2022-05-13T10:39:54-07:00 2021-06-30 135381590 WellSpan Health 3350 WHITEFORD ROAD YORK PA 17402 990 2020-07-01 251716306 SUMMIT PHYSICIAN SERVICES SUMM 7178513055 PO BOX 2767 YORK PA 17405 Laura Buczkowski SR VP & CFO 2022-05-13 false Laura Buczkowski 999009999 See Attached P01871563 7038930600 2 AAL1 IAL1 FAL1 2020 2022-09-23 18:48:47Z Roxanna Gapstur PO BOX 2767 YORK PA 174052767 138048087 false X WWW.WELLSPAN.ORG X 1993 PA Summit Physician Services, in coordination with Waynesboro Hospital, Chambersburg Hospital, York Hospital, Gettysburg Hospital, Ephrata Hospital, The Good Samaritan Hospital of Lebanon Pennsylvania, and WellSpan Surgery and Rehabilitation Hospital, provides medical and surgical care to patients in and around Franklin, Lebanon, Lancaster, York and Adams Counties, Pennsylvania without regard to the ability to pay. 11 1 1214 5 0 56696679 22986928 88131714 71346767 42195 -155999 414767 43677108 145285355 137854804 1326 1958 0 119436125 113741444 0 0 26936601 24111402 146374052 137854804 -1088697 0 25123943 14991039 21577873 11429081 3546070 3561958 Summit Physician Services, and the associated WellSpan Medical Group, operate on the belief that a large, well-organized group practice, based on primary and preventive care, and working collaboratively as part of an integrated health care delivery system, can deliver a superior standard of care. Its mission is to promote and to provide quality, cost-effective health care services which seek to improve the health status of the community. Summit Physician Services provides care without regard for an individual's health status or ability to pay. false false 118325040 1958 115023875 Summit Physician Services, which does not contemplate pecuniary gain or profit, incidental or otherwise, was formed for the purposes of furthering the charitable purposes of WellSpan Health, and promoting the provision of health care services in South Central Pennsylvania, including Franklin, Lancaster, Lebanon, York and Adams Counties, by providing clinically effective health care services, including professional health care services, in a cost effective manner in settings appropriate to patient and payor needs under a variety of health care financing arrangements; enhancing the continuity and quality of health care services provided to patients; ensuring the continued local patient access to health care services; enhancing the health status of the communities served by WellSpan Health; effectively responding to changing payor requirements; achieving excellence in clinical innovations, service, quality, cost and outcomes; and achieving operating efficiencies, such as containing and reducing costs and avoiding unnecessary duplication of services and equipment, thereby utilizing resources more effectively.See WellSpan Health - 2021 Community Benefit Report located at https://www.wellspan.org/about/wellspan-in-the-community/2021-community-benefit-report/ 118325040 true true false false false false false false false true false false false false true true false true false false false false false false false false false false false true true false false false false false false false false false false false false false false false true false false false true 48 0 true 1214 true false false false false false false false 0 false false false false false false false X 11 1 false false false false true false true true true false false true true true true true true false true false PA X DAVID RIZZUTO 7178513055 3350 WHITEFORD ROAD YORK PA 174052767 X Michael O'Connor Former Director 0.00 40.00 0 3058887 208991 Roxanna Gapstur WSH Pres. & CEO 1.00 40.00 X X 0 1531608 72560 Patrick O'Donnell Former Director 0.00 40.00 0 1486416 77222 Joshua Dunklebarger Physician 40.00 0.00 1011579 0 59643 Aylmer Tang Physician 40.00 0.00 984012 0 59435 Arshad Safi Physician 40.00 0.00 971977 0 61961 Nadeem Quazi Surgeon 40.00 0.00 842102 0 46724 Richard Richards II Physician 40.00 0.00 748717 0 55832 Robert Knipe DO Director 1.00 40.00 X 0 674625 63218 Mark Smith MD Director 1.00 40.00 X 0 581515 60205 Tony Aquilina DO CP Executive 1.00 40.00 X X 0 357285 32103 Robert Pargament MD Director 1.00 40.00 X 0 259496 54350 H Wallace Brubaker Director 40.00 0.00 X 299901 0 0 Angie Heiland Director 1.00 40.00 X 0 239658 47482 Almira Contractor MD Director 1.00 40.00 X 0 224811 52437 Rebecca Newcomer Director 40.00 0.00 X 56397 0 31019 Laura Buczkowski SR VP & CFO WSH 1.00 40.00 