | 196912 | 24069 | ||
| Steven P Johnson | |||||||
| President / CEO | 1.00 | X | X | 0 | 619955 | 87088 | |
| Charles J Santangelo | |||||||
| Executive Vice President / | 1.00 | X | 0 | 310862 | 23118 | ||
| Christine A Ballard | |||||||
| MVH President / VP Operations | 40.00 | X | 132483 | 0 | 12825 | ||
| Neil G Armstrong | |||||||
| Executive Vice President / | 1.00 | 0 | 275905 | 23228 | X | ||
| George A Manchester MD | |||||||
| Executive Vice President / | 1.00 | 0 | 307532 | 31445 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 132483 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 2270493 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 227728 | TotalOtherCompensation |
| Number Individuals GT100 K | 1 | 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 | 3047922 |
| Aramark Healthcare | |||||
| PO Box 33170 | Newark | NJ | 01788 | Management / environmental services | 2675463 |
| Alexander Building Construction LLC | |||||
| 315 Vaughn Street | Harrisburg | PA | 17110 | Construction services | 1056405 |
| Emcare Inc | |||||
| 7032 Collection Center Drive | Chicago | IL | 60693 | ER management services | 334058 |
| Paris Companies | |||||
| 67 Hoover Avenue | DuBois | PA | 15801 | Linen services | 261267 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 6 | NumberOfContractorsGT100K |
| Related Organizations | 1084 | RelatedOrganizations |
| All Other Contributions | 31092 | AllOtherContributions |
| Total Contributions | 32176 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (4 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| Net patient service re | 621990 | 42328928 | 42328928 |
| Supplemental payments | 623000 | 1110002 | 1110002 |
| Affiliate rental incom | 621990 | 110875 | 110875 |
| Sports Medicine - athl | 621990 | 30168 | 30168 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 43579973 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 190340 | TotalRevenueColumn |
| Exclusion | $190,340 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 8379946 | Securities |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 8107098 | Securities |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 272848 | Securities |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 272848 | TotalRevenueColumn |
| Exclusion | $272,848 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount |
|---|---|---|---|
| Cafeteria | 624200 | 73263 | $73,263 |
| Television | 900099 | 10451 | $10,451 |
| Purchases discount | 900099 | 6149 | $6,149 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 6938 | TotalRevenueColumn |
| Related Or Exempt Function Income | 1425 | RelatedOrExemptFunctionIncome |
| Exclusion | $5,513 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 96801 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 44172138 | TotalRevenueColumn |
| Related Or Exempt Function Income | 43581398 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $558,564 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1993292 | Total |
| Program Services | 1993292 | ProgramServices |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 12595874 | Total |
| Program Services | 12056399 | ProgramServices |
| Management And General | 535639 | ManagementAndGeneral |
| Fundraising | 3836 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 621224 | Total |
| Program Services | 594617 | ProgramServices |
| Management And General | 26418 | ManagementAndGeneral |
| Fundraising | 189 | Fundraising |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 921630 | Total |
| Program Services | 882157 | ProgramServices |
| Management And General | 39192 | ManagementAndGeneral |
| Fundraising | 281 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1828771 | Total |
| Program Services | 1750446 | ProgramServices |
| Management And General | 77768 | ManagementAndGeneral |
| Fundraising | 557 | Fundraising |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3047922 | Total |
| Management And General | 3047922 | ManagementAndGeneral |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5967 | Total |
| Management And General | 5967 | ManagementAndGeneral |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 36453 | Total |
| Management And General | 36453 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5279047 | Total |
| Program Services | 5152529 | ProgramServices |
| Management And General | 126518 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2847 | Total |
| Program Services | 2847 | ProgramServices |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5032814 | Total |
| Program Services | 4970457 | ProgramServices |
| Management And General | 62357 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 182430 | Total |
| Program Services | 182113 | ProgramServices |
| Management And General | 317 | ManagementAndGeneral |
Royalties Royalties
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 20822 | Total |
| Program Services | 20707 | ProgramServices |
| Management And General | 115 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 815859 | Total |
| Program Services | 768899 | ProgramServices |
| Management And General | 46960 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 13527 | Total |