X X 0 55289 7796 Larry Miller Director 1.00 0.00 X 0 0 0 4914685 8469590 990978 6 true true false ABEO PO Box 680 Frederick MD 21705 Medical Billing and Codin Doppler Diagnostics I 757 Norland Ave Suite 104 Chambersburg PA 17201 Lab Services Press Ganey Assoc Inc PO Box 88335 Milwaukee WI 532880335 Fixed Contract Fees Peerless Credit Services 449 Eisenhower Blvd Suite 120 Harrisburg PA 17111 Debt Collector City Answering Service PO Box 458 Chambersburg PA 17201 Answering Service 0 19945292 2916476 125160 22986928 Patient Revenue 621110 71346767 71346767 71346767 37284 37284 0 0 0 193283 -193283 -193283 -193283 0 0 0 Other Operating Revenue 621110 1481002 1481002 Specialist Income 621110 42107919 42107919 Work First Occupational Health 621110 87994 87994 193 193 43677108 137854804 115023875 -155999 1958 1958 0 0 0 87416 87416 0 94500699 94500699 3322373 3322373 11007637 11007637 4823319 4823319 450000 450000 88627 88627 26328 26328 0 0 0 2639655 2639655 248662 248662 515466 515466 0 0 5627307 5627307 44192 44192 0 399731 399731 41164 41164 0 1566800 1566800 2353943 2353943 Direct Supplies 6323981 6323981 Outside Services 2351038 2351038 Repair & Maintenance 855713 855713 Utilities 164000 164000 414795 -18462598 18877393 137854804 118325040 19529764 0 13312 12775 1829525 503185 7328 6263 8315074 10726310 0 0 2952036 1648731 127587 61542 2397097 1381607 7299249 0 0 57978 57978 0 883554 585961 1241203 6687 25123943 14991039 482222 119526 20695 15172 963531 965596 20111425 10328787 21577873 11429081 X 3513385 3516224 32685 45734 3546070 3561958 25123943 14991039 X 0 15888 X false true X true true true X 30916 50019 56696679 22986928 79764542 72179163 75613366 75298571 88131714 71346767 382569581 0 0 0 72210079 75663385 75298571 144828393 94333695 462334123 0 0 462334123 524878 619525 70622 42045 37284 1294354 0 524878 619525 70622 42045 37284 1294354 0 17915445 19081549 18572660 10749 43677108 99257511 90650402 95364459 93941853 144881187 138048087 562885988 0.82140 0.85210 0.00230 0.00340 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 32685 13049 45734 32685 32685 32685 32685 32685 32685 10002 10002 1.00000 false false false Accrd Payroll W/H 130756 Accrued liablilities 404430 Accrued Payroll Incentives 1820051 Accrued Pension 1203719 Current Portion of Long Term Debt 17994 Due to Affiliates 6165470 LTD Leases 586367 10328787 X 137765494 137765494 89310 89310 137854804 137765494 137765494 89310 89310 137854804 Part X : FIN48 Footnote In June 2006, the Financial Accounting Standards Board (FASB) issued Interpretation NO. 48, Accounting for Uncertainty in Income Taxes-an interpretation of FASB Statement NO. 109, Accounting for Income Taxes (FIN 48), which creates a single model to address uncertainty in tax positions and clarifies the accounting for income taxes by prescribing the minimum recognition threshold a tax position is required to meet before being recognized in the financial statements. Under the requirements of FIN 48, tax-exempt organizations could now be required to record an obligation as the result of a tax position they have historically taken or various tax exposure items. Prior to FIN 48, the determination of when to record a liability for tax exposure was based on whether a liability was considered probable and reasonably estimable in accordance with SFAS No.5, Accounting for Contingencies. On July 1, 2007, the parent company, WellSpan Health, adopted FIN 48. WellSpan Health determined that it does not have any uncertain tax positions through June 30, 2021. Part XI, Line 4b: Other revenue amounts included on 990 but not included in F/S Grant - Waynesboro Hospital $0 Grant - Chambersburg Hospital $0 Revenues netted with expense $89310 Part XII, Line 4b: Other revenue amounts included on 990 but not included in F/S Expenses Netted with Revenue $89310 X X true X X X X false true false false false false false false false Almira Contractor MD Director 223536 1200 75 7609 44828 277248 Angie Heiland Director 238458 1200 9428 38054 287140 Arshad Safi Physician 743854 201200 26923 8550 53411 1033938 Aylmer Tang Physician 746821 200000 37191 8550 50885 1043447 H Wallace Brubaker Director 252047 8393 39461 299901 Joshua Dunklebarger Physician 974514 2450 34615 8550 51093 1071222 Mark Smith MD Director 554967 26548 11515 48690 641720 Michael O'Connor Former Director 611969 404687 2042231 123405 85586 3267878 2042158 Nadeem Quazi Surgeon 585849 249965 6288 8550 38174 888826 Patrick O'Donnell Former Director 942819 57149 486448 25200 52022 1563638 Richard Richards II Physician 738671 1200 8846 8550 47282 804549 Robert Knipe DO Director 673425 1200 13178 50040 737843 Robert Pargament MD Director 253258 1200 5038 10330 44020 313846 Roxanna Gapstur WSH Pres. & CEO 1091608 440000 11619 60941 1604168 242000 Tony Aquilina DO CP Executive 348346 8939 3288 28815 389388 Part I, Line 1a: Relevant information in regards to selections on 1a. The officers receive an allowance that can be considered a discretionary spending account. The monies are in lieu of an automobile allowance, to purchase additional life insurance, etc. Results Fitness Club membership is available free of charge for any officer and active board member. A See Schedule O Form 990, Part VI, Line 6: Explanation of Classes of Members or Shareholder WellSpan Summit Health, a not for profit corporation, is the sole member. Form 990, Part VI, Line 7b: Describe Decisions of Governing Body Approval by Members or Shareholders The governance of the Corporation shall be vested in its Board of Directors, who have authority to manage the business, property and affairs of the Corporation. The sole member of the Corporation is Summit Health, a Pennsylvania nonprofit corporation (the Member). The sole member of the Member is WellSpan Health, a Pennsylvania nonprofit corporation (WellSpan), and WellSpan has certain specified reserved powers with respect to the Corporation as described in Section 2.2 of the Bylaws. Section 2.2. Rights of WellSpan. WellSpan may, with respect to the Corporation, initiate and implement any of the following actions, except as otherwise provided in the Affiliation Agreement, and if any of the following actions are otherwise initiated by the Corporation or the Member, such action shall not become effective unless approved by WellSpan: (a) adoption, amendment, restatement, repeal, termination or any other modification of any governing instrument of the Corporation;(b) any fundamental transactions involving the Corporation, including the reorganization, merger, consolidation, change of control, sale of all or substantially all the assets, conversion, dissolution, assignment for the benefit of creditors, filing of any bankruptcy petition, or similar transaction; provided however, for at least ten (10) years following the Effective Date, WellSpan shall not sell, transfer, convey, lease, exchange, or otherwise dispose of all or substantially all of the Corporations assets, unless otherwise approved by the member and a majority of the Board of Directors of the Corporation (the Board or Board of Directors);(c) except as otherwise provided in Section 10.4(d) of the Affiliation Agreement, investment of any of the Corporations assets other than in accordance with WellSpans investment policy then in effect; provided, that any Corporation assets invested by WellSpan will be invested pro rata in accordance with WellSpans risk allocation strategy applicable to the assets of all other WellSpan entities;(d) incurrence of indebtedness in excess of limits established by WellSpans policy then in effect (which shall in no event be less than One Million Dollars ($1,000,000)) by the Corporation;(e) any sale, transfer, conveyance, lease, exchange, mortgage, encumbrance, pledge,or other disposition of the Corporations assets with fair market value in excess of limits established by WellSpans policy then in effect (which shall in no event be less than One Million Dollars ($1,000,000)), other than in the normal course of business;(f) adopting any annual operating or capital budgets for the Corporation, provided,however, that such operating budget shall include funding for community benefit programs;(g) any capital expenditures by the Corporation in excess of the WellSpan-approved annual capital budgets for the Corporation;(h) except as otherwise provided in the affiliation Agreement, any material changes to licenses held by the Corporation;(i) selecting, hiring, contracting with, or otherwise entering into agreements with,whether oral or written, any outside financial auditors, legal counsel or investment advisors that may be recommended by the Corporation for its local needs or activities, other than the outside financial auditors, legal counsel or investment advisors selected by WellSpan;(j) review and approval of the Corporations nominees for the Corporations corporate officers before such nominees