| Program Services | 13085 | ProgramServices |
| Management And General | 442 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 25966 | Total |
| Program Services | 22261 | ProgramServices |
| Management And General | 3705 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1662997 | Total |
| Program Services | 1662997 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 532693 | Total |
| Program Services | 532693 | ProgramServices |
Other Expenses OtherExpenses (3 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| Bad debt | 2764487 | 2764487 | |
| Miscellaneous | 1253839 | 1232664 | 21175 |
| Repairs & maintenance | 644337 | 644337 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 39282798 | Total |
| Program Services | 35246987 | ProgramServices |
| Management And General | 4030948 | ManagementAndGeneral |
| Fundraising | 4863 | Fundraising |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5495799 | BOY |
| EOY | 7997891 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3915770 | BOY |
| EOY | 5232980 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 149508 | BOY |
| EOY | 154763 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 128081 | BOY |
| EOY | 137071 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 38871489 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 25017576 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 14240658 | BOY |
| EOY | 13853913 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5425024 | BOY |
| EOY | 10005153 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1414552 | BOY |
| EOY | 129834 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 30769392 | BOY |
| EOY | 37511605 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2416221 | BOY |
| EOY | 2826935 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1003279 | BOY |
| EOY | 1744126 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3419500 | BOY |
| EOY | 4571061 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 27042077 | BOY |
| EOY | 32622097 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 96905 | BOY |
| EOY | 106575 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 210910 | BOY |
| EOY | 211872 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 27349892 | BOY |
| EOY | 32940544 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 30769392 | BOY |
| EOY | 37511605 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 4889340 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 701312 | ReconcilationOtherChanges |
| 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 | $5,967 | GrantsOtherOrganizationsAmount |
| Direct Contact Legislators | 0 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 0 | OtherActivities |
| Total Lobbying Expenditures IIB | 5967 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Explanation of Other Lobbying Activities: | Identifier |
| Return Reference | Part II-B, Line 1i: | 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 06/30/11, the amount of dues paid to HAP totaled $11,881 of which 21.26% or $2,526, was used for lobbying purposes. Dues paid to AHA totaled $14,091, of which 24.42% or $3,441, 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 | 2803916 | OtherCostOrOtherBasis |
| Book Value | 2803916 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 20444944 | OtherCostOrOtherBasis |
| Depreciation | 14200423 | Depreciation |
| Book Value | 6244521 | 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 | 14256951 | OtherCostOrOtherBasis |
| Depreciation | 10446508 | Depreciation |
| Book Value | 3810443 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1350000 | OtherCostOrOtherBasis |
| Depreciation | 354967 | Depreciation |
| Book Value | 995033 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 13853913 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities (3 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| Estimated third party settlements | $720,488 |
| Estimated medical legal liability costs | $153,000 |
| Due to affiliates, net | $870,638 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 1744126 | TotalOfAmounts |
| Total Revenue | 44172138 | TotalRevenue |
| Total Expenses | 39282798 | TotalExpenses |
| Excess Or Deficit For Year | 4889340 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | 692684 | NetUnrealizedGLOnInvestments |
| Other | $8,628 | OtherAmount |
| Total Adjustments | 701312 | TotalAdjustments |
| Excess Or Deficit Per FS | 5590652 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 44873450 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | 692684 | NetUnrealizedGainsInvestments |
| Other Revenues | 8628 | OtherRevenues |
| Revenue Not Rptd F990 | 701312 | RevenueNotRptdF990 |
| Revenue Subtotal | 44172138 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 44172138 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 39282798 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 39282798 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 39282798 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Explanation | Part XI, line 8 - Change in interest in net assets of affiliate $7,666 Increase in permanently restricted net assets $962 Part XII, line 2d - Change in interest in net assets of affiliate $7,666 Increase in permanently restricted net assets $962 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. | Explanation |