are appointed by the Board;(k) adopting the statement of mission and vision, strategic and operating plans and any amendments thereto for the Corporation;(l) creation of new (or material changes, including closure or cessation, to existing) lines of business, sites of business, subsidiaries, partnerships or joint venture by the Corporation(subject to WellSpans and the Members right to require the decision-making process described in Section 10.3(a)(iv) of the Affiliation Agreement, if applicable); and(m) Any change in the Corporations tax-exempt status (subject to Section 10.1 of the Affiliation Agreement), charitable mission, or charity care policies and practices (which shall at all times comply with the integrated regional nonprofit health care systems charity care policies and practices in effect from time to time). Section 2.3. Rights of the Member. Subject to WellSpans reserved powers in Section 2.2 above and in addition to all matters required by law or these By-Laws to be approved by the Member, the Member shall have the following rights and responsibilities:(a) recommending (for WellSpan approval) operating plans for the Corporation that are in conformance with System-approved priorities and plans;(b) monitoring the Corporations accomplishment of the Corporations operatingplans;(c) recommending (for WellSpan approval) annual operating and capital budgets for the Corporation that are in conformance with System budget targets;(d) monitoring the Corporations financial performance against the Corporationsoperating and capital budgets;(e) monitoring the quality of and satisfaction with clinical services provided by the Corporation;(f) nominating the Corporations corporate officers for review and approval by WellSpan before they are appointed by the Board of Directors;(g) representing the interests of the community or population served by the Corporation;(h) recommending (for WellSpan approval) changes in the services provided by the Corporation (subject to WellSpans and the Members right to require the decision-making process described in Section 10.3(a)(iv) of the Affiliation Agreement, if applicable);(i) recommending (for WellSpan approval) amendments to the Corporations Articles of Incorporation or By-Laws;(j) recommending (for WellSpan approval) fundamental transactions involving theCorporation, including the reorganization, merger, consolidation, change of control, sale of all or substantially all the assets, conversion, dissolution, assignment for the benefit of creditors, filing of any bankruptcy petition, or similar transaction;4(k) except as otherwise provided in Section 10.4(d) of the Affiliation Agreement,recommending (for WellSpan approval) investment of the Corporations assets other than in accordance with the WellSpan investment policy then in effect;(l) recommending (for WellSpan approval) the Corporations incurrence of indebtedness in excess of limits established by a WellSpan policy then in effect (which shall inno event be less than One Million Dollars ($1,000,000));(m) recommending (for WellSpan approval) the sale, transfer, conveyance, lease,exchange, mortgage, encumbrance, pledge or other disposition of the Corporations assets withfair market value in excess of limits established by a WellSpan policy then in effect (which shall in no event be less than One Million Dollars ($1,000,000)), other than in the normal course of business;(n) recommending (for WellSpan approval) capital expenditures in excess of the WellSpan-approved annual capital budgets for the Corporation;(o) recommending (for WellSpan approval) material changes to licenses held by the Corporation;(p) recommending (for WellSpan approval) any outside financial auditors, legal counsel or investment advisors for the corporations local needs or activities, other than the outside financial auditors, legal counsel or investment advisors selected by the System;(q) recommending (for WellSpan approval) changes to the Corporations statement of mission and vision, strategic and operating plans;(r) recommending (for WellSpan approval) the creation of new (or material changes,including closure or cessation, to existing) lines of business, sites of business, subsidiaries,partnerships or joint ventures by the Corporation (subject to WellSpans and the Members right to require the decision-making process described in Section 10.3(a)(iv) of the Affiliation Agreement, if applicable); and (s) recommending (for WellSpan approval) any change in any the Corporations tax exempt status, charitable mission, or charity care policies and practices (which shall at all times comply with the Systems charity care policies and practices in effect from time to time). Form 990, Part VI, Line 11b: Form 990 Review Process Management provided an electronic copy of the form 990 to each voting member of the organization's governing body, prior to its filing with the IRS. The organization's finance management team provided a presentation to the Audit Committee on the organization's 990 return. Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts Officers, directors, and key employees fill out a WellSpan Health Conflict of Interest Disclosure Statement questionnaire annually. The questionnaire is administered by the Internal Audit Department of WellSpan Health, the Parent Company.There shall be full disclosure by any Director having a business or personal interest or relationship which may be in conflict with the interests of the Corporation. After such disclosure the Director shall abide by the determination of the Board of Directors as to whether a conflict exists, the extent to which, if at all, the Director will be permitted to be present during the Board of Directors' discussion of the matter in which the Director may be interested, and whether the Director will be permitted to participate in such discussion and cast a vote in such matter. Form 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key Employees The Compensation Committee of WellSpan Health is responsible for rewarding and reinforcing key executives for the achievement of annual and long-term performance objectives. The Compensation Committee shall consist of not more than six (6) persons, of whom two (2) shall be the Chairman and Vice Chairman of the Board of the Corporation, and the remaining members shall be such other persons as may be appointed by the Chairman of the Board of the Corporation, with the approval of the Board of Directors; provided, however, that the Compensation Committee shall not include any persons who are employed by the System. The role of the Compensation Committee is to set the Executive Compensation Philosophy for the system and ensure adherence, evaluate performance and establish compensation for the WellSpan President, evaluate team performance of the executive team and establish awards, review and approve senior executive base salary ranges, and oversee employed physician compensation programs. The Committee will approve salary ranges for each executive position and review incumbent salaries annually. The Committee will be responsible for reviewing the President's salary each year, and if warranted, authorizing an adjustment to maintain competitiveness. The President will have the authority to make salary adjustments for subordinate positions. The Committee is responsible for approving and authorizing payment of the performance awards. The Committee will approve and authorize payment of the President's performance awards. Integrated Healthcare Strategies, Inc., based in Minneapolis Minnesota is the external consultant to the committee. This consultant focuses exclusively on executive and physician compensation in the health care industry. In summary, the executive and physician compensation review process consists of the following: 1) Cash compensation reviewed annually 2) Cash compensation reviewed by external consultant biennially 3) external total compensation (cash, incentives, benefits, perquisites) reviewed by external consultant periodically 4) Process is integrated with compensation analysis for other WellSpan positions 5) Committee decisions are documented in minutes maintained in Human Resources. Form 990, Part VI, Line 19: Other Organization Documents Publicly Available Governing documents, policies, and financial statements are available upon request. Other Changes In Net Assets Or Fund Balances - Other Increases Adjustment = $15888 Schedule K- Tax Exempt Bonds 1.2014 GENERAL AUTHORITY OF SOUTHCENTRAL PENNSYLVANIA REVENUE REFUNDING BONDS, SERIES A:On November 11, 2014, the General Authority of Southcentral Pennsylvania issued $213,430,000 of Revenue Refunding bonds, Series 2014A for WellSpan Health Obligated Group. The purpose of this bond issue was revenue refund for bonds issued 06/23/1993 and 11/12/2008. WellSpan Health, the parent organization, allocated portions of the proceeds of