Schedule F IRS990ScheduleF
Accts Actvs Out US Table AcctsActvsOutUSTable
| Field | Value | IRS element (for citing) |
|---|---|---|
| Region | Central America | Region |
| Number Of Employees | 1 | NumberOfEmployees |
| Type Of Activities Conducted | Program services | TypeOfActivitiesConducted |
| Specific Services Provided | Captive insurance company | SpecificServicesProvided |
| Total Expenditures | 426971 | TotalExpenditures |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Subtotal Number Of Employees | 1 | SubtotalNumberOfEmployees |
| Cont Number Of Employees | 0 | ContNumberOfEmployees |
| Total Number Of Employees | 1 | TotalNumberOfEmployees |
| Subtotal Amount Spent | 426971 | SubtotalAmountSpent |
| Cont Amount Spent | 0 | ContAmountSpent |
| Total Amount Spent | 426971 | 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 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 |
| Pcent150 | X | Pcent150 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent250 | X | Pcent250 |
| 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 | 222237 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 222237 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00610 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 9379194 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 7740313 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1638881 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04480 | 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 | 9601431 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 7740313 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1861118 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05090 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3994 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3994 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3135 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3135 | DirectOffsettingRevenue |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 7129 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3135 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3994 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 9608560 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 7743448 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1865112 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05100 | PercentOfTotalExpense |
Workforce Development WorkforceDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 2067 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Building Expense | 2067 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 2067 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 2067 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $1,037,606 | BadDebtExpenseAmount |
| Amount Attributable To | 114137 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 11916774 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 12781679 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -864905 | 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 | Not Required | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
Form990 Schedule H Part VI Form990ScheduleHPartVI (14 entries)
| ExplanationExplanation | Return ReferenceReturnReference |
|---|---|
| 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. | |
| The amount of total expenses used to calculate the percent of total expense in column F was reduced by bad debt expense of $2,764,487. | Part I, column F |
| 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. | Part I, Line 7 |
| 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. | |
| This estimated amount represents the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy - bad debt at cost multiplied by an estimated 11%. | Part III, Section A, Line 3 |
| 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. The studies are currently underway. The results are anticipated in approximately 8 months. The results will be shared broadly and used to develop a response. 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 6: 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 71,000 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 7: 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 $45,641,204 in quantifiable community benefits reported for FY 2011: Charity Care (at cost) $1,666,014; Bad Debt (at cost) $7,498,578; Government-sponsored health care (unpaid cost of Medicare, Medicaid, indigent care programs, SCHIP and other safety net programs) $32,158,701. In addition, various other programs such as Research, Health Professions Education, Community Building, Financial and In-Kind Contributions, and Community Benefit Operations totaling $4,317,911. |
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 Non Cash Assistance | 1993292 | AmountOfNonCashAssistance |
| 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 | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (6 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Dilip K Elangbam MD | |||||||||||||