this tax-exempt bond issue to York Hospital (23-1352222), Gettysburg Hospital (23-1352220), WellSpan Properties (22-2842252), WellSpan Surgery & Rehabilitation Hospital (23-2899911), and Ephrata Community Hospital (23-1370484). To remain consistent with the reporting on Form 8038, all outstanding liabilities associated with this tax-exempt bond issue is reported on the WellSpan Health (22-2517863) Schedule K. As of 6/30/21, the allocation of the Debt Capital program including issue premium of $47,545,967 was as follows:York Hospital: $27,890,452Gettysburg Hospital: $1,922,543WellSpan Properties: $6,845,852WellSpan Surgery & Rehabilitation Hospital: $3,377,167Ephrata Community Hospital: $7,509,953These amounts are reported on the respective balance sheets for each of these entities.An Arbitrage Rebate and Yield Restriction Liability Calculation was performed for the period of November 10, 2014, to November 10, 2019. No rebate was due._______________________________________________________________________________2.2015 LANCASTER MUNICIPAL AUTHORITY BANK LOAN, SERIES A:On May 22, 2015, the Lancaster Municipal Authority issued $36,572,083 of Revenue Refunding bonds, Series 2015A, to an Obligated Group consisting of York Hospital, Gettysburg Hospital and Ephrata Community Hospital. The purpose of this bond issue was to refund bonds issued on behalf of Ephrata Community Hospital, including the Lancaster Municipal Authority Revenue Notes Series 2009, 2010A, 2012, and 2013. To remain consistent with the reporting on Form 8038, all outstanding liabilities associated with this tax-exempt bond issue is reported on the WellSpan Health (22-2517863) Schedule K.As of 6/30/21, the $27,600,768 of outstanding liability is reported on the Ephrata Community Hospital return balance sheet._______________________________________________________________________________3.2019 GENERAL AUTHORITY OF SOUTHCENTRAL PENNSYLVANIA REVENUE REFUNDING BONDS, SERIES A & B:On April 19, 2019, the General Authority of Southcentral Pennsylvania issued $331,502,627 of Revenue Refunding bonds, Series 2019A and 2019B for WellSpan Health Obligated Group. The purpose of this bond issue was revenue refund for bonds issued 11/12/2008. WellSpan Health, the parent organization, allocated portions of the proceeds of this tax-exempt bond issue to York Hospital (23-1352222), Chambersburg Hospital (23-0465970), WellSpan Properties (22-2842252), Chambersburg Health Services (25-1515376), The Good Samaritan Hospital of Lebanon Pennsylvania (23-1794160), Waynesboro Hospital (23-1360854), Summit Physician Services (25-1716306), Gettysburg Hospital (23-1352220), WellSpan Surgery & Rehabilitation Hospital (23-2899911) and Ephrata Community Hospital (23-1370484). To remain consistent with the reporting on Form 8038, all outstanding liabilities associated with this tax-exempt bond issue is reported on the WellSpan Health (22-2517863) Schedule K. As of 6/30/21, the allocation of the Debt Capital program of $324,770,019 was as follows:York Hospital: $109,820,502Waynesboro Hospital: $455,712Chambersburg Hospital: $110,975,751Chambersburg Health Services: $18,656,026Summit Physician Services: $983,590WellSpan Properties: $66,683,198Gettysburg Hospital: $12,384,727Ephrata Community Hospital: $3,372,694The Good Samaritan Hospital of Lebanon Pennsylvania: $42,216WellSpan Surgery & Rehabilitation Hospital: $1,395,603These amounts are reported on the respective balance sheets for each of these entities._______________________________________________________________________________4.2019 GENERAL AUTHORITY OF SOUTHCENTRAL PENNSYLVANIA REVENUE REFUNDING BONDS, SERIES C-E:On April 3, 2019, the General Authority of Southcentral Pennsylvania issued $212,690,000 of Revenue Refunding bonds Series 2019C, 2019D and 2019E for WellSpan Health Obligated Group. The purpose of this bond issue was revenue refund for bonds issued 11/12/2008. WellSpan Health, the parent organization, allocated portions of the proceeds of this tax-exempt bond issue to York Hospital (23-1352222), Gettysburg Hospital (23-1352220), WellSpan Properties (22-2842252), WellSpan Surgery & Rehabilitation Hospital (23-2899911), The Good Samaritan Hospital of Lebanon Pennsylvania (23-1794160) and WellSpan Health (22-2517863). To remain consistent with the reporting on Form 8038, all outstanding liabilities associated with this tax-exempt bond issue is reported on the WellSpan Health (22-2517863) Schedule K. As of 6/30/21, the allocation of the Debt Capital program of $212,690,000 was as follows: York Hospital: $123,530,352Gettysburg Hospital: $19,290,983WellSpan Properties: $22,545,140WellSpan Surgery & Rehabilitation Hospital: $35,731,920The Good Samaritan Hospital of Lebanon Pennsylvania: $1,722,789WellSpan Health: $9,868,816These amounts are reported on the respective balance sheets for each of these entities._______________________________________________________________________________5.2014 FRANKLIN COUNTY INDUSTIAL AUTHORITY REVENUE REFUNDING BONDS, SERIES A & C:On April 30, 2014, the Franklin County Industrial Authority issued $35,795,000 of Healthcare Revenue Refunding bonds, Series 2014A & 2014C for the WellSpan Health Obligated Group. WellSpan Health, the parent organization, allocated portions of the proceeds of this tax-exempt bond issue to Waynesboro Hospital (23-1360854), Chambersburg Hospital (23-0465970) and Chambersburg Health Services (25-1515376). To remain consistent with the reporting on Form 8038, all outstanding liabilities associated with this tax-exempt bond issue is reported on the WellSpan Health (22-2517863) Schedule K.As of 6/30/21, the allocation of the Debt Capital program of $25,493,770 was as follows: Waynesboro Hospital: $6,390,449Chambersburg Hospital: $18,577,321Chambersburg Health Services: $526,000These amounts are reported on the respective balance sheets for each of these entities.______________________________________________________________________________6.2017 BANK LOANS / REISSUE BONDS ISSUED 11/12/2008:On March 13, 2018, the General Authority of Southcentral Pennsylvania issued $34,877,000 of Revenue bonds, Series 2017A Notes (taxable) for WellSpan Health Obligated Group. Such notes were applied to refund 2008A Bonds. Also, on September 4, 2018, the General Authority of Southcentral Pennsylvania issued $29,312,000 of Revenue Bonds, Series 2017B (tax-exempt bonds) for WellSpan Health Obligated Group.Such notes were applied to refund 2008A Bonds.WellSpan Health, the parent organization, allocated portions of the proceeds of this tax-exempt bond issue to York Hospital (23-1352222), Gettysburg Hospital (23-1352220), WellSpan Properties (22-2842252), WellSpan Surgery & Rehabilitation Hospital (23-2899911), and The Good Samaritan Hospital of Lebanon Pennsylvania (23-1794160). To remain consistent with the reporting on Form 8038, all outstanding liabilities associated with this tax-exempt bond issue is reported on the WellSpan Health (22-2517863) Schedule K.As of 6/30/21, the allocation of the Debt Capital program of $50,807,000 was as follows: York Hospital: $29,508,705Gettysburg Hospital: $4,608,195WellSpan Properties: $5,385,542WellSpan Surgery & Rehabilitation Hospital: $8,535,576The Good Samaritan Hospital of Lebanon Pennsylvania: $411,536WellSpan Health: $2,357,446These amounts are reported on the respective balance sheets for each of these entities. Signature Line - Paid Preparer Explanation Paid Preparer ExplanationDue to a software limitation, we wish to clarify that WellSpan Health is the ERO.The paid preparer is:BDO USA, LLP13-53815908401 Greensboro Drive, Suite 800McLean, VA 22102(703) 893-0600 Apple Hill Surgical Center Inc PO Box 2767 York PA 175042767 222842253 Sole GP in limited pntrshp operating sur PA 501(c)(3) 10 WellSpan Health Care Services false Gettysburg Hospital PO Box 2767 York PA 174052767 231352220 Health Care Services PA 501(c)(3) 3 WellSpan Health false Gettysburg Hospital Foundation PO Box 2767 York PA 174052767 232251358 Fundraising for Gettysburg Hospital PA 501(c)(3) 12 Type I Gettysburg Hospital false Healthy Community Pharmacy Inc PO Box 2767 York PA 174052767 200519121 Reduced rate prescription drugs PA 501(c)(3) 12 Type I WellSpan Health Care Services false VNA Community Services PO Box 2767 York PA 174052767 232338591 Home personal care services for elderly PA 501(c)(3) 10 WellSpan Specialty Services false VNA Home Health Services PO Box 2767 York PA 174052767 231352573 Home health services PA 501(c)(3) 10 WellSpan Specialty Services false Wellspan Health PO Box 2767 York PA 174052767 222517863 Integrated Health System PA 501(c)(3) 12 Type III NA false Wellspan Health Care Services PO Box 2767 York PA 174052767 232400237 Health-related activities in community PA 501(c)(3) 12 Type II WellSpan Health false York Health Foundation PO Box 2767 York PA 174052767 233050192 Charitable contributions