| 0 | 339934 | 0 | 218763 | 0 | 630 | 0 | 8850 | 0 | 17105 | 0 | 585282 | 0 | 0 |
| Steven E Yordy MD | |||||||||||||
| 0 | 175895 | 0 | 20610 | 0 | 407 | 0 | 8417 | 0 | 15652 | 0 | 220981 | 0 | 0 |
| Steven P Johnson | |||||||||||||
| 0 | 487740 | 0 | 118573 | 0 | 13642 | 0 | 72603 | 0 | 14485 | 0 | 707043 | 0 | 0 |
| Charles J Santangelo | |||||||||||||
| 0 | 284401 | 0 | 20653 | 0 | 5808 | 0 | 8850 | 0 | 14268 | 0 | 333980 | 0 | 0 |
| Neil G Armstrong | |||||||||||||
| 0 | 257300 | 0 | 15623 | 0 | 2982 | 0 | 14975 | 0 | 8253 | 0 | 299133 | 0 | 0 |
| George A Manchester MD | |||||||||||||
| 0 | 287407 | 0 | 17969 | 0 | 2156 | 0 | 12525 | 0 | 18920 | 0 | 338977 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 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 2010, the amount was $60,077. | |
| Part III | Part I, line 3: Susquehanna Health System (SHS) EIN # 23-2751183, a related organization, uses the following resources to establish the compensation of the top management officials; compensation committee, independent compensation consultant, written employment contract, compensation survey or study and approval by the board. | Supplemental Information |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (11 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| 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. | |
| 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, Section B, line 12c | |
| 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. | ||
| The organization makes its governing documents, conflict of interest policy, and financial statements available to the public upon request. | Form 990, Part VI, Section C, line 19 | |
| Changes in Net Assets or Fund Balances: | Net unrealized gains on investments: 692,684. Change in interest in net assets of affiliate 7,666. Increase in permanently restricted net assets 962. Total to Form 990, Part XI, Line 5: 701,312. | Form 990, Part XI, line 5: |
| Susquehanna Health System (SHS), EIN # 23-2751183 utilizes a common paymaster which includes the following entities: Divine Providence Hospital, EIN # 24-0799343 Muncy Valley Hospital, EIN # 24-0806023 The Williamsport Hospital, EIN # 24-0795508 Susquehanna Health Foundation, EIN # 23-2743470 Susquehanna Physician Services, EIN # 23-2449454 Williamsport Area Ambulance Service Cooperative, EIN # 23-2416166 The total number of employees reported on the Form W-3 were 3,351 for Susquehanna Health System. Included with that total, were 349 employees whose payroll expenses were reported by Muncy Valley Hospital. | Form 990, Part V, Line 2a & 2b | |
| All 1099's are issued by Susquehanna Health System, EIN # 23-2751183. All expenses are then allocated back to all related entities. | Form 990, Part V, line 1a | |
| Steven P. Johnson, Charles J. Santangelo, Neil G. Armstrong and George A. Manchester, M.D. work 40 hours per week for The Williamsport Hospital, EIN # 24-0795508. In addition, they devote 1 hour each per week to the following related organizations: Divine Providence Hospital of the Sisters of Christian Charity, EIN # 24-0799343 Muncy Valley Hospital, EIN # 24-0806023 Susquehanna Health Foundation, EIN # 23-2743470 Susquehanna Health System, EIN # 23-2751183 Susquehanna Physician Services, EIN # 23-2449454 Dr. Dilip K. Elangbam and Dr. Steven E. Yordy work 40 hours per week for Susquehanna Physician Services, EIN # 23-2449454. In addition, they devote 1 hour each per week to the Muncy Valley Hospital, EIN # 24-0806023. | Form 990, Part VII, Section A, Line 1a, Column B |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (5 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Direct Controlling Entity NADirectControllingEntityNA | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|---|
| Divine Providence Hospital of the Sister of Christian Charity | ||||||||||
| 1100 Grampian Boulevard | Williamsport | PA | 17701 | 240799343 | Hospital | PA | 501(c)(3) | 3 | N/A | 0 |
| The Williamsport Hospital | ||||||||||
| 700 High Street | Williamsport | PA | 17701 | 240795508 | Hospital | PA | 501(c)(3) | 3 | N/A | 0 |
| Susquehanna Health System | ||||||||||
| 1205 Grampian Boulevard | Williamsport | PA | 17701 | 232751183 | Coordinate & manage the delivery of healthcare | PA | 501(c)(3) | 11 A I | N/A | 0 |
| Susquehanna Health Foundation | ||||||||||
| 1100 Grampian Boulevard | Williamsport | PA | 17701 | 232743470 | Fundraising for affiliated entities | PA | 501(c)(3) | 11 A I | N/A | 0 |
| Susquehanna Physician Services | ||||||||||
| 1201 Grampian Boulevard | Williamsport | PA | 17701 | 232449454 | Physician services & MRI services | PA | 501(c)(3) | 3 | N/A | 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 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 (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 | 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 | |||||
| Williamsport Area Ambulance Service Cooperative | |||||||||||||
| 1205 Grampian Boulevard | Williamsport | PA | 17701 | 232416166 | Ambulance transport | 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 | 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, 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 |