for WS entities PA 501(c)(3) 12 Type III WellSpan Health false York Hospital PO Box 2767 York PA 174052767 231352222 Community teaching hospital PA 501(c)(3) 3 WellSpan Health false WellSpan Surgery & Rehab Hospital PO Box 2767 York PA 174052767 232899911 Surgery and Rehabilitation Hospital PA 501(c)(3) 3 WellSpan Health false Wellspan Properties Inc PO Box 2767 York PA 174052767 222842252 Leases facilities to affiliates PA 501(c)(3) 12 Type II WellSpan Health Care Services false Ephrata Community Hospital PO Box 2767 York PA 174052767 231370484 Health care services PA 501(c)(3) 3 WellSpan Health false Ephrata Community Health Foundation PO Box 2767 York PA 174052767 800940005 Fundraising for Ephrata Hospital PA 501(c)(3) 12 Type I Ephrata Community Hospital false Northern Lancaster County Medical Group PO Box 2767 York PA 174052767 203033058 Medical and surgical care PA 501(c)(3) 12 Type II Ephrata Community Hospital false Phys Spec of North Lanc Co Med Gr PO Box 2767 York PA 174052767 452537633 Physician Properties PA 501(c)(3) 12 Type II Northern Lancaster County Medical Group false The Good Samaritan Hospital of Lebanon PO Box 2767 York PA 174052767 230794160 Health Care Services PA 501(c)(3) 3 WellSpan Health false Philhaven PO Box 2767 York PA 174052767 231549922 Health Care Services PA 501(c)(3) 3 WellSpan Health false Good Samaritan Health Service Foundation PO Box 2767 York PA 174052767 232356151 Fundraising for Good Samaritan PA 501(c)(3) 12 Type I Good Samaritan Hospital false Good Samaritan Physician Services PO Box 2767 York PA 174052767 251832359 Medical and Surgical Care PA 501(c)(3) 10 Good Sam Health Services Foundation false WellSpan Summit Health PO Box 2767 York PA 174052767 251515371 Integrated Health System PA 501(c)(3) 7 WellSpan Health false Waynesboro Hospital PO Box 2767 York PA 174052767 231360854 Health Care Services PA 501(c)(3) 3 WellSpan Summit Health false Chambersburg Hospital PO Box 2767 York PA 174052767 230465970 Health Care Services PA 501(c)(3) 3 WellSpan Summit Health false WellSpan Medical Group PO Box 2767 York PA 174052767 232730785 Medical and surgical care PA 501(c)(3) 10 WellSpan Health false Summit Health Foundation PO Box 2767 York PA 174052767 831196554 Fundraising for health care system PA 501(c)(3) 12 Type II WellSpan Summit Health false Chambersburg Health Services PO Box 2767 York PA 174052767 251515376 Health care services PA 501(c)(3) 12 Type I WellSpan Summit Health false Apple Hill Surgical Center Partners PO Box 2767 York PA 174052767 232489452 Surgical Cn PA NA false false Central PA Alliance Laboratories LLC PO Box 2767 York PA 174052767 232910950 Ref. Lab PA NA false false Littlestown Health Care Partners 300 West King Street Littlestown PA 17340 232880464 Lease facility PA NA false false Cherry Tree Cancer Center LLP PO Box 2767 York PA 174052767 232915628 Radiation PA NA false false The Rehab Center 855 Springdale Drive Suite 20 Exton PA 19341 251687903 Physical Therapy Rehab PA NA false false Surgery Center Associates 785 5th Ave Chambersburg PA 17201 251845304 Physician services PA Chambersburg Health false false Summit Surgery Center 785 5th Ave Chambersburg PA 17201 251845303 Physician services PA Chambersburg Health false false Cumberland Valley Mobile Services LLC 5 S Main St Sugarloaf PA 18249 200884014 Mobile health services PA Chambersburg Health false false Wellspan Pharmacy Inc PO Box 2767 York PA 174052767 232374072 Dispenses Rx & provides IV therapy PA NA C corp false Wellspan Reciprocal Risk Retention Group PO Box 2767 York PA 174052767 200048457 Risk Retention Group PA NA C corp false GSH Realty Inc PO Box 2767 York PA 174052767 251832359 Rent of non res. real estate PA WSH Care Services C corp false York Health Plan PO Box 2767 York PA 174052767 232664989 Preferred Provider Organization PA NA C corp false Wellspan Provider Network PO Box 2767 York PA 174052767 232907828 Coord. managed car risk contracts PA NA C corp false Apple Hill Condominium Association PO Box 2767 York PA 174052767 232504543 Condo Mgmt Association PA NA Homeowner Assoc false Northern Lanc Co Phys Hosp Alliance PO Box 2767 York PA 174052767 232421885 Coord Phys & Hospital PA NA C corp false Ephrata Health Pavilion Condo Assoc PO Box 2767 York PA 174052767 475367279 Condo association PA Ephrata Hospital C corp false false false false false false false false false false false false false false false false false false false false